HomeMy WebLinkAbout0157 STRAIGHTWAY - Health - 5 T Stt a gh Lway
Hyannis,
A=268-218
1
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0 0
TOWN OF BARNSTABLE
LOCATION SEWAGE# ✓/r✓
VILLAGE !9/ '" AS SSOR'S MAP&PARCEL
INSTALLER'S NAME&PHONE NO.
SEPTIC TANK CAPACITY
LEACHING FACILITY:(type) /;qv[C (size)
NO.OF BEDROOMS .
OWNER JOrJ]�
PERMIT.DATE: OMPLIANCE DATE:
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
L' N
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B
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No. wll� Fee /00
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
Yes
PUBLIC HEALTH DIVISION -TOWN OF BARNSTAB~LE, MASSACHUSETTS
ApplitAtion for I l�tl sa' 6pBtem �Construttion 3pPrmit
Application for a Permit to Construct( ) Repair( Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components
Location Address or Lot No. /`57 j�Igh7i_, Owner's Name,Address,and Tel.No.
Assessor's Map/Parcel r aff' 1 V`
7 3.441)A�l 0/
Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No.
Type of Bu' ing:
Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( )
Other Type of Building 1fV_U-_ No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow(min.required) gpd Design flow provided gpd
Plan Date Number of sheets Revision Date
Title
Size of Septic Tank lS�Z?8 Type of S.A.S. `�y awcA �/ S
Description of Soil
Nature of Repairs rAlterations(Answer when ap 'cabl ) 'lowS
C✓a��r
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 lace the system in operation until a Certificate of
Compliance has been issued by this Board of Health.
igne Date loR1111 .
`Application Approved b Date J/
rr rr y Al
Application Disapproved by Date
for the following reasons
Permit No. ( Date Issued .
11 ..
No. 75 Fee /CEO
- THE"COMMONWEALTH OF MASSACHUSETTS Entered in computer:
6 Yes
PUBLIC HEALTH DIVISION - TOWN OF BARMSABLE, MASSACHUSETTS a.
Z[OpW,dtlon'for Wsposal *pBtemtootCULttott Permit
Application for a Permit to Constnict(�) ,Repair(V Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components
N
Location Address or Lot No. ?57 �&11 h� i Owner's Name,Address,and Tel.No.
Assessor's Map/Parcel a/ S'¢
Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No.
Vdl�/ �Y �- Ou 'f
Type of 11 ing:
Dwelling No.of Bedrooms .S Lot Size sq.ft. Garbage Grinder( )
Other Type of Building h/ w-e_ No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow(min.required) a gpd Design flow provided Zt7 gpd
Plan Date Number of sheets Revision Date
Title '
Size dSeptic Tank n Type of S.A.S.
Description of Soil
d ,
Nature of Repairs rAlterations(Answer when ap 'cabl ) c S r
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 lace the system in operation until a Certificate of
Compliance has been issued by this Board of Health.
�igne � v�c�.� Date
Application Approved by ! Date
Application Disapproved by Date S.
for the following reasons
Permit No. �' Date Issued G r
------------------------- - ------- ----- ------ ---- ----------------------
THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE,MASSACHUSETTS
certificate of Compifattce
THIS IS TO CERTIFY,that the On-site,Sewage Disposal system Constructed( ) Repaired(graded
Abandoned( )by
at 15-7 has been constructed in accordance
with the provisions of itle 5 and the for Disposal System Construction Permit No., /— dated 0 L31111
Installer JG/i�{ L; Designer _,_A_4f Su K�(Ey
#bedrooms Approved design fl and
The issuance oft is p rmit shall not be construed as a guarantee that the system w' 1 t'on as tsigned.
Date 1 t t Inspector
-------------------- - - - ------- ------X --------------- ---------------------------------
No. �J� fr _ --------Fee----- --�-------
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS ,
]Disposal e*pstem OUBtCUctIDIC Permit
Permission is hereby granted to Construct( ) Repair( V1 Upgrade( ) Abandon( )
System located at /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:Construc-ion mu t be completed within three years of the date of this permit.
Date 3 l Approved by
Town of Barnstable
Regulatory Services
. Thomas F. Geiler,Director
BAR
i3LE,
Mom. Public Health Division
i6;.q. gym.
pT�o " Thomas McKean,Director
200 Main Street,Hyannis,MA 02601
Office: 508-862-4644 Fax: 508-790-6304
Installer & Designer Certification Form
Date:
Designer: � J - � Installer: 11 7X-9-1111 A-L S L1,911111
Address: ' I'"U �Z Address: 446 M 44 k)gr
� On , _ � 1 S v- was issued a permit to install a
(date) 1t ( tall )
septic system at 54l I based on a design drawn by
ddress)
���. ��-4r dated
(designer)
I certify that the septic system referenced above was installed substantially according to
the design, which may include minor approved changes such as lateral relocation of the
distribution box and/or septic tank.
I certify that the septic system referenced above was installed with major changes (i.e.
greater than 10' lateral relocation of the SAS or any vertical relocation of any component
of the septic' ystem) but in accordance with State & Local Regulations. Plan revision or
rtified as- ilt by designer to follow.
`ZNOFMggsoy
9
go DAVID
( talle s S gnature) o D.
FLAHERTY, JR,
No. 1211
SA. `,
(Designer's Signature r (Affix Des?, amp Here)
PLEASE RETURN TO BARNSTABLE PUBLIC FJO�ALTH DIVISION. CERTIFICATE
OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS-
BUILT CARD ARE RECEIVED BY THE BAR_NSTABLE P_ LIC HEALTH DIVISION.
