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HomeMy WebLinkAbout0144 SCUDDER'S LANE - Health 180 Scudders Lane Barnstable A= 259 -'010 r � j TOWN OF BARNSTABLE LOCATION 18,'0 SEWAGE# VILLAGE /lewi/w/4' ASSESSOR'S MAP&PARCEL INSTALLERS NAME&PHONE NO./ r QZ,'�4ei2 ,l-k, -y;�' SEPTIC TANK CAPACITY + � _/�. ��/. Al LEACHING FACILITY:(type)ft Z"J (size) 1,2 fT ')c1 NO.OF BEDROOMS ZVI OWNER er i - � PERMIT DATE: /S % COMPLIANCE DATE: Separation Distance Betweeri 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. G� �,✓s�����•ss° i '��• �/3 ` cy- yg� � y 1 lNo. ! >, Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVGSION-- TOWN'OF BARNSTABLE, MASSACHUSETTS 1 9pplicatiou for 33i.5pont 4§pgtem Cou.tructiou Permit Application for a Permit to Construct( ) Repair( ) Upgrade(Abandon Complete System ❑Individual Components Location Address or Lot No. /$0 souaAt6 L',V- Owner's Name,Address,and Tel.No. 3Mn9 b�. Zbe-na'iC Zyw�c ,Tr, Assessor's Map/Parcel Z jct_O 10 Ny N 10O Za Installer's Name,Address,and T No. yt / Designer's Name,Address and Tel.No. c®ko/. �/`9v7'� ii3i1_�P5 Type of Building: 1 Jlobe Dwelling No.of Bedrooms ( L- t Size 3 rk?C,S sq.ft. Garbage Grinder (( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) (e(gO gpd Design flow provided G8 gpd Plan Date 1►aa cyy ZceI Zo07 Number of sheets Revision Date Q Title 5k?6.n ?raea5C4 SCp�& �!nr-&J-Z Size of Septic Tank 1500 Type of S.A.S. (0-5a0 GAL(lnc M6r-,,5 (Z 94'S, Flcick Description of Soil Rec 4 11,1937 0-1 " 1Z'31 Iv 5& LOA-fi 31=-- Z,5`I W 1l rAecl Nature of Repairs or Alterations(Answer when applicable) d 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 Boar of al Sign Signclry Date Application Approved by Date Application'Disapproved by: °Date %for the following reasons Permit No.• '� Date Issued No. a�.-,� / Fee THE COMMONWEALTH OF�MASSACHUSETTS f / Entered in computer: ,T �� N,#_ ter... ,,� n.li�, "..i .J l Yes PUBLIC HEALTH DIV� ION - TOWN OF BARNSTA'BLE, MASSACHUSETTS Yication for lk oat 6 .5tem Cow5truct ors permit pp _ p t Application for a Permit to Construct O Repair O Upgrade(-j""Abandon.O U Complete System ❑Individual Components Location Address or Lot No. /g T Owner's Name,Address,and Tel.No. ZM11VIC 4-,YM4 T�I eAv- Assessor's Map/Parcel 25q—O 10 N 3 N 81s 100 Z`8 Installer's Name,Address,and T I.No. Designer's Name,Address and Tel.No. Po ®,c 1 s5 .c . �kr,kkt OZtoSS- 5n9-428-3311 Type of Building: a µ Dwelling, No.of Bedrooms �s( Y'r1R Lot Size 3,(o 0,t Zgi sq. ft. Garbage Grinder Other Type of Building No.of Persons Showers( ) Cafeteria( ) .. Other Fixtures Design Flow(min.required)' (4(00 gpd Design flow provided (as(„ gpd Plan Date A,(IA ZCof ZC0 7 Number of sheets Revision Date /� -Title 5-k?6n ?a,00Sca Sty-,,_ of!.JVJ_Q_ E Size of Septic Tank 1500 <S,I,dn Type of S.A.S. (p-SCO toAL CY txr 6&,s- i4. 2rC5S' r--Idyl Description of Soil l&( l" 11,53-7 0-1Z IZ--sk" B l er IV 5 MI/ SAATO Nature of Repairs or Alterations(Answer when applicable) 4 Date last inspected: Agreement: 4 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 51of the Environmental Code and not to place the system in operation unfff a Certificate of 0 Compliance has been issued by this Boa�Vv , Signed Date p ,.,.t Application Approved by t//1 D ?f�X.P �Date w Application Disapproved by: V - V v 5 Date for the following reasons Permit No. Date Issued /l a 1 THE COMMONWEALTH OF MASSACHUSETTS 'I1BARNSTABLE, MASSACHUSETTS i F Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal Systtee-m. Constructed ( ) Repaired ( ) Upgraded (i) Abandoned( )by at /90 5cuddk6 &,Q �att\51��J� has been constructed i ccordance with the provisions of Title 5 and the for Disposal System Construction Permit No. '.Q dated Installer r Designer _ #bedrooms (4 Approved design flow / /,� /7 - ( 7 gpd I f �f construed as a guarantee that the system will %unbtio as designed. y The issuance This plerm/}rt shall not be co g y j Date /7� Q 1177 Inspector �/ry t Fee L/ No. f THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE, MASSACHUSETTS Mi5pogar J§pgtem Cou5truction Permit Permission is hereby granted to Construct ( ) Repair ( ) Upgrade (.--'j Abandon ( ) System located at 180 5co�(r,( 5 CknA 64fS�mz 4 _ 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: C`nstruc ion must be completed within three years of the date of Ithislpermt. /� r Date _ Approved by r. Town of Barnstable . Of. _ °w ato er�iees .. Re u� S o -� rY Thomas F. Geiier,Director -RAWNSUAL& Public Health.Divislo 161 n , ED Wit'` Thomas McKean,Director 200 Main Street,Hyannis,jNa 02601 Office: 508-862-4644 Fax: 508-790-6304 Installer & Desizuer Certification Form Date: d� Designer: S�II1�gn �Ati►nPps� ,�n� In taller: / Address .0jC �J j a Address: l'�X 04-R-U\te MN-O vsS 1 On ��1 g�7 �l � 1 �� 7• was issued a permit to install a (date). `(installer)septic system at CU eC5 z based4orf�-a design drawn by � S L9►% (addms) dated c'cd% 1-hl lT (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 e system)but in accordance,with State-& Local Re�Iations. Plan revision or certified as-built by designer to follow. , i3 (Inst er's Signature) (Designer's Signature).. 1. (Affix Designer's Stamp Mere) PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH'DIVISION. CERTIFICATE' OF C0NJ[PLLANCE NYILL NOT BE ISSUED UNTIL BOTH THIS FORM' AND AS- BUILT CARD ARE RECEIVED BY THE B_AR.NST_ABLE PUBLIC HEALTH DIVISION. THANK YOU. Q:Health/Septic/Desigaer Cerdflcation Form To wn of Barnstable. � �`� � 2 _7-1 k P� T Regulatory Services , c. Thomas F:''Geller,Director, • .aue��sss. - '' 9RAM Public Health Division ` :Thomas McKean,Director 200 Main Street,Hyannis,NMA 02601 r Office: 508-862-4644 . Fax: 508-790-6304 µ Installer& Designer Certification Form„ Date: � — _ - -,.__ - --- ,. � ��� ,ram/ ��.5�•'.. Designer: .S1A sCk� "� ��e �� �c Installer: Address: -7 _4�. C�ne_CA Address: 05� w-';v ' On I'Z4 b"1 OIrGOI,/, cl/ : was issued a permit to install a (date) (installer) ( n _ septic system at based on a design drawn by (address) dated 2 100 .— (designer), :�2v� I certify that the,septic system referenced above was installed substantially according to the design, which may include minor approvedF changes such as lateral relocation of the distribution box and/or septic tank..... ` I certify that'the septic system referenced above was nistalled with ma;or chasiges`(i.e. greater than 10' lateral relocation of the.SAS or any vertical.relocation of any component of the septic system)but ut accordance with State& Local,Re�Iations. Plan revision or certifier)as-built by desi'p�er to follow.-' M.^ S.! !VAN cyG" a In (Instal s Signature)'° u wi ' _ ti f f�,) 29733 (Designer's Signature) Y A(Affix Designe�r.s Stamp Here) PLEASE RETURN TO BARNSTABLE,PUBLIC HEALTH DIVISION:' CERTIFICATE OF COMPLIANCE NVILL NOT BE ISSUED UNTIL BOTH THIS FORM Al�FD AS- BUILT-CARD ARE RECEIVED BY THE B_4RNST_4BLE PUBLIC HEALTH DIVISION THANK YOU. Q:Healtb/Septic/Desiper CertLncaagn.Form i. Town of Barnstable 11,5 37 Ito �r o Depnrlmcnl of Iicgulalory Services * -�— _ ■AMITMOLK 1 Public MOM Division Date 200 Main Snccl,ilyannis MA 02601 Date Scheduled Time 1U tree Yd.:` �00, Soil. Suitability Assessanelit for;Sewage bl isposal Performed By-pLL4 I J�yet'nr .L t7 j l/LQO,!'