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HomeMy WebLinkAbout0122 MINTON LANE - Health 122 MINTON LANE, CENTERVILLE A= I` �I uU' � J 4fL125343LQR �,; _NAYTIN09.YR; DATE:_ 6.128100--- PROPERTY ADDRESS:__' __----------- - 122_Jdjul<.QTLJ Cent erv_ilk�________-__ On the above date, I inspected the septic ,system at the above address. This system consists of the following: f 1 . 1 -1000 gallon septic tank �� O 2. 1 =Distribution Box L� 3. 1 -1000 gallon leaching pit Based on my Inspectlon, 1 certify the following conditions: 4. This is a Title Five Septic System. ( 78 Code ) -5. The septic system is in proper working order. — at the present time. 6. The leaching pit is- presently dry. SIGNATURE:,./ _..L:J�If� Name:_,L2-. _.l o_c-QMitr-JU _----- 8h� Company: Jcai,ph_E. Hacomb`r_& Son , Inc . RECEO � Address:- Box----6 6--------------- � Centerville Ha__02632-0066 JUL 6 2000 Phone:___508 775_3338___ H.T►+oevr. ---- �, THIS CERTIFICATION OOES NOT CONSTITUTE A CUARANTY OR WARRAKTY JOSEPH P. MACOMBER & SON, INC, Tanks•C0sspools-LoachfIoIds Purn pod L Instilled Town sower Connections P.O. 8ox 6y75,3338ory 114, 02632-0066 COMMONWEALTH OF MASSACHU§ETTS" EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION ONE WINTER STREET, BOSTON MA 02108 (617) 292.6600 TRUDY COXE Secretary ARGEO PAUL CELLUCCI DAVM B. STRUHS Governor Commissioner 191 SUBSURFACE SEWAGE DISPOSAL SYSTEM WSPECTION FORM PART A CERTIFICATION :7/"f Air.: 122 Minton Lane Nameofown« Douglas Richards Centerville Addressofown«: 2 A arehspettlon: 2 Mendon, Ma. 01756 Naf}1e of yt,p*ct": ( e OJoseph P. Macomber Jr. I am a DEP approved system Inspector pursuant to Section 15.340 of Tide 5(310 CMR 15.000) C*ff „rymmTw; Jose h P. Macomber & Son Inc. Maing Address: o x bb, Centerville, M a. •2 6 3 2-0 0 6 6 Telephone Numkw —7 7 5—3 3 3 CERTLRCAT10N 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 Inspection. The Inspection was performed based on my training and experience In the proper function and maintenance of on-site sewage disposal systems. The system: dpassas _ Conditionally Passes _ Needs Further Evaluation By the Local Approving Authority _ Fails _ Inspector's Slgnsturs: .n r �'<. I Ala Dta: The System Inspecto hall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)wttNn thirty(30)days of completing this inspection. It the system Is a shared system or has a design flow of 10,000 gpd or greater,the Inspector and the system owner $hall submit the report to the appropriate regional office of the Department of►Environmerttal Pratectlon. The original should'ba sent tollw system owner and copies sent to the buyer, If applicable, and the approving authority. NOTES AND COMMENTS revised 9/2/98 page Iorii C,Pnnud on R"Ied Paper SU93URIA09 SEWAGE OI3P0SJLL SYSTEM INSP MON FO" r PART A y . CJF3iT1J34AMN (oflifd++uod) Y PropwTyAddrua: 122 Minton .Lane, Centerville °"""' Douglas Richards Deice of b,aO..ctSon: ou 1 6/28J0� "P*CTION 5VIA16"AYt Ch"k A, . w D. A. SYSTEM PASSES: I havo not found ►ny Informadon wNch WIcats# that any of the fa wo oorl t$w dssc ribod In 310 CMS( 16.303 ozlot Any r#& orttsria not ovalwted we Indicated below, COIi.i.tfNTS: S. SYSTIU CONOmoNAILLY PASSES: ` .414„ ono or mwo #y#tem sompon*nu sa desartbod In NIs 'Conddo"►aao' eootlo+t rood to be►oplaood w rop trod. Thd ayst&m. vp compt•don el the (eplosement or(ope)(,rw approv*d by the Soard of H#e)th,wW pass. tndreate yea, no, w not doterrtJnod IY, W. w NO). Cosutbo baal#of dotwminadon In all Wtart000, it*not doterminod', explain why not. The #epd# tank Is moral,urJes#tlo•wn*r w opwatw has provld*d the sy#t*m 4tap*4101 whh#oopy of a CartrAcate o CompUenoe (onoshad)Indlsadnp that the tank war InataiJod wlWA twenty RO)y#ara pr(w to t%* data of ow tnapoctton the sepds took, whothor *r not mote),It wookod,ovu~ally unsound, show#eub#tar+de)Infuv*don of ozftrvodon, or f►Jlure la ImrrJnent. The system wW pa##Uwpoodon If the oxlodnp #opds tank It roplased with a somptytnp a►pdc tans approved by the loud of Ho&M. Sewage backvp or bro►kovt or high stado water level ob#orved In the distrlbudon box le duo to brokon w obstructed Pip or dve to a broken, sotdod or uneven d#vibudon box. The #yotsrn wW pa##In#pootJon It (wtsh approval of VW loud of Ha►Jth). broken plpo(o)we roplaced obowsdon It(*moved dwiW49n box It lov#Uod or roplacod .2 The syrrtom roclutrod pumpirig—m+t!►an'lour'dms#%" rdus to broi(*rtw obiotrvotod plpo(s). Tho Vro mt ww-vww— IrupectJon If(with approval of the Sowd of Hoolth)i broken plpo(o) ere fsplacid obowcdon It ismoved revised 9/2/98 nce:.r11 SUBSURFACE SEWAGE DISPOSAL SYSTEM WSPECTIQN FORMA � PART A CERTIFICATION (continued) Property Ad&*": 122 Minton Lane, Centerville Owrw: Douglas Richards Dow of M►spectlon. 