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HomeMy WebLinkAbout0003 MANNI CIRCLE - Health 3 Manni Circle Centerville IA = 169 120 0 Sm IN UPC 12534 No.2�15,3LOR MARTIN@• M.11 �v —vsyY 0 No. Fee tr THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS 01pplication for Miquar *pgtem Cow6truction Permit Application for a Permit to Construct( )Repair( )Upgrade)Abandon( ) Oomplete System ❑Individual Components Location Address or Lot No. 13 N���/� L� �� Owner's Name,Address and Tel.No. Assessor's Map/Parcel /9 n 3 Installer's Name,Address,and Tel.No. Designer's f�/LN ,Address and Tel. .No. JQl� Or;&V Type of Building: Dwelling No.of Bedrooms Lot Size 26070 sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow 330 gallons per day. Calculated daily flow 3-'An gallons. Plan Date ✓ . /S 242)2- Number of sheets 2 Revision Date Title OSr¢e D A Size of Septic Tank 6.4G Type of S.A.S. / Description of Soil 6aw/1J" cwojo Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned es to ensure the 'on and matoode of the afore described on-site sewage disposal system in accordance with t provisions of Title 5 e iro nd not to place the system in operation until Certi - cate of Complianc has been issue is Hea j Signe Date Jd 9 Application Approved by Date 4/ U Application Disapproved for t e following reasons Permit No. ` &v)- rr.�-k Date Issued « 0 2 � " 1 No. �00 Fee COMMONWEALTH OFF SSACHUSETTS Entered in computer: ►�✓ Yes PUBLIC HEALTH DIVISION TOWN OF;BARNSTABLE., MASSACHUSETTS 1 f 01ppricatiott for Migonl *pgtem Construction Permit Application for a Permit to Construct( )Repair( )Upgrade)Abandon( ) ,Complete System ❑Individual Components '? Location Address or Lot No. #�7 /�(�/ //Z�L� O ner's Name,Address and Tel.No. Assessor's MapTarcel �j /LQ 3 /f49WI6j 01 �'//ZCLC / C�CJ /Zv/LLG Installer's Name,Address,and Tel.No. Desig er's Nam ,Address and Tel.No. j f� Cd�3 01 /D /7l/>x/ZSff U/Fu✓ /L/� p Type of Building: Dwelling No.of Bedrooms Lot Size Z<o070 sq.ft./ Garbage Grinder Other Type of Building #No. of Persons Showers( ) Cafeteria( ) Other Fixtures DesignFlow U j' 3-10 ' 3�? gallons per day. Calculated daily flow gallons. � Plan Date 11114N. /y; 2co Z Number of sheets 2 Revision Date 0 374 Size of Septic Tank /, GU 67,4 L ;;a' Type of S.A.S. /&G IU t/`x Description of Soil MEi1/yhV7 C04 4jJ d Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agr es to ensure the c stru 'on and mainte. nce of the afore described on-site sewage disposal system in accordance with the e provisions of Title 5 t/e nviro nn al ode and not to place the system in operation until Certi - cate of Compliance has been issued.b r t is , Hea tl�. v l © Z Signed Date cl,— 5 Application Approved by 4- bate 0 Application Disapproved for the following reasons Permit No. a&V?- 6 $ Date Issued ------------------------------------ THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Y Certificate of Compliatice THIS IS TO CERTIF_. tp4yhe On-site ewage ispQsal System Constructed( )Repaired (Y)Upgraded( ) Abandoned( )by at has been constru ted in accordance with the provision f 'tle 5 and a for Disposal System Construction Permit No. 06 a -ds� dated Installer Designer ' The issuance o this pg f�mt shall not be construed as a guarantee that the syste` ie ill,f�J�ction as de I ed Date �� ?11 1 o 7-: 'Inspector 4 X 4. i 1 No. a U U) aSk Fee 10d - -. THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS Mi5po.5a.r 6p0tem Construction Permit Permission is hereby gr nted to Construct( )Repair(V)Up ade( )Abandon( ) System located at 7—�/ and as described in the above Application for Disposal System Construction Permit. The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. F Provided: Construction must be completed within three years of the date of this �rmit.,J Date:���2- Approved by41 � r r P TOWN OF BARNSTABLE /1� LOCATION -� ! ,oa) ,, ; �' SEWAGE # ZCd 0'rK VILLAGEr eede y 6' (tie 11 ASSESSOR'S MAP & LOT _ INSTALLER'S NAME&PHONE NO. Q 002AC-Xkil n SEPTIC TANK CAPACITY l b()O LEACHING