HomeMy WebLinkAbout0208 EISENHOWER DRIVE - Health 208 Eisenhower Drive , Cotut
A = 039-120
i
i
I
TOWN OF BARNSTABLE
LOCATION 60 We SEWAGE# 209D a 3 2 r
,VILLAGE(� ASSESSOR'S MAP&PARCEL
INSTALLER'S NAME&PHONE NO.
SEPTIC TANK CAPACITY /SQU Nor.✓ k o
LEACHING FACILITY-(type) d-,,16,fX S�
T/��tic►� (size) JP,, X;
G�NO,OF BEDROOMS .3 d eS t r, aJ
�,-OWNER 4ad./
�
f�m PERMIT DATE: Ply- COMPLIANCE DATE_- J��-�ZO
Separation Distance Between the: 11�0 �r�✓ �'+�C®
Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility ¢z"S e 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
1 ^�
' FURNISHED BY e �
t
08 Dr
TAC
Y +�
-IV tN^ �5r
ArC) 0
O)f
FE.E�L%��^
COMMONWEALTH OF ASSACHUSETTS �
Boa d of lkahh, MS�-(rlb�_ , MA.
APPLICATION f DISPOSAL SYSTEM CONSTRUCTION PERMIT
Application for a Permit to Construct( ) `Repair( ) Upgrad4 Abandon( Ai Complete System ❑Individual Components.
Location �v s�nh d�1 Q� its r^ Owner's Name �v;
Map/Parcel# Address ZdF�►5 e►��(1�+rer of eon Mrl
Lot# F6Telephone#
Installer's Name Designer's Name
�Ot� (25 t)s✓�
Address 9 0 I A� ayvw nV I N (� -t7 Z(p3 Address
Telephone# jQ8—VC0 -"7-0 Telephone#
Type of Building S'i& \- Ot Lot Size: s ft
Dwelling-No.of Bedrooms 2 Garbage grinder ( )
Other-Tvpe.of Building &[A- No.of persons Sh9wers O;Cafeteria:.( )
Other Fixtures
Design Flow (min.required) "77 d gpd Calculated design flow d Design flow provided 3h$ gpd
Plan: Date, 6.11 J*2-0 Number of sheets '2 Revislon,Date
Title erbj2dseA S o Ss r (fg.{u i i-
Desciiption of Soil(s) 0 g
--ANY—�y'd 1�a (n t.1..i j 7 -e-e Sa
Soil Evaluator Form No:, Narne of Sorl Evaluator r•-ekr 1'l dt!�!k--VDate of Evaluation M4u 2�Z�
.DESCRIPTION,OFREPAIRS OR ALTERATIONS. ��w JyZiCJ i�Ci _ ^�nr Z:..tea cs 4 _ H
The undersigned agrees to install the above described Individual Sew.ageDisposal System in accordance with the.provisions of TITLE 5 and:
further a ees to not to place the.system in operation until a Certificate of Compliance has been issued by the Board of Health.,
:Signed _ Date
Inspections
�j No. &, F.EE
R
COMMONWEALTH OF MASS C USETTS
Board o,f Health,3 ►M -C31 b�rP , MA.
APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT
Application fora Permit to yyConstruct O Repair( Upg ade� Abandon( ��Complete System 0 Individual Components.
'Location Owner's Name �'
Map/Parcel# j W .-(ZQ Address ' ,
Za ter ri e .� Cc A-1 � !'''A
Lot# Telephone#
Installer's Name�® Designer's Name
fd d1J V1
Address
Poo Cerv1F"I IlQ Address �
Telephone# .5ae—Lix --7 74 Telephone#
Type of Building wi�ot Lot Size. 2,0,an sq.ft.,
Dwelling-No.;of Bedrooms Garbage grinder.( ')
Other"-Type of Building M A.- No.of persons Showers(' ),Cafeteria (
e#
Other Fixtures
Design Flow (min.required) �i � gpd Calculated:design flow ' Design.fl.ow provided —)iQ Cl gpd
i Plan: Date &ho !2 n Number of sheets_ �. Revision Date
Title �i�t1 c)n See l �p�h-:c _�c M �54 "a )' !r:✓� Za q l�, r,,40 C..te,- jR!'. Cnf-
Description of Soil(s), Mt 4;aiAd SQ• v 1 -IreL,^,A ,
Soil Evaluator Form No, Name of Soil Evaluator -el t rta.,r I h t --L'Date of l valuation ZOZU
r
+ DESCRIPTION OFREPAIRS OR ALTERATIONS d1J.Q 1 5-GG fc UA C,, •Z U
4
}
The undersigned agrees to install the above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and
further agrees to.not to place the system;in operation until a Certificate of Compliance has been.issued by the Board of Health.:
_ _ t
Date 7- 20 ->^a
Inspections i
I
a
o�'�ao , onoc^'t�co�ir^.0000aoo^o.000v,�.^.na:,oao�oaoocvco.3r.nrocc:>ccr:�< c>.aoochuoco.. :no ,00:�orcoccr�ocauoo;,c_y..�ococ�ac ,,;cr• _c'aoa�.,
,,No .... FEEf �.✓
COMMONWEALTH. OF MASSACHUSIETTS
Board of Health, .c S f"o,b ,MA.
