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HomeMy WebLinkAbout0093 LUMBERT MILL ROAD - Health 93 Lumbert Mill Road Centerville P 168 048 i �►���� J�QECYCLp�co UPC 12543 NoSROR 'o�pOSf•GONSJ��� HASTINGS,MN g TOWN OF BA.RNSTAB.LE LOCATION SEWAGE # VII,LAG n ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. DUI kA 44-In '2�1�o SEPTIC TANK CAPACITY /"So 0 p TEACHING FACILITY: (type) '�o��' ��� (size) NO. OF BEDROOMS -3 BUILDER OR OWNER -LAU C4 Ci O D D AK -F) PERMTTDATE: 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 i Cr OF 2-40uS1- I B-3 4 E�- _.'ia�.=I1..._.•. ___. T}'� .. '.ir.''_�-!.'. T.ref:_ -. ��T_.:".— =i.f e.[�._ No. O FEE 1 (90 COMMONWEALT14 ®F MASSACHUSETTS ' ` Board of Health, �gcx,t A srck-( I e , MA. APPLICATION FOP, DISPOSAL S YSTL[ CONSTRUCTION PERMIT Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon( ) - ❑Complete System W4rflfividual Components Location 9 `3 16 C, M Owner's Name L 4UIZP4 6'O D"P MaI?/Parcel# ' J Address 't 3 4e;7' M Lot# Telephone# Installer's Name A-SsuKtatjce- ( Oc, FF Designer's Name qNk-ee- so/-VC-4 Ct viq&L-ri9Q�; Address Address ® e �����✓ 91bay12�' ►� j►1��15 /17f¢ Telephone# j"O f j' -7 71" 7-/%® Telephone# �'a 8- W-0 0 ES Type of Building Lot Size / sq.f Dwelling-No.of Bedrooms 3 Garbage ghf.oder�l�. `'`'"�� Other-Type of Building No.of persons Showers ( ),Cafeteria( ) Other Fixtures Design Flow (min.required) u 3 3 ® gpd Calculated design flow 3 3 Design flow provided -3G l gpd Plan: Date 3— r 7-- / Number of sheets Revision Date Title 'S /�� pt-a N OF 1,4 A;> Description of Soils) See in(� - 4j�" Soil Evaluator Form No f 4' U pYC N Name of Soil Evaluator Date of Evaluation 7`3 I 9 O u GRI ENGINEER q�, ER MUST SUPERVISE DESCRIPTION OF REPAIRS OR ALTERATIONS r ,_ lrlt 6YSTEM WAS;,':,�:.'` `' WRITING 0RDAj%1,_,-.7 p ?IC. T The undersigned agrees to install the above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and further agrees to m? to ce the sys in operation until a Certificate of Co pliance h s bee issued by the Board of Health. Signed Date Inspections No. FEE 00I Board of Health, 24L-i 0.4 �� ' MA. y APPLICATION FOP, DISPOSAL SYSTEM CONSTRUCTION PERMIT 1 Application for a Permit to Construct( ) Repair(. ) Upgrade( ) Abandon( ) - ❑Complete System W_Jadividual Components i Location Owner's Name G 4utzol G DA MaV/Parcel# I Address Lod Telephone# 4: Installer's Name SSUIZ.AN« �'rrw Designer's Name �e ✓c' Ct a c�L o4�t Address V Address A ,.ti a ,� yo T a�`f� Telephone# 3-0 _771- j 0 0 Telephone# tAV—(.)4;,ru n Type of Building Lot Size 01A I; _sq.ft. Dwelling-No.of Bedrooms Garbage gAN1,eik+V'.P Other-Type of Building No.of persons Showers 1 p Cafeteria ( ) Other Fixtures Design Flow (min:required) C?_ gpd Calculated design flow ��_ Design flow provided - gpd Plan: Date 3_1"7—0 Number of sheets Revision Date Title 5 11< PC A N C,F 4 A A/> Description of Soil(s) St-e " Soil Evaluator Form No���R5, Name of Soil Evaluator a rQ 0 oL� Date of Evaluation '7—? I' V DESCRIPTION OF REPAIRS OR ALTERATIONS The undersigned agrees to<install the above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and. further agrees to not to place the-system in operation until a Certificate of Compliance has been issued by the Board of Health. Signed Date w / �,, � J4 I" Ins ectionWo ffza'o . .._ . , ly tE No. f ..