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HomeMy WebLinkAbout0096 CAMP OPECHEE ROAD - Health 96 Camp Opechee Rd . . Centerville A = 210-140 a f C *PondaflOY"' 0ESe% 1521/3 ORA 10% P2 .�...•.. :,;,etiN�� ,w.ms:,:i� ,_.w,: "---`--•, .. .. a 00 No. w� Fee V THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes 01pplitation for OisposaY *pstrm ConstCULtion Permit Application for a Permit to Construct Repair( ) Upgrade( ) Abandon( ) Vomplete System ❑Individual Components Location Address or Lot No. 9,C mil✓)P o P�cff�� Ac,10 Owner's Nam , dress,and Tel.No. ARC 1 OoLGoF-� Assessor'sMap/Parcel Cc_ � V. � p 1 bdCC weS`T" Installer's Name A&;jress,,and Tel.No. Designer's Name,Address,and Tel.No., `I, -roiaj &9 o i aCo3 s�T 1� /cI c So , A Type of Building: Dwelling No.of Bedrooms Lot Size ��,�/�j sq.ft. Garbage Grinder C"k? Other Type of Building (��c,n��c� No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided 3 So2 gpd Plan Date EF13 SZ-5 &/8 Number of sheets Revision Date Title Size of Septic Tank /So a C,-,q—� Type of S.A.S. a —Soo G„¢ L Le yG G [c,4(j jt�c/s— Description of Soil b —�? — L/.S� —02'� L S — c7:2✓ /aZo 'C GA-A o c)-rW p) X as''k, Nature of Repairs or Alterations(Answer when applicable) (t — /moo 6*L �S 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. Signe Al I 1AA.A66 Date ,3 — P o� Application Approved by Date Application Disapproved by Date for the following reasons Permit No. fly Date Issued iI �D l ot/ _ No: � Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: YesV PUBLIC'HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Zipplication for Disposal 6pstem Construction permit Application for a Permit to Construct Repair( ) Upgrade(. ) Abandon( ) ds`Complete System ❑Individual Components Location Address or Lot No. y Cr9s�l>� a P kr/`f, _ ��; Owner's Name,Address,and Tel.No. Assessor's Ma /Parcel C 'irl E y1��A A i / p n <Fif Installer's Name,Address,and Tel.No. 5�� ,r -N; ky+fl Designer's Name,Address,and Tel.No. 10 J Is- 4 J� rsc c. a ✓ v 5'-E��T/ 9 r/ C, "') e i,.-V /J, i r R� a t=T t r l`"�i� '7- Type of Building: Dwelling No.of Bedrooms Lot Size / � f1J, sq.ft. Garbage Grinder(tA) Other Type of Building r ,Al,01-X, .. No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided ,' gpd Plan Date {� /� /rQ Number of sheets Revision Date Title Size of Septic Tank 1 s r r J Type of S.A.S. _9 _5 _. j '"f r,,,� t, r j • l�-.. Description of Soil �, , +�' ✓' - , ' Z S' - .. r / � r t 9<< �",i X x.S-1e Nature of Repairs or Alterations(Answer when applicable) 4'b 7>/•r A, � Yi s l�.^y ..'7 `ti rrl 1',�.r..i) �F, 6 C i„ .�- l^h'I( r M e ...-} �.� �Y�� a _ ,�,t��• �1 r t Date last inspected: - Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. , Signed . a.t Date ._ -^ P--- P2 .1 Application Approved by Date ? h Application Disapproved by r Date for-the following reasons � x �a --� ' Permit No. Date Issued � ,R r i ---------------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired( ) Upgraded(V)" Abandoned( )by 6,t^+ .- at (`,�,, n C r- 4 A- has been constructed in accordance with the provisions of Title(Sand the for Disposal System Construction Permit No ;/ ^^G`�� dated Installer �_+.C`- I+C Designer e-s,,!-4 s A$;t - #bedrooms Approved design flow g 3,�i gpd The issuance of this permit shall not .e construed as a guarantee that the system twill fun •c"tio as designed. Date 7 xl/R Inspector - -------- - - --- ----------- - - - ---.,_ _.. _ No. %7� I (� d a Fee A20. t P C7 THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION -BARNSTABLE,MASSACHUSETTS Disposal Opstem Construction jermit Permission is hereby granted to Construct Repair( ) Upgrade( ).