HomeMy WebLinkAbout0030 CINDY LANE - Health 30 Cindy Lane
Barnstable
A = 317006
TOWN of BARNsTAsiE
LOCATION 3 O Cl//4 0-`/ ,till AJG SEWAGE # 00$-- 6 ®J
VILLAGE ASSESSOR'S MAP & LOT 317- CV 4,
INSTALLER'S NAME&PHONE NO. JichT�Ei 4Z'i9c. 'R10401!?&YWt'yy/1/y N s k)
SEPTIC TANK CAPACITY
LEACHING FACILITY: (type) "l�?�b' /uF l��'RA`t��S (size) f ��
NO. OF BEDROOMS
BUILDER OR OWNER ` W1t * CeV
PERMITDATE:1 I -3O— O S' COMPLIANCE DATE:
Separation Distance Between the: ,:I�e-e PXT4 S
Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet
Private Water Supply Well and Leaching Facility (If any wells exist
on site or within 200 feet of leaching facility) II1 R Feet
Edge of Wetland and Leaching Facility (If any wetlands exist
within 300 feet of leaching facility) co Feet
Furnished by 04 --,o• -,
B3= a3'
7
No.. b T r Fee „
THE COMMONWEALTH OF MASSACHUSETTS
Entered in computer:
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes
Application for IN 4
6pztem Cow6tructiou Permit
Application for a Permit to Construct( ) Repair Upgrade( ) Abandon( ) KComplete System ❑Individual Components
L Address or Lot No-3 0 C 1 N Y �A W F Owner's.Name,Address,and Tel.No.
1
M �"j91347C V)LLA6-t D16,jr C ¢,[os
Assessor's Map/Parcel #3 / AizcEI-` 0�� UZ'za�Cls 9_ c�c�Z 6
L MC, Q /
Installer's Name,Address„and e. o. O 3 3 rA 4 00 Designer's Name,Address and Tel.No.
5301t1fe5 'f>leAvklriNG- DhvlU 3. /0,690/V;1 ,S.
.Sly (,0Ic0 A-OasG3 >p SANA o 5- 7 '9 . 3-RI7
Type of Building:
Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder
Other Type of Building A F51D awe F No.of Persons ��___, _ Showers( ) ) Cafeteria(Tl
Other Fixtures l/
Design Flow(min.required) //0 — 3 30 gpd Design flow provided 9T gpd
Plan Date 2-26j Number of sheets Revision Date
Title __$ g—F S WA& PZA^I
� apt f
Size of Septic Tank 6-,4L46 _TypeofS.A.S.
Description of Soil S r-e a C4 e-d 5P,/a,,7 ;Da�Yd 7 02 6 ^O,s—
Nature of Repairs or Alterations(Answer when applicable) _T 16TALL CX> L e OyO 6 FP-T7 G
CA W 1 )�/l S
a p Olt 1+ c o ��c, i`cc wvvwoQ 5A5 7rr
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 Env* nmental Code and not to place the system in operation until a Certificate of
Compliance has been issued by Hea
C
Sign Date 12 s O- O
Application Approved by LIZ> Date o,s;
Application Disapproved by: Date
for the following reasons
Permit No. L�b,S- r0( Date Issued ((-30.-US_
No. U t b` .p Fee
! Eniered in computer:
THE COMMONWEALTH OF MASSACHUSETTS _
' PUBLIC HEALTH DIVISION - TOWN OF- BARNSTABLE, MASSACHUSETTS Yes
ZlppYtcatiott for Migog *p5tem Cou.gtructton Permit
Application for a Permit to Construct Re air U rade Abandon
y PP O P ( Pg ( ) O Complete System ❑Individual Components
Location Address or Lot No.3 O C 1 N b y �_ E Owner's Name,Address,and Tel.No.
2AMS'TjA734F L/)LLAC-F �4 00 /Gnr �oS
Assessor's 3 7 AW-V 4
= fi
`� to5uzzu�r�s � SG— 54z 6
Installer's Name,Address,and Tel.No. $ 3 3-a 4(z Designer's Name,Address and Tel.No.
3�tcK fiS ��1��}Vk1"iNd-- 7)Ar//O 3, /Nl4-<d )l R,5,
OaS37 'R33-d/ 7
Type=of Building: m
!' --Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder
'Other Type of Building ,� e3'/'0 46 (yc y No.of Persons Showers( J ) Cafeteria_
„ Other Fixtures
Design Flow(min.required) Z/0 - 3 3 D gpd Design flow provided !S' /�� gpd
Plan Date, '��-a ,(� Number of sheets_� Revision Date .
