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HomeMy WebLinkAbout0031 ANCHOR LANE - Health s� a '•+�1191 h6r ` t. A" 024 03Z OGi� A f 3YT No. J 60 THE COMMONWEALTH OF MASSACHUSETTS FEE too t� BOARD OF HEALTH �o o f `F3�S 1kaL6 APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT Application for a Permit to Construct ( ) Repair (V� Upgrade ( ) Abandon ( ) - ❑Complete System ❑Individual Components 2( MWbf - `Df Lv15 oA>J IAU-MAIJn/ OC ` ,� 1� jl�ayi on Owner's Name ✓I V 3 i s�FnIC,��Q L D2. BTU e q t-4Ac Map/Ifarcel# Address 1}Wl L%5 Lot# �A�12L �tJ TC l�`hone# Installer' nerk Name '5oX '71)Z S bt M 12 'rWS ytL-L S . -MA "SDX 99 Cc DSesi%-NDUJ1LA , KkA y /,.,Address �0 rot` Addr s�2 Telephone# Telephone# Type of Building.. �I'DEF�JT ArL Lot Size Sq.feet Dwelling—No.of Bedrooms Garbage Grinder ( ) Other—Type of Building No.of persons Showers ( ), Cafeteria ( ) Other fixtures Design Flow(min.re ..ired) ® gpd Calculated design flow +1®gpd Design flow provided�gpd Plan: Date t Number of sheets Revision Date Title Description of Soil(s) Soil Evaluator Form No. Name of Soil Evaluator Date of Evaluation DESCRIPTION OF REPAIRS OR ALTERATIONS �A eA P4 C1 L•1W The undersigned agrees to install the above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and fu er agrees not to placelhe system in operation until a Certificate of Compliance has been issued by the Board of Health. Signed Date Inspections FORM t - APPLICATION FOR DSCP DEP APPROVED FORM 5/96 . `. .. T n ..r -��i....F -�'+..n _ ...l.ti..+i:. ,. �,•.s .. -.-..rrr�s-.,fr �.�•r�`•-�F-w..-�rrw„'ati`F...�.r.�.id'u..r'-.. e f ,.�. .,.. , .. ' N THE COMMONWEALTH OF MASSACHUSETTS FEE Ioo t BOARD OF HEALTH t�( O O F -B-ka JS'fka L l 1. APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT Application for a Permit to Construct ( ) Repair (%ol Upgrade ( ) Abandon ( ) - ❑Compfete System ❑Individual Components 31 MCA bR- -D fit V i` O t l nl U c-I-M A IJ p J ion 3 A IJL' b�. DA,s Name Con)f JVI� Map/Parcel# Address _..� Lot# Telephone# ..1 Arrvv<�S. �o ttx 2 �Rc2lr �N?'ar2� Installer's Name �xt f Designerk Name oX l M AASTb1`fS /w I L46 _ AAA QjSttIJDu1�G14 . tek A S'art 4Addr0 Add n g'Q t+ 50d O A ` ressO Z/ Telephone# Telephone# Type cif-Building. .I yEtJ'r�"� Lot Size Sq.feet Dwelling—No.of Bedrooms Garbage Grinder ( ) Other—Type of Building r No.of persons Showers ( ), Cafeteria ( ) Other fixtures d+ Design Flow(min.re uired) TN O gpd Calculated design flow + 11 0 gpd ' Design flow provided L4qt gpd Plan: Date 11 Number of sheets 1 Revision Date Title Description of Soil(s) Soil Evaluator Form No. Name of Soil Evaluator Date of Evaluation DESCRIPTION OF REPAIRS OR ALTERATIONS NEW 1-9-A fit) PA cl LITV The undersigned agrees to install the above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and fu er agrees not to place/ a system in operation until a Certificate of Compliance has been issued by the Board of Health. Signed Date Inspections FORM 1 - APPLICATION FOR DSCP DEP APPROVED FORM 5/96 No. a611 -300 THE COMMONWEALTH OF MASSACHUSETTS FEE Prl?a.s-a,I&L BOARD OF HEALTH CERTIFICATE OF COMPLIANCE Description of Work: ❑ Individual Component(s) ❑Complete System The undersigned hereby certify that the Sewage Disposal System;Constructed-( ),Repaired Upgraded( ),Abandoned( ) by: ko t.. 'Cry i S®tJ C01JS7-.ZtjCTI vrJ Cn 1 LLC at 31 AIJcI- m- ba 1lC has been installed in accordance with the provisions of 3310;CMR 15.00 (Title 5) and the approved desig. Tans/as-built plans relating to application No.Q,D 1 -�tTo dated i t of Approved Design Flow �� (gpd) Installer Desi r L Ir A l�� ( 5 kA gner: �tiQ-t,- �--Arh1"r� Inspector /ti. Date The issuance of this certificate shall Lt be construed as a guarantee that the system will function as designed. FORM 3 - CERTIFICATE OF COMPLIANCE DEP APPROVED FORM 5/96 No. t 011 -300 THE COMMONWEALTH OF MASSACHUSETTS FEE -6A"S'rArPa1-1 BOARD OF HEALTH DISPOSAL SYSTEM CONSTRUCTION PERMIT Permission is hereby granted to Construct ( ) Repair (✓) Upgrade ( ) Abandon ( ) an individual sewage disposal system at 31 EMI G-Eo tL DO t11= as described in the application for Disposal System Construction Permit No. �� (� dated �� 1 r Provided: Con .tructio/n shall be completed within three years of,the date of this permit.All local conditions 4ust be met. Date 1 Board of Health {M n�, B /- FORM 2 - DSCP DEP APPROVED FORM 5/96 FORM 1255 (REV 5/96) H&W HOBBSS WARREN TM PUBLISHERS- BOSTON O OF Acgssq TRANS. NO.: oa � HARRY tiN CITY/TOWN: EARL LANTERY, 1R, H APPLICANT: p No.26575 p �o Fri �� ADDRESS: 3 1 nN C 1�)o �Z� V-j �Fssro T, DESIGN FLOW: '` 4 O 9Pa REVIEWED BY: L-'_ L 1z VjF- DATE: N/A OK NO GENERAL s 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?