HomeMy WebLinkAbout0250 BEARSE'S WAY - Health 250 Bearse's'Way, Hyannis
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TOWN OF BARNSTABLE
LOCATION SEWAGE#
VILAGE S ASSESSOR'S MAP&PARCEL
INSTALLER'S NAME&PHONE NO. • Oki C� �-,,-aAA X- J!gi_ VP
ex 13`E
SEPTIC TANK CAPACITY C� T� p(�o X
LEACHING FACILITY: e ,�0 �.l_ C�,o,, ►bY size X
(type) ) 3 �
NO.OF BEDROOMS k
OWNER
PERMIT DATE: C��f1 ( Ig COMPLIANCE DATE:
Separation Distance Between the: AKI
Maximum Adjusted Groundwater Table to the Bottom of L'`eaching Facility P 14rR.r Feet
.Private Water Supply Well and Leaching Facility(If any wells exist on r
site or within 200 feet of leaching facility) N f Feet
4` Edge of Wetland and Leaching Facility(If any wetlands exist within !
300 feet of leaching facility) Feet
FURNISHED BY D A �( ~
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a�:_ _ _,
No. Fee
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes
ftpliLation for Misp8_4*pstrm Construction Permit
Application for a Permit to Construct( ) Repair( V/Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components
Location Address or Lot No. LG.«S w��/ Owner's Name,Address,and Tel.No.
Assessor's Map/Parcel (S Y _r � e" V\(b y
Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No.
S c od Fc ram,V� t 3 b c d Xr- �c�� !z *C c. P, a C3 G x - .►3
Cj cl6
Type of Building:
Dwelling No.of Bedrooms �--` Lot Size isle sq.ft. Garbage Grinder( )
Other , Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow(min.required) TC{ (� gpd Design flow provided $f P gpd
Plan Date c3 7 los Number of sheets Revision Date
Title
Size of Septic Tank 1 O 0 t iaa0 ®B OLType of S.A.S.?LC L C
Description of Soil
Nature of Repairs or Alterations(Answer when applicable) �P �c %� W�-0� L�e-GCA" a-r�
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 ealth.
Im
S' ed Date ''+'..
Application Approved by Date I o
Application Disapproved by Date'
for the following reasons
4
Permit No. Date Issued
f�`nivil'.Yb�y1"`heyq;; i3��r^�",Syr;p"�'�i,,�{!yj3�"i�PheSNir:[�v"�t6wt'='ka"5�.�;f+r'++i' `:y;;.`.y1'9h.-'1:,;•c.r- .w.4"�,,�W,�il+RTY:�i�.�.�i".;i»+b.'x�..x_,i•1,,:.r-s.�n:� i�t�.'.'Y✓3
No. � �l� ���/ Fee
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes
Zipplication foris !.Lopstem Construction Permit
Application for a Permit to Construct( ) Repair( V/Upgrade( ) Abandon( ) ❑Complete System El Individual Components
i
> Location Address or Lot No. 1�3 rx.(uS' I. C-IC Pwrier's Name,Address,and Tel.No. '
), ,��-s •.t * .e V v b
tv
Assessor's Map/Parcel 310, 1 I Y
Installer''�s Name,Address,and Tel.No. f Designer's Name,Address,and Tel.No.
3 0 t� ��t awC���.R S'�C.�1 C, tcF G.G�S p. 0 V3 a-X
2 G4 F
Type of Building: r -
Dwelling No.of Bedrooms �-� Lot Size G sq.ft. Garbage Grinder( )
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures y-
Design Flow(min.required) sq Q Q gpd Design flow provided �� G P� ~~ gpd
Plan Date )a-) I Number of sheets Revision Date
Title
Size of Septic Tank (Z !O 0 t_ll NUfj ®BO(Type of S.A.S.?LC 1P
Description of Soil /
Nature of Repairs or Alterations(Answer when applicable) c���� A t ��d�1�� �.��i; GL,\ C,-(
:�7
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 ealth.