6/28/00 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 WIIng to protect the public health, safety and the environment. 11 SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERIMINES IN ACCORDANCE WITH 310 C>IAR 16.303(1)(b)THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICKYALL.PRQIECT THE PUBLIC klMTV'AND SAFETY AMD THE B'=OkMEWL Al Cesspool or privy Is within 60 feet of surface water Cesspool or privy Is within 60 feat of a bordering vegetated wetland or a salt marsh, 2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH(AND PUBLIC WATER SUPPLIER,IF ANY)DETERMWES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECTS THE PUSUC HEALTH AND SAF°EIY AND THE 11941MONMENT: The system has a septic tank and soil absorption system (SAS) and the SAS Is within 100 feet of a wrface water wpply or tributary to a surface water supply. The system has a septic tank and soil absorption system and the SAS Is wltNn a Zone I of a pubUc water supply weU. The system has a septic tank andsoll absorption system and the SAS Is within 60 feet of a privets water wppiy weU. The system has a septic tank and soil absorption system and the SAS Is less than 100 feet but 60 feet or more from a private water supply well, unless a well water analysis for collform bacteria and volatile organic compounds Indlcatas that the wall Is free from pollution from that facility and the presence of smmonla andn not dlnJtrsts ntvogen Is equal to or less than 5 ppm. Method used to determine distance (apD o 3J .OTHER revised 9/2/98 Pagt3or11 i SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM > PART A L �- CERTIRCATION (condnu0d) propwty Address: 122 Minton Lane, Centerville Ownw: Douglas Richards Dou of wavcdW: 6/2 8/0 0 D. SYSTEM FAILS: You must Indicate either'Yes' or 'No' to each of the following: V_ I have determined rmne that o below. The Boarde of the lof Health owing lshould beure dcontact d to deteons exist as rmin i what will necessary to correct the failure detsrminat Yes No/ componMrdue,to en ovodoedad crclagged 'fAsOr'cNaD001. •y-.. . �([ Backup of$swage into feei8tyer•�Tetetn f the ground or surface waters due to an overloaded or dogged SAS or ZDischarge or ponding of effluent to the surface o cesspool. Static liquid le i in t e�distf,4butlFbo b3ve outlet due to an overloaded or clogged SAS or cesspool. ury _ Liquid depth in�ijjI@ia than 6" below Invert or aysllable volume Is less than 1l2 day flow. Required pumping more than 4 times In the lost year NOT due to clogged or obstructed pipe($)• D fl Number of times pumped Any portion of the Soil Absorption System, cesspool or privy Is below the high groundwater elevation. Any portion of a cesspool or privy Is within 100 fast of a surface water supply or tributary to a surface water supply• ZAny portion of a cesspool or privy is-within a Zone I of a public well. Any portion of a cesspool or privy Is within So feet of a private water supply well. no Any acceptable portion of s cesspool or privy is less•thsn 100 feet but greater than So feet from a private water supply well w'd+or sclifortm bacteria,quality analysis. organic-c the wellompounds,mpounds h+mmonla analyzed nluo9�end nitrate nitlogen.attach copy of wall water analysis or -co E. LARGE SYSTEM FAILS: 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: The system serves a facility with a design flow of 10,000 gpd or greater(Large System) and the system Is a significant threat to F health and safety and the environment because one or more of the following conditions exist: Yes No j d the system Is within 400 feet of a surface drinking water supply / w N �o� rf&o"#k*dn4•w6W-*uPPly the system•I►-witlwr 200 1a+tof•+-+�►t Y _✓ s(Interim Wellhead Protection Area=IWPA)or a mapped Zone II of• pu the system Is located In a nitrogen sensitive are water supply well) The owner or operator of any such system shall upgrade the system in accordance with 310 CMR 16.30412). Please consult the local regi otfice of the Department for further infognation. Page 1 of II revised 9/2/98 I SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Proa«tYAddr.aa; 122 Minton Lane.Centerville D' Douglas Richards Dau o of f inspecdon: 6/2 8/0 0 Check If the following have boon done; You must Indicate either 'Yes' or 'No' as to each of the following; Yes No Pumping Information was provided by the owner, occupant, or Board of Health. None of the system<ompooanu Maw'bwn paw►padoPacJ•aat two•w".k4 aw64be7ystem haabw qucal .a.d AON rates during that period. Large volumes of water have not been Introduced Into the system recently or as pan of thin Inspection. As built plans have