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0016 COACH LIGHT ROAD - Health
16 Coach Light Road Centerville A= 172 — 999 I M EAe No.2-153LOR UPC 12534 smead.com • Made In USA to' No. Fee L.- — I — / THE COMMONWEALTH OF MASSACHUSETTS Entered in comp-ter: PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS Yes 2pplitation for Disposal *pstem Construction Permit I, I i J"Aelication for a Permit to Construct( ) Repair( ) Upgrade 04"Abandon( ) ❑Complete,System ®Individual Components C 0 fff"' Location Address or Lot No. <7, �1,,L''tA\ Q.cga Owner's N e,Add d Tel.No. Assessor's Map/Parcel �`I o� �� 0 Installer's Name,Address,and Tel.No. �e�S�.L3^' Designer's Name,Address,and Tel.No. P,cn. �3�>c 13 7 I `ice �-ow�—•-�`er�w 1M� �a?5�3 Type of Building: < Dwelling No.of Bedrooms Lot Size s 3g PA=54S sue. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 33CD gpd Design flow provided 3 s- gpd Plan Date M•oV t 7a °�Opp Number of sheets Revision Date Title Size of Septic Tank &Q_q��i G-Ak e rG�C�ype of S.A.S. 14,-05 �'�C AS, ��y-t•J 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 Certificate of Compliance has been issued by this Board of Health. ig ed a Date � Application Approved by Date Application Disapproved bV Date for the following reasons Permit No. Date Issued 117111112 No. ! z a~' Fee THE COMMONWEALTH�OF MASSACHUSETTS Entered in cAerlPUBLIC HEALTH DIVISION-TOWN OF`BARNSTABLE, MASSACHUSE 9pplitation for Misposal 6pstem ConstrUttion Vermit (fig pplication for a Permit to Construct( ) Repair( ) Upgrade(1�Abandon( ) ❑Complete System ®Individual Components co� Location Address or Lot No. �<' 4.L tsa Owner's Name,7ddgd Tel.No. Assessor's Map/Parcel a Q"zk 06 Installer's Name,Address,and Tel.No. '�k�,LT_5*,e 94ZS:5-q_;—r Designer's Name,Address,and Tel.No. P.cD, S3,z:.K 3 71 51011- Is Type of..Building: Dwelling No.of Bedrooms Lot Size .3 gc s is sq-fi. Garbage Grinder Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 3 3C) gpd Design flow provided 3 S gpd Plan Date tMAA l'�, ©(, Number of sheets ( Revision Date Title <. Size of Septic Tank �pc ] C.Ak, CGOC."rl~T ype of S.A.S. 1Q1D.S 4ZQ C _�<Sg Description of Soil 0 ti Nature of Repairs or Alterations(Answer when applicable) �`,�c� ��\�{ ` -,,c L�_ z. it -S Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. ' i ed / a �., Datev� w» Application Approved by / v V Date Application Disapproved by Date for the following reasons Permit No. 1112 Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certifitate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired( ) Upgraded( Abandoned( )by at k C, has been const cted in acc cd ce with the provisions of Title 5 and the for Disposal System Construction Permit No /ated Installer � in_y— Designer #bedrooms 3 Approved design flow gpd The issuance of this permit shall not be construed as a guarantee that the system will function as designed. Date Inspector ._-------- -- No. --------�------•--��-- ----------------------------------------------------------------------------Fee------`-/-�- -��— THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION BARNSTABLE,MASSACHUSETTS Misposal *pstrm Construction permit Permission is hereby granted to Construct( ) Repair( ) Upgrade(t,< Ab don System located at 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. i Provided:C nstruu tion ust be completed within three years of the date of this permit. Date //7 f Approved by i H . TRANS.'NO.: CITY/TOWN: n �f? APPLICANT: ►�j__1� ? a"��ui _ __._________ _ _ _f _r_ -._ M__ ADDRESS: �W �0GX 141-p+ OU I�4Spi tIl :t� ��Jkl }stTfi #{ .< i' r+' gpd-", REVIEWED BY: J9v ,'i r,i 'it9i:.( C e',F J•trr .rr, f(p I. DATE: ':,., - ,,•,ry, 1 -...-.F... .—.�—v. :� �. 4 7.. ) —r,y.Y;�.. 1 .•J 'r r •. . i.+•iif .. `.t.�."f�,Y?,.. .° �v •(id:.i`. t� li ,N/A 'V -OK,,(' NO GENERAL Legal;boundaries denoted 310 CMR',15.220(4)(a)] Street; Lot,tax parcel number and lot-numbennoted�on plan [310' CMRr15.220 4. u _____�_..._._..__ . __...._._ _..s►: :J"� �� ct gin.+s �,} �a- w�. Locus Provided 310CMR 15.2204 t r.,t r>>, �i r . , ; r• t. 3=':"=, i.,i,t,h r _ ,r .,, „ • r _ ai.r,» Plan proper`scale? (1"=40',for plot plans,J"=20';or.fewer,for!, 41 f j, w; • t com 6 i6ts 310 CMR 15.220 4 F- Easements shown [310'CMR 15.220(4)(b)] System located-totally on lot served [310 CMR.15A05(1)(a)for vr , :Fsr, upgrades]-i not, a variance is required [310 CMR 15.412 4 ];; ,. r, ; r,;t' Location of impervious surfaces(driveways;parking areas etc:) i' r4.4 310 CMR 15.220 4 d _� - _ - 7,' Location all buildings existing and proposed 310 CMR 0 C — rf='ii1"% : a. i i Location and dimensions of system components and reserve ,fit..; areas.![310 CMR 15.220(4) ,e ] _.. r rJ!f V,o , , n: ,1 System Calculations 310 CMR 15.220 4- o! ' daily flow! septic tanka ca acr (required andprovided) ,t soil absorption system(required and rovided<1,i whether s stem designed for garbage grinder North arrow 310 CMR 15.220 4 'Existing and prqposed contours [310 CMR 15.220(4)(g)] Location and log of deep observation holes(existing grade el. on each test) [310 CMR 15.220(4)(h)] Names of soil evaluator and BOH representative [310 CMR 15.220 4 h and i Location and date of percolation tests(performed at proper elevation?) [310 CMR 15.220(4)(i)] Percolation test results match loading rate? [310 CMR 15.242] Certification statement by Soil Evaluator 310 CMR 15.220 4 Observed and Adjusted groundwater(method for adjustment given or indicated) [310 CMR 15.103(3)and 310 CMR 115.220(4)(n)] i Address -:r _ ._ _ _ Sheet-I off7 f 1 l N/A OK oNO ,- ,- Location of every water supply,public and private, [310 CMR i 15.220(4)(k)] within 400 feet of the proposed system location in the case t � f. of surface water supplies and avel packed public water supply �i within 250 feet of the proposed system location in the case •. - ,, , •, within 150 feet of the proposed system location in the case - of private water su 1 -wells ' # '`1 _ _ _ _ _ _ _. .- ___ _ _.✓ ' _t '� Location of all surface waters and wetlands located up to 100 ft. beyond setbacks listeddn 310 CMR 15.211 and any catch basins locate€d within 50 ft. [310 CMR 15.220(4)(1)) Water lines and other subsurface utilities located [310 CMR` `. 15.220(4)(m)] ifwaterline cross see`3101CMR-15:211 -1• [l] «. r'" ,,, a ilx � Profile of s stem showing invert elevations of all s stem _ Y_ g w _ _.. Y comp( ents and the bottom of the SAS 310 CMR 15.220 4 0t Stamp of designer[310 CMR 15.220 1 arid!310'CMR15.220(2)] 4 ' 1 Vi Stamp of Re istered Land S e or(re uired if con_ struction 't f•t > ' activities within 5 ft. of lot Cline) [310;CMR 1,5..220(3)] Test Holes adequate (two in each of the primary,and reserve.