FACM=: (type) C ko. (size) a NO.OF BEDROOMS 3 C BUILDER OR OWNER G1411 Mo'o44 t i e PERMIT DATE: a �� COMPLIANCE DATE: f a 1�G Separation Distance Between the: Maximum Adjusted Groundwater Table and 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� Y V TOWN OF BARNSTABLE LOCATION � In s SEWAGE # ! - VILLAGE Cetifery a (lis ASSESSOR'S MAP &LOT 20 INSTALLER'S NAME&PHONE NO. R 1 '� c�+sit- r SEPTIC TANK CAPACITY 1,550 q LEACHING FACILITY: (type) k (size) NO. OF BEDROOMS 3 C BUILDER OR OWNER �Cc^ �°' ✓� PERMITDATE: o'Z �a COMPLIANCE DATE: :Z J aI hx . Separation Distance Between the: Maximum Adjusted Groundwater Table and 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 C l7'CZ a A r3 6 06�--- Jam; °�- Tow n of Barnstable P# 1�1�dc Department o[Health,Safety,and environmental Services o� Public Health Division Date Oi � 2G�2 � • 3:67.Main Street,Hyannis MA 02601 } NARNITLOLK _ oC✓ ►�� Date Scheduled Time D:UV Fee Pd. Soil Suitability Assessment for Sewage Disposal Performed By' aas t:E?�� Witnessed By: �^' ..:::: .. .... . . ......:... ....................:..::..... ...:...... Location Address ....... Owner's Name 61EQ MAC C. Address 3 MAtJIJI f;,(,6 . /IL Engineer's Name 01 Assessor's Map/Parcel: �PZo55WlgrrJ` Pr�� NEW CONSTRUCTION REPAIR ' Telephone N S5_4& 0 Z'O Land Use Slopes(%) Surface Stones Distances from: Open Water Body 'mil,Ar R Possible Wet Area Jt Drinking Water Well n ft Property Line ��_n Olher ft Drainage Way P y SKETCH:(Street name,dimensions of lot,exact locations of tosl holes&pert tests,locale wetlands in proximity to holes) y , I Gi2C(E I i N Depth to bedrock Na� Parent material(geologic) W Depth to Groundwater: Standing Water In Hole: g Q Weep from pit Pace Estimated Seasonal High Groundwater on rtichod usoe; llotJt in. Depot Observed standing In obs.hole: tr16J� in. Depth to soil Adjust ft �in. Groundwater Adjustment .Depth to weeping hom side of obs.hole Ad Groundwater Levtl ._Index Well/!_:._._ Reading Data: Index Well lava) Adj.factor 1 Observation Time at 9" Note N Time al 6" Depth of Pere Time(9"-6") — Sled Pre-soak Time End Pre-soak Retc Min./Inch `2 Itv �— StIG Failed: _ Additional Testing Needed(YIN) Silt Suitability Assessment:.Site Passed nr,�...-<..,s;n„ FTnle Data To Be Completed on Back-) :............ ::.�:::.v.........:::.�:.:...... ..lft.F..,.:v w:::........:::.n...:v...v....:•:y:.:!•ivJ::i�'.....:::::•:•:'::' s>::»:;:.::;.;::•;;>:<,.:;::>;:.;::.<::.:<.::•:::.:...:.:,:...,_..,......:...... Soil Other Depth from Soil 1lorizon Soil Texture Soil Color Mottling Stture,stones,Boulderes. Surface(in.) (USDA) (Munsell) g ( ruc a p ..12 O PD N2.5 G '� i x. Y:>::•;.:.;• ..::r:::.:.:.:........::::.::........ .. .. Other >;:: >;::><;;.:;.::<•;;::;.:•;::.. ::: . ..• :.:::.....:..:...... Soil , `::ii:4ti>^:•:::v::.;:n},:•yT: Depth from Soil Horizon I Soil Texture Soil Color Molllin Structure,Stones,Boulderes. Surface(in.) (USDA) (Munsell) g ( e I ::............... +...... .::::t .................. .... Other C::>;ii ::;::;::i:::::;::;:::>::»>:.;;::.>;:;,:;.;......:.:•::::....:...::::..::.:::•::.::.::..:.�:::......:::::......... soil ept Soil Horizon Soil Texture Soil Color Depth from (USDA) (Munsell) Mauling (Structure,Stones,Boulderes. Surfaco(in.) ConsislcnmYkQRYZD- I i i .......... :•::.::::;:.;.<.::. _ tP:.:O�S�RATIO�I .fJ: ...:...... ....... :...:...... . ................... :....... .....:..::.:::......:..::. .:..... ......:. � Other Depth from Soil Horizon $oil Texture Soil Color Mottling (stlueture,Stones,Boulderes. Surface(in.) (USDA) (Munsell) e Flood InSUMUCe Rtlte MAN ; ' � I Above'.500 year hood boundary No 'Yes - 1 Commonwealth of Massachusetts Executive Office of Environmental Affairs ,Mohan Grad ,nx D.E.P. Title V Septic Inspector P.O. Box 2119 Teaticket, MA 02536 =Horn F.Mold (508) 564-6813 G000 nOr Trudy Coax @acrelcry,EOEA Dovid 0. Struho Commiosiorroi i� SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A /3 v CERTIFICATION Property Address: �j VVL` % Q_%<CKX._j. °�(� (11s�`4., Address of Owner: Date of