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0278 CAP'N LIJAH'S ROAD - Health
278 Captain Lijah's Way Centerville A= 193 — 112 5 M EAD® No.2-453LOR UPC IM emend com • Made In USA f Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal) System Form - Not for Voluntary Assessments Property Address eor SAW014jh _ Owner Owner's Name ll / 7 ll information is required for every _ page. CityTrown State Zip Code Date oMnspection Y Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:out forms A. General Information filling out forms on the computer, use only the tab 1. Inspector: key to move your cursor not return /'la key.use the return Name of Inspector E7,(/j/10 %L 6-H _ Company Name Company Address ����a oa 6i'.2- Cityrrowm State Zip Code Telephone Number License Number B. Certification 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 16.000). The system: Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority _/ JInspect s Date 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. ****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. I I ` 15ins•11/10 Title 5 Official lmwction Form:Subsurface Se e I System•Page 1 of 17 r r I , Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments Rd Property Address Owner Owner's Name information 5 (••—/ ePl B2 6�� 9 required for every _�� page. CityfTown State Zip Code Dat of Ins ection B. Certification (cunt.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System es: 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: 13) 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. Check the box for"yes", "no" or"not determined" (Y, N, ND')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. ❑ Y ❑ N ❑ ND(Explain below): t5ins•11/10 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 2 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments /� �' v► Lam.I A Property Address S U YYL a h Owner Owner's Name information is required for every e'^ T��//-e //'✓� Da 3� / page. City/Town State Zip Code Date of I pecti n B. Certification (cunt.) B) System Conditionally Passes(cont.): ❑ 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 ❑ Y ❑ N ❑ ND(Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below).- distribution box is leveled or replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ 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 ❑ Y ❑ N ❑ ND(Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below): 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 t5ins•11/10 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 61�= kl L I a �s Property Address Owner Owner's Name /� information is L �/ / l required for every .�✓� 7'�✓V� � r / ro, - page. City/Town State Zip Code Date Of Inspeltion B. Certification (cunt.) 2. System will fall 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 fecal coliform bacteria indicates absent 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: D) System Failure Criteria Applicable to All Systems: You must indicate "Yes" or"No"to each of the following for all inspections: Yes No ❑ Backup 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 ❑ Static liquid level in the distribution box above outlet invert due to an overloaded IJVJ or clogged SAS or cesspool El Liquid depth in cesspool is less than 6" below invert or available volume is less ;,--�'than '/2 day flow t5ins•11/10 Title 5 official Inspection Forth:Subsurface Sewege Disposal System•Page 4 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments Property Address UN1,::z1-7 _ Owner Owner's Name �/� information is required for every l�4 re Ile1/'"/7 Qd L Q 0 z page. City/Town State Zip Code Date of Insp ion B. Certification (cont.) Yes No ❑ 2/1'� Required pumping more than 4 times in the last year NOT due to clogged or / obstructed pipe(s). Number of times pumped: El2 Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ �/ Any 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 fecal coliform bacteria indicates absent 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 and chain of custody must be attached to this form.] ❑ E�r The system is a cesspool serving a facility with a design flow of 2000gpd- / 10,000gpd. ❑ ,1 / 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. For large systems, you must indicate either"yes" or"no"to each of the following, in addition to the questions in Section D. 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 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 CM 15.304. The system owner should contact the appropriate regional office of the Department. t5ins•11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Pape 5 of 17 Commonwealth of Massachusetts 'M Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments a c- o Z; ,--Property Address — Owner Owners Name information is required for every 6C, ✓` /, y/ ao? page. Cityfrown State Zip Code Date Insp ion C. Checklist Check if the following have been done. You must indicate"yes" or"no" as to each of the following: Yes No ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ �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? Were as built plans of the system obtained and examined?(If they were not available note as N/A) 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? E ❑ 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 Soil Absorption System(SAS)on the site has been determined based on: LY ❑ 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(5)] D. System Information Residential Flow Conditions: Number of bedrooms (design): Number of bedrooms (actual).- actual : DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): 1/0 t5ins•t 1/10 Title 5 Official Ins pection Form:Subsurface Sewage Dispose)System•Page 6 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments 7 L s �� Property Address �V41A Owner Owners Name / information is 71�.. Q�63� required for every � �//I G / �/L j page. Cityfrown State Zip Code Date o Ins pe ion D. System Information Description: /Ooo / w0 Sao 3.35 5xx Number of current residents: Does residence have a garbage grinder? ❑ Yes P"N'o Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes a--�N o Laundry system inspected? ❑ Yes No Seasonal use? ❑ Yes qlo Water meter readings, if available(last 2 years usage (gpd)): Detail: Sump pump? El Yes ❑� Last date of occupancy: `/'`'C4✓✓'-eiti Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow (based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow (seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins•11/10 Idle 5 Official Inspection Forth:Subsurface Sewage Disposal Sygem•Page 7 of 17 i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments L, A �� Property Address S — Owner Owner's Name / ,(� �7 information is �N i��vi //� 1 11 0.26 g required for every _ page. City/Town State Zip Code Dat of I nspiection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: a(Do — OC✓U.