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HomeMy WebLinkAbout0016 JAMES OTIS ROAD - Health Otis Road Centelv.i11f A.= 171 - 202 it UPC 12534 2.13E 53LO # w No. 0t7 1100 , Fee--t== THE COMMONWEALTH OF MASSACyUSETfS Entered in computer: Yes PUBLIC HEALTH DIVISION TOWN OF BARNSTABLE, MASSACHUSETTS rication for Zig ozar .5tem Con�trurtion. Permit Application for a Permit to Construct( . )RepairX Upgrade( )Abandon.( ) El Complete System dividual Components Location Address or Lot No. ���+,, Q A S C' Q Owner's Narne Address and Tel.No. Assessor's Map/Parcel � oa Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. \WX—\—S a(>�C_ L—)ti1A't Q U- S2>) Type of Building: Dwelling No.of Bedrooms _ Lot Size I 5�O .ft. Garbage Grinder Other 'I�pe of Building �OrY1 No.of Persons Showers(CafIt a{ 9� Other Fixtures / Design Flow '�r gallons per day. Calculated daily flow gallons. Plan Date - - ® Number of sheets Revision Date Title jDac AP Size of Septic Tank �C S�1- OCR Type o .A.S. `� •1 S Description of Soil 1 1 Nature of Repairs or Alterations(Answer when applicable) CZS2C" Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage dis 1 system in accordance with the provisions of Title 5 of the Envir Fnm a and not to place the system in operatio n '1 a ertifi- cate of Compliance has been ' d iris- rd-e a th. Signed -� Date Application Approved by r Date Application Disapproved fo a following reasons Permit No. 00& - 3 `0 Date Issued a. 66 No. d�G 30 () _ Fee—f100 — THE COMMONWEALTH OF MASSACH04,0LT HE in computer: r Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLEs MASSACHUSETTS OfppYicatfon for Mtgpogal 6pgtem Con5truction Permit Application for a Permit to Construct(Ar )Repair( pgrade( )Abandon( ) O Complete System �dividual Components ' Location Address or Lot No. �tv �(�(�nQ 5 0�,-S Cl Owner's Name,Address and Tel.No. �' \ CenA , M 1 Assessor's Map/Parcel 1 Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. ' �\C �G- 5�tc�Y FNu, Se�CS s — 5310 S3ci - Type of Building: Dwelling No.of Bedrooms Lot Size (5.'0_9q.ft. Garbage Grinder( ��� Other Type of Building Mc�K--V No.of Persons Showers( ),Cafetefia( )►� Other Fixtures .La Design Flow �t gallons per day. Calculated daily flow t --gallons. Plan Date - B - 0(o Number of sheets Revision Date Title c o l _ Size of Septic Tank t' 't- rJ G _Type of S-Al. Description of Soil r" ��r�. 1 �U X 1 Nature of Repairs or Alterations(Answer when applicable) _ {- -Ve, U�rr, Date last inspected: 7 Agreement: ` The undersigned'agrees to ensure the construction and maintenance of the afore described on-site sewage disp' a system in accordance with the provisions of Title 5 of the Environmental and not to place the system in operation ti a C rtifi- cate.of Compliance has been issued b_th1&4eafd-ca e ,�_ ` Signed Date 'D Application Approved by r Date <6 Application Disapproved for H0,01lowing reasons - Permit No. Uyf—300 Date Issued t' a -- ------ ----------- — ------THE COMMONWEALTH OF MASSACHUSETTS M BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY that the On-site Sewage Disposal System Constructed ( )Repaired ( )Upgraded 'Abandoned( )by at E has been constructed in accordance with the provisions o itle 5 and the for Disposal System Construction Permit No. 2W6 �� dated K 9—0 Installer �� ��� Designer— The issuance of this permit shall t e con trued as a guarantee that the syste ill �nctt n as designed. Date � —�i Inspector f ___ , No. �(� i --------------------------Fee 011- THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION . BARNSTABLEs MASSACHUSETTS Migpogar *pgtem Congtruction Permit Permission is hereby granted to Construct( )Repair )Upgrade( tendon( ) System located at i n and as described in the above Application for Disposal System Construction Permit. The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided: Construction must be completed within three years of the date of thi ! ermit. Date: Ln - 2 9 -U �' Approved by v x f ��f rneor �unt�rwt Cor�ec. Size �� f.PPl1c �Go Anc� yjvm r o � J s 10/09/2016 18:01 FAX %001/001 Town of Barnstable Regulatory Services 's l Thomas F..Geiler,Director 63a s Public Health Division Thomas McKean,Director 200 Main Street,Hyanuais,MA 02601 Office: 