HomeMy WebLinkAbout0017 CENTER LANE - Health 17 Center Lane
Centerville P
A = 251 061
UPC 10259
NO. HH116,3OR
NAIYIN40 UN
COMMONWEALTH OF MASSACHUSETTS
EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS
DEPARTMENT OF ENVIRONMENTAL PROTE
W
RECEIVED
��M SJeveW
JUN 2 4 2002
TOWN OF BARNSTABLE
" HEALTH DEPT.
� �S TITLE 5
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM
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PART A
CERTIFICATION
Property Address: 17 CENTER LANE CENTERVILLE, MA 02632 fi �Q
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Owner's Name: RICHARD SUHOZA
Owner's Address: C/O CENTURY 21 1550 CENTER PLANCE CENTERVILLE
Date of Inspection: 6/6/02
Name of Inspector: (please print) JOHN GRACI
Company Name: SEPTIC INSPECTIONS
Mailing Address: P.O. BOX 2119 TEATICKET, MA.02536
Telephone Number: 508-564-6813 FAX 508-564-7270
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 tiem of the inspection.The inspection was performed based on my training and
experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system
inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system:
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X Passes
_ Conditionally ' ses
_ Needs Furth aluation by the Local Approving Authority
Fails
Inspector's Signature: Date: 6/6/02
The system inspector shall submit copy of this inspection report to the Approving Authority(Board of Health or DEP)within
30 days of completing this inspecti n. 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
SYSTEM PASSED TITLE V INSPECTION. RECOMMEND PUMPING EVERY TWO YEARS TO PROLONG THE
SYSTEM'S USEFUL LIFE.
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****This report only describes conditions at the time of inspection and under the conditions of use al that time. This
inspection does not address how<the system will perform in the future under the same or different conditions of use.
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Page 2 of I 1
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OFFICIAL INSTECTION`FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE'SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: 17 CENTER L'A,NE CENTERVILLE, MA 02632
Owner: RICHARD SUHOZA
Date of Inspection: 6/6/02
Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D
A. System Passes:
X I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310
CMR 15.304 exist. Any failure criteria not evaluated are indicated below.
Comments:
SYSTEM PASSED TITLE V INSPECTION. RECOMMEND PUMPING EVERY TWO YEARS TO PROLONG THE
SYSTEM'S USEFUL LIFE.
B. System Conditionally Passes:
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_ One or more system componerit�s,as described in the"Conditional Pass"section need to be replaced or repaired. The system,
upon completion of the replacem n�,o er 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.
n/a The septic tank is metal and over 2?0 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 tine 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: n/a
n/a Observation of sewage backup or breakout 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
.F
ND explain: n/a
n/a The system required pumping Fnore thanA4 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: n/a
Page 3 of 1 1 t
OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address: 17 CENTER LANE CENTERVILLE, MA 02632
Owner: RICHARD SUHOZA
Date of Inspection: 6/6/02
C. Further Evaluation is Required by the'Board of Health:
_ Conditions exist which requir'Turther evaluation by the Board of Health in order to determine if the system is failing to
protect public health,safety or tl,1e'envir6nment..
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,ivhich 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
F ..
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 ta'Wh d SAS'-and the SAS is within 50 feet of a private water supply well.
_ The system has a septic fafik'and SAS`and the SAS is less than 100 feet but 50 feet or more from a private water
supply well". Method use'dto'deterrrii'ne distance n/a
"This system passes if the W114ater analysis,performed at a DEP certified laboratory, for coliform bacteria and
volatile organic compounds irid'icates that the well is free from pollution from that facility and the presence of ammonia
nitrogen and nitrate nitrogen is e_;qual 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.
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3. Other:
n/a
Page 4 of I 1
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address: 17 CENTER LANE CENTERVILLE, MA 02632
Owner: RICHARD SUHOZA '3;}
Date of Inspection: 6/6/02 l
D. System Failure Criteria applicable to all systems:
You must indicate"yes"or"no"to each of the following for all-inspections:
Yes No
X Backup of sewage into facility or'system component due to overloaded or clogged SAS or cesspool
X Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged
SAS or cesspool•' ,
_ X Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool
X Liquid depth in cesspool is less than 6"below invert or available volume is less than '/z day flow
X Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number of times
pumped Wa.
X Any portion of the SAS,cesspool or privy is below high ground water elevation.
X Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply.
X Any portion of a cesspoo,l,or privy is-within a lone 1 of a public well.
_ X Any portion of a cesspool or privy is within 50 feet of a private water supply well.
