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HomeMy WebLinkAbout0083 MITCHELL'S WAY - Health 83 MITCHELLS WAY HYANNIS A = 290 153 f Sep-05-01 14: 53 BARNSTABLE HEALTH DEPT 5087906304 P.01 �oFY KWEro Town of Barnstable Regulatory Services r • SARNSTABL.£. y HAsa �, Thomas F.Geiler,Director i6S9• �e �Fo►��" Public Health Division Thomas McKean, Director 367 Main Street, Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6 DATE: CO v-vYA' =r Q 7 RE: 3 �� � ►� The Barnstable Health Division has reviewed the Title 5 septic inspection form for the above referenced property. . The following comments listed below are deficiencies according to 310 CMR 15.300 and the Town of Barnstable Health regulations. Please re- inspect the system, if necessary, complete a new report farm or revise the pages pertinent to the deficiencies listed and resubmit the report to this office within fourteen (14) days: �CLI sepdefdoc M , , _ _ r _ `� r c _ _ .__i_ r 4 t �Y y ^r - Z� r. a f f x- .. �,,., �...ri': COMMONWEALTH OF MASSACH USETTS " EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION RECEIVED 350 MAIN STREET WEST YARMOUTH,MA AUG. 0 3 2001 • �O 508-775-2800 3 TOWN OF BARNSTABLE HEALTH DEPT. TITLE 5 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 83 MITCHELLS WAY HYANNIS,MA 02601 Owner's Name: MICHELLE GILBERT Owner's Address: 83 MICCHELLS WAY HYANNIS,MA 02601 Date of Inspection JULY 25,2001 Name of Inspector:(please print) JAMES D.SEARS Company Name:, A&B Canco Mailing Address: . 350 Main Street West Yarmouth,MA 02673 Telephone Number: 508-775-2800 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 function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: X Passes Conditionally Passes Needs Further Evaluation by the Local Approving Authority Fails Inspector's Signature: Zem Date: The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent tot he buyer,if applicable,and the approving authority. Notes and Comments ****This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future under the same or different conditions of use. Title 5 Inspection Form 6/15/2000 1 Page 2 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 83 MITCHELLS WAY HYANNIS,MA 02601 Owner: GILBERT,MICHELLE Date of Inspection: JULY 25,2001 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: X I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B. System Conditionally Passes: N/A One or more system components as described in the"Conditional Pass"section need to be replaced or repaired. The system,upon completion of the replacement or repair,as approved by the Board of Health,will pass. Answer yes,no or not determined(Y,N,ND)in the for the following statements. If"not determined" please explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not)is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with 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. k 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 inspectipn if(with approval of Board of Health): broken pipe(s)are replaced obstruction is removed distribution box is,leveled or replaced ND explain: The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health)" broken pipe(s)are replaced obstruction is removed ND explain: Title 5 Inspection Form 6/15/2000 2 o Page 3 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(CONTINUED) Property Address: 83 MITCHELLS WAY HYANNIS,MA 02601 Owner: GILBERT,MICHELLE Date of Inspection: JULY 25,2001 C. Further Evaluation is Required by the Board of Health: N/A Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health,safety,or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health safety and the environment: Cesspool or privy is within 50 feet of a surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or