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HomeMy WebLinkAbout0290 AMES WAY - Health S� 290 Ames Way 170-221 Centerville a SIIII/y a�, �Q,ECYC(FpC tele ��° �yy IIII UPC 12543 No.53LOR ��n,cceSu� HASTINGS, MN M �. 672Y nYe No. FeeTHE COMMONWEALTH OF MASSACHUSETTS Entered in computPUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS 4phratioii for Misposal *pstrm ConstrULtloii 3PPrmit Application for a Permit to Construct( ) Repair(:Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. a q0 A Ines LCcc-N) Owner's Name,Address,and Tel.No. Lo\�sonrOO l e. Assessor's Map/Parcel ---2a Lo e kkk,. Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No. Type of Building: Dwelling No.of Bedrooms- 3 Lot Size f,'� Zsq.ft. Garbage Grinder( ) Other Type of Building ML& /G j No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided/ gpd Plan Date �2-,7V-a0!10 Number of sheets 1 Revision Date Title Size of Septic Tank Type of S.A.S. a- 3yo Qc t'r., 4-16 t.c'CA (LIDA��lC Description of Soil Nature of Repairs or�A,,,lteerations(Answer when-applicable) ritpplicable) � /� G nJ���til d/S><rl�i!/TG�� e .� G d a X0 Ckimb(7)fie►'j44 0 S rwee fa le—, 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 a Date Application Approved by Date; Application Disapproved by Date for the following reasons Permit No. —� Date Issued a s':rf.., pry-.�f ._. .r`�...;-...• ",..:.,adb. ..^r'.-,r.�r+r. �.,r....Y...,F"L•9a r+.v.T,:�... q,;w �, ti f, +, •t v'r" ai!'°,.."",a''""' � c cam• "'r..... MV No. � Fee THE COMMONWEALNH OF-MASSACHUSETTS Entered in computer: Ye PUBLIC HEALTH DIVISION= TOWN OF BARNSTABLE, MASSACHUSETTS i ZIpplication for MispbSal 6p6tettt (COIIBtCUctI01I permit Application for a Permit to Construct( ) Repair(ty_**Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. .2 cto A MN LOC4\J Owner's Name,Address,and Tel.No. Assessor's Map/Parcel J a Installer's Name,Address,and Tel.No. ?,. Designer's Name,Address,and Tel.No. Z N 1S -M-1/S'35 ZhNJ Gscj^) Type of Building: Dwelling No.of Bedrooms Lot Size . / sq.ft. Garbage Grinder( ) Other Type of Building MiC/p\*IG No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 3 gpd Design flow provided 3y rl gpd Plan Date ,0 - 20-1 OP O Number of sheets Revision Date # Title Size of Septic Tank X�S ryJ Type of S.A.S. 2- SUO AEG M% 4-10 1,1-61 I rlllcrn_1F�S V Descnption of Soil : Nature of Repairs or Alterations(Answer when'applicable) �� 4 AMjj /yflk*1/ 4 692' au)d 9 --,—.Date last inspected: t Agreement: a y The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in , 1 Y accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of , i Complianceias been issued by this Board of He 1th: — Sited 3, Date Q .�., I.. t Application Approved by Date Application Disapproved by `x.Date . for the following reasons v` Permit No. ;�" .. Date Issued -----•-- -- -- a. --------• - _.-.- -- - e THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired( � Upgraded( ) -Abandoned{—}bY12 - • /rl-/1h.U/1itlf at 61,yo A mes has been constructed in accordance _with the provisions of of Titfe 5 and the for Disposal System Construction Permit N -d-07 9 dated � r Installer s f ,en Designer�)1 tjo-s r' #'bedrooms Approved design flo :3 gpd The•issuance of this per mnit shall not be construed as a guarantee that the syste w•1rfu)' t•', as designed. Date '�,±� ` A('j2( ) Inspector No ----- - - ------- - -- ----- Fee /45 THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS Misposal *pstrm Construction i9ermit s f Permission is hereby granted to Construct( ) .'Repair( Upgrade( ), Abandon System located at � t` and as described in the above Application for Dispo Permit. The applic" sal System Construction ant recognized his/her duty to comply with l 1 ' Title 5 and the followmg.local provisions or special conditions ',2r err art >�a. �• ... '.' � t "° . � ';. �\ Provided:`Construction'must be completed within three years of thedate of this permit: ...._ I Date - !�* _Approved by TOWNDF BARNSTABLE LOCATION q® Ames y SEWAGE# a0Z-C225 VILLAGE ('L.�3`l�f t706 ASSESSOR'S MAP&PARCEL l7 o2�1 I INSTALLER'S NAME&PHONE NO. d J A s",S-ram gClq-gXr>'fS-,yf SEPTIC TANK CAPACITY e2053 tide LEACHING FACILITY:(type) - AJ 1 - 4X6(size) NO.OF BEDROOMS `y OWNER j/�2ekAle -. PERMIT DATE: 12 COMPLIANCE DATE:3/3",-O 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 � 'Dec � -OL3 aur�'3� I-e � _ _{ . � 1 i ' i -�--��_ Town of Barnstable RegWAOry Services Richard V. Scali,Interim-Director Public Health Division - sud' Thomas McKean,Director 200 Main Street,Hyannis;MA 02,0'1 4 Office: 508-862=4G44 k a 9 _ Fax: 508-7906304 Installer_&Designer Certification Form � � Ze 7©Date;. _Sewa a Permit# ; A � Assessors MaP t r. ' 1 4 e Designer: �,� a Installer. . � 17 � ' [sl Address• q Address: 3 AL was issued a permit to install—IPA a _ (date) r (installer) g -I r' septic system at Z © E _ based' n a desigh drawn by= Y (address) - - dat e ted _ , _ •I certify that the septic system•referenceii�above was°installed substantially accoding,to ' --- the design; which may include minor approved!changes such as lateral relocation of the , distribution box .apd/or septic tank, -Strip out (if required) was inspected and the soils ' we 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.,accordancer With State &Local Regulations:,..Plan rdyision or certified as-built by, designer to follow. Strip out(if required)was'iaspected'and the soils were found satisfactory. I certify that the system referenced above was cons -r+Hance. with the tezvms of the AA approval letters (if applicable) Q' VID %r IMS N u' er's Signature) - ' ;L2` 'N0,1066 c r s,A fib SIT �1 (Design s Signature (Affix Designs Stamp Here) g, `PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH D: ION. "CER'I ICATE f OF COMPLIANCE WILL NOT BE.WSUED. UNTIL BOTH THLI%FORM:'ANDASS -,KLULT-CARD ARE RECEIVED°BY THK BARNSTABLE PUBLIC JREALTJ[,�DIMION. THANK YOU. , Q 1Septic\D�signer Cea ficadonToun Rev 8-1,413.doc = ; COMMONWEALTH OFMASSACHUSETTS = EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION SV� 350 MAIN STREET WEST YARMOUTH,MA 508-775-2800 TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSME SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM RECEIVE® PART A MAP 170 PAR 221 CERTIFICATION JuN 2 8. 2002 Property Address: 290 AMES WAY TO1P1,sN OF BARNSTABLE CENTERVILLE,MA 02632 HEALTH DEPT. Owner's Name: BLACKMAN,DANIEL Owner's Address: 9535 HUNTSHAM ROAD CHARLOTTE,NC 28227 Date of Inspection MAY 17,2002 MAP Name of Inspector: (please print) DAMES D.SEARS PARCEL Company Name: A&B Canco l...OT _ Mailing Address: 350 Main Street West Yarmouth,MA 02673 Telephone Number: 508-775-2800 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000). The system: X Passes Conditionally Passes Needs Further Evaluation by the Local Approving Authority Fails Inspector's Signature: Date: .S -19 -,VA The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent tot he buyer, if applicable,and the approving authority. Notes and Comments ****This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future under the same or different conditions of use. Title 5 Inspection Form 6/15/2000 1 i z Page 2 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 290 AMES WAY CENTERVILLE,MA 02632 Owner: BLACKMAN,DANIEL Date of Inspection: MAY 17,2002 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: X _ I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B. System Conditionally Passes: N/A _ One or more system components as described in the"Conditional Pass"section need to be replaced or repaired. The system,upon completion of the replacement or repair,as approved by the Board of Health,will pass. Answer yes,no or not determined(Y,N,ND)in the for the following statements. If"not determined" please explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not)is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND explain: Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken,settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced ND explain: The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health)" broken pipe(s)are replaced obstruction is removed ND explain: Title 5 Inspection Form 6/15/2000 2 t Page 3 of 1 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(CONTINUED) Property Address: 290 AMES WAY CENTERVILLE,MA 02632 Owner: BLACKMAN,DANIEL Date of Inspection: MAY 17,2002 C. Further Evaluation is Required by the Board of Health: N/A _ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health,safety,or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(l)(b)that the system is not functioning in a manner which will protect public health safety and the environment: Cesspool or privy is within 50 feet of a surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or salt marsh 2. System will fail unless the Board of Health(and Public Water Supplier,if any)determines that the system is functioning in a manner that protects the public health,safety and environment: The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. The system has a septic tank and SAS and the SAS is within a Zone I of public water supply. The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance x*This system passes if the well water analysis,performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: Title 5 Inspection Form 6/15/2000 3 Page 4 of 1 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(CONTINUED) Property Address: 290 AMES WAY CENTERVILLE,MA 02632 Owner: BLACKMAN,DANIEL Date of Inspection: MAY 17,2002 D. System Failure Criteria applicable to all systems: N/A You must indicate"yes"or"no"to each of the following for all inspections: Yes No X Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool X Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool X Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool X Liquid depth in cesspool is less than 6"below invert or available volume is less than'/z day flow X Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped X Any portion of the SAS,cesspool