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HomeMy WebLinkAbout0194 POND STREET - Health 194 Pond Street Osteville a _ A= 118-041 , r 4_ 1 d a ° r n + ••,; a .. • .. -156 o� No.Loll - 9 Fee CO- THE COMMONWE LTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS 4pliLation for Misposal *pstem CunstrUftiun Vfmit Application for a Permit to Construct( ) Repair(Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. t Owner's Name,Address,and Tel.No. Assessor's Map/Parcel 109 j V/✓e 1 Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No. � `� `�jfq�Jn9�iJ� S - ��'-`/S� tN �.✓er�I^'.S �1/tr:�G�j Type of Building: Dwelling No.of Bedrooms 3 Lot Size 30,R sq.ft. Garbage Grinder( ) Other Type of Building f p 5 Iof"*IC. No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) -6 '3 U gpd Design flow provided 2>N 8,7 gpd Plan Date 3-f —19 Number of sheets Revision Date Title Size of Septic Tank kQ6is� Type of S.A.S. a 500 Ar,J! LXUM4/-A h N'SA61-C Description of Soil Nature of Repairs or Alterations(Answer when applicable) 4-,Ij .;✓rw r��Jo,, G„✓d 2 SG® hc,��e�J ChCi�I�jY/r N' 6 k0.^J le 0V a i 1.6 X 2 s' 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. Signed Date Application Approved by Date Application Disapproved by Date for.the following reasons Permit No. ;W/R ' 5 6 Date Issued ,✓�!`� , O No. Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS 2pplitation for Disposal 6pstrin Construction Permit � Application for a Permit to Construct( ) Repair(1,)"Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. (9�.� �o�5 f- Owner's Name,Address,and Tel.No. Assessor's Map/ParcePs+e/V Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No. _ Type of Building: Dwelling No.of Bedrooms . 3 Lot Size !C20 q 2,13 sq.ft. Garbage Grinder( ) Other Type of Building ,A` ` No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided ?,cf 5,71 gpd Plan Date t_,x Number of sheets 2. Revision Date Title Size of Septic Tank ', Type of S.A.S. �, 1 Description of Soil Nature of Repairs or Alterations(Answer when applicable) 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. igned Date Application Approved byC Date Application Disapproved by Date for the following reasons L Permit No. (�� / .e Date Issued - --------------------------------------------------------------------------------------------------------�- -----------------. THE COMMONWEALTH OF MASSACHUSETTS Q �! BARNSTABLE,MASSACHUSETTS (tPrtificate of Compliancr THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired(v'f Upgraded( ) Abandoned( )by . ':1(eh T T r at has been constructed in accordance �j with the provisions of Title 5 and the for Disposal System Construction Permit —J.j dated (. Installer_ (ra�v,iJ N, Designer ,,, f;; ,,�v // #bedrooms_ 3 Approved design flow ) gpd The issuance of this permit shall not be construed as a guarantee that the.system will fup� on a designed e . Dat Inspector ( �� CT No.o�tt,>� yJ W Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS MisposaY *pstpm Construction PErnut Permission is hereby granted to Construct( ) Repair( � Upgrade( ) Abandon( ) System located at OJT / J C 4 �1e i CJII i 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 eomp 4-ted within three years of the date of this (rmi5 t. Date Approved by TOWN OF BARNSTAB E LOCATION /y y Po4 d 51- R-e ar dv4WAT# 0OI 9 f s� tVILLAGE5��*j/ri/� _ASSESSOR'S MAP&PARCEL INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY. (type) a a/t/ (size) NO.OF BEDROOMS C o TT 1.4-ao 6looX OWNER ,JetJ PERMIT DATE: S=,��-f `� COMPLIANCE DATE: 7-1 Separation Distance Between the: N NP c, Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility p /-C- Feet Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility)} Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet FURNISHEDBY1 ����„� � � . �-- �. � � � � `� . .. �� �— — — t