- i;' ' ,;. t i I+ unless trenches as permitted in 310 CMRI5!102(2)or`as) i J•• r , t �• ' " ,'�' approved for an'upgrade under LUA at 310 CMR-15-.405(1)(k)] Test hole adequate to demonstrate four feet of suitable material? 310 CMR 15.103(4)]_._. .,.� _ ._ .__..�...___y`j- , ,:j t r,f,.r...� _$�j:,.__.,1. �,, . -ta,' F: •��__ rr } �--S} Test Holes adequate to confirm adequate groundwateruseparation? °c 310 CMR 15.103(3)]_ - 1__ Benchmark within 50-75'_of system [310 CMR 15.220 4 ,_. ] Materials specifications noted? [various sections of 310 CMR'. el, `• t �_. ' 15.000 a E System components not> 36"_deep (unless Local Upgrade' Approval or LUA re uested 3 to CMR 15.405 1 b '«.—•..�..,.._._.,.r............,-.....may.......__...«.. �......_........_�{ � f {S �t '�t a i ) N,�, !,R w�tIe ._....a.�` � ... .1._.,...,•r� -....-•'} `.... ......,...... _.,,1 ........,..........« �._........•�-.._.•..t ifar„r",_,,.tJF � ..�_.,R)i�r'".. rlf ra J~, f.+:�41� 7! +ti '„ " :1I.., .r•_� er . i ' '_ ( .!! `' s!",ff _f'Fi{ C !t". � Iry s•f,� � ..`rl.' fTfFi+ aJ 3 , �» - - -� •-_..,"...�w...� .._•. .....F....,4.,....—.i...,, _ ..; it i —-3"�r ' ti`�, 7fa:,r. 'tl f.... .„d�i+' _.... �._�`.�. 'r � _ '3 y.. .__.,ter.._... � «,._.......--s- _ - '"' .w.�k +jr :..\ � may'- �+ �� I7J!�lr�:.�"{ ilit� :i!� '{. .I.. P `i"•-, . � E ,...-.�.._.,.,.....�._...._...... ��..._..__,,.te ._._.y.. _ '[I ��.l2J d i , ,t l ,. •. J t�t'—Yr is � ; :, '3 .r� !± a''• — ,it�j Address, art: _ _ _ _._ __ __ _ _._Sheet.2'of-7 . Ci :.'.o N/A OK NO SEPTIC TANK _ Size OK? 310 CMR 15.223(1)] 4s ; :+ . + t ', �.;_, I Inlet tee located ten inches below flow line [310 CMR 15.227(6)] +, Outlet tee 14" or,14" +5" per foot for,increase ft depth[310,CMR •lrn 16 l V 1011 It" _'; ,1 0 s; 15.227 6 l , ] �E 1, L .r, l,k ; .� Outlet tee with gas baffle or approved filter 310 CMR 15s227 4 ► t3 f 1 ti r+; �a c i; ; =r �� ; Note regarding iiistallationon stable compacted b_ase'[310 CMR t?.,,• ,a,. :i h%+ , ; , a cs r "I 15.228(1)] fitj; tt Separation between inlet arid outlet tees(no less than liquid depth)3 CMR 15.227(2)] Inlet/Outlet elevations at least 12" above high,groundwater-ti (t) { r' . ,, " , ,i =,,,• 3 (except as described 310 CMR 15.227(5))or permitted for upgrades under LUA[310 CMR 15.405 1 k)] _ Minimum cover 9" (Tanks buried more than 9'e mustthave:risers; at;�'. , ;, �V f r _;;_ i on all openings and on the d-box) [310 CMR 15:2228(1)and 310 t' , t.✓ CMR it5.232(3)(f)] Three'access covers(inlet and outlet must be 20'j':or.-greater);., middle access at;least 8" b, 7/07 310 CMR 15.228(2)] Acces's to within 6 " of grade - one port for systems<I 000gpd, two fors stems>1000 g d [310 CMR 15.228(2)] All at'grade covers secured to unauthorized access?? [310.CMR f , . t .,ra+ + , ;t•�� i -� t , 15.228(2)] 1 Ei ` = ' > 10 ft from building foundation 310.CMR+15.2141 1 r, F;, , !r ., a t i t r Buoyancy calculation Re uired/Done,[310 CMR+15.221 8 ]� .:: j, F,� ► :_� a .:"C, j H-20 Where appropriate? 310 CMR 15.226(3)] ',• F3 , .r : :,, Setbacks from resources 310 CMR 15.211 ##' Multi-Compartment Tanks Required when other than single-family dwelling or flo_w>1000 d 310 CMR 15.223 1 b_ ! =`t ;x4i: ,: ..�•„ti h1 r: ,: fr :,� �; '�'ti r,$; , ',i First compartment_200% daily flow; Second compartment 100% t: ,` ;{' w r r daily flow 310 CMR 15.224(2) and 3 "U"pipe through or over baffle,outlet of each compartment with as baffle or approved filter[310 CMR t15.224(4)], r.,a ivJ. ; ep IrA'� _"--•-�'_.�.. ]..--.._.»,...,._._�,.,.. virtl(k, {-; ;f ;, t ,: Uo, t'ir� 'CF,•>`J:,J► t�;)i.'Efff r." JJ..1'.11 ��c T.) ..: e it t��' l f +��. �t ; `S, t? `, rI t t i F_......r_...-.�.. � ^35 +i3t' + <' _Cr`.�.r�r Irijfljls_ ! •r_-;..�W J� r.� R _ _.. Y i),':_ _ � +r..�f..+,,... i......_ ..�..�'...'........ _ ...._._�t__ Address +• _ _ _Sheet 3 of 7 N/A OK NO BUILDING SEWER AND OTHER PIPING Located at least ten feet from any water line? [310 CMR 15.222-2_ Disposal piping at least 18"below water line'(when water.and,�,i i rt sewer`cross, see 310 CMR,15.211 1 1 V ►' _'_p Clean'outs re uired/ rovide'd? 310 CMR 15.222 8]:..' 0` .; k' 1 Thrust blocks s ecified in force mains?310 CMR+15.221 6 c } Slope of sewer line not less than 0.01'(1/8"/ft) 0.02 preferable 310 CMR 15.222 6 i 1 s:y`�� t;` y, �t or, Proper pitch on all runs? (.005 Ir�!within�gravity-distributed trenches !! s 4V . R 1_......_........._.y, �p and beds [310 CMR 15.251 9 and 310 CMR 15:252 2_ .c ,#�h 1 Siphon roblem/i leachfield below pump chamber }t{,rt,1,1 ; r Endca s or vent manifold specified? [ Size and orientation of discharge holes specified?(notismaller.r'i r. r�s+►c, ,. _. + , G re.t Mr . R than 3/8"not larger than 5/8") [310 CMR .5.251(8)acid 310', i ,.,,.r'_'., t '; CMR 15.252(2)(h)] - Materials specified (310 CMR 15.251+(5)specifies:various pipe w t i't' es allowed ,. ,r i t typ i � �•i r1 l�l.'!. .�fP_ .', il,t t. .,I4 . ..� a�� 1 •y{c l.i'�11 F .. iF..,i DISTRIBUTION BOX t Stable,compacted base [310 CMR 15:221(2) and 310 CMR: 15.232(2)(a)] i Splash late or baffle tee required inlet/ rovided.; when ,, +:_ ,,`,. , 5++ it ' lj:l i . ;} i~It p plate _q P � - pressure sewer to_d-box or `steep pitch of gravity,sewer) [3.10 i,t , t r✓ , CMR 15.323(3)(a)].. , �t Riser if deeper than 9" 310 CMR 15.23 2 3 - w Insideminimum dimension 12" [310 CMR 15.232(2)(b)] Minimum sum 6" 310 CMR15.232`3 e ' „{ r ,- ''; '� , # x„4" . s �•i. r,,:;�, ;.,;, i i Watertight cover;if<2000gpd); waterproof manhole if>20009pd _ 4 i 1. [310 CMR 15.232(3)(d)] �. _j '�., tr..t,' ��t ; . i Ea s'. r.•Stei �! PUMP CHAMBERS ' Capacity(emergency storage above workingdesign flow)?,[310, i 4 .,. CMR 231 2 ] Proper setbacks [310 CMR 15.211 same as septic tanks Watertight 20-in minium access manhole at least 20"MUST BE TO GRADE 310 CMR 15.231(5)] Service components accessible(not too deep with piping, disconnects accessible Alarm floats-alarm on circuit separate from pumps specified? Exceeds two units must have two pumps operating in lead-lag mode. 310 CMR 15.231(6)and 8 d Stable Compacted Base [310 CMR 15.221(2)] Buoyancy calculations needed? Provided? [310 CMR 15.221(8)] }. ., heet 4 f 7 Address ... ____w_ ___ _. __ _ ___. S o a f U NIA OK NO _ SOIL ABSORPTION SYSTEMS(SAS)GENERAL •>' Calculations correct? f c r r F:,f �, ►, . r. i z . 4 feet of naturally occurring material demonstrated?_[310 CMR_.'" 'S `►tl :r /j 1 E t i r, t,v t;• 15.240(l)] ._.. Re uiied separation to oundwater? [310 CMR.15.212 ] I71 Aggregate specified as double washed 310 CMR 15.247(2)] System Venting required/provided?(system'under driveway or r:' ,° :, Ice b •✓04 r � >36" deep) 310`CMR 15.2411 A$ r _ Inspection ports'specified and within 3"final grade? [310 CMRjG f 21 15.240(13)] `iJ, !'