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HomeMy WebLinkAbout0050 BAY ROAD - Health 50 Bay Roa Cotuit _ A = 007 026 I, Commonwealth of Massachusetts 000000000, VA Subsurface Sewage Disposal System Form-Not for Voluntary Assessments C 50 Bay Rd Property Address Dominick Carelli — c Owner Owner's Name . information is required for Cotuit MA 02535 12-19-06 every page. cityrrown State Zip Cone Date of inspection .Inspection results must to submitted on this form-Inspection forms may not be aftered in any way. A. General Information k 7. Inspector: u+ i. Shawn Mcelroy- Name of inspector Shawn Mcelroy Enterprises Company Name 29 Atwater Dr. s ' .t Company Address E.Falmouth MA 02538 Cityrrown State Zip Code (506)495-0905 ,. ,. .. ., Telephone Number Ucense Number B. Certification 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.f am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000).The system: ► ` a k ® Passes ❑ Conditionally Passes Fails i _ {. i. f y1 f pprciving Authority:Needs Further Evaluation b the Local A rQ 12-19-06 : _0 Inspector's Sign tune Date — The system inspector shall submit a copy of this inspection report to the Approvi ig Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared`system or ,• hasr a design flow°of 10,000 gpd or greater the inspector aria the system owner hall submit the re rt to the a po pprdptiate regional office of the DEP.The orihal should be sent to the system owner and copies sent to the buyer,if applicable,and ttte approving aitthaifty. ""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 wiff perform in the future under the same or different conditions of use. + ' t5insp•08108 TdieS O ficW 6s an Foam SW=nface Senmge t Systam•Page 1 ar 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 50 Bay Rd Property Address Dominick Carelli Owner Owner's Flame information is Cotuit MA 02635 12-19-06 required for every page. Cityrrown State Zip Code Date of Inspection Inspection Summary: Check A,B,C,D or E/ahrays complete all of Section D B. Certification (cont.) 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: All H-20 products in good condition. 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 `' ❑ F obstruction is removed .b t5insp•08/06 Title 5 Official Ictspecum Forth:Subsurface Sewage Disposal System•Page 2 of 15 Commonwealth of Massachusetts Title 5 Official Inspection I=or Subsurface Sewage Disposal System Form,-Not for Voluntary Assessments 50 Bay Rd Property Address aw Dominick Carelli Owner Owner's Name _ information is required for Cotuit a, MA 02635. 12-19-06. _ every page. City/Town State Zip Code Date of Inspection • •�,-:. B. Certification ,(coot.) :: f ��B) System Conditionally Passes (cont.):•r �° , , - - s ,•. p i= : , : . ,..� (�i w. ` ❑ distribution box is leveled or replaces 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: 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,'.:•"t"' '' :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: Cj Cesspool'or privy is within 50 feet of surface water T ` ' ❑ Cesspool�or privy is within 5041iie(afra bordeniig vegetated wetland or a salt marsh . '.Si;fir_ •r:,�. rty 4* er�,. -s , .. .: . ., 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: i 's 'Orr. ;+❑ _ 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. ., a' 4 t5insp•08/06 Title 5 Oificiad hapection Form:Subsurface Sewage Disposal System•Page 3 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments 50 Bay Rd Property Address Dominick Carelli Owner Owners Name information is required for Cotuit MA 02635 12-19-06 . every page. CityrFow n state Zip Code Date of Inspection