salt marsh 2. System will fail unless the Board of Health(and Public Water Supplier,if any)determines that the system is functioning in a manner that protects the public health,safety and environment: The system has a septic tank and soil absorption system,(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. The system has a septic tank and SAS and the SAS is within a Zone 1 of public water supply. The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance *x 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: Title 5 Inspection Form 6/15/2000 3 Page 4 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(CONTINUED) Property Address: 83 MTTCHELLS WAY HYANNIS,MA 02601 Owner: GILBERT,MICHELLE Date of Inspection: DULY 25,2001 D. System Failure Criteria applicable to all systems: N/A You must indicate"yes" or"no"to each of the following for all inspections: Yes No X Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ` X Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool X Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool X Liquid depth in leaching is less than 6"below invert or available volume is less than''/,day flow X Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped X Any portion of the SAS,cesspool or privy is below high ground water elevation N/A Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply N/A Any portion of a cesspool or privy is within a Zone 1 of a public well N/A Any portion of a cesspool or privy is within 50 feet of a private water supply well N/A Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. (This system passes if the well water analysis performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal or less than 5 ppm,provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form.) NO (Yes/No)The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CUR 15.303,therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E. Large Systems: N/A To be considered a large system the system must service a facility with a design flow of 10,000 gpd to 15,000 gpd. You must indicate either"yes" or"no to each of the following: (The following criteria apply to large systems in addition to the criteria above) Yes No the system is within 400 feet of a surface drinking water supply the system is within 200 feet of a tributary to a surface drinking water supply the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area—TVPA)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 is 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. Page 5 of I I Title 5 Inspection Form 6/15/2000 4 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE'DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 83 MITCHELLS WAY HYANNIS,MA 02601 Owner: GILBERT,MICHELLE Date of Inspection: JULY 25,2001 Check if the following have been done. You must indicate"yes or"no"as to each of the following Yes No X Pumping information was provided by the owner,occupant,or Board of Health X Were any of the system components pumped out in the previous two weeks? X Has the system received normal flows in the previous two week period? X Have large volumes of water been introduced to the system recently or as part of this inspection. X Were as built plans of the system obtained and examined?