Loading...
HomeMy WebLinkAbout0252 MAIN STREET (CENT.) - HealthMENEM 252 Main Street Centerville A= 209— 112 No. 42101/3 ORA ESSELTE 10% O O O O TOWN OF BARNSTABLE LOCATION P52 /1 oL n S 1 rc.cJ SEWAGE# OW17 --37Cj� VILLAGE C—cn-lcrui 11c. ASSESSOR'S MAP&PARCEL ep09 - 11 p. INSTALLERS NAME&PHONE NO. Q 4$ rx eQyai i on Sob- y?7- O G S3 SEPTIC TANK CAPACITY /SOO 9 Q ) - No70 LEACHING FACILITY: (type)Soogaal ekot AL (3� (size) )3x.43 x 2 NO, OF BEDROOMS OWNER rIr ro o— PERMIT DATE: $ -31 - p*7 COMPLIANCE DATE: It V 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 leaching facility) Feet FURNISHED BY 8 A2•�(�v 82 • � A3-33 Fro -63 •��` Ay•41G A B 13y•la-7, As•�' O �S•3a o 0- J �iy No. —3/ V Fe Q , THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS 01ppYtcation for )igpogal *pgtem Cougtructiou Permit Application for a Permit to Construct( . )Repair( )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. )S a M d I r%.5 4-, C en 4 e r V I1 Le Owner's Name,Address and Tel.No. Assessor's Map/Parcel de-V'roQa-- cel � Q cl I I l a a 5 a M41 h s+-, Ce nfer v it to Installer's Name,Address,and Tel.No.` Designer's Name,Address and Tel.No. lea beer GIt_Fb\j- BtB EXCavaA1on 1Davio Mdson - ngC EnvIrorn�- SI� 1tjTeabtrryLn� �ofe5+da.le. 509-y17-D6 �'-�jgi(1O )IGht &M 5D4 �33.211't Type of Building: Dwelling No. of Bedrooms L— Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow 4`+ gallons per day. Calculated daily flow gallons. Plan Date S 13 0 1 xl Number of sheets Revision Date Title , 14 r t 'l^�f_6� Size of Septic Tank 15 0(1 C,e j1-A C-W H 2YO Type of S.A.S. U 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. Si ed Date 3 Application Approved Date Application Disapproved for the following reasons Permit No. 3=2-322 Date Issued KZ 3�Z 11� No. � fy * �a x -- v _ ) _ A Fee THE COMMONWEALTH OF'MASSACHUSETTS Entered in computer: .PUBLIC HEALTH DIVISION -,TOWN OF BARNSTABLE,, MASSACHUSETTS Yes Zippricatiott for Bfi ozal *p5tem"Cougtruction Permit Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. M Q I t A 5 JrI (e f 1 Q f ll t I 1 e Owner's Name,Address and Tel.No. (1triiube Z-oPp _ Assessor's Map/Parcel 00 ' ' a !j a M Ci i n $► (e n i e f v i(i e Installer's Name,Address,and Tel.No. De signer's Nam ,Address and Tel.No. ` I�vb�ec UI�Y�y- i3tBEKtnval�v� Vnv,oMC160n - D3( � nvtr-(_,m I�Si ns 1�i7eClt�erryLn �c�(e5icla1� 5ax, `117 0653 F-'5C4) fXL,)1&N MA 5a �33 zi � `l 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 Ll y o gallons per day. Calculated dailyflow gallons. Plan Date 3 U Number of sheets Revision Date Title !. f( e ut -i at Pl in a Size of Septic Tank 15 O(Vq n I - lJ C W H ab Type of S.A.S. ' Description of Soil. "* Nature of Repairs or Alterations(Answer when applicable) f 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. Silg°ned llelkf:rTT'Ff9. /_U Date 3 I )1 - Application Approved Date 3� Application Disapproved for the following reasons Permit No. r 7"3 Date Issued �Z THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Comptiauce THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed( ) Repaired ( )Upgraded( ) Abandoned( )by_RC) P G, j G I L f ti\I F i.t n\t G i,C,ri at 5 (t 1 r1 5 £C 1 f'f v t l i C. has been co sttucted i accor a ce with the pr.visions of Title 5 and the for Disposal System Construction Permit No. 7� �� �d � � . Installer_ U r l' j 61 1 r b�l _ Designer a n ei U it �S 1 C n The issu c `o- s ermit shall�no be construed as'a guarantee that the ttxv/zll will nct` ii�s d- rued./^ Date vx1 u) �GP j k�. /,,9"n G Inspector -- — ------------------------- _ . _ . - No E.x`-'_ / g Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS �Bigont �ipztem Construction 'Permit Permission is hereby granted Ato Construct( i;./Repair( )Upgrade( )Abandon( ) System located at 5 w c I -\�Dk ((P t`l � c C i I 1 I C' •F c and as described in the above Application for Disposal System Construction Permit. The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided: Construction mus be co feted within three years of the to o�this Date:_ 3l Approve Town of Barnstable Regulatory Services Thomas F.Geiler,Director ' Public Health Division Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office:.508-862-4644 Fax: 508-790-6304 Installer&Designer Certification Form Date: Designer: 1 i Installer. Address: . 6 1C - Address: Ili Teab e rr Y LQ R �. To(e5F6 a le MA on 8-3 1-0-] � was issued a P ermit to install a (date) �J installer) septic system at based on a design drawn by II JJ AA (address) l U"� dated 6-31- 0-7 (designer) _. I. -certify that-the septic system referenced above was installed, substantially according to the design, which may include minor approved-changes such as lateral relocation of the distribution box and/or septic tank. _ I certify that the septic systean rid above was installed with major change.,,.