HomeMy WebLinkAbout0025 FLEETWOOD PATH - Health EO046-08:7 '
Path
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r Town of Barnstable Pa /
�Tom%,
gyp' a Department of Regulatory Services A
nAMST,,BLZ Public Health Division Date
y MA99.
1 ain Street,Hyannis MA 02601
prED MAC
s
Date Scheduled & Time Fee Pd.
---,,,S���loil Suitability Asse�ssm)ent for Se e D�* Pos�al .PerformedBy:'�;�.6�`0 ' ( A?60& Witnessed By: ✓
/ LOCATION&GENERAL VkMATION
Location Address '///"'��""" Natne 4
Address A�<
Assessor's Map/Parcel: `y �J Engineer's Name . ^ j�J��'�9r ;
NEWCONSTRUCTION REPAIR Telephonek 0 —36Q7— 17 .
Land Use Slopes(%) Surface Stones
Distances from: Open Water Body ft Possible Wet Area ft Drinking Water Well ft
Drainage Way ft Property Line R Other R
SKETCH:(Street name,dimensions of lot,exact locations of test holes&pert tests,locate wetlands in proximity to holes)
r
Parent material(geologic) Depth to Bedrock
Depth to Groundwater:Standing Water in Hole: Weeping from Pit Face
Estimated Seasonal High Groundwater
DETERMINATION FOR SEASONAL HIGH WATER TABLE
Method Used:
Depth Observed standing in obs.hole: in. Depth to soil mottles: in.
Depth to weeping from side of obs.hole: in. Groundwater Adjustment ft.
Index Well k Reading Date: Index Well level Adj.factor Adj.Groundwater Level
PERCOLATION TEST Date Time
Observation
Hole k Time at 9
Depth of Perc 1 Time at 6"
Start Pre-soak Time«<; (i B Time(9"-6")
End Pre-soak l B
Rate MinAnch
00'
Site Suitability Assessment: Site Passed Site Failed: Additional Testing Needed(YN)
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:\S EPTIC\PERCFOILM.DOC
DEEP OBSERVATION HOLE LOG Hole#
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders.
Consistent %Gravel
t
10 A-7
DEEP OBSERVATION HOLE LOG Hole#
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) .(Munsell) Mottling (Structure,Stones,Boulders.
Consistencv,°'Gravel)
� �,
DEEP OBSERVATION HOLE LOG Hole#
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders.
Consistencv,°'Gravel)
DEEP OBSERVATION HOLE LOG Hole#
Depot from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders.
-- Consistencv°'GraNeel)
Flood Insurance Rate Map:
Above 500 year flood boundary No Yes
Within 500 year boundary No P Yes_
Within 100 year flood boundary No Yes
Depth of Naturally Occurring Pervious Material
Does at least four feet of naturally occurring pervi u r t ial exist in all areas observed throughout the
area proposed for the soil absorption system?If not,what is the depth of naturally occurring pe ous material? A '
14
Certification
I certify that on !® r (date)I have passed the soil evaluator examination approved by the
Departrnent of Environmental Protection and that the above analysis was perfo ned by me consistent with
the required t' expeIte an ex e 'en described in 310 CM 15.017.
Signature Date l� CJ✓�(
Q:\S EPTI C\PERCFORM.DOC
TOWN OF BARNSTABLE
LOCATION o� 5 ���r6r���Goo� J�4;WS WAGE#
VILLAGE ASSESSOR'S MAP&PARCEL </�e
INSTALLER'S NAME&PHONE NO. �����G '� ej v
SEPTIC TANK CAPACITY ��-�'���°'6: > 0® 67xee®"
LEACHING FACILITY:(type) �i�s�.vG/�,'� (size) >3'o)�OJI�x
NO.OF BEDROOMS
OWNER J'/ 14Zcl
PERMIT DATE: , COMPLIANCE DATE:
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
14 /.2 :P Li
3 d ,
c, it/sJ erg S
e J
No. Pot _ Fee
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes
Application for Dtoogal *patent Cow5trUction permit
Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon( ) ❑ Complete System LJ Individual Components
Location Address or Lot No.a GCT�/�Od e?41 1 Owner's Name,Address,and Tel.No.
