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HomeMy WebLinkAbout0078 ZENO CROCKER ROAD - Health 78 ZENO CROCKER, CENTERVILLE A=170.107 UPC 12543 No,53LOR HASTINGS, 4:IN UI \ fD SL4(� I Town of Barnstable sasxsrASM Department of Health, Safety, and Environmental Services _ - Public Health Division 367 Main Street, Hyannis MA 02601 Office: 508-790-6265 Thomas A.McKean,RS,CHO FAX: 508-790-6304 Director of Public Health TO: Bruce Fisher 1 Loon Way, Westford, MA 01886 DATE: November 19, 1998 ORDER TO COMPLY WITH 310 CMR 15.00, THE STATE ENVIRONMENTAL CODE, TITLE 5. The septic system owned by you located at 78 Zeno Crocker Road, Centerville, was inspected on September 29, 1998, by John Graci, a Massachusetts licensed septic inspector. The inspection of your septic system showed that your system has failed under the guidelines of 1995 TITLE 5 (310 CMR 15.00) due to the following: • The liquid level was above the invert of the leaching pit. You are ordered to bring the septic system into compliance within two (2) years of the date of discovery. Therefore, the construction of replacement septic system component(s) must be completed on or before September 29, 2000, First, you must hire a licensed Town of Barnstable septic system installer to submit a sketch diagram of proposed replacement septic system component(s) to the Town' of Barnstable Public Health Division Office (Town Hall, 367 Main Street, Hyannis) that will bring the septic system into compliance with 310 CMR 15.00, The State Environmental Code, Title 5. In the meantime, you shall ensure that no raw sewage discharges onto the surface of the ground or into any surface waters. You must maintain the system by hiring a licensed septage hauler to pump the septic system whenever it is necessary. Any person aggrieved by any order issued by the local approval authority may appeal to any court of competent jurisdiction as provided for by the laws of the Commonwealth. P ORDER Q THE BOARD OF HEALTH M/cK�ean—R.S., C.H.O. Agent of the Board of Health gV¢althWbfiatillcS.doc - t SENDER: i v ■Complete items 1 and/or 2 for additional services. I also wish to receive the H ■Complete items 3,4a,and 4b. following services(for an d y ■Print your name and address on the reverse of this form so that we can return this extra fee): Q .. card to you. ai Q d permit.NAttach this form to the front of the mailpiece,or on the back if space does not 1, ❑ Addressee's Address ■Write'Retum Receipt Re uested'on the mail piece below the article number.` � p q p' 2. ❑ Restricted Delivery � q « ■The Return Receipt will show to whom the article was delivered and the date a delivered. Consult postmaster for fee. c d 3.Article Addressed to: 4a.Article Number i Z-. 3(l1' 6 S 'U C i cu �r�� 4b.Service Type u ❑ Registered Certified W y CO ❑ Express Mail ❑ Insured ¢ i1R3jet6mfiReceipt for Merchandise ❑ COD p 7.Date of=pelivery 20 5.Received By:(Print Name) ;S. ddress`ee's Address(Only if requested ✓/`/and fees paid) LU g 6.Signatu94A ressee=Aent) �r i p Lam' o CC Ps Form 3811, Decembe 1994: F Domestic Return Receipt I UNITED STATES POSTAL SERVICE First-class Mail I Postage&Fees Paid N USPS Permit No.G-10 I • Print your name, address, and ZIP Code in this box • Public Health Division Town of Bamstable PO Box 534 Hyannis,Massachusetts 0260' Fax(508)775-3344 Phone (508)790-6265 I I I Z 348 659 - 8Q4 Receipt for Certified Mail No Insurance Coverage 14ovided MrTEU STATES Do not use for International Mail O'OST,LL SERVILE (See Reverse) om Street al M. P. tare a d ZI Add C Postage Cl) E Certified Fee O V' Special Delivery Fee d R S1t1ct4d1Detiuer11Fee' Ffetuffi Filydeip['Stfo'vvirigl to Whom&Date Delivered Return Receipt Showing to Whom, Date,and Addressee's Address TOTAL Postage &Fees G Postmark or Date STICK POSTAGE STAMPS TO ARTICLE TO COVER FIRST CLASS POSTAGE, CERTIFIED MAIL FEE,AND CHARGES FOR ANY SELECTED OPTIONAL SERVICES(see front). m 1. If you want this receipt postmarked,stick the gummed stub to the right of the return a�i rhess- leaving the receipt attached and present the article at a post office service window or hand it to your rural carrier(no extra charge). 2. If you do not want this receipt postmarked,stick the gummed stub to the right of the return rn address of the article,date,detach and retain the receipt,and mail the article. 