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HomeMy WebLinkAbout0284 OAK STREET (CENT./W.BARN) - Health (3) 284-.Oak Street - C Centerville A= 194-001-002 0%,ford, NO. 1521/3 ORA ;:�. 10% Commonwealth of Massachusetts _ Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 284 Oak St. Property Address Richard Lorenzotti Owner Owner's Name information for is every West Barnstable required for eve � MA' 02668 9-23-13 page. City/town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way.Please see completeness checklist at the and of the form. Important:When tilling out forms A. General Information on the computer, I�� use only the tab 1. Inspector. key to move your �III TTTTTTTT cursor-do not ,lames D.Sears use the return key, Name of Inspector Capewide Enterprises,LLC Company Name 153 Commercial St. Company Address Mashpee MA 02649 Cityfrown State Zip Code 508-477-8877 S 1623 Telephone Number License Number B. Certification 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 ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority-� 9-23-13 Lvol0ector's signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP)within 30 days of completing this inspection. if the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ""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. ISlne•3113 � �/ �� �, Title S Onf del ksspecll F :SLAbnelece Sewage Oisp el syst�•Page 1 of 17 c i Sep 24 13 04:59p p.2 i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 284 Oak St. Property Address Richard Lorenzotti Owner Owner's Name information's every West Barnstable required for eve MA 02668 9-23-13 page. Cityfrown State Zip Code Date of Inspection B. Certification (cost.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D Aj System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 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. Check the box for"yes", "no"or"not determined" (Y, N, ND)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 unsoundr exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND(Explain below): t5ins•3113 Titla 5 Offidal Inspection Form:SLLsuTBce Sewage Disposal System-Page Z or 17 Sep 24 13 04:59p p.3 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 284 Oak St. Property Address Richard Lorenzotti Owner Owner's Name reformation is every West Barnstable quired foreve IVlA 02668 9-23-13 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumpsialarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes(cont.): ❑ 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 dfstribubon box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below): C) Further Evaluation is Required,by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines In accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins.3113 Tice 5 Ofrtdal hmpe0on Fonrr Stbeutfem Sewage Disposal System•Page 3 of 17 pep 24 13 05:03p P.1 d1 �■ Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 284 Oak St. Property Address Richard Lorenzotti Owner owner's Name information is required for every West Barnstable MA 02668 9-23-13 page. Citylrown State Zip Code Date of Inspection B. Certification (cont.) 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 fecal coliform bacteria indicates absent 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: 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 Q 0 Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in del is less than 6" below invert or available volume is less than %day flow t5ins•3113 7iea 5 Owiidel Ins pectien Form:Subsurface Sewage Disposal System•Page 4 of 17 Sep 24 13 05:03p p.2 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 284 Oak St. Property Address Richard Lorenzotti Owner Owners Name information is required for every West Barnstable MA 02668 9-23-13 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® 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 acceptablewater quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent 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 and chain of custody must be attached to this form.] ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system.fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no"to each of the following, in addition to the questions in Section D. 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 If of a public water supply well If you have answered"yes"to any question in Section E the system is considered a significant threat, or answered"yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 15ins-3M 3 Title 5 Ol6del Inspection Forth Subsurface Sewage Disposal System-Page 5 of 17 Sep 24 13 05:03p p.3 5 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 284 Oak St. Property Address Richard Lorenzotti Owner owner's Name information is West Barnstable MA 02668 9-23-13 required for every page. Citylrown State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes' or"no'as to each of the following: Yes No ❑ ® Pumping information was provided by the owner,occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ❑ ® Has the system received normal flows in the previous two week period? . ❑ ® Have large volumes of water been introduced to the system recently or as part of, this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ❑ 0 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: ® ❑ Existing information. For example,a plan at the Board of Health. ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable)[310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms (design): 5 Number of bedrooms (actual): 5 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 550 t5ins-3/13 Title 5 Official Inspection Form:subswace sewage Disposal System-Page 6 of 17 i Sep 24 13 05:03p pA Commonwealth of Massachusetts IVTitle 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 284 Oak St. Property Address Richard Lorenzotti Owner Owner's Name information is required for every West Barnstable MA 02668 9-23-13 page. City[rown State Zip Code Date of Inspection D. System Information Description: The system is a 1500 Gal. Tank D Box and 30 chambers. Number of current residents: 0 Does residence have a garbage grinder? ❑ Yes 0 No Is laundry on a separate sewage system?(Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes Z No Water meter readings, if available last 2' ears usage d Well Water S ( Y 9 (gp ))� Detail: Sump pump? ❑ Yes ® No Last date of occupancy: NA Date Commercialllndustrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seatslpersonslsq.ft.,etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins.3A3 Title 5 OKclal Inspection Famt Subsulace Sewage Disposal System•Page 7 of 17 L Sep 2413 05:04p p.5 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 284 Oak St. Property Address Richard Lorenzotti Owner Owner's Name information is required for every West Bamstable MA 02668 9-23-13 page. City/Town State Zip code Date of Inspection D. System Information (cont.) Last date of occupancyluse: Date Other(describe below): General Information Pumping Records: Source of information: NA Was system pumped as part of the inspection? ❑ Yes ® No 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) ❑ Innovabve/Altemative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner)and a copy of latest inspection of the UA system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): f5ins•3113 We 5 Official Inspection Form:Subsurface Sewage Disposei System-Page 8 of 17 Sep 24 13 05:04p p.6 . Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 284 Oak St. Property Address Richard Lorenzotti Owner Owner's Name information is West Barnstable _MA 02668 9-23-13 required for every — — page. City/Town State Zip Code Date of Inspection D. System Information (cunt.) Approximate age of all components, date installed (if known)and source of information: 2011 Permit # 2011 - 166 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): 2' Depth below grade: feet Material of construction: R cast iron ® 40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments(on condition of joints,venting, evidence of leakage, etc.): Pipeing is 4" PVC SCH 40. Septic Tank(locate on site plan): 14" Depth below grade: feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No 1500 Gal. Precast Dimensions: 211 Sludge depth: t5insr 3113 Title 5 Offie al Inspection Fame Subsurface Sewage Disposal System•Page 9 of 17 Sep 2413 05:04p p.7 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 284 Oak St. Property Address Richard Lorenzotti Owner Owner's Name information is required for every West Barnstable MA 02668 9-23-13 page. CitylTown State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle 28" Scum thickness 1' Distance from top of scum to top of outlet tee or baffle 8 Distance from bottom of scum to bottom of outlet tee or baffle 17" How were dimensions determined? Asb d -Tape- Plan Sludge Judge Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage,etc.): Tank at working level. Tank and cover's at 14". In and outlet tee's. No sign of leakage or over loading Grease Trap (locate on site plan): Depth below grade: feet 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: Hate t5ins;3113 Ti9e 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 c Sep 2413 05:05p p.8 Commonwealth of Massachusetts Title 5 Official Inspection 1=orm Subsurface Sewage Disposal System Form -Not for Voluntary Assessments s 284 Oak St. Property Address Richard Lorenzotti Owner Owners Name information is required for every West Barnstable MA 02668 9-23-13 page. Citylrown State Zip Code Date of Inspection D. ,System Information (cont.) j Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert,evidence of leakage, etc.): Tight or Holding Tank (tank must be pumped at time of inspection)(locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other (explain): Dimensions: Capacity: gallons Design Flow. gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): "Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins•3113 Title 6 Official Inspedion Form:Subsurface Sewage Disposal System•Page 11 or 17 Sep 24 13 05:05p p,9 Commonwealth of Massachusetts Title 5 official Inspection Form a Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 284 Oak St. Property Address Richard Lorenzotti Owner Owner's Name information is required for every west Barnstable MA 02668 9-23-13 page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) Distribution Box(if present must be opened) (locate on site plan): 0. 