HomeMy WebLinkAbout0192 SCHOOL STREET - Health 192 School Street
A = 020 -068
�,�. - cot it
— - - ------ --
TOWN OF BARNSTABLE ;^ J
LOCATION J � lyv` S SEWAGE#)010 — 6 Z/
VILLAGE �Oiw�� ASSESSOR'S MAP f&.PARCEL 0,2® o6?
INSTALLER'S NAME&PHONE NO. g o x S 7 7—017 7
SEPTIC TANK CAPACITY (9
LEACHING FACILITY:(type) ��l 30i-by (size) 1,) �/C2d",<a
NO.OF BEDROOMS 3
OWNER rn I
PERMIT DATE: 2-3-/0 COMPLIANCE DATE: ;�—!6—P
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) reet
FURNISHED BY
5
No. G to Fee i a
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS Yes
2ppliLation for Mispo8al bpstem Construction permit
Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components
Location Address or Lot No./ � J`CGJ S Owner's Name,Address,and Tel.No.
Assessor's Map/Parcel
Installer's Name,Address,and Tel.No. _j�99 if`>.7 e'"77 Designer's Name,Address,and Tel.No.
ej
Type of Building:
Dwelling No.of Bedrooms Lot Size OV 2,P sq.ft. Garbage Grinder( )
Other Type of Building et,5 No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow(min.required) 3 d gpd Design flow provided 7 y gpd
Plan Date V Number of sheets Revision Date
Title
Size of Septic Tank W Type of S.A.S.1� _I oYD f
Description of Soil
Nature of Repairs or Alterations(Answer when applicable) S•P'e, ?""4�4:104
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 lth.
&igkedTnZDate C> �'— �C✓/O
Application Approved by M,c Date
Application Disapproved b Date
for the following reasons
Permit No. 2-0 to —03 L/ Date Issued
0
_r.......::-,...V,.;;,:�,r;l,+..XH�h;;s...:.:.�19,'„►.�..;_...+-.•-r--._...:...,�;J4+.fe tiF;.:,. - ' 'way.. ..-c.,...•«::a:u�v:-wr--..-.-.... .w o,.. .- _..._ _. -. ._ -.....µ.� ...'1 y s:
—tvoa G 1 h L 6
Y Fee
THE COMMONWEATH OF MASSACHUSETTS Entered in computer:
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS Yes
application for -Misposai 6pstrut Construction 3pertnit
Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components
Location Address or Lot No./ � SCG1td/ S7 .. Owner's Name,Address,and Tel.No:
Assessor's Map/Parcel !% .1.4 S P S c,
Installer's Name,Address,and Tel.No. -ja9 Designer's Name,Address,and Tel.No.
1 412-10 /_F o a?' &C
Type of Building:
Dwelling No.of Bedrooms Lot Size _ sq.ft. Garbage Grinder( )
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow•(min.required) —T�U gpd Design flow provided 7�) gpd
Plan Date Number of sheets Revision Date w
Title
Size of Septic Tank Type of S.A.S. P 1 tz z
Description of Soil
Nature of Repairs or Alterations(Answer when applicable) S"P P PWON
Date last inspected:
x
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 lth.
ed Date CP 3, G/Q
Application Approved by din t Date — —/C,
Application Disapproved b Date
for the following reasons
Permit No. )0 /o —0 3 t/ Date Issued a-3 —to
----------------------
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
at has been constructed in accordance
with the provisions of Title 5 and the for Disposal System Construction Permit No. 2 0' U—o C dated
Installer 7,',•7ig Sams r Designer
#bedrooms Approved d es igndiow gpd
The issuance of this�,rT
e all not be construed as a guarantee that the system willfunctignasigne,.Date Inspector
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION BARNSTABLE,MASSACHUSETTS
disposal *pstem Construction vermit
Permission is hereby granted to Construct( ) Repair( ) Upgrade( ) Abandon( )
System located at /9 SC`1GG( 5 7-
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:Construction must be completed within three years of the date of this permit;
Date 34 o Approved by �- ell
'Zed w ll ) telIiY�_
h ob t
Property Address Map section parcel lot
Type of building Permit number
(Residential/Commercial) p t L,<.Q_
• r
Number of bedrooms
(residential)or square
footage(commercial)' Date of Installation
Capacity required and Min.G.P.D.required: Special circumstances:
Alternative Technology/
provided(G.P.D.) Variance(s)etc.?Please
G.P.D.provided: specify
t
LTAR(application rate) Installer Name p ,1`e-O`a� P1 L
Leaching facility component
description and dimensions.
XX30 5' I Z k Designers Name ca, � Gill
Water service 1
(Town or well) �( �o„T'P�c Installer Signature*
Depth to Groundwater *Installer's signature above indicates the system was installed`substantially as
proposed in permit plan and is the installers certification as required in Title V C R
State Zone II? (yes/no) 15.02
The septic system location must be placed on the revers side. Use two permanent landmarks(such as house corners)to locate system components.
These landmarks should be identified with letters and the system component should be identified using numbers. At a minimum,two septic tank
covers,the d-box,all four corners of the leaching facility and its inspection ports must be concisely measured from the chosen landmarks.
37-
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W7-
a.
i
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I }
TRANS. NO.
