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HomeMy WebLinkAbout0595 PHINNEY'S LANE - Health 595 PHINNEY'S LANE, CEl`;TERVILLE A= 250 048 llll �cvccEo /n ad. zJ� Co2m UPC 12543 NO. � �snco HAStMOS.till TOWN OF BARNSTABLE LOCATION S9S P ,ns,cu S Q0 SEWAGE# 201 It, - 43 Z VILLAGE 'Ccn4cru'%) )c ASSESSOR'S MAP&PARCEL ZSO INSTALLER'S NAME&PHONE NO. A�- CB EXCc�yQ� ►O/� SEPTIC TANK CAPACITY /Soo N 10 LEACHING FACILITY. (type) S (size) Z X 3 X 3 NO.OF BEDROOMS Z J OWNER �, PERMIT DATE: 1 Z-<9- 1 L 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 leaching facility) {, Feet FURNISHED BY bq- _CG� �G�1,IQV) I�C Al - i9'3 3 y A:3 Ll � R EA R 633 WV' t Ay g ,AAerl LAB c No. I ©1 4 3 Z Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes 21ppliLation for Disposal *pstem Construction permit Application for a Permit to Construct( ) Repair(JS Upgrade( ) Abandon( ) [Complete System ❑Individual Components Location Address or Lot No. 59 5 Ph.nne,�S (-h_ Owner's Name,Address,and Tel.No. Assessor'sMap/Parcel fnck9 250 / Pcacz,eI Oq 0. -To I," Fey (S-08) `6%S - I010 Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No. L'is 4 rc,XcQ-v�t�o� �5��� �177 ' U(os3 Fl�ihe.� (tc.u. C-77q) OiGN - 91(.& 7)rpe of Building: Dwelling No.of Bedrooms 2 Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 2 Z V gpd Design flow provided S 9 gpd Plan Date '1 '30 ' 1(o Number of sheets Revision Date Title Size of Septic Tank 1 j 0 p Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) {TOO q,,,\lc n H - Z-0 po o x 1 (1) 33 3 x Z' 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 ealth. Sig Date 12 a Application Approved by Date Application Disapproved by Date for the following reasons Permit No. �(�l `�,7 Date Issued l (f 4 - P No. 0 I (O 2 { -+:,, Fee I ff THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes It Application for Misposal *pstrm Construction Permit Application for a Permit to Construct( ) Repair(✓S Upgrade( ) Abandon( ) []Complete System ❑Individual Components Location Address or Lot No. 59 5 Ph ne yS ( r). Owner's Name,Address,and Tel.No. Cen4-eJu,t1C, Assessor's Map/Parcel My g Z 170 Par C e I F Qy (SO O$O Installer's Name,Address,and Tell.No. Designer's Name,Address,and Tel.No. ( 09)Type of Building: Dwelling No.of Bedrooms Z Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) U gpd Design flow provided gpd Plan Date III -Sol ((o Number of sheets Revision Date `2, `(o /(o Title Size of Septic Tank 1 j Q o Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) J TOO Ca o 1t r, H - Z U ' CZ-) +ren c.htS 33 X 3' X 2` U Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Boar ealth Sig //� , Date Application Approved by �/`�,` �� C�� Date T 411f, Application Disapproved by Date for the following reasons Permit No. )-D (7 `C/3 Date Issued W/4 THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired(Vill" Upgraded( ) Abandoned( )by 6 V 6 !F4 c-a•,aa-,o Y--, at 5 9 5 Pk'.n he,y Lon 9- has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. (J/6" -&Kted I Installer V)Ohark Designer 4-, (�Cni #bedrooms Z. Approved design flow Z U gpd i The issuance of this p rmit shall not be construed as a guarantee that the system will f triG s^d signed. Date fi t( 1 1 Inspector /��t .✓ --------------------------------------------------------------------------------------------------------------------------------------- No. 10 1(o t4'S Z Fee �oo - THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS Bisposal 6p$tem Construction flermit Permission is hereby granted to Construct( ) Repair( ) Upgrade( ) Abandon( ) Systemlocatedat S�S ��►irwithe5 LQn� , �+erv,�lc v 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:Construc7nTust be completed within three years of the date of this permit. Date Approved by �f �J Town of Barnstable tME "c Regulatory.Services Richard V. Scali,Interim Director anaNsras�.E, 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: _ Sewage Permit# Assessor's Map\Parcel 256 y� Designer: Flah���y Enyi(ome4&1QkrVf(f3 Installer: BA-B F-1coaioV) Address: Address:o 'fox ( ICI Tea b r u Lr�n,� r u�.rmou-Yh po��- ►�� �or�S�dal� M.V� On I�. 