HomeMy WebLinkAbout0087 OLD POST ROAD (CENT.) - Health 87 Old Post Road
Centerville
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No. _ � �}-� ,-�• Fee Q
THE.COMMONWEALTH OF MASSACHUSETTS Entered in computer:
Yes
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS
Application for TDi5po!6a1 *p5tem Construction permit
Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components
Location Address or Lot No. '�7 OW I OS'l fZsAd Owner's Name,Address,and Tel.No. K`VLL � •T-1-us T
Assessor's Map/Parcel �IOi 10Z
Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No.
�a F3a� `?c.3�CQii✓}vtin1, 0L�3 z P(d 36,4 oei
Type of Building: _
Dwelling No.of Bedrooms Lot Size �> U� `� sq.ft. Garbage Grinder ( )
Other Type of Building _ s No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow(min.required) 3 3 O gpd Design flow provided gpd
Plan Date pT 1 Z Zo o`j Number of sheets Revision Date
Title
Size of Septic Tank IDea s Type of S.A.S. 1
Description of Soil
Nature of Repairs or Alterations(Answer when applicable) �c tk-->a fJ2 ?a
Date last inspected: ! ,o1 0
Agreement:
The undersigned agrees to ensure the construction and maintenance of the afore described on-site Y
sewage disposal system in
P
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.
Signe Date Zoo
Application Appro d by Date
Application Disapproved by: Date
for the following reasons
Permit No. 001n_>01L. Date Issued
No.
Fee 0
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:V
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes
Z(ppYicaction for Migogal &paem Congtruction Permit.
Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components
Location Address or Lot No. 4 1 Q LJ ros'r t�o `` Owner's Name,Address,and Tel.No. 1�,nL Cs*,K,'-1
Assessor's Map/Parcel O
Installer's Name,Address,and Tel.No. 4 (/�z Designer's Name,Address and Tel.No. C, (u -j eC4
C() d-, E 1 CCc 7
2 3by a9S
Type of Building:
Dwelling No.of Bedrooms / Lot Size sq. ft. Garbage Grinder ( )
Other Type of Building 5 i hl tee No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow(min.required) -3 3 O gpd Design flow provided gpd
Plan Date ,
epT' 1 Z 2005 Number of sheets /�^ 7"`,�,�_s,�...� Revision Date
Title q' a LJ r r
Size of Septic Tank 1000 Type of S.A.S.
Description of Soil
Nature of Repairs or Alterations(Answer twhen 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.
Signe Date
Application Appro d by Date I �Al t"i
Application Disapproved by: Date
for the following reasons
Permit No. b Date Issued L
THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE, MASSACHUSETTS
Certificate of Compliance
THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed ( ) Repaired ) Upgraded ( )
Abandoned( )by / s,i,, -e'
at k7 a P,2s r /&O-cd has been constructed
in accordance
with the provisions of Title 5 and the for Disposal System Construction Permit No. —CT! {O dated ' G.
Installer �} r'�to t i, � ) LL C Designer C(
#bedrooms_-3 Approved design flow gpd
The issuance of this pe all � t construed as a guarantee that the system ill functi , a si ned.
Date Y✓, Inspector
--- --3�1�'%�� ---------------------
No.r-�} -------.—. Fee
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS
Mfgpoal *pgtem Congtruction 3permit y
Permission is hereby granted to Construct ( ) Repair.O Upgrade ( ) Abandon ( )
System located at l
Y ��i old PaJ r 17,,^d �,
and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty
to comply with Title S and the following local provisions or special conditions.
Provided: Construction must e co. et within three years of the dat ofof th�t.
Date 1 Approved by�f
f
Town of Barnstable
Regulatory Services
s Thomas F. Geller
ire D'
• eiuwer�►sts, • ,Director
79: � ' Public Health Division
P
Thomas McKean,Director
200 Main Street,Hyannis,MA 02601
Office: 508-862-4644
Fax: 508-790-6304
Installer&Designer Certification Form
Date:
Designer: DAvI ClhvGHhNpw.Q R.S. Installer: r^ I '
Address: �3 TRtA1JGLL Cl2CC,C Address:
SR:uOW lets M R 025CO.3 �-tf ��� 1/Irv► 1�
was issued a permit to install a
(date) (installer)
septic system at ';6 7 6(-D �>0 5T 12 D p i
� based on a design drawn by
(address)
NVII) 6006►fAN0WR dated Sept lZ, 2601?
(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.
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.
N'OF Mqs�
�o DAVID �yGN
staller's-S ature) D. a
COUGHANOWR N
No. 1093
m Q/STE��o
(Designer's Signature) (Affix Designer'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.
.Q:Health/Septic/Designer Certification Form
New Page 1 http://www.town.bamstable.ma.us/assessing/2009/HMdisplay.asp?m...