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.): D Box is 21"41%29" below grade. Box is clean and solid w/six lines out. No sign of over loading or solid carry over. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No* Comments(note condition of pump chamber,condition of pumps and appurtenances, etc.): * If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins•3113 U9 5 Ofhdal 1nspec im Form:Subsurface Sewage Disposal System-Page 12 of 17 Sep 24 13 05:05p p.10 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 284 Oak St. Property Address Richard Lorenzotti Owner Owner's Name information is required for every West Barnstable MA 02668 9-23-13 page. Cityfrown state Zip Code Date of inspection D. System Information (cost.) Type: ❑ leaching pits number: ® leaching chambers number. 30 ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovativelaltemative system Typetname of technology: Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Leaching is 30 biodiffusees chambers 17.2'x 26.2'. Ck D Box and camera out lines. No sign of over loading or holding water. Cesspools(cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins-3113 Title 6 Official Inspection Form:Subsurface Sewage Oisposal System-Page 13 of 17 Sep 24 13 05:06p p.11 Commonwealth of Massachusetts Title 5 Official Inspection Form Y Subsurface Sewage Disposal System Form Not for Voluntary Assessments 284 Oak St. Property Address Richard Lorenzotti Owner Owner's Name information is required for every West Barnstable MA 02668 9-23-13 page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) 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.): t5ins•3113 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Pogo 14 or 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments r` 284 Oak St. Property Address Richard Lorenzotti Owner Owner's Name information is required for every West Barnstable MA 02668 9-23-13 page. Cityfrown state Zip Code Date of Inspection D. System Information (cunt,) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including lies to at least two permanent reference landmarks or benchmarks. Locate ail wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ® hand-sketch in the area below [] drawing attached separately i U r j 711 ly i..•�`, i t5ins•3113 Thle 5 Official Inspection Fomr.Subsurtace Sewage Disposet System•Pepe 15 of 17 Sep 24 13 05:06p p.13 Commonwealth.of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 284 Oak St. Property Address Richard Lorenzotti Owner Owner's Name information is required for every West Barnstable MA 02668 9-23-13 page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar © Shallow wells Estimated depth to high ground water: 1+ feet Please indicate all methods used to determine the high ground water elevation: Obtained from system design plans on record If checked,date of design plan reviewed: 5-25-11 Date ❑ 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: T.H. on design plan 5-25-11. No G.W. at 11+', Bottom of chambers around T above T.H. Depth. Before filing this Inspection Report, please see Report Completeness Checklist on next page. 15ins•3f13 Tile 5 Official Inspection Form:Subsurtaca Sewage Disposal System-Page 16 or 17 Sep 24 13 05:07p p.15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 284 Oak St. Property Address Richard Lorenzotti Owner Owner's Name information is required for every West Barnstable MA 02668 9-23-13 page, CityJ7own State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary:A, B, C, D,or E checked ® Inspection Summary D(System Failure Criteria Applicable to All Systems)completed ® System Information— Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 17 I No. VU Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: es PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS 4plitation for Disposal *pstem ConstCUrtion Permit Application for a Permit to Construct Repair( ) Upgrade ) Abandon( ) Complete System ❑Individual Components Location Address or Lot No. 2 8 4 0 41C �;�<t a• �p li Owner's Name,Address,and Tel.No. A2k� 7o hog•(_, 2 Assessor's Map/Parcel `R 9 0 0 p o2 Installer's Name,Address,and Tel.No. ) ,,,II Designer's Name,Address,and Tel.No. (,L�oP.�a' C �tP^1�S %�.71�ax7Lj �w+•�Yiv�LG -J . ( . Y?7S F?'7 Type of Building: Dwelling No.of Bedrooms J Lot Size q q , sq.ft. Garbage Grinder( ) Other Type of Building S } +�vy.r„� No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided � $�. 3 gpd Plan Date 5--2'7— Z j t Number of sheets ( Revision Date Title 274 0,6k 9 Y nn I Size of Septic Tank Type of S.A.S. S-fiz V� G Description of Soil ..11-- 9 Nature of Repairs or Alterations(Answer when applicable) Iv� (� ape (� IA—Lu ' `) yO Lo, Date last inspected: Zd� Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Healt Sife) Date Application Approved by Date 7 �� Application Disapproved by 15r Date for the following reasons Permit No. 10 1 Date Issued No. I j-� . �.� ,p G. Fee _ THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS es 2pprication for -Misposai �§pstrm Corgi truition permit Application for a Permit to Construct Repair( ) Upgrade K). Abandon( ) Complete System ❑Individual Components Location Address or Lot No. Z$1-1 o Q/C �l Owner's Name,Address,and Tel.No. Aa-(1v.t 70�,�r S m Cep (v 2 -T 2 �J-" I2� Assessor's Map/Parcel Q D o i �-p 02 .. Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No. eAFe,.,;,Qt :F. C_. Type of Building: , Dwelling No.of Bedrooms Lot Size LA sq.ft. Garbage Grinder( ) Other Type of Building k, +�ia.n-.� No.of Persons Showers( ) Cafeteria( ) Other Fixtures y4. . Design Flow(min.required) .5?SCE gpd Design flow provided :5-523. 3 gpd Plan Date � •2-7- ?Q,t Number of sheets ( Revision Date Title 0,0,� S) /1 Size of Septic Tank l 00 1^Y - ` Type of S.A.S.a 5�6 A-Q,4� Description of Soil J Nature of Repairs or Alterations(Answer when applicable) lv 2tj ��0� tJ- LU Sc..,q L TT dam cb h,-• t�-iA S tu -u 1 P.►�. &--� 4` Date last inspected: Zb\l Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Heat . Sigife'd� Date *A0- -.Application Approved by " ' Date �`' ? 7 Application Disapproved by Date for the following reasons Permit No. O 1/ —/�g jo Date Issued . _r7 ?- .. -----------------------,--------------------------------------------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS l BARNSTABLE,MASSACHUSETTS Qtertifitate of Compliance THIS IS TO ERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired(,,I_j Upgraded( ) Abandoned( )by �- at Ile l (p vt n has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No.2011- dated Installer"t-4,� 1"C t ��y („!_C Designer #bedrooms Approved design flow U gpd The issuance of jhjs ermit shall not be construed as a guarantee that the system will cti,n Lesiggried. Date �!� / Inspector (/(of (° ----------------------------- /I ---------------------------Fee------------- No. �511 — / 6 - THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS -Misposal 6pstem Construction Permit Permission is hereby granted to Construct( ) Repair Y-4 Upgrade( ) Abandon( ) System located at Ll 64•(.i ��(2�2iS- GP,, and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construct* n must a completed within three years of the date of this permit. Date S I I Approved by +W' /— TOWN OF BARNSTABLE LOCATION of P-/ d a./c s f SEWAGE# Z U 1 VILLAGE e, ,Z ,,Z� ASSESSOR'S MAP&PARCEL /?y INSTALLER'S NAME&PHONE NO. �� u,rd� t n�,tr✓�f dx P77 p�Z] SEPTIC TANK CAPACITY /Sou IV,u LEACHING FACILITY.(type) C?o) "?,G g (size) /.7 a 2/0, Z NO.OF BEDROOM`QS � OWNER PERMIT DATE: ) ' a 7' << COMPLIANCE DATE: 2 o A�- Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility O i Feet Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) I Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet FURNISHED.BY CAP¢ ,;dj fit k1,pV)3eS CQ- 1� 3 � �Z voo j Al elo A � yo s a•s " 3 32 5�•b y s A + 9/16/03 Notice: This Form Is To Be Used For the Repair Of Failed Septic Systems. Only PERCOLATION TEST AND SOIL EVALUATION EXEMPTION FORM 1 F :c�tnY I, ,hereby certify that the engineered plan signed by me dated 5-13,bb ,concerning the property located at 2B14 CORK 1,3- meets all of the. following criteria: 0 This failed system is.connected to a residential dwelling only..There are no commercial or business uses.associated with the.dwelling. • The.soil is.classified as.CLASS I and the percolation rate is less than or equal to 5 minutes per inch. The applicant may use historical data to conclude this fact or may conduct deep test holes and percolation tests,at the site without a health agent present. • There is no increase in flow and/or change in use proposed • There are no variances requested or needed. • The.bottom of the proposed leaching facility will be located no less than five feet above the maximum adjusted groundwater table elevation. [Adjust the groundwater table using the. Frimptor method when applicable] Please complete the following: A) Top of Ground Surface Elevation(using GIS information) Oy B) G.W. Elevation 5-15 +adjustment for high G.W.Z-1 DIFFERENCE BETWEEN A and B SIGNED : DATE: NOTICE Based upon the above information; a repair permit will be issued for bedrooms maximum.. No additional bedrooms are authorized in the future without engineered septic system plans. 5� 2 gASeptic\percexemp.doc Town of Barnstable P# 7 � Department of Regulatory Services RMWOUBM Public Health Division Date 5 ,11 to RFD MK't�,� 200 Main Street,Hyannis MA 02601 Date Scheduled j Time ,,�-- . Fee Pd. Soil Suitability Assessment for Sewage Disposal Performed By: h1G�1"t l i4V►e",�e i �j-T, C S�' Dohuld �esrtcaCal S ; a.s Witnessed By: LOCATION& GENERAL INFORMATION Location Address S�rcc Owner's Name l / Address .'7Z UA Mter (cl, ;{ors6as Mls fK A Assessor's Map/Parcel: tQ y `UO pc'2 Engineer's Name (511 Cr 191e>-5 L #'SC 15,15AA NEW CONSTRUCTION REPAIR Telephone# L) 7 -7 $8 �508-273.0377 Land Use Sl�l� ' �oan:ly akaell(o Slopes Surface Stones — Distances from: Open Water Body ft Possible Wet Area — ft Drinking Water Well ft. Drainage Way ft Property Line L 16 ft Other ft SKETCH:(street name,dimensions of lot,exact locations of test holes&pert tests,locate wetlands in proximity to holes) gee- a�a�HrA Q�cn Parent material(geologic) QWas41 Depth to Bedrock y k-2-9 U�5 Depih to Groundwater. Standing Water in Hole: 7 iz6" ,9S Weeping from Pit Face 7 1 2-6 1prJ S Estimated Seasonal High Groundwater 7 12-8 byS DETERMINATION FOR SEASONAL HIGH WATER TABLE Method Used: D 1(e0V pV.