HomeMy WebLinkAbout0069 EMERALD LANE - Health 69 EMERALD LANE, MARS,
A=046.038
' Page:
CERTIFICATE OF ANALYSIS
Barnstable County Health Laboratory
Report Dated: 02/12/1999
Report Prepared For:
Nichols,Wayne E. Order Number: G9901399
Wayne Nichols
69 Emerald Lane
Marstons Mills MA 02648
Laboratory ID#: 9901399-01 - Description: Water-Drinking Water
Sample#: 01399-01 Sampling Location: 69 Emerald Lane Marstons Mills Collected: 02/11/1999
Collected by: W.Nichols Received: 02/11/1999
Routine
ITEM RESULT UNITS MDL MCL Method# Tested
LAB: IC Lab
Nitrate 2.8 mg/L 0.1 10 EPA 300.0 02/11/1999
LAB: Metals
Copper 0.2 mg/L 0.1 1.3 SM 3111B 02/12/1999
Iron <0.1 mg/L 0.1 0.3 SM 3111B 02/12/1999
Sodium 14 mg/L 1.0 20 SM 3111B 02/12/1999
LAB: Microbiology
Total Coliform Absent P/A 0 Absent P/A 02/11/1999
LAB: Physical Chemistry
Conductance 142 umohs/cm 1 EPA 120.1 02/11/1999
pH 7.0 pH-units 0 EPA 150.1 02/11/1999
Approved By
(Lab Director)
z�tzl�
Superior Court House, PO.Bog 427, Barnstable, MA 02630 Ph: 508-362-2511
TOWN OF BARNSTABLE
LOCATION SEWAGE #
VILLAGE = ° ASSESSOR'S MAP&LOT
INSTALLER S NAME&PHONE NO.
SEPTIC TANK.CAPACITY
LEACHING FACELUY: (type) /a/ �j`✓L I"��.(' (size)
NO.OF BEDROOMS
BUILDER OR OWNER
PERMUDATE: COMPLIANCE DATE:
Separation Distance Between the:
Maximum Adjusted Groundwater Table and 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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A 2.22 132.E
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No. 4 Fee
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
Yes
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS
01ppYicatiou for Miooe;al &proem Cottgtruction permit
Application for a Permit to Construct( )Repair( )Upgrade(/Abandon( ) ❑Complete System k 4ndividual Components
Location Address or Lot No. 0 �� Owner's Name,Address and Tel.No.
G
Assessor's Map/Parcel d Il 1� 6`-5 G�(A S
Installer's Name,Address,and Tel.No. 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 2 G
Design Flow gallons per day..Calculated daily flow y -1 gallons.
,.. Plan4 Date Number of sheets Revision Date
Title
Size of Septic Tank Type of S.A.S. /N 4 s �
Description of Soil
Nature of Repairs or Alterations(Answer when applicable) (dJ O Q � C Lr t61
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 E viron 1 Code not to place the system in operation until a Certifi-
cate of Compliance has beeJ y this B o Health.
Signed Date
Application Approved by s Date
Application Disapproved for the fo owing reasons
Permit No. 9 — Date Issued
No. Fee
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
P Yes
PUBLIC HEALTH'DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS
01pprication for Oiwzaf *pgtem Construction Permit
Application for a Permit to Construct( )Repair( )Upgrade(/Abandon( ) ❑Complete System individual Components
Location Address or Lot No. (A �,���` �A Owner's Name,Address and Tel.No.
Assessor's Map/Parcel 6//�
Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No.
"30 ��►�`r' c
Type of Building:
:Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( )
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures 2 (�
Design Flow ��(� gallons per day. Calculated daily flow 349 gallons.