(1"=40' for plot plans, 1"=20' or fewer for components) [310 CMR 15.220(4)] Easements shown [310 CMR 15.220(4)(b)] System located totally on lot served [310 CMR 15.405(1)(a) for upgrades]- if not, a variance is required [310 CMR 15.412(4)] - �( Location of impervious surfaces (driveways,parking areas etc.) J [310 CMR 15.220(4)(d)] Y Location all buildings existing and proposed 310 CMR 1 15.220(4)(c)] V Location and dimensions of system components and reserve J areas. [310 CMR 15.220(4)(e)] V System Calculations [310 CMR 15.220(4)(f) daily flow septic tank capacity (required andprovided) V - soil absorption system (required andprovided)- . whether system designed for garbage grinder North arrow 310 CMR 15.220(4)(g)] Existing and ro osed contours[310 CMR 15.220(4)(g)] 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 (i)] Location and date of percolation tests (performed at proper / elevation?) 310 CMR 15.220(4)(i)] 1/ Percolation test results match loading rate? 310 CMR 15.242] Certification statement by Soil Evaluator [31.0 CMR 15.220(4)0)] Observed and Adjusted groundwater(method for adjustment given or indicated) [310 CMR 15.103(3) and 310 CMR 15.220(4)(n)] Address Sheet 1 of 7 c N/A OK NO Location of every water supply, public and private;[310 CMR 15.220(4) k within 400 feet of the proposed system location in the case J of surface water supplies and gravel packed public water suppIy V n within 250 feet of the proposed system location in the case .within 150 feet of the proposed system location in the case / of private water supply wells 1( Location of all surface waters and wetlands located up to 100 f'. beyond setbacks listed in 310 CMR 15.211 and any catch basins located within 50 ft. [310 CMR 15.'220(4)(1)] 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)] Stamp of designer [310 CMR 15.220(1) and 310 CMR 15.220(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 V approved 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)] 1/ Test Holes adequate to confirm adequate groundwater separation? 310 CMR 15.103(3)] Benchmark within 50-75' of system [310 CMR 15.220(4)( )] Materials specifications noted? [various sections of 310 CMR 15.000] Y System components not> 36" deep (unless Local Upgrade > Approval or LUA requested) [310 CMR 15.405(1(b)] Y Address Sheet 2 of 7 N/A OK • NO SEPTIC TANK _ g Size OK? 310 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 15.227(6)] Outlet tee with gas baffle or approved filter [310 CMR 15.227(4)] Note regarding installation on stable compacted base 310 CMR g g p [ 15.228(1)] Separation between inlet p e et and outlet tees (no less than liquid depth) 310 CMR 15.227(2)] Inlet/Outlet elevations at least 12" above high groundwater (except as described 310 CMR'15.227(5)) or permitted for upgrades 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 p� CMR 15.232(3)(0] Three access covers(inlet and outlet must be 20" or greater) - middle access at least 8" (b 7/07) [310 CMR 15.228(2)] A <Access to within 6 of grade - one port for stems 10 g P Y 00gPd, � two fors stems>1000 gpd [310 CMR 15.228(2)] All at-grade covers secured to unauthorized access? [310 CMR J 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] Multi-Compartment Tanks Required when other than single-family dwelling or flow>1000 r g d [310 CMR 15.223(1)(b)] Y First compartment 200%daily flow; Second compartment 100% / daily flow [310 CMR 15.224(2) and(3) V "U" pipe through or over baffle, outlet of each compartment with gas baffle or a roved filter [310 CMR 15.224(4)] v Address Sheet 3 of 7• N/A OK NO BUILDING SEWER AND OTHER PIPING w; Located at least ten feet from any water line? [310 CMR 15.222(2)] y Disposal piping at least 18" below water line (when water and sewer cross, see 310 CMR 15.21l(1)[1]) Cleanouts required/provided ? 310 CMR 15.222(8)] Thrust blocks specified in force mains? 