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HomeMy WebLinkAbout0124 STANLEY WAY - Health 124 Stanley Way Centerville A=228-117 f> I J4a��tbg UPC 12534 No.2-153LOR HASTINGS,MN r TOWN OF BARNSTABLE LOCATION /1;/ J2'�04 4,6 7 SEWAGE# VILLAGE ASSESSOR'S MAP&PARCEL.tea k 1/7 INSTALLER'S NAME&PHONE NO. A041,e�' �,,���zt�,� Y•Y ,�f. SEPTIC TANK CAPACITY LEACHING FACILITY:(type)-Z JV �id> (size) $11,,f ro• jt x� NO.OF BEDROOMS y ' OWNER,&_ PERMIT DATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet FURNISHED BY f/OcWAr e' �SV•�iSr vs u O Silt, J 3 4Z No. /� /� Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS Yes 01pplitation for Disposal *pstem Construdiun Permit Application for a Permit to Construct( ) Repair(/Upgrade( ) Abandon( ) ❑Complete System [ /Individual Components Location Address or Lot No.17— S raeeQwI/,/�W471 Ownerrr'ss Name,Address,and Tel.No. Assessor's Map/Parcel � Installer's Name,Address,and Tel.No. Desig er's Name,Address,and Tel.No. Type of Building: ��11 Dwelling No.of Bedrooms Lot Size 7l sq.ft. Garbage Grinder(Z-fp Other Type of Building / No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 1Y gpd Design flow provided gpd Plan Date 7 1 Al Number of sheets Revision Date Title ) Size of Septic Tank �d� i�"l.5 /i19 Type of S.A.S. Description of Soil �- Z71A Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. / Date l Application Approved by Date eZ Application Disapproved by Date for the following reasons Permit No. ��� � Date Issued �� _ No. Fee ` THE COMMONWEALTH OF MASSACHUSETTS Entered in computer. PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes application disposal *pstr'm Construdion #ermit Application for a Permit to Construct(• ) Repair(V�Upgrade( ) Abandon( ) ❑Complete System [Individual Components Location Address or Lot No./Z l� $la- e el Owner's Name,Address,and Tel.No. Assessor's Map/Parcel Z 6— Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No. Or7���a i S 7 �OGf��I 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) !V q,/' gpd Design flow provided u. gpd Plan Date "7 /�--l/ Number of she / Revision Date a Title h Size of Septic Tank /Cj � f- �'`}'; Type of S. .S. �" 2 Description of Soil L// '� Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. (—Signed -- ,q Date Application Approved by t Date [� Application Disapproved by Date for the following reasons Permit No. Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired(yJ/ Upgraded( ) Abandoned( )by r.�� .. /� at Z` has been constructed in accordance with the provisions of Title 5 an the for Dispos System Construction Permit No._ }`�-{ -'�. `ted 7 Installer -�&J, Designer ,. r #bedrooms Approved design flow qTJ/ gpd The issuance of this permit shall not be construed as a guarantee that the system7iil-functio d signed. Date Inspector N No. )o Ed _ Fee THE COMMONWEALTH OF MASSACHUSETTS ` PUBLIC HEALTH DIVISION-BARNSTABLE, MASSACHUSETTS Disposal 6pstem Const action Vermit Permission is hereby granted to Construct( ) Repair( Upgrade( ) Abandon( ) System located at E/7fY 5 Ze I LL.-tl y r,off;fir r 7 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 compl ted within three years of the date of this pe it. Date f r��1/l'';7 Approved bye, FROM :down cape engineering inc FAX NO., :15083629880 Aug. 11 2010 10:55AM P2 R -U aior y MASS,. Publk- llle-�Mhh Division T-jiounn McKean,Director 200 Wfain Shied.,Hylamis,NU 02601 (Xfick-,: 508-86).