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0036 LARCH LANE - Health
larch Lane CenteiviIle ` a A= 189 -006— T r No. v r i Fee AG 10 / THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION ;,.OWN OF BARNSTABLE, MASSACHUSETTS Yes pplication for Ti5.po r bpgtem Con6truction Permit Application for a Permit to Construct( ) Repair( Upgrade( ) Abandon( ) ❑.Complete System L��'Individual Components Location Address or Lot No.�� (�i�� LQHY 0 Owner's Name,Address;and Tel.No. �'/ Assessor's Map/Parcel `� Olt SO ' _3 76 dcy C��e ��9 �✓� Installer's Name,Address,and Tel.No. � ,4/,,/A' Cavd Designer's Name,Address and Tel.No. 2�vw^' yrlr���bl �� g7�1 !�•yl f sat -�/ Sr B'J1d �� �i19 SDY'3(�-4i-Y' crrras .✓ ArMl Type of Building: Dwelling No.of Bedrooms Lot Size � , 6 V/ sq. ft. Garbage Grinder (/C�r Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 73 6 gpd Design flow provided 336 gpd Plan Date // n Number of sheets / Revision Date Title TT4, 3- rile )1 h 0,4 74 Z,,?,CS Z�—,/!P �Mf���i& Size of.Septic Tank /f O C LAX�J`/h Type of S.A.S. ;2- S-401 6 Ewa—f e'A ypj.J Description of Soil yln4 091 y Nature of Repairs or Alterations(Answer when applicable) !" Z-,-as,tsr /7h 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 Bo of Signed Date Application Approved by Date Application Disapproved by: Date for the following reasons Permit No. '1 '�� Date Issued 3 p c No. �� vv :"^rl•.: -c . -..6' ` rr �I� 1`I Fee /E �V THE COMMONWEALTH OF MASSACHUSETTS} Entered in computer: PUBLIC•HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes ZIppgication for Dt.5paar qppmem CICon.5truction Permit Application for a Permit to Construct O Repair(��v Upgrade O Abandon O ❑ Complete System ©'ndI ividual Components „ Location Address or Lot No. � O� Owner's Name,Address,and Tel.No. � ^/ f % dcy L��� Assessor's Map/Parcel f C� 1�_��i Q)� s t--7-71— . 57:2 q Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. S7Q Irr 041` 11 iG1/9 SAY" 3&2-vry AO'',, Type of Building: Dwelling No.of Bedrooms Lot Size f s� �� sq. ft. Garbage Grinder Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) _7 3 d gpd Design flow provided 33� gpd Plan Date A&4 a, ' ;tTjC?" Number of sheets >'r Revision Date � 'J Title T��,� S- S,/e /`'/C'l 0,4 '1 � :� Size of Septic Tank �i� Cs C L'.x�J1th Type of S.A.S. 3W 6 6-w.tf e-47A;4 j Description of Soil ` Nature of Repairs or Alterations(Answer when applicable) /� a/r �,,cc6,t,s '• /Q�,py his A o Date last inspected: b Agreement: t 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 HH`eallth Signed �}'j� ��i Date V/Z Application Approved by Date , Application Disapproved by: Date for the following reasons Permit Nor 1 � Date Issued ' 7 )C -------------------------------- 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 f)11r40/17 `. 1 r6w ) •-� at l�<C ZG'y e l=. �sw,.r//� has been constructed in accordance n with the provisions of Title 55 and the for Disposal System Construction Permit No. ),00 dated 3 �7 N.1 Installer /;o., 1 m. Designer #bedrooms Approved design flowY A gpd The issuance g tAis permit shall not be construed as a guarantee that the system wi l'fuunn�ction as d/essiirg�ne ' Date / Inspector A( � ��1 KJ -=_= _—_-- —�rT _ �T -====_====_ 4_-__ _ �:_—— w== --- ' No. `r" O 6 Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION— BARNSTABLE, MASSACHUSETTS