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Home My WebLink About0105 EBEN SMITH ROAD - Health --------------- 105 EBEN SMITH ROAD, CENTERVILLE A = 171286 UPC 12534 No.2 3_ HASTINGS, MN No._ �c I >✓ V t 14 Fee THE COMMONWEALTl_-, 2fiASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS 01pplitation for Wposal *pstrm Construction 3pPCtttit Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. 165 en 5 ml O ner's Name,Address,and Tel.No. 5 Q$-(�$(-• $7_1} Assessor's Map/Parcel M 11 C� �/r'Q O�r9 . J�lo r tey t 2 e Installer's N ame„Address,and Tel.No. Designer's Name,Address,and Tel.No. t a e-X COVC04on 508-417-0663 T),pe of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.req .red) 3,30 gpd Design flow provided gpd Plan Date 7 1 2. Number of sheets Revision Date Title Size of Septic Tank 1000 qal e x ist t n q Type of S.A.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 Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board 2fliealth. Sign Date 1�d 12-1 12 Application Approved by Date 2 1 Application Disapproved by Date for the following reasons Permit No. �-d /a ��) Date Issued i 2 G /, No.�0 1 (� t Fee U U THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC.HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS es Application for 0113W8AY 6pstem Construction j3ermit Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. ! /� cj E be n 5 r-fii Owner's Name,Address,and Tel.No. Ej U�; •(��I � c� z Ll I 1-Ond c��GP ��I rfjI( ; Ict IUrIe �/ •M I � Assessor'sap/Parcel A✓�r7i( 41 I vex r- r+, L-, 1 a ` F'r r , i -1 / Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No. I J 1 26 �X L_OvQ-i Ivn 609 y 77- U663~ Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided gpd Plan Date I -) 11 2 Number of sheets Revision Date Title Size of Septic Tank �a e X I s i i n Type of S.A.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 Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. s r-. Signe `�{ Date 2 I2-112 Application Approved by Date 1211 . Application Disapproved by 6r Date for the following reasons Permit No. D d / Date Issued I �, ?/, 2- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO CE-RRTTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired( ) Upgraded( ) Abandoned( )by P at (1�j }P' f1 f'Y11 fi' \ 'P 4/-1 has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No., dated Installer /j�I p_ r' � _� C}sI Designer #bedrooms Approved design flow 330 gpd The issuance of this permit shall not b cons/trued as a guarantee that the syste ill fu ion es' ed. Date � / �9 Inspector ------------------------------------------------------------ No. . Fee UU THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION -BARNSTABLE,MASSACHUSETTS Disposal 6pstem (Construction hermit Permission is hereby granted to Construct( ) Repair( ) Upgrade( )r Abandon( ) System located at () `�� (�' ,(� -t � Y 1 ram' l t�C and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction must be completed within three years of the date of this permit. Date .12/ ,7, i :.. Approved by f Town of Barnstable Regulatory Services Thomas F. Geller,.Director saHiasR& Public Health Division 9 1639• �0 ArFot,,prp Thomas McKean,Director 200 Main Street, Hyannis;MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Date: Sewage Permit#2D l 2_ 39R Assessor's Map/Parcel Installer &Designer Certification Form y Designer:g � � Installer: Address: C/"T"':,,� I ' ' �Uv�,�� Address:. ��+� '( On was issued a e p mut to install a (date) (installer) septic system at J" Y7 based on a e d sign drawn by (address) dated (designer) Y 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 u '°rions. Plan revision or certified as-built by designer to