HomeMy WebLinkAbout0025 EDGEWOOD ROAD - Health 25 Agewood Road
Centerville
A = 248 - 126
SMEAD
No.H163OR
UPC 10259
smead.com • Made to USA
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No.
�210 Fee
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS Yes
ZippIitation for Misposai *psteut (Construrtion permit
Application for a Permit to Construct( ) Repair(A Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components
Location Address or Lot No. oZ j eD�,N oe) A/44 Al rm"V U Owner's Name,Address,and Tel.No.
Assessor's Map/Parcel Z`{'ib li. cw•
Installer's Name,
7Address,
�and Tel.No.�'apaw;tAQ (� c��se.i Designer's Name,Address,and Tel.No. C ,� t,�o�li 5
`fL� 70L �o A;)x '�63 !z G✓-WosS F e/r/
CQ.� z� y77—S7313 �resr ��lc
Type of Building:
Dwelling No.of Bedrooms Lot Size �� 34 ± sq.ft. Garbage Grinder( )
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow(min.required) 3 3 O gpd Design flow provided S.Zo gpd
Plan Date 2-S� —Za 1 O Number of sheets Revision Date
Title E
Size of Septic Tank 1860 Type of S.A.S.
Description of Soil
Nature of Repairs or Alterations(Answer when applicable) 7�> rL" -1)-N3 a5C
1-6 LA �
Date last inspected: (j
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.
1 Date
Application Approved by Date
Application Disapproved by Date
for the following reasons
Permit No. Q Date Issued
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---------------
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No. U �� <a�' z Fee Q�
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS! Yes
ftpYication for Bisposal *pstem Construction Permit
Application for a Permit to Construct.( ) Repair(*,Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components
Location Address or Lot No. ots C,Dj-A W41 l / v1 Owner's Name,Address,and Tel.No. & qo l3iAcc��y
Assessor's Map/Parcel
Installer's Name,Address,and Tel.No. C<� cLo /0:e 5e j De'signer's Name,Address,and Tel.No. C4U�Y,cr�r,� �.rorLGc S
(� G �/ 1,0 d.�.� -7 3 /z lIG✓-G✓vsS F=efc�
/�O 7UL� Ca,,z(�� ,tC� ✓h'tr' y77 S'�13 F-(ESro-Ic-
Type of Building:
Dwelling No.of Bedrooms 2' Lot Size 104 sq.ft. Garbage Grinder( )
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow(min.required) 3 3 O gpd Design flow provided 3 ,S.S.20 gpd
Plan Date 1- Z-,5 —zo 10 Number of sheets Z- Revision Date
Title GPI
Size of Septic Tank ) C, ,Q �,�-, 1 Type of S.A.S. Q'S Lgiej
Description of Soil
c
Nature of Repairs or Alterations(Answer when applicable) �L, (OD r NYC I AA TZ> -Kay
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.
Sign , Date
Application Approved by /�- ^� Date
Application Disapproved by _ Date
for the following reasons
Permit No._ 0 � (p Date Issued
THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE,MASSACHUSETTS
Certificate of Compliance
THIS IS TO CERTIFY,that the On-sine Sewage Disposal system Constructed( ) Repaired(x) Upgraded( )
Abandoned( )by
at 0�cJ fin p�,) 9 fa A �(,4 rq ✓J n.S has been constructed in accordance
i
0
with the provisions of Title 5 and the for Disposal System Construction Permit No. �� �dated
Installer (_.A Op�.�;!tr t t) Designer
#bedrooms Approved design flow gpd
The issuance of this permit shall not be construed as a guarantee that the system will functi•n as,designed.
Date �,l , J Inspectors/ _ e
No. �����1� C �.._�._--___-----' ------------•------_-___-- ---------�--------�----•--= Fee
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS
Zisposal 6pstem Construction Permit
Permission is hereby granted to Construct( ) Repair( ) (Upgrade( ) Abandon( )
System located at a-5- L 2t p )God 1 LU ��^+ ✓aMn�. S
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'wiih`in three years of the date of this permit.
