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HomeMy WebLinkAbout0309 CAP'N LIJAH'S ROAD - Health 309 CAP'N LIJAHS RD. CENTERVILLE A = 193 138 No.42101/3 ORS► Pamd'o alvow 10°l0' ( ' o m o a No.r7�I S / / Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: ✓ i� Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS Z(ppYication for ]Digogar *pgtem Congtruction Permit Application for a Permit to Construct( )Repair( i/)Upgrade( )Abandon( ) El Complete System Ter Individual Components Location Address or Lot No. �� A / fl�,�/s 1, Owner's Nam ,Addressand Tel.No. Assessor's Map/Parcel 6?, ,v(/ %/ Ae ^®N le Installer's N e,Address,and Tel.No. Designer's Name,Address and Tel.No. 7 Type of Building: Dwelling No.of Bedrooms Lot Size Z sq.ft. Garbage Grinder(✓ Other Type of Building _ No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow 3 gallons. Plan Date WIA Number f sheets Revision Date Title — s) ,�%1 D C ✓I Z Size of Septic Tank idl-V �i�.��J`//l_Type of S.A.S. 2- Description of Soil / • S 3xZ� Nature of Repairs or Alterations(Answer when applicable) a z-z /,.v 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 issued by t=Barf He_alth. / 'l Signed Date X/Z GID Application Approved by Date e Application Disapproved for the following reas s Permit No.s` j� ' � Date Issued No.rzoi'r-7 / .v Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: ✓ V PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLEs MASSACHUSETTS Yes "I[pp ication for Mtgaal *p5tem Construction Permit Application for atPermit to Construct( )Repair( V)Upgrade( )Abandon( ) ❑Complete System Xilndividual Components Location Address br Lot No. / Owner's Nam ,Addr ss and Tel.No. 3o� L J Aocrox Assessor's Map/Parcel Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. Type of Building: ? Dwelling No.of Bedrooms J Lot Size Z7,Z7� sq. ft. Garbage Grinder(0 Other Type of Building /t!�e&i Z. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow �1 � gallons. Plan Date Number of sheets Revision Date Title r'/ 5 11a,17 O1 D co A Size of Septic Tank /a/y aPz .�i��s/`//14 Type of S.A.S. Z S0.0 Aq/ i Description of Soil 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 Certifi- cate of Compliance has been issued by this B ard.•f He lth. Signed 0 W/W Date 9/22�©� Application Approved by Date 2� 0 Application Disapproved for the following reasofis Permit No. Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CER Y,that 1he On-site Sewage Disposal System Constructed( )Repaired ( V<Upgraded( ) Abandoned( )by or1'110 �� at ?d 9 CA'�/l I Ili -5 fw, C.ell y`2l-4// P has been constructed in accordance with the provisions of Tittle 5 and the for Disposal System Construction Permit No. l". dated Installer Designer The issuance of this permits all not be construed as a guarantee that the system will function as defsignedf. Date 1 Inspector `"h=C, t L �—t No. CN�1�^—�^�/ ------------—---------1�— Fee TV) THE COMMONWEALTH OF MASSACHUSETTS/ PUBLIC HEALTH DIVISION - BARNSTABLEs MASSACHUSETTS =igpool *P!5 oXongtruction Permit Permission is hereby granted to Construct( )Repair( )Upgrade� )Abandon( ) System located at 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:Cons�sttru tion ust be completed within three years of the date of this a it. Date: Approved by , TOW l OF BARNSTAtBLE i -ol, 3o f 4R.d Z-1-raPr IM SEWAGE # P1GO S7/ ASSESSOR'S AP & LOT 113�/38 M ?y di?S a ALLER'S NAME&PHONE NO. i SEPTIC TANK CAPACT. - /.o0o 15;44 LEACHING FACILITY: (type) Sv0 Lp C L,wcs elwA. j (size) /.I J-,,v--sr'�a I- NO. OF BEDROOMS— BUILDER 3 'i O // PERMITDATE: ;kkz CONIPLIANCE DATE: ZJaU 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 - _ k" _J7 / S'y` - x„ A�5 1. TOWN OFBARNSTABLE ESL LOCATION �9 �a� L ��T��'Py SEWAGE,# VILLAGE 4'Y,Y ASSESSOR'S MAP & LOT 193-/JS INSTALLER'S NAME&PHONE NO._�o��o%��' �au��irti•�1io! ya2�89�G SEPTIC TANK CAPACITY LEACHING FACILITY: (type) f°0 %C Zvc4 ekwk-t�yJ (size) �a�3` ��1" j t NO. OFBEDROOMS BUILDER O �N PERMITDATE.