� (/'r X,MO � VV'ALT'L �' ` MSACHi SETTS FEE t t 1 Board of Health a4L M $ MA. Vla WOF COMPLIANCE Description of Work: ❑J,Individ al Component(s,) ❑Complete Syst. tr The undersigned hereby certify that the',Sewage Disposal,System; Constructed ( ),Repaired �y Upgraded ( ),Abandoned ( ) by: C�2 \!t t Ti 4 n �r'v at 9 L.c�n�. �. .T /V1 L_ 4 1 IV! � �U has been install in accorda c with the proowtsions of 310-CMR 15.00 (Title 5) and the approved design plans/as-built plans relating to application No dated _`"Approved Design Flow _(gpd) Installer Designer: V. od tr'e A6 a r4+'1 Inspector: kr A Date: The issuance of this permit sh not be construed as a guarantee that the system will function as designed. No. .ae� �I_ FEE /�""" w Board of Health, %4Lt#L ST r71-P MA. DISPOSAL SYSTEM CONSTRUCTION PERMIT Permission is hereby granted to; Construct( ) Repair(,�.)�-Upgrade( ) Abandon( ) an individual sewage disposal system at L•U thn 6 eT M I L-4— 02 17 as described in the application for Disposal System Construction Permit No. dated VIP- Provided: Construction shall be completed within three years of the date of this permit. All local conditions must be met. Form 1255 Rev.5/96 A.M.Sulkin Co.Boston,MA Date Board of Health M qq TOWN OF BARNSTAB.,L;E LOCATION /.3 LUm6PPr&Ld 234 4> SEWAGE # VILLAGE ASSESSOR'S MAP & LOT — INSTALLER'S NAME&PHONE NO. • SEPTIC TANK CAPACITY /"SO 0 LEACHING FACILITY: (type), 14-7M P-:USES ('size) 'A0 NO.OF BEDROOMS BUILDER OR OWNER .LAQ iel, 0 0 Qxl.F,f PERMITDATE: COMPLIANrE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facilipy (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 C OF 1-4W f 4 Town of Barnstable Regulatory Services Thomas F. Geiler, Director * BAMMBLFE w �6;: �0� Public Health Division 1639 p Thomas McKean,Director 206 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Installer & Designer Certification Form Date: Sewage Permit# r �� Assessor's Map\Parce7/� Designer: 6 0� �fo fJ Installer: ( ZZZL=,1A1W ,A2ZVa�i� Address: 6 6— Address: On �/fi'`��'�al Lioas issued a permit to install a ( ate (installer) _. septic system at based on a design drawn by (address) e 6-, '— dated (designer) I certify that the septic system referenced above was installed substantially according to the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. " l J; certify that the septic system referenced above was installed with major changes (i.e. F greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system) but in accordance with State & Local Regulations. Plan revision or certified as-built by designer to follow. OF 0/1 k;Z,� .. 89UCE u� (Installer's Signa G. �`�, MURPHY can No.749 �t GIST , M N/r (Designer's Signat re) (Affix Desight-p s `tamp Here) u PLEASE RETURN TO BARNSTABLE PUBLIC . HEALTH DIVISION. CERTIFICATE OF COMPLLANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS-BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. Q: Health/Septic/Designer Certification Form 3-26-04.doc • COMMONWEALTH OF NIA-SSACHUSETTS � T 1 3'b T' EXECUTIVE OFFICE OF ENVIRONMENTAL, AFFAIRS > DEPARTMENT OF ENVIRONMENTAL PROTECTION MAP Co PARCEL LOT 13 TITLE 5 OFFICIAL INSPECTION FORINI—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTENI FORNI PART A CERTIFICATIONV MAP Property Address: 0 9- Owner's Name 14// Owner's Address: 9 y C CE'V eti erv, e %sue �L RE E® Date of Inspection: o 0 Name of Inspector. (please print) / a JUL 1 8 2003 Company Name: /t✓li/,o Cif TOWN Mailing Address: t1110 HEAL TH DEPT.ABLE i �► ®a (,4,) Telephone Number. p L� 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 functi and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to ection 15340 of Title 5 (310 CNIR 15.000). The system: Passes Conditionally Passes Needs Further Evaluation by the Local Approving Authority Fails Inspector's Signature: Date: z llf2 The system inspector shall submit a copy of this inspection report to the Apprrning 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 otlice of the DEP.The ori4nal should be sent to the system owner and copies sent to the buyer. if applicable,and the appro"ing authority. Notes and Comments •www•I•his report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. Page 2 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM hi''SPECTION FORM PART A n CERTIFIICATION (continued) Property Address: 7 �� ,.y— /1/l�,j Owner: C4 / Date of Inspection: to p? Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. Sy�zcm Passes: I have not found any information which indicates that any of the failure criteria described in 310 CNIR 15.303 or in 310 CNIR 15.30-4 exist. Any failure criteria not evaluated are indicated below. Comments: B. System Conditionally Pauses: Sy /l� One or more system components as described in the"Conditional Pais"section need to be replaced r re red. e stem Upon completion of the replacement or tz °�' The system, p° pair,as approved-by the Bard of Health,will pass. Answer,yes, no or not determined(Y,N,ND) in the for the following statements. If"not determined"please ..r..uii. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not)is structurally unsound,exhibits substantial infiluadon 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 gill 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 mailable. 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 «ill pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed ND explain: Page 3 of 11 OFFICIAL INSPECTION FORM • NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: L, P b e,- Owner: Ft,Ille ✓ Date of Inspection: ao C. FFurther Evaluation is Required by the Board of Health: /�(V 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. Svstem will puss unless Board of Health determines in accordance with 316 CINfR 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: Page d of I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address eh� �✓, e Oa�3d Owner: �., e k Date of Inspection: D. System Failure Criteria applicable to all systems: You must indicate"yes" or"no" to each of the following for all inspections: Yes NA V ackup 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�/2 day flow Required pumping more than 4 times in the last year NOT due to clogged or obstructed i Of times pumped >;� p pe(s). Number _ �/Any portion of the SAS,cesspool or privy is below high ground water elevation. +i Any portion of cesspool or privy is within 100 feet of a surface%Vhter supply or tributary to a surface "water supply. Any portion of a cesspool or privy is within a Zone 1 of a public well. y 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 %.ith no acceptable water quality analysis. [This system passes if the well water analysis, Fcrforrnc•° DEP certified laboratorv,for coliform bacteria and volatile organic compounds indicates u;,. :ne 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 forth.] (Yes/No)The systcm 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 s-!tem the system must serve a facility with a design flow of 10.001)gpd to 15,0o0 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 suppiv 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 l:-,;e 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 CNIR 15.304.The system owner should contact the appropriate regional office of the Department. • Page 5 of 1 t OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B - CHECKLIST /� Property Address: vt P" /�/�� 1�cj Owner: Fil Ile Date of lnspcction: d o n Check if the following have been done. You must indicate`�-es" or"no"as to each of the following: Ye�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 P� 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 7_ Was the site inspected for signs of break out l✓ Were all system components,excluding the SAS locate d on site Were the septic tank manholes uncovered.opened.and the interior of the tank inspected for the