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HomeMy WebLinkAbout0046 BRALEY JENKINS ROAD - Health 46 Braley Jenkins Road, Centerville _ _ """ ''I Sllll J�aEcvaEoco UPC 12543 ' No. '���sT•coa�J�o HASTINGS, MN No. / Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS RppliLation for Misposal *pstpm Construction permit Application for a Permit to Construct( ) Repair(Upgrade( ) Abandon( ) ❑Complete System Individual Components Location Address or Lot No. f��� ��y tTGs" ,,tlwoo Owner's Name,Address,and Tel.No. Assessor's Map/Parcel XO7 je T 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( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min required) gpd Design flow provided gpd Plan Date 0 S' Number of sheets / Revision Date Title Size of Septic Tank)(/J'%/i✓ 6: /0Oa Type of S.A.S. Description of Soikl��-:f_Ier Nature of Repairs or Alterations(Answer when applicable) 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 Health. Signed Date JQ Application Approved by Date Application Disapproved by Date for the following reasons ^�Permit No. d�()— 3 Date Issued e f No. �t i Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Zipplitation for MispoBal �6pstem ConBtrUttion Permit Application for a Permit to Construct( ) Repair({Upgrade( ) Abandon O ❑Complete System [L]/dividual Components Location Address or Lot No. 'jl���jt��¢y tTGl/�/�/� Owner's Name,Address,and Tel.No. Assessor's Map/Parcel /T Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No. Type of Building: Dwelling No.of Bedrooms -3 Lot Size sq.ft. Garbage Grinder( ) Other Type of Building 1-101G�`- P No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) -3 gpd Design flow provided - � gpd Plan Date 0 s o "� Number of sheets / Revision Date Title Size of Septic Tank-C1�')C/J'7//✓ try /0400 Type of S.A.S. Description of Soike^41- 4' Nature of Repairs or Alterations(Answer when applicable) i 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 Health. Signed Date 01)'�30�� Application Approved by Date 3 i Application Disapproved by Date for the following reasons C _ O13_ 3 _�,_ 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 Upgraded( ) Abandoned( )byat ����j� y ( E`iv,�/,,.r' dt.Q has been constructed in accordance (� ? with the provisions of Title 5 and the for Disposal System Construction Permit No.�(dated �( J O — 13 i Installer/ .G� ,�®E-!/jf Designer4iV J'oA✓ dZj #bedrooms Approved design flo� Syr o gpd The issuance of this pejllmit shall not be construed as a guarantee that the systernA rbun)7/ion as desi(ned. / (��, \ _- Date l 1 ( Inspector` 1 ,,r%" �11 A �J _ i�} `�� 0 - CT I - -------------------------------------------------------- No. �I — ✓�L( Fee 1 THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS Misposal 6pstem Construction permit Permission is hereby granted to Construct( ) Repair(� Upgrade( ) Abandon( ) System located at �� ��c�` �/ (��`/''/'/l— �i�✓J G J`-c�"�l�i LLB' and as described in the above Application for Disposal System Construction Permit. The applicant recognized 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 TOWN OF BARNSTABLE .LOCATION SEWAGE# VILLAGE P//Z 'ASSESSOR'S MAP.&PARCEL--.,--"/ INSTALLER'S NAME&PHONE NO. (�J�9 4e'46'49-eU"f ;�s 0 7-oT SEPTIC TANK CAPACITY a dqAe, LEACHING FACILITY:(type /%%*--,(size) 3 NO.OF BEDROOMS .3 OWNER PERMIT DATE: O ' o COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Jot 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 r � Q�•/�,.r uq ,V Town of Barnstable Regulatory Services Thomas F. Oeiler,Director Y •" `S Public Health Division 'ram All Thomas McKean,Director ZOO Main Street, Hyannis,MA 02601 Office: 508-362 644 Fax 5 8-790-6304 Date: t. 0 SewagePermit#a 4�? 3wAssessor,s Map/Pareel n 1<3 Installer&Designer Certification Form Designer- � � Installer: a y --� '� Address: �-- ��+► � �� C�����/ Address: On 8 3 /, was issued a permit to install a (datW ns alter) .per septic system;at". based on a design drawn by •y�, ���y (address) �'J�'V��e/• Mof dated (designer) �ertify' 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. Stripout (if required) was inspected and the soils were found satisfactory. 