S'gned Date I
Application Approved by Date _�� `}
'Application Disapproved by Date
for the.following reasons
Permit No. / Date Issued IV/� 1
---------------------
THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE,MASSACHUSETTS
Certificate of Compliance
THIS JS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired Upgraded( )
Abandoned( )by t�
- at Q-Pc,t �_� cy ���4 n r, has been constructed in accordance f
with the provisions of Title 5 and the for Disposal System Construction Permit No.P/,J`- -C 5dated z-v /� 9-
Installer �C� � ,�/�� Designer S•MJQ_ tAac s
#bedrooms Approved design flow gpd
The issuance of this perm/it shall
/�pot
Qb'e construed as a guarantee that the sy�e fu~nct as de igned.
Date 'f //P// O Inspecto`r`—...,L r
No. r �(J "`CA r Fee
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS
bisposal *pstem Construction Vermit
Permission is hereby granted to Construct( ) Repair( LK Upgrade( ) Abandon( )
System located at �� C.C'`i-e S UDC, 1±V c 4
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 com leted within three years of the date of this p rfn° it.1
1 / J
Date / j� Approved by
_�,� .. �,
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3
Town of,Barnstable
Regulatory Services
Richard V. Scali,Interim Director
,A81�3tAD,i, .
Public Health Division
Thomas McKean,Director
200 Main Street,Hyannis,MA 02601
Office: 508-8624644 Fax: 508-790-6304
Installer& Designer Certification Form
Date: Sewage Permit# a4sessor's Map\Parcel,3 f 0 J
Designer: ST>dP i{F_tJ k k A kS, Installer: 544 t l A-
Address: 7� tom• "1So'X tL-, Address: QS oc,-:ts.
soya `��,�e� �,1� N,?A>JQ t s . k A. 02ko.I
/ o Zl&o
On / T` � � was issued a permit to install a
(date) (installer)
septic system at c M �I CZ,S_S 6 �� kA� 1lased on a design drawn by
(address) j
dated 2 /- �� '
(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. Strip out (if required) was inspected and the soils
were found satisfactory.
I certify that the septic system referenced above was installed with major changes (i.e.
greater than 10' lateral relocation of the SAS or any vertical relocation of any component
z of the septic system) but in accordance with State& Local Regulations. Plan revision or
certified as-built by designer to follow. Strip out(if required) was inspected and the soils
ri were found satisfactory.
I certify that the system referenced above was constructed in "` _ ! ce with the terms
of the I\A approval letters(if applicable)
f#
(Installer's Signature)
(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:ISepticZesigner Certification Form Rey 8-14-13.doc
! Town of Barnstable Pit
Department of Regulatory Services
$ �
Public Health• zvawa-reaf�a D1Vi8i0II Date r'
MA"
200 Main StroaI.Hyannis MA 02601 n;i
Date Scheduled �/�4
Time Fee Pd._ U
Soil Suitability Assessment for Se age Disposal 'xTay
s�-P�
Perforntcd•Hy: Witnessed By:
LOCATION&.GENERAL INFORMATION
Location Address • �1�"b fir' _y Oymer's Namo �Q� �'�lq,
Address 7
Assessor's Map/Parcel: ` �'�� /b 3 Bngincer's Namo
i NEW CONSTRUCTION REPAIR Tele•hone#
Land Use• Slopcs(96) L 2— Surfkco Stones I o
Distances trom: .:Open Water Body -- ft Possible Wot Ares.._ ft Drinking Water Well ft
Drainage Way ft Property Une ft Other ft
SKETCHt(Street name,dimensions of lot,exact locations of test holes&poro tests,loeato wetlands in proximity to holes)
Tj
Parent material(geologic) Depth to Hedrook
Depth to Groundwater. Standing Water In Hole: N Ik_ Weeping item Pit Feoe
Estimated Seasonal High Groundwater 1-S AL
DETZRAIINATION FOR SEASONAL'BIGH WATER TABLE
Method Used: 1,--
Depth Observed standing in obs.hole: In, Depth to loll mottles: In.
