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HomeMy WebLinkAbout0081 THREE PONDS DRIVE - Health (2) 81 Three Ponds A= 173-074 Centerville S M EAD� Na Z+ISLIOR UPa INt �nwdroom • WiM b WA 109) TOWN OF BARNSTABLE OCATION I Jay� OA, '3 401 LLAGE ASSESSOR'S MAP&PARCEL INSTALLER'S NAME&PHONE NO. �Ad qT SEPTIC TANK CAPACITY`1�t 1V eyyt4 LEACHING FACILITY:(type) lLQ/" (size) "oZ a 6 a 5 2t NO.OF BEDROOMS OWNER PERMIT DATE: I ©� U COMPLIANCE DATE: (P / Separation Distance Between the: p Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility i N( 09 Feet Private Water Supply Well and Leaching Facility(If any wells exist on N site or within 200 feet of leaching facility) r Feet Edge of Wetland and Leaching Facility(If any wetlands exist within r, 300 feet of leaching facility) A_" Feet FURNISHED BY M • D� � 3 a.a. �� 3 �� •�' No. Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Zipptitation for -Misposal *pstem Construction Permit Application for a Permit to Construct( ) Repair( ) Upgrade(Abandon( ) Vomplete System ❑Individual Components Location Address or Lot No. O � � A+ Owner's Name,Address,and Tel.No. � Assessor's Map/Parcel 1 - $I i Installer's Name,Address,and Tel.No. + I Designer's Name,Address,and Tel.No. a-71it V h OcM � UP A)VIA4Z 1'{ M Win. Type of Building: s�DV'�"'''3��6`'a �''�`'� Dwelling No.of Bedrooms Lot Size 1fJ+ sq.ft. Garbage Grinder( ) • d Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided S y Q . a 5 gpd Plan Date g I,1 Is Number of sheets ( Revision Date Title Size of Septic Tank �M Type of S.A.S. �, a• s X �,S !f oa Description of Soil _ S.Pal._-J'AMA , Nature of Repairs or Alterations(Answer when applicable) 1'JM g p94_,V, _AA»ftAajN12? WQ �f- 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. J Q_ ��aw a DateApplication Approved byDate Application Disapproved by Date for the following reasons ,y Permit No. Date Issued ♦ h�11t.n�' t'5.�� '•4MAiC��, r "; " Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: G. Yes l �_/ .,PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS ftplicatlon for 13isposar 6pstem Construction 3permit _. Application for a Permit to Construct( ) Repair( ) Upgrade(Vf Abandon( ) li(Complete System ❑Individual Components Location Address or Lot o. �yn Owner's Name,Address,and Tel.No. � Assessor's Map/Parcel 1 )?j 01 '-i Installer's Name,Address,and Tel.NO. Designer's Name,Address,and Tel.Ni . D. Type of Building: scl '36 a9 Dwelling No.of Bedrooms Lot Size '�.; , 7 7 sq.ft. Garbage Grinder( ) Other Type of Building ,t�; No.''of Persons Showers( ) Cafeteria( ) j Other Fixtures r Design Flow(min.required) ?>36 gpd Design flow provided y gpd Y Plan Date �' Number of sheets ( Revision Date Title Size of Septic Tank 1! Type of S.A.S. Sw e-Jo, Description of Soil nn Nature of Repairs or Alterations(Answer when applicable) CAw o P'a- tom.1 i to e, Qaa 1' 9 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. ai ed , (� Date -I IApplication Approved byjit ; Date i Application Disapproved by Date for the following reasons Permit No. Date Issued k ` VV ------------------------------ --------------------------- --------V----------------------------------------------- P `(a r�+•n� THE COMMONWEALTH OF MASSACHUSETTS I / BARNSTABLE,MASSACHUSETTS Certificateifof Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired( ) Upgraded Abandoned( )by , r-- at has been conF.n ac rdVwith the provisions of Title 5 and the for Disposal System Construction Permit No � Installer�` ( j(��Q,�Q 4�-�e, Designer #bedrooms —�"" Approved design fl w gpd The issuance of this` ermi shall not be onstrudd as a guarantee that the system w Il fun lion as designJd. 