Loading...
HomeMy WebLinkAbout0076 SKATING RINK ROAD - Health 76 Skating Rink Road Hyannis ° A= 291 - 174 1 r s TOWN OF BARNSTABLE "LOCATION S�.s�� ;�v�� SEWAGE#Q;�(2,—,3,7 VILLAGE ASSESSORS MAP&PARCEL O INSTALLER'S NAME-&PHONE NOewcQ. fCc�®'W r'�c�acW—i v� g`� SEPTIC TANK CAPACITY `DOC:) r,-�;, LEACHING FACILITY:(type)-Ql_')L5 C (size) L(S`L KIRt"wX�Cd NO.OF BEDROOMS �'� 3 rowS a vu;CS OWNER PERMIT DATE: /(3 �_ COMPLIANCE DATE: f 7 3 Separation Distance Between the: �, q Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility > 7+ \ 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�Xc3p y,7 (6`6`' O 1 , ,l 10 Town of Barnstable Department of Regulatory Services �y RARN�LK ; Public Health Division Date O � r6j9. 1mg 200 Main Street,Hyannis MA 02601 'srF[r MA'1 A �y / ► 1 Date Scheduled— ; 0 ,J Time Fee Pd. ( O Soil Suitability Assessment for SDi7�4pol�- Ae � Ila Performed By: `'/m� ' Witnessed By LOCATION& GENERAL INF'OIIMATION Location Address '�(� S — t Q (� Owner's Name C�v 4—k-y �., 5 Address Assessor's Map/Parcel: � + L NEW CONSTRUCTION REPAIR Telephone# Land Use �.S ra I. / � 3 Slopes(9'0) r ZA, Surface Stones Distances from: Open Water Body 7 � ft Possible Wet Area �ft Drinking Water Well ft Drainage Way &11421 ft Property Line ✓�I f[ Other Y _ SI�E'TCI-I:(Street name,dimensions of lot,exact locations of test holes Bc perc tests,locale wetlands(n proxintity,to holes) C=3 O N i CD 7 � co 5-1 rp I ?t /03,=� Parent material(geologic) I�C''o( i r 1 Depth to Bedrock Depth to Groundwater. Standing Water in Hole: Weeping from Pit @pee Estimated Seasonal High Groundwater DETERMINATION FOR SEASONAL 11IGH WATER TABLE Method Used: Depth Observed standing in obs.hole: _ _ In, 'Depth to soil mottles: In. Depth to weeping from side of obs.hole: Ill. Groundwater Adjustment ft. Index Well# Reading Date: Index Well level Adj.#`actor- Adj.Groundmarr Level PEI RCOL,ATI0N TE ST Dacl: t z�'f 3 Tuna L Observation Hole# f Time at 9" // Depth of Pere 5Z Time at 6" Start Pre-soak Time @ Time(9"-6") End Pre-soak Rate Min./Incii Site Suitability Assessment: Site Passed Site Failed: Additional Testing Needed(Y/N) Original: Public Health Division Observation Hole Data To Be Completed on Back---------- ***1f percolation 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. tlnselrric\PERcroRM.DOC DEEP.OBSERVATION 11OLE LOG Ifole# � Depth from Soil Horizon Soil Texture .Soil Color Soil other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones;Boulders. onsigtency,46 Oravell o. If p,r w — n 'Z/ �rNt Lriuc S ,OYee. 1� lmYA- DEEP OBSERVATION MOLE LOG Hole# �� Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. onsisten % ravel t Z' > 14 �� so_ 10 YZ 3/z- lS 35'r 5 lOcr.r7 S-.xG 117'(r2 54 35"-137- " G i �✓J«P��Q�Ce le loY/Z. s'Jy yum �',�" DEEP OBSERVATION BOLE LOG Mole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Congiatericy,%Gravel) DEEP OBSERVATION HOLE LOG: Dole# Depth from Soil Horizon Soil Texture Soil Color Soh Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders, Consistoncy,16 Oro MCI) A'loot]Insurance hate Map: Above 500 year flood boundary No Yes Within 500 year boundary No Yes Within 100 year flood boundary No—L/--Yes Deptli of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervioup material exist in all areas observed throughout the area proposed for the soil absorption system? —�'6 5 If not,what is the depth of naturally occurring pervious material? Certification I certify that on -O� 209 2— (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 with the requ' ed ining,expertise and experience described in 10 CMM 15.017. Signatur Date 13 Q:W BPTIC\PERCPORM.DOC No. Jl�a Fee 1 0 THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: we Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS appuration r jBIS `h al �pstem ctCOlYBtrULttOTY Permit Application for a Permit to Construc Rep r( ) pgrade(✓Abandon( ) ❑.Complete System individual Components Location Address or Lot No.`((p 545a N`S Owner's Name,Address,and Tel.No.SQ-1—?RC)^aYSe Assessor's Map/Parcel r' -1 (71 ez—,�, Installer's Name,Address,and Tel.No. c!JT, Designer's Name,Address,and Tel.No. 9-Gam_ ,- cQcw T)rpe of Building: Dwelling No.of Bedrooms C4 Lot Size kd q©Z sq.ft. Garbage Grinder( ) Other Type of Buildingqc��s . No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) (4,9 d gpd Design flow provided �` gpd Plan Date ��� �.