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HomeMy WebLinkAbout0365 MAIN STREET (COTUIT) - Health 365 Main Street (Cotuit) Cotuit A = 022 028 i 1 I� i,� No. `—��� THE COMMONWEALTH OF MASSACHUSETTS FEE BOARD OF HEALTH klh- OF bamo f 'r APPLICATION FOR ISPOSAL SYSTEM CONSTRUCTION PERMIT Application for a Permit to Construct ( Repair (_ ) Upgrade ) Abandon ( ) - omplete System ❑Individual Components aj� '��� Location Own `s Na e MR11' Map/Parcel# Address Lot# Telepho # Installer's Name Designer's Name ss e ep ones `- Telephone# Type of Building: Lot Size3Q1 Z�O7 Sq.feet Dwelling—No.of Bedrooms C7 Garbage Grinder M) Other—Type of Building No.of persons Showers ( ), Cafeteria ( ) Other fixtures Design Flow min.required) �� gpd Calculated design flow I560gpd Design flow providedpd Plan: Date 61-0_q Num er of sheets Revision Date Title Description of Soil(s) '4 SS GJ / Soil Evaluator Form No. Name of Soil Evaluator ' Date of valuation DESCRIPTION OF REPAIRS OR ALTERATIONSZ )3� ' The undersigned agrees to install the above described Individual Sewage Disposal System in accordance with the provisions of S and further agrees not to place the system in operation until a Certificate of Compliance has been issued by the Board of Health. Signed Date `© l S A/ tS lo FORM I - APPLICATION FOR DSCP DEP APPROVED FORM 5/96 ------------- -------------------- --------------------------------------- No.��p�� THE COMMONWEALTH OF MASSACHUSETTS FEE - BOARD OF HEALTH CERTIFICATE OF COMPLIANCE Description of Work: ❑ Individual Component(s) ❑Complete System 1 The undersigned hereby certify that the Sewage Disposal System;Constructed( ),Repaired( ),Upgraded jam,Abandoned( ) by: , \ at c-, has been installed in accordance with the provisions of 310 MR 5.00 (Title 5) and the approved design Ian /as-built plans r ng to application No �dated f©1 l S �U Approved Design Flow (gpd) Installer `` Designer: Inspector .0,- ate 1L) I The issuance of this certificate shall not be construed as a guarantee that the system will function as designed. FORM 3 - CERTIFICATE OF COMPLIANCE DEP APPROVED FORM 5/96 IL lo? ~ 4 A, No.. 'l` \p\F L''THE CO.�M_•MONWEALThD`OF 455sACHUSETTS FEE �_ . B.0AkFiD OFFi'f�ALETH �, n OF UW APPLICATION FOR`DISSP'QSAL SY;ST, CONSTRUCTION PERMIT :. a 4 -Application for a Permit to Cons'tr ct ( Repair( )�Upg ale_ Abwih. (, �'e;t EIAK mplete System E]Individual Components y. t X\ / Location Own 's Na eMOJ I Map/Parcel# ,tom Address "Lot# Telepho # Installer's Name Designer's Name Address 1 ss Telephone# >b, Telephone# Type of Building: lLeS Lot Size'301a:Z Z� Sq.feet , Dwelling—No.of Bedrooms Garbage Grinder (ram) Other—Type of Building No.of persons Q Showers ( ), Cafeteria ( `) Other fixtures Design Flow in.required) gpd Calculated design flow 1560gpd Design flow provided, gpd Plan: Date Number of sheets Revision Date Title&4 CIS C�INv Description of Soil(s) Soil Evaluator Form No. Name of Soil Evaluator ' ' *4 Date of Evaluation DESCRIPTION OF REPAIRS OR ALTERATIONS The undersigned agrees to install the above described Individual Sewage Disposal System in accordance with the provisions of T 5 and further agrees not to place the system in operation until a Certificate of Compliance has been issued by the Board of Health. ` Signed -"" Date /D � S U nsp . ;.. nsp ct�l nsa C` , ` �� l S � FORM I - APPLICATION FOR DSC.P DEP APPROVED FORM 5/96' No. �p� THE &MMONWEALTH OF MASSACHUSETTS FEE LJ BOARD OF HEALTH CERTIFICATE OF COMPLIANCE Description of Work: ❑ Individ'ual�Component(s) . " ❑Complete System { The undersigned hereby certify that the Sewage Disposal System;Constructed( ),Repaired( ),Upgraded,Abandoned( ) ',by' at 'J(n,�: has been installed in accordance with the provisions of 310 MR 5.00 (Title 5) and the approved:design 1 n /as-built plans r min to application No.;. I . p ., g pp — \-t�to�dated I y�l S'�c.)