Loading...
HomeMy WebLinkAbout0086 FOXGLOVE ROAD - Health �v TOWN OF BARNSTABLE LOCATION 06, ro Z3 SEWAGE# y86 VILLAGE —� ASSESSOR'S MAP&PARCEL/y%' /� ®ol, INSTALLER'S NAME&PHONE NO.�o (C1n1eJC SEPTIC TANK CAPACITYX LEACHING FACILITY: (type) 4!(joT_�� _ (size) NO.OF BEDROOMS OWNER PERMIT DATE: / ¢ ' COMPLIANCE DATE: . Separation Distance Between the: N0 NC Ct� f(M ©Cr Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility ?el 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 rf0N r CAI f" �lcve «(1 Iry i 1 .e t� Ya Y Ll S ; 3�'Grl ry iG r� - a No. �`� Fee J91po THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: 1---- Yes PUBLIC HEALTH DIVISION-- TOWN OF BARNSTABLE, MASSACHUSETTS 0(pplitation for BispoBat �bpBtrm Construction permit Application for a Permit to Construct( ) Repair(Upgrade( ) Abandon( ) [:]Complete System ❑Individual Components Location Address or Lot No.& G�/Od r—( t Owner's Name,Address,and Tel.No. Ce,� '611 I t Assessor's Map/Parcel li 1 � o ryfn Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No. ��c9usCa Inc SCE-yayT� � Mc�,orJ Type of Building: Dwelling No.of Bedrooms 3 Lot Size sq.ft. Garbage Grinder( ) Other Type of Building (t%OR� 1 No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 12 O gpd Design flow provided 'S 41 gpd Plan Date //� IZ� Number of sheets Revision Date T� Title Size of Septic Tank �x/Kf 1/� Type of S.A.S. a ,�C"70 QQ��(31N Cis Description of Soil Nature of Repairs or Alterations(Answer when applicable):r-mm1l ;L !Cm oallo,-4 CkcvrlioffS w }H W skoeAt- ash dlcti . 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 Board of Health. Si ed Date A- Application Approved by _ ' Date Application Disapproved by Date for the following reasons i Permit No� Date Issued ,J No. � i �I Fee © THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: ] PUBLIC HEALTH DIVISIPN,,,. OWN.OF BARNSTABLE, MASSACHUSETTS Yes ftpficatiou for bispos'i 6pstent Construction permit A Application for a Permit to Construct( ) Repair(Upgrade Abandon( ) ❑Complete System ❑Individual Components P Location Adcless or Lot No.& f�� /Do a 1< Owner's'Name,Address,and Tel.No Assessor's Map/Parcel InstaIler's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No. V,A '_6(Q w(� -Inc sce-4/cam-7'��� '�,��c� ►�c�so�i Type of Building: Dwelling No.of Bedrooms �\__'� ` Lot Size sq.ft. Garbage Grinder( ) Other Type of Building {( jk,��V�1G 1 No.of Persons Showers( ) Cafeteria( ) Other Fixtures �f Design Flow(min.required) "6`Jj 0 gpd /`Design flow provided gpd Plan Date ///'sF)7/ Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. 9 i Description of Soil Nature of Repairs or Alterations(Answer when applicable) SCO C(Ce (j:U '.t"IA am 16�r 5 W► 4, Of ( 0I 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 itle 5 of he Envirorfimental Code and not 'to place the system in operation until a Certificate of f. , Compliance has been issued=by this Board of,Healthf � �-.- Signedr ' Date Application Application Approved by �T\\, Date Application Disayp�_roved ly � u // { -,f ! Date for the following'reas10\'/% / t � ''1 i � � ��' 11 I � ,r•� 1 Permit N0. Date Issued __--- ------=---------- _ - - = - = - - - _= -- , ----_- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIIFY,that the On-site Sewage Disposal system Constructed( ) Repaired( wl Upgraded( ) Abandoned( )by '*DJ1,74()W"L-1-N(,• at UG Fc"Agloot Ro CFvMN� has been constructed in accordance with the provisions ,of Title 5 and the for Disposal System Construction Permit N� `A����ia dated Installer V,A t,- T�(hat'4 Designer `J v b #bedrooms Approved design flow yj gpd The issuance of this permit shall,not be construed as a guarantee that the system will fun tion�as designed. - Date - '� Inspector ..ram.. 1,, No �`"�[ /"i Fee /d THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS Nsposal 6pstem'Coustructlou 3pefmlt Permission is hereby granted to Construct( ) Repair( /V11— Upgrade( ) Abandon( ) System located at (� 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 mus abe corppleted within three years.of the date of this permit. ^ Date Approved by. n e} %a Town of Barnstable Regulatory Services Thomas,F.Geiler,Director &APPWr MAM eery, s Public Health Division 019. � Thomas McKean,Director Q�A 200 Main Street, Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Date: AbAw Sewage Permit#c?Mj-1136 Assessor's Map/Parcel/y 0 