(Le. greater�10' lateral relocation of the SAS oar any vertical relocation of any component of Ihe septic system)but m accordance with State&Local Itegtdations. Plan revision or certified as-buitlt by designer to follow Wees Si a iE) --i V t S s r ) (Affix Dest's ,` gene) PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION CERTIFiCATB OF COMt''LIANCE 'VVII:i. NOT BE ISSUED UNTIL BOTH•THLS FORM AND AS= BUILT CARD ARE, BY TIM BARNSTABLE PUBLIC HEALTH DIVISION TANK YOU. Q:Heft/SepwDesignerCertification Foam Town of Barnstable r# Department of Regulatory Services Public Health Division Dat e woes. z?/�g t63q �� :200 Main Street,Hyapn' MA,02601 Date Scheduled Tim Fee Pd. Soil Suita ility�jAsses's merit for.Sewage=Disposal ' Performed By: �� / b�L// Witnessed By� wl io2T"fOJ LOCATION& GENERAL INFORMATION Location Address Owner's Name Cq t'r,*rIJCJ e Kr-o p Q Address Assessor's Map/Parcek 0?Q of t�r1-F V t >i?°; Engineecs'Nahte--Dq V OD MC1 Go h �S NEW CONSTRUCTION REPAIR ; telephone V.`'. Land use 4 •Surface Stones Distances from: Open Water Body ft `Possible Wet Area N ft Drinking Water Well Drainage Way 4— Z ft Property Line f�� / ff Other' -' ft SKETCH:(Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands in proximity to holes) 7e # N ZE ( 1 U+ 1 Co , r•n l Parent material(geologic) Depth to Bedrock f�b Depth to Groundwater. Standing Water in Hole: A/K Weeping from Pit Face Estimated Seasonal High Groundwater DETERMINATION FOR SEASONAL HIGH WATER TABLE Method Used ` Depth Observed standing in obs.hole: in, Depth to soli mottles: in. 1 Depth to weeping from side of obs.hole: in. Groundwater Adjustment fr.. Index Well# Reading Date: Index Well level -. Adj.factor— Adj.Groundwater lxval,R e rf,RCOLATI.ON TEST We Time Observation Hole# 71me at 9" Depth of Perc /7% Time at 6" Start Pre-soak Time @ 15mc 9"-611) Had Pre-soak Lt/6 �'"!�� Rate MinJlnch , Site Suitability Assessment: Site Passed Site Failed: Additional Testing Needed(Y/N) Original: Public Health Division - G Observation Hole Data To Be Completed on Back----------- ***If percolation test is to be conducted within 100' of wetland,you must first notify the. Barnstable Conservation Division at least one(1)week prior to beginning. Q:ISEPTICIPERCFORM.DOC i DEEP.OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture .Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones-Boulders. on istenc ravel X/v DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. onsi ten % 41 DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistencv.%Gravel) r 'DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) o (USDA) (Munsell) Mottling (Structure,Stones;Boulders. Consistency. 1 - Rate May: Flood Insur ance T9 -i0j- Above 500 year flood boundary No— Within 500 year boundary No l ' Yes Within 100 year flood boundary No✓ Yes " U Death of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pery 6 material exist in all areas observed throughout the area proposed for the soil absorption system? If not,what is the depth of naturally occurring pervious material? Certification } ' �j I certify that on 1Z (date)I have passed the soil'evaluator examination approved by the Department of Envi ,IeLntal Protection and that the above analysis was performed by me consistent with . the required training,ex erti a rience described in 310 CMR 15.017. Signature Date .17 �7 Q-\S.EPTIC%PERCFORM.DOC Commonwealth of Massachusetts u Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assess ;�nts L° Ub 252 MAIN ST Property Address GERTRUDE KROPA Owner Owner's Name information is required for CENTERVILLE MA 02632 8/20/07 every page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Important: A. General Information When filling out forms on the computer,use 1. Inspector: , 1 �'1G� only the tab key �� "'( to move your MICHAEL DEDECKO cursor-do not Name of Inspector l use the return 0 O 1 ll key. COMPASS REALTY DEV CORP Company Name ree P.O. BOX 2384 _ Company Address MASHPEE MA 02649 renu» City/Town State Zip Code 508-221-5003 Telephone Number License Number , B. Certification " I certify that I have personally inspected the sewage disposal system at this address and that the? information reported below is true, accurate and complete as of the time of the in'spection:_The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Sectioq)5.340.of Title 5 (310 CMR 15.000). The system: �- ❑ Passes ❑ Conditionally Passes ® Fails ❑ Needs Further Evaluation by the Local Approving Authority 8/20/07 _ )Ins e�ctor's Sig atur Date The system inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. 