C
3 of 3 9/14/2009 2:45 PM
TRANS. NO.:
CITY/TOWN: Rhizw -NRLC f C F-1J 1 t:r V r LL(
APPLICANT:
ADDRESS: d7 OLIO POST ROA Q
DESIGN FLOW: gpd
REVIEWED BY: DATE:
N/A OK NO
/�
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 andprovided)
soil absorption system (required andprovided)
whether system designed for garbage grinder o/ .
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 e1. on
each test) [310 CMR 15.220(4)(h)] ✓
Names of soil evaluator and BOH representative [310 CMR
15.220(4)(h) and(i)]
Location and date of percolation tests (performed at proper
elevation?) [310 CMR 15.220(4)(i)]
Percolation test results match loading rate? 310 CMR 15.242
Certification statement by Soil Evaluator [310 CMR 15.220(4)0)]
Observed and Adjusted groundwater(method for adjustment
given or indicated) [310 CMR 15.103(3) and 310 CMR
15.220(4)(n)] c/
Address q 7 OLD PAST �OA-0 Sheet 1 of 7
f �
N/A OK NO
Location of every water supply,public and private, [310 CMR /
15.220(4)(k)] V
within 400 feet of the proposed system location in the case
of surface water supplies and gravel packed public water supply ✓
within 250 feet of the proposed system location in the case
Within 150 feet of the proposed system location in the case
of private water supply wells ✓
Location of all surface waters and wetlands located up to 100 ft.
beyond setbacks listed in 310 CMR 15.211 and any catch basins
located within 50 ft. [310 CMR 15.220(4)(1)]
Water lines and other subsurface utilities located [310 CMR
15.220(4)(m)] (if water line cross see 310 CMR 15.211(1)[1])
Profile of system showing invert elevations of all system
components and the bottom of the SAS [310 CMR15.220(4)(o)]
Stamp of designer [310 CMR 15.220(1) and 310 CMR 15.220(2)] ✓
Stamp of Registered Land Surveyor(required if construction ✓
activities within 5 ft. of lot line) [310 CMR 15.220(3)]
Test Holes adequate (two in each of the primary and reserve
unless trenches as permitted in 310 CMR 15.102(2) or as /
approved for an upgrade under LUA at 310 CMR 15.405(1)(k)] "
Test hole adequate to demonstrate four feet of suitable material?
[310 CMR 15.103(4)]
Test Holes adequate to confirm adequate groundwater separation?
[310 CMR 15.103(3)]
Benchmark within 50-75' of system [310 CMR 15.220(4)( )] ✓
Materials specifications noted? [various sections of 310 CMR
15.000]
System components not> 36" deep (unless Local Upgrade
Approval or LUA requested) [310 CMR 15.405 1(b)]
Address qi ? Ot-6 POST 2 4I) Sheet 2 of 7
s
i
N/A OK NO
SEP1I � E �,
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)] s/
Note regarding installation on stable compacted base [310 CMR
15.228(l)]
Separation between inlet and outlet tees (no less than liquid
depth) [310 CMR 15.227(2)] V/
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(l)(k)]
Minimum cover 9" (Tanks buried more than 9"must have risers
on all openings and on the d-box) [310 CMR 15.2228(1) and 310
CMR 15.232(3)(f)]
Three access covers (inlet and outlet must be 20" or greater) -
middle access at least 8" (by 7/07) [310 CMR 15.228(2)]
Access to within 6 " of grade one port for systems<1 000gpd,
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)] V/
Setbacks from resources [310 CMR 15.211] c/
Required when other than single-family dwelling or flow>1000
d [310 CMR 15.223(1)(b)]
First compartment 200%daily flow; Second compartment 100%
daily flow [310 CMR 15.224(2) and(3)]
"U" pipe through or over baffle, outlet of each compartment with
gas baffle or approved filter [310 CMR 15.224(4)]
Address �� ow) Post 44D Sheet 3 of 7
t i
N/A OK NO
Located at least ten feet from any water line? [310 CMR
15.222(2)]
Disposal piping at least 18" below water line(when water and
sewer cross, see 310 CMR 15.211(1)[11)
Cleanouts required/provided ? [310 CMR 15.222(8)]
Thrust blocks specified in force mains? 310 CMR 15.221(6)(c)] i/
Slope of sewer line not less than 0.01 (1/8"/ft) 0.02 preferable /
[310 CMR 15.222(6)1 "✓
Proper pitch on all runs? (.005 within gravity-distributed trenches
and beds) [310 CMR 15.251(9) and 310 CMR 15.252(2)(c)]
Siphonproblem/(leachfield below pump chamber) ✓
Endca s or vent manifold's ecified? g/
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) V
`,`^°° uX.`' fix.zr.4:•,ew .a� <.. ti ,�r s
Stable compacted base [310 CMR 15.221(2) and 310 CMR
15.232(2)(a)]
Splash plate or baffle tee required on inlet/provided? (when
pressure sewer to d-box or steep pitch of gravity sewer) [310
CMR 15.323(3)(a)]
Riser if deeper than 9" [310 CMR 15.232(3)(f)] ✓
Inside minimum dimension 12" [310 CMR 15:232(2)(b)] L/
Minimum sum 6" [310 CMR15.232 3 (e)] ✓
Watertight cover if<2000gpd); waterproof manhole if>2000gpd /
[310 CMR 15.232(3)(d)]
IN,
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 V/
TO GRADE [310 CMR 15.231(5)]
Service components accessible (not too deep with piping,
disconnects accessible)
Alarm floats - alarm on circuit separate from pumps specified?
