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HomeMy WebLinkAbout0034 SYLVAN DRIVE - Health :34..SYLVAN DRIVE; HYANNIS A=, 289-125 - I; o v o I COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION RECEIVED V JUL 1 9 2001 TOWN OF BARNSTABLE TITLE 5 HEALTH DEPT. OFFICIAL INSPECTION FORM—NOT DISPOSAL � EM FORM PART SUBSURFACE SEWAGE DISO PART A CERTIFICATION Property Address: 34 SYLVAN DRIVE HYANNIS,MA 02601 Owner's Name: ROBERT WASHEK Owner's Address: BOX 179,DOVER,MA.02030 Date of Inspection: 7/2/01 Name of Inspector: (please print) SEPTIC IIN GRACI IONS company Name: Mailing Address: P.O.;BOX 2119 TEATICKET,MA.02536 Telephone Number: 508-564-68f3.FAX 508-564-7270 CERTIFICATION STATEMENT reported I certify that I have personally inspected the sewage disposal system ins ect at hon was performed based onis address and that the rmyttra rang and below is true,accurate and complete as of the time of the inspection. P salsstems.Y 1 am a roved system experience in the proper function and maintenance of on site sewage dispo DEP ap p Y inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: X Passes _ Conditionally Passes _ Needs Fu t r Evaluation by the Local Approving Authority Fails Inspector's Signature: Date: 7/2/01 ector shall subm t a copy of this inspection report to the Approving Authority(Board of Health or DEP)within The system insphared greater,the 30 days of completing this inspection. h the report is a s tthe appropsysteriate regional soffi e of heIDEP.Tilieoriginal should be inspector and the system owner shall submit sent to the system owner and copies sent to the buyer, if applicable,and the approving authority. Notes and Comments SYSTEM PASSES TITLE V IN RECOMMEND PUMPING SYSTEM NOW AND EVERY TWO YEARS T PROLONG THE SYSTEM'S USEFULL'LIFE ****This report only describes"conditions at the time of inspection and tinder the condions of Ilse at that tie.under the same on different u ail uns of This inspection does not address how the system will perform in the future ti . f Page 2 of I I i OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 34 SYLVAN DRIVE HYANNIS,MA 02601 Owner: ROBERT WASHEK Date of Inspection: 7/2/01 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: X I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: SYSTEM PASSES TITLE V INSPECTION. RECOMMEND PUMPING SYSTEM NOW AND EVERY TWO YEARS TO PROLONG THE SYSTEM'S USEFULL LIFE 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. n/a 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: n/a n/a 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: n/a n/a 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 a ND explain: n/a Page 3 of 1 I OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 34 SYLVAN DRIVE HYANNIS, MA 02601 Owner: ROBERT WASHEK Date of Inspection: 7/2/01 C. Further Evaluation is Required,by the Board of Health: _ Conditions exist which require"further evaluation by the Board of Health in order to determine if the system is failing to protect public health,safety or the environment. '1 • 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 aad SAS-and the SAS is within 50 feet of a private water supply well. _ The system has a septic t6k 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 n/a "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: n/a 1 . Z Page 4 of I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 34 SYLVAN DRIVE HYANNIS,MA 02601 Owner: ROBERT WASHEK Date of Inspection: 7/2/01 D. System Failure Criteria applicable to all systems: You must indicate"yes"or"no"to each of the following for all-inspections: Yes No X Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool X Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool X Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool X Liquid depth in cesspool is less than 6"below invert or