CERTIFICATE OF COMPLIANCE �I
,Description of Work: .0 Individual"Component(s), 4 Complete System
The undersigned hereby certify that the Sewage.Disposal:System; Constructed ( :),Repaired ( ),Upgraded ( ),Abandoned (_ )
by
has been installed in accordance with the provisions of 310_CMR 15.00 (Title 5) and the approved design plans/as-built plans relating to
application.No.°l�i1r'ti !773.� ; dated /. l*R ltlpprovecl Design Flow (gpd)
•-<.•-
Installer -n A 'Zr^ . 'T ..►r
�� 3
Designer:. 'G T����. 1r t .l.�,r�0 Inspector: `�,_ ._.tea ---�'"L�'� Da�e."',e-a-:.,. --��.rz-��... .. }
,• ,. n� ,j.. r., tYt
The issuance of this permit shall not b'e construed.as a guaranttJee that the system will function as designed, e,
1v �1 !
'._�,..-.,-.k Y_'C ..c L?'cyt_•{_h t'.A_y.Q- 3.L aP:."r 1':-.. }' ;.(]l^ 2f`i6..0 C';1 Y _ W+131
.__ No.. SJit� 1 �" FEE:
•
COMMONWEALT14 Of MASSACHUSETTS,.,
Board of Health, 1.54CA Sf� lJLE MA.
SYSTEM CONSTRUCTION PERMIT
Perinissioiz is hereby,granted to;,.Construct( ) Repair( ) Upgrade(/(1k) Abandon( ) an indit idual sewage disposal system
at. fZli l�5 eri old / 1:�r' Cca-1kl i as described in.the application.for
Disposal.System Construction Permit No..K'°f)n dated -^ h)�
Provided: Construction shall'be completed within three years of the date of'tliis per-`�it. All.local conditions i iustbe;met.
BoardofHealtl Form1255 Rev.5l95A,M.,SulkinCaChades(mvn,MA Date /y.. 0
-: �yas•.d _ -•tom.,..._ � ,a.. .
f
Town of Barnstable
owl: Regulatory Set-viees Richard V.Scali,Interim Director
."�`� Public Health Division.
i639
lFDMAt Thomas McKcan, Director
200,tilain.Street,.Hyannis,MA 02601
Office: 508-862-4644 Fax: 5OS-790-6304
Installer&Designer Certification Form
Date: Sewage Permit# o20;20-22 3 Assessor's MapTareel 1z.�
Designer: LEI,�; , n �;n J i �Jatl cs li,Z Installer;
Address: c/ P— Address:
o
oil 7a o iv <A ti/-IC seas issued a perinit to install a
-' {date) Installer)
septic system at ZQ E,S e 11 c3L � ter based on a design drawn by
(address)
i`n -7� 6 tl i L(s fii dated. t Z
_ e;- r
desiane.r
( g )
1,/I certify that the septic system referenced above was installed substarinal.ly accordiMy to
the design, which may include minor approved changes such as lateral relocation d-ifie
distribution box and/or septic tank. Strip out (if required) was inspected and the sod s
were found satisfactory.
I certify that. the septic system referenced above was installed with major changes
�areater than 10' lateral relocation of the SAS or any vertical.relocation of any contponerit
bf the septic system) but in accordance with State & Local Re(ul.at.ions. Plan revision or
certified as-built by desig n r to follow. Ship out.(if required) was inspected and the soils
were found satisfactory.
[ certify that the sy-stern referenced above was consu'ucteii in a s with the terms
of the l\A approval letters (if applicable)
9
( rtstaller's Signature) Np 35ip9
o
(Desia er's Signature} (Affix Desi��ne ..ere)
PLEASE RETUR'I TO BARNSTABL.E PUBLIC HEALTH. DIVISION. CERTIFICATE
OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS (FORM AND AS-
BUILT CARD ARE RECEIVED BY T14E BARNSTABLE PUBLIC II'EAL,TI-I DIVISION.
THANK YOU.
Q:'.Sepu,:J esigner Certification Form ie\ 8-14-13.doc
Engineers note:This certification is limited to an as-built inspection of system components as installed prior to backfill.The
engineer did not supenjise construction of the system.The installer asses es responsibility ic•r all materials,:workmanship,backlilling
to specified grades with proper compaction and setting riserbovers as,shown on the design plan.
I =.
Commonwealth of MOSSOChusetts John Grad
Executive Office of ErMrom-ental Affalrs D.E.P. Title V Septic h>spector
Department of P.O. Box 2119
Environmental Protection Teaticket,MA 02536
(50
A
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A !•
RECV EC1 '�,!
`�� CERTIFICATION JUL 3 1997
Property Address: 208 EIsenhOWer ,COtUIt Address of Owner: T0IN 0F8kVWABLE
Date of Inspection:6118197 (if different) lftfhDEPT
Name of Inspector John Gracl Johnson:3 Pine st Derry N.H.03038 '�►
Company Name,Address and Telephone Number:
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:
X Passes This Inspection Is based on criteria defined In Title V
_ Conditionally Passes code 310 CMR 15.303.My findings are of how the system is
_ Needs Fu er valuation B the Local Approving Authority performing at the time of the inspection.My Inspection does
Y PP 9 ty not Imply any warranty or quarantee of the longevity or the
Fails I septic system and any of its components useful life.