Inspection: _�,WA 1\110 (If different) Name of Inspector: Company Name, Address and Telephone Number: 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: _1 _ Conditionally Passes _ Needs Further Evaluation By the Local Approving Authority _ Fails Inspector's Signature: Date: V The System Inspector shall submit a copy of this inspection repon 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 the appropriate regional office of the Department of Environmental Protection. The original should be sera to me system owner and copies sen; io the buyer, if applicable and the appro.ir,g authority. INSPECTION SUMMARY: Checl08, C, or D: AJ SYSTEM PASSES: I ve 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. Bl 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 exfiltration, 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 6/15/95) 1 Ono Mntor Stroot o Gooton,W0000ehuootto 02108 0 VAX(011)8O.1049 o Tdophono(017)2M.No lSc%Printod on RecVdcd Papal, SUBSURFACE SEWAGE DISPOSAL SYSTEM.INSPECTION FORM PART A CERTIFICATION (continued) Property Address: ^� Owner: \ ` Date of Inspection: 61 SYSTEM CONDITIONALLY PASSES (continued) _ Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed pipe(s) or due to a broken, settled or uneven,distribution,box. T.he system( will pass inspection if(with approval of the Board of Health), broken pipe(s) are replaced obstruction is removed distribution box is levelled or replaced _ The system required,pumping more than four times a year due to broken or obstructed pipe(s).`The system will pass " inspection if(with approval of the Board of Health): broken pipe(s) are replaced obstruction is removed Cj FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect the public health, safety and the environment. 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: Cesspool or privy is within 50 feet of a surface water Cesspool or privy is.within 50 feet of a bordering vegetated wetland or a salt marsh. 2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH (AND PUBLIC WATER SUPPLIER, IF APPROPRIATE) DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECT THE PUBLIC HEALTH,AND SAFETY AND THE ENVIRONMENT: _ ine >�sienl nd> a !,eLIUC tank anus Sul; d6wfpLion sysieni and is will-d- 1-00 (Eel iG a 5u.14Cc "Pp!) G- tG is . surface water supply. _ The s�s!P-+- ha, a septic tank and soil absorption system and is within a Zone I of a public*water supply well. _ The system has a septic tank and soil absorption system and is within 50 feet of a private water supply well. _ The s�-stem has a septic tank and soil absorption system and is less than 100 feet but 50 feet or more from a private water supply well, unless a well water analysis for coliform bacteria and volatile organic compounds indicates that,the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal,to or less than 5 ppm D) SYSTEM FAILS: 1 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 sewage into facility or system component due to an overloaded or clogged SAS or cesspool. Discharge or ponding of effluent to the surface of the ground or surface water$due to an overloaded or clogged SAS or cesspool. (revised 8/15/95) 2 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: Owner: \Q,r Date of Inspection: �t D] SYSTEM FAILS (continued): Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool. Liquid depth in cesspool is less than 6" below invert or available volume is less than 1/2 day flow. Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe($). Number of times pumped _ Any portion of the Soil Absorption System, cesspool or privy is below the high groundwater elevation. _ Any portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. Any portion of a cesspool or privy is within a Zone I of a public well. Any portion of a cesspool or privy is'within 50 feet of a private water supply well. Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. If the well has been analyzed to be acceptable, attach copy of well water analysis for coliform bacteria, volatile organic compounds, ammonia nitrogen and nitrate nitrogen. E] LARGE SYSTEM FAILS: The following criteria apply to large systems in addition to the criteria above: The design floes, of system is 10,000 gpd or greater (Large System) and the system is a significant threat to public health and safety and the environment because one or more of the following conditions 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 supply the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area (IWPA) or a mapped Zone II of a public water supply welh 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 8/15/95) 3 I SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 3 rn��r: Q_\<a s. Owner: Date of Inspe Check if the following have been done: �..Pvmping information was requested of the owner, occupant, and Board of Health. Lfl'o'n—e of the system components have been pumped for at least two weeks and the system has been receiving normal flow rites during that period. Large volumes of water have not been introduced into the system recently or as part of this inspection. _built plans have been obtained and examined. Note if they are not available with N/A. _A_T,4e facility or dwelling was inspected for signs of sewage back-up. _�' a system does not receive non-sanitary or industrial waste flow The site was inspected for signs of breakout. _j,hi system components, excluding the Soil Absorption System, have been located on the site. _614se septic tank manholes were uncovered, opened, and the interior of the septic tank was inspected for condition of baffles or tees, 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. L facd;,y n,.,nn, i,D.. n�r�,inan(c if diffarPnt irnm ownp!) were provided with information on the proper maintenance of Sub- Surface Disposal System. (revised 6/15/95) 4 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION. Property Address: Owner: Date of Inspection: Qlo FLOW CONDITIONS RESIDENTIAL: Design flow: allons Number of bedrooms: 2) Number of current residents: Garbage grinder (yes or no):S)b Laundry connected to system (yes or.no):\,A,f-"-, Seasonal use (yes or no): V,t\ Water meter readings, if available: Last date of occupancy: COMMERCIAUINDUSTRIAL: (1\� 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 system: (yes or no)_ Water meter readings, if available: Last date of occupancy: OTHER: (Describe) Last date of occupancy: GENERAL INFORMATION PUMPING RE RDS and source of information: System pumped as part of inspection: (yes or no)C �— If yes, volume primped gallon Reason for pumping: TYPE OF SYSTEM __j.,:::'reptic 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) APPROXIMATE AGE of all components, date installed (if known) and source of information: l "1 Sewage odors detected when arriving at the site: (yes or no) (revised 8/15/95) S SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: Owner: "�__11(( � Date of Inspedtorl:"�� - LAWO(4co SEPTIC TANK: (locate on site plan) Depth below grader Material of construction: jecTnGrete metal FRP _other(explain) Dimensions: t.t i ')It ` U t Sludge depth: I Distance from top of sludge to bottom of outlet tee or baffler t t Scum thickness: tl Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffler Comments: (recommendation for pumping, condition f inlet and outlet tees or baffles, depth of liquid level in relation-1to outlet invert, structural integrity, evidence of leakage, etc.) c aJ C! GREASE TRAP: \� (locate on site plan)y� Depth below grade: Material of construction: —concrete _metal —FRP —other(explain) Dimensions: Scum ihicknr». Distance from top of scum to top of outlet tee or baffle: Distance from ho"om.ni<rt,n, M bottom of outlet tee or baffle' Comments: (recommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity, evidence of leakage, etc.) (revised 8/15/95) 6 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C 2 SYSTEM INFORMATION (continued) Property Addr s: Owner: Date of Inspection: L-A TIGHT OR HOLDING TANK (locate on site plan) Depth below grade: Material of construction: ,,,.,concrete ._metal _FRP _,,,_other(explain) Dimensions: Capacity: Rallons Design flow: Rallons/day Alarm level: Comments: (condition of inlet tee, condition of alarm and float switches, etc.) DISTRIBUTION BOX: (locate on site plan) `` � , De th of liquid level above outlet invert: P 4 —�� Comments: (note if levei and distributwr. i� ryuai, e,dencc of solid: ca:F)u.er, evidence of leakage into or out of box, e!c.) PUMP CHAMBER:\'ee (locate on site plan) Pumps in working order.