-�- Source of information: a� Was system pumped as part of the inspection? ❑ Yes ❑ No If yes, volume pumped: gallons How was quantity pumped determined? — Reason for pumping: — Type of S m: 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/Altemative technology. Attach a copy of the current operation and maintenance contract (to be obtained from system owner)and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments Property Address NiiM6`J _ Owner Owner's Name / information is C,ev,7 ey-Vl Ile Q.26JD //� yrequired for every page. City/Town State Zip Code Date o nspe on/ D. System Information (cont.) Approximate age of all components, date installed (if known)and source of information: �ejL Were sewage odors detected when arriving at the site? ❑ Yes No Building Sewer(locate on site plan): r �� Depth below grade: feet J ;eria construction: cast iron 40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of ieakage, etc.): Septic Tank(locate on site plan): Depth below grade: feet Material onstruction: concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: S X F Sludge depth: a17 t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments L—/ c Ntis �C� Property Address Owner lil�1 G✓► Owners Name �`e // /� / information is l/� w Vim!`l'� �/ L 6 � 2119, f� required for every page. City/Town State Zip Code Date j0 Insp ction D. System Information (cont.) Septic Tank(cont.) 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? / " le I L�'a �V/C-& Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): l%✓>7 r N dl o n-2eC' tr ► -� a µ L,/ ci w e • -ee,S• Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑concrete ❑ metal ❑fiberglass ❑ polyethylene El 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: Date t5ins•11110 TAIe 5 Official Inspection Form:Subsurface Sewage Disposal system•Page 10 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Fno'r^m - Not for Voluntary Assessments Property Address SA W V47 6 P7 _ Owner Owners Name I `v/ Ile information is / CC h l_ /�W required for every liG 777"G i page. City/Town State Zip Code Date o Inspe Ion D. System Information (cunt) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): 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 per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order. ❑ Yes ❑ No Date of last pumping: oate Comments (condition of alarm and float switches, etc.): *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No l5ins•11/10 TdIe 5 Official Inspection Form:Subsurface Sewage Disposal system•Page 11 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments pe Prorty Address Owner O Y I wners Name information is H ✓ v` /� / I // required for every page. City/Town State Zip Code Date f Ins ection D. System Information (cunt.) Distribution Box (if present must be opened) (locate on site plan): Depth of liquid level above outlet invert — Evey) 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 ❑ No Alarms in working order: ❑ Yes ❑ No Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: tsins•11/10 Idle 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments � 7F Ll �.�s Property Address / Owner Owner's Name Ce, ��ff�/information is required for every �yvf /� / /�� ? I b / Ci /Town page. h' State ZipCode Date Inspe ion D. System Information (cont.) i 335� 7a S ' / � / Type Soo it'n/00 C..�6 a vti 41tv,S ❑ leaching pits number: ❑ leaching chambers number: ❑ 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.): ��/ �� c'r.� ,� �0 S��H G�!✓tom . VVIT O / 1 C 4N /,C , l G✓`e— >41 Cesspools (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 ❑ No t5ins•11/10 Ti11e 5 official Inspection Form:Subsurface Savage Disposal System•Page 13 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments C;)- 2�' Z/ I-'r- 4-r R i Property Address S�Vi�G Owner Owner's Name information is O'6 s� 9 required for every 77"�� �%/`' _ page. City/Town State Zip Code Date InspeAion D. System Information (cunt.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): 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.): t5ins•11/10 Title 5 Official Irnq*dion Form:Subsurface Sewage Disposal System•page 14 of 17 r Commonwealth of Massachusetts Title 5 Official Inspection Form • Subsurface Sewage Disposal System Form - Not for Voluntary Assessments r aZ7R �f4pII,1 -/'/' 4f /�d Property Address S4 v Owner Owners Name information is required for every ✓1/v<Ile, 1,94 _a2 6,u '/1 / page. City/Town State Zip Code Dat of Ins lion D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view 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. Check one of the boxes below: hand-sketch in the area below ❑ drawing attached separately 143 -A --�s,� �Pl Oh a � � 'it ff } 1 f c � � r c tsins•11110 rrtle 5 Official Inspection Form:Subsurface a Dis posal sposal System•Page 15 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form a Subsurface Sewage Disposal System, Form - Not for Voluntary Assessments Property Address U1,47Gh Owner Owner's Name �` / l information is / „� ✓� l AK (O�o� g required for every �/C page. Citylrown State Zip Code Date o Inspe ion .D. System Information (cont.) Site Exam.- Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells Altin� Estimated depth to high ground water: feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date ❑,/ Observed site (abutting property/observation hole within 150 feet of SAS) l� Checked wit I cal Board of Health -explain: C4 J- �- T�s 804 ❑ Checked with local excavators, installers -(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•11/10 Title 5 Official Inspection Form:Subsurface a Disposal posal System•Page 16 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 'c a 9? C'ev, 1/1 -, 4 s Property Address Owner Owner's Name information is required for every 1 en v!ii ` •( page. Cityfrown State Zip Code Date tnsp coon E. Report Completeness Checklist Eg-Inspection Summary: A, B, C, D, or E checked inspection Summary D (System Failure Criteria Applicable to All Systems) completed �Ysm Information— Estimated depth to high groundwater Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins•11/10 Idle 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 T t No. ' e + / ' Fee 0 THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: i►---- PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes ftpritation for Disposal *pstrm Construction Permit Application for a Permit to Construct( ) Repair(jC5 Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Locatio Address o;Lot Np. Owner's Name, address,and Tel.No.S03 a -- Vt��Q h N, Assessor's Map/Parcel 95� �n u a,,, s RX-1 QkAex V'I�Z_ Installer's e,Address,and Tel.No. ��7 �O. Designer's ame,Address,and Tel.No.508 j(o�J y Type of Building:Dwelling No.of Bedrooms Ll Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) �11��Ct� 'CZ, Vr,�N,� e- 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 Healt tg e Date Application Approved y Date " t° Application Disapproved by Date for the following reasons Permit No. _ Date Issued _, } 0'�0^ No. � Fee �W, c THE COMMONWEALTH OF MASSACHUSETTS THE in computer: 1...•--- PUBLIC HEALTH DIVISION '-'TOWN OF BARNSTABLE, MASSACHUSETTS Yes application for -Mlsposai*pstrm Construction permit Application for a Permit to Construct( ) Repair( Upgrade( ) Abandon( ) ElComplete System ❑Individual Components .q Lo aattio Address or Lot PS Owner's Name,Address,and Tel.No.So'a-Y a$$- i � n 4We-<'v i l e `9 5 Assessor's Map/Parcel �j O C @ n u� - Installer's Nat e�,Address,and Tel.No.so V?7S' 87 7(o. Designer's ame,Address,and Tel.No. -3(ay• D6 1 t{ o (69 Cex.