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HomeMy WebLinkAbout0064 GLENWOOD AVENUE - Health 64 Glenwood Avenue Centerville P A = 190 120 I I � ff� m 1521/3 ORA 100/6 P2 ... . .. ....... ..:.. . .. PL No. 2-0 W I _ a I Fee vV THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS Yes ZippliLation for 30isposal Opstem Construction permit Application for a Permit to Construct( ) Repair M Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. Owner's Name,Address,and Tel.No. Assessor's Map/Parcel Installer's Name,Address,and Tel.No.CA `cQs i,,j Designer's Name,Address,and Tel.No. CCt�—(teAn. Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building S� _No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 3 o gpd Design flow provided 1A 3 gpd Plan Date j'�—?oa Number of sheets 1 Revision Date Title Size of Septic Tank I -(3 Type of S.A.S. Description of Soil _ P /I V\ Nature of Repairs or Alterations(Answer when applicable) Ems,5 t y 'T l.� 1­0 0-0 . '� l7 Date last inspected: '� �cn 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. Si ne Date 7j—Z.L—Z,0o9 Application Approved by c10 Date Application Disapproved by Date for the following reasons Permit No. CPG 01 — Date Issued - �a �No. '% F o� ee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes 9ppfitation for Disposal *pstem Consitrurtion 3permit Application for a Permit to Construct( ) Repair(1)4 Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. (.41 6 A Owner's Name,Address and Tel.No. Assessor's Map/Parcel 1107120 9—a'"'4 Installer's Name,Address,and Tel.No.Ca J, C-+f Designer's Name,Address,and Tel.No. (�Cv-f<4\.. V6 43 Ti,"4-)le. Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building �✓` a g, \ t, No.of Persons Showers( ) Cafeteria( ) Othei Fixtures Design Flow(min.required) 3 3 p gpd Design flow provided H 3 B .45 gpd r° Plan Date :71_ L-L 2.p o S Number of sheets t Revision Date 2 Tide Size of Septic Tank S0© Type of S.A.S. Description of Soil v._e Nature of:Repairs or Alterations(Answer when applicable) �,�• a 1tL� T yic 7- � o 1 y Date last inspected: 7oocl 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. Signed L Date Z L-2.0 09 Application Approved by Date "7-j-.2— d Application Disapproved by Date for the following reasons \ . q Permit No. CPO I - ` Date Issued -7 -1 a THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired(V) Upgraded( ) Abandoned( )by CtQ ,? cU. K\W UL f at (4 4( tpk-2mLU-o r ,e.L,,u has been constructed in acco dance with the provisions of Title 5 and the fo Disposal System Construction Permit No. a vo1'-2� dated 7 Installer C 4f-cuil J-1 t�1 ^u p✓�,-ej Designer L�CO-I 12c.[,,, #bedrooms Approved design flow, 3 3 y gpd The issuance of this)ermit shall not be construed as a guarantee that the system wii nc-ion as designed. Date / V Inspector Q ------- --- ----- ---- - -- -- - -- - - No. a00 1 ---------------------------------" Fee--=-•----1-- c� " ;I�_ 7�/ yV THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS disposal 6pstem Construction permit Permission is hereby granted to Construct( ) Repair'(./) Upgrade( ) Abandon( ) System located at ( L� �j�12 ,J�q ic� 0^>e,.- 4-tV U 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 corn leted within three years of the date of this permit..----� Date 7" x 9L` 05 Approved by A -S i TRANS. NO.: CITY/TOWN: G e W T L Zy 1 1_L C APPLICANT: ADDRESS: (®4 GL C w dy® (eve p y t DESIGN FLOW: 330 gpd / REVIEWED BY: DATE: 71 N/A OK NO E E � z _ g Legal boundaries denoted [310 CMR 15.220(4)(a)] Street, Lot, tax parcel number and lot number noted on plan [310 CMR 15.220(4)(u)] . Locus Provided [310 CMR 15.2204(t)] Plan proper scale? (1"=40' for plot plans, 1"=20' or fewer for components) [310 CMR 15.220(4)] Easements shown [310 CMR 15.220(4)(b)] System located totally on lot served [310 CMR 15.405(1)(a) for upgrades]- i not, a variance is required [310 CMR 15.412(4)] V 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)] 1/ Location and dimensions of system components and reserve areas. [310 CMR 15.220(4)(e)] System Calculations [310 CMR 15.220(4)(0] 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)(g)] o/ Existing and proposed contours [310 CMR 15.220(4)(g)] Location and log of deep observation holes (existing grade el. on each test) [310 CMR 15.220(4)(h)] Names of soil evaluator and BOH representative [310 CMR 15.220(4)(h) and(i)] Location and date of percolation tests(performed at proper elevation?) [310 CMR 15.220(4)(i)] Percolation test results match loading rate? [310 CMR 15.242] Certification statement by Soil Evaluator [310 CMR 15.220(4)0)] Observed and Adjusted groundwater(method for adjustment given or indicated) [310 CMR 15.103(3) and 310 CMR 15.220(4)(n)] Address `[ i t coW 0c)`I �' 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)] 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)] 1/ 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 / Approval or LUA requested) 310 CMR 15.405 1(b)] �/ ti Address (j9 l l���� ��� V Sheet 2 of 7 I 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" or 14" + 5" per foot for increase ft depth [310 CMR 15.227(6)] t/ Outlet tee with gas baffle or approved filter [310 CMR 15.227(4)] Note regarding installation on stable compacted base [310 CMR 15.228(1)] Separation between inlet and outlet tees (no less than liquid / depth) [310 CMR 15.227(2)] V 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)] V 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" (liy 7/07) [310 CMR 15.228(2)] Access to within 6 " of grade - one port for systems<1000gpd, two for systems>1000 gpd [310 CMR 15.228(2)] All at-grade covers secured to unauthorized access? [310 CMR 15.228(2)] V/ > 10 ft from building foundation [310 CMR 15.211(1)] V, 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] Required when other than single-family dwelling or flow>1000 gpd [310 CMR 15.223(1)(b)] First compartment 200% daily flow; Second compartment 100% daily flow [310 CMR 15.224(2) and(3)] "U" pipe through or over baffle, outlet of each compartment with gas baffle or approved filter [310 CMR 15.224(4)] •1 Address l [Loki W.00Ct 4 V Sheet 3 of 7 N/A OK NO ya` 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)] Siphonproblem/ (leachfield below pump chamber) ✓ Endca s or vent manifoldspecified?, . V Size and orientation of discharge holes specified? (not smaller than 3/8" not larger than,5/8") [310 CMR 15.251(8) and 310 CMR 15.252(2)(h)] ✓ Materials specified (310 CMR 15.251(5) specifies various pipe / types allowed) "--' � � •x Y "" " ,aka 'Pg v �s k' -:w',; f3% roy �'' Wr` .: „c,' .t'.xiv '¢fia�� s�s.La�,r�a.