condition of th es 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: Y n _ Existing information. For example,a plan at the Board of Health. Determined in the field(if any of the failure criteria rciated to Part C is at issue approximation of distance is unacceptable) (310 CNIR 15.302(3)(b)l Page 6 of l l OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORLNIATION Property Address- e�- � 1,2d / e/"v, e, ©� 3� Owner: �y GGPi� Date of Inspection: d� O FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): Number of bedrooms(actual): 3 DESIGN flow based on 310 CN 15.203 (for example: 110 gpd x#of bedrooms): Number of current residents: / Does residence have a garbage grinder(yes or no): Is laundry on a separate sewage system(yes or no): yes separate inspection rcquiredj Laundry system inspected(yes or no): � Seasonal use: (yes or no): Water meter readings,if available(last 2 years usage(gpd)): Sump pump(Yes or no): �/ Last date of occupancy: rci//e0 COM IERCIALIINDUSTRIAL Type of establishment: Design flow(based on 310 CNN 15.203): end 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 S system(yes or no): _ Water meter readings,if available: Last date of oc^lpancy/use: OTHER bc): GENERAL.LYFOPUNUTION Pumping Records �( Source of information: /�lU J w/��� 0 (--Ike y. Was system pumped as part of the inspection(yes or no):,,:�VO If yes,volume pumped:_gpllons—How was quantity pumped determined? Reason for pumping: OF SYSTEM Septic tank,distribution box,soil absorption system _Single cesspool _Overflow cesspool _Privy _Shared system(yes or no) (if yes, attach previous inspection records. if any) _InnovativdAlternative 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): Appro:amate age of all components,Aatc installed of known)and source of information: /YO/71 Were sewage odors detected when arriving at she site(yes or no):/�O Page 7 of 1 I OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: L U 1-7 Owner:_ t;e Date of inspection: BUILDING SEWER(locate og site plan) l Depth below grade: _ Materials of construction: /—cast iron 64�PV _other e. lain : Distance from private water supply well or suction line: (explain): � ) Comments(on condition of joints,venting,evidence of leakage, etc.): SEPTIC TANK:_(locate on site Ian / P ) Depth below grade: 02/ Material of construction:_c(✓ oncrete_metal—fiberglass_polyethylene _other(explain) If tank is metal list age:_ Is age confirmed by a Certificate of Compliance(yes or no): certificate) _(attach a copy of Dimensions: X (6 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 to bottom of pullet teS,or baffle: How were dimensions determined: tDo 6 Comments(on pumping recommendations, inlet and OuGet tee or baffle condition, structural irate as�tlated to outlet invert,evidence of I �tY, uQd levels ,etc.): �s ,��� GREASE TRAP•l(✓(locate on site plan) Depth below grade: Material of construction:— — —concrete metal fiberglass (explain): _—polyethytene — other 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, as related to outlet invert,evidence of leakage,etc.): liquid levels Page 8ofII • . ' OFFICIAL INSPECTION FORNI—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address , ��► rd, Owner. 