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HomeMy WebLinkAbout0043 OAKVIEW TERRACE - Health 43 Oakview Terrace -- Hyannis A = 269 249 I I i i I Commonwealth of Massachusetts F Title 5 Official Inspection Form 's a Subsurface Sewage Disposal System Form -Not for Voluntary Assessments s ,, �✓ice" �'� Property Address f Z. ITQ,� F: Owner Owner's Name information is ��i1• G required for every q � V a 60/ page. City/Town c7LState Zip Code Date o nsp ction Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When filling out forms A. General Information �l /3 � on the computer, use only the tab 1. Inspector: key to move your , cursor-do not Q�/�/ Q lS,e, & use the return Name of Inspector key. Company Name i°o /zo� �a Company Address -- � �� re$aa B/Ls '1 r-IA1 - - oC - City/Town��� ��/�O State` -�� Zip Code ( Y (.[L Telephone umber License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the 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: Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority Inspector'I Signature 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 has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 17 ,�o�Jit�l VS Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 'Fe rr- Property Address Owner Owner's Name information is J �� Qa(OL required for every page. City/Town State Zip Code Date o Ins ection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System ses: I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below. Comments: B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass"section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health,will pass. Check the box for"yes","no"or"not determined" (Y, N, ND)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. ❑ Y ❑ N ❑ ND (Explain below): { t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments Qa 4--vie w -err Property Address S�Y� Owner Owner's Name 40.)6 0� information is f required for every page. Cityfrown State Zip Code Date of ns ection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes(cont.): ❑ 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 ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ 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 ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments Property Address r Owner Owner's Name , information is required for every Gi N✓��I O� " �/ page. Cityrrown State Zip Code Date of I pe tion B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate"Yes" or"No"to each of the following for all inspections: Yes No ❑ 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 or surface waters due to an overloaded or clogged SAS or cesspool ❑ Static liquid level in the distribution box above outlet invert due to an overloaded U or clogged SAS or cesspool ❑ Liquid depth in cesspool is less than 6"below invert or available volume is less than 1/z day flow t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments Property Address Owner Owner's Name ✓\ information is ��/¢ �aG�� //Xv required for every page. City/Town State Zip Code Date of In ec ion B. Certification (cont.) Yes No ❑ Required pumping more than 4 times in the last year NOT due to clogged or bstructed pipe(s). Number of times pumped: ❑ Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ee-10, 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 privy is within a Zone 1 of a public well. ❑ Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ❑ The system is a cesspool serving a facility with a design flow of 2000gpd- / 10,000 ❑ L—y'/ The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a. design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes"or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ` the system is located in a nitrogen sensitive area (Interim Wellhead Protection I E) ❑ 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. t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �f 19G4--yie tv T@r- Property Address S-4Y� Owner Owner's Name information is a 041 f required for every page. City/Town State Zip Code Date o ns ection C. Checklist Check if the following have been done. You must indicate"yes" or"no"as to each of the following: Yes o ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ Were any of the system components pumped out in the previous two weeks? ❑ as the system received normal flows in the previous two week period? El Have large volumes of water been introduced to the system recently or as part of this inspection? Were as built plans of the system obtained and examined? (If they were not available note as N/A) El as the facility or dwelling inspected for signs of sewage back up? [✓� Was the site inspected for signs of break out? ❑ Were all system components, excluding the SAS, located on site? [�❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions,depth of liquid, depth of sludge and depth of scum? Was the facility owner(and occupants if different from owner) provided with El Was on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS)on the site has been determined based on: [� Existing information. For example, a plan at the Board of Health. ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions. - F iF Number of bedrooms (design). — — Number of bedrooms (actual). DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): t5ins.doc-rev.6/16 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System-Page 6 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M Lf3 ©a 4litgc✓ % ✓r- Property Address Owner Owner's Name tJl information is required for every �T page. City/Town State Zip Code Date of Aslaktion D. System nformation Description: / /00o Soo G.r, //.o l GAP#0&7 Number of current residents: Does residence have a garbage grinder? ❑ Yes No Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes No information in this report.) Laundry system inspected? ❑ Yes R--N'o Seasonaluse? ❑ Yes Vo Water meter readings, if available (last 2 years usage (gpd)): Detail: Sump pump? Yes No �L4 Last date of occupancy: Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: — t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments _ [� 'j °M -( �J (9,r-4ey1 e,,,/ T?YID Property Address Owner • Owner's Name � information is /� required for every h page. City/Town State Zip Code Date of sp tion D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: p201 Source of information: Was system pumped as part of the inspection? ❑ Yes to If yes,volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of S 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)and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): I t5ins.doc•rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 17 Commonwealth of Massachusetts -Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �� �3 C>al�liiec✓ ,e✓r- Property Address Owner Owner's Name information is G i#4 y�f /N OP /_G O/ 6 O required for every page. Cityrrown State Zip Code Date Ofinsg6ction D. System Information (cont.) Pet,",f - 0.5-016 �o Approximate age of all components, date installed (if known)and source of information: CV✓� Were sewage odors detected when arriving at the site? ❑ Yes to— Building Sewer(locate on site plan): Depth below grade: feet Material of constructi�40 ❑ cast iron PVC ❑ other(explain): - -- —/- - ---�---) /� T Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): Septic Tank (locate on site plan): ii Depth below grade: feet ;te�rialconstruction: concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: Sludge depth: t5ins.cloc-rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 17 I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ,M �f3 DAt,•y�e�.,✓ Te%.- Property Address Owner Owners Name / / • /�� information is �a [ / V required for every 7page. City/Town State Zip Code Date D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle How were dimensions determined? O Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): fit✓'1 I 4 5 ✓Io Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑concrete ❑ metal ❑fiberglass ❑ polyethylene ❑other(explain): Dimensions: Scum thickness • 4 Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins.doc•rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form R Subsurface Sewage Disposal System Form Not for Voluntary Assessments M 5 ©a►'k11%Yew 7Qor-o— — Property Address �r Owner Owner's Name information is /� required for every �. �+�� f _ �" � _0�)__CQ_/ / page. City/Town C-71— State Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: - Capacity: —---- - gallons Design Flow: -.__ _-_ -._.day _._..--_- - gallons per Alarm present: ❑ Yes ❑ No Alarm level: — Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments Property Address Owner Owner's Name / Q information is required for every page. City/Town State Zip Code Date of I pe Ion D. System Information (cont.) Distribution Box (if present must be opened) (locate on site plan): Depth of liquid level above outlet invert Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): eo-xj AV /" V Z-0,P ------------- - --- - - -- ----- --- _..-...-_:. ---- --. --------- -- -...- Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No` Alarms in working order: ❑ Yes ❑ No* Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): * If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins.doc•rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 17 f Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ©4; Property Address Owner Owner's Name information is required for every H 0 0 V page. CityTrown State Zip Code Date of I pe tion D. System Information (cont.) 101 14 Type: 02- J d // /�N a ls� (� � � ! Ott C/ vh��,f ❑ leaching pits number: ❑ leaching chambers number: ❑ 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.): � ✓f S D� �rAw N c �� /G�r'1C- r Cesspools (cesspool must be pumped as part of inspection)(locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool — Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins.0oc•rev.6/16 - Title 5 Officiai Inspection Form:Subsurface Sewage Disposal System-Page 13 of 17 f Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 6944-P-4e it'll Property Address Owner Owner's Name ,p information is //�� Q�c 0/ 6 l O required for every ✓l� page. City/Town State Zip Code Date of i6spettion D. System Information (cont.) 