HomeMy WebLinkAbout0170 ASA MEIGS ROAD - Health 170 Asa Meigs Road
A = 031 — 001 — 001
Marstons Mills
Town of Barnstable P# ���
Department of Regulatory Services
,,, ,,, Public Health Division Date
� b39.��� 200 Main Street,Hyannis MA 02601 m�
Date Scheduled U _ Time 0" Fee Pd. r_W
Soil Suitability Assessment for Sew a Disposal
Performed By: Robin W. Wilcox Witnessed By: J, w•
LOCATION &-GENERAL INFORMATION
Location Address Owner's Name Daniel laY Lackey
170 Asa Meigs Road 405 Marstons Lane
Marstons Mills Address Cummaquid, MA 02637
Assessor'sMap/Parcel: 3 1/1 Engineer's Name Sweetser Engineering
NEW CONSTRUCTION REPAIR XX Telephone# 5 0 8-3 8 5-6 9 0 0
Land Use 011 44-104rl4'C. Slopes(%) ' Surface Stones
Distances from: Open Water Body _ft Possible Wet Area OAI* ft Drinking Water Well ft
/ !r
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)
LbT � �bT
�qV 51-
o
1.
i
l 1
!
4 p
Parent material(geologic) eel ✓ Depth to Bedrock
Depth to Groundwater: Standing Water in Hole: Weeping from Pit Face
71� f
Estimated Seasonal High Groundwater '
- E.TERMINAT.ION FOR SEASONAL HIGH WATER TABLE ,
M6thod Used: Q if
Depth Observed standing in obs:hole: 7�7 Z - ° ° 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(b`YG4W
me [(:
Observation
Hole# 1 Time at 9"
Depth of Pere Time at 6"
Start Pre-soak Time® D Time(9"-6")
End Pre-soak
Rate Min./Inch '
Site Suitability Assessment: Site Passed !/ Site Failed:.,' ' Additional Testing Needed(YIN)
Original: Public Health Division • Observation Hole Data To Be Completed on Back-----------
***If percolation test is to be conducted within 100' of wetland,you must first notify the
Barnstable Conservation Division at least one(1)week prior to beginning.
Q:\SEPTIC\PERCFORM.DOC
�a �s
. DEEP OBSERVATION HOLE,LOG ,_ Hole#' �
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders.
Consistency,%Gravel
roy,,20 jo s
/aye-�6
23 UZ
Z.�Y
` y
AV..
DEEP OBSERVATION HOLE LOG Hole# Z
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders.
Consistenc %'Gravel'•
__ -- 0--7 e w 4 f /D IVO ��T3
T�3
b�Z-aZo <-z
,DEEP O-BSERVATION HOLE LOG, ;7 _, Hole# f
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders.
Consistency,%Gravel)
I
DEEP`OBSERVATZON HOLE'LOG` Hole#
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders.
Consistency,%Gravel)
Flood Insurance Rate Mau:
Above 500 year flood boundary No— Yes "
Within 500 year boundary No!/ Yes
Within 100 year flood boundary No_v Yes
Death of Naturally Occurrini 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? )(*-I
If not,what is the depth of naturally occurring pervious material?
Certification
I certify that on �(date)I have passed the soil evaluator examination approved by the
Department of Environmental Protection and that the above analysis was performed by me consistent with
the required traini ,ex),97RI's
and
�/ ie cribed in 310 CMR 15.017..��//
Signatur Date
Q:\SEPTIC\PERCFORM.DOC
f TOWN OF BARNSTABLE
LOCATION 1 70 !a-SPIr M 6c S avqtA SEWAGE# aQ IS-31CP.
VILLAGE kq W i (�S ASSESSOR'S MAP&PARCEL G3 I-oo I 'o o 1
INSTALLER'S NAME&PHONE NO. r,[tS rb rS Cr/viS Secs 3Q
SEPTIC TANK CAPACITY 16o8 fg I to,
LEACHING FACILITY:/lh'P e
F.I.jCgGlr GkGp9�t�,<" (size)
NO.OF BEDROOMS
OWNER Dkzn- U
PERMIT DATE: JS COMPLIANCE DATE: 11 I s
Separation Distance Between the:
Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet
Private Water Supply Well and Leaching Facility(If any wells exist on
site or within 200 feet of leaching facility) Feet
Edge of Wetland and Leaching Facility(If any wetlands exist within
300 feet of leaching facility) Feet
FURNISHED BY
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1 �as
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LA
A ^ 3-
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8 '•S'S
3'3- 3►%•
f. {
No. Fee
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes
2[ppliLation for VopoSal 6pBtem Construction permit
Application for a Permit to Construct( ) Repair K) Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components
Location Address or Lot No. /7��jg/�177/ r'L4� Owner's Name,Address,and Tel.No.