-R-t ua{taut 7 t Lb Depth Observed standing in obs.hole: _ In. Depth to soil mottles: in. Depth to weeping from side of obs.hole: 71261 in. Groundwater Adjustment ft. Index Well# Reading Date: Index Well level p Adj.Ihetor Adj.Groundwater Level,e, PERCOLATION TEST Delp 52,5-11 Tine iiA�P Observation Hole# 3 _ Time at 9" i20 ?H Depth of Perc Time at G' 12,03 PM Start Pre-soak Time @ i 1%V 2 AH 11;33 QN Time(9"•6") n1�f1S — End Pre-soak i i•3 7'f1 H i 2.Y 3 Q H Rate MinJlnch < 2- 4 2- Site Suitability Assessment: Site Passed Y�5 Site Failed: — Additional Testing Needed(Y/N) Original: Public Health Division Observation Hole Data To Be Completed on Back----------- ***If percolation test is to be conducted within 100' of wetland,you must first notify the, Barnstable Conservation Division at least one (1)week prior to beginning. Q:ISEPTICIPERCFORM.DOC DEEP.OBSERVATION HOLE LOG Hole# 1 Depth from Soil Horizon Soil Texture .Soil Color Soil Other _ Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones;Boulders. a sistency,%Graven 0-2 — Fr 11 52-5Y L'S �6.`tr 5/b — 5Y-78 C-1 Silk Lvrawl ss' 7/1 76-(2H. C-2 CS 2'.j `( "A it -ZO% 5('otrej • �r�tes of st 14 DEEP OBSERVATION HOLE LOG Hole# 2- Depth from Soil Horizon Soil Texture Soil Color, Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. onsi ten % rave Fitt 26'S2, A "/I 32-5y g �S ]oyr 5/6. — �y-78 c-I sitk Loam 2.517/1 78�128 t✓Z CS 2.3 Y V, tvaceS aF s�t� DEEP OBSERVATION HOLE LOG Hole# 3 Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency,%Gravel) 2- Fill y2-t3Y G M-FS 2,5Yt'/r� — DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency. 2-13y C Flood Insurance Rate Map: Above 500 year flood boundary No_ Yes -. ' Within 500 year boundary No Yes Within 100 year flood boundary Na:1// Yes Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the area proposed for the soil absorption system? If not,what is the depth of naturally occurring pervious material? Certification I certify that on 'o`27- `� (date)I have passed the soil evaluator examination approved by the Department of Environmental Protection and that the above analysis was performed by me consistent with . the required training,expertise and experience described in 310 CMR 15,017. Signature Date Q:\SEPTIMERCFORM.DOC 6/08/2011 23:58 5082730367 :0224 P. 001/003 Town of Barnstable Regulatory Services 4 Thomas F. Geiler,Director S aAaNSIA�LB, : Public Health Division `MAM ,• Thomas McKean,Director 200 Main Street, Hyannis,MA 02601 Office: 508-862-4644 Fax. 508-790-6304 Date: (o'10'(l Sewage Perm �df I' I b� Assessor's Map/P-arcel Installer&Designer Certification Form Designer: SG En�tneeccf) , T+nC. Installer: Gn(�Cw;dc'. ��,�IrEr�ctses Address: 21.54 C caen rzrcT 1 �ouwn�—T----- - Address: e a el Sul a r e1n owl 1'1 A .0 2.5 3 gcla-273••0377 . On s'a��Zc� i CA 044✓z1 was issued a permit to install a (date) (Installer) septic system at 2 d y O alc s*r ee j based on a des n'drawn by (address) G En5toeexL`115 , -ror- dated_ hpZ Zy , 4o ►l '(designer) 1 certify that the septic system referenced above was installed substantially according to the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. Stripout (if required) was inspected and the soils were found satisfactory. I certify that the septic system referenced above was installed with maior changes (i.e. 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. flan revision or. certified as-built by designer to follow.. Stripout (if required) yc.cted and the soils were found satisfactory. ye JOHN 1,r1Q,C 5�� � CHuRCHQ.I (Ins ler' ignatur ML -� esigner s Signature (Ax Deg : ip Here) P ASE RETURN TO ARNSTABLE PUBLIC HEAL DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS- BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEA 1 NTH DIVISION. THANK YOU. gAofflcc foims\designercenification form.doe p THE T°�� Town of Barnstable Barnstable A&A aDepartment "�`ca� "Re Regulatory Services * [lA It, STAFiLE, a "039.Ass. Public Health Division a Tfb MAi A, 200 Main Street, Hyannis MA 02601 2007 Office: 508-862-4644 Thomas F.Geiler,Director FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL 7006 2150 0002 1038 7374 October 27, 2009 Arthur Doherty 35 Allan Rd. Centerville, MA 02632 NOTICE TO ABATE VIOLATIONS OF 105 CMR 410.000, STATE SANITARY CODE II—MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION AND THE TOWN OF BARNSTABLE CODE CHAPTER 170. The property owned by you located at 284 Oak St. Centerville was inspected on September 16, 2009 by Jaime Cabot, R. S. Health Inspector for the Town of Barnstable. This inspection was conducted on the basis of a complaint. The following violations of the State Sanitary Code were observed. 105 CMR 410. 300- Sanitary Drainage System Required: Five bedrooms were observed, the septic system is only designed for three. 105 CMR 410.190: Hot Water: Hot Water was 160 Deg. F. 105 CMR 410.500—Owner's Responsibility to Maintain Structural Elements: Ceiling tiles missing in bathroom. 105 CMR 410.351- Owner's installation and Maintenance responsibilities: Exposed wiring in basement and the electric meter is not properly sealed. 105 CMR 410.354A-Metering of Electricity Gas and Water: Only one utility meter is provided for two units. 105 CMR 410.450-Means of Egress: Basement bedrooms lacks proper egress. The following violations of the Town of Barnstable Code were observed. 1� 70-4—Certificate of Registration. Rental property is not registered with Town of Barnstable Health Department. You are directed to correct the violation listed above within twenty-four (24) hours of your receipt of this notice by removing beds basement rooms lacking proper egress. You are directed to correct the violation listed above within twenty-four (24) hours of your receipt of this notice by removing beds basement rooms lacking proper egress. You are directed to correct the violation listed above within thirty (30) days by pulling a building permit to install a minimum 5' cased openings without doors to eliminate privacy in the basement bedrooms, restoring the house to a three bedroom home as per Disposal System Construction Permit 2006-234. You are directed to adjust the temperature of the hot water in the dwelling to between 110 deg. F. and 130 deg.F. You are directed to repair the damaged ceiling tiles in the bathroom. You are directed to correct the exposed wiring in the basement in accordance with applicable codes. , You are directed to register the rental property with the Town of Barnstable Health Department within ten (10) Days. You may request a hearing before the Board of Health if written petition requesting same is received within ten (10) days after the date the order is served. Non-compliance will result in a fine of$100.00 per violation. Each day's failure to comply with an order shall constitute a separate violation. Should you have any questions regarding the above.violations, please contact the Town health Division and ask tom eak with the inspector who performed the inspection. PER ORDER OF HE OARD OF HEALTH cKean, R.S., CHO Director of Public Health Town of Barnstable Cc: Lindsey Williamson 284 Oak St. Centerville;MA 02632 wti Town of Barnstable Barn SHE` Op TO yip Regulatory Services Department ;m'cac j BARNSTABLE, "A9. i6S9• Public Health Division O ♦0 ATf0 MAC A' 200 Main Street, Hyannis MA 02601 2007 Office: 508-862-4644 Thomas F.Geiler,Director FAX: 508-790-6304 Thomas A.McKean,CHO 10/21/2009 NSTAR 1 NSTAR Way Westwood, MA 02090 RE : (284 Oak Street, West Barnstable) , account number (1465 030 0107) . The Matter of Lindsey Williamson's NSTAR account: Dear NSTAR attached please find a copy of a Board of Health Order Letter issued to Arthur Doherty the owner of the property at 284 Oak St. Centerville please note that the mail address for this property is in West Barnstable. The property in question was the location of an illegal apartment and a residential dwelling that were both served by on electric utility meter for which Williamson the tenant of the apartment assumed responsibility for payment of all electric costs for the dwelling in violation of the State Sanitary Code Chapter II , 105CMR 410.354A. Please contact me if I can be of any help in this matter. Regards, Jai e Cabot ime Cabot, R.S. Health Inspector Town of Barnstable (508) 862-4651 cc: Lindsey Williamson Town of Barnstable Barnstable °f rHE r� �.11 Regulatory Services Department AaAmmicaCO t. BARNSTABLE, • - r MASS. Q 9� 034. Public Health Division ArFv M A 200 Main Street, Hyannis MA 02601 2007 Office: 508-862-4644 Thomas F.Geiler,Director FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL 7007 3020 0001 3429 8554 September 23, 2009 Arthur Doherty 35 Allan Rd. West Barnstable, MA 02668 NOTICE TO ABATE VIOLATIONS OF 105 CMR 410.000 STATE SANITARY CODE II—MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION AND THE TOWN OF BARNSTABLE CODE CHAPTER 170. The property owned by you located at 284 Oak St. Centerville was inspected on September 16, 2009 by Jaime Cabot, R. S. Health Inspector for the Town of Barnstable. This inspection was conducted on the basis of a complaint. The following violations of the State Sanitary Code were observed. 105 CMR 410. 300- Sanitary Drainage System Required: Five bedrooms were observed, the septic system is only designed for three. 105 CMR 410.190: Hot Water: Hot Water was 160 Deg. F. 105 CMR 410.500—Owner's Responsibility to Maintain Structural Elements: Ceiling tiles missing in bathroom. 105 CMR 410.351 Owner's installation and Maintenance responsibilities: Exposed wiring in basement and the electric meter is not properly sealed. 105 CMR 410.354A-Metering of Electricity Gas and Water: Only one utility meter is provided for two units. 