HomeMy WebLinkAbout0040 MORGAN WAY - Health W. Barnstable' F
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TOWN OF BARNSTABLE
LOCATION SEWAGE # , D®Y—W17
VILLAGE . CS 1 ar"'h:5&-b1e- AM /ASSESSOR'S MAP &. LOT
INSTALLER'S NAME&PHONE NO. 5—
SEPTIC TANK CAPACITY AZO
J H?0.
LEACHING FACILITY: (type)
NO.OF BEDROOMS t
BUILDER OR OWNER /311
�C� vl
PERMITDATE: 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
i
33y,
o
r No. Fee
Entered in computer: l/
THE COMMONWEALTH OF MASSdCHUSETTS `
Yes
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS
ZIpprication four IBigo�al bpztem Construction Permit
Application for a Permit to Construct(,/)Repair( )Upgrade( )Abandon( ) MComplete System ❑Individual Components
Location Address or Lot No. 7i0 114 Q P—6 4;(l Owner's Name,Address and Tel.No.
Assessor's Map/Parcel
I7
Installer's Name,Address,and Tel.No. '? Z7)� S�yS' Designer's Name,Address and Tel.No.
Type of Building:
Dwelling No.of Bedrooms Lot Size !7,65_2 sq.ft. Garbage Grinder(A10
Other Type of BuildingWOOb FAAMC No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow 5 S� gallons per day. Calculated daily flow J�� gallons.
Plan Date Y—® Y Number of sheets Revision Date
Title `s 1719—L 4 5 F_P`T-1 C Lqa/
Size of Septic Tank Z,5W 64"Itl Type of S.A.S. G�9 ��L yS
Description of Soil A-2 PF,le- (JMA-" _ ( XQ 7 (6) S dv a 1/un Cry
Nature of Repairs or Alterations(Answer when applicable)
Date last inspected:
Agreement:
The undersigned agrees to ensure the construction and maintenance of the afore described on-site sews stem
in accordance with the provisions of Title 5 of the Enviro a Code a d not to place in in operation until a Certifi-
cate of Compliance has been iss is Bo d o ea t .
Sign Date
Application Approved by Date E
Application Disapproved for a following reasons
Permit No. r Date Issued /J: t)
Lr
No. ` Lt , w..� +l R Fee
Entered in computer: t/I
IT�MMONWEALTH OF MASSd'CHUSETTS a - *" ;'
k , , Yes
PUBLIC HEALTH DIVISION - TOWN OF,BARNSTABLE MASSACHUSETTS
( Rp hration four Miopozaf 6p.5tem Construction Permit
Application'for a Permit to Construct(V)Repair`( )Upgrade( )Abandon( ) U�Complete System El Individual Components
Location Address or Lot No. q0 114 0 je 6 4AI 6!/ ''_/ Owner's-Name,Address and Tel.No. 5'069- </20- 3/ IN,
Assessor'sMap/Parcel 175/ ri -3at) A05 , 0,JTC2VIC--LZ
Installer's Name,Address,and Tel.No. ?7( �? S�CI Designer's Name,Address and Tel.No. fie' (V21r—Q/3
TO rY1
Type of Building:l `
Dwelling No.of Bedrooms Lot Size 17,G S). sq.ft. Garbage Grinder(A/0
i -.Other Type of Buildin W0Q6`,r#4AM� 1
yp g No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design.FlowS r6/ gallons per day. Calculated daily flow ?�� gallons.
Plan D t r1' 1/-0 V Number of sheets Revision Date
Title``^,/7, �F P T l C ►n 1. ��./
Size of Septic Tank /, `)� 0,4 1-' Type of S.A.S. LA9G11-,NN16 4,41 LE �y.
Description of Soil I Pf, 7 t/6l S Ud 4 F 1(ur+ C
Nature of Repairs or Alterations(Answer when applicable)
Date:last inspected:
Agreement: :.
The undersigned agrees to ensure the construction and-maintenance of the afore described on-site sewagee disposaL system
'in accordance with the provisions of Title 5 of the Enviro a Code a d not to place t ,_Sy tin'n p tion until a Certifi-
cate of Compliance has been iss.ed 'is�oard ofHealt .
Signed" / Date
Application Approved by / Date `1/ / U
Application Disapproved fordhe following reasons
Permit No. Duo 4 yi% Date Issued
11 ————————————— —————-------------------
for :2131,VS QJ THE COMMONWEALTH OF MASSACHUSETTS
ST4 DbOx,r lees'dc Sf BARNSTABLE, MASSACHUSETTS
Certificate of Cony#fiance
THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed(V)Repaired( )Upgraded( )
Abandoned( )by %Q 44 eC-:4✓0 e-6'1
at NV 1QR6AA1 4VA-1 , 4VC57. 'NSTi9d3�� has been constructed in ccordance
with tl3 provi� s_i n o T fie'S�and-'flie for tsD posal System Construction Permit No.2 00 Y- Y c�7 dated °I ( � 0 t
Inst ler. - _ �'�_ Designer _ _ N`P_ 1A 9, /-SOIN
The fi ance of this�/ermi nshald not be con e a guars that the s to I'll fu ction as designe .
Date .�/9�(�✓ --'� Inspector
\----------------------------------------
No. C of `7,! 1 Fee /
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS
Di,4pool potent Construction Permit
Permission is hereby granted to Construct( )Repair( )Upgrade( )Abandon( )
System located at 1/B m U+e (o 4AI /.UA`/ Lt/. 6 rRe N 5 7fRt5(-E
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:Construction must be completed within three years of the date of is e 7 t.
