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HomeMy WebLinkAbout0349 MAPLE STREET - Health 349 Maple Street West Barnstable, MA. A = 131 - 008 0 P R r r TOWN OF BARNSTABLE t;LOCATION 344g M0.91c. S-1 SEWAGE# 2018 - pqq VILLAGE QvmSA"]C ASSESSOR'S MAP&PARCEL 131 1 oo8 INSTALLER'S NAME&PHONE NO. o L 53 SEPTIC TANK CAPACITY /SOO ac5..I LEACHING FACILITY:(type) SOD A 1 t4c.. C 2) (size) 13 x 2SX 2- NO.OF BEDROOMS 3 OWNER RnScri1 t PERMIT DATE: Ll-L- 19 COMPLIANCE DATE: J I Separation Distance Between the: Maximum Adjusted Groundwater Table to the 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 Al • $$' AZ. 94' Oz- 98'L " 83 . -19,1, " A 3 $y- /02'3" Cy- 11o ,G,� 0 3 .. .... _ . �_ f NO. �� THE COMMONWEALTH OF MA$SAGHUSETTS Fes 160 �BOARD OF HA �< OF BA1'el�l S M� APPLICATION FOR DISPOSAL SYSTEM CO7c")mpletc STRUCTION PERMIT Application for a Permit to Construct (Repair ( ) Upgrade ( ) Abandon ( ) - System ❑'Individual Components l 3 .i J 0 0`lion —3 'M M AFLIT 1 "Y V F—�l J LLt Map/Parcel p/ G 19 ` / nAl+"T CAFtL 'LAKP / Inua cr'.Nnin�i y�� �D cxigq�rt�J���L�IR i 1 Telephone U Telephone.# Type of Building: K M-T-- F 8 h&112\1 Lot Size 4 Sq.feet Dwelling—No.of Bedrooms Garbage Grinder ( ) Other—Type of Building No.of persons Showers ( ), Cafeteria ( ) Other fixtures Design Flow.( emt- ) gpd Calculated desiPn flow 3�gpd Des- n flow provided��gpd Plan: Date y"S 1 er of she 1, Revision Date Title j s Description of Soil(s) Soil Evaluator Form No. `fame 'I Evaluator C,LAN -'l;ate of Evaluation $' �O� i- DESCRIPTION OF RE . ,.5 9 Fk NS SL PLA C Q-, P3S W J S7 6 .S_h 9G �STE Gar' , �,.��lpttAt The unoe"ig?. ; A revs to install the.above deseribed individual Sewage Disposal System in accordance with the provisions of TRLE 5 and fuY ag . i,ot w place the system in a ergtion until a Cerliliwts of Compliance has been issued by the Board of Health. Signed Date Inspections �{ �D'( FORM I - APPLICATION FOR DSCP DEP APPROVED FORM S/96 t F No ' THE COMMONWEALTH OF MASSACHUSETTS FEE -- --� . /BOARD, OFFHEALT TOW �,? OF ; BAt�lV STABL APPLICATION FOPUDISPOSAL SYSTEM CO O STRUCTION PERMIT Application for i1 Pe`rmit to Construct Repair-(( p' ( ) Upgraded( ) Al andon ( ) - Complete System ❑'Individual Components I ! 3 '9 KARL S T_ O 0 l ;'tinn 3 °�°►-:1�AFL r "am`�J P�W yih4L �j 1 Map/Pared NO A rusx Gci L�,�1 ran - AT L L A N RN Piz______ / Inyla ler N+uric--""'-' Desi rk gJnu � ' 7 1 � r Tulcphunc U Telephone N Type of Building: S) N X E j—/\�I� \� Lot Size 4 �� Sq.feet s `.Dwelling '=.No.of'Bedrooms 'r Garbage Grinder ( ) r `. Other—Type of Building No.of persons Showers ( ), Cafeteria y Other fixtures i Design Flow-(A tn- ui ���gpd Desi flow provided gpd 9 ) Calculated desi n flow Plan: Date ' �ZH °�`M ber of sheets Revision Date Title AI( _,,,Description of Soil(s) "` r' �:� �� P-,AV Soil Evaluator Form No. `�\�� ��yN o�� oil Evaluator�•LA N i CTzIY mate of Evaluation X' 10- l� DESCRIPTION OF REP, I 1 ; It``° IONS �.P LA S P S UI,'1 S7 S_,A S_ The undersigned gees to install the above described Ind :TITLE'S ndual Sewage Disposal System In accordance with the provisions of dnd fu a9 Chat to place-the system in operation until a CerifiwFe of Compliance has been issued by the Boa Health. " Signed Si • g Date 121 Inspection __ FORM t - APPLICATION FOR DSCP DEP APPROVED FORM 5/96 ———— 3 -- —�� — C 'r"- ---_ _----- .. .. _-----;----------- ° z � o THE COMMONWEALTH OF M'ASSACHUSETTS . FEE' TP L3,�RWSIABLE-BOARD OF HEALTH I 3 (�- b_�ox CERTIFICATE OF COMPLIANCE 4 Description of W k j [J Individual Component(s) (Complete System - - The undersigned hereby certify that the Sewage Disposal System;Constructed ''` _ ( ),Repaired( ),Upgraded( ),Abandoned( ) by: �1U� C XG A\J f1 3 1 N G at 3 4-°I­ INA .A-P v- &r-T- \J,?,Na N STAIEUL has been installed in accordance with tfroe provisions of 310 CM 5:00 (Title 