-r Abandon( ) System located at q C li r n Ltti��" /'r ,, «t c•l ✓",r= , a 17 i=61 tit 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:Construction must be completed within three years of the date of this permit. Date A-// Approved'by f Town of Barnstable Regulatory Services Thomas F. Geiler,Director > M Public Health Division ►�� Thomas McKean,Director 200 Main Street, Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Date: 3 — -/P Sewage Permit# 4 cJp— o i" Assessor's Map/Parcel 21691,1 Installer& Designer Certification Form Designer: Installer• r/R''�A) k'pfcr-� � �— Address: 713 Address: ���^� �'�''"� AV'p. On ��r�� `-�sf�"`� was issued a permit to install a (date) (installer) septic system at �-'1 ��`� ���v�� based on a design drawn by (address) e'�.,Js�Tjc..2 CfarK,�dG dated ��� 23�Zd 1g. (designer) y I certifythat the septic stem referenced above was in p y stalled substantially according to the design, which may include minor approved changes such as lateral relocation of the distribution 'box and/or septic tank. Stripout (if required) was inspected and the soils were found satisfactory. I certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system) but in accordance with State &Local Regulations. Plan revision or certified as-built by designer to follow. Stripout(if required) was inspected and the soils were found satisfactory. 4�N eF M TERENCE � (Installer' a re HAYES - _ ho. 9.79 C.. �FG1 (Designer's igna e) (Affix DesigrreM amp 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 form.doc TOWN OF BARNSTABLE LOCATION q�'�Ju p `F� �iorg g SEWAGE# o/8-o rg VILLAGE � �/�of//r- ASSESSOR'S MAP&PARCEL a/0 INSTALLER'S NAME&PHONE NO. 8,Q a)0, ss�N1G s'OP- SEPTIC TANK CAPACITY /Soo 13'x as,`xa.' LEACHING FACILITY:(type) (�prJ ���G Lq �s (size) NO.OF BEDROOMS 3 OWNER 19 Rr#J IR OnLa o F.e Q PERMIT DATE: _ - /8 COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet rivate Water Supply ell 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 1 -ro G GO I C,91AAP o tc �"E oAO TOWN OF BARNSTABLE LOCATION SEWAGE # VILLAGE r' ✓Y7`'�.c'iJa//`� ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY: (type) (size) NO.-OF BEDROOMS— BUILDER OR OWNER PERMTTDATE: 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 V �����a F f!�r�/S% �,. �q- �� ' � �� 14 � �. Town of Barnstable P# Department of Regulatory Services Public Health.Division Date f t61q. � 200 Main Street,Hyannis MA 02601 =I„� !77 - 4!V Date Scheduled AR)/e- Time / Fee Pd. r� SoiltS�itability Assessment for Sew a Disposal rr �t//c.co Performed By: � Witnessed By: LOCATION&`=GENERAL INFORMATION Location Address % Owner's Name Oae�QQ e� 7't ' led Address 96 ea vu v�Qt�J�,m`Je L D 1 Assessor's Map/Parcel: a 1�0 fv y U Engineer's Name`, "7e% /'�C4 y of te,�,,79 NEW CONSTRUCTION /REPAIR Telephone# 38 s Land Use ° !��t�.rn Slopes(%) 2— '" Surface Stones �f Distances from: Open Water Body ft Possible Wet Area ^ ft Drinking Water Well �- It Drainage Way ft Property Line ft Other ft SKETCH:(Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands in proximity to holes) ---------------- 2LI J' a C�1 �d k Pr ec s �Z 1�t718' 3 Parent material(geologic) D'�/ � N Depth to Bedrock �J r Depth to Groundwater: Standing Water in Hole: `� Weeping from Pit Face Estimated Seasonal High Groundwater 7/S DETERMINATION FOR SEASONAL HIGH WATER TABLE Method Used: lO Q�ea4'r7'0 Depth Observed standing in Zs-.hole: in. Depth to soil mottles: in. Depth to weeping from side of obs.hole: in. Groundwater Adjustment ft. Index Well# Reading Date: Index Well level Adj.factor Adj.Groundwater Level_ PERCOLATION TEST Date 23 Ime Observation r Hole# Time at 9" Depth of Perc Time at 6" Start Pre-soak Time @ 0 Time(9"-6'1 End Pre-soak Rate Min./Inch Z 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:\SEPTIC\PERCFORM.DOC 1 . � 0,7 ? 