HomeMy WebLinkAbout0009 FIR LANE - Health Fm-
9.Fir Lane
.Barnstable
_ _ A= 120-052
TOWN OF BARNSTABLE
L(,V�" ION 9 62- I SEWAGE # =. d ��
"J1I-,LAGE D�hYC f u i l�P. ASSESSOR'S MAP & LOT
PNSTALLER'S NAME&PHONE NO —_--c fit 1cl FO cad
SEPTIC TANK CAPACITY l2CCOX/5�-f 4
LEACHING FACILITY: (type) ID (sine) / iC �X 9, _
NO.OF BEDROOMS S
BUILDER OR OWNER
1 - T(o
PERMTTDATE: 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
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THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes
0[pphCAtion for Bizponl �§p$tem Conotruction Permit
Application for a Permit to Construct( ) Repair(K) Upgrade( ) Abandon( ) ❑ Complete System ❑Individual Components
Location Address or Lot No. #i'j `G,����t(�5 hCi L^i I I wner's Name;Address,and Tel.No.
Assessor'sMap/parcel j2U dsc
nstaller's Name,Add r d Tel.No. Designer's Name,Address and Tel.No.
0 � s��J-►ter �)�F/�c� ��0� -y�� &0- 9-30
Type of Building:
Dwelling No.of Bedrooms 3 Lot Size /C76'1_��y sq.ft. Garbage Grinder ( )
Other Type of Building Vlov se No.of Persons (? Showers( ) Cafeteria( )
Other Fixtures
Design Flow(min.required) gpd Design flow provided gpd
Plan Date Number of sheets Revision Date
Title
Size of Septic Tank Type of S.A.S. 2-S-00 ,4x2S—
Description of Soil
Nature of Repairs or Alterations(Answer when applicable) jN3cf(z 1l E lto S -AS
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 Boaqof H lth.
SiR d Date 7` 2 y—d 6
Application Approved by Date
Application Disapproved by: Date
for the following reasons
Permit No.Q N6 3 Date Issued
No.. ` Fee QQ
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: _
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes
Application for Mgo!gar 6p5tem Construction Permit
Application for a Permit to.Construct( ) .; Repair go Upgrade O Abandon O ❑ Complete System ❑Individual Components
Location Address or Lot No. -t+`yj L lob 1 C'f V Nner's Name,Address,and Tel.No.
Assessor'sMap/Parcel
Installer's Name,Addre and Tel.No. Designer's Name,Address and Tel.No.
Type of Building:
Dwelling ', No.of Bedrooms 3 Lot Size /Q-/67 Sy 44 sq.ft. Garbage Grinder ( )
Other Type of Building qN y c No.of Persons 0 Showers( ) Cafeteria( )
Other Fixtures-
•
Design Flow(min.required) ?Zn gpd Design flow provided 'rF3 gpd
Plan Date Number of sheets Revision Date
Title
Size of Septic Tank /-r,, , Type of S.A.S. 2-S-0%G 1 C' keu, V1�4C 1&2 S—
Description of Soil
Nature of Repairs or Alterations(Answer when applicable) f r�C`�l�e �to113 C.
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 B of Health.
Sig.en� Date 7` 2 AP
Application Approved by Date 7 P `/
Application Disapproved by: Date
for the following reasons ,
Permit No. 400 b .�J -Date Issued -7
--------------------------------------------
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 �����4 c A 1 ir]W(13
at y T=, LC=.nl V 1 �Q has been constructed in accordance
with the Y
provisions of Title 5 and the for Disposal System Construction Permit No. 00 6 � dated 7®L/4
P P
Installer�����14 S Tl �C(��f� Designer �oCR�n3 �1PY��
#bedrooms Z Approved designeflow .Ism') gpd
The issuance of this permit shall not be construed as a /ua aantee that the system wi 1 function as desi Hell.
Date p /, tl9 Inspector
----------------------------------------------
No. �L n 6 — Fee
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION-BARNSTABLE, MASSACHUSETTS
0i5pogar;*p5tem Construction Permit
Permission is hereby granted to Construct ( ) Repair ( Upg ade ( ) Abandon ( )
System located at 4.i T y r L� `e n
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: Construction must be com fleted within three years of the date of this perin`it./
Date / " T! 1e' Approved by
Town of Barnstable
Regulatory Services
Thomas F. Geiler,Director
+ IARlY,T-,BEE,
ftsa Public Health Division
FFa. Thomas McKean,Director
200 Main Street,Hyannis,MA 02601
Office:.508-862-4644 Fax: 508-790-6304
Installer&Designer Certification Form
Date: 3It)(
Designer: D16yw(t-A Mg 2e Installer:
Address: . p U t�U�G `�� Address: �
/.�i" �,,9-h was issued a permit to install a
(d e) (installer)
septic system at 9 bA-0 C— based on a design drawn by
(address)
1 (A V/t h e Q, dated
(designer)
J 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.