or privy is below high ground water elevation N/A Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply N/A Any portion of a cesspool or privy is within a Zone I of a public well N/A Any portion of a cesspool or privy is within 50 feet of a private water supply well N/A Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. (This system passes if the well water analysis performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal or less than 5 ppm,provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form.) NO (Yes/No)The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E. Large Systems: N/A To be considered a large system the system must service a facility with a design flow of 10,000 gpd to 15,000 gpd. You must indicate either"yes"or"no to each of the following: (The following criteria apply to large systems in addition to the criteria above) Yes No the system is within 400 feet of a surface drinking water supply the system is within 200 feet of a tributary to a surface drinking water supply the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area—IWPA)or a mapped Zone II of a public water supply well. If you have answered"yes"to any question in Section E the system is considered a significant threat,or answered "yes"in Section D above the large system is failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. Title 5 Inspection Form 6/15/2000 4 Page 5 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 290 AMES WAY CENTERVILLE,MA 02632 Owner: BLACKMAN,DANIEL Date of Inspection: MAY 17,2002 Check if the following have been done. You must indicate"yes"or"no"as to each of the following Yes No X Pumping information was provided by the owner,occupant,or Board of Health X Were any of the system components pumped out in the previous two weeks? X Has the system received normal flows in the previous two week period? X Have large volumes of water been introduced to the system recently or as part of this inspection? X Were as built plans of the system obtained and examined?(If they were not available note as N/A) X Was the facility or dwelling inspected for signs of sewage back up? X Was the site inspected for signs of break out? X Were all system components,including the SAS,located on site? X Were the septic tank manholes uncovered,opened,and the interior of the tank inspected for the condition of the baffles or tees,material of construction,dimensions,depth of liquid,depth of sludge and depth of scum X Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)has been determined based on: Yes No X Existing information. For example,a plan at the Board of Health. X Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable)[310 CNIR 15.302(3)(b)] Title 5 Inspection Form 6/15/2000 5 Page 6 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 290 AMES WAY CENTERVILLE,MA 02632 Owner: BLACKMAN,DANIEL Date of Inspection: MAY 17,2002 FLOW CONDITIONS RESIDENTIAL Number of Bedrooms(design): 4 Number of bedrooms(actual): 4 DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms: 440 Number of current residents: 0 Does residence have a garbage grinder(yes or no): NO Is laundry on a separate sewage system(yes or no): NO [if yes separate inspection required] Laundry system inspected(yes or no): YES Seasonal use(yes or no): NO Water meter readings,if available(last 2 years usage(gpd)): 2000 125,000/2001 124,000 Sump pump(yes or no) NO Last date of occupancy: UNKNOWN COMMERCIALANDUSTRIAL Type of establishment: Design flow(based on 310 CMR 15.203): Basis of design flow(seats/persons/sqft,etc.): Grease trap present(yes or no): Industrial waste holding tank present(yes or no): Non-sanitary waste discharged to the Title 5 system(yes or no): Water meter readings,if available: Last date of occupancy/use: OTHER(describe): GENERAL INFORMATION Pumping Records Source of information: N/A Was system pumped as part of the inspection(yes or no): NO If yes,volume pumped: gallons—How was quantity pumped determined? Reason for pumping: TYPE OF SYSTEM X Septic tank,distribution box,soil absorption system Single cesspool Overflow cesspool Privy Shared system(yes or no)(if yes,attach previous inspection records,if any) Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) Tight tank Attach copy of the DEP approval Other(describe): Approximate age of all components,date installed(if known)and source of information: MAIN SYSTEM 1980 PERMIT 79-751.NEW LEACHING 1997 PERMIT 97-432. Were sewage odors detected when arriving at the site(yes or no): NO Title 5 Inspection Form 6/15/2000 6 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 290 AMES WAY CENTERVILLE,MA 02632 Owner: BLACKMAN,DANIEL Date of Inspection: MAY 17,2002 BUILDING SEWER(locate on site plan): X Depth below grade: 4" Materials of construction: Cast iron X 40 PVC _ other(explain) Distance from private water supply well or suction line: Comments(on condition of joints,venting,evidence of leakage,etc.): SEPTIC TANK(locate onsite plan): X Depth below grade: 8" Material of construction: X concrete metal fiberglass polyethylene _ other(explain) If tank is metal list age: Is age confirmed by a Certificate of Compliance(yes or no): (attach a copy of certificate) Dimensions: 1,000 GALLON PRE CAST Sludge depth: 4" Distance from top of sludge to the bottom of outlet tee or baffle: 26" Scum thickness: I" Distance from top of scum to top of outlet tee or baffle: 12" Distance from bottom of scum to bottom of outlet tee or baffle: 14" How were dimensions determined: ASBUILT AND TAPE Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): TANK AT WORKING LEVEL.INLET TEE,OUTLET TEE.TANK AND COVERS 8"BELOW GRADE.NO SIGN OF OVERLOADING SEEN IN TANK. GREASE TRAP(located on site plan) N/A Depth below grade: Material of construction: concrete metal fiberglass _ polyethylene other (explain): Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping: Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): Title 5 Inspection Form 6/15/2000 7 Page 8 of 1 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 290 AMES WAY CENTERVILLE,MA 02632 Owner: BLACKMAN,DANIEL Date of Inspection: MAY 17,2002 TIGHT or HOLDING TANK: N/A (tank must be pumped at time of inspecti on)(locate on site plan) Depth below grade: Material of construction: concrete metal fiberglass polyethylene other(explain) Dimensions: Capacity: gallons Design Flow: gallons/day Alarm present(yes or no) Alarm level: Alarm in working order(yes or no): Date of last pumping Comments(condition of alarm and float switches,etc.): DISTRIBUTION BOX: X (if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: 0 Comments(note if box is level and distribution to outlets equal,any evidence of solids carryover,any evidence of leakage into or out of box,etc.,): DISTRIBUTION BOX IS CEMENT,ONE LINE IN,ONE LINE OUT. BOX IS 22"BELOW GRADE.NO SIGN OF OVERLOADING OR SOLID CARRY OVER. BOX IS SOLID AND CLEAN. PUMP CHAMBER: N/A (locate on site plan) Pumps in working order(yes or no): Alarms in working order(yes or no): Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.): Title 5 Inspection Form 6/15/2000 8 Page 9 of]l OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 290 AMES WAY CENTERVILLE,MA 02632 Owner: BLACKMAN,DANIEL Date of Inspection: MAY 17,2002 SOIL ABSORPTION SYSTEM(SAS): X (locate on site plan,excavation not required) If SAS not located explain why: Type X leaching pits,number: 1 X leaching chambers,number: 3 leaching galleries,number leaching trenches,number,length leaching fields,number,dimensions: overflow cesspool,number: innovative/alternative system Type/name of technology: Comments(note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation,etc.) LEACHING IS ONE 1,000 GALLON PRE CAST PIT WITH THREE INFILTRATORS ADDED IN 1997. PIT IS DRY,ONE LINE IN WITH NO TEE. ONE LINE OUT WITH NO TEE. PROBED AND DUG TEST HOLE AT INFILTRATOR,FOUND DRY. CESSPOOLS: N/A (cesspool must be pumped as part of inspection)(locate on site plan) Number and configuration: Depth—top of liquid to inlet invert: Depth of solids layer: Depth of scum layer: Dimensions of cesspool: Materials of construction: Indication of groundwater inflow(yes or no): Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation etc.): PRIVY: N/A (locate on site plan) Materials of Construction: Dimensions: Depth of solids: Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.) Title 5 Inspection Form 6/15/2000 9 Page 9 of I 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 290 AMES WAY CENTERVILLE,MA 02632 Owner: BLACKMAN,DANIEL Date of Inspection: MAY 17,2002 SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. l i �.7 s Title 5 Inspection Form 6/15/2000 10 Page 1 I of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 290 AMES WAY CENTERVILLE,MA 02632 Owner: BLACKMAN,DANIEL Date of Inspection: MAY 17,2002 SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to groundwater feet Please indicate(check)all methods used to determine the high ground water elevation: Obtained from system design plans on record-If checked,date of design plan reviewed: Observation site(abutting property/observation hole within 150 feet of SAS) Checked with local Board of Health-explain: Checked with local excavators,installers-(attach documentation X Accessed USGS database-explain: You must describe how you established the high ground water elevation: USGS WELL DATA WELL SDW 252 WELL 47.9 ZONE D 5 ADJUSTED 42.9 USES �2•`I 16,R P1r Title 5 Inspection Form 6/15/2000 1 1 TOWN OF BARNSTABLE LOCATION ��lO f-�1 \ s C�/ SEWAGE # 7- -VILLAGE �d��✓��``'� ASSESSOR'S MAP & LOT � I INSTALLER'S.NAME&PHONE NO.Ida k1 �� F SEPTIC TANK CAPACITY -2F%sT l ��ZY LEACHING:FACILITY:11, Ho r (size) NO.OF BEDROOMS 3 BUILDER OkOWNER PERMITDATE: 1� —a n ' 7 COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private WaterSupply 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 f .. within 300.feet of leaching facility) Feet Furnished by'. ' Cr a , 132 A 3 TOWN OF BARNSTABLE LOCATION a �� �� f S �'�� SEWAGE # K, VMLAGE e £ A,i ASSESSOR'S MAP & LOT� &PHONE NO. /4 D Q /4�/C G Sf �•S"; SEPTIC TANK CAPACITY LEACHING FACILITY: (type) (size) NO. OF BEDROOMS_ BUILDER OR OWNER � C PERMIT DATE: COMPLIANCE DATE: ,Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility (If any wetlands exist within 300 feet of leaching facility) Feet Furnished by o e ' /� `1 v�TOWN OF BARNSTABLE LOCATION aC10 1-�' � (J�� SEWAGE # / 7- a. VILLAGE_ �d�-1`C✓�� ASSESSOR'S MAP & LOT 17a - I INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY �L"��S T t,�5JJ1� tAS� , LEACHING FACELITY (type) (size) i-X NO.OF BEDROOMS -'"> BUILDER OR OWNER PERMTTDATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and 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 1i.r • ,1 i 6 Aj 13 ,� 2 A3�3 L33DIF, No. Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes" PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS 2pprication for Migogat 6pgtem Congtruction Permit Application.for a Permit to Construct( )Repair(V")Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No.aL?O 141�1;S A.MV C6vCj Owner's Name,Address anndd Tel.No. Assessor's Map/Parcel 1—2 0 _DA� Acok-Roki Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. Type of Building: Dwelling No.of Bedrooms Lot Size sq. ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow �� gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Z`00 p Type of S.A.S. 1 �`aCat/1CJ`t - K�t-XV4L _-� _ Description of Soil 1 S Nature of Repairs or Alterations(Answer when applicable) i-V`fST14E� 0 4d,-pax! SV Cstrnn 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 Environme tal Code and not to place the system in operation until a Certifi- cate of Compliance has been ist V d of Heal Signed 0 Date Application Approved by Date Application Disapproved for the following reasons 44 Permit No. Date Issued No. �.//�./ Fee_ l� THE COMMONWEALTH OF MASSACHUSET'tS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLEI�MASSACHUSETTS 0[pprication for Digpo at *pgtem Congtruction Permit Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No.a, o lti J 7 C,-Z ( Owner's Name,Address and Tel.No. Assessor's Map/Parcel 1_�Q p� C4 AJ Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. TTy.pe of Building: Dwelling No.of Bedrooms 3 �'*. �I Lot Size - sq. ft. Garbage Grinder( ) Other Type of Building ". No. of Persons Showers( ) Cafeteria( ) Other Fixtures30 �l Design Flow Z> gallons per day. Calculated daily flow — gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil ✓�4 '� Yl�'�!� I Nature of Repairs or Alterations(Answer when-applicable) Ykh 0 Cr, G,t�` _-dr-:l 4 f.- ltJ fiT7�"L-'.� r✓� �/r{ i r "�-- -,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 Certifi- cate of Compliance has been iss,_ - th' oard of Heal — Signed 0 " Date Application Approved by —Date, Application Disapproved for the following reasons - i Permit No. Date Issued —————————————————————————————T——4— THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of (Compliance THIS IS TO CERTIFY e O site SPwag posal System Constructed( )Repaired ( )Upgraded( ✓� Abandoned( )by �,��C9 ✓ <.> at d `-(Am F.:5 (w y'l 4 , n constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. �' ated Installer Designer The issuance of this permit shall not be construed as a guarantee that the system will function as designed. Date - 1`7._ — ! Inspectors, 0 i No.7?—,T --------------------------Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS lwigpogal *pgtem Congtruction Permit Permission is hereby granted to Construct( )Repair( )Upgrade(V)Abandon( ) System located at GAG'�l r 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. O Provided:Constructi �t b m ted within three years of the date of tliis p rmit. Date: ! Approved // 1 � PP b �/ ti NOTICE: This Form is to be used for the Repair of Failed Septic Systems Only CERTIFICATION OF SKETCH AND APPLICATION FOR A DISPOSAL WORKS C ONS'I•RUC77ON PERMIT(WITHOUT'DESIGNED PLANS) hereby certify that the application for disposal works construction permit signed by me dated 4F C , concerning the property located at �-�D (�s w G`e meets all of the following criteria: • There are no wetlands within 300 feet of the proposed septic system - There are no private wells within 150 feet of the proposed septic system . The observed groundwater table is 14 feet or greater below the bottom of the leaching facility • There is no increase in flow and/or change in use proposed • There are no variances requested or needed. SIGNED: DATE: LICENSED SE iC SYSTEM INSTALLER IN THE TOWN OF BARNSTABLE NUMBER IAttach a sketch plan of the proposed system. Also if the licensed installer posesses a certified plot plan, this plan should be submitted]. � /� �� i i k„ OR .. 6.age Ile low AT7 it lvl trlc`<J `T3+�il -f ie `•Yr�Flye� St 3 �..a t � ,y„ / t C iWny N0 -now A"; t oil iM MW tcY 4 N Y } { r $ t '�`r'\ .i;r?a {}Z'iS a.�'-` �., X•.4. ?�I:' NNN,r 1. 3 .,yA• 'Fr ra_ t .4 N y -a.H'�- .. i y s�y_n,•"`. - sL : 'E e. y 4 r �j i : 'r £ r �!1 w H r: n" 4 -ny'°d'�vrv"'° 'syZ` Jc fi .