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Home My WebLink About0070 OAK STREET (CENT./W.BARN) - Health 70 Oak Street - West Barnstable 250 013 t � e a c , v .b 9 �..� d, �,� ��.` �� '� 4. � - yam• �' .x t� K„,ia� - ^y a. e.� m ,. � -J - n '� '�C � �. � _ x x. a N � ',�w• „ N r , ry 9 � �i7 4 "' �} a M'� . n .. ., ,. ,. , ,. .. uw� .�� a:r #''Si .. . � �- .. � y `. ' - it .. •. . _ iy .. .. .. .. ,p I- ;r No.....Xs--y..... FRic.... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ........ ... - -------OF................................ Appliration -for IN-4paiial Workq Tonstrpjon 1hrmit Application is hereby made for a Permit to Construct r Repair an Individual Sewage Disposal System at: ...............7 ..........4570�� .................................----------- ................................................................................................. jation-Addres or Lot No. ......... ................................. .................................................................................................. ne Address ..............To.Z ,......4 .. . ..... .................................. .................................................................................................. Installer Address Type of Building Size Lot----------------------------Sq. feet U Dwelling—No. of Bedrooms---- Garbage Grinder--------7-----------------------------Expansion Attic a, Other—Type of Building ---------------------------- No. of persons..-_____.-_-________---__-_- Showers Cafeteria Otherfixtures ------------------------------------------------ .......... ----------------------------------------------------------------------------------- Design Flow.. ............................gallons per person per day. Total daily flow--__-_-_300--------------- ---------gallons. Septic b P4 eptic Tank capacity_fi?��C,gallons Length---------------- Width......__...... Diameter---------------- Depth------------ Disposal Trench—No. ---------- Width. .. Total Length--_-__-__--_--___--- Total leaching area-------------- -----sq. f t. Seepage Pit No_____________________ Diameter-/-,-v.............. Depth below plet.......j.......A... ota�Aleingar .1------ _Y?---------sq. It. Other Distribution box Dosing tank wt — Z >I,C,V;4 - k Percolation Test Results Performed by----------------------------------............................4---------- Date....... Test Pit No. 1................minutes per inch Depth of Test Pit..........._........ Depth to ground water-..--4 Test Pit No. 2................minutes per inch Depth of Test Pit.._.._...........___ Depth to ground water-.......... -------- ------------ ........ ......... - ...... ..................................... --------------- - ------------ -—--------- ........------ ----- 0 Description of Soil------------- . ... �4 U ------------------------------------------------------------------------------------------------------------------------------------------------------------------------ --------------------------- W ----------------------------------------------------------------------------------------------------------------- ----- ----------- ---------- U Nature of Repairs or 4Rerations Ans�h�eppIicable---—--- ... -------- ------------ --- :Ylv-464�1------- PP �--------------------------------------------- Agreement I ---- ------- --- --------------------- ---- --------- : 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 by the board of health. Signed . .... .. ....W---------------r n ............................................. ......... Date Application Approved By---- ...... ..... C -4 a, Application Disapproved for the following reasons--------------------------------- .... ........................................................... I .........................................................................................................I----------------------------------------------------------------------------------------------- Permit No......................................................... Issued....7-1; .Date....... / D/te ——---------------a------------------------------- ---- ---- -- No.....x.Q w. Fus. { THE COMMONWEALTH OF MASSACHUSETTS F BOARD OF HEALTH y OF. x-------- -- -------------------- ;. Application is hereby made for a Permit tQ�vConstruct ��o Refiair (Z 1n Individual Sewage Disposal System at 13 /Iif, at,o f res ,� � � or-Lot.Ivo - --•-••• . ... . `--- -----•-- ..... .. .......... ----•---••......• } .. •- ........................................ caner Address v. Installer Address Q Type ofBuildinggNo. of Bedrooms_._____...............`:.... .....Expansion"Attic ( :,� Size Lot Garbage Grinder q feet Other—Typk ,:of Building '____________________________ No. of persons _--_-____x_......... Showers ( ) — Cafeteria ( ) P I er f ures ----- ";t --•-- w Design Flow__:_ .___., gallons per person per day �I'otaall dai y flow...........................................gallons. WSeptic Tank LiquiCisca]ncit�r r/d gallons Length---------- Wldthr Diameter____. .:, .._.__ Depth. ... __ .: x Disposal Trench—No _ --_. Wld�th._ ___. ._,f1Total Length,-. n Total leaching area..............____.sq. ft:- Seepage Pit No................... iameter _ ---_- Depth below let_____ _____�`+��w t 1 ing ar .1 Other Distribution box qDosing tank ...�- aPereolation Test Results Performed by._._... __ :......... ............................. rafe........... : Test Pit•.No. 1________________minutes per inch Depth,=of Test Pit-------------------- Depth toground-water...._�Q_ .:.. � fs, Test Pit No2_•-•_-__________minutes per'inch Depth°of Test Pita--------------•___. Depth to groundwater........._.__..-__--__. tx _ . I l . O Description of Soil "� •. . !'�� - '"`'r ` x t w ----------- ------ -----------------'----------------------------- ----------•--------_..._.._..... U Nature of Repairs or Lfterations Answer he .applicable._` -- .._. ----------- p ^ 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 issu by the and of health. /J Signed ---- -- ••••_............... / •• -- Dat Application Approved By-_... y_. _ . r.5 ,y ate Application Disapproved..f or`h, f ollowing reasons-------------_----------- ---- ......--------_.._.. ; ............................................................. -------------------•---•-------------------•----••-•-••----•----------•-••-•••---••••••.=••••----•---------•----................----•-... Date' Permit No......... Issed.... .............................................. w. Date THE COMMONWEALTH OF MASSACHUSETTS BOARD O HEALTH .............O F...... ........................... ..,. Trrttf rtttr of f,��oolitturr IS I CE FY, That the Individual Sewage Disposal System constructed ( ) or Repaired ------------- - --- -------•----------_--- --------- Inst ller e has been installed in accordance with the p rovisKns of Article X.I of Th State Sanitary 1 as scrl ed in the application for Disposal Works Construction Permit No_____________ _ __ __________ dated_... , ..1� __ THE ISSUANCE OF THIS CERTIFIC4-TE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FU CTION SATISFACTORY. - DATE-,— %------------------------------------•••--•-••-•• Inspector... ..___- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH NO........ --- _ l... FEE .............. wt5#o al rkii Wnstr* t.ramit Permission is hereepair grante _ _, -••••••--•• .. ..••------••••......---••-••--••--......... to Con?ftj or ) n In ual Sewage Da posal System„wat No.. 1 -"-. > . . ................ ------- --------------------- ••... s° Street w as shown on the application for Disposal Works Construction e it No.. ' D�ted... .