—.. ,4 �d'� COMPLIANCE 'DATE: 5^ U Separation Distance Between the: Maxi-Um Adjusted Groundwater-la ble to the:Bottom of Leaching Facility Private Water Supply Well and Leaching -FaciLty (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 Illl � ids FILE No.462 03/21 '01 AN 10:32 1D:BOFTOLOTTI CONSTRUCTION FAX:50c,-"428 9399 PAGE 1 51�510 t NOTICE: This Form Is To Be Used For the Repair Of Failed Septic Systems Only. PERCOLATION 'TEST AND SOIL FVALUATION EXEMPTION FORM hereby certify that the engineered plan signed by me dated�?�(o� , concerning the property located at rneets all eel'the following criteria: + This failed system is connected to a residential dwelling only. There are no commercial or business uses associated with the dwelling. + The soil is 6assified as CLASS I and the percolation rate is less than or equal to 5 minutes per inch. The applicant may use historical data to conclude this fact or may conduct preliminary tests at the site without a health agent present. + 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 fourteen (14) feet above the maximum adjusted groundwater table elevation. LAdjust the groundwater table wring the Frimptor method when applicable] Please complete the following: A) Top of Gmund Surface Elevation(using GIS information) o•o B) G.W. Elevation ±�+ adjustment for high G.W. Li DIFFERENCE BETWEEN A and 13 SIGN ED : ZL DATE: $b t (— NOTICE B.i::ed upon the above information, u repair permit will he issued for bedrooms n.axirnurn. No additional bedrooms are authorized in the future without engineered -je tic system plans. q:haalth:older:imccxmp s L 0 CATION S^ � SEWAGE PERMIT NO. A 07 �! �,�J- /.mil ii1� .�,J�J I�.�.A �c�( VILLAGE INSTA LLER'S NAME i ADDRESS Ale- G U I L D E R OR OWNER �fL -- C e AJ2 Pg V DATE PERMIT ISSUED DATE COMPLIANCE ISSUED FN��% of h�ovs i �r i .S: \'``FEB...J.'-r................ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ...................... ...................OF.......................................................................................... ApplirFation for Bitipati al Works Tomitrtirtion rruti# Application is hereby made for a Permit to Construct (14/or Repair ( ) an Individual Sewage Disposal System at: Locagron-Address or Lot No. .................................................................................................. Owner . Address ---------- ------------------- ---- y �.---------------..................:...------------------ Installer Z Address d Type of Building Size Lot........:..........:........Sq. feet U Dwelling—No. of Bedrooms__......... _ .Expansion Attic ( ) Garbage Grinder (AO �+ aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) Q' Other fixtures .................................. W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity_/QQaallons Length................. Width................ Diameter................ Depth................ 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 ( ) Percolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ --------------------------------------------------------------------------------•---•----.........