HomeMy WebLinkAbout0107 HIGHLAND DRIVE - Health 107 Highland Drive
190 053 Centerville
III
UPC 12534
No.2�153LOR
HASTINGS. UN
O
;S
TOWN OF BARNSTABLE:"4
°LOCATION .\0A SEWAGE# N
VILLAGE,.Ce& W-k \,A. ASSESSOR'S MAP&PARCEL g'1
INSTALLER'S NAME&PHONE NO. cs��'�`� 'ccVC. ��L( Qb
SEPTIC TANK CAPACITY C7= � �- �J 6
LEACHING FACILITY:(type) 14 .2 d (size) /o7 X.2 Fj� cZ C.P
NO.OF BEDROOMS
OWNER
PERMIT.DATE: L�I I/C. COMPLIANCE DATE:
'Separation Distance Between the:
Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility 4NAFeet
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 leachingIfacciilliity) t�4 �.7 Feet
FURNISHED BY `�A�
A
Q3#o
t ,
No. a b 1 0 :13 9 Fee L V D r^
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS es
Zipplitation for MispoSal *pstrm Construction Permit
Application for a Permit to Construct( ) Repair(V1 Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components
Location Address or Lot No. Owner's N e,Address,and Tel.No.
Assessor's Map/Parcel
Installer's Name,Address,and Tel.No. O Designer's Name,Address,and Tel.No.
S Lod ��� SaFS ���
Type of Building:
Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( �
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow(min.required) ��CN gpd Design flow provided f� gpd
Plan Date t-t a z_,1 Number of sheets Revision Date
Title
Size of Septic Tank E X�S� ��a(� Type of S.A.S. �d SC � rc:�rS ,i•Q.
Description of Soil N=e-&
Nature of Repairs or Alterations(Answer when applicable) ?p Q N G( L
i
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 ealth.
Signed Date _
Application Approved by YA Date ( j
Application Disapproved by Date
for the following reasons
Permit No. 0 1(J ^� j Date Issued �7
-------------- - - -
No. Fee v v • .►--
/ v Entered in computer:
THE COMMONWEALTH OF MASSACHUSETTS`-< ..,:pute
'_�PUBLIC HEALTH DIVISION - TOWN P F BARNSTABLE, MASSACHUSETTS' es
g application for Disposal opstem Construction Permit
Application for a Permit to Construct( ) Repair(V/) Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components
Location Address or Lot No. \ t Owner's N e,Address,and Tel.No.
cv.
Assessor's Map/Parcel ..
Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No.
cU\\
1U 6 c..,rNwv \-�c:;, S k �2 �13d-
Type of Building:
Dwelling No.of Bedrooms 3 Lot Size sq.ft. Garbage Grinder(/Ut
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow(min.required) - ��y ° gpd Design flow provided gpd
Plan Date Number of sheets Revision Date
° Title `
Size of Septic Tank Type of S.A.S. 36 S-a Z_"gk�rr->;.�co�s S}Utit
Description of Soil C^_-,
Nature of Repairs or Alterations(Answer when applicable) �Zp C,
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 ealth. .4
Signed Date
Application Approved by Date
Application Disapproved by Date
for the following reasons
Permit No. �� \ Cf Date Issued
THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE,MASSACHUSETTS
Certificate of Compliance
THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired Upgraded( )
Abandoned( )by S d k�
at k \n c eArQAALtconstructed in accordance
with the provisions of Title 5 and the for Disposal System Construction Permit No. 10-1 dated
Installer C U Designer
#bedrooms 2 Approved des' flow V S gpd
The issuance o this pdr/mit shall not be construed as a guarantee that the system wi fun 60;A s designe n�
' Date 20 (+� Inspector ! �C
t .. .-----------------�-------------- ----------
No. C;� ! Fee
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION- BARNSTABLE,MASSACHUSETTS
Disposal *pste onstrnctlon 'ermit
Permission is hereby granted to Construct( ) Repai ( Upgrade( ) Abandon( )
System located at ��7 `��pa\,�`C"� �r- C >-�"ZT_
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:Copstruction must be completed within three years of the date of this permitt�/� L
Date Approved by � " � �� L.
•� 7
Town of Barnstable
DF ZME T �
Regulatory Services
�nxrisrnat,E Thomas F,.Geiler, Director
'""SS.
4i639• Public Health Division
1 ��
AtFD nnA�A Thomas McKean,Director
200.Main Street,Hyannis,MA 02601
Office: 508-862-4644 ? Fax: 508-790-6304
Installer & Designer Certification Form
Date: kO Sewage Permit# —13`( Assessor's MaplParcel 7 k -
Designer: !&TEP PE Installer: 15C,cg'[— K.
E AC,L-E Svf_v J�.C,, !wG
Address: I Z&vm: e,ff! Address: il3 pL'1J YAh2•K6xTr6
YA-R.�oz.>71rf Fb 9-, H A• y2&7j H YA4JAj r S, "A. 6260 1
On !;13( W ::9',cs1 ", was issued a permit to install a
(date) (installer)
septic system at �`� based on a design drawn by
(address)
l�P H6ti� A• 1AAAr,,, `PE dated
w (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.
R � .
N , .tiS
(Installer's ature) � �
X.
(Designer's Signature) (Affix Designer's Stamp Here)
PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE
OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH.THIS FORM AND AS-
BUI LT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION.
