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HomeMy WebLinkAbout0192 LINCOLN ROAD - Health 192 LINCOLN RD. HYANNIS A = 270 049 0 ° 0 ° I No. d _r FEECOMMONWEALTH Of MASSACHUSETTS C_ Board of Health, 1;yyU t--,'Cks MA. APPLICATION FOP, DISPOSAL SYSTEM CONSTRUCTION PERMIT Application for a Permit to Construct( ) Repair( ) UpgradX Abandon( ) - ❑Complete System ❑Individual Components Location L, vGpL,._7;, (Z_p Owner's Name Map/Parcel# Z-7 v — Address Lot# Telephone# Installer's Name fA 1[e vAAp Designer's Name Address Lt e Address Telephone# _ ` p^- �{r�. Telephone# i6'g Type of Building % ' Lot Size /J �'�--' sq.ft. Dwelling-No.of Bedrooms Garbage,grinder ( ) Other-Type of Building No.of persons Showers ( ),Cafeteria ( ) Other Fixtures Design Flow (min.required) © gpd Calculated design flow Design flow provided gpd Plan: Date J Number of sheets l Revision Date\ Title �r- S 4 L �' , flS -L Description of Soil(s) 5-,ee— Soil Evaluator Form No. Name of Soil Evaluator Cb V""�(. ate of Evaluation ©� DESCRIPTION OF REPAIRS OR ALTERATIONS '� ���`�� OF The undersigned agrees to install the above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and further agrees to not to pl a the system in operation until a Certificate of Compliance has been issued by the Board of Health. Signed Date -%-,• '� �' 3 :�'r!�"* - ,.- F ,"�`-'�r t`2'" i }�_ `�i' �'�1,� yV. -`�t.�-! t ,tom j '3 }:. r e x-' 7. - 'Bt TOWN OF BARNSTABLE LOCATION , L i n Go� Rom SEWAGE # VILLAGE j�y 0.{1h�s Tl��S'S ASSESSQ 'S MAP & LOT INSTALLER'S NAMi✓ & PHONE NO. ,ya- dY104 VA ct SEPTIC TANK CAPACITY LEACHING FACILITY: (type) 3 7re (size) 1$ r X c S PF I. NO. OF F BEDROOMS 3 j BUILDER OR OWNER PERIv1ITDATE L1 COMPLIANCE DATE: �� ',��\ ?. Separation Distance,Betweea tbe: Max murnAdjusted G:rotindvtaterTable to the Bottom ofI eacfiing`Facthty. water table Feet .. : Pnvate Water, ppl'y 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 ------------- 3S ._ o .._ _ . m o . o. i o I Np. � _ S / r y5►, i FEE �V t , ILI- C- A—- Board of Health, 6yyu t 'S'� L MA. m �T �T , APPLICATION FOP DISPOSAL SYSTEM CONSTRUCTION PERMIT Application for a Permit to Construct( Repair( ) UpgradX) Abandon( - ❑Complete System ❑Individual Components 3 Location OIL �. .�co(.,,� 2�D Owner's Name re _ Z Map/Parcel# "Z ']V -0 Address Lot# Telephone# Installer's Name t 'R .� Designer's Name G--bLt1't Address jt��lA Address Hod VCJ� - ( (L Telephone# _ �' p �{R t Telephone# Type of Building Ste'7 c Lot Size D ±sq.ft. Y DwellingNo.of Bedrooms - c- S Garbage grinder ( ) Other-Type of Building No.'of persons Showers ( ),Cafeteria ( ) Other Fixtures g P gp Design Flow (min.req red) ✓ gpd Calculated design/flow S Design flow provided d Plan: Date ! Number of sheets ( Revision Date Title p ' S C Ste—AC-° Description of Soil(s) Soil Evaluator Form No. Name of Soil Evaluator ����' -L��ate of Evaluation I I' f DESCRIPTION OF REPAIRS OR ALTERATIONS � � The undersigned agrees to install the above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and further agrees to not to place the system in operation until a Certificate of Compliance has been issued by the Board of Health. Signed 1 Y 1. lC � 4 Ct �c�1 a(0- ,.