HomeMy WebLinkAbout1977 SERVICE ROAD - Health 1977 SERVICE
A=194.049
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THE COMMONN°YVEALeTH OF MASSACHUSETTS ; �. 'SEE 0 (
BOARD OF HEALTH
01 ,ba�Ma .�Q
PERMIT
APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION
Application for a Permit to Construct V Repair ( ) Upgrade ( ) Abandon ( ) �omplete System ❑Individual Components
1 ertion Owner's Name
ff Map/Parcel# Address
-�7q /�, of# Telephone#
Instal is Name k Designer's NJ e
,Address
Telephone# Telephone#
Type of Building: Lot Size 'J 5LeC> Sq.feet
Dwelling—No.of Bedrooms _3 Garbage Grinder ( )
Other—Type of Building No.of persons Lo Showers ( ), Cafeteria ( )
Other fixtures
Design Flow(min.require ) 5 gpd Calculated design flow_5-:30 gpd Design flow provided 55- 6 gpd
Plain,Date - Number of sheets _ Revision Date
Tttic�.�t-t� y�R�-. `�,� �.L� �c,� c� �Lt c/Ym• �,tti.:�c�y.ems C�,c.,dn ,d�c3�t►'�
Description of Soil(s)b"- ~ q 1&1 (0"-(60u G1,t l
Soil Evaluator Form No. Name of Soil Evaluat `17. _I,t L Date of Evaluations
DESCRIPTION OF REPAIRS OR ALTERATIONS
The undersigned agrees to install the above described individual Sewage Disposal System in accordance with the provisions of
TITLE 5 and further a Tees not lac a system intion mtfil a Certificate of Compliance has been issued by the Board of Health.
Signed Date zlh
e DESIGNING ENGINEER WJST SUPERVISE
INSTALLATION AND CERTIFY IN WRITING
/7 THE S S n�T
ACCORD
GfuT''
FORM 1 - APPLICATION FOR DSCP DEP APPROVED FORM 5/96
tit
THE COMMOMWE+A=L HOOF MASSACHUS.ETTS .SEE vG
,, `""'"' s`••' BOARD O F\'H E A LT H - /�
APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT
Application for a Permit to Construct Repair ( Upgrade ( ) Abandon ( ) - Complete System, ❑Individual Components
� I�i`t�? �n�;ems... �..-a W•C�ar�s��� �.e,i��\c�.. �rrrus�'n;u�tsn •
L ation owner's Name
Mc4p1 PC > . !
f Map/Parcel# Address d
Q.ot# Tele one# ~
i
oiya l&�/ Coos?= ('�,1� Ip11�a,�
Instal is Name Designer's N n e
�A� rcss� -_.. 7 -12 dress
Zl/
Telephone# Telephone#
j -
Type of Building: Lot Size 3 5(.00 Sq.feet
Dwelling—No.of Bedrooms _3 Garbage Grinder ( )
Other—Type of Building No.of persons 1,0 Showers ( ), Cafeteria ( )
Other fixtures
Design Flow(min.required)6;-gpd Calculated design flow gpd Design flow provided S gpd
Plam,Date k1Z- Number of sheets �_ Revision Date
Ttl ' a
,I escription of Soil(s)o'= ` Cial.� �O"^�`" b"- 13 cc oL �=j�a S
- -, S 11 Evaluator Form No. Name of Soil Evaluat 'C77.C!�l vt Z lei Date of Evaluation F ciZ'913
DESCRIPTION OF REPAIRS OR ALTERATIONS !
Y
The undersigned agrees to install the above described Individual Sewage Disposal System in accordance with the provisions of
TITLE 5 and furtherxa revs not lac • e system in o gcation-until a Certificate of Compliance has been issued by the Board of Health. . „
Signed Date.
