Loading...
HomeMy WebLinkAbout0380 HUCKINS NECK ROAD - Health 380 Huc:-kins Ne,%-,k Road Centerville A= 233-032 UPC 12534 0.2-153L0 , No. ` J Fee V HE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS 01pprication for Miopo5a[ *pftem Conttruction Permit Application for a Permit to Construct( )Repair(° )Upgrade Abandon( ) ®Complete System ❑Individual Components Location Address or Lot No. /�i��+�/� O ner's Name,Address and Tel.No. Assess arq p cel /1I 51d�U16�� r �(i Installer's Name, ddress,and Tel.No. Designer's Name,Address and Tel.No. 06' 0� ,' Z7COdl�s�` �Owo Cale Type of Building: Dwelling No.of Bedrooms Lot Size Z_ sq.ft. Garbage Grinder Other Type of Building o.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow �J Z gallons. Plan Date ✓ umber of sheets f Revision D e Title C?' $'fl `�'✓ .UG?Cs��Z�F', Size of Septic Tank `✓—C� ��LY�'� /i DDO 40/ ype of S.A.S. //'2 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 place the system in operation until a Certifi- cate of Compliance has been issued b this oar f He lth. /f Signed Date l Application Approved by Date Application Disapproved for the following reas s Permit No. Date Issued Fee THE COMMONWEALTH OF MASSACHUSETTS* Entered in computer: Yes .,ry. . ' a PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS' 2ppricat on for Migponl *p5tem Cottgtruction 3permit 4 Application for a Permit to Construct(` )Repair(' ).Upgrade(v)Abandon(. ) ©Complete System D Individual Components Location Address or Lot No. Owner's Name,Address and Tel.No. Assess ' apwarcel Installer's Name, ddress,and Tel.No. Designer's Name,Address and Tel.No. ' of Type of Building: j Dwelling No.of Bedrooms Lot Size Z✓ sq.ft. Garbage Grinder( ` Other Type of Building / E' /� o. of Persons Showers( ) Cafeteria( )' Other Fixtures Design Flow gallons per day. Calculated'daily flow 3 7 / gallons. Plan Date �l JT /pS ,``Number of sheets l Revision 134 Title ,� S/i'`e "Wow � T .-Y 8"0 Size of Septic Tank / 5'� Q'�i'/� �G��'l ype of S.A.S. • '� - Description of Soil Nature of Repairs or Alterations(Answer when applicable) • i . t Date last inspected: k 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 Certifi- cate of Compliance has been issued b his oard- f He lth. P Y Signed ✓ 1 0 Date ��� Application Approved by Date Application Disapproved for the following reas s Permit No. Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTI Y, that the O -site ewage isposal System Constructed( )Repaired ( ) Upgraded Abandoned ).bpi ©� � ���/ C ate a constructed in accordance with the provisions of-Title 5 and the f1o�Disposal System Construction Permit No. � dated Installers r"` Lo P �' Designerkh The issuance of this , t 1 not be construed as a guarantee that th sy'� s�t� Il u cti n as designed. Date t� Inspector No.�v Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION BARNSTABLE., MASSACHUSETTS ;Diopoal *p.5tem Cow9tr ction 3permtt Permission is hereby gr nted.to Con t ct( )Repair( )U grade )Aba�ndo. ( ) System located at � �/G, / , 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:Const c io must a completed within three years of the date of this Date:_._ � /D O 7 Approved by i i TOWN OF BARNSTABLE n LOCATION 390 �G/G� 'S .-V&C4'1a4�,SEWAGE # ` VILLAGE C e4 I\ I-IfLl1 C- ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY lJr®® �D� 1,✓�Lf G�14' ��/ LEACHING FACILITY: (type) Z"�40 / -Ckl . (size) NO.OF BEDROOMS .