Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Home
My WebLink
About
0052 GLENWOOD AVENUE UNIT #A - Health
52 Glenwood Avenue, Centerville A= ;0.�C'�CIFO0 ni8((�G p 2 UPC 12543 No. 53LOR og�ST•CON`'J�� HASTINGS. MN. No. � �67 0 , t 1 ._.a 15 U`�� LY'��� V � Fee .l W" THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: .PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes ZippYication for �Btgozal i§pgtem Cott.5tructtott vermtt Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon( ) ❑ Complete System ❑Individual Components Location Address or Lot No. `P �tJl t�1 vi�E' Owner's Name,Address,and Tel.No. Assessor's Map/Parcel Installer's Name,Address,and Tel.No. ._ Designer's Name,Address and Tel.No. -27 m o4Sy �oS '7 S 1.362 Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided gpd Plan Date f92 Z 2, Number of sheets Revision Date Title Size of Septic Tank l 5- ®e 57' Type of S.A.S. 4tv '°"��� �2 to 2 s STd .✓ Description of Soil Nature of Repairs or Alterations(Answer when applicable) 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 pla system in operation until a Certificate of Compliance has been issued by th' r o ealth. -- Sig:__ ig Dat"o2 Application Approved by Date Application Disapproved by: Date for the following reasons Permit No. '-0 0-7 - 0 6 y Date Issued VFee (/ THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS � p Zipprication for 3Bt5po9;at *p!5tem Construction Permit , Application for a Permit to Construct( ) Repair( ) Upgrade Abandon( ) ❑ Complete System ❑Individual Components Location Address or Lot No. ir/i r 12 69 OP Owner's Name,Address,and Tel.No. 5 Z e, lrq, WOOG !/ /ti F-/i.S6" <'- 4— 7 S Assessor's Map/Parcel 9 0 ,11-r r Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. 4, S-41 S'ocF : i3 6 2 Type of Building: / Dwelling No.of Bedrooms Lot Size sq. ft. Garbage Grinder (4 Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures ��Design Flow(min.required) � � d gpd Design flow provided gpd Plan Date © s� „ Number of sheets Revision Date Title Size of Septic Tank 0 U Type of S.A.S. �"���A-Z ATo 2 }" /S -C •J f Description of Soil_ Nature of Repairs or Alterations(Answer when applicable)--) V v v Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place-the.system in operation until a Certificate of Compliance has been issued by this Board of Health.' `/` _�-w� Sigged' .-�� - Date ,Z /a/ �✓ Application Approved by C._ Date Application Disapproved by: Date for the following reasons s Permit No. 2 07 Date Issued Z - 1't7 THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed ( ) Repaired ( ) Upgraded ( ) + Abandoned( )by 1-44 ,-1-1 at 5-Z 6'--14ti 4Va e jI ci E- has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. e'2 O b 7- O(0 O dated 2 -'t 7 Installer Designer IJA Y 7-1 1 / #bedrooms `Y Approved design flo gpd The issuance of this permit shall nit be coodstrued as a guarantee that the system ill fuZSr as;designed. Date Ile, Inspector- --- ---------------- ------------ ,l No. o 0 7^060 _. Fee 1 S V THE COMMONWEALTH OF MASSACHUSETTS'' PUBLIC HEALTH DIVISION-BARNSTABLE, MASSACHUSETTS hgpont J§p!6tem Con5tructton Permit Permission is hereby granted to Construct ( ) Repair Upgrade) Upgrade ')Abandon System located at ���� "f %� ' 4 o c�" A)r Z /v' 1.1'.1tc, ,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 mus" b9ecompleted within three years of the date of this permit. .Date J �n%✓1 t/- Approved by �' 1 0 ' TOWN OF BARNSTABLE I�rLOCATION SEWAGE # VILLAGE ASSESSOR'S MAP & LOT / INSTALLER'S/NAME & PHONE No. p SEPTIC..TANK CAPACITY J941 LEACHING FACILITYa(tVpe) �i w` (size) ). NO. OF BEDROOMS P OR PUBLIC WATER Bye OR OWNER DATE PERMIT ISSUED: DATE' COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No 1st , �i� FEB-23-2007 40:22A FROhI:BAXTER NYE ENCaINEBRI 1-508-771-7522 T0:815687719776 P.2 Town of Barnstable Regulatory Services Thomas F.Geiler,Director Public Healtb Division Thomas McKean,Director 200 Main_Street,Dyannla MA 02(01 Office: 508-862-4644 Fax: 508-790-6304 Installer&Designer Certification Form Date: 2 zs 0 Sewage Permit# 2oft7-AGo Assessor's MapkParcel M L90 Designer: $i%ems A. lu. sm., P.C. Installer: Ar& Address: Civ u3&*2" Address: A n. t3.,e 4194 W Ike►Nw S}_ N nMt� QZGOi Wd r.yu% 6 Most,. 02G04 On 2 2/-2aa-7 A..t- was issued a permit to install a (date) (installer), septic system at sz a icN,geeNg Au* . L.-.,1c.,v tic based on a design drawn by (address)_ dated I 1-Z Z-W 7 (designer X I certify that the septic system referenced above was installed substantially according to the design,which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. I certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system)but in accordance with State&Local Regulations. Plan revision or certified as-built by designer to follow. N OF ti 91EAMEN ALLYN 0' (0inst011er—'sSignadve)r' WU0W w No.80216 S/pNAL E esigner's Signature) (Affix Designers Stamp Here) PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED Oh1TIL BOTH THIS FORM AND AS-BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH VMS10N. THANK YOU. Q:H=WdsepticMesigaa Certification Fmm 3-26.04AW (�2ooG•o37 2442-2 , 2442 ( ) BEDROOM RAF PAN ) f� CARPET m 2Qo Y ' r 21_6, l EN 2442 Ej 1/ \ L-- — - (3)2XI2 BEAM ABOVE - - 210 r n _ 2Q 9 LITE (4 Iw NON ATTIC U 4) l 2 - - LIVING 21 o .a (,,, _(3�e12 BEAM ABODE _ / °' 1 "VNYL p EXI5TING HOUSE C, 2442 2442-2 PORCH . I (/` �\/ v P/ g G STEP / _ dloO ill 31_10, T_2` 6'_6' 22'-0. 141_01 38'-0' 74'-0 NOTE, WINDOW DE54HATIONS ARE ANDERSEN WINDOWS. CONTRACTOR SHALL VMIFY LOCATIONS t DIMENSIONS PRIOR TO WINDOW ORDER• INSTALLATU FIRST FLOOR PLAN SCALE: 114" - I'-0' NEW WALL C Z.M� I __ l i °( )a`a OUPPORT WAM eRE J ADDITION RIGHT ELEVATION FR I e .ON LON T ELEYA — SCALE: I/4 I O' SCALE: 1/4' rF= 11T �"OUSE� CONNECTID� gREF�E9NAT . CRAWL SPACE SITE-BUILT ACCESS �-———-� FOUNDATION i--' T�LXWEAD �' 9'-3c 3'-bc 9'-3• I-------I I E---r SITE-BUILT ACCESS DOOR W/ LANDSCAPE - I I TIE BUI-104EAD I ' — -- ————— — — o I J ,17 I o 2as 1 I6' O.C. FZO F.G. INSUL✓ o :e I •';; - 5/6' PLYWOOD WFATRING/ ASPNALT SNIWGLES i FOINDATIOJ WINDONS q, FOR VENTILATION ♦ KOC %4URRJCANE CLIP` OPEN IN SUYIYIER JOB CLOSE IN WINTER I I 4p TRUSS RASTEAFTER R/ AT ALL R / TOP PLATE 0-10" 6'-n' I O, JUNCTIONS 7YP. n III `;;. IIiII erI ---� —�_ ��/� --ggw uOm— IIIII .?;;'; 1III i�v' �• 2x6's 0`16O.0. Rso F.GO. IW3UL. nrm < ITTTwP--F1Ix.ySrF_E5w SBOCRO oR I•IALL I!(2) 2xld. �INUOU VEXnW. x3 STRAPPING t/21 GYP. BOARD ALUMINUM GTTER a GOWN PKT MT Ix6 FRIEE BD. W BED Mot 3IxA. STEEL �rPOSLWxf2° ONCR PORCH 1 2x4 EXT. STUDS• 16' O.C. RJ4 FG. INSUL✓ 3/4' T1G OSB SUBFLOOR I CRAWL SPACE NAILED GLUED TO.lasT in^ OW SWEATWING/S TYVEK WRAP/W.C. INQU _ IP.G. INSUL.2' CONCRETE SLAB RA F d I 1 6 MIL VAPOR BARRIER PT2a6m iibO.C. L •W O.G 1 1 II 1 I I 1 2-2x6 RIM JOIST 5-W2 GIRT44 P.T. POST - - - I I CALL r POST ANu�ORI I q1t, 2° caycRErE SLABGRAWL SPRGE�r7' 'SONO TUBE° PIER TYP. - m iiYp FouI— — — — — — J ( 6 MIL VAPOR BARRIER P.T. I ANGFIORm - ( - S'x3 CONCRETE DAMP PROOF BELOW GRAL 30. IO'x16' CONTINUOUS FOOfIt o j m I o 6'-O• 22'-0' � 1 � I � { ti. ~©i------ ------- -r--------------*--------------- 2-2x6 RIM JOIST 4x4 P.T. POST GALV. METAL POST ANCWOR 12' "SOW TUBE° PIER TYP. FOUNDATION PLAN CROSS SECTION SCALE: 1/4' - 1'-0' SCALE: 114' 1 h TOWN F�yBARNSTABLE LOCATION ��- ��.✓Gv�B /�� SEWAGE #a®e-;—006�5 VILLAGE �%£4 v���' ASSESSOR'S MAP & LOT 0 IN NAME&PHONE NO.140-4/W K_10 F 2_24— i3 6—L SEPTIC TANK CAPACITY v S'L LEACHING FACILITY: (type) (size) .3 ,9X 1,Z1z r NO. OF BEDROOMS BUILDER OR OWNER S �.f ,!