HomeMy WebLinkAbout0015 LAKEWOOD DRIVE - Health 15 Lakewood Drive
Centerville P
_ A 212 021
f
COMMONWEALTH OF MASSACHUSETTS
EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS
;'' •,r`ti:i, -DEPARTMENT OF ENVIRONMENTAL PROTECTION
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MAP
PARCEL : -
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TITLE 5
OFFICIAL INSPECTION FORM-NOT FOR.VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM
PART•A
CERTIFICATION - -
a.
Property Address: /S
Owner's Name: psi;,, / ,"
'y NOV 1 2 2003
Owner's Address: Z 1 /7r L e
GPH lr-vi d?6�2 TOWN OF BARH5TAE3LE
)9 HEAL1H DEPT.
Date of Inspection:
Name of Inspector: (please print) cJO4h !9 1�0/4
Company Name:. �ohH Aa �r"64,k o4- cvi'c
Mailing Address: 2 k/o n f Is IT '
Mu. s ,y,.s i1i47 s /7 ..
Telephone Number: S`y S -if 2 9-- 7 774
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 my
training and experience in the proper function and maintenance of on site sewage disposal systems.I am a DEP
approved system inspector pursuant to Section 15.340 of Title 5(310_CMR 15.000). The-system:
k Passes
Conditionally Passes
Needs Further Evaluation by the Local Approving Authority
Fails
Inspector's Signature: � C Dater //-•./0;03
The system inspector shall ubmit 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,Conunents , ,:;:: .- . '. :
""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 1
Page 2 of I 1
f
e
OFFICIAL'INSPECTION FORM—NOT'k VOI UNTARY ASSESSM N'PS
SUBSURFACE SEWAGE DISPOSAL.SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address: J$ LG 4.e w voaQ P.-i L,-
Owner: 4,for.
Date of Inspection: r/-/O "
Inspection Summary:`Check A,B,C,D or E/ALWAYS complete`aH 4S4ttloa.111
A. System Passes: .
V 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.
s' `'The'septic'tankls 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 IInmineat:System will pass inspection Wthe
`existing tank is r`eplaced'with a complying'septic tank as'approved by 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 breakout or high static water level in the distribution box due to broken or
obstructed pipes)or due to a broken,settled or uneven distribution box.System will,pass inspection if(with
approval of Board of Health):
broken pipes)are replaced .
c 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 4 of 11
OFFICIAI :INSPECTION<FORM'=NOTE-IF-VOZiJN'TARY ASSESSMENTS
SUBSURFACE.SEWAGE.DISPOSAL---SYSTEM:INSPF.IS'I.IONXOW—,.
PART
A"
CERTIFICATION,Y
Property Address: /s" 4he w~1 .ar/i.-e .._
Owner:_ r<Cty/H /Ylorig• y
Date of Inspection:
D. •System Failure Criteria applicable to all systems:. .
You must indicate:"yes"-or."no':to each of the following for all inspectionsA.,.
Yes No
a:5 #✓;Backup of sewage into.facility,or,system component due.to:overloaded or clogged.SAS.or cesspool
taDischarge.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
cesspooliti.
v Liquid depth in cesspool is less.than 6"below invert or available volume is less than''/I day flow
_i,--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.
k Any portion of cesspool or privy is within 100 feet.of a surface water supply or tributary to a surface
:oO la.,waterisupply:;
Any portion of a cesspool or privy is.within a'Zone,l.of a public:well „
✓Any portion of a cesspool or privy is within 50 feet of a private water supply well.
r --Any portion of a cesspool or,privy`is less,than1.00 feet but greater.than'30"feet"&iom aprivate:water
supply well with no acceptable water quality;analysis.°[This system.passesifthe weR•avaier.aa alysis,
performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds
.'indicates that the,well is free'froni pollution fromAhat.facility.and the presence of ammonia
nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failiweariteria
1 .• are triggered:A copy of the.analysis must be attached to this form.] =;r
(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 tocoaw the failure.
E. ,Large
To be considered a large system the system`must serve a facility with a design flow of<1l1,000 gpd..to 15,000
gpd• .