5) and the approved design plans/as-built plans relating to application No. ao�� dated ��-G`� . Approved Design Flow"3 k I (gpd) Installer a I� L k CAY i(.N�I S Aph\14 f 1 Designer:_-CAR L L AN T Cry Inspector ` The issuance of this certificate s all not be construed as a guarantee that the system will function as designed. sue` ''FORM 3 - CERTIFICATE OF COMPLIANCE DEP APPROVED FORM 5/96 N0 ! TH E COMMONWEALTH O � 5 F IVIAS$/AC;�HUSETT$ � . FEE � - j— - ;' A R ktS TAPM 0ARD OF' HEALTH t x DISPOSAL SYSTEM CONSTRUCTIONPERIVIIT�.,_ Permission is her y anted to'Consfruct ( Repair, Upgrade - ��LL „P. ( ) p ° �).Abandon ) an individ al sewage disposal system at I as described--, in the application for Disposal System Construction Permit No. 2ol I-_ ,.dated l ^� Provided: Construction shall be completed within three years of the date of this per Il-local`ond' t, s ust b t Date — —� Board of Health �� FORM 2- DSCP DEP APPROVED FORM 5/96 FORM 12,55(REV 5/96) H&W- Hows a WARHENTM PUBLISHERS-BOSTON .0- Town of Barnstable Regulatory Services * Richard V. Scali,Interim Director • IABNSfABLE. 9� 16gq. Public Health Division Arfp►�,�A Thomas McKean, Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Installer& Designer Certification Form Date: 1a Sewage Permit# Assessor's Map\Parcel _1& Designer. _WL )_AN Tt5N RT_ Installer: BtiB Eggzm A;or-, Address: Address: ly 7rc-o_5crr!,, Lr.3 S��I�1rJ i C hl C�2� _F"or�s�l dal c On 4_[,_ g Q EXCaUQv.Ai on was issued a permit to install a (date) (installer) septic system at 3 �'R �,� 'L� ST. based on a design drawn by (address) dated8'�L (designer) VI certify that the septic system referenced above was installed substantially according to the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. Strip out (if required) was inspected and the soils were found satisfactory. I certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system) but in accordance with State& Local Regulations. Plan revision or certified as-built by designer to follow. Strip out(if required) was inspected and the soils were found satisfactory. I certify that the system referenced above was constructed in compliance with the terms of the IW approval letters (if applicable) (Installer's Sig r ) \ '- HAR Y `\ EA;R- r LF dTER , 2 75 (Designer's Signature) to p ere) - �NG�. PLEASE RETURN TO BARNSTABLE PUBLIC HE A ISION. CER IFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS- BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. QASeptic\Designer Certification Form Rev 8-14-13.doc TOWN OF BARNSTABLE LUCATION-� SEWAGE # VILLRGENt �a� . Q- ASSESSOR'S MAP 6� LOT 131 - o O INSTALLER'S NAME & PHONE NO. SEPTIC TANK CAPACITY } y V �� r � t LEACHING FACILITYA ype) (0\6 ��� (size) NO. OF BEDROOMS_._PRIVATE WELL OR F4FfflR@ WATER BUILDER OR OWNER c DATE PERMIT ISSUED: } DATE COMPLIANCE ISSUED: o VARIANCE GRANTED: Yes, No Si L� i �� � � �b �, `� -��`�e�0.y IIns e L L Town of Barnstable r a y� Department of Regulatory Services .� BAMSTABIZ pe Public Health Division Date ,639. �6' 200 Main Street,Hyannis MA 02601 ao Ma+" Date Scheduled V )L7 Time f/ Fee Pd. t / t�1 Soil Suitability Assessment for Se e Disposal Performed By: Witnessed By: h� LOCATION&GENERAL INFORMATION Locattpn Address + �-� \,r�'� Owner's Name`'� -y} v CTLq wk 0t%_ tj — S e I l Address Assessor's Map/Parcel: / /®z. Engineer's Name - Lp �Q 7s� f V 0.• NEW CONSTRUCTION REPAIR Telephone# w �`� + l✓ J Land Use Slopes(%) Surface Stones Distances from: Open Water Body ft Possible Wet Area ft Drinking Water Well ft Drainage Way ft Property Line ft Other ft SKETCH:(Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands in proximity to holes) JlJ �3 Parent material(geologic) 2_1K),Q" Depth to Bedrock � I Depth to Groundwater: Standing Water in Hole: 'Weeping from Pit Face a :A Estimated Seasonal High Groundwater ! . DETERMINATION-FOR SEASONAL.I'!GH.WATER TABLE 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 9 Reading Date: Index Well level Adj.factor Adj.Groundwater Level ..A.. „ ,.