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0052 LAKEWOOD DRIVE - Health
52"` Okewood`Drive' ci ,Centerville B, SC Gkotj,:P. R�,'�r��� 384 Washington St. Town of Barnstable - - August 22,.2003 Norwell, MA 62o6i :Board of Health AUG 2 2 2003': 200 Main Street aAs JSl ABLE Tel: 78101 =659-798i Hyannis, Massachusetts'02601 T�WHEALTND�PT; _ Eax: 6�7-345-8Oz7 - Re: Request for Variances to'Title 5-of the State Environmental Code for Lot.212-4, at_52 Lakewood Drive, Centerville (Barnstable), Massachusetts: Dear Members of the Board:, This letter"is'to request that the Barnstable Board of-Health review the attached site plan showing - the existing_subsurface sewage disposal-system located at 52.Lakewood.Drive,(Lot 212.-4) in Centerville and either: ; 1) Confirm,BSC`s.opinion that-no variances.are required as statedbelow in-which case the variance request Will-be withdrawn, or,, Z) Approve the variance,items liste.dbelow. The site work includes the:demolition and reconstruction-of a single-family dwelling"on the site. . The;septic system was re-constructed in 1993 with'a 52bedroom:design. Whereas the dwelling is being reconstructed as a three (3)bedroom dwelling there is no increase in approved flow: As such,no-changes to the subsurface'sewage,system are.proposed. At a July23;2003 meeting between Ms. Mirandi and Mr.'Norman Hayes of this office, Ms. 4. Mirandi indicated that the'system:would require variances to-remain in place."This application is submitted.based on the requirement,of Donna.Mira'di. - BSC is of the opinion that-section 310 CMR"15.301 (5)does not require any upgrade of the system and therefore no:requirement_for:variances for the-reconstruction of the dwelling.This is ; '-because there will be.- increase in approved flow to-the system.and the system has an�passed a Title 5.inspection. In'the event the Board disagrees with BSC's opinion, the applicants; David and Allison Graf of 52. Lakewood Drive, Centerville request;the Board allow the existing septic system remain to service the proposed reconstruction,and approve the folfowing;variances.under.Title 5 of the State Environmental Code and the Barnstable;Board of Health Regulations:. ' = VARIANCES': •Section 1-5.211,Minimum Setback Distances Vanarices Requested: Engineers 7 Setback Required Provided Environmental Septic Tank to-Wetland ,' :100' - 50' Scientists -, Sod Absorption System to Wetland T 100* 75'-. . - Soil.Absorptioi-i,;S ms to Property Lin 10 3 GIS'Consultants Septic Tan Foundation Wall `10 Septic Tank to:Property`_Line': ?10 Y. _•Landscape � Pump.Chamber to Property ifie 10 0 Arehrtects`` r ' Distribution Box to Property Line f `40' 0 Planners * See Barnstable Board of Health.Regulations"Part VIII;;Sectiori 1 00 'f K n - s Surveyors, 'j ! '� .n•2 is p< t �� V Title 5 Variances 52 Lakewood Drive, Centerville, MA Page 2 Section 15.214.Nittogeri Loading Limitations F Required; 110 gallons per.day/10,000 SF. Provided: 330 gallons per day/10;426 SF Section 15.242`LTAR-Effluent Loading Rates (based-on as=built card on file at Board of. Health) Required: (330 gal/day) @ 0.74-gpd/sf = 446 sf - Provided: (329 gal/day) @ 0'.74 gpd/sf- 444 sf•. ..As required in 310'CMR 15.4.10,,BSC is of the opinion that-the applicants have`established that granting these variances would provide an equivalent level of environmental protection as-- provided-under.3 10 CMR 15.00, as the proposed condition of a design flow for 2 fewer bedrooms)will result in-a 40% reduction of treated effluent into the-environrnent being less than . the approved capacity. Further,::"it is understood that'public sewer is proposed to-be-installed ° within the next few.years such that the issues described herein are temporary; Denial of these variances request would be inanifestly unjust;in,that strict application of requirements listed at -310 CMR15.000 limit the Graf familys ability to make reasonable improvements to their home and property. Please call meat 61.7;896=44 1 if there are any questions regarding this matter. Sincerely The BSC Group Inc. David J. Crispin PE, PLS - Senior Associate CC/ Mr.-David &Allison-Graf, 52 Lakewood-Drive, Centerville;MA 02632 PAPRi�46`1360MOH-SEPTIC VARIANCE\BOH-varianceletter7-24-03.doc: ABUTTER NOTIFICATION LETTER August 21, 2003 SUBJECT: Upcoming Barnstable Board of Health Public Hearing To Whom It May Concern: As a direct abutter to the proposed project, please be advised that a Disposal Works Construction Permit application has been filed with the Barnstable Board of Health. You are invited to attend the public hearing at the time noted below if you desire or have comments on the project. Applicant: David&Allison Graf Project Address or Location: 52 Lakewood Drive Assessor's Map and Block: Map 212 Parcel 004 Description: The applicants request the Board allow the existing septic system remain to service the proposed reconstruction and approve the following variances under Title 5 of the State Environmental Code and the Barnstable Board of Health Regulations: Variances Requested: 310 CMR Section 15.211 Minimum Setback Distances Variances Requested: Setback Required Provided Septic Tank to Wetland 1001* 50' Soil Absorption System to Wetland 1001* 75' Soil Absorption Systems to Property Line 10, 3' Septic Tank to Slab Foundation 10, 4' Septic Tank to Property Line 10, 3' Pump Chamber to Property Line 10, 3' Distribution Box 10, 0.5' * See Barnstable Board of Health Regulations Part VIII, Section 1.00 310 CMR Section 15.214 Nitrogen Loading Limitations Required: 110 gallons