-4Crv� te_. �`_ 1 C�� S0,\6w;c.V. T)rpe of Building: Dwelling No.of Bedrooms 14 Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: 1 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 Healib. , .e L Date d� Application Approved byYa) — Date 00 Application Disapproved by Date for the following reasons Permit No. '"" Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO CE��RTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired(X) Upgraded( ) Abandoned( )by iiW n is �LJ1 1 i(lam S fL QAC>�, ata728 _aO'A ,(jk' 5 U C&N4--V 1 , I e- has been constructed in accordance %with the provisions of Ti le 5 and the for Disposal System Construction Permit N /V) dated 5/�/G 4 Installer 1 p 6 r\,Zc"- , Designer #bedrooms + Approved design flow ' �Q gpd The issuance of this permit shall not be construed as a guarantee that the system will Functionrasi designed. Date �I " Inspector M �� .' -- -------------- --- - No. r x© q ) Fee OCR, THE COMMONWEALTH OF MASSACHUSETTS S�vmarN PUBLIC HEALTH DIVISION-BARNSTABLE, MASSACHUSETTS ]Disposal 6pstem Construction 3permit Permission is hereby granted to Construct( ) Repair oO Upgrade( ) Abandon( ) System located at �$ (�n`� �� tG S �p �,pX} `J 1 .1 to 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 mus be c mptie ted within three years of the date of this�permit. Date / /% Approved b Y'�,-. TRANS. NO.: CITY/TOWN: CEWTERV LLLLF MA APPLICANT: (56V R.C&C - UO W SO K R Q ADDRESS: J !& CA P'N L-1 j 4 44 `S R040 DESIGN FLOW: 4+0 gpd REVIEWED BY: DATE: N/A OK NO Legal boundaries denoted [310 CMR 15.220(4)(a)] V Street, Lot, tax parcel number and lot number noted on plan [310 CMR 15.220(4)(u)] a/ Locus Provided [310 CMR 15.2204(t)] Plan proper scale? (1"=40' for plot plans, 1"=20' or fewer for components) [310 CMR 15.220(4)] ✓ Easements shown [310 CMR 15.220(4)(b)] System located totally on lot served [310 CMR 15.405(1)(a) for upgrades]- if not, a variance is required [310 CMR 15.412(4)] Location of impervious surfaces (driveways,parking areas etc.) [310 CMR 15.220(4)(d)] ✓ Location all buildings existing and proposed 310 CMR 15.220(4)(c)] Location and dimensions of system components and reserve areas. [310 CMR 15.220(4)(e)] ✓ System Calculations [310 CMR 15.220(4)(0] daily flow septic tank capacity(required andprovided) soil absorption system (required andprovided) whether system designed for garbage grinder ✓ North arrow [310 CMR 15.220(4)(g)] Existing and proposed contours [310 CMR 15.220(4)(g)] Location and log of deep observation holes (existing grade el. on each test) [310 CMR 15.220(4)(h)] Names of soil evaluator and BOH representative [310 CMR 15.220(4)(h) and(i)] 1/ Location and date of percolation tests (performed at proper elevation?) [310 CMR 15.220(4)(i)] Percolation test results match loading rate? [310 CMR 15.242] ,/ Certification statement by Soil Evaluator [310 CMR 15.220(4)0)] Observed and Adjusted groundwater(method for adjustment given or indicated) [310 CMR 15.103(3) and 310 CMR 15.220(4)(n)] Address �� Cqp�`� L;J°��15 P-&r,(q Sheet 1 of 7 n d N/A OK NO Location of every water supply, public and private, [310 CMR 15.220(4)(k)] 4/ 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)] Water lines and other subsurface utilities located [310 CMR 15.220(4)(m)] (if water line cross see 310 CMR 15.21l(1)[1]) Profile of system showing invert elevations of all system components and the bottom of the SAS [310 CMR15.220(4)(o)] V Stamp of 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 ap roved for an upgrade under LUA at 310 CMR 15.405(1)(k)] Test hole adequate to demonstrate four feet of suitable material? [310 CMR 15.103(4)] Test Holes adequate to confirm adequate groundwater separation? [310 CMR 15.103(3)] Benchmark within 50-75' of system [310 CMR 15.220(4)( )] Materials specifications noted? [various sections of 310 CMR 15.000] System components not> 36" deep (unless Local Upgrade ,Approval or LUA requested) [310 CMR 15.405(1(b)] Address Z? 601p l-I� �1�'7 S 04 q Sheet 2 of 7 t N/A OK NO Size OK? [310 CMR 15.223(1)] a/ Inlet tee located ten inches below flow line [310 CMR 15.227(6)] Outlet tee 14" or 14" + 5" per foot for increase ft depth [310 CMR 15.227(6)] Outlet tee with gas baffle or approved filter[310 CMR 15.227(4)] Note regarding installation on stable compacted base [310 CMR 15.2280)] Separation between inlet and outlet tees (no less than liquid depth) [310 CMR 15.227(2)] Inlet/Outlet elevations at least 12" above high groundwater (except as described 310 CMR 15.227(5)) or permitted for upgrades under LUA [310 CMR 15.405(1)(k)] Minimum cover 9" (Tanks buried more than 9" must have risers on all openings and on the d-box) [310 CMR 15.2228(1) and 310 CMR 15.232(3)(f)] Three access covers (inlet and outlet must be 20" or greater) - middle access at least 8" (by 7/07) [310 CMR 15.228(2)] Access to within 6 " of grade - one port for systems<1000gpd, two for systems>1000 gpd [310 CMR 15.228(2)] All at-grade covers secured to unauthorized access? [310 CMR 15.228(2)] > 10 ft from building foundation [310 CMR 15.211(1)] Buoyancy calculation Required/Done [310 CMR 15.221(8)] H-20 Where appropriate? [310 CMR 15.226(3)] Setbacks from resources [310 CMR 15.211] - Required when other than single-family dwelling or flow>1000 d [310 CMR 15.223(1)(b)] First compartment 200%daily flow; Second compartment 100% daily flow [310 CMR 15.224(2) and(3)] ✓ "U" pipe through or over baffle, outlet of each compartment with / gas baffle or approved filter[310 CMR 15.224(4)] Address 27�6 ��/ L J yd s 2��a� Sheet 3 of 7 N/A OK NO IN Wool AM e5 -mot; 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 15.21l(1)[11) ✓ Cleanouts required/provided ? [310 CMR 15.222(8)] Thrust blocks specified in force mains? 310 CMR 15.221(6)(c)] Slope of sewer line not less than 0.01 (1/8"/ft) 0.02 preferable [310 CMR 15.222(6)] Proper pitch on all runs? (.005 within gravity-distributed trenches and beds) [310 CMR 15.251(9) and 310 CMR 15.252(2)(c)] Siphonproblem/ (leachfield below pump chamber) Endcaps or vent manifoldspecified? Size and orientation of discharge holes specified? (not smaller than 3/8" not larger than 5/8") [310 CMR 15.251(8) and 310 / CMR 15.252(2)(h)] o/ Materials specified (310 CMR 15.251(5) specifies various pipe types allowed) D?i��B F : � Oda �sD� � '3 .U� � � zv� „^ �ry��� ����<''.�F�� �* .•}�'' Stable compacted base [310"CMR 15.221(2) and 310 CMR 15.232(2)(a)] Splash plate or baffle tee required on inlet/provided? (when pressure sewer to d-box or steep pitch of gravity sewer) [310 CMR 15.323(3)(a)] ✓ Riser if deeper than 9" [310 CMR 15.232(3)( ] Inside minimum dimension 12" [310 CMR 15.232(2)(b)] Minimum sum 6" [310 CNM15.232 3 (e)] Watertight cover if<2000gpd); waterproof manhole if>2000gpd [310 CMR 15.232(3)(d)] PNUMNC ,� Capacity(emergency storage above working--design flow)? [310 CMR 231(2)] ✓ Proper setbacks [310 CMR 15.211 (same as septic tanks)] ✓ Watertight 20-in minium access manhole at least 20" MUST BE TO GRADE [310 CMR 15.231(5)] ✓ Service components accessible (not too deep with piping, disconnects accessible) Alarm floats - alarm on circuit separate from pumps specified? Exceeds two units must have two pumps operating in lead-lag mode. [310 CMR 15.231(6) and(8)] Stable Compacted Base [310 CMR 15.221(2 Buoyancy calculations needed? Provided? [310 CMR 15.221(8)] Address Cgp h IJ ih S I Pa 4 Sheet 4 of 7 N/A OK NO Calculations correct? 