1 i � 1 Date G Inspector Aj , ---------------------- ---------------------------------------------------------------- ---------------- -- --- No. "/ Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION -BARNSTABLE,MASSACHUSETTS ` -Misposal &pstem Construction 3permit Permission is hereby granted Construct( ) Repair( ) //Upgrade /Abandon(V) System located at g� Dn2 ���/�/~d 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:Constnuction st be-completed within three years of the date of this permit. - Date / Approved by Town of Barnstable Regulatory Services Richard V. Scali,Interim Director snxxsreaM Public Health Division i639• � Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Installer&Designer Certification Form Date: 9 10 6 5 Sewage Permit# QQ( —30 Assessor's Map\Parcel i c)lq Designer: 1 A-I C�—Je Installer: dAlb Address: �I q Address: H MEW_& lnn rn� `'�'`T �`. O 6� t Na. 09,615 On 9110h. 5 was issued a permit to install a (date) �� (inst l��eppr) septic system at .�1,1 yLo, @7y� /L, based on a design drawn by (address) 4Ac, dated V� (designer) 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 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system)but in accordance with State&Local Regulations. Plan revision or certified as-built by designer to follow. Strip out(if required)was inspected and the soils were found satisfactory. .._. . str I certify that the system referenced above was conf d cr liance with the terms of the IAA approval letters(if applicable) 41 V 4(lnster's Si re) $ (Designer's Signature) (Affix signef's Stamp Here) PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS- BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. QASeptic\Desiper Certification Form Rev 8-14-13.doc • �,tia Town of Barnstable P 6 1 y ._�8 g Ek, Department of Regulatory Services Public Health Division �3 r4' Date 200 Main Street,Hyannis MA 02601 ' EEp tAA'1 h I,.w - Date Scheduled Ttme Fee Pd. Soil Suitability Assessment for ,sew ge isposal Performed By: Witnessed By: (ti �.. LOCATION& GENERAL INFORMATION Location Address _ ,(1__ �,,,�,Q_ —LXV\.tClC� �-iy�-'liL l���. Owner's Name Address Assessor's Map/Parcel: 9-1 3 , O-1 Engineer's Name J,d�,l.vtl �„0 • NEW CONSTRUCTION REPAIR _ //�� Telephone Ik � �`�-3 a —�q�2�._ Land Use•&i) Slopes(96) tt� _ Surface Stones . Distances from: Open Water Bel ((j - Y ft Possible Wet Area ft Drinking Water Wellft DWhago Way ft Property ��( ¢_ Line -`ft Other ft SKETCH:(Street name,dimensions of lot,exact locations of test holes&pern tests,locate wetlands in proximity to holes) Parent material(geologic) ) Depth to Sedroel( Depth to Groundwater. Standing Water in Hole:_ i Weeping Ilom Pit Nee � , Estininted Seasonal High Oroundwater Ilk ' DETERMINATION FOR SEASONAL'HIGH WATER TABLE Used: Depth Observed standing In obs.hole:De�th to weeping from aide of obs,hole: In, DepUl to sell mottles: Ill, Oroundwater Adjustment Index Well it Reading Date: Index Well levol A ,factor ,._ ..... . . . . _._ rU Ac>J,dt'nundwdter]..Fuel Observation PERCOLATION TEST >n>,te / xiulm i uxmp Hole# Time at 9" _ Depth of Pero Time at G" ~ k: Start Pro-soak Time @ Time )(9"-G" (� n — End Pro-soak 0 Rate Mih./(uch , L k.1r Site Suitability Assessment: Site Passed�_ Sitp Failed: Additional Testing Needed(Y/N) ' Original: Public Health.Division ` Observation Hole Data To Be Completed on B act --- ---_ If percolation test is to be conducted within 100' of wetland,you must first notify tll.e Barnstable Conservation Division at least one(1)week prior to beginning. Q:ISEPTIC\PERCFORM.DOC DEEP-OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Sol Texture Sdil Color Soil. .. Other Surface On.)' (USDA) (Munsell) Mottling (Stnucture,Stones;Boulders. nsistcttcy.%Ora n dy6 A C. � e DEEP OBSERVATION HOLE LOG Hole# �. Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Cpusistency.