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HomeMy WebLinkAbout0027 BOB-WHITE RUN - Health 27 BOB WHITE RUN, COTUIT A=024-052 i TOWN OF BARNSTABLE C— . LOCATION ��7 d�D L� 're i �" SEWAGE# ?cap VILLAGE LLD,LT- �- ASSESSOR'S MAP &LOT INSTALLER'S NAME&PHONE NO. iJ Ga nnz-' C!�Lt C P 2�P" I SEi'TIC TANK CAPACITY k;00 LEACHING FACILITY: (type) ���'a lra r.��- (size) �� �� NO.OF�BEDROOMS BUILDER OR OWNE / �`C L Yt�`t o n3 �,,'��;'Gzb Cot PERMITDATE: IV, COMPLIANCE DATE: 00 ILI 1 Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet 0 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) /V� Feet Furnish-,d by �' 38 Town of Barnstable P# Department of Health,Safety,and Environmental Services �I Public Health Division Date 367 Main Street,Hyannis MA 02601 BARNSTABM t6I9' ArFDMAt� Date Scheduled ® Time Fee Pd. 1 + ' - Soil Suitability-Assessment for Sewage Disposal 1 I , Performed By: _Lt y, Witnessed By r1c�1Q8,yr�► LOCATION& GENERAi.INFORMATION . Location Address Y71 j� Owner's Name Coro o �7_ Address Assessor's Map/Parcel: O DUr� Engineer's Name ��• —�S1Ds— ` NEW CONSTRUCTION REPAIR Telephone# Land Use i0� M. Slopes(%) — rj Surface Stones li V_b5z-LA)e,0 Distances from: Open Wat r Body — ft Possible Wet Area ft Drinking Water Well LAVA*-ft Lo"f.D Drainage Way ICDI ft Property Line C—_rX, ft Other ft SKETCH:(Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands in proximity to holes) BOB V_/H I Te V-U 0 4�' zot OF OHN Q D_r�S CAU6EY c..3 i\rI No. 35101 STEc��� � Parent material(geologic)" Depth to Bedrock 01 A Depth to Groundwater: Standing Water in Hole: Weeping from Pit Face Estimated Seasonal High Groundwater �'ZOt b `I'PtN 't rOII POD SEAS01A VVA ' TY.`I'�1I#I; t ._... ............ .. ...I—,. ........... .... Method Used: Dep&, Observed standing I.obs.hole in. Depth to soil mottles: Aipi in. Depth to weeping from side of obs.hole: in. Groundwater Adjustment ft. Index Well#_ .Reading Date: Index Well level.. ,Adj.factor____ Adj.Groundwater Level PERCOLATION .....................T ;'atc z z Time �b 47 Observation +� Hole# L _� �A' Time at 9„ Depth of Pere tm,i, IN Time at 6" Start Pre-soak Time @ Time(9"-6") End Pre-soak Rate Min./Inch ;w, ,w ' Site Suitability Assessment: Site Passed Site Failed: Additional Testing Needed(Y/N) Original: Public Health Division Observation Hole Data To Be Completed on Back j �Copy: Applicant ;DEEP OBSERVATION HOLE LOG Hold »» Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(inJ (USDA) (Munsell) Mottling (Structure,Stones,Boulderes. Consistent %Gravel O 0� o rr �By�,•v► 10-3C( 3`� I Za >r DEEP OBSERYAATION HOLE LOG Hole Depth from Soil Horizon Soil Texture ( Soil Color Soil' Other Surface(in.) I (USDA) I (Munsell) Mottling (Structure,Stones,Boulderes. Consistency.%Gravei)e O- A 3z O toye.1i ° +8 -- G H. 5 0 ' I. __ _ .. IEEP.�DBSERYATION ITOLE LO( Hole# . Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulderes. Consistent %Gravel .9 r + r DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulderes. Consistent %Gravel Flood Insurance Rate Map: Above 500 year flood boundary No_ Yes Within 500 year boundary No_ Yes Within 100 year flood boundary No_ Yes Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the area proposed for the soil absorption system? If not,what is the depth of naturally occurring pervious material? Certification I certify that on N;, (date)I have passed the soil evaluator examination approved by the Department of Env' onmental Protection and that the above analysis was performed by me consistent with the required tramm' expertise and xperience described in 310 CMR 15.017. Signature Date ®(- -Z.aap r COMMONWEALTH OF MASSACHUSETTS 4 EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS t d DEPARTMENT OF ENVIRONMENTAL PROTECTION IO, SVev TITLE 5 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION o � e Property Address: 49 Bob-White Run , Cotuit MA 02635 c-)t `n Owner's Name: Willis Michaelson Co Owner's Address: Same Date of Inspection: November 2,2005 Job#05-324 co �� Name of Inspector: PATRICK M. O'CONNELL m U� Company Name: SEPTIC INSPECTION SERVICES CO. Mailing Address: 189 CAMMETT ROAD MARSTONS MILLS MA 02648 Telephone Number: 508-428-1779 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the e information repo below is true,accurate and complete as of the time of the inspection. The inspection was performed based on m training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DE approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system-,NNO' 11 111///�;` •qL9 _X_ Passes ••'•' Conditionally Passes O�� •.