-A,.644 Fax: .509-790-630/1 Mffin sewagge.PeTnIftP Q010 Assegaor's Maq 01- W—el Ad&eqs: A-4 /W 1�4 Av N/f MoL-t-/4 "14 W (MI Z'//' X91-1vle as issued a pf;rIllit to In."Aall a septic-system.at based on a.design drawn by all (desi e- er) I certify that the septic sYslotn reftn'enced -9-bove was inSlalled substantially accordin-F.. to Lhe des'gTl, 'wlnuli l-nay Include mkof approved 0111111geS SLUJI US lLitel.aj, T.Bt(.)6,jfjrjj). Of th.d distribiAioti boxgiadjor septic lank, cerfify thaL the septic sy,%Aem referell.cc:d above was Installed With ITILkj0T GIIIPI-Opes (i-e-. greateT than 10' lateral relocatiou of the SAS or any vulicul i-tioulti,all of any conlPOnellt of the septic system) but in acoorcktrice with State Q4r Local Regulations. Plan Tvvi.,Jon or Geri-ifiled�I.S-11111.1t by desiger to follow. DANGLA..j JALA CfVIL NO,46507 Stallip Ol'i,") PLEASTE 'JlETUlUq TO 13A.RK'STABLE PURLIC YJQCl-ALTfl. DIVISIOM CITRTTYT.CA.'Y'W 0.19, cx-'ry TiAnci-WE!, N(PT B-9 l;',lUaTT4TD TTIITR, ItOTIi THIS FORM ANH) AS-BUIT,T (":A14) ARE RXICEIMID BY ITTY,B.AJZN,9TARTF,'PU%Tj(l IffiiAl.rl-I DjV0Sff(.)N. THANK YOU Cettlficalici.iiloim 3-26-04.doc 4� TRANS. NO.: CITE/TOWN: APPLICANT: � . 1�.�--►T;2���r1,��.� ADDRESS: DESIGN]FLOW: gpd REVIEWED BY: DATE: N/A OK NO ,{'1�(,TAT ��fi..., .,�t<-_,�:,;.:_.,- .,.,-:r- •,,; '{{�.g.:, ? s�#y{t ..,�: g -.r :,; '1.4J�il`I:�l�C2J✓ ai ri t �.. 1 . i, f:< t1� �� 1., ik lei ! o�n)�a6'k��4 '�,5"A -� � ��`�'iPw'a�:!;-'1141�.-:7 +L.,.:ra �e(i ,<..:. 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 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 and provided) soil absorption system(required and provided) whether system designed for garbage grinder 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 CNM 15.220(4)(h) and (i)] Location and date of percolation tests (performed at proper elevation?) [310 CMR 15.220(4)(1)] Percolation test results match loading rate? [310 CMR 15.242] Certification statement by Soil Evaluator [310 CMR 15.220(4)6)] Observed and Adjusted groundwater (method for adjustment given or indicated) [310 CMR 15.103(3) and 310 CMR 15.220(4)(11)] Addiess Sheet 1 of 7 N/A OIL 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(l)[1]) Profile of system showing invert elevations of all system components and the bottom of the SAS [310 C1V1R15.220(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)] in each of the primary and reserve Test Holes adequate (two 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 / 15.0001 V System components not> 36" deep (unless Local Upgrade Approval or LUA requested) [310 CMR 15.405(1(b)] Sheet 2 of 7 Address s N/A OK NO I.J [[���p-�-.'7� 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)] Mm num 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 for systems>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 fromTeSOUIceS [310 CMR 15.211] Required when other than single-family dwelling or flow>1000 gpd [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 gas baffle or approved filter [310 CMR 15.224(4)] Address Sheet 3 of 7 OK NO Located at least ten feet from any water line? [310 CMR ✓ 152���� (2)] Disposal piping at least 18" below water line (when water and sewer cross, see 310 CMR 15.211(1)[11) 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)] Siphon problem/ (leachfield below pump chamber) Endcaps or vent manifold specified? 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) 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)] Ile Inside minimum dimension 12" [310 CMR 15.232(2)(b)] Minimum sump 6" [310 CMR15.232(3)(e)] Watertight cover if<2000gpd); waterproof manhole if>2000gpd [310 CMR 15.232(3)(d)] x rn l {,�;4 WA,, . 