THANK YOU.
Q: Health/Septic/Desiper Certification Form
JOB
TAYLOR DESIGN ASSOC., INC. ;H SHEET No. ( of
P.O. Box.1313 r
Forestdale;-MA 02644 CALCULATED BY—' �� DATE_-CdP
Tel./Fax: (508) 790-4686`
L' CHECKED BY DATE
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TAYLOR DESIGN ASSOC., INC. SHEET NO. OF
P.O. Box 1313
02 T
Forestdale, MA 02644 CALCULATED BY Gy DATE
Tel./Fax: (508).790-4686
T CHECKED BY DAT OF y^�+a_
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EXCERPT BOH Meeting Minutes 6/14/11
B. Edward Stone, EAS Surveying, representing owner, Salvation Army - - _
157 Straightway, Hyannis, Map/Parcel 268-218, 10,544 square feet ---
parcel, gravity system vs. pump. --
Ed Stone presented the plans. Thomas McKean brought up the comment that the
plan should be designed by an engineer should be used. Mr. Stone said it is his
understanding of the regulations that if the wall is under four feet, an engineer is
not required. This wall would be 3 1/2 feet. ---
Upon a motion duly made by Dr. Canniff, seconded by Junichi Sawayanagi, the
Board voted to approve the plan for a one foot variance with the following --
condition: a structural engineer must design the wall and that it must meet the -
requirements of Title V and the staff of the Barnstable Board of Health.
(Unanimously, voted in favor.) ". _:.
APPLICANT:
ADDRESS:
DESIGN FLOW: gpd
REVIEWED BY: DATE:
N/A OK NO
Legal boundaries denoted [310 CMR 15.220(4)(a)]
Street, Lot,tax parcel number and lot number noted on plan [310
CMR 15.220 4 u)
Locus Provided 310 CMR 15.2204 t
Plan proper scale?0"=40'for plot plans, 1"=20'or fewer for .
com onents) [310 CMR 15.220(4)]
Easements shown [310 CMR 15.220(4)(b)]
System located totally on lot served [310 CMR 15.405(1)(4)for
u ades]- i not, a variance is.required [310 CMR 15.412(4)]
Location of impervious surfaces (driveways,parking areas etc.)
[310 CMR 15.220(4)(d)
Location all buildings existing and proposed 310 CMR
15.220(4)(c)]
Location and dimensions of system components and reserve areas /
[310 CMR 15.220(4)(e)] t/
S stem Calculations [310 CMR 15.220(4)(f)]
daily flow
se tic tank ca aci re uired andprovided) v
soil abso tion s stem (re uired andprovided)
whether s stem desi ed for arba e grinder
North arrow[310 CMR 15.220(4)( )]
Existing and proposed contours [310 CMR 15.220(4)( )]
Location and log of deep observation holes (existing grade el. on
each test) [310 CMR 15.220(4)(h)]
Names of soil evaluator and BOH representative [310 CMR -
15.220(4)(h)and Ml
Location and date of percolation tests (performed at.proper
elevation?) [310 CMR 15.220(4)(i)]
Percolation test results match'loading rate?-[310 CMR 15.242)
Certification statement by Soil Evaluator f310 CMR 15.220(4) ')]
Observed and Adjusted groundwater(method for adjustment
given or indicated) [310 CMR 15.103(3) and 310.CMR
15.220(4)(n)]
Location of every water supply,public and private, [310 CMR
15.220(4)(k)]
-------------
Address It t -
Sheet-1 of 7
r' J
Fprirvate
in 400 feet of the proposed system location in the case
water su lies and ravelpacked public water su lv
in 250 feet of the proposed system location in the case
in 150 feet of the proposed system location in the case
water supply wells
Location of all surface waters and wetlands located up to I00 ft.
beyond setbacks listed in 310 CMR 15.211 and any catch basins
located within 50 ft. [310 CMR 15.220(4)0)]
Water lines and other subsurface utilities located[310 CMR
15.220 4 (m) (if water line cross see 310 CMR 15.211(1) 1 ;)
Profile of system showing invert elevations of all system /
components and the bottom of the SAS 310 CMR15.220(4)(o)] l/
Stamp of designer 310 CMR 15.220 1 and 310 CMR 15.22 0(2)
Stamp of Registered Land Surveyor(required if construction
activities within 5 ft. of lot line) [310 CMR 15.220(3)]
Test Holes adequate(two in each of the primary and reserve
unless trenches as permitted in 310 CMR 15.102(2) or as
a proved for an upgrade under LUA at 310 CMR 15.405(1)(k)]
Test hole adequate to demonstrate four feet of suitAble material?
310 CMR 15.103(4)]
Test Holes adequate to confirm adequate groundwater separation?
