HomeMy WebLinkAbout0070 CINDY LANE - Health 1 Cindy Lane
Barnstable
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` TOWN OF BARNSTABLE °
LOCATION 700 6ng SEWAGE #
VILLAGE C kkn\tAIS U to ASSESSOR'S MAP & LOT
INSTALLER'S NAME&PHONE NO. lraat W*(64 �n�a,�_��,�g� S�� Y a8 Sloag
SEPTIC TANK CAPACITY DSO V I
LEACHING-FAC1LrI'Y: (type) (0' lit Cm` k 4-A C (size) /0 k S-0
NO. OF BEDROOMS xY
BUILDER OR OWNER .CG &.Akio" JQ tcW t
PERMITDATE: COMPLIANCE DATE:
Separation Distance Between the:
Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility N0 Feet
Private Water Supply Well and Leaching Facility (If any wells exist
on site or within 100 feet of leaching facility) No Feet
Edge of Wetland and Leaching Facility (If any wetlands exist NJ
within 300 feet of leaching facility) Feet
Furnished by
1 :$
P
8
1
3 0 " 50 b
Al 13.9 6y.7
3 73•5/
ak.9 c 3 aG:S
r- f y7.9
03 3co.a `'s (�'�
No. —� Fee
y �
THE COMMONWEALTH OF MASSACHUSETTS: Entered in computer:
Yes
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLEd MASSACHUSETTS .
2pphtatton for Migogal *Vztem Zonotruction Vermit
Application for a Permit to Construct( )Repair(Y)Upgrade( )Abandon( ) t5Complete System 0 Individual Components
Location Address or Lot No. Owner's Name,Address and Tel.No.
70 c�NJy crt� C4r11j?b014 K N-4i")s
Assessor's Map/Parcel BAM3rho/r M 3' -70 4%0 A LA+l e
Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No:
�4pl.Wi� ��'t.>(C/P�SCS LL t F �e S..•t vs'!ik¢
G+.. .:1`c NZ& ' �{p2C ,,►,,,....rtti. foil .MA-
Type of Building:
Dwelling' No.of Bedrooms Lot Size 2-0,0 5*41 sq.ft.' Garbage Grinder(
Other Type of Building 5�w7 .raM� No.of Persons Z- Showers( Cafeteria( )
Other Fixtures
Design Flow Y 146 gallons per day. Calculated daily flow.' y y y gallons.
Plan Date .S —2�n Number of sheets 1 Revision Date:
Title 7o C i n aY L,4m e• __
Size of Septic Tank 1 ScD Type of S.A.S. 14-)4 c-p.t t k X" T✓�4bcS
Description of Soil Sea 2)4,.n f 6 X1 50 1,K 110 q
Nature of Repairs or Alterations(Answer when applicable) l�
Date last inspected: M�A� 26o1
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 Certifi-
cate of Compliance has been issued by,94kBoardof Health.
Signed Date
Application Approved by Date ti _2 —0.5—
Application Disapproved for the following reasons
Permit No. 0 Date Issued
6. No Fee
Entered in computer:
- THE.COMMONWEALTH OF MASSACHUSE'T(TS. ;
j 4 '-, : + , Yes 1
PUBLIC HEALTH bfViMN - TOW.W00 BARNSTABLE., MA,SSACHUSETTS
Application for Miopogaf *p.5tem Co*aruction 'vermit
4' 1
Application for a Permit to Construct( . )Repair( %�.Vpgrade( )Abandon_( ) EMomplete System El Individual Components
Location Address or Lot No. Owner's Name,Address and Tel.No.
�:.r Yi 7� G '�dY LA,�u C'Lid.�Iv(l�.aic /v�c1+o> � y
Assessor'sMap/Parcel ,�jG1r.�SrAy/o Mh —7o c;.roly 14rre,
Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No.
o. f 4
r'�r �1& - �foz..E . ��,. „0t Po,c- M 07(_7r 362_S13
Type of Building:
Dwelling No.of Bedrooms Lot Size Z—,0 5"( sq.ft. Garbage Grinder( )
Other Type of Building 5i n,1-e ACAt. r No. of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow y`16 gallons per day.'Calculated daily flow y t y gallons.
