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HomeMy WebLinkAbout1207 MAIN STREET (COTUIT) - Health 120 ' MAIN STREET, COTUIT M A= 018 066 i s TOWN OF BARNSTABLE LOCATION Ai a—Rq— SEWAGE# VILLAGE 5,ter, ASSESSOR'S MAP&PARCEL q 19 - 64, INSTALLER'S NAME&PHONE NO. -B C. I- -1-11- SEPTIC TANK CAPACITY - 15crD LEACHING FACILITY:(type)��,l= (size) 4�. i� •�31 NO.OF BEDROOMS �� .,�Bp G L OWNER C f� PERMIT DATE: COMPLIANCE DATE: o Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) N X& Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet FURNISHED BY f' �I i tr y of-get Sit 1 o t o � o �- I o3!grill 4� 1 1 / No. �dl®+�'� Fee l .5 THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes 01pprication for Disposal *pstem Construction Permit Application for a Permit to Construct( ) Repair( ) Upgrade 44 Abandon( ) Complete System_ 0 Individual Components Location Address or Lot No.I;2O?IgOjh-3 Sf. CO` Ut _+ , wner's Name,Address,and Tel.No. 'il,* 9' Assessor's Map/Parcel /� �� i-�6Aa'-'�/ c/o 4&So I»v5 fW b� 1 n �'vM A 09635- Installer's Name Address,and Tel.No.S0$-4-)g%'I Designer's Name,Address,and Tel.No.3fj$ �„ b y�j for ,— y3`T„du sf�j ,t7����C� �n .'.2S �;W,Mach ` d►'lcc�s}otit xV d h Type of Building: �-^ Dwelling No.of Bedrooms V Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) IF SO gpd Design flow provided S�� gpd Plan Date mQ�c� 16_ ao.-O Number of sheets Revision Date Title an i n'Qhre_a m A a Size of Septic Tank Isf)o Q`tt `�to Type of S.A.S. lzvva ) Description of Soil 5a.2. �- l�C� Na_tusre of RSepair1ss or Alterations 'Answer when applicable) f R 10 k 1 a. , X 7 �It-�,ap_ �p 1011� 1/�� M LLrA ArYIAM �, V% � y�aL X t gel.�5�,:.J .�1�[snL�1P/ &,) t.LY►a�;«�rr.L�e .]�e� � f�,Q11 fl �yt� �t� Ors Date last inspected: Agreement: The undersigned agrees to ensure the construction and mainte a afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environme ode and no place the system in operation until a Certificate of Compliance has been issued by this Board of Health Signe - Date L.1,0120 Application Approved by U Date Application Disapproved by Date for the following reasons Permit No. y a0 — a�_� Date Issued No. Fee a�1'-�s�' �•�'J .* *.M '� �_ •� a-....,. THE COMAONW EALTH OF MASSACH Entered USETTS Yes PUBLIC HEALTH DIVISION ,TOWN OF-BARNSTABLE, MASSACHUSETTS application for disposal 6pstem Construction Permit Application for a Permit to Construct( ) Repair( ) Upgrade(/ Abandon( ) ®Complete System ❑Individual Components Location Address or Lot No.j p►? Y (J{'7$}, - '�}� Owner's Name,Address,and Tel.No. �"'VP9~ Y69, ! Y-A;es,&,Vm i� C/v t u '"%c's , + Assessor's Map/Parcel l�OGro / Qnkr-,,I I A,- 't' A-tu.A. 41 A nlp(li,S' Innsstaller's Name,Address,and Tel.No.308-q.)SS.-89 D& Designer's Name,Address,and Tel.No. f"� ,-- (� - (1 SY1 <.Uoric>10t 0vr k+ft t �,irti CIS G��i�r`7 ,CJ©t�e3t� r`►'Iarsh M1►s A4 r�/Il4 r)I„Ue L. ,� a"X .4414 lam �- Type of Building: t �-^ ✓ - r Dwelling No.of Bedrooms J Lot Size qY• sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided , gpd Plan Date M16AA lG aU,3() Number of sheets t1 Revision Date Title`�;f�a+z S J, f��te.,n r)Yl I i r,�'�-r v r� t 144,.j F' to f e � Size of Septic Tank Type of S.A.S. t/ {� Description of Soil ���, 1 A_.� V 1�:.a o t 4 r r., , J_ / f /I Nature of Repairs or Alterations(Answer when applicable)'4),,,) J+1q I JraCJ4 a, \n a1 r /,r^�� 1 ar, . ;sYr,•L.r., ,rw rl '1�D7� q 1k,;i�)r,,f>E..�gee. Yne���, Loa n ar,r��-r,�t��,�3„cam, ' rl mN:s�r'1Jv �PF t Jde[,r�� iv_l Q D n n?Fan Ii , .4 • , e Y Y Date last inspected: Agreement: E . The undersigned agrees to ensure the construction and maintenance-ofrthe 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 Hea/lth.�n � i Signe A(—, - _� _ Date s� lve_° 61 Application Approved by' p,/, (_ , 110 X j Date g> mo t t fe A lication Disapproved b I `t ,�pp pp y s Date for the following reasons Permit No. ' a �v Date Issued -----.