Date f�/ U Approved by, � �
TRANS. NO.:
CITY/TOWN: �4�st�rb4
APPLICANT: ��ra•+� z�'n*-t•p�s�
ADDRESS: Zs—,� ZZ;- r1 / -W
DESIGN FLOW: 33a gpd
REVIEWED BY: tom % M� DATE:
N/A OK NO
MA
Legal boundaries denoted 310 CMR 15.220(4)(a)] ✓
Street, Lot, tax pareel 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 131.0 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 dimpensions of system components and reserve areas.
310 CMR 15.220(4)(e)]
System Calculations 310 CMR 15.22 4
daily flow
se tic tank capacity(required and provided)
soil`abso &n s stem(required andprovided)
t Vhethe -system designed for garbage grinder ✓
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 dale of percolation tests (performed at proper
elevation?) [310 CMR 15.220(4)(i)]
Percolation test results match loading rate? [31.0 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)]
Address Sheet 1 of 9
.N/A OK NO
Location of every water supply, public and private [310 CMR c
15.220.4 k
within 400 feet of the proposed system location in llie
of surface water supplies and gravel packed public water su �1`
within 250 feet of the proposed system location in the case c,
within,]50 feet of the proposed system location in thei�case.,
of private water Lqply 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)] ' :waterline cross see 3 i0 CMR 15.211 1 i
Profile of system showing invert elevations of all system
components and the bottom of the SAS 310 CMR1.5.220(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
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 15.193(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?tvarious sections of 310 CMR
15.000
System compon0s not>36" deep (unless Local Upgrade
Approval or LUA`requested)[) [310 CMR 15.405 l
s
Address Sheet 2 of 9
r
i
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" of 14" + 5" per foot for increase ft depth [310
CMR 15.227 6
Outlet tee with gag baffle or approved filter [310 CMR 15.227 4
Note regarding installation on stable compacted base [310 CMR
15.228 1 ..1 raJti
Separation between-Wet and outlet tees(no less than liquid depth)
[3 10 CMR 15.227(2)]
Inlet/Outlet elevations at least 12" above high groundwater
(except as descried 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)(0]
Three access covers (inlet and outlet must be 20" or greater) -
middle access at least 8" b 7/07 310 CMR 15.228(2)] Y
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 buildin foundation 310 CMR 15.211 1
Buoyancy calculation Required/Done 310 CMR 15.221(8)] ✓
H-20 Where appropriate? [3 TO CMR 15.226(3)] ✓
Setbacks from resources 310 CMR 15.211]
Ammon
Required when gther than single-family dwelling or flow>1000
d 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 througlt or over baffle, outlet of each compartment with
as baffle or approved filter [310 CMR 15.224 4
1
f
Address Sheet 3 of 9
f
L
N/A OK NO
Located at least ten feet from any water line? [310 CMR
15.222 2
Disposal piping it 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' "'' ed in'force mains? 310 CMR 15.221(6)(c)] v
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)]
Siphonproblem/ eachfield 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 (310rCMR 15.251(5) specifies various pipe
types allowed
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 ✓
,M
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 su " 310 CMR15.232(3)(e)]
Watertight cover ,f<2000gpd); waterproof manhole if>2000gpd
310 CMR,l 5.231 3 d
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 pumpsspecified?
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
Address Sheet 4 of 9
lBuoyancy calculations needed ?Provided? [310 GMR 15.221(8)]
a:
r
a,j•
.Address Sheet 5 of 9
f :
r
N/A OK NO
12
Calculations correct?
4 feet of naturally occurring material demonstrated? [310 CMR
15.240 l
Required separation to oundwater? 310 CMR 15.212
Aggregate specified as double washed [310 CMR 15.247(2)]
System Venting required/provided?-(system under driveway or ✓,
>36" de 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
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
tograde) 310 CMR 15.253(2)]
Aggregate P minimum-4' maximum. 310 CMR 15.253 l ]
2' sidewall credit maximum 310 CMR 15.253 1 a
In bed configuration, inlet ev=40 ft. 310 CMR 15.253.6 j
Width 2'minimum 3'maximum 310 CMR 15.251 1 ]
100 feet-maximum length [310 CMR 15.251 1 a]
Minimum separation 2x effective depth or width whichever greater
3x if reserve between trenches j310 CMR 251 1 d
Situated along cpntours 310 CMR 15.251 2
Breakout OK? [3 10 CMR 15.21 1 1 4 and Guidance Document
1;...: ,
minimum 2 distribution lines 310 CMR 15.252(2)(a)] ✓
Maximum separation between lines 61 310 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
Bottom area used in calculations only 310 CMR 15.252(2)(i)]
Address Sheet 6 of 9
f
N/A OK NO
Pressure Dosed System ? Provided pump and piping calculations
as required 1310 CMR 15.220(4)(r)] t/
Pressure dosing required on all systems>2000gpd or alternative
systems under remedial approval [310 CMR 15.254(2) and I/A /
Remedial Use Approvals]
If used in gravellcss-system-make sure jet is directed as not to ✓
scour soil interface Guidance Document
Inspections once per year(systems<2000 gpd)or quarterly
>2000 dgood 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 ?
