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HomeMy WebLinkAbout0086 OAKVIEW TERRACE - Health 86 OAKVIEW TERRACE,HYANNIS A= 268 300 - ,;5� i I e TOWN OF BARNSTABLE LOCATION e-SEWAGE# VILLAGE ASSESSOR'S MAP.&PARCEL INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY.(type)C��.G��\� C ,�„� _5size) NO.OF BEDROOMS OWNER PERMIT DATE: COMPLIANCE DATE: Separation Distance Between the: \ f Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility J • e'1 Feet Private Water Supply Well and Leaching Facility(If any wells exist or' 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 L �_ ACN }-J� W 6 � vo Q O (j Lt w y No. �O � -- Fee l THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS Wnation for Misposal *pstrm Construction Vertmt Application for a Permit to Construct( ) Repair( ) Upgrade(Abandon( ) ❑Complete System Individual Components Location Address or Lot No. Owner's Name,Address,and Tel.No.Sb?% 7`Q Q -Y o2(� Assessor's Map/Parcel Installer's Name Address,and Tel.No. Designer's Name,Address and Tel.No.57'-3<Z_32I•,( 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(min.required) 33 O gpd Design flow provided 3��a . u� gpd Plan Date 2 W `a Q�5- Number of sheets Revision Date Title / 1� 1 Size of Septic Tank o�nO Type of S.A.S. 0- S'o 50d ` Description of Soil�S�a=e Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. Signed Date r 3 l Application Approved by �- S Date Application Disapproved by Date for the following reasons Permit No. 0-d 1 5 r Date Issued �� t . d Fee No. THE;COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS +}d 4plitation for disposal *pstem Construction Permit Application for a Permit to Construct( ) Repair( ) Upgrade(Abandon( ) ❑Complete System 52 Individual Components Location Address or Lot No. QG p,n,KV;=cJ Tat,Tr-AGe Owner's Name,Address,and Tel.No. ,I 5 Assessor's Map/Parcel `a(o 3CQ Installer's Name Address,and Tel.No. Spa - Designer's Name,Address and Tel.No.5M�Q-3,-33F I Co. k �� �c . Sa�.eQ CD;�53 Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder Other Type of Building No.of Persons Showers( ) Cafeteria( ) Othezj-.�ixtures Design Flow(min.required) 33 0 gpd Design flow provided 3�(� . S_ gpd Plan Date �` `a� l a 0 l j Number of sheets Revision Date Title -' Size of Septic Tank 0Q0 _5 Type of S.A.S. Description of Soil S:-P Nature of Repairs or Alterations(Answer when applicable)y n S d c,� W„,c- �� - Coro f L"�L L•d�� J`S cJt� f s� ���c�2 Date last inspected: Agreement: i The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. Signed �'`- Date 3 l Application Approved by S Date - 5 Application Disapproved by 14 Date for the following reasons Permit No. a`V i 5 b Date Issued 1 l THE COMMONWEALTH OF MASSACHUSETTS a, BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired( ) Upgraded( ) Abandoned( )by� �X.kQ��f` ��,vuzw_\ �.r,rz at � �v v`C.�� ��r<NOC2, has been constructed in accordance ' with the provisions of Title 5 and the for Disposal System Construction Permit No. s-0� dated 9-3 a / 5 Installer�C�n�.r r ��(' '`~drl�ciaic" y��. Designer �,,t<,r - i- #bedrooms Approved design flow ) 1 0 and The issuance of this pe its all not be construed as a guarantee that the system w'% fu �tiion as des gned. Date y � (� Inspector --------- ------------------------------------------------------ -- No. ;G 15 , b 7)-- Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION- BARNSTABLE,MASSACHUSETTS ,r Misposal *pstrm Construction Permit Permission is hereby granted to Construct( ) Repair( ) Upgrade V Abandon( ) System located at ��L�`,c \ke P I`b4Z e / b wy"% and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction must be completed within three years of the date of this permit. Date — 3 ( Approved by f Town of Barnstable .�ILI�TO .o Regulatory Services Richard V. Scali,Interim Director sntuv�rnste. MASS. Public Health Division i6 3� ,�� �sn 39. Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Installer&Designer Certification Form Date: Sewage Permit# Assessor's Map\Parcel S& ®D Designer: Kt ripe- c M1 UVIG-, Installer: Address: R) g6A Address: On was issued a permit to install a (d te) (installer) septic system at Nq (AWE-W TEVA-U; based on a design drawn by (address) tl P� t,- C11 �llw3 dated 3 l (designer) DCVrYP-,t\ I certify that the septic system re erenced 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. Strip out (if required) was inspected and the soils were found satisfactory. I certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system) but in accordance with State&Local Regulations. Plan revision or certified as-built by designer to follow. Strip out(if required) was inspected and the soils were found satisfactory. I certify that-the system referenced above was constructed_incompliance with the terms of the INA approval letters (if applicable) or z, DA yG (Installer's Signature (Designer's Signature) NlTARiP� I��i� PLEASE RETURN TO BARNS LE PUBLIC HEALTH DIVISION`. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS- BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. Q:\Septic\Designer Certification Form Rev 8-14-13.doc . L Town of Barnstable Pit ..Department of Regulatory Services . HAartaTAeLA . Public Health Division Date � 16jq A�� 200 Main Street,Hyannis M 02601 ,erEl► ,a Date Scheduled— / (� Time Fee Pd. v � r Soil Suitability Assessment fog- Se Se e Ibis a a art Performed By: Witnessed By: LOCATION& GENERAL INFORMATION Location Address Owner's Name Ro (3e of Address Assessor's Map/Parcel: ���� Engineer's Name VV1,-eX So,-.S, O NEW CONSTRUCTION REPAIR Telephone# S��' J �� COO O Land Use. tom) l 1�E,), 1 l Slopes 1q� 0 Surface Stones Distances from: Open Water Body } a ft- Possible Wet Area > � ft Drinking Water Well >/flo ft Drainage Way C) ft Property Line y�O ft Other ft SIKETCH:(Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands in proximity to holes) P P aTooS t � vt�J (N?