• PERCOLATION TEST Date,: Tune Observation Hole# Time at 9" Depth of Pere Time at 6" Start Pre-soak Time @ Time(9"-6") End Pre-soak 1 Rate Min./Inch Site Suitability Assessment: Site Passed V Site Failed: Additional Testing Needed(Y/N) Original Public Health Division Observation Hole Data To Be Completed on Back----------- ***1f percolation test is to be conducted within 100'of wetland,you must first notify the Barnstable Conservation Division at least one(1)week prior to beginning. Q:\SEPTIC\PERCFORM.DOC rr „ DEEP OBSERVATION"HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency.%Gravel u- $ 0 - 1:(:Z� ) 6A i 9� � - DEEP OBSERVATION HOLE LOG Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistenc %Gravel DEEP OBSERVATION HOLE tiOG Hole 4- Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency,%Gravel) DEEP OBSERVATION HOLE LOG Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency.%Gravel) Flood Insurance Rate Man: Above 500 year Flood boundary No Yes Ate/ Within 500 year boundary No Yes Within 100 year Flood boundary No Yes Death of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pery ptenal exist in all areas observed throughout the area proposed for the soil absorption system? t If not,what is the depth of naturally occurring pervious material? Certification I certify that on (date)] passed the soil evaluator examination approved by the Depart ent E viron enta rotection hat the above analy is wa p r rmed me consistent with the req ire r i p ise a ex described in 310 CM• l Signature Dat4 \\j Q:\SEPTIC\PE RC F 0 RM.DOC _ L AC'C�_�S w /1+-4 Q; oy 6R`� �L 3 A ( C v';? — i r � �. .�- 6�rM!N. / n O uJ 14_ j , tip I �_ _ \ _ _ S,YY ti c 3 r1?� {1�?? i; L j; 6�Q 1-1 3T 0 .a •�� r- HLD�?'c7NF �(C'!'.�i'P�r'.`��1C.1�- -- 7j9- %JfYa I)o-JE-i..E NOTES. �_— vy E c i-�+ ---- % KIN . FS Disposal System to be constructed in strict accordance with bul r L ` ' Commonwealth of Mass. Environmental Code — Title V. 2. This plan is for the sole purpose of construction of a septic system. _ ------- - u-� 3. Contractor to call Dig-Safe 72 hours prior to beginning of excavation. C40r ro gcALE) 4. Pump existing pits, fill with sand and abandoned. 5. Contractor to field check invert of outlet at foundation. . �. 'Ile QQ �„-. � ,�_ __ �._ �,� � a. 6. Bench mark is garage floor, elev. 74.0. 7. APN is 131 008 for the Town of Barnstable. 8. The area is served by private wells. The locus well is 120' from the WE - t - -- ___ , 1 ��I i' new SAS because of setbacks from pool, slope and dry drainage way. SW The SAS is over 150' from abutting wells. j 9. The plan view is based on site plan by Richard Law, PLS and recorded PIT @ Barnstable Reg. Deeds, plan 184-39. 10. Install a new (H-20) 1,500 gal. septic tank with Tee's and gas baffle per Title V over 100' to we11 per Bd. of Health regs. 11. Use 2 — 5'x8'x2' H-20 leach chambers with -,--' of V to 1 %" Double washed stone all around with filter fabric on top. 44 �,�r { 12. Grade loam and seed all disturbed areas. r- r � y� _Sr�F t , , ,:c n?� I `� L_ - � 4 +e VD -`E Xr{-SqT/(N S]— t HARRY cyN i ISde'1�C Q � 66,3- i LA TERY. v N 26575 # \NAL i 31', LOAI`,\Y SM/D JR E V __3 i 116 1)IFF S ET OF I©0' _ 62-6 - R 1:V. /, Z 4f 1-% -- Lf, '5JN)GLE DWELT S'NG, WlJ A 6 d 4 ' L < M_R. RObERT M C C U L i IANPP F_ ST ' to 6 Ala__ , ISN v ?�; T A INA V\ w' I w 1 ,�F�N `1Tt\ c L E. INC F1 I I'i G W ��Ej.9" 1-\ C S, A. .. USE f I i w `ST YTPRLE M ,� -r- ,- EC_TIVE z ,� a- : Z .L!I" n `-\ I N. 1 :I / C108 11U .�_4V �� - � I - _, - �J �- N� r2� Vot — 'Jc�• ILAi1t Ctl�� r� �Q` fP1y-LJ I _ -- - — --� �1�N1 �U 1 � _ 1 � 4Z , 7 ST�t D `d 1�-[ ON 5u I_�i> ;E�11G' _ SA/"J fir, 1y1A T � � ��L. ��..:����1 I � 3�� GALS r3 DATE-.. 0\,ea