HomeMy WebLinkAbout0138 STRAIGHTWAY - Health 138 STRAIGHTWAY, HYANNIS
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TOWN OF BA.RNSTABLE
LOCATION Z (f!2 1 SEWAGE X ^ Z73
VII.�,AGE f l�f'�^�W is SE OR'S MAP & LOT 0-12
INSTALLER'S NAME&PHONE NO.
SEPTIC TANK CAPACITY ncl) J
LEACHING FACILITY: (ty a�%�P7 ( 7 (size)
KNO. OF BEDROOMS
BUILDER OR OWNER
PERMITDATE: L. COMPLIANCE DATE:
Separation Distance etween the:
Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet
Private Water Supply Well and Leaching Facility (If any wells exist
on site or within 200 feet of leaching facility) Feet
Edge of:Wetland and Leaching Facility(If any wetlands exist
within' )0-k-et-(Areaching faci ' ) Feet
Furnished by
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No. L"' y —�� Fee 25
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
Yes
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS
ZippYtcation for Migaal *pgtem Construction Vermit
Application for a Permit to Construct-( Repair( )Upgrade( )Abandon( ) XiC!omplete System O Individual Components
Location Address or Lot No.�.3�t'.d�1t%� ��� /fly. Owner's Name,Address and Tel.No.
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Assessor's Map/Parcel ��G —/Q
Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No.
Type of Building:
Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( )
Other Type of Building -4fle1kr• No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow ® y gallons per day. Calculated daily flow a gallons.
Plan Date Number of sheets / Revision Date
Title
Size of Septic Tank Type of S.A.S.
Description of Soil
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 Certifi-
cate of Compliance has be ' sue and of Health.
Si ned Date ��� O
Application Approved by Date
Application Disapproved for the following reasons
oe
Permit No. " �} Date Issued
� 1i111 � .tf
No. 'J..t; � Fee
` THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: 1
Yes �
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSAIUSETTS
01ppfication for �Digoal *p,!6temt Con.5truction Permit
Application for a Permit to Construct( , )Repair( )Upgrade( )Abandon( ) L7 Complete System ❑Individual Components
Location Address or Lot No. ,`• ner's Name,Address and Tel.No.
III`
Assessor's Map/Parcel
Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No.
7 D�6.1�/�U �./lj,� now 'op•J
i
Type of Building:
Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( )
Other Type of Building No.of Persons Showers Cafeteri a
( )Other Fixtures
i
Design Flow 0,0� y gallons per day. Calculated daily flow gallons.
Plan Date Number of sheets Revision Date
Title
Size of Septic Tank Type of S.A.S.
r
Description of Soil
Nature of Repairs or Alterations(Answer when applicable)
t.
p..
r
Date last inspected:
Agreement:
The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system
+' in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi-
cate of Compliance has been-issu thi"sB'o o Healt .-- 7 _O�
Signed Dately
o°
Application Approved by Date
Application Disapproved for the following reasons
Permit No. Date Issued
-—————`————————— ————————————— ———————
THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE, MASSACHUSETTS
Certificate of Compliance
THIS IS TO C TIFY, that the On-site Sewage Disposal System Constructed ( ) Repaired( )Upgraded( )
Abandoned( )by �� G�po�vF
at _h,,as ben constructed in accordance
W
with the provisions of Title 5 and the for Disposal System Construction Permit No. dd dated ! 1
Installer 0--.01, '�'� �� Designer<5 AIVI'O141, lro1y1 I? .
The issuance�o/ff/t i'� rmit shall not be construed as a guarantee that the sy to will f ction a i ned. r
Date l / Inspector �``•
l
=————————————————— ——
No. �J`.� G �v
Fee
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS
1wi.5pozat *p!6tem Cott!5truction Permit
Permission is hereby granted to Construct( )Repair( )Upgrade( )Abandon( )
System located at '�
and as described in the above Application for Disposal System Construction Permit. The applicant recognizes his/her duty to
comply with Title 5 and the following local provisions or special conditions. Zprmi
Provided:Cons fucti"n must be completed within three years of the date of thi .
