HomeMy WebLinkAbout0095 EBEN SMITH ROAD - Health ';'*115 =?ben Smith
Centerville
A== 171 — 287
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No.2-153LON - -
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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( ) Repair( VUpgrade( ) Abandon( ) ❑Complete System ❑Individual Components
Location Address or Lot Nok� �dJs/1�✓y/ �� wner's Name,Address,and Tel.No.
,cs
Assessor's Map/ParcelJ 7/1 4 "A" LLew
Installer's Name,Address,and Tel.No. 13 3 -A VOO Designer's Name,Address,and Tel.No.
579R'uLFS S j—
Type of Building:
Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder(—I
Other Type of Building No.of Persons � Showers( ) Cafeteria(---
Other Fixtures
Design Flow(min.r 7red) ✓ �j " ® gpd Design flow provided ® gpd
Plan Date //02 Number of sheets , Revision Date
Titles �GL /Q
Size of Septic Tank Type of S.A.S
Description of Soil �e Cc
Nature of Repairs or Alter7ons(Answ when ap cable) ,/j �' G �e4
o
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 It to place the system in operation until a Certificate of
Compliance has been issued by this Boar10
f HeIT
Sign Date / O
Application Approved b Date
Application Disapproved by Date
for the following reasons
Permit No.__� Date Issued
No. Jd :a 'at '�+ Fee l Qo
_ rw. - Entered in computer:
THE`COMMONWEALTH OF MASSACHUSETTS ".' Yes
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS'
f
RpPfication for Misposal 6psteut Construction Vermit
Application=for a Permit to Construct( ) Repair(f Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components
Location Address or Lot Nos �,(fS'/hJpijf R,0 Owner's Name,Address,and Tel.No.
C�rU�Zt/i�G.�'� A • G�.2/C iZ'��
Assessor's Map/ParcelJ / S�C"3 C A Leo
Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No.
3rd z v55 s )--
Type of Building:
Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder(--I
Other Type of Building No.of Persons 3' Showers(
) Cafeteria(---
Other Fixtures_ z1
Design Flow(min.required) gpd Design flow provided `7C' gpd
Plan Date U / 0 Number of sheets J Revision Date
Title q p/CZ
Size of Septic Tank Type of S.A.S. - /
f/ifiA C
Description of Soil Lo
Nat re of Repairs or Alterations(Answer when appf''cable) ��-
.0 lot AD
'0 X
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 Code7andt to place the system in operation until a Certificate of
Compliance has been issued by this Board-of He 4 .
Sign Date
Application Approved bk Date (�
Application Disapproved by Date
for the following reasons
Permit No. Date Issued
THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE,MASSACHUSETTS
' (Certificate of Compliance
THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( VRepaired( graded( )
c
Abandoned( )by
at j' ® has been constructed in accordance e
with the provisions of Title 5 and the for Disposal System Construction Permit No. 338dated /d L/0
c
Installer ?()'/rr1.5 5iE) /,�y-�,r Designer
#bedrooms Approved design flow gpd
The issuance of th?I pe it shall not be construed as a guarantee that the system will function d signed.
Date Q Inspector P-)
• - ------�--_------------•_-__--•-----------�---------------------•-----------------•--Fee----=--=-==-------- --•-- -
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION BARNSTABLE,MASSACHUSETTS
Bisposal Opstem C nstruction Permit
Permission is hereby granted to Construct( ) Repair(7Upgrade( ) Abandon( )
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.
Provided:Construction must be co pleted within three years of the date of thi's permit.