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.): t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments CAM Property Address ��✓� . Owner Owner's Name //�A information is / required for every R N��S page. City/Town C74State Zip Code Date of 1 sp lion D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view 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. Check one of the boxes below: Pd d-sketch in the area below rawing attached separately 4e, 2 Mx4- t5ins.doc-rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 3, TOWN OF BARNSTABLE : °C' LOCATION .:U Q A k Il i e W 7--ex. SEWAGE # 41919--kl ? VILLAGE fig tlAwh r s ASSESSOR'S MAP& LOT INSTALLER'S NAME E&.PHONE NO. .4 e. d .s t g e/2- S o� SEPTIC TANK CAPACITY ;Zo e 61,o LEACHING FACILITY: (type) - A9 4 jz W e 4 c e (size) /.x - A S ;L NO. OF BEDROOMS BULr DER OR OWNER PERMITDATI;: 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 ficility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by ii 2 O r. t ,�: - � �J VV �. - � _.^, `� � , `s — ._ . � , � �- ,J �°� � r a ._ _�.. z ._ , ., #. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments OQ 4 vlet.,- Teo Property Address / Owner Owner's Name information is /' ' // Oa 6 0/ required for every ( page. CityTrown State Zip Code Date of In ecti n D. System Information (cont.) Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells / Estimated depth to high ground water: feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date ❑ bserved 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 d cribe how y ff u established the high ground waterl elevation: C74- Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 16 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments ,M Da -wew 2rr Property Address Owner Owner's Name /� information is V1 De�f0 0/ required for every _ ! page. CitylTownct State Zip Code Date of Inspection E. Report Completeness Checklist Inspection Summary:A, B, C, D, or E checked Inspection Summary D (System Failure Criteria Applicable to All Systems)completed �em Information—Estimated depth to high groundwater Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 - TOWN OF . BAR�NSTABE .C"�AI1Oh �k �/P �e '• SEWAGE ASSESSOR'S MAP LOT d INSTALLER'S NAME&PHONE NO._:� /,'I N, f +�.� 9 ^y SEPTIC TANK CAPACITY LEACHING F kCU-.rN: ('type) A-:�—ei zSL�i ag:Lc s (size) /;Z ,; A NO.OF BEDROOMS BUL DER OR OWNER PERMIT DATE:—. JWhOr °COMPLIANCE DATE:_----,--,—, Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (U 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 2: 1 1 � f ail API y A • 4r �Y b No. ` / Fee F �/ THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes-.v PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS Zippricatton for �Ngpoar *pgtem Construction i3ermit Application for a Permit to Construct( . )Repair( Upgrade( )Abandon( ) O Complete System ❑Individual Components Location Address or Lot No. Owner's N ,Ad ess and Tel.No. i1 a rU'115 1( 5MC-K gljr"' Assessor'sMap/Parcel ^ � ®CiV,UO�� d� C Installer's Name,Addrqss,and Tel., 0 5� 33 Designer's Name,Addrgss and Tel..N4 J Z "©3 Type of Building: Dwelling No.of Bedrooms Lot Size I 39. sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow .4a Q gallons per day. Calculated daily flow 21,11 14;11 gallons. Plan Date g fl Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. F Description of Soil Nature of Repairs or Alterations(Answer w en 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 i d b th' B o Health. C Signed O AQ== Date Application Approved by Date Application Disapproved for t e following reaso s Permit No. Date Issued wr 40' No. Fee THE COMMONWEALTH OR MASSACHUSETTS Entered in computer: Yes. PUBLIC HEALTH DIVISION- OF BARNSTABLE., MASSACHUSETTS 01ppitcation for Ziqaal bp'ekem Con6tructton Permit Application for a Pen-nit to Construct Repair Upgrade )Abandon( ) El Complete System ,E]Individual Components Location Address or Lot No. �K%j V(w 7f 0�cyl S�&Wqg Addrss and Tel.No. Assessor's Map/Parcel 1 4P 6,a R u I R M +4 40M Jg j^YV InItallp's,N ",,s , Tel.No.jff,Address and Te. P-esigner's Name dd d I YT uMn 5 C Cn 0 gs% Type of Building: Dwelling No.of Bedrooms 'Lot Size j sq.ft. Garbage Grinder Other Type of Building No.of Persons Showers Cafeteria( Other Fixtures gallons per day. Calculated daily flow Design Flow gallons. De sit-/ (D 41 Plan Date oiNumber of sheets Revision Date Title 'A Size of Septic Tank U6-ku%, 1000 !�,qMtl Type of S.A.S. 