HomeMy WebLinkAbout0428 SHOOTFLYING HILL RD - Health (2) FF42' 8 Shootflying Hill Road
Centerville
A= 213 -007
No. �" Fee l" -
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS Yes
ftpl tation for Nspo8al �6pstrm Construction i9Prmit
Application for a Permit to Construct(cam- Repair(4f-Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components
Location Address or Lot No. ,VzE S4aar/-lyl wy /-!%1 Owner's Name,Ad ress,and Tel.No.
CrnT�vvi//c �/icl��a el PIVIO
Assessor's Map/Parcel 9/9— 7 S1010-f-6
Installer's Name Address,and Tel.No.,,S'O8-10 7--17-7S Z Designer's Name,Address,and Tel.No. �f'O -sloe
/if 1401 s" L /2�I !'d9kti^.s v!9 !�!i/�S ocvvi �� d! �.< -1dr-
Type of Building:
Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( )
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow(min.required) 3 33 y gpd Design flow provided 3 gpd
Plan Date Number of sheets Revision Date
Title
Size of Septic Tank Type of S.A.S.
Description of Soil
Nature of Repairs or Alterations(Answer when applicable)_ k5r,41Z Q-/?ocy d!` q-hr--20
,* ra ' s-elne a&
�e-e o
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 /®-(,3-0
Application Approved by Lzr Date�D
Application Disapproved by U Date
for the following reasons
Permit No. oho —'3 3 Date Issued D�13 - ��
' .Mi
qq�
No: �p Fee _
THE COMMONWEALTH OF MASSAGHUSETTS Entered in computer:
' Yes
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS,
application for Misposar Opstriii Construction 3permit
. �
Application for a Permit to Construct(4.1' 'Repair.'(4)-Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components
Location Address or Lot No. z/. 9 SLivdT jt:'/yiyy N�� - Owney's Name,Address,and Tel.No.
6alyr,-4-1117/c n�icl���/ .k/vh
Assessor's Map/Parcel a/9 f
Installer's Name,
A d/d3re ssr�'oS Q Designer's Name,Address, d Tel.-No.:- -e
�, 3G2 S
,
Type of Building:
Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( )
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow(min,required) 3 3 y gpd Design flow provided 3 �I gpd
Plan Date Number of sheets Revision Date
Title
Size of Septic Tank Type of S.A.S.
Description of Soil
Nature of Repairs or Alterations(Answer when applicable) .C195Td1/f/ 2- /�Ucc� O!= ei/ /`7/�"20
roes
Date
Date last-inspected:
ti
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. o�
# Signed Date /0
Application Approved by ?- Date /0
Application Disapproved by Date
for the following reasons
Permit No. p� 3 3 Date Issued
THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE,MASSACHUSETTS
Certificate of Compliance
THIS IS TO CERTIFY,that the On-On-site Sewage Disposal system Constructed Repaired(C-4- Upgraded( )
Abandoned( )by O.f�e .c /
at y 2$' %�� �� l: has been constructed in accordance
with the provisions ofTitle 5 and t e for Disposal System Construction Permit No.)031-3 3 2- dated
Installer'1OS CYJ /� �� �f4�'!�'O 5 Designer
T
#bedrooms Approved de ign flow ll gpd
The issuance of this permit shall not be construed as a guarantee that the system will function as designed.
Date 1)` I U �} Inspector ` /r/ II1 J 14e
---------------- ------------------- ----------
No. �� ! 33�2__ Fee �W
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION BARNSTABLE,MASSACHUSETTS
' Misposal Opstem Construction permit
Permission is hereby granted to Construct(G-)- Repair Upgrade( ) Abandon )
System located at ci'2 8 - Sabi oa T /}/4.,
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 - 3 a Approved by
FROM :down cape engineering inc FAX NO. :15083629880 Oct. 118 2009 03:20PM P1
�z
ty
Thomas F.
tAAnN-RTAMZ,
Pnblic .11 ea I Hi Divisim,
1630:,&
200 mflim Sti-eel.,R-yalionii,NU. (112601
C)ffice: 50R-862-4614 F;ix: .508-790-6304
Date-
Desiaimer. 0 "1 P10 Installer: C
7
Address: Address.