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 aay component of the septic system) but in accordance with State & Local P- 'atioas. flan revision or certified as-built by designer to follow. Stripout(if rP Feted and the soils were found satisfactory. OFAf. g�DAV►D �J ;: B. {Installer's Signature) MASON J A 4 esi er s Signature) PLEASE RETURN TO BARNSTABLE PUBL.- OF COMPLIANCE WILL NOT BE ISSUED UN r tL nij i ri i ttt6 r ORAJ AND AS- BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION THANK YOU. q;kofflce tQr 3\lesi9=rmtiFcation Ponn.doc Town of B arnstable P# Department of Regulatory Services Public Health Division Date f'a19 200 Main Street,Hyannis MA 02601 Trine Eb Mltt Date Scheduled ` Fee Pd. ;N < SOU Sul bali Ass t` ` � • e s meat L � .for Se a Dos os Performed By: Witnessed By: LOCATION& GEIJERAL INFORMATION _ Location Address T��� I/ _NJr f Owner's Name - y - Address Assessor's Map/Parcel:c�//_� �� Engineer's Name NEW CONSTRUCTION REPAIR Telephone# Land Use Slopes(9io) Surface Stones Distances from: Open Water Body fit Possible Wet Area ft Drinking Water Well ft - Drainage Way --__ ft Property Line -__ft Other ft SKETCH;(Street name,dimensions of lot,exact 1 lions of test holes&pert tests,locate wetlands?n roximit p y to holes) QDLl Parent material(geologic) Depth to Bedrock Depth to Groundwater. Standing Water in Hole: Weeping frolA Pit IipCe --------------- Estimated Seasonal High Groundwater Method Used: DETERMINATION FOR SEASONAL HIGH WATER TABLE Depth Observed standing in obs.hole: Depth to weeping from side of obs.hole: in, Depth to soil moftleS: In, Reading Date: Index Well level Index Well# in. Groundwater Adjustment Ad factor Adj.b -- ft. . J mundwater Lgvet,�, PERCOLATION TEST bate Time Fin W rTime at 9"Time atk TimeTime(9".6") ch !� t Site Suitability Assessment: Site Passed Sits Failed: _ . Additional Testing Needed(Y/N) Original:.Public Health Division Observation Hole Data To Be Completed, on Back----------- ***If percolation,test is to be conducted within 100,.of wetland,you must first notify the Barnstable Conservation Division at least one(1)week prior to.begirining. Q:ISEPTICIPERCFORM.DOC DEEP.OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil i Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,'Boulders. on i tenc rave D4Q W � l • G0 DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil" Other ° Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. onsi to %Grav /Y DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.), (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Con iste c o Grave DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones;Boulders. Consi ten Flood Insurance Rate Mal!: / Above 500 year flood boundary No_ Yes Within 500 year boundary No K Yes„L Within 100 year flood boundary No Yes Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervi us aterial exist in all areas observed throughout the area proposed for the soil absorption system? If not,what is the depth of rurally occurring per ious material?V` Certification I certify that on � � (date)I have passed the soil evaluator examination approved by the . Department of Enviro mental Protection and that the above analysis was performed by me consistent with . the req uired training, erti nd xp ie ce described in 310 CMR 15.017. Sign atu Date Q:\SBPTIC�PERCFORM.DOC i / _ V i \ )e"t o� Ig9 BORTOLOTTI CONSTRUCTION,INC. 765 WAKEBY ROAD,MARSTONS MILLS, MA 0264 l��F 508-771-9399 508428-8926 FAX: 508-428-9399 & y SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION Property Address: Date of Inspection: - ns ctor's Name: ,� , -, h Owner's Name and Address: ' / , _ `. CERTIFICATION STAT M NT- I certify that I have personally inspected the sewage disposal system at this address and that the informa- tion reported below is true,accurate and complete as of the time of inspection. The inspection was per- formed based on my training and experience in the proper function and maintenance of on-site sewage disposal,6'ystems. The System: - Passes Conditionally Passes Needs Further Ev uation B the Local Aproving Authority Fails f Inspector's Signature: Date:-.. 