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Home My WebLink About1631 MAIN ST./RTE 6A(W.BARN.) - Health 1 331 K 1 A, W. A S A h rA= i I I i RLZ7f ? F� OCT �� ' Town of Barnstable P# ?t �77 � � � t - Department of Health,Safety,and Environmental Services �t Public Health Division Date 367 Main Street,Hyannis MA 02601 M f * BARN3GBLE, 11iAB3. '0re16 9..tA Date Scheduled tw Time OAIM Fee Pd. Soil Suitability Assessment.for oral Sewage g Dis 1� Performed By: �/ %yG y-Y�NS, fC� /�-S Witnessed By:� Lt ,9Ji/Q� LO A IONXXX &�}G�}LNE/RA INFORMA 'ION Location Address // O Address wner's Namei� ✓( /'� YY1� ( 1a�'✓� JGI /� /� a r�ax�a 9S (/�/t✓S! ��v ��L� �'��7��1�/C�� n/ Assessor's Map/Parcel: Engineer's Name NEW CONSTRUCTION REPAIR Telephone# 6c� La - , 0 i?p � � nd Use ��/1��T�C Slo es % a /y(;p ( ) �� Surface Stones /y/ Distances from: Open Water Body 141 ft Possible Wet Area /UO ft 7Drinking Water Well "ZZ ftt 1 Drainage Way It Property Line 7 L-w—ft f Other ft SKETCH:(Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands in proximity to holes) A LL ON AVM 1J0£ AVM 1A 0£ s jig8 �e8 a'$ \ r I.VM 1i Q£ %S g % s . N m OW - O o yY Stag r m� /4MIlly Z&nS`7s Parent material(geologic) Depth to Bedrock cl)5z) p g . 1 Weeping /C3 .�l Depth to Groundwater: Standing Water in Hole: � Wee in from Pit Face � )/T Estimated Seasonal High Groundwater � DETERI�'IINATION FOR SEASONAL HIGH AT R TAB 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#�j __- -Reading Date://fXO Index Well level..t(� Adj.factor�.0'Adj.Groundwater Level ,.U 0)5� ZO — PERCOL ATtON TEST Date T►me Observation Hole# _� 2- Time at 9" Depth of Perc -1 li Time at 6" Start Pre-soak Time @ OU=Gb%W Time(9"-6") End Pre-soak CV'/5�M (046 '00 77bq1'/ �/ Rate Min./Inch L /i y. lhye// P6�c Site Suitability Assessment: Site Passed _ Site Failed: Additional Testing Needed(Y/N) Original: Public Health Division Observation Hole Data To Be Completed on Back j Copy: Applicant DEEP OBSERVATION HOLE LOG Hole#_ Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulderes. Consistency,° ravel) DEEP OBERVATON HOLE LO;G Hale Depth from Soil Horizon Soil Texture I Soil Color I Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulderes. C n istenc ° Grave 27 Log D*e S16i j (P to i i v re,t, DEEP OBSERVATION HOLE LOG Hale# .. . .... Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulderes. Consistent %Gravel .. . .:.... DEEP OBSERVA;TIOIV HOLE LOG Hole . Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface'(in:)` "- `—' (USDA) (Munsell) Mottling (Structure,Stones,Boulderes. Consistency.%Gravel Flood Insurance Rate Man: Above 500 year flood boundary No_ Yes Within 500 year boundary No Yes Within 100 year flood 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? e-S 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 analysis was performed by me consistent with the required training,expertise and experience described in 310 CMR 15.017. SignatureAZk'Wff . J Date /1-9-00 ' TOWN OF BARNSTABLE LOCATION ��— G �� SEWAGE # R- 719 VILLAGE ZE,- ASSESSOR'S MAP & LOT/9 S-- INSTALLER'S NAME & PHONE NO. 78 SEPTIC TANK CAPACITY ® p wd LEACHING FACILITY:(type) (s' )° A NO. OF BEDROOMS _d RIVATE WELL}OR PUBLIC WATER BUILDER OR OWNER h/ DATE PERMIT ISSUED: ls '^ DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No Jr/` �, �i ,�' � � w @+ � � . i � � No...... ._.. f$ F�s.............f..�........... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH APPROVED TOWN OF BARNSTABLE �� irttti�a,t for Divjip ial Workfi Tomitrnr#iun ramit tion is ereby or a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: .A31. - ------I <9N......ALID_...........................n... ......... ........ ocattmi- \ rr•ss � or Lot No. 200 r6 ar. 1 .--- --• --- . --- ✓.._...• ---------------� ----------(7.1.�-----------------------...............---------------- O v rQ p�'ddre a � - �� k------ - ------- •••.... ��•a.�.-�'�G.�................. Installer Address Ue of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms.-_._ _________________________________Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ---------------------------- No. of persons---------------------------- Showers ( ) — Cafeteria ( ) a' 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. 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........................................ a Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ L% Test Pit No. 2................minutes per inch Depth of Test Pit-------------------- Depth to ground water...---_------_------_-_. a -----------------------------------------------•----------•-------•-----------•-------•••••------............................................................ 0 Description of Soil........................................................................................................................................................................ W -----------------------------------------------------------------------------------------------•---------•-------A-------- UNature of Repairs or Alterations—Answer when applicable.----0 A- -f-. o -, - 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 Complia has bee ssu d b he boar of health. Signed . . .... �� 74Z 7 ApplicationApproved B .. '.. .. ... ...--- --- ---------..------ ----------.. ..................----------------------------- .................Date------------ Application Disapproved for the following reasons: ................................................................ ....................................................................................................................................... ........................................ Permit No. � '' /e.................... Issued ....... A � Date N F ............................ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE firatiou for Divjivwial lVark,6 Tomitrurtion ramit Vxpplication is hereby made for a Permit to Construct or Repair an Individual Sewage Disposal System at: \dd or Lot No. t �., , I ( Akg&-------- .............;..................... , _....... ....................................................... ;r Add ................... .... . -------------...... ................... Installer Address 4e of Building Size'.Lot............................Sq. feet Dwelling—No. of Bedrooms.....zX---------------------------------Expansion Attic Garbage Grinder Other—Type of Building ............................ No. of persons_-----.--------..-----.---- Showers Cafeteria Other fixtures ............................................................................................................ ............................ Design Flow............................................gallons per person per day. Total daily flow.---.-.---------\----------------------------gallons. 1:4 Septic Tank—Liquid capacity------------gallons Length---------------- Width---------------- Diameter.---..-------.-- Depth................ Disposal Trench—No. ..................:,Width---_----.-----.----- Total Length------..........---. Total leaching area....................sq. f t. Seepage Pit No--------------------- Diameter...........---.----. Depth below inlet---.---........_._.. Total leaching area..................sq. ft. z Other Distribution box ( ) Dosing tank ( ) 1.4 14 Percolation Test Results Performed by.......................................................................... Date...................................... Test Pit No. I----------------minutes per inch Depth of Test Pit...........--.--.... Depth to ground water........--....----...... 44 Test Pit No. 2................minutes per inch Depth of Test Pit--.--------.---.__.. Depth to ground water..----.........__...... P4 ....................................................................................................................................................*---" 0 Description of Soil........................................................................................................................................................................ W U ...........................................I............................................................................................................................................................ ............... .........!�?....................................................................-------------- -- --------- ................ ------�;- ------------- --- U Nature of Repairs or Alterations—Answer when applicable.---_�------�_ ...J./Itz, Z ..........................................I............................................................................................................................................................. 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 Complia has bee issuedby the board of health. Sig _r, /,;?- Due XR- --—------ -------- - 7, ------------------------------- ------------------------- ApplicationApproved B -- ------- -------- --- ------- . ............... ........................................ .............................. Dare Application Disapproved for the following reaf ons: -------------------------------------------------- ............................................................................... ................................................................................................................................................................................................................ ........................................ Date Permit No. ................. Issued ......../ w- z.:;? — ..............Dare----------------- --------------------- L--——————---—————————————————————————— ----——————————— ————--——————————---— — THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Certifiratr of Contyliartre THIS To CERTIFY, That the Individual Sewage Disposal System constructed or Repaired ----------------------------------------------------------- ----------------------------------------------------------------------------------------- by ......... _/_6§;w,406 Installer at .................... ------------ _�------------------------------------------------------------------------------------------ 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. -9---�1;�----71f?------ dated THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE-CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE--- ��--------- ............ Inspectc—------ ------------------------------------------------ ------------------------/C THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE ...................... .............................................................................. Permission is hereby ranted.--- to Construct or Repair V 6�h Individual posal System at No. : ..... ...�O ..--- ------ -- ................................................. ............................... Street as shown on the application for Disposal Works Construction Permit N89 --71e Dated.,,/ .......................<1... DATE..........Z ;F Board of Health .........................................;�........................... ......... FORM 345508 HOBBS&WARREN.INC..PUBLISHERS