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Home My WebLink About0397 ELLIOTT ROAD - Health 397 Elliot Road Centerville A = 227-105 IIH UPC 10259 g �a No. H 163OR �. Nit*pMniw y;w Commonwealth of assachuse - rQ 1 Subsurface Sewage Disposal System'1 orm--fyof for Voluntary:'Assessments: I f" 397 Elliott Rd -- ------- ... ,..__. ..__ .__...__ Property Address Vivian Greenberg Owner ._..__. _ _. — Owner's Name ~— information is Centerville Ma 02632 1012512013: required for every .._.._ page.. City/Town: 5ta#e ZlpwCode Date:oflnspectton Inspection:results must be's'ubmitted ern this forma Inspection foirns may nsit.be altered an aaiy Way. Please see completeness checklist'at the end of the form:. Important:When u — --- — -- --— filling;outforms A. General:,�t'llforl'il�afth omthe computer, use only the tab A. Ir1Spe0tor: key to move your cursor do not. e8n M , bees `� V C�IJ ......... ..... use,the refucn. _ ____ - --- — — — key.. Name of Inspector _. - Capewlde Enterprises ..... w.... ..... w.... _._,... _. ray Company Name 153 Commercial St. mr Mash ee. Ma 02649 A ............ .:.� _ -- CiWrPwn Ztp'Code 508477 9877 51:4522 ....-... _ _. Telephone Number License Number., Certification ! certify fihat i have personally inspected the:'sewage disposal system at this address and that the information reported befaw is true, accurate'and complete'as ref the time of ttie.nspect on. Th inspection. was performed'based'on my training and experience in the proper function and main'tenance'.61on site sewage disposal systems. I am a DEP apprmved systems inspector pursuant to Section 15:,340'of Title 5 (3.10 CM R 15.009). The.system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving ;Authority _ . .�"— 1:0125/2013 Inspector's Signature Date. The system inspector shall,submit a copy of this inspection report to the Approving Authority (Board of Health or pEP) Within•30 days of completing his inspection. If the ystem is a st ared systemeor has a:design flow of 10,000 gpd or greater the;inspector and'the system ov+rner'shall sabmit the report to ttie'appropriate regional Offlce of the DEP. The original should be sent to the,system ova ner and copies sent to the buyer, if applicable,and the approving authority. *This report only describes conditiotis.,at the time of inspection;and under tho conditions of use at that time 'This inspection does not>.address hoW the system fll pei rffi l the feature under the same or different c6 ditions of use, t5ins•3113 Titles Otfcial Ins,di_ Form:SiipsuAace:Sewage Disposal System•Page 1 of 11 r Commonwealth of Massachusetts W Title 5 Official Inspection Form " Subsurface Sewage Disposal System Form - Not for Voluntary Assessments c,M 397 Elliott Rd Property Address Vivian Greenberg Owner Owner's Name information is Ma 02632 10/25/2013 required for every Centerville page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® 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: The dwelling located at 397 Elliott Rd Centerville is served by a Title V septic system consisting of a 1000 gallon septic tank, distribution box and a 600 gallon precast leach pit. The system was found to be in proper working condition at the time of inspection. B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. 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): i i A t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 397 Elliott Rd Property Address Vivian Greenberg Owner Owner's Name information is required for every Centerville Ma 02632 10/25/2013 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. 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-3/13 Title 5 Official Inspection Form: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 397 Elliott Rd Property Address Vivian Greenberg Owner Owner's Name information is required for every Centerville Ma 02632 10/25/2013 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well"*. Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for 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 or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than '/2 day flow t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �M 397 Elliott Rd Property Address Vivian Greenberg Owner Owner's Name information is required for every Centerville Ma 02632 10/25/2013 page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® 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.