Plan Date 20 a Number of sheets 1 Revision Date
Title —7 t_i n ati &DO-W e-
"` 1
Size of Septic Tank 1 So D Type of S.A.S. 14 ; c4(11,t IL J:�41 ) T314tot S
Description of Soil
Nature of Repairs or Alterations(Answer when applicable) be$v r_4q
Date last inspected: P4�! ( 20 o�
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 Certifi-
cate ofrCompliance has been issued by this . oard of Health.
Signed Date 15 ?!
Application Approved by Date
Application Disapproved for the following reasons
Permit No. ;Zoo- Date Issued -2
THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE, MASSACHUSETTS
Certificate of Compliance bavd/mf
THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed ( ) Repaired ( *Upgraded( )
Abandoned( )by
at 72 4- A4 G4-Le has been constructed in accordance
with the provisions of Title 5 and the for Disposal System Construction Permit No. ", t Sated_
Installer�,4!!e� �-e L�kr D4) Y, - Designer
The issuance of this perrr4t shal not be construed as a guarantee that the syste �wi4 futacii designed.
Date o Inspector �
No. 14y Fee Joo THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS
lwigozat *p5tem Construction Permit
Permission is hereby granted to Construct( )Repair( p�_(Upgrade( )Abandon( )
System located at 7o Gr ni,&, L E ,,a✓-H
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 permit.
Date:_ .--�— Approved by .7 _�
' 9/16/03
i' Notice: This Form Is To Be Used For the Repair Of Failed
Septic Systems Only
PERCOLATION TEST AND SOIL EVALUATION EXEMPTION FORM
I, 6rz:g p,:�43 H,4A5 ,hereby certify that the engineered plan signed by me
dated 514, a concerning the property located at
16 meets all of the
following criteria:
• This 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. The applicant may use historical data to conclude this fact or may conduct deep
test holes and percolation tests at the site without a health agent present.
• There is no increase in flow and/or change in use proposed .
• There are no variances requested or needed.
• The bottom of the proposed leaching facility will be located no less than five feet above the
maximum adjusted groundwater table elevation. [Adjust the groundwater table using the'
Frimptor method when applicable]
Please complete the following:
A) Top of Ground Surface Elevation(using GIS information) qv.
B) G.W. Elevation +adjustment for high G.W.}'/A = i
DIFFERENCE BETWEEN A and B 2
SIGNED :
DATE:
NOTICE
Based upon the above information; a repair permit will be issued for bedrooms
maximum.. No additional bedrooms are authorized in the future without engineered septic system
plans.
gASeptic\percexemp.doc
06/16/2005 08:12 5083628506 EAGLE SURVEYING INC PAGE 02
Town of Aarnstable`
II Regu laOry Services
Thomas F.Geiler,Director
-public E[eaith Division
Thomas McKean,Director
200 Main Street,HyanWs,MA 02601
p5ce: 508-862-4644 Fax: 508-790-6304
Installer&Designer Certffication Form
Date:
Designer: "��
G Y�ustaller: �cvf C
Address: Q s 3 A6V71E"' A Address: p.C). 6141,K.-
kl/VIA was issued A peirmit to install.a
(dote (ins cr)
septic system,at 10 C4vrsj i_Aw�e_� wy� 'h�( � based an a design drawn by
(address)
dated t: a S
(destgnar z. '
J//1 eeoify that-the septic system referenced above was instaw substantially according.to
a relocation of the
ch may include or roved changes such as lateral the design, wht y unn approved g
dist6.bution box and/or septic tarok.
1 certify that the septic system referenced above was installed with major changes (Le.
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. Flan revision or
cerd ied as-built by designer to follow.
A OF ■.
