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HomeMy WebLinkAbout0024 HARTFORD AVENUE - Health �24-Hartford Ave if U6 Marstons Mills A = 103 049 TOWN OF BARNSTABLE ,Jk,OCATION a q /Xq of iry-2, SEWAGE #2-00 VILLAGE A710?-5`P pVS n ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. / G f� �owS 7 7`7.3(-3G -a- SEPTIC TANK CAPACITY LEACHING FACILITY: (type)S�x-' ��'1> (size) Z 5 K(-*3 X �L NO. OF BEDROOMS 3 BUILDER OR OWNER 13` // S-lv t PERMITDATE: G COMPLIANCE DATE: I aLk J 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 ` : 3 F at H �,� F �' t�1 No. '_r7rr���o ,Y Fee 'V THE COMMONWEALTH OF MASSACHUSETTS Entered in computer. z es PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS 01pprication for laigpood *pztem Construction Permit Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No.2�e A-v E Owner's Name,Address and Tel.No. /3,7AAts7'o ,,6r V DL/Glj�rS y Assessor's Map/Parcel Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel. o. 2 c r1 Ca .r i .DA 2.e t N l;E�/t Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder , Other Type of Building S No.of Persons Showers( ) Cafeteria( ) Other Fixtures n Design Flow �� /�rcf/ gallons per day. Calculated daily flow 3 3 d gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank / D 40 f A//a,,i Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) %/a Ate* 'D 4 S �t �5'a 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 issued by this Bogard of ea Signed Date J� 9 o Application Approved by - - Date — o Application Disapproved for the fo lowing reasons Permit No. Date Issued p'�..7 � Fee �, THE COMMONWEALTH OF MAS9,ACHUSETTS Entered in computer: A. es PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS ZippYication for Mi5pogal 6petem Construction Permit .Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No.2 9 144 2 f%`O 2 cV 4 v!F Owner's Name,Address and Tel.No. �,A As-o ,�,� //s di')J S vc wf r_ Vz Y Assessor's Map/Parcel / p 3 Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No._ / fj c rf e-d ..s 5 / D,4 12 R r A,' � , k e",e Type of Building: Dwelling No.of Bedrooms -3 Lot Size sq.ft.' Garbage Grinder Other Type of Building .5 No.of Persons Showers( ) Cafeteria Other Fixtures Design Flow �/ ��.t" gallons per day. Calculated daily flow 3�31 y gallons. Plan--Date Number of sheets,"` Revision Date Title " Size of Septic Tank Type of S.A S. Z s o d WA -4,e-2S Description of Soil; i Nature of Repairs or Alterations(Answer when applicable) /" Ile v / 5 d o 7.4 aver 0 L? a X � S�o� � �� -yt F`2 S y Date last inspected: r 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 issued by this Board of ReaJth. Signed Date 11,19 Application Approved by Date Application Disapproved for the following reasons Permit No. Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS (Certificate of Compliance THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed( )Repaired( )Upgraded Abandoned( )by 4ACII tis 7- at 41,0 4 T Cc 2 has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. 20 a 1• wjZ dated 1 t/0 9 4) Installer Designer t r The issuance of this }ermit shall not be construed as a guarantee that the sysrew'11function�asydesigned. Date Inspector n,,0 qV IL_ - - ---------------- ----- — -- ---n-1 . . No. �O r`y 0 2— ———Fee�Ov THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS Miopoar *pztem Conotruction Permit Permission is hereby granted to Construct( LRepair( )Upgrade( Abandon System located at a. `/ ��� 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:Cons mqA /be completed within three years of the date of this ermit. y Date: l d t Approved by ~_ TOWN OF BARNSTABLE LOCATION r °"� /Z0 A f X,&00 SEWAGE #200 VILLAGE A7,00'-5--r OVS 1041-r 11-V ASSESSOR'S MAP & LOT � d�� INSTALLER'S NAME&PHONE NO. 2 7S SEPTIC TANK CAPACITY LEACHING FACILITY: (type),) (size) t<3 