You must indicate either"yes"or"no"to each of liefollo_wing:.
(The following criteria apply to large systems in addition to the`eriteria above).
yes no
• ' the system is_within 400„feet of asurface-drinki2ig water supply
the system is withm 200_feet of a tributary to asurfarerdnnkingwater supply
the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area—I WPA)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 . i
Page 3 of 11 ,
OFFICIAL;INSPECTION FORM.` NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE:SEWAGE DISPOSAL.SYSTEM.INSPECTION.,fORM:,
CERTIFICATION:(continued)
Property Address: /f" _I l l wv9
Owner: *PW/a Aller.k e*.
.Date of Inspection:
C. Further Evaluation is Required by the Board of Health: T
Conditions exist which require further evaluation by the Board of Health.in order.to determine if the system F
is failing to public he
alth,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:.
4_r. Cesspool or privy is within 50 feet of a surface water;!,,o
Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh f
f...."t! 'r.F_. I il,
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:
t;:',=:The system has a septic tank and soil absorption system(SAS)and the SAS is within.100 feet of a
�.k•surface.•water supply or tributary to.a surface.water supplyr:,
<The system has aseptic tank and SAS and.the SAS'is.within a Zone.1 of a public water supply.
a:.f:i2 i2°d"'r ir:a,:'E?r p`•G X30 t., .,'er ike ,. :'.is .. :1. 3X tv Yr Ni kl ..,)
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 Jess than 100 feet but 50 feet or more front a_
<�r-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
N failure criteria are.triggered.A.-copy of the analysis must be.attached to.this form:;,
-3, t°,i a .J.,A:. • - ., -
3. Other:
. .I.•��i`.Y�.r.. �{. 'ate :?'� - il:3�f". t.:"..•'j ?; e,f•;:fit .. .i l' t ,.'s.._t.i '.'t,., ,,. ..t: ..- .;I ,.
U`v 1S86a1nt1.t 'N) ti;r!f r- -
Z".> ..3 (.: .ia1,:J:.it
3 ..
• Page 5 of 11
Y:OFFICIAL INSPECTION FORM=NOT FOR VOLUNTARY ASSESSMENTS
w-h.SUBSURFACE SEWAGE DISPOSAL'SYSTEM INSPECTION FORM
PART B
CHECKLIST
Property Address: le,A wvovi rives
n le vie /N
Owner:
Date of Inspection:
,
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?
t/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 backup?
v _ 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 jSAS)on the site has been determined based on:
Yes no
✓' Existing information.For example,a plan at the Board of Health.
_Ll�_` 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
t OFFICIAL INSPECTION.FORM NOT FOR OLUNTARY'ASSESSMENTS .
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEIVLINFORMATION
Property Address: /s�u,� wv�a1 Or/•�i
Owner:
Date of Inspection: /O-a-5
FLOW CONDITIONS
RESIDENTIAL
Number of bedrooms(design): S' Number of bedrooms(actual): 5
DESIGN-flow based on 310 CMR-15.203(for example:'110 gpd x It of bedrooms): SSco
Number of current residents: 1.
Does residence have a garbage grinder(yes or no):V
Is laundry on a separate sewage system(yes or no):Lo [if yes separate inspection required]
Laundry system inspected(yes or no):
Seasonal use:(yes or no):No d�
l�9
/91 J
Water meter readings, ' � P
if available last 2 ears usage d �.
g ( Y g (8P ))(
Sump pump(yes or no): No
Last date of occupancy: cc.K
COMMERCIAL/INDUSTRIAL
Type of establishment:
Design;flow(based on 310 CMR 15.203): gnd
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 11
Source of information: <=H '."ways aeco as A„•rpAr-1 -sa-V!
Was system pumped as part of the inspection(yes or no):
If yes,volume pumped: gallons--How.was quantity pumped determined?