available volume is less than '/2 day flow X Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number of times pumped nLa. X Any portion of the SAS,cesspool or privy is below high ground water elevation. X Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. X Any portion of a cesspool or privy is4within a Zone 1 of a public well. X Any portion of a cesspool or privy is within 50 feet of a private water supply well. X 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 forma (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 to the criteria above) yes no X the system is within 400 feet of a surface drinking water supply X the system is within 200 feet of a tributary to a surface drinking water supply X the system is located in a nitrogerrsensitive area(Interim Wellhead Protection Area—I WPA)or a mapped Zone II of a public water supply well If you have answered"yes to'any question in Section E the system is considered a significant threat,or answered " "yT§" in%tion D abOVE Ilse large§y§telii Im.failed: The owner or operator of any large§Sett m comidercd i,§ignificnnl threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. Page 5 of 1 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 34 SYLVAN DRIVE HYANNIS, MA 02601 Owner: ROBERT WASHEK Date of Inspection: 7/2/01 Check if the following have been done. You must indicate "yes" or"no" as to each of the following: Yes No X _ Pumping information was provided by the owner,occupant,or Board of Health _ X Were any of the system components pumped out in the previous two weeks'? X _ Has the system received normal flows in the previous two week period'? _ X Have large volumes of water been introduced to the system recently or as part of this inspection '? X Were as built plans of the system obtained and examined?(If they were not available note as N/A) X _ Was the facility or dwelling inspected for signs of sewage back up? X _ Was the site inspected for signs of break out? X _ Were all system components,excluding the SAS, located on site? X _ Were the septic tank manholes uncovered,opened, and the interior of the tank inspected for the condition of the baffles or tees,material of construction,dimensions,depth of liquid,depth of sludge and depth of scum 9 X _ Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems.? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: Yes no _ X Existing information. For example,a plan at the Board of Health. X _ Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable)[310 CMR 15.302(3)(b)] 5 Page 6 of I 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 34 SYLVAN DRIVE HYANNIS,MA 02601 Owner: ROBERT WASHEK Date of Inspection: 7/2/01 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design):3 Number of bedrooms(actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 Number of current residents:3 Does residence have a garbage grinder(yes or no): NO Is laundry on a separate sewage system(yes or no): NO [if yes separate inspection required] Laundry system inspected(yes or no): NO Seasonal use: (yes or no): NO Water meter readings, if available(last 2 years usage(gpd)): n/a Sump pump(yes or no): NO Last date of occupancy: n/a COMMERCIAL/INDUSTRIAL` Type of establishment: n/a Design flow(based on 310 CM 15.20,3): n/agpd Basis of design flow(seats/persons/sgft,etc.): n/a Grease trap present(yes or no): NO Industrial waste holding tank present(yes'or no): NO Non-sanitary waste discharged to the Title 5 system(yes or no): NO Water meter readings, if available: n/a Last date of occupancy/use: n/a OTHER(describe): n/a GENERAL INFORMATION Pumping Records Source of information: n/a Was system pumped as part of the inspection(yes or no): NO If yes,volume pumped: n/agallons-- How was quantity pumped determined? n/a Reason for pumping: n/a TYPE OF SYSTEM X Septic tank,distribution box,soil absorption