8 I `�� Exm oVtU V) was issued a permit to install a (date) (installer). septic system at based on a design drawn by II (address) f ffiviommWdated ya 4 �(P (designer) ZI certify that the septic system referenced above was installed substantial) according to the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. Strip out (if required) was inspected and the soils were found satisfactory. I certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system)but in accordance with State & Local Regulations. Plan revision or certified as-built by designer to follow. Strip out(if required)was inspected and the soils were found satisfactory. .I certify that the system referenced above was constructed in compliance with the terms of the IAA approval letters(if applicable) iH OF ss DAVID L.-' '`mac-I �..,✓'J�Z..-�" [�. N� -,'(Installer'kSignature) fIAHERTY, JR. N f,` No. 1211 z� ��QISTER�o S � (Designer's igna (Affix bft4WOStamp Here) PLEASE.RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS- BUILT.CARD..ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. Q;\Septic\Designer Certification Form Rev 8-14-13.doc e Is Town of Barnstable P# l�alb Department of Regulatory Services i wwarenr�a k Public Health Division Date hh& mc MASS �j, ie39� 200 Main Street,Hyannis MA 02601 C Date Scheduled Ti me /. o Fee Pd._ � M Soil Suitability Assessment for Sewage Disposal N Performed-By: wb /✓' 6Zx-� W(tnessed By: �i�Vx l PCATION&.GENERAL INFORMAT ON Izeadon Address S' �L�/���e�� � Owner's �(iLP Address Assessor's Map/Parcel: - Z $� Engineer's Name NEW CONSTRUC'f10N '/ D REPAIR )L_ �7 Telephbne# Land Use I nA Slopes(96) [L _ Surface Stones Dlstancea from: Open Water Body ,>/" ft Possible Wet•Area ft Drinking Water Well,>�ft Dralhage Way LC ft Property Llna>_Zo ft Other ft SKETCH:(Street name,dimensions of lot,exact locations of test holes&pero tests,locate wetlands-In proximity to holes) i ANl�J Parent material(geologic) V" ►""""� Depth to Bedrock Depth to Groundwater. Standing Water in Hole: toWeeping from Pit Pnee Estimated Seasonal High Groundwater D + TION FOR SEASONALMIGH WATER TABLE Method Used: Depth 011sorved standing in obs.hole: /v In, Depth to soli mottles: In,' Doilth to weeping from side of obs.hole: i in, Groundwater Adjuattdont Index Well Reading Date: Index Adj hetor—Adj.Groundii4 r. evel,,,_ PERCOLATION TEST Mutsu, Observation ! ( v Hole# 1 Tlme at V /�o Depth of Pero Time At 6" a' Start Pre-soak Time 0 U Time WI.6") Bnd Pro-soak '�-4-� Z_ — Rate Mln./Inch Site Suitability Assessment: Site Passed Site Failed: Additional Testing Needed(YIN) Original: Public Health Division Obserwition Hole Data To Be Completed on B ack--------- ***If percolation test is to be conducted within 100' of wetland,you must first notify the Barnstable Conset'vation Division at least one(I week prior to beginning. Q:ISEPTICIPBRCFORM.DOC c DEEP.OBSERVATION HOLE LOG Hole# — Depth from Soli Horizon Soil Texture Shcl Color. Soil. Other Surface(in.) (USDA) (Munsell) Mottling (Stnucturo,Stones;Boulders. , • , isistency.96't3rave1l Z a r3 77 DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Sall Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Iq L- f 31z, 4 Z4L�l C2, DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(In.) (USDA) (Muosell) Mottling (Structure,Stones,Boulders.. Consistency, DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Solt Color Boll Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Slopes;Boulders, L Flood Insurance Rate Map: Above 500 year f lood boundary No Yes Within 500 year boundary No.= Yes Within 100 year flood boundary No.