120 PRINCE HINCKLEY-08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal system•Page 1 of 15 V i a Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments wM 252 MAIN ST Property Address GERTRUDE KROPA Owner Owner's Name information is CENTERVILLE MA 02632 8/20/07 required for every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) 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 120 PRINCE HINCKLEY•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 252 MAIN ST Property Address GERTRUDE KROPA Owner Owner's Name information is required for CENTERVILLE MA 02632 8/20/07 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes (cont.): ❑ 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: 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 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. Title 5 Official Inspection Form:Subsurface Sewage oisposat System•Page 3 of 15 120 PRINCE HINCKLEY•08/06 Commonwealth of Massachusetts : Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 252 MAIN ST Property Address GERTRUDE KROPA — Owner Owner's Name information is required for CENTERVILLE MA 02632 8120/07 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) C) Further Evaluation is Required by the Board of Health (cont.): ❑ 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 indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate"Yes" or"No"to each of the following for all inspections: Yes No FT clogged 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 to an 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. 120 PRINCE HINCKLEY-08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 252 MAIN ST Property Address GERTRUDE KROPA Owner Owner's Name information is required for CENTERVILLE MA 02632 8/20/07 every page. cityrrown State Zip Code Date of Inspection B. Certification (cont.) D) System Failure Criteria Applicable to All Systems (cont.): Yes No ❑ ® 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 fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ® ❑ The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply the system is located in a nitrogen sensitive area (Interim Wellhead Protection ❑ ❑ Area—IWPA) or a mapped Zone II 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. 120 PRINCE HINCKLEY 08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 15 Commonwealth of Massachusetts w Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments 252 MAIN ST Property Address GERTRUDE KROPA Owner Owner's Name information is CENTERVILLE MA 02632 8/20/07 required for every page. City/Town State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes" or"no" as to each of the following: Yes No ❑ ® Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ❑ ® Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] k 120 PRINCE HINCKLEY-08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �., 252 MAIN ST Property Address GERTRUDE KROPA Owner Owner's Name information is required for CENTERVILLE MA 02632 8/20/07 every page. City/Town State Zip Code Date of Inspection D. System Information Residential Flow Conditions: Number of bedrooms (design): 4 Number of bedrooms (actual): 4 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 440 Number of current residents: 1 Does residence have a garbage grinder? ❑ Yes ❑ No Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes ® No Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available last 2 ears usage d n/a 9 ( Y 9 (gpd)): Sump pump? ❑ Yes ® No PRESENT _ Last date of occupancy: Date Commercial/Industrial Flow Conditions: Type of Establishment: -- --------- ---- --------------.--- Design flow (based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow (seats/persons/sq.ft., etc.): - Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: Last date of occupancy/use: Date Other(describe): 120 PRINCE HINCKLEY-08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 252 MAIN ST Property Address GERTRUDE KROPA _ Owner Owner's Name information is CENTERVILLE MA 02632 8/20/07 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) General Information Pumping Records: Source of information: n/a Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ 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: REPAIRED 1989 Were sewage odors detected when arriving at the site? ❑ Yes ® No 120 PRINCE HINCKLEY•08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 15 <C_\1 Commonwealth of Massachusetts _ Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 252 MAIN ST Property Address GERTRUDE KROPA Owner Owner's Name information is required for CENTERVILLE MA 02632 8/20/07 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Building Sewer(locate on site plan): 7' Depth below grade: feet Material of construction: ❑ cast iron ® 40 PVC ❑ other(explain): Distance from private water supply well or suction line: Town water feet Comments (on condition of joints, venting, evidence of leakage, etc.): joints tight, yes vented, no sign of leakage Septic Tank (locate on site plan): 6'WITH RISERS TO GRADE _ Depth below grade: feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No ---------------------------------------------------------------------------------------- 1000 gallons Dimensions: 2" _ Sludge depth: Distance from top of sludge to bottom of outlet tee or baffle 32" Scum thickness Distance from top of scum to top of outlet tee or baffle 11" Distance from bottom of scum to bottom of outlet tee or baffle 14" measured How were dimensions determined? 