(yes or no) Comments: (note condition of pump chamber, condition of pumps and appurtenances, etc.) (revised 8/15/95) 7 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address:.3 Owner: Date 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: Type: leaching pits, number: Ltko � `Q CtC.n Q I leaching chambers, num r: leaching galleries, number: leaching trenches, number,length: leaching fields, number, dimensions: overflow cesspool, number: Com ts: (note condition f soil, si ns of hydraulic failure, level of ponding, condition of vegetation,etcJ IOUC-h (.41 S � l 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 ground.-,a:r-. inflow (cesspool must be pumped as part of inspection) Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) PRIVY: n (locate on site plan) Materials of construction: Dimensions: Depth of solids: Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,eta,) (revised 8/15/95) 8 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 3 �(� �(01 � Owner. Date of Inspect' iorr 3LR- SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent references landmarks or benchmarks locate all wells within 100' V ron� R AA At 'At (� 19 eC 4 L o �- DEPTH TO GROUNDWATER Depth to groundwater:_SD- feet method of determination or approximation: ags � 't�,\ (revised 8/15/95) 9 TOWN OF BARNSTABLE LOCAr,OE) W, i LIN SEWAGE # VII.LAGE � st� 11,� ASSESSOR'S MAP & LOT INSTALLER'S NAME 6s PHONE vo 4 SEPTIC TANK CAPACITY LEACHING FACILITY:(type)_� i (size) NO. OF.BEDROOMS PRIVATE WELL O PUBLIC W ETA R BUILDER OR OWNER o'\C-c J r-----. DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No 4glF 3/1 �, No.....Q ."�f..`� Fus...... -�F_......... THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH ..............................---•...OF.......c ..... Appliratiun for Uiupuii al Works Tilmitrurtiun Famit Application is hereby made for a Permit to Construct (✓5"'or Repair ( ) an Individual Sewage Disposal System at . . ----_--- ........................ 46T--_ ....C . �1� _..._Z!�......... .......... dress " �'` o ^�.Lot Np. - ` `G}� �]r..........ram.��� ----�f��........................... ..f3�.---C-....------------------......----- a Owner Address W Installer Address d Type of Building Size Lot....Z-059....Sq. feet Dwelling—No. of Bedrooms--------------------------------------------Expansion Attic ( ) Garbage Grinder (Allb P4 Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) 04 Other fixtures _______________________________ ___ w Design Flow......... ---.-.----_----.---_-gallons per person ,p�err dapv. Total daily flow.:............................gallons. it WSeptic Tank—Liquid capacity�� 7�.gallons Length-__- _0.. Width__._to..__ Diameter................ Depth.... --7.. x Disposal Trench—No..................... Width.................... Total Length........................ Total leaching area------- ft. / of Seepage Pit No....... ............ Diameter-------0•__..... Depth below inlet...�_�P..._... Total leaching area.. .......sq. ft. z Other Distribution box Dosing tank (A& '~ Percolation Test Results Performed by../A;A!1r�............................... Date... ............4 ._.............. Test Pit No. 1.....�...._._minutes per inch Depth of Test Pit....%2......... Depth to ground water__ _ _....__._. . rX4 Test Pit No. 2................minutes per inch Depth of. Test Pit.................... Depth to ground water._-______--------_-____. a ........ ..... •---.... Description of Soil. -....................