+r
CITY/TOWN:
AI?PLICANT:
ADDRESS: T
DESIGN FLOW: ,�j� C:s gpd
REVIEWED BY: DATE:
N/A OK NO
Legal boundaries denoted [310 CMR 15.220(4)(a)]
Street, Lot, tax parcel number and lot number noted on plan [310 .
CMR 15220(4)(u)]
Locus Provided [310 CMR 15.2204(t)]
Plan proper scale? (1"=40' for plot plans, 1"= 20' or fewer for
components) [310 CMR 15.220(4)]
Easements shown [310 CMR 15.220(4)(b)]
System located totally on lot served [310 0MR 15.405(1)(a) for
upgrades]- if nor, a variance is required [310 CMR 15.412(4)] �
Location of impervious surfaces (driveways, parking areas etc.) ��
[310 CMR 15.220(4)(d)] _
Location all buildings existing and proposed 310 CMR
15.220(4)(c)]
Location and dimensions of system components and reserve areas.
[310 CMR 15.220(4)(e)]
System Calculations [310 CMR 15220(4)(0] v`
daily flow
septic tank capacity (required and provided)
soil absorption system. (required and provided)
whether system designed for garbage grinder v
North arrow [310 CMR 15.220(4)(g)] o/
Existing and proposed contours [310 CMR 15.220(4)(g)]
Location and log of deep observation holes (existing grade el. on
each test) [310 CMR 15.220(4)(h)]
Names of soil evaluator- and .130H representative [31.0 C:NIR
v
15.220(4)(h) and (i)]
Location and date of percolation tests (performed at proper
elevation?) [310 CMR 15.220(4)(1)]
Percolation test results match.loading rate? [3 10 CMR 15.242]
-Certification statement by Soil Evaluator [310 CM.R 15.220(4)0)] _ Vr
Observed and Adjusted groundwater (method for adjustment
given or indicated) [310 CMR 15.103(3) and 310 CMR V�
15220(4)(n)]
C"+ 1
Address C� ��CA-,C6 �� � j;0 kT Sheet 1 of'7
N/A OK NO
Location of every water supply, public and private, [).10 CMR ,>
15.220(4)(1c)]
within 400 feet of the proposed system location in the case
of surface water supplies and gravel packed public water supply
within 250 feet of the proposed system .location in the case
within 150 feet of the proposed system location in the case
of private water supply wells
Location of all surface waters and wetlands located up to 100 ft.
beyond. setbacks listed in 31.0 CMR 15.211 and any catch basins
located within 50 ft. [310 CMR 15.220(4)(1)]
Water lines and other subsurface utilities located [310 CMR
15.220(4)(m)] (if water line cross see 310 CMR 15.211(1)[1])
Profile of system showing invert elevations of all system
components and the bottom of the SAS [310 CMR15.220(4)(o)]
Stamp of designer [310 CMR 15.220(1) and 310 CMR 15.220(2)]
Stamp of Registered Land Surveyor (required if construction
activities within 5 ft. of lot line) [310 CMR 15.220(3)]
Test Holes adequate (two in each of the primary and reserve
unless trenches as permitted in 310 CMR 15.102(2) or as
approved for an upgrade snider LUUA at 310 CMR 15.405(1)(k)]
Test hole adequate to demonstrate four feet of suitable material? �
[310 CMR 15.103(4)]
Test Holes adequate to confirnl.adequate groundwater separation?
[310 CMR 15.103(3)] v'
Benclunark within 50-75' of system [310 CMR 15.220(4)(q)] V/
Materials specifications noted? [various sections of 310 CMR
15.000]
System components not > 36" deep (unless Local Upgrade
Approval o LUA requested [310 CMR 15:405(1(b)] y
Address ed J�.��`CL�� �� �` e13 `e - Sheet 2 of 7
1
N/A OK NO
Size OK? [310 CMR 15.223(1)]
bitet tee located ten inches below flow line [310 CMR 1.5.227(6)]
Outlet tee 14" or 14" + 5" per foot for increase ft depth [310 CMR
15.227(6)]
Outlet tee with gas baffle or approved filter [310 CMR 15.227(4)]
Note regarding installation on stable compacted base [310 CMR
15.228(1)]
Separation between inlet and outlet tees (no less thzin liquid
depth) [310 CMR 15.227(2)]
Inlet/Outlet elevations at least 12" above high groundwater
(except as described 310 CMR 15.227(5)) or permitted for
upgrades under LUA [310 CMR 15.405(1)(k)] `
Minimum cover 9" (Tanks buried more than 9" must have risers
on all openings and on the d-box) [310 CMR 15.2228(1) and 310 v/
CMR 15.232(3)(fl]
Tluee access covers (inlet and outlet must be 20" or greater) -
middle access at least 8" (by 7/07) [310 CMR 15.228(2)]
Access to within 6 " of grade - one port for systems<1000gpd,
two for systems >1000 gpd [310 CMR 15.228(2)]
All at-grade covers secured to unauthorized access? [31.0 CMR
15.228(2)] V
> 10 ft from building foundation [310 CMR 15.21.1(1)]
Buoyancy calculation Required/Done [310 CMR 15.221(8)]
H-20 Where appropriate? [310 CMR 15.226(3)]
Setbacks from resources [310 CMR 15.211]
lYIU"If�l C011l�c`Il tI]1Cll�t�T1II1CS' � ( x '� z ,� av a � � �u:
.>� 1 - ...e! -.,k 1 d.'f6.' c..�..ti_ .iGr..r §'l ate°`.✓, w'�'
Required when other than single-family dwelling or flow>1000
gpd [310 CMR 15.223(1)(b)]
First compartment 200% daily flow; Second compartment 100%
daily flow [310 CMR 15.224(2) and (3)]
"U" pipe through or over baffle, outlet of each compartment with
gas baffle or approved filter [310 CMR 15.224(4)]
� c.