Exceeds two units must have two pumps operating in lead-lag
mode. 310 CMR 15.231(6) and(8)]
Stable Compacted Base [310 CMR 15.221(2)]
Buoyancy calculations needed ? Provided? [310 CMR 15.221(8)]
Address �� OL D 0OS7 jzeA b Sheet 4 of 7
f
N/A yOK yNO
f I 3 -a.,ti �f SI�'u� �T fE"�fi' yf yEy
�n' nb.. '"WIN s e�
Calculations correct? V/
4 feet of naturally occurring material demonstrated?,[3 10 CMR
15.240(1)]
Required se aration to groundwater? [310 CMR 15.212)]
Aggregatespecified as double washed [310 CMR 15.247(2)] ✓
System Venting required/provided? (system under driveway or
>36" deep) [310 CMR 15.241]
Inspection ports specified and within 3"final grade? [310 CMR
15.240(13)] V/
Breakout requirements met? (No violation of breakout elevation
within 15 ft of SAS unless barrier) [310 CMR 15.211(1)[4] and r
Guidance Document] f f
� ..3: 7 :� V� � �/� J2UN
X aka
Chambers and Gal. in trench configuration supplied with inlet
every 20 ft. [310 CMR 15.253(6)] tl
Each structure with one inspection manhole(if>2000 gpd must
be to grade) [310 CMR 15.253(2)] i
Aggregate I'minimum- 4'maximum. [310 CMR 15.253(1)(b)] /
2' sidewall credit maximum [310 CMR 15.253(1)(a)]
In bed configuration, inlet every 40 s . ft. [310 CMR 15.253(6)] /
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 25l(1)(d)]
Situated along contours [310 CMR 15.251(2)]' VII
Breakout OK? [310 CMR 15.211(1)[4] and Guidance Document] ✓
'n:...
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)O] ✓
Separation between beds 10' minimum. [310 CMR 15.252(2)(0]
Bottom area used in calculations only[310 CMR 15.252(2)(i)]
Address �, QL 1, DOS 'r A-0 Sheet 5 of 7
1 J
N/A OK NO
MOM , e
Pressure Dosed System ? Provided pump and piping
calculations as required [310 CMR I5.220(4)(r)]
Pressure dosing required on all systems>2000gpd or alternative
systems under remedial approval [310 CMR 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] V
Inspections once per year(systems<2000 gpd) or quarterly
(>2000 d) good to note on plan [310 CMR 15.254(2)(d)]
Construction in fill -Did the plan specify that the fill shall meet
the specification of 310 CMR 15.25 5 3 ?
Impervious barrier and/or retaining wall ? [Guidance Document]
Impervious barrier installation must be supervised by
designer [310 CMR 15.255(2)(b)]
Retaining wall must be designed by Registered Professional
Engineer [310 CMR 15.255(2)(a)]
Side slope not exceed 3:1 ? [310 CMR 15.255(2)]
Breakout requirements met? [310 CMR 15.252(2) and
Guidance Document]
At least 5 ft. from impervious barrier to edge of SAS (10 ft.
recommended) [310 CMR 15.255 (2) e
Check DEP Approval letters for credits and design conditions
w press
ure dosing do not allow pressure discharge
If used with p g p g
to scour soil interface
BMW
Was DEP Approval Letter provided and/or have you
reviewed the letter for co
nditions?.
Is the technology being properly applied and does it meet all
DEP Approval Conditions?
Is there a note on the plan regarding the requirement for
perpetual maintenance agreement?
Any alarms involved on separate circuits
Did the applicant submit an operation and maintenance
manual?
Has apRlicant submitted a copX of a maintenance
Are the variances listed on the plan? [310 CMR 15.220
(4)( )] ✓
RLS Stamp necessary on plan if a component is within five
feet of property line [310 CMR
New construction or increased flow proposed- [Refer to 310 /
CMR 15.414] V
Address d��� �0 S� �d Sheet 6 of 7
N/A OK NO
Is the system in a Designated Nitrogen Sensitive Area(Zone II for
a public supply well)? [310 CMR 15.214, 310 CMR 15.215 and
310 CMR 15.216 - also refer to Policy regarding upgrades of such /
existing systems] `/
Is the system proposed on the same lot as served by private well ?
[310 CMR 15.214(2)]
Are the nitrogen loads proposed in compliance? [310 CMR
15.216(1)]
Pumping to septic tank? [ 310 CMR 15.229]
Shared System [310 CMR 15.290]
Address �� 00) D6 5 7 URO Sheet 7 of 7
TOWN OF BARNSTABLE
LGCATION QLA PoST -®01 SEWAGE# ),O®q 7-96
VILLAGE sseAA iev y t%`t —ASSESSOR'S MAP&PARCEL Ze CA- f o 2.
