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HomeMy WebLinkAbout0075 STONEY POND CIRCLE - Health 75 STONEY POND CIRCLE, A= 065 025 a f-S TO r)s `� L L s i No. /' Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes 4plitation for Wapo8al *pBtem Construction Permit Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location.Addkdss SSor Lot No.L17n,Q �` wner's Name,Address�d Tel.No. A�s�ssa9 arcel Insta/ller's Name,Address,and Tel.Nab 36% Designer's Name,Address,and Tel.No. Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) IV Jr, gpd Design flow provided gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank ` Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) �K 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 to plac the system in operation until a Certificate of Compliance has been issued by this Board of Health. Signed Date Application Approved by Date --To �J Application Disapproved by Date for the following reasons Permit No. ? Date Issued 6 ( 0 � �, No. Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes application for Disposal 6pstem Construction Permit Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Lo��ot ddr� ,so r Lot No. C 4,V/� �nQ ���rj ?Owner's Name,Address,and Tel.No. Assesso s Map/Parcel �✓Q� S Q @/ 4 A' Installer's Name,Address,and Tel.NoOM& -? %ip r9''7 Designer's Name,Address,and Tel.No. Type of Building: Dwelling No.of Bedro ms Lot Size sq.ft. Garbage Grinder Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures k Design Flow(min.required) gpd Design flow provided AV tr gpd ' Plan Date ° Number of sheets Revision Date Title ` Size of Septic Tank C7 ti Type of S.A.S. Description of Soil t ,, ef Nature of Repairs or Alterations(Answer when applicable) Date last inspected: f- Agreement: �f 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 eb to place the sys min operation until a Certificate of Compliance has been issued by this Board of Health. / C Signed Date Application Approved by Date (C) Application Disapproved by Date for the following reasons Permit No. �U Date Issued 6 "( 0 THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS �l Certificate of Compliance THIS IS TO CE\I that the On-site S wage Disposal system/Constructed i ) Repaired( Upgraded( ) Abandoned( )by � t Lt_a � at / 5 `�- �� t� /� has been constructed in accordance / with the provisions of Title 5 and t for isposal System Construction Permit No.a 0�U—17 dated (7 _ 1 0 — Installer /C G t/ V 41: n-J Designer J = #bedrooms Approved design flown gpd The issuance of this p rmit shall not be construed as a guarantee that the system will wic/'O�as desi ed. Date d Inspector ---------------------------------------- --------------- No.gu Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS l� Disposal 6pBtem Construction Permit Permitss o s hereby i iiJ e eby granted to Construct( ) Repair(p•� Upgrade( ) Abandon( ) System located at 7 1 S4_ > (' Pam, L t yC l e 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 must be completed within three ears of the date of this permit. �7 P� ' Y — rC/ Date r — Approved b f-� PP Y 7 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM Address of property DS Owner' s name `A1g4 3 WP-Aw) Date of Inspection I \ PART A CHECKLIST Check if the following have been done: !/ .Pumping information was requested of the owner, - occupant, and Board of /Health. ✓ None of the system components have been pumped for at least two weeks and the system has been receiving normal flow rates during that period. Large volumes of water have not been introduced into the • system recently or as part of this inspection. ' As built plans have been obtained and examined. Note if they are not available with N/A. V/ The facility or dwelling was inspected for signs of sewage back-up. �The site was inspected for signs of breakout. i/ All system components, excluding the SAS, have been ` located on the site. _ The septic tank manholes were uncovered, opened, and