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HomeMy WebLinkAbout0493 PRINCE HINCKLEY ROAD - HAZMAT 1 �0 - � � 3 `_ -- TOWN S� OF BARNS-TABLELOCA?ION y3 IN . ,141,of SEWAGE# a®P-2 nj/ VILLAGE 'ASSESSOR'S MAP&PARCEL IM d(JE�j ;INSTALLER'S NAME&PHONE NO.- , (()WAI -1,j( SEPTIC TANK CAPACITY __ jG/S Div` t LEACHING FACILITY.(type) 606�yc;1 C�1rM s aft (size)/2 8 x k5-- NO.OF BEDROOMS 3 ' OWNER M a PERMIT DATE: /-.20-d,2, COMPLIANCE DATE: qj1 -7 eparation Distance Between the: 11 I' Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Ak t27 Feet Private Water Supply Well and Leaching Facility(If any wells exist on `L i�j CSC 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 � r XG -4c qE 5 - 31 C9 No. ` 0(9 Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in comp ter: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS ftplitation for Disposal *pstem ConstrUttion Permit Application for a Permit to Construct( ) Repair(�pgrade( ) Abandon( ) Complete System ndividual Components Location Address or Lot o. l f jj FYJrVI� 1AIZ pY wner's Name,Address,and Tel.No. �n�41',o jp/C' Assessors Map/Parcel �,�e ar NoI M,0.1 tlk'A?j Installer's Name,Address,and T 1.No. Designer's Name,Address,and Tel.No. Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building InAlkod No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided J�e gpd Plan Date & F) j Number of sheets Revision Date Title 7— Size of Septic Tank nUy Type of S.A.S. 2 ZPZ4 Description of Soil Nature of Repairs or Alterations(Answer when applicable) & /d.�G'c�� %7C j' G,d //-`a /60 C�&Y 6 aud 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 B h. Si e Date Application Approved by Date Application Disapproved by Date for the following reasons Permit No. Date Issued a 2- - ti. __. :. r ry No. C t 1 j Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: t./^ Yes �, y PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE „MASSACHUSETTS I IYltatiOTY for i8�108aY pstPtn �DTC�tI'U,ttio Permit Application for a Permit to Construct( ) Repair(Y}upgrade( ) Abandon( ) ❑Complete System F,Individual Components , i% Location Address or Lot o. 1 f�► �y1 �o /„i P7 f�'C� Owner's Name,Address,and Tel.Na Assessor's Map/Parcel / 12 / Aple or f Installer's Name,Address,and T1l.No. Designer's Name,Address,and Tel.No. Type of Building: _ZZ Dwelling No.of Bedrooms 'r Lot Size sq.ft. Garbage Grinder( ) Other Type of Building/ )Uf y1V,1 No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.� requ�W,a�ireed) � gpd Design flow provided "�y�j gpd Plan Date � l Number of sheets Revision Date Title / / C = Size of Septic Tank ,X/ �� ;(fed) Type of S.A.S. 2 4VM Qlrr�ww 6L4#{p Description of Soil Nature of Repairs or Alterations(Answer when applicable)��&IJ G a-I,OX Gsrd 2 %rr./,/j �t 1() _- Date last inspected: Agreement: r y The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with 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 Hea th. - ' Sigyned1.,.,l�" - ./ '„r-i�'�•- Date Application Approved by t c,�r s �11 S3 y Date Application Disapproved by Date for the following reasons Permit No. - U f ) Date Issued ----------------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliante THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired(t/�Upgraded( . ) Abandoned( )by+D A —?-- i(oAy�_t_., r_ at /5+fotl(!f/1"'/ f l ��t)Afldrt� has been constructed in accordance C, I with the provisions of Title 5 and the for Disposal System Construction Permit Now. ?d -9/tated Installer 1�1l1u//� /(� Designer #bedrooms ' Approved design flower gpd The issuance of this permit shall not be construed as a guarantee that the system wills ction as deftne- Date `W fi sf` Inspector f/ -- _ _- - -- -- -- - -- - - - - - -- - - - - ,� - - - -- -- - -, -------- No. . b I Fee u o , THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION -BARNSTABLE,MASSACHUSETTS " lu U BispoBal 6pste Construction Permit Permission hereby granted to Construct( ) Repair(L' Upgrade( ) Abandon( ) n r System located at Rpiee and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. ' Provided:Construction must be completed within three years of the date of this permit. ( J ~ Date 1 .� 1 .