follow. Stripout (if rP- acted and the soils were found satisfactory. ��N OF A4, P s DAVID d'9�ya B. C Installers MASON Signa e � , No.1066 /ST P (Design is Signature) PLEASE RETURN TO BARNSTABLE PUBLA, ��fE OF COMPLIANCE WILL NOT BE ISSUED U1V'I iL DU i rn 1ri16. r'ORM AND .AS- BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. gAoffice fonns\designercertification fonn.doc Town of Barnstable P# ,� To 4 �FINF Tp� Department of Regulatory Services 1 (� BAMffABLE, ; Public Health Division Date t v l I MAES. v� 1639. � 200 Main Street,Hyannis MA 02601 CEO MA't A Date Scheduled I �'�, Time Fee Pd. ��i Soil Suitability A-ssessment for Sewage Disposal. Performed By: I�" "' Witnessed By: LOCATION & GENERAL INFORMATION Location Address OwncL, ame A06- (:5/111A!", F` Address Assessor's Map/Parcel: /7/ .a Engineer's Name NEW CONSTRUCTION REPAIR ✓ Telephone# 4568 Land Use 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&pere tests,locate wetlands in proximity to holes) Diva ;r` v Parent material(geologic) Depth to Bedrock Depth to Groundwater: Standing Water in Hole: Weeping from Pit Face Estimated Seasonal High Groundwater DETERMINATION FOR SEASONAL HIGH WATER TABLE Method Used: Depth Observed standing in obs.hole: in. Depth to soil mottles: in. Depth to weeping from side of obs.hole: in. Groundwater Adjustment fr. Index Well# Reading Date: Index Well level Adj.factor Adj.Groundwater Level I PERCOLATION TEST Date Time Observation Hole# /� f Time at 9" Depth of Perc :04 1 ki Time at 6" b Start Pre-soak Time @ Z Time(9"-6") End Pre-soak ✓ Rate Min./Inch Site Suitability Assessment: Site Passed Site Failed: Additional Testing Needed(YIN) 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:\SEPTIC\PERCFORM.DOC r DEEP OBSERVATION HOLE LOG Role# .'^ Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistent %Gravel n.:- 10 G� e a DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency.%Graven DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency,%Graven DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency,%Graven Flood Insurance Rate Map: Above 500 year flood boundary No_ Yes Within 500 year boundary No��Yes s Within 100 year flood boundary No Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervio a real exist in all areas observed throughout the area proposed for the soil absorption system? ` If not,what is the depth of naturally occurring pervious material? Certification I certify that on (date)I have passed the soil evaluator examination approved by the Department of Enviro ental Protection and that the above analysis was performe by me consistent with the requ' d training,expert' e ' nc described in 310 CMR 15.017. Signa ayz'�� Date 6Z 4?t Q:\SEPTIC\PERCFORM.DOC �. 1 J TOWN OF BARNSTABLE LOCATION Sn,i-Jk `co( SEWAGE# a01a - 39g VILLAGE CcMcry%limo, ASSESSOR'S MAP"&PARCEL INSTALLER'S NAME&PHONE NO. _9+eA Exoo ya)ion 4q7r1- OG53 SEPTIC TANK CAPACITY /o00 LEACHING.FACILITY:(type) roL4 or:; (size) 9 x 3 1 NO.OF BEDROOMS 3 OWNER rnorlct.l PERMIT DATE: 12- 13- IQ. COMPLIANCE DATE: 1 a- 19- 12 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 Al k . AZ- SZ- z ` C3 - -T4'G ,oq - CaD ' REAR Cy - g3•Q „ B" A y BORTOLOTTI CONSTRUCTION, INC. SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM O 11 1 Address Pro ------ P/65"" /--- ,"/I -------............ . ....