Loading...
HomeMy WebLinkAbout0206 WHEELER ROAD - Health A=082-0.12 Nlarsto is IVliils I No.------------------ Fee----------- BOARD OF HEALTH TOWN OF BAR.NSTABLE Application,forlett Con.5tructionPermit &p- imc. -vim,P Application is ereby made for a permit to Construct ( ), Alter ( ), or Repairs )an individual Well at: Location — Address Assessors Map and Parcel 1_14 4_4 LAj Nbl'� Owner Address ---------------- - - ------- ` -----/"1»{ �/�:��e- '---------- Installer — Driller Address Type of Building � � 7 Dwelling---- _S�/ ----------------- Other - Type of Building —------------------- No. of Persons---------------------------_-_—__—____. /1 Type of Well- -- -- --- - ----— YP - ---- - Capacity---------------- ------- Purpose of Well---- ^u�`-' - --- --- --- Agreement: The undersigned agrees to install the aforedescribed individual well in accordance with the provisions of The Town of Barnstable Board of Health Private Well Protection Regulation - The undersigned further agrees not to place the well in operation until a Certificate .of Compliance has been issued by the Board of Health. t � ©------ dateI Application Approve --------- -- -- --- --- -— ------ ------------ date Application Disapproved for the following reasons:--------------------------------------------------------_—________—_________ ------------ -- --- ---- ---- - ---——- - --- —-------------------------------------------- ;�� ) ----------- l ---—date— Permit No.W - -CJ Issued--- -- JI_!_ dat BOARD OF HEALTH TOWN OF BARNSTABLE Certificate Of Compliance 1,-'i;-"o THIS IS TO CERTIFY That the Individual Well Constructed ( ), Altered ), or Repaired ( ) by--- W r�'=1 ---- ------- �-�' ---------------------------------------------------- at— =— "' —1 _— Installer `— — — --- — has been installed in accordance with the provisions of the Town of Barnstable Board of Health Private Well Protection Regulation as described in the application for Well Construction Permit No. --------------------------Dated------------------_---- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORY. DATE-------------------—- — -- - - - --- - -- Inspector------------------------------------------------------------------------- ------- No.------------------ Fee-----------�------- BOARD OF HEALTH TOWN OF BARNSTABLE Zpp[ication-*rMelt Conoruction Permit kx-p �-er Application is hereby made for a permit to Construct ( ), Alter ( ), or Repair ( )an individual Well at: — ---------- -------------------------------- Location — Address Assessors Map and Parcel -� �' - _. —L �u �c-------------— a��__yk'r_-C R�-—M rs N ►.�L- Owner Address w!" = - - --- - h_o -__G t /-o� w► ----- �- - - - --. ---- - - Installer — Driller Address Type of Building / Dwelling-------U_G_a it S t. __ Other - Type of Building---------------------------- No. of Persons------------------------------ Type of Well——----- --- —--------------- ---— ---- Capacity--------------------------------------------- - — Purpose of Well----t-�h, �c. - --- --- --- Agreement: The undersigned agrees to install the aforedescribed individual well in accordance with the provisions of The Town of Barnstable Board of Health Private Well Protection Regulation — The undersigned further agrees not to place the well in operation until a Certificate .of Compliance /has been issued by the Board of Health. S/.igned d'�--� � % �W`�__------ — -zk- date Application Approved adate -I--0---4--r-- ---- Application Disapproved for the following reasons:-----—------------------------------------------------------------------- -------------------------------------------------------------------------------------------------------------------------------------------- Jdate Permit No.wC'G= -`-�j-/-�— -- - Issued— _�f a'l1 /__ - —— -— —-- -- dat --------------------------------------------------------------------------------------------------------- BOARD OF HEALTH TOWN OF BARNSTABLE Certificate Of Compliance THIS IS TO CERTIFY, That the Individual Well Constructed ( ), Altered ( ), or Repaired ( ) by- ' __hh'�✓ L- "`------------- ---------------------- ---------------------- Installer has been installed in accordance with the provisions of the Town of Barnstable Board of Health Private Well Protection Regulation as described in the application for Well Construction Permit No. --------------------------Dated------------------------ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORY. DATE- --- —- ----------------------- ----- -- Inspector----------------------------------------------------------------------------- -------------------------------------------------------------------------------------------------------- BOARD OF HEALTH TOWN OF BARNSTABLE Mell Congtruct ion Permit No. 