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HomeMy WebLinkAbout0042 MAPLE AVENUE - Health 42 Maple Avenue Centerville F/R A = 207 036 No. 4210 1/3 ORA P a Aar& ndaflexo 10% . . 1 No.,:A00--3 7 Fee $5 0.0 0 THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS ZippYtcation for 30tsspogar *pgtem Con6truction Permit Application for a Permit to Construct( )Repair(X)Upgrade( )Abandon( ) ❑Complete System El Individual Components Location Address or Lot No. Owner's Name,Address and Tel.No. 42 Maple Ave. lot 7 Assessor'sMap/ParcelMA Steve Lake 207-36' Installer's Name,Address,and Tel.No. 5 0 8—7 7 5_8 7 7 6 Designer's Name,Address and Tel.No. 5 0 8—3 9 8—8 31 1 W ! E. Robinson Septic Servi e C.R. Short PO Box 1089 Centerville M PO Box 1044 S. Dennis Type of Building: Dwelling No.of Bedrooms 4 Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow 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 sand Nature of Repairs or Alterations(Answer when applicable)plans Of CR Short plan # 1 -987 install Title 5 see i system Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued by thisBo d of Health. Sign _J/i� Date Application Approved by Date Application Disapproved for the following reasons Permit No. o,3 —V 3 7 Date Issued at 15710 ,3 ——————————————————————————————————————— ,c No. i 4,4m $S O.O 0 THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE,, MASSACHUSETTS Application for Migpozal *pgtem Con6truction 3permit Application for a Permit to Construct( )Repair(X)Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. Owner's Name,Address and Tel.No. 42 Maple Ave. lot 7 , MA Steve Lake Assessor's Map/Parcel 207-36 ` Installer's Name,Address,and Tel.No. 5 0 8—7 7 5—8 7 7 6 Designer's Name,Address and Tel.No. 5 0 8—3 9 8—8 31 1 WE E. Robinson septic Servi a C.R. Short PO BOX 1089 Centerville M PO Box 1044 S. Dennis Type of Building: Dwelling No.of Bedrooms 4 Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow 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 sand ...-._..,, Nature of Repairs or Alterations(Answer when applicablM Plans.• bi f CR Short plan # 1 -967 install Tit-Ye 5 septic system Date last inspected: ~Agreement: H � The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- ` Cate of Compliance has been issued by t '. Bo d of Health�r k.. Sig d ,+ .:,�• , �f`� Date Y.�-• Application Approved by Date 5�G Application Disapproved for the following reasons Permit No. c�� 3 "`� 3 7 Date Issued S 3 Lake THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed( ) Repaired( X )Upgraded(, ) W.E Robinson Se K "Abandoned( )by tic Service p at 42 Maple Ave lot Barnstable, MA has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No.UO3- q-37 dated ` S-03 Installer Designer The issuance of this permit shall not be construed as a guarantee that the system . u 'Kol •eKgned. Date �3 Inspector No. mn,Co s - Fee $5 0.0 0 THE COMMONWEALTH OF MASSACHUSETTS Lake PUBLIC HEALTH DIVISION - BARNSTABLE,, MASSACHUSETTS li5po5af *p5tem Construction Vermit Permission is hereby granted to Construct( )Repair(X )Upgrade( )Abandon( ) Systemlocatedat 42 Maple Ave lot #7 Barnstable, MA and as described in the above Application for Disposal System Construction Permit. The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction must be completed within three years of the date 7thils pert i Date:_ k Approved b TOWN OF BARNSTABLE LOCATION q2z /hAI21E- tqy( SEWAGE# a0o3-4 32 ASSESSOR'S MAP& LOTI0-0% 10 INSTALLER'S NAME&PHONE NO. ROWN500,J S-64iC SEPTIC TANK CAPACITY 1500 .LEACHING FACILITY: (type) '3 QB( J u%, is (size) t NO.OF BEDROOMS BUILDER OR OWNER PERMTTDATE: Ia a COMPLIANCE DATE: 7 Z9I0 3 Separation Distance Between the: Maximum Adjusted.Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands'exist within 300 feet of leaching facility) Feet Furnished by r a 1 w 7 f TOWN OF BARNSTABLE LOCATION LIZt rhA121 fqV& SEWAGE# ;too 3-43� VILLAGE Oe-V J jW,,J t �(E ASSESSOR'S MAP&LOT LG'7-6% It INSTALLER'S NAME&PHONE NO. R06NS'G$,J St.P iC 5108-)7S sg 77( SEPTIC TANK CAPACITY 1.500 LEACHING FACILITY: (type) yatu-*Us (size) t 3Y-7. 04 NO.OF BEDROOMS �I BUILDER OR.OWNER PERMITDATE: 21 SS/,_ • : COMPLIANCE DATE 910 3 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 i I a w I �J�j C0.0 ATI0� SEWAGE PERMIT NO. VILLAGE INSTA LLER'Ste NAME ADDRESS r a441� � B UIlD R dR OWNER ' I DATE PERMIT ISSUED DATE COMPLIANCE ISSUED r 1 J � `r i �y 1 ..................,....,....