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HomeMy WebLinkAbout0102 RUE MICHELE - Health i _ e d i IN a t s TOWN OF BARNSTABLE `LOCATION `0Z 12,Ie-. N",eaelle SEWAGE # VILLAGE ASSESSOR'S ASSESSOR'S MAP & LOT 02l NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY: (type) Tr ev,c 0-5 (size) _..NO.OF BEDROOMS BUILDER OR OWNER 11/1 G4fle :Elli b PERMITDATE: COMPLIANCE DATE: 51�12005 Separation Distance Between the: t Maximum Adjusted Groundwater Table and 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) 13® Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet X leaching facility) /00 Feet Furnished by ,C r/a h 4 • T r, lT.l L Na F. ..... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .fF.........?.o.!�/!Y...............OF...............?A,,.R!.r..T..a.cl•:__.......... ._._—..—. Ami iraftri fur Disposal Works 4fintlah t#inn f lumit Application is hereby made for a Permit to Com'"c�t or Repair ( ) an Individual) Se/wage Disposal System at: ,Yri�.��fJ/ eF ✓o/sv 6[L/,OTT E➢�MG�:Ldf.fi?�1.d12__�ra.�.�._...a Ra_'....�'K.�.Z�n?:� ._ 1 o 6=-Addr or Lae Na ..�..........R..... _ Add— Add— Type of Building Size Lot_.2.c2.!�'eAf.Sq.feet .. .�. Dwelling—No.of Bedrooms...'.�...__.._........_......Expansion Attic ( ) Garbage Grinder ( ) WOther—Type of Building.tom. t�'1..6...__...No. of persons........1(a.........__...Showers (tom—Cafeteria ( ) Otherfixtures........................................................................_....._............................................................ W Design Flow.........SAM...-.---- .gallons per Person per day. Total daily flow....._NX..R_4..:.............._......gallons. WSeptic Tank—Liquid rapaci gallons Length...............Width.......-......Diameter................Depth.--._.....-. x. Disposal Trench—No....................Width.._..............Total Length..............._...Total leaching area.........._.�`q.ft. 3 Seepage Pit No...._�............Diameter......$......—Depth below inlet.—A_.........Total leaching areaa9--d.nML.sq.ft. z Other Distribution box( ) Dosing tank( ) aPercolation Test Results Performed Test Pit No. 1,m-2..--minutes per inch Depth of Test Pit ..........Depth to ground water...S4.GxA.a:..__.. rr, Test Pit No.2__....._z...minutes per inch Depth of Test Pit.................Depth to ground water.........._............ �-- O- _. —- - ....... ...... — �i Description of Soil_.....1.....1.Oes^4_A.vsSLR. Nature of Repairs or Alterations—Answer when applirrble---...---.--------...:_._.....--•--•-•------------.-•--•-.__._._...._--.-- _.._..---..._-_--•-•-•-----------................ _ 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 Compliince has been issul by the bogd of ealth. Signed.. _ —-+-- <� D,^c� rlT Application A roved B �!Gf%F�r�� - .- !l _ APP PP Y•-- _ Application Disapproved for the fallowing reasons:.....—.-____..__. -- _...------:.._...._........... ..._—_._.._ .....__ .............. ...._.__..._.......................-—- Permit No.._._._. n k TOWN OF BARNSTABLE LOCATION /U o� �Cce- dj elfe& SEWAGE # :r N-MLAGE .�i4RN�7 i�L�' ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY Y LEACHING FACILITY: (type) (size) N.O. OF BEDROOMS BUILDER OR OWNER 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 1 f LO CE:R-MIT -U O V-1LLhGE—• Ga - --e-t D-D- - S. - --�-- � 4',��+wC-ram - D AT_E-RE R-N_I-C-1_SSU T i �� �� ;, ,. � •� � � �{ ` �� � 1 _ V � Y .}M, �� � 1 .. �., ' .. �. � � � .. Y �_ �V\ - � �" �- - �. ... i f. ` _, << Town a Ba rns• P# talDle C�7 ,- as Department of Regulatory Services Public Health Division Date 200 Main Street,Hyannis MA 02601 .. ' Date Scheduled ) . Titne Fee Pd. r� Soil Suitability Assessmentfmr`Sewa a D' g _isposal Performed By: Witnessed By � J. .. Location Address -VOCATION&GENERAL INFORMATION 102 Rue Michele owner'stvame Elliot cummaquid► . MA Address -.T02 .Rue Michele Assessor`s Map/Parcel: M3351 Parcel 29 Lo 1'. l?nginee• ame BS•C Group,.: Inc. NEW CONSTRUC-nON X S/C REPAIR �. ep 508-778.