The URL can be used to link to this page

Home My WebLink About0038 SYLVAN LANE - Health Ivon Town of Barnstable P# 9 o 7 3 Department of Health,Safety,and Environmental Services Public Health Division Date 367 Main Street,Hyannis MA 02601 Z wuvareaM Mesa. �019. Date Scheduled f 1.. - ' `�7 Time IAJ4,&., Fee Pd. I00, 00 ,o ff C t,eck e ZG7'z Soil Suitability Assessment for Sewage Disposal Performed By: IL+f<bdd - Witnessed By: JZ-� U1IIJ tiJ LOCATION & GENERAL INFORMATION Location Addy s Owner's Name WO syl_VAQ i�10E t)S•�2V1� �sT v� Cart{ ,aE > Address':/o (1DQ6CJJ `$• 'DAVIS , �Q. t; -1+-3 AFAeT ST WAWoL8_ — Assessor's Ma /Pa . Engineer's N6e ` P MA(� (4_0- r�CL- 13o B A-XTa2. 4. V� NEW CONSTRUCTION K REPAIR Telephone# 4-*- Land Use I< �,I�c'*>`I1-IdLL� Slopes(%) �" Surface Stones Distances from: Open Water Body /Stab f ft Possible Wet Area /S0' .t ft Drinking Water Well -- ft Drainage Way — ft Property Line :�?7 ' ft Other ft . SKETCH:(Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands in proximity to holes) \ I �,0. #' A011 Y Parent material(geologic) 49 t9"rLO9 614 140 Depth to Bedrock Depth to Groundwater: Standing Water in Hole: QoWC N5 E72-V Weeping from Pit Face Jb OL aPi Se-A-V Estimated Seasonal High Groundwater .. . D �rEg ry r0r "<�Aw:, AShNAL I H'WA7'ER' A L Method Used Depth Observed standing in obs.hole: in. Depth to soil mottles: in. Depth to weeping from side of obs.hole: in. Groundwater Adjustment ft. Index Well#_-_ •Reading Date:_. Index Well level.-.--- Adj.factor Adj.Groundwater Level PERCOLATION TEST Date f2 16 Y7Troe Observation .( 7- Time at 9" Hole# n 1 Depth of Perc _ Time at 6" Start Pre-soak Time @ Time(9"-6") End Pre-soak 7v�LG RateMin./Inch !J►lrt� +ItN �++a Site Suitability Assessment:- Site Passed k"' Site Failed: Additional Testing Needed(Y/N) Original: Public Health Division' Observation Hole Data To Be Completed on Back--j Copy: Applicant C , __...... _ ......... .. . ._.._ ...................... . ...................... ............... . BEEP OBSERVATION HOLE LO:G `Hole':# I Depth from Soil Horizon Soil Texture Soil Color , Soil Other Surface(in:) (USDA) (Munsell) Mottling (Structure,Stones,Boulderes. Consistency,%Gravel 0 c� v 5 S�'o:JCJ 1 DEEP OBSERVATION HOLE L10G Hole# .. .. Depth from Soil Horizon Soil Texture I Soil Color Soil I Other Surface(in.) (USDA) (Munsell) Motiling (Structure,Stones,Boulderes. / nitn ° D 3b`� S4 n Ca ma) S"AN� /D 2 i6/ S� �TDNBS .... _...._ __... ..._.... ................ ............ ..___ ....._.._ ..... ....... .... DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulderes. Consistency,°° el DEEP OBSERVATION HOLE LU►G Hale# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulderes. Consistency-° Gravel) i F , Flood Insurance Rate Mai: Above 500 year flood boundary No_ Yes i/ Within 500 year boundary No Yes Within 100 year flood boundary No `� Yes Depth of Naturally Occurring Pervious Material i r Does-at least four feet of naturally occurring-pervious material exist in all areas observed throughout the area proposed for the soil absorption system? ES If not,what is the depth of naturally occurring pervious material? Certification I certify that on A4 19 (date)I have passed the soil evaluator examination approved by the Department of Enviro mh ental Protection and that the above analysis was performed by me consistent with the required training,expertise and experience described in 310 CMR 15.017. Signature Ct Date -Q i TOWN OF BARNSTABLE � LOCATION , cl C is60+ SEWAGE# CM Lt C t VILLAGE ASSESSOR'S MAP & LOT L[6 INSTALLER'S NAME&PHONE N0.'Ti w.