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HomeMy WebLinkAbout0088 EBEN SMITH ROAD - Health I 88 Eben Smith Road Centerville A= 171-293 I !fi UPC 12534 N0.215,OR r T. No. d I V " 00 C1 Fee /0 0 THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS Yes ftplitation for �18t1D8 Y 6pstem Construction Permit Application for a Permit to Construct( ) Repair( Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot Nogy /t/ �Q!), Owner's Nam Address,and Tel.Noj%i!'p d/s4C/// Assessor's Map/Parcel 1---oZ?3 0 el-'e 5 V 7 e— la,93 Installer's Name,Address,and Tel.No 0j5f 1^t0,4�Z4( Designer's Name,Address,and Tel.No`._Ny/U ;O IaYs-- Elm;'S4t%vq 7 7 Type of Building: Dwelling No.of Bedrooms 3 Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) :TS3(-:) gpd Design flow provided 3 gpd Plan Date Number of sheets f' Revision Date Title Size of Septic Tank IWO d,411,44) Type of S.A.S.4 //—(no 4& �o��/,�/��s 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 Env ir nmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board o it . Signed Date Application Approved by Date Application Disapproved by Date for the following reasons Permit No.__2 0 1 b— O C3 Date Issued I 12 ZO r ...rw .,��tr+TM.vm..�..r"v+w'..»-,-.•--nw..+..:w+wa.+ti!!.v�,^;9,+t,^�.:""B"WriYr...rs...a`q;..:....v",.^^'*..+.+w.wmr!.+^".n�µ..: -�,.rn.iiww...,...-.«-«-...,,, �,.. , �;.-.,„�, _ An— No. 1 Fee / n Q THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS Yes application for Misposal 6pstem Construction permit Application for a Permit to Construct( ) wRepair(jo) Upgrade( ) Abandon( ) ElComplete System ElIndividual Components Location Address or Lot No'— � it �,�/lp� 411 ,�I�y„ Owner's Name,„Address,and Tel.No.A Ik 6'rell i Assessor's Map/Parcel cZ $ `��,��� ' !DX- �7( /4Z;3 Inst77alleOr's Name,Address,and Tel.No�r�-, �T/')(��/+r ,��� yD�^esigner�')'sName,Addr/ess,and Tel.No*��,(jy�,.�;7 %j h4S,,A{ ..,7fi� /+0..�.`7'4'j�i �/). ��V�� >L/� �v�✓w' ���) `-'./i`S�'-„'�rr �'�LI /"'� �j^�,'.. �,?j -'^ �% Type of Building: �v Dwelling No fof Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) t gpd Design flow provided gpd Plan Date Number of sheets Revision Date Title // Size of Septic Tank A� S�&%W Type of S.A.S.K, 1A Prj 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 Envirdnmental Code and not to place the system in operation until a Certificate of Compliance has been issued by s Boar doealt Signed / �� 4 Date /,/d Application Approved by Date Application Disapproved by y Date for the following reasons Permit No. ;..� .t :' �• ? .{ 1 Date Issued i t THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired(4 ) Upgraded( ) Abandoned( )by at r. 1:p#has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit NoG, t = i dated Installer Designer V A > t #bedrooms Approved design flow and The issuance of this permit shall not be construed as a guarantee that the system will nction las designed. Date Inspector f C/ n? Fee No. rJ/�> ��tea THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION BARNSTABLE,MASSACHUSETTS Disposal 6pstem Construction permit Permission is hereby granted to Construct( ) Repair l( ) Upgrade( ) Abandon( ) System located at (11 4 i,sr Ie V,,�CP and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with r Title 5 and the following local provisions or special conditions. Provided:Construction must be completed within three years of the date of this permit. Date f / f ✓' Approved by _ _ c TRANS. NO.: CITY/TOWN: APPLICANT: ADDRESS: DESIGN FLOW: gpd REVIEWED BY: DATE: N/A OK NO GENERAL Legal boundaries denoted [310 CMR 15.220(4)(a)] Street, Lot, tax parcel number and lot number noted on plan [310 CMR 15.220(4)(u)] Locus Provided [310 CMR 15.2204(t)] Plan proper scale?