Assessor's Map/Parcel D3T— ho
Installer's Name,Address,and Tel.4I0. g jGy•��3' Designer's Name,Address,and Tel.No. _
Type of Building:
Dwelling No.of Bedrooms Lot Size �o �sq.ft. Garbage Grinder(Wo
Other Type of Building Al�,CI No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow(min.required) e> gpd Design flow provided 7�3 5r-?--Sg gpd
Plan Date 40``�`��^`—2— 7 Number of sheets Revision Date
Title
Size of Septic Tank CJ v.2 L C5TsZY Type of S.A.S. p� �pU `9e��.- C et.,
Description of Soil z7o'
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 Certificate of
Compliance has been issued by this�� f Health.
Signed Date
Application Approved by Date C
Application Disapproved b Date
for the following reasop
Permit No. 4e,1'7 Date Issued J.I /
No. / Fee
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
R ;PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes
i
2pplication for MispoSal 6pstem Construction Vermit
Application for a Permit to Construct( ) Repair K) Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components
Location Address or Lot No. /74"6/Si41n/ s /[d, Owner's Name,Address,and Tel.No.
h7/1 I, 7--,v
Assessor's Map/Parcel0 3 0 —
Installer's Name,Address,and Tel.No. J� �j�-3Gy-�623, Designer's Name,Address,and Tel.No.
Z 3 G.✓1� ,r,..s.- /Lr �►.,F!' -.�v����- G�'iv //✓!,�/!i/>1/�' v`' v ►� ��
Type of Building:
Dwelling No.of Bedrooms Lot Size �o?�g3. sq.ft. Garbage Grinder(WV
Other Type of Building' No.of Persons Showers( ) Cafeteria( )
Other Fixtures '
Design Flow(min.required) 7�?3 gpd Design flow provided 7�;5- gpd
Plan Date /O " 2- -7 1 Number of sheets f Revision Date
Title Aloe,�
Size of Septic Tank v vJ (�k(SY�a Type of S.A.S. v7 55O0 end 44, eA/
Description of Soil �rz-�� zl`
i
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 Certificate of
Compliance has been issued by this Boa f Health. / /
Si d , Date l( —6 - `
Application Approved by Date
Application Disapproved b Date
for the following reasola
Permit No.29 •7 Date Issued
-------------------------------------------------------------------------------------=-------------------------------------------------
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 %d/4has been constructed in accordance
with the provisions of Title 5 at7e for Disp sal System Construction Permit No.'� �b dated { 1
Installer �GG�.S SA-Par �yA/y t�!/+�. Designer
#bedrooms 3 Approved design w �i . gpd,
The issuance of his permit shall not be construed as a guarantee that the system will ctio a designed.
Date ( Inspector
---------------- --------------------------------- -----------------------------
No. �O--/ — 1(p - Fee
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION -BARNSTABLE,MASSACHUSETTS
Misposal &pstem Construction permit
Permission is hereby granted to Construct( ) Repair( Y Upgrade( ) Abandon( )
System located at (� �/� / S �i4 .f TGu
61
and as described in the above Application for Disposal System Construction Permit. The applicant recognized 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 //�9/7�l/5 Approved by
Town of Barnstable
Regulatory Services
Thomas F.Geiler,Director
MA Public Health Division
39. 6 Thomas McKean,Director
200 Main Street, Hyannis,MA 02601
Office: 508-862-4644 Fax: 508-790-6304
Date: ti t(o 20(� Sewage Permit# r�YS-37(p Assessor's Map/Parcel 31
,b
Installer& Designer Certification Form
Designer: ��� � �i�Gi.Jos�ti.✓+L Installer: fi2,,Yz,-&-z
Address: Address: �aT�2o�if� �"W
Jylyw ,Pwdw;mil^0
On_ — —`� 25LL1 S 6 /LAC. Co*f -�, � was issued a permit to install a
(date) (installer)
septic system at ��� �f� 10 114 AW based on a design drawn by
(address)
�U1�a''?f�rt ��ai-�a'arr�.✓` dated
r (designer)
v I certify that the septic system referenced above was installed substantially according to
the design, which may include minor approved changes such as lateral relocation of the
distribution box and/or septic tank. Stripout (if required) was inspected and the soils
were found satisfactory.