508-862.4644 Fax: 508-790-6304 Installer&Darner Certification Form Date: 12S D Designer: Shay Environmental Services,Inc, Installer: y� Address: P.O. Box 627 Address: _East Falmouth.AAA 02536 On 7-q a C' ( te) (ins er) was issued a permit to install a septic system at 16 ZE, C�65 CV., C,.r&, based on a design drawn by (address) s511v Environmental $eryqcCs. Inc; dated (designer) 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 ma or changes (i.e, greater than 10' Iateral relocation of the SAS or any vertical relocation o any component of the septic system) but in accordance with State & Local Regulations. Plan revision or certified as-built by designer to follow, 0 OF CARMEN (Installer's gnature) E. SHAY 01 a IaT 6 t, (Designer's Signature} x De p Here) PLEE RKUW TO BARNS T U"BLI C DIY S N. IFICATE F COMPLL&ME WILL BE D B ARE IVED T I T)EL�NK O Q:HeWrh/Septic/D=Iper Ccrttfiearton Form COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION TITLE 5 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION 171 Property Address: 16 James Otis Road Centerville, MA 02632 Owner's Name: Richard Manfredi 2�as Owners Address: �J Date of Inspection: May 30, 2006 Name of Inspector: (Please Print) James M. Ford Company Name: James M. Ford t Mailing Address: P.O.Box 49 _ Osterville,MA 02655-0049 [ Telephone Number: (508) 862-9400 v 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 the inspection. The inspection was performed based on-rny training and experience in the proper function and maintenance of on site sewage disposal systems. am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CAM 15.000). The systerry: < Passes I Conditionally Passes Need rther Evaluation by the Local Approving Authority ✓ Fails Inspector's Signature: � Date: June 6, 2006 The system inspector shall sub a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable,and the approving authority. 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 f Page.2 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 16 James Otis Road Centerville, MA Owner: Richard Manfredi Date of Inspection: May 30, 2006 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B. System Conditionally Passes: One or more system components as described in the"Conditional Pass" section need to be replaced or repaired. The system,upon completion of the replacement or repair,as approved by the Board of Health,will pass. 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 and over 20 years old* or the septic tank(whether metal or not)is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. 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 required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed ND explain: 2 Page 3 of 11 OFFICIAL INSPECTION FORM -NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 16 James Otis Road Centerville, MA Owner: Richard Manfredi Date of Inspection: May 30, 2006 C. Further Evaluation is Required by the Board of Health: Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health,safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner.which will protect public health,safety and the environment: Cesspool or privy is within 50 feet of a surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2. System will fail unless the Board of Health(and Public Water Supplier,if any)determines that the system is functioning in a manner that protects the public health,safety and environment: The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance "This system passes if the well water analysis,performed at a DEP certified laboratory, for 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 that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: 3 Page 4 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 16 James Otis Road Centerville, MA Owner: Richard Manfredi Date of Inspection: May 30, 2006 D. System Failure Criteria applicable to all systems: You must indicate either"yes"or"no"to each of the following for all inspections: Yes No ✓ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ✓ Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ✓ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ✓ Liquid depth in cesspool is less than 6"below invert or available volume