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HomeMy WebLinkAbout0346 ROUTE 149 - Health ( 3-16-lko-ut-e-f4O-,-Mir-s-tc�n-s Mills 1� e TOWN OF BARNSTABLE fLE N y q� /i0`t7'� SEWAGE # / � ✓ /'lJS ASSESSOR'S MAP& LOT Zf-y 3-3 INSTALLER'S NAME&PHONE NO. ��� 77,)y3f� SEPTIC TANK CAPACITY /S'oa Ga L- / LEACHING FACILITY: (type),7-✓/C}ra/&,,I r (size) /1 se;9 X I NO.OF BEDROOMS BUILDER OKO; B- �G�'< - PERMIT DATE: Z I/Z 17 COMPLIANCE DATE: Z- 7 Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility S� Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) '9 Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) IL114 Feet Furnished by __ �3y6 6no�✓�� `�; �1 �. �- . ►S �, O ,b O poi - � - 1 e �� bo �, � _ 02 y3 9 0 4 No. � / 2 .. o F � _•4 Fee ` THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS 01pprication for Wgpo5a[ *p5tem Construction Permit Application for a Permit to Construct( )Repair )Upgrade( )Abandon( ) El Complete System El Individual Components Location Add Less or Lot No. Owner's N me, dress and Tel No. J 31/6 rs/9, 1��c �� � r6 Too Assessor's Map/Parcel Installer's Name,Address,and Tel.No. // Dei' ne 's Name,Address an�Tel.No. Type of Building: Dwelling No.of Bedrooms iJ Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No. of Persons ,L Showers( ) Cafeteria( ) Other Fixtures Design Flows gallons per day. Calculated daily flow 5�2• a gallons. Plan Date - q 7 Number of sheets Revision Date a Title Size of Septic Tank e of S.A.S. Description of Soil p' 1, 0— t-Oa4j 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 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issue t s Bo o th. lam/ SignedA 5; Date 47 Application Approved by Date /o , Application Disapproved for the following reasons E I! Permit No. 97- Date Issued - r: Na �' 7 J; ° .. Fee ( �.v THE COMMONW� EALTH OF<MASSACHUSETTS : rntered in computer: Yes PUBLIC-HEALTH DIVISION=TOWN OF BARNSTABLE., MASSACHUSETTS Application for Mfgogal *pgtem Congtruction, 30errnit Application for a Permit to Construct( )Repair Upgrade( )Abandon( ) ❑Complete System ^O.Individual Components Loc do Add ss or of No. ` Owner's N' e,A dress and Tel.N / p r�9 /�i ' fl P-SPA OO i ' � r� .� � � . Assessor's Map/Parcel s} Installer's Name,Address,and Tel.No. Desjgne;'s Name,Address an4 Tel.No. j Type of Building: s' Dwelling No.of Bedrooms Lot Size 914 300 sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons , Showers( ) Cafeteria( ) Other Fixtures _ Design Flow SAS U gallons per day. Calculated daily flow a gallons. Plan Date 9 — ?� - q 7 Number of sheets Revision Date Title Size of Septic Tank klwy qy, e of S.A.S. �i, `/ 7�� 7 Description.bf Soil 14 ' �' wy� �-O Nature of Repairs or Alterations(Answer when applicable) t t 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 issue "by t s BW, qff,—, th. t Signed Date l z,/ l C Application Approved by �'t�t l �' Date /0 � Application Disapproved for the following reasons Permit No 7" 9 Date Issued - /-0 '� 7 ------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS , Certificate of (Compliance THIS IS TO CERTIFY, that the On-site Se wa`e Disposal System Constructed ( )Repaired Upgraded( ) Abandoned(`� )b at 3 �o / f has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. T Y73 dated ! /U — 9 Installer + Designer The issuee,of this ermit shall not be construed as a guarantee that the'sy a will funcitw n as design Date `/' Inspector:X � i ------!/--------------------------------- No. / �' 7 Fee X/f y ,,. ., THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE: MASSACHUSETTS nigpogar *pgtem Congtruction Permit Permission is hereby granted to Construct( )Repair( ArUpgrade( �)Abandon( ) System located at y& 12,j y-e 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 ot�_limit.e 1 Date: � 2 417 Approved by f ' TOWN OF BARNSTABLE :�:L�OC ON 3 y� /PO�r� /�I SEWAGE # LAGS /1't'� �l/ IJS ASSESSOR'S MAP& LOT — 33 STALLER'S NAME&PHONE N0. A 771`�3Q� ;S1PTIC TANK CAPACITY ISOU Ga L a .eM c4 T r ..-� ACHING FACILrrY: (type)Z�✓�C/.w�r! /T_(size) 9�A -NO.'OF BEDROOMS cS` :.. . $:f DER OR �;AkMTTDATE: COMPLIANCE DATE 7T7 `5e6aradon Distance Between the: _ ...Maximum Adjusted Groundwater Table and Bottom of Leaching Facility S'� Feet #n...te Water Supply Well and Leaching Facility (If any wells exist >`>on site or within 200 feet of leaching facility) '9 Feet Edg .;of Wetland and Leaching Facility(If any wetlands exist .... within 300 feet of leaching facility) :; Feet :Furnished by i 1S , AT 10 SEW A G E PERMIT NO. VILLAGE I N S T LL, R'S NAME. ADDRESS IX1�4,61yt Mi(n"J, ". OR^ OWNER q DATE PERMIT ISSY E D DATE C 0 M P L I A N C E ISSUED ��� ��� r F� `� �, . �. ti 1 4 �a ,;� , �. , , �� No.............(��.... Fus........`.�................... THE COM//M��ONNWEALTH OF MASSACHUSETTS RDXW HE , Appliratiou for Uhipos al Works Tuatgtrurtiuu ramit Application is hereby made for a Permit to Construct ( ) or R it ) an I di idual Sewage Disposal System at* ........