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HomeMy WebLinkAbout0033 ROSS LANE - Health (2) E 3 ROSS LANE, LOT 18, M.MILLS =123-036 'I J N OF�?e ivSiAfiLE i��Y�'► f���1 v 1LOCA17,0 r 042t' �? SEWAGE#r- v`ILLAGEyQ �'I�/�S ASSESSOR'S MAP& LOi. ' INSTALLER'S NAME&PHONE NO. f y 5ya SEPTIC TANK CAPACITY 14,'k/ LEACHING FACILITY: (type) T'k'H Ile (size) NO.OF BEDROOMS y � BUILDER OR OWNER ho P"s r _ PERMITDATE: I 4 f z -I COMPLIANCE•DATE: Separation Distance Between the: ` Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply Welland Leaching Facility (If any wells exist on site or within 200tfeet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet E Furnished by R. r 6 6 s a® ---� 16; /� lq 19 IVfiv i LJ ` WN OF BARNSTABLEllYnt �� g7't69`t . LOCATION, ''�/R 3 3, l'.aSS If}+� SEWAGE# YILLAGE,,Z*4� ASSESSOR'S MAP 8t LOT INSTALLER'S NAME dt PHONE NO.���/5 y �S 19 ZA SEPTIC TANK CAPACITY 4Sb4`AA LEACHING FACILITY: (type)��X b I liVy��its (size) :5?0 If A'/ WOF BEDROOMS BUILDER OR OWNERy411L ttit�LS i PERMTTDATE: I i z • COMPLIANCE,DATE: Sepaiation Distance Between the. k ` Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet 4' Pnvate Water Supply W 11 and Leactung Facility (If;any:wells east , on site or within 200 feet of leaching facility) ' ` Feet Edge of Wetland and Leaching`FaciLty(If any wetlands exist ' 3 within 300 feet of leaching facility) Feet ' , . Furnished by 1.4 I AN � � R i ky �„ ML d Ja s Q QZ s g dg' C, �`g POPNO ° e No. 71, Fee 1 t5 CE) / g THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes UBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS 0[pprication for Migoml *p.5tem Construction Permit Application for a Permit to Construct(X Repair( )Upgrade( )Abandon( ) 11 Complete System ❑Individual Components Location Address or Lot No. 13 V$S L u✓I a v'r 1F Owner's Name,Address and Tel.No. /7 79 2'o'Z Maws,roos d' ;11s/ mcq, Tear if--ev- ;;t4(cfcd Assessor's Map/Parcel F25 34 Lz)T tk P.©, 6©y- 122-q IfYoth wkA.v / Installer's Name,Address,and Tel.No. . D3 5Lf0 3 3 Designer's Name,Address and Tel.No. 3 q5 q/ `15'7 Pal�nnor �✓i� t�ztl�ou7h, 1►'►a, o2Syo �13�i' �tic� `�i<ee�� ygr���h �.y��� Type of Building: Dwelling No.of Bedrooms Lot Size 2'° ;2qp sq. ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures p Design Flow e`. gallons per day. Calculated daily flow ?3® gallons. Plan Date l 2//I,q7 Number of sheets 1 Revision Date Title SrT(t_ f- 15ewct 4,�t_ Pl*elio ©P Lor-18 OSS Lcey?e yy►a, S; M 5; N1111S !A jq Size of Septic Tank 1ECd eaa Type of S.A.S. Description of Soil S'ee% tlotv-? r®j- L©�r- Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: - The undersigned agrees nsure the construction a d maintenance of the afore described on-site sewage disposal system in accordance with the p isions of Title 5 of the nviro mental Code and not to place the system in operation until a Certifi- cate of Compliance h been i e. s owife th. gned Date fJ "`Z'40 Application Approved Date Z—3 " Application Disapproved for the followingIasons Permit No. Date Issued �+1.^r,.....r.�•...r"y��... .-ti-< .. Y -r.+�ti.. .. .., .. ..,... �.. . ,� � � •. ar v.. � y� -..'s .,i ` S"'..