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HomeMy WebLinkAbout0020 QUIET WAY - Health 20 QUIET WAY,CENTERVILLE A= 208 097 �llll J��cva�� �7fll ' UPC 12634 ' No.2� 15R � HASTINGS,MN • TOWN OF BARNSTABLE LOCATION -�el a 10 SEWAGE # 0 l t0 VILLAGE /gin le,-aft Ile ASSESSOR'S MAP & LOT �`b 9 7 INSTALLER'S NAME&PHONE NO. e� /✓� �f o SEPTIC TANK CAPACITY LEACHING FACILITY: (type) (size) fob X`/y X.1 NO.OF BEDROOMS r� BUII.DE R OWNER f r����° ff I��'r6�` J���.rf r✓f PERMTTDATE: 3'a?®"I COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and 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 Wedand and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by A" r aG Y f31 TOWN OF BARNSTABLE LOCATION o2 SEWAGE# VILLAGE ASSESSOR'S MAP&LOT2c 8 0`Ir7 INSTALLER'S NAME&PHONE NO. SEPTIC;TANK CAPACITY LEACHING FACILITY: (type) NO.OF BEDROOMS 3 BUILDER OR OWNER PERMTTDATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by 13� _ � �f � ° �d 3 � �{� i �� �-$ f-I�-e_ � �'� I ft 0. • TOWN,OF BARNS'TABLE LOCATION W.2 0 Q��c f fah SEWAGE # VILLAGE_ n 7e o- `le ASSESSOR'S MAP& LOT ` F-6 9 7 INSTALLER'S NAME&PHONE NO. Ifo SEPTIC TANK CAPACITY LEACHINGFACILITY: (type) (size) / 1"/y .C-1 j. -NO.OF BEDROOMS 5 ITILDE T�,. d i . B R OWNER / //�. Ut tle/ PERMUDATE: .3"_2 O"j COMPLIANCE DATE.: f Separation Distance Between the:. Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply Welland Leaching Facility (If any wells exist .. on site or within 200 feet of leaching facility) Fee[ Edge of Wetland and Leaching Facility(If any wetlands'exist within 300 feet of leaching facility) Feet Furtrished by K•y��``ty,, SIR"•"..h+' 4',,a37 t'_ .y I.. �!Shr '-4 lF`K -#r _:.... .:....: I - ...: .. L 71 ., a. s j 3=i y 31 ' ' E —� No. ODI Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: _,-,_� Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS t� 2pprication for Migo!gal *p2tem Congtructfon Permit Application for a.Permit to Construct(X)Repair( )Upgrade( )Abandon( ) X Complete System O Individual Components Location Address or Lot No. Z O c (� Owner's Name,Ada-xdress and Tel.No. Z Assessor's Map/Parcel h0*1P �� 1 CcH lzry � 0710 3Z 10 Installer's Name,Address,and Tel.No. ,C,a,I Designer's Name,Address and Tel.No. 0 n ,t,{ 13a c lzv,, Or I' Ko l my rer+ ,yr+c N Gib,( 31b g ,� relz Yna,.) Sf., ov'rIle, W.4 o zg ss Type of Building: Dwelling , No.of Bedrooms 1=tvc Lot Size 34, �3E 1 sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow I gs}}easTer-darCalculated daily flow 5-J© gallons. Plan Date Number of sheets o^a Revision Date Title _5Wti,_ ts,v7 Za auc-4- LtX Size of Septic Tank Type of S.A.S. 44ar-ck!y a Ile,�s �''g'x/Z,t K Z��4 Description of Soil Er'l.c.c"e- -3m flan 4D snt 1 I ucrn c i pi&n 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 is e b is Brard of�tl. Signed Date_ ;5"3- o Application Approved by 1�i�P1 Date Application Disapproved for the following reasons Permit No. r2co Date Issued 1:71 L92 � THE COMMONWEALTH OFMASSACHUSETTS �' No. Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS ZippYication for Migooar *pztem (Construction Permit Application for a Permit to Construct(X)Repair( )Upgrade( )Abandon( ) IN Complete System El Individual Components Location Address or Lot No. Z O Owner's Name,Address and Tel.No. Z Assessor's Map/Parcel ZMG zoo PC% ®, a-x 5-7 6- 7 �ct.nFzrvi/� `Yl7A OZfv av� Installer's Name,Address,and Tel.No. {{ Designer's Name,Address and Tel.No. *4Zg-S f 3 / 0 C Q�1.� g 0 v�a ���j�,� 1 I�✓cclzv, 0Y.. � X �o�m yev+ Type of Building: Dwelling No.of Bedrooms F-tvz Lot Size 3�E9 sq.ft. Garbage Grinder((tom) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gx}let3s-ger-day-Calculated daily flow 5-SO gallons. Plan Date io i/ham Number of sheets onW Revision Date Title S. t dk"", 2-¢5 Size of Septic Tank /S00 a Type of S.A.S. Le-aLc: 6c Ile,is 1f 4 xl Z1 tY Z' Description of Soil Ptc...4_ 4.1 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 is e b is Bo of He th. Signed Date "3' Application Approved by 1'b�Q{� Date 3 Application Disapproved for the following reasons t Permit No. r900)—1 R-6 Date Issued 3, R)n >" No. i.