HomeMy WebLinkAbout0007 PENELOPE LANE - Health aiffi�LANE, COTUIT
_ A=039.,E b�1y�`1
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Fax Send Report MAR-13-2013 07:27 WED
Fax Number 15087906304,
Name BARNST HEALTH
Name/Number GMD
Page p
Start Time MAR-13-2013 07:26 WID-
Elapsed Time 00,001,
Mode STD'G3
Results [No Answer]
Town of Barnstable health rnspector
Office Hours
oa' Regulatory Services, 8:30 9:30
$ Thum as F.6ciler,Director 3`30 4:30
BARNWAINX' Public Health Division "
t0so �� 'Thomas McKean,Director
200 Main Street,Hyannis,MA 026,01
Office: 508-862-4644 Fax: 508-790-6304
AMNESTY PROGRAM AP.PLICANT—SEPTIC..Q.UESTIONNAIRE
Date:March 6,2013
1. Ueneral Information: Size of Property:0.55 acre,
Address:7 Penelope Lane Cotui%Ma 02635 Map and Parcel:-039-044
Nance:Peter E Johnson,Jane L Johnson Phone 8:508-237-3309
2a. How many bedrooms exist tit your property now'?4('3 bedrooms in Drain house and 1 bedroom in apartment) Y
2h,�re you,planning add any bedrooms?NO Tf.yes,how many? 0.
2c. ow njiuiy bedroo is total are proposed at this property(including the anmesty unit)'?4
2d.Paense GNielude a ci xpir the floor plans for the entire property..Neally use a straight-edge. Show all existing rooms in the
ho*ynd the propose amnesty apartment. Provide width measurements of any open doorways. Please label each room
cleai-jy.
t'a
3. IsF5,dwctiing connected.to public sewer'/ NO
If the dwelling is connected to public sewer,skip questions M through#9 below.
4. Location of dwelling is INSIDF a Saltwater Estuary Protection Zone?
5. Localiuu of dwelling is OUTSIDE a, Zone of Contribution to public supply Wells? Q
6. Is the dwelling cwnncctcd to an. ONSITF WFU or to PUBLIC WATFR?
7. Is a disposal works construction permit on tile'? YES or NO '
8. If ycs,how many hedroonrs were approved accordiug to this perruit? Bcdreunis'
9. Were any building permits obtained ror construction of additional bedrooms? YFS or NO
10. is there an engineered septic system plan on the at the 11calth Division? YFS or NO. -
11. Has the septic system been inspected by a`DEP certified inspector within the last two years? 'ITS or NO
FOR OFFICE USF.ONIX
The Public:I:lealth Ovision has no objection to Bedrooms at this property.
Special Conditions:. a "
Signed' racer I3. 13
f
McKean, Thomas
From: McKean, Thomas
Sent: Wednesday, March 13, 2013 8:21 AM
To: Dabkowski, Cindy
Subject: 7 Penelope Lane, Cotuit/Peter Johnson and Jane Johnson
I received an amnesty septic questionnaire yesterday for the above referenced address.
The Health Division has no objection to four(4) bedrooms total at this property.
I will FAX the approved questionnaire form to your Office this morning.
1
Town of Barnstable Health Inspector
oFtK t Regulatory Services Office Hours
.1, g yery 8:30—9:30
Thomas F.Geiler,Director 3:30—4:30
■ARNSrABLE. 1 Public Health Division
y MASS.
039. �0
�ArEc�+A Thomas McKean,Director -
200 Main Street,Hyannis,MA 02601 R
Office: 508-862-4644 y _Fax: 508-790-6304
AMNESTY PROGRAM APPLICANT = SEPTIC QUESTIONNAIRE'
' Date:March 6,2013
1. General Information: Size of Property: 0.55 acre
Address: 7 Penelope Lane Cotuit,Ma 02635 Map and Parcel: 039-044
Name: Peter E Johnson,Jane L Johnson Phone#: 508-237-3309
2a. How f aany bedrooms exist at your property now?4(3 bedrooms in main house and i bedroom in apartment)
2b.ire you planning add any bedrooms?NO If yes,how many? 0
M-
2c. Slow many bedroo s total are proposed at this property(including the amnesty unit)?4
caG
2d.please uelude a c f the floor plans for the entire property. Neatly use a straight-edge. Show all existing rooms in the
hornnd tie propose: awnesty apartment. Provide width measurements of any open doorways. Please label each room_
clearly;.
rw Q
3. IsfRe dwk?i'ng connected to public sewer? NO
If the dwelling-is connected to public sewer,skip questions#4 through#9 below.