7 Z 7_ /� G 2lo , / y COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS`' , ;,F t l d DEPARTMENT OF ENVIRONMENTAL PROTE•CTZ�N 9: 1,2 M t /jsro TITLE 5 �a S1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: Cite A _C' 300 Owner's Name: Owner's Add ress: Cr (e Date of Inspection: �S--, - Name of Inspector:(please print)&^n r o dybff Dthy►IASrTcQ Company Name: ;QtJlrrr xisCe' T- Mailing Address: 5-6 y O t D 5T Telephone Number: 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 15340 of Title 5(310 CMR 15.000). The system: (/Passes Conditionally Passes Needs Further Evaluation by the Local Approving Authority Fails Inspector's Signature: 0Date: 6-4,3 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 to the 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 page 1 7 ' Page 2 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: au r_-eWr-rr&1V/4;2 , /P A Owner: -ff-05hvA- Lf-VW*kzd Date of Inspection: S"—; .per S�— Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: 1 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: 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 a 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 Page 3 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBS URFACE SEWAGE DISPOSA L SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: qG C,401/° Owner: a,4 Date of Inspection: C. Further Evaluation is Required by the Board of Health: 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(1)(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 a 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 1 of a 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 **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 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: Owner: �e s h ys�. Go.✓s�2�/ Date of Inspection: D. System Failure Criteria applicable to all systems: You must indicate"yes"or"no"to each of the following for all inspections: Yes No kup of sewage into facility or system component due to overloaded or clogged SAS or cesspool Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool DBoX Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or esspool Liquid depth in cesspool is less than 6"below invert or available volume is less than''/z day flow equired pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number of times pumped kAny portion of the SAS,cesspool or privy is below high ground water elevation. —iZAny portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. _✓Any portion of a cesspool or privy is within a Zone 1 of a public well. -,,---Any portion of a cesspool or privy is within 50 feet of a private water supply well. _ 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 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.] ht b (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: To be considered a large system the system must serve 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 Ua 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 _ �Q( the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area—IWPA)or a mapped Zone lI 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 has 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: 4te Owner: TesLivs¢ l—F / � Date of Inspection: �yaL —o.5— Check if the following have been done.You must indicate"yes"or"no"as to each of the following: Yes No v**" /Pumping information was provided by the owner,occupant,or Board of Health V Were any of the system components pumped out in the previous two weeks? Has the system received normal flows in the previous two week period? _ "-Have large volumes of water been introduced to the system recently or as part of this inspection? l f Were as built plans of the system obtained and examined?