HomeMy WebLinkAbout0078 LINDEN LANE - Health 78 Linden Lane
Osterville
A= 142 —026
TOWN OF BARNSTABLE ���
LOCATION ° SEWAGE#
VILLAGE ��� ASSESSOR'S MAP&PARCEL
INSTALLERS NAME&PHONE NO.
SEPTIC TANK CAPACITY
LEACHING FACILITY:(type)- ��`® (size)'00, Ilk Z-
NO,OF BEDROOMS
OWNER
PERMIT DATE: 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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No. , ; i Fee
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes
0[p plicattou for Ois�pogar 6petemc Cons1ruction Permit
Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon( ) U Complete System ❑Individual Components
Location Address or Lot No. .7P' L�i►'p�.Cr/� LN Ap.� Owner's Name,Address,and Tel.No.
Assessor's Map1Parcel.,..e_.<..#-L — ,�-,Ocv;l�k
Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No.
��� Ler�'O�li�' 77y�.1���j.� '�L-CAS .�/,a•�J'Ar D�'.1'_
Type of Building:
Dwelling No.of Bedrooms Lot Size sq. ft. Garbage Grinder ( )
Other Type of Building ��E.f'. No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow(min.required) a gpd Design flow provided gpd
Plan Date 'S__X " Number of sheets ® Revision Date
Title
Size of Septic Tank ®1' �J9l Type of S.A.S.
Description of Soil
Nature of Repairs or Alterations(Answer when applicable)
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 Board of Health.
Signe ., p aIn Date
Application Approved by Y17A Date
Application Disapproved by: Date
for the following reasons
Permit No.ew.,n
t Date Issued
r`''try^.c�"�k^r^.`++'i'Yw 'Y".-"M.Pw'+��..5..-•.:'s.r. -•.�" v.. 4:.r ,+j":v-`"".:f -.. :.,::7sw,.r7'..^i" S- ;'.e�_'sv�` .rr. tw .,..,..+"'•..^'.. - ... ..r,
No. . /'C _ -- m y � Fee �D
x computer:
Entered in
; v
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HE LTH DIVISION #- TOWN OF BARNSTABLE, MASSACHUSETTS Yes
2pprication for Diiponl 6pztem Con6truction Permit
Application for a Permit to Construct(`')g Repair O Upgrade O Abandon O l-J Complete System ❑Individual Components
Location Address or Lot No. Owner's Name,Address,and Tel.No.
/ Assessor's Map/Parcep---I.s:,� >�
Installer's Name,Address,and Tel.No. a Designer's Name,Address and Tel.No.
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(min.required) a gpd Design flow provided' gpd
Plan Date Number of sheets / Revision Date ?
Title i
Size of Septic Tank r �, � Type of S.A.S.
Description of Soil
Nature of Repairs or Alterations(Answer when applicable) ^~
Date last inspected:
7Ag`reement: ;
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 Board of Health. { t
Al Date
,Application Approved by �,f� O Date Z-
r v �
Application Disapproved by: r Date
for the following reasons
�. 17
Permit No: Date Issued i
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
at :7 � L i .J Ey 1 �- o f T• has been
ncopn5tructe rin accordance
with the provisions of Title 5 and the for DlsposaI System Construction Permit No. /'J � dated
Installer �J I16
�'� Designer
#bedrooms Approved design fl'o--w� gpd
The issuance of this permit shall n t be construed as a guarantee that the system will funct' ion as, esi
Date 5 1 d lei Inspector Al
— ——— ——————
t' CJ �� /�
No. D Fee �'
T H W 7 •.
HE COMMONWEALT OF MASSACHUSETTS
PUBLIC HEALTH DIVISION—BARNSTABLE, MASSACHUSETTS
Oigo!gal *p!6tem Construction hermit
Permission is hereby granted to Construct ( *-5, Repair ( ) Upgrade .( ) Abandon ( )
System located at 7
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: Constru• ion ust be completed within three years of the date oft errriat:�
Date -/ Approved by ✓"
pp '��
`a'1R ��.i•�Y.. n�t mans ant cc i�tivuvnb R ur+i !��Ir r. . FtJE'tT7�(rlOtr�h 17/J
The:plans wd spwifmtions'for every on-site system shall be prepared as follows:
(I) Ewe Zywm tan be duWmd by a Mamchmm Rqftu=d habssimW Eagteeer
m a prf, Me A dmt sch Sar&mffm A&eta dedm a
syA=dc*mcdw&wkvWmces da2AW paw ss31E tMR L$201
Any edw saw of do even MW ptgt M Phus far dm=P*of a V mm dWVwd to
dmdmp mtt aaaw gm dm,2jlOg gAm Per der pa=mm to 310 CYR 15 2tf3 pmai&d
dicy ate:.uoimed by.a S tad a�ov+ad by tope appetap g
/stthotiti. .
