HomeMy WebLinkAbout0043 PINEY ROAD - Health 3 PINEY RO`kp' COTUIT
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FOUNDATION
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POST-EA1tING OH (�)I�'vl]'LVL BEM IO
FOUNDATION
CL� FAMILY Roots I
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P09t PARING CND � -
COWMN BELOW ____________
@EDRooM i BATN i .�•' v I WL'LVL RIDGE BEM
------------------------------------------I
_ ---- AgpyE E
NEN WINDOW ��OOOR -
5E4T III NEW FINISH FLOOR TO
V ALIGN WI IXI9TNG(V,I.F.) A FIONER F
F lac +I eox
CL
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DONOHUE.
NEW 9{'.31'P9L I i -_-�-•-RELEGATE IXIT.
POST LNG ON " 9110NER(BT OfNERS)
FOUNDATION a � ' W ' NEW�'�'P� 43 PINEY ROAD
F BRACKET BUPYRT COTUIT,MA 02635
MO✓E DUST. P%TEND DECK C D
fiCQEfl1 WALL
§ FIRST FLOOR PLAN
IXIBT.POST T'-a I'O• .
NFW 6TEP9
FILENAME:Donohue 012016
SCALE:
ve^.r.o•
DRAWING RELEASE DATE:
A B 0
7.1 A2.1
E SE n)SET DATE:
'FIRST FLOOR PLAN I
SCALE•Us'-I'-O• AR.I - CONTRACT SET DATE:
SEP G'IG Pn 1*44
UP
NEW 1'0 PIPE-M W/
]'v�'vl]'D CONC.FTG.CMRD.
-ATI W NEW PXT A E
FOUNDATION PLAN n
DONOHUE
43 PINEY ROAD
COTUIT,MA 02635
FOUNDATION &
FRAMING PLAN
FILENAME:Donohue 012016
SCALE:
DRAWING
WRJG RELEASE DATE:
ID 6
BID SET DATE: A2.0
CONTRACT SET DATE:
TOWN OF BARNSTABLE `.
LOCATION 413 ?i h e y ie i SEWAGE# O? - 31 t-1
VILLAGE �'p .� ASSESSOR'S MAP&PARCEL
INSTALLERS NAME&PHONE NO. ('-o-oe Lu kg�4 v\,
SEPTIC TANK CAPACITY _/'0 00 a� /0
LEACHING FACILITY:(type) o? SU U /-f'/O C�-(size) /off s X aI
NO.OF BEDROOMS 3 jj
OWNER (iCz/���^?h GUP 1�2C� ✓LQ rICZ yI G l7 —u
PERMIT DATE: /70/y 7 COMPLIANCE DATE:
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) Feet
Edge of Wetland and Leaching Facility(If any wetlands exist
within 300 feet of leaching facility) Feet
FURNISHED BY _C�.CWAO �w'p Me-j, LrL4-
� 3
577, 0
83 g� .
a -
No. O6 7 — L r � Fee Uo—
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
PUBLIC HEALTH DIVISION TOWN OF BARNSTABLE, MASSACHUSETTS Yes
2pplication for Dizpoar *p5tem Construction Verna
Application for a Permit to Construct( ) Repair( °) Upgrade( Abandon( ) ❑Complete System .Individual Components
Location Address or Lot No. '7 3 Pd ey /IVA Owner's Name,Address,and Tel.No. ee-1114 ~Norey
Assessor's Map/Parcel 3 7-0 - 1 me
s
Installer's Name,Address,and Tel.No. CL1(.t¢ti7't� s Designer's Name,Address and Tel.No. 0-T CC�1
(.'V,kfL►ae_ VIM 3Ca�i- 0�4�( sue ; ', �•+�
Type of Building:
Dwelling No.of Bedrooms 3 Lot Size sq.ft. Garbage Grinder ( )
Other Type of Building 5."tAte_ 4�1 No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow(min.required) 3 3® gpd Design flow provided 3 3O. t-( gpd
Plan Date 2 7-zpta Number of sheets ( Revision Date
&� /n
Title �3 c-r
Size of Septic Tank ®op Type of S.A.S. �2 Spo , C• fig S?Jt
Description of Soil _
Nature of Repairs or Alterations(Answer when applicable) �'�t>>i, Ibo a Tb y( l
Date last inspected:
Agreement:
The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in
accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of
Compliance has been issued by this Board o ealth.