Mi5pont �&p5tem Con6truction Permit Permission is hereby granted to Construct ( ) Repair (✓// ) /rUpgrade ( ) Abandon ( ) System located at 310 /ane 4 Z sfo e �,.,��+�vi✓/Y I and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to comply with Title S and the following local provisions or special conditions. Provided: Construction must be completed within three years of the date o'f th',permit Date �/ 7/Q / Approvedab_y. FROM :down cape engineering inc FAX NO. :15083629880 Apr. 02 2009 01:01PM P1. i Town of Barnstable Regulatory Services Ihomas F. Ceiler,Director Public tlealth Division o rnr�' Thomas McKean,Director 200 Main Strcet,Hyannis,ALL,0260l Office: 508-862-4044 Fax.: 508-790-i• `!O I Installer&DesiLmcr Certification Form Date. 4z,4f Sewage Perrlait# a7�� , ad� Assessor's MapWarccl Deluigner: WG dl 8 L(� !Y�( p-9 C. r/12�i'y�t ins allcr: 0�_ /� •'� �/ [�� ,s Address: lJ ✓ i% U0 Address: � 0. l �f1� Cc-r:J.4/!� 1�� j1 rq fi --r Or- was isxued a Pennit to instal a (date) / (inst er) septic system at Lf� ``�� Z-4 t-Q based on a.design drawn by _ _ (address) OINr �- � . dated(desi er) I certify that the septic systew referenced above was installed substantially according to the desigm, which may include minor approved changes such as lateral relocation of. the distribution box and/or septic tank. _ _-- 1 certify that the septic systeam referenced above was in.stal).ed with major changes (i.e. greater than 10' lateral relocation of the SAS or anv vertical relocation of a.ny component of the septic system)but in accordance with State Local Regulations. Phin revision or. celtafied as-built by designer to follow. 1O ANIEI_AOJA wi (Tztista. er's Si.gnatum) CI V L V No.46 ' �. s',SlONAI. (Designer's Sigmtittwe) (Affix De.%gncr's 8tarn�►Here) PLEASE, RETMN TO )BAItN5'rABLE PUHLIS; HXAL7'H DIVISION. CJ:ld'r:UrIC-.XI';N: (w comll'l'uNC L wJUJ, NOT BE S,SSU D UNTIL B XII 1.WS FORM AND AIS-lit 1M't' d'.A RL) ARE J2E''k IWJ)BY T",RARNSTABL1;;t'Ultir.IG III1N:AL`ri[i DIVI;B;tON. T>Ka►ntx YCfiJ. Q:)lealth/Septic/uesigacr Ccrtifkmm ou rcnrn 3-264)4.dtx TRANS. NO.: CITY/TOWN: -1�5,A�LN 5�6LG , MA APPLICANT: V, c,. ADDR.IESS. Gl�`� �T-6R Yn�✓`i DESIGN FLOW: gpd REVIEWED BY: PE,-pLS _ �c-Q,;r(-DATE: NSA OK NO 1�J � 1 r rf j' U 1l 4f 1....,.F .y1 Y.I'. (-••�.KJf 4e. 5J .n11:!Z•- .1 7.v e{7 e;fi;.4r 3n1;.�+v Legal boundaries denoted [310 CUR 15.220(4)(a)] Street, Lot, tax parcel number and lot number noted on plan[310 / CMR15.220(4)(u)] V Locus Provided [310 CUR 15.2204(t)] t✓ Plan proper scale? (1"=40' for plot plans, 1"=20' or fewer for components) [310 CUR 15.220(4)] Easements shown [310 CUR 15220(4)(b)] ✓ System located totally on lot served [310 CUR 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 CUR ✓ 15.220(4)(c)] Location and dimensions of system components and reserve areas. [310 CUR 15.220(4)(e)] System Calculations [310 CUR 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 CUR 15.220(4)(g)] Location and log of deep observation holes (existing grade el. on each test) 1310 CUR 15.220(4)(h)] Names of soil evaluator and BOH representative [310 CNM 15.220(4)(h) and(i)] Location and date of percolation tests (performed at proper elevation?) [310 CNM 15.220(4)(1)] Percolation test results match loading rate? [310 CUR 