r �,R �— 1 ' a � . - �, i � � . i1 �e � � �. �� - � � , ` . -� � 1 ��r I � � �� _ - - �� ' _ .. . � i �� 1� — -' a 0 0 .. �� �� c� . � r .. � � �... pv TOWN OF BARNSTABLE � i LOCATION / loh�( SEWAGE VILLAGE i/S �Y'� 2 ASSESSOR'S MAP & LOT INSTALLER'S NAME & PHONE NO. ,jp[�y1 �r <01 �o %EPTIC TANK CAPACITY %j OO LEACHING FACILITY:(type) 7' (size) i0©oyG./ r`�TIO. OF BEDROOMS_ PRIVATE WELL OR PUBLIC WATER ,44L• BUILDER OR OWNER AG S�l�s�l e DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No tk - / -c n ! . .. � I I cl I z � � ! o (P \ n m � ml I r I � 1 r r ���� �° I m I r � � - m l fn z 10 tA m o_ ch c ° rn m , ICI rn rn ;o (� A a O Regulatory Services T Richard V. 8 uARNSTasLE, call, Inteta Director'rDirector• Y Public R. 0 Ith itil»sib.n li $ 34 ��� °rFD to Tbotnas McKean, ®irector 200 \Iaiii Si.reet;Hyai;nis,bTA 0260'I }ax: 508-790-6 a0 -. Installer & DeciQner Certification F:rsi•in ' Date: � Sewave Perarlit# . .-Assessor's NjaplP rce1 1 — '� C`'1 C Designer: v,a ,'� �:'n� t 14 IY Q Installers. Address: i Z wi C f`us �/cI R Adds ess �cC ( ( rr � es�ct : .M AG.Z L �7 -5 ls.,ucd a permit to install a (date)' / / (installer) — 5cpt1c.sr�stern,at /?��C�.� �S 1 based on A de ig i;dray.in by. (ad'dress) -- n�T Ler�? lnl ,4s�Ilk dated i Q( .-_. (desfglier);. I certify tll�t ille septic. system referene ed:ab v was installed substanti•tll ceordwo to, the design, urllch n13y 111C1'tade nI1n01 approved clanges.;such as lateral relocation of'tne dis[ributlon bot and/or septic tank; Sti'iJ OiA (if required) ���as inspected and the so.its here fu:und satisfactory: I certify that tJle septic system referenced% above1.ayas installed w. innjor changes (i.e:: greater than 10' lateral relocation of the SAS or any yertical relocation:;of an y.con�ponent of the septic s}rstem) 1?ut.in accordalee��.1.ith State& Local Regulations_ Plan revision car certified as-built b_y esigner to follot�. Strip out(if required:) etas ii�s.pt cted acid the soil; itrere f�tind satisfactory. 1 certify that tllc. system ret�renced above was constilicted in t i' witn the icalns Of the I`r� approval letela (if;applicablz) yz �a ►�tss ( nstallei Stsnature) Np.3510g .� Ft315tE (Destgilei-'s Signat>_ue)- (Affit Designer ere PLEASE, RETURN TO BARNST_AB"Ll PUBLIC HEALTH'DIVISION. C. IZTi FICATE OF COMPLIANCE NV ILL NOT BE :ISSUED 11lVTIL BOTH TEIIS .IcOk2stl AND AS= BUILT C.1I2D ARE;RECEIt'ED.'B ' IIIE BARNSTf1BLI;;PUBLIC HEALTH DIVyS]( N. I , VOU.: �1 Sb}a =i�ssi�n r Cenification,Fnnn Rev 3-14-13:doe Engineers note'.Ti is certification is limited to an as b+a It inspection of sys-,em'.componenis as installed orior o backtilf.The engineer did not sup=.`rise construction of the system.The installer assumes responsibi!7ty or all materials;4vork nanship,backliiGny to specified grades with proper compaction and setting:isers'covers as storm on the design plan; Town of Rarnsta.ble r# 159),o Departmentbf 12eguilatory Services- 7 _ Public ealth Division Date �O ]E a 200 Main Stteet;:Hyannis MA 02601 lfAy.A c !� �3 /�1 / Date Scheduled Tzme ` / l C3e)�tA . _ Fee Pd, d} Soil Suitabilitym age Disposal Performed'':Bv: �— Wimessed By: LOCATION& GENE,RAL INFORMATION Tocation.Address I .?� �_ t ` owner's Name. z Address O S i-e ILoz MIA Assessor's Ma , © � Engincer s Name t5v)y t n"1��5 links tni NEW CONS`1'RUCTION REPAIR Telephone# --`i 77 `3 Land Use,' $��tQt�d-o'QA- Slopes,(.8a) "�'' Surface Stones 6 Distances from: Open,Water Body <q 7� :ft Possibie Wet Area" vl ft thinking Water Well Drainage Way /7"'" ft Property.Line ^ J� ft Other —ft _ I SKETCH,(Street name;dimensions of lot,exact locations of testiholm&perc tests,locate wetlands i`n pmximityfo holes) A�� Parent material.(geofogic) Depth to Bedrock Depth to Groundwater.Standing Water in Hole: Weeping frotrl:Plt ftttce lUd Estimated..Seasonal High'Gi'oundwaier. sue._'—!!