HomeMy WebLinkAbout0031 WAYLAND ROAD - Health 31 WAYLAND ROAD,II Y ANNIS
A= 271216
R.
t
i�
i
I
/ TOWN OF BARNSTABLE
'LOCATION Gl�i°t%9 °` SEWAGE # 473 �9, C
VILLAGE�1147 ASSESSOR'S MAP & LOT
INSTALLER'S NAME&PHONE NO. �s�,« 7�
SEPTIC TANK CAPACITY z-
LEACHING FACILITY: (type) ' S`k _� (size)
NO.OF BEDROOMS
BUILDER OR OWNER lZ 5 CA/
PERMITDATE: —COMPLIANCE DATE:_ 2-
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
� . /
\ /;
V
..
� _'
a _,
s
6,
�J
Ai
t
W
N
Y'
l
TOWN OF PARNS ABLE
�5
LOCATION aJ` SEWAGE # 4 Z
(VILLAGE ASSESSOR'S MAP & LOTLI 1'7,21
INSTALLER'S NAME&PHONE NO. 766
SEPTIC TANK CAPACITY _4;--&
LEACHING FACILITY: (type) '. ! (size)
NO.OF'BEDROOMS _
BUILDER OR OWNER 0, '" D�
PERMITDATE: 3 3 \COMPLIANCE DATE: G O
Separation Distance Between the:
Maximu"Adjusted Groundwater Table to the Bottom of Leaching Facility Feet
Private, ater Supply Well Leaching Facility (If any wells exist
on sit�,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
r
-
i
No. �� 3 Fee 5 0.0 0 /
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: it/
Yes
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS
2ppfication for Miopogar Opotem Construction Permit
Application for a Permit to Construct( )Repair( x)Upgrade( )Abandon( ) El Complete System ❑Individual Components
Location Address or Lot No. Owner's Name,Address and Tel.No.
31 Wayland Rd Hyannis Kim Purdy .
Assessor's Ma /Parcel
27�-21 6
Installer's Name,Address,and Tel.No. Des er's Name,Address and Tel.No.
W,E.Robinson Septic Service C•R. Short
P.O. Box. 1089 Centervile P.O. Box1044 S. Dennis MA
Type of Building:
Dwelling No.of Bedrooms 3 Lot Size sq.ft. Garbage Grinder( n6
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow gallons per day. Calculated daily flow gallons.
Plan Date Number of sheets Revision Date
Title
Size of Septic Tank Type of S.A.S.
Description of Soil
Nature of Repairs or Alterations(Answer when applicable) Install a new Title 5 leach
system to plans of C_R_ Short- 01 —O972
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 En ' onmental Code and not to place the system in operation until a Certifi-
cate of Compliance has been issued by thi and QPfHealth.
Si ned Date
Application Approved by Date 1 3
Application Disapproved for the following reasons
Permit No. — 6 —3 Date Issued to 1 r-5 a 3
� '-t'C.-. r, .. .R.. .•t„y.r :i-r`^ n �:.� ..,.. :.: y _ .... 7'„ � .." ,. - ...• try
Fee 50.00
" No. NCO
THE COMMONWEALTH OF MASSACHUSETTS ntered in computer:
. � Yes
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE,. MASSACHUSETTS
p pricatton for Mtzpooal *patent Co Aructiori Permit
Application for a.Petmit to Construct( )Repair(x)Upgrade( )Abandon( ) ❑Complete System ❑Individual,Components
Location Address or Lot No. Owner's Name,Address and Tel.No.
31 Wayland Rd Hyannis Kim Purdy
Assessor's2M7ap/_!rr el �1
Installer's Name,Address,and Tel.No. Desi ner's Name,Address an Tel.No.
W•E,Robibson*Septic Service Cg•R. Short
P.O. Box 1089 Centervile P.O. Box1044. S. Dennis MA
Type of Building:
Dwelling No.of Bedrooms 3 Lot Size sq.ft. Garbage Grinder( nth
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow gallons per day. Calculated daily flow gallons.
Plan Date Number of sheets Revision Date
Title
Size of Septic Tank Type of S.A.S.
{
Description of Soil;
ti
Nature of Repairs or Alterations(Answer when applicable) Install a new Titles leach
system to plans of C R Short 01 -0972
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 Enyronmental Code and not to place the system in operation until a Certif-
cate of Compliance has been iss ed by th' and oJfHealth. ^
Si ned Date "6 J
Application Approved by Date 4, 1 c) .
=' Application Disapproved for the,following reasons
Permit No. o 6 -3Date Issued In 3.
THE COMMONWEALTH OF MASSACHUSETTS
Purdy 5E�
BARNSTABLE, MASSACHUSETTS-i-, ...