X NO. OF BEDROOMS BUILDER OR OWNER PERMTTDATE: 6 U COMPLIANCE DATE: 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 r F DG z� ,� s August 23, 2001 I acknowledge that the residence at 24 Dartford Avenue in Marstons Mills, MA is a three (3) bedroom. dwelling, and that the septic system design dated August 22, 2001 for proposed system upgrade has been designed to accommodate said number of bedrooms. [At en M. Meyer,R.S., Septic Systg4biDesign Engineer Wham Duch , Property Owner 11Iiouq 'buM(%neq. cypeaA4 be e, rue. an a 6 -p-& J�/-OF FORM 11 SOIL EVALUATOR FORIVI Page I of 3 No. Date: 3 0 7 01 Commonwealth of Massachusetts , Massachusetts Soil Suitability Assessment for On-site Sewage Disposal 1) me 6, PII - Perfonnedl By: q............................................. Date: <g, WitnessedBy: . pw�....................................................................................................................... Location Address or A-ve. 0.--"Name. Wl'tl,141 Address,and MATelephone I ew Construction ❑ RepairM /4,14 i Office Review Published Soil Survey Available: No U Yes ❑ Year Published .................. Publication Scale .................... Soil Map Unit ................... Drainage Class ................. Soil Limitations ..........................................:.1-....................... Surficial Geologic Report Available: No 0 Yes ❑ Year Published Publication Scale GeologicMaterial (Map Unit) ................................................................................................................................ Landform ................................... Flood Insurance Rate Map: Above 500 year flood boundary No 0 Yes Within 500 year flood boundary No XYes F-1 Within 100 year flood boundary No NJ Yes E] Wetland Area: National Wetland Inventory Map (map unit) ............................................................................................................. Wetlands Conservancy Program Map (map unit) .............................................................................................— Current Water Resource Conditions (USGS): Month T :.. :. � Range :Above Normal E]Normal OBelowNormal Other References Reviewed: DEP APPROVED FORM-12/07/95 is FORM 11 - SOIL EVALUATOR FORM Page 2 of 3 Location Address or Lot No. Z4- On-site Review Dee Hole Number Dat �;�:..:::::. L Weather �G� g® p Time: . . Location (identify on site plan) .:......:i~ .:::: (.C.IU„PtL.An/ Land Use . :.. .:..5.1.17 ,11'iFD'Ls. ., :.. Slope Surface Stones .. . ...:.. ..... .. :. .. : ... ... Vegetation .:::1�►� ( c:P: Landform Position on landscape (sketch on the back) Distances from: Open Water Body . , (J feet Drainage way:>:: feet Possible Wet Area feet Property Line :: S feet Drinking Water Well :L.5 .. feet Other DEEP OBSERVATION HOLE LOG` Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface (Inches) (USDA) (Munsell) Mottling (Structure, Stones, Boulders, Consistency, % I �rr Gravel) 0 S�r A W� �oY�3�L KI J Iranv j Trcab� rr 3 of 26 w s�� ior�s N I ful'ssiw' 41"k i'D A04 2,Sy/ N /A . Iwe, 4!;-t�"6 S 2.sYl NIA lam, MINIMUM OF 2 HL AT EVERY PROPOSED DISPOSAL AREA II Parent Material (geologic) I qjkfA�jP[ DepthtoBedrock: NJA Depth to Groundwater: Standing Water in the Hole: i FA Weeping from Pit Face: Estimated Seasonal High Ground Water. FSte//44mEm &—r 49� / rU��Ue✓ �JO DEP APPROVED FOR.Nt-1210 /95 FORM 11 - SOIL EVALUATOR FORM Page 3 of 3 Location Address or Lot No. M- 04tp—b AvF Determination for Seasonal High Water Table Method Used: ❑ Depth served standing in observation hole................... inches ❑ Depth weAping from side of observation hole inches ❑ Depth to soli\Tnottles inches ❑ Ground water\\a justment ................... feet Index Well Number .................. Reading Date ................... Index well level ..............._... Adjustment factor ................... ,djusted ground water level ............. ' .