01/e✓' Date of Inspection: o TIGHT or HOLDING TANK: tank must be pumped at time of irspection)(Iocatc on site plan) Depth below grade: Material of construction: concrete metal fiberglass_polyethylene other(explain): Dimensions: Capacity: gallons Design Flow: ea'Ions/day Alarm present(yes or no): Alarm level: Alarm in working order(yes or no): Date of Iasi pumping: Comments(condition of alarm and float switches,etc.): DISTRLB(,ilv"I EOX: �/ (if present must be opened)(Iocate on site plan) Depth of liquid level abov. invert: / Comments (note if box is lc•.;1 ,r:d distribution to outlets equal,any evidence of solids carryover,any evidence of !1� geinou vf im.):/ / PUMP CHAM03ER: (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.): r Page 9 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address; /-vt H-r Owner. cA t� Date of Inspection: o SOIL ABSORPTION SYSTEM (SAS): (locate on site plan,excavation not required) If SAS not located explain why: Type F—1 Q Ll/ Q leaching pits,number._ leaching chambers, number. J leaching galleries,number: leaching trenches, number;length: leaching fields,number,dimensions: overflow cesspool, number innovative/altemative system Type/name of technology: Comments(note condition of soil,signs of hydraulic failure, level of ponding,damp soil,condition of vegetation, etc.): Ot , CESSPOOLS; (cesspool must be pumped as part of inspection)(iocate on site plan) Number and configuration: Depth—top of liquid to inlet invert: L)eptn 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.): .� Page 10 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTENI INSPECTION FORM PART C SYSTEM INFORNLATION (continued) Property Address: / U +-•,�t� ✓"7 Owner. Date of Inspection: ao p D SKETCH OF SEWAGE DISPOSAL SYSTEb1 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. © �2 11 -d 39 ' ITJ_ q3 r Page I l of 11 OFFICIAL INSPECTION FORD[—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEN'( INSPECTION FORNI PART C SYSTEM INFORMATION (continued) Property Address: Owner. 7744 lle-y, Date of Inspection: nt o p SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water 010 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: %f4 a :? J CO Checked with local excavators, installers-(attach documentation) Accessed USGS database-explain: ,. You must descgnoe how you established the high ground water elev Lion: le tv d n /to c✓s n h / oF 7-11 99 �� �'/ TOWN OF BARNSTABLE ,. LOC,'1TION l E /� /G C o7� SEWAGE # 7- T VILLAGE E 1"ry t" ASSESSOR'S MAP & LOT. d�S INSTALLER'S NAME&PHONE NO. IG'1 .rY riGA �tit?Nl / Amy ?+=.5 SEPTIC TANK CAPACITY I ll G:3 4 �r�tl`i , � LEACHING FACILITY: (type) � �(.ot,) � O��.�(size) NO.OF BEDROOMS /� BUILDER OR OWNER - Gw 'V CA LCL.0 PERMITDATE: E��� , 9 COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility A14 Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Ira Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by T liJ,eW i5en/A fC, La Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes , PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS 2pprication for �Diopogal *pgtem Construction Verutit Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) V'Complete System ❑Individual Components Location Address or Lot No. ��yJB m J J e Owner's Name,Address and Tel.No. �;eerC7cugy /Z. L16k_T/_ V/Lt, Assessor's Map/Parcel n M45I-Y_P� J'�/q. D 2,61 Installer's Name,Address,and Tel.No. r Designer's Name,Address and Tel.No. �J Type of Building: o Dwelling No.of Bedrooms Lot Size C'� 0 sq.ft. Garbage Grinder A Other Type of Building 'I _.�- No. of Persons Showers Cafeteria(�e� Other Fixtures Design Flow 3 3o gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Env' onmental Code and not to place the system in operation until a Certifi- cate of Compliance has been Wissedy t i , d o ea 00, /Signe Date // 141— 9Z Application Approved by A Date Application Disapproved for the following reaso 6E_ Permit No. Date Issued Fee lao �r THE COMMONWEALLT OF MASSACHUSETTS Entered in computer: ,. .i' Yes { PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS 2pprication for ;Digpoga[ *pgtem Congtructton Permit Application for a Permit to Construct_( )Repair( )Upgrade( )Abandon( ) Complete System ❑Individual Components Location Address or Lot No. Owner's Name,Address and Tel.No. C+Enn'�, iL� � "L 7�'c'rc1�y �. Assessor's Map/Parcel •J� ./s*)oo /{ 2, 14-6 Installer's Name,Address,and Tel.No. 