\ Approved Design,Flow�(gpd) ' Installer Designer: Inspector p a . C Rafe 11(c I(l t The issuance of this certificate shall not be construed as a guarantee that the system will function as designed. FORM-3- CERTIFICATE OF COMPLIANCE DEP APPROVED FORM 5/96 No. �-lG�p� THE"COMMONWEALTH OF MASSACHUSETTS FEE BOARD OF HEALTH DISPOSAL.SYSTEM CONSTRUCTION PERMIT Permission is hereby granted to Construct ( ) Repair ( ) Upgrade)<.) Abandon (. ) an individual sewage ` disposal system at r�)l c'e> V as described in the application for Disposal System Construction Permit No. dated I� I l D Provided: Construction shall be completed within three years of the date of this permit.All local conditions must be met. Date Board of Health 4� -4-. FORM 2 - DSCP DEP APPROVED FORM 5/96 FORM 1255 (REV 5/96) H&W HOBBS&ARRENT. PUBLISHERS- BOSTON CW _ REMITTANCE ADVICE _ '--=53-574/T17. - # .JASON SOUZA d� d6a ABOVE.GRADE"EXCAVATING= PO`:BOX 323 9:/�:Q K COTUIT,..MA 02635. ro J``tt VQ N , TO THE ORDER OF - 4. $ a CFFECDOLLARSAMOUNT DATE y r ,Q APECOD'BANK -60 PA 0' MASSACHUSET S 11■0 0 2.91,a its 1:0 1 13 0 5 7 4 91: 10 10 19 5 2 7 u■ 1 s 1 � 5/25/01 NOTICE: This Form-Is To Be Used For the Repair Of Failed Septic Systems Only. - - -------_-:i:= PER-COLA-TION TEST AND SOIL EVALUATION EXEMPTION- - FORM h Richard J Bertrand , hereby certify that the engineered plan signed by me , dated. ` 9/28/01. . , concerning the property located at l fap 22 parcel 28, House 365 Main .St.., Cotuitmeets all of the following criteria • This failed system is connected to a residential dwelling only. There are no commercial.or business uses associated with the dwelling. •. The soil.is classified as CLASS I and the percolation rate is less than or equal to 5 minutes per inch. The applicant may use historical data to conclude this fact or may conduct preliminary tests at the site without a health agent present. • There is no increase in flow-and/or change in use proposed • There are no variances requested or needed. • The bottom of the proposed leaching facility will not be located less than fourteen (14)feet above the maximum adjusted groundwater table elevation. [Adjust the groundwater table using the Frimptor method when applicable] Please complete the following: - A) Top of Ground Surface Elevation (using GIS information) 60.0 B) G.W. Elevation +adjustment for high G.W. = 20.0 DIFFERENCE BETWEEN A and B 40.0 SIGNID :_ DATE: 10/1/01 - NOTICE Based upon the above information, a repair permit will be issued for 5 bedrooms maximum.. No additional bedrooms are authorized in the future without engineered septic system plans. q:health folder.percexmp i m -. Ln Cr I C I L U S E ..n Q. Postage_ $ e 3 ( �y(� m Certified Fee Po X u7 (Endorsement Receipt Fee S ((EndorsementRequired) a O Restricted Delivery Fee t3 (Endorsement Required) O Total Postage d Fees s Er, Sent To .I' ^ - - -----------o -- ----5-= - = - StPOBox. ., � 3Z3 r9 or PO Box No. City,State,ZIP+4 lA �'�. M,T O Zb 3 S Certified Mail Provides: o A mailing receipt Io A unique identifier for your mailpiece o A signature upon delivery a A record of delivery kept by the Postal Service for two years