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HomeMy WebLinkAbout0014 CEDARWOOD ROAD - Health 14;Cedal:�.,wood Road .COtCut . �ii � c• I ni I' No. 51 ' r Fee 106 THE COMMONWEALTH OF flpASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS appYicatioln for Misposai *pstrm Construction 3permit Application for a Permit to Construct( ) Repair( ) Upgrade( J Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. ('� c,/ 4 ,d„ Owner's Name,Address,and Tel.No. Assessor's Map/ParceliC.r�/'✓L— Installer's Name,Address,and Tel.No.f SaA A.To dZ Designer's Name,Address,and Tel.No. .27 cov'r-f 7-71(43 - �t9�,t e- -07 Type of Building: p. Dwelling No.of Bedrooms Lot Size a �'" sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) Fza gpd Design flow provided �3-Z-- gpd Plan Date Number of sheets / Revision Date 4 Title Size of Septic Tank /SQ4 ?W&M. M/0 Type of S.A.S. e,, (Zf ./"4e c5tW, L4L Description of Soil Nature of Repairs or Alterations(Answer when applicable) U01% 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 b oard of Health. S' a Date l Application Approved by Date Application Disapproved by Date for the following reasons Permit No. .")M/ d �� d Date Issued 3 �' Fee Q THE COMMONWEALTBRF OASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS 2ppYication for ]Disposal Aster Construction Vermit Application for a Permit to Construct( ) Repair( ) Upgrade( �_. JzWon( ) ❑Complete System ❑Individual Components Location Address or Lot No./ +�G UO C) Owner's Name,Address,and Tel.No. Assessor's Map/ParcelInstaller's Name,Name,Address,and Tel.No.,jr,S �j `1. S'a v7 c.` Designer's Name,Address,/and Tel.No. Type of Building: Dwelling No.of Bedrooms Lot Size ���� sq.ft. Garbage Grinder( ) AJ J Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) ,zC gpd Design flow provided 3 Z gpd Plan Date Z /7 G/�/i Number of sheets / Revision Date 4 Title Size of Septic Tank Type of S.A.S. F /,.,0 G, l Z/ Description of Soils i Nature of Repairs or Alterations(Answer when applicable) P�J✓L tIZc��t_(1 Date last inspected: Agreement: r 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 •'s oard of Health. F Signed r Date Application Approved by Date Application Disapproved by Date for the followingereasons Permit No. / �"t'� tj Date Issued :3 n THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired( ) Upgraded( ) Abandoned( )by =,o, at L C 6�� F �� _ _ ,,/ nia �e constructed in accordance 2 with the.provisions of Title 5 and the for Disposal System Construction Permit No 0 J dated /3� Installer 1 (� , _ � 2 G Designer t y P 0!(4 -4- _,4 <a L #bedrooms Approved design flow $� Z gpd The issuance of this permit shal not be construed as a guarantee that the system w1 functi n es'g�ned. a Date Q�, _�-.� Inspector �_ No. 05? Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION- BARNSTABLE,MASSACHUSETTS Bisposal 6pstrm Construction Permit Permission is hereby granted to Construct( ) Repair( Upgrade( ) Abandon( ) System located at ��_ ( s £( � r and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with I Title 5 and the following local provisions or special conditions. Provided:Construction must be co pleted within three years of the date of this permit. Date l Approved b� �`� Town, of Barnstable Regulatory Services Sl, Thomas F. Geiler,Director z Public Health.Division Thomas McKean,Director 200 Main Street, Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Date: 3 2D 1V Sewage Permit# 2t>/2-0.