0) l t 3. If you want a return receipt,write the certified mail number and your name and address on a return receipt card,Form 3811,and attach it to the front of the article by means of the gummed (a I! ends if space permits.Otherwise,affix to back of article.Endorse front of article RETURN RECEIPT REQUESTED adjacent to the number. Go 4. If you want delivery restricted to the addressee,or to an authorized agent of the addressee, M endorse RESTRICTED DELIVERY on the front of the article. E 5. Enter fees for the services requested in the appropriate spaces on the front of this receipt.If tiN return receipt is requested,check the applicable blocks in item 1 of Form 3811. d 6. Save this receipt and present it if you make inquiry. 105603-93-B-0218 i .� � Town of Barnstable �- Department of Health, Safety, and Environmental Services sa�ttvsrns�.�, ,. Public Health Division 367 Main Street, Hyannis MA 02601 Office: 508-790-6265 Thomas A.McKean,RS,CHO FAX: 508-790-6304 Director of Public Health TO: X r u C2 DATE: Aiw 1 S, I. e 5_y �— �I �8Q�' ORDER TO COMPLY WITH 310 CMR 15.00, THE STATE ENVIRONMENTAL CODE, TITLE 5. nn The septic system owned by you located at--7<3 `l G-O �� At'—J C"--t"(6. was inspected on - z�� �g , by__ " J„ Goo C1 a Massachusetts licensed septic inspector. The inspection of your septic system showed that your system has failed under the guidelines off11995 TITLE 5 (310 CMR 15.00) due to the following: L A- You are ordered to bring the septic system into compliance within two (2) years of the date of discovery. Therefore, the construction of replacement septic system component(s) must be completed on or before- First, you must hire a licensed Town of Barnstable septic system installer to submit a sketch diagram of proposed replacement septic system component(s) to the Town of Barnstable Public Health Division Office (Town Hall, 367 Main Street, Hyannis) that will bring the septic system into compliance with 310 CMR 15.00, The State Environmental Code, Title 5. In the meantime, you shall ensure that no raw sewage discharges onto the surface of the ground or into any surface waters. You must maintain the system by hiring a licensed septage hauler to pump the septic system whenever it is necessary. Any person aggrieved by any order issued by the local approval authority may appeal to any court of competent jurisdiction as provided for by the laws of the Commonwealth. PER ORDER OF THE BOARD OF HEALTH Thomas A. McKean, R.S., C.H.O. Agent of the Board of Health gVxelNWbf ila4itle3 i.da g & 1(T OWN OF BARNST LE LOCATION SEWAGE # VILLAGE CLLtm(�— ASSESSOR'S MAP & LOT00 NA 0C INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY n /coo LEACHING FACILITY: (type) I�� (size) NO.OF BEDROOMS BUILDER OR OWNER PERMUDATE: 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 Gau" C 6 9V v�:3o cc 3K f C. Coinnionwealth of Massachusetts Executive Office of Envirommental Affairs Dept. of Environmental Protection One winter Street Boston Ma. 02108 .titlpti ` D.E.P. Titlee Se V Septic Inspector P.O. Box 2119 Teaticket, WILLIAM F.WELD (508 9 Governor ^ �fo ARGEO PAUL CELLUCCI L�w Lt.Governor Q0 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM NOPART A CERTIFICATION 3to 1998 ,_;4%6 N ite Property Address: 78 2ENO CROCKER RD.CENTEVILLE MAP 170 PAR 107 LOT 6361ress of Owner: Date of Inspection: 9/7/98 (If different) Name of Inspector: JOHN GRACI BRUCE FISHER:1 LOON WAY WESTFORD MA.0 8 '` 1 am a DEP approved system inspector pursuant to Section 15.340 of Title%(310 CMR 15.000) �r Company Name,Address and Telephone Number: 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: _ Passes This Inspection Is based on criteria defined In Title V _ Condition IIy asses code 310CMR16.303.Myfindingsareof how the system is performing at the time of the inspection.My Inspection does _ Needs F rt r Evaluation By the Local Approving Authority not Imply any warranty or guarantee of the longevity ofthe x Fails septic system and any of Its components useful life. Inspector's Signature: % Date: 9129198 The System Inspector shall submit a copy of this inspection report to the Approving Authority within thirty(30)days of completing this inspections. 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: I have not found any information which indicates that the system violates any of the failure criteria defined as in 310 CMR 15.303. Any failure criteria not evaluated are indicated below. COMMENTS: B] SYSTEM CONDITIONALLY PASSES: One or more system components need to be replaced or repaired. The system,upon completion of the replacement or repair,passes inspection. Indicate yes,no, or not determined(Y, N, or ND). Describe basis of determination in all instances. If "not determined",explain why not. The septic tank is metal, unless the owner or operator has provided the system inspector with a copy of a Certificate of C07hpliance(attached)indicating that the tank was installed within twenty(20)years prior