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HomeMy WebLinkAbout0177 OLD STAGE ROAD - Health 177 Old Stage Road A = 189—085 Centerville SMEAD No.2-153LOR UPC 12534 smaad.com • Made In USA Ri9t US®N iFiS RZODULT 1!! SH �SR PROGRAM CERTIFIED 0SD URGNG WWW.SRPROGRmLORC r No. r Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS Yes 01pplitation for VspoSal 6pstrm Construction Permit Application for a Permit to Construct( ) Repair(X Upgrade( ) Abandon( ) Complete System ❑Individual Components Location Address or Lot No. (`I rl 4305 5 TAGela RO Owner's Name,Address,and Tel.No. Q T64p1.�to45 �: lCi47tCn� Q�z.Cnl1�(=S Assessor's Map/Parcel ( S l g fj Installer's Name,Address,and Tel.No. '5 0%— 77—�5'277 Designer's Name,Address,and Tel.No. 509-a73 03"17 "0G1e>tD G OJTpPUs ES LA.,t Type of Building: Dwelling No.of Bedrooms Lot Size ('51 O2 5 ¢ sq.8. Garbage Grinder( ) Other Type of Building AGSID&:)Zj*Cn No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) `) gpd Design flow provided 3 `f' gpd Plan Date �/ —a®l'S Number of sheets Revision Date Title l 1, C)Lb 1 P_041) ��7j9ZVI C,Lg, Size of Septic Tank ` oo C Eu p,j S Type of S.A.S. (a) �QQ e C Ld®j 14"a o 64gk4gia� Description of Soil i vM. "�(QJK 69u)Cj� !t� PC,&�j Nature of Repairs or Alterations(Answer when applicable) (-jC.LO iJ -4 IQ To M-a o A-rvo)C Ty as CC R A0 G6A0Wu Cr (0)IM4 4 I Cw Wit/ UU�IA.�r 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 He Si Zed Date I'— Application Approved by Date Application Disapproved by Date for the following reasons Permit No. ® 33 Date Issued / 1 /D�+, No. CT3 3 Fee ,1 THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION �rTOW14 OF BARNSTABLE, MASSACHUSETTSYes application forI8 osaY 6pstetn Construction Permit Application for a Permit to Construct( ) Repair( Upgrade( ) Abandon( ) )(Complete System ElIndividual Components Location Address or Lot No. J''iq Ot.Aq 51AGcQ Owner's Name,Address,and Tel.No. mow„_ Ta40WAS c KAPAW REZE1J06S Assessor's Map/Parcel $9 8 S �C Po �vK �.7 Wes7= o4aL)5 c Installer's Name,Address,and Tel.No. j 006- 77-827-I Designer's Name,Address,and Tel.No. 50$ -011)3- 0317 ",Q 4ac Pe�r�i�` � -TCS,Enkc iNft�uN� XNJC- Type of Building: -__,_,__,Dwelling No.of Bedrooms 3 Lot Size 15s O.2 S f sq.ft. Garbage Grinder( ) Other Type of Building ( GS J D 6,)1ZiofC.. No.of Persons Showers( Cafeteria( ) Other Fixtures Design Flow(min.required) 31 o gpd Design flow provided T�e C� gpd Plan Date � Number of sheets Revision Date Title '1'1 6 La STD P-041) ejaj7 j9ZIl(1 g Size of Septic Tank 1500 (*ueQMS Type of S.A.S._��0t) C-A L0� 14",)0 44b6w� s& Description of Soil l�g�1 VM /UKy. ) 6f7(,f� Nature of Repairs or Alterations(Answer when applicable) -rsJST.(A, /.1t W 15CD C-I&LO 0 14- 10 SQVTIG l uK, -rU M-ao A-Ou1C To (a) 500 GaYA4W if-A() G +10C-C Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of H e Si ed Date - I'l- �S Application Approved by Date 5 Application Disapproved by Date for the following reasons Permit No. ;VI /7115 3 3 Date Issued --------------------------------------------------------------------------------------------------------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired( x) Upgraded( ) Abandoned( )by C AD E w(r) U4-, at 1-1"II (0 W S-r44x6•- ROM3 Ct V1 LL6 has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit NOw5 �3-3 dated - /7)j 'j Installer Q-QEwI nE (:. Designer #bedrooms 3 Approved design' n flow 33 gpd The issuance o this p rmit shall not be construed as a guarantee that the system will nctlo s desig n Date �� Inspector PL - - - - - --------------1--------- No. �I D,3 3! Fee /Q y THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS Vsposal *pstem Construction Permit Permission is hereby granted to Construct( ) Repair( N Upgrade( ) Abandon( ) System located at 1 n O &D S M&GES Rot? C6� T6VL J I C.t.