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HomeMy WebLinkAbout0100 RUSHY MARSH ROAD - Health 100 RUSHY MARSH RD, COTUIT A= 019 131 TOWN OF BARNSTABLE LOCATION ®� u �,i �(�L�PSEWAGE# a®ICY® 3 S \VILLAGE cQ 1 i�.'� �c ASSESSOR'S MAP&PARCEL tcilrm INSTALLER'S NAME&PHONE NO. OA PE w A 5I77"8377 SEPTIC TANK CAPACITY ®®® 66q l p LEACHING FACILITY. (type) NO.OF BEDROOMS. C. k 3 OWNER i:d5 B.y t>"1 Q CCU( Q-by PERMIT DATE: q XO t COMPLIANCE DATE: q-14"A® i�{ Separation Distance Between the: -r f 14-J Q. 5'50 Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility S7 Feet Private Water Supply Well and Leaching Facility(If any wells exist on / site or within 200 feet of leaching facility) 'V!,' Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) � Feet FURNISHED BY 0_APG(P_r1D6 6�1T&LIM(SUC L&,< tj = y9 � - 3 `A 3 v=Gde� No. Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -,TOWN OF BARNSTABLE, MASSACHUSETTS ftphLation for -Mispo8AY 6pstrm (Construction j3prmit Application for a Permit to Construct( ) Repair(X Upgrade( ) Abandon( ) [Complete System ❑Individual Components Location Address or Lot No. 10O XQSI♦y HApSN 127 Owner's Name,Address,and Tel.No. dclUtT KGKrs -r werjo4 vao\417 Assessor's Map/Parcel Oc1 too 0-SH C°0 u T" Installer's Name,Address,and Tel.No. 5769- Z 2 $$7 Designer's Name,Address,and Tel.No. Sag-;L73—037? Type of Building:. Dwelling No.of Bedrooms 3 Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures II Design Flow(min.required) 330 gpd Design flow provided a34q,,4 gpd Plan Date 9 I Sys egLO t C(' Number of sheets Revision Date a Title I gob USt+�( Mf � C+Co" CVy 1 U 11[' Size of Septic Tank 1 p 0(7 �-�4-L(,c�i.� Type of S.A.S. l�� 00 C-.4G ce a"o iGc Description of Soil M En> S A 0"D QD i 6 t-c— PLA d) Nature of Repairs or Alterations(Answer when applicable) use 6Gi6T!v& ibon L) S 7iG "I*eJv-- -M X)tDLJ -D -t3o 1C -m) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Healt1j. , I Signed Date -��j Application Approved by 1�4�.� Date q Application Disapproved by Date for the following reasons Permit No. N-0 (�} Date Issued 0A 4 No- Oo Iq ;_ Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:—1 L/ Yes PUBLIC HEALTH DIVISION -,TOWN OF BARNSTABLE, MASSACHUSETTS 01pphcation for Misposal *pstrm Construction permit Application for a Permit to Construct( ) Repair(\h Upgrade( ) Abandon( ) Complete System ❑Individual Components Location Address or Lot No. (V O RUS tty MApc,14 (Zlt-) Owner's Name,Address,and Tel.No. KGAAssessor's Map/Parcel p C( 1 3 ��lJ t T" 00 J t)SF! geANSW III C Nay �Y h C 01u l T Installer's Name,Address,and Tel.No. 5 p$-lF'j Z $911 Designer's Name,Address,and Tel.No. .5p$ rZT3-D377 G4t�trt�JtU& E1uT1�2�215�� l.t�C.- TG ENGrtN��-tNCx C#.JL /5 Gc 5T "A' P .1$54 .4r.1 = 14wY 45 Wr4 M Type of Building: Dwelling No.of Bedrooms I Lot Size o sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) w Other Fixtures Design Flow(min.required) 330 gpd Design flow provided 3qg,q gpd Plan Date 9- 19 a-O(q Number of sheets Revision Date Title ,b RUS14`( M ' N Ro" CC t U lr— Size of Septic Tank I' O 0 Q (5FAU QL) Type of S.A.S. l�� j UO C-gi� C. lI�IICa GE��fg�S Description of Soil Mee= S A O"D ( l 56 PLA Nature of Repairs or Alterations(Answer when applicable) t USE 6)6/6T1 U6 lc7no C� 20 UP"IdG -tDE�.11� �72� )UL� D —�SOIt✓ ^I7� Oo k) l Tb Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. II r" Signed Date - a3 -D a t4 Application Approved by Y-k l Date 23 (� L Application Disapproved by Date �? for the following reasons Permit No. 0 ((4 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( ) Abandoned( )by LAA QE(,QA(-�- 2CMR1 at i y C _P,V SG4Y M A15;5 N RD G'O'tU t'r has been cons cte in accord e with the provisions of Title 5 and the for Disposal System Construction Permit No '� ate Installer Designer #bedrooms Approved des' " I w A gpd The issuance of this pe it all n e c ns rued as a guarantee that the system nc'o Date Inspector � �•� No. a Fee THE COMMONWEALTH OF-MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS Misposal *pstrm Construction permit Permission is hereby granted to Construct( ) Repair(X) Upgrade( ) Abandon( ) System located at O rl hCV S,E�� OT 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:Co ction mu t//bee�completed within three years of the date of this permit. r� � Date `f-� Approved by Town of Barnstable Regulatory Services Thomas F. Geiler, Director ' a""" B'E, Public Health Division MA88. 