been obtained and exominod. Note If they are not available with N/A. _ The facility or dwelling was Inspected for signs of sewage back-up. The system does not receive non-sanitary or industrial waste flow, _ The she was Inspected for signs of breakout. _ All system components.'wrcluding the Soll Absorption System,have boon located on the site. _ The septic tank manholes wore uncovered, opened, and the Interior of the septic tank was Inspected for condition of balls or toes, material of const►uctlon, dimensions, depth of liquid, depth of sludge, depth of scum. The size and location of the Sol[Absorption System onthe site has been determined based on; lz Existing Information. For example, Plan at B.O.H. _ Determined In the field (If any of the failure criteria related to Part C Is at Issue,approximation of distance Is unacceptawo) 116.302(3)(b)) v _ The facility ownw(and.n-�---,Jf dltlaraat from tio aarl.+Kara.prntrldrd,wlsh 1aLau=Woavn 0-Xqp—r=-int f SubSurface Disposal Systems. revised 9/2/98 Page SofII SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C ` SYSTEM INFORMATION PmpwtyAddro,": 122 Minton Lane, Centerville Owrw.: Douglas Richards D.ce of{nap.ction: 6/2 8/0 0 FLOW CONDITIONS RESIDENTIAL; Dealgn flow:�_f).p.d•roedro m. Number of bedroom& •al` Number of bedrooms(actual)j Total DESIGN flow, r Number of current residents:,O, Garbage grinder(yes or no):,p Laundry(separate system) ( es or no ,_; If yet, sepauze Ins pacdon•required Laundry system Inspected no) Seasonal use (yes or no): �' Q Water meter readln'a,If a aliable (last two year's usage lgpd Sump Pump(yea or no):� 6AIIA1, Last date of occupancy: COMMERCIAVWDUSTRIAL: �� Type of establishment: Design flow: Al ood I Based on 16.203) Basis of design flow Alli Grease trap present:lye& or no)." Industrial Waste Molding Tank present:(yea or no)'A Non•s&nitary waste discharged to the Tel 6 system:(yes or no)l� _ Water meter readings,If available: Lost date of occupancy: 41A OTHER:(Describe) AM Lost date of occupancy: tM GENERAL INFORMATION PUMPING RECORDSU and sou1cf of Inform&don: System pumped as part of Inspection: (yes or no)A&P If yes, volume pumped: gallons Reason for pumping: TYPE 0 SYSTEM Septic tank/distribution box/soil absorptJon system ._ Single cesspool _ 4: Overflow cesspool Privy —'T— Shared system(yes or no) (If Yes, attach previous Inspection records.If any) I/A Technology etc. Attach copy of up to date operation and maintenance conuact Tight Tank AA _Copy of DEP Approval Other �f APPROXIMATE AGE of all components, date Installediif known)-and sourw of4o formation: Saw"orlon detected when arriving at the site: (yes or no)9 revised 9/2/98 Page 6ofII SUBSURFACE SEWAGE DISPOSAL'SYSTEM INSPECTION FORM .�. . PART C x ,: SYSTEM INFORMATION(con**jed) P►opertyAddresa: 122 Minton Lane, Centerville owner: Douglas Richards Dete of kapectlon: 6/2 8/0 0 BUILDING SEWER: (Locate on site plan) Depth below grade: , Material of construction:_cast Iron 140 PVC.IfD other (explain) Distance fro mprivet• water supply well or suction line 11- Diameter Comments: (condition of joints,venting, evidence of leakageretc.) Joints appear tight - Nn At,j aent-0 of 3eakagP System SEPTIC TANK: 5 (locate on she plan) Depth below grade: Material of conswctlon::oncrete4Ometal��Flberglass,�Polyethylenoj&other(explaln) 4 If tank is fnetal, list age2,(J�Js.age.con�f)kmed by Certificate of Compliance (Yes/No) Dimensions:q'4" & "l d'l&�/dPi 6-2 /TLno Sludge depth::7-1ULAL Distance from top of sludge to bottom of outlet tee or trsffieA&� Scum thickness: -7,--wQ. Distance from top of scum to top of outlet tee or beffle:LAA Distance from bottom of scum to bottom of outlet tee or baftle:"Q& Mow dimensions were determined: IjAQ1r i Comments: (recommendation for pumping, condition of inlet and outlet tees or-baffles, depth of liquid level in relation to outlet invert, st►ucturalwintegrity, evidence of leakage, etc.) PUMP SeDti r' tank cvcry —yg&rcr,.I ie - --' - tees arp i n jal Are TAJ quid level ett bite riatiet tnveL t7 Ts f My one -inc ea a e a snows no evidence of GREASE TRAP: (locate on site plan) Depth below grader Material of construction:aconcrsta&metalaFiberglass A&Polyethylene&other(explain) AJA Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: AM Distance from bottom of scum to bottom of outlet tee or baffle: Oats of last pumping: A_ Comments: (recommendation for pumping, conditlon of inlet and outlet less or baffles, depth of liquid level In relation to outlet Invert, structural Integrity. evidence of leakage. etc.) rease trap revised 9/2/98 Page 7orn ' SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM ►ART C� » �.' •"� SYSTEM INFORMATION(corrdrwQl