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HomeMy WebLinkAbout0022 MARRICK COURT - Health 22 MARRICK COURT, CENTERVILLE A= 210183 Surma ri � . NoUPC 153LOR HASTINGS,MN No.,. .00O6 —DLi ;.: Fee QC) THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: L� PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes 0[pplication for �Oigo5aY �_ p5tem Cow5truction Permit Application for a Permit to Construct( ) Repair(V� Upgrade( ) Abandon( ) ❑Complete System U Individual Components Location Address or Lot No. �Z/v(G1'/�`1�;e'!� (5:�V!d/)'Owner's Name,Address,and Tel.No. Assessor's Map/Parcel lenklle Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. s ®e -sell Type of Building: Dwelling No.of Bedrooms 3 Lot Size �' /�� sq. ft. Garbage Grinder (� Other Type of Building Gy No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.re uired) �� gpd Design flow provided 3�� gpd Plan DateZ& Number of sheets J Revision Date Title _ 5�_6/ Af 0 al, D z Z Size of Septic Tank l aQe sc.�/�S`�a9 Type of S.A.S. 5e(f Description of Soil Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Hea th. / Signe Date �( Application Approved by M!. Date 2 64 Application Disapproved by: Date for the following reasons Permit No. a-UO(9 "' L/_S� Date Issued z 6 U r No. �(1 ��� > �. '� ; an.�a'y,'1 Fee Uv THEE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes plication for �Bizpoal �§pgtem Construction Permit 01 Application for a Permit to Construct O Repair( Upgrade( ) Abandon( ) ❑Complete System L_'J Individual Components Location Address or Lot No. 6"0'4//; Owner's Name,Address,and Tel.No. t ` Assess os Map/Parcel ,-.x. .,�,r� t Installer's Name,Address,and Tel.No. Designer's Nam'/Ad'dressnd Tel.No. 1 -ysy/ Type of Building: Dwelling, No.of Bedrooms /� 3 Lot Size /J�©�✓ sq.ft. Garbage Grinder /t L Other Type of Building -$5 Pw11e No.of Persons Showers( ) Cafeteria( ) Other Fixtures �f Design Flow(min.required) 3 �� gpd Design flow provided 3 3 / gpd Plan Date Number of sheets > Revision Date Title < -5/ /�f Agw e 7_ Size of Septic Tank Type of S.A.S. 5fe' �fq� ,✓ r Description of Soil Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: 4 r 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 o, Health. J � / ✓/( �� Signed Date �/f Application Approved by �1�/ �.� Date 4 Application Disapproved by: Date,--- for the following reasons Permit No. Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS (Certificate of Compliance � THIS IS TO CERTIFY,that the On-site Sewage Disposal Systeym- Constructed ( ) Repaired ( ✓) Upgraded ( ) Abandoned( )by at 7i Z y/ //A?�7& (_OG/!r` r` C. e0l !mil//l/f�fi'as 1been constructed in accordance �Id; with the provisions ofWforisposal System Construction Permit No. C lw6 _GL/S datedInstaller Designer d #bedrooms 3 Approved design flow 3 3 0 gpd The issuance of this permit shall guarantee c nstrued as a that the system 1 func i as de` ie . Date P 3/ / Inspector ———————————————————————————————————————————— No. 0200 6 - 0NS Fee /00 _ THE COMMONWEALTH OF MASSACHUSETTS - PUBLIC HEALTH DIVISION—BARNSTABLE, MASSACHUSETTS 1=i!5poga1 �&p9;tem Con!5truction Permit Permission is hereby granted to Construct ( Repair ( V"))�^ Upgrade ( ) Abandon ( ) System located at and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided: C nst ction must be completed within three years of the date of this Date 21764 66 Approved by °`S I ll j IQ fC,,jr I 1 I i FROM :down cape engineering inc FAX NO. :15oe3629eeo Mar. 10 2006 09:28AM P1 Town of Barnstable Regulatory Services Thomas F. Ceiler,Director MAW g .ter Public Health Division i0�� Thomas McKean,Director 200 MOW Street,Hyannis,MA 02601 Fax: 509-790-6304 Office: 50&.962-4644 installer&Designer Certification Form it# 7 Date: d Sewage Perm 6-4Z Assessor's Map\Parcel a/G ,1 2 r ,el,,,, installer: n Designer: �`� S Address: ��- Address: "el I w --- ° �T-- 5/-was issued a permit to install a On (dam) installer) septic system.at ma rd-J C4 n_ based on a design drawn by - Q (address) �j� ►.:I.. c �� dated 6 0 (deli er) I certify that the septic system referenced above