(�
Date:_ �•�' ���T Approved by
TOWN OF BARNSTABL E 2
LOCATION / SEWAGE ^Z7J
VILLAGEf��s SE OR'S MAP & LOT
INSTALLER'S NAME&PHONE N0.
SEPTIC TANK CAPACITY
'I
LEACHING FACILITY: ( (size)
NO. OF BEDROOMS ,
BUMDER OR OWNER
,1 PERMITDATE: 2' COMPLIANCE DATE:
Separation Distance etween the:
Feet
Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility
.
Private Water Supply Well and Leaching Facility (If any wells exist
Feet
on site or within 200 feet of leaching facility)
Edge of Wetland and Leaching Facility(If any wetlands exist �34 Feet
within 3 eaching faci ' )
Furnished by
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7 1
Town of Barnstable
�oFtHE Tp� Regulatory Services
R
Thomas F.Geiler,Director
i
BARNVrABE,E. +
9KAMPublic Health Division
Thomas McKean,Director
200 Main Street,Hyannis,MA 02601
Office:.508-862-4644 Fax: 508-790-6304
Inst2 ller & Designer Certification Form
Date: S7 1 �OD�
Designer Installer:
v
Address: '� C ��4 Address: X
M� UJS�E7
On 2' was issued a permit to install a
dat ) ((installer)
septic system at �� � � ased on a design drawn by
(address)
dated �� 0
(designer)
T 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 relocatidn 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.
staller's Signature)
A
(De ' er's Signature) (Affix Des`igrs Stamp Here)
PLEASE RETURN TO BARNSTABLE 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:Health/Septic/Designer Certification Form
+a k
COMMONWEALTH OF MASSACHUSETTS �. REcEwEU
EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAI F� NOV 2 5
DEPARTMENT OF ENVIRONMENTAL PROTECTION 1998
ONE WINTER STREET, BOSTON MA 02108 (617) 292-5500 TOWN OF HARNNTSABIF
HEALWILLIAM F.WELD '
Governor S Seefetary �cirX%
ARGEO PAUL CELLUCCI DAVM B. STRUHS
Lt. Governor Commissioner
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A .
CERTIFICATION
Property Address: &),S Address of Owner: "q.S �-
Date of Inspection: E t�7,7,�q (If different)
Name of Inspector: M t c�,-,r-,e,N,
I am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000)
Company Name:
Mailing Address: . .�C,X ;;.N
Telephone Number:
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 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
Inspector's Signature A Date:
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 SUKNi 1ARY: Check A, B, C, or D:
A] SYSTEM PASSES:
I 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: S-ac► aiS ZS Its �AS2 Cv? iR��c�. E— �.� S tN
� Q�
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.
Indicate yes, no, or not determined (Y, N, or ND). Describe basis of determination in all instances. IIf"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 (attached) indicating that the tank was installed within twenty (20) years prior to the date of the inspection. or 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.
(revised 04/25/97) Page 1 of 10
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued) .
Property Address:
Owner: T
Date of Inspection:
B] SYSTEM CONDITION LY PASSES (continued)
Sewage ba\dn
akout or high static water level observed in the distribution box is due to broken or obstructed pipe(s) or
due to a bd or uneven distribution bcx. The system will pass inspection if(with approval of the Board of Health).
Describe o :
oken pipe(s) are replaced
struction is removed
ribution box is levelled or replaced
The systeum 'ng more than four times a year due to broken or obstructed pipe(s). The system will pass inspection
if(with ape Bo d of Health):
oken pi e(s) are replaced
struction ' removed
C] FURTHER EVALUATION IS REQUIRED BY BOARD OF HEALTH:
Conditions exist which require further evaluation by he Board of Health in order to determine if the system is failing to prc[ect the
public health, safety and the environment.
1) SYSTEM WILL PASS UNLESS BOARD OF HEALTR DETER.N LYES THAT THE SYSTEM IS NOT FL'�CTIO\LtiG IN A
MAINNER WITCH WILL PROTECT THE PLBLIC HE, I.TH A-ND SAFETY A.`-D THE ENti'IRO`NIEN-T:
Cesspool or privy is within 50 feet of a surface water
_ Cesspool or privy is within 50 feet of a bordering vege ted wetland or a salt marsh.
