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HomeMy WebLinkAbout0038 PEEP TOAD ROAD - Health 38 PEEP TOAD ROAD Centerville A = 173 — 068 SMEAD KEEPING YOU ORGANIZED No. 12534 2-153LOR SUSTAINABLE FORESTRY MIN.RECYCLED INITIATIVE CONTENT 10% Certified Fiber Sourcing POST-CONSUMER www.stiprogram.org SFW12M MADE IN USA GET ORGANIZED AT SMEAD.COM TOWN OF BARNSTABLE LOr-ATION i m SEWAGE#� VILLAG 1,fA A ESSOR'S MAP&PARCELl INSTALLER'S NAME&PHONE NOL-;Vbi r SEPTIC TANK CAPACITY LEACHING FACILITY:(type)�! '.-,C 11 y' P�/ size) NO.OF BEDROOMS ' OWNER y PERMIT DATE: COMPLIANCE DATE: l 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 • 1 N e f Zo 3i1 6 ` No. 1 Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes _�� PUBLIC HEALTH DIVISION - TOWN OF,.BARNSTABLE, MASSACHUSETTS 4pliCation for Bispo8al *pstem Construction Vermit Application for a Permit to Construct( ) Repair Upgrade Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. Owner's sNName,Address,and Tel.No. Assessor's Map/Parcel 17M> e r, / �✓��� InstallersN�ddl@ s,/and Tel.N Designer's Name Addre d T Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder.4. Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.req red) gpd Design flow provided gpd Plan Date 7J" Number of sheets / Revision Ate Title - , Size of Septic Tank AODD &CCDJWcr2,pe of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer en applicable) LL G_ 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 a system in operation until a Certificate of Compliance has been issued by this Bo 1 e Date Application Approved by Date Application Disapproved by Date for the following reasons Permit No. �2ql J Date Issued / ------------------- - --- —_-_— _—�-_- --- -----��_�a� - ------ - -- No. �✓V� Fee' I � THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS y 01ppYltatlon for Misposal 6pstem Construction 3pPrmit Application for a Permit to Construct( ) Repair( pgrade Y Abandon( ) ❑Complete System ❑Individual Components Locatiori'Address or Llot No.3� Owner's Name,Address,and Tel.No. >, Assessor's Map/Parcel Installers Name,Address, Tel.No. �. M Designer's Name,Address,and Tel.No. � �© Q� t►►''dT n/,fit ..,`j"` CO 4 ' — --r —V_ . 1 r Type of Bu'd 7' ing: '`+ `'—� / Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder'. Other Type of Building No.of Persons Showers(._4)` Cafeteria( ) Other Fixtures Design Flow(min.req red) gp fA'sign flow provided gpd Plan Date Numblr of_isheet"s Revision Dfate Title Size of Septic Tank p 10 S. Description of Soil� r � s '�" 11 ,.�•""`� Nature of Repairs or Alterations(Answer en 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 Bo of Heal Sign e Date_�R,)jn ),-7-�1 Application Approved by Date Application Disapproved by Date for the following reasons Permit No. Date Issued C',G J --------------------------------------------------------------------------------------------------------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS (UrtificatP of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed(�}�Repaired( ) Upgraded Abandoned( )by ( A wy AA�t� at 39:�::�t ,(7 `r Af) 00D has been constructed in accordance ' %with the provisions ��o��fTitle 5 and the for Disposal System Construction Permit No q '3/I dated Installer Designer #bedrooms �, Approved design flow gpd The issuance of this permit shall not be construed as a guarantee that the system will T otion as Mdesigned. Date Q (G Inspector ,, ------------------- ------------- -- ---------------------------------------------------------- = - No. � �' ��� 1< � f -�,� _>.._. Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS Misposal *pstrm Constrnttlon Erma Permission is hereby granted to Construct( ) Repair( ) Upgrade(Abandon( ) System located at and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction ust be completed within three years of the date of this pe it. Date �j Approved by i' TRANS.NO.: CITY/TOWN: APPLICANT- ADDRESS: �'�.,�._ ) 4i�i DESIGN FLOW: gpd REVIEWED BY: DATE: N/A OK NO GENERAL Legal boundaries denoted [310 CMR 15.220(4)(a)] Street, Lot, tax parcel number and lot number noted on plan [310 CMR 15.220(4)(u)] Locus Provided [310 CMR 15.2204(t)] Plan proper scale? (1"=40' for plot plans, 1"=20' or fewer for components) [310 CMR 15.220(4)] Easements shown [310 CMR 15.220(4)(b)] System located totally on lot served [310 CMR 15.405(1)(a) for upgrades]- if not, a variance is required [310 CMR 15.412(4)] Location of impervious surfaces (driveways,parking areas etc.) 310 CMR 15.220(4)(d)] Location all buildings existing and proposed 310 CMR j 15.220(4)(c)] Location and dimensions of system components and reserve areas. [310 CMR 15.220(4)(e)] System Calculations [310 CMR 15.220(4)(f)] daily flow septic tank capacity (required andprovided) soil absorption system(required andprovided) whether system designed for garbage grindei North arrow [310 CMR 15.220(4)(g)] Existing and proposed contours [310 CMR 15.220(4)(g) Location and log of deep observation holes (existing grade el. on each test) [310 CMR 15.220(4)(h)] Names of soil evaluator and BOH representative [310 CMR 15.220(4)(h) and(i)] Location and date of percolation tests (performed at proper elevation?) 310 CMR 15.220(4)(i) Percolation test results match loading rate? [310 CMR 15.242] Certification statement by Soil Evaluator [310 CMR 15.220(4)0)] Observed and Adjusted groundwater(method for adjustment given or indicated) [310 CMR 15.103(3) and 310 CMR 15.220(4)(n)] Address Sheet l of 7 M v N/A OK NO Location of every water supply,public and private, [310 CMR 15.220(4)(k)] within 400 feet of the proposed system location in the case of surface water supplies and gravel packed public water supply within 250 feet of the proposed system location in the case within 150 feet of the proposed system location in the case of private water supply wells Location of all surface waters and wetlands located up to 100 ft. beyond setbacks listed in 310 CMR 15.211 and any catch basins located within 50 ft. 310 CMR 15.220(4)(1)] Water lines and other subsurface utilities located [310 CMR 15.220(4)(m)] if water line cross see 310 CMR 15.211 1 [1] Profile of system showing invert elevations of all system components and the bottom of the SAS [310 CMR15.220(4)(o)] Stamp of designer [310 CMR 15.220 1 and 310 CMR 15.220(2)] Stamp of Registered Land Surveyor(required if construction activities within 5 ft. of lot line) [310 CMR 15.220(3)] Test Holes adequate (two in each of the primary and reserve unless trenches as permitted in 310 CMR 15.102(2) or as approved for an upgrade under LUA at 310 CMR 15.405 1 k ] Test hole adequate to demonstrate four feet of suitable material? [310 CMR 15.103(4)] Test Holes adequate to confirm adequate groundwater separation? [310 CMR 15.103(3)] Benchmark within 50-75' of system [310 CMR 15.220(4)(q)] Materials specifications noted? [various sections of 310 CMR 15.000] System components not> 36" deep (unless Local Upgrade Approval or LUA requested) [310 CMR 15.405 1(b)] Address Sheet 2 of 7 N/A OK NO SEPTIC TANK Size OK? [310 CMR 15.223(1)] Inlet tee located ten inches below flow line [310 CMR 15.227(6)] Outlet tee 14" or 14" + 5" per foot for increase ft depth [310 CMR 15.227(6)] Outlet