(If they were not available note as N/A) X Was the facility or dwelling inspected for signs of sewage back up? X Was the site inspected for signs of break out? X Were all system components,excluding the SAS,located on site? X 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 ofgliquid,depth of sludge and depth of scum X 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)has been determined based on: Yes No X Existing information. For example,a plan at the Board of Health. X Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable)[310 CMR 15.302(3Xb)] Title 5 Inspection Form 6/15/2000 5 Page 6 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART,C SYSTEM INFORMATION Property Address: 83 MITCHELLS WAY HYANNIS,MA 02601 Owner: GILBERT,MICHELLE Date of Inspection: DULY 25,2001 FLOW CONDITIONS RESIDENTIAL Number of Bedrooms(design): 3 Number of bedrooms(actual): 3 DESIGN flow based on 310 CMR 15.203(for example:110 gpd x#of bedrooms: 330 Number of current residents: 4 Does residence have a garbage grinder(yes or no): NO Is laundry on a separate sewage system(yes or no): NO [if yes separate inspection required] Laundry system inspected(yes or.no): YES Seasonal use(yes or no): NO Water meter readings,if available(last 2 years usage(gpd)): Sump pump(yes or no) NO ^ Last date of occupancy: PRESENT COMMERCIALANDUSTRIAL Type of establishment: Design flow(based on 310 CMR 15.203): Basis of design flow(seats/persons/sgft,etc.): Grease trap present(yes or no): Industrial waste holding tank present(yes or no):, Non-sanitary waste discharged to the Title 5 system(yes or no): Water meter readings,if available: Last date of occupancy/use: OTHER(describe): GENERAL INFORMATION Pumping Records Source of information: N/A Was system pumped as part of the inspection(yes or no): NO If yes,volume pumped: gallons—How was quantity pumped determined? Reason for pumping: TYPE OF SYSTEM X Septic tank,distribution box,soil absorption system Single cesspool Overflow cesspool Privy Shared system(yes or no)(if yes,attach previous inspection records,if any) Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) -Tight tank Attach copy of the DEP approval Other(describe): Approximate age of all components,date installed(if known)and source of information: 1999 PERMIT#99-274 Were sewage odors detected when arriving at the site(yes or no): NO Title 5 Inspection Form 6/15/2000 6 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 83 MITCHELLS WAY HYANNIS,MA 02601 Owner: GILBERT,MICHELLE Date of Inspection: DULY 25,2001 BUILDING SEWER(locate on site plan): N/A Depth below grade: Materials of construction: Cast iron _ 40 PVC _ other(explain) Distance from private water supply well or suction line: Comments(on condition of joints,venting,evidence of leakage,etc.): SEPTIC TANK(locate onsite plan): X Depth below grade: 14" Material of construction: X concrete metal fiberglass polyethylene , other(explain) If tank is metal list age: Is age confirmed by a Certificate of Compliance(yes or no): (attach a copy of certificate) Dimensions: 1,500 GALLON PRE CAST Sludge depth: 2" Distance from top of sludge to the bottom of outlet tee or baffle: 34" Scum thickness: F, Distance from top of scum to top of outlet tee or baffle: 9" Distance from bottom of scum to bottom of outlet tee or baffle: III,,- How were dimensions determined: ASBUILT AND TAPE Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.):, TANK AT WORKING LEVEL.INLET TEE,OUTLET TEE.TANK AND COVER 14"BELOW GRADE. TANK SHOULD BE PUMPED. NOTE TANK WILL BE PUMPED AFTER INSPECTION. GREASE TRAP(located on site plan) . N/A Depth below grade: Material of construction: concrete metal fiberglass _ polyethylene other (explain): ` Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping: Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): Title 5 Inspection Form 6/15/2000 7 Page 8 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 83 MITCHELLS WAY HYANNIS,MA 02601 Owner: GILBERT,MICHELLE Date of Inspection: JULY 25,2001 TIGHT or HOLDING TANK: N/A (tank must be pumped at time of inspection)(locate on site plan) Depth below grade: Material of construction: concrete metal fiberglass polyethylene other(explain) Dimensions: Capacity: gallons Design Flow: gallons/day