Inspector's Signature: l/�� Date: mow
l ��
The System Inspector shall su mit a copy of this inspection report to the Approving Authority within thirty(30)days of completing this
inspections. 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] SYSTEM PASSES:
X I have not found any information which indicates that the system violates any of the failure criteria
defined as in 310 CMR 15.303. Any failure criteria not evaluated are indicated below.
B] SYSTEM CONDITIONALLY PASSES:
One or more system components need to be replaced or repaired. The system,upon completion
of the replacement or repair,passes inspection.
Indicate 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 conforming septic tank as approved
by the Board of Health.
(revised 11115195)
One Winter Street 9 Boston,Massachusetts 02108 • FAX(617)556-1049 • Telephone(617)292-5500
1
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: 208 Eisenhower Rd.Cotult
Owner: Johnson:3 Pine SL Deny N.H.03038
Date of Inspection:6119197
Sewage backup or breakout or high static water level observed in the distribution box is 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 leveled 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] FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH:
Conditions 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) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH(AND PUBLIC WATER SUPPLIER,IF APPROPRIATE)DETERMINES
THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECT THE PUBLIC HEALTH AND SAFETY AND THE
ENVIRONMENT:
The system has a septic tank and soil absorption system and is within 100 feet to a
surface of water supply or tributary to a surface water supply.
The system has a septic tank and soil absorption system and is within a Zone 1 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,unless a well water analysis for coliform bacteria volatile organic compounds indicates that the well is
free from pollution for that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal or less than 5 ppm.
3) OTHER
D] SYSTEM FAILS:
_ I have determined that the system violates one or more of the following failure criteria as defined in
310 CMR 15.303. The basis for this determination is identified below. The Board of Health should be
contacted to determine what will be necessary to correct the failure.
Backup of sewage in 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
cesspool.
SAS is in hydraulic failure.
(revised 11115195)
2
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address: 208 Eisenhower Rd.Cotult
Owner: Johnson:3 Pine st.Derry N.H.03038
Date of Inspection:ell&97
D] SYSTEM FAILS(continued)
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).
Numbers 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 1 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 SYSTEM FAILS:
The following criteria apply to large systems in addition to the criteria:
The 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 health 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 II of a
public water supply well)
The owner or operator of any such system shall bring the system and facility into full compliance with the groundwater treatment program
requirements of 314 CMR 5.00 and 6.00. Please consult the local regional office of the Department for further Information.
(revised 11115195)
3
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECLIST
Property Address: 208 Eisenhower Rd.Cotuit
Owner: Johnson:3 Pine St.Deny N.H.03038
Date of Inspection:6119197
Check if the following have been done:
x Pumping information was requested of the owner,occupant, and Board of Health.
x None of the system components have been pumped for at least two weeks and the and the system has been receiving normal
flow rates during that period. Large volumes of water have not been introduced into the system recently or as part of this
inspection.
n1aAs built plans have been obtained and examined. Note if they are not available with N/A.
x The facility or dwelling was inspected for signs of sewage back-up.
x The system does not receive non-sanitary or industrial waste flow.
x The site was inspected for signs of breakout.
x All system components,excluding the Soil Absorption System,have been located on the site.
x The septic tank manholes were 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.
x The size and location of the Soil Absorption System on the site has been determined based on existing information or
approximated by non-intrusive methods.
x The facility owner(and occupants,if different from owner)were provided with information on the proper maintenance of Sub-
Surface Disposal System.
(revised 11115195)
4
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
Property Address: 209 Eisenhower Rd.Cotult
Owner: Johnson:3 Pine SG Derry N.K 03038
Date of Inspection:9118197
FLOW CONDITIONS
RESIDENTIAL:
Design flow: 220 gallons
Number of bedrooms: 2
Number of current residents: 0
Garbage grinder(yes or no): No
Laundry connected to system(yes or no): Yes
Seasonal use(yes or no): No
Water meter readings,if available: Na
Last date of occupancy: May 1997
COMMERCIAL/INDUSTRIAL:
Type of establishment: n1a
Design flow:0 gallons/day
Grease trap present:(yes or no) No
Industrial Waste Holding Tank present:(yes or no) No
Non-sanitary waste discharged to the Title 5 system:(yes or no) No
Water meter readings,if available: n/a '
Last date of occupancy: n1a
OTHER:(Describe) n1a
Last date of occupancy:
GENERAL INFORMATION
PUMPING RECORDS and source of information:
System has not been pumped In the last year.
System pumped as part of inspection: (yes or no)No
If yes,volume pumped: 0 gallons
Reason for pumping: n1a
TYPE OF SYSTEM
X Septic tank/distribution box/soil absorptions system
Single cesspool
Overflow cesspool
Privy
Shared system(yes or no) ( if yes, attach previous inspection records,if any)
Other(explain)
APPROXIMATE AGE of all components,date installed(if known)and source information:
1974
Sewage odors detected when arriving at the site:(yes or no) No
(revised 11115195)
5
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 208 Eisenhower Rd.Cotult
Owner: Johnson:3 Pine SL Derry N.It 03038
Date of Inspection:6118197
SEPTIC TANK: X
(locate on site plan)
Depth below grade: V
Material of construction:X concreate_metal_FRP_other(explain)
Dimensions: L 8'6'H 5'7"W 4'10-
Sludge depth:4'
Distance from top of sludge to bottom of outlet tee or baffle: 23"
Scum thickness:3'
Distance from top of scum to top of outlet tee or baffle:6'
Distance form bottom of scum to bottom of outlet tee or baffle: 15•
Comments:
(recommendation for pumping,condition of inlet and outlet tees or baffles,depth of liquid level in relation to outlet invert,structural integrity,
evidence of leakage,etc.)