�.. ''�'.w., •s�+�w �3,�.! Stable compacted base [310FCMR 15.221(2) and 310.CMR / 15.232(2)(a)] V Splash plate or baffle tee required on inlet/provided? (when pressure sewer to d-box or steep pitch of gravity sewer) [310 CMR 15.323(3)(a)] Riser if deeper than 9" [310 CMR 15.232(3)(0] t/ Inside minimum dimension 12" [310 CMR 15:232(2)(b)] V/ Minimum sum 6" [310 CMR15.232(3)(e Watertight cover if<2000gpd); waterproof manhole if>2000gpd [310 CMR 15.232(3)(d)] PP CBS 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) L/ Alarm floats - alarm on circuit separate from pumps specified? Exceeds two units must have two pumps operating in lead-lag mode. [310 CMR 15.231(6) and(8)] Stable Compacted Base [310 CMR 15.221(2)] Buoyancy calculations needed ? Provided? [310 CMR 15.221(8)] -Sheet 4 of 7 Address 6(py) wnd ot !�f �- J �. i N/A OK NO Calculations correct? 4 feet of naturally occurring material demonstrated? [310 CMR 15.240(1)] Required separation to groundwater?,[3 10 CMR 15.212)] Aggregatespecified as double washed [310 CMR 15.247(2)] System Venting required/provided?'(system under driveway or >36" deep) [310 CMR 15.241] Inspection ports specified and within 3"final grade? [310 CMR 15.240(13)] Breakout requirements met? (No violation of breakout elevation within 15 ft of SAS unless barrier) [310 CMR 15.211(1)[4] and / Guidance Document] V Chambers and Gal. in trench configuration suppliedwith inlet every 20 ft. [310 CMR 15.253(6)f, 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 4G s . ft. [310 CMR 15.253{6)1 Width 2'minimum 3'maximum [310 CMR 15.251(1)(b)] 100 feet -maximum length [310 CMR 15.251(1)(a)] Minimum separation 2x effective depth or width whichever greater(3x if reserve between trenches) [310 CMR 251(1)(d)] Situated along contours [310 CMR 15.251(2)]' Breakout OK? [310 CMR 15.211(1)[4] and Guidance Document] 9 ' y m 8 is? �i�>^k l �-r arer l�i- a'T1I RIP -p f s. .fit ^.'t^3a .. minimum 2 distribution lines 310 CMR 15.252(2)(a)] Maximum se aration between lines 6' [310 CM R15.252 2 (d)] Maximum separation between lines and outside of bed 4' [310 CMR 15.252(2)(e)] Aggregate depth below discharge pipes 6"minimum, 12" maximum. [310 CMR 15.252(2)O] Separation between beds 10'minimum. [310 CMR 15.252(2)(f)] f Bottom area used in calculations only 310 CMR 15.252(2)(i)] Address 6 teVI WOOd - Sheet 5 of 7 N/A OK NO Pressure Dosed System ? Provided pump and piping / calculations as required [310 CMR 15.220(4)(r)] V Pressure dosing required'on all systems>2000gpd or alternative systems under remedial approval [310 CMR 15.254(2) and I/A / Remedial Use Approvalsi`iI 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? [3.10 CMR 15.252(2) and / Guidance Document] V ' At least 5 ft. from impervious barrier to edge of SAS (10 ft. 2 e recommended 1 .255 310 CMR 5 _ OO ry-"e, T .:.` '...rQNO .r Check DEP Approval letters for credits and design conditions ✓ If used with pressur6 dosing do not allow pressure discharge to scour soil interface Was DEP Approval Letter provided and/or have you A reviewed the letter for conditions? Is the technology being properly applied and does it meet all DEP Approval Conditions? Is there a note on the plan regarding the requirement for perpetual maintenance agreement? . Any alarms involved on separate circuits Did the applicant submit an operation and maintenance manual? Has applicant submitted a co ofa maintenance § u Ym.i Are ;?" the variances listed on the plan? [310 CMR 15.220 (4)( )] RLS Stamp necessary on plan if a component is within five feet of property line [310 CMR 15.412(4)] New construction or increased flow proposed- [Refer to 310 / CMR 15.414 V/ Address (�(,�UL 0 C4 VC "� 4�. _ , Sheet 6 of 7 r I 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)] — - '"qs^..<' Vlsellaneaus �� ..�.rw ..,a»,'tum..�u'i�. Pumping to septic tank? [ 310 CMR 15.229] t/ Shared System [310 CMR 15.290] Address �� 4QU� Wood 4ye Sheet 7 of 7 r _ Town of Barnstable Regulatory Services Thomas F. Geiler,Director • s/1WrAkA • s> $ Public Health Division fD N1A� Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office: 508=862-4644 Fax: 308-790=6304 Installer & Designer Certification Form Date: °�-Z2— Zcc�ck Desi er.••>� , R V i n CQQ&h(� 190W 12 Installer: _ �, � �� �i��e ' Address: 43 T zi AIJ LC C I R., Address: ?C> &3x -2 (; b2b3 On I Z Z- 09 c4vew, c e Cn�e t,Dr, ,e, was issued a permit to install a (date) (installer) septic system at �� 6 L ENS, 00 0 AV F based on a design drawn by (address) D F�V 1 O Cbu�H -.Nbw IZ dated U-1 / (designer) V 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. I certify that.the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system) but in accordance with State & Local Regulations. Plan revision or certified as-built by designer to follow. OF Mgss�c DAVID yG� D. a _ COUGHANOWIR N staller's'Si 'tune) No. 1093 aISTE k SgNI TAR\PN (Designer's Signature) (Affix Designer's Stamp Here) PLEASE RETURN TO BARN-STABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS- BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. Q:Health/Septic/Designer Certification Form YOU WISH TO OPEN A BUSINESS? 