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HomeMy WebLinkAbout0038 LAKEWOOD DRIVE - Health 38 Lakewood Drive Centerville P A = 212 002 wy � 2 v TOWN OF BARNSTABLE LOCATION SEWAGE#,ZQ% 7 3 6`9 VILLAGE U N1 `N\e,S C ASSESSOR'S MAP&PARCEL p 000 INSTALLER'S NAME&PHONE NO.t°01'-oy10 Dcc.,,(. 5aY 3 E V -)5 91q SEPTIC TANK CAPACITY ©� O �s i�c�a Go,, kanK f 5�'i' 6a4 P(,Me) LEACHING FACILITY:(type) `�k 5-0 o Gal, NO.OF BEDROOMS OWNERd.��� �� 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) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet FURNISHED BY 1010 A 'Aa o A!S 0,rIO° 0 AN 36 61 6x 13 -3 11%G`' 4`1 a5 %r,° No. v CD )o f O ,�.�(n d���p /l e I Fee THE C MMONWEALTH OF MASSAC USETTS Entered in com ter: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Y- 4plitation for MispoBal 6pstem (Construction Permit Application fora Permit to Construct( ) Repair V Upgrade ) Abandon( ) Complete System ❑Individual Components Location Address or Lot No. `Z Owner's Name,Address,and Tel.No. Assessor's Map/Parcel �� ��t-,,e A."O Installlee/r's Name,Address',and Tel.No. Designer's Name,Address,and Tel.No. 2I7. Type of Building: Dwelling No.of Bedrooms Lot Size 2 L' sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 33 gpd Design flow provided �+ d Plan Date ���' 20 Number of sheets Revision Date a 2 Title Size of Septic Tank S�mo �" S /d'fk?Type of S.A.S. S w 6���e�1 �i��i�'!1� 4 Jr Description of Soil Nature of Repairs or Alterations(Answer when applicable) / e + 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 Certificate of Compliance has been issued by this Board f Healt Sign Date Application Approved by >�A Date Application Disapproved by Date /) ~ e2 I" 1 for the following reasons ! /,per j '3�y �m—i/,j) B� ,el �-4jA(w�� Permit No. Date Issued s ��+ No. U � _ w.V //� /4?r/ Fee / V THE COMMO:NWEALT OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Application for Zieposal ,pstem Construction Permit Application for a Permit to Construct( ) RepairUpgrade ) Abandon( ) 21 6omplete System ElIndividual Components Location Address or Lot No. '7 i 6;0 T LP Av'' Owner's Name,Address,and Tel.No. IM Assessor's Map/Parcel A k e- A.)OC WCe � Axr 4r'"7 �CeAS � Installle/e��r's Name,Address,and Tel.No, Designer's Name,Address,and Tel.No. V.0 /A&sort Type of Building: Dwelling No.of Bedrooms ' Lot Size 2 jrV/7 sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons F�"l. Showers( ) afete"ria( ): #jVOther Fixtures r .% Design Flow(min.required)., gpd Design flow provided g d" Plan Date s Q Number of sheets Revision Date 2/d (O r . Title / . Size of Septic Tank 1/7�00 G"/<W 44 n04/p Type of S.A.S. r�R /s•t l : r!)/,G�r Description of Soil c Nature of Repairs or Alterations(Answer when applicable) ;j2p'�P1G,e�e + �C✓�fr 1 J Date last inspected:. owl •,,, Agreement: f ` The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in w accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of 4 Compliance has been issued by this Board of Health Sign9d., i,,••A'" Date Application Approved by Date .2 �7 Application Disapproved by tA A Date pG r j for the following reasons . Al ,. i -d W �r /.,, ./ ,4 s'1..cY�Y.��.G.•'fi � �'filt�I.s -- .�.1 p�� "77) �yKr� 'y-7'/� ,.. f•,�.. � Permit No. „ Date Issued r 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 %/ 0 h A t"..jt'L /e�,•�^ ---at-- - 42 IX e L,,, p i Q has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No.,?d%7�b '?dated Installer �,t/ie�.o a y 4A1 vy t/ 0<.A acL,h-Designer 0 C,V C/+ AI C. 0 #bedrooms Approved design flow gpd The issuance of this permit shall not be construed as a guarantee that the system wi91 f u►ction as designed. )t Date M-a .I t, �,/► Inspector !`�/ {� 1�1 AP f No. ? Fee /po t THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS Misposai *pstem Construction Permit Permission is hereby granted to Construct( ) Repair( ) Upgrade( ) Abandon( ) System located at �+G ��' JC� ,f �`�/ C ��-�yt +-e/d f�� i and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction mu't be completed within three years of the date of this permit. Date Approved by d' 4 VlAf4 r i i ,. r •-- -_� ` ' 1 Fee THE COMMONWEAL .iUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN JTABLE, MASSACHUSETTS es Zipplitatioii for Dispo at �p6 etti Construction 3permit Application for a Permit to Construct( ) Repair( Upgrade Abandon( ) Complete System ❑Individual Components Loca�Qn Ad ess or � , �''/®—au ,/s Owner's Narr;e,Address,and Tel.No. Ass"es�sors Map/Parcel Installer's Name,A es d Tel. o. De ' 's ame,Addddress, d el No. Type of Build' g: Dwelling No.of Bedrooms Lot Size nos 'sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.require gpd Design flow provided gpd Plan Date `Z®l Number of sheets Revision Date Title j Size of Septic Tank � Type of S.A.S. Description of Soil L10 6� 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 Certificate of Compliance has been issued by this Boar f Health. Sign Date 2 J Application Approved by Date tl Application Disapproved by U Date for the following reasons Permit No. —7 Date Issued tl THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS (Certificate of Compliante THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired(Vr__*_Upgradeda/f' Abandoned( )by at, has been constructed in accordance with the provisions of Title 5 and the for Disposal S s m Construction Permit No. —' Sated " 74 Installer. Designer #bedrooms Approved design flow gpd The issuance of this permit shall not be construed as a guarantee that the system will function as designed. Date Inspector • x K 'ii f '4T ��1t'yvR Fee THE COMMON EA L ^'ACHUSETTS Entered in computer: sOor - PUBLIC HEALTH DIVISION - fi0_ N��. kNSTABLE, MASSACHUSETTS Yes appli ation ,fDr Zisposal-6p$ Pl1I Construction VErmit Application for a Permit to Construct( ) Repair( - Upgrade;( ) Abandon( ) "Complete System ❑Individual Components A Location Address or Lgt N . t Owner's Name,Address and Teel.No. " Assessh Map/Parcel ,(� Installer's Name,Ad�desd Tel.N0. Desi ner's ame Address,�and.el.No. Type of Building: Dwelling No.of Bedrooms Lot Size i/f #6 sq.ft. Garbage Grinder( .) Other Type of Building No.of Persons Showers( )',Cafeteria Other Fixtures Design Flow(min.require 1 gpd Design flow provided gpd Plan Date 47 e)�.�Z 17 Number of sheets �_ Revision/Date Title Size of Septic Tank/ WJ,TD Type of S.A.S. . Description of Soil C-5 EE r ►CAI L Cam► Nature of Repairs or Alterations(Answe%when applicable) ,� � i Date last inspected: 1 " pbr Agreement: rr " The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in i accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Boajgf Health. ff Signed-1 Date l .2 j 0 77 Application Approved by r t Date j/ Application'Disapproved by Date 'for,the following reasons _ Permit No. f / Date Issued J 0 h ?//") - -------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired(V) Upgraded(--') Abandoned( )by �S '�" "r ie � •. `. _ -at- _ j.