679 Thomas McKean,Director 200 Main Street, Hyannis,MA 02601 Office: 508.862.4644 Fax!/508-790-6304 Date: q-Z 5" Sewage Permit# a v('(- '5 J 5_.Assessor's Map/Parcel / 3 Installer & Designer Certification Form Designer: L En. in�e:i�f1 -roc Installer: Ca ek;;de. C-nFzr �ise.5 L� G Address: 2�.511 Q,onloet-X 111eAV%wE_ Address: t 53 S E(e e.+ 6,254 wocehQm HR e1�.3$ �{ushQee , NA 6Z.(a Y On 9' 2_3 - ZcNy Gqe.k:ide_ EAtere(tses was issued a permit to install a (date.) (installer) septic system at /60 Rushy based on a design drawn by (address) Tin C. dated 9^ , (designer) I certify that the septic system referenced above was installed substantially according to the design, which may include minor.approved changes such as lateral relocation-of the distribution box and/or septic tank. Stripout (if required) was inspected and the soils. %vcre 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 certitied as-built by designer to follow. Stripout (if req ' Inspected and the soils were found satisfactory. SHCW JOHN L. CHUFCr+IiL s JR. ( staller's Sig ture) CIVIL No esigner s Signatur (Affix esi e s mp Here), PLEASE RETURN_ O BARISTABLE 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. �'.ulY'i ',imis l:;,ncrccnilicuim fonn.doc 1 t Town of Barnstable P# 1 Department of Regulatory Services Public Health Division Date MA89 �A racy 200 Main Street,Hyannis MA 02601 • rEll MA'I� � � r Date Scheduled_ Y. , ime Fee Pd. V Soil Suitability Assessment for Sew .'e Disposa Performed By: 1'1 aloe,( l l e-o W . �Z/, GS C Witnessed By: Location Address LOCATION& GENERAL INFORMATION ' Owner's Name �A P.$1'i 7k AtI> C o`ilC>'t`T Address t000 RL)$`C-N{ Wou tj '030- U tT ' Assessor's Map/Parcel: 1-1Q 1 1 3 I Engineer's Name CAP 6Wti>l S� Lk,,C_., }- NEW CONSTRUCTION REPAIR Telephone# j(J�. SCC Etiyaee,to3 Land Use Sitl�a �0.!V.d We,((P►9 ,�DS-273-�377 Slopes M ^y Surface Stones . Distances from: Open Water Body ft- Possible Wet Area ft Drinking Water Well ft Drainage Way r ft Property Line 2 I O ft Other ft SKETCH:(Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands fn proximity to holes) zz ouEu,4s�+ 7 i32, b s Parent material(geologic) Depth to Bedrock C) g®- Depth to Groundwater. StandingWater in Hole: Weeping from Pit Face Estimated Seasonal High Groundwater DETERMINATION FOR SEASONAL HIGH WATER TABLE Method Used: 04ferA &saua.rt00 Depth Observed standing in obs.hole: In, Depth to soil mottles. 12 to In. Depth to weeping from side of obs.hole: — In, Groundwater Adjustment ft. Index Well# Reading Date: Index Well level Acj:ISactor m� Adj.Groundwater'Level„e PERCOLATION TEST bale 9"b..�671Y nMe 10'18om Observation I A Hole# a Time at h" 4 i _ Depth of Perc . Time at 6" a Start Pre-soak Time @ �D' am _ Time(9"-6") End Pre-soak W 2-1 om Rate Min./Inch Site Suitability Assessment: Site Passed y e S Site Failed: Additional Testing Needed(Y/N) N Original: Public Health Division Observation Hole Data To Be Completed on Back----------- ***If percolation test is to be conducted within 100' of wetland,you must first notify the, Barnstable ConselE vation Division at least one(1) week prior to beginning. Q:ISEPTICIPERCFORM.DOC DEEP.OBSERVATION HOLE LOG Hole# 1+ 2- Depth from Soil Horizon Soil Texture .Sdil Color Soil Other Surfac'et(in.) (USDA) (Mansell) Mottling (Stnucture,.Stones;Boulders. onsistenc%%Gravel) vt28 _ — Fe 1! 