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HomeMy WebLinkAbout3580 MAIN ST./RTE 6A(BARN.) - Health 3 5 80-Main Street x r Barnstable E A= 318-050 r - W� � w r " • <i h a , 1 No,�'-`�01 p -0- G l _-- BOARD,OF HEALTH oho TOWN OF BARNSTABLE N {� 0pplicationArWell Con0ructionPermit rr i �TeAC Application is hereby made for a pe r it to Construct ( ), Alte or Repair )an individual Well at: f Location — Address Assessors Map and Parcel Owner & 'Address' Installer — Driller Address Type of Building Dwelling „ Other - Type of Building---_—__—_____ No. of Persons--- T e of Well �P_F/_./ Capacity— Purpose YP —— - - --———-- ---- of Well. + � -- — Agreement: The undersigned agrees to install the aforedescribed individual well in accordance with the provisions of The Town of Barnstable Board of Health Private Well Protection Regulation — The undersigned further agrees not to place the well in operation until a Certificate-of Compliance has been issued by the Board of Health. `/ date -- Application Approved _- date — Application Disapproved for the following reasons: date 6 � 0 Permit No. — --- Issued----- -— _---/----- -------- date BOARD OF HEALTH TOWN . O.F ' BARNSTABLE Certifitate Of Compliance t 1 r rr. ' 41 . � THIS IS T CERTIFY, That the Individual Well Constructed ( ), Altered ( ),�'r Repaired ( ) ,,, installer has been installed in accordance with the provisions of the Town of Barnstable Board of Health Private Well Protection i Regulation as described in the application for Well Construction Permit No. —----- Dated------------- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORY. DATE--___—__ -- _ Inspector------------------____ ----__---____-- BOARD OF HEALTH TOWN OF BARNSTABLE . Well Cootruct ion Permit No* Fee Permission is hereby granted l�\Q —------- to Construct (�), Alter ( ), or Repair ( ) an Individual Well at: No. street as he application for a Well Construction Permit � ) Q No own on t�01 ICJ �'�� � aU �° -7- ----- Dated—�_.—____=---------------------------•---------- --- -- — __---------------- Board of Health DATE I No.Q")_O / _ G Fee-------`- ---- BOARD OF HEALTH TOWN OF BARNSTABLE Application-for Well Conf;tructiot�jermit - r � j Applicati�on�hereby made for a permit to Construct ( ), Alte ->_( ), or Rep ( )an individual Well at: Location — Address Assessors Map and Parcel wne Address Installer — Driller Address Type of Building Dwelling Other - Type of Building—=— -[---------- No. of Persons-------- T f e of Well--1=!b Purpose of Agreement: The undersigned agrees to install the aforedescribed individual well in accordance with the provisions of The Town of Barnstable Board of Health Private Well Protection Regulation — The undersigned further agrees not to place the well in operation until a Certificate .of C mpliance has been issued by the Board of Health. 7,2 Sig __—_ _—--- -- -- - ---- Application Approved _— _ _—--— /ate � ho date Application Disapproved for the following reasons:---------------------------------- ---- Permit No. date � � f D �` � l � /Q - --------- Issued-------------p------------------ ------- date BOARD OF HEALTH TOWN OF BARNSTABLE C ertif irate Of Compliance THIS IS T ►C WTIhat th Individ al Well Constructed ( ), tered ), r Repaired ( ) by-- at - - - ----------------------------- has been installed in accordance with the provisions of the Town of Barnstable Board of Health Private Well Protection Regulation as described in the application for Well Construction Permit No. -----------------Dated---------------- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORY. DATE --_— __ — Inspector-- ---------------- ------------- TOWN OF BARNSTABLE LOCATION - ® �'��� 'ram' 'f SEWAGE# f 4"0 VILf,AGEgV