- -: r} ,-•" .- has been constructed'in accordance- with the provisions of Title 5 and the for Disposal Sys m Construction Permit No.�`. (7 p da ed (���- : � r • Installer Designer #bedrooms Approved design flow.�� j' gpd r .'�.. The issuance of this permit shall not be construed as a guarantee that the system will function as designed. • Date i Inspector t -------- No. �a (�.— �4, ? Fee UU� THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION -BARNSTABLE,MASSACHUSETTS Disposal 6pstr tt Construction j3Prut t Permission is hereby granted to Construct( ) Repair( Upgrade 1(Y ) Abandon( ) System located at 1✓! �-1 X(1 s , ~�4/1 and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. r Provided:Construction must be completed within three years of the date of this permit. Date /U�� / ^7 Approved by r V rom: 01/16/2018 12:15 0259 P.001/001 r , Town of Barnstable Regulatory Services Richard V. Scali,Interim Director aAaN9rPA M Public Health Division '0'FONna+° Thomas McKean, Director 200 Main Street,Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Installer& Desiener Certification Form K Date: ( 1 5 "Ild Sewage Permit# ZCI Assessor's Map\.Parcelz Designer: ?�� Installer. "� lZ. _ ( e Address: Address: j� .r K 0 1" L,t C �v 1 f� 2 � On '6 �T� bo011 O VX" was issued a permit to install a (date) (insttallllerr)1 //���� ��ii ��'' _septic system at WiVf— Cat&MN1ULed on a design drawn by �AA ,(address) Ai MW. dated (designer) I certify that the septic system referenced above was installed substantially according to the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. Strip out (if required) was inspected and the soils were found satisfactory. I certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system) but in accordance with State & Local Regulations. Plan revision or certified as-built by designer to follow. Strip out(if required)was inspected and the soils were found satisfactory. I certify that the system referenced above was construe*�__�;*,liance with the terms of the [\A approval letters (if applicable) OFAf oa3 DAVID PWASON m . (Installer's Signature) No. loss a . Is Te?. f �-- `74AII to RON (Designe s Signature)-/ (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- BUELT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. QASeptic\Designer Certification Form Rev 8-14-13.doc r zo INS 11Z A. sd,�`' Sott `� sr� �� � \�� o -�.' + �-34 o ,gip ��_177 Of' ' c� eo 0 —36 P �G�F; N,4�8,4cES` tt - f Sank y EX1sr/N PRO _ 38 �os� oi� 'S<, �o� 40` icf 10 LENE ,,�� 10 Qj -- - -- -- ---- ---48 �y__-------�-%---- --SAD I � Ito Jt 0� Y OS 2 U �' !ACC �O �. + I �5�Y / Town of Barnstable P# Department of Regulatory Services z 114AUL Public Health Division Date '200 Main Street,Hyannis MA 02601 Date Scheduled /`w // Time Fee Pd. too Soil Suitability Assess nt for Sewage Disposal Performed By: I� Witnessed By: :►� mod: Y`�'I�I y �- LOCATION& GENERAL INFORMATION Location Address':2� ,^�� tom/) Owner's Name �1c�E' Address Assessor's Map/Parcel: Z,�2/0 Engineer's Name-a>wlo Wq,�--Dw NEW CONSTRUCTION REPAIR ✓ Telephone# e0a 57 Land Use Slopes(%) Surface Stones Distances from: Open Water Body ft Possible Wet Area ft Drinking Water Well ft Drainage Way ft Property Line ft Other ft SKETCH:(Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands in proximity to holes) I V / e l Parent material(geologic) Depth to Bedrock Depth to Groundwater: Standing Water in Hole: Weeping from Pit Face Estimated Seasonal High Groundwater DETERMINATION FOR SEASONAL HIGH WATER TABLE !�� Method Used: -Depth Observed standing in obs.hole: in.-Depth.to soil mottles: in. Depth to weeping from side of obs.hole: in. Groundwater Adjustment ft. Index Well# Reading Date: Index Well level Adj.factor Adj.Groundwater Level _ PERCOLATION TEST _ Date Time Observation Hole# tl---~'—�--- Time at9" _ Depth of Perc Time at 6" Start Pre-soak Time @ Z/. Time(9"-6") End Pre-soak mac. 1 J Rate Min./Inch } -Site Suitability Assessment: Site Passed Site Failed: Additional Testing Needed(YN Original: Public Health Division Observation Hole Data To Be Completed on Back----------- ***If percolation test is to be conducted within 100' of wetland,you must first notify the Barnstable Conservation Division at least one(1)week prior to beginning. _ DEEP___OB_S_ER_VAT_ION HOLE LOG _Hole# _ Depth^from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. / Consistency,%Gravel © � L,6 IO lb t r/ 1 DEEP OB_SER_VATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency,%Gravel) _ DEEP OBSERVATION HOLE LOG Hole# _ Depth from s Soil Horizon Soil Texture Soil Color Soily Other�� Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency.%Gravel) r DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color _ Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency,%Gravel) Flood Insurance Rate May:Above 500 year flood boundary No V/ Yes Z , Within 500 year boundary No Yes Within 100 ear`flood boun Yeses Y �'Y No Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring perviou terial exist in all areas observed throughout the area proposed for the soil absorption system? If not,what is the depth naturally occurring pe ious material? Certification L, I certify that oti (date)I have passed the soil evaluator examination approved by the Department of Envir ental Protection and that the above analysis was performed by me consistent with the required training,expertis and exve ' nc described in 310 CMR 15.0117 Signatur Date C $ Zoe No. . t .Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH.DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes RPPYicatiOn for ligpogal �bpgtemc Con5truction permit Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. (�,J �('(ll►-e Owner's Name,Address,and Tel.No. Assessor's Map/Parcel 12—`Z _00_ Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. Ii Type of Building: Dwelling No.of Bedrooms Lot Size sq. ft. Garbage Grinder ( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided gpd Plan Date Number of sheets Revision Date Title l cA- Size of Septic Tank Type of S.A.S. 1:—ACA— Description of Soil fz� Nature of Repairs or Alterations(Answer when applicable) �'� ► l K�C� [�`. - 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 Environme al Code and not to place the system in operation until a Certificate of Compliance has been i is �oa, � alth, S'gnedd Date Application Approved b Date �l , k ko �5 Application Disapproved by: Date for the following reasons Permit No. 115 Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS I T CERTIFY the On-site w Disposal S O CE I s e Sewage ispoPAN sa System Constructed ( ) Repaired ( ) Upgraded ([.ate Abandoned( )by ! jj,j,e 5 S-e at ?' Lt,V2 C JOU(Z_c1�K n.e 6f71 —I has been constructed in accordance with the pr ns of Title 5 and the for Disposal System Construction Permit No. c200 5 5 dated 1i16 Installer �S Designer #bedrooms 13 