Cr'S►Slgll ,
esigner's Signature) (Affix e6guer's Stamp Here)
PLEASE RETURN TO BARNSTADLE PUBLIC HkALTH D SXON. CERTMCA
OF COMPL ANC)E W LL NOT BE ISSUED UNTIL BD TMS FORM•AND AS-
B'UMT CARD ARE RECEIVED BY THE BARNSTABLE POLLIC HEALTH pjMSION.
' 7`RANXC'Y4Yi.
Q.-1iOdtb/Sapae/DOdPCr Cartiamthm Form
Date: 1,
TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM
NAMEOFBUSINESS: e
BUSINESS LOCATION: 7C7
MAILINGADDRESS: D Mail To:
Board of Health
TELEPHONE NUMBER: 0 _ — �� Town of Barnstable
CONTACT PERSON: P.O. Box 534
EMERGENCY CONTACT TELEPHONE NUMBER: 50d- 3Zfo -(p�S"0 Hyannis, MA 02601
TYPEOFBUSINESS:
Does your firm store any of the toxic or hazardous materials listed below, either for sale or for you own
use? YES NO
This form must be returned to the Board of Health regardless of a yes or no answer. Use the enclosed
envelope for your convenience.
If you answered YES above, please indicate if the materials are stored at a site otherthan your mailing
address:
ADDRESS:
TELEPHONE:
LIST OF TOXIC AND HAZARDOUS MATERIALS
The Board of Health has determined that the following products exhibit toxic or hazardous character-
istics and must be registered regardless of volume. Please estimate the quantity beside the product that
you store. NOTE: LIST IN TOTAL LIQUID VOLUME OR POUNDS.
Quantity Quantity
Antifreeze(forgasoline orcoolant systems) Drain cleaners
NEW USED Cesspool cleaners
Automatic transmission fluid Disinfectants
Engine and radiator flushes Road Salt (Halite)
Hydraulic fluid (including brake fluid) Refrigerants
Motor oils Pesticides
NEW USED (insecticides, herbicides, rodenticides)
Gasoline, Jet Fuel Photochemicals (Fixers)
Diesel fuel, kerosene, #2 heating oil NEW USED
Other petroleum products: grease, Photochemicals (Developer)
lubricants, gear oil NEW USED
Degreasers for engines and metal Printing ink
Degreasers for driveways & garages Wood preservatives (creosote)
Battery acid (electrolyte) Swimming pool chlorine
Rustproofers Lye or caustic soda
Car wash detergents Jewelry cleaners
Car waxes and polishes Leather dyes
Asphalt & roofing tar Fertilizers
2 3�44 Paints, varnishes, stains, dyes PCB's
Lacquer thinners Other chlorinated hydrocarbons,
/L,kn, NEW USED (inc. carbon tetrachloride)
/ Pai & varnish removers, deglossers Any other products with "poison" labels
Paint brush cleaners
(including chloroform, formaldehyde,
Floor& furniture strippers hydrochloric acid, other acids)
Metal polishes
Laundry soil & stain removers Other products not listed which you feel
(including bleach) may be toxic or hazardous (please list):
Spot removers & cleaning fluids
(dry cleaners)
Other cleaning solvents
Bug and tar removers
WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS
i
_
R
ACCESS COVERS MUST BE WITHIN - INSPECTION 9' MlN1MUM,
J N VER T ELEVATIONS : DES I GN C l TER / A GENERAL NOTES
6' OF FINISH GRAD PORT 3' MAXIMUM COVER
102.91 FIRST 2' TO INVERT AT BUILDING: 100.2 DESIGN FLOW:
BE LEVEL MIN 2" OF PEASTONE INVERT IN SEPTIC TANK: �9.Q 4 BEDROOMS AT 110 G.P.D. PER l. THIS PLAN I S FOR THE DESIGN AND CONSTRUCTION
INVERT OUT SEPTIC TANK: 919.65 BEDROOM EQUALS 440 G,P.0. OF THE SEWAGE DISPOSAL SYSTEM ONLY.
