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HomeMy WebLinkAbout0976 MAIN ST./RTE 6A(W.BARN.) - Health 976 Main Street (6A) West Barnstable A=179—001 - 002 i Town of I3 Trustable Departtticut of ReguTnlory Services 06 OMTA_ Public1lealil J)'V'-o>Ii Date • AM $ 200 Main Street,I lyalmis MA 02601 ` M,�' tt01M� -V i 76Jyf(J� 1Tillic __-f--- rcerd. Date Scheduled I . osal • � nl or Sewage Das • ie '. .�1ss essrr ,� ilr! Soil Suitab y t Witnessed By: Performed By: j LOCATION & GLNEIRA.L INFORMATION 1 Owner's Name D Location Address ('-t7—(6 4 J Address ��i0'✓ 'Y r I r-" ine' Name Q v 1 Assessor's Map/P4reel/ g/�0/,-Ooa I 0� `j 601 NL'W CONSTRU010N ', REPA[R j 4eplicac Slopes(4h)_ Surface Stones Land Use 'et Area R Drinking Water We I ft Possible W = B ' Distances from: open Water Body (r Other Drainage Way ft Property 1•i",p—"'-` \i /+�7 t � `-rT�r, T © ti►'r rJ31L•TCIl:(Street name,dimensions of lot,exact tocatious q •';�,. .� - .I ♦ ;e r 3.Bt•K` 1 fib• `1 • �, TiGC I o a i a / Parent material(gcdlogic) dsrr Weeping from 0 rr Pit Face ater. Standing Water le. r in Ho Depth to Groundw I 4 F Pstimaled Seasonal high Groundwater — oN roR SEASONAL I•i>�GI1 WATER TABLE ll Eft NAB TI I 1 In. Depth to Sol,mottles: MCtl10d UScrI: _��:. In nhg,bole: "I'Allndwater Ad;ustitlOn( Depth Ouserwi ta.. .:i ii➢. A ,UiUUDuwuirr�'"=l from side o[o .hole: Ark,{a@tor �-.- _ DO th lolweeping 06 Index Well level � 4 Lldcx well Ns2L — Reading r,�I� A r/� r�r�+r� n OE;� PRRCOLA���XUN _Ej S A Dater I`✓�O'�Ilrl��.� .�G I 3 Time at 9" Observation � }tole N Depth of Pcrc lime(q"-G') r Start Pre-soak Time-Q J 11 Bend Prc-soak L i Rate Min./inch — Site railed; AJJitional Testing Needed(YM) Site Suitability Assc smcnC Site Passed Original: Public HOW,Di vision Observation Hole Data To Be Completed on Back ------- a ibu test is to be conducted within 1:00' of wetlltnd,you must first notify the ***If percol rior to beginning. I3arllstable Noscryation Division sst least ouc�1)week p DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Ilotizon Soil Texture Soil Color Soil I Other Surface(in.) (USDA) (Mansell) Mottling (Stntcturc,Stones,Boulders. r tency.%Gravol) Ar.%... w Ir - rz— DEEP OBSERVATION HOLE LOG . Bole# Z Depth from Soil horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consis e c a e _ lrS Dry A) 7-5. rt�d W� PEEP OBSERVA'I'ION HOLE LOG Hole# ' Soil Texture - Soil Color Soil Other . Soil If De tl►front I pUSDA) (Munsell) Mottling (Stiucitlre,Stones,Boulders. Surface(in) �... C si 1 e Gra _. 2'I • i I - 'DEEP OBSERVATION HOLE LOG Hole# i I Depth from Soil horizon Soil Texture Soil Color Soil Q►her t! Surface(in.) (USDA) (Murrsell) Mottling (Structure,Stones,Boulders. �) " ons en — r, r.4- Flood Insurake Rate Man: Above 500 year flood boundary No Within 100 year boundary No' L Yes , Within 100 year flood boundary No Yes s' Depth of Natutally Occurrin Perviol Material terial exist in all areas observed throughout the` Does at least ftille feet of naturally occurring pervlotts ma area proposed soil absorption system? If not,..wl►at is the depth of naturally occurring pervi' material?- certification / I certify that on. ( ?i (dale)I have passed the soil evaluator examination approved by the Department of)�nvir run taI Protection and that the abovo.analysis was performed by me consistent with the required tra Ig:expertis nd a 'once descr.'ibed in 310 CMIt 15:017. Date 7" Signature Q;%SflMCWERC6 DRM.DOC I No..----�� 7 : Fsic ......... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH lorD wA.......OF......... 6�tt1s�.S --�461V............................ Appliratiutt -fur Diuvuutti Workii Towitrurtiutt Vautit qlUApplication is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal Sys tem at: ...-- ..................................... Locati Address .r or Lot No. Owner Address w ------------------•�- r-� •--•-- C .S� OdG .----...-•----......-- ...............................••-------..:----...-•••-----------------•-•---•-•---------••--•--- /� Address /-Type of Building Size Lot____________________ ............................Sq. feet U Dwelling—No. of ems..--_'-------------- - •----_----.__--__-Expansion Attic ( ) Garbage Grinder ( ) Other—Type of Building -_ ------- No. of persons---------------------------- Showers ( ) — Cafeteria ( ) a Other fix u,es ------------------------------------------------- d --- ---- -- - w Design Flow........,%t................................gallons per person per day. Total daily flow......_____....�.S...O._...-_... --_-gallons. WSeptic Tank—Liquid capacity�-Q4of)_gallons Length---------------- Width................ Diameter................ Depth----------_--- Disposal Trench--No. ._..___ �_r}G___ Widt T�$tal ennih--_-___--__-----.- Total leaching area--------------------sq. ft. Seepage Pit No..__ .�DUlameter____________________ 1Tepth bw t�nPet_________....._..__ Total leaching ttre:t------------------sq. ft. z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by---------------------------------------------------------- - Date--------------------------------------- ,aa Test Pit No. 1................minutes per inch Depth of "Pest Pit.....___..._..._.._. Depth to ground water........................ Test Pit No. 2................minutes per inch Depth of Test Pit.-----_--________- Depth to ground water_...-.-.--_--_-.-----._. t� ----------------------------------------------------------------•---••----------------•••-•---------......................................................... 0 Description of Soil-------------------------------------------- ......---.....