7 7 The System Inspector shall submit a copy of this inspection report to the Approving authority within thir- ty(30)days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the Department of Environmental Protection. The original should be sent to the system owner and copies sent to the buyer, if applicable and the approving authority. INSPECTIONSUMMARY: A)SYS M TASSES: I have not found any information which indicates that the system violates any of the failure criteria as defined in 310 CMR 15.303. Any failure criteria not evaluated are indicated below. B)SYSTEM CONDITIONALLY PASSES; One or more system components need to be replaced or repaired. The system,upon comple- tion of the replacement or repair,passes inspection. Indicate yes,nor,or not determined(Y,N,OR ND). Describe basis of determination in all instances. If not determined",explain why not. The septic tank is metal,cracked, structurally unsound,shows substantial infiltration or exfiltration,or tank failure is imminent. The system will pass inspection if the existing sep- tic tank is replaced with a conforming septic tank as approved by The Board of Health. Sewage backkup or breakout or high static water level observed in the distribution box is due to broken or obstructed pipe(s)or due to a broken,settled or uneven distribution box. The system will pass inspection if(with approval of The Board of Health): - I _ r y SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A 7 / G' Lw / CERTIFICATION(continued) J Broken pipe(s)replaced Obstruction is removed Distribution Box is levelled or replaced The System required pumping more than four times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of The Board of Health): Broken pipes)are replaced Obstruction is removed C)FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: Conditions exist which require further evaluation by The Board of Health in order to determine if the system is failing to protect the public health, safety and the environment. 1)SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: Cesspool or privy is within 50 Feet of a surface water Cesspool or privy is within 50 Feet of a bordering vegetated wetland or a salt marsh. 2)SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH (AND PUBLIC WATER SUPPLIER,IF APPROPRIATE)DETERMINES THAT THE SYSTEM IS FUNCTION- ING IN A MANNER THAT PROTECT THE PUBLIC HEALTIi AND SAFETY AND THE ENVIRONMENT: The system has a septic tank and soil absorption system and is within 100 Feet to a surface water supply or tributary to a surface water supply. The system has a septic tank and soil absorption system and is with a Zone I of a public water supply well. The system has a septic tank and soil absorption system and is within 50 Feet of a private water supply well. The system has a septic tank and soil absorption system and is less than 100 Feet but 50 Feet or more from a private water supply well, unless a well water analysis for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from the facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm. D)SYSTEM FAILS: I have determined that the system violates one or more of the following failure criteria as defined in 310 CMR 15.303. The basis for this determination is identified below. The Board of Health should be contacted to determine what will be necessary to correct the failure. Backup of sewage into facility or system component due to an overloaded or clogged SAS or cesspool. Discharge or ponding of efluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool. Static liquid level in the distribution box above outlet invert due to an overloaded or clog- ged SAS or cesspool. Liquid depth in cesspool is less than G"below invert or available volume is less than 1/2 day flow. Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped -2- t SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Any portion of the Soil Absorption System, cesspool or privy is below the high groundwater elevation. Any portion of a cesspool or privy is within 100 Feet of a surface water supply or tributary to a surface water supply. Any portion of a cesspool or privy is within a Zone I of a public well. Any portion of a cesspool or privy is within 50 Feet of a private water supply well. Any portion of a cesspool or privy is less than 100 Feet but greater than 50 Feet from a private water supply well with no acceptable water quality analysis. If the well has been analyzed to be acceptable,attach copy of well water analysis for colifornn bacteria,volatile organic compounds,ammonia nitrogen and nitrate nitrogen. E)LARGE SYSTEM FAILS: The following criteria apply to a large system in addition to the criteria above: , The design flow of a system is 10,000 gpd or greater(Large System)and the system is a significant threat to public health and safety and the environment because one or more of the following . conditions exist: The system is within 400 Feet of a surface drinking water supply The system is within 200 Feet of a tributary to a surface drinking water supply The system is located in a nitrogen sensitive area Interim Wellhead Protection Area (IWPA)or a mapped Zone II of a public water supply well. The owner or operator of any such system shall.bring the system and facility into full compliance with the groundwater treatment program requirements of 314 CMR 5.00 and 6.00. Please consult the local regional office of the Department for further information. SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Check if the following have been done: r�_Pumping information was requested of the owner,occupant,and Board of Health. ✓None of the system components have been pumped for atleast two weeks and the system has been receiving normal flow rates during that period. Large volumes of water have not been � ntroduced into the system recently or as part of this inspection. As-built plans have been obtained and examined. Note if they are not available with N/A. _ The facility or dwelling was inspected for signs of sewage back-up. The system does not receive non-sanitary or industrial waste flow. _ /The site was inspected for signs of breakout. ✓All system components,excluding the Soil Absorption System,have been located on site. The septic tank manholes were uncovered,opened,and the interior of the septic tank was in- spected for condition of baffles or tees, material of construction,dimensions,depth of liquid, nth of sludge,depth of scum. The size and location of the Soil Absorption System on the site has been determined based on existing information or approximated by non-intrusive methods. -3- s SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST(continued) -The facility owner(and occupants,if different from owner)were provided with information on the proper maintenance of Subsurface Disposal System ..SUBSURFACE SEWAGE DISPOSAL'SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION FLOW CONDITIONS RIFSMFNTIAI,o Design Flow: 33D gallons Number of Bedrooms: Number of Current Resid nts: -� U a/ Garbage Grinder: Laundry Connected To System: F?�' Seasonal Use. Water Meter Readings,if available: Last Date of Occupancy: ? " )na _ COMMERCIATANDUSTRIAL: Type of Establishment: Design Flow: gallons/day Grease Trap Present: (yes or no) Industrial Waste Holding Tank Present: Non-Sanitary Waste Discharged To The Title V System: Water Meter Readings,If Available: Last Date of Occupancy: OTHER: Describe) Last Date of Occupancy: GENERAL INFORMATION l . �e y PUMPING RECORDS and source of informal' n: � *, G'' `. ��L System Pumped as part of inspection: If yes,volum umped: gallons Reason for pumping: TYPE SYSTEM: Septic Tank/Distribution Box/Soil Absorption System Single Cesspool Overflow Cesspool Privy Shared System(If yes,attach previous inspection records, if any) Other(explain): "Pilo TE AGE of all components,date installed(if known)and source of information: C) 2 > , _ I Sewage odors deteck when arriving at the site: -4- SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C GENERAL INFORMATION (continued) SEPTIC TANK: Depth below grader Material of Construction: 6 concrete metal FRP Other (explain) — Dimisions:V',S'k Cn Y 65' Sludge Depth; Scum Thickness: L)o 1-2,c Distance from top of sludge,to bottom of outlet tee or baffle: -3.G � Distance from bottom of scum to bottom of outlet