X 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 con—pounds 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 forma
(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 Flealth 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
X the system is within 400 feet of a surface drinking water supply
_ X the system is within 200 feet of a tributary to a surface drinking water supply
. •a A
_ X the system is located in ai nitrogen sensitive area(Interim Wellhead Protection Area—1 WPA)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 larbc s�sl'y.:n 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 w.th 310 CMR 15.304. The system owner
should contact the appropriate regional office of the Department.
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Page 5 of 1 I ,
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST
Property Address: 17 CENTER LANE CENTERVILLE,MA 02632
Owner: RICHARD SUHOZA
Date of Inspection: 6/6/02
Check if the following have been done.You must indicate "yes"or"no" as to each of the following:
Yes No i.
X _ Pumping information was provided'by the owner,occupant,or Board of Health
X Were any of the system`components pumped out in the previous two weeks
X _ Has the system received normal flows in the previous two week period'?
X Have large volumes of water`been introduced to the system recently or as part of this inspection ?
X _ Were as built plans of the system obtained and examined?(If they were not available note as N/A)
X _ Was the facility or dwelling inspected for signs of sewage back up?
X _ Was the site inspected for signs of break out
X _ Were all system components,excluding the SAS, located on site'?
X _ Were the septic tank manholes uncovered,opened,and the interior of the tank inspected for the condition of the
baffles or tees, material of cons'"truction,dimensions,depth of liquid,depth of sludge and depth of scum ?
X _ Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance
of subsurface sewage disposal systenisti'?',
x
The size and location of th`e:Soil Absorption System (SAS)on the site has been determined based on:
lip .
Yes no
X _ Existing information. For example,a plan at the Board of Health.
X _ Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is
unacceptable) [310 CMR 15.302(3)(b)]
F.E
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Page 6 of
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
Property Address: 17 CENTER,LANE CENTERVILLE,MA 02632
Owner: RICHARD SUHOZA
Date of Inspection: 6/6/02
,FLOW CONDITIONS
RESIDENTIAL
Number of bedrooms(design):3 Number of bedrooms(actual): 3
DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms):330
Number of current residents: 2
Does residence have a garbage grinder(yes or no): NO
Is laundry on a separate sewage system(yes or no): NO [if yes separate inspection required]
Laundry system inspected(yes or no): NO,
Seasonal use: (yes or no): NO
Water meter readings, if available(last 2 years usage(gpd)):via 60- JU(.;®(D
Sump pump(yes or no): NO V I - 3Z f wo
Last date of occupancy: n/a
COMMERCIAL/INDUSTRIAL {
Type of establishment: n/a
Design flow(based on 310 CMRG5,203): n/Agpd
Basis of design flow(seats/persons/sgft;etc.): n/a
Grease trap present(yes or no): NO
Industrial waste holding tank present(yes or no): NO
Non-sanitary waste discharged'"totthe Yitle 5 system(yes or no): NO
Water meter readings, if available: n/a
Last date of occupancy/use: n/a
OTHER(describe): n/a
,GENERAL INFORMATION
Pumping Records
Source of information: n/a
Was system pumped as part of the inspection(yes or no): NO
If yes,volume pumped: n/agallons--How.was quantity pumped determined? n/a
Reason for pumping: n/a
TYPE OF SYSTEM
X Septic tank,distribution box,soil absorption system
_Single cesspool
_Overflow cesspool
_Privy
_Shared system(yes or no)(if yes,attach previous inspection records, if any)
_innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from
system owner)
_Tight tank Attach a copy of the DEP approval
Other(describe): n/a
Approximate age of all componen[s, date installed(if known)and source of information:
2 YEARS BY OWNER
Were sewage odors detected when arri'ving'at the site(yes or no): NO
,
Page 7 of 1 I
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 17 CENTER LANE CENTERVILLE,MA 02632
Owner: RICHARD SUHOZA
Date of Inspection: 6/6/02
BUILDING SEWER(locate on site plan)
Depth below grade: 12"
Materials of construction:_cast iron X40 PVC_other(explain): n/a
Distance from private water supply well or suction line: n/a
Comments(on condition of joints, venting,evidence of leakage,etc.):
TOWN WATER
SEPTIC TANK: X(locate on site plan)
Depth below grade: 6"
Material of construction: Xconcrete_metal_fiberglass_polyethylene other(expl Jn)n/a
If tank is metal list age: n/a Is age confirmed by a Certificate of Compliance(yes or no): NO(attach a copy of certificate)
Dimensions: 150OG L 10' 6" H 5' 6" W.5'.84"'
Sludge depth: 1"
Distance from top of sludge to bottom of outlet tee or baffle: 33"
Scum thickness: I"
Distance from top of scum to top of outlet tee or baffle: 6"
Distance from bottom of scum to bottom of outlet tee or baffle: 17"
How were dimensions determined: MEASURED
Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity, liquid levels as related
to outlet invert,evidence of leakage,etc.):
SEPTIC TANK AND ALL COMPONENTS ARE STRUCTURALLY SOUND AND FUNCTIONING PROPERLY.
