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HomeMy WebLinkAbout0011 COACH LANE - Health 4� r r gr, �*t ����3� ah lip , o I TOWN OF BARNSTABLE LOCATION i177//��P I L •✓ SEWAGE#2.0 l� ',VILLAGE D,4(2W ST A S)e ASSESSOR'. MAP&PARCEL E 7 INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY X s T 0 Z) LEACHING FACILITY:(type -3. S6ce' 9a, i S (size) A i,.I- x NO.OF BEDROOMS ` , OWNER OLY S'e-11 PERMIT DATE: COMPLIANCE DATE: 3 0 3 I 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 G;�Q ASS s � a f0 X V NFee Entered in computer:THE COMMONWEALTH OF MASSACHUSETTSPUB C HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS l ppYicattOTC f0>C Mi!gpOgAY i§p5tem Curi.5trUCtiOtt Permit . i Application for a Permit to Construct O Repair(Upgrade O Abandon O ❑ Complete System ❑Individual Components S Location Ad ress or Lot No. /�� Owner's Name,Address,and Tel.No. ev �/ ce �� 9- 5 7,0 5 Assessor's Map/Parcel "� S y,, F Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. moo.8 7 7 r 13 F 3 FX .3 11 6 Type of Building: Dwelling No.of Bedrooms Lot Size sq. ft. Garbage Grinder Other Type of Building E No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 41''Y e gpd Design flow provided ��, gpd Plan Date r ,2 > ���- Number of sheets Revision Date Title Size of Septic Tank E ► S C 6 L9 Type of S.A.S. 3 SB �► a'�S Description of Soil Nature of Repairs or Alterations(Answer when applicable) A 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 Environm ntal Code an t to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. Sign — ate 3Z ldZel - Application Approved by Date ..Application Disapproved by: 11 Date for.the'following reasons Permit No. / Date Issued ` No.- ( � "��' Fee Entered in computer: y THE COMMONWEALTH OF MASSACHUSETTS Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS f �4ppficotion for Migo�;oY *Vaem Corr.5truction Permit Application fora Permit to Construct O Repair( ') Upgrade O Abandon( ) ❑ Complete System ❑Individual Components Location Address or Lot No.. ? - Owner's Name,Address,and Tel.No. Assessor's Map/Parcel P-1 Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. o r' 3 2 Sf 3 3 V, Type of Building: Dwelling No.of Bedrooms Lot Size sq. ft. Garbage Grinder (al,)•j . Other Type of Building i� No.of Persons Showers( ) Cafeteria-( ) Other Fixtures Design Flow(min.required) ���� gpd Design flow provided �� gpd _ Plan Date . /�,2 7 ,���- Number of sheets Revision Date Title Size of Septic Tank ' t F /!S U 0 Type of S.A.S. r °Descriptiodof 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. c? d�7 -Date I ✓ Application Approved by �/�}l// i, f /ih_r'I ✓[ ;::>Date y Application Disapproved by: ', Date` for the fo!lov ing reasons e Permit No. f�/ (/� Date Issued _ THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed ( ) Repaired ( ) Upgraded ( ) Abandoned( )by ,-,/ / •» at f � '- t ' �% e /Y `� �f_ r .� has been c�structed i ac dance with the provisions of Title 5 and the for Disposal System Construction Permit No b ,✓/(Jr �V 1 b dated Installer f�. t. /-f Designer ;o �1'I r G #bedrooms Approved design flow �/ `� `T� gpd The issuance of tHis permiit shall not be construed as a guarantee that the system will function as de{igne,6 Date I � I.' Inspector '�!J `� ___ rB � Fee / l THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE, MASSACHUSETTS 1=igpoga1 i§pgtem Congtruction permit Permission is hereby granted to Construct ( ) Repair ( Upgrade ( ) Abandon ( ) System located at . ,�;�,u �•= '�..5©sue/ i' 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: Consinction/nust be complletedd within three years of the date of this p•rmit. r Date / _ l r'/�.'