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HomeMy WebLinkAbout126/128 LAKEVIEW DRIVE - Health 126/128 Lakeview Drive Centerville A= 214—044- T00 7 � i i Y TOWN OF BARNSTABLE T)CAFIGN ✓1aR: LA .UI EJJ /—XI iAe: SEWAGE# QIOSi--/?J `TILLAGE �V)l� ASSESSOR'S MAP&PARCEL o914 �- 44 TOO INSTALLERS NAME&PHONE NO. 19K• ft)0 eL _ /ekM l'l)NVAC IRa L61I SEPTIC TANK CAPACITY 11500 („-��• �- _s LEACHING FACILITY:(type)��.AL 1. `� (size) N j,S V-f3 f NO.OF BEDROOMS OWNER MlW)�L VR'U<_SC)N PERMIT DATE:T f O 5 COMPLIANCE DATE: )T] (" Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility J O fi Feet Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) E Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) �� Feet FURNISHED BY -DA00 D CDU AOOL0P R.s. -c -70 G�S 7 v ' 14 3 ' 4 000 Z.l i.+ --I TOWN OF BARNSTABLE LOCATION - SEWAGE# VILLAGE ASSESSOR'S MAP&PARCEL A I q ` q Too INSTALLERS NAME&PHONE NO. SEPTIC TANK CAPACITY w , LEACHING FACILITY:(type) �'� � �� (size)q , <—X I NO.OF BEDROOMS OWNER E"I 1<cSd PERMIT DATE: COMPLIANCE DATE: Separation Distance Between the: e Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility(If any wells exist t on site or within 200 feet of leaching facility) ISO Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) 154 Feet FURNISHED BY OQ,Y• [� (�,n, q�l F gyp` C G --7o` COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL,AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION FAILED INSPECTION TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL,SYSTEM FORM Ac*tx, 6rt - PART A `-- / CERTIFICATION Ad Property dress• '/�` Llr Owner's Name: I/ ,.� ✓� b ?d Owner's Address: L� D,Z c ky � �' ` ,e �i Date of Inspection• 3'� 0 Name of Inspectomse print) Company Nan: Mailing Address: o o X d Oa�L a� cw,z LTelephone Number:�'0 8 — y� CERTIFICATION STATEMENT I certify that I have personally disposal below is true,accurate and complete �ed the�of the at this address and that the information reported training and experience in the proper functian andmspecoon.The inspection was performed based on my approved system inspector pursuant to Section maintenance of on de �site CMR sewage disposal , TheI am a DEP Passes rij Coadg-onairy Passes ends Further Evaluation by the Local Approving Amy Fails Inspector's Signature: Date: The system inspector shall submi copy of this inspection port to the DEP)within 30 days of completing this inspection the Approving Authority Board of Health or �or greater,the inspector and the �b is a shared system Or has a design flow of 10,000 DER The Original sbould be sent to t o shall submit the report to the appropriate region office of the system owner and copies sent to er,if authority. �3' applicable,and the approving Notes and Comments r / � 0f ****This report only describes conditions at the time of tons of use time.This inspection does not address how the system will perform in the spection and future undeer the r the same or at di that conditions of use, Page 2 of 11 • OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A )Q CERTIFICATION(cootinued) Property Address: /v O h.e—,(/r Owner, cr �6 Date of Inspection: Inspection Summary: Check AAC,D or E/ALWAYS complete an of Section D zA. 7 P asses::I live not found any information which indicates thatany of the failure ne critindicatederia 15.303 or in 310 Cha 15.304 exist.Any failure�*Mja not are below. el&smbedow in 310 CIv1It Comments; yzct Conditionally Passes; ormoresystem components as desmtxd in the"system upon completi�of the Conditional Pass"section need to be replaced or repent or repair,as approved by the Board of Health,will pass. Answer yes,no or not d (y N n the explain. ,ND)i for the following state ments.if o determined"ply unsound,a septic� i is t and ati over 20 years old*or the septic tank(whether metal or no exrdtrabon or t)is seansUng tank is replaced with a complying septic tank as pproved by the tank -System will Nass�on if the A metal septic tank will pass inspection if it is WWUMUY � Board of not indicating that the tank is less than 20 years old is available eakmg and-if a Certificate of Compliance ND explain; obsbucted Observation of sewage backup or break out or high static water,level in the approval of Board of Health):broken,settled or uneven distribution box. System will Gaon if(with a xWon box due to broken or broken pipe(s)are replaced obstruction is removed distnbation box is leveled or replaced ND explain: ---- The vistern reqWmd pumping more than 4 times a year due to broken or pass inspection if(with approval of the Board of Health): ° > (s)•The system will broken pipes)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(contin u4 PropertyAddreas. � �cl✓ r ,/ Owner: 'L� 671 Date of Inspection: C D 1-- C. Further Evaluation is Required by the Board of Health: Conditions e=which require further evaluation by the Board of Health in order to determine if the system is to prated public health,safety or the emviro . 