�<-1a. Q �7 7 " No. / ! - /Q L- 3. Fee rS t^3 -v v - i THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: . - 4 Yes '�r PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLES MASSACHUSETTS 1., application for Mioplool *pgtem ctContruction Permit Application fora Permit to Construct( Repair( )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. �S`� G✓� 2 pY�� Owner's Name,Address and Tel.No. rl 78 —?9 pGl IurS7ov�. W►;J1S� 1Mct. 3P0r)11'Pvlgcci Assessor's Map/Parcel Installer's Name,Address,and Tel.No. D o$ 5 qo- 'cj 3 3 Designer's Name,Address and Tel.No. `j L yr Ciro prV'e I�Owh ✓� r✓Dp�✓7`r� '15'7 Pai,,no✓ / ✓�� Fi�lrc�ou7h, 1►^�t, 025� �/3� i'hai✓� `7Tree Yccrrvto19 MC4_ Type of Building: SIr?�l c Fu w„t PSi e✓�c-C n Dwelling No.of Bedrooms Lot Size �'°t l�y sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow 3 �,cvjrj gallons per day. Calculated daily flow 3 3o gallons. PI 1 N Plan Date 2 / H 7 Number of sheets Revision Date Title Sire dew*-,e_ P.Im✓1 op LoT �8 �3 1�osS «�,Q wlueSl��s rMrilrj f_ j Size of Septic Tank 1 S 0! 0A Type of S.A.S. J4 r2 Description of Soil See_ ll G✓7 f Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: __ Ill The undersigned agrees ns'_construction a d maintenance of the afore described on-site sewage disposal system 1{ Ceisions m accordance with th of Title 5 of the nviro mental Code and not to place the system in operation until a Certifi- 1 cate of Compliance h a b, s o f He the DateApplication Approve Date Application Disapproved for the following easons 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(x) Repaired( )Upgraded Abandoned )by 3Of Se-ei yr,+ at3Ic IVJr�� > ;// `o7 has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. i dated I Installer Designer The issuance of this permit shall not be construed as a guarantee that the system will function as designed. Date Inspector No. / / Fee 0 THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLES MASSACHUSETTS Mi!9paal *pstem Con$truction Permit Permission is hereby granted to Construct(X)Repair( )Upgrade( . )Abandon( ) I System located at 605-" t r4/-)P_ pna r oo/7 y Mi 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 ofthe date of this permit. Date: Approved by 1 Town of Barnstable P# S L/ Ll Department of Health,Safety,and Environmental Services Public Health Division Date 367 Main Street,Hyannis MA 02601 BARMABMKAM • Date Scheduled ( Ct -7 Time 0 Fee Pd. l� 'Soil Suitability Assessment for Sewage Disposal j It Performed By: BAN C JA 1,A , SE Witnessed By: Tex-r'I 2)yN N W6-' LOCATE N & GENE �il�`0 MA'IC'IUN;; Location Address li�T 3 K� L al! Owner's Name u A MIL,-Q ?n , i'h (C—A',T 09�Ft "V'- M)D r P Address 'pbi3 122`j �}y�NNIS� MA , L.oT -►8 75 22r-7 n6:7_77 Assessor's Map/Parcel: 23� Engineer's Name NEW CONSTRUCTION REPAIR Telephone# 3!v 2 LA54 Land Use y�C—/1'N')' Slopes(%) `0 Surface Stones Distances from: Open Water Body i ft Possible Wet Area ft Drinking Water Well ft Drainage Way ft Property Line f ft Other SKETCH:(Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands in proximity to holes) e. I� a o 0 � oV\ \� s- 1, M s , 7/11 -7Ur •�� J Y 1 5 y;�. fr Parent material(geologic) Depth to Bedrock Depth to Groundwater: Standing Water in Hole: p w Weeping from Pit Face Estimated Seasonal High Groundwater �/I /"y � � � 'FbV IV,-P NA'PYCII t IF k SEA USA .HIGH'VVATEti T 1Bl�E .. . 