(1"=40' for plot plans, 1"=20' or fewer for components) [310 CMR 15.220(4)] Easements shown[310 CMR 15.220(4)(b)] System located totally on lot served [310 CMR 15.405(1)(a) for upgrades]-if not, a variance is required [310 CMR 15.412(4)] Location of impervious surfaces (driveways,parking areas etc.) [310 CMR 15.220(4)(d)] Location all buildings existing and proposed 310 CMR 15.220(4)(c)] Location and dimensions of system components and reserve areas. [310 CMR 15.220(4)(e)] System Calculations [310 CMR 15.220(4)(f)] daily flow septic tank capacity(required and provided) soil absorption system(required and provided) whether system designed for garbage grindet North arrow 310 CMR 15.220(4)(g)] Existing and ro osed 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)0)] Observed and Adjusted groundwater(method for adjustment given or indicated) [310 CMR 15.103(3) and 310 CMR 15.220(4)(n) A 'Q0,Address W 6VKN Sheet 1 of 7 I N/A OK NO Location of every water supply,public and private, [310 CMR 15.220(4)(k) within 400 feet of the proposed system location in the case of surface water supplies and gravel packed public water supply 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 supply wells Location of all surface waters and wetlands located up to 100 ft. beyond setbacks listed in 310 CMR 15.211 and any catch basins Y located within 50 ft. [310 CMR 15.220(4)(1)] Water lines and other subsurface utilities located [310 CMR 15.220(4)(m)] if water line cross see 310 CMR 15.211(1)[1]) Profile of system showing invert elevations of all system components and the bottom of the SAS [310 CMR 15.220(4)(o)] Stamp of designer[310 CMR 15.220(1) and 310 CMR 15.220(2)] Stamp of Registered Land Surveyor(required if construction / activities within 5 ft. of lot line) [310 CMR 15.220(3)] ye Test Holes adequate (two in each of the primary and reserve unless trenches as permitted in 310 CMR 15.102(2) or as 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)] Test Holes adequate to confirm adequate groundwater separation? 310 CMR 15.103(3)] Benchmark within 50-75' of system[310 CMR 15.220(4)(q)] Materials specifications noted? [various sections of 310 CMR 15.000] System components not> 36" deep (unless Local Upgrade jApproval or LUA requested) [310 CMR 15.405(1(b)] AddressVl/ � �'"`'{ t D� Sheet 2 of 7 N/A OK NO SEPTIC TANK Size OK? [310 CMR 15.223(1)] 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 15.227(6)] Outlet tee with gas baffle or approved filter 310 CMR 15.227(4)] Note regarding installation on stable compacted base [310 CMR / 15.228(1)] )/ Separation between inlet and outlet tees (no less than liquid / depth) [310 CMR 15.227(2)] Inlet/Outlet elevations at least 12" above high groundwater (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" must have risers on all openings and on the d-box) [310 CMR 15.2228(1) and 310 CMR 15.232(3)(f)] Three access covers (inlet and outlet must be 20" or greater) - middle access at least 8" (by 7/07) [310 CMR 15.228(2)] Access to within 6 " of grade - one port for systems<1000gpd, two fors stems>1000 gpd [310 CMR 15.228(2)] All at-grade covers secured to unauthorized access? [310 CMR 15.228(2)] > 10 ft from building foundation[310 CMR 15.211(1)] Buoyancy calculation Required/Done [310 CMR 15.221(8)] H-20 Where appropriate? [310 CMR 15.226(3)] Setbacks from resources [310 CMR 15.211] Multi-Compartment Tanks Required when other than single-family dwelling or flow>1000 gpd [310 CMR 15.223(1)(b)] First compartment 200% daily flow; Second compartment 100% ✓' daily flow [310 CMR 15.224(2) and 3)] "U"pipe through or over baffle, outlet of each compartment with gas baffle or approved filter[310 CMR 15.224(4)] 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 sewer cross, see 310 CMR 15.211(1)[1]) Cleanouts required/provided ? [310 