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HomeMy WebLinkAbout0033 CAP'N LIJAH'S ROAD - Health FE133Cap'n LijaWs Roadterville 192 158 to#=—LQ)h%, 0� .1 La R . �PoSf. N MASTINGI, MN No. FEE COMMONWEALTH Of MASSAC14USETTS R" Board of Health, rSa -'k f- -&6/o— MA. APPLICATION FOR DISPOSAL SYSTEM['l[ CONSTRUCTION PERMIT Application for a Permit to Construct( ) Repair( Upgrade AbandonO - ❑Complete System/ \ dividual Components Location -33 6LA Owner's Name Map/Parcel# Z ! Address S _ Lot# 3 Telephone# '7 l -SS3 Installer's Name Designer's Name 67 Address 6l �/ Address / / ,„, Lh o ZG � Telephone# Telephone# ,V7—yZ,J;7— Type of Building ��f/®�/LC�� Lot Size /�i r t sq.ft. Dwelling-No. of Bedrooms '7' Garbage grinder ( ) Other-Type of Building No.of persons Showers ( ),Cafeteria ( ) Other Fixtures Design Flow(min.required) gpd Calculated design flow Design flow provided Y�/' Z— gpd Plan: Date OIL., Number of sheets I Revision Date Title } Description of Soil(s) l 0 Soil Evaluator Form No. Name of Soil Evaluator G Aate of Evaluation DESCRIPTION OF REPAIRS OR ALTERATIONS The undersigned agrees to install the above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and further agrees to not to place system in operation until a Certificate of Compliance has been issued by the Board of Health. Signed Date Inspe tic one. '� Vex„- e No. r® N �S FEE T -,in C04MONWEALTH OF MASSAC14USETTS J r. Board of Health, rSa'h 1 tE Qlo 1Z MA. / APPLICATION FOP, DISPOSAL p\P \AL SYSTEMEM CONSTRUCTION PLR MIT i Application for a Permit to Construct( Repair( Upgrade ;Abandon( - 0 Complete System Individual Components Location' Owner's Name 45 i 44,t All Map/Parcel# /g Z /5St Address S a -S- Lot# 3 Telephone# '7 7 / -SS 3�o Installer's Name; 0 Designer's Name 4eJ Address E5/ Owf�'l9 � Address / l W& j4k L6 Telephone# Telephone# t Type of Building IZ f/ /LG� Lot Size i9 � sq.ft. Dwelling-No.of Bedrooms T Garbage grinder ( ) Other-Type of Building No.of persons Showers ( ),Cafeteria ( ) Other Fixtures Design Flow(min.required) / JV 6 gpd Calculated design flow ��D Design flow provided Z- gpd Plan: Date /y DI., l-7 7',"Z Number of sheets Revision Date Title Description of Soil(s) l 0 Soil Evaluator Form No. Name of Soil Evaluator L- Date of Evaluation DESCRIPTION OF REPAIRS OR ALTERATIONS The undersigned agrees to install the above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and further agrees to not to place the system in operation until a Certificate of Compliance has been issued by the Board of Health. _ 'Signed Date Inspections hul No. V FEE , - - COMMONWEALTH 1�ALTH OF MASSAl.itltiL SETT Board of Health, )Ta',"J 60-10 ZP , MA. CERTIFICATE OF COMPLIANCE Description of Work: Xmdividual Component(s) ❑Complete System The undersigned hereby certify that the Sewage Disposal System; Constructed ( ),Repaired ( ),Upgraded,Abandoned ( ) by: /� at IJ CGQ.s-O '% i'iG' f �141 y�` has been installed in accordance with the provisions of 310 CMR 15.00 (Title 5) and the approved desigrr plans/as-built plans relating to application No. dated Approved Design Flow z- (gpd) Installer / n Designer: Inspector: `/1 4-d, Date: ?\ The issuance of this permit shall not be construed as a guarantee that the system will function as designed. No. g FEE4 3-0 i COMMONWEALTH OF MASSACHUSETTS 19 Board of Health, ��h i eAk6f , MA. DISPOSAL SYSTEM CONSTRUCTION PERMIT Permission is herebygranted to; Construct( ) Repair( ) Upgrade(�andon( ) an individual sewage disposal system at 3 3 Co-, �n L� �Gt ti J p( 74A,(/i, CQ as described in the application for Disposal System Construction Permit N ' / dated t Provided: Construction shall be completed.wit �n t ree years of the date ofrp�r (�[f/1�� cal cond' 'ons must be met. Form 1255 Rev.5/96 A.M.Sulkin Co.Boston,MA Date t oard of Health ��%/ TOWN OF BARNSTABLE C LOCATION S ���H L!