Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Home
My WebLink
About
4093 MAIN ST./RTE 6A(BARN.) - Health
4093 Main Street/kfe 6A (Barn) Barnstable �— -- A'= 335 026 60 sNE r Town of Barnstable Barnstable. • BAWWABLE. • AFC erlCa0y b 9 ,ter Board of Health ArfO""Py� 200 Main Street,Hyannis MA 02601 2007 Office: 508-862-4644 Wayne Miller,M.D. FAX: 508-790-6304 Junichi Sawayanagi Paul Canniff,D.M.D. September 8, 2010 Ms. Linda Pinto CSN Engineering, Inc. PO Box 2030 Teaticket, MA 02536 RE: 4093 Main Street (Route 6A) Barnstable A = 335 — 028 Dear Ms. Pinto: You are granted variances on behalf. of your client, Marsha Alibrandi, to construct an onsite sewage disposal system at 4093 Main Street (Route 6A), Barnstable. The variances granted are as follows: Section 360-1 of the Town of Barnstable Code To place a soil absorption system 88 feet away from a wetland, in lieu of the one-hundred feet minimum separation distance required. Section 397-6 of the Town of Barnstable Coder To place a soil absorption system 124 feet away from the onsite private well, in lieu of the 150 feet minimum separation distance required. These variances are granted with the following conditions: (1) No more than three (3) bedrooms maximum are authorized at this property. Dens, study rooms, offices, finished attics, sleeping lofts, and similar-type rooms are considered "bedrooms" according to the MA Department of Environmental Protection. (2) The septic system shall be installed in substantial conformance with the engineered plans dated May 7, 2010. Q:\WPFILES\4093 Main St Barn Aug20IO.doc F Down Cape Engineering Page Two September 20, 2010 (3) The designing engineer shall supervise the construction of the onsite sewage disposal system and shall certify in writing to the Board of Health that the system was installed in substantial compliance with the, plans dated May 7, 2010. These variances are granted because the physical constraints at the site severely restrict the location of the septic tank due to its proximity to wetlands and to the onsite private well Sincerel ours, Wayne Mil r, M.D. Chairman Q:\WPFILES\4093 Main St Barn Aug2010.doc �1NE y� DATE: w � FEE: `✓-00 II MRNMBLE, • MASS. . 039. A�� REC. BYj2 Town of Barnstable ��� •SCHED. DATE:_1/�—&Z ID Board of Health 200 Main Street, Hyannis MA 02601 Office: 508-8624644 Wayne A.Miller,M.D. FAX: 508-790-6304 7unichi Sawayanagi Paul J.Canniff,D.M.D. VARIANCE REQUEST FORM LOCATION I �2 Property Address: 4'oq 3 eouc-61A ctGtIirj Assessor's Map and Parcel Number: Mao 33f 9rarcd Mr Size of Lot: �S•U -At(e-3+ Wetlands Within 300 Ft. Yes Business Name: No Subdivision Name: APPLICANT'S NAME: 'Loj : ���}� Phone GD"6 ' �-`1°1 -3290 Did the owner of the property authorize you to represent him or her? Yes No PROPERTY OWNER'S NAME CONTACT PERSON Name: KU-5 hL A11 lre, , Name: Lyrj,.a -i, 9 x\10 Address: 4 013 Eau -6 A, Address: B Ob-)- 2-030 ,Te,+►c"V M A- ozs (- Phone: Phone:_ &0�- a`► -37,So VARIANCE FROM REGULATION(Lis Reg.) REASON FOR VARIANCE(May attach if more,space needed):'-'- t) F-C4de- SA'S <to+ IOo` r. r,n[u"e, (S&�ar'lr'ra1 ^� J 3 'n C� L 0- 1 f) ho� too, oM 4jj to A-,AS ft' i7keA lz' \/ortAnce-. �otu 5Ac.d - 1� NATURE OF WORK: House Addition ❑ House Renovation ❑ Repair of Failed SepticSystem Checklist (to be completed by office staff-person receiving variance request application) Please submit copies in 4 separate completed sets. — Four(4)copies of the completed variance request form — Four(4)copies of engineered plan submitted(e.g.septic system plans) — Completed seven(7)page checklist confirming review of engineered septic system plan by submitting engineer or registered sanitarian Four(4)copies of labeled dimensional floor plans submitted(e.g.house plans or restaurant kitchen plans) — Signed letter stating that the property owner authorized you to represent him/her for this request _ Applicant understands that the abutters must be notified by certified mail at least ten days prior to meeting date at applicant's expense (for Title V and/or local sewage regulation variances only) Full menu submitted(for grease trap variance requests only) Variance request application fee collected(no fee for lifeguard modification renewals,grease trap variance renewals[same owner/lessee only], outside dining variance renewals[same owner/leasee only],and variances to repair failed sewage disposal systems[only if no expansion to the building proposed]) Variance request submitted at least 15 days prior to meeting date VARIANCE APPROVED Wayne Miller,Chairman NOT APPROVED Junichi Sawayanagi REASON FOR DISAPPROVAL._ Paul J.Canniff,D.M.D. C:\Users\decollik\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\BAS9P9B7\VARIREQ.DOC i TEATICKET STATION TEATICKET, Massachusetts - 37';s+ ? -)097 05/26/2J i L, ;r;i , +:. 77 03:40:24 PM iF eipt -- Product nit Final Descriph} j rice Price HAR1 FORD L1 f u i.,� $0.44 _Zone-2 first lcs: Letter 0.50 c . Ex)eci'M.j I'_ pry: Fri' 05/28/10 Re Corr; R41 ;;,e+r $2.30 C�rd) Certified $2.80 L,ne 1 #: 70 t721iB0000163016982 Issue PVI $5.54 HYANNIS 1'-A 02601 $0.44 Zone-1 First-Claus Letter 0.50 oz. Expected Deli''rery: Thu 05/27/10 Return Rcpt (Green $2.30 Card) Certified $2.80 Label #; 70072GF-0000163L�16999 issue PVI: $5.54 CUMMAQUID MA 02637 $0.44 > Zone-1 First-Class Letter 0.50 oz. Expected Delivery: Thu 05/27/10 Return Rcpt (Green $2.30 Card) ' Certified $2.80 h 1-72663u00163ui7002 Issue PVI: BROOKLYN NY 11201 $0.44 Zone-3 First-',lass Letter 0.50 oz. Expected Delivery: Fri 1',5/2EJi ' Return Rcpt :from $2.30 Card) Ce rt i f l e., `62.80 Label 70072660000163017019 Issue PVI: 65.54 . - _YgRh10UTH POi,T_MA _:'O.44 02675 Zone-1 First-Class Letter 0.50 oz. Expected Delivery: Thu 05/27/10 Return Rcpt (Green $2.30 Card) Certified- $2.80 Label #: 70072680000163016920 Issue PVI: - $5.54 CUMMAQUID MA 02637 $0.44 Zone-1 First-Class Letter 