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HomeMy WebLinkAbout0053 VALLEY BROOK ROAD - Health 53 Valley Brook Road Centerville A= 188 — 159 �P 0 OPendaflWr a 42101/3 ORA 100/* P4 o„ 0 � I r: ery �a v a I 0 2 TOWN OF BARNSTABLE LOCATION S J �I�}LL N SEWAGE# 20 VILLAGE (/((,L E ASSESSOR'S MAP&PARCEL IS$ a- 1Q59 INSTALLER'S NAME&PHONE NO. F-{aL' e: - OuX 65os 111 l USA SEPTIC TANK CAPACITY I OO O !?tcJ LEACHING FACILITY.(type)500 3p� C.tW&W-S (size) ZS "4 l 3 NO.OF BEDROOMS 3 OWNER EUZaBc-T{{ I�1C��iArQr�SarJ PERMIT DATE: I i i Z3 �zo COMPLIANCE DATE: Z I S I ZO Separation Distance Between the: � Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility 16 "® Feet Private Water Supply Welland Leaching Facility(If any wells exist on site or within 20.0 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility)facility) Feet FURNISHED BY C ,tom" IA rl 3 7. 2�. I 50•Z. 9 No. y C) I � Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes 01ppliLatlon for Misposal *pstem Construction 3pPrmit Application for a Permit to Construct( ) Repair( ) Upgrade(X) Abandon( ) ❑Complete System ®Individual Components Location Address or Lot No.,5_3 vC,1 Y &ccvk ka Owner's Name,Address,and Tel.S F ,,No. 11_ Assessor's Map/Parcel 1 G9 ' � � .i1644 ZS' R16.4� tj Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No. V IZ L lei+ . Hawn. }an 9 LacIARxw 1n sjon M i Type of Building: Dwelling No.of Bedrooms Lot Size I51 i�l�*g sq.ft. Garbage Grinder( ) Other Type of Building ReqOG ,CIN No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided gpd Plan Date `� I y Ono 0_0 Number of sheets Revision Date Title Size of Septic Tank WOO ICJ10 n Ty e of S.A.S. LeO4111 .q 'F(e.Ac; , Description of Soil i1 e1'V� c ,nC (4 r Nature of Repairs or Alterations(Answer when applicable) o 5-00 6C,110A Pr$-C&54- H-Io c 6 or1 ber, rkLo P- BOX o kKtj,4�, 1(?0® &'10-r\ -'LAn1c. 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 Application Approved by F Date �c Application Disapproved by Date for the following reasons Permit No. V C7 `-3-76 Date Issued —� a' o. y " Fee THE COMMONWEALTH OF„MASSACHUSETTS Entered in computer: V PUBLIC HEALTH DIVISION = TOWN OF Yes 'BARN:STABLE, MASSACHUSETTS ftplication for Vsposal 6pstem Construction Permit Application for a Permit to Construct( ) Repair( ) Upgrade(x) Abandon( ) ❑Complete System ©Individual Components Location Address or Lot No.S3 VhJlky fwok, IZ Owner's Name,Address,and Tel.No. r Assessor's Map/Parcel q 11�.�0. �h ' .Rttb d b.t)Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No. 9 QV2 .arc. bkA r. krrioa�m Le 1%Roe 6% (NeS6,01b1ES Type of Building: Dwelling No.of Bedrooms Lot Size tom!;Nt sq.ft. Garbage Grinder( ) i Other Type of Building QKJC44M'( N No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) a.?V gpd Design flow provided & 3 gpd Plan Date` It 11419020 19020 Number of sheets �+. Revision Date Title i_ 1 Size of Septic Tank 1000 �,it o IN Tye of S.A.S. Leads;+q Trend L •CC'S Description of Soil me by w ql►� [_sue l�, V 3 r Nature of Repairs or Alterations(Answer when applicable) M $'oo 6c pA 1Pre-cAsa- HAD C 6%(,A bxr', 1 w � Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. 1 Signed A Date / VO Application Approved by Date Application Disapproved by V Date ';. for the following reasons. Permit No: V a C� "� Date Issued xt '- THE COMIOIONWEALTH OF MASSACHUSETTS' 3 BARNSTABLE,MASSACHUSETTS Certifirate of Compliance �� THIS IS�TOCERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired( ) Upgraded(�O Abandoned( )by Roba4 `S, CUR. �.•r at S3 al it ?rook Rd has been constructed in accord ce with the provisions of Title 5 and the for Disposal System Construction Permit No. V 0 3`"dated ! • 3 ,1. Installer 9UG1 • .9 00k Designer & 14 r?S y ; #bedrooms Approved design flow ,33CI gpd The issuance of th•. perjnit shall not be construed as a guarantee that the system will fu cfi tion ash designed. / Date v Inspector _-_.,-_ __-- _ _ ...... _..... ..: w _.