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HomeMy WebLinkAbout0101 WARREN STREET - Health (2) 162 WASHINGTON AVENUE OSTERVILLE A= 139— 086 e � y No. 9p � - Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS Applicati Or i gal *pgtem Congtructton Vermtt Application for a Pe o Construct(Repair( ) pgrade( )Abandon( ) El Complete System ❑Individual Components Location Ad;a2ce No.��Z LOAOOW� A Owner's N�/e,AAddress and Teel.No. Assessor's M4 v'�1 ►s P 4CaA A4J e-S-69- Installer's ame,Address and Tel.No. Designer's Name,Address an Tel.No. / Typ Buil //1— D ing No.of rooms �T Lot Size 01A q-ft. Garbage Grinder( ) Other Ty f Building T No. of Persons Showers( ) Cafeteria( ) Other Fixtur Design Flow gallons per day. Calculated daily flow 44o gallons. Plan Date 14 r, qg Number of sheets Revision Date Title L,I 0-7 tdr Z /J (tc-6 Size of Septic Tank SjQeD QA Type of S.A.S. ' Description of Soil I 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 issued by this Board of Health. Signed Date Application Approved by r._ Date v' Application Disapproved for the following reasons Permit No. Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of (Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed((Vj Repaired( )Upgraded( ) Abandoned( )by at w has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. d dated Installer Designer The issuance of this permit shall not be construed as a guarantee that the system will function as designed. Date Inspector 4 --- ------ No. + " r4� Fee �(d 16d ---------- - THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS Migpogal *p! tem Congtruction Vermtt Permission is hereby granted to Construct Rep r( )Upgrade( )Abandon( ) System located at �D°� G/JA�1�IiJL ►I / ,_ � 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. i Provided: Construction must be completed within three years of the date of this permit. Date: Approved by pJ. F"4s�w { _.. No. �' Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes 0 .Al s PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS 01ppricatio - or Mid gar *p�tem Cow5truction Permit Application for a Permit to Construct Re air rade Abandon ❑Complete System ❑Individual Components PP (��1 P ( ) Pg ( ) ( ) P Y P Location Addresfrot No.l(p Z I,(f��4 � qw isNa e,Address and Tel.No.Assessor'sM % 1S I0�,1 /� �A � Q Installer's ame,Address and Tel.No. 1 r Res&ner's Name,Address aan4Tel.No. TyP o Bu i g: ^I Diin g No. of Bedrooms _ Lot Size �' �Cseq"ft. Garbage Grinder( ) Other Type of Building No. of Persons Showers( ) Cafeteria( ) Other Fixtur -` Design Flow gallons per day. Calculated daily flow 44 o gallons. Plan Date q g Number of sheets, evision Date A Title �-' L QiB)�✓1 A- - t0 --`4 � Lh N I A Size of Septic Tank �JO42 QA-C_D Type of S.A.S. &/1-4 I Z SCS G Description of Soil �'�� a. 2r! 7 �, ►� �( ' Y� ��� 1, CP>Ia-LS S� N® 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 issued by this Board of Health. Signed a Date Application Approved b Date 7— Application Disapproved for the following reasons 44 Permit No. rr, Date Issued "'" i' --------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS (Certificate of (Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed()<)Repaired ( )Upgraded( ) Abandoned( )by at 1&f, UJA-,G I /o W D e7 has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. f 46 dated �/ °� Installer Designer The issuance of this permit shall not be construed as a guarantee that the system will function as designed. Date Inspector No. T T Fee _ THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS Y i osar- pgteiri` or�gtructioi permit -, Permission is hereby granted to Construct O Rep it( )Upgrade( )Abandon( ) System located at (02 u�ASl�ltJl >J �F3; ?�'S'� 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: Approved by s D�StG.+-i DATA �ISt�T I ol= Z"° �1►�1(�LE FAMIt.`{ PL.AI-L oN "BA44 uEzlO q o GA2UA4.,Q -vm�y R.ow = 4-c tlo = � �oT 2 u/�sc�l�►��la v6, 05r vtL SZrne- -Mf4L -44-o 9?Qo%_ lrp&D ' uS� 150o tA�. LiaaGl}I�.IG 5` 6MA DES�N 01C9QvIVA� d'PvG PIPrr: 4 cuLTr-e- 4PpIGA-T1oN A27=-A 44o d` 5F=5TS SF 2!0 ,tp?u44.