Approved design flow "? gpd The issuance of this permit shall not be construed as a guarantee that the system will function as designed. Date Inspector ~�� / ar� „���,,,,�, w•�C1:r :. - 'fir Fee C v THE COMMONWEALTH OF MASSACH'U'StVS Entered in computer: PUBLIC HE kLT�H'01VISION - TOWN OF BARNSTABL"ASSACHUSETTS Yes 1 ZIppricatiow for �Bigpo5a[ *p5tem Con.5truction Permit Application for a Permit to Construct O Repair( j; Upgrade O Abandon O ❑ Complete System ❑Individual Components Location Address or Lot No.3 Lda,�WOVVQ Of_, r"e Owner's Name,Address,and Tel.No. } Assessor's Map/Parcel 2,,-Z _00 : Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. � UP�-s ��U�G� 1� J / ``�/ C��w•c � S��f �f'1S�1�r i Type of Building: I Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder ( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures --- ' a Design Flow(min.required) gpd Design flow provided ' (, gpd Plan Date Number of sheets Revision Date Title :5cv4-�z t Size of Septic Tank Type of S.A.S. 6 Description of SoilT�. S Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: g , 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 Environme tal Code and not to place the system in operation until a Certificate of Compliance has been ssued`by t i'�s Board o alth. '��' —`----� "\ Sig Date _ Application Approved b Date I kD Is Application Disapproved by: Date for the following reasons Permit No. a 0 5 se ( Date Issued 1 l —————————————————————————————————————— — THE COMMONWEALTH OF MASSACHUSETTS ,. BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY the On-siteSewage Disposal System Constructed ( ) Repaired ( ) Upgraded ((� Abandoned( )by at 3 U.Y-2 Uj0&f) <, �,aL has been constructed in accordance 'r with the pr ns f Title 5 and the for Disposal System Construction Permit No. C� 'S 5 dated 1 1 1 1 b 1 5 installer Designer' S Designer 5 0!1� ' #bedrooms Approved design flow gpd I The issuance of this permit shall not be construed as a guarantee that the system will function as designed. Date Inspector No. �T+- '✓ 47--� Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION—BARNSTABLE, MASSACHUSETTS Mi.5pogal *pgtem (ton5tructiou 'Permit Permission is hereby granted to Construct ( ) Repair ( ) Upgrade (Abandon ( ) System located at Lc {�e WOt(n^p _ ` 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 mu s be completed within three years of the da a of this pe it Date 1 �a Approve -by �� l _ �� ���� . S �� '� �� P -�� � �� 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, CAQA-Arav3 �• VAY ,hereby certify that the engineered plan signed by me dated O B 105 concerning the property located at 3 g L AM'a apt , �•2� U��� meets all of the following criteria: • This failed system is connected to a residential dwelling only. There are no.commercial or business use&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: A) Top of Ground Surface Elevation(using GIS information) SO ,O B) G.W. Elevation 3 +adjustment for high G.W. _= 5. So DIFFERENCE BETWEEN A and B 14. 50 SIGNFtD: DATE: b O NOTICE N-A 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. gASepdc\percexemp.doc COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS m DEPARTMENT OF ENVIRONMENTAL PROTECTION r F A Q See David B.Mason,R.S,Certified Title V Inspector,508-833-2177 'L :')ARCEL TITLE 5 _0T a 1 . OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 38 Lakewood Drive,Centerville,MA Owner's Name: Don Sargent Owner's Address:38 Lakewood Drive,Centerville,MA RECEIVED Date of Inspection:April 25,2004 MAY 13 2004 Name of Inspector: (please print)David B.Mason Company Name:_N.A. TOWN OF BARNSTABLE Mailing Address: 4 Glacier Path HEALTH DEPT. East Sandwich,MA 02537 Telephone Number: 508-833-2177 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: X Passes Conditionally Passes Needs Further Evaluation by the Local Approving Au on Fails Inspector's Signat ze: Date: OL The system inspector shall submit a copy of this inspection report to the Approving Au ority oard of Health or DEP)within 30 days of completing this inspection.If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer,if applicable,and the approving authority. Notes and Comments: System as inspected appears to have operated based on occupancy level. Septic tank should j be pumped as a matter of maintenance. The information as identified represents only the condition of the system on April 25,2004 at 3:00 PM. ****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. Page 2 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address:38 Lakewood Drive,Centerville,MA Owner: Don Sargent Date of Inspection: April 25,2004 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: _X_ I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below. Comments: B. System Conditionally Passes: One or more system components as described in the"Conditional Pass"section need to be replaced or repaired. The system,upon completion of the replacement or repair,as approved by the Board of Health,will pass. Answer yes,no or not determined(Y,N,ND)in the for the following statements. If"not determined"please explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not)is structurally unsound,exhibits substantial infiltration or exfiltration or tank failure is imminent.System will pass inspection ifthe existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND explain: Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken,settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced (THIS IS REQUIRED TO BE COMPLETED) 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: OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS Page 3 of 11 PART A CERTIFICATION(continued) Property Address:38 Lakewood Drive,Centerville,MA Owner: Don Sargent Date of Inspection:April 25,2004 C. Further Evaluation is Required by the Board of Health: Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health,safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health,safety and the environment: Cesspool or privy is within 50 feet of a surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2. System will fail unless the Board of Health(and Public Water Supplier,,if any)determines that the system is functioning in a manner that protects the public health,safety and environment: _ The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. _ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. _ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well".Method used to determine distance "This system passes if the well water analysis,performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form. 3. Other: OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM Page 4 of 11 e CERTIFICATION(continued) Property Address:38 Lakewood Drive,Centerville,MA Owner:Don Sargent Date of Inspection: April 25,2004 D. System Failure Criteria applicable to all systems: You must indicate"yes"or"no"to each of the following for all inspections: Yes No _X_ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool _X_ Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool X— Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool NA_ Liquid depth in cesspool is less than 6"below invert or available volume is less than '/Z day flow X— Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped _X_ Any portion of the SAS,cesspool or privy is below high ground water elevation. X Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. X Any portion of a cesspool or privy is within a Zone 1 of a public well. _X Any portion of a cesspool or privy is within 50 feet of a private water supply well. _X Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form.] NO (Yes/No)The system fails.I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails.The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E. Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. You must indicate either"yes"or"no"to each of the following: (The following criteria apply to large systems in addition to the criteria above) yes no the system is within 400 feet of a surface drinking water supply the system is within 200 feet of a tributary to a surface drinking water supply the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area—IWPA)or a mapped Zone II of a public water supply well If you have answered"yes"to any question in Section E the system is considered a significant threat,or answered "yes"in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304.The system owner should contact the appropriate regional office of the Department. Page 5 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address:38 Lakewood Drive,Centerville,MA Owner: Don Sargent Date of Inspection:April 25,2004 Check if the following have been done.You must indicate"yes"or"no"as to each of the following: Yes No X _ Pumping information was provided by the owner,occupant,or Board of Health X_ Were any of the system components pumped out in the previous two weeks? _X Has the system received normal flows in the previous two week period? X Have large volumes of water been introduced to the system recently or as part of this inspection? X _ Were as built plans of the system obtained and examined?(If they were not available note as N/A) _X_ _ Was the facility or dwelling inspected for signs of sewage back up? _X Was the site inspected for signs of break out? _X_ _ Were all system components,excluding the SAS, located on site?(INCLUDING THE SAS) _X_ _ 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? _X_ _ Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: Yes no X_ _ Existing information.For example,a plan at the Board of Health. X_ 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)] ' Page 6 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 38 Lakewood Drive,Centerville,MA Owner: Don Sargent Date of Inspection:April 25,2004 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design):2_ Number of bedrooms(actual): 2 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 265gpd Number of current residents: Does residence have a garbage grinder(yes or no):NO(Not Allowed) Is laundry on a separate sewage system(yes or no):NO [if yes separate inspection required]Per owner Laundry system inspected(yes or no):NA Seasonal use: (yes or no):NO Water meter readings,if available(last 2 years usage(gpd)): 2003;32,000 2002;62,000 Sump pump(yes or no):No Last date of occupancy: (current) COMMERCIALANDUSTRIAL Type of establishment: Design flow(based on 310 CMR 15.203): gpd Basis of design flow(seats/persons/sqft,etc.): Grease trap present(yes or no):_ Industrial waste holding tank present(yes or no):_ Non-sanitary waste discharged to the Title 5 system(yes or no):— Water meter readings,if available: Last date of occupancy/use: OTHER(describe): GENERAL INFORMATION Pumping Records Source of information:Property owner Was system pumped as part of the inspection(yes or no):NO If yes,volume pumped:_gallons--How was quantity pumped determined? Reason for pumping:Per owner system has been pumped each year. TYPE OF SYSTEM _X_ Septic tank,distribution box,soil absorption system _Single cesspool _Overflow cesspool _Privy _Shared system(yes or no)(if yes,attach previous inspection records,if any). _Innovative/Alternative technology.Attach a copy of the current operation and maintenance contract(to be obtained from system owner) Tight tank _Attach a copy of the DEP approval Other(describe):With pump chamber Approximate age of all components,date installed(if known)and source of information: I l years Were sewage odors detected when arriving at the site(yes or no):NO OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS Page 7 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM ' PART C SYSTEM INFORMATION(continued) Property Address:38 Lakewood Drive,Centerville,MA Owner:Don Sargent Date of Inspection:April 25,2004 BUILDING SEWER(locate on site plan) Depth below grade:Approximate; 14 Inches Materials of construction:_cast iron _X_40 PVC_other(explain): Distance from private water supply well or suction line:_NA Comments(on condition of joints,venting,evidence of leakage,etc.): Appears in good condition. No evident leakage. Possible pipe is bowed based on positioning of inlet tee. SEPTIC TANK:N.A.(locate on site plan) Depth below grade: 8" Material of construction:X_concrete_metal_fiberglass_polyethylene —other(explain) If tank is metal list age:_ Is age confirmed by a Certificate of Compliance(yes or no):_(attach a copy of certificate) Dimensions:Typical 1000 gst 8'6"L,4'6"H,518"W Sludge depth:4 inches Distance from top of sludge to bottom of outlet tee or baffle:27" Scum thickness:2" Distance from top of scum to top of outlet tee or baffle: 16" Distance from bottom of scum to bottom of outlet tee or baffle: 14" How were dimensions determined: actual measurements Comments(on pumping.recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.)No evidence of leakage. Septic Tank requires maintenance pumping. Outlet tee in good condition. Tank is H10 loaded. GREASE TRAP: N.A. Depth below grade:_ Material of construction:_concrete_metal_fiberglass_polyethylene_other (explain): Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping: Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS ` Page 8 of l l SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address:38 Lakewood Drive,Centerville,MA Owner:Don Sargent Date of Inspection:April 25,2004 TIGHT or HOLDING TANK: N.A._(tank must be pumped at time of inspection)(locate on site plan) Depth below grade: Material of construction: concrete metal fiberglass_polyethylene other(explain): Dimensions: Capacity: gallons Design Flow: 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: YES_(if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: Even with outlet pipe Comments(note if box is level and distribution to outlets equal,any