310 CMR 15.221(6)(c)] Slope of sewer line not less than 0.01 (1/8"/ft) 0.02 preferable [310 CMR 15.222(6)] Proper pitch on all runs? (.005 within gravity-distributed trenches and beds) [310 CMR 15.251(9) and 310 CMR 15.252(2) c V Siphonproblem/(leachfield below pump chamber) Endca s or vent manifoldspecified? Size and orientation of discharge holes specified? (not smaller than 3/8" not larger than 5/8") [310 CMR 15.251(8) and 310 CMR 15.252(2)(h)] Materials specified (310 CMR 15.251(5) specifies various pipe types allowed) DISTRIBUTION BOX Stable compacted base [310 CMR 15.221(2) and 310 CMR 15.232(2)(a)] v 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)(0] Inside minimum dimension 12" [310 CMR 15.232(2)(b) Minimum sum 6" [310 CMR15.232(3)(e)] v� Watertight cover if<2000gpd); waterproof manhole if>2000gpd , J [310 CMR 15.232(3)(d)] �( PUMP CHAMBERS S Capacity (emergency storage above working=design,flow)? [310 CMR 231(2)] Y Proper setbacks [310 CMR 15.211 (same as septic tanks)] Watertight 20-in minium access manhole at least 20" MUST BE / TO GRADE [310 CMR15.231(5)] 1/ t Service components accessible (not too deep with piping, J disconnects accessible) Y Alarm floats - alarm on circuit separate from pumps s ecified? Exceeds two units must have two pumps operating in lead-lag mode. [310 CMR 15.231(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 N/A OK NO SOIL ABSORPTION SYSTEMS (SAS) GENERAL " Calculations correct? 4 feet of naturally occurring material demonstrated? [31.0 CMR 15.240(l)] Required separation to groundwater? [310 CMR 15.212)]' Aggregate specified as double washed [310 CMR 15.247(2)] System Venting required/provided? (system under driveway or >36" deep) [310 CMR 15.241] Inspection ports specified and within 3"final grade? [310 CMR 15.240(13)] Breakout requirements met? (No violation of breakout elevation within 15 ft of SAS unless barrier) [310 CMR 15.211(l)[4] and Guidance Document] GALLERIES,PITS,CHAMBERS 310 CMR 15.253 Chambers and Gal. in trench configuration supplied with inlet every 20 ft. 310 CMR 15.253(6)] Each structure with one inspection manhole (if>2000 gpd must be to grade) [310 CMR 15.253(2)] V Aggregate I' minimum-T maximum. [310 CMR 15.253(1)(b)] 2' sidewall credit maximum [310 CMR 15.253(1)(a)] In bed configuration, inlet every 40 s . ft. [310 CMR 15.253(6)] TRENCHES 310 CMR 15.251 Width 2' minimum 3' 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 greater(3x if reserve between trenches) [310 CMR 251(1)(d)] Situated along contours [310 CMR 15.251(2) Breakout OK? [310 CMR 15.211(1)[4] and Guidance Document] BED SAS (Maximum size of bed or field 5000 gpd) minimum 2 distribution lines [310 CMR 15.252(2)(a)] Maximum separation between lines 6' [310 CM RI 5.252(2)(d)] Maximum separation between lines and outside of bed 4' [310 CMR 15.252(2)(e)] Aggregate depth below discharge pipes 6" minimum, 12" maximum. 310 CMR 15.252(2)(g)] Separation between beds 10'minimum. [310 CMR 15.252(2)(0] Bottom area used in calculations only [310 CMR 15.252(2)(i)] . Address Sheet 5 of 7 . N/A OK NO DID THE PLAN INVOLVE - Pressure Dosed System ? Provided pump and piping 9 calculations as required 310 CMR 15.220(4)(r)] _ v Pressure dosing required on all systems>2000gpd or alternative systems under remedial approval [310 CMR 15.254(2) and I/A 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 (>2000g d)good to note on plan [310 CMR 15.254(2)(d)] Construction in fill -Did the plan specify that the fill shall meet J the specification of 310 CMR 15.255(3)? Impervious barrier and/or retaining wall ? [Guidance Document] Impervious barrier installation must be supervised by 1 desi ner [310 CMR 15.255(2)(b)] Retaining wall must be designed by Registered Professional J Engineer [310 CMR 15.255(2)(a)] Y Side slope not exceed 3:1 ? [310 CMR 15.255(2)] Breakout requirements met? [310 CMR 15.252(2) and Guidance Document] At least 5 ft. from impervious barrier to edge of SAS (10 ft. recommended) [310 CMR 15.255 (2)(e)] Gravelless System[EA Approval Letters] Check DEP Approval letters for credits and design conditions If used with pressure dosing do not allow pressure discharge to scour soil interface Alternative Septic System[IIA Approval Letters] Was DEP Approval Letter provided and/or have you J " 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 perpetual 