,-*v,i17, if'isry J,0A L41
Assessor's Map/Parcel
Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No.
3 />>
Type of Building:
Dwelling No.of Bedrooms y 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
Plan Date �� // Number of sheets O Revision Date
Title
Size of Septic Tank /O o o Type of S.A.S.
Description of Soil
Nature of Repairs or Alterations(Answer when applicable)
1P 01d
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 Bo rd of Health.
Signed Date
Application Approved by Date 7^ f 9 —(/
Application Disapproved by: Date
for the following reasons
Permit No. �' — I Date Issued r 3
No. PO Fee
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes
01pplicAtion for:Mi!5pogal bp!gtem Cowaructiou Permit
Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon( ) ❑ Complete System U Individual Components
Location Address or Lot No.c7-r_,ezellt 000 40g:�41�y Owner's Name,Address,and Tel.No.
.,-Sov. -!*;7. ism
Assessor's Map/Parcel y,<" P)
Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No.
3 3 />>
Type of Building:
Dwelling No. of Bedrooms y Lot Size sq.ft. Garbage Grinder ( )
Other Type of Building �c C`f' No. of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow(min.required) -'03� gpd Design flow provided may/ gpd
Plan Date > Number of sheets Revision Date
Titles `' 'j f (
Size of Septic Tank �o g 1 Type of S.A.S.
Description of Soil
Nature of.,Repairs or Alterations.(Answer when applicable).Le
t
oDate 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.
y Signed Date ' `w
Application Approved by Date
Application Disapproved by: Date
for the following reasons
Permit No. �Q!' - Date Issued _\143 -
THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE, MASSACHUSETTS
Certificate of Compliance
THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed ( ) Repaired (,�4' Upgraded ( )
Abandoned( )by t�i2� ��o�G/r' ✓'lGaj�� f'
at has been constructed in accordance ^ //
with the provisions of Title 5 and the for Disposal System Construction Permit No. 0;W t- a3 1 dated
Installer V L-,e CIF Designers
#bedrooms y Approve design flow yam/ gpd
The issuance of this permit all n t be construed as a guarantee that the systif.1em will,• n t on as designed.
Date Inspecto�
--°-- N J - . � � Feel -=—
o.
k THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS
lwigoal *Vttem Con5truction Permit
Permission is hereby granted to Construct ( ) Repair (� Upgrade ( ) Abandon ( )
System located at o� S`f�E`ctT Lv ao D �i6T/�
/?l . /f!•
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
Date _ / !(� C
Approved by
i
f
Town of Barnstable
�pF IJE...Tp
Regulatory Services
.. Thomas F.Geiler,Director
{
r or
BA"RN.ST14BLE, + �' • .
9 bfXSS . o
- Public wealth Division�ts�on
Thomas McKean,Director
200 Main Street,Hyannis,MA 02601
Office:.508-862-4644. -Fax: 508-790-6304
Installer&Designer Certification Form
Date: V 01
Designer: 1 Installer.
Address: Address: T i+
date installer was issued a permit to install a
) ( )
septic system at based on a design drawn by
(ad ss)
dated
(designer)
--1�—
/certify that the septic system referenced above was installed substantially according to
�
.he design,-which may include minor' approved changes such as laterzas-reloeatidn of the
distribution box and/or septic tank. .
certify tthat the septic system referenced above was instAIpd with-.zna r c
3p hanger-
greater tl ago,`10' lateral reloeatirga-of the SAS or-any.vertical-:relocati of any compon:mt
of the.septC_system)but in aEcordance with State &Local:Regulations. Plan revision or
certified as-built'bydesig-ner-:to'follow.
�H o,F.
tigs
(Installers Signature) .
