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HomeMy WebLinkAbout0103 LEWIS POND ROAD - Health 103 Lewis Pond Road Cotuit — 1 A= 020-123 r TOWN F BARNSTABLE LOCATION EWAGE # VILLAGE ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITYG�� o LEACHING FACILITY: (type)--�7.�®zj (size),/R�JC/?—a� NO.OF BEDROOMS BUILDER OR OWNER PERMITDATE: 'O:� ZZ _COMPLIANCE DATE: 2-� Separation Distance Between the: 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) Feet Edge of Wetland and Leaching Facility.(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by i � v � y ff2 �3yg� ass A3 fly - s9 8y �5'S,s TOWN OF BARNSTABLE LOCATION /��� SEWAGE # VILLAGE� j, ASSESSOR'S MAP & LOT INSTALLER'S NAME & PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY:(type) (size) NO. OF BEDROOMS 3 PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNER DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: l VARIANCE GRANTED: Yes No )` l t 5,c) 97 60 No. �/ ! THE COMMONWEALTH OF MASSACHUSETTS FEE BOARD OF HEALTH ���0 �— OF APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT Application for a Permit to Construct ( ) Repair ( ) Upgrade >() Abandon ( ) - Complete System ❑Individual Components roca,�n Owner's L—N O 0/1 Z Map/Parcel# �/' dd e p w - GO S5 Lot# 7 Telephone/#� �s rex�a✓Q ��, A c. ��C�Cz�K Nt�1G1��i��Utst��, ►n Installer's Nam Dijigner' Name 13 Address Addre� w 9,3 0 Telephone# v ter— Telephone# Type of Building: Lot Size Z56© Sq.feet Dwelling—No.of Bedrooms Garbage Grinder ( }}I0 Other—Type of Building No.of persons Showers ( ), Cafeteria ( ) Other fixtures Design Flow m'n.required) gpd Calculated design flow gpd Design flow provided gpd Plan: Date 1 Number of sheets Revision Date Title Description of Soil(s) Soil Evaluator Form No. -- Name of Soil Evaluator to of Evaluation DESCRIPTION OF REP RS OR ALTERATIONS L . c� - of a c� ��r��rgL•�i The undersigned agrees to i above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and further to plat a system in operation until a Certificate of Compliance has been issued by the Board of Health. _ Sign Date T (�—— ( Inspe C FORM 1 - APPLICATION FOR DSCP DEP APPROVED FORM 5/96 a. t -No. / THE COMMONWEALT.`H"7OF"IGI�A�SSACHU?SETTS FEE /1 .r BOA•A�D `OF+ H E)ALT•H tbLA_> OF r ^ tea ) APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT "% Application for a Permit to Construct ( ) Repair'( ) Upgrade 1O Abandon;( KComplete System ❑Individual Components t� 3 L.Zw) 5 Pn�► %V '-z1)*A 2 Ca t �ocatton Owner's Name' r a2�f t Z ��,�" t�' "L��s,tS �b 4JtrV_ Map/Parcel# dd e Lot#, r. Telephone# � �Te PXCa✓aY! ol . :rAr F. I'9 Z,. (' II�nstaller's Name i De'goer Nam-eN }� , p /} 4n f JP �Aa f��un l slinc'ij 1)1 �Jll�h! t�7. 5'Gi"k j Ii✓ I Address Addre r �oR yak• 9340 1 Telephone# Telephone# t Type of Building: / LotSize.3`7_. 