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HomeMy WebLinkAbout0042 OAK LANE - Health (2) F ©t� ley i 17 No. Fee 4®0 THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS ftpliration for Mispo8al 6pstrm Construrtion Permit Application for a Permit to Construct( ) Repair(grade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. ��C>�cl[ GN ��,�!✓r`f Owner's Name,Address,and Tel.No. Assessor's Map/Parcel Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No. Type of Building: Dwellm No.-of Bedrooms... : . g � _ `_ Lot Size Garbage'Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) ? gpd Design flow provided ' Y2 gpd Plan Date 1 2121 Number of sheets Revision Date %, `'�.' L� 0 k r o ,l r Title r f Size of Septic Tank --H-/0 Type of S.A.S. S60 !1 k//On) `e614 (X&ghj-1-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 Heal S' ed Date !E' 11— Application Approved by Date Application Disapproved b Date for the following reasons Permit No. Date Issued ----------------------------------------- -------------------- - i �s No. ���r! ( C.(J/.. ; Fee.#/OJ THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:iae� Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS 4phration for Misposal *pstem Construction Permit Application fora Permit to Construct( ) Repair(r Upgrad�( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. aO-0&d 4-Al COV h-"'*1 C' Owner's Name,Address,and Tel.No. Assessor'sMap/Parcel lq,�. -QaCf -•Q(7I Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No. Type of Building: Dwelling No.of Bedrooms 3 Lot Size sq.ft. Garbage Grinder( ) Other . Type of Building i"OL 1 No.of Persons Showers( ) Cafeteria( ) - Other Fixtures Design Flow(ruin.lrequired) gpd Design flow provided *7 J r r / gpd, t Plan Date �1��2/ Number of sheets Revision Date f/) 7 t,� AW Title Size of Septic Tank /rW Type of S.A.S. S-iDQ 0144,J Le-44 110114,%-S Description of Soil r� Nature of Repairs or Alterations(Answer when applicable) 111�,X c.J 9-- - H`Zh 5­60 qedln.,1 Lc ce 6 Af.✓tst�,/ do 1&-j 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 o Health. /Si`gned � - .R"' 2------~ Date Application Approved by / Date ,''j'�/Vzo 7-7 t Application Disapproved b�/6P Date for the following reasons Permit No. Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Comptiance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired(�Upgraded ( ) Abandoned( )by at L1'L� (�� �.-� / 5��►/.f�l�E' has been constructed in accordance with the provisions�o[f}Title 5 and the for Disposal System Construction Permit No/ --j992.-dated 1j°��',7 Installer ,i1 a 1�({��,�1 the Designer t �n j- MOSW r r #bedrooms `� Approved design flow ("� gpd 1 The issuance of this permit:shall not be construed as a guarantee that the system will f inct n}as designed. Date -3/ Inspector --------------- No. 2 Fee THE COMMONWEALTH OF MASSACHUSETTS w PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS Misposal 6pstrm Construction Permit Permission is:hereby granted to Construct( ) Repair ( ) Abandon( ) System located at 1`/'� (),aff I-A) Ll'/U/!!0 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:Consttr/uction must be completed within three years of the date of this permit. Date �j 1.� ZZ Approved by ? / TOWN OF BARNSTABLE LOCATION 1-/v2 Q CL\�\1,rJ SEWAGE#, VILLAGE t JS�tP(� 1 `� ASSESSOR'S MAP&PAR INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY ►IKOC7 fl LEACHING FACILITY: (type) S00 01CX N"aO�I`Cs�� .(size) 12�{ )C NO.OF BEDROOMS 3 OWNER PERMIT DATE: g S- �`� COMPLIANCE DATE: Separation Distance Between the: No co(0 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 BYrQ�,,� —1—f aalc- L� �Go� ps4KV,1) 5 7 2,0 TRANS. NO.: CITY/TOWN: APPLICANT: ADDRESS: A4Z DESIGN FLOW: gpd REVIEWED BY: DATE: N/A OK NO GENERAL 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)] V/ Location all buildings existing and proposed 310 CMR / 15.220(4)(c)] V Location and dimensions of system components and reserve areas. [310 CMR 15.220(4)(e)] System Calculations [310 CMR 15.210(4)(f)] daily flow septic tank capacity (required and provided) soil absorption system (required and provided) whether system designed for garbage grinder North arrow [310 CMR 15.220(4)(g)] Existing and proposed contours [310 CMR 15.220(4)(g)] Location and log of deep observation holes (existing grade el. on each test) [310 CMR 15.220(4)(h)] Names of soil evaluator and 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 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 packed public water supply within 250 feet of the proposed system location in the case within 150 feet of the proposed system location in the case of private water