� (f -'A t NTH"' PERMITDATE: v"z,/a/ �� 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 w. within 300 feet of leaching facility) Feet Furnished by S L �j C: oZ 113 0 D z A D 30" AsZ Postal CERTIFIED MAILTm RECEIPT •. •Qom, . Coverage .Provided) For ri - Q I F p Postage $ ,3 0 Certified Fee ReturnReceipt Fee / Postmark p (Endorsement Required) ��Q ®Cj�Pr42006 p Restricted Delivery Fee V � (Endorsement Required) Total Postage&Fees •!� LISPS p Sent p - --------S -- ( 0.J !�` ..............street Apt.No.; or PO Box No. t - IYI� Oa 63o41 :�iJune 2002 Certified Mail Provides: ■ A mailing receipt (esvanay)zood aunt boat;Wjod Sd ■ A unique identifier for your mailpiece ■ A record of delivery kept by the Postal Service for two years Important Reminders. ■ Certified Mail may ONLY be combined with First-Class Mail®or Priority Mail®. ■ Certified Mail is not available for any class of international mail. ■ NO INSURANCE COVERAGE IS PROVIDED with Certified Mail. For valuables,please consider Insured or Registered Mail. ■ For an additional fee,a Return Receipt may be requested to provide proof of delivery.To obtain Return Receipt service,please complete and attach a Return Receipt(PS Form 3811)to the article and add applicable postage to cover the fee.Endorse mailpiece"Return Receipt Requested".To receive a fee waiver for a duplicate return receipt,a LISPS®postmark on your Certified Mail receipt is required. ■ For an additional fee, delivery may be restricted to the addressee or addressee's authorized agent.Advise the clerk or mark the mailpiece with the endorsement"Restricted Delivery". ■ If a postmark on the Certified Mail receipt is desired,please present the arti- cle at the post office for postmarking. If a postmark on the Certified Mail receipt is not needed,detach and affix label with postage and mail. IMPORTANT:Save this receipt and present it when-making an inquiry. Internet access to delivery information is not available on mail addressed to APOs and FPOs. SENDER: COMPLETE THIS SECTION COMPLETE THIS SECTION ON DELIVERY ■ Complete items 1,2,and 3.Also complete . Si r item 4 if Restricted Delivery is desired. ❑Agent ■ Print your name and address on the reverse ❑Addressee so that we can return the card to you. B. Rec ived by(Printed me))or�! C. Date of Delive ■ Attach this card to the back of the mailpiece, L�]� i S s el��f.4 it) _��—� or on the front if space permits. D. Is delivery address different from item 1? ❑Yes 1. Article Addressed to: If YES,enter delivery address below: ❑No 3. Service Type ❑Certified Mail ❑Express Mail ❑ Registered ❑Return Receipt for Merchandise ❑ Insured Mail ❑C.O.D. 4. Restricted Delivery?(Extra Fee) ❑Yes 2. Article Number 7 0 0 5 116 0 100 poi 01'91` 19 4 9 (Transfer from service label) ry p PS Form 3811,-February 2004 Domestic Return Receipt 102595-02-M-1540 UNITED STATP .4% • Sender: Please print your name, address, and i`iP+-Tl"IF-is li071x PIUBLIC HELATH DIVISION E; TOWN OF BARNSTABLE 200 MAINSTREET HyANNIS, MASSACHUSSETS 0260' i Town of Barnstable. F tHE tp� Regulatory Services *' Thomas F. Geiler,Director • BARNSTABLE. •��' Public Health Division Thomas McKean, Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 October.4,.2006 Ms.Melissa Climents. 52.Glenwood Avenue. Centerville, MA.02632. ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE,.Title 5 The septic system owned by you located at 52 Glenwood Avenue, Centerville, M.A.was last inspected September 1"2006 by Robert J. Bortolotti, a certified septic inspector for the State of Massachusetts. The inspection of your septic system showed that your system"Failed"under the guidelines of 1995 TITLE 5 (310 CMR 15.00) due to the following: Backup of sewage into system due to overloaded SAS. Liquid depth in cesspool is, less than 6" below invert. You have 90 days from the date of the system failure to bring the system into compliance. If there are any questions about this reminder,please feel free to contact the Barnstable Health Department. BARNSTABLE HEALT DEPARTMENT Thomas A. McKean, R.S., C.H.O. Agent of the Board of Health a µ -\ COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS. DEPART.MENT OF.ENVIRONIVIENTAL PROTECTION TITLE S OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE,DISPOSAL SYSTEM FORM PART A CERTIFI CATI ON 0. Property Address: - Ue Owner's Name: Owner's Address: (( Date'of Inspection: Por, Name of lnspecto please'.print Y Company Name: _ P - Mailing Address: C� A 006(If Telephone Number:.-60g• Z—,7/" O",;99 CERTIFICATION STATEMENT 1 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 DE.P .approved system inspector pursuant to Section 15.340 of Title 5'(3.10 CMR 15.000). The system: Passes Conditionally Passes Needs Further Evaluation by the Local Approving'Authority Fails Inspector's Shlbatilre: _ _ Date: (19,� The system inspector shall subunit 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 ffi gpd or greater,the inspector and the system owner shall submit the report to>the appropriate regional oce=of the DEP.The original should be sent to the system owner and copies sent to the buyer, if applicable,'-and the approving authority. } Notes and Comments ****This report only describes conditions at the time of inspection,and under the conditions of use at that time..This.inspection does not address'how the system will perform in the future Under the same or different conditions of use. Title_5 Inspection Form 6/15/2000 page I Page 2 of l 1 OFFICIAL INS.PECTION.BORM—NOT FOR VOIUNI'ARYASSESSIVIENTS SLIBSURFACI SEWAGE'DISPOSAL SYSTEM INSPECTION]FORM PART A. CERTIFICATION (continued) Property Address: z) Jul / .11-C Owner:. Date of Inspection: Inspection Summary: Check? AA,,B°,C,D or E./ALWAYS'complete..all of Section D A. System Passes: I have not found any in which.indiicates that any of tile failure criteria described in 310:CMR h.303 or in 310 CNIR 15'.304 exist.Any failure criteria.not evaluated are indicated bel ow. Comments: B. System Conditionally Passes: One or more systern 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; N;yill pass. Answer yes,no or not determined(Y,N;ND)in the for the following statements. If"not determined"please explain.. The septic tank is metal arid:over 20 years old* or tiie septic tank(whether metal or not)is structurally unsound,exhibits substantial.infiltration or exfiltratioh or.tank failure is imminent:System will pass inspection if the existing tank is replaced with a.complying septic tank as approved b the Board of Health,P PP 1 �. Y *A metal septic.tank will ass inspection if't P P n > >s structurally sound not leaking_ P y ,. and if a Certificate of Compliance indicating that the tank is less than savailable.20.Y ears old i ND explain: Observation of sewage backup or breakout:or high static water level in the distribution box due to broken or. obstructed or due to pipe(8) a broken, settled or uneven distribution box. System x will pass inspection if(with approval of Board of Health): broken}iipe(s)are replaced obstruction.is removed distribution.box is leveled or replaced . ND explain: The system required pumping more thariA 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 B removed ND explain: Paee 3 of 11 " OFFICIAL 1NSPEC TiON FORM -.NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE.DYSPOSAL SYSTEM INSPECTION`FORM PART:A CERTIFICATION(continued) Property Address: Owner: 1 Date of'lnspection: C. Further.Evnlua.tion is Required by the Board.of Health: Conditions exist which require further evaluation by the.Board of Health in order to determine if the system is failing to protect public health. safety or the environment. 1. System will pass unless Board of.Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not'functioning in a manner which will protect public health,safety and the environment: Cesspool or privy is within 50 feet of a•surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2. System will fail unless the board of Health (and'Public,Water.Supplier,if any).determines that the system is functioning in a manner that.protects the public health,safety and environment: _ The system has a septic tank and soil absorption system (SAS)and the SAS is,within 100 feet of surface water supply or tributary to a surface water:supply. The system has a septic tank and SAS and the,SAS is within a Zone I of 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 aseptic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well".Method used to determine distance "This system passes if the well water analysis;performed at a DEP certified laboratory, for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided thatno other failure criteria are triggered. A copy of the analysis most be attached to this form. 3. Other: 3. Page 4 of. I 1 .. ' OFFICIAL INSP.EC,TIONYORI'vI: NOT F.OR VOlLUNTAR 'ASSESSMENTS SUBSURFACE SEWAGE I)ISP:OSAI .S: STEiMI IiSI'EC ION:FORM PART A. CERTIFICATIOd(continued) Property.Address .Owner' !` Date of Inspection: ® ,IAA � ( D. System Failure.Criteria applicable to all systems: You must indicate "yes" or"no"to each.of the.following for all inspections: Y-� No Backup of sewage into facility or system component due to.overloadedor clogged S"AS 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 t/ 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 %day flow Required pumping more than.4times 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 I. 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 501 feet of'a.private water supply well. Any portion of a cesspool or,privy is:less than 100 feet but greater.than.50 feet from a private water, supply well with no acceptable.water quality analysis..(This system passes if.the well water analysis, performed at..a.DEP certified laboratory, for coliform bacteria and.v:olatile organic.compou.nds indicates that the.well.is, free from pollution from that..facilityand the.presence of ammonia: nitrogen and tiitr.ate nitrogen is equal to or less than 5 ppM',.provi ied-that no.other failure criteria are triggered:A.co.pyof the analysis.mustbe attached to this form.] (Yes/No)The system fails. I have determined that one or more of the.above failure criteria.exist as described in 310 CMR.15:303,therefore the system fails. The.system owner should contact the Board of Health to determine what will be necessary to correctthe failure. ' E. Large,Systems: To be considered a large system the system must serve a.facility with a design flotiv.of 10,000 gpd to 15,000 hpd• You must indicate either"yes" or"no"to each of the following: (The following criteria apply to large systems.in addition to the criteria above) yes no the system is within 400 feet of a.surface drinking water supply _ the system is within 200.feet.of a tributary to a surface drinking water supply . — _ the system is located in a nitrogen sensitive area(Interim Wellhead.Protection Area—IWPA) or a mapped Zone II of a public water supply well., If You have answered".yes"to any question in Section.E the system is considered a significant threat, or answered "yes" in Section D above the large system 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. Page 5 of H OFFICIAL INSPECTION FORM—NOT FOR'VOLUNTARY ASSESSMENTS SUBSURF'ACE'SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: Owner: Date of!Inspection: ��' G Check if the following have.been done.You must indicate"yes or no" as to each of the followins: Yes. No /_ Pumping.information was.provided by the owner, occupant, or Board of Health ZWere 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) —11i 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: Yes no Existing information. For example, a plan at the Board of Health. Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(3)(b)] 5 1 t Page 6 of 11 OFFICIAL-!NSPECTIONTORMM.--NOT FOR VOLUNTARY,ASSESSMENTS = SUBSURFACE SEW;A:GE:DISPOSAL SYSTEM INSPECTION FORM PART.C. SYSTEM INFORMATION Property Address:. , ;� �-� Owner: / Date,of Inspection: K&A f ,J 00 ILOW`CONDITIONS RESIDENTIAL Number of bedrooms.(design): Number of bedrooms(actual).:� (/ DESIGN flow based on 310.0 R 15.203 (for example: 11.0 ap d x of bedrooms)-V 7 .. . Number of current residents:. Does residence have a garbage grinder(yes or no).: � Is laundry on.a separate sewage system e or no . if vesseparate 1? �. Y (Y ) [ � inspection required] Laundry system inspected (y .or no) Seasonal use: (yes.or no): Water meter readings; if av nlable(last 2 years usace(gpd)): Sump.pump (yes or no): O y q Last date of occupancy: J (l '► COMMERCIAL/IND USTRIALD Type of establishment:: Design flow(based on 310 CMR 15.203): gpd Basis of-design flow(seats/persons/s.gft,etc,): Grease trap present(yes or no);_ Industrial waste holding tank present(yes or no).- Non-sanitary waste discharged to the Title 5 system (yes or no): Water meter readings, if available: Last date-of occupancy/use: OTHER(describe): GENERAL.INFORMATION Pumping Records Source of information: Was system pumped as part of the ilispej!6o (yes or no):If yes, volume pumped: gallons w was quantity pumped determined? Reason for pumping: TYP/E 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 airy) _Irurovative/Alternative technology.Attach a copy of the.current operation and maintenance contract(to be obtained from system owner) Tight tank _Attach a copy'of thee�DEP approval .Other(describe): r az ' Appr ximme age gf all ,tvnocomponents, date installed (i k n) and source of in i�rmatiom �� Were sewage odors.-detected when arriving at the site(yes orno). ' Page 7 of H OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM.INSPECTION FORM PART C SYSTEM:IN ORMATION(continued) Property Address: �Q Date of Inspection: a 7 ,� /� �(��� BUILDING SEWER (locate on site plan) ® Depth below grade: .Materials of construction:_cast iron _40 PVC other(explain): _ Distance from private water supply well or suction line: _ Comments (on condition of joints; venting, evidence of leakage, etc,): SEPTIC TANK: (locate'on site plan) Depth.below grade: Material of construction:_concrete_metal_fiberglass_polyethylene —other(explain) If tank is metal list age:_ Is age confirmed by a Certificate of Compliance(yes or no):_(attach a copy of certificate) Dimensions: Sludge depth: Distance from top of sludge to bottom of outlet tee or baffle: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: How were dimensions determined: Comments (on pumping rerommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage,etc.): (locate on site plan) GREASE TRAP:A6 ' Depth below Grade:_ Material of construction:_concrete_metal fiberglass_polyethylene_other (explain): Dimensions: Scum fhickness: Distance from top of'scum to top of outlet,tee or baffle: Distance from bottom of scum to bottom'of outlet tee or baffle: Date of last.pumping: Comments (on' pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): 7 Page 8.of 1.1 OFFICIAL..INSPECTION FOlZIVy: NOT FOR VOLUNTARY ASSESSMENTS. SUBSURFACE SEWAGE DISPOSAL SYSTEM INSP;ECTION FORIVI PART C SY"STEM'INFORMATIO.N(continued) Property Address: Owner:* / a Date of Inspection: LA � (`�� TIGHT or HOLDING TANK:AL(tank must be pumped at time of inspection)(locate on site plan). Depth below grade: Material of construction: concrete metal fiberglass polyethylenQ other(explaiD);.. Dimensions: Capacity: gallons Design Flow: gallons/day Alarm present.(yes or no):. Alarm level: Alarm in working order(yes or no): Date of last pumping: Comments(condition of alarm and float switches, etc,): DISTRIBUTION BOX: if present must.be opened)(locate on site.plan) Depth of liquid level above outlet invert:. Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): PUMP CHAMBER:. �(locate on site plan). Pumps in working order(yes or no): Alarms in working order(yes or no): Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.): Pan 9 of 11 OFFICIAL INSPECTION FORM.—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFOW1 ATION`(continued) Property Address! S-�) t Owner: r Date of Inspection: o SOIL ABSORPTION SYSTEM (SAS): (locate on site plan,excavation not required) If SAS'not located explain why: 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; moo Ali et CESSPOOLS: Z(cesspool must be pumped as part of inspect ion)(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: n Materials of construction: Indication of.groundwater inflow.(yes or no): .Aj �C gm'ents (note condition-of soil. signs of hydraulic f i-ure, level of ponding, co nditio of vegetation, etc PRIVY: (locate on site plan) Materials of constniction:_ Dimensions: Depth of solids: Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.):. 9 Page 1,0.of 1.1 OFFICIAL INSPECTION FORM NOT FOR—VOIJUINTARY AS.SI;SSIVIENT.S:. SUBS RFACE SEWAGE'DISP 05:AL SYSTEM -INSPECTIOM FORA.1. PART,F SYSTEM INFORMATION(continued) Property Address: Owner <� Date of Inspection:. SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the.sewaQe 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. eci rbi 7 O � e; Pane 1 I of 1 l OFFICIAL INSPECTION FORI'v1 —NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORIM PART C SYSTEM INFORMATION(continued) Property Address: Owner: Date of In pecfion SITE EXAM Slope Surface water Check cellar Shallow wells Estimated.depth to ground water feet Please:indicate (check)all methods used to determine the hieh ground water elevation: Obtained from system design plans on record-If checked, date of design plan reviewed: Observed site (abuttitig propert),/observation hole within 150 feet of SAS) Checked with local Board of Health-explain: Checked with.local excavators, installers-(attach documentation) /Accessed USES database-explain: You must describe how you established the high groundwater elevation: f l a i C/C i v •' �o i 1] Permit Number: Date: Completed by: lot- HIGH GROUND-WATER LEVEL COMPUTATION Site Location: ,/� �j (� � �� .41171leLot No. Owner:. M56415V5rY Address: Contractor: Address: ✓ � j Notes: - ------- --- - ---- STEP 1 Measure depth to water table tonearest 1/10 ft. ................................................:...........................:.. :Date . month/day/year STEP 2 Using'Water-Level Range Zone and,Index Well,Map locate site and determine: Approprlate.index well....................... OWater_leveI range zone ..................................................... STEP 3 Using monthly report"Current Water Resources Conditions" determine current depth to 0,7 water level for index well ................... � 6 ........ month/year ...... . .. . .._,..-� ...--- ,....... _. STEP 4 Using Table of Water-level Adjustments for index well (STEP 2A), current depth to water level for index well (STEP 3), and-water-level zone (STEP 213) F �— determine water-level adjustment ................................:......................................................... Lfv 1 I STEP 5 Estimate depth to high water _ .:. by subtracting the water- level adjustment (STEP 4) from measured depth to water level-at site (STEP 1) ............... . .................................................... .................................. .. Figure 13.--Reproducible computation form. 15 I -el 6' X6 ' r 4Jd 7 Town of Barnstable P# 1 5 3 oaIME rod Department of Regulatory Services BABD18rABM : Public Health Division Date y MASS. 06 9. 200 Main Street,Hyannis MA 02601 AlF0 MPS Date Scheduled Time�h Fee Pd. Soil Suitability Assessment for Sewage Dis osal Perfomied By: Witnessed By: NS 9,, LOCATION & GENERAL INFORMATION Locntion Address 'f2 Cslsnw.+tim•� Owner's Name ��,(��� G1e 1.,1t„�}S CChwzwak((Q Address SZ ('e 1Cn W..,.i2 AWa Assessor's Map/Parcel: Iilujo tio, W.I L 101 Engineer's Name p Aft. W44d" Baal NEW CONSTRUCTION REPAIR Telephone#(M 77 --750 e / Land Use Slopes(%) Surface Stones Distances from: Open Water Body ft Possible Wet Area ft Drinking Water Well ft Drainage Way ft Property Line ft Other ft SKETCH:(Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands in proximity to holes) I o 01` S 5S51'30' E 123.00' o 01 �I Op0 P g etorte \ 8 00 g 3 c driveway PGA' N 23� • ` SEPTIC COMPONENTS LOCATED No,o ` PER SEWAGE# 90-252 Q0� COMPLIANCE DATE: 7-9-90 Cq L_° O��S to COPY OBTAINED FROM CLIENT o _ CESSPOOL SERVES AS SEPTIC TANK 27.3' N 'S1'30 W 125.00' ;p nKS o r r 41 �M d Parent material(geologic) r 1a r-m 1 Ou�wc3k Depth to Bedrock Depth to Groundwater: Standing Water in Hole: Weeping from Pit Face e- I. C—) Estimated Seasonal High Groundwater DETERMINATION FOR SEASONAL HIGH WATER TABLE Method Used: t7� Depth Observed standing in obs.hole: in. Depth to soil mottles: r— Depth to weeping from side of obs.hole: in. Groundwater Adjustment ft. -- index Well# Reading Date: Index Well level Adj.factor Adj.Groundwater Le el PERCOLATION TEST Date J211A6 Time I I Zo Observation Hole# -TpM� --- Time at 9" //_•'3 Depth of of Perc 6 y a Time at 6" Start Pre-soak Time a //.'Zee Time(9%6") �o Hrin End Pre-soak 11:35 Rate Min./Inch Z wlin /nt�i Site Suitability Assessment: Site Passed Site Failed: Additional Testing Needed(YIN) Original: Public Health Division Observation Hole Data To Be Completed on Back---------- ***If percolation test is to be conducted within 100' of wetland,you must first notify-the Barnstable Conservation.Division at least one(1)week prior to beginning. Q:H EALT H/W P/P E RC FORM (wZd 0(Q-031-1,) DEEP OBSERVATION HOLE LOG Hole# d. _ Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency. Gravel) D ' Zl� a .O�r al'- Z2" 22"-96" C Sure Grr.url I v`t'12 C m 4 re-&-memo, l0 2 .3a.1 DEEP OBSERVATION HOLE LOG Hole# _ Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling . (Structure,Stones,Boulders, ons'stency,%Gravel) �_3 4 Sc�ctl 10 a le arcQ j0t !d y9, S�f Z — DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Corsi is °6 Gravel) DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. n i tent %Gravel) Flood Insurance Rate Man: Above 500 year flood boundary No Yes Within 500 year boundary No/✓o Yes Within 100 year flood boundary No A Yes Denth 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? V/1445-5 If not,what is the depth of naturally occurring pervious material? Certification I certify that on #4 e -it 15rtS (date)1 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. Signature ',: r --m Date I t /I 2004 Q:H EALTH/W P/PERCFORM Commonwealth of Massachusetts ti`V M `* Executive Office of Environmental Affairs 4,9 PI© Department of ray g �99� Environmental Protectlo o � ,qB�F William F.Weld xe Goomw Arpe Paul Celluocl 6' $ ,Serbs LL Co mniaww SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A Q� CERTIFICATION Property Address: 2 �f-�?. � L Address of Owner. Date of Inspection: i/- ,�j— �$ (If different) Name of Inspector. Cow Name.Address d Telephone Number. �2"�. CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. The system: L-fasses _ Conditionally Passes _ Needs Further Evaluation By the Local Approving Authority _ Fails Inspector's Signature: � .:► , Date: The System Inspector shall mit a oopy of this inspection report to the Approving Authority within thirty(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 Department of Environmental Protection. The original should be sent to the system owner and copies sent to the buyer, if applicable and the approving authority. INSPECTION SUMMARY: Check A,B, C,or D: A] SYSTEM ASSES: I have not found an information which indicates that the m violates of the failure criteria as y system any defined to 310 CMR 15.303. Any failure criteria not evaluated are indicated