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Home My WebLink About3951 MAIN ST./RTE 6A(BARN.) - Health 3951 MAIN ST., CUMMAQUID MENNEN A=335-048 TOWN OF BARNSTABLE N LOCATIO l z?Ou7''� M SEWAGE # s VILLAGE L'�WAA 471J& ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. J SEPTIC TANK CAPACITY LEACHING FACILITY (t ) d e 9 � lgll;(size) NO. OF BEDROOMS BUILDEROROWNER.1 MurAsz PERMITDATE: 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 leaching facility) Feet Furnished by u a Asa _w � A f J 8 - t Town of Barnstable P# Department of Health,Safety,and Environmental Services Public Health Division Date 1F t367 Main Street,Hyannis MA 02601 • BARNBTABLR, ' , 1 ! , -,.I 1 •" ' / 1 f n'`,' ArfD MAC�, Date Scheduled �'ILPU5T, -41, .'Z000 Time �Cz>t,Fee ! Pd. l�0- r 1 , � ..0 * �t, �. t r �y { ' !4• �{.mot - -- - ,S'oi,l►Sluiltibiiiij,�A,ssessaien-i fo ° Sewage Disposal 4 Performed By: ✓^N D Witnessed By: LOCATION:A GENERALINFCIRMATION Location Address 3qs 1 !->�' � Owner's Name 4.UMUA {Q V tIZ3 Address �✓'^F Assessor's Map/Parcel: �3Tj f 4e> Engineer's Name J• v,/ ig50,J,es NEW CONSTRUCTION REPAIR Telephone# a 3 Land Use � �j l��yy t Slopes(%) ^^AA Surface Stones •�. Distances from: Open Water Body�_ft Possible Wet Area*100 ft Drinking Water Well •`�� ft t Drainage Way ft Property Line } 10 ft Other ft SKETCH:(Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands in proximity to holes) i38 .b ao a I�.Z9 4i cam,--w ' - Parent material(geologic) Depth to Bedrock � � 0d Depth to Groundwater:_Standing Water.in Hole:_ �� ' --- --,-_-Weeping-from Pit Face- Estimated Seasonal High Groundwater AY.HtI ATEib � TI� BV US9AS( } is 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 PERGOLAT tO1V:TEST; Date :$ Ttme +C 'dC`3 Observation ' 1 Hole# Time at 9" Depth ofPerc 41 �.: n`,'• a' Time at 6" a Start Pre-soak Time @ Time(9"-6") End Pre-soak Rate Min./Inch 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 Copy: Applicant. � tt DEEP OBSERVATION HOLE Ll7G IoIe# Depth 4om Soil Horizon Soil Texture Soil Color Soil Other Surface-(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulderes. on istenc ° Gravel ri nr ' �J k� �tWfL 14 �cr � e �. . Zlbl( 7-0 C/,2 ED.slH Z IVY6 74 /. 1 ' ......... ...... ATIONH Depth fro, Soil ^ Horizon Soil Texture Soil Color' '+ Soil 14 Other Surface(im) (USDA) (Munsell) Mottling (Structure,Stones,Boulderes. 1 C nsistenc %Gravel) \ ` 11 DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture' Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling _ (Structure,Stones,Boulderes. ' C n i tent %Gravel DEEP OBSERVATION HOLE LOG Hole#< Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulderes. C nsistenc %Gravel) Flood Insurance Rate Man: 4 Above 500 year flood boundary No�_�Yes Within 500 year boundary No 11 Yes Within 100_year flood boundary.No v Yes Depth of Naturally Occurring Pervious Material 4 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? A14q• Certification 01 --T^ I certify that on ZZ �d(date)-I have passed the soil evaluator examination approved by the Department of Env' onfn tal Protection and that the abov--analysis was performed by me consistent with the required training,e�pertise d experience described in 310 CMR 15.017. Signat No. Gy�� Fee �✓ /%< THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS 2pplitatton for Ztgogal 6pgtem Cottgtruction Permit Application for a Permit to Construct )Repair( )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. (�f`l /�iSt c E1 (7 Own s N 1 Address and Tel.No. Assessor's Map/Parc 1 � �CJ r VL d,e q/ e / I s d Tel.No. Designer's Name,Address and Tel.No. Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( No Other Type of Building No. of Persons Showers( Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. l Description of Soil DESIGNING ENGINEER L4klgT SIIDER,AarE INSTALLATION AND CERTIFY IN WRITING Nature of Repairs or Alterations(Answer when applicable) THE SYSTEM WAS INSTAi I cn IN1 4T�4�.T ACCORDANCE TO PAW. 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 -_Ti nvironmental de and not to place the system in operation unli a C fi- cate of Compliance has been' sued by s fh. Signed Date Application Approved by Date Application Disapproved for the following reasons`' Permit No. Date Issued ��r� TOWN OF BARNSTABLE LOCATION SEWAGE # � s� VILLAGE--_ L gyp; �I jj' ASSESSOR'S MAP & LO j INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY , ADO LEACHING FACILITY: (ty, (size) BUILDER OR OWNER U PERMITDATE: 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) Edge of Wetland and Leaching Facility(If any wetlands exist Feet within 300 feet of leaching facility) Furnished by Feet 5 C r SEP-22-2000 FRI 10:33 AM SANDWICH BOH CONS BLDG 508 833 0018 P. 01 David B. Masan, R.S. DBC Environmental Designs certification of a Title V Design/installation Location of System: 3951 route 6A Plan prepared by: David B. Mason, RS Date of inspection:$-optembe12oo0 Type of Inspection: Soil Removal/Excavation I, David B. Mason, Registered Sanitarian, duly licensed in the Commonwealth of Massachusetts, do hereby certify that .this firm has visually inspected the soil excavation for the type of inspection noted above as shown on the referenced approved plan, and further certify that for the inspection conducted at that time and required, that as constructed, such generally conforms within acceptable tolerance to the regulations, as varied, set forth in 310 CMR 15.000 and the Town of Barnstable Board of Health regulations. Such certification shall not be misconstrued as a guarantee that the system will operate satisfactorily nor certification of alteration after in pection. s Da e I Glacier Path, East Sandwich, MA 02537 508-833-2177 THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: e PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE,, MASSACHUSETTS { 01pprication for Mi,5poe;ar *pgtem Congtruction Permit Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. Owner's Name,Address and Tel.No. ��s/ i11.q. f,f- VA ,y� � Assessor'.s Map/Parcel rn �/�� ,I, Installer's Name, d s, el.0, j/ Designer's Name,Address and Tel.No. Type of BuiFding: S v Dwelling, No.of Bedrooms Lot Size sq.ft. Garbage Grinder � Other Type of Building r No.of Persons Showers( ) Catete9a( ) Other Fixtures �5 Design Flow 'gallons per day. Calculated daily flow < gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil ,1 Nature of Repairs or Alterations(Answer when applicable) Date last inspected: _ Ag 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 Co a and not to place the system in operation until a Certifi- cate of Compliance has beenpis� s f H h. Signed Date Q /c/,44 Application Approved by Date Application Disapprove o t o owm easons .