INSTALLER'S NAME&PHONE NO. C Ora=cue (;vi� r®t;-,c s LLL
SEPTIC TANK CAPACITY ®0 C)
LEACHING FACILITY.(type) 6TOne�<-I s 1 Cc-vi6tc) (size) oZ. 3)( -6 X 2
NO.OF BEDROOMS r 3 f
OWNER R i a k �A�r►�,��l �(QST
PERMIT DATE: Z101 C� COMPLIANCE DATE: ok
Separation Distance Between the: i
Maximum Adjusted Groundwater Table�o the Bottom of Leaching Facility ( oC WAW 11•I" 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 C4aW,CkR 04Jf(iSe-S LLC,
Declt
� A
L
40
A- 2- %4 '�
A - 3
A , �� '33' � 5 "
13 — 1 Z Z05
3 3c
(01
13- 5 (o(. ;
Town of Barnstable P 1'� S'
of (2 6
Department of Regulatory Services
Public Health Division
Date Pt t61¢ :200 M it�S eet, yanuis MA 02601-
Date Scheduled - !1 `v`
1 Time D _ e•
Fee Pd..
Soil Suitability Assessment or Sewage
Performed By: l,J�V l D 6-q(�6 H 4-U 0W z �
f ge �zsposal
Witnessed By:
LOCATION & GENERA L�'pR-A•TION SSoL,v,
Location Address g^-'2 Q L � " �
` �Srt Owner's Name
Address sy
Assessor's Map/Parcel: 'z 0�/ Engineer's Name 10
NEW CONSTRUCTION REPAIR � ` _ f
Telephone# 1501 '41FO 413 2
Land Use. RLISlden� 1111
Slopes(%) Surface Stones D ADis[anccs from: Open Water Body 1 t/ ft. possible Wet Area ��f7 "f
—�_f, Drinking Water Well ® f ft
Drainage Way 5,0 ft Property Line
C--- 4 _ft Other ft
S 'TCH: (Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands in Proximity imity to holes)
153.32 Ff
ml
jk GROUNDWATER ADJUSTMENT
h EXISTING GROUNDWATER LEVEL
BASED ON TOWN OF BARNSTABLE
O 1 i GIS DEPARTMENT RECORDS.
1
INDICATED GW 24.00
ZO
IND EX WELL M1W-29
READING DATE ADUG. 2009
0 a'1 READING 8.7
ADJUSTMENT 5.0
ADJUSTED GW 29.0
154.00 Ft l�
Parent material(geologic) `o `I q( q1f
0O4 hVg5�l J 1 Depth to Bedrock V to t D Yi e
Depth to Groundwater. Standing Water in Hole: t �.
Weeping*om Pit Pace CO
---------------
Estimated Seasonal High Groundwater e P Ct bo)e
DETERMINATION FOR SEASONAL HIGH ySr�,T , SABLE
Method Used: Q eP- In, C V e
Depth Observed standing in obs.hole
Depth to weeping from side of obs.hole: in. Depth to soil mottles:
Index Well# Re in, Groundwater in,
ading Date: Index Well level Adj. ft.
,factor _ Adj.�lrnundwater Lcvel
Observation
PERCOLATION TEST lance e(�a/05 Time EA-
Hole#
Time at 9" � �9
Depth of Pere
Start Pre-soak Time @ iUf 03 Time at 61'
-- ----
Time(9"•6") _w_!
- End Pre-soak
Rate Min./Inch ZwtPf
_ Site Suitability Assessment: Site Passed
Site Failed: .Additional Testing Needed(Y/N)
+. Original: Public Health Division
Observation Hole Data To B e Completed on Back-----------
.�
***Ifipercolation test is to be conducted within 100' of wetland, you must first notify the
Barnstable Conservation Division at least one (1) week prior to beginning.
\ g
-Q:�SEPTIC F-RCFORM.DOC
I
3SOIL TEST LOG
DATE OF TEST: SEPTEMBER 9.2009 I
SOIL EVALUATOR: DAVID D. COUGHANOWR. R.S. [.
WITNESSED BY: DONALD DESMARAIS. HEALTH DEPT.