below. B] SYSTEM CONDITIONALLY PASSES: One or more system components need to be replaced or repaired. The system,upon completion of the replacement or repair,passes inspection. Indicate yes,no,or not determined(Y,N,or ND). Describe basis of determination in all instances. If"not determined",explain why not) The septic tank is metal,cracked,structurally unsound,shows substantial infiltration or exilltration,.or tank failure is imminent. The system will pass inspection if the existing septic tank is replaced with a ponforming septic tank as approved by the Board of Health. (revised 11/03/95) I One WIMer Street a Boston,Massachusetts 02108 a FAX(617)MG-1049 a Telephone(617)292-SSW i')Primed on R.Kkd Paper ""Cr-,�Ivl SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(oontinued) Property,(,Address: y T Owner. Date of Inspection: J � Bl SYSTEM CONDITIONALLY PASSES (continued) --.Sew4p tickuop�or;breakout or high static water level observed in the distribution box is due to broken or obstructed pipe(s) or due tb a broken,settled or uneven distribution box. The sy#em will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed distribution box is levell or replaced The system required pum ' more than four tim a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval the Board of He h): b en pipe(s) replaced obst ion is moved CJ FURTHER EVALUATION IS REQUIRED BY E BO OF HEALTH: Conditions exist which require further ev tion by the B of Health in order to determine if the system is failing to protect the public health, safety and the environme . 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERM THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND 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 t marsh. 2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH (AND PUBLIC WA . SUPPLIER.IF APPROPRIATE) DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: The system has a septic tank and soil absorption system and is within 100 feet to a surface water supply or tributary to a surface water supply. The system has a septic tank and soil absorption system and is within a Zone I of a public water supply well. The system has a septic tank and soil absorption system and is within 50 feet of a private water supply well. The system has a septic tank and soil absorption system and is less than 100 feet but 50 feet or more from a private water su ply well,unless a well water analysis for coliform bacteria and volatile organic compounds indicates that the well is free m pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen•is equal to or less than 5 ppm. 3) OTHER (revised 11/03/95) 2 1� SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(Continued) Property Address: 5 Zyo Owner. Date of Inspection: /t— 2 v — j ZIP D) SYSTEM FAILS: I have determined that the syste a violates one or more of the following failure criteria as defined in 310 CMR 15.303. The basis for this determination is identified below. The Board of Health should be contacted to determine what will be necessary to Correa the failure. Backup of sewage into facility or system component due to an overloaded or clogged SAS or cesspool. Discharge or ponding of efYluenf•to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool. r Static liquid level in the distribution x above outlet invert due to an overloaded or clogged SAS or cesspool. Liquid depth in cesspool is less than 6" low invert or available volume is less than 1/2 day flow. Required pumping more than 4 times in t last year NOT due to-clogged or obstructed pipe(s). Number of times pumped Any portion of the Soil Absorption System, 1 or vy is below the high groundwater elevation. Any portion of a cesspool or privy is within 100 t of a surface water supply or tributary to a surface water supply. Any portion of a cesspool or privy is wit a Zone of a public well. Any portion of a cesspool or privy ' within 50 feet of private water supply well. Any portion of a cesspool o rivy is less than 100 feet t greater than 50 feet from a private water supply well with no acceptable water quality is. If the well has been yzed to be acceptable,attach copy of well water analysis for coliform bacteria,vo a organic compounds,ammonia ni gen and nitrate nitrogen. El LARGE SYSTEM FAILS: The following trite ' apply to large systems in addition to the criteria a e: The system se a facility with a design flow of 10,000 gpd or greater(LsEge System)and the system is a significant threat to public health and ety and the environment because one or more of the following conditions exist: s 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) The owner or operator of any such system shall bring the system and facility into full Compliance with the groundwater treatment program requirements of 314 CMR 5.00 and 6.00. Please Consult the local regional office of the Department for further information.. (revised 11/03/95) 3 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property dnma Ad Owner. Date of Inspection: Check if the following have been done: Ct'-Pumping information was requested of the owner,occupant,and Board of Health. is have been um for at least two weeks and the m has been receiving normal flow rates None of the system components pumped system vu�g during that period. Large volumes of water have not been introduced into the system recently or as part of this inspection. plans have been obtained and examined. Note if they are not available with N/A. A�Ast -the facility or dwelling was inspected for signs of sewage back-up. L1�he system does not receive non-sanitary or industrial waste flow &The site was inspected for signs of breakout. system components, excluding the Soil Absorption System, have been located on the site. l�The septic tank manholes were uncovered, opened,and the interior of the septic tank was inspected for condition of baffles or tees, material of construction,dimensions,depth of liquid,depth of sludge,depth of scum. C- The size and location of the Soil Absorption System on the site has been determined based on existing information or approximated by non-intrusive methods. The facility owner(and occupants, if different from owner)were provided with information on the proper maintenance of Sub- Surface Disposal System. (revised 11/03/95) 4 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C /SYSTEM INFORMATION Property Address: Owner. Date of Inspection: //- ;2 cu - `f FLOW CONDITIONS RESIDEiVTIAL. -� Design flow: ..1gallons Number of bedrooms: 3 Number of current residents: D Garbage grinder(yes or no): CV laundry connected to system(yes or no): Seasonal use(yes or no):—AVP Water meter readings, if available: last date of occupancy: �1 COMMERCIAL/INDUSTRIAL.