1__/ Installer&Designer Certification Form. Designer: D. *A:2; Installer: , ;jlow Address: ) c i Gil Address: �F7, 0 .i 3 0x I Ll On /J- �- j was issued a permit to install a (date) (installer) septic system at 9 G CMI Qf��- Cc J�f N 4�� f based on a design drawn by (address) ��• �Qb dated 12 (designer) I .. I certify that the septic system referenced above was installed substantial) 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€ound 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 u `Oions. Plan revision or certified as-built by:d'esigner to follow. Stripout(if rp- ­cted and the soils were found satisfactory. QFM4� Y DAVID b `"(installer's Signature) M y 1{1 Ill t c l.d ,00 - LO CAT 10 SEWAGE PERMIT NO. �vILLACE \ INSTA LLER''S NAME i ADDRESS 8 U I L D E R OR , OWNER DATE PERMIT ISSUED DATE C 0 M P L I A N C E ISSUED . � c 3� -S 7 TOWN OF BARNSTABLE LOCATION �(SJ SEWAGE # VILLAGE , ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY: (type) (size) NO:OF BEDROOMS (� BUILDER OR OWNER �� 2 Pem 1.^P PERMTTDATE: COMPLIANCE DATE: 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 _ J - 4A r X J THE COMMONWEALTH OF MASSACHUSETTS BOAR® DF HEALTH c�c.UA-)..............OF...... ApplirFa#ion for Uispwi al Warkii Tiattstrnrtuan Itanfit Application is hereby made for a Permit to Construct ) or Repair ( ) an Individual Sewage Disposal Systpm at: CF1fJ ....- a ....� � �C•Lt4. . ....!. ` --- --...� /� oYT io or Lot No.caOwner ............................. .............................................. Wdress............................................. ............. ..................................................... --------------------------------------------------- ------------------ - "................ Installer Address Type of Building Size Lot....I 4 ...Sq. feet Dwelling of Bedrooms.......... ...........................Expansion Attic Garbage Grinder Other—T e of Building No. of persons............................ Showers a YP g ---------------------------• P ( ) — Cafeteria ( ) Otherfixtures ......-�...-------------------------------•----•---.-----------•-----------------------------------•-•ram W Design Flow..................................gallons per person r day. Total -i���pw...........�/_43_.�.. __._____..__ 1 n�. WSeptic Tank—Liquid capacity_ll �._gallons Length__.... Width._¢.............. Diameter--__-______--__- Depth .._. x Disposal Trench—No .................... Width...........I......... Total Length___.....•...•...... Total leaching area.......... _____sq. ft. Seepage Pit No.......... ........ Diameter....... .... Depth below inlet................ Total leaching area.g6 ...sq, ft. Z Other Distribution box ;,Dosing to ) a Percolation Test Results Performed by............. yC 4:,...__..____ .. ._ Date_..� .....•. _ .. A 1......... ......minutes per inch Depth of Test Pit---- _.. Depth to ground water---0.07e�--_* fX Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ R+' ............••. Description of Soil..... �... , JI!J. -----'-••••-•--�!J Cam✓ ✓. x V --------------------------------------- .------------------------------------------- ------------------------- •------------------------------------ •-------------------------------------- ----.-- -•----•---••-----------------------•---------........-•---------•----•-•---...............------••--------------•---••----------...-•--•---•----•-•-•---------•------•-......--••...................... 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 iITLEJ 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation nti '�Certificate of Compliance has been ed by the board f health. E — yate Application Approved By............ ,• S � --------------------------- Date Application Disapproved for the following reasons:.............................................................................................................. . -••-•-••-••--•••-••••.....'--•-•-••-----...-•'-....••••-•----•••••••-•••-------••-•--...-'•••••..........._.........-••-•-•••••-•••••••--•-•-•••---•----•••••••--•--------•----•------•-•---•••....._..-- Date PermitNo......................................................... Issued........................................................ Date No....1..r.-...... / _« "', Fizz............._............ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH C�c J ................OF..... J - ......