� 1 ! � Approved by 1 ) —•-=� �� Town of Barnstable �"E Regulatory Services Thomas F. Geiler,Director MAS& # Public Health Division ArA`� Thomas McKean,Director 200 Main Street, Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Date: 3 3 �' Sewage Permit#10 i Assessor's Map/Parcel Zq 7 Z Installer& Designer Certification Form Designer: ThONI rS t4(_,J'L f J Installer: ALe LO Address: Address: i3o X �f On was issued a permit to install a (date) (installer) septic system at 11 COACH W. HA VOTAI lIr- based on a design drawn by ( ddress) PA_ CV. 1_2Z-.M THorti/�C Mc �c,oN, P� dated QEV�SI'�j 3— - IZ (designer) 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 box and/or septic tank. Stripout (if required) was inspected and the soils were found satisfactory. I certify that the 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 system) but in accordance with State & Local Regulations. Plan revision or certified as-built by designer to follow. Stripout(if re a spected and the soils were found satisfactory. d II (Installer's Signature) �3i1 ( signers • ignature) (Affix Designer's Stamp Here) PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS- BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. q:\office forms\designercertification form.doc 1 r 3 5 j® Town of Barnstable P a�— a Department of Regulatory Services Public Health Division Date 200 Main Street,Hyannis MA 02601 URt'' Date Scheduled a, Time / Fee Pd. Soil Suitability �^Asses[s�ment fog'Sew a Disposal Performed By: `IDIt tA5 MGITi�, 1'-6. Witnessed By: -- LOCATION&GENERAL INFORMATION Location Address ►I w�, wN Owner's Name DRANN G 12.4 FV5'K► BAVJsJ 1-rAQ UE Address It COA C N dL N�/�,,T'/,, Assessor's Map/Pareel: 21 8/7 Z Engineer's NameC-r f blr),A s /' C LILUN _ NEWCONSTR/U�CTTIIlON REPAIR Telephone# 57oV•3w83'34'" Land Use I;G J es,t Slop 0/0 �. Surface Stones Distances from: Open Water Body /�A ft Possible Wet Area /61A .ft Drinking Water Well �� ft Drainage Way--AA ft Property Line 2 1D ft Other ft SKETCH:(Street name,dimensions of lot,exact locations of test holes&pert tests,locate wetlands in proximity to holes) Parent material(geologic) Q UT V`r/'iS T' A , y� Depth to Bedrock NA , "�t Depth to Groundwater: Standing Water in Hole: (pV o/J y Weeping from Pit Face M O/ )V Estimated Seasonal High Groundwater N(` 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# Reading Date: Index Well level Adj.factor Adj.Groundwater Level_ Observation 31, PERCOLATION TEST Date Time EV'r/ A'IAL`ll ) Ho'e# Time at 9" Depth of Perc Time at 6" Start Pre-soak Time @ Time(9"-G) End Pre-soak Rate Min./Inch Site Suitability Assessment Site Passed 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:4SEPfIC\PERCFORM.DOC DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency.%Gravel 19 A iotin. 3 3 NA 36% R ID`1g, Sf NA. 1801, G ti r INS'SAID IVA DEEP OBSERVATION HOLE LOG Hole# `L Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consisten %Gravel) " o A U, ►L 3 3 NA Lr nF, 67,60 0,4 ul 61 q NA 6fvC 5MO IvA DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other f Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency.%Gravel) DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency,%Gravel) Flood Insurance Rate Mai): Above 500 year flood boundary No Yes - Within 500 year boundary No Yes Within 100 year flood boundary No Yes Depth of Naturally Occurrin¢Pervious Material Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the area proposed for the soil absorption system? �— If not,what is the depth of naturally occurring pervious material? Certification I certify that on (date)I have passed the soil evaluator examination approved by the Department of Environmental Protection and that the above analysis was performed by me consistent with the required train hg,expertise td a perience described in 310 CMR 15.017. Signature Date Q:\SEPTIC\PERCFORM.DOC J S �� �g ' �® o"® e I Sheet f 1573 Main Street 508-896-6601 PHONE P.O.Box 1773 508-896-6602 FAX Brewster,MA 02631 Sieve Analysis Data & Computation Sheet Job#: NA::: Date F/30/12 ' + Job Name: - oac an Notes: Sample Leach Field 10' Below Grade Collected By: Tom McClellen USDA TEXTURAL CLASS=SAND ' Tested By: GM6 i—V---- (SEE ATTACHED) ; i Sieve Opening Weight Percent Cumulative Project Siege In Mesh Retained Retained Percent Millimeters In Grams (Cumulative) finer i &-Mm 4.75 4 8.5 4 15 (4 15) 95 85 i 2.0 10 7.4 3.62 (7 77) 0.425 40 171.4 34.9(42 67) j 57 33 0.075 200 197.3 �" 47.56(90.22) 9 78 PAN PAN 20.0 9.78 (100.00) Passed Mesh Sieve Total 204.6 100.00 �.l ; Sample Weight Wet Natesc i Sample Weight Dry: 206.9 j Percent Moisture: �7:8% Total Percentage of Sand =.90:22% Sample Weight Passed 204 6 Total Percentage Silt/Clay=9.78% j Through Sieves: _.. - ; Soil Texture Calculator NRCS Soils Page 1 of 1 1 Soil Texture Calculator Percent Sand: 90.22 . ....... *Very Coarse Sand: 0 0 *Coarse Sand: CIA 0 *Medium Sand .� 0 oFine Sand: 0 ..... ,�* *oVery ine F Sand 1. '60 Percent Clay: 0 , 9.78 +?i r illt. Graph Color: seen a �.. Red Q cl iI. ..,: Get Type'; Reset" Jay . silty Reset flay loam r +� y /c;la, loam Percent Silt: 30 sa:pdy 1.7763568394002505e-1; 7 L s l q3 .... Texture V . 20 Sand 1 0cIl7... l l - — - CleatGra h sand Njoa�3 oan IIlE�CB�I to f \ gilt ' *Optional : •1 4. And Separoltei z http://soils.usda.gov/technical/aids/investigations/texture/ 1/30/2012 4_ _ - r Sieve Opening (MM) Sieve Mesh . 4.75 4 2 10 0.425 40 0.075 200 pan PAN Passes through sieve 204.6 0 Y a ' Weight Retained in.grams Percent Retained cumulative percent finer 8.5 8.5 4.15% . 4.150Xo 95.85% 7.4 15.9 3.62W 7.77% 92.23% 71.4 87.3 34M% 42.67% 57.33% 97.3 184.E 47.56% . 90.22% 9.78% , 20 204.6 9.78% 100.00% 0.00% TOWN OF BARNSTABLE LOCATION C_oCLC-L SEWAGE # _ /3 VILLAGE i C,,r v�3 bL��4_ . M c. ASSESSOR'S MAP & LO'T�Q� INSTALLER'S NAME & PHONE NO.G 4 v.;, SEPTIC TANK CAPACITY \ O O o LEACHING FACILITY:(type) ° (size) J 0 00 ! NO. OF-BEDROOMS ..-'*PRIVATE WELL OR PUBLIC WATER _ `��, BUILDER OR OWNER TQ� �f`L�-�- LO- Cg, DATE PERMIT ISSUED: e 1 q 4!�, DATE COMPLIANCE ISSUED: �' p t�• v� qS_ VARIANCE GRANTED: Yes - No /" `10 23ov B • r _ t ASSESSORS MAP NO: PARCEL N0: , F THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH i TOWN OF BARNSTA,BLE Appliration for Diripwia1 Works C owitrnrtiun ramit Application is hereby made for a Permit to Construct ( ) or Repair P<an Individual Sewage Disposal System at: l - ...t..�... .. ---- -------�--.----7 I ............................ -t�ddrgss "- or No- :.--0'.K. � `�:`�._..__D S_.��._.._� cis '� �` - ��_�.__. .... .....................••- • Addre Iustaller Address Type of Building Size Lot............................Sq. feet ,.., Dwelling—No. of Bedrooms-----------------------------------------___Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building _______________--__.