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HomeMy WebLinkAbout0009 PARK AVENUE - Health 9 Park Avenue Centerville A= 208 —026 S M E,A D No. 53LOR UPC 12543 smead.com • Made In USA } col� - 15� No. Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS ZIppliLation for ;Disposal 4petem Construction Permit Application for a Permit to Construct( ) Repair(X Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. 'PA kV AVU 8,'of f,..l,15 Owner's Name,Address and Tel No. QAPC HLIF_P Assessor's Map/Parcel PO C3C>,G 3 f' d(1.y V'Z, Installer's Name,Address,and Tel. o.SCE 8—4'T7—98 7 Designer's Name,Address,and Tel.No. C`lADCS�t1�� t ��S �f.G fie- C I jo L--Ml 1 Type of Building: Dwelling No.of Bedrooms Lot Size 13, sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) ri gn gpd Design flow provided 711, 45 gpd Plan Date L4'oL(—,r 4Gi-s Number of sheets Revision Date Title 9 PARK RQ15 GC il��f.C.G Size of Septic Tank l 5C() U-p Lk-,QtJ Type of S.A.S. G CUU1PCJU6S Description of Soil f ES 14NA CM J16 / 6 c E PLAJ Nature of Repairs or Alterations(Answer when applicable) tL S E is 157T`A;& is aD <64ln 6 t1 T,4_ -M Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. Signed Date t 3 Application Approved by 1- ' Date Application Disapproved by Date for the following reasons 2 Permit No. go 13^ Date Issued TOWN OF BARNSTABLE LOCATION 9 `4 v4 s. Ave- SEWAGE# V.ILLAGEC, [& o IIG ASSESSOR'S MAP&PARCEL INSTALLER'S NAME&PHONE NO. C4MWI dQ, r V14 ge-S 44-c- SEPTIC TANK CAPACITYJf LEACHING FACILITY:(type) 4J A6 (size) 17, 3 J( 36, NO.OF BEDROOMS OWNERC cd1^ed Per ° ` ,5i' 'ran 1l11Go PERMIT DATE: / Z- t COMPLIANCE DATE: 5- / /3 Separation Distance Between the: No w g4er XMM$w Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility e¢'} /36'' 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) W Feet FURNISHED BY A—i= 33 A-3c35oq 04of —a---o??e 6 � r gVe � No. O 1 Fee �vV THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes - ftpYication for MisposaY*pstem (Construction J)ermit Application for a Permit to Construct( ) Repair(X Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. 1 PAR V- AX t✓t Vj(.LE' Owner's Name,Address,and Tel.No. %, GAPC HOO 104QP-eV P6Q.5Olvs f10�1�7 Assessor's Map/Parcel POR A6 P(-) GO Ce,).J V C.C. Installer's Name,Address,and Tel.14o.570 8_477--9817 Designer's Name,Address,and Tel.No. l G = .28 5LL lu C: l�i4P..E Type of Building: Dwelling No.of Bedrooms Lot Size 13A 61q sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided 7771, 52 gpd Plan Date LP o1 Number of sheets Revision Date Title 9 PARS. AU6 GZNM.V1C.L6 Size of Septic Tank 1 500 (EAU,,01J Type of S.A.S. �a lCJ bl F St72�l�000py Vlx� Description of Soil_ 04 (t4)k '�F S Ak)b Cp 3 r 5EE PLAhl Nature of Repairs or Alterations(Answer when applicable) Lis e tau s-(1►. Q H`20 a-�Ox TD 14 a- A m &,. we- 14-a b zS m,���_f�C i{s►J1) tr�f o u�u A�G.�` �1.) Ar ` 4 � Date last inspected: Agreement• *' The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. Signed A Date 5 1 Application Approved by ti_� Date S-- Application Disapproved by 1 ! " Date for the following reasons ", Permit No. P O 1 Date Issued S— ' THE COMMONWEALTH OF MASSACHUSETTS I _ BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired( x) Upgraded( ) Abandoned( )by CAIP9WID E- 5!N Qa CtS L4,5--- at q ��jZ�. �EN DWI(.(_15' has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. 1901 3 _19� dated S — J Installer CA06\0(br- Designer Tc— E,*J�Cr,11US&WUA6e XKX- #bedrooms Approved des' flow `7-'] J �,/ gpd The issuance of this ermit sh of a construed as a guarantee that the system ill Ition as design 0 Date 4". Inspector t/ - --- ---- =-------------_----------------- -------------- No. ao 13 - 151 Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS 33isposal *pstem Construrtion permit Permission is hereby granted to Construct( ) Repair()� Upgrade( ) Abandon( ) System located at 9 P ARle.- A U 5 e_�rnew i uL 5 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. Provided:Construction must be completed within three years of the date of this permit. Date 5- /— Approved by -T mmm,5/21/2013 02 : 16 508�2730367 y � 'N�f 4f2`1_Z P. 001/001 �• Town of Barnstable Regulatory Services Thomas F.Geiler,Director `- "MAKS, • Public Health Division iel9'`�� Thomas McKean,Director leo� 200 Main Street, Hyannis,MA 02601 Office: 508-862-4644 Fax; 508-790-6304 Date: -5"Z(' (3 Sewage Permit# 21 t S_ t 5'i Assessor's Map/Parcel Installer& Designer Certification Form Designer: :1G Enstf)ee.ccf)a, TAG- Installer: C_cecwc&- �,�Ee!?ccszs Address: 2954 Ccanloerhr ► '1'11� Address: l53 'Ca"Iti.