Certificate of Compliance
THIS IS TO CERTIFY, that the:On=site Sewage Disposal System Constructed(, )Repaired( X)Upgraded( )
Abandoned( )by W.E. Robinson Septic Service',
at 31 Wayland Rd Hyannis has been construct�ld in accordance
with the provisions of Title 5 and the for Disposal System Construction Permit No. 2-00 3 243 dated w 3 L0-3
-- Installer Designer °
The issuance f t - permit shall not be construed as a guarantee that the syste ign d�
Date 2- Inspector
No. 11_�C 5 — Fee 5 0.0 0
Purdy THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS
Diopozal *pftem Construction Permit
Permission is hereby granted to Construct( )Repair(x )Upgrade( )Abandon( )
System located at 31 Wayland Rd. Hyannis
and as described in the above Application for Disposal System Construction Permit. The applicant recognizes 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 p
'' Date: ! Approved by
TOWN OF BARNSTABLE
LOCATION SEWAGE # 495 �. G
VILLAGE— _ASSESSOR'S MAP &LOT-?: [7-2 t7
I
INSTALLER'S NAME&PHONE NO. A
SEPTIC TANK CAPACITY 'T.h
LEACHING FACILITY: (type) cy —2 (size) �. '0
NO.OF BEDROOMS
BUILDER OR OWNER/�nj, _�
PERMIT DATE: G-13-06 COMPLIANCE DATE: 7"
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 Feet
within 300 feet of leaching facility)
Furnished by
i
i
i
y
I r
i
12/
Commonwealth of Massachusetts
Executive Office of Environmental Affairs
Department of MqY 2 s 0
199b,
Environmental Protection M44, � _
F
WIIHan F.Weld Trudy Coxe
ooN sea@"
n,or a.
Argw Paul Celiucci David B._Struhs"..
CotnmhNoner ,
-
ySUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
k119 y.14 n tQ 'q D PART A -
-,/l9hh/ j CERTIFICATION
Property Address: Address of Owner.
Date of Inspection: J— IS— 9'6 (If different)
Name of Inspector. W.8. Robinson SR
Company Name,Address and Telephone Number. ( 5 0 8 ) 7 7 5-8 7 7 6
W.E. Robinson Septic Service
P.O. Box 1089 Centerville MA
CERTIFICATION STATEMENT
I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate
and complete as of the time of inspection. The inspection was performed based on my training and experience in the proper function and
maintenance of on-site sewage disposal systems. The system:
lZasses
_ Conditionally Passes
_ Needs Further Evaluation By the Local Approving Authority
_ Fails
a
Inspector's Signature: � a Date: s v/�/'9
The System Inspector shall submit a copy of this inspection report to the Approving Authority within thirty(30)days of completing this
inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the
report to the appropriate regional office of the Department of Environmental Protection.
The original should be sent to the system owner and copies sent to the buyer, if applicable and the approving authority. .
INSPECTION SUMMARY:
Check A,B, C,or D:
A] 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 used to be replaced or repaired. The system,upon completion of the replacement or repair,passes
inspection-
Indica yes, no,or not determined(Y,N,or ND). Describe basis of determination in all instances. If"not determined",explain why not)
_ The septic tank is metal,cracked,structurally unsound, shows substantial infiltration or exfiltration,.or tank failure is
imminent. The system will pass inspection if the existing septic tank is replaced with a lonforming septic tank as approved
by the Board of Health.
(revised 11/03/95) 1
One Winter Street • Boston,Massachusetts 02106 • FAX(617)556-1049 • Telephone(617)292-5500
�J Printed on Recycled Paper
s
1
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address: .3 kl y4n n s
Owner. F,
Date of Inspection: /
BI SYSTEM CONDITIONALLY PALES(continued)
_ Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed pipe(&)
or due to a broken,settled or uneven distribution box. The system will pass inspection if(with approval of the Board of
Health):
broken pipe(s)are 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) FUR ER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH:
nditions 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) S STEM WILL FAIL UNLESS THE BOARD OF HEALTH (AND PUBLIC WATER SUPPLIER,IF APPROPRIATE)
D INES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECT THE PUBLIC HEALTH AND
S 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 within 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 50 feet or more from a private water
supply well,unI a well water analysis for coliform bacteria and volatile organic compounds indicates that the well is free
from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm.
3) O ER
(revised 11/03/95) 2
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(oontinued)
Property Address: -3
Owner. !�/,f.�✓/1 i
Date of Inspection:
D] SYSTEM FAILS:
have determined that the system violates one or more of the following failure criteria as defined in 310 CMR 15.303. The basis for
determination is identified below. The Board of Health should be contacted to determine what will be necessary to correct the
Backup of sewage into facility or system component due to an overloaded or clogged SAS or cesspool.
_ Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or
cesspool.
Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool.
Liquid depth in cesspool is less than 6"below invert or available volume is less than 1/2 day flow.
Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).
