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HomeMy WebLinkAbout0079 LAKESIDE DRIVE EAST - Health ,,79 LAKESIDE DR. EAST, CENTERVILLE _//A= 252 095 r / e ..�._,...�•:-.:-......r`��..-ry/-�_ .ter., .. ^-a .-,-s --. -,,,,:;..-. ;w .�.. �.ta,,,,+`*-...,rV' _r»u,•xt. .../�..r, No. ` I7 Feel Entered in computer: THE COMMONWEALTH OF MASSACHUSETTSJ% Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS �I Application for Mi6ponl 6p6tem Con0truction Permit Application for a Permit to Construct O Repair(X Upgrade O Abandon O ❑Complete System ElIndividual Components Location Address or Lot No. �q/.,) e 'l{ "�y Owner's Nam/ee,�Addre(s-s;and Tel.Now. � IN M � 5� f�f t � 1i�!K �7'�[ ��P(7�(1��(11l Assessor's Map/Parcel 2,5 Z ' MT ct j 0q i Installer's Name,Address,and Te. o. ` t^ O W H Designer's Name,Address and Tel.N ��V' O)'Al fh a 31� vZ(�s, ;4. Yaw&Q. Type of Building: I Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder ( ) I. Other Type of Building No.of Persons Showers( ) Cafeteria( ) } Other Fixtures m. I Design Flow(min.required) gpd Design flow provided j30 gpd i Plan Date Number of sheets Revision Date Title Size of Septic Tank _1� M 11014( Type of S.A.S. ©.S K tom, 1,eALlit •tm Id Description of Soil » Nature of Repairs or Alterations(Answer when applicable) te i'54104 — A V1 %�V 1A f Date last inspected: i Agreement: The undersigned agrees to a the construction and maintenance of the afore described on-site,sewage disposal system in accordance with the provisions Title o t wi tal Code and not to place the system in operation until a Certificate of Compliance has been issued b this Ord H lth. 'V f 4 { Signe r An Date •10- Application Approved by rl f f Date log l Application Disapproved by: Date. - `t for the following reasons +` t Permit No. " Date Issued ----------------' ------------- --4----_--- - THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,tha_the O site Sewage Disposal System Constructed (�G Repaired ( ) Upgraded ( ) Abandoned( )by vp at o ktS 1 E1,4 0, CJ 4 has ben constructed.in accordance with the pro isions of Title 5 and the for Disposal System Construction Permit No. - dated Installer e t g7sdw�► Designer 9&kA C P r a #bedrooms Approved design n flow / d The issuance of this permit shall not be o r d as guarantee that the system t gp L p g y fu ctionas signed. Date .-� / Inspector / t y. f I/ V r v l/ v ---------------------------------� r/---------- No. "''� Fee THE COMMONWEALTH OF MASSACHUSETTS ff PUBLIC HEALTH DIVISION—BARNSTABLE, MASSACHUSETTS Oiopogat *pgtem Construction permit 4 Permission is hereby granted to Co A t (�) Repair ( ) Upgr de ( ) 'Abandon ( ) System located at �ptn [(�/t S 4 and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to comply with Title S and the following local provisions or special conditions. Provided: Construction must be completed within three years of the date of ' p Date - O k' ®� Approved by I FROM :down cape engineering inci )FAX NO. :15083629880 Oct. 01 2007 03:02PM P1 down cape engineering, inc. SIEVE SOILS ANALYSIS MANOOG_07-135 .xls DATE OF REPORT: 7/1/2007 CPC,)FJa GRAIN SIZE ANALYSIS-SIEVE TEST SITE: 79 LAKESIDE DR. EAST, CEN'TERVILLE LOCATION: TH1; "C" HORIZON f SIEVE ANALYSIS Weight Sample(Grams): 561.5 FSIZE RETAINED WT. RET. % RETAINED, % PASSED wt -- ind-sieve) (sum) --_._____0.0 0.0%: 100.0% _-_------------__L____------_-----____ _23.4 23.4 4.2%: 95.13--_________------_ _________________p_-______31.6 55.0 9.8%; 90.2% 3/8" 37.5 92.5 16.5% 83.5% #4 41.8 134.3__ 23.- 76.1%: LLNOTE: 0--------- ------------41.0 175.3 '- . --31.2%;----------------6>Z.>s%. --------_.._________ _________________L-----------__--83.7 259.0 46.1%; 53.9% r--------------- ---------- ----_ 182.0 441.0 78.5%; 21.5% ----- -102.2 543.2 _-._o__ 96.7%� _______________. 