*t a _C4W1 5� ros\ Wec(6nom_ nA 02538 IB't(t� c�ZtrS/� ,,oi;-17303 17 . On 15—% ZO t3 was issued a permit to install a . (date) (tnstalle septic system at 9 Park ' based on a design drawn by (address) C En5tt ee.-C 4�5 , T+ne_ dated Aec'l 7-6, 7-013 (designer) t 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 were found satisfactory. l 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 required) ected and the soils were found satisfactory. JOHN , URCHILL in, (lZn S.ignatu a ML L 4190 s Sig (AffixZ- g7n — natur6",'P ASE RETURNTO ARNSTABLE PUBLIC HEALN. CERTIFICATE OF COMPLIANCE WIU NQT_ ISSUED UNTIL BOTH THIS FORM AND AS- BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. q:tnflice lormsWcsignercertification form.doc Town of Barnstable P# Department of Regulatory Services e�►xrrarner$ Public Health Division Date rFD MMl A�� 200 Main Street,Hyannis MA 02601 Date Scheduled_ h Time Fee Pd. 1--l"C. Soil Suitability Assessment for S a e Disposal Performed By: Witnessed By. LOCATION& GENERAL INFORMATION Location Address 9 P � � ���� Owner's Name Cfi N Address l nr"L., Assessor's Map/Parcel: 6 / O Z( Engineer's Name y(4 (PtL r)z C, L NEW CONSTRUCTION REPAIR V Telephone# Z ? — fE 7-1 Land Use Slopes(%) Surface Stones Distances from: Open Water Body ft Possible Wet Area ft Drinking Water Well ft Drainage Way ft Property Line ft Other ft SKETCH:(Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands in proximity to holes) Parent material(geologic) Depth to Bedrock Depth to Groundwater. Standing Water in Hole: Weeping from Pit Face Estimated Seasonal High Groundwater DETERMINATION FOR SEASONAL HIGH WATER TABLE Method Used: Depth Observed standing in obs.hole: ___ in. Depth to soil mottles: in. Depth to weeping from side of obs.hole: in. Groundwater Adjustment fr. Index Well# Reading Date: Index Well level ,,�„ Adj.factor.,,,,.,,e,..— Adj.Groundwater Level,R,e PERCOLATION TEST Ditto Thne,. Observation Hole# Time at 9" Depth of Perc Time at 6" Start Pre-soak Time @ Tim(9"•6") End Pre-soak Rate Min./Inch Site Suitability Assessment: Site Passed Site Failed: Additional Testing Needed(Y/N) Original: Public Health Division Observation Hole Data To Be Completed on Back----------- ***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:\SEPTICVERCFORM.DOC DEEP-OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture .Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Coll ency.%Gravel) DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency,%Gravel) DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency.%Gravel) DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency. s Flood Insurance Rate Map: Above 500 year flood boundary No_ Yes Within 500 year boundary No Yes Within t00 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? If not,what is the depth of naturally occurring pervious material? Certification I certify that on (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 experience described in 3 10 CMR 15.017. Signature Date Q:\.SEMOPERCFORM.DOC Town Fof°Barnstable _p# 1 J - Departinent of Regulato Services rY` Public Health Division sn� Date G y 200 Main Strce H anais MA 02601 Date Scheduled "7 / / Time -Fee Pd.. ,.o- Soil..Suitability Assessment for Swage Disposal Performed-By:-- 1�G4iae` \(m��n4�( , l✓3-..j C S Fr Witnessed By: Location Address © LOCATION&:'CrE4�7Ec�AL11p�Tk+'�RIVIATION``" ' LLC" wner s Name ��pa✓ �� SONS Address 130Y Assessor's Map/Parcel.• e)8 /D.a& Engineer's Name C% ekJTWrQsES t.LC.. c,4 of NBW CONSTRUCTION REPAIR X T G SG Eng(neen,15 ele hone# ��O �77 a8`� 73-0377 Land Use: Sin4e �OM- y c�tue«t Slopes(96) 1 3 Surface Stones Distancea from: Open Water Body _ ft Possible Wet Area ft Drinking Water Well ft Dcalnage Way _ ft Property Line 7 t 0 ft Other g SKETCH:(Street Dame,dimensions of lot,exact:locations of teat holes-&perc tests,Jocatc wetlands in proximity to holes) Sew atta Parent material(geologic) pu�wczs� Depth to Bedrock Depth to Groundwater. Standing Water in Hole: Weeping from Pit Fore Estimated SeasonaLHIgh Groundwater _ 7 13 i S DETERMINATION FOR SEASONAL HIGH WATEH TABI Method Used: DIf"A 0\vsetyatL+" Depth Observed standing in obs.hole: Y 3 In, Depth to 5911 mottlaa:. In, Depth to weeping from aide of obs.hole: In, Groundwater Adjustment ft. Index Well# Reading Date: — Index Well level w AdJ`1lCtbr AdJ',MoutidYMtd1ivel,.;-_ ':PERCOLATION TESL' Ditto Time Observation Hole# — F Time a; Depth of Pere b�_ 5 y r: Time at 6" Start Pre-soak Time® I D:20 A M Time(9"-6") End Pre-soak l 0:18 AM Rate Min.Glnch•. Site Suitability Assessment: Site Passed BLS Site Failed: Additional Testing Needed(YIN) /1/ Original: Public Health Division Observation Hole Data To Be Completed on Back—= ' ***If percolation test is to be conducted within 100' of wetland,you must first notify the Barnstable Conseirvation Division at least one(1)week prior to beginning. O:ISEPTICIPER CFOR M.DOC DEEP.OBSERVAT ON I OLE.LOG''' Hole# tz Depth from: k Soil Horizon Soil Texture .Sdil Color Soil Other Surface(in.) (Mansell).