105 CMR 410.450- Means of Egress: Basement bedrooms lacks proper egress. The following violations of the Town of Barnstable Code were observed. 170-4—Certificate of Registration. Rental property is not registered with Town of Barnstable Health Department. •�1y You are directed to correct the violation listed above within twenty-four (24) hours of your receipt of this notice by removing beds basement rooms lacking proper egress. You are directed to correct the violation listed above within thirty (30) days by pulling a building permit to install a minimum 5' cased openings without doors to eliminate privacy in the basement bedrooms, restoring the house to a three bedroom home as per Disposal System Construction Permit 2006-234. You are directed to adjust the temperature of the hot water in the dwelling to between 110 deg. F. and 130 deg. F. You are directed to repair the damaged ceiling tiles in the bathroom. You are directed to correct the exposed wiring in the basement in accordance with applicable codes. You are directed to register the rental property with the Town of Barnstable Health Department within ten (10) Days. You may request a hearing before the Board of Health if written petition requesting same is received within ten (10) days after the date the order is served. Non-compliance will result in a fine of$100.00 per violation. Each day's failure to comply with an order shall constitute a separate violation. Should you have any questions regarding the above violations, please contact the Town health Division and ask to eak with the inspector who performed the inspection. PER ORDER OF HE OARD OF HEALTH cKean, R.S., CHO Director of Public Health Town of Barnstable Cc: Lindsey Williamson 284 Oak St. Centerville, MA 02632 Y No. d " _ Lt Fee THE GOMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS ZIppYtcation for TDizpogal 4§p5tem Con.5truetion Vertu Application for a Permit to Construct( ) Repair( ) Upgrade( Abandon( ) ❑ Complete System ;�jdividual Components Location Address or Lot No.019 �/Y/t V/ r'✓� `�_ Owner's Name,Address,andjTyt No. Lt/'�Gl✓iv�ti tb� ����� �+ [TV�� Assessor's Map/Parcel (/ d �VV✓ Installer's��d Tel.No. Designer's Name,Address and Tel.No. Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder ( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min,required) 3 30 gpd Design flow provided ^ gpd Plan Date M/*- Number of sheets Revision Date Title Size of Septic Tank ;5v- /adh Type of S.A.S. S L Description of Soil Nature of Repairs or Alterations(Answer when applicable) fL-,r tq--M4-C_ Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board-af�Yeahi. Si Date '� O Application Approved by Date Application Disapproved by: Date for the following reasons Permit No. 1p Date Issued 4 1 No.�rc) T Ll Fee Q� 9MI -E-COMMONWEALTH OF MASSACHUSETTS Entered in computer: ' es PUBLIC-HEALTH DIM ION - TOWN OF BARNSTABLE, MASSACHUSETTS x ' application for Mioponl �&pgtem Cori.5truction Permit Application for a Permit to Construct( ) Repair( ) Upgrade( Abandon( ) ❑ Complete System �94dividual Components Location Address or Lot No. Owner's Name,Address,and T It No. a Assessor's Map/Parcel L/— O/ Installer's a Address,and Tel.No. Designer's Name,Address and Tel.No. �`Q '+:s 0,���/J S) // Gc- TyV'of Building: If Dwelling No.of Bedrooms Lot Size sq. ft. Garbage Grinder ( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 330 gpd Design flow provided �jj'. ��/ gpd Plan Date o'4;ZeZ)& Number of sheets Revision Date Title ✓ �S .' Size of Septic Tank Type of S.A.S. (._, SEE Description of Soil ` aclef. sM� Nature of Repairs or Alterations(Answer when applicable) /477-4 c. Date last inspected: Agrebment: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board-afffeafl#h-.. Si e Date J p" O Application Approved byC Date 15 ;�3-a_ Application Disapproved by: Date for the following reasons p Permit No. Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance i4 THIS IS TO CERTIFY,thatttthe On-site Sewage Disposal System Constructed ( ) Repaired ( ) Upgraded (� Abandoned( )by 1'����45 Sc \C_._ at 8?q a,4{- S V-e-Fr has been constructed in accordance e / with the provisions of Title 5 and the for Disposal System Construction Permit No. �-C^�C`YS1 — ,.3 `-� dated 5/C. - Installer --j—) Q o o,A S Designer > #bedrooms ✓' Approved design flow gpd The issuance of this permit sh I no?be)conn1tr ed as a guarantee that the systei�lll function as�desig ed. Date 7/r/ / Inspector. r u ---- , . -------=------------------------------- ---- No.C...�y/ r-;�)3 Zl Fee / - THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE, MASSACHUSETTS Migw5at *p5tem Cow5tructior� ermit Permission is hereby granted to Construct ( ) Repair ( ) Upgrade (L,'} Abandon ( ) System located at o� D A Lf z" 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,thts pp // t. Date / (0 Approved by � r Town of Barnstable p7NE Tpl, Regulatory Services Thomas F. Geiler, Director anxxsreaXX 9cbp M 9; Public Health Division rFnMor► Thomas McKean, Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Installer & Designer Certification Form f Date: Designer: Shay Environmental Services, Inc. installer: i Address: P.O. Box 627 Address: East Falmouth, MA 02536 On w 5 was issued a permit to install a (date) (installer) septic system at -ZUC�Q k S ( „'Z C m:5� based on a design drawn by (addre s) Shay Environmental Services Inc. dated (.0 LC,2. US- (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. I certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or any vertical relocation of any component i of the septic system) but in accordance with State & Local Regulations. Plan revision or certified as-built by designer to follow. • �'- lvk OF Aggss� `�o`'� CARMEN cyGNm i st er's Signa o . E. - , SHAY No. 1181 0 STE (_(Me'signer's Signature) (Affix De i p Here) PLEASE RETURN TO,BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL. NOT BE ISSUED UNTIL BOTH THIS FORM AND AS- BUILT CARD ARE RECEIVED BY THE BARNSTA13LE PUBLIC HEALTH DI ISION. THANK YOU. Q:Health/Septic/Designer Certification Form '� V / L o�, `'15.E ,k s- •�:':� { ................ �p THE COMMONWEALTH OF MASSACHUSETTS 1 8p� b BOAR® E HE L . H tc44 vNI.............0F...... ----....................... App iraa#ion for Diipwi al Work.5 Tnntrnrtiun VaTit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal t at 7 Sys .. .. L. ......k/....... or Lot No. -•---- o Ac�rers�S �tfJCc -- . ... . O ner Address e �.... . . s _.__............._......_._.._..................._.....................y.........._.........................Jt .. .............. Instal Address - Q Type of Building Size Lots._. `.................. q. fee Dwelling h�No. of Bedrooms............_w ............................Expansion Attic ( ) Garbage Grinder auw:,,e. a Other—Type of Building ............................ No. of persons----•__.•__________________. Showers ( ) — Cafeteria ( ) Otherfixtures -------•---•------------•---•--•-•--= ....----•---------------••-----------•----•---.......................-•---- WDesign Flow................. .:_......_.:_gallons per.person per'day. Total daily flow............................................gallons. WSeptic Tank¢-Liquid capacit�_____'__gallons. L ength................ Width................ Diameter---------------- Depth................. x Disposal'-Trench—No......................Width....:............... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No....../....._------- Diameter------/Y_....... Depth below inlet............... Total leaching area.,�L.de/A�.r.sq. ft. - Z Other Distribution box ( ) Dosinnl ) P Percolation Test Results Performed by. �€ .'. . .................................. Date_ as Test Pit No. 1_ -..minutes per inch Depth of Test Pit____________________ Depth to groundwater_____ (? Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water_-_________-___--__-___. xDescription of Soil............a-a.... U ............................... ------- -- ` ..-..---•------------------- x -----------•----------: ::: ..� ::::::::: -4------ ...-............ r ',� --•-•--------------------- 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 1Zr"47 5 of the State Sanitary Code— The undersigned further agrees not to place the system to operation until a Certificate of Compliance has been issued by the board of health. Sign - - ���ggg r _. ,.', . Date Application Approved BY �'"'� r/ - _4. �--1........ o� / � Date Application Disapproved for the following reasons-----------------------•-------------------------------------------------------------------------............. -----------------------------•--•-...---------------------•--...-••••••'-•------------'•......--•-------'--•...•----•-•----......•----•--•--•----•-..... ......................-........................ Date PermitNo......................................................... Issued....................................................... ° Date . ..... ............. .... No............... . THE COMMONWEALTH OF MASSACHUSETTS BOARD QF HEA TH OF..... . ... ............. ........ ........*......................... Appliration for Disposal Works Tonstrurtion thrutit Application is hereby made for a Permit to Construct or Repair an Individual Sewage Disposal Sys .......................................................... L or Lot No. ..................... ...... A Address ...tKn"e"r. ----------------.......---------------- ----------------------------------------*--- ---------------------- .........*------------ ................................. .................................................................................................. Address Type of Building Size Lo .... .......------------ sq. fe t U -DwellingK No. of Bedrooms___...__.._.................................Expansion Attic Garbage Grinder Other—Type of Building ............................ No. of persons_.__.__........._._._....._. Showers Cafeteria A4Other fixtures ...................................................................................................................................................... Design Flow........................ X,-'� ...... ---gallons per person per day. Total daily flow.............................................gallons. .... 