- of ' ! t �QLAW WOO sun ism OUT I q j f7ONO �2d'Tfi 1M +rcr ��1 a _ +-�iP, -y'4'i. ��°;"., t .y_ ,k�,..yp r �t _ ✓� RR t •' "rm. `wa.� c Krs Mz � tr �lzg, 5 r Kozo 0"AW 6 e Y � w r~ } _ it�'. �� tr�'1F�yiLV i l� d /.��, � A i '- •'i ' r r 4t Y 1 � c° x .i_; _- r.:; —•'1 c y,-ram` s... � ' _. i ti ',c �'�. �'a..s'.3.���m:n kp�% '; -_.�frt y.;��'r�5i... ¢T3 .�" r'�?z.�,',z�.r^`;ii S'�c`` _.�ryrj�a�'� PLAN NUMBER . LOT(Sr FLOOD :HAZARD /NFi�RMATION 'FLOOD MAP COMMUNITY NO.: 250001._. ZONE: x A33ESSORS. MaP PANEL 00.15C DATED 08/.19�19.85 MAPf 170 BLOCK:. PARCEL=221 N LOT :2 s n 150 0p, ' l O . o N/F CROSBY oecK_ tc . R •N 1 1/2 STORY" , LOT 1` 15,000 S.F. U O . Z Ai 94.20' AMES WAY MORTQAt�E LENDER US..�Y THIS IS THE RESULT OF TAPE MEASUREM ENT,`NOT THE RESULT OF_ AN INSTRtiMENT.:..SURVEY AND:.IS.-CERTIFIED TO THE tITLE .. R INSURANCE .COMPANY .AND ABOVE LISTED .AT -OR.NEY AND LENDER : Ni 40:.KENWOOD CIRCLE, SUITE 8, FRANKLIN . MA 02038 THERE ARE NO DEEDED EASEMENTS IN THE ABOVE REFERENCED TEL:(800)281-8800 FAX;(508)528=4011.. DEED OR ENCROACHMENTS WITH RESPECT TO BUILDINGS SITUATED ON THIS.LOT EXCEPT` AS SHOWN.. �H of MA, THE .LOCATION OF THE. DWELLING SHOWN DOES NOT FALL WITHIN c� ROBERT A SPECIAL FLOOD HAZARD ZONE, EDWARD �? Blssbk .ETT v> r � f p 34 k� X r Th ®r. 1_ r r `V �. �,- -N--- tiR 4 . ' 4 � r ti. ...._ I r J Ps;K a r ' � m Rx) s� TAN FEx....3................... THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH ........... own. ..............OF...........Bar..nstab.l-e----------._...--------.._..........---•------ Appliration for Mipatial Workii Tnntrnrtinn ami# Application hereby rpade for a Permit to Construct (X) or Repair ( ) an Individual Sewage Disposal System at: I-Zuiz ,)q() .. ............Ames waY..x...Center.Vii•i&-..................... ..........................Lot---1.......................................................... Location-Address or Lot No, James K. Smith Barnstable ......................--.......................................................................... ................................................................................................. Owner Address W �.>rQxiaia.. x�the a...... ...................Barnstable....................................................... 7 .......................... Installer Address Type of Building Size Lot...l .,OQQ______._Sq, feet Dwelling—No. of Bedroom s................3..__..._......_.._.......Expansion Attic ( ) Garbage Grinder (M) aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) P4 Other fi res -------------------------------- - 0 Design Flow............................................gallons per person er day. Total daily flow............. ..........................gallons. 04 Septic Tank—Liquid capacity__Miallons Length---_...T.6 Tt_. Width.dk t.1_W'. Diameter__-________-- Depth_5.1_Wi.. W Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No.-._____1.__.____- Diameter.......10...... Depth below inlet............... Total leaching area......26.7...sq. ft. Z Other Distribution box ( X) Dosing tank ( ) 9/ /-9 Percolation Test Results Performed byCaPe---COC�__$:ll�'y��__�Qx1S.]1lt,STI.tSDate........... ..2� -_.. .......... Test Pit No. 1...... ......minutes per inch Depth of Test Pit....2Z_........ Depth to ground water-----none.... a Test Pit No. 2..............'.minutes per inch Depth of Test Pit.................... Depth to ground water--,,- 'A OF, s 0 Description of SoilO•.0-0..4__wood..loam_ _..Q_._lk- _.0.._auhsnll_.____2.Q-....5 med.." o R611ai----.•-- _10 x sand. ..5.-12_.0---medt.._white_..sad -- ......Ervwic►c N W - - o B NhAi�t m . - c� f•F/kP x Nature of Repairs or Alterations,Answer when applicable_____________________f� t_Z...7----- __----__...._. --•-•----------•-----•----------•-•-•-----•--•--------------------•-•--•--...---------•-•--•- -•-----••----------- Agreement: ONAL ENG The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accor t i the provisions of TIT 2 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 board of health. Signed........ .....Y .. ................................. ��-D7r-7q v" Application Approved By-•-•------ ------•---- -------------•-----------••- Date Application Disapproved for the following reasons------------------------------------ -------------------•---------•-------------•----------------------=---:..... ........•-•••-•••-•-------...-••-------•-••-•-••---------------------•-••-•-•--•-------••------•----••-----•-••------------••-----------•---•------•-----------------------------...•----•----•--------- � Date Permit No. Issued... .................................................. Date r CPO N C> FEB '� THE COMMONWEALTH OF MASSACHUSETTS r BOARD OF HEALTH ----.....Town...................OF..........Barnstable---------------------------------------------- Aliptiration for Dh4poiial Works Tontrnrtion Frrutit Application is hereby made for a Permit to Construct ( X) or Repair ( ) an Individual Sewage Disposal System at:" ................ tgee may ••Ce�t�r�r#1le•..................