Septic tank and all components are structurally sound.Recommend pumping system every two years for maintenance.
GREASE TRAP:
(locate on site plan)
Depth below grade: n1a
Material of construction: _concrete_metal_FRP_other(explain)
Dimensions: n1a
Scum thickness:nla
Distance from top of scum to top of outlet tee or baffle:nla
Distance from bottom of scum to bottom of outlet tee or baffle: nla
Comments:
(recommendation for pumping,condition of inlet and outlet tees or baffles,depth of liquid level in relation to outlet invert,structural integrity,
evidence of leakage,etc.)
Iva
(revised 11115195)
6
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
w
Property Address: 208 Eisenhower Rd.Cotult
Owner: Johnson:3 Pine SL Deny N.K 03038
Date of Inspection:6119197
TIGHT OR HOLDING TANK:
(locate on site plan)
Depth below grade: n1a
Material of con struction:_concrete_metal_FRP_other(explain)
Dimensions: n1a
Capacity: n1a gallons
Design flow: n1a gallons/day
Alarm level: n1a
Comments:
(condition of inlet tee,condition of alarm and float switches,etc.)
n1a
DISTRIBUTION BOX:
(locate on site plan)
Depth of liquid level above outlet invert: rite
Comments:
(note if level and distribution is equal,evidence of solids carryover, evidence of leakage into or out of box etc.)
n1a
PUMP CHAMBER:
(locate on site plan)
Pumps in working order:(yes or no)
Comments:
(note condition of pump chamber,condition of pumps and appurtenances,etc.)
n1a
(revised 11115195)
7
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 208 Eisenhower Rd.Cotult
Owner: Johnson:3 Pine St.Derry N.K 03038
Date of Inspection:6118197
SOIL ABSORPTION SYSTEM(SAS):X
(locate on site plan,if possible;excavation not required,but may be approximated by non-intrusive methods)
If not determined to be present,explain:
Na
Type:
leaching pits,number: 1,000 octagon pit
leaching chambers,number:n1a
leaching galleries,number: n1a
leaching trenches,number, length: Na
leaching fields,number, dimensions:n1a
overflow cesspool,number:n1a
Comments:(note condition of soil, signs of hydraulic failure,level of ponding,condition of vegetation, etc.)
The overflow is structurally sound and functioning properly.It had V of water In It.Pit has not been more than 112 full.
CESSPOOLS:
(locate on site plan)
Number and configuration: n1a
Depth-top of liquid to inlet invert: n1a
Depth of solids layer: n1a
Depth of scum layer: n1a
Dimensions of cesspool: n1a
Materials of construction: n1a
Indication of groundwater: n1a
inflow(cesspool must be pumped as part of inspection)
n1a
Comments:(note condition of soil, signs of hydraulic failure,level of ponding,condition of vegetation, etc.)
n1a
PRIVY:
(locate on site plan)
Materials of construction: n1a Dimensions: n1a
Depth of solids: Na
Comments:(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.)
n1a
(revised 11115195)
8
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 209 Eisenhower Rd.Cotutt
Owner: Johnson:3 Pine St Derry N.H.03038
Date of Inspection:6118197
SKETCH OF SEWAGE DISPOSAL SYSTEM:
include ties to at least two permanent references landmarks or benchmarks
locate all wells within 100'
� A
4
I44 � y
,4
oa
DEPTH TO GROUNDWATER
Depth to groundwater:12 feet
method of determination or approximation:
USGS Maps and Charts
(revised 11115195)
9
-L.00ATLON 5EWo.64E PERMIT UO. .
-11�1ST. _l�L-LER�S-►J�t�/1E--�--ADDRESS- ------ ---- --__
---BULL, /DER-S—lJ.ANIE_�_Q.D-D-R-E SS
DL�►Z'E-P_ERtv�1T L.SSUED--_�'_�_�s '—_—_—_—.
_ D_ATE_COI�/lP_LL.L�t�ICE_ISSUEQ.9 = � _ —
�,
��
G
f<ovs�
�iSP.v yaw�a ����✓Z
No.................../...... �- D( '�' �Q% FI;:rm.. ....................
THE COMMONWEALTH OF MASSACHUSETTS
BOAR® OF HEALTH C/ ` % fib
-..T6.-W.4,.............OF..71 AR. J..s1...4 k/..----------------------------
Appliratinaa for Ewp aiial Works Tonotrurtion Vamit
Application is her b made fo a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System at:
y
._...4�07 .18.s...... .fc1v..ffaw a......Del u.f..,......CgT .,.j..............................................................
a Elion-Add ............................... �VA)...'+ 4/---Lott z-:.1----------------
then -� $ddress
W 14. ..0::.... �01��_. . y-----•----------------- ----------C ..r. . .p�./.c..,
�r
Installer Address
U Type of Building Size Lot....
rz X�..0----Sq. feet
�Dwelling—No. of Bedr..00ms......................................................................Expansion Attic ( ) Garbage Grinder ( )
Other—T e of Building No. of persons............................ Showers — Cafeteria
Pa Other fixtures --------------------•----------- -
W Design Flow............................................gallons per person per day. Total daily flow.............................................gallons.