THANK YOU.
QASeptic\Desisner Certification Form Revised.doc
TRANS. NO.:
CITY/TOWN: C�tiZ� v�LL�
APPLICANT: "f STE:4—
ADDRESS: /a 7 H 14 H c,',t Z>A"yC�7-
DESIGN FLOW: U gpd
REVIEWED BY: DATE:
N/A OK NO
�
GENIJRALs..; . . -tiw, 321` 1: r
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) [3.10 CMR 15.220(4)] ✓
Easements shown [310 CMR 15.220(4)(b)]
System located totally on lot served [310 CMR 15.405(1)(a) for
upgrades]- if not, a variance is required [310 CMR 15.412(4)]
Location of impervious surfaces (driveways,parking areas etc.)
[310 CMR 15.220(4)(d)]
Location all buildings existing and proposed 310 CMR
15.220(4)(c)] IX
Location and dimensions of system components and reserve areas.
[310 CMR 15.220(4)(e)]
System Calculations [310 CMR 15.220(4)(f)]
daily flow
septic tank capacity(required and provided)
soil absorption system (required and provided)
whether system designed for garbage grinder
North arrow [310 CMR 15.220(4)(g)]
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)(1)]
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)] ..z
Address �g°/S3 Sheet 1 of 7
1 ,
N/A OK NO
Location of every water supply, public and private, [310 CMR l
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 15.21l(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)]
Test hole adequate to demonstrate four feet of suitable material?
[310 CMR 15.103(4)]
Test Holes adequate to confirm adequate groundwater separation?
[310 CMR 15.103(3)]
Benchmark within 50-75' of system [310 CMR 15.220(4)(q)]
Materials specifications noted? [various sections of 310 CMR
15.000]
System components not>36" deep (unless Local Upgrade
Approval or LUA requested) [310 CMR 15.405(1(b)]
Address �4%-3 Sheet 2 of 7
N/A OK NO
Size OK? [310 CMR 15.223(1)]
Inlet tee located ten inches below flow line [310 CMR 15.227(6)] ✓
Outlet tee 14" or 14" + 5" per foot for increase ft depth [310 CMR
15.227(6)]
Outlet tee with gas baffle or approved filter[310 CMR 15.227(4)]
Note regarding installation on stable compacted base [310 CMR
15.228(1)]
Separation between inlet and outlet tees (no less than liquid
depth) [310 CMR 15.227(2)]
Inlet/Outlet elevations at least 12" above high groundwater
(except as described 310 CMR 15.227(5)) or permitted for /
upgrades under LUA [310 CMR 15.405(1)(k)]
Minimum cover 9" (Tanks buried more than 9" must have risers
on all openings and on the d-box) [310 CMR 15.2228(1) and 310
CMR 15.232(3)(f)]
Three access covers (inlet and outlet must be 20" or greater) -
middle access at least 8" (by 7/07) [310 CMR 15.228(2)]
Access to within 6 " of grade - one port for systems<1000gpd,
two for systems >1000 gpd [310 CMR 15228(2)] -
All at-grade covers secured to unauthorized access? [310 CMR
15.228(2)] ✓
> 10 ft from building foundation [310 CMR 15.211(1)]
Buoyancy calculation Required/Done [310 CMR 15.221(8)]
H-20 Where appropriate? [310 CMR 15.226(3)]
Setbacks from resources [310 CMR 15.211]
Required when other than single-family dwelling or flow>1000
gpd [310 CMR 15.223(1)(b)]
First compartment 200% daily flow; Second compartment 100%
daily flow [310 CMR 15.224(2) and (3)]
"U" pipe through or over baffle, outlet of each compartment with
gas baffle or approved filter [310 CMR 15.224(4)]
Address `�a�$-3 Sheet 3 of 7
N/A ' OK NO
BiTILDING SEWER#k.` D O THERf.PTPIN 1.4 � � �r
�..�;», ,� �' "�.�s,,....� �_�..,« �� -��aw�� :�.n£����u,. ��.�"��,':�.,.
Located at least ten feet from any water line? [310 CMR
15.222(2)]
Disposal piping at least 18" below water line(when water and
sewer cross, see 310 CMR 15.211(1)[1])
Cleanouts required/provided ? [310 CMR 15.222(8)] ✓
Thrust blocks specified in force mains? 310 CMR 15.221(6)(c)] ✓
Slope of sewer line not less than 0.01 (1/8"/ft) 0.02 preferable /
[310 CMR 15.222(6)] ✓
Proper pitch on all runs? (.005 within gravity-distributed trenches
and beds) [310 CMR 15.251(9) and 310 CMR 15.252(2)(c)]
Siphon problem/(leachfield below pump chamber) ✓
Endcaps or vent manifold specified?
Size and orientation of discharge holes specified? (not smaller
than 3/8" not larger than 5/8") [310 CMR 15.251(8) and 310
CMR 15.252(2)(h)]
Materials specified (310 CMR 15.251(5) specifies various pipe /
types allowed)
�ax , .s "�s<,`T2''1 r
DISTRIBUTION BOXx ' ry
��. .c
Stable compacted base [310 CMR 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]
Inside minimum dimension 12" [310 CMR 15.232(2)(b)] ✓
Minimum sump 6" [310 CMR15.232(3)(e)]
Watertight cover if<2000gpd); waterproof manhole if>2000gpd
[310 CMR 15.232(3)(d)]
+s r�.r,,^� � 'S.�ia.`' ..'�
PUMP C IAMBERS , � ��
. 2, �, .
