Loading...
HomeMy WebLinkAbout0080 GOAT FIELD LANE - Health 80 G `z , Pikd, net te L t 9 ,Hyannis Fll� 248 270 6 o I , I I - ^�� J . Fee No. O e.. V THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE. MASSACHUSETTS Application for Migotaf *p.!tem Construction 3permit Application for a Permit to Construct( )Repair(,?�)Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No.10 Cypq Owner`'" �s`Na�me�,Address dress and Tel.No. LP Assessor's Map/Parcel to(,QM�4. ,w Installer's N e,Addres and Tel.No. �$ J"'3�3� Designer's Name Address and Tel.No. �J �.�. 1�3+-rt �r won �t Ilca� 4 w, 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 'C') gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. 00 Description of Soil Nature of Repairs or Iterations(A swer when a plicable) I)i4rt6A,64 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 bee y h's oar f Health. Sign d Date 1-1 Application Approved by Date Application Disapproved for the following reasons Permit No. aDP L4 :5ca Date Issued �� Q No. J� Fee l o o THEICOMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION TOWN OF BARNSTABLE., MASSACHUSETTS _ ZIppitratton for Migpoml 6p�ptem Con5tructton Vermit pp p Upgrade(A lication for a Permit to Construct( �)Repair(n)Upg ( � ) El Complete System El Individual Components Location Address or Lot N4$O C-O, 0L r Owger's N e;Address and Tel.No. �N uAful ls�w �h1p, Rf6wwrj Assessor's Map/Parcel IP4/ Q 7 QO C7oA� �JJ� �J,N ll a�1 jC�Qr�' O a 1` Installer's{e Name,Address and Tel. l �n �� ��"',�i `� Designer's Name,,dd�es d Tel.Nok62Q I 1'l'1 q Q q.YtJj t �'i M 09.(0 Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. �902f)ClSute C'.41�» x 13 Description of Soil lr Nature of Repairs or Iterations(A saver when a plicable).o'vt;� ��� I I , At 1 14r-I t�ll'�'-4 zo-k W 5 0 o �,c�l� h I k &rx6Qrv, - Date last inspected: Agreement: ! The undersigned agrees to ensure the construction and maintenance of the afore described on-,ate-sewage-disposalsystein •'` ' { _ in accordance with the provisions-,of Title 5of the Environmental Code and not to place the system in operation until a/Certifi- "care of Compliance has be 'es�t ed by this Board 6 glealth. Sign d Date Application Approved by Date Application Disapproved for the,�following reasons Permit No. Q SG Date Issued OI THE COMMONWEALTH OF MASSACHUSETTS J BARNSTABLE, MASSACHUSETTS Certtf ttate of Comphance THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed ( ) Repaired Upgraded( ) Abandoned( )by CA(Z �,r acrid 5 n -.. • .� ,at G oq 1 t U - W !' ,4r (Y� has been cons tructV,in ccordance with the provisions of Title 5 and the for Disposal System Construction Perm ',. Permit No7" 00 y'JD R dated I Installer Designer The issuance of this p'Frnu'tjshall not be construed as a guarantee that the systeMl ftjnction as <esigned. Date Cl ��� �"f Inspector l ��, i 4-1 r THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS Mt$poga1 *pgtem Cottgtructton Vermtt Permission is hereby granted to Cons ct( )(Repair(�(,)Upgrade( )Abandon( ) 4 System located at t J QTE- I p (w�'. LU . M W1,n' kVQ r— f 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 must be completed within three years of the date of this pYe� it. - Date:_� �"`'�I Q�I Approved by Town of Barnstable Regulatory Services . Thomas F. Geiler,Director ..AR ABM = . KAS& Public Health Division 163. Ec.t ;�a Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Installer & Designer Certification Form. Date: b Desi er: ( Installer: gn =" ' �• `� Address: Address: On J P. ry� was issued a permit to install a (date) (installer) septic system at based on a design drawn by (address) datedy�- (designer) V 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 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. �,kk CFMg90 a RONALD sG JAMES CAD[LLAC • � v #1060 (Installer's Signature) a � . • _ +� Sg1Vf7AP�� Isl (Designer' gnature) (Affix Designer's Stamp Isere) PLEASE RETURN TO BARNSTABLE PUBLIC HkAI.TH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOT14 THIS FORM AND AS- BUILT CARD ARE RECEIVED BY THE BARNSTABLE WrTuLIC HEALTH DIVISION. THANK YOU. Q:Health/Septic/Designer Certification Form f TOWN OF BARNSTABLE LOCATION L�° G A&e SEWAGE # VILLAG oft ' ASSESSOR'S MAP & LOT j INSTALLER'S NAME&PHONE NO. l�� /Yl C-O ,44 /1A SEPTIC TANK CAPACITY I° 000 LEACHING FACILY: (type) .� — /�ie�✓ a e/ee es (size) IT NO.OF BEDROOMS i BUILDER OR OWNER PERNITTDATE: COMPLIANCE DATE: Separation Distance BetweenJhe� Feet Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Private Water Supply Well and Leaching Facility (If any wells exist Feet on site or within 200 feet of leaching facility) I Edge of Wetland and Leaching Facility(If any wetlands exist Feet within 300 feet of leaching facility) . i Town of Barnstable P# P11, 7 ? d Department of Regulatory Services • nrrerr►er�. Public Health Division Date /�� se � 1639. �e� 200 Main Street,Hyannis MA 02601 ArED MA'S� Date Scheduled O Ut Time `' Fee Pd. l U o Soil CSuitability Assessment for Sewage Disposal Performed By: QotJ) 1� \1 �GI��'I I � Witnessed By:�, CA✓ L AT ON & GENERAL INFORMATION Location Address („ � Q / _ Owner's Name /4_ llii nnnn �-q �l''e D�' Address ►'lG S y H/►�t� f DxZrj , (MA ©t54a Assessor's Map/Parcel: a q r .