3.30 552.3AN: 9.2 561.5 100.0%,----_-h-------------- L-------------_-_AMPLE: 561.5 TEST ON PASSING#4 ONLY, 23.9% RETAINED ON#4 <45% O.K. RESULTS: SOIL CLASSIFIED AS AASHTO A4(GRANULAR,SAND) (UNCOMPACTED) PERCENTAGE OF MATERIAL PASSING#4 SIEVE MEETS : 94 100% (TEST ONLY MATERIAL PASSING 04) 1#6010%-100% 4100 0%-20% #200 0%-5% REQUIREMENT FOR "FILL"IN TITLE S. <5% PASSING#200 SIEVE RESULTS: PERMEABLE MATERIAL-CLASS 1 e5 MINAN. MATERIAL NONCOMPACTED SOIL DESCRIPTION: MEDIUM COARSE SAND I ' f o Town of Barnstable Regulatory Services Thomas F. Geiler, Director '"MISTARML M Public Health. Division witt` Thomas McKean, Director 200 Main Street,Hyannis, MA.02601 Office: 508-862-4644 Fax: 508-790-6304 Installer & DesiQner`Certification Form Date: 41 AI Sem,age Permit*' 700"7-qq2.Assessor's Map\Parcel Zvi Z Designer: Installer: Q-e UGC�s •1;S Address: /-(Ct Address: �S�w�'►e� ��`Ca�`��of`', �►CY Y0'-7'-'1VW VA 01 maonc'CO MAI On b •©1`0 ve-' Are I CO was issued a permit to install a (date) / (instal lle'�) septic system at W 1) ✓f based on a design drawn by � / �d� �� D (address) ayy"Q, -Cvf dated (des _ er) 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 certi'n° that the septic system referenced above was installed Aith 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 N;6th State & Local Regulations. Plan revision or certified as-built by designer to follow. �N OF 14,4,9 (In tal er's Signature) ARNE H °yam o OJALA CIVIL -4 No. 30792 �o �F (Des gn`s ature) (Affix Desi� N ;F PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS-BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. �� Q:HeahIdSe-ptic/Dcsicncr Cenification Form 3-26-04.doc TOWN OF BARNSTABLE LOCAnON 7 �—�_f� S c.� �r- • �� l SEWAGE VM;-AGE S4-, ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY /O d U r LEACHING FACILITY: (type) %' t �IT (size) �� �' rX NO.OF BEDROOMS 3 BUILDER OR OWNER + PERMITDATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility 7'° y° 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 POO ����� - - G� �9 of ��! .� ��� RE TROY WILLIAMS AUG 13 SEPTIC INSPECTIONS � 98 eo TOWPJ(IFQA,,.._ cnDEPT _ Certified by MA Department of Environmental Protection (508) 385-1300 �J 19 Hummel Drive , South Dennis, MA-02660 ' COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS Y DEPARTMENT OF ENVIRONMENTA r COP u L PROTECTION ONE WINTER STREET. BOSTON, MA 02108 617-292.5500 WILLIAM F.WELD Govcmor TRUDY CORE Sccrctan ARGEO PAUL CELLUCCI Lt.Govcm DAVID B.STRUHSor SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM Commissioncr PART A CERTIFICATION -7 Property Address: /9 LN K a s v t- 0t,• Cc%. L th f e`✓ 1�-LAddress of Owner: ��'h �v s• + Date of Inspection: �1/e / y8 (If different) Name of Inspector: T r o y W i 11 i am s 7 4 L a,j< s iJt. Ar. 67a . I am a DEP approved system inspector pursuant to Section 1S.340 of Title S (310 CMR 15.000) Company Name: Troy WiI11ams Septic Inspections �`"t�✓v' ��` Mailing Address: _19 Hummpl Drive , South Dpnn1S , MA 02660 ba6 �,2 Telephone Number: (508) 385-1300 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: ,Passes _ Conditionally Passes Needs Further Evaluation By the Local Approving Authority _ Fails Inspector's Signature: L Date: The System Inspector shall submit a copy of this inspection report to the Approving Authority within thirty(30)days of completing this inspection. I(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, 8, C, or D: AI ,SYSTEM PASSES: V I have not found any information which indicates that the system violates any of the failure criteria as defined in 310 CMR 15.303. Any failure criteria not evaluated are indicated below. COMMENTS: BI 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. 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, unless the owner or operator has provided the system inspector with a copy of a Certificate of Compliance (attached) indicating that the tank was installed within twenty(20)years prior to the date of the inspection;or the septic tank,whether or not metal, is cracked, structurally unsound, shows substantial infiltration or exf(ltration,or tank failure is imminent. The system will pass inspection if the existing septic tank is replaced with a conforming septic tank as approved by the Board of Health. _ (r—i—d 04/25/97) Fag. 1 or 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM � �CC PART A M 79 Lakeside Drive,Centerville, AERTIFICATION (continued) Property Address: Irwin Pugatch Owner: August 10, 1998 Date of Inspection: B) SYSTEM CONDITIONALLY PASSES (continued) T/45P Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. The system will pass inspection if(with approval of the Board of Health). Describe observations: broken pipe(s) are replaced obstruction is removed distribution box is levelled or replaced The system required pumping more than four 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 C) FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: /UTA Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect the public health, safety and the environment. 