tee with gas baffle or approved filter [310 CMR 15.227(4)] Note regarding installation on stable compacted base [310 CMR 15.228(1)] Separation between inlet and outlet tees (no less than liquid depth) [310 CMR,15.227(2)] Inlet/Outlet elevations at least 12" above high groundwater (except as described 310 CMR 15.227(5))or permitted for upgrades under LUA[310 CMR 15.405(1)(k)] Minimum cover 9" (Tanks buried more than 9" must have risers on all openings and on the d-box) [310 CMR 15.2228(1) and 310 CMR 15.232(3)(f)] Three access covers (inlet and outlet must be 20" or greater) - middle access at least 8" (by 7/07) [310 CMR 15.228(2)] Access to within 6 " of grade - one port for systems<1000gpd, two fors stems>1000 gpd [310 CMR 15.228(2)] All at-grade covers secured to unauthorized access? [310 CMR 15.228(2)] > 10 ft from building foundation [310 CMR 15.211(1)] Buoyancy calculation Required/Done [310 CMR 15.221(8)] H-20 Where appropriate? [310 CMR 15.226(3)] Setbacks from resources [310 CMR 15.211] ' Multi-Compartment Tanks Required when other than single-family dwelling or flow>1000 d 310 CMR 15.223 1 b First compartment 200% daily flow; Second compartment 100% daily flow [310 CMR. 15.224(2) and(3)] "U" pipe through or over baffle, outlet of each compartment with as baffle or approved filter [310 CMR 15.224(4)] Address Sheet 3 of 7 N/A OK NO BUILDING SEWER AND OTHER PIPING ,t Located at least ten feet from any water line? [310 CMR 15.222(2)] Disposal piping at least 18" below water line (when water and sewer cross, see 310 CMR 15.211(1)[1]) Cleanouts required/provided? [310 CMR 15.222(8)] Thrust blocks specified in force mains? 310 CMR 15.221(6)(c Slope of sewer line not less than 0.01 (1/8"/ft) 0.02 preferable [310 CMR 15.222(6)] Proper pitch on all runs? (.005 within gravity-distributed trenches and beds) [310 CMR 15.251(9) and 310 CMR 15.252(2)(c)] Siphonproblem/ leachfield below pump chamber Endca s or vent manifoldspecified? Size and orientation of discharge holes specified? (not smaller than 3/8" not larger than 5/8") [310 CMR 15.251(8) and 310 CMR 15.252(2)(h)] Materials specified (310 CMR 15.251(5) specifies various pipe types allowed) DISTRIBUTION BOX Stable compacted base [310 CMR 15.221(2) and 310 CMR 15.232(2)(a)] Splash plate or baffle tee required on inlet/provided? (when pressure sewer to d-box or steep pitch of gravity sewer) [310 CMR 15.323(3)(a)] Riser if deeper than 9" [310 CMR 15.232(3)(f)] Inside minimum dimension 12" [310 CMR 15.232(2)(b)] Minimum sum 6" [310 CMR15.232 3 e ] Watertight cover if<2000gpd); waterproof manhole if>2000gpd [310 CMR 15.232(3)(d)] PUMP CHAMBERS Capacity (emergency storage above working=design flow)? [310 CMR 231(2)] Proper setbacks [310 CMR 15.211 (same as septic tanks)] Watertight 20-in minium access manhole at least 20" MUST BE TO GRADE [310 CMR 15.231(5)] Service components accessible (not too deep with piping, disconnects accessible) Alarm floats - alarm on circuit separate from pumps specified? Exceeds two units must have two pumps operating in lead-lag mode. [310 CMR 15.231(6) and(8 Stable Compacted Base [310 CMR 15.221(2)] Buoyancy calculations needed? Provided? [310 CMR 15.221 ] Address Sheet 4 of 7 N/A OK X NO SOIL ABSORPTION SYSTEMS (SAS)GENERAL Calculations correct? 4 feet of naturally occurring material demonstrated? [310 CMR 15.240(1) Required separation to groundwater? 