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HomeMy WebLinkAbout0010 LUMBERT MILL ROAD - Health 'L0 Lumbert Mill Road Centerville P A = 168 097 i + c 0 0)xrford, NO. 1521/3 ORA 10% I TOWN OF BARNSTABLE LOCATION 10 Lom-Scri M i ►1 RcA— SEWAGE# 20E9 3L3 VILLAGE ecn4cr u,11 c_ ASSESSOR'S MAP&PARCEL INSTALLER'S NAME&PHONE NO. - DL SEPTIC TANK CAPACITY b O v Vt A",ti LEACHING FACILITY:(type) S00 1 t_ c Z (size) 13 x Z S A 2 NO.OF BEDROOMS 3 OWNER0_V-,,raJc1777 PERMIT DATE: 9 -2 q- 19 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 Al - I2'L " d31� 35 � 410 A2. 1$ A3' 2 Ay, -31, 4„ A Ci Bq- qZ6 O 3 �-� No. v v Fee IOV THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes ftplitation for Misposal *pstrm Construction VPrmit Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. �0 Lu in bet M.I I KoAd Owner's Name,Address,and Tel.No. E dW o►e d C%andlvr Assessor's Map/Parcel «D S �q1 C tnt of v%Ike, 10 Lurnbtc+ A%tt Rd Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No. Fj 0,h41r1NS a � % tilLco-v . 4on Sog, yl1.0(os3 11q•g6iK- HOP Type of Building: .Dwelling No.of Bedrooms 3 Lot Size 101000 sq.ft"/-Garbage Grinder 44o) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 1)30 gpd Design flow provided 34$ gpd Plan Date C1 I Z 0 1 a1 Number of sheets 2. Revision Date NA Title Size of Septic Tank 1000 (1L1i-A+np) Type of S.A.S.00 SOO gaNkon 11 osokirm fL 6&w%kcs Description of Soil ,X& Nature of Repairs or Alterations(Answer when applicable) ACi d ht"i SAS +R egia{i na ST. 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 of He Si Date Z3 1Ci Application Approved by Date Application Disapproved by Date for the following reasons Permit No. `3 Date Issued �1 9 4,, ;r No. 1,4f .� Fee I ..— ., THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS 01pplitatlon for DisposaY pBteUl Construction Permit Application for a Permit to Construct(! ) Repair( ) Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. 10 Lurnbul K 11 K o c kc( Owner's Name,Address,and Tel.No. E c{.N c,c c� C Hand(e r f Assessor'sMap/Parcel q1 Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No. F 1 c,hQ }y 3 1 cC. 0 S0� �11� OtoS "3 `t ry �oM�nko1 '17`I clay 1166 Type of Building: Dwelling No.of Bedrooms Lot Size 7-6, 0 U O sq.ft+/-Garbage Grinder(j C) �# Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided ')L1 R gpd Plan Date 9 12 0 i 19 Number of sheets "Z_ Revision Date NJ A Title Size of Septic Tank 1000 C'`: �jTrn Type of S.A.S. -L �U p t S Description of Soil Se Q ,n`ra n Nature of Repairs or Alterations(Answer when applicable) A 6 A n Q S Asp„ o -.}, 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 of Hea . Sign e Date Application Approved by Datet q Application Disapproved by Date for the following reasons Permit No. 1 t3 Date Issued --------------------------------------------------------------------------------------------------------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired(� Upgraded( ) Abandoned( )by 3 3 £,x r n k�n4'�an at 10 . 1_U m( v r 1 rei has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No°:.j q-'36 3 dated �)-Lj Installer Z�XA Designer ' _ #bedrooms Approved design flow gpd The issuance of this ermit s all notbe construed as a guarantee that the system w 1 func'ol as designe Date I i Inspector , 1 No: l{11 w ID Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS Disposal 6pstem Construction 7'Nermit Permission is hereby granted to Construct( ) Repaii3llk Upgrade( ) Abandon System located at 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:Constructiop must be completed within three years of the date of this permit. Date f� Approved by Town of Barnstable y*f1HE Tp Regulatory Services Thomas F. Geiler, Director M Y f B*RNS MASSSS.BLE. ' Public Health Division A 039.. Thomas McKean, Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Date: 9.21,- 19 Sewage Permit#2o19 . 3L3 Assessor's Map/Parcel (,� $• 9�1 Installer& Designer Certification Form Designer: �a�e. �'l�ec-�c_t Installer: �8 0 g EX�aVv�� on Address: Ro. t8Ox 31 Address: I4 Tca,_Sc -rd L.tD On •Z 51- 19 24 B EXeauq_Ai o,n, was issued a permit to install a (date) (installer) septic system at la (,u ,NSc,_A m;11 Rck based on a design drawn by (address) .Dave rAU dated 9- 2 o . 