De�th to weeping from side of obs,hole: _ _In, •Groundwater Adjusttdent ft.
Index Welly ReadingDato:_ index Wall Imval �„ AcU,theist*Adj.Groundwatpr•Level,._
,TES-7I'--...r-._-_I)me L.._,!
Observation
—
Hole# ' Time at 9" ....._;_,. _
1t
Depth of Pe Tlme at 6"
ro ,
+ Start Pro-soak Time @ U'°C Time(9"•611
)
+ End Pro-soak Grl J:ou
Rate Mln./Inoh , Z
Site Suitability Assessment: Slid 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:\SBPTIC\PBRCFORM.DOC
DEEP.OBSERVATION HOLE LOG Hole# I '
Depth from Sall Horizon Soil Texture Shc1 Color Sall. Other
Surface(In.) (USDA) (Munsell) Mottling (Structure,Stones;Boulders.
' isietencyL%'Oravell "
Z� b L S to tA- it j
DEEP OBSERVATION HOLE LOG Hole# Z
Depth from Boll Horizon Sall Texture Soil Color Sall Other
Surface(In.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders.
ct L S ' to VOL_ 3/Z-
to
20 ` C 1-�1-� S�jr1> toy,,-
• 'A
'. DEEP OBSERVATION HOLE LOG Hoh#
Depth from' Soil Horizon Soil Texture Sall Color Sall Other
Surface(In.) (USDA) (Munsell) MotUing (Structure,Stones,Boulders,
DEEP OBSERVATION HOLE LOG Hole#
Depth from Sall Horizon Soil Texture Sall Color Boll Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones;Boulders,
Flood Insurance Rate Matt:
Above 500 year Mood boundary No— Yes
Within 500 year boundary No✓ Yes '
Within 100 year flood boundary No.,� Yds" i
peuth of Naturally Occurring Pervious Material
Does at least four feet of naturally occurring pervious mtiterial exist in all areas observed thrpughout the
area proposed for the soil absorption system?
If not,what is the depth of naturally occurring pervious matorial?
Ceftificati r �V/
date I haveed the soil evaluator examination approved by the
I certify that on � � ) pass*
Department of Environmental Protection and that the above analysis was performed by me consistent with .
the required trainl xperdse and experience described In 410 CM .15.017.
Signature Datts 3
Q.xSRFn0PERCPORM.DOC
7
( " SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION PORK '
Address of property QeirS FS !y-
Owner's name Ann Hole Esf�7e
Date of Inspectionkzu Q*
PART A oD JUL 9 1 �a
CHECKLIST
Check if the following have been done:
-VPumping information was requested of the owner, occupant 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
system recently or as part of this inspection.
As built plans have been obtained and .examined. Note if they are not
available with N/A.
The facility or dwelling was inspected for signs of sewage back-up.
V The site was inspected for signs of breakout.
✓ All�• system components, excluding the SAS, have been located on the ite.
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.
The 'size and location of the SAS on the site has been determined based
. on 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.
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
SYSTEM INFORMATION
FLOW CONDITIONS
If residential
number o fl bed rooms h o fe ;
number ofIcurrent residents
Aly �g�ar^bage ,grinder, yes or no-
,01a.u�ndr .0-1 -connected to system,
Yyes or no
seasonal use, yes or no
If'nonresidential, calculated flow:
r
Water meter readings, if available: .