%Or—ayell 36. _ 6 6 ]DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency,%O DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(In.) (USDA) (Munsell) Mottling (Structure,Stones:Boulders. Consistency. y Flood Insurance Rate Map: Above 500 year floodboundary No_ Yes Within 500 year boundary No Yes ' Within 100 year flood boundary No.,. Yes Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the area proposed for the soil absorption system? If not what is the depth of haturally occurring pervious matarlal l �—.--:.•- Certification I certify that on (date)I have passed the soil evaluator examination approved by the Department of Environmental Protection and thdt the above analysis was performed by me consistent with . the required training,expertise and experience described in 110 CMR 15.017. e.; r, f 3 Signature a® '9C � • Date Q:\SH PIDPBRCPORM.DOC 4C TOWN OF BARNSTABLE I' LOCATION Rl. r SEWAGE # VILLAGE. ASSESSOR'S MAP & LOT INSTALLER'S NAME & PHONE NO. . a/►+itj 7W SEPTIC TANK CAPACITY 10C1J J { LEACHING FACILITY:(type)_4a. L (size) 6 )d{1 NO. OF BEDROOMS _PRIVATE.WELL OR PUBLIC WATER BURR OR OWNER '/ DATE PERMIT ISSUED: j_3� DATE, COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No !� 9 THE COMMONWEALTH OF MASSACHUSETTS t BOARD OF HEALTH TOWN OF BARNSTABLE Apptiration for Disposal Works Cfnnstrnrtiun frrmit Application is hereby made for a Permit to Construct ( ) or Repair ( ,/) an Individual Sewage Disposal System 1�..".—n ...i n ----------------------- --------- :_ _ .......-----------------..............--------------...............-- Locatio ddres or Lot No. .. .� ..... .......................... .................................................................................................. t Owne Address Installer Address d Type of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms.............. ..........................Expansion Attic ( ) Garbage Grinder ( ) t4 Other—T e of Building No. of persons__-•________________________ Showers — Cafeteria a Other fixtures -----_---•-----•-----•----=•-••-------•---.... --------•-------------------------------------------•-------•-----------------•--.----- W Design Flow................... 3D_..............gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid*capacity-40A0.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 ( ) 1.4 Percolation Test Results Performed by.......................................................................... Date....................................... t_l Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ Gi, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 04 -------------------------------•---•---•-----------------------------••-............._...._.....----......................................................... 0 Description of Soil.......................... V -------------------------------------- ---------- .--------------- .. --------------- •----------------•-------------------•----------------------•--------------------•-•------• ------------------- W -----------•---------------------------•---•----•--••-----••---•-----•------•---•-•--------•---•-------•----. U Nature of Repairs,or Alterations—Answer when applicable... t.f`! W. ...._V ztJ ------.4...L 4.. -----------------------------•----------------------------------------•-••---•--•-------- 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 Compliance has been issued by the board of health. } Signed ---1 Dace Application Approved By ........... ---... ---- 3-7/.3-:77J'/. Application Disapproved for the following reasons- ...........................------------------------------------------------------................................-------------------- ------------- -- --------------------------------------------------------------- --- ---- ---------------------------------------------------------------------------------------------- --------------------.................. Permit No. !