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(l)(b)that the system is not fWKdoning in a manner wbich 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 failuree criteria are triggered.A copy of the analysis must be attached to this form 3. Other: t • F Page 4 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM S PART A CERTMCATION(continued) k' Property Address: //G' eoG✓ vZ.r r. � � ©o�6 Owner. Date of Inspection: 8 D. System Fanure Criteria applicable to all systems: You must indicate`yes"or`no"to each of the following for all inspections: Yes N� of sewage into facility or system component due to overloaded or cl 5 of po�g of effiucM to the surface of the ground or surface °gpd SAS o cesspool clogged SAS or cesspool waters due to an overloaded or Static liquid level in the distn'bution box above outlet invert due to an overloaded oaded or clogged SAS or z 12 depth m cesspool is less than 6"below invert or available volume is IesS than V2 day flow of times pumpedI Pumping more than 4 times in the last year NQT due to clogged pe(s) Number �yA-Portion the SAS,cesspool or privy is below high ground water elevafm �� 4water r, supply cesspoolorprivy is within 100 feet of a surface water supply or tributaryto a surface ortionofacesspoolorprivyis within a Zone 1 of a public well. on of a cesspool or privy is within30feetofaprivatewaterion of a cesspool or privy is less than 100 feet but supply wen. Supply well with no acceptable water quality analysis. [ stem SO feet from a private water Performed at a DEP �,� O' P�if the well water analysis, certified laborato for coliform bacteria and volatile organic compounds indicates that the wen is tree from pollution from that f and the prewncenitrogen and nitrate nitrogen is�to or leas than S pp�provided that no other Mu are triggered.A copy of the analysis mmst be attached to this form.] admre criteria es/No)The system Lab I have determined that one or more of the above failure described in 310 CM1dR 15.303 therefore criteria exist as Health to determine what will be necessary to correct the failure UM owner should contact the Board of E. Large Systems; Togpd be considered a large system the system must serve a facility with a. design now of 10,000 gpd to 15,000 You must indicate either`des"or"no"to each of the following: (The following criteria apply to large systems in addition to the criteria above) yes no — — the is within 400 feet of a surface ddnldng water Supply system is within Z00 feet of a tributary to a surface drinking water supply the is located in a nitrogen sensitive area(Interim Wellhead Protection Area—IWPA)or a mapped Zone II of a c water supply well If you have answered"yes"to any question in Section E the system is consi `Yea"in Section D above the large system has failed. Thar owe or dtred a sig°fcaut threat or answered significant threat under Section E or failedunder Section.D shall for of any large system considered a 15.304.The system owner should contact the uppade.the SY�ram 314 CMR °mate regional office of the Department, Page 5of11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B J CHECKLIST Property Address: ( ke vi-e i l Owner. Zv►ct ,M —oa C.7, Date of Inspection: 0-1' Check if the following have been dose.You most fix is atte es"or"no"as to each of the following: Yes No Pumping information was provided by the oww,=Want or Board of Health -- W any of the wstem componerds pumped out m the previous two weeks -- system received normal flows in the previous two week period volumes of water been produced to the system reoe 4 or as pan of this in�i Were as built plans of the system.obtained and examined?