P+oqwTy Ad&e": 122 Minton Lane, Centerville "Derto Douglas Richards .a 6/28/00 TIGHT OR HOLDWG TANK:-4h&L(Tank must be pumped prior to, or at time of, Inspection) (locate on site plan) Depth below grado: A Material of consvuction:"concrete IametalW,Flberglsss44IPolyethylene4yother(explaln) AM A —— — Dlmenslons:_ 44 � Capacity: ghIl gallons AlDesign tlow gellonsldsy Alarm present Alarm level: Alarm In working order:Yes A14 NoAlh Dote of p(svious pumping: _yI_ Comments: lcondition of Inlet tse, condition of alarm and float switches,etc.) _ i a n l rl i n g +_^.CGS a"!ri a ii A t=pi�e s 2 Ot•STRIBUTION BOX: llome on elto plan) Depth of lipuid level above outlet Invert:_ Comments: Inots If level and distribution Is equal, evidenoo of solids carryover "dance of leakage Into or out of box. etc.) — Dis fVo evidence of solids carry over.no evidence of ,3} of thQ bgii; PU1AP CHAIM5ER: 14- llocato on site plan) Pumps In working order:(Yes or No) AJA Alarms in working order IYos or No) Comments: Inots condition of pump chamber,condition of pumps and appurtenances,etc.) umo P i c nnl- r�re+e revised 9/2/96 ►a�r�°rIi f SUBSURFACE SEWAGE DISPOSAL SYSTEM WSPECTION FORM PART C x r ' SYSTEM INFORMATION (continued) PropsrtyAddresa: 122 Minton Lane, Centerville Owrw: Douglas Richards Dau of hspecdon: 6 f 2 8/0 SOIL ABSORPTION SYSTEM(SAS):, *TIO aO4 (locate on sits plan, If possible: excavation not required, location may be approximated by nonantruslve methods) If not located, explain: Type: leaching pits, number: leaching chambers, numbs r:Q leaching galleries, number: leaching trenches, numbs(, length: o leaching fields, number, dimension overflow cesspool,number: Alternative systam: Name of Technology: a O ` Comments: Inote condition of soil, signs of hydraulic failure, level of poncUpg, damp soil, condition of vegetation, etc.) Loamy o sicrns of hydraulic or pon q sn; l s ArA dry}. �IPfat;nn s nG?rm:Il. CESSPOOLS: e (locate on site plan) Number and configuration: 0 Depth-top of liquid to Iniat Invert: j Depth of solids layer: Depth of scum layer: Dimensions of cesspool: Materials of construction: Indication of groundwater: Inflow (cesspool must be pumped as part of Inspection) Cesspools Comments: (note condition of soil, signs of hydraulic failure, level of ponding,condition of.vegetatlon, etc.) esspoo s are not tarPGPnf PRIVY:44 (locate on site plan) Materials of construction: .�f/� Dimensions: A/�9 Depth of sollds:—Aa Commenu: Inote condition of soli, signs of hydraulic failure, level of ponding, condition of vegetation;etc.) -Fr—ivv is not- pri-qPnt- revised 9/2/98 PaQe9of11 SVISUR/ACC Il!WAOC CtSPOSAl SYs7W LNsnc oN FORJd PART C SYITt A OF-Op."AltON(aondr+wE) ►rop.rryAaa...,: 122 Minton Lane Centerville 0 vrnwr i Doug Aso,,, Douglas Richards 6/28/00 SK.UCH Of SEWAOE OtSPOSAI SYSTE)A: Inclvd, dqs to .t lg6st two p#rmsnent reference Isndmwks or bsnchmuks loceu ell well& wlWn 100, Ilocste when public wets&supply comes Into house) i z Z rn►� I-n , C�v��«�;lip G. revised 9/2/98 10of11 SUBSURFACE SEWAGE D►3PQSAL SYSTIU INSPECTION FORM PART C ° SYSTEM YOORMAT1,10N (aortf eked) Property Ad&&": 122 Minton Lane, Centerville o"'n'" Douglas Richards oeu of{nsp.ctlon: 6/2 8/0 0 NRCS Report name Soil Type_ Typical depth to groundwater USOS Date websits visited Observation Wells chocked Groundwater depth: Shallow Moderate Deep SITE EXAM Slops Surface waist Check Calls( Shallow wells Estimated Depth to Groundwater Feet Pleaso Indicate ail the methods woad to determine High Groundwater Elevation: _ Obtained from Design Plans on record t,.,m�in.d �1,c.l T.ndlJ!, observation hole, basemeat sump etc.) Checked with local Board of health Checked FEMA Maps I/Chocked pumping records III _j�-IC/hecked local excavators, Installers Used USOS Data Describe how you established the High Groundwater Elevation. JHYd be completed) Used water contours Map Gahrety & Miller Model 12/16/94 revised 9/2/98 Pigs It of11 .•nmr::-w.rw-�^r• rwrww•r.rnr�T.+ew�.�wn�.•++.�.►iw�w+w�n�.wv.ww��n�•n�w�r�-ww`+�r.�.�� .�+-.-.^�++w- . ,- • 'I'OWN OF RARNgTART.F UOARU OF HEALTH _SUBSURFACE 9EWA(;F-(,I 1'USAL�gY1 SYSTEM INSPECTION FORM -' PART D •- CERTIFICATION� - I -TYPI OA PAINT C1.6AALY- 1 PROPERTY INSPECTED STREET ADDRESS 122 Minton Lane, Centerville ASSESSORS MAP, BLOCK AND PARCEL I OWNER' s NAME _ Douglds Richards PART D - CERTIFICATION NAME OF INSPECTOR Joseph P. Macomber Jr, COMPANY NAHE Joseph P. Macomber &'`Son, Inc. COMPANY ADDRESS Box 66 Centerville MA. 02632-0066 Str•.t Tovn or City at�t• i P COMPANY TELEPHONE ( 508 ) 775 3338 FAX ( ) w CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this nddress and that the information reported is true , accurate , and omplete as of the time of -inspection . The inspection was performed and any recommendations regarding upgrade , maintenance , and repair are consistent with my training and experience in the proper function and maintenance of on- site sewage disposal systems . Chec one ; 7 ' System: PASSED ' The inspection which I have conducted has not found any information which indicates that the system fails to adequately protect public health or the environment as defined in 310 CMR 16 . 