�e. DETERMINATION FOR SEASONAL HIGH'WATER-TABLE ' Method Used: y Depth Observedstanding in ohs:hole:` _ in, Depth td Soil mottles: in:. Depth to weeping'hi*side ofohs:hole:'. - in, Grouedwuter Adjustment #t. Index.Well# Jteading Date: Index Well level „, Adji r;%ctbr •Adj:Clraundwater'Uwl PERCOLATION TEST Date- Thne,.� Observation: 'Y Hole# Z Time at tl" i Depth of Perc U,. Time at 6 Start Pre-soak Time @ me(4 -6") -2 M End;Pre-soak 1 !� Rate Mim/lnch, 2- Site Suitabiliiy,Assessment: SiteTasse - Site Failed: Additional Testing Needed(YIN) Original; Public Health.Division Observation Dole Data To Be`Cornpleted on;Back - ----- 4+off percolation testis1o,.be:conducted witWnJ00",0f wetland,-you rtpstfirst notify.fhe. Barnstable Cons0vation,Divisi6n aYleast one.(1)week priorlo beginning. Q:\SEPTICIP.ERGrORm.DOC DEEP OBSERVATION HOLE LOG Foie# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in:) (USDA) (Munseli) Mottling; '(Structure;Stones;Boulders.. i e %' ravel O —Z 0 r—c.tL ?Ab, K bra V-t ioy /z DEEP OBSERVATION HOLE LOG Hole# 2- Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(ia.). (USDA) (Munseli) Mottling (Structure,Stones,Boulders. ons' en % rave 6 — � S'4ve�1 •f�w� l�`�t2`t � —130' L, M St t `Z=Sy f� DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface om (USDA) (Munse[t) Mottling (Structure,Stones,Boulders. Con istency.%Grave DEEP OBSERVATION DOLE LOG Hole# Depth fiom Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders, onsi ten n Flood Insurance Rate.MUP. Above 500 year flood'boundary No Yes Within 500 year boundary No_ter Yes ,- Within l00 year flood:boundary No Yes •� Depth of Naturally Occurring Pervious Material • Does at least four feet of naturally occurringpervious material exist in all areas obsexyed throughout<che area proposed for the'soil absorptionsysiem? If not,what is the depth of naturally occurring pervious material?,. .r_ ._ Certification I certify that on C< <� �(date)I have passed the soil evaluator examination:approved by the Deparunenfof Environmental Protection and that the above analysis was:performed by me consistent with . the regtiired tra' in expertise and experience described,in�I0 CMR 15.017. Signature Date f q\S,EPTIC\PERCFORKDOC No.--- .........................._. THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH Appliration for Disposal Works Tonstrnrtinn Frratit Application is hereby made for a Permit to Construct ( ) or Repair O an Individual .Sewage Disposal System at: ` .......... ...... -f'--===1.o 8--r•_P.0 z-.nAl.....--------------.............---- ` ' Location*�ddress or Lot No. ..................... ... --•-----•-•---•-••----•--•--.......-•--•-------------------•........_.................--- O t .•....Address f _ ......••.... �-•--•-••-•-•------••... ....-•--• •-•----•--••----•-•--_.... Installer Address .�- d Type of Building Size Lotl -:LSq. feet V Dwelling—No. of Bedrooms.....3........................... :..—.Expansion Attic ( ) Garbage Grinder P4 Other—Type of Building No. of persons............................ Showers — Cafeteria Q' Other fixtures ............................ . 5 .. lons� W Design Flow...........�?....�___.....................gallons per persori per days Total dail ;pw......�3�__________ __._._..__ � WSeptic Tank—Liquid capacityl�4�(aallons Length_8." _. Width. � _... Diameter................ Depth. :_'-�.�... x Disposal Trench—No..................... Width__�..__.......... Total Length __....__ Total leaching area....................sq. ft. Seepage Pit No.........I........... Diameter...�.�___. ..... Depth below inle_._ 7�..... Total leaching area.in/1.$..sq. ft. Z Other Distribution box ( ) Dosing tank ( ) o 41 a Percolation Test Result.. Performed byD 1P•,�N•�'ii� -7.R MXMI44J2 Date_...j�/ �? .��_-. Test Pit No. 1........... ...minutes per inch Depth of Test Pit:...