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Home My WebLink About0127 MIDPINE RD - Health ;zl 7hrdQ pine K,d� Alle 1 I i i i I i I j I i i I 1521/3 ORA 10'/0 P2 No........................ t . "` !ss....f . THE COMMONWEALTH OF MASSACHUSETTS BOARD HEALTH Appliraation for Disposal Works Tnnotrnrtiun ramit Application is hereby made for a Permit to Construct ( ) or Repair ( Individual Sewage Disposal System at // ..f ........... --•-•----_.....Z. Ve ell.1� .......................................... T ................................. Loc A dress > or c ner fig. "K.0 f _f'!'r� ......e...... Installer Address d Type of Building Size Lot............................Sq. feet aDwelling No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) p., Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) dOther 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. Seepage Pit No-_----------------- Diameter•___--__-___--_--_. Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) a Percolation Test Results Performed by........................... ---•••--•••-------••-------------------------- Date........................................ ,� Test Pit No. I----------------minutes per inch Depth of Test Pit.............._.___. Depth to ground water------------------------ 44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water-.-____________----____. 04 ----------•--•--•--•---•------•--------------------------------------•--.............•••••-•-•_....--•---......-•-...........•-•............................ ODescription of Soil.....................................................................................................------------------------------------------------------------..----- x of R s or Alteatio — "n apps licable. ......... ..UN Agreement: The undersigned agrees to install the aforedescribed vidual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Sanitary Code und�ee si ed 8rtl r agree t to place the system in operation until a Certificate of Compliance has b n i e th 3oard o Signed ----------- ... ---- ------------------------- ---�®- ---..... ....... ate Application Approved By----------- ------------•... ( � �L% ................................... ate Application Disapproved for the following reaso s.--------...•--••---••-••••-•--•-------------•-------•-------•----------------•-----•-----------•-----------..... --------------------------•--------•------------....-----------------------•--------------------------------------------•--••---••-----•-----------•-•-•--••--•-------•-----•-•••-----•---•-••--•--..... Date .............. Issued....................................................... Date gel THE COMMONWEALTH OF MASSACHUSETTS BOARD Of4 HEALTH .!' ...........OF.......... ............................... Appliratiaan for Elispaasal igar,.kii TonstrurfUvn rantit Application is hereby made for a Permit to Construct ( ) or Repair (101 an Individual Sewage Disposal System at -------- ---------------------------------- ...----..--..--------- Loc A dress or ------------------------- a --- �:.Q�'�:'•-�� er _� ✓°�i�t?..................... Installer / Address Type of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms................................ .....Expansion Attic ( ) Garbage Grinder ( ) U PL4 Other—T e 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. Seepage Pit No--------------------- Diameter-------------------- Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) . '-� Percolation Test Results Performed bY........................................................................... Date....................................... aTest Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water_-_-_______•--_-------_. f� Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a' .............................................. ------•------------- --------------------------------------•-•--•--------------------•-------•-------•----------•----------------------••------------.--•-- ODescription of Soil..............................-.)r---------------------•-•---•--•---•......--------••--•-•-•---••-•----•-..........•................................................. Un -•-------------•-----••----•---------•--------- W r� - Na >ce{of Re rs or, r Alt .atio s saver w e ap icablUs - ._"''... :.!' Agreement: The undersigned agrees to install the aforedescribed.I'n ividual Sewage Disposal System in. accordance with the provisions of TITLi� 5 of the State Sanitary Code=`The and si ne rther agrees, t to place the s stem in. operation until a Certificate of Compliance has been i s e• bry'the-rbo rd o health• Signed • . . ....•. ....,: .................................... -----�-- •�-- /c' a ApplicationApproved BY .......•-- �•------------•-•--.....-•--•----•-•---•-- -------•-------------------- Date Application Disapproved for the following reasons:....................................................................... ...................................... ..........................-----------------•---------•----.......-•••-••--••-•-•••-----•--•--------•-----•--••--•------------------•---••-•-----•-----••-•----•----••----•--------••------......._..-- Date PermitNo......................................................... Issued....................................................... Date THE COMMONWEALTH CIF MASSACHUSETTS BOARD :HEALTH ` :................oF.. ...................... ,. j C9rdif atr ,af =f�untpfianrr ` TYV�� CE ?a41Y at th I idt�al Sewage Disposal System constructed ( ) or Repaired ... --... • . �........