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HomeMy WebLinkAbout0624 PHINNEY'S LANE - Health (2) 4 -1 � CENTERVILLE A=250 015001 UPC 12534 No.2-153LOR HASTINGS,.MN' i FORM30 C&w HOBBS&WARREN TM THE COMMONWEALTH OF MASSACHUSETTS D BOARD F HEA H r CITY/TOWN 4r ,^)� � �V 4 W b ^ I 41 DEPARTMENT /) ,(,. 6s 5aqb GSM SyOy`•w TELEPHONE Address — Occupant_h*� Floor partment No. No:of Occupants No. of Habitable Rooms_- CY_ No.Sleeping Rooms No. dwelling or rooming units No Stories t 4# Name and address of owner 6 Remarks Reg. Vio. YARD Out B d s.: Fences: Garbage and Rubbish Containers: Drainage Infestation Rats or other: STRUCTURE EXT. Steps,Stairs, Porches: Dual Egress:and Obst'n.: ❑ B ❑ F ❑ M Doors,Windows: Roof Gutters, Drains: Walls: Foundation: Chimney: BASEMENT Gen.Sanitation: Dampness: Stairs: Li htin : STRUCTURE INT. Hall,Stairway: • I Obst'n.: Hall, Floor,Wall,Ceiling: Hall Lighting: Hall Windows: HEATING Chimneys: Central ❑ Y 'ON E ui . Repair TYPE: Stacks, Flues,Vents: PLUMBING: Supply Line: ❑ MS ❑ ST ❑ P Waste Line: L* H.W.Tanks Safet and Vent(s) ELECTRICAL Panels, Meters,Cir.: ❑ 110 ❑ 220 Fusing,Grnd.: AMP: Gen.Cond. Distrib. Box: Gen. Basement Wiring: DWELLING UNIT Ventil. L to . Outlets Walls Ceils. /Wind Doors Flo rs LgcKs Kitchen Bathroom L Pantry Den !1 Living Room A A 0 Bedroom 1 Bedroom 2 Bedroom 3 Bedroom 4 Hot Water Facil. Sup.Ten.,Gas, Oil, Elect.: Stacks, Flues,Vents,Safeties: Kitchen Facilities Sink 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 - Locks on Doors: 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, SIGNED AND CERTIFIED UNDER TIJE PAINS AND PENALTIERJ �� I - INSPECTOR TITL%/ 6.E `( � DATE TIME P•M � A.M. THE NEXT SCHEDULED REINSPECTION l O �_ P.M. 9 410.750: 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 11, 105 CMR 410.100 through 410.626 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. (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. .'a Town of Barnstable ' Regulatory Services I sexlvs� Thomas F. Geiler,Director 901 039. Public Health Division Thomas McKean,Director 200 Main Street,Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 April 20, 2007 Attn: COMM Fire Health Inspector Timothy B. O'Connell conducted a rental inspection in accordance with Chapter 170 of the Town of Barnstable Code. In accordance with the State Sanitary Code, 105 CMR 410.482, the Health Department is required to notify the Fire Department if there is a smoke detector violation, or possible smoke detector violation. The following property had possible smoke detector(and\or CO detector) violation(s): 624Phinney's Ln. Assessors Map-Parcel: (250-001): -Smoke detector was not working. No CO detectors in home. 1078 Main Street Osterville Assessors Man-Parcel: (118-014): - Smoke detector not working in home. Timothy O Connell-Health Inspector Q:\Order letters\Housing violations\Rental ordinanceUire ViolationsTIRE TEMPLATE.doc F•. 1 � 1� � � .� S C-4 161 ITG1{�( lit l� � No. q Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes 9pplitatlon for )Disposal 6pstem Construction 3pErmit Application for a Permit to Construct( ) Repair N) Upgrade( ) Abandon( ) ❑Complete System P111'ndividual Components Location Address or Lot No.G94 P h r, LPVl Owner's Name,Address,and Tel.No. Assessor's Map/Parcel p C�V tiV(. (\�S Installer's Name,Address,and Tel.No. ) \/G.C signer's Name,Address,and Tel.No. Type of Building: S-0% a o1 Dwelling No.of Bedrooms W Lot Size sq.$. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) A gpd Design flow provided AM gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) �� �- �-r,-Q f�fi� .rUii,,.� Vic' rnc,!Nven� L✓\ r-JZ— ( old orcv\tt Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. SigRqd Date /1 F-T D I/3 Application Approved by Date f 30 0e Application Disapproved by Date for the following reasons Permit No. 7 - q Llj Date Issued 1113010o15 Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS 01pplication for Disposal 6pstem Construction Permit ,,,fApplication for a Permit to Construct( ) Repair Vf Upgrade( ) Abandon( ) ❑Complete System E111ndividual Components Location Address or Lot No.tD P hl n UCi\-? Owner's Name,Address,and Tel.No. Assessor's Map/Parcel ` C Vw &VL V (� � Installer's Name,Address,and Tel.No., \/fi_ln signer's Name,Address,and Tel.No. Type of Building: �� a a► U O(fly i Dwelling No.of Bedrooms_JA Lot Size sq.ft. Garbage Grinder( ) f i Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided A gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil i Nature of Repairs or Alterations(Answer when applicable) Q Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. S IPfd Date / i Application Approved by Date 0 ?