-.- _-_ - _. -._ _ ..___ _—_-- ----------- - -- - - --fig-(� = No. U. O V Fee l"THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION- BARNSTABLE,MASSACHUSETTS Disposal *pstetn Construction permit Permission is hereby granted to Construct( ) Repair( ) Upgrade( ) Abandon( ) System located at Vallow RnoL Rd I CkA 4.-Wij e MA OASA r and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction must be completed within three years of the date of this permit. c Date ( 4- (,} Approved PP Town of Barnstable Regulatory Services Richard V, Scali,Interim Director BAMSTABLE, MAS& 1�$ Public Health Division ArF4 MA'S Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Installer&Desianer Certification Form Date: 1'00'1 'W Sewage Permit## Zozo 3? Assessor's Map\Parcel Designer: 1114L I'll 1115 iv-,� Installer: X20—6 X ,��92 U& 60 , Address: `'7 L.e c/w �oS'c'��z,�,�_ Address: ?¢.�i, &4 rAA On. / 2 3 Z o 2 0 13_ d v 2 Co. was issued a permit to install a (date) (installer) septic system at S ���1(e~,��Y��r &A.,X C '�`�y%�based on a design drawn by (address) iV dated (y ! Z 0 (designer) I 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 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 u1 accordance with State&Local Regulations. Plan revision or certified as built by designer to follow. Strip out(if required)was inspected and the soils j were found satisfactory. I certify that the system referenced above was constructed in�c�oR,.p lance with the terms of the I`A approval letters(if applicable) oP49 CLEM =�� ER IC yG°� (I ler's Signature) .` HA4ARIN TON �t VIV A' Desi ner's i re� Affix Desi ,t ffl Here ( g ) ( ) PLUASE RETURN TO BARNSTABLE PUBLIC HLALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUD UNTIL BOTH THIS FORM AND AS- BUILT CARD ARE RECEIVED BY THE BARNSTABLE, PUBLIC HEt ALTI1 DIVISION. THANK YOU. Q:1SeptictDesiper Certification Form Rev 8-14-13.doe i • i TOWN OF BARNSTABLF LOCATION J3 ALL tq 7yg*K._...J?J), sFWAGE# ZOW - 578 VILLAGE 1/I LL ASSS��E��SS��O��R'S I✓v�JAP&PARCEL (J3� i INSTALLER'S NAME&PHONE NO. gQW—T'�D. OULL (Go$)ATI S9?7 SEPTIC TANK CAPACITY LEACHING FACILITY:(type)500 4X�•tA!� �S (size) (3 i i� NO.OF BEDROOMS 3 I OWNER ELItABeT I PERMIT DATE: 11 Z3 4?�D COMPLIANCE DATE: Z 1 Z 13 i Separation Distance Between the: Maximum Adjusted Groupdwater 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 ( a I i 50.7- iLi OF Massachusetts Department of Environmental Protection Bureau of Resource Protection 1 L71 GENERAL WELL REPORT Note:GPS coordinates must be in WGS84 datum in degrees. decimal degree format. 1.WELL LOCATION I GPS(Required) North / S cI- a—° West ° Address at Well Location — L Ocd ❑Property Owners Subdivision/Property Description ❑Engineering Firm City/Town �il�Y Mailing Address 3 �tX Assessors Map Assessors Lot# City/Town 612k"Y �& State Board of Health permit obtained ❑Yes Q'Iabt Required Permit Number Date Issued 2.WORK PERFORMED 3.WELL TYPE 4.DRILLING METHOD 6.ADDITIONAL WELL INFORMATION ® ® El ® Overburden Bedrock Fracture 1 El ® 2 ® Developed ❑Y Enhancement ❑Y ON S.WELL LOG OVERBURDEN LITHOLOGY Drop in Extra Loss or Surface Seal Fast or Disinfected ❑N ❑ ❑ From To Drill AdditionAddition Type (ft) (ft) Code Color Comment Stem Drill Rate of Fluid Total Well Depth to [IY [IN [IF ElS ❑L ❑A Depth .,�jC1 Bedrock ❑Y ON OF ❑S ❑L ❑A 7.CASING ❑Y ❑N ❑F ❑S ❑L ❑A From To Type Thickness Diameter ❑Y ❑N ❑F ❑S ❑L ❑A ❑❑❑ ❑Y ON OF ❑S ❑L ❑A 1 10001 ❑Y ❑N ❑F ❑S ❑L ❑A 8.SCREEN ❑Y ❑N ❑F ❑S ❑L ❑A From To Type Slot Size Diameter ❑Y ❑N OF OS ❑L ❑A ❑ 5.WELL LOG BEDROCK LITHOLOGY Extra ❑❑❑ Drop Extra Fast or Loss or Visible From To In Drill Large Slow Addition Rust 