310 CMR 15.212) Aggregate specified as double washed [310 CMR 15.247(2)] System Venting required/provided? (system under driveway or >36" deep) [310 CMR 15.241 Inspection ports specified and within 3"final grade? [310 CMR 15.240(13)] Breakout requirements met? (No violation of breakout elevation within 15 ft of SAS unless barrier) [310 CMR 15.211(l)[4] and Guidance Document] GALLERIES,PITS,CHAMBERS 310 CMR 15.253 Chambers and Gal. in trench configuration supplied with inlet every 20 ft. [310 CMR 15.253(6 Each structure with one inspection manhole (if>2000 gpd must be tograde) [310 CMR 15.253(2)] Aggregate 1'minimum-4' maximum. [310 CMR 15.253 1 b ] 2' sidewall credit maximum [310 CMR 15.253 1 a ] In bed configuration,,,inlet every 40 s . ft. [310 CMR 15.253(6 TRENCHES 310 CMR 15.251 Width T minimum 3'maximum [310 CMR 15.251 1 b ] 100 feet- maximum length [310 CMR 15.251 1 (a)] Minimum separation 2x effective depth or width whichever greater(3x if reserve between trenches) [310 CMR 251(1)(d)] Situated along contours [310 CMR 15.251(2)] Breakout OK? [310 CMR 15.211(l)[41 and Guidance Document] BED SAS (Maximum size of bed or field 5000 gpd) minimum 2 distribution lines [310 CMR 15.252(2)(a)] Maximum separation between lines 6' [310 CM R15.252(2)(d)] Maximum separation between lines and outside of bed 4' [310 CMR 15.252(2)(e)] Aggregate depth below discharge pipes 6" minimum, 12" maximum. [310 CMR 15.252(2)(g)] Separation between beds 10'minimum. [310 CMR 15.252(2)(f)] Bottom area used in calculations only [310 CMR 15.252(2)(i)] Address Sheet 5 of 7 P tJ N/A OK NO DID THE PLAN INVOLVE Pressure Dosed System ? Provided pump and piping calculations as required [310 CMR 15.220(4)(r)] Pressure dosing required on all systems>2000gpd or alternative systems under remedial approval [310 CMR 15.254(2) and UA 01, Remedial Use Approvals] If used in gravelless system - make sure jet is directed as not to scour soil interface [Guidance Document] Inspections once per year(systems<2000 gpd) or quarterly (>2000 d) good to note on plan [310 CMR 15.254(2)(d)] Construction in fill - Did the plan specify that the fill shall meet the specification of 310 CMR 15.255 3 ? Impervious barrier and/or retaining wall ? [Guidance Document] Impervious barrier installation must be supervised by designer [310 CMR 15.255 2 b ] Retaining wall must be designed by Registered Professional Engineer [310 CMR 15.255(2)(a)] Side slope not exceed 3:1 ? [310 CMR 15.255(2)] Breakout requirements met? [310 CMR 15.252(2) and Guidance Document] At least 5 ft. from impervious barrier to edge of SAS (10 ft. recommended) [310 CMR 15.255 (2)(e)] Gravelless System[FA App rovaI Letters) Check DEP Approval letters for credits and design conditions If used with pressure dosing do not allow pressure discharge to scour soil interface Alternative Septic System[FA Approval Letters] Was DEP Approval Letter provided and/or have you reviewed the letter for conditions? Is the technology being properly applied and does it meet all 7Z DEP Approval Conditions? Is there a note on the plan regarding the requirement for perpetual maintenance agreement? Any alarms involved on separate circuits Did the applicant submit an operation and maintenance manual? Has applicant submitted a copy of a maintenance Variances Are the variances listed on the plan? [310 CMR 15.220 4 )] RLS Stamp necessary on plan if a component is within five feet of property line [310 CMR 15.412(4)] New construction or increased flow proposed - [Refer to 310 CMR 15.414] 1z I Address Sheet 6 of 7 N/A OK NO Nitrogen Sensitive Areas Is the system in a Designated Nitrogen Sensitive Area(Zone II for a public supply well)? [310 CMR 15.214, 310 CMR 15.215 and 310 CMR 15.216 - also refer to Policy regarding upgrades of such existing systems] Is the system proposed