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 Variances Are the variances listed on the plan ? [310 CMR 15.220 4)(g)] RLS Stamp necessary on plan if a component is within five feet of property line[310 CMR 15.412(4)] New construction or increased flow proposed -[Refer to 310 CMR 15.414] Address Sheet 6 of 7 N/A. OK NO Nitrogen Sensitive Areas_ v Is the system in a Designated Nitrogen Sensitive Area(Zone II for a public supply well)? [310 CMR 15.21,4, 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 ? / [310 CMR 15.214(2)] Y Are the nitrogen loads proposed in compliance? [310.CMR 15.216(1)] Miscellaneous M1 w Pumping to septic tank? [ 310 CMR 15.229] ►� Shared System [310 CMR 15.290] Address Sheet 7 of 7 Town of Barnstable oFz"E r Regulatory Services Thomas F. Geiler,Director BA MASS. , public Health Division 16 � ArFo �A - Thomas McKean;Director 200 Main Street,Hyannis,MA 02601 Office:.508-862-4644 Fax: 508-790-6304 Installer & Designer Certification Form Date: 14` i 1 Sewage Permit# 2-v i 1 —3 0 o Assessor's Map\Parcel 2q- d 32-00 4 U AAA_ L�-"r Installer: Designer: Address: . u>t cl°� Address: $o x ?o Z MA /I.LA s-ro t✓s s4t u�- XAA On d, m es av wzrr� was issued a permit to install a (date) (installer) septic system at 31 y-d e,40tC CoT✓tT based on a design drawn by (address) t�-AC-t_ LET dated 7 Serr 7 (designe ) �.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. 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 re u' d as inspected and the soils were found satisfactory. N OF M4S. o HARRY N� g EARL -4 (In Ile ' ignature)k.A�IRNSTABL LANTERY, JR. .o ,p No.26575 40 �Ol sT E� �FssioNA1 FNG (Designer's 1 ature) (Affix Designer's.Stamp Here) PLEASE RETURN TO IC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS- BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. Q:\Septic\Designer Certification Form Rev 03-09-06.doc J DEEP-OBSERVATION HOLE LOG' Hole# Depth from Soil Horizon Soil Texture ,,Soil Color Soil Other ^, Surface-f 0 _ (USDA) (Munsell) Mottling (Structure,Stones;Boulders. t i tenry,%Gravel) t C' 245_ DEEP OBSERVATION HOLE LOG Hole# , s Depth from •Soil Horizon �G Soil Texture V Soil Color I Soilfy 1 ;Other Surface(ia.) r r 1 � A. (USDA) }✓ it(Munsell) 14Mottlin`g Z(Structure,Stones,Boulders. onsis %Gravel 'vim cy � DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. C sistency, Gravel) DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil . Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones;Boulders. Co si ten Flood Insurance Rate Map: Above 500 year flood boundary No_ Yes Within 500 year boundary No Yes Within 100 ye ar flood boundary No Yes Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring per 'al exist in all areas observed throughout the area proposed for the soil absorption system? If not,what is the depth of naturally occurring pervious material? Certification OF M I certify that o' ( a a passed the soil evaluator examination approved by the Department of nviro I Ptoarld at the above analysis was pero by me consistent with . the requir r 'n rtiig a�n2i'bxp cribed in 310 CMR 15.017 1ANTER R. �� a Date Signature .2657 , ONAI.ENG\� ... Q:\SBPTICkPERCFORM.DOC Town of Barnstable P# yLf� Department of Regulatory Services J BAMUMBIA S Public Health Division Date rEu a�� 200 Main Street,Hyannis MA 02601 Time Date Scheduled �& L Fee Pd. Soil Suitability Assessment for S a e Disposal Performed Witnessed tnessed By: BY �i LOCATO & GENEIyIAL INFO TION Location Address � � � ® V Owner's Name Q)19?J ] Address Assessor's Map/Parcelc2+'d,Z, _ Engineer's Name r_+\,t9_ NEW CONSTRUCTION REPAIR Telephone# _7• P�! 5 1 51 Land Use Slopes(96) Surface Stones Distances from: Open Water Body-�'Sa ft Possible Wet Are 2 ft Drinking Water Well ft Drainage Way ft Property line ft Other ft SKETCH:(Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands in proximity to holes) �1 Parent material(geologic) ©�T111 Depth to Bedrock �. 