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, discomlects accessible) Alarm floats - alarm on circuit separate nom pumps specified? Exceeds two units must have two pumps operating ill lead-lag mode. [310 CMR i5.231(6) and(8)] Stable Compacted Base [310 CMR 15.221(2)] Buoyancy calculations needed? Provided? [310 CMR 15.221(8)] Address Sheet 4 of 7 N/A OK NO 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] . Iuspection parts 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 Docu�me�n�ta] Chambers and Gal. in trench configuration supplied with inlet / 1 every20 ft_ [310 CMR 15.253(6)] Each structure with one inspection manhole (if>2000 gpd must be to grade) [310 CMR 15.253(2)] Aggregate I'minimum- 4'maximum. [310 CMR 15.253(1)(b)] 2' sidewall credit maximum [310 CMR 15.253(1)(a)] In bed cco�nfiguratiop^ng, inlet everyevery 40 sq. ft. [310 CMR 15.253(6)] MAHER W"t owl Width 2'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(1)[4] and Guidance Document] � 4 (f�V�' ix�a�affi siz� f ;edm ' ,00 �). 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 15252(2)(1)] Address Sheet 5 of 7 N/A OIL NO Pressure Dosed ystein ? Provided pump and piping calculations as required [310 CMR 15.220(4)(1)] Pressure dosing required on all systems>2000gpd or alternative systems under remedial approval [310 CNa 15.254(2) and I/A 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 (>2000gpd) good to note on plan [310 CMR 15.254(2)(d)] Construction ill 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. Rom impervious barrier to edge of SAS (10 ft. recommended) [310 CMR 15.255 (2)(e)] �iF"�aa�"lle`sS ?steata f '`` � 1 e ter-s Check DEP Approval letters for credits and design conditions t d with pressure dosing do not allow pressure discharge oil interface y ,�v �air1�5'�J7757-Vs,e P DEP Approval Letter provided and/or have you the letter for conditions? e tcchnology being properly applied and does it meet all roval Conditions? sere 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 I YfCC1ClYECe Are the.vaiiances listed on the plan ? [310 CIAR 15.220 (4)(q)] RLS Stamp necessary on plan if a component is within five feet of property line [310 CMR 15.412(4)] New construction or increased Clow proposed- [Refer to 310 CMR 15.4141 Sheet 6 of 7 Address N/A Ox NO Is the system in a Designated Nitrogen Sensitive Area(Zone II for a public supply well)? [310 CMR 15.214, 310 CUR 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 CUR 15.214(2)] Are the nitrogen loads proposed in compliance? [310 CMR 15.216(1)] I�ZSCG'�ZCL YE®Zest �,�yc;, t�t•��t Yr � �t;'3�ez12r'� vF��r �ai"".1^drit `�r?vi�'t��i� 1 rx"uy�`r'�6: t � �SIa � µ{ Pumping to septic tank ? [ 310 CUR 15.229] Shared System [310 CMR 15.2901 Address Sheet 7 of 7 / Town Of Barnstable 1Depae't!mG><tt'bi'Regulatory ServicesPublic ff�' a MMSTAHLE, 4 i6y9- y� 200 Main Street,Hyannis MA 02601 ��P6rl PAA'�p J - Date Scheduled <) Tiniv Fee Pd. Soil Suitability Assessnientfor Se*w.age Disposal Performed Byt';`�Y1N���- —'SC. Witnessed By.; s T ~ — 0CATION ark OIC�RAIL I[N'OI[&Lffi0N*----- -- -- - Location Address I/ ` Owner's Name e"-mC, Address Assessor's Map/Parcel: . /I 7 Cugiueer's Name �(JO(/w� � NEW CONSTRUCTION REPALR Telephone If (�� Land Use Slopes(%) (9— _ SurCace Slopes Distances from: Open Water Body �— It Possible Wet Arco �— ft Driuking Water Well— ft Draihage Way ft Property Line 5 ft Other —it SKETCH: (Street name,dimensions of lot,exact locations of test holes sc perc tests,locale weLlands 4n pro)itruay to holes) -�F' 3� • � �ul � G C__Ocv5 Parent material(ge'ologicj_"�` ` '�-` - - -Depth to Becb'Uelt Depth to Groundwater: Standing Water in Mole: Weeplhg Plant Pit PUB Estimated Seasonal High Groundwater N// 1- D]CTERMINATION I[,OR SEASO A1L >F IGH WATER TABLE Method Used: (� Depih Observed standing in obs.hole: '� tfa, Depth 10 5QI1 Ixiwt1�31 Depth to weeping from side of obs.hole: _ I!I, Uroulldmiter AdJUSI aunt Index Well it Reading Date: Index Well level Ad,1•6actor At(i,drIAL111dwater L.evul PE RC0LATI.OZ'4171'JCIST lual� b OA'lirla- IO_A�I . Observation j Hole# r `/ Time tit 4" ` _ N Depth of Pcrc v/J� _��� �� Tlmp at G' Start Pre-soak Time @ V �V _ t Time(9"-6") End Pre-soak `•L'aVal G,9 , _e Rate Min./Incli Site Suitability Assessment: ;life Yasseil— itG Failed: Additional Telling Needed(YIN) Original: Public Health Division Observation Hole Data To Be Coinpleted on Back----------- **q`It percolation test is to be coiriducte.d tiwit➢dn 100' of wetland, you must first uotafy Iflic. B a!nast;ab➢e Conselrvati'oli Y)ivision at least one (I) wwee➢c prior to begiano.d ug, Q:\S13PTIC\PJ3RCF0RM.D0C .IDIEEIE',P.cCD] SE' T. OLLI LOG — R Depth from Soildr'orizona ro Surface(in.) Soil Texture Hole Color Soil.