(If they were not available now as N/A) as the hahty or dwelling inspected for signs of wwav back Was site inspected for signs of beak out annt Wereall system components,egg the SAS,located on site �c tankmaohoies mroovered,opened,and the i of the tank for material afaan�uc�, ,�off$ of the condition depth dodge and depth of storm facility owner(and of cif diffen:nt 5oaa owner)provided with information on the proper The size an location of the SoB Absorption System(SAS)on the site has been determined based on: Yes no — — information.For example,a plan at the Board of Health• _ _ Determined in the field(if any of the faihue criteria related to Part C is at issue approximation of distance is unacceptable)[310 CIR 15.302(3)(b)] • Page 6 of 11 OFFICIAL INSPECTION FORM-NOT FOR YOLiJNTARY ASSESS��NTS SUBSURFACE SEWAGE DISPOSAL,SYSTEM INSPECTION'FORM PART C SYSTEM POORMATION P Wr'ty Addresc /c;;,)- 4c . e4*, Owner. ZL,�,,,, Date of InspechmNuaftr $ D�EN,D,irA�. �.o�v.CoxnrizOrrs of bedr°°m(deign): Number of bedrooms(ter DESM flow based.(m.-310 CMR-15.203(fw example; 11a gpd x of lum e bedi, r Number of cumat residents: Does residence have a garbage g ader(yes or no):— Is laundry on a separate sewage system LaundrysYID inspected(yes or no):—(Y�or go)'— [if yes sqwAe inspection 0 Seasonal use:(yes or no):— L— Water meter reading,if available(last 2 years usage(gp)): Sump pump. Me of(yes or no): Lag — COMMRC141ANDUSTRIAL o Type ofestablshment: Design flow(based on 310 Ci M 152B): Spd. Basis ofdesign flaw(seat *rsons/sgft,etc.): Grease trap lxesent(yes or no):— Industrial waste holding task present(ya or no):— Non-sanitary waste discharged to the Title 5 system(yes or no) Water mew Last date of readings,¢available: — occupancy/use: OTHER(describe): GENERAL,DNFO TLON moping Itecor�ds Source of information: Was system pumped as pat of the inspection(y no):— If yes,volume pumped: vaL —Ho Reason for pumping 'P ? ---------- TyPE OF distribution box;soil absorption system ingle cesspool —Overflow cesspool —ftivy —Shared System IV"or no)(if yes,attach previous inspection records,if any) bnMativobtained from� a vm �clmology.Attach a Dopy of the current Operation and maims (�be —Tim tank _Attach a cePy of the DEP approval —Other(describe): Approximate age of all components,date in ta (if known)and source of information: Were sewage odors detected when arriving at the site(yes or no): Page 7 of 11 OFFICIAL INSPECTION FORM—NOT.FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C / �jSYSTEM/INFORMAJI'ION(cow Property Address: Owner. Z-(4 (A-i- Date of Inspectiot: O� BUILDING SEWER(locate 1111!�plan) Depth below grade: _ Materials of constmct=_Czagma 40 PVC (explain):. Distance from private water supply weltor soc ion Nw. Comments(on condition ofjoints,vpgg evidence of leabn etc.): SEPTIC T (locate.on site plan) Depth below grade: Material of conshwtionr conczte_metal fiberglass_pobethylene other(explain) If tank is metal list age:_ Is age confirmed by.a C tificate of Compliance(yes or no):_(attach a copy of certificate) Dirnens P, Dis�ce topqf-shWge to bottom of Outlet tweorbaffle: Scum thiclmess: Distance from top of scum to top of outlet tee.at baffle.- Distance from bottom of scum to bottom of outlet tee or baffle.- How were dimensions determined: Comments(on pining recommendations,inlet and outlet tee or bale condition,s wkffal integrity;liquid levels as related to outlet inmt,evidence of leskagn,etc.): GREASE TRAP on site plan) Depth below grade: Material of construction:_concrete metal_fiberglass_polyethylene_other (ems): Dimensions: Scum thickness: Distance from top of scam to top of outlet tee or bate: Distance from bottom of scmn to bottom of outlet tee or baffle: Date of last pumping Comments(on pumpng rewmwndations,inlet and outlet.tee or baffle conditioq.structwW.integrity,liquid Ievels as related to outlet imlM evidence of leakage,etc.): Page 8 of I I OFFICIAL INSPECTION FORM=NOT FOR VOLUWARY ASSESSMENTS SUBSURFACE SEWAGE-DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM/ INFORMATION(coemim,ed) /��Property Addrew lei O�raeF: —1 e, Date of Inspectiaa: pr^ TIGHT or HOLDING TANK;,/ (tom must be pumpedof' m�pection)(loc ate on site plan) Depth below grade: Material of construction concrete metal 5boglass-_Polyethylene other(explain}: moons: Design Flow: fflflons/day Alarm p (yes or no): Alarm level: Alarm in working order(yes or no): Date of last V uw—ng: Comments(condition of