per day/10,000 SF Provided: 330 gallons per day/10,426 SF 310 CMR Section 15.242 LTAR-Effluent Loading Rates Required: (330 gal/day) @ 0.74 gpd/sf =446 sf Provided: (329 gal/day) @ 0.74 gpd/sf = 444 sf Abutter Notification Letter August 21, 2003 Page 2 Applicant's Agent: The BSC Group 384 Washington Street Norwell, MA 02061 (781) 659-7981 Attention: Mr. Dave Crispin Public Hearing: Place Barnstable Town Hall, 367 Main Street, Hyannis, MA Date: September 2, 2003 Time: to be determined (evening) Plans and application describing the proposed project are on file with the Barnstable Board of Health. For more information please contact the Barnstable Board of Health at (508) 862-4644. DIRECT ABUTTERS: LOT ID Owner&Mailing Address Property Address 212-3 Barry&Karen Oshry 44 Lakewood Drive 161 West Brookline St Boston, MA 02118 212-5 Judith Huskins 56 Lakewood Drive 1046 High Street Westwood, MA 02090 212-8 Douglas&Patricia Goodwill 398 Lakewood Drive 259 Ohio Avenue West Springfield, MA01089 PAPRJ\4613600\B0H-SEPTIC VARIANCE\board ofhealth-abut.not8-21-03.doc COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: o� Owner's Name 07 Owner's Address: igg Date of Inspection ` s Name of Inspector: please print) Company Name: YVP Mailing Address: ",4 aaBr"y Telephone Number: '�g". 2-2/ 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: Passes Conditionally Passes Needs Further Evaluation by the Local Approving Authority Fails Inspector's Signature: Date:. ylv, 3 The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the. DEP. The original should be sent to the system owner and copies sent to the buyer,if applicable, and the approving authority. Notes and Comments *'This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future under the same or different conditions of use. Title 5 Inspection Form 6/15/2000 page I 'Page 2 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: Owner: Date of Inspection: / Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: I have not found any information which indicates that any of the failure criteria described in 310 CMR l 703 or in 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below. Comments: B. System Conditionally Passes: One or more system components as described in the"Conditional Pass"section need to be replaced or repaired.The system,upon completion of the replacement or repair, as approved by the Board of Health,will pass. Answer yes,no or not determined(Y,N,ND)in the for the following statements. If"not determined"please explain. The septic tank is metal and over 20 years old* or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as'approved by the Board of Health. *A metal septic tank will pass inspection.if it is structurally sound,not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND explain: Observation of sewaee backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken,settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced ND explain: The system required pumping more than'4 times a year due to broken or obstructed pipe(s).The system will pass inspection if(with approval of the Board of Health):. broken pipe(s)are replaced obstruction is removed ND explain: 2 Page 3 of I'l OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: Owne Date of Inspection: 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(i)(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 aseptic tank and SAS and the SAS is within a Zone 1 of a public water supply. _ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. _ The system has a septic tank and SAS and the SAS is less than 100,feet but 50 feet or more from a private water supply well". Method used to determine distance "This system passes if the well water analysis,performed at a DEP certified laboratory, for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A,copy of the analysis must be attached to this form. 3. Other: 3 Page 4 of 1 l OFFICIAL.INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address:b�(1� �g Owner: j Date of Inspection: 4a.,e D.. System Failure Criteria applicable to all systems: You must indicate"yes" or"no"to.each of the following for all inspections: Yes N_o/ i/ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool _ Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool _ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or / cesspool Liquid depth in cesspool is less than 6"below invert or available volume is less than day flow Required.pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number / of times pumped _ V Any portion of the SAS, cesspool or privy is below high ground water elevation. _ Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. _ Any portion of a cesspool or privy is within a Zone 1 of a public well. _ V Any portion of a cesspool or-privy is within 50.feet of a private water supply well. Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well-with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory, for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form.] (Yes/No)The system fails. I have determined that one or more of the above failure criteria exist as described in 3 10 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. 4 Page 5 of 1.1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: c� ^ Oa Owne Date of Inspection: 3 Check if the following have been done.You must indicate"yes" or"no"as to each of the following: Yes No A _ Pumping.information was provided by the owner, occupant, or Board of Health Were.any of the system components pumped out in the previous two weeks? Has the system received normal flows in the previous two week period? Have large .volumes of water been introduced to the system recently or as part of this inspection? Were as built plans of the system obtained and examined?