CMR 15.222(8)] Thrust blocks specified 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)] Proper pitch on all runs? (.005 within gravity-distributed trenches and beds) [310 CMR 15.251(9) and 310 CMR 15.252(2)(c)] Siphon problem/(leachfield below pump chamber) Endca s or vent manifold specified? Size and orientation of discharge holes specified? (not smaller than 3/8" not larger than 5/8") [310 CMR 15.251(8) and 310 CMR 15.252(2)(h)] Materials specified (310 CMR 15.251(5) specifies various pipe types allowed) DISTRIBUTION BOX Stable compacted base [310 CMR 15.221(2) and 310 CMR / 15.232(2)(a)] ✓ Splash plate or baffle tee required on inlet/provided?(when pressure sewer to d-box or steep pitch of gravity sewer) [310 CMR 15.323(3)(a)] Riser if deeper than 9" [310 CMR 15.232(3)(0] Inside minimum dimension 12 [310 CMR 15.232(2)(b)] Minimum sum 6" [310 CMR15.232(3)(e) Watertight cover if<2000gpd); waterproof manhole if>2000gpd [310 CMR 15.232(3)(d)] PUMP CHAMBERS Capacity(emergency storage above working=design flow)? [310 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)] ✓ Stable Compacted Base [310 CMR 15.221(2)] Buoyancy calculations needed ?Provided? [310 CMR 15.221(8) Address 4 f o ' bmi ` ( Sheet 4 of 7 N/A OK NO SOIL ABSORPTION SYSTEMS (SAS) GENERAL Calculations correct? 4 feet of naturally occurring material demonstrated? [310 CMR 15.240(1)] Required separation to groundwater? [310 CMR 15.212)] Aggregatespecified as double washed 310 CMR 15.247(2)] System Venting required/provided? (system under driveway or >36" deep) [310 CMR 15.241] Inspection ports specified and within 3"final grade? [310 CMR 15.240(13)] Breakout requirements met? (No violation of breakout elevation within 15 ft of SAS unless barrier) [310 CMR 15.211(1)[4] and Guidance Document] GALLERIES,PITS,CHAMBERS 310 CMR 15.253 Chambers and Gal. in trench configuration supplied with inlet every 20 ft. [310 CMR 15.253(6)] Each structure with one inspection manhole(if>2000 gpd must be to grade) [310 CMR 15.253(2)] Aggregate 1' minimum-4' maximum. [310 CMR 15.253(1)(b) 2' sidewall credit maximum [310 CMR 15.253(1)(a)] In bed configuration, inlet every 40 sq. ft. [310 CMR 15.253(6)] TRENCHES 310 CMR 15.251 Width T minimum 3'maximum [310 CMR 15.251(1)(b)] 100 feet-maximum length[310 CMR 15.251(1)(a)] Minimum separation 2x effective depth or width whichever greater(3x if reserve between trenches) [310 CMR 251(1)(d)] Situated along contours [310 CMR 15.251(2)] Breakout OK? [310 CMR 15.211(1) 4 and Guidance Document] BED SAS (Maximum size of bed or field 5000 gpd) minimum 2 distribution lines [310 CMR 15.252(2)(a)] Maximum separation between lines 6' 310 CM R15.252(2)(d)] Maximum separation between lines and outside of bed 4' [310 CMR 15.252(2)(e)] Aggregate depth below discharge pipes 6" minimum, 12" maximum. [310 CMR 15.252(2)(g)] Separation between beds 10' minimum. [310 CMR 15.252(2)(f)] Bottom area used in calculations only [310 CMR 15.252(2)(i)] Address rl/�J�'�+1 �rv`�'`� ��" Sheet 5 of 7 I N/A OK NO DID THE PLAN INVOLVE Pressure Dosed System ? Provided pump and piping / calculations as required [310 CMR 15.220(4)(r)] D/ Pressure dosing required on all systems>2000gpd or alternative / systems under remedial approval [310 CMR 15.254(2) and I/A Remedial Use Approvals] YYY If used in gravelless system- make sure jet is directed as not to scour soil interface [Guidance Document] Inspections once per year(systems<2000 gpd) or quarterly (>2000gpd) good to note on plan[310 CMR 15.254(2)(d)] Construction in fill -Did the plan specify that the fill shall meet the specification of 310 CMR 15.255(3)? Impervious barrier and/or retaining wall ? [Guidance Document] Impervious barrier installation must be supervised by designer [310 CMR 15.255(2)(b)] Retaining