1:4 Septic Tank/Liquid*capacit/� gallons Length________________ Width__............__ Diameter__-__........._. Depth................ Disposal Trench—No. .................... Width...._............... Total Length.................... Total leaching area.........:_ ------sq. f t. Seepage Pit No----/............. Diameter-----//-------- Depth below inlet.....jt�.......... Total leaching area*ZA0e_..sq. ft. Z Other Distribution box Dosing lank,,.( X--- ' /lelf-.0---------------------------------- Date3/. 3� Percolation Test Results Performed groun w ter.... 04 --- - --- ------- Test Pit No. I minutes per inch Depth of Test Pit.................... Depth to d a Test Pit No. 2................minutes per inch Depth of Test Pit___.....__.....___.. Depth to ground water..__._.............._... ... . .. ... ............ ............................. ...... ---- 0 --- 0-;�.... .......... ............. ...... Description of Soil..........e?�. ................ .. ................ Z, ............................... ............. U '0... ell, ---- -- -----W W //------ ......�0'e.-- ----v ---------------_5' ............................----­-----------------WIC ......... ---------tx!�t- ­ 3/ r 2-----------*---*--------------- 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'TTLE, 5 of the State Sanitary Code— The undersigned further agrees not to place the system in I- operation until a Certificate of Compliance has been issued by the board of health. Signed ............................................................................... ................................ Da. (3 Application Approved By....... ......................... .....................e.Z......... f" Date Application Disapproved for the following reasons:......................................................................................... ..................... ......................................................................................................................................................................................................... Date PermitNo......................................................... Issued...................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF//YEALT ........ ............OF.............. ............................................................. T,VIS IS.,TO CE#TIFY4hat the Individual Sewage Disposal System constructed or Repaired. .. .......by...... ....... ...................... ...................................................................................................... -,talle, cy��. .30 6IS......... ..... .....X at....lel.A_4...... e�� ........... ------ 5 of The State Sam a�has been'installed in accordance with the provisions of Sanitary o e as &scribed in the application for Disposal Works Construction Permit No. --- ----- .............. dated-----S3_1.... J.............. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION E. SATISFACTORY, ...fVV DATE.................................7/4/ ......................... Inspector-------------..&**42. ................................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OIF,/,MEALTH . ......... .....OF...............A"2- ............................. FEE. ,,,- No.................1i.... ----- .....ry Disposal Works ns wtion Prrmit Permission i h b granted-----"�s 11pre y a ..... 11� ........................................................................ to Constipuct or Rep;irr an Individuaf, Se e Disposal-•'yst 'z... ................. at ................... ks!ireet as shown on the application for Disposal Works Construction P6fnut Nod--.,7. Dated.._.'' "C '�'_f......_... -------------4...... .... ..... k --------- _iioard of Health -------------------- DATE------. .�. ................................................ FORM 1255 HOBBS & WARREN, INC.. PUBLISHERS ' r cl +. c 1j x d f a c Ile : r v h rY f �Y" !i D' LEGEND CERTIFIED 'PLOT AN EXISTING SPOT ELEVATION Ox0 "EXISTING CONTOUR --- p .g1NI.SHED SPOT ELEVATION 10.0 FtNISHED CONTOUR r APPROVED = BOARD OF HEALTH-.,,,� �,` ' �N � I0 . �i DATE AGENT SCALE DATE /GAP, x t iL'Ot GE ENGINEERING C4 /N � ��- P r AN_ CLIE�II ' I CERTIFY THAT T.HULJ? EBISTERE REOISTE'RED JOB NO.'W�G BUILDING SHOWN: ON ::TMt 'LAX CIVIL. LAND CONFORMS 70 1"HE 2ONiNf ;,AI ;tr ' �1, N INEER SURVEYOR OF BARNST B4.E , MASH-. a + . CH. 712 MAIN S7 BY= � � ; HYANNIS, MASS. SHEET._;.-�' OF DATE REG., LAND StRY, 20 Pr M/N. /Y07LC, . . .LF EITHER 7HESEPT/'G T.�1NK OR. GEA�e,,vr/VG P/T ARE /"IOR4 T14 AeAV /2"BELDIw /O F7 M/.v: GRADE "fa 24 DIAMETER CoVCRET.E CORER S{,►ALL BE :/9ROuGNT TO G/gAOE:.�fFN EXTRA 4"PVC PIPE • CONCRETE /dE.4t�yy CAST IRON CO//E=R St/.4LL` !3E L/SE.C7 } M/N. PITCH /F fN VEIoVA Y CO DERS �B"PER FT. l I 2 f. Miw. CD/VCRE•TE 1 ,fi is I Cy/FAOE CU ✓ER CLEAN -TA A' BAC/C/�/LL �Q _ _ L/QU/D LEZ.=L � _.j � _ ' .• 2 LAYER id 4" CAST 1 IRON PIPE ft ✓ r a s o { a.; M/N. o1TGN GAL. D/ST, o • • • • • • • / 1 a „ WASHED STYJNE SEPTIC TANK o n 1 • • • • • • 1 / • • d 4 BOX p B • 1 B • • • • • 1 e Co p•+ " / •EFFECT/✓L ' . 0 3 4 - �2 o ° 1 • DEPTH • • • ' v o ASNEO STONE f o v. c < 1 • • . o • • • / 1 e o•y P/Q'EC,AS T SEEPAGE O o r l • • • • old ' a p P/T DR EQLI/V. /AIV4wAT eLE✓A71-ONS p o A tkERT AT BL/ILO/Nfs .�' FT. —� L=T. D/AM• C SEE TABULAT/O/V> { INLET SEPTIC TANK OUTLET SEPTIC TANK F7 INLET D/STR/Bl/T/ON TABLE BOX Y' O FT SECT/ON O F GROuNO WA rEK Ot/TLETD/STR/BUT/ON BOX " FT /INLET zEAcH/NG oiT RAFT. 5EWA0. Q/S/�OdS'�1 L Sf�STEM -AABULAT/ON i E.EACH//VG PIT 01MEN.S/ON- A FT.. t DES/GN CR/TER/A SCALE 14.. /= o_" - D/AfENS/oN $ FT. Nl/M9ER Of 9EDROOMS I ARBAGED/SPOSAL UNIT _ SO/[. LOG � ? �, SOIL TEST TOTAL ESTlMATEp FLovi/ 3 0.44.14AY SOIL. TEST 10t1 SOIL TEST {. vum8ER (3F'LJr ,EACMING PITS_ I !^ELL=✓. �' � j"ELEY, ��' c. ;DATE Ol, SOIL TEST �' � ' SIDE LEACHIKG PER P/T .Stir PT. i i.r ` RESI/LTS fit//TNESSED &Y&-4`" I 'e'�3 j } 90TTOM 4,64CN/NG oER P/T_ $q. fT. � r e PERCOLAT/O!►� /PATE/OE/ �i hJ/N�/INChf ` PERC&L T' RATE j a M! �. * - -�-G N /NCH � TOTAL.LEACH/NG �►REA SQ. -AFT. /oN . RESERMEI.EACNIMCFAREA SQ. &A. RED7/2 6E EJ1Kt/NEZ'Jv'/AAC�C�I/V : r - mr.�ra + # f x• S. v 10 , f� 7� e t! G F { t li �j 1 . r � 30 L^ LA ti No.......C................ �• YASSACHUSETTS Fizu....��............ . THE COMMONWEALTH OF SOAR® O FiEA -.. . ..OF.......... ............ Apphratinn for Di-gVusal Works Tongtrnr#ion Vrrulil Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal ystem at: .C>�?1L s T- y. �r��t rs1. L E L.6 T 2 Location•Address or Lot r+2• Hint „ — ..._s� �. 1v1 - � —° 'e�P ,_....... c -,..._ Owner Address p Installer Address v 0 Q Type of Building Size Lot_; `'......_............Sq. feet U Dwelling LNo. of Bedrooms-------3--------------------- Expansion Attic ( ) Garbage Grinder ( ) a6-tiler—Type of Building ---------------------------- No. of persons_--_--.---_._.__-_.-__-.-_ Showers ( ) — Cafeteria ( ) a Other fixtures `- --------=-------------------------------------------------------------------------------------------- ------------------ ®______________________ jperfnperson per day. Total daily flow------------- -®__ .....__..._.___gallons. W Design Flow______________ _ gallons' WSeptic Tank/-Liquid capacitvwo©gallons ength................ Width................ Diameter----- .......... Deptli._.-._._.-.-.. x Disposal Trench—No..................... Width.........!_:-------- Total Length.;______________-._ Total leaching area-------------- -----sq. ft. Seepage Pit No �_____________ Diameter../Q.�.O....I Depth below inlet - p l aching area--------- -------sq. It. z Other Distribution box ( ) Dosing tank ( ) �/ n . f'' '?h S-/7 e/ '-' Percolation Test Results Performed by'-_--__. __.J,2`'_ s_______________________ Date-_-_---_----__--_-----_--__.___.--. a Test Pit No. 1________________minutes per itch Depth of Test Pit_.._____......____.. Depth to ground water.-..--._---.__-_-._.. f=, Test Pit No. 2................n lutes pert;inc Dep h f Test Pit.--___/___.._ __. Dep to ground water_. . . a' r (�5- ...c'r'1------ = ------0 ----------------- --- Description of Soil �- .. �----- --� �'��` 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 Article XI of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has bee isstW-d by the board of health. Signed. -- --......... .-- ---^----------- ----------------- ----- - - Date / Application Approved By---- ---• -•-•-• --- `-- -- ---- ------------ ----- --- D to Application Disapproved for the following reasons:............................................................................................................... ..........................•••----••-•-------•-----------------------------------•-••-.........-------•--...--•-•--••---------------------------------------•--------------------------------------.----- Date Permit No. Issued A�� 7 ------•--------------- Date FE .../ ................ Y THE COMMONWEALTH OF MASSACHUSETTS BOARD W HE H jet�- `T,�--- --------- Ajip i-r�flvn -for Uiiipuiittl vrkfi C l��t #r rtilaYi rr Application is hereby made for a Permit to Construct ( ) or Repair ,(.,-' ) an Individual Sewage,,,Disposal System at: -----------------••-------.._._..--------------•------------------------•---•-•-•--- Loc tion-Address or Lot h.._ n113 _ .. ........ � - ---? . W Owner Address �¢ Installe ` Address d Type of Building 'tip Size Lot..V..Y__`__v__-_______Sq. feet Dwelling&-eNo. of Bedrooms....�j---------------------------------Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building --._--__.__'______________ No. of persons............................ Showers ( ) — Cafeteria ( ) Q, Other fixtures ---•------------------�` ----- d . --------------------------------------------------- Design Flow. low- ••--••--•-- Q __..____ � gallons`;,per person per day. Total daily flow............... .___-___,__.__ _..--.-._..gallons. Septic Ttnk/-Liquid caiacityl._ D_ allons 'Length................ Width................ Diameter__:--._----____ Depth.._--___-._. Disposal Trench—No- ____________________ Width-----------------;_.. Total Length______ _______- T tal leaching area-------------.