. fix:.' � I:(.' _' •- � �.tr ri. •1,,;;, a jY'. Fr" Breakout requirements met? (No violationlof breakout elevation a w ,� �;: - `:. �+ .c,; 3}, within 15 ft of SAS unless barrier) [310 CMR 15.211(l)[4] and' Guidance Document] -�-��;t �� ,, ,y; . s �� E�".l tACI Ie ,r GALLERIES,PITS,CHAMBERS 310 CMR 15.253 Chambers and Gal. in trench configuration supplied with inlet '/r} every 20 ft. [310 CMR 15.253(6)] } i�.r r ��� 'j :� .� �� ;�fic \/ r] 1'� f ,, t. Each structure with one inspection manhole(if>2500 gpd must F be to �grade) [310 CMR 15.253(2)] Aggregate 1'minimum-4'maximum.'r310 CMR 154253(l 2' sidewall credit maximum [310 CMR 15.253 1 (a)] In bed configuration,inlet every 40 s'. ft. r310 CMR'15;253 6 ttii"'E TRENCHES 310 CMR 15.251 Width T minimum 3'maximum [310 CMR 15.251 1 b 100 feet-maximum len ` 310 CMR 15:251 1. a Minimum separation 2x effective depth for width,whicheverr,,I r 0 ifs :,{ 1,J'I_ V r eater(3x if reserve between trenches) [310 CMR 251(1)(d ] ✓ Situated alongcontours 310 CMR 15.251(2)] , _ F;V, 7 �' _ , ; - a ,x{ Breakout OK? 310 CMR 15.211 1 4 and Guidance Documerit t 3 BED SAS (Maximum size of bed or field 5000 pd) minimum 2 distribution lines r310 CMR 1.5.252 2 a Maximum se aration between lines 6, [310 CM R15.252(2)(d ] J.owbr,•J t ` .. •u c Maximum separation between lines and outside of.bed,4' [310 •-4.► A A°_; CMR 15.252(2)(e)] t " , . �: ,, sr , as17r = 14 L ,ty Aggregate depth`below_discharge pipes 6" minimum, 12", _1. /. ;,c ,;.r{.�,, ;r A maximum. [310 CMR 15.252 2 1 _ Separation between beds 10'minimum. [310 CMR 15.252(2)(f)] Bottom area used in calculations onl y r310 CMR 15:252 2 01 : _,.. A t 1 _.i1 il! �iyJ r �:i`� .�' (1'S f' 7< . .14'i t3� ��i;+,J*•...(`, �1 r:. C�._ !r + i _ f Address Sheet'5" 7 N/A OK NO DID THE PLAN INVOLVE Pressure Dosed_System ? Provided pump and piping calculations as re uired 31(0 CMR 15.220 4 r Pressure dosing required_on all systems>2000gpd or alternative i systems under remedial approval [310MCMR 15 254(2)aid ILA"",' "f, `r - nr , r, Remedial Use AO rovals .__ If used in gravelless system-make sure jet is:directed as not tot- scour soil interface Guidance Document V t . 3 4 r f Inspections once per year(systems<2000:gpd') or'quarterly i r r E, . �r r =: _ •",r iR �..; >2000 d ood to note on plan 310 CMR 15.254(2)(d)] Construction in•.fill -Did the plan specify that the:fill shall meet 7 the s ecification'of 310 CMR 15.255 3 1 ,,3 cf _ Im erbious barrier and/or retaining wall? Guidance Document V 0; a^. Impervious barrier installation must be supervised by_; designer [310 CMR 15.255(2)(b)]. ;:� �- ,,;� .,s , ,,: , ra z. x.,: Retaining wall must be designed by Registered Professional Engineer[310 CMR 15.255(2)(a)] Side slope riot exceed 3:1 ? 310 CMR 15.255(2)] f , Break_o_ut requirements met? [310 CMR 15.252(2) and : of i . ,,7 E"•" •,,r; Guidance Document] ., ..f ... At least 5 W from impervious barrier to_edge of SAS+(10 ft. recommended) 310 CMR 15.255. 2 '(e ] Gravelless System[IA Approval Letters] Check DEP Approval letters for credits and design conditions If used withipressure dosing do not allow.pressure discharge: . } > > '_ r _ ,. 'Q' i , P i to scour soil interface t I; ,,`' , 0 1 S `; r ; H` i f t Alternative Septic System[I/A Approval Letters/ Was DEP Approval Letter provided:and/or have;you;t:► ; : f i S r t '� __ + reviewed the letter for conditions? 9°+` #"' p �;a' : _ r_:a: a , t' Is the technology being properly applied and does it'nieet all 1 ' t+ r; Ci." e m r f, DEP Approval Conditions? Is there a note on the plan regarding the requirement;for:; perpetual maintenance agrqement? Any alarms involved'on se arate circuits .r r_t --; !�'q 1:4 "f .'`' '�:.. . - ,, +4 Did_ the applicant submit an operation and maintenance _ manual? ! Fi, iJ.,r t��._.-` _. .T , ; ;;` :► Has applicant submitted a co of a`maintenance t": C: ,u: _ • t f;r _ ..r Variances Are the variances listed on the plan? [310 CMR 15.220 4 )] RLS Stamp necessary on plan if a component is within five feet of property line [310 CMR 15.412(4)] New construction or increased flow proposed- [Refer to 310 CMR 15.414 Address-,,," Sheet 6 of-7 N/A OK NO Nitrogen Sensitive Areas Is the system in a Designated Nitrogen Sensitive Area(Zone H for a public supply well)? [310 CMR 15.214, 310 CMR 15.215 and 310 CMR 15.216-also refer to Policy regarding upgrades of such existing systems] Is the system proposed on the same lot as served by private well? / [310 CMR 15.214(2)] Are the nitrogen loads proposed in compliance? [310 CMR 15.216 1 Miscellaneous Pumping to septic tank? 310 CMR 15.229 Shared System 310 CMR 15.290 Address Sheet 7 of 7 f .F 1 ! �� + �I, i°IF �� �1 a .a.•j ✓yU„ ! (_. 1..:^il r� �rl `..• �` A ! ! vi (; l .4r !- r. a,.� r �,t.i tli.,'1 ��. _........,.... .�......>_ �.....- -- --'.._ , i2;.e•rr .-• +! r�l ��e d'� r _ �� .�j., -....-.,...�-.-r:.�+w_«....dd- '� � f;li ,'; o.... �_.._..'._.......,..�.... ....-,.....-_,...f`�.- .. _...��i�;�) / ''`...' .�._.. .ir'3 ! ,.1 r� .�_}.� k 1,.. � ,_7. ., ilk. 4•/ r ! 4'1, �.....-.,,_,.�,........__,..,.......��_.._.___...._.'�... m. .....�....-..,....._. _._.. _.... ... ... 1/W. f COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENERGY & ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION ONE WINTER STREET, BOSTON, MA 02108 617-292-5500 DEVAL L.PATRICK IAN A.BOWLES Governor Secretary TIMOTHY P.MURRAY LAURIE BURT Lieutenant Governor Commissioner MODIFIED APPROVAL FOR GENERAL USE Pursuant to Title 5, 310 CMR 15.000 Name and Address of Applicant: Advanced Drainage Systems, Inc, 4640 Trueman Boulevard Hilliard, OH 43026 Trade name of technologyand model: BioDiffuser• 14 inch and 16 inch High Capacity, 11 inch � g Standard and Bio 2 and Bio 3 BioDiffusers, ARC 36, ARC 36HC, and ARC 50 (hereinafter the "System"). Schematic drawings of each model are attached. Transmittal Number: W000052 Date of Issuance: October 3, 2003, Revised December 17, 2003, Revised June 14, 2006 Revised July 19, 2007, Modified February 14, 2008, Modified July 23, 2008, Modified June 30, 2009, Modified February 18, 2010 Authority for Issuance Pursuant to Title 5 of the State Environmental Code, 310 CMR 15.000, the Department of Environmental Protection hereby issues this Certification to: Advanced Drainage Systems, Inc., 4640 Trueman Boulevard, Hilliard, OH 43026 (hereinafter "the Company"), for General Use of the System described herein. Sale and use of the System are conditioned on and subject to compliance by the Company and the System owner with the terms and conditions set forth below. Any noncompliance with the terms or conditions of this Certification constitutes a violation of 310 CMR 15.000. February 18, 2010 Glenn Haas, Acting Assistant Commissioner Date Department of Environmental Protection This information is available in alternate format.Call Donald M.Gomes,ADA Coordinator at 617-556-1057.TDD#1-866-539-7622 or 1-617-574-6868. MassDEP on the World Wide Web: http://www.mass.gov/dep 0 Printed on Recycled Paper BioDiffuser-Advanced Drainage Systems Modified Approval for General Use Page 2 of 7 I. Purpose 1. The purpose of this Certification is to allow use of the System in Massachusetts, on a General Use basis. 