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)(11)] i Address 3 �Lcm L�4NE C C—t- � v��'� Sheet 1 of 7 e N/A OIL NO Location of every water supply,public and private, [310 CMR iE 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 p P within 1.50 feet of the proposed system location in the case of private water supply wells V Location of all surface waters and wetlands located up to 100 ft. beyond setbacks listed in 310 CMR 15.211 and any catch basins f 310 CMR 15.220 4 1 loc ated within 50 ft ( )( ]) Water lines and other subsurface utilities located[310 CMR 15.220(4)(m)] (if water line cross see 310 CMR 15.211(1)[11) 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 ar[3 proved for an upgrade under LUA at 310 CMR 15.405(1)(k)] st hole adequate to demonstrate four feet of suitable material? ✓ 0 CMR 15.103(4)] st Holes adequate to confirm adequate groundwater separation?0 CMR 15.103(3)J Benchmark within 50-75' of system [310 CMR 15.220(4)(q)] Materials specifications noted? [various sections of 310 CMR 15.0001 System components not>36" deep (unless Local Upgrade Approval or LUA requested) [310 CMR 15.405(1(b)] Sheet 2 of 7 Address 3� Lar-C Lam Ce r\'hWLA I'� N/A OK NO .M.l.± IANjk%u 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 regarduig 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)] Minunum 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 15.228(2)] All at-grade covers secured to unauthorized access? [310 CMR 15.228(2)] > 10 ft fiom 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] lulorrapait�nena�iks., I ,F�� � site a1 ?r�. t # j . _ Required when other than single-family dwelling or flow>1000 / gpd [310 CMR 15.223(1)(b)] V First compartment 200%daily flow; Second compartment 100% f daily flow [310 CMR 15.224(2) and(3)] "U" pipe through or over baffle, outlet of each compartment with V/ gas baffle or approved filter [310 CMR 15.224(4)] Address 3b Ce p4t✓VI)I f Sheet 3 of 7 N/A OK NO Y�1JI LI)�N(aFw ;SI�� EP. D OHI,R)PIIPTI?CYmak; r ���` ^� s . �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)[11) 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 CNa 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 f CMR 15.252(2)(h)] Materials specified (310 CMR 15.251(5) specifies various pipe es allowed) Stable compactedbase [310 CMR 15.221(2) and 310 CMR f 15.232(2)(a)] Splash plate or baffle tee required on inlet/provided? (when pressure sewer to d-box or steep pitch of gravity sewer) [310 CMR 15.323(3)(a)] Riser if deeper than 9" [310 CMR 15.232(3)(01 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)] ArA �� Jl U. � Capacity(emergency storage above working—design flow)? [310 CMR 231(2)] Proper setbacks [310 CMR. 15.211 (sanne 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 - alaim on circuit separate from pumps specified? Exceeds two units inust 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? [331-0 CMR 15.221(8)] Sheet 4 of 7 Address 3 6 ka rA LaIj- N/A OK NO SOBS � 35 ) 2rT1O1� 5%YST+I�JI ,(SEis) �sT+�1'11� #y� ��SI: tr ` ly �1' �SS},�+'+ Calculations correct? 