2) SYSTEM WILL FAIL UtiLESS THE BOARD OF I-�ALTH (�i PUBLIC WATER SUPPLIER, ff APPROPRLATE)
DETEKNUN'ES THAT THE SYSTEM IS FUNCTIOti NG IN A NIAIv�ER THAT PROTECTS THE PUBLIC HEALTH Ati�
SAFETY AND THE ENVIRONMENT:
The system has a septic tank and soil absorption system (SAS)\an `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 supply well.
thin 0 feet of a private water supply well.
The system has a septic tank and soil absorption system and the SAS is }vi 5 pp,
_ Y P rP ) � P
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, unless a well water analysis .`or 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 04125/97) P2ge 2 of 10
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address:
Owner:
Date of Inspection:
DI 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 C/15.303. 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 ponding of effluent to the surface of the ground or surface waters due an overloaded or clogged SAS or
cesspool.
Static liquid level in the distribution box above outlet invert due to an /iless
d or clogged SAS or cesspool.
Liquid depth in cesspool is less than 6" below invert or available volu than 1/2 day flow.
Required pumping more than 4 times in the last year NOT due to clogstructed pipe(s).
Number of times pumped _ Zow
Any portion of the Soil Absorption System. cesspool or privy is the high groundwater elevation.
Any portion of a cesspool or privy is within 100 feet of a su ace water supply or tributary to a surface water supply.
Any portion of a cesspool or privy is within a Zone I of public well.
Any portion of a cesspool or privy is within 50 feet Q`f a private water supply well.
Any portion of a cesspool or privy is less than 1.06 feet but greater than 50 feet from a private water supply well with no
acceptable water quality analysis. If the well Pas been analyzed to be acceptable, attach copy of well water analysis for
` -coliform bacteria, volatile organic compounds, ammonia nitrogen and nitrate nitrogen.
El LARGE SYSTEM FAILS:
You must indicate either "Yes" or "No" as to each of t following:
The following criteria a/nn
system in addition to the criteria above:
The system serves a facsi flow of 10,000 gpd or greater (Large System) and the system is a significant threat to public
health and safety and tht ecause one or more of the following conditions exist:
Yes No
the system iset of a surface drinking water supply
the system iset of a tributary to a surface drinking water supply
_ the system'located in a nitrogen sensitive area (Interim Wellhead Protection Area -IWPA) or a mapped Zone U of a public
water supply well)
The owner or operator of a'ny such system shall bring the system and facility into full compliance with the groundwater treatment program
requirements of 314 CMR 5.00 and 6.00. Please consult the local regional office of the Department for further information.
(revised 04/25/97) Page 3 of 10
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST
Property Address: �lb
Owner: es2'c�(M?
Date of Inspection:,
Check if the following have been done: You must indicate either "Yes" or "No" as to each of the following:
Yes 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 part of this inspection.
As built plans have been obtained and examined. Note if they are not available with N/A.
The facility or dwelling was inspected for signs of sewage back-up.
The system does not receive non-sanitary or industrial waste flow.
The site was inspected for signs of breakout.
_ All system components. excluding the Soil Absorption System, have been located on the site.
The septic tank manholes were uncovered, opened, and the interior of the septic tank was inspected for condition of baffles or
tees, naterial 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:
The facility owner (and occupants, if different from owner) were provided with information on the proper maintenance of Sub-
Surface Disposal System.
Existing information. Ex. Plan at B.O.H.
Determined in the field (if any of the failure criteria related to Part C is at issue, approximation of distance is unacceptable)
[15.302(3)(b)]
(revised 04/25197) Page 4 of 10
f
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
Property Address: i 3�G,ST+ ►���^�t^'a--�
Owner: 'C`c�,3yt,i►
Date of Inspection:
FLOW CONDITIONS
RESIDENTIAL:
Design flow:*��C g.p.d./bedroom for S.A.S.