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: Cesspool or privy is within SO feet of a surface water Cesspool or privy is within SO feet of a bordering vegetated wetland or a salt marsh. 2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH (AND PUBLIC WATER SUPPLIER, 11:APPROPRIATE) DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECTS THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: — The system has a septic tank and soil absorption system (SAS) and the SAS 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 the SAS is within a Zone I of a public water supply well. — The system has a septic tank and soil absorption system_and the SAS is within SO feet of a private water supply well.. _, The system has a septic tank and soil absorption system and the.SAS is less than 100 feet but SO feet or more from a private water supply well, unless a well water analysis 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 S ppm. Method used to determine distance (approximation not valid). 3) OTHER SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 79 Lakeside Drive, Centerville,MA Owner: Irwin Pugatch Date of Inspection: August 10, 1998 D) SYSTEM FAILS: A//19 You must indicate ewer "Yes" or "No" as to each of the following: I have determined that the system 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 correct the failure. Yes No Backup of sewage into facility or system component due to an 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 1/2 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 Soil Absorption System, cesspool or privy is below the high groundwater elevation. Any portion of a 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 I 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. If the well has been analyzed to be acceptable, attach copy of well water analysis for coliform bacteria, volatile organic compounds, ammonia nitrogen and nitrate nitrogen. E] LARGE SYSTEM FAILS: P/4 You must indicate either "Yes" or "No" as to each of the following: The following criteria apply to large systems in addition to the criteria above: The system serves a facility with a design flow of 10,000 gpd or greater (Large System) and the system is a significant threat to public health and safety and the environment because one or more of the following conditions exist: 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 If 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. (—i..d 04/25/97) _ - - SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST 79 Lakeside Drive, Centerville,MA Property Address: Irwin Pugatch Owner: August 10, 1998 Date of Inspection: Check if the following have been done: You must indicate either "Yes" or "No" as to each of the following: Yes, No _ Pumping information was provided by the owner, occupant, or Board of Health. �L _ None of the system components have been'pumped for at least flow rates during that period. large volumes of watervhave enot abeen nd h ntroducede system ainto the s been rsy system recentlyeceiving lor as part of this inspection. As built plans have been obtained and examined. Note if they are not available with N/A. _ The facility or dwelling was inspected for signs of sewage back-up. _ The system does not receive non-sanitary or industrial waste flow. L/ _ The site was inspected for signs of breakout. ✓ _ All system components, excluding the Soil Absorption System, have been located on the site. _ The septic tank manholes were uncovered, opened, and the interior of the septic tank was inspected (or condition of baffles or tees, material-of construction, dimensions, depth of liquid, depth of sludge, depth of scum. / The size and location of the Soil Absorption System on the site has been determined based on: _✓ = The facility owner(and occupants, if different from owner)were provided with information on the proper maintenance of Sub-Surface Disposal System. N/9 Existing information. Ex. Plan at B.O.H. JL _ Determined in the field (if any of the failure criteria related to Part C is at issue, approximation of distance is unacceptable) 115.302(3)(b)] (r.vt..A o�i�cici SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION 79 Lakeside Drive, Centerville,MA Property Address: Irwin Pugatch Owner: Date of Inspection: August 10, 1998 RESIDENTIAL: FLOW CONDITIONS Design flow:-3, y g,p•d./bedroom for S.A.S. Number of bedrooms:_ Number of current residents: Garbage grinder (yes or no): /VO Laundry connected to system (yes or no): `lFS Seasonal use (yes or no): �egg S Water meter readings, if available (last two (2).year usage (gpd):�� = Cj, �boG«//dh� 9�-G$ ,00� �� = �� ✓0 0 Sump Pump (yes or no): Last date of occupancy: L L'-, To ,e- rf. COMMERCIAUINDUSTRIAL• Type of establishment: Design flow: t allons/day Grease trap present: (yes or no)_ Industrial Waste Holding Tank present: (yes or no)_ Non-sanitary waste discharged to the Title S system: (yes or no)_ Water meter readings, if available: Last date of occupancy: OTHER: (Describe) Last date of occupancy: GENERAL INFORMATION PUMPING RECORDS and source of information: L./!-,t✓ System pumped as part of inspection. (yes or no) /Vo If yes, volume pumped: _gallons Reason for pumping: TYYF 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) I/A Technology etc. Copy of up to date contract? Other APPROXIMATE AGE of all components, date installed (if known) and source of information: d r I C. „� 4 4- G-/o h»)c g Sewage odors detected when arriving at the site: (yes or no) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 79 Lakeside Drive,Centerville,MA Owner: Irwin Pugatch Date of Inspection: August 10, 1998 BUILDING SEWER: A119 (locate on site plan) Depth below grade: Material of construction: _cast iron _ 40 PVC _other (explain) Distance from private water supply well or suction line Diameter Comments: (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 Certificate of Compliance _(Yes/No) Dimensions:_ Sludge depth:_,_ Distance from top of sludge to bottom of outlet tee or baffle: 5 �� Scum thickness: 6N6- Distance from top of scum to top of outlet tee or baffle: Ali S vt Distance from bottom of scum to bottom of outlet tee or baffle: NUJ s c v+, How dimensions were determined: Comments: (recommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural 11) integrity, evidence of leakage, etc.) p,C. �� �� 6 v of/-4­1 �, K;G'/ — ,s fr t-t Al GREASE TRAP:�II/.� (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: (recommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity, evidence of leakage, etc.) (rsvis•d 04/25/971 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) 79 Lakeside Drive,Centerville,MA Property Address:Owner: Irwin Pugatch Date of Inspection: August 10, 1998 TIGHT OR HOLDING TANK: /V/19(Tank must be pumped prior to, or at time, of inspection)' (locate on site plan) Depth below grade: Material of construction: _concrete _metal _Fiberglass _Polyethylene _other(explain) Dimensions: Capacity: gallons Design flow: gallons/day Alarm level: Alarm in working order_Yes; No Date of previous pumping: _ Comments: (condition of inlet tee, condition of alarm and float switches, etc.) DISTRIBUTION BOX:- (locate on site plan) Depth of liquid level above outlet invert:��- Comments: (no a if level and distribution is equal, evidence of solids carryover, evidence of leakage into or out of box, etc.) L?-_/_7 t d _ � O lJ+ 1-�/7 / '• h a s _ No !� S 1 0 7'e sc7 / _� � w✓yiy oV-e.+./ d Y r.J c PUMP CHAMBER: A114 (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.) t.. I._A SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 79 Lakeside Drive, Centerville,MA Owner: Irwin Pugatch Date of Inspection:August 10, 1998 SOIL ABSORPTION SYSTEM (SAS):, (locate on site plan, if possible; excavation not required, but may be approximated by non-intrusive methods) If not determined to be present, explain: Type: leaching pits, number:_ leaching chambers, number:_ leaching galleries, number: leaching trenches, number,length: leaching fields, number, dimensions:C>PN t /.Z ' -IQ L �.