( ssessor's Map/Parcel Zv/Z� Installer& Designer Certification Form Designer: 4 Installer: J-,4-S',(17 Address: Address: :;2 Cav/72!v y� On 6/2 was issued a permit to install a (date) -/ (installer) septic system at (L� C1E�L q-Yt&1d c3 based on a design drawn by (address) / dated 2-�2T"^ (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. a� \A OF 4fASq. D RE taller's Signature) No. 1140 �� V - G/STEM ., besi ign e) (A i p Here) PLEASE RET TO B UNWABLE 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:\office forms\designercertification form.doc I TOWN OF BARNSTABLE LOCATION 14 C-C d ptoLLJaa 0 C� SEWAGE# a 1 Z-' O 5 VILLAGE ASSESSOR'S MAP&PARCEL 1 O- I t o, INSTALLER'S NAME&PHONE NO. Z:J'*&,t,. A SaV Z a —17 4-k3 t—S 1')L( SEPTIC TANK CAPACITY d p k li 1 LEACHING FACILITY: (type) L 1 t _ (size) a`l Ot NO.OF BEDROOMS ?J OWNER C n PERMIT DATE: I� COMPLIANCE DATE: o� 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 leachhig facility) Feet FURNISHED BY�J 5 _ A �. 3 3=co" y LIS, Staf j C. L 4 Ott O?> A 3 i 3��" DZZ`" LEI Town of Barnstable Department of Health,Safety,and Environmental Services e. Public Health Division Date 367 Main Street,I lyannis MA 02601 = eAwasreeIA 76J9 ♦ ` / _ rE I,� Date Scheduled / At?'!'') Time �D Fee Pd. oil Suitabi ity Assessment for S a e Disposal v� ? Performed By:. Witnessed By: LOCATION & GENERAL INI{ORMATtON Location Address <y��d /��, Owner's Name / Address TiLl�f+ o 6 Assessor's Map/Parcel: C)Zo /2 Engineer's Name NEW CONSTRUCTION __ REPAIR / Telephone k /,�'2 7 D r "T GI�� C�'Co%1S%.�5 Land Use Slopes(%) �� Sur ac Stones Ix . Distances from: Open Water Body > Z10C) It Possible Wet Area > Wo ft Drinking Water Well �� ft Drainage Way > ft Property Line }�D ft Other It & SKETCH:(Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands in proximity to holes) CS °V Parent material(geologic) v 11 Depth to Bedrock A) Depth to Groundwater: St ding Water in Hole: 1 Weeping from Pit Face Estimated Seasonal High Groundwater _ RET ERi1�I1�iAT Old EOti: SEASONAL'RIGH�°►'E+T'ER Method Used: 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 N_ Reading Date:_ Index Well level Adj.factor Adj.Groundwater Level_ PERCOLATIONTEST uate ' a Tirec Observation Hole N I Time at 9" A Depth of Pere `� Time at 6" +f Start Pre-soak Time @ I �7 Time(9"-6") End Pre-soak 1/l Rate Min./inch Site Suitability Assessment: Site Passed Site Failed: Additional Testing Needed(YIN) Data To Be Com leted on Back Original:'.Public Health Division Observation Hole p —� Copy Applicant DEEP OBSERVATION HOLE LOG '. Hole# _ Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulderes. % 0'' tc ' 14" 1.,u1 ORJ it 2Z'-1 G We mewZ,S lob DEEP OBSERVATION HOLELOG Depth from I Soil Horizon Soil Texture I Soil Color Soil Other Surface(in.) (USDA) I (Munsell) ( ' Mcnling (Structure,Stones,9oulderes. , % o Ito Z15)-16< C 7• '� DEEP OBSERVATION HOLE LOG Hole# 4 Depth from Soil Horizon Soil Texture Soil Color Soil (Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulderes. % % DEEP O ERVATION HOLE LOG Hole# Depth from Soil Horizon Soi,i Texture Soil Color Soil Other Surface(in.) DA) (Munsell) Mottling (Structure,Stones;boulderes. 