the interior of the septic tank was inspected for condition of baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge, depth of scum. The size and location of the SAS on the site has been determined based / on existing information or approximated by non-intrusive methods. ✓ The facility owner (and occupants, if different from .owner) were provided with information on the proper maintenance of SSDS . Cb UN 8 1v S - 8 . SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B SYSTEM INFORMATION FLOW CONDITIONS A If residential number of bedrooms number of current residents garbage grinder, yes or laundry connected to system, YE,)or no season al` u se .yes or If nonresidential; calculated flow: Water meter readings, • if available: A .Last -da to of Oc cupancy' . anc Y GENERAL INFORMATION Pumping records and• source of information: System pumped as part of inspection es if yes u ed P , or no son f or. pumpin Type, system ✓ Septic tank/distribution box/soil absorption system Single cesspool Y Overflow cesspool Privy Shared system (yes 'or no) (if yes, attach previous inspection records, if any) ` Other (explain) Approximate age of all components. Date installed, if ,known. `S.ource -of information: Sewage odors detected when arriving at the site, yes orano 9 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION. FORM PART B SYSTEM INFORMATION continued SEPTIC TANK: (locate on site plan) Pr depth below grade: .� material of construction: V concrete metal FRP - other(explain) dimensions: 1� �a sludge depth distance from top of sludge to bottom of outlet tee or baffle- scum thickness ® distance from top, of scum to top of outlet tee or baffle , distance from bottom of scum to bottom of outlet tee or baffle Comments: (recommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation' to outlet invert, structural integrity, evidence of leakage, recommendations for repairs, etc. ) DISTRIBUTION BOX: e (locate on site plan) IJ depth. of liquid level above outlet invert Comments: (note if level and distribution is equal, evidence of solids carryover,' evidence of leakageinto or out of box, recommendation for repairs, etc. ) PUMP CHAMBER: (locate on site plan) k. - s Pum p in working order,r yes or no Comments: (note condition of pump chamber, 'condition of pumps and appurtenances, ,' recommendations for maintenance or repairs,etc. ) F 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B SYSTEM INFORMATION continued SOIL ABSORPTION SYSTEM (SAS) : _z (locate on site plan, if possible; excavation not required, but may be approximated by non-intrusive methods) If not determined to be present, explain: Type. leaching pits and number leaching chambers and number leaching galleries and number leaching trenches, number, length leaching fields, number, dimensions overflow cesspool , number Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, recommendations for maintenance or repairs,etc. ) CESSPOOLS (locate on site plan) : number and configuration depth-top of liquid to inlet invert depth of solids layer depth of scum layer dimensions of cesspool materials. of construction indication of groundwater inflow (cesspool must be pumped as part of inspection) Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, recommendations for maintenance or repairs,etc. ) PRIVY: . (locate on site plan) materials " of construction dimensions depth of solids Comments: (note. condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, recommendations for maintenance or repairs, etc. ) 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B SYSTEM INFORMATION continued SKETCH OF SEWAGE 11SPOSAL SYSTEM: include ties to at least two permanent references landmarks or benchmarks locate all wells within 100 ' a o Nib DEPTH TO GROUNDWATER depth to groundwater method of determination or a proximation: 12 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C FAILURE CRITERIA Indicate yes, no, or not determined (Y, N, or