Date r/6/� � Approved
TRANS.NO.:
CITY/TOWN:
APPLICANT:ADDRESS. q 15 613N 6
DESIGN FLOW: 340 4TPD 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)] V
Locus Provided [310 CMR 15.2204(t)]
Plan proper scale? (1"=40'for plot plans, V=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 andprovided)
soil absorption system(required andprovided)
whether system designed for garbage grinder
North arrow [310 CMR 15.220(4)( )]
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)] r/
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 15.2421
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)]
Address v IZD'
Sheet 1 of 7
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
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 CMR15.220(4)(o)]
Stamp of designer[310 CMR 15.220(1) and 310 CMR 15.220(2)] LIZ
Stamp of Registered Land Surveyor(required if construction
activities within 5 ft. of lot line) [310 CMR 15.220(3)]
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)( )]
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)]
Address 1 OVEN J W�� VD Sheet 2 of 7
i
SEPTIC TANK N/A OK NO
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)] 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<I 000gpd,
two for systems>1000 gpd [310 CMR 15.228(2)] 7�
All at-grade covers secured to unauthorized access? [310 CMR /
15.228(2)] V
> 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
d [310 CMR 15.223(1)(b)]
First compartment 200%daily flow; Second compartment 1003/o
daily flow [310 CMR 15.224(2) and(3)]
J
"U" pipe through or over baffle, outlet of each compartment with
as baffle or approved filter[310 CMR 15.224(4)]
Address-A " �v��`I Z)M`t y ` VP. She
et 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)]
Si honproblem/(leachfield below pump chamber)
Endca s or vent manifoldspecified?
Size and orientation of discharge holes specified? (not smaller
than 3/8" not larger than 5/8") [310 CMR 15.251(8) and 310 1X
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)(f)]
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 J
TO GRADE [310 CMR 15.231(5)] I/
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)] V
Stable Compacted Base[310 CMR 15.221(2)]
Buoyancy calculations needed ?Provided? [310 CMR 15.221(8)]
Address � I� 15 � t �I� ' I 1�09"
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)]
Aggregate specified 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 I'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 s . ft. [310 CMR 15.253(6)]
TRENCHES 310 CMR 15.251
Width T minimum T 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 RI .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)(01
Bottom area used in calculations only [310 CMR 15.252(2)(i)]
on
Address
` Sheet 5 of 7
DID THE PLAN INVOLVE N/A OK NO
Pressure Dosed System ? Provided pump and piping
calculations as required[310 CMR 15.220(4)(r)] 1/
Pressure dosing required on all systems >2000gpd or alternative
systems under remedial approval [310 CMR 15.254(2) and I/A
Remedial Use Approvals] 1�
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
(>2000 d) 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]
At least 5 ft. from impervious barrier to edge of SAS (10 ft.
recommended) [310 CMR 15.255 (2)(e)]
Gravelless System[UA Approval Letters]
Check DEP Approval letters for credits and design conditions
If used with pressure dosing do not allow pressure discharge J
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 p
e etual maintenance agreement? V
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)( )] V
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_ I� M � � Sheet 6 of 7
Nitrogen Sensitive Areas N/A OK NO
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
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]
�3��f 5UAO Pr)
Address_ Sheet 7 of 7
Town Of Barinsta.b�o���
P
Regulatory Services
Thomas F. Geiler, Director
• 1ARNSTABLE. •
a Public Health Division
Eb
ArFoA Thomas McKean,Director
200 Main Street,Hyannis,MA 02601
Office:.508-8624644 Fax: 508-790-6304
Installer & Designer Certification Form
Date:
Designer: f VI I2 �t v`� Installer: 'UQiW
Address: . Address: _
On /JX)R* was issued a permit to install a
(date (iin,,st�alIFT)
(/''"�
septic system at .916 rT� V-0 V based on a design drawn by
(address)
I 1 dated
(designer)
I certify that the septic system referenced above was installed substantially according to
' Tie design, which may include minor approved changes such as latgr l relocation of the
distribution box and/or septic tank.
r.
e
I certify'that the septic system referenced above was installed with`'a�a}or changes (Le.
greater than 10' lateral reloeation of the SAS or any vertical'relocation of any component
of the septi'C system)but in accordance with State&.Local_Regitlations. Plan revision or,
certified as-b`3lt�iy designer to follow.
�yiN•9�Mgs�
(Installer's Signature)
oa -N .105
(13 er s Signature) (Affix' i er's$taihp Here).
