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HomeMy WebLinkAbout0030 BOG BERRY LANE - Health 30 B �x�3rrjj Lurie Marstons Mills - - A = 044 010002 I� Form 4 -- System Pumping Record Commonwealth of Massachusetts hh n Massachusetts m,4 System Pugging Record PARCEL 0 0 0 Z LOT srtcm Owner Systern Location Fenner Donna Primary Home 30 Sock Berry Ln 30 Bog Berry Ln Marst:ons Mill:, MA, 02648 Mars-tons Mills, MA, 02648 (508) -428-7225 x (508)-428-7225 x * I T_ Type: Emergency Routine Cesspool: hlo Yes Septic tank: Nia [:]Yes Da of Pumping: �j3 Quantity Pugped. 6 ta alkms System Pumped By: Wind River Environmental, UC Permit#: Contents transferred to: t Contents Disposed at: Data. !/ r 'O�Pumper Srgrrature Condition of System/Other Comments bep Approved Form - 12/07/95 8 i 23'-GH AZ 52- 28 o" Il 43 51'-�,� B 3 , 3 TOWN OF BARNSTABLE LOCATION LDT 13b6 .,/>_ L # 9 - f f o VILLAGE l�iA 12STCnfs /14 J us ASSESSOR'S MAP& LOTL'l I• INSTALLER'S NAME&PHONE NO. L r✓I /4 of d12-0.-o Z-g20 SEPTIC TANK CAPACITY 15-6 O LEACHING FACILITY: (type) Chl W6&-1l'-5 (size) Z NO. OF BEDROOMS 3 BUILDER OR OWNER t-9 C0C6J4)DeX_ PERMITDATE: ?�//9/9$ COMPLIANCE DATE: /�16 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 r- a a�� '` OWN OF BARNSTABLE �t �'' LOCATION -3 15OU-tiL SEWAGE # G� VILLAGE NA-"1605 64)LLS ASSESSOR'S MAP & LOT Q yy-Ai®-Dd 2 INSTALLER'S NAME&PHONE NO. 11 r✓) /�f-Ot1,VX- Al2-0 r0 Z-r4O SEPTIC TANK CAPACITY LEACHING FACILrrY: (type) Ch1A7+'76FZS (size) NO:OF BEDROOMS BUILDER OR OWNER TALE C,141A)26?l - PERMTTDATE: 7- /9/QL COMPLIANCE DATE: !0 CIS 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 Az43 t -6 3 55'- 5`i y Y u R-4 �� G2. -� N, No. 9F / v ®'7`1 -- r ®� Fee COMMONWEALTH OF MASSACHUSETTS Entered in computer: �— Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS 01pplication for Migaal 6potem Cun.5tructiun permit Application for a Pernut to Construct(/)Repair( )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location A ress or Lot No. Owner's Name,Address and Tel.No. Assessor'6'Map/Parcel U T4Z'A2_0-Ivfr Installer's.N,ame,Address, d Tel.1 Designer's Name,Address d Tel No. -0-r� k:.l�c��cctd�f n, 33-03" A, Six Itpw1 CN A 0 2Q Type of Building: Dwelling V No.of Bedrooms Lot Size sq.ft. Garbage Grinder(A) Other Type of Building No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow 3 gallons per day. Calculated daily flow 3 13 D gallons. Plan Date Z r a> $ Number of sheets J Revision Date N Title 5 V,4-,C-k O b S'ySrV')-N U411 f�) Zoe &T 3 064 Z W y L Size of Septic Tank- _/Sdt o C to b Type of S.A.S. Description�ofSoil O- L n=1'�ll 1 @4' --Z S A Amy C.�t►`i�L M l 2 4�4 S��7 4 M1 6oa1►; 44 fi lt;�lA'3 51�u� -2 -0 ob 6a 2J I t s t ti i��l ff, 1�M'� G Nature of Repairs or Alterations(Answer when applicable) i-A° Date last'inspected: A 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 nvironmental Code and not to place the system in operation until a Certifi- cate of Compliance has been is d by this Boar f Health. Signed Date 2-' I Application Approved by _ /1 Date -70 cl Application Disapproved for the following reasons Permit No. -/l Date Issued No. / O —111v11►+ "Q d QG Q 4`t —Vp Fee