is less than day flow ✓ Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped_. ✓ Any portion of the SAS,cesspool or privy is below high ground water elevation. ✓ Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ✓ Any portion of a cesspool or privy is within a Zone 1 of a public well. ✓ Any portion of a cesspool or privy is within 50 feet of a private water supply well. ✓ Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for 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 that no other failure criteria are triggered. A copy of the analysis must be attached to this form.] Yes (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 correct the failure. E. Large System: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd• You must indicate either"yes"or"no"to each of the following: (The following criteria apply to large systems in addition to the criteria above) Yes No 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. 4 Page 5 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 16 James Otis Road Centerville, MA Owner: Richard Manfredi Date of Inspection: May 30, 2006 Check if the following have been done: You must indicate"yes"or"no"as to each of the following: Yes No ✓ Pumping information was provided by the owner,occupant,or Board of Health ✓ Were any of the system components pumped out in the previous two weeks? ✓ _ Has the system received normal flows in the previous two week period? ✓ Have large volumes of water been introduced to the system recently or as part of this inspection? ✓ Were as built plans of the system obtained and examined?(If they were not available note as N/A) ✓ Was the facility or dwelling inspected for signs of sewage back up? ✓ _ Was the site inspected for signs of break out? ✓ Were all system components,excluding the SAS, located on site? ✓ _ Were the septic tank manholes uncovered,opened,and the interior of the tank inspected for the condition of the baffles or tees,material of construction, dimensions,depth of liquid,depth of sludge and depth of scum? ✓ _ Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS).on the site has been determined based on: 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 Page 6 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 16 James Otis Road Centerville, MA Owner: Richard Manfredi Date of Inspection: Ma 30, 2006 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): 4 Number of bedrooms(actual): 4 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 440 Number of current residents: 2 Does residence have a garbage grinder(yes or no): No Is laundry on a separate sewage system(yes or no): n1a [if yes separate inspection required] Laundry system inspected(yes or no): No Seasonal use(yes or no): No Water meter readings,if available(last 2 years usage(gpd)): Unavailable Sump Pump(yes or no): No Last date of occupancy: Current.1y occupied COMMERCIAL/INDUSTRIAL Type of establishment: Design flow(based on 310 CMR 15.203): gpd Basis of design flow(seats/persons/sgft,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: Pumped 2 years ago--per owner Was system pumped as part of the inspection(yes or no): No If yes,volume pumped: _gallons--How was quantity pumped determined? Reason for pumping: TYPE OF SYSTEM ✓ Septic tank, distribution box,soil absorption system Single cesspool Overflow cesspool Privy Shared system(yes or no) (if yes,attach previous inspection records,if any) Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) Tight Tank Attach a copy of the DEP approval Other(describe): Approximate age of all components,date installed(if known)and source of information: proximately 22 years-per owner Were sewage odors detected when arriving at the site(yes or no): No 6 Page 7 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 16 James Otis Road Centerville, MA Owner: Richard Manfredi Date of Inspection: May 30, 2006 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: 16" 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: 1250 gal. Sludge depth: 2" Distance from top of sludge to bottom of outlet tee or baffle: 30" Scum thickness: 2" Distance from top of scum to top of outlet tee or baffle: 6" Distance from bottom of scum to bottom of outlet tee or baffle: 