�OV�.:. Fee Entered in computer: THE COMMONWEALTH OF MASSACHUSETTS Yes PUBLIC HEALTH DIVJ.SIdN -TOWN OF BARNSTABLE, MASSACHUSETTS application for Mizpaal *potem Conotruction Permit Application for a Permit to Construct(X)Repair( )Upgrade( )Abandon( ) XCompleteSystem ❑Individual Components Location Address or Lot No. Z O Qu t c- L,jw Owner's Name,Address and Tel.No. Assessor's MapMarcel 9C1 " ZAS y 9 p w . ? 1 Gevrfz. ✓./�a *nA OZ06✓L 0 Installer's Name,Address,and,Tel.No. Designer's Name,Ad ress and Tel.No. rev. ,S►►e N BIZ vYl u i 5f. Os w,/!l ^4 O Z65S v Type of Building: Dwelling No.of Bedrooms f ivr- Lot Size 34 3121 sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow I►v ot 14 art" gattons-perTl".-Calculated daily flow SS© gallons. Plan Date 10,713 rrO Number of sheets Revision Date Title 55.2fu q;60,�r, ZD Way, Size of Septic Tank /Sao Type of S.A.S. 4-..C,4.Z a-.//,Y> -f 4-X I "Description of Soil etc—'e- Vstu" 40 So,1 I S< .1 1 ah ( p,'(5 � I 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 is ie b t is Bo of�H��l��th. Signed C�C. Date 3 Application Approved by AA c, SCKk1bt...>r 7 i=1 �`' _ Date -�3 I a Application Disapproved for the following reasons �- f Permit No. Date Issued 3 h'3 0 I ————————————————————------------------- THE COMMONWEALTH OF'MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS IS TO C13T? , at n-site Sewage Disposal System Constructed( )Repaired( )Upgraded( ) Abandoned( )by at o has een constructe in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. �CD I Y 1�� dated 3201 Installer Designer The issuance ofMthienrrmt shall not be construed as a guarantee that the syste will nct' as.des'g a an Date O/ Inspector No. --------------------------Fee .�- THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS liopoza[ &pgtem Conotruction Permit Permission is hereby granted to Construct(Repair( )Upgrade( )Abandon( ) System located at C. •f "�• )u 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:Constry tion-anust be completed within three years of the date of ` t. Date: Approve , Town of Barnstable P# Department of Health,Safety,and Environmental Services a�Im Public Health Division Date li �r) q 367 Main Street,Hyannis MA 02601 enaetaTAetK HASS , 69 , �fD tMr Date Scheduled0/1-) Time Fee Pd. Soil Suitability Assessment for Sewage Disposal Performed By: Shnh,. /1 W J&6,,1 E5 Witnessed By: �oN�^e, IG✓GnG�► LOCATION &'GENERALINFORVIATION Location Address �►�t t �. Owner's Name e ,­y L o. ('max 579' Address 6e--k a-c r , I LC I Assessor's Map/Parcel:A167P.2 f Engineer's Name Sin.rha-+ A W i l sup PLS I?,O Kl2r OC.� �t C, G 01 i'K�Y171'� 0 NEW CONSTRUCTION REPAIR Telephone N (t t K t 3 N Land Use Slopes(%) Surface Stones Distances from: Open Water Body ft Possible Wet Area ft DrinfCing Water Well ft Drainage Way ft Property Line ft Other ft SKETCH: (Street name,dimensions of lot,exact locations of lest holes&perc tests,locate wetlands in proximity to holes) rp 1 TP Z Exta h POwr house 1 i t �?ul , 4 w'4 Y Parent material(geologic) Glacial Oufr.G,sk Depth to Bedrock Depth to Groundwater: Standing Water in Ilole: Weeping from Pit Face Estimated Seasonal High Groundwater DETE+T iNATYON FOR SEASONAL HIGH WATER`rAB E »: . . Method Used. Depth Observed standing in obs.hole: in. Depth to soil mottles: Depth to weeping from side of obs.hole: in. Groundwater Adjustment ft. .__ index wo.q _R,r.2dinv r7ate Index Well level __ Adi._factor..__ Adi.Groundwater Level PERCOLAT ION;TEST oats iv 3 Timc /ca 3oA Observation Hole M Time at 0 Depth of Pere &0 Time at 6" Start Pre-soak Time Qu Time(9"-V) End Pre-soak seak Rate Min./Inch Site Suitability Assessment: Site Passed Site Failed: Additional Testing Needed(Y/N) Original: Public health Division Observation Hole Data To Be Completed on Back j Copy: Applicant B HoEEPQSEVANHOLR LOG le # . R Depth from Soil Horizon Soil Texture Soil Color Soil Other. Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulderes. Consi tenc %Gravel) d /� '!. /32� � fv1i�R Jcvu:(1 f•r^ro�� �vQ. . 10.1�12 /' .,._.