Signed Date 7,- 2-0 ZL=-07
Application Approved by nc- Date
Application Disapproved by: Date
for the following reasons
Permit No. 'r�C1u 7 -Y y Date Issued '7- b'"u
No. .')b6 _ / ,,.._.. t 4 Fee
THE COMMONWEALTH OPMASSACHUSETTS Entered in computer: ✓�
Yes
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS .
pplicatton for �Otopogal *pgtem Con0ruction Vermtt
I
Application for a Permit to Construct O Repair O Upgrade(VAbandon(j ❑.Complete System krindividual Compone�lr ts�.-.. ,
�e:'
Location Address or Lot No. rl 3 (,Q E7 I&A Owner's Name,Address,and Tel.No. j?eyi'ev,= p".a f4o r7
Assessor's Map/Parcel pt,;t M s
Ca ,r,EQ �Iti
' Installer's Name,Address,and Tel.No. (� � s � Designer's Name,Address and Tel.No. EC O-?Z� it
� (f3�rc;a� ►� c.;��Ic
Type of Building:
II Dwelling No.of Bedrooms Lot Size 51 4 -7 .,( ± sq. ft. Garbage Grinder ( )
�Cfther Type of Building r7•"t i`<. �rkm,t, No.of Persons Showers( ) Cafeteria( )
Other Fixtures _ *.
Design Flow(min.required) C� gpd Design flow provided a`( gpd
Plan Date 2 7-2n�z. Number of sheets ( Revision Date
I
Title P,'v�e-� /n u&,A
i
Size of Septic Tank 0g cn Type of S.A.S. sz�,- y}{. C,. C• f�.J S ren,
Description of Soil D)4,,^
Nature of Repairs or Alterations(Answer when applicable)
Date last inspected: " -
` I
Agreement:
The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in
accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of
Compliance has been issued by this Board of Health.
Signed Date �]� LC� Z=a-)
Application Approved by Date '�- 2a 0 7
Application Disapproved by: Date
for the following reasons
Permit No. a,yv 7 '3( Date Issued -7-
——————————————————————- ——————————————————
THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE, MASSACHUSETTS
Certificate of Comphance
THIS IS TO CERTIFY,that then On-site Sewage Disposal System Constructed ( ) Repaired ( ) Upgraded
Abandoned( )by C A�d)�t,is(L " , - LA-(-
at Li kz,AS • has been constructed in accordance
with the provisions of Title 5 and the`for.Disposal System Construction Permit No. -2UO 7-)r/ t/ dated 7—1 7
Installer VI),-, Designer E c o -
#bedrooms ' Approved design flovA 33ut gpd
The issuance of t is pe` it shall not be construed as a guarantee that the system w'. func as des ig ed ((��
Date Inspector 1 Itl,l �L
i No. 2 CP 7-3 V Fee f dV
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION-BARNSTABLE, MASSACHUSETTS
Th5pogar *p5tpm Con5tructton Vermtt
Permission is hereby granted to Construct ( ) Repair ( ) Upgrade (4,/ Abandon ( )
i
System located at 9.3 R fie"., (L-A gd C>�Illlr
i
and as described in the above Application,'for Disposal System Construction Permit.The applicant recognizes his/her duty
to comply with Title 5 and the following;local provisions or special conditions. yy�
i L
Provided: Construction must be completed'within three years of the date of t ' it
Date 2 G Approved by
1
' 1 . f
Town of Barnstable
TME A Regulatory Services ,
Thomas F. Geiler,Director
• B"Ns mBm
� MAS& Public Health Division
1639.
�Eo Thomas McKean, Director
200 Main Street,Hyannis,MA 02601
Office: 508-862-4644 Fax: 508-790-6304
Installer& Designer Certification Form
Date: �� `3k Z0 6 7 `
Designer: COOGi I hN O W, RS Installer: l� �eS
Address: 43 �126 N Q G LC C l R . Address: ?,C)o %)c'70
5 AWT)WA U> i MA QSS j -(p/va l C
61c. L
On ;c, .was issued a permit to install a
(date) I (instal er)
septic system at 4:3 �NC-:� 1) COTUIT based on a design drawn by
(address)
�AUII) V (0V6\AhW6 .K I RS dated 1Ma`/ 17, 2,00 7
(designer)
V1 I certif}, 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
Y PP g
distribution box and/or septic tank.
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.
• N OF MASS,gCyG
DAVID
er' i ture) COUGHANOW
sR
No. 1093
��Q16T8��O
SANITAktiPN
(Designer's Signature) (Affix Designer's Stamp Here)
PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE
OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS-
BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION.
THANK YOU.