(If they were not available.note as N/A) Was the facility or dwelling inspected for signs of sewage back up Was the site inspected for signs of break out? c/ _ Were all system components,excluding the SAS, located on site (� Were the septic tank manholes uncovered,.opened, and the interior of the tank inspected for the condition of the baffles or tees,material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? _ Was.the facility owner(and occupants.if different from owner).provided with information on the proper maintenance of subsurface sewage disposal systems The size and location.of the Soil Absorption System (SAS)on the site has been determined based on: Yes no _L//_ Existing information.For example, a plan.at the Board of Health. _✓ Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(3)(b)] 5 . Page.6 of I 1 OFFICIAL INSPECTION-FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTI.ON FORM PART C SYSTEM INFORMATION Property Address: aLl Owner:. Date of Inspection: 1� FLOW CONDITIONS RESIDENTIAL Number of bedrooms(:design): . Number of bedrooms(actuaI):. ,� DESIGN flow based on 3 l0.CMR 15.203 (for example: 11:0 gpd x of bedrooms): �j-V Number of current residents: " q Does residence'have a garbage grinder(yes or no): A/v Is laundry on a separate sewage system( es or no):i( ,[if yes separate inspection required) Laundr y system inspected ( es or no)J� Seasonal use: (yes orno)/� Water meter readings, if available(last 2 years usage(a d)):a2 'L2-$ V Sump pump(yes or no): z3©ee Last date of occupancy: C��ceC/tJ COMMERCIAL/INDUSTRIALj/X.Cl Type of establishment Desi-n flow.(based on 310 CMR.15.203): gpd Basis of design flow(seats/persons/sgft,efc,): . „ 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:. Was system pumped as.part of the inspection(ye r n ): If yes,volume pumped: gallons--How was quantity,pumped determined? Reason-for.pumping: TYP OF SYSTEM �Feptic 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 fTom system owner) _Tight tank _Attach a copy of the DEP.approval —Other'(describe): App oximate age of all components, date installed(if known)and source of information: Were sewage odors-detected when arriving at the site(yes'or no): 6 Page 7 of I 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: / Owner. Date of Inspection: 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: /CO Material of construction: concrete_metal_fiberglass polyethylene —other(explain) If tank is metal list age: Is age confirmed by a Certificate of Compliance(yes or no):_(attach a copy of, certificate) Dimensions: Sludge depth: Distance from top of sludge to bottom of outlet tee or.baffle: Scum thickness: Z it !! Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottomf outlet tee or baffle: 13 How were dimensions determined:JQ g �+. (( Kip— Comments(on pumping recommend tions, let and outlet tee or baffle condition, structural integrity, liquid levels *related to outlet invert, e i ence of leakaa , etc.): GREASE TR ocate on.site plan) Depth below grade:_ Material of construction:_concrete=metal_fiberglass_polyethylene_other (explain): Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping: Comments (on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): 7 Page 8 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: Owne Date of Inspection: 3 TIGHT or HOLDING TANK (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:Z(if present must be opened)(locate,on site plan) Depth of liquid level above outlet invert Comments(note if box is level and distribution to outlets equal,any evidence of solids carryover,any evidence of age into or out of box,etc. ti. l G PUMP CHAMBER: locate on site plan) Pumps in working order(yes or no): Alarms in working order(yes or no): omment�s(nWe& ition of pump chamber,condition of pumps and appurtenances,etc.): ` 8 Page 9 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: j Owne Date of Inspection: ula' 3 SOIL ABSORPTION SYSTEM (SAS): (locate on site plan,excavation not required) If SAS not located explain why: Type leaching.pits,number:_ leaching chambers, number: _beaching galleries,number: ,//leaching trenches,number, length: leaching fields,number, dimensions: overflow cesspool, number: innovative/alternative system Type/name.of technology: Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil; condition of vegetation, etc. // v t� °��"�!'> l✓LU!(.� �d .God �'f ���.elh.P 1.�.��C-P-E��+v�CESSPOOLS: 2&(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(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 Pace 10 of 11 OFFICIAL INSPECTION FORM=NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C. SYSTEM INFORMATION(continued) Property Address: ?�2U� Ownek �- 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 buildin;. l � 3 �5 10 Page I 1 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: o�) Owner Date of�nspec SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water 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) Accessed USGS database-explain: You must describe how you established the high ground water elevation: q 11 Permit Number: Date: Completed by: ram/ HIGH GROUND-WATER LEVEL COMPUTATION Site Location: r � T, Lot No. Owner: 0 - Address: Contractor: �� ���i5 Address: Notes. STEP 1 Measure depth to water table to nearest 1/10 ft. .............. .............................................................. .... .Date month/day/year STEP 2 Using Water-Level Range Zone and.Index Wel'I'Map locate site and determine: A Appropriate index well........ "� J OWater level range Zone .................... STEP 3 Using monthly report."Current Water Resources Conditions" determine'current depth.to water level-tor index well .................. C�� Z3+y month/year STEP 4 Using I `.Water-level e. g . able o� Adjustments for index well (STEP 2A), current depth to water level for index.well (STEP 3)., 'and water-level zone (STEP 2B) determine water-level adjustment............................ 3 STEP 5 . Estimate depth to high water by subtracting the water- level adjustment (STEP 4) from measured"depth to water level at site (STEP 1)................................ ......... 7 ......... . ...................... P Figure 13.--Reproducible computation form. 71 " 0 �F L1 J I COMMONWEALTH OF MASSACHUSETTS Z EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION C. ALJ TITLE 5 1oWN� ._- OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A MAP CERTIFICATION Property Address:. a _ PARCEL ®®4' SOT i Owner's Name. Owner's Address: 3D Date of Inspection Name of Inspector: please Company Name: Mailing Address: _ facl� Telephone Number: Q'.-2-2/ Y 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: Passes Conditionally Passes Needs.Further Evaluation by the Local Approving Authority Fails g Inspector's Signature: Date: P The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall!submit the report to the appropriate regional office of the. DEP.The original should be sent to the system owner and copies sent to the buyer, if applicable,and the approving authority. Notes and Comments ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will.perform in the future under the same or different conditions of use. Title 5 Inspection Form 6/15/2000 page 1 Page 2 of 11 OFFICIAL INSPECTION FORM NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: Q Owner: Date of Inspection: Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: I have not found any information which.indicates that any of the failure criteria described in 310 CMR 153 03 or_in 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below. Comments: B. System Conditional ly 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 ass inspection i y p p f the existing tank is replaced with a complying septic tank as'approved by the Board of Health. *A metal septic tank will pass inspection.ifit is structurally sound,not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND explain: Observation of sewage backup or break out or high static water level in-the distribution box due to broken or obstructed pipe(s)or due to a broken,settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced ND explain: The system required pumping more than'4 times a year due to broken or obstructed pipe(s).The system will pass inspection if(with approval of the Board of Health):. broken pipe(s)are replaced obstruction.is removed ND explain: 2 J Page 3 of I'l OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued). Property Address: Owne / r Date of Inspection: 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,.safetyand 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 I of a public water supply. _ The system has a septic tank and SAS.and the SAS is within 50 feet of a private.water supply well. _ The system has a septic tank and SAS and the SAS is less than 100,feet but.50 feet or more from a private water supply well**. Method used to determine distance **This system passes if the well water analysis,performed at a DEP certified laboratory, for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the.presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered. A,copy of the analysis must be attached to this form. 3. Other: 3 Page 4 of 1 I OFFICIAL.INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: onw 12 Owner. Date of Inspection:p /a,, D. System Failure Criteria applicable to all systems: You must indicate"yes"or"no"to:each of the following for all inspections: Yes No _ 1/ Backup of sewage into facility or system component due to-overloaded or closaed SAS or cesspool Discharge or ponding of effluent to the surface of the around or surface waters due to an overloaded or / clogged SAS or cesspool y Static liquid level in the distribution box above outlet invert due to.an overloaded or clogged SAS or / cesspool Liquid depth in cesspool is less than 6"below invert or available volume is less than %Z day flow _ Required.pumping more than 4 times inthe last year NOT due to clogged or obstructed pipe(s).Number of times pumped Any portion of the SAS,cesspool:or privy is below high ground water elevation. Any portion of cesspool or privy is within 10.0 feet of a surface water supply or tributary to a surface l water supply. Any portion of a cesspool or privy is within a Zone 1 of a public well. _ V Any portion of a cesspool or privy is within 50.feet of a private water supply well. Any portion of cesspool or.privy is less than 100 feet-but greater than 50 feet from a private water supply well-with no acceptable water quality analysis..