10" How were dimensions detennined: Measuring stick Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): Cement tees were present. There did not appear to be any signs of leakage. GREASE TRAP: None (locate on site plan) Depth below grade: Material of construction: _concrete _metal _fiberglass _polyethylene _other (explain): Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping: 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 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 16 James Otis Road Centerville, MA Owner: Richard Manfredi Date of Inspection: May 30, 2006 TIGHT or HOLDING TANK: None (tank must be pumped at time of inspection)(locate on site plan) Depth below grade: Material of construction: _concrete _metal _fiberglass _polyethylene _other(explain): Dimensions: Capacity: eallons Design Flow: gallons/day Alarm present(yes or no): Alarm level: Alarm in working order(yes or no): Date of last pumping: Commments(condition of alann 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.): The D-box was under water and backing up from the leach pits. PUMP CHAMBER: None (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.): 8 1 Page 9 of 1 I OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 16 James Otis Road Centerville, MA Owner: Richard Manfredi 'Date of Inspection: MU 30, 2006 SOIL ABSORPTION SYSTEM(SAS): ✓ (locate on site plan,excavation not required) If SAS not located explain why: Type ✓ leaching pits,number: 2-6'x 6'(1000 gal.)w/P stone-per designplans leaching chambers,number: leaching galleries,number: leaching trenches,number, length: leaching fields,number,dimensions: overflow cesspool,number: Innovative/alternative system Type/name of technology: Comments (note condition of soil,signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Both pits were under water and backing up into the D-box. CESSPOOLS: None (cesspool must be pumped as part of inspection)(locate on site plan) Number and configuration: Depth-top of liquid to inlet invert: Depth of solids layer: Depth of scum layer: Dimensions of cesspool: Materials of construction: Indication of groundwater inflow(yes or no): Comments (note condition of soil, signs of hydraulic failure,level of ponding, condition of vegetation, etc.): PRIVY: None (locate on site plan) Materials of construction: Dimensions: Depth of solids: Conunents(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): 9 Page 10 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 16Jmnes Otis Road Centerville, MA Owner: Richard Manfredi Date of Inspection: May 30, 2006 SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate w"here public water supply enters the building. 0-A y � a8 33 3 3T- 39 y ya yy 10 Page 11 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 16 Janes Otis Road Centerville, MA Owner: Richard Manfredi Date of Inspection: May 30, 2006 SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water 25+/- feet Please indicate(check)all methods used to determine the high ground water elevation: Obtained from system design plans on record-If checked,date of design plan reviewed: Observed site(abutting property/observation hole within 150 feet of SAS) ✓ Checked with local Board of Health-explain: Topographic and water contours naps Checked with local excavators, installers-(attach documentation) Accessed USGS database-explain: You must describe how you established the high ground water elevation: Usin z Barnstable topographic and water contours naps,the traps were showing_approxinately 25'+1-to groundwater at this site. This report has been prepared only for the septic system and components described herein. This septic system has been inspected and failed as of the date of inspection. This report is not a warranty or guarantee that the system will function properly in the future. There have been no warranties or guarantees, either expressed, written or implied, relating to the septic system, the inspection, this report and/or any components of the septic system which have not been located and inspected 11 JID No.. l.._i7 �; 4 Fxs... ................ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HJEAkTH ......7-;ez� ...............OF......... ............................. Applirtt i n for Biipniittl IVorkg Toup rnr#inn Frrutit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: I---- �� .... ................... c.. t ����e. -� . --...------ ---- ..................... --.. Owner Address a .. ............... .......G� --.....------.....-----------....----- � ................_ -.._._..._...-------------- Installer Address Type of Building Size Lot...l'��- ...Sq. feet U Dwelling—No. of Bedrooms......:.........................Expansion Attic ( ) Garbage Grinder (/1- Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) a' Other fixtur ....gallons per person per day. Total daily flow................�.''L 4i W Design Flow----------- ---?r:........--••------ ..... ..........._....gallons. WSeptic Tank—Liquid capacity/.1P?ogallons Length................ Width................ Diameter................ Depth................ x Disposal Trench—No. ._ .�......... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No.__ ___'.--_____ X,aer.................... Depth below inlet.................... Total leaching area..................sq. ft. z Other Distribution box ( ) Dosing tank ( ) �•-' Percolation Test Results Performed by.......................................................................... Date........................................ a \ Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ ---------------------------------------------------------------------------------------•-••------...-----•-•----..._......---•-•-------------•----•--....-•-- 0 Description of Soil.................................................-...................................................................................................................... V ......................•----------------------------------------------------------------......------------------------------------------------•-•-------------------------------------------------------• W ---•---------------- ----------------------------•-------•---.....-•-•--•--••---•-----------••--•----..........-••-••...-------•....--•----•-•----•-------------•-----------•-•-------•-•---------...... VNature of Repairs or Alterations—Answer when applicable............................................................................................... Agreement: *Application he undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with �isi Is of TIT 5 of the State Sanitary Code—The undersigned further agrees not to place the system in on t' C sate of Compliance has been issued by the b rd of health. Sing — - d•--- •---•-..•--- ---- --••_..... =-----•--------• /at, ationApproved By...... -•••--..... ... .........................................................•--...... Disapproved for the low g reasons:.... ........... .......................••-------...•--•----------------•-----------------------...-••----•-.........-•------•-------------------------•---------------•---•--•---------••--•-•......--------------...--- Date PermitNo......................................................... Issued........................................................ Date No......................... FEic ,�.�................ • THE COMMONWEALTH OF MASSACHUSETTS ®OAFS® OF HEALTH ........... ....................OF.............................................. -......................................... Appliration for Bhjipwittl Work.5 Tonstrurthin Prrmit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at ; �r ? Loeation Address e„-.,� Lpft'No. /�" ,d ° t0wner ,Address W c4 ..........................f(p Ea `y .2 a/•^-1 sG �"tiCt '----'•----;....... .....:' 21.-------------•---•-------•--........... ..------.._._, .�::�---- ----------------......- ..........................•••.. Installer Address Type of Building Size Lot... feet U Dwelling— No. of Bedrooms............... ........................Expansion Attic ( ) Garbage Grinder ( )"-)'C, aOther—Type of Building ____________________________ No. of persons............................ Showers ( ) — Cafeteria ( ) a' Other fixtures ............................... . . 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........................................ .a Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ L? Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ -----------------------------------------------------------------------••---•---•-•-----•---•-••-•----•-•--•...._.._.........---------...........•---------- ODescription of Soil........................................................................................................................................................................ x U ---------•-"-•-------------------------•---------------------------•-------------------------------------------------------------------------------------------------•---------•---•---•••-••----•--•--- W ............................... ---------------------------------------------- -•---•--•--•-------------•-------------------•---------•---------•------•------••----•-----•--•--•-••--•--••......-_..... UNature of Repairs or Alterations—Answer when applicable._.............................................................................................. --------••-•------------------------•---•----------.....--_._._...........----------._....•---••--•-...••.......------------------•------•---_..__...._......_._............................---•--...._. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with t e prpp�.. .0 of TITI..E!/ 5 of the State Sanitary Code— The undersigned further agrees not to place the system in eras'' n til ��Ce , ate of Compliance has been issued by the board of Health. Si ned _ ation Approved fir.......... / Date Application Disapproved for tlh f ollo, ing reasons:.................•------•------••-•-•---._...............---------------•----•-•--••---•-- •----•---•------... .......................••-----------_.._......_..-•••---_......_.........••-----••-•-•----••---•-••••••-•...••-•---•-•--•--•-•--••--_.._......._.............-----------•...__.....---------•-••••-•••--- Date PermitNo......................................................... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........................................OF..........................................I.......................................... (9rdifiratr of Tlanapliattrr b TO CERTIFY, That the Individual Sewage Disposal System constructer Repaired ( ) Y--../---.(/-------------•--•••--• ---•---_-.---.-•--------- .- -- ---•-----•---------•-----••---•-•----------------------------------------------------•------•-•--•-------------•--•--- //('-•� .-''r % Installer has.been install in accordance with the provisions of T�TLE 5 of The State Sanitary Code as described in the application fo Disposal Works Construction Permit No.Y`1_-:..2_3_-Z................ dated-----------..................................... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE.............................. - 2.� .�-�� ................ Inspector--,f THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH No...--•-•-..--•...._...... FE . Permission is hereby granted......M ................................................................................................................................ to Constru ? or Re an I div' �1 Sewage Disposal System ( ) } '7 g P Y Street as shown on the lication for Disposal Works Construction Permit ......... Dated..:....................................... Board of Health DATE............----------•-------- FORM 1255 A. M. SULKIN, INC., BOSTON " '( ��I►-j La FAML 4- Bcop-oOM I NO GARgAG& 6c21 jDEL2 ' l oiaIiLY F►.ovV .: �JU � •�" 6.P. R 1G (o - • -.., SEPT%G -rAQlC - 1 -GL�.tSD°i 7&WO G.P. p u5c I0125O GAL. M1hf, 611 P. AIUA o�5Po5Al PIT v5E2'tUoD GAL. PISS ^ems PT _ 50TTOM la2EAr jro S.F. Ftor �• f 5p s.F X (• O / 0 �7.P�. PST (w�l N• X = D � z 'ToTA1-- DE51G : ,c}25 G.PD. 2 �, JJ o TANV- Y 'TOTAL.. DA%L (� FLov.( - '44D&pp .'A Oe- N � (t'� to if1 � ! ' PE2�oLATIoN RATes .I,'IN 2MIN o�LG-5S I;. . X,to A Iscoq I 0 35't .,- ;! � OVA OF Mas OF�1H Mq�9 00 Q 5"1• \ 0 RICHARD ram\ DAVID sG j i .n C. ✓ A. •Z THU L IN I� O BAXTER y c�i Np. 2M6 i A/�/� N(x 24046 el I v111-�o Q `c! ,<Y 0/STEN l' �� ►ry rl ram' � ' . . t To P FND= I, HOLt: 12li4j83 R.cS-1 �= Sl ;�s� '� d lNv• `�5 1.opW �2b0 INS. ! 