system _Single cesspool _Overflow cesspool _Privy _Shared system(yes or no)(if yes,attach previous inspection records, if any) _Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) _Tight tank Attach a copy of the DEP approval Other(describe): n/a Approximate age of all components,date installed(if known)and source of information: BUILT 10/9/1997: PCII A9 BUILT' Were sewage odors detected when arriving at the site(yes or no): NO Page 7 of I 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 34 SYLVAN DRIVE HYANNIS,MA 02601 Owner: ROBERT WASHEK Date of Inspection: 7/2/01 BUILDING SEWER(locate on site plan) Depth below grade: 28" Materials of construction:_cast iron•X40 PVC_other(explain): n/a Distance from private water supply well,or suction line: n/a Comments(on condition of joints,venting,evidence of leakage,etc.): TOWN WATER SEPTIC TANK: X(locate on site plan) Depth below grade: 24" Material of construction: Xconcrete_metal._fiberglass_polyethylene other(explain)n/a If tank is metal list age: n/a Is age confirmed by a Certificate of Compliance(yes or no): NO(attach a copy of certificate) Dimensions: 150OG L 10' 6" H 5' 6" W 5' 8"" Sludge depth: 4" Distance from top of sludge to bottom of outlet tee or baffle: 30" Scum thickness: I" Distance from top of scum to top of outlet tee or baffle: 4" Distance from bottom of scum to bottom of outlet tee or baffle: 19" How were dimensions determined: MEASURED Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): THE SEPTIC TANK AND ALL COMPONENTS ARE STRUCTURALLY SOUND. RECOMMEND PUMPING NOW AND EVERY TWO YEARS TO'PROLONG THE SYSTEMS USEFULL LIFE GREASE TRAP:_(locate on site plan) ' Depth below grade: n/a Material of construction:_concrete_metal_flberglass_polyethylene_other(explain): n/a Dimensions: n/a Scum thickness: n/a Distance from top of scum to top of outlet tee or baffle: n/a Distance from bottom of scum to bottom of outlet tee or baffle: n/a Date of last pumping: n/a Comments(on pumping recommendation , inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): n/a Page 8 of 1 I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 34 SYLVAN DRIVE HYANNIS,MA 02601 Owner: ROBERT WASHEK Date of Inspection: 7/2/01 TIGHT or HOLDING TANK: (tank must be pumped at time of inspection)(locate on site plan) Depth below grade: n/a Material of construction:_concrete_metal_fiberglass_polyethylene_other(explain): n/a Dimensions: n/a Capacity: n/a gallons Design Flow: n/a gallons/day Alarm present(yes or no): N/A Alarm level: N/A Alarm in working order(yes or no): NO Date of last pumping: n/a Comments(condition of alarm and float switches,etc.): n/a DISTRIBUTION BOX:X(if present must-be opened)(locate on site plan) Depth of liquid level above outlet invert: LEVEL WITH BOTTOM OF PIPE Comments(note if box is level and distribution to outlets equal,any evidence of solids carryover,any evidence of leakage into or out of box,etc.): DISTRIBUTION BOX IS STRUCTURALLY SOUND AND APPEARS TO BE FUNCTIONING PROPERLY. PUMP CHAMBER: _(locate on site plan) Pumps in working order(yes or no): NO' Alarms in working order(yes or no):NO Comments(note condition of pump chamber,condition of pumps and appurtenances, etc.): n/a II R Page 9 of I l OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 34 SYLVAN DRIVE HYANNIS, MA 02601 Owner: ROBERT WASHEK Date of Inspection: 7/2/01 SOIL ABSORPTION SYSTEM(SAS): X (locate on site plan,excavation not required) If SAS not located explain why: n/a Type n/a leaching pits, number: n/a 500 GALLON LEACHING leaching chambers, number: 2 CHAMBERS leaching galleries, number: n/a n/a leaching trenches, number, length: n/a n/a leaching fields, number: n/a n/a overflow cesspool, number: n/a n/a t innovative/alternative system n/a Type/name of technology: n/a Comments(note condition of soil,signs of hydraulic failure, level of