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HomeMy WebLinkAbout0028 MARK'S PATH - Health 28 MARK'S PATH, HYANNIS IN A= 271094.004 i i i f T OF BARNSTABLE LOCATION ( SEWAGE# . ' VILLAGE I ASSESSOR'S MAP&PARCEL J-7 - 01Y-ovy INSTALLER'S AME&PHONE NO. S®��yqy SEPTIC.TANK CAPACITY - Q "LEACHING FACILITY:(type) (size) NO.OF BEDROOMS OWNER , PERMIT DATE: COMPLIANCE DATE: ioIt gho Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet FURNISHED BY s l V� I F �s \ v No. v(o 3 ` Fee 11 o THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS Yes ZIPPYication for Nsposal 6pstem Construction permit Application for a Permit to Construct( ) Repair(A<Upgrade( ) Abandon( ) ❑Complete System ndividual Components Location Address or LotNo21 rl-iarKs .1h tt v„ni5 Op�r�,n+Add an-r T el0N0o.sod Assessor's Map/Parcel 901 y- "' P-0- Gek aSy(. Installer's Name,Address,and Tel.No. Rfe•'77/- Designer's Name,Address,and Tel.No. _'5Z2r6, 3o,;t _J/SY/ ,13orWo4i 1C6nSh- C,4-iCn,-1P1C iiutn�/1 %n�Cisnf 4S-�-rJ rs('sns i k -OX- 3? *,�,,V, rAZLI h ✓4A- Type of Building: Dwelling No.of Bedrooms 3 Lot Size �� U sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 330 gpd Design flow provided r gpd Plan Date kiin ra'?o, 'l0 Number of sheets Revision Date Title ¢+e b -s rye /" ,09 I"�L%kart 5 Size of Septic Tank 0 ;0 f Type of S.A.S. v2 - Ji 00 4jB&d_, Description of Soil Nature of Repairs or Alterations(Answer when applicable) o y s'-j_ C1 ZIS 0-4 JLA,M44 Cam,VA cea. 3v L XX"aullfij Date last inspected: Agreement: The undersigned agrees to ensure the construction and mai enance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environme Co and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Healt . Si Date Application Approved by P— 11P eu Date o Application Disapproved by Date for the following reasons Permit No. )-Q/o ����(! Date Issued 3° No. o l V Fee QU THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: `> = Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS E ;�'�pIication for Dis�oiif*strm Construction J)Prmit I Application for a Permit to Construct( ) Repair(A<Upgrade( ) Abandon( ) ❑Complete System ndividual Components y Location Address or Lot No�,? �� K�c �� Ova is Name,Address,and Tel.No.SZ6- ??V �s$S' tJfu7t9�S ? (.JI C� i'�i'GJ 1Q `Z.'�►1CY> Assessor's Map/Parcel 901 Vic,/„ P v. /3aX AS`yt. IVA oa(. / Installer's Name,Address,and Tel.No. �•77/. Designer's Name,Address,and Tel.No. 13ori-lo4i �br�5f-t-t.:�4-ion,I,-�c i 4�Gw1I 62-pe &-�.n�s'./��' `f S -!r r �r i r/ . /b P�r Fo 5 ell;11 , l . 0X 3 1�J�c r' �/• i rfi-&,I-A ✓Lt Cz Type of Building: I r° t Dwelling No.of Bedrooms 3 Lot Size '+s 4 U sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 330 gpd Design flow provided RR46 gpd Plan Date �,1�(„�v, ���10 Number of sheets Revision Date Title '�/to S I e Pki o.o �t'% /f rKS Size of Septic Tank JOQnga 14,11) Type of S.A.S. a - �GC gr� � tj:E>Ad.� Description of Soil I 1 Nature of Repairs or Alterations(Answer when applicable) —Dc, -JU A-M W ('Q, `u4.L -Z U 'L 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 Environme tal-Cod2,d not to place the system in operation untila Certificate of- Compliance has been issued by this Board of Healt . Sig A Date ?d/(Q f Application Approved by t/L- Date o Application Disapproved by e1v Date for the following reasons Permit No. of u - �C10 Date Issued 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 (�v�c��r ��',rK40uCkCA'1,•-,C at -, / cAks P,+A J4r 4f, ,,7A,,;s has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. . a/d 3�8 dated T (u } Installer Designer #beliooms: Approved d�esiyflow > a gpd The issuance of this pe it hall not be construed as a guarantee that the system willdesig ed. Date f 1 ) - Inspector . No. 20(u Fee od THE COMMONWEALTH OF MASSACHUSETTS PUBLIC-HEALTH DIVISION -BARNSTABLE,MASSACHUSETTS Disposal bpstem Construction Vermit Permission is hereby granted to Construct( ) Repair Upgrade( ) Abandon( ) System located at � r M /C�s 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:Constr ctionJ must be completed within three years of the date of this permit. ( \ p Date ��b//a Approved by t /�^' K.