� BUILDER O OWNER> �e t® PERMTTDATE: /� O� .. COMPLIAN DATE: �1 I9/O S (>pJrra4c�ed —T Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by 7® ,6 3 63 � —LI � o 2 N TO OF BA.RNSTABLE 'LOCATION /f PCl-1 SEWAGE # cR VI"LLAGE ��� (,I l ASSESSOR'S MAP & LOT-2y-71 INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY: (type) A six NO. OF BEDROOMS BUILDER OR OWNER Q PERMIT DATE: X LANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility, Feet Furnished byy`�� I_ _ ��o� �"I—�� — -� �� . r / -� � � F a _ , .� ` 7 ... FROi—':down cape engineering inc FAX NO. :15083629880 Sep. 12 2005 10:21AM P1 Town of Barnstable dF"'e''0 Regulatory Services c Thomas F. Geiler,Director BA" ffrABLE. Public Health Division Thomas McKean,Director 200 Main Street, Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Installer& Designer Certification Form Date: ll2ll�J Sewage Permit# _06J95_-3 Assessor's Map\Parcels F Designer: _ 1 Installer: Address: Address: / ' 10 0X �l1�� J � C l/ 161 r p 'tea .On � O was issued a permit to instal a Q (date) (installer) 4 I r� septic system at e 17 LAZ �-o (� CR.44o#sd di e on a esgn d awn by (address) N.) dated 0 /)4- ( signer) ►/ I certi-ty e se that the septic stem referenced above was installed substantia y accordingtto p the desigm, which may include minor approved changes such as lateral rblocation of the distribution box and/or septic tank. 1 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. _1H OF&fgS9 $ ARNE H OJALA A(Insta2l'2�'s Signature) U civil. cn No. 30792 o UQ. S�ONAL EN (Designer s Signature (Affix ec's Stamp Here) E,LEASE RETURN TO BARNSTABLE PUBLIC HEAL H DIVISION. CERTIFICATE QF COMPLIANCE WILL N 'I' BE IS-uE;D UNTIL 80TTJ THIS FQRM AND ' 1 MLT CARD ARE, RECEIVED BY THE HARNSTA13LE PUBLIC HEALTH DIVISIQ14. TH YOU. Q:Health/Septii/Designer Cettitication Form 3-26-04.doc J,l� U TC'L. 4. 2CO5 (FRI) 06:99 C7 THRvILLE FIRE PACE. 2 Fire Department retains original application and issues duplicate as Permit. .P2lJ/Xc��T72glL��?�4 %fiJ�4' B'n'UG•t P' �c�G27 �CY�[_7 G?rr..�J '!r6'Lr4�PL1��i Ty APPLICATION and PERMIT" for.storage tank removal and transportation to approved tank uispcsal yard in accordance, with the provisic.r.s of M.G.L. C,tapte, 148, Section 38A, 527 'MR 9.CjG, aopiication is hereby made by: fill ro`_Z, s cl.c X cZ Cv per— w 44 Tank Owner Name(please print) X "�iq.�aturc nr apuymq yr parmu1 Address_. 09 _1 IE I V r Ile. / s Sr rsviri Srar _rl .. i 12­ Company Nam ��rn e n c»c� +r / l eX 4�st� �1�C i aUi 1 .� �! CG, (or Individua; Address Addros3 . .4 !Ut?WM; Pam 'et(Q►r� -� ttryfi e)p 1 I $ignsture(H appfying for permit) Signature(if apply ng tqt permit) U iFC1 Certified then _- _ 9-f'FC1 Certified. O LSP 0 ✓tt7er _ Tank Location o y' ytr' fy 5t i i - 511oer Aidnese — T .... Ch r 'tank Caoacit}r{gaifons} Substance Last Stcred ^ + tom Tank DimcnSiGns (diameter 16r,Gt111 —/..40 e,54 J Remark_: i _ I l Firm transporting was,e Stale sic. # � p I hazardous wane manifest# i�.4ERA, <- 1 • I / f Approved tank.disposal yard�,���,. 7 Tank-yarn 4 3 D Type ct inert gas �"c''l Tank yard address I City or Town Ce.r.terville __ FD1D# 01920 Date Qf`ssue Jul y 13. 1Q04 _ _ Date of expiration __-Ju7y2005 { Dig safe approval r,umGer. rs� 0-ocal � aig Safe I-oil =ree_rel. Number-80a-32? 4sw+Signature J l itle of O ficer granting pert�.itAuer ramevsii;s}sand FprrnFP-29OR signed b Fire Dept. to UST Rte uiatory Compliance iJnit,One...ahburton Place, _ Roam 1310,Boston, IAA 021 08-1 61 a. =P-292(revised 9F'8) - ' Tow ofBarnstable / md�Map/Parcel.. 2....