HomeMy WebLinkAbout0067 CHOPTEAGUE LANE - Health 67 Chopteague Lane
Marstons Mills
A= 012 -009
4
TOWN OF BARNSTABLE
6
LOCATION /-q7 dhgpdcg6 auc LA.) SEWAGE # a609 - /89
x4- .
V1rLLAGE Mcirsions rn:)1S ASSESSOR'S MAP & LOT 9
INSTALLER'S'NAMt&PHONE NO. ExCAVA-Uon> ,T08- y`7?- OLS3
SEPTIC TANK CAPACITY /000 !RwJ
LEACHING FACILITY: (type) Sop SS) Ctiam (size) /3 x a5/ x a,
NO. OF BEDROOMS 3
BUILDER OR OWNER -Dcn►sc. Ruolcr
PERMITDATE: G-0S-O 9 COMPLIANCE DATE: G -04 - O 9
Separation Distance Between the:
Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet
Private Water Supply*ell 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
Ai-12•
B�-TT
137-
A3-SS
Rcar.Aac.)1;ng 133 �
Ay-s�%L
• � � DELK Q ,
A Bq.80 �.
AS '2
i I35'g�
�t r
No. Fee
Entered in co uter:
THE COMMONWEALTH OF MASSACHUSETTS p
PUBLIC
HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS
21ppliLation for Mispo8AY Opstem Construction permit
Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components
Location Address or Lot No. G-7 Cf-jj pf-M�pV�(n. Owner's Name,Address,and Tel.No. �g'y zo-0433
�1 Assessor's Map/Parcel Morr til r Den�2.I ale,(
�r�I a �} C,..rLe.f �'I' b
Installer's Name,Address,and Tel.No. .50�' 477-D&53 Designer's Name,Address,and Tel.No. SOfs-$33 -zl-1 7
fZobe,PT(niu:-oy- -410 �1L15Dt7
eQ rc c�t-a. �05t SLi ILh,
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) 33 d gpd Design flow provided gpd
Plan Date 6, 2Z Number of sheets f Revision Date
Title
Size of Septic Tank I D O C) 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 if Health.
ed Date to 1141
Application Approved by 4,A U Date
Application Disapproved by Date
for the following reasons
Permit No. o � � ej Date Issued Z o e1
-- - _--------.�.-------
•^'"'.- �r r .; �l'1.}uYIA*n'wr--w..n+'.r'W"T
4 j
No. "/ — M Fee /60 '' f
.r THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: !
Ijes''
PUBLIC HEALTH DIVISION-TOWN OF BARNSTABLE, MASSACHUSETTS
2pplitation for Misposar 6pstrm Construction Permit
Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components
t :
Location Address or Lot No. 6-7 C h(sp f eCi o u t L n• Owner's Name,Address,and Tel.No. ,�� `I�4, t�`r;53
MUrrril e �t'ilr. C.R cie,f
Assessor's Map/Parcel Gt O I a l?rL r, c CI -„ rA r-f r Cu
Installer's Name,Address,and Tel.No. 5 L_k r t 7 7- UL 5 Designer's Name,Address,and Tel.No. -5( i 17
6( P_) E.X1/(VC1hLi'1 _Mvii)^1U1t!`�G141 r
I�l lFKIi-)r=Ir _r" r Ie' G< LC
Type of Building:
Dwelling No`.of Bedrooms S Lot Size sq.ft. Garbage Grinder( )
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow(min.required) 33 0 gpd Design flow provided l gpd r Ni
Plan Date U J ZZ L�] Number of sheets I Revision Date (,// / f
Title
CU U U Type of S.A.S.