ND) . Describe basis of det rmination in all instances. If "not determined" , explain why not) Backup of sewage into facility? VD Discharge or ponding of effluent to the surface of the ground or surface waters? Static liquid level in the distribution box above outlet invert? -- Liquid depth in cesspool <6" below invert or available volume< 1/2 day flow? _V Required pumping 4 times or more in the last year? number of times pumped Septic tank is metal? cracked? structurally unsound? substantial infiltration? substantial exfiltration? tank failure imminent? Is any portion of the SAS, cesspool or privy: _ below the high groundwater elevation? within .50 feet of a surface water? within 100 feet of a surface water supply or tributary to a surface water supply? within a Zone I of a public well? I within 50 feet of a bordering vegetated wetland or salt marsh (cesspools and privies only, not the SAS) ? within 50 feet of a private water ter supply well. A— less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis? If the well has been analyzed to be acceptable, attach copy of well water analysis for coliform bacteria, volatile organic compounds, ammonia nitrogen and nitrate nitrogen. r ICKEY s SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM CERTIFICATION Name of Inspector : Donald Perkins Company Name: Hickey Construction Company, Inc. Company Address ; 38 Rosary Lane, Hyannis, MA 026O1 tel : (508) 771-4128 Property address: T)S SCi't�1�4 j C? t-eL- t c_r_t_i.if i.c st.Lon S IC,a t_e m e n.t.: I certify that I have personally inspected the sewage disposal system at this address and that the information reported is true, .;:accurate and complete as of the time of inspection. The inspection was performed and any recommendations regarding upgrade, maintenance, and repair are consistent with my training and experience in the proper function and maintenance of on-site sewage disposal systems. Check e : I have not found any information which indicates that the system 'Fails to adequately protect public health or the environment as defined in 310 CMR 15. 303. Any failure criteria not evaluated are stated in the FAILURE CRITERIA section of this form. I have determined that the system fails as defined in 310 CMR 15. 3C3. The basis for this determination is provided in the FAILURE CRITERIA section of this 'form. Inspector' s signature: Date: � °tom Original t system owner: Copies t icable) approving authority 38 Rosary Lane Hyannis, MA 02601 508-771 -4128 7j" TOWN OF BARNSTABLE LOCATION__ ,6T—n IST—b-, Tby SEWAGE ;,%_ VILLAGE ASSESSOR, I�iAI' � LOT v -- INSTAI..LER'S NAME & PHONE NO. tt `��t� Cp�as�- - ,7 t SEPTIC TANK CAPACITY LEACHING FACILITY:(type) 1�b `i (size) NO. OF BEDROOMS�`3>�PRIVATE WELL � 1'U13�L1C�TE BUILDER OR OWNER DATE PERMIT ISSUED: 1 a g DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No �� 1 1 boo No THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH ------..7170jwR1.................OF........[/3r,:�1tr�71td31.ts Appliration for Disposal Works Tonstrurtiun jJrrmit Application is hereby made for a Permit to Construct ( x) or Repair ( ) an Individual Sewage Disposal System at: .... ..•. ..... ........ ..... ..... - _ _ ...7--•-•••-•-•-• • ••-•..................•-••-------••---•-- Location_Address or Lot No. .__......d�c:�� ....d ss e.0 --..M A zi ............................ .......�f�r��.---- czns.._._C_'tr�1c ..... caner Address Installer Address d Type of Building Size Lot._ ______Sq. feet V Dwelling—No. of Bedrooms_._.._...' !f cc______________________Expansion Attic (/d�ia) Garbage Grinder aOther—Type of Building ____________________________ No. of persons............................ Showers ( ) — Cafeteria ( ) dOther fixtures ------------------------•--------------------•--•--------------------------------------...-------------------•-------------•----••••••-•--•••--•••---- W Design Flow____________________________-__..._: gallons per person per day. Total daily flow... .............