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HomeMy WebLinkAbout0079 LIETRIM CIRCLE - Health 79 Aetrim Circle, Centerville A= 169- Oil - 001 TOWN OF BARNSTABLE LOCATION�f L jP / efil-CLI- SEWAGE# VILLAGE ASSESSOR'S MAP&PARCEL/ INSTALLER'S NAME&PHONE NO SHOD SEPTIC TANK CAPACITY IeLlo LEACHING FACILITY:(type) —S P���/7ifl��G�j(size) NO.OF BEDROOMS OWNER�L/.Zl4L�CT� y� PERMIT DATE: COMPLIANCE DATE: Separation Distance Between the: LMaximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility(If any wells exist on ' site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet FURNISHED BY i A vo e 3 e`L3 FR VAITSG 4e Vv_ C 13 �. �2 T .----_ No. Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer-Yes ��-43PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Application for Misposal *pstem Construction Permit Application for a Permit to Construct( ) Repair() Upgrade(_.):*ktandon( ): Complete System ❑Individual Components Location Address or Lot No.7y�L%r rA/svl /�Q e L/� Owgger's Name Address,aqd Tel.hlo. Z�}C3!TFf /=iNiVi�.�ni Assessor's Map/Parcel /6 f-- " „,4 I_t A,/j��/, Ins�ttaaller's Name Addr ss,and Tel.No.s"'08-y'Ld- 1773� Designer's Name,Addre and Tel No:$D 3!2-�/S y �loS c�l�i ,U /, ter S �Jou�dl CrIP/� c P1hO?/ Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons ers Cafeteria( ) Other Fixtures Design Flow(min.required) Z gpd Design flow provided gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank vo Type of S.A.S. Description of Soil / l Nature of Repairs or Alterations(Answer when applicable) /.VST �� ",9®X —S0��! - A � Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. ned 4 Date Application Approved by J Date Application Disapproved by Date for the following reasons Permit No. j Date Issued erOr,,; i "! S il✓ Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in compu er: Yes PUBLIC HEALTH,DIV ISION - TOWN OF BARNSTABLE, MASSACHUSETTS •', `1 !appliratiotufor Misposal 6pBtem Const union 3pPrm t Application for a Permit to Construct( iI Repair(,_) Upgfade'(�),.,.Abandon( )�,�Complete System El Individual Components Location Address or Lot No.7yZ%!� T / �� C'I Owner's Name,Address,and Tel.N0. �- Assessor's Map/Parcel Cg,44 Installer's Name,Address,and`Tel,No:�-pg_yg d_ c�7,y Designer's Name,Address,and Tel.Nor5"c)E 3 a 2-yS y ;J©S-e� m ,0-, /3orN S i . Pvw/7 �Jf-'/: �G�h /All pvc, l y`a�S // �/ �iOv r�° Type of Building: . ,r Dwelling No.of Bedrooms Lot Size r (-sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons h©we Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided gpd Plan Date umber of sheets .Revision Date Title Size of Septic Tank , /� `, Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) /A4 Ong 0-90 x Z " !1�64 z/_F,0 /4 „ 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 Health. e ,o Date J Application Approved by j% / , Date Application Disapproved by Date for the following reasons Permit No. Date Issued. j THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certifitate of Compiiante THIS IS TO`CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired Upgraded(,�_j Abandoned( )by at�C,//ii�— ice//�fj �V� � has been constructed in accZa;-ec / with the provisions of Title 5 and the for Disposal System Construction Permit No ( lI c 'f Installer;A 5""a J9., i�/"/`f� Designer 1 � #bedrooms 2_ Approved design floA gpd The issuance o this ermit shall not be construed as a guarantee that the system wi• un ion�as designed. Date Inspector ------------------------------------------ ------------ Fee / THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS rf, -Disposal 6pstrm Construction Permit. Permission is hereby granted to Construct( ) Repair( 4,? Upgrade Abandon( ) System located at and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. '* l' Provided:Construction m must b /Je'4completed within three years of the date of this permit. Date / Approved by ate;- . '/ � •f Town of Barnstable Regulatory Services Thomas F. Geiler,Director BAktN5nB ]Public Health Division Thomas McKean,Director 200 Main Street,Hyannis,H.02601 Office: 508-862-4644 Fax 508-790-6304 lfustaller&Desiz aer Certrficatnon Formm. Date:. � // /� Sewage rermmnt# , r Designer: o W r l6mstalller: y —� a Address: 9.3 Address: On J D �'�� was issued a permit to install a (date) (installer) septic systern at / 2 "✓ r cM C r based on a design drawn by (address) aA i e,1 u�ct �'�, .PIS dated Ma 19 (cr6sign(-,r) �I certify that the septic system referenced above was installed substantially according to the design, which may include.minor approved.changes suc as lateral,relocatioA of the distribution box and/or septic tank. 1100 . -1-t o o v I certifythat the septic stem referenced_above was installed with major changes i.e. p y J 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. DANJE1 A. 0JALA "- taller's Signature) ' CIVIL Na 465 2 (Desige,r's Signature) (Affix Designer's Stamp Here) PLEASE RETURN TO BARNSTABL E PUBLIC HEALTH( gDM,910N. CiEh3TII+ICATE OI+' .COYIPLLANCE WILL NOT 19 E ISSUED UNTIL BOTH[ TMS FORM AND AS-BUILT CARD ARE RECEIV)EID)BY THE BARNSTAJBLE PUBLIC HEALTH DIVISION. 7C18rA1oLK YOU i Q:ITealth/Septic/Designer Certification Form 3-26-04.doe /60 Commonwealth of Massachusetts A sagas Executive Office of Environmental Affairs Department of Environmental Protection RECEIVE® WIWam F.Weld �,� r O C T 2 3 TT7 Wretsry Argeo Paul Collucel _Dls ld,gg��..Struhs U.�� HEk i .: m TOWN OF[ ALE SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A waitil T?111 0ERTIFICATION Ll nr Property Address ` OAZAddress of Owner. Date of Inspection: IC)— 'F(a (If different) Name of Inspector. M'O'elov Company Name,Address and Telephone Number. -J-P moR'N 5-;W-6,cS 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 inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. The system: "asses _ Conditionally Passes _ Needs F her Evaluation By the Local.Approving Authority _ F Inspector's Signature: Date: The System Inspector shall submit a copy of this inspection report to the Approving Authority within thirty(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 tfie appropriate regional office of the Department of Environmental Protection. The original should be sent to the system owner and copies sent to the buyer, if applicable and the approving authority. INSPECTION SUMMARY: Check A,B,C,or D: f A] SYSTEM PASSES: have not found any information which indicates that the system violates any of the failure criteria as defined in 310 CMR 15.303. Any failure criteria not evaluated are indicated below. B] SYSTEM CONDITIONALLY PASSES: One or more system components need to be replaced or repaired. The system,upon completion of the replacement or repair,passes inspection. Indicate yes,no,or not determined(Y,N, or ND). Describe basis of determination in all instances. If"not determined",explain why not) The septic tank is metal,cracked,structurally unsound,shows substantial infiltration or exfrltration,.or tank failure is imminent. The system will pass inspection if the existing septic tank is replaced with a conforming septic tank as approved by the Board of Health. (revised 11/03/95) 1 One Winter Street a Boston,Massachusetts 02106 a FAX(617)556.1049 a Telephone(617)292-SM 40?Pnnled on Recycled Paper i SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (oontinued) Property Address: � Owner. Date of Inspection: , r , Bl SYSTEM CONDITIONALLY PASSES (continued) Swage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed pipe(s) or du to a broken, settled or uneven distribution box. The system will pass inspection if(with approval of the Board of Health): broken pipe(&)are replaced , obstruction is removed distribution box is levelled or replaced The system required p ping more than four times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approv of the Board of Health): roken pipe(s)are replaced o ruction is moved Cl FURTHER EVALUATION IS REQUIRED BY TH B D OF HEALTH: Conditions exist which require further evalua on by the Bo of Health in order to determine if the system is failing to protect the public health, safety and the environment. 