HomeMy WebLinkAbout0328 WILLOW STREET - Health 328 Willow Street.
West Barnstable
A= 131-024 ��
TOWN OF BARNSTABLE
LOCATION ,S Lut j1OLU ,TiT_,eT SEWAGE# �1 LJ"323
VILLAGE APA;TA bk ASSESSOR'S MAP&PARCELS / ''A
INSTALLER'S NAME&PHONE NO. O 1
177
SEPTIC TANK CAPACITY /Spg gal µ-10�/.GC�4t) k 4! ovwv0 Ghn�d�
LEACHING FACILITY.(type) 4,!r `j ritl0 (size) .3D X;4
NO.OF BEDROOMS t.l
OWNER—Lri-rh /M a►m o. t!.ro r-k to V
PERMIT DATE: 121�{ COMPLIANCE DATE: .ZD/
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
Da�K
A Firant
A JJ1 n
• 1
171 71 )-6
a 71' �-4>$
3"73 y'
�I'89(0
S-�Sg 3�I YS
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No.,,Z1 1 r 37-3 Fedoao
THE COMMONWEALTH,OF MASSACHUSETTS Entered in computer:
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes
01pplication for Disposal *pstrm ConstTuttion i3ermlt
Application for a Permit to Construct( ) Repair( ) Upgrade(<) Abandon( ) ❑Complete System ❑Individual Components
Location Address or Lot No.328 w m-ow 5T Owner's Name,Address,and Tel.No.-)i►U 4, A44P.G e
tt7• R► 4>S r,E die 2�8 t t.t cxv ST c�. +a�r�t3 c�,Kid
Assessor's Map/Parcel 131 c)Zq (,5'0 ) 362, &G Z-4 024(000
Installer's Name Address and Tel No.` A-OA406 K�NXXDY Designer's Name,Address,and Tel.No.PA 11) j3
pr C,oa,F' �or.1 gM `'�0460
''46 0 3hz- r?� C S�nA�wte�t Iu 4 CO' 933 — Z o
Type of Building:
Dwelling No.of Bedrooms �� Lot Size Q ,3 o At,
sq.ft. Garbage Grinder( )
Other Type of Building R ou5e No.of Persons Showers( ) Cafeteria( )
Other Fixtures Design Flow(min.required) �� gpd Design flow provided ( `/
�4 gpd
Plan Date Number of sheets Revision Date
Title
Size of Septic Tank Type of S.A.S.
Descripfion of Soil(b oy 1 Tu MACD SAND C.1-
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 sewage disposal system in
accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of
Compliance has been issued by this Boar
Si Date Q G
Application Approved byke
Dat ZD
I IF
Application Disapproved 00FDate
for the following reasons
Permit No.O N 3 Z Date Issued !/O/ZOO
No.Zl`I ' 7 > Feud i
THE COMMONWEALH9 OF'MASSACHUSETTS Entered in computer:�
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes
01pplitation for Disposal *pstrm Construction 3permit
Application for a Permit to Construct( ) Repair( ) Upgrade(() Abandon( ) ❑Complete System ❑Individual Components
Location Address or Lot No.328 L.)tt-t-ow 5T Owner's Name,Address,and Tel.No.1(NA 4 0jotg6e
Gt�• �+QnYs,�4�5 LE CACae Z 9 e W►c,ww ST W.54ewe 7-q3 Lf MA
Assessor's Map/Parcel / 31 O Zy 3&Z, (o Z-7 on6Y
Installer's Name,Address,and Tel.No.TA_o 005 Ke.►vNEPy Designer's Name,Address,and Tel.No.PAV I'n 13 /JOMA)
(Am (,7ua- C-w ��?I Tito-ow ST C. 5AAJDWICH M i4
5'e ZG68 2U3bZ ' ?I?? C� im — Z(-77'
Type of Building:
Dwelling No.of Bedrooms y Lot Size" o G DOSq.ft. Garbage Grinder( )
r -
Other Type of Building 14 pu5; No.of Persons Showers( ) Cafeteria( )
Other Fixtures `
Design Flow(min.required) gpd Design flow provided gpd
Plan Date Number of sheets Revision Date
Title
Size of Septic Tank Type of S.A.S.