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® 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 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ,M 397 Elliott Rd Property Address Vivian Greenberg Owner Owner's Name information is required for every Centerville Ma 02632 10/25/2013 page. City/Town State Zip Code Date of Inspection 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? ® ❑ 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: ® ❑ 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): 3 Number of bedrooms (actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 gpd t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 Commonwealth of Massachusetts u Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 397 Elliott Rd Property Address Vivian Greenberg Owner Owner's Name information is required for every Centerville Ma 02632 10/25/2013 page. City/Town State Zip Code Date of Inspection D. System Information Description: Number of current residents: 0 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available (last 2 years usage (gpd)): Detail: 2012— 100,000G; 2011 — 124,000G Sump pump? ❑ Yes ® No Last date of occupancy: vacant 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•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 397 Elliott Rd M Property Address Vivian Greenberg Owner Owner's Name information is required for every Centerville Ma 02632 10/25/2013 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: 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 System: ® 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) 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): l5ins•3/13 Title 5 Official Inspection Form;Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ,M 397 Elliott Rd Property Address Vivian Greenberg Owner Owner's Name information is Centerville Ma 02632 10/25/2013 required for every page. CityTrown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: system installed 9/27/1994 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 1.5 feet Material of construction: ❑ cast iron I ® 40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): Joint were ok, no leaks, vented through the roof Septic Tank (locate on site plan): Depth below grade: 1 feet Material of construction: ® 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: 1000 gallons Sludge depth: t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �M 397 Elliott Rd Property Address Vivian Greenberg Owner Owner's Name information is required for every Centerville Ma 02632 10/25/2013 page. City/Town State Zip Code Date of Inspection 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? tank was cleaned for inspection Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Water level was even with outlet invert, outlet tee was intact. Tank was cleaned for inspection and should be done every two years for proper maintenance. Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ;M 397 Elliott Rd Property Address Vivian Greenberg Owner Owner's Name information is required for every Centerville Ma 02632 10/25/2013 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 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: Date Comments (condition of alarm and float switches, etc.): *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11.of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �^M 397 Elliott Rd Property Address Vivian Greenberg Owner Owner's Name information is required for every Centerville Ma 02632 10/25/2013 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Distribution Box (if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 0" Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): Distribution box was in good condition, no rot, water level was even with outlet invert. 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.): * If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �M 397 Elliott Rd Property Address Vivian Greenberg Owner Owner's Name information is required for every Centerville Ma 02632 10/25/2013 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: ® leaching pits number: 1 ❑ 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.): Leach pit was video inspected and found to be dry with no sign of past hydraulic overloading 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-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ;M 397 Elliott Rd Property Address Vivian Greenberg Owner Owner's Name information is required for every Centerville Ma 02632 10/25/2013 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 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•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form, c Subsurface Sewage Disposall System Forin-Not for Voluntary Assessments 397 Elliott Rd Property Address Vivian Greenberg _. . - Qwner - _ __ _... ... ......._. ..._..._ _ "Owner's Name _ information ie Centerville Ma 02fi32. 