•• --------------------------�,©$-•.}...-••-••----•-•-•-..._...-••--•••••---•----••-- Zoca ion-Ad Tess or Lot No. James K. Smith Barnstable ....•••••••••-•-••••-•-••...-•••-•--•••-•-••-•-•••••••-•-••--------•--•.......................... ....................••--••--•-•-----__.--_-_._........------...--_-__------__------...--------.--- %. Owner Address a ........................Y_etor-icm..Br_others.................................. --•................Harnszable....-••...-•----------.......--------••••••-••••••••-.. Installer Address dType of Building Size Lot...15.,00Q-------Sq. feet U Dwelling—No. of Bedrooms................. -_..-___---_•_---___.-__•Expansion Attic ( ) Garbage Grinder (nC# P4 Other—Type of Building ............................. No. of,,persons............................ Showers ( ) — Cafeteria ( ) PaOther fixtures ........................................- - -- . . . W Design Flow................5.5_..................___gallons per person per day. Total daily flow.............330......................gallons. 1:4 Septic Tank—Liquid capacity...10}®allons Length....814M Width..!. 0't Diameter________________ Depth.5 fast---- xDisposal Trel cli—No. --_•---------------- Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No.........},---------- Diameter--------1.0j .... Depth below inlet.......... !_..... Total leaching area.......2-67..sq. ft. z Other Distribution box\( V Dosing tank ( ) aPercolation Test Results Performed bye gp®-_ ---SLIrv4F--EonBt;Eltantgate...........5L/2${79_-----__. Test Pit No. I......_2.....minutes per inch Depth of Test Pit-----l?,,,-t------- Depth to ground water... ...... Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground wa �- AL.QF��s�9�� • --•--•---•-•---------•---•--.....-- •-•--•--•... .................................................................... •• ----........-- P 0-.,® 4 #s--Wood...l ,....0-4-..-2 0---e oil-,----2-,.4-,5--•tee � Description of Soil_ s . ° V ..................................g,3ndy....5-.-3-12--. 1---med.-•-�At�med.---white ....._ _ a.....-CR y --.-•---_---____________________________________________________ ________________________________________________ - U Nature of Repairs or Alterations—Answer when applicable________7_________f�1-�"7 ------------ .--•_ -----------------------------------•--------------------•-------------------------...............------•------------------------------------------- -------------------- sir©NA Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the''provisions of TITLZ 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 board of health. a Signed.................................•-------•-...............-----•-------•-••---•--•.... ................................ s�1 Dat :1. : ApplicationApproved By............... T-••,9�--�-----•---.......•---•...............•------......--••••-•-•------ P I Date Application Disapproved for the Rowing reasons:------•---------------------•---------------------------------•---------------------------------------••••-••--- ....-----•-•--•-••-•._......-•-------•--•-•-----•---•----•-•-•-•••---------••---•-------•-----••••--••-•-•-•--•--•••--•--••......--•---................................................................ PermitNo.......................•••-------•---.........._.------. Issued_....................................................... Date s THE COMMONWEALTH OF MASSACHUSETTS ' -BOARD OF HEALTH y .......Tov.n.......{...............OF........Bt M$t .b.1e.................................................. 0111rrtifiratr of Tontplianrr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed (X ) or Repaired ( ) by................... Vetorino Brothers .....-•-••-••-••••.............•----•-....._-••-•............................................................... Installer at.................... Lot i Ames:. ax...Cente;vi_141e ---------------------------------•--- has been installed in accordance with the provisions of T _ > of The State Sanitary Code as described in the application for Disposal Works Construction Permit NO __. -/_ __._ _ ...... dated------------------------------------------------ THE ISSUANCE OF THIS CERTIFICATE SHALL • BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE... -2�-de�..............•-----•----- --• Inspector....-- ;. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH 7 5I .......To ' ........................O OF .. b� 0......... ........ FEE Disposal 19orks CTonstrttrtion rprmit Permission is hereby granted------ C_70A.t. ........... .4.14.ci................................... .......................................... to Construct p� ) or Repair ( ) an Individual Sewage Disposal System at No. Lot- 1...-----•-----------•------------------------••---•---..._..M.01.M.AY,---Centervil-le..------•--•--------------------------....