vl-
(2) Evay plan nbudmd for approval must be dated and beat due stamp and signature of
the deaiguec,
t3) Bmy plu Ewa=wM=Wpbafordmwmkwapwcmetanedsibrg systo
wtieob nogaa+m a sammte m>t pwa�>bta xpEboek atinpote:"most abe reae:tna�a @taa
vhhh bow dw smp and same of a--ibdptM.l&=W Lad SorveW is -
_
(4) Every plan for a iymm stall be of snirabh scttle(eme incb=40 f mt at farm for plot
phms and am imlt=20 feet or fearer for demos of system wn�cwmts)and shalt Wude
devictkm of:
} the leer bad of 0 m be served:
(b) the bokkw and lotadt of 9Ay easements appurtenant to Of wWch M"impM the
(c) tltaiop�R'oa®EtlpeaitdaJor6eai�iaS�Fodeadta `J'•1
and of dam to be ssnad by dre syspp= -
/ -ffie d-( y 'i� of�8 or it'll ad toms. B shi�errays tad
,✓ � �-
e) lop6ae tad of s { etsarvt aaesk
W ealam �3► p:lbw.scmdc aawk capacky . .
(oogabed ad poaooideft sea abaogdm 43 Op an sa r*agoiod n d-pmride*aed
9r>setiuptr a�lh dea�pad lfor� I
NK&amm and spas pWp�d
{�, 1ocaBatt tad kE apf dxp obsenadm�tears d�data of eppL eptistiag
/ jmft dvoolm maaaod m am* seer. tad spa wasps of*0 epgtaesaen*m of Om
1/ malft amd M p
. -Y W gseatioa and try d paaoo3atim taaas de:same of test amd the awes�
tlae a# apla®•app ►sad sea arala nm
.pmaee I=wftm oa aatatberaf&saa Data=of ieoeed;
.ddme 40 fiaet-of do peopmoa s3mm t =GM in t0 ease of sedate vim= .
2'==wlBds 20 fapyt of On ps+apa®ed seaters bcadm in dew=w-.of aabdw pabfie
weer sap�ph vast.mad
�/� 3. 1 few of tbp: d s�rsomn�n to*x cos of
< =,
Y
in
b ateop Ofq �of t>� t�
arm'star ao�o� ass or serial bmk%z " Moftay. .
' saa�ea.weeecapp�'�i�ieidoiamsna6esnpaler�eeYo'fied,ppp�sltpo��amr�e . �'
now sappGes or m"ti:lips. Vwd pmftd or ubftr pabtc ate.
boa drel Ieaabe club b lk&or ft and dta 1pipatiia v t s�o ii _
4 iae-s�idapdsepl'ia 31ELE L7da LS.2t3 sei� eb�:.pa�abs '�papoeaoct as IeamLAIAq _ - -
Loodoo<af mtarsane tad otbe'selfapa:aa�oio:eatbe.fadij:` -
77'V
o6toe m toad in f -Wft Siang
C
�aa�ietepee0e�dw t� -
�) a eokm tlrt on l o ft al mbo,-:to an 31jEg GO aae�c
fat oo jartpttioa SOD phnC
(q) ft bafta and dieaona<of m bod mr!'F M.W.50>a 6A a in fic�9
tea aet lldtts pia arlaasdaai� a now
paw ones tadm aeita06e:,e ae� = __
/u� 'plan:B �d>t�r� S'- �°d■a°1°�>i� - - -_ - -
aceaypOlpxeptmspdspea �>�
ala�spdsamslaua.ieltpcatGeps �- - � ` --- _ - .