�. �4�a.....�....�.......�....�o.�...vas..�.�.�...........�.�.�...�...-- COMMONWEALTH OF MASSACHUSETTS. i i 42c EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTE - .�����© r J U L 3 0 2003 TOWN OF BARNSTABLE HEALTH DEPT. TITLE 5 OFFICIAL INSPECTION.FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A FAILED INSPECTION CERTIFICATION Property Address: 7 �' Owner's Name:' Owner's Address: Date of Inspection: e ®� Name of Inspector• (please rint) �z �p�6� MAP Company Nam " t PARCEL 3 Mailing Address: tRm ;LOT Ci Telephone Number: 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: Bate: 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 I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: Vc) /_/a_,a& Qi Owner: Date of Inspection: Inspection Summary: ' heck 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 153303 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 oraank 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 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 pump ing.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 r Page 3 of 11 OFFICIAL INSPECTION FORM -NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE.DISPOSAL SYSTEM.-INSPECTION FORM PART A CERTIFICATION(continued) Property Address: C� It it o J-4ce./Y-/. P Owner: ka 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(l)(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 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 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 I I OFFICIAL INSPECTION FORM-:NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE'SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION`(continued) Property Address: le Owner: Date of Inspection: j�j� 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.ponding of effluent to the.surface of the ground.or surface waters due to an overloaded or / clogged SAS or cesspool V Static liquid level in the distribution box above outlet invert'due to an overloaded or clogged SAS or / cesspool V 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 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. 1/ Any portion of a cesspool or privy is within a Zone 1 of a.public well. 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.] )e�(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.facilitywith 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) f 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 questibn in Section E the system is considered a significant threat,or answered "y es"'in Section 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 I 1 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE.DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: Y Owner: b/J Date of Inspection: ' 00 Check if the following have been done. You must indicate"Yes"or'no"as to.each of the following: t/ N0 Pumping.information was provided by the owner,occupant,.or Board of Health LZ 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? V 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 V Was the site inspected for signs of break:out? Were all system components,excluding the SAS, located.on site? v — 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. VDetermined 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 INSPECTION FORM PART C SYSTEM INFORMATION Property Address: a Owner t," Date of Inspection: U FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): Number of:bedrooms(actual): DESIGN flow based on 310 CMR 15.203 (for example: 11:0 gpd x#of bedrooms): Number of current residents: Does residence have a.garbage grinder(yes or no): o Is laundry on a separate sewage system (y s or no): [if yes separate inspection required] Laundry system inspected(y s or no): Seasonal use: (yes or no) Water meter readings, if available(last 2 years usage(gpd)): Sump pump(yes or no): O Last date of occupancy: COMMERCIAL/INDUSTRIAY4- 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: Was system pumped as part of the inspecti (yes or no): {,o-- If yes,volume pumped: gallons--How was quantity pumped determined? Reason'for pumping: TYPE OF SYSTEM Septic tank, distribution box, soil absorption system _Single cesspool Overflow cesspool —Privy _Shared system.