� 7a•/d overflow cesspool, number: ` Alternative system: Name of Technology: Comments: (note condition of soil,'signs of hydraulic failure, level of ponding, condition of vegetation, etc.) 6 I �- ✓ d L i c5 4 +, v� v.c� S 7 L7 h t N CESSPOOLS: Nl4 (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(cesspool must be pumped as part of inspection) Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) PRIVY:_A 119 (locate on site plan) Materials of construction: Dimensions: Depth of solids: Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) (r—i..a 04/25/97) P.q. ! of 10 I SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 79 Lakeside Drive,Centerville,MA Owner: Irwin Pugatch Date of Inspection: August 10, 1998 SKETCH OF. SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent references landmarks or benchmarks locate all wells within 100' (locate where public water supply comes into house) +-. i 1 I / s IxXzf3XI26 p_Qo"- S , 1 � l � I (r—ised 04/25/97) ` o..._ . _. ... SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 79 Lakeside Drive,Centerville,MA Owner: Irwin Pugatch Date of Inspection: August 10, 1998 Depth to Groundwater 8,S Feet r adjusted high groundwatcr lcvci Please indicate all the methods used to determine High Groundwater Elevation: Obtained from Design Plans on record t/Observation.of Site (Abutting property, observation hole, basement sump etc.) t/ Determine it from local conditions Check with local Board of health Check FEMA Maps Check pumping records Check local excavators, installers Use USGS Data Describe in your own words how you established the High Groundwater Elevation. Must be completed) VI 04 CA-k,J G,.� mil. �j r C.c .A—ci� (�•J c- ''-t..� c ,L-1 c A cUt, � . FJo7TZv�-, , , ��C i1 - y 6 U S /mot. J o c y�"t i (i-t ��c✓ I Gv�� , (r—is.d 04/25/97) .. Pao. 10 ..i 1n a Permit Number: Date: //0 Completed by HIGH GROUND-WATER LEVEL COMPUTATION Site Location: `f [� o� �� S L ✓. � . Lot No. Owner: Address: Contractor: Address: 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: OAppropriate index well.................................................... f1�w Zy� OB Water-level range_zone ..................................................... G STEP 3 Using monthly report "Current Water Resources Conditions" determine current depth to water level for index well ........................... 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 26) determine water-level adjustment .......................................................................................... 1 -5 STEP 5 Estimate depth to high water by subtracting the water- level adjustment (STEP 4) from measured depth to water levelat site (STEP 1) ............................................................................................................. 7. O Fss... ®.............. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Apphrativit for Diiapinittl Works Tomitrnrtion f lumit Application is hereby made for a Permit to Construct ( ) or Repair (X) an Individual Sewage Disposal System at: ..... 116D � � - t f!J _.. G rv.S ldjl f Location: ot Add s or L No -� , IOstaller Address 7................................... S U Type of Building Size Lot.......................... q. feet .. Dwelling—No. of Bedrooms.................a.'�.._-------------------.-_Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building _____________________----- No. of persons---------------------------- Showers ( ) — Cafeteria ( ) dOther fixtures -------------------------------------------------------------------------------------- ----------------------••-•----•-•-••---•--------......---- W Design Flow................., ------------------gallons per person per day. Total daily flow-------------57ZQ................gallons. W Septic Tank—Liquid capacitv_./---gallons Le1ngth---------------- Width---._. __----- Diameter....------------ Depth-----________ x Disposal Trench—No. ___._.__...1.._.. Width...... .-------- Total Length---�9......... Total leaching area....................sq. ft. 3 Seepage Pit No..................... Diameter--------------...... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water..................... 44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 1:+4 ------------------------- ---------------------- ........................................................................................................... 0 Description of Soil........................................................................................................................................................................ x U ----•----•----------•-----------------••-•------------------------------------------------------------•------------------------------------•----------------------.