-----.------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired( ) Upgraded( i n -,.-._ .-Abandoned( )by A1,r�[2,"1a -Y ..t..n C at a,,� m �, f Y - has been constructed in accordance , t 1_ ra r�� -. J with the provisions of //Title 55�and the for Disposal System Construction Permit No. ')vl ,'��2 4jdated Installer „Mr L'..►,`^r,,r�y,,Mr9G_ Designer 00 C", "'o #bedrooms Approved design flow .S' 50 gpd The issuance of this permit shall not be construed as a guarantee that the system wilLfunction as designed. r Date lit o!a-t Inspector 1 r.—pI - --------------- No. 6 7ts' Fee v THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION.-BARNSTABLE,MASSACHUSETTS Disposal *pstem Construction Permit Permission is hereby granted to Construct( ) Repair( ) Upgrade(kj Abandon( ) System located at and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Constructi n must be completed within three years of the date of this permit. Date L/ A Approved by �Vu MAR-22-2021 23:49 From: To:15087906304 Pa9e:1/1 1 Town of Barnstable Inspectional Services Public Health Division 1 6 Thomas McKean,Director 2o0 Main Street,Hyannis,MA 02601 E Office: 508462.4644 Fax: 506-790.6304 Installer&Des) ner CertiScation Form Date:••••3 (0' a-1 Sewage Perrnit#Q0,40, )k6_Assessor's•MapWared V Designer: D0•W n CM M •M A KE• Installer: o rt o i Cork f�-+`ovti (rt c- Address: q5q Address: On A1161 ff1A/,A was issued a permit to install a (date) (installer) septic system at 1 R7 Ji & L Ce—&— , C®�t/f f _based on a design drawn by i (a ••lest) '�( date es►gner). 1 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. 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 mtem referenced above was constructed Wi'q'npIfiace with the to rms of the"!\A�ar etters(if applicable) UANJIL-LA. r' l 7�u'3 CIVIL ��� ho..1L•'SJ2 J nstaller s Signature) ro`ic� +41vT!r (Designee s Signature) ixDesigner's Stamp Here PLEASE RETURN TO BARNSTABLE PIMLIC U_A_LTJ9 DIVISION. CERTICATE OF C C NOT HLr IbbUED U TI OT THIS IV A AS- BU • C ARE—RECE VED B THE ARKS BL U L EA DIVISION, U. \\tooldtiMMEAVWEWER conna0sWiM SIPU Conlltcatton roam Rev 644-13.DOC Commonwealth of Massachusetts Executive Office of Environmental Affairs z �G -a~k Department of {�. Environmental Protection : ° ' William F.Weld Governor Trudy Coxes. 6'.. •� Secretary,EOEA David B. Struhs C4 Qei Commissioner SUBSURFACE SEWAGE DISPOSAL SYSTEM.INSPECTION FORM PART A CERTIFICATION Property Address: /�Z O 7 M Q i 5t: COT V i i. Address of Owner: ` 1 OJ\ W O k`�-- Date of Inspection: "vD—tifP. (If different) Name of Inspector: Company Name, Address and Telephone Number CERTIFICATION STATEMENT I certif}•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: Passes _ Conditionally Passes _ Needs Further Evaluation By the.Local Approving Authority Fails Inspector's Signal Date: p ct�Q The System Inspector shall submit a copy of this:inspection report to the Approving Authority within thirty(30) days of compieting-this . inspection. If the system is a shared:system or has a design flow of 10,000 gpd or greater, the inspector and.the,system owner shall submit the 'report to the appropriate regional office of•the-Department of Environmental°Protection_ The original should be sen:..L.• the system owner and copies.sent to the buyer, if applicable and the approving authority,. INSPECTION SUMMARY: Check A, B, C,.or D:Y A] SYSTEM PASSES:_ . I have not found any information which indicates that the system violates any of the failure criteria as defined in 310 CMR 15.303. Any failure criteria not evaluated'are indicated below. B] SYSTEM CONDITIONALLY PASSES One or,mole system components need to be.