�©(3 Number of sheets Revision Date `T- k3 Title Size of Septic Tank S 0CDED CZA(Ct7)X s � Type of S.A.S.���� tA�z-�36 L Description of Soil ���'� ���.n. n � Nature of Repairs or Alterations(Answer when applicable)�us�� L c^fie,7 je'l al0 Q 43 `o��X "a--I `A fa R,c-3 6"C. L. c.l,�. C�,.►�►�,.,lnY , , G. �- r-o s �'' 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. Date 70? / Application Approved by Date 7 O Application Disapproved Date for the following reasons Permit No.o.0-1 ?j �� Date Issued q/i'31206 13^� F No. ,:.. • ..:�d ,. Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE,'MASSACHUSETTS Yes application for Mis osal 6pstem Construction Permit Application for a Permit to Construc Reep r( ) pgrade Abandon( ) ❑Complete System Z�,rndividual Components Location Address or-Lot No. q�rn.Y_' _Q, Owner's Name,Address,and Tel.No. 7,n',0 a�( Assessor's Map/Parcel ( Installer's Name,Address,and Tel.No.S--q*-F?"7T•G6�65' Designer's Name,Address,and Tel.No. Type of Building: Dwelling No.of Bedrooms CW Lot Size �!b,q((Z)Q) sq.ft. Garbage Grinder( ) Other Type of Building` �� , No.of Persons • Showers( ) Cafeteria( ) i b { Other Fixtures I Design F l�rtin-required) �(t-( © gpd Design flow provided `7�', gpd Plan Date m ©(7� Number of sheets_ Revision Date Title Y Size of Septic Tank �(� � Type of S.A.S.VJ,)-15 tA�L3� C s Description of Soil <;Y.p ,�, �F Nature of Repairs or Alterations(Answer when applicable)' ,,,%_r_, �A e a Ici-act Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system iw 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. .• r S-9frip Date /-3 Application Approved by Date7-013 0 Application Disapproved b ` Date k for the following reasons Permit No. Date Issued qh-?1 20�3 --------------------------------------------------------------------------------------------------------------------------------------- TII E COMMONWEALTH OF MASSACHUSETTS ti BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired( ) Upgraded(Vf Abandoned( )byI Wiz--- at has been constructed in accordance with the provisions of Title 5 an the for Disposal System Construction Permit No dated /3 27ol-3 Installer\�..�� — �'� \ `'—�--_r ��,��e c��,v1z Designer � #bedrooms Approved design,flow �-( 1 gpd �� 1 The issuance of this permit, ,all of be c dstrued s a guarantee that the system will nctio~;designed. L j Date Inspector'' i/ r / yv - J - / l ----------^------------------ ��----------- I Fee& &C) • , THE COMMONWEALTH OF MASSACHUSETTS . PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS Misposal 6pstem Construction Permit u Permission is hereby granted to Construct( ) Repair( ) Upgrade( Abandon( ) System located at 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. Date Approved by ` t. I Town of Barnstable Regulatory Services Thomas F.Geller,Director BAIDWABM t Public Health Division Thomas McKean,Director 200 Main Street, Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Date:I �IQ<:nA�3_ Sewage Permit#::2�Q—357 Assessor's Map/Parcel �7 Installer&Designer Certification Form Designer: I n tt-V—, installer: Address: l�y bfl f o� 1 Address: �,O Eck LeIL13 4er- M/t 4ASX y On was issued a permit to install a (date) (installer) septic system at vL�, based on a design drawn by (address) CS N in e;e.—n I. dated S3 QO Q (designer) I certify that the septic system referenced above was installed substantially according to ___V/ the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. Stripout (if required) was inspected and the soils were found satisfactory. 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. Stripout(if required)was inspected and the soils were found satisfactory. OF umDA J. (Ins ler's Signa e) PI VI a` v esigner's SignatLLre) (Affix D Isere) PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COI IPLIA dCE V5JLL NOT BE ISSUED UNTIL BOTH THIS FOl'M' AND.AS- BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. gAoffice forms\desipemertification form.doc ` Do•_: 1 s`?30 r 704 09-13-2013 12:25 BARNSTABLE LAND COURT REGISTRY Notice of Alternative Sewage Disposal System M.G.L. c. 21A, § 13 and 310 CIvLR 15.0287(10) This Notice to be recorded and/or filed for registration in the chain of title of the Property served by an Alternative _wage Disposal System("Alternative System').] _ NAI�� S) OF OWNER OF PROPERTY SERVED BY ALTERNATIVE SYSTEM: ADDRESS OF PROPERTY SERVED BY ALTERNATIVE SYSTEM: TITLE REFERENCE FOR PROPERTY SERVED BY ALTERNATIVE SYSTEM [check and complete each that appliesj: _Deed recorded with the Registry of Deeds in Book Page Certificate of Title NE lTl 016 issued by the Land Registration Office of the ,,,,, �4►1 P� Registry District —Source of title other than by deed (If alternative System Owner(s) is other than Property Owner(s), complete the following:] Alternative System Owner Name: Alternative System Owner Address: IWHEREAS, Section 15,280 of Title 5 of the State Environmental Code ("Approval of Alternative Systems"), provides for the Massachusetts Department of Environmental Protection (the "Department") to approve or certify, as appropriate, all proposals to construct, upgrade or replace on-site sewage disposal systems using alternative systems; WY=REAS, owners and/or operators of approved or certified alternative systems are subject to general conditions; as specified in Section 15.237 of Title 5 of the State Environmental Code, 310 CNa 15.287, and may be subject to special conditions, as specified in the Department's approvals or certifcations; such general and special conditions potentially including, without limitation, requirements reiaiing to the use of trained operators, periodic inspections, maintenance, sampling, reporting and/or record'beeping; WHEREAS, Section 15.287(10) of Title 5 of the State Environmental Code, 310 CMR 15.287(10), requires that "prior to obtaining a Certificate of Compliance for installation of a new or upgraded system, the system owner shall record in the chain of title for the property served by the alternative system in the Registry of Deeds and/or Land Registration Office, as applicable, a Notice disclosing both the existence of the alternative on-site system and the Department's approval of the system. The system owner shall also provide evidence of such recording to the local Approving Authority [;]" and 'NFiIEREAS, the Property is served by an alternative sewage disposal system. NOW, THEREFORE, Notice of an alternative sewage disposal system is hereby given for the above-referenced Property, as follows: 1 Existence. 'An alternative system has been installed as a new or upgraded alternative sewage disposal system; on or adjacent to the Property, and serves the Property. The trade name and model number(s) of the alternative system are as follows: Trade name of technology, 7��5 Manufacturer Name: „��; .`�a r Model number(s): Eb� 361 �1 UP Page I of 2 i _ i 2. An-oroval/Certification. On�p� �t�— [date], the Department, pursuant to its authority under the section of Title 5 as speci5ed below, approved or certified the technology used in the above- referenced J referenced alternative system, under MassDEP Transmittal Number (Transmittal Number of approval or certification]. [Check one of the following, as appiicable:] Approved for remedial use under 310 CMR 15.284 Approved for piloting under 310 CNa 15.285 _Provisionally approved under 310 CMR 15.286 Certified for general use under 310 CMR 15.288 A copy of the Department's Approval/Certification is available from the Departinent in person or on- line at the Department's website: httpWwww.mass.aov/dep . 7V7l NESS the execution hereof under seal this la day of�� 6� 20 l3' , made by the above-named Alternative System Owner(s)/ W, QQ [Alternative System Owner(s)] Print Name(s): CON ENJONWEALTH OF YLASSACHUSETTS �c✓i'ru �Q�, ss oN_BRO ' � On this L_'day of.�< , 20 1, before me, the undersigned notary public, �tP,R � �� 201q�FS zppeared Qsur•- ,t� (name of document signer), proved to me through sa � . evidence of identincation, wtuch were Id( , to be the person wh el is,, signed on the preceding or attached document, 6,d acknow edged to me that(he) (she) si >� o voluntarily for its stated purpose. NoZPJ�'� _ kvv COMMO (ofrici ignature and seal of notary) MAss [Complete the following P,r'operty Owner(s) Consent if Alternative System Owners)is other than the Property Owner(s):] CONSENTED TO- [Property Owner(s)] Print Name(s): Date: �. i � i COMMONWEALTH OF MASSACHUSETTS w SS = �pw N ' 7W� W On this C_ay..of , 20_, before me, the undersigned notary public, personally o LL oa o c. o' w ' . appeared (name of document signer), proved to me through satisfactory m}o a .evidence of identification, which were , to be the person whose name is <Erw i . signed on the preceding of attached document, and acknowledged to me that (he) (she) signed it M W �J Z voluntarily for its stated purpose. C _ o (official signature and seal of notary) Upon