'r.)e gMZ.,f Designer's Name,Address and Tel.No. (k)G Y-% IG(46 N Type of Building: ,, )) Dwelling No.of Bedrooms Lot Size r�_—sq.ft. Garbage Grinder(14 Other Type of Building FA!ZZ No. of Persons Showers Cafeteria(�Cy Other Fixtures Design Flow 330 gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil 44 Nature of Repairs or Alterations(Answer when applicable)- ;f. 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 Env' onmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued by t t dZoeal Signe Vowl, Date ,/J- 9- t� Application Approved by Date Application Disapproved for the following reaso t7 L t Permit No. Date Issued } Si. --- ,-- -------------------------.------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of (Compliance THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed( )Repaired,( )Upgraded( ) Abandoned( )by at are , nstructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. d Installer Designer The issuance of this permit shall not be construed as a guarantee that the system will function as designed. Date to Inspector�r -- f--- — -------------------------------- No. / Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION -'BARNSTABLE, MASSACHUSETTS MigogaY tpgtem Congtruction,Vermit Permission is hereby gra to to Cons ct Re airy )Upgrade( )A andon System located at and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction must be completed within three years of the date of this permit. Date: y Approved by TOWN OF BARNSTABLE cl>: 3 L V 2'9 R /G C /Z,D SEWAGE # � :LOCATION VILLAGE ASSESSOR'S & LOT INSTALLER'S NAME&PHONE NO. ` �� �tAL SEPTIC TANK CAPACITY L L o A I tv 10, 40 FZo� r Ftr o,7S 1 Y 5Z0 ;LEACHING FACILITY: (type) � (size) C1F BEDROOMS ;$UDDER OR OWNER _ v FERIv1TTDATE: r. COMPLIANCE DATE::? :S station Distance Between the. .� M um Adjusted Groundwater Table and Bottom of Leaching Facility'?' Al Feet P.nvaie,Water Supply Well and Leaching Facility (If any wells existA <: on site or within 200 feet of leaching facility) Feet' 1 Edge of Wetland and Leaching Facility(If any wetlands exist 300 feet of leaching.facility) Feet 'Fain she'd by C,'S . �i"eillru�7 e�-ZIA) t f ' ,,• i Y� H f f+ « a r - � Fr GENERAL NOTES: 1. THE SYSTEM COMPONENTS AND CONSTRUCTION SHALL BE IN ACCORDANCE WITH THE STATE OF NOTE: UTILITY LOCATIONS MASSACHUSETTS SANITARY CODE TITLE 5, AND LOCAL Q`O ARE APPROXIMATE, CONTACT UTILITY BOARD OF HEALTH REGULATIONS. \ COMPANIES FOR DETAILS 2. CONTRACTOR SHALL NOTIFY DIG-SAFE PRIOR TO p0UL 1. CONSTRUCTION AND BE RESPONSIBLE FOR ALL AO UNDERGROUND UTILITIES. vo �yy I 3. ELEVATIONS ARE BASED ON BENCHMARK AS SHOWN. n 4. PIPING SHALL BE SCHEDULE 40 PVC. oG�� 01 5. SEPTIC COMPONENTS SHALL MEET H-10 LOADING UNLESS OTHERWISE SPECIFIED OR H-20 LOADING PO i UNDER DRIVEWAYS. 6. INSTALL D-BOX W/RISER & COVER TO 12 1101 2 y BELOW GRADE. 0011 � 7. D-BOX EXIT PIPE TO BE FITTED WITH INVERT g S�CaG G 00 -, PRECAST CONCRETE FLOW �� 3 � �9. LEVELLER CAPS. OQO`'�Q�1��, 8' EACH WITH 3' STONEDIFFUSERS, 4' XON SIDES & 8. D-BOX TO BE INSTALLED ON MIN. 6" CRUSHED PR '� oti F` 3.5' STONE ON ENDS STONE BASE. 'YF F Pr` FQ y'o. 5 G� ,`OQ p (t 9. ELECTRIC AND TELEPHONE SHALL BE OVERHEAD. p p o. LOT AREA = 14,810 S.F. 3 ZONING = RC SETBACKS: LEGEND: FRONT = 20' SIDES = 10' LOT BOUNDARY REAR = 10' w WATER GAS F ELECTRIC 2 00 + T TELEPHONE 99 EXISTING CONTOURS PROPOSED CONTOURS LIMITS OF OVERDIG ----------------------- LIMITS OF LEACH FIELD F � BENCHMARK: SPIKE IN TREE, EL.