— llEEP 03SRVATXQN HOLE LOG Hole # Depth from Soil Horizon Soil Texture. Soil Color Soil Other . Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulderes. Cons*istencv.%Graven "rip So.uCJ:. Loon to-tie, 4/4 e .. oleO OLR HLOGHA .D Depth from Soil horizon Soil Texture Soil Color. Soil.. Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulderes. Consistency,%Gravel DEEP OBSEI.3VAT:ION -POLE LOG :: Hole<# Depth from Soil Horizon Soil`Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Molding (Structure,Stones,Boulderes. Cons' tenc Gravel Flood Insurance Rate Maw Above 500 year flood boundary No_ Yes Within 500 year boundary No Yes Within 100 year flood boundary No 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? t c_ If not,what is the depth of naturally occurring pervious material? Certification I certify that on 4J.1s (date)l 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 CM 15.017. Signature .- m,. Date /Q re © 77 �* SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM Address of property � r � owner' s name Date of Inspection _ S—_C7 PART A CHECKLIST SEP ? Z 1995 Check if the following have been done: HEALTHDEPT. TM OF BARNSTABLE Pumping information was requested of the own B Health. oard o 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 the are not ./ available with N/A. y V The facility or dwelling was inspected for signs of sewage back-up. The site was inspected for signs of breakout. _ZA11 system components, excluding the SAS, have been locate d on the site. The septic tank manholes were uncovered, r d, 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. v The size and location of the SAS on the site has been determined based on existing information or approximated by non-intrusive methods. V The facility owner (and occupants, if different from owner) were provided with information on the proper maintenance of SSDS. , y'e . r SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B SYSTEM INFORMATION • FLOW CONDITIONS - Pjlum4i_-i. H Cbe rooms _ number .of cut ent residents . �M 1 , -i gakb�age,;g i, d r, yes or no e laundrvF,gajjn.ected to system, yes or no ,&_ seasonal use, yes or no If nonresidential, calculated flow: Water meter readings, if available: Last date of occupancy GENERAL INFORMATION Pumping records and source of information: System pumped as part of inspection, yes or ( io) if yes, volume pumped �`// Reason for pumping: , r-C-- Type of system Septic tank/distribution box/soil absorption system �- Single cesspool V7_ Overflow cesspool Privy Shared system (yes or no) (if yes, attach previous inspection records, if any) Other (explain) Approximate age of all components. Date installed, if known. Source of information: -. Sewage odors detected when arriving at the site, yes or no I I SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART S- SYSTEM INFORMATION continued SEPTIC TANK: Xjo1Nk (locate on site plan) depth below grade:•z material of construction: concrete metal FRP other(explain dimensions: sludge depth distance from top of sludge to bottom of outlet tee or baffle scum thickness g ' distance from top of scum to top of outlet tee or baffle /0,, distance from bottom of scum to bottom of outlet tee or baffle Comments: (recommendation for pumping, condition of inlet and outlet tees or baffles depth of liquid level in relation to outlet invert, structural integrity, evidence of leakage, recommendations for repairs, etc. ) ell DISTRIBUTION, BOX:4 (locate on site plan) NO 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, recommendation for repairs, etc. ) O PUMP CHAMBER (locate on site plan) /lylk_ pumps in working order, yes or no Comments: (note condition of pump chamber, condition of pumps and appurtenances, recommendations for maintenance or repairs,etc. ) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B SYSTEM INFFOORMATION continued SOIL ABSORPTION SYSTEM . (SAS) : ( locate on site plan , if possible; excavation not required, but may be approximated by non-intrusive methods) If not determined to be present, explain: Type. leaching pits and