0.50 oz. Expected Delivery: Thu 05/27/10 Return Rcpt (Green $2.30 Card), Certified $2.80 Label #: 70072680000163016937 Issue PVI: $5.54 CUMMAQUID MA 02637 $0.44 Zone-1 First-Class Letter 0.50 oz. Expected Delivery: Thu 05/27/10 Return Rcpt (Green $2.30 Card) Certified $2.80 Label #: 70072680000163016944 Issue PVI: $5.54 OSTERVILLE MA 02655 $0.44 Zone-1 First-Class Letter 0.50 oz. Expected Delivery: Thu 05/27/10 Return Rcpt (Green $2.30 Card) Certified $2.80 Label #: 70072680000163016883 Issue PVI: $5.54 OSTERVILLE MA 02655 $0.44 Zone-1 First-Class Letter 0.50 oz. Expected Delivery: Thu 05/27/10 Return Rcpt (Green $2.30 Card) Certified . $2.80 Label #: 7007268000,1163016890 Issue PVI: $5.54 SPRINGFIELD MA 01101 $0.44 Zone-2 First-Class Letter 0.50 oz. Expected Delivery: Fri 05/28/10 Return Rcpt (Green $2.30 -Card) _ Certified M $2.80 Label #: 70072680000163016906 Issue PVI: $5.54 OSTERVILLE MA 02655 $0.44 Zone-1 First-Class Letter 0.50 oz. Expected Delivery: Thu 05/27/10 Return Rcpt (Green $2.30 Card) Certified $2.80 Label #: 70072580000163016913 Issue PVI: $5.54 CUMMAQUID MA-02637 $0.44 Zone-1 First-Class Letter 0.50 oz. Issue PVI: $0.44 CUMMAQUID MA 02637 $0.44 Zone-1 First-Class Letter 0.60 oz. Expected Delivery: Thu 05/27/10 Return Rcpt (Green $2.30 Card) Certified $2.80 Label #: 70091680000094889199 Customer Postage -$0.44 Subtotal : $5.10 Issue PVh: $5.10 BARNSTABLE MA 02630 $0.44 " Zone-1 First-Class Letter 0.50 oz. Expected Delivery: Thu 05/27/10 Return Rcpt (Green $2.30 Card) Certified $2.80 Label #: 70072680000163016951 Issue PVI: $5,54 CUMMAQUID MA 02637 $0.44 Zone-1 First-Class Letter 0.50 oz. Expected Delivery: .Thu 05/27/10 Return RcOt (Green $2.30 Card) Certified $2.80 Label #: 70072680000163016968 Issue PVI:, $5.54 WELLESLEY MA 02482 $0.44 Zone-1 First-Class Letter 0.50 oz. Expected Delivery: Thu 05/27/10 Return Rcpt (Green $2.30 Card) Certified $2.80 Label #: 70072680000153016975 Issue PVI: $5.54 Total : $83.10 Paid by: - Debit Card $83.10 Account #: XXXXXXXXXXXX2339 Approval #: 085151 Transaction #: 553 23903410033 Receipt#: 001738 Order stamps at USPS.com/shop or call 1-800-Stamp24. Go to USPS.com/clicknship to print shipping labels with postage. For other information call 1-800-ASK-LISPS. Get your mail when and where you want it with a secure Post Office Box. Sign.up for a box online at usps.com/poboxes. Bill#:1000301454012 Clerk:26 All sales final on stamps and postage Refunds for guaranteed services only Thank you for your business HELP US SERVE YOU BETTER Go to: ?ittps://postalexperience.com/Pos TELL US ABOUT YOUR RECENT POSTAL EXPERIENCE YOUR OPINION COUNTS ' Customer Copy COMPLETE •N COMPLETE THIS SECTIONON DELIVERY ■ Complete items 1,2,and 3.Also complete A. Signature item 4 if Restricted Delivery is desired. 464 - ❑Agent a Print your name and address on the reverse X =Addressee so that we can return the card to you. B. Received y(Printed Name) C. Date of Delivery ! E Attach this card to the back of the mailpiece, or on the front if space permits. D. Is delivdiry a8dress different from item 1? ❑Yes 1. Article Addressed to: If YES,enter delivery address below: No ! Ka rc,t'c i II o+ C'(mn-'4 II d i h O�3 3. S�e��Type V ®"Certified Mail ❑Express Mail ❑Registered ❑Return Receipt for Merchandise ❑Insured Mail ❑C.O.D. o4. Restricted Delivery?(Extra Fee) ❑Yes 2. Article Numberi i;f. a iet ;;.• a •a• ; ii a f°' " "'ai :: iErr ii! ! Ig7O�7 268'0 3OOO1i63011,rl6�96�i; (Transfer from service label) - - PS Form 3811,-February 20041'(r f i i Domestic Return Receipt 102595-02-M-1540; i I UNITED STAPST L IGE: �� ; 'v., r' irs �::htf^c.4 Zs °t1uR • PWd Sender: Please print your name, address, and ZIP+4 in this box • I I I I -- — I I ' Arm P.O.Box 2030 eering Teaticket,MA 02536 L7*T I I I I I I COMPLETE • 0 Complete items 1,2,and 3.Also complete A."Signa u item 4 if Restricted Delivery is desired. ❑Agent X ■ Print your name and address on the reverse L ❑Addressee so that we can return the card to you. B. Received by(Printed NrneK C. Date f Del- ery ■ Attach this card to the back of the mailpiece, or on the front if space permits. OO tkr D. Is delivery address different from item 1? ❑Y94 1. Article Addis'siZ.�o: If YES,enter delivery address below: ❑ No c�U`iE7+ Nl�si 11; 3. Se Ice Type 10 Certified Mail ❑Express Mail ❑ Registered ❑ Return Receipt for Merchandise ❑ Insured Mail ❑C.O.D. 4. Restricted Delivery?(Extra Fee) ❑Yes 2. Article Number (transfer from service labeo ; 7r 0 0 7 2 6 8 q q p O li;63 01 z 6{9 8 2 PS Form 381,1,February 2004 [tt' 1 Domestic Return Receipt lozsss oz-M-154o i_ i i iii i �f11 I �i I II I UNITED STATES POSTAL SERVICE First-Class Mail Postage&Fees Paid USPS Permit No.G-10 I •.Sender: Please print your name, address, and ZIP+4 in this box • CSN ♦�1j�� P.O.Box 2030 j��►;� Engineering Tea""", o2s3s i ik SENDER: COMPLETE THIS SECTION COMPLETE THIS SECTION ON DELIVERY ■ Complete items 1,2,and 3.Also complete A. S' natu e item 4 if Restricted Delivery is desired. ❑Agent • Print your name and address on the reverse Addressee so that we can return the card to you. B. Rec ed by I.Printed Name) C f ' ry ■ Attach this card to the back of the mailpiece, �n AQ D or on the front if space permits. Tt V�I D. s delivery address different from kern 1 ❑Afs 1. Article Addressed to: If YES,enter delivery address below: ❑ No 6La�ry L.n. �T y ClM1 S (k� 2�0 3. S rvice Type t f10 Certified Mail ❑ Express Mail ❑Registered ❑ Return Receipt for Merchandise ❑ Insured Mail ❑C.O.D. 4. Restricted Delivery?(Extra Fee) ❑Yes 2. Article Number ; 7007 26'80•*-000=1 i6301` 6999.: (transfer from service label)1{! i!t x f 1 4!