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HomeMy WebLinkAbout0123 OAKVIEW TERRACE - Health 123 OAKVIEW TERRACE,HYANNIS A= 268 277 5� a a 0 0 TOWN OF BARNSTABLE LOCATION l �( g��yl� es� , SEWAGE# +1 VILLAGE ASSESSOR'S MAP&PARCEL. '��.-t7 INSTALLER'S NAME&PHONE NO. . SEPTIC TANK CAPACITY ffiY f i 1 N& -�ccro-�A L c•C. LEACHING FACILITY:(type) (size) NO.OF BEDROOMS -3 OWNER r PERMIT DATE: 11-44-1.7 COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility -4-1 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 C L�-dx., . n s � u C � i � � b a Ci � � y o� a o No. I Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS ftplitation for Disposal Opstem Construction permit Application for a Permit to Construct( ) Repair oe( Upgrade( ) Abandon( ): E�Complete System ❑Individual Components Location Address or Lot No. / 3 (�l�el� Owner's Name,Address,and Tel.No."5 W_r Assessor's Map/Parcel.o2(- laln (�Wannt,c WWo Installer's Name,Address,and Tel.No. 6?"&. 735P,9 Designer's Name,Address,and Tel.No.3Ua- C3-VSY/ �3or �nS'�✓>Jc�'tCA-n' 439 a- i� ' da4 D Type of Building: Dwelling No.of Bedrooms Lot Size 12d sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) &30 gpd Design flow provided 3 q Q n �,^. gpd Plan Date QC406 �yp a010 Number of sheets �, Revision Date ' kW^4eA ',, DOP) Title` `i i '� 1 �ra 3 C i'�tk I A n 6—�7 A s Size of Septic Tank e_y jS, -r'N JJX) , ,40 2-►' 0A Type of S.A.S. a a, t) A6 x"] "33 Description of Soil 'ne-C. Nature of Repairs or Alterations(Answer when 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 Environment e and t to place the system in operation until a Certificate of Compliance has been issued by this Board of He Signed A Date Application Approved by Date !(— / �� I Application Disapproved by Date for the following reasons Permit No. I Date Issued�— No. t. - i' Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computes: i� Yes PUBLIC HEALTH DIVISION - TOWNOF BARNSTABLE MASSACHUSETTS 4 01pplication for Vispoe4l *pstem Construction Permit Application for a Permit to Construct( ) Repair O Upgrade( ) Abandon( ) ❑sComplete System ❑Individual Components Location Address or Lot No. 1.23 Cb. iUie�r Owner's Name,Address,and Tel.No.656 '7$d-�T] Assessor's Map/Parcel a2Go$ ��� � -4a fl t) S. 1 4 �- ,n e c , M A ®aga/ Installer's Name,Address,and Tel.N�o.�YO d-'?q, 73 Designer's Name,Address,and Tel.No...L-;Z>�--_10- (/Sy/ oY 1, �f <:IOr,SP�t�l"tCti ;� � . t���s5�r �St. y r ,n tr W ;AA6t%r�fi �Q. AAii � 9G�{/ `Uli.e`Y4 x < , Type of Building: g /.2 ��! f q g ( ) Dwelling No.of Bedrooms � Lot Size � s .ft. Garbage Grinder Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) J30 gpd Design flow provided 3 y 9 gpd Plan Date Q C�06 i(, t101'7 Number of sheets / Revision Date lubikA4C,, `; pol") Title .i f �� c��1 F a r fir.< . 4 /`� �3 1►�t t r r.A • ata,,�►��t x` �'t1 i�r Size of Septic Tank Type of S.A..S. [ Description of Soil2� Nature of Repairs or Alterations(Answer when 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-' - Signed -`" , f.F--�`�,-°°:•+:,,,..,a_,.,..-..-�_,�....._._ Date f_ Application Approved by ,,Jc � J A j Date ^- Application Disapproved by Date for the following reasons Permit No. Date Issuedf-- - -- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS k. Certificate of Compliance THIS IS TO CERTIFY,that the[O-st)e Sewage Disposal system Constructed( ) Repaired(� Upgraded( ) Abandoned( )by 6�f k(Gm l �>fr�1 a?`/'L t S��'Ci�+ -/-fi'C - at has been constructed in a cordance _ with the provisions of Title 5 and the for Disposal-System Construction Permit No.IVr r'19 dated " f Installer (� �:r , r 5 A # tc�, �•f�C Designer r i cn7C r; 3 .c ' rt�Y t�`\� -t t� # v r t bedrooms - i Approved design flow ���� I 'gpd The.issuance of this permit shall not be construed as a guarantee that the system will ction �da.gre3 Date 1 ` ~J� Inspector �� � - - --- - - - -- ----- ----------------------------------------1- --------------- ---! Fee vV--------- - No. a20� THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS Disposal *pstrm (Construction Permit Permission is hereby granted to Construct( �)' Repair(Ar Upgrade(r ) Abandon( ) System located at � �t ,�/J { /�r Ae t1-1 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. V51 i/-` Date - Approved by -23-2018 23:34 From: To:15087906304 Pa9e:1,'1 i Town of Barnstable I r Regulatory SeViCeS 7Ch+�m�Ili.C'xeiler,Director )Public Health Division a' Thomas McKeltns DDirector 200 Main Street,Hyannis,MA-02601 Fax: 508-790-6304 Office: 508-862,4644 Irnstau &Desi er Cer'tiftCatnOn FGKM . Date-. Z� Sewage Permit# Z.O�I g Assessor's Map�Farcel 2(08 Z77 Desigimer: Lo Address: Address: . H5 � 0208 I was issued a ermit to install a On (te) (installer septic system at 12� 0� N ! based on a design drawn by . (address) dated ! L1 I (designer I Certify that the septic system.referenced above was installed substantially accordin g to the desip, which may innclnde miaor 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 ma]or changes (i.e. greater than 10'late reloeadon of the SAS or any vertical relocation of MY component Of the septic ut in accordance with State&Local Regulatioms. Plan revision or certified - uilt desi�aer to Follow. `S A OF DANIELA. OJALA -4 (bastallerss ignature) U CIVIL w o No.46502 �Fs CIA 1 ti SIONA6 E M�gner's S`igr�ature) Affix Designer s Stamp Mere) pX,Dr R9 TO AR10TS'' E C HM TH IS ® ICATF ®JR LANCE wH. NOT B 'U!C)m UPTEIL ig TH THI6 FO S-BCTtL CAR1D ARE t R' EIVED BY TIC NSTAAPDE P IUSLIC plyh SON. T]E�AN1fis X U Q:Haalth/Septicffiwignm Certification Form 3-2rr04.doc Dgpairtwmt of RegWatGuy.se vices na p. 2001idala Stmri,Zpniils 14A 02601 • �h°A NLI�� � �• Dat�.SaI�.�duted ^_�__.�1�3 ,� � T�a.v_,.T_l/ •JJE`��'7�d[, fOa' 07� �� • Soil SufthiRty AssesSment fiar So- e Disposal, fr kerfortx:cd:8y. �(�o G�� ( X��Q I L/, S Witnessed By: Location A;ddregs I OQ�vl�►,1 (frdYy{GL D yvner's 1Yatma 0 t TOO[ 1`f'rAA tit c Address ' A,ssossor's Map/I'arael: p2�0�/017?. y Bngin4cr's�IaanG �O rn!v. ��,/C, ' NEW CO�Ta"TftTlJCTZrJ1�1 IMPAIR 1— Zelaphorie# CsD� �6,a/', /s Land Use: lal)0 S CAP e 0 Slops s(9b) '�! s-mfaac Sxo�tes �/ ' T]Istances vm: OpanWaterB.ody �OC ft Posslblowot•Aren ?10/' ArinlagwaterWoll>fX Ft Dralnago Way /(Q'' • ft Prop orgy Line �Z U Fl Other- tt -TCH6 tstrcetname,dlmrmlons of lot,exact locations of test halos&?Ora tests;laeaka watlands Ij:x pznacizri to bolos): Q Q. �Tif Z "'i - o -� karent-xuatemaii(gaologla) ��1i,�1d.1 ..�b(4waS.�) Depthtt7Audmak Depth'ta dro=dwatov Standing'Water laHalo: ZV i—T-c•-,_- Waepin.9fy0Z PltFACer �stl�ated Seasonal�lgh Groundwater ' Method.Used: 2 Depth Observedstandingiacbs.hole: lu4 1Goptlx�tsls llx�igt�l s;. ,'. t� Depth to.wcepingfrora side ofobs,halo: In, K3xt}u i�rAtet<Ad�uattri ¢1 f& I'ndexWell# RoadingDakc: Tx,do�s'NolllpYtil A •f `kbt'. . �d};.ldlx?Uifd,rite11.e11F11, �, -0bsezvation ' Doptb.ofl?o�c. stark F o=soak Time End Pro-soak Rate mit.IJ.zzaIi e4 �It� t3' Sultabili Asscsamozct. AddWonaI UsUa Xroded(.Y4 - oxiginnt: Public Halth Dlvlsloa 0.bBBrV*A:dog Data To a0 ComPlatcd $�s is la lb�.reaxidiactad ve'a.Irbim 100' o�wet(s add YOU Milst firet�c�� Ba r r ust able +Come.Tyatim D dszon at:least one(1)week prior to bagm=g- r�:�ss,�rc�I�P.c�t�z�z.Doa . b s,. o o o a a > ta C33 J m �_ 4 � Nyu O eS zip a 03. U C�j C3 -11 ❑ • •�+�pp �•�O�cp. _ � •-a O ��a ,may •�{� .�...j � . DJ fa Cfj.0 R7Ck �-a 13 iwU A3 • - O H Cdd I top i ] N • r -r cl v ' , 'd d m ,s7 .� � 9 '� { T7 rl n1 H Xl rr I ili Pi t 'any 'spk` ID sn s �O y \_ CD �. �i to Cl awl �G •� tW Fri � A 401 wAr Q - a`�a Rt o ccl it7. r� M Av7 �1to Cann Town of Barnstable P��SwEr��o Regulatory Services Thomas F.Geiler,Director BAMWABLE, s Public Health.Division A, Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 . i Installer&Designer Certification Form Date: 2 3 g Sewage Permim ZO I''- y 1 Assessor's MapTarcel Designer: DOGUN Inastaller: �l�I-0�1�1' '���0►� Address: N !gZ( ft (,A Address: . µ! (WbU�M 2� YMAMUM 009r. RA 0a&7 I ,T0N5 tit(LL5,- MA 02W J was issued a pera-it to install a •( ate) (installer) i septic system at t 2?2 QAK_yJ a/ fg W YAM N!S based on a design drawn by (address) - AMEL A-. MALL L dated 12 i (designer - I 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' laterrelocation of the SAS or any vertical relocation of any component of the septic em ut in accordance with State&Local