Plan Date Number of sheets Revision Date
Title
Size of Septic Tank Type of S.A.S. gj&Co flG' 7 W
Description of Soil
Nature of Repairs or Alterations(Answer when applicable)
-k4oe 4 :l it a 161—cam` ✓ 0
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 E iron al Code not to place the system in operation until a Certifi-
cate of Compliance has been provisions
y this B o Health. ))
Signed Datz lC,�
Application Approved by C- - Date Z -
Application Disapproved for the fol owing reasons
0
Permit No. 751 r Date Issued
------------------------
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 ice— _ Sj=��o
at 109 L u M,0 L q e;7 m has been constructed in accordance
with the provisions of Title 5 and the for Disposal System Construction Permit No. dated
Installer Designer x
The issuance of this permit shall In
be construed as a guarantee that the sys em3w,11 function as des gned.
Date In 4 Inspector �r ,� IV/i�l
———————————————————————————————————————
No. / Fee SV'�r...
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS
lwigogaf *pgtem Con!truction Permit
Permission is hereby granted to Construct( )Repair( )Upgrade(v<Abandon( )
System located at
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 this e t.
Date: Z / Approved by �� .,
1/6/99
NOTICE: This Form Is To Be Used For the Repair Of Failed
Septic Systems Only. -
CERTIFICATION OF SKETCH AND APPLICATION FOR A DISPOSAL
WORKS CONSTRUCTION PERMIT (WITHOUT DESIGNED PLANS)
hereby certify that the application for disposal works
construction permit signed by me dated p�2—! �7 , concerning the
property located at 1-_/Iq 1cl� Lc—e meets all of the
following criteria:
• The failed system is connected to a residential dwelling only. There are no commercial or business
uses associated with the dwelling.
"The soil is classified as CLASS I and the percolation rate is less than or equal to 5 minutes per inch.
C-There are no wetlands within 100 feet of the proposed septic system
There are no private wells within 150 feet of the proposed septic system
fThere is no increase in flow and/or change in use proposed
t . There are no variances requested or needed.
d • The bottom of the proposed leaching facility will not be located less than five feet above the
maximum adjusted groundwater table elevation. [Adjust the groundwater table using the Frimptor
method when applicable]
• If the S.A.S. will be located with 250 feet of any vegetated wetlands, the bottom of the proposed
leaching facility will not be located less than fourteen(14)feet above the maximum adjusted
groundwater table elevation,
Please complete the following:
A) Top of Ground Surface Elevation(using GIS information) i
B) G.W.Elevation +the MAX.High G.W. Adjustment.
DIFFERENCE BETWEEN A and B
SIGNED : DATE:
[Sketch proposed lan of system on back].
q:health folder:cert
d
/ 70 f
t
TOWN OF BARNSTABLE
LOCATION '�7� -,n� /� b � SEWAGE # (�� -�5
VILLAGE ASSESSOR'S MAP & LOT �-�e�
INSTALLEI&'NAME&PHONE NO. XV IA r,u,),r� S'S g f1 C
SEPTIC TANK CAPACITY / SG'C>
LEACHING FACILITY: (type) /AI�11 �rcf r (size)
NO.OF BEDROOMS
BUILDER OR OWNER
PERMITDATE: COMPLIANCE DATE:
Separation Distance Between the:
Maximum Adjusted Groundwater Table and 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
ITTC/ ZF Z
Z- IEi 1 d
r _1�
_ I
� fi
/0 / �o
LOFCATION
SEWAGE PERMIT NO.
VILLAGE
INSTA LLER'S NAME & ADDRESS
1� HA1
B UKDE R OR OWNER
DATE PERMIT ISSUED
DATE COMPLIANCE ISSUED ��
t '
� 1
6
R.&A� or tib�C2
r
�1
No... Fica.....1. ..............
THE COMMONWEALTH OF MASSACHUSETTS
BOARD F HEALTH
f/.... . .. —--------
.OF.......
. .... ..:...