�v S Parent material(geologic). `��� e• Depth to Bedrock /✓ Depth to Groundwater. Standing Water in Hole: Weeping f5'om Pit Free /✓ �l J Estimated Seasonal High Groundwater DETERMINATION FOR SEASONAL HIGH WATER TABLE Method Used: Depth Observed standing in obs.hole: In, Depth to soil mottles: In. Depth to weeping from side of obs.hole: In. Groundwater Adjustment ft. Index Wet!# Reading Date: Index Well level -„ Adj,fhetor- Adj.Groundwater Leve! A PERCOLATION T +'ST ]bate�.� Time r Observation i Hole# / Time at 4" r/ Depth of Perc f � Time at G' Start Pre-soak Time @ I Time(V-6") End Pre-soak / Rate Min./Inch G Site Suitability Assessment: Site Passed�_ Site Failed: Additional Testing Needed(-Y/N) 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. Q:\S EPTIC\PERCFORM.DOC DEEP.OBS)ERVATION BOLE LOG Bole# 1 Depth from Soil Horizon Soil Texture .Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones;Boulders. Consistency,%Gravel) 61 2-3 . 1 M k, L------------- DEEP OBSERVATION BOLE LOG Bole# "2— Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. onsisten %Gravel) QA 34''-13 Z,' C MPa in cL DEEP OBSERVATION DOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency.%O DEEP OBSERVATION HOLE LOG Mole#�! Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency. s r Flood Insurance Rate Map: Above 560 year flood boundary No Yes ._. ` Within 500 year boundary No 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? Ves If not,what is the depth of naturally occurring pervious material? Certification I certify that on 10 '- (date)I have passed the soil evaluator examination,approved by the Department of Enviro mental Protection and that the above analysis was performed by me consistent with . the required rat 'n expertis and experience described in 310 CMR 15.017. Signature AA A r . Date Q:WEPTICPERCFORM.DOC Commonwealth of Massachusetts Executive Office of Environmental Affairs Department of Environmental Protection William F.Weld Trudy Cox* GoVernor Boom" A pPaul Cellucci David B.Struhs inr CamYsMorw 6 04411Q41 -1:e,-/` SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM fly/ PART A CERTIFICATION Property Address: Address of Owner. Date of Inspection: </—;ta —9 4 (If different) ; Name of Inspector. W.E. Robinson SR Company Name,Address and Telephone Number. ( 5 0 8)7 7 5-8 7 7 6 W.E. Robinson Septic Service P.O. Box 1089 Centerville MA CERTIFICATION STATEMENT I outify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurab and complete as of the time of inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. The system: +� Passes _ Conditionally Passes _ Needs Further Evaluation By the Local Approving Authority Fails Ins toys S turc Pro iQna L C Date: `/—r2 e`Z—`) 4, The System Inspector shall submit a copy of this inspection report to the Approving Authority within thirty(30)days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the Department of Environmental Protection. The original should be sent to the system owner and copies sent to the buyer, if applicable and the approving authority. INSPECTION SUMMARY: Check A,B,C,or D: A) PASSES: 1 I have not found mymforma tion which indicates that the system violates any of the failure criteria as defined is 310 CMR 15.303. Any failure criteria not evaluated are indicated below. B] CONDITIONALLY PASSES: or more system components need to be replaced or repaired. The system,upon completion of the replacement or repair,passes L n. Indicate ,no,or not determined(Y,:N,or ND). Describe basis of determination in all instances. If"not determined",explain why not) The septic tank is metal,cracked,structurally unsound, shows substantial infiltration or ez&ltration,•or tank failure is imminent. :The system will passAnspection if the existing septic tank is replaced with a Fonforming septic tank as approved by the Board of Health. - (revised /03/95) 1 One Winter Street • Boston,Massachusetts 02108 • FAX(617)556-10411., .• TeNphone(617)292-SM 0 Printed on Recycled Paper SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: p !o OAK1il�rf� �e�r•4GL ����1/Iic I Owner. j7,9r ta-A J.4t7 Date of Inspection: B] CONDITIONALLY PASSES(continued) Sewage backup or breakout or high static water level observed in the distril)ution boa is due to broken or obstructed pipe(@) or due to a broken,settled or uneven distribution boa. The system will paw inspection if(with approval of the Board of Health): broken pipe(@)are replaced _ obstruction is removed distribution boa is levelled or replaced _ The system required pumping more than four times a year due to broken or obstructed pipe(a). The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed CI FUR ER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect the public health,safety and the environment. 1 SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: Cesspool or privy is within 50 feet of a surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a @alt marsh. z) YSTEM WILL FAIL UNLESS THE BOARD OF HEALTH(AND PUBLIC WATER SUPPLIER,IF APPROPRIATE) ETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECT THE PUBLIC HEALTH AND AND THE ENVIRONMENT: The system has a septic tank and soil absorption system and is within 100 feet to a surface water supply or tributary to a surface water supply. The system has a septic tank and soil absorption system and is within a Zone I of a public water supply well. The system has a septic tank and soil absorption system and is within 50 feet of a private water supply well. _ The system has a septic tank and soil absorption eystem and is less than 100 feet but 50 feet or more from a private water supply well,unless a well water analysis for coliform bacteria and volatile organic compounds indicates that the well is free. from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or lea than 5 ppm. 3) O (reviaed 11/03/95) , SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Pro"rky Address: Owner. Date of Inspection: jy_ 4 DI FAILS: determined that the system violates one or more of the following failure criteria as defined in 310 CUR 16.303. The basis for determination is identified below. The Board of Health should be contacted to determine what will be necessary to correct the Backup of sewage into facility or system component due to as overloaded or clogged SAS or cesspool. Discharge or ponding of effluent to the surface of the ground or Surface water$due to an overloaded or clogged SAS or cesspool. Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or come pool- Liquid depth in cesspool is less than 6"below invert or available volume is less than 1/2 day flow- Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(e). Number of times pumped Any portion of the Soil Absorption System,cesspool or privy is below the high groundwater elevation. Any portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water Supply. Any portion of a cesspool or privy is within a Zone I of a public well. Any portion of a cesspool or privy is within 50 feet of a private water supply well. Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. If the well has been analyzed to be acceptable,attach copy of well water analysis for ooliform bacteria,volatile organic compounds,ammonia nitrogen and nitrate nitrogen. El LARGE STEM FAILS: The f wing criteria apply to large systems in addition to the criteria above: The m Soriaa facility with a design flow of 10,000 gpd or greater(Large System)and the system it a significant threat to public health safety and the environment because one or more of the following conditions exist: the system is within 400 feet of a surface drinking water supply _ the System is within 200 feet of a tributary to a surface drinking water'suPP19 _ the System is located in a nitrogen sensitive area(Interim Wellhead Protection Area(IWPA)or a mapped Zone II of a public water supply well) The owner or of any such system shall bring the System and facility into flrll compliance with the groundwater treatment pro�am requirements o 314 CUR 5.00 and 6.00. Please consult the local regional office of the Department for!lather information.. (revised 11/03/95) 3 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST PnVerty Address: Owner. Date of Inspeotien: 4/— Check if the following have been done: J/roping information was requested of the owner,occupant,and Board of Health. _✓None of the system components have been pumped for at least two weeks and the system has been receiving normal flow rates that period. Large volumes of water have not been introduced into the system recently or as part of this inspection. L'�7 _As built plans have been obtained and examined. Note if they are not available with N/A. _ AL facility or dwelling was inspected for signs of sewage back-up e system does not receive non-sanitary or industrial waste flow LAU/ site was inspected for signs of breakout. system components,excluding the Soil Absorption System, have been located on the site. 4111the septic tank manholes were uncovered,opened,and the interior of the septic tank was inspected for condition of baMes or teey,material of construction,dimensions,depth of liquid,depth of sludge,depth of scum. _, The size and location of the Soil Absorption System on the site has been determined based on existing information or approximated by non-intrusive methods. facility owner(and occupants, if different from owner)were provided with information on the proper maintenance of Sub. Surface Disposal System. r i (revised 11/03/95) 4 i I SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Aadrese: Owner. Date of Inspection:t1 FLOW CONDITIONS Deep flow s,patron. Number of bedrooms: 3 Number of current residents: Garbage grinder(yes or no):JtV - Laundry connected to system(yes or no): Seasonal use(yes or no):_Y_ n�G ���� Water meter readings,if available: &4LL6f� Last date of occupancy: COMMERCIAL/INDUSTRIAL: Type of establishment: Design flow:gallons/day Grease trap present: (yea or no)_ Industrial Waste Holding Tank present: (yea or no)_ Non4 anitary waste discharged to the Title 5 system: (yes or no)_ Water meter readings,if available: - Last date of occupancy: OTHER:(Describe) Last date of occupancy: GENERAL INFORMATION PUMPING RECORDS and source of information: 1--o n-X C/='. Z"/ l(; 'ii 3 o a- L 2 System pumped as part of inspection: (yea or no)_ If yea,volume pumped: gallons Reason for pumping: ' TYPE SYST1�bI � ptic tanWdistribution boa/soil absorption system Single cesspool Overnow owpool Privy Shared system(yes or no) (if yea,attach previous inspection records,if any) Other(explain) APPROXIMATE AGE of all components,date installed(if known)and source of information: Q 6 Savage odors detected when arriving at the site:(yes or no) (revised 11/03/95) 5 r SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: ,f CO Q�/�U/��/ / r ��/��l�/ `J Owner. !719r' Date of Inspection: SEPTIC TANK v (locate on site plan) Depth below grader Material of construction:concrete_metal FRP_other(e:plain) oao o le- Dimensions: x -t Sludge depth:=�•• _ , ` Distance f vm top of sludge to bottom of outlet tee or baSle;�L Scum thickn :�__ Distance from top of scum to top of outlet we or baffle: 9 % , Distance from bottom of scum to bottom of outlet tee or baffle:i Comments: (recommendation for pumping,condition of inlet and outlet tees or baffles,depth of liquid level in relation to outlet invert,structural integrity, evidence of leakage,etc.) t 6 c e>o/ l 6 G E TRAP._ (locate a site plan) Depth be grade: Material construction:_concrete_metal_FRP_other(s:plain) Dimensio Scum top of scum to top of outlet tee or ba81e: Distance bottom of scum to bottom of outlet tee or baffle: Comments: ( tion for pumping,condition of inlet and outlet toes or baffles,depth of liquid level in relation to outlet invert,structural integrity, evidence of ,etc.) o (revised 11/03/95) 6 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C // !/ SYSTEM INFORMATION(continued) Property Address: 6[P 5w aie p/E /L owner: Date of Inspection:y_2 2.^g 4 TI HT OR HOLDING TANK_, ( site plan) Depth grade: Material construction: concrete_metal_FRP_other(uplain) ' Capacity; no Design pUons/day Alarm Comma (conditio of inlet tee,condition of alarm and!lost switches,etc.) DISTRIBUTION BOX:_ (locate on site plan) Depth of liquid level above outlet invert: d Comma (note if level d distribution is equal,evidence of solids carryover,evidence of leafage into or out o�bo, .) PUMP C ER_ (locate on plan) Pumps in wo ing order.