I certify that the septic system referenced above was installed with major changes (i.e.
greater than 10' lateral relocation of the SAS or any vertical relocation of any component
of the septic system)but in accordance with State &Local Regulations. Plan revision or
certified as-built by designer to follow. Stripout (if requir was inspected and the soils
were found satisfactory. A of Mgss�c
TERENCE y�N,
M.
(InstalleX' atur HAYESNo. 979
SgAhrAQX
(Designer's igna e) (Affix De i er's Stamp Here)
PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE
OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS-
BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION.
THANK YOU.
gAoffice formsWesignercertification form.doc
L0CAT10N 5EYoAGE PERMIT P.0.00 �
IV ! LLACE
�0
I N S T A LLER'S NAME ADDRESS
i� ��C �F'u'ELG F'r►1�.r- S C'�0 �i
�D U I L D E D 4R OWN E
za_
DATE PERMIT ISSUED
DATE COMPLIANCE ISSUED L�
2
0
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b �
v,
No.. � Fms.... ....
.�.
THE COMMONWEALTH OF MASSACHUSETTS
B®AR'® OF HEALTH
la. V.............OF......
ApphrFatalan for Roma[ Workii Tnnitrnrtion Famit
Application is hereby made for a Permit to Construct (j,-1 or Repair ( ) an Individual Sewage Disposal
e System at:
g Location-Address •• or Lot No. --------------
Al
... i9N/�1�/................ G
W Pn- Owner Address
a ►�(�
.......-- .... z
Installer Address
d Type of Building Size Lot..7_7-____�.7'�..'......Sq. feet
U Dwelling—No. of Bedrooms............. ...........................Expansion Attic ( ) Garbage Grinder ( )
a'4 Other—T e of Building No. of persons............................ Showers
YP g ----•---•----•-•------------ P ( )--- Cafeteria ( )
dOther fixtures -------------------------------•-••------------.----...--•----------------•----------------------------------------- -----------
W Design Flow.............._____-..._____.____________..gallons per person per day. Total daily flow.......... gallons.
WSeptic Tank—Liquid capacityl ®.gallons Length. J./'--. Width__.�5�6`�_ Diameter................ Depth._.�..�8-��
x Disposal Trench—No--------------------- Width.................... Total Length.................... Total leaching area....................sq. ft.
Seepage Pit No--------/---------- Diameter......f!-------- Depth below inlet..._.4�........... Total leaching area--_Z6,7...sq. ft.
Z Other Distribution box ( ) Dosing tank ( )
'—' Percolation Test Results Performed by-- o �� . -�N Date...�ti •_ l��
Test Pit No. 1---!�n3-.....minutes per inch Depth of Test Pit.... '¢..._ Depth to ground water- ------_..---.
Gi, Test Pit No. 2...: ._..minutes per inch Depth of Test Pit... ......... Depth to ground water........................
9 •--•--•--•-•------------•---------•••--••--•••--.....-•--•--•-•....---•----••-•.....------•-----•--•._...-•------•-••••--••----•..............•--••---..--•--
O Description of Soil...... ��... .. ..........T=r..,SyG3:.Soi G A_Sg $� •¢z,•_ 7c9
-- --------------------
�u 5 ............................WGGA7. Bi9zUs 7p'.. ,9 :..............................................
•-•••--------------------------------------••---•••---•--•---------•-•--•••-••-•--•---•...........•---••--•••••------•-------------•••-•-----•-••-------•-••••----•--••-•-•----••--•-------•-•----.-•---
U Nature of Repairs or Alterations—Answer when applicable...............................................................................................
--------•-••--------•-------•--•---------------------------•------•------------------•-••-•--•--•-•--------....----------------------••----------------•--------------•-----------------••---••--.---••.
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of L , 4 5 of the State Sanitary Code—The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has bee . s d by e bo f health.