---- / IO Date of Inspec} _ Map arcel Owner J u'Y 2 3-- 9�� / ------'�L/9 - -- - -- - - -. - - -- -- - - -- - ---- - —imp PART A - CHECKLIST CHECK IF THE FOLLOWING HAVE BEEN DONE: I✓PUMPING INFORMATION WAS REQUESTED OF THE OWNER,OCCUPANT,AND BOARD OF HEALTH. _NONE OF THE SYSTEM COMPONENTS HAVE BEEN PUMPED FOR AT LEAST TWO WEEKS AND THE SYSTEM HAS BEEN RECEIVING NORMAL FLOW RATES DURING THAT PERIOD. LARGE COLUMES OF WATER HAVE NOT BEEN INTRODUCED INTO THE SYSTEM RECENTLY OR AS PART OF THIS INSPECTION. AS-BUILT PLANS HAVE BEEN OBTAINED AND EXAMINED. NOTE IF THEY ARE NOT AVAILABLE WITH N/A. ___L,�THE FACILITY OR DWELLING WAS INSPECTED FOR SIGNS OF SEWAGE BACK-UP. (/THE SITE WAS INSPECTED FOR SIGNS OF BREAKOUT. ALL SYSTEM COMPONENTS,EXCLUDING THE SAS,HAVE BEEN LOCATED ON THE SITE. ___(_/_-THE SEPTIC TANK MANHOLES WERE UNCOVERED,OPENED,AND THE INTERIOR OF THE SEPTIC TANK WAS INSPECTED FOR CONDITION OF BAFFLES OR TEES,MATERIAL OF CONSTRUCTION,DIMENSIONS,DEPTH OF LIQUID,DEPTH OF SLUDGE, DEPTH OF SCUM. THE SIZE AND LOCATION OF THE SAS ON THE SITE HAS BEEN DETERMINED BASED ON EXISTING INFORMATION OR APPROXIMATED BY NON-INTRUSIVE METHODS. ""THE FACILITY OWNER(AND OCCUPANTS,IF DIFFERENT FROM OWNER)WERE PROVIDED WITH INFORMATION ON THE PROPER MAINTENANCE OF SSDS. PART B — SYSTEM INFORMATION FLOW CONDITIONS RESIDENTIAL --------- -------------- ---- ----------- ------- � No of Bedrooms _ -/- -No of Current Residents _ /V_Q —Garbage Grinder _ Ye Laundry Connected to System /1,4 - -Seasonal Use NON RESIDENTIAL: Calculated flow WATER METE ER BETE ERR ADINGS,IF AVAILABLE: -- - --- --- -- - -umpmg - ----- ----------------- GALLONS umping Records and Source of Information: __ SYSTEM PUMPED AS PART OF INSPECTION?/Y IF YES,VOLUME PUMPED GALS Reason for Pumping: --- -- - - ------ — TYPE OF SYSTEM: - ---- --- ---— --- ___ Septic tank/distribution box/soil absorption system Single Cesspool _Overflow Cesspool Privy Shared system(if yes, attach previous inspection records, if any) Other(explain) Approximate age of all components. Date installed,if/known. Source of information. SEWAGE ODORS DETECTED WHEN ARRIVING AT THE SITE? G 1 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B — SYSTEM INFORMATION (Continued) SEPTIC TANK: Depth below grade: /� Dimensions: Material of construction: oncrete Metal FRP Other} �O Sludge Depth Distance from top of I}rd�e to bottom of outlet tee or baffle Scum Thickness/ Distance from Top of SFum to top of outlet tee or baffle Distance from bottom of Scum to bottom of outlet tee or baffle Comments: 01 '' e o DISTRIBUTION BOX: C lJ� �j�� P DEPTH OF LIQUID LEVEL ABOVE OUTLET INVERT Comments: S PUMP CHAMBER: Pum s in working order? Comments: SOIL ABSORPTION SYSTEM (SAS): IF NOT PRESENT,EXPLAIN: TYPE: — Comments: OL CESSPOOLS: Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimension of cesspool Materials of construction Indication of groundwater inflow(cesspool must be pumped) Comments: PRIVY: Materials of construction Dimensions Depth of solids Comments: SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B - SYSTEM INFORMATION (Continued) SKETCH OF SEWAGE DISPOSAL SYSTEM: INCLUDE TIES TO AT LEAST TWO PERMANENT REFERENCES,LANDMARKS OR BENCHMARKS. LOCATE ALL WELLS WITHIN 100' DEPTH TO GROUNDWATER: / ' DEPTH TO GROUNDWATER METHOD OF DETERMINATION OR APPROXIMATION: SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C — FAILURE CRITERIA (Indicate Y-yes N-no ND-not determined.Describe basis of determination.If"not determined",explain why not.) Backup of Sewage into Facility? /✓ Discharge or ponding of effluent to the surface of the ground or surface waters? V Static liquid level in the districution box above outlet invert? r4 Liquid depth in cesspool, 6"below invert or available volume, 1/2 day flow? /y Required pumping 4 times or more in the last year? Number of times pumped l/ Septic tank is metal?cracked?structurally unsound?substantial infiltration?substantial exfiltration? tank failure imminent? /V Is any portion of the SAS,cesspool or privy, below the high groundwater elevation? /t/ Within 50 feet of a surface water? Within 100 feet of a surface water supply or tributary to a surface water supply? Within a Zone I of a public well? Within 50 feet of a private water supply well? I� �, � --/I/ Within 50 feet of a bordering vegetated wetland or salt marsh (cesspools &privies only, not the SAS)? Less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis? If the well has been analyzed to be acceptable, attach copy of well water analysis for coliform bacteria,volatile organic compounds,amonia nitrogen and nitrate nitrogen. I PART D — CERTIFICATION INSPECTOR: ROBERT J. BORTOLOTTI ADDRESS: 765 WAKEBY ROAD, MARSTONS MILLS COMPANY: BORTOLOTTI CONSTRUCTION INC. MA 02648 (508) 771-9399 CERTIFICATION STATEMENT I CERTIFY THAT I HAVE PERSONALLY INSPECTED THE SEWAGE DISPOSAL SYSTEM AT THIS ADDRESS AND THAT THE INFORMATION REPORTED IS TRUE,ACCURATE AND COMPLETE AS OF THE TIME OF INSPECTION. THE INSPECTION WAS PERFORMED AND ANY RECOMMENDATION REGARDING UPGRADE,MAINTENANCE AND REPAIR ARE CONSISTENT WITH MY TRAINING AND EXPERIENCE IN THE PROPER FUNCTION AND MAINTENANCE OF ON-SITE SEWAGE DISPOSAL SYSTEMS. CHECK ONE: V I HAVE NOT FOUND ANY INFORMA TION WHICH INDICATES THAT THE SYSTEM FAILS TO ADEQUATELY PROTECT PUBLIC HEALTH OR THE ENVIRONMENT AS DEFINED IN 310 CMF 15.303. ANY FAILURE CRITERIA NOT EVALUATED AREAS STATED IN THE"FAILURE CRITERIA"SECTION OF THIS FORM. I HAVE DETERMINED THAT THE SYSTEM FAILS TO PROTECT PUBLIC HEALTH AND THE ENVIRONMENT AS DEFINED IN 310 CMR 15.303. THE BASIS FOR THIS DETERMINATION IS PROVIDED IN THE"FAILURE CRITERIA"SECTION OF THIS FORM. INSPECTOR'S SIGNATURE: DATE: ORIGINAL TO SYSTEM OWNER,COPIES:BUYER(if applicable),APPROVING AUTHORITY r } TOWN OF BARNSTABL + LOCATION fAGE # _ ViLAGE0ezV S4?rC2/�� ASSESS 'S MAP &LOT a zNs�rx 0" NAME&PHONE NO /6V nod SEPTIC TANK CAPACITY 1661G� LEACHING FACILITY: (type) 7 ?lJ (size) CB •_ NO.OF BEDROOMS 1 BUILDER OR OWNER Vl/ ? PERMITDATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) /Y Feet Edge of Wetland and Leaching Facility(If any exist within 300 et of achingfac' ) / All Feet Furnished by O THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF�JHEALTH .V. 1................OF............W lta ls1 Lam. ........................ ,Aplrliratiun for D44pu,ial Works Tonutrurtiun Vamit Application is hereby made for a Permit to Construct ( or Repair ( ) an Individual Sewage Disposal System _l._---b.......G��r'�[�k.59 �>1_'AAD..._ "5' u. = --•.............•--.._..........---- I a' r ss is t No. .............i, ...r.,.� �. s._.._...._.._...........--... . ._......_....j _ �t`1 1.1. ...........-------..........................------- Owner Addr a -•-••.. 1.. �e� ............................................... -•-••---------• .....................L ..... staller Address d Type of Building Size Lot..p..!-l.Ql ;t.....Sq. feet Dwelling—No. of Bedrooms....................................Expansion Attic ( ) Garbage Grinder VV)IP Type 0.a Other— e of Building ............................ Showers i YP g ---------•---•------------• No. of persons• P ( ) — Cafeteria ( ) Other fi tures ..---•--•---•-......•-•-•-•---- -• •. WDesign Flow..........�._�..6............... .; ..gallons pe � �r c}fy. Total daily ow----.... lope WSeptic Tank—Liquid capacityv .gallons Length.�..(Q__.. Width.- .. ... Diameter................ Depth(,�..... x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area..... _..........sq. ft. 2.Seepage Pit No........}----------- Diameter......1. ..... Depth below inlet........-. ...../!._......... Total leaching area. 64jsq. ft. Z Other Distribution box } Dosing tank ) / Percolation Test Results Performed by----- .P ? ............:...: Date..... ],11 _.