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HomeMy WebLinkAbout0049 ROSEMARY LANE - Health 49 Rosemary Lane Centerville A= 147 007 005 No. H163OR UPC 10259 smead.com Made in USA MMMO 2J Cpa m No. Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Loor Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS application for Bisposai 6pstem Construction Permit Application for a Permit to Construct( ) Repair Upgrade( ) Abandon( ) ❑Complete System Xindividual Components Location Address or Lot No. 49 jgoSc_ftAP.f LW Owner's Name,Address and Tel.No. C Assessor's Map/Parcel 14-7 D4 QO av!uF qct � [AJ t Installer's Name,Mdress,and Tel.No. Designer's Name,Address,and Tel.No. t L-3Lbt✓ D.0aZa-- 0 ZL C Type of Building: f 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) gpd Design flow provided 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) (2kifV(:E (`j J/CS:' Fc;YiJt 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 Boar of H Sign Date ' 7 Application Approved by Date Application Disapproved by Date for the following reasons Permit No. .r Date Issued o No. i Fee 7 THE COMMONWEALTH �F MASSACHUSETTS Entered in computer: �* Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS s 2ppYication for jMis osat .pstem Construction Vermit Application'for a Permit to Construct( ) Repair "Upgrade( ) Abandon( ) ❑Complete System Individual Components Location Address or Lot No. 49 (2o5GMAP4j LQ Owner's Name,Address,and Tel.No. Assessor's Map/Parcel ©� �� C V l as RoN4[,-0 CLLjQ�1GU0 Installer's Name,Address,and Tel.No. SOg-�•IZ.$$1'i Designer's Name,Address,and Tel.No. (A Type of Building: Dwelling No.of Bedrooms t1 Lot Size ` sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) t7v gpd Design flow provided gpd Plan Date Number of sheets Revision Date f ° Title .,,Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) r1C_VS t—j uC EpC�M <Ls '?�_ Date last inspected: - x 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 He r,'�4 Signed Date t Application'Approved by Date ^/ Application Disapproved by Date for the following reasons Permit No. r Date Issued i , THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO CERTI that the On-site Sewage Disposal system Constructed( ) Repaired�X) Upgraded( ) Abandoned( )by ©E � _ at " q = Gr V l has been constructed in accordance with the provisions of Title 5 and the forDisposal System Construction Permit No. 'Qat@d — + Installer CA .)/ ",p �+�� Designer 0 #bedrooms _ r /y Approved design flow gpd The issuance of thislpermft shall not be construed as a guarantee that the system will c i (,�as desi ed. Date I Inspector �_'/1 PT ' V ---------------- ------- --------- e------------------------------------------------------------------. -- No. '91dM �v Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS Bisposal &pstem Construction Permit Permission is here b granted to Construct( ) Repair(`^ Upgrade( ) Abandon( ) System located at t _) �/`I� C„/ ' � "�,�` �1�(L.L 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:Construction must be completed within three years of the date of this permit. z _ Date — -4 Approved by YOU WISH TO OPEN A BUSINESS? For Your Information: Business Certificates cost $30.00 for 4 years. A Business Certificate ONLY REGISTERS YOUR NAME in the Town (WHICH YOU MUST DO according to M.G.L. - it does not give you permission to operate). You must first obtain the necessary signatures on this form at 200 Main St., Hyannis. Take the completed form to the Town Clerk's Office, 1" FI., 367 Main St., Hyannis, MA 02601(Town Hall) and get the Business Certificate that is required by law. ,.. -N©co&, DATE ar` Fill in please: APPLICANT'S YOUR NAME/CORPORATE NAME BUSINESS YOUR HOME ADDRESS: yl 00�CQ �vt -✓mil I t— C�, b � TELEPHONE # Home Telephone Number NAME OF NEW BUSINESS C`l�-r'IC.rC IU il\(M TYPE OF BUSINESS C_Nfo=h r IS THIS A HOME OCCUPATION? YES NO Have you been given approval from the building division? YES NO ADDRESS OF BUSINESS MAP/PARCEL NUMBER When starting a new business there are several