PERC NUMBER: 12665
NO TEST PIT I PAARENOTUNDWATER MAATER AL:ENCOUNTE PROGLACA LED
OUTWASH
PERC AT 58 to — 2 MIN/INCH IN C SOILS
ELEVATION DEPTH SOIL USDA SOIL SOIL COLOR SOIL OTHER
53.90 (INCHES) HORIZON TEXTURE (MUNSELL) MOTTLING 4
0-6 Ap LOAM 10 YR 3/2 NONE FRIABLE R
6-36 B LOAMY SAND 10 YR 4/6 NONE FRIABLE
50.90
36-136 'C MEDIUM SAND 10 YR 5/4 NONE LOOSE
42.40
NO NCOUNTERED
TEST PIT 2 PARENTU MATERIAL: PROGLAC AL OUTWASH
2 MIN/INCH IN C SOILS
ELEVATION DEPTH SOIL USDA SOIL SOIL COLOR SOIL OTHER
a 53.'�5 (INCHES) HORIZON TEXTURE (MUNSELLI MOTTLING
i 0-6 Ap LOAM 10 YR 2/2 NONE FRIABLE
50.75 6-35 B LOAMY SAND 10 YR 5/6 NONE FRIABLE
36-138 C MEDIUM SAND 10 YR 5/4 NONE LOOSE-
42.25
DEEP OBSERVATION HOLE LOG Hole#
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders.
Congi5trncy,9' Gravel
DEEP OBSERVATION HOLE LOG Hole#
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders.
Consi ten I
Flood Insurance Rate Map:
Above 500 year flood boundary No_ Yes
Within 500 year boundary No V, Yes
Within 100 year flood boundary No—kL 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? Ve6
If not,what is the depth of naturally occurring pervious material?
Certification y ��� ���
I certify that on NU (date)I have passed the soil evaluator examination approved by the
Department of,Environmental Protection and that the above analysis was performed by me consistent wit
the required training,expertise and experience described in 310 CMR 15.017. 0 OF,ygSsq
Signaturecbs-n Itao #44Date �I°n� �, M DAVID cy�
N
r V D.
COUGHANOWR "
Q:\SBPTiC�PERCFORM.DOC top CENSE�O�
FVALO
No................J....... "�''/ "I ' 'd Fps... ....................
THE COMMONWEALTH OF MASSACHUSETTS
BOAR® OF HEALTH
t� �-7—�
Appliration for DiipooFal Works Tonstrnrtion ramit
lApplication is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System at:
---------- - --------- ----------
Location--Ad ress Lot o.
Owner Address
a /.:................ ..........
Installer Address
d Type of Building Size Lot...
_ __.�Sq. feet
V Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( )
per, Other—Type of Building ............................ No. of persons........................----- Showers ( ) — Cafeteria ( )
a Other fixtures -------------------------------- .
W Design Flow........ .........._rr_____•• ..gallons per person per day. Total daily flow...........3.3 Z.?..................gallons.
WSeptic Tank—Liquid ca acitdd -_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 ( ) ��16— . C��? ` 7-/y -7`J
Percolation Test Results Performed by..............,: .. ? ..._�__.__.•....___...-_........ Date..... --./_. . _ 7_.__._.__.
Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water_-___-_-___-_--_--- -.
(T4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
a ..................................--• •:... ....................•-•-•-----........V..---•-•--........----............ f.....-•---••-•--
O Description of Soil -. ..................r+ /�..... �--'•-•��-- .-�C....... ---- x_��/................
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 i ITI,i; 5 of the State Sanitary Code—The undersigned further agrees not to place the.system in
operation until a Certificate of Compliance has been ' ed by board of health. a
Signe - . ..................•--- .............__.._..... 1.1./__:: '
/ Date ''"
Application Approved B ......• .__.._-� _.__�(.-. .......�� �--�_
/ Date
Application Disapproved for the following reasons---------------------------------------------•----------•----------------------....---••---.........---•--------.
•-•••....................•••-•-••-•-•......-••-••...-•-••-•••-•--••-•-•-•...••••--•----•------•••......--••••••••--•-•••--•--•••••-•-••••••••••-•••--•---------•------------------•--•-••••••-•...._....
G Date
Permit No......................................................... Issued---- •`�-l- 7-7-----...-.
- ---------
Date
No..•-• �1..:. Fps.... ' .....
THE COMMONWEALTH OF MASSACHUSETTS
b4 B
�ARD
OF, HEALTH
......... ... .......... ...OF....... .. ..:.::: /.!j- . ........_-......
Appliration for Disposal Workg Toni itrurtiurt thrmit
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage- Disposal
Sy*a' - te . ..�... '
................. LotAddress o e, VVX.ZAt49r
W fu_ ' w�r sr
�V Address
a �- ........• ...
Installer Address
Q Type of Building Size Lot... _ 'Sq. feet
U Dwelling—No. of Bedrooms..............................................•....................Expansion Attic ( ) Garbage Grinder ( )
aOther—Type of Building ............................ No. of persons........................... Showers ( ) — Cafeteria ( )
a' Otheffixtures ..
W p Design q _ gallons per person per day. Total daily flow____.___ + .. .................gallons.
• --... ...._
Wr4XSe tic Tank—Li uid ac>t ..:_...:. _gallons Length________________ Width._..__._____.... Diameter_ ______._._.•. Depth................
esi ow______.
x Qisposal Trench—No ............... Width...........,_.......... Total Length.................... Total leaching area...,:................sq. ft.
Seepage Pit No--------------_-__-_ Diameter ?.__.... Depth below inl t....... Total leaching area =: sq. ft.