011 was j.ssucd a permit to install a
(installer)
septic system at,.. g a based o ..a.design drawn by
((add'J4 S
dated
(d c-s i r)
T oertify that the septic system rcGerenced above was installed substantially according to
the design, which may i-acludernhaox- app.roved changes such as hftral relocation of the
distribution box and/or septic tank,
I certify that the SePLIC, systeta referenced above was installed with major, cbaiiges (ix.
greater than .10' Ii-iteral i-elocaLion of Lhe 'SAS OT any vertical relocation of any com.pone.iit
ofthe septic system.) but in accoidwice with SLate & Local Regulations. Plan revision 01,
certitied ass-Built by designer to follow.
-N OF '9s'
I)AN L
UANI A.
OJA OJA
((YnAallc�r'� Sigmature) civil. No.4-098o
-%3 No.46502
o 6",
6'/8-1 iL
/Cq ONAL. -
(Designer's Signature) (Affix Dcsigriex's ,Stamp flere)
PLEASE IRTjTT.TRYq T(.) HAKKST.A8.LY PUBLY.0 'HEALTH DIVLSIom C3171-RTIFICATE 0114'
CI)MYLIANCE WILL NOT PPE iSSUED UN"rIL 13qri-o' 'nus FORM A.NQ A,S-)3lI)*11,`.0 (-'AIZD ARE
'LUCEUVED BY TH'L BAkNSTABLE,]PUBLICHEALTH DIVISIGN. THANKYOT.T.
0,1 IcaIth/Scptio/J)(-.sieii&i-Certification x;
--- / TOWN OF,BBARNSTABLE
YS LOCATION rJ'2$ zp0T�1-41/`ia SEWAGE # OD7"33�
v9LLAGE (/A!!V-V ill--G ASSESSOR'S MAP & LOT g 1 L 7
INSTALLER'S NAME&PHONE NO. y73 S JOSe- D-e 9s4rros
SEPTIC TANK CAPACITY /, yV
LEACHING FACILITY: (type).-Rv`r/ Y'f/24 zq�,ll�rr�(s ze) 3 2 X 1�
NO. OF BEDROOMS 3 .
BUILDER OR OWNER &te- lkhlkl
PERMIT DATE: 40 - 11 o 0 I' COMPLIANCE DATE: �� I�'01
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 f et of leac 'ng f ihty)) Feet
Furnished by -r /r/Af f i�
r
9 �9
k
r
_ a 6S Town of Barnstable >P#
�.1ttF
Department of Regulatory Services
q aARMAeM ; Public Health Division Date
MAA 200 Main Street,Hyannis MA 02601
r6�9 ti� Y
AIfO MA'I P4 y/1
Time 00 Fee Pd.
Date Scheduled
to
Soil Suitability Assessment for Sewage isposal
Performed By:
Witnessed By: a r► t VV- S
LO ATION& GENERAL INFORMATION
Location Address LA-V �00V I—& t o 4 Owner's Name `<` Lk V\
CQw- v► Ile -- Address
Assessor's Map/Parcel: 0�13/ Engineer's Name 0 v►/r,\ e
NEW CONSTRUCTION REPAIR Telephone H
Land Use Slopes(°lo) Surface Stones
Distances from: Open Water Body ft Possible Wet Area It Drinking Water Well ft
Drainage Way ft Property Line ft Other ft
SKETCH:(Street name,dimensions of lot,exact locations of test holes&pests,locate wetlands 41 proximity to(toles)
zo
��,mi Of11� �
Parent material(geologic) My U1 ML �!L Depth to Becb'oek
Depth to Groundwater: Standing Water in bole: Weeping from nit Face
Estimated Seasonal High Groundwater
I
DETERAUNATION FOR SEASONAL HIGH WATER TABLE
Depth Observed standing in obs.hole: In, Depth to Sall mottles: itt.
Depth to weeping from side of obs.hole: W in, Groundwnter Adjustment__.-.... rt.