Alarm present(yes or no) Alarm level: Alarm in working order(yes or no): Date of last pumping Comments(condition of alarm and float switches,etc.): DISTRIBUTION BOX: X (if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: 0 ' 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.,): DISTRIBUTION BOX NOTED ON ASBUILT,DID NOT OPEN. PUMP CHAMBER: N/A (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.): Title 5 Inspection Form 6/15/2000 8 a Page 9 of 11 OFFICIAL INSPECTION FORM_NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 93 MITCHELLS WAY HYANNIS,MA 02601 Owner: GILBERT,MICHELLE Date of Inspection: JUL.Y 25,2001 SOIL ABSORPTION SYSTEM(SAS): X (locate on site plan,excavation not required) If SAS not located explain why: Type leaching pits,number: X leaching chambers,number: 2 leaching galleries,number leaching trenches,number,length leaching fields,number,dimensions: overflow cesspool,number: innovative/alternative system Type/name of technology: Comments(note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation,etc.) LEACHING IS TWO(2)500 GALLON PRE CAST CHAMBERS. LEACHING IS 33"BELOW GRADE WITH COVER 16"BELOW GRADE. 2"WATER IN LEACHING.WALL CLEAN,NEW. NO HIGH STAIN LINE. CESSPOOLS' N/A (cesspool must be pumped as part of inspectionXIocate on site plan) Number and configuration: Depth—top of liquid to inlet invert: Depth of solids layer: Depth of scum layer: Dimensions of cesspool: Materials of construction: w Indication of groundwater inflow(yes or no): Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation etc.): PRIVY: N/A (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.) Title 5 Inspection Form 6/I5/2000 9 Page 9 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address_: 83 N1ITCHELLS WAY HYANNIS,MA 02601 Owner: GILBERT,NIICHELLE Date of Inspection: DULY 25,2001 SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. GpRg G= FR o,vT s•s �f O �?g 5V 33 O . I Title 5 Inspection Form 6/15/2000 10 Page 11 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 83 MITCHELLS WAY HYANNIS,MA 02601 Owner: GILBERT,MICHELLE ° Date of Inspection: DULY 25,2001 SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to no groundwater 10 feet Please indicate(check)all methods used to determine the high ground water elevation: Obtained from system design plans on record-If checked,date of design plan reviewed: X Observation site(abutting property/observation hole within 150 feet of SAS) Checked with local Board of Health-explain: Checked with local excavators,installers-(attach documentation Accessed USGS database-explain: You must describe how you established the high ground water elevation: TEST HOLE 10'NO WATER,TEST HOLE 5'BELOW BOTTOM OF LEACHING. Title 5 Inspection Form'6/15/2000 11 23 TOWN OF BARNSTABLE - LOCATION "' y SEWAGE # VILLAG ASSESSOR'S MAP & LOT � INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY ] �� z LEACHING FACII.TTY: (type) r; �` ✓^ I (size) NO.OF BEDROOMS BUILDER OR OWNER i" Z r .1 �, 01 PERMTTDATE: 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 j Edge of Wetland and Leaching Facility(If any wetlands exist within 30,feet of leaching facility) Feet Furnished by <; a I r1 #23 TOWN OF BARNSTABLE LOCATION + A �' � . , �� �'' SEWAGE # VILLAGE 0 i-i ASSESSOR'S MAP& LOT ! + INSTALLER'S NAME&PHONE NO. L� SEPTIC TANK CAPACITY a LEACHING FACILITY: (type) Ck i (size) ' 124. NO.OF BEDROOMS 3ii _ BUILDER OR OWNER t 1 A-) PERIvIITDATE: COMPLIANCE DATE: Separation Distance Between the: ; Maximum Adjusted Groundwater.Table to the Bottom of Leaching Facility Feet Private VI/atei Supply Well and Leaching Facility (If any wells exisc�" on site or within 200 feet of leaching facility),-, Feet Edge of„V1!etland and.Leaching Facility(If any wetlands exist within 3001 Cof leaching facility)' . ' Feet Furnished by s t 1 Ir,.