,
Town of Barnstable
Department of Regulatory Services
: BARMABr$ : Public Health Division Date
>,AS&
rely �e� 200 Main Street,Hyannis MA 02601
Date Scheduled / Time // Fee Pd, Alb
Soil Suitability Assessment for Sewage Disposal
Performed By: Z-4 VIO -10=_1_4#,E � f e Witnessed By: Dc-)"`�'
L CATION& GENERAL INFORMATION
Location Address �� //���5`/v ^'•- ®�('�' Owner's Name #fj A;oe*�0�9y
Address
Assessor's Map/Parcel: 00�.,l C;a 4C Engineer's Name 10i4 v�4 /yj/f!f arm
.� �,7 '
NEW CONSTRUCTION REPAIR Telephone#
4D
Land Use 1 i " Slopes(%) Z Surface Stones
Distances from: Open Water Body ft Possible Wet Area ft /�Drinking Water Well _- ft '
Drainage Way /V 14 ft Property Line ft Other ft
SKETCH:(Street name,dimensions of lot,exact locations of test holes&perc tests,locate-wetlands in proximity to holes)
' N
c
law
oe-.j
Parent material(geologic) Depth to Bedrock A t
Depth to Groundwater. Standing Water in Hole: Weeping from Pit FACe
Estimated Seasonal High Groundwater N
t.
DETERMINATION FOR SEASONAL HIGH WATER TAB +�.
Method Used: ..................
Depth Observed standing in obs.hole: _ in, Depth to 59II mottles: in.
Depth to weeping from side of obs.bole: in, aroundwater Adjustment
Index Well# Reading Date: `' ;Index Well level ._. AAJ,factor, 'm Adj.Groundwater level, _
PERCOLATION TEST Date; "me.� _
Observation ✓` Time at 9"
Hole#
Depth of Perc t, g Time at 6"
Start Pre-soak Time @ Time;(9"4")
End Pre-soak
Rate Min./Inch
Site Suitability Assessment Site Passed Site Failed: Additional Testing Needed(Y/N)
Original: Public Health Division Observation Hole Data To Be Completed on Back-----------
***If percolation test is to be conducted within 1009 of wetland,you must first notify the
Barnstable Conservation Division at least one(1}week prior to beginning.
i
Q:\SEPTICTERCFORM.DOC
DEEP.OBSERVATION HOLE LOG Hole#
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders.
" on isten % ravel
6 I,O7 3/�- /!/,4
DEEP OBSERVATION HOLE LOG Hole#' ' 2—
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders.
} Consiste-gy % ray
3s- S
DEEP OBSERVATION HOLE LOG Hole#
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Stricture,Stones,Boulders.
Consiste vel
1 `
DEEP OBSERVATION HOLE LOG Hole#
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones;Boulders.
Consi ten I
s
Flood Insurance Rate Man:
Above 500 year flood boundary No Yes '
Within 500 year boundary Noiz Yes
�� �,,i
Within 100 year flood boundary No � Yes
Depth of Naturally Occurrime Pervious Material
I 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 pervious material?
Certification
I certify that on (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 Date
Q:\S.EPTICkPERCFORM.DOC
l ,
Mai 11 07 02: 37p p. 1
Town of Barnstable
o`p1H6
RegIllat®ry ,services
Thomas F.Geiler,Director
nARNS'1ADLt.
Pubic Health Division
Thomas McKean,Director
200 Main Street, 11yannis,MA 02601
1 "
Office:.508-8624644
rnx: 508-790-6304
Installer & Designer Certificatioin Form
Date: � z, 0-7
Designer: Installer: - j
Address: Sl _ '4 w Address: l �4- 1�} -
Ora At{ L�0�_ �l �i was issued a permit to instal l a
ate) (installer)
septic system at -g PL-4p► P
based on a design drawn by
(address) -
Q J�V I D gcS OL`7 dated ��' ' Z O
(designer)
°� _ ;certify that the septic: system refiaenced above was installed substauUally according to
.4,he design, wtdch may include minor approved changes such as lat4r', relocation of the
dtstnbution box andlor septic tank_
6uT- wqs tqc T- ur2Ery -Doe,
s/1 p7
— I certify.that the septic system refer ed above was in,,. he'd w'
ith mayor changes greater than 10' lateral relocation of the SAS or any vexticat'relocation of my Cora
ponent
of the sept d.,,,3 Stem) but in accordance with State& Local Regulations. 1>1-in revision< or,
certified as-1-)it;7t'by designer to follow.
tH OFDAVI
s .