was installed substantially according to the design, which may include minor approved changes such as lateral relocation of the distribution.box and/or septic tank. he septic system referenced above was installed with major changes nent cent that t p Y of component I certify greater than 10' lateral relocation of the SAS or any vertical relocation o y P of the septic system)but in accordance ow.foll With State & .Local Regulations. Plan revision or. certified as-built by designer N OF M.4,9& ARNE OJALA �-'� (instal s Signature) CIVIL. No. 30792 eiu 'S�UNAesign is (Aff x Dest er's Stainp Ike•re) pLT', E RETURN To BARNS SUED INT'1BL PUBLIC NETS i RMSAND A --iiiIIILTpCARD ARV OMPLIANCE WILL NOT BE IS Ck;IVPD BY THE DARN,TABLE PUBLIC HEALTH DIVISION. 'THANK YOU Q:Henitb/septic/1)e.igner cutilicntion Norm 3-26-04.doc MAR 13 AM 9, 32 � J o TOWN OF BARNSTABLE LOCATION SEWAGE # VILLAGE 6✓l 1 ra,/le ASSESSOR'S MAP & LOT AA9 �1STALLER'S NAME&PHONE NO. 112- >oldl,4` C vJ1,g A*'J, :r1 r-7'r�G SEPTIC TANK CAPACITY LEACHING FACILITY: (type)-Lf-, Ld1 o�J ) (size) yJ 5 2 f NO. OF BEDROOMS .BUILDER O WNER PERMIT DATE: �AleZ, COMPLIANCE DATE: Separation Distance Between the: Maximum 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 �9r 30 b O 0 OD � p l� b TOWN_ OAF BARNSTABLE LOCATION G�. 1 SEWAGE # VILLAGE. a/y�6 4 ASSESSOR'S MAP &LOT 2 1 Q I INSTALLER'S NAME dt PHONE NO. SEPTIC TANK CAPACITY cion 2�90A LEACHING FACILITY: (type) �t� (size) rcvl NO.OF BEDROOMS 3 `_ BUILDER OR OWNER /�t �'�fl5�® —PORMUDATE: -Z (1t I l'ja COMPLIANCE DATE: Separation Distance Between the: 'f Maximum Adjusted Groundwater Table and Bottom of f�eaehacilit�►--' � 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) 6 ' A-1 Feet Furnished by 7 l h e i 22 AZ.�P /k3 q B3,.-37, c COti1N40\NVEALTH OF KkSSACHL•SETTS EXECUTIVE OFFICE OF E*.,,x iRONMENTAL AFFAIRS DEPARTME 'NT OF ENNIRONNIE\TAL PROTECTION . �IN 0\E %V1\TER STREET. 80570,. NIA O.IQS 61?-.S_•S:CC RECEIVED UILLIAM F.WELD ." RL 1'CO?_ Governc AUG b 1998 SG:TC= ARGEO PALL CELLIXCI � TOWN OFBARNSTABLE DAB $TRL1 Lt.Governor SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION F0k? HEALTH DEPT. C mmissiarsc ® PART A "-" .' :-, :" _ � � � 7_ P_ 4 . CERTIFICATION 1 ivl I�,zac,�tz,c�, C ��ev.�l-tom Property Address; Address of Owner: ��T )� Date of Inspection: •t`e`� :Of different) Name of Inspector: H, o am a DEP ap roved system inspector pursuant to Section 13.340 of Title S (310 CMR 15.000) Company Name:A ) a Al r'e 45701 P''+'e Mailing Address: 2 p l3ox e_37_P 14 H ASNfPSL J 1 26-4-q Telephone Number: r_5-e,2tZ�4 Zeo CERTIFICATION STATEME\T I cenif that I have pe•sonally inspected the sev,•age disposal system at this address and tha: the information reported below is true, accurate and complete a: o:the time of inspectoo^.. The inspection was performed base: on my training and experience in the proper function and maintenance of on-site sewage disposa; systems. The s•s-zern: Passes _ Concitionaik Passes _ Iseec; Further E•-a!:,ation Ev the Local Approving Authonn F 74,Inspector's Signatur - �r Date: I L T:ie 5-s:e7 Ins:eco• sha!' submit a coPe of this inspecion report to the Approving Authority• within them, (30) days of completing this inspection. If(he s%-stem is a shared system o• ha; a design flow of 10,000 god or greater, the inspector and the systerr owner shall submit the repo-, to the appropriate regional office of the Depa-ment of Envirenmerita' Frotecoor.. The prig na! should be sent to the system owne- and copes :--it to the buyer, if applicable. and the approving authorir\. INSPECTION SUMMARY: Check A, B, C, or D: Al SYSTEM PASSES: I 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. . COMMENTS: BI SYSTEM CONDITIONALLY PASSES: One or more system components as described in the 'Conditional Pass' section need to be replaced or repaired. The system, uPo completion of the replacement or repair, as approved by the Board of Health, will pass. Indicate yes, no, or not determined (Y, N. or NDi. Describe basis of determination in all instances. If'not determined-, explain why not. The