ASSESSOR'S MAP&PARCEL 3 I$ 'r�,�d INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY ek-,1',7;-i-'� /Q 1147 te2-ec f LEACHING FACILITY:(type) (size) NO.OF BEDROOMS OWNER -oo��co' PERMIT DATE: �'e� ®'—tea 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 � .. . , � - � �" �_ 3 ,o _ _ . � . � � .. s�:��� � � .. �: �. .w c TOWN OF BARNSTABLE L( �ATION Man S1 SEWAGE # VILLAGE ASSESSOR'S MAP'& LOT INSTALLER'S NAME&PHONE NO. 3 ^© ry o SEPTIC TANK CAPACITY LEACHING FACILITY: (type) (size) NO.OF BEDROOMS BUILDER OR OWNER PERMITDATE: 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 �5 "a4 �. FA 33$ �(l►v � Y GZ Nv°'`�OvN OF BARNSTABLE LOCATION ' VILLAGE ASSESSOR'S MAP &'LOTS I 0 `JAG INSTALLER'S NAME & PHONE NO. SEPTIC TANK CAPACITY 1. ,r4 r, LEACHING FACILITY:(type) NO. OF BEDROOMS PRIVATE WELL 9PU IC WATE BUILDER O OWNER .�nATW _GAgM�crLi—Nee f3s L 7 VARIANCE 1GRANTED: Yes ^ No 0UllJJU;n3j 1 8 8� _ a II_ _ No. Fee r!�U THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Of ppgicatiou for �igpont �§pgtem Cougtruction permit Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon( ) ❑ Complete System Individual Components Location Address or Lot No.3r8O PT R74 1A Owner's Name,Address,and Tel.No. Assessor's Map/Parcel a :3rr�O Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No, wry e-0;�f.0"4edr� 77-.f'07 0> Type of Building: Dwelling No.of Bedrooms 13 Lot Size sq. ft. Garbage Grinder ( ) Other Type of Building ��1'• No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 3�O gpd Design flow provided 3 � gpd Plan Date 5, O Number of sheets Revision Date Title Size of Septic Tank <XZJ.;-­dr /OoO GXe Type of S.A.S. 1411>C �o�.0 X 4C .0 Description of Soil Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. Signed Date Application Approved by Date Application Disapproved by: V Date for the following reasons Permit No. 701D- /0/ Date Issued y—duU /o a.0 t o 1 V Fee fa() 1, THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: ' - PUBLIC HEALTH DIVISION - T(5WIV bF BARNSTABLE, MASSACHUSETTS Yes ` Application for Migvgat *pgtem Construction Permit Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon( ) ❑.Complete System Individual Components Location Address or Lot No. r&,::P f�JrlA- 4' ' ,RT6 Owner's Name,Address,and T ].Iovy If Assessor's Map/Parcel J oz:� ra Tr6t`o -9,7 rig, JET. lZ'T d: $C {" I aller's Name,Addres ,and Tel.No. D si ner's Name,Address and Tel.No. Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder ( ) Other • Type of Building lX fir• No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 3�O gpd Design flow provided 3 / gpd Plan Date �! r-�� Number of sheets Revision Date Title Size of Septic Tank <``X�J'3"�^ G �000 Type of S.A.S. i�'GO o;Z X Description of Soil Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described or-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this B9,a5d of Health. c.� yr a —/o Signed Date Ce `�.�" ��jj Date K Application Approved by % '1A;, J Date t' / Application Disapproved by: V Date for the following reasons Permit No. D 016 - /o/ Date Issued I/- a u_ /0 4 THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed ( ) Repaired ( ) Upgraded ( ) Abandoned( )by m G ��0��� 5���`ic `P--"A 4"f' at �i>�d'�ry . �r 6,4 � a� has been constructed in accordance I , with the provisions of Title 5 and the for Disposal System Construction-Permit No. '�0� dated Installer S�/�l ��Oe�U1� 0 , Designer 4�vip w />'iS�I'O/!' A2:r• #bedrooms -3 Approved desigil flow 3 7° gpd The issuance off t�h'' errriit shall not be construed as a guarantee that the system will func 'on. s desigLd Date 1�! . Inspector / ki .._�J No. L) � �0� Fee • THE COMMONWEALTH OF MASSACHUSETTS ' PUBLIC HEALTH DIVISION-BARNSTABLE, MASSACHUSETTS Migonl �$LPp,5tem Con.5truction Permit Permission is hereby granted to Construct ( ) Repair ( ) Upgrade ( ) Abandon ( ) System located at hI�'-'I"- .