& 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. r.►+ Provided:Construction must be co leted ithi`n three years of the date of thi permit. Date 2 S Approv ldb { TOWN OF BARNSTABLE LOCATION (rI', 0L )� `5 T RbAb SEWAGE# 20I 5 °- 33 VILLAGE C60TEPV1Ltd= ASSESSOR'S MAP``&PARCEL 189 / 95 INSTALLER'S NAME&PHONE NO.0/ P6UAD6GA�Z&V,?RJ&ES SEPTIC TANK CAPACITY 1500 LEACHING FACILITY:('type) NO.OF BEDROOMS .� OWNER PERMIT DATE: °7 — of®L COMPLIANCE DATE: Al a;LO f ' Separation Distance Between the: 140 a.w. Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility OFeet Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) MLA Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) A Feet FURNISHEDBY A13-1 *rr vld S4�z A.z; 2'6° 18.3° A RC-AR 4 A-3,_ 33.4+ L1r-JK A 4: 2-1.3' O � A 7/29/2015 18:25 5082730367 V4136 P. 001/001 Town of Barnstable Regulatory Services �. Thomas F. Geiler,Director BARN9TABLE Public Health Division MAW Thomas McKean,Director 200 Main Street, Hyannis,MA 02601 Office; 508-862.4644 Fax: 508-790.6304 Date: 7'29 15 Sewage Permit#101 —)•33 Assessor's Map/Parcel M 8� Installer & Designer Certification Form Designer: 'YC ec)Aioeei'ii)c , TOG Installer: Ca12e6;i6e_ LnfzrQrlse_�, 4LCr Address. Z�5'1 CtaAWccy Address: t 53 Ga,11me-;'Uc l Street Eas{ KJc+rehAM �HPr a3A HastnQee, NR 67-61Y7 On 11 — 15 Ca ?-wide_ C-4efQ«szS was issued a permit to install a (date) (installer) septic system at 177 old 565e ( 00t4 based on a design drawn by (address) SC Ln�tneercr)ct TytG dated holy (designer) 1 / 1 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. Stripout (if required) was inspected and the soils \wcre found satisfactory. I certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system) but in accordance with State & Local Regulations. Plan revision or certified as-built by designer to follow. Stripout(if req nspected and the soils were found satisfactory. pAQFJOHN L. j CHUI:CHI�L JR. Installer's Sig tore) No 141W NA►. esigiier s Signatur (Affix esigWePsomp Here) LEASE RETURN O BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT HE ISS>U')� _'U'N'T�._BO�_THIS_ )t+0M AND AS BUILT CARD ARE RECEIVED BY THE BARNSTA LE PUBLIC HEALTH DIVISION. THANK YOU. y lai i,e ii>nnslJai,nurccniliwtiun Ibnn.doe J VE Town.of Barnstable P# 73,2. Departiment of Regulatory Services Public Health Division Date MAB9 200 Main Street,Hyannis MA 02601 r ;, Date Scheduled— l0 Co Time U ✓1 /__' Fee Pd. � oO �Vv V1 Soil Suitability Assessment for Suva e asp®sal ' Performed By: I't C IOA '((Me- � C i l-t T-'f CSZ y'- r Witnessed By: P J LOCATION& GENERAL�''ORMATION Location Address _ Owner's Name T'40, _ t �� 0 Lb 5 bvTV e(_ l�l�[✓ Address r d..'CJ©Y"_7 Z �U�i'v(;:j� Assessor's Map/Parcel: t Rcl Engineer's Name- C-A0N5� � . NEW CONSTRUCTION REPAIR Telephone# 508-273-0377 Land Use.. Si/ig1e 61"t(Y dlr2��l✓1G Slopes(ga) /b 2b - Suiface Stones . Distances from: Open Water Body ft Possible Wet Area ft Drinking Water Well ft Drainage Way ft Property Line 7 /6 ft Other ft SKETCH'(Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands in proximity to holes) .see" ak4ac Vted e[avl Parent material(geologic) tXStt r,Q 5Ll Depth to Bedrock Depth to Groundwater. Standing Water in Hole: ^ Weeping iYom Pit Face n Estimated Seasonal HIgh Groundwater 7 1 2-6 t95 S DE17RMINATION FOR SEASONAL'HIGH WATER TABLE Method Used: D treG f �Mo5e;i;A4 Y1 Depth Observed standing in obs.hole: 7 12-C in, Depth to soil tnottleg; Itt, Dcpth to weeping from side of obs.hole: In, Oroundwgler Adjustment rtt. Index Well# - Reading Date: Index Well level __Y Adj,fhctbr. Adj.Groundwater Level PERCOLATION TEST Date 6-z6_.1�l 'ltYttte ��a�,•t [Depth ervation > e# / ^ Time at 9" of Perc $y Time at 6" Start Pre-soak Time @ %0:12 — Time(9"-6") End Pre-soak jp' 2 3 am Rate Min./Inch Z Site!Suitability