-replaced or repaired: The system, upon.completion of the replacement or repair,,- passes-inspection. Indicate,yes, no, or noi.determined_-(Y, K-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'-8/15/95) 1 One Wlnter-Street: e, Boston,.Massachusetts 02108. e• FAX(617)W6.1049 a Telephone-(617)292-&WO, tja j;printed on Recycled Paper, 1 7 . SUBSURFACE.SEWAGE DISPOSAL POSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) i' Property Address: ,/;)LO 7 M OO K 51 COT V 1 i Owner: o Date of Inspection B)SYSTEM CONDITIONALLY PASSES(continued) _ Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. The system will pass inspection.if(with approval of the. Board.of Health): broken pipe(s) are replaced obstruction is removed distribution box,is levelled or replaced The system required pumping more than four times.a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): broken pipe(s) are replaced obstruction is removed C) 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: !. 1--- 1. _ the sysiem'ha5 a Septic tanK ano sole absorpUUn system anU 1b wllllln-,C)G Icci t0 a sulld�c wa�ci SuaN � Gi tribula j t0 a surface water supply. _ The system ha, a septic tank and soil absorption system and is within a Zone I of a public,water supply well. _ The system has a septic tank and soil absorption system and is within 50 feet of a private water supply well. _ The systenl 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 and volatile organic compounds indicates that the.well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm 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 into facility or-system'component due to an overloaded or clogged SAS or cesspool.. Discharge or,ponding,of effluent to the surface of the ground or, surface waters due to an,overloaded or clogged SAS or cesspool. 2` (revised,,/15/95) F SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Ad i /07 /n A-lN S r 6O(V(l Owner: O C111\ _Date of Inspection-3 0``�� 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). Number of times pumped: Any portion of the Soil Absorption System, cesspool or privy is below the high groundwater elevation. _ Any portion of a cesspool or privy is within 100 feet of a surface water supply,or tributary to a surface water supply. Any portion of a cesspool or privy is within a Zone Lof 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 1OO 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 above: t The design floe,- of system is 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 11 of a public water suppiy 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 8/15/95) 3 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST .Property Address: 1 a 0 7 q D!c . - CO t v 171. Owner: 10 Date of Inspection. S 3 Check if the following have been done: Pumping information was requested of the owner,'occupant, and Board of Health. gone of the system components.have been pumped for at least two weeks 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. '--"As built plans have been obtained and examined. ''Note if they are not available with N/A: _`fRe facility or dwelling was inspected for signs of sewage back-up. _&_Tie system does not receive non-sanitary or industrial waste flow _L- a site was inspected for signs of breakout. V" _vKfrsystem components, excluding,the Soil Absorption,System, have been located on the site.. L-�e 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. v 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. occupants, if d;'fere^ +om ov ner;'%vere.provided with information on the proper maintenance of Sub- Surface Disposal System. (revised 8/15/95)' 4 . SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION - Property Address- Owner: 17 �►N 5 C CJ�J\� p Date of Inspections. -3p_��o t FLOW CONDITIONS RESIDENTIAL: Design flow: 7� allo ;. Number of bedrooms: _ Number of current residents: vZ Garbage grinder(yes or no):�1� Laundry connected to system(yes or no): Seasonal use (yes or no): r Water meter readings,.if available: V Last date of occupancy: Q6 