Regulations. Plan revision or certified - unt by designer to follow. p&Of 61gss �,k qoy �co DANIELA. (Installer's Signature) �ivlL cn No. 46502 /� cuss ONA6 t - fD (Designer's Signature) (Affix Design6r s Stamp Here) BLLASE RETURN TO BARNSTABLE, PUBLIC HEALTH DIVISION. CERTIFICATE OF i COMPLIANCE WILL NOT BE ISSUED UNT11 BOTH THIS FORM AND AS-BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVI810N. THANK YOU • f Q:Heaith/Septic/Desiper Certification Form 3-26-04.doc 1 II f w i p 4 b1SN6b8�o O(� � . . •� 66j O N�, 1 wc BORTOLOTTI CONSTRUCTION, INC. t7 765 WAKEBY ROAD,MARSTONS MILLS,MA 02648 508-771-9399 508428-8926 FAX: 508428-9399 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION Property Address: - Date of Inspection: -7/Co/ Inspectore ame: OwAees Name and Address: CERTIIICATION STATEMENT! I certify that I 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 .7,153 disposal tems. The System: Passes Conditionally Passe Needs Further E tion_ By,4e Local Aproving Authority Fails Inspector's signature: Date: -7 The System;Inspector shall submit a copy of this inspection report to the Approving authority within thir- ty,(30)days.�of completing this inspection. If the system is a shared system or has a design now of 10,000 gpd.or grea�er,the inspector and the system owner shall submit the report to the appropriate regional office of theiDepartment of Envirorupental Protection. The original should be sent to the system owner and copies sent to the buyer, if applicable and the approving authority. flVSPECTIONSUMMARY: A)'rSYSTE 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 ` below. B)SYSTEM CONDITIONALLY PASSES; One or more system components need to be replaced or repaired. The system,upon comple- i tion of the replacement or repair, passes inspection. Indicate yes,;nor,;or not determined(Y,N,OR ND).Describe basis of determinaticn in all instances. If "not determined",explain,why not. The septic tank is metal,cracked,structurally unsound,shows substantial infiltration or exfiltration,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 backkup or breakout or high static water,level observed in the distribution box is due ;to broken or obstructed pipe(s)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 HEALTII: 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- mr;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 water supply well. The system has a septic tank and soil absorption system and is less than 100 Feet but SO Feet or more from a private water supply well,unless 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 ii equal to or less than 5 ppm. D)SYSTEM FAILS: t. I have determined that the system violates one or more of the following failure criteria as deStlod in 310 CMR 15.303. The basis for this 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 inveit due to ad overloaded or clog-: ged SAS or oe'sspool.• Liquid depth in cesspool is less than 6"below invert or available Volume is less than 1/2 i day flow., , Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped -2- i i i I i SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) 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, ti Any portion of a cesspool or privy is within 50 Feet of a private water supply well. Any portion of a cesspool 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,amtttonia nitrogen and nitrate nitrogen. E)LARGE SYSTEM FAILS: 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 t' conditions exist: ' The system is vAthin 400 Feet of a surface drinking water supply The systetn'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 II of a public water supply well .The owner,or operator of any such system shell 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 tlnther information. SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST dwk if tJte following have been done: Pumping information was requested of the owner,occupant,and Board of Health. . done 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. As-built plans have been obtained and examined. Note if they are not available with N/A The facility or dwelling was inspected for signs of sewage back-up. _ ,--The system