303 , Any failt►re criteria not evaluated are as stated in the FAILURE CRITERIA section of this form. System FAILED* The ilnspection which I have con 17tted has found that 'the .system fails to protect the Eitiblic health and the environment in accordance with Title 5 , 310 CMR 15 , 303 , and as specifically noted on PART C - FAILURE CRITERIA of this Inspection form , v - Inspector Signature Date 451,--o�/C�l� ne copy of this certification must be provided to the OWNER, the BUYER ( where applicable ) and the BOARD OV HEALTH, If the inspection FAILED , s` the owner oroperator shall u• pgrade ' the system within one ,year of the date of the inspection , unless allowed or required otherwise as provided in 3.10 CHR 16 . 306 . partd .doc No. d� � Fizs........ i THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HE TH -------------OF....1116 Apphration for Disposal Works Tonstrn.rtinn Prrutit Application is hereby made for a Permit to Construct ( -) or Repair ( ) an Individual Sewage Disposal System t ........... ....cl� Location- /ress Lot No. Ow l'r ] ��tj� Address Installer Address Type of Building Size Lot... �J} l2Sq. feet Dwelling—No. of Bedrooms-------I I.............................. Attic (0116 Garbage Grinder p-, Other Type of Building ___________________________• No. of persons............................ Showers ( ) — Cafeteria ( ) a' Other fix s w Design Flow............... .-_�..................gallons per person per day. Total daily flow____ _.....................gallons. WSeptic Tank—Liquid*capacity�G�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.................. . ft. Z Other Distribution box ( ) Dosing �an� ) )7( �' 2Date �- '-' Percolation Test Results Performed by-__._��l�s"� -�--..-.__�J/���'�.'��I. ___--•____. �� _._---__Test Pit No. S__._minutes per inch Depth of �Yest Pit.____ _ _./___ Dept ground water._n_. /} r=, Test Pit No. rhOVA-minutes per inch Depth of Test Pit'-- ____-_•- Depth to ground water�'_!-�.' O ......................•-•-• --••-- O Description of Soil_.- 1 -r-r' 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 TITI1E 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has bee *ssued by the b and of health. Signed _ ........ - - .......................... - Date Application Approved By............... --------• .............. ...... ................................• Date Application Disapproved for the f owing reasons---------------------•-------•-------------------------------................................................... --------------------------------------------•--------------� Z • ...-.•--..--------------•--.._...-----------....--_-----••----------------•----------------- -•-••--------........................ Permit No.....---!_5--------1 3-02----........ Issued_....... �-e 0 _Date Date -� -e V 1 t No......................... Fizz.............................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALT ..............OF..-............. .... ........................... Apptirtttion for Biopoottl Works Tonstrnrtion 11amit Application is hereby,made for a Permit to Construct (,* or Repair ( ) an Individual Sewage Disposal Sy st /a : zt�,le5l:� AVeAr7.e......... ... -------------------- /1 Location- %dress Lot N .......CHO, e. Owner Address PQ Installer Address ,�_��tt ^• U Type of Building Size Lot__ ` _ 2��Lq. feet g— ______________Expansion Attic ??C) Gar ge Grinder 6 P Dwelling No. of Bedrooms_______ ___________________ Other—Type of Building ____________________________ No. of persons............................ Showers ( ) — Cafeteria ( ) P4Other fixt�= ,.;.............................................................................................. W Design Flow.............. ___ _____________-----gallons per person per day. Total daily flow_._ ___:_______._.._____gallons. 1:4W Septic Tank—Liquid capacity 40_ 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�m�k Percolation Test Results Performed by .......�'__ Date__________ ___ .__. .__ _.. Test Pit No. minutes per inch Depth of ' est Pit------ Depth ground water_. _ ,e�_ • GJ 4= Test Pit No. h L __minutes per inch Depth of Test Pit__/ ________ Depth to ground water........................ 