on the same lot as served by private well? [310 CMR 15.214(2)] Are the nitrogen loads proposed in compliance? [310 CMR 15.216(l)] Miscellaneous Pumping to septic tank . [ 310 CMR 15.229] Shared System [310 CMR 15.290] Address Sheet 7 of 7 Town of Barnstable Regulatory Services Richard V.Scali,Interim Director 9 �� Public Health Division 0 3` Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Installer& Designer Certification Form Date: I� Zo[e Sewage Permit# Assessor's Map\Parce Designer: Installer. - Address: Address: M [ On lezol .Zon , was issued a permit to install a I - ( ) (installer) septic system at - based on a desigh drawn by A (address) dated (designer) , ZI 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. Strip out (if required) was inspected and the soils were found satisfactory. I certify that the septic system referenced above was installed with major changes (i.e. greater than 110' 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. Strip out(if required)was inspected and the soils were found satisfactory. I certify that the system referenced above was cons tru es--..�*chance with the terms of the IAA approval letters (if applicable) i`9yt4�aFA A •�� .*. .DAVID s E NIASON m f (Installer's Signature) No.toss FQ/s tree A Deli -s Stamp Here) (Designs s Signature ( Sri p PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE .WILL NOT BE ISSUED IJIVTII. BOTH THIS .FORM AND AS- BUILT CARD ARE-RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. Q:1SepticDesigner Certification Form Rev 5-14-13.doc LOCATION SEWAGE PERMIT N04-,0-r�- 8 &-e�fL5 A VILLAGE e re, A L INSTALLER'S NAME i ADDRESS yA li l Nvl,1` 7- 1L. o,� BUILDER OR OWNER r DA T E P E R M I T I S S U E D DATE COMPLIANCE ISSUED t r ` A ��� 9,ye. s �� _ �' '\!C� l a v�ln� �Rr�� � 7 R t'P� s - ��, I 411 Fms..�o:�........ THE COMMONWEALTH OF MASSACHUSETTS 3__ 04 .I.... lit....... .....OF............. ....... ...------ -- ..--•-----......... .. ApplirFatiou for Uhipoii al Workii Tontitrurtiou tirrafit Application is hereby/made for a Permit to .Construct ( ) or Repair ( ) an Individual Sewage Disposal SY at: 7*��/if d �� ems. d - �, -�-� Loc n-Address or Lot No. 1 ... ..0 - - ........................' �....-...--------------------- ------------------------•-------------•--------- ------.......------...•..-----..............--- Owner -------------•-•............................Address a 1 _A._L_T��. Ad Lot f � Installer Address � �®y`i d Type of Building S' ..,e ...............Sq. feet Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder Qvo) Other—Type of Building ____________________________ No. of persons............................ Showers ( ) — Cafeteria ( ) Other fixtures ,r;y ��^se W Desi n Flow..•...................... ,�6�f/g P '�� P Y �-' -----•-------- a: Septic Tank L' uid capacity ..:_._._:gallons Length-___--$_.... Width._..___ Diameter________________ Depth_. .._..... W Disposal Q —No. ..__._-/•... g g �� 2--_sq. ft. x ...... Width......��._____ Total Length Total leaching area___._._. _.__ Seepage Pit No--------------------- Diameter----_--------------- Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( � Dosing to ~' Percolation Test Results 0Performed by------- .t.. ......................... Date.......4~..........._-�? a � Test Pit No. 1.../•.__ __.____minutes 'per inch Depth of Test Pit.................... Depth to ground water_________.____._...____. (z, Test Pit No. 2-_I!_O....minutes per inch Depth of Test Pit.................... Depth to ground water------- O Description of Soil O -...---- -� -t�''--f--------.