4. Location of dwelling is INSIDE a Saltwater Estuary Protection Zone? O�
5 . Location of dwelling is OUTSIDE a Zone of Contribution to public supply wells?
6. Is the dwelling connected to an ONSITE WELL or to, PUBLIC WATER?
7. Is a disposal works construction permit on file? YES or NO
8. If yes,how many bedrooms were approved according to this permit? Bedrooms.
9. Were any building permits obtained for construction of additional bedrooms? YES or NO
10. Is there an engineered septic system plan on file at the Health Division? 'YES or NO
11. Has the septic system been inspected by a DEP certified inspector within the last two years? YES or NO
-------------------------------------------------=-----------------------------------------------------------------
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FOR OFFICE USE ONLY
The Public Health Division has no objection to bedrooms at this property.
Special Conditions:
Signed• - Date: 1'3 13
AsBuilt Page 1 of 1
LOCATION ` Y la SEWAGE# ;?41 --C
VILLAGE C ASSEESSOR'S MAP
M P/�L T
INSTALLER'S NAME&PHONE NO. `—
SEPTIC TANK CAPACITY IS
LEACHING FACILITY: {type) �� C (size)
NO.OF 13EDROOMS
BUILDER OR OWNER d
PERMPTDATE:Z!" 0*V COMPLIANCE DATE: 0'-
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 cxist
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 facilit Feet
Furnished byd 'f'
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ht.tp://issgl2/inttAnet/propdata/prebuilt.aspx?mappar=039044&seq=1 2/28/2013
Town of Barnstable Geographic Information System February 28,2013
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DISCLAIMERS:This map is for planning purposes only. It is not adequate for legal Map:039 Parcel:044 -
boundary determination or regulatory interpretation: Enlargements beyond a scale of Owner:JOHNSON,PETER E&JANE L Total Assessed Value:$444400 Selected Parcel .
1"=100'may not meet established map accuracy standards. The parcel lines on this map
are only graphic representations of Assessor's tax parcels. They are not true properly Co-Owner: Acreage:0.55 acres Abutters
boundaries and do not represent accurate relationships to physical features on the map Location:7-PENELOPE LANE
Buffer as building locations. - .
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No. ( r/� THE COMMONWEALTH`OF MASSACHUSETTS FEE
BOARD OF HEALTH
OF 7C
APPLICATION FOR DISPOSAL SYSTEM CON TRUCTION PERMIT
Application For a Perm to Coa y st uct ( '/ U m �
Rcpair ( ) pgrade ( ) Abandon ( ) Coplete System Individual Components
0 �I o ---_
G Li ,liun / C Owner Nam
f
MICLIO
\ Map/parer # Address
L ae Laa,ItM / '
Installer's Namr -7Designer's Name
Telephone it Telephone#
Type of Building: Lot Size �� aft
Dwelling—No.of Bedrooms Garbage Grinder ( )
Other—Type of Building No.of persons L2> Showers ( ), Cafeteria ( )
Other fixtures _
Design Flow(min. required)_ gpd Calculated design flow gpd Design flow provided gpd
Plan: Date Number of sheets Re=' Date...,'
Title
Description of Soil(s) 0rL9, L 3u.,
Soil Evaluator Form No. Name., or Sc�vu-G�.iv Date of Evaluation
DESCRIPTION OF REPAIRS OR ALTERATIONS
t
The undersigned agrees to install the above described Individual Sewage Disposal System in accordance with the provisions of
TITLE 5 and further agrees not to lace the stem in operation until a Certificate of Compliance has been issued by the Board of Health.
Signed Date
�tls
FORM t - APPLICATION FOR DSCP DEP APPROVED FORM 5/96
e, ��� �� '{ -• cam`' ;., \ �
NO. S �'� THE COMMO,NWEALTH`OF MASSACHUSETTS FEE
,.