2b-y2 R(6- L S . j if 312. yZ-7L N S fr �� �� 32 H S DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency,%Gravel) DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency, Gravel) DEEP OBSERVATION HOLE LOG Hole# Depth from ' Soil horizon Soil Texture Soil Color soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones:Boulders. Cons' to Flood Insurance Rate Map: Above 500 year flood boundary No ✓ Yes Within 500 year boundary No Yes ' Within 100 year flood boundary No.:Z Yes Depth of Naturally Occurring Pervious Material ' Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the area proposed for the soil absorption system? des _— If not,what is the depth of naturally occurring pervious material's Certification I certify that on la"27- 9I (date)I have passed the soil evaluator examination approved by the Department of Environmental Protection and that the above analysis was performed by me consistent with . the required trainin ,expertise an experi described in 10 CMR 15.017. Signature r Date Q:\SEPTiCWERCPORM.DOC r7 �- e �' e � e113 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION BORM Address of property c Owner's name l�J b 9,o/ Date of Ins ection a t(I I .-� P T A Oct .— lc�2 CHECKLIST 17,07 1*Pfq(Ff - P a Ice to y�Chec if the following have been done: P ping information was requested of the owner, occupant, and Board of ---Health. 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 stem recently or as part of this inspection. As built plans have been obtained and examined. Note if they are not 0�/ available with N/A. vl� The facility or dwelling was inspected for signs of sewage back-up. // The site was inspected for signs of breakout. All system components, excluding the SAS, have been located on the site. . I' 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 udge, depth of scum. , The size and location of the SAS on the site has been determined based existing information or approximated by non-intrusive methods. The facility owner (and occupants, if different from owner) were provided with .information on the proper maintenance of SSDS. e � � .• �8 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B SYSTEM INFORMATION FLOW CONDITIONS If residential number of bedrooms M/-number of current residents garbage grinder, yes or no laundry connected to system, yes or no o seasonal use, yes or no If nonresidential, calculated flow: Water meter readings, if available: C _ Last date of occupancy GENERAL INFORMATION Pumping records and source of information: System pumped as part of inspection, yes .or no if yes, volume pumped Reason for pumping: Ty of system 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 c mponents. Date installed, if known. Source of information: Q Sewage odors detected when arriving at the site, yes or no 9 SUBSURFACE SEWAGE DISPOSAL 8YST8M INSPECTION FORM PART 8 / 8YSTEX INFORUTXON continued SEPTIC TANK: (locate on site plan) depth below grado:_!�� material of construction: concrete ____metal _FRP other(explain) dimensions: — �21 sludge depth distance from top of sludge to bottom of outlet tee or baffle ' scum thickness / 7 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 outlet invert, structural integrity, evidence of leak ge, recommendations fo repa s, at 07 v� DISTRIBUTION BOX: a (locate on site plan) depth of liquid +level above outlet invert Comments: (note if level and distribution is equal, evidence of solids carryover, evidence of leakage into or out of box, recommendation for repairs, 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, recommendations for maintenance or repairs,etc. ) I 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART 8 SYSTEM INFO TION coati ued SOIL ABSORPTION SYSTEM (SAS) : .3 /'7 ! 2 3 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: e Type leaching pits and number leaching chambers and number leaching galleries and number leaching trenches, number, length leaching fields, number, dimensions overflow cesspool, number Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, recommendations for maintenance or repairs,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, recommendations for maintenance or repairs,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, recommendations for maintenance or repairs,etc. ). SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORK PART B SYSTEM INFORMATION Continued SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent references landmarks or benchmarks locate all wells within 100' Tki DEPTH TO GROUNDWATER depth to groundwater method of determination or approximation: /'iY1 I 12 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C FAILURE CRITERIA �--- Indicate yes, no, or not determined (Y, N, or ND) . Describe basis of dete mination in all instances. If "not determined", explain why not) ackup of sewage into facility? Discharge or ponding of effluent to the surface of the ground or rface waters? atic liquid level in the distribution box above outlet invert? Li uid depth in cesspool <6" below invert or available volume< 1/2 day ow? Required pumping 4 times or more in the last year? number of times pumped Septic tank is metal? cracked? structurally unsound? substantial infiltration? substantial exfiltration? tank failure imminent? Is -any portion of the SAS, cesspool or privy: below the high groundwater elevation? w' hin 50 feet of a surface water? with' n • 100 feet of a surface water supply or tributary to a surface w er supply? Thin a Zone I of a public well? 'thin 50 feet of a bordering vegetated wetland or salt marsh (cesspools and privies only, not the SAS) ? within 50 feet of a private water supply well? 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 analysi,- for coliform bacteria, volatile organic compounds, ammonia nitrogen and nitrate nitrogen. 13 8UBBURFACE 8EMAGS DI8POBAL BYSTEM IMBPECTION FORM PART D CERTIFICATION Name of Inspector Company Name Company Address Certification Statement I certify that I have personally inspected the sewage disposal system at this address and that the information reported is true, accurate and complete as of the time of inspection. The inspection was performed and any recommendations regarding upgrade, maintenance and repair are consistent%with my training and experience in the proper function and manite nce of on-site sewage disposal systems. C k one: I have not found any information which indicates that the system fails to adequately protect public health or the environment as defined in 3.10 CMR 15. 303 . Any failure criteria not evaluated are as stated in the FAILURE CRITERIA section of this form. I have determined that the system fails to protect public health and the environment as defined in 310 CMR 15.303 . The—basis for this determination is pr v Wed ALLURE ^RITERIA ction of this form. Inspector's Signature Date Original to system owner e) Copies to: F3 S Buyer (if applicable) n Approving authority © 5 I3l 11 No2 ............... APPROVED THE COMMONWEALTH OF MASSACHUSETTS 4rtn BOARD OF HEALTH TOWN OF BARNSTABLE Applirttfiun for Di1ipwiul Warkii Cnnnutrnr#inn Permit Application is hereby made for a Permit to Construct ( ) or Repair ( an Individual Sewage Disposal System at, ,( .1'l1 5 01A ............................... .... C2-L_:u! ...... � )c R ` t Lo it�n. -l/dYd�ress Or Lot No. ......9X.?,--_-(-t- -.........-.� �1.�--�............................• ..__...._..........--....•.._.......... .--._...------------_ ---•-----.---..-------.------ ........................• �!_.`. _-�s_f ....................v r_Address Installer Address UType of Building ` Size Lot............................Sq. feet ,. Dwelling— No. of Bedrooms--------------------------------------------Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building -_________________________ No. of persons.---_----.__------__--_----- Showers ( ) — Cafeteria ( ) a Other fixtures ------------------------------- -- Design Flow............................................gallons per person per day. Total daily flow............................................gallons. W WSeptic Tank—Liquid capacity------------gallons Length---------------- Width................ Diameter....------------ Depth................ x Disposal Trench--No. -------------------- Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed bY-------- -------------------•••-------------------------•---....---------- Date...................................... Test Pit No. I................minutes per inch Depth of Test Pit-------------------- Depth to ground water........................ L7 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 9 ------------------------------------•--------•---------••----•-----•----.............__......_------........................................................ 0 Description of Soil........................................................................................................................................................................ W -----------•---------------------------------------------------------------------------------------------- - „-�- ----------- - UNature of Repairs or Alterations—Answer when applicable._._..��I j�..'. ._.. .__�'........... .............. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Complian en iss b e board o health. Signed �C/(�........ -- - - .G ...... ................... P�Dace Application Approved By i -'✓ - --------.._-------------- --------- D; te Application Disapproved for the following reasons: .............................. .................................................. ...................... ................ ..... . .................. . ... ....... ...... .................................. --. . -- .. ........................................ Dare Permit No. ..... .. ........... Issued ...........1z�`.--,` `...............��t ........ Daze r.•.•`.`r �h..++...•—..,.. -..... ' ` :r .A....ia :_1.s�� .i•..o.'1�?.ad+�a �. - -yv .' .. � f, ` .. {� .s•-.ram-•,_..a.�-u:--1 wd• -!`�•J-^L�.Jakdrr•� �%� MnwviJ'y'�,C3+.=.iA.-.✓�'....-•:4:r+haN+,..nt�s..•:�C�.•+...�•' 7 �:w..�--�..Jr•�.`-.�'.�'"`.w?' "�.`i+,�yar: �/� 1 ° No,z.............-....... _ F$s.. ..................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Appliratioit for DioVooul ll orkii Tomitrnrtton ramit Application is hereby made for a Permit to Construct ( ) or Repair ( 6) ao n Individual Sewage Disposal System at ( .... ------ ----------------- .... ..-----.---.--..--....-----.._. Lo ion_Address or Lot No. _�.��.. 6% � -------------------•--•- --•--------•----------••••••-••• --..........------------------...-•-•-•--•----...........--••-- Addressner AS . r- -Installer Address U 'Type of Building Size Lot............................Sq. feet ►.� Dwelling— No. of Bedrooms....................................... ....Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ____________________________ No. of persons---------------------------- Showers ( ) — Cafeteria ( ) dOther fixtures ..................................................................................................................................................... W Design Flow--------------------------------------------gallons per person per day. Total daily flow............................................gallons. Gd Septic Tank—Liquid capacity------------gallons Length________________ Width................ Diameter................ Depth................ Disposal Trench--No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. 3 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........................ fx, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ P4 ---••------------------------••-•-•••••----•••-:-•--•-•-•-----•----•-----••-------•--•......._•-••-•......................................................... 0 Description of Soil........................................................................................................................................................................ ---------------"-------­--------------- --------"---------------------------------------------------------V •---••-------------------- ----------------------------------------------------------------------------------- --- --- --•-• •--••---•-----•__ U Nature of Repairs or Alterations—Answer when applicable. .. f t: - Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Compiian gas ,een issu d_b he board of health. �7 Signed . >c -�2(i- .. .............................. .7... -`"�` f Date �•�� Application Approved By ' -- ----- � v .....