wall must be designed by Registered Professional Engineer [310 CMR 15.255(2)(a)] Side slope not exceed 3:1 ? [310 CMR 15.255(2)] Breakout requirements met? [310 CMR 15.252(2) and Guidance Document] /,001 At least 5 ft. from impervious barrier to edge of SAS (10 ft. recommended) [310 CMR 15.255 (2)(e)] Gravelless System[FA Approval Letters] Check DEP Approval letters for credits and design conditions If used with pressure dosing do not allow pressure discharge to scour soil interface Alternative Septic System[I/A Approval Letters] .Was DEP Approval Letter provided and/or have you reviewed the letter for conditions? Is the technology being properly applied and does it meet all DEP Approval Conditions? Is there a note on the plan regarding the requirement for perpetual maintenance agreement? Any alarms involved on separate circuits Did the applicant submit an operation and maintenance manual? Has applicant submitted a copy of a maintenance 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 l CMR 15.414] 1/ Address (Jy r/V ��F �1 �"`�/ Sheet 6 of 7 N/A OK NO Nitrogen Sensitive Areas Is the system in a Designated Nitrogen Sensitive Area(Zone II for a public supply well)? [310 CMR 15.214, 310 CMR 15.215 and �J 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] M�( Address y�/ Sheet 7 of 7 t x Town of Barnstable y Sr Regulatory Services Thomas F.Geiler,Director s.�gi�isra BLEI 11f/CSS. A Public Health Division TFp � Thomas McKean,Director 206 fain Street,Hyannis,MA 02601 Office:.508-862-4644 -Fax: 508-790-6304 Installer &Designer Certification Form Date: . W9) 7,01-0 Desi er: gn i-� ✓ 6 N�aU ' Installer: Address: . � � Address: m4N&M_r2 / L o On � � _ � � was issued a perrrat to install a (d te) (installer) septic system at C'IWZ;-7 14V based on a design drawn icy (adddCr.,ess) �/dated (designer) yo certify that the septic system referenced above was installed substantially accnrdirz 'to , g . design, which may mclude minor approved changes such as lateral relocation of the d stribution box and/or septic tank. I certify,that the septic system referenced above was inst91-d with wa}ar changes_'-(Le. greater the`t 0' lateral relocation of the SAS or any vertical relocation of any componezrt of the septic=system}but in accordance with State &L•ocal;Regulations. Plan revision or certified as-bitty designer-to follow. , 3► r DAVIDc . . s (Installer rgnature) n WSON: rM • ems' ,¢'�0 1066 sgNiTAR\Pd (I3 er s Sigri'ature) (affix a er's Stamp Here) ` PLEASE RETURN TO I3A STAB�IIL+''Pt UBLIC I�ALTH DIVISION. RTINC TE OF CEWLIANCE WILL NO'T E SSUED 1OT1W=THI8,xFORM BUILT CARD ARE RECEIVED BY ACHE B STABLE PU�3�IA�►' 5I01�1 THANK YOU. Q:IHeal&Sept c/Designer Certification' "Form' . t , TOWN OF BARNSTABLE � LOCATION ��T C1U I SEWAGE# 20/0 - C ()d�I VILLAGE /re,(V/&L, ASSESSOR'S MAP&PARCEL INSTALLER'S NAME&PHONE NO�rni�:t/��J�l SEPTIC TANK CAPACITY LEACHING FACILITY:(type)t<,e ��� (size) NO.OF BEDROOMS OWNER n1ke, Ael// PERMIT DATE: o COMPLIANCE DATE: f p Separation Distance etween 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 andt-aching Facility(if any wetlands exist within 300 feet of leaching:facility). feet FURNISHED BY >r� y DEEP.OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones;Boulders. Consistency.% vel 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 DEEP OBSERVATION HOLE LOG' i• Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. C nsi to c o rave DEEP OBSERVATION HOLE LOG Hole# s Depth from Soil Horizon Soil Texture Soil Color Soil Other z Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consi ten Flood Insurance Rate Map: Above 500 year flood boundary No— Yes Within 500 year boundary No Y' Yes ' Within 100 year flood boundary No.;!