�_ .,....... '�R��B} bN SUtuBPr�,� Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervious material exist in II areas observed throughout the area proposed for the soil absorption system? Y65 If not, what is the depth of naturally occurring pervious material? Certification I certify that on 0 277 (date) I have passed the soil evaluator examination approved by the Depart r ent of Environmental Protection and that the above analysis was performed by me consistent with the required training, expertise and experience described in 310 CMR 1 .017. i Signature Date DFP APPROVED FORIM-12/07/95 FORM 12 - PERCOLATION TEST Location Address or Lot No. g1t6�-0P__U AVE, COMMONWEALTH OF MASSACHUSETTS 7�2AJ5 /41"S , Massachusetts Percolation Test* 0 Date: ::: .:: . ®.1. :: .:. Time: .: ` ...:. :..:..:.:::.:: Observation Hole # Depth of Perc Start Pre-soak End Pre-soak Time at 12" l Time at 9" Time at 6" Time (9"-6") Rate Min./Inch * Minimum of 1 percolation test must be performed in both the primary area AND reserve area. Site Passed jg Site Failed ❑ ......................... ............................................................... Performed By: 07,e ce, Witnessed By: Comments: DEP APPROVED FORM-12/07/95 Jul-16-01 08:02 BARNSTABLE HEALTH DEPT 5087906304 P.02 925101 NOTICE: This Form Is To Be Used For the Repair Of Failed Septic Systems Only. PERCOLATION TEST AND SOIL EVALUATION EXEMPTION FORM I, hereby certify that the engineered plan signed by me dated 6 1 ,concerning the property located at 24 t+kqrTe-t--> Ave, . meets all of the following criteria: • This failed system is connected to a residential dwelling only. There are no commercial or business uses associated with the dwelling. • The sail is classified as CLASS 1 and the percolation rate is less than or equal to 5 minutes per inch. The applicant may use historical data to conclude this fact or may I� conduct preliminary tests at the site without a health agent present. • There is no increase in flow and/or change in use proposed • There are no variances requested or needed. • The bottom of the proposed leaching facility will not be located less than fourteen (14)feet above the maximum adjusted groundwater table elevation. [Adjust the groundwater table using the Frimptor method when applicable] Please complete the following: -7q A) Top of Ground Surface Elevation (using GIS information) i �j ) B) G.W. Elevation +adjustment for high G.W. _ ` � DIFFE ENCE BETWEEN A and B SIGNED : DAT E: OTICE Based upon the above information,a repair permit will be issued for bedrooms maximum. No additional bedrooms are authorized in the future without engineered septic system plans. q:health folder:perceamp 10CAT10N SEWAGE PERMIT NO. {�d� 3- VILLAGE INSTLLLER'Sr NAME i ADDRESS ® U I L D E R OR OWNER DATE PERMIT ISSUED DATE COMPLIANCE ISSUED �� � w Y � ,. 6 kfj er THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .........OF........Eby. .".6. -)ZZb-)C....................... Appliration for Dhipaiial Works Tomitrurtion ramit' Application is hereby made for a Permit to Construct or Repair (4--j'ain Individual Sewage Disposal SY t t 0001. )9VC.................... .................................................................................................. o anon Ad or N/fir ... ...... .......... .................... ......... .. .............. . er n. d.. .......................... Installer, Address U Type of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms............................................Expansion Attic Garbage Grinder PL4 Other—Type of Building ............................ No. of persons............................ Showers Cafeteria P4Other 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. ft. > Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. f t. Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date......................................... as Test Pit No. I................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........................ ....................................... .4 ..... .. ....................................................... --- ........................................................... 0 Description of Soil... 11 U ........................................................................................................................................................................................................... ..................................................................................................................................../...........— ... ................................. U Nature of Repairs or Alterations—Answer when applicable...........­.../.::�/ ) ) .... jol.r.............. ... .U-4-0...... ................................................................................................i....................................................................................................... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE LE 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has bee)y issued by the board,,gf health. h ---------- ...... ApplicationApproved ... ... ... ... ..................................................................... .7 --------- Date Application Disapprove r th ollowing reasons:..........................................................................................I..................... ......................................................................................................................................................................................................... Date PermitNo....................................................... Issued_............................."........ ------ Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH Appliration for Di.ivoiittl Workii Tonitrnrtion rumit Application is hereby made for a Permit to Construct ( ) or Repair ( Individual Sewage Disposal System at , ::z-..V .................... ........... --------..... ion-,Ad4ps or Lot No dder ............. W y Owner a ¢ess --�-- ..... Z ................-- Installer Address U Type of Building Size Lot.................... q, 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............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------------......---------............. W Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ r., Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ ---- ODescription of Soil----------------------------------------------------=--:,s�, <.---- L .:U%` 1 x - .....----•-------------------------------------------•---•- V ................•----------••----••••-•------•-.....-•--••-•-•••-----•-------------••----------•---------...•-•••--------------------•••••--....----•---•••-------..................------•-•-•--•••--•-- W U 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 TITILL 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has beejV issued by the board health f, Sign d. _ � r; f------------------- _:. �. f --- Application Approved `= - Z'.^. _........ f/A � Date Application Disapprov( jefollowing reasons:.............................................................................................................. -------------------------------•--------------------------•••----.........-••-----•-•----........------••.•-------..__.......-•-•-----------•--•....-•-••-•------------•-----•-----••---•-•---•.......--- Date PermitNo......................................................... Issued-------•-•---•------------._.._...._............