00 Sq.feet Dwelling—No.of Bedrooms .. Garbage Grinder ( 4(7 Other—Type of Building / No.of persons Showers ( ), Cafeteria t ( ) ;>Other fixtures 1' ; Design Flow min.required) d Calculated design flow Q d Design flow provided" d g (min. q ) o gp g s gP g P gp Plan: Date l�.V 1 t Number of sheets Revision Date ,��.� Title `�tIZly 3 i Y7 S r"�.e `t. ! "b") .. Description of Soil(s) 5¢".� i•..a 1. - Soil Evaluator Form No. Name of Soil Evaluatorwtim a'te of Evaluation - 1" 1 DESCRIPTION OF RED IRS OR ALTERATIONS RA 1765 z- t7 —r l The undersigned agrees to install-the above described Individual Sewage Disposal System in accordance with the provisions of. . - 7LE 5 and further agrees,ndito plat .tl a system in operation until a Certificate of Compliance has been issued by the Board"of Health. Sign * Date Inspe2tions' I t A' V. FORM t - APPLICATION FOR DSCP DEP APPROVEDsFORM 5/96 I NO. v ! THE COMMONWEALTH OF MASSACHUSETTS FEE J 00 o. �\ �BOARDO'F HEALTH CERTIFICATE OF COMPLIANCE f Description of Work: ❑ Individual Component(s) ,-.-0 Complete'System ,r ` The undersi ned hereby certify that the Sewage Disposal,System;Constructed( ),Repaired Upgraded( ),Abandoned( ) by: at 10 has been installed in accordance with the provisions of 310 Cm 5. 0 (Title 5) and the approved design plans/as-built plans relating to application`N / dated 1 ��_ Approved Design Flow (gpd, Installer Designer:-��� C..k Y1i �t� 4�iZ,,, -Inspect \ . Date g1 } +� The issuance of this certificate shall not be construed as a guarantee that the system will function as designed. w FORM 3 - CERTIFICATE OF COMPLIANCE D E P APPROVED FORM 5/96 ' No. THE COMMONWEALTH OF MASSACHUSETTS FEE O U �► BOARD OF HEALTH DISPOSAL SYSTEM CONSTRUCTION PERMIT Permission is hereby granted to Construct ( ) Repair �Upg a e ( ) Abandon ( ) an individual sewage disposal system at 10 \S t as described in the application for Disposal System Construction Permit No. / dated 7 h I' Provided: Construction shal be completed within three years of the date of his p�rmi't%',P-J't-local conditions must be met. Date ! 1 I ST 1 + Board of Health �� FORM 2 - DSCP DEP APPROVED FORM 5/96 F i FORM 1255 (REV 5/96) H&W HOBBS&WARREN TM PUBLISHERS- 60STON 09/29/2011 12:41 5083627606 ANNE MICHNIEWICZ PAGE 01 Town of Barnstable Regulatory Services WLThomas F.Geller,Director MAM Public Health Division Thomas McKean,Director 200 Main Street, tlyanals,MA 02601 Office: 508-862-4644 Fax: 509-790-6304 All Date: 9° / l r Sewage Permit# 90/1-cab 7 Assessor's Map/Parcel va o 1*?3 l,nsliuet&Designer Certif atian Form Designer: p• M1 WIM Installer: ��S f� ca✓ca`;d✓;y�f Address: 'Z *4Af_L"�ffA AC, WNi Address: l 9 San Se 6 s ion p� A v�ncli/,� Oo�JS�3 On • ��' /�s�de @� nL was issued a permit to install a (daft) (installer) septic system at W3-t,*-VA 5 V01 0 TZ0N based on a design drawn by (address) f{OQ4.K.4 N11GNISIrCVJ)CZ-if sated 2-1 )1 (designer) I certify that the septic system referenced above was installed