� ej�-n L. Witnessed By: I�r�nnr•A KNO1' 13-15 LOCATION & GENERAL"INFORMATION Locnllon Address ownci s Name i oom n e L ymv,7,Ti- /go SCudde rs /&3 e fist �} rcet Address .. IV e+..0�u rK 'IV Assessor's MaplParecl: o25.q.O y Q} . 1 `• Engineer's Name.,j�/�fYa pj L�1��1 ii ea li -thee NEW CONSTtt>►CTIOiJ '' RL'PAIR V1 Telephone.# �De.7 qQ?— 3 qV ` � Non-e•.; � Land Use 2it��\0.\ Slopes(%) ,�Q lZ �O Surface Stones 1- Distances from: Opcn Water Dudy�R Possible Wet Area 35 - It Drinking Water.Well J It Drahiage Way S60 R .Property Line (00 R Olhcr SKETCH:(Street name,dimensions of lot,exact locnlions of test holes&pert testa,locale licilnnds lit proximity to holes) :z y 4 ^4.n Depth to tiediock Pinent materiel(geologic), rV" Weeping from Pit rncc A n Dcoul to Gronndwaler: Slandhtg Water In little: Nlt\� I g Estimated Scnsonnl.l`ligis Oroundwnter. �S ���- 't�Pt'"C�,6. (Ci'�`' J DETERMINATION FOR SEASONAL IIIGII VA EIt TABLE T Method Used: /lea Dcplh Observed standing in u is.hale hi. Depth to soil rtiuiVes: Dcplh to wuping Rom side of ubs.hole: in. Groundwaler Adjustment R Index Well p Reading Dale:. index Well level Adj.factor Adj.GnutinJwntcr Level PERCOLATION TESTUalc3l49M Tirne to— Observation Z Time at 9" Lq Ilolcp Dcplh Were Time al G" DLL Stnrl Prc-sank Time© �� (o '1'inic(9'=G") End Pre-soak w ' Rnle Min./Inch 53 rn / n Needed(YIN) Site St ileUilily Assessntcol: Site Passed ✓ Site Tnilcd: Addilionnl I Tcsli q Or1ph,a1: Public licalih 1)ivlston Qbscrvnlion 1 tole Dal, To llc Co mpIcted on Back----------- ***lf percolation tees( is to ile cim4111cted >'thin 100' of ivethuld,you anus( first notify(lie rior lv bcl;inning. I3nimstable Corset-VAOnPivision.a( le"'1 one (1)n'celt p Q:IIt?AI TIVWP/l'I?I!i'1'(11iR1 PEEP OBSERVATION HOLE LOG - --- Hole It�� Ucpal flow Soil Iturizun Suil Tcxhpo Soil Culur Suit Vthcr' 9urlht a(Dt.) (USDA) (Munsoll) Mollling. (Shimuro,Stuncs,Muldels. GtW talon v °a �aUravcll______ Iz 3 s� 101K�J1 lU1IZ S o —17-0 s DB)Cl' OBS)URVATZON MOLL LOG )(Tole It Z Depth from Soil I lorimn Suil Texture Soil Color Soil Other Surface(ht.) (USDA) (Munsell) Motllhrg (Structure,Stones,Duuldcrs. ' Consislcngy,%Grnvcl) _. t CAW — .31 2s Y oWo DEEP OBSERVATION HOLE LOG 1101c It 3 Depth from Soil Ilurlwn Soil Texture Soil Color Soil 01hcr Surlhce(in.) (USDA) (Mupscll) Mollling. (StrucUpe,Stuncs,Moulders. Cunsislclly.�['s_Q!�Ys1.)_ 1r L�vwl 0 I<� Sams(ebb J DEEP*OBSERVATION Hole II t 1 r 1 ON HOLE LOG �. Depth Rum Soil I lurizrrn Soil Texture. Suit Color Soil Ulher Surface(in.) (USDA) (Munsell) Mottling (Stnicturc,Slopes,Moulders: Cunsislc 1c °. raveO Flood(insurance Rate Map: ' Above 500 year flood bomrdary No— Yes Within 500 year boundary No •• Yes ` C'�a�t+on o�S\, C iS (.