Address G12- c�C�ou 1 �� �.i'i 1 Sheet 3 of 7
N/A OK NO
BT1I)LDT§NG S' WERij\1I) O- THER PIl?I°NG rr
Located at least ten feet from any water line? [310 CMR
15.222(2)]
Disposal piping at least 18" below water line (when water and
sewer cross, see 310 CMR 15.211(1)[I])
Cleanouts required/provided ? [310 CMR 15.222(8)]
Thrust blocks specified in force mains? 310 CMR 1,5.221(6)(c)]
Slope of sewer line not less than 0.01. (1/8"/ft) 0.02 preferable
[310 CMR 15.222(6)]
Proper pitch on all runs? (.005 within gravity-distributed trenches
and beds) [310 CMR 15.251(9) and 310 CMR 1.5.252(2)(c)] ,
Siphon problenrl (leachfield below pump chamber)
Endcaps or vent manifold specified?
Size and orientation of discharge holes specified? (not smaller
than 3/8" not larger than 5/8") [310 CMR 15.251(8) and 310
CMR 15.252(2)(h)]
Materials specified (310 CMR 15.251(5) specifies various pipe
types allowed)
DTSTyRi'B�UTION BOX� P � k K y Y.kS 7@ t+ 5 �}zi 3 x h y M k" }y
4
Stable compacted base [31.0 CMR 15.221(2) and 310 CMR
15.232(2)(a)]
Splash plate or baffle tee required on inlet/provided? (when
pressure sewer to d-box or steep pitch of gravity sewer),[310
CMR 15.323(3)(a)]
Riser if deeper than 9" [310 CMR 15.232(3)(f)]
hlside minimum dimension 12" [310 CMR 15.232(2)(b)]
Minimum sump 6" [310 CMR15.232(3)(e)] �,
Watertight cover if<2000gpd); waterproof manhole if>2000gpd
[310 CMR 15.232(3)(d)]
PUIVIP CHAMBERS 3 N `
Capacity (emergency storage above working=design flow)? [310
CMR 231(2)]
Proper setbacks [310 CMR 15.211 (same as septic tanks)] -77
Watertight 20-in miiuum access marl-hole at least 20" MUST BE
TO GRADE [310 CMR 15.231(5)]
Service components accessible (not too deep with piping,
disconnects accessible)
Alarm floats - alarm on circuit separate from pumps specified?
Exceeds two units must have two pumps operating in lead-lag
mode. [310 CMR 15.231(6) and (8)]
Stable Compacted Base [310 CMR 15.221(2)]
Buoyancy calculations needed ? Provided? [310 CMR 15.221(8)]
Address ��� c:�i�G�;� Lc k i'\ Sheet 4 of'7
N/A OIL NO
SOILABSORPTION�SYSTEl1&ZS�(SAS)'GENE � `L ` �� �' ' �' � �_
Calculations correct?
4 feet of naturally occurring material demonstrated? [310 CMR
15.240(1)]
Required separation to groundwater? [310 CMR 15.212)]
Aggregate specified as double washed [310 CMR 15.247(2)]
System Venting required/provided? (system under driveway or
>36" deep) [310 CMR 15.241]
Inspection ports specif ed and within 3"final grade? [310 CMR
15.240(13)]
Breakout requirements met? (No violation of breakout elevation
within 1.5 ft of SAS unless barrier) [310 CMR 15.21.1(1)[4] and
Guidance Document]
GALLEYZLES;PTTS;CH3AMBERS` 310 CMR15 253
. �n G �., .. ., ,., .,.
r
Chambers and Gal. in trench configuration supplied with inlet . ,..o.
every 20 ft. 31.0 CMR 15.253(6)]
Each structure with one inspectiorn manhole (if>2000 gpd must
be to grade) [310 CMR 15.253(2)] V/
Aggregate 1'manimum- 4' maximum. [310 CMR 15.253(1)(b)]
2' sidewall credit maximum [310 CMR-1 5_253(1)(a)] f
�i bed configuration, inlet every 40 sq. ft. [310 CMR 1.5.253(6)]
I12ENCHES 3E10 CM121x5 251 ' ' "
Width 2' minimum 3' maximum [310 CMR 15.251(1)(b)]
100 feet - maximum length [310 CMR 15.251(1)(a)]
Minimum separation 2x effective depth or width whichever
greater (3x if reserve between trenches) [310 CMR 251(1)(d)]
Situated along contours [310 CMR 15.251(2)]
Breakout 0K? [310 CMR 15.211(1)[4] and Guidance Document]
SAS (illuxu�urns�ze of heel 6r6field 5000'gZ�d)
minimum 2 distribution lines [310 CMR 15.252(2)(a)]
Maximum separation between lines 6' [310 CM R15.252(2)(d)] L;
Maximum separation between lines and outside of bed 4' [310 /
CMR 15.252(2)(e)] V
Aggregate depth below discharge pipes 6" minimum, 12"
maximum. [310 CMR 15.252(2)(g)]
Separation between beds 10' minimum. [310 CMR 1.5.252(2)(0]
Bottom area used in calculations only [310 CMR 15.252(2)(1)]
Address C.