�-�_�..�..`.�... � Test Pit No. 1---G.2---minutes per inch Depth of Test Pit.-1 ........ Depth to.ground water..-- -�Zqe 44 Test Pit No. 2................minutes er inch Depth of Test Pit.................... Depth to ground water.--................---.. O Description of Soil••� -•__ . ........(Q..... ! . x -------------------------------------------------- ......---••----------...••-----•••--••••------------•---•••-...-------- w VNature 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 iITL U 5 of the State Sanitary de—.The un rsi ned further agrees not to place the system in operation until a Certificate of Compliance has en s u d th o f health. Signed. ••.•• • •-----•--------•-••----•--••-•-•-••-•-•-•- �. Applicat>on Kpproved BY Date Application Disapproved for the following reasons:-------•-- -----------•-------••----•-------•---------••--------------------•--•------------------......_....._ ......................................................................................................................................................................................................... Date PermitNo.._••. z..P_1....... r................... Issued....................................................... Date r •..—.,,...ram o No................--_..... Fizz ............._...._....._ fw !% D THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH . ........ OF........... IZ I-. ........................ Applirtttiun for Uiopuottl Vorkg Tonotrur#ion Prruti# Application is hereby made for a Permit to Construct ( or Repair ( ) an Individual Sewage Disposal System at: ............... .... 7V _. --2 ............................... I" a -(t�'Q) r s C ...or Lot No. ........--•--"•""""""�:.t�e^. .V_ .`. -••------^...................................._-•--- Owner Address W Installer Address /,, U Type g 19 DLk3....Sq. feet T e of Building Size Lot____ ._). Dwelling—No. of Bedrooms.............. ..............._.......Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ____________________________ No. of persons............................ Showers ( ) — Cafeteria ( ) d Other fix ures _-•--•--•-•-•--•••••---••-----••- W Design Flow...........�_�_______________ ___ .,,..``_gallons pe _p er 4� y. Total da!l 0ow_....__• __- ......................... -gallop. WSeptic Tank—Liquid capacityl�.lgallons Length_ _.10.___ Width_. __�y:___. Diameter________________ Depth _�_(�__.. x Disposal Trench—No_____________________ Width.................... Total Length.................... Total leaching area... _______....sq. ft. Seepige Pit No._.___._.}----------- Diameter...... 2..,..... Depth below inlet.... _.._._._ Total leaching area.7�1�..�_sq. ft. Z Other Distribution box } Dosing tank ) '-' Percolation Test Results Performed by..... -_________________ Date.....1_C?0 Test Pit No. I...G__ __minutes per inch Depth of Test Pit_. ......... Depth to ground water__-. .__ � 44 Test Pit No. 2................minutes er inch Depth of Test Pit.................... Depth to ground water........................ Ri x �1••------ ,,-, --,,�� . � -,r•�... 7` ..... /- v/__ _. ...............Description of Soil � Yl.. . •-•--•--•--•-•-•-•-•-••----••-•--••--•••-....•••••-•-•--•- -••-• ..._U J w x --------------- ........................................................................................................................................................................................ 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 TITLE 5 of the State Sanitary Code—.The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. Signed....................................................................................... ................................ Date Applicat>on Approved By.................................................................................................. ........................................ Date Application Disapproved for the following reasons_______________________________________________________________________________________________________________ •-••-•-•-•-•---••--__-•_._......-•---•._......-•••--•--••••-•---••••••.__-•••......................•--••••-•...••---•-•-•---•-•---••••••••---•-••••••-•--•----•••----•-••_.-••••--•-•• ................. __ `__ / - -•_ -----_._.. Issued----•-----•-••••-•-----•-••-------_•••- -• .......� ----•------- I d Date Permit No. ...._. Q Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ...........I....................I.,.......OF..................................................................................... Trr#if irtt#r of Toutplittnrr THIS IS TC�-- �ERTI�Y. That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) b '� IS !�----------•--•-----------------------------------------------•---•--••-------••-•-----------•- has been installed in accordance with the provisions of TITLE 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit .......... dated.........f___ �.-�1_ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE T AT THE SYSTEM WILL FU.NCT�IONJSATI FACTORY. �;� DATE.._.. 4 -•-. �.. .................. Inspector.... . ..�7 ..- - ....... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH NO.. ..................... 4EE ................ Uiopoottl ork �ono#rttrxionrrnti# Permission is hereby granted....................................................................................._.................................................. ..__. to Construct ( ) or Repair ( ) an Individual Sewage Disposal System atNo................................................................. - ..... .' Street as shown on the application for Disposal Works Construction Permit No. =1 `��'_'_' Dated____ �)_�_�___..l#..__.'_5......... 1 -- .' :LI._T.�s:.mac=•�''f-- -c.�.!:_l.,-,_.B"'� �•..... Board of Health DATE........... ........................................ FORM 1255 A. M. SULKIN, INC., BOSTON t � �G� .;G ESSO°'S MAP NO. PARCEL CAT IONOAb SEWAGE PERMIT N0. VILLAGE INST ALL (E� R',SS NAM,(Ei ADDRESS J B U I L D E R OR OWNER <, DATE PERMIT ISSUED DATE COMPLIANCE ISSUED �� .� f a va , _ � � � �� 4 `� � I _V � .� � �� - �� i - '� -! `r -� i .:J. SECTION - SEWAGE SEPTIC TANK - �' -"D"BOX - � 3� - LEACH El 4-6.,V, 4 7 Cc.- C TOP OF FON� (M.S L)w '•2"O F 118 TO 4:" i WASHED STONE IN• OUT• . . IN• _ , OUT.. IN• '\ 1 I=TA d7 J� r :. L` " I � �eG. _x/�.'ELEV. ELEV. ELEV- 22) c Q I ELEV. 2 1 ELEV. `ELEV. LEI / _ ~ �/ .031 OF3.••-I%" po � � �', WASHED STONE Z b T# s- 2SI O 4C�, Z i TEST HOLE LOG TEST BY WITNESS p. Igi T TEST DATE BEDROOM HOUSE TN•I / DESIGN 5� T.H: +r 1 T.H. +� Z �_ / ELEV.rj�j�'ZO ELEV56lC� O !! LpA SUPS. G2 .:OiSFOSEH DISPOSER. \ n� $ , pal �• U8 // PERC RATE 330 MIWIN. 3 ;� a '�" "tL 67 r,L lbo F,L'61Id,RATE ,. (GAL./DAY) \ �� u ScPTtC TANK 3 30 U SX� I oE .dCI 6 A 5 � .REO D:SEPTIC TANK SIZE M� 144 L o ( I> � LEACIi FACT LiTY S. SIDE iriVALL .')Z77 :� ='157�,72.: (Z,.S) . -? -- i, lD.' q�i,lD BOTTOM (1Zz=IzZr� 13,0 - /0.. Ii G� GL TOTAL 263, 72 ( - S 4o,ZC7 '� S alp j EP, , USE:,-..:- : :E�LLE; LEACHING /T ~ I -WATER ENCOUNTERED �Fi6-� 101 I .�1IQTES: (UNLESS OTHERWISE NOTED) : .._.. --- - 1 DATUM,(MSL)*TAKEN FROM 5N d.�l Ci 'QUADRANGLE MAP 2..MUNICIPAL WATER / oVAlU►6LE _ .. _ J 3:PIPE:PITCH.Ah!'.PER FOOT -J�. •� tN G 4.,DESIGN-LOAOING FOR ALL PRECAST UNITS-.AASHO OF S.MIN GROUNO,COVER OVER.ALLSEWAGE FACILITIES (1)FT.' 6.PIPE JOINTS SHALL BE MADE WATERTIGHT - - 7.CONSTRUCTION DETAILS TO BE ACCORDANCE WITH COMM.OF MASS. E H t S STATE ENVIRONMfNTAL.