2. With the necessary permits and approvals required by 310 CMR 15.000, this Certification authorizes the use of the System in Massachusetts. 3. The System may be installed on all facilities where a system in compliance with 310 CMR 15.000 exists on site or could be built and for which a site evaluation in compliance with 310 CMR 15.000 has been approved by the local approving authority, or by DEP if DEP approval is required by 310 CMR 15.000. II. Design Standards 1. The models listed in Table 1 are covered under this Certification. Table 1. Chamber Dimensions Dimensions Invert Model W x L x H Height Inches Inches I I" Standard BioDiffuser 34 x 76 x 11 6.5 ARC 36 34.5 x 60 x 13 7.13 14"High Capacity BioDiffuser 34 x 76 x 14 9 16"High Capacity BioDiffuser 34 x 75 x 16 11.3 ARC 36HC 34.5 x 60 x 16 10.75 ARC 50 51.5 x 42.75 x 30 22.25 Bio 2 BioDiffuser 15 x 87 x 12 6.87 Bio 3 BioDiffuser 22 x 87 x 12 6.87 1. Only Systems installed with this invert height shall be allowed to use the effective Leaching area associated with this model Table 2 2. The System is an open-bottom leaching unit molded from high density, high molecular weight polyethylene (HDPE) Type III, Class A or B, Category 1 or 3 or Polypropylene Group 03, Class 3, Grade 0. It can be installed without aggregate or distribution pipe as an absorption trench in accordance with the requirements in 310 CMR 15.251 or as a bed or field in accordance with the requirements in 310 CMR 15.252. 3. The use of aggregate as specified in 310 CMR 15.247 is not necessary with the System when installed as a trench, bed or field. When designed with aggregate in accordance with 310 CMR 15.253, the System shall be designed in accordance with Section II item 10. BioDiffuser-Advanced Drainage Systems Modified Approval for General Use Page 3 of 7 4. The minimum separation between any two trenches shall be as specified in 310 CMR 15.251. 5. The requirement that the Chamber installed in trench configuration as specified in 310 CMR 15.253(6) be provided with inlets at intervals not to exceed 20 feet is not applicable to the System. In accordance with 310 CMR 15.240 (13) a minimum of one inspection inlet shall be installed per system. The inlet shall be capped with a screw type cap and accessible to within three inches of finish grade. 6. The total effective leaching area for any Chamber Model shall be calculated by multiplying the Effective Leaching Area per square foot of chamber times the total length of chamber from Side Port Coupler to Side Port Coupler including Side Port Coupler. 7. For new construction, the applicant can size the System in a trench configuration without aggregate, using the effective leaching areas presented in Table 2. No System shall be designed and constructed with a soil absorption system area of less than 400 square feet of effective area. Table 2. Effective Leaching Area for New Construction And Remedial Sites Effective Effective Model Leaching2 Leaching3 Area Area SF/LF SF/LF 11" Standard BioDiffuser 6.5 NA ARC 36 6.8 NA 14"High Capacity BioDiffuser 7.2 NA 16"High Capacity BioDiffuser 7.9 NA ARC 36HC 7.8 NA ARC 50 NA 6.71 Bio 2 BioDiffuser 4.0 NA Bio 3 BioDiffuser T 5.0 NA 2. Effective leaching area is equal to 1.67 (bottom width+(2x invert height)) 3. Effective leaching area is equal to 1.0(bottom width+(2x invert height)) 4. The maximum trench width allowed for calculation of effective leaching area is 3 feet. 8. Systems installed on remedial sites shall be allowed to utilize the effective leaching areas presented in Table 2. above or additional reductions in soil absorption leaching area approved by the approving authority in accordance with 310 CMR 15.284. In no instance shall the reduction in the soil absorption system required in 310 CMR 15.242 BioDiffuser-Advanced Drainage Systems Modified Approval for General Use Page 4 of 7 exceed the maximum reduction allowed for alternative systems approved in accordance with 310 CMR 15.284. 9. In accordance with 310 CMR 15.240 (6) absorption trenches should be used whenever possible. When the System is installed for new construction without aggregate in a bed or field configuration, as defined in 310 CMR 15.252, the System shall be designed using the effective leaching area for the bottom width presented in Table 3. No system shall be designed and constructed with a leaching area of less than 400 square feet of effective area. Table 3 Effective Leaching Area for Bed or Field Configuration Effective Model Leaching Area SF/LF 11" Standard Biodiffuser 4.7 ARC 36 4.8 14"High Capacity BioDiffuser 4.7 16"High Capacity BioDiffuser 4.7 ARC 36HC 4.8 ARC 50 7.2 Bio 2 BioDiffuser 2.1 Bio 3 BioDiffuser 3.1 5. Effective Leaching area is equal to 1.67 times bottom width only. 10. The System, when installed in a bed or field configuration without aggregate on remedial sites, shall utilize the effective leaching areas presented in Table 3 above or additional reductions in soil absorption system area approved by the approving authority in accordance with 310 CMR 15.284. In no instance shall the reduction in the soil absorption system area required in 310 CMR 15.242 exceed the maximum reduction allowed for alternative systems approved in accordance with 310 CMR 15.284. 11. The System, when installed as specified in 310 CMR 15.253: Pits, Galleries, or Chambers, shall have an aggregate base and/or be surrounded by aggregate and shall be sized as specified in 310 CMR 15.253 (1) (a) and (b), effective leaching area is equal to 1.0 times a conventional aggregate system. Effective depth can be increased to two feet with the corresponding addition of up to 17.5 inches of base aggregate for the 11 inch Standard BioDiffuser to up to 12.7 inches for the 16 inch High Capacity BioDiffuser. Bottom width can be increased by two to eight SF/LF with the corresponding addition of one to four feet of aggregate per side. BioDiffuser-Advanced Drainage Systems Modified Approval for General Use Page 5 of 7 12. When the System is installed as specified in 310 CMR 15.255: Construction in Fill, the finished 15 foot horizontal separation distance, item(2), shall be measured from the from the top of the chamber. III. General Conditions 1. The provisions of 310 CMR 15.000 are applicable to the use of the System, except those that specifically have been varied by the terms of this Certification. 