Number of times pumped
Any portion of the Soil Absorption System, cesspool or privy is below the high groundwater elevation.
Any portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply.
Any portion of a cesspool or privy is within a Zone I of a public well.
Any portion of a cesspool or privy is within 50 feet of a private water supply well.
Any portion of a 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, ammonia nitrogen and nitrate nitrogen.
E]LARGE YSTEM FAILS:
Th following criteria apply to large systems in addition to the criteria above:
system serves a facility with a design flow of 10,000 gpd or greater(Large System)and the system is a significant threat to public
and safety and the environment because one or more of the following conditions exist:
the system is within 400 feet of a surface drinking water supply
the system is within 200 feet of a tributary to a surface drinking water supply
the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area(IWPA)or a mapped Zone U of a public
water supply well)
The owner or operator of any such system shall bring the system and facility into M compliance with the groundwater treatment program
requireme of 314 CMR 5.00 and 6.00. Please consult the local regional office of the Department for further information..
(revised 11/03/95) 3
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST
PmPerty Address:
3 J /
Owner. ✓Yi a r/4{1/
Date of Inspection
Check if thzPum.ui,.g
have been done:
information was requested of the owner,occupant,and Board of Health.
V None of the system components have been pumped for at least two weeks and the system has been receiving normal flow rates
j that period. Large volumes of water have not been introduced into the system recently or as part of this inspection.
_V As built plans have been obtained and examined. Note if they are not available with N/A.
e /
1/The facility or dwelling was inspected for signs of sewage back-up.
he system does not receive non-sanitary or industrial waste flow
flz site was inspected for signs of breakout.
system components,excluding the Soil Absorption System, have been located on the site.
_The septic c tank manholes re uncovered, opened,and the interior of the septic tank was inspected for condition of baffles or
tees,material of construction,dimensions,depth of liquid,depth of sludge,depth of scum.
size and location of the Soil Absorption System on the site has been determined based on existing information or
aZ ted by non-intrusive methods.
The facility owner(and occupants, if different from owner)were provided with information on the proper maintenance of Sub-
Surface Disposal System.
(revised 11/03/95) 4
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
' 9 SYSTEM INFO/RMATION
Property Address: ,j
DDate of Inspection:
FLOW CONDITIONS
RESIDENTIAI:
Design ftwj��110ns
Number of bedrooms: 3
Number of current residents:
Garbage grinder(yes or no): _
Laundry connected to system(yes or no):,�—/
Seasonal use(yes or no):_Al
Water meter readings,if available:
Last date of occupancy: 5—q
COMMERCIAL/INDUSTRU
Type of establishment:
Design flow:_gallons/day
Grease trap present: (yes or no)_
Industrial Waste Holding Tank present: (yes or no)_
Non-sanitary waste discharged to the Title 5 system: (yes or no)_
Water meter readings, if available:
Last date of occupancy:
OTHER(Describe)
Last date of occupancy:
GENERAL INFORMATION
PUMPING RECORDS and souzee of information:
&/ 2-
System pumped aspart of inspection: (yes or no)_
If yes,volume pumped: gallons
Reason for pumping:
TYPE SYSTEM
Septic tank/distribution box/soil absorption system
Single cesspool
Overflow cesspool
Privy
Shared system(yes or no) (if yes,attach previous inspection records,if any)
Other(explain)
DQ n
APPROXIMATE AGE of all components,date installed(if known)and source of information: l FO
Sewage odors detected when arriving at the site: (yes or no)A Q
(revised 11/03/95) b
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
/ SYSTEM INFORMATION(continued)
Property Address: I Id,4 y!i}/7D Q j l>lAn t? s
Owner.
Date of Inspection
SEPTIC,TANK
(locate on site plan) i
Depth below grade: j�J
Material of construction: 'co �—metal/—FRP--other(explain)
i G9_ l�0
Dimensions: K "r "1'
Sludge depth: I® °
Distance
����from
����top of sludge to bottom of outlet tee or baffle: 3 3
Scum thicim : -/ , y 1
Distance from top of scum to top of outlet tee or baffle:
Distance from bottom of scum to bottom of outlet tee or baffle: /0
Comments:
(recommendation for pumping,condition of inlet and outlet tees�oAr/baffles,depth of liquid level in relation to outlet invert, integrity
evidence of leakage,etc.) i,a ra c o� �Z Cf�l�`�L`2 T/�A r- rt✓t:[ S C
G E TRAP:_
(locate "site plan)
Depth be w grade:
Material f construction:_concrete_metal_FRP—other(explain)
Dimensio
Scum
DistaaM top of scum to top of outlet tee or baffle:
Distan from bottom of scum to bottom of outlet tee or baffle:
Commen
(recomm dation for pumping,condition of inlet and outlet tees.or baffles,depth of liquid level in relation to outlet invert,structural integrity,
evidence f leakage,etc.)