4 feet of naturally occurring material demonstrated? [310 CMR 15.240(1)] Required separation to groundwater? [310 CMR 15.212)] Aggregate specified as double washed [310 CMR 15.247(2)] ✓ System Venting required/provided? (system under driveway or >36" deep) [310 CMR 15.241] Inspection ports specified and within 3"final grade? [310 CMR 15.240(13)] Breakout requirements met? (No violation of breakout elevation within 15 ft of SAS unless barrier) [310 CMR 15.211(1)[4] and Guidance Document] Chambers and Gal. in trench configuration supplied with inlet every 20 ft. [310 CMR 15.253(6)] Each structure with one inspection manhole(if>2000 gpd must be to grade) [310 CMR 15.253(2)] V/ Aggregate I'minimum-4' maximum. [310 CMR 15.253(l)(b)] 2' sidewall credit maximum [310 CMR 15.253(1)(a)] In bed configuration, inlet every 40 sq. ft. [310 CMR 15.253(6)] Width 2'minimum 3'maximum [310 CMR 15.251(1)(b)] 100 feet-maximum length [310 CMR 15.251(1)(a)] Minimum separation 2x effective depth or width whichever greater(3x if reserve between trenches) [310 CMR 251(1)(d)] Situated along contours [310 CMR 15.251(2)] Breakout OK? [310 CMR 15.211(1)[4] and Guidance Document] minimum 2 distribution lines [310 CMR 15.252(2)(a)] ✓ " Maximum separation between lines 6' [310 CM R15.252(2)(d)] ✓ Maximum separation between lines and outside of bed 4' [310 CMR 15.252(2)(e)] o/ Aggregate depth below discharge pipes 6"minimum, 12" maximum. [310 CMR 15.252(2)( )] ✓ Separation between beds 10'minimum. [310 CMR 15.252(2)(0] t/ Bottom area used in calculations only[310 CMR 15.252(2)(i)] Address �' T J S �� Sheet 5 of 7 N/A OK- NO Pressure Dosed System ? Provided pump and piping / calculations as required [310 CMR 15.220(4)(r)] Pressure dosing required on all systems>2000gpd or alternative systems under remedial approval [310 CMR 15.254(2) and I/A Remedial Use Approvals] If used in gravelless system -make sure jet is directed as not to scour soil interface [Guidance Document] Inspections once per year(systems<2000 gpd) or quarterly / (>2000 d) good to note on plan [310 CMR 15.254(2)(d)] Construction in fill - Did the plan specify that the fill shall meet the specification of 310 CMR 15.255(3)? Impervious barrier and/or retaining wall ? [Guidance Document] Impervious barrier installation must be supervised by designer [310 CNIR 15.255(2)(b)] f Retaining wall must be designed by Registered Professional Engineer [310 CMR 15.255(2)(a)] Side slope not exceed 3:1 ? [310 CMR 15.255(2)] Breakout requirements met? [310 CMR 15.252(2) and / Guidance Document] At least 5 ft. from impervious barrier to edge of SAS (10 ft. / recommended) [310 CMR 15.255 (2 (e •/ Check DEP Approval letters for credits and design conditions If used with pressure dosing do not allow pressure discharge / to scour soil interface V ea, 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? `l Any alarms involved on separate circuits Did the applicant submit an operation and maintenance manual? 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 V/ feet of property line [310 CMR 15.412(4 New construction or increased flow proposed- [Refer to 310 /' CMR 15.414]- �/ Address �i7� ��p h LI 4GJt'1 S ®�� Sheet 6 of 7 N/A OK NO Is the system in a Designated Nitrogen Sensitive Area(Zone H for a public supply well)? [310 CMR 15.214, 310 CMR 15.215 and 310 CMR 15.216 - also refer to Policy regarding upgrades of such / existing systems] V Is the system proposed on the same lot as served by private well ? [310 CMR 15.214(2)] Are the nitrogen loads proposed in compliance? [310 CMR / 15.216(1)] ✓ Pumping to septic tank ? [ 310 CMR 15.229] Shared System [310 CMR 15.290] Address 3 ` ��VL S ��� Sheet 7 of 7 .......... �'ovvn of Barnstable �F1NE Tn.. : Regulatory Services:--,- Thomas F. Geiler,Director 3ARNSfABIk'w.n . Public Health Division-___ 159.' �0 Thomas:McKean,Director 1Vlain Street,Hyannis,MA:fl2601 Office:.508462-4644 Fax :508-790-6304 ... Installer::&Designer Certification.Form,. �� : Sewage Pert# 4�.� Assessor's Map�Parcel Designer. Tostaller .. .Address: . 3 -t �(`i`�Q �(C Address� i was issued apermit to install a (date) - (installer) septic.system at7 _ r' �. ' _ based on a design.drawn_by ' ex V ' - (designer) I certify that the septic system referenced above was.installed substantially according to the desi which may_include-minor: roved char es such as lateral:relocaton ofaha aPP g . distribution-box and/or-septic tank: I certify that_the.septic system referenced above was_.mstalled.-with.maJ'or chars es i e g... ,( greater than 10' lateral relocation of the SAS:or any vertical relocation of any..componena of the septic-Sy em but in accordance with State&LoeaI Regulations. P1atz Yevis�on or certified as built by designer to.follow. ASH OFAf G�. DAVtD (InstMer s Signature): - o D... v COUGHANOWR y No.1093 9SGI5TER . ETA _ (Designer's Signature) s Stamp Here) PLEASE RETURN .-TO- :-BARNSTABLE PUBLIC -HEALTH DIVISION. _ CERTIFICATE OF -:::: COMPLIANCE VML NOT.BE ISSUED UNTIL BOTH THIS FORM AND AS-BUILT CARD RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. Q:Health/Septic/Designer Certification Form 3--26-04.doc - _ I TOWN OF BARNSTABLE LOCATION a78 CAN SEWAGE# VILLAGE C{,4cn' /1e ASSESSOR'S MAP&PARCEL INSTALLER'S NAME&PHONE NO. G..�•c. b„�� Sef�>� s&,,,,, 3-67 775- g�17r. SEPTIC TANK CAPACITY /000 LEACHING FACILITY.(type)7,6)e,Sbd Qr,,,,,,d Jj (size) 33• -,Y /d.S'Y.2 NO.OF BEDROOMS Y OWNER 5A v M PERMIT DATE: j/o_Zlo/a_0P'1 COMPLIANCE DATE: 37l 1.9mog 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 ' 1 1 A-,;k 06° 09 S A .36' -�� aa ' a Town of Barnstable P# oFTME Departiment of Regulatory Services BAJMSrnete, : Public Health Division Date 0AY 4, 2a8 �A 1619. 200 Main Street,Hyannis MA 02601 rEn rrtA<" ' y Date Scheduled _57 v� r O 0 sM U Time Fee Pd, Soil Suitability Assessment for Sew ge ispo al F Performed By: R V1� C01)6 9 PrW1) n/k Witnessed By: V . LOCATION & GENERAL INFORMATION F tion Address y � � L.?1� In h t s Name q s R Owner' I � Address 'Z�$ �9QN� I�•I,Jq4 s IC,°� Assessor's Map/Parcel: C tv lie, M 4Engineer's Name vi` p v QhUu NEW CONSTR��U{{C71ON. REPAIR ✓ Telephone# �$ 7jtioq- ©S'GJQ- Land Use Slopes(%) © Surface Stones Distances from: Open Water Body ®e o 4 ft Possible Wet Area. A 06 ft Drinking Water Well 10 b+ ft J Drainage Way ft Property Line 10 t ft Other ft SKETCH:(Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands in proximity to holes) ice/' r,4 L_l JAH rL 1 rP-, GROUNDWATER ADJUSTMENT 1 ® i EXISTING GROUNDWATER LEVEL I ®� BASED ON TOWN OF BARNSTABLE rP z GIS DEPARTMENT RECORDS. `h INDICATED GW 3B.00 INDEX WELL SDW-252 ZONE C READING DATE APRIL. 2009 READING 46.8 ADJUSTMENT 1.6 I ADJUSTED GW 39.BO Parent material(geologic) R 50&"CI 11�_ 0 UT W gH Depth to Bedrock 1NWE Depth to Groundwater. Standing Water in Hole:_ Q R A��E Weeping from Pit Face w� Estimated Seasonal High Groundwater CC A-Bbu DETERMINATION FOR SEASONAL HIGH WATER TABLE Method Used: 5 C C- 14B00a Depth Observed standing in obs.hole: in. Depth to Soil mottles: jn, Depth to weeping from side of obs.:hole: in. Groundwater Adjustment ft. Index Well# Reading Date: Index Well level,.