1) SYSTEM WILL PASS UNLESS BOAR OF HEALTH DET INES THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT E PUBLIC HEALTH AND�&,AFETY AND THE ENVIRONMENT: Cesspool or privy is within 5 feet of a surface water �� Cesspool or privy is within 0 feet of a bordering vegetated wetland®a�salt marsh. 2) SYSTEM WILL FAIL UNLESS BOARD OF HEALTH (AND PUBLIC WATER SUPPLIER,IF APPROPRIATE) DETERMINES THAT THE SYS M IS FUNCTIONING IN A MANNER THAT'PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRON ENT: �o The system has a sept c tank and soil absorption system and is within 100 feet to a surface water supply or tributary to a surface water supply. The system has a se is tank and soil absorption system and is within a Zone I of a public water supply well. The system has a se tic tank and soil absorption system and is within 50 feet of a private water supply well. _ The system has a tic tank and soil absorption system and is less than 100 feet but 50 feet or more from a private water supply well,unless well water analysis for coliform bacteria and volatile organic compounds indicates that the well is free from pollution fro that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm. 3) OTHER (revised 11/03/95) 2 l r x SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: Owner. Date of Inspection: D) SYSTEM FAILS: I have determined that the system violates one or more of the following failure criteria as defined in 310 CMR 15.303. The basis for this determination is identified below. The Board of Health should be contacted to determine what will be necessary to correct the failure. _ Backup of se age into facility or system component due to.an overloaded or clogged SAS or cesspool. Discharge or pon ' of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool. r _, Static liquid level in the ' ribution box above outlet invert due to an overloaded or clogged S or cesspool. Liquid depth in cesspool is 1 than 6"below invert or available volume is less than day flow. Required pumping more than 4 t' es in the last year NOT due to clo obstructed pipe(s). Number of times pumped Any portion of the Soil Absorption Sys m, cesspool or privy ' low the high groundwater elevation. Any portion of a cesspool or privy is %it ' 100 feet a surface water supply or tributary to a surface water supply. Any portion of a cesspool or privy is within ne I of a public well. Any portion of a cesspool or privy is thin 50 fee of a private water supply well. Any portion of a cesspool or vy is less than 100 f but greater than 50 feet from a private water supply well with no acceptable water quality ysis. If the well has been yzed to be acceptable, attach copy of well water analysis for coliform bacteria, vola 'e organic compounds, ammonia 'trogen and nitrate nitrogen. El LARGE SYSTEM FAILS: The following teria apply to large systems in addition to the criteria a ve: The serves a facility with a design flow of 10,000 gpd or greater( System)and the system is a significant threat to public heal d safety and the environment because one or more of the following nditions exist: the system is within 400 feet of a surface drinking water supply the system is within 200 feet of a tributary to a surface drinking water su ply 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) The owner or operator