Loading...
HomeMy WebLinkAbout0119 RASPBERRY LANE - Health 119 Rasberry Larib Marstons Mills A = 102 - 088 i o 16� Fee to�2_ 9©� THE COMMONW LTH OF MASSACHUSETTS Entered in computer: V . Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS pprication for Migponl *Proem Congtruction Vertu Application for a PernAolConstruct( )Repair(grade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No.- A'" l�/�S/�d Cf� Ao&-P_ Owner's Name,Address and 1.No. .`'d --vigwo vo /yorstd.os -70f/iv J 89'e4ke* -'f- Assessor's MapMarcel /&`O f�-PI'�d t'�K' Di-,'" Installer's Name,Address,and A.No. Designer's Name Address and Tel.No. 8AX�,q- /V ye 77AC- 6P5764-Plito I'A, Type of Building: Dwelling No.of Bedrooms Lot Size sq. ft. Garbage Grinder(N)CI Other Type of Building AkVO No.of Persons Showers( / ) Cafeteria(N(b Other Fixtures +� Design Flow gallons per day. Calculated daily flow 5 Y110=3ao CoJVb gallons. Plan Date_ PPr 17, ! Number of sheets Revision Date Title Size of Septic Tank /o S Type of S.A.S. Description of Soil 5,00Y e004 S, 0by Cm'/AP-y f' He 5.4'1,0 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 issuard of Health. e t ' Bo Signed Date Application Approved by Date /O—3.0-C1 I Application Disapproved for the Qlowi reasons Permit No. e/�5— Date Issued TOWN OF BARNSTABLE ' `.:'LQCATION G` Prr Lh sEW`E # hiILLAGE /YgJ-17", �'l f ASSESSOR'S MAP&LOT INSTALLER'S NAME&PHONE NO. S�''► ;;:;;::SEPTIC TANK CAPACTTY " G✓/ftG 33tJS (size) �� X/►?�� UACK VG FACMr Y: (type) NO:OF BEDROOMS 3- BUII,DER OR OWNER PERMTT DATE: /2-19' 9 COMPLIANCE DATE: Separation Distance Between the: ":Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet lrvate Water Supply Well and Leaching Facility (If any wells exist on site or within 206 feet of•leaching facility) -•.Feet '.%;Edge of Wetland and Leaching Facility(If any wetlands exist Feet within 300 feet of leading facility) • Furnished b ITT z Z� I R h D T :,, .!I •fir �+'.�i ' .:... .. �. o, V No. �'/ �� Fee t Ob g THE COMMONW&LTH OF MASSACHUSETTS Entered in computer: i PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLES MASSACHUSETTS Yes 2pplicatiou for �Digaar *pgtem Construction Permit Application for a Permit to Construct( )Repair( �rade( )Abandon( ) O Complete System ❑Individual Components Location Address or Lot No. 6 91 fAs p'd-&p Y. A1"-4& Owner's Name,Address and Tel.No. s v -y2 8' 0 VO /y/�rs�otis `y/cLS Mi .9 �UNi� 6,gGOIVP J� _ Assessor's Map/Parcel �� {�� f L V-pe P,0w pp-/� ;1 Zo r>r��5,� s ylee< .414 Installer's Name,Address,and T 1.No. Designer's Name Address and Tel.No. �14xW�5¢ /VVe QS�rviClP iyA. Type of Building: Dwelling No.of Bedrooms Lot Size 1d�sq.ft. Garbage Grinder(/Ljo Other Type of Building 4(10/) No. of Persons Showers( / ) Cafeteria(tib Other Fixtures 1/I Design Flow 3 gallons per day. Calculated daily flow 3 J���=3�o co Pb gallons. Plan Date Pr 17 Number of sheets 4-- Revision Date Title Size of Septic Tank/e S-ap Type of S.A.S. Description of Soil VAOY CQA$4 9,4'00Y CrAUv 6 Iwo SA'U4 ' 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 th' Board of Health. Signed Date Application Approved by Date /o-10-c/7 Application Disapproved for the UlowidY reasons Permit No. 7 - 5 y 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 has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. 9 7-6 7V dated Installer Designer The issuance of this permit shall not be construed as a guarantee that the system will unction as designed. Date 3 a - 7 :2 Inspector i No. / / -------------------------- � Fee lnc) T THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLES MASSACHUSETTS Migo0al *pztem Con5truction Permit Permission is hereby granted to Construct( Repair( )Upgrade( )Abandon( ) System located at —4;t ,9 {Ri „,._n_Q�c�v�,.. L v✓ ,� /�t 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 cmust be completedwithin three years of the date of this it. Date: / i`i / �J Approved b fd ANOW D�sl� DATA . IUI.L.� Fill.`{ 3 pE�¢Gt r E pL.A" oN BA44 44 4o aA9P3A4,Q �+ - LoT ��I V45 2j r A/1 'PAIL- Fww = 3 x Ito = JaC •SZrTG 'T'AN4L -zoo 64,0 U Gtl� a'PvG ISoD PrP6r � � CuL,T6G �+WZlb'iZ.330Cl�AiN�S�¢S'I'DUC vrST. �r SF — �3a GPD . 