— / d�j;� �, ' � Mealth Department HeaCthS,ystem '' j Mapes/Parcel 233032 � # Tank Nbr 01 � Tag,Nbr 00000 , 1�stal[ d Locat,ion� 'B � Test Not►fication Date 06/14/1993 Removal Not►ficaUon Da e , � lemoual j " 04/19/1990 y•//ii�% �' ,�i✓jcj' /j%j�jjj �' Fuel S#oced r FO "' Fuel Storage Reason H N f Capacity Cons ruCt�►On J leak Detect on Cathodic Detectan �StorageTan Info 00000C A�dd►t►ona1©eta ls' �' ABANDONED 4/90 380 Huckins Nec hnge� � � � ► k ; '� �� °F THE tp� Town of Barnstable 9MUM„,�M Regulatory Services 1639. ' Thomas F. Geiler,Director ArFD MA'S A Public Health Division Thomas McKean,Director 200 Main Street,Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 July 13, 2005 Mr Frederick Lee 188 Walnut Ave. Roxbury, MA 02119 NON-COMPLIANCE WITH STATE ENVIRONMENTAL CODE TITLE V. The septic system owned by you located at 380 Huckins Neck Road, Centerville,MA was inspected on May 16th, 2005 by Mark Poselli, a certified septic inspector for the State of Massachusetts. The inspection of your septic system showed that your system has Conditionally Passed under the guidelines of 1995 TITLE 5 (310 CMR 15.00)DUE TO THE FOLLOWING: Portions of the SAS, cesspool or privy is below high ground water elevation. Also, a trench has been added without permit. You have two years from the date of the system inspection to bring the system into compliance. If there are any questions about this reminder,please.feel free to contact the Barnstable Health Department. BARNSTABLE HE CH DEPARTMENT r y. COMMONWEALTH OF MASSACHUSETTS Y EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION 2 0 3l TITLE 5. OF INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A r Ne CERTIFICATION • Property Address: ��0 7 tl✓i� f ck Ad vi a6.3dt Owner's Name: re, Irk c x Owner's Address: Date of Inspection: 0 ZZ a Name of Inspector:(please pripi) Li✓!r o P� Company Name: Ali � 0 � �G � L;,I w Mailing Address: o ; Zx Telephone Numher. '" T c� r CERTIFICATION STATEMENT N.) I certify that I have personalty inspected the sewage disposal at below is true,accurate and _ s3' flue address and that the infomsation reported g and experience in the proper function and of the inspection.The inspection was performed based on my training maintenance afon site sews approved system inspector pursuant to Section 15.340 of Title s(310 CMR a disposal s.I am a DEP system: Passes Conditionally Passes Fails Further Evaluation by the Local Approving Authority Inspector's Signature: _ ° Date: 11c system inspector shall a copy of this inspection DEP)within 30 days of completing this inspection.If the report to the Approving Authority(Boardof Health or gpd or greater,the inspector and the s'�is a shared system or bas a design flow of 10,000 DEP.The original should be sent to them owner shall submit the report to the appropriate regional office of the auth system owner and copies sent to the buyer,if applicable,and the approving may. Notes and Comments ""This report only describes conditions at the time of inspection ons of u at at time. This inspection does not address how the system will p rm in the under future underudid a same or different se th conditions of use. I • Page 2 of I I 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL,SYSTEM INSPECTION FORM PART A 7 `gVI CERTIFICATION(continued) Property Address: J GPI v►l /1'�c� Owner. Date of Inspection: Inspection Summary: Check A,B,C,D oor—E l ALWAYS complete ag of Section D r3O3 anyinformationwhichindcatesthatanyofthe failure criteria described in 310 CMR 310 CMR 13.304 exist,Any failure criteria not evaluated are indicated below. Comments: H. S stem Conditionally Passes; One