✓64 45. SEWAGE # �00 • //� VILLAGE /' s � d09✓����" ASSESSOR'S MAP & LOT/?2� /S8 INSTALLER'S NAME& PHONE NO. 0J - V20- 9738' SEPTIC TANK CAPACITY /DOa LEACHING FACILITY: (type)J-100 (size) NO. OF BEDROOMS y BUILDER OR OWNER A*t, i / C-e7-/' PERMITDATE:` l-DiL 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 leac 'ng facility) Feet Furnished by �r v Ile TOWN OF BARNSTABLE 6C LOCATION �' �6�fOl// /VO4 9 SEWAGE # aVae' VILLAGE �' Y��B09�f � ASSESSOR'S MAP & LOT/�f2� /�8 INSTALLER'S NAME& PHONE NO. SEPTIC TANK CAPACITY 1,0100 j LEACHING FACILITY: (type).3-f00 G4l 10"ev�1l (size) NO. OF BEDROOMS 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 leac 'ng facility) Feet Furnished by hT V` �G N�, y o..."'. FicE... .................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH � ( ClZ� ®. _. . ..........OF.... .. -s�.�?.✓..P� 1..^�. ............... �x$17 Apphration -for 43ii mal lVarkii Tomitrurtion Prrulit Application is hereby made for a Permit to Construct ( or Repair ( ) an Individual Sewage Disposal System t Locati�- dress �� or Lot No. !r z/ S1 � ............... �.Q�. a -------------------•----------------- dos A s Installer Address Q Type of Building Size Lot_z7xi � . feet U Dwelling—No. of Bedrooms..................................... .Expansion At 'c � Garbage Grinder T'U !////��/ per, Other—Type of Bttilding �r �,�_______ No. of perso�ts____________ _____________ Showers ( ) — Cafeteria ( ) a' Other fixtures ____________________ ____ d .... per person per day. Total daily flow------------- ...........-gallons. WSeptic "Tank—Liquid capacity` r allons Length---------------- Width................ Diameter---------------- Depth.--._-_.__----. x Disposal Trench—No .................... Width-------------------- Total Length----------_------- Total leaching area--------------------sq. ft. Seepage Pit No....... __ iameter.....4ao<.a._ Depth below inlet.................. Total leaching area...-.-_.---._-_--sq. ft. Z Other Distribution box ( ) Dosing tank ( ) �'�-- �— 76 aPercolation Test Results Performed by------------ ------- ----------------------------------------•--•••--••••• Pate--------------------------------------- ,� Test Pit No. 1................minutes per inch Depth of "Pest Pit-------------------- Depth to ground water....-----.-.------------ �14 Test Pit No. 2----------------minutes per inch Depth of Test .Pit.................... Depth to ground water-.._--_--__.______-_---. P4 -------------------- - --- ................................................. Description of Soil--` '� `�' 'it... ---- -_ .�----"--- --- -- -- -- ----- ------- l� a ­_ c, - , . .. V Nature of Repairs or Alterations— w wer hen appl' ble------------------------------------------------------------------------------------------------Agreement: The undersigned agrees to install the aforedescribed idual Sewage Dispo stem in accordance with the provisions of Article XI of the State Sanitary Code Th ndersign d furtl agrees n to place the system in operation until a Certificate of Compliance has been ' e the bo hea Signed._. . ------------------ Date ApplicationApproved By--•••---•••--•••-----------------•--•-•••-••-••••-•--••-••--••---......._........