-8919.' Land Use• OAS-rq/1_6:- Slopes(96) Surface Stones Distances from: Open Water Body 30r, t` . ft Possible Wet Arw �� �ft Drinking Water Well 2'C>'P ft Drainage Way N�' ft` Property tine_� ft Other. ft SKETCH:(Street name,dimensions of lot,exact locations'of test holes&pare tests,locate wetlands in proximity to holes) �. Parent material(geologic) 8ns S Depth t0 Bedrock I t Depth to Oroundwater, Standing Water in Hole: / Weeping from Pit Race Ud �T Estimated Seasonal High Groundwater DETERMINATION FOR SEASONAL HIGH WATER TABLE Method Used: Depth Observed standing in obs.hole- In. Depth to soli mottles: Depth to weeping from side of obs.hole: in, Groundwater Adjustment {r, Index Well N Reading Date: Index Well level.-_.- Adj,factor,,,r,,-_ Adj.Groundwater level Observation PERCOLATION TEST. bate 18 me ff Ti .A��_ Hole ti Time at 4" Depth of Perc ,. Time at 6" Start Pre-soak Time Time(9..,6..) End Pre-soak 6!U Rate Minlinch � III/// Site Suitability Assessment: Site Passed Site Failed: Additional Testing Needed(Y/N) Original: Public Health Division ObservatS6 Hole Data To Be Completed on Back---------- ***If percolation test is to be conducted within 100'of wetland,you must first notify the Barnstable Conseil vation Division at least one(1)week prior to beginning. QASEPTIC%PERCFORM.DOC i DEEP.OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil• Other Surface(in.) (USDA) . . (Munsell) Mottling (Structure,Stones;Boulders: © �1/ it o i v t► ►d pp OT3 � 1 . S.#�0 E'er , . DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Its Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders, Consi en %Gravel) DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon _ Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure.Stones,Boulders. C to • F .:y 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) i Flood Insurance Rate Mau: Above 500 year flood boundary No' Yes , ,,, Within 500 year boundary No_ '.Yes Within 100 year flood boundary No Yea Death of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervious material exist in all areas observed throughout this area proposed for the soil absorption system? Y E 5 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 Enviro mental Protection and that the above analysis was performed by me consistent with 4 , the required training.expertis and experience described in 10 CMR 15.017. . Signature Date ®✓ .�S" . ' Q:�S.t3r-nC1PZRCPORM.D0C ... .':. . Town of Barnstable P', / Department of Regulatory Services Public Health Division Date `-- f61y `e$ 200 Main Street.Hyannis MA 02601 ' ( Fee Pd f-' . Date Scheduled �• Time — ,foil Suitability Assessment for S a e Di sal Performed By Witnessed By: LOCATION & GENERAL INFORMATION [.ovation Address'. �0 2 �� i'Y�` L Owner's Name �c_c--�-0< Me V - Address (A 2. Xea �c - Fist p� r ' © sName jc 6rR-vuP �.^jc- - Assessor's Map/P�rcel:,�'J 335, Lo7 �`� � ,� � E" i NEW CONSTRU�`I lON REPAIR /6 tt one#,fir O� I �� `� � i o Land Use ��ST✓� St es(35) Surface Stones If_ t i `J l 0D ft Possible Wee Area 22 "=ft Drinking Water Well (Distances from: Open Water Body � I • �:. �. ft a Way i+�° A. Property Line 's ft Other Drainage Y SKETCH:($treet name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands in proxitnity to boles) r i I • 6,4,9 nA,/ 44t3 Parent material(geologic)�[V r A�I_r., i Depth to Bedrock Depth to Groundwater: Standing Water in Hole: SSG LOB-�. Ii Weeping from Pit Face Estimated Seasonal Nigh Groundwater (? 1 yel", - i DtTERMIN TION FOR SEASONAL HIGH'WATER TABLE Method Used: 0 f ai /1 I i /C/Y f/ Depth dbperved standingn obs.hole: — in. Depth tc anti notss: Depth flln, to weeping from side of obs.hole: _.in, aroundwater Adjustment ' ' ---- -.Adj.factor�,,.._ �. Adj.Groundwater Level,,,,_, Index Well# Reading Dates index well lcv4, i PERCOLATION TES Date �ime ' Observation '1:1 44 � Time at V 2 r L17 Hole# 96 / Time at 6° . UD Depth of Perc / Start Pre-soak Time.