4' DIAM PIP INVERT IN DI ST, BOX: �y8-.32
3/4' - I I/2" DIA. 2. VERTICAL DATUM IS ASSUMED. FOR BENCH MARKS
o NO GARBAGE GRINDER
0 99 65 *6o DOUBLE WASHED STONE INVERT OUT DI ST. BOX: 98. I5
GAS 97.3 INVERT IN LEACH CHAMBER: 98. 13 SET. SEE SITE PLAN.
9.9 BAFFLE 98.32 SEPTIC TANK REOUI RED
3 OUTLET 6 HIGH CAPACITY INFIL TRA TOR BOTTOM OF LEACH CHAMBER: 97.�3 440 G.P.D. X 200x - 880 GAL.
3. ALL CONSTRUCTION METHODS AND MATERIALS AND
D-BOX CHAMBERS W/3.5'3 STONE AROUND N
ADJUSTED GROUND WATER: N/A SEPTIC TANK PROVIDED: 1500 GAL. MIN. MAINTENANCE OF THE SEPTIC SYSTEM SHALL
I500 GAL l0'w x 50'1 x IO'd OBSERVED GROUND WATER: NIA " CONFORM TO MASS. D.E.P. TITLE 5 AND LOCAL
SEPTIC TANK 6' CRUSHED STONE OR BOTTOM OF TEST HOLE *3: 91.5 SOIL ABSORPTION SYSTEM REQUIRED: BOARD OF HEALTH REGULATIONS
COMPACTED BASE
DESIGN PERC RATE ! 5 M I N/INCH
PROF l L E : NOT ro SCALE SOIL TEXTURAL CLASS - 1 4. ALL SEPTIC SYSTEM COMPONENTS LOCATED UNDER
EFFLUENT LOADING RATE - 0,74 GPD/SF AREAS SUBJECT TO VEHICULAR TRAFFIC OR GREATER
440 GPD / 0.74 GPD/SF - 595 S.F. REQUIRED THAN 3' 1N DEPTH SHALL BE CAPABLE OF WITH-
STANDING H-20 WHEEL LOADS.
PROVIDED: 6 HIGH CAPACITY INFILTRATOR
S 87*34'OS'E CHAMBERS W/3.5'+ STONE AROUND, A-600 S.F. 5. ALL SEWER PIPE SHALL BE SCHEDULE 40 OR
APPROVED EQUAL.
600 S.F. x 0.74 - 444 GPD
o �
6. SEPTIC TANK AND D-BOX SHALL BE REINFORCED
N 0 �
L O T / 9 SOIL TES T P I T DATA ® PRECAST CONCRETE AND WATERTIGHT. O-BOX SHALL
o `r INDICATES �_ l ND 1 CA TES BE WATER TESTED TO CHECK FOR LEVEL WHEN THERE
2 ` 20, 054t S.F. PERCOLATION OBSERVED 1 S MORE THAN ONE OUTLET.
\ TEST - GROUNDWATER
\ 7. BEFORE CONSTRUCTION CALL 'DIG-SAFE-
.
`\ TP #1 TP * TP .3 1-688-DI6-SAFE AND THE LOCAL WATER DEPT.
HORIZON TEXTURE COLOR HORIZON TEXTURE COLOR HORIZON TEXTURE COLOR FOR LOCATION OF UNDERGROUND UTILITIES.
\� 0 100.6 0' 100.3 0" 100.5
LOAMY IOYR LOAMY IOYR LOAMY IOYR 8° SEPTIC SYSTEM INSTALLER SHALL NOTIFY THE
\\ Q SAND 313 A SAND 3/3 '� SAND 3/3 DESIGN ENGINEER TWO DAYS PRIOR TO CONSTRUCTION
PAVED DR I WWAY GARAGE 15• .......................................... 99.6 8' 99.6 24• 98.5
LOAMY IOYR LOAMY IOYR LOAMY IOYR
OF THE SYSTEM TO ALLOW FOR SCHEDUL ING OF THE
\! D SAND 4f4 B SAND 4/4 SAND 4/4 CONSTRUCTION INSPECTIONS.