0 Flood Insurance Rate MAp Above 500 year flood boundary No: Yes i l ° Within 500 year boundary r ' ,No., . Yes T'•f ./ i i't • Within 100 year flood boundary No.' y Yes Depth of Naturally Occurringhtvious Material M Does at least four feet of naturally'occurring pe v ous material exist in all areas observed throughout the area proposed for the soil absorption system? _ k If not,what is the depth of naturally occurring,pervious material? f: Certification I certify that on b t ;' i(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 the required trai ' ,expertise and ex, erience descri ed in 310 CM11s15 01;7:` .A I Z tt` f I Signature Date r— FORM 30 C&W HOBBSB WARREN TM THE COMMONWEALTH OF MASSACHUSETTS s A-- BOARD OF H H CITY/TOWN , W DEPARTMENT,O r ADDRESS GSM Svb��� �� TELEPHONE Address _ Occupant_ Floor Apartment No. No. of Occupants____ No. of Habitable Rooms ._L73 No.Sleeping Rooms_No. dwelling or rooming units No.Stories Name and address of owner "l Remarks Reg. Vio. YARD Out Bld s.: Fences: Garbage and Rubbish Containers: Drainage Infestation Rats or other: STRUCTURE EXT. Steps,Stairs, Porches: Dual Egress:and Obst'n.: ❑ B ❑ F ❑ M Doors,Windows: Roof Gutters, Drains: Walls: Foundation: Chimney BASEMENT Gen.Sanitation: Dampness: Stairs: Lighting: STRUCTURE INT. Hall,Stairway: Obst'n.: lag :1 Hall, Floor,Wall,Ceilin : Hall Lighting: Hall Windows: in , HEATING Chimneys: Central ❑ Y ❑ N Equip. Repair TYPE: Stacks, Flues,Vents: PLUMBING: Supply Line: ❑ MS LIST ❑ P Waste Line: H.W.Tanks Safety and Vent(s) ELECTRICAL Panels, Meters,Cir.: ❑ 110 ❑ 220 Fusing,Grnd.: AMP: Gen.Cond. Distrib. Box: Gen. Basement Wiring: DWELLING UNIT Ventil. L to . Outlets Walls Ceils. Wind. Doors Floors Locks Kitchen Bathroom Pantry Den Living Room Bedroom 1 Bedroom 2 Q E Bedroom 3 Bedroom 4 Hot Water Facil. Sup.Ten.,Gas,Oil, Elect.: �k , Flues,Vents,Safeties: Kitchen Facilities in ve Bathing,Toilet Facil. Vent., Plumb.,Sanit'n.: Wash Basin,Shower or Tub: Infestation Rats, Mice, Roaches or Other: Egress Dual and Obst'n: General Building Posted Locks on Doors: ONE OR MORE OF THE VIOLLATIONS HECKED ABOVE IS A CONDITION WHICH MAY MATERIALLY IMPAIR THE HEALTH OR SAFETY AND WELL-BEING OF THE OCCUPANT AS DETERMINED BY 105CMR 410.750 OF THE CODE OR THE AUTHORIZED INSPECTOR.(Se fiver) "THIS INSPECTION REPO T, IGNED AND CERTIFIED UNDER T E PAINS AND PENALTIES 91 PERJU Y.' All INSPECTOR TITLE �j A. DATE 1 — D TIME !` P.M' • A.M. THE NEXT SCHEDULED REINSPECTION P.M. 410.750: Conditions Deemed to Endanger or Impair Health or Safety The following conditions, when found to exist in residential premises, shall be deemed conditions which may endanger or impair the health, or safety and well-being of a person or persons occupying the premises. This listing is composed of those items which are deemed to always have the potential to endanger or materially impair the health or safety, and well-being of the occupants or the public. Because Chapter II, 105 CMR 410.100 through 410.620 state minimum requirements of fitness for human habitation, any other violation has the potential to fall within this category in any given specific situation but may not do so in every case and therefore is not included in this listing. Failure to include shall in no way be construed as a determination that other violations or conditions may not be found to fall within this category. Nor shall failure to include affect the duty of the local health official to order repair or correction of such violation(s) pursuant to 105 CMR 410.830 through 410.833 nor shall failure to include affect the legal obligation of the person to whom the order is issued to comply with such