--......................................................... 0 Description of Soil..........................................................................................--------...................................................................... x V ------------------------------------------------------------------------------------ ------------------ -------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- 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 iITIZ- 5 of the State Sanitary Code— The undersigned further agrees not to place the system in o eration until a ert' to of Compliance has bee s ed y t b and of health. ._--- q / Signed .�......---•-•-- F � ! Datg Application Approved By--- -----`......�e---'�_,Xd..- �����a'---------- Date Application Disapproved for the following reasons---------------------------------------------------------------•---------------------------------------•--•------ ...................•--•-•----------------•--•-•---••--••--•----•---------•----••-------------•------•------••-••----------••--------•-•---•----•--••--------------•-----------•------ ----- ----------- Date PermitNo......................................................... Issued....................................................... Date j,r:............... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH -•.................. -- ------.......OF.......................................---...--..........------..........-----........... Appliration for Dwpaii al Works C oustrurtiun ramit Application is hereby made for a Permit to Construct ( ll-�or Repair ( ) an Individual Sewage Disposal' System/ at: LocatAn-Address or Lot No. ....... Z4Z. i?cA .......-----•--••-- y / Owner - Address W �G'9 !•�✓ r!� ( f l��f�4'. ll'C.1.................. : :d e''.- �...!.?....... w. r........................... a Address Installer UType of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms-.-•__-.--_ ...........................Expansion Attic ( ) Garbage Grinder (ILA a aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) - Other fixtures ------......•-- ••-----•-----•--------•••......---•---••••---•---••--...•---•---------...---•••••-------••-•••-•-•-••-••-•------•••••--......-• W -. Design Flow............................................gallons per person per day. Total daily flow............................................gallons. W Septic Tank—Liquid capacity../t)0Qallons j Length................ Width................ Diameter---------------- Depth................ xDisposal Trench—No. .................... Width----'.............. Total Length.................... Total leaching area....................sq. it. Seepage Pit No..................... Diameter...........L:.--- Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) W Percolation Test Results Pe rmed by------•---•----------••••••••-••---•---•---•--------------•-------•-••... Date........................................ Test Pit No. 1................minu es per inch Depth of Test Pit.................... Depth to ground water-._--..----------------- 44 Test Pit No. 2................niinut per inch Depth of ��st Pit.................... Depth to ground water........................ p Description of Soil................................. -------------------------------------•--- x V .._..•-••-•-••-•-•-•...•••••••-••••••-•--••••-••---•.....•••••--••••••••------------•...-------••--•-----•-•••--------------•-•---....------•......---••-•-•-••-•••--•••-••-------•---•......---•--..... 