(yes or no) Comments: (note conditio of pump chamber,condition of pumps and appurtenances,stc.) (revised 11/03/95) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(oontinued) Property Address O lP 6.0 /i e 0 T l-,, owner: /LJi9/' �LCYj/A� Date of Inspeadon: L/_ 1 0 / SOIL ABSORPTION SYSTEM(SAS):el (locats on site plan,if possible;excsvation not required,but may be approximated by non-intrusive methods) If not determined to be present,explain: Type: leachin6 Pits,number: leschin chambers,number:_ leaching galleries,number: leaching trenches,number,length: leaching fields, number,dimensions: overflow cesspool,number: Comme�:(note condition of soil,signs of hydraulic failure, level of ponding, condition of vegetation etc.) S ' iD er-1< G1 Caw CESS LS: (locate on ' plan) Number and on: Depth-top of to inlet invert: Depth of so i layer. Depth of layer: Dimensions cesspool: Materials of n: Indication of water: (cesspool must be pumped as part of inspection) Comments:(not o condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.) PRIVY: (locate on site p ) Materials of Dimensions: Depth of solids Comments:( oondition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.) (revised 11/03/95) g SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM_ TEM INFORMATION(continued) Property Addrem 8�( O✓�s��/2�J �.�t/C �/,4�/rli,� Owner. Dab of Iaapaotioa: SEMN OF SEWAGE DISPOSAL SYSTEM: iacb ties to at least two permanent referenoee kandmarim or benchmarks locate all wall within 100' �r �L yL SLR Ow►� 7 - /6 6 o 1 L!3 1 it L P, S DEPTH TO GROUNDWATER Depth to pomdwater j -A feat MAW of datermiaation or approximation: ((3 o b (revised 11/03/95) 9 CONINIONWEALTH OF N ASSACHUSETTS J: EXECUTIVE OFFICE OF EINVIRONMENTAL AFFAIRS 1= DEPART�IE�T OF E1�'IRON:�IEITAL PROTE 'd �� ONE WINTER STREET. BOSTON. NIA 02106 6I?-252-�400 8 r� %%ILLIA%'F.WELD . , . _,; 11"I i Govcmc _. . .:. : ARGEO PAL1 CELLI'CCI DAVI ul-2 Lt.Governor SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM _ issiortc PART A ! ; g W y .. � CERTIFICATION Property Address; rpj t�G, U l C'1�-��� 1 ` ' ���� dress of Owner: G' �'��0�►tJ Date of Inspection: � tc (If different) — <S�G�jJA ` V Name of Inspector: 1 am a DEP ap roved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000) � Company Name:& a i 4—r'a M Mailing Address: p O /Aox 2C4- 51 Telephone Number: r$'G21!�2 $,— 4 Zeo CERTIFICATION STATEMENT I cenii that I have personally inspected the sewage disposal systern at this address and tha: the information reported below is true. accurate and complete as o:the time of inspec-oo-. The inspecion %-as performed based on my training and experience in the proper function and maintenance of on-site sewage disposa; systems. The cvstem: Passes _ Concnoonaii% Passes _ Neec_ Furthe- Eva!uatlon Ey the Local Approving Authonr� Inspector's Signatur _ Date: 6 T;,e Svs:e-r Ins,e:o• sha!! submr a copy of this inspection reoon to the Approving Autherir,• within them' (30) days of completing this inspecion. h the system is a shared system o• has a design flow of 10,000 god or greater, the inspector and the system owner shall submit the repo-. to the appropriate regional office of the Deparment of EnvironmenW Protection.. The origlna! should be sent to the system owne- and copies s-rt: to the buyer, ii applicable, and the approving authoriM. INSPECTION SUMMARY: Check A, B, C, Or D: AI SYSTEM PASSES: ; 4 1 have not found any information which indicates that the system violates any of the failure criteria as defined in 310 CMR 15.303. Any failure criteria not evaluated are indicated below. . COMMENTS: - BI 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. Indicate yes, no, or not determined (Y, N. or NDj. Describe basis of determination in all instances. If'not determined-, explain why not. The septic tank is metal, unless the owner or operator has provided the system inspector with a copy of a Certificate of Compliance (attachedi indicating that the tank was installed within twenty (20) years prior to the date of the inspection; o: the septic tank, whether or not metal, is cracked, structurally unsound, shows substantial infiltration or exfiltration, or tank failure is imminent. The system will pass inspection if the existing septic tank is replaced with a conforming septic tank as approved by the Board of Health. (rev4.aed 04/25!21) Page 1 of 30 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM !. PART A CERTIFICATION (continued) _.. n _ _ •� - +.ems r '- .��' fq7Dateof4nspec1ion:'A�;'% Add s�}L,STEM CONDITIONALLY PASSES tcontin,e' 44CYMC�ul Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed pipets) or due to a broken, settled or uneven distribution box. The system will pass inspection if(with approval of the Board of Health).. Describe observations: broken pipe(s) are replaced f, obstruction is removed : - distribution box is levelled or replaced The system required pumping more than four times a year due to broken or obstructed pipe(s). The system w•'ill pass l f h and f Health): i n 'f w•i h nova o the Bo o ) inspect o ► t t approval - broken pipets► are replaces _ obstruction is removed - _____ _ C] FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: - Conditions exist which require further evaluation by the Board of Health in order to determine if the iystem is failing to protect the public health, safer and the environment. 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM 15 NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: Cesspool or prnti is within 50 feet of a surface water Cesspool or pri%,- is within 50 feet of a bordering vegetated wetland or a salt marsh. 