-gallons. WSeptic Tank—Liquid capacity/�i.gallons Length.l��`_ >.`_ �tiidth__5°=sue`.'_ Diameter_______________ Depth��e_l.... x Disposal Trench—No_____________________ Width........_........... Total Length.................... Total leaching area--------------------sq. ft. Seepage Pit No...v-�-------- Diameter.....12,....... Depth below inlet.....6............ Total leaching area....P_'v__2___sq. ft. Z Other Distribution box (,-, ) Dosing tank ( ) aPercolation Test Results Performed ...................................... Date... :7.............. Test Pit No. 1....,z_......minutes per inch Depth of Test Pit....IA-4._..... Depth to ground wate f14 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground w 5wOF��4 •-••---•--•-•-------.•......._••-----_-•--- •-----•-•-•--•---••••-•--•-•- -•-•-••-•-- ay' Description of Soil. ' -T� a c3�- ��.. _ n__L!± u--S�a�Q_f_.C: c_x.Q STEP HEN �� m ` ..c L W �•-----Vdit SOPf------ h ►� -••---••-- a 30216�r U Nature of Repairs or Alterations—Answer when applicable_____________________________________________________________ •--- ---••---------•••---•--------------•------•• -...••--•=••-.._...•-•--•--•--•--••----••-•---------••--•--••-••--•-••...-•-•-•-•-•--•-- r Agreement The undersigned agrees to install the aforedescribed Individual Sewage Disposal System i ccor ante with the provisions of:TT .: p 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been d by thqpoard of health. ned.• 4 D Application Approved By -•-- ------------`- ---- ...... Date Application Disapproved for the following reasons-----------------•-•-------••--------•---------------------•---•-------------------•-•••----••--••---••----..._._ --•---•----•-----------------••--•-•-•--••---•-•-----------------•---••--•------------........_------•----•---•--•--•-...•-••---••-•••--------•--••--.._--•-•----•--------...•------•-•._..-----••-••--- Date Permit No._ __ii �; ......... Issued_______________________________________________________ Date No:;6 �* e i i � L _--_7 No. •........ l FER............................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TCJta>N................OF......... ,071,eNST/�4LL? Appliration for llhip a al Workii Tomitrurtinn Permit Application is hereby made for a Permit to Construct or Repair ( ) an Individual Sewage Disposal System at: .GOT 7 - Location--Address or Lot No. clzl�c f21 Trust .S/rn�c �c� Ciro% Owner �y..� Addre ........................................... m Installer Address Size Lot.-- 7" Type of Building o 6' ----- 48-3 Sq. feet -------------------- Dwelling—No. of Bedrooms.......... ...!.r«......•..............Expansion Attic Garbage Grinder ( Vj� p, Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) �t Other fixtures ------------------------•----------------------------.......---••-••-••-.-------.................................................................... W Design Flow.....................................Ssgallons per person per day. Total da�ly flow............._.._ ....'.�' .............gallons. WSeptic Tank—Liquid capacity_��gallons Length..� .L6.__ Width__S._S_4Diameter__---__•" Depth-;F.� Ix Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No.--_ate-------- Diameter.....1z........ Depth below inlet...... Total leaching area.....Z..Z-2..sq. ft. Z Other Distribution box (,C) Dosing tank ( ) Percolation Test Results Performed by.._r:�`x�.. .....N ___________________ /U /—S a --- --•-••_. Date.•. 7•-•---•----- ,� Test Pit No. I.....!?�......minutes per inch Depth of Test Pit._-__��..._.. Depth to ground water_._. -" '--_. f= Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground w ��,Of ags-•••••;•-•------------------••••••-•-••--•-•-•--•--•-•--••-•....i..-------••••......----•--- ` - --------MU, 40 Description of Soil..... S--------.. . ----..'�•• •--•--•--. �V A-L.f_N------- t; W n WIL Sore �1� ----------------------------------------------------------------------------------------------------------------------------------------------------- •..................Mr.