MZON rn
OV 6.toss-
sgN1TAR�P� ,
(I3 .er s Signature) ( X gner''s Stamp.Here)
PLEASE RETURN TO 1BA NST"'U PUBLIC.HEALTH DIVISION RTII�'�CAtTE
OF-. CONFIPLIANCE. L NETiE`° SSiIED BOT$j-THIS 3FEIRIVS AND ASS
$TJ,JI.' ' A"Ad2E_RECEIVED 713' 7f`HE:B STARLE PI R I.C.- SII N'
THANK YOI7: ,
Q:Yealth/Septic/Designer Certification.Forr:,
r
r
July 12, 2011
To Whom It May Concern,
The property located at 25 Fleetwod Path Marstons Mills, Ma
fi ••.
Is and has always been a four (4) bedroom home.
erald R. atanzariti
Kimberly A. Small
r
i'
1
L _
TRANS. NO.:
CITY/TOWN:
APPLICANT:
ADDRESS: ZS
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(l)(a)for
u grades]-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)(f)]
daily flow
septic tank capacity (required andprovided)
soil absorption system (required andprovided)
whether system designed for garbage grindet
North arrow [310 CMR 15.220 4
'Existing and ro osed 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
Y
N/A OK NO
Location of every water supply,public and private, [310 CMR /
15.220(4)(k)] 1/
within 400 feet of the proposed system location in the case
of surface water supplies and gravel packed public water supplyI/
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] V/
System components not>36" deep(unless Local Upgrade
V-,00-
jApproval or LUA requested) 310 CMR 15.405(1(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)(0]
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<I 000gpd,
two fors stems>1000 g d [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)] 10
Setbacks from resources [310 CUR 15.211]
Multi-Com`artnent Tanks = ;
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
N/A OK NO
BUILDING SEWER AND OTHER PIPING
•b �
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)]
Siphonproblem/ leachfield below pump chamber
Endca s or vent manifold specified?
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 µ
s
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 sum 6" [310 CMR 15.232(3)(e)]
Watertight cover if<2000gpd);waterproof manhole if>2000gpd
[310 CMR 15.232(3)(d)]
PUMP CHAMBERS
Capacity (emergency storage above working--design flow)? [310
CMR 231(2)]
fro per 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
N/A OK NO
SOIL ABSORPTION SYSTEMS (SAS)GENERAL, 06. r
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 GMR 15.253,'
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 I'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 s . ft. [310 CMR 15.253(6)]
TRENCHES 310 CMR 15.251 wt rx. a g ,
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 Qx 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 orfield 5000 gpd)"; T
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)(0]
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 ?
Im ervious 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[UA 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 Se tic's stem°I/A roval=Letters rfi
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
DEPApproval Conditions?
Is there a note on the plan regarding the requirement for
e etual 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 F .
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
lz I I
CMR 15.414]
Address Sheet 6 of 7
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]
pp�
Address 2✓r �� -Pv—�4 Sheet 7 of 7
. dit�l
LOCATION SEWAGE PERMIT NO.
.VILLAGE
I N S T A LLER'S NAME & ADDRESS
1 U 1 L D E R� OR OWNER
DATE PERMIT ISSUED
DAT E COMPLIANCE ISSUED
F
THE COMMONWEALTH OF MASSACHUSETTS
_ BOAR® OF HEALTH
oN..................0F...... .....------------........---.........
Applirati>an for Uhip sal Works Tonstrnrtuan rrntit
Application is hereby made for a Permit to Construct (V<or Repair ( ) an Individual Sewage Disposal
System at:
-•CoT .......... . a 2.7 .-
Location-Address r Lot No.
/CNN �Q a e'�o s1 EF f�fy. dF� .....�.. ---•-�-.....�1.. `& k�..............
Owner A bA Gs�g
ai ................• - d � �1a ?. ..............
Z6
� Installer � Address
Type of Building Size Lot.__.....,.601;__.._..Sq. feet
U Dwelling—No. of Bedrooms.......... .....Expansion Attic ( ) Garbage Grinder ( )
PL, Other—T e of Building ............................ No. of persons........ .................. Showers — Cafeteria
Otherfixtures -------------------------------------------•---------------••--•-- ...... .......................................................