(USDA). (Munsell Motulders,el�c "A Dcpth from Soil Horizon HQD]D #Surface(in,) 'Soil Texture Soil Color(USDA Soil} er (Munsell) Mottling (Structu OtlStones, B � 0 . S Consi enc % C Rvel D �P®-BSE-RwATP.�ON H®E� ®G Depth from Soil Horizon Hole #--- Surface(in.) Soil Texture 5°II Colo[ (USDA) Soil Other (Munsell) Mottling (Structure,Stones,B oulders. Co sistencY %(3142 7 ------------ --------------- J lI 1ElElID OBS1E][� I� ®]L� Depth from Soil Horizon LOG HD]e.# Surface(in.)' Soil Tcxture Soil olor - -- (USDA) Other unsell Mottling (Structure,Stones'- Boulders, Cond ten v p6 OrwPn ]Blood Insul'aince][date Ma Above 500 year flood boundary No Yes Within 500 year boundary No / " Yes Within 100 year flood boundary No Yes m_ �PTtutru_11V____ceu¢r'>ringPeirvaousllRater i ,Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the aren proposed for the soil absorption system? R )(f not, what is the depth of naturally occurring pervious mararinl7 tl✓'er�tfl�c�kuon , / A certify that on Iv v (date)I have passed the soil evaluator examination approved by the Department of Environment a].Protection and that the above analysjs,was'performed by me consistent with tP;e re tsire r 9 expertise and exnPrjen cri ed i; �O-Cj":ff 15.017. Signature I ` ` Dada ZO l�j f1,\SPPTICU'EhCrORM.DOC L � CAT ION SEWAGE PERMIT NO. VI L G E INSTA LLER'S NAME & ADDRESS q R U I L D E R OR OWNER DATE PERMIT ISSUED _I�, 79 DATE COMPLIANCE .ISSUED 4 - 7f ° � ©\\ r � . . \ Fss.... ......... THE COMMONWEALTH OF MASSACHUSETTS BOARDS F HEAD .....OF.. �b�k�IZ�I pplirFation for Disposal Works Tonstrur#inn Prrmit on is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: a Lo-r � 6 0>"fAPVi g L ��� 0-� ................__.. ._........ ....... -..... ------..........--- f Lo ion-Address r Lot N .............\1.® 1 Z'.. l ..Y° . ....._.._......----•-------.•..._ �'Szf� ..................... per- y� Owner Address`........... ._....rLSD -------------•---•------ -------------------------------- Installer PQ I Address /� Air e. UType of Building j ® Size Lot...-.......................- �-, Dwelling—No. of Bedrooms-----_--7--•.................................Expansion Attic ( ) Garbage Grinder Other—Type of Building ............................ No. of persons.....--..............--..... Showers ( ) — Cafeteria ) dOther fixtures -------------------------------------------•----------......------•----------.....----- W Design Flow................... j____.----. gallons per person per day. Total daily flow......::��.��1�Q._.�............gallons. WSeptic Tank Liquid capacitygallons Length................ Width................ Diameter................ Depth................ x Disposal Trench No..................... Widt .................... Total Length........._ .. Total leaching area.....................sq. ft. Seepage Pit No.......�...... Diameter.. Depth below inlet..... ' . �;2 � P� ---- ---••------- P �......._. Total leaching area-+�.--------------sq. ft. Other Distribution box ( ) Dosin tank ( ) o �7 Percolation Test Results Performed by.. L�jn.{ ?_....0___�� � ................... Date.....I__':.�. _:..7-�..._.---. Test-Pit No. 1... .A..--.minutes per inch Depth of Test Pit.................... Depth to ground water..--.................--. fs. Test Pit No. 2................minutes per inch Depth of Test Pit.