(revised 11/03/95) 6
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(oontinued)
Property Address; 3 y/57-r1
Owner. rn 6(/'��►�/
Date of Inspection:
OR HOLDING TANK:_
( on site plan)
Depth grade:
Material cons
truction _ooacrete_metal_F1tP_other(explain)
Capacity: ona
Design w: ¢allons/day
evel:
Common
(oonditio of inlet tee,condition of alarm and float switches,etc.)
DISTRIBUTION BOX—
(locate(locate on site plan)
Depth of liquid level above outlet invert:
Comments:
(note if level and distribution is ual,�evidence of solids carryover,evidence ofleakage into or.t of box,etc.)
13 �L r
PUMP HAMBER:
(locate on plan)
Pumps in rking order:(yes or no)
Comments:
(note co n of pump chamber,condition of pumps and appurtenances,etc.)
ru
(revised 11/03/95) 7
r
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 49-n 0 v
Owner.
Date of InspeoUon;
�• /Y!K,^�lL�
SOIL ABSORPTION SYSTEM(SASO
(locate on 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: 1_
leaching chambers,number:_
leaching galleries,number:
leaching trenches,number,length:
leaching fields,number,dimensions:
overflow cesspool,number:
Commnts:(note condition of soil,signs of hydraulic fa, ,re level of ponding,condition of vegetation,etc.)_ `
K�CAS 1 ,
C LS:_
(locate site plan)
Number d configuration:
Depth-to of liquid to inlet invert:
Depth of lids layer.
Depth of scum layer:
ns of cesspool:
Mate ' of construction:
n of groundwater:
in
(cesspool must be pumped as part of inspection)
Commea :(note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation,etc.)
PRIVY:
(locate site plan)
Mate f construction: Dimensions:
Depth of
Comments: note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation,etc.)
(revised 11/03/95) g
I
I .
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATIONS (oontinued)
Property Address: / �,(JA y l�11 (� 1 S
Owner. Y rn �, A V
Date of Inspection: /
SKETCH OF SEWAGE DISPOSAL SYSTEM:
include ties to at least two permanent references landmarks or benchmarks
locate all wells within 100'
�b
o 0 a�
joeo al ypC�s� \
DEPTH TO GROUNDWATER
Depth to groundwater. P x f feet
method of determination or approximation: ) Q. 6 ����
(revised 11/03/95) 9
LOCATION �� SEWAGE PERMIT NO.
L--o T WAY LW ID -71 S
VILLAGE
�Yy�r�.t tii 1 S
INSTA LLER'S NAME i ADDRESS
2bs[a" (3. Quiz Co 1 ur-
C��4T
BUILDER OR OWNER
F2AKICO RJe4�.L GiT"/ -re
-76 5 �A•L M o uTJ4 I2 , 14Y,4& U
DATE PERMIT ISSUED
DATE COMPLIANCE ISSUED l -- 71A
a T4u
1p
Pit
Th
B_,-o
ro PIT g_?'o P17
THE COMMONWEALTH OF M4SSACHUSETTS
BOARD OF HEALTH
...---Town."....................OF.....Barns-table.:....
ApphrFation for Uhipvii al Work.5 Tomitrnrtiun Famit
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System at: f
. ,.1__.�N.. ��.1.�.h ---1 --•----------------- ...... yannis.:...8.... -................. .......-
Capricorn Realo-ray n'1'russt 76,E FalmouthRoad H annis
;. -• ........ ................•--........ ....e.......Y - .......:........
Address
--� /V! /ate/,
Installer Address 1
Type of Building Size Lot-__-1t�_-l3.1...........Sq. feet
Dwelling—' No. of Bedrooms................._........................Expansion Attic ( ) Garbage Grinder ( )
Other—Type of Building ,.ranch........... No. of persons............................ Showers (2 ) — Cafeteria ( )
a' Other fixtures ............................
-- ------------------------------ .-•------------------------------------------------------------ --------------------
W Design Flow.................55..................... per person per day. Total daily flow........3.3.9............................
_. Ions.
WSeptic Tank—Liquid capacity1 Q.Q.Q.gallons Lengthff 1.6...... Width....4-_10 fbiameter................ Dept.... .1 8....
x Disposal Trench—No. .................... Width..............._._._ Total Length.................... Total leaching area__-___--.•--------sq. ft.
Seepage Pit No.__1............... Diameter.._.........
...... Depth below inlet..,.....6.......... Total leaching area..266-.......sq.,ft.
Z Other Distribution box ( ) Dosing tank ( )
aPercolation Test Resi is Performed by.....El_wedge._Ex],gi eex.ing.......... Date1.1.-25m$1..................
