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HomeMy WebLinkAbout0068 GEMINI DRIVE - Health 68 'Gemini Drive West Barnstable A= 131-050 TOWN OF BARNSTABLE t� LOCATION 1 g � -�Z• SEWAGE # 9- 3?0 �yILLAGE (.�). J30�rR '�.5) ASSESSOR'S MAP & LOTEl INSTALLER'S NAME&PHONE NO. E XC xu c 4 i p 1� SEPTIC TANK CAPACITY /OOU 9a l LEACHING FACILITY: (type) S.Q rc 3 (size) I/.3 x W.?— NO.OF BEDROOMS - BUILDER OR OWNER Li r�da- C'-a ro/Qac- ' PERMITDATE: L1-Q-•D 9 COMPLIANCE DATE: I, -U 9 Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by 13 C3 4M?7�3 /V No. i Fee f J THE COMMONWEALTH OF MASSACHUSETTS Entered in computer. i PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Ye Application for �Digogal 6paem Congtructiou Permit Application for a Permit to Construct( ) Repair(e) Upgrade( ) Abandon( ) ❑ Complete System ❑Individual Components Location Address or Lot No. Ejem 1 n 1 r 1 V Owner;s Name,.Address,and Tel.No. V�f 'Barnsfablc_. I.Ind4 don'� Assessor's Map/Parcel ­'—A (3 —Par ( Installer's Name,Address,and Tel.No. D igner's Name,Address and Tel.No. St 9 Excavcukoo 1ne-c tnr WoT-C +6C S�S�'-E7'7-t76 cn �9 A 508- '411-5313 Type of Building: I Dwelling No.of Bedrooms LA Lot Size sq. ft. Garbage Grinder ( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures /� Design Flow(min.required) 1 4 b gpd Design flow provided gpd Plan Date 1 D'�L l 109 Number of sheets Revision Date Title t�r0005ed +lL j )pgrn -e__P1Gc_r� Size of Septic Tank I 0C)b Type of S.A.S. 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. Signe A9 Date I 1 D Application Approved by PfflWWqkS`ate Application Disapproved by: Date for the following reasons Permit No. �� Date Issued } No. AL J� . �:. pr�._. " }. .r. Fee C ry THE CIOMMONWEALTWOFNMASSACHUSETTS Entered in computer: ` PUBLICHEALTH DIVISION TOWN OF BARNSTABLE, MASSACHUSETTS Ve � ' t Rpo.Yication for Tigpogar 6pgtem Con tructiou Permit Application.for a Permit io Construct O Repatr(�' Upgrade( ) Abandon( ) ❑'Complete System ❑Individual Components Location Address or Lot No. 69 &"i e m in t l r("v t Owner's Name,Address,and Tel.No. 1 t...t,,_ lndClCt f C`IC. Assessor's Map/Parcel ..-AArrL 1 3 ( -Pr ri 0 4 C i �(' s i;t,l I s` y.1 Ibr'i + 1 a`16t. f; 4 Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. 13 1kf�t�iGt11ft1i11,i ' � ri47 ( G ''� 1�9 C 1 CICAi (' /�. A '-i7�t C 1' � ca+'t+lt['ica�l i..._ MA S( r Type of Building: Dwelling No.of Bedrooms L Lot Size sq.ft. Garbage Grinder ( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided gpd 4 Plan Date 1 L i`t.�.L.9 Number of sheets Revision Date Title �❑ "✓ . fi S C d 5- -i_) t( L Size of Septic Tank ! Ut!J Type of S.A.S.' 4 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. �, t Signe _t- "( j - G t A Date cl t Application Approved by, �j ' �j� / ( Date Application Disapproved by: J Date for the following reasons Permit No. ,t! Date Issued , r-------------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed ( ) Repaired ( y ) Upgraded ( ) Abandoned( )by To-t I� at l 4 ( r tl+ t-1 i },)l IV P has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. ° oM ---j 70 dated I I t�, { Installer C,r 1.?{' r { C-j i i f t Designer #bedrocros 1~ Approved design flow gP U �) d The issuance of this permit sh 11 not be construed as a guarantee that the system V ill funczl) 'Date � y ( Inspector t - i, .. -r;j —r 1 — s. No. >a' Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION — BARNSTABLE, MASSACHUSETTS Tigpogal 6pgtem Construction Permit ..Permission is hereby granted to Construct ( ) Repair ( N ) Upgrade ( ) Abandon ( ) System located at (.ry, i)( i -P and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to comply with Title.5 and the following local provisions or special conditions. Provided: Construction must be completed within three years of the date of this permit. � . t �j 1 Date ���j Approved by ;� t �? I ' e TRANS: NO.: CITY/TOWN; LC Mr'1- APPLICANT: ADDRESS: Ce 'D r Gti G, DESIGN FLOW: n y 1 U gPd REVIEWED BY; DATE: : & N/A OK _ ND Legal boundaries denoted [310 CMR 15.220(4)(a)] ✓ Street, Lot, tax parcel number and lot number