�,�, Adj,factor..,,,,e,�. Adj.Groundwater Level,,,, PERCOLATION TEST Date St-'I l Io Time A h Observation - Hole# Time at 0" t, Depth of Perc bV t i1 Time at6" Start Pre-soak Time @ I S� Time(9"•6") End Pre-soak D' , Rate Min./Inch Site Suitability Assessment: Site Passed V Site Failed: Additional Testing Needed(Y/N) r ;.hv{1 Original:'..Public Health Division, Observation Hole Data To Be Completed on Back------------ f�t i f f 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:\SEPTIMERCFORM-DOC 1 }' TEST L 0 G DATE OF TEST: MAY 21. 2009 { SOIL O I � APPROVED SOIL EVALUATOR: DAVID D. COUGHANOWR. �r461 WITNESSED BY: DAVID STANTON. HEALTH DEPT. PERC NUMBER: 12569 I TEST PIT 1 PARENOTUNDWATE MAATERIA EPROGLAC ALD OUTWASH PERC AT 66 in - 2 MIN/INCH IN C SOILS ELEVATION DEPTH SOIL USDA SOIL SOIL COLOR SOIL OTHER (INCHES) HORIZON TEXTURE (MUNSELL) MOTTLING 60.20 0-8 Ap SANDY LOAM 10 YR 2/2 NONE FRIABL 57.20 B-36 B LOAMY SAND 10 YR 4/4 NONE FRIABLE 36-142 C MEDIUM SAND 10 YR 6/3 NONE LOOSE 48.37 NO TEST PIT 2 PAARENTUMAATERI L:ENCOUNTERED OUTWASH 2 MIN/INCH IN C SOILS ELEVATION DEPTH SOIL USDA SOIL SOIL COLOR SOIL OTHER ( NCHES) HORIZON TEXTURE (MUNSELL) MOTTLING 60.75 I 0-10 Ap SANDY LOAM 10 YR 2/1 NONE FRIABLE 10-40 B LO AMY SAND 10 YR 4/4 NONE FRIABLE 57.42 40-140 C MEDIUM SAND 10 YR 6/4 NONE LOOSE 49.08 - -- DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Con i to c Gravel DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil . Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders, onsi ten • Flood Insurance Rate Man: Above 500 year flood boundary No— Yes ._. Wiitun 500 year boundary No.)� Yes Within 100 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? ��5 If not,what is the depth of naturally occurring pervious material? Certification I certify that on 00V (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 training,expertise and experience described in 310 CMR 15.017. "jN OF Mgss9 Signatured�w L SC l Date �! { o� 0 D ID yG�� " COUGHANOWR rCENSE° 02 QASEPTIC�PERCFORM.DOC E VA L U P� rs . . 9� t 2 Zia hCU- b WSps' Luy \ - 0/6 T . THOMM RMAJIly (o7-d3 3o 115,97. r' ti t MA9 E' c:at POND DS�tVBs adf , LoT.'°l,?17 , - +--`"s �y -.,.._»,.h*r• { ' . . '�' 'v `3^.. E� a�74;rr,., ! i + 9pZj�.IH yAAMO[TTiIr CERTI`FIED PLAT r , LACATION C ll.T6 W/.L�. r I'il a 55 SCALE �,! 30 . DATE . ., PLAN.REFERENCE 4 7, CERTIFY THAT THEwN4Ar)ON SHOWN ON THIS PLAN IS10CATEO"ON''T"f MlOUNb CN-9 5 /-. STANLEy AS'iHOWN HEREON.AND THAT IT CONFORMS TO SETBACK GOUIREMENTS OF THE-TOWN of, L/TANS ,+`�OA6 E F BftR N$ A 64467 . VMS ONaT C ENTE z vl I: -c MASS DATE PETITIONER: oz 4` �3 , iSTEREo I>u�t ih "roo �. ,' L- �p. 00fj55�j3�/ED' F 1-.. TOP OF FOUNDATION CONCRETE C04* CONCRETE COVERS `. llln*T1��'�'1I71 �fnsrrrllt "wl CAST` IRON 12"MAX. 127.MAX. ss► PIPE (OR 4"ORANGEBURG(OR EOUIV.) ' EOUIV.)- MIN. PIPE- MIN. LEACIH PITCH 1/4-PER. PITCH I/4"PER.FT. PIT . . . PRECAST °'• :•« LEACHING NVERT • PTEL. .47•'.OQ. INVE T INVERT. ! �;•SEPTIC TANK DIET. EOUQYINVERT EL..... lEL�+i G. >_ :�'/OQo 80X ►-tEL.4L+.7�. 'GAL. (NVE(tT INVERT ` W :•• 3/4 TO 1 V2EL.. �. to . WASHED EL;�o./ t� r; // STONE' /Q ' DIA PROF LE OF GROUND' WATER TAkE . SEWAGE DISPOSAL SYSTEM NO SCALE SOIL LOG WITNESSED BY : DATE .S-.1. 80.,. TIME. 10; 3P-"AN- egvG . C 1V.lZ2�Y .- . BOARD OF HEALTH NEST HOLE I TEST HOLE 2 T�-(oMgs; E•.�CECaL�y. P< . ENGINEER' ELEV:. . . : ELEV. . . . . /�i C KEy <'oA/sT Co.. f*04 4-ra L DESIGN DATA s7�Fl NUMBER OF BEDROOMS Th!2EE $ ° TOTAL ESTIMATED FLOW :.3>>' . GALLONS/DAY BOTTOM LEACHING AREA 7 ,SQ . S0.FT./PIT ' l''lEP .FINE SIDE LEACHING AREAS,$. SCO SO.FT./ PIT GARBAGE DISPOSAL !�O (50%o AREA INCREASE) TOTAL. LEACHING AREA .z ��,00 SOFT 4 PERCOLATION RATE 4ES•5.7*lA/.TWQ . MIN/INCH �/ LEACHING AREA PER PERCOLATION RATE4.. S0 FT !V.D.WATER ENCOUNTERED NUMBER OF LEACHING PITS -". QN,6 .7. APPROVED . . . . . . BOARD OF HEALTH 64 T ys + . . DATE . . . . . . t AGENT OR INSPECTOR BF C,4Aie LE.s F. •S7Anll-E . .. i� _ CCAPiv L1.TAN:s ,�GUAD �'EA112. ��LGr THOMAS B. KELLEY CO. 9 �s ! ENGINEERS—SURVEYORII del CoTvt cq®rj CiTAHS 2D 346 LONG POND DRIVE . PETITIONER SOUTH YARMOU'TH+biA93. GNIL � /�✓/L,LE� NA 66. • . . . B 026" • 80 No.._..... �... - FEs. ............... THE COMMONWEALTH OF MASSACHUSETTS BOARD O HE T . ..------..OF......... ,!�ifi 1G CGf........... '. ................. Appliratiou for Disposal Works Trinstrurtiou Frrmit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal Syst at• r.> %►�C'fi !S ..... Z-11 . - --- ...........; ......atio -Ad ess - i Owner yytdrrjess . �• Lsa f� 5..."5 :.. :�t. _ Installer Address , Type of Building ! Size Lot./e !n�le,.)........S`1. feet �-, Dwelling—No. of Bedrooms._.. .................................Expansion Attic ( ) Garbage Grinder—(—) aOther—Type of Building ._........................... No. of persons..-..................._... Showers ( ) — Cafeteria ( ) Other42SIpres --------------------------------------------'--------------•-------------------------...........--.ma�cc W Design Flow......... ...... Design per person yr day. Total daily flow-__-���e! ......................gallons. WSeptic Tank—Liquid capacity.............gallons Length- ........... Width------_......... Diameter................ Depth................. x Disposal Trenclh—No............... Width__''_._............ Total Length.........___ ...... Total leaching area..............__- sq. ft. Seepage Pit No�� `i ageter.......2*_' ..... Depth below inlet._.___e........ Total leaching area.. ..I-sq. ft. Z Other Distribution box' osing tank ( ) Percolation Test Res Its Performed by VON J Y...................... DateAC.1o_./ A a-<_......._.. Test Pit No. 1.. ._ ._._.minutes per inch Depth of Test Pit.....:............. Depth to ground water........................... 04 Test Pit No. 2................minutes per inch ..;Depth of Test Pit................:--- Depth to ground water........................ oa • --- -_ , ••-•••. ..--••-- escr n ooi....... � �• aA� ...:..° e W U Nature of Repairs or Alterations—Answer when;applicable................................................................................................ ..........-•-------------------------------------•---------------------------------------------------------......... Agreement The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TT-.r p 5 of the State Sanitary Code.,The undersigned furt er agrees not to place the system in operation until a Certificate of Compliance has been ' s 'by th .board of 3 Sign - ----- .._......... ' 4' Date Application Approved BY ........ �y'"--------- �'�'........ Date Application Disapproved for the following reasons:` = : ................................................................................................ _ ............................................................................................. ....................__......._......_.._........._............___.._.__._...........__.._.........._____.. Date PermitNo........................................................ Date .i. . THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ......... 4 .l............._y............................. Tntiffrate of Tootplidn-it Tti�� I TO C IFY hat the Individual Sewage Disposal System constructed ( or Repaired ( � ) by..