120 PRINCE HINCKLEY-08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 15 Commonwealth of Massachusetts u Title '5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 252 MAIN ST Property Address GERTRUDE KROPA Owner Owner's Name information is required for CENTERVILLE MA 02632 8/20/07 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): need to pump, tee's intact structurally sound, liquid level equal with outlet invert, no leakage. Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle — Date of last pumping: Date Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): 120 PRINCE HINCKLEY•08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 252 MAIN ST Property Address GERTRUDE KROPA Owner Owner's Name information is required for CENTERVILLE MA 02632 8/20/07 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Tight or Holding Tank(cont.) Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): `Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 1" above with outlet invert Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): D-box is level and distribution is not equal, yes solid carryover, no signs of leakage, flow diffusers(sas) are backing up into d-box Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No 120 PRINCE HINCKLEY•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 15 Commonwealth of Massachusetts • Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments wM 252 MAIN ST Property Address GERTRUDE KROPA Owner Owner's Name information is CENTERVILLE MA 02632 8/20/07 required for State Zip Code Date of Inspection every page. City/Town D. System Information (cont.) Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.): Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: Type: ® leaching pits number: ® leaching chambers number: 3 ❑ 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.): soil gravel to sand, yes sign of hydraulic failure, ponding flow difussers are backing up into d- box, yes damp soil, vegetation normal 120 PRINCE HINCKLEY-08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form Not for Voluntary Assessments M 252 MAIN ST Property Address GERTRUDE KROPA Owner Owner's Name information is CENTERVILLE MA 02632 8/20/07 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert — Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Ian Privy (locate on site plan): Materials of construction: --- -- Dimensions -- Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): 120 PRINCE HINCKLEY•08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 15 Commonwealth of Massachusetts - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 252 MAIN ST Property Address GERTRUDE KROPA Owner Owner's Name information is required for CENTERVILLE MA 02632 8/20/07 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 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. ' Z 3 S A - tb g1 ail �Z- aAI �,z- Ai as (0ni 120 PRINCE HINCKLEY•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 15 • f Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments °M 252 MAIN ST Property Address GERTRUDE KROPA Owner Owner's Name information is required for CENTERVILLE MA 02632 8/20/07 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope ® Surface water ® Check cellar ❑ Shallow wells Estimated depth to ground water: 30.24' feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date ❑ Observed site (abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health -explain: ❑ Checked with local excavators, installers-(attach documentation) ® Accessed USGS database-explain: town of barnstable gis You must describe how you established the high ground water elevation: town of barnstable gis topo shows ground elevation at 30.24' _ 120 PRINCE HINCKLEY•08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 15 TOWN OF BARNSTABLE L-C,ATION-°'4 ,?- SEWAGE # VILLAGE _C/�72-1►jllk ASSESSOR'S MAP & LOT 7 Zl-r76 I INSTALLER'S NAME & PHONE NO.424,og SEPTIC TANK CAPACITY /gyp E C LEACHING FACILITY:(type) f=,i,& f e (size) /gt x I-$& NO. OF BEDROOMS R PUBLIC WATER�� BUILDER OR OWNER DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No r cx- ;�i`i' r i 11945 1 _ s, No......�&.1 FR$....77 f�..... THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH ........................._..........--.--.O F............................---..........----...---------------------......._..._...._..._ Applirativaa for Biupuual Works Tonstrurtivaa amit Application is hereby made for a Permit to Construct ( ) or Repair (4) an Individual Sewage Disposal System at: r .............!;Z -- �. Location-Address or Lot No. .............-C'-s--�c*& --------•-•--•----•--------------- .............` `5 .��far . ....... ... Owner Yddress ess ------------------------------ _... '7''Installer d Type of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms..............