HomeMy WebLinkAbout0017 COPPER LANE - Health 17 Copper Lane ;
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4210113 ORA 100/0 P4
No. Fee /C1 VYes
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS
2pplication for Migo.5a.Y 6pgtem C omaruction Vermtt
Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon( ) ❑ Complete System ❑Individual Components
Location Address or Lot No. 1-7 (p P per La r1 P_ Owner's Name,Address,and Tel.No.
Cen�ery Ili e Charles BpLjn �(
Assessor's Map/Parcel aqg 139 17 r_O per La ne 5 0 g •,3b7- [161,1
S09 N 71-0653
Installer's Name,Address,and Tel. o. Designer's Name,Address and Tel.No.
Or6Excavattoti - fee-rGlLl'oy �0 dF.Mr�v�sl ns 508�833�21 �1�
1'f Tembu r La.,T re +-ci ala- A
Type of Building:
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) Li L4 0 gpd Design flow provided gpd
Plan Date 1 1-1 r'7 R Number of sheets Revision Date
Title S
Size of Septic Tank ( 0 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 Title 5 of the Environmental Code and not to place the system in operation until a Certificate of
Compliance has been issued by this Board of Health.
Signed Date
Application Appr ed by .Date
Application Disapproved by: Date
for the following reasons
Permit No. Date Issued
'^ -•- ..�. X .. .. - ..Yr..+-.��.�,!.,-1. i. :..-,.�.-,. :K4 n°a^-'".:•"�..._�.,.!tw•'.-'J�'��--ov,"..'-. ..... t ., r
V 11 No. C 7lAJ �`-'� � t, �T , Fee
t HE COMMONWEALTH OF MASSAC IUSELTTS Entered in computer: Yes
JVISION
PUBLIC HEALTH - TOWN OF BARNSTABLE, MASSACHUSETTS
01pplicatiou for �Digoga[ �&pzte' Con5tructton Permit
Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon( ) ❑ Complete System ❑Individual Components `
Location Address or Lot No. 17 (p i,pe f Lo�1 E Owner's Name,Address,and Tel.No.
C��-�ierv �ll� Char-le� T3c1�.1�e�
Assessor's Map/Parcel 1�g 1 !7 C.��(�e t Lo { i e 5 b$ ' 3 b-7- I (, 1 -7
Soy: '17 � G53
Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No.
)9 T'&t0etr tCi,-t-LL- VA Ta(?;L cnV• Ta SI'ic15 5U4 33 2- I l
Type of Building: LI 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) 1-I`-I O gpd Design flow provided gpd
Plan Date 1 1-] 1 O'k Number of sheets Revision Date
Title S I F t (�a'{?W/;G . Ir,
Size of Septic Tank 10()(3 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 Title 5 of the Environmental Code and not to place the system in operation until a Certificate of
Compliance has been issued by this Board of Health.
Signed P vL Date �y
Application Appr ed by Date �� V
Application Disapproved by: Date
for the following reasons
Permit No. �—0-a 3 Date Issued
---------------
THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE,MASSACHUSETTS
Certificate of Compliance
THIS IS TO CE-R;T�IFY,that the On-site Sewage Disposal System Constructed ( ) Repaired ( ✓) Upgraded ( )
Abandoned( )by 1 1 i�i rx l n vt" I I n , +T r'1
at & ✓ �P'-f ti C� C P'r) t't vu t^t r has been constructed in accordance /
with the provisions of Title 5 and the for Disposal System Construction Permit No. :P--QA C� dated
Installer �6\DC Z r C-i I L r Designer :DC I i'D MC1-'s
#bedrooms Approved designflbw //,�1 gpd
The issuance of this permit shall not/g'e constrbed as a guarantee that the system will K ctil as
designed. A
Date / Inspector
"�-No. Fee /QCJ
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION-BARNSTABLE, MASSACHUSETTS
Btgonl �&p!gtem Cow5tructton Permit
Permission is hereby granted to Construct ( ) Repair Upgrade ( ) Abandon ( )
System located at 17 j (, r-)r-)P P' r. ,n e C P'Q i P r \t I ( � f
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: ConstruJction ust be completed within three years of the de of tht p it.
Date 1 f' by Approved�by
Town Of Barnstable
1 E.:T. ..
Regulatory Services
Thomas F. Geiler, Director
• BAEiNSFekBEE.
