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HomeMy WebLinkAbout0006 HARVEY AVENUE - Health �1 /016 0 o - N � � e I �; �. :, I r ,; r Al 000iv. l—_O-C—Q—T-1.0—N � SEW A_C;-E_P_ER.MIT 1J O. -&ME 6_A[D DREol -5-U 1_L—D E—R 5-Q—&t A E—�-_Q.D D R F_S S pAT_E_P_ER_Iv�1T-1_SSUED' — -1 ---- — l tI_a so 60 No.......�----•-•• Flamm.. ...�5�.,... THE COMMONWEALTH OF MASSACHUSETTS BOARD F HEALTH ............OF.... .W ........ ................. G O Appliration -for Uiti niiai Worko Towitrurtion Prruld Application is hereby made for a Permit to Construct ( ) or Repair-(- ) an Individual Sewage Disposal Syst � _l./�� r -.•--. ------------ --- ---- ---------------- �- LoationAddress or Lot N:o., J O neer� Address �= ----••• --.... . -•f............•. ....................... ------------------------------------------- Installer Address Q Type of Building I Size Lot............................Sq. feet U Dwelling—No. of Bedrooms_________ ___________________________Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ._-_-_--_-- -------------- No. of persons............................ Showers ( ) — Cafeteria ( ) Q' Other fixtures ------------------------------------------------------ W Design Flow............................................gallons per person per day. Total daily flow--------------------- ------------------------gallons. WSeptic Tank—Liquid capacity------------gallons Length---------------- Width.._-..__..____ Diameter---.------.----- Depth_____..__.._.. x Disposal Trench—No. .................... Width-------------------- Total Length.................... Total leaching area--------------------sq. ft. 3 Seepage Pit No--------------------- Diameter-------------------- Depth below -------------------- Total leaching area------------------sq. It. z Other Distribution box ( ) Dosing tank ( ) '-' Percolation Test Results Performed b '- a Y------- -----------------------------=-------=-----------•--------------__ Date--------------------------------------- Test Pit No. 1----------------minutes per inch Depth of Test Pit..-__________-___.- Depth to ground water.-..___.._.-,.____._._. L14 Test Pit No. 2----------------minutes per inch Depth of Test Pit-------------------- Depth to ground water.-.------_----------__.. 9 •---------------------------------------------------------------------------------------•-------------•----------•------------•---•----------------------- ODescription of Soil------------------------------------------------------------------------------------------------------------------------------------------------------------------------ x U -----------------------------------------------------------------------------------------------------------------------------------------•----------------------- -------------------------------------- x -------------------------- ------------------- ----------------------------------------------------- U Nature o epatrs r Alterations—Answer when applicable.... . _l lr._ 1�' ---. r` �� ------------------------------------------------------------------------------------------ ---------------------------------------------- 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 hasIbe6fiNsued the boar o he g . Signe C6.._ -�� --------- -.-----•--_--•-----------� Date Application Approved By----------- ---------------------- -------------- Date Application Disapproved for the following reasons:................................................................................................................. .. --------------------------------------------------------------------------------------------------------•------------------------------------------------------------------- ------------------------'•- 2 Date PermitNo...... Z10........................................ u Issued......................................................... Date No ........ THE COMMONWEALTH OF MASSACHUSETTS r'* BOARD F HEALT C,t -Z • Appiirtatioat -fur Di!ipmal Workii Towitrurtioat Vrrmft Application is hereby made for a Permit to Construct ( ) or Repair"-t4) an Individual Sewage Disposal Syst ..YA .......9.el . .......... A. Location ddress or Lot No. ......•.... '........ -•-•-� -----� ---r- ......-••--...___.. --•-•____.......................................................................................... or Address W ------ ----- }�`p nstaller +,'e Address d Type of Building Size Lot____________________ _____Sq. feet U Dwelling No. of Bedrooms--------------- -__-Expansion Attic Garbage Grinder a Other Type of Building ____________________________ No. of persons---------------------------- Showers,_( ) — Cafeteria ( ) P I Other fixtures -•-------------------------------•--------- W Design Flow............................................gallons per person per day. Total daily flow__._-._._'_...__.... __..... W Septic Tank—Liquid capacity-___-.___ alions Length'_______________ Width.--__ _ ._ jDiameter_---- 'bepth------------ No . . x Disposal Trench— ____________________ WiYlth_...._.._...... Total Length <_:�_______-.- Total leaching are, ___:__:_--- t-----sq. ft. See"a e Pit No_____________________ Diameter's __.__..._.' Depth below inlet.__._._ ____._. Total leaching trea...._...__._ ;sc ft ..�..�..•��ar P g --... p g� 1• i- Z Other Distribution box ( ) Dosing tank ( ) ` Percolation Test Results Per Pate_---------•------__--- Performed by --__ ' Test Pit No. I................mmutes per;inch Depth of lest Pit . ____________... Depth to ground water �.ry :• f>~ Test Pit No. 2________________minutes per inch Depth'of Test Pit_._.._:__..