Size of Septic Tank yp �
Description of Soil r i
Nature of Repairs or Alterations(Answer when applicable)
Date last inspected: tl
r
Agreement:
The undersigned agrees to ensure the construction and maim nance of the afore described on-site sewage disposal system in
accordance with the provisions of Title 5 of the Environmental Codeand not to place the system in operation until a Certificate of
Compliance has been issued by this Board of Health. 1
IN7
' ed l ✓� -�- V-� / ,.. r. Date ,1 fzq L c7
Application Approved by &.� r Date 6
Application Disapproved by Date
for the following reasons
Permit No. CK)"7 — lh Date Issued (1�1 f u
THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE,MASSACHUSETTS
Certificate of Compliance
THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired(1/�J Upgraded( )
Abandoned( )by
at\ (r.1 h/)n f'(I ri i t n i 1-•0- has been constructed in accordance
withthe provisions of Title 5 and the for Disposal System Construction Permit No. ���p 1 dated
Installer tt��-i r--.f 1 67 1 I t'/i 1 Designer (�V I (� C! 5 L )t
_ 7 pP g �� gpd
#bedrooms •� �l Approved design flow �
The issuance of this penNit shall not be construed as a guarantee that the system will fimction asrdesigne&
Date f �� '].�,p f`l�� Inspector
No. QtA — I� I Fee
`� THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION'-BARNSTABLE,MASSACHUSETTS
Misposal Opstem (Construction i3ermit
Permission is hereby granted to Construct( ) Repair(I-) Upgrade( ) Abandon
l r
( )
System located at ( -7 ! 1 VA--)- ��'el i L Q,_, I /
t '
and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with
Title 5 and the following local provisions or special conditions.
r
Provided:Construction must be completed within three years of the date of this permit. / �
Date J Approved by ICI
/ / ( ( Vtf1U1Q � ��+he 1/oe G l
N/ t ,� r �
A f
' Town of Barus6ble`
.1 E.T. ..
y Regulatory Services
Thomas F. Geiler,Director
• iA1INS3'AiBE:E. s
9�
i a Public Health Division 6�9. `�4'
Thomas McKean,Director
200 Main Street,Hyannis,MA 02601
Office:.508-862-4644 Fax: 508-790-6304
Installer & Designer Certification Form
Date: G-04 -69
Designer: pBC C. NViB&Y7EA✓-rAL Installer: t3�.j3 xcayai�on
Address: . EAs-r _yAN-Dc✓3ck Address:
re)A fores4 d o -,_ rn�_
On_Z, dS-o9 !3 i R. ExeayaI LDA was issued a permit to install a
(date) (installer)
septic system at L,7 CJ�oP-!ea9u a based on a design drawn Ly
(address)
-!)Be- 'CM'y2RomEiv-rAL dated G -,pa-o 9
(designer)
✓. 1-certify that the septic system referenced above was installed substantially according"to
r"I.he design, which may include minor approved changes such as laterla .relocation of the
;tr'ibution box and/or septic tank-
. �.
I certify`-.that the septic system referenced above was insta ied with''uYayoic:changes
greater t} n'10' lateral reloeatio�s of the SAS or any vertical'reioca#ian o£any component
of the Sept; system)but in accordance with State&Locat Regulations. Plan revision o�
certified as-birgii y designer t&follow.
(Installer's tore) l4i50N - m
sgNITAR�P�,
(D er s Signature} (Affix' gner's$taiip Here)
PLEASE RETURN TO BARNS I'ABLF PiTBLIC HEALTH DIVISION: 'U .RTMC TE
OE.. COWLIANCE WiI.L''NO�'.�E': SSUED- TT1—L BOTH°,:T'H[S AND
3F'QR1VM
BUILT CARDARE RECEIVED WV:T IE:BAR1. STABLE PUBLIC REALM DIV��I�IY
THANK YOU.
rr i
Q:HealtiVSeptic/Designer Certificafion'Fo 7, i_
Town of Barnstable P# _,.,`.
Department of Regulatory Services
Public Health Division Dote 6 .1 /2COCI
200 Main Street,Hyannis MA 02601
ED M/'t a
Date Scheduled Time Fee Pd.
Soil Suitability Assessm nt for S wage Disposal
Performed By: � r "l � Witnessed By r
LOC TION & GEN E#AL INFORMATION
Location Address (01 6ho 66 /� • Owner's Name
C� Addift
II!�
Assessor's Map/Parcel: L Engineer's Name
NEW CONSTRUCTION REPAIR Telephone#
Land Use f T� 1 Slopes(96) Surface Stories*
Distances from: Open Water Body it f,0 sible Wet Area ft Drinking Water Well ft
Drainage Way -ih Property Line ft Other ft
i
SKETCH:(Street nam,dimensions of lot,exact locations lac irJl+ers tests t are wetlands in arox 'ty to holes)
Parent material(geologic) Depth to Oedrock v�
Dh toA0nxwdwater. Standing Water in Rote: We*ping fkmrt PhlWas
t3stinxncd Seasonal High 4rmnc3undswater
T _a) RMINATION FOR SEASONAL HIGH WATER TABLE
Method used:•;a::_ . .... ......