[310 CMR 15.103(3)] V
Benchmark within 50-75'of system [310 CMR 15.220(4)( )]
Materials specifications noted? [various sections of 310 CMR I
15.0001 V
System components not> 36" deep(unless Local Upgrade
jApproval or LUA requested) 310 CMR 15.405(l(b
Address � v }'a� Sheet 2 of 7
l
Size OK? '[3I0 CMR 15.223(1)]
Inlet tee located ten inches below flow line 310 CMR 15.227(6)]
Outlet tee 14" or 14"+ 5"per foot for increase ft depth [310 CMR
1 .227(6)]
Outlet tee with gas baffle or approved filter [310 CMR 15.227(4)]
Note regarding installation on stable compacted base [310 CMR
15.228(1)]
Separation between inlet and outlet tees (no less than liquid
Ldeth) 310 CMR 15.227(2)Outlet elevations at least 12" above high groundwater't as described 310 CMR 15.227(5)) or permitted for
es under LUA [310 CMR 15.405(1)(k)]
Minimum cover 9" (Tanks buried more than 9" must have risers
on all openings and on the d-box) [310 CMR 15.2228(1) and 310
CMR 15.232(3)(f))
Three access covers (inlet and outlet must be 20" or greater) -
middle access at least 8" (b 7/07) [310 CMR 15.228(2)]
Access to within 6 " of grade - one port for systems<I000gpd,
two fors stems>1000 gpd 310 CMR 15.228(2)) .
All at-grade covers secured to unauthorized access? [310 CMR
15.228(2))
> 10 ft from building foundation [310 CMR 15.211(1)]
Buoyancy, calculation Required/Done 310 CMR 15.221(8)]
H-20 Where appropriate? [310 CMR 15.226(3)]
Setbacks from resources [310 CMR 15.211]
Required when other than single-family dwelling or flow>1000
d [310 CMR 15.223(1)(b)]'
First compartment 200%daily flow; Second compartment 100%
dail flow 310 CMR 15.224(2) and.(3)]
"U"pipe through or over baffle, outlet of each compartment with .
as baffle or approved filter[310 CMR 15.224(4)]
Address l 1^�
Sheet 3,of7
Located at least ten feet from any water line? [310 CMR
15.2222)
Disposal piping at least 18" below water line (when water and 77
sewer cross,see 310 CMR 15.211(1)[1])
r
anouts re uired/ rovided ? [310 CMR 15.222(8)]
ust blocks s ecified in force mains?310 CMR 15.221(6)(c)]
e of sewer line not less than 0.01 (1/8"/ft) 0.02 preferable
CMR 15.222(6)]
Proper pitch on all runs? (.005 within gravity-distributed trenches
and beds) r310 CMR 15.251(9)and 310 CMR 15.252(2)(c)]
Siphon—problem/ leachfield below pump chamber)
rEndca or vent manifolds ecified?orientation of discharge holes specified?(not smaller
"not larger than 5/8") [310 CMR 15.251(8) and 310
.252(2)(h)]
Materials specified (310 CMR 15.251(5)specifies various pipe
Itypes allowed)
Stable compacted base [310 CMR 15.22](2)and 310 CMR
15.232(2)(a)] I .
Splash plate or baffle tee required on inlet/provided?(when
pressure sewer to d-box or steep pitch.of gravity sewer) [310
CMR 15.323(3)(a)]
Riser if deeper than 9" [310 CMR 15.232(3)(f)]
Inside minimum dimension 12" [310 CMR 15.232(2)(b)]
Minimum sum 6" [310 CMR15.232(3)(e)]
Watertight cover if<2000gpd); waterproof manhole if>2000gpd
[310 CMR 15.232(3)(d)]
Capacity(emergency storage above working--design flow)? [310
CMR 231(2)]
Proper setbacks [310 CMR 15.211 (same as septic tanks)]
Watertight 20-in minium access manhole at least 20"MUST BE
TO GRADE [310 CMR 15.231(5)]
Service components accessible (not too deep with piping,
disconnects accessible)
Alarm floats - alarm on circuit separate from pumps specified?
Exceeds two units must have two pumps operating in lead-lag
mode. [310 CMR 15.23](6)and (8)]
Stable Compacted Base [310 CMR 15.221(2)]
Buoyancy calculations needed ?Provided? [310 CMR 15.221(8)]
Address ��� Sheet 4 of 7
I S.
NOW
Calculations correct? .
4 feet of naturally occurring material demonstrated? [310 CMR
15.240(11)] - 1 7
Required separation togroundwater? 310 CMR 15.212)] 1/ ,21tp
Aggregate specified as double washed [310 CMR 15.247(2)] ra E
System Venting required/provided?(system under driveway or D = ez
>3 6" deep) [310 CMR 15.241
Inspection ports specified and within 3"final grade? [310 CMR J- VP'
15.240(13)] IVA
Breakout requirements met?(No violation,of breakout elevation /
within lift of SAS unless barrier) [310 CMR 15.211(1)[4] and ` /
Guidance Document] � � � �w
Chambers and Gal. in trench configuration supplied with inlet Wl P
eve 20 ft. [310 CMR 15.253(6)] . `� 1,dtL�S�ph
Each structure with one inspection manhole (if>2000 gpd must 2��vtfVl�
be to grade) 310 CMR 15.253 2 ]
A re ate l'minimum-4'maximum. [310 CMR 15.253(1)(b)] I l
YJ
2' sidewall credit maximum,[310 CMR 15.253(1)(a)] U�Y�
In bed configuration, inlet every 40 s . ft. [310 CMR 15.253(6)]
MERV=Boom
Width-2'minimum Y maximum [310 CMR 15.251(1)(b)]
100 feet-maximum length [310 CMR 15.251 1) a
Minimum separation 2x effective depth or width whichever
eater(3x if reserve,between trenches) [310 CMR 251 1)(d)]
Situated along contours,[310 CMR 15.251(2)]
BreakoutOK?[310 CMR 15.211(1)[4] and Guidance Document]
minimum 2 distribution lines [310 CMR 15.252(2)(a)]
MLAggtegate
imum separation between lines 6' 310 CM R15.252(2)(d)]
mum separation between lines and outside of bed 4'[310
15.252(2)(e)]
depth below discharge pipes 6"minimum, 12"
um.'[310 CMR 15.252(2)(g)]
tion between beds 10'minimum. [310 CMR 15.252(2)(f)]
Bottom area used in calculations only 310 CMR 15.252(2)(i)]
•
i lr -
Address Sheet 5 of 7
{
Pressure Dosed System ? Provided pump and piping
calculations as re uired [310 CMR 15:220 4)(r)J
Pressure dosing required on all systems>2000gpd or aItemGtive
systems under remedial approval [310 CMR 15.254(2) and VA
Remedial Use Approvals]
If used in gravelless system-make sure jet is directed as not to
scour soil interface [Guidance Document]
Inspections once per year;(systems<2000 gpd) or quarterly
(>2000 d)good to note on plan 310 CMR 15.254(2)(d)]
Construction in fill -Did the plan specify that the fill shall meet
the s ecification of 310 CMR 15.255(3)?