-.-_-__ No. of persons............................ Showers ( ) — Cafeteria ( ) a' 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 ( ) ►-' Percolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. 1----------------minutes per inch Depth of Test Pit.................... Depth to ground water..................... fi Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a .....---•• --•••-••------••-••. -•--•----•••••-••••-•••-•-....-•..................................••._....__.......------------••. 0 Description of Soil........... �. --•------------------------------••-------.....-----------•------. ......•---•-----•-------••-•---•--•-•--••-••--•-••-•- •------•--------------•---------------._...__...---------•--•. V ................... ------------------------ --------------------------------------------------------------••--------------------------...-----------••--- -- ....................................................... U Nature of Repairs or Alterati ns—Answer wh n p'li ble._._......' S_` - �1.............. ....._._....... ..................... Agreement: cr- The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Com is e has been issued by the board o health. Signed ..... Date ................................ . .......... .................. ApplicationApproved By ............ ...:: -... .......................... .-------------------------------- .;:�............. Date Application Disapproved for the following reasons: ..........0...................... ....................... .. . ..... ....... ..........;� �............ �( .... ........... .................................. . . ................. . ... ....................... ........................................... ............................... ....5. Dare Permit No- ---------- .. ...................... Issued ...... -----........ .�..... . .�^ Dare _ -. THE COMMONWEALTH OF MASSACHUSETTS //0 BOARD OF HEALTH dv TOWN OF BARNSTABLE Appliratinn for Dhip tial Wnr1w Cnnnitrnr#inn ramit Application is hereby made for a Permit to Construct ( ) or Repair ( Individual Sewage Disposal System at• � - -- , )cation-Address or Lo.No. �y�1 Iry `�` �S_. � 9 4wts = � lQQ.ce -•---- •-•-•---..._ -..... Owner Address (( -- W Ci (` -- '1 w�.�.�-. L�.- S G.:'.• S I - G SY� Ea P• YYIr . OZ�, j---------------------------- --••--• -------•---••. ••-••--•••-•••-•-•••-•-�-•.=•-•-•••-� - y Installer- Address UType of Building Size'Lot............................Sq. feet ., Dwelling—No. of Bedrooms___-----------------------------------------Expansion Attic ( _) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons---._-____-__-____.__--.-__. Showers ( ) — Cafeteria ( ) a' 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 ( )~' Percolation Test Results Performed by........_...........................................................!- Date________________________________________ a Test Pit No. I................mmutes per inch Depth of Test Pit.................... Depth to ground water____-_.-_--___--____---. aTest Pit No. 2................minutes per inch Depth of Test Pit-----_---.--...... Depth to ground water......_ .............. 0 Description of Soil-••-•-- - ' r-- ---- •----••• -------- -------- -------- ..__... -------- ------ , U h UW ------------•--------------------------------------------------------------------------••--------•--------------------.......---....