Appliration -for Uhiposat Works Tonotrnrtion Vamit
Application is hereby'made for a Permit to Construct ( if or Repair ( ) an Individual Sewage Disposal
System at:
4x~ ..�Y .....i 9.,t?/��,z��.....LA11iL
Location.Address or Lot No.
c �� 1,r `�. /t r t L..-•-- 6/Z, '---------------•-••-
Owner Address
.h? --------•-------••----------•..............•....... '�L k............a
Installer Address
d Type of Building c:- /A-P-k Size Lot_99,.._ft.t_t------Sq. feet
V g— _....Expansion Attic ( ) rbage Grinder 0/4)
Dwelling No. of Bedrooms......... ...........................
aOther—Type of Building ---------------------------- No. of persons------------................. Showers ( ) — Cafeteria ( )
a' Other fixtures --------------- --------------- - -
W Design Flow--------------PA------------------------gallons per person per day. Total daily flow-------------- ......................gallons.
WSeptic Tank 4 Liquid capacity.izi-e .-gallons Length-----�i Width_---P..`_... Diameter__-... Depth...f._/.......
x Disposal Trench—No..................... Width-------------------- Total Length-------------------- Total leaching area........:_._.-------sq. ft.
Seepage Pit No.......I............ Diameter...... ............ Depth below inlet......,1____........ Total leaching area._/..Or.'..0--_sq. ft.
Z Other Distribution box ( ) Dosing tank ( ) d� fin,? 7
aPercolation Test Results Performed by...................................................... ................... Date---------------------------------------
Test Pit No. 1----------------minutes per inch Depth of "Pest Pit-------------------- Depth to ground water.._.--_----_--.---.__---
f� Test Pit No. 2................minutes per inch Depth of Test Pit-------------------- Depth to ground water........---__..___-.----
-- ---------------------
Description of Soil--------
r�------------------ (/7J�• J�� '�
V •---•-------•-----••-----------•---•----•-•-----------------
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 Article XI 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.
igne
Date
Application Approved By........ . •-••-•• . -• ••.•. • t�-�l�= 7
ate
Application Disapprove(Lfer the Wlowina reasons___________________________________ _____ __ _----_____-.__ --_.___-y�... �y�•
Date
PermitNo......................................................... Issued........................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
:t
BOARD RF HEALTH
3/.... .........OF......
Appliration -fur Uiipviittl Workii Towitrurtiott Vrrutit
Applicatiodis.hereby'made fora Permit to Construct ( Vf or Repair ( ) an Individual Sewage.-Disposal
System at:
P
/ -Location Address or Lot No.
.............. 1 0-11. �' 7 i!fd 1Y A)I S
_------••-------•---_-----------•---
_ Owner Address
W c
a t� t ......•-------..... •-•------•--•------•.................•------•----- a A F e.................................
Installer Address
UType of Building :1�N Size Lot- r_.- r -_------Sq. feet
Dwelling—No. of Bedrooms..-------3...........................-----Expansion Attic ( ) Garbage Grinder (Alt
a4 Other—Type of Building ---------------------------- No. Of persons---------------------------- Showers ( ) — Cafeteria ( )
dOtt-ter fixtures
W Design Flow--------------5__-........................gallons per person per day. Total daily flow-------------gym a.-_--_-.-.---_---.-gallons.
USeptic T::nk 4 Liquid capacity_/a_0 j_.gallons Length....-.'_ Width------ .-....... Diameter------K�....... Depth... .--....._.
xDisposal Trench—No--------------------- Width........------------ Total Length-------------------- Total leaching area----------__------sq. ft.