Im ervious barrier and/or retaining wall ? [Guidance Document]
IImpervious barrier installation must be supervised by
designer 310 C[ MR 15.255(2)(b)]
Retaining wall must be designed by Registered Professional
En ineer[310 CMR 15.255(2)(a)] OV
rid
slope not exceed 3:1 ? 310 CMR 15.255(2)] a-as(Erd
out requirements met? [310 CMR 15.252(2) andDocumentNam.
ast 5 ft. from impervious barrier to edge of SAS (10 ft. 1 / C
ded) [3I0 CMR 15.255 (2)(e)]
Check DEP Approval letters for credits and design conditions V
If used with pressure dosing do not allow pressure discharge
to scour soil interface 71
Was DEP Approval Letter provided and/or have you
reviewed the letter for conditions?
Is the technology being properly applied and does it meet all
DEP Approval Conditions?
Is there a note on the plan regarding the requirement for
1per-petual maintenance agreement?
Any alarms involved on separate circuits
Did the applicant submit an operation and maintenance
manual?
Has applicant submitted a copy of a maintenance
Are the variances listed on the plan ? [310 CMR 15.220
(4)( )] /
RLS Stamp necessary on plan if a component is within five
feet of property line [310 CMR 15.412(4)] aYtcP^�
New construction or increased flow proposed- [Refer to 310
CMR 15.414]
Address !�7—9, oe Sheet 6 of 7
Ts the system in a Designated Nitrogen Sensitive Area(Zone II for
a public supply well)? [310 CMR 15.214, 310 CMR 15.215 and
310 CMR 15.216 --also refer to Policy regarding upgrades of such
existing systems]
Is the system proposed on the same lot as served by private well ? LIX
[310 CMR 15.214(2)]
Are the nitrogen loads proposed in compliance? [310 CMR
15.216(1)]
hum in to se tic tank? [310 CMR 15.229
Shared System [310 CMR 15.290
F
Address Sheet 7 of 7
Town of Barnstable
P# 131 I
Departinent of Regulatory Services
BrAM.4 Public� Health Division
Datewlfn 39. 200 Main Street,Hyannis MA 02601
Date Scheduled_ ��Jjo
Time Fee Pd._- /dD
Foil Suitability Assessment for Sewage Disposal
Performed By: � �
Witnessed By;
CATION GENERAL INFO ION
Location Address /L^�J �� ( /�
�7 l Owner's Na /�IIA$rt 4) -fi n
�l YJ t1 1 Address
Assessor's Map/Parcel: *e � ' •d' 7�` �lYi►2
��'� ""'� Engineer's Name �
7
NEW CONSTRUCTION IN s t�
REPAIR N
Telephone# �Gy
Land Use />>t �Jl/t-► La ° �'
�-�-�--'— --- — !L Slopes(%) Surface Stones
Distances from: Open Water Body ft possible Wet Area
('— ft Drinking Water Well ft
Dreina a Way N
g Y ft Property tine 3 b ft Other - 6a4n ,g Tl S ( py
SKETCH:(Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands fIn proximity to holes)
t 7 z2
V�Tq 1� 7:;
VY1
/ �
Parent material(geologic) Gi a e,_)eVq0Y4 Depth to Bedrock
Depth to Groundwater. Standing Water in Hole: 7 791.01 Weeping from Pit Face_ �ZA
Estimated Seasonal High Groundwater
=DE W.dingin
N FOR SEA ONAL HIGH`WATER TABLE
Method Used: c 7
Depth Observed sole:
De th to weeping�iom side of obs.hole: 6 In, Depth to soil mottles: jn
p ; � In, Groundwater Ad uxtment
Index Well /(f'if�&Reading Date:,�lo Index Well level J ft.
.&�.... AdJ,t5actor „ '�r Adi,Groundwater Level,,, .9 rAz
PERCOLATION TEST note(?-zo-jOTIMe
Observation "1 V
Hole# JY Time at 4"
Depth of Pert 01
Time at 6" 7
Start Pre-soak Time @ 'lime(9"41)
End Pre-soak �! r
Jq � f-4 �L
Rate MinJlnch <i
Site Suitability Assessment: Site Passed Site Failed: Additional Testing Needed(Y/N) `
Original: Public Health Division Observation Hole Data To Be Completed on Back------___
***If percolation test is to be conducted within 100' of wetland,you must first notify the,
Barnstable Consefvation Division at least one(1)week prior to beginning.