BOARD OF HEALTH
1 APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT
Applict�tion for a Perm .to Const uct ( epair ( �) Upgrade ( ) Abandon ( ) - Complete System Individual Components
a L,ruiun / c Owner's Name
\ Map/Parcel q Address
Inslaller'sName ��� Desiggnerr's�Name
Ad �jr
_71-
`J x
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Telephone tt Telephone ti
Type of Building: Lot Size Q. a -
Dwelling—No.of Bedrooms _ _ Garbage Grinder ( )
Other—Type of Building No.of persons Showers ( ), Cafeteria ( )
Other fixtures
Design Flow(min. required) gpd Calculated design flow gpd Design flow,provided gpd
Plan: Date -.�4-u Number of sheets —� Revision Date - t
1` Title �1
Description of Soil(s)U�=SS` ttrw a' 3to•. 1� c1Cu 36"- o" NUA 5'aluj
Soil Evaluator Form No. Name of Soil Evaluator IP• Su�►u [_IAA. _Date of Evaluation 3-11-'61 C1
DESCRIPTION OF REPAIRS OR ALTERATIONS
� c
i The undersigned agrees to install the above described"^Individual Sewage Disposal System in accordance with the provisions of -
j* TITLE S and further agrees not to pllace the stem m o eration until a Certificate of Compliance hasbeen issued by the Board of Health. `
Signed �" Date
-Inspections
FORM t - APPLICATION FOR DSCP DEP APPROVED FORM 5/96
y
"~No - Q` t7- f THE COMM"�07VWEALTH"OF'MASSAiCHU`SETTS' 'FEEr "" -'"� "'
'y QCwv�J/"4 0& BOARD OF HEALTH
O 39 O CERTIFICATE OF COMPLIANCE
Description of Work: [] Individual Component(s) i �mplete System
The undersigned hh eby cyerttiify heat the
,CSe/wageeDii�sposal-System;Constructed( ),Repaired( ),Upgraded( ),Abandoned( )
at /C)[l Wyv o .."t C.C1 di/r CI�
has been installed in accordance with the provisions of 310 CMR 15.00 (Title 5) and the approved design lans/as-built
plans relating to application No.'Zfl .-lZCl dated -3 - Approved Design Flow W4 3 (gpd)
Installer
� . ✓� G� t!� ate
Designer: Inspe
—=T
g
The issuance of this certificate shall not be construed as a guarantee that the system will fun�Stion as designed.
FORM 3 - CERTIFICATE OF COMPLIANCE DEP APPROVED FORM 5/96
• t '
No20270 THEE COMMONWEALTH OF MASSACHUSETTS FEE
O3 —�L� YY�'aSlo� BOARD OF HEALTH
y t
DISPOSAL SYSTEM CONSTRUCTION PERMIT
Permission is hereby granted to Construct (Repair ) Upgrade ( ) Abandon ( ) an individual sewage
disposal system at & - .. ye 1-41 Co 4 14- as described
in the application for Disposal System Construction Permit No. Z477a dated 3 3fl
Provided: Construction shall bebe completed within three ears of the date of this'per .All local condi irons be met.
Date �sf '� l y Board of Heal ��
r
FORM 2 - DSCP DEP APPROVED FORM 5/96
FORM 1255 (REV 5/96) H&W HOBBSS WARREN TM PUBLISHERS- BOSTON
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MAIN FLOOR PLAT:
or
F BARNSTABLE
LOCATION �....
i SEWAGE # GAG
VILLAGE /" ? ASSESSOR'S MAP T r'L
INSTALLER'S N
AME&PHONE NO.
SEPTIC TANK CAPACITY
LEACHING FACILITY: (type) C i
(size) d�
NO. OF BEDROOMS ~
BUILDER OR OWNER '
PERMITDATE: . r"� COMPLIANCE DATE: r -* ��,,,
Separation Distance Between the:
Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility
Private Water Supply Well and Leachin "Facili Feet
pp Y g ty (If any wells exist
I on site or within 200 feet of leaching facility)
Edge of Wetland and Leaching Facility(If any wetlands exist Feet
within 300,feet of leaching facility
r Feet
Furnished byd' 400:
, �4
Z 2: i,
Tuwn of Barnstable 1,#
Department of Health,Safety,and Environmental Services
DIME Public Health Division Date
367 Main Street,Hyannis MA 02601
eentasreer 4
` I?d 00
rE1619. Date Scheddled �r I ime Fee a�l ,. T
F
Soff-Suitability Assessment for Sewage Disposal
Performed By: Y Q I a,/ "S4 0 1 CZ- , Witnessed By: 71d14*1 ef AV/.