• Type of establishment: Design flow: gallona/day Grease trap present: (yes or no)_ Industrial Waste ank present: (yes or no)_ Non-sanitary waste the Title 5 system: (yes or no)_ Water meter readings, if available: Last date of occupancy: OTHER(Describe) lacy: GENERAL INFORMATION PUMPING RECORDS and source of information: System pumped as part of inspectio : (yes or no)_ If yes,volume pumped: gallons Reason for pumping. TYPE OF SYSTEM SSiep�ticc ttaasnsk/diatrt'bution box/soil absorption system (.i'�ve �l rflow oesapool Privy Shared system(yes or no) (if yes,attach previous inspection records, if ally) Other(explain) APPROXIMATE AGE of all components,date installed(if known)and source of information: Sewage odors detected when arriving at the site:(yes or no) _ (revised 11/03/95) 5 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: S JF�trQ �./i2 Owner. Date of Inspection: iy_ SEPTIC TANK (locate on site plan) Depth below grade: Material of construction:_con metal_W_other(e:plain) y Dimensions: Sludge depth: Distance from top of sludge to bottom of outlet tee or Scum thickness: Distance from top of scum to top of outlet or baffle: Distance from bottom of scum to of outlet tee or baffle: Comments: (recommendation f umping, condition of inlet and outlet tees or baffles,depth of liquid level in relation to outlet invert,structural integrity, evidence of 1 etc.) GREASE TRAP:_ (locate on site plan) Depth below grade: Material of construction:_concrete_metal_F other(explain) Dimensions: ' Scum thickness: Distance from top of scum to top of outlet tee o e: Distance from bottom of scum to botto outlet tee or baffle: Comments: (recommendation f umping, condition of inlet and outlet tees or baffles,depth of ' uid level in relation to outlet invert,structural integrity, evidence of etc.) (revised 11/03/95) 6 s 1 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Addrew: 5 Owner. Date of Inspection: TIGHT OR HOLDING TANK:_ (locate on site plan) Depth below grade: Material of construction: concrete_metal_FRP_other(explain) Dimensions: Capacity: gallons Design flow:_ gallon/day Alarm level: Comments: (condition of inlet condition of alarm and float switches,etc.) DISTRIBUTION BOX:_/[ ,&---� (locate on site plan) Depth of liquid level above outlet invert: Comments: (note if level and distribution is equal,evidence of solids carryover,evidence of leakage into or out of box, etc.) PUMP CHAMBER (locate on site plan) Pumps in working order:(yes or no Comments: (cote condition of pump chamber,condition of Pumps and aPP ) (revised 11/03/95) 7 y SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATI O N(continued) Property Address: Owner. Date of Inspection: SOIL ABSORITON SYSTEM (SAS): (locate on site plan, k;acavation not required,but may be approximated by non-intrusive methods) If not determined to be pressen, lain: Type: leaching pits, number-_ leaching chambers, number:_ leaching galleries,number: leaching trenches, n h: leaching fields,n r, dimensions: overflow 1, number: Comme (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation etc.) CESSPOOLS- —'� (locate on site plan) Number and configuration: �'� C�rviir►��1'0� ,-/, - 5 ��� Depth-top of liquid to inlet invert: Depth of solids layer: Depth of scum layer: Dimensions of cesspool: Materials of construction: Indication of groundwater: i'IJv-vt�. inflow(cesspool must be ped as part of inspection) o eg- Comments: (note condition of soil, 9*ps of hydrauli failure, level of ponding, condition of ve tion,etc.) c 42 PRIVY:_ (locate site plan) Materials of construction: Dimension Depth of solids: Comment: (note n of soil,sign�ofhydmfic ilure,level of ponding,onnditao lion,etc.) (revised 11/03/95) 8 ' Il I I ti Ij I I I If II .1 1.111.1-i14 : , A. . ti.it-ut-AAff : SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: Owner. Date of Inspection: ! 2 O 9 6 SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent references landmarks or benchmarks locate all wells within 100' � . 1 Ca. A � DEPTH TO GROUNDWATER Depth to groundwater. /y TL feet U S meth of determination or approximate (revised B/15/95) 9 er : TOWN OF BARNSTABLE LOCATION a u.)O Aal-cR-- SEWAGE # TJ_LAGE ASSESS R'S MAP & LOT O ��g o. SEPTIC TANK CAPACITY LEACHING FACILITY: (type) r � (size) NO. OF BEDROOMS BUILDER OR OWNER PERMITDATE: eOMPLIANCE DATE: i Separation Distance Between the.- Maximum Adjusted Groundwater T b`e 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 l f L �} t MR t �k4ay &�f ' ! ie A-1 Avi-t t A* it01. Y'�. 10 � 'zy 2 g rncrtol r b Q' a. , Ell n S. r u d r1`#i. ,I II II J4tl t 't. - g�t r9V y10, I I IF T 11 - 1 t5 U Y fr. r 10' Gv pt:o ve t} F r i y I I a,L RA►rzR6 eT in 1' s y GE tD�; t� �"• — �. of ear f r< .mz � If>Y apa _ i R 15y I a, „R It b .. PROJECT /�, ... #. -CLEME.NTS RESIDENCE q S ARCHITECTURAL ` A �,���G���j ARG�I��>a,TIJ�L G �fl��� 52 GLENWOOD"AVE. CENTERVIiLE � � c:�ll n,-a I 0._4. 5_4. D•-4• i II. AlI I TTP ROOF 2.D'e•K'O.C. ,5F 1 I ♦ +'. I ,-.I a I Rao F.G.INSUL./6/6'PLYWOOD I, _ -• - .I, I .04. 7� 9 - ASPAALT THING/ 5544INGLES -1 FOUNDATON WINDp:I FOR VENTUATWN `.:' - ,,,1II000LLLJpJpJp��l . OPEN M SIR4IER I Q 1*ee - OC HERS AT I A". `S- t I' CIDBE IN VNNTER ... ,E7' JJB TRU55 /TOP PLATE _ ` 4 ,IANCT10N5 TOP. A 11 4 INSUL. W h 2xee sIG•oc TYP"EAVES p �� ..:I A (2)2x10• FASCIA/IxA SECOND MEMBER II c! SOFFIT by STRAPPING CONTIALUMNUOUS VENTING DOWNSPOUTS 1/r.'�/� I/2•GYP.BOARD O. b®FRIEZE BD,W/BED MOULDING -- ' YS-'. GIRDER 1 I -�,• - b 4 { 3 1,12'DIA.'STEEL COLUMN I - 0'2-x'-30'x12'CONCRETE PAD •oo" IIII - lPT2 PORCH -Rp_G.4b.NO.0 51I`- y ZU -W It. V TYP EXTERIOR Y1LLo EXT 5TU IG' c./ RnF.G.ILJBASEMENT 3/4'TOG OSB 1/2-OSB SNEATNING/ ALEDGEDBTFJ TrVEX Y . . - CONCRETE SLAB RI9 F.G.'a BA W Wi MIL VAPOR 2xe 2-2xbRIM JOIST 3-2xi2 GIRT- - i WZ4x4 O I 1 T'-9 CONCRETE T. IIt,'CONTINUOUS FOOTING CRAWL SPACE . aJJ P.GALV METAL POST AN(5-IOR W J L -- - -- - - - 12' S0N0 TUBE'FIER TTP. -71 :.it FII i�IF I I '! TYP F Mog ATICN WALL �_ U Q ... r. P"T.BILL AN6KXtED 4'-0'D.C. BN-r--r CONCRETE DAMP PROOF BELOW GRADE U R/ Q F- ..j IO'xK'CONTINUOUS FOOTING W V `3 W2'CONCRETE SLAB - ..; MIL VAPOR BARRIER ". LL A ., _ w O N ;GAIN.METAL'P05T ANCIgR , .:-- .-.: '...12••BONO TUBE'PIER TTP. .: ::. .... : V �-. Lo FOL7NDATION PLAN CROSS 5ECTION 4 . -S I .� � -�..�� 1 -:t SHEET�3 OF 3 x i sl A .:? ,JOB,>� OG21 8T: KW ol {b§. a_.:x'•.Ssy¢,.SI;R:s. �F'.o _� YR e- :J;art ��.'_•y�l. < Y :p Y, :.,, ',;r.?.,Y„ a. ram' ' L— THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Appliratiou for Disposal Works Toustrurtiou' lirrmit Application is hereby made for a Permit to Construct ( ) or Repair ( X) an Individual Sewage Disposal System at: 52 Glenwood Ave Centerville ................_-_ -- -•---- - .......................... ••••••-••••-•-•••---•-•••--•-•-•----•-•-••-•••••-•••--•-•••---••••---•.........•••........._--•--- Location-Address or Lot No. Rabbi t t _ ----...... ....... - ..... --......_.. -....---•-- Owner Address w J.P.Macomber Jr. Installer Address d Type of Building Size Lot............................Sq. feet Dwelling-X No. of Bedrooms---------3................................Expansion Attic ( ) Garbage Grinder ( ) 04 Other—Type of Building ............................ No. of persons---------------------------- Showers ( ) — Cafeteria ( ) Otherfixtures -----------------------------------•------------------••••••••••••••••---•••••------------------•-••••••-•-•-•••--...••-•••..................-••••••- W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity------------gallons 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 ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date........................................ W Test Pit No. I................minutes per inch Depth of Test Pit..................... Depth to ground water------.----------.--_-.. pr Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water--------------_------- 9 •---••-------------------••------•••--•-•••••-•-••-•••••---•-•-•--•-•-••••••••----•--------------••-•-----•-•------•-••---•-•••----•••-•--•-•--•--•---•-•--. ODescription of Soil---------------------------------------.Sand----&... rave�-------•-----------------------------•---------------------------•------------•------------ x W x -----•--------- ---------------------- ------•••-----------•-----•------•----------------------••----------------••----------------••----•••••-••----••-•------••••••••••••............•--•-•----•••- U Nature of Repairs or Alterations—Answer when applicable............................................................................................... ----------------------- gallon leacbinE...p t 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 Compliance has beepi issued�by the oar of health. Signed E/8/90 Da A lication Approved B ----------- _pp Pp Y t` [e---- Application Disapproved for the following reasons- ------------------------------------------------------------------------------------------ ............................. --------------------------------------- ........................................ PermitNo. /0—a.0....z�------------------------ Issued ......................................----------------- ------ Dare No._;7- 6 Fes$..$.... J 00_ THE COMMONWEALTH OF MASSACHUSETTS BOARD- OF HEALTH _ TOWN OF BARNSTABLE , ppliratiou for Dispuutti Works Tonstrur#intt 1hrutit Application is hereby made for a Permit to Construct ( ) or Repair (XX) an Individual Sewage Disposal System at: 52 Glenwood Ave Centerville ......... __...__.....--•................... ..... -------------•------------- ----••--•---••------••--............•--------------•---•------•-•......_.......--•---------------. D Location-Address or Lot No. -- . ^----......................... ......................................... ............................... W Owner Address ��Macomber Jr.___._. 1.4 -•-•--------------------------•------ ---•-�--------------•----------------- --------•-•--•-•-----.--•-•--•----- ----------ddre s.........-..----_--*.......--............_. � Installer ( Address Q Type of Building — ! Size Lot............................Sq. feet DwellingNo. of Bedrooms._._______3_____________________..........Expansion Attic ( ,) Garbage Grinder ( ) Other—Type of Building ............................ No. of persons............................`Showers ( ) — Cafeteria ( ) Q' Other fixtures ------------•---••-••-------•--- . W Design Flow............................................gallons per person per day. Total daily flow..................................._..........gallons. P: Septic Tank—Liquid capacity------------gallons Length................ Width................ Diameter---------------- Depth................ Disposal Trench# �N0..................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No..................... Diameter-------------------- Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. I................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........................ ----•--•-----------------------•--•-----•----------•-----...........------------•-----------.....---......................................................... O Description of Soil--------------------------------------- W Sark=....h G:z* v e l---------------- + --------------- U ......................................................................................................................................................................................................... W ------------------------------------------------•------------------------------------......------------•-----------------------------•-----------------------------------........................------ U Nature of Repairs or Alterations—Answer when applicable............................._..__.__...__.................._._..................__._.._.....__. ........................ ------------------------------------------------•---------------------------...._._...........-•---- Agreement: v The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with thelprovisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. ' P Signed .... Dat { Application Approved BY ....--- zw��il ` - _ ..-,.. <s,P.............. �lr� '? Application Disapproved for the following reasons- -------------------------------------------------------------- -----------------------------------------------------................. -------------------------------------------------------------------------------'----------------------------------------------------------------------------------- .................................... .................. ............ e� Date Permit No. 0..Z- ------- Issued -------------------- -----------------.----------------- ----- ...... ..b...v. i Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE (gertifirate of Compttttztr.e- �' � . �' ��� � `• THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired (NA) J.P.Macomber Jr. ......................... ...........................................................................!.--1.----- bY ------ --------------------------------- --------------- .................................... - f c J Installer�Y L� 1 at 52 Glenwood...A.v..e.---C.ente�^v.. �1,e. f.. - - "� --------- ---/ has been installed in accordance with the provisions of TITLE 5 of The State Environmental Code as/described in the application for Disposal Works Construction Permit No. ... ........... dated .- f�.cP 1.����.............__-- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATEGy �----------------------------------------------- Inspect r_._,t.... /.. ------. �... �'r''' ` THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE FEE.- 3 ............ �i��r�a�tt1 urk� ��att,��rttt~tiuu �rrmi� Permission is hereby granted_...sl, ?. ..............•-•---•------------•----•--------------............-----.............----...... to Construct ( ) or Repair.(X ) an Individual Sewage Disposal System �, at NO 57 f�s��r..�r+� lA�ra �!crA a��>i la !. ._ 1* Street t / as shown on the application for Disposal Works Construction Permit N 50,;_:_dZ Dated. ................... ...........................................,/.4 n�.., - ------ V DATE... /�' ....................................................... Board of Health FORM 36508 HOBBS&WARREN.INC..PUBLISHERS - r LOCUS AREA IS COMPRISED OF, ,�. ,: •:.. , � .a � .�; � ;,,:. : � ? 'i ASSESSORS MAP 190 PARCEL 119 �. • r G. LOT 27 0 PI 0 - � - LC 3 545 A (sheet 2) � DEED BOOK C 144893 ' \ .l / tic a < ilea' <. OWNER/APPLICANT: MELISSA L. & ELIZABETH A. CLEMENTS / 52 GLENWOOD AVENUE CENTERVILLE MA 02632 f. • •.. \ - d� / ZONING INFORMATION. ZONING DISTRICT: RC rratin W /D y AP Aquifer Protection Overlay District , • r- � RPOD Resource Protection Overlay District � :,:: .,,:<�� � ^•. fie. ram.. .� • LI.� - \ CURRENT MINIMUM ZONING REQUIREMENTS MINIMUM LOT AREA = 87,120 SF RPOD) LOCUS MAP MINIMUM LOT FRONTAGE = 20' ( • / •�� / MINIMUM LOT WIDTH 100' Scale: 1 200� /C., FRONT/SIDE/REAR SETBACKS _ 20VIOVIO 59 ►- / ' �. GENERAL NOTES BRB FND 100.1 1. A TITLE SEARCH HAS NOT BEEN PERFORMED FOR THIS SITE. IF DETERMINED c ,x1 PROJECT BENCHMARK TO BE NECESSARY'A TITLE SEARCH SHALL BE PERFORMED BY OTHERS. Z ,� 4. MAG SET .O EL - 100.0' 2.) THE PROPERTY LINE INFORMATION SHOWN IS BASED ON CURRENT AVAILABLE RECORD ASSUMED DATUM INFORMATION CONSISTING OF PLANS, DEEDS AND LINES OF OCCUPATION. THE EXISTING FEATURES SHOWN HEREON WERE OBTAINED FROM AN ON THE GROUND FIELD SURVEY PERFORMED BY BAXTER NYE ENGINEERING & SURVEYING ON JULY 19-20 006 Z' 100.0 Q� ' Z 3.) COMMUNITY PANEL NUMBER: 250001 0015 C THE FLOOD INSURANCE RATE MAP DEFINES THIS AREA AS ZONE C. a / 99.9 AREA OF MINIMAL FLOODING. �o 0 4,) ENVIRONMENTAL 'INFORMATION: K_ 10 �H FND • SITE IS NOT WITHIN A STATE APPROVED� ZONE ll GROUND..WATER RECHAF'GE • PROTECTION AREA '110l : . UTILITY INFORMATION . . • '. ., �, • •< THE CONTRACTOR SH - - -ALL CONTACT'DIG SAFE (AT,1 888 DIG SAFE AND UTILITY 100.E COMPANIES TO LOCATE ALL EXISTING UTILITIES, AT LEAST 72 HOURS PRIOR TO THE START - x <.;, OF CONSTRUCTION. THE LOCATION OF EXISTING UNDERGROUND INFRASTRUCTURF, UTILITIES, - loo.� ,-«,. :° c� CONDUITS AND LINES �ry .;�P a },. 100,1C x 1 1,1 100,7 }, _- ARE SHOWN IN AN APPROXIMATE WAY ONLY, MAY NOT BE LIMITED TO o 10+9 �� tJ,.+ ;- THOSE SHOWN HEREIN AND HAVE BEEN RESEARCHED BASED ON THE AVAILABLE UTILITY RECORDS NOTED HEREON THE CONTRACTOR AGREES TO BE FULLY RESPONSIBLE FOR ANY a ` AND ALL DAMAGES WHICH MIGHT BE OCCASIONED BY THE CO R' FAILURE x 100,E �� `�` �`�D• NTI?ACTO S LURE TO } LOCATE SAID INFRASTRUCTURE AND UTILITIES EXACTLY. IF FIELD CONDITIONS DIFFERS FROM x 100.9 `�? ;'' ti-� PLAN INFORMATION THE CONTRACTOR SHALL 17FY TH x o0,6 ti TEST PIT I� s NO E ENGINEER IMMEDIATELY FOR 41 POSSIBLE REDESIGN. 