-----------•---•------•------------ W x -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------•---- ---------•-.------ U Nature of Repairs or Alsatior s—Answer when applicable._._.1.. ......s4-._...._.�_�a. ____.s en"C. �s}Ark/. ........A 4--`---`--AK .7-------------- ----- ..------ 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 ha ee issued t oard of health. Signed ............... ...... Date �G Application Approved y-ti.... .................. :..� .............. - .................. ''��7 T Date Application Disapproved for the following reasons: ............................................................................................................................................ ............................................................. ........................................ qq !✓ N ® /�} ��.may' - �.. Permit No. ...... .0 ---------------------------- ------ - ... Issued .`/...._......._............dam/ ICJ GIf Date ----- —————————————— ————— ----- - — -- -- No.•-•-•.. ._. Fxs...-��......-...... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Appliratiott for Diopooal Works Tonitrnrtion ramit Application is hereby made for a Permit to Construct ( ) or Repair (x) an Individual Sewage Disposal System at: ..... .`�. �/ D6DL aI aLs , J ) s ------. - 1T --•-----------•--........ . y 1 :... Location- Add r•ss or Lot No. � D ' � L~ . Q2 r�1c ,� �l ✓ r�s ,.1.s �!1..1 ----•- Owner ddres WG-t�tv ....._ . 7Lvc�-/ .�.... � "� l�tl�F/L`tCSAy ✓t/1 , ✓1/11 t1 a ---- -- ------• -------•--------•---•--•--•-••---------- Installer Address Type of Building Size Lot............................Sq. feet ►� Dwelling—No. of Bedrooms--------------------------------------------Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ____________________________ No. of persons---------------------------- Showers ( ) — Cafeteria ( ) dOther fixtures ------------- - ---------------------------------------------------------------------- ----------------------------•-----------•-------------------- W Design Flow----------------- - __.........._.gallons per person per day. Total daily flow-------------sZ Q................gallons. x Septic Tank—Liquid capacity..�__gallons Length---------------- Width__..._..____... Diameter._.------------- Depth................ Disposal Trench—No_ ___________ _____ Width....... ___.___._ Total Length_._�?.9- -.... Total leaching area....................sq. ft. Seepage Pit No...................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a' ---...-•...............................•---------••---•------............-•-•---•-•--------...............--------••------•-•--•--......--•-•-•----•--...--- 0 Description of Soil........................................................................................................................................................................ W V •--•--------------------•-•--------•------------------------------------------------------------------------------------------------------------•-------------------------••-•----••......-•---------•-- W x ------------- -------------------- -------------------------------------------------------------------------------------------------------------------------------------- - ----•--- U Nature of Repairs or Alterations—Answer when applicable-__� �= 4`_____4_..______IGUd �.Q 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'''ee issuedf y t oard of health. Signed -------------- ..............................`..... .................................................. ... Application Approved ! `.'''L' ...__..... ... ....................................... .• �`:� . . Dare Application Disapproved for the following reasons: .................... ...... ....................... ... ........... ....................... ------ ------------ ---------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------- .. {� Date Permit No. -------1..� F'"'.. J.v` .. Issued • ..''® ` ----- ��......... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Gerttftrate of Grapliance THIS IS TO CEI— W-Y That the Individual Sewage Disposal System constructed ( ) or Repaired by -.................................... /__ � w./.f..._...._...-.0�I�-U---�1Z�lc�<c-.�......--------------------------_--------------------------------------------- Insr,Jlrr at ------------------------------------------------------- ��' ... . -------04�ol 04i�`4E-------------------- ..................... 