order. (A) Failure to provide a supply of water sufficient in quantity, pressure and temperature, both hot and cold, to meet the ordinary needs of the occupant in accordance with 105 CMR 410.180 and 410.190 for a period of 24 hours or longer. (B) Failure to provide heat as required by 105 CMR 410.201 or improper venting or use of a space heater or water heater as prohibited by 105 CMR 410.200(B)and 410.202. (C) Shutoff and/or failure to restore electricity or gas. (D) Failure to provide the electrical facilities required by 105 CMR 410.250(B), 410.251(A), 410.253 and the lighting in com- mon area required by 105 CMR 410.254. (E) Failure to provide a safe supply of water. (F) Failure to provide a toilet and maintain a sewage disposal system in operable condition as required by 105 CMR 410.150(A)(1)and 410.300. (G) Failure to provide adequate exits, or the obstruction of any exit, passageway or common area caused by any object, including garbage or trash,which prevents egress in case of an emergency 105 CMR 410.450, 410.451 and 410.452. (H) Failure to comply with the security requirements of 105 CMR 410.480(D). (1) Failure to comply with any provisions of 105 CMR 410.600, 410.601 or 410.602 which results in any accumulation of gar- bage, rubbish, filth or other causes of sickness which may provide a food source or harborage for rodents, insects or other pests or otherwise contribute to accidents or to the creation or spread of disease. (J) The presence of leadbased paint on a dwelling or dwelling unit in violation of the Massachusetts Department of Public Health Regulations for Lead Poisoning Prevention and Control, 105 CMR 460.000. (See M.G.L. c. 111 @@ 190 through 199.) (K) Roof, foundation, or other structural defects that may expose the occupant or anyone else to fire, burns, shock, accident or other dangers or impairment to health or safety. (L) Failure to, install electrical, plumbing, heating and gas-burning facilities in accordance with accepted plumbing, heating, gas-fitting and electrical wiring standards or failure to maintain such facilties as are required by 105 CMR 410.351 and 410.352, so as to expose the occupant or anyone else to fire, burns, shock, accident or other danger or impairment to health or safety. (M) Any defect in asbestos material used as insulation or covering on a pipe, boiler or furnace which may result in the release of asbestos dust or which may result in the release of powdered, crumbled or pulverized asbestos material in violation of 105 CMR 410.353. (N) Failure to provide a smoke detector required by 105 CMR 410.482. (0) Any of the following conditions which remain uncorrected for a period of five or more days following the notice to or knowledge of the owner of said condition or conditions: (1) Lack of a kitchen sink of sufficient size and capacity for washing dishes and kitchen utensils or lack of a stove and oven or any defect that renders either inoperable. (2) Failure to provide a washbasin and shower or bathtub as required in 105 CMR 410.150(A)(2)and 410.150(A)(3)or any defect which renders them inoperable. (3) Any defect in the electrical, plumbing or heating system which makes such system or any part thereof in violation of generally accepted plumbing, heating, gasfitting, or electrical wiring standards that do not create an immediate hazard. (4) Failure to maintain a safe handrail or protective railing for every stairway, porch