19 (designer) X I certify that the septic system referenced above was installed substantially according to the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. Stripout (if required) was inspected and the soils were found satisfactory. I certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateraf relocation of the SAS or any vertical relocation of any component of the septic system) but in accordance with State & Local Reizalations. Plan revision or certified as-built by designer to follow. Stripout (if require ected and the soils were found satisfactory. �y DAVI cy� D. ` FLAHER?YP JR. ( taller's Si ) No.1211 /STE7 � �� s'4NI TART P� (Designers Signature) (Affix Designer's Stamp Here) PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS- BBUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION THANK YOU. q:\office forms\designercertification form.doc s COMMONWEALTH OF MASSACHUSETTS. EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS. DEPARTMENT OF ENVIRONMENTAL PROTECTION , t RECEIVED 1M Sve AUG 2 3 2002 TOWN OF BAHN5 I ABLE TITLES HEALTH DEPT. OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION (fy$ Property Address: Owner's Name'. M� Owner's Address: .0 &9 "l l U PARCEL ' "0 I Date of Inspection: / --^���~ �" _ LOT Name of Inspect r:, please rint) - �"`` Company Name: e Mailing Address: Pro- G V ",4 O� Telephone Number: d9- 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: V Passes Conditionally Passes Needs Further Evaluation by the Local Approving Authority Fa' s Inspector's Signature: Date: , 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 6/15/20.00 page I Page 2 of l l OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property.Address: /L Owner: . Date of Inspection: Ins.pection`Suinmary: 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 descri_bed;in 3,l 0 CMR 15.303 or in 3:10 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 sewage backup or breakout 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 11 OFFICIAL INSPE.CT:ION FORM -NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL.SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: AM Owner: Date of Inspection: �d 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: 3 Page 4 of 11 OFFICIAL.INSPECTION FORM—NOT FOR.VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION'(continued) Property Address: t4 /" Owner:. e Date of Inspection: iC:)0oa D. System Failure Criteria applicable to all systems: You must indicate"yes"or"no"to each of the following for all inspections: Yes No >/ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool Discharge or.pond.ing of effluent to the surface of the ground or surface waters due to an overloaded or. I,/ 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 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. _ Vj 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 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 g Y operator of any large system m considered a .significant threat under.Section E or failed under nder 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 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS" SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: A Owner: Date of Inspection: 0 C 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 vl�-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 IX 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? jz_ 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 l l OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM.INFORMATION Property Address: � !'C�✓ ���`c,' Owner.Qp4j kg�el7zZe-Ae Date.of Inspection: L-20 C7 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): . Number of bedrooms(actual): DESIGN`flow based on 310.CMR 15.203 (for example: 110 gpd x#of bedrooms):. Number of current residents: Does residence.have a garbage grinder(yes or R � Is laundry on a separate sewage