COMMERCIAUINDUSTRIAL: Type of establishment: Design flow:_gallons/day Grease trap present: (yes or no)_. Industrial Waste Holding Tank present: (yes or no)— Non-sanitary waste discharged to the Title.5 system: (yes or no)_ Water meter readings, if available: Last date of occupancy: , OTHER: (Describe) Last,date of occupancy: GENERAL INFORMATION . PUMPING RECORDS and source of information:. NdVC,cN e6012J System pumped as part of inspection: (yes,or no)_ If yes,volume pooped- gallons Reason-for.pumping., w TYPE,OF TEM r Septic tank/distribution box/soil absorption system Single cesspool Overflow cesspool Privy .. - Shared system (yes orno)'. (if yes, attach previous inspection records, if any) Other(explain);" APPROXIMATE all-components, date installed (if'known):and source of information: �lrS -h Sewage odors-detected when arriving at the site: (yes or no) (revised 8/15/95) S 5 l si SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address:.0.07 (AA.1 KD S k CO1 V- Owner Date of Inspection: I SEPTIC TANK:y- (locate on site plan) a,t Depth below grade: Material of construction: Vconcrete _metal FRP —other(explain) Dimensions: l0 x — Sludge depth: Distance from top of sludge to bottom of outlet tee or baffle: Scum thickness: Distance from top of scum to top of outlet.tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle Comments: (recommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outler invert, structural integrity, evidence of leakage, etc.) GREASE TRAP-_ (locate on.site plan). Depth below grade: Material of construction: _concrete metal FRP—other(explain) Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: _ ni!tance from bottom ni cro— t^ hottorn ot,o!hlPt,tee orbattle' 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.) -(revised 8/15/95) 6, SUBSURFACE.SEWAGE DISPOSAL SYSTEM.INSPECTION.FORM ' PART C SYSTEM.INFORMATION (continued) Property Addresss:. a 07 Mr, I S i�0?V•t r Owner. 1oc- Date of Inspection:: -'30 ,(p TIGHT OR HOLDING TANK:/Y (locate on site plan) Depth below grade: Material of construction: _concrete_metal _FRP _other(explain) Dimensions: Capacity: gallons Design flow: gallons/day Alarm level: Comments: (condition of inlet-tee, condition of alarm and float.switches, etc.) DISTRIBUTION BOX: (Locate on site plan; r _ Depth of:liquid level above outlet invert: Comments- (note ii.levei and distribut,c,1, r eyua:; e%-dcnce;of solid_.ca;r�o%er, evidence of leakage into or out o, box, etc.) 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.) I • I I , (revised' 8/15/95) 7: SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C. SYSTEM INFORMATION (continued) " Property Address: Q0 Jqrw S 1 (!�o%V Owner: Date of Inspection: 5--Cls 0- SOIL ABSORPTION SYSTEM (SAS): (locate on site plan, if possible; excavation not required, but may be approximated by non-intrusive methods) If not determined to be present, explain: 1 Type,. leaching pits, number:_ leaching chambers, number. leaching aeries number: leaching trenches, numberlength: . leaching fields, number, dimensions: overflow cesspool, number. Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,etc.) CESSPOOLS: (locate on site plan) Number and configuration: Depth=top of liquid to inlet.invert: Depth of solids layer: Depth of scum layer Dimensions of-cesspool: Materials of construction: Indication of groundwater.—- inflow (cesspool must be-pumped as part of inspection) Comments:(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) PRIVY: (locate on-site plan) Materials of construction Dimensions: Depth-of solids:---- Comments::(note condition of soil, signs of,hydraulic failure, level of-ponding,.condition of vegetation, etc.)