tee or baffle: n gky C. Comments: (recommendation for pumping,condition of inlet and outlet tees or baffles,depth of liquid 1 el in re lion to oullet invert,structural integrity,evidence of leakage,etc.) CZ-, t GREASE TRAP:NCB Depth Below Grade: Material of Construction: concrete metal FRP Other (explain) — — — — Dimensions: Scum Thickness: Distance from top of scum to top of outlet tee or baffle: Comments: (recommendation for pumping,condition of inlet and outlet tees or baffles,depth of liquid level in relation to outlet invert,structural integrity,evidence of leakage,etc.) TIGHT OR HOLDING TANK: Depth Below Grade: Material of Construction:—concrete—metal_FRP Other(explain) Dimensions: Capacity: gallons Design Flow: t;allons/day ' Alarm Level- Comments: (condition of inlet tee-condition of alarm and float switches,etc.) DISTRIBUTION BOX: Depth of liquid level above outlet invert: ', Comments: (note if 1 el and distribution is equal,evideb a of solids carryover,evidence of leakage into or ut of box,etc.) e CL , PUMP CHAMBER:�Cl Pump is in working order: Comments:(note condition of pump chamber,condition of pumps and appurtenances,etc.) -5- 3 F SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) SOIL ABSORPTION SYSTEM(SAS): (Locate on site plan, if possible;excavation not required,but may be approximated by non-intrusive methods) If not determined to be present,explain: Type: Leaching pits,number:_L Leaching chambers, number: Leaching galleries,number: Leaching trenches,number,length: Leaching fields,number,dimensions: Overflow cesspool, number: Comme ts: (note condition of soil,signs of hydraulic failure level of nding,condition of vege Lion, etc.) (: ,( , CESSPOOLS:AZ) Number and configuration: Depth-top of liquid to inlet invert: Depth of solids layer: Depth of scum layer: Dimensions of Cesspool: Materials of construction: Indication of groundwater: Inflow(cesspool must be pumped as part of inspection) Comments: (note condition of soilk,signs of hydraulic failure, level of ponding,condition of vegetation, etc.) PRIVY: /0- Materials of construction: Dimensions: Depth of Solids: Comments: (note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation, etc.) -6 - i SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) SKETCH OF SEWAGE DISPOSAL SYSTEM: Include des to atleast two permanent references, landmarks or benchmarks. Locate all wells within 100 Feet. r'q�� t DEPTH TO GROUNDWATER: Depth to groundwater: / y Feet Method of Determination r Approximation: / ,�j� 0' `Yen, Gro� cal a ve rau�r w� -7- No.._.g.6.....50� Fu��a..�..._ THE COMMONWEALTH OF MASSACHUSETTS P + 9 73 BOARD OF HEALTH (/V'�'V ....O F...... / ` ( � Appliration for Disposal Works Tonstrnrtiun Errant Application is hereby made for a Permit to Construct (?,�or Repair ( ) an Individual Sewage Disposal System at: .. - - Location-Address or Lot No. .. �.� ................ W O V, �p�� Address f//�C_F4 Installer t Address dType of Building Size Lot___1..: .._..Sq. feet Dwelling—No. of Bedroorps:.._..... ............................Expansion Attic k4_�' Ga b ge Grinder(--)— p`4 Other—Type of of persons....... ............. Showers,-(- )'— Cafeteria' a' Other fixtures ............................ . ---- ---------•--------•----•.............: W Design Flow.................s,..) .._..__._gallons per person per day. Total daily flow.......__._.—�_._�-.P..............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.........I......... Diameter.......LV..... Depth below inlet... ... Total leaching area.... �. sq. ft. Z Other Distribution box (i Dosing tank -e—) - '-' Percolation Test Result Performed by__ t -. .__.�.. ............. Date...._ Test Pit No. 1.....—.Z- nnutes per inch Depth of Test Pit--- `.... Depth to ground water..'_..../.0.......... 44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ Ri' •• Description of Soil-•••-•--•-•-- _ ... - c.....9�- . --••--------------------------•----•----------------...------------•-•-•-••----•-•--•----.----- W ---------------------------------------------------------------------------------------•----------------------...--------------....-------------------------•-•----•------...