0 __-_ ............. i" Description of Soi�l^py(( = �d ]�-<g eA f----- / ---._ ►.... w x •-••-------•-----------------------•--•-------•---•--------------•-------------------•-----•-••--------------------•-----------------••--- ........................................................... 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 TAIT LE 5 of the State Sanitary Code.—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has be ssued by the b and of heatt . g � rr � J. Date ApplicationApproved By.................................................................................................. ........................................ Date Application Disapproved for the following reasons---------------------•---------------------------...........................................-•--•-----••••-••••- -------•-.........--•--•..............•-•-•----•----------•----_..._.._..------•--...._..__._...------....-------------......_.__--•-•---------•-••--•--•-------•----•-••------------•-----•---------•_.. Date PermitNo......................................................... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS • BOARD OF HEAT /�.'� -tee• ;,. ..............0F. .. _. T .:............................. f�rrtif irtttr of �om��ittnre T� IS TO C TIFY, That h Individual Sewage Disposal System constructed (tlf�or Repaired ( ) f --- ---- ---- ------------------- ----------------------------------- s alley �r /� has been installed in accordance with the provisions of TITLE of The State Sanitary Co as d -cri ed in the application for Disposal Works Construction Permit No..-_.____ga___ig .......... da.ted..... ----------- ............... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GU AN EE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE.............g ... / -_ _................................. Inspector...........-- ----. . ............................................. THE COMMONWEALTH OF MASSAC USETTS �..--�--" BOARD HEALTF e ............'OF.... _z .. PC/= . G'. t '----------------- No......................... FEE..... ................. �io�ro� or�oonotr n rrmit yg S- ____: ta_Permission >s hereby ranted----•---�=-=--=---�----- -----------------------------------•-----------...------.._...._...-•-----•-•--- to Construr ( pa>r ( an Indio-dual Se age D> pos System at No..._t�_$__ '"l /7e.._._. r�' �. rrl ----------•-•---- ----------------•-......................................... as shown on the application for Disposal Works Construction Permit No..................... Dated.......................................... .._...--•---.....---•----•-----------------------------------------------•----------------------------- Board of Health DATE............- -----------�� =-----•-•-•---- FORM 1255 A. M. SULKIN, INC., BOSTON ' e' �j ��+ Ll i / A'9 lb It" r- !`f -43 ALBERT A. MORSE s--- �n A No. 10951uj O 2 —� fk OF Nl BRU mWRE f a ` ��P4SH OF,ygs f 1 0 y K. \ iI / 1 8 /o / ✓1 I PHILIP ,� fL 366��0 ( ! �( y STe \ �� y N e�r►��' !S�� : ' '/ I II ass/ANAL _ I -� � ' r � ;��4 CERTIFIED PLOT PLAN 1. WAY �.. /- '73 !, / IN ; -- 1 C57 J p.T �ylsz/7 S q/8s SCALEt / =. mil/) DATE , ro ;?OIL 95 L DREDGE ENGINEERING Ca CLIENT .. 1 CERTIFY THAT THE PROPOSED E4:ISTERE REGISTERED JOB N0. 3. ! 6UIL.DINO SHOWN ON THL3 .PLAN CIVPk. LAND CONFORMS TO THE ZONING, LAWS DR BY ENGINEER R Y �*--�--� OF SARNSTABL .MAS k. 12 MAIN STREET CN; 9Y a .��. ':y H`YA N.N.I S� M A.3 3. Z, 3NEET...L:`Or :�.., ATE REO.,,. LAND , SURVEYOR /VOTE /f EIrNER TNf SEPT/C TANK OR r 20 FT M//V: LEAC.VIMS A/T A Vgr MORE THgN /O PT• IM/N. lRAPArj A "-,DIAMETER CONCR'.ETI¢ COVER. ? S,4/ALL BE OROU6,yT TO G/T.4OE.64N.EXTRA CON�ETL 9�PYC P/PL /YEAVY CAST/ROV CO 4MM Sf/,4LL- BE US�O M/N. P/TCN !F/N OR/VEJMA r ? 3.0 COYERS �'plgp FT _ 2 R MIN. CCNCR•�TE A : �y of GO rER CLEAN SANG • . . BAGXF/LL o y --- L/ t/ID LEVEL • - � • - - � 1 •-�; .. 21 AYER /R0 P/PL /OOC7 OA4. M/IV.P/TtN D/ST. , • . • . •• • s •,�� /YASHFD ST1�NE . % PAKR IT. SEPTIC TANK BOX o • 8 • • • •• • .•• •� • �. OJEPTJI � �• 1V.4SNED STDiYE s • r • • • ••rf � • , 22G x25 = S6S. 0 � •• • • . • • • �• . I :i PRECASTSEEA"GE / 13x /•O l 13 -y s •� • • • • • • • • • • • P/70R EVVIV l Nf�ERT EL EYAT/G�Nd . �' E r i s •0 b7 8. Day /NYERT AT AWING !9•a FT. 'INLET SEPT/iC TANK. l 6�_o•FT, /2 fT. O/i4M• C SEE Tel/�AF, a DU74ET SEPTIC TANK TAALE ALBERT AFT. E�t 3/c� //VLET O/STR/B/!T/O /G¢g N BOX FT SECT/ON OF GROI!/1/OT - a r v s loantTD/STR/BUT/ON BQX l 64,6 FT, INLEET LL•i4CN/NG PIT Ll 2.0 FT, SEWAGE G15~Al SYSTEM �" No.10951 , TAQWLAT/OH 9 LEACHIMS PIT -SCALE %4• : /=o� DIMENSION A_�_FT. DRS16X CR/TERI.rI D/>".F/irs/oN H-�—FT- Li > :c!0ti'� N/1MQER OF BEDROO/e!S 3 GA,PeAG,E•o/SPOSAL vN/r SOIL LOG s01t TEST r07AL ES7114, reD FLDrt/3_G. 1-.1DAy SOIL TEST / SOIL 7--45-S77-02 NUMBER G1F LL`ACN/NG PITS / ELEY. 132 ELA-s �G4-D OATS Oi SO// TEST -S 3 I- y SIOE LZ'ACHIA/G PER PIT -.tt fT. O'-�2-?