Q:ISEPTICVERCFORM.DOC
_wY
DEEP-OBSERVATION HOLE LOG Hole#
Depth from Soil Horizon Soil Texture .Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones;Boulders.
GraveD
�Z GL
-1 �
Sa..4 Z,7Xf �`
2 s
Z! 7 6
,rum
DEEP OBSERVATION HOLE LOG Hole# V 161)
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders.
Consistency, v
tom- Ca � 1. �•
-0V
DEEP OBSERVATION HOLE LOG Hole#
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders.
Consistency.
DEEP OBSERVATION HOLE LOG Hole#
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones;Boulders.
rnnsistency,
,q
i
Flood Insurance Rate Map: /
Above 500 year flood boundary No_ Yes
Within 500 year boundary No= Yes '
Within 100 year flood boundary No Yes
Dath of Naturally Occurring Pervious Material
Does at least four feet of naturally occurring pervio s material exist in all areas observed throughout the
area proposed for the soil absorption system?
If not,what is the depth of naturally occurring Pe vious material?
Certification l
I certify that on (date)I have passed the soil evaluator examination approved by the
Department of E ironmental Protection and that the above analysis was performed by me consistent with .
the required tra' ' x ertise a7dri c de bed in 310 CMR 15.017.
Signature Date
/
f2 �U / 1,yJ J 1lY�j } ' ✓/P �ZGIj �?�u �7lcYs�� %�/`.•'Ni S �U
Q:\$EPT1C\PERCFORM.DOC
TOWN OF BARNSTABLE
LOCATION J`��G�C, (o(7e. SEWAGE # (?f— 3oi
VILLAGE
v ASSESSOR'S MAP & LOT 4f--,V
INSTALLER'S NAME & PHONE NO. C4 At-(.O} Seel I?--
SEPTIC TANK CAPACITY
LEACHING FACILITY:(type) P (size) G Y4,
NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER
BUILDER OR OWNER I 7-M
DATE PERMIT ISSUED:"!
DATE COMPLIANCE ISSUED: 7
VARIANCE GRANTED: Yes No
z
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NOR ` j ]t Fps... .........
THE COMMONWEALTH OF MASSACHUSETTS
BOAR® OF HEALTH
TOWN OF BARNSTABLE
Appliration for Dispntial Works C nstrnrtinn thrmit
Application is hereby made for a Permit to Construct ( ) or Repair an Individual Sewage Disposal
System at:
......--•---...� 7......j:SA. . . . ..-- �!J fn.JtS�ft ------ - .........
Location-A ess or Lot No.
• '. _5� - -- C a'a -t M�-------------------------- ..........--......
SS _ ...........................................................
a ................... L._s l r- - � L-•---•--------- --•••-•••--- .Q,- 6. ......... ...n..............------..... ............
Installer Address
Type of Building Size Lot............................Sq. feet
U Dwelling No. of Bedrooms...=. ..................................Expansion Attic Garbage Grinder
a` 4, Other=Type of Building No. of persons........................ Showers
YP g ------------------•--------- P ---- -------(---->--- Cafeteria ( )
dOther fixtures ------------------------------------------------------•••-----------•----••-•-•---••......----•••... ..........
w Design Flow.....z5.�5...........................gallons per person per day. Total daily flow----- a.0.......................
WSeptic Tank—Liquid capacity............gallons Length................. Width................ Diameter---------------- Depth................
x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area........ ft.
Seepage Pit No.......I------------ Diameter.../Q_-_______ Depth below inlet..&_l ---------- Total leaching area............... ft.
Z Other Distribution box ( ) Dosing tank ( )
a Percolation Test Results Performed by •-- -----------
•-----------------------
. Date
Test Pit No. I................minutes per inch Depth of Test Pit..........._........ Depth to ground water------_.................
Test Pit No. 2................minutes per inch Depth of.Test Pit---:................ Depth to ground water-.______-__.____---.___-
---------------------------------------------------•-------•------........-----------•--•--••.--•-•---------------•-------•--•--••-•---•-•-•••--•---....••--
0 Description of Soil............................................................................... -----------------------------..........................................................
w
V Nature of epairs or Alterations—Answer when applicable------A.s1 ........ .............
......................-.......................................
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the
system in operation until a Certificate of Com ' been ' sued by the board o health.
Signed .............. ....�... - �� ------------------- ---`T.l...�-cif.....
Dace
Application Approved By ---- : 1 -�"f Y "`�--.' -J-........ e
Application Disapproved for the following reasons: ..................................................... ..................................................... ----------------
.............. j ---.....
Dare
Permit No. r... .......... Y:......�-------------------- Issued f. ` ,e- -
No ....... _
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
-
TOWN OF BARNSTABLE
Appliration for Disposal Works To, strulrtiott Prrutit
Application is hereby made for a Permit to Construct ( ) or Repair (K' an Individual Sewage Disposal
System at:
............ ..... ��`r � -w ......-•------...t om-14--- ....................................................
Location-A-64ess y�,� or Lot No
-`�.!�a_ .`6.: ?`.--.. C.d TQ ...............•-----..... ......-•----......:�-0 .' `--.� ....._...........
Owner n ( d-ess
a .................... L_ 11Y_ ..S?�{�I ...................... ......--•---C- _. �k Cn
..
