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HomeMy WebLinkAbout0249 COTUIT BAY DRIVE - Health 249 C®TUIT BAY DRIVE Cotuit - - - -- -- - - - ---- - -- - - - _ A = 056 - 032 3� No. Fee BOARD OF HEALTH TOWN OF BARNSTABLE 2pplicatiou ff or Yell Cou5tructiou Permit Application is hereby made for a permit to Construct(!<' Alter( ), or Repair( ) an individual well at: Ycl Ce T iT 84y Dr Location-Address Assessors Map and Parcel C41ke. K 6 !%'l�o�� ayj Go%.,,T /3ay D/ corGl7 Owner // Address ��NNls Sca",uer/ loll DtG/GSS AJ A4S4,OC-e o,4& Installer-Driller Address Type of Building Dwelling Other-Type of Building No. of Persons Type of Well /00 C Capacity Purpose of Well !so!ic, Agreement: The undersigned agrees to install the afore described individual well in accordance with the provisions of the Town of Barnstable Board of Health Private Well Protection Regulation-The undersigned further agrees not to place the well in operation until a Certific to of Compl' nce s been issued by the Board of Health. SignedQir,+� Pate Application Approved By I qV Date Application Disapproved for the following reasons: Date Permit No. %�Ul 1— Issued Z' Date BOARD OF HEALTH TOWN OF BARNSTABLE Certificate of Compliance THIS IS TO CERTIFY,that the individual well Constructed(!< Altered( ), or Repaired( ) by NCNN!$ PCaIeV e// ��11 Installer at a y cf o j'`�t t T o y 'J/ • c.9��e!7' has been installed in accordance with the provisions of the Town of Barnstable Board of Health Private WqfI Frotection Regulation as described in the application for Well Construction Permit No. Dated THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORILY. Date Inspector No Fee BOARD OF HEALTH ° TOWN OF BARNSTABLE 2pplication _for Veft Cou0truction, permit Application is hereby made for a permit to Construct(`), Alter( ), or Repair( ) an individual well at: yq Cc, Tu lT Ioe y ar Location-Address Assessors Map and Parcel G d �5/1 coF,,T /16y pr' coTU17 CAD �i Owner Address/ Installer-Driller Address Type of Building Dwelling Other-Type of Building No. of Persons Type of Well 0 C-- Capacity Purpose of Well (rf i galy i✓-- i Agreement:— The undersigned agrees to install the afore described individual well in accordance with the provisions of the Town of Barnstable Board of Health Private Well Protection Regulation-The undersigned further agrees not to place the j well in operation until a Certificate of Compliance has been issued by the Board of Health. Signed Ze% bate Application Approved By Date' Application Disapproved for thel following reasons: Date Permit No. "U` c Issued ---------------a_-a__---_3 _____o____m,°o a--- aoe>emedemseme_on-4-4m_o_. ---_____e_____ v,. BOARD OF HEALTH TOWN OF BARNSTABLE �i Certificate of Compliance THIS IS TO CERTIFY,that the individual well Constructed(t< Altered(. ), or Repaired( ) by �/CtirUr� JCctiu'yE'r Installer at ayq Ca r`u lr 1?6y 0 1 cc)7e has been-if stal-led-i-n-aeeor-dance-with-the-provisions-oftlre-Town of Barnstable Boar of-H-alth Private Well Protection Regulation as described in the application for Well Construction Permit No. Datedf 2.--j { THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE ONSTRUED AS A G A NTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORILY. Inspector � _._.__._.. ._....._�. ---------------------- _-_____-- - __._ <______.-,,r___________-------- --P-_-_------__--_-- BOARD OF HEALTH TOWN OF BARNSTABLE i M /, 19ell Con.5truction Permit No. V\J I/ � r � Fee Permission is hereby granted to Df,-Jtil S 5C6.104vix,l Installer to Construct Alter( ), or Repair( an individual well at: No. y9 7-u (T a% �) Street as shown on the application for a Well Construction Permit No. �� '� '' Dated 6�1 � Date ! ( � Approved By A/,-- i 1v S ` a �q cotu'�T 6Gy Of, . -------------------------------------------- -------------------pQ-� ----------------------------- Co 7-a,T /3�� (Jr TOWN OF BARNSTABLE LOCATION )6(1 I`, SEWAGE# VILLAGE �, ��\ ASSESSOR'S MAP.&PARCEL INSTALLER'S NAME&PHONE NO. 0, G.Av7� SEPTIC TANK CAPACITY LEACHING FACILITY.(type) QZ6 AAR,C 3 G-JA G (size) 3 Q� x�� 'K NO.OF BEDROOMS OWNER PERMIT DATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility S Feet Private Water Supply Well and Leaching Facility(If any wells exist on` site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet FURNISHED BY C'A Q 3 ' L 0 3 o -� t No. u 7 'OV �Q Fee G16 THE.COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS ftplitatlon for -MispoSaf *p6tem Construction Permit Application for a Permit to Construct( ) Repair( ) Upgrade(,_�Abandon( ) ❑Complete System Z�ndivi:l Components Location Address or Lot No. Z `, b f, Owner's Name,Address,and Tel.No. Assessor's Map/Parcel (� '�C� — ;��1 v.�i�G S�rc�"�' e� Q Installer's Name Address,and Tel.No.S�g �oSS Designer's Name,Address,and Tel.No. 3QD—33 b f Type of Building: Dwelling No.of Bedrooms Lot Size �(��3Q)C sq.ft. Garbage Grinder( ) Other Type of Building , No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min. equired) 3�� gpd Design flow provided 33 a.©� gpd Plan Date T Qc)(di Number of sheets Revision Date Title Size of Septic Tank Q:L'� a4 Type of S.A.S.