=-' Mottling< z(Structpie,Stone;Boulders. 777 ;.y. 'Orayeq �- IZ LS 14�� 36- 13(o L F1-GS 2,5 YbA, DEEP OBSERVATION HOLE LOO ;; Hole# Depth from Soh Horizon '' Sotl Texture '`•• Soil Color Soil Other; Surface(1m), (USDA) (Mansell)` Mottling (Structure,Stones,Boulders. DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency,%Gravel) DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Sol[ Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Slopes;Boulders. Flood Insurance:Rate,.lVap• -. . Above 500 year flood bound No— Yea witiin.5oo`yearboundary No a__Yes' Within I year flood boundary.No ✓ Yes Death of Naturally Occur•,•rrrma Pervious Material Does at least four feet"of naturally occurring pervious miterial exist in all areas observed throughout the area proposed for the soil absorption system? -- If not,what is the depth of naturally occurring per material? �..._._..� Certification ed b the • approved 1 0-27-R 4 date I have passed the soil evaluator�examtnsittan r! Y I certify that on (date) Department of Environmental Protection and that the above analysis was performed by me consistent with. the,required training,expertise and a rience described in l 0 CIvIR 15.017. Signature - Datt: Q . :�SEprnopERCFORM.DOC OWN OF BARNSTABLE LOCA11C-N OC`r'� t SEWAGE # VILLAGE ASSESSOR'S MAP & LOT INSTALLER'S NAME & PHONE N��Cl��t1�A�`� SEPTIC TANK CAPACITY LEACHING FACILITY:(type) t�, (size) NO. OF BEDROOMS r7 PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNER DATE PERMIT ISSUED: 10 DATE COMPLIANCE ISSUED: 10 cl q VARIANCE GRANTED: Yes No � C 349l� 49 �. No.... APPROVED THE COMMONWEALTH OF MASSACHUSETTS aarnstab%Conservation-DePrUmnt BOARD OF HEALTH A `%�qned 3oyo.,q4 OWN OF BARNSTABLE ,, ate Applir 1D1111 for Di-ripagal Works Tic atitrurtion Urrmit Application is hereby made for aP.e Construct or Repair an Individual Sewage Disposal System at ........................... ............. ....... ........... .................................... ........... .......... LoczL&n-Address ....... .... ....... ................ ..... --- 0----1_--------------------- ---------------- C V'L dc' )S, V. ...... ..............I.............. ........................................ .........V ....... ------------------------ ...I...... Installer Address Type of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms----- ----7------------------ --------------Expansion Attic Garbage Grinder �1 04 Other—Type of Building ............................ No. of persons--____--_-.-__-____-_-----__ Showers Cafeteria Other fixtures ----------------------------------- ------------------------------------------------------------------------------------------------------------------ Design Flow--------------------------------------------gallons per person per day. Total daily flow............................................gallons. 9 Septic Tank—Liquid capacity............gallons Length---------------- Width.--_----.-____- Diameter---------------- Depth................ Disposal Trench—No. .................... Width.._.._.............. Total Length......._._._........ Total leaching area---------_--------sq. f t. Seepage Pit No-_--------- ------- Diameter.............._...__ Depth below inlet_...___............. Total leaching area..................sq. ft. Z Other Distribution box Dosing tank Percolation Test Results Performed by.---------------------------------------------........................... Date........................................ Test Pit No. I................minutes per inch Depth of Test Pit-------______-.----. Depth to ground water..__.........._......... 40 Test Pit No. 2................minutes per inch Depth of Test Pit.............._..... Depth to ground water....__....._............ 