septic tank is metal, unless the owner or operator has provided the system inspector with a copy of a Certificate of Compliance (attachedi indicating that the tank was installed within twenty (20) years prior to the date of the inspection; c the septic tank, whether or not metal, is cracked, structurally unsound, shows substantial infiltration or exfiltration, or tanl 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. trev.Sed 04/25!17) page 1 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM r � PART A _ CERTIFICATION (continued) - Property Addr4ss: Owner: - Date of Inspection: 81 SYSTEM CONDITIONALLY PASSES tcontin,�,d- Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed pipets) or due to a broken, settled or uneven distribution box. The system will pass inspection if(with approval of the Board of Health). Describe observations: broken pope(s) are replaced obstruction is removed ; _ - distribution box is levelled or replaced The system required pumping more than four times a year due to broke or obstructed pipe!s). The system will pass inspection if tw•ith approval of the Board of Health): - broken pipets) are replacec obstruction is removed C3 FURTHER EVALUATION 15 REQUIRED BY THE BOARD OF HEALTH: ~ _ Conditions exist which require funhe•evaluation by the Board of He h in order to determine if the iystem is failing to protect the public health, safety and the environment. 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES HAT THE SYSTEM 15 NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY / D THE ENVIRONMENT: Cesspool or prnti is within 50 feet of a surface water` Cespoo! or pri N is.w ithin 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 15 FUNCTIONING IN A MANNER THAT PROTECTS THE PUBLIC HEALTH AND SAFc'TY AND THE ENVIRONMENT: - J; The syste n has a septic tank and soil absorption system (SAS) and the SAS is within 100 fee: to a surface water supply or tributary to a surface water supple. The system has a septic tank and soil absorption system and the SAS is within a Zone 1 of a public water supoty well. The system has a septic tank and soil absorption system and the SAS is within 50 feet of a private water supply well. The system has a septic tank and soil absorption system and the SAS is less than. 100 feet but 50 feet or more from a private water supply well, uniess a we!I 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. Method used to determine distance (approximation not valid). 3) _.OTHER - _. ... _... (revised 04!25/37) Page 2 of 10 k � SL 6SURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM 1 PART A CERTIFICATION (continued) Property Addross: / Owner: Date of Inspection: / D] SYSTEM FAILS: You must indicate either `Yes` or `No" as to each of the following: 1 have determined that the system violates one or more of the following failure criteria a_ defined in 310 CMR 13.303. The oasis for this determination is identified below. The Board of Health should be contacted t determine what will be necessary to correct the failure. Yes Na Backup of sewage into facility or system component due to an overloa or clogged SAS or cesspool. Discharge or ponding of effluent to the surface of the ground or surf ce waters due to an overloaded or clogged SAS or cesspool. S;a:ic !iouid level in the distribution bo). above outlet. invert due o an overloaded or clogged SkS or cesspool Lieuid depth in cesspool is less than 6- below invert or availab a volume is less than 1/2 day fioy. Required pumping more than a times in the last year NOT due to clogged or obstruc er pipe's . Number o;times pumped _ Any portion o:the So!l Aosorption System, cesspool or privy is below the high groundwate• a;evatio- Am po,::on o:a cesspool or privy is wither. 