noted on plan [310 CMR 15,220(4)W] 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 CMR 15.405(1)(a) for ✓ upgrades]- if not, a variance is required 310 CMR 15.412 4 Location of impervious surfaces (driveways, parking areas etc.) [31,0 CMR 15.220(4)(d)] Location all buildings existing and proposed 310 CMR ✓, 15.220(4)(c)] Location and dunensions of system components and reserve areas. ✓, 10 CMR 15.220(4)(e)] System Calculations 310 CMR 15.220(4)(0] ✓ daily flow ✓ septic tank ca aci (required andprovided) soil absorption system (required andprovided) whether s ystem designed for garbage grinder ✓ North arrow 310 CMR 15.220(4)(g)] Existing and ro osed contours 310 CMR 15.220 4 ✓ Location and log of deep observation holes (existing grade el. on each test) [310 CMR 15.220(4)(h)] Names of soil evaluator and BOH representative [310 CMR 15.220 4 h and i Location and date of percolation tests (performed at proper elevation?) [310 CMR 15.220(4)(i)] Percolation test results match loading rate? 310 CMR 15.242] Certification statement by Soil Evaluator 310 CMR 15.220(4)0)] Observed and Adjusted groundwater(method for adjustment given or indicated) [310 CMR 15.103(3) and 310 CMR 15.220(4)(n)] Address Sheet.,1..of 9 N/A OK NO Location of every water supply, public and private, [310"CMR 15.220 4 k within 406 feet of the proposed system location in the case ublic su l of surface water su lies and avel eked ter . _ "w within 250 feet of the ro osed:s: stem location in the case c/ within 150 feet of the,proposed system location in the case of rivate water siipOy wells Location of all surface waters and wetlands located up to 100 ft. beyond'-setbacks listed in 310 CNM 15.211:and any catch basins loca SO.ft.j310•CMR 15,220(4)(1)] Water lines and other subsurface utilities aocated [3 lfl CMR 15.220 4 m ° water-line cross see 310 CMR 15.211 1 1 Profile-of system showing invert elevations of all system. com onents"And the bottorn of the.SAS 310;CMR1,5.22Q,.4 0 Stamp of desi er 310 CNM 15.220 1` and310CMR 15.220 2- Stamp of Registered Land.Surveyor(required if construction activities within 5 t. of lot line).;. 3 L0 CMR,15.220 3 Test Holes adequate(two in each of the primary'and reserve unless,trenches as permitted in 310 CNM 15.102(2)";or as approved for, an-upEade under LUA at 310 CMR 15.405(1)(k)] Test hole adequate to demonstrate four feet of suitable material? 310 CNM 15.1 3 4 Test Holes."eggate:to confirm adequate groundwater separation? 3,10 CMR 15.103 3 Benchmark-within 50-75' of system 310 CNM 15..220 4 Materials specifications noted? [various sections of 310 CNM 15:000 System compongnts not> 36" deep (unless Local Upgrade k� roval or.�LUA re uested). 3.1 Q CMR 15.405 .1 'Address Sheet 2 of 9 N/A OK NO Size OK? 310 CMR 15.223 1 Inlet tee located'ten inches below flow line 310 CMR 15.227 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 4,x S Separation between inlet and outlet tees (no less than liquid depth) 310 CMR 15.227(2)] Inlet/Outlet elevations at least 12" above high groundwater (except as descriped 31,0 CMR 15.227(5)) or permitted for upgrades under LUA 310 CMR 15.405 1 k Minimum cover . (Tanks.buried more.than 9" must have risers on all openings and on the d-box) [310 CMR 15.2228(1) and 310 CMR 15.232 3 Three access covers (inlet and outlet must be 20" or greater) - \ S �- middle access at least 8 7/07 310 CMR 15.228(2)] Access to within 6 of grade -one port for systems<1000gpd, ✓ two fors sterns>1000 gpd 310 CMR 15.228(2)] All'at-grade covers secured to unauthorized access? [3 l 0 CMR z/ 15.228(2)] > 10 ft from buildn foundation 310 CMR 15.211 1 Buoyancy calculation Required/Done 310 CMR 15.221 8 H-20 Where appropriate? 310 CMR 15.226(3)] Setbacks from resources 1310 CMR 15.211 Required when other than single-family dwelling or flow>1000 d 310 CMR 15.223 1 b First compartment 200% daily flow; Second compartment 100% � daily flow 310 CMR.1.5.22 2 and 3 "U' pipe.througfi or over baffle, outlet of each compartment with as bale or approved filter 310 CMR 15.224(4)] Address Sheet 3...of 9 N/A OK NO Located at least ten feet from any water line? [310 CMR 15.222(2)1" Disposal piping�t least 18"below water line(when water and sewer cross ,see 310 CMR 15.211 1 1 Cleanouts-required/provided ? 