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 Sanitary Code— The undersigned further agrees not to place the system in operation until a C rti- to of Compliance has been sued thq bo rdof health. Signed------jV. ... ..............................----------••---- . ...2- . . . Date Application Approved By --a!1 ..��- -'1 --------- ate Application Disapproved for the following reasons------------------------------------- ' ---------------------------------•-•----...-----------------•--------•----•------•---.....-•---.....--•----••---•-•••••-•-----•----•--••-•-•----•••---•--•--•--•--•••-----•.--------------------------- Date PermitNo.................................. . Issue(L...................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........................................OF.................................................................................... Tnrtifiratr of ToutpliFanrr THIS IS TO-CERTIFY, That the Individual Sewage Disposal System constructed ( or Repaired ( ) by................• -----.............-•----------------..................-----•---------••---............:...-•-------•--....._..-----•----•-•-•-••-- I,,}sta ler at....................- -. ? .- ------��w----- ------c..... ,� — has been installed in accordance with the provision gTITLE 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No........(5 4.__...... dated................................................ ' THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATI FACTORY. DATE -�S v ----••---••• Inspector------------------------- . ............................... � I THE COMMONWEALTH OF MASSACHUSETTS xr BOARD OF HEALTH OF........................................................................•............ 3S No..... I.- /E FEE........................ Raposat Works Tnnstrttrttian rratit Permission is h eby granted � = -4 =='=�..................................................................................... to Construct ( or Repair ( ) an Individua�,Sewage Disposal System e J ,1 1 at No........... ...-fix---•------� ¢' _:.----- -- -------C-----c! ' ';------------------------------------------------•------- r Street as shown on the application for Disposal Works Construction Permit No..................... Dated.' ....------------- ---.•-...--------... . ...............•.......---------------- OC DATE.................. Bo o Health FORM 1255 HOBBS & WARREN. INC., PUBLISHERS S1i.IGLC- FAMILY - :6 BeoP-ooM Wo GARBAGE 6PJwr)r--. O � ��ea►�Y is FLOW : 110 A 3 = a3oG.Pt? �o. 5EPT1G TASK = 330x15o% =.4956RO. �Z y5E l000 GAL. Z4, z10 � � 53 015Po5AL PIT u6E 10o0 GAL. 51 DcWALL ARM-A. _- 1 Jc s.I= 150 6A. X 2.5 r 37 5 6.P o o 50T,'OM A2E.A= �O 5,r- 96 96 & -T CPT A" DE51GN a 42CJ G-PD- 1 ClK ♦ � � -TOTAL- DA 1 LY FL-ova! = 330 G.Po. C/ ' 91 ,� PROP Piz ` j PE Z COLATIOW RATE I 1"IN WIN oP.LE 55 ee\\ y'.'.A� _<_ 1 , c� � �� , ►• WAT �I � � 1 � I 1 ti �� �•� i 11A OF A/ ♦`� OF btgs , r_ wI I t 1 1 I ALAN O�G� � R1CHiiFiD w. ;! A. u ` )ONES BAXTR 25100 Q Na 24fi48 P '� {� V .a p- IZ. 1 •TB-5T F Top FNu=IdL► o�� loon lNv. j; us Sol` D►ST. INS, GA qQ,$ SEPTIC. 73- IODO INS/ 6uX 'G TANK LEAGu PIT INV. INY. w/I•f u q,a.z qo.¢ I FINE 1'�3�4' �L e ! (� K�SU s�N o 1 ov ! 6TOµ� Mrs ' TC E�/. 90 CE2TIr-IGC PLoT P►--A1.1 �� _ GCNTERV 1LL� too 5CA--LE SCALE ��N • GOFT._- e'. Z3 NO WAT F.?,, .7 : Z3 : 8z pL. 41 REJ=rc- GE 1 GE RTtFY 'THAT THE.PRoP FouµogTloy Sllo�N NEREo►.l GOMPt..`(5 1nI1TN'THE S1oELItJE LC> 5 Z IAuD S6TEQo►CK 9-6.QV1R.EtAE1`4-M, 0F 'C14E •To W N Or- BARN 5TA a L E A N V 115, tIk O V L A N 3 K. Z -7 ct ff �I LOCATED WITNIIJ TNS G%-ooD PLAIN j DATE a 23•g2 � , C.