Assessment: Site Passed e-S Site Failed: Additional Testing Needed(Y/N) /V Original: Public Health Division Observation Hole Data To Be Cornpleted on Back----------- `,J ***If percolation test is to be conducted within 100' of wetland,you must first notify the. Barnstable Conservation Division at least one(1) week prior to beginning. Q:\SEPTIC\PERCF6RM.DOC RM.DOC DEEP.OBSERVATION ROLE LOG Hole# I + Z. Depth from Soil Horizon Soil Texture Sdil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,,Boulders. C onsi tency %'Gravel) 0r12- A L5 iUY� 3�( ^ t Z_66 to DEEP OBSERVATION BOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. onsisten % ra DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Congiatency.%Qmven DEEP OBSERVATION HOLE LOG Mole# Depth from Soil Horizon Soil Texture Soil Color soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency. Flood Insurance hate Map: Above 500 year flood boundary No— Yes . _ Within 500 year boundary No_tl Yes Within L00 year flood boundary No.✓ Yes Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the area proposed for the soil absorption system? Y� If not,what is the depth of naturally occurring pervious material? . Certification I certify that on I y"y7'�g (date)I have passed the soil evaluator examination approved by the Department of Environmental Protection and that the above analysis was performed by me consistent with the required training,expertise and experi c described in�10 CUR 15.017. Signature 6-2 6-/ l,�-- -- Date Q:\S.E?TlC\PERCPORM.DOC AQ U4-ASWtos tcefrtoval Notirication Form ANf--uul- transaction.-. napsrreaep.aep,mass.gov//WCOtO ns/ASDeST05/lsvvrANruul.asp) Commonwealth of Massachusetts 1104222496R1 -- - y _� t Asbestos Notification Form ANF-001 Project Revision Asbestos ProjectNurrtbar 4 � IIV Project Revision Notification _ ProjectCanceilatian A. Asbestos Abatement Description 1.Facility Location: ___-.:._..:.-,w_.,,•_..-_____._._.—._....-.._....___._._.._.._.-._._....._-__._..__.. 1177 OLD STAGE RD THpMAS&KAREN REZENDES Name of Facility ------------------N-- Street Address e of Fa 7 i IRAA 102632 l �508-744-77�5 : 1 , Cityfrown State Zip Code Telephone tnatracaons 1.al Facility Contact Person Name 5acltlty Contact Person Title Sections of this form must Worksite Location: ,1345EMENT&GAIz4G1 a be completed In order to 6ullding Name,Wing,Floor.Room,etc, complywithWssDEP nofirrcationn quirementa 2.Blanket permit Project Approval, If applicable: ..................... ._..__...�_._...... of 310 CHAR 7,15 avid Approval ID tt DepartmentotLaW 3,Non-Traditional Asbestos Abatement Work Practice Approval,if applicable: Standards(OLS) Wilicatrmrrequtrements :06l2612016 — ------__.�_��... .,, .---•- i I06/26r220_--- -.`-___ ,-,-------------- of 453 CIAR 6.12 Project Start Date(MhA/Dp1YYM End Date(MM/DD/YYYY) ftrk Flours-Monday Through Friday Work Hours-Saturday&Sunday MassDEP use Only - -...._..- ._...........r i m oateRaaeivetl-'•- B. Other Project Revisions: - --• - -...._.._.._.._.._..__.m...._...----_._.......:..........._,..,.........-.._.._...._....._........-----------....._:._ _ I i 2.SubmitOrlginal Form To: • i Commonureaith of Massachusetts P.O. Boat 4052 Boston,MA 02211 C. Certification "I certify that 1 have personally examined ;DF_W--- - ——� IDFIN-- y ------ the Foregoing and am famlllar with the Name Authorized Signature Note:Temporary _.._...._... --..._... _.. ......._...._._._.....__...................•,....,._., information Contained in thisdocumerlC 106124/2015 storage orAsbestoa and all attachments and that,030 on nnntle'VP . ---- .1 m inquiry of those individuals PosiGonRltle Date(f+SMrDD/fYYY) containingwaste Y rW ry ...----_._.._..-_....__.......................:.:....:.._... ._-_----............,,...,....,._....---._._._........