Reason for
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.Attat;h'a copy of the curmat 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:
rt-114 7-10-7/J 0.",
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
`•£�4 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued) :
Property Address: .Q pri
O v?
n !rv/ D
Owner: ff Vj r, vria.-
Date of Inspection: /—/o—0 3
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: 9
.Material of construction: oncrete metal_fiberglass_polyethylene
_other(explain)
If tank is metal list age:_ Is age confirmed by a Certificate of Compliance(yes or nod (attach a copy of
certificate) '
Dimensions: /v,s )1 S,s
Sludge depth:
Distance from top of sludge to bottom of outlet tee or.baffle:
Scum thickness:: o-'
Distance from top of scum to top of outlet tee or baffle:. 7"
Distance from bottom of scum to bottom of outlet tee or baffle: /3"
How were dimensions determined: M1asN rr++o vG�
Comments(on pumping recommendations,inlet a6d outlet tee or baffle condition,structural integrity,liquid levels
as related to outlet invert,evidence of.leakage,etc.). /�
�nA Aas kith 44,Q A,r�1/ and Kiyrk, •6,. Serf 1r+eio I �.
GREASE TRAP:_(locate on site plan)
Depth below grade:
Material of construction:_concrete metal_fiberglass___polyethylene_other
(explain): M
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
Page8of11
�+OFFICIAL'INSPECTION.FORM NOT.FM? Vi)�.UNTARY. S SSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM.INSPECTION FORM: ,
•,pAR�'.C• � Y ..
SYSTEM INFORMATION(continued)
Property Address: P,.1 aiL-e
Owner: �pvi•► vriRv
Date of Inspection: //— /d G 3
TIGHT or HOLDING TANK: (tank must be pumped at time of iitspectionkkiute an site plan)
Depth below grade:
Material of construction: concrete metal fiberglass ' Polyethylene other(explain):
Dimensions:
Capacity: gallons
DesignTlow: gallons/day
Alarm present(yes or no):
Alarm level: Alarm in working order(yes or no):•
Date of last pumping:
Comments(condition of alarm and float switches,etc.):
DISTRIBUTION BOX: ✓ (if present must be opened)(locate on site plan)
Depth of liquid level above outlet invert: 0,
Comments(note if box is level and distribution to outlets equal,any evidence of solids carryover,any evidence of
leakage into or oout of box,etc.):
5../, : v�i^ bVel
PUMP,CHAMBER:. (locate on site plan)
Pumps in working order(yes or no):
Alarms in working order(yes or no):
Comments(note condition of pump chamber,condition of pmnps and appurtenances,etc.
i
Page 9 of l l
OFFICIAL;INSPECTION FORM,—' NOT;FOR-VOLUNTARY ASSESSMENTS
{SUBS.URFACE SEWAGE,DISPOSAL,SYSTEM INSPECTION FORM
4_ PART C;�.:
SYSTEM INFORMATION(continued)
Proper4y Address a / Lalc� wa•v� �rwo
Owner: ivies /1/lnviu.-
Date of Inspection:) — /y —D 3
SOIL ABSORPTION SYSTEM(SAS): 3f(locate on site plan,excavation not required)
If SAS not located eplai�twhy:
Type
leaching pits,number:'
leaching chambers,number.
leaching galleries,number:
leaching trenches,number,length: '
:011, leaching fields,number,dimensions: z I d;-fi4
_ . . w
overflow cesspool,number:
innovadve/altemative system Type/name of technology: _
Comments(note,condition of soil,signs of hydraulic failure,level of ponding;damp soil,condition of vegetation,
etc.): f _..._-•. __ .._ -}
S= LIrT��II'LiloiS W/f4 �V 51.E Ct'4 Oh CsylrQ0� kvlo2tr1
CESSPOOLS: (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 layei:
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: (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.):
9
Page 10 of I 1
OFFICIAL INSPECTION FORM-:NO FOR-%riDL NTny ASSESSMENTS
SUBSZJRFACE;SEWAGE'bISPOSAY:`SYTE113INSPECTION`FORM '`
PARTC
SYSTEM INFORMATION(continued)
Property Address: l
Owner:k v/n lopr/itr -
Date of Inspection:
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 where.public water supply.enters.the building. .,• . v
coot✓
!1yy_
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$ I
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Page 11 of l l .