�i�ir� (lJ�rl Within 100 year(loud butindnry No Yes 7SO` 7 Jf Depth of Naturally Occurring Pervious material Does at least four feet or-naturally occurring pervious tuatcrial exist in all areas observed throughout the area proposed for the soil absorption system7 if not,what is We depth of naturally occurring pervious matcrinl7 Cct•titication - ' I cortify hat on (datc)1 line passed the soil evaluator examination approved by the Dopartment of Cnvirotttttcntal Protection and that the above nunlysis was performed by me consrstent wills tho required lramwi g',ex ttiso and cxpet•i I nco describcd in'310 CMR 1.5.017. { Date �( Signature Q:I ICALTI UWPIPERCfORM No. 0 Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Ye PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS 2pplication for Th6pont .6p$tem Construction Vermtt Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon(01) 7 Complete System ❑Individual Components Location yAddress or Lot No. /6O Jt✓. Owner's Name,Address,and Tel.No'.:. Assr'sM�/Par x't?el �jL'l'rr/�j <e 1 Installer's Name,Address,and Tel.No. �5 Designer's Name,Address and Tel.No. ff 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) gpd Design flow provided gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) Ce S55 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 Bo o e / l J Signed U to !/ l/ Application Approved by 4 ate Application Disapproved by: Date ,for the following.reasons Permit No. Date Issued J '-�,�"�;iiv=tt.F+t/i:y.,��s��'<i:.r-t� 3 +.Rrr A`s�_a:.s_ _may . fa,.,;�;a,,�-.Q yam,,... +ram.;..--r. .. :.w•'...::.'-.r ... G No. �5wFee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: / YeT PUBLIC HEALTH DIVISION, TOWN OF BARNSTABLE, MASSACHUSETTS `Z Yicaction f r wig o al �terrY c�or� traction�� � .� p �ern�it Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon(V�� Complete System ❑Individual Components Location Address or Lot No. !0 JC// i✓/�r� ��� Owner's Name,Address,and Tel.No. . Assessor's M©/P� �el 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 ( ) r Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil 5 Nature of Repairs or Alterations(Answer when applicable) � �//mil r�� C S S 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 of He lt:h. -- ,Qat. 7 Signed / CJ // ,� — Application Approved by 1. © u 7 lFA � i / Date Application Disapproved by:U v V (/ U Y V Date for the following reasons IVY -i Permit No. aC20, +' _�Llral— 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 7 c%'17/ at _5�C Xh has eeen cco�nsst cted in a cordance with the provisions of Title 5 and the for Disposal System Construction Permit No. 5 dated Installer Designer Albedrooms /I ffi Approved design flow ( /1' gpd The issuance of thi permit shall, of be construed as a guarantee that the system will fun•tt/i�.�n as deeJsigned, a,y/JQ v Date / Inspector !/.! No. I Z5' r� / ��'—! Fee — / THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE, MASSACHUSETTS xillulizpool fpp.5tem Cori.5truction Permit Permission is hereby granted to Construct ( ) yRep it ( ) Upgrade ( ) Abandon ( � / System located at l ® G G(G�/ii'I�'rS �.✓/ /�l5 y��i /t'' and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to comply with Title S and the following local provisions or special conditions. Provided: Construction ml be comp-le ed within three years of the date of this ermit. Date �oq // Approved by y/ / �I Vs P Nosture (n � _ ctf ,y6 One trust C C rove / -.. n ,,6 4ql7e c�NN o / m Fence F 40 / O k"DOCX / 6tz 00 r n . .. . ............. . I — g _ � N z n .. _ . ` II: PMIIRI' LNWG RM. Is [GS(:NM r II• 5W wLAIM • O P"05rlv MEN Y� e 0 0 FM , 1/2 MTH ..2 ' ~ � ��I[Ct16i1G - ff.IS F>GrtG, ��IB ttlNt•L� NW.-� X NR' .. � I FI<?5T FL00� t'LAN z :z ri I fiZ�\. '1 ti..r ILA I I L N a I . . O L_____ J L---- . ,DEDROOM.01 mmoM#2 0 0 \ I I I BAm tt s PLAYROOM.. _ BEBROOM y .. BEDRO -+' u r m.e-0 aae-0 _—� o R _o -------------- — —————— -- --- m '. ursn..sr . I z \ ttfl.a iNl�l7 FLOOt? PLAN -. ; :. S�CON17 LOOK PLAN A-2 , ,