5u pie,OIL DIST• INV.INV S6PriG 54•Y� tl -/O ' Z 1000 TANK '• GnAv�t. LEAGId PITS INV. INV. , G WITq e VL I ` WASUG� G14A 4 '$t LOOM Dc�S(�-b� -7 /16I`9- i 6Tv�1 E �• ar48 I �,11gII;Ca9-TIFIC-CD PLO-T PLAID .:A A. T_►o IJ CENTETi�� No SCALE SGAL� AIL cO VATS SIIIIBd ° ate- �-^ p L.A N R E F S 2E r4 C ` CERT% Y -fuAT 'Tµ� t'oUQt>A'ncIJ SNoWN ►{EREoli GonAPI-Y5 Y�IITN'CH�• �j l PEL11�1 � � IG�{ � ' 1 Aug SC---T >Z>rMEwT> DV- IC q - ?4-,L\IJ Fog- A-Lt-\u SMALL•- ANC. �AwN o� 'F3At21,15t14T3l .ND ISour j! LOCPTED •WMAW T E ':LOOD PLAIN 1�41 Z OF S DATE S+/(-'8`4 ..,, BA-ATEtZ.e Lt`(6 INS• REG I'SZ 626�'t�u D 5 u fCY EYoZS `fUIS PL o►d A 43TE2.V(LLam' lu5-r?'UMENT Suczvey �_ -r Aa oF=F,SErS •SuouLID �. NoT DE 'USEDTO pETEP.!^Iti.IE L_oT' L-I►-1E�j APP�.ICAIIT (: ,,., TOWN OF LOCATION: 1 ir, \OT� VILLAGE: LOT#: -7 MUL 2D;L7 PERMIT#: INSTALLER'S NAME: P INSTALLER'S PHONE#: 570 F--2-7 LEACHING FACILITY: (type) (size) t 5 o'er e NO.OF BEDROOMS: 6 BUILDER OR OWNER: PERMIT DATE: Le—72�—O`e COMPLIANCE DATE: DRAW DIAGRAM ON BACK A 2 A i _ TOWN OF BARNSTABLE. LOCATION 071 S SEWAGE# ,VILLAGE Cannfo,16, ASSESSOR'S MAP&PARCEL INSTALLERS NAME&PHONE NO. SEPTIC TANK CAPACITY Ic�SD4 _ 1 LEACHING FACILITY:(type) a (size) /0/!b NO.OF BEDROOMS OWNER PC.�1 P``�� PERMIT DATE: OMPLIANCE DATE: Separation Distance Between the: �..v Maximum Adjusted Groundwater T ,l 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 a wk 3 a S I �a� 9 y � a8 33 3 3s 39 S-1 y y� Yy E-T � 32- -7 LOCATION SEWAGE PERMIT NO. 41 ?S VILLAGE IN TA LLER'S NAME i ADDRESS ILOE R OR OWNER � 0ATE PERMIT ISSUED Zt DATE COMPLIANCE ISSUED mod, 2- ? �y z , �y 3S 3°► s WAIT SECTION A -A �' ALL OUTLET PIPES FROM THE DISTRIBUTION Box SHALL BE *NOTE: ALL PIPES ARE TO BE 4" SCHEDULE 40 P.V.C. 10' min. from PROFILE VIEW OF ADDITION TO LEACHING SYSTEM SET LEVEL FOR AT LEAST 2 FT. 12" CONCRETE COVER ; Existing Foundation house to septic tank D-Box cover must be ; T.O.F. elev. _ ,00.00 Septic tank covers must be within 6 in. of finished grade `=` _ ' a within 6 in. of finished grade 3" of 1/8" - 1/2" Washed Peastone ! < 'l KNOpcoU S�� 2 q ra�"git Grade over Septic Tank - 99.00 Grade over D-Box- 99.00 i--Grade over SAS- 99.00 - �,; _ #, F a i 3/4' to 1 1/2 ' Washed Crushed Stone J OUTLET ,l 12" INLET - 4'PVC(CAPPED)INSPECTION PORT TO BE `ti`- `_ S. S = 0.02 3 HOLE Top OF System- Elev. =96.75 INSTALLED AND TO BE WITHIN 6' OF GRADE - �� m (H-,0) DIST. BOX 3' Maximum Cover - 2' 9 d ? 5=0.01 or greater ,0" Effective Depth Y r j S= 0.010" er foot .. EXIST. PIPE ��' 0 16• EXIST. 1,000 GA • , - 1.75' FRON FOUNDATION SEPTIC TANK 10' PLAN SECTION CROSS-SECTION o) H-10 cCNI 0 5' 0.83' (10 inches) _ II a..e.nr p Units - 4 co co CONCRETE FULL FOUNDA u rn J.1251 .125 3.75' 3 HOLE H-10 DISTRIBUTION BOX , SYSTEM PROFILE mNOT TO SCALE 1 7r > 3.5' 3.5' II 5U' ��un,c t Not to Scale 3' Effective Length [Sa) 0 10' 0 S❑IL ABS❑RPTII7N SYSTEM (SAS) < Effective Width 4) GENERAL NOTES 6 in.of ted stone 1/2' o m 1. Contractor is responsible for Digsafe notification, Verification of Utilities NOTE: ALL COMPONENTS MUST HAVE RISERS TO WITHIN 6" BELOW GRADE compacted stone o INFILTATR❑R HIGH CAPACITY (H-20 LOADING)/ GE❑RGE ❑'BRIEN Z Bottom of Test Hole 1 Dev.=Bs.00 (OR EQUIVALENT) Not to Scale and protection of all Underground utilities and pipes. W Groundwater_Observed - NONE OBSERVED NOTE: OVERALL HEIGHT OF INFILTRATOR IS 18" /EFFECTIVE HEIGHT IS 10" 2. The septic tank and distribution box shall be set level on 6 of 3/4"-1 1/2" stone. 3. Backfill should be clean sand or gravel with no i stones over 3" in size. PERCOLATION TEST - C\ Oj�� 4. This system is subject to inspection during installation 1� I by Carmen E. Shay - Environmental Services, Inc. 5. The contractor shall install this system in accordance Date of Percolation Test: JUNE 28, 2006 with Title V of the Massachusetts state code, the approved plan Test Performed By: CARMEN E. SHAY, R.S., C.S.E. and Local Regulations. Results Witnessed By: DONALD DESMARAIS (Barnstable B.O.H.) 6. If, during installation the contractor encounters any EXCAVATOR: Shay Env. Svcs. soil conditions or site conditions that are different Percolation Rate: Less Than 2 MPI ® 36" PT from those shown on the soil log or in our design 76.64' installation must halt & immediate notification be Test Hole Test Hole \���� made to Carmen E. Shay - Environmental Services, Inc. No. 1 No. 2 7. No vehicle or heavy machinery shall drive over the DEPTH SOILS ELEV. DEPTH SOILS ELEV. septic system unless noted as H-20 septic components. 