COMMONWEALTH OF MASSACHUSETTS Entered inyomputer: PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLES MASSACHUSETTS Yes 01ppiication for Oigoml 6pztem Construction i3ermtt Application for a Permit to Construct(Y )Repair( )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location A¢dFess or Lot No. Owner's Name,Address and Tel.No. L off-3/)/s b )3 b C ��1Z `�Aj,1E 0- 9-Z Assessor's Map/Parcel V 22. ukC a Ago-28y$ Installer„s„�tame,Address, d Tel.No. WV Designer's Name,Address and Tel.No. e It cAi2VE]Z. 1)1i(c-4, f&.4 4AAtTQ / f\SS6r-- 1 6'•0j". 33-03 L"-. 51\1J10WI04 A o -2 Type of Building: 3 35 � 9 aA y Dwelling Y No.of Bedrooms Lot Size ) sq. ft. Garbage Grinder Other Type of Building No. of Persons Showers�, ) Cafeteria( . ) Other Fixtures Design Flow 3 0 gallons per day. Calculated daily flow a gallons. Plan Date Z ' $ _Number of sheets Revision Date N& Title 511H t4 t S149VbA4% me Fl (9 I°3t Z-T 3 i ra 6 G_�h Ll tj Size of Septic Tank J 5'0 o C 6\ Type of S.A.S.` `J o- 4 0653 U 1CS' ��'-Z t' S�t4mm Cl nH_� E, i, Des9 r�tion;of Soil MI' 2 Q-S 5 P,LbOL,,C.nh on�� sr � -Qa mryr C 4-1sr s& ui> 0- o6i�,j)CS ' = 36 rA f20AM' 3 G `1 Z4 ' ) C ,M�gP-J-�Dt-5",K,L S►�` 1� Nature of Repairs or Alterations(Answer when applicable) Al A 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 nvironmental Code and not to place the system in operation until a Certifi- cate of Compliance;has been is ed by this Bo of Health. Signed Date 2 h Application Approved by Date -ZE✓-.�9 ; Application Disapproved for the following reasons Permit No. Date Issued ———— —————————————————————— --------- THE COMMONWEALTH OF MASSACHUSETTS`-/ BARNSTABLE, MASSACHUSETTS Certificate of (Compliance t� THIS IS TO CERTIFY}}that the On-site Sewage Disposal System Constructed(V Repaired ( )Upgraded( ) Abandoned( )by Ca(•Q Cr v i-J e at 3 8 SO LR<-r c4101,tJ h has been constructed in accordance with the provisio s of Title 5 and the for Disposal System Construction Permit No. -114 dated 2 Installer s 0�— Designer .14�SJ QC. 2 t7_ 4, .f2 4" The issuance of this permit shall.no be construed as a guarantee that the system will function as designed. Date Inspector `� A o - ---- /------------------'---------------- No. �! Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLES MASSACHUSETTS Mi!6pogaf 6 5tem Construction Vermit Permission is hereby granted to Construct( Repair( )Upgrade( )A�b/andon( ) System located at U0 5 .114.y. 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 completed within three years of the date of IN p it. Date: 2 90�"" Approved by r � F 1 own ul Li►r►►slablc I' ;r Department of Health,Safety,and Environmental Services Public Health Division Date 367 Main Street,Hyannis MA 02601 aArrrraTA'nll. ""as -;�_ 6 Tim e>/� © o Fee Pd. a 0 N Date Sclieduied�!A �/ �� -3',1, 1 r, Atli Via.. t\ Soil Suitability Assessment for Sewage>Dcsp,-, L Witnessed By: Performed By: t, 3 p LOCATION & GENE INFORMATIONt ILAOwner's Name Loc Uress (' ' 2 L�� Address -emu `n—A , d z j�3 i 0 3Engineer'sName CAR 5 Z, Assessor's Map/Parcel: 0� I%� ��`-Sq y REPAIR Telephone 0 -S � V NEW CONSTRUCTION A � r. —, ., ( W�1, � o Surface Stones Land.Use, IF Slopes(%) ft 'PossibleN et Area ft. Drinking Water Well ZYD ft -Dlstences from: •Open Water Body w L t 1.i 3,rh„} Z50 I/ ft P�p e; 6D �D Drainage Way erty`L'ine` ft ,' �. lel 1. .7 SKETCH:(S(reet name,dimensions of lot,exact locations of test holes dt perc tests,locate wetlands to proximity to-holes)` L Q ;,:..L r tt i 'kt11 e .... _...