RECOMMEND PUMPING EVERY TWO YEARS TO PROLONG THE SYSTEM'S USEFUL LIFE.
GREASE TRAP:_(locate on site plan)
Depth below grade: n/a
Material of construction:_concrete_metal_fiberglass_polyethylene_other(explain): n/a
Dimensions: n/a
Scum thickness: n/a
Distance from top of scum to top of outlet tee or baffle: n/a
Distance from bottom of scum to bottom of outlet tee or baffle: n/a
Date of last pumping: n/a
Comments(on pumping reconuneiidatio,ns, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related
4.
to outlet invert,evidence of leakage,,.etc.):
n/a
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7.
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Page 8 of 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 17 CENTER LANE CENTERVILLE,MA 02632
Owner: RICHARD SUHOZA
Date of Inspection: 6/6/02
TIGHT or HOLDING TANK: (tank must be pumped at time of inspection)(locate on site plan)
Depth below grade: n/a
Material of construction: concrete metal_fiberglass_polyethylene_other(explain): n/a
Dimensions: n/a
Capacity: n/a gallons } "
Design Flow: n/a gallons/day
Alarm present(yes or no): N/A
Alarm level: N/A Alarm in working order(yes or no): NO
Date of last pumping: n/a
Comments(condition of alarm and float switches,etc.):
n/a
DISTRIBUTION BOX:X(if present must be opened)(locate on site plan)
Depth of liquid level above outlet invert: LEVEL WITH BOTTOM OF PIPE
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.): 1;F1
D-BOX WAS VIDEO INSPECTED'AND'APPEARS TO BE STRUCTURALLY SOUND.
PUMP CHAMBER:_(locate on site plan)
i,
Pumps in working order(yes or no): NO
Alarms in working order(yes or no):NO
Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.):
n/a
e,
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Page 9 of 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 17 CENTER LANE CENTERVILLE, MA 02632
Owner: RICHARD SUHOZA
Date of Inspection: 6/6/02
SOIL ABSORPTION SYSTEM (SAS): X (locate on site plan,excavation not required)
If SAS not located explain why:
n/a
Type
n/a leaching pits, number: n/a
INFILTRATORS leaching chambers, number: 8
n/a leaching galleries, number: n/a
n/a leaching trenches, number, length: n/a
n/a leaching fields, number: n/a
n/a overflow cesspool, number: n/a
n/a r� I i innovative/alternative system
Type/name of technology: n/a
Comments(note condition of soil,signs of hydraulic failure, level of ponding,damp soil,condition of vegetation,etc.):
INFULTRATORS ARE STRUCTURALLY SOUND AND FUNCTIONING PROPERLY.SYSTEM SHOWS NO
SIGNS OF FAILURE.
CESSPOOLS: (cesspool must be pumped as part of inspection)(locate on site plan)
Number and configuration: n/a
Depth—top of liquid to inlet invert: n/a
Depth of solids layer: n/a
Depth of scum layer: n/a
Dimensions of cesspool: n/a
Materials of construction: n/a
Indication of groundwater inflow(yes or no): NO
Comments(note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation,etc.):
n/a
PRIVY: (locate on site plan)
Materials of construction: n/a
Dimensions: n/a
Depth of solids: n/a
Comments(note condition of soil, signs of hydraulic failure, level of ponding,condition of vegetation,etc.):
n/a
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Page 10 of 1 1
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 17 CENTER LANE CENTERVILLE,MA 02632
Owner: RICHARD SUHOZA
Date of Inspection: 6/6/02
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. Locatelwhere public water supply enters the building.