�`1s Description of Soil Nature of Repairs or Alterations(Answer when applicable) �a p 5 �R� 3��-1r� L��w G.,,,,.k•,wl�t��'� �u��.., t, c�,��t,�.,- t� Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. Date Application Approved by Date Application Disapproved by Date for the following reasons Permit No. � �� �j (� Date Issued Iv No.cq c:�V.(Oo 'Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS Yes application for Dispo8 > ,�.it,m Construction Permit Application for a Permit to Construct( ) Repair( ) Upgrade(�andon( ) ElComplete System ndividual Components Location Address or Lot No. c��(�(Cps c�'.\ �j,pv f. Owner's Name,Address,and Tel.No. lz C 5j S Assessor's Map/Parcel Installer's Nar9A Address;iand Tel.No.�� oSS Designer's Name,Address,and Tel.No. 3<2D-331 N�,>1 ``6' da5--t3 Type of Building: �. s Dwelling No.of Bedrooms Lot Size 1� , 3CDC sq.ft. Garbage Grinder( ) Other Type of Building , No.of Persons Showers( ) Cafeteria( ) Other Fixtures �--� Design Flow(min. equired) �J-J gpd Design flow provided S 3 , 03 gpd Plan Date a0(L`� Number of sheets Revision Date Title Size of Septic Tank � � ai Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable)—���`,e�\ AA-ad l7 3- 3 3G"C_ Date last inspected: Agreement: i The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of i Compliance has been issued by this Board of Health. `� ne Date Application Approved by Date Application Disapproved by Date for the following reasons Permit No. c� "7 C515 to Date Issued -----------------------------------------------------1------------------------------------------------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS JS'TO CERTIFY that the On-site Sewage Disposal system Constructed( ) Repaired( ) Upgraded Abandoned(")by" c_SZy at Q Lk<Z� y`e-- has been constructed'in accordance with the provisions of Title 5 and the for Disposal System Construction Permit NrI c956dated i Installer��' c .� FCC--�� r' kc� ��. Designers #bedrooms Approved design flow /.l gpd �The issuance of this permit shal of be o strue�d as a guarantee'°that the system i 1 nati dens/igne . /`� cln&k D�e � JInspector / ! Q � --------------------------------------------------------------------------------------------------------------------------------------- L� No,r W L-1 6)L15 b Fee .1 THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION -BARNSTABLE,MASSACHUSETTS Misposal 6pstem Construction permit i Permission is hereby granted to Construct( ) Repair( ) Upgrade(.� Abandon( ) System located at -Z�a and as described in the above Application for Disposal System Construction Permit. The applicants ognized his/her duty to comply with Title 5 and the following local provisions or special conditions. r Provided:Construction must a corqpleted within three years of the date of this pe it. Date Approved by ---- __ -� f y j Town of Barnstable ..�WE'O�+ti Regulatory Services o� Richard V. Scali, Interim Director • BAMSfABLE, 9�A MASS. ��g Public Health Division ren�nr►. Thomas McKean,Director 1 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 m Installer & Designer Certification Form Date: ' l� Sewage Permit#(:! -(h •Q5 G Assessor's Map\Parcel a�C 03 7/ Designer: [�J_J,L4 S /i2� Installer: 5— �a _T Address: P0 &)( �� Address: On - ,, ,� �„� was issued a permit to install,a (date) (installer) septic system at �!s'.," � 'J 1 6 D/2/ based on a design drawn by (address) Uv 1 ('�, S /`YI.G 1 � �L dated 7 (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. Strip out (if required) was inspected and the soils were found satisfactory. N 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. Strip out (if required) was inspected and the soils were found satisfactory. I certify that the system referenced above was constructed_in compliance with the terms of the IAA approval letters (if applicable) o DARR y� (Installer's Si ature EY No. 11--40 I STE�� (Designer's Signature) SgNfTAR�aN PLEASE RETURN TO BARNS ABLE PUBLIC 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 8-14-13.doc f Town of Barnstable pPIMF Tq� Regulatory Services 'LSO Richard V. ,Scali,Interim Director ? $A MAW. is. ' Public Health Division 9`bA�Fo �a` Thomas McKean, Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Homeowner Certification Form for Alternative Systems Property Address: dIT l CO i-tT 6A`1 CAVE i Assessor's MaplPareel• OTC,/®3 2, I Property Owners Name: In accordance with Massachusetts DEP alternative system approval letters, the following certification information_is required by the Owner of record. The Owner of record must place an 'Y' in the applicable box next to each line certifying the information. Yes NSA ❑ I have been provided a copy of the Title 5 UA technology Approval letters. (15 page Standard Conditions letter and the specific technology letter) ❑ LJ I have been provided with the Owner's Manual ❑ I have been provided with the Operation and Maintenance Manual ❑ For Systems installed under a Remedial Use Approval,I agree to fulfill my responsibilities to provide a Deed Notice as required by 310 CMR 15.287(10) and the Approval ❑ L�J For Systems installed under a Remedial Use Approval, I agree to fulfill my responsibilities to provide written notification of the Approval to any new Owner, as required by 310 CMR 15.287(5) ❑ If the design does not provide for the use of garbage grinders, the restriction is understood i and accepted ! ❑ Whether or not covered by a warranty,I