-•---•-••-••......--...---- U Nature of Repairs or Alterations—Answer when applicable.................................................................................0.._..._._.__. ......................� •-•-----•---------------------••----•.._----••..... . ------------------. --•-••---••-••••-----------------••-......•-••••-•••••-•-•-••---..- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TLNIZj 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of Nealth. , Signed.-!I/�-a � �'� .--.--•----------------------------------- -----------......... ---•- Application Approved By.............................:. ate Date Application Disapproved for the following reaso s: --•-•--•-- ---••-. . •--•--. ...---• ---------- .................................•------...................................................................................... ----------•-----•-•••-••••••----•--------••---••-•---------•------...... Date PermitNo......................................................... Issued....................................................... Date •4 I ! No................_....... Fims............._............... . THE COMMONWEALTH OF MASSACHUSETTS ,L BOARD OF HEALTH ...•----... .... �.. ..�? ./= Aplifiration for Disposal Works Tontrnrtion thrutit Application is hereby made for a Permit to Construct (✓)"or Repair ( ) an Individual Sewage Disposal System at: •-•--••-----•••.................................'--..... ............ Location-Address 11 ") or Lot No. - -� L..:� - --l '' r.....----.. 1. .i .....k-n ...........!_.23...L.......... O n a ='-•.. ................�_�._:._f__�:.,�.� �= .......Address..._.....�G.��t"f.._...... Installer t �` Address Type of Building Size Lot...Z�...._©........Sq. feet Dwelling—No. of Bedrooms............................................Expansion Attic Garbage Grinder-(--')` aOther—Type of Building �._ �? '?_. ?'No. of persons.....__.e. ............ Showers ( ') — Cafeteria"(�) Other fixtures ------------- --------•-•—--------- W Design Flow.................. =3-•-.---------gallons per person per day. Total daily flow_...._.__._:--- --�._G.............gallons. WSeptic Tank—Liquid capacity. �9gallons Length... Width... ..". Diameter________________ Depth.............. x Disposal Trench—No...................... Width.................... Total Length................._. Total leaching area--__-��------sq. ft. Seepage Pit No..........�......... Diameter.......�__?_._... Depth below inlet.._.3_..` _._. Total leaching area.............�sq. ft. Z Other Distribution box (b,)" Dosing tank-(-")— Percolation Test Results Performed by.... -� : .................................................. Date ----------------- ................�� Test Pit No. I....... .-minutes per inch Depth of Test Pit____ ______________ Depth to ground water--------_..._._.......... fT4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water....................... f� ............ i_...- O Description of Soil................/1'J...............................................................Cl x -••----------•--•--------•---•--•-•----••-•--•••--•••--•••-----•----•-................. •••--•---•-••---...••••-•---••-•----•---•--•---•---••----••--••-•-•--•------•------------------•••--•-•-••-•-•----------•••----•••----•---•---•----•-•--•-•---•••-•--------•--••--•---•-•.......--••--. U Nature of Repairs or Alterations—Answer when applicable._.............................................................................................. Agreement:- \ G,J The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TIT1Z- 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. Signed--- )t!1 =2��'- L :. �, d Ali r� ate -••-•-••....Application Approved BY = Z= Date Application Disapproved for the following real s:---•-••-----••--••••--•-•-••--•----•...•--•-•------•-•--•----•-••--•••-----•••-•---••-••----•--••----•••-------. -••• •----...-•-•-••-------•---•-•---....-•---------•. --------------------------------------------------------------- Date PermitNo......................................................... Issued-....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH e ..........1c7 u>1I.............O F.......4j..J��'.'