--••-------•----'-•--•--•------------------•--...................._. Nature of Repairs or Alterations—Answer wh n' ppli bl --------- S_4 ............ ' ............. -• \ -------- L.P cc�... I; Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Comp°tial�ce has been issued by the board of health. tt - �- SI ned � .................................S Application Approved B PP PP Y - ---------... - Dace Application Disapproved for the following reasons: ...................................... .-. ...._........................................:........................................... o� cl .. ....................................................................................... . . ..... ..... ............................. ---- . -- . ..... --.. ..................................... . 9�j Dare Permit No. �. - - -- Issued ...... .............................................V...... Dace i THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE ��rTT 7441S IS TO CERTIFY, That the ndividual Sewage Disposal System constructed-( ) or Repaired ( ) L S by ...... - ..�l... u 1 �L r... t.............................. ........ 1 . h.�aue� l......_...._ .--�.�1..�. ...-- ---- _ ..... has been installed in accordance with the provisions of TITLE 5 of The State Environmental Code as described in the application for Disposal Works Construction Permit No. .......lq .-.-.! _-.--...- dated ._---..._..............._.-......._....._. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. �� `CY�//�����2 DATE - ........- r'.. .r- -....-_._. Ins ecto � P - .----- .._.-.-... - THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH l®� / TOWN OF BARNSTABLE r FEE...:.................... �tn�n�nlrnrkn �nn�tr�.rtinn rrnti#� - 1 �-o .. - 5---•---••-••......•-•-........ Permission is hereby granted......... `�---------------`'�_..--------•---------- --•---.. to Construct ( ) or Re_ it ��)_an Individual Sewage Disposal System atNo............................ •-... --•-_ Street as shown on the application for Disposal Works Construction Permit No -!4�/__... Dated.... ..m....................... .._. .; Board of Health ------ - -- ---- C DATE---- -----------•�--•-------•------••---•-------- J __ FORM 36508 HOBBS&WARREN.INC..PUBLISHERS No.--G�-•-•--• Fx$.. ........................... THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH 2l o� Appliration for :41sposal lVarkfi Tonstrnr#inn Pumi# Application is hereby made for a Permit to Construct ( ,1�1 or Repair ( ) an Individual Sewage Disposal Syst at, Loca AdV or Lot N . ...... ..... .... ....44�----------- ....................... Owner Address W Installer Address ,/ Q Type of Buildin Size Lot� .� ......Sq. feet U Dwelling No. of Bedrooms_______..-•••______________________Expansion Attic ( ) -garbage Grinder ( ) aOther—Type of Building ____________________________ No. of persons............................ Showers ( ) — Cafeteria ( ) P4 Other fixtures W Design Flow_ _______________ _____________________gallons per person per day. Total daily flow...... __ ............................. gallons. WSeptic +ank Liquid capacity------------gallons Length................ Width-----------.---- Diameter.......--------- Depth__--_________--- x Disposal Trench—No_____________________ Width..................... Total Length-------------_---- Total leaching area--------------------sq. ft. Seepage Pit No--------------------- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) . Dosing tank ( ) t�p aPercolation Test Results Performed by------------- --------••---•--•--•-•--•••••---•----•--••-----•---•------.. Date........................................ Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water________-__________----- f3� Test Pit No. 2------_.........minutes per in h Depth of Test Pit.................... Depth to ground water---------------------- P4 -------------------- ---- ------- _Soil................................. ---•--••--••-•----------------------------------------•------- - 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 Article XI 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. Sid........ •• -•-••••-------------•-••---------•--••••-•--------•----•---••••-••••-- -•••-•-••••-----•-•-••••-------- �'�.��� g ,, YG-� Date Application Approved By.... -_-- ���- Date ' Application Disapproved for the following reasons------------------- --- ------------------------------------------------------------------Date ------------- --------------------------------------- Date Permit No. Issued_---•- �a�,-/'.- ........... fit' • ' r /1111 No.•-�:a................ Fmic :..�� ........ THE COMMONWEALTH OF MASSACHUSETTS I BOAR® OF HAI_TH t Apphration for Diaposal Works Tontrnrtion Prmit Application is hereby made for a Permit to Construct or Repair ( ) an Individual Sewage Disposal S st at y _ _-_�f >rs•- w. r'AS' S,.jpsw.i"•` ,'`>t fi gp ---- �'.. ... Locahp A`dder y t Lot No.� �.t�'�rA''f 'C'�___IF..------.....�d-- -Owner ---- --- •-��-' �' ------'�-.....-•---- " �� ress r� Installer Address d Type of Buildin Size Lot__._. .. ._t°_._..Sq. feet V Dwellin No. of Bedrooms---------.... ..._.Expansion Attic arba e Grinder 04 Other—Type of. Building ---------------------------- No. of persons---------------------------- Showers ( ) — Cafeteria ( ) Other fixtures W Design Flow_.. ............. per person per day. Total daily flow------- , _z`�____:___..--------.gallons. WSeptic Tank—Liquid capacity------------gallons Length................ Width---------------- Diameter--._.-..._._... Depth---------------- x Disposal Trench—No. ..:................. Width.................... Total Length.................... Total leaching area--------------------sq. ft. Seepage Pit No...................•. Diameter.................... Depth below inlet.................... Total leaching area-----.............sq. ft. Z Other Distribution box ( ) Dosing tank ( ) 1, Percolation Test Results Performed by.......................................................................... Date---------------------------------------- W Test Pit No. 1----------------minutes per inch Depth of Test Pit____________________ Depth to ground water...::_--_-.--____-_----- 44 Test Pit No.-2................minutes per i ,h :Depth,of Test Pit------__._,___.......Depth to ground water.---___-_-______.___...- o -- - . ----- �,,. --- ----- Descriptionof Soil =1 - ---- --------------------- -------------------------------............. x W UNature of Repairs or Alterations—Answer when applicable----------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ ..---------------------------------- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Article XI 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-. Date Application Approved By. f .. - Date Application Disapproved for the following reasons:....................... -------------------------•--------------------- ------------------------------ --------------•-•.