-Approved by I _ Cj i i Town of Barnstable Regulatory Services Thomas F.Geiler,Director $ H Public Health Division Thomas McKean,Director 200 Main Street, Hyannh6 MA 02601 Office: 508-9624644 Fax: 508-790-6304 Date: k Sewage Permit#,29-'O�-()fy Assessor's Map/Parcel Q installer&Designer Certification Form Designer: ,�fJ►�l^7� 1� � Installer• �_ A /;ldw�nr L Address: ��i�q,ley l� Gi"f Address: y-':A/zOg alL ^/C was rued a permit to install a insta'l/ler) septic system at�` _ _�/,�4rP /1 r�✓r�/� ���/ based on a design drawn by F T— dated j9- , certify that the septic system referenced above was installed substantially acconliag to the d which may include minor approved changes such as lateral rel�on of the diataibutioa box and/or septic tank. Strrpout(if required) was inspects end the soils verb Found satisfactory. I certify that the.septic system referenced above was installed with ma'or changes(Le. greater than 10'lateral relocation of the SAS or any vertdcal reloca:io oP any component Of the septic system).but in accordance with State 8:Local p' '9hons. Plan revision or certified wbuilt by.8esigaer to follow. Stripout(if rP- azted:and the soils were found satisfactory. k3y�N OF DAVID Iasta er's Sigpaturer u e TRANS. NO.: CITY/TOWN: APPLICANT: ADDRESSA �9-5 DESIGN FLOW: gp REVIEWED BY: DATE: N/A OK NO F GENERAL 1 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)(u)] Locus Provided 310 CMR 15.2204 t Plan proper scale? (1"=40' for plot plans, 1"=20' or fewer for components) 310 CMR 15.220(4)] Easements shown [310 CMR 15.220(4)(b)] System located totally on lot served [310 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.) 310 CMR 15.220(4)(d)] Location all buildings existing and proposed 310 CMR 15.220(4)(c)] Location and dimensions of system components and reserve areas. 310 CMR 15.220(4)(e)] System Calculations 310 CMR 15.220(4)(0] daily flow septic tank capacity (required andprovided) soil absorption system (required andprovided) whether system designed for garbage grindei North arrow 310 CMR 15.220 4 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 ) 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 7 N/A OK NO Location of every water supply,public and private, [310 CMR. 15.220(4)(k)] within 400 feet of the proposed system location in the case of surface water supplies and gravel packe&public water supply" = within 250 feet of the proposed system location in the case within 150 feet of the proposed system location in the case of private water supply wells Location of all surface waters and wetlands located up to 100 ft. beyond setbacks listed in 310 CMR 15.211 and any catch basins located within 50 ft. 310 CMR 15.220(4)(1)] Water lines and other subsurface utilities located [310 CMR 15.220 4 m if water line cross see 310 CMR 15.211 1 1 Profile of system showing invert elevations of all system components and the bottom of the SAS 310 CMR 15.220(4)(o)] Stamp of designer 310 CMR 15.220 1 and 310 CMR 15.220(2)] Stamp of Registered Land Surveyor(required if construction activities within 5 ft. of lot line) [310 CMR 15.220(3)] Test Holes adequate (two in each of the primary and reserve unless trenches as permitted in 310 CMR 15.102(2) or as approved for an upgrade under LUA at 310 CMR 15.405 1 k Test hole adequate to demonstrate four feet of suitable material? 310 CMR 15.103(4)] Test Holes adequate to confirm adequate groundwater separation? 310 CMR 15.103(3)] Benchmark within,50-75' of system 310 CMR 15.220 4 Materials specifications noted? [various sections of 310 CMR 15.000 System components not> 36" deep (unless Local Upgrade Approval or LUA requested) 310 CMR 15.405 1 b Address Sheet 2 of 7 � t N/A OK NO IT 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 Separation between inlet and outlet tees (no less than liquid / depth) [310 CMR 15.227(2)] V Inlet/Outlet elevations at least 12" above high groundwater (except as described 310 CMR 15.227(5)) or permitted for upgrades under LUA 310 CMR 15.405 1 k Minimum cover 9" (Tanks buried more than 9" must have risers on all openings and on the d-box) [310 CMR 15.2228(1) and 310 CMR 15.232(3)(f)] Three access covers (inlet and outlet must be 20" or greater) - / middle access at least 8" (b 7/07) [310 CMR 15.228(2)] ✓ Access to within 6 " of grade - one port for systems<1000gpd, two fors stems >1000 gpd 310 CMR 15.228(2)] All at-grade covers secured to unauthorized access? [310 CMR 15.228(2)] > 10 ft from building 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 310 CMR 15.211 v 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 15.224(2) and(3 "U"pipe through or over baffle, outlet of each compartment with as baffle or approved filter 310 CMR 15.224(4)] Address Sheet 3 of 7 f N/A OK NO Located at least ten feet from any water line? [310 CMR / 1 5.222 2 ►/ Disposal piping at 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 specified in force mains? 