to the date of the inspection, or the septic tank,whether or not metal, is cracked, structurally unsound, shows substantial infiltration or exfiltration, or tank failure is imminent.The system will pass inspection if the existing septic tank is replaced with a conforming septic tank as approved by the Board of Health. (revised 04177)971 One Winter Street • Boston,Massachusetts 02108 • FAX(617)556-1049 • Telephone(617)292-5500 f SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 78 ZENO CROCKER RD.CENTEVILLE MAP 170 PAR 107 LOT 636 Owner: BRUCE FISHER:1 LOON WAY WESTFORD MA.01886 Date of Inspection:917198 — Sewage backup or,breakout or hioh.static water level observed.in.the distribution box is due to a broken. or obstructed pipe(s)or due to broken,settled or uneven distribution box.The system will pass inspection if (with approval of the Board of Health). Describe observations: broken pipe(s)are replaced obstruction is removed distribution box is leveled 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 system has a septic tank and soil absorption system and is within 100 feet to a surface of water supply or tributary to a surface water supply. The system has a septic tank and soil absorption system and is within a Zone 1 of a public watersupply 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 the SAS is less than 100 feet but 50 feet or more from a private water supply well, unless a well water analysis for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presense of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm. Method usedto determine distance (approximation not valid) 3)Other D] SYSTEM FAILS: You must Indicate either"Yes"or"No"as to each of the following: X 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. Yes No _X_ Backup of sewage in facility or system component due to an overloaded or clogged SAS or cesspool. _X__,_ Discharge or ponding of effluent to t11e s41rfa5?0f 111e gr01llld or surNrt7 waters dtle 10 dll 0%mi"l0dde-d 0r clogy@d cesspool. x_ — SAS is in hydraulic failure. (revised 04127)97) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 78 ZENO CROCKER RD.CENTEVILLE MAP 170 PAR 107 LOT 636 Owner: BRUCE FISHER:1 LOON WAY WESTFORD MA.01886 Date of Inspection:917198 D] SYSTEM FAILS(continued) Yes No X Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool. X Liquid depth in cesspool is less than 6"below invert or available volume is less than 1/2 day flow. X Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Numbers of times pumped x Any portion of the Soil Absorption System,cesspool or privy is below the high groundwater elevation. —X. Any portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. X Any portion of a cesspool or privy is within a Zone 1 of a public well. —X- Any portion of a cesspool or privy is within 50 feet of a private water supply well. X 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. E] LARGE SYSTEM FAILS: You must indicate either"Yes"or"No"as to each of the following: The following criteria apply to large systems in addition to the criteria: The system serves a facility with a design flow of 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: Yes No X the system is within 400 feet of a surface drinking water supply X the system is within 200 feet of a tributary to a surface drinking water supply _ x 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) 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 04127)97) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECLIST Property Address: 78 ZENO CROCKER RD.CENTEVILLE MAP 170 PAR 107 LOT 636 Owner: BRUCE FISHER:1 LOON WAY WESTFORD MA.01886 Date of Inspection:917198 Check if the following have been done:You must indicate either"Yes"or"No"as to each of the following: _c_ — Pumping information was requested of the owner, occupant,and Board of Health. x None of the system components have been pumped for at least two weeks and the 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. x As built plans have been obtained and examined. Note if they are not available with N/A. x — The facility or dwelling was inspected for signs of sewage back-up. x — The system does not receive non-sanitary or industrial waste flow. _c_ — The site was inspected for signs of breakout. x All system components, excluding the Soil Absorption System,have been located on the site. x 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. x The size and location of the Soil Absorption System on the site has been determined based on The facility owner(and occupants, ff different from owner)were provided with information on the proper maintenance of Sub-Surface