0 5F: Zri ZPPUG�.Tv�-I Q¢FA � pLaN VI =-1J _ L��•Ir� C44AM8Ee5 S11r,[---wQu- Ap�A= 3"1x�x2�Iq$sF t.rOM AZE44 s s 4-�F •OIL .�. . .�. . .r 'To'jAf' A� ! I p�ZGo�•A.TIo1J �� L.2Mlv�lt�u1 � 2 '/g•!IZ N Of c `' •o C 330� w�*5 �WA OO OF PETER - 2" 9MMAID SULLIVAN r Z A. NO.29733 y 1 vo X701 CIVIL 4M3 4F�� 9FGlg'1'c�`io Q Snuff err t"IOU C °l�•O glI SAaa [m Lrd41 CKAM R5 ru�c r t�, 9ro.� (Soo iIF -Pr.NEWF%Z> wF�l� tip - M�.Saab � 1 11—►�� �-(,J 1 BAN Nr, w�2 lvo;mSepr ' Pao» b-�ul� S�vtivN PLAW G�•flfY r►�T tflB �w A►1v �,,- �� ,�L SI� �F�N ctwcRyS vrlTu T .567 14- YEnuIzGmG9T OF l wr. 'multi of MAF IO2 PAP.CC--1- gp� �kTM�9CJ; A►� l 9 AdT' LUCATEU w I T 4I W BAkTl —. 4 14YM I NG SpG�J 4L FLzop HAZE ZON I�. t,AJJD StJQV�YQu • G�1G►�16� 9 •ig,cn zc�� oSTBZVILLG Ml�•fS• of:Fsers vv..0M WILZAW05 scpou NoT a�. QppUc4NT: J"q Vy� � t�'t�t5u�y PRGpEz-�'ty Lr►Jetf, _ �' f'IirT, �o�rf F31�c.AnFEdz OF . � � J''20•' Scpr' a9,14R7 ^� MAP' In2 PGL SS 4-1 oil i I � I i . / N 7U Z I 1 L zs � � I ; • Q N AetO 71 AA►N, ( I OF o r i 1 r tw OF � PETEAI� - " +W A. No�ia BAX M CIVIL No awe 1 L v TOWN OF BARNSTABLE t1 LOCATION`4�# rr 6d,. SEWS GE # 27® 5 � VILLAGE Agr 17,01 f ASSESSOR'S MAP& LOT INSTALLER'S NAME&PHONE NO. lto q SEPTIC TANK CAPACITY LEACHING FACILITY: (type) c111 teC s (size) NO.OF BEDROOMS 3 BUILDER OR OWNER PERMITDATE:/2-29- %-Z COMPLIANCE DATE: -7 7 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 f. o -1 3 g 'I'own of Barnstable I'#�� ----- Department of Health,Safety,and Environmental Services Public Health Division Hate _ `� `�� 367 Main Street,Ilyannis MA 02601 noes 1 0. Date Scheduled �t StWr i� 1q`�� Time ID r Fee Pd. ids Soil Suitability Assessment for Sewage Disposal Witnessed By: Performed By: LOCATION & GENERAL INFORMA ION �eVA Jo�W3a���i — Location Addr ss V,4 88Sz9 y f A. �-d`1' Andress R/1M2t—Wde. V" Assessor's Map parcel: Engineer's Name i3aX'TeV_ l�2 NEW CONSTRUCTION GC. REPAIR Telephone# l"q 1�� Land Use ����y�r Slopes(%) Surface Stones fi Distances from: Open Water Body R Possible Wet Area It Drinking Water Well ft Drainage Way —ft Property Line _ft Other �� ft SKETCH:(Street name,dimensions of lot,exact locations of test holes&pert tests,locate wetlands in proximity to holes) (Oq I nI 5-1 S Zi VA .+m i I Ifl los`7 Parent material(geologic) IXJTGI/L N Depth to Bedrock �•4 A� Depth to Groundwater. Standing Water in Hole: Weeping from Pit Face Estimated Seasonal I ligh Groundwater DETERMINATION FOR SEASONAL HIGH WATER TABLE Method Used: in. Depth to soil mottles: in. Depth Observed standing in obs.hole: in. Groundwater Adjustment ft. [?epth,to weeping from side of obs.hole: Ad' factor Adj.Groundwater Level Index Well#_ Reading Date:— Index Well level_ J• PERCOLATION TEST n;rit -%2 TIM �phfA Observation Time at 9" I Tole# Depth of Perc s Time at 6" Start Pre-soak Time n U�.1 q�X E9_� Time(9"-6") End Pre-soak Sa�/ Rate Min./inch �5��'►'!r G/-�,//"J __!! Site Suitability Assessment: Site Passed Site Failed: Additional Testing Needed(Y/N) Original: Public Health Division Observation Hole Data To Be Completed on Back--� Copy: Applicant DEEP OBSERVATION HOLE LOG Hole # d Depth from Soil I lorizon Soil Texture Soil Color Soil Other Surface(in.) (IISDA) (Munsell) Mottling (Structure.Stones,Boulderes. Consistency.%Gravel) a ri ,Q fa�J4 &I'o l D Q J17— 'O S/ O p 72" C spJJ CA'l.w. to e S,& o "'M4,sT Zq ..�MJ-0 7 DEEP OBSERVATION HOLE LOG Hole# 21 Depth from Soil Ilorizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulderes. Consistency.%Gravel) 0Q, 6Ai,1 16111-2 ,31V 0 0 Z du✓7 Zv < 2 r4 67 lalk- DEEP.OBSERVATION HOLE LOG Hole# Depth from Soil,Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulderes. Consistency.%Gravel) DEEP OBSERVATION HOLE LOG Hole# Depth Irom Soil I lorizon Soil'I'exture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulderes. % Flood Insurance Rate Map: j 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? 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 training,ex ertise and experience described in 310 CMR 15.017. Signature_ C� Date