� Yes „ Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervi tertal exist in al areas observed throughout the area proposed for the soil absorption system? If not,what is the dept of turally occurring pery us material? Certification G� I certify that on to + (date)I have passed the soil evaluator examination approved by the Department of Environ ental Protection and that the above analysis was or ed by me consistent with . the required training, rtis ex er n described in 310 CMR 15.01 i `�I Signature Date QASEPTIC�PERCFORM.DOC r Town of Barnstable P# � Department of Regulatory Services Public Health Division Date tb �� 200 Main Street,Hyannis MA 02601 Date Scheduled l I-VI k r1l Time t a✓-M Fee Pd. �.00 Soil S it ility Assessment for Sewage isposal Performed B nessed By:Wit ✓: LV .� S, LOCATION& GENERAL INFORMAT ON Location Address Fe;Cti 05M I X D.. Owner's Name Address j�,,o 6)"'? Assessor's Map/Parcel:17 f:-4 9j Engineer's Name%,4✓o Ci,.i /I j f&A) NEW CONSTRUCTION REPAIR ,_�` Telephone# 4 Land Use `4 Slopes(%) Surface Stones Distances from: Open Water Body ft Possible Wet Area ft Drinking Water Well ft Drainage Way ft Property Line ft Other ft SKETCH:(Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands in proximity to holes) � r 1 r Parent material(geologic) � T--Depth to Bedrock Depth to Groundwater. Standing Water in Hole: r Weeping from Pit Face Estimated Seasonal High Groundwater DETERMINATION FOR SEASONAL HIGH WATER TABLE Method Used: r Depth Observed standing in obs.hole: _ in, Depth to loll mottles: Depth to weeping from side of obs.hole: in. ©roundwater Adjustmeet fr. Index Well# Reading Date: : Index Well level ; Adl.factor. �_� Adj,Grouttdwater Level, ' - PERCOLATION TEST bete , Tfine.� Observation - Hole# Time at 9" t Depth of Perc . . Time at 6" Start Pre-soak Time @ �. Time(9"•6") En - i d Pre-soak Rate Min./Inch Oki ' Site Suitability Assessment: Site Passed Site Failed: Additional Testing Needed(Y/N) Original: Public Health Division Observation Hole Data To Be Completed on Back----------- r. f ***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:\SEPTIC\PERCFORM.DOC ASSESSOR'S MAP NO. -yam PARCEL # LOCCATION SEWAGE PERMIT NO. �CJzv�s VILLAGE I N S T A LLER'S NAME A ADDRESS r S U I L D E R OR OWNER DATE PERMIT ISSUED DAT E COMPLIANCE ISSUED ---) �� a. a 6 / .m® t THE COMMONWEALTH OF MASSACHUSETTS ( BOARD F• �!-(I[E�A' LTT{H� O-I{�.I�..I.................OF........... ....... t�.L Itf_vlsl.k'..--. -._...................... Appliratiou for Uhgvoiittl Workii Towitrurtiun Famit Application is hereby made for a Permit to Construct or Repair ( ) an Individual Sewage Disposal system- .... - Q - Locatio -A d ss or Lot No. �t �p Owner Address .P..j ...................................................... Installer Address Type of Building Size Lot..11.2,Cj ..._..Sq. feet U Dwelling—No. of Bedrooms.............. .......................Expansion Attic ( ) Garbage Grinder (,A '4 Other—T e of Building No. of persons............................ Showers — Cafeteria Q+ Other Axtures --------•------------------------- cvm ----------------------------•--- --•---- Design Flow............. ....................gallons per-fin r ay. Total d4il l�iow..._....... ....................._-.••• lons�C WSeptic Tank—Liquid capacity_�Q�..gallons Length. �Q..... Width.t�'7..k..-- Diameter________________ Depth_ �_. x Disposal Trench—No. .................... Width.................... Total Length............ Total leaching area....................sq. ft. Seepage Pit No----------1-:--_----. Diameter.... ............. Depth below inlet....._C2.......... Total leaching area.�Q.(.t..(.-sq. ft. z Other Distribution box ) Dosingtank ) '-' Percolation Test Result Performed b ._.. � .... .. ` a y ,. ---•-••-•--•.... Date_....�0141`_1- ••--�� LLL C, ... a Test Pit No. 1.... ...