�7a Engineer's Name 9 j„ CGw I(" NEW CONSTRUCTION REPAIR ✓ Telephone# SD - Z 7S-q-7d 0 Land Use `I fR rJ Slopes(40) "C 2 Surface Stones Distances from: Open Water Body N ft Possible Wet Area—�!�—ft Drinking Water Well —AtA_ft l Drainage Way NIA- _ft Property Line 15 ft Other ft SKETCH:(Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands in proximity to holes) bd ttl L O-r V 10 LI'9, DNW. q R''►'\ "'S Depth to Bedrock Parent material(geologic) _ `Pt Weeping from Pit Face Depth to Groundwater. Standing Water in Hole: P g 6 r" -fo ' llpoo Estimated Seasonal High Groundwater 20/ �JP.I�w � A4 . 6.W DETERMINATION FOR-� SEASONAL HIGH WATER TABLE J�a�v �992 Method Used: WA> 61-5 /N7Lr/2(V1,A7150 w1f A .2 7A-8G--- Depth Observed standing in obs.hole: __ in. Depth to soli m011148: tn. Depth to weeping from side of 9bbs.hole: in. Groundwater Adjustment It. Index Well# 230 Reading Date:_ Index Well level_ Adl.factor 6_ Adj.10roundwater level PERCOLATION TEST bate , Time Observation Time at 9" .._�..®. Hole# Depth of Perc Time at G" Start Pre-soak Time @ ®��7 Time(9"-6") End Pre-soak 7 Rate MinJlnch �G �► / y Site Suitability Assessment: Site Passed Site Failed: Additional Testing Needed(YIN) Original: Public Health Division 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. QNS EP'TICIPERCFORM MOC r DEEP OBSERVATION HOLE LOG Hole# Z Depth from Soil Horizon Soil Texture Soil Color Soil , Other Surface(in.) (USDA) ._ (Munsell) Mottling (Structure,Stones,Boulders: Consistent %n Gravel ce DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistent %Gravel i DEEP OBSERVATION HOLE LOG. Hole# . Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) ;r" (Munsell) Mottling (Structure,Stones,Boulders. Consistent %Gravel DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. onsiste el rr Flood Insurance Rate Map: Above 500 year flood boundary No_ Yes _ Within 500 year boundary No Y Yes Within 100 year flood boundary No Yes Depth of Naturally Occurring Pervious Material Does at least four feet.of naturally occurring pervious material exist in all areas observed throughout the area proposed for the soil absorption system? YES If not,what is the depth of naturally occurring pervious material? Certification yDv �� •I certify that on (date)I have passed the soil evaluator examination approved by the Department of Environmental Protection and that the above analysis was performed by me consistent with 'the required atning, xpertise a d7erience described in 310 CNM 15.017. SignatureIL a-C� Date—E 'T�+ Q:VSEPTIC\PERCFORM.DOC 4 MAP �-� � PARCEL ;_�`z`7 O- f LOT -_.- ,3---- 6117104 FAILED INSPECTION DATE---------- ��j PROPERTY ADDRESS: 80 0 Kyann i.eRo.¢t, Na., 02672 On the above date, the septic system at the above address was Inspected. This system consists of the following: RECEIVED 1. 1-1000 ga.e.Pon .6e�t is tank. 2.- 1-di.6tn-i9ut.ion 9oz. 3. 1-1000 ga.Uon .Peach-ing pit. JUN 18 2004 Based on inspection, I certify the following conditions: TOWN OF BARNSTABLE 4. 7h.iz .ib a t.itie )give zept.ic zyztem (78eode) `HEALTHDEPT. 5. The .6ept.ie .iyztem :i.6 .in hydizau-e-ic 7p-d i e"e.' • • 6. Leach.ing ,a zea. must ge u/2g zaded to (9 5 code) ' SIGNATURE: ,� Name:_ a32u �l�o� � e�-------- Company: .Tnc pb P,Ddacom} er— —Son, Inc. Address:- P- -Q..—BQx-6-6----_------ C e n t-c rc» 1 1 o MA n 4-32, n 6 6 F . Phone:---1�4��ZZ5=333s--------- THIS CERTIFICATION DOES NOT CONSTITUTE A GUARANTY OR WARRANTY COOSEPH P. MACOMBER Dd Tanks-Cesspools-Lea Pumped & Insta Town Sewer Conne Box 66 Centerville,775.3338 775- • COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE"OF ENVIRONMENTAL AFFAIRS a DEPARTMENT NVIRONIVINTAL pR,OTCTION V TITLE 5 OFFICIAL INSPECTION FORM—NOT;.FOR.VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART•A CERTIFICATION. Property Address: . 8 0 Go rit ce�d /2c1. IV, IlUnnnLA anal-, as Owner's Name: /U c nn r/ H p o n A Owner's Address: 1 N r k i n A f a j D 4 mrrA Date of Inspection: 6 17 n 4 Name of Inspector: (please print),../32u.r o- /tl a_a j d 2 Company Name: 7_ 2_P¢comRe2 & .S,on Inc. Mailing Address: C— e n;te/z VTF Te, a 6T. 026 32 Telephone Number: 5 0 8—7 7 5:3 3 3 8 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system.at this address and that the.information reported below is true;accurate and complete as of the time of the inspection.The inspection..was performed based on my . training and experience in the proper fiinction and maintenance of on site sewage disposal systems.I am a DEP approved system inspector pursuant w Section.15c340.of Title 5(310 CMR 15A00). The system: Passes Conditionally Passes Needs Further Evaluation.by the Local Approving.Authority —7 Fails Inspector's Signature: Dater Lf� The system inspector shall submit a copy of this inspection report to the.Approving Authority.(Board of Health or 1. 