9.WATER-BEARING ZONES, 00 (ft) Code Comment Stem Chips Drill of Fluid Staining Rate From To Yield(gpm) job Q ❑Y❑N❑Y❑N❑�F❑S❑L❑A❑Y❑N OYONOYONOFOSOLOAOYO ~ ❑Y❑N❑Y❑N❑F❑S❑L❑A❑Y❑N OYONOYONOFOSOLOAOYON 10.PERMANENT PUMP(IF AVAILABLE) ❑Y❑N❑Y❑N❑F❑S❑L❑A❑Y❑N pump PME❑Y❑N❑Y❑N❑F❑S❑L❑A❑Y❑ Description : Horsepower ❑Y❑N❑Y❑NOF❑S❑L❑A❑Y❑ pumpinta Nominal ❑Y❑N❑Y❑N❑F❑S❑L❑AOY❑ Depth Pump ft Cavacity gpm 11.ANNULAR SEAL/FILTER PACK 12.GEOTHERMAL INFORMATION(Opt;Open Loop only) From To Material 1 Weight Material 2 Weigh Water(gal) Batches Method of Thermal Thermal Formation Placement Conductivity Diffusivity Water (BTU/hr•ft•°F) (ftZ/day) Temperature(OF) ❑ ❑ ❑ ❑ r ❑ ❑ ❑ ❑ 1 DEP UIC# 5-r✓( Sample taken from this well❑Y rr-a- 13.WELL TEST DATA 14.WATER LEVEL Date Method Yield(GPM) Time Pumped Pumping Level Time to Recover Recovery Date Static Flowing (hrs) (min) (ft BGS) Mrs) (min) (ft BGS) Measured Depth BGS(ft) Rate(gpm) FiEf 15.COMMENTS 9 o l.os t°,_4 Lod /G� S 16.WELL DRILLERS STATEMENT This well was drilled or altered under my direct supervision,according to the applicable rules and regulations,and this report is complete and accurate to the best of my kno Driller �Q� Supervising Driller Signature Certification# $ ,5 Company. Date Job Complete y, `—Rig Permit# CJ U U LIMassachusetts Department of Environmental Protection Bureau of Resource Protection GENERAL WELL REPORT Note:GPS coordinates must be in WGS84 datum, in degrees. decimal degree format. NOTE: Well Completion Reports must be filed by the registered well driller within 30 days of well completion. Rev.912aol o �- L// CAS Page 1 of 1 Subj: UIC registration Barnstable_53 Valley Brook Road Date: 2/13/2015 11:21:08 A.M. Eastern Standard Time From: eric.cheungastate.ma.us To: ELIGOTWATER aaaol.com CC: ►oseph.cerutti(cD-state.ma.us, health(a)town.bamstable.ma.us Hi Elias, The purpose of this email is to issue you Underground Injection Control (UIC) registration MAS41A020230-5CL for the installation of 2 closed-loop ground source heat pump(GSHP)wells and system start-up at 53 Valley Brook Road, Barnstable, MA. The wells will be installed by Richardson Wells and Pumps. This UIC approval is conditional upon meeting all of the requirements provided in the MassDEP Guidelines for Ground Source Heat Pump Wells. This approval is for the installation of conventional closed-loop wells using high density polyethylene(HDPE)tubing. If you are proposing the use of Rygan HPGX or Kelix well materials you must inform the MassDEP UIC program of your intent to do so prior to installing the wells. Since MassDEP has not completed a detailed review of this proposed installation, you are advised to contact me if you have any questions regarding the requirements that are detailed in the guidelines. The guidelines may be obtained as the 3rd document in the"Guidance"section on the following MassDEP UIC web page: http://www.mass.gov/eea/agencies/massdep/water/drinking/underground-iniection-control.html If you haven't already done so, a copy of the UIC application must be submitted to the local board of health. Please be aware that the issuance of the above UIC registration number only indicates that MassDEP's UIC Program has received the information that we have requested. There may be other local permits, ordinances, or regulations that apply, including but not limited to board of health permits for well installations and building department regulations regarding trenching work. The issuance of a UIC registration number by MassDEP does not supersede the requirements of any other state or local regulatory entity. A copy of this email has been sent to the local board of health. The board of health should be aware that as of Friday, February 19, 2010, MassDEP significantly reduced the level of effort that goes into the review of a