�7e_ ....... Depth to ground water..........._0_._...- Test Pit No. 2................minutes per inch Depth of Test Pit.... ...0....... Depth to ground water..N-1 !.&J:1V_ Rai ff ........... "' .. � �r- �' Description of Soil__ : Ci �`-- '^`-e-." ...�- -`".�yy'�bb --------•----•---------------•--•-•--------- de i x ----------------------------G-�..........----..1`�- ----------� .C---SA1.0b-I......SON-siE.-_-�-�-YL.................................. U Nature of Repairs or Alterations—Answer when applicable.................._.....___............._____....._..........._.........._................._.... •---------------------------•---••-••------•---•-•------•--•-----------------------••••-----•---•••---•-....-•--•------------•------•----------------------------------------------•------•-----•----•-- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITL LE 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been iss by he board of health. Signed:------- ..-•--•- ...-• -- ae - Application Approved By.................. ---••. _ ..... ............................... •--•---•-•-•--•.............. ( D to Application Disapproved for the f ollUlm*g reasons: - ---------------------------------•-- ............................••-•---•-......-----.....----•--••--•--------•-••---••-------......-----...---•-•--••-•--•--•••------•-•------•-•---•-----•-•------....----•--------•----------•---••------. Permit No....4� ................................ Issued....................................................... na .._� Date J No... ..........�....J ( U FEs............._...'......._ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH �. -r-t5- .'1•.� --..:...OF...-. . Appliration for Disposal Works Tonstrurtion Prrutit uPGF_;)VE Application is hereby made for a Permit to Construct ( ) or Repair (x) an Individual Sewage Disposal System at: ...........• ...... .................................... •q� `' 7Loca ion- ddress*� .• or Lot,No. ...............� 1 .M__ fie' �....�?.7. .... Address .......................................... C lie ►'�" 1 1...... ...__.. 5A - ✓-... ..........__ Installer Address .t U Type of Building P ( ) Size LotlQ f9 --'-:-Sq. fe feet Dwelling No. of Bedrooms............................................Ex Expansion Attic Garbage Grinder ( Other—Type of Building No. of persons............................ Showers — Cafeteria a' Other fixtures ............................ W Design Flow............ .........................gallons per person per day, Total dail T$w.._....3.50.......................vijons. , WSeptic Tank—Liquid capacity allons Length) . �o.. Width_ . Diameter................ Depth-5..... x Disposal Trench— o..................... Width..�.____.__._.___ Total Length ............. Total leaching area....................sq. ft. Seepage Pit No......�........... Diameter...�. ._-__..... Depth below inlet?40k...... Total leaching area.. - __j_8!..sq. ft. Z Other Distribution box ( ) Dosing tank ( • '-' Percolation Test Results Performed by.AAA1. ........ aTest Pit No. 1------9t...minutes per inch Depth of Test Pit...J.t.......... Depth to ground water-___-- Q _ Test Pit No. 2................minutes.per inch Depth of Test Pit.... ..Q_`.._.. Depth to ground water-_-N x `1'f''1------..... C��. =----j PJ09L-... S.0 JesSb 1 r �.,�--------..1_. L.. O Descri Description of Soil_ YOL.JV% y`.�._ C,_ S P >< 4m-e C�-��. , ' - --------------------------------------- x .------------------------------`T 1��°.2....----- ."-... 'r..`` "gyp' ' b11--- '---T_ t�.1. : ...• ....--------------------......_ U !! UNature of Repairs or Alterations—Answer when applicable............................................................................................... ----------------------------•--•---•-------••---••-•-----------..........._......