B. Certification (cont.) C) Further Evaluation is Required by the Board of Health(cunt:): ❑ 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 indicates absent 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: D) System Failure Criteria Applicable to All.Systems: You must indicate"Yes"or"No"to each of the following for all inspections: j i 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 f due to an overloaded or clogged SAS or cesspool ❑, r ® 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 h day flow ❑ ® Required pumping more than 4 times in the last year NOT due to dogged 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. t5insp•08106 Tine 5 Official inspection Few Subsurface Sewage Disposal System•Page 4 of 15 Commonwealth of Massachusetts : Title 5 Official In"spectionfo'hn, Subsurface Sewage Disposal System Form Not for Voluntary Assessments :t".L M sV.,y 50 Bay Rd ► , .r Property Address Dominick Carelli Owner Owner's Name . information is Cotuit +" :' MA 02635 12-19-06 rtM1 required for every page. City/Town State Zip Code pate of Inspection •, B. Certification (cunt.) w. D) System Failure Criteria Applicable,to:All Systems (cunt.):;,.'-,-­,r,c.; .f :'r 1f1J Yes No -v? L s V El 0' Any portion of a cesspool or privy is within a Zone 1 of-a public well. (j t ` ,® '_ Any portion of a cesspool or privy is within 50 feet of a:private water supply well. a ' El Z,, V Any poition of a cesspool or privy'is less than 160 feet'but greater than 50 feet t •.f rf¢ xfrom a private water supply well.with no acceptable water quality analysis. [This system passes if the well wate�analysis,performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent 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 and chain of custody,must be attached to this form.] ® The system is a cesspool senring a facility with a design flow of 2000gpd- 10,000gpd. El ® " =; 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. ' _ 1� i ° •.Z 1':1 .a G M1:'t'tit ._{ -: t_.. . - 4 r e _ .. 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- r, _ �.:.f +?4r a', f! . ,I.N it i.,,Ir r. .,t:a k` For large systems, you must indicate either"yes"or"no"to each of the following, in addition to the questions in Section D. ` Yes NO•., +, �5 ;fit; t El E],-, ; r the system is within 400 feet.of a surface drinking water supply ❑ r. ❑ the system is Within 200 feet of a tnbartary to a surface drinking water supply the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area—IWPA)or a mapped Zone 11 of a public water supply well If you have answered°yes7 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. t5insp•08/06. tale 50fiaal Inspection Form:Subsurface Sewage Disposal System•Page 5 of 15 Commonwealth of Massachusetts Title 5 Official- Inspection Form Subsurface Sewage Disposal System Form-Not for.Voluntary Assessments 50 Bay Rd Property Address Dominick Carelli Owner Owner's Flame information is required for Cotuit MA 02635 12-19-06 every page. City/Town State Zip Code Date of Inspection C. Checklist 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 Z. El available note as WA) ®' ❑ 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 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: ® ❑ - 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(5)] t5insp•08M Title 5Official inspection Form Subsurface Smite Disposal System•Page 6 of 15 I Commonwealth of Massachusetts ^z + r • ' . . :t ,, Title 5 official Inspection -1=o rrm: .l Y ' � p Subsurface Sewage Disposal System Form :Not for Voluntary Assessments .1.; 50 Bay Rd . Property Address ,. _ t-o Dominick Carelli Owner Owner's Name information is t Couit MA 02635 12-19-06,_ required for ,.. 