supply wells Location of all surface waters and wetlands located up to 100 ft. / beyond setbacks listed in 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 1 5.220(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(l(b)] Address Sheet 2 of 7 N/A OK NO SEPTIC TANK 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)] ✓ 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 for systems>1000 gpd [310 CMR 15.228(2)] V 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 a ro riate? [310 CMR 15.226(3)] Setbacks from resources [310 CMR 15.211] Multi-Compartment Tanks Required when other than single-family dwelling or flow>1000 gpd [310 CMR 15.223(1)(b)] First compartment 200% daily flow; Second compartment 100% daily flow [310 CMR 15.224(2) and(3)] "U" pipe through or over baffle, outlet of each compartment with as baffle or approved filter [310 CMR 15.224(4)] Address Sheet 3 of 7 N/A OK NO BUILDING SEWER AND OTHER PIPING Located at least ten feet from any water line? [310 CMR 15.222(2)] Disposal piping at least 18" below water line (when water and sewer cross, see 310 CMR 15.211(1)[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)] Siphon problem/ (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 DISTRIBUTION BOX Stable compacted base [310 CMR 15.221(2) and 310 CMR 15.232(2)(a)] Splash plate or baffle tee required on inlet/provided? (when pressure sewer to d-box or steep pitch of gravity sewer) [310 / CMR 15.323(3)(a)] ✓ Riser if deeper than 9" [310 CMR 15.232(3)(f)] Inside minimum dimension 12" [310 CMR 15.232(2)(b)] Minimum sump 6" [310 CMR15.232(3)(e)] Watertight cover if<2000gpd); waterproof manhole if>2000gpd / [310 CMR 15.232(3)(d)] V PUMP CHAMBERS ` 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 N/A OK NO SOIL ABSORPTION SYSTEMS (SAS) GENERAL A Calculations correct? 4 feet of naturally occurring material demonstrated? [310 CMR 15.240(1)] Required separation to groundwater? [310 CMR 15.212)] Aggregate specified as double washed [310 CMR 15.247(2)] System Venting required/provided? (system under driveway or >36" deep) [310 CMR 15.241] ✓ Inspection ports 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] GALLERIES,PITS,CHAMBERS. 310 CMR.15.253. Chambers and Gal. in trench configuration supplied with inlet eve 310 CMR 15.253 6 every 20 ft. [ O] 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 configuration, inlet every 40 sq. ft. [310 CMR 15.253(6)] TRENCHES 310 CMR 15.251 Width 2'minimum 3' maximum [310 CMR 15.251(1)(b)] 100 feet -maximum length 310 CMR 15.251(1)(a) Minimum separation 2x effective depth or width whichever / greater(3x if reserve between trenches) [310 CMR 251(1)(d)] ✓ Situated along contours [310 CMR 15.251(2)] Breakout OK? [310 CMR 15.211(1)[4] and Guidance Document] BED SAS (Maximum size of bed or field 5000.gpd) minimum 2 distribution lines [310 CMR 15.252(2)(a)] Maximum separation 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 THE PLAN INVOLVE 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 I/A Remedial Use Approvals] If used in gravelless system -make sure jet is directed as not to scour soil interface [Guidance Document] Inspections once per year(systems<2000 gpd) or quarterly (>2000 d) good to note on plan 310 CMR 15.254(2)(d) Construction in fill -Did the plan specify that the fill shall meet the specification of 310 CMR 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 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)] Gravelless System[EA Approval Letters] Check DEP Approval letters for credits and design conditions If used with pressure dosing do not allow pressure discharge to scour soil interface Alternative Septic System[UA Approval 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? Has applicant submitted a copy of a maintenance Variances 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 15.4141 Address Sheet 6 of 7 i N/A OK NO Nitrogen Sensitive Areas 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 15.216(1)] Miscellaneous Pumping to septic tank? [ 310 CMR 15.229] Shared System [310 CMR 15.290] Address Sheet 7 of 7 ' f Town of Barnstable Regulatory Services } Thomas F.Geller,Director UML ti Public Health Division i6s¢ Thomas McKean,Director 200 Main Street, Hyannis,MA 02601 Ott: 508-962.4644 Fax: 508-7904304 Date; 3 a6-A2- Sewage Permit# 9�2L Assessor's Map/Parcei 23t W Installer&Desictter Certlfleation Form Designer. ZlAr,7 is, NU"4 Installer: Address: C46r Address: :P-0,gg L Itl tea �S �I s/NG was issued a permit to install a ((date) — �istaller) - septic system at V-.Oo44 1-,j 66G'f cljle based on a design draw_n by dated f !