Capacity(emergency storage above working--design flow)? [310
CMR 231(2)]
Proper setbacks [310 CMR 15.211 (same as septic tanks)]
Watertight 20-in minium access manhole at least 20"MUST BE
TO GRADE [310 CMR 15.231(5)]
Service components accessible (not too deep with piping,
disconnects accessible)
Alarm floats - alarm on circuit separate from pumps specified?
Exceeds two units must have two pumps operating in lead-lag
mode. [310 CMR 15.231(6) and (8)]
Stable Compacted Base [310 CMR 15.221(2)]
Buoyancy calculations needed ? Provided? [310 CMR 15.221(8)]
Address 190 0 A___3 Sheet 4 of 7
N/A OK NO
SOILABSO�RPTOlkSYSTEiYIS{S' SEN,E � � � 1., =aw
Calculations correct?
4 feet of naturally occurring material demonstrated? [310 CMR
15.240(1)]
Required separation to groundwater? [310 CMR 15.212)] d/
Aggregate specified as double washed [310 CMR 15.247(2)]
System Venting required/provided? (system under driveway or
>36" deep) [310 CMR 15.241]
Inspection ports specified and within 3"final grade? [310 CMR
15.240(13)]
Breakout requirements met? (No violation of breakout elevation
within 15 ft of SAS unless barrier) [310 CMR 15.211(1)[4] and
Guidance Document]
Chambers and Gal. in trench configuration supplied with inlet_
every 20 ft. [310 CMR 15.253(6)]
Each structure with one inspection manhole(if>2000 gpd must ✓,
be to grade) [310 CMR 15.253(2)]
Aggregate 1' minimum-4'maximum. [310 CMR 15.253(1)(b)]
2' sidewall credit maximum [310 CMR 15.253(1)(a)]
In bed coTnfiguration, inlet every 40 sq. ft. [310 CMR 15.253(6)]
.I�NI +�S30 CMRS � YSR_ � hi 3, PL =. '3 x 14vaa a z
,�....�».�.» m b,"�m' .. :3u P ,.'X :
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]
minimum 2 distribution lines [310 CMR 15.252(2)(a)] 1/
Maximum separation between lines 6' [310 CM RI5.252(2)(d)]
Maximum separation between lines and outside of bed 4' [310
CMR 15.252(2)(e)]
Aggregate depth below discharge pipes 6" minimum, 12"
maximum. [310 CMR 15.252(2)(g)]
Separation between beds 10'minimum. [310 CMR 15.252(2)(f)]
Bottom area used in calculations only [310 CMR 15.252(2)(i)]
Address 96 IS-3 Sheet 5 of 7
N/A OK NO
r
Pressure Dosed System ? `Provided pump and piping
calculations as required [310 CMR 15.220(4)(r)]
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 gravelless system -make sure jet is directed as not to
scour soil interface [Guidance Document]
Inspections once per year(systems<2000 gpd) or quarterly
(>2000gpd) good to note on plan [310 CMR 15.254(2)(d)]
Construction in fall - Did the plan specify that the fill shall meet
the specification of 310 CMR 15.255(3)? V
Impervious barrier and/or retaining wall ? [Guidance Document]
Impervious barrier installation must be supervised by
designer [310 CMR 15.255(2)(b)] r/
Retaining wall must be designed by Registered Professional - /
Engineer [310 CMR 15.255(2)(a)] V
Side slope not exceed 3:1 ? [310 CMR 15.255(2)]
Breakout requirements met? [310 CMR 15.252(2) and ✓
Guidance Document]
At least 5 ft. from impervious barrier to edge of SAS (10 ft.
recommended) [310 CMR 15.255 (2)(e)]
Check DEP Approval letters for credits and design conditions
If used with pressure dosing do not allow pressure discharge
to scour soil interface
r �
AlternataveSepttcSystean jl/AAPP�rvaltettef s � x=. � � +,g�� �
� ��� a
Was DEP Approval Letter provided and/or have you
reviewed the letter for conditions?
Is the technology being properly applied and does it meet all
DEP Approval Conditions?
Is there a note on the plan regarding the requirement for
perpetual maintenance agreement?
Any alarms involved on separate circuits
Did the applicant submit an operation and maintenance
manual?
Has applicant submitted a copy of a maintenance
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]
Address 140 IS-3 Sheet 6 of 7
_ N/A OK NO
NltYd en Se`�isitzve AYeas� � z spa m y�" 'g Qs r r iE�s
r
Is the system in 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)]
.f z.€na �'�'r ��� �: v�`4y��t��� ;�, �" '..� 7'�''�'K`4�ar ,.a 1e - ,�� F.z .."'� 5'x✓'� �,s.�+av�4a^ �.
„��. �,. �.,, �?':,z s`, ,�:.as�. ,:vt�;ar s,�: xmY�,w,r�._ u<t 4�.: .•;G::::.�.r�.� �'+w a.«..mom, �.�,�SF ".�.:'-...�,3� s.