310 CMR 15..222 8 Thrust,blocks spiipcified in force mains? 310 CMR 15.221(6)(c)] Slope of sewer line not less than 0.01 (1/1 0.02 preferable 310 CMR 15.222.6. Proper pitchlon all runs? (.005 within gravity-distributed trenches L and beds) [310 CMR 15.251 9 and 310 CMR 15.252(2)(c)] Si phonproblem/. eachfleld below pump chamber Endcaps or vent manifoldspecified? 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 Materials specified (310 CMR 15.251(5) specifies various pipe / types allowed Stable compacted base [310 CMR 15.221(2) and 310 CMR 15.232(2)(9)] Splash plate or baffie 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" 1310 CMR 15.232 3 Inside minimum dimension 12" 310 CMR 15.23 2 2 b Minimum s 310 CMR15.232 3 e Watertight cover if<2000gpd); waterproof manhole if>2000gpd 310 CMR 15.232(3)(d)] Capacity(ernergpncy storage above working=design flow)? [310 C1VIR`231-2 Pro er setbacks: 310 CMR 15.211 same as s tic tanks Watertight 20-in minium access manhole 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)] . Address Sheet 4 of 9 1Bpoyppy calculations needed ?Provided? 310 CM R 15.221 8 r; ' 1 Address Sheet 5:of 9 N/A OK NO � . Calculations correct? 4 feet of naturally occurring material demonstrated? [310 CMR 15.240 1 Required separation togroundwater? 310 CMR 15.212 Aggregate specified as double washed 310 CMR 15.247(2)] V System Venting required/provided?"(system under driveway or >36" deep) 310 CMR 15.241 Inspection ports ispecified and within 3"final grade? [310 CMR 15.240 13 Breakout requirements met? (No violation of breakout elevation within 15 ft of SAS unless barrier) [310 CMR 15.211(1)[4] and Guidance Document f Chambers and Gal. in trench configuration supplied with inlet every 20 ft. 310 CMR 15.253 6 Each structure v�ith one inspection manhole(if>2000 gpd must be �J tograde) 310 CMR 15.253(2)] G Aggregate 1' minimum- 4'maximum: 310 CMR 15.253 1 2' sidewall credit maximum [310 CMR 15.253 1 a In bed configuration, inlet eveEX 40 N. ft. 1310 CMR 15.253 6 Width 2'minimum 3' maximum 310 CMR 15.251 1 100 feet-maximum length [310 CMR 15.251 1 a] Minimum separation 2x effective depth or width whichever greater l 3x if reserve between trenches 310 CMR 251 1 dl Situated along cpntours 310 CMR 15.251(2)] Breakout OK? 10 CMR 15.211 1 A4j and Guidance Document minimum 2 distribution lines 310 CMR 15.252(2)(a)] Maximum separation between lines b' 310 CM R15.252 2 d o� Maximum separation between lines and outside of bed 4' [310 CMR 15.252(2)(16)] Aggregate depth below discharge pipes 6" minimum, 12" maximum. 310 CMR 15.252 2 Separation between beds 10' minimum. 310 CMR 15.252 2 Bottom area used in calculations only 310 CMR 15.252 2 i Address Shot 6 of 9 N/A OK N:O Pressure Dosed System ? Provided pump and piping calculations as required 310 CMR 15.220(4)(r)] Pressure dosing Tequired on all systems>2000gpd or alternative systems under remedial approval [310 CMR 15.254(2) and I/A Remedial Use ovals 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 >2000 dgood to note on plan 310 CMR 15.254(2)(d)] Construction in fiA -Did the plan specify that the fill shall meet the s ecification of 310 CMR 15.255 3 ? Impervious barrier and/or retaining wall ? Guidance Document Impervious barrier installation must be supervised by designer 310 CMR 15.255(2)(b)] Retaining wall must be designed by Registered Professional Engineer 310 CNIR 15.255(2)(a)] Side slope not exceed 3:1 ? 