Design Flow......._................. . ..........gallons per person per da _.__....._..._g y. Total daily flow................,..30allons.
WSeptic Tank—Liquid capacity4 ..gallons Length..0'6 7..... Width' 71.4'. Diameter________________ DepthS I .�...
x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft.
Seepage Pit No......../---------- Diameter./Z'--C"._. Depth below inlet............. Total leaching area.Agq....sq. ft.
Z Other Distribution box (✓j Dosing tank ( )
'-4 Percolation Test Results Performed by._L� _. .... �!�A!?A..../Iyc�............ Date..... �_'�Z74�__....__....
IV
,aa Test Pit No. 1....X.......minutes per inch Depth of Test Pit../..V ........ Depth to ground water........................
(i Test Pit No. 2.....zn......minutes per inch Depth of Test Pit... Depth to ground water........................
0 •--------------------------••------•--....�3'-�................................................------- - 8-............................................
O Description of Soil.....!`T /ury - oA SE N?...._._..f3E...ow y
V .-----------------------------------------•-•---•----•---------.....•-•--•-•-----•--------------•----•--•-------------------•----•....-•--•-....--------....:,..........._.........---...---....••..•----
V 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 i ITLL , 5 of the State Sanitary Code—The undersigned further agrees not to place the system in
operation until a Certificate of Com li ce has been issued by the board of health.
Signed 2,H? ._�_._v..!'�r���....................... ...............................
D to
Application Approved By........... ..... .. / 2/2
Date
Application Disapproved for the following reasons---------------------------------••------------------------------------------••-•------------------•-•-----.----
..............•-----...--•-•---•--•-•----•--••-......._..-------•----•-•---------------•-•••--------•---•......---•--•-------•-------•--------•-----------•-----••-•-------...._._... •----......--
Date
Permit No... .............` frl ... Issued.......................................................
�����
1
i
THE COMMONWEALTH OF MASSACHUSETTS
_ BOARD OF HEALTH
0 .. ..............OF.......ZRR!NS7;?�/3GC
Appliration for Disposal Works Tonstrnrtion rrrmit
Application is hereby made for a Permit to Construct ( or Repair ( ) an Individual Sewage Disposal
Systemat... ...... ...... .....f---- - - - ----------------------•--•--•--..........-- ----- -•-•---•-.......-----.......
.oT /09 ��.� i klvo i� MTh'
Location-Address -h /or Lot No. �y�t
jTNN. ..�+»....--6E62) QtIE ........ - ..._ 1. Z` _c� !.�....: .. 5....•.....................
Owner
ss
� _�..__... .......................................... .�..... �I/. I � _ . e c.... p o421eu*......
AAA.. :t-
Installer ddress
Type of Building Size -------Sq. feet
U Dwelling—No, of Bedrooms............. .................. .....Expansion Attic ( ) Garbage Grinder ( )U
PL4
Other—T e of Building No. of persons........�................ Showers — Cafeteria
Q' Other fixtures --------------•------------------------------.------------------------•-------------------------------------------------------------------------------
W Design Flow...........................�': ........gallons per person per day. Total daily flow................. 30.............gallons.
WSeptic Tank—Liquid capacity./aoe..gallons Length_�.C?....... Width.-I.'-Al?... Diameter................ Depths_!9......
x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft.
Seepage Pit No........./---------- Diameter../4'.'G_..__. Depth below inlet.....' 1........ Total leaching area._-2.a ....sq. ft.
Z Other Distribution box (✓) Dosing tank ( )
'_4 Percolation Test Results Performed by..:L Ob_.6_....kle4-L4S Ef,. _�'vG.:............ Date....-�!:.!_7-0"// . .
. . --,. ..._.
Test Pit No. 1....Z-.......minutes per inch Depth of Test Pit._Z_/_/L.__.... Depth to ground water........................