Pumping to septic tank ? [ 310 CMR 15.229]
Shared System [310 CMR 15.290]
Address Sheet 7 of 7
T Town of Barnstable . .P# . ? 2—F
Department of Regulatory Services
BABMABM 4* Public Health DihUss. vision Date ha
%639. �' 200 Main Street,Hyannis MA 02601
rfa�,ta� �
Date Scheduled U Time D d`r Fee Pd. /Uy
Soil Suitability Assessment for Sewage isposal
Performed By: X1?� l�e��� l 04_4 S t P. C/ ,
unessed By: JQ
I.(1CA:I(.N EN xALT".
Qx n.m oN
Location Address / er's Namet �1�1�W . �, g��nn S�2r
Ce".�"(�v��'I" Address
Assessor's Map/Parcel: 0S3 Engineer's Name S%&Pkf&A-'
NEW CONSTRUCTION REPAIR Telephone# S106 Roz 513 z_ _
i
kand Use
Slopes(90) /Om y, Surface Stones
Distances from: Open Water Body ��&¢
p Y ft Possible Wet Area 4V t ft Drinking Water Well ft '
Drainage Way
g Y— � ft Property Line /� ft Other ft
SKETCH:(Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands in proximity to holes)
}
a ,
Parent material(geologic) te�3B 4-
Depth to 13edroGlc
t
Depth to Groundwater: Standing Water to Hole: J!* Weeping from Pit Face 70 ZA,
Estimated Seasonal High Groundwater f
DETERMINATION FOR�SEA5.0NAL—HIGH'W�,T��
Method Used: w Of t^k..0,0 &a %50
Depth Observed standing in obs.hole: In. Depth to soil mottles: In.
Depth to weeping from side of obs.hole: 1.4. Groundwater Adjustment ft•
Index Well# Reading Date: Index Well level , Ad.factor Adj,Groundwater Level
I'ER OLA�': T T Ott' � tL is 11Ue4
Observation
Hole# Time at 9" _
Depth of Pere s to�l Time at 6"
Start Pre-soak Time @ &q° Time(9%6") J a M t Ad
End Pre-soak
Rate Min./Inch
Site Suitability Assessment: Site Passed 610 Site Failed: Additional Testing Needed(Y/N)
Original: Puolic 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:\SFFnC�PERCFORM.DOC
- r ;
DEEP OBSERVATION HOLE LOG Hole# 1
Depth from Soil Horizon Soil Texture Soil Color Soil
Surface(in.) Other
(USDA) (Mansell) Mottling (Structure,Stones,Boulders.
_ Consistency,%Gravel
L S ®eA %G
DEEP OBSERVAT'TON° T(JLE.LOG Hole## Z
Depth from Soil Horizon Soil Texture Soil Color
tn. Soil Other
Surface
(in.) (USDA) (Munsell) Mottling (Structure,
( cture,Stones,Boulders.
onsistenc %Gravel
LL
L S
el
DPEP`ODSE"RVATTON HOLE.LOG Hole#
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Mansell) Mottling (Structure,Stones,Boulders.
Consistency,%Gravel
DEEP`013SERVATION HOLE LOG Hole#
Depth from 'Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling
(Structure,Stones,Boulders.
Consistency, o Gravel)
Flood Insurance Rate Man:
Above 500 year flood boundary No_ Yes _
Within 500 year boundary No u� Yes_____
Within 100 year flood boundary Now Yes c>
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? r�S _
If not,what is the depth of naturally occurring pervious material?
Certification �t
I certify that on 111 H 4 1 (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 with
the required traini ertise and experience described in 310 CMR 15.017.
Signature Date
Q:\SEIYrIC\PERCFORM.DOC
I
7
LO�C ! T ION SEWAGE PERMIT NO..
/-o T x7/0 H16-N Lk-h gnlu�.
VILLAGE
C- - vlL E lC/o
INSTA LLER'S NAME & ADDRESS
Y✓�/Zti 5 T /,ELF
B UI'LDE R OR OWNER
T/ CIE S
DATE PERMIT ISSUED
DATE COMPLIANCE . ISSUED 27 .
�.
0
� '
�' .�ao3�' e`'1
���.
` � /G-N L/9�`-!� f�/1/vim
. LOCATION SEWAGE PERMIT NO.
G-0 T `710
VILLAGE "
INSTA LLER'S NAME & ADDRESS
B UI'LDE R OR OWNER
DATE PERMIT ISSUED
I
DATE COMPLIANCE ISSUED
fly
,o �h
I
lap
THE COMMONWEALTH OF MASSACHU..ET.Tr.
i
�f- BOARD OF HEALTH
...............OF........0o.6.. ln......... ........................--. ..............--.----
Appliratiun -fur Biupu',ottl Works Ton,itrurtiun Vrrntit
Application is hereby'made for a Permit to Construct ( X) or Repair ( ) an Individual Sewage Disposal
System at:
�• .Highland._Drive,...Centerville-------------•----. --------------Lot.--��------••--•-••-•-•------------•----------------•-•--------•-
Location-Address or Lot No.
----------------•----------•--•---------------------•-•--•-•-•-- ..---.....------------------------•-----------•------•---•--•-----•-----•------------.........----
Owner Address
a __3teherino---Brathe-rS................................................ ..................................................................................................