..
juspe
f '# FORKA%- APPLICATION FOR DSCP DEP APPROVED FORM S/96
1
No. ( � THE COMMONWEALTH OF MASSACHUSETTS FEE ®U. r
94L,4'*75h4iLf. BOARD ,OF HEALTH
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 15.0 Title 5) and the approved design plans/as-built
plans relating to application No. 9%f' ��Y dated /Z / 7 9 Approved Design Flow (gpd)
Installer ha
,yt . a ,
Designer: Inspector //t A',ate �
g . ,vv ,,v
' The issuance of this certificate shall not be construed as a guarantee that the system will function as desig pe d.y
FORM 3 - CERTIFICATE OF COMPLIANCE DEP APPROVED FORM 5/96 r�1
a
NO. THE COMMONWEALTH OF MASSACHUSETTS FEE
(30- dam/ BOARD OF HEALTH
DISPOSAL SYSTEM CONSTRUCTION PERMIT
Permission is hereby ranted - Construct (V Repair ( ) Upgrade/( ) Abandon ( ) an individual sewage
disposal system at i77 �""� C� I �/ �Q��' �N r5ch �P as described
in the application for Disposal System Construction Permit No. �� 7ly�� ,dated 12 17--g41
Provided: Construction shall be completed within three years of the date of this permit.All local conditions must be met.g
Date . - / / Board of Health
i
FORM 2 - DSCP DEP APPROVED FORM 5/96
r
FORM 1255 (REV 5/96) H&W HOBBS&WARREN TM PUBLISHERS- BOSTON
Lbf TOWN OF BARNSTABLE
LOCATION ��' J I) T G s ro�.
SEWAGE #
VILLAGE_ GV. Xl'i^fPS7�011,,,Pi ASSESSOR'S MAP& LOT AO
INSTALLER'S NAME&PHONE NO.
SEPTIC TANK CAPACITY
LEACHING FACILrI'Y: (type) CO ,¢ h�S � '
(size) �L x
NO.OF BEDROOMS 3
BTJII.D OR OWNER CLt` (4 ` Cci►.IS C "e,f
PERMITDATE: COMPLIANCE DATE:
Separation Distance Between the:
Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility
Private Water Supply Well and LeachingFacilityFeet
on site or within 200 feet of leaching facility) any wells exist
• : � Feet
Edge of Wetland and Leaching Facility(If any wetlands exist
within 300 feet of leaching facility)
Furnished by Feet
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CAPE & ISLANDS ENGINEERING -
•SUMMERFIELD PARK ;
800 FALMOUTH ROAD,SUITE 301 C -
MASHPEE,MA 02649
(508)477-7272 FAX(508)477-9072
February`4, 1999
Mr. Thomas McKeon
Barnstable'Board'of Health
367 Main Street
Hyannis, MA"02601
RE: Map 194 parcel 049, House 9 Cap'.n Jacs Road, W. Barnstable.
,:MA
Dear Mr:McKeon:
Our office inspected the strip out at the above referenced'lot on February 1, 1999.
On February 2,4999 our,office_inspected the installed system. It is our opinion the
strip out and installation was in accordance with our plan.
Sincerely,
John . Slavinsky
... JPS/cma
'Town of Barnstable P#
Department of Health,Safety,and Environmental Services V
�tHE Public Health Division Date ci
367 Main Street,Hyannis MA 02601
eAarrsreerA
is a
rED Mld" Date Scheduled—�1 Time Fee Pd.
Soil Suitability Assessmefit or Sewage Disposal
Performed By: �T...�� Sq �+• e .�• Witnessed By: �;if elf. VV ✓��+
LOCATION & GENERAL INFORMAJION
Location Address 'Gl I"I^'� Q ic_e P � Owner's Name v���Ul _•
1 p�o10�11�Kia- h-x Address
Assessor's Map/Parcel: 9L!1` Engineer's Name& �_
i /�
NEW CONSTRUCTION REPAIR Teieptione k
Land Use u•�o.d t c� f Slopes(%) Surface Stones '
Distances from: Open Water Body It Possible Wet Area` R Drinking Water Well R
Drainage Way R Property Line R Other R
""'SKE.(lI ( treet name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands in proximity to holes)
.g ve
f
0 �-
Parent material(geologic) Oaf'• &s ti Depth to Bedrock
Depth to Groundwater: Standing Water in Hole: .4-If, Weeping from Pit Face
Estimated Seasonal High Groundwater
. ..... ... ...
DETERMINATION FOR.SEASONAL HIGH WATER.:TABLE
Method Used:
Depth Observed standing in obs.hole: in. Depth to soil mottles: in.