@ i c End Pre-soak Rate MinAnch t ' Site Failed Additional Testing Needed(Y/N) Site Suitability Asse0stnent: Site Passed OriginaL• Public He*lth Division Observation Hole Data To Be Completed on Back ---- ***If percola4ion test is to be conducted within 100' of wetland,you must first notify the Barnstable C44servation Division at least one(1)week px for to beginning. DEEP OBSERVATION HOLE LOG Hole# f Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. onsis enc ravel D 8 rr G,SrtN� %v y2 5/3 i�d t'S 'x� W���1n✓lr DEEP OBSERVATION HOLE LOG Hole# Z Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency, Gravel) v'3 Z " 5• L19�1 a /o i2 3 ITT /0' 111 � LDS�r_ M 2 Gr c�IQ U YA 6 ' �jeettc ✓//� el- 4`e DEEP OBSERVATION HOLE LOG. Hole# 3 Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. IT,: Consistency.%Oravel) l./ C /0 a DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA). (Munsell) Mottling (Structure,Stones,Boulders. Consistency.%amyg1 �i�'f o•r CJ .Ccoy coP)m /v Flood.Insurance Rate May: Above 500 year flood boundary No_ Yes Within 500 year boundary No_ Yes Within l00 y ear^o-:d boundary No— 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? 1 i' 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 3:10 CMR 15.017. Signature /d` r' Date ..�// � QASEPTIC%PERCFDRM.DOC Town of Barnstable P# VV � Department of Regulatory Services auwersar�, Public Health Division Date teas. 200 Main Street,Hyannis MA 02601 M1x� t � Date Scheduled / Time �0 Fee Pd, Soil Suitability Assessment for Sewage Dis osal /� Performed By: 1��ax �.�8�4 /"�- Witnesses By: OCATION& GENERAL INFORMATION Location Address ley Owner's Name 5,//Q Address /d Lu a -C "e cx Assessor's Map/Parcel: l.O'f I# Z Engineer's Name H0 e K Ot 813, Pz NEW CONSTRUCTION _,L- REPAIR Telephone# Sly 6- 7 7 1'— '23 9� Land Use Slopes M 0 /O Surface Stones N.4 Distances from: Open Water Body y ft Possible Wet Area ' + ft Drinking Water Well �d?ph ft r it Drainage Way A/4 ft Property Line '70 ft Other ft SKETCH:(Street name,dimensions of lot,exact locations of test holes&pert tests,locate wetlands in proximity to holes) t r izvr -- ---..... " Parent material(geologic) U to C'O'l S d Depth to Bedrock NA Depth to Groundwater. Standing Water in Hole: AI' Weeping from Pit Face /V Estimated Seasonal High Groundwater @ f 3a°j m N Q �r► ?-f"�"' o �'+•»° DETERMINATION FOR SEASONAL HIGH WATER TABLE Method Used: t>(35 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 Adi,factor Adj.Groundwater Level PERCOLATION TEST lute 1 / Time , v ObseR'2tioR Hole# .. Time at 9" /dv/ Depth of Perc �g <g mwrZ A C��°�3_ Time at 6" Start Pre-soak Time @ � � � / G v Time(9"•6") V End Pre-soak ` Rate Min./Inch L 2.#"W, 4 2,r° i), 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. Q:\SEPTIC\PERCFORM.DOC DEEP OBSERVATION HOLE LOG Hole# / y Depth from Soil Horizon Soil Texture .Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones;Boulders. Consistency,% ravel 0- -lz- L, 5�n//� 10Y2 / olve I Z'r_.. 4" L 5 HN 36- �y" S. /a Y12, 615 AloAl-r, 6,1 , _. 2 (r Z ,5 W�-0 v'Yli 7 DEEP OBSERVATION HOLE LOG Hole# 2- Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency.%Gravel) L.Shc 3 Now �dYX 7 OFVf 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) DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency, t Flood Insurance Rate May: Above 500 year flood boundary No— Yes .., Within 500 year boundary No= Yes Within 100 year flood boundary No— 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? ,E 5 _— If not,what is the depth of naturally occurring pervious material? Certification I certify that on 0 2- (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 110 CMR 15.017. 7 � S /�3 ,9 Signature Date , Q.\SEVnC1?ERCFORM.DOC