Q:Health/Septic/Designer Certification Form
- - I
: l
commonweofth of Massochusetts
Executive Office of Environmentol Affairs
.Department of RECEIVE®
Environmental Protection
MAY 1 1996
Willlam F.Weld ucA,
Governor
Trudy Co,e 7ntUN OF BARNSTAE3LE
secretary,EOEA
David B.Struhs
Commissioner
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION
'-� Address of Owner: D 1 Oor 1prc y`
Property Address: - 1�0�� 'T� �.S `�b t e w�
Date of Inspection: L $_t eY � �O (If different)
Name of Inspector-�,��1; ;-�
Company Name, Address andVelephone 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:
Passes
Conditionally Passes
_ Needs Further Evaluation By the Local Approving Authority
Fails
c—.
Inspector's Si ature: /' Date:
The System Inspector shall submit a copy of this inspection report to the Approving Authority within thirty (30) days of completing 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 sent tu :n.e system owner and copies sent to the buyer, ii applicable and the appro\ing authority.
INSPECTION SUMMARY:
Check A, B, C, or D:
A] :71
M PASSES:
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:
:V 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 8/15/95)
One Winter Street • Boston,Massachusetts 02108 • FAX(617)SWI049 • Telephone(617)292-WW
0 Printed on Recycled Paper
<I
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SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: y 311Y.� CGTvt i—
Owner:
Date of Inspection:
B] SYSTEM CONDITIONALLY PASSES (continued)
Y4 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 15 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 svbtem had a septic tanK anti soli absorption system anu is wllluji iQu fEei iu a �iil-ce '"ate; suNN!) o, tributai�'t�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 system has a septic tan, 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 3.10 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.
(revised 8/15/95) 2
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: y 3 4l t, Cc) v i
Owner: 5,p)lI-e✓
Date of Inspection:
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
IV 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.
(1 Any portion of a cesspool or privy is within a Zone I 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 above:
/ Y 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 "ater 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 B/15/95) 3
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B .
CHECKLIST
Property Address: 7 v P(Ne_r r� C
:•Owner:,Sp�
Date of Inspection:
L4—s-'r,c�
Check if the following have been done:
Zpumping information was requested of the owner, occupant, and Board of Health.
L'None 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.
�s built plans have been obtained and examined. Note if they are not available with N/A.
j,elhe facility or dwelling was inspected for signs of sewage back-up.
1,�T-he system does not receive non-sanitary or industrial waste flow
'The site was inspected for signs of breakout.
-L-'A'II system components, excluding the Soil Absorption System, have been located on the site.
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.
-XThe size and location of the Soil Absorption System on the site has been determined based on existing information or
approximated by nun-intrusive methods.
occ::part:, if d`fe.A frog-: ov:•ne" were provided with information on the proper maintenance of Sub-
Surface Disposal System.
h
(revised 8/15/95; 4
f
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
Property Address:
Owner: S `` v--
Date of Inspection:
—'6—c FLOW CONDITIONS
RESIDENTIAL:
Design flow: __gallons
Number of bedrooms:
Number of current residents: C�
Garbage grinder(yes or no):�
Laundry connected to system (yes or no):4
Seasonal use (yes or no):
Water meter readings, if available: f ed
Last date of occupancy:
COMMERCIAUINDUSTRIAL:
Type of establishment:
Design flow:_ga►Ions/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:
No L'-2_
System pumped as pan of inspection: (yes or no)_
If yes, volume pumped. gallons
Reason for pumping:
TYPE CIP SYSTEM
IK Septic tank/distribution box/soil absorption 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 of information:
Sewage odors detected when arriving at the site: (yes or no)
(revised 8/15/45) S
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 3 �i~�Y CO(QN% l
Owner:
Date of Inspection:
SEPTIC TANK:
(locate on site plan)
1 ,
Depth below grade: 3t,
Material of construction: V concrete _metal _FRP —other(explain)
Dimensions:
Sludge depth: d" q
Distance from top of sludge to bottom of outlet tee or baffler
Scum thickness: yjt
Distance from top of scum to top of outlet tee or baffle: r /ytf
Distance from bottom of.scum to bottom of outlet tee or baffle:
Comments: or(recommendation for pumping, condition of inlet and outlet tees ffles, depth of liqui5level in relation to outlet invert, structural
integrity, evidence of leakage, etc.) Yam``
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:
Distance from bottom M <rj,- to hoiorr: ot'ctltlpt. tpe o,battle'
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.)
6
(revised 8115/95)
r
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION..FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: ?'P_+�`j O 10��
Owner: S���p r
Date of Inspect`'`
TIGHT OR HOLDING.TANK:
(locate on site plan)
Depth below grade:
Material of construction: _concrete_metal _FRP other(explain)
Dimensions:
Capacity: Qallons
Design flow: Qallons/day
Alarm level:
Comments:
(condition of inlet tee, condition of alarm and float switches, etc.)