--...........--.... Depth to ground water........................ ....... . ...................__ z Description of Soil---- --- --- -..__ill_ ®..-2.___•-52--- -• ---•- _...-- .................................................... W U 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 A ITLE 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has b n is ed b th5ly6a of ealth. Sign ............. ..................................... •-- 3 I ate Application Approved By•.... �- ��� . ;Z >�a7 -•--•- te t Application Disapproved for the following reasons---- ----------------••----------------------•---------------------------------•---------------•-----••••---_... ..............................----•-----...----•--------•----------•-•----------•----•--....------------....-----------•--------------------------------------•---------•------------------------------ Date Permit No........ ... ............................... Issued:- ...Y----- . ----- r"-r Date .� to No... ._ ......... �. Fps..................... ... .THE COMMONWEALTH OF MASSACHUSETTS BOARD F HEAL T ......OF... : ............... ........:.•-...... Appliration for Biopoiial Work.6 Tonotrurtion ramit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: 9't- �1­ c� �.. _._ � ..................... .... Location- dress .1 ... - ���.0...._...�° " -.••---••••-•--•-•--...... 1�U.�?.�?/ i....�._. '.....t NlN W 1...)jok!Lil.._ e?007 �� s ner Address W _. ...................... �. �:�(��..... ..t.... Installer Address Type of Building Size Lot___,.(7_ V Dwelling—No. of Bedrooms.______._____________________________Expansion Attic ( ) Garbage Grinder IN Other—Type e of Building No. of ersons____________________________ Showers a yP g --------•----._.---•----__.. P ( ) — Cafeteria ( ) d Other fixtures -------------------•--...-•••--- -------------._..__.------------------------......_..._------ .. ---------•-•..._.. W Design Flow._.......l..........J`.J.___._____-.gallons per person per day. Total daily flow_-__.____-___ .............................gallons. WSeptic. Tank/-Li�uid capacity/2S7!..gallons Length................ Width................ Diameter................ Depth................ x Disposal Trench—No..................... Wid h---- Total Length....... Total leaching area____;_ __ sq. ft. Seepage � Depth below inlet_,___l(.�?_____.___. Total leaching area'�_."� ...sq. ft. See e Pit No._._. ^.___..__ Diameter____ __________ Z Other Distribution box ( . ) Dosm a. ( ) Percolation Test ResuZA Performed by.... _c41 ......0...1�:��A�_................... Date......... ��=_7�______.. Test Pit No. 1 .. .____minutes per inch Depth of Test Pit____________________ Depth to ground water........................ 44 , Test Pit No. 2.0---_---------minutes per inch Depth of Test,.Pit..............__..... Depth to ground water......................... ! F D Description of Soil•--- �F .z•--.: at'�___ � r "� --~--�------ x . _..._ ... -•---------------------........................_................ W U 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 TIT:.': 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the and Sign ........................ ..... ..... --. Application Approved By...... �._ :-....-- ...-_ ----------------•-- ------2 �/c��r '- ��� -------- ----D ate--•.......... Application Disapproved for the following reasons:_______________________________________________________________________________________________________________ 1/ =.......-•------------------•------•-----...----------------------•--•----------•-•- ---...------------------------•--------•--••-•------•-•---------•---••--------------._.--------------------------- Date PermitNo........................................