understand the requirement to repair, replace, modify or take any other action as required by the Department or the LAA,if the Department or the i LAA determines the System to be failing to protect public health and safety and the environment, as defined in 310 CIVIR 15.303 f i C� agree to comply with all terms and conditions above. Property Owners pri ted n __joperty Owne re Date Note: This form must be s itted along with the septic system disposal works permit application for all IAA systems including new construction, repairslupgrades, with and without aggregate (stone) and with conventional design criteria or credited design criteria. Q:15eptic\IA homeowner certification.doe Town of B nstabk p# � . Department of Regulatory Services" a. J STADIA PublicIealth Division Date / YAM tee$ 200 Main Stre 4 Hyannis MA 02601 - ` Time ..Fee Pd. Date Scheduled - � !' - , -y ` .' l Si oil Si tat ilaty AsessYi ent for Se to . Ui 0 , ; .< : Witnessed By: Performed By: a i 'L®C�D,TION & GENERAL IlVI+'ORIVIATION Location Address T Owner's Name:: 1 Ay .1;�:l l V V 1k Address., Assessor's Mdep/Parcel: OS(�16.3�i I Engineer's Name 331 J NEW CONS1RUt�CION REPAIR `y Telephone# Land Use Slopes `lt?' Surface Stones e H > ' 0 :7 0 ft Drinkin Water Well ! left Distances from: Open Water Body ft Possible Wet Area t`,, g d 1)rainageWay'r ft Pro- Drainage ��[� fc Other ft ` s. SKETCH:(Street name,dimcnstons'of lot,exact locations of test holes&perc tests,locate wetlands in proximity to holes) 10 . . I ;z O t r't's i + fdintatc, ,.71Depth to BedrockParent material(geglogic)Depth to Groundwater. St in Hole:, '. 14, I Weeping from Pit FnCe 1" Estimated Seasonal Vigh Groundwater i — D)�° ��IIN�TION FOR SEAS OVAL FIIO�i WATER T.�.�3LL - II Method Used: I 1n, Depth Observed standing nobs.hole: in. Depth td sgll mottles: fr Depth toiweeping from side of obs.hole: i in. OroundwnterAdjuetment ' Index Well# Reading Date: Index Well level.�' A�• �Cfor — Adj,Oroundwaterlevel.,,,,e, PERCOLATION TEST • n�tp . '>rl � ObservationHole# t I *�dTime at9" Depth of Pere The at61' Start Pre-soak Time-C� �17 TimC(9Y'-6") { End Pre-soak 1� 0 Rate MinJlnch Site Suitability Assessment: Site Passed Site Failed:' Additional Testing Needed,(Y/N) Original: Public lT41th Division Observation Hole Data To Be Completed on Back—=-- ✓(/1 , ***If percolation test is to be conducted within 100' of wetland,you must first notify the one (1) wetYk prior to beginning. Barnstable Cdoservation DWision at least DEEP OBSERVATION HOLE LOG Hole#-- Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.). (USDA) (Munsell) Mottling '(Structure,Stones,Boulders. Consistent %Gravel oil (9'`'14 1�:ISIP -v,-tom ID 'AJO DEEP',OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color '-` Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistent %Gravel) Oil 1� rl �0 '/ iJL DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil, , Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistent %Gravel i DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color $all Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stories,Boulders. Consisten ra t Flood Insurance Rate Map: Above 500 year flood boundary No. Yes Within 500 year boundary No_ Yes Within 100 year flood boundary No/ Depth " of Naturally Occurring`Pervious Material Does at least four feet of naturally occurring perviotip material exist,in all areas observed throughout the Area proposed for the soil absorption system? If not,what is the depth of naturally occurring per 'ous material? Certification I certify that on /0 (date)I have passed the soil evaluator examination approved by the Department of Environmental Protection and that the above analysis was performed by me consistent with ra .10 CMR 15.017. the required ' in exertise and experience described in 3. 9 P P Signature Date QASEPTIC�PERCFORM.DOC l N g, 3_2. ., - Fxs...... d..�._ THE COMMONWEALTH OF MASSACHUSETTS x . . BOARD OF HEALTH . .....OF............... ................. ...................: Apli iratiolt for Disvoii al Works Tonotrui"tiOn Application is hereby made for a Permit to ConstAuct (\A or Repair ( ) an Individual Sewage Disposal System at• I . . .................�� .. A!.: .`......-.�Y ......------------.�=-�--�---------� �------......---------......-----.........i s .... ��� -�^ --. ............:�. - ----- ......�_� _ ..� .. . ................ �-� ----.. o. er Address. � �-� ---.. .:. .. � --Q = . .......-----�.-�.......................... � Installer Address Type of Building Size Lot_._1!_ __ ... ! .Sq. feet U Dwelling—No. of Bedrooms.........:...... .........................Expansion Attic ( ) Garbage Grinder a aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) dOther fixtures .. ................ .............................................. Design Flow............................................gallons per person per day. Total daily flow...._..__.__....__._%_�_�,_.._.__.galIons. WSeptic Tank—Liquid capacityll'�..0.gallons Length................ Width................ Diameter---............. Depth................ x Disposal Trench—No. .................... Width..................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No........