HomeMy WebLinkAbout0015 PINE CREST ROAD - Health 15 Pine Crest Road
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COMMONWEALTH OF MASSACHUSETTS
EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS
DEPARTMENT OF ENVIRONMENTAL PROTECTION
PARCEL. ;_ _ 1 a�-
FRECEIVE]D
TITLE-S" �"
OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM
PART A
CERTIFICATION
Property Address: 15 Pine Crest Road
'P� iisrcrt. MA 02672
Owner's Name: Kristin Josefec
Owner's Address:
Date of Inspection: July 20, 2004
s
Name of Inspector: (Please Print) James M. Ford
Company Name: James M. Ford ,
Mailing Address: P.O. Box 49
zr—
Osterville,MA 02655-0049 = .
Telephone Number: (508) 862-9400
CERTIFICATION STATEMENT Es
I certify that I have personally inspected the sewage disposal system at this address and that the in ormatior imported
below is true,accurate and complete as of the time of the inspection. The inspection was perform d based p-0 my T,-
training and experience in the proper function and maintenance of on site sewage disposal systems I am a OEP w
approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The syst m: c n rn
✓ Passes
Conditionally Passes
Needs F er Evaluation by the Local Approving Authority
Fails
Inspector's Signature: Date: July 25, 2004
The system inspector shall submL 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.
Title 5 Inspection Form 6/15/2000 page 1
Page 2 of 11
OFFICIAL INSPECTION FORM -NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: 15 Pine Crest Road
West Hyannisyort, MA
Owner: Kristin Josefec
Date of Inspection: July 20, 2004
Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D
A. System Passes:
✓ I have not found any information which indicates that any of the failure criteria described in 310 CMR
15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below.
Comments:
B. System Conditionally Passes:
One or more system components as described in the"Conditional Pass" section need to be replaced or
repaired. The system,upon completion of the replacement or repair,as approved by the Board of Health,will pass.
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:
2
Page 3 of 1 I
OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: 15 Pine Crest Road
West Hyannisport, MA
Owner: Kristin Josefec
Date of Inspection: July 20, 2004
C. Further Evaluation is Required by the Board of Health:
Conditions exist which require further evaluation by the Board of Health in order to determine if the system
is failing to protect public health,safety or the environment.
1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the
system is not functioning in a manner which will protect public health,safety and the environment:
Cesspool or privy is within 50 feet of a surface water
Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh
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 I 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:
3
r
Page 4 of 11
OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: 15 Pine Crest Road
West Hyannisport, MA
Owner: Kristin Josefec
Date of Inspection: July 20, 2004
D. System Failure Criteria applicable to all systems:
You must indicate either"yes"or"no"to each of the following for all inspections:
Yes No
✓ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool
✓ Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or
clogged SAS or cesspool
✓ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or
cesspool
✓ Liquid depth in cesspool is less than 6"below invert or available volume is less than '/z day flow
✓ 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.1
No (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 System:
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
the system is within 400 feet of a surface drinking water supply
the system is within 200 feet of a tributary to a surface drinking water supply
the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area-IWPA)or a mapped
Zone II of a public water supply well
If you have answered"yes"to any question in Section E the system is considered a significant threat,or answered
"yes"in Section D above the large system has failed. The owner or operator of any large system considered a
significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR
15.304. The system owner should contact the appropriate regional office of the Department.
4
Page 5 of 11
OFFICIAL INSPECTION FORM -NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST
Property Address: 15 Pine Crest Road
West Hyannisport, MA
Owner: Kristin Josefec
Date of Inspection: July 20, 2004
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?
✓ _ 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?