_.. •.......--•-•-...:/--------------------------------byInstaller ` at. s . .� --- '' ----------- T i"a has been installed in accordance with the provisions of TITL0 �of T �tj to Sanitary Code as described in the application for Disposal Works Construction Permit No________________________________________ #'dated__.-------........................................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS AP,UARANTEE THAT THE SYSTEM WILL FUNCTION SAT SFACTORY. DATE................................ ,'.... Inspector......... ( ..... ............................................ THE COMMONWEALTH OF ASSACHUSETTS BOARD, OF HEALT Q L/ r�r cI ..........O F......... . J � 11, �� ...... No.------.. 'FEE. .......... pia as Unk Pan , Permission is hereby granted-- „.. •---- ---•------ ................. �....................................... ----------------------------••--••--•-- . -----.............. to Construct R (. � ivl!d gew Isposal Sy, ' at No. _ .... " .. -------...........-------- Street as shown on the application for Disposal Works Construction Permi N ........... 1' .. ....................................... . ---•-••-•-••• -•----------•--•- Cd G� oard of Health DATE. •-- FORM 1255 HOBBS & WARREN, INC.. PUBLISHERS LOCATION SEWAGE PERMIT . NO. I V Ml0 17i� VILLAGE �.t � "4 3S_4 OZ3CO WOU t CcluD I-4 16�It�- INSTA LLER'S NAME R ADDRESS '�� 1j3 Z P B U I L D E R OR OWNER MccloD T AYI G DATE PERMIT ISSUED /oz5./1� DAT E COMPLIANCE ISSUED 3� SOIL EVALUATOR& PERCOLATION TEST FORMS Page 1 of 4 OF tF1E . P Town of Barnstabl e BARNSTABM $ Department of Health, Safety, and Environmental Services 64. Public Health Division �lFp MA'S 367 Main Street, Hyannis MA 02601 Off ice: 508-790-6265 FAX: 508-775-3344 Soil Suitability Assessment for .Sewage Disposal ASSSESSORS MAP NUL � pARcako-,. �� n NO. le � Date: Performed By: 17 �--e �ss�/ ✓ C— Date: Witnessed By: Location Address ' � � Owner's Name Lot#: 6 Address,and CCl/�'1iT114 Q c3i c� Assessor's Map/Parcel: Telephone f/ NEW CONSTRUCTION _✓ REPAIR _ Office Review ,$q,�i✓ CTY�oi� au�✓� Published Soil Survey Available;. No Yes Year Published /cJg3 Publication Scale !: Soap Soil map unit �✓� Drainage Class WXJZ R4,;= Soil Limitations Surficial Geological Report Available: No Yes GE ?oi TyE �,*.,,V,-s Year Published / 7 Publication Scale -t: �v JZo38�:oC�.(t Geologic Material (Map Unit) Landform Flood Insurance Rate Map: ! , caOs C Above 500 year flood boundary No Yes zo vAC Within 500 year boundary No Yes Within 100 year flood boundary No Yes i Wetland Area: i✓O National Wetland Inventory Map(map unit) Wetlands Conservancy Program Map(map unit) Current Water Resource Conditions(USGS): Month Range: Above Normal Normal v/ Below Normal Other References Reviewed: DEP APPROVED FORM- 12/07/95 ' FOR1o4 11 - SOIL EVALUATOR FORNI Page 2 of 4 ,Cori' 121 Location Address or Lot IJo. oln-site Review . Deep Hole Number#, �" 3 Date.. d/�l9eo Time: /.?..30 Weather C.loabKlj"/o-W.3 on site plan!- Slo ::..:....:::. .. Location (identify a (%! ,(6v,c j Surface,Stones /✓o Land Use �6si�6•�.i�+ p Vegetation ,... Landform �6✓t L. poi Position on landscape (sketch on the back) Distances from: )ioa ` feet nl 4 feet Drainage way Open Water Body property Line SO feet Possible Wet Area N/A -,feet Drinking Water Well .n/�A' feet Otfier DEEP OBSERVATION HOL ''LO' or Soil Other ou Depth from Soil Horizon So�USDAIre MunseSoil llq Mottling - (Structure,Stones,�ravleljrs, Consistency. °� bar, Surface (Inchesl ?.•' iq hw�y�Ca9A'1 is YRyik 4/6 _. cA fEO,= N, 3 yo~ -G3' z�b-F"V JOA Y2i/ IV p~�!7B" o YNc19 o.YR 714i 76 „DepthtoBedrock: �O t tPar :77=== Weeping from Pit Face: Water in Hole: ^'^-�� --- '4 Death to Groundwater:' Standing Estimated Seasonal High Ground Water: /Y w I DEP APPROVED FORM-12/07/95 - �. .. f 1 �. � � � � � � N � ,...: 8 �3 �� r ,. � ,� _ �o ., .� .i: :� " . , , . . . . . _ ,: , . 5 .., .` 4 _ . � � _ __ _ .. '. - d' .., ., 4.� 3 L _ FORM II -;SOIL EVALUATOR FORM Page 3 of 4 Location Address or Lot No. Determination for Seasonal High Water Table Method Used: ❑ Depth observed standing in observation hole.��,- inches ❑ Depth weeping .from side of observation hole/%.%✓z- inches ❑ Depth to soil mottles lVo vE inches ❑ Ground water adjustment ................... feet`. 'S�7 Reading .4�..�s� Index well levei��!.� Index Well Number A...._r....✓.? g Date Adjustment factor s./ ' Adjusted groun water level : Depth of Naturally Occurring 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? Y� S If not, what is the depth of naturally occurring pervious material? Certification I certify that on (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. Sign re Date �� --- DEP APPROVED FORM• 12/07/95 y FORM 12 - PERCOLATION TEST Page 4 of 4 1 Location Address or Lot No. ��27 /y?.�?�%✓� �a�� COMMONWEALTH OF MASSACHUSETTS Massachusetts Percolation Test* Date: .. .8�� [ %� Time:. :.�.Z�`So:. Observation Hole N Depth of Perc .5__ ' /o� Start Pre-soak End Pre-soak Time at 12" Time at 9" Time at 6" Time (9"-6") Rate Min./Inch 2 /1/ Minimum of 1 percolation test must be performed in both the primary area AND reserve area. Site Passed Site Failed ❑ . ........././.............................................................................................................—_......-.......- Performed By: Witnessed By: F ze Comments: ::,..::...�..,�. . . H.k:. ::..:..... ...:.,.:..—__ �_... :... DEP APPROVED FORM-12/"/95