100 fee::of a surface water supo!y or tributar to a suriace water supply Any portion of a cess000: or prwy is withir. a Zone I of a public well. / An\ pe^io- c:a cesspool or privy is within SO/feet of a private water supply well Am• por,,or. o:a cesspool or privy is less th n 100 fee: but greater than 50 fee: from a private water sucoly well with no acceptable Ovate- qualir, analysis. It the w• II has been analyzed to be accevtabie, anach cope of well water analysis for coliiorm,, bacteria volatile organic comp nds, ammonia nitrogen and nitrate nitrogen. E] LARGE SYSTEM FAILS: You must indicate either -Yes- or 'tip- as to each of a following. The ioliow:ng criteria aep;% to large system in addition to the criteria above: The system serves a facilir, with a desig flow of 10.000 gpd or greater (Large System: and the system is a significant threat to public hea!th and safer and the enviro ment because one or more of the following conditions exist. Yes No . the system is within 400 f _t 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 i. a nitrogen sensitive area (Interim Wellhead Protection Area - IWPA) or a mapped Zone II of a public water supply wI11) __.... ....... . .__ , 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-funhe.r-iniormadac>:--- - - .--- - SUESURFACE SEWAGE DISPOSAL.SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 1p S1 Owner: Date of Inspection:,II� Check if the following have been done: You must indicate either 'Yes' or 'No' as to each of the following: Yes No Pumping information was provided by the owner, occupant, or 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 bull: plans have been oo:atned and eyarnined. Note if they are not available with N A. _ The factlta, or d,-•elltng ..as inspected for signs of sewage back-up. Trte s,,-ste�n does not receive non-sanitary or industrial waste flow. The site %%as inspected for signs of breakout. _ All !vsterr. components. excludtns the Soil Aosorption System, have been located on the site. The septic tank manholes Nere uncovered. opened. and the interior of the septic tank was tnspectec' for condition of baffies or tees. materta: o• construction. dimensions, deptn 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. The fac,lit% c%%ne• ,ano occupants. if dtrteren: from owners were provided with tniormatton on the prope• maintenance of Sub-Suriace Disposal System. Existing information. Ex Plan at E.0 H. _ Determined to the field of am of the failure criteria related to Part C is at issue, approximation of distance is unacce::able It 5.3o2;3t:b+j SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FOR..m PART C SYSTEM INFORMATION Propert% Address:p�M,\R- Owner: l iG, Date of Inspection:71c' FLOW CONDITIONS RESIDENTIAL: Design floe% p.d./bedroorr for S.A�S Number of bedrooms 0 Number o'current residents- Garbage g•. der (yes or no: t%-S Laundry Co-•^ected to system (yes or no` +� Seasonal use ryes or nw.±=� 1 Water meter readings, if available (last two '.2 vear usage tgpd): _I1� Sump Pump (Yes or no) Las date or occupanc\. COMMERCIAL'INDUSTRIAL: Type of establtshmen: Design fio%. gahons•da% Grease trap present tves or no_ Industrial \%ante Holding Tani; oresen: -ves or no Non-san+tan Naste discnargec to the T!:ie 3 Svstern ryes or no_ 1�ater meter readings if a%ailable Las:pa;e o: c. ".. anc. OTHER: .De�cribe Last care of occ,,canc. GENERAL INFORMATION PUMPING RECORDS and urce of mformatior. N)o System pumper as par, r tnspectoon. wes or no. If yes, volume pumped gallons Reason for purnping TYPE OF SYSTEM Septic tankldistrtbution box,soil absorption system Single cesspool Overflow cesspool Prn-)' Shared system (yes or no) (if yes, attach previous inspection records, if any) I/A Technologv etc. Copy of up to date contract? Other APPROXIMATE AGE of all components, date installed (if known) and source of informationfi� Sewage odors detected when arriving at the site. Ives or no) (revised 04/25/91; Page 5 of 20 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: t Owner: k10/1!PCCv(0 Date of Inspection:•71G 1y(L BUILDING SEWER: (Locate on site plan) Depth below grade. Material of construction. _cast iron —40 PVC _other (explain: Distance from private water supply well or suction (r-t Diameter Comments: (condition of joints, venting, evidence of leakage, etc.) SEPTIC TANK:4(5 (locate on site plan Depth below grade Material of construct on _Iconcrete me-,a _Fioerglas _Polyethylene _othertexpla�n If tank is meta;, lis: age _ Is age cor.:irmec b\ Ce-t:fica:e of Compuance _(lres'vo Dimensions f,000C1 V4 Sludge depth �w Dtsiance from top a s:udge to bortorn o-' ou:ie: tee o, ba-";e Scum thickness X c t Distance from top o' {cum to top v outle, tee or ba^,e r I I Distance from bottom of scu—, to bo-o-n of outle: tee c• bare How dimensions were determnec Comments trecommendation for pumping rondition o; iniet and outlet tees or baffles, depth of liquid level to relation to outlet invert, structural ntegr evidence f leakage. e:c.t 1r%t�e. ,��\ � ' �1�\ tivi CA-- 0 �:t �, .