-,4 t I Application Disapproved by'. Date •. for the following reasons 4 i I Permit No. 20 15 — Z. Date Issued 3 U Z(j/rj --------------------------------------------------------------------------------------------------------------------------------------- I THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS (Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired Upgraded( ) Abandoned( )by S c y at < « ^AM-(_ !T � 1 � has been constructed in accordance 1 with the provisions of Title 5 and the for Disposal System Construction Permit No&S J7 S dated Ir 1 l?o j 2wi� Installer !,� �_o-C_ = Designer #bedrooms /Un Approved design flow A)A gpd j The issuance of this permit shall not be construed as a guarantee that the system will-funct�o1n�/a's designed. Date l r �C��/ Inspector .T,_, --------------------------------------------------------------------------------------------------------------------------------------- No.COI h 'L'Z�� Feelg/y 0 U0 THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION -BARNSTABLE, MASSACHUSETTS Disposal &pstem Construction �Prmit Permission is hereby granted to Construct ) Repair(LA", Upgrade( ) Abandon( ) System located at C� \ and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/ r-el�t to comply with Title 5 and the following local provisions or special conditions. i Provided:Co ilo ruction must be completed within three years of the date of this permit. Date Approved by No. - Fee Ts . THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS ZIpprication for Mfopooar *pztem Cottgtruction 3permit Application for a Permit to Constrict( )Repair( Upgrade Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. C, y Owner's Name,Address and Tel.No. Assessor's Map/Parcel vvk 25 ) Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. Type of Building: Dwelling No.of Bedrooms�0__ Lot Size�sq.ft. Garbage Grindeafet:eria( Other 'I�pe of Building No. of Persons Showers( ) ) Other Fixtures Design.Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: — The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with.the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been'ss by this Board of Uealth. Sigrid Date Application Approved by Date Application Disapproved or the following reas s Permit No. Date Issued r r i No. Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS 2pphration for �Diopq l *pgtem Conotruction Permit Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. Owner's Name,Address and Tel.No. Assessor's Map/Parcel Installer's Name,Address,and 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 gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees,to ensure,the construction and maintenance of the afore described on-site sewage disposal system in accordance with.the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued by this Board of Health. Signed Date Application Approved by Date Application Disapproved for the following reasons Permit No. Date Issued �f a Z-� I ��.My/ "i�.�M Via, No. �/ 012 •""""y°.' �"r-- , Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer; Yes. PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS ZippYication for Oigooal 6potem Conotruction Permit Application for a Permit to Constrict( . )Repair( ;<pgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. G a1 y ph i n n ry 5 LG nQ. Owner's Name,Address and Tel.No. Assessor's Map/Parcel M Z..'S 0 1.5'"- 1 Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. Lc— Type of Building: Dwelling No.of Bedrooms Lot Size g�U!105 sq.ft. Garbage Grind �(�--)' Other 'Type of Building O. No.of Persons Showers( ) 'Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow -gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: .- �. The undersigned agrees to ensure the construction and maintenan;ce=of'the afore described on-site sewage disposal system in accordance with,the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued bythis Board of Health . Signed�l ZAJ Q� f� 4 '.� /� Date a 16 -0 Application Approved by _ Date Application Disapproved/Sr- the following reasons «.� 7 Permit No. X l J/AIC:� Date Issued c W1,7 /t/ THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS �. certificate of (Compliance THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed ( )Repaired(/ )Upgraded( ) Abandoned( )by `c h� (1®.a !9' at ——•.r S k c_ . O�e�-T has been constructed in accordance with the provisions of Tit e 5 and the for Disposal System Construction Permit No.., _ dated Installer � c V Designer 1k_01*1 The issuance of this permit hal;ncot4e construed as a guarantee th t h syst'm �4_lncti�onas esigned. Date J ✓ Insp�tor-- � »_u.,. _...No. A J�.../ q �--------------®-----=—Fee l la'/'^ . . _ . Cf THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS Aligo!aY *p6tem on5truction Permit Permission is,hereby granted to Construct( )Repair( )Upgrade( )Abandon( ) System located at 4 ail `4- �» -�r 1 Lc.