+ S PS Form 3811,FebruaI:ry 2004 Domestic Return Receipt 102595-02-M-1540 iPl i ilft i I !E11 ifElf[ 1 � E ' F n rl UNITED STATES POSTAL SERVICE First-Class Mail Postage&Fees Paid USPS I Permit No.G-10 I I I • Sender: Please print your name, address, and ZIP+4 in this box • j I I j I G+S� 1� , P.O.Box 2030 Teaticket,MA 02536 Engineering I I I Ji:ii:r::ii:.i SECTIONSENDER: COMPLETE THIS SECTION COMPLETE THIS DELIVERY ■ Complete items 1,2,and 3.Also complete A. Si�ure item 4 if Restricted Delivery is desired. ❑Agent ■ Print your name and address on the reverse X Addressee so that we can return the card to you. B. Received by(Printed Name) C. Date f Deli ery ■ Attach this card to the back of the mailpiece, or on the front itspace permits. D. Is delivery address different from item 1? ❑Ye 1. Article Addressed to: If YES,enter delivery address below: ANo NGrl 4- I ca i C1-11W\M,gjytd, Plot o2f63-1 3. deType 7Certified Mail ❑Express Mail ❑ Registered ❑ Return Receipt for Merchandise ❑ Insured Mail ❑C.O.D. 4. Restricted Delivery?(Extra Fee) ❑Yes 2. Article Number {7 0 p 9 116`8 0 0 0 0i0 i 9 4 8 8 ►919,9 (Transfer from service labs � PS Form 3811,February 2004,11 Domestic Return Receipt 102595-02-M-1540 i i It li i r FFiilil fi i� UNITED STATES POSTAL.SERVICE' _' "� FirsE"Class'Mail .a, geRip`sacl, `w'',�1..`uw...::'._..r • Sender: Please print your name, address;and Z14 n-,ti Ifs box • -_^=' CSN 1��j,� P.O.Box 2030 Engineering Teaticket,MA 02536 I�► COMPLETE • E Complete items 1,2,and 3.Also complete A. Sig ure item 4 if Restricted Delivery is desired. X ❑Agent e Print your name and address on the reverse ❑Addressee so that we can return the card to you. B. Received by Pri ted me) C. Date of Delivery ■ Attach this card to the back of the mailpiece, � 10ol B���-ia.. or on the front if space permits. �l���r!! D. Is delivery address different from item 1? ❑Yes 1. Article Addressed to: If YES,enter delivery address below: ❑ No n �j!n`rY�vt`n C� t �Ll rt OZ-31 3. SSWce Type / 19 Certified Mail ❑Express Mail ❑ Registered ❑ Return Receipt for Merchandise ❑ Insured Mail ❑C.O.D. 4. Restricted Delivery?(Extra Fee) ❑Yes 2. Article Numberi (Transfer from service label)' f7 0 7 2�6 8 0 0 GOT 6'3 0'1 °7 0 0 I PS Form 3811,February.2004 Domestic Return Receipt 102595-02-M-1540 1 ii i i3 t f=! ! ! � li ,!� ;; ; UNITED STATE E ,r -Fjf§V Mai Paid R Sender: Please print your name, address, and ZIP+4 in this box 11194 P.O. ox 201 #0 Engineering ea cket, 02536 P.O.Box 2030 CSN Teaticket,MA 02536 ON 011011 Engineering SENDER: COMPLETE THIS SECTION COMPLETET'HIS SECTION ON DELIVERY ■ Complete items 1,2,and 3.Also complete A. 'gn ture item 4 if Restricted Delivery is desired. ❑Agent le Print your name and address on the reverse a"Addressee so that we can return the card to you. ceived by(Wedf meL C. to Delivery ■ Attach this card to the back of the mailpiece, CCCC�//JJJJ/� // or on the front if space permits. Is delivery address different from item Yes 1. Article Addressed to: If YES,enter delivery address below: o 3. Se ice Type CA M M A vt.d A 0^)--G 31 15 Certified Mail ❑Express Mail Registered ❑Return for Merchandise❑ ❑Insured Mail ❑C.O.D. 4. Restricted Delivery?(Extra Fee) ❑Yes 2. Article Number; (rransfe'r from service labeq' IPS Form 3811,February,20041 {1 I It Domestic Return Receipt 102595-02-M-1540. I i I fill I ,`,rllltl� ffrl � tilil UNITED STATES..P:o. , y4cE:: "� m '", •:>attt�srenil�� ^- o .Postage..&Fe6s Paid JJSFI • Sender: Please print your name, address, and ZIP+4 in this box • CSN .�,�, P.O.Box 2030 Eagineerillq Tea"cke"MA 02S3s =::�i lliffi:i�I�lilitilitiitlli:ifi�ilififfflifliff,ffflf111fifllfl� J COMPLETE •N COMPLETE THIS SECTIONON DELIVERY ■ Complete items 1,2,and 3.Also complete A. Signature item 4 if Restricted Delivery is desired. ❑Agent ■ Print your name and address on the reverse X ❑Addressee so that we can return the card to you. B. Received by(P,rint Na C. Date of Delivery ■ Attach this card to the back of the mailpiece, or on the front if space permits. D. Is delivery address different from item 1? ❑Yes 1. Article Addressed to: If YES,enter delivery address below: ❑ No aii-�� ''nn � I & n�`ff�4t myl 3. Se ceType UJ Certified Mail ❑Express Mail ❑Registered ❑Return Receipt for Merchandise ❑Insured Mail ❑C.O.D. 4. Restricted Delivery?(Extra Fee) ❑Yes 2. Article Number (Transfer from service label) I i 17 Q N71129 8,01 0 0 0 li'16-q 16 9 5 x111 I PS Form 381,1,Fjp0,Wary 2004 Domestic Return Receipt 102595-02-M-1540 UNITED STATES.POSTAL SERVICE A�F, id 6sta 9 Sender: Please print your name, address, and ZI-P+41 this box 030 CSN '0 P.O. P.0.TeatitY et.,M 02536 Engineering' i No. � ___—_-� 1. 5i_09 Fee-- BOARD OF HEALTH AP �.� TOWN OF BARNSTABLEl12OARCEL : i E AppiicationArlVefi Con0tructionpermttV Applica ' her ade for rmit to Construct ( ), Alter �r Repair ( ) irid vdual?We . af: t'on Address r -- -- ----Assessors Map and Parcel ---— caner Address Installer — Driller — Address Type of Building Dwelling ----- — — —---— Other - Type of Building---- ------ No. of Persons------------------------ Type of Well — Capacity--------— --——--- --- Purpose 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 hndersigned further agrees not to place the.well in operation until a Certificate of Compliance has been issued by the Board of Health. Signed -- - v --- /— -- --- date Application Approved By date--—-------—— ------- Application Disapproved for the following reasons:-------— - - ----——-- --------- --------- ----------- ----- -- - /' date Permit No. --�/ --- —� — Issued-- - �- ------ dat i BOARD OF HEALTH TOWN OF BARNSTABLE Certificate Of Compliance THIS IS T ERTIFY,. at a Intd�'v d 1 ell Ctped ( ), P}ltered ( ), or Repaired ( ) by------ _ 'may k � - -- --- -- ---- -- — .O q,,g ro 4 Z � sta er IN)/ at A( Slbx has been installed in accordance with the provisio s of the Town of Barnstable Board of Health Private Well ro tion-...9 Regulation as described in the application for Well Construction Permit No.—00/Dated—� THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORY. DATE--------------------------- —-- Inspector-- - ------------------------——-----— - :a No.