�. -•---•------.... -I- / fz1 -----------------------------------•-------•----• y1 ' J�.f 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 L i:I y g g p . y 5 of the State Sanitary Code— The undersigned further reel not to lace the system in operation until a Certificate of Compliance has bee .ssu-d by the board of!healt igned ✓ -----------.•. �_j .....------•---•-. Date Application Approved By..... _-_ZG:..B.e............ Date Application Disapproved for the following reasons--------------------------------------------------------------------------------------------------------•--_..... -----------------•-----•----.........-------•----------------•------------------------•--....---------------...--••••--••--••---•••---- •------•------•••-•••--•--•••-•-----•-----••-••••••---•------- Permit No............................... Issueda d- Date ............. ----- Date ' M F>is ...0 ........ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .. ../1.. ... ......O F...............4.10.n....,5... a. L.E'..... Applirtttion for Diipngttl 10orkii Towitrurtinn Vautit 3 ' Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal Syst at e e ..........f...: �'.a.... .. ..•-"---� p ... ...---'-----------------------------------...7/�'_..-----------------.......---•--......--- Location-Address or Lot No. ......................_.......................................................................... .......------............•...............••. -_.........._.............x................ .... W Owner Address .• . , Installer Address Q Type of Building Size Lot--- ; _ �....Sq. feet U �Dwelling—No. of Bedrooms............ ..........................Expansion Attic ( ) Garbage Grinder (/ aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria, ( ) Other.. fixtures'......... ik -------- -•- ---••-------••---•----•-•------•------•--- W Design Flow....................../ G'_..•...._._.gallons perms pe`e day. Total daily flbw...................... �i_._..__gallons. WSeptic Ta L•quid capacity/-._-. _-gallons Length...... Width_--1�!....... Diameter................ Depth..,y..._..... Disposal cc No. ------,/........... Width.....,/,l��,.'." . Total Length...... i Total leaching area... sq. ft. Seepage Pit No--------------------- Diameter-................... Depth below inlet.................... Total leaching area..................sq. ft. Z (�'� g ( ) Other Distribution box Dosing tank Percolation Test Results Performed by-------R..... ...... -----------_----_----_ Date....... P P P � Test Pit No. 1___ _<_.�/....minutes per inch Depth of Test Pit.................... Depth to ground water.......167_1........ 44 Test Pit No. 2.-/,.G_......minutes per inch Depth of Test Pit.................... Depth to ground water......6--.,c......... �+ / -------------------•---•----------------•-----------•---------------•----------------•-•---•-----•......-• ....•••. D Description of Soil C7 . .s-..._r �7�-`_./� `--- l---------A. �_ = �` W -•--•--•-•-•-•............................................--------------•-- ......-----••-••-•-•-•----•------------------------------.... .. -- -� ..44=- �=c ---•-•-----••---••---•-•....--•••--------•--•••-•------•-----------•••--•-•••---------•---••----------•---•----•---------••---------------••-------•---••••-•-----.........•-•----•-•-•--.............. 0 Nature 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 i i:;., p 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has ee Is ued by the board of health g Si ned.... . •. -.• Date Application Approved 'By....... t s ._...................................... - j„J __.....