✓ Was the facility
_ ty 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 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: 15 Pine Crest Road
West Hyannisport, MA
Owner: Kristin Josefec
Date of Inspection: July 20, 2004
FLOW CONDITIONS
RESIDENTIAL
Number of bedrooms(design): 3 Number of bedrooms(actual): 2
DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 220
Number of current residents: 0
Does residence have a garbage grinder(yes or no): No
Is laundry on a separate sewage system(yes or no): n/a [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)): Unavailable
Sump Pump(yes or no): No
Last date of occupancy: Unknown
COMMERCIALANDUSTRIAL
Type of establishment:
Design flow(based on 310 CMR 15.203): gpd
Basis of design flow(seats/persons/sqft,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: New system-never pumped
Was system pumped as part of the inspection(yes or no): No
If yes,volume pumped: _gallons--How was quantity pumped determined?
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)
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):
Approximate age of all components,date installed(if known)and source of information:
Installed on 7119102-per as built card
Were sewage odors detected when arriving at the site(yes or no): No
6
Page 7 of 11
OFFICIAL INSPECTION FORM -NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 15 Pine Crest Road
West Hyannisport, MA
Owner: Kristin Josefec
Date of Inspection: July 20, 2004
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: 32"
Material of construction: concrete _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)
Dimensions: 1500 gal.
Sludge depth: 2"
Distance from top of sludge to bottom of outlet tee or baffle: 30"
Scum thickness: 2"
Distance from top of scum to top of outlet tee or baffle: 6"
Distance from bottom of scum to bottom of outlet tee or baffle: 10"
How were dimensions determined: Measuring stick
Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity, liquid levels
as related to outlet invert,evidence of leakage,etc.):
Tees were present. The liquid level was even with the outlet invert. There did not appear to be any signs of leakage.
GREASE TRAP: None (locate on site plan)
Depth below grade:
Material of construction: concrete _metal _fiberglass _polyethylene _other
(explain):
Dimensions:
Scum thickness:
Distance from top of scum to top of outlet tee or baffle:
Distance from bottom of scum to bottom of outlet tee or 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.):
7
Page 8 of 11
OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 15 Pine Crest Road
West Hyannisport, MA
Owner: Kristin Josefec
Date of Inspection: July 20, 2004
TIGHT or HOLDING TANK: None (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: ✓ (if present must be opened)(locate on site plan)
Depth of liquid level above outlet invert: Even
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.):
The D-box was level and clean. No solids were present The cover was 36"below grade
PUMP CHAMBER: None (locate on site plan)
Pumps in working order(yes or no):
Alarms in working order(yes or no)
Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.):
8
Page 9 of 11
OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 15 Pine Crest Road
West Hyannisport, MA
Owner: Kristin Josefec
Date of Inspection: July 20, 2004
SOIL ABSORPTION SYSTEM(SAS): ✓ (locate on site plan,excavation not required)
If SAS not located explain why:
Type
leaching pits,number:
✓ leaching chambers,number: 5-infiltrators w/4'stone on the sides and 1 %2'stone on the ends (per design plans)
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.):
There did not appear to be any signs of backup or failure in the leach field.
CESSPOOLS: None (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: None (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.):
9
f
Page 10 of I 1
OFFICIAL INSPECTION FORM -NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 15 Pine Crest Road
West Hyannisport, MA
Owner: Kristin Josefec
Date of Inspection: July 20, 2004
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.
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10
Page I 1 of 11
OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 15 Pine Crest Road
West Hyannisport, MA
Owner: Kristin Josefec
Date of Inspection: July 20, 2004
SITE EXAM
Slope
Surface water
Check cellar
Shallow wells
Estimated depth to ground water 30 +/- 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: Topographic and water contours maps
Checked with local excavators, installers-(attach documentation)
Accessed USGS database-explain:
You must describe how you established the high ground water elevation:
Using Barnstable topographic maps and water contours maps the maps were showing approximately 30'+/ to ground water
at this site.
This report has been prepared and the system inspected and passed as of the date of inspection. This report is
not a warranty or guarantee that the system will function properly in the future. There have been no warranties
or guarantees, either expressed, written or implied, relating to the system, the inspection and/or this report.