- RESULTS iV/T/VESSED SY B E �iGFo20 U- G. z L o R m AER cazAwoN vATls / L.fss Ay/v/l ychf EOTTOM L6ICN/NG PEJ�P/T_LL3..._Sq. pT. GOA/Y! A � ""� ,4 S FT. Svr3 So«- )W/eCOLAT/ON RATE 02 �NM/X f/JVCN O .�1 L /NG REA �- T T L EACH. 4zz RESERIiEGEAC"NlN6ARE/� 339 Shi. FT r r �. 2 .- 8 � 2-0 �t�iur� (0,vy So/L TEST Tom- 34IO comPAcTE/� PLZH OF�yS \'i' Ss�-NO `r ' L.U T /8 M/NTvN �A IV' F «Af cic I- d F„vEs /--E MRU(: `w .sssG r r�NE �Ati►? ELORED6LFEIV PlAtA ERIAUCO,/IVC. ��sTE�A�`��; � +o ELEV 120-1 EtEv 152.O 7/Z MAIN -9 NYANNl9, AIAS e - FrS10NAlENG` �Nd 5ll ®. IVOGROUND YYATrR AWC041 TV7A G CL/EN7GPE,--Al E,e DATE= - 20"- G7 G/ROLIAI p yvs�TER AT ELEL!. ✓OD /41D. 3 Zv Sf/E.L�T?-OF 2- GENERAL NOTES . f NLOCATIONS ARE BASED ON ANON THE GROUND'INSTRUMENT SURVEY AND ELEVATIONS BASED ON THE NAVO 1988 DATUM.COORDINATE SYSTEM USED IS THE MAMAINlANO COORDINATE SYSTEM. LANE CC DATUM:RAD 83,UNITS:U.S.SURVEY FEET. �NL DIMENSIONS OF EXISTING BUILDINGS AND BUILDING OFFSETS SHOWN HEREON ARE TO CORNER "� R tf �� M50 Y.1SDE-PRSVATEI BOARDS OR SIDING EXTENTS AND ARE DISPLAYED IN ENGINEERING UNITS WITH A PRECISION OF ONE EDGE OF PAVEMENT TENTH(0.1')OF A FOOT. 1 THE FINISHED FLOOR ELEVATION(FIN,FL.EL.)SHOWN HEREON IS BASED ON AN ASSUMED I'LOWER WATER R_398 85 THAN THE SURVEYED THRESHOLD ELEVATION.AN INTERIOR INSPECTION OF BUILDINGS WAS NOT GATE L_124.7T PERFORMED. co QW OO ZONING DISTRICT:RF(RESOURCE PROTECTION OVERLAY DI6TRICT) ZPROPERTYIS LOCATEDWITHINANAREAHAVINGAZONEDESIGNATIONOFMINIMALHAZARDXBYTHE =LOCUS mI ' �) § '^- `h'- BENCHMARK O" FEDERAL EMERGENCY MANAGEMENT AGENCY(TEMA),ON FLOOD INSURANCE RATE MAP NO. WATER GATE COVER 2—00561J WITH A MAP EFFECTIVE DATE OF JULY 16,2014. [,r ELEVATION=142.46'NAVD88 THIS LOT IS NOT LOCATED WITHIN A OEP APPROVED ZONE II WELLHEAD PROTECTION AREA- THIS LOT IS NOT MAPPED WITHIN AMESA NATURAL HERITAGE AND ENDANGERED SPECIES AREA Alas s Y,h LOCUS MAP NOT TO SCALE LOT 18 WIND EXPOSURE CATEGORY:ZONES 45,761 S.F. DEED REFERENCE:BOOK 13117 PAGE 1M PLAN REFERENCE:BOOK 38,1 PAGE 85 I / •1297 OWNER: SUSAN A LAVOIEA -131 7 EILEEN R.S ALLYN R.GARDNER 1 In MINTON LANE WEST BARNSTABLE,MA 021%8 �HAIM LINK FENCE�� 2 \ -100 � LOT 17 LOT 19 PROPOSED GARAGE aO PROPoSEO C:S4N GRADES TO BE ORR'EZYAV - PRO P SET BY BUILDER OARAGSE 152—— E ^vo[ / 15 IR- j 53.D�W 159.9 Z � z CONC,PA ilO S 5 10 :g GASH( PAL 1By. NOTICE METER/\A/ SH o.oE�Erto rnox.w u*EVFo1v N+r wAr er NnoxE orvEu*wv uae EO // POOL 162 4Nr.vos EucweEwvV,w. j ONE.PAD i 1S<\ �vFA.mxS.xuw vAtoe Pu&Ic ofnau Nnv pF.tOrl suwxixEwwewtlox coNTNx[O wEw:nxC PROPOSED DU PMENT/^bry�/ S TIMBER WqC ]74 _ aror ewre auo lsuvos Evelvcfwxc.lxe ADDITION / \' ^ TEP COPYRIGHT(C)BYCAPEB ISLANDS ENGINEERING,INC.AL LRIGHTSRESERVED j 2 .9 OE K eRlco, BENCHMARK DATE ]DESCRIPTION BV CHK W PREPARED FOR: _ EDGE R PATIO AT STAIRS SUSAN A.LAVOIE& Ali / A111 — ELEVATION=161.68'NAVD88 LEGEND � / `�/ � OWEIIIN PgT10 EILEEN R 8 ALLYN R GARDNER ■CB-------CONCRETE BOUND / / p + FVV FL O PROPOSED 122 MINTON LANE _______ 5i El_ - _ ADDITION WEST BARNSTABLE,MA 02668 SRC-------STONESROD UNO /\�1/\ I GAS EC,ME 74.S �T10 1p DECK TO BE DIP -------IRON PIPE FOUND 2 \J J METER; REMOVED PROJECT: �y -------HYDRANT / Z J J 169.7/ RICK 11.ry PROPOSED B -------WATER SHUTOFF 3 J1 1 O STpOP 188 \ 010' WOOD DECK 122 MINTON LANE --CATCH BASIN SQUARE OW 69.fi 1p' AND STAIRS �0,� -------UTILm POLE i / aWN F( ��S BRICK t0' 10, WEST BARNSTABLE.MASSACHUSETTS I O- _-____-GUY POLE / I I 10, . -------GUY WIRE 1 '. -------LIGHT POLE 66.7 \ GR EDGEOF SHEET NO.:1 OF 1 DATE:MARCH 18.2021 ___ DRIVEL~ LAWN COBBLE CBDH FOUND DRAWN BY:MPR CHECKED BY:MC ---SIGN / E ✓/ -------CONIFEROUS TREE N \ EDGING PREPARED BY: ® -------DECIDUOUS TREE COBBLE EDGE OF GRAVEL ® -------TREE STUMP APPROXIMATE LOCATION APRON A�1 _____--SHRUB OF SEPTIC SYSTEM _ CCAPE&ISLA DS --CONIFEROUS SHRUB FROMTIECARD 13OAZ EDGE OF PAVEMENT TREE LINE S r 5B 15"W SEMENT--- E N G I N E E R I N G ��iGMT OF WAY AND UTILITY E1= UP ONW OVERHEAD WIRES 800 FAL OUT PARK 5884777272 PHONE OOO C]O- STONEWALL UP UP LOT it MAFALMOUA 02IM9 SUITE]O1C 5884779072 FAX wwW.CapeElg.tnm LOT 10 �] MASHPEE.MA 02fi49 . O 0----0 —POST 6 RAIL FENCE DRAWING TITLE: —p—p—�STOCKADEFENCE 0 30 60 100 PICKET ROW PROPOSED ADDITIONS PLAN CHAIN LINK FENCE O---____AREA OF STRUCTURE INCLUDED IN SCALE:1"=30' EXISTING LOT COVERAGE ASSESSORS INFORMATION: MAP 174 PARCEL 025 INTO~t22 IAVOIE PROP gpDITgNB �LONGFELLOW D E S I G N B U I L D GARDNER