�:\. Street as shown on the application for Disposal Works Construction /Permit No..................... Dated.......................................... . ------------------------------------------------•-- C Board of Health DATE--...../.2-- ------ ..... /.................................... FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS LOCATION SEW �YPERM_ IT NO. VILLAGE INSTALLER'S NAME i ADDRESS BUILDER OR OWN R J DATE PERMIT ISSUED DATE COMPLIANCE ISSUED �� 3Q _ �_�., _ _ . �.� \ �' ' :. � i �� \ �� �y ��� � � � ��G i r � � /J 4_ r H � 1 R SOIL LOG E. PEASTONE•" ...LOAM FILL---' 12"MAX /( p I 9� N t4"C.ITli DIST. 1 j,�;;;•, ° ° , o I $c S;o r..r �. , 0 BOX I^.••• • 1000 GAL.• • • 1 -" A, 10 MIN. GAL. Ie:%': PRECAST OR , ° e�` 24" , ,+�G. qL r I••'jO • ° • I MIN LG ttJ SEPTIC 1,• ;�;. BLOCK TANK Sj 6' i '•;o.e . SEEPAGE o '•. : I "� a"©6 0�• • . 'a`od18o PIT go 20' MIN. � .000m -_ - - -- - -- °.....I p��J3r FOUNDATION I I I I /2 WASHED STONE"** I � wi4"3'&f . ELEVATION SKETCH 10' I 9 PERC. RATE= utivalz 2tu �r«iol• SCALE I = 4 TEST BY : G, F.W' 11 TOWN INSPECTOR' Pr t24t34P,r4`� BACKHOE OPERATOR;_ -- •a TEST MADE ON : q ZS 1 79 , 3 o . 'x'r,1r_.; war✓r L.>�:.tni'(,a ;?':.-,r'.o.:...>+J r��e:..•6?'�..cr.•,� f l -. Gs K� �7 c•7- ..7'f ,r 7?7'J .4�rL��g �7 c•Cz'..'l ' ,� �f:1'.�r•�.•�w✓'/'Y') �""J y./'•.s_/fi.► .F G:h,ir i f✓irs'j - �' '.�"��. +`- i+'a.wl f`.✓ �l— IC,.J'"f,.�•./�r��+��fin.�. OF MAS�,4�d �j JAMES `Y(l P_ No.22bq f O I C'ryle� r�J 97 - l S o• 0 " . 3 i qyr 3 Prr 1 m a° ` � . ! . too a, 67" 0Z , ov- 0 .. 3 73EU Ito 44t.. s�t3�.ui�i�Gs. /88 S, x 2.5 F;,P.,0,j S,F, _ ?�? I i �P AOFM e RENWICK 1 z B. v CHAPMAN c T � No 2765 o p�. �0 r14;� /ST e \�w • �SS10NAL frc: <+2/ 7 ELEVATION SCHEDULE PROPOSED SITE PLAN I. INV. AT FOUNDATION = all 4 3L INN SEWAGE SYSTEM DESIGN 2. INV: INTO SEPTIC TANK = i 3. INV. OUT OF SEPTIC TANK —�- 4. INV. INTO DISTRIBUTION . BOX = '� SCALE: I"= 40' C>C.- � 19-7 5. INV. OUT OF DISTRIBUTION BOX •_ C - *7 4(' -3 6. INV. INTO SEEPAGE PIT = a* ? CAPE COD SURVEY CONSULTANTS ROUTE 132 7. BOTTOM OF PIT = HY.ANNIS ,MASS. I r MA i -i�,ntal Code Title V and Town of&4 TF 1w. ) The insta;iaon shall ownply with tile SLate Eovirrinp PARCEL Board of Health REg(jt43t,;0llS- ^c 1 -.1 q.. p 2) TiThv sept;c. systeill 35 proposed on this olan shall not be installed until a licensed town installer I'D,,' N F. 11 t__�_D i receive, approval ;nd �in installation permit from the aopkable town. (S--MJ l.. T�L CX1 D PPI,A It6elE_ 61 kR S-r E P F N-P -if C;A`E_ 3) Prlot tolstal;a�ion,th,,Insraer sall verify tF c)caticr ot utilities, sewerI:t-vers, sewe r lines ailej eXiSTing sept c components prior to Installation. feet ou' of 4) Ali gravity scwp- at 1 W' per foot. The first I)Iping,;s to be 4 inch SLhedt,41�� 40 PV� 7�L .A. 'IT 00 U-. '; thr- CliStl ibUtiOrl hox Shrill be level. All Piping connections to be glued. 6 ------- 5) Ti,;i,,, sepir,de5ign ular,is not to be utili?,-il for propertylins?determination cir for any othF�-' .0 14 Pt'•*Pose oths!t th;-.1 the proposed septic _ysterri instal Idtion. Ali TI-de V ,.-ompor.ents are to meet Title V soecificaflons. .7.1 Pc kirip, shall he prohibited over Title V c.(_­r-,:­orients kinles'.in*-ripooents are 1­1201 ioaded. 8) The existing leaching, �-r Cesspools shall be r.,�o'nfNd and filled with •material per"ritie V ab*�,t%.ciaiirreritpi-,-,cedi,.i?s Leachin� ardctp'ssp the ";ol(s) and cotitarninated soils within Zi- proposed SAS sh ml! be rern,�)vecl and replaced with clean sand per Title V 9) Septic rnmpa.rientE at.,co be 10' frurn a water service line. Sewer lines crossing a wasp( -J, > bt- 5leevf-dwith ariapplioPriateiy sized schedule 40 PVC with ends grouten. TI-P water servic- Um, or t`w ran ne slfeved with the sleeve being a distance of 1 bo+- sid--2 is Vussing t)e lille. A10 0--AY.,rl4re 11 1 1:)'/ If agarbage gi i.,ider exists In the structure, it is to tar. ernoved if the septic system is not de&signed to ac.ozilmodate a garbage grinder, j I The instafloi it re�,pcinsible for carp of excavation around all itilitles on the property and" �7��, ~ _ _r E protect.ing,the structural integrity of all structures during the installation process of liese.1-1 i- system. '11.2) This plan only represents that a septic systern can be installo.d an the property -rleez;ng Title reqUirernerts, GAi.O`DAY.�BEDPOOM 41-1 /11)AY 15 0.00 lb R f't 11w T I The. property' owner�!hal! review desigi,, criteria to appravp tk total number of bedrooms and design flow, Installation of the septic system as proposed and receipt of paw-rent for the de iF -ope shad be deemed approval of isle design Criteria by the pi rtycomer oragentof. 0 this plan st all expire with the expiration of the town installation permit issue(. f(;i 14) Tile validity of t thi, plan or the validity of this plan shall expire onthe expiration of the Certificate ofCamplianc , 10 :H r AN K LF,)U"-?-n issued for vie iostallat �:i%of the propus�:a sysTern rn .,-his pkwi. Cq C14 ... ... ..... �A! \Vt OF L DAV ID '9Ln C r r , / ARcA MASON cm " ' No.1066 T 7 tK IAJ Err=;- v4 7 P F�q 31.5 13 A L. 5� ;i i N 01- 77 ID A N E W 1_ N; T­ DATE. 8 MAS 0 ENV 1 R0NME-"NYx_ DESIGNS HEALTHAGEN' �2_57`5,77