10 Depth to Groundwater. Standing Water in Hole: Weeping from Pit Face ' > Estimated Seasonal High Groundwater Method Used: +D + MINATION FOR SEASONAL HIGH WATER TABLE Depth Observed standing in obs.hole: in. Depth to soil mottles: Depth to weeping from side of obs.hole: in, Groundwater Adjustment ft. Index Well# Reading Date: Index Well level_____a__.. Adj.factor Adj.Groundwater level , PERCOLATION TESL' Date� Time,r Observation Hole# Time at 9" p Depth of Perc Time at 6" ' Start Pre-soak Time @ 1 'lime(9"-6") End Pre-soak «,Y' Rate MinJlnch , V j a , Site Suitability Assessment: Site Passed Site Failed: != Additional Testing Needed(Y/N) i 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 Conservation Division at least one(1) week prior to beginning. Q:XSEPTICIPERCFORM.DOC TOWN OF BARNSTABLE LOCATION 3! A&f e4ko 2 to wt 67 SEWAGE# 2011 — 'So 0 VILLAGE a-u i'r ASSESSOR'S MAP&PARCEL 24-6 3 Z— oa INSTALLER'S NAME&PHONE NO. TJ trm GjS 14V LEER Sbt4 7-0O SEPTIC TANK CAPACITY 1006 1 4-t ("Isna e.) LEACHING FACILITY:(type) LX. — Sao (size) 3X. Sao NO.OF BEDROOMS OWNER J�, r U U,MA-FJ PERMIT DATE: 6 g. 4 0 COMPLIANCE DATE: l Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility >/O Feet Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) KI LA Feet Edge of Wetland and Leaching Facility(If any wetlands exist within _300 feet of leaching facility) #1/A Feet FURNISHED BY *P(,Atf 01l/ A?C64,4D Z 33 a 2 27 - a ri 8 3 32 -0 09��-f Ova. y /FEE No....T3n.I_�6 ......,©. ....._ THE COMMONWEALTH OF MASSACHUSETTS P -roww BOARD �O�F ' H�--E�A�L) T�'H Alip iration for Bitipagal Works, Tututrurtion Prruat Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: ... - ---•---D•--__!..._•E---•••-•-••--•-•---- ----------"--------------------!. -r-.-----------.....-•--•---------------................_ car rr -- ��ss sea! s2,K ..IlnN wst �/►ILZL 4-w-t .----------•----••--- -__--- ----•............................••-----------.----.._.......... Owner Address Installer Address dType of Building Size Lot____.�'Q�--. q. feet U Dwelling—No. of Bedrooms.__.___. ............................Expansion Attic Garbage Grinder 'k Other—T e of Building No. of persons____________________________ Showers — Cafeteria a' Other fixtures ________________________ _ W Design Flow-------_•------� ------- ---------- - allons n �Y. Total a}1 or�A'-----------------__----_----------_-----gallons. 9 Septic Tank—Liquid capacit allons Length_ __ Widt M - ameter-----------_-- Depth................ Disposal Trench—No.+_...__._ _____ Width_________f......... Total Length...... Total leaching area............ sq. ft. Seepage Pit No------------l....... Diameter...... De th-below inlet______ _.__ Total leaching art ` _.__..-_sq. ft. z Other Distribution box Dosin t nk4% �- a Percolation Test Resul Performed by.. Date Date___4?__ __. � __..._. ,4 Test Pit No. 1____-2c___minutes per inch Depth of Test P Depth Depth to ground water.____ ' 44 Test Pit No. 2_______�__minutes per inch Depth of Test Pit_________ ____ Depth to ground water______ _____________ 0 Description of Soil__•----®. �1-• -- w - fj - 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 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 issued by the board o ealth. Signed �-- ---�-- - -- -----------.. --Z2-- --.......-...-.. ...... ' oa7 ' --- ----------Date-----..------....- Application Approved B --------------------------------------------------------------------PP PP Y - 6 3z -?3 A Da e Application Disapproved for the following reasons: -- ----- -------------------------------------------------- ------------------ ------- --- ------------------------------- ------------------ --...-...-....------...---...-..-......-......--.-....-.... pps Date PermitNo. ---------f..-3---"-----vv-6-------------------- Issued -....................----------------- --- --...-....---------- Date No.---Li...__ f., .Z FEs P ' THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH -----TOWN..............OF.... N� LG Appliratilan for Uiipn,i al Work,6 Tomilrnrtiun Prrutit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at -•... ?-1....._t�'NC:�.:�.......� t;l�C L.OT ••-•. --------•. .... ---------------------------•-......._..-------•-----------...----•- W '_)0y+K j #AV Owner Address -•--•----.............................. ......_.._........-----------------------•.._...... ..-•-•••••------•-•----•------•--•----•...._..................----•-..................._______.... Installer Address Type of Building Size Lot_____ � -------------- t U Dwelling—No. of Bedrooms......... ..................................Expansion Attic Garbage Grinder Other—Type T e of Building No. of persons............................ Showers — a YP g ---------------------------- P ( ) Cafeteria Q' Other fixtures ______________________ _ _ _ ----------------------------------------------- ---------------------------- ------------------------ - Design Flow................... ................... allons sen r �y. Total da�lyji°J�____ ��- .................__gallons. 9 Septic Tank—Liquid*capacitiallons Length.���.. Widt1 ;_,,��_��___.`k7iameter................ Depth................ Disposal Trench—No.r Width.......... Total Length....._._ ._._ Total leachingarea............ s ft. Seepage Pit No..•....._....1... .. Diameter....... De th elow inlet----I......... Total leaching ar lye .....sq. ft. Z Other Distribution box Dosingtpkg `" Percolation Test Resul Performed by . �....._.�j�� Q iQ a �'i---------__�.'�__!�F��C�1- i___l�_--- Date---U-_--�-��-•{---/��--... 1.4 Test Pit No. 1-----�---minutes per inch Depth of Test Pit..___._.�'i .... Depth to ground water_.__ri, Test Pit No. 2.......�-._minutes per inch Depth of Test Pit._...... .... Depth to ground water______ __________ -- •• ................................................................................................................... 0 Description of Soil....... ---"2.........._ - x -------------- dil . ... -•------------- U p?- ------------------------------------- --�-.1 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 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 issued by the board of health. Signed ------------------------------------------------------------------__......----------------------------- -----..... ....------------ Dare Application Approved By ................. . ,-h Date Application Disapproved for the following reasons- ------------------------------------------------------------- ----- -- - ------------------------- --------------------- ----------------- --- -------- -- ---------------------------------------------------- ----------------------------- ---- -- ---- -- ------- -................................................. ............... ------------------ � Permit No. .--...---/.... ......... .. .................. -S ............... Issued ....................................__................De ac.-- Dare THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .............�ef.:,✓( OF ......... mom f'....--......-..-..-----------..--------------- CPrttftcax#e of C ampliaxnce THIS IS U., RTIFY, That th Individual Sewage Disposal System constructed ( ) or Repaired ( ) by......................... - ------ '.', ,.-: ".......-------------------------------------- 3 Installer l .+ rl at .............�- �. . �.::... t- ,- ---------------- -'_-rI .f� --t - has been installed in accordance with the provisions of TITLE 5 pf The State Environmental Code as described in the application for Disposal Works Construction Permit No. -.......7 ..-. .y.7fy.... dated ------------------------------------------------ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE------------------- Y .............................................. Inspector ------------ -. ------------- - ............. THE = COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH p � ...••-•-•................................ r! ........./• •=':C't wo..............0F...........4?F':tic -' .�1 Disposal Word T� on #rudion rrmit Permission is hereby granted C�L�-'` C}n-------------•----------------------------•..........------............__•----..._.. to Construct (� ) or Repair ( ) an 1 diQZISewage Disposal System at No. :: 1. ..mot'' _ Street _ as shown on the application for Disposal Works onstruction Permit No __ S... Date _ --t_........... f. .-•-•-----------•--. ��-----••--- �-- •-------- Cp Board of al DATE------------- .......i -----_-_--. -� FORM 1255 HOBBS & WARREN, INC., PUBLISHERS TOWN'OF BARNSTABLE LOCATION SEWAGE # "?VILLAGE °j-f„` ASSESSOR'S MAP & LOT C � �,6ay INSTALLER'S NAME & PHONE NO. SEPTIC TANK CAPACITY jOO .; LEACHING FACILITY:(type) (size) /0 NO. OF BEDROOMS,'. PRIVATE WELL OR' UBLIC WATER BUILDER OR OWNER DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No ;✓ 4 . 1 �� �1� � �t � i (' � � i �. , ► i � � '� � , y3- � , , , s � i V`a� 4 ��.i TEST PIT PERC. TEST ' EXISTING .I 28 Mariner �Cir Aji, ^ I OO.G # 1 GRADE # 2 f ,,d ! C6tuitj, MA�M263 I OO.G f ' r k� y/a 1 �I CIA LOAM ` !l 100. 1 100. 