Test Pit No. 2......�......minutes per inch Depth of Test Pit---- y`f:-L. Depth to ground water......_.._^':......
Q+' •••--•-•---•-••---------••••••-----•-••--...-•-•....-•••---------•------------------•-•--•••..--•.••.........................................................
O Description of Soil.....�`/c /u!7 - oil.e SE..----=v'c'9�'' e4_ow ��6 A�.....
x
V -••--••-•-•--••---••-••-----•••-----••....................•...............--------------••------•-•.._....--•-•---•------------------••-•---••-----••-•-••-•---•----------•------•••-•--•-----------••-
W
.................... -----------•-------------------------•----•-----------------------------------------------------------------------------------------...-----•---............•-•-----•----•-.....
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 TITLE 5 of the State Sanitary Code— The undersigned further agrees not to place the system in
operation until a Certificate of Complt `ce has been issued by the boalyd�of'l�lth/
Signed------,r r .,.;•Y�..��, � �..,� c.
---------------•-----....-----.....------------------------------..........-- ................................
C,=.,'"�--•7�;''.. Date
Application Approved By............: :.. �. ..............................................................
ate
Application Disapproved for the following reasons:..............................................................................................................
.............••-•--------•.........---•-•------•-----•-•-----..............--------•--•..._..---...........-•----•-----•---••-------•----•....--•----•••---•••-•..................••.....----------------
Date
Permit No. ....... . Issued.....................................................-
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
..........................................OF.....................................................................................
Trr#ifiratp of Tomplianrr
THIS ISYTO CERTIFY, Th t the Individual Sewage D'sppsal System constructed ( ) or Repaired ( )
by �r >� . i/ ----------------- ---------------------------- --------------------------------
- -
Installer
{ -.
at Z p l D t
has been installed in accordance with the provisions of TIT2 5 of The State Sanitary Code as described in the
application for Disposal Works Construction Permit No------- -1 `l ...... dated--..-1_: __� 6 -----------------
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE...................... yr/��`................................. Inspector.........m-----..........-----------......----------------•-----------•-•-----
r•--
THE COMMONWEALTH OF MASSACHUSETTS
/ BOARD OF HEALTH
�t``1Cn ...........................................OF.....................................................................................
?�
No......................... FEE........................Disposal Works Tuonstrudion rr i# -�-
Permission is hereby granted----- -=------ }... 4TIVA ....1 kv! .. ...................................................
to Construe ( or
7RIpair ( ) an Indivi ual Sewage Disposal System
atNo... .............•-•-•-• ........... -------- 4........----.••••--•----•••-•••••••••--•-•--•••••••-•••-•---••........•-•-•---••-•-••••--•----••--••...-•---
Street
as shown on the application for Disposal Works Constructiou'Pemift N .�..�_.^t/y&• Dated--__-----_.--0...... ...........
---------------------------------------------------------------------------------------
Board of Health
DATE.............
.2..9 ��
FORM 1255 HOBBS & WARREN, INC.. PUBLISHERS
S'YS TEM PROF1 L
NOT TO SCALE
TOP FDN. FINISH GRADE . '°• - FINISH GRADE OVER
EL . :tl::.a.". FINISH GRADE OVER
DIST. BOX � FINISH GRADE OVER
B' ® SEPTIC TANK s ` LEACHING PITp
o, e
Q•• :.tea ''0 :9:...,.e.. 'O.'':O:•. a:•• :e'.. e;d•O:o a. •y0
,, ,a .o... .• 3 OF 1/8 112
PRECAST CONC. OR
ASHED PEA STONE
BRICK 6 MORTAR
, OUTLET PIPE LEVEL TO 12" BELOW GRADE
FOR 2 FT. MIN. A O. °•.p•.�:0.40: O p:o
••p'. :d. �.� .e •e: � .x � », ;� '®,.:!,:e•i..• ,_,� �op;:0:/'o.;e:p'.v: :� ;o .�-'� a••CQp'4.'°•!