Installer f' Address
Type of Building Size Lot............................Sq. feet
U a Dwelling—No. of Bedro ......oms.___ ............................Expansion Attic ( ) Garbage Grinder ( )
Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( )
d Other fixtures ---------
...----....-•...................•---------
W Design Flow.....7 .'5............................gallons per person per day. Total daily flow...... .......................gallons.
WSeptic Tank—Liquid'capacity..........__gallons Length................ Width................ Diameter................ Depth................
x Disposal Trench—No. .................... Width...............l_... Total Length.................... Total leaching area....................sq. ft.
-Seepage Pit No....___ Diameter--_(_..___.___.. /r?---__.__. Depth below inlet__............ Total leaching area..................sq. ft.
Z Other Distribution box ( ) Dosing tank ( )
aPercolation Test Results Performed bY--------- ------------------------------•--------•------------•----------- Date........................................
Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water........................
fro Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
a -------------------------------------------
----------------
•---------------------------------
-......
.........................................................
O Description of Soil....................................................................................................-----------------------•-------------------•------•-----........_..
x
V .-----------------•--------------•--•-----------•--------------•--•-----------------•--------------------•------•---•-------------•--------------------•-••-----------------•....-----------•------------
W `
U Nature of epairs or Alterations—Answer when applicable._-_-__4..Z t7,67-_-__--d_� ........... f'Jj7-____.._._...
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the
system in operation until a Certificate of Compliance-has been 'sued by the board of health.
Sgne�1 ......4 +- ,. --"-...... .....`7-..1.. - .�...
.,.
.. t
I Date.- r
Application Approved BY '' .f..------- ....................... . '----'--------------------------- ---'--
Date
Application Disapproved for the following reasons: ......... ...................'--. . ......----"----'--"------..............----------------------------------.............
-------------------------- --------.................. ... --------' . `----- ...................'
/._
ay'l
Permit No. .. -----------
Issued ...-___ _->/C `-J -�
.....................Date__--..
Da'fe -
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE
Gerttf ra e of Complian e
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired
by------'----'C-- OC..G- rat .....Si-r44-------------------I--nsta--stall --------------------------..................................................-------------- -----------------..........
�-
has been installed in accordance with the provisions of TITLE 5 he "tevironmental Co e als desi �d in
the a lication for Dis osal Works Construction Permit No. ...................... dated __.--__... _--.-,-_ _....,_.............
rspp P / /
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUES AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE----- '~ /. ''"' " .... .. Inspector -----. � " ' "
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
�-' TOWN OF BARNSTABLE ��
No. .I_..l......... .... FEE. .
..
Disposal Works To�trurtion rrmit
Permission is hereby granted �G�IV------------- --1......------------....---......................................
to Construct ( or Repair (�Lan Individual Sewage Disposal System '
at No.-------1 - -......... .. � ..........�-_%6q_r ✓� :.Yf""
_ ........... I d,
-------
Street (� �
as shown on the application for Disposal Works Construction ermit No...I•......J . ated._____ _�C./_�� .,!.. __._._....
DATE. Board of''Health
----- -------------•--
f . _....j �---------------------------------
FORM 36508 HOBBS&WARREN,INC..PUBLISHERS
VARIANCE REQUESTED: PER 310 CMR 15.00: H YAN N I S
TO REDUCE VERTICAL SEPARATION BETWEEN S.A.S. AND
ADJUSTED GROUNDWATER .ELEVATION FROM 5' i0 4% A ONE
FOOT VARIANCE.
y STREET
PARCEL ID: pkp
PARCEL ID: . 268/219 N TO �-� LOCUS
268/234 \ .t 'Qp v_
qp 0
\ D =
N82-48'14'pW
98'
\ a CR WGMA
BROAD
24.4 LOCUS MAP
,w 18" PINE_ �
PARCEL ID:
39.5' 268 218 LOCUS INFORMATION
N AREA= 10,554t S.F.
TAPERED R.R. TIE I PLAN REF: 240/15
TITLE REF: 2610 105
Z REWALLNG —G I /
GROUND G PARCEL ID: MAP 268 PAR. 218 IN STATE ZONE II
I ZONE: "RB" "WELLHEAD PROTECTION ZONE" (WP)
19.0f � . . . ..������� GUY ,
FLOOD ZONE: "C"
CESSPOOLS TO BE o p #157 �� I �-- COMMUNITY PANEL: 250001-0008-D DATED:07/02/92
PUMPED AND REMOVED a I I o 10' 3—BEDROOM W b 24.3 Q SEPTIC SYSTEM
PER TITLE 5 — DWELLING ; W _o REPAIR PLAN
a N I i TOF=23.12 11 I
LO
18 — W -L : l J I ~ LOCATED AT:
OAK M i' TBM GU I
#157 STRAIGHTWAY
PARCEL 68/233 8'5r ROUND ON EL.—=119H0 ;' h I H YAN N I S, MA.
18.4 . 201 ..:::::....: I I - - - 0 — Q
— �24 0 PREPARED FOR
IP
lad _ p, 1 I I-- SALVATION ARMY OF
ASP;�ALT DECK I (� MASSACHUSETTS, INC.
�
N DR{VE
MARCH 2, 2011
o
12" OAK rc6j23.7 ��SNOFMgss9 0 EDWARD9cy�
I IO2 DAVI D �� U� A.