-X— Yes Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervious mtiterlal exist!nail areas observed thrpughout the area proposed for the soil absorption system? If not,what is the depth of naturally occurring per sous material? Certification I certify that or. U, 2U2r-�(date)I have passed the soil evaluator examination approved by the Department of Envi on ntal Protection and that the above analysis was performed by me consistent with . the required trai ,expertis an ex ienc described in 10 CMR 15.017. Signature Date QzWUp'rlC\PBRCPORM.DOC TROY WILLIAMS `� SEPTIC INSPECTIONS *4R ;a Certified by MA Department of Environmental Protection `9'96' (50z8) 760-1819 40 Old Bass River Road w South Dennis,MA 02660 9 Corrnnonweatth of Massachusetts Executive Office of Environmental Maim Cno (� De art rent of %7 • Environmental Protection WWam F.Wald Go..mor tt.a�y�[-opt Davld IL trw ma conwillowSUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION Property Address: ys /01 in y y L,, . Leh ���� '/ 'Address of Owner. Date of Inspection: 'l/q /9 6 Of different) C Name of Inspector:—�goyy i J� Company Nana,Address and Telephone Number: LSe-c o a e- 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 inspection..The inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. The system: asses Conditionally Passes _ Needs Further Evaluation By the local Approving Authority Fails Inspector's Signature: Date: �1.�� 2J.tQ� The System Inspector shall submit a copy of this inspection report to the Approving Authority within thirty(30)days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the Department of Environmental Protection. The original should be sent to the system owner and copies sent to the buyer, if applicable and the approving authority. INSPECTION SUMMARY: Check A, B,C,or D: A) SYSTEM PASSES: t have not found any information which indimtes that the system violates any of the failure criteria as defined in 310 CMR 15.303. Any failure criteria not evaluated are indicated below. B) SYSTEM CONDITIONALLY PASSES: One or more system components nerd to be replaced or repaired. The system. upon cornpletfon of the replacement or repair, passes inspection. Indicate yes, no, or not determined (Y, N, or ND). Desaibe basis of determination in all instances. If'not determined-, explain why not) The septic tank is metal, cracked, structurally unsound, stows wbstantW infiltration or exfiltration, or tank failure is imminent. The system will pass inspection if the existing septic tank is replaced with a conforming septic tank as approved by the Board of Health 1 S SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: s yS- 4; h�r S L h Owner. Date of Inspection: B) SYSTEM CONDITIONALLY PASSES (continued) Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. The system will pass inspection if(with approval of the Board of Health): broken pipe(s) are replaced obstruction is removed distribution box is levelled or replaced The system required pumping more than four times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): broken pipe(s) are replaced obstruction is removed 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 the public health, safety and the environment. 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND 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 APPROPRIATE) DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: The wctem has a septic tank ano soli aosorpuon system and is within 100 feet to a surface water supply or tributary to a surface water supply. The s\•stem has a septic tank and soil absorption system and is within a Zone I of a public water supply well. The system has a septic tank and soil absorption system and is within 50 feet of a private water supply well. The system has a septic tank and soil absorption system and is less than 100 feet but 50 feet or more from a private water supply well, unless a well water analysis for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm. )I SYSTEM FAILS: /�,/�jJ I have determined that the system violates one or more of the following failure criteria as defined in 310 CMR 15.303. The basis for this determination is identified below. The Board of Health should be contacted to determine what will be necessary to correct the failure. Backup of sewage into facility or system component due to an 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 remised 8/1S/9S1 2 