-- (revised.8/15/95) B SUBSURFACE SEWAGE DISPOSAL SYSTEM,INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: %a 0 7 f R i N 5/... CO%V 1 Owner: I - Date of Inspection: (p SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent references landmarks or benchmarks locatp,all wells within Ipo' � o CJ� �e�1c.r� . r v w _ . A Y DEPTH TO,GROUNDWATER Depth to groundwater. ���� feet.: method'of determination or approximation: TOE 0 �1�c5 t 1�S Coy IQ kA�c k ' '4e ' StY 5 Q�� l C�PC'�.�nn��•P', _ , (zevised'8/15/951 9 TOWN OF BARNSTABLE LOCATION I D �2 ,�19 SEWAGE # - 7 VILLAGE � "�. — ASSESSOR'S`,MAP & LOT INSTALLER'S NAME & PHONE NO. &- &4 /� - 4fa o -I —r ;SEPTIC TANK CAPACITY EACHING FACILITY:(type) .3 . �t (size) 'O. OF BEDROOMS _P-R4r' =&L OR PUBLIC WATER E� x OR OWNER ✓jxm'► ! DATE PERMIT ISSUED - - i.4 DATE COMPLIANCE ISSUED:, VARIANCE GRANTED: - No �' ._..---� ;� �; �� �� °% � .�' �-r �.� ' � � > �--_ �/.- r. r �� ' ` � t p 2:2Ny.. Fins THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH _.._....T_QWN.........-•- .......OF..........BARNSTA.BLE............................................... Appliratinn for Uhipmal Works Cnnnitrurtann ramit Application is hereby made for a Permit to Construct (X ) or Repair ( ) an Individual Sewage Disposal System at: ...........1252Z....IVJAUN,..STREET. GOT.=......KL.-- --------------IV ........LOT..-06...................................... •a♦ e S. A Location ♦n-'Address or Lot No. i��TI T m��T T�}� ......r�T .. 3`3S�N;..�Y......B�O.�Ai............................................. .LRL1VZT0 ---t.ZU... 29...AD]]I S ON..STREET..... =ems" 4 Owner Address ...........ALFRFD..A...---FULLER......................................... ------R•9-5...COT.UIT...80AD._.MARS-'2AvS---MIL,IdS...Ila. Installer Address dType of Building WOOD. FRAME Size Lot....33.82Z----------Sq. feet V Dwelling—No. of Bedrooms........4 ..................................Expansion Attic (N q Garbage Grinder (YEF ►+ Other—T e of Building No. of persons.......... ... Showers 2 Cafeteria O d Other fixtures ..2TOILETS_..1.._JACCUZI-......UOTH... A.SHIER........................................................ W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. P4 Septic Tank—Liquid capacity............gallons Length................ Width................ Diameter................ Depth................ 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 ( ) aPercolation Test Results Performed by.........................:.............-•••--•-•---..............�,. . Date........................................ Test Pit No. I________________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........................ a -------------------------------------------------------------------------------------"...-•••--------------------••......•------••-••........................ ODescription of Soil............SL� •--.&---Czl'�A.YEL----------------------------------------------------------------------------------------------------------------------- W U x •••--•----------------------•----•-•--•-----•••••------•---------------•--•------------...----•----•--------------------......---•••-----------•------•••--•-•-••-......----•--•--•-•-•••-•••--......._. U Nature*Qf Repairs or Alterations—Answer when applicable................................................................................................ REPLACE THE EXISTING SYSTEM ----------------------------------•-----------------------------------------------------••---......•--.........••••••-----------•---•-----......------------------------•••--------------•............. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of'i'�l. 5 of the State Sanitary Code—The undersigned further agrees not to place the system in j operation until a Certificate of Compliance has been issued by the bo d of th. Signed... ---•----------------------------------------- -----------•--•----------- Date Application Approved By•-••-...... "AD-�s �','°�....................... ----------- !9_�...t.7.. ••......-•..................•••............•.......................