310 CMR 15.25 5 2 Breakout requirements met? [310 CMR 15.252(2) and Guidance Document At least 5 ft. from impervious barrier to edge of SAS (10 ft. recommended 10 CMR 15.255 2 e Check DEP Approval letters for credits and design conditions If used with pressure dosing do not allow pressure discharge to scour soil interface c/ Was DEP Approval Letter provided and/or have you reviewed the letter for conditions? Is the technology being properly applied and does it meet all DEP Approval Conditions? Is there a r+cite on the plan regarding the requirement for perpetual maintenanceagreement? Any alarms involved on separate circuits Did the applicant submit an operation and maintenance manual? Has licnt submitted a co of a maintenance agreement? Are the variances listed on the plan? [310 CMR 15.220 4 RLS Stamp-necessary on plan if a component is within five feet of property One 310 CMR 15.412(4)] Address Sheet 7 of 9 New construction or increased flow proposed; [Refer to.310 CNrR J1S:4r14 > ' Vflll u , { l w.. { Address Sheet-8 of 9 I N/A OK NO. Is the system in a Designated Nitrogen Sensitive Area(Zone II for a public supply well)? [310 CMR 15.214, 310 CMR 15.215 and j 310 CMR 15.210 - also refer to Policy regarding upgrades of such t/ existing systems] Is the system proposed on the same lot as served by private well ? 310 CMR 15.214(2)] r/ Are the nitrogen loads proposed in compliance? [310 CMR 15.21 1 Pnm in to septic tank ? 310 CMR 15.229 Shared System 1-0 CNM 15.290] IN r _ t 1 1 Address Sheet 9.of 9 f Town of Barnstable Regulatory Services Sl, Thomas F. Geiler,Director • Public Health Division Thomas McKean,Director :Nlld 200 Main Street, Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Date: 11 Sewage Permit# Assessor's Map/Parcel �_� Installer&Designer Certification Form Designer: "v� ���e CA ' L� ��C Installer: KCQ�14 d`, Address: )-L W Cr&4 s-C�-L 1 ci 0-h, Address: 1 A� �1 On C 13 d (J �'�L�VgA-'v" was issued a permit to install a (date) (installer) septic system at A �i W - t? . based on a design drawn by (address) dated 16 LZ/11 (designer) / — _ 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 bcx and/or septic tank. Stripout (if required) was inspected and the soils were found satisfactory. I certify that tae 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 systems but in accordance with State &Local Regulations. Plan revision or certified as-built by designer to follow. Stripout(if required) was inspected and the soils were found satisfactory. _ \yH pFP,q4SscyG �� 9 � PETER T. u' (Installer's Signa X) � o WENTEE ' CIVIL -o No.35109 Q @ �0 Fp/ (Designer's Signature) (Affix De re) PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISI N. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS- BUILT ARD ARE'RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. q:\office foimAdesipercer ification form.doc �As CM -Nr Ao o o r 4"���a, pVIA a w vo i.�P Lx tA G1 Sid14 r % G � v G A-500 i d11 Ore U"►rIC V M ` �! (• r,p0� n� �� N /^pP mac• -'�- — -� _ . . ` - - - - - - .i � a� � � oa fA N c.v goo w Oo 4 l c U A) 1 � C � J J �Q � 4 J r Town of Barnstable P#J27 Department of Regulatory p Services . • &MtNffASM = Public Health Division Hate. Z s r zbsy 200 Main Street,Hyannis MA 02601 �Ep MKIi� Date Scheduled U Time� Fee Pd. a ' Soil Suitability Assessment for Sew ge isposal M� �'.�f Performed By: ►���C Witnessed By: J% LOCATION& GENERAL INFORMATION Location Address Owner's Named L o.rr� n ode �'n S Qr`Q /-� Address Assessor's Ma /Parcel: > /' ® .S7Q P Engineer's Name NEW CONSTRUC 1ON REPAIR Telephone#'t �Q0' L. --7 6 Land Use z ,Sam Ot Slopes(g'o) Surface Stones D V� Distances from: Open Water Body?t—S--'D It Possible Wet Area 56ft Drinking Water Well 2�ft Drainage Way CJU ft Property Line 6 2U ft .Other` ft SKETCH:(Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlandsn proximity to holes) Lye 1\ "` P+�`V,4- . � Parent material(geologic) eJac�al v �S Depth to Bed 1.rock A))b- Depth to Groundwater. Standing Water in Hole: Weeping from Pit Face Estimated Seasonal High Groundwater f -3 Z i, DETERNIINATION FOR SEASONAL_HIGHNATER ABLE _. Method Used Depth Observed standing in obs.hole: In. Depth to soil mottles: Depth to weeping from side of obs.hole: in, Groundwater Adjustment ft. Index.Well.# Reading Date: Index Well level -_„ Adj,fictor, m Adj.Groundwater Level PERCOLATION TEST Date Time,. Observation Hole# � 5 ( Time at 9" Depth of Pere Mc�,; Time at 6" � n - Start Pre-soak Time @ 'lime(9"-6") End Pre-soak Rate Minllnch. C Z ~ Site Suitability Assessment: Site Passed 1-5� 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:ISEPTWERCPORM.DOC DEEP.OBSERVATION HOLE LOG Hole Depth from Soil Horizon Soil Texture. Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling '(Structure,Stones;Boulders.. Co istenj,WGravel) 2 7 w DEEP OBSERVATION`HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency, Z77/ 3 DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Con.istency. O e DEEP OBSERVATION:HOLE LOG Hole.# Depth from Soil Horizon Soil Texture Soil Color Soll .. Other ' Surface(in:) (USDA) (Munsell) Mottling (SiructureCo ;:Stones;Boulders. Flood Insurance Rate Man; - Above 500`year flood boundary No— Yes -_ Within'S00 year boundary No Yes. Within 100 year flood boundary No 0 Yes ...� Death ofNaturally Oceurring Pervious Material Does at least four feet of naturally occurring pervious material exist in all areas observed throughoutille area proposed for the soil absorption system? If not,what is the depth of naturally occurring pervious material? Cerhataon (date)I have passed the soil evaluator examination a'proved by the' I certl that on 1p Department of Environmental Protection and that the above_ analysis was performed by me(consistent with the required •ng,expertise and experience described in 310 CMR 15.017. Signature Date © 0 Q:\SEFnCtPERCFORM.DOC LOCATION SEWAGE PERMIT NO. f Alr DA VlUM E /� ASSESSORS MAP N0 60 No INSTA LLER'S NAME i ADDRESS R U I L D E R OR OWNER a C D T IT D A E PERM ISSUE DATE COMPLIANCE ISSUED � ,.��� � �' .. _. S _ `� � _ �E� � Ji I ,�Y 1 ,Rc�j � �� , tR � �P�� � � �' - _,. - • , '� T �,. L.. � �, � � �— "_ — � J Nc�.—�.._..►.i 2�.� Fz�s..�15�,OO......M THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH `SA1 Tgwnop....Barns..a14...... .. �A Apphratiun for Diupuuttl Workii Tunutrurtiun ramit Application is hereby made for a Permit to Construct ( ) or Repair (X) an Individual Sewage Disposal System at: a �� Gemila _JRX....Y�...Barns tali#,1e--------•-------•-----•------•------ ..............--------------#Ae---•--............----...--•---•-----......----............................ Location Address or Lot No. Mr......Joes h_.Cardone - . ........68 .e. .-...... .....•-..... .. ............ ....... tAb& ............. o ner Address .. & B Canc.. ... -------•--- --- ...Yarmou-th,..kja.................... Installer Address elType of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms...............3....._._..........._......Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) GL 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 (Y) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date.................................... .4 Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ G 4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ P4 ........................-.................................................................................................................................... 0 Description of Soil......................................................................................................................................................................... U .........-•---•------•--•--•-----•-----•-••.............................••----------......_.....-------•-••....---•--------------•••••-•-•-------••-•-••-------------------..---•••----•----............. W U Nature of Repairs or Alterations—Answer when applicable...Ln LQQQ...galIon••-stone-•packed•-leaf pit_with_D_Box -------- ....................................................._................. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System.in accordance with the provisions of iI'IU 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 f health. S' d..TI?P .. ..................................... ne ate Application Approved By-------- .role................ .......... ',............................... Date Application Disapproved for the following reasons:.............................................................................................................. ---••••-••--•-•-----••.........................•--------....----•----•-•---•-----.....----------.......-----......................