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
.": SUBSURFACE SWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 1 wvod nrivo
Owner:
Date of Inspection: -/D— 05
SITE EXAM
Slope
Surface water
Check cellar
Shallow wells
Estimated depth to ground water 3 S 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:
Checked with local excavators,installers-(attach documentation)
V Accessed USGS database-explain: / al 61 t
You must describe how you established the high ground water elevation:
767
! 37, It/
11
TOWN OF BARNSTABLE Di 101307 N
LCYX-'.;"ION /�r Lke W4 I&' y z SEWAGE# " 79'
VILLAGE Cph l?vv� .� / ASSESSOR'S MAP &LOT
INSTALLER'S NAME&PHONE.NO. �nG►h �• `7G lto
SEPTIC TANK CAPACITY /5-00
LEACHING FACIL=: (type)"Ih `f.'r. t S (size) 5/ •X/a 'A 2
NO.OF BEDROOMS
BUILDER OR OWNER
PERMTTDATE: y ' °COMPLIANCE DATE: 90
Separation Distance Between the:
Maximum Adjusted Groundwater Table and 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
t
3 Lf b`
L
J
No. 7 4' , Fee!o
THE,COMMONWEALTH OF MASSACHUSETTS Entered in computer:
Yes
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS
01ppYtcatton for topogai 6pgtem Cori.5tructton 30ermtt
Application for a Permit to Construct( )Repair(, )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components
Location Address or Lot No. t5' LAyr�VoU 7C:h.\vj Owner's Name,Address and Tel.No.
Assessor's Map/Parcel C��;1.�r t=-t\if `3 i✓6t �15�.\C6G-.L. o\�+ '
Installer's Name,Address and Tel No. �a S f Designer's Name,Address and Tel.No.
7AH � a, f� STEPHEN J. DOYLE & ASSOC.
42 Canterbury Lane
fSU t!✓yfh�YST /Yf/�� East Falmouth, MA 02536
Type of Building:
e ep one: 508/540-2543
Dwelling No.of Bedrooms Lot Size M-1 i(go .) sq. ft. Garbage Grinder( )
Other Type of Building No. of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow cirri gallons per day. Calculated daily flow S-Srb gallons.
Plan Date q'l Number of sheets Revision Date
Title A yMM_V\L L4'-, h-w- -!!��>
Size of Septic Tank i �Dl� Type of S.A.S.
Description of Soil � �. \V e4'c, '75Lk�i
Nature of Repairs or Alterations(Answer when applicable)
Date last inspected:
Agreement:
The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system
in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi-
cate of Compliance has been issued b this Board of-peal
r Signed Date y—12'97
Application Approved by Date
Application Disapproved for the following reasons
Permit No. 9 -' �� Date Issued _q - / s/ 9 .2
TOWN OF BARNSTABLE LOCATION /5 r.0 u/D26ar I v Q SEWAGE # /q
7 �y
VILLAGE C?h 1 w y/�l�t ASSESSOR'S MAP&LOT
INSTALLER'S NAME&PHONE NO. J0407 174 l
SEPTIC:TANK CAPACITY /5-00
LEACHING FACILITY: (type)5 (size) S/ •X/o 'A 2
NO::OF'BEDROOMS
BUILDER OR OWNER <<<' `* �01• �''
PERMITDATE: L1 '/7' 3 7 COMPLIANCE DATE:
Separation Distance Between the:
Maximum Adjusted Groundwater Table and 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
�Q
a i
��0 nil='
�fy.r>v. .� .. v ,_. �. t t �s�"tf'.Yt ��,,yp�e.•,..-,r, m'a, ,,y��,.� .. ... �.�3i ._
No: V Fee
4-. Tk16COMMONWEALTH OF MASSAC SETTS ' Entered in computer:
-PUBLIC HEALTH-DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes
ZIpplication for tg0.5ar *potem Con.5truction Permit
Application for a Permit to Construct( Repair( )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components
Location,Address o'"'r ro No. Owner's Name,Address and Tel.No.
Assessor" ss Map/Parcel C 1=1.�`��c-�W lU. ILGVIIJ M oM WL vr�;
3 8a Ar�'Ne6Gl..�
Installer's.-Name;Addres_srand Tel.No. a Designer's Name,Address and Tel.No.