------sq. ft. Seepage Pit No----- Diameter_:IlJ(�v Depth below inle�_'_� �,taljrachiiig area _ sq. ft. Other Distribution box ( ) Dosing tank ( ) � ®. fly 71 4f ~" Percolation Test Results Performed by___________________-----A!"Y_'�!�._!....................... Date........................................ a Test Pit No. 1----------------minutes per inch Depth of Test Pit.................... Depth to ground water.---_-----_--.-._-.----- (� Test Pit No. 2________________miptes pel inc De of Test Pit...... __ _ De p to round wat5r_ M A♦ �' !�t! `�'>j �r .................... -- ------ ----------O Description of Soil. ____r ___/---_____ � /� - - fin _ -----------------------------------------------......................................................................................................................................................... U Nature of Repairs or Alterations—Answer when applicable.......................................................�"":..____._...___._-.._:__________...: ------------------------------------„___--------------------------------------------•-•--•---------------------------------------------------------------- =---------------------------------------.... Agreement: a The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of,Article NI of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has be iss ed by the board of health. Signe �w� ate Application Approved BY l �`--------• -- - }� �. • - to Application Disapproved for the following reasons:---•---•---•-----••-------------•---------- ----------------•---•---•--------- --•------•---------•------------- ................................................... ...---------•--.._.....--•---------------..-----•---•..-•-•------•-'--._..__..._.._..-•-•"---------- ._.___..._._'•-•---._.--------._.-•---•--••'_.. ate Permit No..............---•••--••-•-••---•----•-•••------•••-•--- Issued....!•-�- •••./.�_.`__.7.__... ......... Date THE COMMONWEALTH OF MASSACHUSETTS + • ! w. / BOARD HEALTH ... ................... ..........OF.......... 1 r..... ".. '.�.... ..:................ (9rdifiratr of fITnm liattrr I IS TO - That the ndividual Sewage Disposal System.constructed ( or Repaired nst le at • has been-Installed in accordance with the visions of Articl d of The State Sanitary esc n the . application for Disposal Works Construction Permit No....___ .....f_________________ dated----� ._....__._._ ____ ............ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTR; D AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DE �.. ---7�.----••-'--••'••--••••.................••--- inspector r• t., Inspector.----- Y ••-•-• ------ THE OF MASSACHUSETTS /fin -r BOARD O HEALTH r ` " v` .. .._. . ......... ......... ................... No.. tr FEE j f 1 , 7 sww --... ................... Permissio ereby granted -- - •••'•-t , ;, , vy A :, to Cons uct -( ) or e a Indiv al ewage, Dis 1 S at No i�` -• -- as shown on the application for Disposal Works nstruction t No.. . ted.... �.... ......... .......... .� - �- I Board of ealth DATE-- FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS - yo FORM 30 G&W HoBBs&WARREN TM THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH t46t CITY/TOWN W H04('M a DEPARTMENT � MN 0®® '�+� 57"i.—'fir e� w � 'i S &o I ADD�IESS �///� f//1j 1 //� //ply (/4 GSM Sve y`eW 65-0 ) ��J�� COZ16& TELEPHONE Address!6 q 0,&v� ST __ Occupan Floor Apartment No. No. of Occupants No.of Habitable Rooms No.Sleeping Rooms No.dwelling or rooming units No.Stories Z. 1 3s A LL,g �p 1 ►rd, `� Name and address of owner Aig-TH v eL. ,Do/�,��T. L Remarks Reg. Vio. YARD Out Bld s.: Fences: Garbage and Rubbish '-9E w Containers: Drainage Infestation Rats or other: STRUCTURE EXT. Steps,Stairs, Porches: Dual E ress: and Obst'n.: 1510 cr N\ L&.cv-S Q10 � a ❑ B ❑ F ❑ M Doors,Windows: a-00 f A- V_G tsS Roof Gutters, Drains: tv O PA-TcC lA -r ,t Walls: g_&.f I eJD A Foundation: O/L Cr,g Chimney: BASEMENT Gen.Sanitation: iC:., f- Dampness: ,-. f-0 e - - wjo I,G rTC Vit; ,d Stairs: Z Q o 9-v U S. \ Na A S rmrN-( Lighting: r-D eGOi.� ov r"AAfN rL,00/L STRUCTURE INT. Hall,Stairway: 10 /ti L i vi / Obst'n.: Hall, Floor,Wall,Ceiling: f-%L% w c T LDS W� i sS� u Hall Lighting: N li�"A-tK 9-r,0t_^ 4 10 Hall Windows: HEATING -Chimneys: Central ❑Y ❑ N Equip. Repair TYPE: Stacks, Flues,Vents: PLUMBING: Supply Line: ❑ MS ❑ ST ❑ P Waste Line: H.W.Tanks Safety and Vent(s) ELECTRICAL Panels, Meters,Cir.: (,sue L, ❑ 110 ❑ 220 Fusing, Grnd.: Ato AMP: Gen.Cond. Distrib. Box: Gen. Basement Wiring: DWELLING UNIT Ventil. L to . Outlets Walls Ceils. Wind. Doors Floors Locks Kitchen d &-1 160 f0 6 Bathroom Pantry Den Living Room Bedroom 1 / Bedroom 2 Bedroom 3 Bedroom 4 Hot Water Facil. Sup.Ten.,Gas,Oil, Elect.: Stacks, Flues,Vents,Safeties: Kitchen Facilities zS ink 61 Stove Bathing,Toilet Facil. Vent., Plumb.,Sanit'n.: Wash Basin, Shower or Tub.- Infestation Rats, Mice, Roaches or Other: . Egress Dual and Obst'n: General Building Posted u't-1D1N4 V3orC gcc I S-r e-440 Locks on Doors: %1 it 'vO&9_0 L7 fr ONE OR MORE OF THE VIOLATIONS CHECKED ABOVE IS A CONDITION WHICH MAY MATERIALLY IMPAIR THE HEALTH OR SAFETY AND WELL-BEING OF THE OCCUPANT AS DETERMINED BY 105CMR 410.750 OF THE CODE OR THE AUTHORIZED INSPECTOR. (See Over) "THIS INSPECTION REPORT IS SIGNED AND CERTIFIED UNDER THE PAINS AND PENALTIE OF PERJUR ." INSPECTOR & TITLE 1104lGWI ?/� S�fC70/L A.M. DATE 40 TIME 2 �U A.M. THE NEXT SCHEDULED REINSPECTION �� P.M. 410.750: Conditions Deemed to Endanger or Impair Health or Safety The following conditions,when found to exist in residential premises, shall be deemed conditions which may endanger or impair the health, or safety and well-being of a person or persons occupying the premises. This listing is composed of those items which are deemed to always have the potential to endanger or materially impair the health or safety, and well-being of the occupants or the public. Because Chapter II, 105 CMR 410.100 through 410.620 state minimum requirements of fitness for human habitation, any other violation has the potential to fall within this category in any given specific situation but may not do so in every case and therefore is not included in this listing. Failure to include shall in no way be construed as a determination that other violations or conditions may not be found to fall within this category. Nor shall failure to include affect the duty of the local health official to order repair or correction of such violation(s) pursuant to 105 CMR 410.830 through 410.833 nor shall failure to include affect the legal obligation of the person to whom the order is issued to comply with such order. (A) Failure to provide a supply of water sufficient in quantity, pressure and temperature, both hot and cold, to meet the ordinary needs of the occupant in accordance with 105 CMR 410.180 and 410.190 for a period of 24 hours or longer. (B) Failure to provide heat as required by 105 CMR 410.201 or improper venting or use of a space heater or water heater as prohibited by 105 CMR 410.200(B)and 410.202. (C) Shutoff and/or failure to restore electricity or gas. (D) Failure to provide the electrical facilities required by 105 CMR 410.250(B), 410.251(A), 410.253 and the lighting in com- mon area required by 105 CMR 410.254. (E) Failure to provide a safe supply of water. (F) Failure to provide a toilet and maintain a sewage disposal system in operable condition as required by 105 CMR 410.150(A)(1)and 410.300. (G) Failure to provide adequate exits, or the obstruction of any exit, passageway or common area caused by any object, including garbage or trash, which prevents egress in case of an emergency 105 CMR 410.450, 410.451 and 410.452. (H) Failure to comply with the security requirements of 105 CMR 410.480(D). (1) Failure to comply with any provisions of 105 CMR 410.600, 410.601 or 410.602 which results in any accumulation of gar- bage, rubbish, filth or other causes of sickness which may provide a food source or harborage for rodents, insects or other pests or otherwise contribute to accidents or to the creation or spread of disease. (J) The presence of leadbased paint on a dwelling or dwelling unit in violation of the Massachusetts Department of Public Health Regulations for Lead Poisoning Prevention and Control, 105 CMR 460.000. (See M.G.L. c. 111 @@ 190 through 199.) (K) Roof,foundation, or other structural defects that may expose the occupant or anyone else to fire, burns, shock, accident or other dangers or impairment to health or safety. (L) Failure to install electrical, plumbing, heating and gas-burning facilities in accordance with accepted plumbing, heating, gas-fitting and electrical wiring standards or failure to maintain such facilties as are required by 105 CMR 410.351 and 410.352, so as to expose the occupant or anyone else to fire, burns, shock, accident or other danger or impairment to health or safety. (M) Any defect in asbestos material used as insulation or covering on a pipe, boiler or furnace which may result in the release of asbestos dust or which may result in the release of powdered, crumbled or pulverized asbestos material in violation of 105 CMR 410.353. (N) Failure to provide a smoke detector required by 105 CMR 410.482. (0) Any of the following conditions which remain uncorrected for a period of five or more days following the notice to or knowledge of the owner of said condition or conditions: (1) Lack of a kitchen sink of sufficient size and capacity for washing dishes and kitchen utensils or lack of a stove and oven or any defect that renders either inoperable. 