�j to , 9 i Parent material(geologic) V v v�+�Z �, Depth to Bedrock Depth to Groundwater: Standing Water in Hole: o Weeping from Pit Face O Estimated Seasonal High Groundwater . ............. .... ...................... DETERMINATION FOIL SEASONAL NIOKWATEIt TABL Method Used: in, De th to soil mottles: In. Depth Observed standing in obs.hole: p ft Depth to weeping from side of obs.hole: in. Groundwater Adjustment Index Well#_ •Reading Date: Index Well ievei._.___ Adj.lacior Adj.f'r�n'w^4'r L••_! __ PERCOLATION TEST ':Det `d�g Observation , Time at 9" Hole# 1 r� Depth of Perc S S' Time at 6", Time(9",6") Start Pre-soak Time Q End Pre-soak Rate Min Anch 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 r � dole 1)I�,CI' OIZ5LItVATIO CN ....1IOL LOG sail :ut(,)e Soil'Icxlure Soil ColorI)cpllt rrnm Soil I lorizon (Munsell) Mottling (Stru Stones.touldercs. (USDA) on Surface(in.) /C- rr GCS /6 R 3 �� �N�SAND 0 5 l)_ (� (j LGd9L 026R� D, ^flc PLao"r Sr Uc� A� R s s�rwv��onr+� A 2 zo� w 0'^7N� sE ID 2 6 4 �Mh4t, ST0�1� �'��t" 12ot C �totZttot� I4o1e#.. UCEI' OI3SCI2VA'1'ION IIOL LOG son other Soil Texture Soil Color Mottling (Structure,Stones,Douldercs. Depth from soil I lorizon (USDA) (Munsell) Surface(in.) r, le—S lb 2 3 4 l�onl� Fi�tf s�ND o b„, 8" d h�o 2. 0""I r✓S flco r S-r"e 0-,— SArsj% g"-34 A flv"Zbhc SgAjl>Y ID "!2 a CAA _ wAM SHWA-u. s-r,005E hLve,ua ao yjuE SAS ra : Ito le# bl"Jrlt O�sC,RV Soil Texture ATION 110LC LOC Son Soil Color Dcpth from Soil I lorizon (USDA) (Munsell) Mottling (Structure,Stones,Douldercs. Surface(in.) llCEP OI3SCI2VATION HOLE LOG Soil other L(USDA) xture Soil Color I)cptlt from Soil Itorizon (Munsell) Mottling (Strucl ,Slog es,Doulderes. Co en Surface(in.) r • P Above 500 year flood boundary No __ Yes Within 500 year boundary No �% Yes Within 100 year flood boundary No— Yes • l u Does at least four feet of naturally occurring perv �aterial exist in all areas observed throughout the area proposed for the soil absorption system? �-�— I f not,what is the depth of naturally occurring pervious material? c'ertifictt<tI411 1 certify that on .�1 b (date)I have passed the soil evaluator examination ap b proved cons steel with Department of Environmental Pro y tection and that the above analysts was p the rertt�ired traitor= ,expertise and experience described in 310 CMR 15.017. •, j N_ -Ts FLo 0R �E�Lf Ft a EL.765 R �ALLAN ��'ctiG ?8 oF'o� F►N.GR eL-74-o 9� 26101� Y z4 1a- EX iS;r NG GR•EL. `70.0 74 X xx�c J'1 o TE : PEE M 0N/E .ALL 1 MPE 1?�/1CJ_S { � y`w.c. 1�IhT't- P hL S i rN✓.GB2_ 4 K QV l'l D 5 YS T>`m f 7 o wV.. G3 5 GAL_ i / - c,�7, / Sri roe ! C` LARFL-00A, to NrN, S,ccoric c-r•z ,� Tp ,. Op NON• TAr'K idV. 66 v .S. 20 �- 0 e LOW72 SCE-11.