does not receive non-sanitary or industrial waste flow. Vl�site was inspected for signs of breakout. _ All system components,excluding the Soil Absorption System,have been located on site. _idTIm septic tank;manholes were uncovered,opened,and the interior of the septic tank was in- ` for condition of baffles or tees,material of construction,dimensions,depth of liquid,' depth 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 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST(continued) V' The 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 1 REST INTIALi Design Flow: llons Number of Bedrooms: Number of Current Residents: Garbage Grinder_ Laundry Connected To Systemv� Seasonal Use: Water Meter Readings, a 'table: Last Date'of Occupancy: D .a Q -I COMMER AIJiND 1STRI_AI- -./-)(>. . Type of Establishment: Design Flow: _Lgallons/day Grease Trap Present: (yes or no) Industrial;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: GENERA INFORMATION iUWING RECORDS and source of information: If A System Pumped as part of inspection: jO If yes,volume umped: Q gallons ReaFon for pumping: TYPE Old'SYSTEM: Septic Tank/Distribution Box/Soil Absorption System Single Cesspool Overflow Cesspool Privy Shared System(If As,attach previous inspection records, if any) _Other(explain): �'/ ' ( ✓J APPRO? IMATE AVE of all compone ,date installed(if known)and source of information: SewagFogors detected when arriving at thg site: / J -4 r J i i I i SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C GENERAL INFORMATION (continued) SEPTIC TANK: Depth below grader Material of Construction: V concrete metal FRP Other (explain) — Dimisions:i _ ' Sludge Depth: Scum Thickness: Distance from to of sludge to bottom of outlet tee or baffle: q P g 3 Distance from bottom of scum to bottom of outlet tee or baffle: /Z Comments:(recommendation for pumping,condition of inlet and outlet tees or baBles,depth of liquid IeAel in lion to udet invert,structural integrity,evidence of leakage,etc. 0�2'J GREASE TRAP: A—)r) Depth Below Grade:—' ' Material of Constnuction: concrete metal FRP Other (explain) — — — — Dimensions: Scum Thickness: :y 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 of leakage,etc.) ' TIGHT Oft HOLDING TANK: w Depth Below Grade: Material of Construction:—concrete—melal_FRP—Otlter(explain) -'Dimensions: Capacity: gallons Design Flow: gallons/day Alarm Level: Cginments: (condition of inlet tee,condition of alarm and float switches,etc.) DISTRIBUTION BOX: A)Q Depth ofli!iu d level above outlet invert: Comments: (note if level and distribution is equal,evidence of solids carryover"evidence of leakage into or out of bo I,etc.) N _ PUMP CHAMBER:AA -_Pump is in working order: Comments: (note condition of pump chamber,condition of pumps and appurtenances,etc.) ' S_ l SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) SOIL ABSORPTION SYSTEM(SAS): (Locate o�site plan,if possible;excavation not required,but may be approximated by non-intrusive methods) If not determined to be present,explain: Type: Leaching pits,number: Leaching chambers, number: Leaching galleries,number: Leaching trenches,number,length: Leaching fields,number,dimensions: Overflow cesspool,number: Comm ts:(note condition of soil, igns of rau ' failure 1 el of pond' g,condition of vegetation, etc -.,'CESSPOOLS:— 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.) At PRIVY: ' Materials of construction: Dimensions: Depth of Solids: Comments:(note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation, etc) -6 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) SKETCH OF SEWAGE DISPOSAL SYSTEM: Include ties to adeast two permanent references, landmarks or benchmarks. Locate all wells within 100 Feet. DEPTH TO GROUNDWATER: - Depth to groundwater: Feet /'�iY/lll�1 .5 �G Method of DD/ettbrminationor/[A�`�ppro 'matio�n: _7_ No. .8/ 33�_ Fss..3o ........... THE COMMONWEALTH.OF MASSACHUSETTS BOARD OF HEALTH � ........................... .............O F......................................--------------------......_._......._............... Apli iration for' Dispati al Works Tomitrttrtion 1hrutit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: •.. •••. L` rQ v........ = C Ii r..... clHj3/.s � ` t �p Location-Addl/s 6r Lot No. ........!,_'r!1l. ....;!._!.S": -�"' ....................................... ••---••-----•----- --.........-------•------------.......---...-- .Owner Address W .1 ...:Ii:Y._...... l3 t_.. -• ----•------••--•-•-----•............................................•---........--•- 1 Installer Address Type of Building Size Lot.......S �2.........Sq. feet Dwelling—No. of Bedrooms..........................................Expansion Attic ( ). Garbage Grinder ( ) Other—T e of Building No. of persons............................ Showers — Cafeteria a' Other fixtures ............................ W Design Flow......................:.....J ___-..gallons per person per day. Total daily flow....._._._._...-..-._33..�............gallons. WSeptic Tank—Liquid capacitylAQLgallons Length.?'..!"... Width._! '-!R.. Diameter_______________ Depth.4_'` V" x Disposal Trench—No..................... Width.................... Total Length.....................Total leaching area....................sq. ft. Seepage Pit No.......1............. Diameter.._�.f.l l.... Depth below inlet.... .......... Total leaching area..?A.!......sq. ft. Z Other Distribution box ( ) Dosing tank ( ) '~ Percolation Test Results Performed by.....sW-k -?(.4 :........................................ Date.. ..7, 19$1.._.__....- ,aa Test Pit No. 14A J:r _minutes per inch Depth of Test Pit...j.�:4..... Depth.to ground water.!Va__w,*?Er (i Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a --•------------------•-------------•------------------......••------------...---...--------•------•-.........--•------.....------•--•--•-----............•--- D Description of Soil........�/-.F'qN...... t t7tu!�'f----S-�h..".--••--uN/1�......----�-G-�.......'D.��at r�w� U -------------•------ r �L••------------------------------------------------- ------------------------------------------------------------- ------------ ----------------------------------- W 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 TIT11j, 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certifica, f C pI' e has been issued by th ar of health. t ApplicationAppr e By...........=----.................................................................................. Date Application Disapproved for the following reasons-................................----•-------•-•-----------------------------•--•------------------.....--------- -•----•••-•--------•----••••---•-•--•--------------------•-••-----------•----------.........-•----------.-----•--••-----••••----•------------------------------•---------•------------------•----------- Date PermitNo......................................................... Issued........................................................ Date L THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ,`�Oc / 7`"`�` S ` ® ..........OF...... a�,.�� 3 q Y:�13 V 7.n. f9rdif iratr of Toutpliattrr TBIISV,TO CERTIFY, That,th Individual Sewage Disposal System constructed or Repaired ( ) by.....- ------- ` ` .�a..- C,, o Installer j has been installed in accordance with the provisions of TIT E 5-of��TThe State Sanitary Code as described in the application for Disposal Works Construction Permit No... csl._.. !.................. dated................................................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE................................................................................ Inspector..................................................................................... No...r :. C' FEB :.. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ........................................._O F......................................----------------.._.......-----............_...._... Applira Lion for Bispoii al Works Tonutrurtion rruti# Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: +p-� ...�..`.....�.�__C.............. �14....!..s . ..................... .........1 _) .---W.?"Q.J_.......pr�/fs� Address or Lot No. Or i.t 1.,�---.....