•-•-•---------•--•--•-••-•------------••----••----- ••••--------•--- Date PermitNo......................................................... Issued........................................................ Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH Towr-O F....Barns talb1be Appliratiun for Disposal Works Tonstrur#iun rami# Application is hereby made for a Permit to Construct ( ) or Repair ( X) an Individual Sewage Disposal System at: Gemine__ . .ht....Alaxr� ta >a................................... .... .... ••#68...---•---• .........................................._.................. Location-Address or Lot No. Mr. Joesj* Cardone 68 Gemine Dr. W Barnstabl.................. . ............ ............................................... . ........ .. ... L... .. Ow er Address W A & B Canco �.t.. .: .. :� :;- =1.......... . 350 Main StA..WA...yV1'Vj 9U1h M4!.................... a -•-•--••---------------------- ....... .--- ... Installer Address Type of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms..................3.......................... Attic ( ) Garbage Grinder ( ) '4 Other—Type T e of Building ...._._ No. of persons............................ Showers Ltil yP g ---------•----------- P ( ) — Cafeteria ( ) 04 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. 3 Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) 1.4 Percolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. I................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........................ a •-----•-•-....---•-•••--••-•-----••-•--•--...-••-----•---•.....................•---.............................----------•------........................---- 0 Description of Soil.....................•--••--------------•-•--------------•--..........--•------...........-•----.......-•----•-••--------.............--•------•--------•.........------ W V ............................................ ---------•----....... ------ .-........ •-------------• ---------.-------- ------------ •••---------------- W U Nature of Repairs or Alterations—Answer when applicable..L-1000._Q_allon... tone packed leaching pit with -Box Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System.in accordance with the provisions of TITI.i 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. Steed...............:.......... -... ...�.... _.. yp_ Application Approved By........... :'.....s� :_.ry.►: - ' „. ate .................•^ ------•------•------Date�.... Application Disapproved for the following reasons:.............................................................•..............._..................._......____ ----•-•---.....-•-•--•.................................••-------.........-•---........---------•-•------•.•-•---•-•••-------•--•------------......._......•---...._._....-------•--•--•.....--......--- Date PermitNo.................•----------..._........----------.. Issued..................................................... ... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH W Town OF Barnstable .............. ....... ................................................................. Trr#ifiratr of Tamphatur THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired by-----A --------Cameo 350 Main n St. W. Yarmouth:::ilia:......_..- 68 Gemine Dr. . W. ,Barnstable Ma. Joe Cardone at .--••••--•-•-------------••-------------•--•-•----------------------------...............------ ..... 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-------..1.. ?_.3/ ,........... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE ' SYSTEM WILL FUNCTION SATISFACTORY. DATE....................I- 4 ��........................................ Inspector.................................................................... THE COMMONWEALTH OF MASSACHUSETTS Joe Cardone BOARD OF HEALTH Tpwn Barnstable $15.00 No.�-�`.-r.. "":i.�:>'� ...........................................OF............-------................................................ ............. Fzz........................ �iu�ruuttl�„ ur �nnu#r�tr#iun �rrnti# Permission is hereby ln• ......................anted .. e to Construct ( ) or'Repair F� ) an Individual Sewage Disposal System at No.... ...... ; . ri:�.