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HomeMy WebLinkAbout0055 SURREY LANE - Health 55 Surrey Lane 1298-053 Barnstdble 1 Depn of Public Health-Childhood Lead Poisoning Prevention Program Deleading Notification PleasLInspector tions of this form clearly.Incomplete or illegible forms will be returned. Lead �kcb �e A - �1/c.,g License# v?7 Inspection Date 8 .�� , lPrope �Propeess �", 5 tirreL f h . Act, s r�de - Zip Code 02-6-3 Authorized person performing work: s Lic#/Auth.# Address of authorized person 5`y Svr&j: f_0 94,^5 1e4_4fe , �44A Zip Code Telephone Number 56� -7-7 b G So! Address where the work will be done: Building Name(if any) Floor Street Ad ress 3a7 No. City " Zip Code A4 4 The property is a_multi-family .�single family. Deleading Method(s): ❑ Making paint intact(high risk) ❑ Making paint intact(moderate ar-."Applying vinyl siding on exterior ❑ Demolition risk) ❑ Component removal(low risk ❑ Scraping Liquid encapsulant components) ❑ Component removal/replacement ❑ Covering 0 Other: ❑ Dipping 0 Capping baseboards The work will begin on `�1-241 If and will finish by f 131/1.The work will be done in'the vaam__pm or-weekends: In Case of Emergency Contact Daytime Phone Evening Phone The Property Owner must complete and sign the following information: I certify that only authorized persons who have complied with the training requirements of the MasWa usetts 1AW'' Poi ning` Prevention and Control Regulations, 105 CMR 460.000,will conduct deleading work.I further certify that the a ihonzed person(s)will not exceed the scope of his/her authority and will be performing only those activities indicated abo_e Alf the information contained in this document is true and correct to the best of my knowledge and belief. Date i / Signed The following people/agencies must be notified ten days before beginning work: r' 1. Occupants of the dwelling unit 2. All other occupants of the residential premises,if any work will be done in the common areas 3. Childhood Lead-Poisoning Prevention Program,DPH Fax(781)774-6700 MWRHO 5 Randolph Sheet, Canton,MA 02011 4. Asbestos and Lead Program,DLS 19 Stanford St, I'Floor,Boston,MA 02114' `' "'� -r f Fax-(617)626-6965 ' 3R 5. Local Board of Health/Code Enforcement Agency *If the home is on the State Register of Historic Places,call the MA Historical Commission at(6.17)727-9470.. . t¢ uo TOWN OF BARNSTABLE LOCATION 5�� Su rrr� �uN SEWAGE # VILLAGE ASSESSOR'S MAP &SLOT�J��rC%�� . INSTALLER'S NAME & PHONE NO. Tc44 17 Aa 1 f SEPTIC TANK CAPACITY /Svc LEACHING FACILITY:(type) (size) NO. OF BEDROOMS ` PRIVATE yWELL OR PUBLIC WATER BUILDER OR OWNER JD t DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes- ._ No . i zy r vL, pp-ov's'n ttoy. fro a L I LOT. - 2 S. ��•� ti Icy O�. � - V k9- - P� foo IF e2 �� s.� •a rt.. THE FOUNDATION SHOMV ON THIS PLAN WAS LOCATED BY AN INSTRUMENT SURYEY ON AUGUST 15, 1994 AND EXISTS ON I THE GROUND AS SHOWN.. DA TE PROFESSIONAL LAND SUR OR THE ENTIRE LOCUS IS SHOWN IN FLOOD ZONE ON FIRM PANEL 250001 0005 C. PLOT PLAN — LOT 40 SURREY LANE SARNSTABLE MA SCALE 1 " = 40 ' AUGUST 16, 1994 EAGLE SURYEYING 19 ENGINEERING INC. 44.E ROUTE 130, SANDWICH, ILIA PROJECT NUMBER 93-155 16-c- Loi',wd TOWN OF BARNSTABLE LOCATION SEWAGE # 9zf- VILLAGE ASSESSOR'S MAP & LOT 5p4rr O�- INSTALLER'S NAME & PHONE NO. Jy4N R &I Z SEPTIC TANK CAPACITY 15-00 LEACHING FACILITY:(type) y. 6a/le,s (size) NO. OF BEDROOMS 4/ PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNER J-.4 A/14 DATE PERMIT ISSUED: 8 io-'?y DATE` COMPLIANCE ISSUED: VARIANCE GRANTED: Yes, No M 29 • �5 Zs No.. + � Fss......�a��........ ` THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Appliration for Di-aipw3al Work.6 Tonotrurtion ramit Application is hereby made for a Permit to Construct (X ) or Repair ( ) an Individual Sewage Disposal ys5`�RR Y---�. -..........�fr�sTi�Lt: Nd� 40 Location-Ad r s or Lot No. --- --- .................•---..........--•••- Owner Address W he.1_�.._ N °i s�c�'�o!� ...... °� � ©23 `2_ r •.• ••••• ......-•••••-------••---•--- Installer Address Type of Building 2 Size Lot...; q;y.4�...........Sq. feet Dwelling—No. of Bedrooms-------- -________--------------_------Expansion Attic ( ) Garbage Grinder ( ) '4 Other—Type of Building VE . 1 '.. ENo. of persons----_--__. Showers — Cafeteria 0.' Other fixtures . ----------- d W Design Flow............ ......................gallons per person per day. Total daily flow..........1.1.0.........................gallons. WSeptic Tank—Liquid capacity-l50,6--gallons : Length----IP-5---- Width_,-5;v ._..... Diameter................ Depth..... x Disposal Trench—No. .................... Width-------------------- Total Length-------------------- Total leaching area-_---434........sq. ft. Seepage Pit No--------------------- Diameter-__-_-__-----__.__ Depth below inlet-----------_........ Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) / '~ Percolation Test Results Performed by------ ....._ �.1�? `L� ................ Date...... Z¢1_Q.............. Test Pit No. I----r.-------minutes per inch Depth of Test Pit____________________ Depth to ground water........................ f1 Test Pit No. 2.... ........minutes per inch Depth of Test Pit.................... Depth to ground water........................ 94 -----------------------------------•---------•--•--•------•----••---------------•-••••-••-••-••••••......••••••-•-••-••-••-•--•............•••............... 0 Description of Soil.......}'`!�EDIV!�..S-!!-AD.......................................................................................................................... x 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 TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of h Signed,.:--- _.....� ----- -4 p - ace �/ Application A Loved B ------------------------------------------- PP PPY - � Date Application Disapproved for the following reasons- ------ ---------- ------------------------------------------------------------------------------------------------------------------- ... .......... ...................... .............. ............................ ........ . . .............................. _ Date PermitNo. Ll — 3` 15 ---------------- Issued ....... .. ........................................ ...... Date ,»~No... .....6.�> Fxs......1. ........ 7 THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Apphration for Diipnial Works Towitrnrtinn Prrmit Application is hereby made for a Permit to Construct (X ) or Repair ( ) an Individual Sewage Disposal ystem at: R L Y LN f}tzN STM t E N!A 4 ------------------------------------- -----------•-- ---------....--•---.---------......... •------------- ...............-------- .............................................. Location-Ad r ss or Lot No. �FreFY '_J..c�l E vs A. 3 e; 1DO� Sr. ------------- ---•-----..........---...---------------------------- �11 Owner Address W (i.)l� Cp N$TkJGTr p t l - ---------------------................................................ -----.._w N.r ..;....tu.�l.-----•--oz3S2. 