-.. ... � �... l..s.......... :....... . . Instal . a f J ._....... at .02 �sz� � has been installed in accordance with,the P(fov isions of 'h:_, of The State Sanitary Code as described in the application,-for Disposal Works Construction-Permit NoE) ......��'( dated-_zp-_S-a ACC-),--------------- -. THE ISSUANCE OF THIS}CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM'WILL FUNCTION SATISFACTQRY In ........................................ DATE ...... -----•--_.. -------------------- THE COMMONWEALTH OF MASSACHUSETTS BOARD Oq HEALTH /'...40.0& .'I..........OF........ �..,............................................... FEE ........... i o ` I Ivork it tuitott Virrmit Permission ts_hereby granted . . ..................................................... �' to Constr t ) or Re ai� ( a an I dividual ,age is sal tem at No.Ex� �� l7or -140�'- Street as shown on the application Disposal Works Constructior it No._-.._. Dated.._ _� :__'t d.'._._._.... Board of Health DATE....... ............................................... FORM 1255 HOBBS & WARREN. INC., PUBLISHERS "ter n '.a J No..- •- -•- ----Y. 4 ............ THE COMMONWEALTH OF MASSACHUSETTS .� BOARD Og HEA T G2 .OF......... - - -------------- ......._...---- ApplirFation for Uiipniial Works Tomitrartion ramit Application is hereby made for Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal y S stem at• . .. ob -----• cation-Ad ss �/' or t N ... - ..�1. a_.. er z .. . - Owner ress w .... .. ...................................... .._.__.._._.__y..__. ........ _..... Installer, Address •� Type of Building Size Lot._ feet Dwelling—No. of Bedrooms.__._________________________________Expansion Attic ( ) Garbage G .ue. ( --� Other—T e of Building No. of persons............................ Showers — Cafeteria Q' Other fixtures ............................ . �ry a Design Flow.........I� ...__......�•. _ gallons per persona5r day. Total daily flow...... �!......................gallons. WSeptic Tank—Liquid capacity............gallons Length-4.......... Width................. Diameter................ Depth................ Disposal Trench--No.........__,.,.._p Width.... ... .. .... Total Length .... Total leaching area........__..._____,sq. ft. Seepage Pit No, ial eter........ �... Depth below inlet__ ---_ ...._. Total leaching area._. .���sq. ft. Other Distribution box ( ) Dosing tank ( ) Percolation Test Result Performed by..._.r B.A'I.. ... ....................... Date...�.'_l�.�Q...._......__. ,al Test Pit No. 1.. � '____minutes per inch Depth of Test Pit_____ _____________ Depth to ground water..................... Test Pit No..2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ V - � = "---•--�---_.__ . ---- .=:e .escrp ..1..-----•=------•-•.....................•-•-•----............------•---------------------- .. - W ...............--.........................................................................................................................................-............................................. UNature of Repairs or Alterations—Answer when applicable............................................................................................... ----•---•-------------------•---......------------•-----------........------------...................---........----------------------••----•-------....--------------------------------•---•--•---•---- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TIT .;,,. 5 of the State Sanitary Code— The undersigned furt r agrees not to place the system in operation until a Certificate of Compliance has been •issue,. by th board of - i 3 Sn- ---•••-•----------- -------------• Date Application Approved By...... ........ C I ----- =Date Application Disapproved for the following reasons_____________________________________________________________.............................. .......------- ....................•--------...-•--•-------•-----------------------------------------•._....--------------•••••--•--••--•-----------------------------------•------•------------.................................................... Date PermitNo.............................'-.......................... Issued----- ...�................................................. Date � 6 -AT IO �� a f , j � WAGE�PERMIT �O. Z to *-VIILAGE ('-00e / I NS�J�Aj' LLE 'S NA i ADDRESS_ / ��S � ',�7�EN�et 54P1Lfe 4?e S Z y!BV e R U I L D E 0 OR OWNER DATE PERMIT ISSUED DATE COMPLIANCE ISSUED n ' n o. No J //// - F��............................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH 4W _4 Z.4 ..........OF............ ............. Appliratiun -for Uhipunttl Works Towitrurfinn Vrrntit Application is hereby made for a Permit to Construct ( or Repair ( an IndividuallSewage Disposal Syst at: o ---- ----r--•-•-.-_. aC �= .....••-.............................. jocation• ddr ✓ or Lot No. Owner Address W _ �o�• ..�c t Installer Address Q Type of Building Size Lot.��9�'____-Sq. feet U Dwelling—No. of Bedrooms-------------______"-------___"-_.____.-__"Expansion Attic 44Garbage Grinder `1 Other—Type T e of Building �'��*'`�'- < 0.� YP g-------=------------•---•--- No. of persons._________...........__ Showers ( ) — Cafeteria ( ) Ga Other fixtures .......... ------------------------------------------- W Design Flow....... __---"________________""gallons per person per day. Total daily flow................ _0 ?..............gallons. WSeptic Tank—Liquid capacit); Ogal Ions Length................ Width................ Diameter-----..._-...... Depth._.______-._.... x Disposal Trench—No- _____".............. Width.................... Total Length----_--------------- Total leaching area-------.------------sq. ft. Seepage Pit No..... _______"_- Diameter... . _ ±.._ Depth below inlet________ __________ Total leachin _area.................. ft. z Other Distribution box (zf Dosing tank �^ aPercolation Test Results Performed bY-------------------------------------------------------------------------- Date..................... ------------- ,� Test Pit No. 1----------------minutes per inch Depth of "Pest Pit____________________ Depth to ground water...___.._".-.._."-..---. f4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water.--_-_--___-.-__-..-.. 9 ------- -------- ------ ... ..•-------•---_...._._.................... A 7 - O Description of Soil__... ( `_ _ 1� ,// .f��.. l s ' -- - ---•- 1 - - - - -- , (7 w --P....... , - _2 ��.�.-....---- --- ------- -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- U Nature of Repairs or Alterations—Answer when applicable.--.--._"""_""""."._.""""..-"""-..""-""--"-"--":-._.----"-.""""................................- ---•----------------------------------------------•-- ....................... .................................................. --------••-----•-----•-------•---------------------------------------- Agreement: The undersigned agrees to install the aforedescribed,.Individual Sewage Disposal System in accordance with the provisions of Article XI of the State Sanitary Code— The ersigned further a t to place the system in operation until a Certificate of Compliance has been issued board olt . ed.