LOCATION & GENERAL INFORMATION
Location Address 10 CC1 NO�� Lwa_ Owner's Name:1bt n 1�6`G,ZYUOSV�
Address
• �'�1�1'� �Wvw�a�S l
Assess c's ivdac/Par ei: 0-5/q' `� Engineer's Name eQ 11 e-
1 NEW CONSTRUCTION W REPAIR Telephone#
and Use 4�.-e"_Cf Slopes(%.) �L 7o Surface Stones �0 `
Distances from: Open Water Body ft Possible Wet Area ft Drinking Water Well f
Drainage Way » ft Property Line ft Other ft
SKETCH:(Street name,dimensions of lot,exact locations of test holes&pert tests,locate wetlands in proximity to holes)
L,4-69
Parent material(geologic) O t w a s 4 Depth to Bedrock
Depth to Groundwater: Standing Water in Hole: Weeping from Pit Face
Estimated Seasonal High Groundwater
UETERMINATIOI i 'OR>SEASONAL. MGH WATER TABLE
Method Used:
uei:ir. ose;;vea €ancing inoos.-.oic: iii. ' to sot!mottles:
Depth to weeping from side of obs.hole: in.- Grove;:undwater Adjustment ft.
Index Well# Reading Date: Index Well level Adj.factor Adj.Groundwater Level
::-JrERCOLATION TEST Dat ime 9.3•�
Observation C
Hole# , Time at 9"
Depth of Pere G O Time at 6"
Start Pre-soak Time @ Q Y O Time(9"-6")
End Pre-soak
Rate Min./Inch Z
i
Site Suitability Assessment: Site Passed Site Failed: Additional Testing Needed(Y/N)
Original: Public Health Division Observation Hole Data To Be Completed on Back—�
Copy: Applicant '.
DEEP OBSERVATION HOLE LOG Hole #
Depth from Soil I lorizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Doulderes.
AA �/ Consistency.° Gravel)
8 •• L046y /0YR 7Z
F 0 3G Y (3 Lo4�r /O Yi2 yl
36"—/Zo" c a�� 16Y2 °lt
DEEP OBSERVATION HOLE LOG :Hole#
Z
Depth from I , Soil Horizon Soil'rexture Soil Color I Soil' I I Other
Surface (uSDA) (Munsell) Mottling (Structure.Stones;Doulderes.
� . t _.
Consistency,° Gravel)
—CO " /¢w Lo a /o Y/L ��
8 3G /3 Z.W -e z 1/�
v -4re_w
36 -/20 C $_4 110F /o YA
DEEP OBSERVATION_HOLE LOG Hole#
Depth from Soil Ilorizon; Soil"rexture 'Soil Color _ Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Doulderes.
Consistency,°o ravel
DEEP OBSERVATION HOLE LOG Hole#
Depth from Soil Ilorizon Soil'rexture Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Doulderes.
Consistency,%Qravel
i
I
Flood Insurance Rate Man:
.'above 500 year flood bcunda:y No_ Yes
Within 500 year boundary No v' Yes
Within 100 year flood boundary No Yes
Depth of Naturally Occurring Pervious Material
Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the
area proposed for the soil absorption system? Xe-5
If not,what is the depth of naturally occurring pervious material?
Certification
I certify that on f(date)I have passed the soil evaluator examination approved by the
Department of Environmental Protection and that the above analysis was performed by me consistent with
the required training,expertise and experience described in 310 CMR.15.017.
Signature GY .� � Date.- /i, /$;F F
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LOCATION SEWAGE # �
VILLAGE-
C_ �� ASSESSOR'S MAP & T
INSTALLER'S NAME&PHONE NO:
SEPTIC TANK CAPACITY
LEACHING FACILITY: (type) .5 C (size)
NO. OF BEDROOMS
BUILDER OR OWNER 111/11
PERMITDATE: COMPLIANCE DATE: A47;;� 9- 7
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-11 Feet
Furnished.by low, � �
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S YS TEM PROFILE
NOT TO SCALE
FNDN. FINISH GRADE OVER
FINISH GRADE
EL •- 7� , S FINISH GRADE -7�1-.8 FINISH GRADE OVER OVER TRENCHES 73.S
DIST. BOX 3. 5
SEPTIC TANK 4. 3
kc° �cMKTMAW
.o 'a' 12" MAX.
s QAC
d o,4 q. • �'..e.• 'V'••. .0�'•pO:D�,a0,'::Qs�ti0.°'.o.a oA.19d4p�!.a,• '! .e•1•�p.•.1 d� _
a �� .� _ TOTAL LENGTH OF TRENCH 3'- "
OUTLET PIPE LEVEL
9 3 :a
p FOR 2 FT. MIN. t-' �" - �" ..� .,
,1• .�0:�Q '� - :e o O Of ' .: ' ' '.�i ' ••D: ' • ;od• b• •` 'eA' b6cpQ��
oo 0
000
C. I OR P VC TEES G9 7 1 ' 3 '7 � =10. .� 4 o C7 C� O o o.
y ro �. .1 50 0 GALLON DIS TRIBU TION BOX
..a •e•o
b'
$SMT FL .