------ -_-----:-- Fee BOARD OF HEALTH ,J.. 33 � TOWN OF BARNSTABLE 0(opCication-*rWell Cootruction erMit Applic� '��n is here. ' ade for .permite to Construct ( ), Alter ( or Repair ( )�a indi'vidu�al We e�YI at: � i at on• =Address. Assessors Map and Parcel �. a Owner Address -------------- ----------------------------- - - - -- - - Installer — Driller Address Type of Building Dwelling - --- ---- —- -- ' jOther - Type of Building------------------- No. of Persons------__-________—__----____ t _ i P �_ } Type of Well _ 1.�-�_-�' Capacity—FT-------------------------- Purpose of Well ---- r— =--------— � .................. h3 4 Agreement: �`' ? 9 The undersigned agrees to install the aforedescribed individual well in accordance with the provisions of The L 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. i Signed — - g ' date i E Application Approved By ' — ---------— -- -- date Application Disapproved for the following reasons: -------- - ---- — - ---- ---- date Permit No. �— � _— Issued----, ------ ------------------- I dat BOARD OF HEALTH TOWN OF BARNSTABLE Certificate Of COMPliance THIS IS TO CERTIFY, That the Individual Well Constru-ted ( ), Altered ( ), or Repaired ( ) . a er lt at ll I Ifl� t`J'l P� , �S � I{V , �'!1U _ _�V_'! '1i✓ ! �/ has been installed in accordance with the provisions of the Town of Barnstable Board of Health Private Well 'rote¢tion_ (� � Cl Regulation as described in the application for Well Construction Permit No. kz�__ --Dated >---���-- -5 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 3pertnit No. ® oFee- Permission is hereby granted !6"""' to Constr/ c/t ( ), Alter ( ), or R IfIlepair (, ) an Individual Well a `::M). :--�r.:�—r—�. .�-------- — —------ _ - -- - kolp IPA, streetas shown on the application for a Well Construction Permit C _/1--��(,�J -- No.----- ._ —_------- Dated --------------------------r ------ Boaid of Health DATE---�1 � / :�!- ----- TOWN OF B kRNSTAALE 0 I.---OC;ATIOi9_ �1��. SI.1VA(dE 4ILLA.GE,S`vyv�v�'t�- _ ASSESSOR'S MAP & LOT ��� INSTALLER'S NAME & PHONE I4O. C V .�. la Sew EI`TIC TANK CAPACITY- 1 V LEACHING FACILITY:(typc)_p '�— NO. OF BEDROOMS 7�, ATE WCL OR PUBLIC; WATER_I S C BUILDER OR DATE PERMIT ISSUED: �G k-7—T —-- -_ DATE COhIPLIA.NCE ISSUED_ _ - --_--_ VARIANCE GRANTED: Yes_--------No_ No _�_� E [/ W� 71 ...YmB ... i THE COMMONWEALTWOF MASSACHU.SETTS } BOARD OF HEALTH • , ApAration.for UispvM Works: Tonstrn.cf nn Vamit Application is hereby made for Permit to Construct, ( , ) or Repairj ' ) an,Individual`Selvage Disposal System at: n (� .....-•-- ......X.9.�&LS.:L: -. f..E .... - -......C_L.2.k'Vl Y.Se1_4:.u. t.•• •-• - Location Address ` V or Lot No ............0�A�S�t W_.. .L .� :_�CisCew -•--•-•.' �?? '�.` _• ...... --- - Owner -••- WW1 •--•----•--C .C. ._L `. ../ -•• � C i�dress„ �y - .. .. Installer _ Address - ' Type of Building . .' � Adr Size Lot---- --... ......Sq. feet ' U �..� Dwelling-No. of Bedrooms __ ...___.r_Expansion Attic ( ) Garbage Grinder ,( °") Other—Type of Buildiig _. No. of persons ____..................... Showera Cafeteria Other fixtures . --------- .......................................................--- r�-� W Design Flow.L:... 7 .r �....... •.._____gallons per person.per day. Total daily flow.:_.___ U .__gallons. ` Ri Septic'Tank—Liquid_ capacitvl_6UVgallons Length _jZ_)`____.'Width r Diameter-----:.......... Depth . _._. p _._._..__.. Total Length...................... Total.leaching.area_____ ____________sq: ft. Disposal Trench No. ................. Width.._. ' P� / ..---- P ..._._. Total leaching area:............. :.sq. ft. See e'Pit No. __ ____ Diameter.___.�_sz�..__..__.EDe Depth below inlet._._.�e r >.- - 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........................ GL, Test Pit No. 2..::............minutes per inch Depth of Test Pit..................... Depth to ground water- ; O f Description of Soil ..... :.....----•----........ ..._ -•-`--- -.............................. W -•-----•-• -----•• •.................................... ----- .......----------- ••--------------------------------------------------• --••-- ••----------------•••-- ------ •.........................•---•--•-- U Nature.of Repairs or Alterations Answer when applicable �-p_c_4G n- �i f11 � 5r, p< ` Agreement The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of'LI'I LE . 5 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 th. _ Signed -- ----- ---• ----- ............. ------ ---—7- Date - t --- P,. -- •-•--APPliation Approved By------ ff t Date il, t s Application Disapproved for the following reasons:•--------------•--..::._. ... -••--f---•------ --_... • -----_... __...--- ---•- • y • ..` .f. ..... - ..LL.J1............... ti Date a M Permit No...- �-------- --------- Issued.-=-•- r - _ Date•" - ............. . . r •r. - -+.fl.,.;;:,L..a ►, _.. � ...-.cG � i.,�7 :..�-^h...,sk3;':%,.�n..,f,.s.;,w s::.'S....-. .._ _ �;:,,,.a€.a_ .. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH Appliration far'Disposal Marks Tonstrnrtiinn "permit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: Location-Address or Lot No. ........... !2.�;r_C•(; ...... .......... .......... ...........•......•........................... Owner Address ... ..... ......... _ 4_ .............. Installer Address Type of Building Size Lot.....................:......Sq. feet a Dwelling—No. of Bedrooms._... ?................................Expansion Attic ( ) Garbage Grinder ( ) �'4 Other—Type T e of Building .............. No. of persons............................ Showers YP g ...-•-•-•----- ...--•-•--......-•---P .- -- ( ) — Cafeteria ( ) W Design Flow........-'. ..................gallons er erson er da . Total dail•- flow......3..U....................... ns. Other fixtures .................... . . W gn m• _.. g P P P Y Ygallons. WSeptic Tank—Liquid capacity L SR)gallons Length---/D Width...b_r...... Diameter................ Depth................ x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No....../............ Diameter.....1. _�._...... Depth below inlet...../............ Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground Water........................ L=, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ phi ..........................-------••----•-•---•---...---•--......................•............•••••.......................................................... ODescription of Soil........................................................................................................................................................................ W M ..... ------- ---... ------ -..... •---------------------------------------------------- •------------------------------ ......._..------------------------- •------------- --------------- •--------- .... UNature of Repairs or Alterations—Answer when applicable..._ -H' ..__.-4_ ..- .��..._..Q�(Z—......... S d..:��� ...... -----------� --�•� ..:�a'�7� �.....................................................---------------------------------------------------------------•••---......._.....-•-_.... 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•Compliance has been issued by the beard-of-health. Signed..-------•-- ---- Date Application Approved BY...................5. �.z..............�d�._.�--------------•- ---------------s? - 7=.-9K. Date Application Disapproved for the following reasons:................................................................................................................ ....................••-----.....-----•--....----••--••--------•-----••-•-------------....---------•--•-•--•----•--•----•-----------•--------•.°....................................................... G Date Permit No--------/ ..............1737 ...............•••••_. Issued.------- ' --- ••---•-•-•••..........--•--•-•.--••- Date L._-------------------------------------_—_.—_.-- _. ------�-- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ......OFF-�� .. ,........................... (Intifiratr of Tompliatta THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) b ............... ......... .................-'' --------......................................................................................... Installer at. Q ?..?.............. .... ......1'!= - r1'�- 5 C .. has been installed in accordance with the provisions of TITLE 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No----------------------------------_...... dated................................................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. - JS� - � DATE. .............................•--...-•-••-••----•-•-•-•-•-- Inspector.......-----•--• • . - .................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH FEE.....;k �- i9ispos 'il orkv Taanstrnr#ion :permit Permission is hereby granted....... L.t!:�.Y�. 5 :- ...-.................................................. to Construct ( ) or Repair ( c)_an,Individual Sewage Disposal 4stem Streets i as shown on the application for Disposal Works Construction Permit No.................:... Dated.......................................... -------------------------- i.-L�......-•c--.. ...................... DATE- .----- /,' t7 r `13�ard of Irealtl� ) • t TOWN OF BARNSTABLE LOCATION SEWAGE# Q0k0 - l- VILLAGE tin�1 ASSESSOR'S MAP&PARCEL 33 sI INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY S'v-`5 LEACHING FACILITY:(type) L-c (size) --%r, x 11,s'' k 3 "'r NO.OF BEDROOMS a OWNER PERMIT DATE: C. O 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) `ate. Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) TT , Feet FURTIISHEDBY�C.�cS��i 7 ' � O� YI LO 1 _ a i VIWD No. D / 16pa%&o V� Fee ✓ THE COMMONWEALTH OF MASSACHUSETTS Entered in compu er: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes S� � 0 �. �prication for MtsposaY *pstPur �Cot�struttion permit®� Application for a Permit to Construct( ) Repair( ) Upgrade(/rAbandon( ) ❑Complete System [I dividual Components Loca;' nAddreWarcel o. �s ,,g; �� Owner's Name,Address,and Tel.No.a`r1.�r A I' aAsse "Mai3 S s"' , Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No.L o Aw iq,eb. �- a33� 3��d 27y- ?3Y7 rnA c)Q�6 u off` - ©�S" Type of Building: Dwelling No.of Bedrooms Lot Size W,,r--$ sq�-ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) j.3© gpd Design flow provided j S,S' gpd Plan Date C35" 0I NO Number of sheets � Revision Date Title Size of Septic Tank] �,!-c C.s� G� ,`��;h Type of S.A.S. �r—kK)Cj 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. Si ed Date Application Approved by Date Application.Disapproved by Date for the following reasons Permit No. U Date Issued +r-.wrv.r ,�^,r.. .., ,t _r„ .,,:...__ _ ....-, ,." .:;-•w ++ow..-:a.s•�.w++u+r—^__� .-114 A aD4 No. Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS Yes jn�S� ' application 33Isposal *pstem Construction Permit. �D9� Application for a Permit to Construct Repair pP ( ) p ( ) Upgrade(Abandon( ) ❑Complete System 1 Individual Components Locati�n Address os Lot No. � � �� Owner's Name,Address,and Tel.No. U1f> � ®� 3�� sue• 3c�- �3 Assesr's Map/Parcel 3 3 S' C� m .eca Installer's Name Address,and Tel.No. Designer's Name,Address,and Tel.No.L,\gyp Q ►��o Type of Building: Dwelling No.of Bedrooms ° Lot Size A 5 A5_T tZ 5 sq-ft. Garbage Grinder( Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 3 3© gpd Design flow provided gpd Plan Date C 5l �00 1 (O Number of sheets Revision Date Title /' 1P ;D r- Size of Septic Tank ,500 C,k l fie,S;•v.