��A Date -K c ,3 01 aspA�ctions ✓�y�� - 2 3 ` fr i C M NW ¶ ¶' ,{` U FEE SETTS Board of Health, ���G'a�+�- MA. � CERTIFICATE Of COMPLIANCE Description of Work: ❑Individual Component(s) ❑Complete System tw, The undersigned hereby certify that the Sewage Disposal System; Constructed ( ),Repaired (t Upgraded ( ),Abandoned ( ) 'by: '� IY e �7'1 �5 at `�� L, nCC,� QC\ t�l�c"- c 5 "has been installed in accoi°dance.w of�th�the i-vxsc ns 310 CMR 15.00 (Title 5) and the approved design plans/as-built plans relating to application No. C!i " dated � �3, � r /. Approved Design Flow (gpd) Installer r` l,� l Designer: I Inspector: Date: B The issuance of this permit shall not be cons"ed as a guarantee that the system will function as designed. No. 000/4- / FEE COMMONWEALTH EALTH OF MA./SS/ACHUSETTS ✓'r Board of Health, MA. yam/ DISPOSAL SYSTEM CONSTRUCTION PERMIT Permission is hereby granted to; Construct( ) Repair( ade( ) Abandon( ) an individual sewage disposal system at / ? ��kC� dI pklo as described in the application for Disposal System Construction Permit No 2al , dated Provided: Construction shall be completed within three years of the date of th' it. All Valndiudoi- must be met. Form 1255 Rev.5/96 A.M.Sulkin Co.Boston,MA Date 2 3 W Board of Health r Appendix Q Page 1 No. _. One Commonwealth of Massachusetts Massachusetts Site Suitability Assessment fawn-cite Sewag,�� �n1 Pafomed,lay--. WiMmed By-- Now Canstauctiw ❑ Repair Office Review Published'Soil Survey Available: Nq ;ff Yes Year Published _ _ ._.. Publication Scale .......... _... Soil Map Unit ................... Drainage Class _...._.._ Soil Limitations SUMC181 Geologic Report Available:. No Yet ».❑ Year Published __. ._. Publication Scale .._ Geologic Material (Map Unit) Landform Flood insurance Rate Map: Above 500 year flood boundary No ❑ yes Within 500 year flood boundary No 0 . . Yes ❑ b1/Wn 100 year flood boundary NCO Yes 0 Wetland Area: • National Wetland Inventory Map lmap .unit) Wetlands Conservancy Program Map (map unit) Current Water Resource Conditions, (U GS): Month Range : Above Normal Normal ❑ Below Normal ❑ Other References Reviewed: • .__---.� . _ __ _ _ _ _ .__........ 77de S.- Drqft Printed September 22, 1993 Appendix 4 Page 2 On-si& Re Deep Hole Number ........ Date:... 44t .... ..Time:..... ........... Weather .... .. Location (identify o%snie plan) ...........................................- ............................................................................................................................. Land Use...................... ................ slope M 0-7:3 Surface Stories ............PiD ................................................................. Vegetation Position on landscape (sketch on the back) ....................................................... ........................................................................... Distances from: Open Water Body....2,60.. feet Drainageway, fm Possible Wet Area feet Propwtv Line .......ZiL feet Drinking Water Well feet Other DF" OBMRVATION HOIX LOG D%wh frant surface Sail Marian: $a Town" $a clot ad ma"Mm" Otlre onatlaw ItJSOJU tsaerca h.stonew.scumem. L5 l y,e L it ,is tr 1216 Parent Material (geologic) Depth to Bedrock. Death to Groundwater: Standing Water In the Hole: D Weeping from Pit Face: Estimated Seasonal High Ground Water: NOTICE: This Form Is To Be Used For the Repair Of Failed Septic Systems Only. PERCOLATION TEST AND SOIL EVALU ATION EXEMPTION FORM - hereby certify that the engineered plan signed by me dated 6 concerning the property located at l meets all of the following criteria: • This failed system is connected to a residential dwelling only. There are no commercial or business uses associated with the dwelling. • The soil is classified as.CLASS I and the percolation rate is less than or equal to 5 minutes per inch. The applicant may use historical data to conclude this fact or may conduct preliminary tests at the site without a health agent present. • There is no increase in flow and/or change in use proposed • There are no variances requested or needed. • The bottom of the proposed leaching facility will not be located less than fourteen (14) feet above the maximum adjusted groundwater table elevation. [Adjust the groundwater table using the Frimptor method when applicable] Please complete the following: A) Top of Ground Surface Elevation (using GIS information) `7 B) G.W. Elevation 2� + adjustment-for high G.W. 3 T . DIFFERENCE BETWEEN A and B SIGNED idt DATE: �— NOTICE Bused upon the above information, a repair peririit will be issued for bedrooms maximum. No additional bedrooms are authorized in the future without engineered septic system plans. q:health folder:percexmp - - FORM 11 - SUIL EVALUATOR FOI Page 3 t Location Address or Lot No. Detenninatioll ,for Seasonal Him Water Table Method Used: ti EJ Depth observers :standing, obseavatlon h-ote--- -.-.-- inches F1 Depth weepang ..€rorn Vie:o€tibservatiNon hale........ inches 1 nth to sof,,awtts clams Ground water adjustment._ feet: Index Well Number .................. Reading Date .................. Index.well level ......... . .. Adjustment factor .................. Adjusted ground water level ......................................... .._.:.... Deoth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervious material exist observed throughout the area proposed for the soil absorption system? if not, what is the depth of naturally occurring pervious material? Certification I certify That on - (slate] °I have passed the soil evaluator examinati+ approved b the.Qepa #of Envir. :on +exvtal Protee<t n:a that-the above analy., was performed by—fne c siste a rle Araining, expertise and experien described in 3VD 15.Qt7_ Signature. _ Date flt3°.