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HomeMy WebLinkAbout2390 MAIN ST./RTE 6A(BARN.) - Health 2390 MAIN'S ET Barnstable A = 237 — 024 � o a I a - _ e q F ° d t Town of Barnstable P# I L9 Department of Regulatory Services i�.A'MABLE. Public Health Division Date 3 63Q Main Street,Hyannis MA 02601 r d � Date Scheduled fi 1 Tm e I Fee Pd. �� Soil uitability Assessment for Sew. ge 'sposa Lp Performed By: � Witnessed By: ✓ tN• r, 2 LOCATION&GENERAL INFORMATION 4" Location Address Owner's Name /Jp► , dre Assessor's Map/Parcel: ;z /IEF�A�M )00o""' ng 's Namee // 'NEW CONSTRUCTION Telephone# �7 56 � `t�f Land Use Slopes(%) Surface Stones ' Distances from: Open'vVater 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) Parent material(geologic) Depth to Bedrock Depth to Groundwater:Standing Water in Hole: Weeping from Pit Face Estimated Seasonal High Groundwater DETERMINATION FOR SEASONAL_ HIGH WATER TABLE Method Used: Depth Observec 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# Time at 9" Depth of Perc .- Time at 6" ' Start Pre-soak Time @ 1 Time(9"-6") End Pre-soak 1. Rate MmAnch Site Suitability Assessment: Site Passed Site Failed: Additional Testing Needed(Y/N) Original: Public Health Division Observation Hole Data To Be Completed on Back----------- �j ***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 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 41 d DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders.. Consistencv,%Graven 01, DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency,%Graven t 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) Flood Insurance Rate May: Above 500 year flood boundary No ,//}'des •V/ Within 500 year boundary No Yes Within 100 year flood boundary No-L-. Yes Death of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pe . .al exist in all eas observed throughout the area proposed for the soil absorption system? If not,what is the dep of n turally occurring pe ous material? Certification /y I certify that on (date)I have passed the soil evaluator examination approved by the Department of Enviro' en I Protection and that the above analysis was pe d by me consistent with the required training,exp AiseeMribedin3lOCMR15.01'7 Signature Date Q:\SEPTIC\PERCFORM.DOC TOWN OFBARNSTABLE LOCATION 3qO 6 I SEWAGE#Z®d4 — 0�7 VILLAGf0q,&J;� -Ok-- V/j Z INSTALLER'S NAME&PHONE N9? SEPTIC TANK CAPACITY /5'W Q4116,t LEACHING FACILITY: (type ),!!ko ewlmi e4l, (size) 07 X j3 NO.OF BEDROOMS OWNER i E77//IQdf, PERMIT DATE: /S+ COMPLIANCE DATE: 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 leach ing,facility) - Feet FURNISHED BY y � � _ w n � s x . =20 l i THE COMMONWEALTH OF MASSACHUSETTS FEE ��t BOARD OF. HEALTH �� / 4'(V OF APPLICATION FOR DISPOS STEM CONSTRUCTION PERMIT Application for a Permit to Construct ( ) Repair ( Upgrade ( ) Abandon ( ) - ❑Complete System ❑Individual Components -ed IT ,T ocation' Owner's Name �^ Z �i a /Parcel Address I' P ax Telepho o� J 1— lIEIL(`'b�y �f©�Installer_s N �,^ /� � Designer's Name Gg Address 4A 1��JCL��1/ 5 y� ss J�7 Telephone# b/'LV Telephone# Type of Building: Lot Size Sq.feet Dwelling—No.of Bedrooms Garbage Grinder ( ) Other—Type of Building No.of persons Showers ( ), Cafeteria ( ) Other fixtures Design Flow*�pi . uired) gpd Calculated desi n fl gpd , Design flow provide gpd Plan: Date Number of sheets I Revision Date IV Title Description of Soil(s) Soil Evaluator Form No. Name of Soil Evaluator Date