DISTRIBUTION BOX:
(locate on site plan)
Depth of liquid level above outlet invert: LzolzL►4
Comments:
(note if ievei and distribui,L,;, > equa:, e\'wince of solid ca,rno%er, evidence of leakage into or out of box, etc.)
PUMP CHAMBER: �L
(locate on site plan)
Pumps in working order.(yes or no)
Comments:
(note condition of pump chamber, condition of pumps and appurtenances, etc.)
(revised 15 95) 7
ised B/ /
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address:
Owner: Sp�k� C
Date of Inspectio
SOIL ABSORPTION SYSTEM (SAS): 1!'
(locate on site plan, if possible; excavation not required, but may be approximated by non-intrusive.methods)
If not determined to be present, explain:
Type: i
leaching pits, number:__
leaching chambers, number:_
leaching galleries, number.
leaching trenches, number,length:
leaching fields, number, dimensions:
overflow cesspool, number:
Comments: (note condition of soil, sighs 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 grounds+ate.:
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: IA,)
(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:)
trevised 8/15/95) 8
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SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: co 1 V t c
Owner: S P%,�a
Date of Inspection:
SKETCH OF SEWAGE DISPOSAL SYSTEM:
include ties to at least two permanent references landmarks or benchmarks
locate all wells within 100'
( )
I BOO 5 1 t
DEPTH TO GROUNDWATER
Depth to groundwater: �U feet `
method of determination or approximation: i X)Vw 1 lo
e G
(revised 8/15/95) 9
TOWN OF BARNSTABLE
LOCA-TION �- ����� �lA� _ SEWAGE # t'
VILLAGE.. C-A Jr ASSESSOR'S MAP & LOT.l'/3 - OZ 0
INSTALLER'S NAME & PHONE NO.
SEPTIC TANK CAPACITY d1 Ar .
'LEACHING FACILITY:(type) 5�0 , `k l ,�, (size)
NO. OF BEDROOMS PRIVATE WELL O PUBLIC ATER
BUILDER OR OWNER C-
DATE PERMIT ISSUED:
DATE COMPLIANCE ISSUED• "� d A'D
VARIANCE GRANTED: Yes No
,-
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No.... _ .._ FEs......7..S..... ...._
THE COMMONWEALTH OF MASSACHUSETTS "1
BOARD OF HEALTH
M .............[O W-0....._0F......t.....f�(Z d�.�................ .....
S
Appliration for Dispasal Works Tonotrurtion Permit
Application is hereby made for a Permit to Construct ( or Repair ( ) an Individual Sewage Disposal
System at Lo_r 2a �t � C rL_L T
............. _„'��iJ�--�(��ation.....................
•Ad.-eS--1�--•---•--.............-•- ........... -- ....................................................
. ..........._»�..._..��...........
--......... ..._»_._. .-- �.._.._.. : '.................. ........._.,..........�. ....» ..... ... . ,
O nee Ad r s
a .r. .l...... .f.._t 5-•-••_-_----....•-_-.......:. Q.�.--`......al .... l...�.......
M Installer Address ��
Type of Building Size Lot......_._�........_..b......Sq. feet
U DwellingNo. of Bedrooms .......................Ex Expansion Attic
a — p ( ) Garbage Grinder ( )
aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( )
Other fixtures ..................................... ..._ ..
W Design Flow............._.1..0 L1.0.................... per �n pjr iday. Total daily flow................2 .o................gylops.
WSeptic Tank—Liquid capacitylQ 0.gallons Length.-e.).-(�.._. Width:..,--(-D.. Diameter................ Depth.5..
x Disposal Trench—No. .................... Width.................... Total Length.--.---___-.-.l.. Total leaching area....................sq. ft.
3 Seepage Pit No............I......... Diameter.........J_&... Depth below inlet.._��...r..S____. Total leaching area.z+��_.�..sq. ft.
Z Other Distribution box ) Dosing tank ) _
0-4 Percolation Test Results Performed by.......2...:-ASK%>M. .. _. t Date..... .�Z`?� �........._...
0.4 c.2 �.................
1.4 Test Pit No. 1................minutes per inch Depth of Test Pit........ �t_. Depth to ground water... ...._
�l�bSt3Test Pit No. 2.._.�...... nutes per inch Depth of Test Pit..... _ __._. Depth to ground water_.......................
��
a V'���R1 Y� I '� �•-•a..................................C,,......•---t(...........................1.�4:....-••--_...-.........................................................
O Description of Soil.1... ._�Ja1AD
Ah
V ----- --••_-•--•--••-•...•--•-•-•------•--•-••--•_-___••---••-__•......