7,43
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' Page I I of I I `
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 17 CENTER LANE CENTERVILLE, MA 02632
Owner: RICHARD SUHOZA
Date of Inspection: 6/6/02
SITE EXAM
_Slope
_Surface water
_Check cellar
Shallow wells
Estimated depth to ground water 10+feet
Please indicate(check)all methods used to determine the high ground water elevation:
NO Obtained from system design plans on record-If checked,date of design plan reviewed: n/a
YES Observed site(abutting property/observation hole within 150 feet of SAS)
NO Checked with local Board of Health-explain: n/a
NO Checked with local excavatofs,installers-(attach documentation)
NO Accessed USGS database-explain: n/a
i
You must describe how you established the high ground water elevation:
HAND AUGER- 10+FT. C
II
7
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a 7- /B� ,TOWN OF BARNSTABLE
LOCATION 1'"1 l q Q r I el fiz SEWAGE #
VILLAGE CQ rV1.0 Q- ASSESSOR'S MAP & LOT
INSTALLER'S NAME& l PHONE NO.
ITY SEPTIC TANK CAPAC O �p
LEACHING FACILITY: (type) C (size) ]�
NO. OF BEDROOMS
BUILDER OR OWNER COY l tJli L! UU 11�
PERMITDATE: COMPLIANCE DATE:
Separation Distance Between the:
Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet
Private Water Supply Well and Leaching Facility (If any wells exist
on site or within 200 feet of leaching facility) Feet
Edge of Wetland and Leaching Facility(If any wetlands exist
within 300 feet of leaching facility) �� / Feet
Furnished by G� r' J SQ J CP_ 2
t,"
/Fee v
No. ._
THE COMMON SACHUSETTS Entered in computer:
Yes
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS
Application for Mizpozar *pgtem Con5tructiun Permit
Application for a Permit to Construct( )()Repair( )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components
Location Address or Lot No. l.o T 8�/7 C e,.►-p a L.1, Owner's Name,Address and Tel.No.
Assessor's Map/Parcel
�j6aTuX_vtw� J00#4 t 6AeZ4oza `-'►,pC}f. eS
ZS 1 4�` 1 G+aN'�.2.J�C.C��
Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No.
T—
Type of Building: _f r-fl
Dwelling No.of Bedrooms Lot Size 2-ot oc esq.ft. Garbage Grinder( )
Other Type of Building No.of Persons Showers( ) Cafeteria
Other Fixtures
Design Flow 4 4 o gallons per day. Calculated daily flow `f`fS gallons.
Plan Date -I Number of sheets l Revision Date .k 4
Title g2=6"► f):F L 07- �R-
Size of Septic Tank ( sbo Type of S.A.S.
Description of Soil e-6
f
Nature of Repairs or Alterations(Answer when applicable)
Date last inspected:
Agreement:
The undersigned agrees to ensure the construction and m ' ce of the afore described on-site sewage disposal syste
in accordance with the provisions of Title 5 of the Envir ental Code an o 1 th s stem in operation upAS101!40
cate of Compliance has been is i' o d of lth. (o
Signed Date
Application Approved by Date
Application Disapproved for the following reasons
Permit No. 2- Date Issued
+� �r/* ,> --b 9f,7
.
`No.
ate
Fee
THE COMMONWE-AhTH-OF-M- SACHUSETTS >iced in computer:
Yes I
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLES MASSACHUSETTS
r
2ppftcation for'Miquar *pztem Con.5truction Permit
Application for a Permit to Construct( Y)Repair( )Upgrade( )Abandon(: ) ❑Complete System ❑Individual Components
Location Address or Lot No. ks117C E,.,T-i_a 1~u Owner's Name,Address and Tel.No.
6ra_t.4-1-;`•,2v,'L.Lf. 10V1tir + 6A,4,3e.rjn 61iZi�++,S
Assessor's Map/Parcel ZS 1 Co 6,µ 1 C v 0"
l
Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. -
T) r J Cf
Type of Building:
Dwelling No.of Bedrooms Lot Size Zvi q. ft., i Garbage Grinder( )
Other Type of Building No. of Persons ." e Showers( ) Cafeteria
Other Fixtures i
Design Flow `�`}J gallons per day. Calculated daily flow `++S gallons.\
Plan Date -�=' `1 Number of sheets l Revision Date
Title OF (-e7-
i Size of Septic Tank Type of S.A.S.
Description of Soil
Nature of Repairs or Alterations(Answer when applicable)
Date last inspected:
Agreement:
k, The undersigned agrees to ensure the construction and mainte. ce of the afore describe on-site sewage disposal syste
in accordance with the provisions of Title 5 of the Environ n al Code an o pl th s stem in operation upti ,C,e� 10 G
cate of Compliance has been i o d f Hj lth. -'
Signed aA4-.e-. Date Z
Application Approved by _ Date gS
Application Disapproved for the following reasons
Permit No. 2 L( Date Issued
----------------------------------------
THE COMMONWEALTH OF MASSACHUSETTS.