Depth ng in obs We: _ _itr.:''Depth to loll mbi(t�; in.
" `Depth taweeft from side.of obs.hole: in. Groundwater Adjaettat n! $•
Index Well# Reading Date: Index Well livel y Adj;factor- Adj.Oroundtaiter Level
RC
z # PE$ Oi;AT flN JUG' D*�...�' .�.._
Observation
Depth of%c Tdme at8"
S=.Pre-jtlait Tian @
#✓nd Are-soak" ,- - , .
Rate Mirl.lirrcli -
Site Suitability Assessment: Site Passed Site Failed: Additional Testing.Needed(Y/X),
<rigiaaI: Public Health Division Observation Hole Data To Be Completed Qn Back .
pex4a on testis to be conducted within 10 -of wetland,you Must
first notwy the
Barnstable Conservation Division at-least,onc(1)-week prior tolbeginning:
Q:\SEPTKV. ERCMRM.DOC
DEEP OBSERVATION HOLE LOG Hole#
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders.
Consistenc o Grave
li
/-W Ilia
t
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
eel
DEEP OBSERVATION HOLE LOG Hole#
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders.
Consiste Gravel)
DEEP OBSERVATION HOLE LOG Hole#
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders.
• C it a
r'1'tlq iq
Flood Insurance Rate Mau:
r6' liar'1 1 17k C :1'
Above 500 year flood boundary No_ Yes
Within 500 year boundary No— Yes
Within 100 year flood boundary No—
Yes
Depth of Naturally Occurring Pervious Material
Does at least four feet of naturally occurring perv' u ial exist.in al areas observed throughout the
area proposed for the soil absorption system? i
If not,what is the dept of naturally occurring pervi us.material? ;s
� . y
Certification s
i J.certify,that on, �® (date)I have passed the soil evaluator examination approved by the 'ZI ;
_.._
Department of EnvirorlImental Protection and that the above anilysii was perfo� -" by"ine"consistent with
SY
the requir`Y ainirig,a rf an e p rience described'in 3:10 CMR 15.01 .
Signatur Date
Q:\SEPTICVBRCFORM.DOC
ASSESSOR'S MAP NO. Z PARCEL OM lo+''
J-0 CAT ION Paysc- (67SEWAGE PERMIT NO. _
p71 F-'A LEI
YiLLAGE
INSTA LLER'S NAME , ADDRESS
0
0�0
BUILDER OR OWNER
DATE PERMIT ISSUED �f�/p�
DATE COMPLIANCE ISSUED
- l
b
a`
Z0r�� I
Fims..
No..... .�.!s .. . �.
THE COMMONWEALTH OF MASSACHUSETTS
BOARD PF HEALTH
...........,O. t .4.............OF........ ... .f 1(Z .. i.i-- ..........................
012-n�j Appliration for Riipvii al Work In trnrtuan omit
Application is hereby made for a Permit to Construct ( or Repair ( ) an Individual Sewage Disposal
System at:
Cv •-----....»- --....- �. ...._. `I � ....... � f� VV.11 1........................
. Location-Address � r Lot No,,,
Ow
/ L__ . c��z��r�`�! . ......--
y
-- ---- .. ............... ? ..L!/&� 1_ - /A f_Jj�'°S. r�—mot /
Installer Address
Type of Building Size Lot. $.01�.......Sq. feet
U Dwelling—No. of Bedrooms........... ..............................Expansion Attic ( ) Garbage Grinder ( )
j
Other—Type of Building ____________________________ No. of persons............................ Showers ( ) — Cafeteria ( )
dOther fixtures -------------------------------- .
W Design Flow.................`�,X.....__.� _....gallons per person per day. Total daily flow.......................;�.3®.......gallons.
WSeptic Tank—Liquid capacity.____._. _gallons Length................ Width................ Diameter................ Depth................
x Disposal Trench—No. .................... Width ....... Total Length........_..._....... Total leaching area_._. _.... sq. ft.