Z -�`•� Other Distribution box ( ) Dosing tank ( ) ',t'r .�. ►"
Perco ation Test Results Performed by._•.__-___-_ X. -.. •-----••- Date..........��r.._
est Pit No. 1................minutes per inch De t i est Pit f.:..._..._.___ Depth to ou `� . '��
P P P grw2te
04 Test Pit No. 2................minutes per inch Depth of Test Pit..................... Depth to ground water........................
D Description of Soif-r......_ �f .._.-__-___ yC
..... . ^ .. K .. •_ _••
';• ,r 4. a
UY.. � . ...............
UNature of Repairs or Alterations—Answer when applicable..............................................................._..............................
- --•-----•------- ----•-- --------------
Agreement: � f
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with "yM
the provisions of TITL i� 5 of the State Sanitary Code—The undersigned further agrees not to plate the system in
operation until a Certificate of Compliance has been ed by board of health.
Signed ----- at t
Application Approved B Hate �.
........................ --
Application Disapproved for the following reasons:. ...........=------ .........................................................
..................••--•-••...........----•--•-•-••.---•••••--------••---•..........•-••-----•---•--•
Date
Permit No............ ,:.._..__: Issued ---- - --------------------•-••---
Date
'i4
THE COMMONWEALTH OF MASSACHUSETTS
BOARDJOF HEALTH
.............OF.... ..................
Trrtifiratr of fauntpliatta
THIS IS TO CERTIFY, That"the Individual Sewage Dispo 1 System c nstructed {; ) or Repaired. ( )
b" . ............ ;W. .............. ... .......... ............. ....
29
has been installed in accordance with the provision'' T " " ` of The State Sanitary Co s described in the
application for Disposal Works Construction Permi �' ....................... da.tede�z ":. ._7 ..._.__.__._..____._.
THE ISSUANCE.-OF THIS CERTIFICATE SHALL NOT BE'CONSTRU-ED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
s
DATE...........................••........-•••...... :r=.<eInspector............................................
THE COMMONWEALTH OF.-MASSACHUSETTS ^.
BOARD . HEALT
N0.................. .�:. F ...................
Disposal orkt-Tomitrurtion amit
Per iss�x+is hereby granted........... -• .---••--••-•-•--- ::----•. :.....
toat str t ? ) R ( n I vl a S wa isp ystem ,
\i
-/...................................................... _..__.. ...Fr............. ............4_•_ _ _• __ ....
Street
as shown on the application for Disposal Works Constructio rmit b . .`_�_.' ..... Dated..........................................
" 7 i
M � --
`°`
f j�^r.............................
DATE: ABoard of He
FORM 1255 HOBBS & WARREN. INC., PUBLISHERS - ' -
A
0 c S E E ARMIT NO..
Z-o
VILLAGE
0--e � Y Ll
INSTALLER'S NAME & ADDRESS
ch C'd �► �T 7
B U f'L D E R OR OWNER
DATE PERMIT ISSUED '�► .— 2— 7
DATE COMPLIANCE ISSUED
��
� ib
� �
4
1
u
NOTE w. I' CONTOURS ._.
i�
4\ - - - - - Y ..,
INSTALLER MAY MOVE VENT PIPE r-----�__ 53 52 EXISTING - - 5t7 0
TO A DIFFERENT LOCATION. I I ---- ------ 153.32 f t MINIMAL GRADING PROPOSED ROUTE 28
O i -- -- - FALMOUTH ROAD
h 52
52` 1 1 o OLO LOCUS ti
O 1 CENTERVILLE. MA
ll1l WATER m \ 1
O GATEQ� LOCUS MAP
NOT TO SCALE
�J O J �IO \ \ 1
1 W o �I2-P
\ m , LEGEND
55— M Q 1
l � � � -1 � 1000 GALLON
) _v 52 EXISTING
BENCH MARK / '4 P SEPTIC TANK
PAINT SPOT- ON 1 LEACHING GALLERY
CONCRETE STEP* / PA VED �RI 1 -SEE DETAIL ON REVERSE EXISTING LEACH
l ELEVATION = 55.31 VEW,�I y PIT/CESSPOOL O
O � ---�_ 20 t � O �
BARNSTABLE GIS DATUM TP-2 72-P 53
� 1 UTILITY POLE -�
— �/ 54
Iz-P a�0�I4-D 55 TEST PIT® D-
BOX ❑
O �
LOT 3 1 DECIDUOUS CONIFEROUS
*2-p 1 TREE oQo TREE
0 l AREA = 15004 s F +- �a� 0Qb 12-M *2-P
[� � a0 14 O I GARBAGE GRINDER -NUMBER REFERS TO DIAMETER IN
VARIANCE REQUESTED ��� VENT N 1 INCHES. LETTER DENOTES TYPE.
MAY BE GRANTED IMMEDIATELY BY HEALTH AGENT OR HEALTH INSPECTOR. --��—_��— a �I4 ° -PIPE 1 IS NOT ALLOWED O-OAK M-MAPLE P-PINE C-CEDAR
------ _-� WITH THIS DESIGN.