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.shalt 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. Motes and Comments ****This report only describes conditions at the time of inspection-arid un der the conditions of use at that time.This inspection does not address how the system will perform in the future under.the same or different conditions of use. Title 5.InsP ection Form 6/15/2000 page 1 Page 2 of I I OFFICIAL INSPECTIONYORM—NOT- FOR-VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 80 Go aY 11-ie-ed Rd.- Owner: R.ichalLd Hee7r s Date of Inspection: 6117104 Inspection Summary: Check A;B;C,D or E/ALWAYS.-complete>all of Section;D A. System Passes;'No uv,s 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: 7ho ' Aonfir ATAem !A in hydar Pir erli(lie 4 nom . O.orirhinq in C i f�in./r. no r anon n¢¢�/6 �G, 0 2 cLt GLQ eQ G7! P.�Q—C C..�L_�.( B. ,System Conditionally Passes: 1 Vv One or more system components as described in.the"Conditional Pass".fsection need to be replaced or repaired.The system,upon completion of the replacement or repair,as approved by the Board of Health,will pass. Answer yes,no or not determined(Y,N,ND)in the for the following statements.If"not determined"please explain. The septic tank is metal and over 20 years old*or the.septic tank(whether metal or not),is structurally unsound,exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing,tank is replaced with a complying septic tank.as approved by the Board of Health. 'A metal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND explain: Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken;settled or uneven distribution box. System will pass inspection.if(with` approval of Board of Health): broken pipe(s)are replaced obstruction is removed distribution box.isleveled or:replaced nND�explain:. . l lJ� The system required pumping.more than 4 times a year due to broken or obstructed pipe(s).The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed ND explain: 2 Page 3 of 11 OFFICIAL-INSPECTION FORM_NOT-FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION.FORM PART A CERTIFICATION(continued) ' Property Address: 80 goatjie-ed Rd,. !d. /Zyann.i.62o2t, Na. Owner:. R-icha zd hee.2.s Date of Inspection: 6117104 C. Further Evaluation is Required by the Board of Health: Conditions,exist which require further.evaluation.by.the,Board;.of;Heaith;in order to:.detennine 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 mannerzwhich.:will protect public health,safety and the,-environment: KA 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 tahk and soil absorption system(SAS).and the SAS is within 100 feet.ofa surface water supply or-tributary to a.surface water supply. The system has aseptic tank and SAS and the=SAS is4ithin a Zone 1 of apublic water-supply. The system has a septic tank and.SAS and the SAS is within..50 feet of a private water.supply well. The system has a septic tank and SAS and the-SAS is less than 100 feet.but 50 feet or-;more fron]a private water supplywell"*. Method used to determine distance murVA "This system passes if the well water analysis,performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5.ppm,provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form. 3. Other: 3.. Page 4 of 1] OFFICIAL=INSPECTIO.N-FORM_NOT,FORYOLUN'TARY.ASSESSMENTS SUBSURFACE SEWAGE.:DISPOSAL SYSTEM:INSPECTION FORM PART::A : CERTIFICAT,ION(continued) Property Address: 80 Goat�tieid Rd., Owner: Richri2d HP_P12A Date of Inspection: 6/17/0�% D. System Failure.Criteria applicable to all systems:. You must indicate."yes":or"no"to.each:of the:following,for a, ll;inspections: Yes No Backup-of sewage..into facility:or system:component due.to overloaded:or clogged SAS or cesspool Discharge.or:ponding.of effluent.to the surface•of the ground ur,surface:waters due to'woverloaded or clogged SAS or cesspool /01 _ Static liquid level in the distribution box above.outlet invert due-to,aa overloaded or clogged SAS or cesspool i000-L� Liquid depth in esspeel is less than.6"below invert or.availablOyolume is less than'/s.day flow / Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number of times pumped ✓ Any portion of the SAS,cesspool or privy is below high ground water elevation. .Any portion of cesspool or privy is within 100 feet of a surface water supply.or tributary to a surface water:supply. / Any portion of a-cesspool-or,privy4is within a,Zone 1.of apublic well... _ Z 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 le.ss.than-100 feet but greatenthan.5.0.;feet from a private:water supply well with no acceptable water quality analysis.:[This system..pass6s 4f the well water.anaiysis, performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicatesAhat the.well is.free from-pollution•fr..om:.that:facflity:and:th@ 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 oUthe analysis must be attached. this form.) UUPS_(Yes/No)The system fails.I have determined that-one or:more-of the.:above.failure�criteria exist as described in 310 CMR 15.303,therefore the system-..fails.The system owne. r.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:Ilivsystem:must serve.a>faeility. with.a,design flow of i3O;00.0.gpd to 15;000. gpd You must indicate either"yes"or"no"to,each of the following: (The following criteria apply to large systems in.addition to the criteria above) yes nc� the system is within 400 feet a surface drinking water supply the system.is within 206 feet of a utary 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. 