recording,return to: [Name and address of Property Owner(s)] ` Page 2 of 2 BARNSTABLE REGISTRY Of DEEDS r Town of Barnstable OF1ME r Regulatory Services ti Richard V. Scali, Interim Director 1STAB Public Health Division y MASS. g `bAl039. p,0 Thomas McKean, Director Fa�r 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Homeowner Certification Form for Alternative Systems. Property Address: Assessor's Map\Parcel: � Property Owners Name: "t aSc� �G In accordance with Massachusetts DEP alternative system approval letters, the following certification information is required by the Owner of record. The Owner of record must place an "x" in the applicable box next to each line certifying the information. Yes N\A P" ❑ I have been provided a copy of the Title 5 VA technology Approval letters. (15 page Standard Conditions letter and the specific technology letter) V_ ❑ I have been provided with the Owner's Manual ❑ have been provided with the Operation and Maintenance Manual El or Systems installed under a Remedial Use Approval, I agree to fulfill my responsibilities to provide a Deed Notice as required by 310 CMR 15.287(10) and the Approval ❑ LJ For Systems installed under a Remedial Use Approval, I agree to fulfill my responsibilities to provide written notification of the Approval to any new Owner, as required by 310 CMR 15.287(5) ❑ If the design does not provide for the use of garbage grinders, the restriction is understood and accepted Y ❑ Whether or not covered by a warranty, I understand the requirement to repair, replace, modify, or take any other action as required by the Department or the LAA, if the Department or the LAA determines the System to be failing to protect public health and safety and the environment, as defined in 310 CMR 15.303 agree to comply with all terms and conditions above: erty Owners ri d n e Property Owners Signature Oat Note: This form must be submitted along with the septic system disposal works permit application for all I\A systems including new construction, repairs\upgrades, with and without aggregate (stone) and with conventional design criteria or credited design criteria. Q:\Septic\IA homeowner certification.doc AL `Q VILLAGE. -1 1 .4STi LLERIS DAME A ADDRESS e*IP/vo --Z1L1Lc( ?I, 4 1, ZAZ 6fe& _ I UtLacR I OR . OWNER �—w it-- n ,ATE PERMIT OSSUED � OAT E £ 0MPLIANCE ISSUED A S T. LA No. -........._....... E _. Fms........................... THE COMMONWEALTH OF MASSACHUSETTS _ BOAR® OF HEALTH Qd-v.....................OF.......... ' ApplirFation for Uhipoii al Workii Tum4rnrtion ramit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal �X�System at JG ►i I�Lb ;leis ..�X ®� � ... f ?1�:.__.. ---------••-•.....................................' ......... ................. ..... Location- dress or Lot ......AhaL?j....A...�iIU.a-F.T---....................................... ............................ Owner Address `,W ...................................... .........•----•---••-----•.. ......----••........... Installer Address Type of Building Size Lot �._$<:�O-------Sq. feet 3hU Dwelling—No. of Bedrooms................ .............._.......Expansion Attic ( ) Garbage Grinder ( ) p, Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) a, < Other fixtures ---------------------------------•-----•------•---•---.•-------------------------------------------------------••----........_._...._.....---.....---- W Design Flow...............�a'Ir..................gallons per person ger day. Total daily flow.........ZZ%......................gallons. 9 Septic Tank—Liquid capacityf -_gallons Length@,�___... Width. -'6_..__. Diameter---------------- Depth. W..... Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. = 3. Seepage Pit No....__.�-------- Diameter....AO."...... Depth below inlet....Z........... Total leaching area.. �--sq. ft. 'Z; Other Distribution box ( ) Dosing tank ( ) ._ Date------- --•- ,:; Percolation Test Results Performed by........_�:��-�J._..�!�-�L�'. ................ . �r' ........... Test Pit No. 1.........a..minutes per inch Depth of Test Pit../� ....... Depth to ground water........................ (z, Test Pit No. 2................minutes per inch Depth of Test Pit-------------------- Depth to ground water........................ P4 Description of Soil -Q � <1k ..._ ------..1 ;;..... U ................. --------------.....----------------------------------------------------------•----------------------------------------------- W -••----•---------------------------•-------••------•--•----•....