To Sheet 5 of 7
N/A OK NO
Pressure Dosed Sy stern ? Provided pump and piing
.� ..,..... �.. ,..
calculations as'required [310 CMR I5.220(4)(r)]
Pressure dosing required on all systems >2000gpd or alternative
systems under remedial approval [310 CMR 15.254(2) and I/A
Remedial Use Approvals]
If used in gravelless system - make sure jet is directed as not to ,.
scour soil interface [Guidance Document]
Inspections once per year (systems< 2000 gpd) or quarterly
(>2000gpd) good to note on plan [310 CMR 15.254(2)(d)]
Construction in fill - Did the plan specify that the fill shall meet /
the specification of 310 CMR 1.5.255(3)? ✓
hnperVIOUs barrier and/or retaining wall ? [Guidance Document]
hpervious barrier installation must be supervised by
designer [310 CMR 15.255(2)(b)]
Retaining wall must be designed by Registered Professional /
Engineer [310 CMR 15.255(2)(a)] f/
Side slope not exceed 3:1 ? [310 CMR 15.255(2)] V
Breakout requirements met? [31.0 CMR 15.252(2) and
Guidance Document]
At least 5 ft. from impervious barrier to edge of SAS (10 ft.
reconunended) [310 CMR 15.255 (2)(e)]
Check DEP Approval letters for credits and design conditions v
If used with pressure dosing do not allow pressure discharge
to scour soil interface
Al ernritri e'S_e tzc Systei�i[I/A AP-W"l Letters] y$ ''y h n
Was DEP Approval .Letter provided and/or have you
reviewed the letter for conditions?
Is the teclunology being properly applied and does it meet all
DEP Approval Conditions?
Is there a note on the plan regarding the requirement for
perpetual maintenance agreement? v�
Any alarms involved on separate circuits '
Did the applicant submit an operation and maintenance
manual?
Has applicant submitted a copy of a maintenance
Are the variances listed on the plan ? [310 CMR 15.220
(4)(q)] ,/
RLS Stamp necessary on plan if a component is within five
feet of property line [310 CMR 15.412(4)]
New construction or increased flow proposed - [Refer to 310 VZ
CMR 15.414]
Address �C� i t A
Sheet 6 of 7
N/A OIL NO
1s the system in a Designated Nitrogen Sensitive Area (Zone II for
a public supply well)? [310 CMR 1.5.21.4, 310 CMR 15215 and
310 CMR 15.216 - also refer to Policy regarding upgrades of such
existing systems]
Is the system proposed on the same lot as served by private well ?
[310 CMR 15.214(2)]
Are the nitrogen loads proposed in compliance? [310 CMR
15.216(1)]
Pumping to septic tank ? [ 310 CMR 15.229]
Shared System [310 CMR 15.290]
Address CSC C � sly, C Sheet 7 of 7
Town of Barnstable
�FTHE T
Regulatory Services
Thomas F. Geiler, Director
* BARNSTABLE,
9 MASS.i639• Public Health Division
��
Thomas McKean, Director
200 Main Street,Hyannis, MA 02601.
Office: 508-862-4644 ti Fax: 508-790-6304
Installer& Designer Certification Form
Date: ;
Designer: Shay Environmental Services, Inc. Installer: ���, &Z—
Address: P.O. Box 627 Address:
East Falmouth, MA 02536s ., ;
On �j CPY,3A�')cyvJ was issued.a permit to install a
da ) (installer)
septic system at (�o� S( Go i C�l'T' based on a design drawn by
(address)
Shay Environmental Services, Inc. dated, '��1
(designer) r 1
_X 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.
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.
_ZN OF lvlgs F
O� CAR VII S
cP .
(Ins er's Signature) E.
c0� U'1
No. 1181
GIST E��
s Pia
Desi 06e ignature) (Affix Desi p Here)
PLEASE RETURN TO BA ABLE 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
Town of Barnstable P# �3v
Department of Regulatory Services
Public Health Division D 1-2-111161MASS. ,I ate
�39. t 200 Main Street,Hyannis MA 02601
Date Scheduled- ? /J Time Fee Pd.. Uu
,- Soil Suitability Assessment for Se age ispa�"0
Perfoc r�74 By: Witnessed By: es
LOCATION& GENERAL INFORMATION
Location Address (� Owner's Name � 'en}_SH"C44
C-`\--) ;7 Address S A M'E
Assessor's Map/Parcel: V %OU s Engineer's Name C A Q-1-NE V-4 Sam
i
NEW CONSTRUCTION REPAIR .-k Telephone# fso P,
i
Land Use l Cti� Slopes M. �5% Surface Stones
Distances from: Open Water Body _ft Possible'Net Area. 'ft Drinking Water Weir A) A- ft
Drainage Way y�� ft Property Line aZ ft Other ft
SKETCH:(Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands fin proximity to holes)
�>LS
av5t.