pcc�piL'`�
Last date of occupancy
GENERAL INFORMATION
Pumping records and source of information:
- 4,pPIoX ?iV��r�"S uo kL�ord,'. v f� p"/n
- ' A✓yuSr /�190 a«�i".4 ado
f ,,Jrrlo 'wy /ecOr�S ro..i.7
_✓10 System pumped as part of inspection, yes or no
if yes, volume pumped
Reason for pumping:
Type of system
✓ Septic tank/distribution box/soil absorption system
Single cesspool
i Overflow cesspool
Privy -
Shared system (yes or no) (if es attach
records, if any) Y previous inspection
i
Other (explain)
Approximate age of all components. Date installed, if known. Source of
information:
sue, 'ferry /h Aez/AIV
Sewage odors detected when arriving at the site, yes or no
9
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
SYSTEM INFORMATION continued
SEPTIC TANK:
(locate on site plan)
depth below grade: �� ��
material of construction: ✓ concrete metal FRP. other(explain)
dimensions: n X Y"r
a 3 sludge depth
31 distance from top of sludge to bottom of outlet tee or baffle
scum thickness
�'►" distance from top of scum to top of outlet tee or baffle
��. distance from bottom of scum to bottom of outlet tee or baffle
Comments:
(recommendation for pumping, condition of inlet and outlet tees or baffles,
depth of liquid level in relation to outlet invert, structural integrity,
evidence of 4leakage/, rec/ommendati s for /repairs, etc. ) /
A/>OP4l- To 6� i Gi0✓�X L,� +a� .J�7
DISTRIBUTION BOX: ✓
(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.)
, K'. ny►L o�7 P� d;o�
PUMP BER:
(locate site plan)
pumps in ng order, yes
Comments:
(note condition of p chamber, con 1 of pumps and appurtenances,
. recommendatio or maintenance or repairs,e
f _
• 4
! .l 0
. SUBSURFACE SEWAGE DISPOSAL, SYSTEM INSPECTION FORM
PART B
SYSTEM INFORMATION continued
SOIL ABSORPTION SYSTEM (SAS) Irac�
(locate on site plan, if possible; excavation not required, but may be
approximated by non-intrusive methods)
If not determined to be present, explain:
ype
V-Tleaching pits and number O"e - IV005 L�
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 mainten ce or repairs,etc. )
Tn oho, f' '1 6 /vim✓ g���/t •a�
4 PgI e /
CESSPOOLS (locate on site plan) :
number figuration
depth-top of liq o inlet invert
depth of solids layer
depth of scum layer
dimensions of cesspool
materials of construction
indication of groundwate
inflow (cesspool mu a pumped as
I
part of inspect )� .
Comments• -
(not ondition of soil, signs of hydraulic failure, level *of ponding,
co dition of vegetation, recommendations for maintenance or repairs,etc. )
PRIVY:
(loca n site plan)
materials of constru
dimensions
depth of solids
Comments:
(note cond' on of soil, signs of hydraulic failur evel of ponding, 1 Condit of vegetation, recommendations for maintenanc r repairs etc. ) --�
i
- • SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
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'
ra4�
A 0 J
A 13
3 3' /7'
3
y y8�� 3qs o y
DEPTH TO GROUNDWATER
depth to groundwater
;:.method of determination or approximation:
fSA-" tte bd"4 en teV g1A�t
12
' SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORK
PART C 1 :
FAILURE CRITERIA
Indicate yes, no, or not determined (Y, N, or ND) . Describe basis of
determination in all instances. If "not determined", explain why not)
1� Backup of sewage into facility?
Discharge or ponding of effluent to the surface of the ground or
surface waters?
./• Static liquid level in the distribution box above outlet invert?
ALiquid depth in cesspool <6" below invert or available volume< 1/2 day
flow?
w .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? 1
Is any portion of the SAS, cesspool or privy: . `J
_ / below .the. high groundwater elevation?
A within 50 feet of a surface water?
within . 100 feet of a surface water supply or tributary to a surface'
water supply?
IV within a Zone I of a public well?
within 50 feet of a bordering vegetated wetland or salt marsh
(cesspools and privies only, not the SAS) ?
Al 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 analysis
for coliform bacteria, volatile organic compounds, ammonia nitrogen
and nitrate nitrogen.