Index Well k Reading Dale: Index Well level _ - _ A ti,faetor.,.,,-.,,_ Ad].Oroundwuter Level
PERCOLATION T 1�lflt .� _17 ; Time
TEST
Observation TinietitV � ®
Hole H
Time at G" �U 1 o
Depth of Pere ��� 7 '
Start Pre-soak Time @ � _ Time (9"-G")
End Pre-soak
Rate Min./Inch --mr=---
Site Suitability Assessment: Site Passed Site Failed: Additional Testing Needed(YIN)
Original: Public Health Division Observation Hole Data To Be Coinpleted on Back-----------
***If percolation test is to be conducted within 100' of wetland,you must first notify tlie.
Barnstable Conservation Division at least one (1) week prior to beginning.
Q:1S EPTIC\PER C FORM.DOC
DEEP.OBSERVATION HOLE LOG Hole# !/
Depth from Soil Horizon Soil Texture
Surface(in.) Soil Color Soil Other
(USDA)
(Munsell) Mottling (Structure,Stones;Boulders.
Z Con istenc % ravel
/vr /b ,
DEEP OBSERVATION HOLE LOG Hole# Z
_
Depth from Soil Horizon Soil Texture
Surface(in.) Soil Color Soil Other
r
(USDA) (Munsell) Mottling (Structure,Stones,Boulders.
.m A Consistency.%Graven
S /G Y/Z y/lo
DEEP OBSERVATION HOLE Dep
th from Soil Horizon LOG Hole#
Surface(in.) Soil Texture Soil Color
Soil
(USDA) (Munsell) Mottlln Other
g (Structure,Stones,Boulders.
Co siste c O vet
DEEP OBSERVATION HOLE Depth from Soil Horizon LOG Hole #_
Surface(in.) Soil Texture Soil Color Soil
(USDA) Other
(Munsell) Mottlln
g (Structure,Stones: Boulders.
Consi2tency,c a I
Flood Insurance Rate M
Above 500 year flood boundary No Yes _
Within 500 year boundary No_ Yes
Within 100 year flood boundary No Yes
Depth of Naturall Occurrin Pervious-- - v e Material
Does at least four feet of naturally oc currtng 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 124-4- �'�. (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 traini i ,expertise and experience described in.310 CMR 15.017.
,s
Signature `� �" "
Date
Q:1SBPTIC FRCFORM.DOC
w y
THE COMMONWEALTH OF MASSACHUSETTS
o=ja=C====cZ==8OARD OF HEALTH
TOWN OF BARNSTABLE
vv trativti h Disposal Workii Totes rnrttun throat
Application is hereby made for a Permit to Construct ( ) or Repair ( Individual Sewage Disposal
System at:
...................... ... .6.,p . ' � �df ...................4f.e T..........................................................
Location Address or Lot No.
..............�. .�,.ti —......ZK c� ,.,1... .... 54w_e--------- ----- ...
Oq/w}3)er /f _ Ad(d�r/�c{s�'/'
1 Installer Address
Q Type of Building Size Lot............................Sq. feet
U Dwelling No. of Bedrooms.....- ------------------------------Ex Expansion Attic�-+ g— p ( ) Garbage Grinder. ( )
aOther—Type
of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( )
dOther fixtures .----•------•-•--•-------------------•---...------------....---------------•---••-•-------....------•---------------......................_......----
W Design Flow.....�1'�_._................. .gallons per person e ay. Total daily flow............................................gallons.
� Septic Tank-rLiquid capacity.�!� allons Length----p_ ....._ Width�...- Diameter________________ Depth...............
Disposal Trench`p �No ----- idth...... Total Length---z .._ Total leaching area....................sq.`'f't.
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........................
13;q Test Pit No. 2................minutes per inch Depth of Test Pit---:................ Depth to ground water........................
Pd . .-----------------------------------------------------------------•-----------....-------•----•-----.........................................................
0 Description of Soil...................................................................................................................................................---------------.-----
x1.
U .------------------------•-----------------•--------------------------------------------.......--------------------------------------------------------------------------........------------------------
w
x ---•--------------------------------------------------------------------------------------------------------------------------------------- -------- -----------------
V Nature of Repai s.or Alterati ns—Answer when applicable..... ... ...... �..._.____�.a�._vim' ...___.
-----�'- .......... -&b ..........
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 Com liance has been 'ssue t�doSigned .. ....- ... -----.-- -------- ------------...........................
Dare
Application Approved By -----... r --- �- wn
.-------- -------90:f� .. .
