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HomeMy WebLinkAbout4405 MAIN ST./RTE 6A(BARN.) - Health F 4405, MAIN ST., RT.6A, CUMMAQUID A=350-009 ' 5 . . ° f,r c r i4 m o , r ' � i, i e • i ' o�IKE�,1 Town of Barnstable Health Inspector Regulatory Services Office Hours BARNMBLE� • , v �. Richard V. Scali,Director 8:30—9:30 �A .e�q.A,m 3:30—4:30 Public Health Division Thomas McKean,Director 200 Main Street,Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 ACCESSORY AFFORDABLE APARTMENT PROGRAM APPLICANT SEPTIC QUESTIONNAIRE Date: 1. General Information: Property Address: f l -S C t) V Assessor'sMap/Parcel Number: '� � �� Size of Pro erty: v Applicant(s)Name: `_7 Applicant Address: /4 tm St 17,7 E�f)X 1 6 (,/) /mil Zvi A L) Q /V 4 L Home Phone: 5 U161 Email: tfl 2a. How many bedrooms exist at your property now? Z 2b. Are you planning to add any bedrooms? No Yes X If yes, how many? 2c. How many bedrooms total are proposed at this property(including the amnesty.unit)? 2d. Please include a copy of the floor plans for the entire property. Neatly use a straight-edge. Shaw all existing rooms in the home and the proposed amnesty apartment. Provide width measurements of any open.doorways. Label each room clearly. 3. Is the dwelling connected to.public sewer? No A__ Yes If the dwelling;is-connectedi',to.public sewez`skip.guestions.94,through#9:below,: 4. Location of dwelling is INSIDE or OUTSIDE a Saltwater Estuary Protection Zone? 5 . Location of dwelling is INSIDE or OUTSIDE a Zone of Contribution to public supply wells? 6. Is the dwelling connected to an ON-SITE WELL or to PUBLIC WATER? 7. Is a disposal works construction permit on file? YES or NO 8. If yes, how many bedrooms were approved according to this permit? Bedrooms 9. Were any building permits obtained for construction of additional bedrooms? YES or NO 10. Is there an engineered septic system plan on file at the Health Division? YES or NO 1 l. Has the septic system been inspected by a DEP certified inspector within the last two years? YES or NO FOWOFFICE.USE-ONLY, - The.Public Health Division:has no:objection to bedrooms at this,property,. Spectal_Conditio s0 n+ ^ :`3 '��1 '�( rt,� 3 'R 2 lam► Se Signed:. �mw Date 1 . . Jq �J� ^ems K t. %K ro f i i s - 5 . File No.2009-30 1 Page#11 Building Sketch Borrower Client PETER B.&LINDA L.COES Pro,e Address.4055MAIN.STREE7 Cit BARNSTABLE CountyBARNSTABLE State MA Lender CAPE COD FIVE CENTS SAVINGS BANK Zip Code 02630-1730 C.. OATH WORK`SHrQp f CONCRETE �t'�.I \h\)'V� ✓11 PAT19P DET FAD BARN - '', WOOD DECK o SCREEN BEDROOM PORCH - - b BEDROOM LMNG ROOM - FP BATH . DINING ROOM _ 12.0' _ KITCHEN - - zzo• Ske1M by Apm N"' - Comments: ✓ AREA CALCULATIONS. SUMMARY Code bescriptlon LIVING AREA BREAKDOWN Net Size Net Totals Breakdown GLAl First Floor 1082.0 Subtotals 1062.0 First Floor MO x 14.0 140.0 26.o x 27.0 702.0 12.0 x 20.0 240.0 Net LIVABLE Area . (Rounded) 1082 3ltems (Rounded) 1082 Form SKT.BldSkl—"TOTAL for Windows"appraisal software by a la mode,inc.-1-800-ALAMODE TOWN OF BARNSTABLE LOC ON 6 A SEWAGE# VILLAGE R A& S t,4 8Z-e ASSESSOR'S MAP& LOTjaD7©O INSTALLER'S NAME&PHONE NO. 'm A C oA If e -0 Al SEPTIC TANK CAPACITY f A N 4 - lal l' LEACHING FACILITY: (type)3")CG0fd>Cf1.4M i3Pe rs (size) rO O G A L NO.OF BEDROOMS 3 BUILDER OR OWNER PERMITDATE: COMPLIANCE DATE: 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 ��`,., _t� �� _. .r ��� � r N� ��� � � .r°- �,�- 1 O i 3 ` � ��.. d� -(?S ��, / ��� � � � �� S� � � o �,� \ ® '� � <1 °,��°.. � Y � � \ � �:� z� e � _°' � x \ ., ,. . � - 6 . \ \ �\ �' No. �-- Fee 5 0. 0 0 THE COMMONWEALTH OF MASSACHUSETTS V Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS 01pphratton for ]Dtoozal *pgtem Con.5truction Vermtt Application for a Penn it to Construct( )Repair a X)Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Addressor Lot No. 4 4 0 5 R T E 6 A Owner's Name,Address and Tel.No. Cummaquid ,Mass . 