--"---------------------------•----- -.............. W , e Owner Address Installer Address Type of Building Size Lot.... ......Sq. feet U Dwelling—No. of Bedrooms.................3......................Expansion Attic ( ) Garbage Grinder ( ) a`14 Other—T e of Building No. of persons............................ Showers YP g -------------•----...------- P ( ) — Cafeteria ( ) dOther fixtures -------------"------------------------•--------"-"---"----••""-"--••-•--•---•--------------••----•---•----"--""--"---........"-"-"-.............•--- W Design Flow............ - ....................gallons per person per nay. Total daill flow_--_.-_--�"4®................._....ga�llon�� WSeptic Tank—Liquid capacity../.Cf gallons Length_,__�..__.. Width_._. ..�d Diameter________________ Depth._ .... x Disposal Trench—No ____________________ Widthi-___--•-I--__-_-_-• Total Length.._........------- Total leaching area...................sq. ft. Seepage Pit No-----------j_....... Diameter... _." ..... Depth below inlet................. Total leaching area_20.1......sq. ft. Z Other Distribution box ( ) Dosing tank ( ) ~" Percolation Test Results Performed by......... `................. ............ Date._. 7, )I,� _... �a Test Pit No. 1._ --minutes per inch -Depth of Test Pit------ __ Depth to ground wa�:f_.f*J#0__6L*T:A �%4 Test Pit No. 2__j?-.,. minutes per inch Depth of Test Pit.......LVY Depth to ground water------ !........... ................. D Description of Soil------.....-"-"" I �. ....... .F _�_: -' ` a In ±-f r GJ. , �1 l ,«., .�, 4-,mats W x ••--•----.-•----"------"--"--•-------•.......•.."---•-"--•.--••-•"•-"-"""-""-•-"-••-"--""----•"••••-".".-"--•-""••--•-•."•••-••.•---•••"-"•-•--.---•---"-•--.-"-"--•........----•".•".-----------"•-"-- --"--------"-----------------•-••---------•"•••-•------------------•-•-••"-•"•-------------•------------------------................................................................................. 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 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. Signed...............I4� cv: ✓ llate ApplicationApproved By.................................................................................................. Date Application Disapproved for the following reasons---------------------•--------"-•------•------•-"----•-...------------------------_....----•"-•----•-------...... --•-"----••"--"••-••............••-••-•....--"----""-•-•----"................"-•-•...._.._.."••-----"""-••"-----•"-----"----•"-•-"•-•-••-••---•-•-•"-•-•--•----...•-•-----••--------------------......_. Date PermitNo......................................................... Issued-....................................................... Date -,t THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ic9a, OF..... .:.y ..................................... uprrtifirair of Toutpliaanrr THIS--IS TO CERT FY, That the Individual Sewage Disposal System constructed ( L-j"or Repaired ( ) by.....— sl ---- --------•---------------------------------------------------------------------------------------------------------------- - �.Q , Installer at ......................................... .... ._(? rye /f/ '�"~�-�` ----------------------------------- ------------------------------------- has been installed in accordance with the provisions of TITL_.' 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No.4 f��_ .. _____________•_-- dated-............................................... THE ISSUANCE OF THIS CERTIFICATE SHALL MOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE..............................................................••-".._.......•••. Inspector..................................................................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD- OF HEALTH .(... ....................0 F... -..�1 - ........................................... a v NC).?�/... FEE..` Diupo,iaa$. Arku �o ruan ramit to Construe io i) hereby Repair(ed_._an Individual Sewage Dispos System... •--•--•-----------•------------------------•----............... St et as shown on the application for Disposal Works Construction-Permit No.................'­ Dated.......................................... 0:V Board of Health DATE--"-----""••............... ..........