�. Ct�,_ r r A t1t-- , 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: Constructio, yet be completed within three years of the date of this permit. Date:�_ k) _ Approved by / JUN-06-2005 11 :05 AM DOWN CAPE ENGINEERING 508 362 9880 P. 01 Town of Barnstable a Regulatory Services 1 Thomas F. Geiler,Director s" AM Public Health Division t6�y A Thomas McKean, Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Installer & Designer Certification Form Date: Sewage Permit# Assessor's Map\Parcel Designer Installer: Address: ti Address, On was issued a permit to install a (date) // (insta er) septic system at 6°�� nei �^ f based on a design drawn by (address) 0—,V-"& daied �J (de finer 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 of the septic system) but in accordance with State & Local Regulations. Plan revision or certified as-built by designer to follow. AR NE H cs= OJALA (Inst� al— ler�s Signature) No 0I792 es�gner's Sign e) (Affix Designer's Stamp Here) PJ,EA TO BARNSTABLE JEU13LICAL IVISION, CFgTIFICATE C0MV%,1kNCE WILL N T 13E ISSIIED JJNTIL BOTH THIS F bL A D B iLT CA D R RECF 1VEp BY THE BARNSTABLF puuLIC EALTH DIVISION. THAN K YOU, Q. Hcalth/Septic/Designer Certification Form 3-26-04.doc TOWN OF BARNSTABLE T.00AT?ON (O� � I��H.� L�Nt� SEWAGE # VILLAGE e,e,>GeZ t/1 ASSESSOR'S MAP & LOT A910 Pol dn� INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY I NRow Cal-hPcx>l LEACHING FACILITY: (type) Ca wC® &.A,(Sizc) ' NO.OF BEDROOMS I �V� ?11 BUILDER OR OWNER 10 e, Ju4t 0, _ *FMMTDATE: 2 COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility S > Fee Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Fev Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching`` facility) Fe= Furnished by Ge U&ani2 1 , t � .36 f'3 - Hb 63- W a oa 3 CD- C0�Imo.N 'EALTH OF bLkSSACHUSETTS EXECUTIVE OFFICE OF EN'VIR0NMENTAL AFFAI = == F DEPARTMENT OF ENVIRONMENTAL PROTEC �9 ONE n1\T3 R STP.EET BOSTO\ �L4 02106 (615J 292•5.50o v, o O,r► Q 'DY Se�, n �\D H S ARGEO PALL CELLUCCI � Co cner Governor SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A Z j IUM1l �Q - CERTIFICATION iA1�- D tS°b� •� Property Address: 1,Z�C��`�'�+•C t tS Ln.r--<-- Name of Owner i��S`� �-• �`G+�-�`�, Address of Owner: '-1F-t7t�c�+- \'�t�\1�2 rj Date of Inspection:. Z�� t / � � C Name of Inspector:(Please Print)d a a r-C '/ —1)ELK U V`'"'\�"h"^• �►� bZ'1 S I am a DEP appr oved system inspector pursuant to Section 15.340 of True 5(310 CMR 15.000) ' Company Name. 2[L�., �r Ft�v� j��., _e L.'F.�- I� LG4-� MaMng Address: All, _1 3 �4 {-I��.���— � Telephone Number: / 15:0- ) ( /4- �G CERTIFICATION STATEMENT I certify that 1 have personally inspected the sewage disposal system at this address and that the information reported below is true. accurate and complete as of the time of inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. The system: Passes _ Conditionally Passes _ Needs Further Evaluation By the Local Approving Authority Fails Inspector's Signature I� t Date: 44Q�� The System Inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within thirty (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 Department of Environmental Protection. The original should be sent to Ore system owner and copies sent to the buyer,if applicable, and the approving authority. NOTES AND COMMENTS revised 9/2/98 NceIof11 w �i Printed on Recycled Paper �. SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) �E *roperty Address: •.R, II c, Jwner: Date of Inspection: INSPECTION SUMMARY:' Check A, B, C, or D: A. SYSTEM.PASSES: - eny information which indicates that any of the failure conditions described in 310 CMR 15.303 exist. Any failure I have not found criteria not°evaluated are indicated below. COMMENTS:-A 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. Indicate yes, no, or not determined (Y, N, or ND). Describe basis of determination in all instances. If "not determined", explain why not. _ The septic tank is metal, unless the owner or operator has provided the system inspector with a copy of a Certificate of Compliance (attached) indicating that the tank was installed within twenty (20) years prior to the date of the inspection; or the septic tank, whether or not metal, is cracked, structurally unsound, shows substantial infiltration or exfiltration, or tank failure is imminent. The system will pass inspection if the existing septic tank is replaced with a complying septic tank as approved by the Board of Health. _ Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. The system will pass inspection if(with approval of the Board of Health). broken pipe(s) are replaced obstruction is removed distribution box is levelled or replaced - - _ The system required pumping more than four times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): broken pipe(s) are replaced obstruction is removed revised 9/2/98 Page 2 of It t � 1 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: Owner: Date of Inspection: C. FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: Conditions exist which require further evaluation.by the Board of Health in order o determine if the system is failing to protect the public health, safety and the environment. 