�IPPRo'\QED�o3Z� -1?tG::53 . r TOP OF FND ELEVATION = 100 LIBSER VA TIE7N TEST PITS TP 1 TP TP CAST IRON ELEV= 99.5 ELEV= ELEV= COVER TO GRADE FIN, GRADE EL, FG GRADE AT 2 % MIN, MIN. OF FIRST 2 FEET MX100'0 51.0 LS 3' MIN 3' MIN OF OUTLET PIPES TO BE 4" A 10YR3/1 LEVEL 1/8' TO 3/8' WASHED 12' MIN 3' 6' 6' 3 12' MIN, 18" LS B 10YR5/6 4- PVC SCH.40 97.25 STONE 4" PVC SCH.40 s� 97.33 _[.2, s" INV= 97.5 IINV= 6" o,�o�o�o�o�o"o�o"o 0 0�0 0�0�0�0 2' S= 29 14_ TEE S= 29 100(a v o`-� - �--zz-zt -v - 4' 9 6.83 INV- 10' TEE - 6" �. -°�°�°57�O�o�d�o�o�d� 00000a00000°°00000Q00000Qa°°ooa 4' 120" SAND C 5Y5/3 INV,= INV.- ' TO 1-1/2 WASHED STONE °o°o°o°o°o°o°o°o°o°o°o°o°o°o° 97.8 4' LIQUID 1500 GAL. 97. 17 97.0 v v v v v Q v v c� 6" 000000°0000Q000000000O°0°O°°a°O00 6 (1-o-o-o" INV,= 0 0 0 0 0 0 0 0- o 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 DEPTH SEPTIC TANK GAS /� �°o° °o°o° d°0°0°°°0°0°0-0-0- BAFFLE ° ° °0 O O O O O O LEVEL STABLE DISTRIBUTI❑N 96.95 0 0 0 0 0 0 96,33 . o a o o c 6 CRUSHE' OF 25' 18, PERC. TEST PERC, TEST PERC. TEST o_ _o_o BASEL o @---3--FT. @-------FT. @-------FT, SEPTIC- TANK �0000a000c ;D STONE NTS L.L{'ACHING FIELD 6.83 TYPICAL --2--MIN/IN ____MIN/IN ____MIN/IN 'o°a°o°o°c W/BAFFLE OPTIONAL NTS WATER ELEV— LEACHINC FIL�'LD CROSS SECTION WATER EL= WATER EL WATER EL= NTS a_o n _ 89.5(DES "N NONE ) NTS ---------- ---------- ALL STONE TO BE DOUBLE WASHED ---------- PROFILE OF L'E'A CHI.NC FIELD' SE'WA CF DISPOSAL SYSTEM . SNIL TEST PITS AND PERC, TEST PER�BRMED B Y NTS LEGEND BILL GOTTWALD DATE 08117101 EXISTING ELEVATINN 248 0 PRDPDSED ELEVATINN x 248.0 EXISTING CDNTDUR ---248--- T YPE DF BUILDING EXIST 3 BDRM HOUSE PRDPDSED CONTOUR DESIGN FLOW SDIL. TEST PIT 3 x 1 10 ' GPDIBDRM 330 GPD RESERVE AREA SEPTIC TANK GENERAL NOTES: 150% DF DESIGN FL D W 330 x 1,50= 495 GALL DNS USE 1500 GALLE7N SEPTIC TANK T. THE SEPTIC TANK SHALL BE 1500 GALLONS MINIMUM, UNLESS OTHERWISE SPECIFIED ON THIS DESIGN PLAN, AND FITTED WITH SCHEDULE 40 PVC TEES OF PROPER LENGTH SEPTIC TANK CONSTRUCTION SHALL CONFORM TO 310 .CMR 15.226. THE SEPTIC TANK GARBAGE GRINDERS OUTLET COVER SHALL BE BUILT UP TO WITHIN 6" OF THE FINISHED GRADE UNLESS OTHERWISE SPECIFIED.. NOT ALLOWED! 2. SEPTIC TANK ANF DISTRIBUTION BOX SHALL BE PLACED ON A 6" MINIMUM COMPACTED GRAVEL BASE. LEACHING FIELD 3• ALL JOINTS MUST BE WATERTIGHT, SEALED WITH SUITABLE CEMENT FOR THAT SPECIFIC COMPONENT. DESIGN PERCOLATI❑N RATE = 5 MIN/IN 4. SOIL PREPERATION FOR THE LEACHING AREA SHALL CONFORM TO 310CMR 15.246 & 15.247 SOIL CLASS „-__ -____ 5, ANY EXCAVATION OF UNSUITABLE MATERIAL DESIGNATED ON THE PLAN SHALL CONFORM O TO CONSTRUCTION IN FILL REQUIREMENTS AS OUTLINED IN 310CMR 15.255 1-6 O Q EFFLUENT L❑ADING RATE =_`_0.74----GPD/SF \ 6o' 6, FILL MATERIAL FOR SYSTEMS CONSTRUCTED 1N. FILL SHALL BE COMPRISED OF CLEAN 330 GAL/DAY = 0.74 GPD/S F - 446 SF' ❑F LEACHING AREA GRANULAR SAND, FREE FROM ORGANIC MATTER AND DELETERIOUS SUBSTANCES. GRANULAR SAND, FREE FROM ORGANIC MATTER AND DELETERIOUS SUBSTANCES. PROPOSED AGGREGATE SPECIFICATIONS SHALL, CONFORM TO 310 CMR 15.247. FIELD —_,— FT, WIDE X _ 25.-- FT, LDN'G 18'x 25' LEACH FIELD 17 25 i q a 24 HOUR NOTICE REQUIRED FOR INSTRUCTIONS wIJ LEACH'LINES , ANY ALTER DONS MUST BE REPORTED TO THE DESIGN ENGINEER PRIOR TO -- _ _ea. 24' LONG, I � I y - .PROCEEDING WITH CONSTRUCTION. TOTAL = _ 450 - SF _ ALL SCf l 40 PVC T'� 1 T SHALL BE RUN OVER THE ONE R CHIN NO HEAVY EQUIPMENT COMPONENTS 0 LEACHING BED, DURING USE 18'x 25,. FIELD ® r. I 7. CONSTRUCTION. --- PROPOSED 1ST 1500 GAL \ SHEIDE'NCHMARK. 