�rminutes per inch Depth of Test Pit--- 1..._.. Depth to ground w ter.` _... .. .. . Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ Description of Soil--- ---- - . V''` - �� ��.._.. . U ••••-----••-•••--••---------•••------•--------------------•-•••.......----•...---....•••.......-•-------.---- .............................. W -•----••••----------------••---•••••-•----•••••-•-•----•--------••---•-----•••--•-------------•--------------------------------•••------•---...---•----•••-•--•-••-•-••-••••-••-•••......----••-----•- UNature of Repairs or Alterations—Answer when applicable............................................................................................... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TIT= 5 of the State Sanitary Code—.The u dersigned further agrees not to place the system in operatic—a til a Certificate of Compliance has be i s ed y d of health. igned---- ---• - --•- --.............................................. Application Approved Y ---------------• . .... (� .. Date Application Disapproved for the f ollo • g reasons:-----•--------••---------------•--------------------•---------•---------------....._..•---••---•-•••..._•..... ..........................................................................................•.................................................................. ........................................... Date PermitNo......................................................... Issued....................................................... Date No....................... Fizim............................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .................OF........... .... aL ......................... Appliration for Di-spoiial Workii Tomitrurtion ramit Application is hereby made for a Permit to Construct or Repair an Individual Sewage Disposal system at �A .....U-r.... OEM. LIMITW....Ei �0............AQTUM-�=----&Z-4E.......................... ...... foca ..r Lot No. 1i (rusw.��........................ . ..........................................0 tZ. ..................... Owner Xd­d'r­e`s`s .......... Installer Address Type of Building Size Lot.j.q..Z Sq. feet U . ........ Dwelling—No. of Bedrooms............... ...:....................Expansion Attic Garbage Grinder a 91.4 Other—Type of Building ............................ No. of persons............................ Showers Cafeteria P4 Other fixtu_res ...................................jo;X .......................... ----------------------------I----------------- ..5 Design Flow..............11-C)................ gallons per pamian I Jay. Total daA V ffow----------- -W-­..................gqlonsji- C4 Septic Tank—Liquid capacity.10'g- allons Length..�!6..... Width.-5. Diameter................ De Disposal Trench—No..................... Widt .................. Total Length........_.... narea..__...............sq. f t. f-----I Total leach' g Seepage Pit No..........I.......... Diameter..... ......... Depth below inlet_-_6.0......... Total leaching area.. ft. Z Other Distribution box Dosin nk PAJ(Z2.�.-..__�•�{---.--__•__.----. ) Percolation Test Result Performed by. ...t.. Date......I.P. E Test Pit No. I.....c,Zminutes per inch Depth of Test Pit.... ..... Depth to ground w ter_. J ....... 44 Test Pit No. 2................minutes per n h Depth of Test Pit.__..............._. Depth to ground water._._....... 9 fir.......... ........1.31.41.... .... ............ ­­­­ __ -1.... .. ........ .. .. ... ... ................................. M 0 Description of Soil._..16-Pt._...U- A ...... ... . ............................................................................................................... ......... ........... U ................ ................................ W MI .................................................................................... .................................................................................................................. 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 T I TIE 5 of the State Sanitary Code— The undersigned further agrees not to place the system in ;/)terl, s&-Ko .k. CL operation til a Certificate of Compliance has been issued by the board of health. Slged...................................................................................... .......................... ate Application Approved Y .. ................ *.................. ......... ,------_--------"----- .... -5..... Date Application Disapproved for the followin easons:..................................I........................................................................... .......................................................................................................................................................................................................... Date PermitNo......................................................... IssuedL....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ...... ........OF (9rdifiratr of Tomptlaurr THIS IS TOC411TIFY That the Individual Sewage Disposal System constructed or Repaired by------------------------ --- ------------ 4: <=......R---Installed_,'"'*................................................................................................ C. at......................L 4...... ..........�..1 ........ has been installAd in accordance with the provisions of TITLE 5 of The State Sanitary Code as I-scribed in the application-for.,-Pisposal Works Construction Permit No.......— — —1 ':71�—. . dated----- L Code J:.................... I -W_ -6- ---------------------- SY THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE STEM WILL FUNCTION SATISFACTORY. DATE...........*'_._Lj.aJ.s.S!�............................................ Inspector........................... ............................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD Off HEALTH ............... ......OF......._.... . ......... . . N oY. ........... .... FEE. ............. . kv Tomitnution mit Permissionis hereby granted............ ...... ............................................................................................................ to Construct R 0.............. 0, Re air.. )--.ap Indivj��Jg&age System _I at N .......i ..... . ....................................................................................................... Street as shown on the application for Disposal Works Construction Permit No.........9...S.......4---4-tated........ 1) —4. .................................. ................................. - -- --- -----------­--------- - -_Vard_.�� DATE................. o e.ith FORM 1255 A. M. SULKIN, INC., BOSTON iJ SECTION - SEWAGE z�c"cu-) r�IAu.K CAT CN BSI&/ SEPTIC TANK- -"D"BOX - LEACH T TOP OF FDN � (MSL)+► "2"OF,118TO:h" / WASHED STONE eD tW OUT \ IN .� OUT. IN. G - • ,7` SEPTIC TANK J`7,53 54, ELEV. ELEV. >ELEV. ELEV. ( �: 5d.2 I ► �, \� � ELEV. ELEV. OF'A"-Iws•' 1 �\ If L� WASHED STONE. 1 — TEST-HOLE LOG, p + LBO 27 eL-E=v, q�, �, ,0041 s TEST BY .�A I ..C.O.KW 1�1. - 9�.WITNESS a y-� TEST DATE LU' I . BEDROOM HOUSE .DESIGN , T.H. T T.H. # 2 No ELEV.SCn,$o ELEV. �I 10, LIES S PERC RATE < 2 " MIN/IN. DISPOSER DISPOSER 4 3 30(GALJDAV) ; FLOW r S6 LOW RATE G •SEPTIC TANK 3 ao ILl REO'O-SEPTIC TANK SIZE C6 GO d. S ;LEACH FACILITY r SA D SIDE.WALL ��� =/57J I (2,5y77 G/D BOTTOM T a r/,cal 52::2; 3 G/D. C� ✓V� TOTAL � F A i G o� USE: 77 d LEACHING T' 7 20 WATER ENCOUNTERED X I • f h V NOTESE OTHERWISE NOTED (UNl SS O 1 1.DATUM(MSU*TAKEN FR 5 QUADRANGLE MAP 2.PIPE PITCH:4�"PER FOOT LABLE 2.MUNICIPAL WATER ^_ —______AVA1 - -' 4.DESIGN LOADING FOR ALL PRECAST UNITS:AASHO- P_/O -44 5.MIN.GROUND COVER OVER ALL SEWAGE FACILITIES:(1)FT. Of 6.PIPE JOINTS SHALL BE MADE WATERTIGHT �. 