-r t ' OCT-22-2010 08:12 From:BORTDLOTTI CDNST 50842B9399 To:15087906304 P.1/1 FROM :down cape engineering inc FAX NO. :150 629880 Oct. 21 2010 02!WM P1 ag w • � W49ABTAgr,�, � 1.101mas McKamm,Director 26010vlm !Ata"t,XrY11 n6,AU 0266L Fcw ��9"�ll��gt€r.�a.�...rx•�:e���a:_�n�ne�aT.l��rra�n Date. '�1 I� r�n�;a Pe�no�ad# ��0 c f��A�y�AAaFA'`8 1VJ174�3I i4!'44�i ��� —6 ( —00� T�e,t+mer: r�i,Jn cue 010. ;arc: wrya ism rd A pew it to insUL11 u ��r��llcQ�) ..^� septic sygtern.at `��' 1 l Gt�✓� /"Q,� „,�I��.sact nn a drsigu cl.aw�x by {MMOSU) Id LY_ ,i'tintcd l a o-ify that the .1coc 03-rrM xa orkawed above waa instilled EnWsatinlly srnotdiug to "l7r cicail+,a,Which may smclurtc':u=ur approved c;la�q�;es Pw.bL as 1n,Ct al relocatiuu u tPic dibtnbutiou box anNor sNlic led i lc. Xyf�r /`�v✓� n o ,-�,k .r/ r/•. ,. vo , ��,l T L& ily [tat Oia wp(ic wy4Wrri refere�rceri (010c WAS inatallcd 'WilllJ Tvgjor cshangm (1.0, ma.m tban 10'ltxteral ralr mfi'mi of W,,;11,S OT auy vedical reluouaon of My cnmp011 au Of thc $Cp is 9yatcm) prat in 04cor(jarirc with State&T'u;al Rugulubwng- ).,Jnr►'reviAiar err Cowl- nilt by desiGau to foLow. DANikLA. .- - IV OJAI A -z (hiss. ti4�°si�llA.hJit! �' civil. VD.46502 g t o(s i ls-010 cugtcox's Sigaasfn- �'V (!��f(a.,�TV@1,ucr's"St';ijuP HurM1) Af NA�i)F 3.MR1 T(s j3�A R�' i,[ PY7�T.TC' i7a'Az�l4� _,�b,���;agD�I. C i��PtN 4�rtTtt tD41 t•,i 14B'f�T,,T.�l�i"RC wrLL NGT at 78, .4!Q'fH THTS FORNN. AND A8-WTgZ.:,' <:t'<Atl') Aar, Rif'YCiV T�BY'1 1C9]11 �1 :Al3L�PlnFiT�t4:190?'AL11�1,�31VJ l�TV HANICY011, ` �'ficyltlt/�cpTlaA.r�t'I�rx C;cnN�^�1aon D'rxm r;,L•U4 dor - Sep 3010 01:50p MBM AUTO SALESS 508-775-2277 p.1 Tt 461'4-,�' ;7 7 91�1 Albl 1 n.f N `i r� BORTOLOTTI CONSTRUCTION, INC. 765 WAKEBY ROAD,MARSTONS MILLS,MA 02648 508-771-9399 508428-8926 FAX: 509 428-9399 6 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION Property Address: I V Date of Inspection: r7 Inspect is Na e: ees Name and Address: NA o - CERTIFICATION STATCMFNT• I certify that have personally inspected the sewage disposal system at this address and that the informa- tion reported below is true,accurate and complete as of the time of inspection.The inspection was per- formed based on my training and experience in the proper function and maintenance of on-site sewage disposal stems. The System: PassesA Conditionally Passes Needs Further Ev lion y Local Aproving Authority Fails Inspector's Signature: Date: �0 The System Inspector shall submit a copy of this inspection report to the Approving authority within thin- ty,(30)days,of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpdor greater, the inspector and the system owner shall submit the report to the appropriate regional office of the, of Environmental Protection. The original should be sent to the system owner and copies sent to the buyer, if applicable and the approving authority. QiSPECTION TMMARY• AYPYS PASSES: I have not found any information which indicates that the system violates any of the failure criteria as defined in 310 CMR 15.303. Any failure criteria not evaluated are indicated `1 below. ti B)SYSTE CONDITIONALLY PASSES; One or more system components need to be replaced or repaired. The system,upon comple- tion of the replacement or repair, passes inspection. Indicate yesj nor„or not determined(Y,N,OR ND). Describe basis of determination in all instances. If "not determined",explain why not. The septic tank is metal,cracked,structurally unsound,shows substantial infiltration or 'enfiltration,outank failure is imminent. The system will pass inspection if the existing sep- tic tank is replaced with a conforming septic tank as approved by The Board of Health. Sewage t:u high static water.level observed in the distribution box is due to brokobstructed pipes)or due to a broken,settled or uneven distribution box. The ;,system will pass inspection