of any such system shall bring the system and facility into full compliance with the groundwater treatment program requirements of 314 CMR 5.00 and 6.00. Please consult the local regional office of the Department for further information., (revised 11/03/95) 3 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM , PART B CHECKLIST Property Addm&- —7 Owner. Date of Inspection. Check if the following have been done: !'Pumping information was requested of the owner, occupant, and Board of Health. ­-_None of the system components have been pumped for at least two weeks and the system has been receiving normal flow rates during that period. Large volumes of water have not been introduced into the system recently or as part of this inspection. _—As built plans have been obtained and examined. Note if they are not available with N/A. CZ—The facility or dwelling was inspected for signs of sewage back-up. �Them does not receive non-sanitary or industrial waste flow /site was inspected for signs of breakout. All system components, excluding the Soil Absorption System, have been located on the site. 'R'he septic tank manholes were uncovered, opened, and the interior of the septic tank was inspected for condition of babes or gees,material of construction, dimensions, depth of liquid,depth of sludge,depth of scum. The size and location of the Soil Absorption System on the site has been determined based on existing information or approximated by non-intrusive methods. The owner(and occupants, if different from owner)were provided with information on the proper maintenance of Sub- Surface Disposal System. (revised 11/03/95) 4 I SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: `7 G Owner. (� Date of Inspection: `Q _ FLOW CONDITIONS RESIDENTIAL• Design flow:_-.:[730,gallons Number of bedrooms: Number of current residents:-2- Garbage grinder(yes or no):_&/V Laundry connected to system(yes or no):41--O Seasonal use(yes or no):AP ^, / Water meter readings, if available: Last date of occupancy: . COMMERCIAL/INDUSTRIAL: Type of establishment: Design flow:_gallons/day Grease trap present: (yes or no)_ Industrial Waste Holding Tank present: (yes or no)_ Non-sanitary waste discharged to the Title 5 syate s no) Water meter readings, if available: Last date of occupancy: OTHER(Deed ) Last date of occupancy: GENERAL INFORMATION PUMPING RE49ORDS and source information: System pumped as part of inspection: (yes or no)_ If yes,volume pumped: gallons Reason for pumping: TYPE. OF STEM 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) Other(explain) APPROIQMATE AGE of all components,date installed(if known)and source of information: Sewage odors detected when arriving at the site: (yes or no)AdO (revised 11/03/95) 6 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (oontinued) Property.�Rvss: � .,. Owner. I� Date of Inspection: SEP17C TANK (locate on site plea) Depth below grade: -- Material of construction:Concrete_metal_FRP_other(e:plain) Dimensions: C' / X Sludge depth: Distance from top of sludge to bottom of outlet tee or baffle:_,�L Scum thickness:e0 Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: y� Comments: (recommendation for pumping, condition of' t and outlet tees or baffles,d th of liquid levelin-relation to outlet,' rt, integrity, wide of leakage,etc.) GREASE TRAP:_ (locate on site plan) Depth below gra : - Material of construction:_concrete_ etal_FRP_other(e:plain) Dimensions: Scum thickness: Distance from top of scum to!top of outlet tee or baffle: Distance from bottom of scum bottom of outlet tee orComments: (recommendation for pumping0 of inlet and outlet.tees or baffles,depth of li evel in relation to outlet invert,structural integrity, evidence of leakage,etc.) (revised 11/03/95) 6 I SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYnSTEM�I/N�FORMATION (continued) Property Address: (-- - - Owner. Date of Inspection: -7 6 TIGHT OR HOLDING TANK:_ (locate on site plan) Depth below grade: Material of construction:_concrete_me FRP—Other(explain) Dimensions: Capacity: gallons Design flow: gallons Alarm level: Comments: (conditio f inlet tee,condition of alarm and float switches, etc.) DISTRIBUTION BOX:_ (locate on site plan) Depth of liquid level above outlet invert:_ Comments: (note if level and distribution is eq nce of solids carryover,evidence f leakage ' to or out of box, etc.) (J 14 PUMP CHAMBER_ (locate on site plan) Pumps in working order:(yes or no) Comments: (note condition of pump chamber, ion of pumps a�app cea, etc.) (revised 11/03/95) 7 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: Owner. a �DDate of Inspection: SOIL ABSORPTION SYSTEM (SAS): (locate on site plan, if possible;excavation not required,but may be approximated by non-intrusive methods) If not determined to be present,explain: leaching Pits, number: j- 9 _ . leaching chambers,number:_ leaching galleries,number: leaching trenches, number,length: leaching fields, number, dimensions: overflow cesspool,number: r Comments:(n ndition of soil, signs of hydraulic ailure, level of ponding, condition.9fvegetation,etc.) 4.1 CESSPOOLS: (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(cesspool must be pumped as part o pection) Comments: (note condition of soil, signs of hydra failure, level nding, condition of vegetation,etc.) PRIVY: (locate on site plan) Materials of natruction: Dimensions: Depth of ds: ta: (note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation, ) (revised 11/03/95) 8 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property.Address: Owner: Date of Inspection: v �� SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent references landmarks or benchmarks locate all wells within 100' f2 vit) 13 1 -3 i DEPTH TO GROUNDWATER Depth to groundwater:_L3.__feet �— method of determination or approximation: ® ° (revised VIVA) V. `* *c4, ...a}J. 6 _ o� No.._.4�.5. ..! FEB/J� ;,�— THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF !HEALTH Ow. �--�-' Appliration for Disposal Works (fnnstrnrtion Prrmit rl Application is hereby made for a Permit to Construct (Isf'or Repair ( ) an Individual Sewage Disposal System at t erg t Nl... a� �-C341 A�� �6 PA ram, r........ . ................. .Loc io -Addr s r Lot No. ----...... y .a........ .............. .. .. c ... Owner /t /i Address W Installer .Address Type of Building Size Lot....-.5.7 ..Sq. feet U Dwelling—No. of Bedrooms.............. .Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) Q' Other fixtures ............................ . W Design Flow................5!5....................gallons per person ear dray. Total daily flow............a3.0..................gallons. WSeptic Tank—Liquid capacity.-gallons Length__Ainr, .. Width...JL-10.. Diameter................ Depth..............In. x Disposal Trench,—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. � Seepage Pit No.........f........... Diameter_..... .._.CY__. Depth below inlet... Total leaching area..................sq. ft. Z Other Distribution box ( Dosin ,tank aPercolation Test Results Performed by... �? ..6 L..__._....__`.._. .� .... Date.t .1...?................ Test Pit No. 1...._-��--......minutes per inch Depth of Test Pit....)�:'�-_... Depth to ground water._11G91 _EhU�Ti�ie�+! Test Pit No. 2......1........minutes per inch Depth of Test Pit......l.l.`�^1�-.. Depth to ground water......11.......!9 O Description of Soi ..._.. L_.1k.r-._`-R.T-�{.... �'. 4'��_1_� Sa&t_ S s .��QL�- �i= t �� ► ...!� y V.M. U W -4 nep ------------------------------------------------------------------------------------------------------<.