4 Page 5of11 I OFFIjCIAL•I•NSPECTION FORM-NOT FOR�OLUN'I'ARY t�►SSESSMENTS SU$SiTRFACE:SEWAGE DISPOSAL SYSTEM:INSPEC`I:ION FORM PART B CH'ECIaIST Property Address: 80 GoaLf1.e_id Rd. Gl Huanniinnn.f; Pln_ Owner: Richa2d /Ze Date of Inspection: 6177104 I Check if the following have been dpne You must indicate•"yes"or"n4°'as-•to each of the.—following: Yes No — Pumping information was provided by the owner,occupant,or$oard of Health J 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 th(sinspOtion? Were as built plans of the system obtained and exMi fined?(If they were.not available gow 0 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, t%cluding'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,depthof sludge and..depth•ofscum? _✓ - Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil.Absorption System(SAS)on the site.has been determined based on: Yes nod �/ 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 CNM 15.302(3)(b)] 5 r i Page 6 of 11 OFFI;CIAL INSPECTIONTO.R —NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL;SYSTEM.—.—:INSPECTION FORM PART.0 SYSTEM INFORMATION Property Address: 80 Goats-.eid Rd, �. huann c�s�oat. Na, Owner: Richa2d Keeaz Date of Inspection: 6/9 7/0 4 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(designs): :< . : ,Number of bedrooms(actual): DESIGN flow based on'310 CN;9t 15.203 (for example: 110 gpd z#of bedrooms): g X 11� Number of current residents: .. Does-,,residence have a garbage grinder(yes or no)AP Is laundry on a separate sewage.system(yes or no):5� [if yes separate inspection required] Laundry system inspected(yes or no je Seasonal use: (yes or no):AL�, 7Tc2 �� Water meter readings,if available(last 2 years usage(gpd)): Sump pump(yes or no): ( IO Last date of occupancy: COMMERCIAL''i6USTRIAL Type of estabalunnt: Design flow(lased on310 CMR 15.203): gpd Basis.of desigg'flow(seats/persons/sgft,etc.): Grease trap present(yes or'no):CSL-, Industrial waste holding tank present(yes or no): Non-sanitary waste discharged to the Title 5 system(yes or no): NA Water..meter readings, if available: �qa Last date of occupancy/use:• _ OTHER(describ.e):. , GENERAL INFORMATION Pumping Records Source of information:j.P, MAC&M),,g - _ Was system pumped as part of the inspection(yes or no):jXCj If yes,volume pumped:_gallons--How was quantity pumped determined? Reason for.pumping: TYPE OF SYSTEM ZSeptic tank,distribution box,soil absorption.system 6-Single cesspool. t-c) Overflow cesspool tW Privy (`s- Shared system(yes or no)(if yes,attach previous inspection records, if airy) M Innovative/Alternative.technology.Attach a copy of the current operation and maintenance contract(to be obtained from system owner) 'Yb Tight tank. N� Attach a.copy of the DEP.approval Other(describe): Approximate age of all components,date installed(if known)and source of information: Were sewage odors detected when arriving at.the site(yes or no):%— 6 _ Page 7 of I I OFFICIAL.IPLCT:ION-FORM.--NOT FOR VOLUNTARY ASSESSMENTS SUBS> l>LF�k:CE SE'VVAGIr hISPOsAI,:S�ISTENi I1�ISPEC'TION FORM PART C SYST.EM-INFORIYI`ATION (continued) ProPerty address, 80 goa-t �.ee-ed Rd., aizrzz-sao2 .l'la., own-e.r: R icha z a.s Kee Date of fnspcction: 4,/9 7/n 4 ,__,__ BUILDpI'NG SEWER(locate cn site plan) Depth bc.igw.grade: ._.,� Materials:of,constrticbiorl: /"cast Iron,-, 9 PVC,,.,..o,tlt.cr(cxplatn) . distance from private wste- -supply well or suction Ilrtc: .� Comm 5o �s'(on condit olf Joihtsvcnting,evldcnxe of I age, tc.); I? Jn PPIIs0.-Uer SEPTIC TANK' (locate on site plan) I000 OaU n. L/ DVA b.clow grade: a4_ Material of consovetiononcrptc . . metal�„t.t . � bcrglas-s___P thybne. othsKcxplatn) If tatt�c is mctsl list tt:gc:! is age cottfrmc.d by a C.criflcaia of Comltaitec(yes or noj: (attach a copy of ccrsiftcatej .. 4 `!o wide Z h �imcniio ns:�(v Sludge depth: D.istancc from top of sJtidgc tv.bottom of outlet ace or baffle: Scwrn thiekncss: Distanea t ore tap of scant to lop of outlet tee or bafn;:'v D.iswncc.6om.bottom-of$.Cron to bottom of outlet tee or.baff(lc How w.c.re dimenlions determined; s1(Le��w'� Commcnyts.(on purn.pin.g re.corn-MendWons, .let and out.eGtcc or bUM4.condi:t�on,structural integrity, liquid levels as rditeda ovt:li.t invert,avidcnce o.t.lcaJage.,etc;); �n /?.eace.-Ae. tan ins .61-2uc#uaagiy (e'' no evidence C-REM T 63':'&6ocate on site plank �, r Depth below gradC:M— Matcriai of co.r►struction:Y�concrctc"( ,fiberglass J polyethylene_Uqthcr (explain): D'tmcrt;.ions; Scum th.it-Metsift, Di-seance r om top of scum to top of outlet fee or baffle: CV& Di:suncc from bottom of scum to bottom of outlet tee or bat'fle: Date of last pttin.ping:.L�'.:r..... Comments(on pwmping recoMM;n*l-.qns,.tnlat and outlet toe.or baffle condition, structural integrity, liquid Icvels ► as related to outlet invert,evidence of:lcaks:ge,CO. 2ea.Se t Page 8 of 1 I OFFICIAL INSPECTION.FORM—NOT FOR VOLUNTARY ASSESSMENTS S>IhBUF.ACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 80 Go c tZ Le.pd Q.