•---- FORM 1255 HOBBS & WARREN. INC., PUBLISHERS � qua R j SS f tw'.t' •b T � :- z iw '3 f I 1 ..r s�� e��.l.,.� � ; + _.. � i -�1•. _, r � �I ; I jjt `4 j jet i � �, ZA- .{.I P' `'z- 1'r /�. /i / '\ ,•t S 1 °' t t r' j mr$ 7-9 -47 A' to r. +LI .I +ZZ��_ �'�T= 1�. �. 7•... I � .. .. �. _.jil OD s t j r} f c i d �, ? .„...4 } r _; ,. .�`t � '. Ctr' � \z•!.I = t � S fh+ f. 4 �$: • t .;i...t � � .� ! t -,! , {�' :..� �. .�\` { /' i l n j' O 1• G''7'. � i -t � q � { �-f , L _ x..r t,�, y...•-g �r I.. m. -' t c r H _9 , ; ; V�� t +# .t s.: y.+ L r-..i ! •IJ ,\ f ` t s 3•{' r i t't. e..r z V t � t + Ij ti i a c r+ •-.� ..L_i 9' �:�, 3i 'J.-'I._l4 r t a 0 �'j � [ ' + S § R R >fw }`F _ - .,. t t -(" i � � � t�tn,l N IS t-.1 ,`'4•• 4=4.117,'� ,�jD:O - ... 't� f-#-j i •�_t �t,��i {fI ' i{ ! z 9 a I I �p �GuI t� DATE SCALE An' J� .4''•J1� �h ./`"`;J�;a ��� �CZI�ti1�.._�C�I .__ ;,' t , 4 ' JI low °'a�, ��T�1 ti✓ � �f�l t�._� ��r, Ze� I?�`� ���/ �t.p9-�:.`�C..l,okf E.. � --- F.B. 'I S R. SWEETSER s •ff ENGINEER HO�MAS`rq 51 97 SEA STREET DENNISPORT, MASS. �® ST/�N s RAY �. NOTES sw r r ELEVATIONS SHOWN ARE IN FEET ABOVE v t — .K t- F HEALTH A AGENT A 'S BOARD Ott ,A DATE _ ty I CERTIFY THAT THE SHOWN ON THIS of MA�n 4 4 PLAN IS LOCATED ON THE GROUND AS SHOWN M.• . �'y� THEREON AND THAT IT CONFORMS TO THE ZONING �NLr1 ; + lia AND BUILDING LAWS OF THE TOWN OF .- WHEN77 CONSTRUCTED AND TO THE RE:�TRICTIONS ON RECORD Y g '$lu DATE — - — - - ----REGI STEREO L.ArdC SURVEYOR Y. y� R. ;SHEET 1 OF Z o is �A' •�4 ,# 0.. �. 4 --- r - — - -- - I � c• j P PITJ'H _ 1/*' PER FT. 12"wMIN. GROUND t COVER ,j .. (MIN.) IO0G GALLON 2% GRADE(MIN.) {; >mEPTIC TArew DIET. BOX t.IEACH11WC3 PIS' ea t •�sffl_111-111�f11_I/f . ^ — .iticul attl-a ltl:I/l�fll�t11=111 IUL11f 6111 1 i „ S f1+7 Ilgbl�ftf —'�--' �~3" MIN. 2"40F 1/8 -1/2' WASHED STONE RLIOUID LEVELS �'- \Z. '. PITCH 61 1/6"}PER FT. (MIN.) .,:. SCHEDULE 40 PVC OR EQUIVALENT g4•+ NO SCALE 1/4"-11/2' I �� WASHED STONE ;t a DESIGN CALCULATIONS k � FOR A �J BEDROOM HOUSE SEPTIC TANK:3�--VPX 150%= `-1q` USE A 100C.) GALLON TANK <�/ ,yr-• '. $'-i f LEACHING PIT: AREA FLOW #1 ` f SIDEWAL L= HEIGHTX 2 X 1C X RADIUS F x2X1(X �I I _6, X ;N Y J X GPD/QJ= ��� LEACHING3 PIT'' GPD.W ITH Y BOTTOM = (RADIUS)21` X /. O GPD/ ° �� 7 O GPO ¢J TOTAL - Z- GPD J DESIGN FLOW = �_ GPD 4--77 9 4 I RESERVE _ 1_ C3PD SOILS TEST DATA: . "GEaWAC3E PLAF®I'�. FOR ;. N i ak I LOCATION: LOT ,N� �� Ls+b.►'�.� J� Z i-✓�.t�el t;• ��..1Zt1`���.�L.E... P'l�' .:E �*�j���'Y rY`rh� DATE: 1vtaY Z71 �q�� : +` 1N Of SAP 1 `s 1 RAYMO e SWE Ro.124 c r Fed �w 1 - _ � eu �G � •� WATER ENCOUNTERED 0 WATER ENCOUNTERED EETSER TEST MADE 1��A�� — ; 1 ` ,1, TEST MADE: N /x` W/— F.1 LA 1 y'G— Gr W/_ )Er PERC RATE:LESS THAN Z MIN. PER INCH DROP �NQISU w r t ' SHEET 2 OF PROVIDE GENERATOR ti• LEGENDCONNECTION ON PANEL �y Sc�oh ACCESS FOR ROUTINE MAINTENANCE SYSTEM PROFILE ALL SYSTEM COMPONENTS SHALL BE 99_ EXISTING CONTOUR MUST BE PROVIDED FOR ZABEL FILTER. CAST IRON COVER MARKED WITH MAGNETIC TAPE OR INSTALLER MUST FOLLOW ALL TO GRADE (NOT TO SCALE) COMPARABLE MEANS FOR FUTURE LOCATION. PROVIDE MIN. 20" DIAM. WATERTIGHT X gg, PROVIDE QUICK DISCONNECT FOR PUMP - EXIST. SPOT ELEV. MANUFACTURERS SPECIFICATIONS FOR ACCESS COVERS TO WITHIN 6" OF FIN. GRADE CONCRETE COVERS TO WITHIN 3" GRADE o n a R -[99]- PROPOSED CONTOUR TOP FOUND. EL 30.6' PROPER FILTER INSTALLATION 2" PEASTONE OR GEOTEXTILE e \\L oc \ NOTE: 600t GAL. RESERVE FILTER FABRIC OVER STONE tpo� o �98 4] PROPOSED SPOT EL. PROVIDED IN PC MINIMUM .75' OF COVER OVER PRECAST 2% SLOPE REQUIRED OVER SYSTEM 32.9' 0\d 30.0 a PRECAST H-10 ,` NOTE: 2" MIN. WALL TH1 RISERS2�TYP.) ALARM AND CONTROL PANEL \\%ii �r %%%i%y% i `i%y%\iii%%` THICKNESS REQUIRED BLOCKS OR Locus TO BE INSTALLED INSIDE ' 4"OSCH4o PVC MORTAR ALL PRECAST RISERS TEST HOLE . .. i��i�.� ..: INV. IN 22.11 6" MIN. SUMP PIPES LEVEL 1ST 2' COMPONENTS H-20 �o BUILDING. ALARM TO BE ON INv's EL. 29.07 4' SLOPE OF GROUND 2" PRESSURE LINE t2" MIN. INT. DIM. ENDS (TYP.) . 