Parent material(geologic) 0 Depth to Bedrock r" A�
1 h
Depth to Groundwater. Standing Water in Hole: I a (-SS ONYtC` Weeping from Pit Face
Estimated Seasonal High Groundwater �t Of- 1)-1 y rt SSt l 2G�
DETERMINATION FOR SEASONAL HIGH WATER TABLE
Method Used: ►,�1 A
Depth Observed standing in obs.hole: —— in. Depth to Soil mottles: in.
Depth to weeping from side of obs:hole: in. Groundwater Adjustment fr.
Index Well#—_ Reading Date: Index Well level s— Adj,factor,,,,,.m,g Adj.Groundwater bevel,,
PERCOLATION TEST Hate Tlnte 1, ba
fo-
Observador-
Hole# � 'time at 9"
u
Depth qfc Perc _�� L'p,V Time at 6" r� y
Start•P a-soak Time @ I I 'lime(911-61)
End Pre-soak L-0 L4
Rate MinJlnch La M Pl
Site Suitability Assessment: Site Passed Site Failed: Additional Testing Needed(Y/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 Conservation Division at least one(1)week prior to beginning.
Q:\SEPfIC1PERCFORM.DOC
DEEP.OBSERVATION HOLE LOG Hole# t
Depth from Soil Horizon Soil Texture .Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders.
Consistency,% ravel
LS
,. C� M _e are o
P
DEEP OBSERVATION HOLE LOG Hole# r
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders.
Consistencv.
(�- 6A a�
n
Cow L
y q'1 L S�0
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.
Con i t
.r
Flood Insurance Rate Man:
Above 500 year flood boundary No_ Yes
Vol ,
Within 500 year boundary No Yes
Within 100 year flood boundary No_ Yes
Depth of daturally Occurring Pervious Material
Does at least four feet of naturally occurring perviigu�s material exist in all areas observed througho:ttt�he
area fir posed for the soil absorption system? Ye— , }
If nce what is the depth of naturally occurring pervious material? _.
Certification
I certify that on i C- I (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 training,e I ience described in 310 CMR 15.017.
Signature Date i
Q:\SEPTICVERCFORM.DOC
No....V.__-�____- Fms.....1.. ....... _
THE COMMONWEALTH OF MASSACHUSETTS
�D BOARD OF HEALTH
............. .........................OF...........-.--............-......-...._._..-...
a ' Applira#ion for Disposal Workii Towitrurtion ramit
Application is hereby made for a Permit to Construct ( ) or Repair ( an Individual Sewage Disposal
System at:
,�—
cat n-Address or Lot No.
•---.......: V--n---- 1. --------------------------------------- ------------------------------------------ ------------•-------------...-----------------
W MACO W 6 E� Address
..............•-••-f._...-- � �----------------------.....------ ----:.._._..----------------.....---------.._....................------.......------.....---------
Installer Address
Type of Building Size Lot............................Sq. feet
aDwelling—No. of Bedrooms. ____ ______________Expansion Attic ( ) Garbage Grinder (1440
aOther—Type of Building _:. _!1?.. No. of persons____________________________ Showers ( ) — Cafeteria ( )
Ot _ xtures --------------------------•------------._....-•-------.••-•-•-••-••--•••---•••-------- ..............................................................
W
Design Flow...... _________________gallons per person per day. Total daily flow............................................gallons.
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 ( )
Percolation Test Results Performed by.......................................................................... Date:........................................
Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water_______________________.
(%4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
P4 ---•----•-----•---------•..............••--••-•---------....----•---......•-•-•----------...._....--......-.---------------___""------._...................
O Description of Soil___ ' �1D
x --------------------------•--...........--•-----•--••-•--------------------------------------•----------------------------------...._•---••---•-
W
x -•••••••--••----------------••-----•----•---•-•----••-••----------------------------•-•....--•••-•••-------------•---•--•------------••--•-.---.--•-• •-•• nq
U Nature of Repairs or Alterations—Answer when applicable....... '1_`� _.. �01..___._)_ ,_e�'►__�? .___.
...-------- -------------•--------------------------•-------•----------------.....---------•• ..........................................................
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TITHE 5 of the State Sanitary Code—The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has bee ssue the o r of health.
S.
e •--••-• -•--••--•-_ - • -......................'............................. ................................
at
Application Approved By :...C..�I-( ---. ...= =--
ate
Application Disapproved for the following reasons________________________________________________________________________________________________________________
-•-•-•---------------•-----•-------------...-•--••-•-------------•-------------------........------------I-•.._.__...•••-••-•••-••-•-•-•----••--•-•••--•---••--•-••-•----•••--•------•••-•-----•••••-•---
Date
PermitNo.......................................................- Issued_.......................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
..... ......._................O F......................... ...........
ApplirFatiou for Rapos al Works Tonstrnrtiun rrmi#
Application is hereby made for a Permit to Construct ( ) or Repair ,•-) an Individual Sewage Disposal
System at
_ -- ...............••-••••...........-•-._..........••-•--
Locatiion-Address or Lot
No
g O
Installer Address
Type of Building M— Size Lot............................Sq. feet
Dwelling—No. of Bedrooms....... '""""'"":�:.......................Expansion Attic ( ) Garbage Grinder (t41)
pal Other—Type of Building ... 2i?s... No. of persons............................ Showers ( ) — Cafeteria ( )
P4 "-" Other fixtures .----•------------------------•-- ------
W Design Flow...... ......................gallons per person per day. Total daily flow............................................gallons.