04 ------------------------- ------------------------------------------------------------------------------------------------------------ 0 Description of Soil......................: ....... ............................................................................................................ �4 Si. U ...................................................... .................... ............................................................................................................. ..................................................................................... - --------------------------------------------- ----------------------------------........ ature Repairs or Alter Uion --Answe wh atplicable-------------- _--------------------- . .... ............................... .......................J_� QD......... ................... ..... Ag-r-ei ent: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Comps' issued by the bo4rd of health. -3--- ----------------------------- a a Signed ............. ---- ------------------ Date Application Approved By ................ ................................................................... . ........- ---0 ---- Dare ------- Application Disapproved for the following reasons-- --------------------------------------------------------------------------------------------------------------- --------T9L 30, ....................... ace PermitNo. ----------7_�j-------- .3.................. Issued ----------------------.........----------------------------------- Due THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Trmfifirate of Compliance 1�ADIS TO CE TIFY, That the Individual Sewage Disposal System constructed or Repaired Q9,5- . .......... ------- ------ Ely ............... In J,•r --- -- -------------------------------------- ------------------ ------ -------------------------------------- ......... .................... ... . ....... ---------- ....... ------------- ------------------ at -------------------- ....... ------- —------ ...... has been installed in accordance with the provisions of TITI. 5 of The State Environmental Code as described in the application for Disposal Works Construction Permit No. ......a. dated ............................................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE.............. ----------------I--------------------------------------------------------------------- Inspector,—------------- -———————---——— ,:�5 5� r—— ———————————————---— ————————————————————————— lb THE COMMONWEALTH OF MASSACHUSETTS 4 t)?JO BOARD OF HEALTH TOWN OF BARNST ABLE N01�1.-.J;L.� FEE.--•--••.'..k)... UWplar! Worig Permission is hereby granted a v- kt�4' ........ .......... .......................................................................................... -------------------*---------*------- .... to Construct or Re air granted___. Individual Sewage D* osall System,............ .... -,P at No.................... .......I.....(............................A..e........... . ..... . . .... ...................... Street — 0—.7 as shown on the application for Disposal Works Construction Permit No--------------------- Dated___- -- ------------- .......... '11� � .............................. . .............................................................. DATE................ --—---- 0---—--- ...L/......................... Board of Health FORM 38808 HOBBS 6 WARREN.INC..PUBLISHERS Ftz No.---;..L�. • s.............................. �V/ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH 3pmo„gyTOWN OF/BARNSTABLE Appliration for Di5.puutti Work.5 C ongtriirt- t Frrmit Application is hereby made for a Permit to Construct ( ) or Repair an Individual Sewage Disposal System at .... p Location-i\ddress '• ��`��� / 1 L ��f�L Lot No. \ - ry �`.----- ..-aCe...' .............v ,O \n j f/\� It, .....CInstaller Address UType of Building Size Lot............................Sq. feet �. Dwelling—No. of Bedrooms--------------------------------------------Expansion Attic ( ) Garbage Grinder ( ) p`4 Other—Type of Building ____________________________ No. of persons--_-________----______--_- Showers ( ) — Cafeteria ( ) a Other fixtures ----------------------------------------------------- W Design Flow--------------------------------------------gallons per person per day. Total daily flow............................................gallons. W Septic 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..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by.......................................................................... Date.......................