72i�St ormation: Business Certificates COST $30.00 for 4 years. A Business Certificate U MUST DO BY M.G.L. - it does not give you permission to operate). You must first n ., Hyannis. Take the completed form to the Town Clerk's Office, ONLY REGISTERS YOUR NAME in the Town ness Certificate that is required bylaw. obtain the necessary signatures on this form e, 1'' Ff., 367 Main St., Hyannis, MA 02607(Town Hall) and get Fill in please: DATE: APPLICANT'S OIO ' M BUSINESS YOUR NAME: Q e Lela YOUR HOME ADDRESS: 45 02 52-4 i e M� 2+0 2 TELEP pNE # Home Telephone Number. NAME OF NEW BUSINESS fS THIS A HOME OCCUPATION? W TYPE OF BUSINESS C'.pyyt Have you been given approov�I from the ng divisioriYES OYES �vf Cep ADDRESS OF BUSINESS NO v M�02 7 MAP/PARCEL NUMBER When starting a new business there are several things you must do in order to be in compliance with the rules and regulations Barnstable. This form is intended to assist you in obtaining the information you may need. Yo Yarmouth Rd. & Main Street) to. make sure you have the appropriate ermit Mai t. the Town of u MUST GO TO 200 Main St. — (corner of town. permits and licenses required to legally operate your business in this 7. BUILDING COMMISSIONER'S OFFICE This individual has been informed of any permit requirements that pertain to this type of business. COMMENTS: Authorized Signature** 2. BOARD OF HEALTH This individual h inform d e per equi rem is that pertain to this type of business. Authorized Si ture** COMMENTS: MUS coh ' y 3. CONSUMER AFFAIRS (LICENSING AUTHORITY) REG—ULATIQNS This individual has been informed of the licensing requirements that pertain to this type of business. COMMENTS: Authorized Signature** • TOWN OF BARNSTABLE OCATION G(A CAI QMt.jo o J SEWAGE# OL009 Z 7-L4 VILLAGE C¢.snu v� l\ ASSESSOR'S MAP&PARCEL lc(Q-%JC) INSTALLER'S NAME&PHONE NO. Cajew:a& L(-( SEPTIC TANK CAPACITY S OO IN-I c) LEACHING FACILITY:(type) I'a• (V%toy 1�j, oa t7 i C (size) Cam-\ 3 X 3`1• NO.OF BEDROOMS 3 OWNER_'(^ 1it� 5LS2deZ � ar+t10 PERMIT DATE: L0 aQ COMPLIANCE DATE:-,? -23 - 2-o oq Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility 1 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 C1lD2caZ.wt L�4V td�-Y,-> Lj A 3o o Al '0q ,27,0 �3 5 3 .5 Town of Barnstable P# ` y7 Y c� Department of Regulatory Services > L& = Public Health Division MAIM Date if 200 Main Street,Hyannis MA 02601 Date Scheduled Time Fee Pd. ! �G T Soil Suitability.Assessment for Sewage isposal Performed By:_�MAr) . COVG�1 -1�btrlllZ Witnessed By; - OCATIQN & GENERAL INFORMATION Owner's Name Location Address �j �'Q W��/ - j 11 Address Assessor's Map/Parcel: °16 a 0 Engineer's Name NEW CONSTRUCTION REPAIR Telephone# Land Use RIE 5 1. 69 `vT +L Slopes % N o w rrRR p ( ) /,`` Surface Stones t Distances from: Open Water Body C�V 0-t ft Possible Wet Area L0 U t ft Drinking Water Well to o t ft Drainage Way / ft Property Line V + ft Other ft SKETCH:(Street name,dimensions of lot,exact locations of test holes&.pere tests,locate wetlands fn proximity to holes) r. �uj ® ' --- ,P2 I ;, GROUNDWATER ADJUSTMENT 0 >s� EXISTING GROUNDWATER LEVELON TOWN p 0 �I ` J t G SS DEPARTMENTD O ECCBARNS ORDSTABLE p INDICATED GW 32.00 i W 4 INDEX WELL A1W-230 ZONE D READING J I If' READING DATE JUNE. 2009 22.9 ADJUSTMENT 3.2 ADJUSTED GW 35.2 ac -- ------__- RIVE Parent material(geologic) A� `�' s� Depth to Bedrock, ---------------- �v e Depth to Groundwater. Standing Water in Hole: Noyl a Weeping from Pit Face e Estimated Seasonal High Groundwater WMM�T N FOR SEASONAL HIGH WATER TABLE Method Used: Depth Observed standing in obs.hole. in, Depth to soil mottles: jn Depth to weeping from side of obs.hole: fn, Groundwater Adjustment ft. Index Well# Reading Date: Index Well level `Adj.factor �4 Adj.flroundwttter Level„ a PERCOLATION.-TEST- - -Dote�I'zil0y alit�. i0 .0A Observation Hole# & Time at 9" vv L q � Depth of Perc 1 n Time at 6" Start Pre-soak Time @ ��S lime(9"-6") N End Pre-soak w '13 Rate Min./Inch Site Suitability Assessment: Site Passed Site Failed: Additional Testing Needed(Y/N) N 4 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:\SEPTIWERCFORM.DGC .a SOIL TEST yL 0 G DATE OF TEST: DAVI 1D. COU R I APPROVED SOIL EVALUATOR: DAVID D. COUGHANOWR. #461 WITNESSED BY: DAVID STANTON. HEALTH DEPT. PERC NUMBER: 12635 TEST PIT I NO GROUNDWATER ENCOUNTERED t PARENT MATERIAL: PROGLACIAL OUTWASH PERC AT 68 In — 2 MIN/INCH IN C SOILS ELEVATION DEPTH SOIL USDA SOIL SOIL COLOR SOIL OTHER 62.25 (INCHES) HORIZON TEXTURE (MUNSELL) MOTTLING 0-4 Ap LOAMY SAND 10, YR 2/2 NONE FRIABLE 59.08 4-36 B LOAMY SAND 10 YR 5/4 NONE FRIABLE 50.75 36-136 C MED—COARSE SAND 10 YR 6/4 NONE LOOSE 1NO{ TEST PIT 1 PGROUNDWATER ENCOUNTERED L OUTWASH 2 MIN/INCH IN C SOILS ELEVATION DEPTH SOIL USDA SOIL SOIL COLOR SOIL OTHER ' 62.35 (INCHES) HORIZON TEXTURE (MUNSELL) MOTTLING 0-6 Ap LOAMY SAND 10 YR 3/2 NONE FRIABLE 59.02 6-40 B LOAMY SAND 10 YR 5/4 NONE FRIABLE 50.85 40-138 C MED-COARSE SAND 10 YR 6/4 NONE LOOSE DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency,9 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 en I Flood Insurance Rate Man: Above 500 year flood boundary No_ Yes Within 500 year boundary Now Yes Within 100 year flood boundary No V Yes . Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the area proposed for the soil absorption system? Lo S If not,what is the depth of naturally occurring pervious material? Certification ���` l q-6 S ` I certify that on (date)I have passed the soil evaluator examination approved by the Department of Environmental Protection and that the above analysis was performed by me consistent wit the required training,expertise and experience described in 310 CMR 15.0117. 