310 CMR 15.22117J - COMPONENT 154.00
DEPTH TO FINISH GRADE. 36 in
60 n OF itAOFN
MAX REQUIRED
OVER REQUESTED.- VARIANCE O o`'� jDAVID SSgcj1A OF � DAVID ss�cy�s
FLAN o� D. �� D.
SCALE: 1 in = 2� FL " COUGHANOWR COUGHANOWR
FLON PIRDFILE
ALL PIPE ELEVATIONS SPECIFIED ARE INVERT ELEVATIONS E No. 1093
O
EXPRESSED IN DECIMAL FEET NOT FEET AND INCHES tp l/
— 20 0 20 40 9Fcl TE �O O�� CENS� Q-
VENT S ,pt� EVA ,UP
TOP OF FOUNDATION RAISE COVERS TO WITHIN USE^SCH 40 PVC PIPE e 10 20
6 in OF FINAL GRADE .01 FLl f-MIN/ AT
/ EL =56.02 +- ,pte via be 1 ( Z, 2-09
55.00 SEWAGE DISPOSAL SYSTEM PLAN
D_13DX INSPECTION
��� TO SERVE EXISTING DWELLING
/ LLB, J` 5 PORT (ONE i
3" DROP I� MAX PER TRENCH) EST. KIRK FAMILY REALTY TRUST
FLOW LINL-- {1 OWNERS OF RECORD
50.44
I 14Iry d 87 OLD POST ROAD
48" GASH - - - ® 1995 �� CENTERVILLE. MA
BAFFLE 5121 6 in ----------------- - ------ ®���� PROPERTY ADDRESS
EXISTING STONE
BASE 50.18 BOTTOM OF ASSESSORS MAP 209 PARCEL 102
EXISTING 5035 LEACHING SOIL ABSORPTION 43 TRIANGLE CIRCLE
.
EXISTING SYSTEM SANDWICH MA 02563 PLAN BOOK 315 PAGE 21
1000 GALLON 5005 GALLERY
508 364-0894 DATE: SEPTEMBER 12, 2009
SEPTIC TANK 5.00 ft+ JOB #ETE-3229 PAGE 1 OF 2 A VERSION:
EXISTING 11 ft aI 5 ft -SEE DETAIL ON REVERSE THIS PLAN IS BASED ON AN INSTRUMENT SURVEY AND IS INTENDED
49.11 SOLELY FOR INSTALLATION OF THE PROPOSED SEPTIC SYSTEM
6I 11 ft 29.0 ADJUSTED DEPICTED HEREON. FOR ANY OTHER CHANGES TO PROPERTY INCLUDING
SEASONAL HIGH PLACEMENT OF ADDITIONS. SHEDS. FENCES OR SWIMMING POOLS. OWNER
GROUNDWATER SHOULD CONSULT WITH A MASSACHUSETTS REGISTERED LAND SURVEYOR.
I
A.
SOIL TEST LOG � . - 3 DESIGN CALCULATIONS
DATE OF TEST: SEPTEMBER 9.2009 DESIGN FLOW: 3 BEDROOMS X 110 GPD = 330 GPD
SOIL EVALUATOR: DAVID D. COUGHANOWR. R.S. SEPTIC TANK: 330 GPD X 2 DAYS = 660 GALLONS
WITNESSED BY: DONALD DESMARAIS. HEALTH DEPT. USE EXISTING 1000 GALLON SEPTIC TANK IF IN SOUND STRUCTURAL CONDITION.
PERC NUMBER: 12665 IF NOT. INSTALL 1500 GALLON SEPTIC TANK (MINIMUM ALLOWED)
NO GROUNDWATER ENCOUNTERED DISTRIBUTION BOX: USE 3 OUTLET D-BOX.
TEST PIT 1
PARENT MATERIAL: PROGLACIAL OUTWASH SOIL ABSORBTION SYSTEM: INSTALL 10 ADS HIGH CAPACITY BIODIFFUSERS (160OBD)
PERC AT 56 in - 2 MIN/INCH IN C SOILS
10 UNITS x 6.25 ft / UNIT = 62.50 L.F.
ELEVATION DEPTH SOIL USDA SOIL SOIL COLOR SOIL OTHER 62.50 L.F. x 7.90 S.F./L.F = 493.75 S.F.
(INCHES) HORIZON TEXTURE (MUNSELU MOTTLING 493.75 S.F x .74 G.P.D. / S.F. = 365.3 GPD
53.90 USE 10 HIGH CAPACITY BIODIFFUSERS AS CONFIGURED BELOW
0-6 Ap LOAM 10 YR 3/2 NONE FRIABLE — VL = 365.3 GPD > 330 GPD REOUIRED
6-36 B LOAMY SAND 10 YR 4/6 NONE FRIABLE REFER TO DEP APPROVAL LETTER TRANSMITTAL # W000052 FOR CERTIFICATION
50.90 36-138 C MEDIUM SAND 10 YR 5/4 NONE LOOSE OF ADANCED DRAINAGE SYSTEMS BIODIFFUSER SYSTEMS.