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (contlnuec4 Property Address: `1 S P , c y S Owner. Date of Inspection: DJ SYSTEM FAILS(continued: Static liquid level in the distribution box above outlet invert due to an overloaded or dogged SAS or cesspool. Liquid depth in cesspool is less than 6' below invert or available volume is less than 1/2 day flow. Required pumping more than 4 times in the last year NOT due to dogged or obstructed pipe(s). Number of times pumped _ Any portion of the Soil Absorption System, cesspool or privy is below the high groundwater elevation. Any portion of a 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 I 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. If the well has been analyzed to be acceptable, attach copy of well water analysis for coliform bacteria, volatile organic compounds, ammonia nitrogen and nitrate nitrogen. El LARGE SYSTEM FAILS: /\///g The following criteria apply to large systems in addition to the criteria above: The design flow of system is 10,000 gpd or greater (Large System) and the system is a significant threat to public health and safety and the environment because one or more of the following conditions exist: 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 It of a public water supply well) The owner or operator of any such system shall bring the system and facility into full compliance with the groundwater treatment program requirements of 314 CMR 5.00 and 6.00. Please consult the local regional office of the Department for further information. (revised 0/15/95) 3 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: y P ys Owner. Date of Inspection: 3/iy/yb Chec k'if the foflowing have been done: ✓Pumping information was requested of the owner, occupant, and Board of Health. ✓None of the system components have been pumped for at least two weeks and the system has been receiving normal flow rates during that period. Large volumes of water have not been introduced into the system recently or as part of this inspection. NL As built plans have been obtained and examined. Note if they are not available with WA. ✓The facility or dwelling was inspected for signs of sewage back-up. t/The system does not receive non-sanitary or industrial waste flow ✓The site was inspected for signs of breakout. ✓All system components, excluding the Soil Absorption System, have been located on the site. N/ The septic tank manholes were uncovered, opened, and the interior of the septic tank was inspected for condition of baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge, depth of scum. The size and location of the Soil Absorption System on the site has been determined based on existing information or approximated by non-intrusive methods. _The facility ovvne• (and occupants, if different from owner) were provided with information on the proper maintenance of Sub- Surface Disposal System. ,revised 8/15/95) 4 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: S 9 S ®�• �r S . Owner. arµ ' Date of Inspection: FLOW CONDITIONS RESIDENTIAL: Design flow: �o gallons Number of bedrooms: c� Number of current residents: Garbage grinder(yes or no): .V a Laundry connected to system (yes or no):�rS Seasonal use (yes or no): N6 Water meter readings, if available: yy = S-z UouJr�//.7h c Last date of occupancy: O 6, COMMERCIAUINDUSTRIAL: Type of establishment: Design flow: aallons/day Grease trap present: (yes or no)_ industrial Waste Holding Tank present: (yes or no)_ yon-sanitary waste discharged to the Title S system: (yes or no)_ Water meter readings, if available: _.ast date of occupancy: OTHER: (Describe) Last date of occupancy: GENERAL INFORMATION PUMPING RECORDS and source of information: /.