^.C._- C-••----•-•-•-U'-•---. a.�lr: --��` ". ...........................•-•--•---...............-•---••---..................--••- :: Street as shown on the application for Disposal Works Construction P r it No Dated...... .f ..................... .... _�... .................•. _------------ Board of Health DATE.......•-�1 '''................................................... FORM 1255 A. M. SULKIN, INC., BOSTON ky - i } Exi L EXISTING LEACH PITS WELL ` TO BE PUMPED & FILLED N9 W/SAND AND ABANDONED ��. LOTOf 6-� \ 43, S.F. � � 102 ap 131 z __ -102 Parcel 50 -► o 102.47 0. PA ID I LO 06 CA O 10251 , UPPER PA TlO / PA T10 I I 8 LOT 14 0 �;`r5 / /Ax 108, 103.8 x 106,55 WALKO T 10806 ' r•r f LOT 15 05.51 - `n EXISTING 1 c P D '102.37 10 HOUSE(#68) m T.O.F.=110f ' o• w ° ' 10 SHRUBS -�- � m 10 , • 110, 101.-7 102.39 c� �. LA b 0 { ' w 150 ARC FROM \ e o SHRUBS ABUTTING WELL » 1 a x 111, 108.62 TREES/SHRUBS. G S• o C 110, x 111,11 x p 02.43 c a U Is GS r cV STON 1 7.10 L/ T S DRIVE Y x �� 7.58� 07,35 SHRUBS &107.2 91 x 1\12.80 Ret. wall M 11 ,9 3.22 �� \ U SHR +M LAMP 105.04 edge -10 01- 102.82S x 104.40 _ . .4 -� 22' 04.33\ 104.90 cc chbasin rok. 10 3: c TREES/SHRU _ het, 3 `VENT-MANIF0L0 Ko/i ALL ROWS STONE + EXIS77NG SEPTIC TANK DR(UEWAY LAMP O DO (TO REMAIN) �6 +20 102.67 TOP OF TANK, EL.=108.491. x 104.92 �I, 16 `� �n� o INV.(OUT)=1OZ16f / x + a 1� P R 1 � x 1 5.13 e of O +` 10 11 GENERM NOTES- 1. ALL CHANGES TO THIS PLAN MUST BE APPROVED BY THE LOCAL 100.85 / / t BOARD OF HEALTH AND THE DESIGN ENGINEER. 2. ALL WORK AND MATERIALS SHALL CONFORM TO THE REQUIREMENTS 1 / N,' OF THE.STATE_ENVIRONMENTAL CODE, TITLE V, AND ANY APPLICABLE r.��1- LOCAL RULES AND REGULATIONS EXCEPT AS REQUESTED BELOW: Ilk �/ / V \ 1) LOCAL REGULATION: 150' SETBACK REQUIREMENT-WELL TO S.A.S. " 9 A 25' variance, private well (subject site) to proposed S.A.S., 00.97 for a 125' setback. 1 g� L 3. THE SEWAGE DISPOSAL SYSTEM SHALL NOT BE BACKFILLED PRIOR TO INSPECTION AND APPROVAL BY THE BOARD OF HEALTH AND THE 9 /9 .67 DESIGN ENGINEER. 4. ANY CONDITIONS ENCOUNTERED DURING CONSTRUCTION DIFFERING FROM THOSE SHOWN HEREON SHALL BE REPORTED TO THE DESIGN ENGINEER BEFORE CONSTRUCTION CONTINUES. t - 5. ALL ELEVATIONS BASED ON ASSUMED DATUM. Benchmark Set' 6. THE DESIGN ENGINEER IS NOT RESPONSIBLE FOR THE FAILURE OF OF Mq THE CONTRACTOR OR OWNER TO NOTIFY THE LOCAL BOARD OF CONC. AIPRONIGARAGE ENTRANCE, Q��� ssq� HEALTH FOR PROPER INSPECTIONS DURING CONSTRUCTION. EL.=102.43 (Assumed) �`` yG 7. WATER SUPPLY PROVIDED BY PRIVATE WELL. o PETER T. J MCENTEE `- $• THERE ARE NO ABUTTING WELLS WITHIN 150' OF THE PROPOSED S.A.S. �. CIVIL "' 9. ALL AREAS CLEARED FOR CONSTRUCTION SHALL BE RESTORED AS ` No. 35109 AGREED UPON BY OWNER AND CONTRACTOR OR AS OTHERWISE DIRECTED BY THE APPROVING AUTHORITIES. N 1?0, ° R£GIS ER�ot,, 10. IT SHALL BE THE RESPONSIBILITY OF THE CONTRACTOR TO VERIFY THE LOCATION OF ALL UNDERGROUND UTILITIES, PRIOR TO BEGINNING LOCUS CONSTRUCTION. \C� 11. WHERE REQUIRED,'CONTRACTOR SHALL REMOVE ALL UNSUITABLE SOILS IN THE AREA BENEATH AND FOR 5' ON ALL SIDES OF THE S.A.S. AND REPLACE WITH CLEAN SAND AS SPECIFIED IN 310 CMR 255(3). 12. AREAS REQUIRING STRIPOUT OF UNSUITABLE MATERIALS SHALL BE PLAN REVISION - 11/12/09 INSPECTED BY HEALTH DEPARTMENT PRIOR TO BACKFILL o \3 1) ADD NOTE STATING Arc36HC UNITS 13. THIS PLAN IS TO BE USED FOR SEPTIC SYSTEM PURPOSES ONLY AND edor �� 'MUST BE STAMPED H-20. - IS NOT TO BE CONSIDERED A PROPERTY LINE SURVEY. _-,01=-EXISTING CONTOUR PROPOSED SEPTIC SYSTEM UPGRADE PLAN Chbr x ioam EXISTING SPOT GRADE °h S -U-UNDERGROUND WIRES 68 GEMINI DRIVE, WEST BARNSTABLE, MA 1?00 -(,-EXISTING GAS SERVICE Prepared for: Linda Cardone, 68 Gemini Drive, West Barnstable, MA 02668 . . . 6 TEST PIT Engineering Y�En ineerin b SCALE DRAWN JOB. NO. Engineering Works, Inc. 1"=20' P.T.M. BENCHMARK 203-09 LOCUS MAP 12 West Crossfield Road, Forestdale, MA 02644 DATE CHECKED SHEET'NO NOT TO SCALE LEGEND (508) 477-5313 10/21/09 P.T.M. 1 o f'2 w ; •. .sit. +.. • ,6 L .