(� Issued Date Date No....... 1_..:.. .G %' r �, THE COMMONWEALTH OF MASSACHUSETTS t� f BOAR-D-OF HEALTH TOWN OF BARNSTABLE Appliratinn. for Disposal Works,4onstrurtion jhrmi# Application is hereby made for a Permit to Construct ( ) or Repair ( �/}' an Individual Sewage Disposal System at: —I n ----!' ��? "lQf �n----=------------------- ofi I nn Locatio ddres or Lot No. --------------------------- ----------•----•-----......--------...............-•-------------......_...._...................._ Own.rN f Address RC Installer Address d Type of Building Size Lot............................Sq. feet U g— ..............Expansion Attic ( ) Garbage Grinder ( )Dwelling No. of Bedrooms______________��_____._ aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) Other fixtures . - --------------------------- WDesign Flow....................�.__.?Y2__._..._..__._gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity_.lpoO_gallons Length................ Width................ Diameter---------------- Depth................ x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No..................... Diameter.................... Depth below inlet...............__._ Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by.. =--•-••-••............... ... Date ... Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water........................ w Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 04 •-•-•--•--••----------------••••-•••......•-•-•-,•••••-•••---•••-••---•......---............--------......................................................... 0 Description of Soil---------------------•--------------------------•-•-------- x W ----•------------------------------•--•- -------••----•••-•--------••--•-•--•... .----•--•--••-•••-----•-•-•-•- • • . -------------•-- ---•-- V 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 TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. y Application Approved By ....-....)�;P_ ....-..��. �...... ........................................ --------- . Dare ............................ Application Disapproved for thollowing reasons: .................................. -----------------.................................................----_--------------- --------------------------------------- [e PermitNo. .---------�/-------F6--_....................... Issued .........................................................Da 7.. ---- Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Certificate of CZompliance THIS IS TO CERTI Y, That the Individual Sewage Disposal System constructed ( ) or Repaired ( � ) b ---------- r . --------------------------------------------------------------------------- Installer at ---------------�i'.....�.... .Q�t.-�-.-......y� c�� � - n_.:.�.;�.xp.;.............................................--............----------------- , has been installed in accordance with the provisions of TITLE 5 of The State Environmental Code as described in the application for Disposal Works Construction Permit No. ..-..c� -..��. ................. dated ................................................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE---- -� '`�� -------------------------------------- InspectoA........ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Disposal Works Tonstrudi.sn Vernti# Permission is hereby granted. _..._•--..�J...c. f�,�i.e,4. 41 .............�' .................................................... . to Construct ( ) or Repair ) an Ndi 'dual Sewage Disposal System atNo......... ./... Q:,:. .4.,......�.f ... �.:.................f�.c T.:"-A............................................-.................. Street p [.O as shown on the application for Disposal Works Construction Permit No..l .c&..... Dated.......................................... t ............................ ..t ........................................................ �. DATE_ Board of Health FORM 36508 HOBBS&WARREN,INC..PUBLISHERS " LOCATION SEWAGE PERMIT NO. VILLAGE ' INSTA-CLER'S NAME i ADDRESS hiVj,Jg iv Aire /II- li B U It �D�E)R / OR / OWNER `1 DATE PERMIT ISSUED DATE COMPLIANCE ISSUED / '� r �� f G �� .� // � ,� � �4 � / � G � 3S � �� __ ,N No... ;..� .. G S,-3 Fmc.. :��.�� THE COMMONWEALTH OF MASSACHUSETTS _ BOAR® OF HEA/L�TH J04a/-.�t_...................OF......... . . e.42.a?r.`.4_4 .-.................................... Apphration for Bigvngal Worbi Tomitrutiun Vrruat Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal G / System a -74 QQ �Q /� ocati"sj or Lot No. ......ke� .._ .......,.�.... ..-------------------•----...... .---.......---------------- ._.... � Owner Address 1-k..... --------- ---------------- ----------------------- .................. ......... . Ir staller Address Type of Building Siz Lot............................Sq. feet Dwelling—No. of Bedrooms......... `.............................Expansion Attic ( Garbage Grinder ( ) PL4 Other—Type of Building ...- K.......... No. of persons............................ Showers ( ) — Cafeteria ( ) Other fixtures ................................. . W Design Flow........... .....................gallons per person per day. Total daily flow.... _._------_----.._-.-..-.gallons. WSeptic Tank—Liquid capacitK .gallons Length---.-6...... 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.............t s . ft. z Other Distribution box ( ) Dosing tank ( ) ��7 '-' Percolation Test Results Performed b .._ Test Pit No. 1...`. ..........minutes per inch Depth of Test Pit---/�........ Depth to ground water........................ Gz, Test Pit No. 2................minutes per inch Depth of Test Pit..............---... Depth to ground water........................ Ri .................................................... ----------•---- --- --------------------- ---- ---- ----- .......... .... ...... O Description of Soil-----d._'.... 4r '-�r�b � � - x V ----------------------------------------- •--•-••----- ----------------------------------•-----------------------------------•-------•--------------------------------------------------•---- W ------------------------------------------------------- ------------------ ------------------------------------------------------------•--------.••---- VNature of Repairs AI erations—Answer when applicable---------_.... ............................................................................. -•--•-•-•--v ......................................................------------•-•-•---•-----------•---•---------- ----------------•-----------------•----....................................... Agreement: ----- -_.-- The undersigned agrees to install the aforedescribed Individual Sewage Di o - stem in accordance with the provisions of TIT i-; 5 of the State Sanitary Code he ersigned f a not to place the system in operation until a Certificate of Compliance has been . sued e and o al ign -•-- ------ - -----------------------•-------•---- -•------------------------- -•--------------•--------------- Application Approved By......... ... ...... ... ................ ----A0----- -Z _s''?� ' Date Application Disapproved for t e following reasons------------------------•---•----------------•----•-•------------------------------------------•----------_..._. ---•-------....-•-------------------------•-•--------------------•---------------•------•-----------•----...-•••----------------------------------------------------------------------------------------- Date PermitNo......................................................... Issued_....................................................... Date � No.... .� G Fps.............................. ;. r. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH �r ..A .............OF.......... .... Aptira#ion for lliipooal Workii Tomtrurtion Frrutit Application is,;�hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: 7 9- el(_�........&t'c�...................4� .......a�::". * ( � Iyoeatigdi-Ad Tess or Lot No. • ....(, �.?�? d._•«(w'''-.;......(.r..'... ? .. ................................ ..........--------• ------•.......................•-------------------- Owner Address _.k. ....... ......................••----......._..... --•'--------------------•----------__._.......--•---•-----.._.._..------...........------..._. I taller Address Q Type of Building Size Lot___________________________Sq. feet aDwelling—No. of Bedrooms........�___________________________Expansion Attic ( Garbaget Grinder ( ) aOther—Type of Building __._ ' __:_.____. No. of persons____________________________ Showers ( ),— Cafeteria ( ) Otherfixtures -------------------------------------------------------•-••--•••••-•--•-•••--••-•-••----• ----..._..---------••......-••----------...-•---• Design Flow...........!;"S"�_____________________gallons per person per day. Total daily flow-___ .............._..........gallons. WSeptic Tank—Liquid capacit<%6 '.gallons Length.....t��'__._ 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.................. ft. z Other Distribution box ( ) Dosing tank ( ) ''' Date = Percolation Test Results Performed by______________________ _________________________--------•-------- ,� �`------•-_-- Test Pit No. 1___'!�:........minutes per inch Depth of Test Pit....��__:_______ Depth to ground water________________________ (s, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ �' � __ _�D Description of Soil....... ^____ It _u-&4/- - � ____-_ x kA ---- c., W ------------------------------------------------------- ----- ---` -- UNature of Repairs or-Al erations—Answer when applicable................2.......................................................................... ...........--...........................................................................................................---=-- Agreement: The undersigned agrees to install the aforedescribed Individual.Sewage Di po 1; - stem in accordance with the provisions of iITl 5 of the State Sanitary Code he u ersigned f�e'` gr' snot to place the system in operation until a Certificate of Compliance has been i ued y e rd O dal -- ..................................... •---------------•--------- ................................... Application Approved By......... t...........•.... � Date Application Disapproved forte following reasons:........ -••----•-------- ••--•-••••••-•----•-•...---•---•--••--••••--••-••••-•---••-.._.. -•••-...•••----- ......•••••••-•-•--•••--•.....•••--•--•----••-•---•--•-••-•-••_...__...••--•--•--....•--.....-•----•_•--- Date PermitNo.......................................................... Issued....................................................... Date THE-COMMONWEALTH OF MASSACHUSETTS BOARD Qu HEALTH " ................ ........................OF--....0*44_1 Y-....E............_................_............_... C9rdifiratr of ToutptiFaurr TIIF1'IS TO�T�FY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) fir`- .................................... ........... -- by.... . 'c,�',, t .. 44. In taller at.. .. has been installed in accordance with the provisions of T ` of T e State Sanitary Code as described in the application for Disposal Works Construction Permit No. �� - �_ dated--..7.--`� __'0---�-----_ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM W L FUNCTION SATISFACTORY. : DATE9 _----_----------_-----1�........... ___---•...............•-•... ......... Inspector:.; `..: THE COMMONWEALTH OF MASSACHUSETTS 1 BOARD OF HEA TH tt 1 �d 7�" � ...................0F...........f �rS!''t �'...". .