___.._. --•------------- _" Date Application Disapproved for the,following reasons: -------- ---•---• ----------------•-•--•-•----••-•---•-•---.......................................... .... .. ..-- •-•---.....-•------•-----•-•••................................................................................................... ........................ Date PermitNo......................................................... ---•---------------Issued --------------•-••-•••-•-••••••....._ Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH '7.�J(N:A)..............OF...... .0 , ' . ..................................... C�rr�i�irtt#.e ,af f�nnt�littnrr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( or Repaired ( ) b I taller at--------4-Q7----------S-R................Rd—,,�`�1.'OA .......T'�..�U-"----------- .................................................. has been installed in accordance with the provisions of TITLE j of The State Sanitary Code as described in the application for Disposal Works Construction Permit No...... U.-12.@ ______...__. dated_._..__......................................... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE ... CTIS SYSTEM WILL FUNCTION SAT RY. DATE....................... . .. Inspector.. THE COMMONWEALTH OF MASSACHUSETTS BOARDy.�OF HEALTH No...��U.' Z t�. ,�. ............OF......LF.�k1V. L Z'................................. FEE.... .. ..✓. ... .. Disposal Works TwOmitr ion amit Permissionis1PIereby granted---=---- --------- ................................................----------•--•---.......----••---•---•....•---•-••....•---..._......•••... to Construct ( L4 or Repair ( ) an Individual Sewage Disposal System at No......1-Q? 5.:9-------••-----Pe.-e_P.7�rft,l?_..........X.he............. ?���'0t4= Street as shown pa the application for Disposal Works Construction P t No..................... Dated....... ___..__....._.. .................. ................................ / ... ..........4...................... Board of It DATE.. ��/�_ FORM 1255 HO.BBS & WARREN. INC.. 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''rt h{EiO�Y�RED� t`4RLD1 JOIN PdO. $Oc9./ �UIt:,DIIm�3 : SHOWN • QPd THI �� ��`` CfViL f1 LAN® II `f CONFORMS TO'_ THE e E f S'; �SURVEYOP��. . OF : 9ARNSTA LE' _ _ r } 4 ' a Nibfd�igliy'ST 712 MAIN ST. CM. f3Y .� :P,i9`_ C6 Jl(ARQIOt�Tp1-MASS. HYANNIS, MASS. / �' b S4�EET_ OF _ DA E E LAQON; �� 4y� •F^<''►.rtQ�� f•�w?,��"3''� .Y.-Y?,r" 3.N �.� .,fir y,, - � n} A .., (. 's.t.-. c�' ..}.-�,rf5 ..:�s`�t�' Fl+ � A or'7� PriC 7A A f'S 'JW OR�F 20 - WIN. AN 'm 'ae�&,to U6.Vr -7"0 i*oQAA:;>,&. eA",fi:)f7-RA -YlEAVY, • MlIv. RIM-y- COVER SRAI-9. 49Z WSRO /.P CoAlepE 74' dCA37pPR0A.f //v zt- covffRs P�Mo-ORA17WD PbeC I=1.=e I-10111D L C4ZAIV SAWD -4"CA s-r-J e-z-, IRO" P/pr /0 o a GAL.' A-11AI R/7CH Se,071C 7A DISW v �c rA BY"7 e- LEAC141IV6 )�JELD o Flo SEC7710AI'019, CuR0411+/D I-VATEff 7A,6LE SEWA 4SE DISAOSA 4 S Y6 rEM 7,.4 6 1&A r10 IV I-EACHIM6 )=IRLD s I,oy A P- 4 FTA FT. 6 FT 40.C. SCA&Z R,-rlf o v_- X� TI)TEST e--R A vr o C7 OF V,6 3/B.. RZRF0,TA 7-EP SOIL TEST Af WASMEA9 I 570M_O" pvc PIPE DA715 0.= 90/J- TZ..rr 7 V. ME50175 W1;rA4ESJZ0 J6 Y R-MB AfIN N eLeA A/. r =,Tco44- FEtrCOLArIOAl AA AF P, rlox RA r-. 2 SILI-S 5 0, DHSlGAVCR17'ff1?lA Ve, PEiQfORATED STONE WA SYZD 5E7 1. ON CZIA/TeR. B S77 MA 70P PLOW 3 1 O GA L.10A Y ('"R vvp,-rig M LZACH-ON6 AjT,=_A 41 SQ. F77 SECS/0JV I?