Disposal Systens. x Existing information. Ex. Plan at B.O.H. x Determined in the field(if any failure criteria related to Part C is at issue, approximation of distance is unacceptable)[15.302(3)(b)] (revised 0427)97) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 78 ZENO CROCKER RD.CENTEVILLE MAP 170 PAR 107 LOT 636 Owner: BRUCE FISHER:1 LOON WAY WESTFORD MA 01886 Date of Inspection:9/7198 FLOW CONDITIONS RESIDENTIAL: Design flow: 33o g•p•d./bedroom for S.A.S. Number of bedrooms: 3 Number of current residents: 6 Garbage grinder(yes or no): No Laundry connected to system(yes or no): Yes Seasonal use(yes or no): No Water meter readings, if available:(last two(2)year usage(gpd): rda Sump Pump(yes or no): No Last date of occupancy: nla COMMERCIAL/INDUSTRIAL: Type of establishment: nla Design flow:0 gallons/day Grease trap present: (yes or no) No Industrial Waste Holding Tank present:(yes or no) No Non-sanitary waste discharged to the Title 5 system:(yes or no) No Water meter readings, if available: nla Last date of occupancy: nra OTHER:(Describe) rda Last date of occupancy: GENERAL INFORMATION PUMPING RECORDS and source of information: Na System pumped as part of inspection: (yes or no)No If yes,volume pumped:0 gallons Reason for pumping: rda TYPE OF SYSTEM x Septic tank/distribution box/soil absorptions system Single cesspool Overflow cesspool Privy Shared system(yes or no) ( if yes, attach previous inspection records, if any) I/A Technology etc.Copy of up to date contract? Other: APPROXIMATE AGE of all components, date installed(if known)and source information: SYSTEM IS 13 YEARS OLD. Sewage odors detected when arriving at the site: (yes or no) No (revised 04127197) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 78 ZENO CROCKER RD.CENTEVILLE MAP 170 PAR 107 LOT 636 Owner: BRUCE FISHER:1 LOON WAY WESTFORD MA.01886 Date of Inspection:917198 SEPTIC TANK: x (locate on site plan) Depth below grade: 4" Material of construction:x concreate metal FRP Polyethylene_other(explaln) If tank is metal, list age pia . Is age confirmed by Certificate of Compliance No (Yes/No) Dimensions: Le'6"He•7^w4'10^ Sludge depth:4" Distance from top of sludge to bottom of outlet tee or baffle: 30" Scum thickness:1" Distance from top of scum to top of outlet tee or baffle:OVER Distance form bottom of scum to bottom of outlet tee or baffle: rda How dimensions were determined: MEASURED Comments: (recommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity, evidence of leakage, etc.) SEPTIC TANK AND ALL COMPONENTS ARE STRUCTURALLY SOUND.RECOMMEND PUMPING NOW AND THEN MAINTAINED EVERYTWO YEARS. GREASE TRAP: (locate on site plan) Depth below grade: rda Material of construction: concrete metal FRP Polyethylene_other(explaln) Dimensions: rda Scum thickness:rda Distance from top of scum to top of outlet tee or baffle:rda Distance from bottom of scum to bottom of outlet tee or baffle:rda Date of last pumpingiila Comments: (recommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity, evidence of leakage, etc.) rda BUILDING SEWER: (Locate on site plan) Depth below grade: 1, Material of construction:_cast iron x 40 PVC_other(explain) Distance from private water supply well or suction llne:TOWN Diameter: Me (Tve,mments: (conditions of joints,venting, evidence of leakage, etc.) (revised 04127191) i SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 78 ZENO CROCKER RD.CENTEVILLE MAP 170 PAR 107 LOT 536 Owner: BRUCE FISHER:1 LOON WAY WESTFORD MA.01886 Date of Inspection:917198 TIGHT OR HOLDING TANK: (locate on site plan) Depth below grade: rda Material of construction: concrete metal FRP Polyethylene_other(explain) Dimensions: We Capacity: We gallons Design flow: rda gallons/day Alarm level:_nra Alarm in working order?_Yes_No Date of previous pumping: Comments: (condition of inlet tee,condition of alarm and float switches,etc.) rda DISTRIBUTION BOX: (locate on site plan) Depth of liquid level above outlet invert: nIa Comments: (note if level and distribution is equal, evidence of solids carryover, evidence of leakage into or out of box etc.) rda PUMP CHAMBER: (locate on site plan) Pumps in working order:(yes or no)No Alarms in working order(yes or no)_Yes Comments: (note condition of pump chamber, condition of pumps and appurtenances, etc.) rda (revised 04127)97) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 78 ZENO CROCKER RD.CENTEVILLE MAP 170 PAR 107 LOT 636 Owner: BRUCE FISHER:1 LOON WAY WESTFORD MA.01886 Date of Inspection:9J7198 SOIL ABSORPTION SYSTEM (SAS):x (locate on site plan, if possible;excavation not required,but may be approximated by non-intrusive methods) If not determined