or more system compensate as described in the"Conditional Pass"section need to be replaced or repaired.The system upon completion of the replacement or repair,as approved by the Board of Health,will pass. Answer yes,no or not determined(Y,N,ND)in the for the following statements If"not determined"please explain The septic unsound,exhibits ark is mettial infiid over 20 years old*or the septic tank(whether metal or not)is tank filtration or extiltration or tank faihue is imminent, System will pass inspection if the xi meal is replaced with a complying septic tank as approved by the Board o f Health. septic tank will pass inspection if it's structurally sound,not leaking indicating that the tank is less than 20 years old is available. 'if a Certificate of Compliance ND explain: Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken,settled or uneven distribution box System will pass inspection if(with approval of Board of Health): broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced ND explain: The System rewired Pass�P aPPMal Of the Board of Health) year due to broken or obstructed pipe(s).The system will broken pipe(s)are replaced obstruction is removed ND explain: Page 3 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL,SYSTEM INSPECTION FORM PART A CERTIFICATION(contimued) Property Address: O V ti it yl 1 j-e `✓ �� Owner. �� �•Z- Date of Inspection: " C,.( Further Evaluation is Required by the Board of Health: i V Conditions exist which require further evaluation by the Board of Health no to protect public health,safety or the environment. in artist to determine if the system 1. System will pans unless Board of Health determines in accordance with 310 CMR 11303(i)(b)that the system is not functioning in a manner which will protect public health,safety and the environment: _ Cesspool or privy is within 50 feet of a surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2. System will fail unless the Board of Health(and Public Water Supplier,if any)determines that the system is functioning in a manner that protects the public health,safety and environment: The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a surface water supply or tributiny 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 1�te water supply well**.Method used to determine disharwe **This system passes if the well water analysis,performed at a DEP certified lobo bacteria and volatile organic compounds indicates that the well is free from Pollution fromfor that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppn,pmvided that no other failure criteria are triggered,A copy of the analysis must be attached to this farm. 3. Other. Page 4 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE _ SEWAGE DISPOSAL SYS TEM INSPECTION FORM PART A CERTMCATION(continued) Property Address: �D �(/ /"4 G l'-jit1 ✓. �oZiL'�.s� Owner. Date of Inspection: D. System Failure Criteria applicable to all systems: You must indicate`Yes"or"no"to each of the following for all inspections: Yes No/ —,I3ac W of sewage into facility or system component due to overloaded or clogged SAS or cesspool or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool _ Sjatiic liquid level in the distnbution box above outlet invert due to an l overloaded or clogged SAS or cesspoo — Uqdd depth in cesspool is less than 6"below invert or available volPupume is less than%day flow of tiaras pu Retired um mpe ped d-more than 4 times in the last year N T due to clogged or obstructed pipe(s).Number . any portion of the