�(O k_ SEPTIC•TANK CAPACITY I., LEACHING FACILITY: (type)} CeCs t�� (size) NO.OF BEDROOMS BUMDER OR OWNER. GwA to v PERMIT DATE:.F a" COMPLIANCE`DATE: 1 U Separation Distance Between the: ' Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility bJQ� Feet Private Water Supply Well and Leaching Facility (If any wells exist , on site or within 200 feet of leaching facility) _X Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 ffe of leaching facility) 41 Feet Furnishedy�'/� ��..� ' r �� yam•-�+� TOWN OF BARNSTABLE ` LOCATION '�N u1/5-PU l SEWAGE # VILLAGE ASSESSOR'S MAP & LOT 140 1,12 INSTALLER'S NAME&PHONE NO. i SEPTIC TANK CAPACITY (nxn #' r: LEACHING FACILITY: (type) C ;s l.,(;�5 (size) NO.OF BEDROOMS i BUILDER OR OWNER 7 �aO F-b441 QL, _ PERMIT DATE: 10 Cti COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility vJ r Feet Private Water Supply Well Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) �-J Feet Edge of Wetland and Leaching Facility(If any wetlands exist Feet within 300 fee f leaching facility)/ { Furnished by%/� j, L 1 { qe No.1 �°— ��f � � ' Fee 1 00 THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLES MASSACHUSETTS �/ ZIPPYication for Mifspaal *p5tem Cone;truction Permit Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. " Owner's Name,Address and Tel.No. Assessor's Map/Parcel 144 O Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. qua �7 � �L�16'�� Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( . Other Type of Building j'. No.of Persons Showers Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil ld'as Pz,— t� en>P—D S1 Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issu d by this B and of Health. Signed Date (� A �(.—cL11 Application Approved by 1's Date `7 M /s Application Disapproved for the following reasons Permit No. Date Issued Fee �All. 4 Entered to computer: x THE COMMONWEALTH OF MASSACHUSETTS Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUS'FTTS Application for Migpogar *pgtem Congtruction Verinit t Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) 0 Complete S,ysLem O Individual Components r _ Location Address or Lot No. 3� 44 Owner's Name,Address and Tel.No. 2-,v Assessor's Map/Parcel 1 cl C) 'Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. Type of Building: -t / I Dwelling No.of Bedrooms I; Lot Size sq.ft. Garbage Grinder(9)4) Other Type of Building S� K-4AJ , No.of Persons Showers Cafeteria( ) ther Fixtures Design Flow y o gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date �.. Title Size of Septic Tank Type of S.A.S. Description of Soil dos L a �L,l49� Nature of Repairs or Alterations(Answer when applicable) Date last inspected: . Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issu d by this Board-of Health. t Signed 6Date Application Approved by Date "7 1,57- 99 # Application Disapproved for th followmg reasons • R > Permit No. /�— Date Issued j--- ------------------------------ THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS -` Certificate of Compliance THIS IS TO TAP that the On-site S ag Disposal,. ystem Constructed(�Repaired ( )UpgradedAbandoned( )by at S90 has been constructed in accordance with the provisions of iqtje 5 and the for Disposal System Construction Permit No. Y/ Q dated Installer Designer The issuance of this permit s a of c n ed as a guarantee that the to will function a es' Date Inspector Y No. ` Fee /n� THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS lwfgpogar *pgtem Congtructfon hermit Permission is hereby granted to Construct(Ne�Repair( )Upgrade( )Abandon( ) System located at 3 and as described in the above Application for Disposal System Construction Permit. The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction must be completed within three years of the date of this permit. Date: 1 Approved by