1 ` '"\B8rn Skble '' a q f Bw LOAMY SAND Sarduft'1� r ` : 4b " AN 97.G3% !t PERC RATE 9G.G LOCUS N37031'07"W N.T.S. i` 252.52' r Z DESIGN REMOVE TREES 01 V C-MED SAND AS NEEDED. N �� RESERVE EXIST. (EACH. PIT 5% GRAVEL SINGLE FAMILY DWELLING W/4 BEDROOMS L____ .I SHED NO GARBAGE DISPOSAL i, (f0 BE PUMPED, FILLED W/SANp � (� _ DAILY FLOW= I I O X 4 = 440 GPD 96x9 1' AND ABANDONED) I Ri ° ' ' SEPTIC TANK(VOL.REQ'D) Sex/ .- QN234 36 50'W 71 98x3 �-- I�.C./J� -rn 75.4'_ sBX4 TP �8x7 \ 440 G.P.D. X 2 = 880 GALS �IJ 1000 GAL.TANK-O.K. (EXISTING) m `ti i BENCHMARK: OUTSIDE CORNER 32' OF BULKHEAD. EL.. = 100.00 90.G NO H2O NO H2O 90.G LEACHING AREA(S.A.S.) D.B.co (ASSUMED) o 9 9990 x USE 3 @ 5' X 8' X 2' P.C. CONC. L.C. + 4'STONE O N 9ax7 iu 1 CA N EXIST. 1,000 GAL, 99 sJ EFFECTIVE DEPTH = 2' N SEPTIC TANK I - - 2 X [G4 + 2G]X 0.74 = 133 DECK TESTED : H. EARL LANTEKY, PE rn 32 X 13 X 0,74 = 308 No, 31 - — X Z I z STY. WD. FR. o TOTAL CAPACITY = 441 GALS. T.O.F. - 102.91 - - T--- J APN 24-03 2-004 � NOTES: (� ca to 70 (43,G70±5F) r' 1 . DISPOSAL SYSTEM TO BE CONSTRUCTED IN STRICT ACCORDANCE WITH n COMMONWEALTH OF MASSACHUSETTS ENVIRONMENTAL CODE - TITLE V. F--1rn 2. CONTRACTOR TO CALL DIG-5AFE 72 HOURS PRIOR TO BEGINNING OF EXCAVATION. GRAVEL I 3. EXISTING PITS TO BE PUMPED, FILLED WITH SAND, AND ABANDONED. i DRIVE GRAVEL 4. CONTRACTOR TO FIELD CHECK INVERT AT FOUNDATION. DRIVE 5. THIS PLAN DOES NOT REPRESENT AN INSTRUMENT SURVEY AND 15 NOT TO BE USED OTHER FOR ANY PURPOSE OTHER THAN FOR THE CONSTRUCTION OF THE ELEMENTS SHOWN. G. BENCHMARK IS BASED ON AN ASSUMED DATUM, AS SHOWN. 7. LOCUS 15 SHOWN ON A PLAN RECORDED AT PLAN BOOK 210, PAGE 1 13, AT THE B°C.K.D. 8. LOCUS IS SERVED BY TOWN WATER. �p 2 4.83' �! 9. PUMP EXISTING 1000 GAL. SEPTIC TANK; CHHCK TS AND GAS BRFFLE, PER TITLE V. 537031'07"E 395.G8' 10. USE 3 @ 5' X 8' X 2' LEACH. CHAMBERS WITH 4' OF 4"TO 12' DOUBLE WASHED STONE ALL AROUND W/ FILTER FABRIC ON TOP. ANCHOR (50- WIDE) DRIVE GRAPHIC SCALE 30 0 15 30 60 ( IN FEET ) LEGEND 1" = 30' FIRST FLOOR SITE PLAN 24 PROPOSED CONTOUR /-EL. 103.9 10 \ / EXISTING CONTOUR TOP OF WALL — — DRIVEWAY L. 102.9 C. N ,� FIRM ZONE s \ OF d1gS °B° FIN. GR. EL. 99.6 EXISTING GR. EL. 99.5 2%SLOPE {o HARRY �\y ACCESS OF �/\/ \ \ \/ / / / / / / / ` EARI. \ \\\\i\\\ \\\\\\\\ \\ \\\\ c NLAR-265TRY, JR.75 q v= i i\ i\i i\ �, 9"MIN. COVER \/ / G"MIN./3'MASC.ic VE \� r EL. 98.7 ACCESS I ORTS �' C't$"` K O TEST - _ ° �"�ONAL FC ( FOR LEVEL 2'LEVEL o° t'o•aoOo ,w /\ EL. 98.5 GAL EL. 98.2 D-BOX EL 97.6 "6� /1 P.C. CONC. oa�a000-o° °noo-1 / FIELD goo$°n o,o$"o g°ogoo$0000goo CHECK SEPTIC TANK(H- I q) GA5 BAFFLE G"MIN. b-60 ti° EL 95.6 y°y o9 oob�o EL. 98.0 EL. 97.8 °o°0 00°po° �0 80°o°o°°o° H. EARL TERY, P.E. HEALTH AGENT APPROVAL a boo« ° °oo°o°080 o° ga�o °°o Qo ,9 0°80 00 DATE DATE VELOCITY REDUCER j 1 G"CRUSHED STONE -1 O'MIN � 5'MIN- I PROPOSED SEPTIC SYSYTEM DESIGN DEPTH� OF LIQUID =0 20'MIN.. 31 ANCHOR DRIVE INLET TEE DEPTH = 10" 0 BELOW BARNSTABLE OUTLET TEE DEPTH + 14" "Z ( (MARSTONS MILLS) MA EL. 920.E { r PREPARED FOR: DEREK BARSHAM (OWNER) �p� DE51GNBY- 5URVEYBY: ,�14��0� Sc ¢ LANTEKY A55oaarEs r�. hood son, Inc. DATE: SCALE= JOB No. PROFILE Of D 15 P05AL 5 T M XX P.O.BOX 99 r. ROUTE 6A 07SEP 1 I AS SHOWN 101 28 RIt HARD J. HOOD, PLS PATE EasrsaNDwicrl,raao2s37 sarvDwcn,nnaozs63 DRAWN: ( DRAWING NOT TO SCALE ) 774.313.9547 CHECKED CHECKED 508.833.7100 rjh HEL rjh(survey) r.. N 57'44'33 E 137.03'00 CA Cli 3 " IIz N 57'44'33" E o i 32.00' �OO I i v�� I I� II LOT 1 43,670 S.F. i NOTES: .. 1 . HOUSE NUMBER: 31 (ANCHOR DR.) , 2. ASSESSORS NUMBER: 024-032-004-31 w i 3. ZONING DISTRICT: RF w �0 4. FLOOD HAZARD ZONES: C cry 5. ELEVATIONS SHOWN ARE BASED ON THE NATIONAL 2' STONE GEODETIC VERTICAL DATUM. ALL AROUND ITS rm , 6. REFERENCE: PLAN BOOK 482 PG. 78 100 BULKHEAD 0 GA. I 40 _ LEACH PIT II W I I -P 20, � 10 HOUSE + 3 HOLE 1000 GA. FF ELEV=74 N DBOX SEPTIC TANK W ----W 60;�—W c� DECK No 24, I � 'P 2 G_--G'G I I m 75':¢ G�� Cr— G—GJ—G c� 3 _ II Ii � II DATE DESCRIPTIONlDrownIChecked R E V I S I O N S PLOT PLAN FOR LOT 1 PREPARED FOR 10 0 20 SCALE IN FEET COTUIT TRUST N 52':Z8'53,. E IN 139.22' SANTUIT BARNSTABLE, MASS. r SCALE: 1"=20' DATE: 8/17/93 CIRCLE �� MICHAEL 8. �G M A,RINER holmes and mcgrath inc. � MoGr�ATM , civil engineers and land surveyors � c�L y 200 main street No.