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HomeMy WebLinkAbout1074 PHINNEY'S LANE - Health Sunset 'If tin - /U 7 G 273-096 Hyannis 7 x M 6 F k Y k 1 'I v a Dear Sir, ry I am from his neighborhood and I just found out the address of 1074 Phinney's Lane In Centerville,Mass addtioned about 12' by 16' new room building by Capozzi Construction' in around 3 years ago... That new addition 12 by 16' room with 4' opening without door and after inspector passed then owner added door that bedroom due too many people live that house also (behind garage other bedroom for in law and main house has also other 3 bedroom now 4 plus in law behind garage) and I disagree with that because of septic system size and will u check with Heath board or HDC Thank, Neighborhood of Phinney's Lane t TOWN OFBARNSTABLE LOCATION i O'Z�( �G�',;,���,y S SEWAGE 4,30% — VILLAGE (3,,�t�o ASSESSORc'�S MAP&P.ARCEL Q73ZC��_ INSTALLERS J&PHUNE NO.c \tt".( Vp6snc3"-i-Ac 'VoV- -G®SS" SEPTIC TANK CAPACITY 1 C)08 ra®z +at`G 361 b a O LEACHING FACILITY:(type) ti-zc.ev.. G\na�nor.r-S(size) & ro cJ 6 NO. OF BEDROOMS o`�S `t•_�"'' x t g" OWNER PERMIT DATE: LY jl S/ /® COMPLIANCE DATE: JCS Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility > Feet Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) �I Feet Edge of Wetland and Leaching Facility(If any wetlands exist o within 300 feet of leaching facility) Feet FURNISHED BY �pc��1 �.Oc�� '.r'� ✓�G. .. Y > 1 r %.A R) 4� Ll v 0 1 ol i OH n W (� 1 � ' No. 6 D Fee 4 THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS YeS ftplitation for Misposal 6potem Const ution Permit Application for a Permit to Construct( ) Repair( ) Upgrade b') Abandon( ) ❑Complete System EfIndividual Components Location Address or Lot No. 10'1!4( .���,� y e Owner's Name,Address,and Tel.No. Assessor's Map/Parcel ?3 �, � -ate — -s ^^• �� s-o�- le gwn.0 Installer's Name,Address,and Tel.No.lj�c,� Desig�r's Name;Address,an¢Tel.No. .-4, 0 Gs.�..) � Type of Building: Dwelling No.of Bedrooms Lot Size q-ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided gpd Plan Date ✓g (O Number of sheets Revision Date Title Size of Septic Tank PQ® ��'KS_ , �o� Type of S.A.S. Description of Soil Nature of Repairs or Alterations 7(Answer when applicable) �a„<3 ��, ^r e_> 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 oard of Health. ed Date ✓ Application Approve Date Application Disapproved by' Date for the followirg reasons Permit No. -6 0?77 Date Issued �n.w•-�.e,.sv• ,.._..-. ._......_..�—. v,�. _.,�..., 4yrN.s„�r," 'Yeryie3�strr.:���i9`Ww +n,,.yq�^`'vw..w,+s..,g...y.r..--e.....-.,.-....-- ,_ "'n}*•i-n+ai+a"ash:,+r+.srwy.�w,+rr..s.,�...�....,. f No. w/O V °- Fee ,® V THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: i Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS r pIitration for Disposal *pstem Construction 3permit Application for a Permit to Construct( ) Repair( ) Upgrade Abandon( ) ❑Complete System ✓❑Individual Components Location Address or Lot No. 1074J Q�.;,n, 9 L.,� �, Owner's Name,Address,and Tel.No. Assessor's Map/Parcel a 7 3(crkc 12o2_ 7 f_ 6 aC Installer's Name,Address,and Tel.No.' e a-R— Designer's Name,Address,and Tel.No. �.c,,r rs K �-7 L 5�,-ESL v� c��s�3 cs-�.� ; , c ra.rYc3_ �-�2-- aR�i- -L 2.5 Ste`�'- ��77. - �o Ss- 'tom-.cam, �►r ��""� '`C�.;;c'`���:,,r�� �S.� Type of Building: Dwelling No.of Bedrooms 3 Lot Size ,' ( �r��sq.-ft. Garbage Grinder( ) Other Type of Building < No.of Persons Showers( ~) Cafeteria Other Fixtures Design Flow(min.required) gpd Design flow provided gpd Plan Date ' 1 U Number of sheets ( Revision Date LZ 1/Z11)(9 Title �— Size of Septic Tank pow ccx_s 7, Type of S.A.S. IZ r G,-:zG ( moo« Description of Soil Nature of Repairs or Alterations(Answer when applicable) 3i,,,� 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. \ i ed - Date 41111/ i�A2,1 Application Approvedb_y Date ! ' Application Disapproved by Date for the following reasons - Permit No. Q Date Issued y l Q THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired( ) Upgraded tv J Abandoned( )by at 4'Z' ',�� S (�. e has been constructed in accord �ance _ ` �/O -0 //dated L 0 with the provisions of Title 5 and the for Disposal System Construction Permit No. Installer ��j�� Designer P\ Y #bedrooms `�� Approved design flow 3 2> c) gpd The issuance of this permi shall not be construed as a guarantee that the system w '1 fi n)ction as designed. Date �! a`� 0 Inspector Q _- N0.( _.. _----------- ------ ------------- - --- - Fe e 0 THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS Misposal 6pstem Construction 3permit Permission is hereby granted to Construct( ) Repair( ) Upgrade(c/)" Abandon( ) System located at O 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 Approved`by_ t Town of Barnstable P,,oF�HE r�,o Regulatory Services Thomas F. Geiler, Director " H MASS. HealthMnss. Public Health Division 9 1639. °lE0 rnA�°i Thomas McKean, Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Installer &Designer Certification Form Date: 3 Sewage Permit# QOkO—C9 Assessor's Map`Parcel a?3 to Designer: Installer: Address: Address: , CQ03 On Cr � was issued a permit to install a (da e) installer) septic system at l d:2�4 based on a design drawn by (addre s) dated 41W)ID �ey LHiq to -7 (designer) I certify that the septic system referenced above was installed substantially according to the design, which may include minor approved changes such as lateral relocation of the -distribution box and/or septic tank. I certify that the septic system referenced above was installed with major changes (i.e. greater than"10' lateral relocation of the SAS or any vertical relocation of any component of the septic system)but in accordance with State& Local Regulations. Plan revision or certified as-built by designer to follow. tN of LINDA o PINTO CIVIL H (Installer's Signature) No. 46504 a �0 /STER�C?� ASS/ONAL ECG` (Affix Designers Stamp Here) esiter's Signature) PLEASE RETURN TO BARINSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE W11L NOT BE ISSUED UNTIL BOTH THIS FORM AND AS-BUILT CARD ARE RECEIVED BY THE BAIZNSTABLE PUBLIC HEALTH DIVISION. THANK YOU, Q:Health/Septic/Designer Certification Form 3-26-04.doc i APPLICANT _I �(Jltti Pi n�'o GS 1J C�'1� i rig ADDRESS: Q14- Pt'linneq,s Ln Cc�-k yIlle DESIGN FLOW: js gpd REVIEWED BY: DATE: N/A OK NO Le al boundaries denoted [310 CMR 15.220(4)(a)] Street, Lot,tax parcel number and lot number noted on plan [310. CMR 15.220(4)(u)] Locus Provided 310 CMR 15.2204 t Plan proper scale?