evidence of solids carryover,any evidence of leakage into or out of box,etc.): Box is level. There is evidence of solid carry over. Box is not leaking. PUMP CHAMBER: YES—(locate on site plan) Pumps in working order(yes or no):_YES_ Alarms in working order(yes or no):YES Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.): Pump is in working order. Alarm is located in crawl space. OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C C'�t 7C`�TT7�T TATTATI�ii 1 TT/1AT i i Page 9 of 11 Property Address:38 Lakewood Drive,Centerville,MA Owner: Don Sargent Date of Inspection: April 25,2004 SOIL ABSORPTION SYSTEM(SAS): X_(locate on site plan,excavation not required) If SAS not located explain why: Type leaching pits,number: 1 6'X6' _leaching chambers,number: _X leaching galleries,number: Two flow diffusors w/2' stone leaching trenches,number,length: leaching fields,number,dimensions_ overflow cesspool,number: innovative/alternative system Type/name of technology: Comments(note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation, etc j.No indication of staining,no ponding or damp soil. Probing Stone does not indicate hydraulic failure._2 inches of effluent in the leaching. CESSPOOLS:_NA (cesspool must be pumped as part of inspection)(locate on site plan) Number and configuration: Depth—top of liquid to inlet invert: Depth of solids layer: Depth of scum layer: Dimensions of cesspool: Materials of construction: Indication of groundwater inflow(yes or no): Comments(note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation,etc.): PRIVY: N.A._(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.): Page 10 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address:38 Lakewood Drive,Centervill,Ma Owner: Don Sargent Date of Inspection: April 25,2004 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. SEE ATTACEHED PLANS OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS Page 11 of 11 PART C SYSTEM INFORMATION(continued) Property Address:38 Lakewood Drive,Centerville,MA Owner:Don Sargent Date of Inspection: April 25,2004 SITE EXAM Slope Surface water Check cellar (crawl space) Shallow wells Estimated depth to ground water_15_feet Please indicate(check)all methods used to determine the high ground water elevation: _X_Obtained from system design plans on record-If checked,date of design plan reviewed: _X_Observed site(abutting property/observation hole within 150 feet of SAS) X_Checked with local Board of Health-explain:Recent Test Holes, Existing engineer records with BOH _X_Checked with local excavators,installers-(attach documentation) Accessed USGS database-explain: You must describe how you established the high ground water elevation: Utili zed ed existing site design information on file with the Board of Health. Additionally,existing site and abutting site topography does not indicate ground water to be within 4 feet of bottom of leaching facility. See attached engineering design plan. 4' AsBuilt Page 1 of 1 �D TOWN OF 3ARNSTABLE LOCATION tinr.�`� �1 SEWAGE a 2 -IW VILLAGE_ j4z,-\ .wp�� ASSESSOR'S MAP & LOT 1i I INSTALLER'S NAME & PHONE NO. L . \ � SEPTIC TANK CAPACITYT ,I_ LEACHING FACILITY:(tppe)TLCU� �=c (size)_a 14 n NO. OF BEDROOMS PRIVATU WELL OR PUBLIC WATER V ., BUILDER OR OWNER. �)� .� (LA DATE PERMIT ISSUED: • qq I DATE COMPLIANCE ISSUED VARIANCE GRANTED: Yes No , lot 4 L-3LI , TX http://issgl2/intranet/propdata/prebuilt.aspx?mappar=212002&seq=1 11/9/2017 I� TOWN OF 3ARNSTABLE LOCATION �, " `� �,� �� SEWAGE # (4 VILLAGE C-1CQ\D , :',SSESSOR'S MAP INSTALLER'S NAME & PHONE NO., •__ \ 7� T71 L"mac SEPTIC TANK CAPACITY-�� - i LEACHING FACILITY:(type) (size) a 14 X �S NO. OF BEDROOMS ,PRIVA7"- WELL OR PUBLIC WATER BUILDER OR OWNER DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED.• VARIANCE GRANTED: Yes No l� , 1 � 1Ni " r --- - cm No.. 3.n.14.+ FEB.... )j�5............. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH Barnstable Con errvation Department TOWN OF BARNSTABLE Applira#iuit for Di►ipwial World, TouBtrur#i nat Date Application is hereby made for a Permit to Construct ( ) or Repair ( ") an Individual Sewage Disposal Syst at: JYV:ooOTk .. ....._ ------•-----•-------------------------------------•--------- -••••••-•-----•----•-------••--•--••-•-•---•-••---•-•---•-----------•---------.......------•--•-•- inn-� Addres- ----------•.................or Lot No.\ ------------------------ ----•-------- ------------- ..._.................!................ ) J - Owncr d rc s Installer Address Type of Building Size Lot............................Sq. feet Dwelling— No. of Bedrooms...............................-------------Expansion Attic ( ) Garbage Grinder ( ) 04 Other—Type of Building ............................ No. of persons---------------------------- Showers ( ) — Cafeteria ( ) a Other fixtures ------------------------------ - - -----------------••-•-----•----•------------- ............. W Design Flow............................................gallons per person per day. Total daily flow..--___......_.___._._._.........._.......__gallons. WSeptic Tank—Liquid capacity............gallons Length________________ Width-----........... Diameter---------------- Depth................ x Disposal Trench--No. .................... Width-------------------- Total Length.................... Total leaching area....................sq. ft. Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date........................................ W Test Pit No. 1................minutes per inch Depth of Test Pit..................... Depth to ground water........................ r3 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a ---••-•••-••-•-------•--•---••-•••••-•-••--•••--•-•-•--•-•••••.......-••••-••••----•-------------•-•----•••-•--.......................----.....---........... 0 Description of Soil........................................................................................................................................................................ x V ........................................•••••-•-••-•••••••••-••••-•••--••---•--•.....•-••••--•••-•--••••••...._..._.........._...-•-....-•-................................................---.......... W ............. ..........•-------------------•------------------------------------------•------••-••----•-----••-------------------•---•--------•-----•• U Nature of Rep ' s or ALterati ns— we when a licable-UPR. _ , ---M t�� ... ...................... j� q rat.._._ = �� .�.....J.t '...� v�ca ,................................................ 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 Comp lance s ss d by the board of health. 3 Signed ... .. ........ .. .. . ................... ApplicationApproved By ............. .. .............................. . ....................................