substantially according to the des' , 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 certifi as-built by designer to follow. Stripout(if required)was in*eetod.and the soils w o satisfactory. PA ■sta er 5 S• Lure) MICMNI V (Designer' Si at (A x ere) pARNSTABLE PURUC HE&LM DDMLq—N-. CER FDim BEI§SMLJLIgWrJL g In IHIS FO D NX ITAB I q:W5W rame\da4"M"fifkafiM fbwA d- AsBuilt ,., r Page 1 of 1 TOWN OF BARNSTABLE, LOCATION r ���� P- jP6as�!' SEWAGE # VILLAGE_ ASSESSOR'S MAP LOT INSTALLER'S NAME & PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY.-(type) (size)' NO.OF BEDROOMS PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNER DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED; VARIANCE GRANTED: 'Yes , i 97 1 http://issgl2/intranet/propdata/prebuilt.aspx?ma-opar=020123&seq=1 7/22/2011 09/15/2011 14:20 FAX 002/002 September 15, 2011 The Town of Barnstable,Board of Health This letter is to.inform you that the-house at 103 Lewis;ponds Road:Cotuit, MA is a four .(4) bedroom house- Please update your records accordingly: Sincerely, 103 Lewis pond Road Nominee'Realty Trust,®U/D/T Dated July 23,.1996 William Burdett Co-Trustee Home: 603 673 5490 Cell: 603 769 9144 x 103 LEWIS POND ROAD COTUIT, MA 02635 1 Town of Barnstable Department of Regulatory:Services Publics Health Division Hate 3 o ) 1 r t• %6y �� ` 200 Main Street,Hyannis MA 02601 -, .MldA _ 1 Time �/" Fee Pd. ir}'t,J c.Cf Date Scheduled_ rv' Soil'SuitabilityAssessment nor Se wa a Dis R oral .f P Perfornied By: e ' _ `C �K 'Q'� Witnessed By- LOCATION _ & GENERAL INFORMATION f-' Location Address Owners Name _ k r.�3 (Rw�5 d, �'�e/ 'wvC�c:- ��'ri.¢S� gl�'s`�.i 47 Address f(Y3 L<,.v,j I S ` C-0 t-t-1 I �_ . . Assessor's;Map/Parcel: 2O -' 1 Z3 Engineer's Name � , �. 'A NEW CONSTRUCTION REPAIR ,' Telephone'#. j' g'— 3 7-�{T.(p ' Land Use. f"`5` ti{t(� ( Slopes(3'0)' 'Z+`— Surface Stones AV X Distances from: Open Water Body ft Possible Wet Area N f�'- ft. 'Drinking Water Well "" ft Drainage Way ft Property Line 1. ft *.Other` - ft SKETCH:(Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands in proximity to holes) G lG r- f_0- 1.7 � . l^ h Parent material(geologic) > " ` Depth to Bedrock Depth to Groundwater. Standing Water in Hole: �j Weeping from Pit Face Estimated Seasonal High Groundwater j DETERMINATION FOR.SEASONAL HIGH WATER TABLE 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:# Reading Date: Index Well level Adj,fhetor Adj.t"ro0dwaterLevel,­. .PERCOLATION TES_T We , Thne�. Observation Hole# Time at 9" Depth of Pere6 g c,c���C1tti� Time at 6" Start Pre-soak Time® t�d �� Time(9"-6") End Pre-soak t Rate MinJlnch, Site Suitability Assessment: Site Passed !'' Site Failed. Additional Testing Needed 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:\SEPTlCV13RCFORM.DOC 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) t i z- 1Ts lA inn .