�yG' Needs Further Evaluation by the Local Approving Authority = TRI K :m Fails = : i ' 0 L y Inspector's Signature: _ -- Date: 11/2/OS %,�ij� RT�F5V. The system inspector shall submit a copy of this inspection report to the A 11 P Approving Authority(Board of�Frea tor,`` 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: System in good condition,tank is not in need of pumping at this time and leaching system shows no evidence of saturation or backup. ****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 I Page 2 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 49 Bob White Run Cotuit Owner: Willis Michaelson Date of Inspection: November 2,2005 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: _XX_ 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 s stem will pass inspection if(with approval of the Board of Health): y broken pipe(s)are replaced obstruction is removed ND explain: Tit1u Tncnurtinn Rnrm 4/1 CI7nnn 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: 49 Bob White Run,Cotuit Owner: Willis Michaelson Date of Inspection: November 2,2005 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. I. 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 th system is functioning in a manner that protects the public health,safety and environment: e _ 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: Title C lncnurtinn Fnrm 4/1 3 f Page 4 of 11 OFFICIAL INSPECTION FORM -NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 49 Bob White Run,Cotuit Owner: Willis Michaelson Date of Inspection: November 2,2005 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 1/2day flow — —X— Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped _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. 1 . _X_ Any portion of a cesspool or privy is within 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 _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 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 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—1 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 "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. Title C I»c»artinn r+nrm ail�i�nnn 4 f Page 5 of I 1 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 49 Bob White Run,Cotuit Owner: Willis Michaelson Date of Inspection: November 2,2005 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 ? _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)] Titlo G Tncr�untinn Fnrm 41, 5 Page 6 of I I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 49 Bob White Run,Cotuit Owner: Willis Michaelson Date of Inspection: November 2,2005 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: 1 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): Seasonal use: (yes or no): No Water meter readings, if available(last 2 years usage(gpd)): Two years total: 98,000 gal. = 134 gpd. Sump pump(yes or no): No Last date of occupancy: Currently Occupied COMMERCIAL/INDUSTRIAL 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): Pumping Records: None GENERAL INFORMATION Source of information: Owner 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 1 _Single cesspool _Overflow cesspool j 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: 3 years. Were sewage odors detected when arriving at the site(yes or no): No T41. t incnur}inn Rnrm 4/1 6 Page 7 of I I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 49 Bob'White Run,Cotuit Owner: Willis Michaelson Date of Inspection: November 2,2005 BUILDING SEWER: XX (locate on site plan) Depth below grade: 3' Materials of construction:_cast iron _X_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: XX (locate on site plan) Depth below grade: 3" Material of construction: H-20_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: 10.5' long x 5.8'wide—1500 gal. Sludge depth: 3" 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: 12" How were dimensions determined: STICK WITH HINGE FLAP. 