��� t'Ti4Bl� and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to comply with Title S and the following local provisions or special conditions. Provided: Cony s/tructiod must be completed within three years of the date of this permit. �^ Date '7 // U Approved by J t z TRANS.NO.: CITY/TOWN: APPLICANT: ADDRESS: 3500 &A 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 15.2 20 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)(f)] daily flow septic tank capacity(required and provided) soil absorption system(required andprovided) whether system designed for garbage grinder North arrow [310 CMR 15.220(4)(g Existing and ro osed contours 310 CMR 15.220 4 Location and log of deep observation holes(existing grade el. on each test) [310 CMR 15.220(4)(h)] Names of soil evaluator and BOH representative [310 CMR 15.220(4) h and(i)] Location and date of percolation tests (performed at proper elevation?) [310 CMR 15.220(4)(i)] Percolation test results match loading rate? 310 CMR 15.242 Certification statement by Soil Evaluator [310 CMR 15.220(4)0)] Observed and Adjusted groundwater(method for adjustment given or indicated) [310 CMR 15.103(3)and 310 CMR 15.220(4)(n)] Address ���t�,. �j� 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 suppI 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 CMR15.220 4 o V Stamp of desi er [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)] 1/ 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)(q)] Materials specifications noted? [various sections of 310 CMR 15.000] System components not>36" deep(unless Local Upgrade 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)] 1� 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(l)(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 Three access covers(inlet and outlet must be 20" or greater)- middle access at least 8" (by 7/07) [310 CMR 15.228(2)] Access to within 6 " of grade -one port for systems<I 000gpd, 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 Re uiredMone 310 CMR 15.221(8)] H-20 Where appropriate? 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 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 gas 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)] 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 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 sum 6" 310 CMR15.232 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)] 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 Com acted Base 310 CMR 15.221(2)] IBuoyancy calculations needed?Provided? [310 CMR 15.221(8)] Address Sheet 4 of 7 N/A OK NO SOIL ABSORPTION SYSTEMS(SAS)GENERAL Calculations correct? 4 feet of naturally occurring material demonstrated? [310 CMR / 15.240(l)] r/ 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 every 20 ft. 310 CMR 15.253(6 Each structure with one inspection manhole(if>2000 gpd must be to grade) [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 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 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 15.255 3 ? Impervious barrier and/or retaining wall? Guidance Document] LIU Impervious barrier installation must be supervised by designer 310 CMR 15.255(2)(b)] 1/ 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[I/A 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 15.414 Address � J� �/ 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 existingsystems] Y stems ] 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 i Address Lr2e0 �Ix� v' 1 Sheet 7 of 7 npr 25 10 05: 28p Colleen Mason 1509) 533-2177 R. 1 Town of Barnstable Regulatory Se* mces Thomas F.Geiler,DirectOr ainrda s, �s ��a Public Realth Division A�a.