4 every page. City/Town v ` ' State 7.ap Code Date of Inspection D. System Information . .,. ►, z Residential Flow Conditions:`i­� _ ;,...". Number of bedrooms (design): 4 Number of bedrooms(actual): 4 DESIG14flow'based 0'n3310 CMR 15.203 (for example: 110 gpd x#of..bedrooms): 440 ' Number of current residents: 0 Does residence have a garbage grinder? + �,�• rr,. ae`+ +, i. ❑ Yes ® No Is laundry on a separate sewage system? [if yes separate inspection,required] Yes ® No Laundry system inspected? ,J':"x►, ;c ❑ Yes ® No Seasonal use? t ,r,. k� 3;; _„,��.; ® Yes ❑ No Water meter readings;if available(last 2 yearn usage(gpd))::<<. ; Sump pump? • t El Yes ® No f - Last date of occupancy: 11-06 Date Commercial/industrial Flow Conditions: F).Type of Establishment: , W t.t~ 'Design flow(based on 310 CMR 15.203): ,r! .. .j..t_c t .r .. . ..-s- .; .: + e•' + .«to Gallons per day(gpd) Basis of design flow(seaWpersonsisq.ft.; etc):. .a Grease trap present? . ..Via.ta, w "' ❑ Yes ❑ No Industrial waste holding tank present? - ❑ Yes ❑ No Non-sanitary waste discharged to•the:Title 5 system? ❑ Yes ❑ No rr:� - Water meter readings,if available:- Last date of occupancy/use:, -r Date 4 ~• Other(describe): t5insp•08/06 Titte 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 50 Bay Rd Property Address Dominick Carelli t Owner Owner's Name information is required for Cotuit MA 02635 12-19-06 every page. Cityrrown state Zip Code Date of Inspection D. System Information (cunt.) General Information Pumping Records: Source of information: Owner, not pumped since new. Was system pumped as part of the inspection? ❑ Yes ® 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 r ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Attemative 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: 2002 Were sewage odors detected when arriving at the site? ❑ Yes ® No t5insp•08106 Tide 5 Offiztaf Inspection Form:Subsurface Sewage Disposal System•Page 8 of 15 r Commonwealth of Massachusetts �,' :� R�. 4a'r ;,, � r • ,, lugTitle 5 Official Inspection Forrn' ' Subsurface Sewage Disposal System Form-Not for Voluntary Assessments-,-11" 50 Bay Rd Property Address Dominick Carelli Owner Owner's Name information is fr _ required for Cotuit MA 02635 12-19-06 every,page. City/Town state Zip Code Date of Inspection .-,x 3 D. System Information (cunt.) Building 3ewer'(locate onrsite�plan) s y AL 16" Depth below grade: feet - Material of construction: ❑ cast iron ®40 PVC ❑ other(explain): Distance from private water supply well or suction liner feet _- Comments(on condition of joints,venting,evidence of leakage,etc.):. a Septic Tank(locate on site plan):.c Depth below grade: : - feet Material of construction: •; r<r� „�; ® concrete ❑metal ❑fiberglass ❑ polyethylene,, ❑ other(explain) If tank is metal, list age:-4i `, , .... r . "< years ' Is age confirmed by a Certificate of Compliance?(attach a"copy of certificate) 1.,._ ❑ Yes ❑ No --- ---- --- --- --------------------- - -- ---------------------- 1: r n -r• t i �. t--,3 fit, i;'• •,3:.. - � Dimensions: 1500 Gal Sludge depth: N Distance from top of sludge to bottom of outlet tee.or baffle ;.29 Scum thickness : ., 6' Distance from top of scum to top of outlet tee or baffle - 16" . ' ' Distance from bottom of scum to bottom of outlet tee or baffle _ . How were dimensions determined? Tape t5insp•08= TNe 5 Official fropeclJon Form:SubsurFace Sewage Dsposal System•Page 9 of 15 Commonwealth of Massachusetts - Title 5 Official Inspection Forte Subsurface Sewage Disposal.System Form -Not for Voluntary Assessments 50 Bay Rd Property Address Dominick Carelli Owner Owners Name information is required for Cotuit, MA 02635 12-19-06 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cunt.) . 1. Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert,evidence of leakage, etc.): a Grease Trap (locate on site plan): Depth below grade: feet 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: Date Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert,evidence of leakage, etc.): Tight or Holding Tank (tank must be pumped at time of inspection)(locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): r t5insp-08f06 Idle 5 Official bspection Form:Subsurface Sewage Disposal system-Page 10 of 15 Commonwealth of Massachusetts •}r�:. ;, , , . Title 5 Official Inspection Foem '.- Subsurface Sewage Disposal System Form-Not for Voluntary Assessments .. -�• �. 50 Bay Rd Property Address Dominick Carelli Owner Owner's Name information is required for Cotuit' MA 02M 12-19-06 every page. city/rown State Zip Code Date of Inspection D. System Information (cont.) -Tight or Holding Tank(cont.). ..- Dimensions: Capacity: gallons Design Flow: `gallons per day Alarm present: ;.❑,Yes ❑ No,,! Alarm level: Alarm in working order- ❑ Yes ❑ No Date of last pumping: Date Comments(condition of alafm and float switches,etc.): ti. I • S Attach copy of current pumping contract(required).Is copy attached? '❑ Yes ❑ No Distribution Box(if present must be opened) (locate on site plan): ;�? Depth'of liquid level-above outlet invert . 0 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.): H-20 D-box in good condition. - .' i..;, . ' . . i ' e. - r 4i. .,i.y.� r}"..s •• .;•.dtYa" �,7.. .j „ }-'s.'4'��':f r-1 Pump Chamber(locate on site plan): Pumps in working order _ ❑ Yeses ❑ No Alarms in working order: ❑ Yes ❑ No t5insp•08= ..„ _ Title 5 Official Inspection Forth:Subsurface Sewage Disposal P� 9 po`a System-Page 11 of 1 5 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments uM s 50 Bay Rd Property Address Dominick Carelli Owner Owner's Name information is required for Cotuit MA 02635 12-19-06 every page. City/Town State Zip Code Date of Inspection D. System Information (cunt.) Comments(note condition of pump chamber,condition of pumps and appurtenances, etc.): Soil Absorption System(SAS)(locate on site plan, excavation not required): If SAS not located, explain why: Type: ❑ leaching pits number. ® leaching chambers number4-500's ❑ leaching galleries number. ❑ leaching trenches number,length: s ❑ 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.): Concrete leach chambers in good condition with no sign of break-out. t5insp•OaW Title 5 official Inspection Form.Subsurface Sewage Disposal System-Page 12 of 15 Commonwealth of Massachusetts - Title 5 Official. Inspection Form Subsurface Sewage,Disposal System Form -Not for Voluntary Assessments ., 50 Bay Rd 4 = Property Address Dominick Carelli Owner Owner's Name _ information is Cotuit MA 02635 12-19-06 required for ' every page. Cityrrown State Zip Code Date of Inspection a' a D. System Information (cunt.) Cesspools(cesspool must be pumped as part of inspection)(locate on site.plan): Number and configuration ;•; !`� ,,'i . ' ^s 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 '"` ` El Yes Q" 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.): t5insp•08106 Tittle 5 Official Inspedon form:Subsurface Sewage Disposal System-Page 13 of 15 Commonwealth of Massachusetts - Title 5 Official Ins ecti®n For' Subsurface Sewage Disposal System Form'-Not for Voluntary Assessments 50 Say Rd Property Address Dominick Carelli Owner Owner`s Name information is Cotuit ' MA 02635 12-19-06 required for every page. cayrrown State zip code Date of Inspection D. System Infoir maWn (c©rrt.) 