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HomeMy WebLinkAbout0134 COTTONWOOD LANE - Health 134 Cottonwood Lane Centerville �. A = 252 147 No. 4210 1/3 ORA 10%s ..ta..:__ .�.��...r..:..�,. ....._ ..:WYYYIIe.bu:rL�uTY�:.:'..._. .,._.. .._..�4 v.e...-... .,-i..a.,rW..r`:..v�.�_.._. .. _.__�__...,.� _._ .. :Yti:�.'','�'. ,..m✓_u .�v�6Cvawt.v�.']x.......�..... ..�. ....._.. Fee �t THE COMMONWEALTH OF MASSACHUSETTS Entered in compute Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS 01pplication for Miopooar *pttem Con6truction Permit Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No./3 L� Q n LjQ p Owner's Name,6e�es f -y dress an¢Tel.No. c 1 ` Assessor's Map/Parcel7,�pL � I U� cu ll e y Installer's Name,Address,AlSe$ICANCO Designer's Name,Address and Tel.No. S50 Main Street W. Yarmouth, MA 02673 G �d 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 gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank 4 Type of S.A.S. Description of Soil Med S:A ! Nature of Repairs or Alterato ' l o� f 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 Certifi- cate of Compliance has been issued by this Board of Health. Signed ADate Application Approved by ® Date Application Disapproved for the following reasons Permit No. Date Issued ta t.Nxvi fin. s Ne... —No. "° a" = Fee t ✓ THE COMMONWEALTH OF MASSACHUSETTS \Entered in compute Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS Application for Xigpogar *p5tem Construction Permit t � M Application for a Permit to Construct( )Repair( )Upgrade'( )Abandon( ) ❑Complete System ❑Individual Components t Location Address or Lot No. L� � p n�p p Owne/r's N�a/me, dress d Tel.No. Assessor's Map/Parcel Y� � — �� 2e, �V/�¢f �� `� Installer's Name,Address,and•Tel.No.. • Designer's Name,Address and Tel.No. Type of Building: Dwelling No.of Bedrooms _3 Lot Size 1 sq.ft. -Garbage Grinder( ) / Other Type of Building No. of Persons -Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow �` gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank /00—o G'x%�f"� 5 Type of S.A.S. Description of Soil M e d Nature of Repairs orAlteratio (Answer w en applicable) -1111ItA Y _�Q o� 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 Certifi- cate of Compliance has been issued by this Board of Health. Signed �V '414) Date Application Approved by / / ® Date Application Disapproved for the following reasons e � v Permit No. %fQDate Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of (Compliance THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed( )Repaired( W )Upgraded( ) Abandoned )b at 13�1 n constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. dated Installer Designer The issuance f t s permit shall not be construed as a guarantee that the Date 11 3! U J systepwill "nc`t ii'on=asesigned. Inspector No. � ----=-----------------=Fee vv THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS 1=igpo9;ai *pgtem Construction Permit Permission is hereby granted to Cons�t( )Repair( �ade(/ )Abandon , ) System located at �3 y C o C-�r� • 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: Cons tru tion ust com 1 ted within three years of the date of this Date: ) Approved by I n =� 1/6/99 t NOTICE: This Form Is To Be Used For the Repair Of Failed Septic Systems Only. CERTIFICATION OF SKETCH AND APPLICATION FOR A DISPOSAL WORKS CONSTRUCTION PERMITIWITHOUT DESIGNED PLANS) I, C1051 VAY - hereby certify that the application for disposal works construction permit signed by me dated & -I � , concerning the property located at Co /,q meets all of the following criteria: This failed system is connected to a residential dwelling only. There are no commercial or business uses associated with the dwelling. ell The soil is classified as CLASS I and the percolation rate is less than or equal to 5 minutes per inch. There are no wetlands within 100 feet of the proposed septic system There are no private wells within 150 feet of the proposed septic system / There is no increase in flow and/or change in use proposed / There are no variances requested or needed. / The bottom of the proposed leaching facility will not be located less than five feet above the maximum adjusted groundwater table elevation. [Adjust the groundwater table using the Frimptor method when applicable] / If the S.A.S.will be located with 250 feet of any vegetated wetlands,the bottom of the proposed