(1"=40'for plot plans, 1 20'or fewer for com onents) [310 CMR 15.220(4)] Easements shown [310 CMR 15.220(4)(b)] System located totally on lot served [310 CMR 15.405(1)(a) for u ades]-i�not, a variance is required [310 CMR 15.412(4 ] V Location of impervious surfaces (driveways,parking areas etc.) [310 CMR 15.220(4)(d) y� a, Location all buildings existing and proposed 310 CMR 15.220(4)(c)] Location and dimensions of system components and reserve areas [310 CMR 15.220(4)(e)] S stem Calculations [310 CMR 15.220(4)(f)] daily flow - se tic tank ca acit re uired andprovided) soil abso tion s stem (re uired and provided) whether s stem desi ned for arba e ndet North arrow[310 CMR 15.220(4)( )] Existing and ro osed contours [310 CMR 15.220(4)( )] Location and log of deep observation holes(existing grade el. on / each test) [310 CMR 15.220(4)(h)] V Names of soil.evaluator and BOH representative [310 CMR / 15.220(4)(h)and(i)] V Location and date of percolation tests (performed at.proper / elevation?) [310 CMR 15.220(4)(i)] V Percolation test results match loading rate?-[310 CMR 15.242] Certification statement b Soil Evaluator 310 CMR 15.220(4) ')] Observed and Adjusted groundwater(method for adjustment r given or indicated) [310 CMR 15.103(3) and 310 CMR 15.220(4)(n)] Location of every water supply,public and private,.[310 CMR 15.220(4)(k)] �' Address Sheet 1 of 7 within 400 feet of the proposed system location in the case of surface water supplies and gravel packed public water supplyJ within 250 feet of the proposed system location in the case within 150 feet of the proposed system location in the case of private water supply wells Location of all surface waters and wetlands located up to 100 ft. beyond setbacks listed in 310 CMR 15.211 and any catch basins f located within 50 ft. [310 CMR 15.220(4)(1)) Water lines and other subsurface utilities located [310 CMR / 15.220 4 (m) (if water line cross see 310 CMR 15.211(1) 1]) V Profile of system showing invert elevations of all system / components and the bottom of the SAS 310 CMRI 5.220(4)(o)] Stamp of designer 310 CMR 15.220 1 and 310 CMR 15.220(2)] Stamp of Registered Land Surveyor(required if construction activities within 5 ft. of lot line) [310 CMR 15.220(3)] J Test Holes adequate(two in each of the primary and reserve unless trenches as permitted in 310 CMR 15.102(2)or as J approved for an upgrade under LUA at 310 CMR 15.405(1)(k)] Test hole adequate to demonstrate four feet of suitable material? 310 CMR 15.103(4)] Test Holes adequate to confirm adequate groundwater separation? [310 CMR 15.103(3)] Benchmark within 50-75'of system [310 CMR 15.220(4)( )) Materials specifications noted?[various sections of 310 CMR ` 15.000] V System components not> 36" deep(unless Local Upgrade Approval or LUA requested) 310 CMR 15.405(l(b) Address 1014 inns 5 1-r1. C,�4 ►�lx Sheet 2 of 7 i IS ize OK? j7" 1 r4' 15.223(1)] Inlet tee loceches below flow line 310 CMR 15.227(6)] Outlet tee 1 5"per foot for increase ft depth [3I0 CMR Nor1. .227 6)] ✓ 1/ Outlet tee with as baffle or approved filter [310 CMR 15.227(4)] te installation on stable compacted base [310 CMR 15.228(1)] Separation between inlet and outlet tees (no.less than liquid ICNMI 10 CMR 15.22 7 2) let elevations at least 12" above high groundwater s described 310 CMR 15.227(5)) or permitted for upgradesunder LUA [310 CMR 15.405(1)(k)] cover 9" (Tanks buried more than 9" must have risers nings and on the d-box) [3l0 CMR 15.2228(1)and 310 f 232(3)(f)] Three access covers (inlet and outlet must be 20" or greater) - / middle access at least 8" 7/07) [310 CMR 15.228(2)] Access to within 6 " of grade - one port for systems<1000gp43 / two fors stems>1000 gpd 310 CMR 15.228(2)] . r/ All at-grade covers secured to unauthorized access? [310 CMR / 15.228(2)] �/•-,,,. > 10 ft from building foundation [310 CMR 15.211(1)] Buoyancy calculation Required/Done 310 CMR 15.221(8)] H-20 Where appropriate? [310 CMR 15.226(3)] Setbacks from resources [310 CMR 15.211] Required when other than single-family dwelling or flow>1000 / d [310 CMR 15.223(1)(b)] . V First compartment 200%daily flow; Second compartment 100% daily flow 310 CMR 15.224(2) and (3)] "U"pipe through or over baffle, outlet of each compartment with as baffle or approved filter 310 CMR 15.224(4)] Address Atnnev Ln Sheet 3 of 7 r. Located at least ten feet from any water line? [310 C777 15.222(2)] J Disposal piping at least 18" below water line (when w sewer cross, see 310 CMR 15.211 1) 1])1 Cleanouts required/provided ? [310 CMR 15.222(8)] Thrust blocks specified in force mains?310 CMR 15.221(6)(c)] Slope of sewer line not less than 0.01 (1/8"/ft) 0.02 preferable / [310 CMR 15.222(6)] . lProper pitch on all runs? (.005 within gravity-distributed trenches / and beds) 310 CMR 15.251(9)and 310 CMR 15.252(2)(c)] Siphon problem/ leachfield below pump chamber) Endca s or vent manifolds ecified? Size and orientation of discharge holes specified?(not smaller than 3/8"not larger than 5/8") [310 CMR 15.251(8) and 310 CMR 15.252(2)(h)] Materials specified (310 CMR 15.251(5)specifies various pipe / Itypes allowed) d Stable compacted base [310 CMR ]5.221(2) and 310 CMR... ........_ . ._> . ,.�- -- r• -- Splash plate or baffle tee required on inlet/provided?(when pressure sewer to d-box or steep pitch of gravity sewer) [310 CMR 15.323(3)(a)] Riser if deeper than 9" [310 CMR 15.232(3)(f)] Inside minimum dimension 12" [310 CMR 15.232(2)(b)] Minimum sum 6" (310 CMR15.232(3)(e)] Watertight cover if<2000gpd); waterproof manhole if>2000gpd / [310 CMR 15.232(3)(d)] Capacity(emergency storage above working=design flow)? [310 CMR 231(2)] Proper setbacks [310 CMR 15.211 (same as septic tanks)] Watertight 20-in minium access manhole at least 20"MUST BE TO GRADE [310 CMR 15.231(5)] Service components accessible (not too deep with piping; disconnects accessible) v Alarm floats - alarm on circuit separate from pumps s ecified? Exceeds two units must have two pumps operating in lead-lag mode. [310 CMR 15.23](6)and (8)] Stable Compacted Base [310 CMR 15.221(2)] Buoyancy calculations needed ?Provided? [310 CMR 15.221(8)] Address q�[ Q h,nne�s Ln Sheet 4 of 7 T Calculations correct? 4 feet of naturally occurring material demonstrated? [310 CMR 15.240(1)] Re uired separation to groundwater? 310 CMR 15.212)] A e ate specified as double washed [310 CMR 15.247(2)] Are required/provided?(system under driveway or >36" dee ) [310 CMR 15.241] Inspection ports specified and within 3"final grade?[310 CMR / 15.240 13) Breakout requirements met?