PLEASE RETURN TO BARNSTI A �PUBLIC.HEALTH DIVISION. C RTIFICA TE
OF COMPLIANCE Wes.-, NOT" SSUED.-UNTIL 'BOTH T�3Is�FOR1Vi
BUILT CARD ARE RECE"rELi B'Y THE.BAR STABLlE PU$LIC HEALTH DIVISION
THANK YOU. <:
Q: Health/Septic/DesiganerCertification Forrii
of
Town of Barnstable P 4t
Department of Regulatory Services
Public Health Division
Date
i619 ,b� 200 Main Street,Hyannis MA 02601
Date Scheduled
Time 6 Fee Pd,
Soil Suitability Assess ent for Sewage Disposal�/ g
Performed By: 1 1 _ �
Witnessed By;
INFORMATION
Location Address LOCATION & GE(? r
VV � Owner's Name >�
GC�-�1 V,0)�'C Address �v�, � y
Assessor's Map/Parcel: �7/' /� �+ `
/ // - Q"� 7 . Engineer's Name
NEW CONSTRUCTION REPAIR '
Telephone#
Land Use W�_'
Slopes(90) sufface 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,ex I ions of test holes& err-tests,ts,locate wet]
ands in proximity to holes)
2 .
a
o
Z
Parent material(geologic)
Depth to Bedrock
Depth to Groundwater- Standing Water in Hole:
Weeping from Pit Face
Estimated Seasonal High Groundwater
Method Used: DETERMINATION FOR SEASONAL HIGH WATER TABLE
Depth Observed standing in obs.hole:
Depth to weeping from side of obs.hole: in, Depth to soil mottles:
Index Well# Reading Date: Index Well level GroundwaterAdjdslment h.Ad,factor- Adj.f3routidwater
Level
PERCOLATION TEST[Depth
bservation Date Time.
ole#
Time at 9"
of Perc ter"
Time at 6"
Start Pre-soak Time @ �
Time(9"-6")
End Pre-soak
Rate Min./Inch
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:\SEPTIC\PFRCFORM.DOC
r
DEEP-OBSERVATION HOLE LOG Hole#
Depth from Soil Horizon Soil Texture Surface(in.) (USDA) Sdil Color Soil.
(Munsell) SoilOther
Mottling (Structure,Stones,,Boulders.
—10 onestency,% ravel)
G 15
o �-
DEEP OBSERVATION HOLE LOG Hole'#
Depth from Soil Horizon Soil Texture Soil Color Soil
Surface(in.) Other
(USDA) (Munsell) Mottling (Structure,Stones,Boulders,
Consistency,%Gavel)
DEEP OBSERVATION HOLE LOG Hole#
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders.
CongiNtency,'Y Gravel
DEEP OBSERVATION HOLE LOG Hole#
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders.
Consi ten I
Flood Insurance Rate'Man:
Above 500 year flood boundary No_ Yes
Within 500 year boundary No '_ Yes
Within 100 year flood boundary No v7 Yes .
Depth of Naturally Occurring Pervious Material
Does at least four feet of naturally occurring pervio s t rial exist in all areas observed throughout the
area proposed for the soil absorption system?
If not, what is the depth of naturally occurring pervi6us material?,.,_.A
Certification G
I certify that on l� / (date)I have passed the soil evaluator examination approved by the
Department of,Enviro mental Protection and that the above analysis was performed by me consistent with .
the required fining,exper ' e an e e described in 310 CMR 15.017.
Signat Date
Q:�S EPTiC�PERCFO RM.DOC
f;
TOWN OF BARNSTABLE
LOCATION S�J �i(J S✓Yli�i' � SEWAGE# 3.3
,VIJLLAGE C°C v/LLB: ASSESSOR'S MAP&PARCEL �'7jj�� 7
INSTALLERS NAME&.PHONE NO
SEPTIC TANK CAPACITYCisp''i :- 1-[Tt'sri
LEACHING FACILITY: e !� s
(typ )r� �/dCLc%J �C`� (size) �(
NO.OF BEDROOMS
OWNER
PERMIT DATE: 16 O COMPLIANCE DATE: y
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) VAO Feet
Edge of Wetland and Leaching Facility(If any wetlands exist
within 300 feet of leaching facility) A1,1A Feet
FURNISHED BY
I _ 3C61 1
13r�_ �f '
m CiNo. .. r Fims.....�..................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
................OF....... •c�/ - ..............................