4 feet of naturally occurring material demonstrated? [310 CMR 15.240(1)] Required separation to groundwater? [310 CMR 15.212)] Aggregate specified as double washed [310 CMR 15.247(2)] System Venting required/provided? (system under driveway or / >36" deep) [310 CMR 15.241] V Inspection ports specified and within 3"final grade? [310 CMR / 15.240(13)] V Breakout requirements met? (No violation of breakout elevation within 15 ft of SAS unless barrier) [310 CMR 15.211(1)[41 and Guidance Document] GyA �EJ +S;P TSB :. ]BJ 310 C1VII2 1°5'253 i � 11.15C, 611" t , Chambers and Gal. in trench configuration supplied with inlet every20 ft. [310 CMR 15.253(6)] V Each structure with one inspection manhole(if>2000 gpd must be to grade) [310 CMR 15.253(2)] Aggregate I'minimum-4'maximum. [310 CMR 15,253(1)(b)] ✓ 2' sidewall credit maximum[310 CMR 15.253(1)(a)] In bed configuration, inlet every 40 sq. ft. [310 CMR 15.253(6)] 14 Width 2'minimum 3'maximum [310 CMR 15.251(1)(b)] 100 feet -maximum length [310 CMR 15.251(1)(a)] VII 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] TO,a imu ize o bed o geld SOOU ci �t-la- minimum 2 distribution lines [310 CMR 15.252(2)(a)] Vt Maximum separation 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)(g)] Separation between beds 10'minimum. [310 CMR 15.252(2)(f)] Bottom area used mi calculations only [310 CMR 15.252(2)(1)] j n Address 3 L L4-,,k n��"¢.,�V Sheet 5 of 7 N/A OK NO J ,+,��j *tt' Stk �h'' 1r + 73.E T?1f z M'00 V ' �.� < Yk '�1� ��' 'c,. 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 310 CMR 15.254 2 and I/A remedial approval ( ) systems under rem pp [ 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 f (>2000gpd) good to note on plan [310 CMR 15.254(2)(d)] Construction in fill -Did the plan specify that the fill shall meet f 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 15255(2)(a)] Side slope not exceed 3:1 ? [310 CMR 15.255(2)] Breakout requirements met? [310 CMR 15.252(2) and Guidance Document] At least 5 ft. from impervious barrier to edge of SAS (10 ft. recommended) [310 CMR 15.255 (2) e)] 3 r yGra s Sys em U pl r;o - e1;s.. a Check DEP Approval letters for credits and design conditions t/ If used with pressure dosing do not allow pressure discharge to scour soil interface TIP! ' o 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 rygwf1aM lrIlC2 Are the variances listed on the plan? [310 CMR 15.220 (4)(q)] RLS Stamp necessary on plan if a component is within five feet of property line [310 CMR 15.412(4)] V v New construction or iicreased flow proposed- [Refer to 310 MIR 15.4141 Sheet 6 of 7 Address �LL'v``- + .� C✓✓1 I i N/A ®K NO j - -i( e�y_�-�r �- si.l t ih Fi f��t�St�,_ MEN. Natrogeri Sensitcve,A�,2C$S! + ,_.k:.A.N,a46 .i2.[. Is the system in a Designated Nitrogen Sensitive Area(Zone II for cps-p a public supply well)? [310 CMR 15.214, 310 CMR 15.215 and ✓�' w, s 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)] ✓ V Are the nitrogen loads proposed in compliance? [310 CNM 15 216(1)] } rrKt T?1fi' Li i7(� t.EG 7'�a k Iy Lsc,'ellaTleoi�s tJijtf�" sn.i`ylt?j y4 i!}.a r: @4r t�,S .hA tad Pumping to septic tank? [ 310 CMR 15.229] Shared System [310 CMR 15.290] 'I i i Sheet 7 of 7 Address J 6 /� `-C ASSESSOR'S MAP NO.A �_ PARCEL \u� LOCATION - .3 (a SEWAGE PERMIT NO. �.._cz ' ' y`a. t ` —'fir — �Cc VILLAGE I N S T A LLER'S NAME i ADDRESS a (b U I L D E R OR OWNER DATE PERMIT.. ISSUED f DATE COMPLIANCE ISSUED JCJ0% V-IN v icl LA LA I, i G�y - No......