7.CONSTRUCTION DETAILS TO BE ACCORDANCE WITH COMM.OF MASS. STATE ENVIRONMENTAL CODE TITLE 5 - A + SffE PLAN $. TN�S pLA�J FQ'G 7't'p7e�_+c:� ►.JOZJ"� C7w�t.•.`C a.-�T9 ��-10�J�..'C � � '' �•" Locus• L o 7 - 3 c u�/+€� ,���iA 1 .307 REG. ER tr, �MAL ARM ` , REF i d0W/1 CtI.Pe engiaeeria4f PREPAREDFOR: L�II�c SCiLLQV.��_ CIVIL ENGINEERS o4 _ ± � IR R.—� 4 ....-'---- r BOARD OF HEALTH G � on 11Ir1A$f. LANDSURVEYORS�• �/ SJ SCALE CONTOURS (PROPOSED)—O—O—O—O-" APPROVED DATE 2 q YJl ..�A. SAL LAIA DATE � t ASSESSORS MAP : PARCEL : #� TEST NODE LOGS _. NOTES: FLOOD ZONE: �/C'./ LPG /� 1 .... .. SOIL EVALUATOR: tAVI 1� - REFERENCE: ��'� � WITNESS : -------- ?9S ..._..__ DATE: ` ,tra 1) The installation shall comply with Title V and Town of Barnstable Board of / G. .,/ _B �� `�, PERCOLATION RATE': „G Z, {�1 I Health Regulations. L� - ,,q �„ / 9 � , t✓ 0. 2) The installer shall verify the location of utilities, sewer inverts and septic components prior to installation and setting base elevations. TH- I TH-2 _ 3) All gravity septic piping to be 4 inch Sch 40 PVC at 1/8"per foot. The first ' `�►V V two feet out of the d-box to the leaching shall be level. X'1 1� I Ll� 4) This plan is not to be utilized for property line determination nor any other y r\0 t)DAA4 A v purpose other than the proposed system installation. �. lti t-� 'i In 5 All septic components must meet Title V specifications. LOCATION MAP �-( _�_..�'� '� � ) p p p 6) Parking shall not be constructed over H 10 septic components. 7) The property is bounded by property corners and property lines. 8) The property owner shall review design considerations to approve of total design flow and number of bedrooms to be considered for design. Receipt . Corr r10►4 w E ALT H Or' M ASSA c H s E Tt"S � /`'� of payment for the plan and installation based on the plan shall be deemed P'o R E ST approval of the design flow by the owner. 9) The existing leaching or cesspools shall be pumped and filled with material per Title V abandonment procedures. Those within the proposed SAS shall A l _e �, 1�11if,r b11J� be removed along with contaminated soil and replaced with clean sand per 130 ELTitle V specs. =L o-t- IS 6— �u ---� �1 -- 10)System components to be 10 feet from water line. Sewer lines crossing the S E P T I;C SYSTEM DESIGN water line shall be sleeved with 4 inch SCH 40 PVC with ends grouted if N I a applicable. The proposed SAS is being installed below the water service N ° _"lo-r 3 A- - line. The line is to be sleeved as aforementioned and maintained in place. FLOW EST 1 MATE ---' �: 11) If a garbage grinder exists it is to be removed and is the responsibility of the owner to ensure such. BEDROOMS AT l7 GAL/DAY/BEDROOM -��Ja GAL/DAY 12)The installer is to take caution in excavation around the gas line if such ' exists. 'SEPTIC TANK 13)The installer shall verify the location, quantity and elevation of the sewer F lines exiting the dwelling prior to the installation. - '-,a1-auryg"`or,p,;� CoAL/DAY x 2 DAYS - GAL USE k""X GALLON SEPT I C TANK E-X I zf,-;11 W , I S01 L ` BSORPT I ON SYSTEM HZD A, � a.z9 - 1 DE AREA: ZX Z ,3(P-fi I I��1�1 X ��� D i1 30TTOM �AREA: E B E N S 1`1 I T H R O! D b� .�csl? j/ SEPT I 'C SYSTEM SECTION � N ; or— r'ow . _ ►5t�nc�+ off'. 4 ux Z"f 5-►owl. �►�1��- �C. IbA'ClJ! 0 D G n p -'a IDDD GAL 96,Z _D-� ��:� o 0 0 0 o o q CtR ►� SEPTIC TANK 15 J o D e r T SITE AND SEWAGE PLAN 1 ' LOCATION : 0 - LOCATION 1 PREPARED FOR : M O SCALE: ! DAV I D B . MASON R_ DATE: DBC ENVIRONMENTAL DESIGNS Z EAST SANDWICH . MA W DATE HEALTH AGENT ,",� ( S 0 8 ) 8 3 3- 217 7