__............. Test Pit No. 1................minutes per inch Depth of Test Pit-------------------- Depth to ground water........................ 44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 9 .-•-------------------------------------•---------------------------------------••---------••-------......................................................... O Description of Soil....................... ....... . ------,---_-- UW --------------------------------------------------------------------------------------�---.------------------------------ Nature Repairs or Alterations—Answe whe i�a plicable--------------_ -:._5_ -a..... .__... P:�....... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Compl' nce has been issued by the board of�health. q Signed .........:... .�.-�------------�- L�-�`---^-`'` ............... .., ............................... �,,�,,,, Application Approved By ............ .J..............�-. - ..�-"'"-.-.'�-..... Dare ''S...�.3. -.�.1. ... Dare Application Disapproved for the following reasons: .. . ..... .................... . .. ..... ........ .................... ........................................ .............. .............. ....... ............ ............. ............ ......... . ------3.—.30.` .. Permit No. L� �... .. - _ _c ,`Da e Issued -►' Dace �p1NE rq Town of Barnstable Public Health Division °"n„sreLe.$ 200 Main Street Hyannis,MA 02601 i i �� ---�_ i ._. _ - . .��-� - ..._ �� . -�-.�.....�r �+w�la��wNl� �.�aw+. rat ��� -�- ..� v ,� ..- - � � i :M� ' ,.: i I N', yi qig4-alwv L0. ,r�iTI0'N SEWAP..E PERMIT NO. L . VILLAGE INS A LLE 'S NAME ,i ADDRESS ' e UILDE'R OR 0 II DATE PERMIT ISSUED rZ_a5'- / DATE COMPLIANCE ISSUED 9 c �- A I 0. `rRn t IIST 1000 gAI L./? 1000 THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH Application is hereby made for a Permit to Construct or Repair X) an Individual Sewage Disposal System at: Location-Address or 0 Installer Address Z Other Distribution box ( ) Dosing tank ( ) - U Nature of Repairs or Alterations—Answer when applicable..irkatall�Lti.Qn.. ..tank, Agcccozcoz: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE �� d� S C�� operation until a Certificate of Compliance has been issued by-the bo 0 Ith -~n —/-----------'r----T-------------------- ----- --'--'' | Application Approved By--------. ----`--------'- ------ -_____ / � �=" � Application Disapproved for the following reasons:................................................................................................................ .................................................................................................................'--................................................................................. Date UI Paoo�[�o----�................................................ Issued.................. ..................... � 4 NOSZ'... ..... FEs... ...5.00........ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .-------- ------- --T':sin.......OF.........&rnstable...- Appliration for 14,6p sal Works Toustrairtion ramit Application is hereby made for a Permit to Construct ( ) or Repair (X ) an Individual Sewage Disposal System at: Paxk Ave. Centerville r�A e26 2 Location-Address or Lot No. Dorothy3Ig......--••--•-------------------•----.........------•----..•... 1►7..^i Y� ..uum�s �..+ uZ z'dB.. � .......... owner Address a A_&__B Cesspool Service 128 Bishops-Terrace, Hycnnis, MA 02501 Installer Address U Type of Building Size Lot............... ..........Sq. feet Dwelling—No. of Bedrooms................. ........................Expansion Attic ( ) Garbage Grinder ( ) a Other—T e of Building ............. No. of ersons._...__..8.._.__..________ Showers a YP g P ( ) — Cafeteria ( ) Other fixtures . W Design Flow............................................gallons per person per day. Total daily flow............................................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..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by.......................................................................... Date...........,............................ Test Pit No. I................minutes per inch Depth of Test Pit................... . Depth to ground water........................ 44 Test Pit No. 2................minutes per inch Depth of Test Pit..................... Depth to ground water........................ 9 --•-----------------------•--•----•-••-------------------...