Description of Soil 16 OV 1 "ru r)�S ANT) C 1
Nature of Repairs or Alterations(Answer when applicable)
Date last inspected:
A\"reement:
The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in
accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of
Compliance has been issued by this Boar t .
Si Zz, Date p G
Application Approved by Dat
Application Disapproved Date
for the following reasons
Permit No.7-0 N — 3 Z3 Date Issued V o zzq/y
---------------------------------------------------------------------------------------------------------------------------------------
THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE,MASSACHUSETTS
Certificate of Compliance
THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired( ) Upgraded )
Abandoned( )by Pon^4,364--
at 3 & I0,-11r,") 571 , k) has been constructed in accordance
with the provisions of Title 5 and the for Disposal System Construction Permit No7_Q1q- 373 dated `I 2p y
Installer]f,KfA5 K4'kWf_ !j Designer UA�/10 T3. MA500.
#bedrooms Approved design flow "1 gpd
The issuance of this pe t s1�halll oft be construed as a guarantee that the system rt ful nct o esi ed.
Date 7/ // / Inspector
------------
No. 2OI 3Z3 Fee
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION -BARNSTABLE, MASSACHUSETTS
]Disposal *pstetn Construction Permit
Permission is hereby granted to Construct( ) Repair( ) Upgrade(k) Abandon( )
System located at 3Z(gam),Uk 2 S 1
and as described in the above Application for Disposal System Construction Permit. The applicant recognized 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 this permit.
Date ��� ( � Approved by ----�
Assessing As-Built Cards Page 1 of 1
TOWN OF BARNSTABLE
LOCATION cr�i � ow sTitrT SEWAGE f Lt'3X3
VILLAGE Aj3arrZA 6t ASSESSOR'S MAP&PARCELS /
INSTALLER'S NAME&PHONE NO, LOON-2-7-17-7
SEPTIC TANK CAPACITY 1,ro gal 9-10/Lax�J� o np GAce6r
V
LEACHING FACILITY:(type) i t (size)
NO.OF BEDROOMS 4�
OWNER (rrh r c.
PERMIT DATE: COMPLIANCE DATE: 07/!0ty
Separation Distance Between the:
Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet
Private Water Supply Well and Leaching Facility Of any wells exist on
site or within 200 feet of leaching facility) Feet
Edge of Wetland and Leaching Facility Of any wetlands exist within
300 feet of leaching facility) Feet
FURNISHED BY
pa1-K C q
GIeQr °",
A Frahl Q G
71' �Q
-Sy,; 313y,
. �l'94� y•78�
�•1�3 �-I5� �
7•�91 7-/�0'
3
http://www.townofbarnstable.us/Assessing/HMdisplay.asp?mappar=131024&seq=1 9/1/2015
I
Town of Barnstable P# /�z
Department of Regulatory Services
1L&FU4ffABM: Public Health Division
.e� Date
►
' 200 Main Street,Hy is MA
0�2601
Date Scheduled Time L .� Fee Pd.
w
0
of S�ability As��ses�ment for Sewa i s
Performed By: V(�, Witnessed By:
LOCATION&GENERAL INFORMATION
Location Address A A^ �'L � Owner's Name
Address
Assessor's Map/Parcel: 1 (/ Engineer's Name^�Vn
NEW CONSTRUCTION{ REPAIR Telephone# �..f ui 7`I.
Land Use Slopes(%) 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&perc tests,locate wetlands in proximity to holes)
t C
CN
s U)
N
1
Parent material(geologic) Depth to Bedro
Depth to Groundwater: Standing Water in Hole: 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.
Depth to weeping from side of obs.hole: in. Groundwater Adjustment ft.
Index Well# Reading Date: Index Well level Adj.factor Adj.Groundwater Level
PERCOLATION TEST Date Time
Observation
Hole# y � j� Time at 9"
Depth of Pere (i Time at 6"
Start Pre-soak Time @ V1� Time(9"-6")
End Pre-soak `
Rate MinJlnch `� 7-
Site Suitability Assessment: Site Passed Site Failed: Additional Testing Needed(Y/N)
Original: Public HealtNDivision Observation Hole Data To Be Completed on Back-----------
i
***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:\SEPTIC\PERCFORM.DOC
y
DEEP OBSERVATION HOLE LOG Hole#
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Mansell) Mottling (Structure,Stones,Boulders.