=102.43 ! TP-1 TEST PIT, LOCATION & NUMBER REVISIONS: LOCUS: i 99 FALMOUTH ROAD (ROUTE 28) nlsrER � TITLE: SITE PLAN & SEPTIC SYSTEM DESIGN wEsrrnr ti�5 93 LUMBERT MILL ROAD, CENTERVILLE, MA DRIVE � OWNER: GREG DEVAUX LUMBER MILL ROAD 0.00 300 FALMOUTH ROAD, UNIT 14E 0�� 9 31°1a,5 0,> MASHPEE MA 02649 W y ,4a < CJ ENGINEERING �,�- ° awns � OF 449 ROUTE 130, SUITE 13 %v �� �`� 1q� SANDWICH, MA 02563 N DRIVE i � ��� � `. CAROLYN (508) 888-4975 UTU J. .a M BENT TREE DRIVE A SITE 0 20 40 F #35A18 '�-' DOYLE y MAP: 168 PARCEL: 48 No.34531 RIVER ROAD �90r� �� .o DATE: 811219 7 BUMPS SCALE: AS SHOWN a 9p�€fig ISTER�®Q SCALE: 1 20' DWG NO.:CJ27/LUMBMILI.DWG SHEET 1 OF 2 '' �li 1 1 DESIGN CRITERIA: SOIL TEST LOG PERC TEST P-8985 DESIGN FLOW. 1 SOLID PVC, FIRST 2' TO BE LEVEL, TP-1 TP-2 3 BEDROOMS AT 110 GPD = 330 GPD SOLID PVC, S=0.083 SOLID PVC, S=0.042 REST AT S=0.005 DEPTH HORIZON DEPTH HORIZON SEPTIC TANK = 1,500 GALLONS GRADE = EL. 100.58 GRADE = EL. 99.56 NO GARBAGE DISPOSAL 0" 0 TOWN WATER -------------iil NO WATER SUPPLY WELLS WITHIN 400 FEET 2 0 o NO WETLANDS WITHIN 100 FEET 3 5 6LOAMY SAND AP LOAMY SAND AP SIZE OF LEACH FIELD REQUIRED: n � DESIGN PERC RATE: 2 MIN/INCH 4 7 `�✓ REQ'D AREA = 33010.75 = 440 S.F. t 8" toll PROVIDE INLET TEE OR 8 AREA PROVIDED: NEW SEPTIC TANKI BAFFLE IF S=0.08 FT/FT AA = (10'+1) X (39'+1) = 440.0 S.F. MED. SAND Bw MED. SAND Bw PROVIDE GAS BAFFLE EFFECTIVE LENGTH = 39' PROPOSED SEPTIC SYSTEM - PROFILE 30" 31" EFFECTIVE WIDTH = 10' NOT TO SCALE MEDIUM TO Cl MEDIUM TO Cl COARSE SAND COARSE SAND 93" 96" MED. SAND C2 MED. SAND 02 120" 120" SYSTEM COMPONENTS* ELEVATIONS** SOIL TEST CONDUCTED ON 7131197 BY CAROLYN J. DOYLE AND 1. TOP OF FOUNDATION ................................................ 103.00 WITNESSED BY BARNSTABLE BOH AGENT JERRY DUNNING 2. INVERT OF PIPE AT FOUNDATION ............................ 99.50 NO GROUNDWATER AT 10' (EL. 89.56) \j MIN. 3" TOPSOIL \j 3. INVERT OF PIPE AT SEPTIC TANK INLET ................. 98.67 \\ (FREE 0 \\ SEE ATTACHED PERCOLATION TEST ORGANIC MATERIAL & \ FORM FOR DETAILS 4. INVERT OF PIPE AT SEPTIC TANK OUTLET .............. 98.50 / BOULDERS, IN COMPLIANCE / \j WITH 310 CMR 15.255(3)), \j 5. INVERT OF PIPE AT D-BOX INLET ........................... 98.08 \j COMPACT TO 90% DRY \j REVISIONS: \\ DENSI TY \\ 6. INVERT OF PIPE AT D-BOX OUTLET ........................ 97.92 \� 2" LAYER OF 1/8-1/2" \� 7. INVERT OF PIPE AT DIFFUSER INLET ....................... 9Z90 \\ DOUBLE WASHED STONE \\ . . BOTTOM OF DIFFUSER ..............:. \// \i 7 TI TLE: SEPTIC SYSTEM DESIGN 8 96.90 \\/ 8 93 LUMBERT MILL ROAD, CENTERVILLE, MA 9. BOTTOM OF AGGREGATE ........................................... 95.90 \// 3' 4' I 3' OWNER: GREG DEVAUX \ \X 300 FALMOUTH RD., UNIT 13E \, \� MASHPEE, MA 02649 \\/ 3/4-1 1/2" DOUBLE \\ WASHED STONE �.tiIN OF CJ ENGINEERING *LOCATED ON SECTION & PROFILE 9 � �+� \ \ \ \ \ \ \ \ \ \ \ \ \ CAROLYN 48 GULLY LANE, SANDWICH, MA 02563 "BENCHMARK = ASSUMED 102.43 SPIKE IN TREE SECTION A - A , -Z� J. ''; (508) 888-4975 SEE SHEET I OF 2 v DOYLE TYPICAL SECTION NOT TO SCALE ; No.34531 MAP: 168 PARCEL: 48 �O,r IS DATE: 8/12197 SCALE: AS NOTED 8�/��� DWG NO:CJ27/LUMBMIL2.DWG SHEET 2 OF 2 POOL REQ UIREMENTS PLAN REF 31043—A, 210—73, 316—61 BARNSTABLE 2$ ASSESSORS MAP.- 168 PAR. 48 BARNSTABLE ZONING: "RC" `��� g0��� BY ZONE SETBACKS CURRENT SETBACKS: 20-10-10 25' FROM LEACHING AREA TOWN WATER �0 10' FROM SEPTIC TANK 0' FROM HOUSE `C LOCUS 5 ROAD �a��;���`GCB/Dlsc � ♦ \� ..o � ��' ��,� �2 (FAD) �` \9G �� LOCUS MAP O lb \ BENCHMARK TOP OF FOUNDATION / ELEV.= 100' (ASSUMED) W LOT 12 f�f• G�' // 100 5.00 A.M. 168/4 7 / � � � f � —MAD TAKING SEE PLANS L C. 31043 A DECK ✓ & P.B. 210—73 100 4o5ti \ / 's, \ / r• , 0' NOTE.