things you must do in order to be in compliance with the rules and regulations of the Town of 'Barnstable. This form is intended to assist you in obtaining the information you may need. You MUST GO TO 200 Main St. — (corner.of Yarmouth Rd. & Main Street) to make sure you have the appropriate permits and licenses required to legally operate your business in this town. L BUILDING COMMISSIONER'S OFFICE This individual has been informed of any permit requirements that pertain to this type of business. _Authorized Signature** COMMENTS: 2. BOARD OF HEALTH o This individual has b n informe of the permit requirements that pertain to•this type of business. � --a �".Authorized Signat re** a �. COMMENTS: 3. CONSUMER AFFAIRS (LICENSING AUTHORITY) rn O This individual has tn. in r ed of the licensing requirements that pertain to this type of business. Authorized Signature** COMMENTS: I ` COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION TITLE 5 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 49 Rosemary Lane /' M 00-/ 005 Centerville, MA 02632 Owner's Name: Frank Mello 9�� = CD Owner'S Address: J I Date of Inspection: June 12. 2006 Name of Inspector: (Please Print) Jaynes M. Ford e Company Name: James M.Ford �•� --- Mailing Address: P.O.Box 49 s Osterville.MA 02655-0049 ! ?— Telephone Number: (508)862-9400 ' CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of the inspection. The inspection wag 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 Ne s Further Evaluation by the Local Approving Authority Fai Inspector's Signature: Date: June 22. 2006 i The system inspector shysubay of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable,and the approving authority. Notes and Comments ****This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future under the same or different conditions of use. Title 5 Inspection Form 6/15/2000 page I Y Page 2 of I I OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 49 Rosemary Lane Centerville, MA Owner: Frank Mello Date of Inspection: June 12, 2006 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: ✓ I have not found any information which indicates that any of the failure criteria described in 310 CMR 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. Answer yes,no or not determined(Y,N,ND)in the for the following statements. If"not determined",please explain. The septic tank is metal and over 20 years old* or the septic tank(whether metal or not)is structurally unsound, exhibits substantial infiltration or exfiltration 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. ND explain: Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken,settled or uneven distribution box. System will pass inspection if (with approval of Board of Health): broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced ND explain: The system required 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 obstruction is removed ND explain: 2 Page 3 of 11 a OFFICIAL INSPECTION FORM -NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 49 Rosemary Lane Centerville, MA Owner: Frank Mello Date of Inspection: June 12, 2006 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 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 I 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 coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: 3 Page 4 of 11 r OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 49 Roseinary Lane _Centerville. MA Owner: Frank Mello Date of Inspection: June 12, 2006 D. System Failure Criteria applicable to all systems: You must indicate either"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 Static liquid level in the distribution box above outlet invert due town overloaded or clogged SAS or cesspool ✓ Liquid depth in cesspool is.less than 6"below invert or available volume is less than'/2 day flow ✓ Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped_. ✓ Any portion of the SAS,cesspool or privy is below high ground water elevation. ✓ Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ✓ Any portion of a cesspool or privy is within a Zone 1 of a public well. ✓ Any portion of a cesspool or privy is within 50 feet of a private water supply well. _ ✓ Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form.] No (Yes/No)The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303;therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E. Large System: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd• You must indicate either"yes"or"no"to each of the following: (The following criteria apply to large systems in addition to the criteria above) 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 11 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. 4 Page 5 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 49 Rosemary Lane Centerville, MA Owner: Frank Mello Date of Inspection: June 12, 2006 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? ✓ _ Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS)on the site has been determined based on: Yes No ✓ _ Existing information. For example,a plan at the Board of Health. ✓ _ 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(3)(b)]. 5 Page 6 of 1 I . OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 49 Rosemary Lane Centerville, MA Owner: Frank Mello Date of Inspection: June 12, 2006 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): 3 Number of bedrooms(actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 Number of current residents: I Does residence have a garbage grinder(yes or no): No Is laundry on a separate sewage system(yes or no): n/a [if yes separate inspection required] Laundry system inspected(yes or no): No Seasonal use(yes or no): No Water meter readings, if available(last 2 years usage(gpd)): Unavailable Sump Pump(yes or no): No Last date of occupancy: Currently occupied COMMERCIAL/INDUSTRIAL Type of establishment: Design flow(based on 310 CMR 15.203): apd Basis of design flow(seats/persons/sgft,etc.): Grease trap present(yes or no): Industrial waste holding tank present(yes or no) Non-sanitary waste discharged to the Title 5 system(yes or no): Water meter readings, if available: Last date of occupancy/use: OTHER(describe): GENERAL INFORMATION Pumping Records Source of information: Pumped after the inspection for maintenance Was system pumped as part of the inspection(yes or no): 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) Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) Tight Tank Attach a copy of the DEP approval Other(describe): Approximate age of all components,date installed(if known)and source of information: Installed on 418191 -per as built card Were sewage odors detected when arriving at the site(yes or no): No 6 • Page 7 of I 1 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 49 Rosemary Lane Centerville, MA Owner: Frank Mello Date of Inspection: June 12, 2006' BUILDING SEWER(locate on site plan) Depth below grade: Materials of construction: _cast iron _40 PVC other(explain): Distance from private water supply well or suction line: Comments(on condition of joints,venting,evidence of leakage,etc.): SEPTIC TANK: ✓ (locate on site plan) Depth below grade: 10" Material of construction: ✓ concrete _metal _fiberglass _polyethylene _other(explain) If tank is metal list age: Is age confirmed by a Certificate of Compliance(yes or no): (attach a copy of certificate) Dimensions: 1000 ag 1_ Sludge depth: 2" Distance from top of sludge to bottom of outlet tee or baffle: 30" Scum thickness: 8" Distance from top of scum to top of outlet tee or baffle: 6" Distance from bottom of scum to bottom of outlet tee or baffle: 10" How were dimensions determined: Measuring stick Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert,evidence of leakage, etc.). Tees were present. The liquid level was even with the outlet invert There did not appear to be any signs of leakage Note: The tank was pumped after the inspection for maintenance GREASE TRAP: None (locate on site plan) Depth below grade: Material of construction: _concrete _metal _fiberglass _polyethylene _other (explain): Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping: Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): 7 Page 8 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 49 Rosemary Lane Centerville, MA Owner: Frank Mello Date of Inspection: June 12, 2006 TIGHT or HOLDING TANK: None (tank must be pumped at time of inspection)(locate on site plan) Depth below grade: Material of construction: _concrete _metal _fiberglass _polyethylene _other(explain): Dimensions: Capacity: gallons Design Flow: gallons/day Alarm present(yes or no): Alarm level: Alarm in working order(yes or no): Date of last pumping: Comments(condition of alarm and float switches, etc.): DISTRIBUTION BOX: ✓ (if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: Even 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.): The D-box was level. No solids were present. PUMP CHAMBER: None (locate on site plan) Pumps in working order(yes or no): Alarms in working order(yes or no) Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.): 8 Page 9 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 49 Rosemary Lane Centerville, MA Owner: Frank Mello Date of Inspection: June 12, 2006 SOIL ABSORPTION SYSTEM(SAS): ✓ (locate on site plan,excavation not required) If SAS not located explain why: Type ✓ leaching pits,number: 1 -6'x 6'(1000 gal.) leaching chambers,number: leaching galleries,number: leaching trenches,number,length: leaching fields,number,dimensions: overflow cesspool,number: Innovative/alternative system Type/name of technology: Comments(note condition of soil,signs of hydraulic failure, level of ponding, damp soil,condition of vegetation,etc.): _The leach nit had 2"of liauid on the bottom The scup:line was approximately 1'up from the bottom There did not appear to be any signs of failure. The bottom to Qrade was 9'. CESSPOOLS: None (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 or no): Comments (note condition of soil, signs of hydraulic failure, level of ponding,condition of vegetation,etc.): PRIVY: None (locate on site plan) Materials of construction: Dimensions: Depth of solids: Comments(note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation,etc.): 9 • Page 10 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 99 Rosemary Lane Centerville, MA Owner: Frank Mello Date of Inspection: June 12, 2006 SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. 3 a- O O (3 1a y c as 3 a a� 3� 3-7 . i 10 �r Page 11 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 49 Rosemary Lane Centerville, MA Owner: Frank Mello Date of Inspection: June 12, 2006 SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water 25 +/- feet Please indicate(check)all methods used to determine the high ground water elevation: Obtained from system design plans on record-If checked,date of design plan reviewed: Observed site(abutting property/observation hole within 150 feet of SAS) ✓ Checked with local Board of Health-explain: To and water contours mans Checked with local excavators, installers-(attach documentation) Accessed USGS database-explain: You must describe how you established the high ground water elevation: Using Barnstable topographic and water contours maps the mans were showinggppr oximately 25'+/-to Around water at this site. This report has been prepared only for the septic system and components described herein. This septic system has been inspected and passed as of the date of inspection. This report is not a warranty or guarantee that the system will function properly in the future. There have been no warranties or guarantees,either expressed, written or implied, relating to the septic system, the inspection, this report and/or any components of the septic system which have not been located and inspected. 