�..`�. .............................. uprrtif iratr of Tomplianrr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( or Repaired ( ) bY..............�. -..3. ..:. _...-•---• .Z �... ..�r _...--- �' `£' t'�--•------•� '� .-tL` 4„ ..... Install at.---•--. `r �-� /. .G � -- w -- .5 l l v e '" has been installed in accordance with the provisions of TITIZE 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No......................................... dated------------------------------------------------ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE................................................................................ Inspector.................................................................................... THE COMMONWEALTH OF MASSACHUSETTS ------- BOARD OF HEALTH L-�? 'r ........OF.... '�'�f �....:..• •. .................................. FE Disposal Works C nstrnrtion pamit. Permission 1 hereby granted.....- 1)- - ---. --�.- to Constru t (�'� or Repair ( d an Individual Sc�age Disposal S tem at No..-- ��® r / _ t� r L y :1 0.:- �- -- . k 0 ------------•-•••-.............-••-•••---•--•---••••-••-•................... Street as shown on the application for Disposal Works Construction Permit Nov.6 _5_611-__ Dated.......................................... .......................................... 0. I e 1th - - ------••-•----------------_ DATE---'V)- --1-0------Qkv-....................................... FORM -1255 HOBBS & WARREN. INC.. PUBLISHERS TOWN OF BARNSTABLE icJ 1,6CATiO�i C.� ' / �,�'�J�J .�i �7�C� SEWAGE # /7/ VILLAGE OrrAlf/e,20. (° ASSES R'S MAP&LOT /63 Tj SPm?Ok S.NAME&PHONE NO. SEPTIC TANK CAPACITY IG�'l _ i� // LEACHING FACILITY: (type) ,� (1i� (size) A 0 ,�C/L, NO.OF BEDROOMS-3 BUILDER O PERMITPATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and 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 leachingfaciJkty4, Feet Furnished by Z Z— �g���` -3 i - TOWN OF BARNSTABLE �l71�03� LOCATION b`� 1 5 �Co.\e� Sew\C��� SEWAGE # �LLAGE c Pry e�y \\ p ASSESSOR'S MAP & LOT3OG INSTALLER'S NAME & PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY:(type) (J 11,4k- (size) 6 6 C) NO. OF BEDROOMS _PRIVATE WELL O PUBLIC WATER BUILDER OR OWNER_ O DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No t, l la) Q 0 9 1) IIII:IIII:IIIIIII i '!i' �'�•.I lil ll� L._ - F II C = 1 n ro � I J Ri A C qu� ! l .I i I i ci t, 1 �46 6pfi w i i I t9 0 I �• - A ED 03 ON y it I p — WkJC+ - — I I i� �• IS �{ I i I II N — a , I q .11 f' � '{Nl'vl P � Ni 1 4 �• -q D UY � Q1 V0j paaa�SS9 0? Q $ I r FI�I Uo •7 'c� � ' � � � I b i B a J9 f lo-lKwtCM�Ct3T .-r•1T,— I a. f1l' i } A ; h i - I ' U _ h= r n i� II w I II S 1. i4 N N` �i I. I N 1 I I II 'fi P 14 Ln I I it I nlll 111 If I j �I I P j � J I y �i � nne i g C i �. Po I F I. _� �} � a � �. :f• PSG �. r' t. ` G 1 • ,A pip :F• ;.o '� - 1 'i �."n,:`� .is� � �• � t. �� I..i. .. .�•� '1• i .i j S 0 1 L L 0 G R 6 7e 6v 4 aT Z7 '2 DATE: 29 0T ? +N WITNESSED BY: A/ 7 . Jlo 9, 24" -F-Z- =7 C 14 7 4- 15 f 00 , tn(o /Vl)jF"r-) (JAII X IT I N a 7 0 7z 6-1, (3 cc I- MANHOLES AND COVER TO BE BUILT WITHIN ELEV. TOP OF 0*.�:: FOUNDATION OF FINISHED GRADE . (s i I KA I N. 2,1.1' SLOPE 6 Ir'',ill rt 'INISHED GRADE-_vl' ,- --_ IRO 4!'CAST 0 R 4!7 P V C SC N . . ' '.: 40 IST 'R'-, PVC SCH. 40 PITCH I• CH FT. 7— /,.:57 4. MIN. 2" LAYER 10 I ITCH i/8" 1/2" PEA S T O N E d4e. /I 4." T c:) 7. 08, INVERT 4 GALLON INVE 1,NVE R I V E R T 0 314te- I 1/2"D I A . i SE PT ICTANK 3 INVERT -5 4U tj WASHED STONE HACH INVERT "i C:I 0 ALL AROUND . < cl P/ 77 mwv X \ to' 2 3�5t GARBAGE (L 0 M IN. _j bl*.� ELEV. BOTTOM GRIND 3 Of PIT 0' MIN_ a 6-6'D I A43 0 00 4f 4 ELEV. PROFILE OF GROUND WATER TABLE Per- L-07-1,574 S A N I T A R Y DISPOSAL SYSTEM t P /Z�>Ez .5,E Jz vr NOT TO S C A L E DESIGNN DATA BEDROOMS 0 CONSTRUCTION OF SANITARY DIS P 0 S A L DESIGN FLOW DAY SYSTEM SHALL CONFORM TO MASS. —GAL ./ LEACH RATE MIN./INCH E NVII RONME NTAL CODE TITLE V (REVISED 7- 1 - 77) AND THE TOWN OF PROPOSED LEACH CAPACITY : HEALTH REGULATIONS. 7)- 4- /. 