1 (2) Failure to provide a washbasin and shower or bathtub as required in 105 CMR 410.150(A)(2) and 410.150(A)(3)or any defect which renders them inoperable. (3) Any defect in the electrical, plumbing or heating system which makes such system or any part thereof in violation of generally accepted plumbing, heating, gasfitting, or electrical wiring standards that do not create an immediate hazard. (4) Failure to maintain a safe handrail or protective railing for every stairway, porch balcony, roof or similar place as required by 105 CMR 410.503(A)and 410.503(B). (5) Failure to eliminate rodents, cockroaches, insect infestations and other pests as required by 105 CMR 410.550. (P) Any other violation of 105 CMR 410.000 not enumerated in 105 CMR 410.750(A)through (0)shall be deemed to be a con-- dition which may endanger or materially impair the health or safety and well-being of an occupant upon the failure of the owner to remedy said condition within the time so ordered by the Board of Health. TOWN OF BARNSTABLE LOCATION c=-2ff3o" a4'Z'<S'?7Zf97- '~'`` SEWAGE # VILLAGE ASSESSOR'S MAP & LOT/Py- INSTALLER'S NAME & PHONE NO. 9399 :SEPTIC TANK CAPACITY /4®O✓ � G T'�'� LEACHING FACILITY:(type) (sue) /D629 NO. OF BEDROOMS PRIVATE WELL OR IC=WAiER ;BUILDER OR OWNER %aRl y DATE PERMIT ISSUED: /�301S :DATE COLIPLIANCE ISSUED:�� VARIANCE GRANTED: Yes No i r _ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE ApplirtaWn for Disposal Works Tonstrurtion ramit Application is hereby made for a Permit to Construct ( ) or Repair (>() an Individual Sewage Disposal System at: .......... rI.__._g! ...cS....��>='�" G��1rr� �. Location-Address or Lot No. Z ..................................... � QAAa..'s7..... � s-................................. Wa 020, Owner �TA dress � - £�y�Ql� /� J� _..__ T ._..._.... A .% n�3S✓1lttCg Installer Address UType of Building Size Lot---=_DOMO._'`---Sq. feet Dwelling—No. of Bedrooms................ .._._.._......._.____.Expansion Attic ( ) Garbage Grinder ( ) `4 Other—T e of Building No. of persons............................ Showers a Other—Type g ---------------------------- P ( ) — Cafeteria (----)- Otherfixtures . ---------------------- ------------------------------------- W Design Flow...................s_: ..........___gallons per person per day. Total daily flow..........cS�Q_._.__._...._-------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 ( ) aPercolation Test Results Performed by.......................................................................... Date........................................ a Test Pit No. I................minutes per inch Depth of Test Pit----- ._...._...._.. Depth to ground water........................ rXq Test Pit No. 2................minutes per inch Depth of Test Pit....1.............. Depth to ground water........................ a ---•----••••-------------------•--•---•------•--•---•-•--------....----•---..... ------......---------••----------------•-------------------------------- 0 Description of Soil........ =.Z_....---- If.....�...- -------•---1 `�---..:.&�50....7a._.. /IS' -------------- .W . .6.................................................................................................................................................................................... W U Nature of Repairs or Alterations—Answer when applicable_...;t—.k?!4 V6........01) ..... ...•.. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance s een issued by he board of health. Signed ---- - = Application Approved B j�.........�... � . ----------- --- ---- llace Application Disapproved for the following reasons- ------------------------------------------------------------ ---- --------- --------------------------------------- ....... ............................................................... ---------------------- - ----- --------------------------------- ----------------------------------------------------...... ---- -------------------ce-------------------- > Permit No. ------���''----------- --------- --------7/.� Issued ---------ll----------� --��------------- Dace -- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Appliratilan for Uhipusal Works Cfunstrurtiun, Errant Application is hereby,made for a Permit to Construct ( ) or Repair (>�) an Individual Sewage Disposal System at: Location-Address or Lot No. i -----1.....-v-Y...........:....... c.�- .._.............--------------------- a ._ss-r,..... .v� s.................................. I w o ago 2 G 0 s. Installer Address Type of Building Size Lot.........�ad4_-...Sq. feet U Dwelling—No. of Bedrooms...............` _.._..____ .....Expansion Attic ( ) Garbage Grinder ( ) a pa, Other—Type of Building ________________•_-•._____-- No. of persons............................ Showers ( ) — Cafeteria ( ) Q' Other fixtures ........................................--•--•--- ----------------•------------------------------------------------••--•-------•---.....---•- W Design Flow.................... -------------gallons per person per day. Total daily flow..........3�0........._..._......gallons. WSeptic Tank—Liquid capacity............gallons Length---------------- Width................ Diameter................ Depth................ w x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area..------------------sq. ft. Seepage Pit No--------------------- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by.......................................................................... Date...........-•-----•--•----------•--•--- Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a' --•-------•------------•------•------•-•-- -------•---••--•--------.• -••---•--------------------------•---•--------------------------.....---•----...... 1 O Description of Soil.......jQ---1........... -----------'/ l y....AX D-_Z-�. '2er42s-c............. V --- .....--•----------•---•....................•-•-------------- ••----•-•-•-•----....------•-• -•-------•-•------•••---••---•-----•-----------------•-•--•-•---••---•--...._._..__.. W x �av U Nature Repairs or Alterations—Answer when applicable- %�_.._.___...�____._�J����u1_._..L'�S.S!'�p_G:____. - -- -------- •---------------------•--• �lGU�'a-Q - ---.....---�T -......-......� -•---- ---------------------------•------...-----• Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance: as been issued by he board of health. / _ . // Signed ....... ------------------------- ------------------ ---- ... 149 21� Application'Approved By.................. ' �/..-�-- -------------- - -- ------------------------------------------------------ Date Application Disapproved for the following reasons- ---------------------------------------------------------------------------------------------------- ------------------------------ --------------------------------- -------------------------------------------------- --------------------------------------------------------------------------------------------------------------- ---------------------------------------- Dare Permit No. { --...-�-'��-"'---- ---,--=� --- --�J-�� Issued .........��---/---�� ...----- Date 3 THE COMMONWEALTH OF MASSACHUSETTS 1 BOARD OF HEALTH TOWN OF BARNSTABLE (fextifirate of (11ampXianee THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired by------------------------------------Zit; �L...—)77.. GOtiJsi' iNC_ -------------------------------------------------------------------- ................................................... --.----. Insmller at ---------------------------- �o 1.......---- Df�iC� c 1 '`�'`�' Cr---------..G)/GG, ......--------....--------------------------------......------............. has been installed in accordance with the provisions of TITLE 5 of The State Environmental Code as described in the application for Disposal Works Construction Permit No. ----4r.- ..-_---.. dated --// ..j5; ro .�7 THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL��FUNCT9N ... 1 SATISFACTORY. DATE DATE..............r Ins ect am. ----- ---------- THE COMMONWEALTH OF MASSACHUSEfTS, 0 BOARD OF HEALTH ' TOWN OF BARNSTABLE No.............. .. %posal Works 01111nitrnr#tun Prrutit Permission is hereby granted......... r- �/`__.._.___.G�01C1.S% 7AAL ........................................ to Construct ( )�or Repair (V) an Individual Sewage Disposal System O�/,. S% Gr�l7vicc at No. - ......... ••-•--•-----•-------------------•-•----.........---••-. Street as shown on the application for Disposal Works Construction Perm' e r`. �' - Dated .. —_s--------- ... �f rd of Health �. DATE........ r-------•--------r-••---.�....._..--•----....-•--•- FORM 36508 HOBBS&WARREN.INC.,PUBLISHERS �L3 � �L 0o°1 os 35 `f F 5' b 00 j FamyRoom so u N C) fie J- ------- r - W = H m Bath t LU Q So O LLJ � �], � Kitchen Bed Room 2 ' .—23'7 — 1 S 4" � < E cn Hodl ' L11 00 'IY PORCH Q C 3 14'3' h Bed Room 1 Bed room 3 :;ving Room 1 ST FLOOR 1917, EXISTING 10/29/707977:] 508-771-7270 1 `* S F--BULKHEAD . 00 �O N 26' 7" UNFINISHED W 12' 5" 7' 1 6'1 BASEMENT Fol _ --------------- o--------- = w Q ® �/ ■ CV Q N ® o Z REFRIGERATOR MICROWAVE 11 Both p� - a' enNcE �J LAUNDRY AREA Q m KITCHEN 1 T 3" --�--> _ 0 N DISHWASHER T 1 5-2 J J u Ile co � Q NN Hal lV 4'6" Ln LIVING ROOM o BEDROOM#4 ::j 12'1" o 12'5° 3' 11" _ r BASEMENT BEDROOM#5 EXISTING 10/29/09 F5 7 11-72 00 J' 0 F No 1-0 26'7„ O G�ifil a;1 r-e UNFINISHED S ' " BASEMENT F LJu 12 5 �T 10"� F--6'1"� _ T o owQ LU v ----� rEll E - W N LAUNDRY AREA - < Q m i 17'3" 15'2" llq c~n w Harr -------- Q CO 3 M GAMEROOM FAMILY ROOM ;O 12' 1"� o Q 12'5" _ 13'11" _ BASEMENT NEW 10/2--1 9/09 508-771-7270 i I i . i ,o cV O Q 26'7' ih L1J CO O J UNFINISHED K < BASEMENT Z t-7' 10 N '�E✓M ol_ts}? £wS-r►+�1 Ca T��fL A _ o 1N 1 u- OC.D S`tt��1Z. o N�� Q m T V JZ 0O H I ® Both 1 �, o V) ;o ___ LAUNDRY AREA 00 0 w 17' -- . 15,2' CV ------------ Hai zo N _-- - inBASEMENT LIVING ROOM b Q 3' 11„ _ I EXISTING 310,00 c 1 WotZK- C-,-C oVG' 'R�Pc4c� iNSLMtTIo� 2. � .� wodP pwIJE�-�nf�� �. �fnove $ R.t'Pc,+cF � _ yZG�ov� 12E�c�►ca' �,Y�su� w a �� 3orrcp aD 5—� F S 00 Fomay Room N 1 ® o w .J ® ® W CO Balh l �, �U D Q t1AOL-ISH E)dSr)�(? SrA1a- ^r.�i) 14'3° - Kitchen IDIE�AOL-ISH � N -- NF1L1.-o Z�D S-twlg- opw�Ny N Bed Room 2 2317 - O Hall LLJ \ ——y—; PORCH N 3 143• -- e'lr - -- �1E1� STAIR- OVS1.1Jf.Iy . Bed Room 1 - Bed room 3 i Living Room 1 ST FLOOR i IS'2' EXISTING I i i i i - i i i i TOP OF FOUNDATION = 84.8'± (lower) PROVIDE EXTENSION RISER INISH GRADE OVER D-BOX= 80.2'± 4"SCHEDULE 40 PVC MIN. SLOPE 1 % FINISHED GRADE OVER BIODIFFUSERS= 78,5' - 80,0' GENERAL NOTES WITH COVER OVER INLET& SLOPE @ 2% MIN. INSPECTION PORT WITH FINISH GRADE OVER TANK EL.= REMOVABLE WATER-TIGHT COVER OVER 1. UNLESS OTHERWISE NOTED, ALL SYSTEM COMPONENTS AND CONSTRUCTION FINISHED GRADE OUTLET TO WITHIN 6"OF F.G. 80.8'+- RISER TO WITHIN 6"OF FINISHED GRADE ACCESS BOX TO WITHIN METHODS SHALL BE IN ACCORDANCE WITH TITLE 5 OF THE STATE ENVIRONMENTAL FOUNDATION = 81 .4'±@ 3"OF F.G. (ONE PER ROW) CODE AND ANY APPLICABLE LOCAL RULES. 