SAS,Cesspool or privy is below high ground water elevation. "' AnYportion of cesspool or privy is within 100 fed of.a surface water supply or tributary to a surface Imliter mPPIY. — Aiy portion of a cesspool or privy is within a Zone 1 of a public well. r/— A�rportioa of a Cesspool or privy is within 50 feet of a private water supply well. —_ — Any lemon 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. MIS system Passes if the wen water analysis, Performed at a DEP certified laboratory,for eWorm bacteria and volatile organic compounds indicates that the wen is free from pollution from that faculty and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria re a triggered A copy of the analysis must be attached to this form.] 4 (Yes/No)The system fad,I have determined that one or more of the above failure criteria exist as described in 310 CUR 15.303,therefore the system fails.The system owner should Con Board of H tQ determine what wDill be necessary to correct the failure. E. Large Systems:To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd You must indicate either`yes"or"no"to each of the following: X,_,Zone a apply to large systems in addition to the criteria above) s within 400 feet of a surface ddnldng water supply within 200 feet of a tributary to a surface ddnldng water supply looted in a nitrogen sensitive area(Interim WellheadProtectionArea—IWPA)or a mapped public water supply well youaveanswered yes to any question in Section Effie system is considered a si "yes"in Section D above the large system has failed The owner or operator of an b threat, answered s'Vmficant threat under Section E or failed under Section.D shall y large system considered a '.5.304.The system owner should contact the a f the system�aceotdanc a with 314 CUR appropriate regional office of the Department. Page 5 of I 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B 7Q CHECKLIST ftoperty Address: J v 0 �►��/�hl �fj�—G�i/ Owner: �ems, r�i aa-C3� Date of Inspection: j r Check if the following have been done.You most indicate gees"or"no"as to each of the following: Yes No — _ Punp 9 information was provided by the owner,occupant,or Board of Health — — W any of the system components pumped out in the previous two weeks — �HavpAarzc system received normal flows in the previoustwo week period volumes of water been introduced to the system recently or as part of this inspection ere as built plans of the system.obtained and examined? they thy were not available note as N/A) Wa— s the facility or dwelling inspected for signs of sewage back up j as the site inspected for signs of break out ere all qstem cemponenhk excluding the SAS,located on site _ _ W the septic tank manholes uncovered,opened,and the mterm of the tank inspected for the condition of the ce tees,material of won,dmenwoM depth of liqui$&Vh of sludge and depth of scum Was the facility owner(md omits if diarent from'owner)provided with fotn>atkm on the maintenance of sewage disposal 1p The size an of the Soil Absorption system(SAS)on the site has been determined based on: :Yes no — sting inf7inthe on.For example,a plan at the Board of Health. _ Determinedfield(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable)[310 CMR 15.302(3)(b)] Page 6 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION'FORM PART.0 SYSTEM ROORMATiO1N Property Address: J O W e- `✓ `J / Owner. 