(If they were not available note as N/A) V _ Was the facility or dwelling inspected for signs of;sewage back up? Was the site inspected for signs of break out? Were all system components,excluding the SAS,located on site? 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? 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$oil Absorption System(SAS)on the site has been determined based on: Vi so'g- .:N mr-4ti io v Yes no Existing information.For example,.a plan at the Board of Health. Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable)[310 CMR 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:a Gg' .m P Ole -e Al, C`.FeNf eowte ,s F Owner: U-0 5 h vA «aa/ W-d Date of Inspection: j 1&0 s­ FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): 2— Number of bedrooms(actual): DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): Number of current residents: Does residence have a garbage grinder(yes or no): Is laundry on a separate sewage system(yes or no): to (if yes separate inspection required] Laundry system inspected(yes or no):T Seasonal use:(yes or no):_b1q Water meter readings,if available(last 2 years usage(gpd)): W k OOU In a003 1- q 1000 Sump pump(yes or no):—MU Last date of occupancy:_ N oyj o cwr i e COMMERCIAL/INDUSTRIAL Type of establishment: NA Design flow(based on 310 CMR 15.203): avd Basis of design flow(seats/persons/sqf,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): N GENERAL INFORMATION Pumping Records Source of information: N eN a 4 Da r('¢b L e Was system pumped as part of the inspection(yes or no):_Y!tS If yes,volume pumped:I..Wgallons--How was quantity-pumped determined? FS7-1,6 P-f_ Reason for pumping: _eyna Agw+- _e,e � J4­ TYPE OF SYSTEM Septic tank,distribution box,soil absorption system Single cesspools 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 a copy of the DEP approval Other(describe): Approximate age of all components,date installed(if known)and source of information: Al0 T frNOWAI lYd ;r:/V X-'fJ t/A fl.4,QL� Were sewage odors detected when arriving at the site(yes or no):Al Title 5 Inspection Form 6/15/2000 6 Page 7 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: a..jp 00�� oepl C NriPo4 o%/Lr -m.9 ' Owner: d 0 S�7✓ L F�algeco�— Date of Inspection: ?,-D 5- BUILDING SEWER(locate on site plan) Depth below grade: Materials of construction: cast iron _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 on site plan) Depth below grade: Material of construction:_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: Sludge depth: Distance from top of sludge to bottom of outlet tee or baffle: 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: How were dimensions determined: Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): GREASE TRAP:_(locate on site plan) 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 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: Owner: VA- LrS apy ARV V Date of Inspection: TIGHT or HOLDING TANK /' (tank must be pumped at time of inspection)(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:No (if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: 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.): PUMP CHAMBER: (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 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued] Property Address: C.