(No violation of breakout elevation within 15-ft of SAS unless barrier) [310 CMR 15.211(1)[4] and V Guidance Document] all W Chambers and Gal. in trench configuration supplied with inlet every 20 ft. [310 CMR 15.253(6)] Each structure with one inspection manhole(if>2000 gpd must j be to grade) 310 CMR 15.253(2)] ✓ Aggregate I'minimum-4'maximum. [310 CMR 15.253(1)(b)] 2'sidewall credit maximum [310 CMR 15.253(1)(a)] In bed configuration, inlet every 40 s . ft. [310 CMR 15.253(6)] now 7777mmever aximum [310 CMR 15.251(1)(b)][310 CMR 15.251 1) aeffective depth orwidth whichever ` eater(3x if reserve between trenches) [310 CMR 251 1)(d)] Situated along contours [310 CMR 15.251(2)] Breakout OK?[310 CMR 15.211(1)[4] and Guidance Document] minimum 2 distribution lines 310 CMR 15.252(2)(a)] Maximum separation between lines 6' 310 CM R15.252(2)(d)] Maximum separation between lines and outside of bed 4' [310 CMR 15.252(2)(e)] Aggregate depth below discharge pipes 6"minimum, 12" maximum. [310 CMR 15.252(2)(g)] Separation between beds 10'minimum. [310 CMR 15.252(2)(f)] Bottom area used in calculations only 310 CMR 15.252(2)(i)] Address DI n�l1Ael �1 S LA, .��►'k I L Sheet 5 of 7 0' Pressure Dosed.System ? Provided pump and piping calculations as required [310 CMR 15:220(4)(r)] Pressure dosing required on all systems>2000gpd or alternative systems under remedial approval [310 CMR 15.254(2) and I/A Remedial Use Approvals] ` If used in grave Iless system-make sure jet is directed as not to scour soil interface [Guidance Document] V Inspections once per year(systems<2000 gpd) or quarterly (>2000 d)good to note on plan 310 CMR 15.254(2)(d)] Construction in fill -Did the plan specify that the fill shall meet the specification of 310 CMR 15.255(3)9 Impervious barrier and/or retaining wall ? [Guidance Document] Impervious barrier installation must be supervised by / .designer[310 CMR 15.255(2)(b)] Retaining wall must be designed by Registered Professional Engineer[310 CMR 15.255(2)(a)] Side slope not exceed 3:1 ? 310 CMR 15.255(2)] Breakout requirements met? [310 CMR 15.252(2)and / Guidance Document] At least 5 ft.from impervious barrier to edge of SAS .(10 ft. / recommended) [310 CMR 15.255 (2)(e)] V Check DEP Approval letters for credits and design conditions If used with pressure dosing do not allow pressure discharge to scour soil interface Was DEP Approval Letter provided and/or have you ` reviewed the letter for conditions? Vf Is the technology being properly applied and does it meet all DEP Approval Conditions? V Is there a note on the plan regarding the requirement for perpetual maintenance agreement? Any alarms involved on separate circuits Did the applicant submit an operation and maintenance- . manual? Has applicant submitted a copy of a maintenance Are the variances listed on the plan ? [310 CMR 15.220 (4)( )] t/ RLS Stamp necessary on plan if a component is within dive feet of property line[310 CMR 15.412(4)] New construction or increased flow proposed- [Refer to 310 CMR 15.414] Address Oh1 na LYE. &,e rii k y Sheet 6 of 7 r i j. Is the system in a Designated Nitrogen Sensitive Area(Zone II.fo a public supply well)? [310 CMR 15.214, 310 CMR 15.215 and f 310 CMR 15.216- also refer to Policy regarding upgrades of such existing systems] Is the system proposed on the same lot as served by private well ? / [310 CMR 15.214(2)] v Are the nitrogen loads proposed in compliance? [310 CMR J 15.216(1)] Pumping to septic tank? [310 CMR 15.229 Shared System [310 CMR 15.290 Address eknnt J 5 6. Sheet 7 of 7 Town of Barnstable P# l Department of Regulatory Services Public Health Division Date 3 231(n 200 Main Street,Hyannis MA 02601 Date Scheduled a' Time l Fee Pd. °v Soil Suitability Assessment for Sewage isposal Performed By: Witnessed By: LOCATION& GENERAL INFORMATION Location Address l �� /�j f , Owner's Name _ P Rf t A l !� r J?MR S uV Address 07 y�k 1017 -S Assessor's Map/Parcel: 2?3 — G Engineer's Name L 1 K,1,A o f w*- NEW CONSTRUCTION REPAIR Telephone# Land Use �S I fA GII �,. Slopes(%) D - 1 v Surface Stones t` 0 Distances from: Open Water Body too ft Possible Wet Area 7 ot0 ft Drinking Water Well y ad ft Drainage Way ft Property Line 7 I 0 fft Other ft SKETCH:(Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands in proximity to holes) v­ ��il lny Co 10 _ Parent material(geologic) ZL-�aS� Depth to Bedrock fib° r Depth to Groundwater. Standing Water in Hole: N I� - Weeping from Pit Face NIA T Estimated Seasonal High Groundwater DETERMINATION FOR SEASONAL HIGH WATER TABLE Method Used: Depth Observed standing in obs.hole: —in. Depth to soil mottles: Depth to weeping from side of obs.hole: in, Groundwater Adjustment tt. Index Well# Reading Date: Index Well level,. Adj.factor., Adj.droundwaterLevel, PERCOLATION TEST Date Time,__._! Observation Hole# 12-,'1 Time at 9" Depth of Perc 4q 11 Time at V Start Pre-soak Time @ n:6 U - 'time(9"-61 End Pre-soak X. Rate MinJinch l,Z pr►�tn�� Site Suitability Assessment: Site Passed L/ 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:\SEPTIC\PERCFORM.DOC I DEEP.OBSERVATION HOLE LOG Hole# , Depth from Soil Horizon Soil Texture .Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones;Boulders. Consistency,% vel. 0- �-1�1 S L4krn 1bj2 2/1 �oaM 4' - I CI �4-/2-o CZ C S& J.b '7/2 DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil , Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. n p C nsi % 6 . Lo A.M I 2 'gk 94-- SA,d I'0 yet TA sal 6-o tl U�— 20 GL SAns( O 2 BIZ LGvbc P DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. C i to c Gravel) DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones.Boulders. Cons' t n 4,°a@ 1 7. xs p G',.. Flood Insurance Rate Map: f —j Above 500 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? e-$ If not,what is the depth of naturally occurring pervious material? _ Certification I certify that on )-00 (date)I have passed the soil evaluator examination approved by the Department of Environmental Protection and that the above analysis was performed by me consistent with . the required training,expertise and experience described in 310 CMR 15.017. Signature Date Q:\S.EvnC&ERCFORM.DOC COMMONWEALTH OF MASSACHUSETTS ExECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION a93 c9 9� TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address- /0 h e Ge,i ,v,' e Owner's Name: Owner's Address: o L h h 4 zW4 D Date of Inspection: Va 01,0 / Name of Inspector: (please print) /Var[/4 Company Name: EA1111 p Mailing Address: 15�'o &o x /a 8.5�1 EAs4h cuz -Xd Oo?G q61- Telephone Number:t5o�� 