[This system passes if the well water analysis, performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form.] (Yes/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 systemthe system must serve a facility with a-design flow of 10,000 gpd to 15,000 gPd• You must.indicate either"yes"or"no"to each of the following: (The following criteria apply to large systems in addition to the criteria above) yes no the system is within 400 feet of a surface drinking water supply the.system is within 200.feet of a tributary to.a surface drinking water supply — _ the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area—IWPA)or a mapped Zone II of a public water supply well If you have answered"yes"to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. ,4 Page 5 of 1.1 OFFICIAL INSPECTION FORM.-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGEDISPOSAL SYSTEM INSPECTION FORM ART B;._ .,: .. CHECKLIST Property Address: o ^ Owne 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? 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) v _ Was the facility or dwelling inspected for signs of sewage back up L _ Was the site.inspected for signs of break out? Were all system components,excluding the SAS,located on site.? Were the septic tank manholes uncovered; opened; and the interior of the tank inspected for the condition of the baffles or tees,material of construction, dimensions,depth of.liquid, depth.of sludge and depth of scum? Was.the facility owner(and occupants.if different.from owner).provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location.of the Soil Absorption System(SAS)on the site has been determined based on: Yes no / Existing information.For example, a plan.at the Board of Health. Determined in the field(if any of the failure criteria related to Part.C.is at issue approximation of distance is unacceptable) [310 CMR 15.302(3)(b)]. 5 Page 6 of 11 OFFICIALINSPECTION-'FORM_NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTI.ON.FORM PART C SYSTEM INFORMATION Property Address: Owner: Date of Inspection: FLOW CONDITIONS RESIDENTIAL Number of bedrooms(:design):, Number of bedrooms(actual): DESIGN flow based on 310.CvIR 15.203 (for example: 11:0 gpd x#of Bedrooms): " Number of current residents: Does residence,have.a garbage grinder(yes-or no): /V(� Is laundry on a separate sewage'system (yes or no):�f if yes separate inspection required] Laundry system inspected( es or no)• Seasonal use: (yes or no) Water meter readings, if available(last 2 years usage(gpd)):D2 `�$ �- Sump pump(yes or no): 0 y ,, Last date of occupancy: C� av//(.00 COMMERCIAL/INDUSTRIALj/X-C�- Type of establishment:.. Design flow(based on 310 CMR.15.203): gpd Basis of design flow(seats/persons/sgft,etc.): . . Grease trap present(yes or no): Industrial waste holding tank present(yes or no):_ Non-sanitary waste discharged to the Title 5 system(yes or no):_ Water meter readings, if available: Last date of occupancy/use: OTHER.(describe): GENERAL INFORMATION Pumping RecordsPj ') "o Sourceof information:, CN Was system pumped as part ofthe" spection(yesCir n ): If yes,volume pumped: gallons--How was quantity pumped determined? Reason for.pumping: TYP OF SYSTEM Aeeptic 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'(des crib e): App oximate age of all components,date installed(if known)and source of information: Oyu A Z�p R4QZZ Were sewage odors-detected when arriving.at the site(yes'or ri) 6 Page 7 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: Owner. Date of Inspection: d.A3 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: Material of construction: y/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:��•S }(�p` ,1C St ' Sludge depth: Distance from top of sludge to bottom of outlet tee or.baffle: Scum thickness: Distance from top of scum to top of outlet tee or baffle: !� Distance from bottom of scum tobotto f outlet tee..or baffle'_L How were.dimensions determined: , a 4. al�,��)r Comments(on pumping recommend tions,Inlet and outlet tee or baffle condition,structural integrity, liquid levels related to outlet invert,e i ence of leakao ,etc.): � U `f a GREASE TRAP: locate on site plan) Depth below grade:_ Material of construction:_concrete_metal_fiberglass_polyethylene_other (explain): Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping: Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): 7 Page 8-of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: Owne' Date of Ii►spection �Q1�, � C� 3 TIGHT or HOLDING TANK% (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: y if present must be o ened locate on siteplan) Depth of liquid level above outlet invert:' Comments(note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of age into or out of box, etc. PUMP CHAMBER: locate on site plan) Pumps in working order(yes or no): Alarms in working order(yes or no):_Z. omments(note condition of pump chamber,condition of pumps and appurtenances,etc.): ` 8 Page 9 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION. FORM PART C SYSTEM INFORMATION(continued). Property Address: I Owne Ijwff' Date of Inspection: - f SOIL ABSORPTION SYSTEM (SAS): (locate on site plan,excavation not required) If SAS not located explain why: Type leaching,pits,number: leaching chambers, number: -----Ieaching galleries,number: ✓ leaching trenches, number, length: a 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. CESSPOOLS: _A Ncesspool 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 (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 11 OFFICIAL INSPECTION FORM=NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM .PART C SYSTEM INFORMATION(continued) Property Address:. Owne Date of Inspection: 21� 1)00 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. r %Q - �" o 5, 10 Page 11 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM.INFORMATION(continued) Property Address: aAAII Owner _ _ Date of nspeRn �dQ 2j SITE EXAM. Slope Surface water Check cellar. Shallow wells Estimated depth to ground water 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) _74Accessed USGS database=explain: You must describe how you established the high ground water elevation,,.,... l 11 Permit Number: Date: Completed by: HIGH GROUND-WATER LEVEL COMPUTATION Site Location: i�y �oa ��,� Lot No. :Owner: - Address: Contractor: Or Address: ,�rt!S Notes.: ' STEP 1 Measure depth to water•table to nearest 1/10 ft. ................ ..............................................................., .Date J month/day/year STEP 2 Using Water-Level Range Zone and_lndex WelI•Map locate site a.hd determine: I OA Appropriate index well................................'41v.W.. ' _J [� Water-level range zone ..............................................:........ I STEP 3 Using monthly report."Current Water Resources Conditions" determine current depth.to I . w.a.t>r level for index well ..................... D ®7 ' a3rzl month/year STEP 4 Using Table of.Water-level Adjustments .or index well (STEP 2A), cun:ent depth to water level for index.well (STEP 3), 'and water-level zone (STEP 2B) determine water-level adjustment-...................................................... ,ply ' ...................................... STEP 5 . Est.imate depth to hi.gh'water by subtracting the water- .'level adjustment (STEP 4) from'measured'de'pth to water level at site (STEP 1) .:.................'.................:......•.:....: 7+ ........................................................... Figure 13.--Reproducible computation jcrm. i fF L T # � ./ J TOWN OF BARNSTABLE LOCATION �vz SEWAGE # 9,3— 6;l7 VILLAGE ASSESSOR'S MAP & LOT�i-;x-O®V INSTALLER'S NAME & PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY:(type)S-ln� GT7Z�'y��' (size) NO. OF BEDROOMS -�5-- PRIVATE WELL OR BLIC WATER ' BUILDER OR WNE DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No J ram-' � No..ltd?-.��. Fica...... �... . APPROVED THE COMMONWEALTH OF MASSACHUSETTS Barnstable Cons®rvati"DePanmMBOA R® OF HEALTH l'kPjoVq?TOWN OF BARNSTABLE Do $ Applirativiltour Uijplitial Wlark,6 Cna mitrnrthin Permit Application is hereby made for a Permit to Construct ( ) or Repair an Individual Sewage Disposal System at: ...... -�� 1nJ11e.0 t &;1= ............. r ------------...............................--.......... i.o -Address or o. I. ........ i`LC ................ .. . ............... ..._._. ................ ...................( . ....-•-•__.... .__.... ........................................ O cnc Addre Installer Address Q Type of Building Size Lot............................Sq. feet UDwelling— No. of Bedrooms.............. -------------_-----Expansion Attic ( ) Garbage Grinder ( ) p� Other—Type of Building ............................ No. of persons---------------------------- Showers ( ) — Cafeteria ( ) a' Other fixtures ________________ ______________ _ _ W Design Flow.............._'5``...............gallons per person per day. Total daily flow........... ......................gallons. WSeptic Tank—Liquid capacityl. galIons Length________________ Width....------------ Diameter................ Depth................ x Disposal Trench—No. ........../...... Width_._.__...._....... Total Length...KS.��........ 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........................................ Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water......................... Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ A+' ----------------------------------•-•------------•--•-----•••---•.................................•-••--..............................----------.--•-- ODescription of Soil........................................................................................................................................................................ W V .....----•.....--•---....---•----------•---••--------•-•--------•--------•--•------•----••--••••--------------------••-------------------•--•-----•------•--•------------•••--•-.........._------....... W x ----••-•-----------------•-•---------------------------------------------..............---.-......------------... ---------....-------•---------------------- ........................ Na re of Repairs or Alterations—Answer when applicable__l_�r�__._-.......................S ...._----��'�!� ��s U P PP .4-.......... 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 Si ned -... . .. . .... - - system in operation until a Certificate ofgm Coplian as e `-ed by board health.... -... . ..��/./� Q�—�... Date Application Approved By .............. ....10 _ ....ill...-. Dam Application Disapproved for the following reasons: . ... ........................ .. ........ .. .. . . .. ................................... ....... ................................................................... . ................................................... ....................................... . . .. ........................................ Da Permit No. ..............F t- ............. Issued ..........---.......... te Daze THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE No.... FEE ....... ..... Uiopoal Workv Taantrudiaan raermi# Permission is hereby granted... �------------------ �'rr��........•---....------------ ..................L� �-?------.. to Construct ( ) or Repair ( ) an Individual Sewage Disposal System l '��--�)G � . t Vat No.----•-------------------------------------------:� --------- -- ---._ C r••� - 1�./l C 4..t........ Street (� as shown on the application for Disposal Works Construction Permit No._../.._�_-.�/_,�.7__ Dated........................................... ................................ ��--.......------.....--------•--•--•-•-•............•--.-•--- DATE. II - ...............................••• �\' Board of Health [ t ` FORM 36508 HOBBS h WARREN.INC..PUBLISHERS f--..� .�-r�.,-.-t.�-�.�.-rf�..:_.r.�...�-. .-,_...�.e--"'--�---L'�-----�-_-•---v,r�...�...._..a,.,.- '�==�r�-_.._..r--�-•-�--�,�--•••..�..--,�::a-ti..-- -:�"' ��L--�-.�e..-:'ram,.-�' THE COMMONWEALTH OF MASSACHUSETTS J� BOARD OF HEALTH IANo,g3TOWN OF BARNSTABLE Apphratiou for Uijpimal Work,i Towitrnrtiun "rrmtt Application is hereby made for a Permit to Construct ( ) or Repair an Individual Sewage Disposal System at: - - ..........................................P4.............................................. Location-Address or Lot No. a a GN� I:' — G �- �= __ am_ � - --- O n Add re UL67/ � lG�ci --rJ ( �wA�Lt.Q y D ✓✓J, t C 5 Installer Address Type of Building Size Lot............................Sq. feet ..� Dwelling—No. of Bedrooms...............ram_-----...._.----_--.-...Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons---------------------------- Showers ( ) — Cafeteria ( ) dOther fixtures ..................•------------•-----..._._..-•------.....-•---..........-•----------•--...............-•-•----------•-----•--•--•---................. WDesign Flow..............; .. ....____.____..gallons per person per day. Total daily flow...-.------ ................gallons. WSeptic Tank—Liquid capacity,/100.gallons Length---------------- Width---------------- Diameter................ Depth................ x Disposal Trench— No. ----------;....... Width......7-_........ Total Length. 75_0�57Total leaching area....................sq. ft. Seepage Pit No--------------------- Diameter._._...--_-------- Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water........................ G4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a ....................................... ..................................................................................................................... 0 Description of Soil........................................................................................................................................................................ --••- -----•-------------- •------••-•-•-------- ------------------------------....---•--•---•••-•------------•-----------------------•------------------------..... ----••••--•----•......•. U Nature of Repairs or Alterations—Answer when applicable.-.L �...-_-4 /-tTZ6- ................................. ....... T ?`� Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance''has een 'ss(�:/ued by the board �o-f-,�health. Signed .....f.1.• .Y....... ...................................✓ .. ApplicationApproved By .............. 4-. ....' .. ey. ................................... ..................--. .. .... Dare Application Disapproved for the following reasons: . ........................ .............................. --- ....................................--`. . . ................................................................................ .. .......................... ... ................................................................. ........... ........................................ Dare PermitNo. -------------- -`...1..7 ..... .............. Issued ............................................. ................... Dare THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Clertift ate of C�omplinure THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired -U L.,.&71?... -6.0 Al 5'Tllit�C7�/uvJ by ............................................................ � ----------. ----- ............. ....................... ..................................................... at .......... 5.. - .......C' t.ti1Dc��....-...J✓c sLl.l� �-- ......4 ..... - .�...�� .ULL�. ...;:...:. has been installed in accordance with the provisions of TITLE 5 of Th State Environmental Code as described in the application for Disposal Works Construction Permit No. ......�......./r_v:...�j'��'... dated ......_._.................................... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE...................._......-.....±....i......_......... - :........... Inspector ............................�........,~ ................................................ �.---------------- -- - --- REVISIONS: - - - - - - - i - - - ' - - - - - . _ - • - - - - PROPOSED PLANTING LEGEND NO. DATE DESC. S 1 7/29/03 EDIT TO 2ND STORY I WATER LINE 3966 - = PROPOSED TREE WEOUAQUET EXPANSION \ WITH SPECIES LABEL LAKE BA = Black alder (Ilex verticillata) N \j 2 8/13/03 CON COM REQUESTS BT = Black tupelo (Nyssa sylvatica) 2 �*00 3 8/22/03 ADDED VARIANCES FOR HB = Highbush blueberry (Vaccinium corymbosom) PPK \ SEPTIC C = Clethra (Clethra alnifolia) .32 ANNABE�LE LOCUS A KE-2, IB = Inkberry (Ilex glabra) _T / H S = Shadbush ( Amelanchier canadensis) 0 AKE vA a vE L vET r v aEQvAQ —z� �wo LEGEND MARSHES ROA = EXISTING BUILDING NNEYS LA = SECOND STORY LOCUS: NOT TO SCALE N/F RM = RED MAPLE CONSTRUCTION NOTES: DAVID G. & ALLISON P. GRAF N/F DAVID G. & ALLISON P. GRAF A . ASSESORS MAP 212 ASSESORS MAP 212 P.P. = PITCH PINE 1. FULLY WATER PROOF SIDE OF L►A,� PARCEL 4 FOUNDATION FACING SEPTIC SYSTEM. '3 4(4 PARCEL 4 10,426±S.F. WO = WHITE OAK �`� 10,426±S.F. - ^r ` " r _#1 WI #1- 2. WATER SERV;C� v o� LC:;A T E i AS `�• P = TREE TO BE PRUNED SHOWN. r�� ;PI" N�� ' EDGE OF WATER N, s^"` 06/16/03 ~ _ ._. �- ` = TREE TO BE REMOVED T}11CKE PLAES NKS BE TIED ROUND TRUNK xAND 2.