alarm and float switches,etc.): DISTRIBUTION BOX;Z/olfpoesent must be opmWocate on site plan) Depth of liquid level above outlet invert Comments(note if box is level and lion to outlets equal,My eXimce of solids carryover,any evidence of leakage into or out of box,etc.). PUMP CHAM"zPR: (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 appurteriances,etc.): ' Pago 9 of I I OFFICIAL INSPECT[ON FORTH-NOTFOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYMU INSPECTION FORM PAATC. .; SYSTEM INFORMATION(metier Property loZ-fOwnw / 40 r✓ N �+ V-1 Date SOIL ABSORrf30 i SYSTEM(5AS):. _ .ait�plate,crca�vstiot not If SAS not locateie�W wlty: Type leaching pAp� auaibec; 1ea¢>un$c leaching , leach�, ,�mensio®s: overflow nember: system .Typdnam (note condition of soil,signs of bydmuhc level of ponding,damp soil,condition of vegetation, eta): CESM"O (cesspool�t be as part of inspecaion ovate on site plan) Number and : Depth—tap of liqMto,inlet iervEef: -Z( t 12 Depthof salkU layer -e—, Depth of mw by= -e!!!j 10 Dimes of cesspool: Mauls of comma of Indic abm of der inflow(yes of nod./cV Comments(noo n ofsoil,S*s of fae'lo�e;level afponftg condition efvWwfiM etc.) PRIM inn she plan) Mates of constroctiow Dimes Depth of sow Comments(notes ofsofl,*w of hey c level ofpc�g CWdhion e�fvegetatiM eft). • Page 10 of I I OFFICIAL INSPECTION FORD—NOT FOR vOI.UNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION&onfimmeo Property Address: / '"'�+lye, vi-P Owner. Date of Inspection. per SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at least two permanent reference bndmaft or benchmarks Locate all wells within 100 feet.Locate whae public water supply enters the Ngldmg. of L �`�L✓ !-,h d (�i Page 11 of I1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION( Property Address: O da� Owner: Date of Inspection: SrrE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to pound water r/0 fed Please indicate(check)all methods used to determine the highgrnund water devatim 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) Chedwd with local Board of Health-ea�lain: Chedwd with local excavators,installers-(attach documentation) Accessed USGS database-explain: You mast dmcrnbe how you established the high ground water elevation: Owl 0 es o r3 o °v in cd No. �L o Fee THE COMMOMWEAL'i'H OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS Zipphration for ;Migpo5a1 bpgtem Con.Mruction Permit Application for a Permit to Construct( . )Repair(V/)Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No.124 A2.1 Lace-view Dr Owner's Name,Address and Tel.No. Ce.nl'ervitle l�Ato/ Vi Kh 9, Laturq Rw►4 e- Assessor's Map/Parcel V+ / ^,t --I-DO b ` / �t�t 6 k�wtr-K M� Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. SOS 344 0$q PV)gvI4 Co,l1 o-4vwr -kco -Ter-t a NVI rO►tlkek 43 T r'l aor Ci rc.le `;d vkh, in 4 o2S'c3 Type of Building: Dwelling No.of Bedrooms_ Lot Size O'$SqG sq.ft. Garbage Grinder(ha) Other Type of Building ir,014f 7i`at No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow W 0 gallons per day. Calculated daily flow 6D•55 gallons. Plan Date 5 13 10 Number of sheets Revision Date Title SnnE4te Qt'sooS41 5�.47e-m O N i Size of Septic Tank 6500 !01l011 Type of S.A.S. Gal ef-I Description of Soil; F TO P SOt( Sub 5 O;1 57 cy tl a( �,�, Nature of Repairs or Alterations(Answer when applicable) ski!I L500 �1 U k SP p�;c ��y k t �`�OX� the ng ill®�y f'�bgho(y� wll eW5.f;nSl c.e5gvols Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with.the provisions of Title 5 of the Environmental ode and not to place system in operation until a Certifi- cate of Compliance has been issued by this Board of Health. �p Signed �"'— Date Application Approved by Date Application Disapproved for the following reas Permit No.. Man Date Issued !P1 , No. Fe THE COMM' t4,WFAUTH OF�MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS f 2pprication for Mgonl *pztem Construction Permit Application for a Permit to Construct( )Repair(V )Upgrade( )Abandon( ) ElComplete System ElIndividual Components Location Address or Lot No.IU A 2,$ . Lq t;e v I e.w Dr Owner's Name,,Address and Tel,No. Assessor's Map/Parcel - C`�Yltev v 111 e )60 to Vi ►1 r1 9- 'Lq or al R,? V+ / 44 - TOO to Li . lm Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. - S 68 364 0$y¢. pt)qurr$ COLjhahowr - Leo -Tec- 1 614tel rohX1e 1 �0 -3 Tr' � 63C � � I Type of Building: .i Dwelling No.of Bedrooms Lot Size 17 gs GC sq.ft. Garbage Grinder�)o) Other Type of Building Ye5401'Fiu! No.of.Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow SS 0 gallons per day. Calculated daily flow C-GD• 55 gallons. ,Plan Date S I 1 1 o S Number of sheets 9 Revision Date Title S ela_ee 1-1,4p a s,11 T�yp�n Q I u h Size of Septic Tank I 00 q32�14?o Type of S.A.S. _ G_Ghi Description of Soil.- F:I I T,)n Ski I S t)D S D r 5•oI 0 Nature of Repairs or Alterations(Answer when applicable) 11115`M 11 t SD0 qlo dH S(' TR N k 1 oI`Bohr �a,lHiN/� 2:08PfY Aboodoo GI1 exit CpeJ) t)k Date last inspected: tr , s 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 he system in operation until a Certifi- cate of Compliance has been issued by this Board of Health. Signed Date Application Approved by /4� �i r. // Date Application Disapproved for the following reas ' Permit No. •■- Date Issued /'� v �7��"�(p THE COMMONWEALTH OF MASSACHUSETTS 101311 °1311 BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed( )Repaired ( )Upgraded( ) Abandoned( )by at �✓ r has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. 0 _ dated < r Installer A) Designer The issuance of this pe "t hall 'ot be construed as a guarantee that the s stemid.1 futac 'on as designed. Date I Inspector '.- ---- _ — -----------------------_'". �j�No. Fee. - THE COMMONWEALTH OF MASSACHUSETTS C PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS Oi!6pozal bpgtem Cow6 ruction Permit Permission is hereby granted to Construct( )Repair( )Upgrade( }Abandon( ) Systemlocatedat 121'1124 014Va 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 this permit. Date: Approved by TOWN OF BARNSTABLE L'txAT101d' �a� k 1e•t/i e r� SEWAGE # `TILLAGE ASSESSOR'S MAP & LOT HONE NO. vita k S A �, SEPTIC TANK CAPACITY %- Q �h ~ LEACHING FACILITY: (type) �s ze) NO.OF BEDROOMS &6�= OWNER A4 N�v PERMITDATE: e;C®MPLIANCE 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 by No. Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: c Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS Zfpprication for 30iopool Oraem Construction Permit Application for a Permit to Construct( )Repair( )Upgrade Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No.1�4p J j ag (jqW/ Dl�, Owner's Name,Address and Tel. o. Assessor's Map/Parcel 1 q 6� (,� Installer's Name,Address,and Tel.No. �t Designer's N e,Address and Tel. o 0 7 313 Wwyn Rock- R-D PO ,BD075 F q3 TRIPW64-C, OAk SPDODOWA mp 5 Type of Building: f% � Dwelling No.of Bedrooms J�/ Lot Size G& y 5 Sq:ft:—S Garbage Grinder( o Other Type of Building_ IqItr No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow ! nbo. C5� gallons. Plan Date Number of sheets o� Revision Date Title Size of Septic Tank 1 S0 Q gtLt Type of S.A.S. G.AtkPaq Description of Soil I%l-(,�, t,l L , Sy g �Ul C� S ftw D Nature of Repairs or Alterations(Answer when applicable) ftA-10Dca) CFS 12t3(X S I 1)191t) Su S . Date last inspected: Agreement: The undersigned agrees to ensure is tru tion and maintenance o the fore scribed on-site sewage disposal system in accordance with the provisions of the o th E ironmenMI—Code and to pl a the system in operation until a Certifi- cate of Compliance has been issued y d o ea th. Signed Date Application Approved by Date Application Disapproved for the following reasons Permit No. Date Issued --------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed( )Repaired( )Upgraded'�/) Abandoned( )by at IQL(o 1pg < 1 has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. dated Installer_Fam(Ac K. M600wtt uL ---Designer IF—CI) --'rY,C The issuance of this permit shall not be construed as a guarantee that the system will function as designed. Date Inspector ---------------------------------------- No. Fee ( THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION . BARNSTABLE., MASSACHUSETTS Miopogal OpOtem Construction Permit Permission is hereby granted to Construct( )Repair( )Upgrade( )Abandon( ) System located at_ �v I j � 11 c� -1)VU 11, C 4'r�AIJV�Jf LL E 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 this permit. Date: Approved by No. s._ h „ :n Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS ZIooYication for Migaal *pMem Construction permit Application for a Permit to Construct( . )Repair( )Upgrade Abandon( ) O Complete