to be present,explain: rda Type: leaching pits, number: oNELEACHPIT leaching chambers,number:nla leaching galleries,number: nla leaching trenches, number,length: rda leaching fields, number,dimensions:rda overflow cesspool,number:nla Alternate system: rda Name of Technology:_rda Comments: (note condition of soil, signs of hydraulic failure,level of ponding, condition of vegetation, etc.) THE LEACH PIT IS PAST THE EFFECTIVE DEPTH OF LEACHING,LIQUID LEVEL WAS OVER INVERT,PIT IS IN HYDRAULIC FAILURE. CESSPOOLS: (locate on site plan) Number and configuration: n/a Depth-top of liquid to inlet invert: nla Depth of solids layer: rda Depth of scum layer: rva Dimensions of cesspool: nla Materials of construction: nla Indication of groundwater: rda inflow(cesspool must be pumped as part of inspection) rda Comments: (note condition of soil, signs of hydraulic failure,level of ponding, condition of vegetation, etc.) Na PRIVY: (locate on site plan) Materials of construction: rda Dimensions: rda Depth of solids: rda Comments: (note condition of soil, signs of hydraulic failure,level of ponding, condition of vegetation, etc.) Na (revised 04r17)97) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) 78 ZENO CROCKER RD.CENTEVILLE MAP 170 PAR 107 LOT 636 BRUCE FISHER:1 LOON WAY WESTFORD NIA.01886 W7198 SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent references, landmarks or benchmarks locate all wells within 100' (Locate where public water supply comes into house) C 3 � Lid 3u (revised 04127197) Ply t of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) 78 ZENO CROCKER RD.CENTEVILLE MAP 170 PAR 107 LOT 636 BRUCE FISHER:1 LOON WAY WESTFORD MA.01886 917198 Depth of groundwater 12 Please indicate all the methods used to determine High Groundwater Elevation: Obtained from design plans on record. Observation of Site(Abutting property, observation hole, basement sump etc.) Determine it from local conditions Check with local Board of Health Check FEMA Maps Check pumping records Check local excavators, installers X Use USGS Data Describe in your own words how you established the High Groundwater Elevation.(MUST be completed) USGS MAPS AND CHARTS I (revlsed04)27197) rage 10 of 10 _ No. - Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS 0(pprication for 30i_qpogar 6potemc Construction Permit Application for a Permit to Construct( )Repair(✓)Upgrade( )Abandon(' ) ❑Complete System Vllt hvidual Components Location Address or Lot No.7r 'pD G� .+ Owner's^Name,Address Tel.No. Assessor's Map/Parcel !of- rill e_ 9i 11G /9s1el- Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. -1413 Type of Building: Dwelling No.of Bedrooms ,3 Lot Size sq. ft. Garbage Grinder Other Type of Building ,Qe-SI Pitice No. of Persons Showers( ) Cafeteria( ) Other Fixtures • Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title _ Size of Septic Tank / dOd ill .4/r/=S,"1;f Type of S.A.S. a �� /��1eX*4a1-,S Description of Soil Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued b this Signed A Date Application Approved by Date Application Disapproved for the following reasons Permit No. Date Issued No. 170 Fee � THE COMMONWE OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE;MASSACHUSETTS 2pprication for &9;pogal 60tem Construction Permit Application for a Permit to Construct( )Repair(✓)Upgrade( )Abandon( ) El Complete System k�vidual Components Location Address or Lot No. Owner's Name,Address Tel.No. Map/Parcel Assessor's Ma Installer's Name,Address,and Tel.No. wr 1 Designer's Name,Address and Tel.No. 7 ZZ_ WY Type of Building: 2 Dwelling No.of Bedrooms J Lot Size sq.ft. Garbage Grinder Other Type of Building A''5,1 eece No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow �/1) gallons per day. Calculated daily flow 330 gallons. Plan Date Number of sheets Revision Date Title - Size of Septic Tank / add' jr,0 ,�.�1"/ST/�+y Type of S.A.S. c� 0 /��yO�`�='�S lfi9y� S Description of Soil Nature of Repairs or Alterations(Answer when applicable) �/�`/ �6� ✓rE"�p�� LP ��'� Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system i 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 b this o. o e th Signed Date Application Approved by - Date 0,2fZ,17,1Rr _ • k Application Disapproved for the following reasons Permit No. l ' 7yY Date Issued ' THE COMMONWEALTH OF MASSACHUSETTS, A BARNSTABLE, MASSACHUSETTS (Certificate of Compliance THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed( )Repaired(✓ )Upgraded( ) Abandoned( )by at efO vOC- Ge A-5I/V 7�s )been constructed in accordance 9 with the provisions of Title 5 and the for Disposal System Construction Permit No. 7- / dated 11-17" . Installer