'L- Description of Soil Nature of Repairs orAlter'a"tions(Answer when applicoble) b, K 0 a to Y) Imo. QYVWYW.5 Date last inspected: 4 Agreedient: 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 Cornpliance',,ras;�,been i r-"l� -d_�Vts Bo _&�o rHeal Signed Wr Date /I's /0 Application Approveld by Date Application Disapproved for the following reaso Permit No..D� U Date Issued I f Yl- A-, j THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance Upgraded THIS IS TO CYTI , that the On-site S ewage PiSl System Constructed Repaired n-, Abafat 4oned by '10 constructed in accoydance Ll 1_//0 with the provisions o� Title N' - ,,5 and the for Disposal System Construction Pernut a. .dated Installer Desig6erl-)- The issuance of this hall no be construed as a guarantee that d,�esystemiwi C�Ifi o n a s�de s i�ned. Date'— V0106 Inspector ————— ——————-- -———————-- No. Fee THE'COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE MASSACHUSETTS Mtqooal *p5tem Construction Permit Permission is herebgan&ted�Monaruct )Re a ( N)Uqgra d Abando[P "V,) T air p System located, 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: Con c/tion 4st be-completed within three years of the date of this Date: L A Approved by F7t4* APR-13-2005 12 :28 PM JCENGINEERING 508 273 0367 P. e3 ti y (7 9l16101 Notice: This Form Is To Be Used For the Repair Of Failed Septic Systems Only PERCOLATION TEST AND SOIL EVAJ.-Ur, ,'.1 :N LXEMPTION JFORM I,����� <<�a✓ltr/,c[ ,hereby certify that th:;onFIneered plan signed by me dated ,i i'oo', concerning the property located at L/ 3 GA lC L)'L'4,\/ %e-gek cr ,;j q,,,,�i; following criteria: • This failed system is connected to a re;idontial d,vcll;:;:;, rlly. There are no commcmial or business uses associated with the dwelling, • The soil is classified as CLASS land the percolation rate: is less than or equal to 5 minutes per inch. The applicant may use histr,rical data to this fact or may conduct deep test holes and percolation tests at the site without nscout present. • There is no increase in flow andlor change in use proposed • There are no variances requested or needed. • The bottom of the proposed leaching facility will_bc located no less than five feet above the maximum adjusted groundwater table elevation. [Adj:i;l t1Ac groundwater table using the Frimptor method when applicable) Please complete the following; A) Top of Ground Surface Elevation(using GlS inforrnation) Z- 5 �/— B) G,W.Elcvabon adjustment for high G,W._11.7 _ • DIFFERENCE BETWEEN A and B 2 2, 3 SIGNED : 1•1 tin 1/ 1 C7 NOTICE Based upon the above information,a repair permit will be isy,ued for bedrooms maximum. No additional bedrooms are authorized in the future without enguleered septic system plans. q:health folder;psroe=p i APR-21-2005 10 :03 AM JCENGINEEPING 508 273 0367 P. 01 'i own of narnstame Regulatory Services t �5L o Thomas F.Geiler,Director Public Health Division Thomas McKean,Director ry 200 Main Street,Hyannis,MA 02601 Office; 508-862-4644 Fax; 508-790-6304 Installer& Designer C.srtiflPati4n_F2r1m Date: 4/- 2 1-C' Desigaer: �rc. �.ni ti e«<n�, �,c:.._ -..._ Insta1.ler e ..... P. �i<<�,�V%b e< --- Address- Z8.79 t_���nbe« 1� �� r_ Address: E. t!wQfctt'10lrl 4tA 0Z,5.3 <<5' Ce�1l2.s�;1le y X 0-26 3Z On`i �✓�4 -_was issued a permit to install a ate) (installer) septic System at '7 j C>>Uk�� e� l�;(�c"� tt o�lYl l S , �((A based un a design drawn by (address)) SC Ln ,^e.r.rin ," v1C. dated �601�,,St i y (designer)- T. l 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 anchor 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 bydesigner-to follow-. {f��._......_ rM na ,�t4 cHUACKLL (Instal er's SlgXlat ire;l -- --- CN41 No. 41807 (Designer's ature) (Affi, esigner's tamp Here) c LEASE RET o BARI�ISTABLE P BLIC �IEAI,TH IDIVISION. CERTIFICATE ®F CO1V1 CE 7LL NOT BE ISSUED UNTIL. BU'Y'H T S gORM A EUIL'I' AR) jBECE �' BY E B ST E Pit IC �AN�'�tOIJ. Q:Health/Septic/Designer C:e,tincation Forrn �i TOWN OF.BARNSTABLE LOCATION :Ll QA Leg- SEWAGE # VILLAGE 9 s ASSESSOR'S MAP& LOT INSTALLER'S NAME&PHONE NO. Z A? A C 6 t SO A, SEPTIC TANK CAPACITY' LEACHING FACILITY: (type) A_ A2 4 ii W 9 4t s (size) NO. OF BEDROOMS BMDER OR OWNERIL PERMITDATE: COMPLIANCE DATE: Separation DistaQce 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 O �. /Taw 011" \ ti /yip a•. �`a\ r. �..-,^�.....:.r.-...,•.,.<•f!'��-+'.+-..pM -^mr,•. .� 'ors^ -.a-.re v[r_„s �r�r�r.�n ri'�^.• z kt�{.,+p`"" -_-..�•.,e��.q�+^ �••r;^"-^e. .y;.•.r ..;n rw.R.... - :�. wr• '' s `��, ,4r, r� �"f(,"-. r f , :t,. - .:s:t �i �.. "1`r;.-?--- s. TOWN OF BARNSTABLE BAR-W Ordinance or Regulation WARNING NOTICE 2694 y� Name of Offender/Manager r" "> ,, Address of Offender hI 3 ; ✓ r , -flefri r r _ MV/MB Reg.# Village/State/Zip > r. .A .