-.... .. Dare Application Disapproved for the following reasons: ..... .................................. ....................................................... ................................. ................................................................................................................................................................................................................ ........................................ Date PermitNo. ..... ..^...1.��.. .............................. Issued ......-- .......................................................... Dare ---------------------------- ---- -- -- - -- - - - - - -- - ... ...... ............. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Apphration for Dieipwial Works Tvtwtr�rtiv, up j 7n im Application is hereby made for a Permit to Construct or Repair ( 'I__a_n Individual Sewage Disposal Systegi at: Tk ............................................................... ................................................................................................. ...q 0,,ocmion-Addrcs or Lot No. ----------** .. ..... . 3 S" 0"o ..... ..... ---------------------------.................kre.......(a.......................... ................. 3-- --—----------------_------ ss ................ -C----------- Installer Address U Type of Building Size Lot---'t.......................Sq. feet Dwelling— No. of Bedrooms................0-............................Expansion Attic Garbage Grinder aOther—Type of Building ---------------------------- No. of persons._.......................... Showers Cafeteria Otherfixtures ------------------------------------------------------------------------ ----_------ ............................................................. <W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. IY4 Septic Tank—Liquid capacity............gallons Length---------------- Width...___...__._... Diameter--.--._-_.._-.__ Depth................ Disposal Trench--No. .................... Width.._....__........... Total Length....___.....-__._... Total leaching area....................sq. ft. Seepage Pit No............. ....... Diameter..__.._.._._........ Depth below inlet.................... Total leaching area..................sq. f t. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. I................minutes per inch Depth of Test Pit...........__.___... Depth to ground water........................ 4 Test Pit No. 2................minutes per inch Depth of Test Pit....__._....____.... Depth to ground water.............._....._... 94 .............................................;:............................................................................................................... 0 Description of Soil....................................................................................................................................................................... U ........................................................................................................................................................................................................ ......................................................................................................................................................... ....... t4 ;�-—-------- !)&__� U Nature of Rep,;urs or Alterations—Answer when ---------ks�v�......... __D ................................................. 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 Comp lance s-bee fr assd by the board of health. Signed -------- ----------- ------- ........... 4�Q.....:..3...... ApplicationApproved By ------------- ....................................................................................... Daw Application Disapproved for the following reasons: ......................................................................................................................................... ................................................................................................................................................................................................................ ....................................... Da, ... Issued .................................................................... Permit No. ...... ............................ Date —————————————as—— ——————­_­—————— THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE i Q'Iertifirate of Complinure TM)NIS TO CT&ww:-T,-, That the Indivi- ual Sewage Disposal System constructed or Repaired su by ...... ------ ........-k ......... -- ----------------- ­ ............................................ ............................................................... at ......... .... .. ... ........ ..... ........ ........................................I- ------------- ------------- has been installed in accordance with he provisions of TITLE 5 of The State Environmental Code as described in the application for Disposal Works Construction Permit No. ........?i ... dated -------------_...................... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WI FUN T I 0 N SATISFACTORY. 17DATE..... _� "I_7.92.-....... .....-.... ... . ........... Inspector ................� _D ------ .................................... .....------------- ------------------------ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE FE E,.--.?0.............. Permission is hereby granted........ ---- ------ ....................................................................... to Construct or Repair Ltr an 1 1 fidividual Sem-%A-age Du' posal Sys _ at No...+62Qhr.VT.T -�- ------------------------ .............................................................. k,SCE— Street ON as shown on the application for Disposil Works Construction Permit Dated........................................... .....................I..................................... 6), Board of Health DATE. .. ... ................................. FORM 38308 HOBBS&WARREN.INC..PUBLISHERS Finish grade above system shall slope at 2% or greater 4diam. cost iron or schedule 40 PVC pipe A 20'min. distance (building to edge of leaching system) { 10 min. dist. L I mi n. cover 2, clean backfill 2" layer of I/8 to 1/2 washed 0 0 r,. o stone. First EL: 0 R. El.= Inv e1.39+17 16� �"' I -� I e1.41 .Ot Inv.ell.39+0. Inv. el.38+93 CRAWL I of 3/4" to 1 1/2" Removable washed stone on ends and on SPACE �'� S covers sides of flow diffusors. -0.0 n+irr. ' �•—��Clean backfill Liquid level SEPTIC TANK ,• '�• wgsned gravel * Inv.ela I,QOO GAL. , L•`r' Inv. el= • _ El.= P R O F I LE o `; diameter ., , gravel as necessary-95% optimum compaction. Not to scale PUMP .STATION DESIGN CRITERIA ' NUMBER OF BEDROOMS 2 (equbt to 220 gals/day) 1 GARBAGE DISPOSAL UNIT NONE GENERAL NOTES LEACHING CAPACITY REQUIRED 220 GALS/DAY. I-NO CHANGE TO THIS SYSTEM SHALL BE MADE SIDE AREA PROPOSED 120.9 sf. UNLESS APPROVED IN WRITING. BOTTOM AREA PROPOSED 144 sf. 2-FLOOD ZONE TOTAL AREA a6-4•9 y LEACHING CAP. 265 3-ZONING .