�sa�s falmouth, ma. 02540 508 548�--3564 �FIsf�4`G���w`� SS/ONAL DRAWN: SDH CHECKEDY,-,( r FILE:93182PP.D WG .JOB. N0: 93182 DWG. N0: 55-3-12 SHEET 1 of 2 7 F 7; SOILTEST • Finish grade above and adjacent to system shall slope away at a min. of 2%. 4* diam. cast iron or Schedule 40 PVC pipe (tight joints). Date of soil test: AUGUST 19, 1993 Test taken by M.B. McGRATH 20' min. distance (building to edge of leaching system) Results witnessed by. JERRY DUNNING 10' min. dish. Percolation rate: 2 MIN./IN. GENERAL NOTES Ground water NONE ENCOUNTERED First floor elev. = 74.00 1) No change to this system shall be made unless approved in writing by holmes and mcgrath, Inc. ReLpovable covers within SOIL LOG 12 of finished grade 2) Subject to inspection during construction by the S 02 7-� Dist. box 3) Board of Health and holmes and mcgrath, Inc. NO 1 Heavy construction equipment shall not travel DEPT11 ELEV. emovab e cover 4) Disposal system to be constructed in accordance 0 TOP SOIL 2- S-.02 Clean backfill 72 t: level with Title 5 of the State Environmental Code. igui eve 2' layer of 1/8" to 1/2" 5) A copy of these plans must be kept on the site LOAM washed stone during the time of construction. 0 7 I.f± 000.00 0; C) S -02 Aft 008..- OC 4) 0 6) A copy of these plans must be furnished to the 't a 0 C 0 00 C a contractor constructing the disposal system. 0 0) .::!�-SEPTIC TANK -. (3) C 0 M 0) 0 6 0 0C 7) Before backfilling, the contractor shall notify SUBSOIL 00 06 'o Oc u) 0 2 ft. of 3/4' to 112" washed stone Foundation 7; W Precast 0 1000 GAL*­"`Zo a) (D 0C,0 a holmes and mcgrath, Inc., or the Board of Health design 00 0 concrete 0C 0 0 all around precast pit, providing an It 11 leach OC.C,0 Agent to inspect the system as constructed. by others T 3�K A 311k > Ing c w 0 effective diameter of 10 ft, 3.0' 69± q) N 4) 0 Z -W, pit c� C 0 8) If the contractor encounters any variation between C 0 the existing conditions shown on the plan and the 5 > )80 C qu 0;0; Elev.= 62 conditions encountered on the site, or any soil 5 o— 0 .7 condition different than shown on the soil log, or SAND any adverse soil, the contractor shall immediately 12.0'1 60+ 10'(�omet#r contact holmes and mcgrath, Inc. Holmes and PROFILE PROVIDE 12' LAYER OF mcgroth, inc. will examine the soil condition Not to Scale COMPACTED GRAVEL UNDER` and report to the owner any suggested revisions. L THE DISTRIBUTION BOX Elev.— 60. BOTTOM OF TEST HOLE THE CONTRACTOR SHALL EXCAVATE 4' BELOW THE BOTTOM OF THE LEACHING SYSTEM TO CONFIRM THAT THE, SOILS ARE CONSISTENT WITH THE SOILS FOUND IN THE TEST HOLE. IF THE SOILS ARE NOT Design Criteria CONSISTENT NTH THE TEST HOLE RESULTS,THE CONTRACTOR SHALL IMMEDIATELY CALL THE ENGINEER. Number of bedrooms: 3 Equivalent to 330 gals/day Garbage disposal unit: Na Leaching area — capacity required: 495 gals/day Side area proposed: 188 sq. ft. Bottom area proposed: 79 sq. ft. Total area proposed: 267 sq. ft. Proposed leaching capacity: 549 gal/day Water supply Town Precast concrete units: H-10 loading design 8'-6" ALL ACCESS MANHOLE COVERS FOR SEPTIC TANK, DISTRIBUTION BOX, AND LEACHING STRUCTURE SET MORE THAN 12" BELOW FINISHED GRADE, INLET =3 OUTLET SHALL BE RAISED TO WITHIN 12" OF FINISHED GRADE. 777: FRAME & COVER STEEL REINFORCED PRECAST CONCRETE OVER "T'S* WHERE REQUIRED. PLAN MEW —PRECAST CONCRETE DATE DESCRIPTION Drawn hecked TANK RISER WHERE 3* 3" REQUIRED R E V I S 1, 0 N S REMOVABLE COVERS 4 4 7 4 71 ALL OUTLET PIPES FROM THE INSTALL TUFTITE SPEED LEVELERS PLOT PLAN DETAILS 3" min. crearance required INLE-l—r DISTRIBUTION BOX SHALL BE ON ALL OUTLET PIPES OUTLET 0" min. % PREPARED FOR INLET 2' min. inlet to outlet 6" min SET LEVEL FOR AT LEAST 2 FT. 12" CONCRETE COVER OF PROPOSED SEWAGE DISPOSAL SYSTEM % Liquid level 3 5" OUTLET KNOCKOUTS COTUIT TRUST FOR LOT1 ANCHOR DRIVE E Ln E I N 15.5* 28" INLET OUTLET SANTUIT MASS. 12 t 6" 8 BARNSTABLE' 3 0 F f,! 7 5 f 1.75" SCALE: AS SHOWN JDATE: AUG. 17,1993 _o. 4'-10' M Atmlsz ECTIO CR05S—SECTION ­P IMiCHAt Es H PLAN N holmes and mcgrath, inc. CROSS—SECTION END-5ECTION civil I engineers and land 'surveyors 200 main street 3"m TYPICAL 1000 GALLON SEPTIC TANK. 3 HOLE DISTRIBUTION B falmouth, ma. 02540 NOT TO SCALE NOT TO SCALE DRAWN: SDH CHECKED: L 0� 0 0�00 0 0 0`0'0 r min 0, m E L JOB NO: 93182 DWG. NO.: 55-3-12 SHEET 2 OF 2