11 W OF BARNSTABLE j LOCATION SEWAGE # VILL1 GE () V ASSESSOR'S MAP & LOTI'/7 a7 ,�> INSTALLER'S NAME & PHONE NO.:10 SEPTIC TANK CAPACITY IOOz) 91/, LEACHING FACILITY:(type) l b pc) q (size) x �, NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER_ 0 BUILDER OR OWNER mt/--v S DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: iT' L VARIANCE GRANTED: Yes N__or e oT ov e Z3 11to 40 3 h k6 O TOWN OF BARNSTABLE MAry TION y� . gas lAtjL SEWAGE # C1 — 4 Z11AGE CQ/11 w. t ASSESSOR'S MAP & LOT /'/7—007 INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY / n� LEACHING FACILITY: (type) u" 1 h x (size) /oQ o NO.OF BEDROOM BUILDER OR OWNER Mellow PERMITDATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility (If any wetlands exist within 300 feet of leachi g faccility) _ Feet Furnished by J D/C-J f,,4 S(JC CTv^ A 6 ck OF O 6 y �. c)3 X 3 ao as" y 37) 1 3-7 , �0 No.._....---. _..--- Fps ....... C� a�" c THE COMMONWEALTH OF MASSACH SE S BOARD OF HEALTH 91- 10 .....................OF.... ....................................... Appliratinn for Bis'nsttl urkg Tonstrar#ion Permit Application-is hereby made for a Permit to Construct ( ) or Repair, ( ) an Individual* Sewage`Disposal System at --- os@.mar'•t.( �0�vV2 C�vtet'v►1�:� �a� .�. _ Location-Address or Lot No. ................_....___........__..........O ...........-----------'------------------------ --------------••---•--•-.......----•-••-••----•-----•._................._.._................:._. Owner Address • Installer Address +. Type of Building Size Lot__ -..Sq. feet A' Dwelling—No. of Bedrooms................:...........................Expansion Attic ( ) ' Garbage Grinder ( ) aOther—Type of Building.____________________________ No. of persons............................ Showers ( ) — Cafeteria dOther fixtures .--=-•-•----------------------------=-------------------------------=---------•-•-----•----.._._........ ----------.._.............----......_----•- W Design Flow.........:.....-�_-�J__......................gallons per person �ff r ,day. Total #ly flow....... 30_.........__......_.___ to WSeptic Tank—Liquid`capacity�!?.gallons Length�_�.a"L..._. Width:_ .Z.-._ Diarrieter...............: D.epth. E% • x Disposal Trench=No..................... Width_____ _.._._...... Total Length........ Total leaching area_......__.._.....__sq. ft. 3 Seepage Pit No... ff)!9ri._-__.. Diameter.)o.e Depth below inlet..�._ :Total leaching area.. � s-q-€t. 1­4z Other Distribution box Dosingnk ( ) Date.......................:............•-'. Percolation'Test Results Z Performed by.... .._.:..5'�\�' �!!� :_�.i -•. . . g ' gs ,.a Test Pit No. 1____��.____-____minutes per inch Depth of Test Pit.:..\%�©_...;:. Depth to ground water..hO1°? _ fir Test Pit No. 2:::.:..........minutes per inch, Depth of Test Pit.................... Depth to ground water........................ O Description of Soil....©....Z�of '0aY.--� w�S�� Z4'' - ]�Cc�i1. yeah rvt� Sav�c_ U ...................... ......... ...................................................� -S c a` .c�,e c� �.�`v��.......... U Nature of Repairs or Alterations-Answer when applicable...:................................................___..___..-....._-_-.:...._._........._.._.. ......................................• ----••-•----•----- -•--._....•••--•-•...._.__......__..._...------..........I Agreement The. undersigned agrees to install the aforedescribed Individual'Sewage Disposal System in accordance with the provisions of:I;U 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance h len'issued b b rd of, Health. , Signe .._ ;l/1m 7 .... .... Application Approved By.............>.--.. ..... :......_...................... .... �. ........:. Date Application Disapproved for the following reasons..............:.........................................:....................................................... 0 Permit No....q.�............ ............................. Issued............................... ....._...:.Date...... Date .t Tim �° y�'^� + / .S r! N -•--- ..... FE. 100 THE COMMONWEALTH OF MASSACHUSETTS c.J BOARD OF HEALTH " Wh . C3 b1 Application for Disposal Works Tontrnr#ion fermi# Application is hereby.made for a Permit to Construct (X) or Repair ( ) an Individual Sewage Disposal System at: acneev� e re= -- -- -• � S ........... ............................................... TT. .... . Location Address or Lot No. ................