WSeptic Tank—Liquid capacity-JAM __gallons Length................ Width................ Diameter................ Depth................
x Disposal Trench—No. .-........ Width_..__.._.__._�._ Total Length..... .... Total leaching area......._............sq. ft.
Seepage Pit No.--.1.9VO. _--- '� �t�epth . ............... Total leaching area..................sq. ft.
z Other Distribution box ( ) Dosing tank
Percolation Test Results Performed by.......................................................................... Date........................................
aTest Pit No. 1................minutes per inch Depth of Test Pit.............._..... Depth to ground water........................
r3. Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
9 ......................... - ............._... -••----------------- •. ....................................
--...•--...--• . ...
0 ....._ ��Description oaf Soil---- �...._.. ----- -•- -• - �-�-- ---- ---- `_ . .. ..-- ---- -------� --- --
v a�
W -----------------� f�-/----- ... - 9 ------
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 Article XI of the State Sanitary Code— The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has been issued y e board of Jealth. c
Date
Application Approved By..:. PZne-d
.-------__- _ a - _
Date
Application Disapproved for the following reasons:----•-------------------•-----•-----••------•--•---------------------------••-•-•-------•---...---------------•-
......................•-•------------.........----•-•--•---•---------------------.............-----------•------•-------•-------•-•-•--••...--•----•-------••-•••-••......._....•-----------------------
Date
PermitNo............................ .... Issued........................................................
Date
- _ �_ _ _ _�s_ _ .._ ..�.__.._, --------------------)A
FED... .. .. . ._
THE COMMONWEALTH OF MASSACHUSETTS
BOAR® OF HEALTH
4-w ._.----....OF.... ; fe'.iW.S----- :. -----------------------------------
Appliration for Difipmat Works Tomitrurtion rumit
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System at: y _
1 �Ljocatiioon-Address oor`Lot No.
... — c •F, v"f ..-:y1................................. ......
.a................
O ner ,,, A—d ress
t d
.;.. ........................ .......... l °? +s .l.3�r -.. '`�.e'1..5....
Installer Address
Type of Building Size Lot.... r.+__4:v....Sq. feet
U Dwelling—No. of Bedrooms___
Other—Type of Building .........7o......... ................Expansion Attic ( ) Garbage Grinder ( )
a yp g ............................ No. of persons............................ Showers ( ) — Cafeteria ( )
a Other fixtures -------------------------------------------------- -
W Design Flow............................................gallons per person per day. Total daily flow............................................gallons.
WSeptic Tank—Liquid capacity./M.O.-gallons Length................ Width................ Diameter................ Depth................
x Disposal Trench—No. ...... Width.._.................... Total Length .�.......... Total leaching area....................sq. ft.
Seepage Pit No._. /�1 � _ ter _f+ a ,,i(epth l0w..�, et/t............... Total leaching area..................sq. ft.
Z Other Distribution box-( ) Dosing tank
Percolation Test Results Performed by.......................................................................... Date........................................
Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................
Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
...............
O -ition of Soil............... = p . , $ ) I � :E C esc r
.. ^'m . ....................
_'_....___. _.._.� � . D
P 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 Article XI 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.
//mt ,. ....................Signed---- Date
Application Approved By.....;.•!" C .� ..!<t!l -,-............................... ...
Date
Application Disapproved for the following reasons:---------•------------•-------"-----------•---••-""-------------------"•------------------......................
.....................................•------"-----------"----------------.....---••--•-•--......-"-"-----'------"------------•---•------""-------••---------------........-••••••----• ......••---.._...
Date
PermitNo......................................................... Issued........................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
L ri- if irate jaf Tlluty tattrj�
THIV TO CERTIFY, That the individual Sewage Disposal System constructed ( or Repaired ( )
by Z"11,41-''j-------------------- , ---------•-•-•------------••------•------•-•-----------------------------------
In;taller
has been installed in accordance with the provisions of Article XI of The State Sanitary Code as described in the
application for Disposal Works Construction Permit No 7 ..........�:._�l_�.._.._..... dated.- -.-.2_�_-___;S�!'...............
THE ISSUANCE OF THIS CERTIFICATE SMALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE................................................................................ Inspector....................................................................................
THE COMMONWEALTH OF MASSACHUSETTS
' BOARRI OF HEALTH
C ............o F.... +- �
No....... FEE....... ...44.....
Disposal Works Tv8t/ptrudivp ramit
Permission is hereby granted...._ r+%-�!fi��. ...............................................................
_.. .,� :.............:,..._-- �.t
to Construct (_ ) or Repair (_ ) an Individual Sewage D1 posal�Sl
stem
at No.. . v .- �.4 -f• t, !v_ �t.`.:�: .. � 1.C'-t - t�r;•t' ..fr..... . -- --•-•-.....•---
Street rli
as shown on the application for Disposal Works Construction Permit No........Z..._,.,,Dated... .'.>z_. ..........
f,
Board of He t
DATE...................."--...•-----•--••----•----------•--"----._...---._..--•---•• �I
FORM 1255 HOBBS B WARREN, INC., PUBLISHERS
_... . .,,,,,,",,, ,�.�•. „r,r„r,,,,,,r,,,,,r„;.,,.".m.. _r,, ........................................... r�,,..�,..w...,,m�••m„•„
_,,..,_.,. ..,...,;.............:_.,.r.....,.....,................__...................•...,,..,.,,.,........_,.„:......,,,•....:...,.,....,:.....,,.,. .,..,....,.....,...............,
n 5��4,•5 �U�( l,:o:urlhrrr, ....- , d�'l' "✓r:nrn, ;r.... •..;r,'v../S?�....