Index Well N Reading Date: Index Well level Adj.factor Adj.Groundwater Level
PERCOLATION:TEST Date Time
Observation
Hole# Time at 9"
Depth of Perc Time at 6"
Start Pre-soak Time @ Time(9"-6")
End''re-soak
Rate Min./Inch
R i
Site Suitability Assessment: Site Passed Site Failed: Additional Testing Needed(Y/N)
Original: Public tlealih Division Observation Hole Data To Be Completed on Back—�
Copy: Applicant
DEEP.OBSERVATION HOLE LOG Hole#
Ucpth,frorn Soil I lorizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulderes.
Consistency,°
7 •
Loq.... /uY/L. 2-/z
G
60 '=/3Z�� G ���'� S4•o( �c7/2 71P
DEEP OBSERVATION HOLE L-OG Hole# Z-
Depth from, Soil Horizon Soil Texture i Soil Color Soil Other
Surface(in.) I (USDA) II (Munscll). Mottling (Structure,Stones,Boulderes.
nitn• %Gravel)
to
W/se,not Lo,»
2 C ,C.; Ss»�' /0Y"e F S l Sfinti
DEEP OBSERVATION HOLE LOG Hole# ..
Depth from Soil Horizon Soil Texture Soit Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulderes.
Consistencv.°o Gravel)
DEEP OBSERVATION HOLE LOG Hole#
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulderes.
onsistenc °° ravel
I
Flood Insurance Rate Map:
.Above 500 year Rood boundary No_ Yes �
Within 500 year boundary No rYes Y
Within 100 year Rood boundary No V 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? yt ,
If not,what is the depth of naturally occurring pervious material?
Certification
1 certify that on i��2 Y�9 8 (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 --//Z-y19 F
S YS TEM PROFILE-
NOT T7 SCAL E
TOP FNDN. FINISH GRADE OVER FINISH GRADE
EL 11 .0 FINISH GRADE 68- 7 FINISIN GRADE .OVER DIST. BOX GG.9 OVER TRENCHES CoS.S - C�ro.S
.•., .. .: SEPTIC TANK Gb. 3
`Av WA
0 oeA: 12" MAX. '
°°•d-C
v o4 a. a' 1,17. ' :oa';oe•a��e':C•gs°'e•:v opY�bo�!•�.. p l.ti. r i0
e..r•. e o
a o:o'.. •a TOTAL LENGTH OF TRENCH 25' _
o:'o.P• OUTLET PIPE LEVEL
3" FOR 2 FT. MIN.
Qe:�• 0 •'� .f ,O O 0�"... '•R: er ••O,v J0� o :4. :: .. ..v w. bbt•°���
q 00
6" 00
e oppo
'o' A:•. CAP END
Toro.00 /�GG p0.� a 0; �C
C. I. OR PVC TEES G5.s3 :?�� �S. 14 FL
�.
;o•-•p; • �,; �=-� REMOVE ALL A 6 B UNSUITABLE MATERIAL MI THIN 5 FT. �--
°'° oa � LEACHING FACILITY AND REPLACE l✓ITH CLEAN SAND
1500 b' DISTRIBUTION BOX
P•
ro GA L L OIV
BSMT FL
INSTALL ON LEVEL BASE "500 GALLON DR YWEL L S "
•e 9
PRECAST CONCRETE
p•• `' H=-00 REINFORCED
:;bap )e.•.�•�•'..0 0� 0:
a
•,4�b.'4b.i,:yo:Op�reD: O;a.:Q•/f�e'Q►'p•.qp:DDO•�o•eq�.4F4:
SEPTIC TANK
TRENCH SECTION
44' INSTALL ON LEVEL BASE
NO TE.• EXCA VA TE TO EL EV WL OR _ .:.
L OYER TD REMOVE ALL IMPERVIOUS T Erna
12" MIN.
Y/
MA TERIAL BENEATH THE, LEACHING AREA 4" orAM.