Public Health Division
AIFp a Thomas McKean,Director
200 Main Street,Hyannis,MA 02601
Office:.508-862-4644 Fax: 508-790-6304
Installer & Designer Certification Form
Date: A�"`� , �
Designer: ��_ j ( ��,�/ Installer:
Address: . Address: N_Fete r- j_
1zj�1 �./`� i`��'J
On was issued a permit to install a
(date) (installer)
septic system at + Cy per L_n ne., C1C-n+C-ry 1 l le based on a design drawn by
(address)
Da,j • Q,S on dated t `7 t 68
(designer)
J:certify that the septic system referenced above was installed substantially according'to
`Ae design, which may include minor approved-changes such as late relocation of the
distribution box and/or septic tank.
s�
I cerffy:Athat the septic system referenced above was installed with'''mafor:changes.'( ;e,
greater than`10' lateral relocation of the SAS or any vertical'irelooation of any component
of the,septtld system)but in accordance with State&I,6cai.Regiilations. Plan revis ozi or
certified as-l;i ltf iy designer t6 follow.
OF,4
OAVU_
cyc
(Installer's Si ature�—� B. �n
NIASON. .
so�sTle¢
qNI TARP
(D er s Signature) Affix gner's St=p Here)
PLEASE RETURN TO B S'I'ABILKTUBLIC-11EALTH.DIVISION. CERTIFIC TE
OE. COMPLIANCE VVII.L NC➢'F'SE ISSUED UNTIL - OTH=,T IIS FORM<AND' AS'
BUILT"CARD ARE RECEIVED 11"Ir- CHE:BaNSTABLE PUBLIC HEAI;TR DIES OI N.
THANK YOU.
Q:Hea1tidSeptic/Designer Certification Fon-, Y
Town of Barnstable P#
0
Department of Regulatory Services ,cy
Public Health Division Date l�
200 Main Street,Hyannis MA 02601
00?Time
Date Scheduled ®
Fee Pd.
Soil uitability Assessment for Sewage
/e Disposal& 0
E-Performed By: 1 X C C S4 C 1 t C7 n Witnessed Bye r /V'/V , 7® Y ) N
LOCATION& GENERAL INFORMATION
Location Address Owner's Name C h Ca r�2 S Q eJne
►`7 Ca peer Ln n-e 17 Co pper L-a'n 2
Address C�fe�4 111-e
Assessor's Map/Parcel;-
2N$03q Engineer's NameCIVIC) /t'(OSor1
NEW CONSTRUCTION REPAIR _ Telephone# 5 0?- 3( 7- 17. e.
Land Use 1 �' � M,
Slopes(`1�) Surface Stones N fV
Distances from: Open Water Body ft Possible Wet Area -'ft Drinking Water Well ft
Drainage Way ft Property lane Y ft Other 717-ft to
j�
GBl..
r r:3
SKETCH:(Street name,dimensions of lot,exact locations of test)oles&pere tests,locate wetlands in proximit` o holes)
r
L s
Parent material(geologic) ?W � Depth to Bedrock /O
-7
Depth to Groundwater. Standing Water in Hole---- 4 Weeping from Pit Face
Estimated Seasonal High Groundwater �/ 1
DETERMINATION FOR SEASONAL HIGH WATER TABLE
Method Used:
Depth Observed standing in obs.hole: In. Depth to soil mottles:
Depth to weeping from side of obs.hole: in. Groundwater Adjustment ft
Index Well# Reading Date: Index Well level- -_, Adj.factor- Adj.Groundwater Level
Observation
PERCOLATION TEST' Date , dine j
�� --
Hole# Time at 4" _
Depth of Pero I/ Time at 6"
Start Pre-soak Time @ el Time(9"-6")
End Pre-soak
Rate MinJlnch G li l
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:%SEPTTCIPERCFORM.DOC
a
DEEP.OBSERVATION HOLE LOG Hole#
Depth from Soil Horizon Soil Texture .Sdil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones;Boulders.
i toGravel)
dq
DEEP OBSERVATION HOLE LOG Hole#
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders.
ns'
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.
on ' e
a •
Flood Insurance Rate May:
Above 500 year flood boundary No_ Yes
t 'Within 500 year boundary No= es
Within l00 year flood boundary No Yes
Depth of Naturally Occurring Pervious Material
1 Does at least four feet of naturally occurring perviQu&mat nal exist in all,areas observed throughout the
area proposed for the soil absorption system?