---•-------------------•--------------•------ ••-------•----•---•---------------••-•---------••- .-•••--•••------•-------•------------•--•---•----------------•---------------•-. Date PermitNo........................................................... Issued........................ Date THE COMMONWEALTH OF MASSACHUSETTS BOARD 015, .HEALTH G .:...............O F......... a.... ue :.:: (Irdif iratr of Tome ianrr THIS IS-TO CERTIFY t the ridividual Sewage Disposal S stem constructed 21 or Repaired tw r �4 � T�-� g . f I �A( Installer by ----------------------- at----�T`°-'-�!"t...............................` " •,s'�-"•--�"'--:'.C*.._._ 1,�''ow�`,• "L^ ,,.... 'd '�Sie`ay„�f__£x'°•'- - .�`' __-__�___.�. _F - -------------- -------- has been installed in accordance with the provisions of Article XI of It Q State Sanitary CodeN desc ibed :in_the. application for Disposal Works Construction Permit No...................�':... _'.__--:__- dated.... -____ ` '� Z .--•.-._-_-. . --- --- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION NC(TIION SATISFACTORY. DATE---------------s-.. --C---...... Inspector------r__��c fig :-•--------•------- THE COMMONWEALTH OF MASSACHUSETTS - i BOARD F HEALTH ��$ 'o, .......... .OF.... ... .. f '✓`. �� - {� ........................ No. FEE �L Permission is herebyranted__. i _ • '-�� "`.._. _._ ..._. to Construct &0/) i Repair (", ) an `I divi Sewage D0posal Sy em f , ' t n� at No...,--eat`--�`.-•------------�------------�-= -�'-=--t---.�-----�,��.�_.-:._.� ..._� -..�--;--- -------- ---- `� -- `�- -------- - Street as shown on the application for Disposal-Works Construction •Permit ;,, ated__-4 _. ._ _.> -' r f ........... .. --•--- '-----6,4--- _p_.. _ `' a Board of Health n DATE_ ` FORM 1255 HOBBS-,& WARREN. INC.. PUBLISHERS mm } t pn�� L I / Zq 0'7� 1. O 1 ,G7 /� v � Qj Q7� 64.0' ---------------------� LOT 71 A ; �- 37,134 SFf w EXISTING ' ' N EXISTING STOCKADE DEC DWELLING I N o w FENCE ao CAI P VED 1, 10.0' } --7 "' DIVE i ONO 32.00' EXISTIN BEG SHE �p 9� 0 RELOCATED ;SHE HE , PLAN OF LAND cVQo N 90 _ PROPOSE IN N f -- _ 1 GARAGE PROPOSED NEW B A R N S TA B LE, MA 5 �, o°, LOCATION OF EXISTING SHED 11 COACH L N E \ \ ` PAVED PREPARED FOR cp / DRIV C� �\ E X ,� PATRICK LANCASTER y � t SCALE: 1, - 30 DATE: JUKE 7, 2006 ED X BASED ON LAND PLAN BY: DOIN CHI 1I0MM D=M 8,M PA KING, A EA RED (bo- h6 \\ CHARLES L, SI VENS, ASSOC. AIA O 53 WHITE ROCK ROAD i 508 375-9490 DCE #94-159 N LOCUS KEY: 4 EXISTING CONTOUR:---- SEPTIC SYSTEM DESIGN SEPTIC SYSTEM SECTION A PROPOSED CONTOUR:............. 7_3 T EXISTING SPOT ELEVATION:25.5 2"PEASTONE Z PROPOSED SPOT ELEVATION: 5.5 FLOW ESTIMATE: � © COVERS WITHIN 6" 3!4"-1 1/2" TEST HOLE: 4 BEDROOMS AT 110 GAL/DAY= 440 GAL/DAY 109.42 a TOP OF OF FINISHED GRAD WASHED STONE Z O UTILITY P L -O- ? FENCE LINE: FOUNDATION INSPECTION PORT Ci SEPTIC TANK:0Q PGC�5 ZO pn= Z HYDRANT: , E-L�E�Vx .=104.24 440GAL/DAY x 2 DAYS= 880 GAL RETAINING WALL: USE 1000 GALLON SEPTIC TANK (EXISTING) 105.9 COVER ELEV. (1'MIN)104.5 LEACHING AREA: (EXISTING) ELEV. GALLON CHAMBERS(8.5'x 4.8'x 2'EFF.DEPTH)WITH 104.7 104.0 USE 3-500 LOCATION MAP 103.83 D ELEV. ELEV. ° 101.41 LOT 71A (37,134 SF) ELEV. D-BOX ELEV. ASSESSORS MAP:298 PARCEL:72 4'OF STONE ALL AROUND (33.5'x 12.8'x 2'DEEP) (6"STONE UNDER) 4' 4' 1000 GAL < 33.5'x 12.8' -� PLAN BOOK:268, PAGE:62 SIDE AREA: (33.5'+12.8')x 2 x 2= 185 SF (0.74)=137 GAUDAY SEPTIC TANK 103.41 3-500 GALLON CHAMBERS WITH FLOOD ZONE:C BOTTOM AREA: 33.5'x 