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&Lo ons. Plan revision or
certified as-built by designer to follow.
DARREN
taller'
(D s Signature) o
/ aISTE��
SgAUTARIPN \
esigner's Signature) (Affix Designer's Stamp Here)
PLEASE RETURN TO BA.RNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE
OF COMPLIANCE WILL NOT BE ISSUED UNTIL, BOTH THIS FORM AND AS-
BUILT CARD ARE RECEIVED BV TtIE BAI2NSTABLE PUBLIC HEALTH DIVISION.
THANK YOU.
Q:Health/Septic/Designer Certification Form
LSO C-A, T ION SEWAGE PERMIT NO.
l
LLAGE
INSTA. LLER'S NAME i ADDRESS
:1-1
BUILDER OR OWNER
�,� ✓t ��r !mil ��
DATE PERMIT ISSUED 613d/g�
DATE COMPLIANCE ISSUED
D
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YJ� a,
No. I---359 Fss..... d..`.
THE COMMONWEALTH OF MASSACHUSETTS
0� BOARD OF HEALTH
I .................Town---------------OF.........Barnstable...
Appliration for Dispas al Works Tonstrnrtion Famit
Application is hereby made for a Permit to Construct ( X) or Repair ( ) an Individual Sewage,Disposal
Sys at:
.. Fir Lane L ...............................................................................................
ocati n-Address r Lo No.
Kennet)1 Capp 24 Garden Rd, Weld es�ley Hills, MA 02181
... ............................ ............................................... ..........--......................................................................................
W Spiros Cons .... ...... .................
Installer Address
15,467
d Type of Building Size Lot...........................Sq. feet
Dwelling—No. of Bedrooms.__three (3) Expansion Attic ( ) Garbage Grinder ( )
Other—T e of Building .. No. of persons............................ Showers — Cafeteria
W Other fixtures ------------------------------••............•.....
W Design Flow.....................55------------------gallons per person per day. Total daily flow.............330 gallons.
WSeptic Tank—Liquid'ca.pacity..1000gallons Length................ Width................ Diameter................. Depth................
x Disposal Trench—No..................... Width.................... Total Length.....................Total leaching area....................sq. ft.
Seepage Pit No.....I.............. Diameter.........8........ Depth below inlet....6.1............ Total leaching area...ZOO........sq. ft.
z Other Distribution box ( X) Dosing tank ( )
'-' Percolation Test Results Performed by.... axter & Nye:and Allan JonesPE Date...../.31/79 .
r7 i
a Test Pit No. 1......... ....minutes per loch Depth of Test Pit _1;..___.._._.. Depth to ground water -None -
Test Pit No. 2..........;-...minutes per inch Depth of Test Pit....12-........... Depth to ground water----None
.........•-••--••----------------•-•-.......•-•-••-•---•--•---•-•••..................__._._.............-••••.........•-•-••................_.......•--......
ODescription of Soil.........Medium.Cotuit__S_a_nd...•-•-••----•-----•-••••-••••-----•-------•---•-•-----------•-••-----•---•-•--•--•--••-------•-•-•--.._..•--.•----
W
---------------------------------------------------------------------------------------------------------------------------------------------------•---------------------------------------------------
U Nature 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 TITIL- 5 of the State Sanitary Code—The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has been issued by the board of health.
The Centerville Corporation
Signed---- - •• -- 6/25 81
-- ---..._.... -----------------•--- -•--------------•--......_....
By: � �yl Date
Application Approved By••--•--- .......... ,/� �.1......
-- Date
Application Disapproved for the following reasons: .. - - - ------•--------------------------- ----•-------.......
........................................................ ._...------------•-------------...-•--------•------••••-•-•••-•••--•••--•-•--•--•-•-----••......------•---••••-----•-------•-----•••--•--•_..._
Date
PermitNo..................................................._.... Issued.......................................................
Date
No..--...................... FBI& ............
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
.................Town................OF.........94motable
.................................................................
Apt iration for Dhivasal Works Tonstrurtion ramit
Application is hereby made for a Permit to Cofistruct (X) or Repair an Individual Sewage Disposal
System at:
Fir Lane -Lots 30A 1 '31B
................. ..................................... •
..................................................................................................