ApplirFation for BiopooFal Works Tonotrnr#ion ranfit
Application is hereby made for a Permit to Construct or Repair ( ) an Individual Sewage Disposal
System at:
.......1�.T.... -----e ------------- ---- : ........
Loc io d <�or Lot No.
-•••-•......_...LL
.` - ..`- ._...._..... - OYN..l...........................................................
-Owner Address
Installer Address
Type of Building Size Lot.15 2-9ZSq. feet
U ......... Expansion Attic ( )_, Dwelling—No. of Bedrooms.__ Garbage Grinder a Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( )
Q' Other fixtures .._--•.-•----------------------
- - -
allons er er, Total da'lyP flow.._ `7 W Design Flow---------•-•..Il• ,�5/�j g p 4Y t � •...� '� _ lori�i
WSeptic Tank—Liquid capacity_ 000 allons Length._ .... :._.. Width__.___.__. Diameter................ Depth U0-__.
x Disposal Trench—No_____________________ Width.__ __._...._...... Total Length................... Total leaching area.__��_l!-1l!1_l_-77_. sq. ft.
Seepage Pit No---------1_.......... Diameter..... ....... Depth below inlet.....0..._._._ Total leaching area_-L L. .sq. ft.
Z Other Distribution box Dosin tan.k��jj. ). rr//
Percolation Test Results Performed b ._ ... f�l l Date....�1�
a Test Pit No. 1..,4_ minutes per inch Depth of Test Pit.... ..... Depth to ground water.01Q (..�..._.
Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
l � r I� {+ ----------- -.-
Description of Soil _�...__ t�l--- ---= 00.• �. �?-..-61' . . ` +.�-�SJ-►`^
W -•---•--•••-•••-•-----•---•••-------•---.....---•.......................................................... t � � �--------------•-------•------------
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 TL I'N-E 5 of the State SanitaryWledder i ned further agrees not to place the system in
oper n until a •sate of Compliance has of health.
Signed--�/Application Approved By--•-•--••-•------• .. .. ....................--•-----•- ---- f f--- `'1 .......
._
� Date
Application Disapproved for the f oil ing reasons:...........................................-................................................Da•-••-•......-•--
....................................................•--------------.....•--•••-------•--•--••-------•-----•---•------•-----•-•--•--------------•-•-•-•-----•-•--•-----••••......•-----......--•--••----
Date
PermitNo......................................................... Issued.......................................................
Date
No................-.....-- � �. Fs$.............................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
�r ................OF........��A.e' � 1i�J '�_._._....
Appliration for Bispoattl Works Tonitrurtion rprutit
Application is hereby made for a Permit to Construct or Repair ( ) an Individual Sewage Disposal
System at:
....:........ Q t -5-- � 1�1....�t. l.i.T...N._.. ............. .o11u1 ..0 -
............
� } or I.ot No
I--------------- ....°so o_ r` .....................
--•---•----•------......_..._..........._..... ....
......
•------------ -----------
W Owner Address
Installer Address /J
UType of Building Size Lot_________j______ __ ______Sq. feet
Dwelling—No. of Bedrooms______________3_______________________Expansion Attic ( ) Garbage Grinder ( )
aOther—Type of Building ____________________________ No. of persons............................ Showers ( ) — Cafeteria ( )
Other fixtures ..-••-•--...--••-------•--••-• t -
Design Flow..............l_.�_____________._,.1_,_l_ gallons per ree �er� Total aflyl ow.____.__.._ long!
WW P 9capacity.I DO g �j� y /�Ifi . ----•----- ..
Septic Tank—Liquid allons Length-- _____ Width_.a�. .. _._. Diameter................ Depth �(�__.
x Disposal Trench—NP_ ____________________ Width____..._._.____._.. Total Length.............I...... Total leaching area____ sq. ft.
Seepage Pit No.........I..__.______ Diameter...... Depth below inlet...... ......... Total leaching area_�U.�.L.�.sq. ft.
Z Other Distribution box 1\/� Dosin tank ) �., + ` rr��
'-' Percolation Test Results Performed by. �" l� l( �S
a Y -- -------- ---AITZ......--••----�-�--�-----•---•----._. Date-----�j/--•�--1-----'-•----.