14 Test Pit No. LS,2.._Qminutes per inch Depth of Test Pit..12' p ground none encounter-
. ...__..._... Depth to ound water.none...............
f= Test .Pit No. 2_N/A.....minutes per inch Depth of Test Pit-_N/.A......... Depth to ground water--_-N-A.--..___--- e
Pa --•-----------------------•-----•--......-----•-•---•-----------........--•----------•----.-•-••-.........................................................
O Description of Soil...........
---••-••-•-•--------------------••-•----•-......--•••-••••••••••-•••••••--•-----•--......-----•••_..
--------------------------------------••-•2.1 m1-C•.•-•-•-Medium...e�.�Qw..Sand
W ......----------------------------------1_Q_'.-12'......Med_..__W.h.ite_--Sand/traces...of Graveljno water___at__12 '
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 TITL%, 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 boa d of health. i
Signed-•-• ... --••-•••••-- ................................
Date
Application Approved BY .. .` --------------
Date
Application Disapproved for the following reasons:--- -•-•-....------••-•••---•-•------•-•-----•-•----••••.._..-••-•--•-•--••-•=-••---••-•---•-----•-••...........
-------•-------------•-----------------------------------------------•----------------•----••--------------------------••-------.-----------.................................................-.........
Date
PermitNo......................................................... Issued........................................................
l
Date
No....df-2j46 � FEs......�2..,:)..............
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
Appliration for Bi-qVooal igorkg C> omitrurtion ami#
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System at: 1 `„
..............._... ......._......._ .._.._................................ ............ ....... •- ............•..................
Location-Address r or Lot No.
Ca-nr, �'f. rn � G3'1�i'V..._. _. 7 A K PP.1 me-%p+h P^nA. tT-tra n"i cr
------------- � ... ............. ......_ .............. ...... ... ................._
er -,,4 Address
Installer Address
d Type of Building Size Lot._VV�j.M...........Sq. feet
U Dwelling—No. of Bedrooms................................ .Expansion Attic ( ) Garbage Grinder ( )
?- •---•______..____ No. of persons____________________________ Showers 2 ) — Cafeteria
a Other—Type of Building � -+^nh p ( ( )
a' Other fixtures ......................................................
d ......................................
W Design Flow.................55......................gallons per person per day. Total daily flow........ 30.-__..-_•---_-_x...........gallons.
Gd Septic Tank—Liquid capacityl.Q.O.O.gallons Length.C%'.6....... Width.... ,4'Diameter................ Depth.5!.8.!!....
Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft.
Seepage Pit No...I................ Diameter........6.1........ Depth below inlet.......6.!........ Total leaching area..2lb........sq. ft.
Z Other Distribution box ( ) Dosing tank ( )
aPercolation Test Results Performed by..._-^:�..??:'a _':a..._..?:t�`..... ......................... Datel_„2__5__s�1••.-_-..
Test Pit No. 14...2..,Q.minutes per inch Depth of Test Pit-_12!......._._ Depth to ground_ waternone---ene0unte �-
Gz, Test Pit No. 2_ 1�d�_.....minutes per inch Depth of Test Pit._DI/L....._... Depth to ground water-__�/ ............ e
--------------------------•.....---•-----•---------•----...................--•...---......--•--••---.........................................................
ODescription of Soil----------0�--2-.------..J_Lo m---&... '-ob 4,2.1----------------------------•-•--------------...........----•---•-----.........._
----------------------------------------... ...... �►-Y-ejlaic- 'man ....--------------------...----------------:---............-----------...._._..----
W -- - --------------- r iA�7 a Y`t '� °o ��e?ti�� .^,3S1 -0f r �r'.7- x30 �4r 1rd+ r...�,.2.
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':I':l:a. 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 b the boated of health.
Signed.. ................
�! ................................
Date
Application Approved BY ...... ---------•---•--••••-•••-•--- .l ----•-
Date
Application Disapproved for the following reasons------------------------------------•-------------...---•--------------------------------•--•--•-••---•----•---•-
---------•-----------•----------••-•-•-------------•----------------------------------.......---------------...---------------••---•-••--••-•-••-••--•••••------•-------•••---••-•••--------••-•--------
Date
PermitNo.................................-------------------- Issued.......................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
'OZm oF..�arnsta.ble
................................. .. . ...................................................•••......... �.
%_wrrtif irab of Tomptiattrr
T1U4 1e L �='''IFY, That the Ind lu lvS�e`,aiWosal System constructed ( ) or Repaired ( )
....................................________._............................._.............._.................___........._... +
Insta
at.. I?T.. .�,� .�w.�e ....�4c ...N;� ^1"' - r o h�State Sanitary C
has been installed in accordance with the provisions of TITLE,. S S y ode aV-4_scrAe*ive the
application for Disposal Works Construction Permit No.....B_./__.;ie............... dated................................................