I(ennetkcein-Address
app 24 Garden Rd, Welfe'sie; Hills, MA 02181
.......................... ................................................................
Sner
Spiros Construction Co 35 Carla Rd, HyannYs.dre SOMA 02601
.................................................................................................. ..........7.......................................................................................
Installer Address
PQ III Type of Building Size Lot..15,467..........................Sq. feet
U
Dwelling—No. of Bedrooms......three (Vt............ ....................Expansion Attic Garbage Grinder (
Other—Type of Building ............................ No. of persons............................ Showers Cafeteria (
QI
Other fixtures .....................................................................................................................................................
Design Flow......................55 330 '� ,
................. gallons per person per day. Total daily flow...........................................gallons.
9 Septic Tank—Liquid capacity..IQQQgallons Length________________ Width................ Diameter---------------- Depth___...._..._.._.
Disposal Trench—No...................... Width...:.._._._.._._._..
Total Length.....................Total leaching area....................sq. ft.
1_..... . ,I. Total I Seepage Pit No.....I.............. Diameter.........a- Depth below inlet.....6.1........... caching areg..20.0........sq. f t.
Z Other Distribution box ( X) Dosing tank ( ) I -
0-4 Percolation'Test Results-- Performed by.._Baxter Allan JonesPE................................ Date.....!�!;�t/7.9..................
�4 None
Test Pit No. 1......... ....minutesperinch Depth of Test Pit----P............ Depth to ground water........................
�_q 1� None
Test Pit No. 2..........2 'Test Pit----I?............ Depth to ground water..--------------_-----
......minutesper inch Depth of
... .........................................................
0 Description of Soil.........lieAu...m----C---o-,t---u-i"t-----Sand_d..........**....... .......... ...........
..............................................................................................................................................................
U ............w..........w......................................................m.........................................................................................................................
..........................................................................................................................................................................................................
U Nature of Repairs or Alterations—Answer when applicable.................................................................................................
........................................................................................................................................................................................................
Agreement:
The undersigned agrees to install the aforedes'cribed Individual Sewage Disposal System in accordance with
the provisions of T I TLE 5 of the State Sanitary Code— The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has beig issued by thifiard'of health.
e Centery e Corporation
Signed-----................... 6/25/81
Date By: t X,"-0�1�11 a I /
Application Approved By........ ......... ..........6� ......
----------------------------
Date
Application Disapproved for the following reasons:-.... /.................I..............................................................................
........................................................................................................................................................................:.................................
Date
PermitNo......................................................... Issued.......................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
........ a............OF.....:rnt ......................................
Trrtifiratr of Tompliatta
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed or Repaired
by................. ........... ........................................................................................7...............................
In taller
at.........rKt:............ .................*-------------------- .. ....................................................................
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._4�5�_).3.,_V............ dated................................................
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE................................ ..................... Inspector.......-- ------------------------------------------
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
OF...... ..................................
N ......... ...3 FEE..
--....................
Permission is hereby granted.--- ....... ..........................................................................................
to Construct ),or Repair an Individual Sewup Disposal S stem
atNo........... ...... ......... .......
& --------------------------------------------------------
Street
as shown on the application for Disposal Works Construction Permit No..................... .Dated..........................................
........... ..............................................
)Ard'.f Health
DATE..................... ..................... ....
FORM 1255 HOSES & WARREN, INC.. PUBLISHERS
LAO GA AG6 6RII•lt1F� r
t>A•I L,{ V-. V./ Ito V. 3 °G.p.�
nc TAI.IK s 330" ISO %. • egg 6.Pv.
I; U E- 10
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pOSAL PIT USE loco GA4-. O� U� (1(✓ (�'. ,
' SMGU ALL L Aze A - 150
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a TOTA L 'V E6IG s"
1 N 425 G.ptr>. -
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S �5ci�. 4 Pp� vKr. tw. GAL. 9/,8 �•' ('
Z IMIC '. fox 9G.G SEPT IC
1000 9G u, To�tK
GAL INV, 11lV.
ti �AcH I
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PIT
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' GGR't'IF1j TI-(A'r T14r �oL)QDATIO14 5UowU -Q� TZLi='�-2E►�1C(; I
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AUD SETC�AGK 1`CqutCErt�t�uTS of TNT Lars 3b + 3(
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vAT� Ju�Jt , r1 i98� 'bpTir� �,ta �l (9e0 -�( �4xT6l,
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TI-115 PLAW IS L10T ZASCC? 064 AW � OSTE�VtLt.0 o t1rC.LS„
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-
- ASSESSORS MAP : , NOTES:
TEST HOLI_ LOGS
4 PARCEL : 1) THE INSTALLATION MUST BE IN SUBSTANTIAL COMPLIANCE WITH
FLOOD ZONE : C�v � '� SOIL EVALUATOR : D mzxj�' �s. Q HIS PLAN, 1995 MASSACHUSETTS TITLE V & TOWN OF
WITNESS : "MSS ( pctx ;, 5T �k BOARD OF HEALTH REGULATIONS.