•----..Date Application Disapproved for the following reasons:................. .__....._..._ .................................•-------------------------....-----•----------------------•---------------••----........_..-------•-------•-•---•---------------------••-•••••••-------•---••••--•-•--- pp Date Permit No....... _?....'....'7..�f_ ---------------- Issued ------------------- Date No._- 7......... -.. F:cs.........................— THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .....................--------- .........OF..........................------...............---........-----------..................--- Applira#ilan for Miyosal Works Tonstrnrtion ramit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: -------------------------------------------------------------------------------------------------- ---------------------------------------------- ........................................... Location-Address or Lot To. ......................__........................................................................ -----•----•----.........-------•--...........•---•--------•-•----•---------------.........._...-- Owner Address W Installer Address Type of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) A, d Other fixtures --------------------------------------------•---------- W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. 9 Septic Tank—Li uid ca a cit ............gallons Length___.•_..._..._._ Width................ Diameter-_._ _-___---- Depth................ Disposal Trench 9 No. .. ............. Width.................... Total Length.................... Total leachingarea....................s . ft. Seepage Pit No--------------------- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by.......................................................................... Date........................................ a Test Pit No. 1----------------minutes per inch Depth of Test Pit.................... Depth to ground water........................ G%, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water_..................... a -•-••-----•---------------•--•----....._....-••--•-•---••...........----................------------............................................... ---------- 0 Description of Soil.....................................................................................................................................................----•-.........--- U ------------•-------------------------•----•---•-•-•--•----•------•-••-•-----•-•---...•---...............--•-•-------•-•-•-------•--•-----•----••---------------•---•--••-•-----------•----•------------ 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 TTI1E, 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been n ssl�ed by he,board o ji lth. r. Signed Date Application Approved BY " ._._ s ._,.Y .r= --•----------•----------•----- Date Application Disapproved for the following reasons----------------•----.........------••--............-----------•------------------------.._......----•--••------ ..-----•-------------•----..........-••--•--•---•------•-•-----•-•----•---....------......----------...--'•---------••-•-------------•-••---•-••-•-••--------•-•--•-••----------------•-----•---•-------- Date Permit No.c`......-• ...-7-- --........-----•-----...... Issued-...................... ................................ Date THE COMMONWEALTH OF MASSACHUSETTS �- BOARD OF HEALTH 1....`.= OF.... .......................................... (9rdifirate of Toutplianrr THI TO (--ERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaire� ) bY / t .................•---'-'...--------------•-----•----------------------•--------•-•----------......--•---....------------------------•-----•--.....-•---•---•. ------ I staller ------------------------------------------•-------------------------------------------------- has been installed in accordance with the provisions of T i T LE: 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No..,K?