RESIDENCE o�N UV 122 MINTON LANE,WEST Number Sheet Neme Revision BARNSTABLE,MA 02668 A000 COVER A001 ABBREVIATIONS B SYMBOLS A010 DEMOLITION PLANS AIN BASEMENT FLOOR PLAN A101 PROPOSED FIRST FLOOR PLAN A102 PROPOSED SECOND FLOOR q�y� PLAN _ A201 EXTERIORELEVATIONS v oescwanary onn: - - -- -- A202 EXTERIOR ELEVATIONS - - - AM1 TYPICAL BUILDING SECTION 1� drARDNER RESIDENCE 122 MINTON LANE.WEST I BARNSTABLE.W W— s I ISSUED FOR - - _ CONSTRUCTION i u _ T COVER a PROJECT NUMBER 0122 •DATE OM1212021 " •DRAWN BY: SGE A000 .Sane �LONGFELLOW O E S 1 B N B 11 1 L 0 oa sn1N o u+rE oesl"" { aensron ' w 1 �Na I uc aoov -m /\ tlPAS NN I I •a s-z.tt W-IN- I I uo rows Nwu� swwN1 L I F G� � �ansovE lwu�oodl �3 souorosrswwnu � ro swr m cRo H oiazIF e W I H x i RARDNER RESIDENCE 122 MINTON LANE.WEST BARNSTABLE,MA 026 otcN MaEsoEo ISSUED FOR CONSTRUCTION PROPOSED FIRST FLOOR PLAN FIRST FLOOR PLAN a PROJECT NUMBER 0122 4' x DATE 09112/2021 c DRAWN BY: SGE A101 �LONGFELLOW DESIGN BUILD -------------------------------- r° � } Rn � rwc Ryon vsc I �I ------------- .- I I I I I _IT avEwnc I,: I wrt Inc.wonrc1_—_—_ I wrtH 7w 11Evwav(1Vv.) 1 "l wT m swaE as�OuaEo as ualwEn CE vnT.TnE..I— _ V�—cnwnEvfWno.vlv. I crtavrt svacE B•atEMExT ao I "� Ja MxconcM �.. 1.1EFT acTEo wE I I aev.is o.c. p I I oRx 6Ts L ——— — 4777777177777777771 — -- -- �--- ---------- __ a:•—T.. RDNER RESIDENCE nE�Essan� FA an _ 122 MINTON LANE WEST BARNSTABLE,MA 02668 (IVV.)aBOVE ISSUED FOR CONSTRUCTION nBASEMENTFLOOR ----' PLAN •PROJECT NUMBER 0122 •DATE I-1=021 n DRAWN BY: SGE 1 BASEMEN 1/a' 1'O• A100 a � �LONGFELLOW DESIGN B 11 I ID ri N -- — --- ----- — _ na -- — wELSPNG BEORWM nTTF KCE55��� •rnC EASnac eOOR + ----------------i-gym-- •uARDNER RESIDENCE B€S5 122 MNTON LANE.WEST BARNSTABLE,MA 02EB8 ISSUED FOR 1 secoNRPvw CONSTRUCTION N-1 0' PROPOSED SECOND FLOOR PLAN •PROJECT NUMBER 0122 .DATE WIM021 a DRAWN BY: SGE f� A102 •Sz a 1/,'-V -jr's map and lot number Sewage Permit number .... s..........�.�q c: � @ j ARNSTABLE, �r �` Yaea House number ....... eeqq 'oo �YPY TOWN OF BARNSTA? r BUILDING INSPECTOR - 4 APPLICATION FOR PERMIT TO C `: 5 ' Z�'.. .... ..................... TYPE OF CONSTRUCTION �.Y. �'� -�"�.'.. ............................................. ................. .... .......................................................... .................1.` 4.z.z.-..19.... ... TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permi according to the following information: Location ..............................v6T.................... .l.. ..........1"!Z ................................... � Proposed Use .................................... -/t�/.�.........f%:.':.7-- ..................................................................................... !!! Zoning District ......................K............................................Fire District ......................... .........Q.................... . . Name of Owner .............off. �.!a, .......Address ................f v� .......... ....... ic„ Name of Builder ......'...........................Address .............................. Nameof Architect ..................................................................Address .................................................................................... Number of Rooms ......................6......................................Foundation ................60a'.v::.�..................... Exterior G L.... 'fit..fJ.lJ........ � .......Roofing A5� ..,�!�� 1......... 23.................... InteriorFloors ..................�j. ...................... .......T ...<.... ......................... Heatingj�� ....x....../6.�...... 6.��.............. .......................... � ............ Fireplace ....................................................................... ......Approximate. Cost ............... .5.�/.. ..©.v....... �. Definitive Plan Approved by Planning Board ______ ----------19_ Area l ../.�.....`t Ov Diagram of Lot and Building with Dimensions C. Fee SUBJECT TO APPROVAL OF BOARD OF HEALTHcj y YI 1 P\ 1 A LI M / J*Q 0 { /fit,'po✓•-rnc4,: P I i d r /8 1 9 ,7 & s, F 1 I � ' o r ' 4 237 r : M Ill., X34 OF r I • �Y n RODERT ►� ELDIIL•DOE '^ ko. 1 D;,07 P l t I s T /S 1 45,-763 s, F i I f � 1 r . I n, 3-4- 0 •�/ q1 13. `}7 I ' v CERTIFIED PLOT PLAN n o I N ISAAASTASLA4 MASS* "c)"f SCALES /,r_ �D DATE - 411�/�s. E ENQ! EE lNG CO.l 1 CERTIFY THAT THE °v'✓vpT' CLIENT SHOWN ON THIS PLAN IS LOCATED EGISTERED REGISTERE CIVIL LAND D JOB N0. g3 zo ON THE GROUND A9 INDICATED AND ENGINEER SURVEYOR glti.BY, ' '4' CONFORMS TO THE ZONING LAWSOF BARNSTABLE , MASS. CH.By I 7f a3.E"• T 12 M A i N STREET . �--- 4DA HYANRIS SHEET MASS. I QF SUP'"