system (yes or no)� if yes separate inspection required] Laundry system inspected(yes or no�f�,v- Seasonal use:(yes or no Water meter readings, if available(last 2 years usage(gpd)): Sump pump(yes or no):.," Last date of occupancy: 01 hAZ10' COMMERCIAL/INDUSTRIAL.:-4t6' 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 Records Source of information: V,/i A-A '-'714e 99 Was system pumped as part of the in pection(yes or no - . If yes; volume pumped: gallons--How was quantity pumped determined? Reason-for.pumpina- TYPE F SYSTEM eptic 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): Approximate age of all components, date installed(if known)and source of information: Weresewage odors detected when arriving at the site(yes or no): 6 Page 7of11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS' SUBSURFACE.SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM..INFORMMA�TQION(continued). Property Address:ADRv ' Owner. �Q� Date of Inspection: Qooa BUILDING SEWER(locate on site plan)v — 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:Z(locate on site plan) Depth below grade: Material of construction:_zconcrete_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: 1 11 Distance from top of scum to top of outlet tee or baffle: >/ Distance from bottom of scum to bottom. f outlet tee or baffle: / How were dimensions determinedt, " Qp Comments (on pumping recommendations, frilet and outlet tee or baffle condition,structural integrity, liquid levels s related to outlet invert, evid nce of leakage, tc.): GREASE TRA . cate on site plan) 600 ; 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: A Owner: - Date of Inspection: aMd1,4 �a TIGHT or HOLDING TANK: Ihfftank 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 (ifpresent 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 1 kage into or out of bo), etc. PUMP CHAMBE� (locate on site plan) Pumps in working order(yes or no): Alarms.in working order(yes,or no):. Comments(note condition of pump chamber,condition of pumps and appurtenances, etc.): 8 Page 9 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARYASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM.INFORMATION(continued) Property Address: VW Owner. Date of Inspection: SOIL ABSORPTION SYSTEM (SAS): �ocate on site plan,excavation not required) If SAS not located explain why: neachin'a pits,number: Ieaching chambers,number: leaching 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, �a ,l�` e 7 L� ^ %/ CESSPOOLS-�cesspool must be pumped as part of inspection)(locate on site plan) Number and configuration: Depth—top of liquid to inlet invert: Depth of solids layer: Depth of scum layer: Dimensions of ce.ssp.00l: 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.): PRIVL -(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 l0 of l l OFFICIAL INSPECTION FORM NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEMJNSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: Owne Date of Inspection:ion. 0a, 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. 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: 4 ^jW Roa Owner: r Date of Inspection:- 02 SITE EXAM Slope Surface water Check cellar Shallow wells Q 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: hecked-with.local excavators, installers-(attach documentation) Accessed USGS database-explain: You must describe how you established the high ground water elevation: Il - 1 Permit Number: Date: Completed by:. ,:::5;" HI'Gi i GRO•UND-WA,T ER LEVcL COMPUTATION Site Location: (/ ��� � , l /' i Lot N`o.. Owner: �/�/� �' �/�'�� _Address:. O/ 7— o Contrac_or:_ © �ML Address: _ ✓�'�2 I&e)( y r"�'Y �/ Notes:. ✓�/�J" !'� ',/� ��� 1 • Measure depth;-Lo•water table. l to nearest.1./1U."... Date month/day/year I ST,EF 2 Using.Water-Level.Range Zone and lhde.x We11::Ka.p:locate site,a n.d•dete rmi'n e 0"A:ppropriate.index well..:............. ` . �J �.Water4evel ranee z.one_._.........:_....._........_.._... STEP;:3:: Using-mo nth ly.repor.t,"Curren"i - �- Water Resources Conditions" _ determine current-depth to water. I�ev_•el for-index well ............................ month/year ST••EP. 4. Using:Tab!e.o.f-Water-level Adjustments for index'weli (STEP 2,A),;curr-ent depth • to water'level for.index well (STEP 3)., and.water-level zone (STEP•2B) I determine•water-level •adjustment ................................;..:.....................,..................:...... ....-.... !r' ST P 5 -stimate•depth to:high water by SUbSracilhQ th.e water-: level adjustman.t.(Sl EP 4) from measured=.depth to.water level"at sit—(S T�EP'1} ._.........__..................... ..... ...... l3 i`;Ufc 13:--t1ct7id.c'IIvMU1 av;,iC,i.Ti: zr / (l9ZOO f©DDj®� d i I i LOCATION StWAGE PERMIT NO. -VILLAGE INSTA LLER'S NAME j ADDRESS ISUILDER OR OWNER DATE PERMIT ISSUED _ z2_ ��- 0 DATE COMPLIANCE ISSUED 3_ �� Y i31 �+� offkl- �; 3ak THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH .................................O F...-...-.-...................-..-......-- Appliration for Disposal Works Tons rnr#inn Prrutit Application is hereby made for a Permit to Construct (P11 or Repair ( ) an Individual Sewage Disposal System at: ..... ocahon- dr ss �J` or.Lot o. 9 i..G./ ------.i9l, 1— '........................•----. ---------------- i?s12 .��.iJ<< ...._ iC�/ d1..................... Owner �Addres .......................................... • .......... Installer Address dType of Building Size Lot.--a?'._t.................S feet U Dwelling—No. of Bedrooms.....�_____________________ _____Expansion Attic ( ) Garbage Grinder ( ) _ daW Other—T YPe of Building ------•--------------------- No. of ersons.......-_-------------...-. Showers -Cafeteria Otherfixtures ---------- --._ ..--•----• ---•---- .••--------..--•---- ---------------� (-----)-- Design Flow......1 'J .........................gPePnPer dayl dailyflow �©-��-�V----------- Septic Tank—Liquid*ca acit -�..-Ggallons Length Width . Diameter. _-._.__-_ De th--__ - W 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 ( ) aPercolation Test Results Performed by............................................................ Date........................................ Test Pit No. 1----------------minutes per inch Depth of Test Pit.................... Depth to ground water........................ GXq Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ ._...-----••--------------•------•----------------------------------------•-•---•----•--•--•---..........................................................O Description of Soil-.---------- e.v_k�...... -'-................................................ ................................... U -----•-----------------•--•--•-----•--•...-----•--..........---•---•-------._..._...------•--•--•-------•-•-------------....--•----•----••-------------- =----•-- W ----------------------------------------------- --------------------------------------------••----••--------••--------------------•---------..................................................... UNature of Repairs or Alterations—Answer when applicable............................................................................................... -----•------------••--•--------------•-•---------------------------•-••-•------------._..__...-----•--•-•-------•--•..-_.-.-.......-------•---..-..----------•----------•--•----------•--------.....---• Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with. the provisions of TITLE, 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issu�bth a�f --Si ned ................................ Da e Application Approved T (D........................................................ ...... Date Application Disapproved for the following reasons---------------------------------------------------------------------........................................ .................•--••---•---••••.....__...--•------------•-•-•----------....-••-------....._•------••--•---•-----.---....------------------------------------------------- ............................ Date PermitNo......................................................... Issued....................................................... Date fl THE COMM NWEALTH OF MASS BOARD OF HEALTH ..........................................OF..................................................................................... (Irr#ifirati of Tomplianrr THIS IS TO C 4TIFY, That the Individual Sewage Disposal System constructed ( or Repaired ( ) /T� `^ at �F-f_-�1Z Installg�J� A has been installed in accordance with the provisions of TITLE._/5 of The State Sanitary Code as described_in the application for Disposal Works Construction Permit No--------- __ .::.'.. 'L dated------- ------------------------------------- THE ISSUANCE OF,THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WI11 LL FUNCTION 'SATISFACTORY. (� DATE '° 5 .... Inspector............ .... N ` THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH cJ No....-:.................... FEE Disposal rk n,�tr uan rrntit Permission is hereby granted .............. '------•-----•---...-'............................................. to Construct or kRepair ( ) an- Sstern Individual Sewage Dispoyl atNo. #! ' a!�.t . &!4121------//V.�=-------------------------------•-•-----------------------.-.----------------------------------- .._. Street � �. `+"- as shown on the application for Disposal Works Construction Perrot...Ikio---=•__w.............. Dated......................................... ..., a.�..... tY DATE------ y a ?��Z-.'•..................•- •-•------- Board of Health FORM 1255AP. LKIN, INC., BOSTON No.................... THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH .................._... . .......--....O F............ , ppliratiou for Dhiposal Works Cnonstrurfivit Prrutit Application is hereby made for a Permit to Construct (✓) or Repair ( ) an Individual Sewage Disposal ................ .. ..._.......... - -�-•--......... ..._•-----------•-- ------•-•-••----------•-------•------------ --_. ...._...._•-------...........-- ocation- d s or Lot o. 1 Owner Addle Installer Address U r� � r.Type of Building -Size Lot________�:.................Sq. feet Dwelling—No. of Bedrooms___..,. .................................Expansion Attic ( ) Garbage Grinder ( ) py Other.=:Type of'Buildii g ............................ No. of persons......_ -.................. Showers Cafeteria ( ) <" Other fixtures ..............................:.. W Design F1'ow...: .......................gallons per person per day. Total daily flow------_•p -_---__-__-f-----__-._-•gallons. WSeptic Tank—Liquid*capacity/4.66 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 ( ) aPercolation Test Results Performed by.......................................................................... Date......................................... Test Pit No.; l ..............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........................ a+ ......................................................................... O Description of Soil........... �a - '�?W ---•------------------------------------------•------------------•---------------------•-------....-------------•----------•--------------------------------------------------------------....---...... U Nature of Repairs or Alterations—Answer when applicable............................................................................................... • •-------------••--••-••••-•-•-------------------•----•-----•----••--------•-•-••... ................................ Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issue t oa of t Wined . ;.. ch Application Approved Bey ~` ' �Lr.�r �'.... �� 1�Date " •------ • --Date Application Disapproved for the following reasons-------------------------------------------------------------•----•---------•--•-------••--•----............... .......-•-•.................................•---.....---------•-•-----------•-------....-•----...------...--------------..._...-------------=-----------------------------------••.•-----•-•---•-•--•---- Date PermitNo......................................................... Issued_....................................................... Date p,ES/G/V Z ,W 7`,4 �l S E F4,1V/L Y �-' 3 BE0.2UOrt? A,10 GL1,2B,4 GE OA/LY -=-L_OtV - //D X.3 = 730 G.P.O. 140 �J !3o TTorL1 A.P�•.