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HomeMy WebLinkAbout0028 OAKMONT ROAD - Health r A . • • 0ad • aBanistable - �cax tr7e^t'+mT"f�+`�"' 4 160No. Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS Yes fltlfltation for Misposal 6pstem ConstrUttion 3p¢rmit Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon( ) ,Complete System ❑Individual Components Location Address or Lot No.,20 .0 ft/mav k&tO Owner's Name,Address,Teel.No. S p� Assessor's Map/Parcel /Y1, !& zz;Pp W Installer's Name,Address,and Tel.No. Designer's Name Address,and Qf emu✓ ode t °°`� �E � Type of Building: !� Dwelling No.of Bedrooms ` Lot Size ®Z sq.ft. Garbage Grinder( ) Other Type of Building V 1.,�_ No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) / gpd Design flow provided 4S gpd Plan Date Number of sheets / Revision Date Title S>7LC_ t- Ew,46-,5_ PL,*Y Abe 26�S.7 Size of Septic Tank / l9t� Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintena ce of the afore described on-site sewage disposal system in accordance with the provisions of Ti o the i en 1 Code not to place the system in operation until a Certificate of Compliance has been issued by t_is card of He Si dIn Date Application Approved by Date Application Disapproved by Date for the following reasons A ,n Permit No. Date Issued TOWN OF BARNSTABLE LOCATION '60,K W10v1 f JZ k. SEWAGE-9 Q/0 — jOcys VILLAPE i3atf yi g 6,,61.e ASSESSOR'S MAP&PARCEL '�� INSTALLER'S NAME&PHONE NO:. /�� � ��5177,cef7ht �j YC`2 SEPTIC TANK CAPACITY L j 00 14- (o LEACHING FACILITY:(type) 5-00 5 (size) Y2)( 3 NO.OF BEDROOMS OWNER PERMIT DATE: )0 COMPLIANCE DATE' &6 ¢s _ 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`L'-eaching Facility(if any wetlands exist within 300 feet of leaching facility). feet FURNISHED BY 4 Z, 33_3 a o� 3A- 8 3 b _ V7 ff c� o � � s! -Fe Noe THE COMMONWEALTH`OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS' 0(pprication for Bisposat.6pstern Construction Permit r Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon( ) /Complete System ❑Individual Components Location Address or Lot No.,20 Q Owner's Name,Address,a qTel.No. . Assessor's Map/Parcel � ' Installer's Name,Address,and Tel.No. r Des i ner' Name„Addre and Tel.No. /740 4L/A Doc Type of Building: Dwelling No.of Bedrooms Lot Size 02 17L sq.ft. Garbage Grinder( ) Other Type of Building DWA9.Z4 No.of Persons Showers( ) Cafeteria( ) -7•3. Other Fixtures i Design Flow(min.required) j gpd Design flow provided s gpd Plan Date —� '�D Number of sheets Revision Date Title S/ { �L 7 t ,a�E 41✓ Fo2 V_11S�v s11�7 Size of Septic Tank Type of S.A.S. d ` Description of Soil '1 � f A Nature of Repairs or"Alterations(Answer when applicable) Date last inspected: ' Agreement: The undersigned agrees to ensure the construction and mainten nce of the afore described on-site sewage disposal system in t accordance with the provisions of Title-5—ofEh, ii ee tal_Code a,d not to place the system in operation until a Certificate of Compliance has been issued by t 's Board of He 1 .._ 1 ! Signe _ ! i Date = Application Approved by Date V Application Disapproved by Date for the following reasons rn 1 -- v Permit No. Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,,th tithe On-site Sewage Disposal system Constructed Repaired( ) Upgraded( ) r Abandoned( )by 1 r _ at �'�_ has been const cted i?accora with the provisions of Title 5andthe fo Disposal System Construction Permit No. � d Installer /� � L- : Designer #bedrooms 4- Approved desi• flow gpd The issuance of this V e �t shall not be construed as a guarantee that the system wi fun do as desig d. Q Date ( Inspector v it'). ►`S" --------------- -- --=------- ------- -------------- No. a Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION- BARNSTABLE, MASSACHUSETTS Dis Osat *pstem (Construction Permit Permission is hereby granted to Construct( •�R_ep�i.r-( Upgrade y�� System located at and as described in the above Application for Disposal System Construction Permit. The applicant recognized 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 permit. Date Approved by Town of Barnstable Regulatory Services Q. Thomas F. Geiler,Director KAM _ Public Health Division 63 `� Thomas McKean,Director 200 Main Street, Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Date: 3 /7- Z o/° Sewage Permit#Z��b ' D6 2 'Assessor's Map/Parcel m• 3 19 01 S 2- Installer&Designer Certification Form 1A)s,0,Ec M - 2old, , Designer: Installer: iQt CoA.sT�CycTio-A Address: Address: Al d, L,�A/.