9Q Installer Address UType of Building Size Lot...Zq�3a ...........Sq. feet Dwelling—No. of Bedrooms--------3________________________________Expansion Attic ( ) Garbage Grinder ( ) a`4 Other—T e of Building QA 5-1-1`L-C.. Other—Type g ______ ___ ____ �a!0ENo. of persons___._____�,�-_ ---------------- Showers (�j ) — Cafeteria ( ) 0 Other fixtures -------------------------- -------------------------------------- -•------------ .............................................................. W Design Flow............lq_+O______________------gallons per person per day. Total daily flow.----------U_0.........................gallons. WSeptic Tank—Liquid capacity_1S_Ql1..gallons Length_-_-��: __.. Width__S•. ------ Diameter.-.------------- Depth..... x Disposal Trench—No. .................... Width-------------------- Total Length.................... Total leaching area_--_gat_.......sq. ft. Seepage Pit No..................... Diameter..................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) '-' Percolation Test Results Performed by....... ....���I.. !N�................ Date........ Z¢l93 Test Pit No. I....2.......minut`per Inch Depth of Test Pit.................... Depth o ground water........................ 44 Test Pit No. 2....7........minutes per inch Depth of Test Pit.................... Depth to ground water........................ 04 .......-..................................................................................................................................................... 0 Description of Soil.......M. !? yM -ti ------------------------------------------- U -------------•-•-------•----•-••---...--------------•----•-•------------------......------------•--------------------•-•--•-----------•-----•------•--•----------••--------------.....--•-------•----- 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 TITLE 5 of the State Environmental Code—The undersigned further 11 agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of h al.t"hh. —/ av Date ' ApplicationApproved By ---- �,.� ..�.�.-tw- ........... _.-. -`�:..-. .�....................................------........ Date Application Disapproved for the following reasons- ---------------------------------------------- .-------------............-.............-.......---------------------------- --------------------------------------------------------------------------------- ---------------- --------- ------------------------------------------------------------------------------------- -- -- . ................... i i Permit No. ------- ---' 3�---�-- ---------------------- Issued .................................................... Date - Dve ------------------------------------------------------------------------ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE l U��ertifi ate of (ILTDrit lianve THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) by ---------------------�1�.> - ....I b_A..�Y:l------------------------------------------------- / / Installer at ............1!�' ... �� �� ..E<c- 7ti.. .........L.�J�-------------------- - wr {'�' �<r^, Q -D '.._-------------- --------------------------......------------- has been installed'in accordance with t e provisions of TITLE 5 of The State Environmental Code as described in the application for Disposal Works Construction Permit No. _-.....��_ . ....- S��_.. dated _......_---------------------------------.. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL.FUNCTION S CTORY. f} DATE.... .. ✓ ... _ ..� � - ... - Inspect ...-�... . •--��r` .. �----� THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE No... ..�.:. 3 FEE....t o.....---- �t��,a��t1 nrk� �nn,�tr�r#uan �prntit Permission is hereby granted------...... ... to Construct'( or Repair ( ) an In ividual Sewage Disposal System atNo-------------------- �' �'l®---... �- !rv�......-- � ----------------------...-------------------•--------------- Street q / 2 as shown on the application for Disposal Works Construction Permit No !