310 CMR 15.221(6)(c)] Slope of sewer line not less than 0.01 (1/8"/ft) 0.02 preferable 310 CMR 15.222(6)] Proper pitch on all runs? (.005 within gravity-distributed trenches and beds) [310 CMR 15.251(9) and 310 CMR 15.252(2)(c)] Siphonproblem/ leachfield below pump chamber Endca s 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)(h)] 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)(a)] 1/ Splash plate or baffle tee required on inlet/provided? (when pressure sewer to d-box or steep pitch of gravity sewer) [310 CMR 15.323(3)(a)] Riser if deeper than 9" 310 CMR 15.232 3 Inside minimum dimension 12" 310 CMR 15.232 2 Minimum sum 6" 310 CMR15.232(3)(e)] Watertight cover if<2000gpd); waterproof manhole if>2000gpd 310 CMR 15.232(3)(d)] f �4 Capacity(emergency storage above working--design flow)? [310 CMR 231 2 Proper setbacks 310 CMR 15.211 same as septic 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)] Buoyancy calculations needed?Provided? 310 CMR 15.221(8 Address Sheet 4 of 7 r' r N/A OK NO fli '.ABS4RI'TI©1�1 SI'5 1 A9 :€ 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)] System Venting required/provided? (system under driveway or >36" deep) 310 CMR 15.241] ✓ Inspection ports specified 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 Chambers and Gal. in trench configuration supplied with inlet every 20 ft. 310 CMR 15.253(6 Each structure with one inspection manhole (if>2000 gpd must be tograde) 310 CMR 15.253(2)] Aggregate 1'minimum-4'maximum. 310 CMR 15.253 1 b 2' sidewall credit maximum 310 CMR 15.253 1 a In bed confi ration, inlet every 40 s . ft. 310 CMR 15.253 6 ] Width 2' minimum 3' maximum 310 CMR 15.251 1 b 100 feet- maximum length 310 CMR 15.251 1 a Minimum separation 2x effective depth or width whichever / greater 3x if reserve between trenches 310 CMR 251(1 d ✓ Situated along contours 310'CMR 15.251(2)] Breakout OK? [310 CMR 15.211(1)[4 and Guidance Document] EIS: ASum.si Ui lied o ;Geld 5UQQ.. minimum 2 distribution lines 310 CMR 15.252(2)(a)] Maximum se aration between lines 6' 310 CM R15.252 2 d Maximum separation between lines and outside of bed 4' [310 CMR 15.252 2 e Aggregate depth below discharge pipes 6" minimum, 12" maximum. [310 CMR 15.252(2)(g)] Separation between beds 10' minimum. 310 CMR 15.252(2)(f)] Bottom area used in-calculations only 310 CMR 15.252(2)(i)] Address Sheet 5 of 7 N/A OK NO DID,TIIE:P�..�Ai fiV(J�.� Pressure Dosed System ? Provided pump and piping calculations as required 310 CMR 15.220(4)(r)) Pressure dosing required on all systems >2000gpd or alternative systems under remedial approval [310 CMR 15.254(2) and UA Remedial Use Approvals] If used in gravelless system - make sure jet is directed as not to scour soil interface Guidance Document Inspections once per year(systems< 2000 gpd) or quarterly >2000 dgood to note on plan 310 CMR 15.254(2)(d)] Construction in fill -Did the plan specify that the fill shall meet the specification of 310 CMR 15.25 5 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 CMR 15.255(2)(a)] Side slope not exceed 3:1 ? 310 CMR 15.255(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) [310 CMR 15.255 2 e Cr��ueles� st Al Qc1 Lees Check DEP Approval letters for credits and design conditions If used with pressure dosing do not allow pressure discharge to scour soil interface Allernative Se'nc`� a .,�9 ` roual Letters _� � ` 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 note on the plan regarding the requirement for perpetual maintenance agreement? Any alarms involved on separate circuits Did the applicant submit an operation and maintenance manual? Hasa licant submitted a cogy of a maintenance �flridll�e� ' s F i t (t r 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 line 310 CMR 15.412(4)] New construction or increased flow proposed - [Refer to 310 CMR 15.414 Address Sheet 6 of 7 N/A OK NO 1it _ens#rve�lerr 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 310 CMR 15.216- also refer to Policy regarding upgrades of such existing systems) Is the system proposed on the same lot as served by private well ? 