Ra a b 't'9S` "80 J, DOYLE A Afleae.
42 Canterbury Lane
East Falmouth,
Type of Building: / Telephone: 5 0 8/5 4 0-2 5 4 3
Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( )
Other Type of Building No. of Persods Showers( ) Cafeteria( )
Other Fixtures
Design Flow AW- 7 gallons per day. Calculated daily flow��f� gallons.
Plan Date Number of sheets 'Z„ Revision Date
Title
Size-of Septic Tank ���,7 Type of-S.A.S.
1
Description of Soil
Nature of Repairs or Alterations(Answer when p-plicAt",
Date last inspected:
Agreement:
The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system
in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi-
cate of Compliance has been issued b this card of Health.
Signed Date AY-/--9;2
Application Approved by 0 A _ _ Date
Application Disapproved for the following reasons
Permit No. - / ::2 / Date Issued L/ - �
THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE, MASSACHUSETTS
(ferttftcate of (Compliance
THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed( ) Repaired ( )Upgraded( )
Abandoned( )by
at j _- La�,a , )tt,,,o 0,e44�"-U1, & has been constructed in accordance
with the provisions of Title 5 and the for Disposal Syste4i Construction Permit No. -/ dated c¢/-
Installer Designer
The issuance of this permit shall not be construed as a guarantee that the system will function as designed.
Date '-; _ Inspector
No. Fee a y
7 THE COMMONWEALTH OF MASSACHHUSETTS
PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS
Dfigpo.5af *p5tem (Eon.5truction Permit
Permission is hereby granted to Construct( ,k1 Repair( )Upgrade( )Abandon( )
System located at /S` Z=< .,gf 0 A 06 14
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: 2 Approved by
e �
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'STEPNEN J. DOYLE AND ASSOCIATES
OUTH MA Q253B
- 42 CAN'fEF2HURY LANE 'EAST,FALM ,
TELEHO E p N r 508 540 25
GENERAL C ONSTRUCTION NOTES
1. ALL WORKMA
NSHIP AND MATERIALS SHALL CONFORM TO D.E P. TITLE 5
--
AND THE TOWN OF _ �. �.�.
._._.�._._._� .RULES AND REGULATIONS FOR
PROFIL
E OF SEWAGE DISPOSAL. SYSTEM
THE SUBSURFACE DISPOSAL OF, SEWAGE.
2. AT LEAST
AS ONE ACCESS PORT OVER TANK TEES SHALL BE ACCESSIBLE
NOT TO SCALE L
WHITHIN SIX INCHES OF FINISH GRADE WITH ANY REMAINING
E NG ACCESS
PORTS BROUGHT TO WITHIN TWELVE INCHES OF FINISH GRADE.
3. ALL COMPONENTS OF THE SANITARY SYSTEM SHALL BE
CAPABLE OF
TOP FOUND. EL. �3, y WITHSTANDING H 10 LOADING UNLESS THEY ARE UNDER OR WITHIN 10
OF DRIVES OR PARKING. H-20 OA I L D NG 'SHALL BE USED UNDER OR WITHIN
10 OF 'DRIVES OR PARKING UNLESS NOTED.
4. THE EXCAVATOR/CONTRACTOR SHALL VERIFY THE LOCATION OF ALL
- +1 z
SITE UTILITIES PRIOR TO ANY EXCAVATION.
< ,-- _ 5. SEWER PIPES SHALL BE, 4 SCHEDULE 40 P VC LAID AT 0.02 .SLOPE.
INV. EL rTo.9
6. ANY MASONRY UNITS"USED TO BRING COVERS TO GRADE SHALL BE
Ile
WATER TIGHT COVER MORTARED IN PLACE.
FLOW LINE
:... _10 MIN. s GRADE SHALL HAVE A MINIMUM SLOPE OF 0.02 FEET PER FOOT.