�&ffl VE AlTE�A 43 sajcrr -SCALE -0 UND WATEN eNC041,VrA=_&lED -- ;vOaRO U, croczouy -11WERT ELEVATIONS ­4. ffl/EC, 14 Y ­zz -7 i� Z V r ;air ROB:-R Rl� tz nu- Zc,'_t `A NIKIS:, Jlo.22 2 WY. ` P Ad� A V:fu v M, W, 7;-�;,pf 1- 77-77-7-- L CAT N S I W A G I PERMIT NO. VILLAGE INS A L 'ER,S NAME R ADDRESS BUILDER OR OWNER x DATE PERMIT ISSUED DAT E C 0 M P L I A N C E ISSUED f , �aT la �1 SY�e�Y A 5 S E S S C; MAP. E J KnLE Z) L. 0 G 1) The installation shall comply with the State Environmental Code Title V and Town of PARCEL : /c F Board of Health Regulations. ,, PLOOD :.ONE -1,0 1 L E V A L U A T 0 R1 2) The septic system as proposed on this plan shall not be installed until a licensed town installer W1 THE SS I-)7Y4r1, 117")k] receives approval and an installation permit from the applicable town, REFEREN,""E : 11' - - -_:;�D /07 DATE :, ' ,,Ij\ou 3) Prior to installation, the installer shall verify the location of utilities, sewer inverts, sewer lines PERCOLATION FATE: and existing septic components prior to installation. 4) All gravity sewer piping is to be 4 inch schedule 40 PVC at 1/8" per foot. The first 2 feet out of / - `� � TH- I TH-2 the distribution box shall be level, All piping connections to be glued. 5) This septic design plan is not to be utilized for property line determination or for any other purpose other then the proposed septic system installation. LID 6) All Title V components are to meet Title V specifications, A T I ON MAP I Parking shall be prohibited over Title V components unless, Components are H2O loaded. 8) The existing leaching or cesspools shall be pumped and filled with material per Title V 9.4�4 r abandonment procedures. Leaching and cesspool(s)and contaminated soils within the proposed SAS shall be removed and replaced with clean sand per Title V specifications, 9) Septic components are to be 10' from a water service line. Sewer lines crossing a water line shall be sleeved with an appropriately sized schedule 40 PVC with ends grouted- The water service line or the septic line can be sleeved with the sleeve being a distance of 10' on t. t"- crossing the line, 10) If a garbage grinder exists in the structure, it is to be. removed if the septic system is not designed to accommodate a garbage grinder. I i) The installer is responsible for care of excavation around all utilities on the property and T E MI I GN SEPT ' ( S Y Q protecting the structural integrity of all structures during the installation process of the septic SIP system, IG FLOW :7S! ! MATE1' 12 This plan only represents that a septic system can be installed on the property meeting Title V requirements. L)Lq It Al' GAL/DA',(,,:BEDR00M GAL/DAY 13) The property owner shall review design criteria to approve the total number of bedrooms and design flow. Installation of the septic system as proposed and teceipt of payment for the clesign SEP'rj� TANK shall be deemed approval of the design criteria by the property owner of agent of. v 14) The validity of this plan shall expire with the expiration of the town installation permit issued toi- *AL/DAY x 2 OAYS� GAL USE GALLON IE PTJ C TANK this plan or the validity of this plan shall exr)ire on the expiration of the Certificate of Compliance it issued for the k;� al!ation of the propos�,ci lystem on the plan. Q e j A OIL ASSOP.PiTION 'SYSTEM LID 2Z La r_A01 L L C .VV vl t5 1, A-PVL,I e"41e�UE-,W SIDE AREA. AREA: Tr�OF Itf 8 DAVID 5 E P T 11 C Nrs Y S -jPU_j,,A T MASON1066 3t E lid 93 A*I- - \Lie 577 N, :Z GAL L 7- �715 FT 61 'Box 0 40 SEPTIC TANK , 4\1 FW, F 20 5� 2 5 WW VJA4 C) �1() kr 012- OLKM L? r1we y14.111_f;l 'WAGE PLAN PlIZOM60 ILT)ewwo W14TE&I S I TF A N D ZS L R. Ae2 ,i- Ie. LOC AT I 0,N ,, !� � i " ��� I�0�;�.�' Fr RE PAR ED FOR AVLD)V4 4'1, (�P,' W b�k E '117 iJAV I D ER IMASON DATE �09 BC ENV ; RONMENTAL DES 1 GNS AT 1E HEALTH AGENT