__. material is only allowed Immediawy responsible for obtaining L7 81-762-3333 _ - --„ !AIR SAFE,INC µ _at the place of the Information,I Wleve that the Telephone Representing business of a US information Is true,accurate,and 122 WILLOW ST- i,64 L EA ticaMed Asbestos complete.I am aware that there are Addrew Cltynbwrl contractor or a transfer significant penalties for submitting false _-._.............__._ —_....._,.:.:.... ___--•---...___.___.......:_..._.: MA station that is permmed information,in6iudng possible fines and oy MassDEF and Imp4sonrcent,The undersigned hereby State--— -- — Zip Code operated in compliance states that I have read the wtfi Solid Waste Commonwealth of Massachusetts Regulations 310 CMR regulalima governing asbestos 19.0w abatement(453 CMR 6.00 promulgated by the Department Of Labor Standards and 310 CMR T.15 promulgated try the Note.contractor must Department of Environmental sign this form for DLS Protsetion),and that I am aware chat 1 of 2 6/24J2015 9:22 AA 90/ZO 39t7d HS-lVM 3AVC ZbbS WdST:ZT STOZ/VZ/90 t y AQ 04-Asbestos Removal Notification Form ANF-001-Transaction... bttps:lledep.dep.mass.gov/WebFoTms/Asbestos/B'WPANFOOLaspx Commonwealth of Massachusetts ,Asbestos Notification Form ANF-001 AsbeatoePrajeotNumber L I ra:Project Revision � I '7:Project Cancellation A. Asbestos Abatement Description 1. Facility Locatlorr �TttOMAS&KAREMREZENDES � '1770LDSTAGERD E Marro of Facility Street Addrtass fJ�ARPtftBkE �VL 4 ---,---------•----,-!!'V!I I iMA �0Z632 150f3 744 7735 City/Town State Zip Code Telephone SAME---- -- ----,• .:.,_.. _--_--------- :S+1ME- ------ ---—. -- - Facility ContaCt Person Name Facility Contact Person"fkle IrteTTUCtiens 1.All Worksite lAGatlOn: BASE WENT&GARAGE -- serAom of tldsform must Building Name,Wrng,Floor,Room,etc. be Completed to order to comply veth m—DGP 2. Is the facility Occupied? 4, :'Yes LI I No nobfta6on requirements of310CNR 7.15 and 3.Is this a fee exempt notification(city,town,district,municipal housing authority,state facility,or owner- oepadroont of Labcr occupied residential property Qf tour units or less)? j Yea r;No Standards(DLS) nolireation requirements q Blanket Permit Protect Approval,if applicable: ofaJ3Crvlt e.12 Approval ID# 5.Non-Tralitionai Asbestos Abatement Work Practice Approval,if applicable: '_____-__,.,._—___••-•_' MassDEP Use Only Approval ID At,.,..._...._.__..� 6.Asbestos Contractor. Date Received -- Name 2.SubmltQrlglnal Citylrawn State zip Code Telephone FormTo: t..,..- ---- - --..__._....__._...._.__..._.._._..........._......... - .._......... Commonwealth of Contract Type: wnner l- Verbal Massachusetts P.O. DLS License# Box 406Z8aston,MA i'- ___._.—.__.__....__._.:..___.._.....•_•.___.._....-....___._.___.._ i 02211 Name of Contrartior's On-Site Supervisor/Foreman DLS Certification 8- AM060787 Name of Project Monitor DLS Certification# Name of Asbestos Analytical Lab DLS Certification 0 101ITF4F2015 --------._.._...-- _ ..,..,..,.,.. .__— ---� 106/24i2201 Project Stag Date(MMlDDlYYYI() End Data NWD NYYY !7AM-6PM _._.._...__.....� ' INA I Work Hours-Monday Through Friday Work Hours-Saturday&Sunday 11.What type of project is this? r€ -Demolition Renovatlon r,i Repair f f_m,1 Other•please Specify: ��� 12.Abatement procedures(check all that apply): I ` _r;love bag gut Encapsulation Enclosure %t�.Disposal Only r�jr Cleanup gjI.t Full Containment f ;othar-Please specify. ''" o� .., ----•a--s-�« "� a«.�...f I of 4 6/11/20I5 2:01 PM 90/60 39Vd HS-1dhi 3AV(I Zhb9 NdST:ZL 9TOZ/bZ/90 s i AQ 04-Asbestos Removal Notification Porm ANF-001-`ihmsaetion,., https,/!edep,dep.mass.gov/WebForms/AsbestoslBWPANFOOI.aspx B. Facility Description 1.Current or prior use of facility: ;RESIDENTIgt �--- ----- 2. Is the facility owner-occupied residential with 4 units or less? i I Yes r-ffl!No 3. .SAME {SAME _ Facility Owner Name Address .: f�A._.. i i02832 Cdyrrown state Zip Code Telephone 4, 'SAME isAME Name of Fecaity Owner's On-site Manager " Address . 