--------•---------•-••--••------------------•---•-----------•--------•-------•--------•---•---------•---•--•-------------•---••--_.... VNature of Repair's or Alterations—Answer when applicable............................................................................................... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage isposal System in accordance with the provisions of TITL U 5 of the State Sanitary Code—The undersigned.fdrther agrees not to place the system in oper4on until '-drtifijate of Compliance has been ' sued by the oard of health. Signed••• --------------------••--•-- ^/ l Date 6?pplication Approved By.......................... -•---•-------.C-•......0.4 --------•---. Date Application Disapproved for the following reasons-................................................. .............................•-•-••--•---•---•---•-------------•-•••.:.......---•--.._._...................•------•--•-•---------•---------------.........-•--------•------••----••--•-----••-•-••-•••--- Date PermitNo......................................................... Issued_....................................................... Date F iw s w FEs.: THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH t��t .x-................OF.......... '(s.o.�_... Appliration for Disposal Works Tonstrnrtiun rrmit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: ....... ' .Fr► y U ...�....1....... ... All Ay % -....4 ----------------------------------------------- Location-Address I or Lot No. Owner J Address .......... ---•-•--------------•----------------- ------•--•------------------•-------------•---•-•-------•-•--------------------------------•------ Installer Address Type of Building Size Lot,l _� ?_� .....Sq. feet Dwelling—No. of Bedrooms...............Z.......................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ---------------------------- No. of persons............................ Showers ( ) — Cafeteria ( ) Otherfixtures .---•-•-----•-----------------•-•-•------•-•----•---.........-------------------------------•-•------•----------•----------••---•-•--•----•......-•--- W Design Flow...............,_,j--:_------------_gallons per person Ver day. Total daily flow........ZZCi........................gallons. WSeptic Tank—Liquid capacrty,/Cr6t�__gallons Length ��,_..:._ WidthC�'._�__._... Diameter---------------- Depths ..._. x Disposal Trench—No. .................... Width.................... Total Length.....................Total leaching area....................sq. ft. Seepage Pit No.......,/......... Diameter.__1 ......... Depth below inlet.... :..:......... Total leaching area..0,CC�>...sq. ft. Z Other Distribution box ( ) Dosing tank ( ) - aPercolation Test Results Performed by_.._!r 's � __.1 _' ................ Date....- .'/`� r Test Pit No. 1._`�._Z.._minutes per inch Depth of Test Pit.,l�i� .:..... Depth to ground water________________________ Pr Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 9 •------••-------------------------------------•-•-•--------.........-----------.............._............................................................... Description of Soil....f�. `!......pis* !�.........•...�''Y= 5'.�....... — -4 `~`�S_�2 � ..... V --.......•-•----••-.._........•-• uflt2 �'?' ------------------------•-- ------. W --------------- -----------------------------------------•---- ---------------------------------------------------...-----------•--•------------------------•------•-----._...--•---•--•••--•••-•---•••- 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 TIT1E 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---,�>..�r.�' __'.."_'•-------------------------•---••---- ................................ — Application Approved By = 1a --.................. Date Application Disapproved for the following reasons---------------•-------------------•---------------------------------------------•---••-•---••----•-.........._ .......-----•----•-----••..........•----•.........-••--•----•-••--••........--•••------•---•-------------••---•-•--•--•--•--••-•-•--•••••---•••••-•------•--•-----•--•----------•......•--•--••--•-••--- Date oPermit No...................................................