^(Installer s Si�,nature) .� ; MASON
N
^,
No.1066
S4NITARt
Des t`r'$Sigtiahirc) (Affix i Signer's Stamp1erc)
PLEASE, RF T URN TO BARNSTAB.LE PUBLIC FWALTU DIVISION. CIFItTYFICATL
OF CONdPLI. Ck- LL" NO.T DE, ISSUED-.{JNTj L IIOTFI THIS F'OI AND As_
CARD A RF k ;c..FTV>;n �C>tIF RAC S7fAT3LF PUIILIC U.r,&Frur D-VIoi-N
TiAlilK YCDIJ. >:
Q: 1lc;1lth/Septic/Uosigncr C'crtilicatiun Form '
ASSESSORS MAP: l _
do
PARCEL: TEST HOLE LOGS�7— NOTES:
FLOOD ZONE: 1-/r?-T" �T�'G 1 SO I L EVALUATOR: L
- - - _ -. WITNESS : `-�T�II� " I
1` 1) The installation shall comply with Title V and Town of Barnstable Board of
�E'"REFERENCE. E-J DATE: Health Regulations.
L ib0 /� �25 PERCOLATION RAT 2 �'llr I 2) The installer shall verify the location of utilities, sewer inverts and septic
�`
components prior to installation and setting base elevations.
_ ' 3 All gravityseptic piping to be 4 inch Sch 40 PVC at 1/8" per
TH 1 TH 2 p P P g p foot. The first
- - two feet out of the d-box to the leaching shall be level.
A�� L� c) 4) This plan is not to be utilized for property line determination nor any other
1 �D purpose other than the proposed system installation.
S) All septic components must meet Title V specifications.
6) Parking shall not be constructed over H10 septic components.
LOCATION MAPAA+�1b t,orgwt ,1
G� ' 2! folio �2 G� ', Z � �'"1�j 7) The property is bounded by property corners and property lines.
8) The property owner shall review design considerations to approve of total
rn � tTVD. �{i� design flow and number of bedrooms to be considered for design. Receipt of
` 1�� payment for the plan and installation based on the plan shall be deemed
�2 approval of the design flow by the owner. �Q>
9) The existing leaching or cesspools shall be pumped and filled with material
per Title V abandonment procedures. Those within the proposed SAS shall be
l 12 removed along with contaminated soil and replaced with clean washed sand
I►�0 Ut _.._0D_.. 1P'L per Title V specs.
10)System components to be 10 feet from water line. Sewer lines crossing the
- water line shall be sleeved with 4 inch SCH 40 PVC with ends grouted if
SEPTIC SYSTEM DESIGN applicable.
' 11) If a garbage grinder exists it is to be removed and is the responsibility of the
r FLOW ESTIMATE MATE owner to ensure such.
._ 12)The installer is to take caution in excavation around the gas line if applicable.
3 BED RiOOMSAT 1/0 GAL/DAY/BEDROOM -?50GAL/DAY 13)The proposed septic tank is rated for H10, if it is installed as such, vehicular
traffic is prohibited over the tank.
�J2 \ SEPTIC TANK: 14)Excavate 5' around the proposed SAS and below to approx. elevation50.3 or
Medium Coarse Sand which ever is encountered first and fill with clean sand
\ / GAL/DAY x 2 DAYS GAL per Title V Specs.
ek,
USE /,500GALLON SEPTIC TANK
Z S01L ABSORPTION
VA.>N tt�j2�20 VA-11 7
fir y^
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1 < C `�✓ t�C7+.� , , SIDE AREA: X IZ. -t-- 21i � = �✓?7 �� 0�'1�"�
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BOTTOM- AREA: >Z � � f3� s.���j �
MASON
No 1066
`'
ISTS
�, - E ` : PT I C SYSTEM SECTION
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M.' *.. SEPT I C TANK
—7777711,
SITE AND SEWAGE PLAN
LOCATION : it►-►p 1-. �-I
PREPARED FOR :
SCALE: ZC7
W
DAV i D B . MASON � DATE: Z
DBC ENVIRONME0AL DESIGNS
W DATE SANDWICH MA
ATE HEALTH AGENT
t508 ) 833- 2I77
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