12.8'=429 SF (0.74)=317 GAUDAY TEE SIZES: (TO BE CONFIRMED) ELEV 4'OF STONE ALL AROUND INLET:6"UP, 13"DOWN . (33.5'x 12.8'x 2'DEEP) CAPACITY=454 GAUDAY OUTLET:6"UP, 14"DOWN GAS BAFFLE (TO BE VENTED) AT OUTLET TEE (H-20) IN ACCORDANCE WITH THE MASSACHUSETT �r�----ry- N 00 1 -102 BUILDING CODE,THE BONUS ROOM,IN IT'S LLLLLU TH-1 106.0 TH-2 106.0 -103 CURRENT STATE,CAN NOT BE USED AS A BEDROOM. TEST HOLE LOGS ELEV. ELEV. OiA HORIZON O/A HORIZON // / / �104 ENGINEER: THOMAS McLELLAN,P.E. LOAMY SAND LOAMY SAND 2� / 105 BONUS 6., 10YR 3/3 105.5 4" 10YR 3/3 105.7 /101 106 WITNESS: DONALD DESMARIAS,R.S. B HORIZON B HORIZON ORANGE PAINT ON DATE: 1-3-12 CHMARKAT 10YR 5518 AND 1LOAMY 0YR 5/8 AND 30" 103.5 28" 103.7 CCU I I / / / i 08 CONCRETE SLAB BATH PERCOLATION RATE: <5 MIN/IN � J � I O / / 109 ELEVATION= 108.78 Cl HORIZON C1 HORIZON (� Q / I I ( Z / / SS BED BED SILT LOAM SILT LOAM / f rz / Q ROOM ROOM ATTIC 120 2.5Y 6/4 f 2g 96.0 120" 2.5Y 6/4 96.0 00 J / / J / / l S �S7, 5'SOIL REMOVAL C2 HORIZON C2 HORIZON / �/ / / / `� SEE NOTE 15) FINE SAND WITH FINE SAND WITH ( FINE LOAMY SAND FINE LOAMY SAND Q� / 180" 91.0 180" 91.0 m / 2nd FLOOR NO GROUND WATER ENCOUNTERED 110 111 ' NOTES: / 102/ // / r , ! SUN <a / / / / / r ` / / ROOM caa 1.VERTICAL DATUM: ASSUMED 112 100 / / / / / / / It bGig ` / / / RM BATHDINING KITCHEN TOT 2. MUNICAPAL WATER IS AVAILABLE. / 104 / / / / 7, ` / / AREA 3.SCHEDULE 40-4"PVC PIPE TO BE USED THROUGHOUT SEPTIC SYSTEM. FAMILY 4.ALL PRECAST UNITS SUBJECT TO TRAFFIC LOADS TO CONFORM WITH AASHTO H-20 SPECIFICATIONS. 105 (4J �,� 1 BED BATH LIVING ROOM / EXISTING o RM ROOM 5. PIPE PITCH= 1!4" PER FOOT(UNLESS NOTED OTHERWISE). 106 4 BEDROOM m Rho ies N / �� I DWELLING a -PORCH ---- DWELLING/ 1 � � �`\ � 6.FIRST 2'OF PIPE OUT OF D-BOX TO BE SET LEVEL, top fnd.= 109.42 Deck m �� o o 1st FLOOR \ \ \ 107 I C / @ a / �C0�� 7.THE SEPTIC SYSTEM HAS NOT BEEN DESIGNED TO ACCOMODATE THE USE OF A GARBAGE DISPOSAL. \ \ m ( ���` EXISTING FLOOR PLAN m / n 8.ALL CONSTRUCTION DETAILS ARE TO BE IN CONFORMANCE WITH THE STATE OF MASS. ENVIRONMENTAL Sun / ; �� \\ `�� CODE(TITLE FIVE)AND LOCAL HEALTH REGULATIONS. Room 1 ��� \ \ \ 9.CONTRACTOR TO VERIFY LOCATIONS OF ALL UTILITIES PRIOR TO CONSTRUCTION. \\ \ �AVED\ l\ 1 8 3 109 _ \ \1 �� sue° 10.GROUND COVER OVER ALL SEPTIC SYSTEM COMPONENTS NOT TO EXCEED 3'. \ \ DRIVE \ \ s \ tone�a\` \ o"� 11.FIELD SURVEY PROVIDED BY TERRY A.WARNER, P.L.S., HARWICH, MA. 12.THIS PLAN REQUIRES THE REVIEW AND APPROVAL OF ONE OR MORE TOWN DEPARTMENTS AND 101 \ \� \ \ , \ I IS SUBJECT TO CHANGE UNTIL SUCH TIME. \\ \ \ \\ Garage e I I 112 13. EXISTING LEACH PITS ARE TO BE PUMPED AND FILLED WITH SAND OR REMOVED. Garage 102 \ \ \ 9 111 1 113 \ \ \ \ \\ I \ 14.D-BOX TO BE WATER TESTED TO ENSURE LEVELNESS AND EQUAL FLOW. 103 \\ \\ \\\ \\ _ i l\ \\ 15. IS BE RIEMOV TABLE DOAND R SILT PLAC LOAM D APPR WITHOCLEAN M DIP)WITHUM SANIDN 5'OF PROPOSED LEACH AREA \ \\ \ \' \ \\ \ 16.THIS PLAN REQUIRES THE APPROVAL OF A VARIANCE FROM TITLE FIVE,SECTION 15.221 (7), D-BOX AND LEACH AREA TO BE MORE THN T DEEP, (VARIANCES OF V AND 1.8'). �0 104 ' �o \ I \ Shed \ \ \ DRIVER \ \ \ 105 I j I \\ // > \\ SITE PLAN LOCATION: \06 �.� 112 °� � � � 11 COACH LN., BARNSTABLE, MIX PREPARED FOR: NN DR. ANN GRYBOSKI ® 1 // / S6gi DATE: 1-27-12 107 / ' .� b REVISED:3-13-12(BONUS ROOM NOTE) SCALE: 1"=30' / 110 / BASS RIVER ENGINEERING 109 108 THOMAS J. McL. LLAN, P.E. P.O.BOX 1163, EAST DENNIS,MA 02641 M 11-41 508-385-3426