hn ervious barrier and/or retaining wall ? [Guidance Document
Impervious barrier installation must be supervised by designer l/
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 10 CMR 15.255 2 e
Check DEPApproval letters for credits and design conditions
If used with pressure dosing do not allow pressure discharge
to scour soil interface
r ys'
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 rote on the plan regarding the requirement for
perpetual maintenance eement?
Any alarms involved on separate circuits
Did the applicant submit an operation and maintenance
manual?
Has a li2nt submitted a coRX of a maintenance! Bement?
Are the variances listed on the plan? [310 CMR 15.220Y
4 I/
RLS Stamp.necessary on plan if a component is within five /
feet of property line 310 CMR 15.412(4)]
Address Sheet 7 of 9
New construction or increased flow proposed - [Refer to 310
CMR 15.414
'43
a
Address Sheet 8 of 9
N/A OK NO
Y a
z:
Is the system in a Designated Nitrogen Sensitive Area(Zone II for
a public supply Nell)? [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 CNN 15.214 2
Are the nitrogen loads proposed in compliance? [310 CMR
15.216 1
Pumping to septic tank? 310 CMR 15.229
Shared System [�1-0 CMR 15.290]
Address Sheet 9 of 9
02/10/2010 13:29 5084775313 ENGINEERING WORKS PAGE 01
' 'own of Barnstable
Regulatory Services
R Thomas F. Geiler,Director
1NAM Public Health Division
10s�' Thomas McKean,Director
200 Main street, Byanub,MA 02601
Office: 508-362-4644 Fax: 508-790-6304
Date: 2 io /e Sewage Permit# Zd 10- 240 Assessor's MaP/Parcel 'L4? - 1 Zr,.
Installer&Designer Ce1gfca 'on Form
K c_.C,. _ e
Designer: Installer: _qa
Address: LV, Cr9 i-�:�1�{ �c?� Address: P 0. JGeA 7&3
M4 1 Le M4 626 3Z
Onf, 'as issued a permit to install a
(date) (installer)
septic system at Zd" .'Joad ��_XghH•'i based on a design drawn by
(address)
►M C_G�w t`��e ' i dated
(designer) t---
I certify that the septic system referenced above was installed substantially according to
the design, which may include minor approved changes such as lateral relocation of the
distribution box and/or septic tank. Stripout (if required) was inspected and the soils
were found satisfactory.
I certify that the septic system referenced above was installed with major changes (i.e.
greater than 10' lateral relocation of the SAS or any vertical relocation of any component
of the septic system)but in accordance with State &Local Regulations. Plan revision or
certified as-built by designer to fallow. Stripout(if required) was inspected and the soils
were found satisfactory.
a��cyjH OF 04
0
��s
(Installer's Signature) PETER a Gy
CIVIL
,0 9 No.35io(De8 C
signer's Signature) (Affix D i8 )
PLEASE RETUIQ TO RARN"LE P IC HEALTH DM E S�X
ISSUED
B ARE EIVED BY THE BARN T L P
THANK'YOU.
q:lotticc fMz\ck3igr=Mtific*b6b focm_doc
4t
Town of Barnstable P#
Department of Regulatory Services
Public Health Division /
Date
200 Main Street,Hyannis MA 02601 -
rED MA'S A
Date Scheduled 6
T
ime_ D✓�}N�1 Fee Pd. ( —
Soil Suitability Assessment for Sewage PiSposal
Performed By: r
Witnessed By: kv.