Installer Address
d Type of Building Size Lot.2.1-,Q4Q...t....Sq. feet
U Dwelling—No. of Bedrooms______________3----------------------------Expansion Attic ( ) Garbage Grinder (/(A)
aOther—Type of Building ............................ No. of persons.--_____.6---------------- Showers ( ) — Cafeteria ( )
dOther fixtures .--- ---------------------------- ------------• ------------------------------ --------•----..........
W Design Flow----__....=5:Q.....................__..gall ns per person per day. Total daily flow._........3QQ.__.........._...._.....gallons.
P4 Septic Tank—Liquid capacity-.1.QQQ�gs Length.......6....... Widt------ Diameter................ Depth-------------_.
xDisposal Trench—No. .................... Width-------------------- Total Length.................... Total leaching area....................sq: ft.
Seepage Pit No..................... Diameter-------------------- Depth below inlej....__ _____...... Total leach ttg trea._:.-_.._..______.sq. it.
z Other Distribution box ( ) Dosij��, tank r d�'- �" -& ��� 2 - _7
~" Percolation Test Results Performed by u+---- ----- !� _____________________________________ Date____y.:.�s+'7 7'
a ------- -------------
aTest Pit No. I................minutes per inch epth of Test Pit-------------------- Depth to ground water-----------.............
* : fX4 Test Pit No. 2................minutes per inch Depth of Test Pit.--_-_-__-_____-.-- Depth to ground water-_.--._----_.--._-------
; -••-••.. .
Descr' tton of S 1 �_... - . _0" 4.t -P..a�'_.._ 91•.
--------------- ------ ----------------------- ----•----------------------------•----•----------------------------------------------•-•--------------_-------------------------------.-----•-----------
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 Article XI of the State Sanitary Code—The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has been issued by the board of health. s
_� 6-16-77-
Igned iI or-_'lamas---K ---sITi2t-h------ate-• -
D
Application Approved BY ..... �✓ ,------------------ _Date
;
Date
Application Disapproved for the following reasons--------------------•----------------------------------------------------------
--------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
f� Date t
Permit No......................................................... Issued....&7:f.l- 7-7
Date
f t
THE COMMONWEAUTHJOF MASSACHU$ET#&--
i' BOARD OF . HEALTH
.......
Applirat on -for Bi-spooal Worka Tonotrurtion Vrrmit
Application is hereby made for a Permit to goitvWlict ( X) or Repair ( } an Individual Sewage Disposal
System at
_Highland--Drivtj ..Centerville....... Lot- 1
-------------------------------------
Location-Address or Lot No.
eta a
IJS.IS Cti tt._ -------------------------•------•----...........................
Owner Address
Othero...--
Installer Address
kwH Type of Building Size Lot.2.1-,.000__f----Sq. feet
Dwelling—No. of Bedrooms..-_--------- _--______________ _________Expansion Attic ( ) Garbage Grinder 14)
aOth' r—Type of Building p ( ) ( ) F____________________________ No. of ersoiis.________�______.____._.__ Showers — Cafeteria
dOthern fixtures --------------------------------- --------------- ----------------------------------------------------------------------------------------•------
;.< W Design Flow----- = 0------------------------g s per person per day. Total daily flow----------.3.0.0...............-..........gallons.
WSelitic Tank—Liquid capacity._ 4 a ns Length_.--_-6------ Width_--_8._....._. Diameter-.............. Depth.....:.._..._. .
x Disposal Trench—No_____________________ Width---------------- Total Length-.------------------ Total leaching area--------------------sq. ft-. r
Seepage Pit No--------------------- Diameter :--_... _..-.__ 4eth belinle_-4. _.....ff-etAl l�Idlig area--_ .._.__.._sc 1.
. it.
Z Other Distribution box ( ) Dosi i�
W
Percolation Test Results Performed by _. ._-- ------- --------------------------------------------- Date... .. ....._-----------------.----------
Test Pit No. 1----------------minutes per inch;`;:Depth of "Pest Pit.................... Depth to ground water..-.-._---_.--.---._.
(s, Test Pit No. 2___--_ __minutes r inch Depth of Test Pit ... :_ Depth .to ground water____________ ___ __
p dam'
a
04-i
x Des ri i ' ( `
�"' e . -. -- _.
un---------- ---- -------------------------------------------------------------- w------------------------------
UW ------------------------- ------------------------------------------------------------------------------------------------------------------------------- ----------------------------------------------
Nature of Repairs or Alterations—Answer when applicable._--_ __-__:_:.-_-----___-_
--------------------• -------- ...........--------------- _---------_.-_- ----- --.-..-..-•------------------------------
Agreement
ThJundersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of Article XI of the State Sanitary Code"=The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has been issued by the board of health,...
w '
��0..w- 7
-
ign
Application Approved B
PP PP Y
Date
Application Disapproved for the f1b/lowing reasons ----------------------- ----•-••--•--------•----------------.-.-----•-----------•-•-------•-----•---•-------
.............•----...---------•---•----••.---.------------•-•----------••-•--•---••--••--•--.........-----•------------•---..........--•----•--•--------•-...--------------------......-----------
Date
PermitNo------------------ "---•----- --------- ----------- Issued..........-..........-..................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF.,, HEALTH`
'4.W ..........................
......OF.......Baz%
et.a-�ke..............................................