-H4�rinni tnnnf /rlri . Owner:. 1?.jrhn17r/ y�b Date of Inspection: 7'/n TIGHT or HOLDING TANKJ\tJ (tank must be pumped at time of inspection)(locate on site plan) Depth below.grade:to Material of construction: 1 concrete metal Ji fiberglass n41 polyethylene Nother(explain): Dimensions: Capacity: Vo gallons Design Flow: {\%\ gallons/day Alarm present(yes or no): Ak Alarm level: Nk _ Alm in working order(yes or no): f Date of last pumping: Comments(condition of alarm and float switches, etc.): 7.z qh.z< o2 ho.Qcl�n c no DISTRIBUTION BOX:(ffl,5 (if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: I\P 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.):. PUMP CHAMBER: (locate on site plan) Pumps in working order(yes or.no): Alarms in working order(yes or no): Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.); /ocm ch 2m9ea rzo t 2 8 .Page 9 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL.SYSTEM INSPECTION-FORM PART�C SYSTEM INFORMATION(continued), Property Address: 80 qoatPie-ed Rd. i GJ Kuann.���o2t, (7a. Owner: /?irhnnr/ Hpjpa Date of Inspection: /17/0 4 SOIL ABSORPTION SYSTEM(SAS): (locate on site plan, xcavation not required) 1000 gai-eon pzeca�f leaching 12t If SAS not located explain why: Located -6ee Rage 10 Type `jA leaching pits,number:_ leaching chambers,number: D leaching galleries,number: leaching trenches,number,length: leaching fields,number,dimensions: �D overflow cesspool,number:.- innovative/alternative system Type/name of technology: ►,ke. �v e l7$ co d�-J Comments(note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation, etc.): eoaaze nand. Signh o� hyd2au.g.ic �a�Qu2e. lJa�te „r,fon (" Pe ow inueat. 7ank an /2.c 12umHe Zn Vegetation iz noamai.- New leaching aaea nee to ge jnztatted• CESSPOOLS: r1k (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: Y\% Depth of scum layer: Dimensions of cesspool: Materials of construction: Indication of groundwater inflow(yes or no): Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): PRIVY: (locate on site plan) Materials of construction: Dimensions: Depth of solids: � — Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): 9 Page 10 of 11 OFFICIAL INSPECTION FORM—,NOT-FOR:VO.LUNTARY,.ASSESSMENTS SUB SURFACE-SEWAGE;DISP.OSALL SYSTEM':INSPECTION;FORM PART C SYSTEM INFORMAT'I.ON(continued)" 80 Goa.t�ie.ed Rd. Property Address: Gl.•iluann.i�Ro2.t. 17a. , Owner: �Ucha2cl Keene Date of Inspection: 6/9 7/N SKETCH OF SEWAGE•DISPOSA,L SYSTEM vide 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. i Y a 10 Page I I of I I OFFICiA.L INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C ,.. SYSTEM INFORMATION (continued) Property Address: 80 ,Goa.t�.ieid 1?d. Owner: Li _ aar/ HOD-,,0,3 Date of lospecdoo; 6/ 7 L4 SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water feet Please indicaie (check) all methods used to determine the high ground water elevation; _ Obtained from system design plans on record - If checked, date of design plan reviewed: Observed site (abutting property/observation hole within 150 feet.of SAS) Checked with local Board of Health-explain: _ Checked with local exca.vators, installers. (anach documentation) _Accessed USGS database-explain: You tdescribe n L � et�ruza C/ edwaeaie c oaanPvatul�e.Ge wate2 bul?12Jy and ),)o-UhPe7r/ nnnfvr.tJ n odi maR ae2i 1995 I�1 Leaching Pit :cc( Groundwater: Feet Below Bottom of Pit High Groundwatef Adjustment 1.8 ft per Frimpter Method 9f i r7 T'hercfore, the vertical.separation distance between the bosom Of the leaching pit and the adjusted 9Toundwatcr table is feet. :J I I rn r•ni•r�'rr-,rn:rt+.•nmrrrn.+az+r.mr..-.�r++rvrr: r n 1'oWN OF Barnstable [BOARD OF 11EA.LT11 SUBSURFACE SEWA(;E D18fOSAL SYSTEM INSPECTION FORM - PART D •- CERTIFICATION ..._.. _T..,.•.: ^r.,, -•---n:nr.,n•nrnrn,r rs�trrT�'r-•.��,mrrtr+r,vr<rn*r�cstt nramrs-te'rR'f inn•.en��r►t,t.rrrnn+r'.•...rrrr-•�. —•. -TYPL OR PRINT CLEARLY- PROPERTY INSPECTED STREET ADDRESS 80 Cgoat�ieed Rd.- ASSESSORS MAP , BLOCK AND PARCEL # 248-270 OWNER' s NAME Richaad WeeRz PART D - CERTIFICATION NAME OF INSPECTOR B/tu.ce Pl.acaiiiatea COMPANY NAME Joseph P. Macomber &,,Son Inc COMPANY ADDRESS Box 66 Centerville Mass 02632 Street Town or Cliy State E I P COMPANY TELEPHONE ( 508 1 775-3338 FAX ( 508 ) 790-1-578 CERTIFICATION. STATEMENT I certify that I have personally inspected the sewage dieposaj system at this nddr.ess and that the inrormati-on reported is tr.ue., accurate , and 'complete as of the time of :inspection. The inspection was performed and any Jrecommendations regarding upgrade , maintenance , and repair are consistent with my training and experience in the proper function and maintenance of on- site sewage disposal systems . Check one ; System PASSED • I The inspection which I have conducted has not found any information which indicates that th.e system fails to adequately protect public ItealCit or the environment as defined i:n 310 CMR 16 , 303 , Any failure criteria not evaluated are as stated in the FAILURE CRITERIA section of this form . �XX System FAILED* The inspection which I have conalacted h.as found that the system fails to protect the j)ub.lic health and the environment in accordance with Title 5 , 310 CMR 15 . 