8• DEEP TEST HOLE INFORMATION INDICATES SOIL CONDITION, PERCOLATION RATE AND WATER TABLE ELEVATION AT THE TIME AND LOCATION OF ACTUAL TESTING ONLY. IF SEPTIC TANK TOP OF "CONC. BLOCK UNSUITABLE MATERIAL OR A HIGHER GROUNDWATER ELEVATION IS ENCOUNTERED, THE " BOARD OF HEALTH AND DESIGN ENGINEER SHALL BE NOTIFIED. T❑TAC LEACHING AREA PR❑.VIDEO,. 450 : o � 0 24K � ' �� � BULKHEAD ENTRANCE. o _ oo EL.- 100.00 (ASSUMED) BARNSTABLE 446 EXIST CESSPOOL o 9. AREAS DISTURBED DURING CONSTRUCTION SHALL BE STABILIZED TO HELP PREVENT MINIMUM REQUIREMENTS PER B❑A R D ❑F- HEALTH = S�F, E BE PUMPED j EROSION. THE AREA OVER THE SYSTEM SHALL BE GRADED TO A MINIMUM OF 2% 450 446 CRUSHED & BACKFILLED Zq SLOPE, TO PROVIDE POSITIVE SURFACE DRAINAGE. S,F,� S.F 10, NO STRUCTURE MAY BE CONSTRUCTED OVER THE RESERVE AREA. OIL 11. THE SYSTEM SHALL BE VENTED IF THE TRENCH LENGTH EXCEEDS 50' OR IF IT IS Y COVERED BY IMPERVIOUS SURFACE. ALL PUMPED SYSTEMS ARE TO BE VENTED. oc DESIGN EXISTING 12, IF ANY COMPONENTS OF THE PROPOSED SYSTEM ARE SPECIFIED AS HEAVY DUTY, ELEVATINN SCHEDULE 26 HOUSE THOSE COMPONENTS SHALL CONFORM TO ALL STATE AND LOCAL REQUIREMENTS FOR ELEVATINN AASHTO H-20 LOADING. TDP DF F17UNDATIDN 100 , O # 1 92 13• THE SYSTEM MUST BE INSPECTED BY THE BOARD OF HEALTH AND THE DESIGN FINISHED BASEMENT FLDDR ENGINEER, PRIOR TO BACKFILLING. 14• UNLESS SPECIFIED IN THE BASIS OF SANITARY DESIGN, THIS SYSTEM IS NOT FINISHED GARAGE FL DDR DESIGNED FOR THE USE OF A GARBAGE GRINDER OR OTHER HIGH WATER USAGE DEVICE SEWER INVERT AT FDUNDATIDN 15. 1F THE D—BOX IS DOSED OR THE INLET SLOPE EXCEEDS 8%, AN INLET TEE OR SEWER INVERT INTD SEPTIC TANK 82��+s� BAFFEL IS REQUIRED. 16. ALL CONSTRUCTION SHALL CONFORM TO 310 CMR 15.00, TITLE V AND THE SEWER INVERT Q U T ❑F SEPTIC TANK 1) , 2� � - REGULATIONS OF THE LOCAL BOARD OF HEALTH. SEWER INVERT INTD DIST, BDX q - _ SEWER. INVERT DUT DF DIST, BDX D 99 — — —� 17. IT IS.THE CONTRACTORS RESPONSIBILITY TO SECURE ALL NECESSARY PERMITS PRIOR " \ TO ANY SITE ACTIVITY. A STAMPED COPY OF THE APPROVED PLAN SHALL BE KEPT SEWER INVERT INTD LEACHING FIELD `l - — ON-SITE. ELEVATION. DF GROUND WATER TABLE �'� "7� r C +V W I 18. ANY EXISTING UTILITIES SHOWN ARE APPROXIMATE ONLY, CONTRACTOR TO VERIFY 60 PRIOR TO EXCAVATION. i 19. ALL KNOWN PUBLIC AND PRIVATE WELLS PER 310 CMR 15.220(k) ARE SHOWN. 20• CONSERVATION COMMISSION APPROVAL MAY BE REQUIRED. T l�Tl-+O�1�T ROAD 21• FOR OPTIMUM PERFORMANCE, THE SEPTIC TANK SHOULD BE INSPECTED ANNUALLY AND 11 V l� 1 V lti WHEN THE SOLIDS AND SCUM DEPTH EXCEEDS 1/3 OF THE LIQUID DEPTH, THE TANK '� �t LOCUS SHOULD BE PUMPED. REPAIR UNCOLN ST oLANDER tNa= ON—SITE SEWAGE DISPOSAL SYSTEM Goy LD 192 LINCOLN ROAD � Q CML 32e HYANNIS`, MASSACHUSETTS PREPARED F❑RI MICHAEL MORESHEAD E0 Ul410 .� .A SCALE; 1'=20' DATE+ o8 20 o1 DM DMG ASSOCIATES 40 THOMAS RD. BERKLEY, MA (508) 828'-9591 >,v.