& GENERAL�p '
Location Address LOCATIONINFORMATION
zs ED�¢�w�®�t Owner's Name ' � a f \
C�e.. ��Ads Address
Assessor's Map/Parcel: `�
` Engineer's Name�-40 � 2f
NEW CONSTRUCTION . �`,; '��� � -
REPAIR Telephone# 0 28
Land Use
Slopes(%) Surface Stones
Distances from: Open Water Body / ft possible We Area G
y y ft Drinking Water Well ft
Drainage Way 7 l _ft Property Line ft Other ft
SKETCH:(Street name,dimensions of lot,exact locations of test holes&pere tests,locate wetlands in Proximity ty to holes)
Z
714o it-f
D 1
Q
rI
. v
Parent material(geologic) 6-6t;
Depth[q Bedrock Lid
Depth to Groundwater. Standing Water in Hole: Kl
Weeping from Pit pace
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:
in, arnundwnterAdjustm---------- In'
Index Well# Reading Date: Index Well level fr.
Adj.factor— Adj.Groundwuterl..cvel
Observation PERCOLATION TEST bats Time __Hole#
Time at 9"
Depth of Perc
Time at G"
Start Pre-soak Time @ S�/ "'t
Time(9"•6")
End Pre-soak Z4-
fa
Rate Min./lnch Z
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:\SP-PTIC\PERCFORM.DOC
DEEP-OBSERVATION HOLE LOG Hole# i Depth from Soil Horizon Soil Texture .Soil Color Soil
Surface(in.) (USDA) Other
(Munsell) Mottling (Structure,Stones;Boulders.
y on istenc % ravel)
sc os�
C
DEEP OBSERVATION HOLE LOG Hole
Depth from Soil Horizon Soil Texture Soil Color Soil
Surface(in.) (USDA) Other
(Munsell) Mottling (Structure,Stones,Boulders.
Consistenc %GrayQ______
0c
DEEP OBSERVATION HOLE LOG Hole#
Depth from Soil Hbrizon ' Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell
Moulin) g (Structure,Stones,Boulders.
Co i to c S' Gravel
! t r Jj
DEEP OBSERVATION DOLE LOG Hole#
Depth from Soil Horizon Soil Texture Soil Cola Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders.
Consistency, I
r (;' , n.I i..•'.,`�� �..a'fir Jr J��..��� -
Flood Insurance Rate Map:
Above 500 year flood boundary No— Yes
Within 500 year boundary No Yes
Within 100 year flood boundary No/` Yes .
Depth of Naturally Occurring Pervious Material '
Does at least four feet of naturally occurring pervious material exist in all' reas;observed throughout the
area proposed for the soil absorption sys tern?
�
If not,what is the depth of naturally occumrg�iervt us material?
Certification
I certify that on (da`te)I have passed the soil evaluator examination approved by the
Department of Environmental Protection and that the above analysis was performed by me consistent with .
the required/tra Wing,expertise and experience described in 310 CMR 15.017.
Signature Date ..16
Q:\.SBPTIC�PERCFO RM.DOC
FEB.Zq................
THE COMMONWEALTH OF MASSACHUSETTS
BOA RD�&F HEALjH
..........OF..... .. ................................
Alipfiration for Dhiposal Works Toutitrurtion frrufit
Application is hereby made for a Permit to Construct or Repair (k/'ran Individual Sewage Disposal
S stem
.............................................
........... --------- --------------------------------
ion- 2
"324�.k 9
Y 0M Location Address or Lot No.. ............ .....
.. .................. .... .... .................................................................................................
'r Address
- , &.......... .........
Installer Address
Type of Building,/ Size Lot............................Sq. feet
U
Dwelling No, of Bedrooms............................................Expansion Attic Garbage Grinder
04
aOther—Type of Building ............................. No. of persons............................ Showers Cafeteria
Otherfixtures ......................................................................................................................................................
Design Flow............................................gallons per persGri per day. Total daily flow------.....................................gallons.
1:4 Septic Tank—Liquid capacity------------gallons Length________________ Width_.____.____.__.. Diameter________________ Depth................
Disposal Trench—No-----------------__ Width____._.__.______._.. Total Length.____.______._._._.. Total leaching area....................sq. ft.
Seepage Pit No..................... Diameter____._.__.__..___.__ Depth below inlet_..____...._..._.._. Total leaching area.................sq. ft.
Z Other Distribution box ( ) Dosing tank ( )
Percolation Test Results Performed by.......................................................................... Date........................................