_.............. Issued_....................................................... Date .r s THi'',COMMONWEALTH OF MASSACHUSETTS f \,BOARD OF HEALTH .. bF........... � .,..... Trrtifiratr of Tomplianrr TVIIS IS TO C IF ; hat-the Individual Sewage Disposal System constructed ( or Repaired ( ) by s� stalle at-_"rr ' - .. t " ... ` ate- .............. - - ------ has been installed in accordance with the provisions of T 5 of Tkie State Sanitary Code as describe(L in the application for Disposal Works Construction Permit No. _._�. ................. dated....... `:1_2:�'-7_ ............. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL UNCT1GN SATISFACTORY. DATE...............X`........... .............................. Inspector.-•---- .................................... 11110 THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH No..:......7.d....... ,.i�' '... FEE........................ Maps Work.5 T o ion omit Permission eby gra„ted._._. G ! � ..... .: .. to Constr ) n�nddualSewa os Syst .- 4---- •-----•. -•-----------•- •----- ..__.. .._......y - ' 9��, at No.. .: I C as shown on the application for Disposal Works Construction Perm*Str ✓� y - -�• Board of Health DATE-------------------------- .............................................. ,!` tS '" �d/Y FORM 1255 HOBBS & WARREN, INC., PUBLISHERS r c►- , �� .. ,j, �... .. _. �� , __ _ ,r _ _ . _ _ . III ,. c 4 A - •: r t v q Y' �� r }r I.0 I 1�:I"I,;-I.:,I��.�I.I��-.,-I-..i I I.I'.—1...I.G 0II I-.���,1I'i..�-1,I..�I--....,I..1.o l,.-0;I.(I�I-,I—'1 I 0:,.,.I..I'6�I I.I 1�.".I�I,� iI II II I. 1. ?A�� x r { 4 �—/ %�r; fur r� , ,A, � k"° .fir r :p V, y tLk .• 4t� (L' r .+ lJ , 1 d . U d, {� kT Y 5 d I � .. + A ,u's✓ y ' ' � is ". 1�-.. y, �,E`" I 3 x a ;r _ fa 1 f 1 X � ,hem /r 1 �' L }5J' � .+ ' a _ y - 2 x $ a rar 5. 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( ` r , \ ( �- a hit ] . ,� Ts 5 r t - - t,} - 'S z x s s z d t i t`�' k �' �' r e s : { " i, aq r s. k 17�2IVF Q O a(� i $ F f I f ° + -.� , ARC K �- Fp,ry 41.. k 5� T 'h`' f t, J Q - r r, w x ti' 3 t: G'e' y��%f+ Si t Y r" �' #' ✓}': rQ '�M1 i vi I. i a � 'rr'a . a w $ /ZO I O O 5rx N k :1 f,� wS a 1 7 I a - tia\jH f A ,,,*., a e,r < , M r =; , F jn .•., r_• I • h ����, �?' ..�� RICH RU 11 r`1, t t e > f ' g. LD I- 1-3) wf .. 1AMC5 .a x zx ! x RICH, . rp 4'EAR,S 4 A, :` I I.= 7AME5 t'4 No Y7s71 1 "lam; w Y e��. pfHEARN v,I C 'p !? `'it r+ No 691 a>f1 �" LEGEND -' '. f , TING `;SPOT '.ELEVATIONS O,A EXIS - x ' EXISTING CONTOUR.-,- — 0 — — — 'w` � ., F(NISHED ...SPOT ELEVATION'S O-O t '} F' NISHEo ' ,ON OUR o . : PROPOSED PLOT PLAN k . A I OVE.D• 60ARD ;'OF HEALTH .�— { MASS' y DATE r AGENT �OT � j,9/✓LEY' I/U - R. ✓.- O'f>EARl1/ �IVC RL S � S �ry It -CERTIFY THAT .: THE PROPOSED I— , {, x ,6UILDING SHOWN ' ON; THIS " PLAN 1346 ROl1TE 134 CONFORMS` TO THE '" ; - LAWS . EAST . DENNIS MASS" , . $. . -0 ,- •, ' MASS. DATE SCALE _ L 9 ? 9 / "' ' `fi :� 1 JOB* N0. 9 �o'45 CLIENT �1 Q ' Ott 4jt ' . ----- , cDATE `tZE�ISTCRE.O LA'!VL Sc1RVFYOR, . U,R. R`f. - SHE T OF �-- _S; 3:yt' tp tfr `1 rAk .j:y •.F AF 'Ax^" y�. '..- 4 .. .a.w w.. .,. ;. TEST LWERT ELEVATIONS 'NOT ES o A HIP AN :MATE"RIALS : OF ..SOI `TEST /8 9 _. :. INVERT: AT , BUILD.ING, FT. DAT E . L - , m INLET .SEPTIC:. TANK - 9°7..'s" FT. - T WITNESSED • BY,; �- S A HALL.; CONFORM TO -D E QE<�'�T1 LE ` � .., 7 3 AND THE .TOWN OF.' 92ivs u�RULE`S T SEPTIC , TANK 9 FT. CATION: RAT 4`' ,Z, :,MIN./iNGH OU ;LET , PERCO EL.— AND REGULATION. .'F.QR SUBSURFACE{ T. DISTRIBUTION+` BOX 9G•7 FT. INLET'. RY, .,_SEiNAGE : s4 E - B"SERVATION HOLE , 2 DISPOSAL OF sANITA; , OBSERVATION, H.OL I 0 UTLE•T DISTRIBUTION ::B:OX . .; 96 a. , FT ` ;. . ;.' . ., r - _ , o :r ELATION- - :. n , :: _ _ R N ./oo./ _ _ ,., E L. a „ ELEVATr10. ; , r ,a INLET ,L EACH I N`G PIT >' 9G FT. _F lNoo p�o.9�1 ' BOTTOM . LE'ACMI'NG' PIT 90«0' FT. , ' ,S IG gso;e v . z¢ NUMB:ER `OF BEDROOMS . . �. , GARBAGE, DISPOSAL UNITI ¢4o GAL:/DAY ' . TOTAL ESTIMATED FLOW (.1LGAL. .../BR./DAY x� BR ) - ,4.