closed- loop UIC registration application for a GSHP well. Specifically, MassDEP no longer requires that the applicant submit site plans and proposed well construction details. Therefore, it is up to the applicant to ensure that all applicable set-back distances are met per the MassDEP Guidelines for Ground Source Heat Pump Wells (January 2012). If you have any further questions you can contact Joe Cerutti at Joseph.CeruttiCa)_state.ma.us, (617)292-5859, or by fax(617)292-5696. Eric Cheung MassDEP 1 Winter Street, 5th Floor Boston, MA 02108 Eric.Cheunga-state.ma.us ph 617 292-5992 fax 617 292-5696 Friday, February 13, 2015 AOL: ELIGOTWATER Message /22- Page 1 of 1 Miorandi, Donna From: McKean, Thomas on behalf of Health Sent: Friday, February 13, 2015 12:35 PM To: Stanton, David; Desmarais, Donald; Lavelle, Timothy; Malkus, Karen; McKenzie, Marybeth; Miorandi, Donna; O'Connell, Timothy; Parciale, Jim Subject: FW: UIC registration Barnstable_53 Valley Brook Road -----Original Message----- From: Cheung, Eric(DEP) [ma i Ito:eric.cheung@state.ma.us] Sent: Friday, February 13, 2015 11:21 AM To: ELIGOTWATER@aol.com Cc: Cerutti, Joseph (DEP); Health Subject: UIC registration Barnstable_53 Valley Brook Road Hi Elias, The purpose of this email is to issue you Underground Injection Control (UIC) registration MAS41A020230-5CL for the installation of 2 closed-loop ground source heat pump (GSHP)wells and system start-up at 53 Valley Brook Road, Barnstable, MA. The wells will be installed by Richardson Wells and Pumps. This UIC approval is conditional upon meeting all of the requirements provided in the MassDEP Guidelines for Ground Source Heat Pump Wells. This approval is for the installation of conventional closed-loop wells using high density polyethylene(HDPE)tubing. If you are proposing the use of Rygan HPGX or Kelix well materials you must inform the MassDEP UIC program of your intent to do so prior to installing the wells. Since MassDEP has not completed a detailed review of this proposed installation, you are advised to contact me if you have any questions regarding the requirements that are detailed in the guidelines. The guidelines may be obtained as the 3rd document in the "Guidance" section on the following MassDEP UIC web page: http://www mass gov/eea/agencies/massdep/water/drinking/underground-injection-control html If you haven't already done so, a copy of the UIC application must be submitted to the local board of health. Please be aware that the issuance of the above UIC registration number only indicates that MassDEP's UIC Program has received the information that we have requested. There may be other local permits, ordinances, or regulations that apply, including but not limited to board of health permits for well installations and building department regulations regarding trenching work. The issuance of a UIC registration number by MassDEP does not supersede the requirements of any other state or local regulatory entity. A copy of this email has been sent to the local board of health. The board of health should be aware that as of Friday, February 19, 2010, MassDEP significantly reduced the level of effort that goes into the review of a closed-loop UIC registration application for a GSHP well. Specifically, MassDEP no longer requires that the applicant submit site plans and proposed well construction details. Therefore, it is up to the applicant to ensure that all applicable set-back distances are met per the MassDEP Guidelines for Ground Source Heat Pump Wells(January 2012). If you have any further questions you can contact Joe Cerutti at Joseph.Cerutti(Dstate.ma.us, (617)292-5859, or by fax (617)292-5696. Eric Cheung MassDEP 1 Winter Street, 5th Floor Boston, MA 02108 Eric.Cheung c(D.state.ma.us ph 617 292-5992 fax 617 292-5696 2/13/2015 LOCATION SEWAGE PERMIT NO. VILLAGE I N S T A LLER'S NAME i ADDRESS BUILDER 'OR OWNER DATE P_ERM1T IS-SUED DATE COMPLIANCE IS U E 0 42 Z, q,C611 10 iY-IF -1st Fps....a.R................... THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH r \o W.n -----......OF........ M..S. -.. .� ................. Applirativat for Uhipati al Work,5 Taimtrurtivat Fautit Application is hereby made for a Permit to Construct (,/) or Repair ( ) an Individual Sewage Disposal System at: Location-Address r t No. -- . nn....i�............. . .•.. .- .. . ... .......----------------..............-- % ` owne V�R ..................... -----..................... --•---...... .. ..-•--••----•---------..............-•-----•---•-•---•... c��� ` ddes Installer Address Type of Building Size Lot.15_.1,.3y:","'___--•--Sq. feet Dwelling—No. of Bedrooms.............................................Expansion Attic (U C)1 Garbage Grinder (jju) aOther—Type of Building ............................ No. of persons----.--.--.................. Showers ( ) — Cafeteria ( ) Q' Other fixtures ................................. . W Design Flow.............\.\.q......................gallons per person per day. Total daily flow............73....._................gallons. W Septic Tank—Liquid capacitAe.".. ...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 t k ( ) � 1 ~' Percolation Test Results Performed by....... .` '' .�.........a.-.. --------------- Date..... ....... a ,.a Test Pit No. 1----------------minutes per inch Depth of Test Pit.------............. Depth to ground water............. ... Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water..--..--................ a ............................... -------------•---....-•-----•-•--•...........----------...•----•••----•--...-•------•--....--•---•-•-•--••---.......---.----- O Description of Soil........GQ-Pt:..............\.0 s' v ••-••---••-••-•-•••••--•--••••--•--••••••�'-`-{•--------------• -D•-...'----.....--------- CIA c'`v ---•----------------•-------------- --------------------------------------- -"' L... e 5a,�1 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 E 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 board of h lth, Si ned ��O 2! � � •.......... ............ ............Dat............... Application Approved BY /. •--••-----•-•-•----•--••-•--........ ......2j-.� '.✓......... �!��� 'Date Application Disapproved for the following reasons----------------------------------------------------------------------------------------------------------------- ..--••........................••••-••-•--••-••••.....--•••-•....•-•••-•-•--•--•••........•------•-...............--•--•-•-----•••-•••-----••••---•-••-------------••-•--•------••-----••--••------------- Date PermitNo......................................................... Issued....................................................... Date No..s.�:f ....f��G Fizi3_��...�`�....:"�......... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .....---..���.W.n...............OF.......... !�r.Ll-. .: .- ........................ Appiiration for Diipnsai Workii Tonstrur#iun rrutit Application is hereby made for a Permit to Construct or Repair ( ) an Individual Sewage Disposal System at: U cti� av� \ � �...an�. 4i Location-Address -s tt Qr Lot }Now. ...... ?U(Yl Cis ... ......... .' L l \n `• =1^=--"` ' -•----................................. Owner- % ddress k>A ,.� =......... = .....--.... .......... Installer Address d Type of Building Size Lot_� ,_�`. -------Sq. feet aDwelling—No. of Bedrooms.................._...._.....__..__.........Expansion Attic (P1 <) Garbage Grinder (w) p-I Other—Type of Building ............................ No. of persons-----------------------------Showers ( ) — Cafeteria ( ) P+ Other fixtures ...................................................... W Design Flow.............