(yes or no)(if yes,attach previous inspection records, if any) _Innovative/Alternative technology.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 ther(describe):AaQ-,-Q�Y�-e L1Ae1. d1Z7'1-1-S' e approximate 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 i Page 7 of l 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)/X6. 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:_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: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: How were dimensions determined: Comments (on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): GREASE TRAP: Cate 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: Q JAY /Q Owner: e Date of Inspectio TIGHT or HOLDING TANK: .I (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:-Akif 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 leakage into or out of box,etc.): PUMP CHAMBERAHocate 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 Paoe 9 of I 1 OFFICIAL INSPECTION FORM—NOT.FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL.SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION.(continued) Property Address: Owner: �n Date of Inspection: C-) SOIL ABSORPTIO SYSTEM (SAS): t--- ocate on site plan,excavation not required) If SAS not located explain why: Type leaching pits,number: leaching chambers,num er: 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, / /.. CESSPOOLS: (cesspool must be pumped as part of inspection)(locate on site plan) Number and configuration: — C)(6 Depth—top of liquid toailet 'nveDepth of solids layer: Depth of scum layer: Dimensions.of cesspool:. Materials of construction:' fi Indication of.groundwater inflow(yes or no): omments(note condit) o soil,sic o by ra failure, level of ponding,condition of vegetation, C�. PRIVYY-Ik (locate on site plan) Materials of construction:. Dimensions: Depth of solids: Comments(note condition of soil; signs of hydraulic failure, level of ponding,condition of vegetation, etc): 9 Page 10 of I I OFFICIAL INSPECTION FORM=NOT FOR VOLUNTARY ASSESSMENTS -SUBSURFACE SEWAGE DISPOSAL SYSTEM.INSPECTION.FORM FART C SYSTEM INFORMATION(continued) Property Address: Owner: �, , wo,� Date of Inspection: d 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. c P 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: Owner: Date of Inspection: SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water /7 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: /1 7 1i - . Permit Number: _ Date: Completed by: HIGH GROUND-WATER LEVEL COMPUTATION Site Location: �� (,I Lot No. Owner: Address: Contractor: Address: 5 ��'/�S�`/Y Notes: STEP 1 Measure depth to water•table 7 �� to nearest 1/10 ft. ..................................................... . ......................•.... .Date // V13 month/day/year STEP 2 Using Water-Level Range Zone. and Index Well•Map locate site and determine: OAppropriate index well.;........................................ .... OB Water-level range zone ...................................................... STEP 3 Using monthly report."Current Water Resources Conditions" determine current depth to • r l 2 y water level-for index well .......::.................. ®�C�/ month/year STEP 4 Using Table of Water-level,Adjustments, I for index well (STEP 2A), curnent depth to Water level for index.well(STEP 3)., and water-level zone (STEP 2B) determine water level adjustment ............................................................ ............................. r 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).................................................... ................................................................ Figure 13.--Reproducible computation form. 15 . M OL O� _..-..�..-•.--r..-..�s..._�.�- 1. � •_rw•.rv...�rsw....�n.nn.. !SJ �« i' O FEi&.....$',�....00....... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH Town ................OF ......Barnstabl ......................................_.......... .