• _ .....Expansion Attic V,10 Garbage Grinder (/ } pa, Other—Type of Building ......... No. of persons.......:—�.............. Showers (a) — Cafeteria ( ) a Other fixtures ..................... 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--•••-•....P•••-••-•-•--••-----•---•-•••••..............••••--•P•-_... Date........................................ Test Pit No. 1________________minutesp er inch Depth of Test Pit.................... Depth to ground water....................... Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water-______________--_--_-.. -------------------------•••-------•----•--------•----•-------------•-----------•---..........------......................................................... 0 Description of Soil..............................................................................................................................----------.............................. W V •••••-••••••-••--•••-•••--••-•--•--•........--•-----•••---•-••-•-•........•------•-•.....-----•-••.........--•••------•••-•-•-••----••••----••------••••••••-•••-•--•••......•----------•--••.......... ---------------------------------------•-----------------------------------------------•-•------•--•----•••...--••-••---••....... •-•-•••••--•--•-----••••-------•-•-•----•---••• ---•--- U Nature of Repairs or Alterations—Answer when applicable____/W.-•--c1,•...../? 'k,4---------- •7'�,�------- --------•-------------------•----••---•--••-•••--•--•-••••-••-•••••-•••••--•••-•••-•--•-....---•---•-•--•-----•-----•---••....--••••••--•------••-•---...---••••--•••--••••-•--•-•--•-•--.............. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with !'lT l'1-•--� the provisions of iy;IE 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. gSigne •-•• •- . ......... ----•- ................ ... ••••p2 -• Date Application Approved By.............. 0 ....�.. ........- Date Application Disapproved for the following reasons:-----••-•••-•-•---••-----•-•-••-•-••--•-••••-•••....••••-----•....•••-•••••••--••------••-•-•---•••-•.....------ ------•------------•-•-------•------------•---•• ---•••-•-•••-----••--•------•------....-•--•---------•-•---------•-•--•-•--•----••--- •••--------••--••----•--••-••-••-••--•-----••...--••-••------- Date PermitNo......... ....................... Issued_....................................................... Date • e THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..... ..............................OF............................................... Appliratiou for Dispviial Workii Tomilrurtiou 11antit Application is hereby made for a Permit to Construct ( ) or Repair (,r an Individual Sewage Disposal System at: _ ....-----...s-.. ./`_��ofr.-- -----��----------------•------•-------•-- ------•----•....... ---./•3_.... % :-�? -Y=' '----------- . :.� ............. ................ Address or Lot �o �� .....---•-----•--•--•--•...............................•-------•-- ................. l ....... 1.:'::_.....---••-•-•-•--------•----... �f ) Owner _` f j� y ess �+� �y rW� `cs!r7! Xf lier_�-........ !✓ !................................ ---;%X...lzm:` �!`w� �i��!!�=?Ci.�.'a��../"!1^-_.�'6�� Installer ess UType of Building Size Lot__-.--------•______________Sq. feet Dwelling—No. of Bedrooms...............-.........................Expansion Attic (/+rc) Garbage Grinder ()V-) Other—T e a —Type of Buildin g .__...._ No. of persons........--.................Showers (�) — Cafeteria ( ) 04 Other fixtures -------------------------------------------------------------•------------------------------------•---•------•-•--•-------------••-...---------------- 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........................................ 14 Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water....................... Pzl Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water------_................. 04 .............•----------------•-•-•--•-••-•--•-••----•--------••••-----•---•••----•---------•-••----....----•----•---------------•-•--•-•--•-----•---•---•-- 0 Description of Soil................. x w VNature of Repairs or Alterations—Answer when applicable....___✓* _. .__....._ ' _--____ -'�Q�? ....._.../t�1 `""._.._...... -----------------------------------------------------------------------------------------------------•-•--••••-•----•-------------•-••-•--••------•----•-•----••••••••-•••-•••-•••-•--•--.....-•--•-•--- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of 'T:IE 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has 'been )issued by the board of health. Signed=- ? r4F.t .. ....< ' - .... r Date Application Approved By.............. ` `"'""��- ----••-•/�= Date cG Application Disapproved for the following reasons:-----•--------•-------------•---------•------------------------------------------------•---••-••--•---.......--- ----•----•-•--•-•-•••-••••--.._.....--•--•••-•--••--••••------•-•-•-•-••-----.....