__ _. _._ ......... - ------ --- ----- .._ y ' fie.. � oa of Health DATE h-- FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS ' 1'f)wn (i,I lfarnstablc Pll 1)cparinlcnl of health,Safety,and Enviroomental Services �Iigl Public Health Division Date 4 767 Alain Slrcel,I lyannis NIA 02601 UARINTrAWY. ) ►IAS& Dale Sche(lnled 'lime �l It-cc I'll. Soil Suitability Assessment fins Selvage Disposal a •1'crfunncd Hy:<� 2N/J2r, /o(ir�t/� 1Vitncssed 13y: �Junin�/1 /'�i2A/U.,! " 1,QCA."UO . & GI,N1�itAL INI(OW",I T10N z, cNiplL��o�/6�iv,S� Location Address O\vncr's NalnW 6/4,, G✓O°D Trz� \ / Address 1 Assessor's N1ap/I'arccl: j 3/z Engineer's Nalnc Au- GAe'a E�✓Giwc3E3/Z/ NIiW COt,&I CTION i) IMPAIR I •telephone 11 7�& Land Use loeSl'Ib //)L— Slopes(96) L`3 Surface Slunes } 1)tstanccf Irorll: Open Widcr7lody > oQ Il Possible Wet Arco R Drinking\Vater\Nell 7f o0 ft ' Drainage way; zJ Il I'loperly Line 7/OU II Other A/A , p I .SKETC11: (Street name,dimensions of lot,exact locations of ie$('ll(IICs&perc tests,locate\hands Ill proximity to holes)r - t /.4t4Gw.r/0 5., ivaT i3� � #L �:; . . ... : IL) t. ..:fig rC tR, . + I Pamil malcrl ll(geologic) A/✓oi✓iG/� / 'u2/9�/✓d �c91�JCjyS Depth to Bedrock Z 00 I { Depth it)Groundwater: Standing Willer in I lole: Weeping from],it Face /V ; _, Eslllllil(Cd Seas01181 Iilgh GfoU11dN'il(l'f Ali y0 x ZS �3�Lot✓�ir�n ram' -_ i r. DETERMINATION FOR SEASONAL 111011A A R,VAB1,E, Nlcllloll!!sell: �-7 C?uw/+*o l/�rAfDj= /^''o i u'%7/Gu✓fi/ 7j12 ' Depth Observed standing in oils.hole: in. Depth to soil mottles: �a Depth to wccping from side of obs.hole: ill. Groundwater Adjusinleill Il, Index Well ll;_• ,. Rvading Dote: — ._ Index Well level. _ Ad.j. faclor__ Ad.i.Groundwater Level . i Pr1.2,C01..A"PION '1'LS'1 //�VV 1.: J Obscrvalino Jule,ll I ime at 9" //;Ti L r Depth of Puc ,.' HTi'sy .Time at 6' Stall PIC-soak•time (1 0, 66 Time(9"-6") End Pre-soak of,q 5 _ Rate Min./Inch • Site Suilabllny Asi(,ssalenl i'Silc Passed Site Failed: Additional testing Needed(1'M) N tell f Original: Public;health Division t, Observation IIole Data"I'o Ile Con►pleletl on flack` -s,.` Copy: Applicant x kil 013SCIWA'I')tON' I1( LL.LO.G llcilc # / :4.i;r Delidi lium'. Soil Ilorizon . Soil Soil Soil Color" Soil Other Surl ice(in.) (USDA)' (Monscll)� Mollliog (S(roclurc,Slimes,Ilooldcres' '1 Sio Nl� — Ay��J9 y�fny - - - _ _ -- --- _ ----- - -- — -�'� _— --- prz�� -- GIN Fiwl3 / — — , ,. k.� UI I�I' OBSERVATION 1I0I-XI LOG Hole # I)cltlli holo I Sail Ilolizol Soil'I'esture Soil Color Sail 61ter Surface(in.) (USDA) (blunscll) Mottling (Slroclurc,;SUo)cs,'Iknddu�s: t�✓sw'�2.oi7✓ S ULI;f' 013SII;RVATION 1I0LE L,OG'r I)chlhlion Soil Iforizon . Snil'fcxUuc Soil Color Soil Ulhcr .Sill Ifice(ill.) USDA ( ) (�tunscll) Mottling (Slruclurc,'Slrincs,Iluuldcres.<. � - ---- S.S111�S1CllSY...ieS.i1llY.til) •;�:�+-� 1)1.,1 P. 013`SI�IZVATION I'IULI� LOG Hole# I)cplh I'ioo Soil Ilorizon SOII'I'e3111n'C Soil Color Soil Olhcr Surl'ace(in.) (USDA) (Munscll) Molding (Structure,Slimes.Iloul(leres. . --_ ��111515.LS�114Y.1itSll i1.Y51) a_,. two 1,it - f�li)utlji)silt�,tttcc t? e 11�1� 2.S`ac�a/ O�/S C.: .'• g''d�''`�S � � F ' :7 .h;: Above 500 year Ilood boundary No _ Yes within 5110 year boundary Na Yes Wilhin 100 year flood boundary No Yes— - $A I)c AILf Nah 'I I y )cc ItAilig_L'_c1Y1)►_!s_MLiferbiji ' I)oei at least four feel of naturally occurring pervious material exist ill all areas observed throughout file area proposed for file soil absorption system? f nol, what is the depth of naturally occurring pervious material? Cczlf csl.(im1 I certify that on --AG —9S (da(e) I have passed the sciil evaluator exanlinalion apprcivcd by the l - f . I)epai-tillenl of Environmental Protection and (hat the above analysis was performed by nle consislenl with ' the required training, expertise and experience dcserlbed t 3 I O CM i 1 S.0 17. : ..•'t . , � �. ,• `:,; Signature _.. . ---- —, ---- -- Date /—Z �j