Application Disapproved for the following reasons- ............................----- - - - --- ------------------ - - -------------------------------- ---------------
.......................................
C Date
Permit No. .........../..a.......L/...�. ------------------ Issued -- -------- --------------.......
Date
1 , 'A-
'^►�'
No....2. :. ... � °� Fles.... :........
THE COMMONWEALTH OF MASSACHUSETTS
t� BOAR® OF HEALTH
ykY+.X�TOWN OF BARNSTABLE
�-� Appliration for Disposal Works Tonstrnrtion ramit
Application is hereby made for a Permit to Construct ( ) or Repair ((..),.a�i Individual Sewage Disposal
System at:
Location-Address " or Lot No.
.... i,L_ OM.
! ............................. ....................... A............................
!-..,( . .. 1...A�.t�� ._�-'` ��?7_r.�_—_..._.. ���p �'a'�'...AaCzp'S��..._/rl.!. ...1.r,/�t'...
r. ....
Installer Address
g ............................Sq. feet
Q Type of Building Size Lot____________________
U Dwelling—No. of Bedrooms___...?- ...........................•.Expansion Attic ( ) Garbage Grinder ( )
aOther—Type of Building ____________________________ No. of persons............................ Showers ( ) — Cafeteria ( )
QOther fixtures ...... -•---------------•--------------------•----------••-•......•--••-•-••••-- -•--•....-•-•-•••----•-----•-•-•-....._•--•--........_...._....•-----
W Design Flow......_"` _>.......................gallons per person per day. Total daily flow............................................gallons.
AG Septic Tank-A-iq�uid capacity/. ....gallons Length...., ..... Width. ....... Diameter................ Depth................
Disposal Trench No. s .?,.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 ( )
Percolation Test Results Performed by.......................................................................... Date........................................
Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................
fT4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water.........................
----------------------------------------- -•........
.
0 Description of Soil............................................................................... -------------------=------••-----------••...=
x
Wi
......................................................................................................................................................................................................
U Nature of Repai s or Alterations—Answer when applicable._-_____---- (�._..._./__ ..���10-- .....___.
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 Complia�hhasbee�n&sued,-by.,the ova d of heal h
Signed ---------------
Date
Application Approved By ---------- ------ �^^'�. '`,' �te
11 Dale
Application Disapproved for the following reasons: .... ............................ ............. ......!..............------......................................................
---------------------------------- ------------------ .............................-------.......................................... ........... --------------------------------- --------------- -------------- -----------------------
SDate
Permit No. /....a. - - ... ......... Issued IN-- ------------------ --
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE
CITPrtifir to of CTontlatian.ce �f
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired
by ..
---......4�-I, os fD i_(C—
.................................................
J— r� In t Iler / ,� ��
has been installed in accordance with the provisUrns of jTITLE 5 of The State Environmental Code as described in
the application for Disposal Works Construction Permit No. ....... --... .�-g---. dated ................................................
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE........................ - f �.. .�
-- ...... �� - ......... .... Inspector ------ '----- ............................................. --------------
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
No... L TOWN OF BARNSTABLE
�r� LL FEE
_.-_.=F.-J� ..:�.3..............
Disposal Works T.'ainstrurtion Pgrutit
Permission is hereby granted.............. y d\• �,ll!0..... 4
• to Construct ( ) or epair ( ...)_an-Individual Sewage Disposal System
�t- at No -••-•----•--••-•--- -- Y. Street
as
qq UU PP
as shown on the application for Disposal Works Construction Permit No.................l�_. Dated..........................................
U Board of Health
DATE... 1 --�0�
FORM 36508 HOBBS 6 WARREN.INC..PUBLISHERS �. f
` TOWN OF BARNSTABLE
r .
LOC s.TION4aer57X62,d7--r I-m4 /lj/ SEWAGE #
VILLA GE ( ,
o-
ASSESSORS MAP G LOT 00
INSTALLER'S NAME & PHONE NO.
SEPTIC TANK CAPACITY
LEACHING FACILITY:(type) � � d (size)
NO. OF BEDROOMS c PRIVATE WELL ORcPUBLIC WATER
BUILDER OR OWNER �oi>o
DATE PERMIT,ISSUED:
DATE COMPLIANCE ISSUED: % - Il,� ✓ I °�-
VARIANCE GRANTED: Yes No
4n
o d:)+s
iS�ooj- yI'Y raa�
No...r./...Y..:......... Fmc..�.1�. ..