II
1
C TOWN OF BAJRNSTABLE
Lu'�CATION 1! P)4(-4(4rr SEWAGE # Oa
VILLAGE '1Tf'� ���'�` ' ASSESSOR'S MAP & LOT�y�
INSTALLER'S NAME&PHONE NO.
SEPTIC TANK CAPACITY SGO PO I y
LEACHING FACILITY: (type) S" ^CJ&4h4 (size) ! X I I 10
NO. OF BEDROOMS—
BUILDER
r" n. �OSe�"e c►
OR OWNER
PERMITDATE: COMPLIANCE DATE:
Separation Distance Between the:
Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet
Private Water Supply Well and Leaching Facility (If any wells exist
on site or within 200 feet of leaching facility) Feet
Edge of Wetland and Leaching Facility(If any wetlands exist
within 300 feet of leaching Facility) Feet
Furnished by -�• �n� inn C C
A t3Ak 6 r-
�
A Q a
3s 3
33Sya
TOWN OF BARNSTABLE T L
L{ CATION Pdi-t�—Cy-r-Q— ref' SEWAGE #
VILLAGE K(— t _ ASSESSOR'S MAP & LOT 2 y b
INSTALLER'S NAME&PHO NO. ��
SEPTIC TANK CAPACITY
LEACHING FACILITY: (type) � (size) `Y 1 I ,Ott ,
'. NO. OF BEDROOMS
BUILDER OR OWNER N
PERMITDATE: I O COMPLIANCE DATE:
Separation Distance Between the:
Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet
Private Water Supply Well and Leaching Facility (If any wells exist
on site or within 200 feet of leaching facility) Feet
Edge of Wetland and Leaching Facility(If any wetlands exist
within 300 feet of leaching facility) Feet
Furnished by
,. _.
�-/. 1g`
a
�-- �� �'
as� ��,'
No. pug Fee
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
Yes
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS
Zippftca.tion for Miopozar *pztem Con!Wuction Permit
Application for a Permit to Construct( )Repair( )Upgrade( Abandon( ) []Complete System ❑Individual Components
Location Address or Lot No. Owner's Name Address and Tel.No.
Assessor'sMap/Parcel n Cn�c j�,C��taller' Name, ssl and 1.No. Desi nerds N/�me�Ad`dress o. 1 n ee�
5 s
� r
Type of Building:
Dwelling No.of Bedrooms�� Lot Size sq.ft. Garbage Grinder( )
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures 2
Design Flow 3 gallons per day. Calculated daily flow 3 3 gallons.
Plan Date Z Number of sheets Revision Date
Title
Size of Septic Tank o e Type of S.A.S.
Description of Soil 2k8
Nature of epairs or Alterati ns(Answer w a plica le) � 0 C
sw
1
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 provisi ns of Title 5 of the Environmental Code and not to place the system in operation until a Certifi-
cate of Compliance has been i ued b this Board MW
h.
SignedDate
Application Approved by 2S, Date
Application Disapproved for the following reasons
Permit No. Date Issued
.'� -No. �C�o`a _ c` e Fee:a�
THE COMMONWEALTH OF MASSACHUSETTS `=Entered in computer: ►/'��
t, 1 , Yes
" ,- PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS'
ZippYica.tion for �Digponl *p6tem Construction Permit
Application for a Permit to Construct( )Repair( )Upgrade(VfAbandon( ) ❑Complete System ❑Individual Components
Location Address or Lot No. (Yle�YG' Owner's�N/a►me,Address and IT(el(.No.
Assessor's Map/Parcel rl `6 �" ""�I�`� " `�' ""0
` .
Vam'
Desi nersNeAdd `G �`nee
Type of Buildingf' _, r
Dwelling Nd of Bedrooms_, Lot Size sq.ft. Garbage Grinder( )
Other Type of Building No. of Persons E Showers( Cafeteria( )
Other Fixtures 2
' Design Flow . J3a gallons per day. Cal ulated daily flow 34. gallons.'