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. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................
fZo Test Pit No. 2---_-----..-_-minutes per inch Depth of Test Pit:................... Depth to ground water........................
P4 ----•--------------------------•--...,-•-------•---•----•--••--....---•-...............-----.....---................
D Description of Soil...:7:w ��. -?-........... ---•
W ----••-••-----•-•-•--•-••-•--------•-•••--•----...---•------•--•..0.....--•--•--... ----•-------••-------------•--•----------•--•... ----------------...------•-•--•. ....•....-----
UNature of Repairs or Alterations—Answer when applicable_--__ .. ?.__._.24 �tkt_.._.__t _ +. ......
-----------------------------------------------------------------•---------......••..........------_....: .
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 and_rsigned further agrees not to place the system in
operation until a Certificate of Compliance has bee issue E the Aoar of health.
Signed { r� . ! _....
�• „ ^ ti•�i• -- Date•
Application Approved By----•- t `I1_t.� - "..--- -- ate
Application Disapproved for the following reasons---- ------------------------•--------------------------•--------------------........------•--••-----••--••----
--.........•--•--•..................•-••--------•••------•-•--•----------•••••---•-••------............--••-------.......-----•------•--•--•----•----•-----=-------•-----•----.........................
Date
PermitNo......................................................... Issued....................................................... "I
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
..........................................OF..........................................................................
Tatifiratr of Tomplianir
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired (
b -A-_,tea I .
.......................
Installer
at.........1- 1.. ----. y� ---•-•---
has been installed in accordance with the provisions of TITLE 5 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.
3
DATE ..J. ..._..._... .................................. Inspector...................
-................ ............................................................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
...................
>,IV, FEE. ..
i ern �t1 %#,r-1JC_)
11Q.,vustrnfirrn amit
Permission is hereby granted...... "_:;_.. .
to Construct ( ) or�Repair ( ) an Individual Sewage Disposal System
Street ,
as shown on the application for Disposal Works Construction-Plermit.,,No�:. �...." .......................
fy
2 //�� Board of Health
DATE.--------_ j!
FORM -.1255 A. M. SULKIN, INC., BOSTON -
LOCATION SEWAGE PERMIT NO. \
V-tl L A G E 4, -6-
®A&
INSTAALLL, EIt's NAME ADDRESS.
R U I L D E R OR OWNER
DATE PERMIT ISSUED
DATE COMPLIANCE ISSUED _
�\ tee( \
o�
c�
3-24" pIAM. ACCESS MANHOLES
SECTION A --A ,D' -6 Ewa
fr
VEN
.. .,..
.{�:•. " a ..';+.•^'.a1' •_.r,°r:.::.._.•..♦ ....•�: dt tr �'�. 4,�,q a�
yy
r 1.
If r
Schedule 4d Least
2 arcoal Odor Filter
1n
10' min. from NOTE: ALL PIPES ARE TO BE 4" SCHEDULE 40 P.V.C. PIPE PROFILE VIEW OF LEACHING SYSTEM 1� �' x
Existing Foundation house to septic tank NOt t0 Scale INLET -�
TOP OF FOUNDATION = ELEV. 100.00 Assumed Septic tank covers must be D-80x cover must beINLET / ` / ` / oU ET s %
within 6 in. of finished grade wn 6" of GRADE 3" 0 1 Q" - 1 2" Washed Peastone 4 ` THE ACCESS GONERS FOR THE SEPTIC TANK,
Grade over Septic Tank - 9&00 3 HOLE H-10 Grade over D-Box - 98.50 rode over SAS - 99.50 f / / "
"I I ` DISTRIBUTION BOX AND LEACHING COMPONENT '
DIST. B0� 3/4" to 1 1/2 " Washed Crushed Stone _.- ` ,
.. ,..r....",_, ....�'•; SHALL BE RAISED TO WITHIN 6" OF
n.,+ '•. ^T'.•,• e; •. ,., FINISHED GRADE.
s = 0.02 rs „ r ON ALL OUTLET TEE ENDS $gym . _ �-. F
„, 4 PVC (CAPPED) INSPECTION PORT TO BE STEEL REINFORCED PRECAST CONCRETE INSTALL TUF-TITE GAS BAFFLES OR EQUALS 1
y. n V
NEW PIPE ca N 1,500 GAL o 35' S= Per foot MaximumCover Top OF System- Elev. =95.75 ' PLAN VIEW sM1 _.-- , d ;,....,,,,•"�"b .�� �r'"
o t0' NEW s=o.ot or Greater INSTALLED AND TO BE WITHIN 6 OF GRADE I
0.01"
FROM EXIST, FpUNDATIDN a, SEPTIC TANK o 3-24" REMOVABLE COVERS
(D
II rn N O 5
> H 10 ca"eam" I
CONCRETE FULL FOUNDATIO y lI. N
II ui °' 0 2 EFFECTIVE DEPTH :•a
W
w,•
'} ' 3 min. clearance `
SYSTEM PRQFILE
6 In.of 3/4"-1 1/2" II > 24 Effect2ve INLET e" min_��K_min. inlet to outlet g"min. ' "' '"`ETA` GENERAL NOTES
compacted atone i y �, a' 4 J 4 i S2de`�all INLE LiquiaTevel u• OUTLET
1D"m�. •:
Not to Scale - c I} 12,
'c ,; u 3 Units 2 7' = 21' S' -7" `� - L__ �, s' -7" 1. Contractor is responsible for Digsafe notification, VERIFICATION
- Effective width y ;. E r' and protection of all underground utilities and pipes.