� certify that the septic system referenced above was installed substantially according to lbe desi$a,which may include minor ap,Rroved changes such as lateral relocation of the distributtoa box and/or septic tank. Stnpout(if required)was inspected and the soils weib Tound satisfactory. I certify that the.septic system referenced above was installed with Marx changes(i.e. greater than 10'lateral relocation of the SAS or any vertical relocation-oP any component Of the septic system)-but in accordance with State&Local A- -'axons. Plan revision or cerdfiod as-built by.dmigner to follow. Stripout(if rF'• -wed and the soils were found satisfactory. N OF . aR� DAVID y ' is Sigusture ve I 1) The installation shall comply with the State Environmental Code Title V and Town of — •- _.� : TEST HOLE LOGS ASSESSORS MAP: Board of Health Regulations. 2 The septic system as proposed t • licensed 1EVALUATOR- 4 ) P 1►s P P don his plan shall not be mstailed until a town PARCEL, SOIL . installer receives approval and an installation permit from the applicable to". —" p+ JET L;.�! REFERENCE: � WITNESS: 3) Prior to installation,the installer shall verify the location of utilities,sewer inverts, ..-- se wer lines and xi stin septic component s riot to instal lation DATE: 1 . I 4) All gravity sewer piping is to be 4 inch schedule 40 PVC at 1/r per foot. The first 2 1 �.�E feet out of the distribution box shall be level. All piping connections PERCOLATION RATE. P P g� ect ons to be glued. . . W. 5) This septic design plan is not to be utilized for roe line determination or for an a � ELEV. -1�/►�� 7.H.#2 ELEV. � property � Y /� T.H.#1 E other purpose other than the proposed septic system installation. _ 6) All Title V components are to meet Title V specifications. LOCATION MAP � _ _ _� - . t,o 7) Parking shall be prohibited over Title V components unless components are H2O otJG. f t�lfz' }t tia 10 ' , �� loaded. t'5 U8) The existing leaching or cesspools shall be pumped and filled with material per Title V abandonment procedures. Leaching and cesspool(s)and contaminated soils within ' the proposed SAS shall be removed and replaced with clean sand per Title V ol ,.,�, specifications. • t 1 9) Septic components are to be 10'from a water service line.Sewer lines crossing a • -e-_--__. _.,__ _ _ ..__ ,- ram- ,, 1, water line shall be sleeved with an appropriately _ - s edul n s � sized schedule 40 PVC with ends {� Jj grouted. The water service line or the septic line can be sleeved with the sleeve being "t v' l ( �� " ; t a distance of 11Y on both sides of crossing the line. 57 10 If a garbage grinder exists In the structure` it is to be removed if the septic system is L4= My✓qRr.:.-N*Y49't .,.. -.. _..,..r,,...-. ,f not designed to accommodate a garbage grinder. 1 11)The Installer is responsible for care of excavation around ali utilities on the property and protecting the structural integrity of all structures during the Installation process SEPTIC SYSTEM DESIGN CALCULATIONS p g g g of the Septic s stem.. FLOW ESTIMATE: 12)This plan only represents that a septic system can be installed on the property -or meeting Title V requirements. GAL/DAY 1 ....��. BEDROOMS AT _ GAL/DAY/BDRM= \ 13)The property owner shall review design criteria to approve the total number of SEPTIC TANK: bedrooms and design flow.Installation of the septic system as proposed and receipt \ 4 g p � p p P GAL/DAY/BDRM X 2 DAYS Y = GALLON of payment for the design shall be deemed approval of the design criteria by the .. � S property owner or agent of. USE GALLON SEPTIC TANK 4 =-yJ 14)The validity of this plan shall expire with the expiration of the town installation p,errnit " ! (GARBAGE GRINDER IS PROHIBiTED) ; . "issued for his 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 on this # SOIL ABSORPTION SYSTEM. F plan._ , , _ r�.� o -. .: ..,. ---._r._ .. tt /� #j)))�.(+(j(��+� // � •J ��.10(�/+�O(p`��.' i.�,�.1 57//IL�'' .:i. - :..;nm, `ry`/ �Y .,.:. t \r/ i of � Y • '_'" {��r�rf .. ._ /�'j Ids! • o - � � �_ 1 A. • V ,, __w�.. 2_ttiI> x�SIDEWALL AREA: _ i f t ifs ,.� - `• f' - ' ' f �� _ _ f - BOTTOM AREA: - �► iitooa. a ; SEPTIC SYSTEM SECTION Nl!Kell •' � +: \ p ......F..:.r^P."-t,ua.':ttaFYY.tH•`. ts;. } tW w ®� BENCHMARK „ d X IL de AITOP OFFOUNDATION j�. ` • � t r1 O _ 63-57 `6 ELEV. I,` I i >—; Q � o BASE 6 STONE i (DATUM ASSUMED) 04 .' t z._ .. 41 1420 D-BOX _.,,. . .. _..__ _.. _�...__ 6 STONE BASE OR COMPACTED BASE fr WATER TEST FOR LEVELNESS _6 � /SO GALLONS h1 u r &61t4 lbtw 0I SEPTIC TANK 4i• q, SITE AND SEWAGE PLAN ®Avid �s LOCATION - -' -� MASON N .1066 q y TE�'k 6 ! PREPARED:-TV C.. { Z o ' - i �___w • r SCALE. DATE. _ 2oZ mot' jl _ ! - - -- 7-