D
/ " STONE
e r I FLAHE J o No. 289 0 e
I �O FS GAS
" E
N89'15'3 W 99'f CBNAL N
SANITAR\P'�
PARCEL ID: " 23.4
268/217
E. A. S.
GRAPHIC SCALE SURVEY, INC.
�'' 141 ROUTE 6A
20 0 to 20 40 so SALT POND BUILDING
P.O. BOX 1729
SANDWICH, MA. 02563
( IN FEET )
1. inch = 20 ft~ BUS:(508)888-3619 CELL:(508)527-3600
SHEET 1 OF 2 J 1305
r
n..
TOP. OF FOUNDATION_. ' ,
EL=23.12
4" SCHEDULE 40 P.V.C. y OBSERVATION PORTS
10' MIN. PITCH 1/8" PER FOOL W/SCREWCAPS
TO GRADE OUTSIDE END UNITS
EL=22.4 -E
• EL= 22.3 � TAPERED RR. TIE
., . ,:�.,.........::� ,..............::�• L= 22.0 I EL= 21.7 RETAINING WALL
6" .... EL= 21.5
... .. MAX.""""...........: :........::
:; ::::::::...........:......:: ....
aaaa••••••.........-
,•••. 9 MIN.
ET ` COVER CONC. TOP OF LINER: 20.3 . `15" ....,..........1-5
INSTALL SLEVE & GASKET ' O CLEAN SAND FILL ""
QQL PER 310 CMR 15.255 ,Q��c
EL= 21.56 COVER LEVEL i ��do INVERT BETWEEN AND TO A MIN. OF 6" 9" MIN.
ll
m 10' S=.02 FOR 2' �OQ� EL= 19.97 OVER UNITS
0 o ff�IN
E 5.0 S= .02 7.0' i s=.or 'zo EL= 20.3
Ln
m a INVERT 14�� 7NET INVERT INVERT tt
INVERT
ADD 20.32 £L= 20.21 6" SUMP EL=20.04 IVVVMVVVTVVMVVYVV I yyyyyII
12"
EL= 19.3
a GAS 6" BASE OF MECHANICALLY
EL=16.62BAFFLE COMPACTED SAND
PROP. DB3 LONER 32.0'
ExtsTlNc PIPE- LINER 24-(H-10)QUICK 4 STANDARD PLUS INFILTRATORS
PROPOSED J=
EL= 15.98 DISTRIBUTION BOXBOT. OF LINER: /� (34"W X 48"L X 12"H) EACH w
1 ,500 GALLON TANK �' STONELESS SOIL ABSORBTION SYSTEM (S.A.S.) D
(BED FORMATION) 8.5' X 32' (STRIPOUT: 18.5' X 42') m W
VARIANCE REQUESTED: PER 310 CMR 15.00: PROFILE OF °�� -�- 34" CLEAN SAND FILL 4Q4J� �o0
TO REDUCE VERTICAL SEPARATION BETWEEN S.A.S. AND SEWAGE DISPOSAL SYSTEM ��:�`�� � ��� L0Q
ADJUSTED GROUNDWATER ELEVATION FROM 5' TO 4', A ONE (NOT TO SCALE) hAR°e`ti g"
FOOT VARIANCE. 8.50
I CERTIFY THAT I AM CURRENTLY APPROVED BY THE DEPARTMENT OF END VIEW
GENERAL NOTES ENVIRONMENTAL PROTECTION PURSUANT TO 310 CMR 15.017 TO CONDUCT ADJ. GROUND WATER ® ELEV.= 15.2
SOIL EVALUATIONS AND THAT THE ABOVE ANALYSIS HAS BEEN PERFORMED INDEX WELL: MIH29 ZONE "C" DECEMBER 2010 = 8.4' ADJUSTMENT = 3.6'
1. ALL WORKMANSHIP AND MATERIALS SHALL CONFORM TO D.E.P. BY ME CONSISTENT WITH THE REQUIRED TRAINING, EXPERTISE, AND EXPERIENCE
TITLE 5 AND THE TOWN OF BARNSTABLE RULES AND REGULATIONS DESCRIBED IN 310 CMR 15.017. I FURTHER CERTIFY THAT THE RESULTS OF MY
FOR SUBSURFACE DISPOSAL OF SEWERAGE. SOIL EVALUATION, AS INDICATED ON THE ATTACHED SOIL EVALUATION FORM, DESIGN DATA
2. AT LEAST ONE ACCESS PORT OVER TANK TEES SHALL BE ARE ACC A IN C WITH 310 CMR 15.100 THROUGH 15.107.
ACCESSIBLE WITHIN 6" OF FINISH GRADE, WITH ANY REMAINING �.
ACCESS PORTS BROUGHT TO WITHIN 6" OF FINISH GRADE. A.
3. ALL COMPONENTS OF THE SANITARY SYSTEM SHALL BE NUMBER OF BEDROOMS......... 3
CAPABLE OF WITHSTANDING H-10 LOADING UNLESS THEY ARE EDW A. ONE, CE FIE SbIL EVALUATOR GARBAGE DISPOSAL.................