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 eaters the building. r A , .. fl ' [ Y7S ri j�_� 3 , C7 t5lnsp•08106 Tde 5 Of<icrd Inspection Form:Subsurface Sewage Disposal System•Page 14 of 15 Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 50 Bay Rd Property Address Dominick Carelli e Owner Owners Name information is required for Cotuit MA 02635 12-19-06 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cunt.) Site Exam: Slope Surface water Check cellar Shallow wells Estimated depth to ground water: Please indicate all methods used to determine the high ground water elevation: ® Obtained from system design plans on record If checked,date of design plan reviewed: Date ® Observed site(abutting property/observation hole within 150 feet of SAS) ® Checked with local Board of Health-explain: ® Checked with local excavators, installers-(attach documentation) ® Accessed USGS database-explain: I You must describe how you established the high ground water elevation: Original design plans show no groundwater within 12'. t5insp-08/06 Title 5 Offocmi trspectbon Forth:Subsurface Sewage Disposal System-Page 15 of 15 TOWN OF BARNSTABLE — ~ LOCATION 46 e V A' CI SEWAGE # VIj LAGS ASSESSOR'S MAP& LOT INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY /`J 0 LEACHING FACILrrY: (type). Z er.6/ Cat/4 w A/erS (size) y-SOU 5 NO.OF BEDROOMS BUILDER OR OWNER ®O M h.,C �a�e l r v�*�'i e✓ PERMTTDATE: 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) // 1 Feet Furnished by—'5Actw /0 Sb B``y Rc1 Gru'l . alit 36 �41 WS-1' TOWN OF BARNSTABLE LOCATION aq ec SEWAGE # ZOO Z ZZ1 VILLAGE C 6 rl("—k ASSESSOR'S MAP & LOT Qb7—62 6 II4STALLER'S NAME&PHONE NO. �A /U Con-S SEPTIC TANK CAPACITY 0 Sys M LEACHING FACILITY: (type) (size) S d0 NO. OF BEDROOMS BUILDER OR OWNER PERMITDATE: 6 'Z- -COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leachin<<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 Weiland and Leaching Facility (If any wetlands exist within 300 feet of leaching facility) Feet Furnished by � 3 ' �� ��� Z r�----- �?�y No. c7`J�J d— ''",� ' Fee'- THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: V ✓ Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS ZIppricatiou for 33tgogal bpztem Cou5tructiou permit Application for a Permit to Construct )Repair( )Upgrade( )Abandon( ).VComplete System ❑Individual Components Location Address or Lot No. 5"6 Owner's Name,Address and Tel.No. i 3 r/a •��� Assessor's Map/Parcel 66 �Co /iv�T r ooA s�Ot l�2�9 Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. �G Ta(v T7% G•�s .60uJiJ 9 3 9 6,9 6 Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder(,PO) Other Type of Building No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow 2 Lf© gallons per day. Calculated daily flow Lj gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. 'S ` Description of Soil ��',' 5, �QS . 2.S 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 been issued b s B ea Signed Date Application Approved by Date c S' .3`� Application Disapproved for the following reasons Permit No. �� Date Issued 5 Z W No. Fee THE COMMONWEALTH OF'FAASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION TOWN OF BARNSTABLE MASSACHUSETTS y. 01pplication for Mizpozal *p5tem Construction Permit A catiNdnor a Permit to Construct Repair Upgrade Abandon El Complete System Individual,Components 1 Location Address or Lot No. .5 0 Owner's Name,Address0 and Tel.1.No.Assessor's Map/Parcel, 6_7 ei 3 PVZF!5 Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. fG g, ::p 4"', '731 Type of Building: .6,7 ----Dwelling— No.of Bedrooms Lot Size- , sq.ft. Garbage Grinder qVQ Other Type of Building C. No.of Persons Showers Cafeteria( Other Fixtures Design Flow j_jq U gallons per day. Calculated daily flow Lj sq gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank —Type of S.A.S. Description of Soil 2 Sl XdS 2."S' Nature of Repairs or Alterations(Answerwhen 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 been issued b s Boar eal1 . th. Signed G tt Date Application Approved by 0 Date cry s /D Application Disapproved for the following reasons Permit No. Date Issued 'S/2.ci 10-21 ——————————————————————————————-- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY, that the On-site,Sewage.Disposal System Constructed ;a ;'-" )Repaired Upgraded Abandoned( )by AOKI at has been constructed in accordance C)L with the provisions of Title 5 and the for Disposal System Construction Permit No. __?dated C-N- L Installer Designer The issuance ofithis/permit shall not be construed as a guarantee that the systr 0 -7il!1 function as deXgned. Date Inspector— J ij --------------------------------------- N'. Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS lwizpozal bp5tem Construction Vermit 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. Provided:Constructi t e completed within three years of the date of th'/ 0 r s b t e Date: /MV, y Approved b k/ V 6/ TOWN OF BARNSTABLE LOCATION nq eci SEWAGE # ZOO Z- —Z z1 I VILLAGE C c/ ASSESSOR'S MAP & LOT 007—6.26 INSTALLER'S NAME&PHONE NO. �A rN)�/ SEPTIC TANK CAPACITY 0 LEACHING FACILITY: (type) (: Yz (am Q r,-- (size) NO. OF BEDROOMS__ BUILDER OR OWNER CXirN PERMIT DATE: (.-) Z_COMPLIANCE DATE: 1 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 36_` , C� .::isti•>rJ.,iii•.;�ai.i�iGr-.';Ylia��:.: � - .. '4 DtC :GSi ..e IIF ,f i r Y 1'•� - IYIO-U3 ..Tt. CPl l 1. 9r.-O HISHfIQ JGl10E,- i 1 , 1� I.. , � T $7EF'bJ'.L-:SNLW1iY:UI+A'R 'S-rsvL\L�♦,., I, - .. , 1. Q 4 1 ' i I >�� a 7 p �� I• C ,n; atr 40. s6 s•o-, s•c I , .r ,v. •1 1 , r L' • 'mot+.f:.,:., 'T J _ i , 7 =4s6 � d1VA P: D" �$r% In _ G , 4'. 1. 17. s r r r b - - r Y i 7 f- I b ;`,: ap. .., . ...,-• .' 1• _ rf r... a :;r rA' is �S .0, .9fT.; , 'K:•I - i y' x - Yfl n < r Y .. , .. ,.. f.. .. ... .. ...d } t: 11 n 9 :3 1. rr -•Tf. Ygk�• Y' , Lx r :b�. ?_fie 1' .i-, i� .I •.Ndd' .J 1 t•.+ .,'tit 5 o R T 1 ;1 , I i i a ::��r-.• fin.•a �� } 'r,°r qNr t� h hf- e, s ,. •G ,1. - -.r , t- ( J 1 1 r - t �Y •Ja aa C.<L t• v. .f L 4'- L, l;. 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CC,:� ._ ,nl •1 _ T r• •;I ;o< a- �3 -a' '-`fir ry �r:I F iQ. 1 v ti , f. i' - T- - s'n, 5 ,f L R 3 € cr 1 1 kla ^u: : -',:. {�}} �� .x'..i- t '•:SAT - ... . 1. .?.� :5.: •1 ..,�'!'71 - to, -•r s •Y'. i is v t•t �+ F :I ¢r: .rr. i> =1r .r ,,tom ri 1. I fi- r JM1 ti rr 7 i 5' C I r jI ..r. 5 �• i 4 h- 7 r.* i .W :.vr. t' 1( 'N '.r. ( •I L r. i. >5, v. n i. 'C • , , 4 l • c - . .�. r r ... .... : .. ... ..._ .. ,..... ;... .. .:.-...Kr+^ '\fir .L r "f t•0 1 4_ - Q b. S, .r t.Y ,,,,...N--.. .. ... .. .yr -. .. A. O ^.O , > ..,, •. .. - ,%_.i^r'.' ly, 1 J ra 5r :fir ..• Lp l..I^ a •:a .n.. .r:.,.,•.n rx"^t. ,...r.J. :..:.,...r.r..1, w..;a.,., •4 r :r.. ?... .. ....... ..:.. ..:•,: ...�: , ::it.i l i , n.. ....... ...:. a.. ., ....r:. ,. _ .,.. .. _.. .. :...r e. .:. ''y���'� ' .;•,M,j.: < .;ter' LEGEND TOP FNDN AT EL, 44.5' SYSTEM PROFILE ACCESS COVER TO WITHIN 6' OF FIN. GRADE (NOT TO SCALE) <, LOCUS SEPTIC DESIGN= (GARBAGE DISPOSER is NOT ALLOWED > /"" TEST HOLE L 0 G S i 100.0 PROPOSED SPOT ELEVATION ACCESS COVER (WATERTIGHT) TO DESIGN FLOW: 4_ BEDROOMS (110 _ 440 42.5' WITHIN 6' OF FIN. GRADE GPD) - GPD ; MINIMUM •75 OF COVER OVER PRECAST . 