1W 5/2013 required for every �_. __�.__ ___.._ ... . ---._—.... _ _..--- _ _ .. Gitytiown S#ate Zip;Code Date of.Inspect on Sketch CJf Sewage DispQsai.System: Provide a view of the sewage disposal syste,tn h lud" t'es.tc� at,ie st iwo permanent reference landmarks or benchmarks,�cicate all�ve1ls within fbo feet Locate where public water°supply enters the building. Check we of'the boxes belo (� hand-sketch;n 'he area belovi c t:'.drawing pttad ed se i ratelY7777-1 i I i ° „ 1 S ;� ; 41 {N e 8 i t O Sins 3113 Title 5 Ofr.lnl Inspe ,tt _ _:a n _ s a€S3M>ro Paye 15 of 17 Commonwealth of Massachusetts - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments °M 397 Elliott Rd Property Address Vivian Greenberg Owner Owner's Name information is Centerville Ma 02632 10/25/2013 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to high ground water: 12'+ 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) ❑ Checked with local Board of Health -explain: ❑ Checked with local excavators, installers- (attach documentation) ❑ Accessed USGS database -explain: You must describe how you established the high ground water elevation: Groundwater elevation was determined by accessing Town of Barnstable groundwater contour map. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 16 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ^M 397 Elliott Rd Property Address Vivian Greenberg Owner Owner's Name information is required for every Centerville Ma 02632 10/25/2013 page. Cityrrown State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems) completed ® System Information—Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 TOWN OF BARNSTABLE 09 LOCATION Ler,��397 rLb/ r'40 SEWAGE # �•� / VILLAGE G-rNn�i?,Ji//� ASSESSOR'S: MAP & LOT 3 INSTALLER'S NAME & PHONE NO. ] jS,�/„jam ��-0 ftvy SEPTIC TANK CAPACITY Ago 6.V7 LEACHING FACILITY:(type) j2,QC-,g S7- A%T (size) c,91 3 s� NO. OF BEDROOMS & PRIVATE WELL O PUBLIC ATER BUILDER OR OWNER R iC&A".—��S'i�d�J� DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: 9z z VARIANCE GRANTED: Yes No 9Eck 9 -#39? ulk f / o/ T s. l�•tSSCO��Sf 2Z� lip 0FEB /00 - N0.9. .... THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH TOWN OF BARNSTABLE ,� r ltrtttll�Yt fur Diripimal Wur1w Tomitrnr#inn anti Application is hereby made for a Permit to Construct (/) or Repair ( ) an Individual Sewage. Disposal System at- -, uG -, �� Ceo.r �,L�� CC�� 3 ...... ..J.......•............................................. ................ - -- Coca'on•Address or. Lot .. - ...._.: :s:. ----------------------------- Q ''' ''`` '^ f ...._ �... ...... W l l/] OTT�C ....._.\5zC .w( .� __ ✓ `!:�.�.�.l.S.?:�t.�,/V Address O��/ ......................... 'B [� u�ss �� Installer �/i� 0" j � �J �b�,ress uv� �9q d Typ....T.'e o ut ding 1 `Si`"-z;*erYY Lot_.__�.(.J_�..................Sq. feet UDwelling— No. of Bedrooms.............3-------------------------Expansion Attic ( ) Garbage Grinder (/40 Other—Type of Building ---------------------------- No. of persons---------------------------- Showers ( ) — Cafeteria ( ) < Other fixtures . �c. ----------------•--••---- ---••---•--...--••--•-•-•----••---.�-.-.--_-.------------ d - W Design Flow ... `07JT7.gallons per p gerp r- Total Iy(9 P ' ?� Vg I W Septic Tank—Liquid capacity[_-.-..._._gallons Length......... .... .�idth......-_ .-.---- Diameter................ Depth............ .... x Disposal Trench--No. .................... NA idth.... Total Length.................... Total leaching area....................sq. ft. 3 Seepage Pit No---------/.......... iameter............ Depth below inlet..._...._.._.._. Total leaching area.... ...sq. ft. z Other Distribution box ( Dosing k 7 Percolation Test Results Performed b .._...-.. .... C�o.JS'uC j r aGZ y cf�.