\1`......................gallons per person per day. Total daily flow............. _ ....................gallons. WSeptic Tank—..Liquid capacity:...'O...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____.____�.� _. a• ' '�-':........ Date...... __. -...._..... ..--•-------------------- aTest Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water......................... f� Test Pit No. 2................minutes per inch Depth of Test Pit.__.._......__.__._. Depth to ground water________._...._.._..__.. ----•---•------------------•---•------•-••------•--•-----.....................___---•-........_..-•-.......................................................... O Description of Soil.------- --•--•-••-••-•,•••`�`- ^, � �.> >s . •... �.. ---------- V W ........................................�k......... . L . UNature of Repairs or Alterations—Answer when applicable------------------------------------------------------------_---------------------------------- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. Si ned_....... ..IV\..........�. -•-�'."------------ ----�1---=D/J.... ..Z �!• •,,t�om ,�� /� / Date Application Approved BY------------ i. 1.!'x: ���� mil. --•--21 oz1 ?. - ate Application Disapproved for the following reasons:..••-•-••---•-••----•••-•--••••--•---•--•••-•-------•--•---•-•---••••-•--•••-•-•------•--••-••-•--•............. .....................................................................................................................................................................................................---- Date PermitNo......................................................... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH t�..............................OF.............. ........... . (In ifiratr of Toutph anrr THIS IS TO CERTIFY,at Individual Sewage Disposal System constructed ( for Repaired ( ) b C' O r'i lW lY �.s y............. .:....... •--• -- .._......._.............._........--•••-- •• -------------•- Installer r _ has been installed in accordance with the provisions of TITLE j of The State Sanitary Code as described in the application for Disposal Works Construction Permit No----- ......... .dated_-..______._-_______-____-__-___----•---•-_--•-- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. �DATE........................................ --4�'--••••....... Inspector...-------.....A THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH 1 �) S�,..... r) . ...............��'.C•+,./1 (°� t,� ...OF FEE.... ............. Bispoo ai Workii Mantra uan rrntit Permission is hereby granted............__•_- ..��✓ .__....____. S • -----•-•----••--••-••-•--•--•.............•-•••-•--...........•--_-•--- to Construct ( 1-for Repair ( ) an Individual Sewage Disposal System at No............... "�,� ?::............._ _. r_�_ -_ \� 1 ---------------- -•------ Street as shown on the application for Disposal Works Construction Permit No..................... gated.._.....____.__.....__.................... ealth ----------------------------------------- �I DATE_._.`���= �l, �Y.��---------•--•----•-••---_...- �ard�of FORM 1255 HOBBS & WARREN, INC., PUBLISHERS VI_=- -�.Iyry ice••--i �± SttitGtL FAMtt_Y -- 3 6EID9-0OM I.ID Gaa�c�.Gs= {�wNDE2 .j pAtL�( FLOW ^ 11O x 3 = 330 G.P.n , /� 5EPT1G TAkJK = 33Oxl5o% = .497r6,P. 0 �/ USE 100o GAS.-. • 0t5Po5AL. PIT C> 5 i DEWALL A26A = t 5o S.F � , � I 2.5 = 37 5 G.P 4 BOTTOM AREA= So S.F, i -TOTAL- c)E'5104 = ,+25 -foTAt, DA t L,( Ft-ova! - 330 G Po, �t PE2GoLQTt0�1 RATE I''tN 2MtN o�L�55 .. � t O '�• per �2 pr ALAN R#CHAnD . . W. A. JON BAXTEA �, •. No.24048ar i A5D TE�T P I21°� 1 6 = 4Z ' Top FND+ 43 , LoMit ''a. � .. loov INS• Z�s'ictl' T. B-K 3N SEPTIC, 3� � Gprd(tFitT t000 ttJ�l. 9. TANK � �5s GAL. LEACta 1 PIT INV. .iNV, _._._.. _.... ......... .. ��. I WASNG.D I ; AAeri 6ToNE . . . . . . 