3i 4'-0" min, p 9 p P
6 In.of 3/4"-1 1/2" p ae'i 1 - c Co. • Uqutd depth 2. The se tic tank distribution box shall be set
compacted stone a 3,5 3r5 �� level on 6" of 3 4'-1 1/2" stone.
° m Effective Length +'• 3. Backfill should be clean sand or gravel with no
B, ,.,,.�'" ^'••;' 'r a,; Y: ',',•. `• :' '1 stones over 3" in size.
NOTE: SEPTIC TANK & D-Box TO BE CONSTRUCTED ON LEVEL COMPACTED BASE w Bottom of Test Hole 2 Elev.- 87.00 10'-0" 5' -g 4. This system is subject to inspection during installation
__ ___ __ CROSS SECTION END-SECTION by Carmen E. Shay - Environmental Services, Inc.
NOTE: ALL COMPONENTS MUST HAVE RISERS TO WITHIN 6" BELOW GRADE Groundwater Observed - NONE OBSERVED SOIL A B S 0 R P T I0 N SYSTEM (SAS)S) - 5. The contractor shall install this system in accordance
With Title V of the Massachusetts state code, the approved plan
CULTEC 3050 INFILTRATOR CHAMBER H--20 (OR EQUIVALENT) TYPICAL 1500 GALLON SEPTIC TANK and Local Regulations.
NOTE: OVERALL HEIGHT OF INFILTRATOR IS 30" /EFFECTIVE HEIGHT IS 24" NOT TO SCALE 6. If, during installation the contractor encounters any
soil conditions or site conditions that are different
(H- 10 LOADING) from those shown on the soil log or in our design
installation must halt & immediate notification be
made to Carmen E. Shay - Environmental Services, Inc.
7. No vehicle or heavy machinery shall drive over the
P E R C O LAT I O N TEST septic system unless noted as H-20 septic components.
LOCAL UPGR8DE APPROVAL VARIANCE REQUESTED 8. Install Tuf-Tite gas baffles or equals on all outlet tee ends.
Date of Percolation Test: JANUARY 27, 2010 9. All Distribution Lines shall be 4" diameter Sch. 40 NSF PVC pipes.
Test Performed By. CARMEN E. SHAY, R.S., C.S.E. 10. All solid piping, tees & fittings shall be 4" diameter
1. REQUEST A LOCAL UPGRADE APPROVAL TO DOUBLE SLEEVE Results Witnessed By. DAVID STANTON -BARNSTABLE BOH
EXCAVATOR: Shay Env. Svcs. Schedule 40 NSF PVC pipes with water tight joints.
SEWER LINE 10 FEET EITHER SIDE OF EXISTING WATER LINE LEWIS POND Percolation Rate: <2 MPI 0 30" 11. MUNICIPAL WATER IS AVAILABLE TO THE SITE and Surrounding
WITH 6" SCH. 40 PVC. TO BE SEALED 0 ENDS OF SLEEVE. / Properties WITHIN 150 FEET of PROPOSED SAS
Test Hole Test Hole
No. 1 No. 2
DEPTH SOILS ELEV. DEPTH SOILS ELEV.
o 99.50 o 99.00 THE PROPERTY LINES ARE APPROXIMATE AND
EDGE O ---- - - ----'' �� Sandy Loam Sandy Loam COMPILED FROM THE PLAN BY DAVID GREEN, RLS OF BARNSTABLE, MA
10 YR 3/2 10 YR 3/2 MA, ENTITLED "PROPOSED DRAINAGE PIPE EASEMENT IN COTUIT, MA
EDGE OF ETLANDS 0"-6" AB 99,Qp 0"-6" Ae 98.50 FOR THE TOWN OF BARNSTABLE" DATED NOV. 1975, BOOK 301, PG 87
72 rl AND IS NOT INTENDED TO BE A SURVEY PLOT PLAN
\ �.' Loamy Sand Loamy Sand IT SHOULD BE USED FOR NO PURPOSE OTHER THAN
74 \\\\ �.' i cc THE SEPTIC SYSTEM INSTALLATION.
10 YR 5/6 10 YR 5/6
6"- 30" B w 97.00 6"- 30" B w 96.50
i' c� lr Med-Coarse Med-Coarse
20.00' �� i Sand Sand NOTE: ANY STRIPPED OUT SOIL CONTAINING LEACHATE
76 ------- _ _ __-�� X 1`P�'+ 25 Y 7/4 2.5 Y 7/4 FROM THE EXISTING LEACH PIT TO BE DISPOSED
Z i �, 36"-144" C, 87.5D 36"-144" C, 87•00 OF AS PER BOARD OF HEALTH SPECIFICATIONS.