�� lcs' �L`ll t_ `' . . '` • 47--13F . C— ,rat 5-"� zr5`f 6/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.%Graveft DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. f ConsistQy, Gravel) DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,.Stones,Boulders. Cons'. 4 Flood Insurance Rate Map:. Above 500 year flood boundary No' Yes Within 500 year boundary No Yes es Within too year flood boundary No Yes Depth of Naturally Occurrme_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? If not,what is the depth of naturally occurring pervi us matorial? — Certification I certify that on i t `�OL 9 , (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 310 CMR 15.017. Signature.. C / . _R.. Date 7 t lk f Q:\S&nC�PBRCFORM.DOC r' Nully C7tuit E - LEWIS - PO N ROA.D 82008'15"W b 28.81' ,. 100 A— 2 0 3, CHOOL µ=3itT; BENCHMARK.* T'OP OF EXISTING R 0.1 - BULK HEAD FOUND. N Is!� /dQ ..LO CUS MAP . - - EL=100.00 DEED REFERENCE EXI'S�N 3 af�� Exrs�N BOOK 10322 PAGE 062 4 BED G s-NE G „ ROp .. - 9 -L--� �,. D�'�ELLING ioo, 2- • �X T OI'FD1V V� �35.4±1 1 ��, 66 C7 YAl DECK Upper SPq� �j W Zo " PROPOSE • � AR&4 7IRS EXISTING �Cy N S.A.S. • 9 PRO SEWER SEWE PIPE - G� `p 8 S 4°'dia. INSPEGT?NDt W �O DER !pE REPLACE IF 1 = W N A • •• PROPOSED NECESSARY CLEANOUT WITH 4"DG1 N ED \— O GRADE PVC PIPE) M • �+ GE WITH A SCREW \p PROPOSED �� OF GgRD nPECAP oM - INSPECTION `- \ Z. PORT EXISTING Da Y PROPOSE CESSPOOLS 1SUU al. \ �O BE PLMPEO 0 g CLEAN AND S r �SO��� tl SEPTIC FILLED WrITI I;L :3 TANK SAND. 9� (APPROX.LOCATION) lry LOT AREA 32,800t SQ.FT. S 86041'54"B 24.04' ,ss70o2'1r'E ASSESSORS MAP .020 PARCEL 123 .. 173.43' s' E PROPOSED SITE PLAN OF 103 LEWIS POND ROAD MPNo a a�� aoo�� r= COTUIT(BARNSTABLE), MA ��. UL eMICHTMEW, �, Engineering by. CANAL LAND SURVEYING & PERMITTING INC. LEGEND ,r � No.��► t � - Roger P. Michniewicz 306 OLD PLYMOUTH ROAD SAGAMORE BEACH MA � � Roge EXISTING_ = Professional Civil En eer _ 2 Registered Profess Civ _ 4 �� R 508 88 5955 canalsurve v 'zon.net 8 en CONTOUR II�� 1 7 21 2 Hearthstone Way,E. Sandwich,MA 02537 PROPOSED= __1=+C_.I___ �° DA ROF SSION ENGI ER pVI Phone: (508)362-9542 Scale: 1"=30' Date: 07/21/11 Job: 11 - 026 CONTOUR s Email: rpmichniewicz@hotmaiLcom Drawn: P.D.R. Checked: R.J.H Sheet 1 of 2 GENERAL NOTES: , I SOIL LOG DESIGN FLOW: DATE: JULY 19, 2011 (REF. P#13,351) 4 BEDROOM DWELLING @ 110 GAL/DAY PER BEDROOM 1. THIS PLAN IS FOR THE DESIGN AND CONSTRUCTION soil EVAwATOR: PETER MoENTEE (sE1sa2) EQUALS 440 GALS.PER DAY.(NO GARBAGE GRINDER) OF THE SEWAGE DISPOSAL SYSTEM ONLY. wmaEss: HEAL oESMARNs R.S.HEEALTH AGM SEPTIC TANK REQUIRED: 440 x 2.0 =880 gal. 2. ALL CONSTRUCTION METHODS,MATERIALS AND 96.33 TP-1 DOOth 96.7 TP-2 D„w SEPTIC TANK PROVIDED : 1500 gal.