Trrtifirn r of fa MVIianrr
THIJ IS TO CERTIFY, That the Individual Sewage Disposal System constructed P:X) or Repaired ( )
by------------- erino- "othei^s--
r.�.. "a` Iqs r
at....... ��t 10 Hghlandvb's_ Cnterv .
has been installed in accordance with the provisions of ejI� he State Sanitary:C$c'Ie Vees7rild in the
application for Disposal Works Construction Permit No.:................:...................... dated................................................
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE...... --•-------•-•----------------------------------------------------------- Inspector.......................................................... •-----•----••---------
THE COMMONWEALTH OF MASSACHUSETTS
6 y BOARD OF HEALTH
�ot�.n. . .... . ... .. ...of....$.testable.........
No.....................
FEE
- ���� � �i��n,�ttX nrk� (nnn�trnrfingt �drrutit . ,
r
Veterino Brothers
to Consfr fission is hereby granted -----------------•- -----••---------------•--------•-----------..----------------- .--•---
Perm
uct ('C or Re air ( ) an Individual Sewage DisjL�§al System }
at No.-•--�' t 0 xi�.a�nd ;3 Zive! Centery it - �ji� .w/y�/y:
St r et �' � /4- -I
as shown on the application for Disposal Works Cdnstructio i T ..__.___
} - Dated------------------------------ ----------------••-------------------------------Boa alth
DATE
- ------------•-----------
FORM -12.55 HOB.BS�&- WARREN. INC.. PUBLISHERS ;.�^
�'?M"""t"''F".- 3: :r'-1*t^may• •,-M ;�.. 'a - ,...r-iar`r r+ S ')%--'-4•. -.i,r a •'1•-' i,i: �.. _q...r" '',.?`"kA.,y,.i•+i
ar_��,3, `..,r '� �'.. 'V:' .J5- �:, 't' -K;..
ra r yi, .. Y' ._,._ `!l:�'. ,-.r.z..al `_ *`.",:,.*M• �Xt' �f^ •;yr'�' '�.{J� oF` !'�"h'• t:� -f �2' ,Pr
lwy
3"e.,� .u4t }�'A+. ��' ,;;c•F*d,. ;t-:t�. ... •�.�". � �yY•e .4. .•s�.�. "iY'�_t't �
'.»,f
"'S '� ..�.�;_� �.`�f:�`''�� r !,•:'� t5k���F'�3 r���4"�'_> ♦ f S '�.t,, � .r s_ .+ F a k i _
f
,
y✓� ,a
P`
afy -�i' &�''�`wt-:;,f� t, 'v �,� .'�:. = i'•� ,,.a .., - .,-L,Q�f' >� ;'t"j"^""'w•.M,:�.,r �n �r �. �� �, e
y
r•.+'y� 1`�4 R i-. k:'+.�#'.' `K'fi' aytt :.�.."f'�Y Gf,".. 1 :F a ..f -- .y. , .'4.'� � � •.3
5- 1
"0'31�T9t{y/f�• Air
-_'yYY !4{ b fi. a4�tt.3i�i� �•. 5 t w' * r+ ` fw�7.w1 •. /,�.YV`�
/Ne r
f.t +,.t v � ��. � �.� 3 rY `.�`4►' t' t { Y^U ':�"� _ + � 'w� '�``, �f�.
: '. �
� ,.}„-r!i•�Z� ,a- a. v ma�yy,,,,K� yinr� ' .w e`N Lt�£ � � y � � y� '`� `,
*r :� M j'7aYYS'"�J ��•4} ,,.e' ` �J '�' ,0.9 S-tf' -2 '� t l Imo.' ` f�qv1� - �K7:Ur)+C. T
� .. ss, r ;�<. �Af Ate: .-� � Q � �. � /�t Iid' �nJ
'
a
t MD L t r �4L ..- ;q' .. 1
M
.y
fY't'-rAN 'V�.� /." 1 ��' H7`Jl•!i 0.V?,>Z-
^'�t
20,
'3r}
G
P •-� , Fn,;, A/AI: V/�i vP 7'�s• `T.+'±- _ k :� ^�^�T' n2..- ■i.�., 1 _ 3. i 2 "' i CO. S
,a 1^�k �' •Y £ 4 by^. �l �F�� V1✓ ! 'f ,. - .'M{Gr
y r7 E.f. ♦ i t] W - `t ,�^ •� t.
� ..,. 4 �C' �• +. t _e d.• ., ?r {r "f'i`t+"?.. .!i �,o.:.+•- �.:.7 •'L.•1"J: "� r . tJ%��,A/,7�V
f
PIT i
,/�fiIf /y4. 1 ti4 �.»/�p�r/�'yry�,
FAY '#.j�,, '; i yy,. •w V I :.kV' , el v,4,+,+%.:.a vp
3'tJ/Ic::DiAvG 5 ETL3AC�. f2FQUr, M�h;7'T �:. - :. - .. 7' /�C,� /►� +, , 8.✓ ,7 L S r r
yX.
Q �T'•' OrvT /Q r S'i CIE-
4 �t , TF�4:�;' [ R/: ',Q�►�!o =r " ,:' ,.. ur✓7 3 .$,
SEP T/'�. 3 TE/►�1. CoN.S'T2 CAC.T/ON
Ya s.HA L::L GOn�co2M: 7ro MAC.SS • 3 O
DE5/GJV FLOW GAL 1l3AY
/r20/VM.ENT G CODE. T/T4,,E
Y L6ACN' Z.4TE 2 M/
' , u'.�41N0 TOGcJ�J 'pF *� N'S TA+G G. A //t/CN
AC
t .. ..