------------------------------------------------------------------------ UNature of Repairs or Alterations—Answer when applicable............................................................................................... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITTLE 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been is ed e board of health. Signed °................ ,�� �`----f----�, Date/ �- Application Approved By.................. ......... Date Application Disapproved for the f ollo ing reasons---- -----------•------------•-------•------------------------------------------•------------------.............. Date r PermitNo......................................................... Issued........................................................ Date t .f- No......................... F>s.............................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........$ .. `'` OF.... Appliratilan for Uispaa al Works Tnnstrnrtinn Prrmit Application is hereby made for a Permit to Construct ( f'or Repair ( ) an Individual Sewage Disposal System at: r°� ........................... � ,�•; 5" y a a a io Addre s ...........-- - �A .Loc .1-------------•---------.... -----. ..6 3A., Owner W Address d •------------------------••-...........---•-•----•------........-•-•--....................••...... .-••--•............_.....-•---••••.................---•••••...._......._...._..................... Installer Address Type of Building Size Lot------15 __..... Sq. feet a Dwelling—No. of Bedrooms.............._5 Attic ( ) Garbage Grinder ( ) pa Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) a' Other fixtures ........................... ........................................................... W Design Flow................ . ..... gallons per person er day. Total daily flow....... ..................gallons. - et W. Septic Tank—Liquid capacity ...,.? gallons Length--- Width._. __.. Diameter................ De th... �, x Disposal Trench No..................... Width.................... Total Length....................Total leaching area.....................sq. ft. Seepage Pit No......... Diameter..... ... __. Depth below inlet... .: ..... Total leaching area..................sq. ft. Z Other Distribution box ( '` Dosin tank `-' Percolation Test Results Performed by:. t+.}Z6 `..___'_ ' �) ? Date.. ...... a Test Pit No. I....... ..._minutes per inch Depth of Test Pit I.a�-_ ?.... Depth to ground water ,1� f� Test Pit No. 2...... -.....minutes per,^inch .Depth of.Test Pit......+ .._. Depth to ground water....__.t'._._.._.'........................ a .� ...._...--•- O Description of Soil �t B r.. �j l .._.....- . �_� t _. '!: 15f V � x ......... r..r.....-t�-------•-••...................••-•-•......-----•......-•----••---•-- -----/----------------•-------------------...--------------------------------- U Nature of Repairs or Alterations—Answer when applicable.:.............................................................................................. .........................1•---•--••----••••••---••••-••---....•••••-•--•...•---•--•--••••------••-•--•••---•-•••••••--•••-••-•••-•--•••................ Agreement: 9t1. The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. Signed••-• ••--.....-•--•-..•---- ----------- --------• ---------------------- •-------- ---------.......... Date Application Approved By.. --•-•---••• -----•-• ••--•....-•-•---•--•-------••-- ....... ----- 1 c -a - Date Application Disapproved for the follo, ing reasons:..•-------------------------•-------=-----------------•------•--------•--------•---•--.._.........•-----...---- "---------------------------------------••...••....•. Date Permit No......................."Y.................................. Issued_........ -.............................................. Date - THE COMMONWEALTH OF MASSACHUSETTS BOARD,; OF HEALTH . � �.