____._.__ Depth to ground:.wafe`r _-_--__-._: ; .:.*� . _• Description of Soil-------- -------------------------------- . G"l ----------- ----- ---------------------------- --- --------------------------------------- r _ �. . U Natu repairs Alte itions—Answer when applicable_ - d"�°:_ . X' ...................................................... 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 n ' sued the boar, yof,Signe ••••- .+► •-----..> f L Date Application Approved B -, ____..___:_:.......... Date . Application Disapproved for the following reasons:................................... .................................................... =---------•-----------7----------------------------------- ------------------------------------.....11............................... ........ Date Permit 1Vo. •, Issued....... • ••- Date u: THE`COMMONWEALTH OF MASSACHUSETTS BOARD OF,, HEALTH ................/...v `'.........OF.......*ay d.g9........................... ............... err#if iratr of Toutntiat rr THIS IS TO CERTIFY, That the Individual Sewage Disposal, System constructed ( ) or Repaired �Ve + - Installer r at..........� - --••--------------_UaG '• C!�/� . •--•..d_!yZ,�,e�'�.�..._fF -.._:..e47��!_w�l! ?S�'�"... has been installed in accordance with the provislionswf Article XI.of The State Sanitary.Code as described'in the application for Disposal Works` i� Gruction Permit{ lo;_ G_._,................... dated---------- ............. ^__ 1--7E/.. °�,u THE ISSUANCE OF THIS CERTIF(PATE SHALL-NOT-BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE.-------••____.JA I ... ......................_.........•---- Inspector_- _..r C�.T.4 S ♦....a \,�` x �w - J.f THE COMMOWWULiH OF MASSACHUSETTS BOARD 0)�F-- EALTH t A4lr.P.- :OF......4,4 wS1'Af CQ ............. ............... No.__.. >d_ � l FEE .... € ork,i `Tuatstrurtioat :Prrktit wy Permission is hereby granted..___ �1rl t'Iz S 1�c_o. _�.. . ---------•-•-••-••- to Construct ( ) or Repair (x ) an Individual Sewage Disposal System at No...... - �-�,4--mot--f-----�-�-�------P r r-----------...c��.�-�•�.a:.�..-- -----t -------=----.�,�-dr._�t:�-.tt�_��_�...�................. Street ry as shown Abe application for Disposal Works Construction Permit No-----e�.�G___.._. Dated.....................7 _____________ ----.._..-••-••-_._..._...•---- - ........ ............•_.._------•--•- 77 y Bo of Health DATE...........-.....__._..---------------s---------------------------------------- FORM 1255 HOBBS & WARREN.'hNC.. PUBLISHER$,,. , " Town of l3arnstable Department of Health,Safely,and Environmental Services Public Health Division Date 'aG�Jvw 367 Main Street,I lyannis MA 02601 ' KAs`�$ \ Fee Pd. /f�17 ",to ►�� Date Scheduled �Ut-y 113 I��1�1 Time 1 c� Soil Si .Y litabilit Assessment for.Seivage Disposal Performed By: Y �� tlt�o,e�tr Witnessed By: T- LOCATION & GENE1 L'INFORMATION ++ hers Name IJ Atic"y. ��A 14 IUG Location Address Lnr FZ I{ArL�15 MEpDo�v LA u/A 40 G/,, *3"SI'DE $(-0G � $fi2l15TA1:3LG Address Ct7JT�`/1L-i—' / Engineer's Name '3AX"1"� 4 E IUr✓ Assessor's Map/Parcel: 'z-1 9 g3 REPAIR Telcohone# A-Z 3 6—911 NEW CONSTRUCTION c n�J Surface Stones /0 Land Use 121Z DE -rl A l' Slopes(%) n Possible Wct Arca fl Drinking Water Well n Distances from: Open Water Body Drainage Way —n Property Line fl other n f test holes&pere tests,locate wetlands in proximity to holes) SKETCH:(Street name,dimensions of lot,exact locations o Z1 Q �Q\ Tesf t .S-1one Wa / Parent material(geologic)Glpual take Cu^ t Depth to Bedrock Depth to Groundwater: Standing Water in Hole: Weeping from Pit Face Estimated Seasonal High Groundwater :.:...... . `BLT;CRIVIINATTON FOR SRA5ONAL HIGH WATER T ' Method Used: in. Depth to soil mottles: in. Depth Observed standing in obs.hole: in. Groundwater Adjustment n Depth to weeping from side of obs.holc�'LyY {Ptt tVvct Adj.factor Adj.Groundwater Level_ Index Well N Reading Date: PERCOLATION T1+✓ST Ditc 7 r Time w:30 Observation 2 Time at 9" Hole tl Time at 6" Depth of Pere(1x41z+� �5 Time(9"-6") Start Pre-soak Time© .1ta�t �.3,4 243 End Pre-soak RateMin./inch less +ViAA I ,MA 11C" Site Failed- Additional Testing Needed(YIN) Site Suitability Assessment: Site Passed Original: Public Health Division Observation Hole Data To Be Completed on Back—� Copy: Applicant DEEP OBSERVATION HOLE LOG Hole # �L il Color Soil other Depth from Soil I lorizon so Depth S�Munsell) Mottling (Structure,Stones,Bouldcres. Surface(in.) (USDA) ( o Yk 7/4 — /o S�/6 c/a Ll /0 ve DEEP OBSERVATION HOU LOG litheSoil Clor # Z Soil other Depth from Soil Ilorizon Soil Text 1f e I (Munscll) I Mottling I (Structure,Stones,Bouldcres. Surface(in..) C onsi�lencv %Gravell. l0 /z'=/ofr" C1 r'.cc 5p.►o/ /o Varved zo'' C2 DEEPiOBSERVATION I-IO I.E tOG' Ilolc Other Soil Depth from Soil Horizon Soil Texture SMunselloii r Mottling (Structure,Stones,Boulderes. Surface(in.) (USDA) ( ) o j DEEP OBSERVATION HOLE LOG hole Other Soil Depth from Soil Horizon Soil Texture Soil Mottling (Structure,Stones,Boulderes. Surface(in.) (USDA) ( ) Consistcncy.fLQLaY9D- Flood ir"i I Rate Man: Above 500 year Hood boundary No Yes Within 500 year boundary No Within 100 year flood boundary No'-2L Yes ll nmrrring 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? If not,what is the depth of naturally occurring pervious material? ('crti�cation 1 certify that on 4 95 (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. ��� Date 7