}----------- Diameter...N. _..... Depth below inlet................. Total leaching area..3 Y 7.....sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed b IR_�_X.7 e�:.X..._N._Y4"..................... Date.._._ _/!.?�91_..___.____... a Y . Test Pit No. 1......./.....minutes per inch Depth of Test Pit- ............. Depth to ground water..?,xoAdA-........ (X4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ -------•--------------------------------------- •---------•---- ------.....---------......------------------------------------------- •----------.----•- 0 Description of Soil...............0._-:.L 4'Q'�5...........Z.._..../Z--. h.E-1)-------�� ....................................................... U .............................................------•-••----------......---•----------•--•-----------•---....--------------•--------------•-------------•--------•-------......----.......-----•-----••. W --------------------------------------..........................................................................--•-•-•--•-•------------•-•-••--------••--............................................. U Nature of Repairs or Alterations—Answer when applicable................................................................................................ --------•--------------------------------------------------------------•------------••-•-----.......----••--------------------------•---------------------------------•-----------------....---•----•••- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal.System in accordance with the provisions of iiT1 L 5 of the State Sanitary Code—The undersigned further agrees not to place the system in . operation until a Certificate of Compliance has been issued by the board of?11eth.�Signed.._.. . d. .. .. - -• ---- ----- Date Application Approved B - _ i Date - .?- ••1 Date Application Disapproved for the following reasons-------------------------------------•-------------------------------------------------------------•••-------.._ ...........-•----....-•----••--•----•--------••-•----------------------------•••---•-•----•---••- j Date PermitNo......................................................... Issued....................................................... Date Fmc d 'r'...... d• THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ............ ..............................OF.................................................. Appliration for Dhipati al Vorkfi Cfon.6trur#inn ramit Application is hereby made for a Permit to Construct ( or Repair ( ) an Individual Sewage Disposal System at IL.........---•----•.................... .... .--•.................................4 ..............................................fir................................................... \ Loc LU4i A ss Lot .... .�.�.`►:� ?l. ..... ,... _ s?�'^' ` ._. •.... ........ . .......N -! ...t.. V. ...... queer 11 Address •-�- ..-----•-•-••... ..........-•---•.. �3_ ..tl..t '�. ...........................` ... a - � Type of Building Size Lot... +. '. i q; Installer Address feet Dwelling—No. of Bedrooms........._.. .........................Expansion Attic ( ) Garbage Grinder; a .: aOther—Type of Building ......:..................... No. of persons.............................. Showers ( ) — Cafeteria4( ) Other fixtures ------------- -••-••••......-•-----•--•-•.... ....--•---•----.._..- --------------------------------- Design W Flow ._ gallons per person per day. Total daily flow.................... -_._.___.gallons. WSeptic Tank `LigdPil-capacity� }gallons Length................ Width... Diameter---__- ... Depth................. x Disposal.Trench No ......... Width . ...._.. Total Length_._...... _. Total leaching area....................sq. ft. Seepage Pit 'No..... ......:.... Diameter... _..... Depth below inlet......_........... Total leaching area._.317.....sq. ft. Z Other Distribution box ( ) Dosing tank ( ) ''' Percolation Test Results Performed by..........13.4-474,4?.-1.... .X4..................... Date... 40,li l.............. a Test Pit No. I......./.....minutes per inch Depth of. Test Pit. ........:.... Depth to ground water..A.tuattlQ ._..___. 1 (i Test Pit No. 2................minutes per inch Depth 4-Test Pit.................... Depth to ground water........................ ----- ---- --------------- -- ------ ...........-........... ......-.......•......---------- ...... O Description of Soil............... �' �° 5....-------� ��...L�- ..... ....... ....................................................... ----••----•----•----------------------------------------•-•--------------------------------••----•----•- W VNature 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'1_E 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of h th i � Signed 0 .... .:_ ... . 11 . D to Application Approved BY -""'" i�' ,r V------. Date Application Disapproved for the following reasons:-----•--------•--•----------•-------------------------•------••--------------------------------------•-------•- .........-•-----•--•--------••...............•----•-----•---.......-----------•....••------•-•-----•----•---•••---...-•-•----••------••----•-•---•----•------------•-•--•----•------------•----••••-•--- Date PermitNo......................................................... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH Q' ?..............OF..... . C�lertifiratr ,af TO-Utpliatta THIS IS TO CERTIF t the Individual Sewage Disposal System constructed (�) or Repaired ( ) bY.............-=- -.-----�'= -•----------------------•-••--------------------•----------------•-•--....---..........----•------•---•--....--------•--•--••---•••--•-- �-�-y � � �, Installe ,�-'',�►at.......... _ •------•�+-40..--...... a «tut.. -•----•--------------------------•--•-- has been installed in accordance with the provisioI T �- r of The State Sanitary Code as described in the application for Disposal Works Construction Permit No.... ,r..__3� d........:_. dated...... ......................................... THE ISSUANCE OF THIS CERTIFICATE SHALT. NOT BE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SA ISFACTORY. DATE...............................15.!_.�L.: �..----------...........--- Inspector..... -:4L-------------------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH f �� ........ _OF...... ................................... 1 .. ... FEE...2.Q..��.... Raposal �orko Tnnotrur#ion i an t Permissionis eby granted........4�-t"••-�`-c--......-• ------•--•------------•--------------------------------------------------------•--•---•--. to Construct r, Repair ( an Individual Se r. Disposal System ,.-�-y Street as shown on the application for Disposal Works Construction Ztxnut No..................... Da;ed.......................................... _.._1 ---- .........--......................... - DATE................ -----' --- ................................. B of health FORM 1255 HOBBS & WARREN. INC., PUBLISHERS No......................... - FE$.............................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..............................--.--.......OF.........................----•---........-----------...---....................--......... Appliratiuu for Uhipaaal Works Tontitrurtion Frrutit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: .................................................................................................. .................................................... .......................................... Location-Address or Lot No. ......----•-----------.................•--••-------.....------------............................. . .........•-••.........--•-----------............................-••.................. .....-------- Owner Address W Installer Address Type of Building Size Lot............................Sq. feet Dwelling—No, of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) '4 Other—T e of Building No. of persons............................ Showers — Cafeteria Q' Other fixtures -------------------------------- - - W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity............gallons Length................ Width................ Diameter................ Depth................ x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No..................... Diameter.--.......--.--..... Depth below inlet.................... Total leaching area..................sq. ft. z Other Distribution box ( ) Dosing tank ( ) HI Percolation Test Results Performed by........................................................................... Date........................................ 1.4 Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water......------.........--. 44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water------------------------ P4 ................ ------------------------------ .---------- -...... ------------------------------------ -•--------..-...--------------- -.-------- ---------------- 0 Description of Soil........................................................................................................................................................................ x V ----------------------------------------------------- --------------- •--------- ------------ •----------------------------- ------------------------- •----------------------....-------- W ••-•-•----------------------••-------••-••-••--•••--------------•---••••-•--••-•-•••-•--••---••----•----------•---------•--------•-•-•-------•------•••-•••••••••••••---•••-••............-•-•----•-•••- U Nature of Repairs or Alterations—Answer when applicable............................................................................................... ---------------------------------------•-------•---------------------------------•------------•-------•---------------......------------------------------ ........................................... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. Signed...................................................................................... ................................ Date ApplicationApproved By.................................................................................................. ........................................ Date Application Disapproved for the following reasons----------------------------------------------------............................................................ -•---••....•-••--•••----•-•••-•••...---•-••-•-----••--•--•-•.........•-••--••-••--•-••.....................----•-••--••--•-•••••-•••••=----••----•••••-••--•••••••••••••••---••-•--------•-•...•...•••--- Date PermitNo......................................................... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........................................OF..................................................................................... Tlertifiratr of Tompliaure THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) b Installer at--••-•-----.....-••--•-••-•••••-••••••••••-----•••-•--•-•-•••••----••••--••-------•--••--•••••-•••---•--••••-•-••---•-•••-•••••--••••-••••---•••--•--•--••-••-••••••••••---------------•-•---•-----•- has been installed in accordance with the provisions of TITIZ 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No----------------------------------------- dated----------.-----.---------------.---.-.-----•--. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE................................................................................ Inspector.................................................................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ...........................................OF_................................................................................. No......................... FEE......................... �iu�ouul orku �ouu�rion pruti� i Permissionis hereby granted.............................................................................................................................................. to Construct ( ) or Repair ( ) an Individual Sewage Disposal System atNo............................................................................................................... •••-•--•-••--•...-••-•-••-•••-•---•••-------•-••-••--•-••--......•-----•....... Street as shown on the application for Disposal Works Construction Permit No..................... Dated.......................................... ..--------•................•------------.....------------------------------------•----•.._.....•-•-•-.• Board of Health DATE............................................................................... FORM 1255 HOBBS & WARREN, INC.. PUBLISHERS No................_....... - FEig.............................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ...........................................O F............................_.......... Aptiratiutt for Uiupouttl Workii Tanstrurtiott "truth Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: .................................................................................................. ........-----------...----------•-............-----•--.....------..........-•••••..............._. Location-Address or Lot No. ......................_.......................................................................... ........------•---••.........................••................---•............................... W Owner Address Installer Address UType of Building Size Lot............................Sq. feet I—I Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) `4 e of Building a Other—T yp g ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) Otherfixtures ------------------------------------------------------............................................................................................... W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity............gallons Length................ Width................ Diameter................ Depth................ x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) I~ Percolation Test Results Performed by.......................................................................... Date........................................ a Test Pit No. 1................minutes per inch Depth of Test Pit-----............... Depth to ground water........................ 94 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water...._................... a ----•------••-----------•------•...............................•----......------..........----•.....•-•••--••-••........------......----- --------•-••-- ODescription of Soil......................................................................................................................................................• ......•-•..---- U ....--•--------------••----•-------•----•-----•-•--..._............_..--------------------•------••-•----...---------•--•--------------------•-•-•-••-•------...---•---••---------••-----••------------- W x --------------------------------------------------------------------------•--•---•-•----------•------••-------------•---••-•.--•••--•-•-••-------•-----•--•---------•---•-.._..------..........------. U Nature of Repairs or Alterations—Answer when applicable............................................................................................... ..............•------------------------------------.....--------•--••-•-------•-•-- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TI-TILE' 5 of the State Sanitary Code—The undersigned further agrees not to place the system,in operation until a Certificate of Compliance has been issued by the board of health. Signed...................................................................................... ................................ Date ApplicationApproved By.................................................................................................. ........................................ Date Application Disapproved for the following reasons:---•-----•---------------------•-------------------------------------------------.............................. ................................----------------------------------------------------------------.----- Date PermitNo......................................................... Issued_....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........................................OF.......... ...................................*.. ............ Tutifiratr of Toutphtrr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) by---•---------------------------------------------------------- --•-- --- ----------------------------------.------------------------------------------------------------ Installer at...................................................................................................................................................................................................... has been installed in accordance with the provisions of TIT 1E' 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No......................................... dated................................................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE................................................................................ Inspector.................................................................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..............................--.OF..................................................................................... No......................... FEE........................ orku �ottu�r�r#ion rrbti� Permissionis hereby granted............................................................................................................................................. to Construct ( ) or Repair ( ) an Individual Sewage Disposal System atNo............................................................................................................................................................................................... Street as shown on the application for Disposal Works Construction Permit No..................... Dated.......................................... -------------------------------------------------------------------------------------------------------_ Board of Health DATE................................................................................ FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS I CET _ t • S►1a G LE .:FAM�LY • � �QOO�I ' ' \J it 0 .,GA A L- C.VJs.Ett OA t L.`{'���.COw s I led �t Z +50%.a�.P.U! ! ? SEy"1 C. A.W V. •3.3 0 V Zoo ;!9 9 0 . ISoo oP,•L '%>15 Pco,SA.L PIT v r e 1 oop GAC_I L S'f4M S1t�wAt.L A►e� s....2�•G..._'�.F... ....._..__-•_- - -.__..._. _._ ',�F�..__�LA-1+�-. Qt�._ l�-�C,.._ -._.. --_... 22Co ,c 2.5�� Slo SC•��'b ,•!' ��� '� ToTa ldT 1C>1J EAIt= l 11t % 11btJ o2 L � A I I AL Na 2 & tip MW. 4 yiE 4 - . wu• 90 l.vy� �► 4 wE ISoo 1wv 2 Sant. � S�,(o S�Pf1C . uw� TAUtL i - ,, S P1T `. Y VJM4 t 40 cTuwtOD El Z!s zu I ' b 1' TIF i NO W/\TO 2 r ! Pt-A.1-1 2 �tr�ct✓ 1 CLCrI F,Y T"A►T Ta00,_: S1.1mmw � "ScLe ow GO"PL-Y s wtTM T"rA6 sIxw-%-% •tom �r ',C> , Aijl> Sf='ti'BPG� Re4viQLMi-s T; OF TLaE Tbvj" OF' 8 A,;?.N STA - ' I QSIG.ISTt= LZE� LAt.1D �,c�QVE"(Oe� f TONS PLOAJ IS U OT 'SA5ED OLIO AU IL*Tf)AAe-My OSTE-zVtLL.6. M�LSry. ' 5utv*gr-f 41 Tilt: t3FF$r.T; -SWWL� L40T 8E VI$ex> " i. i AMLIC A W Ir fin/I L,L ', To 'PmTr-lwiwL LOT L.INE.;. `' • r r 1 6 y •, ,.I ' � t ,. a • •V r, 90�1 � !:s�l �� ti `1 Q 74 x • X S y q3.4 x AwV, ; ..s AaEA - FT 00 350 1 j s i L , C A ION SEWAGE PERMIT NO. VtLLAGEE INST LER'S �AEA► AOORESS OR OWNER q o DATE PERMIT ISSUEEK �1 DATE COMPLIANCE ISSUED - � - -�� r � E/i R I 1 g � « � V � yn_ .� O � !�� l � L� �4 i y. GENERAL NOTES: COTUIT 1. ALL CHANGES TO THIS PLAN MUST BE APPROVED BY THE LOCAL BOARD OF HEALTH AND THE DESIGN ENGINEER. 2$ 2. ALL WORK AND MATERIALS SHALL CONFORM TO THE REQUIREMENTS Qv O OF THE STATE ENVIRONMENTAL CODE, TITLE V, AND ANY APPLICABLE O LOCAL RULES AND REGULATIONS.\ -o G 3. THE SEWAGE DISPOSAL SYSTEM SHALL NOT BE BACKFILLED PRIOR Q ¢ TO INSPECTION AND APPROVAL BY THE BOARD OF HEALTH AND THE' N I DESIGN ENGINEER. LOCUS 0 4. ANY CONDITIONS ENCOUNTERED DURING CONSTRUCTION DIFFERING y FROM THOSE SHOWN HEREON SHALL BE REPORTED TO THE DESIGN O ENGINEER BEFORE CONSTRUCTION CONTINUES. 4 OO 5r 5. ALL ELEVATIONS BASED ON ASSUMED DATUM. �O �� N `G ��st LOT 69 t 6. THE CONTHE ITRACTOR OR ENGINEER OWNER TTOENOTIFY THE SPONSIBLE FLOCAL BOARD OF OR THE FAILURE N OF O HEALTH FOR PROPER INSPECTIONS DURING CONSTRUCTION. 7. WATER SUPPLY PROVIDED BY TOWN WATER SERVICE. 8. ALL AREAS DISTURBED DURING CONSTRUCTION SHALL BE RESTORED rt' TO A CONDITION AGREED UPON BETWEEN OWNER AND CONTRACTOR. 9. IT SHALL BE THE RESPONSIBILITY OF THE CONTRACTOR TO VERIFY THE LOCATION OF ALL UNDERGROUND UTILITIES, PRIOR TO STARTING WORK. LOCUS MAP (` G i 10. EXISTING LEACHING TO BE PUMPED, CRUSHED AND REMOVED PER TITLE 5. W `` EXIST. LEACH REPLACE WITH CLEAN MEDIUM SAND PER TITLE 5. LOCUS INFORMATION 11. 