��: w No. ! rJ771LFee f THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS . � 760-1— ZippYtcatton for MtopogaY *pgterrt Con!5tructton Permit Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. & r-r, t tt t PI I W#i —H4 Owner's Name,Address and Tel.No. 0 C- 33q, _7S)S Assessor's Map/Parcel �l I 5 ` 'Vr 0 (�P»I Ye, �4M e S;` Installer's Name,Address,and Tel.No. Designer' Name,Address an�Tel.No., 5sq,5 Qwe eg 3* 6 tb.6.�0.1wm0u Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building ffl( m e�- No.of Persons Showers( /) Cafeteria( ) Other Fixtures (� Design Flow gallons per day. Calculated daily flow ° 7 gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank 1 �;O® Type of S.A.S. Ek 0.?n h e r So 8 Description of Soil Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construct' and mainten a of the afore described on-site sewage disposal system in accordance with the provi ' s o o e ironmental a and not to place the system in operation until a Certifi- cate of Compliance has bee issued by t ' oard f Healt Signed Date Is �/ '� � Application Approved by 9&iV1 Date Application Disapproved for the ollowmg rea s Permit No. J- 7 y Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of (Compliance THIS IS TO CERTIPYPat the On-site wa Di osal System Constructed(t [')Repaired( )Upgraded( ) Abandoned( )by at has been constructed in accordance with the provisions of Title 5 and the for Disposal System CokilructioVPennit No. dated Installer Designer The issuance of this permit sha be o strue s a guarantee that the sys functi n as des Date Inspector r� No. ", Fee f G THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS 0[portcation for Migofml *p5tem Construction Permit Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) ❑Complete System. El Individual Components t - Locition Address or Lot No. g �j PI t W H4 Owner's Name,Address and Tel.No. 'FF0 0- B a 7\ -M S Assessor's M p/Parcel " 0 �C:' e ( (e y T YQi b r�0" 6 -W.—0Ve k )q Installer's Name,Address,and Tel.No. Designer's N e,Address and Tel.No. �r� � ry (Y1� .,3oF o�J. `t�l�vnouT� �ol. ` bk U0}C (, 5 (:Uffpe.�nfArrr/1 h�X} U�-S'7l �r�a w s b S3 Type of BuWding:„' ! ;- Dwelling" —" No.of Bedrooms Lot Size_ sq.ft. Garbage Grinder( ) Other Type of Building `f ,Q�Yn R.o No.of Persons Showers Cafeteria'( ) Other'Fixtures Design Flow C) gallons per day. Calculated daily flow . 4!F gallons. Plan Date /0-off$ 9 Number of sheets Revision Date Title Size of Septic Tank I SO O Type of S.A.S. a-m L P r(.0 S 61) ., Description gf Soil l, Nature-of Repairs or Alterations(Answer when applicable) r.., a'z ! RYA^k h ~"' Date last nspected 's :.�0 Agreement: The undeisigned agrees to ensure the construct and mainten e of the afore described on-site sewage disposal system in accordance with the provi ' hiso�'Thle5 0 vironmental a and not to place the system in operation until a,,Certifi cate of Compliance has bee issued by t ' oard f Healt . Signed _ Date Application Approved by / Date Application Disapproved for the following rea s a Permit No. Date Isstled THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance k� THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed( )Repaired ( )Upgraded( ) Abandoned( )by at has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. dated Installer Designer n u.y The issuance of this permit sha be to/strue as a guarantee that the sy _will functi�oyn as desg Date ' Inspector d t Y ill v t� No. Fee a. THE�COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS Migoar 6potem Construction Permit Permission is hereby granted to Construct( )Repair( )Upgrade( )Abandon( ) System located at 5��j. 62� 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 permit. Date: �i�'`� Approved by v l 9. g� ti 162. 