`//,) �ivgn. ha — , - L 0".)C System pumped as part of inspection: (yes or no)�S If yes, volume pumped SCU u eallons Reason for pumping: ( �4 TYPE OF SYSTEM Septic tank/distribution box/soil absorption system Single cesspool V Overflow cesspool Privy Shared system (yes or no) (if yes, attach previous inspection records, if any) Other (explain) APPR jXI TE AGE of all components, date installed (if known) and source of information: dr ., / 4 u _jo c`p/or-ex. C;z Y rS a�o Sewage odors detected when arriving at the site: (yes or no) n/v irevlsed B/15/951 S SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (contintx(D Property Address: Owner. Date of Inspection: 311 Yl G SEPTIC TANK: N// (locate on site plan) Depth below grade: Material of construction: _concrete _metal _FRP_other(explain) Dimensions: Sludge depth: Distance from top of sludge to bottom of outlet tee or baffle: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Comments: (recommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural ,ntegrity, evidence of leakage, etc.) GREASE TRAP: /VIA (locate on site plan) Depth below grade: Material of construction: _concrete _metal _FRP —other(explain) Dimensions: >cum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of «tin, in bong^ of ou!t?t tee or bante- Comments: recommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural ,ntegrity, evidence of leakage, et(.) revised 8/1S/9S) 6 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued, Property Address: S 9 s /04 I Owner. 13 r w h Date of Inspection: 3 TIGHT OR HOLDING TANK: �iKj (locate on site plan) bepth below grade: Material of.construction: concrete metal_FRP_other(explain) Dimensions: Capacity:_ gallons Design flow: aallons/day Alarm level: Comments: (condition of inlet tee, condition of alarm and float switches, etc.) DISTRIBUTION BOX:-L/�/? iiocate on site plan) Depth of liquid level above outlet invert: Comments: knote if level and distribution is equal, evidence of solids carryover, evidence of leakage into or out of box, etc.) PUMP CHAMBER:,�✓/,c) (locate on site plan) Pumps in working order:(yes or no) Comments: mote condition of pump chamber, condition of pumps and appurtenances, etc.) !revised 8/15/951 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C } SYSTEM INFORMATION (continued Property Address: -e y s Owner. �r a, 47>i, Date of Inspection: SOIL ABSORPTION SYSTEM(SAS):_ (locate on site plan, if possible; excavation not required, but may be approximated by non-intrusive methods) if not determined to be present, explain: Type: leaching pits, number:_ leaching chambers, number:_ leaching galleries, number: leaching trenches, number,length: leaching fields, number, dimensions: overflow cesspool, number: e>c e_ 'X S o 0 Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,etc.) St,% � �a.>..� � be— o o l �, CESSPOOLS: (locate on site plan) ',4umber and configuration: o ,t t-, Depth-top of liquid to inlet invert: 5 ", Depth of solids layer: 6 �/ Depth of scum layer: " Dimensions of cesspool: ' G4 - Materials of construction: ndication of groundwater: Alo N /_ inflow (cesspool must be pumped as part of inspection) Cc 5 S ✓�o o W e-L s �Jv�, eA !(nTG�/)GcihG" . i Comments: (note condition o soil, sjgns of hydraulic failure, level of ponding, condition of vegetation, etc.) (� �J �, c, ��cra w S vor, 4s- t, vas. �•.. PRIVY: _6Yj9 (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.) revised S/15/951 8 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C z SYSTEM INFORMATION (aontinueO Property Add[ess: zq�t OwneR 01C . Date of Inspection: Br-e-`- +O `' SKETCH OF SEWAGE DISPOSAL SYSTEM: indq&ties to at least two pernur ent references landmarks or benchmarks locate all wells within 100' a2,G If Le,351, ,> I C-tSg�poo�. (DEPTH TO GROUNDWATER Depth to groundwater, feet adjusted high groundwater level method of determination or approximation: U w o , ,, `, v a 4 H� J LJ revised 8/15/95) 9 A &s,HoUtIcation Form— ANF-OOt 50 Asbestos Abatement Descriptlon 1. Facility location: - _. r.............._.................... ........... .......:,.:......_.._....y. .._....._....t.Q-rle -. 5 .. hlnne DISTRUCT10111 Add=(� 2 1.M secQoro of this 1�_L.. .- r 5!.k.'_......._..- !..!.............�-d..���_`'•-••••..lN ._..._....____ __.____-- - lorm must a completed ab/rowa �a o0G In adar to comply with p,,,� [ro 0a arlmard of �.� `�n�........_.............._.__...._........._._........ .....___.__...___.__._......._.....__ p 11f�y k M aakG trJdpn7 Duld6q parr,/,a4pt Iba roan ErOodmontal Floridian noff atim 2. Is the facility occupied? Yes O No toVuiamarts of 310 CMR 7.1$(aerarorlbpd10 3. Asbestos Contractor_ C t PdormWiadoae poieal:slat the rectos Dopodmant of Labor ^ r� Q (� R 1 anaIrdurtrlaa ( V 1 1�'0� O c VO v�'S� O—OO l norilblionraWiamerts ............... 0 &........................................_............................. _ ..._ _._........_-_...__...._ _.._._..._........._.............._. N of 63 CM 6.12 (lea C!11— dars PrAr noffrdW h roguiarlolAxt A C __. .......................................... ...................................................................................................................... Aura all prpied praafa Cl!tt+ara l Canrm rrp fwurntierw9 Ica wee reuar of sgraebA- 4. On-SKe Project Supervisor/Foreman: C 2.Srbml01gialFam ................... . ..........1.a .. ._._........_._....___..._....__ _ To: ,tips: DUCrWbeonl comaooweaitL of Yassackasotu 5. .Project Monitor. Asbestos Program P.C.1.11200e7 _......................................._.....__.....__ _ _ Boston,MA02112- Attar LYlCodpdan/ 00e7 6. Asbestos Analytical Lab: 3.Thhfammaybe uWke Tidily to _......... .t-1.._......_..:............................._................................................_............................................. .._..._..�__----- U S.Enviaenertal XWO 111 Grlldaf V I (y 00 PratoWonAgencyRe0- 9 if 96enddate5 it q4 ecHie work hours(Mon.•Fri.) (Sat.Sun.)= I of asbestos dameil'ion/ 7. Project start date J� rendwdon opersltons ssbjed to NESl1APS(40 R What type of project is this? (circle one): dnnraop nysae CFA Srbpat W. worallAaafj � :z. 9. Describe the asbestos abatement procedures to be used (cifcl tubM�c Oasis folcalymull dOW s'�re c� '` ara;�mdyaw drpararoNy plrr(aoPktr) wartltaa� ^r:, 10. Is the job being conducted Indoors O outdoors? 11. Total amount of each type of Asbestos Containing Materials(ACM)to be handled on pipes or ducts(linear ft J ± orother surfaces(square ft.). to be removed,enclosed or encapsulated: T' Aneadsquare lest boarr,bfmddnp.riot brat vxbx cpaflrps..._/ slwmsl,solid ewe p(po budaflon...... carupafod a brwsd p4 e'Ply frwdaUon....q / hsuWhp canenf.................. _J spar`an6repoohng....................._l trowellsprarereoatings.............. data,noses h b ks....................._J raaske board,waU board............. oem!(please describe)...................._J 12. Describe the deconlaminalion system(s)to be used: , ...... 13. Describe the containeriution/disposal methods to comply with 310 CMR 7.1 1and 4}553 CM R 6.14(2)(g): .................-.....................................:............................................................................................_..._....................... 14. For Emergency Asbestos Abatement Operations,the DEP and DLI officials who evaluated the emergency: N.IA...: ....... xaer of brr olasy mk aA+AnaU�aan wyKrl xansr dcu aarlal INk ......................................:............_..................,.............._..._._..._ �k dAulAorftalfoa wyKr l I5: Do prevailing wage rates apply as per M.G.L.c.149.§26.27.or 27A-F to this project? O Yee No Facility Description 1. Current or prior use of facility: Re S iden CQ ' 2. Is the facility owner-occupied residential with 4 units or less? lAyes O No 3. Facility Owner. __.S r_Y,. .CG�I ...._..........._................................_.............._......................_..__ C*/T— rn ma rdrplmr 4. Facility's Owner's On-She Manager. _..................................i�,1...1..... ......................................... ................... ...............................................................................__......_._ Ad*W 5. General Contractor. ............W.A. ._..........................................................._........................_........._..._......__ _..._ .. X+mi AOQntr _-_.-_................................._........._.............._...._......._.............................._......