02637 R. Pikel Assessor's Map/Parcel tY 6_0 a LI) 4405 R t e 6 A C u m m a q u i d ,Mass 02637 Installer's Name,Address,and Tel.Nos 0 8-7 7 5-3 3 3 8 Desi ner's Name,Address and Tel.No. 5 0 8-7 7 5-3 3 3 8 J.P.Macomber & Son Inc . J. .Macomber & Son Inc . Box 66 Centerville ,Mass . 02632 Box 66 Centerville ,Mass . 02632 Type of Building: Dwelling X)No.of Bedrooms 3 Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow 384 gallons per day. Calculated daily flow 3 x 110=3 3 0 gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank 15 0 0 &B o x Type of S.A.S. 3_1I 2 0-5A 0 8 211 o n Descri tion of Soil C 1 a for 5 ' C 1 tu b e r s p y can coarse from 5 to A no water encountered Nature of Repairs or Alterations(Answer when applicable) 1-15 0 0 gallon tank . 1=D i s t r i b u t i o n box, 3—H2O 500 gallon chambers packed in 4 ' of stone . 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 Certifi- cate of Compliance has been issue by this B d • He th. Signedve Date 3/2/9 9 Application Approved by Date ' Application Disapproved for the following reasons Permit No. Date Issued �� s' _ No�\ -- i Fee 5 0. 0 0 JPNUBLI THE COMMONWEALTH OF MASSACHUSETTS ntered in computer:t Yes C HEALTH DIVISION —TOWN OF BARNSTABLES MASSACHUSETTSoi 2pprication for Zioozal *p5tem Con6truction Permit Application for a Permit to Construct( )Repair g X)Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No.44 05 R T E 6 A Owner's Name,Address and Tel.No. Cummaquid ,Mass. 02637 R. Pikel Assess9r's Map/Parcel t3 �_6 4405 R t e 6 A C u m m a q u i d ,Mass 02637 Installer's Name,Address,and Tel.Nos 0 8—7 7 5—3 3 3 8 Desi ner's Name,Address and Tel.No. 5 0 8—7 7 5—3 3 3 8 J.P.Macomber & Son Inc. J. '.Macomber & Son Inc . Box 66 Centerville ,Mass. 02632 Box 66 Centerville,Mass . 02632 Type of Building: Dwelling XXNo.of Bedrooms 3 Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow 384 gallons per day. Calculated daily flow 3 x 1 10=3 3 0 gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank 1500 &Box Type of S.A.S. 3-1I20 500 oa 1 1 nn Description of Soil Clay for 5 ' Clean coarse from 5 ' to rl��mbers no water encountered . Nature of Repairs or Alterations(Answer when applicable) 1-15 0 0 gallon tank. 1—D i s t r i b°u t i o n box, 3-112O 500 gallon chambers packed in 4 ' of stone. 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 Certifi- cate of Compliance has been issue by this B d I f He lth. Signed !- Date 3/2/9 9 Application Approved by Date Application Disapproved for the following reasons / r v� i Permit No. Date Issued ''- —=-------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of (Compliance THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed( )Repaired(XX)Upgraded( ) Abandoned( )by J.P.Macomber & Son, Inc . at 4405 Route 6 A C u m m a q u i d Mass . has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. 1' 9 i;;_p_ dated Installer J.P.Macomber & Son Inc . , Designer J.P. acomber & Son Inc. The issuance of this permit s 11 t b clnstrued as a guarantee that the system will function as desi,�ZleZl Date L Inspector i ——————————————————————————————————————— No. Z •, �^ _. ��. Fee$ 50. 00 THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION BARNSTABLE} MASSACHUSETTS Digooaf *p5tem Construction Permit Permission is hereby granted to Construct( RepairY X )Upgrade( )Abandon( ) Systemlocatedat 4405 Route 6A ummaquid ,Mass. 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 •ermit. Date: Approved bye' y �I Q ® i f 10, i to cn cr ; �9 a i � 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) I _ S 6:1P -eeby certify that the application for disposal works construction permit signed by me dated ) I q9 , concerning the property located at 4401E K5 AL 6 f) e qyn n-9 'n1% 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. V• The soil is classified as CLASS I and the percolation rate is less than or equal to 5 minutes per inch. �t• There are no wetlands within 100 feet of the proposed septic system There are no private wells within 150 feet of the proposed system septic stem P �• 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 not be located less than five feet above the maximum adjusted groundwater table