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES IN ACCO ANCE WITH 310 CMR 15.303(1)(b) THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PURL HEALTH AND SAFETY AND THE ENVIRONMENT: _ Cesspool or privy is within 50 feet of surface water Cesspool or privy is within 50 feet of a bordering vegetate wetland or a salt marsh. 2) SYSTEM WILL FAIL UNLESS THE BOARD OF H LTH(AND PUBLIC WATER SUPPLIER, IF ANY)DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: _ The system has a septic tank an soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water sup ly. _ The system has a septic tank nd soil absorption system and the SAS is within a Zone I of a public water supply well. _ The system has a septic tan and soil absorption system and the SAS is within 50 feet of a private water supply well. _ The system has a septic t k and soil absorption system and the SAS is less than 100 feet but 50 feet or more from a private water supply well unless a well water analysis for coliform bacteria and volatile organic compounds indicates that the well is free from polluti from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm. Method sed to determine distance (approximation not valid). 3) OTHER revised 9/2/98 Page 3orn SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (corrtinued) Property A�ress Owner: Date of Ins D. SYSTEM FAI IS. You must indicate 'ther "Yes" or "No" to each of the following: I have dete ined that one or more of the following failure conditions exist as described in 310 CMR 15.303. The basis for this determinatio is identified below. The Board of Health should be contacted to determine what will be necessary to correct the failure. Yes No _ y or system component due to an overloaded or clogged SAS or cesspool. Backup f sewage into facilit _ Discharg\I.ev g of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool _ Static liq the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool. Liquid depth n ces ool is less than 6" below invert or available volume is less than 1l2 day flow. _ Required pumping mo than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pump _ Any portion of the Soil Ab rption System, cesspool or privy is below the high groundwater elevation. Any portion of a cesspool or ivy is within 100 feet of a surface water supply or tributary to a surface water supply. _ Any portion of a cesspool or priv is within a Zone I of a public well. Any portion of a cesspool or privy i within 50 feet of a private water supply well. Any portion of a cesspool or privy is le s•than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. If th well has been analyzed to be acceptable, attach copy of well water analysis for -coliform bacteria, volatile organic compo ds, ammonia nitrogen and nitrate nitrogen. E. LARGE SYSTEM FAILS: You must indicate either "Yes" or "No" to each of the following: The following criteria apply to large systems in addition to a criteria above: The system serves a facility with a design flow of 10.000 gp or greater(Large System) and the system is a significant threat to public health and safety and the environment because one or more of he following conditions exist: Yes No the system is within 400 feet of a surface drinking waters ply the system is within 200 feet of a tributary to a surface drinki water supply the system is located in a nitrogen sensitive area(Interim Wellhea Protection Area•IWPA)or a mapped Zone II of a public water supply well) The owner or operator of any such system shall upgrade the system in accordance with 10 CMR 15.304(2). Please consult the local regional office of the Department for further information. revised 9/2/98 Puge4of11 t SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: ;� \`+ll�►N Gy S Owner: Date of Inspection: Check if the following have been done: You must indicate either "Yes" or "No" as to each of the following: Yes No NoPumping information was provided by the owner, occupant, or Board of Health. None of the system components have been pumped for at least two weeks and,the system has been receiving normal flow rates- during that period. Large volumes of water have not been introduced into the system recently or as part of this inspection. As built plans have been obtained and examined. Note if they are not available with N.A. The facility or dwelling was inspected for signs of sewage