2 a�' jNQFMAssgti Signature C'�'"� � ���= Date J Al 2 , ��� �° DAVID g a o D. COUGHANOWR Q:\SEPTIC\PERCFORM.DOC `s0 ENS E�IN 0 Q /� EVALU COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION F--� FEB 0 3 2005 TITLE7Ve,..JF 6/HRNSTABLE ritALTH DEPT. OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION ,� O Property Address: 64 Glenwood Ave !Z() Centervile Ma. Owner's Name: Lima Owner's Address: (SAME r 1 Date of Inspection: 2/1/05 `v �3 sr _. Name of Inspector:(please print)Timothy E.Cash Company Name: Cash's Trucking Inc Mailing Address: PO Box 7 , Yarmouthport, Mass 02675 Telephone Number:_(508)362-3221 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of the inspection.The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems.I am a DEP approved system inspector pursuant fo Section 15-W of Title 5(310 CMR 15.000). The system: XX Passes Conditionally Passes Needs Further Evaluation by the Local Approving Authority Fails / Inspector's Signature: 1--- Z Date: 2/1l05 Al The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection.If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP.The original should be sent to the system owner and copies sent to the buyer,if applicable,and the approving authority. Notes and Comments System should be pumped,solids are heavy ****This report only describes conditions at the time of inspection and under We conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. Title 5Inspecion Form 6/15/2000 page Page 2 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 64 Glenwood Ave Centervile Ma. Owner: Lima Dante of Inspection:211/05 Inspection Summary: Check A B C,D or E/ALWAYS complete all of Section D A. System Passes: XX I have not found any information which indicates that any of the failure criteria described in 310 CUR 15.303 or in 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below. Comments: I Have found nothinq that would indicate that this system fails under the requlations set by the DEP or the town B. System Conditionally Passes: One or more system components as described in the"Conditional Pass"section need to be replaced or repaired.The system,upon completion of the replacement or repair,as approved by the Board.of Health,will pass. Answer yes,no or not determined(Y,N,ND)in the for the following statements.if"not determined"please explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not)is structurally unsound,exhibits substantial infiltration or exfiltration or tank failure is imminent.System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health *A metal septic tank will pass inspection if it is structurally sound,not leaking and if a.Certificate of Compliance indicating that the tank is less than 20 years old is available. ND explain: Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken,settled or uneven distribution box.System will pass inspection if(with approval of Board of Health): broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced ND explain: The system required pumping more than 4 times a year due to broken or obstructed pipe(s).The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed ND explain: Title 5 Inspection Form 6/15/2000 2 Page 3 of 1 I OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 64 Glenwood Ave Centervile Ma. Owner: Lima Date of Inspection:2/1/05 C. Further Evaluation is Required by the Board of Health: Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health,safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15303(1)(b)that the system is not functioning in a manner which will protect public health,safety and the environment: Cesspool or privy is within 50 feet of a,surface water _ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2. System will fail unless the Board of Health(and Public Water Supplier,if any)determines that the system is functioning in a manner that protects the public health,safety and environment: _ The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a rf suace water supply or tributary to a surface water supply. The system has a septic tank and SAS and the SAS is within a Zone 1 of a.public water supply. _ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well".Method used to determine distance "This system passes if the well water analysis,performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form. 3. Other: Title 5 Inspection Form 6/15/2000 3 Page 4 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address:64 Glenwood Ave Centervile Ma. Owner: Lima Date of Inspection: 2/1/05 D. System Failure Criteria applicable to all systems: You must indicate"yes"or"no"to each of the following for all inspections: Yes No xx Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool got Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool xx Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool xx Liquid depth in cesspool is less than 6"below invert or available volume is less than%Z day flow xx Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number of times pumped roc Any portion of the SAS,cesspool or privy is below high ground water elevation. xx Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. xx Any portion of a cesspool or privy is within a Zone 1 of a public well. xx Any portion of a cesspool or privy is within 50 feet of a private water supply well. xx Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private wailer supply well with no acceptable water quality analysis.[This system passes if the well water analysis, performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facflity and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other faflure criteria are triggered.A copy of the analysis must be attached to this form.] i (Yes/No)The system fails.I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails.The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E. Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd- You must indicate either"yes"or"no"to each of the following: (The following criteria.apply to large systems in addition to the criteria above) yes no xx the system is within 400 feet of a surface drinking water supply roc the system is within 200 feet of a tributary to a surface drinking water supply _ xx the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area—IWPA)or a mapped Zone II of a public water supply well If you have answered"yes"to any question in Section E the system is considered a significant threat,or answered "yes-in Section D above the large system has failed.The owner or operator of any large system considered a. significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304.The system owner should contact the appropriate regional office of the Department. Title 5 Inspection Forth 6/15/2000 4 Page 5 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 64 Glenwood Ave Centervile Ma. Owner: Lima Date of Inspection: 2/1105 Check if the following have been done.You must indicate"yes"or"no"as to each of the following: Yes No roc _ Pumping information was provided by the owner,occupant,or Board of Health xx Were any of the system components pumped out in the previous two weeks? xx Has the system received normal flows in the ?— — y previous two week period. xx Have large volumes of water been introduced to the system recently or as part of this inspection? xx — Were as built plans of the system obtained and examined?(If they were not available note as NIA) got — Was the facility or dwelling inspected for signs of sewage back up? xx — Was the site inspected for signs of break out? roc — Were all system components,excluding the SAS,located on site? xx _ Were the septic tank manholes uncovered,opened,and the interior of the tank inspected for the condition of the bales or tees,material of construction,dimensions,depth of liquid,depth of sludge and depth of scum? xx — Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: Yes no xx _ Existing information.For example,a plan at the Board of Health. xx — Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable)[310 CMR 15.302(3)(b)] Title 5 Inspection Form 6/15/2000 5 Page 6 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 64 Glenwood Ave Centervile Ma. Owner. lima Date of Inspection: 211105 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): 3 Number of bedrooms(actual): 3 DESIGN flow based on 310 CUR 15.203(for example: 110 gpd x#of bedrooms): 330 Number of current residents: 3 Does residence have a garbage grinder(yes or no): No Is laundry on a separate sewage system(yes or no): No [if yes separate inspection required] Laundry system inspected(yes or no): I�il Seasonal use:(yes or no):hLo Water meter readings,if available(last 2 years usage(gpd)): 2003-79000 2004-82000 Sump pump(yes or no):NO Last.date of occupancy: 2105 COMMERCIAL/INDUSTRIAL Type of establishment: Design flow(based on 310 CMR 15.203): gpd Basis of design flow(seats/persons/sgft,etc.): Grease trap present(yes or no):_ Industrial waste holding tank present(yes or no):_ Non-sanitary waste discharged to the Title 5 system(yes or no): Water meter readings,if available: Last date of occupancy/use: OTHER(describe): GENERAL INFORMATION Pumping Records Source of information: Owner supled info Was system pumped as part of the inspection(yes or no):_ If yes,volume pumped:_gallons—How was quantity pumped determined? Reason for pumping: TYPE OF SYSTEM _Septic tank,distribution box,soil absorption system _Single cesspool _Overflow cesspool _Privy _Shared system(yes or no)(if yes,attach previous inspection records,if any) _Innovative/Alternative technology.Attach a copy of the current operation and maintenance contract(to be obtained from system owner) _Tight tank _Attach a copy of the DEP approval _Other(describe): Approximate age of all components,date installed(if known)and source of information Installed by Hickev Const. 12/17/01 Were sewage odors detected when arriving at the site(yes or no): Nb Title 5 Inspection Form 6/15/2000 6 Page 7 of l l OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 64 Glenwood Ave Centervile Ma. Owner:Lima Date of Inspection: 211/05 BUILDING SEWER(locate on site plan) Depth below grade: Materials of construction:_cast iron 40 PVC other(explain): Distance from private water supply well or suction line: Comments(on condition of joints,venting,evidence of leakage,etc.): SEPTIC TANK:_(locate on site plan) Depth below grade: 12" Material of construction: concrete metal_fiberglass_polyethylene other(explain) If tank is metal list age:_ Is age confirmed by a Certificate of Compliance(yes or no):_(attach a copy of certificate) Dimensions: 1500 oallon septic tank Sludge depth: 3" Distance from top of sludge to bottom of outlet tee or baffle:2•8 Scum thickness. 