+ i Permit No. ' Date Issued --- -----------------------r�---------- `V THE COMMONWEALTH OF MASSACHUSETTS (�I BARNSTABLE, MASSACHUSETTS Ac � R =~� erfffate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System �'�r� c,. -��j a RY�ired (_ )Upgraded( ) Abandoned( )by at ff'v 0 rd G has been constructed in accordance with visions iffe3 an e for Dis(Po aSy &r'onstruction Permit No.. ted 3, .04 Installer Designer The issuan of s0 ermlt Waft not ce ons rued as a guarantee that the tern will function esied.C Date Inspector /I, r ru ---------------------------------- ---- Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS 'Wi5po5ar *pMem Congtructton Permit Permission is hereby granted to Construct( )Repair(X )Upgrade( )Abandon( ) System located at t r „ i . 6 i and as described in the above Application for Disposal System Construction Permit. The applicant recognizes 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 t. Date: f Approved by 7' �/� U �t, TOWN OF BARNSTABLE — UNDERGROUND FUEL AND CHEMICAL STORAGE REGISTRATION OWNER AND INSTALLER INFORMATION ADDRESS: 3�t S` Gt IA St- . �Q� �� ; MAP NO. � � �S� PARCEL NO. +� / OWNER NAME: �'f L . t�t r P VILLAGE: VA tM a G L t' INSTALLATION DATE: .� BY: UY1VWnu�.t ADDRESS: 3 HUA44 c 1'V tV(t-A.,% 0, CERT. NO. TANK 'INFORMATION LOCATION OF TANK: DO A CAPACITY Db a TYPE �? AGE $FUEL/CHEM I CA 1�tr e No TESTING CERTIFICATION C ] PASS C ] FAIL DATE LEAK DETECTION C ] CHECK IF N/A TYPE/BRAND ZONE OF CONTRIBUTION C ] YES C)((] NO DATE TO BE REMOVED FIRE DEPT. PERMIT ISSUED C ] YES Cl] NO DATE CONSERVATION Cx] CHECK IF, N/A ' / *� DATE BOARD OF HEALTH TAG NO. ^C ]C ]C ]C ] 'DATE 1 PLEASE PROVIDE A SKETCH SHOWING THE TANK LOCATION ON THE BACK OF THIS CARD ASSESSORS MAP' ~ ---------- - TEST HOLE LOGSA,_ 4 PARCEL• FLOOD ZONE: SOIL EVALUATOR : '�V( �J^ wl� __.___ I TNESS : I �I �L�.��1 J� �.bt1�.�1 l�J -� / REFERENCE � _� aa1C.-#_ � �_.._ ��I��~ �3 DATE; Z ;DD 'J �rI�C.� (-Tl - '`�,l•191.`l �3L7d�C.. �G.3 ��`11��-' PERGOLA I N RATE: 5A/1�� Cl-XfS II lL • TH- 1 � TH-2 ' tad nog( Nr,7 ,2� !-� 1k.l�j� L�� v - `ee, _ LOCAT10N MAP��,� '� ��cr. rv1 /� ....-.. ______ _...__-__--.._ ...._. . _...__..,. .._.__,-•-___._...r_.._.. .____,_.__ __�._— . 451 i v=" 'l c_tz�EQ _ ►2. �4Tt�l— a ' CM -„ QAV* --P� SEPT I C SYSTEM DES I GN -- . A y FLOW ESTIMATE MATE '-1�-��✓V 12� �Q��^-j Tb �v� 2- ►t� .IC-�-�.. __ -_ X t '(fit_ I I _. _.. .. . vim, Ho , WC_ LA-?ITH '' YZeE ->(, Q)_l ._ _._._J::�JTP�!4t- BEDROOMS AT //O GAL/DAY/BEDROOM 33' 0 GAL/DAY SEPTIC TA14K j u-U w—A-f 1'J A-CC D \ .. : � 3 GAL/DAY x 2 DAYS GAL II ` 1E / /T Z�'_ $� USE/000 GALLON SEPTIC TANK ABSbRPT I ON SYSTEM _.__ �..iS� 1-�i i" I "ila L�cz�c�T c a = Iss , SI DE,AkEA: 2 x 32 y` /v X Z. k Q. , BOTTOM AREA: 3Z X /3 K d� �4 �.ly� -�. r.j( �I OG�_ W1 T1--� � „ , ; . -.• SEPTIC SYSTEM SECT I ON Gl+ ► . 1- y 04 As I /� GAL - SEPTIC TANK IL 141 - zz � 1 /6►5� v� —M15 z1WON -- e- hl �tlP ` SITE AND SEWAGE PLAN OFF _ ._, LOCATION : 'n Cv�f�Li� l TJ ul PREPARED FOR : �' H C�S7-eLK,77b� _._��_._.��!?�..?a, ��._.__._..�Div ki� ,¢ off•./ .��i° >�' B . SCALE DAV ( D B MASO : - N 'RS DATE DBC ENV I RONMEN�AL DESIGNS -- EAST SANDWICH . MA DATE HEALTH AGENT ( rj08 ) 833- 2177 I - 4 i