'lo v� Fee---------5 --- Permission is hereby granted-- -� --- -----------------__-___-_____ to Construct ( ), Alter ( ), or Repair ( ),an Individual W 11 at: No. - —��-C��[?_ _u?,�_�—��=—` - -----V ------------------------------------------------------------------------------------ Street as shown on the application for a Well Construction Permit dc' 1r Board of Health DATE----�--�-- �----�--�—-------- I� CT , .81 if so Sla TP 7e ' : 1 , i - AIM,4617H AEA SID 10 GAR�9GE / /� jJ ;'� :' I ;' i j' �' BVW >�,Z6 ' 3 ---31'f �--- - ` / ,fir, ,�' ,.@OVW,j24 AL .H w0 ' LICH 0 ST.. / 11 TANK D�4X' / ; � A �N , 61�irjl .1L y ' AL AIA .. T.O.F. _� ! if ! /' BVW, 21/ 0--- ► I I 1 , r tic 76Ak Ak ' 2-STORY • WOOD F GAR ''i ;` '; ( l� BYW 20AL 74 �_ 7t.t9, RAMS A E / / , I r ! , y►� AL AL RK 74 ! Q J4�S. F. .E.=7 i.9 G.F.E. 70.5' ` f l' i i it ; i r<I ,'' %' Ak I Ali r ' I KENNBVW fig, AL DN PIPE FND -'' ' ' Ak --' ------------. L • . : I f r r � � ` - E)OSTIHG WELL � ,.O�O;�. � � � � r AL � i / 1 1 Ak 1��� .��,. 1 I 6 1 y _ r • Ak CB/DH FND HELD ``-- _ --- - ^ - -- BVW 05 AL AIL BVW #14 _ w00�`- AL B _ 'E�aN`id � - ' ' M Ak BVW IF2 _ _�� -- FRAME ' �4 - - - ` --------------- F.F.E=51.1 , ' B 3 �"�_ ala TOWN OF BARNSTABLE LOCATION �Gfp 1t1 CCf� SEWAGE # 92— .a r� VILLAGE �!� s�>f�l� ASSESSOR'S MAP & LOT '�/-�- INSTALLER'S NAME & PHONE NO. 'c2 �t � SEPTIC TANK CAPACITY /�Ue LEACHING FACILITY:(type) (size) &,,>e-/, NO. OF BEDROOMS PRIVATE WELL OR BLIC WAT�__. BUILDER O OW elll7 J/ DATE PERMIT ISSUED: P-3 DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No l e c 1 /Fimic...Zo.. THE COMMONWEALTH OF MASSACHUSETTS APPROVED BOAR® OF HEALTH Bamstabto Conssrvatian Department TOWN`O F B A R N S T A B L E a 1 Biripinial Wurkii Toutitrurt"tun Famit Application is hereby made for a Permit to Construct ( ) or Repair (>,/-) an Individual Sewage Disposal System at: e e.. Lek ,/1iJiLeS�, w t�� Location-Address or Lot No Owner Address W DlLi' �� GDN-- �lo�� �£, y. .. . .......- 4L S t Installer � Address UType of Building Size Lot............................Sq. feet ., Dwelling—No. of Bedrooms---------------�- .--________-._--_Expansion Attic ( ) 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/4W..gallons Length................ Width__...______-_--- Diameter................ Depth................ x Disposal Trench—No. .................... Width-------------------- Total Length.................... Total leaching area.... .........sq. ft. 3 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. I................minutes per inch Depth of Test Pit.................... Depth to ground water........................ G14 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ P4 -------------------------------------------------------------------•------........-•----....................------•----•-----•---........---......---.....-- 0 Description of Soil............Q_--`3 _�!_.Sc� ,SU1�f `-?.-..�� .`---`--�"JO x W ........................................................ --------•---....------------------•-----------....-----------------------•....---------•-------------- U Nature of Repairs or Alterations—Answer vAen a plicable.______%15./ -_._ 4. --. ................. .... .... ........../IlCJO. .. 4� 1�� i u� �� Si7�x(/ .......................... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code —The undersigned further agrees not to place the system In operation until a y p Certificate of Compliance e n iss e y th oard of health. Signed -------- ------------------------ - .... 7 Dace Application Approved By ........... ...�. ..-.. --------------------------------------------------- ......?'.-..r�....... Dare Application Disapproved for the following reasons: ......... ... ................ . . .-- .. ....................................................................... ................................................................................ ... ...... . . ....... ........................... .............................................................. ........................................ Dace PermitNo. -9. � ............ Issued ..... ... . ............................ ................... Dare �i. --n:.._.z... �-v:1•• -�. rw,..a .`►s'V-._.. �.. ...._ � -..r a ._.;.._s. � - a ..... _ �.,..,,i.:.... a«. .... •` -rfy.- �y.�-••�..--.�...- ..._.._-,,,...,�,''.1,....:.__ i r�. No... ?� - Q -�.... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH }TOWN OF BARNSTABLE _ t Appliratiun for Di.!ipuul Ourks Tunfitrurtiun ranfit Application is hereby made for a Permit to Construct ( ) or Repair an Individual Sewage Disposal System at: ..... U�pj LiIJ �� L�/L ( �C��O 6'�'J /1/1!L C /J ] } .... .-•••.........-••--•••••. .-- ..• •------- ---- ........• ................................................................................................. Loc:Lion-Address o A- l. Lot ... Owner v Address Installer Address Type of Building Size Lot............................Sq. feet [..t Dwelling— No. of Bedrooms...................... _......._._.._.... .xpansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ------------------------_-- No. of persons----------.---.--_-_------- Showers ( ) — Cafeteria ( ) dOther fixtures -------------------------------------------------------------- ------------------- WDesign Flow...............�-r-........._......gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacitv/ZOO..galIons Length---------------- Width--............. Diameter...--........... Depth................ x Disposal Trench-- No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. 3 Seepage Pit No.......-./....... Diameter......../--/Q-!... Depth below inlet......1.-,....... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) 0.4 Percolation Test Results Performed by.........................................................................- Date........................................ Test Pit No. 1................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 water........................ ---------------------------------------------------------- -......... •------•---.........------•------..................... . ........ ..----- D Description of Soil.------..... •-- ......../G/, =/ cad..�.G I/_..-�..... 5 =J(J U ••••••••-•••-•--•••---•--------••-•••....•----------•-•----------------------•--•-••-•-................---•---••---••--••••••--••--------••......•--...--- . .......... ------------- U S�/J2 _ Nature of Repairs or Alterations—Answer when applicable ..............�-..-..�4:..._l.�n.4-rr��.-=S_L PT!�---•i�-N� Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code —The undersigned further agrees not to place the system in operation until a Certificate of Compliance ha Abe n issued y the.board of health. .--- � ..................... .... M Signed .......... - - t ---.... _... .... - .7 Dale Application Approved By ----------- ._ .. - n. e. .�..--_ /-- ...._7-.0_Q......�Z. Application Disapproved for thefollowin reasons: ........................................................ . .............................. .............. . ................... ........................ . ........ .................................. ... . ...................... -- .... . .... -- --. . . . . . .. .....................-----------....---- Dare PermitNo. ...��. ...-.. .. ..j.......... ......... Issued .................................................................... Dace ---------------------------------------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE AT C.ertifirate of Cnamplianre THIS IS TO CERTIFY,,, That the Individual Sewage Disposal System constructed ( ) or Repaired ('Ne ) by .............. �, 1` "G.�<J�------- �.J........... _......... at ................. ......1 J .c Installer�.C-- � .._...1 �... ...............' ..../.7../(....L:: ----------------------:------------- has been installed in accordance with the provisions of TITLE 5 of The State Environmental Code as described in the application for Disposal Works Construction Permit No. ------ dated ....................................... ..__. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THEo SYSTEM WILL FUNCTION SATISFACTORY. DATE_........... Il 11(?..I ,... ....................._. Inspector ........ ...._.... /..d..(.:,• .. ........ ........... � r t / ; ------------------------------------------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH d TOWN OF BARNSTABLE �iu�r,auiil ur�� ��nu�ri�tiun rrmi� Permission is hereby granted......................... �<�� �.L-07,-_-........