-.... Issued....................................................... Date ' r r ^`v THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH I `.................OF...... .................................. I Tnrtifiratr of Tuamplianrr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed(X) or Repaired ( ) ------••-•-•-•----..... -• ----•----•-...------•..............•-•---.._...-----•............---••---•--------•---•._._...........--•-----.........--•--•.......---------- j Installer L /e`, f] at--•-••-•••--•-•-••..�..'•,- �......c - 1`-j =-� --. 1 --•--------- has been installed in accordance with the provisions of TITIF 5 of Ttie� State Sanitary Code as escribed in the application for Disposal Works Construction Permit No.........:. :..:. ................... dated_....4 �....... ___.___.___._.______.__ !T THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONST UED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE. ...........................................................� Inspector....-------- ..... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH w'C:................OF.... .................................... .... FEE.....: ..C ......... Disposal Works 01,11ntrnrtinn rrmit Permissionis hereby granted.`t/g-! -, ;;.._..---,-- --•--. •-----------•-------•-•-----------------•----••-------........----•-••..........-•-•--•--- to Constructs( ) or-,Repair ( ) an Individual Sewage Disposal System at No...-=••••--`•-+=•---•----`---`- --•--f----..tf-------------'- )..... •••----•---------------------------Street _t---------.! as shown on the application for Disposal Works Construction Permit No=..,.t..._......_ Dated. ................................................... ..................•....•--•-----•-••.----•-•--•••-••---------••--•--••••--••••......-•-•-•----•--_....% _ Beard Hof Health DATE.................. ........................................................... FORM 1255 A. M. SULKIN, INC.. BOSTON r - -- - - Z 3N�� I I4/1 � - Z Lo T { — ¢b p 47Isri. C, W n1 4 /rLVND, I N 4o7 �/` M37- � IW Z�' O seync ( ¢ese�zvd 2 vis r sox PIT 1 �G ,ei•v�c , 36 I 3 Ae L-OCATION SCALE . . ./ 1i:'3o DATE .^!ov.. 7s /9SS r �t PLAN REFERENCE Cou/L T - 7'E. KELLEY PL,�IN /�fO3¢ N S/ 8T l 'No. 28100 ,+0 '`fs GISTER``- . O` s�o/lAL l,A��S I CERTIFY THAT THE SHOWN ON THIS PLAN IS LOCATED ON THE GROUND AS SHOWN HEREON ,AND THAT IT CONFORMS TO THE SETBACK REQUIREMENTS OF THE TOWN OF . . . . . .. . .. . . . WHEN CONSTRUCTED. DATE :. . . . . . . . .. . 770^/,6-7Z- REGISTERED LAW,�iSURVEYOR TOP OF FOUNDATION CONCRETE COVER CONCRETE COVERS 3,78 a 4"CAST IRON II2"MAX. 12"MAX. "'�"'n''' • ''. OR SCHEDULE 40 4°SCHEDULE 40 PV.C.(ONLY) P.V.C: PIPE PITCH I/4"PER.F PIPE- MIN. LEACH T PITCH 1/4"PER.FT. PIT PRECAST o INVERT e a LEACHING INVERT INVERT p . �.; PIT OR e , SEPTIC TANK 3 3� DIST. g w .c EQUIV. ,•a INVERT EL.:. .. . . . BOX ELAV-. 4 >s / 37,5/ 9� GAL. INVERT F-a '" 3/4"TOII& o' EL.. "' INVERT '' vw o: :�• EL37;Z3 ELG.Bo k� WASHED .STONE �,. WDIA. I /o' DIA.;—q 8.4' PROF LE OF GROUND WATER TABLE SEWAGE DISPOSAL SYSTEM NO . SCALE SOIL LOG WITNESSED BY : DATE TIME. 5.3oAr, ?�� .�'��'� . BOARD OF HEALTH TEST HOLE I TEST HOLE 2 ENGINEER ELEV. 38;8o ELEV. .. woo�lo�,y J -' swig-So; DESIGN DATA • -Z,3C,$o NUMBER OF BEDROOMS z. . : . . . . . . . TOTAL ESTIMATED FLOW . . ,Z,2v GALLONS/DAY dO eZ.33 80 BOTTOM LEACHING AREA 78,So SO.FT. /PI TIC, P.D. • SIDE LEACHING AREA . . .�81�'So SQ.FT./ PIT1471 G.p,D. GARBAGE DISPOSAL (50% AREA INCREASE) Sip TOTAL LEACHING AREA . ZG74. . SQ.FT /44" en,Zf.Bo PERCOLATION RATE ?�.5�.�!^!G!'�. . . MIN/INCH LEACHING AREA PER PERCOLATION RATE .SQ.FT�C.RD. No, •WATER ENCOUNTERED UNE /�T Gt/iTJ� NUMBER OF LEACHING PITS . . . . . APPROVED . . . . . . BOARD OF HEALTH p• r GF S�'aN� D�/ !-I GL S/��3 DATE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . AGENT OR INSPECTOR eMA ` SH OF Of LoT 017. . . o /1 E. " o. KELLEY y sA:4 G. /N/C �O/Yjj No. 26100 `� 9 ' C? /STE•P� PETITIONER , w�4_ �� F SWI TOP OF FOUNDATION 24 dameter concrete covers HYAN N S, EL=3G.0 raised to wrthm 6"of finish grade MA (or as noted) fnspectro. Port and cap with magnetic TWENTY SEVEN 7) ADS A 2( RG3GHG(3G I GBD2) e . Pal cad LEACH CHAMBERS IN BED CONFIGURATION WITH yrte s Exotmy EL=35.4t mar[-�ng tine to wrthm 3"of grade EC=34.0+ fL=32.0-34 /(max) THREE(3) ROWS OF NINE (9) CHAMBERS Ge Ln �am� cOs 45 MaN �o\PJ C4 �tc9 V a\� � 5.0' 5.0' 5.0' -5.0' 5.0' 5.0' 5.0' 5.0' 5.0' gt G oc0e e 33.3+ w „ 0� ..: Ewstm _ N 32.2+ g 31.!