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HomeMy WebLinkAbout0050 SALT ROCK ROAD - Health 50 Salt Rock Rogd, Barnstable A= 317-- 049 TOWN OF BARNSTABLE, LOCATION, ' � I-t- �+ SEWAGE # VILLAGE t ASSESSOR'S.MAP'& LOTJ H N. INSTALLERS NAME&P ONE 0 ••� SEPTIC TANK CAPACITY �D-o" is ' 'LEACHINeFACILITY: (type) '1 �� � :(size)! °Z• "X �� NO.OF BEDROOMS i BUILDER.OR OWNER - C� PERMITDATE: �"lC ¢7 COMPLIANCE DATE: Separation Dii a 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 sift-e or vvithtn Meet of-leaching facility) Feet Edge of Wetland and Leaching Facility'(if'any wetlands exist within 300 feet of leaching facility) Feet Furnished by y r ti J No. t �� _ Fee 60 THE COMMONWEALTH OF MASSACHUSETTS` Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes pplication for Wgpozar i§p5tem Cott.5truction vermtt Application for a Permit to Construct O Repair �Upgrade O Abandon O ❑.Complete System ❑Individual Components Location Address or Lot No. (� ^1 fi 1 /J Owner's Name,Address,and Tel.No. Assessor's Map/Parcel '� Installer's Name,Address,and Tel.No. 36 ow Designer's Name,Address and Tel.No. Type of Building: y Dwelling No.of Bedrooms Lot Size sq. ft. Garbage Grinder ( ) Other Type of Building �—� , No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) �v gpd Design flow provided (�, ' (,� gpd Plan Date ;5.e-10�- 7 t 7 Number of sheets Revision Date Title Size of Septic Tank 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 maintenance of the afore described on-site sewage disposal system in accordance with the provisions of T11TFN the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by th' rd Health. Signed Date v Application Approved by Date Application Disapproved by: - Date for the following reasons Permit No. a 'Z Date Issued , ._,._,... x.tw,�,rtryyt• ti .,r,rv..- ..�yv may,*...�y _�,_,. .,�,. a. No. .Doc? �" " '`� y Fee �Q as ��ri d I' Entered in computer: THE COMMONWEALTH OF MASSACHUSETTS Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Rpplication for Misspogal bpotem Con0tructiou Permit Application for Permit to Construct O Repair( Upgrade O Abandon O ❑.Complete System ❑Individual Components Location Address orLot No. �� Owner's Name,Address,and Tel.No. Assessor's Map/Parcel Installer's Name,Address,and Tel.No. 3G 3 O(C 0 Designer's Name,Address and Tel.No. to 1,q-0 1 oeu It �c 43s�/ZcA/ C Type of Building: j Dwelling No.of Bedrooms Lot Size Z sq.ft.\ Garbage Grinder ( ) Other Type of Building a-�a, _ No.of Persons Showers( . ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design;gn flow provided X. gpd Plan Date S 21Q 7 - 1�s' Number of sheets ! Revision Date Title r Size of Septic Tank 16 (>U Type of S.A.S. _1,y��/444 f Description of Soil t i I Nature of Repairs or Alterations(Answer when applicable) e I G 141 nr,6!t"�,',Q S i �' •I t I 4 Date last inspected: _ I Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of itle 5'a�the Environmental Code and not to place the system in operation'until a Certificate of Compliance has been issued by thi rd o Health. { Signed �,,; Date,, d Application Approved1by Date 3 Application Disapproved by: r.4 "Date for the following reasons r'1 I 1 :d Permit No. �C�i J�r'"""`7r Lit L n i t Date Issued i ————————————————= t= =— — ——————————————-- THE COMMONWEALTH OF MASSACHUSETTS 'j BARNSTABLE, MASSACHUSETTS Certificate of Compliance i THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed ( Repaired ( ) Upgraded ( ) Abandoned( )by � kl U 2 1 K } i at G S/4 (f R !R�/ K_s�q o �. has been constructed in accordance ,I with the provisions of Title 5 and the for Disposal System Construction Permit No. aX7— 1Y©0 dated "1 t Installer DesignerK #bedrooms Approved design flow gpd' j The issuance of this pe )it shall not b onstrued as a guarantee that the system vn l unction�as designed. Date `�/ / Inspector �� No. D_©C / — _1oO Fee /00_ THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION—BARNSTABLE, MASSACHUSETTS Anhopomf *p!gtem Construction Permit Permission is hereby granted to Construct � ) Repair � Upgrade Abandon � ) System located at sa �-� �s i and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to comply with Title S and the following local provisions or special conditions. Provided: Constructio must be completed within three years of the d e of this p it p Date -! ) � 'O Approve i• et� -' 'own of Barnstable FIKETo�o Regulatory Services Thomas F. Geiler,Director * sARN8TABM * j M�. `0g Public Health Division ArFDNIIP'�p Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 ` Office:. 