32 11 n PA �" OPOSEp � 7E--�E9�yICE tz . 00 O D o j � min. � Q � c � o S. T. Q D.B. LOT 3 11663t_ S. F. 112. 17 Y . THE FOUNDATION SHOWN ON THIS PL AN WAS L OCA TED BY AN INSTRUMENT SURVEY ON 515199 AND EXISTS ON THE GROUND AS SHOWN. PAULR. s , �/� PYLL No.32448 DATE PROFESSUONAL LAD S RVEY017 4 1 PLOT PLAN - LOT 3 MI TCHEL L S WA Y, BARNSTABL E, MA SCALE I " = 30 ' MAY 5, 1999 CANAL LAND SURVEYING 306 OLD PL YMOUTH ROAD, BUZZARDS BAY, MA PROJECT NUMBER 99-040-03 o G 11- tiA�fL E 4- GENERAL NOTES.' •ror �ou�b�Y�o�-� t� ou-n�-T- Y'E SOIL TEST PIT DATA 1. THIS PLAN IS FOR THE DESIGN AND '��-' "- g ' 40 CONSTRUCTION OF THE SEWAGE DISPOSAL INVERT ELEVATIONS." G D. ELEV. G D ELEV. FACILITY OX Y. INVERT AT BUILDING q 00 G. W. EL Ell. G. W. ELEV, 2. ALL CONSTRUCTION METHODS, MA TERIAL S AND INVERT IN A T SEPTIC TANK 7.3,15 MAINTENANCE FOR THE SEPTIC SYSTEM SHALL INVERT OUT A T SEPTIC TANK '2 3 5y 27 ACCESS COVERS MUST BE WITHIN 6 ' OF FINISH GRADE. CONFORN vs BOARD OFT HEAL TH REGULA TIONSI TL E 5 AND LOCAL INVERT IN A T DIST. BOX �� 3 °`s �� INDICA TES '4 qq-0 3 O V A 9.L�_S .PERC. TEST 3. ALL SEPTIC SYSTEM COMPONENTS SUBJECT TO INVERT OUT A T DIST. BOX 3 •2 b _ Z , 23 2 0 L 2 G •5l� VEHICLE LOADING (I.E. UNDER DRI VEWA YS, ETC.) INVERT IN A T S.A. S. 'Z 3 . 00 - MIN. 2 OF SHALL BE DESIGNED TO WITHSTAND H-20 LOADING. 21,o� 75 4' MIN. 0 0 1/B -1/2 DIA. BOTTOM OF S,A. S. - WASHED STONE INDICATES L IGUID ,4. ALL SEWER PIPE SHALL BE SCHEDULE d0 OR OBSERVED GROUNDWA TEA o 2 OBSERVED APPROVED EOUAL. J0 ,, DEPTH DIST. GROUND✓A TER ADJUSTED GROUNDHA TEA min, r 0 D BOX N W w 3/4"-! !/2' DIA. p 5. BEFORE STARTING CONSTRUCTION CALL DIG SAFE --�} SAL. p MASHED STONE 1-800-322-4844 FOR CA TION OF SEPTIC TANK a SEPTIC TAAK N D-BOX TO BE SET,ON A Z)•0O ` I TEST PIT 6. UNDERGROUND UTIL ITIES 6. DATUM IS ArSS u M 6' BED OF COMPACTED G?9LCSHED S.%ONE. CONTRACTOR TO WA TEA TEST D ROX TO PROP. S.A.S, j 7. NO DETERMINA TION HAS BEEN MADE AS TO COMPL IANCE SNOW LEVELNESS. WITH DEED RESTRICTIONS 0,9 ZONING REGULATIONS. IT SHALL REMAIN THE OWNER'S RESPONSIBILITY TO OBTAIN ALL REOUIRED PERMITS, SPECIAL PERMITS, S (l l ( (I DA TE.• VARIANCES, ETC. FOR THIS PROJECT. 6. IT SHALL REMAIN THE OWNER'S RESPONSIBILITY N0. r-�-' �� (I, Z TEST BY.• TO HA VT THE PROPOSED DWEL L ING FOUNDA TION S 0 DESIGNED TO ACCOUNT FOR THE EXISTING GRADF WITNESSED BY.' AND SOIL CONDI TIONS A T THE L OCA TION OF THE PROPOSED DWELL ING. S'S ' z(�r ,v'3 S�� PERC. RA TE MIN./ IN. ?q s Z 3,j 3 cc Zz,s q v n s -Ta 5 `' ' �, DESIGN CRI TERIA.' Z 25 r1 nJ t h N n �� 40, 5� 6 DESIGN FLOK ' �_ BEDROOM DWEL L ING ? 110 GAL/DA Y PER BEDROOM Svrtt 'liAtL S�auES �� �1, S � 17 ' EOUALS �_ GALS. PER DAY. iB,S" ► Lo �,3a GA::,rR,wA-GlC-, 6Cz.�o��EiZ j SEPTIC TANK REGUIRED•- 3 GPD X,Z01OX n �.�0_. GAL. t s 'D -15ox SEPTIC TANK PROVIDED.' a L500 GAL. ►.fir I+U h 7.�Q E n� ,C1� - I SIZE OF LEACHING FACILITY REOUTAFD C a\/iti t,, � 3• � 13 J PivoPoSa .� - - -- - ' N ES/1'NCH 15 - © GALLONS PER DAY PERC TEST RESULTS SIZE OF LEACHING FACILITY PROVIDED.' ---s--�o- 5"oc� G�rLl.�o..r GA-F� �`'� PERC RATE : itict� W H I T N E S S E 0 B Y : T b�� _(�I c-K E.o►,j_ SIDE-WALL ) z- S.F. X 4-- 7 - L�l GPD —._ BOARD OF HEALTH BOTTOM '326 S.F. X -24D GPD DATE : _ . Z-7_.'8 TOTALS 4-7-7 S.F. 352- GPD w� •� _ REVISIONS.' J62. 32 119. 1 f NO. DA TF_ REVISION 18. tie h r'l3� t 0 . 9 h min20 _ P/ _.--✓ o � � . �o _ o N o ^ S. T. Q \fit r \'y f �•�' LOT 3 � - 3' L ti' FLAN SHO6�ING THE DESIGN OF A PROPOSED 2 .11663t, S. F. RY1 - ., f4o , ��} " �: SUBSURFACE SEPTIC DISPOSAL SYSTEM L OT 3, MI TCHELL S hA Y, BARNSTABLE, MA SCALE -1 " 30 ' MA Y 14, 1999 CANAL LAND SURVEYING 306 OLD PL YMOUTH ROAD, BUZZARDS BAY, MA