number x leaching chambers chambers and number leaching galleries and number leaching trenches, number, . length leaching fields, number, dimensions overflow cesspool , number Comments: (note condition of soil , signs of hydraulic failure, level of ponding, condition of vegetation, recommendations for maintenance or repairs, etc. ) CESSPOOLS (locate on site plan) : number and configuration c,2 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 (cesspool must be pumped as part of inspection) Comments: - (note condition of soil , signs of hydraulic failure, level of ponding, condition of vegetation, recommendations for maintenance or repairs, 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, recommendations for maintenance or repairs, etc. ) 8118sURFACE sEWAG E DXSPOBAL de�erm to Yes, no FAILURZ C C YBTEM IZJ3pECT10N Inatlon in 'a11 not adeterm . CRITERIA FORM Backup of s Instances. rf �(Y, N, or N . eWage into facility? acilit ? not determ Dned,r, e cribe basi Discharge or y' xplain whY surface waters onding of efflu ant to the surface Static li A19qu D aoX of the veI ground Liquid in the dlstrlbutio flow, depth in cessPOpl c6,. n box above outlet invert �6 below invert or av Y-� number Pum allabl mbar of times pumped °r more a Volume< d Septic tank In the last Year' infiltrat -s metal -> cracked q/ IS an tantlal exfilt ruc u;allY uns �L below the high of the n' tank ' substant . igh groundwater cesspool �pool or r failure I�Inent?al within 5p f ation, Privy: �"!� w • eat of a Surface Water? I hin Ipp water supply eat of a surface within a water supply or trio �( Zone r of a Public tributary to a surface �"•-- within well' (cesspools and of a bordering on Ing veget ' within 50 IY, the SA wetland ° feet of a private S) • r salt marsh Ses-s than IO water SUPP1y haPPIY well w• feet but Well? s been Ith no greater and coliformlba�d to be acceptable water5p feet from nitrate bacteria ePtab quality an a Private ' nitrogen. ' volatile °rgan3cach cOpya° sas?f Well If the cOmpounds, a nia nl anal Ysi nit rt SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B � SYSTEM INFORMATION continued SKETCH OF SEWAGE SPOSAL SYSTEM: include ties to at least two permanent references landmarks or benchmarks locate all wells within 100 ' ------------------ � � I 1 i DEPTH TO GROUNDWATER depth to groundwater method of determination or approximation: �9 .2, TOWN OF 4C BOARD OF HEALTH SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM - PART D CERTIFICATION TYPE OR PRINT CLEARLY- PROPERTY INSPECTED STREET ADDRESS ASSESSORS MAP, BLOCK AND PARCEL 0 OWNER' s NAME ART D CERTIFICATION A NAME OF INSPECTOR COMPANY NAME COMPANY ADDRESS Street Town or City state ZIP COMPANY TELEPHONE (,5-0 0) '7r79 0,.Z' 7"C1 FAX (5--o F ) 77 8 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage dispostil system this address and that the information reported is true , accurate , and complete as of the time of inspection . The inspection was performed and any recommendations regarding upgrade , maintenance , and repair are consistent with my training and experience in the proper function and maintenance of 01 site sewage disposal systems . Check v e : System PASSED The inspection which I have conducted has not found any information which indicates that the system fails to adequately protect public health or the environment as defined in 310 - CMR 15 . 303 . Any failure criteria not evaluated are as stated in the FAILURE CRITERIA section of this form. System FAILED The inspection which I have conducted has found that the system fails t. protect the public health and the environment in accordance with Title 5 , 310 CMR 15 .303 , and as specifically noted on PART C - FAILURE CRITERIA of this inspecio form. Inspector Signature gate One copy of this certification must be provided to the OWNER, the BUYER (where applicable ) and the BOARD OF HEALTH. If the inspection FAILED, th*e owner or operator shall upgrade the system within one year of the date of the inspection, unless allowed or required otherwise as provided in 310 CMR 15 . 