2. The facility served by the System, and the System itself, shall be open to inspection and sampling by the Department and the local approving authority at all reasonable times. 3. In accordance with applicable law, the Department and the local approving authority may require the System owner to cease use of the System and/or to take any other action as it deems necessary to protect public health, safety, welfare or the environment. 4. The Department has not determined that the performance of the System will provide a level of protection to the environment that is at least equivalent to that of a sewer. Accordingly, no new System shall be constructed, and no System shall be upgraded or expanded, if it is feasible to connect the facility to a sanitary sewer, unless allowed pursuant to 310 CMR 15.004. 5. Design, installation and use of the System shall be in strict conformance with the Company's DEP approved plans and specifications and 310 CMR 15.000, subject to this Certification. IV. Conditions Applicable to the System Owner 1. The System is approved for the treatment and disposal of sanitary sewage only. Any wastes that are non-sanitary sewage generated or used at the facility served by the System shall not be introduced into the on-site sewage disposal system and shall be lawfully disposed of. 2. For new construction, the owner initially shall size a soil absorption system in accordance with 310 CMR 15.242 to demonstrate that a conventional Title 5 soil adsorption system using aggregate, including a reserve area, can be installed on the site. The owner may than size the soil absorption system for the System. The total area required for the aggregate system, which may include the area designated for the System, and a reserve area shall be preserved and the owner shall ensure that no permanent structures or other structures are constructed on that area and that the area is not disturbed in any manner that will render it unusable for future installation of a conventional Title 5 soil absorption system. 3. The System owner shall at all times properly operate and maintain the on-site sewage disposal system. BioDiffuser-Advanced Drainage Systems Modified Approval for General Use Page 6 of 7 4. The System owner shall furnish the Department any information that the Department requests regarding the operation and performance of the System, within 21 days of the date of receipt of that request. 5. No System owner shall authorize or allow the installation of the System other than by a person trained by the Company to install the System. V. Conditions Applicable to the Company 1. By January 31 st of each year, the Company shall submit to the Department a report, signed by a corporate officer, general partner, or Company owner that contains information on the System for the previous calendar year. The report shall state known failures, malfunctions, and corrective actions taken for the System as well as the date and address of each event. 2. The Company shall notify the Department's Director of Watershed Permitting at least 30 days in advance of any proposed transfer of ownership of the technology for which this Certification is issued. Said notification shall include the name and address of the proposed new owner and a written agreement between the existing and proposed new owner containing a specific date for transfer of ownership, responsibility, coverage and liability between them. All provisions of this Certification applicable to the Company shall be applicable to successors and assigns of the Company, unless the Department determines otherwise. 3. The Company shall furnish the Department any information that the Department requests regarding the System,within 21 days of the date of receipt of that request. 4. Prior to any sale of the System, the Company shall provide the purchaser with a copy of this Certification. In any contract for distribution or sale of the System, the Company shall require the distributor or seller to provide the purchaser of the System, prior to any sale of the System,with a copy of this Certification. 5. The Company shall prepare and provide the Department an installation manual specifically detailing procedures for installation of its System. The Company shall institute and maintain a training program in the proper installation of its System in accordance with the manual and provide a training course at least annually for prospective installers. The Company shall certify that installers have passed the Company's training qualifications, maintain a list of certified installers, submit a copy to the Department, and update the list annually. Updated lists shall be forwarded to the Department. 6. The Company shall not sell the System to installers unless they are trained to install these Systems by the Company. VI. Conditions Applicable to Installers of the System BioDiffuser-Advanced Drainage Systems Modified Approval for General Use Page 7 of 7 1. Each Installer shall install the System in accordance with Company training on the installation of the System and the conditions of this Certification. 2. No Installer,shall install the System unless the Installer has been trained by the Company on installation of the System. VII. Reporting 1. All submittals of notices and documents to the Department required by this Certification shall be submitted to: Director Wastewater Management Program Department of Environmental Protection One Winter Street - 5th floor Boston, Massachusetts 02108 VIII. Rights of the Department 1. The Department may suspend, modify or revoke this Certification for cause, including, but not limited to, non-compliance with the terms of this Certification, non-payment of an annual compliance assurance fee, for obtaining the Certification by misrepresentation or failure to disclose fully all relevant facts or any change in or discovery of conditions that would constitute grounds for discontinuance of the Certification, or as necessary for the protection of public health, safety, welfare or the environment, and as authorized by applicable law. The Department reserves its rights to take any enforcement action authorized by law with respect to this Certification, the System, the owner, or operator of the System and the Company. Town of Barnstable Regulatory Services Thomas F.Geiler,Director BABNffABM Public Health Division ,39. Thomas McKean,Director 200 Main Street, Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Date:J�,,e.ar m Sewage Permit# —'-�Olp Assessor's Map/Parcel Installer&Designer Certification Form Designer: G..�nota.