THE ISSU CE OF THIS CERTIFICATE SHALL NOT BE CONST ED AS A GUARANTEE THAT THE
SYSTEM WILL F NCf1ON SATISFACTORY.
DATE....../..."..��... .................................................. Inspector-- ----- ........).............................................................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
r• ��?`...`......'�f� ........9c'xz^................OF...-. �Q�
No....... .. FEE.�5-•-•-•••.......
Permission is hereby granted....P.�-0'�7--0--_L0�?�:�........................... '
-------------••• w ............. a.. .••••••-••......
to Construct (11 ) or Repair ( ) an I dividua Sewage Disposal System
at No. _ �A h ..
Street /� �
as shown on the application for Disposal.Works Construction Permit No..................... Dated........_.........................
/ �_J._.- ....................................
e2nvrlir
ealth
DATE............. - -
FORM 1255 HOBBS & WARREN, INC.. PUBLISHERS
d
00
Olt- y
45)
1 �
n ,c
_l y.•�JC PIS'
Dyk
ALBERT4--.. tiG
A )
No.10951 O
I O,OG70 .F
p GISTS WIDTH IQc�
OFFSIONAI.GC�� F S. P:: Zo
LEGEND OF�'gs\ CERTIFIED PLOT PLAN
EXISTING SPOT ELEVATION Ox0
EXISTING CONTOUR --- 0 --- J N �� 2i - wA� �+ �� ��. 9,s �R�u �cA�
FINISHED SPOT ELEVATION - E Rlk
FINISHED CONTOUR 0
Na 29874 C IN
APPROVED = BOARD OF HEALT
DATE AGENT SCALE, DATE : �2•o�.gk
LDREDGE ENGINEERING CQ IN
CLIENT I CERTIFY THAT THE PROPOSED
EGISTERE REGISTERED JOB NO. BUILDING SHOWN ON THIS PLAN
CIVIL LAND. CONFORMS TO THE ZONING LAWS
ENGINEER SURVEYOR DR.BY OF BARNSTA LEt- -MASS.
CH. BY J
YA MAIN ST. e �t,tR�t 21 �".., �--,;.
HYANNIS, MASS. SHEET_L OF �— DATE � G. LAND SURVEYOR
/Y07E /F E/TNER THE SyP7-1 C TANK 0R
20 FT. M/N. ♦6ACHI/VG P/T ARE MORE THAN /2"BEL0$lV
r'RAOE� A 24'O/AM ET.ER E7.A.7- COPE. 1
!D F7! MIN SWALL BE BROUGHT TO 4,TAO.E EX7•R.q
CONCRCTE q~PVC P/P� 1e,4VY CAST /.PO/Y CO{/ER .Sf�ALL. C3E US,PO
EL=ica c> COVERS �9"pF,q FT
�:'•• CONCRETE
2J M//V.
p7�AaE COVE.' CLEAN SANG
L/Q[/JD LEVEL
IRON P/PE 1000� GAL. •Q l • • • • • • • 0 e o4�M/N.PITCH 0/S'T, o WASHED S7i7NE
SEPTIC TANK BOX • ` i i • :•e��
!' t (cPrelP� •'• 0 6 • r t •a 3/4
]fi o r b / 11EP?W'ECT/Ve y • r
• • • • Of�Tit/ • • 1 • v o WASHED STONE
s • • • 1.1 • • • • • f 1
...: . . • o O ' PRECAS T SEEPAGE
1 8.5x2.5= 4716.PD , . a• . • • •. • • • • • • D •�p P174OREQU/V.
7g.5 x I.O ' 7H °`
6.Q.D. y. • • • • • • • • a e
I NV,CKT �'L.=VAT/GN s •
INVERT T.AT OZMDIA/G (00.5 FT PIT cA�rri� = 54.9 6.R D. 6 J� D/AM.
10 FT. D/A/N. C�$EE TABIlLATJON�
INLET SEPrJC Ti4AW 100.3 FT, k
O�lTL�T SEPTIC TANK too• 1 pT
DISTR/$VT/ON BOX 9q•q FT GROuNO TER TALE `
SECT/ON-OF INLET �.
O0%IETD/STR/BUT/ON" q`�• '' S�yVAGL� D/Sf�OSA L .SYSTEM.
INLET LEACN/JvG 217 9`i.s Fr � T/I 8ULATlON �.
LEACH!/VCs /T p/MENS/ON _A 2.5 FT.