305 . partd.dc SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM Address of property ' Co mom- U~� 3Z Owner's name Date of Inspection _ e7 Ste' C �D PART A ' CHECKLIST -S EP 2 2 1995 Check if the following have been done: HEALTH DEPT. 'iM OF BARNSTABLE Pumping information was requested of the own,--,. , Board o /Health. V 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 site was inspected for signs of breakout. _ZAll system components, excluding the SAS, 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 SAS on the site has been determined based on existing information or approximated by non-intrusive methods. The facility owner (and occupants, if different from owner) were provided with information on the proper maintenance of SSDS. ------------------- DIRECTOR OF PUBLIC HEALTH SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORH Address of property �>2 m�- Owner' s name 7 � W Date of Inspection �_� �_C7 �C��� PART A ' CHECKLIST SEP Z Z 1995 Check if the following have been done: ' IiF.14l.THDEFT. IOMIN OF OMSTABLE Pumping information was requested of the own , Board o 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. V The facility or dwelling was inspected for signs of sewage back-up. The site was inspected for signs of breakout. ''.. _jZAll system components, excluding the SAS, 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 SAS on the site has been determined based on existing information or approximated by non-intrusive methods. The facility owner (and occupants, if different from owner) were provided with information on the proper maintenance of SSDS. F-. SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B SYSTEM INFORMATION y , FLOW CONDITIONS c.Hti n 8d le rooms g �. cu ent residents rat) e0Al�l r, yes or no ry q ted to system, yes or no AZO seasonal use, yes or no If nonresidential, calculated flow: Water meter readings, if available: Last date of occupancy GENERAL INFORMATION Pumping records and source of information: System pumped as part of inspection, yes or(�io) if yes, volume pumped 0 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) Other (explain) Approximate age of all components. Date installed, if known. Source of information: / N_ Sewage odors detected when arriving at the site, yes or no 4�a C D� SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B SYSTEM INFORMATION continued TANK: XV0 '(-"4-Nk SEPTIC ., (locate on site plan) depth below grade material of construction: V concrete• metal FRP ' ' other explain dimensions: sludge depth distance from top of sludge to bottom of' outlet tee or baffle a' scum thickness distance from top of scum to top of outlet' tee orsbaffle 10,, distance from bottom of scum to bottom of outlet tee or baffle Comments: (recommendation for pumping, condition of inlet and outlet tees or baffles depth of liquid level in relation to outlet invert, structural integrity, evidence of leakage, recommend tions for repairs, etc. ) Teems rt",s, DISTRIBUTION BOX: (locate on site plan) )VII 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, recommendation for repairs, etc. ) ._n in PUMP CHAMBER: (locate on sit plan) -� � pumps in working order, yes or no Comments: (note condition of pump chamber, condition of pumps and appurtenances', recommendations for maintenance or repairs,etc. ) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B SYSTEM INFORMATION continued SOIL ABSORPTION SYSTEM (SAS) : (locate on site plan, if possible; excavation not required, but may be approximated by non-intrusive methods) If not determined to be present, explain: Type. leaching pits and number _0,..rl� leaching chambers and number leaching galleries and number leaching trenches, number, length leaching fields, number, dimensions overflow cesspool , number Comments: (note condition of soil , signs of hydraulic failure, level of ponding, condition of vegetation, recommendations for maintenance or repairs, etc. ) CESSPOOLS (locate on site plan) : number and configuration n2 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 (cesspool must be pumped as part of