�►96 tl Ty f�� D2 5,36 /�lA2S7 Al IWILL_ 4M On 3 '/2 - 2 o/a ,d9A.D Q�P/1 X,g,_IVo/s was issued a permit to install a (date) (installer) septic system at 2 8 DAKin,�A✓T oo4-h based on a design drawn by (address) �T%�oyc E AYs°c 1,4�s' dated �/AA), 6 , Zola (designer) —Z 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. Stripout (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 I V 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. Stripout(if required)was inspected and the soils were found satisfacto 5. Ot� :�� • (Ins er s ignature) ': DOYLF_,1!T v No.33339 rk c;.� (Des er's Signature) (A e� i tamp 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. gAoffice fotmAdesignercertification form.doc Town of Barnstable P# z e-01 Department of Regulatory Services Public Health Division Hate _ d sue. 200 Main Street,Hyannis MA 02601 Date Scheduled ' U � Time �k Fee Pd. �uo Soil Suitability Assessment for.SMo Disposal Performed By: �Tb &1 �, 1�OYL E Witnessed By: 61' H/> - .r C r y. LOCATION& GENERAL INFORMATION I.ocation Address 04,K/Y/d/V 7- 4,4,1,6 Owner's Name f1 k THUrQ BE�Q 6LCs2�� -�•e- Address IAJff L 7W,9 M Assessor's Map/Parcel: In•3 �.g /�• SZ Engineer's Name f-0.0 YL E f�sSo G NEW CONSTRUCTION REPAIR Telephone# Sd g -jr'3 9 9 Land Use V46 ni N T RE5-/1J F,J714L Slopes(% Surface Stones_yam SO/kE 4i4SE.e1/61b Distances from: Open Water Body- ft Possible Wet Area 3!�d ft Drinking Water Well �-�D ft Drainage Way. /✓ ft Property Line r. ft Other ft SKETCH:(Street name,dimensions of IoG exact locations of test holes&pere tests,locate wetlands in proximity Wholes) / Z D_ 9 "1 ,t 3' 0 2 7 s N Z'3. N N /S N CJ VE CaVr _7 w � . Parent material(geologic) L �'�� `� .ASS`/ Depth to Bedrock Depth to Groundwater. Standing Water in Hole- Weeping from Pit Fpce N� w Estimated Seasonal High Groundwater LPL Z d /0 ''e 6 el"#_ry , A14.Le-411 /YI e DETERMINATION FOR SEASONAL HIGH WATER TABLE Method Used: gv Depth Observed standing in obs.hole: _ in. Depth to soil mottles: in. G7 Depth to weeping from side of obs.hole: ----- in. Groundwater Adjustment ft. Index Well# Reading Date: Index Well level „� Adj.t'.tetor Adj.Groundwater level PERCOLATION TEST Date Time r Observation . Hole# T /. T"3 Time at9"1/:/3,'Zb //%Z/•".DS' "- Depth of Perc 3S(" 3 .Z Time at G" Start Pre-soak Time @ %Df y �:,y'p . /0•: Ss; b y© O g" Time(9"-6") End Pre-soak 't� ll'-%'D! 30 Rate MinJlnch g .M nl G.E M-1/l f Site Suitability Assessment: Site Passed ✓ Site Failed: Additional Testing Needed(Y/N) Original: Public Health Division Observation Hole Data To Be Completed on Back--------:-- ***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. QASEPTIC�PERCFORM.DOC DEEP OBSERVATION HOLE LOG Hole# Depth from SoiI Horizon Soil Texture .Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistencv.%Gravel) L apNGV�1� I-a'9 ldY/1 �3 ir/ G081�L �,S DEEP OBSERVATION HOLE LOG Hole f . 2 -- Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. ConsistencX.%Gravel) DEEP OBSERVATION HOLE LOG Hole# 7-3 Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell). Mottling (Structure,Stones,Boulders. Consistency. o Gravel) p -.9" 19 zo'�w ,� `�/Z �✓ a u/�i°Des g"- 32 4 61 -:ro IV Z /Zo'' C `s A44 pY4 DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. onsi en yE -/74 SLo,g /o/t �y� N o w GoBB�,E_s' Flood Insurance Rate Map: / Above 500 year flood boundary No V Yes Within 500 year boundary No Yes -- - Within 100 year flood boundary No, _V Yes 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? If not,what is the depth of naturally occurring pervious material? — Certification I certify that on 7 /9 (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 CNM 15.017. Signature ,� �✓ Date Q:�SEPTIC�PERCFORM.DOC • ' 5 • i A A • a: -- I !— NIL IL f pp Fn • FO , ✓/�yy • _ III 04KMC,\I " Aeon C'Um ch<) vi ml EeALE: .���"�` ArPr+ov®ev: oitA%vw. 'DATE: I•d b t O nevOeo r 1= a91 . - :. oiuiVbo rnnYesi I J ofli TU IJ- v.:;Tl A r. 12 • f i -lCAIL: 5✓a%" APPROVED SV: MAVM Br•�••f" DAM RUVMW - 's1 T-PP FavN �9� 710,oll C-L 7.5. G ' s6WAGE SYSTEM PRdF/LE z COVE,R' Of �+`"S� SCr;✓. SAD /'YC sy/G s Te s7" �C'ESUG� 5 y2" STbN /NS`P4G7-/0/11/ AOR7* -� 7 F/ti: GR4PE ✓f/N, a" a'+ T-`l`y L.G;L.G CdvER 6 3 Nt►n1. COVER wl-rylN 6"f/N- GR. _ CO ME/R WITN'IN G,�'� "Mid• G vAM Z-OAlf G rJ.4iy D Nl WITM/N G" 36"MAx* WATERY/GH? 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