MAAJiIOL CD'✓Er2 To 'C—X TEJJD TO
pE,2VC/S Co v�Q
L/EA/T A-/AASS s
TN/NG..0A DE. •�/20M /NF/G.7;2,4 77A (S,
t / STon/E
w WV4
4 Y ' i
N �
3"AAW Q IA.
�--�-- - - 41
'r pL] ,4/ F ow . crivE' Miy p, c T
N
' O 10:M/N �4„ A9��F00� Mi/v p/Tcsr �_ 14" �Z�D/A.
Y..; A41V r FQOT
GA e e- 1)Jw7vE.e T d;- STO NE
Cam'/nA C/T Y �} OuNO 3
• S FAT/G, TA Nr� b '. S < F LEW
$o77-cK4 OF
( WATEJZ'7"J45 S-q /A/Vf_-.e7-
_ _' - L _ _�, _ PJ_T_ _/
/N V 2T /�/CSA. 281GE GINDL /p' ���%, /. ////''��� 3o-o C�
h '�' S�PT/C T-i"v 7-0 8E A /14INIJt PLl/1r�
S/ T6 pL', f
LEA /T,5 . q�/D 2.5.' M//viuliri•fi
LC�T ./os Sri FI�c�J�
DEG.Y�. 6 —
�r"'�I+•{ - a
Qom.-4A r TAT": 3ez�ric TANK l�/.-5;- E3UT/O/V 8OX ,5
�$ ovT�ETs) A/D 1.E.4C:W1A/0 Al/T i
O ' TO BE 4F E/NFOri?CErD GO.vG.2ET�
r. CCN ;5•
C.2rET� ST.EE•c/GT�y 3000 ' . /
20000 ,..
/�;r0I�7- %/V )Y-/O LOA D 1AJ&
C
f4 TQ�y'L AAIE- �k?/V�1N.4Y /VQ.T TD BE LQC:4T.�27
O,✓f2 SYSTEA/ .Uni4.E55 .A/- ZU
W,OF DES/G/V LOAD A./CCAP
RAYMOND
O (7tAtG. y
- � SHORT ^��• .
No..27AS3
Q?ST y'� @ '
,• "12G..-:';G Fn if,y +(" .'7— Jam•Z'.VJ - r �r R ��' .
� _- a •�- 1>AT� �-1EALT�1 ,AGE�c+sT
w ... a
t.
d k
f�a--jArcw...:+t:Wit:.�.;._•� .:..'�''.........._x.x..Rrt.aw,.-..r',c�.,.. .-n .#•i.,:.,..... ... .. a in.. - .. .. - - .-- ... .... ' .,»a 4.i`5r,w.;.
ACCESS COVERS MUST BE WITHIN 9" MINIMUM.
6' OF FINISH GRADE 3' MAXIMUM COVER INVERT ELEVATIONS : DES I GN CR I TER I A : GENERAL NOTES :
92. 8 FIRST 2' TO MIN 2' OF PEASTONE INVERT OUT SEPTIC TANK: 89. 3 DESIGN FLOW:
BE LEVEL OR FILTER FABRIC 3/4' - 1 I/2' DIA, INVERT IN DIST. BOX: 87. 57 3 BEDROOMS AT IIO G. P.D. PER I. ' THIS PLAN IS FOR THE DESIGN AND CONSTRUCTION
DOUBLE WASHED STONE INVERT OUT DIST. BOX: 87.4 BEDROOM EOUALS 330 G.P.D. OF THE SEWAGE DISPOSAL SYSTEM ONLY.
85. 0 INVERT IN LEACH CHAMBER: 84. 5
87.4 10T22' a S• BOTTOM OF LEACH CHAMBER: 82. 7 NO GARBAGE GRINDER 2. VERTICAL DATUM IS ASSUMED. FOR BENCH MARKS
87.57 84.5 1 82,7 40 MILL POLY ADJUSTED GROUND WATER: N/A SET. SEE SITE PLAN.
BAFFLE OBSERVED GROUND WATER: N/A VAPOR BARRIER SEPTIC TANK REQUIRED:
3 INFILTRATOR 3050'S `�
EXISTING 3 OUTLET 330 G.P.D. X 200X - 660 GAL. 3. ALL CONSTRUCTION METHODS AND MATERIALS AND
l000 GAL
D-BOX W/4 ' STONE AROUND. l2'r x 28'! x 22"d 182. 0 BOTTOM OF TEST HOLE *I : 78. 0 SEPTIC-TANK PROVIDED: 1000 GAL. EXISTING MAINTENANCE OF THE SEPTIC SYSTEM SHALL
SEPTIC TANK CONFORM TO MASS. D.E.P. TITLE 5 AND LOCAL
6' CRUSHED STONE OR ( SOIL ABSORPTION SYSTEM REQUIRED: BOARD OF HEALTH REGULATIONS.