�--,p D4eclf-e e Owner: c70s L1 Jr4- L Eyn/ t Date of inspection: SOIL ABSORPTION SYSTEM(SAS): (locate on site plan,excavation not required) If SAS not located explain why: Type leaching pits,number: leaching chambers,number: leaching galleries;number: leaching trenches,number,length: leaching fields,number,dimensions: overflow cesspool,number: 3 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.): CESSPOOLS: (cesspool must be pumped as part of inspection)(locate on site plan) . Number and configuration: 3 ri'f!EQ1 iN SER��S Depth—top of liquid to inlet invert: ;L(< Depth of solids layer: T- Depth of scum layer: 3,97 Dimensions of cesspool: -4&-4d)c —��^�8. Materials of construction: Cd A CAr T— R LOC4 Indication of groundwater inflow(yes or no): /to Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): GT�rr C,-'sS drie/ .�Cyin/C, p5 T.9r�I.0 wee So/i'� c /UE�T .2 SS�ao/5 PRIVY: (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 10 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 1(e C,4,91P ('ENrE2rJI// Owner: sT�S ll y� L�dNs�e Date of Inspection: 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. 1 ftu)i �� IfodSF � I yA Title 5 Inspection Form 6/15/2000 10 Page 11 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: Ite W DP dnl_ fz ✓i,//r ,I A9 Owner: Josh,dJg- Lr_et1AeeK Date of Inspection: . —0 S' SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water I S 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: Observed site(abutting property/observation hole within 150 feet of SAS) Checked with local Board of Health-explain: Checked with local excavators,installers-(attach documentation) Accessed USGS database-explain: You must describe how you established the high ground water elevation: 41/ M17 GLIA17 ✓a 3O -t- a F u ✓S? snrr ,09L-i l� l To W.4T�2 Title 5 Inspection Form 6/15/2000 11 4w �,-m-r Town of Barnstable Health Inspector pEtwe tp� Office Hours Regulatory Services 8:30—9:30 Thomas F. Geiler,Director 1:00—2:00 aniwsr"LE, 9� ' Public Health Division QED �a Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 AMNESTY PROGRAM APPLICANT— SEPTIC QUESTIONNAIRE 1. General Information: Size of Property: Address: ;&vA- Map .ParcelA_ Name: Phone #: Q 2a. How many bedrooms exist at your property now? 2b. Are you planning to add any bedrooms? �� If yes,how many? 2c. How many bedrooms total are proposed at this property (including the amnesty unit)?� 2d. Please include a copy of the floor plans for the entire property - showing the existing rooms in the home plus the proposed amnesty apartment and/or addition. Please label . each room clearly on the plans. 3. Is the dwelling connected to public sewer? YES or ( NOD If the dwelling is connected to pu„blic sewer,skip questions#4 through#9 below;, 4. Location of dwelling is INSIDE or OUTSIDE a Zone of Contribution to public supply wells? 5. Is the dwelling connected to an ONSITE WELL or to PUBLIC WATER? 6. Is a disposal works construction permit on file? YES or NO r 6a. If yes,how many bedrooms were approved according to this permit? Bedrooms. 7. Were any building permits obtained for construction of additional bedrooms? YES or NO .8. Is there an engineered septic system plan on file at the Health Division? YES or NO 9: Ha a septic system been inspected by a DEP certified inspector within the last two years? YES or NO ------- -- ------------------------------------------------------------------------------------------------------ i FOR OFFICE USE ONLY N17 c ublic Health Division has no objection to bedrooms at this property. Special Conditions: � Signed: Date: �S O;/health1wpf les/amnestyapp R �F� � . /� ✓,�5 J raw, t� �� �� ,�� C4r � a ti McKean, Thomas From: McKean, Thomas Sent: Friday, April 15, 2005 12:01 PM To: Dillen, Elizabeth Subject: Septic Questionnaires/ New Amnesty Applications 20 Lantern Lane/Applicant-Eric Hubler This application is approved. The dwelling is connected to public sewer. 55 Blueberry Hill Road/Applicant-Faythe Collins-Azevedo This application is disapproved. The dwelling is limited to 5 bedrooms per the 1999 permit#99-501. Six bedrooms would violate 310 CMR 15.214, State Environmental Code, Title 5. 