important Reminders: to Certified Mail may ONLY be combined with First-Class Mail or Priority Mail. Io Certified Mail is not available for any class of internationa�mail.l tt o NO INSURANCE COVERAGE IS PROVIDED with�Certified Mail:uFor, valuables,please consider Insured or Registered Mail f1 'e For an additional fee,a Return Receipt may be requested to provide proof of delivery.To obtain Return Receipt service,please complete and attach a Return Receipt(PS Form 3811)to the article and add applicable postage to cover the fee.Endorse mailpiece"Return Receipt Requested".To receive a fee waives for a duplicate return receipt,a USPS postmark on your,Certified Mail receipt is required. o For an additional fee, delivery may be restricted to•the addressee or addressee's authorized agent.Advise the clerk or mark the mailpiece with the endorsement Restricted Delivery". o If a postmark on the Certified Mail receipt is desired,please present the arti- cle at the post office for postmarking. If a postmark on the Certified Mail receipt is not needed,detach and affix label with postage and mail. IMPORTANT.Save this receipt and present it when making an inquiry. ee, - PS Form 3800,January 2001 1(Reverse) 102595-M-01-2425 aER: COMPLETE THIS SECTION: • • ON ■ Complete items 1,2,and 3.Also complete A. n item 4 if Restricted Delivery is desired. ❑Agent ■ Print your name and address on the reverse ❑Addressee so that we can return the card to you. B. R eived by(Printed Name). �.Ja2oM Us Attach this card to the back of the mailpiece, J or on the front if space permits. D. Is delivery address different from item 1? d Yes 1. Article Addressed to: If YES,enter delivery address below: ❑No �ve G--rA ansf, �. JUN 13 2003 i 3 23 f 1-1,� 21�3S 3. ervice Type �B f49,Certified Mail ❑Express Mail I ❑Registered ❑Return Receipt for Merchandise ❑ Insured Mail ❑C.O.D. 4. Restricted Delivery?(Extra Fee) ❑Yes 2. Article Number - (transfer from service tabu ` 7 0 01' 19 4 0 0 0 0 5 3769 6 6 9 5 r. S PS Form 3811,August 2001 Domestic Return Receipt 102595-02-M-1540 I UNITED STATES POSTAL SERVICE First-Class Mail' '> l ttPo��sta��ge&Fees Paid .SUN 1 Za No.G-10 I • Sender: Please print your name, address,and ZIP+4 in this box° I I pubkHmambw Town of BamsW10 200 Main St Hyannis,Massachusetts 02601 I I 11} i y { j jj jy p j ! } j i 1!!!!!1!I!�Ifdl!I'r!!!1I!i!111i!!-lilt!IIldiiIId l!!!!Ilid d 6 f { Py F��wt ��cm A . Sw ecJ �Vt �,(�'� C�S-� 1�•5 �S a,,d r 1 1�e� - �► 4�ovtkS s� i JUL-7-2004 22:41 FROM: TO:5087906304 P.1 American Excavating Contractors, Inc. 27 County Rd. Mashpee, NM 02649 Phone/Fax, (508)477-7411 Cell, (774)836-5774 To whom it may concern, July 7,2004 This letter is to inform you that,Jason A. Souza,is no longer with Above Grade Inc. and is now pr;ksident of American Excavating Contractors,Inc.He wishes to inform you that ho is the only person authorized to pull permits in his name.Also please make note qf the new contact info.Please call if you have any questions regarding this mater. Sincerely, as n A. Souza(President) 1' i{ I• I . SYSTEM PROFILE TOP OF NOT TO SCALE FOUNDATION FINISH GRAF,- '*FINISH GRADE OVER EL. 75.8 FINISH GRADE OVER EL. 75.0 SEPTIC TANK 75.0 DISTRLBUTION BOX 75.0 FINISH GRADE o _ _ OVER TRENCHES 75.0 OF TO 6" �� - 9' _p ,oY OF FINISH GRADE PRECAST CONCRETE ADJUST 3"MIN. RISERS TO 6" ,;--�' b' 500 GALLON DRYWELLS INTERIOR :��� Mw.SLOPE 1% OF FINISH GRADE - OUTLET PIPE(S) LEVEL H-10 REINFORCED LOADING 3 6° MIN.SLOPE 1% FOR 2'( MIN.1% SLOPE TRENCH LENGTH = 42'-0'° g BEYOND -- MIN. DRYWELL LENGTH = 8'-6" 13"MIN. 14" _ _ 7 3.65 k 72.25 ° `'° ���i ��� o o ° _� 6"SUMP n,O:r v Q o:r r. of u• °, 1 ° r. ' r o_ ° MIN. 0 o v - �, �,r ,•r.. ,r moo,_ „ q+o '0 ;�- - - ' - PVC OR CAST IRON TEES 7 t . ') Fd,:r ,t.. „ ,o:r 7�.63 —y.