2% SLOPE REQUIRED OVER SYSTEM EL. 43.0' RICK JUDD,_RS 100x0 EXISTING SPOT ELEVATION USE A 440 GPD DESIGN FLOW '` ENGINEER: �. T1RUN PIPE LEVEL 2' DOUBLE WASHED PEASTON WITNESS= DAVID STANTON �y� v Poo] SEPTIC TANK: 440 GPD ( 2 ) = 880 PROPOSED CONTOUR _,_ \±1.75'� "-'" FOR FIRST 2 0 1500 PROPOSED 1500 3' MAX. DATE: 3/1/02 Q°a USE A ___ GALLON SEPTIC TANK 100 EXISTING CONTOUR - GALLON SEPTIC 40.25' _ 40.46' LEACHING! 40.50 'rANI( (H 20 ) H-20 CHAMBERS PERC. RATE < 2 MIN/INCH / 2(39 + 10.83) 2 (.74) = 147 .- :: .. ___._ GAs 39.82' SIDES= BAFFLE 39.99'1ga CO O C� "C� 0 0 'O I 10187 . CLASS SOILS P# °ro 39 x 10.83 (.74) = 312 ( 10 % SLOPE) C� CJ CI C] C7 C� CI 3' ® SIDES BOTT �T OM: �6 CRUSHED STONE DR MECHANICAL 2. O END 0 0 0 � TOTAL: 620 S.F. 459 GPD DEPTH OF FLC'W _ 4, COMPACTION. (15.221 123) 2' C� 0 C7 L� 0'0 0 (� c 37.63' ( 1 % SLOPE) ti/. SLOPE) USE_(4) H-20 500 GAL. LEACHING CHAMBERS WITH 3' TEE-suEa� _ 10" 3/4" TO i i/2' DOUBLE WASHED STONE Cp ELEV. Cp 0 42.4 0 43.2 STONE AT SIDES AND 2.5' AT ENDS INLET DEPT 14" LOCATION MAP NTS OUTLET DEPTH = 0 0 3„ 3„ ! FGIUNDATION 28' SEPTIC TANK 26' D' BOX 21. TEACHING 5.73' -FACILITY A/E A/E ASSESSORS MAP 7 PARCEL 26 BOARD OF HEALTH LS LS ZONING DISTRICT: RF 8" 1OYR 4/2 10YR 4/2 YARD SETBACKS, APPROVED DATE MA Bw Bw FRONT =1 30' BOTTOM TH 1 SIDE = 5 LCOS EL. 31.9' LCOS REAR = 15' 10YR 4/6 _ PLAN REF. - 132/143 28" 40.0' 26„ 10YR 4/6 41.0' FLOOD ZONE: A11 EL, 11 AP DISTRICT C C _ MS MS a 2.5Y 6/6 5.0 2.5Y 5/4 s s I 2.8 . 126„ 31.9' 126" ' :7 #6 NO WATER ENCOUNTERED NOTES, 1. DATUM IS NGVD 2. MUNICIPAL WATER IS AVAILABLE 5 3. MINIMUM PIPE PITCH TO BE 1/8' PER FOOT. l = 4. DESIGN LOADING FOR ALL PRECAST UNITS TO BE AASH❑ H- 20, QO 2.9 � �3 5, PIPE JOINTS T❑ BE MADE WATERTIGHT. VO 6. CONSTRUCTION DETAILS TO BE IN ACCORDANCE WITH MASS. s� ' 37.5 � : : ENVIRONMENTAL CODE TITLE V. g • '�� 7, THIS PLAN IS FOR PROPOSED SEPTIC SYSTEM ONLY AND IS NOT � 0 � 2 - ' _ � •:: TO BE USED . FOR ANY OTHER PURPOSE. + 39.8 4 8. PIPE FOR SEPTIC SYSTEM TO SCH• 40-4' PVC. 4, c T�-1�10T f0 BE isAC-r.r ILI -OCi1�CEALtU WITHOUT INSPECTION BY BOARD OF HEALTH AND PERMSSIr.riv i;B41 TAINEL >x� S 2.6 # FROM .BOARD OF HEALTH. 3,1 �"` .2 /�� 41.1 4. s 39.2 AL 2 5 5.1 � ,9 � IBENCH MARK - TOP OF CONCRETE BOUND TITLE 5 SITE PLAN ELEVATION =- 38.6' (NGVD) OFj O BAY ROAD ! PROP. 3' WIDE i NATURAL PATH + 41.8 4 ,� ` (STABILIZED WITH LANDSCAPE TIES As IN THE TOWN OF: NECESSARY) - DESIGN ` i (COTUIT) B A R N S T A B L E .8 BY OTHERS \ PREPARED FOR: JOHN J. CONNERS h� � \ DOCK 6 43 ( + 1.5 6 ' - 20 p 20 40 60 .1 LOT 2A �✓"�l ' 8,1 t SQ. FT. /. �� �. 3 36.1 2.':� SCALE: 1„ = 20' DATE: MARCH 12, 2002 ti ry � �• 0• � 33.9 REV. 5/15/02 (DEL. STAIRS, ETC.) STAIRS 22.8 �. I �. S0' / 43.1 / a��� + 43.1 �•.� 0 1 ^) 11 PROP. 4 \ + D / N OF /t9 N 01 �^� ,4 BR DWELL. � "� �tA�� z� �y TF 44.5' / /I 37, \ p' �o'r ARNE ��y� o OJ.E H. Gam, a �oo H / / s H. � CIVIL H + .7 37.1 N a a. � /��4 0 TH 2 / / •^,� o �� ��� O Z � ._ 494 4.2 GAR , 2 // W / OJA P.L.S. DATE SLAB EL. 44.0' • PROPOSED WORK LIMIT LINE OF 7 ST STAKED HAYBALES/SILT FENCE TO BE REPLACED WITH PERMANENT OPEN WORK 44.7 / FENCING OR SIMILAR PHYSICAL h O BARRIER WHEN GRADING AND N, + 43.8 �• 40.1 LANDSCAPING ARE COMPLETE ('' + 4 + 44, / / � 3 off 508-362-4541 fax 508 362-"80 42.3 w �. 70, / _ down cape engineering, in[, PROP. VENT (FINAL PLACEMENT BY L=28.85 CONTRACTOR WITH HOMEOWNER) / R=61.73' CIVIL ENGINEERS 4 43.0 LAND SURVEYORS i i 939 main st. yarmouth, ma 02675 43.6 02-031 + 43.8 ;