`j d y
s ;
5
!
�;,^* �� ! i fir;•C;: ,G<:.� e
r � e�S.1,�.�.:',Y,,1�,:i•�,"].'�'i%1 11I:5;�'{"i 7.",{.'i %ti!.(,`"a"','/
3 Zfr.{..�, .�.•+d.11�'t.Y.i'i L'''N.6�°r(:1 VIA
.L.T ..r 2C)'
1
Y
(
e k
rL O y/A S, "r: tPEU�E ,yam p,,...+...W.'•'.' •r•�.�r•r•......•.••...•wr....r.,:,•rrr•.,•r,»r•,.,.:....••.,,•.,,,..,,,.:,:rr•,,:�,,..,,.....,.,,...,,,Il,
� r`"o YE.f ~( J Iff`V'I iE.7�M 1.47 Ur,i
i. Y..�1{u) :.lu l'.�''�Ji;�ii3iy �• .....,.•�.,......,..n.,,«,w.,,,. _..,.«..�.�..,.. ,. ..,���'.,4.//I.',., II' ....�!'..61�
fC)ND DRIVE
:�5�'7 --u- a/�S'Y�1'Jifir':.) ' ;;, i':i�'.���• '1, ! .. ...
/ � � 6.pig 1/� G•4 4:.8 1(•a"�i�;,1 W�r�� . •:'�� •J(:"At•�"� ,
�l",l!"" I '8�`l, .L.•L�.../4,�. ��:il•, ".�A•. �I 11 1 A_�p'. /'.y �/ +. !
t ;r,
'.I'].y 9'/N',L'�. ,.,�•�i•'r,, r,�`� / . . . . . . • . . . . '
d Ca":a•R"4`d('.f' � � yr.• „l,:r ;:','{.!','•;'�'`', THAT THE! ' .... . , • ..,,. .. S id!„/4SiiV I
� a � _ '�n.,n::,}�^�;nlr��'""' ��l+), f1 r 1„r 1.%/G!'•�1 1,..r 1...Glayj',..�.i �:I{''h .f�y"i�::, {:i�i�ll;,ii,.}�d'+i i..] I
AS'S4'iO'ViN 1"1i RECYNj AND'i''r9A'd' "i'fi
( y•� f } dki "'
`'uJ'E'l) �:l'4,Thf„%t' rl.•�.i,id°`'''�"' 7 t:JIZ L�nr�{..5 �r.,l .l.." r aJr ,n r• r'Y' "
ry .x. � .A.. w.1..�1:.A...,.�.r. • . .,y`,ll'hi'IS.,?:r E:U�i'i".Y .11.�d:�..d..1::.�.W. �
•� „� v ' �'J,r:�w., Ma1i:i >;kt:['o,r�;-pti;
•^. Mass
DATE
... .. _. . J w) r.r Cn✓J o;.
-- 98 -- EXISTING CONTOUR s
x 100.98 EXISTING SPOT GRADE
W PROPOSED WATER SVC. { '
G EXISTING GAS SERVICE
Gyy-- UNDERGROUND WIRES ,3 fib �
TEST PITk
36608 0 BENCHMARKS #
LGP LEGEND{
T 4J
20BEis�hower ri e
19 v7�
x
}
pJ
i
BENCHMARK LOCUS MAP
COR./STEP F0077NG EL. 100.05 NOT TO SCALE
= j
S 16*05'18" W x 95.18
98.65 x
125.09 x 97,27
I 0 /
I
I 97.80 96. 0Ln
x /
LOT 18 x
20,000 SF
TP-2 VENT
TP-1
A* /
96.37 ••v.+ W.77
v �'
EXISTING S.A.S. ���'
PUMPED, FILLED W/SAND w 22 +: W 2��5 PS' CID -
AND ABANDONED O�R�Q
PROPOSED SEPTIC TANK \ P 29'
98.20 - �. r��'i Z3' 98.97
EXISTING SEPTIC TANK ojam
TO BE PUMPED, RUTUREO, 38' 99. 5
FILLED WITH SAND AND 0 00 x SHED
ABANDONED + ' 99.82
INV.(IN)=97.1f .3�99.27 99,53 FTNG x
w 10 J 100.05
100.07
o 99.97x
o a, 16
0 _ DECK
100,96 UNR00 _ L
PROPOSED 99,83
n BH rips GARAGE Iv
U' 21.8' b 04
: GARAGE
16 ``'
/ ,EXISTING 25.8' �
/ HOUSE(#208) 101.16 z
T.O.F.=102.3t1
I 101.39 \
loo,7a EXISTING,:` c \
DRIVEWAY.