if(with approval of The Board of Health): ' - 1 - , SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Broken pipe(s)replaced Obstruction is removed Distribution Box is levelled or replaced The System required pumping more than four times a year due to broken or obstructed pipe(s). .The system will pass inspection if(with approval of The Board of Health): Broken pipe(s)are replaced Obstruction is removed C)FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: Conditions exist which require further evaluation by The Board of Health in order to determine if the system is failing to protect the public health,safety and the environment. 1)SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: Cesspool or privy is within 50 Feet of a surface water Cesspool or privy is within 50 Feet of a bordering vegetated wetland or a salt marsh. 2)SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH (AND PUBLIC WATER. SUPPLIER,IF APPROPRIATE)DETERMINES THAT,THE SYSTEM IS FUNCTION- ING IN A MANNER THAT PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT:'. The system has a septic tank and soil absorption system and is within 100 Feet to a surface water supply or tributary to a surface water supply. The system has a septic tank and soil absorption system and is with a Zone I of a public water supply well. The system has a septic tank and soil absorption system and is within 50 Feet of a private T water supply 1 well. The system has a septic tank and soil absorption system and is less than 100 Feet but 50 Feet or more from a private water supply well,unlegs a well water analysis for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from the facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm. D)SYSTEM FAILS: I have determined that the system violates one or more of the following failure criteria as defirlod in 310 CAM 15.303. The basis for thus determination is identified below. The Board of Health should be contacted to determine what will be necessary to correct the failure. Backup of sewage into facility or system component due to an overloaded or clogged SAS or cesspool. Discharge or ponding of efluent to the surface of the ground or surface waters due to an ` overloaded or clogged SAS or cesspool. Static liquid level in the distribution box above outlet invert due to an overloaded or clog- ged SAS or cesspool. depth Liquid d th in cesspool is less than 6 below invert or available volume is less than 1/2 q day flow. Required pumping more than 4 times in the last year hM due to clogged or obstructed pipe(s). Number of times pumped i -2- .1 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continucd)' Any portion of the Soil Absorption System,cesspool or privy is below the high groundwater elevation. Any portion of a cesspool or privy is within 100 Feet of a surface water supply or tributary to a surface water supply. Any portion of a cesspool or privy is within a Zone I of a public well. Any portion of a cesspool or privy is within 50 Feet of a private water supply well. Any portion of a psspool or privy is less than 100 Feet but greater than 50 Feet from a private water supply well with no acceptable water quality analysis. If the well has been analyzed to be acceptable,attach copy of well water analysis for coliform bacteria,volatile organic compounds,ammonia nitrogen and nitrate nitrogen. E)LARGE SYSTEM FAE S: The following criteria apply to a large system in addition to the criteria above: The design flow,of a system is 10,000 gpd or greater(Large System)and the system is a significant threat to public health and safety and the environment because one or more of the following conditions exist: The system is withirf400 Feet of a surface drinkingwater supply The system is within 200 Feet of a tributary to a surface drinking water supply The system is located in a nitrogen sensitive area Interim Wellhead Protection Area (IWPA)or a mapped Zone 11 of a public water supply well.