� 4' DRDPLT or- DISID0SP\L SYSTI=M ?6 74 1 C E •/,h lS OSA S . . N � S" � L STEM' •ro B Co VC ` i Y . � M ST-t� TEA t N .STR1 C�" 76 A CCOr2DAN GE OF C oM M. of -MAS S. �N v IRO1';. COOS-T � y` I C: CON?OUR 'R. M. TtWU TO Pb. - 05. 3 ® INTER SEC-T. of II06 8EIRRV LN. A.V.-b. RIVF-RR �lAO. - ISZri Z,1�T:UM. t ' 3. SURVE y T no�� PLAN T)T1.ED •` 1306 -BE RRY KNOLL" [DAi 1=D 8 i ll�- )-%T R I. )I-3o-87 RECORDED I- BARN STA6LE-•PLAM SK 444 � 78 TEST PI T s it R Ro- 7-Es f s; y E P6 15. - . , �6 • Z 7c 3 /30 SDG BERRY LN. "MARSTOW CS MILL NSSESSoR MAP '� -Cx1 ]TiNr3— Qg0�i1 °-� 66 +04 ` 0 44 Pc. 30 / 0) 0. OOZ. 1 74 _ 0 RAW `T O_b nnS SIGN CLfh - LoA i rr --6T .9CAL E: I" 4�J 4 S ANON L \y SINGLE FAiAl l-Y DWELLING W 3 REDRooM S ' �`3 5 - c rss-r��� tr o'Aty\ No &AV,'BAGE 1)ES-CS1k1. /�A1L�j FL a W � / 1 a X 3 = 33 o G. P, t�. ?- 1$- 1�f � - � 5E Wln6E lJISPOSAt SYSTEM DESIGNN? OF Fa R SE PS I C 7AriK (\/ 0— RScq-11�,� GALS HARRY _ _ 330 G, P, i-1_ X 'd.S = GAO " g N _ L/�R� \ SI-1ELFt RS. I IVC . vv {r. D�L� CRUWl�EF2 ) SOO GAL . � �`� � l � . h • AN RY, N\vfl• i — <01.0 a FO_F3GTL IS97 a C A? S E p�No. 57 i J . TALMCIVTI-1 I�1A OZ55G LEACHING .,r� � MBER S s� ►� 6)� 03 2 - s 'xS'xZ' W, c&INsl ,c_ + 4 STorlE ONA ' i ' I LOB"3 / 30 f30G C3ERR`e U) /\ SSL- SSDR MAY [� 4Pc - U10-00Z E 1 r= E CTIVc- Z>E PT:', = 2 .O ® j M 1�PS►DNS M 1tL5 1 M A._ � I i 3x A SSOQ* TECH- -SERVICES 'i- �T�L CAP�e >T`/ 34-! GAL DNSv_T Z7NGrR E.SN-M,) � • TESnv; 2-�0-�8 i DATE' 2- 1 5�- !�06 Dv4G. t 18Z 3 Fm FLo -78 �a EL.Z65 � t OF R�sr z6 �6. ALLAN EA GR,EL. -70.0 I X k x 26101 ' t1`^oV t �2 xxn 17 : RE MOVE- I\LL IMQEt2�/tUJ-S �� I y" eo P>/c. ����s -�� �2 4 K oU t-1 D 5 Y,5 T.L tM /.6T,o 7o //YV. 5 I GA t _ I 68 CcLLaRF�oor� In utN. I�'CC1 rN-c1.Z �`� -� ��" T"'r 4,2 1 nc' EL. GB.o SE irG ldY. 66u ® ' \ �� 66 2o.1H I N, O 72 J / SST" L Z L _ �3 J-?oR7-_ t = 101 ` --- -- VErr. PP ( 1nLE o� D1SI� OSAL SY5TEM �6 ' o E LSFoS-nL SYS'r"EM• To B CorIsr-VVCTED tN STRtcT - .4 ccoaD N CE o C o M_ o -1`�1 A S S. N �/ I R O h. pO E-TI T -� � 1 C. CO7JZOUR 13. M. 1:2bm 7-tWN TO PC) . - Co5. 3 Q INTER SECT. of EDG ' BERRY LN. Av RIVF-RRL�Y�.D - 19Z� Dl�.TUM. 4r f PL/-\N TITLED ` i30C� BE RRY I�NOLL:' UAT tD j T8 Its- 1-�7; REV. 11-30-87 l7� CORDED � BAC�ZN STA6LE-•PLA}J gK 444 � -Z - i ��$ TEST Pt rs � PLRC T-6sf T6 I ' I?6 15. T6 7g �Z ?0 3 66 6 e+.LoT /3 o 0 BDG BERRY LN. MARSTWS MILL f�SS� SSc�R Ml\P , -ExIZrINa 4 0 44 Pr. 30 / Ol 0, 00Z. 74 0 RAbL j - -73. a— ;— I — 7 O_0 �t+�NIC-5, 14DYQSZ SIGN ' z�.o ; 0 CA L E: Sl NGLE FAIAI LY DWEL III G W/ 3 GiEDR oo i� S ��3.5 S ANmY tY\y L C 9c T a 7.J L SE W[-\6E Dt 5 P0%S S`�S 1 E M DES1G1�' /DPAIL`Y FL aW = / 1 0 X 3 33o G: RD. , I I - t M i FO 1Z S1= PS 1C 'F�1N►� (�/ C`. R .GZD,� ��``P�c ,oi.)�`rti�: I 3 3 0 HARRY yG\ L/�R \ 1-i L 11= }� EARL ��" Mtn. - DALF CROWI�ER A1`1Y, - 0 . 1{- I LA N � I- s i vA sE - 6�.o i P_o_F3� i5� C ,J . f ALMUT , 0 ?� ' FTSE ` LDT3 / 3D BC)G �E�I��' DJJS � 2 - 5 'xg'xZ ' vl� c iti � 1 = � STbrJE A i � _ i /\ 5Sti SSUSR "N - t�44-Pc . 010.00�- ; r >-t= F C T I V 1P' - 2 .0 ' M IX►TI;' N� 1\/11LL5 � f� A_ 0 0 _ I 3x 24 x o �. 4 - � 31 I I � ASS OCR �CN_ •SRVICES f G3.0-- — � 7.51 T E i -(- yT�� CA�f^,C TESTL-v: c-lo „` Cor.� su'- .�NGR E.\3N-ic_� Mx CA E- c- t li�- �% DV4 2185