_.. r°' 4 z,�pvftration for Dtovo'a1 Works Tonstrurtion Vrrmit Application'-is hereby made for a.Permit to Construct ) or Repair ( ) an Individual Sewage Disposal System at: ._....f`� cc%t .._. ....:.... ' -•/-e............................................ -/Locatio -Ad r / A or Lot No ...... ..._...... .._....- ...- Owner Address W Installer Address Type of Building Size Lot... ....Sq. feet a DwellingLo. of Bedrooms.........,,............................Expansion Attic (�,`) a Garbage Grinder (JV} aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) Otherfixtures ----------------•-----------------------------------------•------------------------------------------ --•-------- ------ n Flow--------••-•------••.... - r lons W Design S__.....___gallons per person per day. Total daily�f�ow__._.._.__ ...1_.f ................. al ; WSeptic Tank—Liquid capacityl-(,le.=(,)__.gallons Length,*-_�..... Width�--:J6-... Diameter________________ Deptld.�_6..... x Disposal Trench—No. .................... Width.........r......... Total Length............ Total leaching area....................sq. ft. Seepage Pit No---------/-____-__-- Diameter.......o.L_>..... Depth below inlet---�............ Total leaching area.;2.66.....sq. ft. Z Other Distribution box Dosing tank ( ) W { Percolation Test Results Performed Performed by----- 1 '" ..:. y �l( TPct Pi+ �. 1------- ...minutes per inch Depth of Test Pt--- ----- Depth to ground water_C) ...�V� PLI Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ o ................................................... ...... f .............._ x p ' j 3 _ / � �' Descri Description of Soil----�-"=------------�4.�/-'.��'�c'. � �1.�__ll r--•------------=-----�----`"� '`yo'J---- -- U --------------------------------------•--•----------•-••-------•----- ---------------.----- ------ •----------------------------------------------------------------------------------- .--------------- 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 IT 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. Signed...................................................................................... ................................ Date Application Approved By.......... ';_A(--•----•--- -------- Jac �f.... Application Disapproved for the ollowing reasons:................................................................................................................ •.............•--•--•------•••-----.....------------•-------•---...........-------•-----•--..........------•--•-••---•-------•••------••-•-••---•--------••------••-----••-------•---•-•••-----••------- Date PermitNo.......................................................- Issued....................................................... TH`E:COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........................................OF.............................. ................................................... "01rrtif irate of Tomplinrr THIS IS TO C' he Ind' •dlual Se_agg Disposal ystem constructed ( ) or Repaired ( ) by....................i '...L.4. ••-------C--.--•--- '�.' -------•-••----•--------------..--........---••----•----------•------------ Installer at.••--•-•-•--....-----••-----•-------•-•---••..........-•-••-----.....--•-- -•-•---••-----•-•--•--• �.-• } ....................... has been installed in accordance with the provisions of TI' IEF 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No......................................... dated------------------------------------------------ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SA/TISFACTORY- .._ Inspector-.- - r.�r. .........................................................:......... DATE.....-•...................tom h,C . . . --- . .-._ . THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH21 j ......................................O F.............................................._...................................... No......................... FEE........................ �i��ro�ol cotrnrtton prnttt Permission i�5r\Repairy g�ryed. --- ' i to Construct ( ) an In 1 a wa Sewage Disposal System atNo............................................................................................................................................................................................... t1� as shown on the application for Disposal Works Construction Perr��;el'lif`I�e.................... Dated.......................................... ......