_... _�C_�,l___.__.._... dated-----------------------_-_--___-------.--___.._ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT YHE SYSTEM WILL FUNCTION SATISFACTORY. DATE. •-✓ ......�..$.............................. Inspector........---•---d�.......-----------------------..............--•--•---- THE COMMONWEALTH OF MASSACHUSETTS r� BOARD OF HEALTH .I.�Zt--...............OF.0 �"� i .........C................_ . 0........... ...... FE7.S ...... Uisvo<� nrk i Tfn..n_ s#r ion r mi# .__.____________________________________------------------•--•--------•----•...._..........•---- Permission is hereby granted.... ...............:_:...P: `-to Construct ( ) or ReepaiV( ) an Itt ' idual Sewage Disposal System at No...j_ti_�'_.1........: J.:.. M-- ... 5 .........................................•.............. Street as shown on the application for Disposal Works Constrttetion Permit . �__ Dated.......................................... • Board of Health DATE------------J ................................. FORM 1255 HOBBS & WARREN, INC.. PUBLISHERS "` SYSTEM PROFILE ALL SYSTEM COMPONENTS SHALL BE NOTES LEGEND. MARKED WITH MAGNETIC TAPE OR (NOT TO SCALE) COMPARABLE MEANS FOR FUTURE LOCATION. PROVIDE MIN. 20" DIAM. WATERTIGHT 1. DATUM IS NAVD 88 school 99 - ACCESS COVERS TO WITHIN 6" OF FIN. GRADE 2' CAST IRON COVERS TO GRADE EXISTING CONTOUR BED IN CONCRETE 2" PEASTONE OR GEOTEXTILE 2' CAST IRON COVERS TO GRADE 2, MUNICIPAL WATER IS EXISTING St. BED IN CONCRETE X 99 EXIST. SPOT ELEV. \ TOP FOUND. E 35.4' FILTER FABRIC OVER STONE l 32.0' 3. MINIMUM PIPE PITCH TO BE 1/8" PER FOOT. oc • -[99]- PROPOSED CONTOUR EXISTING PLUMBING TO BE MINIMUM .75' OF COVER OVER PRECAST 2% SLOPE REQUIRED OVER SYSTEM 30.0' cotuu RE-ROUTED. PLUMBER TO VERIFY 4. DESIGN LOADING FOR ALL PROPOSED PRECAST UNITS PRECAST H-10 BLOCKS OR y 198.41 PROPOSED SPOT EL. FEASIBILITY PRIOR TO INSTALLING ANY 3 RISERS (TYP.) PRECAST RISERS TO BE AASHO H-ZQ (H-10 TANK) Shell 6/� Bay TH1 PORTION OF THE SEPTIC SYSTEM. _ �•- 2� 6" MIN. SUMP 4"SaSCH40 PVC MORTAR ALL H_20 err 495' 12" MIN. INT. DIM.' PIPES LEVEL 1ST 2' �4. COMPONENTS , 5. PIPE JOINTS TO BE MADE WATERTIGHT.TEST HOLE ±• ENDS (TYP.) INV'S EL. 26.0 4 Locus *28 5� SIDES 6. CONSTRUCTION DETAILS TO BE IN ACCORDANCE WITHe22%"' SLOPE OF GROUND MIN. 2 TEE 1500 GAL H-10 TEE - 7\27.70'10 14* o 0 0 0 ®®®' ®®® ® �®® 'Oo0o0o00 310 CMR 15.000 (TITE 5.)SEPTIC TANK L o000 000 o 0 0 0 0 °o°o°o°o° ® ®®®® ®® ®�®®®® ®� �o°o°o°o° (7 a' LIQ. LEVEL o0000000'>Oo0 WATERTEHT D BOX o °0°°°0° ;0°0°0°0° 7. THIS PLAN IS FOR PROPOSED WORK ONLY AND NOT TO GAS BAFFLE +900000°0°0°• o°o°o°o° �®® �=3=m ®® °o°o°oOo c� UTILITY POLE ACME OR EQUAL ���•^ FOR LEVELNESS N i00000000 ®®®®®®®®®®® ®®®®®®®®®®® 00000000 PBE USED URPOSE.FOR LOT LINE STAKING OR ANY OTHER �pC FIRE HYDRANT 26.31' .1 4' -000000-0 00000000 4 0' •' ' 8. PIPE FOR SEPTIC SYSTEM TO SCH. 40-4" PVC. NOTE NOT ALL SYMBOLS MAY APPEAR IN DRAWING 00000000000000000000000000000000000000000000o NOTE: 2" MIN. WALL ^moo^0^o_0_n_n_n.n o 0 0 0 0 r.0_ft_�_n_0.o o THICKNESS REQUIRED 3�4"-'I-1�2" DOUBLE WASHED STONE 4' MIN. H-20 500 GAL. LEACHING CHAMBER BY ACME PRECAST OR EQUAL. (4) UNITS REQUIRED 9. COMPONENTS NOT TO BE BACKFILLED OR CONCEALED Nantucket' ALL AROUND PRECAST STRUCTURES 6" CRUSHED STONE OR MECHANICAL OVERALL DIMENSIONS TO OUTSIDE OF STONE: 42.00, X 12.83' WITHOUT INSPECTION BY BOARD OF HEALTH AND *THE INSTALLER SHALL VERIFY THE COMPACTION. (15.221 [21) o PERMISSION OBTAINED FROM ,BOARD OF HEALTH. Sound LOCATIONS OF ALL UTILITIES AND ALL 10. CONTRACTOR SHALL BE RESPONSIBLE FOR CALLING on BUILDING SEWER OUTLETS AND DIGSAFE (1-888-344-7233) AND VERIFYING THE ELEVATIONS PRIOR TO INSTALLING ANY LOCATION OF ALL UNDERGROUND & OVERHEAD UTILITIES PORTION'• OF SEPTIC SYSTEM 3 SLOPE) 5.5 % SLOPE 1 19.0' BOTTOM TH-1 PRIOR TO COMMENCEMENT OF WORK. LOCUS MAP ( ) ( ) ( % SLOPE) NO GROUNDWATER FOUND y 11. ANY UNSUITABLE MATERIAL ENCOUNTERED SHALL BE SCALE 1"=2000'f D' E3 LEACHING BENEATH ASSESSORS MAP 18 PARCEL 66 AND 5' AROUND THE PROPOSED FOUNDATION- 17' SEPTIC TANK 25' BOX 16' FACILITY LEACHING FACILITY. 