171,7S=Y# CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of the inspection.The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section15.340 of Title 5(310 CMR 15.000). The system: L Passes Conditionally Passes Needs Further Evaluation by the Local Approving Authority Fails Inspector's Signature: �G� Date: 9 The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection.If the system is a shared system or has a design flow of 10,000 gpd.or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP.The original should be sent to the system owner and copies sent to the buyer,if applicable,and the approving authority. Notes and Comments ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. f } q Page 2 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICAT'IO�N/(continued) Property Address: O 7 A i rn rr e S �v fto r✓ l Owner. -j7MV1VS Date of Inspection: 9 O 0 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. Systt Passes: V I have not found an information which indicates that an of f y y the allure 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. Answer yes,no or not determined(Y,N,ND)in the for the following statements.If"not determined"please explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not)is structurally unsound,exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND explain: Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken,settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced ND explain: The system required pumping more than 4 times a year due to broken or obstructed pipe(s).The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed ND explain: ` Page 3 of 11 OFFICIAL INSPECTION FORM- NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A n CERTIFICATION(continued) Property Address: �� Pti� ✓�2� S L/f/ Owner. 0 Gt n i d PS Date of Inspection: zo 0 C. Further Evaluation is Required by the Board.of Health: V 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 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 coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered A copy of the analysis must be attached to this form 3. Other. I f Page 4 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: /0 7 Lf Ce N ,tell/eT, r. J Owne oa Date of Inspection: 9 o O D. System Failure Criteria applicable to all systems: You must indicate"yes"or"no"to each of the following for all inspections: Yes No -ZBackup 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 or clogged SAS or cesspool ,Liquid depth in cesspool is less than 6"below invert or available volume is less than''/z day flow -cZ' Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number of times pumped . Any portion of the SAS,cesspool or privy is below high ground water elevation. Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. Any portion of a cesspool or 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 coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form.] (Yes/No)The system fails.I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails.The system 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. You must indicate either"yes"or"no"to each of the following: (The following criteria apply to large systems in addition U:J the criteria above) yes no the system is within 400 feet of a surface dhnldn g water supply the system is within 200 feet of a tributary to a s1urface 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 If you have answered"yes"to any question in Section E the system is considered a significant thrreat,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..r i d Page 5 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM . PART B CHECKLIST Property Address: /O C' W, rvi l e Oa 3 Owner. Date of Inspection: 24 514/ Check if the following have been done.You must indicate`Yes"or"no"as to each of the following: Yes No 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 Has the system received normal flows in the previous two week period Have large volumes of water been introduced to the system recently or as part of this inspection V _ Were as built plans of the system obtained and examined?(If they were not available note as N/A) Was the facility or dwelling inspected for signs of sewage back up Was the site inspected for signs of break out Were all system components,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 V — Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems The size and location of the Soil Absorption System(SAS)on the site has been determined based on: Yes no 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 CUR 15.302(3)(b)] a — Page 6 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C I- SYSTEM INFORMATION Property Address• 119 ILf'Ceti 40-,y,lie Owner: c�o e 1 d63� Date of Inspection: < o D FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): Number of bedrooms(actual):3, DESIGN flow based on 310 CIvt 15.203(for example: 110 gpd x#of bedrooms): Number of current residents. (/ Does residence have a garbage grinder(yes or no): Is laundry on a separate sewage system(yes or no):��[if yes separate inspection required] Laundry system inspected(yet or no): Seasonal use: (yes or no): Water meter readings,if available(last 2 years usage(gpd)): Sump pump(yes or no): IV47 Last date of occupancy: COMMERCIAlANDUSTRIAL Type of establishment: Design flow(based on 310 CMR 15.203): ' god Basis of design flow(seats/persons/sgft,etc.): Grease trap present(yes or no):_ Industrial waste holding tank present(yes or no):_ Non-sanitary waste discharged to the Title 5 system(yes or no):_ Water meter readings,if available: Last date of occupancy/use:,., OTHER(describe): GENERAL INFORMATION Pumping Records Source of information: IV0 eyge lqs A t7 w N-e i ' Was system pumped as part of the inspection(yes or no):_41*1 If yes,volume pumped:_pllons—How was quantity pumped determined? Reason for pumping: TYPE OF SYSTEM _Septic tank,distribution box,soil absorption system _Single cesspool Overflow cesspool —ivy _Shared system(yes or no)(if yes,attach previous inspection records,if any) _hmovative/Altanative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) _Tight tank _Attach a copy of the DEP approval _Other(describe): Approximate age of all components,date installed(if known)and source iIIf rmation: ; 9� Were sewage odors detected when arriving at the site(yes or no): /V0 5 Page 7 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) / Property Address: /0 7,f I"A n n L 41 Ceti ev►I 3.2, Owner. :7j7A,1A'1jeS Date of Inspection: oto rD BUILDING SEWER(locate on site plan) Depth below