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. ...V._......` Q._------- dated THE ISSUANCE OF THIS CERTIFICATE SHALL NOt I E CONSTRU AS A GUARAtiTEE THAT THE SYSTEM WILL FU NCTION �ATISFAO'>`���_----�� DATE ---------------------------------- ------------------- - .... - .._._.. Inspe for.f. - —__---- ——------------------_------ ----------------------------___ -------- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ' TOWN OF BARNSTABLE l.No.. . "'..2 FEE................ .... %yont Noprkii Tonotrudion "amit Permission is hereby granted-------------- LLe�-,>� 1 !! ...r . ...................................... to Construct ( ) or Repair an Individual Sewage Disposal System at No--------------------------------------•-...7$-----------. � € r'd�.----- �iganl.. ✓d�I/�Ls 77,,�S_,�YJ........y Street �j as shown on the application for Disposal Works Construction Perm g7:.'`_ ..�74_ Dated__. .' ..._. � . -'`�'�" _ --------- DATE_ � �� Board of Health / FORM 36508 HOBBS 6 WARREN.INC..PUBLISHERS 3 --- --- L I - i ADV 8''z'--.� _rF I I� I� _e X'r51 t.N G.:_ i"JS.pK:. - - II, co :o M tl, ry k II �Y c I^ III 6 J I I !n r�LigER r `• � � _I' - - "• �. - - h l.ram-.:� _f i — t'�rrc1z5�9EAa ir•j .Fcu . :.I p j;rJ-rrt v�1'0, tN r l�,t•s ,-=, t _ .G_A_[LA.G E ,� � ro LIl1 ar, •j l. o 'N�. i t 2" 1ILI ,tip` s g•_w _ ,..t3 L o': :i I. . _ F'.I oWi �rai"e:�ora'• 243cn..: C 2°S5. i 3 0'-9` ..- .: - . . ..- � - .. ,r � �. � : --- "..--=-�--_.:_..t�C=.' 7i t-rJ-::_:EXI S.T tJA-: - -- - -- --�•'..`- ---7---. 'IS'-� Q4" . - pik—opols" 4cA : I�w r ._ AVPf10VED B`/: DAWN Bt BATE:J U TN 01 I . v,ocT'�► DRAWING NUNBEA 4 3 l v t w 1 -1 n3awnn�ra� '9 also= ?1C1 3utS:371b'1�L 1- --- gOONVV/ N.Vio -- 10 1,0 03SIA 10 rmL :31VQ A9 aMVtlO AB 03AO— 1 p 4` -- ----- - - O 1 O ' Ira _ - - - - -- - y.. 400 I J ---- --- --, -- :' h -- „�1�v � - .. �� � Ifs� Q• I — _ — - .. - - -•� ,L t•f-IV r� -'7J QVI/I_ _.� •'Z_V/._00_71:43_ _ to CD rd 1 d i } I ' -Cer, 12Att L�eRceRS'nZ2'=a--a.�. p ' - .('r'=�.CEOG+>=Jcr3onrty m C>✓-'*_.��-_,:_ GA nr oLu PG`TS F-sr - -3s�''9l'i0.D1NG:.F£/:rSPu 1.Ic _/�(•ems:r"'ST�_r�,. . Rya-f"`aCL"FltciiyN(s U TH.�'.J GJOLTC• - � J01.9T HAN PJZ 3G"�'jta"G�.E�T. c PT 2x I 11 ro_r-0N� f210G;C VE t�IT. _ c- Y „f' =1a9ElCA--LT=ILC]DSHINCs:LES== I �' . ��ClaLJ-Cam_'-O_ �C01:1-n- - �1-d' (L.__--.te Tz3�F vl i _ins _- 2L�L4t�.o_o.� TIVAIJL Cs tsicr� IXAT ,1I..EAVE..DET-AtI. _ I. " V L!:l_G 1 I W Ca" 1 � - I --{��J FL 2EC`z�A�-_ --_ � � � • ( ; — 1r�-r_'n�rSNEP7NiuG�--cyy�c�V_(Z;SP CD `D � W - - - 1x�o � cl�1£aV'^ ..^yT T J I "9!/>. 1 a/4•. � � " ~ "� "•gam--. - { � � - -- '. f / V �!6\.i•. (' �i'_— -rye 2 .. r. - PU I . It - UP CD PoJzcH.,I' syf:i �p r --• N I" I I— E�yC - L'6LCs__'� /\ I�1T'-�:.�OUJFl l:4T O:tc1._ .- -Ps 1 l l O 2? - O' ,L•o LLUALCs'' J�"A�ti:I:-FiO.IJ-S-cA E"NS'fL"Ja Nc:.E-=_{pyn tl_•( -....._.. 1y - - , I - curl --"F 4o=-r 1 A.Ct- --- -- I I :E-R-PST- czrit s�ATtpN I ' AL.. SGE: 1/4 ,1_11-0 APPROVEDIW: DRAWN 9'f - DATE:SEPT OI ..F REVISED OCT�Ol 1L\TC.sStixxta-:1A"A-N-Cwc : --- DRAWINGNUMl�r . - r �Eoc��o—Ft.Oo_fZ—_LL9L� -._...... _ _ f Elan G RS A9p HALT fF-0 I ' - 77 { - Fr_..�TET:` CC.�-'CT6_FL SCALE: 1�(ill��'� APPROVED BY: DRAWN8. DATE:'S V OI � pE\I6lD . N _ _��OT'tri=JnAN:QOG 1 1 �-- � - .. pRAW—NUMBER a�`— EyEA--T D6N i d _RZu:iA rIJ:.ain-__Gu:-r_r_`:�ct���.CA'q: — - ILT_.. Ill tt 71 N ( E�c�Et•iSlo.�•i.:ol-- ! 1iI�:—�y1II � �:` .. � .. . i El E scA .1/4.M1_'� APPROVED Br: DRAWN Br .. DATE:JVNE?Do1 - -REVISEDOCj COI { E.,4 DRAWMG NUMBER I L ` E _ tl�iJ _ �Ct --f2"tG"u- --- •LC------ ' f .. _ 11c-1 1 .1 0_P. APPROVED W: oRwwN er - DATE:CSEP OI REVISEDO.CT.'oI DRAWPIG NUM6Qt i to -(=I —0:. : i .:or- 41 I. -Nd :\VG>fLt<:;Itl THtS.:' i m o: _N 1c Ft4-------------------- 9�` �•. . =[fie=�n'v:vc-"::.E. L��:�N:G_:Ram=LZTEc'ElerG-'Jot ST-; . ... 1 - �\U�Q7-STS FG72-SEC-0."7r .. t_:/c:-Foe:"_ t4,_c�Iz:C_¢�5...----- _ . . ,. pLCLIYncT t=t'G. , r 1 _ SGAIC: I�4,�=�I_" APPROVED Br: DRAWN Bf ,1 DATC:SEP •QI - RCV6ED OC_{,OFil GTr-- DRAWING MVMMR j : +Jll IL .. 0-,8 777 ULr 00 .o .•s 8 I i - i i I 1.4 SGLE.1/4!=110 'APPR VEDB : DRAWN BY 4 DATE:Sep. Ot RMSED {� �A.K��tTi�q=lCt..�FJ_T_E2�J_Lt_.t_er._!