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HomeMy WebLinkAbout0026 BOG BERRY LANE - Health I i �I i 0 TOWN OF B / ABL LOCATION t' ' SEWAGE# !�77— ��1 VII LAGS a S ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY: (type) `i... m` (size) .X ,'Z.. NO.OF BEDROOMS RbUZER OR OWNER ,C 4:2 PERMIT DATE: —COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and 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 �� ®�� e ��/��� ��s��` ���J� � /li�G� �� � � � � � / � ' � � �'l � / I� � �� � `v No. -3 / Fee © o p p THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: V 1 1 � V Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLEs MASSACHUSETTS 01ppYication for Migogar *pgtem Construction permit Application for a Permit to Enstni)ct )Repair( )Upgrade( )Abandon( ) L complete System ❑Individual Components Location Address or Lot No. L94 Z Lo-L M im Ow er's Name,Address and Tel.No. 9 Z$_3 9 t T 11 nn Alor"10 Assessor's Map/Parcel 6.4o* f 4 ler ✓i/wA Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. 03.Qtjr Comm 64a,4 tXAII'% ��� r lc k f� 32- 05 3o Type of Building: Dwelling No.of Bedrooms 3 Lot Size so.ft. Garbage Grinder( ) Other Type of Building Wool QVhe, No. of Persons Showers(:Z ) Cafeteria( ) Other Fixtures S'iy%ys , ev Design Flow 10 ( i gallons per day. lalculated daily flow 330 gallons. Plan Date 1110148 Number of sheets Revision Date Title Size of Septic Tank ��� Type of S.A.S. Ol dale Description of Soil & (kln Nature of Repairs or Alterations(Answer when applicable) S�,Aew. Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance o he afore described o -site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code no to lace the s m in operation until aZ Certifi- cate of Compliance has been is d y this Board o Health. Signed Date 0 Application Approved by Date Application Disapproved for W folio ing reasons Permit No. — �J Date Issued ,�J TOWN OF BARNSTABLE LOCATION L7"rt �e/1J t�f' .w,� SEWAGE# 1 VII LAGE �,� S ASSESSOR'S MAP&LOT_ y INSTALLER'S NAME&PHONE NO. Ur 3 SEPTIC TANK CAPACITY LEACHING FACILITY: (type) —< I (size) NO.OF BEDROOMS R bq LIZER OR OWNER f� PERMTTDATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and 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 Fee (0D C� 3 THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE,, MASSACHUSETTS 01pprication for Migoaf *pmem Con,5truction Permit Application for a Permit to GrDuct �O Repair( )Upgrade( )Abandon( ) [FlComplete System ElIndividual Components Location Address or Lot No. L o� Qo� P er i-U k4— Owner's Name,Address and Tel.No. `7 r Assessor's Map/Parcel -ewn Nor.1kvo)o 0 l�oXIm _Coo a n Pfi, 014 dorl.l / In♦taller's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. R.13.0or CoMPahr - Crreo.l I�e��c�h 1PnGc( m :�- 05 3a Type of Building: Dwelling No.of Bedrooms 3 Lot Size sq.ft. Garbage Grinder( ) Other Type of Building MOA 17ja v„e. No. of Persons y Showers(,,"t,) Cafeteria( ) Other Fixtures Design Flow it 0 X gallons per day. alculated daily flow 3 3 D gallons. Plan Date YT20 Number of sheets r Revision Date Title Size of Septic Tank I SO Type of S.A.S. � Or 9�� Description of Soil Nature t Repairs or Alterations(Answer when applicable)�1/� e,u)sNs4ey^ Date last inspected: 1 Agreement: The undersigned agrees to ensure the construction and maintenance of.he afore described o site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code a riot to lace the sy fem in operation until a Certifi- cate of Compliance has been iss d by this Board of Health. Signed Date Application Approved by Date'A/- .x Application Disapproved for fithollo9ing reasons - t - Permit No. LF Date Issped THE COMMONWEALTH OF MASSACHUSETTS -BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed ( >r) Repaired ( ) Upgraded( ) Abandoned( )by at has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. - 3/ dated Installer Designer The issuance of this permit shall not be construed as a guarantee that the syste will function as designed. Date Q' - �. Inspector No. 31f Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS Mi!40ar *pgtem Congtruc'tion Permit Permission