_7__-� 53- Dated.....__h_-. .:. .y...... ............................ , --•-------------------------------------------------•-------•- Board of Health DATE--- = .................................. FORM 36508 HOBBS 6 WARREN.INC..PUBLISHERS 1 G SOIL TEST Pll� DA T.�1 GENERAL NO ` TO P 0 rr P-$157 J. THIS PLAN IS FOR THE DESIGN AND INVERT ELEVA TION.S' Fov N VA-r10 tti..� T.P. . T.P. -2 CONSTRUCTION OF THE SEWAGE DISPOSAL e L 110,O O G. h,. EL EY. I �' S. r' . EL V. �' b " G. W. ELEV. _,.._ G. W. ELEV. _ _--- FACILITY ONL Y. INVERT AT BUILDING I Oo,0010 TERIAL S A T SEPTIC TANK 9 ,g0 ro P t_ ^ ?'' ) P. ALL CONSTRUCTION METHODS AND MA INVERT IN 1 C '?,pu � W,�LK4VT ' �' 1 FOR THE SEPTIC SYSTEM SHALL CONFORM INVERT OUT AT SEPTIC TANK 55 — ACCESS COVERS MUST BE WITHIN 12' OF FINISH GRADE. `� '` IL TO MASS. D.E.0.E. TITLE 5 AND LOCAL INIJICA TES f ` BOARD OF HEAL TH AEGULA TIONS. INVERT IN AT DIST. BOX y 1 OC.►,o 0' PERO. TEST J 11�' i- �,,u is 5 o 3. ALL SEPTIC SYSTEM COMPONEVTS SUBJECT TO INVERT OUT AT DIST. BOX °1 2 - - -- 99.2g MIN. 2" OF ETC. L � q S• 0 � —' VEHICLE LOADING (Jr.E. UNDER DRIVEWAYS, l INVEAT IN A r EA tr ��� � •_ JrSHALL BE DESIGNED TO WITHSTAND H-20 LOADING. _ r i7 1#A 1D DIA. r �. C' BOTTOM OF GAS���1 5 q 2• d T3aSEM�.�I'i" �I MIN. WASHED STONE INDICATES 4. ALL SEWER PIPE SHALL BE SCHEDULE 40 OR OBSERVED GROUNDWATER r 5 OBSERVED ,;ti► ;, ; - �' `��`i I F!^O 0 R � DEPTH GADUNDWA TER APPROYED EQUAL. _ 1 P DIST. 3/4 -1 1/2 DIA ADJUSTED GAOUNDWA TER E L. 102. 50 �: 1,5 O O BOX nj WASHED STONE 5. BEFORE STARTING CONSTRUCTION CALL DIG SAFE -`� GAL. �_1 1-800-322-4844 FOR L OCA TION OF SEPTIC T NK cl 2,5(7 INDICATES E9GR UND UTILITIES. V ART - 1 O TEST PIT UND 0 � 11J �, �� � 3, V 6, DATUM IS 1�55VM�if� B ArjC,l�l�k� ►7 *H -2 O I r- 13 o R1 V.� t I , ► 7. IT SHALL REMAIN THE CLIENT'S RESPONSIBILITY �LO0 D���'�¢- �' >J 109 oD ��-` --- --. i' . ._ _�� D�q TO OBTAIN ALL PERMITS SPECIAL PERMITS, VARIANCES, ETC. FOR PHIS PROJECT. 8. IT SHALL REMAIN THE CLIENT'S RESPONSIBILITY 4- GA DATE.• LLfc.�CS TO HA VE THE PROPOSED DWELL INS FOUNDA TION W! ,3/ ' G'("O»r-- TEST BY' _ DESIGNED TO ACCOUNT FOR THE EXISTING GRADE AND SOIL CONDITIONS A T THE LOCH TION OF THE _ PROPOSED DWELLING. �-2'� WITNESSED BY' v�T I1�1 M �)vM 5A1J'D o -r t-t I S LOT l S LO C A`r'�b 1 ►-� Y►�E ��j,7;�.o r�,r�;',i., PEAC. RATE .� MI/4 i IN. I I.� }..,,C .17, r,,.•, .�1� Al? 6n RD U>..lVWA t'f,-R ©vv R.l. "`S ROGFR PAU L �'�'�• - � N, 331120 ��, DESIGN CRITERh: • `� ,�\ CIVIL DESIGN FLOk r c 1 BE[JAOOM D/fE.LLING � .t.iU v,�l_%J.JY PEA b Dflvu.J I? i EQUALS 4-1- 0 9AL.5. PER DAY. DA TE PRO SIONAL NGINEERF YIL DA T D PROFESSIONAL LA EYOR SEPTIC TANK AEOUIf f Q• q G C_)GPD X 15oX 6o GAL. SEPTIC TANK PNOVll a'=0.' SAL. SIZE OF LEACHING F,1 CIL ITY REClUIRED P E - tiff; 4 S A p 4 `? GALLONS PER UA Y y,�/ 313`1"0►J L OT�'40 157�64 1 `� SIZE OF LEACHING FACILITY PfIOVI� L!' 20398f S.F. G ��E _�cr STONE WITH\ _ �? SIDEWALL �_I 1 S.F. X I R�S BOTTOM 2 2 S.F. X I .O GPD ir,1 \ ' �\ TOTALS 5'.F. I } _ GPD BREAKOUT CAL CULA TICKS' Q o Q o / Q, \ \ SLOPE -� X 150 , 1" 0 11 O o n I'�r'• 2 a v �' �' REVISIONS.' ` NO. DA TE REVISION Wq i ! 50o6.4L voo� h i 01 A� TP- 1 10 �S A TCH SAS t_ 100,00 �o % _ RIM = 109 90 I ' �A 1 5� PLAN SHOWING THE DESIGN OF A PROPOSED P SUBSURFACE SEPTIC DISPOSAL SYSTEM G LOT 40, SURREY LANE, BARNSTABLE, IYA SCALE 1 " = 30 ' NO MEMBER 22 1993 EAGLE SURVEYING G ENGINEERING, INC. -' 441 ROUTE 130, SANDWICH, MA \0� PROJECT NUMBER 93-155 Cr 11.g6M.�iJ4J(Y11�d...#I1 Ma.µ..)•../.1.1(.,1Y...KL.-Hr....m.y......♦y......,..... a.1c i+.r N}........tr.....i..... ._...+._.._.Y