2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH (AND PUBLIC WATER SUPPLIER, IF APPROPRIATE) DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECTS THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet to a surface water supply or tributary to a surface water supply. The system has a septic tank and soil absorption system and the SAS is within a Zone I of a public water supaty well. The systern has a septic tank and soil absorption system and the SAS is within 50 feet of a private water supply well. The system has a septic tank and soil absorption system and the SAS is less than. 100 feet but 50 feet or more from a private water supply well, uniess a well water analysis for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm. Method used to determine distance (approximation not valid). 3) _ OTHER (revised 04:25137) Page 2 of 10 SL BSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Addross: Owner: Date of Inspection: DJ SYSTEM FAILS: You must indicate either "Yes` or "No" as to each of the following: I have determined that the system violates one or more of the following failure criteria as defined in 310 CMR 15.303. The basis for this determination is identified below. The Board of Health should be contacted to determine what will be necessary to correct the failure. Yes No _ Backup of sewage into facility or system component due to an overloaded or clogged SAS or cesspool. Discharge or pond)ng of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool. Sta:1c houid level in the distr,bation boa above outlet invert due to an overloaded or clogged SA5 or Cesspool. lrauid depth in cesspool is less than 6" below invert or available volume is less than 1/2 day floe. Required pumping more thar. 4 times in the last year NOT due to clogged or obstructea p1pe s . Number o- times pumped _. Any portion o'the Soil Ansorption System, cesspool or prrv)• is below the high groundwate• eievatror. Am por::on of a cesspool or privy is within 100 feet of a surface water suooly or tributar to a surface water supply And por,,on of a cesspoo: or privy is w rthir. a Zone I of a public well. Am. pe-jo-% cf a cesspool or privy is within 50 feet of a private water supph well Am.• por,or. of a cesspool or privy is less than 100 feat but greater than 50 fee: from a private water sucoh., well with no acceptable Ovate- oualin. analvsis. If the well has been analyzed to be acceotabie, arach copv of well water analysts for coliform bacteria volanle organic Compounds, ammonia nitrogen and nitrate nitrogen. E] LARGE SYSTEM FAILS: You must indicate either "Yes` or "No" as to each of the following. The following criteria aop;% to large systems in addition to the criteria above: The system se-,,es a facilin with a design flow of 10,000 gpd or greater (Large System; and the system is a significant threat to public hea!th and saiety and the environment because one or more of the following conditions exist. Yes No . the system is within 400 feet of a surface drinking water supply the system is within200 feet of a tributary to a surface drinking water supply - the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area - IWPA) or a mapped Zone 11 of a public water supply well) The owner or operator of any such system shall bring the system and facility into full compliance with the groundwater:treatment program requirements of 314 Ch1R..5.00 and 6.00. Please consult the local regional office of the Department for_furthe.r.iniorm*2—tloc4:--- (revised 04/25/91) D.n. ] of 10 ' J 1 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Propert% Address: Owner: L,,U�1 Date of Inspection: 6CL�: Check if the following have been done: You must indicate either "Yes" or 'No" as to each of the following: y . No ' Pumping information was provided by the owner, occupant, or Board of Health. None of the system components have been pumped for at least two weeks and the system has been receiving normal flow rates— during that period. Large volumes of water have not been introduced into the system recently or as pan of this inspection. As built plans have been ootamed and examined. Note if they are not available with NIA. The fac:lin or d%•ellrng was tnspeaed for signs of sewage back-up. _ The system does not receive non-sanitary or industrial waste flow. _ The site µas inspected for signs of breakout. _ All systerr. components. excludins the So+l Aosorpuon System, have been located on the site. r: The septic tank manholes µere uncovered. opened. and the interior of the septic tank was inspected for condition of baffies or tees. matena' o' construction, dimensions, depth of liquid, depth of sludge, depth of scum. _The size and location of the Soil Absorption System on the site has been determined based on. _ The facd-(% oµne• .ano occupants. a difieren: trom ov.•nerr were provided with information on the prope, maintenance of Sub-Suriace Disposal Svstern. Existing iniorrnation. Ex. Plan at B.O H. _ De;ermined in the field ur am of the failure criteria related to Part C is at issue, approximation of distance is unaccentabie (15.302+.31:bll SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORtit PART. C SYSTEM INFORMATION Properv, Address: Owner:W f'j Date of Ihspect)on: FLOW CONDITIONS RESIDENTIAL: Design floes` p.d..tbedroom for ►cumber of bedrooms 6 Number o`current residents- Garbage g•:.,der (yes or no,: Laundry cor—ected to system (yes or no` Seasonal use Ives or no-: Water meter readings. if available (last two {2 year usage tgpd): Sump Pump (yes or no)_L• La<-. da:e o`occupanc\-' hj 1 r^Tlrn VC101L T(j COMMERC t4L'INDL'STRIAL: Type of establishment Design fio%% 22honsvaa,, Grease trap present rues or no_ Indusina! \taste Holding Tani; present. ,ves or no_ ':on-san)ta- Aasie discnarged to the T!tie 3 system Ives or no_ \%ater meter readings if availabie Las:pave o: o OTHER: .De:cribe Last care of occuoanc. GENERAL INFORMATION PUMPING RECORDS and source of )nformatuor. System pumped as Oar, of inspecoon. Ives or n .-#?-(.-, If yes, volume pumped ¢allons Reason for pumping TYPE OF SYSTEM Septic tankrdistnbution boxisoil absorption system _V� Sing:e cesspool Overflow cesspool Pn.