42.40
LEA CHING GALLERY NOT TO 1000 GALLON SEPTIC TAW
TEST PIT 2 NO GROUNDWATER ENCOUNTERED SCALE DIMENSIONS AND DETAIL NOT TO
PARENT MATERIAL: PROGLACIAL OUTWASH CONSTRUCTION DETAIL USE EXISTING H-10 UNIT SCALE
2 MIN/INCH IN C SOILS USE ADS HIGH CAPACITY BIODIFFUSERS 1#16003D1. GRAVELLESS
ELEVATION INSTALLATION - USE DEP APPROVED INSTALLATION PROCEDURES. SEPTIC TANK IS TO BE PUMPED DRY
DEPTH SOIL USDA SOIL SOIL COLOR SOIL OTHER AT TIME OF INSTALLATION AND IS TO
(INCHES) HORIZON TEXTURE (MUNSELU MOTTLING 31.25 f't , BE EXAMINED FOR STRUCTURAL
53.75 INTEGRITY. INSTALL NEW PVC OUTLET
0-6 Ap LOAM 10 YR 2/2 NONE FRIABLE TEE EQUIPPED WITH A GAS BAFFLE.
c�
6-36 B LOAMY SAND 10 YR 5/6 NONE FRIABLE O
50.75 �j N 1 1n
36-138 C MEDIUM SAND 10 YR 5/4 NONE LOOSE Ll TAPER
42.25 CD
(Ln D � o �o �
DISTRIBUTION BOX
G R O lJ N D W A T E R ADJUSTMENT DIMENSIONS AND DETAIL USE SHOREY 08-3 H-10 C �
EXISTING GROUNDWATER LEVEL 31.25 f t N L(�
BASED ON TOWN OF BARNSTABLE
i.., GIS DEPARTMENT RECORDS. i�
NOT TO 12 in 1�
• ', INDICATED GW 24.00 SCALE MIN _ CROSS SECTION VIEW s '��-61n
''INDEX WELL • MIW-29 —� A
ZONE D FROM c TANK C TO USE H—Z0 INLET OUTLET
f 'READING DATE AUG. 2009 O C
f i READING 8.7 Q
`0 a to R.9 TED UNITS COVER COVER
ADJUSTMENT, 5.0 O 16 11.3 in
ADJUSTED G W 29.0 6 in STONE BASE 1^ EFFECTIVE 3 IN DROP
. —�
L( DEPTH Il FLOW LINE
CROSS SECTION VIEW BUILDING DING
10 In la TO
5 In I• 34 In 12.83 FL) 66 in (5.66 F0 34 in 12.83 f tJ in D-BOX
48 in
LIQUID GAS
LEVEL BAFFLE
NOTES
1) INSTALLER TO OBTAIN DISPOSAL WORKS PERMIT BEFORE STARTING WORK. CROSS SECTION VIEW
2) SEPTIC TANK TO BE PUMPED DRY AT TIME OF SYSTEM REPAIR AND CHECKED
FOR STRUCTURAL INTEGRITY. INSTALL PVC OUTLET TEE FITTED WITH GAS BAFFLE.
3) ALL COMPONENTS INSTALLED SHALL MEET THE MINIMUM REQUIREMENTS
OF MASSACHUSETTS TITLE 5 SEPTIC CODE (310 CMR 15).
4) INSTALLER TO VERIFY LOCATIONS OF ALL UNDERGROUND UTILITIES SEWAGE DISPOSAL SYSTEM PLAN
BEFORE EXCAVATING FOR SYSTEM.
5) EXISTING LEACH PIT TO BE PUMPED, COLLAPSED. AND FILLED OR REMOVED. -TO SERVE EXISTING DWELLING
61 ECO—TECH ENVIRONMENTAL RECOMMENDS THE INSTALLATION OF LOW FLOW FIXTURES
AND APPLIANCES. AND BIANNUAL PUMPING OF THE SEPTIC TANK. KIRK FAMILY REALTY TRUST
7) SYSTEM IS NOT DESIGNED TO WITHSTAND VEHICULAR LOADING. DO NOT 67 OLD POST ROAD CENTERVILLE. MA
PARK OR DRIVE VEHICLES OVER SEPTIC SYSTEM. ECO-TECH ENVIRONMENTAL
6) SEPTIC TANKS SHALL BE INSTALLED LEVEL AND TRUE TO GRADE ON A LEVEL
STABLE BASE THAT HAS BEEN MECHANICALLY COMPACTED AND ON TO WHICH 43 TRIANGLE CIRCLE SANDWICH MA 02563
SIX INCHES OF CRUSHED STONE HAS BEEN PLACED TO MINIMIZE UNEVEN SETTLING.
ETE-3229 SEPTEMBER 12, 2009 2/2