506 744 7735 Cllyrrown State Zip Code Telephone S [ _.__......._ ___._._.._. Mama of General Contractor Address --'----:.---------------- -'- - --—� I�^._^wJ i02ti32 lttt-it1-1111 City/Town State Zip Code Telephone Contractor's ftrker's Cornpensetion Insurer (NA ------.,.._..._..—.._.......---....._ ' ;112J5112015 _ policy A ------- ----- --- -- ------Expire6on Oate(MMIDD/YYYYJ--+ B,What is the size of this facility? luau -- .____._....._- I Squom Feet t«of Floors C. Asbestos Transportation & Disposal 1.Transporter of asbestos-containing waste material from site of generation: �1;Directly to Landfill or ;gS;To Temporary storage Loratlonaransfer station --- ---- ---- - -•----------- AFE 122 WILLOWST - Name Of Transporter Address iCHELSEA� 0�2U i 178 782-3390 Cltyrrown State Zip Code Teephone _ 2.If a temporary storage location/transfer station is used,list name of transporter of asbestos containing waste material from temporary storage location/transfer station to final disposal site: SERVICE TRANS - Nam orTrarisporler Address NEW CASTLE ^w � ^-'m ^ !DE f01872 �977.a99-9b59y� Clty/Town Stale Zip Code Telephone ~„ 3.Name and address of temporary storage location/transfer station for the asbestos containing waste material, AIR SAFE. ,. .... n ... d....�- ,.T LLOwST.,Temporary Storage LoCalon Name yy '' Address �1 f�',:,„'7 2150 - �.•- .•.-n.:.,T _F . .. r� md -BINl$2-33BO^ City/rown State Zip Code Telephone 4.Name and location of final disposal site(asbestos landfill): !MINERVA � ;--_.__..___.._.._.:._...,......,...._.....---_._._._...._...__.....,,....._......._.__._........_...., Final Disposal Sne Nance _.__._ ----•- Disposal Site Owner Name Final Oig ------ �^ - ----- -.----_...._____.�_.--.------_-----. �8000 MINERVA Rp - _.-_-••--•--__...__,_I Address---- --«----•---------�------.._------ 2 of 4 5/1112015 2:01 FM 90/PO 39Vd HS-1dhl 3AVG 3bb9 HcI9T:ZT 9TOZ/b3/90 AQ 04-Asbestos Removal Notification Form ANF-00 I-Tratlisaction— bttps://edep.dep_mass.gov/Web*Fomns/Asbestos/BWPANF001.aspx 0fASbwtDscoi1sWng ---------- Olt i tA4fi98.......................I 33D 877 3455......... wasl)shhateitat iswy Cityfrovyin State Zip Code Telephone afilmntedl at the place of 13Mheet0faDILS 13.Job is being conducted: Indoors Outdoors lirensedAsbastas 14.Total amount of each type of asbestos Containing materials(ACM)to be remoued,enclosed,or Conlrectororstraftifor encapsulated: station that i$pornitted by hib9SIDEP and operated in Linear Feet(Lin.Ft) Square Foot(Sq.Ft.) comp)lanca wan solid Boller.Broaching,Duct,'rank Trantite Pip ........... —--------------- Waste Reguhilions 310 Surftce Coatings �l n—.Ff. Sq.Ft Lin.Ft Sq.F1. CNR 19.000 Pipe insulation :!.................. Transite Shingles li Lin.Ft. Sq.Ft Lin.Ft, Sq.Ft Spray-On Fireproofing !k I Transite Panels Lin.Ft. Sq.Ft. Lin. Ft Cloths,Woven Fabrics IL Other-.Pleaw Specify: Lin.FL Sq.FL Insulating Cement Lin.Ft Sq,rl."- tin.R. Sq.Ft 15.DescAlbe the decontamination system(s)to be used; I ................. .......... ............ -------- 16. Describe the containerization/disposal methods to comply with 310 CMR 7.15 and 453 GMR 6-14(2)(g): NOW,contractor must sign this form V DLS ------- noull000ti purpose* 17.For Emergency Asbestos Operations,the MassDEP and DLS officlals who evaluated the emergency, —----------- Mrne of MasuDEP Official Title Of MassDEP Official ..................................... ................ Date of Authorization(MM/DDNYYY) Waiver# Neme of DLS Official Title of DL.S 01ticial .............. Date Of Authorization(MM/DDA") Vhlver It 18.Do prevailing wage rates as per M.G.L,c, 149,§26. 