C. I. OA PVC TEES
GALLON BSMT, FLR. o ri DIS TRIBUTION BOX o
INSTALL ON LEVEL BASE s " "
4: PRECAS T CONCRETE PRECAST p
:.a:.,.•.®•.•,•..e,o; a IVASHED
' H—• /0 REINFORCED o CRUSHED CONCRETE '+
O,O.o. s.o-4..o...Q:B ::a:u.®,�.e.p•, Q•,:Q:pQ e::a:.� : 6 p, 'e p':o: STONE y
.b;.e:•o.b,.a.00.o:oA•.°.+.°.,•Q_•d'.o.o••m-a o•:o•o•,• ;o:.•o:.•o•b:°• :- •a ° .,0:.
H— /0 REINF.
SEPTIC TANK �•:
INSTALL ON LEVEL BASE a
NOTE.' EXCA VA TE TO ELEV. OR
LOWER TO REMOVE ALL IMPERVIOUS _
MA TERIAL BENEA TH THE L EA CHINL' AREA 3= d
REPLACE EXCA VA TED MA TERIAL N TH 141
CLEAN, CLA Y FREE SAND
i
EFFECTI VE DIAMETER
- - c GENERAL NOTES LEACHING PIT
INSTALL ON LEVEL BASE
1. ALL EL TIONS SHOWN ARE BASED ON ,.: �'S% .�-�,�n�`:
ow
2. ALL PIPES IN THE SYSTEM MUST BE CAST IRON
OR SCHEDULE 40 PVC.
BEER VA TION PI T
3. THE BOARD OF HEAL TH MUST BE NOTIFIED
WHEN CONSTRUCTION IS COMPLETE PRIOR "
PERCOL A TION RA T
TO BA CKFIL L LNG E.•
4. ANY CHANGES IN THIS PLAN MUST BE APPROVED
s' MIN./IN.
BY THE BOARD OF HEALTH AND CAPE 6 ISLANDS
WI TNESSED B Y,•
SURVEYING CO. INC.
5. MATERIALS AND INSTALLATION SHALL BE IN
s.
i F p f COMPL LANCE WI TH THE S TA TE SA NI TARP BRD. OF HEALTH DESIGN DA TA
— ? CODE — TI TL E V — AND LOCAL APPLICABLE DA TE.• `• '_ _ _a _
RULES AND REGUL A TIONS S�
NUMBER OF BEDROOMS
6. NORTH ARROW IS FROM RECORD PLANS AND
10�00 6AL011� ' ' M GARBAGE DISPOSAL Nd
IS NOT TO BE USED FOR SOLAR PURPOSES ��,
• fi f " f ,-9 DAILY FLOW
PRECAST 'ccAwvc,� .F { ; �� .__-., Fes" 7. FLOOD HAZARD ZONE
• SEPTIC.`SANK }
B. WA TER SUPPLY , = ref ° ,, SEPTIC TANK REO 'D.
� 11 -`:S SEPTIC TANK' PROVIDED
Fv LEACHING REOUIRED3�
SIDEWALL AREA 157 S. F.
1,57 S. F. X 2 G/S.F. = 3 2 GPD
f
�
BOTTOM AREA
_ /23 S.F.
PRECAST C01VC4'TE y t
LEACHING PI d !� So LEGEND 12,3 S.F. X A G/S. F. = 12-5 GPO
LEACHING PROVIDED GPO
$ a
PROPOSED ELEVA TION
_07/
`"e
Ica, ;
— —— EXISTING CONTOUR � T :,'
— ` r a SINGL E FA MIL Y RESIDEENCE &'
OBSERVA TION PIT
139, DISTRIBUTION BOX PROPOSED SEWAGE DISPOSAL SYSTEM
O PREPARED FOR
V►zC4 e .4//7 1/
o o SEPTIC TANK
OA- 4-A�a-11, A NN c ' FRED ROB' �E
tRP, RESERVE LOT 109 FL EE TWOOD PATH
BARNS TABLE — M. MILLS — MASS .
f PIPE INVERT ELEVATION
DA TE,'_ � 9, CAPE 6 ISLANDS SURVEYING, INC.
