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Home My WebLink About0770 MAIN ST./RTE 6A(W.BARN.) - Health 770 Main St. , Rte. 6A, W. Barn. A= 156-016 a 4 4 I u No. 4210 1/3 BLU ESSELTE 10% 0 0 0 No. t p�J� �(0 _ " FEE . Board of Health,Z4 CW&e , MA. APPLICATION FOP, DISPOSAL SYSTEM CONSTRUCTION PERMIT Application for a Permit to Construct( ) Repair( ) Upgrade/ Abandon( ) - ❑Complete System ❑Individual Components Location 72Q2 Owner's Name Map/Parcel# % S" i Address Lot# Telephone# Installer's Name T . ys O Designer's Name V1/ A s.5o Address Address Sratj W v-( Telephone# .2.0 10 Telephone# `762 Type of Building l Ajas C Lot Size sq.ft. Dwelling-No.of Bedrooms 2&60 r Garbage grinder ( ) Other Type of Building IO No.of persons Showers ( ),Cafeteria ( ) Other Fixtures Design Flow (min.required) Z d gpd Calculated design flow d Design flow provided e:d ® gpd Plan: Date _ s 7 Number of sheets Revision Date Title shgW4616 fv Description ofSoil(s) `f {AA1 /�,�� ` �± Soil Evaluator Form No. Name of Soil Evaluator � ��—Date of Evaluation c-= "7 7 DESCRIPTION OF REPAIRS OR ALTERATIONS The unAag;renot es to ins a above describe Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and further o�lace tem' peati n til a Certificate of Compliance has been issued by the Board of Health. Signed (� Date 6�`/�S7 Inspections No. 7-2— 1' a . � ~ /0 COMMONWEALTH Of MASSACHUSETTS Board of Health, �/2 (�%�• L� , MA. APPLICATION FOR ➢ ISPOSAL SYSTEM CONSTRUCTION PERMIT Application for a Permit to Construct( ) Repair( ) Upgrade/Abandon( ) - ❑Complete System ❑Individual Components f Location 2 Owner's Name L( DO ¢p a Map/Parcel# S .� Address) j s. Lot# Telephone# Installer's Name TCJZ> Designer's Name VP ASSG T1[Address \ Address S� (C elephone# 8 _ O Telephone# Type of Building � Lot Size sq.ft. Dwelling-No.of Bedrooms 2CD I C ) Garbage grinder ( Oth'ei=-Type of Building No.of persons Showers ( ),Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Calculated design flow 2�0 Q-- Design flow provided 2:0 gpd Plan: Date /v/ Number of sheets Revision Date Title .S19W C5Lr )9 f Description of Soil(s) Soil Evaluator Form No. Name of Soil Evaluator 111414 C Date of Evaluation DESCRIPTION OF REPAIRS OR ALTERATIONS The undersi 4ees to inst a above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and further afire not to,place a tem in peratii ntil a Certificate of Compliance has been issued by the Board of Health. (.%C (r ♦,,,�/ Signed - Date sy, "C/7 Inspections r f .. No. 3 FEE COMMONWEALTH Of MASSAC14US ETTS Board of Health, MA. CERTIFICATE OF COMPLIANCE Description of Work: ❑Individual Component(s) ❑Complete System The undersigned hereby certify that the Sewage Disposal System; Constructed ( ),Repaired ( ),Upgraded ( ),Abandoned ( ) by: at has been installed in accordance with the provisions of 310 CMR 15.00 (Title 5) and the approved design plans/as-built plans relating to application No. dated Approved Design Flow (gpd) Installer Designer: Inspector: Date: The issuance of this permit shall not be construed as a guarantee thatid system will function as designed. No. `+ 9 FEE COMMONWEALT14 ®F MASSACHUSETTS Board of Health, MA. DISPOSAL SYSTEM CONSTRUCTION PERMIT Permission nii(s+hereby grPZ&- Construct( ) Repair( 4.