------ .. —�-� �D 1/ �. ___ate _ / Application Approved BY---"-. f'--- ------- , ...... •.... Date Application Disapproved for the,following reasons:---------------------------------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------------------------------------------------------------------------------------- ---------•-------- Date PermitNo......................................................... Issued........................................................ Date No.......... . �.. Fss........�..:.......— THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTHHEALTH ---..-...--.OF.............. -''r'. ................................................. Appliratinn -for Uiipuiittl Works Tonotrurtinn Vernnit Application is hereby made for a Permit to Construct ( `) or Repair ( ) an Individual sewage Disposal System,at: l Location.Xddres "r or Lot No. Owner Address i C Installer Address Q Type of Building Size Lot...e .. i°......'....Sq. feet aDwelling—No. of Bedrooms.............................................. Expansion Attic .(X/�'� Garbage Grinder p, Other—Type of Building .--.-.-..- .-..-..--- No. of persons............ ........... Showers ( ) — Cafeteria ( ) daI Other fixtures ------------------------------- -- >- -----------•---------•--- W Design Flow....-. ......................gallons per person per day. Total daily flow--------------- ................_.gallons. WSeptic Tank—Liquid capacitvZU�kallons Length.....•.......... Width...... ......... Diameter----- -------- Depth................ x Disposal Trench—No. .................... Width.......•------------ Total Length-------------------- Total leaching area--------------------sq. ft. Seepage Pit No........!!�--------- Diameter----- Depth below inlet•................... Total leaching,area------_----------sq. ft. z Other Distribution box ( 4�' Dosing tank ( ) / • ' C ^ "6 • aPercolation Test Results Performed by------ ---------------------••.................----••...._-••-....•..... Date...._----------------------------------- Test Pit No. 1----------------minutes per inch Depth of Test Pit-------------------- Depth to ground water.......-...-.--------.-- (3:1 Test Pit No. 2................minutes per inch Depth of Test Pit.....-.---.-------.- Depth to ground water.........------- ------ G4 -------------------------------------------------------------•------•..---•---•-•---------••------------------------•------------------------------. ....... ODescription of Soil------------------------------------------------------------------=---------------------------- ----------------------------------------------- ------ -------f------ x � c.��t - (� - --- W U Nature of Repairs or Alterations—Answer when applicable.-..-........................................................................................... •-------------------------------------------------•-------••--•----.-....-..---••----•----•-------------•----------••-----•---•----•--•-------•-•--•-••---••-•---..-...-.--.-....--------------------- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Article XI of the State Sanitary Code—The uxld rsigned further agrees not to place the system in operation until a Certificate of Compliance has been issued y hh bard of health. Signed............... `..--......... /._.... Date / ApplicationApproved By---------------------------------------------------------------------------------------------- • 1 _ t�. Date Application Disapproved for the following reasons----------------•--------------------------------------------------------.-....-..------------------------------- ...............•----------------------------------------------•-•------------------•--•------....--------....---••--••---•-----------•-•-------•.-•-•- ------------------------- ........................ Date PermitNo......................................................... Issued......................_................................ Date _ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ............. .......................OF..........:........................................................................... uIertifirate of W"JIMplittnrr THIS IS-TO CERTIFY, That the Individual Sewage Disposal System constructed ( -1-0--r--Repaired ( ) -<-,d Installer C / . � ]_. has been installed in accordance with the provisions of Article XI of The State Sanitary Code as described in the application for Disposal Works Construction Permit No-----------------------/............... dated.......... �..�.:� :...j.......... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. ,*" t DATE...........------..........=-----��---------..._ --�`''-�----.._.-•----------- Inspector---='==-------�=`-=�--f-`--------==--u:'..n.,=',...."--•-•----------------------------- THE COMMONWEALTH OF MASSACHUSETTS 1 BOARD OF HEALTH - OF.. ............ �'...........".....'------------------------------------------- /f..................,........ . .. No.. ........... FEE-------••--•----........ �-: RnVviial Norbi Tnnitrnrtinn Permit Permission is hereby granted_-------------------------------- ......-----------------------------••------•-•-----------.......•--•-•-----......•-----....._...••••- to Construct ( 4. orr,Repair, ( ) an, Individual Sewage Disposal, System atNo-------------------------'h C�"� 1_1'; '7- t---------------------•••: .-------------------•-----. - ---------------------------------------....::..... :----------------------------- Street as shown on the application for Disposal Works Construction Permit No--------------------- Dated......-- ..^.--------- ----------------•-------•-------•----..........--------•---------- DATE..._ Board of Health, FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS LOCATION ' 5EWO CxE PERMIT W0. VILLAGE - -�lz: cz;-EiicLv IWTTALLLEER•5 KI&Nl[�-n 4,-- Q.DDRESS BUILDER 5 Al &"F- ADDRESS DDJE PERW7 ISSUED l DATE COMPLI &MCE ISSUED ; �� 7� �- a9 P �' ©X J NarE: Ar .5F-7sk4cr L)Nt ' ca. 5-26- 76 0� L.o vc, Meg iz Y OL � �� � TES �"` d-6' wt�oL�c.OA►rt 1 W Ho►c j 27 i 1 1 t Q N•i NT � �80JC �� [XiSTN� `07` 6 � �Ef"-2' SU$SOI L 1 ,Y 20 t' 99,± q 2'-8 ttEpi vm GUVEJ- `\Jv/ SDK /84, 7,5 jy ►+.r0 A� A4 AJ/MC//!// 3 CJ/LD/NG S ETOAC� ,eE_CPU/,eE-MEA./TZ 20 «ONT /O P2v po'SED 3 BEDI2ooM5 SE P T/C 5 y5 TAM CONS T2 UC T/O/V SHALL G-OAA=02i4 TO Mkt s5 . 17E5/GN FLOW 300 GALI17'► Y ENV/,2on/MG-/vTAL Coop TirL�, � AND 7 0Z VAI OF L G-A G,4/ 24 TE C M/N. /"VCN c�AT2n1ST.4SGE AE.ALT,A1 U4.A7-,'0NS a Top OF /o20�oSEV L.EAC14 .A.2EA 070 Fo UNDATiON /MPL-,2✓iDc/5' co VEQ MA V 14 0LE } Co VE,r--, 70 EX TE/n/D -ro TO ,a2E VENT W/ TN/N P OF F//�//SHED GTLADE. .=/2On-/ /AV,F/LTi2AT/A/6 STOVE r I Sox All —6 Miwl y 3 M�,v 4"D/A. 7Fz c� p/T��/ F�Ow LINE M/N OiTGN � .� Y4"1FOO7- /O"A9iN 14„ / A a. M/ni A"/rc fi ^ P/T -Y_ MiN /�"/Foor WAS HEO /O D O - - /Nt/ r STO n/E GALLON/ /NV 6 ' 07 ALL //VVIC-e CA PAC/ TY ELEV ,QlZDun/O SE,oT/G T�►vt/.0 BoTlcM aF �WA TG Z T/G A/T� //V VE,2T /N vE�ZT A14 GA�e8A6E G,2/nNDE,� C� 20' M/A/1A4UA4 ` ,� 6 ' S C .TG �L A A'/ . 5'&`?T/C 74' n/,K Ta BE .4 1%4/n//MUM LoCA7-/O/l/ � C6A1T47ZVIL- ."C A-114515 aF /0 '�•��� FoQNn,4r,O-V 4;VC> IZEFE2EnlCE L 6AC14 LOT 26 .9S ���1�/� LA/ 2:: L1, 61 074, CS OUTL.ETS� �q,U,rj LE.4C.4/i�lG �/T Fob TO .BE OF ,�E/�/F02C�D CO,VG.2ETE CC _ Con/ce�TE ST,2G/c/GT,z/ 3000 ps/ Mii /. T��L 4S - I`"' Z /\/ a. STEEL 20000 A o# 14- /O LOA D//vG 3Y C. O. SNORT /NC. �`-_ /4 TO,�y LAME RA'T NO �� � . D2/VE W4Y MoT TO BE LOG4TED T:J: O✓E,e sYSTF--M U/vLEs5 A-1 20 DENn/iS MLI sS• '� 'u° `'`E~ IDES/&^/ LOACVAIG /S USED. C E Z-r Y 7-/-1A T 7/-16 T/A.1Gk ,�C7cJ�/Dy4T/en/ L0C,4T/Gsv /S Col - !