33 I I • Cti=�TiFtGP PLOT PLAN li ' � P\ZOFILr~ L O G A-T 10 N 29 iZ NO 5CAL& SCALE 1 = (,D pQ.TE '1 /14'82. {o I,V�tt�t- P L-A N R E F S tzE►mot G1= GE2Tt�Y -THAT 'THE quot*TtotJ 5No4YN I N1=RCOIJ COMPL.YS WITO-rHGL SIVe-LItJC-- (2- AWO 'SGTee.GK 2.6QutR•�MFN�'S -ro W N o F::! 'BNMl44TWa U3 ANC ►s Wor LAIJr> Cover 35S 4 g LOGp.TED WITVI T E G1.00D PLAtN pA-r�1'I�•$Z BAxTEQ.t=_ A1`(E INC. I REG I SZ>✓QFYD'I.AN D'S u V.V W?6V-S TulS pL�N 15 NOT gASFst> Oki AN OSTE2VILl.� N1G+�5. INSTP,uM6NT SUQ-VC-` 4-TNE oFF5�T5 SNOUt,� f' NoT �E. V�jEDTb C7ET[-�.MIN�c Lc>T t-INE�j APP�-IGANT �AME'�, tL• �MtTt4 N VALLEY BROOK ROAD GENERAL NOTES_ f _ RMTE - 40 FT WIDE 1. ADDRESS: #53 VALLEY BROOK ROAD za "-—' 2. ASSESSOR'S NUMBER: MAP 188 PARCEL 159 .— ---- --ecrg­e of pavement_ 3. DEVELOPER'S LOT: LOT 12 4. TOPOGRAPHIC INFORMATION WAS COMPILED FROM AN ON THE GROUND INSTRUMENT SURVEY. 5. TOWN WATER IS PROVIDED TO THE SITE & SURROUNDING PROPERTIES. 6. NO. WETLANDS ARE LOCATED WITHIN 150 FEET OF PROPOSED SAS. SITE 1 00..fig 7. REFERENCE PLAN: L.C. PLAN 35548 D SHEET 2 8. U11UTIES LOCATED BY DIGSAFE. $ co^ 9. THIS DESIGN PLAN IS TO BE UTILIZED FOR SEPTIC REPAIR PURPOSES ONLY. Bumps Rhvr S 10. THE PROPERTY IS NOT LOCATED WITHIN A GP GROUNDWATER PROTECTION ZONE/ZONE II.- * `°o 11. THE PROPERTY IS NOT LOCATED IN A FLOOD HAZARD ZONE. 12. THE PROPERTY IS LOCATED IN THE SALTWATER ,ESTUARIES PROTECTION ZONE. " '� LOT 12 ENT AREA- 15 246�SF VE:.....::: LOCUS � : :":;`:DRIVE, N 0 SCALE } A aQ� n o. 53 :X 5 .55 SAS LAYOUT Scale: 1"=20' House Corners ,to SAS Corners 'r EXISTING ;;::::::....::::.:.....2 N DWELLING w _- - A-1 = 38 —9 B-1 = 44 —6 FIRST ELEV57.74 FL. .= (�I _ _ o A-2 - 49'-10" B-2 34'-3" o cellar a111 56.�41 � Co a , deck �,� W X 55:Bfl�.s �o o H- 20 o — ox PROPOSED SAS F .1 0 -7 2 H-10 500-gal chambers cgs 1 :V with 4 stone all around in iST��` 0 5:25' 10' 25' x 13' x 2' leach trench. 1fTAa��'� '� 1.91• O 55.151 ::.; :: LEGEND PROPOSED SEPTIC SYSTEM REPAIR TRESS Test Hole location PREPARED FOR tb —SAS-- 9 Proxe ate location ROBERT B. OUR, CO., INC. : 6 T.H. #2 -, o '. rpl._ Approximate location AT water line B,M.i _ Existin contour �. � -• #53 VALLEY BROOK ROAD g (CENTERVILLE), BARNSTABLE, MA sep lc;setback H. #1: o o. Ex.t,OOD Ti. H-10 loading 47.08' X h Brant septic tonk C.B. 1 fn1 SHED OWNER: ELIZABETH J. RICHARDSON . 70 . 4.8 , 58 / ( ^�1 1 Existing leach Pit PREPARED BY: 3 a (to be pumped & backfiHed) Glen E. Harrington, R.S. ,�° 9 Leda. Rose Cane SITE PLAN Marstons Mills, MA 02648 AA C- "'~ -- 7.76 SCALE: � — 20� - 53.04' ed C-13, fnd.-...... a �—�• 6' stockade fence. Tel: 774-238-1813 529— " ~ 9@ Of � - Email: gharr880hntmnil.com B.M.=50.00 (ASSUMED) ON � __ pOVern Dt 5 Approximate location c.B. f�,d. sa / 1� !Y _ _ _ -X 54.59' geothermal well (closed loop) SCALE: 1"=20' DRAWN BY: GEHRS DATE: 14 NOV 2020 T/ l ROAD OA D P DATUM: ASSUMED FILENAME: 53Vailey8rook SHEET 1 OF 2 - - - - � SYSTEM PROFILE_- - - - - - - - -- - -- - -- - - -- Existing Dwelling Not to Scale PROPOSED 3 HOLE H-20 DIST. BOX Existing Grade 5fi't Finished grade over system=2% slope away Existing Grade 55't Min. 2"-1/8"-1/2" Double—Washed Stone CELLAR Septic tank covers must be D—Box cover shall be One chamber cover shall be or gem—textile filter cloth CELL S = 0.02'/ft. within 6" of finished grade within 6" of finished grade within 6" of finished grade. S=0.01'/FT T 'of Peastone Elev.-53.5't ' � EXISTING Level for 2' S=0A1 ft/ft 10' 1000 GAL. 15' is ® ® ® ilk C3 24" SEPTIC TANK P=5283' ID ® ® ® ® ® C3 invert Elev.= .70' Ex Invert H-10. . � ffl 4' 2® 8'-6" Install Gas Ba e Ex. = 53.4Q' or e u - 5 3/4"-111" Double—Washed, Crushed Stone 5' Min. (5.0' PROVIDED) fi" OF 3/4"-11/2" STONE H— 10 ottom of T et Hole #2 Elev.