13" Distance from top of scum to top of outlet tee or baffle: 4" Distance from bottom of scum to bottom of outlet tee or baffle: 10" How were dimensions determined: measured Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): Tank is in good shave, no leaks,is all in place 3.5"drop from inlet to outlet,but tank does need to t GREASE TRAP:_(locate on site plan) Depth below grade: Material of construction: concrete metal_fiberglass_polyethylene other (explain): Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping: Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): Title 5 Inspection Form 6/15/2000 7 Page 8 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address:64 Glenwood Ave Centervile Ma. Owner: Lima Date of Inspection: 211/05 TIGHT or HOLDING TANK: (tank must be pumped at time of inspection)(kocate on site plan) Depth below grade: Material of construction: concrete metal fiberglass_polyethylene other explain): Dimensions: Capacity: gallons Design Flow: gallons/day Alarm present(yes or no): Alarm level: Alarm in working order(yes or no): Date of last pumping Comments(condition of alarm and float switches,etc.): DISTRIBUTION BOX: (if present must be opened)(locate on site plan) Depth of liquid level above outlet invert.even Comments(note if box is level and distribution to outlets equal,any evidence of solids carryover,any evidence of leakage into or out of box,etc.): D-Box in good share no sign of anv failure PUMP CHAMBER: (locate on site plan) Pumps in working order(yes or no): Alarms in working order(yes or no): Comments(note condition ofpump chamber,condition of pumps and appurtenances,etc.): Title 5 Inspection Form 6/15/2000 8 Page 9 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 64 Glenwood Ave Centervile Ma. Owner: Lima Date of Inspection: 2/1/05 SOIL ABSORPTION SYSTEM(SAS): (locate on site plan,excavation not required) If SAS not located explain why: Type leaching pits,number._ xx leaching chambers,number: 2 leaching galleries,number: leaching trenches,number,length: leaching fields,number,dimensions: overflow cesspool,number:_ innovative/altemative system Type/name of technology: Comments(note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation, etc.): 2-500 qallon leaching drywells, good shape 6"water in bottom,no sign of anv breakout,or vondinq vegatation normal CESSPOOLS: (cesspool must be pumped as part of inspection)(locate on site plan) Number and configuration: Depth—top of liquid to inlet invert. Depth of solids layer. Depth of scum layer: Dimensions of cesspool: Materials of construction: Indication of groundwater inflow(yes or no):_ Comments(note condition of soil;signs of hydraulic failure,level of ponding,condition of vegetation,etc): PRIVY: (locate on site plan) Materials of construction: Dimensions: Depth of solids: Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): Title 5 Inspection Form 6/15/2000 9 Page 10 of I 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 64 Glenwood Ave Centervile Ma. Owner: Lima Date of inspection: 211105 SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks.Locate all wells within 100 feet.Locate where public water supply enters the building. A C-Sy` A..F-S3' 3 C:5-0, BE 4' 0 A s I � E i� 1 O C. C Title 5 Inspection Form 6/15/2000 10 Page 11 of i l OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 64 Glenwood Ave Centervile Ma. Owner: Lima Date of Inspection:_211/05 SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water feet Please indicate(check)all methods used to determine the high ground water elevation: _Obtained from system design plans on record-If checked,date of design plan reviewed: Observed site(abutting property/observation hole within 150 feet of SAS) Checked with local Board of Health-explain: Checked with local excavators,installers-(attach documentation) xx Accessed USGS database-explain: Cane Cod Commision You mast describe how you established the high ground water elevation: Augered 10 feet,no water note next page Title 5 Inspection Form 6/15/2000 11 u Permit Number: Date: 2/1/05 Completed by: Timothy Cash HIGH GROUND-WATER LEVEL COMPUTATION Site Location: 64 Blenwood Avv,, Hyannis Mass Lot No. Map 190, Lot 120 Owner:Mauricio Lima Address: Sarre Contractor: Cash's Trucking Inc Address: Notes: No water encountered STEP 1 Measure depth to water table 2/41/05 10 0 to nearest 1/10 Et. .........:. ...... .Date month/day/year STEP 2 Using Water-Level Range Zone and Index Well Map locate site and determine: OAppropriate index well......................... ..... sdwr25� OBWater-level range zone..................................................... B STEP 3 Using monthly report"Current Water Resources Conditions" determine current depth to 01/05 47.1 water level for index well........................... month/year STEP A Using Table of Water-level Adjustments for index well (STEP 2A),current depth to water level for index well (STEP 3), and water-level zone (STEP 20) F1. $ determine water-level adjustment.......................................................................................... STEP 5 Estimate depth to high water by subtracting the water- level adjustment (STEP 4) from measured depth to water f3 2 levelat site (STEP 1) ................... ...................................................................................... I TOWN OF BARNSTABLE C if LOCATION SEWAGE # •S VILLAGE ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY %s`d'e LEACHING FACILITY: (type) r �} (size) /c X NO.OF BEDROOMS BUILDER OR OWNER ' PERMITDATE: vl MPLIANCE DATE: I2 Separation Distance Between the: _ Maximum Adjusted Groundwater-Table to the Bottomof Leaching Facility Feet Private Water Supply Welf-an Leaching Facility*(If any wells exist • on site or within 200 feet,of�ching facility) Edge of Wetland and Leaching Facility(If any wetlands exist Feet within 300 feet of leaching facility) Feet Furnished by A se: TOWN OF BARNSTABLE LOCATION 64 MPAIM-4 Arne SEWAGE # d00/ -�Sy VILLAGE_ VrJCrAdt�►-�it Ile- ASSESSOR'S MAP & LOT 0 1Z-10 INSTALLER'S NAME&PHONE NO. S SEPTIC TANK CAPACITY S00 LEACHING FACILITY: (type) d Sdd lrc wslls (size) Nv:OF BEDROOMS J BUILDER OR OWNER PERMITDATE: COMPLIANCE DATE: Separation Distance Between the: -Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply Well Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet F ge of Wedand and Leaching Facility(If any wetlands exist / within 300 feet of leaching facility) Feet Furnished by CAs�vs -r%4X_`i uQ T Jc_ Ac tic c7 ` Qe S3' I B u ,rs- TOWN OF BARNSTABLE LOCATION gel, r SEWAGE VILLAGE .