48 HOUR NOTICE FOR ENGINEER CERTIFICATION PLAN REF: 292/26 TBM — 12. THIS PLAN IS TO BE USED FOR SEPTIC SYSTEM PURPOSES ONLY TITLE REF: 8272/247 � _ CELLAR FLOOR �_ . ��= arZ�1 O 1 AND IS NOT TO BE CONSIDERED A PROPERTY LINE SURVEY PARCEL ID: MAP 56 PAR. 32 EL=40.0 � ' 13. NO PRIVATE WELLS WITHIN 150 FT. OF PROPOSED LEACHING ZONING: "RF" ^'� CIDt4. ALL PIPING TO BE 4" SCH 40 ® 1/8"/FT (UNLESS SPEC. Q �� ` FLOOD ZONE: "C"� ) o #249 In Oj R�8 15. THE DESIGN OF THIS SYSTEM DOES NOT ALLOW COMMUNITY PANEL: 250001-0018—D DATED:07/02/92 FOR THE USE OF A GARBAGE GRINDER O / /% ' /: 16. NO WETLANDS WITHIN 150 FT. OF PROPOSED LEACHING SEPTIC SYSTEM ,,z:c MM �► �ti� EXIST. 1,oDOG ;';' ;' ;'; = REPAIR PLAN LOCATED AT: 249 COTUIT BAY DRIVE O , i o , COTUIT, MA. N PREPARED FOR WI LLI AM E. & CAROL A. 2 BEGGS b` ' / r.............. JUNE 17, 2014 OF -�1 j- H-2 Q`" .��.,.•••'# �� Cyr 1 WOODED ' ;, 'L -' r% /; ;k.P. No. 140 / 6 " " � RfG/ST r, E ` .. .. '•'�••• ' /2 �. 1 / SANITAR LOT 70 '"'--''•'�•� SCALE: 1"=30• MEYER & SONS INC. AREA=45,306t S.F.' ' ' '�.' ✓•• LOT 71 LEGEND P. O. Box 981 PROPOSED CONTOUR E. SANDWICH , MA 02537 /, ;.• ® PROPOSED SPOT GRADE PH. (508)360-3311 -- 98 -- EXISTING CONTOUR fax (774)413-9468 mail.comerandsonsinc� •''' �;' �; + 96.52 EXISTING SPOT GRADE me Y g W— EXISTING WATER SERVICE ' :••' TEST PIT SHEET 1 OF 2 J#1665 NOTE: TO PREVENT BREAKOUT, THE PROPOSED NOTE: MAGNETIC TAPE TO BE PLACED OVER ALL COVERS FINISH GRADE SHALL NOT BE < EL:26.21 FOR A DISTANCE OF 15' AROUND THE PERIMETER OF THE S.A.S. SEPTIC TANK PROPOSED D-BOX PROPOSED S.A.S. INSTALL RISERS & COVERS OVER INLET & INSTALL RISER & COVER INSTALL A 4" DIAMETER INSPECTION PORT OVER 14" OUTLET AND SET TO 6" OF FINISH GRADE SET TO 6" OF GRADE ONE CHAMBER (MIN.) AND SET TO 3" OF F.G. INSTALLED F.G. EL.=40.Ot LEM;TH OF F.G. EL.=39.50t F.G. EL: 29.Ot F.G. EL: 29.0(MAX.) 9" MIN COVER/ I EYE 36" MAX COVER L = 70' �.�g L = 1O'(MAX) INSTALL TWO INSPECTION PORTS (MIN.) b' No. 1140 0 S=1% (MIN.) EL = 37.36 0 S-1% (MIN.) 0 S=1% (MIN.) IZ37" 4"SCH40 PVC 4"SCH40 PVC 4"SCH40 PVC 10' " '�fG/STER� 14" e11) 1�N VERT O `4N I TAR�a� \INV.=36.301'1,; 4a"uouro } k INV.=36.05 INV.= 25.75 COUPLER DETAIL 1,7 1LEV� Lq GAS BAFFLE) PROPOSED D-BOX INV.=26.0 3 ROWS OF 6 UNITS ® 5'/UNIT + 1 COUPLERS 0 1.16'/UNIT = 31.16'/ROW INV.=26.2 SOIL ABSORPTION SYSTEM (PROFILE) EXISTING 1,000 GALLON SEPTIC TANK EXISTING SEWER OUTLET RESTORE VEGETATIVE COVER BACKFILL WITH CLEAN PERC SAND TO TOP OF CHAMBERS 60 NOTES: 1) CONTRACTOR SHALL VERIFY ALL EXISTING BREAKOUT=TOP ELEV.=26.01 PIPE INVERTS PRIOR TO CONSTRUCTION INV. ELEV.= 25.60 2) D-BOX SHALL BE SET LEVEL AND TRUE TO BOTTOM ELEV.= 24.73 GRADE ON A MECHANICALLY COMPACTED SIX EXISTING SUITABLE .INCH CRUSHED STONE BASE, AS SPECIFIED IN 2.88' MATERIAL 310 CMR 15.221(2) 5' MIN. ABOVE BOTTOM OF 3) REPLACE EXISTING 1,000 GALLON SEPTIC T.P. EXCAVATION OR G.W. EFFECTIVE WIDTH 3 x 2.88' = 8.64' (7.53' PROVIDED) USE 3 ROWS OF 6-ADS ARC 36HC TANK WITH 1500 GALLON SEPTIC TANK FAILED, DAMAGED, OR UNDERSIZED. ADJ. GROUNDWATER EL.=17.20 _ UNITS - NO STONE W/ 1 COUPLERS IN EACH ROW 4) INSTALL INLET & OUTLET TEES W/ ZABEL FILTER AND GAS BAFFLE AS REQUIRED SEPTIC SYSTEM PROFILE TYPICAL SECTION n.Ts 16" N.T.S. CRITERIA SOIL LOGS P#: 14379 DESIGN DATE: JUNE 3, 2013 SECTION m75' NUMBER OF BEDROOMS: 2 BEDROOM DWELLING/3 BEDROOM DESIGN SOIL EVALUATOR: DARREN MEYER, CSE 1614 EIGHT END CAP SOIL TEXTURAL CLASS: CLASS I DESIGN PERCOLATION RATE: <2 MIN/IN WITNESS: DONNA MIORANDI, BARNSTA13LE HEALTH DAILY FLOW: 110 G.P.D/BR. DESIGN FLOW: .330 G.P.D. ADS ARC 36HC CHAMBER Elev. TP-1 Depth Elev. TP-2 Depth GARBAGE GRINDER: NO (NOT DESIGNED FOR GARBAGE GRINDER) 28.60 0 0", 28.20 0 0" fR MODEL ARC 36HC SEPTIC TANK: 330 gpd x 200% = 660 gpd USE EXIST. 1,000 GALLON SEPTIC TANK ORGANICS ORGANICS LENGTH 63" 28.10 6" 27.70 6" NOTE: UNIT CONFIGURATION AND AVAILABILITY SUBJECT l� A A EFFECTIVE LENGTH 60" TO CHANGE WITHOUT NOTICE. PRODUCT DETAIL MAY LOAMY SAND LOAMY SANG DIFFER SLIGHTLY FROM ACTUAL PRODUCT APPEARANCE. LEACHING AREA REQUIRED: (330)/0.74 = 445.94 S.F. 27.60 12" 27.04 14"1OYR 3/1 1OYR 3/1 SIDE WALL HEIGHT 10.75" DISTRIBUTION BOX: 3 OUTLETS (MINIMUM) B B OVERALL HEIGHT 16 Cim,= PRIMARY S.A.S. LOAMY SAND LOAMY SAND OVERALL WIDTH 34.5" 4640 TRUEMAN BLVD 1OYR 5/8 5/8 10.7 CIFs HILLIARD, OH/0 43026 USE 3 ROWS OF 6 - ADS ARCHC 3616 UNITS-NO STONE 25.77 34" 25.45 33" CAPACITY LULWA C C 8( GAL ADVANCED DRAINAGE SYSTEMS, INC. AND EXTENDED 1.16' W, COUPLER IN EACH ROW ) MEDIUM pare test ® 1ss MEDIUM BOTTOM AREA: (GENERAL USE APPROVAL FOR 4.80 SF LF OF CHAMBER SAND SANDPROPOSED SEPTIC SYSTEM/SITE PLAN (CHAMBERS: 6/ROW)18 UNITS x 5.0 LF x 4.80 SF/LF = 432.00 SF 17 60 2sY 6/a 132� 17.20 zsY s/a 132" (COUPLER: 1/ROW) 3 UNITS x 1.16 LF x 4.80 SF/LF = 16.70 SF 249 COTUIT BAY DRIVE, COTUIT, MA TOTAL AREA = 448.70 SF PERC RATE UN MINER OBSERVED HORIZON) Prepared for: Beggs NO GROUNDWATER OBSERVED P 99 DESIGN FLOW PROVIDED: 0.74GPD/SF(448.70SF) = 332.03 GPD > 330 GPD req'd I Design and Site Plan by: SCALE DRAWN DATE: Meyer&Sons,Inc. NTS D.M.M. 06/17/14 • I, Darren M. Meyer, R.S., CSE, hereby certify that 1 am currently approved by MADEP pursuant to 310 CMR 15.017 PO BOX961 to conduct soil evaluations and that the above analysis'has been performed by me consistent with the E4STSANDIN/CH,MA02537 REV. DATE: CHECKED SHEET NO. requirements of 316•CMR 15.017. 1 further certify that'll have passed the Soil Eval. Exam in October, 1999. 508-362-2922 D.M.M. 2 Of 2