-: . ..:.... - ' .........1� Application Disapproved for the following reasons- -- ---------------=------------------------/............................................................................. ...............................................................'' ' .... ..............................:-.............................. ' '-' ' ' ...................................... ........................................ Date Permit No. ----- `- Issued `..'`�j. ....��� ....... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE (fertifirate of Tompltttnce THIS IS TO CERTIFY That the Individual Sewage Disposal System constructed ( ) or Repaired y.... . ............ .. /............. '- .........................,--.... ...._..--......--....................--..... Ott .....//.z2.a.............� c.s..��--.--__%���5' .....Installer /�G"":'f -'���1/' �!"� ... has been installed in accordance with the provisions of TITItttvv(UJJ///'Err/5 of The State Environmental Code as described in the application for Disposal Works Construction Permit No. _- ---",-,�.-_ - ._ - .- dated ._ :��� THE ISSUANCE OF THIS CERTIFICATE SHALL NO BE CON TR AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SAT FACTORY. M DATE.-......- ls........... ...........-- -- -- ----........-- --.. Inspecto .....,-. THE COMMONWEALTH OF MASSACHUSETTS ` BOARD OF HEALTH TOWN OF BARNSTABLE t O No..........- FEE. ................. Disposal Vvyks Tomotrit- tion "Vlermit �A // per Permission is hereby granted...... ----�-(..�-----------------------------------------...... .._.._....-•---_•--.......__ - to Construct ( ) or Repair ( v)an Individual S�e✓w. age Dis s System at No....._ _ .... - _ �J !I �",' � v ------------------------------------ ------------------------__--_-_- /` Street / L/ as shown on the application for Disposal Works Construction Permit No�_�r^_/__r� ated....j-.''. :__. L Board of Health DATE......... ...�� __ ___ ------------------ FORM 36508 HOBBS R WARREN.INC.,PUBLISHERS TOWN OF BARNSTABLE ^r LOCATION �� {"S SEWAGE /✓ ...'VILLAGE (��� ASSESSOR'S MAP-& LOT ~j,� INSTALLER'S NAME & PHONE"NO. Wh /✓ d���cJi S �G a L/o SEPTIC TANK CAPACITY aad �' �� 11 LEACHING FACILITY:(type) f /t,+�S(size) 1 ' !"NO. OF BEDROOMS _�_PRIVATE WELL OR PUBLIC WAT R ,,BUILDER OR OWNER C7 t-'b5 DATE PERMIT ISSUED: L� DATE COMPLIANCE ISSUED: `7 VARIANCE GRANTED: Yes No i �r 9 COX 3- k-S r ' a � � ta al s� �h } FINISH GRADE OVER D-BOX= 16.3'± � _ GENERAL NOTES T.O.F. EL.= 20.7'±_ FINISH GRADE OVER CHAMBERS= 15.9 16.3 2% MIN. OVER SYSTEM 3/4"TO 1-1/2" DOUBLE WASHED SLOPE PROVIDE EXTENSION RISER REMOVABLE WATER-TIGHT COVER OVER @ STONE TO CROWN OF PIPE 1. UNLESS OTHERWISE NOTED,ALL SYSTEM COMPONENTS AND CONSTRUCTION WITH COVER OVER INLET& RISER TO WITHIN 6"OF FINISHED GRADE 4"SCHEDULE 40 PVC INSPECTION PORT WITH ACCESS FINISH GRADE OUTLET TO WITHIN 6"OF F.G. 0 2"OF 1/8"TO 1/2"DOUBLE WASHED METHODS SHALL BE IN ACCORDANCE WITH TITLE 5 OF THE STATE ENVIRONMENTAL @ FND. EL.= 18•2'± F.G. OVER TANK EL. = 17.1�± 5" DIA. OUTLET(S) MIN SLOPE 1 /o BOX TO F.G. (SEE NOTE#21) STONE OR GEOTEXTILE FILTER FABRIC CODE AND ANY APPLICABLE LOCAL RULES. -"- ------- -_ - -� 2. ANY CHANGES TO THIS PLAN MUST BE APPROVED BY THE BOARD OF HEALTH AND THE TOP OF SAS= 13.33' PLACE RISERS ON ALL DESIGN ENGINEER. PROPOSED 4" 9" MIN. CHAMBERS WITH �-EXISTING 4" SCH. 40 PVC 36" MAX. 12.5Q' 36"MAX.I INLET PIPES TO 6"OF 3• 4"SCHEDULE 40 PVC PIPE WITH WATER TIGHT JOINTS SHALL BE USED IN DISPOSAL /f SEWER PIPE SEWER PIPE BREAKOUT EL= 13.00 FINISHED GRADE SYSTEM UNLESS OTHERWISE NOTED. _2t _ 3"DROP MAX " 1 4. TO PREVENT BREAKOUT, THE PROPOSED FINISHED GRADE SHALL NOT BE LESS THAN 6" 3" 3 9 L=21 ± __1___L 2" DROP MIN 714.2' PROVIDE WATERTIGHT ' C. o ELEVATION = 13.00' FOR A DISTANCE OF 15'AROUND THE PERIMETER OF THE SAS. UNLESS A 10" 4"PVC IN FROM JOINTS (TYP.) �w� 40 MIL GEOMEMBRANE LINER IS PLACE AT LEAST FIVE FEET FROM S.A.S.AND THE TOP OF 14" SEPTIC TANK 4"PVC OUT TO O 0 0° O o THE LINER IS NOT LESS THAN THE BREAKOUT ELEVATION. CONTRACTOR TO PROVIDE LEACHING FACILITY Tpo 0 0 5. SLOPE ALL SOLID PIPE AT 1.0% MINIMUM. SPECIFIED DROP BETWEEN I " oo ooINLET AND