� ...j�� ! r Fps.............................. THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH .eve A i2n/S �•a i3 �� -4r ....................................-....OF.....................-----•----........................................................... Appliratilatt'fur Disposal Works Towitrur#ion Permit Application is hereby made for a Permit to Construct ( <or Repair ( ) an Individual Sewage Disposal System at: Y\S£ ... .. .. .................................................... Location-Address or Lot No ............. _.._.. -------_..... ... -----••----••-•--•--_... ........ .-- O Address W Installer Address ; O Type of Building Size Lot...........................Sq. feet Dwelling—No. of Bedrooms................ __ .Expansion Attic.(-� Garbage Grinder.—k—)" ------------------ pa, Other—Type of Building ���-� ?......a..... No. of persons.....__._�'.............. Showers ( ) — Cafeteria t-` — 0-4 a' Other fixtures ...... _._.±NA� ._...._..__ ---------------------------- ------------•....----............-------•...._.......... W Design Flow.......................... .......gallons per person per day. Total daily flow----_-------- . _ ..............gallons. WSeptic Tank—Liquid capacity!®c O.gallons Length... Diameter................ Depth....f........ x Disposal Trench—No.......... ......_.. Width.....l.. _'..__ Total Length...... . .a_ Total leaching area....4_!?+..sq. ft. Seepage Pit.No.__ !.:�.. Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. z Other Distribution box Dosing to _ `" Percolation Test Results Performed by......................................................� ,......'_�S� Date._.f�� Test Pit No. I...{.�-_.minutes per inch Depth of Test Pit.....j.. _ ._. Depth to ground water----- .(_• '' �� (14 Test Pit No. 2__.'{_..+.minutes per inch Depth of Test Pit...... Depth to ground water.____7-........... 9 -------------------------------------------•--•----------------......--------•-••-------•----........-----........--••----...-------•---•----.............--- O Description of Soil------. Cam! Nit=:'--'...-- - =n/ - `s - ev / T'1 v ---•--....--••......................•...... • '°" ? L•-' -•� rZ--S-•----�� _/ ��r.. )=, U Nature of Repairs or Alterations—Answer when applicable............................................................................................... -------------------- -•------• -------------------------------------------------------------._. ----------------------------------......._.___....--- ......-----------------------•----...-•-------------------------------------------------------- Agreement: The undersigne agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITI U 5 of the State Sanitary Code—The under igned further agrees not to place the system in operation until a Certificate of Compliance has bee"ued y the rd of health. - --- . -------••---•-------...-•----------- -----1 2a p Signe X..... -.A.(a. `� Dat / Application Approved By------------------------------ ----V!D. . .----••--•--•- •-•---•-•----••---... •---•--- L...r- ` Date Application Disapproved for the following sons:................................................................................................................ -••---•-------------------•--------•-----.....-•----------....--•---•----...-•--------.......------....-•.......................................................