� REQUIRED SEPTIC TANK ��, CAPACITY:.. , . . . . ., GAL. o s ACTUAL SIZE. OF SEPTIC TANK TO BE INSTALLED .. . /5 GAL. LEACHING AREA REQUIREMENTS SIbE :*WA LL AREA Z.S GAL./S:F, r tys' �'GAL•/S:F , ' - BOTTUM AREA - w L, ACHING. CAPACITY (-BOTTgM4 SIDEWALL • . . . 9 � GAL SERVE >LEACHING CAPACITY. . lG� �J GAL. • - . TOP OF • - FOUNIj. 4 SCiri. 40 ELEV:=1o/ a / - CONCRETE CLEAN SAND O�r'Ml�.r CQVERS PV.0 PIPE MI PITCH '.-: CONCRETE w N� COVER 2 % MI : H N PITC ,�� RICH O� 12 MAX. �` Yz-RD. r RICHARO , 1 • - Z �� ca C"Fif'.5 1 .4 .o. ;JAMfS .- o.. _ _ ARN,_ c�. O'H£ARN cV 2 `' ,A Nu , No:-694 C cn FLOW_ LINE , ONE8. I g�, c aW _ .� _ STE ,r CE. . 6 LAYER R (— D S T E. .,. a: 1 N — rs � R 4 CAST I ;. - �M " Q N .. r: .WASHED STONE lit' - P-.- MIN.- PITCH S�1R� S JT(4RtiA PRE :LE•ACHLNG P.E.R. wF, . .. �.,. i _. a: w _BOX.. a. - �. p W ° .. _ _ p �c%+ _ 4. NZa ....,,. ' , •r t 0 1 >r v l S t - -. • ..:. .. .. .. , v a' :-r .,'} E ,• ., .4�:" ..,fin , a :e t S F E A R .N. J.- 0 H R. T 4 .. . .�: .....•. _. _ .,. -- _n-. .. ti..... _ .. .. mar._ ...._ +,.. _.. . . .. . . , , < 1348 U E 3 ..� _ r., � ._ _: -,. w..i-..fit iz ....:.: <. .-... . ., ,.. '..: „ .o- ,.-.. ♦. ..> . -+. - +,_,.'f. .. - n '.L -Y.: Yv ...- -:.:M,. " ... n:,„. s _ ,.T': yr ra _ -. f..s �: .fir .:..... ,.._ ..Y:. .; ,p !L B T BLE , .-. JOB;N0. CLIEN ,v +�" ..4 /ITT} . _, .... r. .. .,. .. ..,,t. _,..., ._ '" , :.:.,., ,.- ...: ... ... r.,. ct.F:C ,, ..... 'a., -. ,,.. k x ..4 ,.t �:h':.: �:.b p ,r :. �Y 4 „ SWAG E �FD � . , .�� . . x. �� �.�.� �-.�r�, � �� ,, ° . ,, . , ,: , �. �. , _ � � .. . ,�•< DATE rtE:ET Z0. .� - _ .., � ,NOTE � • .._ 3 _, , _ ,,. : . _� ., �. Z .. .. 2 .. r ._. .. .:,.l S:ef. ^s .., ..... r.. .. _.. ,. p ". 's. b � _. ..... '%4 r Y.. i ..F:. -A. ��ss R- S1_•' - : c .- :. ✓':" ... .. r . .R r v '.'. -> ...r,,'••_ . ,.. -." ... ., _. Y 4... „_ '3 ..-x ,,. ,rz` t/`. ..,nd t ... ,...4E_. s'R n t,.5r,3.. -., _ �.. i. .:. J.". .._ F.. - _. .1. ..k . -.,¢a.. ,r w i. ... (� .. r ., _ '•sl;?+' ....Tl:,,i L±- K_` _;a•° 3� ,.. ,. .,. _-... . . �.y ._.. ., ..., " .,. a _ _ ,.,. _. - "� ....v ""�:...... . .._::�,"'., , . ,' :. .. �. ... - a-,. a .- _ -, �4 '�'_..m" vim:: .x 'r£ _f,r ,Jh. ,� tFkt ,�.. �: --. .^ 4'.. x u• _.,s•. . _. y. +ra -ova .`3":4� - - o ", ... . ... ,c?� -. d`':ar`'��e°E'r �>r..'_ `�.r_. di., .. .. a .,�D"'� ._.a,. .., „ .ie <-.,s �Rkr ... ,. 1� �, b.v •� _-C .,�,'. ,,.�u4. t .l -as.:..3', -.-... ..a ,._: r. , fi a-.. ,., .�-".r>>„� `�:.: n . ... ....�. n... ., '"s.fi r, -,._.r..ar... ..�.. `�.��,.,��, .�R..�.n• .S°y'.3�. �s. �., ,.. ,_.. r.. ..,l"`r'.. .,. �.. .. . x s.-. .,r. - �r f,r .. .i. ,.�. .. '-� ., .:> .,... ,. a x .,.. ,.-s.- _.#-=+£`... .xi° ..'-w $•�'. "-['ts`i::'. .1r .,.-.", .. .. ,-,,. ..:n,. x„-•, >a,3..,, r<;�nrn_. >__X'E.wr...�,r.. _. �.r ...::P ��._r_ -_. �_�.,r�,.,�.�„<, .�r=,,,..•___.A,,,.�<,�,,..r��_1. �� _.� ,,.:r: _ �,.,._.:.K �.i,,. __ ALL SYSTEM SHALL L E E N SYSTEM PROFILE MARKED WITHCMAGNETICTTAPE OR BE NOTES COMPARABLE MEANS FOR FUTURE LOCATION. SYSTEM DESIGN. PROVIDE MIN. 20" WATERTIGHT, (NOT TO SCALE) 1. DATUM IS APPROX. NGVD 99 - EXISTING CONTOUR - ACCESS COVERS TO WITHIN 6' OF FIN. GRADE AS REQ. X 99. EXIST. SPOT ELEV. GARBAGE DISPOSER IS NOT ALLOWED TOP FOUND. EL. 55.1' PROVIDE INSPECTION PORT TO WITHIN 3" OF FINAL GRADE 2• MUNICIPAL WATER IS EXISTING \ MINIMUM .75 OF COVER OVER PRECAST 2% SLOPE REQUIRED OVE SYSTEM 53.fi' 3. MINIMUM PIPE PITCH TO BE 1/8" PER FOOT. 99 PROPOSED CONTOUR FLOW: 4 BEDROOMS ® 110 GPD = 440 GPD 4. DESIGN LOADING FOR ALL PROPOSED PRECAST UNITS a [98.4] PROPOSED SPOT EL. USE A 440 GPD DESIGN FLOW - TO BE AASHO H-LQ 5 3'f*� 4"0SCH40 PVC Locu TH1 PIPES