(CODE TI LE S _ p 8. T�-itb 'PtA7-J FQ'+C.TIC�7YY�c'� ►.��GCJL Cti�``f 4.�td b+- J�..b - -. -. - _-ftt IAIr .. . VI . 7, .: ►-Ja-r �E t1bEb r=aZ 71'>✓o�•Z'* C �...`tC- ��'tiv W' i Locus LILT OF MA _ .RE GINEER r �� Ali <�o ARNEyGv REF: OoK ��Q 3 /,�(7 w_ _ r, u r .. .. d • a,,c,o�IS own cape e�gineerid� , c� PREPARED FOR• CIVIL ENGINEERS R SURVEYORS - BOARD OF HEALTH I 4a• LAND (EXISTING)............. :' L.LAMO LE O I (30NTOURS (PROPOSED)-0-0_0-0-. APPROVED DATE ��'�^MA 'DATE r , r '-;,. ..L.• q I'.F.� . ly,• :0 r� t' 4t-^:,• `� s r.. J.... '..a.,. .. ,.. . .. s v. ... ... .... -. ......e - ,. .....,,., ,..... •.. .. .- a S , ASSESSORS MAP : _ NU'I'GS: 1 E S T I-I 0 L I LOGS PARCEL : Zg� _ FLOOD ZONE: /�/o/ ,�P�/G�J�,LL`- SOIL EVALUATOR: G 1) 'I Ise installation shall comply with`Title V and '1'owu of q Oard of WITNESS : 1�,. 1) 1 lealth Itegulatiolm REFERENCE: 7Z�01D �C.,. 7 )�4, 2) 'I'lie installer shall verify the location of ulililies, sewer inverts and septic -----— _.. — ---— --- --- �_ _ - - DATE. 0\ ln� b T f� f d✓ D�� iJ� W� ,�- PERCOLA 1'1 OIJ RATE: 1 I I conlponcnls prior to installation and setting base elevations. `- - -- - 3) All gravity septic piping to be 4 inch Sch 40 PVC at 1/8"per loot. The first `�--_ �7_ � �'�� ' two feet out of the d-box to the leaching shill be level. TII- I TH-2 4 This plan is not to be utilized for property line determination nor any other ) P y 7� 1pPcN'tV Nq0 A UAI'„ 0 purpose other than the proposed system installation. 1 YJM I 0 ( 5) All septic components must meet'Fitle V specificatious. Ib � G) Parking shall not be constructed over 1110 septic components. 7) The property is bounded by property corners and property lines. ,� ID (o 21 1D ty owner shall review design considerations to approve of total LOCAT 1014 MAP _ �� ,Z�I 8) "1'lre proper Z� 2� design Ilow and number of bedrooms to be considered for design. Receipt of payment for the plan and installation based on the plan shall be deemed approval of the design flow by the owner. 9) The existing leacliiug or cesspools shall be pumped and filled with material �.? �er'Fitle V abandomnent procedures. Those within the proposed SAS shall 1 P P I I--C/ q be removed along with contaiuinated soil and replaced with clean sand per ( I — �_�— `,� � 3,101 1.`,1`' ,��,lo� Title V specs. / q \ 4C� �C�c 10)System components to be 101eet from water line. Sewer lines crossing the water line shall be sleeved with 4 inch SCI 140 PVC with ends grouted if applicable. 'Fhe proposed SAS is being installed below the water service S L P I C SYSTEM D E S I GIB line. The line is to be sleeved as aforementioned and maintained in place. 11) If a garbage grinder exists it is to be removed and is the responsibility of the owner to ensure such. i FLOW ESTIMATE 12)Tlie installer is to take caution in excavation around the gas line if such / exists. �f BEDROOMS AT LO GAL/DAY/BEDROOIA -�..0 GAL/DAY 13)The installer shalLverify the location, quantity and elevation of the sewer / f lines exiling the dwelling prior to the installation. �l f � SEPTIC TANK 14)'1'his plan is representative only that a system can lit on a property meeting r i Title V requirements. l I 3 GAL:DAY x 2 DAYS - GAL USE I(XX7 GALLON SEPTICWOT TAIJIt�� t�Ti (,�� R 1 AD SOIL ABSORPTION SYSTEM Qfi� KCW b • _ � � MASON m - IV V . / rb L `� SE C SYSTEM ; SECT I Oil o rpm rd.56, , fiG ryKAIKJ Lu; pit /OGI�j SAL ,a`17 t. v SEPTIC TAIJI OF 31TE AND SEWAGE PLAN LOCAT I ON : 4 low .5ECVI I -Ra,� PREPARED FOR : EXC, v►�T7 NJ T O. 1 SCALE : Z DAV I D 13 . MASONIT•S DATE : _ DBC ENV I RONMEN rAL DES I GIJS 1.'AST SANDW I CH . MA DATE HEALTH AGEN-r 2177 l k2 Iq(12-0 lZ