-------:�---•----•---------- -rf--•----•--••------- Date--- --•�-- •Ci-�-*t-- ,.a Test Pit No. 1................minutes per inch Depth of Test Pit--ll7-0 _1y... Depth to ground water...........,t..... Test Pit No. 2__G`-"_minutes per inch Depth of Test Pitlll ........... Depth to ground water....O..c.......... Ri ri......._ jv.... .1.l... .. 14...... U... .. O Descri Description of oil _. 2 (�S�� f0/C.• �2 —J... �2 ------------ --- ----------"------------ -----......-------•----------...-------------•...---•------•------------------------------------------•-------•-------•---•-----•----------•-••••••.............•--'••...... C) 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 TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation u til a Certificate of Complia as been issued the balth. t 2 > Signed -- �. . .... ................. .... .......... ...... ..........., . Date Application Approved By ------------- -- - -- -- ------ ---- --------- --b....- .... .. . .. ..................... .................I->ate- ........... --- D Application Disapproved for the following rear n : ........................................... ......................................................................................... ................ ..... ............ .............. .................................... ....... I /� Date Permit No.. .��...... ..................... Issued ........ .( .............................. .•..y.-."« -.^"'^..� `.^'✓, �; v .. ,-...� ., y�, � .. .,.tip,,, rd�.��:+��..�..-. .:v�...,.� _ ry...:..-...... ..- _ _ _�1 ....�....�.+w--. - __. � .. _ 2 r� I e 1 U _...,. S FE No.... S. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Appliration for Diripniul Wnr1w Tontitrurtion 1rrmit Application is hereby made for a Permit to C onstntct (✓) or Repair ( ) an Individual Sewage Disposal System at: Cc ...--�. `••-------------------•l....... _........•-I•-•.-•••---• ..-...--- •--••----------....-----•......-----......•. --.........-•--•-••4-p------------•-_•. Address' `� } t _1 �- / {5 r Lot No\ n S !t�iL�lA2 ` ..... .. `j'M`�N� �_� � ) (— ` ) s...l)_ n ..�: _)� .........--•--••...._---•....._ .. _--, 0«ner.,— �� . 1 Address ,.a . ... ---- � rr) Installer t ) q e ��1 �� !C I SS 1�l a, 1 o lv�lJ S J �J��}JtC diress LC� 0 UType of utlding 3 Size Lot-----------U�. 9...........Sq. feet �. Dwelling— No. of Bedrooms............................__.._........_Expansion Attic ( ) Garbage Grinder ( aOther—Type of Building ---------------------------- No. of persons............................ Showers ( ) — Cafeteria ( ) Other fixtures ------------------------------ Q (Djs�;3rtz may.j------------------------- ------------------------------------------------------------ Design Flow............ ------------------------------gallons per pear Total avl f1 `�- -7?------•...__. W }' Pry' gallo s 1 WSeptic Tank—Liquid capacity/� .gallons Length... _. ----- Widt----------- Diameter________________ Depth S.._ .. x Disposal Trench—No. .................... Width.................... 'Total Length.................... Total leaching area....................sq. ft. 3 Seepage Pit No---------/.......... Diameter----------- z_. Depth below inlet................ Total leaching area... �3...sq. ft. z Other Distribution box ( �� Dosing tank ( )" ��G 7 7 a Percolation Test Results Performed by... .........................................:.�...._...---------_. Date._----` - .-•------------•-•,t--. ,.1 Test Pit No. I.... -.Z'_minutes per inch Depth of Test Pit_-/�°.�.,... Depth to ground water___..r�7Y'r. . _.- (i, Test Pit No. 2._G`--_minutes per inch Depth of Test Pit-/y ........ Depth to ground water..... 3 .......... Per ........... „ i r /I z...... o � Z U _ '/�sc�rL -y z �� Sb� 5�2' — I r Description of oil --------•---•------------ ----------------------.3---------.. . V S `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 TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Complia-ce-has been issued b the boa d df health. Z Signed ' ......_ ...,,. ..........:...^.:- —_ 11....._. . ............... ......Dare......... Application A roved B - ./7�. iv.- ff �/hl ...:..................... PP Y . - _ .... .-.. .... .... //........... _e.................. Application Disapproved for the following reasonf: ......... .................... . ...............................................................f a .............. v Permit No. I............�`T... ..' ------------------ Issued ...............