�^�. CJt No.... ' FEE.... :Ya io oo orkii udion Errant Permission-is-b reebb` granted....... _.._.. �.........•••--- ----------••-•• ................................................ to Constr (' ) 6fRep it ) an ivid 1 Sevyr Disat No. p tem,. , r � Street o. ---- -- as shown on the application.fo r Disposal'Works Construction Perm ___ :___ __ ated_ __ t r ......................... Board of Health DATE--- ----------•----••--:- .............................................. _. FORM 1255 HOBBS & WARREN, INC.. PUBLISHERS 4 7 [o 6.il, ° ., ir. "' .. 'fit• ' i OF a 'Al -OUNIK �21[I � �lY 76 R 'ohAi0'i a. n CERTIFIED. PLO I- TL,AN� ;lt 4 isfl�G�nIPOT ELEVATION QAO ' ` ,EXI sTiNt3' �QOKITOUR — 0 "= FINISHED 'SPOT 'EL.EVATION 9.0 k ;i�►SiIEt)° CORT4}UR -- 0. -- - ~�11` F OO RD OF FIEALTH " DATE f'� AGENT SCALE F� O DA a' L , DGE'1�t1IGINEERIU& CO IPJC Ci_IEc�T .��4ti=°!, --~---- '' I• IrC+�'�IS° THAT '1�HL Fl-?Ui 0 ' ' EGISTEI" P-E0ISTEf?t=U J©d; �S€7. t _ BUILDING .�i;IC�t'lI10 OW THIS PL t " •GAfJ0 CONF(�I2tIS '0 TIE ZONING L ,�? .r'r ENGINEER � SURVEYCiP DR.BY! _ OF DARNSTOWLE ,"MASS. i ° :a3 .NO'MAt,M ,�: B=,'�_: 712 MAIN SIT CF1 DY I ,.YARM v�H MA f-F11"N 'S' MA �.. � . . 0 , S • . , N SHE- I OF' � DATE ?EC. LAt�Ia SIIRVf_ `0 z.r. . ? . ... _-.--�- ...,....._ AOL- 7&1- _ �d +�e M/N• •_ E/TiYER ?Nfi`.�PT/^� TA1',�`P SJ�A L L eE B R©LIGHT TG 6'IQiA OlE.�•-��✓'E.rTiPA . - �, I CONCRPTE g`PVC P/PE-, li HEAVY CA5T bieC Y COt/FR SfYA 4. 04- USED NJ/N- PITCH 1 /F/N .OR/✓E1k/A y E COYERS --- _ GR�1Z, COVER CLEAN SAND / i� i — . ' . - . — BACK)/LL - -_ DQUID LEVEL d, 2 LAYER " CAST -- = rR . 4 J/B IRON P/PE Op0 fi a , o `ol� CJF /B"_ „ 6- M/N. P/TGN L1 l— GAL. U/ST, l ° o / • • • . . • • r a sn�4 j WASHED 5T-O/YE PfM I:T. StPT/C TANK o n • • • • • �'c ° Q : BOX o1y� • t r 8 • • • • • r e p o+1; 14 F ( i o r r • • oEF�TIi • • r o wASHED STDNE L� i.aT �:l.C�,v': r ;,;R% :� • 7 = r ► • • • • • • • 1 = c o 0 0', i�J ° a � r • • • o • • • • r �: D p• p � •— /�RE�STSEEPAGE o v e �o • o ' r • • • • • • • r6 e o/ PIT OR EQU/✓. I NVeRT EL E VA T/DN s �_p Y G Fr D/AM. /NYERT AT Q[J/L!a/NG 9••� FT. /D FT LJ/f1 hJ.�i C("SEE -rn,601-AT)ONV� INLET SEPTIC TANK 78.1 Fr OUTLET SEPT/C 7-.4/vK Z8 Fr. r INLET!U/STR/B!/Tl0/v _BOX GROO^10 WIATER TABLE O c/TLET-D1 STR/B UT1U1v dUX 7�9 FT `TNL6r LEACH/N[C, .��T _�/.`o FT. SEWAGE AO/SPOSA L SYSTEM T,4&411-AT/ON L EACH//V6 P/ T -_FT SCA L E %a _ / - O' UIMENS/ON A_ _ DESIGN C'R/TER/A D/HENS/ON $—�— FT• NUMBER OF BEDRO<UMS __ 3 /y///✓- GARQAGED/SPUSAL UNIT _ SO/L LDG SOIL 7EST TOTAL EST/MATED FLOh/_33v_GAL.1DAY 60/L TEST lot/ SOIL 7A--7STgdf2 / NUMBER OF FACNING: /r�^�_ T^ELEV 74.0 -ELF✓_. /SATE OF SOIL 7-E.57- S/DE LEACH/NG PE.'{ P/T (Ff�_SCJ FT. RESULTS /t//TNESSwcO BY !� eUTTUM LE/iCH/NG / EK P/r_��$Q. 17- 1- Sv/35 1L `4 /TCOLAT/ON RATE #/ _Z _ M/N//NCH TOTAL LEACH//vG AREA zb 6 SQ. FT. PERCOLA-rION RATE 072 -- M/N./INClY RESERVE LEACH/NG Ai?EA_ Z(p�54. FT. I ' I 3 - NOFM4ssq M�olv/y LO T /9 Rolls ati, �yc�, V/4.-� 1t f ti o '�RUNIKIS ` y ita zziez�'�Q� EL D�EDGE�ENG/N'f�R!!YC NC V. r _ G HYANMtJ� ;1.:J✓ 3 ^iit uu�t R ? 7-f,, I�c✓k NoGROv/vc7 arEa ,,. ►° ' -. t CaR0'UK, 6 «TAR AT.E!_. cv; _ �► r � ._� TEST HOLE LOG SEPTIC SYSTEM PROFILE BM @ T.O.F 100.0 not to scale DATE: 8/13/15 TEST BY: MIKE O'LOUGHLIN ASSUMED COVERS TO WITHIN 6" WITNESS: DAVE STANTON 8/4/78 TEST HOLE OF FINISHED GRADE PERC RATE: < 2 MIN ON FILE WITH B.O.H. 1-99.4 F.G. F.C. 99.2 MINIMUM 2" PEASTONE OR PIPE TO B E LEVEL GEOTEXTILE FABRIC TEST HOLE # 1 TEST HOLE # 2 TEST HOLE # 3 97.75 (D FOR 2' OUT OF D-BOX 99.2 EL 99.2 EL 0" 0" 0" 90.7 EL TOP @ 96.3 A LOAMY SAND A LOAMY SAND LOAM 10" INLET TEE ( g" 10Y 4/3 98.7 EL 6" 10Y 4/3 98.7 EL AND 0 =___= SUBSOIL � z 97 0 N _ _===_=== LOAMY SAND LOAMYSAND 96.67 __________ -g OTTOM 93.32 B W l0Y 6/6 B W l0Y 6/6 14" OUTLET 96.42 __________95.42 =====00000TEE WITH 95 59 ____=o 0 0 0 