_.....---...........-----......---------------------•------•-••----•--•------------._......------------•...........---- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITIE 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been iss by e board off hhe�eaa�lth. $7 Signed --------:•-------• -............. ----•.............. ........... ---- --,------- .............. r' Pat Application Approved BY...... ....... f ` -•--•----•--•--......................----- .. l i --........ D e Application Disapproved for the jut Zng reasons:....................................•-------------.._..---•---------------------------:------...-----•••_.--•- .........-•-------------------------------•-•---------------•---...... Date ••------------.............---...----------•------.......-•-•----------------------------•-------••-----••-----------------•-•--•. Permit No...... �v Issued...........................�-- ---••--•--•-•---... --- --.---------------------....... ...... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ...............................OF..................................................................................... Tn tifirab of Toutpliattrr by THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( or Repaired ( ) ....................... -----..----------- --------....... •----.............-----_----- -------------- ------------ ------------------ . --•-------........._..--••-------...._ e)F'dnstaller at...................................................................................................... --............................................................... ............................. has been installed in accordance with the provisions of TITIE 5 of T e State Sanitary Coq as fltscrib� ''} the application for Disposal Works Construction Permit No... _. _...__.___. dated......... . t 1_.___... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE.. 2.................... Inspector ...2J...._......._..........----..._-•---•------..........-- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH No......................... FEE......................... Disposal Works Taanu#r ivit rrutit Permission ' hereby granted.........................................•-----......----------------•--•--------------•--•-------------..................................... to Construct ( or Repair ( ) an Individual Sewage Disposal System atNo................•--..........-•-------•-•--•------..............._._....----------..............---...---------------------...------...----..............--•---.....----------...........------ Street as shown on the application for Disposal Works Construction Permit N Dated...... _ ._........ ---a a1d al �7* -:_•-•----••-•-----•---- f� t'h� DATE......./0 g--•� -•--•------•--------------••--------- ara o FORM 1255 HOBBS & WARREN. INC., PUBLISHERS Z No - ` l/ o�/ '�-- � Fizz............................ THE COMMONWEALTH OF MASSACHUSETTS r BOARD OF HE L 7,&f� ..........OF..... . ..... . . ........................................... Apphration -for Di,iplaiitti Works Towitrurtion Prrniit Application is hereby`"made for a Permit to Construct ( ) or Repair (Llo�an Individual Sewage Disposal System` at: ////�\ e. ! Y...... ...Z ............ ...�. .... .........Sa. . .........._.._.__.......__..........__............._•..........._.._............................. ocatio dres / or I.ot No. f+ ner Address ............................................ Installer Address Uype of Building Size Lot----------------------------Sq. feet Dwelling l'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. 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..-._---.-_---.-_.-..... (s, Test Pit No. 2----------------minutes per inch Depth of Test Pit.--_----_.:_-_-__.-- Depth to ground water__.--._..-___-.