`� Type of S.A.S. S ARC 3C1� Description of Soil Nature of Repairs or Alterations(Answer when applicable) _� se `?O ��.5 vRc.3��6 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. Si ed _/y _ r p l� Date ' tee,l\s Q�`'"Z. Application Approved by p / Date Application Disapproved by / / Date for the following reasons U /''11 � Permit No. U! U 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 �e�� ,t cr'�U�"� --t- , o at C4QP,:�) '[-, 4 has been conssxt ucted i n a rdance with the provisions of Title 5 and the for Disposal System Construction Permit No. o,sn dated Installer � i� z .� .�-� Designer #bedrooms J Approved desigkflow, R':Z gpd The issuance of this p rmit shall not be construed as-a guarantee that the system will f u/'oln as des ned. Date a Inspector / yt^. /,Q Fee N 0.ti 4q77 THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION M,BARNSTABLE,MASSACHUSETTS 33isposal *pstem Construction Permit Permission is hereby granted to Construct( ), y Repair( ) Up ade(✓) Abandon(,�'�) System located at d` �jc���. �j / ` /.� v and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Conss;/ cti6n m t b Mcoted within three years of the date of this permit. Date G%/ 7� Approved by r Town of Barnstable P# a Department of Regulatory Services Public Health Division Date � o IN 200 Main Street,Hyannis MA 02601 Date Scheduled JZ 7 y Time Fee Pd. Soil Suitability Assessment for Sewage isposal Performed By: Witnessed By: W- S DY! LOCATION& GENERAL INFORMATION Locations Address Owner's Name A O( 5 l Address G irM ev" III coo— J �A d✓ta d lQ G U✓K r1V10 a R c9 O Z(O3 7 sessor's Ma 1. / Engineer's Name NEW CONSTRUCTION REPAIR Telephone# Land Use I �q p Slopes(%) (� °(� Surface Stones A O Distances from: Open Water Body ? �Op ft Possible Wet Area 1�� ft Drinking Water Well Z ( ft Drainage Way :y ft Property Line 10—ft Other ft SKETCH:(Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands in proximity to holes) .. .r DlGvt" +..` f � / Parent material(geologic) � I a I II Depth to Bedrock. 7 Z o,) &epth to Groundwater. Standing Water in Hole: D 3 Weeping from Pit Face 1',sdmated Seasonal High Groundwater- �- 3 t '® ,E I DETERMINATION FOR SEASONAL HIGH WATER TABLE cz: Method Used: e ® Depth.Observed standing in obs.hole: :L ___ In. Depth to soil moUles: in. Depth weeping from side of Pbs,hole: in. Groundwater Adjustment ft. 0 Index Well# fie?- Reading Date: /a Index Well level a Adj,&ctor o.0o' Adj.Groundwater level PERCOLATION TEST Date Time..�� 1-- Observation 'Hole# Time at 9" Depth of Perc Time at V Start Pre-soak Time @ 'lime(9"-6") 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:\SEPTICVERCFORM.DOC . 7 DEEROBSERVATION HOLE LOG Hole# / Depth from Soil Horizon Soil Texture .Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones;Boulders. Consistency,% vel 0 3 t- /' C/ 3 8-- W C3 col t o 4A Luse DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistencv.% DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency, a ve DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones.Boulders. consistency, Flood Insurance Rate Map: Above 500 year flood boundary No— YesV Within 500 year boundary No Yes Within L00 year flood boundary No:.____. Yes Depth of Naturally Occurring 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? Aes 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 trainin ,expertise and experience described in 310 CMR 15.017. Date (o - o Signature , Q:\SEPTIOPERCFORM.DOC Town of Barnstable �t r Regulatory Services ti Thomas F. Geiler, Director BABNSPABLE. Public Health Division MASS. g � Thomas McKean Director FD p�pl 200 Main Street, Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Date: �?U�,.e �3� Sewage Permit# -k'-(S_ Assessor's Map/Parcel 3a: aS Installer& Designer Certification Form Designer: Installer: Address: P-0, 3©X ©30 Address: 'K—,(2D, Q�,%c 3 _ On � ��� ��(6 ���:�� —L'rs, ,�, was issued a permit to install a (date) installer) septic system at 'f0`13 , 6� ��,nwaua�:c5?, based on a design drawn by (address) dated S-Xn?/to (designer)__Z ' 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 Re s. Plan revision or certified as-built by designer to follow. Stripout (if require d and the soils were found satisfactory. NNr J. o p cym CIVIL y (Installer's Signature) NO.46504 �FSSCf's esigner'sSignature) (Affix Designe p 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. gAoffice formsWesignercertification fonn.doc LlMassachusetts Department of Environmental Protection Bureau of Resource Protection - Wetlands WPA Emergency Certification Form Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 C. General Conditions 1. Failure to comply with all conditions stated herein, and with all related statutes and other regulatory measures, shall be deemed cause to revoke or modify this Emergency Certification or subject to enforcement action. 2. This Emergency Certification does not grant any property rights or any exclusive privileges; it does not authorize any injury to private property or invasion of property rights. 3. This Emergency Certification does not relieve the applicant or any other person of the necessity of complying with all other applicablejederal; state, or local'statutes, ordinances, bylaws, or regulations. 4. Any work conducted beyond that described above, and any work conducted beyond that necessary to abate the emergency, shall require the filing of a Notice of Intent. 5. The Agent or members of the Conservation Commission and the Department of Environmental Protection shall have the right to enter and inspect the area subject to this Emergency Certification at reasonable hours'to evaluate compliance with this Certification, and may require the submittal of any data deemed necessary by the Conservation Commission or the Department for that evaluation. 6. This Emergency Certification shall apply to any contractor or any other person performing work authorized under this Certification. 7. No work may be authorized beyond 30 days from the date of this certification without written approval of the Department. D. Special Conditions 1. Sediment controls shall be deployed around the area of disturbance. 