REFERENCE: PJ� 67 :• DATE: TuLu LOO& 2) THE INSTALLER SHALL VERIFY THE LOCATION OF UTILITIES.
15b PERCOLAT I 0 RAT7-: l M`"`I SEWER INVERTS AND SEPTIC COMPONENTS PRIOR TO
INSTALLATION.
13( CLASS 1 � .S I-TAP a.'t
joS sul��, TH- 1 EL.W-J.�U Q'� TH-2 - (�qt 3) THIS PLAN SHALL BE USED FOR SEPTIC SYSTEM INSTALLATION
ONLY, AND SHALL NOT BE USED FOR PROPERTY LINE
J' .f.1'm( ' .. - � '= ejx -- I LL L, p rl 1[.(i p DETERMINATION.
G 4) ALL PIPING TO BE 4" SCHEDULE 40 @ 1/8 "/ FOOT. (UNLESS
l�y'�
° Poo , fy 1� 6 lo�t�3/v SPECIFIED OTHERWISE)
LOCATION MAP r l T.5 $ ,(,� �' T� 5) THE DESIGN OF THIS SYSTEM DOES NOT ALLOW FOR THE USE OF A
'GARBAGE DISPOSAL.
29 Tlo o 6) SEPTIC TANKS AND DISTRIBUTION BOXES (WHEN INSTALLED)
e01t,�, eU y� S P MUST BE PLACED ON A MECHANICALLY COMPACTED BASE OR ON
C � »�5 2_ P- A BASE OF 6"OF CRUSHED STONE.
7-
IA) 06SEn.V6b rim .
l50-„O SEPTIC SYSTEM DESIGN /
J) .
�� �--- FLOW ES (MATE 10) N11 VAPAIJ 1� wrt
- ..
f BEDROOMS AT 110 GAL/DAY/BEDROOM - 3 GAL/DAY �47(-T*f
46
48 o SEPTIC TANK
K r' ._ ___._... _. .K.. . .,_ ..
4-60
'� IO GAL/DAY x 2 DAYS -- � GAL
50
LOTS 30-/i 83 - m USE ( 06D GALLON SEPTIC TANK -<EX,6TWj 1�pL , W/ ! 5bn 66divy, 5017G
AREA 15467 s f+ \ 3 -�- - ( )
1 Z 1-pcNtG. t 1; +�c t.£7 r� •t t7 .
o SOIL, ORPTION SYSTEM
ABS
Two�?-) :5 00 CIA 11,on fre ea 0 4"(,,q e��A,"Apts
�r vJ l 5'I) oN A-LZ G 51 Ott'I - L K 13l x Z '.D
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o.1 I'�h LI''1 �,,,, \ m..`� &+ y"."4,a „k�' +.:. al�r'. ,•".. °Ji". � "�. _ _._ ,. ....... _._... _._. _
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�� ' BO':'TOM AREA
rn 35.2 :R8 P D )
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SEPTIC SYSTEM SECT I ON y33o 6P
BENCH MARK n�= Et, 51 �03
Cc. �f,7- elf.Z
TOP OF GAS GATE
_ �11 -
ATEVp0°� `�� � � � ELEVATION 46.J�USGS DATUM ASSUMED i+z►s(� ru dc20 f A s Gas&-rA L4 7:�4 3iq � y eP �11,? Z 3rr I�
50 tf Dfk GAL D 0L0.$ F7
!` CI L.
w / q7, �jt
� 1 ffi ��•� - Cr Lam: �..�. L� �` ace
/ SEPTIC TANK �Gv (✓te55 ,
(14
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Le
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OF MqS
I R N SITE AND SEWAGE PLAN- o
13 L OCAT 10 N : /A L.�97V
I Ft, � _
rn
m I -_�. _'"'�.' t 48 / 'PFG1&TE��� �c-Av/ I"�'Wit'
'132.4g
_ D� PREPARED FOR : 0,)T P 06
1000
SCALE:
0
DARREN M. MEYER, R.S.
DATE:
P.O. BOX 981
Z
EAST SANDWICH, MA 02537
Z DATE HEALTH AGENT Ph: (508) 362-2922
FAMMEMEW
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