--------•-••......--•---•-------._....--........................................................ 0 Description of Soil.........Sa??d.......................... x U •---•--•-•-----•-------•--•................................................................•--------•-----•-----•-------------....----------------------••----------------------.........-•-•••--.---••- W V Nature of Repairs or Alterations—Answer when applicable.iris &11stiOn_-Of__a.. _+_ 00-• � o ._ � i -_te11k, 1 distribution box and 2 1.000 mllon stone rcked lsch_-pits. __.______-_•____- -••----------------------------------••- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been 'ssued by the bo of alth.. , Signed------------ -- Application Approved BY................ ' ......... 7l f-- -------------- Date Application Disapproved for the following reasons-----------------------------•----------------------------------------------------------•--...._......--•-------- ••••---•-•----.......•---.....•••--._....-••-------•---••----...•••-•----...--•••-•-----------------•---......_.....--••---•---•••----••----•••--....•••---••---•--•••••-•------...-----••---------...... Date PermitNo..81-............................................... Issued•....-----•--------Datec 18--------------------- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ....................T own...........OF........Ba.M stable ...........................................................•---.... Tn#ifirttte of Tomplianrr THIS IS TO CERTIFY, That the Individual Sewage Disposal S stem constructed ( ) or Repaired (X ) by A & B Cesspool Service, 128 Bishops Terrace, Hyanns,t MA .02601 - 77 -6264 ............. Park Ave. Centerville - DorothyInstall at----------------•--`-------------------••---------•--------------------.---- - -Lansi ng has been installed in accordance with the provisions of TITLE j of The State Sanitary Code] as escribed in the application for Disposal Works Construction Permit 0�4_ �2i dated_._..___?/-2 81 THE ISSUANCE OF THIS CERTIFICATE- SHALL NOT BE CONSTRUED AS A GUAR NTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE...............7/2 7/81................................................ Inspector-------- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH Town .OF.........Barnstable .......................................... ...................... Disposal Works Tarntrndinn rrmit Permission is hereby granted.__&..2_.Cesspool-.S iCe,._ 12�i_�3ishops.Tez aee,___ ,y2nnis 02601 to Construct ( ) or Repair (X ) an Individual Sera e Disposal System at No.....9 Park Ave.:�. Centerville, - Doro hX Lansing .................... Street as shown on the application for Disposal Works Construction Permit No.8......._�,dofi ted.. 12 1....................... _...._ . . --__. . .............................._ 81 alth DATE-------•---•---.�•------/--•-------•------------------••--•----........... FORM 1255 HOBBS & WARREN. INC., PUBLISHERS T.O.F. EL.= 45.0'± -FINISH GRADE OVER D-BOX= 44.6'± 4"SCHEDULE 40 PVC MIN. SLOPE 1 % PROPOSED 4" PVC VENT FINISHED GRADE OVER BIODIFFUSERS = 42.8' - 44.5' GENERAL NOTES f PROVIDE EXTENSION RISER SLOPE @ 2% MIN. INSPECTION PORT WITH WITH COVER OVER INLET& REMOVABLE WATER-TIGHT COVER OVER ACCESS BOX TO WITHIN 3"OF 1- UNLESS OTHERWISE NOTED, ALL SYSTEM COMPONENTS AND CONSTRUCTION FINISH GRADE OUTLET TO WITHIN 6"OF F.G. RISER TO WITHIN 6"OF FINISHED GRADE F.G. (ONE PER OUTER ROW) METHODS SHALL BE IN ACCORDANCE WITH TITLE 5 OF THE STATE ENVIRONMENTAL @ FND. EL.= 44.8 ± F.G. OVER TANK EL. = 44.9± 5"DIA- OUTLET(S) CODE AND ANY APPLICABLE LOCAL RULES. } 2. ANY CHANGES TO THIS PLAN MUST BE APPROVED BY THE BOARD OF HEALTH AND THE DESIGN ENGINEER. PROPOSED 4" SEE NOTE 21 SEE NOTE 21 3. 4 SCHEDULE 40 PVC PIPE WITH WATER TIGHT JOINTS SHALL BE USED IN DISPOSAL EXISTING 4" PVC SEWER PIPE L4" PVC 3.68' MAX. 4.27' MAX. TOP OF SAS/B.O. = 4.0.23' 4" SCHEDULE PIPE � �] _, � SYSTEM UNLESS OTHERWISE NOTED. - - Y' '� 3" DROP MAX p 4. TO PREVENT BREAKOUT, THE PROPOSED FINISHED GRADE SHALL NOT BE LESS THAN 6" 3" 2" DROP MIN 3 9 MIN.SLOPE(a�1% PROVIDE WATERTIGHT ELEVATION =40.23' FOR A DISTANCE OF 15'AROUND THE PERIMETER OF THE SAS. UNLESS A 10' FROM JOINTS (TYP.) 1.33' nJ(TYP) 16p 40 MIL GEOMEMBRANE LINER IS PLACE AT LEAST FIVE FEET FROM S.A.S.AND THE TOP OF 42.6'` _1 14" J*41 .5'± NK o 4" PVC OUT TO 0 90, (TYP.) THE LINER IS NOT LESS THAN THE BREAKOUT ELEVATION. LEACHING FACILITY �TT' 5. SLOPE ALL SOLID PIPE AT 1.0% MINIMUM. n ni 12" 6p