- Uj _._ AH ;• WF#1- .. � PLYWOOD OR EQUIV, LENT PLAC 0 TO 1 _ _ C,1-- 1F#1- 4 ,#;1-.'�'• r -_) = TREE WELL OF THE GROUND 10 FROM THE TRUNK. WF 1-4� WF -3 WF# E 1 WF#1-1 ;- BI # WF#1-1 �-'"j2 _.. yy 0 B214 I WF#1 _ (./ B3 -. _.. ..- `'"HE � -,:�'y °�' WF#1 y_ - -- ' � ' SEWER MANHOLE 4. ONLY TREES MARKED ON THIS L BECK _ N E3LAGK. - SHALL BE REMOVED.K_ J EDt,E � cr BLACK v'YI-�1 N P OFESSIONAL ENGINEER DATE o gOAK = WATER VALVE WI #1 1 ' DAK PROPOSED 'fJ ytrn .A w / fig ' ' Wv 5. SEPTIC SYSTEM IS TO BE PROTECTED Wi #i._.8 _ 9 PLANTING AREA 'o Q? M oD BY MATTING FROM CONSTRUCTION DAMAG r _ s H B'• ' XI 5- SHED - RM -- -- = HERBACEOUS LAYER 18 (TO R DEAD o _ 18 RM �. - r TO NATURALIZED DEMOLISHED)--- lND ' (TYP) �" "" " �-' ^f- D W (TO BE M , t"EX35T. f ~ - W •�•� .gT PROPOSED _PROPOSED ��4......_ (3) „ RM DEMOLISHED ;' _.(3)-18 RM -SHED UNDER " " 18 - .. } . _,f j /�: RUSHED � �� � '� p G "�H@ DECK TO BE _�3~ - E-�-� Q _ 3' p BE DEM ,,-' RE-BUILT _.RE-BUILT BUILOT - • ~ ... (T . ,�r� - vt"J _ Z -_...12" RM _ .._ -34-- ,µ _ �`;,'` I fir' ,, / 1 �"- > _..._ '" ... - ~ 1 �„ P P T I T L E V -"16 P P R R r 11 ' OAK 1 fi" P 12" P.P i / ,16 / 35--- �.._. 1 - 35--� _._. �, ` i` ,` 11" OAh _ PROPOSED VARIANCES FOR EXISTING SEPTIC SYSTEM t - � __ SITE PLAN HAYBAL 31OCMR 15.211 REQUIRED SETBACK TO PL PROVIDED LINE (TYP) S.A.S. 10' 3' / EXIS1 PEBOSL f PROPOSED EXIST. PORCH SEPTIC TANK 10' 3' �, f / / PORCH PROPOSED REBUILT RE-BUILT PULP CHAMBER 10' 0, AT ,� (TO BE RYWELL TYP FIRST f TO BE E t �/ 'if DEMOLITION) - _ ...._ .._ �=LOCP #SZ 37- � ��, PROPOSED 6'x10' D Box 10' o r EXISTING �`` E EXPANSION SECOND STORY STORY EXIST. TREE TO i D ONE ti T ' PROPOSED 2'x10' 31OCMR 15.211 REQUIRED SETBACK TO FOUNDATION PROVIDED LAKEWOOD DRIVE - �• BE REMOVED _ =� WOOD r'` r HOUSE # 56 12 P.P, R J ' ; o EXPANSION FIRST STORY 4' 12=� 3 l"� �, OUSE #52 _ r (TYP _ � ;x ��x SEPTIC TANK 10' „ 7 _ H 57 _ 10 \P.P3 1O �' TOF-� HER) `- Z 31ocMR 15.211 REQUIRED SETBACK TO WETLANDS PROVIDED 1N 1�„ P F' - � (TO BE DEMOLIS ��,r�` `' P xBT �• r. �,,• '�. ��' �.0 WO 50 WE PROPOSED 'X t :�. � g�FFERILAND S.A.S. 100;* 75' """` dOW-- N F SUMP PUMP PRO,OSAp X C P SEPTIC TANK SUP'LEMENODTARY 50 - CENTERVILLE N/F EXISTING PING / PROPOSED SULKHE " O EXISTING_ BARNS TABLE . c�r� BARRY & KAREN / BARRY & KAREN SECOND STORYpR( ' A ` SEPTIC TANk REGULATIONS PA�'T ��!!!, SEcrON 1 lV 1JJtll.flUiJC 1 1 S 19.3 3.7' _ SEPTIC TANK OSHRY r >'Si. 19.5' r ;. �, if OSHRY / �„ P�, T � � BARNSTABLE COUNTY) 24" r .F + g A SSESORS MAP 212 Y 50 WETLAND '-" � � � � _ ASSESORS MAP 212 �,. EXISTING / EXIST. ; EXISTING 310CMR 15.214 REQUIRED PROVIDED EXIST, PUMP PARCEL 3 _.- ' BUFFER PUMP PARCEL 3 _ ( y --r- 1 WATER � a- NITROGEN LOADING 110 GPD/10,000 S.F. 330 GPD/10,426 S.F. _www �"r W?�TE. p - - ; ' F11 - R Q�E® E T08 I -�-E - `�, _ . ., .. r `' - _ - _,• ' (WIN 310CMR 15.242 REQUIRED PROVIDED _ ''_' -' .� 8 TWIN O RED MAPLE S.A.S SIZING 444 S.F. O 0.74 GPD= -- -- -' REC) MAPLE .h CB/DH - `�T, KVJA`� --^ h�CB/DH - FNf3 -�4zlcl�• �'L` K` � PROPOSED ,, ,_ _.. (�. _. .,5k'"' � `�9 ,v_ - 329 GPD G330 GPD FND 18>,WO METER _ 3. - - ~. '. WATER M E R � ,>c ;x.�'� .� --� `� �7 g-- � _: _ _ �__ o' RETAININ� � ~_ �1-',` _W P1_I _ _ �' JULY 25, 2003 _RETAIN �-r- �,r ~- ,,.�_ ---` .� 2 �cr_ " _.... .,_WALL -'^I-'^ '� -1` � W P .. WALL .. l � �1 P.P. EXISTING I < 1 D-BOX � �� 1 TREE-WELL-D NOTE: EXISTING SEPTIC SYSTEM LOCATION IS SHOWN FROM vi 4�: ..--- __ �� 4 THE TOWN OF BARNSTABLE BOH TIE CARD z4----' „ - ._.---" '�" �. 4 - - . . �..�' 18 P.P. �---- --- . iF_,� 18 P.P. ~- -_ _ - , N/F ,� ---- �' N/F LOCUS c U�z __--~~ \5 1NG i r JUDITH L. HUSKINS EX\S��A�OR \ JUDITH L/HUSKINS L C U J INFORMATION E7C� �TOp, ~ ASSESORS MAP 212 l 11°ti �L .--- _.-41 -- -� � ASSESORS MAP 212 1 cn1 �N<"1 39, y4t^ _.� ASS _ ,i- - .- ----_ _ ~ �` - PARCEL 5 CURRENT OWNER: DAVID G. & ALLISON P. GRAF _ - *�-p'p� I_rQ ` -- r-�� -"i' ,3 PARCEL 5 -41-" `' '' P.Pgj -`}ty �/r TITLE REFERENCE: BOOK 1409, PAGE 863 - -4E- -' - -- �- tp ,, .. PLAN REFERENCE: BOOK 204, PAGE 23 '�-P-P-. t8 P-P -^� - - r B/ / ASSESSORS MAP. 212 FND ''.••\.. - - _.._4;� _ - _ __ . FND .• �' .• `� PARCEL: 4 _ _._.43- _.._ _ j . FKZNAIL - w j PK�•NAIL J - R=30.0 - -' - R=30.Op / �� -_ . _ 0, FND\ �' ZONING DISTRICT: RD-1 - 4 .61 N49 'N �- - ._. -4 3- -- 12. FND _ t q ._ .._. 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EXIST, WATER LOCATION t i TO BE CONNECTED TOx J COMMUNITY PANEL J EXISTING WATER LINE / ZONE DISTRICT: ?5000� ^�'d ^A'T^ VA i BENCH MARK: # ���� o i y a5 BENCH VARK: ) � � .� V Lw HYDRANT TAG BOLT � OVERLAY DISTRICT: ZONE II HYDRANT� TAG BOLT : : : D V R , D R VE E W 0 0 ELEV. 44.72 (NGVD) O DELEV. 44`72 (NGVD) i L A I BSC T m LAKEW _ t` (30' WIDE PRIVATE) V 1 (30• WIDE PRIVATE) # FINISH GRADETW/ 3'-0" DIA. AND COVER HEAVY 657 Main Street, Unit 6 I DUTY C.I. FRAME R.R. SPK t J R.R. SPK I SEWER BRICK & FND I j �` FND ,� ) MORTAR-� 3" LAYER OF W. Yarmouth Massachusetts // HYD ; 3'-0" DIA. /\\ 02673 508 778 8919 © 2003 The BSC Group, Inc. R.R. SPK I o 0 j SCALE: 1" = 10' R.R. SPK ,` .`� r ' / FND 0 1.25 2.5 5Rs 3'-0' \ 2'-0 2'-0" ! FND 0 0 0 0 \' 0 5 10 20 CB / PROD. MGR.: N. W. HAYES -. 0 3/4 - 1 1/4' % 12" MIN. / FIELD: D. GAZZOLO / R. FITZPATRICK DIA. WASHED � CALC./DESIGN: P. RACIST STONE l / DRAWN: N. GIRARD PLAN VIEW CROSS-SECTION CHECK: N. W. 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