�Upgrade( ) Abandon( ) an individual sewage disposal system at 1 /0 6 Y f NS f M as described in the application for Disposal System Construction Permit No. 9-1 233, dated Provided: Construction shall be completed within three years of the date of this permit. All local conditions must be met. Form 1255 Rev.5/96 A.M.Sulkin Co.Boston,MA Date � I/ Board of Health i ! TOWN OF BARNSTABLE LOCATION 7 7o P-7 g I SEWAGE # VILLAGEW61 ��QIuS9AgiQ_ ASSESSOR'S MAP & LOT INSTALLER'S NAME & PHONE NO.f�jou5�-te(c� ��j�-L01 d SEPTIC TANK CAPACITY IS 3- ltop? rr. LEACHING FACILITY:(type) flaw��✓Stld(3) (sue) It, k30 x i NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNER DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED; VARIANCE GRANTED: Yes No o 0 9 � OLL IMIN -S TOWN OF BARNSTABLE LOCATION () P-i(p A SEWAGE # VILLAGE(�Sl 6k2 sygl- ASSESSOR'S MAP & LOT INSTALLER'S NAME & PHONE NO.�uS-�t e SEPTIC TANK CAPACITY o P7 LEACHING FACILITY:(type) V'lowA 9zleS(3) (size) (b k 30 XI NO. OF BEDROOMS ►PRIVATE WELL OR PUBLIC WATER We P BUILDER OR OWNER DATE PERMIT ISSUED: 1 -,)s DATE COMPLIANCE ISSUED: e��=� VARIANCE GRANTED: Yes No �� 42 _ . a ca s Town of Barnstable P# P 9 13 ? Department of Health,Safety,and Environmental Services eve Public Health Division Date 13 p- y 7 367 Main Street,Hyannis MA 02601 enaxafrAHLK Date Scheduled -to 9 ? Time 10,;6 64 Fee Pd._ 100 Soil Suitability Assessment for Sewage Disposal Performed By: Witnessed By: �ya<N/N�� A61017`. LOCATION & GENERAL INFORMATION Location Address `7 74 9-�r, ro 7A w, Owner's Name" Address 7SO A7ZFF ,0• � Assessor's Map/Parcel: /✓��o/�� Engineer's Name /i/' /W &V ��,k7!' NEW CONSTRUCTION REPAIR Teleepphone# Land Use ,� �h�isi�li �luSiit,.��dopes(%) % Surface Stones Distances from: Open Water Body It Possible Wet Area 455;0 ft Drinking Water Well ./.2 ft Drainage Way ft Property Line _25 ft Other et z ft SKETCH:(Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands in proximity to holes) ( 3 r r/ flovs� � r Parent material(geologic) Zd25 —m7s // Depth to Bedrock f Depth to Groundwater: Standing Water in Hole: FD Weeping from Pit Face Estimated Seasonal High Groundwater r : :: 1� 1 1�1V1INATION rOi� �am S ';n �� Method Used: Depth Observed standing in obs.hole: flOd in. Depth to soil mottles: CZ in. Depth to weeping from side of ole: in. Groundwater Adjustment D, 8 Index Well#�ZReading Date:� Index Well level �� Adj.factor /Adj.Groundwater Level :Sep PERCOLATION TE'sT Date h jl`rme .fie"E L� �srN r � Observation Hol�of Time at 9" Dep Pere Tim 6" Start Pre-soak Time C! Time(9"-6") End Pre-soak Rate Min./inch Site Suitability Assessment: Site Passed ✓/ Site Failed: Additional Testing Needed(Y/N) Al Original: Public Health Division Observation Hole Data To Be Completed on Back-� 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.