Title 5,rl--- Ayzv- S,FGuAG r P1/4/\/
Size of Septic Tank S� �j-/v`LO Type of S.A.S. ,{19/c�7i2g 0,75-
Description of Soil $el' a7 4 c4 rI/ 216,95 1 1,-d 7 a 6 -O 5—
Nature of Repairs or Alterations(Answer when applicable) *'�NI ITA L L. CX:> 6-/7 L 6F
-1- r _3:� 51A L t 16-6 C• P G ►`r Y S _
- c IU4 NIr h rt `�iC� S `Gt u ov�� 5A /qrr
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 Envir nmental Code and not to place the system in operation until a Certificate of
Compliance has been issued by Hea
Sign "UlDate /Z
Application Approved by _Crl hA.4 - Date /
Application Disapproved by: Date
for the following reasons
Permit No. s��Ja - �0( 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 Fes'r L M c•PA ["A
at—2� „�4'3 z;,f^tj* has been constructed in accordance
with the provisions of Title 5 and the for Disposal System Construction Permit No. U(I 4 0 1 dated /(_,30—c).S.
Installer Designer
#bedrooms Approved design flow 2 2 Q gpd
The issuance_ of this permit shall not be construed as a guarantee that the system will uncogn�s des' ned.
Date 4 7 /)h/r�l Inspector
--- - �Ui).�_ - Fee D------------------------- — ----
THE COMMONWEALTH OF MASSACHUSETTS'
PUBLIC HEALTH DIVISION e—BARNSTABLE, MASSACHUSETTS
=tgpo!5a1 ,pgtertY Cow6tructton,permit
Permission is hereby granted to Construct ( ) Repair (x) Upgrade ( ) Abandon ( )
System located at _30 r r nCf�
•
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 must be completed within three years of the date of t ' �pejA
Date �� d Approved by ,c.
I S�n� 0cJ( �� l 1�-i�jr�C)PYV )
1
Town of Aarnstable .
• ptWET. . Regulatory SeI'V1CeS
Thomas F. Geiler,Director
BARNs1hEFLE. =
Mass. Public Health Division
t6S.9. �0
TEo. A ° Thomas McKean,Director
200 Main Street,Hyannis,MA 02601
Office: 508-862-4644 Fax: 508-790-6304
Installer& Designer Certification Form
Date: �G . I!°
Designer: _DqAJ I D • A�S� Installer: /WVp—Y-F, ey(Ay�
Address: -A 6L04leJz Address: �L1 � ,—,
E, 6.4_1 IDW 16H Al bZ52-77 �� �
On V"C� WW was issued a permit to install a
(date) (installer)
septic"system at Jalsed on a design drawn by
(a dress) 7
Ik111 6 , M A-S o O� dated 7 /Zo /
(designer)
I 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& Local Regulations. Plan revision or
certified as-built by designer to follow.
Installer's Signature) 9
M 1
1
� tY
si er's Signature) (Affix Designer's Stamp Here)
PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE
OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOT11 THIS FORM AND AS-
BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION.
THANK YOU.
Q:Health/Septic/Designer Certification Form
THE FOLLOWING
IS/ARE THE BEST
IMAGES FROM POOR
QUALITY ORIGINAL (S)
I A- I
m /��-C&' L
DATA
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1, TOWN OF BARNSTABLE — UNDERGROUND FUEL AND CHEMICAL STORAGE REGISTRATION
C p(,1 l,.E C OU MAP NO. _K,g I J _�PARCEL NO. P;_-F t'I
ADDRESS OF TANK: ckluL, { I VILLAGE: A.R LP
{ NlAm bar �tr��t I -
t1
MAILING ADDRESS ( I F 'D I F'FERENT`FROM ABOVE-),-:---- ? irk Lf
0 3 D
OWNER NAME: ..� Y� �, V ' aA' ' '� PHONEi: ' ' 2—
I NSTALLAT I ON DATE: i `7` BY: c S is c
t Ci
^:STALLER ADDRESS:
n CERT.NO.