310 CMR 15.214(2)] Are the nitrogen loads proposed in compliance? [310 CMR 1.15.216 1 1Jfis��llut�enu� ;: Pumping to septic tank? 310 CMR 15.229 Shared System 310 CMR 15.290 Address Sheet 7 of 7 ASSESSORS MAR: ` - - - - TEST HOLE LOG — _ ) i staiiation shall comply with the State Environmental ode Title V and Town of i ,�.. rd of Health Regulations. PARCEL: t 1g-�1 2) The septic system as proposed on this plan shall not be Installed until a licensed.town SOIL EVALUATOR. A=-oj Installer receives . REFERENCE: ,i approval and an installation permit from the applicable town. p� WITNESS- - �'6'lv 0,5pefrA,) �S ) Prioir to installation,the installer shall � ,�r��� 3 verify the location of utilities,sewer inverts, C�� � - r DATE: �OVUAAUZ :501ZC& 1 sewer lines and existing septic components prior to installation. Z 4) All gravity sewer piping Is to be 4Inch schedule 40 PVC at 1/8"per foot. The first 2 NIELPERCOLATION RATE: '"� i"�, ' feet out of the distribution box shag be level. AN piping conitettions to be glued,4/ . 5) This septic design plan Is not to be utilized for property line determination or for'any - T.H.#1 ELEV. T.H.#2 ELEV Z other purpose other than the proposed septic system installation. LOCATION MAP 6) All Title V components are to meet Title V specifications. 4%6- f/ 7) Parking shall be prohibited over Title V components unless components are H2O _ -- � 1� loaded. _ .. . I-� S) The odsting leaching or cesspools shall be um � ,!11 � pumped and filled with material per Tale V S 1 abandonment procedures. Leaching and cesspool(s)and contaminated soils within a _ the proposed SAS shall be removed and replaced with clean sand per Title V ZAE, specifications. 9) Septic components are to be 1W from a water service line.Sewer lines crossinga water line shall be sleeved w'400, ed with an appropriately sized schedule 40 PVC with ends a 7 grouted. The water service line or the septic sine can be sleeved with �- p n h the sleeve being ,g, .j -1' `1 �a "I� a distance of 10'on both sides of crossing the line. 4000P � g 10)If a garbage grinder exists in the stricture,it is to be removed If the septic system Is ;. not designed to accommodate gn a garbage grinder. ' 4r ` _ _� 11)The Installer is responsible for care of excavation around all utilities on the.property f . and protecting the structural i P B Integrity of all structures during the Installation SEPTIC SYSTEM DESIGN CALCULATIONS �� of the septic system. ROW ESTIMATE. . � 12)This plan only represents that a septic system can be installed on the property 46. ` _ �Z meeting Title V requirements. � • -`.� BEDROOMS�4T GAL/DAYf BDRM- GA[f DAY r % � )The property.� 13 e - + � �. - p p rty►owner shall review design criteria to approve the total number of ; - SEPTIC TANK: -n bedrooms and design flow. Installation of the-septic system as proposed and receipt 1 4 ' 3_;!�>Q GAL/DAY/BDRM X 2 DAYS= �60 GALLONS of payment for the design shall be deemed approval of the design criteria by the property owner or agent of. USE GALLON SEPTIC TANK E>�ItSV 14)The validity of this plan shall expire with the expiration of the town installation permit (GARBAGE GRINDER IS PROHIBITED) issued for this plan or the validity of this plan shall expire on the expiration of the Certificate of Compliance issued for the installation of the proposed system SOIL ABSORPTION SYSTEM: _ _"- � P p posed s m on this plan. I-., SIDEWALLAREA: �C IZ>�3 2 �i r / r 1, DAVID BOTTOM AREA: 12 r a: B. MASON c10 l �? t 0.106$ a /BTB� SEPTIC SYSTEM SECTION BENCHMARK t (o y IL 4e ► � o TOP OF FOUNDATION ELEV. i N r EI �I T�ERI 07 V-1 0 DATUM ASSUMED) 44L$ $+wlf Ir-STONE BASE .— •� � S Hza D-Box s x 1?,�" `e` � F/ 6"STONE BASE OR COMPACTED BASE WATER TEST FOR LEVELNESS GALLONS • lobo t) �} 6M . �IU, l t SEPTIC ANX 1V SITE AND SEWAGE PLAN 1- 312� 1 «cAToN: �I L PREPARED: dills DATE: l I