0 99.00 0 99.00 8. Install Tuf-Tite gas baffles or equals on all outlet tee ends. Sandy Loam Sandy Loam --- -- 9. All Distribution Lines shall be 4" diameter Schedule 40 NSF PVC pipes. 10 YR 3/2 10 YR 3/2 SHED 10. All solid piping, tees & fittings shall be 4" diameter 0"-6" As 9B.50 0'-6" A, 98.50 \\\\ Schedule 40 NSF PVC pipes with water tight joints. Sandy Sandy CID \\\\ 11. Municipal Water is Connected to ALL OF The Residence and Abutting Loam Loam CID `98 Properties Within 150 Feet. 10 YR 5/6 10 YR 5/6 6"- 36"1 8, 96.00 6"- 36" Bw 96.00 THE PROPERTY LINES ARE APPROXIMATE AND Medium/Coarse Medium/Coarse 1919 COMPILED FROM THE SURVEY PLAN GENERATED BY Sand Sand Failed BAXTER & NYE OF OSTERVILLE, MA 7-5s Y 7/4 is Y 7/4 Leach P1t O DATED DULY 16, 1984 Leach Plt Failed ENTITLED "CERTIFIED PLOT PLAN OF LOT 169A JAMES OT►S RD, CENT. ,MA �'`�-_ 36"- 120 G 89.00 36"- 120 G as.00 -- 0, AND IS NOT INTENDED TO BE A SURVEY PLOT PLAN TEST HOLE #2 IT SHOULD BE USED FOR NO PURPOSE OTHER THAN . _-.��3, Y _-,-� •,�..;��- >Lti-- ,, -_ _ THE SEPTIC SYSTEM INSTALLATION. 10' • • • . . . . f EXISTING LEACH PITS TO BE PUMPED OUT AND FILLED IN PLACE -�� ^ D-BOX -3` &. tx�::�Sc�•'F.,CY•i�s 1'y.�F:.�� ,cam-.Y'+.. ` r , NOTE: ANY STRIPPED OUT SOIL CONTAINING LEACHATE ��4, TEST HOLE 1 l I \\\\ # l l �y FROM THE EXISTING LEACH PITS TO BE DISPOSED ELEV.= 99.00 19 OF AS PER BOARD OF HEALTH SPECIFICATIONS. LOB EXIST. 1,000 GAL. 0 20 40 50 27, SEPTIC TANK Pere #1 1 1 1THERE ARE NO WETLANDS ARE PRESENT WITHIN 200' OF THE PROPERTY Depth to Perc: 36" to 54" Pere Rate= 2 MPI PATIO ASSESSORS MAP 171 PARCEL 202 Groundwater Not Observed PROJECT BENCH MARK No Observed ESHWT SCALE: 1 "=20' cr TOP OF FOUNDATION LEGEND ADJUSTED H2O Elev. = None EXIST. ELEV. = 100.00 (Assumed) GARAGE >s 104X1 DENOTES PROPOSED 2-18"DIAM. ACCESS MANHOLES EXISTING SPOT GRADE B 4 BEDROOM [rousE DENOTES x 104.46 SPOT GRADE ISTING W PL PROPERTY LINE INLET ^ OU ET 96P PROPOSED CONTOUR THE ACCESS COVERS FOR THE SEPTIC TANK, I n M- - DISTRIBUTION BOX AND LEACHING COMPONENT EXIST. - - - _- -97 EXISTING CONTOUR SET DEEPER THAN 6 INCHES BELOW FINISHED DRIVEWAY _ GRADE SHALL BE RAISED TO WITHIN 6" OF LOT #169A STEEL REINFORCED PRECAST CONCRETE FINISHED GRADE. DEEP TEST HOLE & PLAN VIEW INSTALL TUF-TITE GAS BAFFLES OR EQUALS I-- 15,5i�0 Square Feet F�- ---- ----------------- ------------- _ ____________ __�9 PERCOLATION LEST LOCATION /-3-24• REMOVABLE covERs 99 ' 6 FOOT STOCKADE FENCE _3" mM•dearance =` 100.00' 8'm1n.T- 2'm INLET m. inlet to outlet in t3' INLET' �---- B"m - - Uquid level - OUTLET - 5' -7' ^- •5' -7- L- _ _ � _ _ P LOT P LAN E o I V-0' min. Mfft : Liquid depth ® TI,S' _n ®A_3 OF PROPOSED SEPTIC SYSTEM- UPGRADE I .L �o :z = (40 FOOT RIGHT OF WAY) PREPARED FOR 1 t CROSS6 SE' TION END-SECTION R I C HAR D 8c CAROL MAN ,R DI AT TYPICAL 1000 LLON c SEPTIC TANK # 16 JAM ES OTI S ROAD NOT T SCALE 0 � CENTERVIEEE, MA Design Calculations m EXIST. Number of Bedrooms: 4 Bedroom EXISTING Bedmom Bedroom GARAGE Bedr 1AOF 4Sn A D BY: Mud Kitchen q Garbage Grinder: No v C Leaching Capacity Required: 440 Gal./Day (MIN. PER TITLE V) Room �o CAM Septic Tank : - 2 x 440 Gal./Day = 880 USE EXIST. 1,000 GAL. Septic Tank. am 0 -4 L1 1 it�%1 ► ll SOIL ABSORPTION AREA: Using percolation rate of <2 min./inchU) ENVIRONMENTAL SERVICES, INC. Dining DEN O � Bottom Area: 0.74 gal/sq. ft. x 500 sq. ft. = 370 gallons n Sidewall Area: 0.74 gal./sq. ft. x 99.6 sq. ft. = 73.7 gallons 2nd Floor ( L! -P �0 P.O. BOX 627 Providing: = 443.70 gallons �\ 0� r� , I IcS lr,ke IIA e sG TAR�Pl EAST FALMOUTH, MA 02536 V f `�� 61 q 60 1st Floor � � TEL/FAX : 508-539-7966 Use: (7) INFILTRATOR HIGH CAPACITY H-20 UNITS, HAVING A 0.83' (10 INCHES) EF CTIVE�DEPTH, 3 BR HO SE FLOOR SCHEMATIC TO BE USED WITH 3.5' OF WASHED STONE ON THE SIDES, AND 1' OF WASHED STONE /1 SCALE: 1"=20' DRAWN BY: CES DATE: JUNE 28, 2©06 ON THE ENDS. NO STONE UNDER. +J `o J�Q{y Or r a l . 11 b� f n� ) Iar'e r/ (Descr*- tion Provided By Owner) ( X fv. caw ° ` a S PROJECT#SD936 FILENAME: SD936PP.DWG SHEET 1 OF 1 �;wgfLnn 5�,°WS 1 0/1 elks �J��I 0r1t� E1G✓�S I On Q �,