--••-•------•-•------•-----------------•----------------------...-----....••-•--................._ Board of Health DATE................................................................................ FORM 1255 A. M. SULKIN, INC.. BOSTON /G/c/ O,dT,4' \ encl ,p,CSPo, L Pi7'-U. /aG� e5A s7bVer At S. G 0,7 Z `7`�1G'•�1�. T07- Z / i 7�STirbLE OF ` �T Imo/-Z ///t� /•V✓ �,.•: i*,t! S c.J ` iVJ. ::i��6 c." ;,' 4V I LC I A f11 �•�, t 1�1��� � :r \ 14 Y t ; O. AQQ�Jr1m SC.•� '�y0��,V SU���•� �u i GL-OT T,'-IAT TA/C- F✓� p.4 T� .s // c� SCA Z- ,�© y ,S la,6E C/,c/t-- A SETBA C/C I ,�EQvieEME�c/Ts. of T�/� �"ow�/oF cf--lT' Z L ��✓.5��i8L� A�/� /S ��� �l41t/.�o���y-�cG .4 aC'A TEo /W/Tfl/N Th/,:5 •C Z4P OA T-:S// �3A XT,E,2 E NYE /it/C. ' Tf//S 1,[..41t//S 1t/a7- BASED D mot/ .2EG/STE.eE1� L. /O SU.eY6Yb�I TS.SyaL✓•V-51-10vl-D .1/0/ 9� qoVI /NG. ASSESSORS MAP' TEST HOLE LOGS 1)S—±Re— instaop shall comply with the State Environmental Code Title V and Town of ky� - ' Board of Health Regulations. PARCEL; f (D 07-4/ tt/f, G� 2) The septic system as proposed on this plan shall not be Installed until a{icensed-town , 47 � SOIL EVALUATOR: installer receives approval and an installation permit from the applicable town. REFERENCE:' "T l WITNESS: ` -?ice ` ! 3) Prior to installation,the installer shall verify the location of utilities,sewer inverts, �/ sewer lines and existing septic components prior to installation. �i DATE; >V 4 All gravity sewer piping is to be 4 inch schedule 40 PVC at 1/8 1 g ty P P g " per foot. The first 2 PERCOLATION RATE: "" L- "" feet out of the distribution box shall be level. All piping connections to be glued. 0` ,!` ,�j 5) This septic design plan is not to be utilized for property line determination or for'any T.H.#1 ELEV. T.H.#2 ELEV6 other purpose other than the proposed septic system installation. LOCATION MAP , 6) All Title V components are to meet Title V specifications. ` t 01 6++- 7) Parking shall be prohibited over Title V components unless components are H2O 1� l � 1 loaded. I Jt t� l 8) The existing leaching or cesspools shall be pumped and filled with material per Title V abandonment procedures. Leaching and cesspool(s)and contaminated soils within the proposed SAS shall be removed and replaced with clean n 42 P P� _ p an sand per Title V r specifications. 9) Septic components are to be 1(Y from a water service line.Sewer lines crossing a ----' /C>(:f:>. _. _ („ ` (t ? water line shall be sleeved with an appropriately sized schedule40 PVC with ends grouted. The water service line or the septic line can be sleeved with the sleeve being a distance of 10'on both sides of crossing the line. 10)If a garbage grinder exists in the structure,it is to be removed if the septic system is not designed to accommodate a garbage grinder. f 21)The installer Is responsible for care of excavation around all utilities on the property SEPTIC SYSTEM DESIGN CALCULATIONS and protecting the structural integrity of ail structures during the installation process of the septic system. FLOW ESTIMATE: 12)This plan only represents that a septic system can be installed on the property i BEDROOMS AT I 10 GAL/DAY/BDRM= GAL/DAY meeting Title V requirements. 13)The property owner shall review design criteria to approve the total number of SEPTIC TANK: bedrooms and design flow.Installation of the septic system as proposed and receipt GAL/QAYf BDRM X 2 DAYS= GALLONS of payment for the design shall be deemed approval of the design criteria by the property owner or agent of. ! USE GALLON SEPTIC TANK i 14)The validity of this plan shall expire with the expiration of the town installation permft (� (GARBAGE GRINDER IS PROHIBITED) Issued for this plan or the validity of this plan shall expire on the expiration of the (� C� SOIL ABSORPTION SYS EM:_ Certificate of Compliance issued for the installation of the proposed system on this plan. ' SIDEWALL AREA: �� °�� �" Z�� � r '7y = r BOTTOM AREA: C r SEPTIC SYSTEM SECTION -- '°.---� -- - `-r` 6'71 BENCHMARK ��am t,, , FOUNDATION TOP OF t ,r 'r ON ywuw � ,p (DATUM ASSUMED) FE 5"STONE BASE H2O D " 6b 6 STONE BASE OR COMPACTED BASE X Z, --- - WATER TEST FOR LEVELNESS � � GALLONS SEPTIC TANK L -t->--n tA4 e-T SiTE AND SEWAGE PLAN �k\orr � LOCATION. �e(, F � �q 0.40 DAVID IVASQN t No.1065 'j PREPARED: SCALE: 20 DATE: —IDVI t