ponding,damp soil,condition of vegetation,etc.): TWO 500 GALLON CHAMBERS APPEAR TO BE FUNCTIONING NORMALLY. BOTH CHMBERS SHOULD BE PUMPED NOW. CESSPOOLS: (cesspool must be pumped as part of inspection)(locate on site plan) Number and configuration: n/a Depth—top of liquid to inlet invert: n/a Depth of solids layer: n/a Depth of scum layer: n/a Dimensions of cesspool: n/a Materials of construction: n/a Indication of groundwater inflow(yes or no): NO Comments(note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation,etc.): n/a PRIVY: (locate on site plan) Materials of construction: n/a Dimensions: n/a Depth of solids: n/a Comments(note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation,etc.): n/a Page 10 of 1 I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 34 SYLVAN DRIVE HYANNIS,MA 02601 Owner: ROBERT WASHEK Date of Inspection: 7/2/01 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. Fte,A} A ° A g C Q 6 AA ,a` At O L Ac a� �A 3 t1 e bg 356 • �c 31 in Page 11 of 1 I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 34 SYLVAN DRIVE HYANNIS, MA 02601 . Owner: ROBERT WASHEK Date of Inspection: 7/2/01 SITE EXAM _Slope _Surface water _Check cellar Shallow wells i Estimated depth to ground water 12+feet Please indicate(check)all methods used to determine the high ground water elevation: NO Obtained from system design plans on record- If checked,date of design plan reviewed: n/a NO Observed site(abutting property/observation hole within 150 feet of SAS) NO Checked with local Board of Health-explain: n/a NO Checked with local excavators, installers-(attach documentation) YES Accessed USGS database-explain: n/a You must describe how you established the high ground water elevation: USGS MAPS AND CHARTS- 12+FEET TOWN OF BARNSTABLEi 1:0CATION 3`- ��/��� �r SEWAGE # VILLAG /-ASSESSOR'S MAP& LOT Z6: INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY JS'cid e"L LEACHING FACILITY: (type)5'00 G, ( <«4 r4g-y 4cl (size) I NO.OF BEDROOMSi�c�MS� �� 3BUILDER OR ee PERMTTDATE—� �� COMPLIANCE DATE: y ,3 Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by OO i Li I I i O I "Zi � �s j :,: No. /' � ~, '�• Fee ` THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS 01ppYicatton for Mte;po$al 6pttem ComArurtton Verna Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) El Complete System ❑Individual Components Location Address or Lot No. �(�L�,�/' �) ` Owner's Name,Address and Tel.No. V ,� y� I Assessor's ap l �/�Odf/,vl Installer's Name,Address,and Tel.No. 0 _ II Designer's Name,Address and Tel.No. ` e,9A 7-0 2? D V-h , rA Type of Building: Dwelling No. of Bedrooms Lot Size �.9, `�b�. sq. ft. Garbage Grinder Other Type of Buildin No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow ' gallons per day. Calculated daily flow ' gallons. Plan Date .• 7 Number of sheets Revision Date Title Size of Septic Tank `• Type of S.A.S. "' ,C'z Description of Soil Nature of Rep 'rs or Alterations(Answer when applicable) Cf ACE 7 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 the Environr pental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued �l Signed Date Application Approved b Date 9� 9°` 7 Application Disapproved for the following reasons Permit No.V Z'' •_ Date Issued �' V, .A. Fee ,THE COMMONWEALTH OF MASSACHUSETTS .Entered in computer: ti Yes PUBLIC'HEALTH DIVISION-,-TOWN OF BARNSTABLE, MASSACHUSETTS 0ppfication for 30isspogal 6potem Congtruction Permit Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No; �(� J / r) , Owner's Name,Address andTel.No L z ry Assessor's ap l� �� �jL'/!