`t�` ASSESSOR'S MAP & LOT IQ-�.Z,D INSTALLER'S NAME&PHONE NO. r SEPTIC TANK CAPACITY .LF,ACHING FACILITY: (type) jG / (size) A;s? '` r ` NO. OF BEDROOMS 7 . BtUDER OR"OWNER lan�"- PERMITDATE: `. `' OMPLIANCE DATE: �2 Separation Distance Between the: ' l Maximum Adjusted GroundwaterTable 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) - w Feet Sage of Weiland and Leaching Facility (If any wetlands exist within 300 feet of leaching facility) Feet IFurnished by S f . ✓ �', No. � 1 �.� Fee _ THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS Z(ppliration for Mizpooal *pMem Conotruction Permit Application for a Permit to Construct( )Repair( ,Apgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Addres,s,q Lot No. Owner's Name,Address and Tel.No. � Assessor'sMap/Parcel Q0 Installer's Name,Address,an Tel.No. Designer's Name,Address and Tel.No. 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 gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank I Sit). Type of S.A.S. Z— a \C rf 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 Certifi- cate of Compliance has been issue this Board o ealt__ Signed Date Application Approved by Date Application Disapproved for the following reasons Permit No. fZO 7 Date Issued v� Fee� t r " c� THE COMMONVALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLES MASSACHUSETTS, Zipprication for �Digpogal *pztem Construction Permit Application for a Permit to Construct( )Repair( grade( )Abandon( ) El Complete System ❑Individual Components Location Addre qr Lot No. �VQ Owner's Name,Address and Tel.No. (ill M\ew.vwod& Assessor's Map/Parcel q r Installer's Name,Address,an Tel.No. Designer's Name,Address and Tel.No. 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 gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date 4 Title Size of Septic Tank Type of S.A.S. DVo,� \C -,Ay rf j Description of Soil 0t X Z�, 1 Nature of Repairs or Alterations(Answer when applicable) � r 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 Certifi- cate of Compliance has been issue this B and o ealt Signed ���•-- Date /2. n 6 t 7.Application Approved by, -6vj' Date I? 0 Application Disapproved-for the following reasons Permit No. b U I- •7S�I Date Issued / G THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS (Certificate of Compliance THIS IS TO CERTIFY,that the O -site Sewage Disposal System Constructed( )Repaired Upgraded( ) Abandoned( )by �e\e � Ow S at `� e hwoo � �-�✓1 T-e rv• �f'• has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. Z 1 • I dated /z 7 U OO Installer &Kti"r— Designer The issuance of this permit shall not be construed as a guarantee that the system will function as designed. Date Inspector No. ZOO 1 — 5 ! Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLES MASSACHUSETTS 1=i5po0ar *p5tem Congtructton Permit Permission is hereby granted to Const;ttct( )Repair( �pgrade( )Abandon( ) System located at G 4 (;�\e w out Av e _ and as described in the above Application for Disposal System Construction Permit.The applicant recognizes 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 Date: �52 �/7 /O 1 Approved by ALL PIPE SPECIFIED ARE INVERT ATIONS F L_O W PROFILE EXPRESSED INV DECt IMAL FEET NOT FEET AND INCHES ELEVATIONS RAISE COVERS TO WITHIN SIX INCHES OF FINAL GRADE TOP OF FOUNDATION USE 4 in SCHEDULE 40 PVC PIPE EL = 62.51 +- 61.00 �D-BOX INSPECTION BOX 3 PORT PONE 3" DROP MAX PER TRENCH! FLOW LIN 10' = II 14' 46 G A S� BAFFLE 6 inJ.63 5B.55 EXISTING STONE 57 -- ------ --- -_-- BOTTOM OF EXISTING BASESOIL ABSORPTION EXISTING 56.00 LEACHING SYSTEM EXISTING 1500 GALLON _ L56.77 GALLERY 5.00 FL+ EXISTING SEPTIC TANK 7 FL 4 f tE DETAIL ON REVERSE bl 13 f't 27.0 ADJUSTED SEASONAL HIGH GROUNDWATER y�XX m _ <� z O GL Byrn z w0 _am m OD n3irn�n �� c�F EDG= / V P/iVEM ' VENUE ova= �T ~o m �N mm 3rncon� rn m n U)co z p r m ] DRI VEWA y ;u=0� Z mo3 M 0- Z m Wmrnrn 1 m�o° m ' EXISTING \ `I I z;o � 1 � g 3 BED j� � 1 N�,m 1 WELL�OM 1 mz3 < o �I NG o � . ' TDP I W rnrn O mj EL = 626NON rn o f4l P�q TIC / N I arnx I i F-nco / iN m P Im �9 VED I 1 1T � EG✓,q Y � CD IT rn oco ! Z R 02) � � �TT� z I3�e ` 1 = ZTTa N 'Y.::':'y n O ID >co I rn� , / 1 1 = � > >o ' R1 I o � cnrn Z 3� O N IT z o XZ 0 - o > I ! 1 z o > w 3 cj) 3m =oocn= o Co w Nt� -'� z x o� z �b�� rn 3U n o3nrm� q o�7 ®° nC �z O m m <r (T� > -p n z—zi� co oz � � _� ® fTl ® X . G7� r m� i I >m ul N o co O foZ )> N � m n �� COM � � z i C ��oao 19 cNnn �' MOtiiy 0 � � >o�r-o Ul � Wrn ''�1 L.� ,�-aZ0 �� fir' (f) In>>z C o o z r X i '100 cn _ on m °� o � o � Ntoo 0 Cm->oz =0 z > (I>R n c0c) IT_ mL o IT In -- o AmG � rn c o -I (f) oj o z � �IT m� gymz> rn o �z tZ mmO mod F �om -i cIT oMo j' I � n - XO �c N ( m <O p o m� 000O Z O oy .uIoo 505 r nzm 3 o < R1M I ry r❑ Z7 z > z = v C o rnCD 3 ® O m cn O GL oc~zi-�> CD > f�l c o p zo �O �Z � ' I orn ���wOpO ono >-;-mu o O co ci s n M> N o W v� ° ay °o rTlz V J a ENVE g IT m a z n3 N � � r 3 z nmA rn � O �r OT FL <r- rn � r3 r O r �c lfU >Z fi <rn� oY >mm 0�� rn 0 YIN4�G � Ro40 O Z V SOIL TEST LOG DATE OF TEST: DAVI 21. 