Test Pit No. 1________________minutes per inch Depth of Test Pit_..___________._____ Depth to ground water.-___..___._.._____.___.
Test Pit No. 2................minutes per inch Depth 5 Test Pit" :.......
Depth to ground water.______.._..____._.____.
.......................................................................
Description of So S_.,_il ------.......................................................................
0 Soil.......... ...... . ...
U ........................................................................................................................................................................................................
............................................................................................................... - --------------F.............A-----------------------------------------
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 TL I Ti IS 5 of the State Sanitary Code—The unders•igned further.agrees not t place the system in
operation until a Certificate of Compliance has bee issued by th bo li Ith.
S* .. ..........A... ... 4------
Date
ApplicationApproved By........... ... ..... .... ............................................ ............?.......
Date
Application Disapproved for the flowing reasons:...............................................................................................................
........................................................................................................................................................................................................
Date
PermitNo......................................................... Issued........................................................
Date
No......... ........... Fi$..,1. .`........
THE COMMONWEALTH OF MASSACHUSETTS
BOAR® I-1EA TH
:-..14W.-Nt1.-•--....OF...-....:-:,d9 ► ---------------------------
Appliratiun for Disposal Works Toustrurtion thrutit
Application is hereby made for a Permit to Construct ( ) or Repair ( an Individual Sewage Disposal
SystemVZ'�-
------ ® j
.�� _/: t' �.-•........ .................................................. .......................•----------......------
Location-Address or Lot No.
----"!.............. .............. ........_. .._ _.........----------....._................. ..__...-•----..................._._._......---
W 8 = 1� !91"I✓l- .... --9ZS ... � ° Address
Installer Address
Type of Building Size Lot............................Sq. feet
., Dwelling No. of Bedrooms..............._.............................Expansion Attic ( ) Garbage Grinder ( )
aOther—Type of Building ____________________________ No. of persons............................ Showers ( ) — Cafeteria ( )
Otherfixtures ---------------------------•--"---"------._....-------•----•-------------•---------•---- .............................................................
Design Flow...................._........................gallons per person per day. Total daily flow............................................gallons.
WSeptic Tank—Liquid capacity............gallons Length................ Width................ Diameter................ Depth................
Disposal Trench—No...................... Width.................... Total Length.................... Total leaching area....................sq. ft.
Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft..
Z Other Distribution box ( ) Dosing tank ( )
Percolation Test Results Performed by.......................................................................... Date........................................
Test Pit No. I................minutes per inch Depth of Test Pit............_....... Depth to ground water........................
44 Test Pit No. 2................minutes per inch Depth rof f Test Pit.................... Depth to ground water........................
DDescription of Soil---------: ........ ...... ... ------ --------------"------------......................................................
x
U ......--••----••-•------------
UW ----------------- --------------------------------------------------------------------------------------------
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 t place the system in
operation until a Certificate of Compliance has be . issued by t . bo f h lth.
e
Sign �ar' � -"•--__ _:"--
Dat
Application Approved BY------•--- ---------------------• g�
Date
Application Disapproved for the Bowing reasons----------------•-----"---------=----------------------.........................................................
-------•-------------•----....---....----.....------"--"-----":_---------....---------......-"------...-------•---------•-------------------------•.---------------------------------------.--..-------
Date
PermitNo.......................................................- Issued.......................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD F' HEAL !� `�
� ...._......oF..... ...- .. `� ....
•...................•-_...
l, Irnd;v
ifiratr of Toutpliattrr
TH S *! 'TIFY T ati ual S a e DisposaL-Sw&tern onstruc ed ( ) or Repaired
by_ - _ _ZJ---- -- ---•- �---•-• -------------• ------•-----------
I taller
has been installed in accordance with the provisions of TITLE 5 of Th tate Sanitary Code as described in the-
application
for Disposal Works Construction Permit No.......................... _____________ dated................................................
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE C STRUE®AS G ANTEE HAT THE
SYSTEM WILL FU C ON SATISFACTORY.
DATE..............�• S- • --•--"--•----•-•-----------•--"-----•---- Inspector.......... �l�ll... -----
THE COMMONWEALTH OF MASSAC SETTS
----�` BOARD HEALTF '/ ,
.............. Lc. :.........OF......,1f rr'1 f_ ! �� !l' "r
::............................ �.> -- .