­ The '. .The owner or operator of,any such system shall bring the system and facility into full compliance with the groundwater treatment program requirements of 314 CMR 5.00 and 6.00. Please consult the local regional office of the Department for further information. •r SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B v CHECKLIST ' Check if the following have been done: L-�Pumping information was requested of the owner,occupant,and Boaid of Health. `None of the system components have been pumped for atleast two weeks and the system has ;,been receiving normal flow rates during that period. Large volumes of water have not been introduced into the system recently or as part of this inspection., _Ae�_As-built plans have been obtained and examined. Note if they are not available with N/A. e facility or dwelling was inspected for signs of sewage back-up. The system does not receive non-sanitary or industrial waste flow. The site was,inspected for signs of breakout. ; All system components,excluding the Soil Absorption System,have been located on site. _ The septic tank manholes were uncovered,opened,and the interior of the septic tank was in- spected for condition of baffles-or tees,material of construction,dimensions,depth of liquid, ydepth of sludge,depth of scum. The size and location of the Soil Absorption System on the site has been determined based on existing information or approximated by non-intrusive methods. 3- b SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST(continued) X� facility owner(and occupants,if different from owner)were provided with information on the proper maintenance of Subsurface Disposal System SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION FLOW CONDITIONS RESIDENTIAL! FI�:,a,A_gallons Number of Bedrooms: Nu r of Current Residents: Garbage Grinder:_ Laundry Connected To System:, Seasonal Use: r) Water Meter Readings,if a ailable: Last Date.of Occupancy: IN Type of Establishment: da• Gr ease Trap Present: es or no) Design Flow:�_gallons/ y p (y n Indlstrial Waste Holding Tank Present: Non-Sanitary Waste Discharged To The Title V System: Water Meter Readings,If Available: Last Date of Occupancy: OTHER: Describe) Last Date of Occupancy; GENE INFORMATION iUMPING RECORDS and source of information: ` System Pumped as part of inspection:A&_ if yes,volu pumped: gallons Reason for pumping: - TW&OF SYSTEM: Septic Tank/DistributionBox/Soil Absorption System Single Cesspool Overflow Cesspool Privy Shared System(If yes,attach previous inspection records,if any) Other(explain): ROXIMATE AGE of all components,d-apa installed(if known)and source of information: Sew ge odors detected when arriving at the site: _ -4- i SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C GENERAL INFORMATION (continued) SEPTIC TANK: Depth below grade: Material of Constriction: concrete metal FRP Other (explain) I — Dimisions:�. Sludge Depth: Scum Thickness: Distance from top of sludge to bottom of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: y Comments,(recommendation for pumping,condition of inlet and outlet tees or baffles,depth of liquid level in relation to outlet invert,structural integrit ,evidence of leakage etc. ,(o Il alpp ,4� OIX � it GREASE TRAP: T{tJ Depth Below Grade- Material of Construction: concrete metal FRP Other (explain) — — — — Dimensions: Scum Thickness: ` Distance from top of scum to top of outlet tee or baffle: ".comments:;(recommendation for pumping,condition of inlet and outlet tees or baffles,depth of liquid level In relation to outlet invert,structural integrity,"evidence-or leakage. etc.) TIGHT OR HOLDING TANK: A),,) Depth Below Grade: Material of Construction:_concrete—metal—FRP—Other(explain) Dimensions: Capacity: gallons Design Flow: gallons/day . Alarm Level: Cgptments:'(condition of inlet tee, condition of alarm and float switches. etc.) DIfSTkMUTION BOX: Depth of liquid level above outlet invert: Comments: (note if 1 1 an distr'butio►is equal,evidei e f solids carryover,evidence of eakage to or out of box,etc.) PUMP CHAMBER- Pump