If not,what,is the depthVinaturalloccurring pervious material?CertificationI certify that on ate)I have passed the soil evaluator examination approved by the
Department of Envir mental Protection and that the above analysis was performed by me consistent with .
the required training,expertise and eri nce described in 310 CMR 15.017.
Date 20
Signature
Q:1S.EPTICVERCFORM.DOC
TOWN OF BARNSTABLE
LOCATION _1,7 L)!. SEWAGE# loog- O P 3
VILLAGE Ocnjr-r u;I I c.. ASSESSOR'S MAP&PARCEL
`!NSTALLERS NAME&PHONE NO. B £ Q ExcAyAT.Zon!
SEPTIC TANK CAPACITY J ODO ocz
LEACHING FACILITY.(type) Soo 9alcAa.,%5 (3) (size) 13 x 33 1 a
NO.OF BEDROOMS L4
OWNER far c
PERMIT DATE: / -/G - D$ 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
Al _3 '
/42
►Z 2? .
Rear 9wc)1�nd
FL-f--
sq- 2`-1' B A O
AS ya. �(-� z .
.65 9
s 4
ASSESSORS MAP :
TEST HOLE LOGS NOTES:
PARCEL:
FLOOD ZONE: b�T` f�G- � C.• SOIL EVALUATOR : Lj
1) The installation shall comply with Title V
WITNESS : �� � I�' ( and Town of Barnstable Board o
REFERENCE-: 7�> ,t> 23t�, <�2 DATE: '.T '?,a " Health Regulations.
2 The installer shall v '�"� ) verify the location.of utilities, sewer '
PERCOLATION' RATE: - r inverts and septic
! components prior to installation and setting base eleva '
_�.. .-/ g bons.
�, — ,ram' rj E
. �a �_
Co � �� ;_ G� +C��" r•�¢-t�„/,� � �E� � _ .��..� 3) All gravity septic piping to be 4 inch Sch 40 PVC at 1/8"per foot. The first,
---- - - TH- 1 TH-2 two feet out of the d-box to the leaching shall be level.
/f c,5 r O 4) This plan is not to be utilized for property line determination nor any other
n,t x e� # / -� purpose other than the proposed system installation.
�
.
j LU 1 5) All septic components must meet Title V specifications.
fb , 5) Parking shall not be constructed over H10 septic components.
.
L 0 C A T { ON MAP �if �� _..., � .� � 7) The property is bounded by property corners and property lines.
8) The property owner shall review design considerations to approve of total
design flow and number of bedrooms to be considered for design. Receipt
of payment for the plan and installation based on the plan shall be deemed
approval of the design flow by the owner.
f � 1
9) The existing leaching or cesspools shall be pumped and filled with material
per Title V abandonment procedures. Those within the proposed SAS shall
U` 3 be removed along with contaminated soil and replaced with clean washed
j
sand per Title V specs.
-� 10)System components to be 10 feet from water line. Sewer lines crossing the
water line shall be sleeved with 4 inch SCH 40 PVC with ends grouted if
�--` S'E P T I C SY4STEM DES I G N applicable.
11) If a garbage grinder exists it is to be removed and is the responsibility of the
r owner to ensure such.
FLOW ESTIMATE 12)The installer is to take caution in excavation around the gas line.
jf 13)The installer shall verify the location. quantity and elevation of the sew
er
BEDROOMS AT 1 O GAL/DAY/BEDROOM - 7 GAL/DAY lines exiting the dwelling prior to the installation.
P)y �.� 0e
f47 SEPTIC TANK
CAL/DAY x 2 DAYS - GAL
USE/1200GALLON ScPT I C TALK ,� f ?
r c SOIL ABSORPTION SYSTEM - -
, - C ' ,e . `
. l
SIDE AREA: � ��' kY
✓- BOTTOM AREA
t
SEPTIC SYSTEM SECTIE}N
1
7
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0
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ID
ly
Ab
GAL Z t
f t
SEPTIC TANK � � , t
tr r ��, /�?Fes► �� r , - �' I _� t� �y a,� �
67
C 35
SITE AND SEWAGE PLAN
r
LOCATION : I �.
PREPARED FOR : � Y� W A,/er
o >TI)
SCALE: f�
DAV I D B . MASON DATE: �rA.0,,,
DBC ENVIRONMEN AL DESIGNS
w DATE HEALTH AGENT
EAST SANDWICH . MA
Z ( 508 ) 833- 2177