-T. P,n-),o Installer: Address: P.o. dog 1.A 3o Address: ©, n2cn x 3 71 T�-h olr�ti�- MA o2s 3(0 OnQne_(. J z&r-� L Cr--Mt c, was issued a permit to install a (date) installer) septic system at based on a design drawn by 1 (address) dated 1 (designer) r I certify that the septic system referenced above was installed substantially according to the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. 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 any component of the septic system) but in accordance with State & Local Regulations. Plan revision or certified as-built by designer to follow. Stripout(if require . spected and the soils were found satisfactory. AOFMA �o LINDA J. PINTO (Installer's Signature) U CIVIL No.46504 &GSn. f S T E�,J-. n- �G��'� (Designer'sSignature) (Affix D Here) PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS- BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. gAoffice formsWesignercertification form.doc Town of Barnstable P# f 3 ;2, Department of Regulatory Services Public Health Division Date MASS, 1639.a�� 200 Main Street,Hyannis MA 02601 Date Scheduled_ lit It d Time Fee Pd. 0 Soil Suitability Assessment for Sewage is al Performed Br. Witnessed By: btu a LOCATION& GENERAL INFORMATIO Location Address L�y ` Owner's Name A/ Address Assessor'sMap/Parcel: ? Z 00 Engineer's Name NEW CONSTRUCTION REPAIR Telephone# 5 0 0B —Z-f-77 L3 V 7 Land Use r Slopes(%) "e . Surface Stones o Distances from: Open Water Body Mft Possible Wet Area I A ft Drinking Water Well L A ft Drainage Way ft Property Line gr ft Other_L'is ft SIMTCH:(Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands in proximity to holes) Parent material(geologic) - m. Depth to Bedrock 001 Depth to Groundwater. Standing Water in Hole: N A. . Weeping from Pit Face N Estimated Seasonal High Groundwater DETERARNATION FOR SEASONAL HIGH WATER TABLE Method Used: --.Depth Observed standing in obs.hole: in._ Depth to soil mottles: Depth to weeping from side of obs.hole: -in, Groundwater Adjustment tt. Index Well# Reading Date: Index Well level— Adl.factor Adj.Groundwater level PERCOLATION TEST Date Thne,.�v Observation Hole# Time at 9" Depth of Penc Time at 6" Start Pre-soak Time @ _ Time(9"-6") End Pre-soak Rate MinJlnch Site Suitability Assessment: Site Passed Site 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 beginning. Q:\SEPTICIPERCFORM.DOC DEEP.OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture .Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency,%Gravel) LS 10 gAl Irv, 0I , Sand ID Q- SI1. `1�- 13y C-L -C Sand loy� ��y (,mod GTc,��l DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. C nsisten %Gravel) DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistengy.%Oravell DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Cons' t n a Flood Insurance Rate Man: Above 500 year flood boundary No Yes ._._____ Within 500 year boundary No V Yes,;_. Within 100 year flood boundary No>3 Yes Death of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervio s material exist in all areas observed throughout the area proposed for the soil absorption system? 13 If not,what is the depth of naturally occurring pe rvious material? ...._ Certification I certify that on ov �— (date)I have passed the soil evaluator examination approved by the Department of Environmental Protection and that the above analysis was performed by me consistent with . the required tr�aijng,.expertise and experience described in 310 CMR 15.017. Signature / Date Q:\.SEPTIGIPERCFORM.DOC TOWN OF BARNSTABLE LOCATION �� ��•�����—� �,®�� SEWAGE#Q010® `G 1. VILLAGE ��vv�J•u�`�•P. ASSESSOR'S MAP&PARCEL INSTALLERS NAME&PHONE NO. � ,�;SEPTIC q - -5- SEPTIC TANK CAPACITY \<0Z2C3 w.s csX*.g���` LEACHING FACILITY:(type)M6 thj�,C,:3aI Co (size) ct, s' ae(4rn �. c a*C.L., Gln�bw�n r..r' 4 NO.OF BEDROOMS OWNER PERMIT DATE: C-) COMPLIANCE DATE: "2 r 10 Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility 7 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 BYQ� 1 a c- of j oa Qa- 3o` 3 Ow e f 'a No......................... ............... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH f. :.c v._:.... .oF...... :G ...e ............................ l Appliration -for ' i o ttl orko Tontitrurtion Vrrntit Application is hefeby made for a Permit to.Construct ( ) or Repair ( ) an Individual Sewage Disposal System'at L> - ? y f� /Z (y(7/' � Location•Address f r Lot No. ;t .!� �t:•-�-1 y�r7'?!a-!�7...................... ✓ ` ?......... - J �• ,r Z. Owner, AddrJess a / Installer Address Q Type o Build Size Lot..Z�-/__ rO' ---Sq. feet U Dwelling rNo. of Bedrooms----_-------_��-_...._...____...___...-Expansion Attic ( ) Garbage Grinder (/I/ Other—Type of Building ____________________________ No. of persons---------------------------- Showers ( ) — Cafeteria ( ) Q' Other fixtures ----------------------------------- _ -------------------------------------------------------------------- W Design Flow...................... .........I gallons per person per day. Total daily flow......` ' .................gallons. WSeptic Tank�-Liquid capacity/�' allons Length................ Width................ Diameter._.---_-_._-__ Depth._-.-_-.--._.... x Disposal Trench—No-____________________ Widtli.___.__. .._.��. _ otal Length------------------_ Total leaching area--------------------sq. ft. Seepage Pit No---------- --------- Diameter... �_�_'—_' epth�below i•let.... .__,.._ _. Total leachin area._-_-.-_----_.._.sq. ft. z Other Distribution box ( ) Dosing tank ( ) _ ��— - J 77, aPercolation Test Results Performed by.......................................................................... Date------------------------------------.... Test Pit No. 1................minutes per inch Depth of Test Pit-------------------- Depth to ground water--.__.--_.--_--._-.---- Li, Test Pit No. 2................minutes per inch Depth of Test Pit-_-_____..._-______. Depth to ground w ter---------------.-------- tx ...................... -------- '-'....A ............----•---'---.....- - ------------------------------- O Description of Soil. J -�_ ✓4 �r�ti ' - - .'. `-1----=' '- *� :_ V - at �:f S � + �✓lr � „�-/---ram'-ll��'• �� � - - ------------ f, ------- V 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 Article XI of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has beean d by t�uehe board of health igned✓ c // t - Z ate .—>'� Application Approved By-----=--- ------- t .....----}-- -- � /�/7 s r �— :��'` - --------------------------- Application Disapproved for the following reasons______________ _--- ------- ..................................................Date................ ...................................................... .........................................................................................----------------------------------- ------------ Date Permit No.