27 or 27A—F apply to this tJ Yes Na 1. D. Certification 'I certify Mt I have personally examined 1 DFW the foregoing and am ramillarwith the NaMe Authorized Signature information contained in this document and all attachments and that based on my inquiry of those individuals Positloori-ift Cate(MM/DD/YYYY)' imMedlatoly responsible for obtaining [711-762-3390 the information,I believe that the Telephone Representing Information is true,accuraft,and cOmPIet6-I am swore that there are '"LLLOYOT---- CHELSEA 9griffloaril penalties for submitting false Address cayfrown Information.including possible fines and Imprisonment The undersigned hereby State Zip Code 3 of 6/11 Ml 5 2:01 PM 90/90 39Vd HS-1VM 3AVG ZVt?9 HClGT:ZT 5TOZ/VZ/90 AQ 04-Asbestos Removal notification Form ANF-001-Tmnsa:ction... https_/iedep.dep,mass.gov/Web]Forms/Asbestos/B WPANFOOI.aspx states that I have read the Commonwealth of Massachusetts regulations governing asbestos abatement(453 CMR 6.00 promulgated by the Depsrtrnem of Labor standards and 310 CMR 7,15 promulgated by the Department of Environmental ProteCtlon).and that t am aware that this permit application or notification shall not be deemed valid unless payment cf the applicable fee Is made." 4 of 6/11,12015 2:01 PM 99/90 3E)Vd HS-IVM 3AVCl ZbPS WdST:ZT STOZ/bZ/90 - TOP OF FOUNDATION = 55.1'± FINISH GRADE OVER D-BOX= 44. '± 0 FINISH GRADE OVER CHAMBERS= 41 .0' - 44.0' PROP.VENT WITH CHARCOAL FILTER TO ABOVE GRADE GENERAL NOTES �- PROVIDE EXTENSION RISER SLOPE @ 2% MIN. OVER SYSTEM 3/4"TO 1-1/2" DOUBLE WASHED WITH COVER OVER INLET& REMOVABLE WATER-TIGHT COVER OVER STONE TO CROWN OF PIPE 1. UNLESS OTHERWISE NOTED, ALL SYSTEM COMPONENTS AND CONSTRUCTION " FINISH GRADE OVER TANK EL.= RISER TO WITHIN 6"OF FINISHED GRADE 4"SCHEDULE 40 PVC INSPECTION PORT WITH ACCESS �- FINISHED GRADE OUTLET TO WITHIN 6 OF F.G. 46.50� MIN SLOPE 1% BOX TO F.G. (SEE NOTE#21) 2"OF 1/8"TO 1/2"DOUBLE WASHED METHODS SHALL BE IN ACCORDANCE WITH TITLE 5 OF THE STATE ENVIRONMENTAL @ FOUNDATION = 47.0'± 5" DIA. OUTLET(S) STONE OR GEOTEXTILE FILTER FABRIC CODE AND ANY APPLICABLE LOCAL RULES. - - 2. ANY CHANGES TO THIS PLAN MUST BE APPROVED BY THE BOARD OF HEALTH AND THE 20"MIN.ACCESS �� - } 9 MIN. 1 I TOP OF SAS = 3$.00' PACE RISERS ON ALL DESIGN ENGINEER. COVER(3 TYP.) 36"MAX. PROP. SCH. 40 5.33' MAX 6.00' MAX CHAMBERS WITH 3. 4" SCHEDULE 40 PVC PIPE WITH WATER TIGHT JOINTS SHALL BE USED IN DISPOSAL PVC SEWER PROP. SCH.40 4"PVC TEE SEE NOTE 22 37.00' SEE NOTE 22 INLET PIPES TO 6"OF PVC SEWER BREAKOUT EL= 37.50 FINISHED GRADE SYSTEM UNLESS OTHERWISE NOTED. V13 2" DROP MIN. _j 1 4. TO PREVENT BREAKOUT, THE PROPOSED FINISHED GRADE SHALL NOT BE LESS THAN " MIN.SLOPE@1% 3" DROP MAX. 3" 9" L=16'±MIN.SLOPE @ 1% PROVIDE WATERTIGHT o ELEVATION =37.50' FOR A DISTANCE OF 15'AROUND THE PERIMETER OF THE SAS. UNLESS A 4" PVC IN FROM JOINTS (TYP.) �-P 40 MIL GEOMEMBRANE LINER IS PLACE AT LEAST FIVE FEET FROM S.A.S.AND THE TOP OF * '-I- 14" ' SEPTIC TANK 4" PVC OUT TO 0 0 0 0 0 0 0 0 0 0 0 o i THE LINER IS NOT LESS THAN THE BREAKOUT ELEVATION. 44.3 _ 44•00 O LEACHING FACILITY o0 0 0 6 o � � � � � � 5. SLOPE ALL SOLID PIPE AT 1.0% MINIMUM. 44.25 12"OUTLET TEE 37.67� MIN. 6" 37.rjQ' 2� o0 0 0 0 6. THIS SYSTEM IS NOT DESIGNED FOR A GARBAGE DISPOSAL. 48 0 0 0 0 0 00 CDC) cao 7. LOCAL BOARD OF HEALTH AND DESIGN ENGINEER TO BE NOTIFIED PRIOR TO BACK GAS BAFFLE 6" CRUSHED STONE 0 00 0 CD FILLING WHEN SYSTEM IS NEARLY COMPLETE AND READY FOR INSPECTION. SYSTEM IS OVER MECHANICALLY CPCDI 0 0 _ NOT TO BE BACK FILLED WITHOUT FIRST OBTAINING APPROVAL FROM BOARD OF HEALTH 11.5'OFFSET TO FND COMPACTED BASE 8.5' TYPAND DESIGN ENGINEER. 6" CRUSHED STONE 5 OUTLET DISTRIBUTION BOX 4.0' (TYP) P_� . 4.0' 4.0' 8. ELEVATIONS BASED ON APPROXIMATE M.S.L. DATUM. BENCHMARK ELEVATION OF 45.00, OVER MECHANICALLY TO BE INSTALLED ON A LEVEL STABLE 25.0' (TYP.) ESTABLISHED ON TOP OF SPIKE SET IN TREE AS SHOWN ON PLAN. COMPACTED BASE BASE. FIRST TWO FEET . OUTLET 35.00, GROUND WATER ELEV.