THE COMMONWEALTH OF MASSACHUSETTS
BOARD. ® HEALTH �a;f;JICA f",w^1,7ro
. o
APP�®VA-a
....._... CONSE OF........ L ��....... . �I=
Arioi
Applira#ion for Digpaaa1 Workii Cnowitraartion rrIft'i"
Application is hereby made for a Permitto Construct ( ) or Repair ( ) an Individual Sewage Disposal
...----
L on-Ad r ss 3 or Lot No.
:... ............:�-------------- -- ------------- -- - - -----....... ----------------- .........
j Owner' ( O.�s�( t(7 5-/7 L/b b . /
t
Installer Address
Type of Building Size Lot............................Sq. feet
Dwelling Building
of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( )
aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria
a' 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 ( )
Percolation Test Results Performed by.......................................................................•-- Date........................................
1.4
� Test Pit No. 1................minutes per inch Depth of Test Pit..................._ Depth to ground water-------------------------
0� Test Pit No. 2................minutes per inch Depth of Test Pit..........._........ Depth to ground water........................
xDescription of Soil.......................... .-aZ- ; "._.__ ._' 1 '�.1 G --.-•-•-----
r, V •--••-•------------•-•---•-••-•--•-•••---•----------------•---•--•••--••-•---•--•--------------.........-----•......------...
fxj Nature of Repairs or Alteration Ans er wlyn applica e.__....-- d------------- --- �! � 'L4
Agr eement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of:iTL
p 5 of the State Sanitary.Code— The undersigned furtl er agrees not to place the system in
operation until a Certificate of Compliance has b e issued by the beard/offhealth. L,�
igned- •- •--•-------•-•-• •-••-----------------•-- /. -Date .. ,
....
Date
Application Approved By--• t ...--- .. ........ ----•-.�y -z Y" �,e
Date
Application Disapproved for the following reasons---------------------------------•--------...-------------------------------------------------- .................
....................•----...----------------•------•--------•--------------------•------•-----------••-----•--•-••••••-•-----------•----------------------•------••----•----•-----------•-••••----------
Date
PermitNo............................•............................. Issued.......................................................
Date
4:
No...t..�.. :......... FEs.. �......................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD O HEALTH
........... .....-OF........ .... +. .............................................
. ppliration for Uiipnga1 10orko Tnnstrnrtinn ami#
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
y at
. ... h_. ..... '. � ,
. . -• ...........--
L .ion-Ad s or Lot No.
•• `...........1. - ft -•'- ------ ---'--`• - ---------•----- ...3--- --•--- ---- --•--- -
Owner �^ Slsi/y1 Ad
Installer
Address
Type of Building - Size Lot............................Sq. feet
���,,,,,�
Dwelling—^'No. of Bedrooms............:...............................Expansion Attic ( ) Garbage Grinder ( )
aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( )
P4Other 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 ( )
'.� Percolation Test Results Performed �y.........................•----•--•--•-•------•---•------------------------ Date........................................
a
Test Pit No. 1________________minutes per inch Depth-of Test Pit....:............... Depth to ground water........................
fil Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
a ------- ---- • •• --- ......- •. .... -.._ ---•-------------•-------•-----........•---.-----
D Description of Soil '" '--.Zr ""_.
x ......................................
U --------------------------------------•.....---•-----••----•-------------------------•---•-•------------•--------------••----------- ----•-------------•-----------•-----------•-•-••---•-•----.......
W _______________ ______________________________________________________________________________•-.---__._-_______
------- ___ t............
U Nature of Repairs or Alteration An er w n applica fi -- -
4 - s ... ._._` .. -------------
Agreement
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of i?`T L
p 5 of the State Sanitary ode— The undersigned further agrees not to place the system in
operation until�a Certificate of Compliance has b e issued by the by rd of health.
igned- ---• -•---- '..._.. --•------------•--. 1 "Date/ _< 1 Date.