��.a� - Thomas McKean,Director 200 Alain Street,Hyannis,MA 02601 Office:.508-362-4644- Fax: 505-790-63€4 Installer&Desiner Certification Form I; Bate. -- �6 rGo 10 Designer. Address: : � tC, Address: L On 'a �1. �-`� U � ' was issued a permit to install a (date) (installer) septic system ai - Pik ?? based on a design drawn by (address) Ila dated (designer) Zi,certify that the septic, system referenced above was,installed.substaxatiat .1�a.ccord�g"to t :Thy design, whichiay include inoi approved c tzges such as laterae selocatian of the distribution box and/or septic tank— ! T certafY.Ahat the septic system xefereneed above was inst-&-zd witit.`wa or cbange�'q' greater a 10' lateral relocaatiori of the SAS or-azy vertical relocatiexL-of any co4oneilt of the.seplKsy4em)but in accordance with State:&76cal ReNdlatic us, Plan remslAlx or certi ed as-bit by desi_gcer to kliQ v. OFF nDAvin ��- st er's Signature) n MASON . �ITARI�'�� er s Signa.tme) (Affix er'.s 5taxia Ham) PLEASE RETURN TO W�R-NSIRT"Lk�'€�l�l<�.HEALTH D1 TnW- rvui r .NQT—mil✓:=,SSL?_D: _NM 'BOTH! F � A ]..€TT� A �7 �4kt1 'F '_:'lt` -�At Sly P � A ; lS ?`d Q:Health/Sep dDesigner Certification Farr, j Town of Barnstable P# I a�-7 Department of Regulatory Services &AMMAW MIR Public Health Division Date 3 1? �0 E1 39�- 200 Main Street,Hyannis MA 02601 Date Scheduled t Time /L Fee Pd. D 0 v Soil Suftabil&yyi Assessment for age e Des t ' , t , posal Performed By:- p; J �,� l , (j 1•�:'�+ t j Witnessed BY !L r'J ,SvCI` LOCATION& GENERAL INFO 'TION Location Address'3s Cp a 1�� J% Owner's Name��j� ��� oG� '• Address 3T�® � 6-.4 Assessor's Map/Parcel: Engineer's Name@.�vF�j�sc� f NEW CONSTRUCTION REPAIR . Telephone# Land Use 1 t.!`? Slopes(%) + Surface Stones j + Distances from: Open Water Body yv - ft `Poss1tile Wet Area_ ft Drinkin ' Drainage Way 1 t t i '� -� g Water Well g Y---='°' 'ft` Property Line "L•: +� Other c1 yA.; - —=---ft ,. , ft SKETCH:(Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands 3`n proximity t V y .a,,r P y o holes) Parent material geologic) G Depth to sedrocit t Depth to Gro dwater. Standing Water in Hole: Weeping from Pit Face F Estimated Seasonal High Groundwater ADE4%lffION FOR SEASONAL HIGH VVAT7E�t TABLE Method Used: .Depth Observed standing in obs.hole: th o ping from side of obs.hole: In. Depth to S411 mottic5: in Index W in- Groundwater Ju:atment ft. eliding Date: Index We level Ad,thCtor J Adj.(7routidwater 1 evel PERCOLATION TESTbated Time. F Time at 4" e Time at6 Time @ ✓( T� —`..... Time(9"-6") ._ h Site Suitability Assessment: Site Passed Site Failed: 1 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 Amust first notify the Barnstable Conservation Division at least one(1)week prior to beginning. ,f--�> Q:ISEPTICIPERCFORM.DOC DEEP.OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture w Soil Color Soil Other Surface(in.) (USDA) (Munseli) Mottling '(Structure,Stones,Boulders. Consistency.%G.vel .1, ► NfrL , a+ -`, w - DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color .Soil Other Surface(in.) (USDA) (Mansell) Mottling (Structure,Stones,Boulders. Consistency,%Gravel) l On 12-D G DEEP OBSERVATION HOLE LOG Hole# Depth from r „, Soil Horizon Soil Texture ' ' Soii Color. , Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Can si to c Grave ► DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color_* L Soil _ .Other Surface(in.) (USIA) (Mansell) l Mottling (Structure,Stot►es;Boulders. Cons' ten !_A Flood Insurance Rate Map: Above 500 year flood boundary No_ Yes . Within 500 year boundary No Yes, ..