is in working order: Comments: (note condition of pump chamber,condition of pumps and appurtenances,etc.) -5- I ; SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) SOEL ABSORPTION SYSTEM(SAS): 1,�' (Locate on site plan,if possible;excavation not required,but may be approximated by non-intrusive methods) If not determined to be present,explain: 1 Type: Leaching pits,number: I Leaching chambers, number: Leaching galleries,number: Leaching trenches,number,length: Leaching fields,number,dimensions: Overflow cesspool,number: Comm nts:(note condition of soi ,signs of hydrauli failure 1 vel,of pond' j wndition of vegetation, �/ 1/ r I CESSPOOLS: w Number and configuration: Depth-top of liquid to inlet invert: Depth of solids layer: Depth of scum layer: Dimensions of Cesspool: Materials of construction: Indication of groundwater.. , Inflow(cesspool must be pumped as part of inspection) Comments:(note condition of soilk,signs of hydraulic failure, level of ponding,condition of vegetation, etc.) PRIVY: Materials of construction: Dimensions: Depth of Solids: Comments: (note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetadQn, etc.)", -6- i r SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) SKETCH.OF SEWAGE DISPOSAL SYSTEM: Include ties to atleast two permanent references, landmarks or benchmarks. Locate all wells within 100 Feet. A � ; h 1 1 ' DEPTH TO GROUNDWATER: Depth to groundwater: Feet Meth�t of Detbrmina n or Ap roxi lion: v -7- LOCATION a SEWAGE PERMIT . NO. Bar i1 q"? VILLAGE f� INSTA LLER'S NAME i ADDRESS e U Il D E R OR OWNER O - ieA ns DATE PERMIT ISSUED 2fj DATE COMPLIANCE ISSUED z � gs w 0 a � r TA 0 /� LOCAT ION SEWAGE PERMIT NO VILLAGE INSTA LLER'S NAME & ADDRESS BUILDER OR OWNER DATE PERMIT. ISSUED 77 DATE COMPLIANCE ISSUED �\ `, ` �� �� � L No......s`:I THE COMMONWEALTH OF MASSACHUSETTS �. BOAR® OF HEALTH lf7Ga� _................OF... e—E...--..................... Allphraftan for Uiopoo l Workii Tnntrnrflon Urrmit Application is hereby made for a Permit to Construct (4) or Repair ( ) an Individual Sewage Disposal System at: ....1�f' .......? .�? -------------------------------- ......................................__' ......... - ..................................... -Address or Lot No. lo, Z_`-A ------------------------------- -.----------.--------•-----•-•-•--•----------- O n ----------••......•.............Address- Installer Address f Q Type of Building Size Lot_.f_•.............._._....Sq. feet U Dwelling—No. of Bedrooms............ ._...Expansion Attic ( ) Garbage Grinder Wo aOther—Type of Building ............................ No. of persons___-_____-_____-_.._-___-_-- Showers ( ) — Cafeteria ( ) f-4 Other fixtures .----------••......•-•-••......• • . - W Design Flow.............�4_.....................gallons per person per day. Total daily flow________.-730 .................gallons. WSeptic Tank—Liquid capacity_?®ategallons Length__ ". Width.4.'15?-_ Diameter________________ Depth.. `¢�.`. x Disposal Trench—No..................... Width.................... Total Length.....................Total leaching area....................sq. ft. Seepage Pit No--------- .......... Diameter.__....L------------ Depth below inlet_4o47...._. Total leaching area...44FX....sq. ft. Z Other Distribution box ( ) Dosing tank ( ) '-' Percolation Test Results Performed by---474P a. �!'` __.�� s� 9i Date...-. �':' `� ,aa Test Pit No. 1....�.......minutes per inch Depth of Test Pit.....zlz.�...... Depth to ground water---_f.�®!v '._._. PLI Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water_-______-__-___..-_-___. -----------------------=----------------•----------•------•-----•-----------•-............---................................................................ Description of Soil...?•• -'�4c�•3%Y►••...A.....Z Si P-i Fi t�-:'�......`-�--....... �gc` V ©X- •� ----.........D>...M__e-L...