back-up. The system does not receive non-sanitary or industrial waste flow . The site was inspected for signs of breakout. All system components, excluding the Soil Absorption System, have been located on the site. The septic tank manholes were uncovered, opened, and the interior of the septic tank was inspected for condition of baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge, depth of scum. The size and location of the Soil Absorption System on the site has been determined based on: Nl14, Existing information. For example, Plan at B.O.H. Determined in the field lit any of the failure criteria related to Part C is at issue, approximation of distance is unacceptable) )15.302(3)(b)) The facility owner land occupants,if different from owner) were provided with information on the propermaintanat"-0f SubSurface Disposal Systems. revised 9/2/98 Page$orIII 1 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C �( o SYSTEM INFORMATION 'roperty Address: Owner: Date of Inspection: FLOW CONDITIONS RESIDENTIAL: Design flow: v g.p.d./bedroom. Number of bedrooms (design):0�,33 Number of bedrooms (actual): Total DESIGN flow. 3'S Number of current residents: OZ Garbage grinder(yes or no): Laundry (separate system) (yes or no).: fJ; If yes, separate inspection required Laundry system inspected 1 es or no) Seasonal use (yes or no): t.�5 Water meter readings, if available (last two year's usage (gpd). Sump Pump (yes or no): p Last date of occupancy: COMMERCIALANDUSTRIAL: Type of establishment: Design flow: 9pd 1 Based on 15.203) Basis of design flow Grease trap present: (yes or no)_ Industrial Waste Holding Tank present: (yes or not_ Non sanitary waste discharged to the Title 5 system: (yes or no)_, Water meter readings, if available: Last date of occupancy: OTHER:(Describe) Last date of occupancy: GENERAL INFORMATION PUMPING RECORDS and source of information: A System pumped as part of inspect on: (yes or not UM If yes, volume pumped: gallons Reason for pumping: TYPE OF SYSTEM Septic tank/distribution box/soil absorption system _ } _ Single cesspool 1Vv,-`t'v lGpj(2c.C\ ,T I ©u tvL r<<w C.2-S S 1�UU l Overflow cesspool Privy Shared system(yes or no) (if yes,'attach previous Inspection records.if any) I/A Technology etc.Attach copy of up to date operation an d maintenance contract ract Tight Tank Copy of DEP Approval Other APPROXIMATE AGE of all components, date Installed(if known)and source of information: �— _ �I i N�cwtr2. Sewage odors detected when arriving at the site: (yes or no)41-10 1 .revised 9/2/98 Page 6afll SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) 'roperty Address: Owner: Date of Inspection: BUILDING SEWER: (Locate on site plan) Depth below grade:_ Material of construction:_cast iron_40 PVC_ other (explain) Distance from private water supply well or suction line Diameter Comments: (condition of joints, venting, evidence of leakage, etc.) SEPTIC TANK:_ (locate on site plan) Depth below grade:_ Material of construction: _concrete _metal_Fiberglass _Polyethylene —other(explain) If tank is metal, list age_ Is age confirmed by Certificate of Compliance_(Yes/No) Dimensions: Sludge depth: Distance from top of sludge to bottom of outlet tee or baffle: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: How dimensions were determined: ;omments: (recommendation for pumping, condition of inlet and outlet tees or baffles, depj of liquid level in relation to outlet invert, structural integrity, evidence of leakage,etc.] / GREASE TRAP: (locate on site plan) Depth below grade:_ Material of construction:_concrete_metal_Fiberglass _Poly ylene—other(explain) I Dimensions, Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Comments: (recommendation for pumping,condition of Inlet and outlet eas or baffles,depth of liquid level In relation to outlet invert,structural integrity, evidence of leakage,etc.) revised 9/2/98 T age7of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) 'roperty Address: Owner: Date of Inspection: TIGHT OR HOLDING TANK: (Tank must be pumped prior to, or at time of, inspection) (locate on site plan) Depth below grade:_ Material of construction: _concrete _metal_Fiberglass_Polyethylene _other(explain) Dimensions: Capacity: gallons Design flow: gallons/day Alarm present Alarm level: Alarm in working order: Yes _ No_ Date of previous pumping: Comments: (condition of inlet tee, condition of alarm and float switches, etc.) DISTRIBUTION BOX:_ ' (locate on site plan) Depth of liquid level above outlet invert: Comments: (note if level and distribution is equal, evidence of solids carryover, evidence of leakage into or out of box, etc. PUMP CHAMBER:_ (locate on site plan) Pumps in working order:(Yes or Not Alarms In working order(Yes or No) Comments: (note condition of pump