Test Pit No. L G_Zminutes per inch Depth of Test Pit___________ _____ Depth to ground water.NJO�•C____.
fs, Test Pit No. 2................minutes per 'nch Depth of Test Pit.................... Depth to ground water........................
AGUW . ._____=_ --��It � 1_AU 5JO . ..- I -• --° Description of .oil _____- - .-----•-
...�-;( jt-✓'}-U �/1_...__.
------------------•--•--•------------•----____----------------- ----______••--•-----•--------•----- - _ -•- ---....--•------...•--.._..••-•--
----••••--••-------------
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 TITIE 5 of the State Sanitary Code—.The undersigned further agrees not to place the system in
operRhqn until a e •• to of Compliance has been issued by the board of health.
y. igned--•-••..................•-•-----•---
,DcD t o
Application Approved By ..... --_......-- ........... 1
Application Disapproved for the f ollo g reasons__________________________________________________ Date
••-•••---_-__
--....._••---•--•-•...._._._..•-•-------------•---...-•---•...------...-•-----•----•-•._.._..•-----••••-•..-------------------•-••-•--•----•••--•--••-•--••--••••---•••---•-•••--•-••---•••-••-•--•------
Date
PermitNo........................................................ Issued_.......................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
—Ti)L�r) _P
S l�
OF.................,...................
.....^�'...\�?.. ..........
(Irrtif iratr of Toutplittnrr
THIS IS TO CERTI Y;�Te th ndividyal Se isposal System constructed) or RepairedbY-------•-_ ---f_-- -- �G G ......... . .. ••-------•--=--•--•-- ---•---•-•--------.._.....-----••-•-•-• •-------
at. Sal In .. � ��
---•------------------------------•---_._....•--..._•---•-•-•-----••--
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 No_________________________________________ dated.._.._.__.__..r___.._.._____._________......___.
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FU CTI' N SATISFACTORY.
DATE................... ..� � ...........--.................. - Inspector.........---•-•-...-•-Y--� .................
V
THE COMMONWEALTH OF MASSACHUSETTS
.. BOARD OF . HEALTH
No....:` i .`...9q� ............ `I !.�..OF -.------•---... `�W.�..................
7
Disposal Iforkii Tonstrudion 'prrutit
Permissionis hereby granted........................................................................................................................................
a;to Construct ( ) or Repair , ) an Individual Sewa e i posal stem
at No.................... �.
............................................
Street �r
S as shown on the application for Disposal Works Construction Permit No............. ...... Dated
-------- •.,-----
...................•••-•---____....__...-•- ...----••---•---_....
DATE___________________L'" rd o Health
_...g •-----•.............................
"'.FORM 1258,,.-;a:�M. SULKIN,.,INC.• BO.STON -
AS OR� R-S K9 NO PARCELS 5 - �
Lt� CATIOw L SEWAG PERMIT NO.
ViLLACE i �l
ce, , 4t
o-3
INSTA LLER'S NAME a ADDRESS
R U VLD R OR OWN ER
DATE PERMIT ISSUED ,9�5
DATE COMPLIANCE ISSUED ��
__
,4 �--�, o
III
l�\, r ��' �y.
�•,
L,
{
SECTION - SEWAGE
SEPTIC.TANK _..D..BOX- -LEACH
TOP OF FON . .
5q,pQ:
.:.. .
(MSL-I�► '•2. OF 1ISTO'.1h^ -
WASHED STONE "
C57.3� 01
IN-
OUT- IN-
0 . . OUT• IN
G
6i.150
: `' • '.'.:SEPTIC ;, b
I
3 :.:
a_
t
' TANK .���.
E L EV.
E Cfl
EV x• Y L E z LE ;i
.. ,. ELEV.' i.
k
E EV. ELEV.
OF
lw
71
4tey ''
i� l�
5"
AHED S ONE :• . r
� s
-
_ rTvt�l O�
TEST HOLE LOG:... F��9 _
9
TEST BY U WITNESS Y i
TEST DATE<' DESiGI�' BEDROOM HOUSE -
T.N: r 1 T.H. +� 2
_. ELEV.57r 30 ELEV.`
G2 DISPOSER DISPOSER
- 3011 � J,� PERC RATE- MIN/IN. '
5�{rj0 FLOW RATE 330 (GAL./DAY.) ,
SEPTIC TANK: 330 (/,=
GO S REQ'DSEPTIC TANK SIZE" -
N 1 v LEACH FACILITY
SIDE WAL BTT+v = .�7 5 d . q
G V BOTTOMS 2 -T= ��3 (/COI . $7J: G/D.