-----•--------. --•---------------..... --------------- Date Application Disapproved for the following reasons:-.-_---•------------------------- °'--------------------.---------------------•----.--•---•••-•--------•--------- ................................•----------------------------•••••--•------------•-•••••-•--••----•-•••--............-•-••••------•--.........--•••••----•...---------------------..........----------•-- Date PermitNo......................................................... Issued........................................................ Date No. yl " Fas....� .... THE COMMONWEALTH OF MASSACHUSETTS _ BOAR® OF HEALTH � Appliratioo -for Di-spa orkii C iamitrnrtion Permit Application is hereby made for a Permit to Construct ( or Repair ( ) an Individual Sewage Disposal System t --------------------------------------------------------------------- Lo atio - dress or Lot No. O r'"""' // Add/toss F-1 --••-- ...... -------•---------------------•- --•---•--•----•------ -F -...........---.................................................... Installer Address U Typeg .- ..--;Xe. S�j. feet of Building °""3 Size Lot_�� Dwelling—No. of Bedrooms------------------------------------------•.Expansion A c Garbage Grinder (10P pa, Other—Type of Building,-,X ------ No. of persons-------------. ............. Showers ( ) — Cafeteria ( ) a' Other fixtures ---------------------- ------------------------------- W Design Flow----------------- _3.-�;;.._.__--gallons per person pei day. Total daily flow.............. U.......__....gallons. Septic Tank—Liquid capacitv�V: allons Length................ Width................ Diameter.....----------- Depth.__-__-__.__---- xDisposal Trench—No. ............ ....... Width--------------------- Total Length-------------------- Total leaching area...............-----sq. ft. /- �n••� - Seepage Pit No._-_____ _-----__ iameter______ 4_0- Depth below inlet____________________ Total leaching area------------------sq. ft. Z Other Distribution box (' Dosing tank ( ) d 0— 7[-- 76 aPercolation Test Results Performed bY-------------------:...................................................... Date.......................... ------------- Test Pit No. 1................minutes per inch Depth 'of "Pest Pit.................... Depth to ground water........................ GZ, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water------------------------ ------------------- - -_-.- ---•---------------•-------------- Descript n of Soil / d' �s ('/ = �y - -Z1-•.. . - - -- -- - --- t W ------------- - (3 _II --- -- ------------- '----------- ............... U Nature of Repairs or Alterations—An$tver hen appli ble. ---------------------------------------------------------------------------------------- Agreement: The undersigned agrees to install the aforedescribed jndiyidual Sewage Dispoal.,.S. ttem in accordance with the provisions of Article XI of the State Sanitary Code The undersign furth t�agrees not to place the system in /�'" . operation until a Certificate of Compliance has been issu d`by the board'of healt� --- Stgned �'G` ----- .._... � r ApplicationApproved By_-----------------_-----•---•-- ---------••-------•-----•--•-•--••---•----------------------/ ....................Date.__..--------------- Date Application Disapproved for the following reasons:-------------•----------•--------•-------------•--•----•-----------------------.