0 7;�-(6) 'Z e SEPTIC TANK,, DISTRIBUTION BOX AND LEACHING PITTO BE OF REINFORCED CONCRETE : GAL/DAY MIN. CONCRETE STRENGTH 3000 PSI MIN. STEEL STRENGTH 2QOOOPS I H 10 DESIGN LOADING * DRIVEWAYS MOTTO BE LOCATED OVER SYSTEM UNLESS H - 20 DESIGN LOADING IS USED. ALLPIPES AND FITTINGSTO BE WATERTIGHTAND TO BE OF CAST IRON OR SCHED 40 P.V. C. SH.1- OF SHS 'SITE PLAN SHOWING PROPOSED CONSTRUCTION LEGEND L 0 C A T 1 0 N: a/_ 16 f"7_,F�Z of L Lf rY-) --C) FOR : L 0 C', <�JZ P. APPROVED 19 SCALE: DATE : BOARD OF HEALTH BUILDING SETBACK REGULATIONS PER EXISTING CONTOUR R E F E R E N C E: Z- c 7- 1--,4 e;Iev e/< 3 (o BUILDING INSPECTOR OR BU ( LD [,NG PROPOSED CONTOUR DATE AGENT COMMISSIONER . rq E7, 7;R> c MIN. FRONT SETBACK EXISTING SPOT ELEVATION 17. 6 - F MIN. SIDE SETBACK PROPOSED WATER SERVICE _W_ r. OF TEST HOLE LOCATION C MIN. REAR SETBACK CIVIL cn C . R . SHORT, - INC . No. 27463 GISTE PROFESSIONAL LAND SURVEYORS & ENGINEERS AL a- .Al� r I,, Y jll� 3/4 - I 3: W A 15 H ALL L W4 E L E 1586 MAIN STREET (RTE. GA), EAST DENNIS, MASS. 02641 J N. --_� ASSESSORS MAP : �. PARCEL : j TEST I-IOLL LOGS—(J;�" INO -- FLOOD ZONE: II,, II (� SOIL EVALUATOR : Y c` ) ', with 'Title V and Town ol`4V)1 � Board of �_ _._�_�_.__ . i � 1 The installation shall c.onr,. REFERENCE: - WITNESS . C W V J 1(Q� I I Ieallh Regulations. `� _ it l �t�✓__ ll _ "`1__ _ 1 DATE: 1 bl 2) The installer shall verify the location of utilities, sewer inverts and septic PERCOLAI ION RATE: .-C APAII / components prior to installation and setting base elevations. 3) All gravity septic piping to be 4 inch Sch 40 PVC at 1/8"per foot. The first — �— two feet out of the d-box to the leaching shall be level. TIl- I TN-2 4) 'Phis plan is not to be utilized for property line determination nor any other purpose other than the proposed system installation. I Mr) 5) All septic components must meet 'Title V specifications. 6 �*4 6) Parking shall not be constructed over F110 septic components. �i tb &J/ `� �� I6 (& `2� 7) The property is bounded by property corners and property lines. LOCATION MAP �� �I� / 8) The property owner shall review design considerations to approve of total design flow and number of bedrooms to be considered for design. Receipt �� �r✓ of payment for the plan and installation based on the plan shall be deemed ell (b p 2�� 9) approval of the design flow by the owner. The existing leaching or cesspools shall be pumped and tilled with material per Title V abandonment procedures. Those within the proposed SAS shall r1, Ip 01110 � .,� be removed along with contaminated soil and replaced with clean sand per �' Title V specs. I 10 System components to be 10 feet from water line.Y P Sewer Imes crossing the BRALE'Y JE'NKINS RQAD water line shall be sleeved with 4 inch SCII 40 PVC with ends grouted if applicable. The proposed SAS is being installed below the water service line. The line is to be sleeved as aforementioned and maintained in dace. SEPTIC SYSTEM DESIGN 11) If a garbage grinder exists it is to be removed and is the responsibility of h � - N.27 05'38"E 100. 00'. r _ � 1 y the owner to ensure such. FLOW, ESTIMATE ! 12)The installer is to take caution in excavation around the gas line if such 'I w 1 exists. BEDROOMS AT 11� GAL/DAY/BEDROOIA - 5�GAL/DAY 13)The installer shall verify the location, quantity and elevation of the sewer i j lines exiting the dwelling`prior to the installation. SEPTIC TANK 14)This plan is representative only that a system can fit on a property ineetin 1 P Y g Title V requirements. GAL/DAY x 2 DAYS GAL 3 ✓� -- USE GALLON SEPTIC TANK G7C1 Its .o `HSE 46 - __OIL ABSORPTION SYSTEM LOT 154 - _ - `�== - - LOT 152 `Ltd � �J�� (�✓ L `� 6 ti�b�,� 186y 3Q IH. U J 14 P Tm ( b SIDE AREA: 0 3S, D30 a & o BOTTOM AREA: Z ZAt22 OF v ' { Q $1/ ' �t� Mg�s ` � DAVID icy ` Aryl✓ ��>7 �tTv(� •• � - 10 8 N m SEPTIC SYSTEM SECTION v No lti 1`11�U9-T 153 t la� �-q(� ! rl�f� '� Cl�(ll�l n ln'� ,lL l�l(o R'�W A 1 4J _ __ I - - o1�,Ck � 1`G1? I1U{� tlll✓�='R-Bl r'�I _ 100G) GAL It - 1z SEPTIC TANK I TE AND S EVIAGE PLAN 4V0U- ° PRI_PARED FOR �t SCALE : UX �31 1�0 DAV I D Q MAS014IRS DATE : 2 DBC ENV I RONMENTAL DES I GIJS OAST SANDWICH . MA IIEALTII AGENT ( 50� ) 833- 2 i 77 a DATE w