-....................................... Date Permit No......�R(a......./94.................... Issued------------------- ............................... Date 1 t No........................ Fps.............................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH 10 ......... .. ....... ...............OF.................................`........-`a .................... Appliration for Disposal ig. orks Tonstrurtion Prrutit Application is hereby made for a Permit to Construct ( vl'or Repair ( ) an Individual Sewage Disposal System at: •- Location-Address or Lot�N_o. ........L e� ,ni ..s Tj � !-'= L_. , f-- ®i t. ? ,y,. t 3 04.Q +Z� V � ... ..................•---•--•-.-•--- .......... W O Address..........-•••............... _... a --•-------••----... Installer Address V Type of Building Size Lot--------- ......-�.o..Sq. feet 13 Dwelling—No. of Bedrooms...........................................Expansion Attic (--~j'" Garbage Grinder.-�^"— Other—T e of Building ��'` �' - .. No. of � yP g ---------•---------------- persons.........-----.............. Showers ( ) — Cafeteria Other fixtures .......... ...;_�.T-..T__..+ ...... .. .................................... W Design Flow............................=?...=?-......gallons per person per day. Total daily flow-_.-.-.--_- ..............gallons. 1:4 Septic Tank—Liquid capacity'ry p.gallons Length..-6'..'.1�+_ Width.`f_..!_`?.. Diameter................ Depth...."�__0..... Disposal Trench—No.......... ......... Width.....1..� Total Length...... Z.R. Total leaching area..... o�_sq. ft. Seepage Pit No------- :.. Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( t Dosing tank-,t--)— _ _ `-' Percolation Test Results Performed by....�'-:...! ...:........:1.�_..` ...........�.�`�G Date.... a Test Pit No. 1...�....�'�n_minutes per inch Depth of Test Pit...... _ .. $ Depth to ground water.._..5P J (Tq Test Pit No. 2...:c.....minutes per inch Depth of Test Pit......� ."Depth to ground water-___7.�......._. Description of Soil........ Y`- � -��'---- ?'?..._ ''�°�' -:5 === c✓ _5 �o �"1 ---.----- ------.....•••--•---•--•••--- ......•• • _ � / �� r+—/ i � ..i✓ .. `.. .row U Nature of Repairs or Alterations—Answer when applicable............................................................................................... Agreement The undersigne agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. Signed-X....................•••. -••--•--••-•--•------......_.................•--•-- Date Application Approved By............................. .. -.t)..G •--•••.......... ........................................ P I ' � Application Disapproved for the following .................... ..Date ........... -----------------------------------------------------------------•------------•--------•---•---....------•••--••-•••--•--•-••••---••--••--•-•--•...-••••-•----•--••-•--•--•---......................... Date PermitNo........'.�4...�?..`__ ---•---------------- Issued_....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ........OF.... -+:•, `�.1? Trrtifiratr of ToutpliFanrr THIS IS TO/ CERTIFY, That the Individual Sewage Disposal System constructed ( 1-<or Repaired ( ) by----------------------..............---•-•--...I :;;' ------------------............-----------------------------------..................---....--------------- Installer -------------•-•----.........