chamber,-condition of pumps and appurtenances,etc.) revised 9/2/98 PaFcsorit SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) 'roperty Address: (Nri lt�1� Owner: Date of Inspection: SOIL ABSORPTION SYSTEM(,SAS):A-;) (locate on site plan, if possible; excavation not required, location may be approximated by non-intrusive methods) If not located, explain: Type: leaching pits, number:—A�kr)((r, leaching chambers, number:_ leaching galleries, number:_ leaching trenches, number, length: leaching fields, number, dimensions: overflow cesspool, number:_ Alternative system: Name of Technology: Comments: (note condition of soil, signs of hydraulic failure, level o pond) g,.dam s condition of vegetation, etc.) — A.w. c r v t J CESSPOOLS:GCS (locate on site p n) Number and configuration: ("OVA Depth-top of liquid to inlet,invert: 3 I Depth of solids layer: 11 )epth of scum layer: Z `r Dimensions of cesspool: 4 b 14 is �.` 3 �� �f=%e e T✓f Materials of construction: 4'Oti. 6:.'- "'- Indication of groundwater: /✓v inflow(cesspool must be pumped as part of inspection) c� Comments: (note condition of s it signof hydraulic failure,level of pending, condition of vegetation, etc W I PRIVY:�� (locate on site plan) Materials of construction: Dimensions: Depth of solids: Comments: (note condition of soil, signs of hydraulic failure,level of pending, condition of vegetation, etc.) revised 9/2/98 Page 9of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) l�� ;� 'roperty Address: 2 li� � Q S )wner: Date of Inspection: SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent reference landmarks or benchmarks locate all wells within 100' (Locate where public water supply comes into house) d z 3 63 revised 9/2/98 P.getooru SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) roperty Address: Owner: Date of Inspection: NRCS Report name ---- ----- Soil Type_ _ —..-------- ------ Typical depth to groundwater—___,_ USGS Date website visited Observation Wells checked Groundwater depth: Shallow Moderate SITE EXAM Slope,S�+\ Surface water 0 • Check Cellar pp I{e, Shallow wells N'r-'r I Estimated Depth to Groundwater 5Feet Please indicate all the methods used to determine High Groundwater Elevation: Obtained from Design Plans on record Observed Site (Abutting property, observation hole, basement sump etc.) Determined from local conditions Checked with local Board of health Checked FEMA Maps Checked pumping records Checked local excavators. installers Used USGS Data om leted) established the Hi p Describe how you est h Groundwater Elevation. (Must be c g IC)� l C CV 1 3%ZQL� revised 9/2/98 Page 11oru LdCATI m SEWAGE PERMIT NO. :)- - VI 3� LACE LCE NA E i� ADDRESS T i B U I L D E R OR OWN ER DATE PERMIT ISSUED 2- 0 A T,E COMPLIANCE ISSUED 1L- 13 � �` i i 4# V0 /`w r � • of �� •, `��' e Noo�7.t'... �- Fizs.Z....c.............. THE COMMONWEALTH OF MASSACHUSETTS BOAR® 0Y HEALTH Appliration fear Dispnnnl Works Tonotrnrtion ranfit Application is hereby made for a Permit to Construct ( ) or Repair ( Z--J"'an Individual Sewage Disposal System at: � A La�ation- ddr s or Lot No. .....-- -�.sa_ �,,.. ............................ .. ............................................. �� Address ddre Installers" Address QType of Building .♦ . Size Lot............................Sq. feet 0-4 Dwelling:: o< of Bedrooms............................................Expansion Attic (+ ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons..............--.....--.--.. Showers ( ) — Cafeteria. ( ) Otherfixtures ----------------------------------------------------------------------------------------------------------•-----------------------••----------....--•- Design Flow............................................gallons per person per day. Total daily flow............................................gallons. Septic Tank—Liquid capacity............gallons Length________________ Width........---.---. Diameter--.-.- .---_._. Depth................ x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area•.-.----___ --_____sq. ft. Seepage Pit No--------------------- Diameter............---..... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date........................................ aTest Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water........................ Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water....................--.. a' ............. •• - -------_-- .................•-•---•-----------•--=............................................................ W x Description of Soil------ --------------------------------------------------------•---------------------------------........_..--- W •--•------•-----------------•--•••----•-•---•-...-••••---••--•------••--•---•-----•--------•--••---------•-•---> ---------------•-- ----------- V Nature of Repairs or Alterations—Answer when applicable...