leaching facility will not be located less than fourteen (14)feet above the maximum adjusted groundwater table elevation, Please complete the following: A) Top of Ground Surface Elevation(using GIS information) B) G.W. Elevation c)�),C +the MAX.High G.W. Adjustment. = o� DIFFERENCE BETWEEN A and B SIGNED : J. � DATE: [Please Sketch proposed plan of system on back]. NOTICE Based upon the above information, a repair permit will be issued for bedrooms maximum. No additional bedrooms are authorized in the future without engineered septic system plans. q:health folder:cert „�, ,�� ��`' �1 „ � � �� _ .. L G T-, ' TOWN OF BARNSTABLE f LOCATION - C�//�A� }� SEWAGE ` -qsq VILLAGE u/&-p]gyp L C L, ASSESSOR'S MAP & LOT 23-.2-� INSTALLER'S NAME & PHONE NO. A & B C = 775-6264 SEPTIC TANK CAPACITY r X iS jsv4 G" !!�y4 l LEACHING FACILITY:(type)C.1I 2L&#11 Q BLS (size) Z 12 NO. OF BEDROOMS ,PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNER S eL- V DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: ��- VARIANCE GRANTED: Yes No r �Gn��Lyc,�j"I a �� a��� ;_ _, _ . : ..�:.� �✓ ( � � '�.� ,.� �. �.. ��r TOWN OF BARNSTABLE LOCATION �, .� // A1' '� —SEWAGE # - S VILLAGE l�f 'iJr C L� ASSESSOR'S MAP & LOT 252-r INSTALLER'S NAME & PHONE NO. A & B CANCO 775-6264 SEPTIC TANK CAPACITY 1,S la�141� LEACHING FACILITY:(type)(. ) size NO. OF BEDROOMS 7 PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNER SLR DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No V ak t,� i � t '..r/ + ar. ` Do•_c1P119s352 07-20-2009 1 :41 BARNSTAB,LE LAND COURT REGISTRY Deed Restriction WHEREAS,Horace Cully Beasley, III&Paula C. Beasley of 134 Cottonwood Lane, Centerville MA are the owners of 134 Cottonwood Lane located At Centerville MA(hereinafter referred to as residence and being shown on a plan entitled"Subdivision of Land in Centerville MA. Duly recorded in Barnstable Count Registry of Deeds in Land Court Plan Number 20239-C,Sheet 8,Lot 160. WHEREAS,Horace Cully Beasley, III&Paula C. Beasley as the owner of said lot has agreed with the Town of Barnstable Board of Health to a restriction as to the number of bedrooms which can be included in any home built on said lot as a pre-condition to obtaining a disposal works construction permit in compliance with 310 CMR 15.000 State Environmental code, Title V, Minimum Requirements for the subsurface Disposal of Sanitary Sewage; WHEREAS, the Town of Barnstable Board of Health, as a pre-condition to granting a disposal works construction permit for a septic system in compliance granting a disposal works construction permit for a septic system in compliance with 310 CMR 15.200, State Environmental Code, Title V, Minimum Requirements for the Subsurface Disposal of Sanitary Sewage, and authorizing the issuance of a building permit for the construction of a single family home on this property, is requiring that the agreement for the restriction on the number of bedrooms in any house constructed on the lot be put on record with the Barnstable County Registry of Deeds by recording this document. NOW, THEREFORE,Horace Cully Beasley&Paula C. Beasley does hereby place the following restriction on their above-reference land in accordance with his agreement with the Town of Barnstable Board of Health,which restriction shall run with the land and be binding upon all successors in title: 134 Cottonwood Lane may have contracted upon the lot a house containing no more than three (3)bedrooms. Horace Cully Beasley&Paula C. Beasley agrees that this shall be permanent deed restriction affecting residence located on 134 Cottonwood Lane, Centerville, AM,and being shown on the plan recorded on Land Court Plan 20239-C, Sheet 8,Lot 160. CT F 14 q 0 4 Executed as a sealed instrument 20 day of C1 I-y 200 q Owner's Signature ir C Owner's Signature COMMONWEALTH OF MASSACHUSETTS � ► lEfl- ,ss )k- ) 1.1 2 � , 20CD I Then personally appeared the above-named Po, a C RecOnly Known to me to. a the person who executed the foregoing instrument and acknowledged the same to be free act and deed, before me, Notary Public My commission expires: BARNSTABLE COUNTY 3 REGISTRY OF DEEDS date A_�TRRU�UE COPY,ATTEST LESLIE KING JQFIyF. 