°'� � o0 o:r 1 `,r �s..J -I GAS BAFFLE 6 �,� . �b ,bl DI RIBLI I ION BOX 7�1.20 r �.� i ,, •r 4 r O :r v ,O:r'•-,�i,:r ,�:r ,� ,r O�p•r r. d >> 1500 GALLON J MINIMUM INSIDE DIMENSION 12" 3l4"- -1 2" DOUBLE - "' 3l4"- 1-1/2" DOUBLE '= �- 4' WASHED CRUSHEDi:� • _ 'o �< W ���• C� T T INSERTS 2 BELOW INLET INVERT _® PRE-CAST CONCRE-'E M,'!1 UM CONCRETE WALL THICKNESS 2 WASHED CRUSHED o o _4' rr STONE BSMT.FLR. '�'� 4" I-I-10 REINFORCED ALL ON COMPACTED LEVEL BASE STONE J ELEV. q ® �0 TRENCH SECTION ` �`�'°•1• � r�e' 'o ��f `i ,, re', Irf ', �n rl, '••'/I,r'... rr ,, °(\r % •71rll Ot,ro�, r'®� O,O '•�°• r.' Or,J' �, (J r`�o 0 0 r'® ' 1 r.d �I '•U' 'P,.1 '•1':r y NOTE: EXCAVATE TO =C= STRATUM IN ORDER TO SEP 1 IC TANK REMOVE ALL =A= & =B= IMPERVIOUS MATERIAL INSTALL ON COMPACTED LEVEL BASE , WITHIN 5' OF THE SAS. REPLACE WITH CLEAN, 9" MIN• 3" OF 1l8" -1/2" /ZO—wo et�� Jd4 11C11C � � CLAY-FREE SAND IF NECESSARY r Rd..�� '-- c�: _ 4" DIAM. 36" MAX. DOUBLE'WASHED .}_..... PEASTONE 0.o Q ��f� - 4 6brP 6r,o. I r 0 r r OQO r ,0 Hv`on °0 :ro 0 or. 'oro• 3/4"- 1-1/2" DOUBLE z{ 1 �S 48" 5'-211 4 rr WASHED CRUSHED STONE TRENCH WIDTH \ 8an held �� Lows s r 13'-21' t- li Rd: �� NUMBER OF TRENCHES 1 L=39.8,, � �,;�a D � o��lERAL NOTES: . . a NUMBER OF DRYWELLS 4 yO°sP C b' ELEVAT<ONS ,r OWN ARE BASED ON ASSUMED ' ' � "' ' "� �' ""' _w YSTEIVI MUST BE OAST IRON _ u. .\ �•\ � ; , ,.Y�•• �z ..• , r�s - , ,\ ,yam� � ,. t.__.. � .�; . OR SCHEDULE 4),PVC. 3.'HEALTH AGENTrt�,APE & ISLANDS'ENGINEERING Ott MUST BE NOTIs 1=D WHEN CONSTRUCTION IS .�� otui1 �'_ COMPLETE PRIOR TO BACKFILLING. 4.ANY CHANGES 1�4 THIS PLAN MUST BE APPROVED 5 / ^ BY CAPE & ISLANDS ENGINEERING AND THE BOARD °°O OSTT OF HEALTH. DESIGN DATA 5. MATERIALS AND INSTALLATION SHALL BE IN / -\ TIOTMELIANCE V'AND LChCAL APPLICABLE RULE THE STATE S AND �' \ o ?. REGULATIONS. NUMBER OF BEDROOMS 5 co 6. NORTH ARROW IS FROM RECORD PLANS AND IS GARBAGE DISPOSAL NO �� N NOT INTENDED f OR SOLAR ENERGY PURPOSES. DAILY FLOW 550 GPD. P���/ �G 7. WATER SUPPLY MUNICIPAL WATER SYSTEM. SEPTIC TANK REQUIRED 1500 GAL. �/ CESSPOOL TO BE 8. FLOOD ZONE C a NON-HAZARD] PUMPED&FILLED \ `� _ SEPTIC TANK PROVIDED 1500 GAL. 9. THIS PROJEC i GOES NOT INVOLVE ANY PHYSICAL LEACHING REQUIRED 550 GPD. <\ N� I \ GROUND DISTUr`'BANCE OR VEGETATION REMOVAL PQ6T \ ^� a�� I WITHIN 100' OF`JETLANDS INLAND OR COASTAL BANKS ORFLOC�:D HARD ZONES. SOIL ABSORPTION SYSTEM CALCULATIONS: ti SIDEWALL AREA = 220 SF. 220 SF. X .74 G/SF. = 162 GPD. BOTTOM AREA= 546 SF. 546 SF. X 0.74 G/SF. = 404 GPD. °° \ L, GEND LEACHING PROVIDED = 566 GPD. PROPOSED CONTOUR SEPTIC SYSTEM UPGRADE / -4 \ ---52--- EXISTING CONTOUR 0 PROPOSED SEWAGE DISPOSAL SYSTEM \ 'OBSERVATION PIT 1 PREPARED FOR ISE.N0.365 -—75——— —_ ❑ DISTRIBUTION BOX EDWARD M U RP HY 30,230 SF' �Iry HSE.NO.365 MAIN ST. 1 � o 0 o SEPTIC TANK �� 156.24' \ � a - COTUIT - BARNSTABLE - MASS. -—————75 SOIL ABSORPTION SYSTEM PLAN NO. 092801 SCALE: AS NOTED RESERVE RESERVE AREA 'r FILE NO. 387BA ` DATE: SEPT.28,2001 SEPTIC FILE NO. 70 PCS FILE: MAINST365 22.26 ;PIPE INVERT ELEVATIONS CAPE & ISLANDS ENGINEERING PLOT PLAN 22 28 365 0 0 0 800 FALMOUTH ROAD, SUITE 301C SCALE: 1" - 30' MAP SEC PCL LOT HSE �'' '�'' W =i ' MASHPEE,MA 02649 (508)477-7272 �' 1' i