3031 and as specifically noted on PART C - FAILURE CRITERIA of this inspection. form., Inspector Signature . • y: yne copy of this .carcification must be provided to the OWNER, the BUYER '( where applicable ) And the 130ARD OF HEAL711 . * If the inspection FAILED , the- owner or operator shall upgrade ' the eyetem- within one year of the date of the inspection, unless. allowed or required otherwise as provided in 3.10 CMR 16 . 3.05 partd . doc /Z aL 1� Lb / O V: � q , In \ Zo- Z3 'f �v s Gtj r�- CERTIFIED PLOT PLAPI. 5. LbT l f/YPUP-r /�'ICI�DocJ_S4� IN SCALE' / '-3a .DATE 5 y. !,.'DKQGE ENG1 EE J 0 .r. u ... _ SdaC I CERTIFY THAT THE _ .. c4ieNT _. SHOWN ON -TH19 PLAN 13 LOC T EGISTEREO REOI$TERED _' : a6Z r CIVIL LAND..,''.:: dOd NO.:. B ..._._ :ON� THE GROUND A9 INDIC .t... EN.OIIdEER SURVEYOR. " CONFORMS TO , THE .ZONING,'L�A1 OR.sY.�,= OF s A R S TA a N LE MA16: T 12. �.A.L N...5.fi R E E ` 1:;,,�r• `"' -,-r—.� S `1 � �G :: r TOWN OF BARNSTABLE f LOCATION ® " G O AT &91-0o G A a SEWAGE # I VII.I_AGE/.U. lS/ A W..,V 15 ASSESSOR'S MAP & LOT ! INSTALLER'S NAME&PHONE NO. T IM A C-O,0 I gRi 10.0 SEPTIC TANK CAPACITY COb LEACHING FACII.ITY: (type) .2 — A7 tea✓ u/eLLo (size) /`3— d"- •°L NO.OF BEDROOMS BUILDER OR OWNER PERMITDATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet I s ri 4 ` M j'i LOCATION SEWAGE PERMIT NO. VI LACE . -A- 111s ? orU i INSTAL ER'S NAME i ADDRESS 1 1A t's e U I L D.E R OR. OWNER H,'nei Co DATE PERMIT ISSUED t� A 3 4 o DAT E COMPLIANCE ISSUED �. V'� �o �. �- .� G �+-� � � , � r x s= F p�� L i r - `' � - _ I No. '. .. FEs........!-6...�.. THE COMMOK3 VEALTH OF MASSACHUSETTS BdARR OF JE&LTH .................OF. ........... .�t�. . ------•---............................... .���ltrtt�il�tt fnr ��i��n,�tti �xk �n��r�r�tnn .ernti# Application is hereby made for a Permit to Construct ) or Repair ( ) an Individual Sewage Disposal System at: __ j .. �. Locatio d ress t No. „ ............ _. .--•--•-•••..... :. - ; .. . a `fir/L � r. ._ ._ .................. l..`Y.c_.Address ..._._............................_.. Installer Address U Type of Buil ing Size Lot.._11�. ..�...Sq. feet Dwelling—No. of Bedrooms.................... .....................Expansion Atic (� Garbage Grinder V76 Pk Other—Type of Building ......... --------.- No. of persons........................... Showers (� — Cafeteria ( ) 04 Other fixtu ----------•------------------.-------------------•-•----•-•--------•--•----... j WDesign Flow.............S-5..................... __-gallons per person p�e/r day. Total daily flow...................o.....................gallon�. WSeptic Tank—Liquid'capacity.i ..gallons Length...1?d....... Width.....(jr-------- 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 (.V,�r Dosing tank Percolation Test Results Performed by.......... :... _... .... ._.. Date........ ,..... Depth Test Pit No. 1.....rf.. ..minutes per inch Depth of Test Pit..... 2......... De th to ground water...... G% Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ O }1... {.j 1�.. ... _i _... Description of Soil ............. ..� ..9.....:....... V ... W ...............................................................................................................•-----•.............---..........._....----------......_........-----•---•-•...•-•....... UNature 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 iITI.E 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------. - �.:..._ 3,� CK�. Date - . Application Approved BY = --------•---------- D Date Application Disapproved for the following reasons:--------------••--......-------•------------•---........----------------------..........._....--•------•--•..... ...-•.........................•-•----•--..................................-----•------......................-•-•--•-••--•-•.........................------••-----••-----......---.... ----......._ Date PermitNo....................................................... Issued.------•................................................. ate No................_....... FEs............................. THE COMMONWEALTH OF MASSACHUSETTS �- BOYAR, OF !-i ALTH .......... -+r...............o F....... .. ......�.N... , VVfira ion for Diovooal I7) 0r C9onotrnrtion anti# Application is hereby made for a Permit to Construct ( Repair ( ) an Individual Sewage Disposal System at: / L�✓1-e�/� —/ ....................... .......A-�/.... --- .... .. __ .--- --•----•-•-- ..----•............... Location ddress 11 NNo _ 1� lA ....i dS (fie �eS -�'-�,Ct,�/1 A �e r,.: ........: .... .... ......'I.......-.< Owlier n ddress V ` Installer Address d Type of Buil ing Size -Lot----- ...........Sq. feet U Dwelling—No. of Bedrooms................... 3..................Expansion Attic (/1 o Garbage Grinder (/I6) Other—Type of Building «R .... No. of ersons.....--.....6.---.------- Showers QI YP g ---------•--•--- P (� Cafeteria ( ) dOther fixtures .....---- --------------------------------••----•----•-•-------••--------------•--•-- _..._..... W Design Flow.............