----_ ..................�a......-- --------''L?-y}--lw-e---KMO/#tAsfi ti>e. --w O4r Y11►- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE THIS,IS TO CER IFY, That the I dividual Sewage Disposal System constructed ( ) or Repaired ( ) by .....-' /fir -. - - � ... ..--. ........ - ................ ......- ........ - ......................-- .............. _ o � �V has been stalled in accordance with the provisions of TITLE ,f he St at �' ��.�1.71 IVY.- . . p t Environmental Code as described in the application for Disposal Works Construction Permit No. -. ..- ..... --_--.- dated ......_........................ . .. ..........-. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTR AS A GUARANTEE THAT THE SYSTEM WI 4 FUNCTION SATISFACTORY. - DATE. ...-.-_.._....................... ........`..... .......................... lnspecto�....... ... --..... .-..-.....(-� J z... � THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE �� No........................ !.J FEE........ .......... Diapmal nrkp Tan tr`udiart rrutit Permission is hereby granted.......7R ), j .............................w.................................. to Construct ( or..Repair ( ) an,) Iividual Sewa,e-Disposal System atNo. •---•-. - ,.... .................. y; `�•-F------•--�---�--- u-•� � street f : (�- h as shown on the application for Disposal Works Construction Permit N��:!.......r� ........ ---------••...................... q .r Board of Health DATE----•---------- 7...= ^Z ............................... FORM 36508 HOBBS&WARREN.INC..PUBLISHERS \ at It TOP OF FOUNDATION20 FT. MINIMUM -- ------- - SOIL TEST r, a s ELEV. CLEAN SAND : 10 FT. MINIMUM DATE OF SOIL TEST _;�.� y ' - � — -- , r CONCRETE WITNESSED BY PERCOLATION RATE _ _MIN./I COVERS 4" SCHEDULE 40 PVC PIPE MIN. PITCH 1/8" PER FT. 2" LAYER OF OBSERVATION HOLE 1 OBSERVA HOLE 2 ,CONCRETE 1/8 TO 1/2„ ELEV.= ELEV.= COVERS - WASHED STONE 000 P 12" MAX. TO 4" CAST IRON PIPE OR EQUAL) MINIMUM PITCH 1/4" PER FT. FLOW LINE — N f . ELEV. _ _ 10„ ELEV JMIN. 19" ELEV. _ _ _ 2�0„ -- ---- _ ° ° _ ° Q ELEV. = LEVEL 0 00 0 0 0 ELEV. _ o ° ° WATER AT - EL.=_^ _ WATER AT- EL. -- - DISTRIBUTIONELEv. _ _- ° ° 0 ° � - 3/4" TO 1 1/2" ° w DESIGN CALCULATIONS B 0 X WASHED STONE 00 * 0 ° NUMBER OF BEDROOMS _ 1000 GALLON TO BE WATER TESTED ° w ° ° ELEV. _ __ GARBAGE DISPOSAL UNIT ' SEPTIC TANK IF MORE THAN ONE OUTLET TOTAL ESTIMATED FLOW ( GAL./BR./DAY X BR.) 3 "` GAL./DAY PRECAST LEACHING- 6' DIA. REQUIRED SEPTIC TANK CAPACITY GAL. BASIN OR EQUIV. ^ WELL ,. ACTUAL SIZE OF SEPTIC TANK '�''� GAL. ZONE LEACHING AREA REQUIREMENTS INDEX =_ SIDEWALL AREA F GAL./S.F. SEWAGE DISPOSAL SYSTEM PROFILE ADJUST___ BOTTOM AREA GAL./S.F. NOT TO SCALE LEACHING CAPACITY (BOTTOM + SIDEWALL) t ' GAL./DAY RESERVE LEACHING CAPACITY '�-�f} GAL./DAY BOTTOM OF TEST HOLE OR USGS PROBABLE WATER TABLE ELEV. _ OBSERVED WATER TABLE ( / /.: ) ELEV. = NOTES: 1. ALL WORKMANSHIP AND MATERIALS SHALL COW-ORM TO D.E.P. LEGEND: TITLE 5 AND THE TOWN OF _fir.'k^� RULES AND EXISTING SPOT ELEVATION 00,�0 REGULATIONS FOR THE SUBSURFACE DISPOSAL OF SEWAGE. 2. ALL GIVERS TO SANITARY UNITS SHALL BE GHT TO -' EXISTING CONTOUR -----00---- FINAL SPOT ELEVATION WITHIN 12" OF FINISHED GRADE. FINAL GOt�S?OUR_._.__.__. � 0�, --_._ 3. EXISTING AND FINAL GRADES SHALL REMAIN E NTIALLY THE SAME. 4 4. ALA. COMP�ONEPtTS OF THE SANITARY SYSTEM SHALL BE CAPABLE OF SOIL .EST LOCATION WITHSTANDING H-10 LOADING UNLESS THEY ARE UNDER OR '�MTHIN UTILITY POLE -4 10 FT. OF DRIVES OR PARKING AREAS. H-20 LOADING SHALL. BETOWN WATER =W---,.r---W / � USED UNDER OR WITHIN 10 FT. OF DRIVES OR PARKING AREAS. CATCH BASIN `®` 5. ANY MASONARY UNITS USED TO BRING COVERS TO GRADE SHALL BE MORTARED IN PLACE. 6. NO DETERMINATION HAS BEEN MADE AS TO COMPLIANCE WITH DEEDED OR ZONING REGULATIONS. OWNER / APPLICANT 1S TO .. / OBTAIN SUCH DETERMINATION FROM APPROPRIATE AUTHORITY. �y ` 7. �,((fv q-fE 4L.i. vN l �o o Ahaf, ''h t �AL )C� " Ai�v�?N� �LEgcmjp a. i N yr' j� I fi n (r f � N( wJ ?i _t.A► �,ASt1i L1 pq� •�,i i� /t 9 / �� ;. ,', �/. t_ � r_ ,j�` t. t'1'�d� i , r- ,. 4�1JGN?�tSK SaP . A6W `y y y APPROVED: BOARD OF HEALTH qv �P DATE AGENT PROPOSED PLOT PLAN FOR PROJECT LOCATION _ If S'WE'ETSER yyE�sNGIN '��NG 235 Gr�E 0 61TY OAD 398-3922 SOUTH DENNIS, M 02660 T;. SCALE l /f :' � • ,� .. REVISED REVISED � / -/f`�� LOCATION MAP Joe N0' -+—� SHEET i OF 0 1994 SWEETM EUMNEERINQ