--•-•---------•-----•--••------- ------•••---•-•-•-••---------------------•--------------------•-•---------------•-•------•-----•---------------------------•- --•--•-•-•---•---•-•-•-------•-----------------•-------------------------- Date PermitNo......................................................... Issued........................................................ Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ...`....,rf'c..........................OF.............. ........ Y Trrtifirate of TlImpliatta THL a—S TO CF�RTIFY hat the Individual-Sewage Disposal System constructed ( ) or Repaired ( ) by L J cs_ - ----------•-•--- - •---•------ --------------------------------------------------------------------------- ----------- ------------------------------------- - 1 Instvller at.... ''. ' "/----- i �J� ----------- ------•-------•--•------------------------ has been installed in accordance with the provisions of A iple XI of t�3 a Sanitary /CCode as described in the application for Disposal Works Construction Permit No_ _______ __ _____-----_---__-__--_ dated_ ,!!P_ /_S C 7 THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM W�ILL F N/CT �ATISFACTORY.DATE--------- ----------- 1G Inspector THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH 7W ^'�s _ _ -. ... . O F.......... %'-"7 t/-r - ..�4- .......................................................... /, N -- FEE.-/t )------------ Dispotittl ork,o ClIomit urtio$t rrmit Permission is h •eby granted____--_--_<%'���? ............_�-sir✓-�______--''�'`�� ------•-------••--••-------------••-•-------------.------------ to Construct_( or Repair-( ) an Individual Sewage wage Di posal System at No...-----""'' > �-----------��`'' G�-r.�_:,� Street / as shown on the ap catio for Disposal Works Construction mit N _ ___________________ Dated----lJ..----- ....... / — --------- ----------------------------------------------------------- Board of Health DATE.......... ------- ---------------------- -----............................. FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS S�'t f � CID purr i -'� $/L L f1.E.✓.._--—--Ff...�T ADO✓E PO.d D L0CArioN JG,E^1Liz.✓.�d — SCAL4 _ '_- IDA T& CLAN 2EFr2ENC� : /NG l�) 2-74 ii OF v LO I A/bZ68Y C,6.eriFY TNA r THE Exisr- Y /NG F'OUND.Q T/ON 4OC;A7'/0ne /5 00ZAe4 R - 4s ,5wo AI A v�VD 7.�o�S__Co coQM WlrN. �» TNE $41/1-0/416 OF 7 • 4CLWAOI 1-04 -rA ZA _ `O 6t/EObV ST YM4QT N1A... .+ Masthead Ln. #47 CAP' N LIJAH 'S ROAD LOT 40 A. M . �" SITE 192/ 128 206 ,44 1 - 33.5 'L X 13 'W X 2 .0 ' D s leaching trench using 01d Sto e Rd. 3 H - 1 0 500 gal , chambers with 4 4' of stone on sides & ends, -I' °� a LOT L x AREA = 19 ,588± SQ. FT. gravel driveway 97,78' 7y 0 96,91' Q) n 9,19' I 0 o A. M , � 98,83' 0> m C� 0 5 HOLE Q 192/ 127 0) D— BOX 7,63' 0 25 ! catch basin X a' X 96,5 S �- � ?, /1)'. C GENERAL DOTES LOCUS Lu 'i a 9929' / M-� X 9 ,59' 1. ADDRESS: 33 CAP'N LIJAH'S ROAD NO SCALE �✓�� � 2. ASSESSORS NUMBER: MAP 192 PARCEL 158 ) 3. DEVELOPER'S LOT: LOT 3 ()890, X 97,72' f\ T 4. TOPOGRAPHIC INFORMATION WAS COMPLIED FORM AN GROUND1�1 ON THE INSTRUMENT X- d N it 5. MMUN CIPALWATER S ROVIDEDSTOVSITE AND L2 O o- O Q 97.5 X O Q� SURROUNDING PROPERTIES. QQ� Q0 6, REFERENCE PLAN: PLAN BOOK 274 PAGE 5 PERC TEST Cx SOIL EVALUATION 2 r,0vel I 7. NO WETLANDS ARE LOCATED WITHIN 100 FEET OF SAS. 8. NO POTABLE WELLS ARE LOCATED WITHIN 150 FEET OF SAS. Date of Pero. Test & Soil Evol.: March 13, 20028'79 - 1 II 96,26' 9. SITE IS NOT LOCATED WITHIN A ZONE IL Test Performed By: GLEN E HARRINGTON, R.S., CSE '/ J ?, 10. NO VARIANCES ARE REQUESTED. Witnessed By: David Stanton, Health Inspector V red mdpl.e (save)Excavator: Joe's Septic Service } 'I' CONSTRUCTION NOTES PERK TEST @ T.H. #1 X97 43 o Test Hole waived 1. Contractor is responsible for Digsafe notification No. 1 USE PERK RATE < 2 MPI (ASSUMED) and protection of all underground utilities and pipes. DEPTH SOILS ELEV. FOR DESIGN PURPOSES // B . 