� ��J•; r " �, 1" �; ` _ Within 100 year flood boundary No— Yes 4 Ir, ) ,s 4 'ti p. r" ' y Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring perv'o tonal exist in all areas observed throughout the area proposed for the soil absorption system. If not,what is the depth of Linurally occurring Peru ous material?CertificationI certify that on t (date)I have passed the soil evaluator examination approved by the Department of Environ ental Protection and that the above analysis was performed by me consistent with . the required training,a rtis nd erience described in 310 CMR 15.017 �Z Signatur Date Q:\.SEPTi0PERCFORM.DOC down cape engineering, inc. SIEVE SOILS ANALYSIS 3580 Main Barn TH1.xlsx DATE OF REPORT: 4-5-10 (sample date 3-25-2010) JOB : GRAIN SIZE ANALYSIS-SIEVE TEST SITE: 3580 MAIN ST, BARNSTABLE, MA LOCATION: Jim LeBeouf TH1 SIEVE ANALYSIS Weight Sample(Grams): 296.3 SIZE ;WEIGHT RETAINED ; % RETAINED % PASSED -------- (sum) ------------ ---- -.. - ------ 1" 0.0: 100.0% ------------ ----------------•-------V---------------------------------------- 3/4.. 0.0 0.0%: 100.0% 1/2" 0.0: 0.0%: 100.0% —----------- --- ---•------------------------------------------------------------ 0.0: 0.0%: 100.0% ------------=------------------------- ---------------------- ----------------- 0.0: 0.0%: 100.0% ------------- --------------------- ------------------------------------ ---- 10 18.0%: 82.0% 20 162.2; 54.7%j 45.3°/a -------------1..-..-..-..--•---•------..d---------------------\._.........__._... 0 232.2: 78.4%: 21.6% -------------I ------------------_...---------------------� -.••--- 50 263.4; 88.9%; 11.1% ------------:................... ---------------------- ------------ 0 285.7: 96.4%: 3.6% ---- ................. .a--------------------- ----.............. 100 290.7: 98.1%. 1.9% 200 294.7: 99.5%; 0.5% PAN: 296.3: 100.0%: 0.0% ------------- --------------------------•---------------------------------------- SAMPLE: � 296.3: NOTE:TEST ON PASSING#4 ONLY, 11% RETAINED ON#4<45%O.K. RESULTS: SOIL CLASSIFIED AS AASHTO A-3(GRANULAR,COARSE SAND)(UNCOMPACTED) PERCENTAGE OF MATERIAL PASSING#4 SIEVE : #4 100% (TEST ONLY MATERIAL PASSING 94) OK #6010%-100% OK #100 0%-20% OK #200 0%-5% OK SAMPLE MEETS TITLE 5 FILL SPECIFICATION I"OF$UPS RESULTS: PERMEABLE MATERIAL.CLASS 1<2 MIN./IN. MATERIAL DANIELA NONCOMPACTED OJA A SOIL DESCRIPTION: MED/COARSE SAND, 0.74 GPDISF MATERIAL " CIVIL in No.46502 � t7 0. NA F down cape engineering, inc. SIEVE SOILS ANALYSIS 3580 Main Barn TH2.xlsx DATE OF REPORT: 4-5-10 (sample date 3-25-2010) JOB : GRAIN SIZE ANALYSIS-SIEVE TEST SITE: 3580 MAIN ST, BARNSTABLE, MA LOCATION: Jim LeBeouf TH2 SIEVE ANALYSIS Weight Sample(Grams) 269.8 SIZE ;WEIGHT RETAINED % RETAINED % PASSED (sum ) ----------- --- ---------------------------------off --------100.0% ----------- -------------------0.0y---------------- %;---------1 00.0% ---------------------- -------------- 1/2" 0.0; 0.0%: 100.0% ------------I---------------------- 5.6:----------------.8%:-----------94.2% 5.8%: 942% ------------------------------------ --------------------------------------- ---- 10 37.0: 13.7%: 86.3% ------------*-------------------- ---------------------- - - 20 0 170.0: 63.0%; 37.0% ------------- -----------------------...,---------------------, - 50 205.3 76.1 ------------:............... ----------------------•------------ ....-- 80 254.0: 94.1%: 5.9% ............................................................I---------......... 