2009 DESIGNCALCULATIONS A I I I A APPROVED SOIL EVALUATOR: DAVID D. COUGHANOWR. #461 "�J C / \ I� C l_.1 � / \ T I O N S WITNESSED BY: DAVID STANTON. HEALTH DEPT. PERC NUMBER: 12647 DESIGN FLOW-3drBEDROOMS X HO GPD = 040 GPDO �v TEST PIT 1 NO GROUNDWATER ENCOUNTERED SEPTIC TANK: 440 GPD X 2 DAYS = 680 GALLONS PARENT MATERIAL: PROGLACIAL OUTWASH USE EXISTING 1500 GALLON SEPTIC TANK IF IN SOUND STRUCTURAL PERC AT 64 In - 2 MIN/INCH IN C SOILS CONDITION. IF NOT, INSTALL NEW 1500 GALLON SEPTIC TANK (MINIMUM ALLOWED) ELEVATION DEPTH SOIL USDA SOIL SOIL COLOR SOIL OTHER DISTRIBUTION BOX: USE 3 OUTLET D-BOX. 60.75 (INCHES) HORIZON TEXTURE (MUNSELL) MOTTLING SOIL ABSORBTION SYSTEM: INSTALL 12 ADS HIGH CAPACITY BIODIFFUSERS (160OBD1 0-3 O LOAMY SAND 10 YR 3/2 NONE FRIABLE 12 UNITS x 6.25 Ft / UNIT = 75 L.F. 3-7 A SANDY LOAM 10 YR 3/4 NONE FRIABLE 75 L.F. x 7.90 S.F./L.F = 592.5 S.F. 592.5 S.F x .74 G.P.D. / S.F. = 436.45 GPD 57.92 7-34 B LOAMY SAND 10 YR 4/4 NONE LOOSE USE 12 HIGH CAPACITY BIODIFFUSERS AS CONFIGURED BELOW 34-138 C MEDIUM SAND 10 YR 5/4 NONE LOOSE - Vt. = 438.45 GPD > 330 GPD REOUIRED 49,25 REFER TO DEP APPROVAL LETTER TRANSMITTAL u W000052 FOR CERTIFICATION OF ADVANCED DRAINAGE SYSTEM BIODIFFUSER SYSTEMS. TEST PIT 2 GROUNDWATERNO PAARENTMAATER AL ENCOUNTERED PROGLAC AL OUTWASH 2 MIN/INCH IN C SOILS ELEVATION DEPTH SOIL USDA SOIL SOIL COLOR SOIL OTHER (INCHES) HORIZON TEXTURE (MUNSELL) MOTTLING L Eft CHING GA L L ER Y SNOT TO CALE 1500 GALLDN SEPTIC TANK 60.85 DIMENSIONS AND DETAIL NO T TO 0-4 O LOAMY SAND 10 YR 2/2 NONE FRIABLE CONSTRUCTION DETAIL USE SHOREY ST-1500-H-10 SCALE 4-B A SANDY LOAM 10 YR 3/4 NONE FRIABLE USE ADS HIGH CAPACITY BIODIFFUSERS (0160080 57.85 B-36 B LOAMY SAND 10 YR 6/4 NONE LOOSE 37.50 f L 1 49.35 36-138 1 C MEDIUM SAND 10 YR 5/4 NONE LOOSE m 1n TAPER CD GROUNDWATER ADJUSTMENT `(' � s Ft- '� 0 8 In EXISTING GROUNDWATER LEVEL BASED ON TOWN OF BARNSTABLE N GIS DEPARTMENT RECORDS. 43.75 Ft INDICATED GW 25.00 r, z; INDEX WELL .„_.SDW-252 CROSS SECTION VIEW 4 ZONES READING`DATE "JUNE::•2009 • READING: 46. .`': 4,,, ti .•y � '=1'r ADJUSTMENT'I�(�2.0 -.'T 16r(rDEPTH 4 r *: ADJUSTED GW. .27.0 1 in INLET CENTER OUTLET CTIVE END COVER END 34 1n (2.83 f o 68 to (5.66 FO 34 in (2.83 Ft7 3 IN DROP -� -► /l FLOW LINE FROM le 1n = I4 TO . � BUILDING ,: D-BOX NO' T E S �� .. .3 46 in LIQUID GAS LEVEL BAFFLE 1) INSTALLER TO OBTAIN DISPOSAL WORKS PERMIT BEFORE STARTING WORK. 2) SEPTIC TANK TO BE PUMPED DRY AT TIME OF SYSTEM REPAIR AND CHECKED FOR STRUCTURAL INTEGRITY. CONFIRM PVC OUTLET TEE FITTED WITH GAS BAFFLE. 3) ALL COMPONENTS INSTALLED SHALL MEET THE MINIMUM REQUIREMENTS CROSS SECTION VIEW OF MASSACHUSETTS TITLE 5 SEPTIC CODE 1310 CMR 15). DISTRIBUTION BOX 4) INSTALLER TO VERIFY LOCATIONS OF ALL UNDERGROUND UTILITIES BEFORE EXCAVATING FOR SYSTEM. DIMENSIONS AND DETAIL USE S(-GREY Ds-3 H-10 5) EXISTING LEACHING GALLERY TO BE PUMPED. COLLAPSED. AND REMOVED. SEWAGE DISPOSAL SYSTEM PLAN 6) ALL STONE TO BE DOUBLE WASHED AND FREE OF IRON. FINES AND DUST IN PLACE. "" ' ;u;.,a,"" Nor TO 12 i^ -TO SERVE EXISTING DWELLING 7) ECO-TECH ENVIRONMENTAL RECOMMENDS THE INSTALLATION OF LOW FLOW FIXTURES SCALE MIN AND APPLIANCES. AND BIANNUAL PUMPING OF THE SEPTIC TANK. ;Y FROM 3 TALITA & JUAREZ CAMILO 6) SYSTEM IS NOT DESIGNED TO WITHSTAND VEHICULAR LOADING. DO NOT O [ TANK ;' 5 TO PARK OR DRIVE VEHICLES OVER SEPTIC SYSTEM. O ): SAS 64 GLENWOOD AVENUE CENTERVILLE, MA O (0 eezr.;t ts1(zze;-,:;r.-;r„ -{7 9) SEPTIC TANKS SHALL BE INSTALLED LEVEL AND TRUE TO GRADE ON A LEVEL ECO-TECH ENVIRONMENTAL STABLE BASE THAT HAS BEEN MECHANICALLY COMPACTED AND ON TO WHICH i� 6ln STONE BASE SIX INCHES OF CRUSHED STONE HAS BEEN PLACED TO MINIMIZE UNEVEN SETTLING. ISS in 1�5 CROSS SECTION VIEW 43 TRIANGLE CIRCLE SANDWICH MA 02563 10) SEPARATION OF TEES IN SEPTIC TANK SHALL BE NO LESS THAN LIQUID DEPTH. ETE-32051 JULY 22, 2009 1 1212 .o ',bra• o S' �•��:d •pp d VAO Aj p� a �• BM60 Hatc ry •• f ♦" _ RD•. �`` It chw Lot 27 ee an .;• p / �. t: :�'•����• �p Lot 29 r LOCUS PLAN Scale:I tt= 2000' Ground-Water Overlay s District AP ko a / Ao M s Q � / o Lot 21 Sarwilak yjb 4' ,qC��F Ex ti Connect Septic H PITS isr, e Tank to Existing II N s f G.62.8 House Sewer F.G.62.0 0 / 1 c w 0 . t O c 60.8 59.6 1500 Gallon �\ 60.6 Septic Tank 60.4 ` Top EL 60.8 7BM EL=6213 �M �� 'y p H-20 Bot.El.57.8 TOP e.R.e (ASSUMED) 60.2 ` A 4m :•C ::ram.: 60.0 Ground Water at Elev.82 Bedding asrt _ ..•_ Per Title 5 Tee or 25.0 per TO.B.Grounc / N O Baffle. Water Map ato DELVELOPED PROFILE OF PROPOSED SEPTIC SYSTEM _ Not to Scale IQ• / tiJAj FIaNh Coto Grad. Filter _ \ !� Lot 20 0,M Fabric Coapaged FIII ` f N J 0 Pao Stan. RG t' Leaching a Chamber 3/4"-1 I/2"Doable t Washed V I_ 4-10 I IP-0" CROSS SECTION OF CHAMBER o NOTES NOT TO SCALE \/ I. Water Supply For This Lot is Municipal Water. DESIGN DATA 2.Location of Utilities Shown on This Plan Are Approx. Single Family-3 Bedroom 4y At Least 72 Hours Prior to Any Excavation For This No Garbage Grinder _ Project The Contractor Shall Make The Required Dail Flow: 110 x 3 = 330 d Notification to DIG SAFE-1-888-344-79233. Y 9P 0 3.The Contractor is Required to Secure Appropriate Septic Tank 330 gpd x 200%=660gpd PLAN VIEW O 'Po Permits From Town Agencies For Construction Use a 1500 Gallon Septic Tank. Scale : 1 �t= 204 4 � Defined by This Plan. LEACHING AREA SULLIVANoy '��' 4.Install Risers as Required to Within 12"of Finished 330 gpd/0.74=446 s.f.Required Grade. Sidewalk 2(12 t25 )2=148 s.f. lr oa Bottom Area:12 x 25 =300 s.f. 5.All Structures Buried Four Feet(4 ) or More or 448 sJ.Total Provided. / Subject toVehiculortobeH-20 Loading. 6.Septic System to be Installed in Accordance With LEACHING CHAMBER DESIGN r7f 310 CMR 15.00 Latest Revision And The Town of Al I Pipes to be Schedule 40 PVC. Use 2 Barnstable Board of Health Regulations. -500 Gallon Leaching Chambers in a 7. All Piping tobe Sch.40 PVC. 12'x 25' Washed Stone Field as Shown. f , Ttle: PREPARED BY. PREPARED FOR: Notes/Revision: s PROPOSED SEPTIC SYSTEM UPGRADE ��PC�Sury MARGARET JACKSON Sullivan ]Engineering, Inc. cCb u 64 GLENWOOD AVENUE PO Box 659 7 Parker Road 64 GLENWOOD AVENUE `"- CENTERVILLE , MASS. Osterville, MA 02655 Osterville MA 02655 CENTERVILLE , MASS. (508)428-3344 (508)428-3115 fox (508)420-3994 (508)420-3995 fax O _ 20 0 10 20 40 8o Field: WHK/MDH Draft: WHK Date: Scale: 1 Co MP.: RHL WHK Review: December 17, 2001 As Shown --- Prof. # Drawing # C436P..1 '