0 96, 96,54 2. The septic tank and distribution box shall be Set level on 6 of 3/4"-11/2" stone. 0 97.11' P10,184 O ;//Q' s 3. Backfill should be clean sand or gravel with no o/E � S ;'� stones over 3" in size. T.H, #1 4. This system is subject to inspection during installation B 97,11 by Glen E. Harrington, R,S. loa yweana k 5. The contractor shall install this system in accordance 28' 1orR5 s 94.78' �O °L 95,68' with Title V of the Massachusetts Environmental Code � S and the Regulations of the Town of Barnstable. C 1 e i 1 6. Provide a Acme Precast H-10 D-Box and 3 H-10 500 gal. chambers or equal. ed.—Coors �Q 96,83' / 7. No vehicle or heavy machinery shall drive over the son septic system unless noted as H-20 septic components. 8, Install gas baffle or equal on septic tank outlet tee end. 120" 25Y6/4 8711' �'j 9. All existing inverts and site conditions shall be verified by contractor. No GROUNDWATER ENCOUNTERED ��. 10. Existing 1,000 gal. septic tank to be pumped & inspected for structural integrity. Replace with 1,500 gal. septic tank, if necessary. S 11. This design plan is to be utilized for septic installation only. 12, Existing leaching pit is to be pumped and backfilled (location unknown). 1-20"WAM.ACCESS MANHOLE Design Calculations " X'` 95,33' Number of Bedrooms: 4 5' Garbage Grinder: No ~' Leaching Capacity Required: 440 Gal./Day Leaching Area Required: 440 Gal./(0.74 Gal./Sq.Ft.)=595 Sq.Ft. :a ;-1 Proposed Leaching Structure: 1-33.5'L X 13'W X 2'D Leaching Trench J I TE PLAN � I=] ® ® 24„ 34" Leaching Area Provided: 624 Sol,Ft. i SCALE: 1 "=20' Proposed Leaching Capacity: 462 gpd > 440 gpd, req'd. BENCH MARKON CORNER OF STEEL REINFORCED PRECAST CONCRETE 3 H-10 500 gal. chambers BRICK STOOP ELEV.=100.00' (ASSUMED) PLAN VIEW END-SECTION 4' S' 4' 2" of 1/8" To 1/4" 40 H-10 500 GALLON CHAMBER PEASTONE (WASHED) NOT TO SCALE © o © o USE ACME PRECAST OR EQUAL ® ® 24" MIN. 3 H-10 500 gal. chambers 4FAggs, PROPOSED SEPTIC SYSTEM UPGRADE 3/4" TO 1 1/2" WASHED CRUSHED STONE �' q> G EN y� PREPARED FOR TRENCH CROSS—SECTION o R PAUL E. GiBERTI NO SCALE .1070 AT a 33 CAP'N LIJAH'S ROAD 0 is *NOTE: ALL PIPES ARE TO BE 4" DIA. SCHEDULE 40 P.V.C. LEGEND ,9N/TAR�Q,'� BARNSTABLE (GENTERUILLE), MA 10' min. from *NOTE: INSTALL GAS BAFFLE OR EQUAL ON SEPTIC TANK OUTLET TEE. house to septic tank Finished grade over s stem=2% sloe away Septic tank covers must be 9 Y p Y EXISTING 1,000 GAL Existing House within 6" of finished grade 5 HOLE O o H-113 SEPTIC TANK PREPARED BY: First R. Elev.=100.6' DIST. BOX EX1STl ADE Existing Grade Elev.=97.7'± szx GLEN HARK NG 0 104.46 DENOTES EXISTING N t R.S. SPOT GRADE full 002' 36., max 9 LEDA ROSE LANE ' S=Ot level for 2' Min. 2" 1/8" 1/2" ' Cellar G o EXISTINC 15' S=01 washed stone Top Peostone Elev-95.62' 95- -- EXISTING CONTOUR M A R S T O N S MILLS, MA 02648 n SEPTIC TANK 21' Invert E .12' rn s s ® DEEP TEST HOLE P H-10 m N ® o®o 0 ffI4 �f Leach TEL: 508-428-3862 GAS OR EOVALE n 33.5 ench Elev.= 93.12' - Approx. location FAX: 508-428-3862 LEACH TRENCH - ------ - - -6" OF 3/4"-11/2" STONE v IIexisting water service > of T.N. #1 Elev.=87.11' SYSTEM PROFILE __. Approx, location SCALE: 1 "=20' DRAWN BY: GEH MAR. 13, 2002 6' OF 3/4"-11/2' STONE existing water service DATUM: ASSUMED FILE: GIBERTI.DWG SHEET 1 OF 1 Not to Scale c