•�l = So S..0 �., G.��� _.. �„� �.,, x TOT,4L_ IJ"4/LY�LOW= .3_30G•.�0. ,` ' ;C we_, � OES/G�/ �.E'.2C�L4T/Dis/.24�.'/"/.c/2•y/rt� U•G�LE.� '�seG•J i��,�s� H OF .i / PETER o SULL►VAN A. v No. 297,3 � R4a.24J-i8 sSSIONA J.e�. � �Arb ��� 35/S�Z- G-LG -8f 7 _ FG• _ moo•-7 �• �, .r e ZOAAf /voo //VV GAL. Z 6AG. /iy{/• BOX "-• � ,. .• ,fTGNE •� 9�% 99/ G'E.2TiF/EO �.�-07'" P!-4�✓ ff A T.E /Z-Z� � /Z ova u%�r AY.4AV .26�EeE.c/c� I 7 97 ,4MO.SETl�/�G` .eE4LJ/�E�I�iVTS o� Th'� ,2�Gisr�ecl Ga�vo.SU.2riEya,P� L oc.4r�.o w/T///y 7',�/.E �L caoPLQ�iti GAl Afit/iiY.ST,e— I�.E U.SEp To E.ST�dG/Sy LaT- G/N,�� LOCATION ar- U rr. M'i I� !eta en�LS !'�i LAf 1`- 1 -1-5 �'-.. .-�f� N VILLAGE \.,QIr�-�'.�r��i1��. r DATE X S�Z3�g`1 F E E/Y Lw :QO APPLICANTLm11f_ennA+± 11 (Non-refundable ADDRESS pQ. 6nrx 1 q Y1TPr�1 �. TELEPHONE NO. TELEPHONE NO ,ENGINEER +PJr t n - DATE SCHEDULED—rulS. ..,� Q "�I 1��,\ (Applicant ' s signature SOIL -LOG //// / SUB-DIVISION NAME DATE G�•a - TIME EXPANSION AREA: YES C,-*140 P� ENGINEER 'h TQWN WATER-f::::�fRIVATE WELL BOARD OF HEALTH EXCAVATOR SKETCH: (Street name , etc. ,dimensions of lot, exact location of test holes and ',*: percolation tests , locate wetlands in proximity to test holes ) ,� NOTES : lilt C Q�. PERCOLATION RATE : TEST HOLE N0: ELEVATION : TEST HOLE NO: ELEVATION: 2 /c- 2 RL)5A 3 4 456 6 5 99 10b 10 11 11 12 12 13 N� r 13 14 wo, 14 15 15 16 16 SUITABLE FOR SUB-SURFACE SEWAGE ; LEACHING FIELD LE CH G PITS LEACHING TRENCHES_ UNSUITABLE FOR SUBSURFACE SEWAGE . REASONS :-- NOTE : ENGINEERING PLANS MUST SHOW NUMBER ASSIGNED ON PERC TEST APPLICATION ORIGINAL: COMPLETED N ENT P AN URNED TO BOARD OF HEALTH ,y .COPY: RETAINED BY APPLICANT , TOP OF FOUNDATION COJERS'T0 BE WATERTIGHT AND SEPTIC SYSTEM PROFILE BROUGHT TO WITHIN 6 OF FINAL GRADE (not to Scale) Flaherty Environmental Services EL. 58.0' EL. 56.0' INSP. PORT W I 3" OF GRADE CLEAN SAND P.O. Box 331 2"ofJ" to 4" DOUBLE WASHED EL. 56.0' Harwich' MA 02645 4" PEASTONCOR GEOTEXTILE CAST IRON or EQUIVALENT FILTER FABRIC 774.994. 1166 MIN. PITCH 1/4" PER FOOT 4" SCHEDULE 40 PVC PIPE 4"SCHEDULE 40 PVC PIPE FLOW LINE VENT IF REQUIRED (first 216 be Ievel) ;•••. . 1 .. .. .... E . :•••''` L. XIST. -i . . o o•o 0 —�► o 0 0 0 0 0 0 0 R. • ' EL EXIST EL.53.6' o°0°000°0° o o .'®LJ I ® 00ooc �i�i 0 0 0 0 0 0 0 ORE..o c 0 0 0 0 0 0 o O o0 0 0' EL.53,03' o 0 0 0 0 0 C� �O® 0 0 D o c 0 0 0 0 0 0 0 0 0 0 0 , EL.53.2' o o°o°o°0°0°0°0 O. �' o 0 0 o a 2.0 r GAS BAFFLE EL.53.0' Oo0o0o0000 000000 �Q Q��] ® °0°0°0°0°— (H-20D BOXJ o00000000° 000000 a4 d •• :00000000C EL. 51.0' '•'� 6"CRUSHED STONE OR STALL INLET TEE SOIL ABSORPTION SYSTEM ?'q: ..,..:••, ': 1"ABOVE OUTLET INVERT 2 500 GALLON H-20 CHAMBERS ••• MECHANICALLY COMPACTED ' 1000 GALLON SEPTIC TANK f 60' (DATUM: ASSUMED) EXIST1Nc 3„ 1„ WITH 4'STONE AROUND IN A to 1� DOUBLE WASHED STONE 12.83'X 25'X 2'CONFIGURATION BOTTOM OF TEST HOLE EL. 45.0' EL. 45.0' USGS ADJUSTMENT: N/A LOCATIONMAP _GROUNDWATER ELEV: N/A NO TH t cP �0 ? LOCUS J DECK Bumps River Rd. C. LOT 5 EXISTING 20,000 SFt GARAGE (SLAB) 3 BR NTS MAP 168 LOT 97 BENCHMARK: DWELLING TOP OF FNDN fA OFAEq_r„ PORCH EL. 58.0' c 56 F H TY J N DRIVEWAY 26,2 N 2 56 I O 54 18TE�� S2 Ar N17AR� �lr J L TH-1 el Y '� / ' x: �•15 DATE.•912012019 REVISED: 0 \ J / TH-2 r4 i LEGEND / NO SZTE AND SEWAGE PLAN r WATER LINE R0 FOR GAS LINE 54 B & B EXCAVATION, INC./ `34.4�� EDWARD CHANDLER E—E—E E E EXIST. ELECTRIC G i 99 EXIST. CONTOURS Q5 52 10 L UMBER T MILL ROAD ———— 99 PROP. CONTOURS / �� q . tt — t (CENTERVZLLE) BARNSTABLE, MA d�E—kI�E kt�t UNDERGROUND UTIL. -" -•� �/ � � LE . 1 - 30 REF:PB 309 PG 5 PAGE 1 OF2 t ...................................................................................................................................................................................................................................................................................................................................................................................................................:A...................... ...................... .........................................................................................................................................................................................................................................................