System ❑Individual Components Location Address or Lot No.'R�//ae LHf-<EUI EW DP,--, Owner's Name,Address and Tel. o. �iCl�t:C. �AUI.Ksd�l Assessor's Map/Parcel / r-t I[ q -5�m Installer's Name,Address,and Tel.No. ' (J Designer's Name,Address and Tel.No. 5D g "3o y — U gq y Pon C,�tJi1Z�C�12S, (AJC 1�1i) C 0914 l4iv 0U�-' E00-1'ECH 313 NUKUW\ ROCV- RD PO bbX7�5 IF 1"P,IRrJ&4,e Cif.' 5"Dc)ICQ MP bay Type of Building: Dwelling No.of Bedrooms Lot Size 01 65 s�� Garbage Grinder( 00 Other Type of Building i� No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow 562o. gallons. Plan Date 1(l ti Number of sheets Revision Date Title r Size of Septic Tank I<,I)0 CIA- Type of S.A.S. 1' t /1 V ~''Description of Soil; I✓I LIo_�)���1 l,�� Sol t, Y4u)17 Nature of Repairs or Alterations(Answer when applicable) 14ioD6 A Cfr<,C Pax,S ; A)t 0 Date last inspected: Agreement: The undersigned agrees to ensure construction and maintenance of the fore d scribed on-site sewage disposal system in accordance with the provisions of the o the E vironment�a and'o to place the system in operation until a Certifi- cate of Compliance has been issuedvy?l aa(d o ealth. rSigned (`1 �l Date g10lo Application Approved by Date / Application Disapproved for t1le following reasons' r Permit No. Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of (Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed( )Repaired( )Upgraded(�) Abandoned( )by P KV1'1 (-©IlTRW,t'U k S ate I a.R L1qA<r1/1150 1)K_u)f,, has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. dated Installer Mc00LA)aL- Designer t>C() -Tr-C- The issuance of this permit shall not be construed as a guarantee that the system will function as designed. Date 1 Inspector No. Fee THE.COMMONWEALTH OF MASSACHUSETTS, w' PUBLIC HEALTH DIVISION BARNSTABLE., MASSACHUSETTS Migogat *p!tem Construction 3permit Permission is hereby ranted to Construct( )Repair( )Upgrade( )Abandon( ) System located at IaWI a r'Ne—EtI 1 A) Dki dI%. C A)'ilz toUI LL . 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 this permit. Date: Approved by 9/16/03 Notice: This Form Is To Be Used For the Repair Of Failed Septic Systems Only PERCOLATION TEST AND SOIL EVALUATION EXEMPTION FORM I, David, D Co yt- 0 wow►',hereby certify that the engineered plan signed by me dated Vgay 34 2,00 S ,concerning the property located at Lq�p-Vl Pw Dv (Not Dv��Ex) meets all of the. following criteria: • This failed system is connected to a residential dwelling only. There are.no commercial or business uses associated with the dwelling. • The soil is classified as CLASS I and the percolation rate is less than or equal to 5 minutes per inch. The applicant may use historical data to conclude this fact or may conduct deep test holes and percolation tests at the site without a health agent present. • There is no increase in flow and/or change in use proposed • There are no variances requested or needed. • The bottom of the proposed leaching facility will be located no less than five feet above the maximum adjusted groundwater table elevation. [Adjust the groundwater table using the Frimptor method when applicable] Please complete the following: ��i /� A) Top of Ground Surface Elevation(using GIS information). `q• �t/ Luke WeSuaov6`4 t s 9 B) G.W.Elevation 33 .41 +adjustment for high G.W. O = 33 co wi t elled (.aKP DIFFERENCE BETWEEN A and B ( �• 3 SIGNED C'"'""" �j DATE: NOTICE 4 Based upon the above information; a repair permit will be issued for bedrooms maximum.. No additional bedrooms are authorized in the future without engineered septic system plans. gASeptic\percexemp.doc I Town,of Barnstable Regulatory Services g rY • Thomas F. Geiler, Director • sNwereSta, • '679. Public Health Division �EDN11�� Thomas McKean, Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 509-790-6304 Installer & Designer Certification Form Date: Designer: 60VCH#00bV1�, Installer: -04 D Address: 4'3 7 W�(,.(% C12CCL? Address: 77 �( � �(oc J' G � i cl4, 0Z 3 �L3 llrn Iz�c�c 1eD - �w fS OW 00 On as issued a permit to install a '(date) (ins septic system at t� (JUI-EyI lew ,:)/Z based on a design drawn by ( (address) MwD [2 C006 N OW, dated M" '3, 2-00-5 (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 se tic system referenced above was installed with major changes (i.e. greater than 10' lal r relocation of the SAS or any vertical relocation of any component of thee to ) ut in accordance with State & Local Regulations. Plan revision or ertifle as-buil d signer to follow. SH OF iygSsq �o DAVID o D. (Installer's Signa e) COUGHANOWR m No. 1093 &O/STE��O ZW4 � SgNITARk (Designer'sSignature) (Affix Designer's Stamp Here) 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. f LgKEVIEIV A VENUE . 