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 Adj.factor Adj.Groundwater Level . PERC(�LATIO TEST DatA .. Trme Observation Hole# Time at 9" tl Depth of Perc 9 0 Time at 6" Start Pre-soak Time @ 2 Lk Time(9"-6") End Pre-soak Rate Min./Inch G2 ,V, VN 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 a D EI' O13SEI�VATION IIOI,E EOG ... .# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(m.) (USDA) (Munsell) Mottling Structure,Stones,Boulderes. % �- & /A, -2g 13 LS )o Yam-vs? ��lG G 1 M'.a/c��►5� 6/y oo 2 2 GZ- N+A,. 4,4PJb 2.5 Y7/3 »> DEEP OBSERVATION HOES L;OG Holy# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(m.) (USDA) (Munsell) Mottling Structure,Stones,Boulderes. % 41 G 1 DEEP OSEIATION I IOLE IOCot+e# . Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling Structure,Stones,Boulderes. % . DEEP OSERVATIOI'�1 HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(m J (USDA) (Munsell) Mottling (Structure,Stones,Boulderes. % DEED OBSERVATION flCl► . I�OG IInI� Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulderes. % 1 n 6 A-- . ... ...... 7, 4 2 c, % X,� 'OF ORADE t: EPTIG PROEI.L�& tL ,' 9 �'6 Aj" (NOT TO Z �; ACCESS -ENGIN �CbVR JO ,W"IN T, hN TlElftfM TO b� 4Z �1%1 SLOPE�REWRM OVER SYS� WITNt55- Y�OF OVER PRECAST -r"v OWE 7777 DATE: RUN �PWE IXVEL f DOUBLE WASHED PEASTONE 17R. FIRST 2* V -:RATE ERC. _P" 3' MAX. GALL014`.:SEPPC P4 -S S SOIL TANK ju, cl ov OR, MECft�NJCAL "X,7' 0 0_0 CO#APA"ON !,(15.221 [2]) $7, �CRUSHEO STONE ELEV. ELE�.- 06 6� Fo� w� SLOPE) � SLOPE) NE 'TEE -SIZES: % 3/47, :,TO A 1/f D STO: ot� ­.t, i_ q IN�`DEPTH Ll�� NA 0ON P 6uttT,OEP, PARCEL-� LEACHING -.:MAP FOUNDATION SEPTIC TANK, ASS SORS, w D' ,BOX FACIL17Y A 9- �OMNG ,:disttzict y -SETBACKS: .. ARD' < FRONT E SID -XI Y 4�. 77 TO R 01 7 j,& :tj 0 j, ? XT 4 A4. 0 r t NOTFS: A. io� OARSAGE T`IC DESIGN. 7 4, SEP �v INSPOSER !S___ e% GPa 4;� U., CIPAL-WATER -IS DESIGW-rujw:� BEDROOMS-,: `MINIM M IPE`l'PITC R_f OT '14 `T6:;8E,._l. :,fr t"'PE t 'USE "A -SIGN�'PLQW �'U P f GPD bE a 'ALL�tPRS WA �j _;'j6jNTS'__,r to't�atl'MADE TAN GPD Cc UNITS -to_ BE- 4.' ST SEPTIC DES GN'10ADING,,�OR 1: t I 5> K L f E ITO BE 04 E �'Wl NSTRUC ION, t ACt,h 6 CO T RD C I G I C TANK�.:: .6 t2 �Us A ALLON SEPT g� E1717LE,-,�V-,;,", VAL COD LF EWRONME -ACHING NLY�,-`AN 11 N( ­10 ED WORK, )R, PIR60ht `­ w + EM Sc 4A SIDES. ': �WOR LOT,'LIN P '80 TTOM. USED E,.,..sTAkING 9 Q M N b4 Lo� GPD PO TOTAL-, *lf;*9 S.F.- v 0 SPECTION RY A ��,O e '90 R F HEALTH-AND �PERM SSION', 0 :IN �013TAJNED' FROM,,BOARD: OF 10 C NTRAC HIA "VERf NG` O'_ E ERGROJUND,,. OVERH AD'llj Tl Ll Ti ,OCATI, L bk,�vr"EALL UNI) 0 COMMENCEMENT OF-'WOW.,� T 4, oil WA 'PLAN EGEND L AND !,,z -,' 7E 07. 4� A, -1 PROPOSED,SPOT ELEVATION 100.'0 V, N, 100*0 .. .... -EXISTING. 'SPOT"E LEVATION CONTOUR PRO jj 0 j Aj� EX I S"T :P E,PARED 100 ING--tONTOUR .�.' FO C� �wk BOARD Or: 5, % A ALE. 1,j, 24 �7' APPROVED DATE Z 30 c J111W u W" C�lp nglpeenngl, A, 4, 3� -Z `-k!4 :]qE GI El V VM ic 7 T N L Si. i a 11 v j -DA7 y� 4, nz,