-noN a2ZA v�slel�t . SIt�V,/QLL 1Lt�A=4']x�x2=igt3 PLQIJ VIl=YV - LFM F41 -, CNAMBEe5 toTToM A=4 4-U T VM- AMA s 608V Fru►sy 4MAZr� Di=¢GoLATIo►J SITE �-5'�'��I�l . ... .,, •. .,w ....•..p Z" 3%ycax S-AL C1J4-�5 I '/g-%z OfMgss9� ono,°a' 0J Cu T G �vavr � E OF �O STEPHEN yG ' a `'�I '�I Wu*5� wASNO yr, c ALLYN No.30216 , o a'tid�- lZ � A N 90 FAST"R� C>z0`y5-SC'GTID►1 OF CI A,Mpjlr7 lk z. qA- Irsr, �Z /O/e S/z lw lbu 14ISMLU4l CVAAMly r44- a ,eye 4A - t� - 30-, Spa-.car, t� 17�yE1.� �OFIt.� _ CEA"— RGD PLOT FI ALA P qn(, tsm �•►8.98 �n�5�D �SCAL� �"- 4r� v�LTE 7. 1�•�g 1 GF.3zTt r-y r"AT rEl E Qwel ,►N 6, S9004 PLAIJ NON ccmpL j5 'virn4 T14E s e—LAWE Alm (tr- 2 L.CG I Sb 6 IMB"V- zMuIZ6�MG T'��O,F"�T+ED T146 `mrvN OF MAP' 131 PAZCrC 166 �A�NS�LF A►•* l S Not Lc 1dJ l T 1l I N /a I SPG:�a4L NE ��� ,• W61at6W4 �'� oST�evlr f L M�fS• oi"FSL�'S Mom $V ILt>lw.6 49mxrp Nor sa �1PPlJGQNT: v5tn �t, )-i,�Eus►� PRcp�-�y Lr►Je�f, �M - ( oz Z j Per V111,150i MAP �i3� PCL 1 S,/ ; LA & " _ h > \ \ W , wt, Box 3l - 0 ( 1 P. 9 77Dk 1�lAsc�i►��rD� �ti �Pv�u�� � � ����� �VgtiP ��� ST�r=Fitiv ALLYNWILSON BAXTER& NYE INC h ¢ ° lcve i .812 MAIN STREET OSTERVILLE, MA 026- Town of Barnstable P# !2/ � Department of Health,Safety,and Environmental Services Im Public Health Division Date b�- � 367 Main Street,Hyannis MA 02601 eAerteresr8. Meea. QED MKt IAA Date Scheduled D b — L& - q 6 Time l b Fee Pd. [OD Soil Suitability Assessment for Sewage Disposal Performed By: �1 lA-��T ! = T '��- — Witnessed By: LOCATION & GENERAL INFORMATJON Location Addre Owner's Name b ST�\11 t-LC Address - --- -� Assessor's Map/Parcel: (3q /S� Engineer's Name ',A�C1 t={L + I4� )'`� NEW CONSTRUCTION �_/ REPAIR Telephone# Land Use t: 5e>1 DGV`i71✓_L__ �y Slopes(%) Surface Stones G' Distances from: Open Water Body �OD 3 f{ Possible Wet Area ft Drinking Water Well ft Drainage Way ft Property Line ft Other ft SKETCH:(Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands in proximity to holes) 3S0 Cmpea) L I 13� lBLG Jc� 3© `,. _ o , I z o a _. t1C.2i n Parent material(geologic) CC?r'6U,4S4 Depth to Bedrock Depth to Groundwater: Standing Water in Hole: Weeping from Pit Face d Estimated Seasonal High Groundwater ATMRJVHNATI011 FORSEASONAL HIG 'V�ATETt' ABL 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.-.__ Arlj.factor Adj.Groundwater Level PERCOLATION TEST= Date �' ro` Observation r Hole# Z Time at 9" Depth of Perc 4 Time at 6" Start Pre-soak Time @ 111J�' —� Time(9%6") / End Pre-soak Rate Min./inch Site Suitability Assessment: Site Passed ✓ Site Failed: Additional Testing Needed(YM) Original: Public Health Division' Observation Hole Data To Be Completed on Back—� Copy: Applicant BEEP O$SERVATION HOLE LOG Hole# ; Depth from Soil 7oriz4onsoil Texture Soil Color Soil Other Surface(m:) USDA) (Munsell) Mottling (Structure,Stones,Boulderes. Consistengy.° 11 le f7vP' (� sa w ? 7/1 e� ,Lvosc DEEP OBSERVATION HOLE L!DG Hole Depth from Soil Horizon Soil Texture ( Soil Color Soil Other Surface(m.) (USDA) (Munsell) Mottling (Structure,Stones,Boulderes. Consistency.° 0 7,' c �-44� ,n e /z. go DEEP bBSERVATIb11 HOLE LO;G Hole# Depth from Soil Honzon Soil Texture Soil Color Soil Other Surface(m.) (USDA) (Munsell) Mottling (Structure,Stones,Boulderes. Consistency.° Gravel) DEEP OBSERVATIOl'�i HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulderes. Consistency,° Gravel) Flood Insurance Rate Man: Above 500 year flood boundary No_ Yes X Within 500 year boundary No_ Yes 94 Within 100 year flood boundary No__)t Yes Depth of Naturals Occurring Pervious Material Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the area proposed for the soil absorption system? If not,what is the depth of naturally occurring pervious material? Certification I certify that on 64 /n, (date)I have passed the soil evaluator examination approved by the Department of Envir nmental Protection and that the above analysis was performed by me consistent with the required EKIMM e dI0 CMR 15.017. Signature Date 0