.- \ # �`
Date:_ � ' Approved by /#. (�
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No.30216
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Town of Barnstable P# 1 a,$a Z
Department of Regulatory Services
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Public Health Division Date 3 h
� 16j1 e 200 Main Street,Hyannis MA 02601
ArFG Hl/`l�
Date Scheduled Time Fee Pd.106 e
Soil Suitability Assessment for Sewage Disposal
Performed By: 5ln*2 t" A ( 3 1 sn 1_T__!C_! Witnessed By: /
n LOCATION & GENERAL INFORMATION
Location Address +/l) 1V 0 J' LAA W tA Owner s Name
bbs.
W e 4. Address
8 c�rnJ'
Assessor's Map/Parcel: si
Engineer's Name 5*29 r A•W�
l ?S D `1 Oarif►., tires s
NEW CONSTRUCTION X REPAIR Telephone#
I.and Use Slopes(g'v) 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&pere tests,locate wetlands in proximity to holes)
/06.. +
Si2yds N 9.. / 1 O'
� N 1
Parent material(geologic) t'la r^uu^R- � 9t Depth to Bedrock
Depth to Groundwater. Standing Water in Hole: Weeping from Pit Face
Estimated Seasonal High Groundwater
DETERNIINATION FOR SEASONAL HIGH WATER TABLE
Method Used: In. Depth to loll mnttlas: in,
e
Depth Observed standing in obs.hole: p }r,
Depth to weeping from side of obs.hole: -- — ill, Groundwater Adjustment
Index Well# Reading Date: Index Well level^.„..,,---.... Adj.fnClor.
Adj.Groundwater Lovel,�
PERCOLATION TEST )late TimeObservation Time at 9"
Hole#
Time at 6"
Depth of Perc `b•� .. �-.-----
Start Pre-soak Time @ .S _ Time(91•6") . 2QrAd —
End Pre-soak
Rate Min./Inch /0 Min /Mo _CL Owas Ti 501A—T
Site Suitability Assessment: Site Passed 1100-, Site Failed:
Additional Testing Needed(YIN)
Original: Public Health Division Observation Hole Data To Be Completed on Back-----------
***If 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:\.SEPTICIPERCFORM.DOC
DEEP OBSERVATION HOLE LOG `Hole# I
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders.
Consistency.%Gravel)
1-0 YR sht
yr—12 a er Lo4 wr
12',-34„ , G� g�l� 5cahcl to YR ��G
, a u a Wru(,-Coarsc. 6�3
3l0 — "1�. � SoraO W SfvneS /0 YK
MCA, 50wj 7/
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DEEP OBSERVATION HOLE LOG Hole# Z
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(ih.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders.
Consistency, Gravel)
y o A Uu4� l.o�w, 10 'gyp
H L� N '.(AI d7
3 7 11I3
i V- 36 r< CI . Say.dt I O`� ►Z S�Y
36 - is6° " �� s t`y Io Yt? 4/41
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
DEEP OBSERVATION HOLE LOG Hole#
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders.
onsistency, e
Flood Insurance Rate Man:
Above 500 year flood boundary No Yes
Within 500 year boundary No
Within 100 year flood boundary No V Yes
Depth of Naturally Occurrine 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? _qSA—
If not,what is the depth of naturally occurring pervious material?
Certification
I certify that on 411 115 (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 Date
Q:\SBPTiC%PBRCFORM.DOC
DtE5T6N DATA
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No.30216
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Town of Barnstable
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Regulatory Services
NAP O�
-Thomas F. Geller,Director
Wes. Public Health Division
EoAa. Thomas McKean,Director
200 Main Street,Hyannis,MA 02601
Office: 508-862-4644 Fax- .508-790-6304
Installer & Designer Certification Forth
Date: 5 Z�tiS
Designer: Sh g,w , A . W l Ls" r'E • Installer: 1 dt" At _/'I it 6,C, .
Address: 1320711 7,, hJ "; 1-{0►,,,tg Address: J 7J 1S/
On was issued a permit to install a
W/
(date) (instal!r
septic system at 516 6)rsf 46ar -9$6 4, based on a design drawn by
da( bidress)
Sk h�l A 6)"/St-i r 1-7C dated %I3o Z2oa y
(designer)
I 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.
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.
-\N 0f l�jgSs� a
1
STEPHEN
ALLYN m
o WFLSON
(Inst ' er's Signature " No.30216 y
4
�FGist
FSS/p�lAL E '�
signer's Signature) (Affix Designer's Stamp Here)
r
PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE
OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM' AND AS-
BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION.
THANK YOU.
Q:Health/Septic/Desiper Certification Form
C `aoo'Y-1/7/
TOWN OF BARNSTABLE
LOCATION SEWAGE # 200Y �
VILLAGE. �eS� �'�g �t //ASSESSOR'S MAP & LOT
INSTALL.FR'S NAME&PHONE NO.
SEPTIC TANK CAPACITY e4 � - r
LEACHING FACILITY: (type) �� � �/i/l�� �(size) X ,
NO.OF BEDROOMS t IE
BUILDER OR OWNER
(PERMIT DATE: 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
Feet
on site or within 200 feet of leaching facility)
Edge of Wetland and Leaching Facility(If any wetlands exist
Feet
within 300 feet of leaching facility)
Furnished by
x.
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