--___.... ------------- G Description of Soil_._...._ ._. _ x --------------- ------------------------------------------------------------------------------------------------ U Nat}r1 of ep<'rs or..Alterations—Answer w en le......... :.. .....-'__ 64 _ _Q._11 _ c�Q_�y__---.....--... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Article XI of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has b)Sajf issued by the board of health. Signed-. ���f f `---------- .--- ------------------------•---. ate ApplicationApproved By-------- /Qf{� --------------------------------------------•----------------------------- ---------------------------------------- /f Date Application Disapproved for the following reasons:---•---•---•---•----------------------•----•---•-------------••-•--------..........----------••-----••--•------- ...............••-•---------•-----•-._........----------------------.._....-----••-------•-------------••-•-------------------------•-----•-------------------•---------------•••------•--------------- Date o Permit No.. ......... Issued ......................................... Date No...... ...... Fsa....�................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF t—aE L .✓. .........O F:... . ApV trtttton -for Uhipoiittl Works Tonntrnrtton Vanttt Application is hereby made for a Permit to Construct ( ) or Repair .(L/an Individual Sewage Disposal .. System at: ocatio ress -- or Lot No. _ ._... er Address Installer Address ype of Building/' Size Lot............................Sq. feet Dwelling X. of Bedrooms......................................_-----Expansion Attic ( ) Garbage Grinder ( ) per, Other—Type of Building ____________________________ No. of persons............................ Showers ( ) — Cafeteria ( ) dOther 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................E... 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....--------..-.--.----- f� Test Pit No. 2.................minutes per inch Depth of Test Pit---___-.__._________ Depth to ground water-_--.---_--_--.-__----. Ri -- ..................................................................................... ODescription of Soil "' ----------•-••----•---------------•------------•---•-•--------------.......----------------------------------- x U --------------------------------- ---------------------•---••-••----•-•---•••--••---••-•-•----------•-•..._----•...-•--•-•••----•------------------•---•--••••-•---------------•----•----...----------- UW ---------------------------------------------------------------------------------------------------------------------------- ----------------------- Natur of epa}rs or,Alterations—Answer wen �licable...... .. ...... ~' / U -e 1-..-.._-._ �j G_pplic. �rt c� - •------------------------------ Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Article XI of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has W issued by the board of health Signed •. ...-_.--•---•- � /ate Application Approved By---- ... �-- --------------------Date---- Application Disapproved for the following reasons-----------------------------------------------------------------------------------•--------- a.------- -------- ---•--•----------------••-----•---•--•••••---------------------------------------------------------•---•-------------------------------------------------------------------------------= ` Date �. ermtt No.--------•--- Issued. i' Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH /1t...........OF...... ......:.. : ................................. Tprttftrntr of 101,11ntpltttnrr THI IS TO ER" F at the ividual SQWage Dispo 1 System constructed ( ) or Repaired by - " -% ......- ---- •------ ------- ler at-----------1 `1'----•--...•- ' '..