5" DIA. OUTLETS) SLAB 20"MIN.ACCESS 9"MIN } 2. ANY CHANGES TO THIS PLAN MUST BE APPROVED BY THE BOARD OF HEALTH AND THE COVER(3 TYP.) 36"MAX I DESIGN ENGINEER. PROP.4"SCH.40 PVC SEWER PIPE 6"MIN. 9 MIN. 3. 4"SCHEDULE 40 PVC PIPE WITH WATER TIGHT JOINTS SHALL BE USED IN DISPOSAL PROP.4' SCH.40 36 MAX. 36 MAX. TOP OF SAS/B.O. = 77,00 1.2'COUPLIING 11 " PVC SEWER PIPE (TYP OF 6) SYSTEM UNLESS OTHERWISE NOTED. MIN.SLOPE�1% 6~ 3�� 2" DROP MIN. 3 9 3"DROP MAX. MIN.SLOPE�1% L - 15'± PROVIDE WATERTIGHT 4. TO PREVENT BREAKOUT, THE PROPOSED FINISHED GRADE SHALL NOT BE LESS THAN 10" JOINTS (TYP.) ELEVATION =77.00' FOR A DISTANCE OF 15'AROUND THE PERIMETER OF THE SAS. UNLESS A 78.8�+ " 4"PVC IN FROM 1.33' Q 40 MIL GEOMEMBRANE LINER IS PLACE AT LEAST FIVE FEET FROM S.A.S. AND THE TOP OF 14 78.25' SEPTIC TANK t6"' C OUT TO 0 90, (NP') 10.75"(TYP) 16 THE LINER IS NOT LESS THAN THE BREAKOUT ELEVATION. EXIST. PIPE 78.50� ING FACILITY31 i5. SLOPE ALL SOLID PIPE AT 1.0% MINIMUM. 48�� OUTLET TEE 77.17' 77,00' 76.57' 75.67' (laid flat) 2.875'(34.5")�I6. THIS SYSTEM IS NOT DESIGNED FOR A GARBAGE DISPOSAL. GAS BAFFLE 5.0' (NP•) 7. LOCAL BOARD OF HEALTH AND DESIGN ENGINEER TO BE NOTIFIED PRIOR TO BACK CRUSHED STONE (NP.) 5'MIN. FILLING WHEN SYSTEM IS NEARLY COMPLETE AND READY FOR INSPECTION. SYSTEM IS ER MECHANICALLY 17.25' NOT TO BE BACK FILLED WITHOUT FIRST OBTAINING APPROVAL FROM BOARD OF HEALTH 42.9'TO FND. REQ'D COMPACTED BASE 26.2' AND DESIGN ENGINEER. 6" CRUSHED STONE 3 INLET DISTRIBUTION BOX in M�,,.n (TYP.) 8. ELEVATIONS BASED ON APPROXIMATE M.S.L. DATUM OF 84.00' ESTABLISHED OVER MECHANICALLY TO BE INSTALLED ON A LEVEL STABLE M r GROUND WATER ELEV.= < 70.33' ON A NAIL SET IN UTILITY POLE#5A AS SHOWN ON PLAN. COMPACTED BASE Ci BASE. FIRST TWO FEET OF OUTLET i^ BIODIFFUSERS (END VIEW) PROPOSED 1 ,500 GALLON CONCRETE SEPTIC TANK PIPES TO BE LAID LEVEL. �,� �i 9. CONTRACTOR SHALL VERIFY ALL UTILITY LOCATIONS PRIOR TO CONSTRUCTION BIODIFFUSERS (PROFILE) THROUGH DIG-SAFE AT LEAST 72 HOURS PRIOR TO COMMENCING WORK ON SITE AT LENGTH 10'-6' WIDTH 5'-8" DEPTH 5'-8° (Dimensions per Wiggin 7���I (BY ADVANCED DRAINAGE SYSTEMS, INC.) 1-888-DIG-SAFE AND ANY OTHER APPLICABLE AGENCIES. REPORT ANY DISCREPANCIES Precast Corp., Pocasset,MA) CROSS SECTION VIEW rr�� TO THE DESIGN ENGINEER. `CONTRACTOR TO VERIFY THIS ELEVATION& SEPTIC TANK PROFILE DISTRIBUTION BOX DETAIL ARC 36HC (#3616 B D) BIODIFFUSERS (H-L O)REPORT TO ENGINEER IF DIFFERENT NOT TO SCALE NOT TO SCALE NOT TO SCALE 10. ALL JOINTS WHERE PIPE ENTERS AND EXITS CONC. STRUCTURES SHALL BE MADE WATERTIGHT. 11. NO DETERMINATION HAS BEEN MADE AS TO COMPLIANCE WITH DEEDED OR ZONING NOTES: :--~- �' = - TEST PIT DATA TEST PIT DATA REGULATIONS. OWNER/APPLICANT IS TO OBTAIN SUCH DETERMINATION FROM ,� 'j r `-' APPROPRIATE AUTHORITY. 1.) MAGNETIC MARKING TAPE SHALL BE PLACED ALONG THE TOP EDGE OF EACH SEPTIC SYSTEM COMPONENT. "` '�' �► �� "` ';, M } - ®rnz� ` ' PERC NO. 13293 PERC NO. 13293 .^ INSPECTOR: Donald Desmarais, R.S. INSPECTOR: Donald Desmarais, R.S. 12. ALL SEPTIC SYSTEM COMPONENTS SHALL WITHSTAND H-10 LOADING UNLESS 2.) CONTRACTOR SHALL VERIFY SOIL CONDITIONS IN THE LOCATION OF THE PROPOSED LEACHING FACILITY TO LOCATED UNDER PAVEMENT, DRIVES OR TRAVELED WAYS IN WHICH CASE ENSURE CONSISTENCY WITH TEST PIT DATA SHOWN ON THIS PLAN. REPORT TO ENGINEER AND LOCAL BOARD , l� (� _ �^�,..., EVALUATOR: Michael Pimentel, E.I.T. EVALUATOR: Michael Pimentel, E.I.T. f ~' :� �'J""^ a 0 .� THEY SHALL WITHSTAND H-20 LOADING. OF HEALTH IF SOILS ARE NOT CONSISTENT WITH TEST PIT DATA. '` / === , ' C.S.E. APPROVAL DATE: Oct. 1999 C.S.E. APPROVAL DATE: Oct. 1999 N ""� c L'A �' 13. DOUBLE WASHED CRUSHED STONE SHALL BE FREE OF ALL DIRT, DUST AND FINES. t DATE: May 25, 2011 May 2011 M w DATE: Y 25, J t TEST PIT#: 1 TEST PIT#: 2 14. WHERE REQUIRED, CONTRACTOR SHALL REMOVE ALL LOAM, SUBSOIL AND UNSUITABLE �, 4 �' MATERIAL IN AREA BENEATH AND FOR 5 FT. ON ALL SIDES OF LEACHING FACILITY. �"-�" 1 '^�. ELEV TOP= 81.00' ELEV TOP= 81.00' MAP 194 o ,w REPLACE ALL UNSUITABLE MATERIAL WITH CLEAN COARSE SAND FREE FROM CLAY, PARCEL 001 001 N f : ELEV WATER= < 70.33' ELEV WATER= <70.33' FINES OR OTHER UNSUITABLE MATERIAL IN ACCORDANCE WITH 310 CMR 15.255(3). MAP 194 _ u f PARCEL 001-002 ` I ' PERC RATE _ <2 min./inch PERC RATE = 15. CONTRACTOR SHALL NOTIFY DESIGN ENGINEER OF ANY DISCREPANCIES FOUND IN rig CO44,717 S.F.t '. LOG'US' -"`. " SITE CONDITIONS FROM THOSE SHOWN PRIOR TO CONTINUATION OF WORK. DEPTH OF PERC = 78"-96" DEPTH OF PERC= 16. PROPOSED PROJECT IS LOCATED WITHIN: TEXTURAL CLASS: 1 TEXTURAL CLASS: 1 ASSESSOR'S MAP 194 PARCEL 001-002 EXIST. 1,000 GAL. SEPTIC TANK TO BE ABANDONED i.e. f.a t ' ( �ti , � ,�'' r c �' �? �/.� OWNER OF RECORD: ARTHUR P. DOHERTY, JR. PUMPED, BOTTOM OPENED/RUPTURED AND FILLED w/ 1� x, � - ZONE 2 } ADDRESS: 72 WHEELER ROAD ` _... CLEAN SAND) PER 310 CMR 15.354 • � ,� MARSTONS MILLS, MA 02648 `° \ v --~�' Fill Fill c� �6' \ ` c u _,.--. r -... �► 28" 78.67' 28" 78.67' a co n I oo c .+ ...�'{ " ' ,�� A Loamy Sand A Loamy Sand uS g ' ` I. - y e FEMA FLOOD ZONE C �,� Benchmark DIRT DRIVi + ' -""= f, - .. r 10Yr 3/1 10Yr 3/1 m Nail in U.P.#5A � � \ � "'""" II' �6 �� _v + 0{ 4 ~`�.,\ 32" Loamy Sand 78.33' 32~ Loamy Sand 78.33' Elev. =84.00 = � �' � �:.�;• « '� ��• . B B COMMUNITY PANEL# 250001 0015 C r �i 17. DEED REFERENCE: DEED BOOK 21544, PAGE 98 a J �-\. ` -?j ` r 10 , 10Yr 5/6 10Yr 5/6 Approx. M.S.L. ��� �86` ....�` o , ' • " , 1Y " c •( " 76.50' " 76.50' �� Sys % o • t . " « + ✓ 18. PLAN REFERENCE: PLAN BOOK 335, PAGE 96 N Silt Loam Silt Loam #2$�NC, pOR c� m 2 •• • ' `• �'' � `! �� "1+ . C-1 2.5Y 7/1 C-1 2.5Y 7/1 19. ALL DISTURBED AREAS SHALL BE RESTORED TO ORIGINAL CONDITION. G OR \ w .c O 7 4 / + 78 74.50 78 74.50 20. PROPERTY LINE INFORMATION IS ONLY APPROXIMATE. THIS PLAN IS TO BE USED ONLY 8 ��N or jeC1 I T, O l �? o �G r, �� �, (�`! V • r Perc FOR SEPTIC SYSTEM UPGRADE. JC ENGINEERING WILL NOT ASSUME ANY LIABILITY EXIST. 3050 CHAMBERS (APPROX. LOC.) F;$ ,$�A m , •• „u�« IC4 - « « _ • ■ 96 73.00' FOR USES OF THIS PLAN OTHER THAN ITS INTENDED PURPOSE. (35'x 12'x 2')PER AS-BUILT CARD 100, 31 �O S�p.6 a • • ' ;,� /• ; --; .• i a6 N, ALE .; • Coarse Sand Coarse Sand 88-.._. C-2 2.5Y 6/1 C-2 2.5Y 6/1 W 6 81x4 84 �6' (10-20%gravel) (10-20%gravel) 82� m (traces of silt) (traces of silt) PROP. TOTAL 30- 16" HIGH ARC 36HC(#3616BD) LOCUS PLAN H-20 BIODIFFUSERS IN A FIELD CONFIGURATION � j v'�o '86 �' \ SCALE: 1"= 1000' ~ a \ f I 128" 70.33' 128" 70.33' v 80� m �V rr a No Mottling, Standing or Weeping Observed No Mottling, Standing or Weeping Observed PROP. TEL. LINE 4 L3 G �� - TP ' 2 - m TEST PIT DATA TEST PIT DATA LEGEND PROPOSED INSPECTION PORT(TYP OF 6) J 82 0 A0 � �" DESIGN DATA PERC NO. 13293 PERC NO. 13293 50xO' EXISTING SPOT GRADE 4 C/O a \ INSPECTOR: Donald Desmarais, R.S. INSPECTOR: Donald Desmarais, R.S. P \Q _ NUMBER OF BEDROOMS (EXISTING) 4 - 50 -- - EXISTING CONTOUR PROPOSED 1.2'WIDE ARC 36HC COUPLING (TYP OF 6) O - / f Q � \� J b EVALUATOR: Michael Pimentel, E.I.T. EVALUATOR: Michael Pimentel, E.I.T. d O TP - ro o NUMBER OF BEDROOMS (DESIGN) 5 81.01 _, Q QP o 50 PROPOSED CONTOUR �, �' / C.S.E. APPROVAL DATE: Oct. 1999 C.S.E. APPROVAL DATE: Oct. 1999 1 , ` O \ Q ,,� moo. DESIGN FLOW 110 GAUDAY/BEDROOM 34.5 �, ., DATE: May 25, 2011 DATE: May 25, 2011 ❑/H/W EXISTING OVERHEAD UTILITIES 8 TP 2 \6-1 �' TOTAL DESIGN FLOW 550 GAUDAY I TEST PIT#: 3 TEST PIT#: 4 TELE EXISTING TELEPHONE LINE REMOVE ALL UNSUITABLE MATERIAL (INCLUDING EXIST. 70 N 81 U' { \ ✓ DESIGN FLOW X 200 % _ 1100 GAUDAY SAS) DOWN TO "C-2"SOIL (IF NECESSARY)& REPLACE PROP. N 8� ELEV TOP= 82.00' ELEV TOP= 82.00' TELE PROPOSED TELEPHONE LINE 6-OUTLET - L=165.34 - USE PROPOSED 1,500 GALLON SEPTIC TANK < 70.83 ELEV WATER=WITH CLEAN COARSE SAND PER 310 CMR 15.255(3) v 8 D-BOX 1059.71 ELEV WATER= < 70.83' N \ R- GAS EXISTING GAS LINE \ / PERC RATE _ <2 min./inch PERC RATE = EXIST. TEL. LINE TO BE RELOCATED AS SHOWN I PAVED DRIVE W W EXISTING WATER LINE DEPTH OF PERC= 42"-60" DEPTH OF PERC= �o� l INSTALL 30 - ARC 36HC (#3616BD) BIODIFFUSERS (H-20) TEST PIT LOCATION / 3 - " TEXTURAL CLASS: 1 TEXTURAL CLASS: 1 ? - OAK STREET SYSTEM CAPACITY PROPOSED 1,500 GALLON SEPTIC TANK EDGE OF PAVEMENT EXIST. LEACHING PIT(ABANDONED) 60'WIDE) (TOTAL L.F.OF BIO-S 4.8 SF/LF 0.74 GPD/SQ.FT.)=GPD I PROP. 1,500 GAL. TO BE PUMPED& FILLED WITH 1926 COUNTY LAYOUT- (1572)(4.8 SF/LF)(0.74 GAL/SQ.FT.)= 558.3 GAL. LEACHING/DAY of, 82.00' Off 82.00' PROPOSED 4"SOLID SCHEDULE 40 PVC PIPE 3 H-10 SEPTIC TANK CLEAN COARSE SAND Fill Fill 0 PROPOSED DISTRIBUTION BOX TOTALS: PROPOSED ARC 36HC(#3616BD)BIODIFFUSER(H-20) TOTAL NUMBER OF BIODIFFUSERS: 30 42" 78.50' 42" 78.50' TOTAL NUMBER OF COUPLINGS: 6 Perc o PROPOSED ARC 36HC BIODIFFUSER COUPLING (H-20) GN TOTAL LEACHING AREA: 754.5 60" 77.00' HC-� #SvAG pOFt TOTAL LEACHING CAPACITY: 558.3 REV. DATE BY APP'D. DESCRIPTION E E�ROOG PROPOSED SEPTIC SYSTEM UPGRADE $ �o� OF- ,$1 Q' SWING-TIES SCALE: 1" =20' NOTE: C Medium-Fine Sand C Medium- Fine Sand PREPARED FOR: ,5\0 EFFECTIVE LEACHING AREA OF 4.80 SF/LF OBTAINED FROM THE 2.5Y 6/6 2.5Y 6/6 DESCRIPTION HC-1 HC-2 U.P. DEPARTMENT OF ENVIRONMENTAL PROTECTION APPROVAL LETTER CAPEWIDE ENTERPRISES HC-2 "MODIFIED CERTIFICATION FOR GENERAL USE" ISSUED TO ADVANCED SEPTIC INLET COVER(1) 64.6' 45.7' 28.8' DRAINAGE SYSTEMS, INC. ON OCTOBER 3, 2003(LAST MODIFIED LOCATED AT JANUARY 11, 2011). TRANSMITTAL NUMBER=W000052. SEPTIC OUTLET COVER(2) 71.7' 52.1' 36.0' 284 OAK STREET U P BIODIFFUSER CORNER(3) 71.6' 54.4' 30.9' �• CENT. / W. BARNSTABLE, MA = ti BIODIFFUSER CORNER(4) 56.6' 43.0' 13.7' 134" 70.83' 134" 20 FT. DATE: MAY 27, 2011 70.83' SCALE: 1 INCH�./ (4 BIODIFFUSER CORNER 5 74.5' 66.5' 29.9' `},�oFri o 10 20 ao so FEET O No Mottling, Standing or Weeping Observed No Mottling, Standing or Weeping Observed \o�y�� gss9c (5 JOHN L, <; PREPARED BY: BIODIFFUSER CORNER(6) 86.4' 74.4' 40.8' RESERVED FOR BOARD OF HEALTH USE CHURCHILL JR. JC ENGINEERING, INC. IVI.4 2854 CRANBERRY HIGHWAY N O EAST WAREHAM, MA 02538 26.7 3) 2) SITE PLAN (6 „ _ � 508.273.0377 SCALE. 1 -20 Drawn By: MCP Designed By:MCP Checked By:JLC JOB No.1999