166 54 ' 3 GARAGE 79 e18 55"W -N- - a ni cv rn o m 44. 47' o o PROPOSED EXIST. N ADDITION - RES. z 9�6 RES. to U/C 3 co ro"U SEPTIC LOCATION o �n rn O,V N Lo 3 48837. 61 SF+\- co ti 1. 121 AC+\- A�• O V e y A Vl \ WEDUAOUET w`'S,� LAKEMICHAEL o��N \T1 s. , \� LADUE c q No. PROPOSED ADDITION PLAN LADUE LAN RVEYING PREPARED FOR: MICHAEL 9 LISA FALKSON MICHAEL S. LADUE, P. L. S. LOCUS: 128 LAKEVIEW AVENUE, CENTERVILLE, MA 51 CAPTAIN' S VILLAGE LANE DATE: . 11/10/08. BREWSTER, MA 02631 SCALE: 1 "= 40 ' 508-896-6707 / TOWN OF BARNSTABLE LOCAFIGN ldto(] Lf} SEWAGE# VILLAGE C:Ek�i QJE ASSESSOR'S MAP&PARCEL 1-00 INSTALLERS NAME&PHONE NO. 10}S mLj L'k�LL PKM 0 9VT 1�S 1 SEPTIC TANK CAPACITY 1,5DD LEACHING FACILITY.FACILITY:(type)&J4L ,6AP— (size) NO.OF BEDROOMS OWNER M JCj44eL FAIL"OM PERMIT DATE: 05 COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility f 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 j')N i 0 D 0y0M J40 )LL) R.S. D (Pat G -70 W -1 1�1 1 q cis 7� pop IL, e� R ,; I TOWN OF BARNSTABLE LOCATIONl �- SEWAGE# ' VILLAGE CFCCI=} I 'E ASSESSOR'S MAP&PARCEL INSTALLERS NAME&PHONE NO. K ;�l — w ,VYI � ;C SEPTIC TANK CAPACITY j ��at LEACHING FACILITY:(type) r � (size) 1 , �X NO.OF BEDROOMS OWNER PERMIT DATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) `•-� Edge of Wetland and Leaching Facility(If any wetlands exist i Feet within 300 feet of leaching facility) FURNISHED BY s Feet 4 E ' IQ C � F _-711 6 ' >-1- -73 _. c`�-�*a'�•4 - •..�g t ,�� .�s. aTM177e.�V 1. «'•'� €i r �\, T"I . / � k 5TORAGE LL a r1C, LOFT �a LOW . � �. RAILING LL e i Y 1 The Contractor shall verify all dimensions promptly notify the architect In writing of an; BOOK5HELVE5 J No. Date Revision 10.31.08 G I lent Gha LINE OF I 2. 11.12.08 Structura I �; 3 8'-41/211 � - ,` fit;x � �;i� " �#�^�A�A a nf'�S�S f 4. 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T. BEAM = KIN6 BED REUSE i B. WOOD w : I ABOVE �9 6r8rr x 6 Orr LOFT ' W.C,. I m +1 O (Y n PANELS TWIN BED II — T ABOVE E Cf� N Lam\ BELOW " 3 3 x BOYS' BEDROOM 7fill Go- O ITS ---------J L \ ° - ------- V DOWN - - - - - - - - - - - - - - -/ — — — — ' — 11 -- o N !-'AD13R®8" / 1 HIG / I \ OF -10 _4r_ �� i / A � 0 I I� � ITI MASTER — t105 i x SUNRbOM 4 FAMILY \ i I O � ROOM \ TWIN BED / I SK / I \ 3r3�r X 6 3rr / I 42"x`l2" O TUB 0 _ A E BO -)ABOVE n _ CE J ' FLOOR . FLAN' II -Cl 1/4 7 -6 ,1 ( EQUAL EQUAL Ek�UAL IF LINE OF BUILDING SMOKE DETECTOR BY RUUD, EDWARDS,`OR , EQUAL. HARDWIRED WITH BATTER BAGKUP �. i,. „. ...w....:. •__r..,._ g::oam..:-">. .,:... Sr i st;� p 4 .a':it ze- ` WELL CENTERVlLLE. MA NOTE l - NOTE 3:. ft F WELL �0 150.6 ROM 50 . 0 INSTALLER MAY ELECT TO REROUTE EXISTING WATER" WELL IS TO SE ABANDONED 4B �52 N INTERIOR PLUMBING TO REDUCE THE AND DWELLING TO BE CONNECTED TO 'y.�,9 AMOUNT OF EXTERIOR PIPING PROPOSED MUNICIPAL WATER SUPPLY AT THE TIME OF Z + + FLYING IF DEEMED FEASABLE. SYSTEM REPAIR. USE CLASS /50 PRESSURE -ss PIPE WHERE SEWER AND WATER LINES CROSS. REFER TO 3/0 CMR /5.21/ III 46 a �� 0 �oo� NOTE 2 GARAGE LAKEvra, DMVET _ CLEANOUT PLUGS ARE TO BE WSTALLED + / I \ 1 � y LOCUS— AT ALL 45 DEGREE BENDS BETWEEN 44 + PIPE FROM IRR/G ► N-- DWELLING AND SEPTIC TANK AND BROUGHT 42 _ + \ WELL . SEE N6TE 4 m TO FINAL GRADE. 40 �� 54 T 41.5 ft x 13 tt x Z ft WEOUAOLET " , LAKE 36 38 L EA C /NG GALLERY + GAS LOCUS MAP rRRroArIonl u ° NOT TO SCALE - SEE NOTE \ VENT O PIPE I —� 56 Exfsr#4+6 �, R► BENCH MARK SEE TOP OF GAS GATE \ ROM J ( / lc NOTE 3 m USGS DATUM A 53.35 F 1 / 54 `5A \ ` r s2 \ ( / PPOPOSE WATER L L E GEND PA T/O(( STONE SEc NOTE 3 es-v � 1 2 O 1500 GALLON Z `� ao Z cx Z $p ac SEPTIC TANK O o WE-QUAQUET -� � � LLV \`\ , , ,� i—O LL II m D-Box o (n m W , I; TEST PIT �} \ W 4 �� s' so Exlsr/NG LAKE , ` � J � , CESSPOOL A CONTROLLED ELEVATION LAKE `'t ` ;1 1 �T� % �'Py / UTILITY POLE $ ELEVATION - 33.41 56 TREE NOTE 4 �_ —� -, �= ro S T \ b� IRRIGATION WELL NEAR POND MAY BE \ �� \ '.. ; / / N wca tFTrFrr aE%rrfs rroE RETAINED. BUT