_-&J"11S 1`/Gc-c f T G w -------------------------------- to Construct ( ) or Repair (\-,/) an Individual Sewage Disposal System at No........................................ "a J&...-•.••••./X/f- ': �_ ,C_... .le=)...------.1�/I,./1�1/(�1............ --- Street q as shown on the application for Disposal Works Construction Permit No..,�:...��......... Dated.... � C Board of Health DATE........... � < = f -----------------•------------ FORM 36508 HOODS&WARREN.INC..PUBLISHERS • o .;, � �is r- J,s Tr' Ani ittalFLe S ',Gjj {" ,�lth Board o Hea To: s ,200 Main Street -� -------w Hyannis,MA 02601 Attn: IDo v,n-a rno r�cQ From: Stephen A. Wilson, P.E. Subject: 2c, w_k«<<f- rz Vvt.r-r-3+V-K& M'Ms- Date• 1- We are sending you R Attached ❑Under Separate Cover The following documents: ❑Prints❑Order of Conditions El Variance Approval❑Recording Slip ❑Septic System Permit ❑Notice of Intent®Other DATE QUANTITY DESCRIPTION 04 These items are transmitted as checked below: ❑ For Your Use ❑ As Requested ® For Your Files ❑ For Review and Comment ❑ For Recording ® As Required Other: Additional Distribution File No., - :Baxter Nye Engineering&,Surveying Phone: 50&771-7502,ext.13­,- 78 North Street,P Floor Fax: 508-771-7622 Hyannis,Massachusetts 02601 E-Mail:swilson@baiter-nye.com TransnittalLetter5.doc z k Town of Barnstable P# -THE Tp� o Department of Regulatory Services R , : Public Health Division )Date D. y MASS. i639• 200 Main Street,Hyannis MA 02601 �ArFo MPS Date Scheduled Fee Pd. _ Soil Suitability ,Assessment for Sewag.l, DI'Sposal Petfornned By: S k'eve tr.1:15c•% P'a Witnessed By: 'Do-v- F I.om-cO LOCATION & GENERAL INFORMATION Location Address Zc„ ta1 ti«I�r 'Rco Owner's Name /r (Nis 4r..a YVl 1 t S Address 112 /ore berg V�l/•+' !gyp Assessor's Map/Parcel: ��� �z'�Qty�� Engineer's Name S+*rt-R., A, (,u o laebe 116 NEW CONSTRUCTION REPAIR Telephone# 0 ckt 1 Land Use rz e'tA...•.h-a 1 Slopes(%) Surface Stones Distances from: Open Water Body ft Possible Wet Area ft Drinking Water Well ft Drainage Way ft Property Line ft Other tt SKETCH:(Street narnie,dimensions'of lot,exact locations of test holes&perc tests,locate wetlands in proximity to holes) 00 Eel- � ' w L ' n C� Parent material(geologic) 0 Shwcs h Depth to Bedrock Depth to Groundwater: Standing Water in Hole: Weeping from Pit Face :Y- �. Estimated Seasonal High Groundwater DETERMINATION FOR SEASONAL HIGH WATER TABLE Method Used: Depth Observed standing in obs.hole: in: Depth to soil mottles: itt• Depth to weeping from side of obs.hole: in. Groundwater Adjustment ft• ` Index Well N Reading Date: Index Well level Adj.factor Adj.Groundwater Level— - PERCOLATION TEST Date d Ot Time lO'•cr9 °� Observation n e a'"i --- Depth of Perc a 2 6 o Time at 6" Start Pre-sonk Time a 0!3 o Time(9"-6") EndPre-soak u­6"ti4 p� /O,'20 /0-%4'© Rate Min./Inch Site.Suitability Assessnnent: Site Passed. X f Site Failed: 4 y Additionnl Testing Needed(YIN) Original: Public Health Division JLsei"vati0°;E C'3: :i.)aY:''.' Be COtIl3!pied on Back----------- ***If percolation test is to lie'con -uicted�i-.•etliin,!O()' of wveiiand,yoll 1m st fir`,st notify the Barnstable Conservation Division at least one(1)week prior to beginning: Q:HEALTH/W P/PERCFORM DEEP OBSERVATION HOLE LOG Hole # 1- Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. ° Gravel) 3 _ /o" 14AO e2 5a rGotrt� 10 /'�/f — / ee�bb/t-e DEEP OBSERVATION HOLE LOG. Hale# P— Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) , Mottling (Structure,Stones,Boulders. Consistency.%Gravel) 4 50 A.0y /C) YR q14 --- S'a"dy 4009M l0 yR 4/Q DEEP OBSERVATION HOLE LOG Hole# 3 Depth from Soil.Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency.° Gravel) 0 �! O ,� soy=� Loam io �►� �l� — ga 1 -to I. C2 M cA t"., sC.n A C. Sand I G�y DEEP OBSERVATION HOLE LOG Hole# _ Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency.°o D 11yel 0 -y" „ 224—•76 1 Ct GP-Ire- rw.e /OY12 e- � Flood Insurance Rate MaM: Above 500 year flood boundary. No— Yes k Within 500 year boundary No�_ Yes Within 100 year flood boundary NoX 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? Yes If not,what is the depth of naturally occurring pervious material? Certification I certify that on /�-r r�l 1fr3" (date)1 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,expertise acid experience described in 310 CMR 15.017. Signature Date l'16 ' fie. Q:HFALTFI/W P/PERCFORM ��2uo-7