+ _ f-t4 Business Name aII% on ' 2011)�- ., Business Address Signature of Enforcing,'Officer Village/State/Zip .0 ; . rid 1 Location of Offense Enforcing Dept/Division Offense h i t/ (1•Atj1 r «•j 1r�o n .P I Facts `'fr,V—� - i - " f.A i!' v y' I This will serve only asta wa'rning. !At/this time no legal action has been taken. It is the goal of Town agencies to achieve voluntary compliance of Town Ordinances, Rules and Regulations. Education efforts and warning notices are attempts to gain voluntary compliance. Subsequent violations will result in appropriate legal action by the Town. WHITE-OFFENDER CANARY-ORD./REG.-PROG. , PINK-ENFORCING OFFICER, GOLD-ENFORCING DEPT. Ki TOWN OF BARNSTABLE BAR-W 3622 Ordinance or Regulation WARNING NOTICE Name of Off ender/Manager ' 51 e r l Zn t, 44 Address of Offender 93 64V,rw Tet ra MV/MB Reg.# Village/State/Zip ,,,• 10A 0.2 C.ta 1 7 ry y j Business Nameam/p on 20 'Business Address.„,, . „V Signature of Enforcing'Officer Village/State/Zip � ian�.e Location of Offense. __3 6fA It d fA.AI 4-a ,r'rK a Enforcing IDdpt/Division Offense' 9v, Facts1�`� i�, � This will serve only asia warrning. /Atjthis time no legal action has been taken. It _is the goal of Town agencies to achieve voluntary compliance of Town Ordinances, Rules and Regulations. Education efforts and warning notices are attempts to gain voluntary compliance. Subsequent violations will result in appropriate legal action by the Town. WHITE-OFFENDER CANARY ORD/REG PROG. PINK-ENFORCING OFFICER GOLD-ENFORCING DEPT. Health Complaints 11-Feb-02 Time: Date: Complaint Number: 3265 Referred To: DAVID.STANTON Taken By: DAVID.STANTON Complaint Type: NUISANCE CONTROL REG. 1. RUBBISH Article X Detail: Business Name: Complaint Description: HAS TRASH PILED UP IN DRIVEWAY Actions Taken/Results: There was some garbage at the end of the driveway, as well as a few scattered pieces in the yard..The homeowners were not available, but I left a notice with the daughter. Bill Robinson will contact me if it is not corrected. 2 photos on file. Investigation Date: 2/8/02 Investigation Time: 3:15:00 PM 4 r 1 LO CAT IO SEWAGE PERMIT NO. VILLA IN LER'S NA VE �&X ADDRESS 3` y fS e C R U I L 0 E R OR OWNER r,r dQp- Iros DATE PERMIT ISSUED DATE COMPLIANCE ISSUED e, 380 t �✓1 \ M 'VJ c in b o... G......_....... Fmc.......` ................ THE COMMONWEALTH OF MASSACHUSETTS BOAR .....OF...... . - - --------- -------- Appliratiou for Disposal Works Tonstrurtion Prrutit App 'cation is/hereby �made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal Syst .. at: ...�1.. 4 --- ...... ... ..... ------ . ---- ------ ` / /��i�► Locatio A ess �' 4� or Lot No. �._..: ......----•...._...---•---•---•.........................•---------................. ner Address a --•-•---•------- _. --.. Installer....... ... --- ............................................Address............................................ QType of Building Size Lot............................Sq. feet U �Dwellng— o. oerooms_________________ _____Expansion Attic Garbage Grinder ( ) �: .___ No. of ersons___________ ___ Other—Type of Building _ _. p __________ Showers Cafeteria ( ) Q' Other fixtures ...................................................-------------- Desi n Flow_ _ � ___ allons per person per day. Total daily flow__________ __ _ W g �'�?quidl� -- g P P P ` Y�o �Y � ��----- -----------l�lona. d/ WSeptic Tank—I_ apacity�V40.gallo s Length__ ' �Vidth.�jL_,! _. Diameter-----___._. llepth__.'s``c ' x Disposal Trench—No -- �/ATotal Length.--------- Total leaching area---- -- ----sq. ft. Seepage Pit No_________ __________ Diame er.__/�}_______.__ Depth below inlet______ __ __ Total leaching area ....sq. ft. Z Other Distribution box ( ) Dosing to ) 14 Percolation Test Results o Performed by------- -•--- - --------- Date-----"' ................... - a Test Pit No. 1... __minutes per inch Depth of Test Pit______ -...... Depth to ground water....... Test Pit No. 2... __..minutes per inch Depth of Test Pit_____._.__"....... Depth to ground water________________________ - - - • - - Description of Soil----------.+ --•---- �.. ... ?f .._...... °.4 -- x - - = ---------------------------------------------- U W ---•-•-- ------- • --------------- ------------ - ----...----------•-------------------•---•--•-••••--•-----•------•------•-•- UNature of Repairs or Alterations—Answer when applicable.______________---------- ________ _________________________________________________________ ---- -----------------------------------------------•---------------------.........................................- Agreement: The enders' ed grees to stall the afo abed In ' dual wa isposal System in accordance with the provisions L T '� 5 he ate Sam ar ode— unde 'gne urtl:er agrees not to place the system in operation until ca of om ce h y e b Ilea h. (y Sied.------•-- ------- -- --......... •---•-•----- ................ rrL_f ate Application Approved By..... a Date Application Disapproved for the following reason __________________________________________________•______...______....._..-____________________.