--•-----'---•--'---•-•--••"-'•-'-"----'---'------•--.. Issued---J.....11.7 Date _,_________________________----------------------------------------------- 7, No_______________ZAPO' Fu$.. .............. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH le-1 C?"4C.L/z L/-----------OF....... ... ..t.. %.I L`-... ApV irtttion -for Dispaval Workii TonMrurtion Prrntit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: r Location•Address / or-Lot No- ' / Owner,, v Address ----- -_--• ----.....•-•--•--•---•-••_______________________............. Installer Address UType of Building,. rrgg Size Lot__._ `-� 1�__v__Sq. feet �-, Dwelling—No. of Bedrooms--------------.+3'---------------._..-----Expansion Attic ( ) Garbage Grinder ( /)A5 aOther—Type of Building ............................ No. Of persons............................ Showers ( ) — Cafeteria ( ) dOther fixtures - - ---------- ----------- ------------------•----------------•------------------------•------•------------- Design Flow__ __________________' ._ allons per person per day. Total daily flow_-____._ gallons. ----------------------------- '44 Septic Tank Liquid capacityh ,'T allons Length---------------- Width................ Diameter__.__.--------- Depth----------..-- - Disposal Trench—No. .................... Width-_._---_. ____ .__ tal Length.................... Total leaching area....................sq. ft. Seepage Pit No.____..__.�..______. Diameter___ _ epth�below i et__._. _ Total leaching area ----------- -----sq. ft. :`Other Distribution box ( ) Dosing tank ( ) ��r ��� �`� '►�"` '-' Percolation Test Results Performed by--•---- ----------------•-----.....--•----._._.._....._..---------------- Date-----------------------------..----- a Test Pit No. 1................minutes per inch Depth of Test Pit-----------_........ Depth to ground water.--._--_--.---.-_.--._. fZ4 Test Pit No. 2................minutes per inch Depth f Test Pit-------------------- Depth to ground wa er-..--.---_-__-.---.__. O A. ie► -*.;. r Description of Sotl i '' t `� ---= ----------- -- -- -•-- - 1 x --------------------- t -:----- = ---------------------------_---------------- ------------------------ U Nature of Repairs or Alterations—Answer when apphcable..................:.............................. .................... .. .................. ----------------------------------------------------- -------------------------------___-•------------------------------------- Agreement The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in'accordance with the provisions of Article XI 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 healthc gned _ r -- Application Approved By----: - --- -- tT—-------------- r Date Application Disapproved for the following reasons______________________________ ...._.............._.................................._........................... -•-••-•------•...........................•----------------------_-------------------•------------------••--•--------------------•••--- ------...__.. --------------------•---------------------------- Date :. PermitNo......................................................... Issued._.S` / ._7..................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF EALTH rrti$iratr of Tong hattrr THIS C F t the Individual Sewage Disposal System constructed ( ) or Repaired ( ) by- � ----- - ---- - ------- --•--------------- .. `. mt5 at has been installed in accordance with the provisionsState Sanitary Code as described i the application for Disposal Works Construction Permit ...... dated..._. --_2__s-_:--_?.�_'._______ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM VV` FUJJCTION 'f SATISFACTORY. G `'2 i DATE------� { '/�` Inspector -••--• --•---------••••. THE COMMONWEALTH OF MASSACHUSETTS BOARD O HEA 7, No- :... � .. ...OF :...... . ... ................. FEE....... -••-•-•- 005 �i���a�tti � ,urtion mutt - Permission • ereby granted `` �' ...... ---- ------ .............------ to Con str ct ( ) r Re tr '( ) an fi ual S e DispO - atNo.I •--`--'- �-•— �---- Street . .............................. as shown on the application for Disposal Works Construction Per o_________ _____ ___ D e ------�"'�.-7f'-- PP P ,-. . ._. .--- dr 7 7 _._.....••-- -------- --------- --°� ............... Board of Health V ! , DATE ----------------------------------- - --------------------- FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS %J h I* 0 r -N •m I f°K6F r: 44 41 > xP 15�, RICHARD SAXTERA. i #a Na 24048 gUS i -�mPT t c- `r'Aw v- ,- tOOO 6,A L ►GAGW tPiT V./IT L 4 t&0"fo Ew.P Ca ZT1F ialD 'P LC>I- 5CAL 1 "r 3Q` t G 6 iZ T t t=Y T a4 AT' T i-A r lFo u N'DA'rt oq 5140%Aj J WSL7Eaj1 G lt'LYS W i'TtA TW6 5(P L.t►..tt `,.d T -4 Z AUD SET>I GtL SZEQt)i2EN�ci,ITS of T"e ,C 3 85 t SH of Z 'rd W U ��1�- r PAYE B!4 X-t'EtrZ � tJ�E tl-iG. REGIS��an t-Ai.i� �uevE�(o2s 064 AN oSTEizv%L-.E SV2r/Ey' TKI= C FC'Si T'S 6'4t>wt.I> APRI 1 Ct1.l.lT A �-vrr tm To lDeTmzm' tC-. LO-r Ll WeS I. tCATION EWAGVB— VILLAGE RMIT NO. .� INSTA LLE 'S NAME & ADDRESS TP B U I'L D E R OR OWNER DATE PERMIT ISSUED o DATE COMPLIANCE ISSUED 77 .Y t' a g" r ° �' TOP OF FOUNDATION 24"diameter concrete covers CENTERVILLE, EL=GO.I raised to within 6"of frrnsh grade (or as noted) MA Inspection Port and cap with magnetic marking tape to within 3"of grade TWENTY(20)ADS ARC 3G I GBD2 LEACH CHAMBERS IN BED CONFIGURATION IN FOUR(4) Exstwy EL=5B.O1t EL=575.:t EL=57.0-58.0A ROWS OF FIVE(5) UNITS EACH 3 5.0' 5.0 5.0' 5.0' 5.0' O 57.7+ 18"min Cover for as /�Sta OUt Errstmg 56.5- H-20 Loadhnghost Lh 553+ m ch x a c� Eristmg 56.6f _ 0� OmU �a 56.3� 55./7 N 55.00 54.90 „ D-BpX Existing _ WON �H& Existing Proposed Gas Daff/e- 54.00 �� � and Zabe!Flter LOCU5 w� � Longest Run TWENTY(20)ADS ARC36(361625D2) 8 O+ Inspection Port(see Note A4) '0 � �� o 17 9' LEACH CHAMBERS IN BED ' n cwG g DB-6 CONFIGURA FIVE WITH FOUR(4)ROWS PLAN VIEW P EX15 RAIC 1000 GALLON (H-20 Rated) OF (5)CHAMBERS EL=46.Ot Bottom of Test Hole SCALE: I" = 10' 51TE LOCUS 5EPRC TANK D-BOX LEACH CHAAI ER5 NOT TO SCALE FLOW PROFILE sz NOT TO SCALE GOo O L.C.P.�3255I B-2 I 5Certificate, #I p 17 2Parcel 99 as 3.) Land Court Plan 32851-8 Sheet 2 (5o.2) n' 4.) Th15 property 15 not in a Zone 11 of a Public I CERTIFY THAT I AM CURRENTLY APPROVED BY THE rL CON 5T RU CT I O N N OTE5 DEPARTMENT OF ENVIRONMENTAL PROTECTION PURSUANT TO ^N M Parcel 158 Water Supply 3 10 CMR 15.017 TO CONDUCT SOIL EVALUATIONS AND THAT KH d. 3 2"Trees Town Water THE ABOVE ANALYSIS HAS BEEN PERFORMED BY ME nj� 4"Tree I.)ALL WORK SHALL CONFORM TOTHE5TATEENV1RONMENTALCODE TITLE 5(310 CONSISTENT WITH THE REQUIRED TRAINING, EXPERTISE, AND �3 31� \ CMR 15.000):STANDARD REQUIREMENTS FOR THE5/TING CONSTRUCTION, EXPERIENCE DESCRIBED IN 310 CMR 15.017. 