COMPACTED BASE
a j DESIGN PERC RATE C 5 MIN/INCH
PROF I L E : NOT TO SCALE D �LI SOIL TEXTURAL CLASS - 1 4. ALL SEPTIC SYSTEM COMPONENTS LOCATED UNDER
�C EFFLUENT LOADING RATE - 0. 74 GPD/SF AREAS SUBJECT TO VEHICULAR TRAFFIC OR GREATER
330 GPD / 0. 74 GPD/SF - 446 S.F. REQUIRED THAN 3 ' IN DEPTH SHALL BE CAPABLE OF WITH-
STANDING H-20 WHEEL LOADS.
PROVIDED: 3 INFILTRATOR 3050 'S
\ W/4 't STONE AROUND, A-482 S.F. 5. ALL SEWER PIPE SHALL BE SCHEDULE 40 PVC OR
482 S.F. x 0.74 - 357 G.P.D. APPROVED EQUAL.
l6. SEPTIC TANK AND O-BOX SHALL BE REINFORCED
SOIL TEST PIT DA TA & PRECAST CONCRETE OR APPROVED POLYETHYLENE.
INDICATES �_ INDICATES BOTH SHALL BE WATERTIGHT, D-BOX SHALL BE WATER
PERCOLATION OBSERVED TESTED FOR LEVEL WHEN THERE IS MORE THAN ONE
TES T GROUNDWA TER OUTLET.
i TP *I P*12895 TP *2
s 7. BEFORE CONSTRUCTION CALL 'DIG-SAFE'.
W ° she HORIZON TEXTURE COLOR HORIZON TEXTURE COLOR 1-888-DIG-SAFE AND THE LOCAL WATER DEPT.
�� , O' BB.O 0. 89. 3 FOR LOCATION OF UNDERGROUND UTILITIES.
FILL FILL
/ 24' 86.0 12' ....•..... - . 88. 3 8. SEPTIC SYSTEM INSTALLER SHALL NOTIFY THE
s DESIGN ENGINEER TWO DAYS PRIOR TO CONSTRUCTION oo A LOAMY 11YR ^ LOAMY /OYR OF THE SYSTEM TO ALLOW FOR SCHEDULING OF THE
� 3 SAND 2/2 H SAND 2/2
28- . . .. .. ... . ... .... 85. 7 16' ---- . .. ... 88. 0 CONSTRUCTION INSPECTIONS.
p LOAMY IOYR n LOAMY IOYR
D SAND 3/6 D SAND 376 9. EXISTING LEACH PIT TO BE PUMPED DRY AND
42' ....... .................... ........... 84.5 30' ....... 86. 8 BACKF/LLED.
LOAMY 10YR C I LOAMY IOYR
C SAND AND 5/8 SAND AND 5/8
56' GRAVEL GRA VEL
wF 2 ✓O� �° t \ �P�� CATCH BASIN 72' ....... ................................. 82.0 54" .... ...... _.. ..... . ...... 84. 8
EXISTING C2 MED/UM I OYR C� MED I UM I OYR
SEPT I C TANK V SAND 7/6 SAND 7/6
�\ 40 HILL POLY �E�CH,
' \APOR HARR Q�� �p 1201 NO WATER 78•D 1201 NO WATER 79 3
wF DATE: APRIL 6. 2010
4ST 8Y: STEPHEN HAAS
WITNESSED BY: DAVID STANTON
N� o
PERC RATE: l 5 M/N/INCH
h
� ID
� J 2 D-BOX
TPv > F 40: VARIANCES REQUIRED :
3 INFILTRATOR 30 o gf EPHEPI ' • T 1 TL E 5. MAXIMUM FEASIBLE COMPLIANCE
CHAMBERS W/4't ON. SOLID aF A. �,�';
L Q T I O sroNf AROUND CATCH BASIN S
KAAS
C,: SECTION 15.211 : (I) MINIMUM SETBACK DISTANCES
RIM-89.76 CAVIL
No.35461 20 ' IS REQUIRED BETWEEN THE SAS AND THE FOUNDATION. 15 ' IS PROVIDED
18. 6521 S. F. sit. =� A 5' VARIANCE IS REQUESTED.
S 88°39 'OO'W 192 80 '
eel!` S' L�_ P 7T / C S Y S T E-M OE- 5
G/V
m
/ 07 H / OHLAAID OR / VE . MAP / 90 . PARCEL S0
Z O
m p
p SA FR /vS rA SL E .
m < CE/V TER V / L L E ) MA ,
i
? PREP.4 REO FOR
L EGEND
N .�' A /�/ B ,4 N N / S T E R r m h ■ CB CONCRETE BOUND
WATER L I NE
m SCALE APR IL 28 2010
O HYDRANT
-G GAS LINE OHW- OVER HEAD WIRES E. AG L E SURVEY I NG , I NC
# LIGHT POST _._ _ 923 Route 6A
�UtE, -E UNDERGROUND ELECTRIC LINE \� Y a r ma u t h p o r t MA 02675
-T- UNDERGROUND TELEPHONE LINE /ij I/� �`I��� ( 5 0 8 ) 3 6 2-8 1 3 2
-- CTv-- UNDERGROUND CABLEVISION LINE �I`�/ i ( 508 ) 432-5333
+ 40.4 SPOT ELEVATION
-40 EXISTING CONTOUR
40 - PROPOSED CONTOUR [ JOB NO: /0-C34 FIELD:CFW/RPM CAL C: SAH/CFW CHECK: CFW ORN: SAH
LOCUS MA FJ � ?0 20 40 - -