------------•---------------..............-----.......-.................................................................................. has been installed in accordance with the provisions of TITLE 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No............ ! ... dated----------7.-`_1._1_"..................... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM WILL FUNCUON SATISFACTORY. DATE ^� ..................... Inspector......- -----...---------------......---------.._....---•--•--.--•••- THE COMMONWEALTH OF MASSACHUSETTS >t BOARD OF HEALTH . '................................142'/? f✓� r� Z� ... Tr©� ....................... O F........' ._...-.......................................... C` a �- FEE......................... Disposal Works T-Ponstrttrtion anti Permission is hereby granted............... . ...._.. ,' -.... = to Construct or Repair an Individual Sewage Disposal System (� P � ( ) g �..� P Y ..... .........•-•••••--•-••-- •••••-•---------••••-••-••• -•••---•-•-•---•--••-•••••••••••••••-•••-•--•--••--•••- ,� Street �.. _� as shown on the,application for Disposal Works Construction Permit No.. �....... D ed.._._ __...)j.......`......'.......... -----------------------------------------•-•- -- ... .......... Boa(d §f'Health DATE..... .{._l..z.....�---•••-•-••-•-••••......-•-••-•-•-• \J FORM 1255 HOBBS & WARREN. 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I I �L 1 '-,, . , � . . .',;,;'�)' ,' �' .'.',�. - - � , , . ,� , e . ; ._, , � ,:,� �",; . - :,"_�,* L'�" "'�, � V- - . . -'-%", L 'L",- �', �", - _.L�`P., _�,, , , "i��",,� ":" ,L,�, �,_, �� ._ __ I "��.� ,� I �l�, . . � ., ,, _� � � .1 � -�.,_I'--- .� . , , - , , L' .. _:�,,, , ,� . �"�L , �, I ,� ,L :� _ ��"�� , ,,�, . - I rZ_ � ,, ;, , , �, ,�,, L ; - -,,:,�,:'r �,_ 1�1�7"'-- - "n, ,, ,7 - , ""' , �Y,f_��, ! I � - ,, � -_-:" , _ ,; -I I I � -, �_,�L�_" " , ` I- - - - _ ,��, , � - L 11 , - �, - """ , �_. , �- ':4� I _,; � ,_i, '. ,7" . - rl ��-__'l 4-1 , � - ., ,� , �-.. �1. - -,,_ , I ��,__��, L , , , - -, ..". � ,, , � . I 1� I . I I , I � " ,_,.i, ,, _ - -- , ," ." ,." ,� � % , �'. "L � , _ -,,"_;,.;. . - ,� ", , . I I . .1 z . I _ 11 �;�__. I . :%, - � - - - FTOP� N. AT EL. -33,2! SYSTEM PROFILE PROVIDE MAGNETIC TAPE FOR FUTURE LOCATION OF COMPONENTS NOTES ACCESS COVERS TO WITHIN 6' OF FIN. GRADE (NOT TO SCALE) (AS REQUIRED) ASSUMED / a ACCESS COVER (WATERTIGHT) TO ACCESS COVER TO WITHIN 3" OF FIN. GRADE 1• DATUM IS a MINIMUM .75' OF COVER OVER PRECAST /` WITHIN 6' OF FIN. GRADE 2% SLOPE REQUIRED OVER SYSTEM 2. MUNICIPAL WATER IS EXISTING I_ 31.0 RUN PIPE LEVEL 2" DOUBLE WASHED PEASTONE 3. MINIMUM PIPE PITCH TO BE 1/8" PER FOOT. � FOR FIRST 2' OR GEOTEXTILE FABRIC Route 28 EXISTING 1000 3' MAX. 4. DESIGN LOADING FOR ALL PRECAST UNITS TO BE AASHO log, GALLON SEPTIC ;1ilz 29•7�t* H- 10 29.0, TM TANK (RE-USE)** GAS 28 33' 5. PIPE JOINTS TO BE MADE WATERTIGHT. BAFFLE 28.5' o000 0 � (] � 0 0 0 0 o0 ly"i'E1= IT"M,N• 77' 06. CONSTRUCTION DETAILS TO BE IN ACCORDANCE WITH 6" CRUSHED STONE OR MECHANICAL N s,�E ,�i�n. 0 (� p p O p pCOMPACTION. (15.221 [2]) , 2' p 0 (� 0 p p p � � 0 26 17' MASS. ENVIRONMENTAL CODE TITLE V. 17 DEPTH OF FLOW = 4' 000 7. THIS PLAN IS FOR PROPOSED WORK ONLY AND NOT TO Rood TEE SIZES: 3/4" TO 1 1/2" DOUBLE WASHED STONE BE USED