96 Camp Opechee Road/Applicant-Joshua Leonard We do not have any septic system records on file for this address. Please require the applicant to hire a certified septic inspector to fill-out a 16 page septic system inspection report. 1 McKean, Thomas From: McKean, Thomas Sent: Friday, June 10, 2005 9:43 AM To: Dillen, Elizabeth Subject: 96 Camp Opechee Road/Joshua Leonard Hi Elizabeth, This application is approved for three bedrooms. The septic questionnaire form will be FAXED to you today. 1 pus--- Town of Barnstable Health Inspector of Tory Office Hours Regulatory Services 8:30—9:30 • Thomas F.Geiler,Director 1:00-2:00 BARN TABLE, ]Public Health Division Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 COPY Office: 508=862-4644 Fax: 508-790-6304 AMNESTY PROGRAM APPLICANT- SEPTIC QUESTIONNAIRE 1. General Information: Size of Property: Address: Map 12 l•u Parcel Name: 671V &AId- Phone #: - &, 2a. How many bedrooms exist at your property now? _"Y 2b. Are you planning to add any bedrooms? If yes, how many? 2c. How many bedrooms total are proposed at this property(including the amnesty unit)?� 2d. Please include a copy of the floor plans for the entire property- showing the existing rooms in the home plus the proposed amnesty apartment and/or addition. Please label . each room clearly on the plans. 3. Is the dwelling connected to public sewer? YES or ( NOD I£ iexdwe3ling s.....ted t©public server` ship questions#4 2 rough #9 belouv 4. Location of dwelling is INSIDE or OUTSIDE a Zone of Contribution to public supply wells? 5. Is the dwelling connected to an ONSITE WELL or to PUBLIC WATER? 6. Is a disposal works construction permit on file? YES or NO 6a. If yes;how many bedrooms were approved according to this permit? Bedrooms. 7. Were any building permits obtained for construction of additional bedrooms? YES or NO .8. Is there an engineered septic system plan on file at the Health Division? YES or NO 9. Has the septic system been inspected by a DEP certified inspector within the last two years? YES or NO FOR OFFICE USE ONLY The Public Health Division has no objection to bedrooms at this property. Special Conditions: Signed: Date: Q;/health/wpfzles/amnestyapp f r, s L�I `1 f I Coe . O S you Q 5 �Y I. Y /YJ 1 1l s 0 8UIC SOIL TEST � TOP OF FOUNDATION 20 FT. MINIMUM FROM CELLAR OR CRAWL. SPACE DATE OF SOIL TEST FEBR ELEV. � 1��_ 10 FT. MINIMUM 10 FT MINIMUM FROM SLAB UARY 23, 2Q!8 CLEAN SAND SOIL TEST DONE BY j ETSLR €NGiNEE_RiNG (ASSUMED) WITNESSED BY > �5 CONCRETE INSPECTION PORT COVERS 4" SCHEDULE 40 PVC PIPE -LOAM AND SEED � MIN. PITCH ?/8" PER FT. 2" .>YER OF OBSERVATION HOLE 1 ELEV.=-_-- - \ 1/8" TO 1/2" PERCOLATION RATE __;__2__ MIN./INCH AT 48 INCHES r \ \ WASHED STONE 95.55 MAX. OR FILTER FABRIC VENT DEPTH HORIZ1. TEXTURE COLOR MOTT. jOTHER 24' 4" CAST IRON PIPE 0.30 MIN. NOT REQUIRED 0-7" Ap !LOAMY SAND 10YR4/1 INO ROOTS (OR EQUAL) MINIMUM PITCH 1/4" PER FT. j LEVEL FLOW 1 , TEE ? 7-27" B GLOAMY SAND 10YR6/8 i ROOTS I 92 55 Ii 127-120" �C MEDIUM SAND 2.5Y7/4 15% GRAVELS FLOW LINE rn' ELEV. _ _98.OU 10" NO WATER ENCOUNTERED AT __120- ELEV. = _ 84.8 ._ MIN 2 o ° � uu ❑ ❑ O ❑ ❑ ❑ ❑ C OBSERVATION --- J ELEV. _ _950-0- LEVOEL� ° ° ❑ ❑ ❑ C ❑ ❑ ❑ ❑ ❑ ❑ Cl o ° ELEV.=-_94.$- ELEV. _ _8 GAS ELEV. _ _� �1�J 6" SUMP ELEV. = _93_.t�0_ ° ! DEPTH HbRIZ i �C -��^ BAFFLE ° ° ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ u 2 10 TEXTURE 'COLOR MOTT. (OTHER 0 0 0 ° 0 0-7" A LOAM. SAND 10YR4 NO ROOT DISTRIBUTION ELE'�Y = ° , ❑ ❑ ❑ ❑ ❑ ❑ ❑ o12mc i ° I p I Y �1 I i DEP LIQUID OUTLET I I TEE BOX ���_ o o �jo ° ° o EL�= �19.a0- 7-27" IS ILOAMY SAND 12.5Y7 10YR6/8 ROOTS (TO BE PLACED ON FIRM BASES i7 2 500 GALLON GALLEYS WITH ! 