1 FURTHER �e INSPECTION, UPGRADE AND EXPANSION OF ON-5I7E5EWA6,ffTRE4TMENTAND CERTIFY THAT THE RESULTS OF MY SOIL EVALUATION AS D15P05AL SYSTEMS AND FOR THE TRAN.SPORTAND 0/5P05AL 01`5EPTAGE AND THE INDICATED ON THE ATTACHED SOIL EVALUATION FORM, ARE Parcel 98 \' \ 5G c' LEGEND- THROUGH LOCAL BOARD OF HEALTH REGULATIONS. ACCURATE AND IN ACCORDANCE WITH 310 CMR 15.100 \ �1�' Off, 15.107. Town Water 3 2"Trees 2.) ANY5EPTICSYSTEMCOMPONENTINSTALLEDINA LOCATION WHERETHEREIS \ ? EXISTING SPOT GRADE POTENTIAL FOR VEHICLES OR HEAVYEQU/PMENT TO PAS5 OVER ITSHALL BE 58. i I I 24x5 PROPOSED SPOT GRADE DESIGNED TO WITHSTAND AN H-20 LOADING. /FONDER AN IMPERVIOUS SURFACE \� sh 24 EXISTING CONTOUR 5Y5TEMSHALL BE VENTED TO THE ATMOSPHERE 24- PROPOSED CONTOUR 3.) TO MIN/MIZE UNEVEN SETTLING, ALL SYSTEM COMPONENTS SHALL BE lN5TAL 159 ON Linda J. Pinto, Certified Sod Evaluator rij0 Oec� -w-w- WATER SERVICE LINE A 5TABLEMECHAN/CALLY-COMPACTED BASE ON 5/X INCHES OF CRUSHED STONE. 0 ''0 `")"' rL \ / ;sue o OVERHEAD UTILITY LINES 4.)COVERS OVER THE/NLETAND OUTLET TEES OF THE5EPTIC TANK, THE \ 1 11 ' \ I G"Tree \ U UNDERGROUND UTILITY LINES D157RIBUTIONB0X, AND T11E501L AB50RPT10NSYSTEMSHALL BE RAISED TO WITHIN f' 1 /� -GA5- GAS SERVICE LINE 6"OFF/NAL GRADE LEACHING FlELD5, TRENCHES, AND OTHER SOIL AB50KPT10N " i C TOP OF BANK SYSTEMS W/THOLITACCE55 MA1VHOLE5,5HALL H,AVEATLEA5TONE(1)INSPECTION / �I ��\�� ♦--a=a- LIMIT OF WORK 51TE PLAN PORT CON5IST/NGOFPERFORAI'ED4°PVC)-/PE PLACED VERTICALLY TO THE BOTTOM �Ph 1 III \ 1 2"Oak I ��o� �/�/ EDGE OF CLEARING OF THE SO/L AB5ORPTlON SYSTEM WTH A CAP, TIED WITH MAGNETIC MARK/NG TAPE \ ACCESSIBLE TO W/THIN 3"OF FINAL GRADE ` I Fi. i ` TIP - FENCE SCALE: I„`_. 2O s= y ( To St, r 5�s; ° �P ao �9 � `':'\ 1 ® _....TEST-HOLE LOCATION 5)P/PIN651-IALLCONSI5TOF4'SCHEDULE40PVCOREQUIVALENT PIPE5HALLBE "owe ST SEPTIC TANK LAID ON A MINIMUM CONTINUOUS 6R419E OF NOT LE55 THAN 29ol FROM THE BUILD/NG / I o,� e9h qd o I DB DISTRIBUTION BOX TO THESEPT/C SANK, AND NOTLE55 T11AN 1%OTHERW/SE Jc�'c �'o�F°'o� I BENCHMARK Ste` `JOIL,ABSORPTION SYSTEM l 6)DISTRIBUTION LINES FOR THESOIL AB50RPTION5Y5TEM5HALL BE4"DIAMETER C�� 6O ''9 1 Corner Concrete Reserve RESERVED FOR FUTURE USE SCHEDULE 40 PVC(OR EQUIVALENT)LAID AT 0.005 FT/FT. UNLESS OTHERW/SE NOTED, c�� j I �� ��j f EL=G0.00(Assumed Datum) CQi UTILITY POLE L/NE5 SHALL BE CAPPED AT END OR AS NOTED. a 28"Oak/ � CATCH BASIN 7.)LINE5 FROM THE D15TRIBUT/ON BOX TO BE LEVEL FOR THE FIR5T TWO(2)FEE tT J11 oe p ��+ � � FIRE HYDRANT BEFORE PITCHING TO THE 50/L ABSORPTION SYSTEM. D15TR1BUTlON BOX SHALL BE h�O � I J ® DRINKING WATER WELL WATER TESTED TO ASSURE EVEND/STRIBUT/ON. e} �2� f CONCRETE BOUND 6.)GROUT TO BE USED AT ALL POINTS WHERE P/PES ENTER OR LEAVE ALL CONCRETE I I b STRUCTURES IN ORDER TO PROV/DEA WATERTIGHT SEAL. ZN OF 4 LOT 42 Parcel ►oo �w`' 'ass, 9.)HEAVYEQU/PMENT5HALL NOT RE ALLOWED TO OPERATE OVER THELIMIT5 OF THE + / Town Water a� LtNDA J. SEWAGE D15PO5AL FIELD DURING THE COURSE OF CONSTRUCTION OF THE SYSTEM. ` Area=0.38 Acres- U 'F' (5U.2i 6 o PINTO /0.)!NACCORDANCEWITH310CMR /5.22/, ALL SYSTEM COMPONENTS SHALL BE \�' o <0 r CIVIL CIOMARKED WITH MAGNETIC MARKING TAPE Cjs `JS / ��0 ,6 No.46504 l S •� � I I.) THERE ARE NO KNOWN WELL5 WITHIN I 50'OF THE PROPOSED 501L ABSORPTION Kitchen g0'cF FG t 5 T ER�O��' 5?STEM. G67 9h SS�ONAL ECG 12.)FROM THE DATE OF THE INSTALLATION OF THE SO1L AB50RPTIOiV SYSTEM UNTIL RECEIPT OF THE CERTIFICATE OF COMPLIANCE THE PERIMETER SHALL BE5TAKED AND `�'� to ! Family DmmcJ Bath Bath Bdrm FLAGGED TO PREVENT USE OF THEAREA THAT MAYCAU5E DAMAGE TO THE SYSTEM. � I- ! L q 7 Survey Work by.• 13,) THE DESIGNER WILL NOT BE RE5P0N510LF FOR THE SYSTEM A5 DES/GNED CP. UNLESS CONSTRUCTED A5 SHOWN ON PLAN. ANYCHANGE5 SHALL REAPPROVED!N H �S O� A & M Land SerWces WKIRNGBYTHEDE5/GNER. TE✓T 1 TOLE LOGS , Bdrm CL �- Garage Living Bdrm 618 Main Street 14.) THE BOARD OF HEALTH REQUIRES INSPECTION OFALL CONSTRUCTION BYAN t, F South Yarmouth, MA 02684 Pb. (508) 737-1777 Email. ann2land®comeast.net AGENT OF THE BDARD OF HEALTH AND THE DES/GNER. THE DESIGNER SHALL CERTIFY � Test Hole#I (EL=57.2±) IN WRITING THAT T1)E5EWA6;E0/5P05AL SYSTEM WAS INSTALLED INACCORDANCE WITH THE TERMS OF THE PERMIT AND THEAPPKOVED PLANS. 48 HOURS ADVANCE Depth Layer Sod Class Sod Color Comments Prepared for: NOTICE 15 REQUESTED. o" G" fillFLOOR PLAN Anthony /5.J CONTRACTOR SHALL BE RESPONSIBLE FOR DETERMINING THE LOCATION OFALL G"-1011 A/E Fine-Medium Loamy Sand I DYR 5/I SYSTE IVI DESIGN :CALCULATIONS y J. Ves p UNDERGROUND AND OVERHEAD UTILITIES PRIOR 7-0 COMMENCEMENTOFANYWORK. 1 O"-25" B Fine-Medium Sandy Loam I OYR 5/8 I G Coachlight Rd., Centerville, MA THIS INCLUDES, BUT 15 NOT LIMITED TO, REQUESTS TO D/65AFE ANY PR/VATS UTILITY 25"-77" C I Medium Sand I OYR 5/G 20%Gravel-Perc @ G2" NOT TO `.SCALE COMPANlE5, AND THE LOCALWATERDEPARTMENT 77"-134" C2 Medium-Coarse Sand IOYR4/4 1 and Gravel 5EWAi5EDE5I6NFLOWRE(_?U1RED_3BEDROOMDWELLING(MINALLOWED)9 Pt"OpOSeG� SeWaGJE DISpOSaI S�/Stet11 110 GPD/BEDROOM=330 GPD REQUIRED 16.)CONTRACT09S1-1ALL VEKIFYTHAFALL WA5TELINE5ARECONNECTEDBYWATER I G Coachhcjht Rd., Centerville, MA TE5T/NG WITHIN THE DWELL/NG PR/OR TO/NSTALLA T/ON OFANYSEPT/C COMPONENTS DATE OF TESTING: 05/18/10 SEWAGE DE51GN FLOWPROV/DED: TWENTY(20)AD5 UN/T5!N BED SOIL EVALUATOR: LINDA J. PINTO, P.E., CSN ENGINEERING CONFIGURATION IN FOUR(4)ROWS OF FIVE(5)UNIT5 EACH 17.)CONTRACTOR SHALL VER1,FYEX15TING/NVERTELEVAT/ON5 PRIOR TO INSTALLATION BOARD OF HEALTH AGENT: DAVID STANTON, BARNSTABLE HEALTH DEPARTMENT Prepared by: OFANY5EPTIC5YSTEMCOMPONENT5. PERCOLATION RATE: LE55 THAN 2 MIN/INCH IN"C"LAYERS Vt=[(33010.74)1(4.8 FTZ/FT)/50Lf7 = /9 ADS UNITS REQUIRED(20 PROVIDED) 10.)/N57RLIMENT5URVEYC0NDUCTED FOR PROP05E9 WORK ONLY. 51TEPLAN5HALL NO GROUNDWATER ENCOUNTERED 1�,",O� NOT BE USED FOR STAKING OR ANYOTHER PURPOSES 355 GPD PROVIDED>330 GPD REQUIRED CSN � SEPTIC TANK CAPAC/TYREQU/RED: 330 GPDX 200% =660 GPD REQUIRED ��:►;' Engineering I9j EX15T/NG !000 GALLON SEPTIC TANK TO BE UTILIZED. PVC TEES TO BE 11V57ALLED ON INLET AND OUTLET PIPES/F NECESSARY, AND A GAS BAFFLE AND ZABEL INSPECTION NOTE: SEPTIC TANK CAPAC/TYPROVIDED: EXLSTING 1000 6ALLON SEPTIC TANK FILTER INSTALLED/N THE OUTLET TEE PRIOR TO FINAL INSPECTION BY THE ENGINEER,SYSTEM A GARBAGEDI5PO5AL 15 NOT PERMITTED WITH THIS DE516N FLOW 0 20 40 GO P.O.Box2030 Phone:(508)299-3250 20.)EXISTING SEPTIC COMPONENTS TO BE LOCATED, PUMPED DRY, FILLED WITH CLEAN NEEDS TO BE COMPLETE INCLUDING BUILDUP FOR COVERS. Teaticket,MA 02536 Fax.(508)548-5478 SAND AND ABANDONED/N PLACE: AREA TO BE COMPACTED TO MINIMIZE SETTLING. SCALE 1"=20' C:\C5N\RR-Coachli6jht\5D5-RR-Coachhght.dwg Date:05/17/10 Scale:As Shown By:LIP Check:GSP Project No.CSN0095