HomeMy WebLinkAbout0074 FROST LANE - Health (2) �� ���o�-� �� I � � ►� �s
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Towlt 01F.13arnstable P ei 115
Department of Health,Safety,and Environmental Services
�TIM 31� Public Health Division Date 6 - )\ -9s
767 Main Street.I lyannis MA 02601
• URMAWK
NAM
Date Scheduled do-1\ - l A t"` I1go
• �a r� Time 'A Pd.
Soil Suitability Assessment,for Sewage Disposal
Performed By: 3�ArNI��- _ A. OJ/�1-Ij .+,C, `Witnessed By: - 3C—fnR`f wNN1N(,-
. LOCATION & GENERAL INFORMATION
Location Address —7L1 rRpc5T L�rNF Owncr'sNamc TtN+ PEi4tz-�^�
N\S , MR �"f4s�-tcwoa7o C�Q'
Address 1\o } tEt=VS 14
VN\Ivlr 10 HyANM5
Assessor's Map/Parcel: 215ok 1 5-7 tingineer's Name-4')OW r.l G.44'pl✓ j5W(ft)4,
NEW CONSTRUCTION Rr;PAIR Telephone# 1, 5v(a -3L2-%-1 5%-11
Land Use VA-eA/sf Slopes(°•b) O - 1 6 Surface Stones
Distances from: Open Water Body ft Possible Wet Area f1 Drinking Water Well R
Drainage Way R Property Line ft Other. R
SKETCH:(Street name,dimensions of lot,exact locations of lest holes&perc tests,locate wetlands in proximity to holes)
0
1c) o
Tl�l L
15' -1
r
*7111 o-r 2
.. 0 2$ ►.0��5 $
o � .
0
7
Parent material(geologic) Depth to Bedrock /00
Depth to Groundwater; Standing Water in Hole; 10.19 8.13 Weeping from Pit Face
Estimated Seasonal high Groundwater �r�s. "Tb B.1o.V. )V7— lb COW 0, T Y) I
DETERMINATION FOR SEASONAL.HIGH WATER TABLE
Method Used: CCCa Sir t2 +vt TH 1
Depth Observed standing in obs.hole: ID.$= 12°I�(e in. Depth to soil mottles: in.
Depth to weeping from side ofobs,hole: in. Groundwater Adjustment 1.11- ft.
Index Well# '�� Reading Date:M/4*/_ _ Index Wcll level Adj.factor 1+2 Adj,Groundwater Level el. 1\.'�
-" . PERCOLATION TEST Date'• GA I Tim 11 AM
Ohservation IN Timc at 9"
Holc#
It ��it
Depth of Pere �J6 Time at 6"
Start Prc-soak Time Q ^ `l Time(9"•6")
Fnd Pre-soak �����`�I)��� a�tl" t~ ID•�S
Ralc Min./Inch
Site Suitability Assessment: Site Passcd t/ Site Failed: Additional Testing Needed(YtN) /y
Original: Public Ncalth Division Observation Hole Data To Be Completed on Back-,------�
Copy: Applicant
I
DEEP OBSERVATION HOLE LOG Hole # -Tip A e t
Dcpth From Soil Horizon Soil Texture Soil Color Solt Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulderes.
Consistency.0
—7.S
�g• 12°►. 1 C� M�G SAND I o �/
5 w�• C�- to
DEEP OBSERVATION HOLE LOG Hole# TZ e 1 14111
Depth font Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Soulderes.
o.n Gravel
5Q-25a 3 5N
Mt/�S/ -t
s DEEP OBSERVATION:HOLE LOG Hole#
' Depth from Soil Horizon Soil Texture Soil Color Soil Other
(USDA) (Munsell) Mottling
Surface(in.) ( (Structure,Stones,Bnul eres.
Consistency,0%Gravel)
DEEP OBSERVATION HOLE LOG Hole#
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munscll) Mottling (Structure,Stones,Boulderes.
Consistencv-%-Graycll
Flood Insu gBaMap:
Abovc 500 year flood boundary No_
Yes
Within 500 year boundary No`� Yes � �•� �� $
Within 100 year flood boundary No_✓ Yes
Depth of Naturally Qccurring 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? )/s
If not,what is the depth of naturally occurring pervious material')
Certification
I certify that on V 7—(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.
THE COMMON®ALT
BOAR F H OF HEALT MASSACHUSETTS
/q��9
CA
7—op—ICA",. t14,. ............OF...... . .. ... . ........ ............
Appliration for 43isposal Warks Tomitrurtion umil
p pplication is hereby ade for a Permit to Construct
pl, or Repair an Individual Sewage Disposal
SystemAat
........... ........... .....
ion- dress v 1��
r t .ram ------------
0(40C. ........ .... . ........................... ..L --------*..........
r Ad re
ss
.............. ............... ..................................................................................................
Installer Address
pe of Buildi Size Lot----------------------------Sq. feet
U
Dwelling—No. of Bedrooms________________�>— _-___Expansion Attic Garbage Grinder (
.4
P-4 Other—Type of Building ............................. No. of persons............................ Showers Cafeteria (
P-4 Other fixtures .
.< 'e, --------------------------------------------------------*---------------------------------------------------------------�f----------------------
Design Flow-_ .............C aa ons per person per day. Total daily flow..........`____. ____________gallons.