------------ GENERAL NOTES DESIGN CALCULATIONS SYSTEM DETAIL Flaherty Environmental Services 16 P. O. Box 331 1. ALL PRECAST COMPONENTS TO BE H-10 Harwich, MA 02645 RATED UNLESS OTHERWISE SPECIFIED, NUMBER OFACTUAL BEDROOMS 3 774.994.1166 DISTRIBUTION BOX AND ANY COMPONENTS WITH ANY ANTICIPATED GARBAGE DISPOSAL UNIT NO VEHICULAR TRAFFIC TO BE H-20 RATED. 2. THE DESIGN OF THIS SYSTEM DOES NOT TOTAL EST/MATED FLOW ALLOW FOR THE USE OF A GARBAGE (110 GAUBR/DAYX 3 BR) 330 GAL✓DAY GRINDER. REQUIRED SEPTIC TANK CAPACITY 660 GAL. 3. MUNICIPAL WATER IS AVAILABLE. 4. ALL CONSTRUCTION TO CONFORM WITH 25' SIZE OF SEPTIC TANK 1000 GAL. (EXISTING) 310 CMR 15.000 AND ALL OTHER APPLICABLE LOCAL, STATE AND FEDERAL SOIL CLASSIFICATION 1 CODES AND REGULATIONS. 5. INSTALLERICONTRACTOR TO REVIEW& DESIGN PERCOLATION RATE <2 M/NAINCH VERIFY ALL ELEVATIONS AND DETAILS EFFL DENT LOADING RATE 0.74 GAL./DAY/FT? AND REPORTANY DISCREPANCIES TO Q Q 12,83' DESIGNER PRIOR TO CONSTRUCTION OR LEACH/NG AREA V ASSUME ALL RESPONSIBILITY. (2)x(25.0'+ 12.83)(2) = 151 SF 6. INSTALLER/CONTRACTOR IS 25.0'x 12.83' =320 SF RESPONSIBLE FOR MAINTAINING SAFE 471 SFx 0.74 =348 GPD WORK AREA, VERIFYING ALL UTILITIES AND NOTIFYING "DIG SAFE" USE(2)500 GALLON H 20 CHAMBERS WITH 4'STONE (1-888-344-7233) 72 HOURS PRIOR TO /NA 12.83'X25'CONFIGUR4TIONASDIAGR4MMED CONSTRUCTION. 7. ANY CHANGES TO OR DEVIATIONS FROM RESERVE LEACHING CAPACITY N/A THIS PLAN MUST BE APPROVED IN — WRITING BY FLAHERTY ENVIRONMENTAL SERVICES AND LOCAL BOARD OF HEALTH. 8. FINISH COVER OVER COMPONENTS IS NOT TO EXCEED 3'PER 310 CMR 15.000 (NTS) UNLESS SHOWN PER PLAN. 9. ALL ABANDONED SEPTIC SYSTEM COMPONENTS TO BE PUMPED DRY AND SOIL EVAL UA T/ON FILLED WITH CLEAN SAND OR REMOVED TEST HOLE#1 TPT#19 131 TESTHOLE#2 TPT#19 f31 AND REPLACED WITH CLEAN SAND. Evaluator.• David D.Flaherty Jr.,RS,REHS Evaluator. David D.Flaherty Jr.,RS,REHS 1O.ALL COMPONENTS TO BE PROVIDED SE#2755 SE#2755 ZNOF BOH Witness. David Stanton,RS BOH Witness. David Stanton,RS ' WITH WATERTIGHT ACCESS PORTS Date. September 13,2019 Date. September 13,2019 �a2`� WITHIN 6"OF FINISH GRADE, p p D 11.ALL SEPTIC TANKS, DISTRIBUTION TH-1 ELEV.56.0' TH-2 ELEV.56.0' J BOXES AND PIPING TO BE INSTALLED I. WATERTIGHT. 0"-12" A LS 10YR&2 0"-12" A LS 10YR3/2 O 12.NO KNOWN WETLANDS OR WELLS WITHIN 150 FEET OF PROPOSED NITAR% LEACHING. 12"-24" B LS 10YR5/8 12"-24" B LS 10YR516 13.THIS IS NOT A CERTIFIED PLOT PLAN AND UNDER NO CIRCUMSTANCES IS THIS PLAN TO BE USED FOR ZONING OR 47) Pero l cert/fy that on November 12,2002,l have passed SITE AND SEWAGE PLAN the examination approved by the Department of FOR BUILDING PURPOSES. Environmental Protection and that the above analysis 14,LOT IS SHOWN AS ASSESSOR'S MAP 168 has been performed by me consistent with the B & B EXCAVATION, INC./ LOT 97. 24"-132" C MS 2.5Y6/6 24"-132" C MS 2.5Y6/6 required training,expertise,and experience described In 310 CMR 15.018(2)." EDWARD CHANDLER 15.LOCUS PROPERTY IS NOT LOCATED IO LUMBERT MILL ROAD WITHIN AN AQUIFER PROTECTION (CENTERVILLE) DISTRICT(ZONE II). G.W.ELEV.N/A G.W.ELEV.N/A BARNSTABLE, MA BOTTOM TH-i ELEV. 45.0'1 1 BOTTOM TH 2 ELEV. 45.0, PAGE2 0F2 DATE.•912012019 ............................................................................. .............................................................................................................................................................................................................................. ...........................................................- ....................................... .............................................................................................................................................................