___._....._______ •--------------------- ------------------------------------------------- •---------------------------- ----------------------------------------------------------------------------------------_------ Date PermitNo......................................................... Issued....................................................... Date 0— KzB ................. ............ -T. THE COMMONWEALTH OF MASSACHUSETTS —BOARD F HE T . ............ OF....... . ... . . ......... -------- ................ Appliration for Uhipa.4al Works Tomtrurtion 1hrutit Application is hereby made for a Permit to Construct or Repair an Individual Sewage Disposal Syst at: ................. ---------. .. .......ss 4" ­'—or"Lot"No .... .......... ........... ....... ....... . .. ...... ................ .....................................................I............................................ O ner Address ----------- ..................................................... ------------- Installer Address U Type of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms.................—-_------_-----------Expansion Attic Garbage Grinder Other—Type of Building .... No. of persons.......`________—----------- Showers Cafeteria Other fixtures ...................................................................................................1 .........................*------------------------- Design Flow --gallons per person per day. Total da flow.... -3--3-0-----------_------gallons. i;y ...v, Diameter________________ 1:4 Septic Tank --�i-Tiqu-i:le�-�apDacitfy,/Joil.40.?gallo s Length-_- %idth__y..;.0--- " — Depth....5__4f Disposal Trench—N Total Length................./. Total leaching area -------- .......sq. f t. Seepage Pit No_____________________O��Dz i 7am e It' r.....&--------- Depth below inlet.......4_<......... Total leaching area &0...sq. f t. r... Z Other Distribution box Dosing tan........44 Percolation Test Results Performed by ............ ....... Date----- 01 1 .....I......................... Test Pit No. ...minutes per inch Depth of Test Pit--..-/Z....... Depth to ground water----- 44 Test Pit No. 2........--Minutes per inch Depth of Test Pit---_____ --—_ Depth to ground water----- ................. ................... .............. ............................ ........... .... ............. ...................................................... 0 7 ....... .. .. Description of Soil........... ....... . ..... .....�-1044--- ----------­ ­ ...........................I................0� ............................................ U ..........................................i=.g Soil .... ... ....... ----_ --------- I ......... -------------------- . ......./-3----------- ............................................................................ U Nature of Repairs or Alterations—An'wer when applicable.________________________ --- ---- ---- .................................................... ..................................................................................................................... ... .................................. ...................... Agreement: The undersi ed grees to i stall e afo abed In * dual wav'Oisposal System in accordance with the provisions ii 5 e to Sanitar ode unde igne urther agrees not to place the system in operation until a of o ce h e bo f heawi- 0-e 405V'Lle'. aed---------- - _1_-1 ------- S* ---7A - -------------------------- ----------------- 1)a1e . ApplicationApproved By----.---- .......... . . ......................................... ....... . -------- Date Application Disapproved for the following reason :................................................................................................................ ......................................................................................................................................................................................................... Date PermitNo......................................................... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD .PF HEALTti ...............................OF..... ............................................. ('11rdifiratr of Toutpliana THIS IS TO CERTIFY, That the IM'a* icdual Sem*F by Dispo- k1sm constructed or Repaired . ......................................................................................... .......... ............ _.Jnstaller .............. ............ ... . ..... . ...... ............................................................... at...........tip ......... . ...... .. ...... . .........7 .... ------ has been installed in accordance with the provisions of 5 of he State Sanitary Code as described in the application for Disposal Works Construction Permit Nd .................. d-ated_.A/_6._' ............... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE................................................................................ Inspector................................................................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALT N ......... ............OF ....... ................................ P ... FEE. .................... Dispoal tut Vrrm- it Permission, ssion �Aereby granted--- ... to Cons dct , .......... .. .. .. ............_4..... ....... ........................................................... or R.7e6 F alq Individ ewage Disposal S stem 'd ...... ....... ....... .. ......v....................... a .... tre 24 as shown on the application for Disposal Works Construction Pe fj it No Dated. �...el—OC -------------------------- DATE.......... ---------------------- ....... Boara of Health FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS Ereµ(o&, -;';�1.7."t { ( :`. ?.-:'..: i tt( ; ...�w»a. .....w.�....:..':-;..�..�..`d.. f yfr { ,}iy '� ir ,�::t .s t ,t,: tti .11 sm. .i�.. ":a 56W . 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( k' - r L ,'J f f .,�.li{.�, 11 `h `.,` dY 4 , x y a 5, '��j 1. 1 P �,7l{ �'ft �yy'6ayR,a? , " r 4 r f rr i k - \ xi .t i l 22£f?2�ti`.r�,1',/ , R' ,ff T JN,q-f F 4 / f�bl i01 :}&4ac7�Y�.. 3 v. r ( ip"- @ t a ..\� r�T '���a J/.., ,,fir,1�'t ,��� ' '"', 'i�f.B.K 3t J w ,p"�, F' s � .t ♦ F b��`'1,Ji7 4�� / m is1�`r i t; y,,.� r r: N , et`"ynf7 ✓s,1 i f�,: k ? r ,,, r r ,� .r .;9 i +ire sa aii .1, 7 f i � - I - ' s . 3 i ,y t!, ' " i -<, s ' y ki 3 �` W; •�ti„ ,, t r ar -ri,.' ,tom--....+.-1--,— a .. +vi.` ,n. i,, ✓ @ r�5}a `. LEGEND '� TI IG 'SPOT EL'EVA410N � O,cO � . . CERTIFIED P.LOT,' PL,A ��, ~ 0—ING 'vCON.TOUR`.— =".,. 0 —_— Cor :3Z 0<,„wvlrw Trdz;�J D' SPOT: ELEYA.TION .0 N y 11 NN►5 ° ;,, N , t "CONTOUR: 0 ., _� 6 . { e: r r 1 N . ' 'ICED= BOARD OF " HEALTH ;� na., ' .� s 1 :j' AGENT SCALE )' ,a.4p D s fit:. ' / ) k = ATE 3 ' r 3ar > ' ENG/NEER/NG CO. IN CLIE'NTCpP11"'r'" I CERTIFY THAT, THE PROP <, i 1 T 'RE REOI�TERED J08 N0. B " "" BUILDING SHOWN ON THis PLI� - " i �� Cr1/j LAND T CONFORlbi3 " TO THE tON1Nt �. , �r DR.BY= J- D• 1 4ii E' . R rr SURVEYOR OF BARNS BLE , MAS8. ' . (� F�. r �, 4 1N0 MAIN ST',. ,,,. 712 MAIN ST. CH..BY �' ia 1 r �fAlAAOUTH,''MASS.. HYANN{S, MASS. SHEET-1— OF �' DA E. . 'T� ` � . '::, �x - REO. LANO SUIiVEXR'_.-. � r C'J J r Y -T r O N A iL lb u v ` - J V d:�yr } • • � • •• 1 i 06 it ,{ .• o • o ID Hwb Ya FA to t x $ z ��� � i�� T&M u_ ----------- ------- --- -------- _ _ __ PROVIDE PRECAST CONCRETE 5-DIA. OUTLET(S) TOP OF FOUNDATION = 101 .53' EXTENSION RISER WITH CONCRETE REMOVABLE COVER FINISH GRADE OVER CHAMBERS 97.581 - 99.501 GENERAL NOTES COVER TO WITHIN 6"OF FINISH GRADE SLOPE @ 2% MIN. OVER SYSTEM 1. UNLESS OTHERWISE NOTED,ALL SYSTEM COMPONENTS AND CONSTRUCTION WHEN NECESSARY FINISH GRADE OVER D-BOX=99.50' 4"SCHEDULE 40 PVC MIN SLOPE 1% 3/4"TO 1-1/2" DOUBLE WASHED STONE TO CROWN OF PIPE METHODS SHALL BE IN ACCORDANCE WITH TITLE 5 OF THE STATE FINISH GRADE @ FND. EL. VARIES FINISH GRADE OVER ANK EL.= 99.60 2"OF 1/8"TO 1/2"DOUBLE WASHED STONE ENVIRONMENTAL CODE AND ANY APPLICABLE LOCAL RULES. ----------- ----------- 2. ANY CHANGES TO THIS PLAN MUST BE APPROVED BY THE BOARD 20"MIN.ACCESS PLACE RISERS ON ALL CHAMBERS OF HEALTH AND THE DESIGN ENGINEER. COVER(TYP.) 36'MAX. TOP OF SAS 96.83 TO 6"OF FINISHED GRADE 3- 4"SCHEDULE 40 PVC PIPE WITH WATER TIGHT JOINTS SHALL EXISTING 4" 96.001 9"NIN. BE USED IN DISPOSAL SYSTEM UNLESS OTHERWISE NOTED. 36"MAX. 10 PVC PIPE BREAKOUT EL = 96.50' 4. TO PREVENT BREAKOUT, THE PROPOSED FINISH GRADE SHALL NOT BE LESS THAN PROVIDE WATERTIGHT If, ELEVATION =96.50' FOR A DISTANCE OF 16AROUND THE PERIMETER OF THE SAS. UNLESS 6"1 3- JOINTS (TYP.) 3-DROP MIN. 3" 9" ,,, 7 A 40 MIL GEOMEMBRANE LINER IS PLACE AT LEAST FIVE FEET FROM S.A.S.AND THE TOP OF 6 4-PVC IN FROM 4-PVC OUT TO Cb THE LINER IS NOT LESS THAN THE BREAKOUT ELEVATION. EXT ENSION W O\VER p 10" SEPTIC TANK 0 0 5. SLOPE ALL SOLID PIPE AT 1.0% MINIMUM. (DC> 6. THIS SYSTEM IS NOT DESIGNED FOR A GARBAGE DISPOSAL. 14" \-9(3.52'+ WHIN. " LEACHING FACILITY <:>C:) = = = = = = =(D�93_ 7. LOCAL BOARD OF HEALTH TO BE NOTIFIED PRIOR TO BACK FILLING WHEN CDC>96.27' 96.10' 21OUTLET TEE C>C� C, SYSTEM IS NEARLY COMPLETE AND READY FOR INSPECTION. SYSTEM IS NOT TO CONTRACTOR SHALL 4�" CONTRACTOR SHALL cz)c> (DC:> C)(D, BE BACK FILLED WITHOUT FIRST OBTAINING APPROVAL FROM BOARD OF HEALTH. VERIFY CONDITION OF 6"CRUSHED STONE C> CD 01 8. ELEVATIONS BASED ON ASSUMED DATUM OF 100.00'MSL OBTAINED 14.1 VERIFY SIZE AND EXISTING TEES OVER MECHANICALLY C> 00�3 CONDITION OF AND REPLACE AS COMPACTED BASE FROM A CB/DH AS SHOWN ON PLAN. EXISTING SEPTIC TANK 4.0-1 - 4.0' NECESSARY 8.5' 3.55'1 4.9' 3.55' 9. CONTRACTOR SHALL VERIFY ALL UTILITY LOCATIONS PRIOR TO CONSTRUCTION 5 OUTLET DISTRIBUTION BOX /I _n ) (TYP.) THROUGH DIG-SAFE AT LEAST 72 HOURS PRIOR TO COMMENCING WORK ON SITE TO BE INSTALLED ON A LEVEL STABLE 25.0' AT 1-888-DIG-SAFE AND ANY OTHER APPLICABLE AGENCIES. REPORT ANY BASE. FIRST TWO FEET OF OUTLET C GROUND WATER ELEV.