✓... G..................................... ....... W ------------------------•----------•-------------_----------------------•-----•-•--•----------•------------------•-----------------------------•---------•-----•----•---•----- g •••.RWER U Nature of Repairs or Alterations—Answer when applicable..........................................................................& PAUL t $� TMC"f�ifwicz GO -----------------------------------------------•------------------------------------------------------•---------------------------------------•-----•-•-•--••-••-•-• ....„. Rg...30azo #. A CIVIL Q Agreement: �aE, `�� a6� The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accoi the provisioi :.I.LL 5 of the State itary Code—The undersigns further agrees not to place the s o eration unt ertificate of Complianc ha n is"edabbe board further )ignred � � � ='r -: Date lication Approved By-••--••--•-••••..•• •••• ----••-- • ••......•-••-••-••••-•---•• ----•--•••••.. -" 15=95 Date Application Disapproved for the foliog easons-----------------•--•-------•----•-•------------------------------•--•-•------------•----•-•••.................. ......-•-------------------••----•--•-------•--•-----•-•---------•----•--•---------------------•----------••-•••••-•-•••-•-•--•---•--•----•-----•--••••-••-------••-------------------•---••-------..•-- P Date Permit No........ ........... ......................... Issued------------ .......... ------ Date r+1 No................_....... Fmc.............................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ...:..............OF... f !di!% �"".+ f. i�.f. --••--••------------•---- Appliratiou for Uigpoiia1 Work.5 Tonstrurfivit ramit Application is hereby made for a Permit to Construct (OK) or Repair ( ) an Individual Sewage Disposal System at:: -•--.,!.�''ACT'... �"0r400.. .e�.. 'I"° �` ._..... ... ..D •-••- --- ..... Location-Address or Lot No. Owner Address W Installer Address Type of Building Size Lot._/.57_.11A......Sq. feet U Dwelling—No. of Bedrooms-____.______ _..__Expansion Attic ( ) Garbage Grinder (Ng aOther—Type of Building ____________________________ No. of persons............................ Showers ( ) — Cafeteria ( ) P4Other fixtures --------------•-••---------------- -------------------------•-----•-------------- W Design Flow............. ____.__.:_____________gallons per person per day. Total dai��ow.......... ` ......................gal�ons. WSeptic Tank—Liquid"capacityl491PP.gallons Length__6__��. ,Width._"-'_�____--_ Diameter................ Depth__$_4... x Disposal Trench—No_ ____________________ Width-------------------- Total Length.................... Total leaching area....................sq. ft. Seepage Pit No________ ___________ Diameter-__-_e&.`._.._. Depth below inlet_3_'t�7_.____ Total leaching area__.Z "l.___sq. ft. Z Other Distribution box ( ) Dosing tank ( ) '-' Percolation Test Results Performed b 4 e - �+!Q�" "�'S44r `I "'28e � Y ---- Date Test Pit No. 1....Z+.......minutes per inch Depth of Test Pit-----�e___...... Depth to ground water.... f14 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water..-____--_--_______-__-. a' -•-------------------------------- -------------------------•---•-----•.....__.....__. ...__......._.......................................... D Description of Soil__Q_`:_ ''--- op1?_ a l+►_______ -....•1'0 !°--- T• j"i_F� 41 J•aw+t�_ _ y ®E�, v s�x.l �_; . 4 GcS __�! ' .-"_�. .sr t....u•r_....................................................v... �/,�-.�..... e� --------------- ------------------------•-- ------•. ------------------•---•---------- ------•-----•------------------_.. ............................................ ROGER G UNature of Repairs or Alterations—Answer when applicable............................................................ b MI�HNIEINICZ ¢ram' No.30420 go - -------------------------•----•--------•-------•-----•------------._......_...-•-•--•••---••------------------------------------------...--------.._..---•- e�Wa� Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System.in c the provisions of TiTILE 5 of the State Sanitary Code— The undersigned further agrees not to c operation until a Certificate of Compliance has been issued by the board of health. j igned........................ _ Date Application Approved By..................... .. ....... --.......- ... .............. Date Application Disapproved for the f ollo g reasons----------------------------••----•--•----------------------------------------------------------------------_.... ....-----••----•-----•--------•----••--------•-------•------•--••--•-----------------•--•---------------------------------------------------••--•------------------------------------------------------- Date Permit No......�.5.-. �-•--7--••-•......•--•----_. Issued_......... — S §6. ... ... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........................................OF................................................------..........................._... QPertifira a of TrrtYt li�attre THIS IS TO CEeTIFY, That t e Individual Sewage Disposal System constructed or Repaired ( ) by------------------- ----•----fj-t•- •---• -•--•------•••-••-------•---------------•------•------------------------- ----------•-----------••-•••-••-----------. I ler at---•---•-•----• .L .......... :__-•-------- has been installed in accordance with the provisions of i " j of Tile State Sanitary Code a desc 'bed in the er_ application for Disposal Works Constriction Permit No______ _____________J____.__?._____ dated__..___.�L,/J..� __�.......... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUA' ANT THAT THE SYSTEM WILL FUNC IONS TiSFACTORY. DATE...............2 _____ ------_--------------• Inspector--•--- -------- ......................... v THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..............?�.No.. . ........................ l U�� ��rimrtt er�tii Permissionis hereby granted..... ........ 11 • - - ---------------------------------------------------------------------------------------- to Construct ( ) or Repair ( ) an Individual Sewage Dis s System atNo............................................................................................................................................................................................... Street as shown on the application for Disposal Works Construction Permit Dated--------- .-----------•----••-•••--•---•------------------------------------------•--------•-----•--•...---•-•--_.. DATE..................-- ----. C--------�- ------•--•----............... Board of Health ------- FORM ,1255 HOBBS & WARREN. INC.. PUBLISHERS i ALL SHALL SYSTEM PROFILE MARK DSTE WITHC MAGNETIC TTAPE OR BE (NOT TO SCALE) COMPARABLE MEANS FOR FUTURE LOCATION. ACCESS COVERS TO WITHIN 6" OF{, FIN. GRADE PROVIDE WATERTIGHT C.I. COVERS TO GRADE TOP FOUND. EL. 57.2 SECURE PROPERLY AGAINST UNAUTHORIZED ACCESS \ 2" PEASTONE OR GEOTEXTILE $ MINIMUM .75' OF COVER OVER PRECAST FILTER FABRIC OVER STONE 2% SLOPE REQUIRED OVER SYSTEM 58.5' o o Q� Rou{e 28 PRECAST H-10 J ' RISERS (TYP.) 2'0 BLOCKS OR PRECAST RISERS O a rl 54.7' 4"OSCH40 PVC MORTAR ALL H-10 Locus'° o PIPES LEVEL 1ST 2' FENDS 4' COMPONENTS �(TYP.) 9 53.79'SIDES ` o p loll 14„ no roFro4ro°v° o o°°o°°o=° a TEE > o 0 0 0 - oao o' _'� TEE EXISTING t*53.3' ° ° ° ° El 0 (]�El0 00°��0 ��aa-o °°°°°°°° �oaoa000aao ° SEPTIC TANK** o n 0 00 0o 00° °o° 6" SUMP >o°o °°°°°000 > 00 0 GAS BAFFLE ..: o o°o 12" TNT. DIM. N >°o°o°o°0 0����0����� °po°o° o„ o 0 0 0 o0 0 0000or53.1' 2.93' °°°°°°°° °o°o°o . °oo°o°°0 50.79 > 0 0 0 0 ,�'0000 D 0 0 0 H-20 D'80X L H-20 500 GAL. LEACHING CHAMBER BY ACME PRECAST OR EQUAL. 