FOR LOT LINE STAKING OR ANY OTHER PURPOSE. et INLET DEPTH = 10„ MIN OVERALL SYSTEM DIMENSIONS: 30' x 9.83 x 2 DEEP ,. Bumps OUTLET DEPTH = 14" ( 5 % SLOPE) ( 1 % SLOPE) 8. PIPE FOR SEPTIC SYSTEM TO SCH. 40-4" PVC. FOUNDATION EXIST. SEPTIC TANK 24' D' BOX 16' LEACHING 12.6' 9• COMPONENTS NOT TO BE BACKFILLED OR CONCEALED LOCUS MAP FACILITY WITHOUT INSPECTION BY BOARD OF HEALTH AND PERMISSION *THE INSTALLER SHALL VERIFY THE **INSTALLER SHALL CONFIRM MINIMUM SEPTIC TANK SIZE AT OBTAINED FROM BOARD OF HEALTH. NOT TO SCALE LOCATIONS OF ALL UTILITIES AND ALL 1000 GALLONS AND ITS SUITABILITY FOR RE-USE. REPLACE 10. CONTRACTOR SHALL BE RESPONSIBLE FOR CALLING BUILDING SEWER OUTLETS AND ELEVATIONS WITH 1500 GALLON H-10 SEPTIC TANK IF NOT SUITABLE. ASSESSORS MAP 189 PARCEL 6-14 PRIOR TO INSTALLING ANY PORTION OF A� Gqs '1�A1 F..E/jz.�-,a►��� -SEES P,S iz-E42. OFDIG ALL UNDERGROUND -344-7233) AND VERIFYING THE LOCATION -z-c>m c SEPTIC SYSTEM BOTTOM TH 2 EL. 10.0 OF ALL UNDERGROUND & OVERHEAD UTILITIES PRIOR TO A� COMMENCEMENT OF WORK. SATE ire► �y�v,�,z»�,F w,,4ii� LEGEND 11. EXISTING LEACHING FACILITY SHALL BE PUMPED AND VPG�Avc _ rvoT "ANGw 29.00\ REMOVED 100.0 PROPOSED SPOT ELEVATION \ 12. ANY UNSUITABLE MATERIAL ENCOUNTERED SHALL BE REMOVED 5' BENEATH AND AROUND THE PROPOSED x100.00 EXISTING SPOT ELEVATION .87 \ LEACHING FACILITY. 5' REMOVAL OF UNSUITABLE SOIL REQUIRED -6Z 100 EXISTING CONTOUR AROUND PERIMETER OF LEACHING FACILITY, 28.96 \ DOWN SUITABLE SOIL LAYER. REPLACE �� SYSTEM DESIGN. WITH CLEAN AN MED. SAND. \ 11�� oe�� F e��e � ��300 GARBAGE DISPOSER IS NOT ALLOWED �ce Vo �� 29.95 \ °Goa .32 OWe�s /^ t� \ DESIGN FLOW: 3 BEDROOMS 0 110 GPD = 330 GPD 0 �Xo. jN�,e_„- e'R` \ USE A 330 GPD DESIGN FLOW p�.nc'T`� � lto edge 30.94 \ !� �+ 2 ; . 0 SEPTIC TANK: 330 GPD (2) = 660 42 r x 05% o � RE-USE 1000 GAL. SEPTIC TANK** 1 / \ 1 0 LEACHING: TEST HOLE LOGS S \ SIDES: 2 (30 + 9.83) 2 (.74) = 118 GPD x 31.78 12" Cherry 0 3 y \ BOTTOM 30 x 9.83 (.74) = 218 GPD ENGINEER: A.H. OJALA, PE r.�C--#-I�o`i � � \ WITNESS: D. DESMARAIS, RS O 2.16 \ TOTAL: 454 S.F. 336 GPD Deck DATE: MARCH 12, 2009 03 52 USE (2) 500 GAL. LEACHING CHAMBERS (ACME OR EQUAL) 0 32 03 a WITH 4' STONE AT ENDS AND 2.5' AT SIDES & 5' PERC. RATE _ < 2 MIN/INCH 2 20 Exist. ST** �/1 �\ Garage \ N3 0 \ BETWEEN UNITS CLASS I SOILS P# 12490 Pergola 3 . 0 \ `?. �`o \ Benchmark: cor conc. � a bulkhead elev. 32.26' Existing Dwelling \ �32. MA ELEV. ELEV. Top Fndn. = 33.2' o \ APPROVED DATE BOARD OF HEALTH ' 0" 30.25' 0" 30.25' 32.14 °��� \ \ 30.0, \ TITLE 5 SITE PLAN FILL UNSUIT. FILL UNSUIT. \ 32" 32" °^ \ OF 40 n \ /LS UNSUIT. /LS UNSUIT. \ 34" 10YR 2/1 34" 1OYR 2/1 1.52 ° 3218 36 LARCH LANE B B � m 32.23 CENTERVILLE UNSUIT. �LS UNSUIT. CD 46 10YR 4/4 26 4, 60 10YR 4/4 25 25 ° 7� 31.80 s PREPARED FOR Lot 14 0.36 Acres± (15,681± sf) BORTOLOTTI CONSTR./MORIN c c 0.0 PERC �1 _ ' MCS MCS GE of P MARCH 12, 2009 Eo, � 31.09 , off 508-3 62-4541 30.94 � OF fax 508 362-9880 2.5Y 7/4 2.5Y 7/4 DANIELA DANI EL OJALAdown cope engineering, in c. 138 18.75' 138 18.75 CIVIL OJALA A 2 , No.40980 Cl VIL ENGINEERS NO GROUNDWATER ENCOUNTERED Scale: 1"= 20' 3��2IoGt �o��s! STe �� , `q0 Fss o� 1 LAND SURVEYORS S NAL S V 939 Main Street - YARMOUTHPORT, MASS. 0 10 20 30 40 50 FEET DATE DANIEL A. OJALA, P.E., P.L.S. 09-038 09-038(SBO)