�• Shared system (yes or no) (if yes, attach previous inspection records, if any) I/A Technologv etc. Copy of up to date contract? Other -. APPROXIMATE AGE of all components, date installed (if known) and source of information: Sewage odors detected when arriving at the site. h•es or not�;'� =-�••�_- '=� ••• • ••• • • • •• - - (revised 04/25/91) Page 5 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTIO-N FORNt PART C r SYSTEM INFORMATION (continued) Property Addre4s: Owner: Date of (nspettion: 6(t LpI 1 BUILDING SEWER: (Locate on site plan) Depth below grade. Material of construction. _cast iron _40 PVC _other (explain'. Distance from private water supply well or suction Ire Diameter Comments: (condition of joints, venting, evidence of leakage, etc.) SEPTIC TANK:J'%.5 (locate on site.plate Depth below grade material of construction, _concrete _meta _Fioerglass _Polvethvlene _othertexplain If tank is metal, lls: age _ Is jage conflrmea o. Ce^.6ca:e o: Comp)iance _(Yes.-No Dimensions ft 1 Sludge depth `=WL ti Dlsiance from top o: s:uaee to bororn o' ou:iet tee o• ba�:;e _ E Scum thickness- it t� Distance from top of scum to top o'outle: tee or bale _ t� Distance from bottom of scum-: to bo-o-: o,outlet teF e• bane . Now dimensions were determined Comments trecommendation for pumping. rondltion o' )niei and outlet te=s or baffles. depth of liquid level in reiation to outlet invert. structur I integrity .iderice of leakage, etc !Y'l? ` rJc �-t i G GREASE TRAP: (locate on site plan; 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 baffie: Date of last pumping: Comments: —' (recommendation for pumping. 'condition of i-filet and outlet tees or baffles, depth of liquid level in relation-te outlet4nvert:structur-al-- - ;ntegrin•, evidence of leakage, etc.; - .._... SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FOR.tit PART C SYSTEM INFORMATION (continued) Propert% Address: Owner— Date of Inspection: TIGHT OR HOLDING TANK:U`�� --Tank must be pumped prior to, or at time, of inspection, (locate on site plan, Depth below grade. Material of construction. _concrete _metal _Fiberglass _Polyethylene —other(explain) Dimensions: Capacm gallons Design floe galionsda. Alarm level Alarm in %:orking orde• _ Yes. _ No Date of previous pumping Comments (condition of inlet tee. condition o- a'a•m and float switches. etc.t DISTRIBUTION BOX:4-S (locate on site p-a-: L Death o'. liouid le.e' a00%e ouue: m%e- -�_— Comments tnote :f leve! and distributor is eaua' vidence of solids camover, evade. of leakage into or ut of boa, etc.) PUMP CHAMBER:-4j-�I (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.) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FOR'-) PART C SYSTEM INFORMATION (continued) Property Addr-ss: bu {`"ll1)I-evi Owner: 6l j Date of nspecuon: ks� SOIL ABSORPTION SYSTEM (SAS): (locate on site plan, if possible. exca, on not required. but may be approximated by non-intrusive methods; If not determined to be present, explain. Type. leaching pits. number. %OX,U leaching chambers, number:_ leaching galleries, number: leaching trenches. number length: leaching fields, number, ci,rnensions overflow cesspool, number Alternative ivstem Name of Tecnnoiogv Comments inot condition of soil, stggr.s of hydraulic fail re, lee` of ponding, condition of vegetation, et .t . � e ,t� VIJCt CESSPOOLS: _ Ioocate on site plar. Numbe• and conftg-ira:.on Depth-top of liquid to inlet Inver, Depth of solids lave- Depth of scum layer Dimensions of cesspool Materials of constructior Indication of groundwate- inflow• (cesspool must oe pumpec as par, of inspenion, 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.): (rwas•d 04/25/97) Paq• 8 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: J�p � ; Owner: �(j�` t Date of n5pection: I I SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent references landmarks or benchmarks locate all wells within 100' (Locate where public water supply comes into house) a � Z 3 3b N a .. SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Add resF• ;�' Q, C--U Owner: L-111 b� Date of Inspecuor: Depth to Groundwater feet Please indicate all the methods used to determine High Groundwater Elevation: Obtained from Design Plans on record Observation o'Site (Abutting property. observation hole, basement sump etc.) Determine it from local conditions Cnec'K with loca! Board o• neaar Check FE.NAA Maps Check pumping records Check local exca,ators installers - l_se L SCS Data a r• Desciibe in poi, o% %%oros r.o•.% %ou established the Hie') Groundwater Elevation. (Must be completed! lzav-aad 0�;25'9'. Page 10 of 10 TOWN OF BARNSTABLE LOCATION 6 Oa LV 1-? V-2 SEWAGE # VILLAGE Uu 6 iL M%--)rJLu ,24,T — ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY 005 �f' LEACHING FACILITY: (type) (size) b K NO.OF BEDROOMS 73 BUILDER OR OWNER /L—v\o N N N--), 4€I<PflTDATE: fo { �� l�7lr7 COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and } 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)_ A- , Feet. Furnished by �- - / su ' Z7 59�- f W N O V' e n 0�1074� " L)-619 - LOC T10 SEWAGE PERMIT NO.' VILLA.G I it S T AIAER' NA E i ADDRESS BUILDER OR OWNER �y4 llcll- D A T PERMIT ISS XED DATE , COMPLIANCE ISSUED Y � •t�f y,I4, �� .+�� f.. me.µ �, .-_ la { „a 4. , No.....1 ............... THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH 7-6 14**'ry ...... ....... .................................................... Appliratiou for Diipniial Workii Tonfitrurtion ami# Application is hereby made for a Permit to Construct (✓) or Repair ( ) an Individual Sewage Disposal System at: 6 AIGv>Ot a 7 7Z/2AC£ ,�-/�1��./.fi 5 �� SS� ....... ...--- .... .-•-••----••-----•-------••-••----•-•................................•---------•--............--- a'on-Address or Lot No. (�:!�IL:CO-n ,/ �VS7- /�3 Z A 61/G!�!..!?�i... //A_n/n/s� !,A. •---- ...........•... .............. Owner ... *-----------•-------------- ..................... ------Address ----------------­-­-------------------- Installer Address QType of Building Size Lot__1....�..................Sq. feet U Dwelling—No. of Bedrooms._..........3.............................Expansion Attic ( ) �O Garbage Grinder (IIG} aOther—Type of Building ............................ No. of persons........................