Plan Date n 2 Number of sheets Revision Date
Title _
Size of Septic Tank A111A
1 b Type of S.A.S. l l Q rs
Description of Soil 01 V 12)0 M
I'
Nature of Repairs or AlteraN ns(Answer w n a plica le) J ✓1� D �, j,
.�I
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 if ued b this Board o
k
Signed L Date.-qlleld 2
.� `lv:' 1 r
App iCation Appcoved;by ` y. ,, ,, ! a D at e r.,
Application Disapproved for the following reasons y
Permit No. Date Issued
-------------------------------------- -
THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE, MASSACHUSETTS
Certificate of Compliance
THIS IS TO C TIFY,that the On a Sewag isposal System Constructed( )Repaired( )Upgraded
Abandoned by ."`
at S 1 .f_ has b'e�ten'.constructed in accp�rdance
with the pr�visio s of Title/ d the fo isposal System Cons ction Permit o.?C1(,I � ated
Installer Designer
The issuance this ermit shall not be construed as a guarantee that the syste ill f nction as des'-n d.
Date , Inspector Y kN
'�
No. �G{laV ��� -------------------------Fee
-
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS
&2;pogar *pztem Construction Permit
Permission is hereby granted te-,C>onstruct( )Re ai ) pgrade Vbandon( )
System located at / .Y/ (ZA5_ i d
/
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 must be completed within three years of the date of this permit.
Date: �� ( `1^2__ Approved by JJ
4 i TOWN OF BARNSTABLE J �LOCATION Pi-e_ r SEWAGE # QKV_� _3/f
VILLAGE feT IAI,S <.ASSESSOR'S MAP & LOT 2Y7
INSTALLER'S NAME&PHO NO.
SEPTIC TANK CAPACITY 561D 00 Lq
O�r
LEACHING FACILITY: (type) gCL ��`. (size)
NO.OF BEDROOMS
BUILDER OR OWNER N 1�
PERMIITDATE: 7 I U COMPLIANCE DATE: U
Separation Distance Betweeb the:
Maximum Adjusted Groundwater Table to the Bottom of beaching 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
"Ac CfeS) .
qq w
�A
July 22, 2002
Outback Engineering
106 West Grove Street
Middleboro, MA 02346
(508) 946-9231
Town of Barnstable
Health Dept.
200 Main Street
Hyannis, MA 02601
Re: 15 Pine Crest Road
Septic System Inspection
� I
To Whom It May Concern:
Please be aware that Outback Engineering has conducted the necessary inspection for the
newly installed septic system for the referenced property..
This system was found to be in conformance with the approved plan.
Very truly yours,
ames A. Pavlik, P.E.
I� (SAS) SHALL BE t �`
C2 = 3S.o �
MANHOLE COVERS TO EXTEND TO �; 34.25 LONG �VJ
�N� WITHIN 6' OF FINISH GRADE .� 11.0' WIDE (,R-p` `� T
O 10" DEEP. 10 kAC CoteS7, it
.► I QV E
BAFFLE REQ'D t.
Z:. ►.Jc h! a 4 GQp,V"jt
1 ZS - 2' PEASTONE TOPPING
f2o W �:D D.B. - - -
TNoJK _ 6• cusp 7wE ,;�: - — CAP ENDS
3 4' oou - ELEVATIONS SHOWN NOTES:
BASED ON U.S S
_ . .
Z��10 SYSTEM PIPE SHALL BE EITHER C.LGOR DA
EL S ONE ALL AROUND D
TUM.
+ ,� ro. Ceusrlcn
o a `r SCHEDULE 40` P.V.C.f` S'��t
— THE BOARD OF HEALTH SHALL BE NOTIFIED
20' MIN. t 3t.25' .5' PRIOR TO BACKFILLING OF SEPTIC SYSTEM.