�e s'. ...... ........OF.....: �rrf�rtttle of`(f�n���i�nrr J THIS IS TO gERTIFY, That the Ind vidual Sewage Disposal System constructed O or Repaired ( ) by-•--............................... you_-r ........! �,Nw........................•. allen;- at C �••49 1T. lu�M-._ -t�-- -' ' --------------�N"! �J� 4• _... j` 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.......'9!$-Aki............ dated......... -"-:��•..___-•••- TFI6 ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CO STRIIED AS A GUARA TEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY, DATE......_.... .�...�.�a. ..:..........................••.._'._.`_. Inspector........ ----•- " THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH /S 0 No...................•• •. FEE..:....---.............. Disposal Workii fit uEnwitrnrtion Vprrmit Permission is hereby granted..............PD-6ft.-I.....!!�141 N ...-............................-............................................... to Construct (J or Repair (.. ) an Individual Sewage Disposal System. at No.. / •=�4uT�Gs2 vs t 4 Y` = ............. Street ras shown on the application for Disposal Works Construction Permit No.:`$ `�k . Dated.. __...� ............................. 'Y Z .............•--- •-•-•------.... -oar of Health_ l w �. DATE ... K.."- 1 --•----•------ ................. j' FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS t LO CATION E PERMIT NQ. vtn C% Lam s&,-4t- 751 VILLAGE c v" v t E r INSTALLER'S NAME i AD DRESS B U I L D E R OR OWN ER' E DATE PERMIT ISSUED /a / 20 Ass DATE COMPLIANCE ISSUED 38,7 # ICI, 5 >c.ove- 1060 �. P.s w .:i; i l t --RELOCATE SLIDER---- , 14' 9' b ii 2 .d Ivc,M X �U) o g ! + existing existing (6 sz W361824 W1536 �:oP I BCW1536R ' N �= s SB33 OLazy Susan p I m > m ADDITION w' cn ;fl x [tea ry Lazy 5usan N I Q N O Zlu m — U30248 3D633 �� � Z FLR TO CLG a = PANTRY UNIT 3 � o I� — 2736� W2736 � N LO O r O f1L 264 DH 3 4'-10 13/1 b" 4' _a„_ .: �, .. � .,:,. ..,. ... I PORCH u m N 0 j existing v o LIVING ROOM v a •L J =L � � N existing existing Date: -12-13 existing existing existing Revisions: 22' 14' 301 5-12-13 5-22-13 Final Plans 1 FI R5T FLOOR PLAN scale: 1/4=1 -O BUILDER TO CONFIRM ALL CONDITIONS 3 0 AND DIMEN51ON5 ON 51TE - -. _. , .. _- . _ . , , -. , , .. - . , . . ' , .. . . .r .. . - :: • . ,� T -: : a'= I - TE'�S II�-I0.-0��-. I I .I" .� 0 , . s . . : : I ....:` / ,44 ." ,,ks'YAT/ONS %5HOPM ARE U CFC5 - - dti 4_ „ E _ a�::::,�: . O s-L- c�Sa i ,� TUM"`To rya Ta '., /9 __ . -� ' . , - . - -�►- , " �. .. 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'? �l�t� t .: .� ;�. �0.� SHEE o QQ . G3 , ¢ tx / - f �. �n +L- 4V .. S TO T.r4/.�= ` . � 3 # AS NOT O': T� � i, I a' .r ; 2� , �� -�--,o, OR.dN'N BYE CHECA'EO BYE APPV BY: P.C,AN NO. r �V� . -6.e� ,v ' c ram /' o `� 7'� le c E .� 3 . • - . . - , _ . 11 . t SYSTEM PROFILE MARSYSTEM WTHCMAGNETICTTAPSHALL E OR BE NOTES . (NOT TO SCALE) COMPARABLE MEANS FOR FUTURE LOCATION e PROVIDE MIN. 20" DIAM. WATERTIGHT 1. DATUM IS NAVD 88 eta t�et ACCESS COVERS TO WITHIN 6" OF FIN. GRADE 2" PEASTONE OR GEOTEXTILE CONCRETE COVERS TO WITHIN 3" GRADE / 2. MUNICIPAL WATER IS EXISTING \ TOP FOUND. EL. 44.0' FILTER FABRIC OVER STONE / c�eti 42.0' 3. MINIMUM PIPE PITCH TO BE 1/8" PER FOOT. ° MINIMUM .75' OF COVER OVER PRECAST 2� SLOPE REQUIRED OVER SYSTEM 39.5 � o n PRECAST H-10 NOTE: 2" MIN. WALL BLOCKS OR 4. DESIGN LOADING FOR ALL PROPOSED PRECAST1 RISERS (TYP.) PRECAST RISERS -Q THICKNESS REQUIRED UNITS TO BE AASHO H- P� 2'0 4"0SCH40 PVC MORTAR. ALL H-10 6" MIN. SUMP PIPES LEVEL 1ST 2' COMPONENTS 5. PIPE JOINTS TO BE MADE WATERTIGHT. 