---
Date
Application Approved By.. . ••--••---••-C�=- --•--- •----- ---•--------------------- ..........6ylC 6AM-5..........
Application Disapproved for the following reasons--------------------------------•----•--...--•-------•---------•-----------------------•••-....-------•---.•-----
•-•-•-•-•---••-•................•••--••-•.....--•••••---•---•......••-•--•---•-....---••......----•-••-•--•--•--•---•••---•---•-----------••----•••-•-•••--•---•---••--•••-----••---•••--------......._
Date
Permit No....7Ra...zaq s..--•--•---•--...... Issued-.......................................................
Date
i'----- ---- -- -. -- --- - -- - .....��....�...--- ----------------—__�
t
d
No .. - Fina...........................
r
THE' COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
..........T.wry-------------OF...... ..A
Appliration for Disposal Works Tous#rur#inn rrntit
Application is hereby made for a Permit to Construct (A,,-) or Repair ( ) an Individual Sewage Disposal
System at:
l�Ta/
.... .............................................................
Location-Address _ or Lot No.
...................•--------•---•----...............
W y /Owner Address
Installer Address
Type of Building Size Lot.-7-z_�-_��........Sq. feet
�. Dwelling—No. of Bedrooms.............3...........................Expansion Attic ( ) Garbage Grinder ( )
`4 Other—Type T e of Building ............... No. of ersons._..._....._................ Showers — Cafeteria
�4 YP g ------------- P ( ) ( )
QI Other fixtures ------------••. •-----•-----... . .
W Design Flow............. .......................gallons per person per day. Total daily flow......... * 0...........................
WSeptic Tank—Liquid*capacity.!OPP.gallons Length.8.% Width.. li",.. Diameter---------------- Depth__.-,5..........
x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft.
Seepage Pit No......../---------- Diameter....../-.a-------- Depth below inlet_.-_4............. Total leaching area.... 7....sq. ft.
Z Other Distribution box ( ) Dosing tank ( )
Percolation Test Results Performed by._ :. a..s�!'Zv -�!`!- r ✓fs_ Date... _F�- ..9 �y8
--• i ............
a Test Pit No. 1..G_.X-_-__minutes per inch Depth of Test Pit..../ ... Depth to ground water...-r__•__-______-
(Z4 Test Pit No. 2...4r-J'.....minutes per inch Depth of Test ......... Depth to ground water-----................
a ------. ...............••-- .......-•-••--•••----------...----•--•---••-••••-••-•...--•--•.........................................................
O Description of Soil---- _ `fz"_. �. r -5��3_So�_L•.,S _- %'G A.f 4Z-, 7`�--".1
U ?LSD S `.� �✓�/c�'`,� -Bps----- -•---��'-,i �� `5 / J?r� -"S/9 /)
W
-----------------------------------------------------------------•----------...-------•------------------•------------------------------------------------------------------------------------------•--
U Nature of Repairs or Alterations—Answer when applicable................................................................................................
--•-----•----------------------------------------------------------•----------------........-•----------------•--...--------------------------------------------.......................................
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of T ITIE 5 of the State.Sanitary Code—The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has bee Y s d by e bo health.
,Signed -----------------------
Date
Application Approved BY `�'~ _.�� ��,Lr-;L. �. -----------r P
a a�^r car
Date
Application Disapproved for the following reasons________________________________________________________________________________________________________________
a
Date
Permit No....... ------ Issued--------------------------------------•......--•---•---
._...._.. Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
............te .........OF.... a!e=P...........
Trrtifiratr of Toutpliattu
THIS I TO n.CERTIFY, That the Individual Sewage Disposal System constructed (,- or Repaired ( )
bY-•-----•------- -J--.......................•---•---------••-•..._......•--------•-•••-• •-•--•--------•--••-----••-------••••••--._........--•-•.....•-------•-•....----••----•-•--•••--
Installer
at
has been installed in accordance with 65 provisions of TITLE r of The State Sanitary Code as described in the
application for Disposal Works Construction Permit No.Z.•�'5__-- S............ dated...... 7 �. .................
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE..............
1 -- ............. Inspector .................................................................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
............./0. .........OF......!.7 :�'.............................
FEE.