2. Disturbed area shall be loamed seeded and watered following installation E. Appeals The Department may, on its own motion or at the request of any person, review: an emergency certification issued by a conservation commission and any work permitted thereunder; a denial by a conservation commission of a request for emergency certification; or the failure by a conservation commission to act within.24 hours of a request for emergency certification. Such review shall not operate to stay the work permitted by the emergency certification unless the Department specifically so ` orders. The Department's review shall be conducted within seven days of: issuance by a conservation commission of the emergency certification;denial by a conservation commission of the emergency certification; or failure by a conservation commission to act within 24 hours of a request for emergency certification. If certification was improperly granted, or the work allowed thereunder is excessive or not required to protect the health and safety of citizens of the Commonwealth, the Department may revoke the emergency certification, condition the work permitted thereunder, or take such other action as it deems appropriate. WPA Emergency Certification Rev.01131/0 Page 2 of 2 LlMassachusetts Department of Environmental Protection Bureau of Resource Protection - Wetlands WPA Emergency Certification Form Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 A. Emergency Information , Important: Town of Barnstable Conservation Div. When filling out Issuance From: Issuing Authority forms on the 4093 Main St., Barnstable Village computer, use 1. Site Location: only the tab key to move 2 Reason for Emergency: your cursor- do not use the Impending summer rental use will likely cause the presently poorly-functioning septic system to fail, return key. resulting in threat to public health and adjacent wetlands. r� 3. Applicant to perform work: By property owner's agents 4. Public agency to perform work or public agency ordering the work to be performed: Conservation Div. following discussion with Health Div. (Board of Health has approved new system). 5. Date of Site Visit: Start Date: End Date*: 6/15/10 6/16/10 7/16/10 'no later than 30 days from start date or 60 days in the case of an Immediate Response Action approved by DEP to address an oil/hazardous material release. 6.- Work to be allowed*: Installation of Title V septic system as approved by Board of Health. *May not include work beyond that necessary to abate the emergency. B. Signatures Certified to be an Emergency by this Issuing Authority. Signatures: C�rnS. �rr1:� 6/15/10 Chairman(or designee) Date A copy of this form must be provided to the appropriate DEP Regional Office. WPA Emergency Certification Page 1 of 2 Rev.01/31/0 Therefore, it is their contention that they do not fall under the Feb 2009 regulation until January 28, 2011. The Board voted to approve the plan dated May 3, 2010, pending agreement with the legal department on extension of deadline, and with the following conditions: (1) Quarterly Monitoring Plan must be submitted and (2) Operating and Maintenance Agreement for the system must be submitted. IV. Hearing — Septic Failed (Cont.): APPROVED Michael Santos, owner—26 Bishops Terrace, Hyannis, Map/Parcel WITH 251-215, septic failure. CONDITIONS The Board voted to allow Mr. Santos to continue with the current system with the following conditions: 1) the septic must be inspected yearly for the next three years and the reports will be submitted to the Health Division, 2) if the property is sold within five years from today I (June 8, 2013), then Mr. Santos must replace the septic system at his own costs or he must inform the buyer of the Board of Health's concerns and the buyer must sign.off on such a statement, and 3) prior to renting, Mr. Santos must:undergo a rental inspection and register it as a rental to meet regulations. V. Variance — Septic New Item): APPROVED A. Linda Pinto representing Marsha Alibrandi, owner—4093 Route WITH 6A, Barnstable, Map/Parcel 335-028, 15.0 acre lot, 2 setback, CONDITIONS variances requested. Approved without any additional conditions to the plan. The Board voted to approve the proposed plan dated 05/07/10 with the two variances: 1) setback of 124 feet of SAS from a drinking water well (26 foot variance), and 2) setback of 88 feet of SAS from the edge of wetlands (12 foot variance). CONTINUED B. Peter McEntee, Engineering Works, representing Mary Schoebel, TO BOH owner— 11 Nyes Point Way, Centerville, Map/Parcel 233-069, 0.5 JUL 13, 2010 acre parcel, multiple setback variances. The Board asked the engineer to rework the plan and see if some of the distances of the setbacks can be improved on —trying to maintain as a minimum, „ the distance of the current setback of 70 feet. The Board voted to Continue it to the July 13, 2010 Board of Health meeting. ADDITIONAL NOTE ON A SEPARATE TOPIC: Page 2 of 4 BOH 5/11/10 ic-14p u,,i,4 Cngineenrg i-dins-a40-DWO P.iu 4093 Route 6A, Cummaquid, MA Floor Plan F First C--,'loor fo o Second Floor l • Y9r . • APPLICANT: MGtts �, ono ADDRESS: `l,o°I3 (�a., �Ptt G� vtcl . DESIGN FLOW: 5� gPd REVIEWED BY: DATE: r N/A . OK NO Le a] 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)] f 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)] Fupgradesl- sements shown [310 CMR 15.220(4)(b)] stem located totally on lot served [310 CMR 15.405(1)(a) for i 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 and provided) whether system desi ned for garbage grinder North arrow[310 CMR 15.220(4)( )] Existing and proposed contours [310 CMR 15.220(4)( )] Location and]og of deep observation holes (existing grade el.don / each test) [310 CMR 15.220(4) h)] V . Names of soil evaluator and BOH representative [310 CMR 15.220(4)(h)and(i)] J Locationi and date of percolation tests (performed at.proper elevation?) [310 CMR 15.220(4)(i)J re ation test results match'loading rate?