�..5.._......................gallons per person per day. Total daily flow...................U.._._...............gallon�. WSeptic Tank—Liquid'capacity.�M—gallons Length---1 __..... Width...-15.---/.. Diameter................ Depth..... .....:. x Disposal Trench—No. ._-.Ir7z Width.................... Total Length.................... Total leaching areaeRl_.�!.._....sq. ft. Seepage Pit No.............:....... Diameter.------.----.------. Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box (Le,� Dosing tank ( ) / / Percolation Test Results Performed by....--...�P._-...�e...1:- '�'".^R.�— Date.......__��_1.�rl-.4�.. j.................... ,a Test Pit No. I....�A.minutes per inch Depth of Test- Pit......1A.......... Depth to ground water......h......`...-. L14 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ P4 .................. !} ! ......••....••........ ................................. 1A AN Description of Soil.............................�-. -�� r -•-- -�----- -- ......................................... x 11 / �Q VW --- .........................................................-............................................. •----- =N •---�------ ---------------.....-•--------••-•---•..... 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 TITLI: 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. A, Signed......- � �st��i l Gl/„_• Gji 'l� s��- Date ApplicationApproved BY......................................................•----•----•-----------......------....--••-- ........................................ Date _. Application Disapproved for the following reasons:------•--------•----••-•-•-•-•-----••.........................•-------------•-------------=-----.......•--.... ....................•---.............................--...------................------..........------.............-•----•----•-•----"-•---------------•--••-------------............ Date PermitNo......................................................... Issued......................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOAR F HEALTH. .............. .I.:L'".............OF....... r '?C.: ..P:................................. Tntif iratr of Tom;diattre THIS IS TO CERTIF That the n idual Sewage Disposal System constructed ( or Repaired ( ) by.....................•..... - - ¢.. ,._..._...------ •-----------...-••-•--•--..........---•--••••......_._..................._.. ... .._•...._ at_ (�? �"-''' / ar, a - %/l!/._ -----------------------•--------•--•.........••--•-........... __...................................i. ...- -- .... has been installed in accordance with the provisions of TITLE G 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No..........-.Q. "._._ � .. dated.................�.13".8 ........ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE..................................................... L 1-' ...... Inspector........... Qom. �~± THE COMMONWEALTH OF MASSACHUSETTS BOARD F HE LTH .. No... .. .'.9 .. FEE................:':.... Biglasal Nor ion lion permi# Permission is hereby granted........ .j to Construct ( ) r ep it ( ) a vidJ�.al Sewage Dispo al System _/J / at No............. ........................ ®��/ �� 1�rr! fG��......•--- � !,`' r� -:—�-�.�,A.•... .-•^_....._.........Street - .- as shown o/thea icati for Disposal Works Construction Permit 0..f3'74 r/Date .-.--.----.l�----....••----.....-• ------------ ----- .....-----••--••---..../ -•.............•................... and of Health DATE.--•- - �-•--••-----•-- FORM 1255 A. M. SULKIN, INC., BOSTON r , ICJ t i1. • t. 123, Lor ti .. . 4-01 too a , p � n 3 R. NO HAD A Qr VAf A 366 P2 D/ /STf- S/ ronL Togo D^'r/k •►s J/}Sl`� pdS PLf1OS 77 a' V (TNEY LEGEND EXISTING SPOT ELEVATION CERTIFIED PLOT PLAN �tN of ss EXISTING CONTOUR ——— 0 — FINISHED SPOT ELEVATION o? ROBERT �cG� T FINISHED CONTOUR --- 0 ---- g .Bf2UCE' CA D 9`l , $ fi,D.REDI N APPROVED BOARD OF HEALTH na ISTEP+per 9 A;I h J If w - A., M A z5o zp o ND SO", DATE AGENT " SCALE, I }— ��} DATE % Cl�� 3 �l �DREOGE ENGINEERING Ca INO CLIENT �. ladf- I CERTIFY, THAT THE PROPOSED EGISTERE REGISTERED JOB No.. t. .�..2., BUILDING SHOWN ON THIS PLAN CIVIL LAND CONFORMS TO THE ZONING -.LAWS - ENGIN R DR►8Y!;, � ,.. OF.:BARNSTASL E MASS ' _•.—�712 MAIN STREET CH. BY$,Q, .Q.� � HYANNIS MASS. XRE :.__ ._.._.. .__ __. SHEET..L OF DA E D. LAND SURVEYOR 20 FT. MIA--. /VOTE /F E/TNER THE SEPTIC TANk OR �EACN/wG P/r ARE MORE TNA. / /2"BELOjV /0 pr. /H/N. 1RA OEM 24"O/A M E TER LONG R E T� CO fiER q'PNG, PJPL St/ALL BF BROUGHT TO 4/TADE.6-+N EiYTRA CO/VCRCTE J9-0E.4Vy CAST IRON COVER SHALL a_= C/SEO COVERS M/N. P/TCN /F/N pR/VEJ4/A y /B"/'FRET p J MiN. CO/VCRETE A _ p1�AOE CO VER CLEAN SAN O • _ LQI//O L EYE[ - c 4•.: 4~CA - 2 LAYER IRON P/PE (] o o � �v AF �/8•-'��B •'a MIN.P/TC/!I GAL. ' o f • • • • • • • • o �e WASHFO 5701YC PEA J"T. SEPTIC •TANX D/sT. " • . f • . . . • • , , . :-`:: _BOX o • • 8 a • • • • i .�� • �� :.t;: '♦ p • ; ; SECT.VL • • 4 �2 • DEPTH • o WASHED STONE • • • •. • • •. • o PREG45 T SEE.PAGE gg.a x 2,5= y71 6,Po t s..