TO TA L �La� / ,/ 27,3
USE: d >c LEACHING
• = _B'.�;Gt ?JJ,o1�/ . X Gam.' Lc{f T�'f'?•�- _ j �— WATERENCOUNTERED
,
p _
_
NOTES'• (UNLESS OTHERWISE- NOTED)
x
1.DATUM(MSL) TAKEN FROM 2r�14 DUJ/� QUADRANGLE MAP.. : �7
2.`MUNICIPAL WATER' oVAILABLE
-. 3..PIPE PITCH:W"PER FOOT, { .j�
4.DESIGN LOADING FOR ALL PRECAST UNITS:AASHO- r ��� -44 Of
_.: _
S.MIN.GROUND COVER OVERALL SEWAGE'FACILITIES:(1)FT. `N - --- - --•- ' --- _ __. .
6-PIPE JOINTS SHALL BE MADE WATER TIGHT { e
7-CONSTRUCTION DETAILS TO BE ACCORDANCE WITH COMM.OF MASS. ;>s E NA.. SITE - - Ft.AN
STATE ENVIRONMENTAL CODE TITLES _
a, T�-:,��'.'i�LA�J FoL 7°Ir�7tY�c� ItiI�C.JC 0►��._�C L►._.aQ 7H�tJLD - - --- - - .
ti,a-r *.� urn �a� �b�v�� �.�c— -��.r.••._.� . // F Locus: - L-oT- S ��iFN SM(T1-) ROAD 't,
REG.PR ER
1N OF GPNTF V! S
i �ooK CE r E
+� REF:
--- dawn cope ea�ineering .�
PREPARED FOR:
_ CIVIL ENGINEERS
BOARD OF HEALTH D S VEYORS - -- v //'_ 5 LAN UR
EXISTING - -- �z, ` A� �
CONTOURS- (EXISTING) APPROVE 'GATE F� )�I�t /f- - iMA r�A� S
SCALE
(PROPOSED)-O.-O-O-O- - Yi�'W�. .', _ DATE
f.. r
e
SECTION - SEWAGE
�S ®
99 �
SEPTIC TANK - Q+ -"D"BOX - '7 -LEACH F2 /
TOP OF FON
(MSL)• ..2..OF trsTO tih"
WASHED STONE
(S7,
IN• r
OUT• IN
OUT• IN-
ELEV.
55301 •D(91 TANK
ELEV: ELEV. lI [ 9ELEV.
ELEV. ELEV. ~��M
�ry -WASHED STONE
TEST HOLE LOG:
.TEST BY�r � I,—4—
TEST
TEST DATE g5 DESIGN: BEDROOM HOUSE
T.H.- r 1 T.H. * 2
ELEV:S I r 30 ELEV. NO / x
30" �8 PERC RATE G 2 MIN/IN. DISPOSER DISPOSER
54,7v FLOW RATE .330 (GAL✓DAY)
r t,
SEPTIC TANK. aSC?
GO 5 REQ'D'SEPTIC TANK SIZE C700 �,� � 20' �.�'�-.(o
LEACH FACILITY ,.
SIDE WAL Biro =/ (z 5) 73 7,O ,G/D.
BOTTOM 8 T= ��3_ (/.0) . j?J, G/D.
�r TOTAL ��� / ,/ 27.3�/P /.•� S� `
N .
USE: 'bn�?c LEACHING ��
WATER ENCOUNTERED 'P
NOTES: (UNLESS'OTHERWISE NOTED)` J . r 7
1.DATUM(MSL):TAKEN FROM -.5A C>w/J Gf T QUADRANGLE MAP
2.MUNICIPAL WATER __AVAILABLE, :
3.PIPE PITCHs Vs"PER FOOT•' 1 /
—/� .44
4.DESIGN LOADING FOR ALL'PRE CAST UNITS:AASFIO I-``N or w
S.MIN,GROUND COVER OVER ALL SEWAGE'FACILITIESs.(l).FT.