�! '� _ v9 � �"--------•- ----��;���... ------ U ---------------------------------------------------- •----moo -! c -. w UNature of Repairs or Alterations—Answer when applicable- -----•------------------•--•---•---•--•----•---•-------------------••---------•----•-------------•------•-•------------•------•--•-------•-----•-...--------•--•-•---•-•--•---•-••--•--.._..------•---• Agreement: The undersigned agrees to install the aforedescribed I t • 'al Sewage Disposal System in accordance with the provisions of�I 12 5 of the State Sanitary Code dersigned further agrees not to place the system in operation until a Certificate of Compliance has been i e board of health. Signed........ .-- • --_-------•-•------•••••-•-•..................•--...._..---- -----1Q'. �.:. . ._ Date Application Approved By............. `�; .8,,, Date Application Disapproved for the following reasons:................................................................................................................ .......-•-----•-•---•---........-••--••----------•---••---••-•--------•--•••-------------•••---•---•-----I-•--•••...._....-----•------•-•---------•----•------------------••------------••--••----....--- Date PermitNo.......... ------------------ Issued....................................................... Date THE FOLLOWING IS/ARE THE BEST IMAGES FROM POOR QUALITY ORIGINALS) I M ^C&L DATA - y THE COMMONWEALTH OF MASSACHUSETTS _ BOARD OF HEALTH OF..........�................ ,Apure#inn for Ui"owd Morkii Tonitrnrtinn ramit Application is hereby made for a Permit to Construct (�') or Repair ( ) an Individual Sewage Disposal System at: .. _ �, ocat ion-/pddress� .••.� .....................` .�Z��.......�/......,.1/ ��........................... ..(......(..........F-..........::�_ .`.......---_/.... ...... Owner Address ................................................................................•................ •............. PQ Installer Address / cl� Type of Building Size Lot....Z''.'? ._.___Sq. fee Dwelling—No. of Bedrooms................:''......._.......__.._.Expansion Attic ( ) Garbage Grinder (A,�c: P4Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) d Other fixtures s WDesign Flow..........'., j.......................gallons per person per,day. Total daily flow----------- ..............................ga_llons. WSeptic Tank—Liquid capacity'f<�gallons Length... .._ WidthJ_../C Diameter................ Depth_._ram.7 W Disposal Trench—No. .................... Width.. Total Length.................... Total leaching area--- sq. ft. Seepage Pit No.......�....__.._.. Diameter....... Depth below inlet_.. .G_....... Total leaching area_.�?�_...__.sq. ft. Z Other Distribution box (`� 7 Dosing tank (� W Percolation Test Results Performed by------------------------------------ - --------•--;---------•----------. Date--------------•-•--------------------- - a Test Pit No. 1----- --------minutes per inch Depth of Test Pit....a. ......... Depth to ground water._:_-:-' ___________ 4, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water------.................. R: ................................................. ---•--•--------•------------•-•--•-----•---......................................................... D Description of Soil........ _.__ _.... r { c� ` f: I G L.. ..!-.....(/ . "`f ..jn'r ..- ..../ram"' UNature of Repairs or Alterations—Answer when applicable._-.-___________________________________________________________________________________________ -----------------------------------------------------------------------------------------------••••••••--•----••.......-•-••-----•---•---•----•-•---•-••---•---•-••....•••-•--•--------••---•-•-'----•-- Agreement: The undersigned agrees to install the aforedescribed I I ' lal Sewage Disposal System in accordance with TT/'1' the provisions of :s;LE 5 of the State Sanitary Code dersigned further agrees not to place the system in operation until a Certificate of Compliance has been i e board of health. Signed........ -• -••---......