Seepage Pit No-------1------------ Diameter......./---:--_.---. Depth below inlet_..._6--____.-_----_ Total leaching ft.
z Other Distribution box ( ) Dosing tank
'� Percolation Test Results Performed by--------- ---------- ----------------------------------------------------- Date--------------------------------------
a
a Test Pit No. 1-----------------minutes per inch Depth of Test Pit-.,--,---_--_.---- Depth to ground water...--_-----.-----------
f� Test Pit No. 2................minutes per inch Depth of Test Pit.---_--.---..-_-_--- Depth to ground water-..--.---_----.--.--....
a' -------
O
Description of Soil-------,--d.,� r-_ . .fix --- --------- ---- ------- ------------------ ------ -------------- -
------------------------- -- t..`-- - -------------------
W r;
UNature of Repairs or Alterations—Answer when applicable!-----------------------------------------------------------------------._.-------------------
y
..................................•----.--_--.... ..---_----.---_--.._...----------...........--..-.--.....-------_----------.----.._-...-_-.._....-.-----•-_.--.------_--------•.--.•-_•---------'--"'
Agreement:
The undersigned agrees to install the aforedescribed Indiy-idiial Sewage Disposal System in accordance with
the provisions of Article XI 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.
g A�.' --- - L .-.-..----•---------•-----------
Daate
Application Approved By-------- ........ ` .----.---- �a<e
Application Disapproved for the following reasons----------------------t'----------------------•------•------•----------•........-•----------•------•-•---------
--•--•-•_•_-•_•-_•__-•-•--••-_-_•--_•-------------------------------------------
....................Fh__-_.._=-------_.-_----------�.�---------------•--- ---------------_ ---------_------------------
PermitNo......................................................... issued............ ........ ...............................
Date
THE COMMONWEALTH OF MAS�SACH;USETT"S
r
BOARD OF HEALTH
t.:.. .........OF............. lr ....
Trrtifiratr >af f�uutlinrr
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed (,--) or Repaired ( )
by...............� : .,t•Y- -�r..................................•-----•-•-----•••----- ...:-..-----------------•----•-------•--•-------•----•---•-•------------------•--••-•---
Installer
` at.... W..!` rr l'>!i_k_-l�. !L{, Z�r !t i d'r , �'-------•---•---•-----------------••-• -•-----•---•----•-----•----•----
has been installed in accordance with th'e provisions of,Ar XI of The State Sanitary Code as described in the
application for Disposal Works Construction Permit No.._ y r'............. dated....$7 fe ...................
THE ISSUANCE OF THIS CERTIFICATE SHALL. NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WI FUN TON ATISFACTORY.
0
DATE------------- ................................. Inspector =-------------_---_---.-....-------.--.
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OP7 HEALTH
...OF........... —---t...............•-----------------..----
No........ FEE f + .....
Permission is hereby granted........... ...... _/ 1'�..::.......------------------------------------------------------------------------
to Construct ( (�`) or Repair ( ) an Individual Sewage Disposal System
at No. -� €� �5 _�a f, 'f' !-{� -A....'--
............... -&A! 44_S----------------
Street
as Shown on_the application for Disposal Works Construction r it No.-_. ...... I...-. ted-- ............
. ......... . �"--i---- -�.............
7 7
DATE...........:.....µy
.................................. Board o IIealth
FORM 1255 HOBBS & WARREN. INC., PUBLISHERS -
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I. HEREBY CERTIFY. THAT THE PLAN OF LAND a' STRUCTURE s
STRUCTURE SHOWN—HEREON—WAS .LOCATED
BY AN ACTUAL FIELD. SURVEY ON ON t rr 1a4 ' r 4r '
1977 AND. CONFORMS TO THE
f �
Z0; NG .,BY—LAW OF.THE TOWN OF : 'r MASSACHUSETy .,IN
r/'
} '' ,.. Lam. � /� �t' / `.+��,• s
REGISTERED LAND SURVEYOR s r +r7'• "" �� r"a s ff"Fkr
t o. SCALELi i1 1977
/ J�
f•C/1��/,' - %� OF
Jf • DATE
r:
s JANEs yG}a CAPE COD SURVEYY CONSULTANT
' WISWELL �I
A .DIVISION OF BOSTON SURVEY CONSULTANTS,IPIC '
r: No.11029 4 , s ;
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