2i Date of hupectioa: i� o DENTLIL �- FLOW CON DI INS NumbergESI of- (design): Number of bedrooms(xtualr DESIGN flow based.on:310 C R15103(Aw example: 1.10 gpd.x#of bedrooms}: Number of current resider: Does residence have a garbage Binder(yes or no):/tea Is laundry on a separate sewage system or no):zLV[if yes separate inspection required] Launcky system inspected es or no): Seasonal use:(yes or Water meter readings+if (last 2 years usage(SPA): Sump pump(yes or no): Last date of occipancy: COMMERCIALMDUSTRIAL Type of establishment: Design flow(based on 310 CUR 15.203). mod Basis of design flow(seats/persons/sgft etc.): Grease trap present(yes or no):_ Industrial waste holding tank present(yes or no): Non-sank ay waste dischazgad to the Title 5 system(yes or no):_ Water meter ,if available: Last date of accupancy/use: OTHER(describe): GENE INFORMATION Pumping Records Source of information Was system pumped as part of the' (yes or no):If YOM — Reason volume Pumped Reason for pumping: _plkm-How was quantity Pumped determined? TYPE STEM tardy distribution box,soil absorption system _Single osspool _Overflow cesspool —Shared system(yes or no)(if yes,attach previous inspection records,if any) Innovativelobtained from stem ire technology.Attach a copy of the can nt opm=on and centred(to be system ) —Tight tank ,_Attach a copy of the DEP approval —Other(describe): age of o date installed(if known)and source, information: f�4 S r-t c, Were sewage odors detected when arriving at the site(yes or no): PV6 .Ps�- g° Page 7 of 11 OFFICIAL INSPECTION FORM NOT.FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART.C SYSTEM INFORMATION(contim4 Property Address ,L e.4 Owner. 2 Date of Inspechor. BUILDING SEWER(lomte orte plan) Depth below grade: Materials of consbrncti ca:_ iron 40 PVC other(e:qiaW):. (�'�Q►�t C� C r Distance from private water supply wetfa—r=ctjon Ime: Comments(on Condition of joints;v90ti!1&4hidence of ge,etc.): SEPTIC TANK:&Jilocaw.on site plan) Depth below grade: Material of Construction:—concrete_metal fiberglass_polyet$ykene .other(explaW If tank is metal list age:— Is age confirmed by a Certificate of Compliance(yes or no):—(attach a copy of certificate) Dimensions: Distanceiv n#opof stye to bottom of outlet tee%orbaffie: SCUM thickess: Distance from top of scum_to top of outlet tee or baffle: Distance from bottom of scam to bottom of outlet tee or baffle: How were dimensions determine(t Comments(on pumping recommendations,inlet and outlet tee or baffle �g°ty; condition,structural '' liquid levels as related to outlet invert,evidence of leakage,.etc,j: GREASE TRA Oocate on site plan) Depth below grade: Material of construction;—concrete metal_�_Po1y�y�, 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 bane: Date of last pumping Comments(au Pumping recommendations,inlet and outlet.tee or bade condition,strucuval.inte as related to outlet invert,evidence of 1 eakage,etc.): &ntY,lignid levels Page 8 of 11 OFFICIAL INSPECTION FORM=NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE'DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: �� (il C �� fi e c 1 /� owner. f� w �✓i � �?� Date of Inspection: j. pr' TIGHT or HOLDING TA 41 X—(tank must be pumped at time of inspec'tion)oocate on site Plan) Depth below grade: Material of construction concrete metal fiberglass_Jolyethylene other(explain): Dimensions: Capacitr. nallons Design Flow: today 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:(jifpe+eseut must be opomWocate on site plan) Depth of liquid level above outlet invert: Comments(note if box is level and motion to outlets equal,any evidence of solids carryover,any evidence of leakage into or