-. - -- •-- --•-• ---- has been installed in accordance with the provisions of Article XI of The State Sanitary Code as described in the application for Disposal Works Construction Permit No---___-I _&----------------------- dated _//-/;, 7--_._____________ _ __ THE ISSUANCE OF THIS CERTIFICATE SHALL. NOT BE CONSTRUED AS A GUARANTEE THAT TIME SYSTEM WILL FUNCTION SATISFACTORY DATE........./-- ..'--•�- Inspector -----•--------•-------------•---------------••-•--------------•-••--•. /0- / — THE COMMONWEALTH'sOF�MASSACHUSETTS �L/� —�/T BOARD OF HEA TH l7ays� y ............./..G? .........OF.....1 . :.�fr - ✓... .:........._.............. , No.-- •--•-- FEE--- ................. ork,s ( o ,� rnrtt �rrnt Permission is hereby granted f .1 _ C1?!"t°'d' ..�•'-...r' `..: f�... +"'�„ t------------•----- to Construct 6 or epair x dvidu S age Di al System at No...... � C..... --.. Street as shown on the application for Disposal Works Construction Permit ,No... f `�...___ Dated.......................................... .................................. - / —-------------------_ r^ $oard of Heal DATE -�� ••70---------------------------------------------• FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS e - 97--EXISTING CONTOUR N ter re en x 100.98 EXISTING SPOT GRADE - W EXISTING WATER SERVICE G EXISTING GAS SERVICE OVERHEAD WIRES TEST PIT a 0 rn BENCHMARK 9. m• LEGEND ul Q ems, Cu -0 Ly c pond LOCUS LOCUS MAP EXISTING SEPTIC TANK NOT TO SCALE TOP OF TANK, EL.=9 7.8 7 INV.(OUT)=96.54f -71 chainlink fence 99.18 �` SHED 98.08 1 73'- 97.64 `\^\ x 99.79� x9.28 ,• x 99.3 BENCHMARK OUTSIDE COR./STEP �> 0 I EL.=99.34 x Y00.;5, `,... ..,, DECK 99.06 98.86 I / /EXISTING 9.as DWELLING NO.2 / 99.73 T.O.F.=100.6f 98.93+ GARDEN(. PARK/NG 1.'' 99. 4 t •{�i� + � `99.ze° /PORCH ®G 98.7 98.8�1� O c 99.79 L 7 ^ 101.04 { 99.56 98.49 \\ x V), x 99.41 CO 99.20 x 99.45/ 1 98. :., P 7 xl100.10 9. (� �I .0'1' VENT I t 98. x 99.67 >O': D1 TP_2_ 1 ,� i = Cn Nam- - - - x 98 x 7,3 N �' \� 9930 99.67 \\ \ N / 145. --- -- ✓ x 98.43 LAMP \ U.P. O x 9 DECK `L 9.83/�-�� EXISTING LEACH PIT x 98. / F l00 ss r \ x 100.� CONTRACTOR SHALL PUMP, FILL W/SAND & ABANDON /EXISTING 00.21 . DWELLING lV0.1 100.48 - - LAMP ARK/NG EXISTING SEPTIC SYSTEM DWELLING NO.1 f 9.60 6 100.21 (APPROXIMA TE) FRONT BUILDING-TO REMAIN 0.00 100.46 A x 99.18 I , RK/NG ---LOT AREA 30,928 ±SF • t 100.04 �`' 100. 1 11 ,100.71 ' 102.11 kJ 101.62 { U� 100.36 sidewalk I U.P.':` .: ' ::' > • 100.23 edge oflo1.16 pavement catch basin 99.91 100.32 OF M ss9cti A POND STREET PETER T. v CIVIL No. 35109 RfG/Si �� OWNER OF RECORD L ONEIL, MICHAEL B & CHERYL H �i (� 1LQ 194 POND STREET \ OSTERVILLE, MA 02655 PLAN REFERENCE: PARCEL ID: 118-041 CERTIFIED PLOT PLAN BY BAXTER AND NYE DATED 6/30/87 Engineering by: St&E DRAWN Jag. Na. PROPOSED SEPTIC SYSTEM UPGRADE PLAN Engineering Works, Inc. 1"=30' P.T.M. 131 -19 12 West Crossfield Road, Forestdale, MA 02644 DATE CHECKED SHEET No. 194 POND STREET OSTERVILLE MA (508) 477-5313 3/13/19 P.T.M. 1 of 2 Prepared for: D.A. Brown, Inc., P.O. Box 145, Centerville, MA 02632 1 NOTE: TO PREVENT BREAKOUT, THE PROPOSED FINISH GRADE SHALL NOT BE < EL:93.00 SEPTIC TANK FOR A DISTANCE OF 15' AROUND THE INSTALL RISERS & COVERS OVER INLET PERIMETER OF THE S.A.S. AND SET TO 6" OF FINISH GRADE. PROPOSED D-BOX PROPOSED S.A.S. INSTALL WATERTIGHT RISER & PROVIDE ONE ACCESS MANHOLE TO WITHIN 3" OF FINISH GRADE FOR INSPECTION PURPOSES T.O.F.=100.6t COVER SET TO 6" OF GRADE CHARCOAL F.G. EL.=99.5t . F.G. EL.=99.1 t F.G. EL.=98.4t F.G. EL.-98.4t VENT MAINTAIN 2% GRADE (MIN.) OVER S.A.S. ' L52' L = 5' _ ® S=1% (MIN.) p S=1% (_MIN.) 4"SCH40 PVC 4"SCH40 PVC 6' 70^I nNanuffimm as O as 14" 6 2' EFF. a sasses EXISTING 48- LIQUID DEPTH aaaaaaa LEVEL ADD INV.=93.17 4' 4.8' I4' GAS BAFFLE . .INV.=96.54t D-BOX EFFECTIVE WIDTH = 12.8' (FIELD VERIFY) INV.=92.50 EXISTING SEPTIC TANK ]� 2-500 GALLON LEACHING CHAMBERS �J SURROUNDED WITH STONE AS SHOWN H-20 RATED TOP CONC. ELEV.