+ v m x D Box 5t 5e c� G m o��tc 1 0 Ewstm 32. °F 3/.8+ 30.90 ✓ a C Enstrn O 30,73 30.65 9 = N 9 fxistmg Inspection Port(See Note#4) kytr0 Gas Baffle 29.75 40 md. HOPE L ner(see Note#24) o5 }- Long5t Run TWENTY SEVEN(27)A05 ARC36HC _ LOCUS90' 0 pLAV VIEW(3 ) E R SX15T/NG 1000 GALLON DD-6 CONFIGURATION WITH TtlREE(3)ROWS SCALE: I (h1-20 Rated) OF NINE(9)CHAMBERS " = 10' 51TE LOCUS p�7- /� TANK / R/� / ^ /'�/.../ /../n p AQ p IEL=2l.Bi-Bottom of Test No% Sf/ l 1 /A VK �-301V L_fACam/ / C/ /A/V/L f9,5 NOT TO SCALE FLOW F'ROFI LE _ G NOT TO SCALE IN I STALLER TO VERIFY THE LOCATION OF ALL I .) A55e55or'5 Map 29 1 Parcel 174 CO NSTRU CTI O I y I y OTE5 UNDERGROUND AND OVERHEAD UTILITIES 2•) Deed Book C 18142G Bth PRIOR TO THE START OF ANY EXCAVATION 3•) Land Court Plan 1403441 Lot 17 1.) ALL WORK SHALL CONFORM TO THE STATE ENVIRONMENTAL CODE, TITLE 5 (3 10 CMR 1 5.000): 4.) This property i5 in a Zone I of a Public STANDARD REQUIREMENTS FOR THE SITING, CONSTRUCTION, INSPECTION; UPGRADE, AND ACTIVITIES'AND RELOCATE AS NECESSARY Water Supply EXPANSION OF ON-51TE SEWAGE TREATMENT AND DISPOSAL SYSTEMS AND FOR THE TRANSPORT (SEE NOTE #1 5) 5.) Flood Zone: C AND DISPOSAL OF SEPTAGE, AND THE LOCAL BOARD OF HEALTH REGULATIONS. Bdrm Bdrm 2.) ANY SEPTIC SYSTEM COMPONENT INSTALLED IN A LOCATION WHERE THERE 15 POTENTIAL FOR VEHICLES OR HEAVY EQUIPMENT TO PA55 OVER IT SHALL BE DESIGNED TO WITHSTAND AN '1-20 Exrstrng Septic Tank to be LOADING. IF UNDER AN IMPERVIOUS SURFACE,SYSTEM SHALL BE VENTED TO THE ATMOSPHERE. Utilized(See Note#2/) LEGEND Second Floor Exlst/n 5e tic Com onents to 3.)TO MINIMIZE UNEVEN SETTLING, SEPTIC TANKS SHALL BE INSTALLED ON A STABLE 9 P p - ' MECHANICALLY-COMPACTED 5A5E ON 51X INCHES OF CRUSHED STONE. be Abandoned(See Note#22) 12.3 EXISTING SPOT GRADE 24x5 PROPOSED SPOT GRADE 4.) COVERS OVER THE INLET AND OUTLET TEES OF THE SEPTIC TANK, THE DISTRIBUTION BOX, AND Bth Kitchen THE 501L ABSORPTION SYSTEM SHALL BE RAISED TO WITHIN G" OF FINAL GRADE. LEACHING Bdrm za EXISTING CONTOUR 24- PROPOSED CONTOUR FIELDS,TRENCHES, AND OTHER SOIL ABSORPTION SYSTEMS WITHOUT ACCESS MANHOLES SHALL Garage 34 N 6°� HAVE AT LEAST ONE (1) INSPECTION PORT CONSISTING OF PERFORATED 4"PVC PIPE PLACED m 3'50„ WW WATER SERVICE LINE VERTICALLY TO THE BOTTOM OF THE SOIL ABSORPTION SYSTEM WITH A CAP, TIED WITH MAGNETIC \ , (�, 0 105.pO 1 , O OVERHEAD UTILITY LINES MARKING TAPE, ACCESSIBLE TO WITHIN 3"OF,FINAL GRADE. Den/ Living _Bdrm U UTILITY L LINES UNDERGROUND UTI 33.5 G GAS SERVICE LINE 5.) PIPING SHALL CONSIST OF 4" SCHEDULE 40 PVC OR EQUIVALENT. 'PIPE SHALL BE LAID ON A \ ` I 34.9 MINIMUM CONTINUOUS GRADE OF NOT LESS THAN 2% FROM THE BUILDING TO THE SEPTIC,TANK, EDGE OF CLEARING AND NOT LE55 THAN I%OTHERWISE: First Floor 35.4 7 TEST HOLE LOCATION G.) DISTRIBUTION LINES FOR THE SOIL ABSORPTION SYSTEM SHALL BE 4 DIAMETER SCHEDULE 40 :'<:1::. 2 She LOT 17is PVC(OR EQUIVALENT} LAID 0.005 FT/FT. UNLESS OTHERWISE NOTED. LINES SHALL BE CAPPED '� \ :•i>/ 3a.9� 08' d + ST SEPTIC TANK .,_._ :a - Area 10,400 _ _ LI11 C7n.A.J NOTED :' �..:_.�_.....-::::._nr._ :.. . ,..... , �._. ... •_. ....-,___ -. ..z.s ` ..J. .. I I _- �... s yy 1 i.: Lv ° FLAN _I �� L N �A� 501L a - / � � :. O L BSORPZ ION SYSTEM , 7.) LINES FROM THE DISTRIBUTION BOX TO BE LEVEL FOR THE FIRST TWO 2 FEET Bfl=OR`r O m ' 3'4 1 PITCHING TO THE SOIL ABSORPTION SYSTEM. DISTRIBUTION BOX SHALL BE WATER TESTED TO 32 NOT TO SCALE ASSURE EVEN DISTRIBUTION. Ln o 33 I - Exis Ei 8.) GROUT TO BE USED AT ALL POINTS WHERE PIPES ENTER OR LEAVE ALL CONCRETE STRUCTURES U q \ p I Porch n9 4 g� 31 G , dr IN ORDER TO PROVIDE A WATERTIGHT SEAL. (L/ N To/,oDWelfin� oo r G l ,r,I', E at 5Y5TEM DE51GN CALCULATIONS .� \: ,on 9.) HEAVY EQUIPMENT SHALL NOT BE ALLOWED TO OPERATE OVER THE LIMITS OF THE SEWAGE DISPOSAL FIELD DURING THE COURSE OF CONSTRUCTION OF THE SYSTEM, 0s` 5EW16E DESIGN FLOW REQUIRED.•4 BEDROOM DWELL/N @ 9G , 10: IN ACCORDANCE WITH 3 10 CMR 1 5.22 I ALL SYSTEM COMPONENTS SHALL BE MARKED WITH l!O GPD/BEDROOM= 440 GPD REOUIRED � S/eeue astelme " eck 1 ) RK H MAGNETIC MARKING TAPE. r.I": (See Note#23) SEWAGE DE5IGN FLOW PROVIDED: TWENTY5EVfN(27)ADS UNITS 1N BED �= m x� OF (I.)THERE ARE NO KNOWN WELLS WITHIN 100'OF THE PROPOStD SOIL ABSORPTION SYST:`.M. CONFI6JlZ4TION IN THREE(3)ROW5 OFNINE(9)UN1T5 EACH. co , si CD O Grav n el I oN Y Dnu NUNDA 12.) FROM THE DATE OF THE INSTALLATION OF THE 501L ABSORPTION SYSTEM UNTIL RECEIPT OF Vt=I(440/0.74)/(4.B FTZ/FT)/5.0lt7 =24.7A05 UNITS 00 `THE CERTIFICATE OF COMPLIANCE,THE PERIMETER SHALL BE STAKED AND FLAGGED TO PREVENT REQUIRED(27 PRO VIDED) USE OF THE AREA THAT MAY CAUSE DAMAGE TO THE SYSTEM, 479 GPD PROVIDED> 440 GPD REQUIRED 13.) THE DESIGNER WILL NOT BE RESPONSIBLE FOR THE SYSTEM AS DESIGNED UNLESS 0.3 -E «T� CONSTRUCTED AS SHOWN ON PLAN. ANY CHANGES SHALL BE APPROVED IN WRITING BY THE- SEPTIC TAI4,� CAPACITYREQUIRED. 