£�fo'1`t. ! e-«�ToP r5��t9�u. �t G(_�raoJ CarRSc-t ►�t�.
� 4....... ....•- ----------------------....-----....................-....................................
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 LI':LZ 5 of the State Sanitary Cfqe—The undersigned further agrees not to place"the system in
operation until a Certificate of Compliance has i ued by the oard o l.�j�lf.
Signed ............. ........... ............................... .� _.......�..5 ..
q Date
Application Approved By........a �J... _.r.�.,�� __.....I._.-._�. _-.. ..7......
`"`."�-------•-----------------------------
Date
�.-10,� Application Disapproved for the following reasons:.............................................................................................................
....................................•--....._•---_--••------•_---_....................................................--•----•-------------•-----.................................. ............»
Date
&- - Permit No...... .. -' ............._ Issued...._........._._....
'\ .............. Date._.........._................»
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
...............t..C.�(00......OF.....-.. -�-�..� -1 -fit. �.. 1
..
�5 AVV- firation for Biupnuttf Works Towitrurtinit rrrutit 1•
Application is hereby made for a Permit to Construct ( } or Repair ( ) an Individual Sewage Disposal
System at: - ,
.............. • .----••----•l-•--•--..............-• --•---•--. _....__.......-►•------
•--....a..----• •Location-Address � .or'LoUNo. � � e� .................................................C� r ' ...._!.b�:: :... eAT ...... Sl.. �rr.
rd i
!�
...................•......---..._...-•-••-••--•------_.... .--• ---. -----------. --- _......_...
--------------
Installer Address /
Type of Building _ --� Size Lot.....�'_�..Z3-:? Sq. feet
., Dwelling—No. of Bedrooms................ .......................Expansion Attic ( ) Garbage Grinder ( )
Other—T e of Building ....._.. No. of persons............................ Showers
a YP g ---•-•--...--•----• P ( ) — Cafeteria ( )
d Other fixtures ......................................
'................ •---------------------------------•••-•------.......----••--•-••-•-••-•.......
.., _
W Design Flow............. I..F ....................gallons per person�per day. Total daily flow..........._.73_31Z2...............gallons.
WSeptic Tank—Liquid capacity Mleallons Length._:a.lv._.. Width:..1A.d. Diameter................ Depth..5.¢_-...
x Disposal Trench—No. j.................. Width.................... Total Length.................... Total leaching area....................sq. ft.
3 Seepage Pit No....... ....1 ...... Diameter......... -._. Depth below inlet-:_� .... Total leaching area.Z4:5:..Lsq. ft.
Z Other Distribution box'()<) Dosing tank ( ) r.7 ,
'" Percolation Test Results� Performed by.......�..�L?•..� :�....�___...d,.t:................. Date.....G...Z`��..�.�.._....__....
a
Test Pit No. I....__:__........minutes per inch Depth of Test Pit........ ��. Depth to ground water..!)..
��LSt3 - --
rZ," Test Pit No. 2---_42....minutes per inch Depth of Test Pit...... _ ._... Depth to ground water... U.w�
x -----------------------------------tall--------....................... 4-
O Description of Soil..(1-0.3(�"TnP t Ss1P�31�, � 144 C LEA to M .SA�I.p
-•--- •
v _.. ..................
z1 - " TGPt sue, �bt' - t44' G��A� P eP, 5A0-)9
W ------------ f'�: ?_... ......................................................( QF s ( 1 ' 14 ` C c &JAW (04SE t NCV. c��
........................................................I
V Nature of Repairs or Alterations—Answer when applicable...............................................................................................
••.....................•----•---•-••------------•--------------•--------------...------............._..........--------------------------------------------•------......-----...--------••••-•---.-••---
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TITLE 5 of the State Sanitary Code— The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has been issued by the board of,health.
P 0—
Signed ------------- -•-•-....... -----------------.................. ......--•-..........�....
- � � DDate
Application Approved By------. J....tall- .. ......-a•-" '- X -7
Date
Application Disapproved for the following reasons:............................................................................................................_..
-•-••...............................•--.•------...........---------------..._.......----•-------.tall......-------•-----------------•----•------------------------------•------------........--•.._....�
Date
PermitNo......7`� ----------------------•-------- Issued_....................--...................................
t Date
THE COMMONWEALTH OF MASSACHUSETTS ;
BOARD OF HEALTH
..........................................OF.........r''�...............................................................
Trrtifiratr of Toutpliattrr
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( )
/Jn ,-- -- � , -------------------------•-------------._------------.-------------.------.---.-----.--------- 1
by..............J...-- -,-_..-.-.._.. .......... 1 ....