12. EXISTING LEACHING FACILITY SHALL BE PUMPED AND LOCUS IS WITHIN FEMA FLOOD ZONE X REMOVED OR PUMPED AND FILLED.WITH CLEAN SAND. (AREA OF MINIMAL FLOOD HAZARD) AS SHOWN ON COMMUNITY PANEL #25001 CO752J DATED 7/16/2014 \� REMOVE OR RE-LOCATE SHED ZONING SUMMARY C& oy PROPOSED DECK PROPOSED SCREENED FNo PORCH ZONING DISTRICT: RF DISTRICT - / 3� ��, SYSTEM DESIGN: S BENCHMARK: MIN. LOT SIZE 87,120 S.F. i �e PROPOSED ADDITION CEMENT BOUND °y F =32.7' NAVD88 MIN. LOT FRONTAGE 150' GARBAGE DISPOSER IS NOT ALLOWED MIN. FRONT SETBACK 30' S85'18 2E MIN. SIDE SETBACK 15' 5" FNO PROPSOED 5 BEDROOM DWELLING - �� BENCHMARK: 104.20 ce P� MIN. REAR SETBACK 15' DESIGN FLOW: 5 BEDROOMS ® 110 GPD = 550 GPD CEMENT BOUND R - =33.3' NAVD88 i MAX. BUILDING HEIGHT 30' USE A 550 GPD DESIGN FLOW HED BH SITE IS LOCATED WITHIN THE RESOURCE OVFRN ^ c PROTECTION OVERLAY DISTRICT SEPTIC TANK: 550 GPD (2) = 1100 :::::.:.. ::::.::;:: ::::::::. : ;::::::... FqD o ` ` .0 SITE IS LOCATED WITHIN THE AQUIFER USE A 1500 GAL. SEPTIC TANK PROTECTION OVERLAY DISTRICT w d ( '.`.: ; : ;;:: :;'::.`.'.`::;:::: EXISTING W_ N I'v w%�L-Tln< tii'`-��"U "� OV�•`►11,�} LEACHING: z `C : : :.. :/ DWELLING W SIDES: 2 (42 + 12.83) 2 (.74) = 162 GPD / TOF=35.4 o BOTTOM 42 x 12.83 (.74) = 398 GPD N Ns v Nlu EXISTING "M TOTAL: 756 S.F. 560 GPD » mac, / SCREENED PORCH 33 USE (4) 500 GAL. LEACHING CHAMBERS (ACME OR EQUAL) O K CDWITH 4' STONE ALL AROUND 'o "o c^ Q � 8 -•,,. PROPOSED ADDITION 3 _ 210,95' MA APPROVED DATE BOARD OF HEALTH 9 PROVIDE 58' OF 40 MIL LINER AT 5' O OFF SAS IN AREA SHOWN. TOP AT ELEV. 26.5', BOTTOM AT EL. 22.5't I I I SEPTIC TAN NOT j I TH I of SUITABL R VEHICLE PROP. VENT WITH CHARCOAL FILTER �I LOADI , CONTACT AND BUGSCREEN (FINAL PLACEMENT BY T I m ENGIN ER PRIOR TO ANY CONTRACTOR WITH HOMEOWNER rml C ES TO DRIVEWAY CONSULTATION) II R PARKING 5` R E 0 I �I 5' REMOVAL OF UNSUITABLE S0I EQUIRED O �� AROUND PERIMETER OF LEACH IN AGILITY, o^ Z �TH DOWN TO SUITABLE SOIL LAYER. REPLACE 00 WITH CLEAN MED. SAND, TO ME T H o I SPECIFICATIONS OF 310 CMR 1 .255(3) LOT AREA /b 50 I ; 34,388±S.F. ! I cif 3 TEST HOLE LOGS I o ENGINEER: DANIEL E. GONSALVES,. SE #13587 WITNESS: DAVID STANTON, RS N87 2'40"W DATE: 3/6/2020 210.26' i PERC. RATE _ < 2 MIN/INCH _ KEELA ROAD CLASS I SOILS P# 20-34 - ------ _ TITLE 5 %" OF ELEV. ELEV. ELEV. ELEV. 0" � 29.5' o" 4 29.6' o�' 30.0, 0" 30.5' #1207 MAIN STREET 2499 20 12 FILL FILL H 10 FILL 90 FILL COTUIT, MA A A A "A PREPARED FOR LS LS LS LS 30" 1OYR 3/2 27.0' 28" 1OYR 3/2 27.3' 16" 1OYR 3/2 28.7' 14" 1 OYR 3/2 29.3' Ilk, --�` � ;a,, DALE EDMUNDS AND E E E E 77- (!- ,e BARBARA FAY MS �NOFM�ss' MS MS MS % D;�nll � ties 36" 1 OYR 4/1 26.5' 34" 1OYR 4/1 26.7' 20" 1 OYR 4/1 28.3' 17" 1 OYR 4/1 29.1' DANIELA. / I c B NaCIVIIL ��JF +i to0� B B B 1� 46502 Ess\ DATE: MARCH 16, 2020 LS LS LS LS �� °� ��sTER<,� `��` qND 5t} °� �` � Scale:1"= 20' '� 6 5.6' 10YR 5 6 27.7' 10YR 5 6 28.5 Fss� � ��M�S``�� 46 10YR 4/6 25.7 48 10YR 4/ 2 2g / 24 / �� Sqc ��o• DANIEL JSo� DUJAL4 yG�m� J( OJALA � 0 10 20 30 40 50 FEET C C C C PERC MS MS PERC MS MS � CIVIL � '�'.` �oN0.409oO off 508-362-4541 P �, V VNo.46502 0 0 FESS\ o� I fox 508-362-9880 P° �GISTE���t`� " /ASSL E�G down co �in 2.5Y 7/4 2.5Y 7/4 2.5Y 7/3 2.5Y 7/3 - /ONASUFN downcope.com�a en inee� f' inc• i 126" 19.0' 126" 19.1' 132" 19.0' 132" 19.5' "�_t�� �L62� ��--- engineers -_.� land Su civil en eyorS NO GROUNDWATER ENCOUNTERED NO GROUNDWATER ENCOUNTERED 939 Moin Sheet ( Rte 6A) DICE # 1 9-4 1 7 DATE DANIEL A. OJALA, P.E., P.L.S. ' YARMOUTHPORT MA 02675 19-417 i