- & - `a Application Approved B Date Date Application Disapproved for the following reasons-----------------------•----•----------------------------------------------------•------------------------------- ---------••-----------------------------•---'-----'.................................................................................................................................................... ec�� Date Permit No..........U-�5.-__G..y 5.........-•--_..... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..................... ....OF........... .......................................................... Tarrtifiratr of Tontpliatta THISAS TO CERTIFY, That the Individual Sewage Disposal System constructed (x) or Repaired ( ) by............... ........................•-'-'--••--•----------._....------•----...----'•---••-----•---•--•-------'--•---------•-----...----•------'--•--....---•-- /�. rr. Installer /J at ..g2 -----•-Sri p... =f'•r-=Q `ti2.!l.a.. tuPi --... C_ _._t:.............................. has been installed in accordance with the provisions of TI jLE 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No.__.-SZ _:.�?_yS................. dated................................................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE--•--•.........................�]..-.�.`l.'. �✓._...... Inspector._.. ....................) .......................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH No. Q.:....../.� 'C/ /...............OF..............1 .t•���C�(.t'9 ............................... ._._.. O '!� FEE... :�--•---•-•--• Disposal((� oni orkv Ttrnrtion rrntit Permission is hereby granted 1�_.....r►"_C�:w�:J--•-----•---------------------------------•------.......-•---.....----.................... to Construct (err} or Repair ( ) an Individual Sewage Disposal SystetP at No............. r A •• �'�•••..•-•--•--- r..iC e,r2 ti. Street as shown on the application for Disposal Works Construction Permit No._ =S?y ^ Dated.......................................... ............................... ' ............................................................. Board of Health DATE ... : ..... ...................................... FORM 1255 HOBBS & WARREN, INC.. PUBLISHERS .� A 76 z 9y 911 o T.l,� Slo Q� 77� /V c,/�1 . _ /ZoaF'f�: . 1JC�<<�/� T ' 'L/�Ticy✓ Lis/T /` tic/ OF ORAN 1 DN ' Existing Living P FX15TING Room Existing 5tudy e N "o ns \� (p ram—existing op,Pose' $ �closct 6ne SUe L ridge-pportng beam / neyflnslf" \ ,ri�design by others N �� V _ heaAer above FAMILY ROOM w N o 1\\\ `e``•• i ``he ` open to&,aver chapel ceiling OPEN B oELOW a LU% m .. $ 1`1`` 13 0 i \��Stul.F,iclge sopportng beam above N$ 2 r N� __- `i design by others O CL 1' o ` wood'Po 6`h abbe 0Osb) o o Z v % a ` / Z'+ L ;\ OPEN BELOW S. Q m, �11 ifl nd�coF; $ � 2 5TORAGE LAUND9. RY o +\ Q 'aa° •2r ARAGE � F- to — 4� nZ AAr- � o 61 +Z'O N t`1�gg8 Q Y 24.0° \ 6.0' 2k cy z 5EGOND FLOOR PLAN a� a WINDOW SCHEDULE Frl Q1Y FLOOD PJO GLASS AREA U VALUE CODE QTY 1 O 301/8X411/4 8.4 .W TW2432 1 + v 3 , 481/2X533/8 17.6 .32 C245 3 FIK5T FLOOR PLAN 1 1 287/8X531/4 10.4 .32 CWI45 1 3 1 301/8X571/8 11.7 .33 ]W2446 3 1 1 82 7/8X53 3/8 35.2 .32 CN245-2 1 3 2 287/8X531/4 10.4 .32 CM45 3 1 2 301/8X571/8 11.7 .33 - 7W2446 1 hWW� W O p U N I /j1 N A h G LEI�TH BEDROOM#1 IV,� Y� O �O KITCHEN /) I^ _ 4t p N FAMILY - / V P,I'ln� O��I O w BATHL *J o to ATTIC BEDROOM#2 C) BEDROOM#3 COVERED LIVING 5TUDY O PORCH z v g ._._... w ATTIC Existing stmcturo Z `\ GREATROOM __- � Vaulted Ceiling }-� Existing 5t—ture ,�+ 4- OPEN BELOW Propoeed New comet—tion Proposed New construction C UN� MUO ROOM O N Y ' OPEN 6ELOW p ]L U O > 5TOPAGE FIR5T FLOOR PLAN _,—'1 , 2 nG SECOND FLOOR PLAN `\ 1` GARAGE p tc) ATTIC lz AL C) Q H Z J >L O �c w v ^ N � G N rf i \\ 4 vN l N/F Williams Water Easem nt 3 150.0 4 W�;5 34 4. 3636.3 38 j 40 _ 42 4 ent 39,3 1�. ' 38 CO — 41,6 0fl M 37.1 et — O O' P OPOSED D Bo4 AS 37.7 3 AD ITION - 37'- i MAN NI 21' - 12' 367 CIRCLE 3 / i /N / �1 /dC 36.5 / 137 5 GLA S ptic "nk 38 8.5 3 33.5 �T Lot 49A ��9 tioG 0,,,. o, 30 7.1 sDa O�°o0 37.0 CF 36.9 C 2 ,o � Lot 51 / 34.2 LOT 50A — - P 267070+/- S.F. 0 29.0 A, 30.5 A,,O�C - 31.6 r NOTES: 1. Property is located in Wellhead Protection District. 