--L'�.z- A.A..--.... l'/ ------------- ...••-•-•-•--------•-••-•-•--•--------------•------•-----•-----••---•••••-••-•--...........................•--------•--••-•••---------•-••-•-----•-•-----••......-••-------•-......------•--•••....... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of iITI.L 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has bee .ssued by heb d of ealth�. %Signed. ........ ... .. .. ��d.....�.... . .-- ......-- -• a��p7.. l � ate Application Approved By__ ___ _/_2Z�fi�► Date Application Disapproved for the following reasons:............................. Date ^�rmit No......................................................... Issued-..................................... .................. Date t ' THE COMMONWEALTH OF MASSACHUSETTS BOARD O HEALTH �,�I�y y� � . .........................` e.................OF.......".. dr "'f E, �.... Appliration for Dispno al Works Tontitrnrthin runfit Application is hereby made for a Permit to Construct ( ) or Repair (d')f an Individual Sewage Disposal System at: ..........i"......... ......... ... Location ;AddKqss or Lot No. ---•�!`-Jf't .�r a-' ..:ram` .f'i�'���-'3``'.aLr ... --- .......-•---------------••---.............. ..._..._..---••-----.................. -----• r. Addre� .. . G P z .1 .. --•___._ ...................... Installer ress 'I'- • PQ U Type of Building, i ; e Lot_____________`:__.._.......Sq. feet Dwelling—No. of Bedrooms.......................................:....Expansionic ., )- Garbage Grinder ( ) Other—Type of Building ____________________________ No. of persons___.-__:_______________--__ Showers ( ) — Cafeteria ( ) Otherfixtures -------------------------.......................................................................................................................... W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity............gallons Length................ Width................ Diameter---------------- Depth................ x Disposal Trench—No______________________Width.................... Total Length.................... Total leaching area--------------------sq. ft. Seepage Pit No..................... Diameter.................... Depth below inlet ................. Total leaching area..................sq. ft. z Other Distribution box .( ) Dosing tank( ) Percolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water......................... (� Test Pit No. 2................minutes per inch Depth of Test Pit..............._.... Depth to ground water........................ At -----•-----•------------•----•-----------------•.:... ----------------------------- •---------- oDescription of Soil -.2; x '} "° ---------------------------------------------------•-------------------------------••----•------------. x U W ----- - - ------------- --- ----------------- ---------------- - ------ ----- U Nature of Repairs or Alterations—Answer when applicable -------------------------------- ---------------------- ....-•• ---•-•---------------------------------------------------•--------------------.........._......---- Agreement The. undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has bee,M`Vissuedb�1yAhe bgar /�' o ealth. di pSigned �,, , � ....... .......• --......_ ----- --- -------- le Application Approved By___---,ram:__.__ _.____ ` 7 �1 I ate!� Date Application Disapproved for the following;reasons----------------•-•-----------------------------------------------------...................................... ---------------------------------------------------------------------------------------.................................................................................................................. Date PermitNo.......................................................... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS s BOARD O HEALTH i .� i;.� � �rr�i�irtt#r oaf f��rnt�rli�anrr - '� T S FS T 9 !'ERTIF TbAt the In^idual Swage Disposal System constructed ( ) or Repaired by. tl;_fr ph ' � a .ty .. l t Insal at... . j ._ff �1tiA� !/f .. . ✓ ., . has been installed in accordance with the provisions of TITLE 5 of The State Sanitary Code a described in the application for Disposal Works Construction Permit No._____ _ __'-1._(. ,_ ____._.. dated------- __�.:Z_l_ f_________________ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE............... ...__,� = = Inspector............. _ ............................................................. THE COMMONWEALTH OF MASSACHUSETTS BOARD O HEALTH P 9 Y........... .._......_. G / No.. ............. FEE..> ...__........... �rk�, �un� nr�uan Prnti� -. .Permission > hereby granted.....:.:..... :::__.___._ ............................................ to Copstr t, ) or/Aepair �anrindividual Seyefte Disposal S s em r•---- Stre.e+ i,�. t //� is— as shown-on the application for Disposal Works Construction Permit.". .Dated....�_��t.f_�.1. Boa alth DATE --------•-.---..:--- ; FORM 1255 A. M. SULKIN, INC., BOSTON � � L0CATI SEWAGE PERMIT NO. I �LAG E Lt [. NA E a ADDRESS BUILDER OR OWNER DATE PERMIT ISSUED r. DAT E C 0 M P L I A N C E ISSUED f1. f r i b r I TOWN OF BARNSTABLE J;LOCATION �02 A I NJI' 1 49AL, SEWAGE # .2.0r" 19 J� NAZI AGE',"_;.:�p_nT�r✓t • e ASSESSOR'S MAP & LOTAZ OVS-41 INSTALLER'S NAME&PHONE NO. Kt C`ztf (.�d SEPTIC TANK CAPACITY / LEACHING FACILITY: (type) / (size) // X Sid NO.OF BEDROOMS y BUILD OR OWNER �"QS PERMITDATE: --s--6 -?> COMPLIANCE DATE: - - r Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If wetlands exist within 300 feet of leaching facility Feet Furnished by c,a 0 0 s V N I TOP FNDN. AT EL. 60.14' SYSTEM PROFILE TEST HOLE LOGS ACCESS COVER TO WITHIN 6" OF FIN. GRADE (NOT TO SCALE) PROVIDE INSPECTION PORT WITHIN 6" OF FINISH GRADE ARNE H. OJALA, PE o ACCESS COVER (WATERTIGHT) TO ENGINEER: o ` 54.0 MINIMUM .75' OF COVER OVER PRECAST WITHIN 6" OF FIN. GRADE 2% SLOPE REQUIRED OVER SYSTEM 52.0' - 53.0 WITNESS: D. DESMERAIS, RS �P LOCUS RUN PIPE LEVEL 2" DOUBLE WASHED PEASTON DATE: 4/22/05 i �o �- FOR FIRST 2' \ < 2 MIN/INCH PROPOSED 1500 �. 3 MAX. PERC. RATE = s 71 \NEC BASE. SLAB AT GALLON SEPTIC 50 4c�' SO.O' i 10952 CLASS SOILS P# °0rss� ELEV. 53.3' 50.70 TANK (H- 10 ) GAS [] 0 Q 0 0 0 Cl a a _..__�'___ BAFFLE 49.55' �� 49.38 9 49.2 O INVERT(S) OUT NOT FOUND O 0„ ELEV. �6" CRUSHED STONE OR MECHANICAL � 2, O O 0 o 47.2' 3�0 COMPACTION. (15.221 [21) oo�o A DEPTH OF FLOW = 4' ( 6 SLOPE) ( 1 SLOPE) 3 4" TO 1 1 2" DOUBLE WASHED STONE TEE SIZES: / / �LS UNSUIT. INLET DEPTH = 10" 2" 1OYR 2/1 OUTLET DEPTH = 14 E LOCATION MAP NTS /FS UNSUII FOUNDATION- 25' SEPTIC TANK 15' D' BOX 20' LEACHING 3" 1OYR66/2 ASSESSORS MAP 250 PARCEL 15-1 N FACILITY 5. U-) / BENCH MARK - TOP OF � �SL UNSUIT. CONC. BOUND EL. = 50.8 49.8 24 10YR 5/6 1 (0�lb *THE INSTALLER SHALL VERIFY THE 6 00 + 56.7 LOCATIONS OF ALL UTILITIES AND ALL C1 1z -K49.2 BUILDING SEWER OUTLETS AND ELEVATIONS 49.1 �-' PRIOR TO INSTALLING ANY PORTION OF /S L UNSUIT. 4 . a 8 SEPTIC SYSTEM 42.2 4 53.9 NOTE: INVERTS) OUT NOT FOUND. 1OYR 6/2 -I_ ���J' CONFIRM ELEVATIONS) AND PROVIDE 48" 48.2' ¢ ,--K48.2 Co GRAVITY FLOW TO 1500 GAL. SEPTIC TANK AT MIN. 2% SLOFE PERC C2 Q a7 ° L. � MCS/GRAVE GRAVE of 5' REMOVAL C.F UNSUITABLE SOIL REQUIRED i U) PR P. 40 IL LIN R +,3 PARKI 88 AROUND PORTION OF PERIMETER OF LEACHING 2.5Y 5/4 FACILITY (HATCHED AREA), DOWN TO SUITABLE 120" 42 2' SOIL LAYER. REPLACE WITH CLEAN MED. SAND. 96, PROVIDE APPFOX. 70' OF 40 MIL LINER AT 5' NGWE 46. + 4 h /' OFF SAS IN AREA OF REMOVAL. TOP AT ELEV. CO o 50.0', BOTTOM AT ELEV. 46.0' NOTES: PROP. 1500 h^ + a - GAL. SEPTIC SEPTIC DESIGN: NOT ALLOWED APPROX. NGVD SPOT ELEV. GIS TANK (GARBAGE DISPOSER IS ) 1 . DATUM IS ( ' ) + a9,4 F`S / o DESIGN FLOW: 4 BEDROOMS ( 110 GPD) = 440 GPD ,T�� EXISTING .6 �' `0 r`~ USE A 44U GPD DESIGN FLOW 2. Pf.v ,,.,Ir'r;L WVAILA iJ - - 58.0 / 3. MINIMUM PIPE PITCH TO BE 1/8" PER FOOT. \ 57.0 ch SEPTIC TANK: 440 GPD 4.5 = 880 _ 10 40 (-) 4. DESIGN LOADING FOR ALL PRECAST UNITS TO BE AASHO H + 57.0 `O I USE A 1500- GALLON SEPTIC TANK 5. PIPE JOINTS TO BE MADE WATERTIGHT. 41.3 + 50. `O LEACHING: 6. CONSTRUCTION DETAILS TO BE IN ACCORDANCE WITH MASS. .1 GASLINE THIS AREA (NOT + 62.5 2(39 + 10.83) 2 (.74) 147 ENVIRONMENTAL CODE TITLE V. - ° FLAGGED UP) SIDES: 7. THIS PLAN IS FOR PROPOSED SEPTIC SYSTEM ONLY AND IS NOT 2' i BOTTOM: 39 x 10.83 (.74) = 312 TO BE USED FOR ANY OTHER PURPOSE. v 50. ,a i 8. PIPE FOR SEPTIC SYSTEM TO SCH. 40-4" PVC. �` ' 7i TOTAL 621 S.F. 459 GPD 9. COMPONENTS NOT TO BE BACKFILLED OR CONCEALED WITHOUT �%.Oez / USE (4) 500 GAL. LEACHING CHAMBERS WITH 3 INSPECTION BY BOARD OF HEALTH AND PERMISSION OBTAINED EXIST. DWELLING SHED IN THIS AREA i STONE AT SIDES AND 2.5' AT ENDS FROM BOARD OF HEALTH. (NOT LOCATED) �7 10. PUMP & REMOVE (OR FILL W/CLEAN SAND) EXISTING SEPTIC SYSTEM DECK �' LEGEND SEWER LINE MUST BE SLEEVED FOR %' 1 OO.O PROPOSED SPOT ELEVATION TITLE 5 SITE PLAN ENTIRE LENGTH BETWEEN DWELLING _ AND PROPOSED SEPTIC TANK 2O6 4i 10OX0 EXISTING SPOT ELEVATION OF . o _.. 624 PHINNEY S LANE O LOT AREA / 100 -o PROPOSED CONTOUR IN THE TOWN OF: 22,430f SQ. FT. o / C d / J� ° 100 EXISTING CONTOUR (CENTERVILLE) BARN CHARLES KIPNES / EXISTING OAK PREPARED FOR: 20 0 20 40 60 / BOARD OF HEALTH F PPR�VED DATE MA SCALE: 1 " = 20' DATE: APRIL 24, 2005 / / off 508-362-4541 / fax 508 362-9880 � ����SN OF M,yss9c a����1-� down cape engineering, inc, ARNE ARNE H OJAI A H. / CIVIL ENGINEERS 0!VIL o.lALA Ida,26348 LAND SURVEYORS � � o.3Q79 0 "� � S 5 939 vain st, yarmouth, ma 02675 �A �u RN �. 05-049 AR . �JALA, ., P.L.S. D7ITE