Number of bedrooms:U-"'t-
Number of current residents: 6
Garbage grinder (yes or no): f�j
Laundry connected to system (yes or no):—kl*
Seasonal use (yes or no): tJ
Water meter readings, if available (last two (2) year usage (gpd):
Sump Pump (yes or no):_tJ
Last date of occupancy:
CONEgERCIAL/INDUSTRIAL:
Type of establishment:
Design flow: eallons/day
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:
OTHER: (Describe)
Last date of occupancy:
GENERAL II\-FORNIATION
PUNIPLNG RECO12DS and source of information:
QW%,(D2i'k C (�-ALv�C'�
System pumped as pan of inspection: (yes or no)-;,zc-
If yes, volume pumped: gallons
Reason for pumping:
TYPE OF SYSTEM
Septic tank/distribution box/soil absorption system
Single cesspool
Overflow cesspool
Privy
Shared system (yes or no) (if yes, attach previous inspection records, if any)
I/A Technology etc. Copy of up to date contract?
Other
-4
APPROXIMATE AGE of all components, date installed (if known) and source of information:
4 �I
Sewage odors detected when arriving at the site: (yes or no)
(revised 04/25/97) Page 5 of 10
e
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address:
Owner:
Date of Inspection:
BUILDING SEWER:
(Locate on site plan)
Depth below grade:
Material of construction: _cast iron _40 P C _other (explain)
Distance from private water supply well or suctio Tine
Diameter
Comments: (condition of joints, venting, evidence o leakage, etc.)
SEPTIC TANK:_ -
(locate on site plan)
Depth below grade:
Material of construction: _concrete _metal _Fiberglas Po yethylene _other(explain)
If tank is metal. list age_ Is age confirmed by Certificat of Compliance _(Yes/No)
Dimensions:
Sludge depth:
Distanct; from top of sludge to bottom of outlet tee or baffle:
Scum thickness:
Distance from top of scum to top of outlet tee or baffle:
Distance from bottom of scum to bottom of outlet tee or baffler_
How dimensions were determined:
Comments:
(recommendation for pumping, condition of igl�t and outlet tees or baffl , depth of liquid level in relation to outlet invert, structural integrity,
evidence o6leakace, etc.)
GREASE TRAP:
(locate on site plan)
Depth below grade:
Material of construction: _concrete _metal _Fiberglass _Pclyethylene _other(e lain)
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:
(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.)
(revised O4/25/97) Page 6 of 10
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
t PART C
SYSTEM INFORMATION (continued)
Property Address:
Owner:
Date of Inspection:
TIGHT OR HOLDING TANK: (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:
Capacity: gallons _
Design flow: gallons/day
Alarm level: Alarm in workinc order _ Yes: _ No
Date of previous pumping:
Comments:
(condition of inlet tee. condition of alarm and float switches. etc.)
)ISTRIBUTION BOX:_
(locate on site plan)
Depth of liquid level above outlet invert:
Comments:
(note if level ana distribution is equal, evidence of solids carryove/evidence akage into or out of box, etc.)
PUMP CHAMBER:_
(locate on site plan)
Pumps in working order: (Yes or No)
Alarms in working order (Yes or No)
Comments:
(note condition of pump chamber, condition of pm appurtenances, etc.)
(revised 03/2S/97) Page 7 of 10
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
1
Property Address:13%5Rfh4,rw
Owner: 1 ,CQ yytefL1}
Date of Inspection: �c:' '
SOIL ABSORPTION SYSTEM (SAS): 1
(locate on site plan, if possible; excavation not required, but may be approximated by non-intrusive methods)
If not determined to be present, explain:
Type:
leaching pits, number:_
leaching chambers, number:_
leaching galleries, number:
leaching trenches. number.length:
leaching fields. number, dimensions:
overflow cesspool, number: q�,iA,xL'
Alternative system:
Name of Technology:
Comments:
(note condition of soil. signs of hydraulic failure, level of ponding, ZOLU itioNf vegetation, etc.)
CX, y y
CESSPOOLS:
(locate on site pla )
Number and configuration: .
1 4
Depth-top of liquid to inlet invert: `sys7zx.."1 5` S yricw.aL y
Depth of solids layer:
Depth of scu4n layer: ti u;Te a --y"
Dimensions of cesspool: Sc.sTtw.�( - �Jih�L ;y, c ,. Z- '31 i 5`
Materials of construction: cjc se.giZt Q�'\e:CAL
Indication of groundwater: WC..
inflow (cesspool must be pumped as pan of inspection) t.l=3
Comments:
(note condition of soil, signs of hydraulic failure, level of ponding, conditi n of vegetation, etc.)