6 � ��,�' S�,E Notary Public \,� •••. ... Commonwealth of Massachusetts 4 ��SS11ff;�. My Commission Expires March 8, 2013 f BARNSTABLE REGISTRY OF DEEDS ,' N I'3 SEWAGE PERMIT NO. VILLAGE INSTALLER'S NAME & ADDRESS -,T ./Y7 Q BUILDER OR��,<A1KN ER DATE ' ERWT 1SS"(d' DATE COMPLIANCE ISSUED G�� �v���o� ��,�-� �. �� a a� � �---S� ICI oy THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH :7` i OF....,.34�ti.s .9 9.. Appliration for Uhip idl Workii Tnntrnr#iun rrntit Application is hereby made for a Permit to Construct (v) or Repair ( ) an Individual Sewage Disposal System at: 44A7......... .---- ........................................................ Location-Address or Lot No. Cr •v E' to --•--•--•-----------•............................................... Owner .......................................... ddress ....... ..'--'....---•--..............:-v...................•---•----....------•--........-•-- ........Z �nr _ .�2 ...................................................... Installer Address dType of Building Size Lot..fat,.n5K.......Sq. feet U Dwelling—No. of Bedrooms.._..:.................................Expansion Attic (V)LI Garbage Grinder (V t)7 Other—Type of Building .......... No. of persons...::!:;5�................... Showers ( ) — Cafeteria ( ) a' Other fixtures ................................. . W Design Flow._�X./..........................gallons per person per day. Total daily flow................._.�3.a.............gallons. WSeptic Tank—Liquid"capacity i ... .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.._..C7P ` ....jF ..5................................ Date.....7:`_.. .............. ------...... Test Pit No. 1......(...._..minutes per inch Depth of Test Pit....... Depth to ground water...... ......... Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ ::............. ......----....------.....-•••-...........--•-••---....-••••....--.•---- O Description of Soil........0.^_.-V...........e.74!epmot?c r7..... ------------- W VNature 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 iITLL 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance ha 'bnd byth . o health. Si d.L. :....................... 9 .I 3 .... Date Application App ed BY................ ......... Date Application Disa ro �fqthf oll wi 9 = .................... ....................•---...---....Date•............ Permit o.---.... ................... Issued....................................................... j Date FEs......1�`U........f... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH 7`�1t-se.^r .._............. OF....•c ;!9s ,STi ., ?.. !.----.---._.-................................ Appliration for Mipaiial Worko Towitrurtion ami# Application is hereby made for a Permit to Construct or Repair ( ) an Individual Sewage Disposal System at: loT l . .........�Q7?Ly✓GtJO hd !v F'��/C��3--•-----••--•-----•-----------------•-•-----------...... ••_. }, Location_Address or Lot No. ........................................... Owner Address --..... B... -----•-•-•`.......................................•- ........ ? !Vai. l < ...................................................... Installer Address QType of Building Size .......Sq. feet Dwelling—No. of Bedrooms......4.................................Expansion Attic (v)6 Garbage Grinder Other—Type of Building .......... No. of persons... ................... Showers ( ) — Cafeteria ( ) Q' Other fixtures ................................... W Design Flow---3XIe-0.........................gallons per person per day. Total daily flow................... ............gallons. WSeptic Tank—Liquid capacity.�5?c_gallons Length................ Width................ Diameter................ Depth................ 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-._.s?C.1?! __.. «%_.S________________________________ Date...... '__ :>'__.....3__.... ,aa Test Pit No. I...... .......minutes per inch Depth of Test Pit.......1.5R.'_. Depth to ground water.......q.._.._-_. Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ --------------------------------------------------------•--•---.....----------------......•---------.......................................................... O Description of Soil--------�w-'�/........... ----•---------------•-••--- -.. •-----......•-•-•--•--•............. W ---------------------------------•-----•--------•-----------------•-•----••--••-•-••••••-•------•----•••-----------•-------•-•----•----------••-•-••------------•-••-•-•-----•----•---•---•--------•-- UNature 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 TITL L 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance ha§••been issued by the bo d of health. Signed_,.. &_z: ......................... ..........7-•... �...................... Pate Application Approved BY-------- ,-•••- �% �r ..1 -......