—USE FIVE 5) INFILTRATORS SEPTIC SYSTEM STRUCTURAL COMPONENTS
(
SOIL TEST LOG PROPOSED SEPTIC SYSTEM wrrH 4.0 OF STONE 0 SIDES SHALL BE CAPABLE OF WITHSTANDING A
H-10 LOADING. UNLESS SPECIFIED OTHERWISE
PERC RATE=< 2 MIN/INCH I ENDS
NO SCALE NO STONE AT BOTTOM '�� — SEPTIC SYSTEM UNDER DRIVEWAYS SHALL
_ELEv 0 THl��.I �
( p.0'3 wo Wjhr-TSIL IS COMPLY WITH A H-20 LOADING.
DEPTH — THE DESIGN AND COMPONENTS OF THE SEPTIC
.- �j,2+ � '"R. �A LOAMY SAND 10 SYSTEM SHALL BE IN COMPLIANCE WITH THE
$� YR 1�I� n� � /r_� "T ' S'L,
1
,. s LOAMY SAND tOYR STATE OF MASSACHUSETTS SANITARY CODE Dt�.
TITLE V. AND SHALL BE IN COMPLIANCE WITH
QO THE LOCAL BOARD OF HEALTH RULES AND
cI MMUM SAND 14YR I- REGULATIONS.
— THE CONTRACTOR SHALL BE RESPONSIBLE FOR
LOCATION OF ALL UNDERGROUND UTILITIES AND
I SHALL NOTIFY DIG - SAFE PRIOR TO
t, 3 CONSTRUCTION.
fl I�tJ1�7OC 'r �rf 4F NE"'l - 0 GARBAGE GRINDER
o�y
t2` C e! o TAOK rDESIGN
N CRITERIA:
' o
LEGEND: FLOWEXISTING CONTOUR — — — — — 3OOMS AT 110 G.P.B. / DAY 330 G.P.D.
WATER SERVICE VIF—Nf-- ,� ACT REQUIRED SEPTIC TANK:
TEST HOLE Q� 3 �[ 1-IF-0 P_O Ly e'/'r;l y C,- Thn!
GAS SERVICE G--6 - L(5� �_(j 6�1 C� ( SEPTIC TANK PROVIDED /, S SOO GA W
BENCH MARK �Bt♦ 0 DESIGN PERC RATE <2 MIN/INCH
_ SIZE OF REQ'D (SAS) AREA = 330/0.74 = 446 S.F.
C) ® SIDEWALL BOTTOM ffl� 50.83)(3)4.25)+(2)(O.83
S F)(1 1)= 75.12 S.F
Q SIZE OF LEACHING FACILITY PROVIDED.
T< 45 376.75 S.F. + 75.12 S.F. _. 451.87 S.F.
'
NOTE: = 334.4 GPD
PRIOR TO INSTAWNG THE NEW (SAS) THE
CONTRACTOR SHALL PUMPOUT ALL CESSPOOLS 3 EFFECTIVE DEPTH:AND BACK FILL WITH CLEAN MEDIUM SAND 3 10`
IF CESSPOOLS ARE ENCOUNTERED IN THE G EFFECTIVE LENGTH: 34.25'
(SAS) AREA THEY SHALL BE REMOVED 1 HOF \ EFFECTIVE WIDTH: 11.0'
I
JAMESA D UTBACK ENGINEERING PAVUK a
� � � CIVIL N 106 WEST GROVE STREET.
C ND 3 IL MIDDLEBORO, MA 02346.
9 (508) 946-9231
=J A9o,��, PROJECT: SEPTIC SYSTEM REPAIR
S. O O i J 0 NG� FOR
!^1c'-
0— D 7OWNE :
ow�wo ire., Jp
pi ►� C: sT �o R� MAP 247/ LOT 15 2 7
N( SCo
L tV Ro, i3ox 41-3