_ /� �. t!1..._ �.LEA.. .i4�1 �N n� h' S."- ------------------••--------•----..............................................
Installer
at-------------- -------- _a...................................................
has been installed in accordance with the provisions of TITLE j of The State Sanitary Code as described in the
application for Disposal Works Construction Permit No...... _....�................... dated................................................
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL/FUNCTION SATISFACTORY.
DATE.............. Inspector._.,..Y-----------------------------------•-• -
L-..------------------__-_.__ _. ,_... _....,_-- ---• ------------------ - ---_------- ---------.._...._..---
THE COMMONWEALTH OF MASSACHUSETTS
_ BOARD OF HEALTH
l9lE dd .... ...?...............OF.......... ... ............:Q :'�.._.................................
No...f?.��. .�...... Fn._�..��............
-
Disposal Works Tonutrurtion f rrutit
��� CPermission is hereby granted-•-----•-•-=-----=-=------......--------.... ....-----....................................................................................
- to Construct or Repair ( ) an Individual Sewage Disposal System
atNo......................lr_._I�nZ--.a..ef......! .. .... ` .-.... ` ---- --------------------.----------•--------•-------------
Street
as shown on the application for Disposal Works Construction Permit No.� .�........ Dated..........................................
` ................................................ ----------
DATE ..............................» Board of Health
�, ....��
....�._ ._._..�_ _�.:�� .,•;_;..�_._....��x.....;,,,,�.�...��...�...,..W,.irk...�..�,:...�-.:.-:�_....-:�.�.��.-.,�:�_;�w,�..��.�,.::,.,���..�,.:,...:,�� .��:_:,_� .._.....�,���._. � a ,
r 1 r I I I
SOIL TEST LOG
TEST: MAY' DY. 2007 `� DE•SI T GN CAL U \ T10N
SOIL EVALUATOR:
A
DAVID D. COUGHANOWR. R.S.
WITNESSED BY: DONNA MIORANDI. HEALTH DEPT
PERC NUMBER: 11720 DESIGN FLOW: 3 BEDROOMS X 110 GPD = 330 GPD
NO GROUNDWATER ENCOUNTERED SEPTIC TANK: 330 GPD X 2 DAYS = 660 GALLONS
TEST PIT 1
PARENT MATERIAL: PROGLACIAL OUTWASH USE EXISTING 1000 GALLON SEPTIC TANK IF IN SOUND STRUCTURAL
PERC AT 66 in - 2 MIN/INCH IN C SOILS CONDITION. IF NOT. INSTALL 1500 GALLON SEPTIC TANK (MINIMUM ALLOWED)
DISTRIBUTION BOX: USE 3 OUTLET D-BOX.-
ELEVATION DEPTH SOIL USDA SOIL SOIL COLOR SOIL OTHER SOIL ABSORBTION SYSTEM: A 24 Ft x 12.5 Ft x 2 FL LEACHING GALLERY CAN LEACH
(INCHES) HORIZON TEXTURE (MUNSELU MOTTLING
19.95 Abot = ( 24 x 12.5 ) = 300 sf
A s d w = ( 24 + 24 + 12.5 + 12.5 )- x 2 = 146 sf
0-4 O WOOD LOAM 10 YR 2/1 NONE FRIABLE Atot = 446 sf
4-9 E LOAMY SAND 10 YR 3/1 NONE FRIABLE Vt 0.74 x 446 = 330.04' GPD _
9-16 A LOAMY SAND 10 YR 3/4 NONE FRIABLE USE A 24 Ft x 12.5 Fi:, x 2 f t ,GALLERY. Vt = 330.04 GPD > 330 GPD REOUIRED
16-38 B LOAMY SAND 10YR 4/6 NONE LOOSE
16.78 L EA CHI NG GA L L ER Y 1000 GALLON SEPTIC TANK
38-120 C MEDUIM SAND 10 YR 6/4 NONE LOOSE DIMENSIONS AND DETAIL NOT TO
9.95 USE SHOREY PRECAST 500 GALLON NOT TO USE EXISTING H-10 UNIT SCALE
TEST PIT 2 NO GROUNDWATER ENCOUNTERED
LEACHING DRYWELL (H-10 LOADING) SCALE
PARENT MATERIAL: PROGLACIAL OUTWASH CONSTRUCTION DETAIL EXISTING SEPTIC TANK IS TO BE PUMPED
2 MIN/INCH IN C SOILS DRY AT THE TIME OF INSTALLATION AND
DRYWELL UNIT IS TO BE EXAMINED FOR STRUCTURAL
ELEVATION DEPTH SOIL USDA SOIL SOIL COLOR SOIL OTHER STON INTEGRITY. INSTALL A NEW PVC OUTLET
(INCHES) HORIZON TEXTURE (MUNSELU MOTTLING 24.0 FL TEE EDUIPPED WITH A GAS BAFFLE.