No..............�.Zf•!� FEE ............... =
Disposal Works :E-Pons ton vrrmit -
Permission is hereby granted.........' ...............................................................
to Construct-(- ) or Repair (L)-'in Individual Sewage Disposal System
at -
Street
as shown on the application for Disposal Works Construction Permit No.V5 D ted........ .�-�-��.................
------------------------•--•----
DATE---------------.. _"..5.
....................................... Boar of Health
FORM 1255 A. M. SULKIN, INC., BOSTON -
i
LEGEND
a
-- gg - EXISTING CONTOUR no W s T qt
f a
J ,d X 100.98 EXISTING SPOT GRADE � Sr 102 Pine Street M N PROPOSED CONTOUR `
J�
z -W EXISTING WATER SERVICE
EXISTING GAS SERVICE
'T -G Linda Ln Q.a
_ P -O.-H.-W.-OVERHEAD WIRES t, N
STK TK 100.90 _ S 75'57'50"_ E _ stockade fence_ ___ TEST PIT �i� coriotto
100,50 + 100. 101_29' VENT 98,65 -j� BENCHMARK 3 oid
O = ),own
Rd <%a
QCA
H
EXISTING LEACH PIT + 99.15 -99�a�_ga �'� `�',P�S��\ 100 76 X ocus
TO BE PUMPED & FILLED 99,14
W/SAND AND ABANDONED 97 23 97.7 e'� y/�'�� �� � 1 L CUS MAP
NOT TO SCALE
+ 101.141
,�--� � y i TP-2 GENERAL NOTES:
� ii
EXISTING SEPTIC TANK 97,05 SHED I - . I i 1. ALL CHANGES TO THIS PLAN MUST BE APPROVED BY THE LOCAL
��� �� I i BOARD OF HEALTH AND THE DESIGN ENGINEER.
TOP OF TANK, EL.=95.58 X i
INV. (OUT)=94.25E I `_+ 61.81 I ii 2. ALL WORK AND MATERIALS SHALL CONFORM TO THE REQUIREMENTS
w �\ I-T i X 9 . 4 `� i OF THE STATE ENVIRONMENTAL CODE, TITLE V, AND ANY APPLICABLE
96.68 X 97.27 I o LOCAL RULES AND REGULATIONS, EXCEPT AS REQUESTED BELOW:
O /_� i -3.LO.XC,MR-15:405(1)(b): _
O > C DECK N 1).. A_:1 -variance-tafrthe 3' maximum cover-requirement for 4' of
I O O X C\ X 96,59 97 25 j max. cover. S.A.S. shall be vented and rated H-20. '
1 O ;� 95,38� i� a 3. THE SEWAGE DISPOSAL SYSTEM SHALL NOT BE BACKFILLED PRIOR
7.19 j TO INSPECTION AND APPROVAL BY THE BOARD OF HEALTH AND THE
DESIGN ENGINEER.
Benchmark X shr. DECK " 4. ANY CONDITIONS ENCOUNTERED DURING CONSTRUCTION DIFFERING
OUTSIDE CORNER OF AC PAD I 9 4.4 81 FROM THOSE SHOWN HEREON SHALL BE REPORTED TO THE DESIGN
EL.=97.48 (Assumed datum) j 9 58 AC. I ENGINEER BEFORE CONSTRUCTION CONTINUES.
J i �ence EXISTING i 5. ALL ELEVATIONS BASED ON ASSUMED DATUM.
i I 6,81 HOUSE(#25) I
,96,51 T.O.F.=98.45E 6. THE DESIGN ENGINEER IS NOT RESPONSIBLE FOR THE FAILURE OF 97.03 THE CONTRACTOR OR OWNER TO NOTIFY THE LOCAL BOARD OF
x 98 88 HEALTH FOR PROPER INSPECTIONS DURING CONSTRUCTION.
0 XO/
,49 X 9�`6 7. WATER SUPPLY PROVIDED BY TOWN WATER SERVICE.
i GRA VEL PA VED 3
� DRIVE DRIVE \ 8. THERE ARE NO WELLS WITHIN 150' OF THE PROPOSED S.A.S.