DES/GN CRITERIA SCALE : %s' _ /�.��
p�MENS/ON C. 4 FT. M N
NUMBER OF 6EDR00AfS 3
CA,RaAGE o/SPOSAI-4VN/7' a SOIL LOG SD/L. TE$T
T[3TAL E3T/MA7�E0 FLOrt/ 33o GAL.1,0AY SO/L TEST At/ SOIL TL�ST#2
N(/MBER OF 4rACNING P/TS I fELEY. 10 . ELFY, OATS OF SOIL TEST
S/iOE L1`ACHhVC, PER PIT 187 Sig RT. RESlJLTS h/lTNESSED LOAM Sy j E�i R-fJ 1 j
BOTTOM LEr'1CH/NG PER P/T �g $Q. F7 pr-2 r � PERCOLRT/ON RATES / L�S 1"J/N�IJNCN
2�(, ? �� AEJeCOLA7"/ON RATE.*2 �,N-J M/N 1/)VCN
TOTAL L AR.-SA SQ. f T-
RESERI�ELEACN/NG 1-0 E
M EV `
ZH Mq YEu�W
4 ZH OF�Assq P� DF Ss9n 2-10 SAr.rO LOT IL I WAKcAwr> RD 24 SUDBv2,,' Ltil
N u A !- A �J ti.! 1 S
MORSEL v,I 10 I� SR��
o No.10951 ,0 mra-D wil
�I ��,�,�� EL®REDGEENG/NEAR/JVG CO,1)VC-
74 ,0
APo��G�sTEQ�\a� AL
7/2 MAIN Sr. I
US S/()NM-�a� -1` ° 1 � NN/3 p MASS.
S ElNO GROL/ND yY.4TER EcNC 0U.,VT.L�REO HYA
c Q GRO[!NO Yt/ATER AT ELEL! JOB "0 gl/205 SH 57-2OF �-
i
s
TOP OF FOUNDATION
20 FT. MINIMUM FROM CELLAR PATE OF SOIL T!L TEST9 3 -
100.00 10 FT. MINIMUM 10 FT. MINIMUM FROM SLAB OR CRAWL SPACE SOIL TEST DONE BY _r'�_ ^ � j_ �+�+
ELEV. - CLEAN SAND WITNESSED BY
(ASSUMED)
COVERS 4" SCHEDULE 40 PVC PIPE LOAM AND SEED OBSERVATIONPERCOLATION
S HOLE _1 MIN./INCH AT INCHES
MIN. PITCH 1/8' PER FT. 2" LAYER OF
1/8" TO 1/2" DEPTH HORIZ TEXTURE COLOR MOTT. OTHER
4" CAST IRON PIPE WASHED STONE P 4.0
a �Y 3�R
�'< 9 8.4Sr�,e,r E< VENT K �,
(OR EQUAL) MINIMUM ` �•P Al, NOT REQUIRED Z
PITCH 1/4" PER FT. -Z
i 30,
FLOW LINE 9J_ 4 f 0
ELEV. _ 29G_z5 10" ❑ ❑ ❑ 0 ❑ O ❑ ❑ ❑ ❑ ❑ ___ Co4r'sc /oJ�i2
J MIN. _ �Ssf r Q 0 . C / .� n( 4/`
__ J 4o ELEV. --- L VEL O ° ° ° ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ° °° ° 9G
ELEV. = 9S,>�O GAS ELEV. = 9S� 6" SUMP -ELEV. _ �''F_� o 0
- BAFFLE DISTRIBUTION ` ° ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ 0 2' ° coa-.sue
ELEV. ° ° ° ❑ ❑ ❑ ❑ ❑ ❑ O ❑ ❑ ❑ ❑ ° Z .70 Ct `
BOX �-�-- ELEV. = 9�__ / 3 2DEPTH ME
LIQUID OUTLET ,TOE o °° o ° ° °
(TO BE PLACED ON FIRM BASE)
4 FEET - 14 INCHES TO BE WATER TESTED
5 FEET 19 INCHES IF MORE THAN ONE OUTLET 2 -- 500 GAL. DRYWELLS WITH STONE 3 ' Na WATER ENCOUNTERED AT !! ELEV. = 6t 7• 4
7 FEET 29 INCHES FEET 24 INCHES 1000 GALLON (TO BE PLACED ON FIRM BASE) -N AN fZ X2�'X 2 1R�NQy fA�/i1mv WELL ^�
8 FEET 34 INCHES SEPTIC TANK ZONE
3/4" TO 1 1/2" CLEAN INDEX
r�-vG ) DOUBLE WASHED STONE SOIL ABSORPTION ADJUST
FREE OF FINES & SILT SYSTEM (SAS) DESIGN CALCULATIONS
USGS PROBABLE WATER TABLE ELEV. _ NUMBER OF BEDROOM_^-'�"� GARBAGE DISPOSAL UNIT
SEWAGE DISPOSAL SYSTEM PROFILE OBSERVED WATER TABLE ( / / ) ELEV. = _ "'!� TOTAL ESTIMATED FLOW
NOT TO SCALE BOTTOM OF TEST HOLE ELEV. = _$7'�� 3x i/a a+P"D -33' GAL./DAY
REQUIRED SEPTIC TANK CAPACITY 6 4- GAL,
ACTUAL SIZE OF SEPTIC TANK 9F-^/Sr Casa GAL,
SOIL CLASSIFICATION
DESIGN PERCOLATION RATE MIN./IN.