of Evaluation r� DESCRIPTION OF REPAIRS OR A TERA�TIONSS , f The undersigned agrees to in tall the above described Individu I Sewage Disposal System in ac ordance with the provisions of TITLE 5 and further a ees not to ace the system in opera. n until ertificate of Compliance has bee issu by the Board of Health. Signed Date 5 7 —70 Inspections FORM t - APPLICATION FOR DSCP DEP APPROVED FORM 5/96 THE COMMONWEALTH OF MASSACHUSETTS "'.. FEE 1BkOARL -b IRtH, E-�AL)T� H� OF .,--APPLICATION FOR DIS .1 STEM CONSTRUCTION PERMIT Application for a Permit to ConstruA( ) Repair ( Upgrade ( ) Abandon ( ) - ❑Complete System []Individual Components ocation Owner's Name ap/Parcel : Address 1"° Telepho_n� J O�Ins[aII�N.ague_ �.,^ T— Designers Name Address I I ss Telephone# Telephone#* Type of Building: t t�+f=k' :"Lot Size�"' _ �� Sq.feet Dwelling—No.of Bedrooms 2K -Garbage Gfinde��( ) N OtherjL Type of Building No.of persons I ; ' " Showers; ( ), Cafeteria ( ) Other fixtures Design Flow*�pi .. wired) gpd Calculated desi n fl gpd Design flow provide gpd Plan: Date Number of sheets Revision Date Title >t f Description of Soil(s) r• Soil Evaluator Form No. Name of Soil Evaluator Date of Evaluation h oW� DESCRIPTION OF REPAIRS OR`6 AL��T��ERATIONS / The undersigned agrees to in tall the above described Individu I Sewage Disposal System in accordance with the provisions of- TITLE 5 and further a4rees not to ace the system in opera'on until ertificate of Compliance has bee issued by the Board of Health., r; Signed Date 5, Z Inspections 0,0 1 -FORM 1 - APPLICATION FOR DSCP DEP APPROVED FORM 5/96 :w No.ado/5 - � THE COMMONWEALTH OF MASSACHUSETTS .•.Sys .o•�— �� FEE ....-..........-.«� � ABOARD OF HEALTH .- CERTIFICATE OF COMYUANCE' Description of Work: ❑ Individual Component(s) Pcoomplete System The undersigned hereby certify that the Sewage Disposal System;Constructed( ),Repaired(( ),Upgraded " ,Abandoned( ) �42�Drv� Caw r , . by: at has been installed in accordance with the provisio s of 310 CMR 15.00 (Title 5) and the approved design plans/as-built plans relating to ap lication No. dated Appiroved Design Flow (gpd) Installer � "�`✓ Designer: Inspector n Date 11 , The issuance of this certificate shall not be construed as a g rantee that the system will function as designed. FORM 3 - CERTIFICATE OF COMPLIANCE DEP APPROVED FORM 5/96 No. THE COMMONWEALTH OF MASSACHUSETTS FEE v G �W4'_�—*J-,e�BOARD OF HEALTH DISPOSAL SYSTEM CONST ',-VCTION PERMIT Permission is hereby granted to Construct ) Repa' i pgr de ) Abag�On ( ) an individual sewage disposal system at2tq 0 ¢"'; as described in the application for Disposal System Construction Permit No. _ 7,dated 5 Provided: Construction shall e completed within three years of the date of his per 't. ca conditions must be met. Date Board of Healt FORM 2 - DSCP DEP APPROVED FORM 5/96 FORM 1255 (REV 5/96) H&W HOBBSB WARREN TM PUBLISHERS- BOSTON I Town of Barnstable �p THE►� Regulatory Services Richard V. Scali, Interim Director • antwsrnet:e, MASS. Public.,Health :Division. 