</ �6 � Ig X Installer's Name,"Address,and Tel.No. + Designer's Name,Address and Tel.No. ` 7-0 Z D V h Type of Building: \ / Dwelling No.of Bedrooms i Lot Size sq. ft. Garbage Grinder Other Type of Buildin No.of Persons Showeis( ) Cafeteria( ) _ Other Fixtures } Design Flow X.?K gallons per day. Calculated daily flow," t? gallons. Plan Date / Number of sheets Revision Date Title #' Size of Septic Tank 44W I� Type of S.A.S. rF Description of Soil ' .r Nature of Rep 'rs or Alterations(Answer when applicable) Cf Date last inspected:---- Agreement: / t 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 the Environ ental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued by e Signed _ Date ✓v' Application Approved by ' i'' Date Application Disapproved for the following reasons Permit No. Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance' } THIS IS TO CER •IFY, that the On-site Sewage Disposal System Constructed Repaired ,�U Pgladed ( ) Abandoned( by r 7f'1/ Gd/1S/ at �� v/.�/17 / �jyYti s been constru ted in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No 7' w`�dated Installer Designer The issuance of this permit shall not be construed as a guarantee that the system will function as designed. Date (, `7 Inspector o I ———------------------------------------- NO. �' r I Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS Mig;potal *pgtem Construction Permit Permission is hereby granted to Construct( )Repair( )Upgrade( )Abandon(, d System located at !�"1� t3� and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction mus be 9 c let within three years of the date of t Date: Approved by B LOCATION yA&NiS). SCALE - / -30! . . . DATE ,PLAN REFERENCE , ,�j. /,^�G ,�oT �� Al Lo 7 - /3 .543_ i I-N I • I �5� n1 Pose,'/ nn LoT ,#/o ►� ; 1 3-'r &YI-sn ,vG 1:�aND g77oN •3S / 33' v 11 mmo i � � �0 � ��•' g is X - Rf se rNE_ I 1 30 33 E / o,c P.gv&olrwr D�7rq D/Z/VE • 30, I ( • zg1 z8' /\/oyZ% - �R lST/NG•CEssvOOL iN Z45AZ A\%k 0; To /-sp ED . W a �iGc�-n bV iTJ�/ c� EU CL��9N SAr/o. � , �•• ,:51SZ/STl NG C SS�pocG /�i./o LEa3cN .P� E Tb !3G R,c-WoV&D o. 28100 1,Vi 77'/ CGE'79 N oil &R/ST/NG /w c�zc�-2 m syS>-F. TOP OF FOUNDATION T CONCRETE COVERS 4"CAST IRON 9 $,� . � „ , , OR SCHEDULE 40 4"SCHEDULE 40 P.V.C. (ONLY) 9."MIN . LEACHING TRENCH (/)REQ. _ P.V.C.PIPE MIN. '1/8"- 1/2" WASHED STONE 36 MAX. PIPE-hi "P 2 .., PITCH 1/4"PERFL PITCH I/4•PErZ.r% -as-<••1 .«„n_:.�„--.:..� :.� ,,n INVERT 'CJ��; EL__.3o./3 SEPTIC TANK . INvt=�i D1ST. lNv=� p'=r�•c�_a[��:t�''tI' '. 24' • _ ELZf. BOX E 11VE3 ��t7 15,• �. , INVERT /.Boa GAL.. INVERT EL.zJ: o INVERT Precast 500Gal.Leach 3/4"-1V?-11 .,; 6"CRUSHED STONE EL�9'• • (2) REQ. Chamber WASHED STONE ,yam ' PROR LE 0F GROUND WATER TABLE SOIL LOG SEWAGE DISPOSAL SYSTEM TYPICAL CROSS SECTION DATE SEPT 3/�y7 111,,E io:eo At!y.,, NO SCALE LEACHING -TRENCH . N O SCr'_ TEST HOLE I TEST HOLE 2 ELEV. .33: Z Z ELEV. .. . . .. . ... DESIGN DATA . „ + _ s.!`avvy Lnr)py PlIJ;'.°ER 0 BE�ROCh:S `3. .. . . . . . . . . . .. ��r7c, 36"MAX. 11 ��� "6"' sgivoy GsI}ry TOTAL EST11MATED FLOW .'70 , ..330 . .. GALLONS/DAY y.'~ -X . _ 8" �•'h. >Er.Ja B-=01M LEACHING A� A .. S .. :./ � i� ���_•i �- AA 3/r _, Js.t.4 /•�lJz 9 P. ;Ct tf;L1 •, 24 G SIDE LEACHING .AREA . . . . SQ.FT./MENCH E Ma"*MADE i•�/rt�� GARBAGE DISP0SAL .Nm'4!E..(50% AREA INCREASE) C3 Z864 TOTAL LEACHING AREA . . �7z•.�7: SQ..-►. CoR2s� /�yQ/ PERCOLATION zz I/O /y ii - fb yS,7s LEACHING AREA PER PERCOLATION oa �S,o+vv GROUND 'RATER u BLE IZe~ L3.ZL f•YA APPROVED . . . . . . . .. . ... BOARD OF HEALTH A�?...WA T ER ENCOUNTERED DATE ..... .. .. ... . .... . ._. . AGENT OR INS?cCT03 . • �a'�N Of �' SHOF�� WITNESSED BY : _'-T . Du"N//�c/G BOARD OF HEALTH . . . . . .LdT lI . . . . . �o E E. O`L' G LEY ;5, 'IIiN �:N/.1 _iL S_. ENG 1 N EER S�rLV ! _ Da✓�/E. . . _ 0. 