PLOT PLAN SCALE AS NOTED P. 0. BOX 334
SCALE.• 1 "_ 1 J PLAN NO. ,,�l I-. _-`�, TEA TICKET. MASS. '
/�' MAP SEC PCL LOT HSE
i
ASSESSORS MAP:
TEST HOLE LOGS
Q 2 PARCEL:
NOTES:
�^ SOIL EVALUATO
I FLOOD ZONE: , • 2 ` .
f --- off- - f -- -- WITNESS : k 1 1) The installation shall comply with Title V and Town of Barnstable Board of
REFERENCE:
._. DATE: UW E �� Health Regulations.
PERCOLATION RATE: . -{ d 2) The installer shall verify the location of utilities, sewer inverts and septic
components prior to installation and setting base elevations.
��/o c',_�.5' ic•�.../ .� _� -___ �.�/ fit.+ w1� 1�i � 1�1�S
/9c
- -- 3 All gravityseptic piping to be 4 inch Sch 40 PVC at 1/8"
TH- I TH-2 ) two et out of the d-box to the leaching shall be level. per foot. The first
4) This plan is not to be utilized for property line determination nor any other
purpose other than the proposed system installation.
5) All septic components must meet Title V specifications.
6) Parking shall not be constructed over H10 septic components.
LOCATION MAP 7) The property is bounded by property corners and property lines.
8) The property owner shall review design considerations to approve of total
F-D,:5V1 2 . 5� .1 Yam" design flow and number of bedrooms to be considered for design. Receipt
of payment for the plan and installation based on the plan shall be deemed
p
approval of the design flow by the owner.
9) The existing leaching or cesspools shall be pumped and filled with material
per Title V abandonment procedures. Those within the proposed SAS shall
be removed along with contaminated soil and replaced with clean sand per
Title V specs.
10)System components to be 10 feet from water line. Sewer lines crossing the
• �,�� l water line shall be sleeved with,4 inch SCH 40 PVC with ends grouted if
s SEPTIC SYSTEM DESIGN applicable. The proposed SAS is being installed below the water service
line. The line is to be sleeved as aforementioned and maintained in place.
•� �6' <O 11) If a garbage grinder exists it is to be removed and is the responsibility of the
FLOW ESTIMATE
/� F owner to ensure such.
/ / �e 12)The installer is to take caution in excavation around the gas line if such
p aj2' �� BEDROOMS AT GAL/DAY/BEDROOM - 4GAL/DAY
exists.
13).The installer shall verify the location,quantity and elevation of the sewer
SEP7 I C TANK lines exiting the dwelling prior to the installation.
GAL/DAY x 2 DAYS - GAL _
�.� /�`? ., ,y ti0 Z• USE /GALLON SEPTIC TANK OX-16771
�0 I L ABSORPTION SYSTEM OF
py(N �qS
��` � � '► 6A:5 All_
o B. c
I `,7 MASON 9 y
No.
SIDE AREA:
y
s _\\`6• /������ Q Q� X c � -�- , Z X = �. ,�j, ,..- `' 9
II \ �
BOTTOM AREA:
1-7
l t � S iC SYSTEM SECTION
_ _...�-�uw�0w�ito�i,
lt L ._Y. .(06 gib_(
o+oo
i l4 'Wh G'"q,
0
/C�Ol7 GAL (�+-Zd� tom+ -4, �W I tEE�l 1 6
SEPTIC TANKPoo 0-u"C
SITE AND SEWAGE PLAN
LOCATION : .• 5- 1t;Z 7-k 0
71 0 1
'� .
PREPARED FOR :�I
�,( 2 SCALE E. I
W
DAVID B . MASON, DATE:
DBC ENVIRONMENTAL DESIGNS
z EAST SANDWICH . MA
DATE HEALTH AGENT ( 508 ) 833- 2 177
W
2
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