*4-THE CONTRACTOR SHALL FIELD DETERMINE WATER SUPPLY TOWN THE INVERT OF THE EXISTING PRECAST CONCRETE UNITS H-10 LOADING. SEWERAGE PIPE. BENCHMARK SPINDLE OF HYDRANT #587(e1=4a85) 5-NORTH ARROW SHALL NOT BE USED FOR SOLAR OBSERVATION PURPOSES. SOIL LOG 6-THE SEWERAGE SYSTEM SHALL BE BUILT ACCORDING TO TITLE V. N' I N° 2 Depth Soils El. Depthl Soils El. 0.0 Loam 47.8 and HOUSE DATE DESCRIPTION Drawn by Checked by 2.5 Subsoil 45.3 N' REVISIONS 38 Coarse -DETAIL SHEET �� ASH pf and of PROPOSED SEWAGE DISPOSAL SYSTEM FA Sf Medium TITLE REFERENCE LOT 15, • LAKEWOOD DRIVE �o JOHN `/G\ Sand DATE OF SOIL TEST 3/17/92 Deed Bk. 1429 Pg. PC) Prepared For o Lk DERS-CAULEY 1 and TEST TAKEN BY JACK LANDERS-CAULEY M/M DONALD: a HOPE SARGENT CIVIL Gravel RESULTS WITNESSED BY Scale: as noted Date: 4/13/92 No.s��o� JACK LANDERS CAULEY, P.E. A�oFGFSTE�E�r�``� 9.5 38.3 DONNA MIORANDI SHEET 2 of 2 PERCOLATION RATE 2 min/in P.O.BOX 364 �,�,�1 E _ West Falmouth,Mo. 02574 a^r GROUNDWATER NONE ENCOUNTERED ASSESSORS N' 212-02 Drawn-by J.D.R. Checked by DWG NS A-221 ' - LoA EGI t ` ® — ev - - r& �' t�dv�. -mot toll oof JO/ _ .� : � - � All �- 1 Atf + '�( p : II k: {t YEY' '.w %S( �aT L •.-Yin° <"F�'uv.J i3 ail a��1� .p . .> ,' � P / I r � ./ tpV Ilr d"�'"' WN1 I�,tri� c 'P y i : 04 DO 00 r1 ---- _ -- �; ._.___........ —.._...._.__.._.__._ n No.16978 ��L 1`"7�/� SCiMUAATE +- y ��'��- 1 (fro�� , . . •'yd-�.�' 4-t 41. 4 I !0- 2 �ERED aRCti� No. 6978 F ' , o SCITUATE �- .re�b�'✓ �"��Ir00 74� p MA JG' , I iz+� '► ls► NOW w f i` ff.� �44 ®t- r�a�rfi .: 1-vi �O T�cl c� No.-6978 <nP°'41""i� e°VV2 F "I�IIJ (s� SCITUATE MA lNw4pwrI4pl4 W/ ZXb-1 ,rr . An- 6le"o c— &yrv) q'IV rIGh) I-K8►GUIr jot V N G V ' lio r mow 1-�e10 J01" *r t6p O,G7 v rovvj W&A n r } WAS PAW- 1• .Pl c °� W4, V.a AT- I(®"v,e, �.14 N&WWWV, ova- 'YX 'h/14""C'+� pillyw , 4wf� ...... gam+ • n No. 6978 SCITUATE CAL 50 t i 77777411 PA M.1 Z ' Z TEST HOL" LOGS oc v� IIIIII L I --- -— --- I` 1 The insli lulion sllull conyI Willi 'Title V wid Town of I uatd ul FLOOD ZONE: �`t��1 SO I L EVALUATOR: 1 d �5' I lealth Regulations. \ _— w l TNESS : ap!L4 A 2) '1110111,0111ol, Nh1111 vul(ly Ihu loolioll o illlllle'll, Novel, Illk'.111 l,l 111111 11ol lu REFERENCE. 1 � -9 DATE t ,. ,..� Iti1� components Iprior to installation and setting; hose elewitions. bt' ww� fl� KIL. ' W �� PERCOLATION RA t E: >y 1 l , 3) All gravity septic piping to be 4 inch Sch 40 PVC at 1/8" per foot. The first f' �• two Ieet out of the d-box to the leachingshall be level. '�•� 04. 4) This plan is not to be utilized for property line determination nor any other j i 11 Zbo TH- I TH-2 n -- �— purpose other than the proposed system installation. ,� l0 R� r 5) All septic components must meet Title V specifications. - - `�— RL G� ! `. 6) Parking shall not be constructed over H 10 septic components. 1- - � TTC 7) The property is bounded by property corners and property lines. 8 The property owner shall review design considerations to approve of total G0lr-FSI ?'RSZ= 't ?lh _ �.��► -�! aG 2� !� 'i,�; ) P p' r g pp LOCATION MAP , T'p { 1� �jl.E ��r design flow and number of bedrooms to be considered for design. Receipt ^mow of payment for the plan and installation based on the plan shall be deemed approval of the design flow by the owner. h� 9) The existing leaching or cesspools sliall be pumped and filled with material per Title `' abandonment procedures. Those within the proposed SAS 'shall be removed along with contaminated soil and replaced with clean sand per Title V specs. \ 10 System components to be 10 feet from water line. 1') y p to ne. Server ,Ines crossing the water line shall be sleeved with 4 inch SCE 140 PVC with ends grouted if ,.� - applicable. The proposed SAS is being installed below the water service ��=?, _ b' _�UC��/. p,N line. The line is to be sleeved as aforementioned and maintained in place. ! SEPT 11. S Y S T EM DES I GN 11) If a garbage grinder exists it is to be removed and is the responsibility of the �c \ / owner to ensure such. FLOW ESTIMATE 12)The installer is to take caution in excavation around the gas line if such ' exists. i \ \ ✓ BEDWOMS AT Ih GAL/DAY/BEDROOM -�j GAL/DAY 13)Tne installer shall verify the location, quantity and elevation of the sewer lines exiting the dwelling prior to the installation. �\ SEPTIC 'TANK 14)This plan is representative only that a system can fit on a property meeting \ \ \ _--- Title V requirements. GA:_/DAY x 2 DAYS r` GAL USE 2��� GALLON SEPT 1 C TANK ' J G� SIDE AREA: 2� Z -� I2►'�� XZX (�,l �� 1C31 6. �`� BOTTOM AREA: Z Z b�-1t � �� MASON �1 i�z��,_�. jQ , � 1 �CpuYL SEPTIC SYSTEM SECTION i _ .. -. `ll 1-0— _92 L/�( 00 10 Op 7MD MR bp \ 2� GAL SEP I C TAN �► ° Ib �� z5 x iz, t� -- , p�W o, ___-- -__--- ����---� I �°�^- SITE AND SEWAGE PLAN LOCATION . kv w � EPAFOR . P R RED ; r�T1�►•., ?,� �„�, M _ fioyL, 01% 1 v _ l r, ° ���.�va (aou� _1t�--- _-v5�__-�R�r �?_N�!� ��t�00 (.��, 2Cl��i' !� ---��D�. _. _�► DAV I D B . MASON I DATE: Zo\ DBC ENVIRONMENlfAL DESIGNS 5 EAST SANDWICH . MA W DATE HEALTH AGENT SOS ) 83 = 2 177 Z , ..- a Qv LAWN AREA LOT 15 i 12,500 :E ,S.ir w +� a rn c) i rC� + DRIVEWAY �� n CaNC / s Idmp pouf , stairs i 2 QAK ~~ 31" r—� 1 . k/ OUAOUET � f ` f � �" y catch basin (typ.) /�► LAWN CD� I, AREA \ water cn meters �AKE pit I STgRY,,1/JC qp HOUSE, .�. DECK o PAK s ..A, u'i;. .� ., S ... x ...S. 1 ,.. �)h ... .... .. r ..: �„ x.. .:..Y.r`.. f .: •.v . x . „,:.r : h �,,. .. ..t ah sit .... s. 1 .. f.. ,4....._. .., �., ..- y ..ab... .o. .§ ... ,. .. .,,..;. ,- a "• ES - Sk'3:.- �...v.' '. . O NON Me, f r ProX x water gate ►�I ?- o� VON 4 T WI N W23 1'� -i , a , . , - Dw alFFusaRs Q�� A d� D`BOX ndergwly o sweeping o - elec#rac , � — P � rT - 99a 0 service fo�:tsend � � n 0p0 GAL, i+ o > i TANK� over to grade) � 9.5 t I h D � t :4 � existingI " t o ` ✓ o r'M cesspool k i 10("nin) `mow TW I rd 81" I t7, .1 -�!ay anchor u. pole I P011`� ..4 water gate valve w l 0 N ` \j co -- ----- _ _ _ -- -- E water meter pit BATE D ESCR I PT 10 N DRAWN BY CHECKED E PLAN �J LOT 14 of LET - LAKEWOOD DRIVE \ PREPARED FOR 'OPE SARGENT GENTERVILLE, A MA' a) JOB N0. SCALE: I""= I0t DATE: g /13/92 DWG. NO. A-22! DRAWN BY : CHECKED BY : ovation of electric ,service to pump D - _ J.D.R. .try', be determined , the installer. JACK - RS - CAULEY , PE . 2o PO. Box 364, °H ' � West Falmouth , Mo. 0257 11YD 587 (508) 540- 2035 Acat SHEET I of 2 �t\' 6`Sr��� CIVIL ENViRON@d"ENTAL .-....ENGINEERING _ a- „ pp�- c��' r ...�.,,. .:..e,..w.._... ,.>..n..,....«....�.,»,-,........,,...... .. ... �.....:...:.w... .........,., _.._.;..,....:..� ....r,a..,,�,..,,.ww..,...r:...4,w:>;.:.,�..µ-..,....,,.- ,,�......,,, ,.,-,r ,.,.,...,.«:.«,.:r",..,....:w„.«...:................„,...,,..max.,.-....-,...............,.�. ,.......w .-, �-,,. .e • wL*�n u SECTION. A -A ` .. - 'ALL OUTLET PIPES FROM THE R BE 4 SCHEDULE 40 P.V.C.NOTE. ALL PIPES ARE TO SET L9UIION BOX SHALL BE " _-.. LE VIEW OF LEACHING SYSTEM 12 PROFILE :. SET IEVEl FOR AT LEAST 2 FL CONCRETE COVER - D BOX cover must be •# - within 6 ..of.fimshed rode-: - .,r_ . .. . ., .,.x:.