.k,f .nr; , `• _ '�� �
*TANK LOCATION .. —u ( � r _" a( f /-roc. c ..✓i.
l (DKOOR I JOK iT'AlV K LOCAT I of 1j` W I TN -RB®F-GCT - T.O Hu I_ LD I Nm)
CAPACITY �U Q .. ._T_YP-E OF ,TANK---`;-:;. —_ —AGE J-4 YRS. FUEL/CHEMICAL = p - Ot(-
TESTING CERTIFICATION [ ] PASSE-[ _V FAIL DATE '
LEAK DETECTION [-A- CHECK"CHECK IF N/A k,TYPE/HRAND�`�•. �`
f , 00
ZONE OF CONTRIBUTION [ ] YES I 'NO DATE TO- BE REMOVED 0'
FIRE DEPT. PERMIT ISSUED [ ] YES [ ] NO DATE'
CONSERVATION [ ] CHECK IF N/A DATE i
BOARD OF HEALTH TAG N0. [ `' ] DATE S /� � / t
* PLEASE PROVIDE A SKETCH SHOWING THE TANK LOCATION ON THE BACK OF THIS CARD
TLAP�\
ASSESSORS MAP: tc3I 7 - -
TEST HOLE LOGS
PARCEL NOTES:
FLOOD ZONE: SOIL EVALUATOR: G 6
WITNESS: "VkG
� REFERENCE:� � DATE: VI, �. �4 � C�� I °T �� installation P
1) The stallataon shall comply with Title V and Town of Barnstable Board of
-ti �1 �� � 1 n
•---� PERCOLAT 10 RATE: L Z M i Healtegu atio s.h R
2) The installer shall verify the location of utilities, sewer inverts and septic
components prior to installation and setting base elevations.
�T
TH- 1 TH-2 3) All gravity septi1
c piping to be 4 inch Sch 40 PVC at 1/8"per foot.
�w Logw► 4) This plan is not to be utilized for property
p perry line determination nor any other !
purpose other than the proposed system installation. I
DANt t.�� 5) All septic components must meet Title V specifications.
APd.5 ab 6) Parking shall not be constructed over H10 septic components.
. Pa Po
7) The property is bounded by property comers and property lines.
LOCATION MAP1� property owner shall review design considerations to
Gc��E�,5�?� 'J # 8) . The ro gn approve of total
7AX 4w4u, design flow and number of bedrooms to be considered for design. Receipt of
t payment for the plan and installation based on the plan shall be deemed
approval of the design flow by the owner.
9) The existingcesspool(s) shall be pumped and filled with material per Title V
abandonment procedures. Those within the proposed SAS shall be removed �ff
along with contaminated soil and replaced with clean washed sand per Title V f
specs.
o yk `3 10)System components to be 10 feet from water line.
-- '' 11) If a garbage grinder exists it is to be removed and the responsibility of the 1
-
- a ,� SEPT I C SYSTEM DESIGN owner to ensure such.
�p 12)Excavate 5 around proposed SAS and below to elevation 38.46/medium sand
/ � FLOW EST I Ir1AATE and replace with clean washed sand per Title V specifications. '
�v � � F`
2
BEDROOMS, AT 10 COAL/DAY/BEDROOM -?J CAL/DAY
SEPTIC TANK
<�
N / t w I ` G. % GAL/DAY: x 2 DAYS - GAL
USE POO GALLON SEPTIC TANK
' 301LABSORPTION SYSTEM
- A `. r
T
ASIDE AREA: 2-�• �3� ��� �LX 0•71 = IZ ,
i \ BOTTOW AREA: X r r
1 SEPTIC SYSTEM SECTION
oe v
\\ — lr:L"V. 100
d VK4au
,
D-BOX
r
_ 851
SEPT I C TANK
VAI�� p�.
rx�
J"Va '..qa oPo6EC? Ohl .
V��I►q�-1UES s
-�- SITE AND SEWAGE PLAN
___ 5`�t'S. --� Uw��-no�I z� -Q �QE; Leo ,b Yaer►+��.
- - LOCATION : a$ 3O Gl t,...1V
�p t�tt,'�D - _uw� t s 't�►e.o���E1�__�k5_ ��.�► ,----- 51�1� 1(I l.1.�4 T�pt
PREPARED FOR : �kG�1�! 'ctv�l4
N f
j At"DLAA4)11 .Mlot
SCALE: 1
DAV I D B . MASON,RS DATE: 7 & oS
_ DBC ENVIRONMENTAL DESIGNS
W EAST SANDWICH . MA
DATE HEALTH AGENT
� :- ( 508) 833-2177