19.75
0-6 D -WOOD LOAM 10 YR 2/1 NONE ;FRIABLE m� 14' _
c�
6-9 E LOAMY SAND 10 YR 4/1 NONE FRIABLE IF 11 m Lq 1 in
9-15 A LOAMY SAND 10 YR 3/3 NONE FRIABLE Lq 4 N TAPER
m
15-40 B LOAMY SAND 10YR 4/6 NONE LOOSE m 4 0 0
16.42 5 F'f.-
40-126 C MEDUIM SAND 10 YR 6/4' NONE. LOOSE o
3.5 ft 8.5 ft 8.5 ft 5 ft 81n
9.25 -
' 24.0 f t
GROUNDWATER ADJUSTMENT
500 GALLON DRYWELL ,1m
EXISTING GROUNDWATER LEVEL
BASED ON TOWN OF BARNSTABLE DIMENSIONS AND DETAIL 8 f`cz_6 In Q
st *' GIS DEPARTMENT RECORDS. USE H-10 UNIT INSTALL INSPECTION
VIEW
INDICATED GW 5.00 RISER TO WITHIN THREE CROSS SECTION
INCHES OF FINAL GRADE
rt: �' i' Li. � .'� r INDEX WELL M1W-29 AND INDICATE LOCATION
READING DATE APRIL. 2007 ON AS-BUILT PLAN INLET
O UTLE
ZONE A END r
READING 7.0
ADJUSTMENT 0.9
3 IN DROP
33 Il FLOW LINE —�
ADJUSTED GW 5.9 —>
F l o000 000 in, l0 ,, - i4 TO
FROM
Y p�O000000O�O� ODD�O BUILDING 1n D-BOX
N •O`TES 0000aooc o ZI s . F
1) INSTALLER TO OBTAIN DISPOSAL WORKS PERMIT BEFORE STARTING WORK. o00000 0 i� 48 inLIQUID GAS -
2) SEPTIC TANK TO BE PUMPED DRY AT TIME OF SYSTEM REPAIR AND CHECKED 102 BEVEL BAFFLE
FOR STRUCTURAL INT-EGrRITY. INSTALL PVC OUTLET TEE FITTED WITH GAS BAFFLE.
3) ALL COMPONENTS INSTALLED SHALL MEET THE MINIMUM REQUIREMENTS
OF MASSACHUSETTS TITLE 5 SEPTIC CODE (310 CMR 15). CROSS SECTION VIEW. _
4) INSTALLER TO VERIFY LOCATIONS OF ALL UNDERGROUND UTILITIES q '
BEFORE EXCAVATING FOR SYSTEM. 2 in PEASTONE 2 in PEASTONE
5) EXISTING LEACH PIT TO BE PUMPED, COLLAPSED. AND FILLED OR REMOVED. o 0 SEWAGE DISPOSAL SYSTEM PLAN
24
28 3/4 in To EFFECTIVE 3/4,, ro 26 —TO SERVE EXISTING DWELLING
6) ALL STONE TO BE DOUBLE WASHED AND FREE OF IRON. FINES AND DUST IN PLACE. in a/z,.,GAVEL DEPTH 1-1/z,,G AVEL in
7) ECO-TECH ENVIRONMENTAL RECOMMENDS THE INSTALLATION OF LOW' FLOW FIXTURES LAWRECE & REGINA MAHONEY
AND APPLIANCES. AND BIANNUAL PUMPING OF THE SEPTIC TANK. 46 in 56 In .46 in
8l SYSTEM IS NOT DESIGNED TO WITHSTAND VEHICULAR LOADING.-DO NOT 43 PINEY ROAD COTIIIT. MA
150
PARK OR DRIVE VEHICLES OVER SEPTIC SYSTEM. in`
{ INSTALLER MAY SUBSTITUTE AN APPROVED GEOTEXTILE FABRIC IN PLACE OF THE 2 PEASTONE LAYER SPECIFIED. E C O-TECH ENVIRONMENTAL
9) SEPTIC TANKS SHALL BE 'INSTALLED LEVEL AND TRUE TO GRADE ON A LEVEL in.
STABLE BASE THAT HAS .BEEN MECHANICALLY COMPACTED AND ON .TO WHICH t 43 TRIANGLE CIRCLE SANDWICH MA 02563
SIX INCHES OF CRUSHED STONE HAS BEEN PLACED TO MINIMIZE UNEVEN SETTLING. ,;�'. . _* `
ETE-2584 MAY 27, 2007 1212
s .