100.65 a 10 V6
100.68
0 100.83 ° \
100.76 + 100.51 As \
�PLANTINGS� LAMP
+ 1 � \
PED`
TRANS 1.25:00'
O 99.74- }Bpi N 16-05'18" E W .100.36 W . \
98•88 99.71 edge of 100.08 pavement 100.15
100.04 99,88
�ZH OF MAs
of 4f4ss9cyG I S ENHO W E'R DRI V E
o PETER T. ✓' OARY S.LABRIE
McENTEE
CIVIL "' NO.40039
No. 35109
Ec�s1E ° 21ST PARCEL ID: 39-120
PROPOSED SEPTIC SYSTEM/SITE PLAN
(PI i0 S-t:o o HAZARD-ZONE X FLO NTI N 208 EISENHOWER DRIVE,. COTUIT, MA
OWNER OF RECORD Prepared for: D. A. Brown, Inc., P.O. Box 145, Centerville, MA 02632
ZONING CLASSIFICATION: ZONE RF
REZENDES, ARNOLD F TR SETBACKS: FRONT YARD=30' Engineers: Surveyors: SCALE DRAWN JOB. N0.
208 EISENHOWER DRIVED SIDE/REAR YARD=15' Engineering Works,Inc. Warwick&Assoc.,Inc. 1"=20' P.T.M. 173-20
COTUIT, MA 02655 MAXIMUM BUILDING HEIGHT = 30' 12 West Crossfield Road Box 801-63 County Road DATE CHECKED SHEET N0.
Forestdale, MA 02644 North Falmouth, MA 02556
Ii,CrADY, DAVID J & AMY L WIND EXPOSURE CATEGORY: Exposure 8 (508) 477-5313 (508) 563-7777 6/10/20 P.T.M. 1 of 2
0
NOTE: TO PREVENT BREAKOUT, THE PROPOSED
FINISH GRADE SHALL NOT BE < EL.93.5
FOR A DISTANCE OF 15' AROUND THE
EXISTING SEPTIC TANK PERIMETER OF THE S.A.S.
PROVIDE RISERS WITH. COVERS OVER INLET & PROPOSED D-BOX
OUTLET MANHOLES SET TO 6" OG FINISH GRADE. INSTALL RISER & COVER PROPOSED S.A.S.
SET TO 6" OF GRADE INSTALL RISER & COVER OVER ONE CHAMBER AND
T.O.F=102.3t SET TO 3" OF F.G. TO SERVE, AS INSPECTION PORT
F.G. EL=100.Ot F.G. EL.=99.5t F.G. EL=98.2t F.G. EL=98.Ot
VENT
MAINTAIN' 2% SLOPE OVER S.A.S.
L = 10' L = 23'
L = 5'
® S=1% (MIN.) S=1% (MIN.) p S=1% MIN.
4'SCH40 PVC 4'SCH40 PVC (MIN.) 2" LAYER OF 1 8" TO 1 2"
6,. 4"SCH40 PVC DOUBLE WASHED STONE
is"I B aaa�.a. (OR APPROVED FILTER FABRIC)
1a 2' EFF. aa0aaa6
INV.=96.90 48" LIQUID DEPTH aaaaaaa -3/4" TO 1-1/2" DOUBLE
ADJUST LEVEL App GAS PROPOSED 4' 4.8' 4' WASHED STONE
AS REQ'D. 9AFFLE INV.=94.87 INV.=94.70
INV.=96.65 D BOX EFFECTIVE WIDTH = 12.8'
'* 3 OUTLETS INV.=93.00
FLt PROPOSED SEPTIC TANK H-20 2-500 GALLON LEACHING CHAMBERS
SURROUNDED WITH STONE AS SHOWN
CONNECT TO EXISTING SUITABLE SEWER, INLET H-20 RATED
END OF EXISTING TANK, INV.=97.1 t(verify) TOP CONC. ELEV.= 94.1 t
BREAKOUT ELEV.= 93.50
NOTES:
INV. ELEV.= 93.00 ease
aaaBa
aaaaaaaaaaa
1) CONTRACTOR SHALL VERIFY ALL EXISTING PIPE Baaaaaaaaaa
INVERTS, PRIOR TO INSTALLATION. BOTTOM ELEV.= 91.00
4' 2 x 8.5' = 17.0' 4'
2) SEPTIC TANK & D-BOX SHALL BE SET LEVEL AND 4' OF NATURALLY OCCURRING EFFECTIVE LENGTH = 25.0.
TRUE TO GRADE ON A MECHANICALLY COMPACTED PERVIOUS MATERIAL
STABLE BASE OR OR SIX INCH AGGREGATE BASE, AS 5' (MIN.) ABOVE G.W.
SPECIFIED IN 310 CMR 15.221(2). LEACHING SYSTEM SECTION
3) INSTALL INLET & OUTLET TEES AS REQUIRED. BOTTOM OF TEST PIT, EL.=84.7
4) A GAS BAFFLE SHALL BE INSTALLED ON OUTLET TEE SEPTIC SYSTEM PROFILE
AS MANUFACTURED BY TUF-TITE, ZABEL OR EQUAL.
i
GENERAL NOTES: /EXISTING
1. ALL CHANGES TO THIS PLAN MUST BE APPROVED BY THE LOCAL HOUSE(1208)
BOARD OF HEALTH AND THE DESIGN ENGINEER.
2. ALL WORK AND MATERIALS -SHALL CONFORM TO THE REQUIREMENTS GARAGE
OF THE STATE ENVIRONMENTAL CODE, TITLE V, AND ANY APPLICABLE BACK OF HOUSE
LOCAL RULES AND REGULATIONS, EXCEPT AS REQUESTED BELOW:
-310 CMR 15.405(1)(b): rinseEH
1) A 3' variance to the 3' maximum cover requirement, for up to DECK ZUNI00
6' of max. cover. S.A.S. shall be H-20 and vented.