inspection) Comments: (note condition of soil, signs of hydraulic failure, 'level of ponding, condition of vegetation, recommendations for maintenance or repairs,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, recommendations for maintenance or repairs, etc. ) P -hNp. (°e a-t-Fl SUBSURFACE BgwAGg DIgP08AL . Indicate FgILOU T c YBTgM udBpgCTION FO determination no, or not determined RITgRIA ., RM Instances. Backup of sewage i nces. If '�17pt Bete ND) ' Des nto facilit z-M'1%dn� scribe bass. —�-L Disc y• xPlaln whY barge or • surface waters?nding of effluent Static li lulu D to the surface of th .. quid leVeQ on the dls a ground Liquid de trlbut1On bov above flow? depth in cesspool "" b outlet rove slow rt invert or available number qulred Pum v tim r olume< °f times p roped es o more , - Septic tank 1n the last Year? infiltration? nfiltrat •s n is metal,o ' s crubst acked� Is any antlal eXfilta tiotn;allY unsound below the high ion of the tank failure ubstantial 1 grou SAS, cesspool -Imminent? 9h with • ndwater elevin°r Privy: in So feet of a surface face water water s P 0l feet of a P y• Surface water su within a Zone pPly Or tributa �( I Of a Public well? � to a surface within ga (cessPools and P I�. border• µ In wit ies only, Vegetated wetlan bin 50 feet Of a Private a SAS) ? d °r salt marsh ivats water ses-s than 1p supply well? has PlY ea l with no but greater and-for nitrate lb Zed to be eptable waters feet from nitrat acteri vn ccI table quail analysis?m a Private j e nitr°gena latile organic copy Of well If the w wa 11 ✓e C��� ��sf = compounds, aOnia n t analysi rogen SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B SYSTEM INFORMATION continued SKETCH OF SEWAGE � =SPOSAL SYSTEM: include ties to at least two permanent references landmarks or benchmarks locate all wells within 100 ' r , F Z t I r.�r• ' z DEPTH TO GROUNDWATER i depth to groundwater method of determination or approximation: 3 /MA l � q � «. r TOWN OF BOARD OF HEALTH SIJBSIJRFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM - PART D .- CERTIFICATION -TYPE OR PRINT CLEARLY- PROPERTY INSPECTED STREET ADDRESS ASSESSORS MAP, BLOCK AND PARCEL # c�- 0 9 `7 OWNER' s NAME bu— la zt ART D - CERTIFICATION NAME OF INSPECTOR COMPANY NAME 1�2 COMPANY ADDRESS C ty state LIP Street V Town or COMPANY TELEPHONE (�_e 0) FAX__ 7-2 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposed system i this address and that the information reported is true, accurate , and complete as of the time of inspection .' The inspection was performed and any recommendations regarding upgrade , maintenance, and repair are consistent with my training and experience in the proper function and maintenance of or site sewage disposal systems . Check o e: System PASSED The inspection which I have conducted has not found any information which indicates that the system fails to adequately protect public health or the environment as defined in 310 CMR 15 . 303 . Any failure criteria not evaluated are as stated in the FAILURE CRITERIA section of this form. System FAILED The inspection which I have conducted has found that the system fails i protect the public health and the environment in accordance with Title 5 , 310 CMR 15 . 303 , and as specifically noted on PART C - FAILURE CRITERIA of this insppc to form. Inspector Signature ate t One copy of this certification must be provided to the OWNER, the BUYER ( where applicable) and the BOARD OF HEALTH. If the inspection FAILED, the owner or'";Perator shall upgrade the system within one year of the date of the inspection, unless allowed or required otherwise as provided in 310 CMR 15 .305 . partd.dc 4r )e C op 4est' .all AP t7 DEcJK 18I9z ZA& FW4 &,D&b t�4b -J, Oj C• - *I �Q Dt.nin4 �, A In —� LLp�` Ir t..*de wa115.. bea 4m Q�cr, S13c J o Ln II — -. - cS,�n the ----- 4''I,al rrs� t�til` 3'�i _.. LILZ 3�0r;, ut.f - • to �.s . ¢ ` m 134.X iL�. M C77 I - I _, _ •. _, '. _ q I[o'x�'atkD_ ui(+t..-nsam. a�rLr. J - Gor1 C._ t-1s fi =q zclo J f'1. tll000 3t9 n (:t4n) 0 3,31 9x _ Z2-p L:.all of aI l s arc to b�,zx4 tln}��s Ahextot5e no+r4. i.. FiE�115 E.D !