CONTRACTOR TO PROVIDE CONTRACTOR CONTRACTOR SHALL ' ' 39.80' 38.90' laid flat 2.875'(34.5")_I 6. THIS SYSTEM IS NOT DESIGNED FOR A GARBAGE DISPOSAL. SHALL VERIFY SIZE 48" VERIFY CONDITION OF OUTLET TEE 40.17 MIN. 40.00 ( (TYP.) 7. LOCAL BOARD OF HEALTH AND DESIGN ENGINEER TO BE NOTIFIED PRIOR TO BACK SPECIFIED DROP BETWEEN 5.0' AND CONDITION OF EXISTING TEES 6"CRUSHED STONE TYP.) PROP. 1.2'WIDE COUPLING 5' MIN. FILLING WHEN SYSTEM IS NEARLY COMPLETE AND READY FOR INSPECTION. SYSTEM IS INLET AND OUTLET EXISTING SEPTIC AND REPLACE AS GAS BAFFLE ( 17.25' OVER MECHANICALLY AT END OF EACH ROW REQ'D NOT TO BE BACK FILLED WITHOUT FIRST OBTAINING APPROVAL FROM BOARD OF HEALTH TANK NECESSARY COMPACTED BASE 36.2' AND DESIGN ENGINEER. 6 OUTLET DISTRIBUTION BOX (TYP.) 8. ELEVATIONS BASED ON APPROXIMATE M.S.L. DATUM. BENCHMARK ELEVATION OF 45.00' TO BE INSTALLED ON A LEVEL STABLE GROUND WATER ELEV.= < 33.77' BIODIFFUSERS (END VIEW) ESTABLISHED ON A CHISELED SQUARE AT THE BULKHEAD AS SHOWN ON PLAN. BASE. FIRST TWO FEET OF OUTLET 9. CONTRACTOR SHALL VERIFY ALL UTILITY LOCATIONS PRIOR TO CONSTRUCTION EXISTING 1 ,500 GALLON CONCRETE SEPTIC TANK PIPES TO BE LAID LEVEL. BIODIFFUSERS (PROFILE) THROUGH DIG-SAFE AT LEAST 72 HOURS PRIOR TO COMMENCING WORK ON SITE AT CROSS SECTION VIEW (BY INFILTRATOR SYSTEMS, INC.) 1-888-DIG-SAFE AND ANY OTHER APPLICABLE AGENCIES. REPORT ANY DISCREPANCIES TO THE DESIGN ENGINEER. *CONTRACTOR TO VERIFY EXISTING ELEVATION PRIOR SEPTIC TANK PROFILE H-20 DISTRIBUTION BOX DETAIL ARC 36HC (#3616BD) BIODIFFUSERS (H-20) 10. ALL HE DE GNENGHERE IPEENTERSANDEXITSCONC. STRUCTURESSHALLBEMADEWATERTIGHT. TO ANY WORK & NOTIFY ENGINEER IF DIFFERENT NOT TO SCALE NOT TO SCALE NOT TO SCALE 11. NO DETERMINATION HAS BEEN MADE AS TO COMPLIANCE WITH DEEDED OR ZONING + - - • �'+:� o PERC NO. 13925 TEST PIT DATA REGULATIONS. OWNER/APPLICANT IS TO OBTAIN SUCH DETERMINATION FROM 4� • APPROPRIATE AUTHORITY. '*•++ . � � � �, '�� « �� * �w INSPECTOR: Donald Desmarais, R.S. 12. ALL SEPTIC SYSTEM COMPONENTS SHALL WITHSTAND H-10 LOADING UNLESS • ' 50 LOCATED UNDER PAVEMENT, DRIVES OR TRAVELED WAYS IN WHICH CASE .•. • me ra « • EVALUATOR: Michael Pimentel, EIT, CSE C.S.E. APPROVAL DATE: Oct. 1999 THEY SHALL WITHSTAND H-20 LOADING. �' + .• . • • « • . •« O« 13. DOUBLE WASHED CRUSHED STONE SHALL BE FREE OF ALL DIRT, DUST AND FINES. • • s ` • DATE: April 18, 2013 `` *, « • '. X% ` TEST PIT#: 1 14. WHERE REQUIRED, CONTRACTOR SHALL REMOVE ALL LOAM, SUBSOIL AND UNSUITABLE 14 MATERIAL IN AREA BENEATH AND FOR 5 FT. ON ALL SIDES OF LEACHING FACILITY. • © .,, « « • + ELEV TOP= 45.30' REPLACE ALL UNSUITABLE MATERIAL WITH CLEAN COARSE SAND FREE FROM CLAY, MAP 208 • '���' t 1 ELEV WATER= <33.97' FINES OR OTHER UNSUITABLE MATERIAL IN ACCORDANCE WITH 310 CMR 15.255(3). ••• • ° -_ 15. CONTRACTOR SHALL NOTIFY DESIGN ENGINEER OF ANY DISCREPANCIES FOUND IN PARCEL 27-001 * • ••. « , ) PERC RATE _ <2 min./inch SITE CONDITIONS FROM THOSE SHOWN PRIOR TO CONTINUATION OF WORK. \ N « « a • p • .� ' F� • DEPTH OF PERC= 36 ` " 16- PROPOSED PROJECT IS LOCATED WITHIN: Benchmark oti���� �� �tiF�� N r _�_ �• •• •� 1�� • TEXTURAL CLASS: 1 ASSESSOR'S MAP 208 PARCEL 26 Chiseled Square O l 0 ■ • , � r. PPROX. LOC. OF EXISTING Elev. =45.00' ti O� 2 6 an rry . • • • LOCUS OWNER OF RECORD: CAPE HEAD INJURED PERSONS' HOUSING AND CACHING PIT TO BE PUMPED. Approx. M.S.L. Busy+(TYP \ /LF z + « « . • + ' '' EDUCATION GROUP, INC. EMOVED & REPLACED WITH % `-RAMP9sD� ; 0 45.30 PROPOSED 12 WIDE ARC 36 CLEAN COARSE SAND PER ��� ^ --_ ^ a - • * •♦ 4" Fill 44.97' ADDRESS: P.O. BOX 315 BIODIFFUSER COUPLING (TYP OF 6) 310 CMR 255(3) N69^2a3�, /�i�+� \c J • + a ~ ► 4 ' '� • A Loamy Sand CENTERVILLE, MA 02632 �o� ���°��� a 9s MAP 208 •. • .! 10Yr 3/1 PROPOSED INSPECTION PORT / �Pl L- 1 \ • + ' „�• �� O . • 12" 44.30 FEMA FLOOD ZONE C WITH H-20 ACCESS BOX (TYP OF 2) CE l \ PARCEL 27-002 « DECK d' • � COMMUNITY PANEL# 250001 0016 D i �; so '" • ; " II «' Loamy Sand xX� p`5 ' �'� 9`^� nor, �jkS` � 3 : 11 + B 10Yr 5/6 17• DEED REFERENCE: L.C.C. 130574 / / . ` LSA #9 \Jo s 0 0 18. PLAN REFERENCE: L.C. PLAN No. 12422-G BI1-.DRIVE-- EXISTING � � ---� ° o • • 36" 42.30' � MAP 208 BH 7-BEDROOM �' � � \` Perc 19. ALL DISTURBED AREAS SHALL BE RESTORED TO ORIGINAL CONDITION. PARCEL 142 �p� Fy DWELLING _y _ ( 54" 40.80' 20. PROPERTY LINE INFORMATION IS ONLY APPROXIMATE- THIS PLAN IS TO BE USED ONLY L.P.f � TOF =45.0'± G.M `44\ - - ' / C FOR SEPTIC SYSTEM UPGRADE. ,-C ENGINEERING WILL NOT ASSUN%,,,NW LIABILITY INV -42.6'± -- '�-' ! FOR USES OF THIS PLAN OTHER THAN ITS INTENDED PURPOSE. �� .