a°a "500 GALLON DR YWEL L S "
�;EL . ��. 0• .;oo•o 9� INSTALL ON LEVEL BASE
PRECA S T CONCRETE
.H- /0 REINFORCED
a� �•e�:a r�.d,:4:'v d•a•!?••a::o:�.•:'a•,a'�•Q r•®'••vp�o'0•�"4'e''•°.a"F�'
s.° .•p.v p•o., .p o D..e:.a. y fpro;00, 4 Y .p.p:
sw TRENCH SECTION
SEPTIC TA NK
INSTALL ON LEVEL. BASE
NOTE' EXCA VA TE` TO EL EV V. N/A
-OR
LOWER TO REMO VE AL L IMPER VIOUS
MA TERIA L BENEATH THE LEACHING AREA 4" orAM. t 2" MIN.
REPL A CE EXCA VA TED MA TERIAL WI TH 3" OF 1/8"-1/2"
,b,.:0;, �•�? WASHED PEASTONE
' CLEAN. CLAY FREE SAND .4, v' i•:.b•,:.p. coo •
�o- ••�' D[o•,•.• cam••
.Ip 314" - 1-1/2" WASHED
CRUSHED STONE
a
GENERAL NOTES
TRENCH WIDTH
1. AL L EL EVA TIONS SHOWN ARE BASED ON ASSUMED NUMBER OF TRENCHES 1
N 37.1 s'40 2. AL L PIPES IN THE S YS TEM MUS T BE CAS T IRON NUMBER OF DRYWEL L S 3
;. 17?.B2
OR SCHEDULE 40 PVC. -
?�3S�R�� A��'�-0N PIT
�jC�L 4L{. 3. THE BOARD OF HEAL TH MUST BE NO P-9419
ti WHEN CONSTRUCTION IS COMPLETE PRIOR
LOT 155. .- TO BA CKFIL L ING PERCOL A TION RATE.'
4. ANY CHANGES IN THIS PLAN MUST BE APPROVED <2 MIN./IN.
BY THE BOARD OF HEAL TH AND CAPE C ISLANDS WITNESSED BY*
o SURVEYING CO., INC.
DONNA MIORANDI
in i . D ►= -- � � J 5. MA TERIAL S AND INSTALLATION SHALL BE IN BARNS. BRO. OF HEAL TH DESIGN DA TA
^ W COMPLIANCE WITH THE S TA TE SANITARY
a • ' `0 ti 4 CODE - TITLE V - AND LOCAL APPLICABLE DA TE.• MAY 11 1999
i rnm
i Q q RULES AND REGULATIONS
- -� �i W NUMBER OF BEDROOMS
6. NORTH ARROW IS FROM RECORD PLANS AND Z rrT I E�I'f 2
15E: W IS NOT TO BE USED FOR SOLAR PURPOSES O O• GARBAGE DISPOSAL NO
r
z a' 7. .FL 000 HAZARD ZONE NON-HAZARD 8" w L.00N ioY z 8• Lc7�'t1 o Y z: DAILY FL OW 440 GAL .
i B. WA TER SUPPLY TOWN Wa TER s�dY SANDY SEPTIC TANK REO 'D. 1500 GAL .
s �. -��--_�:.CjAk2. _� N L o�.1 (__ _Lo�•M �0 4 GAL .
o SEPTIC TANK PROVIDED �.�
LEA CHING REGUIRED 440 GPD.
j 3, N� Q •
ti \ MEVIUM t'1C-DIu�1
• y SIDEWALL AREA = 1B6 S.F.
=_.?-ES f2VE `r 0�00 % Ia Y1��6 10 Ytt
rr/6 1B6S.F.X o. 74G/S.F. = 137 GPD.
„ BOTTOM AREA = 441 S.F.
125.00 P L EGEND 441 S.F.X D. 74G/S. F. = 326 GPD
r s 30'37•os"w 12�"_= ua 120UNL�WQ'r. 120" ► O 9='Ql'`lL�'TM - LEACHING PROVIDED = 463 GPD
a 7 PROPOSED EL EVA TION
r CONSTANT LANE
-- 4--- EXISTING CONTOUR SINGLE FA MIL Y RESIDENCE G
bl OBSERVA TION PIT
❑ DISTRIBUTION BOX
PROPOSED SE NA GE DISPOSA L S YS TEM
Ire
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