=45.70' 6" OF 3/4"-11/r STONE LEACHING CHAMBERS Design Calculations ALL OUTLET PIPES FROM THE Number of Bedrooms: 3 EXISTING (per 1982 Permit) DISTRIBUTION SET LEVEL FET LEVELF BOX ORAT SHALL BE 1r CONCRETE COVER LEAST 2 FT_ Garbage Disposal: Not allowed with this design 3 — 5" OUTLET Septic Tank Capacity Required: 1.500 gallons (min. per Title V) ' ` 3" KNOCKOUTS CT ION O N NOTES Septic Tank Capacity Provided: Existing 1,000—gal H--10 septic Tank C O N ST R U Leaching Capacity Required: 330 gpd x LTAR= 446 SF Req'd Area is` ( 12• INLET oUTLEr 1 . Contractor is responsible for Digsafe notification Long Term Application Rate for <2 min./inch = 0.74 gal/sq. ft. s• a• Proposed Leaching Structure: 1-25'x13'& Leaching Trench d . - 2" 1.4 and protection of all underground utilities and pipes. Bottom Leaching Area Provided = 325 Sq.Ft. �s• ~ 2. The septic tank and distribution box shall be set Side Leaching Area Provided' = 152 sq. ft. 3" level on 6" of 3/4"-1 1/2" stone. Total Leaching Area Provided = 477 sq. ft. > 446 sq. ft req'd. PLAN-SECTION CROSS SECTION 3. Backfill should be clean sand or gravel with no Leaching Capacity Provided =477 sq. ft X 0.74 gal/sq.ft.=353 gpd. 3 HOLE H-=20 DISTRIBUTION BOX stones over 3" in size. 4. This system is subject to inspection during installation NOT TO SCALE by Glen E. Harrington, R.S. SOIL EVALUATION & PERK TEST 5. The contractor shall install this system in accordance Date of SOIL EVALUATION & PERK TEST: November 4, 2020 with Title V of the Massachusetts Environmental Code Evaluation Performed By. Glen E. Harrington, R.S. and local Board of Health Rules and Regulations. Witness: aa David a idtantonR SoOnc gentcvto ' a 6. If, during installation the contractor encounters any Percolation Rate:< 2 mpi in C1 & C2 soil conditions or site conditions that are different Test Hole Test Hole from those shown on the soil log or in the design, PERK DEPTH he installer shall halt installation and immediately notify No. 1 v srnl, ELEV 28_46" PROPOSED SEPTIC SYSTEM REPAIR t DEPTH SOILS ELE . Glen E. Harrington, R.S. START SOAK 0:00 PREPARED FOR END SOAK 8:25 7. No vehicle or heavy machinery shall drive over the 5" 10YR5/2 55,45 6" 10yR55/2 55.20 24 GALS APPLIED ROBERT B. OUR, CO., INC. septic system unless noted as H-20 septic components. Bw Use <2 mpi for AT oamy sand loamy sonc design purposes. 8. Install Tuf-Tite gas baffle or equal on septic tank outlet tee. 23" 10YR5/6 53.95 2e 10YR5/6 53.70 #53 VALLEY BROOK ROAD 9. All piping shall be SCH 40 PVC. m—c lsand m-c lsand ' �.�.� 1 (CENTERVILLE), BARNSTABLE, MA 10. No potable wells or wetlands are located within 150' of proposed SA 9 9 t ei ,r ����., ! HARDSON " 10YR6 s 10YR6/6 50.78 ' . OWNER: ELIZABETH J. R C 57 / 51.12 59" n 11 . Provide 1 H-20 DB-3 distribution box and 2 H-10 500-gal. �' ,:�;:_ PREPARED BY: chambers by Wiggin Precast or equal. m- waned m2z "d l Glen E. Harrington, R.S. shall be pumped and backfilled. Z SY7 3 2.SY7/3 O` 7{3 9 Leda Rose Lane 12. The existing leach pit p P / MA 02648 13. Removal of trees for SAS installation shall be determined by 120" 5.87 12o" 5.70 , ���s-�1vt�,f Marstons Mills, E 4 ti.r. Tel: 774-238-1813 Installer and Owner. 10' around SAS recommended. No Observed Ground Water ° ��' = Email: ghorr88®hotmail.com Soil Evaluation Certification '��"" 14. Provide magnetic marking tape over components one-foot below by SCALE: 1"�20' DRAWN BY: GEHRS DATE: 14 Nov 2020 r' 1, Ii1en E. H°rtingtpn, hereby certify that on Ocbber. 1995,f passed the ®Olt svnlu°tor grade to facilitate relocation of components. exen,I�Wst ° ' a the uEP and that the a,.°n"'a "°® Qerrar esaned e p ,,,e con9lstent wla, the required training.eapertise a>Hf °"p°`�^CO °d DATUM: ASSUMED FILENAME: 53Vailey9romh SHEET 2 Of 2 In MO CUR M0117.