2. Proposed S.A.S. is greater than 100', but less than 250' from wetlands. 3. Pump-out&remove existing septic tank,distribution box and leaching pit. l4. Relocate existing water service to a minimum of10'from �. S.A.S.and septic tank. 35' Abandonned Bog o p lift e Make SITE SEWAGE °iSean's U Ra �a t� a0 �Nc„ Ames W QD Rd .��°t 1&/Y I. cc a tie o N NOfiMAM yG �d Rd amaq` d 8riu e� palh An �� +a t DISPOSAL PLAN GROSSMAN2705 Rua Sat a� �' Ci pe6 CIVIL LOT 50A, #3 MANNI CIRCLET �ISTE�NG��`�``� IDNAL E 7 LOWS CENTERVILLE , MA. 28 .%�`51° 1w of FALMO misre , Ftd HYMNA wE TE. APPLICANT: ENGINEER: oaoRMAN G� Glen MacKenzie Norman Grossman, PE, RLS GROSSMAN Poi:r! k �� a. 3 Manni Circle 10 Marsh View Road No. 12775 LOCUS MAP Centerville, MA 02632 East Falmouth, MA. 02536 ftlsn SCALE : 1" = 2000' 508-548-1920 '' � >�► MAP SEC PAR LOT FLOOD ZONE ELEV. MAP SCALE DATE SHEET NO PLAN NO. 169 120 1 50A C --- 1250001 0015 C 1"= 30' JAN. 15, 2002 1 OF 2 H -701 1 SEPTIC SYSTEM PROFILE FIRST FLOOR NOT TO SCALE VENT ELEVATION 40.0 FIN. GRADE AT FIN. GRADEOVER FIN. GRADE OVER FOUNDATION SEPTIC TANK FIN. GRADE OVER SOIL ABSORPTION SYSTEM TOP FOUNDATION 38.2 38.0 DISTRIBUTION BOX 37.8 ELEVATION + 38.0 + . + RISER SET TO W/I INVERT AT + 6"OF FIN. GRADE FOUNDATION + ELEVATION 36.00* +} 2"DOUBLE-WASHED 35.20 3" M6MP _ 1/8' 3/4'PEASTONE ( Verify in field prior ++ o _ to installation ) + + Cp 17 - 4_?E�PVC PIS - + 35.40 , + 354 .65 1500 GALLON / 34.70 + 35.30 35.13 34.75 + SEPTIC TANK �* 10 BASEMENT FLOOR + + GAS BAFFLE ON OUTLET TEE 9 HOLE DIST. BOX 34.20 ELEVATION + + H-10 LOADING + + TO BE SET ON A LEVEL 54' + + + AND STABLE BASE 3' 9 DIST. LINES 6'0"O.C. =48' 3' + : + SEPTIC TANK SET LEVEL AND TRUE TO GRADE - - - - - INVERT LEVELERS ON _ _ ON 6"CRUSHED STONE BASE ON ALL OUTLET INVERTS MECHANICALLY COMPACTED NATURAL MATERIAL SOIL EV ALUATION ON DESIGN DATA 10' + 1'= 1 V TOTAL EFFECTIVE LENGTH DATE OF TEST: JAN. 11, 2002 54'+ 1'=55'TOTAL EFFECTIVE WIDTH NUMBER OF BEDROOMS................... 3 MAX. ( SEE NOTE 9 ) LOGGED BY: J.E. LANDERS-CAULEY 11 X 55=605 S.F. LEACHING AREA G.P.D./BEDROOM................................ 110 G.P.D. WITNESSED BY: DAVE STANTON TOTAL DAILY FLOW............................ 330 G.P.D. TOWN OF: BARNSTABLE LEACHING FIELD "GARBAGE DISPOSAL.......................... NO SOIL CLASS: 1 ( 0.74 GALS./S.F.) LEACHING REQUIRED........................ 330 G.P.D. GROUND WATER: NONE ENCOUNTERED LEACHING PROVIDED........................ 448 G.P.D. SEPTIC TANK REQUIRED................... 1500 GAL. 0" 38.0 TEST PIT#1 0" TEST PIT#2 NOTES: SEPTIC TANK PROVIDED................... 1500 GAL. 1. ELEVATIONS BASED UPON ASSUMED DATUM. 12" O/A LOAM 2. TOPOGRAPHY BASED UPON AN ON-THE-GROUND SURVEY. SIDEWALL AREA................................. 000.0 S.F. LOAMY SAND 3. PROPERTY LINE INFORMATION FROM PLAN BOOK , PAGE BOTTOM AREA.................................... 605.0 S.F. 27" B 2.5Y 5/6 4. NORTH ARROW NOT TO BE USED FOR SOLAR ORIENTATION. TOTAL AREA........................................ 605.0 S.F. 5. ALL PIPING TO BE CAST IRON OR SCHEDULE 40 PVC. TOTAL AREA X 0.74 G.P.D./S.F........... 447.7 G.P.D. 6. ALL SYSTEM COMPONENTS TO BE INSTALLED IN ACCORDANCE MEDIUM SAND WITH SEC TITLE V AND LOCAL BOARD OF HEALTH REGULATIONS. 7. NO CHANGES TO LOCATION/ELEVATION OF SYSTEM COMPONENTS 78" C1 2.5Y 6/6 WITHOUT WRITTEN APPROVAL FROM ENGINEER. 8. NOTIFY ENGINEER 24 HRS. IN ADVANCE FOR AS-BUILT INSPECTION. NOTE: EXCAVATE TO ELEVATION , OR LOWER, AS SOIL 9. LOT IS LOCATED IN WELLHEAD PROTECTION DISTRICT. CONDITIONS REQUIRE, TO REMOVE ANY TOPSOIL, SUBSOIL, SILT, CLAY OR OTHER UNSUITABLE MATERIAL BENEATH THE INLET INVERT OF THE SOIL ABSSORPTION SYSTEM FOR A MEDIUM SAND MINIMUM DISTANCE OF 5' AND BACKFILL WITH CLEAN SAND, PER 310CMR 15.255:3. 132" C2 2.5Y 6/4 GLEN MACKENZIE SHEET NO. 2 OF 2 '• NO MOTTLING #3 MANNI CIRCLE, CENTERVILLE H - 704 - 2