2' L INV. EL. 7 0,4 €VEL 7. FINISH
10' MIN. 4' LIQUID DEPTH " ;
INV. EL. 'to. II hflUN. s' 1 h1
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INV. EL c,�•4
INV. EL. �a•Z
—
1500 GALLON PRECAST REINFORCED CONCRETE SEPTIC TANK. 2" 1 f 8w MIN. TO 1/2 WASHED STONE
=
MINIMUM CONSTRUCTION MATERIALS PER 310CMR 15:226(2) PRECAST REINFORCED CONCRETEt,v u
DISTRIBUTION BOX INFILTRATOR t ,
TEES SHALL BE CONSTRUCTED OF SCHEDULE 40 PVC AND
" EFF. DEPTH
SHALL EXTEND A MINIMUM OF 6"PABOVE THE FLOW NE 3/4" - 1 1 2 WASHED STONE LINE I -, � S ED ONE
INSTALL ON A LEVEL BASE
0�' THE SEPTIC TANK AND BE ON THE CENTERLINE OF THE � _ -
SEPTIC TANK LOCATED DIRECTLY UNDER THE CLEAN-OUT
MINIMUM WALL THICKNESS - 2
MANHOLE.
_ Sit
THE INLET PIPE ELEVATION SHAH MINIMUM INSIDE DIMENSION 12 BE NO LESS THAN 2" NOR ,
S.A.S. — LONG x 'ID WIDE x Z EFF. DEPTH
" I o WITH _; HIGH CAPACITY MORE THAN 3 ABOVE THE INVERT ELEVATION OF THE OUTL' NV EL. <.�t CITY INFILTRATOR CHAMBERS
. E,T INVERTS SHALL BE EQUAL TO EACH .
OUTLET PIPE. OTHER AND AT 2 MINIMUM BELOW INLET ;INVERT.
THE ;
SEPTIC TANK SHALLBE IN DISTRIBUTION LINES FROM THE DISTRIBUTION "BOX STALLED LEVEL AND TRUE TO GRADE ,
ON A LEVEL STABLE BASE THAT HAS BEEN MECHANICALLY SHALL ALL HAVE EQUAL INVERTS AS DETERMINED BY FLOODING
COMPACTED AND ON TO WHICH SIX INCHES OF CRUSHED STONE THE DISTRIBUTION BOX TO THE HEIGHT OF THE DISTRIBUTION
HAS BEEN PLACED TO ENSURE STABILITY AND TO PREVENT LINE INVERT AFTER ALL LINES HAVE BEEN SEALED IN PLACE.
SETTLING. INVERT ADJUSTMENTS SHALL BE MADE BY FILLING WITH DURABLE
AND NON-DEFORMABLE MATERIAL PERMANENTLY FASTEND TO THE
SEPTIC TANK SHALL HAVE A MINIMUM COVER OF 9". LINE OR RECONSTRUCTING THE LINES UNTIL,ALL INVERTS ARE OF
EQUAL ELEVATION.
THREE 20" MANHOLES WITH READILY REMOVABLE IMPERMEABLE
COVERS OF DURABLE MATERIAL SHALL BE PROVIDED WITH ACCESS
PORTS BEING PLACED AT THE CENTER AND OVER THE INLET AND Lz.a 1J
�F�race
OUTLET TEES.
THE OUTLET OU
TEE-SHALL BE EQUIPPED WiTN GAS BAFFLE.
REFERENCE MAP:
SOIL OBSERVATION DATA:
T 990 1 CAPE COD DESIGN DATA: a
WATER TABLE CONTOURS
:AND
STRUCTURE — r
TEST N
.PUBLIC WATER SUPPLY "� �•
1E DATE I Aq�..1.1. 't'�i 't al�t*1WELLHEAD
ae;
PROTECTION AREAS TYPE N0. BEDROOMS - GARBAGE
a7� L� SEP7EIABER 1995 .-- ..
SOIL EVALUATOR .__` e � ..._ DESIGN FLOW � �c '�� � � � � ;.
'. A1
� WATER RESOURCES R CES OFFICE
B.O.H. AGENT ,MTL, l: y�..ts�a�I1�- ,"" t. ,.. . 1-t 5- +• t -_ `�:4
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4 2 CANTERBURY ANE FALMOU MA :02536 L . TH�Z LoTz 13Z _
508 54 TELEPHONE: / 0--2534
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