LEVEL 1ST 2' 2" DOUBLE WPISHED PEASTON 5. PIPE JOINTS TO BE MADE WATERTIGHT. TEST HOLE SEPTIC TANK: 440 GPD (2) = 880 OR GEOTEXTIL FABRIC 50.61' 2 SLOPE OF GROUND RE-USE EXISTING SEPTIC TANK** 6. CONSTRUCTION DETAILS TO BE IN ACCORDANCE WITH TEE SEPTIC TANK** TEE 50.9f*'ip q 310 CMR 15.000 (TITLE V.) ° °�°'°'°'°'°: '. c 50.11' 08 7. THIS PLAN IS FOR PROPOSED WORK ONLY AND NOT TO �, UTILITY POLE LEACHING: cas ° °°°°°°°°°°°° °° SIDES: 2 (41.5 + 10.25) 1.85 (.74) = 141 GPD 50.3 ° o°^Oo°^OOOOO °50 13 �$$ BE USED FOR LOT LINE STAKING OR ANY OTHER r FIRE HYDRANT ' 2' PURPOSE. BOTTOM 41.5 x 10.25 .74 = 314 GPD o� 48.11' NOTE: NOT ALL SYMBOLS MAY APPEAR IN DRAWING o 0 0 0 0 0 0 0 0 0 o c 6" MIN. SUMP H-20 3050 INFILTRATORS 8. PIPE FOR SEPTIC SYSTEM TO SCH. 40-4" PVC. 0 0 0 0 0 0 0 0 0 0 0 0 000000onono0o00000oo0o0c 12" MIN. INT. DIM. G 'va n n n n n n n n n n r9.TOTAL: 615 S.F. 455 GPD 3 4" TO 1 1 2" DOUBLE WASHED STONE WITHOUT INSPECTION BY BOARDNENTS NOT TO BE OFANDLED OR CEALED Q� orseshoe6" CRUSHED L COMPACTION. (115.221 0[2]MECHANICAL / / �<b USE (5) INFILTRATOR 3050 S WITH 3 STONEPERMISSION OBTAINED FROM BOARD OF HEALTH. OVERALL DIMENSIONS TO OUTSIDE OF STONE: 41.5' X 10.25' a *THE INSTALLER SHALL VERIFY THE ALL AROUND 5.51' 10. CONTRACTOR SHALL BE RESPONSIBLE FOR CALLING LOCATIONS OF ALL UTILITIES AND ALL BUILDING SEWER OUTLETS AND DIGSAFE (1-888-344-7233) AND VERIFYING THE LOCATION OF ALL UNDERGROUND & OVERHEAD UTILITIES ELEVATIONS PRIOR TO INSTALLING ANY PRIOR TO COMMENCEMENT OF WORK. PORTION OF SEPTIC SYSTEM ( 1 SLOPE) ( 1 SLOPE) LOCUS MAP MA 11. ANY UNSUITABLE MATERIAL ENCOUNTERED SHALL BE APPROVED DATE BOARD OF HEALTH FOUNDATION- EXIST. SEPTIC TANK 60' D' BOX 4' LEACHING BOTTOM DWA & FOUND 42.6' LEACHING REMOVED FACILITY. AND AROUND THE PROPOSED NOT TO SCALE FACILITY NO GROUNDWATER FOUND 12. EXISTING LEACHING FACILITY SHALL BE PUMPED AND ASSESSORS MAP 228 PARCEL 117 REMOVED OR PUMPED AND FILLED WITH CLEAN SAND. **INSTALLER SHALL CONFIRM MINIMUM SEPTIC TANK SIZE AT TEST HOLE LOGS 1000 GALLONS AND ITS SUITABILITY FOR RE-USE. REPLACE L= WITH 1500 GALLON H-10 SEPTIC TANK IF NOT SUITABLE (OR H-20 �'� � ' s• ENGINEER: F IT WILL BE SUBJECT TO VEHICLE LOADING). � R=1s DANIEL A. OJALA, PE, SE SEPTIC TANK I ww`` G;C� ,0° WITNESS, DAVID STANTON, RS DATE: 7/16/10 �pbc 69 PERC. RATE _ < 2 MIN/INCH S CLASS I SOILS P# 12988 I � `' ELEV. ELEV. J Olt1 53.6' 0„ 53.6' A A LS LS 4" 10YR 3/2 5" 10YR 3/2 } LOTS 17 & `18 20,419 SFf LS LS � . / I?J- 52.63 3000 10YR 5/6 51 .1 ' 30" 10YR 5/6 X, I £'S 1 31. x 53.32 I PERC C C X 5149 FH 1 MS MS 2 I x 53.63 I 2.5Y 8/3 2.5Y 8/3 X 54.0 TH r I 1 I 132" 42.6' 132" 42.6' N 52.81 52.91 5 3 NO GROUNDWATER ENCOUNTERED � 4.40 x 1 O 5 "X X 11 N EDGE LAWN x 5 . 0 N " LY x 7 ox G I 54.19 zs GAS x 5 8 f 14" OAK x 5 5 s METER 1 BENCHMARK .21 x 5 8 x Q t`3.07 CDR CONC. BLKHD ELEV. = 54.6' >_ TITLE- - SITE PLAN 1 LAJ V 7.93 1 J OF LG. TREE > Z' 53.79 7.81 h 1 a Q 54.10 58.40 W '--- 124 STANLEY WAY 1� 70 1 w EXISTING , CENTER VILLE -`X�t5�2 3 DWELLING 53.81 \\ SS ,\ 2. 1 TOP FNDN. 53.05 \ 7 ELEV. = 55.1' LG. TREE ❑ 53.68 1 5 .94 PREPARED FOR 3.57 53.99 \LPIT) DECK �-' 3.80 53.61 53.97 53.91 BORTOLOTTI CONSTRUCTION/ 54,08 h� 1 SHWR 5 5- )52.85 McDERMOTT K-53.19_ w-- w $1� 53. 53.22-, I PAVED 1 x iLPITI I DRIVEWAY 1 DULY 19, 2010 53.93 - _ 52,991 Scale: 1"= 20' x � 52.66 �S 1 0 10 20 30 40 50 FEET H OF A11 120.00 1 f l �°� °A '„ m gyp` IFA. LA c c 1 cfi OJALA OJALA 1t CIVIL q No.40980 v 52.49 No.46501 Q W 4 QF „ra off 508-362-4541 fax 508-362-9880 AILA: I L cy�N I downcape.com OJALA A. , C OJALA down copa en ineerin8, inc. � � ND 46502 q No.40980 �a civil engineers /11 I �,� �` T ���`� �F!C S R land surveyors V 11 939 Main Street ( R to 6A) DATE DANIEL A. OJALA, P.E., P.L.S. YARMOUTHPORT MA 02675 10- 146 10-146.DWG