.. • 13
,
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART D )
CERTIFICATION
Name of Inspector JO 0
Company Name
Company Address /5:�7 St
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
manitenance of on-site sewage disposal systems.
Che9k one
v I have not found any information which indicates that the system fails
to adequately protect public health or the environment as defined in
310 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 provided in the FAILURE CRITERIA section of this
form.
Inspector's Signature
Date
0'.11 Original to system owner
Copies to:
Buyer (if applicable)
Approving authority Fir�ti �o a r�/ kG 7'��•��.� til. /L1. �����
r
CUIE)TOMEL R CONSUMPT:I:ON FITSTORY
I. A ()( n,►I hdl lh I13L r
i ('(h,1 Oh1E 1� hlAhll F1F hJIY J Fiol-!I L:..
t,i.. I;'JT(:F LOCATION QrJ c'sU ;F�Eo SEE 4JAY
C)ThIG
. ...
DATES READS.NGS USn(3
PL-r:IOF.) (MIIDDYY) ( CCF) (CCF)
r='LI...OWAI\ICI:= BALD NCE FIRST 06 Ob 9! 1005 A 12
( E-COND o- 03S5 9 CTR
t:aVl:I f�(�F= WA'T* 13 IJSI r`'0 TH:IRD 12 0G 914 . 90S A 12
YC::(.I I O I)l`TF 4Jf-l.'11 F .USE: 20 FOURTI•I 09 00 94 973 A 42 �c
__06__0.3 94 s3
rAON I...WI_..I: USE SI:XTF1 03 00 94 917 A 7
(.)TF•IER LJSf SEVENT1.1 12 Ob 93 910 A 11
EI CI_iTI J O'_QBS3 a5�s A i 00
YTC:) IJS��Gf= tfth-C�11 t?0 N7IVTFi: 06 04 93 791 A 33
TE=NI.1-•1
03 03 93 75sZ A 17
=L1V NIFJ_ L _0�9.2 7-41 A i8----
NON F E. R SECOND F2EO D:I:NG TWE:L_FTFI 09 03 92 723 A S7
-I 1 H:I:f;TE.-I. NTH 06 04 92 666 A 30
EQUIRT 0-3 04 92
i F SCFdEEN F'FKEY 144 = PRINT SCR E-N
lee (4, Y& oo 3- 7 oa 1-/54/ vsc `re- Ar../
- - — ;—3 G S _ 5-G 9 q eve. ✓s�
�vti�sos
LOCATION SEWAGE PERMIT NO.
VILLAGE
A r) rj,
IN14A LLER'S NAME i ADDRESS
0 U:I L.0 E R Ott OWNER / /_
Ile AI A- /7d C4
?� eGirSej Ld'1 AS
0A '- E; P E R M I T I S S U ED
DA .T. E.' COMPLIANCE ISSUED
I
�0 C A T 10'N 1`', � SEWAGE PERMIT NO.
V 1LAGE
77oa�► e='�s
I N S T A LLER'S NAME i ADDRESS
UILDER OR OWNER
C�GJl�S'f f WdL (�h r7 r g i
DA T E PERMIT ISSUED
DATE COMPLIANCE ISSUED
k
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Fmc...... ............_. '
THE COMMONWEALTH OF MASSACHUSETTS
BOAR® OF HEALTH
h........O F......�.�.J"'l.f/y�j��2..........................................
.............. .... . . .. .
Appliraftatt for Ii-spniiFal Works Tnnitrnrtiun Famit
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System at: ,
................................................ r� r
Locatio Addr s
t No.
00
- ... •••..................•---•-•-•----......_.... _... ----O ` ....
ddro
Installer 'Address
Type of Building Size Lot............................Sq. feet
U Dwelling—No. of Bedrooms..............--�_............___ .Expansion Attic ( ) Garbage Grinder ( )
Other—T e of Builditl No. of persons............................ Showers — Cafeteria
a' 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 ( )
Percolation Test Results Performed by--••---------•-----•••--•••--•--------••••------•---•..............••••-• Date........................................
Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water.........................
(i Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
----------------- ---•- . ..-._..------------------------------__-__-___----•--------•--_-_-•-----•-----------------_-----
O Description of Soil.............................._Y•`-p`a� ..... rer; e I. =
V -••••-•-•-••-••--••----•••••••--••-••••-••-•---••••..........•-•----•-•--•-----•--•--•----•-•--••--••......--•-.t•-••-•--••-•--
W .................................................................................................................p
U Nature of Re irs or Alterjttns— wer when applicable....ls �.`"/-_.___ --Ob® S - �O110
!,
Agreeme
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of iITLE 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 boa d`,'of'health.
igne .•-•------•------•..:...........•---•---••-•--------•-•----._......-•----•-•---_•-••-
/� L 7
Dat
Application Approved By..
.... -- -----------•-•........................
Date _.._.__.._.
Application Disapproved f olowing reasons:
...............................•-••----•---••--••-•••-•••••---••__•--••••-....••-------•--••••-----------.--•••••-----•------•-••--- ....7•------•-••••--•-••--•-•--••-----•••......---••--••-.......--
Date
PermitNo......................................................... Issued.......................................................
Date /
5.................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
K/. ........OF...... h.s'y �4.........................................
Applirafiun for DiipuoFa1 Works Toan itru.rtiun Permit
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System at:
Locatio Add s '�ff or Jot No.
PHl �O6I d vim. .2 a -
Ja1 Own QQ ``!!/, /.. e ddres /
e"9 =-•/7�i .f!:_ F�-.`�._`'ff' /• 6'...
......................................
.................................................... .._....._..._...... ............_._.
Installer Address
Type'of Building Size Lot............................Sq. feet
U Dwelling—No. of Bedrooms......................................Expansion Attic ( ) Garbage Grinder ( )
aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( )
Q' Other fixtures ............................... . .
W Design Flow............................................gallons per person per day. Total daily flow............................................gallons.
W Septic Tank—Liquid'capacity Length................ Width................ Diameter................ Depth................
x 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 ( )
.-1 Percolation Test Results Performed by.......................................................................... Date........................................
� Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................
44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground, water........................
� • --------------- ----------------••••---
.
D Description of Soil-•---------------------•--•••--'�.... •-- �vv t f
.--------------------------••--. - -- . -. -----• •--- -•--- -- -----------------...
x
-•--•-•...-•--
...- ® ---•• ---- --
x �,s joao s7; ....woo
U Nature of Rep rs or Alter t ns— wer when applicable_._._/.__�j_..j. .....................................................:...................
Agreemen� /
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TITIS 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.
Ithfollowing
SL(� �� 1.�aApplication Approved BY -••--- • •-----•-----•-•--•----•----------------------------••...........__._. --• "DateAPPlication Disapproved fo reasons-........................-...................................................................Da.t.---------•----
•-----------•-••----••-------•--•...••-------••------••---------------•-••----•-----.........•---------•-'••----•------••--•----------•••-•-•-----•--•-•---------•-•--•-•-•-•••----•--•••-•--------------
Date
PermitNo....................................................... Issued_.......................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF H _ LT
.....................OF....... . . ..........................................
{ �;' �rrtif iratr of (Cum iFanrr
TII IS T Y, That the Individual Sewage Disposal System constructed or Repaired
_ g P �' ( )
1... .
,� • � nst er
at.. .••--•- ,�.� 1, '.. ----------
- --------•--•----------------•-------•-----------------------•--._.--- ----•---•-----------
as been installed in accordance with thovisions T _IF 5 of Th;,-State Sanitary Cod as scribed in the
jer
application for Disposal Works Construction Permi .-___-__ f_ ._. j _1....... dated__,..... ._ '"_________________
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE/CPONSTE AS A GUARANTEE THAT THE
SYSTEM WIL FU CTION SATISFACTORY.