= < 28.00� 12 83' 9. CONTRACTOR SHALL VERIFY ALL UTILITY LOCATIONS PRIOR TO CONSTRUCTION PIPES TO BE LAID LEVEL. PROPOSED 1 ,500 GALLON H-10 CONCRETE SEPTIC TANK THROUGH DIG-SAFE AT LEAST 72 HOURS PRIOR TO COMMENCING WORK ON SITE AT 2 - 500 GALLON H-20 CHAMBERS 5 MIN. CHAMBER END VIEW LENGTH 10'-6' WIDTH 6-8" DEPTH 6-87 (Dimensions per Wiggin CROSS SECTION VIEW 1-888-DIG-SAFE AND ANY OTHER APPLICABLE AGENCIES. REPORT ANY DISCREPANCIES Ctviv i k> TO VERIFY EXISTIN�­ Precast Corp., Pocasset,MA) TYPICAL CHAMBER PROFILE TO THE DESIGN ENGINEER. ELEVATION PRIOR TO ANY WORK & SEPTIC TANK PROFILE H-20 DISTRIBUTION BOX DETAIL H-20 CHAMBER DETAILS 10. ALL JOINTS WHERE PIPE ENTERS AND EXITS CONC. STRUCTURES SHALL BE MADE WATERTIGHT. NO-r`r`,' rr,' INEER IF 1-,ir-z-o-gF7NT. NOT TO SCALENOT TO SCALE NOT TO SCALE _ _ _ _ - 11. NO DETERMINATION HAS BEEN MADE AS TO COMPLIANCE WITH DEEDED OR ZONING % • - • TEST PIT DATA REGULATIONS. OWNER/APPLICANT IS TO OBTAIN SUCH DETERMINATION FROM NOTES: ; • • " * • ` • ` PERC NO. 14732 APPROPRIATE AUTHORITY. 1.) MAGNETIC MARKING TAPE SHALL BE PLACED ALONG THE TOP EDGE OF EACH SEPTIC ; ; , ►• ` * '* • INSPECTOR: David W.Stanton, RS 12. ALL SEPTIC SYSTEM COMPONENTS SHALL WITHSTAND H-10 LOADING UNLESS SYSTEM COMPONENT. ,' • ; . �•• : . a . " EVALUATOR: Michael Pimentel, EIT, CSE LOCATED UNDER PAVEMENT, DRIVES OR TRAVELED WAYS IN WHICH CASE r • , • . • • * ; THEY SHALL WITHSTAND H-20 LOADING. 2.) CONTRACTOR SHALL VERIFY SOIL CONDITIONS IN THE LOCATION OF THE PROPOSED �.�` + •• , , a s y ! C.S.E.APPROVAL DATE: Oct. 1999 LEACHING FACILITY TO ENSURE CONSISTENCY WITH TEST PIT DATA SHOWN ON THIS PLAN. ' " • • • ► ; ,', DATE: June 26, 2015 13. DOUBLE WASHED CRUSHED STONE SHALL BE FREE OF ALL DIRT, DUST AND FINES. REPORT TO ENGINEER AND LOCAL BOARD OF HEALTH IF SOILS ARE NOT CONSISTENT WITH ` • ; • 40 TEST PIT#: 1 14. WHERE REQUIRED, CONTRACTOR SHALL REMOVE ALL LOAM AND UNSUITABLE MATERIAL TEST PIT DATA. ,' • • ` • • • IN AREA BENEATH AND FOR 5 FT. ON ALL SIDES OF LEACHING FACILITY. REPLACE ALL " „ • • •,. . „ .# •` ELEV TOP= 40.90' UNSUITABLE MATERIAL WITH CLEAN COARSE SAND FREE FROM CLAY, FINES OR OTHER 3.) ENTIRE PROPERTY IS LOCATED WITHIN THE ESTUARINE WATERSHEDS. ' ` • • • ELEV WATER UNSUITABLE MATERIAL IN ACCORDANCE WITH 310 CMR 15.255(3). • ' . ` = < 30.40' 4.) DWELLING IS SERVICED BY OIL HEAT. ; • • + • 41 w ( 15. CONTRACTOR SHALL NOTIFY DESIGN ENGINEER OF ANY DISCREPANCIES FOUND IN // • . . • • PERC RATE _ <2 min./inch SITE CONDITIONS FROM THOSE SHOWN PRIOR TO CONTINUATION OF WORK. MAP 189 MAP 189 `V _ W � • . •• LOCUS � � DEPTH OF PERC 66"-84" 16. PROPOSED PROJECT IS LOCATED WITHIN: L 82 PARCEL 81 � Z • * ASSESSOR'S MAP 189 PARCEL 85 PARCE p + ; • • • . • . TEXTURAL CLASS: 1 a N • ,* , 1. • • • ; OWNER OF RECORD: THOMAS J. & KAREN M. REZENDES a; • « r I REMOVE ALL UNSUITABLE MATERIAL �* M ,� • " re .. . • • • , j 0" 40.90' ADDRESS: PO BOX 277 DOWN TO"C"SOIL& REPLACE w/CLEAN 00 •. i' • `•+, ` �, • j Loamy Sand WEST BARNSTABLE, MA 02668 r 0 a r A 10Yr 3/1 S COARSE SAND PER 310 CMR 255(3) * ;* • . • • .• I PROPOSED 2 - 500 GALLON H-20 627;r, + , �* •• ' • + LEACHING CHAMBERS WITH AGGREGATE PROPOSED INSPECTION PORT Benchmark 3� On •• �• • • • * I 12" 39.90' FEMA FLOOD ZONE X 8 , F '� 9 Spike in Tree • a + ' • • COMMUNITY PANEL# 25001C0563J • Elev. =45.00' %� ' �� •'�` . • *• . • • ` Sand Loam 17. DEED REFERENCE: BOOK 5121, PAGE 60 PROP. VENT A rox. M.S.L. " „• • �} , • B y 10Yr 5/8 18. PLAN REFERENCES: 1.)P.B. 139, PG. 153 2.)P.B. 193, PG. 15 x36.9 cA I I Q �/ r._ �� i •+*i co TP / I I I ., • 66" 35.40' 19. ALL DISTURBED AREAS SHALL BE RESTORED TO ORIGINAL CONDITION. TP 1 2"PINE 28"MAPLE • 111 I Perc x 36. 