- - -: -:.. --•.-------•-----------......................................................... L!�n-�/A�ddress or Lot No. ....-------• - .. `� .!'a. •-------- ..................................-----.. •••-- - Ad �W •--- --- ='-=#•-----'--- :�1 =:.4c..--•---•-••...................... .4:.fi=F.-- - res___•------- ... Installer �- Address Type of Building Size Lot............................Sq. feet U Dwellingtko. of Bedrooms________________________________ _Expansion Attic ( ) Garbage Grinder ( ) Other—T e of Building No. of persons____________________________ Showers — Cafeteria Q' Other fixtures -------------------------------- - W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity------------gallons Length................ Width................ Diameter................ Dgth................ x Disposal Trench—No_____________________ Width.................... Total Length.................... Total leaching area......................Sq. ft. Seepage Pit No--____-- . -_-_-.__ Diameter____________________ Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by-------------•---••--•--•-----•--•---••------•-...------•---•----------_. Date........................................ Test Pit No. 1________________minutes per inch Depth of Test Pit.................... Depth to ground water_______--_____-_-____--. Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ ------- ----- -- -------•------•---••-•---•-••---� ......... Descri i . of Soil �n! 4 "' x -_-------- -� ............................................................. U Uw .............. 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 TITLE 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 he board of health. Sign - •-- ----•-•---1�'` T� -----------------•----_-- �•�....... Date Application Approved By. ------ Date Application Disapproved for the following reasons:•-•--•------•--------•-•-•-•-••-----•--------•-••-•-•---------•-----------------•---••--•------•------..._•----- --•-------------------•----••-•-••-•-•---•--•------••--•------...------.....••-••-•-•-.....--•--••-•---------•--...---•--------•---------.-.---...--------------------------------------------...._..-- Date PermitNo......................................................... Issued_....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS i BOARD OF HEALTH .............. ....OF............. ... ......................................... rr#ifirtttp of Toutpliatta THIS CE IFY, the Individual Sewage Disposal System constructed ( ) or Repaired (� by........... -� - -- ............ -- yn ler at .... -- - -••-- ....... _..... .......... �-----I -------------------------------------------- has been installed in accordance with the provisions of T 5 o The tate Sanitary Code as described in the application for Disposal.Works Construction Permit Note _ ��_.____ dated-.....t.d_`-1.T--n_ J�_ _________ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE T4T_ THE_ SYSTEM WILL FUNCTION SATISFACTORY. DATE................................................................................ Inspector.................................................................................... No.- •- --.. FEz........ .._............ _ THE COMMONWEALTH OF MASSACHUSETTS BOARD HE �!'�'�.....-----.OF........:. - --- - -------- -• ....... ..................__.. ApplirFation for Disposal Works Tontrnrtion runfit Application is hereby made for a Permit to Construct ( ) or R air )A ua Sewage Disposall System at; 2)pr -� A;g�� � awwow w ...... . r, Loc n-Address or Lot No. ... .. ... ....... ....................................-•-- o Addres .... a ................................... Installer Address Type of Building Size Lot............................Sq. feet Dwellings. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) 04 Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) Q' Other fixtures ---------------------------------------------- W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity............gallons Length................ Width................ Diameter................ Depth................ x Disposal Trench—No. .................... Width.................... Total Length..................... Total leaching area....................sq. ft. Seepage Pit No---_-_------------- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ). Percolation Test Results Performed by•-----•----------------•-........---•----•-----••-•••------••-•........ Date........................................ 4 Test Pit No. 1:...............minutes per inch Depth of Test Pit.................... Depth to ground water........................ Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ r _... .. "', '� .D Descri in of Soil V11--4 - -----•- UNature 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 TIT12 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 he board qf health. p - Sign +�< Date Application Approved By - (`" ....:...:. .y... --•------------------------ --------- Date Application Disapproved for the following reasons---------- -----------------------•------------•-------•-....................................................... ......................•----------•-•-•---------------•-------•---••------....----............----------•.......--------•--------------------------•------------......------......-" ----•--•---_•. Date PermitNo--------------------------------------------------------- Issued-.... .............................................. Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..:..O F............. ........................................ s ntifiratr of TontpliFanrr THI C IFY a the Individual Sewage Disposal System constructed ( ) or Repaired by. IIn ler ...............I---------------- k--------------------------------------- has been installed in accordance.with the provisions of T 5 The State Sanitary Code as described in the application for Disposal<.W;orks Construction Permit No : _ dated___.. ."'_ �' .............. &- THE-ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE T AT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE................................................................................ Inspector.................................................................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD HEALTH 7 ,g No.............. ......... FEE......... ........... 19ioroottl r trnrtion rrnttt Permission is herebyrante ---- -- �--• •.... . '""[....... to Construct ( or epai ( n In ldual Sew ss Sys , I N tr `� / as shown on the application for Disposal Works Construction Pe No._ . ated../G!'L ......... Board of Health DATE....../ /. ..}....... .......................... FORM 1255 HOBBS & WARREN, INC., PUBLISHERS - Town of Barillstable I�u Department of Health,Safety,.and Environmental Services Public Health Division Date Sl, 367 Main Street,I lyannis MA 02601 f a BARMABta, _ 1NABB. 1619 �� tn�utt& Date Scheduled September 2, 1997 Time 10:.00 AM Fee Pd. $100.00 Soil Suitability Assessment fog• Sewage Disposal ___Performed By: Witnessed By:. LOCATION & GENERAL INFORMATION Location Address 346 Route 149 (Cotuit Rd.) Owner's Name Michael O'Toole Marstons Mills Address P.O. Box 1068 MArstons Mills, 02648 f Assessor'sMap/Parcel: 7.9/33 Engineer's Name Sweet ser Engineering F t NEW CONSTRUCTION REPAIR X Telephone N (508)398-3922 Land Use Slopes(%) Surface Stones t Distances from: Open Water Body R Possible Wet Area It Drinking Water Well fl Drainage Way R Property Line n Other R 1� SKETCH:*&Ucet name,dimensions of lot;exact locations of lest holes&perc tests,locate wetlands in proximity to holes) t o " m r 0 L\ 1 ` K 1-ocvs 3a' w19y Parent material(geologic) Depth to Bedrock Depth to Groundwater: Standing Water in I lole: Weeping from Pit Face Estimated Seasonal I ligh Groundwater DETEIIMINATIONkF'OR'SLASONA.IIYGH.WATER TA13LE s Method Used: Depth Observed standing in obs.hole: in. Depth to soil mottles: Depth to weeping from side of obs.hole: in. Groundwater Adjustment _ _ll. Index Well N Reading Date: Index Well level Adj.factor Adj.Groundwater bevel i PERCOLATION TEST Date —`rime a g7 Observation / Z_ Hole N 1 / Time at 9" Depth of Pcrc r b Time at 6" Start Pre-soak Time Q V Time(9"-G') 1 End Pre-soak i Rate Min./Inch G Z z Site Suitability Assessment: Site Passed Site Failcd: Additional Testing Ncedcd(YIN) Original: Public Ilcellh Division,d, Observation Hole Data To He Compleled on Back j Copy: Applicant DEEP.OBSERVATION HOLE LOG IWe# Depth from Soil Ilorizon Soil'Texture Soil Color Coil Olhcr Surface(in.) (USDA) (Munscll) Mottling (Structure,Stones.Ilouldcres. r Consistency,",'o Qt2,v o-IS S to 3,57-(ZU (0 yx yL DEEI';�OBSERVATION IIOLE LOG.;: ' I I01c # Depth front-- Soil Ilorizon Soil'I'exture Soil Color Soil Other Surface(in.) (USDA) (Munscll) Mottling (Structure,Slopes,nouldeies. y C�isislcncy.",osirayL 47-7 17 DEEP,OBSERVATIONIIOLE'LOG ­ Hole# Depth from Soil Ilorizon Soil'1'cxlure Soil Color Soil Other Surface(in.) (USDA) (Munscll) Mottling (Structure,Stones,noulderes. Coitei rav DEEP OBSERVATION HOLE LOG I-Irile# Depth front Soil I lorizon Soil'Texture Soil Color Soil 0111cr Surface(in.) (USDA) (Munsell) Molding (Structure,Stones,Itoulderes. Coils islcncy_�o-(era el) Flood Insurance Rate Maw. Above 500 year flood boundary No Yes Wilhin 500 year boundary No Yes :Vilhin 1100 year rood 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��u>a�l 'sis was perFormed by n1e consistent tvillt the required Uaining. �!-�ertiand expe fence desc ibed,rh 3 =tYCMR 15.017. Signature_ Date Z__/17 - __­..._----z7,l�­­­ q---�V. 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