EFFLUENT LOADING RATE a•7 GAL./DAY/S.F.
LEACHING AREA I z x 2 l t 7"fx 2 SQ. FT.
LEACHING CAPACITY (AREA X RAT ) 331 GAL./DAY
44a X,7
RESERVE LEACHING CAPACITY GAL./DAY
MOTES:
1. ALL WORKMANSHIP AND MATERIALS SHALL CONFORM TO D.E.P.
TITLE 5 AND THE TOWN RULES AND REGULATIONS FOR THE SUBSURFACE
DISPOSAL OF SEWAGE.
2. ALL COVERS TO SANITARY UNITS SHALL BE BROUGHT TO
WITHIN 6" OF FINISHED GRADE.
3. ALL COMPONENTS OF THE SANITARY SYSTEM SHALL BE CAPABLE OF
WITHSTANDING H-10 LOADING UNLESS THEY ARE UNDER OR WITHIN
10 FT. OF DRIVES OR PARKING AREAS. H-20 LOADING SHALL BE
USED UNDER OR WITHIN 10 FT. OF DRIVES OR PARKING AREAS.
4, ANY MASONRY UNITS USED TO BRING COVERS TO GRADE SHALL
BE MORTARED IN PLACE.
5. NO DETERMINATION HAS BEEN MADE AS TO COMPLIANCE MATH
ELDED OR ZGNIrIG REGOLATiGivS. OWNER / APPLICANT IS TO
OBTAIN SUCH DETERMINATION FROM APPROPRIATE AUTHORITY.
6. UTILITIES SHOWN ARE APPROXIMATE ONLY, EXCAVATION CONTRACTOR
IS TO CALL "DIG-SAFE" AT 1-888-344-7233 AT LEAST 72 HOURS
PRIOR TO COMMENCING WORK ON SITE.
WA D ROAD 7. CONTRACTOR IS TO VERIFY GRADES AND ELEVATIONS AS WELL AS
Y�A N 8 SITE CONDITIONS PRIOR TO COMMENCING WORK ON SITE. ANY VARIATION
IS TO BE BROUGHT TO THE ATTENTION OF THE DESIGN ENGINEER
96.7 IMMEDIATELY.
8. PARCEL IS IN FLOOD ZONE _ C
9. LOT IS SHOWN ON ASSESSORS MAP AS PARCEL
• 97 2 95 78' 'o. 10. ALL UNSUITABLE MATERIAL SHALL BE REMOVED FROM UNDER, AND
97.2 96.3 FOR A MINIMUM OF 5 FEET FROM AROUND THE SOIL ABSORPTION SYSTEM,
t AND BE REPLACED WITH SAND AS SPECIFIED IN 310 CMR 15.255; (3)
_ -9&0 �+�'" LOT 21 (I.E. TITLE 5) IF ENCOUNTERED BELOW S.A.S. PIPE INVERT.
3 -t l '(98�_ _ _ 11,420..3't S.F. 96.8 96.6 �_ _ 11. EXISTING L FACf-I f'17- TO BE PUMPED AND FILLED WITH SAND
96.3 ,N. CF\ '�' OR REMOVED
�,�ti` f tl+I 12. P20 Po iEL�
C- Go.vJ T"R v G Tio.v is r v /�G�s'tit C.F
G, GH A Alu ��' i't k Li1V►f
9� R yGI
SHOAT
98.6 APPROVED: BOARD OF HEALTH
SA S-_t� CIVIL r
j 1)lJo7-. `99.2 �i \\ No. 27483
'R A
C3 " ; :��o� .p 0
9 8. 98.4 ` Zap fc --
"" ` �f 98.4 �X s r�,✓c, » 99.2 m L 5 - DATE AGEN T
D w,d•��i�Gt \ A'
99g 8 PROPOSED SEPTIC DESIGN �
FOR
WM. ROBINSON for KIM PURDY
96.9 \ LOC. 31--- -A T
AM ROAD
DECK 95.9 Y,�E, MASS.
\ Fr iST i'`�G \ 98.8 96.7 ROUSE 28 0 n YAiNNIS
49 7.8 -,n 98.4 /
I T"'�K
R `� CRAG R SHORT P.X
s el�e I N4 235 GREAT WESTERN ROAD
NOTle G �� 508- P. 0. BOX 1044
12s84 LOCUS c 398-8311 SOUTH DENNIS, MASS. 02660
<7 DATE MAY 29 2003 SCALE 1 " = 20'
--
REVISED JOB NO. 01_097rf
LOCATION MAP REVISED J SHEET 1 OF 1
- 0 2002 CRAIG R. SHORT, P.E.