�,455. ..fCC�J'��QtS7 DRwwu+cNuweEw - rr_�t=-r S--ra SYSTEM PROFILE ALL SYSTEM COMPONENTS SHALL BE NOTES FTOP� N. AT EL. 44.8' MARKED WITH MAGNETIC TAPE OR ACCESS COVERS TO WITHIN 6" OF FIN. GRADE (NOT TO SCALE) COMPARABLE MEANS FOR FUTURE LOCATION. 1. DATUM IS WEQUAQUET LAKE DATUM SYSTEM C.I. COVER TO GRADE PROVIDE INSPECTION PORT TO KHIN 3' OF FINAL GRADE 75. 2. MUNICIPAL WATER IS EXISTING 43.5' MINIMUM .75' OF COVER OVER PRECAST 2% SLOPE REQUIRED OVER SYSTEM 42.0'-43.0' 3. MINIMUM PIPE PITCH TO BE 1 8" PER FOOT. ` 42.8 RUN PIPE LEVEL 2" DOUBLE WASHED PEASTONE / *EXISTING FOR FIRST 2' OR GEOTEXTILE FABRIC 3' MAX. "EXISTING 1000 4. DESIGN LOADING FOR PROPOSED D-BOX TO BE AASHO V R LOCUS EXISTING GALLON SEPTIC TANK 41.4'f .-12 -20 H- 20 k Side GAs 40.3' BAFFLE 40.73' �� 40.56' 40.5' o � g =° 5. PIPE JOINTS TO BE MADE WATERTIGHT. o o 0 5 0 39.8' 6. CONSTRUCTION DETAILS TO BE IN ACCORDANCE WITH 6 CRUSHED STONE OR MECHANICAL ; . COMPACTION. (15.221 [23) 3/4" TO 1 1/2" DOUBLE WASHED $TONE MASS. ENVIRONMENTAL CODE TITLE V. I ties �o 6 DEPTH FLOW 4 PIPING TO BE AT .005'/' SLOPE I`' 7. THIS PLAN IS FOR PROPOSED WORK ONLY AND NOT TO I wequaqud TEE SIZES:LETNEPTH = 0"_ BE USED FOR LOT LINE STAKING OR ANY OTHER PURPOSE. Lake a „ O OUTLET DEPTH = 14 SLOPE) ( 1 % SLOPE) 50 8. PIPE FOR SEPTIC SYSTEM TO SCH. 40-4" PVC. H-20 WITHOUTOINSPECTION BY BOARD OFHEALTH AND CONCEALED LOCUS MAP FOUNDATION EXISTING SEPTIC TANK 12' D' BOX g' LEACHING 9.FACILITY *THE INSTALLER SHALL VERIFY THE PERMISSION OBTAINED FROM BOARD OF HEALTH. SCALE: 1" = 2,000'f LOCATIONS OF ALL UTILITIES AND ALL L BOH ,PPROVED G.W. EL. 34.8' 10. CONTRACTOR SHALL BE RESPONSIBLE FOR CALLING BUILDING SEWER OUTLETS AND ELEVATIONS PROVIDE VENT WITH CHARCOAL FILTER `eke DIGSAFE (1-888-344-7233) AND VERIFYING THE LOCATION ASSESSORS MAP 252 PARCEL 95 PRIOR TO INSTALLING ANY PORTION OF AND BUGSCREEN (FINAL PLACEMENT WITH s/cfe OF ALL UNDERGROUND & OVERHEAD UTILITIES PRIOR TO SEPTIC SYSTEM HOMEOWNER CONSULTATION) COMMENCEMENT OF WORK. LOCUS IS WITHIN FEMA FLOOD ZONE C R`740.88 'Drive Fas AS SHOWN ON COMMUNITY PANEL #250001 0005 C Lztz-64-69 11. EXISTING LEACHING FACILITY SHALL BE PUMPED AND DATED AUGUST 19, 2007 **THE INSTALLER SHALL CONFIRM MIN. REMOVED OR PUMPED AND FILLED WITH CLEAN SAND. SEPTIC TANK SIZE AT 1000 GALLONS AND 4'1 T ITS SUITABILITY FOR RE-USE � NEw BENS H MARK - CTR OF LOCUS IS WITHIN GP OVERLAY DISTRICT So ALL CATCH BASIN EL. = 39.75 12. ANY UNSUITABLE MATERIAL ENCOUNTERED SHALL BE T -2 -4 NO G.W. INTERCEPTION) REMOVED 5' BENEATH AND AROUND THE PROPOSED 41 �, LEACHING FACILITY. o � H-1 43.00 13. SAWCUT AND REPLACE ASPHALT PAVING AS NECESSARY. LEGEND �2 T SYSTEM DESIGN: 2.0' GARBAGE DISPOSER IS NOT ALLOWED 100.0 PROPOSED SPOT ELEVATION 4 -ex, `" -^. - �=" DESIGN FLOW. 3 BEDROOMS ® 110 GPD = 330 GPD +100.00 EXISTING SPOT ELEVATION / 42 - 0 Pq �H AtAA 4 > USE A 330 GPD DESIGN FLOW 10 PROPOSED CONTOUR { o - 0 OR1� r._ _ T_ , .__�.----- �--- - - SEPTIC TANK:... 330 GPD (2) = 660 0 100 EXISTING CONTOUR / J III **RE-USE EXISTING 1000 GAL. SEPTIC TANK TEST HOLE LOGS 44 ��� LEACHING: �•. o Q ' SIDES: N/A ENGINEER: DAVID FLAHERTY, R.S. • co BOTTOM 40.5 x 15 (.74) = 449 GPD c� WITNESS: DONNA MIORANDI, R.S. •••� II +: TOTAL: 607 S.F. 449 GPD > 330 GPD O.K. DATE: JUNE 28, 2007 +�• > EXISTING 3 BR DWELLING USE 40.5' x 15' LEACH FIELD OF 3 ROWS OF PERC. RATE _ < 2 MIN/INCH �.. TOP OF FNDN EL 44.8' 4" SCH. 40 PERFORATED PIPE WITH 3.5' STONE -N (3 BR PER OWNER 9/27/07) BETWEEEN ROWS AND 4' STONE AT SIDES CLASS I SOILS P# 11808 °' DECK 5' REMOVAL OF UNSUITABLE SOIL ELEV. ELEV. X. REQUIRED ROUND p 41.5' p" 41.5' LEACHING FACILITY, „ MA ''•� S� SUITABLE APPROVED DATE BOARD OF HEALTH REPLACE WITH CLEAN MED. SAND. TITLE 5 SITE PLAN �••.� w OF 79 LAKESIDE DR. EAST (CENTERVILLE) BARNSTABLE, MA 96„ FILL 33 96" FILL 33.5' `• PREPARED FOR SHED •�.. JOHN MANOOG III C C o DATE: JULY 27, 2007 SIEVE ': REV. 9/27/07 (3 BEDROOM DESIGN FLOW) ;.•': CMS CMS SAMPLE ,moo 10YR 7/4 10YR 7/4 •`• Scale:l = 20 0 10 20 30 40 50 FEET 41 94" 33.7' 94" 33.7' ��HOF�S off 508 362-9 80 ��• S9c ��,SH OF Mgss fax 508 362-9880 0o DANIEOJALA Gs� ��� DAANIEL yG� CIVIL down cape en gin eerin g, Inc. 144" 29.5' 120" 31.5' OJALA FO 465020 No.40980 Cl VIL ENGINEERS NO GROUNDWATER ENCOUNTERED cF O °`�cs O'sTE N0� �Es \0 LAND SURVEYORS ONAL E F w �r� su 939 Main Street - YARMOU THPOR T, MASS. DCE #07-135 � q TF DATE DANIEL A. OJALA P.E., .L.S. 07-135 MANOOG.DWG (DDF)