OUTLET CONTRACTOR CONTRACTOR SHALL 12 6 , 6. THIS SYSTEM IS NOT DESIGNED FOR A GARBAGE DISPOSAL. SHALL VERIFY SIZE 48" VERIFY CONDITION OF 12.90 MIN. 12.73 2 0 °° � 0 0 0 pppp 7. LOCAL BOARD OF HEALTH AND DESIGN ENGINEER TO BE NOTIFIED PRIOR TO BACK AND CONDITION OF EXISTING TEES GAS BAFFLE i 6"CRUSHED STONE I 0 0 000 oo FILLING WHEN SYSTEM IS NEARLY COMPLETE AND READY FOR INSPECTION. SYSTEM IS EXISTING SEPTIC AND REPLACE AS OVER MECHANICALLY I po 0 0 o NOT TO BE BACK FILLED WITHOUT FIRST OBTAINING APPROVAL FROM BOARD OF HEALTH TANK NECESSARY COMPACTED BASE 5 4.0' 8•5• (Np) _ I 4.0' 4 0, 4 83' 4 0' AND DESIGN ENGINEER. OUTLET DISTRIBUTION BOX (TMp) 8. ELEVATIONS BASED ON APPROXIMATE U.S.G.S. DATUM. BENCHMARK ELEVATION OF TO BE INSTALLED ON A LEVEL STABLE 25.0' 18.00' ESTABLISHED ON TOP OF NAIL SET IN 18" PINE TREE AS SHOWN ON PLAN. BASE. FIRST TWO FEET OF OUTLET 1050, GROUND WATER ELEV.= 5.50' 12 83' 9. CONTRACTOR SHALL VERIFY ALL UTILITY LOCATIONS PRIOR TO CONSTRUCTION • PIPES TO BE LAID LEVEL. THROUGH DIG-SAFE AT LEAST 72 HOURS PRIOR TO COMMENCING WORK ON SITE AT EXISTING 1 ,000 GALLON CONCRETE SEPTIC TANK 2 - 500 GALLON CHAMBERS 5'MIN. CHAMBER END VIEW 1-888-DIG-SAFE AND ANY OTHER APPLICABLE AGENCIES. REPORT ANY DISCREPANCIES CROSS SECTION VIEW TYPICAL CHAMBER PROFILE TO THE DESIGN ENGINEER. "CONTRACTOR TO VERIFY EXISTING ELEVATION PRIOR SEPTIC TANK PROFILE DISTRIBUTION BOX DETAIL CHAMBER DETAILS 10. ALL JOINTS WHERE PIPE ENTERS AND EXITS CONC. STRUCTURES SHALL BE MADE WATERTIGHT. TO ANY WORK& NOTIFY ENGINEER IF DIFFERENT. NOT TO SCALE NOT TO SCALE NOT TO SCALE 11. NO DETERMINATION HAS BEEN MADE AS TO COMPLIANCE WITH DEEDED OR ZONING Benchmark /'J1 !(,, £ f/ r ' w Q TEST PIT DATA ! REGULATIONS. OWNER/APPLICANT IS TO OBTAIN SUCH DETERMINATION FROM Nail in 18"Pine I /l` l ` ;�f�'r' ti ti -'. • APPROPRIATE AUTHORITY. PERC NO. 14478 Elev. = 18.00 R ` /� '•• =' Donna Z. Miorandi, IRS 12. ALL SEPTIC SYSTEM COMPONENTS SHALL WITHSTAND H-10 LOADING UNLESS Approx.rox. USGS .�,yJ ' 1 ' # ••' • '"• ' INSPECTOR: �< �� - ,s • " + '•••' LOCATED UNDER PAVEMENT, DRIVES OR TRAVELED WAYS IN WHICH CASE / ;: • r EVALUATOR: Michael Pimentel, EIT, CSE THEY SHALL WITHSTAND H-20 LOADING. �' • C.S.E. APPROVAL DATE: Oct. 1999 / r ` •« v. ;'� ' • 13. DOUBLE WASHED CRUSHED STONE SHALL BE FREE OF ALL DIRT DUST AND FINES. -18-- - PROPOSED INSPECTION PORT ;+< k` ` _ • � "r DATE: September 8, 2014 ' TREE (TYP) 000 TEST PIT#: 1\ / C` ;j fir• • ` ,�' ` ? 14. WHERE REQUIRED, CONTRACTOR SHALL REMOVE ALL LOAM, SUBSOIL AND UNSUITABLE �� p \ rat} .5 j + ,F+•+ « • MATERIAL IN AREA BENEATH AND FOR 5 FT. ON ALL SIDES OF LEACHING FACILITY. �;V� \ \ ° 'i` ' 'J• ' fi ' ' + • ?, l i ELEV TOP= 16.00' REPLACE ALL UNSUITABLE MATERIAL WITH CLEAN COARSE SAND FREE FROM CLAY, \ , _ - --18- - _ Q 4 :I a a� • s` a r---I ► *+- - FINES OR OTHER UNSUITABLE MATERIAL IN ACCORDANCE WITH 310 CMR 15.255(3). ei9 Yei • • «•• ` r dirr,�. « ELEV WATER- 5.50 FRp t ( � _ ,` « *o, ' - - 15. CONTRACTOR SHALL NOTIFY DESIGN ENGINEER OF ANY DISCREPANCIES FOUND IN _ _ - - c, (40 'T y } / . M PERC RATE - <2 min./inch SITE CONDITIONS FROM THOSE SHOWN PRIOR TO CONTINUATION OF WORK. CIS 44AiIIIr'r,, �yOUT ` � •� • LOCUS ' �: DEPTH OF PERC= 42"-60" 16. PROPOSED PROJECT IS LOCATED WITHIN: APPROXIMATE LOCATION OF \ __ -_ ) 0 t '�# �'� EXISTING SAS COMPRISING THREE 6� ` �� °' ' '"" + ASSESSOR'S MAP 19 PARCEL 131 2� � �M � �� r � � . �� . TEXTURAL CLASS: 1 - (3) INFILTRATORS (PER AS-BUILT57. m4 /' TP 5 a ' 4 f {� OWNER OF RECORD: F. KEATS BOYD, III and WENDY R. BOYD CARD)TO BE ABANDONED---__ BUSH (TYP) 16x0' TREELINE / 1 S� t �/ ) • - __ -16 _ _ m + _ . ,�r 0" 16.00' ADDRESS: 100 RUSHY MARSH ROAD 20 PROP. 2 - 500 GAL a a • • �; `^�� °� - )„ . 16x0' r LEACHING CHAMBERS `� ' .' . �;": «�� � 'r •� �`)`sti�' a... M / ' «•� COTUIT, MA 02635 - - - - 16 _ « 'a : �. , Fill � �O�' _16- WITH AGGREGATE { , �� . 'ley �1 r t. * +� < Q JP . / 4 , .. • . FEMA FLOOD ZONE X( 500 yr.) i= Y1, � �� y e ' `e ° '/` ' / • �� 28" Loamy Sand13.67' COMMUNITYPANEL# 25001CO752J o �X'X SHED ��.u_ -a ti11 `p( i l •j{7{ U' �E 10Yr 3/2 17• DEED REFERENCE: BOOK 26042, PAGE 146 ,'• r^. 