Application Approved BY ..-'_._ r i; - ✓ ' -•�{ .......... ---
Date
Application Disapproved for the following reasons---------------------------------------------------------------•---------------------...........................
..-•---••-•--•-•-------------•--------------------------------------........------------•-----•--------...---•--•-------------------------•...------------•--------------------------•-----•-----•----•-
Date
PermitNo........................................................... Issued_.......................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
/Z.< 1
OF........... .��%'I/�r�.....-......................................
�rr#ifirtt�.r ,af f�rrm�r�t��rr
THIS T RTIFY hat the Individual Sewage Disposal System constructed ( ) or Repaired
by _
t ................
Inszall v 1 A&, - /.... �vp ..'`^
at ....
has been installed in accordance with the provisions of TI ii;q g3�The State Sanitary Code as.described in the
application for Disposal Works Construction Permit No._._.V-___ _?_,�(------------- dated......... _�1--- _.__...
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM -WILL FUNCTION SATISFACTORY. J
DATE...............-� � 3� ...................................... Inspector..... ....... #- - -------------------------------
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
✓••••d`�?� 't.............OF........
No.........................
FEE ..:...... .......... .'.
Disposal Qwnii tr Uan. prmi#
Permission is hereby grante
l�F/ rr- . ..................
to Construct ) or a air ( (am ndividual Sewa a ,:is osad s em
ix
Str/et
as shown on the application for Disposal Works Construction Per No. _!IDated y, ............................
. -� 'fir- t-f-,rl . 0
.-----.......:....----•-
. Board of Health
DATE...... '25 d
FORM 1255 HOBBS,& WARREN. INC., PUBLISHERS24101
90 -- /9 F
LSD C A T ION SEW 1 G E PERMIT NO.
VILLAGE
c�.Kioru le
INSTA LLER'S NAME i ADDRESS
I U I L D E R OR JMLNER
DATE PERMIT ISSUED
DAT E COMPLIANCE ISSUED
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LOC:�TION SEWAGE #
VILLAGE ASSESSOR'S MAP Si LOT
INSTALLER'S NAME PHONE NO.
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SEPTIC TANK CAPACITY
LEACHING FACILITY:(type) (size)
NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER
BUILDER OR OWNER
DATE PERMIT ISSUED:
DATE COMPLIANCE ISSUED:
VARIANCE GRANTED: Yes No
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LEGEND SYSTEM PROFILE ALL SYSTEM COMPONENTS SHALL BE NOTES
MARKED WITH MAGNETIC TAPE OR
99 - EXISTING CONTOUR PROVIDE IF NEC. MIN. 20" DIAM. WATERPROOF COMPARABLE MEANS FOR FUTURE LOCATION.
(NOT TO SCALE) 1. DATUM IS WEQ. LAKE DATUM SYSTEM
ACCESS COVERSjRISERS TO WITHIN 6" OF FIN. GRADE PROVIDE INSPECTION PORT TO WITHIN 3" OF FINAL GRADE 7PROP. VENT ServiGe Rd
X 99 EXIST. SPOT ELEV. TOP FOUND. EL. 47.1' 2. MUNICIPAL WATER IS EXISTING
\ 3. MINIMUM PIPE PITCH TO BE 1/8" PER FOOT.MINIMUM 99 PROPOSED CONTOUR .75' OF COVER OVER PRECAST 299 SLOPE REQU D OVER SYSTEM 46.0' - 47.0'
198.4] PROPOSED SPOT EL. c INtR DIAM• 4. DESIGN LOADING FOR ALL PROPOSED PRECAST UNITS
2" PEAST01 OR GEOTEXTILE MAX. 5 OF COVER OVER SAS TO BE AASHO H-jD 00
UV 43-5'