out of box,etc.): PUM CAMBER:�ocate on site plan) Pumps in working order(yes or no): Alarms in working order(yes or no): Comments(note condition of pomp chamber,condition of pumps and etc.): I pap 9of11 F• A OFFICIAL INSPECTION FORM=NOT FOR VOLUNTARY ASSESSMENTS ` SUBSURFACE SEWAGE DISPOSAL SYSTM JNSPECMON FORM 2nQ SYSTEM EWORMAXION(oodingo Property Addmw ' ✓ v o Awektof N/,c l k owner: Date of Inspecti.m: SOIL ABSORtnM SVS7.F.216t(SAS): . (tom a..sitg plan,a mwstim nat If SAS not located op4w whys Type teaching1 leaciing ganuiek=mbw. aver,leaching fidkk leogEh: , An Overflow cesspool,number: s Comte(Wade condition of te Tyld�of .' etc-) soil,signs of hydraulic failure,level of pondmg,damp soil,condition of vegetation, CESSMI. (eesspoad amst be as part of inspection)(iorate on site plan) Number and / Depth—top-of I*Wto islet invent: Depth af solids kgw Depth of seams lay= 0 Di of Materids o Indication of grexmdrer mom,,(yO or no): Coaime'oft(nOL' Of 4=of hi' c Ind of pondeag,condWmofveSeUdWq ebc.�. PRIVY:/V nrn she plan? Matesids of cmstractim Diniensiom Depth of sOFkk Cow(note condifim of s*signs of hydratdic faihmr,leve}ofpondiM condition ofvegeta6xvke1r); + Page 10 of I I . OFFICIAL INSPECTION FORM—NOT.FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM POORMATION(oomim,� Property Address: J�O x c ki✓1 r /f/e—c(i Q� Owner. Date of Inspection: SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system mchxhng des to at least two perms reference laadmiarl�or benchmarks Locate all wells roil-100 feet.Locate where public water sup#y enters the building, Pd n `� /-� S► 5e _ C�sSOoo/ x1 e ell 1 el 0 Gi v 2 • Page 11 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE'SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C ? �1 SYSTEM INFORMATION(contim,ed) Property Address: v�'V �c�sey /Gv e`v P Owner. Zee- Daft of Inspection: Q r' SITE EXAM slope ' Surface water Check cellar Shallow wells 3 Estimated depth to ground water/O feet Co,n-}o w� / 0. 5 Please indicate(check)all methods used to determine the highground water elevation; Obtained fiom system design plans on record-If checked,date of design plan mvwwc& observed site(abutting Poperty/observatiion hole within 150 feet of SAS) C xdmd with local Board of Health explain; Checked with local excavators,installers-(attach documentation) Accessed USGS database-explain: You mad dplcn7x how you established the hi ground water el/ev n: / iy e S Oo D /o W C+e a .AS s i i, SYSTEM PROFILE TEST HOLE LOGS ACCESS COVER TO WITHIN 6" OF FIN. GRADE (NOT TO SCALE) PROVIDE INSPECTION PORT WITHIN ACCESS COVER (WATERTIGHT) TO 6" of FINISH GRADE ENGINEER. DANIEL A. OJALA, SE r4l.0' MINIMUM .75' OF COVER OVER PRECAST F FIN GRADE REQUIRED OVER M WITHIN 6 0 2�..SLOPE, REQU ED. Q E SYSTEM 46:0 WITNESS: DON DESMARAIS, Rs 9 ( SHALLOW 2" DOUBLE WASHED PEASfONE\ DATE: JULY 20, 2005 % �� POND RUN PIPE LEVEL 'I-,' �� �z� FOR FIRST 2' ' _ < 2 MIN/INCH �' \�/L0a's PROPOSED]500 3 MAX. PERC. RATE \ \ GAR SLAB AT EL 39.0'* - GALLON SEPTIC 3$.TS`' QJ ITEE 43.0' CLASS i SOILS P# 11041 1 41.45' TANK (H- 10 ) GAS �� 42.26' a o a a O C] O CI 0 og i '' Ja 42.43 BAFFLE 4 0 42:1T 0 [] [] 0 0 C? 0 0 4' AROUND �6" CRUSHED STONE OR MECHANICAL WEQ COMPACTION. (15.221 [21} gig 2' C1. Cl Cl Cl Cl. Cl Cl 0 40.17' Q ELEV. Q LAKE DEPTH OF FLOW = 4v MIN " - " O" 46.1' 0" 46.8' TEE SIDES: SLOPE) ��o ( 1 SLOPE) ( 1 34 TO 1 12 DOUBLE WASHED STONE% SLOPE) / / A I INLET DEPTH = 10" LS A OUTLET DEPTH = 14" 6" 1OYR 3/2 LS LOCATION MAP NTS FOUNDATION 62' ST g' PUMP 4.2' D' BOX 