BARNSTABLE, MASSACHUSETTS
s'
Certtftcate of Comphance -
THIS IS TO CEM W O -site S age is osal S ,ern Constructed( )Repaired ( )UpgradedAbandon ( )b t
at L V Grnk 1 has been cons'tructe' in cccrdance
with the provisions of Title 5 and the for Disposal System Construction Permit No. �7 Z K dated I l 0
Installer Designer , r 7 o
The issuance of t 's pht s° n t be construed as a guarantee that the s to will unctio as d sign'' . �� ('�" t�Date Inspector
—————————————————————————
No. �� 7 t �� '' F'e / tl Cj
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION - BARNSTABLES MASSACHUSETTS ru
MtOpOa[ 6potem Construction Vermtt�—.(- !
Permission is hereby granted to Construct( )Repair( )Upgrade( Abandon
( ) �
System located at �-V� 9 CO-AM-
and as described in the above Application for Disposal System Construction Permit. The applicant recognizes.-his/her duty,to
comply with Title 5 and the following local provisions or special conditions.
Provided:Construction-must be completed within three years of the date of this it.
Date: y ` �T Approved b �fL-
TOWN OF BARNSTABLE
LOCATION SEWAGE #
VILLAGE L4,*)4 f8jr,"A*// ' ASSESSOR'S MAP & LOT
W
INSTALLER'S NAME&PHONE NO.
SEPTIC TANK CAPACITY d C/
LEACHING FACILITY: (type) zm 4 f s�,l+�"�na 9 (size) I epz)
NO. OF BEDROOMS
BUILDER OR OWNER
PERMITDATE: ��Zf//,� _COMPLIANCE DATE: Nv
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 c
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
y:
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6-
1
JTOWN OF BARNSTABLE -—
LOCATION
VILLAGE
� �^ SEWAGE #
ASSESSOR'S MAP & LOTW-
INSTALLER'S NAME&PHONE NO.
SEPTIC TANK CAPACITY +�
LEACHING FACILITY: (type)
— (size)
i NO.OF BEDROOMS
BUILDER OR OWNER
PERMIT DATE: COMPLIANCE DATE:
j Separation Distance Between the:
Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility
Private Water Supply Well and Leachin Feet
8 Facility (If any wells exist
on site or within 200 feet of leaching facility)
Edge of Wetland and Leaching Facility(If any wetlands exist Feet
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JOHN LEBLANC PROPOSED RESIDENCE FOR CUSTOM 3 BEDROOM HOUSE II-21-55 rrT+Tre�
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TEST HOLE LOGS
T.O.F. AT EL. 49.25' - Nor To SCALE)
ACCESS COVER TO WITHIN 6" OF FIN. GRADE (
ACCESS COVER (WATERTIGHT) TO 'J. JODICE (DOWN CAPE ENG•)
47 WITHIN 6" of FIN. GRADE ENGINEER:
•8 MINIMUM .75' OF COVER OVER PRECAST WITNESS: ED BARRY
I 2% SLOPE REQUIRED OVER SYSTEM ,'
47.0'
10/18/94 1
RUN PIPE LEVEL 2" DOUBLE WASHED PEASTONE.+� DATE: ` ►+UCKINS NECK RoAO
46.25' FOR FIRST 2' }� _ < 2 MIN/INCH
PROPOSED 1500 f + 45.5' PERC. RATE -
GALLON SEPTIC 45.5' a
45.75' — CLASS I SOILS P# 8289
TANK (H— 10 ) GAS r w
BAFFLE 45.20' o00 45.03' Cl 45.0
( 4 % SLOPE) �6" CRUSHED STONE OR MECHANICAL 2' �*'
, � CENTER