10" EXISTING 14" SEPARATE CIRCUIT FROM PUMP PROP. TEE SIDES 29.9' TEE SEPTIC TANK** TEE ZABEL FILTER 000°0,0,0,° Q� UTILITY POLE `y *22.4'f 14" TEE SLOPE TO DRAIN BACK ° To eY EXISTING ° ° ° ° -OO�� GAS BAFFLE.., FLOAT SWITCH ALARM ON ° ° o ° ° ° ° ° ° ° 0�00 0 ���(] ��®O O OUTLET TEE W/EXTENSION WEEP HOLE o 0 0 0 0 0 0 0 0 0 0 0 � ° ° ° ° ° °t ST D'BOX °°°°°°°° ®®®®0�®®ADO ®®�®®�®0�® °FIRE HYDRANT SETTINGS: PUMP ON ELNESSci ° °1500 GAL. MIN. ° o 0 0 0 0_ ' ° ° o„ CHECK VALVE ° ° ° ° ° ° °°^O °°°°°°° Croi ville Beac Rd.THIS SIDE ° 9" °°°°°°°° °°°°°°°° 27.07 mifh NOTE: NOT ALL SYMBOLS MAY APPEAR IN DRAWING •;#�': 5 WORKING RANGE 6 29.34 � ° ° ° ° ° ° ° ° - ., � • OF BAFFLE MYERS SRM 4 5 SUBMERSIBLE 4/10 HP PUMP LH-10 500 GAL LEACHING CHAMBER BY ACME PRECAST OR EQUAL. a PUMP OFF 12 .SYSTEM (OR EQUAL) 3/4"-1-1/2" DOUBLE WASHED STONE 4' MIN. (2) UNITS REQUIRED (ON BLOCK) ALL AROUND PRECAST STRUCTURES *THE INSTALLER SHALL VERIFY THE o00000 000�0 o0 0000 6" CRUSHED STONE OR MECHANICAL OVERALL DIMENSIONS TO OUTSIDE OF STONE: 25.00' X 12.83' COMPACTION. (15.221 [2]) ^ LOCATIONS OF ALL UTILITIES AND ALL LOCUS MAP BUILDING SEWER OUTLETS AND ( 1 % SLOPE) 6" BAFFLE SCALE 1"=2000't ELEVATIONS PRIOR TO INSTALLING ANY ( 1 % SLOPE) PORTION OF SEPTIC SYSTEM EXISTING PROPOSED H-20 FOUNDATION EXISTING SEPTIC TANK 29' SEPTIC TANK PUMP CHAMBER - 12' NO2GROUNDWATER FOUND ASSESSORS MAP 268 PARCEL 277 / D BOX 12 LEACHING FACILITY COMBO SYSTEM DESIGN: GARBAGE DISPOSER IS NOT ALLOWED DESIGN FLOW: 3 BEDROOMS ® 110 GPD = 330 GPD USE A 330 GPD DESIGN FLOW NOTES SEPTIC TANK: 330 GPD (2) = 660 1. DATUM IS NAVD 88 **RE-USE EXISTING 1000 GAL. SEPTIC TANK 2. MUNICIPAL WATER IS EXISTING ADD A 2500 GAL. SEPTIC TANK/PUMP CHAMBER COMBO / 3. MINIMUM PIPE PITCH TO BE 1/8" PER FOOT. LEACHING: - �G / S 4. DESIGN LOADING FOR ALL PROPOSED PRECAST UNITS SIDES: 2 (25 + 12.83) 2 (.74) - 112 GPD \o �R A'4l . 0 , TO BE AASHO H-2Q (H-10 LEACHING CHAMBERS) BOTTOM 25 x 12.83 (.74) = 237 GPD yF / / 5. PIPE JOINTS TO BE MADE WATERTIGHT. 6. CONSTRUCTION DETAILS TO BE IN ACCORDANCE WITH TOTAL: 472 S.F. 349 GPD v s � 310 CMR 15.000 (TITLE 5.) O MAP 268 PARCEL 277 1 7. THIS PLAN IS FOR PROPOSED WORK ONLY AND NOT TO USE (2) 500 GAL. LEACHING CHAMBERS (ACME OR EQUAL) / �� 12,711 f S.F. BE USED FOR LOT LINE STAKING OR ANY OTHER WITH 4' STONE ALL AROUND / �� O N �� 1 '" PURPOSE. ' 8. PIPE FOR SEPTIC SYSTEM TO SCH. 40-4" PVC. CB F` 9. COMPONENTS NOT TO BE BACKFILLED OR CONCEALED WITHOUT INSPECTION BY BOARD of HEALTH AND PAVER , y PERMISSION OBTAINED FROM BOARD OF HEALTH. APPROVED DATE BOARD OF HEALTH MA DRIVE o ` � 10. CONTRACTOR SHALL BE RESPONSIBLE FOR CALLING DIGSAFE (1-888-344-7233) AND VERIFYING THE LOCATION OF ALL;UNDERGROUND & OVERHEAD UTILITIES EXISTING PRIOR TO COMMENCEMENT OF WORK. o DWELLING C-A �• _- - _r _ ____ ,_ _- _ . ____ _ __.. 11. ANY UNSUITABLE_MATERIAL N -�,, --_, _ -___ _ .� __ ._-- _U _ _ E COUNTERED SHALL BE TOF = 30.6 c9 REMOVED BENEATH AND 5' 'AROUND THE PROPOSED v LEACHING FACILITY. 12. EXISTING LEACHING FACILITY SHALL BE PUMPED AND pq REMOVED OR PUMPED AND FILLED WITH CLEAN SAND. DECK SHRO \ 13. INSTALLER TO VERIFY THE ELECTRICAL SYSTEM IS S k SUITABLE FOR PUMP CONNECTION. ELECTRICAL PERMIT REQUIRED. TEST HOLE LOGS 32 ENGINEER: DANIEL E. GON�ALVES, SE #13587 33 WITNESS: DON DESMARAIS. RS �`� 10� TH1 LAWN 4 DATE: 10/23/17 O PAVER PERC. RATE _ < 2 MIN/INCH } DRIVE oy \ `1 Y CLASS I SOILS P# 15508 ELEV. ELEV. A 1 1 0„ 4 31.5' 0" 29.2' LANDSC E A A 3� - BENCHMARK LANTER_ LS LS VE -. EL. 8 6WALL 1OYR 4/2 1OYR 4/2 REE list 30.6' 10" 28.4' B B 11 LS LS 1OYR 4/6 1OYR 4/6 o 30" 29.0' 28" 26.9' �2 TITLE 5 SITE PLAN C c of PERC 2s 123 OAKVIEW TERRACE M/CS M/CS r HYANNIS, MA ; CAS N 132" 2.5Y 7/4 20.5' 144" 2.5Y 7/4 17.2' MAP 268 PARCEL 278 PREPARED FOR NO GROUNDWATER ENCOUNTERED NO GROUNDWATER ENCOUNTERED 10,2787t .S.F. o0 BORTOLOTTI CONSTRUCTION/ I ROBERT O'TOOLE { DATE: OCTOBER 24, 2017 REV: NOVEMBER 7, 2017 (TANK LOCATION) j, REV: DECEMBER 15, 2017 (PUMP) REV: DECEMBER 21, 2017 (SAS LOCATION) 4 tiSN OF AS N OF IVA off 508-362-4541 fax 508-362-9880 DANIELA. DAA. I downcope.com o OJALA 4 OJALA CIVIL 00WO cape engkeerbi �IIc. 46502 No.40980 �oFF ,STEM ° -0. � I�°Ps `" ti civil engineers 21_1 Ssi NALENG 5av�! ` Scale = 20 land surveyors 1 ," 939 Main Street ( Rte 6A) DICE # > 7-374 DATE DANIEL A. OJALA, P.E., P.L.S. 0 10 20 30 40 50 FEET YARMOUTHPORT MA 02675 JOB NO.=F31690 E0301