318.60 Ft
SCHOOL STREET
BENCH MARK / 4
i o ti
TOP OF CONC BOUND 24 / Z�
ELEVATION = 25.81 LOT 1 I GARBAGE GRINDER a N ROAD
BARNSTABLE GIS DATUM / IS NOT ALLOWED I �I 1 TT
/\ AREA = 51974 _- +- WITH THIS DESIGN.
LOCUS \ 2
F
COTUIT. MA
� \18 �o .� TEL Lam- _ _ FOCUS MAP
/ \ \ oG
T '
_ ► NOT TO SCALE
GAS
GATE
/ \ `l�� ' LEGEND
-6
ti \ IN EXISTING
/ O \ \ ��TER�' 1000 GALLON ED
E SEPTIC TANK
0 15-P ����` S L PY D-80X ❑
E
24 Ft x 12.5 f t x 2 Ft TEST PIT
EXISTING LEACHING GALLERr - ON \
cG TP-1 _ // LEACH PIT
�
/ UTILITY POLE
TREE
I8\ QV DISTANCES 'NUMBER REFERS TO
NOT TO LETTER DENOTES TYPE 1$-P
� SCALE 0-OAK M-MAPLE P-PINE
6A.
TO LEACHING GALLERY �I
ALL DISTANCES ARE IN DECIMAL
'CONTOURS \�� \ \ FEET NOT IN FEET AND INCHES.
� \
\ \ n I e I C
EXISTING - - - - - - - 50 20Ssr�\ 24 / FDLAN 1 54.9 152.5.1 91.4
MINIMAL GRADING PROPOSED \ / 2 58.6 59.4 83.3 A
\� 22 /w .SCALE: 1 In = 30 f t 3 T0.6 59.4 83.3 tN OF M,gSs jH OF
20 4 6FA 63.9 99.4 Z1 qC �J ASS
30 0 30 60 �o�' DAVID ti� o� DAVID q�yG
/ I I B o D. D. Na
0 10 20 30 4 U C No.H1093 R COUGHANOWR `n
FLOW PROFILE `
ALL PIPE ELEVATIONS SPECIFIED ARE INV RT ELEVATIONS ' '• s TE o� EN
EXPRESSED IN DECIMAL FEET NOT FEET AND INCHES. lM �/ Aft IA
TOP OF FOUNDATION RAISE COVERS TO WITHIN SIX INCHES OF FINAL GRADE a 2_00 7
EL = 26.69 += INSTALL ONE INSPECTION RISER FOR LEACHING GALLERY
TO WITHIN 3 INCHES OF FINAL GRADE AS INSPECTION PORT
AND INDICATE LOCATION ON AS BUILT. SEWAGE DISPOSAL SYSTEM PLAN
20.15 ��®e
o �/ -TO SERVE EXISTING, DWELLING
/3" DROP z D-BOX MAX ALL PIPE TO BE EST. OWNERS OF RECORD
EDGINA MAHONEY.
g FLOW LINE SCHEDULE 40 PVC
TEE 17.15 AND TO PITCH AT
10" = 1/8 in/ft MIN. d 43 PINEY ROAD
l4 PRECAST ��® 1995 ��' COTIJIT. MA
48 GAS PROPERTY ADDRESS
3
BAFFLE
DRYWELL
6 in BOTTOM OF ASSESSORS MAP 40 PARCEL 2D-1
22.16+- STONE LEACHING 43 TRIANGLE CIRCLE
EXISTING 16.53 LEACHING GALLERY
ELXISTING _ BASE GALLERY14.40 5.00 ft + SANDWICH MA 02563 PLAN BOOK 48 PAGE 8
EXISTING 16.70 I 506 364-O8J4 DATE. MAY 27, 2007
EXISTING 16.40 (END VIEW)lZ00 GALLON REVERSE rr JOB # ETE-2564 PAGE 1 OF 2 VERSION:
SEE DETAIL
THIS PLAN IS BASED ON AN INSTRUMENT SURVEY AND IS INTENDED
EXISTING SEPTIC TANK 31 ft el 5 Ft 12.5 ft SOLELY FOR INSTALLATION OF THE PROPOSED SEPTIC SYSTEM
bl 12 ft N Y DEPICTED HEREON. FOR ANY OTHER CHANGES TO PROPERTY INCLUDING
ADJUSTED SEASON
5.90 PLACEMENT OF ADDITIONS. SHEDS. FENCES OR SWIMMING POOLS. OWNER
HIGH GROUNDWATER SHOULD CONSULT WITH A MASSACHUSETTS REGISTERED LAND SURVEYOR.
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