18. PLAN REFERENCE: P.B. 159, PG. 91 - -1 X' �k ./ �+ �s • Perc Q o EXISTING 1,000 GALLON SEPTIC TANK !� 8� _ X * ` w Medium Sand .--� � ' �\ fx 49 ��. 9, 2 0,,� •;!+J 11.00' 19. ALL DISTURBED AREAS SHALL BE RESTORED TO ORIGINAL CONDITION. 3. TO BE UTILIZrD IN THIS DESIGN \ - _ PROPOSED DISTRIBUTION BOX , ,'., � 11 .r �� 10Yr 5/8 �- o O �'p x ` 1i �I {/ B 74 20. PROPERTY LINE INFORMATION IS ONLY APPROXIMATE. THIS PLAN IS TO BE USED ONLY _ t U'o T -_WALK_ _- � °� I 1 �, �•.. Ilp i o - /, 72" 10.00' FOR SEPTIC SYSTEM UPGRADE. JC ENGINEERING WILL NOT ASSUME ANY LIABILITY w m FOR USES OF THIS PLAN OTHER THAN ITS INTENDED PURPOSE. C) - I i � Cn Z 1t ✓° • - C:) �-� O �) ' O all r; 21. A 4" PERFORATED SCH.40 PVC PIPE SHALL BE PLACED IN A VERTICAL POSITION TO A oCO a� O "' - + $' Medium Sand DEPTH OF THE BOTTOM OF THE SAS AND EXTEND TO WITHIN 3"OF FINISH GRADE. A z �1 z C 2.5Y 6/6 REMOVABLE THREADED CAP SHALL BE PLACED ON THE TOP TO ALLOW FOR INSPECTIONS. LOCUS PLAN #100 O Mottling @ 126" EXISTING r MAP 19 126' - 5.50' 3-BEDROOM PARCEL 126 SCALE: 1" = 1000' 132" 5.00' I DWELLING TOF = 20.7'± No Standing or Weeping Observed DESIGN DATA TEST PIT DATA LEGEND PERC NO. 14478 NUMBER OF BEDROOMS (DESIGN) 3 INSPECTOR: Donna Z. Miorandi, RS 50x0' EXISTING SPOT GRADE EVALUATOR: Michael Pimentel, EIT, CSE , MAP 19 DESIGN FLOW 110 GAUDAY/BEDROOM C.S.E.APPROVAL DATE: Oct. 1999 50 EXISTING CONTOUR PARCEL 131 TOTAL DESIGN FLOW 330 GAUDAY DATE: September 8, 2014 50 PROPOSED CONTOUR 56,100±S.F. SWING-TIES SCALE: 1"=20' DESIGN FLOW x 200 % = 660 GAUDAY N � TEST PIT#: 2 r-5-0-1 PROPOSED SPOT GRADE �ry4v rycVy DESCRIPTION HC-1 HC-2 SC USE EXISTING 1,000 GALLON SEPTIC TANK ELEV TOP= 16.00' GAS - EXISTING GAS LINE V�--�_w Ate' CORNER OF STONE(1) 53.4' 47.2' 48.9' ELEV WATER= 5.50' l---w w w "' `' ❑/H/W EXISTING OVERHEAD UTILITIES _ vP CORNER OF STONE (2) 64.7' 60.1' 54.6' PERC RATE - W W-- -- EXISTING WATER LINE J // GPS CORNER OF STONE(3) 78.8' 65.0' 36.3' INSTALL 2 - 500 GALLON CHAMBERS DEPTH OF PERC = r_/C1��aG GAS GAS - GAS GAS GAS - - - GAS CORNER OF STONE(4) 69.9' 53.4' 26.8' SIDEWALL CAPACITY TEXTURAL CLASS: 1 TEST PIT LOCATION GAS/° C3 F (LENGTH + WIDTH) (2 SIDES) (2' HIGH) (0.74 GPD/S.F.) = GAUDAY _ O O EXISTING 1,000 GALLON SEPTIC TANK p! 3) (25.0'+ 12.83')(2 ) (2' ) (0.74 GPD/S.F.) = 112.0 GAUDAY 0" 16.00' \ --25.9 -� PROPOSED 4"SOLID SCHEDULE 40 PVC PIPE N BOTTOM CAPACITY (2 p O °1D1 (LENGTH x WIDTH) (0.74 GPD/S.F.) = GAUDAY Fill Q PROPOSED DISTRIBUTION BOX 1 (25.0'x 12.83') (0.74 GPD/S.F.) = 237.4 GAUDAY 1 (4 2 28 Loamy Sand 13.67 �p PROPOSED 500 GALLON LEACHING CHAMBER ( 68, A/E 10Yr 3/2 SIC TOTALS: 42" 12.50' N7 o2g3p„ TOTAL NUMBER OF CHAMBERS 2 Medium Sand REV. DATE BY APP'D. DESCRIPTION 19000, SHED TOTAL LEACHING AREA 472.2 SQ.FT. B 1OYr5/8 PROPOSED SEPTIC SYSTEM UPGRADE TOTAL LEACHING CAPACITY 349.4 GAL./DAY � 72" 10.00' PREPARED FOR: MAP 19 CAPEWIDE ENTERPRISES PARCEL 132 C Medium Sand LOCATED AT 2.5Y 6/6 - HC-1 /-HC-2 z 100 RUSHY MARSH ROAD G) Mottling @ 126" COTUIT, MA 02635 �10 126" - 5.50' NOTES: C SCALE: 1 INCH = 20 FT. DATE: SEPTEMBER 19, 2014 Z 132" 5.00' ► 1.) MAGNETIC MARKING TAPE SHALL BE PLACED ALONG THE TOP EDGE OF EACH SEPTIC MAP 19 -,. -� o 10 20 ao so FEET SYSTEM COMPONENT. No Standing or Weeping Observed ,,``( PARCEL 137 #100 00 _ __ _ - ----- JOHN L. PREPARED BY: EXISTING RESERVED FOR BOARD OF HEALTH USE CH CHILL JR. 2.) CONTRACTOR SHALL VERIFY SOIL CONDITIONS IN THE LOCATION OF THE PROPOSED <„ JC ENGINEERING, INC. 3-BEDROOM Ivl ' LEACHING FACILITY TO ENSURE CONSISTENCY WITH TEST PIT DATA SHOWN ON THIS PLAN. DWELLING 807 2854 CRANBERRY HIGHWAY REPORT TO ENGINEER AND LOCAL BOARD OF HEALTH IF SOILS ARE NOT CONSISTENT WITH TEST PIT DATA. TOF = 20.7'± EAST WAREHAM, MA 02538 SITE PLAN 508.273.0377 3.) A PORTION OF THE PROPERTY IS LOCATED WITHIN THE ESTUARINE WATERSHEDS. ALL - r - -- -- - --T -- - PROPOSED WORK IS LOCATED OUTSIDE THE LIMITS OF THE ESTUARINE WATERSHEDS. SCALE: 1" =20' Drawn By: MCP I Designed By:MCP + Checked By:JLC JOB No.2875