UNDER OR WITHIN 10' OF DRIVES OR PARKING AREAS THEN THEY TOTAL ESTIMATED FLOW
MUST WITHSTAND H-20 LOADING. TEST PIT RESULTS . . _ 330
4. THE EXCAVATION CONTRACTOR SHALL VERIFY THE LOCATION (110 GAL /BR./DAY X 3 BR ) ------
OF ALL UTILITIES PRIOR TO ANY EXCAVATION. 330GPD X 200% = 660 GAL
5. ANY MASONRY UNITS USED TO BRING COVERS TO GRADE SOIL TEST DATE: DEC. 20, 2010 USE NEW 1500 GAL. TANK
OR WITHIN 6' OF GRADE SHALL BE MORTARED IN PLACE. INSTALL:
6. FINISH GRADE SHALL HAVE A MINIMUM OF 2% GRADE B.O.H. AGENT: DON DESMARAIS, R.S. 24 (H-10)QUICK4 STANDARD PLUS INFILTRATORS (34"W X 48"L X 12"H)
OVER THE S.A.S. AND DISTRIBUTION Box. SOIL EVALUATOR: EDWARD A. STONE AND BACKFILL WITH CLEAN SAND FILL PER 310 CMR 15.255
7. SEPTIC TANK SANITARY TEES SHALL BE CONSTRUCTED OF
SCHEDULE 40 PVC AND SHALL EXTEND A MINIMUM OF 6" ABOVE BACKHOE: RODNEY FISHER (8.5 X 32 )
THE FLOW LINE AND SHALL BE ON THE CENTERLINE AND
LOCATED DIRECTLY UNDER THE CLEANOUT MANHOLES. �� SOIL CLASSIFICATION.....ATE.....__
8. THE INLET PIPE INVERT ELEVATION SHALL BE NO LESS THAN TH#1 EL.=18.1 P ER C RATE<2M I N./I N. @54 B 0 TTOM DESIGN PERCOLATION RTE.....52_Bd(I��1N•
2 INCHES NOR MORE THAN 3 INCHES ABOVE THE INVERT EFFLUENT LOADING RATE.........-__74___
ELEVATION OF THE OUTLET PIPE. ELEV. DEPTH (IN.) HORIZON TEXTURE COLOR MOTTLING OTHER REQUIRED LEACHING CAPACITY.....330 GAfDAY
9. THE SEPTIC TANK SHALL HAVE A MINIMUM COVER OF 9 INCHES. 17.1 0"-12" FILL FILL ----- LEACHING CAPACITY PROVIDED.....336_GAL/DAY
10. THE OUTLET SANITARY TEE SHALL BE EQUIPPED WITH A GAS 10YR3 3
BAFFLE, 4 INCHES IN DIAMETER AND CONTRUCTED OF 4" PVC. 16.8 12"-16" O/E ORGANIC 1OYR5/1 --- ----- (3) ROWS OF (8)INFILTRATORS X 4.73 S.F./L.F.
15.8 16"-28" B LOAMY SAND 7.5YR5
11. ALL PIPES SHALL BE SCHEDULE 40 PVC SEWER PIPE AND 8
FIRST TWO FEET OUT OF THE DISTRIBUTION BOX SHALL / --_ ----- 96 L.F. X 4.73 S.F./L.F.= 454 S.F.
BE LEVEL. 15.1 28"-36" Cl COARSE SAND 10YR5/4 --- O7.GRAVE 454 S.F. X .74 GPD./S.F.= 336 GPD
12. CHANGES OR REVISIONS TO SEPTIC DESIGN REQUIRE NOTIFICATION ______ 336 GPD PROVIDED - 330 GPD REQUIRED = 6 GPD RESERVE
TO EAS SURVEY, INC. FOR B.O.H. AND DESIGN 9.1 36"-108" C2 MEDIUM SAND 2.5Y7,/6 ---
ENGINEERS REVIEW AND APPROVAL. GROUNDWATER ® 78"/NO MOTTLES
13. NO ABUTTING WELLS ARE WITHIN 150' OF PROPOSED S.A.S. &
NO ABUTTING SEP11C SYSTEMS ARE WITHIN 150' OF PROPOSED WELL �k� vOgcy
CONSTRUCTION NOTES: TH#2 EL.= 18.1 �`jNOFM4SS9 moo? EDWARD G� SEPTIC SYSTEM DETAIL PAGE
1. CONTRACTORS / INSTALLERS SHALL VERIFY GRADES AND ELEV. DEPTH IN. HORIZON TEXTURE COLOR MOTTLING OTHER o?� DAVID c A N
STONE
ELEVATIONS AND SITE CONDITIONS PRIOR TO COMMENCING 17.4 0"-8" FILL FILL --- ----- �� a 28960 o- #157 STRAIGHTWAY
WORK ON THE SITE. o o No. ,
16.1 8"-24" B LOAMY SAND 7.5YR6 6 --- ----- FLAH TY �'o '�F A'r HYANNIS MA.
2..NO DETERMINATION HAS BEEN MADE AS TO COMPLIANCE / N 211 '
WITH DEEDED OR ZONING REGULATIONS. OWNER / APPLICANT 15.3 24"-34" Cl COARSE SAND 10YR5/4 --- 10%GRAVEL S ONAI A MARCH 2, 2011
IS TO OBTAIN SUCH DETERMINATION FROM APPROPRIATE AUTHORITY.
I 9.1 34"-108" C2 MEDIUM SAND 2.5Y716 GIST" a
3. ALL SYSTEM COMPONENTS SHALL BE MARKED WITH MAGNETIC MARKING j S'gNIT W i
TAPE OR A COMPARABLE MEANS. GROUNDWATER ® 79"/NO MOTTLES (( " .: 3.2 I I SHEET 2 OF 2 J# 1305
Y
i, +i