Seepage Pit No........ _ . _............ iameter......._ ...... Depth below inlet...... Total leaching area_ ..sq. ft.
Z Other Distribution box (o Dosing tank ( )
~' Percolation Test Results Performed b .. .K/4 .44........._-•---&j -
04 Test Pit No. 1.... '-.minutes per inch Depth of Test Pit.................... Depth to ground water........................
Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
O Description of Soil.......... A
...........
x
U --•------------•--•-•••---•---------------•--------------------..._................--------.................----•--------------------------•--•......---•-•------------....---•------------.....--..--•-
W -----•-------------------------------------•------•••----•-•-----------•------------------------•---------------------------------•---••-----------------------••-------------------••••.......----_....
UNature 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 TLl'i i, 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 boa of
Signe . ............ -
Date
ApplicationApproved BY ,i� ------------------•--•--------•--------•------•.-•--•-•--•--•------- .....................y--........
Date
Application Disapproved for the following reasons:-------•------------------------------------•---•-------------•-------------•--•----------------------........
....-----•------------------••----...------------------------.....---•-----•----•-------•---------.....----------------------------------------------•-•--••---•-•---------------------•--•-------------
Date
Permit No. f /•----- to�� --........ Issued---•------••-------•-•---...-•--••------•--
...
Date
No
................. Ficz
THE COMMONWEALTH OF MASSACHUSETTS
BOARD ,-,OF HEALTH
................................................................................... ----- .............OF........ 17;7-^�!,:��-
ontitrurtion for Disposal Wor
Application is hereby made for a Permit to Construct or Repair an Individual Sewage Disposal
System at:
..VLp_ �11.4�', -:�_4.......................................... ........1.9................................................... ................ ....... ..........
Location Address Lot N
.................. ........
-------------. . ......
er�, 11
..... ---- ...... ............... ............ .................
Installer
lio.,taller Address.7
Type of Building Size ........Sq. feet
Dwelling—No. of Bedrooms........... ............................Expansion Attic Garbage Grinder
Other—Type of Building ........................... No. of persons............................ Showers — Cafeteria
Otherfixtures ------------_---------------- .....................................................................................T;��..........................
Design Flow............
....... ....... ....gallons per person per day. Total daily flow._.__................_I-.22........gallons.
V4 Septic Tank—Liquid capacityl-------
W gallons Length................ Width._____.......... Diameter---------------- Depth...._........__.
Disposal Trench—No. .................... Width.,,,:.-.__.:......... Total Length...... Total leaching area... sq ft.
�4ol . . ----------- *
Seepage Pit No______i------------- Diameter........ Depth below inlet...... Total leaching area...2,!9.--:#1.sq. ft.
Z Other Distribution box (� Dosing tank
rPfs
.................Percolation Test Results Performed by....._A. ............. Date..........................------------
Test Pit No. 1.... minutes per inch Depth of Test Pit.................... Depth to ground water.__..........._.._.._...
44 Test Pit No. 2................minutes per inch Depth of Test Pit._............._._.. Depth to ground water..__._..........._.._....
P4 ----------------------1.............. ...
;�------------------?-------------------------------------------------------------------------------
0 f
Descriptionof Soil............I'M ......ko............... ......... ............................................................
U ........................................................................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 T I T ILj 5 of the State Sanitary Code—The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has been iss d by the boa pd of,�h.
............. ......!0.
Sig neck-
•
ApplicationApproved By........ .................................................................................... ........................................
Date
Application Disapproved for the following reasons:..............................................................................................................
---------- -------------
Date
Permit No1 .-
......n .............................. Issued_.......................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
..........................................OF................ .....................................................
TrrtifiraU of Tompliattrr
'THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed or #Repaired
by----------------C.IM. ........................................................................................................................................................................
,07 eAo A rz:le. , In2ller /—,#, o9'.e,4 S
at------------------................................................................... ................................................................................................
has been installed in accordance with the provisions of TITLE 5 of The State Sanitary Code as described in the
........r... dated....... ..................
application for Disposal Works'!Construction 2
THE ISSUANCE OF THIS CERTIFICATE -SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTNN SATISFACTORY.
DATE.....