- . • C Med.-Coarse Sand F « • 2.5Y 6/6 ,per �`�,� _ i► = ePS�// � �,� \� • , � F 21. IN ACCORDANCE WITH 31U CMR Y5.401 - 15.405, THE FOLLOWING LOCAL UPGRADE & MAP 208 �ti ��� APPROVALS ARE REQUESTED FROM 310 CMR 15.221 (7): l (1.) A 1.27'WAIVER(3.00'-4.27') FOR THE MAXIMUM COVER OVER THE LEACHING SYSTEM. PROPOSED 4" PVC VENT PIPE; 1�F�' '^ O � � �0p�o�Po PARCEL 26 �� (2.) A 0.68'WAIVER(3.00'-3.68')FOR THE MAXIMUM COVER OVER THE DISTRIBUTION BOX. O EXACT LOCATION PER OWNER 1 O � ��� G °C _ ` AR 131014 S.F.± C� ) LOCUS PLAN PROPOSED TOTAL 42 ARC 36HC (#3616BD) I ��F '�� p,• SCALE: 1"= 1000' TP 2 LP '_TREE f BIODIFFUSERS (H-20) IN A FIELD CONFIGURATION /ph / \\�, `� �,rO 136" 33.97' 1 45x1' J _ LSA 'Lio No Mottling,Weeping or Standing Observed i PROPOSED 6-OUTLET H-20 DISTRIBUTION BOX - - O P TEST PIT DATA _ EXISTING DIS f RiBUTiON BOX T O BE RENIU'dEu T DESIGN DATA LEGEND TREE'' 45x3 Q O�G � PERC NO. 13925 EXISTING 1,500 GALLON SEPTIC TANK TO BE J f ti Q,P �� �w,q4P� INSPECTOR: Donald Desmarais, R.S- 50x0' EXISTING SPOT GRADE UTILIZED IN THIS DESIGN (PRE-APPROVED BY B.O.H. � �, O \ NUMBER OF BEDROOMS (DESIGN) 7 EVALUATOR: Michael Pimentel, EIT, CSE - - 50 -- EXISTING CONTOUR DIRECTOR THOMAS MCKEAN FOR UPGRADE ONLY) �',q srp G �2°TREE ��O J�Ci Jt�1 DESIGN FLOW 110 GAUDAY/BEDROOM C.S.E. APPROVAL DATE: Oct. 1999 -� 50 PROPOSED CONTOUR APPROX. LOC. OF EXISTING LEACHING pJ pJ TOTAL DESIGN FLOW 770 GAUDAY DATE: April 18, 2013 PIT TO BE PUMPED, FILLED WITH CLEANJiO�pO ��'� -( ��P�IG�� o = 1,540 ❑/H/W - EXISTING OVERHEAD UTILITIES COARSE SAND &ABANDONED r DESIGN FLOW X 200 /o GAUDAY TEST PIT#: 2 EXISTING h '� ���� P5�,.00�� GREENHOUSE p,6 9 �� QP Q 3� 4z USE EXISTING 1,500 GALLON SEPTIC TANK* ELEV TOP= 45.10' ELEC EXISTING UNDERGROUND ELECTRIC LINE 18"TREE pI OF � = �C. *THE USE OF THE EXISTING 1,500 GALLON TANK WAS PRE-APPROVED BY B.O.H. ELEV WATER < 33.77' MAP 208 LSA ��°G p�`� SWING-TIES SCALE: 1"=20' DIRECTOR THOMAS MCKEAN FOR UPGRADE PURPOSES ONLY. EFFECTIVE PERC RATE - W W EXISTING WATER LINE I/ LIQUID CAPACITY OF 195/o OF THE DESIGN FLOW IS PROVIDED IN THE PARCEL 143 GUYWIRE DESCRIPTION HC-1 HC-2 EXISTING 1,500 GALLON SEPTIC TANK. GAS EXISTING GAS LINE DEPTH OF PERC= BIODIFFUSER CORNER(1) 25.4' 30.1' TEXTURAL CLASS: 1 �' TEST PIT LOCATION u.P.#4o INSTALL 42 - ARC 36HC (#3616BD) BIODIFFUSERS (H-20) BIODIFFUSER CORNER(2) 41.8' 41.9' and 6 COUPLINGS EXISTING 1,500 GALLON SEPTIC TANK BIODIFFUSER CORNER(3) 48.5' 70.1' 0" 45.10' O O O BIODIFFUSER CORNER(4) 35.3' 63.8' SYSTEM CAPACITY 4" Fill 44 77' PROPOSED 4"SOLID SCHEDULE 40 PVC PIPE (TOTAL L.F. OF BIO'S &COUPLINGS)(4.8 SF/LF)(0.74 GPD/SQ.FT.)=GPD A Loamy Sand (2172)(4.8 SF/LF)(0.74 GAUSQ.FT-)= 771.5 GAL. LEACHING/DAY 12^ 10Yr 3P, 44.10' E PROPOSED H-20 DISTRIBUTION BOX 0 PROPOSED ARC 36HC(#3616BD)BIODIFFUSER(H-20) TOTALS: B Loamy Sand O� TOTAL NUMBER OF BIODIFFUSERS: 42 10Yr 5/6 TOTAL NUMBER OF COUPLINGS: 6 " REV. DATE BY APP'D. DESCRIPTION HC-1 TOTAL LEACHING AREA: 1,042.6 PROPOSED SEPTIC SYSTEM UPGRADE BH EXISTING TOTAL LEACHING CAPACITY: 771.5 ^A- 7-BEDROOM �'�� PREPARED FOR: � DWELLING TOF =45.0'± NOTE: Med.-Coarse Sand CAPEWIDE ENTERPRISES C(3 EFFECTIVE LEACHING AREA OF 4.80 SF/LF OBTAINED FROM THE 2.5Y 6/6 <<J�`t��� DEPARTMENT OF ENVIRONMENTAL PROTECTION APPROVAL LETTER LOCATED AT `s / "MODIFIED APPROVAL FOR GENERAL USE" ISSUED TO INFILTRATOR o�°Pc`� SYSTEMS, INC., DATE OF ISSUANCE OCTOBER 3, 2003 (LAST MODIFIED 9 PARK AVENUE A �pP MARCH 14, 2012). TRANSMITTAL NUMBER=X235253. CENTERVILLE, MA 02632 SPECIAL NOTES: HC-2 0� o' 136" 33.77' SCALE: 1 INCH = 20 FT. DATE: APRIL 26, 2013 1. MAGNETIC MARKING TAPE SHALL BE PLACED ALONG THE TOP EDGE OF EACH SEPTIC � 2) --r o 10 20 ao so FEET No Mottling, Weeping or Standing Observed P�Ti+of _-- SYSTEM COMPONENT- -- �� PREPARED BY: 2.) CONTRACTOR SHALL VERIFY SOIL CONDITIONS IN THE LOCATION OF THE PROPOSED r RESERVED FOR BOARD OF HEALTH USE CHUF;CN11 L JR y IOHN L. JC ENGINEERING INC. LEACHING FACILITY TO ENSURE CONSISTENCY WITH TEST PIT DATA SHOWN ON THIS PLAN. �G� No. 07 2854 CRANBERRY HIGHWAY REPORT TO ENGINEER AND LOCAL BOARD OF HEALTH IF SOILS ARE NOT CONSISTENT WITH O TEST PIT DATA. �p�`Q ���° ; ,,r�Fc `w EAST WAREHAM, MA 02538 SITE PLAN Gay 508.273.0377 3.) ENTIRE PROPERTY IS LOCATED WITHIN THE ESTUARINE WATERSHEDS. -- - ------- -- -- - -- I SCALE: 1"=20' Drawn By: BSM Designed By:MCP Checked By:JLC JOB No.2410