�, ------------------ ---------------------------------------------- U /Z.�-T-------L1.4.40= 4,6V9.. v-&..............'I.........�......c•'�---A------�,,O' �J w ------------------------------------- ----------------------------------------------------------------------------------------------------------------------------------------------------------------- VNature 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 Article \I of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been iss the t Sied._- .---:---• . _--•. . ----- -•-- .-• ----- ---•-•------------------------ Date provedB ------- ---------- - •------ �• ----------------------------------------- -/7>----------------Application Ap -Date Application Disapproved for the following reasons------------------------------------------------------------------------------------------ -------------------- ----•------------•---------------•-•••---•---•---------•-•---------•---•--------•----------------- ••---•. ----------------------------- Date Permit No........`? --•-------------••-•----------•---- Issued-•-- ........ . . ... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .. .....r ----OF.........A/ /�.�-:.:c.r.r���'�'t.........._..... ......... App iration -for Diopoottt Workii Tanotrnrtion Vrrmft Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: `-d o A J`f r. C- ....% j` - f_� - �.r L - /�f� Locatioa-�„„Address ��-jj J l:_/t L'Sr� C/AA-- or Lot No. t J ( = ------------ --------•--- ---------------- •-•-----------•-••-••-•---•- Owner Address /y l.Ilnstaller Address d Type of Building ) O Size Lot----------------------------Sq. feet U H BeDwelling—No. ofmis____________________r .Expansion Attic Garbage Grinder ( ) Other—Type of Building --- No. of persons____________________________ Showers ( ) — Cafeteria ( ) Other fi lures ------------------------------- -- Design Flow........1__5........................... _gallons per person per day. Total daily flow---------------- ______------....gallons. W WSeptic Tank—Liquid capacity�/f -gallons Length................ Width................ Diameter................ Depth.--.----_-.._- Disposal Trench—No. ._._..._._•_ Widtll____.___ Total enZh-------------------- Total leaching area-------.------------sq. ft. Seepage Pit No.___�_---_------� Diameter____________________ Dept b w inlet-_-_________________ Total leaching area------ -----------sq. ft. 4000 z Other Distribution box ( V) Dosing tank ( ) Percolation Test Results Performed by------- ----------------------------------------•--------•-------•-------- Date_-_______---•-----------•-----••------- a a Test Pit No. 1----------------minutes per inch Depth of "Pest Pit.................... Depth to ground water..-.---------------.--.. f1 Test Pit No. 2________________minutes per inch Depth of Test Pit.................... Depth to ground water--..-.---__-----_---_-. P4 ------------------------------------'----------------------------------------------•...................................---------------•-------•------------ D Description of Soil F =------------ U -------------------------- - ---------------------------------------- •• ----•-•-- ---------------------------------------------------------------------- w ------------------------------------ --------- --------------------------------------------------------------------- ---------------------------------------------------------------------------------- UNature 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 Article XI of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued" 'the o Ala It . G Signed. ' -----_=- -'` ------------Date------•------ f� Application Approved BYJ(-__/<----------T............................................... Date Application Disapproved for the following reasons:---------------------------------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------- Date Permit No. �7 �� Issued sr-.._'O_'.. --------------------------------- Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH •-;- --- �.cL. ` ............OF........../? f:l�. �/-/�-92d. r' Trrtifiratr of f'o'ntplionrr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) Zi l S S f�'r/G S_ i Installer / y w`y J ,�i r fiI r - /r at ------•-----__-_--•-------------------•------------------------------------•-----------------------------•----------•--__----------•---------------------•----•--------••-----•--------- has been installed in accordance with the provisions of Article XI of The State Sanitary Code as described in the application for Disposal Works Construction Permit No_______________ °.________.______..... dated...---.-�-:_---_-_- --._--_-____________ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM WILL FU CI ATISFACTORY. r --'-_-"-- . -- Inspector� THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ......................................... OF_...���`� r� �T..,� o No........:.... .•••-- FEE_..................... Dinpoottl ork Tonotrnrtion Prrmit Permission is hereby granted............... __ ..fl r ' .S '-(.s----•----------------------------------____________---__________-_--•- •----• - to Construct ( � ) or Repair ( ) an Individual Sewage Disposal System /7-----` /,, �� j- r 1,.d~7 . t (=s r" ,_, �,/�_S,7 -•---------------- ----- -----. - z� Str eta as shown on the application for Disposal Works Construction Permit No----- _2 /____ Dated._-.---.�.:--f'.-�_----___________ ---------------------------------------------------------------= '-----------•---•••-------•---•-•--• Board of Health DATE................................................................................ FORM 1255 HOBBS & WARREN, INC.. PUBLISHERS --