balcony, roof or similar place as required by 105 CMR 410.503(A)and 410.503(B). (5) Failure to eliminate rodents, cockroaches, insect infestations and other pests as required by 105 CMR 410.550. (P) Any other violation of 105 CMR 410.000 not enumerated in 105 CMR 410.750(A)through (0)shall be deemed to be a con- dition which may endanger or materially impair the health or safety and well-being of an occupant upon the failure of the owner to remedy said condition within the time so ordered by the Board of Health. f i NOTE: EXTEND COVER5 OF DEEP OBSERVATION HOLE LOGS N N SEPTIC TANK TO WITHIN `_ ?cr.+ z..�z ;►/rra,�/. ` '� .',;;; W G" OF FINISH GRADE ..- 4 t G t Z LAYER c � ,Oe�}✓7"'d1� 4v� DATE:' z /-7- W ✓J!*/�_ `. /!y''_;pd tu$C.g,w4id�.b. v!'1AX, GO4vezG TE5T BY. = w �/_ a w w Z oC PIPE TO BE LAID LEVEL FOR t. tC~t5v.ut�. .-...":..._. _.. .. e ' 3."o WITNE55 . A i !7°��4, wl dwr _ O Q P PERC RATE _. : ' r , N (L 4 SC 40 PVC P If E 2' OUT OF DIS?'RiBUTION BOX .�' 2 4/ J:rvctt . � r �r� ; wry , a � .v, /zea S'j•:n s U O N T.O.F. @ N S/u SCN �/� ���• DEEP OB5ERVATION HOLE#I EL. O a- ✓1'3,d5 SIN advG o ya.a�G J DEPTH i uri, n 3l`t i, }; iIQQpErs i Q EL. �SE�/ A i�G dab_ i.;- TOP @ EL. c G?. A E HORIZON TEXTURE 5MLIN5 OR MOTTLING 5uprG+ FROM OTHE •'sue __ r . `y.�.s;Beach - Z c . ,� PEE G R lr dtspicr.., s'H : ' ° S(.t J `•" tf� / `�.., _._.�._ _. ... .;D tj/G.c3 C L►G..S / 2�/ZC INSTA'_t^aA5 SAFFLE 1��1/ T� �— OTTOM (r� EL.T 7'. .ae7 yJz r/z. �� / evel L. rjG+,a NII... F -�c GZ` �7 f✓ ' B u� a / 411 w ysx r lJ < 2 O Av`L,,%a,Cr�'y. N our. Te_ L.,Y7 2Z'1Z 2!" NF -Ia Its'or 3�W LT Z._Yn.. 24 ' aF; 'i3g �Tlaut nauj a 1 a M amp L a . Landi tg ��' �G 7 �/^�",' o Q / `oca GALLON PRECAST �'� VOtult J -I DEEP OBSERVATION HOLE#2 EL.5c , SEPTIC TA _ S I�►/SR�c 7N.0 1S'dT. . DROi� SOIL SOIL SOIL COLOR 501L OTHER - 0 p. "�Ry''EX� URFACE HORIZON TEXTURE (MUNSELL) MOTTLING 'Y3=/i a ,may. 16rfd.•'-"� �,q,;av'a,3 . . /Y1�2�.j M 5 E PT I C �YSTE f� F'RO�f I_�_E DE5IGN DATA DAILY FLOW: ( z- )BEDROOMS x 110 GPD = ..zzc? GPD SEPTIC TANK:ZZc> GPD x 200% = 1 y0 GPD GALLON PRECAST SEPTIC TANK DISTRIBUTION BOX: USE: 501 L ABSORPTION SYSTEM: USE:_ . "� cr:► G'q'-'•. �?�' " 15�'-, '�''tv�L�..s CAPACITY: 51DEWALL AREA: 2G: X x x 0.74 BOTTOM AREA: _�� x. 2 7+ x 0.74 = Zlf-a GPD 33z•3 GPD . . ' GENERAL NOTE5 I I . CONTRAr TOR TO BE RESPONSIBLE FOR THE LOCATION ' OF ALL UTILITIES, ABOVE � UNDERGROUND, PRIOR TO yg � � ANY EXCAVATION OR CONSTRUCTION. 2. SEPTIC SYSTEM IS TO BE INSTALLED IN COMPLIANCE WITH 3 10 CMR 1 5.00: TITLE V. 3. THIS PLAN 15 NOT TO BE USED FOR PROPERTY LINE yto o' p . : DETERMINATION. 0© =�r '� 4. ALL DISTURBED AREAS ARE TO BE LOAMED SEEDED. 5,. CONTRACTOR TO PROVIDE 48 HOUR NOTICE FOR ANY REQUIRED INSPECTIONS. O ''� ` '°`'''� ' G. THIS SYSTEM IS NOT DESIGNED FOR THE USE OF A y '` ; .�.a .G' .r9r. �,• GARBAGE DISPOSAL. 5 --- , �. 5 ITE --- 5 EWAG�E PLAN .. . .-_...________-•_. .___,_.�' _..._ .� _ _ _ ..f`7.. ..'=�%�� Cam ' . .�""�. ' �"c��„.,'�! ';�,"" Gs,• e.G ,d,¢cr ca 85w' SCALE DATE: DRAWN BY: _. ...... . _/. . ..Af K.Av ,,� `- n„+::tau : .`_- wr,v.Fa JOF3 NUM_ BER: REVISION: 5HEET NUMBER: A R WFLLER A550CIATE5 ER Q . 1140 1 G45 FALMOUTH RD., SUITE 4C P.O. BOX 417 CENTERVIL-LE, MA 02G32 RU BA SGISTER ��� 2 WINDY WAY, #232 NANTUCKET, MA 02554 0 o. 781 ANITARi�N ..�`� TEL.: (508) 775-0735 --- FAX: (508) 775-0754 �qNn suave°� EMAIL: trisweIIcr@comca5t.net PROFE5510NAL ENGINEERS LAND 5URVEYOR5