� • • • • • . • • • a�•o O/T OR E4U/V. /NYERT AT Oti/LD/N6 99l JNLET ",PT/C TANK g�$ FT.: 1� FT. PIA.W. (-WE T�V/•'4TJON> OtlTLET SEPTIC TANK 8=L FT. " JNLET O/STR,4PvvoN BOX _FT. GROV VO N447,fN ZAALE Ot/TLETD/STR/BI/T/ON BOX•79, Z' F7► SECT/ON 4F J/VLET LBACN/NG P/7" B.o Fr. SEWAGE 0/SP05A A. SY.�TEM T,'QULAT/ON LEACH//VG .,/T , DES/6/V CR/TEfi/A - SCALE : %s" _ o/JyiEJvs/ N 8 FT JVt/MOER OF 6rEDR00/yS D/MEII/S/ON C _FT. A/A GARQAGED/SPOSAL UN/r Nor SO/L LOG SD/L TEST TOTAL FLOW 330(7AL.IDAY SO I L TEST At/ $O/L 7WS.7-02. NUMBER QF L,SAC///NG P/7:5 rezEY. /00-c7 -.FLa•% PATE OF SOIL TEST Ile �3 S/OE,[,EACH/NG PER P/T / SQ fT. RESIItTS /i//TNESSED dY r/E. - mil, Je cep% .40TTOMLZ4CN/NG PER P/T �' so. FT. oa O �S /DAM PERCdAAT/OJN RATE,*/ oL h)//KI/NCH TOTAL LEACH/NG AREA a�SO. FT. ro�Jf A MCOLAT/ON RATE.At-2 M/N.1/NCH RES4FMVE4e.EAC'MIN6 AREA SQ. FT. � 1-5- /d2� 7T No. 'P-20 / ;''• . ,��ti or�� SOT /l� ' ROBERT BRUCE I RG $ E9-DRE CCAP p No. 366 a; A EL DREDGE ENG/IVEE)P/JVG CO,INC. �G'sTElk ��� C�' �Ft� Q� E�rry B� Ov 7/2 MAIN ST• , HYHc/NiS. Li MAS1. }J n'1AL V" / 4N� SUR�Fy� Ml' No d TOVV 7 yY,4TER ENCOU-VTEREo CLIENT: /- DRTE / 7s 3 . (� GROUV0 kVATE,P 4T ELEV - JOB /VO. ?304 SHEET�OF �_ ALWAYS DIG SAFE PRIOR TO CONSTRUCTION--UTILITY LOCATIONS SHOWN INCOMPLETE. JOB NO. 804-12 NOTES Heeps.dwg 2 INSPECTION SCHEDULE 1. LOCUS IS A.M. 248, PARCEL 270. u°`'Sa°.t N /F CALL R.J. CADILLAC TO 2. ELEVATIONS SHOWN ARE ASSIGNED. a N /F INSPECT PRIOR TO BACKFILL. 3. LOCUS IS IN FLOOD ZONE C ON FIRM DATED JULY 2, 1992. 4. ALL PIPES TO BE 4" SCH 40, AND PITCHED AT 1/4" PER FOOT. (UNLESS NOTED) D OWLI N G ° 5. MUNICIPAL WATER IS AVAILABLE. LOTS WITHIN 100 ARE ON TOWN WATER. N B 0 TTA R 0 6. COMPONENTS TO BE AASHTO H-10, UNLESS NOTED. as a6 7. INLET TEE TO PROJECT DOWN 13", OUTLET TEE DOWN 14". a 8. IF TWO OR MORE LINES, WATER TEST D-BOX FOR EQUAL FLOW D-BOX EXIT PIPES TO BE LEVEL FOR FIRST TWO FEET. BENCH MARK--N.E. CORNER OF 9. DEPTH OF COMPONENTS NOT TO EXCEED 3', OR VENTING MUST BE PROVIDED. NOT TO CONC. BULKHEAD=31.72 ASSIGNED / COVERS: BUILD UP COVERS TO 6" BELOW GRADE--2 ON TANK, 1 ON D-BOX, 1 ON LEACHING SCALE 10. STONE TO BE DOUBLE WASHED 3/4 TO 1 1/2" WITH 2" MIN. 1/8 TO 1/2" PEA STONE ON TOP. LOCATION MAP E o 11. IF UNSUITABLE SOILS, OR SOILS DIFFERING FROM THE SOIL LOG ARE FOUND, N �g'11'15� �\ CONTACT THE BOARD OF HEALTH, OR R.J. CADILLAC. F �(� '1 T 3� 12. IF AN OVERDIG IS CALLED FOR BELOW, FILL MATERIAL FOR 5 AROUND AND UNDER LEACHING 12365 4 \\ \ IS TO BE CLEAN GRANULAR SAND MEETING SPECIFICATIONS OF 310 CMR 15.255(3). TEST HOLE 1 rf \ O \\ N \ 13. PUMP AND FILL ANY EXISTING CESSPOOLS. REMOVE ANY CLOGGED SOIL, BLOCK, AND STONE IN \ LEACH AREA, AND DISPOSE OF AS DIRECTED BY HEALTH AGENT. DEPTH (inches) ELEV.(feet) 01 3 31.1% ��1� \ \ �"� \ 14. ALL CONSTRUCTION TO MEET TITLE 5 AND LOCAL REGULATIONS. 0 31.2 0 _ T H 1 \ \ fill \ TEST HOLE DATE: August 12, 2004 5" BENCH MARK--TOP OF WOOD E layer 10yr 5 2 0 1 PERFORMED BY: Ron Cadillac, Soil Evaluator p -''- d STAKE= 31.37 ASSIGNED loam sand 2A 30,7 X; 0 d # (14'-3" OFF NEAR CORNER DECK) WITNESSED BY: David W. Stanton, RS 8" l PERC RATE: <2'-00"/inch (C layer) B layer 10yr 5/6 1 to SOIL SURVEY(1993): Carver coarse sand sandy loam 30.1 31.5 T.' N GEOLOGIC MAP(1986): Barnstable plain deposits 32" 28.5 \ LOT 10 31.2 NO GRADE CHANGES (20� gravel) 'o N /F ARE PROPOSED Invert 28.06 2 DRY WELLS 46' o_ \ 14, 2 2 0 S. F. o� 31.3 Use Gas Baffle 27 67 C layer 2.5y 6/4 \ F� c� / TU R E TZ K I Proposedj245op Conc. medium sand `sT/ - _ - - op Peastone 10 Existing S=1/4 /ft „ \ �q y� 31.4 Invert 28.31 1000 Gal. S=1/8 / Tank\ 7 30., 8� �/SF Proposed Septic " O .. . ... - - - - 24 144" no water 19.2 �0 �� 30,` Invert 27.84 25.62 \ a. Invert 27.62 O 6 Stone or CompaCt Proposed Proposed Bottom 31 x 31.4 x/ :- .. < 5' Bottom TH1=19.2 \ 0,32 \ > /80.51 DESIGN DATA `° 0 BEDROOMS:30,* 3 .��/�, ^�, 29, GARBAGE GRINDER: No 9, 4 30,8 - o LEACH AREA P0 REQUIRED CAPACITY: 330 GPD x 30,6 O� 30,46 R 1. 30.21 SEPTIC TANK: 1500 GAL. USE 2 DRY WELLS WITH APPROX. 4' OF 9 � 9.9 / BOTTOM LEACHING AREA: 325 SF STONE ALL AROUND TO MAKE A 25' X W 129 8 0 // Ly,90 [(25' X 13')] 13 X 2 DEEP LEACH AREA. 28,9'- SIDE LEACHING AREA: 152 SF RESERVE AREA \ ,Q��Z�2�s 29,4 S �6 15,69 6/ [2(13'+ 25') X 2' DEEP)] Q p0• DESIGN CAPACITY: 352 GPD , USE 2 DRY WELLS SET 4 APART WITH �2 � .48 APROX. 3' STONE ON THE SIDES AND 4' [(325 SF + 152 SF) X .74 GPD/SF] 11TON 2ODE PELENDS TO MAKE A 29' X ACH A. NIB SITE PLAN FOR THIS PLAN IS A VALID COPY ONLY IF IT BEARS AN ORIGINAL RED STAMP AND SIGN R I C H A R D A. & SANDRA K . HEEPS ATURE. LEGEND LOT 109 80 GOAT FIELD LANE, WEST HYANNISPORT, MA TH 1 TEST HOLE LOCATION, NUMBER \ °M L �. AUGUST 26, 2004 SCALE: 1 "=20' W WATER LINE MARKINGS Ac n --G- GAS LINE MARKINGS 4 35779 9.5 X8.7 EXISTING & PROPOSED ELEVATIONS ('X' MARKS POINT) ��cR.c / 4 AEss\0 �6--. EXISTING CONTOUR suRIA" t RONALD J. CADILLAC, PLS, RS $-- PROPOSED CONTOUR �J��j I �t PROFESSIONAL LAND SURVEYOR & REGISTERED SANITARIAN - x - FENCE (IF SHOWN, NOT ALL SHOWN) P.O. BOX 258 0 TREE (IF SHOWN, NOT ALL SHOWN) WEST YARMOUTH, MA 02673 HEALTH AGENT APPROVAL DATE (508) 775-9700 ©2004 BY R.J. CADILLAC PAGE 1 OF 1