is hereby granted to Construct( Repair( )Upgrade( )Abandon( ) System located at , Li 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� ; Town of Barnstable Pm 9/3y Depa0ment of Healthi'Safety,and Environmental Services �m Public Health Division Date Q, 367 Main Street,Hyannis MA 02601 •l a►axer,►at$ � Fee Pd. l c3 a'tEorax+r' Date Scheduled �� /G/-�';� Time //��'" Soil Suitability Assessment for Sewage Disposal Performed By: [r IZn/iy2.t, J iinidlA Witnessed By: `�fBrLyy� I�u^-/V)n/L� )v CATT0IV &.G*-NL+`Y2AL Location Address n Owner's Name .Lai Z �bo� �drett/ LN /�,✓.v /tio�TN�p� �,���jS Address 7y c,4 pr Assessor's Map/Parcel: pC�t///v Engineer's Name MA2S? S /'�«S /"J1► aZG `v' NEW CONSTRUCTION REPAIR Telephone# 4/3Z- ;S-e, Land Use Slopes(%) `5` z o Surface Stones �O Distances from: Open Water Body '7/ U ft Possible Wet Area -:'/D ft Drinking Water Well. No 11 Drainage Way 7 Z 5 ft Property Line /o 4 ft Other5-i-ro A11V111a/ ftG2owNp 1,Vp7ee SKETCH:(Street name,dimensions of lot,exact locations of test holes&.perc tests;locate wetlands in proximity to holes) /3d�2p ors out t3 y I NS9'ZµI'��WL' IAJ 0. Parent material(geologic) M SNr-7iL Depth to Bedrock Depth to Groundwater: Standing Water in Hole: /t,-'O Weeping from Pit Face Estimated Seasonal High GroundwaterL D -TERN—T�, vokSEASONAt`:= WA-9-A M Method Used. ./tio T 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_ PERCf�LATTON:TEST Date > g Tiute '` Observation 1 Hole# Time.at 97. 2 sS Depth of Perc �y �SG" yy fG.` 'Time at 6 .,, : '.` r 32� Start Pre-soak Time© O �. Time(9"-V). P f!2-4;. 1-3 End Pre-soak Z'S Z'3 Rate MinAnch . �-Z �-Z e3roG/^ R/b•ro C�J� Site Suitability Assessment: Site Passed _ Site Failed: Additional TestingNeeded(Y/N). Original: Public Health Division Observation Hole Data To Be Completed on Back----� Copy: Applicant. BEEP OBSERVATION ff 0LE'LOG :H. # J Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulderes. % I Ole ��`Z/ �„�/ Si�T`Loa!✓1 0 2 �� AS!/vd �iKi/H �/ M44b S.arb I tZ ��� Sw"d �j�ZA/�✓ �6oSd Zs Co�2t� nn / (�2N✓�L 1-1Z-1 i:� l /YlJ1� S.oi✓D /o ya �� G? SNGcd G�o�� Lcic)sd DEEP OBSERVATION HOLYLOG Hole#"_ G Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulderes. a O—Z -- Z 0 Y n S1Z /V l7orsiul z-Z �3 ,�T Ga6 zY-V7, G/L.d>T /CAoSd ZSi°a Gd�2td G rUev�' L 7i I ZI G dl7 S/Jw'� i-0 y/& DEEP:O SERVATION HOLE:L'O Tole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Bouldcres. a DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure;Stones,Boulderes. % Flood Insurance Rate Man: ZSWc)l Dj/SC- . 9-14-85' Above 500 year flood boundary No— Yes Within 500 year boundary No °� Yes Within 100 year flood boundary No Yes , Depth of Naturally 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? t/�3 If not,what is the depth of naturally occurring pervious material? `— Certification ^' ` I certify that on `!�S (date)I hake p�ssed'the soil evaluator examination a roved b the .� PP Y Department of Environmental Protection and that the v p above analysis was performed by me consistent with the required training,expertise and experience described in s 10 CMR 15.017. Signature Harp "\ O h7) 2 f n l o , fo fo d 1 y , C nc , covers i n , caaf it-on or , / 5 h. -40 � P , PP w/rrrlrt. : • �, h, 9 ; .. p . w a• .. G. a c et tpea,. htone. P /4 P r< � �� 4 zo vc 1 �✓ rrtr ,t h er.: r � P P f - t ! - _a /�� c a p, /G .n S nd ow .. _ 1 /lam e J 1k , . . . e a / S3� e O r co 1r7V. . e C� u\ \ • • f e • 0 F e / • OR S f e b e _ V. a t V a I .. • .. - O e O rc a / r S . � > / one JJ . ! / wQ�h�d St o 1 t ... 1 p ec! Stone, base. • � , .crush chsfn . X bO 0 r �(_ y r I r pJ f" t: J f a.6/,o a/ev. %-f , `w o o r a b ff M fe s f hole. e r o E. p ,,- tY a , yv U �1 I - t G /V L:) A T,q = i o TE T OLD L G � A/UMBER OF BEDP_c>oNtS S t \ , GAP_BAGE DISPOSAL N/T . TEST UFgTE • \ �\ t T OT�L EST ATED FLO ' . r -L� f C7 DAY x B�2. COLAT/O :, ,..- � r `' GAL. DAY f-� EGG?'" ��'v� ':• �v�.� Aj c c'� �Lx..16'L•/j� r' ''`, , I � �, � . ; � EQ S PT/G TANK F�Pl9 Y. G HQL E HOLE e ,Q , /'� ! r _ _ .J A SEPTIC TAN1k `,S/ZE . 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