° ct� .._ -_._.___--..__.—__—_.._._.._ �. II- M APPROVED/Y• WMWM/Y I"� GAT.: 5.`...l r" �!lL.-. IIEVIftD 3 x I Fz'�'i F Lee IJ 1 1.. .. .I� LIC l.J. DES I��1 DMWiNO lx1MEER 49'B" $�_ 111-4' 1 11 i II 1 1� I tl I 11 1-4 tl , 11 3 t-4 P I p I M 1 11 2-¢ 5-0 Z-� 3-[0 1-l0 ROM Us -c� Z-44& 'mdL�(sr �31o ' 7f}410 m�.LL6tiP) - f�E.DFOOrn _-• _ p D #k etc Pam. - _ Y gEo FcootTl i I -� - -� _ �.. KV I`inen (Zb4& -_ -=----------__---- Z` L sshGlvrS 1_A r6w. line of 1 ht: S O J _ N = on HF O __ II I . 3 " i3 E.DIZDD(71�3 S: Q 73 Z44ld Z4 _Lt........ t N n q D = D{#PIo� Dk(Y 344L'-.D{�Plo¢lo 444.o'%TOULLL4p): 244to. _ 1 n _ 14.-0 - I. �ray.ld2 �rc� 5falr .�n.:znd. tI: I it . Put- p roV 7: -:vctT - _ prl...1 �= i��m of Barnstab To Box53 0260A ---- — �aCh�se I,. �l�V I.,S.E D .G b D OLE 1 '��vE z.n I. w ash�r __ - - — �y�nn�s, 344 Fax�508� p-6265� ! U �:i 4N_. �_ �.D... DR.W... c��• -17 y -. .__ [�•. i✓ `—D L1L{� DMWIMO NUYDER . _ _ I e t�tr I r-1 ' LEGEND o o R EXISTING PROPOSED o ZONES DesignSchedule Leaching Area Requirements POSTELEVATION g POND _ ------- Edge of Pavement TOP OF FOUNDATION 88•p �o Duo Sewer Pipe ( - ZONING DISTRICT R D—1 , IR C ,, 5 BEDROOMS A7 i 10 GPD BEDROOM - 550 GP �9ti �o ��' N �' oe°N _ _ �_ �__� _ Water Pipe w FINISHED BASEMENT FLOOR / D o tiFF ZONING DISTRICT GP iLeach Pit MINIMUMS FINISHED GARAGE FLOOR ADDITIONAL 50% FOR GARBAGE DISPOSAL N.A. O SEWER INVERT AT FOUNDATION q m : FRONT SETBACK 20 85.5 o Q iti c, � ; (Catch Basins r SEWER PERC RATE = 2 1 MIN. INCH CLASS 1 a 6,Q/ S a x - 0 ?.,.. SIDE SETBACKS - 10 INVERT INTO SEPTIC TANK 85.3 / / ) q� LOCUS z> 5eptis Tank p p lti C � ,_ , = SEWER INVERT OUT OF SEPTIC TANK 85.0 z 3 D o ti Distribution Box o REAR SETBACK - 10 1TAR = 0.74 GPO S.F. FERN ,o -4 a I SEWER INVERT INTO DISTRIBUTION BOX 84.4 / o y ,� �� x Water Gate ►1 L Li ht Pole SEWER INVERT OUT OF DISTRIBUTION BOX 84.2 N s g MIN. LEACHING AREA OF S.A.S. m 9 _. ._- Utility Pole � � �?- SEWER INVERT INTO LEACHING SYSTEM 84.0 w Z �-ti �J ef �z Contours t--.4%1 cn BOTTOM OF LEACHING SYSTEM = EM 82.0 550 GPD/ 0.74 GPD/S.F.- 743 S.F. MIN. of Grade y F WATERSID ELL( 0 0 Stu ,r,.8 P DR � Test Pit � e4 ` WATER TABLE N.A. '�' PROPOSED SYSTEM SIDEWALL (12+44)(2)(2) = 224 S.F. �i BOTTOM 12' X 44' = 528 S.F. R TOTAL = 752 S.F. Ni LOCATION MAP \ ! ✓ HYANNIS QUADRANGLE SCALE: 1.25,000 \IQOI\ hASSESSORS 'y$ � 0 � i � \ � �'MAP 208 PARCELS 146, 9711, ,�y'1`t �1 GENERAL NOTES ALL SYSTEM COMPONENTS SHALL BE INSTALLED IN ACCORDANCE WITH TITLE V OF THE STATE SANITARY CODE DATED MARCH 31, 1995 & ANY LOCAL RULES APPLICABLE. t ,F S • - " ANY CHANGE TO THIS PLAN MUST BE APPROVED IN WRITING 1 1,5 WASHED STONE \ BY THE DESIGNING ENGINEER. \ 0� 1 ? { C. \ HYDRANT #523 f W SEAL --SP14DLE EL=102.85' ' AS;UMED DATUM O / s � FN � 12 f , WHEN CONSTRUCTION IS COMPLETED, PRIOR TO BACKFILLING, NOTIFY THE ENGINEER & BOARD OF' HEALTH AGENT 44' FOR INSPECTION. CONC. BND. N w cr rn 00 °° rn/ ,,•:yG C 49 rn rn r '•, \F PLAN OF LEACH CHAMBERS / w/DH FND. "; r � FOUNDATION ELEVATION MUST BE CHECKED WHEN COMPLETED. s / C.R.B. \O 1 \ / ` E F NO SCALE / �. ''; `: ,. w/SEAL a ; # } t FN \v� THESE ELEVATIONS MUST NOT BE CHANGED WITHOUT WRITTEN ; APPROVAL BY THE DESIGNING ENGIINEER. /� 1 9Q i i �hJ ' 4 : I GAS » , �, I '� \ 12 ALL SANITARY DISPOSAL SYSTEM PIPING TO BE 4 PVC SCH. 40 . a / �.'- , GATE .,.: ' • C3:°.^x-t�..� ''� r7 t' ,..^.\ ;:.'R�'j.>7:� Cn .. l�, : 'S <, tS } 'j 1 �' ` }.' - f .ThF (S1r i „.. : Ir 2 FINISHED GRADE !/ F 2 / o �, 2 / �. \ \ \ \ \ \ \ \ \ h: mac, \ \ \ \ ti \ \ \ \ \ \ \ \ EXCAVATE AND REPLACE ALL UNSUITABLE MATERIAL SURROUNDING / _ .,• � �, F ,.:.. !� � : ;,, � 36 - / / / / /\/\/\/\/\/\/\/\/\/ COMPACTED FILL r. MAX. 12MIN. / / / / / / / / / / / / / / / // F' . - / -1 \ \ \ \ \ \ \ \ \/\/\/ / / SURROUNDING T , ,;' \ \ \ HE.LEACHING FIELD FOR A DISTANCE OF 5 , / 5 • ' �(+ ; = ' � �` ... .. / may. -.._ :•:..:: , PPRO =. LOCATION :` _ ;: , . �.�.:: �. / •" ,. "'. .. PEASTONE PER 310 CMR 15.255. { OF ,OLD PI :..... - -82'814 O.•. 