- - �''� ►�+ No.302�6 f. V Nature of Repairs or Alterations—Answer when applicable________________________________________-------------------- � 'I,.---------- AGO Agreement: ON The undersigned agrees to install the aforedescribed Individual Sewage Disposal Sys t i ccor a ce with T T the provisions of iI:� 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been ss by t and of health. -_.-,_ r �!. .. / Date Application Approved By.... `-=�P`.�....................... r� ;.�-.__...•--.. W Application Disapproved for the following reasons-...............................................................---------------------------------•••----------- ..--•----------------------------------------------------•-----•---•-------------•---------•---------------•--•-•--•---•-••......--•----------------•-••••-----•--•-•-••-•--•----••----••-•••-....•----- Date Permit 4 Issued ....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH l 1 Z-')'Jj,J �c ..........................................OF.... ..:-. : ... .C:....._................ Tntifiratr of Toutph anrr f THIis TCERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) 1 by------------- - -• . . •--•-••-•---••--••-••-•-............--•---......•--••-----•-------•-•-••--•-••••.....---•-•--•---•---•-•-•-•-........-••-------.....----•-......•--------•-•-- C-11 I -- Installer ,1 i has been installed in accordance with tie provisions of TITIE 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No.__�. ------ Ill........ dated..... -. . �_/l//_ _;_�- ------------- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GBJAR�NtEE'TRAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE........................... ... ............... ..-.. .^ .�... Inspector ---......_..------......•-••••.....-•••---- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH t .......... ....t. W. ............oF.----- c v9L _ ......_......._... N _. .. ........... FEE...................••••• `�/al 'Vorko Tnns#rnr�tion rrmit tY Permission is hereby gran .F.+� •------•-----------------------------------------------------------------•-•-------••--------.................... to Construct ( ) or Repair (. ) an Indiv• ual Sewage Disposal System _ tr ...r J ' Street as shown on the application for Disposal ,o Construction Permit-No..--.:. Dated. 1 ( 6 ' r ............................ ���� t -Ql DATE............................. .................................... FORM 1255 HOBBS & WARREN, INC., PUBLISHERS 1 S%tt%c Faw►tly 3 B4Siropms -- -- rsper�• any/user ssv,(;o7�iiiis%4�t. �n/ilf/" Garbo�c Grinat;r — -- .—.- DAILv., rLOW 110 x 3 = 33© Gpd S�s�rtc TANK 330 x zopy = Goo G;Olons U94• ISO© 'Golion SeP'i=►c Tani6 t;•,. DIsc R.l_ PIT- 'L U, se. logo gatiu,-, p;t u,,f 3 �� o f crushe�Q sinnc CPcPac�T`l 2Z6 x 2.5 = S�o$'6;PcQ �cs-rrom 113' S1= CAPAc�TY 1I �.K 1.O . 1 13 GPcP TOT•q L .,5 P CPA 3 3r,• S� 678 G�� o A. r TER p"R,p No.240 Cl 48 11 'PFCISYEK� �'A�� u, G�all ve z�a.s F'G =.Ps-r,o . . . . �'G,� S9,o ,•i;, T�a,`s'.o,= �oeo w� °.a ( f<.. O/Sr �.52'slEa Sf�� /SOS 87,0 d 7vo 0 BoX /wV G,4L, /.vV $6,80 FrT 33 &7'Sg' ',•;. SEPrrG 87,04 S7ZY T3'1 80.867 , 7, S1�i�er_�a►►ar Girc% SHow.v YE.�Eov GDMPGY,S �.t//T�lTiy`'S/dE�,/.NE 4//O.f67'"l�,QG.� .2EQV/PEN1�NTS o� B.dX7�,2 '�t/YE, I've. ToW.t/ of9u_ Th'� •C���isr�-2c!>.Garvo-SU.2t�Eyo,Ps �98L� 11.t!47 /..S it/OT' 4&7- - • S�Gf�iv f�E,eEaN stv�DUG p it/pT-Qom, USEp _ ` 77a'EST.dQL/Sy •�4r-G/iYE,s; gla3/ / ry . j �/ N Lo 76 oo, Prop sA; r Gi4�iv Waiter ��;\ �0 li�iin/ Se�u1Ct >> qd 33 �.. TbN[o one Mf co LCO-r 7 5-MNEY t'oNi� (Zoat� M A RS70US M I U-S A,4c '3dD2. -C�2CoZ I ® OW.4 So,d ssev 6D W�+.�2 Awusrvn,E 54.7 :1 " 1 r q Z3 9.63 • q9 A ,s b •••� f` yam_ Y OW-2 �9 ' OW-1 49 fa OW-3 q•so � 0 51 .0 - , t , FIGURE 6: GROUNDWATER CONTOURS LEGEND ® OBSERVATION WELL l ..�52 GROUNDWATER CONTOURS —► DIRECTION OF GROUNDWATER FLOW. SCALE:1:1320 C. SsiE=�T 3 or- 3