Consistency.%Gravel
-27
.715
1) I�
zo ( ll
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.
Consistency,%Gravel)
DEEP OBSERVATION HOLE LOG Hole#
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Mansell) Mottling (Structure,Stones,Boulders.
Consistency,%Gravel)
Flood Insurance Rate Map:
Above 500 year flood boundary No Yes
Within 500 year boundary Noes
Within 100 year flood boundary No Yes
Depth of Naturally Occurring Pervious Material
Does at least four feet of naturally occurring pervious trial exist in areas observed throughout the
area proposed for the soil abs tion system?
If not,what is the depth na lly occutring pervi material?
Certification ((}}
I certify that on �® —I (date)I have passed the soil evaluator examination approved by the
Department of Enviro ental Protection d that the above analysis was perfo ed me co sistent with
the re 'ed g,expert a aWepe ' nc e escribed in 310 CMR 15.017.
Signature Date
Q:\SEPTIC\PERCFORM.DOC
AsBuilt Page 1 of 1
TOWN OF BARNSTABLE
LOCATION R Cut 0 W STI'te SEWAGE i! ,����'3 Z3
VILLAGE ar,sTA 61,c ASSESSOR'S MAP&PARCELS
INSTALLER'S NAME&PHONE NO.JhLjW -7-177
SEPTIC TANK CAPACITY [ q,gal 1' lwD /—S4KI -JeW r_A&w61'
LEACHING FACILITY:(type) ,t (size) ,3o X;
NO.OF BEDROOMS
OWNER , U KAAPA
to(_
PERMIT DATE: COMPLIANCE DATE: .Zp(
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 Teaching Facility Of any wetlands exist within
300 feet of leaching facility) Feet
FURNISHED BY
nn..i vv �LIe
V Qr au.
QLA C
A Prang Q G
A g- ►sr° 4.g 7
I"11 1-6�1
79` k G$ k
3-gy� 3-73y
s7ls�, 3-/10 t
7.191 7l1k ,1
A �Aw�. .
http://issgl2/intranet/propdata/prebuilt.aspx?mappar=131024&seq=1 8/25/2015
Town of Barnstable
y�ETKKE'O�ti� Regulatory Services
Richard V. Scali, Interim Director
* BARN srne[.e.
9�A Public Health Division
39.'Fc Thomas McKean,Director
200 Main Street,Hyannis,MA 02601
s
Office: 508-862-4644 Fax: 508-790-6304
Installer & Designer Certification Form
Date: Zol`' Sewage Permit# Assessor's Map\Parcel �� Z
Designer. Y��(I OG, Installer: i7oyyy�g!
Address: ► � Address:
On q z�2!91 lvt Ar�- was issued a permit to install a
( ate) (installer)
septic system at PUA� �5 . based on a design drawn by
-- ' � (address)
.�'�F1Il� c Y6`a4 � dated Zb� �i2►�. S 2 J
(designer)
Y 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. Strip out (if required) was inspected and the soils
were found satisfactory.
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. Strip out (if required) was inspected and the soils
were found satisfactory.
I certify that the system referenced above was constructed ' nce with the terms
of the IAA approval letters (if applicable) ti ��A OF
DAVID
B.
(I re) (s MASON r
No.1066 ;
,v
(Desibner's ignature) (Affix Desi ,& p Here)
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:\Septic\Designer Certification Form Rev 8-14-13.doc
FLOORPLAN
orrower. Maki William E. I e o.: 2012-089
ProoeU Address: 328 Willow Street Case No'
City.West Barnstable State' MA Zip' 02668
L i
2za
Bedroom Bath
Down
a First Floor a
o c
N N
Living Room
PO"en
220'
FRONT
Comments:
AREA CALCULATIONS SUMMARY LIVING AREA BREAKDOWN
Code Description Size Net Totals Breakdown Subtotals
oral First Floor 440.00 440.00 First Floor
20.0 x 22.0 440.00
TOTAL LIVABLE (rounded) 440 1 Calculation Total(rounded) 440
1t i i
j
ASSESSORS MAP:
�j PARCEL : •z
_ TEST I-10 E LOGS 1) '1'lre installation shall conk,,, with'Title V and 'I'owu olow 3oard o1.