Designer / r The issuance of this permi.Ahalll not be co strued as a guarantee that the systtam will function as designed. Date 1 �l Inspector J' � � I �`- 611-19 7y� -------------------��—`6® ) No. h Fee � �-. d THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS Migogar *pMem Con! truction Permit Permission is hereby granted to Construct( )Repair(t/)Upgrade( )Abandon( ) System located at 7 1- '7,eAla G Yd y ee,,�p7`ere-11/e and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided: Constructio must be completed within three years of the date of this / , Date: 7 /�Z Approved by 1019/97 NOTICE: This Form Is To Be_,Used For the Repair Of Failed Septic Systems Only: CERTIFICATION OF SKETCH AND APPLICATION FOR A DISPOSAL WORKS CONSTRUCTION PERMIT (WITHOUT ENGINEERED PLANS) 1, �p G/'�� &0 ///-i , hereby certify that the application for disposal works construction permit signed by me dated /��//� , concerning the property located at end elee4f/ �Gr' G�'N ���/`meets all of the following criteria: i/ ere are no wetlands located within 100 feet of the proposed leaching facility ;/T'bhere are no rivate wells within 150 feet of the ro osed se tics stem P proposed P Y ere is no increase in flow and/or change in use proposed needed. �Pnere��Ir the proposed leaching facility will be located within 250 feet of any wetlands, the bottom of the proposed leaching facility will=be located less than fourteen (14) feet above the maximum adjusted groundwater table elevation. Please complete the following: A)Top of Ground Elevation (according to the Engineering Division G.I.S. map) �� B) Observed Groundwater Table Elevation (according to Health Division well map) SIGNED : DATE: LICENSED SEPTIC SYSTEM INSTALLER IN THE TOWN OF BARNSTABLE NUMBER (Attach a sketch plan of the proposed system.Also if the licensed installer posesses a certified plot plan, this plan should be submitted]. q:health folder.ccrt A a� � > cV 1 4q I VI a ��.� ►U TOWN OF BARNSTABLE • CfL� LOCATION �� Z��© lGra��er SEWAGE VILLAGE C e 7 ��jll�' ffASSESSOR'S MAP&c LOT INSTALLER'S NAME&PHONE NO. Af rc-,7 COS-5 7 7/` SEPTIC TANK CAPACITY LEACHING FACILITY: (type) L•�'�l�f�/,,-j �S!�(size) �o NO.OF BEDROOMS BUILDER O (� R/ J fZ �h PERMITDATE. I117/9� 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 l— Ll g1.f 1b 0 TOWN OF BARNSTABLE �Ci• L',LP LOCATI �' LL!® GI®l' SEWAGE# 0 7�7 V i;AGE Cep�rLl//1� /A_SSESSOR'S MAP & LOT �7O��a INSTALLER'S NAME&PHONE NO. GAvn�- 7 7/` SEPTIC TANK CAPACITY �iOli� �tiL LEACHING FACILITY: (type) z.�,�l,�, nT __(size) i®� NO.OF BEDROOMS 3 BUILDER OCl/ Rl ��— e•- PERMIT DATE: /�7 �� 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 Feet on site or within 200 feet of leaching facility) j// Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by �a`by t r37 L01CAT10N IU SEWAGE PERMIT NO. \ Y" LLAGE 0 Ge,A)ILL V ll� \ INSTALLER'S NAM1E i ADDRESS B U I L D E R OR OWN ER b DATE PERMIT ISSUED DAT E COMPLIANCE ISSUED . SJ •q _ 7.0-t3 No..... FRic..... THE COMMONWEALTH OF MAS CHUSETTS BOARD OF HE , TH _ __JS�A _r -2,C,6" ....................................................OF.........-....;;i Af- Appfiratiou for, Dhipuiial Workii Totwtrurtiott Prrutit Application is hereby made for a Permit to Construct or Repair an Individual Sewage Disposal System at: ............ ... ...... ........................... Location-Address & No. .....vi ;7 . ... .... .. . .................... S.S. 0 V' ea.e. _'. 4 , ................ .................... 7' Installer Address Type of Building Size Lot...U6,, f.!a....Sq. feet Dwelling—No. of Bedrooms....... ................................Expansion Attic Garbage Grinder (/YP aOther—Type of Building ............................ No. of persons____________.______.__-_.___ Showers Cafeteria P4Other fixtures ...................................................................................................................................................... Design Flow............2�5�. .......................gallons per person per day. Total daily flow......... ..................gallons. Ix Septic Tank—Liquid'capacit,v.)-0!00._gallons Length..6.v.TP... Width________________ Diameter._..._.____.____ Depth__._________.._. Disposal Trench—No_.................... Wlid h................... Total Length_.__...__._.._.;.___Total otal leaching area Sq. f t. Seepage Pit No. iameter....VV_---- Depth below inlet.....jf3...... Total leaching area__ .....sq. f t. ------I-------- Y Z Other",Distribution box Dosin tank V .,ao P _ .'V Date....ljq� ercoLion'Test Results Performed by .................. 1.4 f Test Pit No. I...-5'—.?