•----------••-••-----•--•-•-----•---•-----••••----•-••----•-•----•--................................................. Date Permit No.-•-•---� c....=..�-�--•------••--------------- Issued....................................................... Da--- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH / 'L trz ..........O F..............r! ..:. %.:::- �^ .i.......................... .................. .............. ............... (9rdif iratr of Touts haurr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired>') by.....................K--- 'r.:.._ ...- . eriz, ,_r�? 7 Ins[�.11er .••••. ' has been installed in accordance with the provisions of T IT E 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No.......�_✓_-__t��.�_.__..•... dated---------------_-____-_--__._--._-------__-_--- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE................ .-.1`f:_. .c� Inspector •.................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH; �.. OF...........1...:..... �' ".................. M�Ge,�................... ............................_.... � i\TO. ......:: �i��ro��tl ork� �oat�#rttr�ion rruti� Permission is hereby granted............ .:tic= ........ •------••-•-----•-----------------•------ to Construct ( ) or Repair (e) an Individual Sewage Disposal System at No-_------------_-- - ?._.�.; ==' - ................ ..................................................... Street as shown on the application for Disposal Works Construction Permit Nol...�_��___ Dated.......................................... ............................... - Board of Health ----------------------------- DATE--------------- ------------•---•-----------•-----..............--•--•.......... FORM 1255 HOBBS & WARREN. INC., PUBLISHERS LQtC AT ION SEWAGE PERMIT NO. Ay /22A/A!% �-ST. VILLAGE � time RGl/L C, INSTA LLER'S NAME & ADDRESS r�D hill 1T • B U I'L D E R OR OWNER o CoLI Lei DATE PERMIT ISSUED 8-� - PO DATE COMPLIANCE ISSUED q� � P'tX ^._0 a THE COMMONWEALTH OF MASSACHUSETTS BOAR® % HEALTH ------..-0F............... .... a?-..--------------------............................... ApplirFatiun for Diiivuiial urk . Tilustrurtiun omit Application is hereby made for a Permit to Construct ( or Repair ( ) an Individual Sewage Disposal stem at: r L c Address r o No. r / Address ...... .....___. _....__.._. `^� � ......_ ....................•- Installer Address /S 0 Type of Building Size Lot...._ .-.,.___®_®_._._Sq. feet Dwelling—No. of Bedrooms.. ...................................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) a' Other fixtures ....:............................. w Design Flow___________________________________________gallons per person per day. Total daily flow.__-------__-�-� . ................ P4 Septic Tank—Liquid capacity.&01allons Length................ Width................ Diameter________--_----- De,,PP�,th..._ -•-- Disposal Trench—No. ..................... Width-----T.............. Total Length.................... Total leaching area----�..1__.1.:T_sq. ft. Seepage Pit No----------_-------- Diameter......_....:........ Depth below inlet..... _ g q. l0 _________._ Total leaching area 2-__..__.�.s ft. Z Other Distribution box Dosing tank'( ) /! Percolation Test Results Performed by_______________________!".__i :r._.._. ... ... ....c..... Date........................................ ,.� Test Pit No. 1......J......l3�es per Inch Depth of Test Pit.................... Depth to ground water........................ Gig Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ R+' Z _ ...... Description of Soil.--•--•-•- - e ? �a � •--•-=• --�a- --- /2 . .� ............................ .....----------------------------------------------------------- ---------------------------------------------------------------------------------------------------------------------------------- w UNature of Repairs or Alterations—Answer when applicable............................................................................................... ----------- ------------------------------------•----------•------------•--•---•----......-------------•---....-------'-----------------=--••--------.....----------------------------•-------••----••. Agreement: The undersigned agrees to install the aforedesc ibed Individual Sewage Disposal System in accordance with the provisions of iITI..E 5 of the State Sanitary C d — The undersigned further agrees not to place the system in operation until a Certificate of Compliance has bee • s ed by o rd ot health. Sign .._.......--••---•-------- ...F-7 7--_.... Pate Application Approved By..... Lal. .. .la d-� _ ----•-..�X -7-�-•------ Date Application Disapproved for the following reasons:_. .............. Date Permit No......................................................... Issued_--_- !- ~7� Date No................ .....-- FE$ ........ THE COMMONWEALTH OF MASSACHUSETTS BOARD Qg HEALTH ... OF....... ....:.':.. ................................................. A ,Vf ra fou for Difqp.auaf arks Tonotruainn ami# r Application is hereby made for a Permit to)"Construct ( or Repair ( ) an Individual Sewage Disposal System at .... iP /�g Jt q� ..::__.:.. ti✓ i� r Address 0 O e Address W1 - J11 •-•------------•-•----------------•-- ---•-----• �'� ' � 'J i Installer Address Type of Building Size Lot_.___ . �...............,Sq. feet Dwelling—No. of Bedrooms__. Expansion Attic ( ) Garbage Grinder ( ) ------•. p`4 Other—Type of Building a_--_ ___-•--- sNo. of persons. ._______ Showers ( ) — Cafeteria ( ) QI Other fixtures _. •• 'w ----------------------- -----•------ W Design Flow...:.......................... g allons per person per day. Total daily flow............. !! .....gallons. Septic Tank—Liquid capacity'.?.__....•gallons Length................ Width................ Diameter...... D th••_ Disposal Trench +No ........... ....... Widt . Total Length____............._._ Total leaching area........... t...sq. ft. r 3 Seepage Pit No____ _____ ________ Diameter. � .......... Depth below;inlet.._..:............ Total leaching area.�":....M---...sq. ft. ;xm. Z Other Distribution-box (*-I' Dosing tank a Percolation'Test Results erformed b .............................. x ..................!..... Date........................................ Y a Test Pit No. 1.... 1�Prtlertes per'inch Depth of Test Pit xr__.. Depth'to ground water________________________ ,.. Test Pit No. 2:...............minutes per inch Depth of Test Pit............... Depth to ground water___-•_.--_--:•_-___-___. P'+ r, O Description of Soil...•--- . '. - ' 'f` " --- � x =..__.._... UNature of Repairs or Alterations='Answer when applicable. -•_ ___ --------------- - -----------------•_-------..---..---:-._. Agreement: The undersigned agrees to install the aforedes ibed Individual'Sewage'Disposal System in accordance with the provisions of iIT1Z 5 of the State Sanitary 6dc—The undersigned further agrees not to,`place the 'system in { operation until a Certificate of Compliance has bee�is ed b a -' rd o heal4h. s Sig <: = r '. ate ,.Application Approved By....... . " Date yv r `t I , Application Disapproved for the f ollowing'ireasons:----...----•- -------------------------------------------------------- -•-- ....•.. /i ............... ......s..................„.............................................................__...................... ............. c 4ad! Date j PermitNo.•-...................................................x -..>, Issued...............`.........................,................ Date ,h THE COMMONWEALTH OF MASSACHUSETTS BOi4RD= OF HEALTH ... L ..... 0F...:a . "� '' � ..................... I. Trrfffiral e of Tontlifitturr T S IS O RTIFY, That the Individual Sewage Disposal System constructed. ( ror Repaired by-2f... _x. •----- -------------- ..... at..... }! - nstailrl ijG .. "*Yr J ._ � '-_ has been installed in accordance with the provisions of i of T e State Sanitary dE� s dZs r bed in the application for Disposal Works Construction Permit No.:__ 7 .____r__._. da.ted___ '._�'../.. ................... THE`ISSUANCE-OF THIS CERTIFICATE SHALL NOT,BE'CONSTRUED AS A GUA ANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. Via.. DATE --'2 .-•---• ..................... Inspector... ! .......................... 1 r.. � r• TJE COMMONWEALTH OF MASSACHUSETTS BOARD HEALTH . t Iry /� ...� ®F.. y iatt u k unu un �erntit Permission is hereby granted-. " s.... !.. 1J,.2- „.... ........................... h........i:...... ........ to Cons t O r. ) an i dual See Djspo 4�yst s I at No.'t - � ��i .."".. 4 i !l.l !!x.. '_.. l ,tC.,.,.f... Street p, - as shown on the application for Disposal Works Construction Per o:. ed;:�[. ��"__�..._.�............. T ]Ilt }a. k' Board of Health « b DATE ` FORM 1255 HOBBS & •WARREN,ANC.- PUBLISHERS _j•. e a _ r 7-OR EL = /oG. o CLEAN SAND igssu,,.,En /O FT CONCRETE 4" SCN. 40 CONCRETE COVERS PVC P/PE COVER e, NIIN. PJTC H— i/B"PER FT. 3' t 27;MIN PITCH Lj I- • FLOW N ? L/NE 2" LAYER „ 4 CAST IRON �.p Y OF y8- V2 PIPE-N//N. ° �' >� o o WASHED STONE PITCH / D/ST. o ' 0 PER FT BOX o o 0 o F` 1 V Q 0o WASHED STONE /000 GAL. PRECAST LEACHING SEPTIC ° ° W PIT OR EQUIV, TANK _ - 6 Fr DiA _ INVERT ELEVATIONS /O Fr o�•9. �9Lc W02X/�?i9N5N/P� .vn/n INVERT AT BUILDING 971 o FT.' /IOATE2/�L 5iy/�c c Cani.�o2.•_� ro. IA&E T SEPTIC TANK �G• 7 FT. GROUND' WATER TABLE 7WI= 2OVl_s"/GA/S': OUTLET SEPTIC TANK 96•5 FT. T/TLF_ �VA/D. 'T,�fff TOvvN SECTION OF . l3igi2NS T�J T,3�E S 2,E=C'CJG�TI on/-S INLET DISTRIBUTION BOX 2,6- Z FT. SEWAGE DISPOSAL SYSTEM Fo/L SUI3 v2.c/�cE n/sl�o s,� C OUTLET DISTRIBUTION BOX 96.O FT. Nor TO SCALE o� sF w4 ro E INLET LEACHING PIT 9 5•7 FT. • SOIL TEST DESIGN CALCULATIONS DATE OF SOIL TEST z s WITNESSED ,BY T�•G�� � �•�'' � NUMBER OF BEDROOMS 3 PERCOLATION RATE_G 2OFMq�fq GARBAGE DISPOSAL UNIT. .. _Nowt S/DEWALL AREA Z' � GAL.IS.F, RICHARD tiG BOTTOM AREA -L_ DAMES TOTAL EST/MATED FLOW.. 3 3 D GALIDAY O GALS.F. GAL/BRIDAY X ' 3 Sf?