(PROPOSEI?) MAINTENANCE FOR THE SEPTIC SYSTEM SHALL FILL FlLL SIZE OF LEACHING FACILITY REQUIRED CONFORM TO TITLE 5 AND LOCAL A LOAMY SAND 'r A LOAMY SAND B- DESIGN PERC RATE< 5min/in. BOARD OF HEALTH REGULATIONS. - e 10YR 4/2 B 1orR 4/2 14. _ 440 gal.per day 3. ALL SEPTIC SYSTEM COMPONENTS SUBJECT TO LOAMY SAND LOAMY/6° SIZE OF LEACHING FACILITY PROVIDED: VEHICLE LOADING(i.e.UNDER DRIVEWAYS.ETC..) 9'�=8 ° 42' 93'7 ° ' THREE 500gal.CAPACITY CONCRETE STRUCTURES w/4'OF STONE SHALL BE DESIGNED TO WITHSTAND H-20 LOADING. 4W SIDEWALL: 186sf.x 0.74= 138 G.P.D. E°.N 4. ALL SEWER PIPES SHALL BE SCHEDULE 40 OR _ "wE°:S6/6 AND M sANo BOTTOM: 436sf.x 0.74=322 G.P.D. 2srR Am. a , PROPOSED 4"DIA. PERFORATED PIPE /s TOTAL- 622sf.x 0.74=460 G.P.D. APPROVED EQUAL. INSPECTION PORT SET VERTICALLY 84•8 13s" 85.2 138. 5. BEFORE STARTING CONSTRUCTION CALL DIG SAFE DOWN INTO THE STONE TO THE PERC RATE <2 MIN/IN. (-c- HORIZON) 1-800-322-4844 FOR LOCATION OF UNDERGROUND NATURALLY OCCURRING SOIL BELOW No GROUNDWATER ENCOUNTERED UTILITIES. THE STONE.THE PIPE SHALL BE CAPPED 6. DATUM IS ASSUMED. WITH A SCREW TYPE CAP SET TO WITHIN 103 LEWIS POND RD, COTUIT, MA 3 INCHES OF FINISH GRADE. 7.THE ENTIRE SITE IS LOCATED IN THE AQUIFER PROTECTION OVERLAY DISTRICT AND THE RESOURCE PROTECTION DISTRICT. 8.ALL DISTURBED AREAS OF THE EXISTING-LAWN SHALL BE PROPOSED S.A.S. THREE 500gal.CAPACITY INVERT ELEVATIONS: - LOAMED AND SEEDED FOLLOWING CONSTRUCTION OF THE NOT TO SCALE CONCRETE STRUCTURES INVERT AT BUILDING 98.00 PROPOSED SEPTIC SYSTEM. WITH 4'OF STONE 33.5' INVERT IN AT SEPTIC TANK 95.00 9.THE EXISTING CESSPOOL LOCATIONS SHOWN ARE BASED INVERT OUT AT SEPTIC TANK 94.75 UPON AN AS-BUILT CARD PREPARED BY THE OWNER AND Y INVERT IN AT DIST.BOX 92.87 ON RECORD AT THE BARNSTABLE HEALTH DEPARTMENT. 255 ' INVERT OUT AT DIST.BOX 92.70 INVERT IN AT S.A.S. 92.50 BOTTOM OF S.A.S. _ 90.50 THREE ACCESS RISERS AND COVERS REQ'D. ADJUSTED GROUNDWATER MIN.20"DIA.@ INLET&OUTLET ` MIN.s"@ MIDDLE OBSERVED GROUNDWATER (12"MINIMUM INSIDE DIMENSION • &6"MINIMUM SUMP BELOW 99.3 INSTALL A GAS BAFFLE -BOX PIPE INVERT ELEVATION) ACCESS COVERS MUST BE.IN OUTLET TEE 1U0.66 ;r. WITHIN 6 OF FINISH GRADE, TI II2EE RISERS v EXISTING PROPOSED FINISH GRADE REQUIRED rnS :2% OVER S.A.S.EL.=98.00 a 92.87 MAX. 3' 4'N N. S =2% 92.70 MAX' U8°LAYER OF 98.00 DOUBLE ASSESSORS MAP 020 PARCEL 123 95.00 4.75 0 92.50 WASHED STONE "° STON PROPOSED SITE PLAN DOUBLE ' w 4'MINIMUM DIST. 90.50 wnsttEDED s•roxE LIQUID BOX PROPOSED-S:A.S. r ; L DEPTH (H-10) (H_I0) ® 103 LEWIS POND ROAD S1500 EPTIC TANK INLE TF �"°� ��� COTUIT(BARNSTABLE), MA (x-Io) ;x PAULROOER MINo rva CANAL LAND SURVEYING & PERMITTING INC. NOTE: M I CHN I Ew��2 THE SEPTIC TANK AND D-BOX TO BE SET ON A , No.lv�i� �'�e;w 306 OLD PLYMOUTH ROAD, SAGAMORE BEACH, MA 6"BED OF COMPACTED CRUSHED STONE. (508)-888-5955 canalsurvey@verizon.net CONTRACTOR SHALL WATER TEST __-__--- D-BOX TO SHOW LEVELNESS, Scale: 1"=30' Date: 07/21/11 Job 11 - 026 DA P110,FESSIONAL VNGINEER(CI L) Drawn: P.D.R. Checked: R.J.H Sheet 2 of 2