—..minutes per inch Depth of Test -tit------- 1r..!.... Depth to ground water........................ 'rest Pit No. 2................minutes per inch Depth of Test Pit._.__._...__________ Depth to ground water.._.___.._.._._.______.. ------------------------------------------------....... ----------:;Wl............................ -- ---------------------*...... 0 Description of Soil................... 0_-Z1 �, ------ .......f...........1-Ti .- 9�`. '15 :: PA.U. U .......... --------------------------------------------- ....UL,�.v.................................................................. W x ....................................................................................................................................................................................................... U Nature,of Repairs or Alterations—Answer when applicable............................................................. . ................................. ......................................................................................................................................................................Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TL I'�U 5 of the State Sanitary Code— Th undersigned further agrees not to place the ystem in u operation until a Certificate of Compliance has b led b t oard of health. /Iacetne.., Compliance has Abis uKe ig J Signe .. ....................................... ...... . .... .... e �S Apx� By.._.. .... ... ..... . - . <9 C ............................................ ......... .. A- ...... ....T*ZL ate 'o . 7 Application Disapproved for the o lowing reasons:................................................................................................................ ........................................................................................................................................................................................................ I Date PermitNo--------------------------------------------------------- Issued....................................................... Date No..........s .... Firm; ...J_ 5 r THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH Application is hereby made for a Permit to Construct ( or Repair ( ) an Individual Sewage Disposal System at: ........:.........: ............ :...... ��......... �� 17: ...►JT:�'�Z.�i_......-� ......------......--------- Location Address or Lot No ... _ Installer Address UType of Building Size Lot_.__�. ,!®.�.d_..Sq. feet Dwelling—No. of Bedrooms....... �...............................Expansion Attic ( ) Garbage Grinder ( / WOther—Type of Building ............................ No. of persons............_............... Showers ( ) — Cafeteria ( ) Otherfixtures .............•- -•----•------------•--••-•-•-------------------------------•-----•-------.......------------------. W Design Flow.............. . gallons per person per day. Total daily flow-._----.-.-`� _© g �-r�------------�._..----g P P P rn Y� Y -- -•-.................l�lons. WSeptic Tank—Liquid-capacity.. 0gallons Length... __._._ Width................ Diameter................ Depth....__..._...... x Disposal Trench—No.^.................... Width..................:. Total Length._............. I Total leaching area----- __.. sq. ft. Seepage Pit No---------t_'__ ...... Diameter...... Depth below inlet....... ..... Total leaching area... __sq. ft. Z Other Distribution box ( Dosing tank ( ) ~' Percolation Test Results Performed by..QkL►AZ.�.V-4. f S.UG{!_________________ Date..... ,� / ... Test Pit No. 1.....4:-2-.minutes per inch Depth of Test Pit.........-.1_.__. Depth to ground water-------------....... 0:4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ ----------------------------------- --------•------- ---------------------------------•---•--------•-••-------- ..... - O Description of Soil---------- d -' Z r . - `�.c `a. ! 2. -- ....�/�...).i -- � j w VNature of Repairs or Alterations—Answer when applicable.................................................................... _._.__................... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Sanitary Code— The Andersigned further agrees not to place the s stem in operation until a Certificate of Compliance has ben, s-ed.by bard of health..,,.. Si ne ------------- ----.._.....C-:...:.. Da Application Approved BY .4 D to Application Disapproved for the f 1 owing reasons-----------------------••-----•-------------------------------•-----------------•-------------- -------•-------- .. ...................................................-•-•-----------------------•-------------•----------•--•------------- ---------------- Date PermitNo......................................................... Issued........................................................ Date THE COMMONWEALTH OF MASSACHUSETTS BOARD ;OF HEALTH l ..........................................OF.........?- % 1 � ! A ................................ Trrt faratr of Toutpliatta THIS IS TORTIFY, That the Individual Sewage Disposal System constructed ( �,.6r Repaired ( ) Installer at......Jea� hz3.6. /` = == '`' p--------- .. = !�.1. has been installed in accordance with the provisions of TITLE 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No......... .......... dated...... _-_6..' 5................... THE ISSUANCE OF THIS CERTIFICATE SHALT. NOT BE CONSTRUE® AS A GUARANTEE THAT THE .SYSTEM WILL FUNCTION SATISFACTORY. DATE............. --__f..---35•--•---------•••---..._..---•-•--••---•-- Inspector........ --- ---&_"j�V.\............................... THE COMMONWEALTH OF MASSACHUSETTS . BOARD F HEALTH , No..... '�3 OF.... .' :; .; .:. .�..:; :............. ��/�oc► FEE........r�.ja..... - �i��r�a��t1 ����• ��att� tilan �eruti�, - Permission > here y granted....... 1 ....... ........................... Construct ( t, r Repair ( ) an Individual Sewage Disposal teur (/ Street�; as shown on the application for'?Dispos`al Works Construction Permit No____________________ Dated......._,........ ...................... �/z -------------------------------------- -,-•-`�J�------------------------------------- ••-••-- Board of Health DATE. NNLL,�ff ' ------•-•-- FORM 1255 HOB WARI�4�!I1 PUBLISHERS Y a` S/TE PLAN SHEET I OF.2 SCALE: /" Zo �w lr2v44 I zz I e477' — N ` c �O s � i d 17 1 h r, �-IAviF-- - - ag Sklo�vN ov �Y_PF 3Th'("vk..)r__ 4`r_0Li�.! D IF Q ASH Of S tA.C- wsm mac` FOR REGISTERED LAND SURVEYOR - ZONE G :. t j T t_w i L-L-- S - PLAN ,REFt DATE `2l �j BENCH MARK-DATUM WM. M. WARWICK 8 ASSOC.' INC. DOMESTIC WATER; SOURCE BOX 80I - NORTH FA L MOUTH FLOOD ZONE. ��� � '� - ��--� MASS. 02556 - (6/7) 563 -26 38 LEACHING 3ASIN SECT/ON NOT TO SCALE S/2ee 2 f Z --24"C./M/1 COVER EARTH FILL BRICK AND MORTAR COURSES AS REo'D• TO BRING COVER TO GRADE 4 B"FLOW LINE \ . ' I l INLET.. - L _ .- _ _ 2' /q"TO/" WASHED PEASTONE FREE OF IRONS, PIPE FINES AND DUST IN PLACE OPENING WITH 4%8" 1•• 3�4 TO l%2 WASHED CRUSHED STONE FREE OF lj�J j1 •�� OUTER DIAMETER IRONS, FINES AND DUST IN PLACE AND l3/4" INSIDE DIAMETER 1. CONCRETE TO BE 4000 PSI 28 DAYS _3 1- ' •• 2. REINFORCED WITH 6"x ro" NO. 6 GA. W.W.M. ' 3. 2'AND 4' SECTIONS ARE AVAILABLE FOR GREATER DEPTH REQUIREMENTS 4'0" s"o" I 3�—� -4, NUMBER OF PITS REQUIRED P��- MIN. I EFFECTIVE DIAMETER -{ NOTE: EXCAVATE TO ELEVATION 3o•oOR (NOT TO EXCEED 3 TIMES EFFECTIVE DEPTH) LOWER AS REQUIRED TO REMOVE ALL WATER TABLE - LOAM AND CLAY BENEATH PIT. REPLACE EXCAVATED MATERIAL WITH CLEAN TYPICAL PROFILE GRAVEL TO DESIGNED GRADE. 51' IB"STD, LT. WGT C.I.NH COVER 4'CI.PIPE 4'B/T.FIBER PIPE OUTLET LEVEL DWELLING FLOW LINE _- TIGHT JOINT o .. TO FIRST JOINT - /0" 00 1 10 00 1 rT CI. T£E 47 6 2 I 10 00 1 1 'P _� 1 1 1 0 0 0 O 0 V 1 1 1 `�3 0 A-7.ps 'STD. PRECAST CONC. DIST. BOX TO BE A5 1 1 0 00 00 1 1 1 1 laVOAL.SEPTIC TANK'. INSTALLED ON LEVEL, 1 1 1 000 00 0 1 1 1 . STABLE BASE 1 11 000 00 0,1 1 1 SEPTIC TANK TO BE 1 1 000 0 0 0 1 I INSTALLED ON LEVEL, 1 1 1 1001O0 STABLE BASE. 11 1 00 00 11pQ0 0 01111 L ACHING BASIN 1 I G 0 0 0 0 1 „ BASE TO BE LEVEL r 1 80 0 0 1 1 L�✓ q Z.o SOIL AND PERC. DATA PERC. RATE �" MIN. /IN. 0„ TEST PIT NO. P ?17101 TEST PIT NO. 2 -Z TOP, esp I _ TEST BY �yL L��cLD 5 �A►.jo 6, =L WITNESSED BY: o�J M 18- D JM TEST PIT GR. EL. `�'� • 4 ► S A IJ ELEI/. DATE: I,0 2--2 IZ' 37,4 DESIGN DATA GENERAL NOTES 1 BEDROOMS NO HEAVY EQUIPMENT TO RUN OVER SYSTEM. ,--� - 7tSPCSAL ►� SEPTIC TANK, DIST. BOX-AN LEACHING-BASINS TO BE STANDARD EST. TOTAL DAILY EFFL�'�GPD. PRECAST REINFORCED CONCRETE UNITS. SEPTIC TANK l000 GAL. ALL SYSTEM COMPONENTS SHALL BE INSTALLED IN ACCORDANCE TO REVISED TITLE 5 OF THE STATE ENVIRONMENTAL CODE SIDEWALL AREA Z SGAL./SQ.FT. MINIMUM REQUIREMENTS FOR THE SUBSURFACE DISPOSAL OF BOTTOM AREA GAL./SQ.FT. SANITARY SEWAGE EFFECTIVE ON JULY 1 , 1977. LEACHING-REQUIRED Zoe SQ.FT. ANY CHANGES TO THIS PLAN MUST BE APPROVED BY THE BOARD ACTUAL LEACHING AREA OF HEALTH. Q.FT. AT COMPLETION OF CONSTRUCTION, PRIOR TO BACKFILLING, THE BOARD OF HEALTH SHALL BE NOTIFIED FOR INSPECTION. PITCH ALL SEWER LINES 'A" / FT. UNLESS INDICATED OTHERWISE. SEWAGE DISPOSAL SYSTEM o MARTIN E. FOR.' L. � {JAL - � h10RAN NIF�. .A f234171Q !�'4 Z o Rs. ��t���e�°• SCALE AS INDICATED DATE 3 �S WM. M. WARWICK 8 ASSOC., INC. 8OX 801 - NORTH FAL MOUTH •G� � � l'I/L(�7��^-�`- MA .SS - 02556 (617) 563 -2638 PROFESSIONAL ENGINEER