---- Showers ( ) — Cafeteria ( ) Q, Other fixtures ..--•----------------------- W Design Flow................... ........................... per person per day. Total da ly flow------------ -3©��.._...___.-.._.__-gallons. WSeptic Tank—Liquid capacity/ ..gallons Length--- "-_ Width-- /4 0.... Diameter.- _�_ ... Depth_.�._8-........ x Disposal Trench—No. ..... .......... Width_..:.......... Total Length....... ......... Total leaching area_....'-.......sq. ft. Seepage Pit No-------------t------ Diameter........ --------- Depth below inlet.............. Total leaching area..2o®----sq. ft. Z Other Distribution box (J) Dosing tank ( ) V��/ �O Percolation Test Results Performed by....... %.� .:. ...............................................� Date---- aTest Pit No. 1..G.Z---minutes per inch Depth of Test Pit-----/Z Depth to ground water_.it/aN£-.---- (T4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water F,� �V ------ .. ... ............ .. . ... O Description of Soil ® 2 ............... ............f1'...' Fi �..... �-..... - U W ----••••••-•-------------------------------------------------------------------------------------------................................................................................................. U Nature of Repairs or Alterations—Answer when applicable.--...-.......................................•-._.--.....-._.---.---_._-.-._..--_-__-----_.-.-. -------------------------------------------------•---------•------------------------.....:......-•••--••-•-••---• ..................................................................................... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of'TT y g g p y 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. S/.. ed. - ............Dat.e-•-••-•....... �� Date Application Approved BY...... . . - • ......... mil --------------------- y� Date Application Disapproved for the following reasons:_....................................................................-•-------------------------•----------- ..............••-••-•---••---........---•••-•-••--•-......---...-•---••--•...•--•-•••-•------•--•••-•.....•...••••-••-•-••••-•--••••------••----••-••--••••-•---•••-•-•--------------•--••--•-•--------- i b Date Permit No......................................................... Issued...�'� ! { Date J K .'yi • lip THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ......... ."'' ...................OF...... �! " °•? ........................... AliptiratiAn for Di-41jimia1 Works T atitrudivit thrmit Application is hereby made fora Permit to Construct or Repair ( ) an Individual Sewage Disposal System at -.... L ca ion Address or Lot No. +(••1 ? ?" ..` .... '� ............................ E/ .�`t.v../r��M.G7;• ........................ Owner Address W Installer Address �� Type of Building Size Lot--_---•-_-_--•_-------------------------------Sq. feet U.: Dwelling—No. of Bedrooms........... _ Expansion Attic ( ) /t/O Garbage Grinder ( )' pl Other—Type of Building ________________________•••- No. of persons............................ Showers ( ) — Cafeteria ( ) P4 Other fixtures W Design Flow.................. ..... __gallons per person per day. Total daily flow----------- I ....................gallons. W Septic Tank—Liquid ca acitYr�d 13.. allons Length. " Width__1/- O."._ Diameter.q�_`.06.*'._ llepth_�---g-p----- Disposal Trench—No. ..... .......... Width__ .._-_:--______-- Total Length....'*.......... Total leaching area...... ..........sq. ft. Seepage Pit-No............I------- Diameter_______ _________ Depth below inlet....:.......... Total leaching area..ZOP.....sq. ft. Z Other Distribution box (fir'"`) Dosing tank ( ) '~ Percolation Test Results� Pegormed by....._._ .t.x2 ?` '! .T......... ..................... Date----- 3/ 0--•__.__.__. ,aa Test Pit No.. 1________________minutes per inch Depth of Test Pit -4......... Depth to ground water.A/4rWdr_.._.. (� Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground waterSl�<o ✓� a ............... . r O Description of Soil...._...� - ..___ .�a l�____.__ U •-••---•-•-•-•--•---•-••••••-•••--••-•• .......... rva �r� ����""""x ---•--------------------------•----•--•-.......... 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 TITLE, 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. g > e Application Approved By....... 4` _ / L' °� 'rat' ----� 4 °T D ., ..; Date Application Disapproved for the following reasons:-------•------------------------------•--------------------------------------------.._...-••---•------•-----•--- -•---------•----•---•--------•---•--•----•-•••--•--•-----•-------------------------•--.......--------------•------------•-------•---------•-•--••-----------------•-------------...-••--=------•..._.._. Date PermitNo......................................................... Issued....................................................... . Date •*THE COMMONWEALTH OF MASSACHUSETTS t¢' BOARD OF HEALTH ..............................0F............ C3............................. Tntifiratr of Tompl Faitrr THIS T That thtIndividual Sewage Disposal 'System constructed ( ) or Repaired ( ) bY•••••.........�••. . . _.�...L. ...................•---- ------------.........-----•=••--•-••------••---------•---•-•-----•-- ............................. Installer at...............L =- �" / �o ,�b ..................... ° -----------------•-------------------•-----•--------- has been installed in accordance with the rodtstoits f T d�°r ,44State Sanitary Code. as described in the application for Disposal Works Construction Permit No....... = ...... dated-............................................... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT B?-dO E® AS A GUA'ANTEWYAT THE SYSTEM -.ILL F NC O SATISFACTORY. DATE--- .... ................................................. Inspector--- OP -------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH � N........... �1/►-n S7_j G'e � .......................... ....... OF........ No..............�::� _ FEE........ ... irraV11r or "o � rrti .. Permission is hereby granted-•--••...... .. ------------------•--•---••-•---._...................---•----•--•--•- to Construct ( �'br Repair ( ) an Individual Sew at No... C �" - ....- -•-••-•-- ----•-------------•--------------------------------------------------- as shown on the application for Disposal Works Construc ion er It pro•____________________ Dated.......................................... ------- -' j �of Health DATE............-................................................................... 'r (((�..... `r FORM 1255 HOBBS & WARREN, INC., PUBLISHERS HYANNIS LEGEND MN -®—� PROPOSED CONTOUR ® PROPOSED SPOT GRADE LOCUS ST. ROTARY VI W TERR. � N — gg —— EXISTING CONTOUR cn 0 BEN'S P�F' w + 96.52 EXISTING SPOT GRADE POND f,100� W— EXISTING WATER SERVICE = GJO TEST PIT �y v SMITH 40.9 ► ST. +41 .9 LOCUS MAP vc\j 68.61' LOCUS INFORMATION PLAN REF: BK 11646 PG 287 C l !� ����' \ +40. I PARCEL ID: MAP 268 PAR. 300 rn o , ELEACH OOOG 0 I,PIT 10 ;- ' �°� SEPTIC SYSTEM +41 .9 �° REPAIR PLAN moo. G v o <n LOCATED AT: EXIST. 1,000G 86 OAKVIEW TERRACE SEPTIC TANK m e� ���, HYANNIS, MA. PREPARED FOR 70 \ctSST °� ROBERT SITEMAN / �e F READY ROOTER EXCAV. MARCH 26, 2015 REV: APRIL 3, 2015 rn + ,\41 .7 0 40 �Y,\, of ss9� C � G> > 1P-1 O / r D R N .M. s .. 114 42.5 R 14! / � . 38 41 . I SANI TAR\�`� MEYER Bc SONS INC. \ 59.3 P. O. Box 981 - __ E. SANDWICH , MA 02537 PH. (508)360—3311 I �v fax (774)41,3-9468 40 me erandson stitle5@ moil.com 38.7 + ji. k. SCALE: 1"=20' J 168 SHEET 1 OF 2 9 T.O.F. NOTE: MAGNETIC TAPE TO BE PLACED OVER ALL COVERS NOTE: PLACE RISERS W/IN 3" OF GRADE NOTE: PLACE RISERS OVER ALL COVERS W/IN 6" OF GRADE FINISHED GRADE (41.80) EL: 43.50 F.G.EL: 42.0 a F.G.EL: 41.70 F.G. EL: 42.0 ` j MAINTAIN 2% MIN SLOPE OVER LEACHING AREA :Q 2" OF 3/8" DOUBLE WASHED TOP TANK=EL. 40.50 i 3/4" - 1-1/2" . . STONE OR FILTER FABRIC :A 6"�• • I T17 DOUBLE WASHED STONE 4" SCH 40 PVC :a t0"1 ®®®®- C ®®®® TEE'S ARE TO BE 14 6 IINV.38.35 1 (MIN. ®EME-3 ®®®® 4' SCH 4o PVC INV.38.55 E33 3E ®®®®® 2 E F. DEPTH ®®®®®®®ER®®® INV.39.20 GAS _ 4' 2 .X 8.5' 4' r EXIST. INVERT BAFFLE PROPOSED DB 3 , �, :...•. ., DISTRIBUTION BOX EFFECTIVE LENGTH = 25 INV. 39.45 (H20) INV. ELEV.= 37.80 EXIST. 1 ,000 GALLON SEPTIC TANK OF GAS BAFFLE TO BE INSTALLED ON ����` MAss9�y BREAKOUT OUTLET TEE AS MANUFACTURED BY o A RAN Gr ELEV.= 38.80 TUF-TITE, ZABEL, OR EQUAL R TOP CONC. ELEV.= 38.80 NOTES: 1) CONTRACTOR SHALL VERIFY ALL EXISTING �11 INV. ELEV.= 37.80 E3 ®® PIPE INVERTS PRIOR TO CONSTRUCTION ®® ®®® . 2) D-BOX SHALL BE SET LEVEL AND TRUE TO 'AEG/STE ®®®®®®® EM®®®®®®® .. �N1W / BOTTOM EL.= 35.80 ®®®®®®E3 GRADE ON A MECHANICALLY COMPACTED SIX S \a� 3.75' 5 FT. 3.75' INCH 310 CMRUSHSE DONE BASE, AS SPECIFIED IN 3 I 3) REPLACE EXISTING 1,000 GALLON SEPTIC TANK SEPARATION 5.4 FT. EFFECTIVE WIDTH = 12.5' WITH 1,500 GALLON SEPTIC TANK IF FAILED, SEPTIC SYSTEM PROFILE DAMAGED, OR UNDERSIZED, INSPECT AT TIME OF INSTALL SOIL ABSORPTION SYSTEM (SECTION) 4) INSTALL INLET & OUTLET TEES W/ ADJUST. GRNDWATER EL: 30.40 GAS BAFFLE AS REQUIRED (500 GALLON LEACH CHAMBER) GENERAL NOTES: DESIGN CRITERIA 1. ALL CHANGES TO THIS PLAN MUST BE APPROVED BY THE LOCAL SOIL LOGS P#: 14645 BOARD OF HEALTH AND THE DESIGN ENGINEER. NUMBER OF BEDROOMS: 3 BEDROOM DESIGN 2. ALL WORK AND MATERIALS SHALL CONFORM TO THE REQUIREMENTS SOIL TEXTURAL CLASS: CLASS I (0.74 GPD/SF) OF THE STATE ENVIRONMENTAL CODE, TITLE V, AND ANY APPLICABLE DATE: MARCH 17, 2015 LOCAL RULES AND REGULATIONS. DESIGN PERCOLATION RATE: <2 MIN/IN SOIL EVALUATOR: DARREN MEYER, CSE 1614 3. THE SEWAGE DISPOSAL SYSTEM SHALL NOT BE BACKFILLED PRIOR WITNESS: DONNA MIORANDI, BARNSTABLE HEALTH DAILY FLOW: 110 G.P.D. X 3 BR = DESIGN FLOW: 330 G.P.D. TO INSPECTION AND APPROVAL BY THE BOARD OF HEALTH AND THE GARBAGE GRINDER: NO not designed for garbage ender DESIGN ENGINEER. ( 9 9 9 grinder) 4. ANY CONDITIONS ENCOUNTERED DURING CONSTRUCTION DIFFERING r SEPTIC TANK: 330 gpd x 200% = 660 gpd, USE EXIST. 1,000 GAL. SEPTIC TANK FROM THOSE SHOWN HEREON SHALL BE REPORTED TO THE DESIGN Elev. TP-1 Depth Elev. TP-2 Depth ENGINEER BEFORE CONSTRUCTION CONTINUES. 5' ALL ELEVATIONS BASED ON ASSUMED DATUM. 41.70 FILL 0" 41.40 0" (330) = 445.94 S.F. FILL LEACHING AREA REQUIRED: �l 6. THE DESIGN ENGINEER IS NOT RESPONSIBLE FOR THE FAILURE OF 40.20 18" 40.15 15" .74 THE CONTRACTOR ER OWNER TO NOTIFY THE LOCAL BOARD OF A A USE TWO (2) 500 GALLON PRECAST LEACH CHAMBERS W/ 4' HEALTH FOR PROPER INSPECTIONS DURING CONSTRUCTION. LOAMY SAND LOAMY SAND 1OYR 3/2 ' 10YR 3/2 t� 7. WATER SUPPLY PROVIDED BY MUNICIPAL WATER. 39.79 23" 39.40 24" STONE ON ENDS & 3.75' STONE ON SIDES: 25' L x 12.5' W x 2'D 8.ALL AREAS DISTURBED DURING CONSTRUCTION SHALL BE RESTORED B LOAMY SAND TO A CONDITION AGREED UPON BETWEEN OWNER AND CONTRACTOR. 10YR 6/8 } B LOAD SAND BOTTOM AREA: 25' x 12.5'= 312.50 SF 9. IT SHALL BE THE RESPONSIBILITY OF THE CONTRACTOR TO VERIFY THE THE LOCATION OF ALL UNDERGROUND UTILITIES, PRIOR TO BEGINNING 38.37 C 40" 38.24 C 38" SIDE AREA: (25 + 12.5) X 2 X 2 = 150 SF CONSTRUCTION. 10. EXISTING LEACHING TO BE PUMPED, CRUSHED AND FILLED PER TITLE 5. BOTTOM MEDIUM MEDIUM TOTAL SQUARE FEET PROVIDED = 462.50 vs. 445.94 REQ'D 11. 48 HOUR NOTICE FOR ENGINEER CERTIFICATION PERC ® EL. 37.20 SAND SAND DESIGN FLOW PROVIDED: 0.74(462.50 S.F.) = 342.25 G.P.D. vs. 330 G.P.D. req'd 12. THIS PLAN IS TO BE USED FOR SEPTIC SYSTEM PURPOSES ONLY 2.5Y 6/4 2.5Y 6/4 PROPOSED SEPTIC SYSTEM UPGRADE PLAN AND IS NOT TO BE CONSIDERED A PROPERTY LINE SURVEY � 13. NO ABUTTING PRIVATE WELLS WITHIN 150' OF PROPOSED LEACHING. 30.70 132" 1 30.40 132" 8 6 OAKVI EW TERRACE, 14. NO WETLANDS WITHIN 100' OF PROPOSED LEACHING. HYAN N I S MA 15. ALL PIPING TO BE 4" SCH 40 0 1/8-/FT (UNLESS SPECIFIED) PERC RATE <2 MIN/IN. ("C" HORIZON) dR Prepared for: Siteman ea NO GROUNDWATER OBSERVED Pfe P / Y Rooter Exc. System Design and Topography Plan by: SCALE DRAWN DATE • I, Darren M. Meyer, .S., CSE, hereby certify that I am currently approved by MADEP pursuant to 310 CMR 15.017 MEYER&SONS,INC. N.T.S. 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