2s o. 27 AEDS Nt1pQ� `♦ LAM PETITIONER c4v4!r_ -07rZ VE tOQ� Town of Barnst lble ` Department of Health,Safety,and l,nvironmenlal Servlce0. t ✓� ,f,� Public Health Division Date 367 Mnin Slice[,IIynnnis MA 02601 S rAnyarAutz. t �— ernrw. _ ^�Fa li, Date Scheduled —SLR/ j Time /O ice Pd. Soil Suitability Assessment for Sewage'Disposal Performed 17y. s O/� i�1�e- Witnessed By:�� �NA//NG �- LOCATION&:;,G1NLltAL;1NTOIZIVIATION Location Address 34 5y//—(//.j-,t.i 01/0j(/'Lr Owm.r s Nome pp Address �/�'lZhotiTf{PO/iT' Assessor's Mnp/Parcel: /-/4)P Rio/ �'%1'.Z' /�S Engineer's Name NEWCONSTRUCTION REPAIR 'telephone# 3dZ—dam Land Use,P.Awd'00VT79 Slopes N 6 a ._ Surface Stones N4N4F I Distances from: Open Water Body Nq R Possible Wel Arca�i :?III 'Drinking Water Well AIA it , Drainage Way R Property Line 3G _R Other R i SKETCH:(Street name,dimensions of lot,exncl locations of test holes do pere tests,locate wetlands In proximity to holes) i I 0 0 10 GY/LT/NG DwewNG Q i M M Z., ' /oo•o a SyG V l/ -" 02i V&- t i • i i t parent materi2l(geologic) 9rl' � Depth to bedrock aOO r � r Depth to Groundwater. Standing Water in Ilole: Wreping from Pit face t Estimnted Scasonol I ligh Groundwater DL,7'L1tMINATION TOIL SL A:3UNAL 1-C1C11 VVA1'1 R:1A13L) Method Used: In, Deplh Obscrvcd!:landing in obs.hole: in. Depth to soil mottles: Depth to weeping Goo side of obs.hole: in. Groundwater Adjustment R. Index Well N •Jtrnding Dnle:__ Index Wcll Icvcl.____ Adj,factor Adj.Groundwater Level_ " ,P);RCOI;ATION TI ST : _ Date•• Time io:ee ., ; Observation Time el9" I1uIc H / l Depth of Perc Time al 6" Rmrr Pn-noak'rimc Q Time(9"-6") i i j End Pre-soak ZiN LHnv 3o S42•. j Ralcblin.flnch flews 7749,/ LHLv//A/. Silc Suitability Assessment: Silc Passcd Sile Pniled: ._ Additional Testing'Needed(Y/N) I Original: Public health Division Observation Hole Data To Be Completed on Back—� Copy: Applicant DEL,P:OBSERVATION HOLE LOG: Holey; r Dcplh from Soil Iluriron Soil Tea lure Soil Color Soil Other d Surface(in.) (USDA) (Munscll) Mottling (Structure,Stones,Doulderes. %G- , yY_, y it Yves rX o`c Y 3p%Fc C S DEEP OBSERVATION HOL)1 LOG: Hole Depth from Soil Horizon Soil Tcxlure Soil Color Soil Other Surface(in.) (USDA) (Munscll) Mottling (Structure,Stones,©oulderes., o' 1 EEP OBSERVAnON HOLE LOG:: Depth from n Soil I luiun Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Doulderes. I DECI'.OI3SERVATION..HOLE LOG Holc# Depth from Soil I°loriron Soil Texture 'Soil Color Soil Other ' Surface(in.) (USDA) (Munscll) Mouling (Slruclure,Stones,Boulderes. % Flood Insurance Rate Mao: J Above 500 year wood boundary No_ Yes_ Within 500 year boundary Nc_ Yes Within 100 year flood boundary No_ Yes_ ' Depth of Naturally Occurring Pervious Material e 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 /✓o✓_/ 4 (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�traini9g,expo is an fence described in 310("MR 15.017.. Signatthc- 11•�• Date 94 17 TOWN OF BARNSTABLE LOC-nON S' r�JY ��/�/�/1 O�• EWAGE #- 7 VII LAGE 5 /ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. BO��Gy / �eAo SEPTIC TANK CAPACITY CIO LEACHING FACILnY: (type)Soo G,�< <<as 4 ��ia�,���� (size) /�-J' �-.2S�,cZ NO.OF BEDROOMS BUILDER O O GdllcS �� PERMIT DATE: /O COMPLIANCE DATE: 14 " separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility �� Feet Priv.at6: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) /v Feet Funished by 19 I I ° -�'r'"'� 21 : 1 t�aa > .Er TOWN OF BARNSTABLE 'J• Y' ! LOCATION 50 ��,pGI L/L SEWAGE VILLAGE A ESSOR'S I P 6z LOT INSTALLER'S NAME PHONE NO. SEPTIC TANK CAPACITY AVO LEACHING FACILITY:(type) �� (size) NO: OF BEDROOMS PRIVATE WELL OR PUBLIC WATER J )�,, . BUILDER OR OWNERact l � &64— DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No V ,F yf T ol r3 i \� A ' e TOWN OF BARNSTABLE LOCATION �vti � �'� SEWAGE # VILLAGE /!��—S ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY: (type) (size) NO.OF BEDROOMS BUILDER OR OWNER PERMITDATE: COMPLIANCE DATE: Separation Distance Between the:. Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by ' ,' r . , . � , a as e n -'` �� � � � � � —. �,,�1 �+ o.,y � �„� c- a� � i, I � , �, c.,, c� a