3. THE SEWAGE DISPOSAL SYSTEM SHALL NOT BE BACKFILLED PRIOR
TO INSPECTION AND APPROVAL BY THE BOARD OF HEALTH AND THE
DESIGN ENGINEER. N
4.ANY-CONDITIONS-ENCOUNTERED^'DURING CONSTRUCTION DIFFERING
FROM THOSE SHOWN HEREON SHALL BE REPORTED TO THE DESIGN N CV
ENGINEER BEFORE CONSTRUCTION CONTINUES. SHED D� ap
5. ALL ELEVATIONS BASED ON AN ASSIGNED DATUM. /
6. THE DESIGN ENGINEER IS NOT RESPONSIBLE FOR THE FAILURE OF 34.0'
THE CONTRACTOR OR OWNER TO NOTIFY THE LOCAL BOARD OF
HEALTH FOR PROPER INSPECTIONS DURING CONSTRUCTION.
7. WATER SUPPLY PROVIDED BY TOWN WATER SERVICE. 3• �dw40.1, \\
B. THERE ARE NO WELLS WITHIN 150' OF THE PROPOSED S.A.S. \ 5,
9. ALL AREAS CLEARED FOR CONSTRUCTION SHALL BE RESTORED AS sO• a OP'S P��
AGREED UPON BY OWNER AND CONTRACTOR OR AS OTHERWISE CP;
DIRECTED BY THE APPROVING AUTHORITIES. \ '/Z SEPTIC LAYOUT
10. IT SHALL BE THE RESPONSIBILITY OF THE CONTRACTOR TO VERIFY \YY SEPTIC l�
THE LOCATION OF ALL UNDERGROUND UTILITIES, PRIOR TO BEGINNING
CONSTRUCTION. SOIL LOG
11. WHERE REQUIRED, CONTRACTOR SHALL REMOVE ALL UNSUITABLE SOILS
IN THE AREA BENEATH AND FOR 5' ON ALL SIDES OF THE S.A.S. AND DATE: MAY 7, 2020 (REF#TPT-20-85)
REPLACE WITH CLEAN SAND AS SPECIFIED IN 310 CMR 255(3). SOIL EVALUATOR: PETER McENTEE PE(SE#1542)
12. AREAS REQUIRING STRIPOUT OF UNSUITABLE MATERIALS SHALL BE WITNESS: DONALD DESMARAIS R.S.HEALTH AGENT
INSPECTED BY DESIGN ENGINEER PRIOR TO BACKFILL
13. THE ENGINEER IS NOT RESPONSIBLE FOR ANY UNDOCUMENTED SEPTIC ELEV. TP-1 DEPTH ELEV. TP-2 DEPTH
SYSTEM COMPONENTS NOT SHOWN ON THE PLAN 96.4 A 0"1 96 2 A 0"
LOAMY SAND LOAMY SAND
95.7 1 OYR 4/2 95.5 10YR 4/2
8„I 8„B B
LOAMY SAND LOAMY SAND
DESIGN CRITERIA 10YR 5/8 10YR 5/8
93.4 36"' 93.1 37"
C1 r Cl -
NUMBER OF BEDROOMS: 2 BEDROOMS M-C SAND M-C SAND PERC
32"/50"
(LOADING RATE=0.74 GPD/SF)SOIL TEXTURAL CLASS: CLASS I 2.5Y 6/6 2.5Y 6/6
DESIGN PERCOLATION RATE: <2 MIN/IN 91.4 cz 60" 91.2 c2 60"
DAILY FLOW: 220 GPD
DESIGN FLOW: 330 GPD MED. SAND MED. SAND
GARBAGE GRINDER: NO-not allowed with design 2.5Y 7/3 2.5Y 7/3
i
LEACHING AREA REQUIRED: (330 GPD) = 445.9 SF 84.9 138" 84.7 138"
74 GPD/SF PERC RATE <2 MIN/IN. "C" HORIZONS
PROPOSED SEPTIC TANK: 1500 GALLON CAPACITY NO GROUNDWATER ENCOUNTERED
PROPOSED D-BOX: 1 INLET, 3 OUTLET (MINIMUM), H-20 RATED
USE 2-500 GALLON LEACHING CHAMBERS IN SERIES PROPOSED SEPTIC SYSTEM/SITE PLAN
SURROUNDED BY DOUBLE WASHED STONE ON ALL SIDES 208 EISENHOWER DRIVE, COTUIT, MA
SIDEWALL AREA: 2(12.8' + 25.0') X 2 = 151.2 S.F. Prepared for: D. A. Brown, Inc., P.O. Box 145, Centerville, MA 02632
BOTTOM AREA: 12.8' x 25.0' = 320.0 S.F. Engineers: Surveyors: SCALE DRAWN JOB. NO.
,. 471.2 S.F. Engineering Works,Inc. Marwick&Assoc.,Inc. 1"=20' P.T.M. 173-20
TOTAL AREA:........................................................... 12 West Crossfield Road Box 801-63 County Road
DESIGN FLOW PROVIDED: 0.74 GPD/SF(471.2 SF) = 348.7 GPD
Forestdole, MA 02644 North Falmouth, MA 02556 DATE CHECKED SHEET NO.
(508) 477-5313 (508) 563-7777 6/10/20 P.T.M. 2 Of 2