6.PIPE JOINTS S14ALL BE MADE WATER-TIGHT
7-CONSTRUCTION DETAILS TO BE ACCORDANCE WITH COMM.OF MASS.
STATE ENVIRONMENTAL CODE TITLE S
$. T�•�N5 Qt�ls+-J ,�Qc. ���a ,�, Ic. „� a.._.t> � ��'o $ SITE PLAN
�.14 �., ►=ate ���c " -d.��,.,� . �OCvs L O T- S F�iFI,J '! H R
REG.PR EER. + F E u
REF Bc yo 3 PACE
r • • E � e'y
down ca a ea iMOM xsa- �
FOR.
p
'PREPARED
TF
:CIVIL .ENGINEER
UINDSURVEYORS
BOARC.OFHEALTH" 1 i 1 , k,✓i., f ri �<„ t
Q:fItYiA slt, /.o �a s .
Y jEXISTING).............
CONTOURSAPPROVED
DATEAMA s": YrowIw�r.MA,
(PROPOSED) O�O•-O"O" $ ~S GATE
3,#yg � wr
i f
r s r t a
,,. , 6.,
,. y ,r. .< . _ c, ., .} w -. _ .... , ..r ,.S.•..... t .i.•.�st:r...._,k..a... .._s._.,,,..-...`�i:.._....,,.k'._: -. .._., ..,.X. _.}...a. .• ., .. .. 4..w i�C7.d er..- #�,.,, ,,r:.-.5;
a
SECTION - SEWAGE
/2 -SEPTIC TANK- Q -"D"BOX - '7 -LEACH �_
�
TOP OF FDN
(MSL). "2"OF 1IeTO Va"
WASHED STONE
1B
IN• OUT• IN
OUT• IN-
ELEV. I
✓'JDI �J,.OIY(. SEPTIC \l-�il t
TANK '?f(l,I
ELEV. ELEV. i ELEV.
ELEV. ELEV. I �E
—c.�1- OF i4"-lYz"
WASHED STONE
TEST HOLE LOG, .
TEST BY T-f �l m-&-.JY7
U P> �� WITNESS
TEST DATE/ l/ �g DESIGN, BEDROOM HOUSE rr "
T.H. 0 2 'r l
-�C ELEV:S I f3O ELEV. NO / r
30a lJJ PERC RATE G2 MINAN. DISPOSER DISPOSER
54,�O FLOW RATE 330 (GAL./DAY) 30
SEPTIC TANK 33p S
GO S REQ'DSEPTIC TANK SIZE ADO �'�-Co —
N l U LEACH FACILITY
SIDE WALy BTU _/5D, Z 5 �d
G V BOTTOM O) G/D. \\ T n` \
TOTAL 20
USE: d >� LE/tCHINGlJ��-�
WATER ENCOUNTERED
NOTESI (UNLESS:OTHERWISE NOTED)
1.DATUM(MSU:TAKEN FROM 2�1 D W QUADRANGLE MAP.
2.MUNICIPAL WATER � - AVA
ILABLE
3.PIPE PITCHe W"PER FOOT`—T j`
4.DESIGN LOADING"FOR ALL'PRE CAST UNITS:AASHO _-44 SN OF /
S.MIN.GROUND COVER OVER ALL SEWAGE•FACILITIES:(1)FT.: j
6 PIPE JOINTS SHALL BE MADE WATERTIGHT
7-CONSTRUCTION DETAILS TO BE ACCORDANCE WITH COMM.OF MASS. "'AFIRE N.% -
STATE ENVIRONMENTAL CODE TITLE 5 SITE PLAN
a. T.�.� per , I�Q,c I ,o�? a w�c,c oti�� �.a �•-,��� / $ Locus: LOT' � FI3�N SMITH ROAD
-JOT �E USED r-OL �i O"✓t�.Z��C 1...�`1C �:iT�►L'�+�iGa - 1� � ',rG
EE
--.. REG +
•
PR EERY
G�NT�� lL.t_
E . v REF -$Qo ND 3' PA GE,«�? —
{ down cape engineering- oL�
PREPARED FOR:
CIVIL .ENGINEERS
t, ! o
r
LANDSURVEYORS _ ---
BOAROOF'HEALTH' _
_ 1
CONTOURS, (EXISTso
ING)..:.....:....