3 4 ro 1 1» a a 1 r : } � 1 2 1 1 < , v PICKET \ 30.5 < .. ° _ _.. Tart e •::, :� ,,.::.: ..::,. 1 s+: . ,. -, ;' ..,- i'. ` k t,''� :":-..7:1 ° .. FENCE a ., ° DOUBLE PRIMARY BENCHMARK ASSUMED. I. PIPE'. . \ , FND. ° � ,� ._,;' 4 PROJECT BEN ° WA BENCHMARK SEE PLAN ;u Q. o ', / SHED STONE / • I CAR-PORT ,� � ?',,: F, . .c>- ,. '. � ' L c r� l/ j CONE. BND. \ \X F, p W/DH FND f, / TO BE , l i �•_._. 5 �� MOVED j \ i •`V / (' , ,. I I / , ( , a , . \ _- EFERENCES .r ;- ..�>�.„.,� Q �,. a .. :,, � • -�:- { ., ,: ,;, i,-� 1. PARKING ,i / SECTION / � .. .r... � : . ass _.. � �,,., ....e'er t ..: .,r . :: �'\ - . i r v •r:. / r �. ;' / / � '� � y ,,,. , , .. �:.. __ -.: ,.. PROPERTY , .. e 2.. . . .. _ .. . . .. \ AREA E TY LINE M L PL. .2 NO SCALE <08 17 151 PG.103 1 , a, >, / _.. BK. 126 PG.1 loorF. : _ \ # u r { o / 5 rn ' / / f , 4 s i l 1 P. / \ L? .G STONE P r h - ASONARY , WALL O PR SED r LEACH SYSTEM WITH INPILTRA TOR DESIGN. O• Q' ,f ��_ ., \ EASEMENT FOR LEACHING,:.SYSTEM �� t f885 SF , �u� 10=Oft :s / / ALL PIPES TO BE SCHEDULE 40 PVC `-. - I ,� ,? ..,., / USE 1 4 DISTRIBUTION LINE IN 6 RECHARGER UNITS c -• 6` -•,.,, � � ,.,,,; .: , ••; O fir. ...GONG. iBND. .. + ,-•-,:,-•-' (L t. > .1 W DH IFND:- __ 1 r F , . CONC. BND. �,:. _ _ A 12 X 44 WASHED STONE R '. „m.r... { 9� H SHOWN > IN TRENC AS ,,: . ::•.,, / +a �• a ...,w- ,. .,1.l,,,;,. _ /O' STEP(-IEN lt .. C , D •1/ 'fit{, "-w- _ ,.. I Jg • n 96 J S a , i , 5 � t 4. PROX. LOCATION w : " " t •• � .. ..: , ,; ;. ::.: .:. .._ �� °�.is�� ..,:. .. ,..,.:, \ OF NEW•PIT { 4 , /, R ;� S JA • > , t ,._r.... � ,., , • ,, ,f: , '����. ,, ! r' AS OF 8 24�82 O -,q- \ r r - 6 - \ � :,. , � I CERTIFY TO THE 8STRUCTURES ti EST OF MY KNOWLEDGE THAT THE EXISTING 1 ♦ SHOT' '�. SHOWN s o IN COMPLIANCE WITH LOCAL ZONING BY 9 LAWS (WITH RESPECT TO SETBACK. REQUIREMENTS \ ,..� y.i-.. �. .'.•�., J : :.:. .;.I ( J FM1�,,S�n Y1. ,:.. ., ,kt.v \\ •,., j \J ONLY) AND DOES NOT FALL WITHIN A SPECIAL FLOOD HAZARD AREA. Septic Design J; ! ,.. 161 Ma in n Street 20 Quiet Way s THIS PLAN IS NOT TO 8E RECORDED OR USED TO ESTABLISH PROPERTY LINES. - {{ ♦' Centerville, Massachusetts �- - 13 - �00o e, o 0ZIP, oREGI TERED R(OFESSIONAL DAT URVEYOR 9 \ LANDS E PREPARED FOR PARCEL AREA 34,389 SQ. Ff. Colette Development Trust 9 ., 7 .H 0� API SCALE: 1 = 20 �3 JO 5G\ as / w TITLE °. 6 �100 , , ... �y ,. ,� f. 0 20 40 60' L-1,, ' , . 1ti� / f 90 �� j1+ SANITARY DISPOSAL SYSTEM 674 Yk 9 \,0000P BAXTER NYE & HOLMGREN INC BAXTER, NYE & HOLMGREN, INC. P-9844 Registered.Professional Finished Grade = 8Tf TYPICLAL SYSTEM PROFILE • ` Engineers and Land Surveyors SOIL LOGS DATE.10/3/00 10.00AM 812 Main Street, Ostervllle, Ma. 02655 ENGINEER: BOARD OF HEALTH AGENT Proposed CONSTRUCT ACCESS NOT TO SCALE MANHOLE OVER INLET Stephen A. Willson,P.E. D.Morandi Barnstable Health De t Phone - 508 428-9131 Fax 508 428-3750 Pop of Dept. ) ( ) Foundation 88.0 To TANK To AT LEAST WITHIN"6" FWISH GRADE FINISHED TEST PIT 1 TEST PIT 2 TEST PIT 3 .. HED GRADE OVER TANK = 8Tt FINISHED GRADE OVER D. BOX = 87'f - - G.S.E. 87.9 G.S.E. 88.4 FNISHED GRADE OVER LEACHING TRENCH = 87't 0' 20' 40' 60' 0 Ai SANDY LOAM 0 A 4" SCH: 40 PVC .: '..:' '.: nRST 2' TO BE LEVEL 12" min Cover SANDY LOAM TYPICAL) -- mu, —' 4" SICH. 40 PVC 36 ( » 10YR 5/2 » 1OYR 4 4 e•(min.) (max) Cover 5 6 OL2"(min) PVC or :: 4" SCH .40 P 2"Layer 1/8"to1/2 B B »_ ,I o• CI tees GAS ALE a wmp VC SANDY LOAM SANDY LOAM SCALE. 1 — 20 DATE. October 13, 2000 Peastone LEACHING CHAMBERS Slope = 0.005 (min ) ; 10YR 6/4 » 10YR 3/6 :. 18 19 REV. DATE: REMARKS e s' CRUSHED 4" PVC O O O O O O O O O O O C 1 ' Reinforced Concrete C 1r STRATIFIED MED. STONE BASE MEDUIM FOOTING 0 0 0 0 0 0 O O O O SAND & FINE GRAV. SAND cm , 0 00 cc 0 cc 00 00 0 q 0 co 19 132 10YR 6/6 132 10YR 7/8 BOTTOM ELEV. _ 82.0' 1500 GALLON SEPTIC TANK DISTRIBUTION BOX 5.1' NO WATER ENCOUNTERED DRAWING NUMBER - P'ERC @ 60 r, TO 8E INSTALLED ON A LEVEL STABLE BASE TO BE INSTALLED ON A LEVE.:. STABLE BASE N , No Groundwater Observed Elevation = 76.9' RATE= Less Than 2 MIN IN H:\2000\2000-47\SURVEY\worksht\O 047-SSDS.dw i LEACHING SYSTEM - 2000 47 ,