..':` . ... . .................................. Inspectw.-7--7--- _-------------_I---------------------------------------------------
1 4
THE COMMONWEALTK OF MASSACHUSETTS
BOARD OF`` HEALTH
.......................................................................
................... .......OF............
No..... FEE........................
Disposal Works TO.Witstriulion rrutit
Pi
Permission is hereby granted.......................................................... (YI-yi-
................................................................................
to Construct (X") or Repair an Individual Sewage Disposal System
'2� ...7elf ?-,C 419, e.-1 -
at No.........�441 Z:......�..Z 7------- .. .... Al-exf re"_ ..............................................
VV---------------------------------------------------------------------------
as shown on the application Ifor"Di'gposal Works Con-sir' tion-Permit No..................... Dated.._.__..............................
I
. ............ ...............................................................................
Board of Health
DATE----------------- ...........................
FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS
V/
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LOC.arE.O W/Tf1/iS/ T!�E .CLt�vO[�Q/iV.
,AAMica.vy- �(iJ,ge(C G'• G2ZEl�o2Z�1�45�/
86 ll�r CI /��,-� Tylt Pt.Q�v /S AYoT I94fEO ani Axl
-!/�1EiYT.SU.eI�CYQivO T//E o�FS�T.S
To ESTG/Sy Lo>- G/iVE,S
ASSESSORS MAP_ /z - TEST HOLE LOGS
_ w'4" PARCEL: 9 NOTES:Aev'�.� FLOOD ZONE: SO I L EVALUATOR : ,I)AYI9 72 . tl-145j,�fi
W I TNES S : I'a"o T--.;. 1m L.-rT�� , >2 `� 1) The installation shall comply with Title V and Town of Barnstable Board of
c�'�. �• REFERENCE: CEA2"7 =1EZ> ;:��-d7- 7:L Al L,� DATE : =-UL'i E 2 1 2 0 Health Regulations.
v , �� PERCOLAT I ON RATE: L Z M ,
R;-6 ` 8� 2) The installer shall verify the location of utilities, sewer inverts and septic
81 60, W/' components prior to installation and setting base elevations.
TH- 1 TH-2 3) All gravity septic piping to be 4 inch Sch 40 PVC at 1/8 per foot. The first
two fecet out of the d-box to the leaching shall be level.
L � 4) This plan is not to be utilized for property line determination nor any other
purpose other than the proposed system installation.
lib 6 �� (1j b so 5) All septic components must meet Title V specifications.
n - Qjb' t�'' - 6) Parking shall not be constructed over H10 septic components.
LOCATION MAP(4,T,S). 7) The property is bounded by property corners and property lines.
5'�'� S�1D 8) The property owner shall review design considerations to approve of total
Ito.
design flow and number of bedrooms to be considered for design. Receipt
G �V 5 of payment for the plan and installation based on the plan shall be deemed
�!) q 3'QD - - ------- - p -1 approval of the design flow by the owner.
�.. — ►e'Mi►1, 9) The existing leaching or cesspools shall be pumped and filled with material
�0 per Title V abandonment procedures. Those within the proposed SAS shall
J
OL N0 ,9 tx7 Np 4RAD W14 be removed along with contaminated soil and replaced with clean sand per
�Fk Title V specs.
nO
e) `(_.'' �' 1 10)System components to be 10 feet from water line. Sewer lines crossing the
M d. water line shall be sleeved with 4 inch SCH 40 PVC with ends grouted if
SEPTIC SYSTEM DESIGN applicable. The proposed SAS is being installed below the water service
N , line. The line is to be sleeved as aforementioned and maintained in place.
N. FLOW ESTIMATE 11) If a garbage grinder exists it is to be removed and is the responsibility of the
19 �x►y'(i►{� v / 0 ( _ owner to ensure such.
The installer is to take caution m excavation around the gas line.
3 gDeM BEDROOMS AT I ( GAL/DAY/BEDROOM - GAL/DAY -� � ._ -_-__ - — - 1,
Sri b 13)The install er shall verify the location, quantity and elevation of the sewer
lines exiting prior to the installation.
b the dwelling P •
i 33D GAI./DAY x 2 DAYS kD GAL
USEI OL) GALLON SEPTIC TANK EK IrJ
SOIL ABSORPTION SYSTEM
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