78 ---- _ Ld _
I
FILLEDEXISTING J LEACH PIT TO BE PUMPED DRY &
_ \
\
LLJ \
ASSESSORS MAP 020 LOT 068
44 ZONING - RESIDENTIAL
< `.� `� \ o k Perc #1
M Depth to Perc: 30" to 48"
\` o Perc Rate= <2 MPI
86-------- Ld + �� ��� N NO Groundwater Observed 0 144"
` ® z co �� `� ADJUSTMENT = NONE ,
WETLANDS ARE LOCATED WITHIN A 200 RADIUS
88--_.__w Co q` �� �`. p No Observed ESHWT OF THE PROPERTY ARE AS SHOWN. SAS IS LOCATED OVER 100'
q
FROM WETLANDS ASSOCIATED WITH LEWIS POND.
°�
9O1`- M `I` ALL OUTLET PIPES FROM THE
DISTRIBUTION BOX SHALL BE
SET LEVEL FOR AT LEAST 2 FT. 12"
a9�. CONCRETE COVER
\\ �\ \ `•�\-LOT
\ �� \\ \\ r.,. 3 - 5' OUTLET Pr.ro a r,r, 2 LEGEND
\ �\o -Lol #18` �� \� `�80 KNOCKOUTS
82 _ J OUTLET 12. INLET DENOTES PROPOSED
9,388 Square Feet +/- `�\ . \���
6" 88X0
2 SPOT GRADE
207 90'��� �`� ��� 15.s"
4" - �aGH. 40 Te t.75"
\\\ ` 84 P� AN SECTION �RQS-SECTION X 104.46 DENOTES EXISTING
SPOT GRADE
86
88
3 HOLE H-10 DISTRIBUTION BOX pL PROPERTY LINE
Failed � \�'^ -- 90 PROPOSED CONTOUR
a ^ Cesspool
6y 1q ��\
Failed ___ 4 Des IC lotions 97- - - - ` --97 EXISTING CONTOUR
q _Leach •P;t- - - ---
\`� o - PERCOLATION DEEP TEST O EST cLOCATION
96 Number of Bedrooms: 3 Bedroom EXISTING "~
Garbage Grinder: No ------ FENCE
SUN Leaching Capacity Required: 330 Gal./pay (MIN. PER TITLE V)
` ROOM Septic Tank - 2 x 330 Gal./Day = 660 USE NEW 1,500 GAL. Septic Tank.
�-\ _-, SOIL ABSORPTION AREA: Using percolation rate of <2 min./inch - - PRIVATE DRINKING WATER WELL
8.00�� Bottom Area: 0.74 gal/sq, ft. x 336 sq. ft. = 248.64 gallons
----- ---98 Sidewall Area: 0,74 gal./sq. ft. x 160 sq, ft. = 118.40 gallons REVISIONS
J ¢ EXISTING �' Providing: = 367.04 gallons
1 > 3 BEDROOM 100 Use: (3) 3050 H-20 INFILTRATOR CHAMBERS,,HAVING A 2' EFFECTIVE DEPTH, NO. DATE: DEFINITION
Q HOUSE (4' W x 7' L) TO BE USED WITH 4' OF WASHED STONE ON THE SIDES AND
l #192 r 3.5' OF WASHED STONE ON THE ENDS. 1 2/16/10 design caICs
10
10
01
r- ' TEST HOLE #2
p � � ELEV.= 99.00 I
M o O 20 ; PROJECT BENCH MARK
I o q•j
p t TOP OF FOUNDATION PROPOSED
ELEV. - 100.00 (Assumed)
( 11L5' r, t PREPARED ORo
3 r •ii •S•..•i.r: ,,
..: , 'r,'r W "''S4'1�,' '`•sad'"; N
I o I dir"'"�"•vR,.ys }tr ui^.Cr.eir'?..e!:�M+ VP:'IQt
1 • 'r 12'PiA SUBSURFACE SEWAGE DISPOSAL SYSTEM
I I 1 D-Box •""t.R+ rA`$.i t
r•.4 ,h iMr;'h.%1W Ns Al.T (13i
( i I 14.5' 28 o' \ 0 F
l20"°° ELZABETH M . SHEA
192 SCHOOL STREET
15 7' TEST HOLE #1 `�
j 100.00' ELEV.= 99.50 �� COTU IT, MA
98___fi--------I- N 89D 05' 55" W -�
15 GAM ELI N STREET
-------------------------------------- __ - ___t =t___----___----__--_ _____----------_-___-_ _ H YOK , MA 0 1 1 04 R PREPARED BY.
OL E _
CATCH - ---____ ____ / �OrA
BASIN ,s C O O"L, S T�EE T PHEY E. SHA Y
off ` ry ,v 4 ENVIRONMENTAL SERVICES, INC.
(40 FOOT RIGHT OF WAY)
E'a
`^I 31
1 1 1 THORNBERRY CIRCLE
4 PIPE TO BE DOUBLE SLEEVED Ti- MASHPEE MA 02649
WITH 6 SCH 40 PVC
10 FEET EITHER SIDE OF WATER LINE � s� ,I Fr�,.y.
SLEEVE PIPE TO BE SEALED AT EACH END TEL/FAX 508-539-7966
SCALE: 1 "=20' DRAWN BY: CES DATE: NOV. 11 , 2009
PROJECT#SD-1 161FILENAME: SD1 161 PP.DWG SHEET 1 OF 1