FLOOD ZONE: —' �I C lleallh Regulations. '
p �o/ J ICq G SOIL EVALUATOR: • }IUI
.�
w l REFERENCE: WITNESS : TOWW y1/1( ! 2) The installer shall verify the location of utilities, sewer inverts au septic
DATE:: U .
components prior to installation and setting base eleva(ions.
�
����� PERCOLAT 1014 RATE: � Zt�1 1 3) All gravity septic piping to be 4 inch Sclr 40 l'VC at 1/8"per loot. '1'lie first
' two Ieet out of the d-box to the leaching shall be level.
-
����� 4) This plan is not to be utilized for property line determination nor any other
TH- 16�- I TH 3 purpose other than the proposed system installation.
0, � _j�iJ/�,�j Lvl{q ,qt�l/ �p 5) All septic components must meet Title V specifications.
- 7 `•
10 6) Parkin shall not be constructed over I I 10 septic components.
K /joj 1 , ,1 1 7) The property is bounded by property corners and property lines.
C r ( wl� Ib 8) The property owner shall review design considerations to approve of total
y I,� 8
LOCAT ICON MAP --- � ��._..__ �'� ���9 XdZ� �20�� � t '�I�� ,�Z,�_ � �j�%�� design (low and number of bedrooms to be considered for design. Receipt
of payment For the plan and installation based on the plan shall be deemed
\ \ _3___ tp Ct 1D approval of the design flow by the owner.
nZj 9) The existing leaching or cesspools shall be pumped and filled with material
�/ \ � _ per Title V abandonment procedures. Those within the proposed SAS shall
— ..
�— — ,�� •��� 1�,�j� 15t ,5 1/ `55 be removed along with contaminated soil and replaced with clean sand per
1. � a
/� Title V specs..
r71 1 r �71 10)System components to be 10 feet from water line. Sewer lines crossing the
water line shall be sleeved with 4 inch SC1140 P VC with ends grouted if
applicable. The proposed SAS is being installed below the water service ,
line. The line is to be sleeved as aforementioned and maintained in place.
I \\ SEPT I C SYSTEM DESIGN 11) If a garbage grinder exists it is to be removed and is the responsibility of the\
/ owner to ensure such.
`! 12)The installer is to take caution in excavation around the gas line if such
��(l _1►,�( FLOW ESTIMATE 1 exists.
�y�A 1
i \ I 13)The installer shall verify thelocation, quantity and elevation of the sewer
f BEDROOMS AT � � GA /DAY/BEDROOM - �GAL/DAY lines exiting the dwelling prior to the installation.
_-_ p
�, \ (�_�_P'`^"1_ T Y,l _- - -- -___— 14)This plan is representative only that a system can fit on a property meeting
l �114 I �'� SEPT I C TANK Title V requirements.
-
'� _ [L'f11<
I
r _O�P -fi-4g �Y�� ��QGAL/SAY x 2 DA l S GAL WI�� I -�1�( o
1- USE (60�' GALLON SEPTIC TANK -._.
SOISORPTION SYSTEM
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1` \ SIDE AREA: J OT 1At'
BOTTOM AREA• I Zo 3o X C� t!7 ,S C
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SEPTIC SYSTEM SECTION
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TANK �Oti• I- 'HIDSEPTIC
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'�&4' TWO' UWA� �y, 2.5, 9� SITE AND SEWAGE PLAN
- -
Local ION : 0IU60
T
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{O 77W_ _ \ \ \ Z — PREPARED FOR : 41M K ►�
•
SCALE: 11,
-� f DAV I U B . MASON,RS DATE: Zol
DBC ENVIRONMENTAL DESIGNS
x — EA8T\,SANDW I CH . MA
DATE I HEALTH AGENT SO$ ) 833- 2 177
9 5 201 �rtal, ►—o
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