508-862-4644 Fax: 508-790-6304 Installer & Designer Certification Form Date: 411-V07 Sewage Permit# 67- qO Assessor's Map\Parcel ..:'3 K- 1 09 Cl Designer: /Z, l74GG- Installer: 1,i�S v 2 r/ll Address: /2P Address: 7 S4-(+ kc:�-C, GsT� �c�L M . GzG.t &RfU. On was issued a permit to install a (date) (installer) septic system at -T 3/fiz-,--AvC4 e0 9/.,/ZA(5 based on a design drawn by 4--nw1,4D (address) & !mac-2�cfy d STL�;�,&I /2. ���z L dated Se--PT Ze,90 7 (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. 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 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. Stripout (if required) was inspected and the soils were found satisfactory. c4z_ , o "r : �i" EDWARD-.' t► (I staller's Signature) E. KELLEY I& No.527 �`� No. 251M g ` EVALU (Designe s Signature) (Affix Designer's Stamp 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\Designer Certification Form Rev 03-09-06.doc ON No......................... ...`J THE COMMONWEALTH OF MASSACHUSETTS E®AR® F HEALTH •. ----...... .....!/_.'^'. -------------OF...... ......... - --_- -- ----- �� AppUration for Difipmal Iforks Tonstrurtiott Vantit Application is hereby m e for a Permit to Construct (11'.r Repair .( ) .an Individual Sewage Disposal Syst at• � �/{� d4� �1J'`� _ ......... _Y_S..................� ._._.. _r'_ ._.......___.........................(_.__ .................. _.. ...... . .. ....... L ation?-Address or Lot o Owner A ress W - - •---- 4Z _. .._. - •--------- -------------------•---•-•- In alter Address UC Type of Build' Size Lot............................Sq. feet Dwelling No. of Bedrooms-__--•--•-----�-----------------------Expansion Attic ( ) Garbage Grinder ( ) `L Other—Type of Building ________________ __________ No. of persons---------------------------- Showers Cafeteria a YP =------------•-__-•-••-•---•--------------�-•- ( ) Q Other fixtures Design Flow:....... allons per person per day. Total daily flow________ gallons. W g ------�- :-••-----=-g P P P Y• Y ............................... WSeptic "Tank—Liquid capacity__..___.____gallons Length................ Width---------------- Diameter................ Depth---------------- x Disposal Trench— '^o____________________ Wi th___._ ___ otal Length.................... Total leaching area-__________________sq. ft.'� � �� Seepage Pit No------ _______°;Diameter_��_ _____________ Depth below inlet.................... Total leaching area------------------sq. ft. - Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by.......................................................................... Date---------------------------------------- Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water------------------------ (L, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water/9_,_______________-_-- tyi -- ------ Descr� _oO n of Soii_ _ ��V _��w U ----------�t -•- -•------ - --------- .-------- W - -- - - UNature of Repairs or Alterations—Answer when applicable-----_------------------------------------------------------------------------------------------ ----------------------------------------------------------------------------------------•-----------------------------------------=------------------------------n--------------- ----------------- 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 Compliance has been issued by the�oard health. Signed......... •-•-��-,------ ate Application Approved BY----•- - •----= ..... Date Application Disapproved for the=f6llowi ng reasons: = --•------------------------------------------------------------------------ . ----------•--•------------••-----------------•-•----:-------==•--•-----•-••---•------•---•------•-•••----•-------•---------------•-•---•------_-------- ------------- -------------------------------- Date Permit No......................................................... Issued.... 