40• .......................................... 97.5 22" .......................................... 98.5 48' ..................................... .... 96.5
\\\ mow Y C l MEDIUM IOYR C MEDIUM IOYR C ! MEDIUM IOYR 9• EXISTING SEPTIC SYSTEM TO BE PUMPED DRY AND
SAND AND 6/3 SAND AND 6/3 SAND AND 613 BACKFILLED.
t ` i GRA VEL GRA VEL GRA VEL
/0. ,, ALL ONSUI TABLE MATERIAL (A d B HORIZONS)
N KITCHEN r
` w � ! ENCOUNTERED BELOW THE INVERT OF THE LEACHING
DINING DECK ; I t FACIL I TY TO BE FSOOVED FOR A DISTANCE OF 5'
ROOM // f AROUND AND REPLACED WITH SAND IN ACCORDANCE
BATH ti ,I W I TH TITLE 5.
1500 64LON 96- .......................................... 92.8 84' ._........ 93,j 96' 92.5
SEPTIC TANK
d 1 l CZ COMPACT 2.5Y C2 COMPACT 2.5Y C2 COMPACT 2.5Y 11, THE EXISTING INVERT AT THE DWELLING TO BE
LIVING to t d SILT LOAM 5/4 SILT LOAM 5/4 SILT LOAM 5/4
Roots 1 �l lOB' 9f.8 96" 9I.3 f08' 91 `5 RELOCATED TO THE LOCATION AND ELEVATION SHOWN.
99.r,' ? NO WATER NO WATER NO WATER
� f 3
100.2 .. I o DATE: APR I L 8. 2005
3C i Do.7 t o/` O M
p �\ BM-CORNER BULKHEAD O TEST BY: STEPHEN HAAS
N n EL-102.93
e 00 \\ c EXIST/N N o PERC RATE: C 5 MIN/INCH
N TANK cv
i k .
4
2 ITP*310,
` 99,4
L z
1 1 ExI STI
95.7 ` ;LEA FIELD \�f BEDROOM BEDROOM
\h \
I.y \✓"'
CATCH BASIN � , s � BA�TN
RIM-98.80 I 30
t J ► v.:Box J 15
f TPt2 ;! i 6 HIGH CAPACITY 5
INFILTRATOR CHAMBERS BEDROOM BEDROOM
Yi
W/3.5 STONE AROUND
100.9
S EP TIC` 5 YS TE-M LE E S / OA/
/00,3 1 TPf le
SECOND FLOOR PLAN 70 C I /VO Y L A !VE . "A P 3 / 7 , PA R CEL 8
REMOVAL
i SEE NOTE hD. SA i N'✓ TA L • MA
•
PRE-PA RE-D FOR
'- �'__- LEGEND
rUTEj 6a �--_ d CB CONCRETE BOUND r l R 5 T �,../ P H L..- ! \ / V 0�7 0 L 5
/DH FND _W WATER L I NE
�,}- -L OC 'S �' s 4 HYDRANT S CAL E : / 2 O MAY 0 . 2 O O S
' i- �.y f� .\ n, >��24• -G ! GAS LINE EAGLE SURVEY I N G , 1 NC
RAILROAD •_--- \ 3? 4q'Iy OHW---- OVER HEAD WIRES
LIGHT POST 923 Rou t • 6A
--E- UNDERGROUND ELECTRIC L l NE �_ = Y a r mo u t h p o r t MA . 02675
s + CB/DH F --T-- UNDERGROUND TELEPHONE L INE 5 O$ 3 5 2--8 1 3 2
-CTV- UNDERGROUND CABL EV I S I ON LINE �I,i/ 1 ( 5 0 8 ) 4 3 2 '5 3 3 3
+40.4 SPOT ELEVATION
t i 1 ,,._. 40-_ EXISTING CONTOUR
! _41 00 PROPOSED CONTOUR
LOCUS l A P o to -2Q 4o JOB NO: 05-010 FIELD:CFWIEEK CALC: SAH/CFw CHECK; CFw DRN: SAH