38x5' 40x9' I O • •� • 8M fit} ' 20. PROPERTY LINE INFORMATION IS ONLY APPROXIMATE. THIS PLAN IS TO BE USED ONLY MAP 189 37x5' HatCh t'y + • 84" 33.90' FOR SEPTIC SYSTEM UPGRADE. JC ENGINEERING WILL NOT ASSUME ANY LIABILITY PARCEL 84 PROP. H-20 DISTRIBUTION BOX /1 �r +,• FOR USES OF THIS PLAN OTHER THAN ITS INTENDED PURPOSE. 0 •` • P Medium- Fine Sand� ,, 21. A 4„ PERFORATED SCH. 40 PVC PIPE SHALL BE PLACED IN A VERTICAL POSITION TO A w CV) x36.6 37x5 3 .4 I f R�` / p`b r'' - - -- .. ( ,_`"��. _ r _ Ir �� n C 2.5Y 6/6 DEPTH OF THE BOTTOM OF THE SAS AND EXTEND TO WITHIN 3"OF FINISH GRADE. A REMOVABLE THREADED CAP SHALL BE PLACED ON THE TOP TO ALLOW FOR INSPECTIONS. 2 x37.1 �` / i f' - 52 - 22. IN ACCORDANCE WITH 310 CMR 15.401 -15.405,THE FOLLOWING LOCAL UPGRADE EXISTING CESSPOOL TO BE 38, " `-J LOCUS PLAN APPROVAL IS REQUESTED FROM 310 CMR 15.221 (7): � �>:",'1 � ( 18 OAK PUMPED, FILLED WITH CLEAN _ _ / o`� / v`�' I DECK STAIRS (1.) A 3.00'WAIVER(3.00'-6.00') FOR THE MAXIMUM COVER OVER THE LEACHING SYSTEM. SCALE: 1" = 1000' (2.) A 2.33'WAIVER(3.00'-5.33') FOR THE MAXIMUM COVER OVER THE DISTRIBUTION BOX. COARSE SAND &ABANDONED �� �/ �`� � DECK � � TO BE 126" 30.40' 12" AK/ �p� RELOCATED � No Mottling, Standing or Weeping Observed 40J - ` ` / / ' / DESIGN DATA TEST PIT DATA LEGEND l� Q PERC NO. 14732 42- 12"OAK / #177 NUMBER OF BEDROOMS DESIGN 3 INSPECTOR: David W.Stanton, IRS X 50.0' EXISTING SPOT GRADE _ / EXISTING �� p (DESIGN) 42 / '. 3-BEDROOM _ , ' DESIGN FLOW 110 GAUDAY/BEDROOM EVALUATOR: Michael Pimentel, EIT, CSE -- - 50 --- - EXISTING CONTOUR DWELLING TOTAL DESIGN FLOW 330 GAUDAY C.S.E. APPROVAL DATE: Oct. 1999 PROPOSED CONTOUR eiy / TOF = 55.5'± i / 0 o DATE: June 26, 2015 /N 2S,,�ry �\ s� / DESIGN FLOW x 200 /o = 660 GAUDAY (V �Q TEST PIT#: 2 50 PROPOSED SPOT GRADE OGFO 5 . I �' \ \ ��� USE PROPOSED 1,500 GALLON SEPTIC TANK Fpq�FMNT j DRIVEWAY \\ \ �'• WV Q 4 ELEV TOP= 38.50 W-----W- EXISTING WATER LINE / 3 do ELEV WATER= <28.00' -- O/H/W - EXISTING OVERHEAD UTILITIES c o PERC RATE = GAS EXISTING GAS LINE PROPOSED 1,500 GALLON SEPTIC TANK �c I � MAP 189~ 3 p -INSTALL 2 500 GALLON H-20 CHAMBERS TEST PIT LOCATION I \qr I / / DEPTH OF PERC= PARCEL 85 _\�' � 3 SIDEWALL CAPACITY 15,025±S.F. , (LENGTH + WIDTH) (2 SIDES) (2' HIGH) (0.74 GPD/S.F.) = GAUDAY TEXTURAL CLASS: 1 CP EXISTING CESSPOOL SWING-TIES PLAN SCALE: 1"=20' `� / 3 (25.0'+ 12.83')(2 ) (2' ) (0.74 GPD/S.F.) = 112.0 GAUDAY PROPOSED 4"SOLID SCHEDULE 40 PVC PIPE Q O��� / / // / BOTTOM CAPACITY 0" 38.50' El PROPOSED H-20 DISTRIBUTION BOX �9s�• �ly�\ l (LENGTH x WIDTH) (0.74 GPD/S.F.) = GAUDAY A Loamy Sand (C� / (25.0'x 12.83') (0.74 GPD/S.F.) = 237.4 GAUDAY 10Yr 3/1 �O PROPOSED 500 GAL. H-20 LEACHING CHAMBER Uti �qs�` ' / 12" 37.50' PROPOSED 1,500 GALLON H-10 SEPTIC TANK � � � TOTALS: 5) �q I ' �I Sandy Loam 6) I I 3 / TOTAL NUMBER OF CHAMBERS 2 B 10Yr 5/8 0.9, p I '" �/ REV. DATE BY APP'll DESCRIPTION TOTAL LEACHING AREA 472.2 SQ.FT. GPI(4 O \ I �9s �1--�'_ GV / \ TOTAL LEACHING CAPACITY 349.4 GAL./DAY 66" 33.00' PROPOSED SEPTIC SYSTEM UPGRADE <J 1, \• GASt t.��'7-GAS GAS-_._ PREPARED FOR: 3) CAPEWIDE ENTERPRISES (1 HC-2 Medium- Fine and 2) DECK C 2.5Y 6/6 _l\ , LOCATED AT SWING-TIES 177 OLD STAGE ROAD #177 1 DESCRIPTION HC-1 HC-2 CENTERVILLE, MA 02632 HC-1 EXISTING SEPTIC COVER IN (1) 20.6' 34.8' 126" 28 00' SCALE: 1 INCH = 20 FT. DATE: JULY 14, 2015 3-BEDROOM 0 10 20 40 80 FEET DWELLING SEPTIC COVER OUT(2) 26.9' 27.7' No Mottling, Standing or Weeping Observed o F r1�s s c _ TOF = 55.5'± _ _ `P 1� 9 ° Jofi �. PREPARED BY: CORNER OF STONE (3) 36.2' 39.0' RESERVED FOR BOARD OF HEALTH USE CFiUR ' JR. JC ENGINEERING, INC. CORNER OF STONE (4) 47.7' 48.9' '4 2854 CRANBERRY HIGHWAY CORNER OF STONE(5) 61.8 40.4 EAST WAREHAM, MA 02538 CORNER OF STONE(6) 53.4 27.6 SITE PLAN p �� ��,� 508.273.0377 SCALE: 1"=20' Drawn By: JC Designed By:MCP L Checked By: JLC JOB No.3143