• 'Q6, \ / / ;// EXISTING SEPTIC SYSTEM SHO WN TAKEN FROM THE TITLE 5 SEPTIC INSPECTION FORM 6120103 y 1) ` LOT 13 A.M. 168148 15,213E S.F. I , �r ►� 4 / // , e 0 0 C) // 4 /o tK SITE PLAN OF LAND LOCATED AT.• #93 LUMBERT MILL ROAD LOT 14 CENTER VILLE MA o v A.M. 168/49 LOT 39 0 A.M. 168/26 PREPARED FOR. Y LA URA GODDARD MARCH 17, 2004 SCALE: 1"=20' ee tH OFM�ss�a� c BRUCE � ;, :�pP�G1STEq�CgyGm 1 a � � U STEPHEN N YANKEE SURVEY CONSULTANTS URm DOYLE C UNIT 1, 4 0B INDUSTRY ROAD ` y #3' P. 0. BOX 265 ` MARSTONS MILLS, MASS. 02648 SUR v •� TEL: 428-0055 FAX 420-5553 SHEET 1 OF 2 JI 53587 ij MP OF FOUNDATION EL.=L00__ 20' MIN. 10 MIN. CONCRETE COVERS 4"SCHEDULE 40 P.V.C. MIN. P/7rH I/8 PER FT. 2"LAYER OF EXIST/NCl/2'CONCRETE COVER WASHED S71ONE EL gz2' Z. / i i i i i 4" CAST IRON PIPE B'MAX B"MAX r (OR EQUAL, MINIMUM CLEAN SAND y P/7L'H I/4 PER FT FLOW LINE 94.6' c4 EXIST INVERT 1�N l4" �zO•� o 00 0 0 0 0 0 0 0 0 0 0 0 ogo°o EL.=96.0' INVERT LEVEL ° °o 0 0 0 CO 0 0 0 0 0 0 o g° CAS 6 SUM °;°°o° o0000000000 00 IN yER7 BAFFLE EL.=95.5' INVERT INVERT o o° o 0 0 0 0 0 CO 0 0 0 0 °°8 o EL.=92.75' EL.=95.75' EL.=94.5' EL.=94.25' 3 s DISTRIBUTION r4� fZOIID,FFUSOR4 GALLONS INVERT BOX EL.=93.75' EXIST. SEPTIC TANK T O BE WATER TESTED X W TRENCH IroRVAT,ON h Z IF MORE THAN ONE OUTLET PLACE ON 6" STONE SOIL ABSORPTION 3/4" 7Y1 1-I/2" DOUBLE WASHED STONE SYSTEM (SAS BOTTOM OF TEST HOLE OR USGS PROBABLE WATER TABLE ELEV=_875 _ NO OBSERVED WATER TABLE (7-31-97) ELEV.=_875 _ OBSERVATION HOLE 1 ELEV.=97 5_ PROFILE OF OBSERVATION HOLE 2 ELEV.= 9_7.3__ PERCOLATION RATE _ Z__ MIN./ INCH SEWAGE DISPOSAL SYSTEM PERCOLATION RATE __2__ MIN./ INCH DEPTH HORIZ TEXTURE COLOR MOTT. OTHER NOT TO SCALE DEPTH HORIZ TEXTURE COLOR MOTT. OTHER 0-8" AP LOAMY SAND 0-10" AP LOAMY SAND 8"-30" BW MEDIUM SAND 10"-31" BW MEDIUM SAND 30"—93" Cl MED—CRSE SAND 31"-96" Cl MED—CRSE SAND 3"-120' C2 MEDIUM SAND P# 8985 6"-120' C2 MEDIUM SAND SOIL TEST NO WATER ENCOUNTERED AT 10' DATE OF SOIL TEST 7-31-97 SOIL TEST DONE BY CAROLYN J. DOYE PE NO WATER ENCOUNTERED AT 10' WITNESSED BY: JERRY DUNNING GENERAL NOTES 1) ALL WORKMANSHIP AND MA TERIALS SHALL CONFORM TO D.E.P. DESIGN CA L C ULA TIONS. TITLE 5 AND THE TOWN OF _—BARNSLI&E--- RULES AND INSTALL' 3 REGULATIONS FOR THE SUBSURFACE DISPOSAL OF SEWAGE. (4) FLOWDIFFUSORS NUMBER OF BEDROOMS . . . . . . . . 2) ONE COVER ON SEPTIC TANK SHALL BE BROUGHT TO WITH 3' STONE ON SIDES AND 3.5' ON ENDS GARBAGE DISPOSAL . . . . . . . . . NO WITHIN 6" OF FINISHED GRADE, OTHERS WITHIN 12" !O' X 39' TOTAL ESTIMATED FLOW 3) ALL COMPONENTS OF THE SANITARY SYSTEM SHALL BE CAPABLE OF HORIZON INSTALL LEACHING IN ClHO GAL DA Y WITHSTANDING H-10 LOADING UNLESS THEY ARE UNDER OR WITHIN ( 110__GAL/BR./DA Y x _3__ BR.) 330 10 FT. OF DRIVES OR PARKING AREAS. H-20 LOADING SHALL BE USED UNDER OR WITHIN 10 FT. OF DRIVES OR PARKING AREAS. NOTIFY YANKEE SURVEY 48 HOURS REQUIRED SEPTIC TANK CAPACITY 1500 GAL 4) ANY MASONARY UNITS USED TO BRING COVERS TO GRADE SHALL PRIOR TO SEPTIC INSPECTION. SOIL CLASSIFICA TION . BE MORTERED IN PLACE. 5) NO DETERMINATION HAS BEEN MADE AS TO COMPLIANCE WITH DESIGN PERCOLATION RATE . . . . . 2 MIN./IN. DEEDED OR ZONING REGULATIONS. OWNER/APPLICANT IS TO EFFLUENT LOADING RATE . . . . . . • 74 GAL/DAY/S.F. OBTAIN SUCH DETERMINATION FROM APPROPRIATE AUTHORITY. LEACHING CAPACITY AREA X RATE 361 GAL DAY 6) UTILITIES SHOWN ARE APPROXIMATE ONLY, EXCAVATION CONTRACTOR IS TO CALL 'DIG—SAFE" AT 1-888-344-7233 AT LEAST 72 HOURS RESERVE LEACHING CAPACITY . . . 361 GAL/DAY PRIOR TO COMMENCING WORK ON SITE. 7) CONTRACTOR IS TO VERIFY GRADES AND ELEVATIONS AS WELL AS (39x10x. 74)+(39+39+10+10) x 1 x . 74 SITE CONDITIONS PRIOR TO COMMENCING WORK ON SITE. 8) PARCEL IS IN FLOOD ZONE___"C"_____. 9) LOT IS SHOWN ON ASSESSORS MAP _168 AS PARCEL _48___. SHEET 2 OF 2 J# 53587