= 89.00' DISCREPANCIES TO THE DESIGN ENGINEER. EXISTING 1000 GALLON CONCRETE SEPTIC TANK PIPES TO BE LAID LEVEL. 94.00' 2 - 500 GAL. CHAMBERS 12.0' 10. ALL JOINTS WHERE PIPE ENTERS AND EXITS CONCRETE LENGTH 81-611 WIDTH 41-101 DEPTH 51-7" CROSS SECTION VIEW 5'MIN. STRUCTURES SHALL BE MADE WATERTIGHT. SEPTIC TANK PROFILE DISTRIBUTION BOX DETAIL CHAMBER DETAILS Z TYPICAL CHAMBER PROFILE CHAMBER END VIEW 11. NO DETERMINATION HAS BEEN MADE AS TO COMPLIANCE WITH DEEDED OR ONING REGULATIONS. OWNER/APPLICANT IS TO OBTAIN SUCH NOT TO SCALE NOT TO SCALE NOT TO SCALE DETERMINATION FROM APPROPRIATE AUTHORITY. ----------- -------- --------------------------- ----------- /W1 1 1 12. ALL SEPTIC SYSTEM COMPONENTS SHALL WITHSTAND H-10 LOADING UNLESS TEST PIT DATA LOCATED UNDER PAVEMENT, DRIVES OR TRAVELED WAYS IN WHICH CASE THEY SHALL WITHSTAND H-20 LOADING. *NOTE: ENTIRE PROPERTY IS LOCATED WITHIN A DEP APPROVED ZONE 11 • AGENT: Unwitnessed 13. DOUBLE WASHED CRUSHED STONE SHALL BE FREE OF ALL DIRT, DUST AND SOIL EVALUATOR: Michael Pimentel FINES. is DATE:- August 11, 2004 14. WHERE REQUIRED, CONTRACTOR SHALL REMOVE ALL LOAM, SUBSOIL AND UNSUITABLE MATERIAL IN AREA BENEATH AND FOR 5 FT. ON ALL SIDES OF TEST PIT#: 1 LEACHING FACILITY. REPLACE ALL UNSUITABLE MATERIAL WITH CLEAN ELEV TOP: 99.50' COARSE SAND FREE FROM CLAY, FINES OR OTHER UNSUITABLE MATERIAL IN ACCORDANCE WITH 310 CMR 15.255(3). ELEV WATER: 89.00' 15. CONTRACTOR SHALL NOTIFY DESIGN ENGINEER OF ANY DISCREPANCIES FOUND IN PERC RATE: <2 Min./In. SITE CONDITIONS FROM THOSE SHOWN PRIOR TO CONTINUATION OF WORK. 00 • 16- PROPOSED PROJECT IS LOCATED WITHIN: DEPTH OF PERC : 52"-70" ASSESSORS MAP 269 PARCEL 249 TEXTURAL CLASS: I 17. OWNER OF RECORD: ZELIAN & LOLA STERK ADDRESS: 277 POSKUS STREET • STOUGHTON, MA 02072 0 99.50* • FEMA FLOOD ZONE C • L Loam 2" 99.33' AS SHOWN ON COMMUNITY PANEL# 25,00010008 C • 18. PLAN REFERENCE: F Fill 1. PLAN BOOK 340, PAGE 92 MAP 269 MAP 269 W PARCEL 248 9. 98.75' 19. DEED REFERENCE: 0 PARCEL 247 1. DEED BOOK 3459, PAGE 10 N/F BETTEN jr W some 0 MAP 269 N/F FAWCETT Organic < r 20. ALL DISTURBED AREAS SHALL BE RESTORED TO ORIGINAL CONDITION. > " ' PARCEL 222-2 6 W 0 00 11 98.58 21. PROPERTY LINE INFORMATION IS ONLY APPROXIMATE. THIS PLAN IS TO BE USED ONLY S88'10'55"E a- % Loamy Sand uj W N/F HOUGHTON FOR SEPTIC SYSTEM UPGRADE. JC ENGINEERING WILL NOT ASSUME ANY LIABILITY 212.54� W A 1 OYR 3/6 LO FOR USES OF THIS PLAN OTHER THAN ITS INTENDED PURPOSE. W 14" 98.33' STONE DRIVE Loamy Sand > B C.0 It A-A p C� 1 OYR 5/6 W W -_W� ____ I - A-A 0)q z _99- • 'ask 5%Gravel # 70 `T O30" 97,00' z EXISTING 1 U00 GALLON C) SEPTIC TANK -IN 0 LOCUS PLAN 52" 95.17' Perc. EXISTING "D BOX"TO q SCALE: 1" 1000' Coarse Sand ------------- Z 70' _Z 93.67' BE ABANDONED cc) I OYR 6/8 EXISTING FENCELINE z C 15%Gravel W EXISTING LEACHING PIT AND SPOILED #4 SOIL TO BE PUMPED, REMOVED, AND W FILLED WITH CLEAN SAND HC2 EXISTING > < j DESIGN DATA 3- BEDROOM EC DWELLING 0 i LEGEND %919 W V) BM 0 7,> TOF = 101.53' MAP 269 No Groundwater or 0/) a ui 126"' 1 89.00' 50 EXISTING CONTOUR 'q-c:> Moffling Observed CB/DH tv 70 - 0 C) 09 CB/DH 7`�11 PARCEL 250 PROPOSED SPOT GRADES Elev. = 100.0 z50 Assumed TND)- BH HC1 N/F ROBINSON NUMBER OF BEDROOMS (ASSESSORS) 3 11 70 NUMBER OF BEDROOMS (DESIGN) 3 50 PROPOSED CONTOUR 2) TP1 70, DESIGN FLOW 110 GAUDAY/BEDROOM 3) 19-11 EXISTING WATERLINE TOTAL DESIGN FLOW 330 GAUDAY �-'-`MAP 269 Q0 99x50 DESIGN FLOW X 200 % = 660 GAUDAY PROPOSED -1 PARCEL 249 USE EXISTING 1000-GALLON SEPTIC TANK E/T/C EXISTING OVERHEAD UTILITIES 0 DISTRIBUTION BOX ... 91- iv12,632 SQ. FT. ........ .. ........ ----- 10.5' ........ .. . TEST PIT LOCATION .01 CB/DH 01 EXISTING 1000 GALLON SEPTIC TANK MAP 269 (FN S8801 0'55"E INSTALL 2 - 500 GAL. CHAMBERS T7 102.34' 4'SOLID SCHEDULE 40 PVC PIPE PARCEL 222-1 CB/DH N/F PASQUERELLA MAP 268 EXISTING TREELINE (FND) MAP 268 SIDEWALL CAPACITY 13 DISTRIBUTION BOX PARCEL 284 PARCEL 283 500 GAL. LEACHING CHAMBER N/F LOFTUS N/F LOFTUS (LENGTH +WIDTH)(2)(2'HIGH) (.74 GPD/S.F.) = GAUDAY PROPOSED 2-500 GALLON (25.0'+ 12.0') (2)(2') (.74 GPD/S.F.) = 109.5 GAUDAY LEACHING CHAMBERS BOTTOM CAPACITY (LENGTH x WIDTH) (.74 GPD/S.F.) = GAUDAY REV. DATE BY APP'D. DESCRIPTION (25.0'x 12.0') (.74 GPD/S.F.) = 222 GAUDAY PROPOSED SEPTIC SYSTEM UPGRADE TOTALS: PREPARED FOR: DESCRIPTION HC1 HC2 JACK STERK LEACHING CORNER(1) 35.2' 55.1' TOTAL NUMBER OF CHAMBERS: 2 LOCATED AT TOTAL LEACHING AREA: 448 SQ.FT. LEACHING CORNER(2) 283 43.2' TOTAL LEACHING CAPACITY: 331.5 GALJDAY 43 OAKVIEW TERRACE LEACHING CORNER(3) 51.9' 46.5' IHYANNIS, MA 02655 LEACHING CORNER(4) 56.0' 577 ----- SCALE: 1 INCH 20 FT. DATE: AUGUST 17, 2004 0 10 20 40 80 FEET JOHN IL PREPARED BY: JC ENGINEERING, INC. CiVil No 41K7 2854 CRANBERRY HIGHWAY SITE PLAN- EAST WAREHAM, MA 02538 SCALE: 1"=20' 508.273.0377 Checked By:JLC JOB No.706 Drawn By: MCP Designed By:MCP