Dztnc
JZ�
PRIVY: 'ice
(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.)
(revised 04125197) Page 8 of 10
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: k
owner: •C i��
Date of Inspection:
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)
l
t
(revised 04125197) Page 9 of 10
r
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address:
Owner: .E �2.A ,
Date of Inspection: t V
Depth to Groundwater } Feet
Please indicate.all the methods used to determine High Groundwater Elevation:
Obtained from Design Plans on record
Observation of Site (Abutting property, observation hole, basement sump etc.)
Determine it from local conditions
Check with local Board of health _
Check FEMA Maps
Check pumping records
Check local excavators, installers
Use USGS Data
Describe in your own words how you established the High Groundwater Elevation. Must be completed)
�;�� ��z:1�c.. i 3 II Nv G.r:��Li ��r✓� �s T C.��.�cr�\ p•T 1 C!1
(revised 04/25/97) P2ge 10 of 10
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TOWN OF BARNSTABLE
LOCATION ` `R � 1 SEWAGE #
VILLAGE L-,S 14 cMNt-)` ASSESSOR'S MAP & LOT—akil �V
0
INSTALLER'S NAME&PHONE NO.
SEPTIC TANK CAPACITY
LEACHING FACILrrY: (type) (size) SD t N x
,NO.OF BEDROOMS IS
BUILDER OR OWNER �--
PE ofFi-BATE: !L�Otcb COMPLIANCE DATE:
Separation Distance Between the:
Maximum Adjusted Groundwater Table to the geftmfflof 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 i
within 300 feet of leaching facility) t 6 + Feet
Furnished by ` �R7
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N � �
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W s r
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ASSESSORS MAP:
W
TEST HOLE LOGS
WE-5r YA Vat �11t 67 PARCEL:
FLOOD ZONE: .__Q __. .1.�1G �! �.� SOIL EVALUATOR: Imod
-
WI TNESS : /. i )c / ^ � NOTES:
REFERENCE �d ,.�_.._ jo^_. DATE: l '
S d#- PERCOLAT I 0 RAT .G U+� 1) The installation shall comply with Title V and Town of Barnstable Board of
�T -- e,
�► ��� Y1,4 Health Regulations.
TH 1 TH-2 2) The installer shall verify the location of utilities, sewer inverts and septic
�q,,�� components prior to installation.
l Y Z�Z 3) All gravity septic piping to be 4 inch Sch 40 PVC at 1/8"per foot.
7,, /� . 4) This plan is not to be utilized for property line determination nor any other
M �
— � purpose other than the proposed system installation.
%6�� �` 5) All septic components must meet Title V specifications.
i
LOCAT I ON MAP d a'S� z7' / / 6) Parking shall not be constructed over H10 septic components.
< 5�` 7) The property is bounded by property corners and property lines as depicted.
s W 8) The property owner shall review design considerations to approve of total
106 number of bedrooms to be considered for design. Receipt of payment for the
l� '� plan and installation based on the plan shall be deemed approval of the
number of bedrooms.
`� (J 9) The existing cesspools shall be pumped and backfilled per Title V
�� Na Abandonment Procedures. j
n� 3 10)Proposed leaching is to be within 36 inches of grade or provide venting r
g gt• p g o cut
grade as permitted by the Board of Health.
11)System components to be 10 feet from water line.
SEPTIC SYSTEM DESIGN
FLOW ESTIMATE
1 BEDROOMS AT 110 GAL/DAY/BEDROOM --�DGAL/DAY
SEPTIC- TANK
/ Mo GAL/DAY x 2 DAYS - LL� GAL
USE _16DDGALLON SEPTIC TANK
o SOIL BS�RPTI N SYSTEMl�(5 1 y� l�xx�� �
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BOTTOM AREA: 1,
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SITE AND SEWAGE PLAN
LOCAT I ON :
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PREPARED FOR : /�� ��' L•
I � SCALE:
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W DAV I D B . MASON V� DATE:
Z DBC ENVIRONMEN AL DESIGNS
EAST SANDWICH . MA
DATE HEALTH AGENT ( S 0 8) 83 3- 217 7
W
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