_SpI 14E 1N__ POLE- REPLACE EXCAVATED MATERIAL WITH,, •. 3 OF 1/9 S/2
r
_C L _. 6.7 __. d�Ui'1ED. :
• T CL EAN. CLA Y FREE SAND c..: ' WASHED PEA STONE•
5 i+ _J/P asWA eC
CRUSHED STONE ;e ;
` --' GENtR L NO TES IREN.:H WIDTH
CE. RO
�� ASSUMED NUMBER OF TRENCHES 1
1. ALL- EL EVA'T1'C v:3 SH011 N AR BASED ON
PIPES .. N--SHE•, 5 YS TEE MUS T BE CAST`IRON NUMBER OF DRYi✓EL L S 2
f 1.07 �- 2 ALL
• R 272 - •
- -
A 950`. OR SCHCfJU4� '�- G '
�v jrz 3. THE BOARD OF :SEAL ,H MMUST BE NOTIFIED P-92�3
WHEN CONSTRUCTION IS COMPLETE PRIOR
PSG —� TO, BA CfCFIL L INS; PERCOL A TIDN_RA TE.'
^ . �., 5 MIN./IN.
4. ANY CHANGES �IV THIS PLAN MUST BE;APPROVED
WITNESSED BY.-
,. lNG
cu�v�r�-t: BY THE BOARD 7F HEALTH AND CAPE G ISLANDS
SURVEYING CO., INC. GERRY DUNNING
1Q 5, MATERIALS AND INSTALLATION' SHALL BE IN
g BARNS TABU%p" OF THDESIGN DA TA
COMPLIANCE W1 rH THE STATE SANITARY p L
CODE - TI TL E V _ AND LOCAL APPL ICABL E
DATE.,
a
N` •0° o , � �., RULES AND REGJLA TIONS 3
NUMBER OF BEDROOMS
2°•0
0 cn 6. NORTH ARROW 13 FROM RECORD PLANS AND 0 " O
o -A= LOAM GARBAGE DISPOSAL �_
__ IS NOT TO BE JSED FOR SOLAR PURPOSES
00 o z a. C (NON-HAZARDI N v c> < GAL ..
�a. o r G� 49 w 107. FLOOD HAZARD `PONE 6 �a= DAILY FLOW
'� o /•; �-} LOT hW WA_ TER
5
i , B. WA TER SUPPL Y
=B= LOAMY SAND SEPTIC TANfC REO 'D. � GAL .
43, 560 SF. �o r e ) u GAL .
o N (W/77� 9/GT
60 SEPTIC TANK PROVIDED
GPO.:.
LEACHING REQUIRED
- rod =C- FINE
ro
SAND
S152WALL AREA ?52 S.F.
�e yP ?�� S. F.X G/S.F. = GPO.
BOTTOM AREA = 329 S.F.
LEGEND243
329S.F.X. 0. 7S.F..= 55 GPD
LEACHING PROVIDED = GPD
29�•5QA o W as NO GROUNDWA TER
S �2•�0
70 F90POSED ELEVATION 132
EVISTING CONTOUR
SINGLE FA MIL Y RESIDENCE C
03SERVA TION PI T
{�a=L-t Co�J p DISTRIBUTION BOX
PROPOSED SEWA GE DISPOSAL S YS TEM
PREPARED FOR
ALL A B B UNSUITABLE MATERIAL
MITHIN 5 FT. OF THE LEACHING'FACILITY IS TO k ,
BE REMOVED AND REPLACED Ni CLEAN SANG c �
CENTRAL CONSTRUCTION
O o SEPTIC TANK �; r,;E r k,
.f
W
LOT 5 CAP 'N �.JAC 'S RD.
.—._. SERVE AREA a
WEST BARNS TABLE — MASS.
ii; QF Al°,t�, �
Co6.0O PIPEINVER7 ELEVATION D��v��\\
t,,;,, DA TE.: C7EG. f 5 1 g a CAPE 6 ISLANDS ENGINEERING
�� L,i�i ei, �
---------------
PLOT PLAN °� ,�, �, J l SCALE AS NOTED 133 FALMOUTH ROAD - SUITE 2E
SCALE: ? "�_•40 . _ Fl aJQ q-`3 S [977 ��'`Q�
,. , , , C, —, - - MA SHPEE, MASS.
F E PLAN NO. 17 ,5g
_ ,� C PCL LOT HS
- ,N P SE
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