grade: Materials of construction: cast iron (/40 PVC_other(explain): Distance from private water supply well or suction line: Comments(on condition of joints,venting,evidence of leakage,etc.): SEPTIC TANK:_(locate on site plan) Depth below grade:_( Material of construction:�ncrete metal_fiberglass polyethylene _other(explain) If tank is metal list age:_ Is age confirmed by a Certificate of Compliance(yes or no):_(attach a copy of certificate) .jJtg Dimensions: Sludge depth: Distance from top of sludge to bottom of outlet tee or baffle: 344 / Scum thickness: d-11 i /� F Distance from top of scum to top of outlet tee or baffle: 2 Distance from bottom of scum to bottom of outlet tee or baffle: How were dimensions determined: �le Rca s c%yi c e Comments(on pumping recommendations,inlet an`a outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): no v�ee�e a A -l-�y"+P. TAn�r ati %EIS t n 0,009 e -foo d riot,/ GREASE TRAP:ZOocate 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 baffle: Date of last pumping: Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): Page 8 of 1 l L OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C /SYSTEM INFORMATION(continued) Property Address: 107i"f [� thin v►e '/ v Ce Owner: ci i,rt i d e Date of Inspection: a,o p TIGHT or HOLDING TANK: I (tank must be pumped at time of inspection)(locate on site plan) Depth below grade: Material of construction: concrete metal fiberglass_polyethylene other(explain): Dimensions: Capacity: gallons Design Flow: _ gallons/day Alarm present(yes or no): Alarm level: Alarm in working order(yes or no): Date of last pumping: Comments(condition of alarm and float switches,etc.).- DISTRIBUTION BOX:/y (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 eviden of leakage into or out of box,etc.): 1 7 C� (/I� 4-Q J a L-4 IO 6e PUMP CHAMBER L/L(locate on site plan) Pumps in worldng order(yes or no): Alarms in working order(yes or no): Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.): Page 9 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: d)I h✓►2 Cep — Owner. Tr,hni e- Date of Inspection: 0 0 SOIL ABSORPTION SYSTEM(SAS): (locate on site plan,excavation not required) If SAS not located explain why: Type leaching pits,number:_ n ' ���' �S /S�Pak— - 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.): _ jo SO Q►h f p to ir:2 kc, �e CESSPOOLS:ZV" (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 or no): Comments(note condition of soil, signs of hydraulic failure,level of ponding,condition of vegetation,etc.): PRIVY: &( (locate on site plan) Materials of construction: Dimensions: Depth of solids: Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): Page 10 of I l OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: /0 ►n r'1 e Z-/V Owner. alb o / Date of Inspecti n: ,°I ©anh►c'AS SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks.Locate all wells within 100 feet. Locate where public water supply enters the building. cG� c to �oufG f{ res i Tet� tio�z ] y j � 3 j V 4 Page 11 of 11 • OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 109if 41 n✓l P 4 ✓ ,h Owner: VIA; Date of Inspection: 0 0 SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water 4S feet Please indicate(check)all methods used to determine the high ground water elevation: Obtained from system design plans on record-If checked,date of design plan reviewed: Observed site(abutting property/observation hole within 150 feet of SAS) Checked with local Board of Health-explain: Tow h N?oil,'S Checked with local excavators,installers-(attach documentation) Accessed USGS database-explain: You must cri how you established the high ground water el ev tion: P,,O QrM / o,io. a 1o%✓ % L/�� ✓1e a /S oY ONh w�' Pv d+dill 41/024� I GN h� 1��-� _ _ I �— ,ter. ►�_ :,r if J 4o ,ll L Ciff�N✓�hl�:iCr Gl vl /�� �. #3ti Date: ^C�Is TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM NAMEOFBUSINESS: �5ua,-DSE`C y�\V'ST\*"Jo BUSINESS LOCATION: �C�� Y�1 OVDEA, � � 1�° MAILING ADDRESS: SANG Mail To: TELEPHONE NUMBER: - d - Board of Health Town of Barnstable CONTACT PERSON: P.O. Box 534 EMERGENCY CONTACT faELEPHONE NUMBER: Hyannis, MA 02601 TYPEOFBUSINESS: il��Tl fir., Does your firm store,,any of the toxic or hazardous materials listed below, either for sale or for you own use? YES NO This form must be returned to the Board of Health regardless of a yes or no answer. Use the enclosed envelope for your convenience. If you answered YES above, please indicate if the materials are stored at a site other than your mailing address: ADDRESS: TELEPHONE: LIST OF TOXIC AND HAZARDOUS MATERIALS The Board of Health has determined that the following products exhibit toxic or hazardous character- istics and must be registered regardless of volume. Please estimate the quantity beside the product that you store. NOTE: LIST IN TOTAL LIQUID VOLUME OR POUNDS. Quantity Quantity Antifreeze(for gasoline or coolant systems) Drain cleaners NEW USED Cesspool cleaners Automatic transmission fluid Disinfectants Engine and radiator flushes Road Salt (Halite) Hydraulic fluid (including brake fluid) Refrigerants Motor oils Pesticides NEW USED (insecticides, herbicides, rodenticides) Gasoline, Jet Fuel Photochemicals (Fixers) Diesel fuel, kerosene, #2 heating oil NEW USED Other petroleum products: grease, Photochemicals (Developer) lubricants, gear oil NEW USED Degreasers for engines and metal Printing ink Degreasers for driveways & garages Wood preservatives (creosote) Battery acid (electrolyte) Swimming pool chlorine Rustproofers Lye or caustic soda Car wash detergents Jewelry cleaners Car waxes and polishes Leather dyes Asphalt & roofing tar Fertilizers 5 1124 Paints, varnishes, stains, dyes PCB's Lacquer thinners Other chlorinated hydrocarbons, NEW USED (inc. carbon tetrachloride) Paint & varnish removers, deglossers Pay^ri N^� Any other products with "poison" labels -KS64L Paintbrush cleaners (including chloroform, formaldehyde, Floor & furniture strippers hydrochloric acid, other acids) Metal polishes Laundry soil & stain removers Other products not listed which you feel (including bleach) may be toxic or hazardous (please list): Spot removers & cleaning fluids (dry cleaners) Other cleaning solvents Bug and tar removers E COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS S a �a� __ q A` Date: .TOX : AND HAZARDOUS MATERIALS REGISTRATION FORM NAM FBUSINESS- 5C..,tJ,5ell BU'SINESSLOCATION: MAI LING ADDRESS: S ff\Z-, Mail To: � Board of Health TELEPHONE NUMBER: �O� - t0 - Town of Barnstable i CONTACTPERSON: . - A P.O. Box 534 EMERGENCY CONTACSS: T�I l.