039. �0 ArFp �s Thomas McKean, Director 200 Main Street,Hyannis,VIA 026,01 Office' 5,08-862-4644 Far: 508-790-6304 Installer&Designer Certification Form. Date: co Sewage Permit# Assessor's Map\Parcel { Designer: V Installer: ' Address: . Ca-� Address: COW On ' 9W C. CO was issued a permit to install A. (d te) (installer) septic system.at - based.on a design drawn_by (address) e 1A , f )Amy) �• VV� dated (designer) 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 ce ify that. the system referenced above was constructed !,m li rice with the terms of t e I\A approval letters (.if applicable) ���0FIt/4,s DA`'�VID taller's atu e) i�: tilASON (� a _ sf ,Sign re) (Affix Desib 1ii, 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\Desi;ner.Certitication Form Rev 8-14-13.doc 1 i 1- 1W1�1, ! ASSESSORS MAP : Z37 TEST HOLE LOGS PARCEL: 'Zd -- - ------- - - SO ,-� 1) The installation shall cornp� with Title V aiKI 'Town of ward ol. -> FLOOD ZONE: ��-- IL EVALUATOI • >�ul A. � I lealth Regulations. - --- p WITNESS : I I 2) The installer shall verify the location of utilities, sewer inverts and septic REFERENCE: . DATE: ( (� components prior to installation and setting base elevations. PERCOLATION RATE: G to — 3) All gravity septic piping to be 4 inch Sch 40 PVC at 1/8" per foot. The first L �. two feet out of the d-box to the leaching shall be level. TH- I TH-2 4) This plan is not to be utilized for property line determination nor any other purpose other than the proposed system installation. / A Ld � 5 � M D 5) All septic components must meet Title V specifications. — p` �• /IN � �5 I �► 1 6) Parking shall not be constructed over 1-I10 septic components. -- -- - ,, 11�7 8)JI 7) The property is bounded by property corners and property lines. �o' � The property owner shall review design considerations to approve of total vt LOCATION MAPowilk 12 - — �j� / design flow and number of bedrooms to be considered for design. Receipt �17 of payment for the plan and installation based on the plan sliall be deemed i � approval of the design flow by the owner. 9) The existing leaching or cesspools shall be pumped and filled with material per Title V abandonment procedures. Those within the proposed SAS shall 0 �, ►�(1l be removed along with contaminated soil and replaced with clean sand per 6 2 I �'' ' Title V specs. �y 10)System components to be 10 feet from water line. Sewer lines crossing the water line shall be sleeved with 4 inch SC1140 PVC with ends routed if I ,5� g _ ( applicable. The proposed SAS is being installed below the water service line. The line is to be sleeved as aforementioned and maintained in place. • `-�� � SEPTIC SYSTEM DESIGN 11) If a garbage grinder exists it is to be removed and is the responsibility of the owner to ensure such. / \ FLOW ESTIMATE 12)The installer is to take caution in excavation around the as line if such g / exists. I // f � �1�1f Ol►a _._�_ Z BEDROOMS AT 110 GAL/DAY/BEDROOM -:�,;D GAL/DAY 13)Tile installer shalt verify the location, quantity and elevation of the sewer lines exiting the dwelling"rior to the installation. SEPTIC TANK 14)This plan is representative only that a system can fit on a property meeting i Title V requirements. I I 1-. ' 06AL/DAY x 2 DAYS GAL I USE ! ALLON SEPTIC TANK C�02 _- 121 nCZ No1 \1 \ SOIL �BSORP ION SYS7EM�� ii dd - \ �' 1 � `� \ SIDE AREA: 2 2� -t- IZ, + �� t7�"t = fl ( ,q7 0� D gVl[� \ ° �/ ' BOTTOM AREA: Z. >, I Z, x, b�� = 7, MASON n,1 ° � v ,p No.1066 0 SEPTIC SYSTEM SECTION O or- Awl hill 6 10 C?7►�TU � v �. y _=_-�3.2a _ _ 3 1S00 GAL "tZ 7Z !l I_ vir/ 7_ SEPTIC TANK ��(.. fir - Of i/ All Hz0 u w trs S / SITE AND SEWAGE PLAN �i LOCATION : Z�jO �T (�Zooi E, 4=,q `3 i�� �41�LZ VIUA4E4 ►�1A PREPARED FOR : CAePjkll -1, M 0 -CC U9 9 scALE• ��r--7- W DAV I D B . MASON RS DATE: 2 a15 DBC ENVIRONMENtfAL DESIGNS DATE HEALTH AGENT EAST SANDWICH . MA W Z ( 508 ) 833- 2177