_........._................_____. — C/y/foMn Ito code TAphon con"dor's Women Camp.Insunr Po" txo.nsu 6. What Is the site of the facility f d- (sq N)�' (/of Ibors) Asbestos Transportation and Disposal 1. Transporter of asbestos-containing waste material Irom site to temporary storage site(I necessary)to final disposal site: .............._............_...............,....... ...1.1.a.......�.C'an.._..d rC �" —sc? 1{� 36 . Xma A&*w ........... Gov.n n............................................ ..:.......Q.a- ..�.�.......... ...w .....'�s�a..'c�0!q_ Gnno»A rr� rr�v�a,r 2.• Transporter of asbestos-contalning waste material from removalf temporary storage site to final disposal site: &V= `P�..(-+I clot....................�^TJ ................ 0.�.`f..8...0...................................................`..2`•"0667 Note.Transfer ubAowr 1{000a rd0we Stations must 3. Refuse transfer station and owner(If applicable): comply with the Solid Waste ohdslonrepula• ---______ ..___._.._._ .._...._.._._.._.. ..._._._._......._..._........_...._.............__.__.___.._ �� AOM van$310 CMR 1&00 ...._................................................................................................_.__.-.................--------__ C4/T- Ito w* rdepAoa 4. Final Disposal Site: ................___.... __.._..._ (=am AWS Acorn NM _ .___ __...._..__.__._.._Y....................__-......._........................ Ad*w 1..► ,A. '1' _..i................................ ...................................................... .............:.........................................._.._.__ MA— Ilp oaar fdgalod certification The undersigned hereby dales,under the penalties of perjury,that he/she has read the Commonweahh of Massachusetts Regulations for the Removal,Containment or Encapsulation of Asbestos,453 CMR 6.00 and 310 CMR 7.15.and that the Information contained In this notification Is true and correct to the bed of his/her knowledge and belief. _ .._.._� _ ► _._.�'�1_.. C'` ......._............ .... _......._.. ....... . ............ . ._ PYNPWn Aumatr S rve Rre� Note:Contractor C ��— QD must sign this !_�_4. O W form for DU Posiravm� __ ......._...._...._.............._.ft"Mikp......__.._.__........_....._...._.__.r.SIVUr notification ' purposes I10 Depn__SkCV............ ...............rQun�-00 0 aT tO AAhn Gry/roxn jIp p7d/ • Fee exempt(City.Town,district,,municipal housing authority,owner-occupied residential of four units or less)7 as O no Sticker I(from front of form): 1 J J y i TOP OF FOUNDATION COVERS TO BE WATERTIGHT AND BROUGHT TO WITHIN 6" OF FINAL GRADE SEPTIC SYSTEM PROFILE EL. 100.0' EL. 99.0't NOT TO SCALE �� Flaherty Environmental Services INSP. PORT W I 3 OF GRADE P.O. BOX 89 2" PEASTONE OR EL.98.0'f CLEAN SAND Yarmouth Port, MA 02675 I.LLU �=/4" CAST IRON or EQUIVALENT GEOTEXTILE 774.994. 966 MIN. PITCH 1 4" PER FOOT — FILTER FABRIC 1 VENT (IF REQUIRED) 4"SCHEDULE 40 PVC PIPE �� ••• • ' ;, ••. • • � . 4 SCHEDULE 40 PVC PIPE FLOW LINE (frrst2'tobe/eve0 " 30' 6% 5 1% 999WEL.92.5' .1' EL.97.7" 14" EL.97.0' A EL.96.5' —� —"� EL 94.7' EL.94.53' _ GAS BAFFLE EL.94.5' 10' 2.5%MIN. H-20 DBOX CLEAN,DOUBLE- SOIL ABSORPTION SYSTEM • WASHED "To 1 STONE (2) TRENCHES 3'W X 331 X 2'D USING 6"CRUSHED STONE OR 5 0' MECHANICALLY COMPACTED PERFORATED PIPE AND SURROUNDED BY DOUBLE-WASHED J" TO 1 2"STONE , (DATUM: ASSUMED) 1500 GALLON SEPTIC TANK EL. 87.5 (PROPOSED) 98 BOTTOM OF TEST HOLE EL. 87.5't USGS ADJUSTMENT: N/A LOCATIONMAP LOT 1 GROUNDWATER ELEV: N/A t ZM732 0,5 ACRES± N TH Y BENCHMARK: J p0 TOP OF FNDN 1 EL, 100.0' 111 35,4L99 O �� CP NTS EXISTING DWELBLING 42,6' �'(N OFkq D I \ Cc^ \ G TH-1. 'VIP \ GARAGE !� \ �3t�` S T 0" rH-2 39. Epp' SgNIT R\ N \ ' 2016 DATE:1 113 0/ REVISED: Z 9s SITE AND SEWAGE PLAN FOR 99 B & B EXCAVATION INC./ 52A� JOHN F. FAY 595 PHINNEY'S LANE ® SCALE : 1 �� = 30� CENTERVILLE F�R� BOA (BARNSTABLE), MA OL O REF.