` — , GREASE TRAP: (locate on site plan: Depth below grade Material of construction: _concrete _metal _Fiberglass _Polyethylene _other(explain) Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle. Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping Comments: (recommendation for pumping, condition of islet and outlet tees or baffles. depth of liquid level in relation to outlet invert, structural :ntegriry, evidence of leakage, etc., (re,iiad 04/25.'97) Pago 6 of 10 ' r SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FOR.1-t PART C SYSTEM INFORMATION (continued) Propert% Address:pM'omcc OH ner: ) �Qjj (C Date of Inspection: zy �� TIGHT OR HOLDING TANK:_Tank must be pumped prior to, or at time, of inspections (locate on site plan, Depth below grade. Material of construction _concrete _metal _Fiberglass _Polyethylene _cther(explain) Dimensions: Capacm• gallons Design flow gahons.da. Alarm level Alarm in %corking orde• _ Yes. _ No Date of previous pwnping Comments (condition of inlet tee. condition o- a!a•rn and float switches. etc.) DISTRIBUTION BOX: ilocate on site p-a- De_:h o; liquid le%e' aoo.e outle: in�e^ Comments tnote :f leve! and distri or eaua' evidence of solids carrvo e(. evidence of leakage into or out of box, etc.) PUMP CHAMBER: (locate on site plan. Pumps in working order: (Yes or No, Alarms in working order (Yes or No Comments: (note condition of pump chamber, condition of pumps and appurtenances, etc.) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Adrfr-ss: P� Owner: Date of Inspection: SOIL ABSORPTION SYSTEM (SAS): (locate on site plan, if possible: exca.at n not required, but may be approximated by non-intrusive methods; If not determined to be present, explain: Type: leaching pits. number._ iU100 leaching chambers number. — leaching galleries, number. leaching trenches. number,length: leaching fields, number, ci.rnensiors overflow cesspool, numbe- Alternative system name of Tecnnotog-v Comments inote ondi ion of oli• s!gr.s of hydraulic failure. leve' of pond. gtcond� �o of vegetation, etc r CESSPOOLS: CSC; (locate on site plan. Numbe• and coniig�ra:,on Depth-top of liquid to inlet Inver, Depth of solids lave- Depth of scum layer Dimensions of cesspool Materials of constructior Indication of groundwate- 1nf w'%- tcesspool must oe pumpec as par of inspection Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) - PRIVY: ........ (locate on site plan) Materials of construction: Dimensions: Depth of solids: _ _. .... Comments - --.- (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): (revised 04/25/97) - Page a of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued! Property Address: o)-NPA6 , Owner. Date of Inzpeclion: 71(,h , SKETCH OF SEWAGE DISPOSAL SYSTEM. include ties to at least two permanent references landmarks or benchmarks locate all wells within 100' (Locate where public water supply comes into house) Pr2, S �Z 4 • SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Propertv AddresF Owner: Date of Inspeciion:�� � i Depth to Groundwater _ Feet Please indicate all the methods used to determine High Groundwater Elevation: Obtained from Design Plans on record Observation of Site (Abutting property, observation hole, basement sump etc.) Determine it from local conditions Cneck %%tth loca! Board o- nea- Chec� FE.�AA maps Check pimping records Check local excavato,s ins:alle,s Jt l se :SCc Da:a r• o Describe in voxco%%'. no••+ %O:. es:aolished the Hieh Ground ate! Elevation. (Must be completed: 6 , 4 ry)i, - — trev:sad 04:2s'9'. \' Page 10 of 10 i No.. ........ .. ,. ��.__. Fx$............................ THE COMMONWEALTH OF MASSACHUSETTS BOAR®. HEALTH Appliration for UWposFal Works Cnututrurtiun Prrutit Application is her by mad for a PepTij to Construct ( ) or Repair (�) an Individual Sewage Disposal System at: UP 2 ----------------------------------------------------- ocati -Address o Lot No. �-----�������--��--we Owner Address VA. f b -- tWaxiK�/a.. Z r/ ................................................. � . ..............._............................. Installer Address Type of Building Size Lot./429M--•-----.Sq. feet U Dwelling—No. of Bedrooms.._...tY................................Expansion Attic ( ) Garbage Grinder ( ) '04 4 Other—T e of Building No. of persons............................ Showers — Cafeteria a Other fixtures ........................................ . W Design Flow .......................................gallons per person per day. Total daily flow__530......._....................gallons. WSeptic Tank....Liquid'capacity/'�gallons Length................ Width................ Diameter................ Depth................ x Disposal Trench—No. .................... Width.`.............. Total Length_._.- .._........ Total leaching area....................sq. ft. Seepage Pit No..................... Diameter.. _._'. Depth below inlet......... Total leaching area.R!?66.....sq. ft. Z Other Distribution box ( ) Dosing tan ( ) '-' Percolation Test Res 1 flab Performed b ... a � Y � ............................ Date--Date__ ........ �_'__....----- ,.� Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ fi Test Pit No. 2_4_..........minutes per inch Depth of Test Pit............:___---- Depth to ground water........................ a ••-•-•--••-•--------------- ---- ..................!..... .A.. _ O Descriptio f Soil 3 .. -1 - Urn ............................................................................................................................ W ---•----------------------------------------------------------------••---•---...-----••------------•----•--------•----•------------••-----------•--•-•-•-•••...-•-•-•-•........._........--•-•-..--•-•- 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 TL ITIE 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has bee issued by the oard of health. Signed ..-•-------•----•-------------•--•94 1 . ate Application Approved By.. ....... .,r.._. '.1 �..--•-•- - Date Application Disapproved for the following reasons----------------•----....----•-------•-------------------------------------------•............•------•........ ....................................•-•-----•-----------..........--------------------------------........---.•...............----------------------------------•-...................................... Date Permit No______________ --•--- -- --._ Issued_...�.----•-------------�.�.---------------- Date LO-C`AT'ION SEW G E PERMIT NO. VILLAGE Of Aj- '� INSTA LLER' NAME i ADDRESS BUILDER OR OWNER DATE PERMIT ISSUED a_ �j�-1� t - DAT E COMPLIANCE ISSUED g-- 2L-72 L,o`17 f4 2� ITS. .. b No.....----•••-•- --••• � FE$.............................. THE COMMONWEALTH OF MASSACHUSETTS BOARD HEALTH ......... -.,...OF........ r0&r_V.6-.. • _..... Appliration for Disposal. Works Tonutrurtiun lirrmit {. Application is hereby made for a Permit to Construct ( ) or,Repair (V) an Individual Sewage Disposal System at: { ocattii -Address + or Lot No. - -- •-- .: �!!'.�A�- ..:. �`-- ` d�;,c�i aj a'•�'•,"1�v�df �;,.., is �....... ... ,g•� . Owner , Address .d P .......................•-•---•------•- -14 Installer Address ,. Type of Building Size Lot.. ._...__..Sq. feet f a Dwelling—No.-.of Bedrooms......_ ________________________________Expansion Attic ( ) Garbage Grinder ( ) p, Other—Type of Building z Na of persons Showers ( ) — Cafeteria t b d �:.. Other fixtures - j* to----- x: --- : -- -- ---------------- ------ r ? W :Design Flow____________________________ _________ _gallons per person per day` Total daily fl'ow_.0 ...................... gallons+.ri t4 Septic Tank Liquid capacitylgallons Length_______________ Width._................ Diameter.............._. Depth_.. ......... W Disposal Trench-No_ ____________________ Width.....................Total Length_ Total leaching area...................sq. ft. x Seepage Pit No-------- --- Diameter.. ..... _1__rDepth below inlet ____ ._. Total leaching area_!26l __.sq. ft. f Z Other Distribution box ( ) Dosing tank ( ,�) ' �,,,� Percolation Test Resjtlts Performed by.. + y:�'r!• �=�' ............................ r�_3 r� ......... Date.. ,, e __ 4e !+ '% Test Pit i\To: 1_.�_._._______.minutes per inch Depth of Test Pit____________________ Depth to ground water __:______________- ' 44 Test Pit No. 2.n�..______._minutes per inch Depth of Test Pit____________________ Depth to ground water_:..........._.......... ,- . s �c -------_...•. O Descriptio f Soil.....`�..-_Q .... ..`.14 ''V_ F .................... x _ .. �. U:, Nature of Repairs or Alterations—Answer when applicable--------------------- _..__._.__..______.____._..___.____._____..___._._.________.____.. ..----•--•-•-----------•--•--------------------------------- -------- --_ -------------•-------- Agreerhent The undersigned agrees to install."the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITI 5 of the State Sanitary Code The undersigned further agrees not to,place the system in operation until a.Certifica.te of Compliance has bee_ issued by the oard of health. y: Signed s1 4:: .9 ..................................... ��(y .. .r Date` .Application Approved BY -- _ .• :. _ R ..__ ? -•----- �G - Date Application.Disapproved for the"-following reasons:-----=---------•-------._._...----------••----•- ---•• •---•----------•••--------• --••----......••-- .......................... ....---...--------------•-•--------------------------.......------..... -----•---•----••-----------------------------------------------------------•=------•--•------ Date ' Permit No.....A................................................. Issued_.................... Date #,� a THk ,COMMONWEALTH OF MASSACHUSETTS Y- -- BOARD Of7 HEALTH ........... ....OF..........k... r i�!.. , x .-1 7 Tatifiratr of ToutpliFanrr T IS TO C'E IFY, at the Individual Sewage Disposal System constructed ( ) or Repaired ( ) by ... - Vh staller at... . - •--�-t�_d . •-- 0- - ........................................---has been installed in accordance with the provisions of T � ' S of``T�he State Sanitary Code as described in the application for Disposal Works Construction Permit No. __.__ #___.__ ,7.'______________ da.ted_-�'-.,/ '^ ................. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE,THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE........... 02� �J`.. -••-_.... Inspector ----•--•-••-•----- THE COMMONWEALTH OF MASSACHUSETTS BOARD O)j HEALTH ......... ...... .. OF..--......- .._._....................................... No .....:................. FEE... . .......... Disposal urku o atrtion �erutit Permission s ereby gran'd • .. ------ ......................... ............... to Cons uV or RepairA an Indivlr3u Sew Dispo Syst at i Street as shown on the application for Disposal Works Construction Per it o._:.... __-___ ed._ .."/ '7.yt"�':'_.... /y i.� ...... ..... ..... - �C J +/r. `i +�✓ ✓ oard of Ith DATE: �,�.. - •------• s. FORS'-1255, Hoess & WARREN. INC.. PUBLISHERS k 'P, f 7 ,OW/ 5,0P ;'C'.-rA .4v AMLF *ji� tire. 7w aNA441.:OW SAPV&6.Vr 7-04FRAXW. pvc.Ppz 4-A V V- ,CAST/,V OW 0 V--N SOV,44 4. &E. V.S AI IN..,017'CN O/f/VKWA Y­ .A: % :CLEAN 46A co P, VIP 0 0 vo WAS. HPD SrO-'V.-- . . ........ GAL. rAMK a too • 314 av 0 Li Z PAwEr,45r,5 PAGE paim jp/7. 1 V. 7&V S CJ-r. PIA)6o7. VOIV AT C(5ES WOULA7 IC 7TANK _57 , 0417449T.S.-JOTIC TANK6 j3, 6 GROUND W,4 rEX 7A 4E� 9 0 -,SEC jv Box , rION OjW W$rq/fivr/,ON Box 95.9 P7 Fr -rA8VL.ATIDV 4 W45r 4CACMIlVa, )MO,r 0/7 hml. A CA Z A D&S1ZFtV C At VMSER �z. 7,e4s r T07iA 4=40 kv 3 3 o;�a�41_1,4.:4 v sol.L 7 MS DATE �,F A�LAFpl ' - /Z�)7 V 40ACMIlVr- R/73 0 '7 RESULTS Awm.