0 36" 96.2 EL 36" 96.2 EL 36" 87.7 EL _========o GAS B AFFLE H-20 95.32 2 500 GAL DRYWELL H-10 6 HOLE ( ) C FINE - COARSE C FINE - COARSE D-BOX 12.5' x 25' x 2' 2.5Y 6/4 2.5Y 6/4 MED SAND 1500 GALLON H-10 MONO SEPTIC TANK 6" COMPACT STONE BOTTOM OF T. H. #1 & #2 89.2 OR COMPACTED BASE NO WATER NO WATER ENCOUNTERED ENCOUNTERED BOTTOM OF ORIGINAL TH (#3) LOGGED AT 62.0 120" 89.2 EL 120" 89.2 EL 120" 78.7 EL CONVERSION TO ASSUMED DATA FROM NAVD88 GIS MAP = 7E.7 NO WATER BOTTOM OF PERK 72" ENCOUNTERED PRESOAK NINE MINUTES < 9" GENERAL NOTES 1. CONTRACTOR TO BE RESPONSIBLE FOR THE LOCATION OF ALL (L UTILITIES, ABOVE & UNDERGROUND, PRIOR TO ANY EXCAVATION ,r m OR CONSTRUCTION. N 2. SEPTIC SYSTEM IS TO BE INSTALLED IN COMPLIANCE WITH 310 CABLE T C M R 15.00:TITLE V. m THREE 3. THIS PLAN IS NOT TO BE USED FOR PROPERTY LINE DETERMINATION PONDS DRIVE 4. DESIGNER TO INSPECT & CERTIFY OVER-DIG, WHEN REQUIRED J BY PLAN, AND FINAL INSPECTION BEFORE B AC KFILL. 5. CONTRACTOR TO PROVIDE 48 HOUR NOTICE FOR ANY REQUIRED NDERGROUND CABLE INSPECTIONS. roe TV SEE NOTE #3 BATH LAUNDR 6. THIS SYSTEM IS NOT DESIGNED FOR THE USE OF A GARBAGE EOP CLOSET DISPOSAL. 7. THE TOP OF ALL SYSTEM COMPONENTS SHALL BE MARKED WITH BED BED MAGNETIC MARKING TAPE OR A COMPARABLE MEANS IN ORDER BED TO LOCATE THEM ONCE BURIED. 8. IF SOILS ARE FOUND UNSUITABLE OR DIFFERING FROM THOSE N �� 59'26 E 12-713 �aa?� FOE ND IN SOIL LOG, CONTACT DESIGNER AND THE BOARD OF EXISTING SECOND FLOOR 9. IF AN OVERDIG IS REQUIRED, OR IF UNSUITABLE SOIL IS FOUND IN A-B LAYERS, CLEAN GRANULAR SAND MEETING 310C MR NEW WATER SERVICE O<, 15.255(3) SHALL BE USED AS FILL MATERIAL, 5' AROUND AND RELOCATED ANDAGO, UP UNDER S.A.S. SLEEVED 8 26 15, ��������\ 10. ALL 4" PIPE CONNECTIONS AT SEPTIC TANK AND D-BOX SHALL / / �`' O P KITC HENJBATH PER NOTE #2 :---- �}�\�O 000 roYErz BE MORTARED IN PLACE. IF USING 18" PLASMIC RISER PIPES, "TH 1 ®TH 2 O �`�� THESE TOO SHALL BE MORTARED IN PLACE. �C� O ��o° �4' OPENING TV ROOM DESIGN DATA o O LIVING DINING DAILY FLOW: (3) BEDROOMS X 110 GPD = 330 GPD wq� ^�� U SEPTIC TANK: 330 GPD X 2 = 660 GPD EOP k,�'' o USE: 1500 GALLON H-10 MONO SEPTIC TANK o M EXISTING FIRST FLOOR DISTRIBUTION BOX: USE: DB-6 H-20 SOIL ABSORPTION SYSTEM: #81 �� USE: (2) 500 GAL DRYWELLS H-10 WITH DOUBLE 9 WASHED STONE /M T SIDEWALL AREA: 75' X 2' X 0.74 = 111 GPD o -0 F �� LOCUS „ FINISHED BOTTOM AREA: 12.5' X 25' X 0.74 = 231.25 GPD AREA = BASEMENT CRAWL TOTAL AREA: = 342.25 GPD (UNHEATED) StiFo NOTES o uP 1. THE EXISTING SEPTIC SYSTEM LOCATED IN THE BACK YARD IS EXISTING BASEMENT COVERED BY DECK AND CONCRETE PATIO. THE EXISTING SYSTEM ti �FCk IS TO BE DISCONNECTED AND ABANDONED. 2. WATER SERVICE TO BE RELOCATED AND SLEEVED WHERE IT WILL BE v . LOCATION OF EXISTING 1000 GAL. WITHIN 10' OF SEPTIC SYSTEM COMPONENTS SHOWN ON PLAN. OF EXISTING SEPTIC TANK TO BE 3. CABLE TV TO BE DISCONNECTED AND MOVED OUT OF THE WAY, PUMPED OUT AND FILLED IN AND RECONNECTED AT COMPLETION OF SEPTIC INSTALLATION. Z VARIANCE REQUEST APPROX. LOCATION OF THE � qpp NONE REQUESTED� � EXISTING LEACHING PIT. THE PIT WILL NOT BE PUM ED OUT AND FILLED A qTp o IN DUE ITS DEPTH AND THE CONCRETE PATIO COVERING HE AREA. /' 7a 3 Pords Dr LOT 19 � �"' #81 .36A 15,717.7 S.F. canarutn HEALTH AGENT APPROVAL DATE +/- MAP 173 - PAR 074 85cit SEWAGE PLAN ENGINEER: ws STEPHEN HAAS '4itch'nq post Lr �' LOCATION: 81 THREE PONDS DRIVE OF TH 3 8/4/78 C EN TER VI LLE, MA ON FILE WITH B.O.H. PREPARED FOR: DAVID & ANNE C URLEY '' putp4stLn SCALE: 1" = 20' DATE: AUG 26, 2015 RE JOB NUMBER: REVISION: N;�6 2342,,W 6224 a SHE MA 173 4 ST NUMBER: PARCEL: SEPT 9, 2015 7 z 0 Scale: 1"=20' �/� 0 20 40 6o REc� J. O'LO U G H LI N INC . 714 MAIN STREET, YARMOUTH PORT, MA 02675 PREPARED FROM CERTIFIED PLOT PLAN BY ELDREDG,E ENGINEERING �° (508) 362-4942 CO. INC, DATED 10/25/18