97.28 (LOT 3) 9. ALL AREAS CLEARED FOR CONSTRUCTION SHALL BE RESTORED AS
96.21 PND 248-126 \�\ D 430 R EDEDU ONTBEPPROY AOWNER N AND
ACON
TRAC RIT ETOR OR AS OTHERWISE
i S.
1.58 R=1 j \ t 10. IT SHALL BE THE RESPONSIBILITY OF THE CONTRACTOR TO VERIFY
STK TK S 7 '57'50" E 0.Og O THE LOCATION OF ALL UNDERGROUND UTILITIES, PRIOR TO BEGINNING
97,38 9 ,ft,90 L�1.
AIRY
`� 96.135$ . CONSTRUCTION.
SKART 9$ �- -- �l 11. WHERE REQUIRED, CONTRACTOR SHALL REMOVE ALL UNSUITABLE SOILS
97.89 96.43 96.15 - -_, IN THE AREA BENEATH AND FOR 5' ON ALL SIDES OF THE S.A.S. AND
catchbasin 95J7 edge of 7. REPLACE WITH CLEAN SAND AS SPECIFIED IN 310 CMR 255(3).
96,29 oo�e� P LE 9 12. AREAS REQUIRING STRIPOUT OF UNSUITABLE MATERIALS SHALL BE
eat INSPECTED BY HEALTH DEPARTMENT PRIOR TO BACKFILL.
97,65 13. THIS PLAN IS TO BE USED FOR SEPTIC SYSTEM PURPOSES ONLY AND
OF MgSs9��G EDGEWOOD ROAD
IS NOT TO BE CONSIDERED A PROPERTY LINE SURVEY.
PETER T. PROPOSED SEPTIC SYSTEM UPGRADE PLAN
McENTEE
CIVIL N 25 EDGEWOOD ROAD, HYANNIS, MA
No. 35109
o Prepared for: Capewide Enterprises, P.O. Box 763, Centerville, MA 02632
O REGISZE`�� Engineering by: SCALE DRAWN JOB. NO.
I AL ! OWNER OF RECORD Engineering Works, Inc. 1"=20' P.T.M. 107-10
BRADY, BRIAN 9 9
25 EDGEWOOD ROAD 12 West Crossfield Road, Forestdale, MA 02644 DATE CHECKED SHEET NO.
HYANNIS, MA 02601 (508) 477-5313 1/25/10 P.T.M. 1 Of 2
~' NOTE: TO PREVENT BREAKOUT, THE PROPOSED
1 FINISH GRADE SHALL NOT BE < EL.94.3
FOR A DISTANCE OF 15' AROUND THE nlb
PERIMETER OF THE S.A.S. �0
SEPTIC TANK PROPOSED S.A.S. P�pPOS S PS.
PROPOSED D—BOX
INSTALL RISERS & COVERS OVER INLET & INSTALL RISER & WATERTIGHT INSTALL INSPECTION PORT OVER END UNIT VENT—CONVENTIONAL
T.O.F. OUTLET AND SET TO 6" OF FINISH GRADE COVER SET TO 6" OF GRADE OR CHARCOAL
EXISTING F.G. 98.3(MAX.)
F.G. EL.=97.3t F.G. EL: 97.5f
MAINTAIN 27. GRADE (MIN.) OVER S.A.S. h srj
6-
INSPECTION
L = 1 7, L _ 6(MAX) o
® S=1% (MIN.) ® S=1% (MIN.) PORT �J h
4"SCH40 PVC 4"SCH40 PVC nh DECK B .6" It -
10"I
1 a" ' 6 10.38" TO f-"
EXISTING 48" LIQUID INVERT I 1
LEVEL ADD INV.=94.08 PROPOSED INV.=93.91 I /UNIT = 25.0' shr. DECK
GAS BAFFLE 4 ROWS OF 5'UNITS AT 5.0'
.. INV.=94.25f D—BOX INV.=93.84 SOIL ABSORPTION EXISTING �SYSTEM (PROFILE)
EXISTING SEPTIC TANK
S.A.S.LAYOUT
ESTABLISH VEGETATIVE COVER
BACKFILL WITH CLEAN NATIVE OR
PERC SAND TO TOP OF CHAMBERS 21„ - 6-4' POLYSEAL OUTLETS
BREAKOUT=TOP 2 2�� 1-4• P�YSEAL INLETS
NOTES: TOP ELEV.=94.30
1) CONTRACTOR SHALL VERIFY ALL EXISTING PIPE INV. ELEV.=93.84 x
INVERTS, PRIOR TO INSTALLATION. BOTTOM ELEV.=92.97—� `V in y O 0 =
2) -BOX SHALL BE SET LEVEL AND TRUE TO 2.83 ao
GRADE ON A MECHANICALLY COMPACTED SIX 5' MIN. ABOVE BOTTOM OF
INCH CRUSHED STONE BASE, AS SPECIFIED T.P. EXCAVATION OR G.W. EFFECTIVE WIDTH=11.3' z
IN 310 CMR 15.221(2). N Top View D—BOX
EXISTING SUITABLE Section
3) INSTALL INLET & OUTLET TEES AS REQUIRED. NO G.W., EL=86.7 = MATERIAL
4) GAS BAFFLE TO BE INSTALLED ON OUTLET TEE USE 4 SEPTIC SYSTEM PROFILE SEPARATONSBETwEEN OF DEACHc 36HC UNITS ROW & NO S OINE NO 63.25"
AS MANUFACTURED BY TUF-TITE, ZABEL OR EQUAL.