_...._.._.........:........ ......---•-•............................... -••--•••--•-•--••-............•............... ^- ..........__....--- ._ Owner Address W Installer Address Type of Building 3 Size Lot.. Sa000 - Sq. feet )-.t Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) `4 Other—T e of Building No. of persons............................ Showers Ga4 YP g ..------•------------------- P ( ) — Cafeteria ( } QOther fixtures . .-------•--•.....................................••••• Design Flow................a..............._.....gallons per person $ r day. Total ily flow---............C?_........----.-.-.-•--- to ff I "3 Septic Tank—Liquid capacity Length8_l.'�r._.. Width:_ _2_... Diameter................ Depth. e • Disposal Trench—No..................... Widtll...._ Total Length......_a..._ Total leaching area....................sq. ft. 3 Seepage Pit No...9)!?e-....... Diameter..\?_ Depth below,,inlet-. -. :Total leaching area.1m. ar.f. Z Other Distribution box Dosing,•�ank ) V { Percolation Test Results Performed by....K:.. alrb.....lam..PE Date. '.g. 35.. .... C�- p :.... ...... ground h�knc o�h ..7 u Test Pit No. 1................mintites per inch Depth of Test Pit_.. .._.........:._ Depth to ound water...._..... Se ....... 04 Test Pit No. 2................minutes per inch Depth of Test Pit..............._.... Depth to ground water...................... ere P P P t� r................. .... ............ --. ..t....jl..... ..------........ ._... p O —Z oCA Vv-% ..v�oSo� Z — Co c leah M C54.-SaVvcj Description of Soil ,..:;.l............... �� .. �..........4 �.`.........__. W Se.e_ a c1•.� 0.h ._...... ........................•••••---..._........... ...._..---.....................----......-••-••......-••.•-•-- ---..............---._...••_---• ..........................................................................................................•..................:......................................................................... V 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 T I T LZ 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance h en issued b bQ ealth. SigneML % ...........-•-- DApplication Approved By.............- k ..- �= .. � --.......... ... .............. Date Application Disapproved for the following reasons:................................0.................................----••---•--..........................._...— __ Date j r ,l� ! l Permit No....... i. � -...-•----------------- Issued_....................................................... F Date .:..„ �_....._...._...... .o a.._..._.,...,..,.,."..... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .......................................OF..................................................................................... Trrtifiratr of Toutph ttrr THIS IS TO, CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) by............1R.�1t..:..:40.!�?sX4<,Tjcxu...........:... .•------•----------------•----. ....-------------- .........------. Install T ?� - r has been installed in accordance with the provisions of TITLP , 5 of,,T�he State Sanitary Code as described in the `'. application for Disposal Works Construction Permit No.......---- +-------.... dated................................................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL/FUNCTION SATISFACTORY. .� °~"•' ........... In ector DATE. � '".......... p f ............... a.........a+.. .sH OF MA.... .....am.. +:.- ....,........t.�...-.. .r..............». THE COMMONWEALTH ,('� BOARD OF HEALTH 10 ("/ t, � OF .�......-•........ a i No....— - — Fly..----•`✓--.......... / ` 11isposal Works Tonstrur#ion thrmi# Permission is hereby granted----•-4.9�,,---*...--•------•-••............................•--•-••--•--:..--------------........................................ to Construct ( ) or Repair ( ) an Individual Sewage Disp sal System Street as shown on the application for Disposal V1'orl:s Construction' 'Tait No..................... 'Pated.......................................... -------------------- ---------------------------- _ Board of Health DATE... ...... /� f f ram...., r .^ c,• �-,, _ *`� c>y ., .ice. °'_`. yam- `�. t SECTION - SEWAGE 13h^ C� .-G•t�fLNt&iZ L:oT t ��u�• �,�uTli aaFi N T. NYC • E3t .4z sq -SEPTIC TANK- 5 -"D"BOX - 9 - LEACH P I T TOP F FDN P4.`1:5_0 (MSL)s '2"OF 1/8T0 42" Q c WASHED STONE 4 I O O.'O O „ v IN•t OUT• ✓ /1 V� d y +I/ IN• OUT• IN• •/- I 7 I(-I 0) 4�D.Od 4 CJ S SEPTIC ELEV. TANK 4�-- S•�O s Fj °. I� .I EL(--V. ELEV. ELEV. 39.00 6, 4fi ELEV. ELEV. El l o; :�.._ OFY."-142" 211t 2O2t Q WASHED STONE 1 _ E LOG F'�`4�34 � � ' - � N � o TEST HOLE O 0 ° - 10 TEST BY R.-rAiMl5ANK,P.E• TOM MG KEA N \� 6 WITNESS 3 TEST DATE 2 8 / 5 DESIGN BEDROOM HOUSE ODks T.H. # 1 T.H.., # 2 _ ELEV. + ELEV. NO \ PERC RATE L 2 MIN/IN. DISPOSER DISPOSER + lS,000 S• I L 24 4CO-� FLOW RATE 33© (GAL./DAY) 330 ( - CLEAN SEPTIC TANK-430 )4, 05)= 495 REQ'D SEPTIC TANK SIZE /O 0 0 _ _ ` AI vf _ LEACH FACILITY SAND SIDE WALL 10916 188.5s� ( 2'S) _ A71.z G/D. BOTTOM 101612/9 78.5 ( I.G?) _ G/D. ` TOTAL Z�j•O S. = J9 J•� 44< USE: QI`I E- -LEACHING -P 11 Nb WATER ENCOUNTERED 10, � :d lct x 6'e- (le NOTES: +(UNLESS OTHERWISE NOTED) 1.DATUM(MSL):TAKEN FROM---HY, N'V&e-_--_---QUADRANGLE MAP ��1� OF 2.MUNICIPAL WATER --w�S___ AVAILABLE �3. �ijC Of 3.PIPE PITCH:44".PER FOOT 4.DESIGN LOADING FOR ALL PRE-CAST UNITS:AASHO- /O -44 ARNE H. O r^.+ y - 5.MIN.GROUND COVER OVER ALL SEWAGE FACILITIES: (1)FT.' (c_- JALA -� ERNE Gam, C>- , DISTANCE AS CERTIFIED 6.PIPE JOINTS SHALL BE MADE WATER TIGHT ?C.3 CIVIL qH, 7.CONSTRUCTION DETAILS TO BE ACCORDANCE WITH COMM.OF MASS. Wit` No.30792 {J,1/� ti - SITE PLAN STATE ENVIRONMENTAL CODE TITLE 5 '21°�, 9F 4 • ,o LOCUS: GOT S /C dSEMiltY G.�4/6.G6 TER�� /VA REG.PROF INEER REF: LOT Jr down cope eftfilIeE/Ift� PREPARED FOR: �_ y `--►�f N -- CIVIL ENGINEERS t LAND SURVEYORS -------- BOARD OF HEALTH REG.LAND SURVEYOR (EXISTING)------------- SflPNSTABLE 920 Main SCALE III'4� Z 7 85 CONTOURS (PROPOSED)-0-0-0-0= APPROVED DATE 1-MA Y �VA. :, DATE #Q� �6 Z r° • l s SECTION - SEWAGE 13��\ C 13 C.,vamom Lor (. cL 4zsq -SEPTIC TANK- rj - "D"BOX - 9 -LEACH P 1 T TOP F FDN q += �(MSL)e 112"OF IlaTO Vz" e WASHED STONE - .._�\.V_..J--`.._L.._� .[.\_l ._ L✓ lv-. .. - 00. 0Q1 0. 001 v f, OUT IN- IN- OUT• 1 �O_O_O G 46.Oo �' SEPTIC rj.rJO ��3e 4.5.. S TANK 5.00 e % I .I ELEV. ELEV. ELEV. s 'ry'• ELEV. �� � � 6= •�� S.g-o 4S.Z3 ELEV. ELEV. ELEV• I� / I no, le.. OF 3/a" 142" 21 It ZO,r WASHED STONE v t Q TEST HOL E LOG Pt 4�3,e 1 o ° —T-- TEST BY-R•T�AIRT5ANW,.,M- TOM M°K,EAN Zi.a 9 WITNESS 3 s DESIGN TEST DATE BEDROOM HOUSE T.H. # 1 T.H. # 2 03 ELEV. ELEV. NO \ PERC RATE L 2 MIN/IN. DISPOSER DISPOSER + L 24 4co FLOW RATE 330 (GAL./DAY) 330 1S,000 S• CLEAN SEPTIC TANK C X (15) -4,95 REQ'D SEPTIC TANK SIZE /O D 0 LEACH FACILITY SAND SIDE WALL i0n6 - i68.5s ( 2,5i = q'712 G/D. 1 98 BOTTOM 10 9/9 78,5 ( 1.(') s _ G/D. TOTAL 2.Cv' © S.�` 59�'•� g7 USE: ONE LEACHING I T Nb WATER ENCOUNTERED 10, `d;Gl x 61 Cw death NOTES: (UNLESS OTHERWISE NOTED) 1.DATUM(MSL)+TAKEN FROM HY,4 A/A//S__.___QUADRANGLE MAP ^ ti<_ , 2.MUNICIPAL WATER___�S___-__--_.-_.:__AVAILABLE ��� ''7C OF M 3.PIPE PITCH:V4"PER FOOT �a 1 4.DESIGN LOADING FOR ALL PRE-CAST UNITS:AASHO- .44 ARt�E H. ay1 -y --0-DISTANCE AS CERTIFIED 5.MIN.GROUND COVER OVER ALL SEWAGE FACILITIES: (1) FT. ,ALA ..a OT ARNE `3,L.i y :^. 6.PIPE JOINTS SHALL MADE WATER TIGHT CIVIL kro NO 30792 O A -� SITE PLAN 7.CONSTRUCTION DETAILS TO BE ACCORDANCE WITH COMM.OF MASS. -�+� o �„ STATE ENVIRONMENTAL CODE'TITLE 5 LOCUS: LOT S /Zds>-M !/Y G,•�I�•eE 6'EN7Ems' vl,c_.,� REG.PROF % INEER I REF: L-�T S I - down cape e47, eefidg PREPARED FOR: __..\y f-A L CIVIL ENGINEERS � LAND SURVEYORS ------------ BOARD OF HEALTH REG.LAND SURVEYOR. 11_ 9" Main SL ' z 7 s5 6 CONTOURS (EXISTING)------------- APPROVED DATE gA2NSTABLE MA Ya111Nais..ltiA SCALE i '4O DATE #F33 - 6Z (PROPOSED)