° 2 5; 6 DEEP OBSERVATION HOLE LOG Hole# Depth frar. I So l I lorizon Soil Texture Soil Color Soil I Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulderes. Consistency,° Gravel) :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 OBSERVATION HOLE LOG: : . Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulderes. Consistency.°o Gravel) Mood Insurance Rate Map: Above 500 year flood boundary No_ Yes Within 500 year boundary No Yes Within 100 year flood boundary No ?C 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? If not,what is the depth of naturally occurring pervious material? Certification I certify that on Ao�(f (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. Signature S �� Date 7 ASSESSORS MAP : t5�a TEST HOLE LOGS NOTES : PARCEL :. /( - I . VERTICAL DATUM : 4, �5`s FLOOD ZONE : !, / I,rG ,61 ' v '� . G t ✓%�� 7,� SOIL EVALUgT R : �9 � ,� ay ram, 2 . MUNICIPAL WATER 40 AVAILABLE , L� WITNESS : GE; , t�r�. �' REFERENCE : /;; �v'S �"� DATE : _ 3 . SCHEDULE 40 PVC PIPE TO BE USED THROUGHOUT SYSTEM UNLESS F-s 1_0& /"ovJ Rr ,+/ ,�„� 'Y 9 P 9c3 7 v 6L1 PERCOLATION RATE : / OTHERWISE rJOTEa . 4 . ALL PRECAST UNITS TO CONFORM WITH AASHTO : 5 . PIPE PITCH - I /4' PER FOOT UNLESS OTHERWISE NOTED. TH- 1 96. y TH- 2 6 . ALL CONSTRUCTION DETAILS TO BE IN CONFORMANCE WITH MA . ENVIRONMENTAL '( { CmODE ( TITLE V ) AND LOCAL REGULATIONS 7 . CONTRACTOR TO VERIFY LOCATIONS OF ALL UTILITIES PRIOR, TO CONSTRUCTION . /OYR- LOCATION MAP tL� �,�� /ov, ?- /FI y� 5 c � 5 l3Z y /3 9 SEPT I CXSTM DESIGN FLOW EST-I MATS Aa;-1¢/4 ,,%�� `,' AT SO GAL /DAY 110W. ,517 GAL/DAY .�a J # yZ 4/ - - - SE?TIC TALK ) �r �" ' °``T t ` _- �, 'J G4L/DAY x 2 DAYS - 4' O GAL t-67-6 _ ( ,, ,� USE ,S; YOGALLON, SEP-T I C TANK r 1 c --,-,SOIL ABSORPTION SYSTEM SHOF�'1gsIAMY 3T c' t ` i.�5 FGvu�Lf!', ,, 'Sri ='ra�TPf �3 ill'fiY -=>r�"?7sf�" o VON HONE � h>�''�� Pry+a ', �a �� CD Na 2�9t3� �, - ` SIDE AREA - r-rAR fQr cut q Pa— _. (n✓d u ' .¢g' o �2, , 9 BOTTOM AREA : (3 G +✓ ' /o r t ,1�:U. / ?5.�. �_, �. %1,� __ l�� I N��E ssr �oQ l SUR`i ,7, f SEPT I C SYSTEM SECT [ ON 7 _ ,�F•rou-�, _ _ a1-�X E1 moo.•(, 7L. �4,�t s�-GE-- ,Llin1. 2 4 '&W Jul i� r ya 7' . , f 'f �(N/i � a/Or .. , r0 y Z�1 r«.r"' �•+1 .y # Z �'� . ` 3!_ ._-._ {. SDI IL %v�IG� LL dc� /t1L Qb.l l�fl GAL z �+�-3 /6 u5'ca.�t5 1 SEPTIC TANK ,aiw. L ' �. Sra \ � P/'�fh"�` ��C/3T/'�"'1�'' .� �� 4 �� .STD•c%a!' _ S L-- 53. 5 ' -t- --' T o,t - 7.. i �,�� ,�►► j S I TE AND SEWAGE PLAN �---,-----•� � �:.,. . ( py --- -- _ �OCAT I ON %' 9rr/� 0 � 6fl ice. L. j s -- ------- - PREPARED F 0 R14 - � - ► � �,•_._- ,E ��'_ ,....�'- Nam/°�� V . H . ASSOCIATES SCALE :/= c r-- 320 C 0 T U I T R-0 A D DATE : - 7 . DATE HEALTH AGENT SANDWICH . MA 02563 ( 508 ) 833 - 0041 r