-PB 237 PG 117 PAGE 1 OF2 F ............. . ..... ...................................................................................................... ....................................................................... GENERAL NOTES DESIGN CAL CULA TIONS S YS TEM DETAIL Flaherty Environmental Services P. 0. Box 81 1. ALL PRECAST COMPONENTS TO BE H-1 0 Yarmouth Port, MA 02675 RATED. ALL COMPONENTS WITH ANY NUMBER OFACTUAL BEDROOMS 2(DESIGN FOR 3) 774.994.1166 ANTICIPATED VEHICULAR TRAFFIC TO BE OBS, PORT GARBAGE DISPOSAL UNIT NO H-20 RATED. 3/ 2. THE DESIGN OF THIS SYSTEM DOES NOT TOTAL ES TIMA TED FLOW ALLOW FOR THE USE OF GARBAGE (I 10 GA LIBRIDA Y X 3 BR) 330 GAL./DAY GRINDER. 7-- 61 RESERVE RVE 3. MUNICIPAL WATER IS AVAILABLE. REQUIRED SEPTIC TANK CAPACITY 660 GAL. 00% 4. ALL CONSTRUCTION TO CONFORM WITH 310 CMR 15.000 AND ALL OTHER SIZE OF SEPTIC TANK 1500 GAL. (PROPOSED) H-20 DBOX APPLICABLE LOCAL, STATE AND FEDERAL ar CODES AND REGULATIONS. SOIL CLASSIFICATION 5. INSTALLER/CONTRACTOR TO REVIEW& DESIGN PERCOLATION RATE <2 MIN./INCH VERIFY ALL ELEVATIONS AND DETAILS 33' AND REPORT ANY DISCREPANCIES TO EFFLUENT LOADING RATE 0.74 GALADAYIFT2 DESIGNER PRIOR TO CONSTRUCTION OR ---------------- ASSUME ALL RESPONSIBILITY, LEACHING AREA 6. INSTALLER/CONTRACTOR IS BOTTOM.- (3'X33)X2= 198 FT2 9' .MIN. OF SOIL RESPONSIBLE FOR MAINTAINING SAFE SIDES: 2' PEASTONE OR FILTER FABRIC—� WORK AREA, VERIFYING ALL UTILITIES .[(2'X33)X2 (2'X3)X2]X2 288 F7- AND NOTIFYING "DIG SAFE" TOTAL= 486 FT2 (1-888-344-7233) 72 HOURS PRIOR TO X0.74= 359 GAUDA Y 1 CONSTRUCTION. 2 7, ANY CHANGES TO OR DEVIATIONS FROM USE(2)TRENCHES OF PERFORATED PIPE SURROUNDED BY" j THIS PLAN MUST BE APPROVED IN j"TO I J"STONE,EACH TRENCH CONFIGURED AS WRITING BY FLAHERTY ENVIRONMENTAL XWIDE X 33'LONG AND 2'DEEP 3' SERVICES AND LOCAL BOARD OF HEALTH. RESERVE LEACHING CAPACITY 359 GAUDA Y 8. FINISH COVER OVER COMPONENTS IS NOT TO EXCEED 3'PER 310 CMR 15.000— TRENCH END VIEW (N TS) UNLESS SHOWN PER PLAN 9. ALL ABANDONED SEPTIC SYSTEM COMPONENTS TO BE PUMPED DRY AND FILLED WITH CLEAN SAND OR REMOVED SOIL EVAL UA TION AND REPLACED WITH CLEAN SAND. TESTHOLE#1 P#.-15210 TEST HOL E#2 P*15210 H OF U4 10.ALL COMPONENTS TO BE PROVIDED Evaluator., David D.Flaherty Jr,RS,REHS Evaluator: - David D.Flaherty Jr.,RS,REHS WITH WATERTIGHT ACCESS PORTS SE#2755 SE#2755 SOH Witness. David Stanton,RS BOH Witness David Stanton,RS WITHIN 6"OF FINISH GRADE. Date: Novemeber22,2016 Date, Novemeber22,2016 11.ALL SEPTIC TANKS, DISTRIBUTION H 3 rn BOXES AND PIPING TO BE INSTALLED TH-1 ELEV.98.0' TH-1 ELEV.98.0' N 2 1 WA TER TIGHT. GIST Rk 12.NO KNOWN WETLANDS OR WELLS 0"-14" FILL 0"-14" FILL TA IPN WITHIN 100 FEET OF PROPOSED 14"-22' A LS IOYR312 14"-22" A LS 10YR 312 LEACHING. 13.THIS IS NOT CERTIFIED PLOT PLAN 22"-33" B LS I0YR516 22"-33' 8 LS I0YR516 AND UNDER NO CIRCUMSTANCES IS THIS PLAN TO BE USED FOR ZONING OR 33"-61' C1 SL JoyR 616 F7/' 33"-61" C1 SL 10YR 616 BUILDING PURPOSES. pert 14.LOT IS SHOWN AS ASSESSOR'S MAP 250 "I certify that on November 12,2002,1 have passed SITE AND SEWAGE PLAN FOR PARCEL 48. the examination approved by the Department of B & B EXCAVATION INC./ 15. LOCUS PROPERTY'S PROPOSED SYSTEM 61'-1201 C2 MS 2.5Y614 Environmental Protection and that the above analysis JOHN F. FAY 61 126" C2 MS 2.5Y 614 has been performed by me consistent with the APPEARS TO BE WITHIN AN AQUIFER r required training,expertise,and experience described595 PHINNEYS LANE PROTECTION DISTRICT(ZONE 11). G.W.ELEV.NIA G.W.ELEV.NIA In 310 CMR 156 018(2).^ CENTERVILLE BOTTOM TH-I EL EV. 87.5' BOTTOM TH,2ELEV. 88.0'1 (BARNSTABLE), MA PAGE 2 OF 2 .................................................................................. .......... .................. ........................................................................................................................................................................... .................. ............................... ...................................................................................... .................... ............... ............. ................................................................................................................