-[310 CMR 15.242] cation statement b Soil Evaluator 310 CMR 15.220(4) ')J ed and Adjusted groundwater(method for adjustment r indicated) [310 CMR 15.103(3) and 3 1&CMR 15.220(4)(n)] Location of every water supply,public and private,.[310 CMR 15.22.0(4)(k)J , Address Sheet l of within 400 feet of the proposed system location in the case / of surface water supplies and gravel packed public water supply within 250 feet of the proposed system location in the case within 150 feet of the proposed system location in the case of private water supply wells Location of all surface waters and wetlands located up to 100 ft. beyond setbacks listed in 310 CMR 15.211 and any catch basins / located within 50 ft. [310 CMR 15.220(4)(1)] V Water lines and other subsurface utilities located [310 CMR / 15.220 4 (m) (if water line cross see 310 CMR 15.211(1) 1]) V Profile of system showing invert elevations of all system / components and the bottom of the SAS 310 CMR15.220(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)] V Benchmark within 50-75'of system [310 CMR 15.220(4)( )] Materials specifications noted? [various sections of 310 CMR 15.0001 System components not> 36" deep(unless Local Upgrade Approval or LUA requested) [310 CMR 15.405(l(b) F Address Sheet 2 of 7 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 1 .227(6)] Outlet tee with as baffle or approved filter[310 CMR 15.227(4)1 Note regarding installation on stable compacted base [310 CMR 15.228(1)] Separation between inlet and outlet tees (no less than liquid Fdh10 CMR 15.227(2)1 let elevations at least 12" above high groundwater s described 310 CMR 15.227(5))or permitted for under LUA [310 CMR 15.405 1 k( )( )] cover 9" (Tanks buried more than 9" must have risers nings and on the d-box) [310 CMR 15.2228(1)and 310232(3)(f)] Three access covers (inlet and outlet must be 20" or greater) - middle access at least 8" (b 7/07) [310 CMR 15.228(2)] 1/ Access to within 6 " of grade - one port for systems<1000gpq. two fors stems>1000 gpd 310 CMR 15.228(2)] . V All at-grade covers secured to unauthorized access? [310 CMR / 15.228(2)] ✓ ' > 10 ft from building foundation [310 CMR 15.211(1)] Buoyancy calculation Required/Done 310 CMR 15.221(8)] H-20 Where appropriate? [310 CMR 15.226(3)] Setbacks from resources [310 CMR 15.211] I ired when other than single-family dwelling or flows 1000 310 CMR 15.223(1)(b)] compartment 200% daily flow; Second compartment 100% flow 310 CMR 15.224(2) and.(3)] ipe through or over baffle, outlet of each compartment with as baffle or a roved filter[310 CMR 15.224(4)] Address Sheet 3 of 7 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 re wired/ rovided ? [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) r310 CMR 15.251(9)and 310 CMR 15.252(2)(c)] Siphon roblem/ 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) ;s - Stable compacted base [310 CMR 15.22](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)] 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, disconriects accessible) Alarm floats - alarm on circuit separate from pumps specified? Exceeds two units must have two pumps operating in lead-lag f 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 i Calculations correct? 4 feet of naturally occurring material demonstrated?[310 CMR y 15.240(l)] Re uired separation togroundwater? 310 CMR 15.212)] Aggregate specified as double washed [310 CMR 15.247(2)] System Venting required/provided?(system under driveway or / >36" deep) [310 CMR 15.241] V 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] 3. Chambers and Gal. in trench configuration supplied with inlet e.ery 20 ft. [310 CMR 15.253(6)] Each structure with one inspection manhole(if>2000 gpd must be to 'rade) 310 CMR 15.253(2)] Aggregate I'minimum-4'maximum. [310 CMR 15.253(i)(b)] 2' sidewall credit maximum [310 CMR 15.253(1)(a)] In bed configuration, inlet every 40 s . ft. [310 CMR 15.253(6)] Tmm7mhever aximum [310 CMR 15.251(1)(b)] [310 CMR 15.251 1) aeffective depth or width whichever eater(3x if reserve between trenches) [310 CMR 251 1)(d)] Situated along contours [310 CMR 15.251(2)] Breakout OK?[310 CMR 15.21](1)[4] and Guidance Document] minimum 2 distribution lines [310 CMR 15.252(2)(a)] Maximum separation between lines 6' 310 CM RI5.252(2)(d)] �. Maximum separation between lines and 'outside of bed 4' p [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 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 J Remedial Use Approvals] If used in gravelless system -make sure jet is directed as not to / scour soil interface [Guidance Document] V Inspections once per year(systems<2000 gpd) or quarterly / (>2000 d)good to note on plan 310 CMR 15.254(2)(d)] Construction in fi11 -Did the plan specify that the fill shall meet the specification of 310 CMR 15.255(3)? Impervious barrier and/or retaining wall ? Guidance Document] Impervious barrier installation must be supervised by / designer[310 CMR 15.255(2)(b)] Retaining wall must be designed by Registered Professional / Engineer[310 CMR 15.255(2)(a)] Side slope not exceed 3:1 ? 310 CMR 15.255(2)] Breakout requirements met? [310 CMR 15.252(2) and Guidance Document At least 5 ft. from impervious barrier to edge of SAS (10 ft. recommended) [3,10 CMR 15.255 (2)(e)] Check DEP Approval letters for credits and design conditions If used with pressure dosing do not allow pressure discharge / to scour soil interface 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? J Has applicant submitted a copy of a maintenance Are the variances listed on the plan ? [310 CMR 15.220 (4)( )] RLS Stamp necessary on plan if a component is within five feet of property line [310 CMR 15.412(4)] New construction or increased flow proposed [Refer to 310 CMR 15.414] Address Sheet 6 of 7