�� r�ELEPHONE NUMBER: G� �, Hyannis, MA 02601 . TYP,EOFBUSINEl i� Does.your firm store any of the toxic or hazardous materials listed below, either for sale or for you own use? YES NO This form must be returned to the Board of Health regardless of a yeas or no answer. Use the enclosed envelope"for your convenience.' '{ If you answered YES above, please indicate if the materials are stored at a site other than your mailing �.. address: way r� ADDRESS: f 1 TELEPHONE: x, LIST OFTOXIC AND HAZARDOUS MATERIALS " The Board of Health has determined that the,follgwing products exhibit toxic or hazardous character t istics and must be registered regardless of volume. Please estimate the quantity beside the product that t you store. NOTE: LIST IN TOTAL LIQUID VOLUME OR POUNDS. Quantity. i Quantity +a, Antifreeze for asolineorcoolants stems Drain cleaners -NEW USED °T Cesspool cleaners ,. Automatic transmission fluid Disinfectants Engine and radiator flushes,-,,,,, _ _ Road Salt (Halite)_ i Hydraulic fluid°(including brake fluid) Refrigerants .Motor oils }a 3 ;.. � , Pesticides ♦ + a NEW - USED. (insecticides, herbicides, rodenticides) t' Gasoline, Jet Fuel Photochemicals (Fixers) J Diesel fuel, kerosene, #2 heating oil NEW USED Other petroleum products; grease, "Photochemicals (Developer) NEW USED Degeasers,for,engines and metal h Printing ink Degreasers for driveways & garages Wood preservatives (creosote) Battery acid (electrolyte) Swimming pool chlorine J Rustproofersu.- Lye or caustic soda ``4'. "_. Car wash detergents ' Jewelry cleaners Car waxes and polishes- Leather dyes Asphalt & roofing tar . °p Fertilizers Paints, varnishes, stains, dyes PCB's Lacquer thinners Other chlorinated hydrocarbons, NEW USED (inc. carbon tetrachloride) Paint & varnish removers deglossers Paint brush cleaners a�,^tN^ems' Any other products with "poison" labels ' ,� .� (including chloroform, formaldehyde, 'g Floor & furniture strippers hydrochloric acid, other acids) -_ Metal polishes YtiM -_ Laundry soil & stain removers Other products not listed which you feel may be toxic or hazardous lease list (including bleach) Y (p ): Spot removers & cleaning fluids (dry cleaners) Other cleaning solvents e Bug and tar removers COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS TOWN OF BARNSTABLE LGCTION lD_ SEWAGE # VILLAGE__ 7` v ASSESSOR'S MAP 6 LOT, e INSTALLER'S NAME & PHONE NO. F,6VA62 ' z SEPTIC TANK CAPACITY 1d)6 T;3,,V, 1.01'0T 13v 4/V Zr,/ �S Y LEACHING_FACILITY:(type) e/ ,7'W c.�/1:4eA 5(size) ?7�a STasvg ..NO.,.OF BEDROOMS PRIVATE WELL OR PUBLIC WATER ')WWA) BUILDER OR'OWNERla DATE PER"MIT ISSUED: DATE COMPLIANCE ISSUED: aS� �` VARIANCE GRANTED: Yes _No ��, t �� � �� �� � � � i � _ � �. �� r v n d �� "V � ��. r � r '� z �� �. �� �- . �. � .. e� �;� • l •:� t ASSESSORS MAP NO- r� PARCEL NO:� THE COMMONWEALTH OF MASSACHUSETTS -BOARD OF HEALTH .TOWN OF BARNSTABLE Di, 1n3al Work Tomitrnrtinn rrrmi# Application is hereby made for a Permit to Construct ( ) or Repair an Individual Sewage Disposal System at: ....-.-zv— y.........................�Z<........................, ....DIY' Location-Address or Lot No. � a LZj"P.....mot .: =- �,�Z_J A ----------------- ...... Qwner Address a �� 1�y1•.. r / ../, i✓ ' S 3"� ............................... �f Installer Address Type of Building Size Lot............................Sq. feet U r Dwelling—No. of Bedrooms....-.,-....�---------------------------Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ---------------------------- No. of persons--------------.------------- Showers ( ) — Cafeteria ( ) Q' Other fixtures ------------------------------- - - W Design Flow............................................gallons per person per day. Total daily flow--------------------------------------------gallons. WSeptic Tank—Liquid capacity............gallons Length................ Width---------------- Diameter................ Depth................ x Disposal Trench—No. .................... Width-------------------- Total Length.................... Total leaching area....................sq. ft. Seepage Pit No..-.----_--_------ Diameter----------------_- Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) . Dosing tank ( ) aPercolation Test Results Performed by...................--............................................... ..... Date........................................ a Test Pit No. .1................minutes per inch Depth of Test Pit............-------- Depth to ground water.............-..-.------ rX4 Test Pit No. 2................minutes per inch Depth of Test Pit-------------------- Depth to ground water....--.................. 94 •---•-••--•------------•-----------------------•-----••------------••--•-------------.................................................................... .... 0 Description of Soil.....................................................................................................................................................--....---•-•------ U ---•-------------------------------------•-------------------------------------------------------------------------------------------------...-------------------------------------•-•--•---•---••-•... W x ----•----------------------------------------------------------- -------------------------------------------------------------------------------------------------------------------------------------- U Najure of Repairs or Alterations—Answer when applicable._- -r ?-: '_ - .j---.06�.----r ............ Z .......g.'-;,e- et------ -!��.77X'&:5, ------------------------ Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code —The undersigned further agrees not to place the system in operation until a Certificate of Complia ct4c-e leas been issued,by,,t-hr board of alth. Signed ----..... .... " Date Application Approved By ............... -- ----- Date Application Disapproved for the llowing reasons- ---------------------------------------------------------------------------------------------------------------------------------- ............. .................................................. ........................... ..............._......... . . -- .......................... ---------------------------------------- Date................ ........................ ............................._.. ...... Permit No. .................�1.....�...�.,. . Issued Date © 94 Fss... - �)..... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH rr TOWN OF BARNSTABLE a t>�tIjI3r �a ti�3Ml DXjt� C��itt tr rttnt rrbttt Application is hereby made for a Permit to Construct ( ) or Repair an Individual Sewage Disposal System at: ----------------- •---•---•-----------------••-----•----------------•---•--------------------•----------•-•----•---- Location-Address or Lot No. /Q y� -/ WnCr yam/ ____________________________________________Address a ............... :jxL:7JJ /p... ... _C—._._ _........._ ........................................... � Installer Address UType of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms.__--__---_2--------- ----------------Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons-_.__-----__--__-----._.._ Showers ( ) — Cafeteria ( ) aI Other fixtures ............... --------------------------------------------------•--------------------- ---------------------------------------------•--••--•-------- w Design Flow............................................gallons per person per day. Total daily flow..................................____-_._--gallons. WSeptic Tank—Liquid capacity............gallons Length---------------- Width--------.---_- Diameter---.------------ Depth................ x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No.-_----___-_-.---_ Diameter-------------------- Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed bY-------------------------------------------------------------------------- Date........................................ aTest Pit No. 1................minutes per inch Depth of Test Pit-------------------- Depth to ground water........................ 44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water...._................... u+ ------------------------------------------------•--------•---------------•••-•--------------•--•-•--......................................................... ODescription of Soil......................................................................................................................................................................... x U ---------------------------•--•------------•-•-•-•-...-----•----•••--•-•--•------••-•------------------------•--•------•------------------------•••---------------------••....------•-----------------•. w U Nure of Repairs or�Alterations—Answer when applicable._. j4_ '_ ��f._..t1�! _.__.�'�sS�PA.4/,S_____________ L'vi7A-.......1 0•0-0---Q?-,V-4--- ...... ------` .7-r 7XA: :o�eS........................ Agreement: W)7'A AZ f'T v y= 5-V�✓� The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliances as been(issued,by the board of health. 1:2 Signed ...... 1�!1�2�^!, '...`..... -------- `.-... Dace Application Approved BY .-......... ...4..-..c�' Lf Dare Application Disapproved for the Ilowing reasons- ----------- ----- -------------------------------------------------------------------------------------------- ----------------- ---- --------------------------------------------------------------------------------------------------------------------------------- ---------------------------------------- --------.....---. ------------------ Permit No. t^�f" .............1..----.1-..._�...r�..7,��. ---------.-.-._ Issued .....---............._..--------........-------.........Dace...... Date ------------------------------------------------------------ ------------- THE COMMONWEALTH OF MASSACHUSETTS 'T BOARD OF HEALTH TOWN OF BARNSTABLE (Ile ti irate of ILamplinure THIS j� TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired by --------------- ---4y#!u,rJt?Z-----.... ------�'=-------------------------------------------------...-------------------- ------------------------------------------------- InstaOer t at ........../49-7-1/. ;�0.h._'Io P y-------4*... ..... --------------------------------------------------------------------------------.-------- has been installed in accordance with the provisions of TITLE 101 The State Environmental Code as described in the application for Disposal Works Construction Permit No. dated .-...._._-_----------------------------- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE------ ------- �"---------------- Inspector_.-~". ` `- _'G✓-_ ..:.-_------------------- -._. —————————— ——— ------"'*- ------- -- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE %. �. 06 No...... FEE-: Disposal Worbi Tut3trudivit ".erttit Permission is hereby granted .. `/y!0/!/ ............................................................... to Construct ( ) or pair it ( �n Individual Sewage Disposal System at No.- �Q�Y �"'-g /t!�1i PY.5-----1-k.......•GT f{/`t ?/ ? -------- _!._#...................... ----------------------•----- Street 1�3' as shown on the application for Disposal Works Construction Permit No.....����� Dated------- 7_-J`�-_--:.-`-"'a::y.:.�� .........................--..... ;_�-------------------------------------------------------- Board of Health DATE.............. .......... �� .....T............................ FORM 36508 HOBBS&WARREN,INC..PUBLISHERS TOP Of FOUNDATION 24"diameter concrete covers EL=50.5 raised to within 6"of finish grade / Centerville, (or as noted) Inspection Port and cap with magnetic /A marking tape to within 3"of grade MA EL=49.4-t EL=4B.8+ \\ / EL=48.7*-49.2(max) J� �O0 r R�Vte y3 LOCUS _n E m &A O J01 0 Enstmg 473-- E Q ej 4 j ✓ale 46.2±- Enstm 46.6+ 203 Parcel23G g 46.4. 4C. 55 45.M 45.60 �° R Town Water h Existing _ V Existing N Proposed PVC Tee, 44.90 FND Ex15tm43 Raved _ + Gas Baffle,and Zabel Filter BRB ®rive (p Longt Run TWENTY(20)AD5 ARC36(36/6B0) / fristinq-f 5.0'+ O ��5' LEAC/-I C/-/AMBERS/N BED DB-6 CONFIGURATION WITH FOUR(4)ROW5 m p` EXISTING 1000 GALLON (I1-20 Rated) OF F/VE(5)C1-1AMBER5 r Q ^7 5EPTIC TANK D-L5OX LEACH CHAIV i5f95 Bottom of7est Hole 0' ^ Lot / �k \ 0.59± Acres \ `" 5IT LOCU5 f LOW PROF I LE NOT TO SCALE NOT TO SCALE \ O 9)"� \\ LEGEND 00� BENCHMARK EXISTING SPOT GRADE Top of Slate at B.C. 98x3 PROPOSED SPOT GRADE TWENTY(20)ADS ARC36 (3G I GBD)I EACH t���OJ� LL=50.00(Assumed Datum) 98 EXISTING CONTOUR CHAMBERS IN BED CONFIGURATION WITH FOUR ' \ �y 0' - -0-PROPOSED CONTOUR (4) ROWS OF FIVE(5)CHAMBERS %' \ �o w WATER SERVICE LINE 25' ^� Parcel 235 ❑ OVERHEAD UTILITY LINES > Town Water O ` / .� UNDERGROUND UTILITY LINES ' 5.0' 5.0' 5.0' 5.0' c GAS SERVICE LINE 0. " '�Existing Soil Absorption r TOP OF BANK r,i \ / A\ � System to be Abon,5 n ��J EDGE OF CLEARING CONSTRUCTION NOTES o_BOX N Ln /�,/ (SeeNote#/B) -.-.-TP FENCE TEST HOLE LOCATION /.)ALL WORK SHALL CONFORM TO THE STATE ENVIRONMENTAL CODE TITLE 5(3 f O - \ /° �' Existing /000 Gallon Septic Tank ST SEPTIC TANK CMR 15.000):STANDARD REQUIREMENTS FOR THE51TING, CONSTRUCTION, INSPECTION, N ` to be Utilized(See Mote#17) UPGRADE AND EXPANSION OF ON-SITE SEWAGETREATMENTANDD Y5 15PO5AL5TEM5 0� <f� DB D15TKIBUTION BOX AND FOR THE TRAN5PORTAND DISPOSAL OFSEPTAGE AND THE LOCAL BOARD OF N O o / - �.