9 Septic Tan/—Liquid capacity7_�Iel.ns, Length................ Width---------------- Diameter---------------- Depth----------------
Disposal Trench—�io. .................... .VVidth......—.4t. Total leaching area--------------------sq. ft.
C, --- --------
Seepage Pit No../ T;------------- Diameter V Total leaching area__T_a q. ft.
Z Other Distribut box Dosing tank
�_l 0-4 Percolation Test Results Performed by.......................................................................... Date---------------------------------------.
Test Pit No. 1................minutes per inch Depth of Test Pit......_............. Depth to ground water.-----------------------
Test Pit No. 2................minutes per inch Depth of T st Pit.._............_.... Depth o D th t round water__-____-________-_____..
P4 .................................. ------------- ............................. ....... ----------------------------------------------
I
0 Description of Soil-------------------------------- ...... ... ... . ........... ---:--------------------------------------------------
U ..................................................................................................................... ..................................................................................
.........................................................................................................................................................................................................
U Nature 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 ful9 er agrees not to place the system in
operation until a Certificate of Compliance has bee 'ssu by th oa o h.
"of
_A gned De
Xe
44
Application Approved BY----------------- .. ..... ....... ... . ... --- ....
Application Disapproved for the following reasons__________________________________________________ -------------- -----------------------------------------
.......................................................................................................................................................................................-------------
Date
PermitNo.......................................................... Issued------------------------------------...........--.------
41�1 Date
------------------------------------------------------------ --------------------------------------------------
No - Fm>m .................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF H EAe LT H,.a ,
p
a«
App ilrtation for Uiipooal Works C onotrurtiou thrmit
Application is hereby made for a Permit to Construct ( or Repair ( ) an Individual Sewage Disposal
Syst ,at,/ i
� � t y! s .-
ocauo. f
f a
ddress. ® �•:,sss w � Pr Lot o d
' O r ` Address
W
U 44,�// Installer Address
e of Buildi. - Size Lot.............................Sq. feet
Dwelling—No. of Bedrooms-______________ __---______-____--_-_...Expansion Attic ( ) Garbage Grinder ( )
aOther—Type of Building ---------------------------- No. of persons............................ Showers ( ) — Cafeteria ( )
dOther fixtures - - - ------------------------------------------------------•-------- -----------------------
Design Flow...................... . Ions per person per day. Total daily flow_.._.__..._ ...__
W ,� gallons.
WSeptic Tan) -Liquid capacltgallons Length...:............ Width----------...... Diameter----------------- Depth__.__________._.
x Disposal-Trench—110..............:.......VVi th__. T,to�ta= n Total leaching area-__- -_-___•sq. ft.
Seepage Pit No Diameter .�5� _4e th elow i*e .rl -_•__. Total leachin area.: �'L s ft.
•..... Pg q
z Other Distribution box ( ) Dosing tank ( ) . -
'-, Percolation Test Results Performed by.......................................................................... Date----------------------------------------
a
Test Pit No. 1................minutes per inch Depth of Test Pit..................... Depth to ground water..-________---_-____--..
G4 Test Pit No. 2................minutes per inch .Depth of T st Pit.................... Depth to round water------.____----____--_-.
-------------------------------- ............ ............................................ .••-----....•----•............----••..__------
O Description of Soil ..
U -•----•--•-----•••--•-----------------•••-----•-•-••-•......--- ••-• --•• --------•-••• -••--••-••-••• •-- -A -- -----------------------------------------------•---------•------------
---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
U Nature 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 beenyissu i by th ab;a of h lfh.
igned
r
Application Approved BY -- :. � ;; r `� �` 'Da ---
Application Disapproved for th ollowing reasons:....................
---------•--•-••-•--------------------------------------------------------------........................................................................................................................
Date
PermitNo......................................................... Issued........................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD. >; :HEALTH
.. ... ................OF..... ,L a pp........-•--
Trrtifirtatr of T"Outplitturr
/een
IS T CERTIFY, T e Individ .al Sewage Disposal System constructed ( or Repaired ( )
by � Q..�-
� --; . Ins al r --------•-•---•-------•-----.__...-•-•-•-•---------••-----•----------------
at � `��� ' �� s� �°' - -�-----------------------------------------------------------•---------------
llasstalled in accordance witE the provisions of Article XI of The State Sanitary Code s described in the
application for Disposal Works Construction Permit No.......... . .. .............. dated.......
PP P
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A.GUARANTEE THAT THE
SYSTEM WILL, FUNCTION SATISFACTORY. -
DATE--- '�` -f -------------------------------------------- Inspector--- )I/.- "- =
f THE COMMONWEALTH OF MASSACHUSETTS
BOARPADF HEAL H
Ir4 . ... ......OF....- ------ --.. . .... ......................... P
r � Clan t"gatrmit
Permission is hereby granted...... �_...... `� _- .-G�_-�__� ✓
..........................:........
to Constrict ( or Rep a* ( ) 'ividual S age,Disposal System
at No. _ sP
Street
as shown on the applicati n for isposal Works Construction Permit o _ a .___. Da ed._..: / .: ,t'_._ _....__..
t - ......
-Board o Ifealth' � •.--_•-�
DATE----...1�d-- ----- . -- .......� -•-------------------
FORM 1255 HOS S & W RREN. INC.. PUBLISHERS