�� 'r •-m E C T AS CQ,tJFOICA46 rc'E- Q v/V E M E A-4 7-0 wN O,= 13,4;Z AJ/.S 7'�413 G...E, t>,A TE 41E.4 Z-7 4 , (5EA17 A p)P,eO Vi4 L. DATE OF TEST: MAY. 2009APROVED - DESIGN CALCULATIONS SOIL TEST LOG WITNESSEDI BY VALUATOR: DAVID SDTANOTON. HEOALTH#DEPT. - PERC NUMBER: 12569 DESIGN FLOW: 4 BEDROOMS X 110 GPD = 440 GPD NO GROUNDWATER ENCOUNTERED SEPTIC TANK: 440 GPD X 2 DAYS = 880 GALLONS TEST PIT 1 PARENT MATERIAL: PROGLACIAL OUTWASH USE EXISTING 1000 GALLON SEPTIC TANK IF IN SOUND STRUCTURAL PERC AT 66 In - 2 MIN/INCH IN C SOILS CONDITION. IF NOT. INSTALL 1500 GALLON SEPTIC TANK (MINIMUM ALLOWED) ELEVATION DISTRIBUTION BOX: USE 3 OUTLET O-BOX. DEPTH SOIL USDA SOIL SOIL COLOR SOIL OTHER(INCHES) HORIZON TEXTURE (MUNSELU MOTTLING SOIL ABSORBTION SYSTEM: THE LEACHING GALLERY DEOICTED BELOW CAN LEACH 60.20 A b o t = (33.5 x 12.5 ) - 1/2 (2 x 4 ) = 414.75 sf 0-6 A SANDY LOAM 10 YR 2/2 NONE FRIABLE A s d w = ( 33.5 + 12.5 + 29.5 + 4.47 + 10.5 ) x 2 = 160.94 a 8-36 B LOAMY SAND 10 YR 4/4 NONE FRIABLE Atot. = 595.69 o 57.20 Vt 0.74 x 595.16 = 440.61 GPD 48.37 36-142 C MEDIUM SAND 10 YR 6/3 NONE LOOSE USE THE LEACHING GALLERY DEPICTED BELOW. Vt = 440.81 GPD > 440 GPD REQUIRED NO NDWATE TEST PIT 2 PAARENOTUMAATERIA EPROGLACIALD OUTWASH 2 MIN/INCH IN C SOILS LEACHING GALLERY CONSTRUCTION DETAIL ELEVATION DEPTH SOIL USDA SOIL SOIL COLOR SOIL OTHER SHOREY PRECAST CONCRETE 1000 GALLON SEPTIC TAW (INCHES) HORIZON TEXTURE (MUNSELU MOTTLING 500 GALLON DRYWELL 60.75 LEACHING UNIT OR DIMENSIONS AND DETAIL NOT TO 0-10 Ap SANDY LOAM 10 YR 2/1 NONE FRIABLE EOUIVALENT ST USE EXISTING H-10 UNIT SCALE 57.42 10-40 B LOAMY SAND 10 YR 4/4 NONE FRIABLE q 29.5 Ft ON A� m SEPTIC TANK IS TO BE PUMPED DRY 40-140 C MEDIUM SAND 10 YR 6/4 NONE LOOSE a• AT TIME OF INSTALLATION AND IS TO 49.06 , IJ BE EXAMINED FOR STRUCTURAL +� m INTEGRITY. INSTALL NEW PVC OUTLET O O O Ln TEE EOUIPPED WITH A GAS BAFFLE. DISTRIBUTION BOX '� N RISER REQUIRED IF COVER B e I in GROUNDWATER ADJUSTMENT DIMENSIONS AND DETAIL IS DEEPER THAN 9 INCHES TAPER USE SHQREY Da-3 H-10 m EXISTING GROUNDWATER LEVEL 4.0' 8.5' B.5' 8.5 .0' �� c BASED ON TOWN OF BARNSTABLE -• GIS DEPARTMENT RECORDS. 33.5 Ft C 0 pp INDICATED GW 3B.00 SCALE 7MINqlll� LL INDEX WELL SDW-252 NE C _ K /► - ,READING DATE;ARRIL. 2009 O FROM 3 -� CROSS LEACHING GALLERY READING 4 6.8�.t' „ O TANK 3 TO USE SHOREY PRECAST Ssrd GALLON LEACHING DRYWELL (H-1.0 LOADING) 1� S ADJUSTMENT, 1.B-k , �. (p e,er:r.e,e...e.,.rr,e,e.. ADJUSTED , i39:80 ,;(I 2 in PEAsronE 2 rn PEAsronrE 6 f f'6 1n Q �C 6 in STONE BASE o 0 * INLET OUTLET IJ U �', : 15.5 1i> >5' CROSS SECTION VIEW 2 24 In t F i t L_V; r � . In -132 in ip7AVEL DEPTHEFFECTIVE i-1 2 fn rGRA VEL n To [26n COVER COVER IN DR.0 OFLOW LINE _� 46 in 58 In 46 in FROM TO 1) INSTALLER TO OOT'`XIN 15k7 in DISPOSAL WORKS PERMIT BEFORE STARTING WORK. BUILDING - 10 4 - ;� D- LIQUBOX 2) SEPTIC TANK TO BE PUMPED DRY AT TIME OF SYSTEM REPAIR AND CHECKED INSTALLER MAY SUBSTITUTE AN APPROVED GEOTEXTILE 48 U FABRIC IN PLACE OF THE PEASTONE LAYER SPECIFIED ID FOR STRUCTURAL INTEGRITY. INSTALL -PVC OUTLET TEE FITTED WITH GAS BAFFLE. LEVEL BAFFLE 3) ALL COMPONENTS INSTALLED SHALL MEET THE MINIMUM REQUIREMENTS OF MASSACHUSETTS TITLE 5 SEPTIC CODE (310 CMR 15). 500 GALLON DRYWELL 4) INSTALLER TO VERIFY LOCATIONS OF ALL UNDERGROUND UTILITIES DIMENSIONS AND DETAIL CROSS SECTION VIEW BEFORE EXCAVATING FOR SYSTEM. USE H-10 UNIT INSTALL ONE INSPECTION RISER TO WITHIN THREE 5) EXISTING LEACH PIT TO BE PUMPED, COLLAPSED. AND FILLED. ^ INCHES OF FINAL GRADE AND INDICATE LOCATION 6) ALL STONE TO BE DOUBLE WASHED AND FREE OF IRON. FINES AND DUST IN PLACE. ON AS-BUILT CARD. 7) ECO-TECH ENVIRONMENTAL RECOMMENDS THE INSTALLATION OF LOW FLOW FIXTURES SEWAGE DISPOSAL SYSTEM PLAN AND APPLIANCES. AND BIANNUAL PUMPING OF THE SEPTIC TANK. -TO SERVE EXISTING DWELLING 8) SYSTEM IS NOT DESIGNED TO WITHSTAND VEHICULAR LOADING. DO NOT 00 34 PARK OR DRIVE VEHICLES OVER SEPTIC SYSTEM. ooao 0 000) ir' GEORGE AND JEAN SHUMAN 9) SEPTIC TANKS SHALL BE INSTALLED LEVEL AND TRUE TO GRADE ON A LEVEL ao�0000000 278 CAP'N LIJAH'S ROAD CENTERVILLE. MA STABLE BASE THAT HAS BEEN MECHANICALLY COMPACTED AND ON TO WHICH ���000000 SIX INCHES OF CRUSHED STONE HAS BEEN PLACED TO MINIMIZE UNEVEN SETTLING. G,8 EEO-TECH ENVIRONMENTAL 10) SEPARATION OF TEES IN SEPTIC TANK SHALL BE NO LESS THAN LIQUID DEPTH. 43 TRIANGLE CIRCLE SANDWICH MA 02563 ETE-3147 I MAT 2Y. 2009 1 212 CENTERVILLE. MA ' LOCUS CONTOURS' ' . EXISTING - - - - - - - 50 oPo MINIMAL GRADING PROPOSED 3 ? OWNER L� OQ J oZ} Ouw m y R / ® Ok<J �' m 5�., N ow< '� m � _ � cF mom m GARBAGE GRINDER�' il\ H 60 = 23.60 F IS NOT ALLOWED � INT _ A_- >� �" N F p A VEME_ 4w WITH THIS DESIGN. LOCUS M/ \P A m�< :.;;_;` �� / EDGE 0 sl '�° I NOT TO SCALE w J ,;.;,;; Ln (n <3 15-D q� LEACHING GALLERY o of 0 w a Ow o }- _ W m z ��� -SEE DETAIL ON REVERSE �Ny LEGEND ~� JUZ� M J LL 3 �� 64 _—_ /10 <cn<� <w = W w Z �, Nc� ss wW L13 > o �= 1_� l > 1N EXISTING W uw} U ,,, m __� I -A 4 le h Q� X a0 < _j C: Q N o_ \ I� J E 1000 GALLON e� o? e m< LIJ < w w \ / /GPI\- 15-0 60 BENCH MARK > m c0 o I W 2 o Z< U W 1 / Z T _i o I TOP OF CONC BOUND EXISTING LEACH O U < z W -::.y> w / PAVED I 61 ELEVATION = 62.22 PIT/CESSPOOL :.::: ;i_>;rxa: BARNSTABLE GIS DATUM DRIVEWAY L L J W ::crccr;rs: Y I TEST PIT D-BOX O Z j e Z J� L I ER T -2 62 WW W 0_j X m / - DRAIN EM Lu1L L- LL o m 1 I %ING e o w ,� s I; E X I s O O M / 11.21 `♦ DECIDUOUS CONIFEROUS Wcn R Z I = m L Li 4 g E❑ TREE LQo TREE �w z ffO o� 1 WELLING s'S d6b 12-M *2-F 6 Gi W - Z U) D \8 -NUMBER REFERS TO DIAMETER IN IL X 0 W z W FNpN ♦�, INCHES. LETTER DENOTES TYPE. ui J m om_ o cn Tpp OF, + / \ O-OAK M-MAPLE P-PINE C-CEDAR U Q �1 I _ 45 z z z W? co m m EL 6G ♦ S tN M ASH OF rNgS OF qSS 0 3 z Z 1 ♦ o�'� DAVIDLLJ cyG� o�� DAVID 9cy�� -I p w c�v `� \ / COUG ANOWR % `D. �' D. y W z i • COUGHANOWR W� � 0 3 + z � ,� \ / �/ No. 1093 m . �� x N 1 \ / ��/ �S01STE�aO �0���ENSEP 0 J X U w 1 / R\P VA i w w \ LOT 26 i ,�,,/ Z�, 2a a� WI W W z Z 1 \ .�\7226 sF +- ,, a SEWAGE DISPOSAL SYSTEM PLAN H L o < ��/ -TO SERVE EXISTING DWELLING � �L z � \ LL_ o J ;m < v 66� /-'/ GEORGE AND .JOAN SHUMAN \ /�'� OWNERS OF RECORD ry o 0 `` i,, m XIL cn � ��- 64 NOTE 278 CAPTAIN LIJAH'S ROAD n O W W ��/'� INSTALL A 40 MIL POLYETHYLENE LINER CENTERVILLE, MA LL + / ss BETWEEN LEACHING GALLERY AND PROPERTY ADDRESS m 1 �� FOUNDATION WALL AS DEPICTED ON PLAN. 43 TRIANGLE CIRCLE ASSESSORS MAP 193 PARCEL 112 O FLAN VARIANCE REQUESTED SANDWICH MA 02563 PLAN BOOK 5246 PAGE 225 C) " ? 506 364-08J4 J z N N MAY BE GRANTED IMMEDIATELY BY HEALTH AGENT OR HEALTH INSPECTOR. DATE' MAY 26. 2009 W m x x SCALE: t i n = 20 f L 310 CMR 15.211(1) - SOIL ABSORPTION ..IOB #E T E-314 PAGE 1 OF 2 VERSION: h w w w SYSTEM TO CELLAR WALL. 20 f t MIN 20 0 20 40 REQUIRED — VARIANCE TO 11 FL THIS PLAN IS BASED ON AN INSTRUMENT SURVEY AND IS INTENDED SEPARATION REQUESTED. SOLELY FOR INSTALLATION OF THE PROPOSED SEPTIC SYSTEM DEPICTED HEREON. FOR ANY OTHER CHANCES TO PROPERTY INCLUDING 0 10 20 PLACEMENT OF ADDITIONS. SHEDS, FENCES OR SWIMMING POOLS. OWNER SHOULD CONSULT WITH A MASSACHUSETTS REGISTERED LAND SURVEYOR.