4°scH4o PVC 4"mSCH40 PVC FILTER FABRIC OVER STONE 5. PIPE JOINTS TO BE MADE WATERTIGHT. r Locus
TH1 PIPES LEVEL 1ST 2'
TEST HOLE
Y <, 42.0'
**INSTALLER SHALL CONFIRM MINIMUM SEPTIC TANK SIZE AT L �8 6. CONSTRUCTION DETAILS TO BE IN ACCORDANCE WITH We ua uet
2� SLOPE OF GROUND 10• EXISTING 14" o00 o r Q 4
1000 GALLONS AND ITS SUITABILITY FOR RE-USE. REPLACE TEE 1000 GAL H-10 TEE CDC) 41.46' 310 CMR 1�.000 (TITLE V.) Lake
WITH 1500 GALLON H-10 SEPTIC TANK IF NOT SUITABLE. SEPTIC TANK \42.10 f ° ° ° ° ° ° ° s" MMI SUMP o
* °°°°°°°°°°°°U 12" MIN. TNT. DIAM 7. THIS PLAN IS FOR PROPOSED WORK ONLY AND NOT TO
Q� UTILITY POLE (RE-USE**) GAS BAFFLE ..• ° °o°°o°°o°o°o°o o° go 0.83' o BE USED FOR LOT LINE STAKING OR ANY OTHER a
FIRE HYDRANT 41.85' f 41.60' oo�o DODO 40.63' PURPOSE. e
NOTE: NOT ALL SYMBOLS MAY APPEAR IN DRAWING I
�•`' •' � � • 8. PIPE FOR SEPTIC SYSTEM TO SCH. 40-4" PVC. 0 p�
*THE INSTALLER SHALL VERIFY THE DEPTH OF FLOW = 4' 3/4 TO 1 1/2 DOUBLE WASHED STONE 9. COMPONENTS NOT TO BE BACKFILLED OR CONCEALED o
LOCATIONS OF ALL UTILITIES AND ALL 6" CRUSHED STONE OR MECHANICAL WITHOUT INSPECTION BY BOARD OF HEALTH AND
BUILDING SEWER OUTLETS AND TEE SIZES:INLET DEPTH 10„ COMPACTION. (15.221 [21) H-20 HIGH CAPACITY INFILTRATORS IN FIELD 6.0' PERMISSION OBTAINED FROM BOARD OF HEALTH.
=
ELEVATIONS PRIOR TO INSTALLING ANY (32' x 14.5' OVERALL) 5.8
10. CONTRACTOR SHALL BE RESPONSIBLE FOR CALLING /�
PORTION OF SEPTIC SYSTEM OUTLET DEPTH = 1 4» LDIGSAFEN(10 FALL UNDERGROUND & OVERHEATHED LOCUS MAP
( 1 % SLOPE) ( 1 % SLOPE) HIGH G-W ELEV. 34.8' PER BOH PRIOR TO COMMENCEMENT OF WORK.
(WEQ. LAKE DATUM) 11. ANY UNSUITABLE MATERIAL ENCOUNTERED SHALL BE NOT TO SCALE SCALE 1"=2000'f
D' BOX 7' LEACHING 34.6' BOTTOM TH-1 REMOVED-V BENEATH AND AROUND THE PROPOSED ASSESSORS MAP 213 PARCEL 7
FOUNDATION EXIST. SEPTIC TANK 21 FACILITY LEACHING FACILITY.
- 12. EXISTING LEACHING FACILITY SHALL BE PUMPED AND SITE LIES WITHIN ESTUARINE PROTECTION DISTRICT
REMOVED OR PUMPED AND FILLED WITH CLEAN SAND. AND WITHIN GP DISTRICT
I
NO CONSTRUCTION PROPOSED
I
SYSTEM DESIGN:
�I
GARBAGE DISPOSER IS NOT ALLOWED Ld i
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DESIGN FLOW: 3 BEDROOMS @ 110 GPD 330 GPD VARIANCES FOR SEPTIC SYSTEM REPAIRS WHICH MAY BE
= I
USE A 330 GPD DESIGN FLOW Q I IMMEDIATELY GRANTED BY THE BOARD OF HEALTH AGENT OR
I J 56.s6= BY HEALTH INSPECTOR
lifI /
SEPTIC TANK: 330 GPD (2) = 660 0 ► // j6 70 PAPERWORK AND HEARING REDUCTION PROPOSALS APPROVED
RE-USE 1000 GAL. SEPTIC TANK**
BY THE BOARD OF HEALTH REVISED DURING A PUBLIC TEST HOLE HEARING HELD ON NOVEMBER 15, 2005 LOGS
LEACHING: / �� 50.34 FAILED SYSTEMS ONLY SOIL ABSORPTION SYSTEM
SIDES: N/A / i `� INSTALLATIONS PROPOSED MORE THAN THREE FEET BELOW ENGINEER: A.H. OJALA, PE, SE
GRADE WITH PROPER VENTING PIPED TO THE ATMOSPHERE
BOTTOM 32 x 14.5 (.74) = 343 GPD / h�, 1 I ( ) WITNESS: DAVID STANTON IRS
x 52. 2 AND WITH H-20 LOADING, BUT IN NO CASE SHALL THE SAS
TOTAL: 464 S.F. 343 GPD P
o BE LOCATED MORE THAN FIVE FEET BELOW GRADE. DATE: 4/17/09
USE 2 ROWS OF (4) H-20 HIGH CAPACITY INFILTRATORS EACH, 0� I x4 .79 PERC. RATE < 4 MIN/INCH
WITH 3.5' STONE AT ENDS, 3' AT SIDES AND 2.8' BETWEEN ROWS f I
CLASS I SOILS P# 12529
4.20 I
/ 50.0 ELEV. ELEV.