=93.6t BREAKOUT ELEV.=93.00 INV. ELEV.=92.50 aaaa NOTES: aaaa wl 0aaa aaaaa 1) CONTRACTOR SHALL VERIFY ALL EXISTING PIPE ase aaaaa w\ INVERTS, PRIOR TO INSTALLATION. BOTTOM ELEV.=90.50 4' 2 X 8.5'=17.0' 4' 2) D-BOX SHALL BE SET LEVEL AND TRUE TO GRADE 4' MIN. OF NATURALLY OCCURRING ON A MECHANICALLY COMPACTED SIX INCH CRUSHED PERVIOUS MATERIAL EFFECTIVE LENGTH = 25.0' STONE BASE, AS SPECIFIED IN 310 CMR 15.221(2). 5' MIN. ABOVE GROUNDWATER LEACHING SYSTEM SECTION 3) INSTALL INLET & OUTLET TEES AS REQUIRED. BOTT. OF TP-1, EL.=85.0 - 4) CONTRACTOR SHALL INSTALL A GAS BAFFLE ON THE 3/4" TO t-1/2" DOUBLE OUTLET TEE. WASHED STONE 3" LAYER OF 1/8" TO 1/2" SEPTIC SYSTEM PROFILE DOUBLE ST° (OR APPPRPRWASHEDOVED FILTER FABRIC) SOIL LOG DATE: MARCH 13, 2019 (REF#15,920 /EXISTING SOIL EVALUATOR: PETER McENTEE PE(SE1542) HOUSE(#194) WITNESS: DONALD DESMARAIS R.S.HEALTH AGENT T.O.F.=100.6E >) ELEV. TP-1 DEPTH ELEV. TP-2 DEPTH �, 8 1 98.0 0.. 98.2 A 0 PORCH -� FILL SANDY LOAM 96 3 20 97.9 10YR 4/2.. -4.. - A SANDY LOAM B 438' 95.8 10YR 4/2 26„ SANDY LOAM 5? 71• �- 10YR 5/6 SSANDY LOAM Cl 95.7 42" QROP �16' 10YR 5/4 PERC �� 5 92.8 Cl 62" 42"/60 2 SEPTIC LAYOUT a FENCE M-C SAND M-C SAND 2.5Y 6/6 2.5Y 6/6 GENERAL NOTES: 1. ALL CHANGES TO THIS PLAN MUST BE APPROVED BY THE LOCAL BOARD OF HEALTH AND THE DESIGN ENGINEER. 85.0 156" 86.7 138" 2. ALL WORK AND MATERIALS SHALL CONFORM TO THE REQUIREMENTS OF THE STATE ENVIRONMENTAL CODE, TITLE V, AND ANY APPLICABLE NO GROUNDWATER, PERC RATE: <2 MIN./IN. LOCAL RULES AND REGULATIONS, EXCEPT AS REQUESTED BELOW: -310 CMR 15.405(1)(b): 1) A 3' variance to the 3' maximum cover requirement, for up to 6' of max. cover. S.A.S. shall be H-20 and vented. 3. THE SEWAGE DISPOSAL SYSTEM SHALL NOT BE BACKFILLED PRIOR DESIGN CRITERIA TO DESIGN NSPE TIONER D APPROVAL BY THE BOARD OF HEALTH AND THE 4. ANY CONDITIONS ENCOUNTERED DURING CONSTRUCTION DIFFERING NUMBER OF BEDROOMS: 3 FROM THOSE SHOWN HEREON SHALL BE REPORTED TO THE DESIGN SOIL TEXTURAL CLASS: CLASS I ENGINEER BEFORE CONSTRUCTION CONTINUES. DESIGN PERCOLATION RATE: <2 MIN/IN 5. ALL ELEVATIONS BASED ON ASSUMED DATUM. (0.74 GPD/SF LOADING RATE) 6. THE DESIGN ENGINEER IS NOT RESPONSIBLE FOR THE FAILURE OF DAILY FLOW: 330 GPD THE CONTRACTOR OR OWNER TO NOTIFY THE LOCAL BOARD OF HEALTH FOR PROPER INSPECTIONS DURING CONSTRUCTION. DESIGN FLOW: 330 GPD 7. WATER SUPPLY PROVIDED BY TOWN WATER SERVICE. GARBAGE GRINDER: NO LEACHING AREA REQUIRED: (330 GPD) = 445.9 SF 8. THERE ARE NO WELLS WITHIN 150' OF THE PROPOSED S.A.S. 9. ALL AREAS CLEARED FOR CONSTRUCTION SHALL BE RESTORED AS .74 GPD/SF AGREED UPON BY OWNER AND CONTRACTOR OR AS OTHERWISE EXISTING SEPTIC TANK: 1250 GALLON CAPACITY DIRECTED BY THE APPROVING AUTHORITIES. PROPOSED DISTRIBUTION BOX: 1 INLET, 3 OUTLETS 10. IT SHALL BE THE RESPONSIBILITY OF THE CONTRACTOR TO VERIFY USE 2-500 GALLON LEACHING CHAMBERS IN SERIES THE LOCATION OF ALL UNDERGROUND UTILITIES, PRIOR TO BEGINNING SURROUNDED BY DOUBLE WASHED STONE ON ALL SIDES CONSTRUCTION. 11. WHERE REQUIRED, CONTRACTOR SHALL REMOVE ALL UNSUITABLE SOILS SIDEWALL AREA: 2(12.8' + 25.0') X 2 = 151.2 S.F. IN THE AREA BENEATH AND FOR 5' ON ALL SIDES OF THE S.A.S. AND BOTTOM AREA: . 12.8' x 25.0' = 320.0 S.F. REPLACE WITH CLEAN SAND AS SPECIFIED IN 310 CMR 255(3). 471.2 S.F. 12. AREAS REQUIRING STRIPOUT OF UNSUITABLE MATERIALS SHALL BE TOTAL AREA:.............................................................. INSPECTED BY HEALTH DEPARTMENT PRIOR TO BACKFILL. DESIGN FLOW PROVIDED: 0.74 GPD/SF(471.2 SF) = 348.7 GPD 13. THIS PLAN IS TO BE USED FOR SEPTIC SYSTEM PURPOSES ONLY AND IS NOT TO BE CONSIDERED A PROPERTY LINE SURVEY. Engineering by: SCALE DRAWN JOB. NO, PROPOSED SEPTIC SYSTEM UPGRADE PLAN Engineering Works, Inc. N.T.S. 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