• . .•. •• .. . .•. .. • ELEVAT/ON °oE694N y REQUIRED SEPTIC TANK CAPACITY........ 4 9 s GAL. —0 Glss�-�`o .ACTUAL SIZE OF SEPTIC TANK _ �p` ��� - s T TO BE INSTAL LED. . . . . . . . . . . . . . . . . . . . . . . . . . . .. . / 00 O GAL. = SUBSaIC LEA CHIAIG PIT(S) 1 - /D F T DIAMETER — Zo REQUIRED LEACHING AREA. . � 79- 1 S.F. T �3. 2 FT. EFFEC T/VE DEPTH E.9n i M E D A2n/S7—i5'Z3 G/� , MA aS S. AC Tl/AL LEACH/,'VG AREA Z G -2 S.F. ;SAND aw"gV,- L FT. E'FFEC T/vE DEPHN " "" RICHARD J. O'HEARN,R.L.S.,R.S. Fr' T. SERvE LEACHING AREA z � 7. - S.F. WEST 9DENN SS MASS. Joe No.a /�O.�WATEPL ENeOUniTE2 E U �a c �57-7- +. •..,., DATE: `. .. .. .....o. ` 7/Z 7/j-/ SHEET Z OF Z i 1, 10 -r 14 //!. 34 ' 1 /�� FOTU2� �0'D/A • .ees�,evF 1' £3o7 L EACtI/h/4�; F/T sE-'NIiG p TiC1/JK i t, '?: - y �11 V r r t' itfi;�ytit�t3 `III Of E� S �V. �.. o JAIRES N r.�„� '`'��`i`a_,a=�„ 6 i•S x�" v �OARN No.�6 4 to —.. C-S V-T 1�t aD �..� , tea . ST SANXf �� LOClATI aV-J ��Ni�= ✓!L L�� 1 CMIZTct=-( TNAT' TNG tj 4aLAQ RLP,cR-E�lIGa W r--Z C _1 GGNLPLYG W i Tt-1 T►•-1E S t t�'E.t i►-�E= L G T /.�� aWa SETI3ActC WC-QUiCGAfAa"TS OF TNe 'Town o;= rh'. � •s ' '.5' '.�f.��. Y�/c�:v / J cDATA /� 7 T tJ�l� 1aiG_ REC.IS c'e.tZ�D . -t-A.tLp 5U"Z.�/�.�fotzy Tt415 V LAW IS CLOT S,aSE� UN Aa.,t OSTEQ�/il_liV a /1fCr1SS• 1,445'M JAAE%-IT �,vQvc�{ Ttat= ut=G,�rli S�IokJt� I�pPL.tc-&"T Gv Co/c rrf } } F ""'0" , i ¢ #+ a c a t k ' ASSESSORS MAP: © TEST HOLE LOGS NOTES: PARCEL: 64 /C SO I L EVALUATOR NE FLOOD ZONE: • _ .� _ - _ __.. WITNESS : 1 1 01 ) The installation shall comply with Title V and Town of Itarnstable Board of REFERENCE: DeED _ DATE Health Regulations. PERCOLAT 1 RATE �. yWtt 4 r 2) The installer shall verifythe location futilities, /�l../+f�•,/y �3Qo" I S' �+9 E''gr'�Z C� o sewer inverts and septic ! j ,e fiL, 3612 wr INt a components prior to installation and setting base elevations. r4X lL 3) All gravity septic i in to be 4 inch Sch 40 P r 8 Ypiping g VC at 1/8 per foot. The first _ two feet out of the d-box to the leaching shall be level. hh ,rG H/4121� c�.4 x T�'2 i2 GS 3 !��77 g 4) This plan is not to be utilized for property line determination nor any other purpose other than the proposed system installation. C L.��1 LggMt 1� Y ✓ i ttf'g' art; ?a ,r ,.�. 5) All septic components must meet Title V specifications. ' 3e7 ) Parking shall not be constructed over H10 septic components.6 7) The property is bounded by property corners and property lines. 'f LOCATION MAP �S, (/ 1/ 8) The property r0 p owner shall review design considerations to approve of total f-j.I .,. .; y o (� design flow and number of bedrooms to be considered :for design. Receipt of payment for the plan and installation based on the plan shall be deemed / approval of the design flow by the owner. 9 The existingleaching or cesspools shall r g p a l be pumped and filled with.material k; per Title V abandonment r p t procedures. Those within thr proposed SAS shall be tij '�, ,� 'j, �",,, removed along with contaminated soil and replaced with clean washed sand r �S�I�.. per Title V specs. o s„ 10 System components to be l0 feet from water ) Y p line. Serer hues crossing the „" water line h 1 r , t s a l be sleeved with 4 inch SCH 40 PVC vvith ends routed if ., SEPTIC SYSTEM DESIGN applicable. fiN w 11) If a garbage grinder exists it is to be removed and is the responsibility of the ,- 44 i FLOW S I MATE owner to ensure such. R, „ 12)The installer is to take caution in excavation around tyre gas line if 1' ;,! b applicable. a: h,�' ,,.•- �2 1 j� ) e ins taller staller shall verify the location, quantity and elevation of the sewer lines BEDROOMS AT /(� GAL/DAY/BEDROOM 7� GAL/DAY $ exitin the dwellin prior to the installation. / y g SEPTIC TANK GAL/DAY x 2 DAYS GAL "fi / J USE i5I03ALLON SEPTIC TANK 64CW # ZC� SOiL ABSORPTION SYSTEM -•-. • {1 S 1 DE AREAS1�137 Ofe '� —•'' ':1 r. ^.; .. «» - BOTTOM AREA: 33� /Z• 3 X b,-7ca OVA / AMU ' r ./� nr ' o K1 tp D W B• G MASON No.106& w ,-- �► SEPTIC SYSTEM SECT ION (.dr;s, S K � { wt o� 1 ,r'n+.�.,,� wra,+w0"0j" •+•e:_..ew. � ��,yn�i'{.,y5v+'rt .,r � ..,.. � "�..,� _} s 11 t r: 3 c7 op ., . , r �— 1 4/��C11 ' `� ,,;roc �''- -- //,- • f _ Lvglum V r+`✓ F �-o� � .��..�F__,~ ..,�ssG.....��f►�_�ri+c�s.c_ _ 36 BMX, > / '�• .�•.►^. ./• 1}•�M 35 _ 4 ♦ , a � t .'w�'"" f GAL t e 31�b WA SEPTIC TANK . , i ti J ;. k ,e o i 20 LA/`,/I e� � .g -- - Ob .,, -.>. q..r'�—=—•-"-.,,yra-----rr .h. - .,.' y •, ,:. ........-wz ...1C.+.._.�....�..... - :r..,_,a_ab'.w._... - +, :!f '. ..` :.. t. •r a,... r ..:-:.'L'.stf.!im. :..�'�.t'o`, .r".. .. .rr...A`:'+ ._S. �,.} . +..,...,v d f, +,,r• eYrfrs,a +,�" .� �I{j �) pyy Q/�� r � y 30 {SITE AND SEWAGE PLAN ; LOCATION : �6� t0j A11 67 " 61 MA _ r ' PREPARED FOR ;�` 'XGAysrn 'f�► w r SCALE: s DAV I D B . MASON RS DATE a o7 NVIRONMENYAL DESIGNS Z t=> EASTDBC E'SANDW I CH . MA , W DATE HEALTH AGENT k ( 508)� 833- 2177 W : i 8 331 *-AC VRML F 3 {x G,