3/4"-1-1/2" DOUBLE WASHED STONE (2) UNITS REQUIRED S �� 6" CRUSHED STONE OR MECHANICAL OVERALL DIMENSIONS TO OUTSIDE OF STONE: 30' X 9.83' n COMPACTION. (15.221 [2]) i0 20'+ 0 N ova .1 % SLOPE) ( 1 % SLOPE) 48.5' BOTTOM TH-1 & 2 (NOTE: G-W EXPECTED AT ( NO GROUNDWATER FOUND ELEV. 30 PER TOWN MAP) FOUNDATION EXIST. SEPTIC TANK 20' D' BOX 16' LEACHING LOCUS MAP FACILITY INSTALLER SHALL CONFIRM SUITABLE SOILS FOR 4' NOT TO SCALE *THE INSTALLER SHALL VERIFY THE ** I BENEATH SAS PRIOR TO INSTALLING ANY PORTION INSTALLER SHALL CONFIRM MINIMUM SEPTIC TANK SIZE AT LOCATIONS OF ALL UTILITIES AND ALL 1000 GALLONS AND ITS SUITABILITY FOR RE-USE. REPLACE OF SEPTIC SYSTEM ASSESSORS MAP 271 PARCEL 94-4 BUILDING SEWER OUTLETS AND WITH 1500 GALLON H-10 SEPTIC TANK IF NOT SUITABLE (OR H-20 ELEVATIONS PRIOR TO INSTALLING ANY SEPTIC TANK IF IT WILL BE SUBJECT TO VEHICLE LOADING). PORTION OF SEPTIC SYSTEM VARIANCES FOR SEPTIC SYSTEM REPAIRS WHICH MAY BE IMMEDIATELY GRANTED BY THE BOARD OF HEALTH AGENT OR BY HEALTH INSPECTOR TEST HOLE LOGS BYPERWORK AND HEARING REDUCTION THE BOARD OF HEALTH REVISED DURING OA PUBLIC SALS ROVED SEPTIC SYSTEM DESIGN HEARING HELD ON AUG. 4, '2009 A.H. OJALA, PE, SE ENGINEER: GARBAGE DISPOSER IS NOT ALLOWED i WITNESS: DAVID STANTON, RS DESIGN FLOW:. 3 BEDROOMS ® 110 GPD = 330 GPD DATE: 9/16/10 3) FAILED SYSTEMS ONLY SOIL, ABSORPTION SYSTEM USE A 330 GPD DESIGN FLOW PERC. RATE _ < 2 MIN/INCH INSTALLATIONS PROPOSED MORE THAN THREE FEET BELOW 13049 GRADE WITH PROPER VENTING (PIPED TO THE ATMOSPHERE) SEPTIC TANK: 330 GPD (2) = 660 CLASS SOILS P# AND WITH H-20 LOADING, BUT IN NO CASE SHALL THE SAS **RE-USE EXISTING 1000 GAL. SEPTIC TANK BE LOCATED MORE THAN SIX FEET BELOW GRADE. ELEV. ELEV. LEACHING: Orr 58.5' 0" � 58.5' SIDES: 2 (30 + 9.83) 2 (.74) = 118 GPD O/A O/A BOTTOM 30 x 9.83 (.74) = 218 GPD SI LOAM SI LOAM TOTAL: 454 S.F. 336 GPD P' 2" 1OYR 2/1 3" 1OYR 2/1 USE (2) 500 GAL. LEACHING CHAMBERS (ACME OR EQUAL) E E WITH 2.5' STONE AT SIDES, 4' AT ENDS AND 5' FS FS BETWEEN UNITS '°oo� 41r 10YR 7/1 5's 10YR 7/1 �o B B °o LS LS APPROVED DATE BOARD OF HEALTH MA 30 10YR 6/6 56' 30" 10YR 6/6 56' - C C PERC MS MS f 59.37 T 59.63 59.62 1 1 120" 2.5Y 7/1 48.5' 120" 2.5Y 7/1 48.5' 59.32 I o NO GROUNDWATER ENCOUNTERED 4.31 o � � 0 c / / a X �9.12/59.17 .24 c� / / NOTES � 59.27 58.98 WATERLINE MUST BE SLEEVED WHERE WITHIN 10' OF / 1. DATUM IS APPROX. NGVD SEPTIC SYSTEM COMPONENTS / cu 58.99 2. MUNICIPAL WATER IS EXISTING 659/09 X 75 PROP. VENT WITH CHARCOAL FILTER AND 3. MINIMUM PIPE PITCH TO BE 1/8" PER FOOT. / BUGSCREEN (FINAL PLACEMENT BY CY _ ` _ C0l+1TP.A^.TOR WITH H�J!!E04!�NER - -- 8.64 11' 1 6 _ __, _ ____-- __.__ � _ ______ ___--_.,�.--GtSiGN LOADING-FOR ALL PROPOSED PRECAST UNITS s CONSULTATION) BENCH MARK - TOP OF � � � TO BE AASHO H-2Q BOTTOM STEP EL. = 57.0 �C 58.37 / 59.14 6.33 5 TH 1 5. PIPE JOINTS TO BE MADE WATERTIGHT. 6.40 �58. �' 5 2 6. CONSTRUCTION DETAILS TO BE IN ACCORDANCE WITH 5,67 310 CMR 15.000 (TITLE 5.) S��p / 7. THIS PLAN IS FOR PROPOSED WORK ONLY AND NOT TO 57. 58. 1 4, NOTE: ELECTRIC LINE AND TELEPHONE BE USED FOR LOT LINE STAKING OR ANY OTHER 3.53 LO APPROX. LOCATION PURPOSE. Ln 1 4 Aa X 56.49 / 8. PIPE FOR SEPTIC SYSTEM TO SCH. 40-4" PVC. c� 0 N 9. COMPONENTS NOT TO BE BACKFILLED OR CONCEALED X 56.27 7.86 WITHOUT INSPECTION BY BOARD OF HEALTH AND 56.9 � X 52.90 7.01 O 5 7.59 LS 11E RET. WALLS PERMISSION OBTAINED FROM BOARD OF HEALTH. 7 4� LOT 4 Sl- rn 10. CONTRACTOR SHALL BE RESPONSIBLE FOR CALLING t5,92o t SF Ss � DIGSAFE (1-888-344-7233) AND VERIFYING THE EXIST. DWELL. 55.04 ov LOCATION OF ALL UNDERGROUND & OVERHEAD UTILITIES PRIOR TO COMMENCEMENT OF WORK. i TOP FNDN = 57.2' 11. ANY UNSUITABLE MATERIAL ENCOUNTERED SHALL BE I rn REMOVED 5' BENEATH AND AROUND THE PROPOSED W ss 56.80 LEACHING FACILITY. \ s 12. EXISTING LEACHING FACILITY SHALL BE PUMPED AND i REMOVED OR PUMPED AND FILLED WITH CLEAN SAND.*** DECK X 52.09' 53.49 R ***NOTE: CAUTION: GASLINE AND WATERLINE ARE EITHER NEAR OR OVER LEACH PIT co t"NITE ffm% LAN TITLE 5 OF 28 MARK'S PATH HYANNIS PREPARED FOR off 508-362-4541 fax 508-362-9880 downcope.com © BORTOLOTTI CONSTRUCTION/ZINOV a0W# Cope engineefing, h7C. < oFMgss9 civil engineers ;o° D NIEL. � SEPTEMBER 20, 2010 OJALAland surveyors ' CIVIL �° i1ANIEL A. 939 Main Street ( Rte 6A) No.46502 v OJg Scale: 1"= 20' YARMOUTHPORT MA 02675 Pow TER �`` ?lo.40980 , � _ j � RSS �G� �c -- L_ !� `7 `10 /ON L q'`"�sue° o, 0 10 20 30 40 50 FEET DATE DANIEL A. OJALA, rTr 1 O