N.T.S. TYPICAL SECTION
16'
SOIL LOG 34.5"
DATE: JANUARY 21, 2010 (REF 12,820)
SOIL EVALUATOR: PETER McENTEE SE#1542)
DESIGN CRITERIA WITNESS: DAVID STANTON R.S. TOP VIEW
HEALTH AGENT no -
NUMBER OF BEDROOMS: 2 BEDROOMS ELEV. TP- 1 DEPTH 'ELEy. TP-2 DEPTH END CAP END CAP
60"
SOIL TEXTURAL CLASS: CLASS 1 97.0 A 0" '96.7 A 0" FRONT VIEW SIDE VIEW
DESIGN PERCOLATION RATE: <2 MIN/IN SANDY LOAM SANDY LOAM END CAP
DAILY FLOW: 220 G.P.D. 96.5 10YR 4/2 6" 96.1 g„10YR 4/2 REAR/TOP VIEW
al
DESIGN FLOW: 330 G.P.D. B B NOTE: UNIT CONFIGURATION AND AVAILABILITY SUBJECT SIDE VIEW
SANDY LOAM SANDY LOAM TO CHANGE WITHOUT NOTICE. PRODUCT DETAIL MAY
GARBAGE GRINDER: NO 10YR 5/8 10YR 5/8 DIFFER SLIGHTLY FROM ACTUAL PRODUCT APPEARANCE.
94.0 36" 94.2 30"
LEACHING AREA REQUIRED: (330) = 445.9 S.F. C 48„ C 4640 TRUEMAN BLVD
.74 PERC mm;mHILLIARD, OHIO 43026 Are 36HC DETAIL
EXISTING SEPTIC TANK: 1000 GALLON CAPACITY 50" ADVANCED DRAINAGE SYSTEMS,INC.
PROPOSED D-BOX:: 1 INLET, 4 OUTLET (MINIMUM) M-c SAND M-C SAND
PROPOSED SEPTIC SYSTEM UPGRADE PLAN
USE 4 ROWS OF 5-ADS Arc 36 UNITS WITH NO
2.5Y 6/4 2.5Y 6/4 25 EDGEWOOD ROAD, HYANNIS, MA
SEPARATION BETWEEN EACH ROW & NO STONE Prepared for: Capewide Enterprises, P.O. Box 763, Centerville, MA 02632
e Engineering by: SCALE DRAWN JOB. NO.
BOTTOM AREA: (GENERAL USE APPROVAL FOR 4.80 SF/LF OF UNIT) 87.0 120" 186.7 120" Engineering Works, Inc. NTS P.T.M. 107-10
(Arc36HC Units) 20 UNITS x 5.0 LF x 4.80 SF/LF = 480.0 SF PERC RATE <2 MIN/IN. ("C" HORIZON) g g
NO GROUNDWATER ENCOUNTERED 12 West Crossfield Road, Forestdale, MA 02644 DATE CHECKED SHEET N0.
DESIGN FLOW PROVIDED: 0.74(480.0 S.F.) = 355.2 G.P.D. (508) 477-5313 1/25/10 P.T.M. 2 of 2