1 %� ----------- Da@e No. FiR;ic...... ..... .......... THE COMMONWEALTH OF MASSACHUSETTS f BOARD aOF HEALTH .ram. ✓ ,y .,... ...... OF.... ve ---------------------------- Appliration for 11i iposal Marko Tamitrurtion Prrutit Application is hereby mane for a Permit to Construct ,/or Repair ( ) an Individual Sewage Disposal Syst *at: Y_ Location s! ddress-- ±►C -'__• :�_4+C I- ._• ! dD _ Lt _ -wn, �t _c.......................••-$ A ress In Iler Address Q Type of Buildi g Size Lot----------------------------Sq. feet U DwellingNo. of Bedrooms.................. .Expansion Attic ( ) Garbage Grinder ( ) P-4-, Other—Type of Building .....................ANo. of persons___-•..•__•.-__--•_-.-.__--- Showers ( ) — Cafeteria ( ) Other fixtures , ' , t r W Design Flow..•______________ _ gallons per person per day,, Total daily flow......... .__�"'� --------------gallons. WSeptic Tank—Liquid capa _.,_a Ilons Length............... Width---------------- Diameter_._._ ._..____. Depth_ ---------- - Disposal Trench—No .... ..,Width.........¢._ Total Length.................... Total leaching area....................sq. ft. x Seepage Pit No...... ............. Diameter. �' e pth below inlet.._.._._.-...._... Total leachin area____-_-________-__s ft. _ P g q z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by-------------------------------------------------------------------------- Date---------------------------------------- ,� Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water-_____-______--.___-_--- Ci, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water-------------------- - - :./ -- --------- -- -- Descri tion of Soil ._... _._• ..... .._ 4-;,; .... O �r " - -------- r U ---------------------- UW --••-----•••--------- ---------------------------------------------------•-------------------------------------•-•--•----------••-•---------•---------•--------•--•---.........-•--•-•-----•-•-•-...... Nature of Repairs or Alterations—Answer when applicable.................................................................... ____._-_:____-___-.--. --------------•-•---•----•-•------•-->---•-•---•......•----•.._......•-••---••-•-------•-----•-•••-•-------•••----------------•---------------•------•--•..._.........•--------.:._......---•--••--•--- 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 Compliance has been,issued by th board of health. Signed.. '- ----- --------------------------- ------------------------------- s Date "OV - --------- Application Approved BY 'Da ------------ APPlication Disapproved for the.following reasons:.......... ....... •--=.••---•---- -•=-••-••-•-•--•-•---•---•-•--•---------•-•---•...-•----••------••••--- ....................................................... ..............................----------- ------- ----------------•------------•------------------------------------------------------ Date PermitNo......................................................... Issued........................................................ Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH o _ ..........OF. �-a�"s _.. ��` r (Ipa#if iarat of Cantpliatur THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( r. Repaired ( ) by ~' , -- € ------- •-•------•••-- at `ter lid. __<:. 1 r_ r rV}F s}. ' I r s _2.v has been-installed .in accordance with the provisions of Article XI of The State Sanitary Code as described in the application for Disposal Works Construction Permit No..... _________________ dated ° a� THE ISSUANCE OF THIS CERTIFICATE SMALL NOT BE CONSTRUED AS'A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE.............................................................................._. Inspector----------------------=---------------------------------------------................ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH �9 No_-,,,;.��..i........ FEE ".:: i= htpaaii al lVarkii Tomitrnac#ion ram. it Permission is hereby granted ,l_ --- r......................... a to Construct ( or Repair ( ) an Individual...Sewage Disposa"Y System ? at NO.- ti ;}'� .__ y� f al.. _. a+ Street"' '� ? ^� y:r_ sf• ll" �- • ' as shown on the application for Disposal Works Construction Permit No e,- :.. Dated.__, z ............... Board of Health DATE................................................................................. FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS \ - �` � \ , �� �� _ , 'r' r T FORM 11 - SOIL'EVALUATOR FORM r n Page 2 of 3 Location Address or Lot No. a Review .'Do � a4q��, ° �( Time:. eat :.... ..�..:. Deep Hole Number .: Date:, . 07 Location (identify on site plan) '_.,_ . Surface Stones :.. .:. ::.:.:.,....a:,.:..........: Slope (° ........�..._. r Land Use �.......::...::.w..::. ...w::H...:.:..:.:.. .... p Vegetation __ t ` Position on landscape (sketch on the back) .::::::. .:: �.... .:. .; Distances from: Open Water Body feet Drainage way feet Possible Wet Area ..::. . `feet Property Line feet Drinking Water Well feet Other _....w..:. DEEP OBSERVATION HOLE LOG* . _? Depth from Soil Horizon Soil texture Soil Color Soil Other Surface(Inches) (USDA) (Munsell) Mottling (Structure,Stones, Boulders, Consistency, % o( Gravel) 3U r s © �. �` r Parent Material (geologic) Deptht°BedrOck' Depth to Groundwater: Standing Water in the Hole: Weeping from Pit Face: Estimated Seasonal Kiigh Ground Water: 0 DEP APPROVED FORM-LVO7195 r ` t f q } 1 . a 1' 3 .' y { + FORM 11 ,- SOIL EVALUATOR FORM Page 2 of 3 Location Address or Lot No. Fat On-site Review Deep Hole Number .:� µ Date:.._1 0� Weather Location (identify on site Land Use Slope M Surface Stones Vegetation Landform Position on landscape (sketch on the back) ...:::.;:: .. .. Distances from: Open Water Body feet Drainage way feet /.� Possible Wet Area .4... . feet Property Line m H feet 4 Drinking Water Well ::.::.:.. ...:. feet Other . DEEP OBSERVATION HOLE LOG` Depth from Soil Horizon Soil Texture Soil Cglor Soil Other Surface(Inches) (USDA) (Muns II) Mottling (Structure,Stones, Boulders, Consistency, % Gravel) CD Q f4 Z7 �. In( Parent Material(geologic) DepthtoBedrodt: Depth to Groundwater: Standing Water in the Hole: Weeping from Pit Face: Estimated Seasonal F)igh Ground Water: . DEP APPROVED FORM-1210719S T TOP OF FOUNDATION CONCn_Tc COVE.RS 7 95-•' 4C:ST IRON 9� -�--", _^ _ OR SCHEDULE 40 - - - 1 - - - EG, 9 CoHHOK P.VL.PIPE MIN. _ _ SGIi�ULE 40 ?V.C. (ONLY) = _-. _ %i PrICH 1/4"P-rRf"[ PIPE-MIN, 9 MIN _ - LEACHING TRENCH ( /)R= 1' _ PITCH I/4'Pc-Rs - I/8"- 1/2" WASHED STONE GAS MF LE—+.EL SEPTIC TANK tNvi � INv_.�- cam.B9 Zo .-• INVERT Elzlsr�/�c ��rS.�� �C�Ez-L 9z-8 — ^�� —J' /i%y y�i•� � � •� a GAL-- INV_.z, DIST •,' BOX 30' HIGH CAPACITY =-S?iL''' STONE av�2 Q 37 I I N Fl LTRATOR 3/,Ls �✓�uf r PROF]LE 0 F -3 zs . 514� GE DISPOSAL GROUND w:T GG a LSOIL LOG J SYSTEM DAi_ Qua.Zr?o07 TIM7 �!' 4r?. . NO SCAL_ I G h r 1 ZS7 HOLE I ?=Si HOLE Z - _ - , ELEV . :'!.8g--. .. _>_=v. .� !°. ... DESIGN.... / .... + ' T �, r I/ Ems, a7, WZ ✓C/"Y�� � !/- G��V' -A/o ��Y� %� yes NUM o= =_���o `3 's 20 - -- iN ' EZ9l, n 3 i 7/- /GAL!ONS/D:•YL3 4. �oYK 6/c 5v, , M L=4C_1NG A?rA ♦Z 5.0 s r, /� 53" ; ;, L-A--X IN G AP=A -, 37 � a 5�.� ,_Iir�ICH I \ t c GE ilia ' apz 7/¢ i C l v�O�5 GAr? A DISr�CSAL . . .. .. ?EA 1NCP=.",5c) I 34" "` - -t- EL. 7�8Q / r Et, 8•S89 +:,�, �H�. s/r,�n ,�.AL L-::Cri v :.��a -Z ' „ � - _ ' herb. .i��' Bo77o♦y of � CoT .cr • / .,' ^,. ,sA D CI(." LPL. 84/0 , ZRCOLAi ION v NAM, :R N C Xr`'/' / � L'L J7D•!E3 C Z, Sg�✓= LEACHING A ZEA ?E i r CDf�`.-lON u oYL �/� .oye sTb ,_r,, . .vci✓� �;Z�Si 3 � / evcs �� ?OARD Oi iiEA GRCL'ND WITNESSED BY ' -G OR .ST�TSoN _ ALL sE - - - • • . . . . . _ . . ¢ .._1710N=- � .T. i'L/-)N 94, TN• f, d, 7 96 4c' f. OAV- ' D / L a 7 xa' 'Y1 L104 P; / o Egli Srin/G 94 0 sern ffo - Ts1/v� z 1� /00 7-- 771- 13e qlj I V Z, V I ? j� '\ zj LSZ Sc� /7L�N SC�GG-' / _ .30 ♦ -SG�l- 7 Zao 7 SC/-2e- f!s 1\167 4`a 1-7 I z I M �� EOYNp,RD PI-26F L/�ry1� Sli/ZV� ��orG l`'r KELLEY ' 5/ /I� y»V1. No. 26100 � o b l . GIST -SAIL T //••�- �/C�C '� '°'�mac' _ [�G�//`/��>( /�-J♦9SS. /'//� LAB