\�'�/ SAS SOIL ABSORPTION SYSTEM HEALTH REGULATIONS. 4p, Inspection Port(see Note#3) Reserve RESERVED FOR FUTURE USE 2.) ANYSEPTIC SYSTEM COMPONENT INSTALLED IN A LOCATION WHERE THERE lS �1_ POTENTIAL FOR VEHICLES OR HEAVY EQUIPMENT TO PASS OVER/T SHALL BE DESIGNED iP TO W1T115TAND AN H-20 LOAD/N6. /F UNDER AN IMPERVIOUS SURFACE,SYSTEM SHALL PLAN VIEW rr �) Q N V' BE VENTED TO THE ATMO5PHERE > 41 0 2C 3.)COV5R5 OVER THE INLET AND OUTLET TEES OF THE SEPTIC TANK, THE D1STRIBUTION SCALE: I° = 10 0- BOX AND THE50/L A550RPT10N 5YSTEM SHALL BE RA15ED TO WITHIN 6"OF FINAL !_ I CERTIFY THAT I AM CURRENTLY APPROVED BY THE GRADE LEACHING FIELDS, TRENCHES,AND OTHER 501L ABSORPTION SY5TEM5 WITHOUT Proposed SAS DEPARTMENT OF ENVIRONMENTAL PROTECTION PURSUANT TO ACCESS MANHOLES SHALL HAVEATLEA5T ONE(I)INSPECRONPORTCOA1515TINGOF 9- (See Detail) 310 CMR 15.017 TO CONDUCT SOIL EVALUATIONS AND THAT PERFORATEO4"PVCPIPEPLACEDVERTICALLYTOTHE307TOMOFTHE50/L �O THE ABOVE ANALYSIS HAS BEEN PERFORMED BY ME A55ORPTION5Y5TEM WIRY CAP, TIED WITH MAGNET/CMARKING TAPE ACCESSIBLE TO -A O CONSISTENT WITH THE REQUIRED TRAINING, EXPERTISE, AND WITHIN 3"OF FINAL GRADE O TP-2 EXPERIENCE DESCRIBED IN 310 CMR 15.017. i FURTHER Shed CERTIFY THAT THE RESULTS OF MY SOIL EVALUATION A5 4.)PIPING SHALL CONS/ST OF 4"SCHEDULE 40 PVC OR EQU/VALENT. PIPE SHALL BE °� LA/DONA MINIMUMCONTTNUOUSGRAVEOFNOTLE55THAN2%FROMTHEBUILDING INDICATED ON THE ATTACHED SOIL EVALUATION FORM, ARE TO THE SEPTIC TANK,AND NOTLE55 THAN /%OTHERWI5E / nj� ACCURATE AND IN ACCORDANCE WITH 310 CMR 15.100 5J DISTRIBUTION LINE5 FOR THE SOIL ABSORPT/ON SYSTEM SHALL BE 4"DIAMETER SYSTEM DE51GN CALCULATIONS O � /� THROUGH 15.107 SCHEDULE 40 PVC(OR EQUIVALENT)LAID AT 0.005 FT/FT. UNLESS OTHERWISE NOTED. $1 / Parcel 234 LINE5 SHALL BE CAPPED AT END OR A5 NOTED. SEWAGE DESIGN FLOW REQUIRED:3 BEDROOM DWELLING @ Q / /10 GPO/BEDROOM=330 GPD REQUIRED Parcel 009 / Town Water 6.)LINE5 FROM THE DISTRIBUTION BOX TO BE LEVEL FOR THE FIRST TWO(2)FEET Town Water � \ // t^�� 1> 0) 6 n� BEFORE PITCHING TO THE SOIL ABSORPTION 5Y57EM. D15TRlBUT/ON BOX SHALL BE WATER TESTED TO ASS SEWAGE DESIGN FLOW PROV/DED: TWENTY(20)ADS UNITS IN BED URE EVEN DISTRIBUTION. D-BOX TO BE INSTALLED ON A STABLE CONF(GURAT/ON IN FOUR(4)ROWS OF FIVE(5)UNITS EACH. / (Y �C, tq Cert[fled SOIL �'v81u8 tOr COMPACTED BASL. � // � ��� '�r, '; GROUT TO BE USED A Vt=L(330/0.74)/(4.8 FT2/FT)/5.OL17 = 19AD5 UNITS \ / �� L11ND,", , G 7. T ALL POINTS WHERE PIPES ENTER OR LLAVE ALL CONCRETE REQUIRED(20 PROVIDED) Or PINT(, cP STRUCTURES!N ORDER TO PROVIDE A WATERTIGHT SEAL. va 6. HEAVYEQUIPMENT SHALL NOT BE ALLOWED TO OPERATE OVER THE LIMIT5 OF THE 355 GPD PROVIDED>330 GPD REQUIRED \ CIVIL Cn No. 46504 SEWAGE DISPOSAL FIELD DURING THE COURSE OF CONSTRUCTION OF THE SYSTEM �f .p � SEPTIC TANK CAPACITY REQUIRED: 330 GPD X 200% = 660 GPD REQUIRED , O� 9. IN ACCORDANCE WITH 310 CMR 15.221, ALL SYSTEM COMPONENTS SHALL BE SEPTIC TANK CAPACITYPROVIDED: EX/STING 1000 GALLON 5EPT1C TANK S i T E PLAN cqSS QNA L EN�'\�� Su"ejv Mork bp. WIT H TH MAGNETIC MARKING TAPE SCALE: 1° = 20 A GARBAGE DISPOSAL/S NOT PERMITTED WITH THIS DES/GN FLOW ` /O. THERE ARE NO KNOWN WELLS WITHIN 150'OF THE PROPOSED SOIL AB50RPT/ON \ ti A & M Land Services SYSTEM 618 Mein Street //.)FROM THE DATE OF THE INSTALLATION OF THE501L ABSORPTION 5Y5TEM UNTIL TEST HOLE LOGS \Parcel 008 Ph 506 South Yarmouth MA 02664 RECE/PT OF THE CERTIFICATE OF COMPLIANCE, THE PERIMETER SHALL BE STAKED AND 737-1M Email- enm1and0comcast.net FLAGGED TO PREVENT U5E OF THE ARE4 THAT MAY CAUSE DAMAGE TO THE 5Y5TEM Town Water 12.) THE DESIGNER WILL NOT BE RESPONSIBLE FOR THE SY5TEM AS DE5/GNED UNLESS �. CONSTRUCTED A5 5HOM ON PLAN, ANYCHANGE5 SHALL BEAPPROVED IN WRITING BY Test Hole#I (EL=49.9±) THE DESIGNER. Parcel 233 Depth Layer Soil CIaSs Soil Color Comments 13.)THEBOARDOFHEALT1­1REQUIRE5IN59ECTIONOFALLCON57RUCT/ONBYAN Town Water REVI5ED 04114110: Moved SAS; No Variance Rec(ue5t. AGENT OF THE BOARD OF HEALTH AND THE DESIGNER. THE DE5/GNER SHALL CERTIFY IN 0"-4" A fine-Medium Sandy Loam I OYR 211 WRITING THAT THE 3EWA6E0/5PO5AL 5Y57FM WA5I11/5TALLE9 IN ACCORDANCE WITH 4"-24" B Fine-Medium Sandy Loam I OYR 4/G Prepared for: THE TERMS OF THE PERMlTA (D THE APPROVED PLANS. 46 HOURS ADVANCE NOTICE/5 24"-84" Cl Medium Sand I OYR 5/G 50%Gravel - Perc @ 44" REQUESTED. 84"-1 20" C2 Coarse Sand I OYR 7/2 Loose t Jennifer Toner 14.)CONTRACTORSHALLBERE5PON5/BLE FOR DETERMINING THELOCA71ONOFALL 1074 Phinney5 Ln., Centerville, MA UNDERGROUND AND OVERHEAD UTILITIES PRIOR TO COMMENCEMENT OF ANY WORK. TH15INCLUDE9, BLIT15NOTLIM/TEDTO, REQUE5T5TOD/65AFE ANYPRIVATEUTILITY I .) Deed Book 19794, Page 37 ' /t1 RT COMPANIES,AND THE LOCAL WATERDFPARTMENT Test Hole#1 (EL=49.9+) ff Pro 05ed Sewa e D1s O5a1 5 Stem 2.) Assessors Map 273, Parcel 09G it v� f 9 p Y 3.) This property 15 in a Zone II of a Public N N 1 074 Phinney5 Ln., Centerville, MA /5.)CONTRACTORSHALL VERlFYTHATALL WASTELlNES ARE CONNECTED BYWATER Depth Layer Sod Class Sod Color Comments p TESTING WITHIN THEOWELLINC PRIOR TO INSTALLATION OFANYSEPTICCOMPONENT5. Water Supply w 01 0"-5" A fine-Medium Sandy Loam I OYR 211 4.) Flood Zone: C J 0' Prepared by: 16.)CONTRACTOR SHALL VERIFYEY/ST/NG 1NVERT ELEVAT10N5 PRIOR TO INSTALLATION ` O OFANY5EPT/C5Y5TEMCOMPONFNT5. 28"-45 B fine-Medium Sandy Loam I OYR 4/G 5.) Vertical Datum Shown is Assumed 282" Cl Medium Sand I OYR 5/G 50%Gravel 17.)EX15T1NG 1000 GALLON SEPTIC TANK TO BE UTILIZED. PVC TEES TO 82"-1 20" C2 Coarse Sand I OYR 7/2 Loose BE INSTALLED ON INLET AND OUTLET PIPES IF NECESSARY, AND A GAS 1I,� BAFFLE AND ZABEL FILTER INSTALLED/N THE OUTLET TEE �11 /B.)EXISTING SEPTIC COMPONENTS TO BE LOCATED, PUMPED DRY, FILLED DATE TESTING: INDA I O wSPECTION NOTE: SOIL EVALUATOR: L ALUATOR: INDA J. PINTO, P.E., CSN ENGINEERING ,-- W1T//CLEAN SAND AND ABANDONED IN PLACE AREA TO BE COMPACTED BOARD OF HEALTH AGENT: DAVID 5TANTON, BARN5TABLE HEALTH DEPARTMENT PRIOR TO FINAL IN5PECTION BY THE ENGINEER,5Y5TEM I 0 20 40 GO TO MINIMIZE5ETTLING. PERCOLATION RATE: LESS THAN 2 MIN/INCH IN"C"LAYERS NEED5 TO BE COMPLETE INCLUDING BUILDUP FOR COVERS. P.O.Box 2030 Phone:(508)274-7347 NO GROUNDWATER ENCOUNTERED SCALE I 20 Teaticlret,MR 02536 Fax:(508)548-5478 C:\CSN\RR-Phmney5\5D5-RR-Phmneys.dwg [-Date:0415110 . Scale: As Shown I By: UP Check: GSP I Project No. CSN0078