='t-r, S19�'er UAr5 PV17 SSIEAD BY 7Z_P 4arj.OM LEr4CKlNG PER S--- -Oe*cOLA71 O N RA JO/ r"YA"'MJA,1IVCH Zb 6 WICOIAr/aA '*A7E z_ ' SIP.' eT:.l,, 40 T.- C/ I C K.- CO. ' /LI,4 tIJ 33 XAM TOP FNDN. AT EL. 47.2' SYSTEM PROFILE TEST HOLE LOGS ACCESS COVER TO WITHIN 6" OF FIN. GRADE (N OT TO SCALE) PROVIDE INSPECTION PORT WITHIN LISA LYONS, RS ACCESS COVER (WATERTIGHT) TO 6" OF FINISH GRADE ENGINEER: MINIMUM .75' OF COVER OVER PRECAST /� WITHIN 6" OF FIN. GRADE 2% SLOPE REQUIRED OVER SYSTEM 41.75' MIN. WITNESS: D. DESMARAIS, RS RUN PIPE LEVEL 2" DOUBLE WASHED PEASTONE DATE: 1/19/06 I GREAT MARSH ROAD iz - -FOR FIRST 2' PERC. RATE _ < 2 MIN/INCH EXISTING 1000 * 41.0' GALLON SEPTIC 41 .0' _ CLASS I SOILS P# 11200 o TANK (H- 10 ) GAs �406 0 40.58' rj-dA `" y �' BAFFLE 40.83' �� 1p go 0.58' LOCUS 0 6" CRUSHED STONE OR MECHANICAL ��� 40.0' �09 COMPACTION. (15.221 [2]) Q ELEV. E� DEPTH OF FLOW = 4' MIN ( 1 % SLOPE) 0" 43.0' 0" 42.0' JaE TEE SIZES: ( 1 % SLOPE) 3/4" TO 1 1/2" DOUBLE WASHED STONE FILL FILL INLET DEPTH = 10" 7» 12., OUTLET DEPTH = 14 A A LOCATION MAP NTS FOUNDATION- SEPTIC TANK 4' D' BOX 10' LEACHING LS LS FACILI-Y 5' 13" 10YR 3/3 16^ 10YR 3/3 ASSESSORS MAP 210 PARCEL 183 *EXISTING 1000 GAL. SEPTIC TANK TO BE RAISED APPROX. B B 1 ' TO MINIMUM EXIT INVERT ELEVATION OF 41 .0' TO M)9.2 LS LS GROUNDWATER ADJUSTMENT DATA: PROVIDE GRAVITY FLOW TO PROPOSED D'BOX. MUST HOLD 1OYR 4/6 10YR 5/4 WELL: AIW 247 MIN. 5 SEPARATION BETWEEN SAS AND ADJ. GROUNDWATER. 24 41 .0' 24" 40.0' ZONE: BORDER OF C & D U:;E ADJ. WATER AT ELEV. 35.0' Cl Cl ADJ: 2.8' & 3.5' (DEC) BENCH MARK - CENTER OF LS LS (USE AVG OF 3.15') WATERLINE MUST BE RE-ROUTED TO C.BASIN ELEVATION = 39.2 MIN. 10' FROM SEPTIC SYSTEM 44" 2.5Y 6/6 39 3, 45" 2.5Y 6/6 38.25' �` t'`ytl' �� COMPONENTS OR SLEEVED WHERE t . {w��� 4 �u Q,� 40 WITHIN 10' OF COMPONENTS MARR/CK COURT f " PERC C2 PERC C2 `,-�R / 0 CS PROVIDE APPROX. 75' OF 40 � MS MIL LINER AT 5' OFF SAS IN 441�i3 + '�W 40.0 1 22, OBS WATER 31 .8 2.5Y 6/4 AREA SHOWN. TOP AT ELEV. 7 -�-q.�-4" 6,� 41.0', BOTTOM AT ELEV. 37.0' 1 f- 40.2 ram. .5Y 5/4 ' 41 �� � �°�� � 40. � 128 2 32.3' 144" 30.0' NOTE: OVERHEAD WIRES 7 NOTES: CAUTION 2150 NGWE I 3 SEPTIC DESIGN: (GARBAGE DISPOSER IS NOT ALLOWED ) 1 . DATUM IS APPROX. NGVD + 40.2 + T - DESIGN FLOW: 3 BEDROOMS 110 GPD = 330 GPD � I � I 8 - ( ) 2. MUNICIPAL WATER IS EXISTING 43 �� USE A 330 GPD DESIGN FLOW 3. MINIMUM PIPE PITCH TO BE 1/8" PER FOOT. 3 '�' I SEPTIC TANK: 330 GPD ( 2 ) = 660 4. DESIGN LOADING FOR ALL PRECAST UNITS TO BE AASHO H- 10 40.3 41. O SAS DIMENSIONS O I 5. PIPE JOINTS TO BE MADE WATERTIGHT. N 44 I 1" = 20' USE A 1000 GALLON SEPTIC TANK (RE-USE, BUT .4/ 44 7 MUST BE RAISED) 6. CONSTRUCTION DETAILS TO BE IN ACCORDANCE WITH MASS.2 44.9 b 45 I LEACHING: ENVIRONMENTAL CODE TITLE V.41.5 45.4 7. THIS PLAN IS FOR PROPOSED SEPTIC SYSTEM ONLY AND IS NOT 4115� � � t 45.6 NOTE: GASLINE NEAR/AT PERIMETER = 452 SF (0.74) = 334 GPD TO BE USED FOR ANY OTHER PURPOSE. 4 AREA OF SOIL REMOVAL USE LEACH FIELD IN CONFIGURATION SHOWN (SEE DETAIL), 8. PIPE FOR SEPTIC SYSTEM TO SCH. 40-4" PVC. EXIST. DWELL. - CAUTION WITH 8 STANDARD INFILTRATORS 9. COMPONENTS NOT TO BE BACKFILLED OR CONCEALED WITHOUT 46,1 INSPECTION BY BOARD OF HEALTH AND PERMISSION OBTAINED 40.2 TOP FNDN 64�.8 FROM BOARD OF HEALTH. 47.2' 10. PUMP & REMOVE EXISTING LEACH PIT J 5' REMOVAL OF UNSUITABLE SOIL DECK REQUIRED AROUND PORTION OF PERIMETER OF LEACHING FACILITY L �' (HATCHED AREA), DOWN TO J/ LEGEND SUITABLE SOIL LAYER. REPLACE TITLE 5 SITE PLAN WITH CLEAN MED. SAND. LOT 19 100.0 PROPOSED SPOT ELEVATION OF 15,015f SQ. FT. 22 MARRICK COURT 10OX0 EXISTING SPOT ELEVATION 7 100 IN THE TOWN OF: s9 PROPOSED CONTOUR (CENTERVILLE) BARNSTABLE 100 EXISTING CONTOUR PREPARED FOR: BORTOLOTTI CONSTRUCTION/CASTRENZE 20 0 20 40 60 BOARD OF HEALTH APPROVED DATE MA SCALE: 1 " = 20' DATE: JANUARY 26, 2006 off 508-362-4541 fox 508 362-9880 r+of r.�ASS9c c3��H OF Mass ti 9c down cape engineering, inc, OAS ARNE yG CIVILI IH. CIVIL ENGINEERS 0 N 0 3fl7 0 � �0. 8 ?� LAND SURVEYORS 939 vain st, yarmouth, rya 02675 05-315 ARNE H. OJALA, P Ems, P.L.S. DATE