00,7 x 100.8 z x 101,1 h 100.0 APPROXIMATE LOCATION OF SEPTIC SYSTEM COMPONENTS PER SEWAGE 190 252 ., ^ D SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM (9-15-06) - INFORMATION u Tip ITT' PULE x;,100, SUPPLIED BY CLIENT. _645%3 100,1x 14 9 101.8 k TEST PIT �. *? �?n. PROPOSED NEW CONSTRUCTION ' 0 � • WATER LINE AND APPURTENANT INFORMATION IS BASED ON A PLAN BY CENTERVILLE- L o . - >C 101,8 OSTERVIL.LE-MARSTON MILLS WATER SYSTEMS DATED: 10-25-2006 fax / tr, 11 x 1, BREEZEWAY (fox)1o1,9,, x >oo. % 22 x 22 ADDITION / ��., ' CB/DH FND • ELECTRIC LINE INFORMATION PER NSTAR ELECTRIC PLAN DATED: 10-25-2006 E�, � 6 x 20 PORCH WITH STEP 101. OVERHEAD LINE FROM UP 645 3 X x 101,4 (x .d04 / CP `. •(�� 10 101,7 t_ 0 1 27 L. C. Pi.:3t.,545 101,E ti x 10 ;41 0L6 15 uC1rJf SO. -,. 9 x:101.2 i`�S'1 �� ,• �, 101.9 k; / 102.3 0,34-E ACRES 100.3 4► CB/DH FND 101.2 3 �•, t �v r __•; 102,1 101.9 ,./�i... \ • - t7 \� x x . . y ,t ,, , �- x 102,E CONSTRUCTION NOTES. ,\ ^, f 1. PRIMARY BENCHMARK . MA NAIL IN„� :• �• � .;. � _ ) G L ROAD. ELEVATION 100.00 (ASSUMED) / 1► 101,E �w - C! 101. O 102.1 r ry � -2. ALL SYSTEM COMPONENTS / -12,6 x ) SHALL BE INSTALLED IN ACCORDANCE WITH TITLE 10' . �n2,4 V OF THE STATE SANITARY COD DATED MARCH o , E TED C 31, 1995, AS AMENDED , a THROUGH THE DATE OF THIS PLAN dt ANY LOCAL RULES do REGULATIONS / x 102.5 - ,k o . 102.4 .c4' c,' APPLICABLE � ,x��t �-�-� 7CESSPOOL s�,o x loz. ANY CHANGE T / 2 � ,,, - 3.) GE 0 THIS PLAN MUST BE APPROVED IN.WRITING BY THE 021 ENGINEER. ELEVATION INFORMATION MUST-NOT BE CHANGED WITHOUT WRITTEN PRIOR APPROVAL BY THE ENGINEER. c 4. WHEN CONSTRUCTION IS COMPLETED NOTIFY THE BOARD F ) E 0 HEALTH AGENT i 02,1 AND DESIGN ENGINEER FOR INSPECTION AT LEAST 48 HOURS PRIOR TO __ x 102,3 BACKFILLING.' THE SYSTEM SHALL` NOT BE BACKFIL.LED UNTIL INSPECTED AND APPROVED. 5. ALL DISP OSAL SYSTEM PIPING TO BE 4 SCHED 40 PVC. UNLESS OTHERWISE NOTED HEREIN. •, 6, 1F UNSUITABLE MATERIAL IS ENCOUNTERED BELOW THE TOP OF SAS PEASTONE LEV V » » .• ( E ), EXCAVATE AS NOTED TO THE C,HORIZON", FOR A HORIZ. DISTANCE OF 5 SURROUNDING THE HIN Fl LEAC G ELT?, AND REPLACE WITH t CLEAN SAND PER 310 CMR 15.255 TO THE TOP ELEVATION OF THE SAS. 7.) INSULATE ALL PIPES AGAINST FREEZING AS REQUIRED WHEN LESS THAN 3 OF COVER. / B.) THE SEPTIC SYSTEM DESIGN DOES NOT INCLUDE GARBAGE GRINDER DISPOSALS. 9,) UTIO THE CONTRACTOR SHALL CONTACT DIG SAFE (AT 1-888-DIG-SAFE) AND UTILITY COMPANIES TO LOCATE ALL EXISTING UTILITIES, AT LEAST 72 \ 1b, \' HOURS' BEFORE THE START OF CONSTRUCTION. THE CONTRACTOR SHALL DETERMINE THE EXACT LOCATION, BOTH HORIZONTALLY AND VERTICALLY, OF ALL EXIS71NG UTILITIES BEFORE THE START OF ANY WORK. THE LOCATION OF EXISTING UNDERGROUND UTILITIES ARE SHOWN IN AN APPROXIMATE WAY ONLY, / MAY NOT BE LIMITED TO THOSE SHOWN HEREON AND HAVE NOT BEEN INDEPENDENTLY VERIFIED BY THE OWNER OR ITS REPRESENTATIVE THE \ r CONTRACTOR AGREES TO BE FULLY RESPONSIBLE FOR ANY AND ALL DAMAGES ` . WHICH MIGHT BE OCCASIONED BY THE CONTRACTORS FAILURE TO LOCATE THE UTILITIES EXACTLY. IF ELEVATION INFORMATION DIFFERS FROM PLAN INFORMATION, THE CONTRACTOR SHALL NOTIFY THE ENGINEER IMMEDIATELY FOR POSSIBLE REDESIGN. AT UTILITY CROSSINGS, VERIFY IN FIELD THE LOCATION / \ INVERTS OF ELECTRIC, GAS, TELEPHONE do DATA/COMM AND RELOCATE IF CONFLICTING WITH PROPOSED INVERTS PER THE ENGINEERS DIRECTION. THE CONTRACTOR SHALL PRESERVE ALL UNDERGROUND UTILITIES AS REQUIRED. \ \ EXISTING CESSPOOL 10.) AND LEACH PIT TO BE PUMPED AND FILLED WITH SAND OR REMOVED. i SOL Loss P• 11,631 DATE 12/v2M LEACHM AREA REQUIREMENTS NITROGEN LOADING .LIMITATION. ... NIA 12 BARNSTABLE RESIDENTIAL 4 x BEDROOMS FINISHED GRADE µ SOIL EVALUATOR: BOARD OF HEALTH AGENT. x 110 cPD/BEDROOM » - \ \ \ ,\ .\ ,\ �y� STEPHEN A. WILSON, P.E. DON DESMARAIS TOTAL DESIGN Flow = 440 cPD 36 MAX. 9 IN. ����/COMPACTED F1LL,.������� 2" LAYER DOUBLE WASHED . . . . . . . . . , . . . T P F D TEST PIT 1 TEST PIT 2 GARBAGE GRINDER (NOT INCLUDED) N/A • . . . , . , . . = 0 O CHAMBER STONE ,1/8 TO 1/2" LO OR GEOTEXTILE FABRIC Q= co G.S.E. - 101.2 G.S.E. -- 1L)1.5 PERC RATE = 2 MIN. / INCH (CLASS 1) PIPE INVERT » 0" 0" LTAR = 0.74 GPD/S.F. 3 4" TO 1-1 2 N 24 { / / AP , 7.5 YR 3/4, SANDY LOAM " AP , 10 YR 2/1, SANDY LOAM MIN. LEACHING AREA OF S.A.S. REQUIRED: ' DOUBLE WASHED EFFECTIVE STONE c� DEPTH 8' ELEV 100.5 3" ELEV 101.3 440 GPD/ 0.74 GPD/S.F. = 595 S.F. MIN. PROPOSED M. i B , 10 YR 5 8, SANDY LOAM B , 10 YR 5/8, SANDY LOAM SE SYSTE . 4N PLASTIC LEACHING CHAMBERS 4 4 4 , » » WITH 4 OF STONE ON SIDE do 2 OF STONE AT ENDS 22 ELEV 99.4 22 ELEV 99.7 SECTION SIDEWALL AREA (36 + 12 2 x 2 .DEPTH - 192 SF NOT TO SCALE C1, 10 YR 546, SAND do C 1, 10 YR 5/4. SAND BOTTOM AREA (36 x 12) - 432 SF GRAVEL L TOTAL''EFFECTIVE LEACHING AREA = 624 SF ' ACHING CHAMBER » »PLASTIC LE R DETAIL 96 ELEV 93.2 96 ELEV 93.5) - - ( ) _ r_ � _ �( -- . _ S�,rEM DESIGN cAPAcrIY - � F , T� S2 S x 0.74 GPD SF - 462 GPD C 10 YR 613. MED. COURSE / . C 10 YR 6/6, MED. COURSE SEPTIC TANK SIZING: '440 GPD x 2 SAND SAND 200�L 880 GAL USE 1500' GALLON TANK INIMUM) 144" (EL.EV 89.2) 144» (El EV 89.5) DIST. LINE IN NO WATER AT 144" (ELEV 89.2) NO WATER AT-144 (EL.EV 89.5) PERC 0 64" ELEV 95.9 » ( ) SITE LOCATION: 3/4 -1-1/2 RATE= 2 MIN/IN UBLE wASHED STON 52 Glenwood Avenue Centerville Ma. 02632 2 32 2 DESIGN SCHEDULE ELEVATION r 36 PREPARED FOR TOP OF FOUNDATION ELEVATION 103.2 _ PLAN VIEW SEWER INVERT AT FOUNDATION EXISTING 100.5 • . (EXISTING) Melissa L. & Elizabeth A. Clements NOT TO SCALE` SEWER INVERT INTO SEPTIC TANK 99.5 SEWER INVERT OUT OF SEPTIC TANK 99.2 TITLE SEWER INVERT INTO DISTRIBUTION BOX 99.0 Septic System Repair plan SEWER INVERT OUT OF DSMIBU71ON Box 98.8 Proposed New Construction SEWER INVERT INTO LEACHING SYSTEM 98.6 p Ln TYPICAL SYSTEM PROFILE BOTTOM of LEACHING SYSTEM 96.6 BAXTER NYE ENGINEERING & SURVEYING TOP OF SET ALL THREE COVERS To WITHIN NOT TO SCALE WATER TABLE: NONE OBSERVED AT EL.. 89.2 FOUNDATION = 103.23 6" OF FINISH GRADE Registered Professional Engineers and Land Surveyors o _ Hyannis, Aft 0 4 ' GRADE ova raWc = 102 4t FlI�Im 78 North Street 3rd Floor Massachusetts 02601 �.�- � GRADE OVER LfACHM TRENCH = 1012f r w GRADE OVER ;D. BOX = 1024f ; ,� 4 CWAM FILL Phone - 508 771-7502 Fax 508 7 1- 22 A KPH SEr COVER TO WITHIN 9' mtn Coro► 7 76 � � INSTALL ONE INSPECTION PORT IN • ., �. 3" mm. 6" OF FINISH GRADE ACCORDANCE WITH 0 r SCH 40 PVC :y..•.. .... •. 38' (max) Corer FIRST 2' TO 2• LAYER 1/8%llf MANUFACTURERS DOUBLE WASHED STONE N 20 0 - 20 40 INV� t00.S 6" RECOMMENDAMONS ci 10" Mll1. -'� ., - BE LEVEL OR GEOIDRNE FABRIC 4 CULTEC [`IYPE� , INV IN- 99.5 - R PVC -TNV OUr� 99.2 W IN- 99.0 +' .i LEACHING CHAMBERS •_ SCALE IN FEET ,tom a CHAMBER INV ++� Z� GAS BAFFLE .� • f -� a 14" 6• SUMP our- 9" SCALE: 1 = 20 o REWFORCED CONCRETE '1 r•.,�`'•,•,.,a 1 :;'r ;• j., N .� t.► ♦ WT. DATE: 12-12-2006 s• •::- ..r. •. • Alf W �� ., , •� .:,,. :.•• .• . , ti~ ! a � 3/4 TO 1-1/2 DOUBLE ,. ,• W 1 o sroNE SW BASE wA� 2. SAW 111210 7 ADD PIPE REVISE INVERTS LEVEL . STOW E].EV-9&6 1. JCH 12/4/0 ADD TEST PITS 5' MIN HORIZON-EXISTING SOILS �CONSTRUCTION NOTE 6 BE REMOVED TO THE c N0. BY DATE REMARKS WOO GALLON OIIE-COWAffM*NT SEPTIC TAW .HEREON cn DRAWNire IDESIGNED CHECK BY: MWE DRAWING NUMBER TO BE INSTAtED ON A LEVEL STABLE BASE NO GROUNDWATER OBSERVED ELEV. 89.2 SEPTIC TANK TO BE WSPECiED & CLEANED ANNUALLY NIS DISTFAYMON BOX SOL'ABSORPTION SYSTEM (SAS) LO 0: 2006 2006-037 SURVEY worksht 2006-037SP.dw O TO BE MALLS ON A LEVEL STABLE BASE LEACFNO CHAUIOER (TYPICALI 2006-037 o � O 0