� lirtttiun -fur Bi,ipuiitt1 10orbi Tunitrurtiun P.erntit Application is hereby-made for a Permit to Construct ( ) or Repair (X ) an Individual Sewage Disposal System at: .....................aple.Avenue--------------- ................................................................................................ -Address or Lot No. Harm Lake... Centerville_s-._ .asi...........-............................ ------------------------------- Owner Address ----- ---------0.enteruilile.,...Mass...----------------------------- Installer Address Q Type of Building Size Lot----------------------------Sq. feet U Dwelling—No. of Bedrooms.............................. .............Expansion Attic ( ) Garbage Grinder ( ) Other—Type of Building ---------------------------- No. of persons---------------------------- Showers ( ) — Cafeteria ( ) 04 Other fixtures W Design Flow...........................:................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity------------gallons Length................ Width................ Diameter-.------------.- Depth................ x Disposal Trench—No. .................... Width------------------------------- Total Length.................... Total leaching area....................sq. ft. Seepage Pit No--------------------- Diameter-------------------- Depth below inlet..--...---.......... Total leaching area------------------sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date------------------------------------ W a Test Pit No. 1----------------minutes per inch Depth of Test Pit.................... Depth to ground water........................ f=, Test Pit No. 2................minutes per inch Depth of Test Pit..--.--.......--.... Depth to ground water............-.---....._- -----------------------------------••------------------------------------------------------•-----------•----------------------- ............................ 0 Description of Soil------Sand---&__Gr&Y_el------------------------------------------------------------------------------------------------------- x W V Nature of Repairs or Alterations—Answer when applicable.....-1.-l.000__gallon---pit----(overflowl-------- ---------------------------------------------- ---------------------------------------------------------------------------------------------------------------------------------------•--------------- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Article XI of the State Sanitary de— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has ee lssued by the boar o e th. Sig d- ( __lG'Z13 f...• /7/ 7 ---- •.-- •--•••--°------ Date Application Approved By. = -------------------------- ---�/� 7 7 Date Application Disapproved for the following reasons----------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------•-----------------•----------------------------------------------------------------------------------------------- Date PermitNo......................................................... Issued----------------------------I--------------------------- Date TJ E'COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH Town.........OF...3' n!st-n�.�.�............................................... wftT kati$irate of f�nm ii nrr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired (X ) Jon-1— P. '. non il)r—r, on Tom:° by .--•------------------------------- "-c-•••••............•.... ....---•-.......---•-•-•-•--------••-••-..............�...�e------•----••---••--•-••-•--•--•-•--•- �� Installer tit c�J1^ Avkn e_-' CPC tPrv; 7_!-A has been installed in accordance with the provisions of Ar XI of The State Sanitary Code as described in the application for Disposal Works Construction Permit No--- .. ............... dated-.--.f__7 --------------------- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE-----•-•-•-,/�---�--��-------------•--•-------- Inspector_::---... ... ----- - == ---------••- THE,COMMONWEALTH OF MASSACHUSETTS - BOARD OF HEALTH 7 ....................T.o n......._OF.....8,rn-t,-ble... ------. ........... r. � No. 1`� FEE........=----o....... Permission is hereby granted............ ----__ ---nn T rI t� to Construct ( ) or Repair (X) an Individual Sewage Disposal System �-2 '^ple Ave,)?tt- . ['^.itervi .?e . T,n P at No. = -- ---•---------------•-•-•--••••-•••••....•••-•-••----..........-•-•.-•----. Street as shown on the application for Disposal Works Construction it No ______________ Dated__.__y" .7 .. _...____....... .. 