Disposal Works Tonstrnduan fermit
Permission is hereby granted.....`.t'_�n(.........................__............-.
to Construct (✓f"or;Repair ( ) an Individual Sewage Disposal System
at ��•--• �----•--��'-.�.`.�"-•-�--'�-i�+{-`-s••-•--�rrl...-----j'-'-�-�---....------Street-•---••-•-•---------------------••--•--....-•--•---•--•--•-••-----..............
as shown o the application for Disposal Works Construction Permit No d _ Dated...I-n__!o�/ ..................
�?- Board of Health
DATE.. --.- a - 5
FORM 1255 A. M. SULKIN, INC., BOSTON
APlPPLICATION FOR PERCOLATION TEST AND OBSERVATION PITS
LOCATION WS4 /77.v 4 �� /77 Ag gz0y /Yt f�/x Crj7 � � NO. r"/3
41
'� VILLAGE '22:�Z V R S7,QA,- h1 i/A DATE ���
APPLICANT eve cueeAttCN�ix�av FEE /S
ADDRESS 7-2 Li✓ ��'NT�Qv�L�� TELEPHONE NO.�����/�, (Non-refundable)
ENGINEER Jwtu2cl_LOz DJ 1,b° TELEPHONE NO.
DATE SCHEDULED, /f¢'/ �?"Jo
(Applicant's signature)
• • • • • • • o •• o • • • • • s o o e o • • s • • • • • e • • o • • • • • • • • o • • • • • • • e • • • • o • • • • • • • • o • o • • • • • • • • o • • • • • •
SOIL LOG
:SUB-DIVISION NAME DATE .9, 1,78� TIME /o sov
EXPANSION AREA: YES ✓ NO _ ENGINEER.
TOWN WATER PRIVATE WELL �/ /�.4�.� �7uiP.P.4)/ BOARD OF HEALTH
�hy .gLTo EXCAVATOR
. SKETCH: (Street name,etc. ,dimensions of lot, exact location of test holes and
percolation tests, locate wetlands in proximity to test holes )
NOTES:
0
�W
V� '
s
f 8�
PL rK
W
M
y�
oss�
PERCOLATION RATE:
TEST HOLE NO: / ELEVATION: TEST HOLE NO: Z ELEVATION:
1 co.c�n r Ca Ts /Pao r'J
:r
2, 2
3 so.a o.o 3 Su43Jo..4A-
s�•
4 4
5 (�o.vRJ E s.oro A 5
7 /•"Ta ell
8 8
9 S N,o,PP $wa O 9
10 10 S WiG{iPA Co.a�J
11 11 s-e�ev1�
12 12
13 13
14 14
15 15
16 16
i_SUITABLE _FOR SUB-SURFACE SEWAGE: LEACHING FIELD LEACHING PITS
LEACHING=TRENCHES
UNSUITABLE FOR SUB-SURFACE SEWAGE. REASONS:
NOTE: ENGINEERING PLANS MUST SHOW NUMBER ASSIGNED ON PERC TEST APPLICATION
ORIGINAL: COMPLETED IN ENTIRETY BY P. E. AND RETURNED TO BOARD OF HEALTH
COPY: RETAINED BY APPLICANT
i I __II_ I -.� -"I I I-__* � lt�I I I � I I I � i, � � I I I I I f I� t I , .. I I I � I I� I I I I I � ..� .I .,�r I -,� , , � �I �,, � , .1 I t ,'.I ,,,I :� .1- ,.,�,� '��, -1 � �, I� �� : , I I,� �', � �, '. � _. :� -� � � , -,, ,I11 �., `P,'� "� � I�,��t! '--,.", I _,,�II :,7t��, � , �_ , ,,�, 1'�,, t,�I t - ;, I -� � I:I -I�. � ., , " I .: I �
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SOIL LOG
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. l�,�• ,• s � DATE .,,. . . . TIME. . ... . . . .
TEST HOLE 2 � Lr GoD SurtuSc-�
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WATER ENCOUNTERED ,
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NUMBER OF LEACHINv PITS . . . . . . .
APPROVED : . . . . . . . . . . BOARD OF HEALTH
1 . . .. . . . . . . . . . . . : . . . . . . . . . . . . . . .
A D TE . . : . . 4
AGENT OR INSPECTOR
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E �r,� KELLEY
A2---zG s�eir�a A No. 26100 c;
Q / PETITIONER
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