440 GPDX 200% - 880 GPD REQUIRED .. , o BENCHMARK 4. i®1�ALG� DESIGNER. To of Gara e Slab SEPT/C TANK CAPACITYPROVIDED: /000 GALLON SEPTIC TANK � p 9 tir, w + w, 0 f =35.8(Assumed Datum) r, _ - 14.)THE BOARD OF HEALTH REQUIRES INSPECTION OF ALL CONSTRUCTION BY AN AGENT OF THE �:; ;, ,;, l w, BOARD OF HEALTH AND THE DESIGNER. THE DESIGNER SHALL CERTIFY IN WRITING THAT THE A GAR6AGf DISPOSAL lS NOT PERMITTED WITH Thl5 DES/GN FLOW O w I ty E TERMS OF THE PERMIT Qg Survey )Fork by.SEWAGE DISPOSAL SYSTEM WAS INSTALLED IN ,ACCORDANCE WITH TH ' AND THE APPROVED PLANS. 48 HOURS ADVANCE NOTICE 15 REQUESTED. 319 �,5� �2' 9 A & M Land Services 1 5.) LOCATION OF UTILITIES 15 APPROXIMATE AND CONTRACTOR SHALL BE RESPONSIBLE FOR TES HT I I O LLF LOG..' ry 42051, 35. 818 Route RA Suite 3 DETERMINING THE LOCATION OF ALL UNDERGROUND AND OVERHEAD UTILITIES PRIOR TO eamleadicomcast 3� 35.1Hest Yarmouth, MA02673 COMMENCEMENT OF ANY WORK.TI11S INCLUDES, BUT 15 NOT LIMITED TO, REQUESTS TO DIGSAFE, . .• .net ANY PRIVATE UTILITY COMPANIES, AND THE LOCAL WATER DEPARTMENT. Te5t Hale#I (EL=32.8±) 34 Pb 608 J y97=1T7�' Email I G.) CONTRACTOR SHALL VERIFY THAT ALL WA5TELINE5 ARE CONNECTED BY WATER TESTING Depth Layer Sod Class Sod Color Comments C, F \I WITHIN THE DWELLING PRIOR TO INSTALLATION OF ANY SEPTIC COMPONENTS. 5 ITE PLAN LAI V REVISION 9/13/1 3: Added Reserve Area 0"-14 Fill' 17.) CONTRACTOR SHALL VERIFY EXISTING INVERT ELEVATIONS PRIOR TO INSTALLATION OF ANY 14"-1 7' A Fine-Medium Loamy Sand I OYR 3/2 Prepared for: SEPTIC SYSTEM COMPONENTS. 17`-29 5 Fine Loamy Sand I OYR 5/G SCALE: I " = 20' 29 1 32" C I_ Medium-Coarse Sand I OYK 5/4 40% Grave Re5ureccion Mangaha5 15.) INSTRUMENT SURVEY CONDUCTED FOR PROPOSED WORK ONLY. SITE PLAN SHALL NOT r3E Perc @ 52" 7G Skatinag Rink Rd., Hyanri5, MA USED FOR STAKING, OR ANY OTHER PURPOSES. 19.)THI5 PLAN DOES NOT CERTIFY, GUARANTEE OR WARRANTY COMPLIANCE WITH DEEDED OR ` Te5t Hole#2 (EL=33.8±) PI"OpO5ecl 5eWaGje D15p05al 5y5tCM ZONING BYLAWS, SPECIFICALLY; BUT NOT LIMITED TO, SIDELINE SETBACKS AND BUILDING HEIGHT 7G Skatln Kink Rd., I1 annls, MA RESTRICTIONS. OWNER IS RESPONSIBLE FOR OBTAINING SUCH A DETERMINATION FROM THE Depth Layer Soil C1a55 Sod Color Comments I CERTIFY THAT I AM CURRENTLY APPROVED BY THE 9 y APPROPRIATE AUTHORITY. DEPARTMENT OF ENVIRONMENTAL PROTECTION PURSUANT TO INSPECTION NOTE: O' 12" F111 310 CMR 15.017 TO CONDUCT 501L EVALUATIONS AND THAT Prepared by: 20.) IF SOILS DIFFER FROM TH05E SHOWN IN THE SOILS LOGS, DESIGN ENGINEER 15 TO INSPECT 1 2-1 5 A Fine-Medium Loamy Sand I OYR 3/2 THE SOIL ANALYSIS HAS BEEN PERFORMED BY ME CONSISTENT c THE SOILS PRIOR TO PROCEEDING WITH INSTALLATION. 15"-35" B Fine Loamy Sand I OYR 5/G WITH THE REQUIRED TRAINING, EXPERTISE, AND 'EXPERIENCE PRIOR TO FINAL IN5PECTION BY THE 35"- 32 C I Medium-Coarse Sand 10YR 5/4 40% Gravel DESCRIBED IN 3 10 CMR 1 5.01 7. 1 FURTHER CERTIFY THAT THE 1 ENGINEER;SYSTEM NEEDS TO BE COMPLL7E 2 1.) EXISTING 1000 GALLON SEPTIC TANK TO BE UTILIZED. PVC TEES TO BE INSTALLED ON IwLET RESULTS OF MY SOIL EVALUATION AS INDICATED ON THE INCLUDING BUILDUP FOR GONERS. AND OUTLET PIPES IF NECESSARY, AND A GAS BAFFLE INSTALLED IN THE OUTLET TEE. ATTACHED SOIL EVALUATION FORM, ARE ACCURATE AND IN ACCORD CE WITH 0 CMR 15.100 THROUGH L 5.1 0722.) EXISTING SEPTIC COMPONENTS TO B DATE OF TEST1NG: 08/28/13 P#141 12J.E LOCATED; PUMPED DRY, FILLED WITH CLEAN SAND AND ABANDONED IN PLACE.: AREA TO B 501L EVALUATOR: LINDA J: PINTO, P.E., C5N ENGINEERINGE COMPACTED TO MINIMIZE SETTLING. BOARD OF HEALTH AGENT: DONNA MIORANDI, BARNSTABLE HEALTH DEPARTMENT �31 - 0 20 40 GO 23.)WATER/SEWER CROSSING: 4" PVC WASTELINE SHALL BE SLEEVED IN A 20'SECTION OF G" PVC PERCOLATION RATE: LE55 THAN 2 MIN/INCH IN "C" LAYER P.O.Box201 Phone:(508)299-3250 PIPE CENTERED OVER THE WATER LINE TO MAXIMIZE DISTANCE TO JOINTS. Linda J. Pmto rtlfied Soil Evaluator Brewster,MA 02631 Fax:(508)896-1783 =20 NO GROUNDWATER ENCOUNTERED SCALE I $" CAC5N\RR-5katin Rink\RR-5katin Rink-5D5 Plan.dw 9 9 9 Date'. 08/29/f 3 Scale:As Shown By: UP Check: VITA Project No.C5N0390