7—7 Boar of Health DATE `---------------------------------------------------------------------- FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS U71 13 FicE......... ...."? No.-•--•-•............. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..n........ of ........ r is 16-b �.e r ' ............----............................................ .................. Apphration -for Uiipooal. orko Tonotrnrtion Vanlit .v Application is hereby made for a Permit to Construct ( ) or Repair (X) an Individual Sewage Disposal System at: •-•-----••------=-'----•--••-----------•---------•--•-------------•-•--•---••-•-•-...--•--••----•• •-----•--•--.......................................-•-•-•-•-----•-•----•-----•-•------•---•----- r _^ Location-Address or Lot Ro. 1f rr�r .._ ' t� Cent=r=*' 'i1P. M�sfi ..-----•--•-----------------•---•----------------•--------•••------------------------------------- ..........................................-....................................................... Address W J c'^T:i1 r�. nC,^ .t;nr _ ' .1^ ?'nc� Installer Address Q Type of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms-----_......................................Expansion Attic ( ) Garbage Grinder ( ) per, Other—Type of Building ____________________________ No. of persons---------------------------- Showers ( ) — Cafeteria ( ) Q' Other fixtures -------------------------------- --- WDesign Flow............................................gallons per person per day. Total daily flow-'...................................--_----gallons. WSeptic Tuck—Liquid capacity_-...______gallons Length________________ Width................ Diameter___-----_-_-____ Depth-__-__-__- x Disposal Trench—No. .................... Width-------------------- Total Length-------------------- Total leaching area--------------------sq. ft. Seepage Pit No--------------------- Diameter.................... Depth below inlet____________________ Total leaching area__-__:-_-________sq. ft. z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by-------------------------------------------------------------------------- Date........................................ Test Pit No. 1................minutes per inch Depth of -Test Pit_----------------- Depth to ground water-..____-_-_-_-_____-.. f= Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water------------------------ ------------- ------------------_ •----•------._--_.---.._....---•-------------------------••-_-------•-•----------•--•------------------------------------ O Description of Soil 5^ C _._r:..;st'a .nl---------------------------------------•--.._ ................................ x V ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- W ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- U Nature of Repairs or Alterations—Answer when applicable._-___ r------i'I_I_^r-_ r_� f, - tn-vrav f'1 .,. _ ___y_____ .... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Article XI of the State Sanitary-Code—The undersigned further agrees not to place the system in operation until a Certificate of dmpliance has/been issued by the board of health. Sig d_. , / ` 'l ✓ 1a.1717 - Date Application Approved B �,� f,�,,t�/) �/ _,.__________________________ ��" �".7 -----------•-•--------------------------------•--•---------------------Date-------------- Application Disapproved for the following reasons______________________ •--------------------------------------•-•-------•--•• -------------------------•-----••----•-----------------------------...------•-•--•-----------------.._.........-----------------------------•---- Date PermitNo......................................................... Issued------------------------- Date BENCHMARK SOIL TEST TOP OF FOUNDATION 20 FT. MINIMUM FROM CELLAR 0 00 10 FT. MINIMUM 10 FT. MINIMUM FROM SLAB OR CRAWL SPACE DATE OF SOIL TEST QJ� � 10 ELEV. - _�_� CLEAN SAND SOIL TEST DONE BY �• T. P,E. (ASSUMED) CONCRETE WITNESSED BY NM. E. RQ0►59N. SR. _ COVERS LOAM AND SEED 4" SCHEDULE 40 PVC PIPE OBSERVATION HOLE 1 ELEV.= 97_4_ MIN. PITCH 1/8" PER FT. 2" LAYER Of_ PERCOLATION RATE _< 2 _ MIN./INCH AT 80� INCHES �• 1/8" TO 1/2" LEGEND: DEPTH HORIZ TEXTURE COLOR MOTT. OTHER 3.5' 4" CAST IRON PIPE " 97.4 MAX. WASHED STONE EXISTING SPOT ELEVATION 00,0 (OR EQUAL) MINIMUM x 96.5 MIN.