- st Y ` r NOTE: TO PREVENT BREAKOUT, THE .PROPOSED FINISH r FOR A DISTANCE OF 5'DE SHALLT AROUND ETHEO 8 PERIMETER OF THE S.A.S. SEPTIC TANK PROPOSED D-BOX PROPOSED S.A.S. INSTALL RISERS & COVERS OVER INLET INSTALL WATERTIGHT RISER & INSTALL INSPECTION PORT OVER END UNIT WITH T.O.F. AND SET TO 6" OF FINISH GRADE. COVER SET TO 6" OF GRADE PROTECTIVE METAL COVER SET WITHIN 3" OF F.G. PROVIDE ACCESS TO GRADE OVER OUTLET COVER CHARCOAL EXISTING F.G. EL.=108.9t F.G. EL: 104.2t F.G. EL: 103.5t VENT 11 MAINTAIN 2% GRADE MIN. OVER S.A.S. BIAXIAL GEOGRID—BX TYPE INSPECTION L = 56' L = 15't EXTEND 1 FT. BEYOND S.A.S. PORT ® S=1% (MIN.) S=1% (MIN.) PLACE 4"SCH40 PVC 4"SCH40 PVC 12" COUPLER 79-T6" AT END 10"I " s 10.38" TO To 1 4" INVERT MANIFOLD EXISTING 48" LIQUID I I VENT �vEl INV.=100.37 r- ADo INV.=103.17 PROPOSED INV.=103.00 (4 ROWS OF 6 UNITS AT 5.0'/UNIT) + 1.2' (1 COUPLER) = 31.2' GASH INV.=107.16t D—BOX PLACE COUPLER AT END OF EACH ROW FOR VENT MANIFOLD . .... . ... .• . .••• EXISTING (4 OUTLETS) SOIL ABSORPTION SYSTEM (PROFILE) EXISTING SEPTIC TANK E GEOGRID / BX TYPE CED BY TENSAR CORP. GEORGIA _ RESTORED DRIVEWAY SURFACE COMPACTED, CLEAN GRAVEL BACKFILL BACKFILL WITH CLEAN PERC SAND 18" TOTAL COVER (MIN.) F Tp. TOP OF CHAMBERS BREAKOUT=TOP ' NOTES: TOP ELEV.=100.83 }. " 1) CONTRACTOR SHALL VERIFY ALL EXISTING PIPE INV. ELEV.=100.37 INVERTS, F'RIOR TO INSTALLATION. 12" 2) D—BOX SHALL BE SET LEVEL AND TRUE TO BOTTOM ELEV.=99.50 GRADE ON A MECHANICALLY COMPACTED SIX 2.83' INCH CRUSHED STONE BASE, AS SPECIFIED IN 5' MIN. SEPARATION 310 CMR 15.221(2). TO HIGH GROUNDWATER EFFECTIVE WIDTH=11.3' 3) INSTALL INLET & OUTLET TEES AS REQUIRED. EXISTING SUITABLE 4) GAS BAFFLE TO BE INSTALLED ON OUTLET TEE NO GROUNDWATER, EL=93.3 = MATERIAL AS MANUFACTURED BY TUF—TITE, ZABEL OR EQUAL. USE 4 ROWS OF 6—ADS Arc 36HC•UNITS + 1 COUPLER PER ROW WITH NO SEPARATION BETWEEN EACH ROW & NO STONE SEPTIC SYSTEM PROFILE UNITS MUST BE STAMPED H-20 TYPICAL SECTION N.T.S. SOIL CONSISTANCY TO BE VERIFIED AT PROPOSED.-- , S.A.S. LOCATION AT TIME OF'INSTALLATION. SOIL LOG y DATE: OCTOBER 8, 2009 (REF.#12,718) SOIL EVALUATOR: PETER McENTEE (SE#1542) WITNESS: - DAVID STANTON-HEALTH AGENT _�. - Elev. TP- 1 Depth Elev. TP-2 Depth 10.5.3 0" 104.3 0" FILL FILL t y y 104.6 8' 103.6 8' ��LMGTH C C 36" 9.45" PERC 16" q 8" 12.37" DOME END ' MED. SAND MED. SAND INVERT ` HEIGHT 2.5Y 7/3 2.5Y 7/3 POST END NOTE: UNIT CONFIGURATION AND AVAILABILITY SUBJECT • TO CHANGE WITHOUT NOTICE. PRODUCT DETAIL MAY DIFFER SLIGHTLY FROM ACTUAL PRODUCT APPEARANCE. H-20 RATED WITH rl' 18" MINIMUM COVER 94.3 132" 93.3 132" 4640 TRUEMAN BLVD +PERC RATE <2 MIN/IN. ("C" HORIZON) e HILLIARD, OHIO 43026 Arc 36HC SIDE PORT COUPLER NO GROUNDWATER OBSERVED nnva+ceo oruNnce SYSTEMS.INC. 63.25" 16" 34.5" DESIGN CRITERIA NUMBER OF BEDROOMS: 4 BEDROOMS SOIL TEXTURAL CLASS: CLASS I TOP VIEW DESIGN PERCOLATION RATE: <2 MIN/IN so" END CAP END CAP DAILY FLOW: 440 G.P.D. FRONT VIEW SIDE VIEW DESIGN FLOW: 440 G.P.D. END CAP REAR/TOP VIEW GARBAGE GRINDER: NO - NOTE: UNIT CONFIGURATION AND AVAILABILITY•SUBJECT - SIDE VIEW EXISTING �aEPTIC TANK: 1000 GALLON CAPACITY TO CHANGE WITHOUT NOTICE. PRODUCT DETAIL MAY DIFFER SLIGHTLY FROM ACTUAL PRODUCT APPEARANCE. w PROPOSED DISTRIBUTION BOX: 4 OUTLETS MINIMUM 4640 TRUEMAN BLVD Are 36HC DETAIL LEACHING AREA REQUIRED: (440) 594.6 S.F. HILLIARD, OHIO 43026 H-20 RATED WITH ADVANCED MANAGE�,INC.Iff4w. - 18" MINIMUM COVER ak USE 4 ROWS OF 6-ADS Arc736HC UNITS + 1 COUPLER PER PROPOSED SEPTIC SYSTEM UPGRADE PLAN ROW WITH NO SEPARATION BETWEEN EACH ROW & NO STONE 68 GEMINI DRIVE, WEST BARNSTABLE, MA BOTTOM AREA: (GENERAL USE APPROVAL FOR 4.80 SF/LF OF UNIT) Prepared for: Linda Cardone, 68 Gemini Drive, West Barnstable, MA 02668 (Arc36HC Units) 24 UNITS x 5.0 LF x 4.80 SF/LF = 576.0 SF (COUPLERS) 4 COUPLERS x 1.2' x 4.80 SF/LF = 23.0 SF Engineering by: SCALE DRAWN JOB. NO. TOTAL AREA = 599.0 SF Engineering Works, Inc. NTS P.T.M. 203-09 12 West Crossfield Road, Forestdale, MA 02644 DATE CHECKED SHEET NO. DESIGN FLOW PROVIDED: 0.74(599 S.F.) = 443.3 G.P.D. (508) 477-5313 10/21/09 P.T.M. 2 of 2