DATE._._!_. v Inspector
_U-____--•--•-•--•------------• ••------_--
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEA T
.................. o......................OF....... .:.. ....--------.._..................................
FEE._"o..............
t �t o a1 uaiu ri iun permit
Permission is eby granted-^` .:... :....................
to Constr> or Repa' ndividual Se, ag Disposal System
at
Street � �
as shown on the application for Disposal Works Constru • n Permit No_______________ a`t d _.. ....... __......___._.__.___....
-!°.................................
oard of Health
DATE................................................................................ g
FORM 1255 HOBBS & WARREN, INC.. PUBLISHERS
i
ACCESS COVERS MUST BE WITHIN 9" MINIMUM.6" OF FINISH GRADE 3' MAX/MUM COVER
INVERT T ELEVATIONS : DESIGN CR I TER I A : GENERAL NO TES :
FIRST 2' TO INVERT OUT SEPTIC TANK: 97. 1 DESIGN FLOW:
BE LEVEL MIN 2" OF PEASTONE INVERT IN D 1ST. BOX. 97`0 4 BEDROOMS AT 110 G.P.D. PER I. THIS PLAN IS FOR THE DESIGN AND CONSTRUCTION
100.6 MAX OR FILTER FABRIC INVERT OUT DIST. BOX: 96.83 BEDROOM EQUALS 440 G.P.D. OF THE SEWAGE DISPOSAL SYSTEM ONLY.
4' D1AM PlPlr 97.65 INVERT IN LEACH CHAMBER: 96.65
° C DOUBLE WASHED STONE BOTTOM OF LEACH CHAMBER: 94.65 NO GARBAGE GRINDER 2. VERTICAL DATUM IS ASSUMED. FOR BENCH MARKS
97. 1 96.83 2' �' SET. SEE SITE PLAN.
GAS BAFF 97.0 °� $ 96.65 s 94.65 ADJUSTED GROUND WATER: N/A SEPTIC TANK REQUIRED:
LE
3 OUTLET 3-500 GAL LEACHING CHAMBERS OBSERVED GROUND WATER: N/A 3. ALL CONSTRUCTION METHODS AND MATERIALS AND
EXISTING D-BOX 440 G.P.D. X 200st - 880 GAL.
W/4' STONE AROUND. 12.8'M x 33.5'1 x 2'd BOTTOM OF TEST HOLE *1: 90.2 SEPTIC TANK PROVIDED: 1000 GAL. EXISTING MAINTENANCE OF THE SEPTIC SYSTEM SHALL
1000 GAL H-20
SEP T l C TANK 6" CRUSHED STONE OR CONFORM TO MASS. D.E.P. TITLE 5 AND LOCAL
COMPACTED BASE SOIL ABSORPTION SYSTEM REQUIRED: BOARD OF HEALTH REGULATIONS.
DESIGN PERC RATE f 5 MIN/1 NCH
PROFILE : NOT TO SCALE SOIL TEXTURAL CLASS - 1 4. ALL SEPTIC SYSTEM COMPONENTS LOCATED UNDER
EFFLUENT LOADING RATE - 0.74 GPD/SF AREAS SUBJECT TO VEHICULAR TRAFFIC OR GREATER
440 GPD / 0.74 GPD/SF - 595 S.F. REQUIRED THAN 3' IN DEPTH SHALL BE CAPABLE OF WITH-
STANDING H-20 WHEEL LOADS.
PROVIDED: 3-500 GAL LEACHING CHAMBERS
W/4' STONE AROUND. A-6I4 S.F. 5. ALL SEWER PIPE SHALL BE SCHEDULE 40 PVC OR
614 S.F. x 0.74 - 454 G.P.D. APPROVED EQUAL.
SOIL TEST P i T DA TAs 6. SEPTIC TANK AND D-BOX SHALL BE REINFORCED
PRECAST CONCRETE OR APPROVED POLYETHYLENE,
INDICAERCOLr£S V_ INDOBSERVED
BOTH SHALL BE WATERTIGHT. D-BOX SHALL BE WATER
PERCOLATION � OBSERVED
TEST = GROUNDWATER TESTED FOR LEVEL WHEN THERE IS MORE THAN ONE
STOCKADE FENCE
100 4 TP mI Ps15585 TP s2 OUTLET.