V 5 � .62 5
MA r/ / 53.54 00 0f, `:P 47' 0„ Q 47'
s
APPROVED DATE BOARD OF HEALTH �� / 5'3 ' - �� � -
/ 36 I x4 6 A A
/ 5�6 I ho SL
SL
2.81
Q
, .
10YR 4/2 _ 10YR- 4/2
/ 52. 12" 12"
�O 2.29 1� 0 x 51 B g >
OL x ✓ / �Cb 51.18 .. S 1 I c
\ / X 47.84
LS LS
58 50.54 s4 10YR 5/6
°9.62 I TH2 46.55 10YR 5/6
\O / TH1 10" FIR TREE 48" 2.5Y 6/4 POCKETS 43.0' 36" 44.0'
49
49.88 .51
\\s / .58 48.61
\ //50.93 0.01 63 49.94 48 16// q8 6.31 �' PROP. VENT WITH CHARCOAL FILTER C 1 C 1
\ / 50.83 PAVED �\ 32I AND BUGSCREEN (FINAL PLACEMENT BY PERC
f�
\/ DRIVE � � N CONTRACTOR WITH HOMEOWNER
M FLS M FLS
/\ CONSULTATION)
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/ 1 O
X \ SHEDS 71 0 ND �79 10YR 6 4 10YR 6/4
1.47 .00 49.32
No FNON. L _ - 0 96" 39' 96" 39'
GSLABE L1� ,8,
.01 C2 C2
/ za\
a x' x 45.58 M/COS M/COS
63 \ 10YR 5/6 10YR 5/6
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48.66 77 I Ik i
BM - EDGE OF CONCRETE; 148"
34.6 144 35'
47.11Este. E T. sT** PATIO ELEVATION = 46.5
NO GROUNDWATER ENCOUNTERED
\ � �� 46.66�ro
\ 45.91 42.96
50.28 EXIST. DWELLING 47.81 7.00 41.23
Ike 41 I
49.79
N
rV
51.83 ` ° 41 x 0 40
53.33 40.91 TITLE 5 SITE PLAN
45.82 3.45 x 8
40 0. 3g OF
3
38.14 428 SHOOT FLYING HILL RD.
7� 44.a2 ��P�� SHED I ..
25���� 37.67 CENTERVILLE
LOT H-1A ° PREPARED FOR
40.06 28,480t SF PER PLAN i
- 35.28 6.85 5.28 M/M MICHAEL KLUI�I
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APRIL 17, 2009
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ORO�RNG/PN�� No gEp.CN Scale: 1"= 20'
M\�Oig� SP 4.16
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6.18 � I 0 10 20 30 40 50 FEET
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� A. �" OJALA �+ downca e.com
DANIEL DANIELA P
OJALA �� k OJALA CIVIL (n
OJA %� k CI I No.40980 o No.46502 down cape engineering, inc.
!, r No.4098 '-� o Nc�465 2
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o FIST civil engineers
s\ y0 } a� T� q"a uRVE - ss� N E` land surveyors
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,J,� � 939 Main Street ( Rte 6A)
09-065 DATE DANIEL A. OJALA, P.E., P.L.S. YARMOITHPORT MA 02675
09-065.DWG(SBO)