elevation. (Adjust the groundwater table using the Frimptor method when applicable] V• 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) 7 B) G.W. Elevation +the MAX. High G.W. Adjustment. DIFFERENCE BETWEEN A and B SIGNED . i DATE: �� [Sket oposed plan of system on back]. q:health folder:cent AsBuilt Page 1 of 1 TOWN OF BARNSTABLE LOC Rk A SEWAGE M VILLAGE J.5 IARZ e ASSESSOR'S MAP&LOTA INSTALLER'S NAME&PHONE NO. f Al A C OA e Z/i'— SC Al SEPTIC TANK CAPACITY Z .S0O - d d D• /.o o o r,4 N4 - p/T LEACHING FACH=: (type)3-/LO 1y C11,4 r1 det"S (size) Sry o G A G NO.OF BEDROOMS 3 BUILDER OR OWNER PERMITDATE: qql� COMPLIANCE DATE: 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 Vk f v http://issgl2/intranet/propdata/prebuilt.aspx?mappar=350009&seq=2 8/5/2014 LVCA 10N RT hH" SEWAGE PERMIT NO. VILLAGE C u rv-A rvi&A v INST LLER'S NAM i (.ADDRESS _ B UILDE R , OR OWNER DATE PERMIT ISSUED `�-- DAT E COMPLIANCE ISSUED-�f.__ � r I r� . ;i t , �� � � \ � � �' � � �' d� ~ �` � e 1 _. � e X,� �. ,. �.�, , ` � 1 � � � �-: �, � k i F � .�,�_, .�1= �;� �l No. F�s.......�r............. - THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH ------...... .................O F.......................................................................................... Appliratiun for Uispvii al Worko Tonstrurtiun frrmft Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: �C',CIL-( o,! 1, 6 v �ocati Ad� or Lot No. Owner Address �1_� .L.�r..-�'- ...1-3_ il',? .................. .................................................................................................. Installer Address Type of Building// Size Lot............................Sq. feet U Dwelling zl o. of Bedrooms............./_.........................Expansion Attic Garbage Grinder ( ) Other—Type of Building No. of persons............................ Showers — Cafeteria Pa Other fixtures -----•------•----•-•---•--•--..... W Design Flow............................................gallons per person per day. Total daily flow.............................................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..................... Diameter-------------------- Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed bY.....................................................................-•-•• Date........................................ Test Pit No. 1-----------------minutes per inch. Depth of Test Pit.................... Depth to ground water-_________-_____-_...__. f1-4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ R, ----------------------------------------•--••-•----...-•-•-•---------------•--------••-•.._.................................................................. 0 Description of Soil-----•-••----•-----•-4/�.............................................................................................................................................. V .........................................................._............................................................ /O©a 7 �J_ U Nature of Repairs or Alterations—Answer when applicable.____./�"________________-..__. _._ ..._ . ._._:..............._._........ --�CYU 7`. ......•-•-••-----------------------------•--- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TIT11 5 of the State Sanitary The undersigned further agrees not to place the system in operation until a Certificate of Compliance has een i e health. A,pi-I Signe ..-............... ......----•-------------------------- APPlication Approved BY ..........• -•........._.. s._ f.._...• �`•---------------- --------••. �S Date Application Disapproved for the following reasons:.............................................................................................................. ....................•-•-••-----------•--...-----.....----.....-------...----------------.•.•........-•---••--•••----••---••-•---••---------•-•--•--•-------------------••-•-••••......•---•-----.._.... Date Permit No...... .`. t. ............................ Issued.............4_:.' `� I£ 5................ Date. ----------------------------------------------------------------------- Now................. FEB THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH -- .....................OF.............. ,Apure#ion for Disposal Works Tonstrurtion 11truitit Application is hereby made for a"Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal 'System at 4.v'!' 0 0C3 L+4 t .. ............ --- ---- b ,, ,,z ocaf A ess �y- f or Lot No. U «► !C F. „fir / Address a ............ — ' J -� .L(..............•---- -••---........----•---•....---•-•..........••---••-----•.............••------•-•---•-------...... Installer Address Type of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms.._____..._.________------------------- Expansion Attic V V)6 Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons............._.......__._.._ Showers ( ) — Cafeteria ( ) dOther fixtures .------••---------------•------•---•------------•-•-----------------------•-----•-•---•---•------------•-••--------•---....----................------ WDesign Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity............gallons Length................ Width................ Diameter................ Depth.........._.._.. x Disposal Trench—No. .................... Width.................... Total Length.4................. Total.leaching area....................sq. ft. Seepage Pit No--------------------- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by.....................................................................:_.._ 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........................ W .................................. w r D Description of S.oiL' ----------- ps t t -----------••----•---------------------------------•--.----- 1 V .............................. ' . ------. ---.---- ... -----•---•--------....--••-•--•------••---------------•------.._...-----------•---------_.. ...=' -- 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 TITLE 5 of the State Sanitarr�y' The undersigned further agrees not to place the system in operation until a Certificate of Compliance has bbeen d _ao r h th. Application Approved By......... .. ..``Y °- .0 'r ° '` " ...... .. ...............•--------_.. Date Application Disapproved for the following reasons---------------------•------...--------------------------------•----------------------•----•-------......._-•-- .........................•---•-----........--•-•-----•-..._..----•---•--•--------._....-••----•..........._.........-----•-----------------------•--------------------------------- Permit No........�r� - -- H Issued.•....- 9� Date Dat •....... ....••... -THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........................................OF................................................................................. (9rdifirtt#r of fwootpfianrr TI S IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( or Repaired by-------• ---------------- --•-----•-----•.---..-------- Installer has been installed in accordance with the provisions of TITLE 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No...�.-�-'_--.:.. . .. ........... dated__-.--"" _Z_. �,�F............... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CON TRUED AS A GUARANTEE THAT THE SYSTEM W L FUNCTION SATISFACTORY. DATE.-----•---•......................"d.----••-•---...........-••--•......•-•-_. Inspector..........•.............. --- t THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH F� J No.. ................... n. t FEE.. .................. rosatl ork �onorion �ernti Permission is hereby granted------- fa 4:`'"$ ` ---------------•-•----.....-•---•-----•-•-•••------.........---.......-•••••.. to Construct (})� �Re r�( ) an Indiv. Sewage Disposal System c(C� narr.rxyv (� C f rs �1 at No.- -- ...................... . ............................................................ as shown on the application for Disposal Works Construction Permtit,Nora. _ Dated.__. r �` .: ,,!•�y ------------•---.....----• - DATE - --------------------------------- ... Board of Health FORM 1255 A. - suL N, INC., BOSTON