PIPE FROM WELL TO \\ / CONTROL UNIT IS TO BE REROUTED AWAY\• _ FROM'SOIL ABSORPTION 'SYSTEM. LOT 44 \ \ \ i \� 54 �N + 1 t AREA,1 0.85 ac - \ ` VE lam 52 52 PLAN o D. 1 \ 48 50 CO.IGIiI;iOWR 1 260 D0 ft 46 SCALE: I in - 30 f t ,9 11093 44 VENT NO OTHER WELLS WITHIN FLOW PROFILE �� �► RAISE COVERS TO WITHIN � PIPE I50 FEET OF PROPOSED SAS ( '�gJtA TOP OF FOUNDATION RAISE in OF FINAL GRADE NOTES 0 �S d EL - 58.80 +- ONE INSPECTION RISER FOR INSTALLER TO PUMP COLLAPSE AND FILL MCI y O� LEACHING GALLERY EXISTING CESSPOOLS AND ANY ADDITIONAL '' i 49.25 CESSPOOLS NOT SHOWN ON THIS PLAN. _ 3 2' LAYER OF 1,8- SEWAGE DISPOSAL. SYSTEM PLAN �/�X MAX I/2 STONE -TO SERVE EXISTING DWELLING 3- DROP V FLOW LINE PLAN REFERENCE DEBRA FINN & LAURA BARONE t _ _ 1O 4- / PLAN BOOK 188 PAGE 23 126/128 LAKEVEW DRIVE CENTERVILLE. MA `\ PRECAST 3i4--I114' PLAN BOOK 552 PAGE 3 48- �As DRYWELL ,55.80+- BAFFLE STONE ECO-TECH ENVIRONMENTAL BOTTOM of ASSESSOR'S MAP: 214 e"aTtNo 46.00 6 inSTONE \�_ LEACHING ' SOIL ABSORPTION LOT: 44-Too 43 TRIANGLE CIRCLE SANDWICH MA 0256 45.63 SYSTEM BASE GALLERY 46.25 6 in STONE BASE 45.80 g5.50 43.50 5.00 it 508 364-0894 1500 GALLON (END VIEW) —� CONTOURS - - ETE-2016 MAY 3. 2005 1/2 Iza tt nAx 4.4 ft o) 5 ft I2.5 fi EXISTING 50 THIS PLAN IS TO BE CONSIDERED A DRAFT PLAN UNLESS IT a8 r+ MIN SEPTIC TANK ' 14 f' v FINAL 50 BEARS THE $TAW AND SIGNATURE OF THE DESIGN ENGINEER ALL PIPE ELEVATIONS SPECIFIED ARE INVERT ELEVATIONS LAKE EL 33.41 ORIGNAL PLANS INTENDED FOR SUBMITTAL TO THE BOARD OF HEALTH WILL BE SIGNED N BLUE AND STAMPED IN RED. . SOIL TEST L O G" DATE OF TEST,: APRIL 30. 2005 SOIL EVALUATOR: DAVID D. COUGHA RS D�E S I G N CALCULATIONS " WITNESS REQUIREMENT WAIVED - NO VARIANCES SOUGHT TEST PIT I PARENT MATERIAL:NO GROUNDWATER E ROG ACIALDOUTWASH ELEVATION 49.80 PERC AT 64 in : 2 MIN/INCH IN C SOILS DESIGN FLOW: 5 BEDROOMS X 110 GPD - 550 GPD SEPTIC TANK: 550 GPD X 2 DAYS - 1106 GALLONS DEPTH SOIL USDA SOIL SOIL COLOR SOIL OTHER INSTALL 1500 GALLON SEPTIC TANK (MINIMUM ALLOWED) (INCHES) HORIZON TEXTURE (MUNSELL) MOTTLING 49.80 DISTRIBUTION BOX: USE 3 OUTLET D-BOX. 0-12 FILL 12-24 AP LOAMY SAND 10 YR 3/4 NONE FRIABLE SOIL ABSORBTION SYSTEM: A 41.5 ft x 13 ft x 2 ft LEACHING GALLERY CAN LEACH Abot - ( 41.5 x 13 ) - 539.5 sf 24-48 Bw LOAMY SAND 10 YR 4/6 NONE FRIABLE A s d w - ( 41.5 + 41.5 + 13 + 13 ) x 2 - 218 sf 45.80 Atot - 757.5 sf 48-144 C MEDIUM SAND 10 YR 6/3 NONE LOOSE. 20% STONES 37.00 Vt 0.74 x 757.5 - 560.55 GPD USE A 41.5 ft x 13 ft x 2 ft GALLERY. Vt - 560.55 GPD > 550 GPD REOUIRED LEACHING GALLERY GROUNDWATER DETERM14ATION CONSTRUCTION DETAIL HIGH GROUNDWATER LEVEL .IS BASED ON WATER LEVEL OF LAKE DRY WELL UNIT STONE WEOUAOUET - .A CONTOLLED s'-2 s-o�= 2'-8- LEVEL LAKE z it EFF• DEPTH �� 41.5 ft POND LEVEL 33.41 v M v� ►2 4 ft 8.5 4 ft 8.5' 4 fr 8.5' 4 ft �.. , ES--_ , 41.5 f t NOT TO NO T SOLE 1) GARBAGE-_.GRINDER NOT ALLOWED WITH THIS DESIGN 2)' ALL LINES- TO BE SCH 40 PVC AND PITCH AT 1/8 INCH PER FOOT MINIMUM. 500 GALLON DRYWELL 3) ALL COMPONENTS INSTALLED SHALL MEET THE MINIMUM REQUIREMENTS DMENSIONS AND DETAL OF MASSACHUSETTS TITLE 5 SEPTIC CODE (310 CMR 15) 4) INSTALLER TO VERIFY LOCATIONS OF ALL UNDERGROUND UTILITIES USE M-10 UVT INSTALL ONE INSPECTION BEFORE EXCAVATING FOR SYSTEM, RISER TO WITHIN SG INCHES OF FINAL GRADE 5) EXISTING CESSPOOLS MAY NOT BE LOCATED PRECISELY AS SHOWN ON PLAN. AND INDICATE LOCATION ON AS-BUIL T PLAN 6) ALL STONE TO BE DOUBLE WASHED AND FREE OF IRON. FINES AND DUST IN PLACE SEWAGE DISPOSAL SYSTEM -PLAN 7) LINES EXITING D-BOX TO RUN LEVEL FOR 2•-0' BEFORE PITCHING DOWN -TO SERVE EXISTING DWELLING 8) ECO-TECH ENVIRONMENTAL RECOMMENDS THE INSTALLATION OF LOW FLOW FIXTURES AND APPLIANCES. AND BIANNUAL PUMPING OF THE SEPTIC TANK 34 00 000 ,- DEBRA FINN & LAURA BARONE 9) SYSTEM IS NOT DESIGNED TO WITHSTAND VEHICULAR LOADING. DO NOT �OpO�o �� �0- PARK �Q 126/128 LAKEVIEW DRIVE CENTERVILLE. MA OR DRIVE VEHICLES OVER SEPTIC SYSTEM. Do�Q�ooa�o4 � 101 INSTALLER TO OBTAIN DISPOSAL WORKS PERMIT BEFORE STARTING WORK, o�����p ECO-TECH ENVIRONMENTAL 11) SEPTIC TANKS SHALL BE INSTALLED LEVEL AND TRUE TO GRADE ON A LEVEL (�� STABLE BASE THAT HAS BEEN MECHANICALLY COMPACTED AND ON TO WHICH 102 in 43 TRIANGLE CIRCLE SANDWICH MA 02563 SIX INCHES OF CRUSHED STONE HAS ..BEEN PLACED TO MINIMIZE UNEVEN SETTLING 2/2 ETE-2016 11AY 3. 2005