11� LEACHING g 6" 10YR 3/2 * CHAMBER MAX. FACILITY 10YR 6/6 B ASSESSORS MAP 233 PARCEL 32 *THE INSTALLER SHALL VERIFY .THE 507' LS LOCATIONS OF ALL UTILITIES AND ALL LS _. .. " 6 , BUILDING SEWER OUTLETS AND ELEVATIONS 36pp 4 .1 PRIOR TO INSTALLING ANY PORTION OF . .._..._ 40 10YR 6/ 43.46 SEPTIC SYSTEM Cl NOTE:. EXISTING INVERT INTO PERc M/C SAND CESSPOOL IS 39.1' BANDS GRAVEL ALARM AND CONTROL PANEL 41'0' 96„ 1OYR 6/3 TO BE INSTALLED INSIDE 35.1' Cl BUILDING. ALARM TO BE ON INV. IN 38.6' PERC SEPARATE CIRCUIT FROM. PUMP 2" PRESSURE LINE BANDS GRAVEL 1000 GAL. H-10 S C2 700 GAL.+ SLOPE TO DRAIN BACK TO PC M/C SAND ALARM ON. RESERVE WEEP HOLE I FLOAT SWITCH M/C SAND SETTINGS: PUMP ON 8! CHECK VALVE 10YR 6/3 I 4" WORKING RANGE N MYERS SRM 4 10YR 7/1 4 SUBMERSIBLE 4/10 HP PUMP PUMP OFF 8' SYSTEM (OR EQUAL) NOTE: GROUNDWATER MAY BE ENCOUNTERED 132" 35.1' 132" 35.8' DURING EXCAVATION FOR SEPTIC TANK AND PUMP NO GROUNDWATER ENCOUNTERED NOTES: CHAMBER L7TUMP CHAMBER WEQUAQUET LAKE DATUM SYSTEM SEPTIC DESIGN: (GARBAGE DISPOSER Is NOT Al I OwFn � 1. DATUM IS (NOT TO SCALE) _ v�cTlni� UE'SiGN FLOW: -� BEDROOMS ( 110 GPD) 330 GPD_ 2. nrjrq',L,II-'HL Vvi�I E-i 15 USE A 330 GPD DESIGN FLOW 3. MINIMUM PIPE PITCH TO BE 1/8" PER FOOT. SEPTIC TANK: 330 GPD ( 2 } = 660 4. DESIGN LOADING FOR ALL PRECAST UNITS TO BE AASHO H- 10 5. PIPE JOINTS TO BE MADE WATERTIGHT. 1 36 �34.07 USE A -laC 'L GALLON SEPTIC TANK 6. CONSTRUCTION DETAILS TO BE IN ACCORDANCE WITH MASS. LEACHING: ENVIRONMENTAL CODE TITLE V. N 7• 2(25 + 12.83) 2 (.74) 7. THIS PLAN IS FOR PROPOSED SEPTIC SYSTEM ONLY AND IS NOT % SIDES; - -- TO BE USED FOR ANY OTHER PURPOSE. �# t .02 a BOTTOM: 25 x 12.83 (.74) = 237 8. PIPE FOR SEPTIC SYSTEM TO SCH. 40-4" PVC. 4.61 , SHALLOW POND. 4 .63 9. COMPONENTS NOT TO BE BACKFILLED OR CONCEALED WITHOUT r `; pORCN 3.32 -t43.61 5 39. �, TOTAL: 472 S.F. 349 GPD WATER ELEV. 34.0, INSPECTION BY BOARD OF HEALTH AND PERMISSION OBTAINED Oo 6 Me�H1 2, 0 ft USE (2) 500 GAL. LEACHING CHAMBERS (ACME OR FROM BOARD OF HEALTH. .21 DES $ EQUAL) WITH 4' STONE ALL AROUND 10. PUMP & REMOVE EXISTING SEPTIC SYSTEM ' +4 ` EXIST. + 4.8 DWELL 4.29 + 0.23 446�4 11. WETLAND FLAGGED BY HAMLYN CONSULTING 34.06 1.2. INSTALLER TO CONFIRM ADEQUACY OF ELECTRICAL GAS 7 • SYSTEM FOR PUMP INSTALLATION GAR SLAB 5 LEGEND TITLE 5 SITE PLAN q JFR L N 13 ► ELEV-41.45• 39.6 o, s29 4.03 t 46.55 29 . 3. '� �,. 1 9 GAS ,' �Jlc 31 � 83 5*41.35 ,1 +4 0 -' � 84 +41.14 + .47 PROPOSED SPOT ELEVATION OF 0". 1 _ . \,'..�33.97380 H U C K I N S NECK ROAD 2 2 �'� + 1 L41 4323 ;� �3593 ` + A8 +3520 . 100xO EXISTING SPOT ELEVATION IN THE TOWN OF: 1 6. 41.40 ' 4 3f�07 g74326 - *77'W--j;..I_37.83 1 OO PROPOSED CONTOUR (CENTERVILLE) B A R N S TA B LE V01'1 + 5.36 .BE�� .�' 39, + 51 :#5 - - PAVED ,�,r1'�i:i�'' �D 37.83 ' #4c,,` 100. EXISTING CONTOUR PREPARED FOR: LORTOLOTTI CONSTRUCTION/LEE n o .i7 DRIVE �: +40.8 4B �G311[3642 7 41. 4 � �i PROP, WORK 30 0 30 60 90 (n �1 41.63 , LIMIT LINE �4ra BOARD OF HEALTH MA SCALE: 1" = 30' DATE: AUGUST 3, 2005 '1 4104 .LESS .53. APPROVED DATE ' O �40.87 11 +4 ACH 37.75 TRENCH Q � ,r1 35.99 off 508-362-4541 40M fax 508 362-9880 880 s's OR�� EXISTING SEPTIC SYSTEM PER DEP .5D, INSPECTION REPORT I gyp,-)' Gr* SH OF 14AS BENCHMARK + 09 `�� Eoo� down cape 'engineering, inc. AR�y,Nfr ���� ARNE H.�cyc GRANT T #672 .` H, g OJALA T ELEV 43.0' 03 .- 788 CIVIL ENGINEERS WALA CI IL En CC 26348 7 ,)},34}f�9.46J1''38.31 LAND SURVEYORS. ���v v T 939 main st. yarmouth, ma 02675 ' SS' 05-- 1 63 A OJALA, ., .L.S. DATE. M. n