(PROPOSED)—O—O�O—O— APPROVED DATE Mq �s;q Y • ., �LEAD AL ( S (- DATE
. •., ;. � ' . r:. .;,"• �r �x,i r s. psty ;-:4, .,' :r >x• �
.. ... _. a-r ..... _ ,,. � .- -, :.,... :,.:. e...c .j... t .. s Gt'A{} i. •fit. V .V '� ,.�,. } �.,
.Y
ASSESSORS MAP : -4I`1
TEST HOLE L 0 G S NOTES:
PARCEL
FLOOD ZONE: V,. oI V)-FPLjLA9 5LC, .. _ _..._. _
SOIL EVALUA -OR- 'WI wI�
WITNESS :
q 1) The installation shall comply with Title V and Town of Barnstable Board of
�lJ REFERENCE:^C'E�T/�/ "T..� /�L,G f" f-`�. c. /�� � ) DATE: . !o Health Regulations.
g
�QtiJ,- _____.__./ , ZMi 69 �r ,1 ,5 PERCOLATION RATE: G -2 !Ylla. 2) The installer shall verify the location of utilities, sewer inverts and septic
p components prior installation and setting q p g base elevations.
3) All gravity septic piping to be 4 inch Sch 40 PVC at 1/8"per foot. The first
two feet out of the d-box to the leaching shall be level.
A L1�n �� �r 4) This plan is not to be utilized for property line determination nor any other
1 D � � /a b purpose other than the proposed system installation.
. /b !� - � , 5) All septic components must meet Title V specifications.
21 it. - 2�' � � 6) Parking shall not be constructed over H 10 septic components.
LOCATION MAP G� G, /v 2 q�
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
Iof payment for the plan and installation based on the plan shall be deemed
approval of the design flow by the owner.
I 9) The existing leaching or cesspools shall be pumped and filled with material
per Title V abandonment procedures. Those within the proposed SAS shall
D be removed along with contaminated soil and replaced with clean sand per
rlo RW�. IrJ�C EQ, �`� _�' �-
O 3� � —�----- - --- - Title V specs.
10)System components to be 10 feet from water line. Sewer lines crossing the
water line shall be sleeved with 4 inch SCH 40 PVC with ends grouted if
" - o o S E P'T I C S Y 1 T E M DES I G N applicable. The proposed SAS is being installed below the water service
line. The line is to be sleeved as aforementioned and maintained in place.
- -�� FLOW ESQ'I MATE 11) If a garbage grinder exists it is to be removed and is the responsibility of the
owner to ensure such.
� 222�
3 BEDROOMS AT 110 GAL/DAY/BEDROOM - 350 GAL/DAY 12)The installer is to take caution in excavation around the gas line if such
exists.
13 The installer shall verify the location, quantity and elevation of the sewer
SEPTIC TANK lines exiting the dwelling prior to the installation.
n 3?�OGAL/DAY x 2 DAYS GAL
USE I GALLON SEPTIC TANK
r S01L ABSORPTION SYSTEM
j—, j
fl
I SIDE AREA: 2-`4 IX (3 XZ X "1 i"I6
Q BOTTOM AREA: x p
1
-- IoZ6� � __- -- S T I C SYSTEM SECT I ON
�� Ib ft 3/8'�PSm�^l7 _�,g82/L b �Ga
57BO
►A �' , I ,,rams. ►
s
GAL
SEPTIC TA K 5 9 LA
i
0 5�v'L7,5_
0I SITE AND SEWAGE PLAN
---- t LOCATION : �(� ✓ �I ��p
lull
o.
> � PREPARED FOR : -FbQKf, fwAy nv4
M
O.
O ••
SCALE:
DAV I D B . MASON S DATE:ID 11009
Z DBC ENVIRONMENTAL DESIGNS
J
Z EAST SANDWICH . MA
DATE HEALTH AGENT
z ( 508 ) 833- 2177
:'i