---••- Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ........Flol./�L!,,,"-)..........OF........6U.-I � . 'r ���z�` .................. C9rrtif iratr of ("'ontpliatta TH,LS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired by....... ' "--- at... 1 J'�.t-1 1 a �,i"' } �lns '.'r -----•--� ._._..._ sue._... .._ l..._ ... has been installed in accordance with the previsions of T F 5 e State Sanitary Cod as scribed in the application for Disposal Works Construction Permit No .. � ........_.. dated-.T'.10 ........................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE................................................................................. Inspector..................................................................................... THE COMMONWEALTH OF MASSACHUSETTS --- BOARD OF HEALTH 17.. ! . ....... ...(.✓1, �? .............OF...... [ ' ._ ........................ IC/: f No. _ i fro ttl orkii Tonstr ion Pr Writ Permission is hereby granted--------- --.......... `.1. z..:. ._......_..... to Con r Re air -a Indi ual Sewage - osal Sy tem Street as shown on the application for Disposal Works Construction Permit No.r.. ated.......................................... C� ........................• • -•----....--•-------•--•-•--•----......•-•------•-•--------••••_------ DATE_.,l Board of Health FORM 1255 A. M. SULKIN, INC., BOSTON �u)L� frJC� 2© 1 00 9 TIC tR, EXI TTI G HOME CD - -- -- 9 ._.. -__ W „ 00 eEn�+ -- NEW WINDOW NEW WINDOW 64" 136" zq 264" U� i -NEW ADDITION - Residence: Duchesne y Residence - f -I DWG NO. A- 1 — ADDITION FLOOR PLAN ? SCALE: 1/4"=V-0" — SHEET: 1 of 4 Avg tw�� its A,mt�Y Roon1 �2 � 1b 1?1 A, 718 GAZAG E Sezzoon 8 (z�cr Livinq doom to k1-J, 10 yk� tG C. ASSESSORS MAP : Ip�j TEST HOLE LOGS NOTES: PARCEL: 1 THE INSTALLATION MUST BE IN SUBSTANTIAL COMPLIANCE WITH l �� ) SOIL EVALUATOR: D� M, J�/� RY �S THIS PLAN, 1995 MASSACHUSETTS TITLE V & TOWN OF i FLOOD ZONE: Moo --e—T J WITNESS : NIA} �gNtL� BOARD OF HEALTH REGULATIONS. REFERENCE: MIA DATE: U 2001 2) THE INSTALLER SHALL VERIFY THE LOCATION OF UTILITIES, t PERCOLATION RA E: L 2 h4i1 /tv(� SEWER INVERTS AND SEPTIC COMPONENTS PRIOR TO 'Q C-Ass = 50/� INSTALLATION. u - 3 THIS PLAN SHALL BE USED FOR SEPTIC SYSTEM INSTALLATION owe TH I �., °lc�,�f n TH-2 ) ONLY, AND SHALL NOT BE USED FOR PROPERTY LINE . A SANOV WA-N) DETERMINATION. ' a��� SNU ,► 1 a (L3 Y ►tl� �y� �p►Jt� 5 �� 4) ALL PIPING TO BE 4" SCHEDULE 40 @ 1/8 "/ FOOT. (UNLESS SND� AAi SPECIFIED OTHERWISE) B o S LOW !`f.�`c7 .���?y 5) THE DESIGN OF THIS SYSTEM DOES NOT ALLOW FOR THE USE OF A LOCATION MAP ( ) GARBAGE DISPOSAL. �I SI LT Loh Z'5.1 Y 7`3 6) SEPTIC TANKS AND DISTRIBUTION BOXES (WHEN INSTALLED) -72 62 MUST BE PLACED ON A MECHANICALLY COMPACTED BASE OR ON C049-5s SA-n/A A BASE OF 6"OF CRUSHED STONE. ��SAP G y 32- GEss P s ' � Z�sy /3 7!, 7� G�R.ust _ 1t�t.� . xrsr�,n� __..._. ..._ .. ._.__.. ... 42 442 ► ,�. v�J �o�ra �'��J� �►ot.��..r _.T'�.I�T`"-�.'-ul��—�►!� �L�C?�-� .=._..._.._ f,� Nc, s SEPT I SYSTEM DESIGN �� 7�- g b . __a ._L - arc. G��e o��'\ ��''n�r s �� W/a"N �t6Ct yM 5 ND p6t,Tim FLOW ESTIMATE 2�' 3 .BEDROOMS AT LO GAL/DAY/BEDROOM - 330 GAL/DAY I �3 __�-I o /r 5 t R �to� SEPTIC TANK 0 7o str 7Z,�Z w 3W CaL/DAY x 2 DAYS O GAL 1 t' UR-TVP< <-4 USE I GALLON SEPTIC TANK NGty SOIL i8SORPTION SYSTEM I DE AREA: F( 25') 2-4-0-5) 1-1 • Z X 0,74 = 11 7 , ¢$ 1. 130TT0M AREA: S j x /3 ' y, O,7 _ 2•40 ' ter-"Q SEPT I ., SYSTEM SECT I ON \ r t, 77, Bit �v�s ",,;j;,� ..:.... ...... \ 7�r7s. IOW 0(-O -'kde. s fig• \ 7 .�� LL Z7 D-Box 7¢,s-2-- �- -- r r © 72.4 /r,S GAL 74,Gi � S�- 1!.1 _„t (.. f� SEPT I C TANK r STQRJ6 I SITE AND SEWAGE PLAN D FOCAT I ON : 2- ' H f--o?--D 24 cV • ' t1l.40 l�-1C�57- � Z./1'/ t PREPARED FOR DARREN M. MEYER, R.S. SCALEce 43 VINE STREET DATE: DUXBURY, MA 02332 W DATE HEALTH AGENT (781) 585-0293 W Z F