�•, ... " _ _ ode over SAS ELEV 48.00 � L Grade over D Box 48.00 t tib I 1 f /s"Aed Lrr"Aad Sbon� 4/I/d - l/Y /asMd Pw.fmv � , � _ -: .. _ - • 5.5 -- T _ / "INSPECTK)N,cover must be r I 12 pY.E to • Grade over Septic Tank - 4200 Grade over Septic Tonk 42.00 , OUTLET � - 10 TYt1n:. from. within 6 in. of finished grode .,, - - . i tank - wsUng Foundation house to', septic to 3 HOLE M 10 A - lev.=45.00 - 3 k covers must be covens must be I T X 3 Maximum Cover Top of S S E med Septic ton Septic tank co n D S BO TOP OF FOUNDATION ELEV. 43.00, (Assu ) - `• E laketwrd Or , Within 6 in. of finished grade within 6 in. of finished grade - - yy S= 0.010 per foot 1 o o o"G7 G7 -t5.5•-- ; o o O O o GT 4" - SCH. 40 Te 1.75' ea:,:v T - p 20' 0 1''Effective Depth - p p p p p © `" r ,n PLAN SECTION CROSS-SECTION r0 o o 4 Units 2 B' = 32' -` . to 1' 32' 11 1 0.02 S=0.01 a .f � 4 o EXIST. o EXIST. II w e 2 , 4 2 rr s ' .'EXIST PIM - 1,000 GAL:. o � 1,000 CA N > m > _ u 34• 3 HOLE H-10 DISTRIBUTION BOX FROM EXIST. FOUNDATION PO SEPTIC TANK 00 PUMP CHAMBE y y - 10 - Effective Length - NOT TO SCALE aMD M H-10 M Effective Vidth > +,. - T'W.Rand kthAv 8 swmmv®:Y`5 NAYTEu I,. p H-10 °'eo"'' II II c >c v SDIL ABSORPTION SYSTEM (SAS) GaNcrtEt> FULL Fot,NDATro - - _ GENERAL NOTES - - o a> 6 in.of 3/4'-1 1/2' 0 4' x 8' CONCRETE FLOW DIFFUSER / WIGGINS PRECAST 6 in.of 3/4--1 1/2' a5 W w compacted stone m " SYSTEM PROFILE 6 in.of 3/a--1 1/2- Not to Scale 1. Contractor is responsible for Digsafe notification compacted stone > > Bottom of Test Hole 1 El".- 38.00 c compacted atone � ----- --- ----------____-__-_--_ -- and protection of all underground utilities and pipes. - v Obs. Groundwater - Test Hole 1 Elev.= NONE OBSERVED 2. The septic tank and distribution box shall be set Not to Scale i NOTE: ALL COMPONENTS MUST HAVE RISERS TO WITHIN 6" BELOW GRADE level it h of 3/4"-1" 1/2" stone. 3. Backfill should be clean sand or gravel with no stones over 3" in size. 4. This system is subject to inspection during installation NOTE: WATER LINE TO BE RELOCATED AS SHOWN by Carmen E. Shay - Environmental Services, Inc. 5. The contractor shall install this system in accordance W \ with Title V of the Massachusetts state code, the approved plan PERCOLATION TEST �. o� Q \ \ and Local Regulations. a � 1 1 \ _ t 1 6. If, during installation the contractor encounters any Date of Percolation Test: OCTOBER 27, 2005 \\ \ 120 F� \ soil conditions or site conditions that are different Test Performed By. CARMEN E. SHAY, R.S., C.S.E. \ \ i t �p from those shown on the soil log or in our design Results Witnessed By. WAIVER (per BARNSTABLE B.O.H.) \\ \\ i `t installation must haft & immediate notification be SHAY ENVIRONMENTAL SERVICES, INC. \ \ i 1 \'� made to Carmen E. Shay - Environmental Services, Inc. Percolation Rate: Less Than 2 MPI ® 30" \\ \\ + \\ O� 7. No vehicle or heavy machinery shall drive over the �y septic system unless noted as H-20 septic components. LOT #15 -. 3�A 17% 8. Install Tuf-rite gas baffles or equals on all outlet tee ends. 4,2\ \\ `\ i 12,500 Square Feet +/- �� 9. All Distribution Lines shall be 4" diameter Schedule 40 NSF PVC pipes. Test Hole Test Hole # 10. All solid piping, tees & fittings shall be 4" diameter No. 1 No. 2 LOT 5 \\ \ \\ o \\ \ �L� \ Schedule 40 NSF PVC pipes with water tight joints. ` \\ 11. Municipal Water is Connected to The Residence and Abutting \ r \ELE ELEV. - DEPTH SOILS ELEV, DEPTH SOILS \ Properties Within 150 Feet. 0---- 48.00 0 48.00 \ \ Q Loamy Loamy ' `\\�� �p1\ \ \ O \ ' �� \ THE PROPERTY LINES ARE APPROXIMATE AND Sand Sand \ O-\ \ \ \ COMPILED FROM THE SURVEY PLAN GENERATED BY 10 Y 3/2 10 Y 3/2 , \\ � \\ \ \\p \ o"-s" A 47.25 0"-9" A 47.25 / o� \ \�� \\ JACK LANDERS CAULEY, P.E., ENTITLED PROJECT BENCH MARK "ITE PLAN OF LOT #15 (HS #38) LAKEWOOD DRIVE, CENTERVILLE, MA" Loamy Loamy �i �i �\ �\ \\ \ Sand Sand TOP OF CATCH BASIN DATED MARCH APRIL 13, 1992 10 YR 5/6 IO YR 5/6 ELEV- 50.00 (Assumed) IT SHOULD BE USED FOR NO PURPOSE OTHER THAN 9"- 30" B" 45.50 9"- 30" B" 45.50 44, / ! \\ \\ \\ O \ THE SEPTIC SYSTEM INSTALLATION. Sand Sand 46` i��A�PHALT ice/ EXISTING 2.5 Y 74 i 2.5 Y 74 i� DRIVEWAY , 3 BEDROOM 32"-120" C, 38.00, 32"-114" C, 37.50 / HOUSE 38 \` \ 48, r ST. 1000 L O Septic Tank WETL,,.D., ,,,,,E :.E.,E,., W.T,,:.1 _QO OF THE PROPERTY .. T R ASSESSORS MAP 212, PARCEL 002 r rr 10 / CI/ E :.` • LOT #14 LEGEND ;r, z De14 so- pth to Perc POSED -------_ R, �\ • - DENOTES PRO p 36" to 54" / 2 3 r \ 104X 1 SPOT GRADE Perc Rate= Less Than 2 MPI - 3 r �96' - Groundwater Not Observed J r - EST H \ • \ `- EXIST. 00 aL No Observed ESHWT ELEV.= 48. 2�\.\ ,r PUMP HAMB�P, DENOTES EXISTING ADJUSTED H2O Elev. = None \j / X 104.46 SPOT GRADE TEST HOL >, 11 10� PL PROPERTY LINE ELEV.= 48. PROPOSED CONTOUR - -97 EXISTING CONTOUR st 'C-0OT R/G �� LSO - - - - r ` of DEEP TEST HOLE & 2-18" DIAM. ACCESS MANHOLES PERCOLATION TEST LOCATION 8' � \ _ 6 FOOT STOCKADE FENCE o CO 00 \ a THE ACCESS COVERS FOR THE SEPTIC TANK, \\ INLET t� - DISTRIBUTION BOX AND LEACHING COMPONENT v PLAN \ OU ET SET DEEPER THAN 6 INCHES BELOW FINISHEDPLOT CRAOE SHALL BE RAISED TD INTHIN 6 OF FINISHED BADE T��`-{ INSTALL TUF-T1TE GAS BAFFLES OR EQUALS NOTE: ADD TWO FLOW. DIFFUSERS TO EXISTING 2 DIFFUSER TRENCH OF PROPOSED SEPTIC SYSTEM UPGRADE STEEL REINFORCED PRECAST CONCRETE TO INCREASE FLOW FROM 220 GPD to 330 GPD, PREPARED FOR PLAN VIEW TO ACCOMODATE EXISTING THREE BEDROOMS. DONALD Bc HOPE SARGEANT I TILE COVERS AT __.. 3-24" REMOVAB # 38 LAKEWOOD DRIVE 3" min. deviance f Jr INLET.r - CENTERUILLE MA INLET 8^min.ri2min. inlet to outlet 8' min. a.111 Liquid level I I OUTLET 1 5. _r ) cL I L '5. -7• Design Calculations N hV '• E o I - 4'-0" min. 'A OF �,;S , PREPARED BY: b� �• l Liquid depth Number of Bedrooms: 3 Equivalent to 330 Gal./Day (33C Gal./Day Min. per Title Vj C r u/� Y r o Garbage Grinder: No P�I. CC1�111 �1 ► E. S 11� l -7] 0 Cl) Leaching Capacity Proposed: 330 Gal./Day Minimum (Min. Per Title V) a' -io. Septic Tank - 2 x 330 Gal./Day = 660 USE EXIST. 1000 GAL. Septic Tank. I ENVIRONMENTAL SERVICES, INC. SOIL ABSORPJION AREA: Using percolation rate of G2 min./inch CROSS SE CTION END-SECTION Bottom Area: 0.74 gal/sq. ft. x 340sq. ft. = 251.60 gallons - �� � {' k. P.O. BOX 627 Sidewall Area: 0.74 gat./sq. ft. x 176 sq. ft. = 130.24 gallons S q1 EAST FALMOUTH, MA 02536 Providing: = 381.84 gallons gNITAR\A USE EXISTING 1000 GALLON H- 10 SEPTIC TAN K SCALE: 1 '=2o TEL/FAx 508-539-�966 Use: ADD TWO PRECAST FLOW DIFFUSERS TO EXISTING.TRENCH, HAVING A 1' EFFECTIVE NOT TO SCALE DEPTH. TO BE USED WITH 2' OF WASHED STONE ON THE SIDES AND SCALE: 1 "=20' DRAWN BY: CES ATE: NOVEMBER 8, 2005 1' OF WASHED STONE- ON THE ENDS. PROJECT#SD829 FILENAME: SD829PP.DWG SHEET 1 OF 1 I