27-120" C iMEDIUM SAND /4 ?5% GRAVELS 4 FEET 14 INCHES TO BE WATER TESTED i 5 FEET 19 INCHES I IF MORE THAN ONE OUTLET STONE IN AN ^ 1 7 FEET 29 INCHES c y GAL .C}N (TO BE PLACED ON FIRM BASE) 13' X 25' X 2' TRENCH FORMATION I z WELL N A No WATER ENCOUNTERED AT t?� ELEV. _ _ e4•e _ 8 FEET 34 INCHES SEPTIC TAN K ZONE 3/4" TO 1 1/2" CLEAN SOIL ABSORPTION �� INDEX n� ! �y��+ DOUBLE WASHED STONE DESIGN CALCULATIONS FREE OF FINES & SILT `�C'�� AQJUST QD NUMBER OF BEDROOMS _ 3 _ (SAS) GARBAGE DISPOSAL UNIT SEWAGE DISPOSAL c 't'c USGS PROBABLE WATER TilBLE ELEV. = ______ TOTAL ES7MATELD FLOW SEWAGE SYSTEM PROFILE OBSERVED WATER TABLE ( / / } ELEV. = ------ ( 110 GAL.fbR./0AY X 1 . FAR.) : - GAL.JDAY NOT TO SCALE BOTTOM OF TEST HOLE ELEV. = _�}� _ REQUIRED SEPTIC TANK CAPA' $¢Q__ GAL. ACTUAL SIZE OF SEPTIC TANK _1NQ GAL. 1 SOIL CLASSIFICATION H FM DESIGN PERCOLATION RATE MIN.JIN. EFFLUENT LOADING RATE 0„74_ GAL./DAY/S.F. LEACHING AREA 47 _...' "�'s.00 SQ. FT N (13X25)+(3&X=) I Xi LEACHING CAPAO 11, (AREA X RATE' 35241 GAL./DAY 9 477.00 X 0.74 RESERVE LEACHING CAPACITY Aft, GAL./DAY � NITA�it NOTES: 1. ALL WORKMANSHIP AND MATERIALS SHALL CONFORM TO D-E.P, TITLE 5 AND THE TOWN'S RULES AND REGULATIONS FOR j r� 9 .49 THE SUBSURFACE DISPOSAL OF SEWAGE i i 2. ALL COVERS TO SANITARY UNITS SHALL BE BROUGHT TO i WIT SHED GRADE. 1 ALL HICOMPONENTS i OF THE SANITARY SYSTEM SHALT. BE CAPABLE OF 1 ASo.54' 99.39 WITHSTANDING H-10 LOADING UNLESS THEY ARE UNDER OR WITHIN 95.2,2- 10 FT. OF DRIVES OR PARKING AREAS. H-20 LOADING SHALL BE USED UNDER OR WITHIN 10 FT. OF DRIVES OR PARKING AREAS. 4. ANY MASONARY UNITS USED TO BRING COVERS TO GRADE SHALL �37,98 BE MORTARED IN PLACE. I 94,46. 5. NO QETERMINATION HAS BEEN MADE AS TO COMPLIANCE WITH I `;? r DEEDED OR ZONING REGULATIONS, OWNER / APPLICANT IS TO I '0 f /1 r. O � :,3 Alty .�vC-H :3z.TE?MtNA.'"iON FROM 4.PPi�L'r RtA=E -94,23 p i r 6. UTILITIES SHOWN ARE 'APPROXIMATE ONLY, EXCAVATION CONTRACTOR D. IS To CALL "DIG-SAFE" AT 1-888-344-7233 AT LEAST 72 HOURS ' TESTL 2` / /BOx �(N of f�'A� PRIOR TO'COMMENCING WORK ON SITE. $2 1 TE�T �/ p / 100.00 '''" �` sq� 7. CONTRACTOR ,S TO VERIFY GRADES AND ELEVATIONS AS WELL AS j 1 �7 �p RO I J SITE CONDITIONS PRIOR TO COMMENCING WORK ON SITE. ANY VARIATION f ;�I g ; 5 O77 WILLIA IS TO BE BROUGHT TO THE ATTENTION OF THE DESIGN ENGINEER I W!L u' IMMEDIATELY. ,V 0 95.13 1500 GALLON ► ,15 1 1 8. PARCEL IS IN FLOOD ZONE SEPTIC TANK LOT AREA 9. LOT IS SHOWN ON ASSESSORS MAP Y210 _ AS PARCEL p i iST 97.33 # 93 18,718.3 S.F.5; 41 t F P��� 10. EXISTING CESSPOOLS ARE TO BE PUMPED BACKFILLED UNLESS THEY �'�.. =� � t e E 5 tph� s/o AL LAB'DSJ ARE IN THE NEW SOIL ABSORPTION SYSTEM, IF INSIDE ;HEY ARE TO BE 95.14tREMOVED ALONG WITH ANY POLLUTED SOILS ENCOUNTERED. ---�'--- `--_.__ / '�_,•,`_'�'� ^." � 99.51 11. THE INSTALLER i5 TO GIVE THE ENGINEER A M1NiMUM OF 48 HOURS I x 94 90 03 96.93 (2 WORKING DAYS) NOTICE FOR THE FINAL INSPECTION (NUMBER BELOW), 94.50 94.27 � 94. 1 i "�• 99.07 I i 100,40 APPRO D: DAD 0I HEALTH 7r.s7' DATE AGENT BAR-1-TABILE, MASS. PROPOSED E8 SEPTICI3E I 'N i FOR CENTER'VILLE � ( ARTHUR DJOTUGIO ff I 1 I Lac. 96 CAMP OPE HIEE ]ROAD B. S"TABL , MASS. I GREAT MA R , 'wa SH 205 SETUCKET ROAD i Qv 508- 0. BOX 7' z I LEGEND: �&; Looc J "►' `� , .•� i so�ITI� D£NNIS, nAss. ., Qd � Q 13�s5._69J4 a U2660 � EXISTING SPOT ELEVATION 0010 p; DATE SCALE �__ EXISTING CONTOUR ----oo---- F -� FINAL SPOT ELEVATION ( � Ft ZU f I = U } FINAL CONTOUR SOIL TEST LOCATION � I UTILITY POLE -_o- ' r REV. i Jam E Nu- 98 4-00 TOWN WATER -`N l �3 CATCH BASIN `im; "....� �- GAS _iNE - �_ __. CLEAN OUT c ��-- LOCATION MAC � � REV, � ��t sT 0F 1� f CESSPOOL C P. Q _ -__- ___ C. S8 PROD T.984-00 aw '9?4-S S.DKC 0 2018 SNEETSEP ENGINEERING