HOR HORIZON
N 83°05� 3-500 GALLON 0' IZON TEXTURE COLOR TEXTURE COLOR IOO.a o' - --- 100-2 T. BEFORE CONSTRUCTION CALL "DIG-SAFE"
.
LEACHINGLOAMY IOYR LOAMY IOYR
CHAMBERS A A
EXISTING '. W/4' ST0NE AROUND SA 3/2 SAND J12 1-888-DIG-SAFE AND THE LOCAL WA TER DEPT.
///---
SEPTIC TANK / SHED - - - ND- - - - - - - - - - - - - "'5 9' - - - - - - - - - - - - - - - 99.5 FOR LOCATION OF UNDERGROUND UTILITIES.
CB/DH FND �! ` . - t1' LOAMY IOYR LOAMY IOYR
/' 100.2 g - - N B SAND 4/4 B SAND 414
DRiVE i2 tno.5 - - - - - - - - - - - - - - - - - - - - - - - - - - -
\\ STONE 28- 97.9 24' 98.2 8. SEPTIC SYSTEM INSTALLER SHALL NOTIFY THE
_ LEACH cr+ MED-COARSE IOYR A/ED-COARSE IOYR
c
PIT C/ SAND AND 516 l SAND AND 5/8 DESIGN ENGINEER TWO DAYS PR I QR TO CONSTRUCTION
O GRAVEL GRAVEL OF THE SYSTEM TO ALLOW FOR SCHEDULING OF THE
�' CONSTRUCTION INSPECTIONS.
m / 44
7c rrs"i 9. EXISTING SEPTIC TANK TO BE PUMPED AND CLEANED.
•o W cr+
ao LOT
f 7 vf r INSPECT AND REPLACE INLET TEE IF REQUIRED.
rP•2 -'
N
& 8.650t S.F. Q - ' f - f AW JIATER
' NO WAXER
c m `A 120 90.2 12 90.2
DATE: FEBRUARY 14. 2018
BM. CORNER PATIO �� 99.7 / TEST BY; STEPHEN HAAS
CATCH BASIN\� EL-100.,29 VE fti� 7 WITNESSED BY: DONALD DESMARAlS
\ i CKP�. / PERC RATE: C 2 All N/I NCH
_ �_. _
Z'3"
� 5
i
i
4 fi
} YVrgl� 3
1
SEP T / C S YS TEM DES / GN
2SO BEARSE . S WAY . MAP 310 . PARCEL 3 1
BARNS TABL E . ( HYANNI S ) MA .
ROUTE PREPARED FOR :
KATHL_ E K l RBY
(` LEGEND
CB CONCRETE BOUND SCALE ' 1 2 0 MARCH 27 , 2018
o _W WATER L I NE REVISED: APR l L 2. 2018 (ADD RESERVE)
O HYDRANT REVISED APR l L 12. 2018 (CHANGE SAS)
GAS LINE ST' EPHEN A . HAAS
OHW- OVER HEAD WIRES
# LIGHT POST _ ENGINEERING
---E -` UNDERGROUND ELECTR I C LINE N� %� P . O . Box 16
--T-- UNDERGROUND TELEPHONE L I NE r ° �"� S o u t h D ie n n i s , MA 02660
--CT•V UNDERGROUNO CABLEVIS/Off LINE -� //� '� �'� ( 5O8 ) 362-5 1 32
+40.4 SPOT ELEVATION
.•-•40------- EXISTING CONTOUR
LOCUS MAP 0 to 20 40 qnp PROPOSED CONTOUR ,JOB NO: 18-003
t