__... -- Date Application Disapproved for 'e following;reasons................................................................................................................ _ >. — Date .._.. �j PermitN .-•------------------------------------ ................ Issued-....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARCC$F' 1� ..........................................OF..................................................................................... '?;,- Trrtifiratr of Tontpliatta TV IS CERT Y That the Individual Sewage Disposal Syst constructed ) or Repaired ( ) y .� �o o z� � •t.Q �'e�,�.-w,c----------------------------------•......._ by...'�.................. a = a f row Installer at...................................................................................................................................................................................................... has been installed in accordance with the provisions of TITLE 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No...... . ......... dated________________________________________________ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM WILL U TION SATISFACTORY. DATE....... ... Inspector ... THE COMMONWEALTH OF MASSACHUSETTS -7'ow BOA RR?4&P"FfitAIC�H No.---. FEE.........��...r -0-ttAP or ���vrn�#rttr�ion �eruti# Permj$ 7i's herCgranted�ft37 ,Tc;� �y�i ••--.- 1`I/ -.. z� 'vit`�Ci to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at Street as shown on the application for Disposal Works Construction Permit No_______________,- .__ Dated.......................................... � _...�...���P& -- -------------------- ----- Board of Health DATE............................; U ---- FORM 1255 A. M. SULKIN, INC., BOSTON OF hl o�� OpHN ��\ © J.j•. BERT 0 Q W91 y E '.p Na 29874 n �GISTs `ate rn SU L S �hp RV ! 1 Oy 1I " I RNOD G o .- ,1.0Lp o S9 ,I w ' � ''q�',• - erg S. � �L � o\ j + i ,.• V, h lop i J AQ ZC , C7oo `��.•F ;1a tir G I I-, w 1 D-r+a " A5,MuAA CO PPA'rECTnoN unnpe-Z. A-P-T. Crf-A-PT,=,, LEGEND , EXISTING SPOT ELEVATION y.`.0SO +�oFA CERTIFIED PLOT PLAN EXISTING CONTOUR ® ssq ,..._ a•" ,a�_ o t��- /.G v G�T1'vvL✓v v r> L}+.✓E f FINISHED SPOT ELEVATION , � ` , A. "N c -/✓ C=..f? �/� �.i- FINISHED CONTOUR 0-- - o sE H IN No.10951 0'g .APPROVED I BOARD OF HEALTH A9o�FcisTE�`�`�`� S�,1i3,`J S '�'�J J � A, ull�1 5:,.� FSS/ONA4�a� DATE AGENT SCALE S / "= 3� DATEG��3 LOREDGE ENGINEERING Cat IN aD AV !sr -._._ - Cial�NT� � I CERTIFY THAT THE PROPOSED • EGISTERE REGISTERED : J08 N0... 3 BUILDING ' SHOWN ON THIS PLAN CIVIL LAND CONFORMS TO THE ZONING '-LAWS . ENGINEER 1 DR.BYI•.,.c4. : .3.: O.F ,BARNSTAS E I MASS.- s s; FI;BYE } . 712 MAIN STREET• C HYANNIS, MASS. ` '. SH.EET. .L4F. .__.'' GATE O.�LANO SURVEYOR ; r �— zr."s,�yysry,,..w „auwfr+:s'wars.ear•-•+rwd«w+°"""'�'kw?""'" ;>'v777-777— i, _ � .•". rrr *r=} Y a ..'' ;� r '' s:fY�G �� �'�TIY�� %Iy�ScPT/C TA�Y.;� 'O,Q' t - ?'E/IChr/ivG PIT ARE MORE 7-AiA.'/ /2'. BELow la P't /•I/wL.- . �;Ri4 oE,A ?4 O/•���9 . 7 4'PYC P/Pt StIAGL Sir BROUGHT TO 4.gAOF. `.4,v CONCOTAF . Ie-4VY CA ST /.?O/V C JYE A?IK, AITC-v COYl�J�.S �A � 2 � .+1�N. 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Q/�-sf.�v.�� •l-�= � �, y,' ivv�aER a�arE�aeeo 3: , �.: 4 �� rip}��• /► _e.Iy .'i GARG.tGE'O/SPOS�I{L U/1/IT Nl�.arE TOTAAL C371ASOI FLOr{/ � G.4t�QAY, SOIL TEST�/ y:_SQ/l TFST�� � t � 74,f NUMBED? QF Lf�tGXI�vG P/T3_ L `l.•-/,g LR EY t SIDE tl'ACHING oER 0/T Aso.a �T •E1�`✓_. GMT OF.So/L'.TEST ? z O - 4 RFSC/LTS ii/1TNGSSED dy �J,MC J�4w5i ± 90 rTOM LAICNINer/PER f�JT t l 3 � Sd FT. Gv�tpAcc-rcp PE1t CCLAT/Odv �lRTE L�s ror, 1- LEACN/NG AREA : 1-63.9 SQ. FT' P.TCOLA rioN RATE A2 ~fJ V. /.vCN . ?EsE4VEGE.4C'NjAI AREA 263.9 54. FT. z, o l - 1 z' ss�L ems,- P- 2 244 MLD► Lol i P ��� H aFAq� s ! r�O L0T 160 CoT7e�n! u�vov GA NC y . E m .°. C 2.4✓C-L C�NTE,2�//�L� MORSE No.10951 O A �F P� DREDGE cN&IA/EFRING CO NC. .pN0.2si874'� 90� C'ISTE ��� •L�' �,_S .: 7/2 M/1//Y ST. • /IYA.c+'viS. ,�f �?. FQigiE�'�pQ` FS��CNAL ND GdTOt110I yY.4TI lriVCOUNTF2�o i 4ND St)g�� Q GT0LIVO-'LvATE,e AT ELEV. LL/ENT: p�°T2 DRTE= JOD .1I0; $3 2i3 SHEET .Of z