12" MIN. INT. DIM. 4 (TYP.) `} , les o ENDS SIDES 36.83 6. CONSTRUCTION DETAILS TO BE IN ACCORDANCE Locust *41 .4' 10" ��L H-10 14" °�°�oa 28 > ° ° ° to 39.95 TEE SEPTIC TANK TEE 39 70' ° 0��� O [=J[][�0 00�0_O ���� WITH 310 CMR 15.000 (TITLE 5.) Route > °° (�0����00�0�' ���C�L�JC�IC�ICICJ@JCLJ )°°°°°°°° Route 28 °°°°°°°°°°oo WATERTEST D'BQX o 0 0 0 0 0 0 0 ° ° ° ° ° ° '°°°°°°°° aoa�aooa�®� (]0��0������ °°°°°°°° 7. THIS PLAN IS FOR PROPOSED WORK ONLY AND GAS BAFFLE :.; °o�o�o°o°o° FOR LEVELNESS (V °o°00000 �� ;0000000a >°o°o°o°o. C�CJ���O����O al�l��al�a ml�l�l� °o°O°O00 , NOT TO BE USED FOR LOT LINE STAKING OR ANY g °o°o°o° °o°o°o0 34.0 4' LIQ. LEVEL (ACME OR EQUAL) . 36.29 36.12 0 ° o o ° °_° OTHER PURPOSE. /�JJ o o ° .o..° J I L 8. PIPE FOR SEPTIC SYSTEM TO SCH. 40-4" PVC. .°000000000°o oo 000000000000000000 oo oo°0000000° o° °°°°°°°°°°°e_"?"?"?" o).o°°° 3/4"-1-1/2" DOUBLE WASHED STONE 4' MIN. H-10 500 GAL. LEACHING CHAMBER BY ACME PRECAST OR EQUAL. _ o ALL AROUND PRECAST STRUCTURES (2) UNITS REQUIRED 9. COMPONENTS NOT TO BE BACKFILLED OR Rood 6" CRUSHED STONE OR MECHANICAL ALL DIMENSIONS TO OUTSIDE OF STONE: 25.00' X 12.83' CONCEALED WITHOUT INSPECTION BY BOARD OF a yet COMPACTION. (15.221 [2]) o HEALTH AND PERMISSION OBTAINED FROM BOARD Bumf s R c r 1900 GA- �` � Iri OF HEALTH. 8•0 . 4 10. CONTRACTOR SHALL BE RESPONSIBLE FOR ( q SLOPE) �j ( SLOPE) ( 1 % SLOPE) CALLING DIGSAFE (1-888-344-7233 AND ��'�/( 1 29.0' BOTTOM TH-2 VERIFYING THE LOCATION OF ALL UNDERGROUND & LOCUS MAP FOUNDATION- 18 SEPTIC TANK 84 D' BOX 12' LEACHING NO GROUNDWATER FOUND OVERHEAD UTILITIES PRIOR TO COMMENCEMENT OF FACILITY WORK. SCALE 1"=2000'f *THE INSTALLER SHALL VERIFY THE LOCATIONS OF ALL 11. ANY UNSUITABLE MATERIAL ENCOUNTERED SHALL ASSESSORS MAP 169 PARCEL 43 UTILITIES AND ALL BUILDING SEWER OUTLETS AND ELEVATIONS BE REMOVED BENEATH AND 5' AROUND THE PRIOR TO INSTALLING ANY PORTION OF SEPTIC SYSTEM PROPOSED LEACHING FACILITY. SITE IS LOCATED WITHIN A ZONE II 12. EXISTING LEACHING FACILITY SHALL BE PUMPED . (,r�U" �vL AND REMOVED OR PUMPED AND FILLED WITH CLEAN 2 BEDROOM DEED RESTRICTION REQUIRED LEGEND a� y I SAND. 99 _ SYSTEM DESIGN: EXISTING CONTOUR ,� S X 99-1 EXIST. SPOT ELEV. \ ° �` GARBAGE DISPOSER IS NOT ALLOWED -[99]- PROPOSED CONTOUR �`9 43 DESIGN FLOW: 2 BEDROOMS @ 110 GPD = 220 GPD 198.41 PROPOSED SPOT EL. .�• � USE A 220 GPD DESIGN FLOW TH 1 TEST HOLE O\ SEPTIC TANK: 220 GPD (2) = 440 2� SLOPE OF GROUND USE A 1500 GAL. SEPTIC TANK UTILITY POLE CP �586�a2 LEACHING: Je �O PATIO S SIDES: 2 25 + 12.83 2 74 = 112 GPD y FIRE HYDRANT ( ) NOTE: NOT ALL SYMBOLS MAY APPEAR IN DRAWING B0 r1 OM 25 k 12.83 (.74) = 21) GPD " EXISTI �C� YTH �-�,� TOTAL: 472 S.F. 349 GPD NG DWELLING USE (2) 500 GAL. LEACHING CHAMBERS (ACME OR EQUAL) 9 TEST HOLE LOGS 2 \moo FFLR = 44.0 TH2 Ro WITH 4' STONE ALL AROUND ENGINEERP.: CRAIG J. FERRARI, SE �13871 PAVqDR IV D /�j / SLEEVE ER LINE Js WHERE WITHI ' WITNESS: DAVID W. STANTON RS j j o w JT0 LIVATE��SERVICE MA DATE: 5/20/2019 o BENCHMARK:TOP OF STEP o_ w 38� APPROVED DATE BOARD OF HEALTH � 00 � � ko PERC. RATE _ < 2 MIN/INCH O =41.9' NAVD88 CLASS I SOILS PT, 19-33 �� `ti� G EL 37 ^^� ELEV. � ELEV. I D RIV 0� 0" 4 41 ' p" 4 40' A FI LL I LS 0 R 3/2 A 12„ LOT 2 6 LS B 17,05 S.F.f sa� 9'w_ --- TITLE 5 SITE PLAN 10YR 3/2 LS 6 �� -7 09 10" . V OF 10YR 4/6 g 24' 38' ' #74 LIETRIM CIRCLE LS pT c CENTERVILLE, MA 24" 10YR 4/6 39' C ��� LIETRII� 3� ^� PREPARED FOR M S \ ELIZABETH FINNIGAN PERC 32` 33f>>F%�r _ DATE: MAY 22, 2019 �y _L \� k 1OYR 7/4 =28.76 _ \ �,< .° DANIELA ` l OJALA '` off 508-362-4541 M/CS �` � =23 43 w u i` ` �� } �11 pia CIVIL. �'�. W 1 .� fax 508-362-9880 Z AfJo.465020 Q7 downcope.com 1 OYR 7/4 132" 30' 132" 29 down Cape engineering, MC. s,v civil engineers NO GROUNDWATER ENCOUNTERED Scale: 1"= 20' 5-22- --�°� - �� land surveyors 939 Main Street ( Rte 6A) DCE # > J- > 5 > o 10 20 30 40 50 FEET DATE DANIEL A. OJALA, P.E., P.L.S. YARMOUTHPORT MA 02675 19-151