100 261.2' __96.8%L _ 3_2% ---- ---------------- -A- ------ 200 268.7: 99.6%: 0.4% -------------:- -----z--------------------=------------------ PAN- 269.8 100.0%: 0.0% ---------- --------------------------------�---------------- •-------------------- SAMPLE: 269.8: NOTE:TEST ON PASSING#4 ONLY,6% RETAINED ON#4<45%O.K. RESULTS: SOIL CLASSIFIED AS AASHTO A-3(GRANULAR,COARSE SAND)(UNCOMPACTED) PERCENTAGE OF MATERIAL PASSING#4 SIEVE : 94 100% (TEST ONLY MATERIAL PASSING#4) OK #5010%-100% OK #100 0%-20% OK #200 0%-5% OK SAMPLE MEETS TITLE 5 FILL SPECIFICATION RESULTS: PERMEABLE MATERIAL-CLASS 1<2 MINAN.MATERIAL � yZ"OFhrq�4c NONCOMPACTED �� DANIELA. SOIL DESCRIPTION: MEDICOARSE SAND, 0.74 GPD/SF MATERIAL cfiwL £CIVIL No:•465G2 ST S/Q AL A V L Re / I o 00 0 ,5 0 1. A SO evl P T RAT , / G New AR • 0-0 VA " 6 0 N Quo p o°cQ p 0' s 00 4 t � 0 LNG + p OWE o. \ VAG 14 D� W '{ �N o �� \ ' o NE A N EW I�WAY OE J ,..-� ASSESSORS MAP : NOTES:. TEST HOLE LOGS PARCEL: 6 , VtL�►`' �'- FLOOD ZONE: � SOIL EVALUATOR:W 1) The installation shall comply with Title V and Town of Barnstable Board of WITNESS:S S: l REFERENCE _ Health Regulations. '+ jam , 1 112» DATE: r 1 0 I o I , 2) The installer shall verify the location of u ' ..� .-..�..«.._.: �....:.. ......_.�.,.,�____..._.�v..m,..�., ..�.,,_..._..._....__�._._._ fy utilities, sewer inverts and septic _ PERCOLATION RATE: 7i 1 , ► � components prior to Q � p p installation and setting base elevations. V 3 All gravity septic ,� gr y p c piping to be 4 inch Sch 40 PVC at 1/8 per foot. The first TH- I TH-2 two feet out of the d-box to the leaching shall be level. 4) This plan is not to be utilized for property line determination nor any other l i i� i0 purpose other than the proposed system installation. l 5) All septic components must meet Title V specifications. -1 g 1�WX 6) Parking shall not be constructed over H10 septic components. 7) The property is bounded by property corners and property lines. LOCATION MAP _ y1L'r !.C) `�t%'t" 1p 8) The property owner shall review design considerations to approve of total 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 i ^ COW 64%4 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 I be removed along with contaminated soil and replaced with clean sand per p Title V specs. ------ — 10)System components to be 10 feet from water line. Sewer lines crossing the water line shall be sleeved with 4 inch SCH 40 PVC with ends ro-g uted if applicable: The proposed SAS is being installed below the water service SEPTIC SYSTEM DESIGN 0 line. The`line is to be sleeved as aforementioned and maintained in place. I (o 11) If a garbage grinder exists it is to be removed and is the responsibility INGROUND 1 I IMMING p y of the Q I FLOW ESTIMATE owner to ensure such. SW / a m t POOL ri � J\ 22 � 12)The installer is to take caution in excavation around the gas line if such- Z ?. J BEDROOMS AT 11D GAL/DAY/BEDROOM -%7',�D GAL/DAY _exists. i \ i 13)The installer shall verify the location, quantity and elevation of the sewer SEPTIC TANK lines exiting the dwelling prior to the installation. i �- I 14)Excavate 5 feet around the proposed SAS and;below to a rox. eleva i 1 ' GA/DAY' x 2 DAYS - GAL 33.81 or until Coarse approx. ton..: i se Sand is encountered. Fill.with Clean Sand per Title V specifications. m USE 100O GALLON SEPTIC TANK I,ytt nW( SOIL ABSORPTION SYSTEM i r I SIDE AREA. Q\ , BOTTOM AREA: ZZ ,`7L' - `u_.. _ y� 1 _4-b-F, SEPTIC SYSTEM SECT ION % EXISTING DWEI LING FNpN TOP OF L 49.90 m 2 p N C�1 JI't� I GAL �. A �3F ICI SEPTIC T K �... ` { Lo i SITE AND SEWAGE ,PLAN i � ID BENCH MARK L3CAT I ON • ( . ntJ r;ds V1 " PAINT_SPOT ON c t't!✓�c r : CONCRETE SLAB ELEVATION = 42.46 I '} PREPARED FOR : I BARNSTABLE GIS DATUM I. 15 �ti SCALE , ; o DAV I D B MASON . aaTE: a I o � : DBC ENVIRONMEN AL DESIGNS ; o I EAST SANDWICH . MA W I w DATE HEALTH AGENT W m I . ; .833- 2177 Z , ...-. 132.74 Ft P p a Q t