` FINAL SPOTONTOUR ELEEVATION -O70-0 . PITCH 1/4 PER FT. a z FINAL CONTOUR 0-18 LOAMY SAND 10YR8 3 NO ZABEL FILTER PVC SLEEVE H2O H2O SOIL TEST LOCATION FLOW LINE M 94.40 UTILITY POLE -O- PLUMB/NG T27 B£ RAISED TOWN WATER -W��W-� ELEV. = 96 5 MIN. ° ° ❑ ❑ ❑ ❑ ❑ O ❑ ❑ ❑ ❑ ❑ / 18-42 B LOAMY SAND 10YR8 8 NO EL 93.9 AND RE-PIPED BY A _T 95.25 2'0" o GAS LINE UCENSED PLUMBER As ELEV. - _ _ LEVEL o ° ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ° NEEDED ELEV. 95_5 GAS ELEV. = 94.70 6' SUMP ELEV. _ _94_50 °° ° H2O ° ° CLEAN OUT C ❑ ❑ ❑ ❑❑ ❑ ❑ ❑ ❑ ❑ ❑ 0 2' o CESSPOOL C.P. 0 42' H2O BAFFLE DISTRIBUTION ° ° C MEDIUM SAND 1011it7 8 NO ELEV. ° ° ❑ ❑ ❑ ❑ ❑ ❑ ❑ O ❑ ❑ ❑ ° ° LIQUID OUTLET BOX _ ¢�_ o° ° ° ° ° ELEV. _ _91.65_ DEPTH TEE (TO BE PLACED ON FIRM BASE) 4 FEET 14 INCHES TO BE WATER TESTED 1. _150• 5 FEET 19 INCHES IF MORE THAN ONE OUTLET 3-500 GALLON DRYWELLS WITH STONE 6 FEET 24 1NCHES 1500 GALLON 7 FEET 29 INCHES (TO BE PLACED ON FIRM BASE) /N A 13' X 32' X 2'T14ENCH FORMATION ? 6.75'WE N A NO WATER ENCOUNTERED AT __ilia_ ELEV. _ fl�Q_ 8 FEET 34 INCHES SEPTIC TANK 3/4- TO 1 1/2" CLEAN ZONE N, SOIL ABSORPTION INDEX DESIGN CALCULATIONS DOUBLE WASHED STONE `n ADJUSTNZA FREE OF FINES do SILT SYSTEM SAS _ NUMBER OF BEDROOMS. 4_ • s. USGS PROBABLE WATER TABLE ELEV. = _N/A_ GARBAGE DISPOSAL UNIT NOT_ALLOWED SEWAGE DISPOSAL SYSTEM PROFILE OBSERVED WATER TABLE ( / / ) ELEV. = A_ TOTAL ESTIMATED FLOW NOT TO SCALE BOTTOM OF TEST HOLE ELEV. _ 110 GAL./13R./DAY X 4 _ BR.) MCI GAL./DAY REQUIRED SEPTIC TANK CAPACITY GAL. ACTUAL SIZE OF SEPTIC TANK 1 GAL. SOIL CLASSIFICATION I- DESIGN PERCOLATION RATE S-_ MIN./IN. EFFLUENT LOADING RATE GAL./DAY/S.F. LEACHING AREA SQ. FT. (13'x32')+(90'x2') LEACHING CAPACITY (AREA X RATE) _ 441 GAL./DAY .74 TITLE 5 & B.O.H. VARIANCES REQUI r RESERVES E CHING CAPACITY _NL&- GALJDAY SECTION 15.211 DISTANCE OF S.A.S. TO WATER SUPPLY LINE NOTES: A 1.5' VARIANCE REQUESTED 1. ALL WORKMANSHIP AND MATERIALS SHALL CONFORM TO D.E.P. TITLE 5 AND THE TOWN RULES AND REGULATIONS FOR THE SUBSURFACE DISPOSAL OF SEWAGE. 2. ALL COVERS TO SANITARY UNITS SHALL BE BROUGHT TO WITHIN 6" OF FINISHED GRADE. 3. ALL COMPONENTS OF THE SANITARY SYSTEM SHALL BE CAPABLE OF WITHSTANDING H-10 LOADING UNLESS THEY ARE UNDER OR WITHIN 10 FT. OF DRIVES OR PARKING AREAS. H-20 LOADING SHALL BE USED UNDER OR WITHIN 10 FT. OF DRIVES OR PARKING AREAS. 4. ANY MASONRY UNITS USED TO BRING COVERS TO GRADE SHALL BE MORTARED IN PLACE. 5. NO DEitRMINAiiON HAS BEEN MADE AS TO COMPLIANCE WITH DEEDED OR ZONING REGULATIONS. OWNER / APPLICANT IS TO OBTAIN SUCH DETERMINATION FROM APPROPRIATE AUTHORITY. 6. UTILITIES SHOWN ARE APPROXIMATE ONLY, EXCAVATION CONTRACTOR IS TO CALL "DIG-SAFE" AT 1-888-344-7233 AT LEAST 72 HOURS PRIOR TO COMMENCING WORK ON SITE. 7• CONTRACTOR IS TO VERIFY GRADES AND ELEVATIONS AS WELL AS ■ 95.5 SITE CONDITIONS PRIOR TO COMMENCING WORK ON SITE. ANY VARIATION x 9 3 IS TO BE BROUGHT TO THE ATTENTION OF THE DESIGN ENGINEER IMMEDIATELY. B. PARCEL IS IN FLOOD ZONE _ C - 9. LOT IS SHOWN ON ASSESSORS MAP __207 AS PARCEL 95. LOT 7 10. ALL UNSUITABLE MATERIAL SHALL BE REMOVED FROM UNDER, AND 10,823 t S.F. ?�9' FOR A MINIMUM OF 5 FEET FROM AROUND THE SOIL ABSORPTION SYSTEM, ■ 95.5 9.7 r AND BE REPLACED WITH SAND AS SPECIFIED IN 310 CMR 15.255: (3) II �+ (I.E. TITLE 5) IF ENCOUNTERED BELOW S.A.S. PIPE INVERT. •p 4 s^ 11. EXISTING SEPTIC SYSTEM TO BE PUMPED AND FILLED,WITH'SAND N - - 99.0 �TN CFI /o�� OR REMOVED ` CONCRETE ,.�" ' t SLAB :� CFI1+3G %' Q SEPTI --- SHORT--- �, J � �Ir TANK , 0 988 APPROVED: BOARD OF HEALTH (I , CIVIL Rom' ;.o NO. 274 3 1 . Nn , 6" PVC RAWL -AIL�'4 �� 2499 a' 96.2 SLEEVE 99.1 SPAc �'' DATE AGENT 98.4 97.3 EXS/71NG PROPOSED SEPTIC DESIGN •. _^ Pik;• � DWELLING �_�35 3' o FOR 7 D.B. SR./STEVE LAKE N . ��.P WM. E. ROBINSON, ,mot ,�4 cv 98.6 LOC. 42 MAPLE AVE, LOT 7 S.A BARNSTABLE 9 , MASS $ 7.9 BUMPS RIVER RD. o t3 97.0 94.0 I N 95.2 96.0 98.3 0 CWG R SHORT, P.E. Rr. WAL 9812 " 9 4.1 z 235 GREAT WESTERN ROAD a P. 0. BOX 1044 94.2 �, LOCUS 398�8311 SOUTH DENNIS, MASS. 02660 95A ONCE 93.7 f7SH POND 1/S 08 � � Q f BA CON LN. DATE(? SEPT 4, 200,317ALE 1 „ = 20' �Y. REV. JOB NO. 1--987 LOCATION MAP . FSHEET 1 OF 1 01-0987 Lake SP-OO.dwg 0 2DO3 CRAIG R. SHORT, P.E.