4 COMPACTION. (15.221 [21) ELEV. Q
DEPTH OF FLOW = 1 5 00258 o 'g' `a Sir o 43.0' 47.55'
( % SLOPE) o 0' 47.60 0 ' Focus
TEE SIZES:
INLET DEPTH = 10" 3/4" TO 1 1/2" DOUBLE WASHU STONE
TOP AND TOP AND
OUTLET DEPTH = 14"
18" SUBSOIL SUBSOIL LOCATION MAP ►+o sc�u.E
46.10' 18" 6,05'
LE/- SING
FOUNDATION— 13 SEPTIC TANK 19 D BOX 3 24' FINE SAND
FACILITY 7.9 FINE ASSESSORS MAP 251 PARCEL 61
KEEP PROP. WATERLINE MIN. 10' FROM
SAND MED. ZONING DISTRICT: RD-1
06 (IF PRESERVE TIC PAREA TNSTALLED, SLEEVE 30" 60" SAND YARD SETBACKS:
6.29 WATERLINE WHERE WITHIN 10' OF
V
SEPTIC COMPONENTS) I FRONT = 30'
305 CLEAN MED/FINE
�o• +-46.77 35.10' SILTY SAND SIDE = 10'
HEv'IiMARK MED/COS 78 REAR - 10'
j. E�DV^NT TAG 50.00'BOLT p643
PLAN REF, - 177/97
` F',Q SAND CLEAN
W �� Cq�� tiY o00 W/ FLOOD ZONE: C
MED/COS
SOME LOT LIES WITHIN TOWN AP DISTRICT
�FtiT.\ Op• COBBLES SAND SEPTIC SYSTEM LIES OUTSIDE STATE
+311.8a \ ,p� W/ ZONE II DESIGNATION
\\F,QNI 7. SOME -
.S•
,o \0 .,\ COBBLES e
IN
LOT q o \\ �, ` \ 150" 35.10' 156" 34.55'
{
4ie5 �� 3 _ NO WATER ENCOUNTERED` NOTES:
a UnL1TY
r3 .a0 POLE 7Itt 1 [)AT is n'>UMED
SEPTIC DLSIGN (GARBA+.,E DFSMSER IS NOT �9W ) _---
s- 8 � .�. AvnrLAet_E
'°s GARAGE 47.57 � DESIGN FLOW: �_ BEDROOMS ( 110 GPD) 440 GPD 2. MUNICIPAL WATER IS
PROP. 3 BR WIRE �GUY , t ' 1 ICF A 44'9 GPD 017�1IGN FLOW 3, MINIMUM PIPE PITCH TO BE 1/8" PER FOOT.
DWELLING ,
SEPTIC TANK: 440 ,3pD ( 2 ) - 880 4, DFSI N LQA0Nb FOR AI_i_ FriECAST UNITS TO DE AASHO H-
TF 49.25' Jo 30 1500- ------ 5. PIPE JOINTS TO BE MADE WATERTIGHT.
O 4 USE A _ GALLON _)EPTIC TANK
'N �-- LEACHING: 6 ENVIRONMENTAL CODECONSTRUCTION ST TOLEBV• IN ACCORDANCE WITH MASS.
� N' SIDES: -2(53 + 6.83) 2 (,74) = 177 7. THIS PLAN IS FOR PROPOSED WORK ONLY AND NOT TO BE
. —
USED FOR LOT LINE STAKING.
\ +333 BOTTOM: 53 x 6.83 (.74)TOTAL: _ 268 8. PIPE FOR SEPTIC SYSTEM TO SCH, 40-4" PVC.
601 S. 445 GPD 9. COMPONENTS NOT TO BE BACKFILLED OR CONCEALED WIT
/ PT TH 1 INSPECTION BY BOARD OF HEALTH AND PERMISSION OBTP
P� USE 8 HIGH CAPACITY INFILTRATORS WITH 2 STONE�60 ( ) FROM BOARD OF HEALTH.
rp AT SIDES, 1.5' AT ENDS AND 14" UNDER
3
+4 4�03
47---
301
+3� 1 PT +48.10 �o� +316 LEGEND SITE AND 4 7 SEt-/ACHE PLAN
43.53 � 2 100.0 PROPOSED SPOT ELEVATION OF
a LOT B CENTER LANE
46.30 / 100x0 EXISTING SPOT ELEVATION
IN THE TOWN OF:
oo PROPOSED CONTOUR ( CENTERVILLE ) B A R N S T A B L E
+324
43 55 .,� 100 EXISTING CONTOUR PREPARED FOR: JOH N LE B L A N C
I v
C� \ +4�7
20 0 20 40 60 Feet
Epp \\ ( BOARD OF HEALTH
O ` LOT B
O 20,000 SFt �� ;. MA SCALE 1�. = 20' DATE: JULY 8, 1999
\ APPROVED DATE
+44 05 a
REV. 12/19/99 (HSE)
off 508-362-4541
i
fox 508 362-9880
�s ENGINEER TO INSPECT SOILS AT TIME OF
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\ BENEATH LEACH FACILITY gRNE ARNF H yG�
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