•y — i3AxTEiz.e t..IYE INC• R.EG 1 S'T icQ6'D't•A►.t D 5 u My EYovs N 7,4415 PL&KI 1 5 NOT oa A.N o5-rE2vI%-Lr-- - MASS. IN,5T2uMr-WT SVQVC-y -TNE 0F�'SETS 6uou1� ►-'o-r e -. v,c.D-TCP c�cTc^c• iNE L.nT" VING�� APPLIGA►-AT 'BRUCE �%�NDEBR()c F SYSTEM PROFILE ACCESS COVER TO WITHIN 6' OF FIN. GRADE (NOT TO SCALE) ACCESS COVER (WATERTIGHT) TO MINIMUM .75' OF COVER OVER PRECAST /` WITHIN 6" OF FIN. GRADE 2% SLOPE REQUIRED OVER SYSTEM 70.0' — 71.0' I ����t LOCUS 70.9' RUN PIPE LEVEL 2' DOUBLE WASHED PEASTONE a4 - FOF2 FIRST 2' � 4� EXISTING 1000 3' MAX. GALLON SEPTIC / 69.S' 68.0' Ace °'° TANK <H- 10 ) GAS ¢ <n ' BAFFLE 67,45' 67.28' _ _. � Q m 0 0 L� E � m a a 67,17' d 0 ED M L-1 0 :3 E] c 4' AROUND z SLOPE) 6" CRUSHED STONE OR MECHANICAL ,� (� [] ] [] [_] [] [_J [-] (� Q COMPACTION, (I5.221 C2]) c5=' 2' CD E3 CI 0 ED C D = � 7 �l � 65J7' z V DEPTH OF FLOW = 4' < 7 % SLOPE) % SLOPE) r TEE SIZES 10N 3/4' TO 1 1/2' DOUBLE WASHED STONE INLET DEPTH = OUTLET DEPTH = 14' LOCATION MAP NOT TO SCALE FOUNDATION— EXIST SEPTIC TANK 28' D' BOX 13' -LEACHING ASSESSORS MAP 193 PARCEL 138 FACILITY 18'f CONTRACTOR TO CONFIRM SUITABLE SOILS AT INVERT ELEVATION AND FOR 5' BENEATH LEACH FACILITY PRIOR TO INSTALLATION OF ANY PORTION OF SYSTEM. ANY UNSUITABLE SOILS ENCOUNTERED, 2 $ I t3I�2 REMOVE FOR 5' AROUND LEACH FACILITY, DOWN TO SUITABLE SOIL LAYER. REPLACE WITH CLEAN MED. SAND. •b'g, $ �4 a 7 + 84.D 8 77 Q GROUNDWATER ESTIMATED AT EL. 47't LOT 52 73_^ ,.• \ + 24,270± SO. FT. 71 ` c� NCITES 74-- - �, Q \8+ g �— 7 4,. 86 �--�` 6 86 SEPTIC DESIGN (GARBAGE DISPOSER IS NOT ALLOWED ) 1. DATUM IS BALD QN BAF�N QIS SAPS 64 —} -- E - _ t� 8 — o 84 33F�z4 DESIGN FLOW: 3 BEDROOMS ( 110 GPD) = 330 GPD 2• MUNICIPAL WATER IS_EXITING _ 4 74.2/ 83 USE A 330 GPD DESIGN FLOW 3, MINIMUM PIPE PITCH TO DE 1/8 PER FOOT, / +Ql ✓., ` / \... .�.._...-...-.- - T -. ....n:r �-n;.�•, ,, i r• .-. !•.r C T I.9 `�Gj ------ ------"-`_'.' � 'SEPTIC TANK: 330 GPD ( 2 ) = 660 4. uL �tt�ly U;. L � ,r EDGE OF LA E< ' a _ 67 • •'`---.._" � � � �-``,� / USE A 1000 GALLON SEPTIC TANK (EXIST) 5. PIPE JOINTS T❑ BE MADE WATERTIGHT. �. a. 71 i h, 7, 6• CONSTRUCTION DETAILS TO BE IN ACCORDANCE WITH MASS. 6 � LEACHING_ _ ENVIRONMENTAL CODE TITLE V, 6H ` \ 2(25 + 12.83) 2 (.74) - 112 7• THIS PLAN IS FOR PROPOSED WORK ONLY AND NOT T❑ BE cpC, /a \a / SIDES: USED FOR LOT LINE STAKING. 70. 71.1 /� 72.0 / 0 BOTTOM: 25 x 12.83 .74) - 237 705 .� 8• PIPE FOR SEPTIC SYSTEM TO SGH. 40-4' PVC, DECK EXIST. DWELL. 472 349 9. COMPONENTS NOT TO BE BACKFILLED OR CONCEALED WITHOUT TOTAL: S.F, GPD INSPECTION BY BOARD OF HEALTH AND PERMISSION OBTAINED I� / USE (2 500 GAL. LEACHING CHAMBERS WITH 4' © FROM BOARD OF HEALTH, 7G., 7 A /78 STONE ALL AROUND 10, PUMP & REMOVE (OR FILL W/CLEAN SAND) EXISTING LEACH PIT + !!/ -, ba,s���' 7V? � 0 17 62 rri 1.7 � 77.8 4, / n. 70.7 PAVED N DRIVE s / 6 LEGEND TI71E J NS".ITE PLAN �4.4 r } 100.0 PROPOSED SPOT ELEVATION OF > -- 309 CAP N LIJAH S ROAD 39 / A 100x0 EXISTING SPOT ELEVATION ` IN THE TOWN OF: 00�1�_ PROPOSED CONTOUR / ( CENTERVILLE) BARNSTABLE + 77.� 100 EXISTING CONTOUR + .3 w 726 �' � 5 PREPARED FOR: BORTOLOTTI �+ 72.4 CONSTRUCTION/POCHRON tK C" 7t�1 �/ 2 20 0 20 40 60 1 BOARD OF HEALTH /70.0 + 72.0 MA rn APPROVED DATE SCALE: 1" = 20, DATE; AUGUST 20, 2001 6?6 off 500-368-4541 ct? fax 508 362-9880 BENCH MARK — HYDRANT ON TAG BOLT 6T.7, # 701 ELEVATION = 77.5 I ��P�111 OF Mq a NE down cape engineering, inc, A F ARNE H. ��' OJALA OJALA CIVIL ENGINEERS 4 Cl VIL o.2ss4a a - 5 . a LAND SURVEYORS )A °792 939 main st, yarr�Outh, ma 02675 H. OJALA, P.E., P.L.S. DATE