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 intact and clear,liquid level at bottom of outlet invert Recommend numning tank in 18 24 . months and every three to five years GREASE TRAP: No (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.): Titlo C incnartinn Fnrm till�i�nnn 7 I Page 8 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 49 Bob White Run,Cotuit Owner: Willis Michaelson Date of Inspection: November 2,2005 TIGHT or HOLDING TANK: No (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: XX (if present must be opened) (locate on site plan) Depth of liquid level above outlet invert: 01' 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.): No solids or high stains liquid level at bottom of single outlet pipe PUMP CHAMBER: No (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.): TitlA C inenortinn Rnrm All Vlnnn 8 f- Page 9 of I 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 49 Bob White Run,Cotuit Owner: Willis Michaelson Date of Inspection: November 2,2005 SOIL ABSORPTION SYSTEM (SAS): XX (locate on site plan,excavation not required) If SAS not located explain why: Type leaching pits, number: _X_leaching chambers, number: Five infiltrators. 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.): Checked interior of infiltrators with Dine camera and found no evidence of surcharge. CESSPOOLS: No (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: No (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.): Title G incnortinn Fnrm F�1�i�nnn 9 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: 49 Bob White Run,Cotuit Owner: Willis Michaelson Date of Inspection: November 2,2005 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. Bob White Run Water service 21. 31 16 24 18 18 • #49 Titles G Tncn—tinn Rnrm 411 10 Page I 1 of 1 I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C I SYSTEM INFORMATION(continued) Property Address: 49 Bob White Run,Cotuit Owner: Willis Michaelson Date of Inspection: November 2,2005 SITE EXAM Slope None Surface water None Check cellar Dry Shallow wells None Estimated depth to ground water: More than 15 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: _X_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: You must describe how you established the high ground water elevation: Pond at rear or property is 15-20' lower than bottom of SAS. t T41. Inenar}inn Rnrm !�I�nnnn I 1 FEE COMMONWEALTH OF MASSACHUSETTS Board of Health, _, 30- &/ITs4,3 C,E , MA. APPLICATION FOR DISPOSAL SYSTEM CONSTRUCbON PERMIT Application for a Permit to Construct,< Repair( ) Upgrade( ) Abandon( - .Complete System ❑Individual Components Location O 2 /306 Ay/1-F7 Owner's Name /✓f�GjjffE(� /G(/s Map/Parcel# Address 473 P/A 16 SJ~ 46 � RUFF Lot# Telephone# 0177.0_ /716Z Installer's Name r E C Alp N/e Designer's Name &4045�10 65 Address P.1/ Address ld l p�f �FW �� 6r C� Telephone# -5 0 S 9—a Q Telepho[nee# '5 B— ZD Type of Building �5eA16!.15- A 41V IW Lot Size 3/• :rW � sq.ft. Dwelling-No.of Bedrooms `� Garbage grinder ( ) Other-Type of Building No.of persons Showers ( ),Cafeteria ( ) Other Fixtures Design Flow (min.required) 330 gpd Calculated design flow 330 Design flow provided 3 gpd Plan: Date as Number of sheets / Revision Date —" TitleS%TE dye -446 6- eer:2 07 �3 Description of Soil(s) /1146W Ia yl 1,4-/0 Soil Evaluator Form No. Name of Soil Evaluator s Date of Evaluation -01131/t3o T DESCRIPTION OF REPAIRS OR ALTERATIO Th ersigned agrees to install a above described Individual Se a Disposal System in accordance with the provisions of TITLE 5 and further afire to not to place the syste ' operation until a Certificate of Compliance has been issued by the Board of Health. Signe jZ Date Inspections TOWN OF BAR'nNSTABLE LOCATION ��7 a (ti/��'(r� l'C�ti SEWAGE # doo VII.LAGEc? l La T— ASSESSOR'S MAP&LOT INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY.__ AR11© i LEACHING FACILITY,: (type) (size) NO..F DFDI:.00MS m� BUILDER OROWNE PERMITDATE: COMPLIANCE DATE: iSeparation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet 1 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) l 4/� Feet a Furnished by 1441 i j r er �' f�1 No. � rt_t FEE h Board of Health,1 AI:5T,4l3 65 , MA. APPLICATION FOP DISPOSAL SYSTEM CONSTRUCTION PERMIT Application for a Permit to Construct(< Repair(') Upgrade( ) Abandon( ) - XComplete System ❑Individual Components Location 4�2 136d A2,41/T~ O Owner's Name Map/Parcel# V —`j 2 Address 473 Lot# / Telephone# O _ l ZG 2— Installer's Name Designer's Name C v ATio 1 g ,�( .G�2USS/�-✓�� P� Addres' O 1 Address 1,)FI;V Telephone# 5709— ,, L Telephone# Type of Building 15Z.e 1G 605 ��i d27/G�/ 2_ `1 L/�/G 7 Lot Size 3 f, -5 " sq.ft. Dwelling-No.of Bedrooms Garbage grinder ( ) Qther-Type of Building No.of persons Showers ( ),Cafeteria ( ) Other Fixtures Design Flow (min.required) 9-7SC--1 gpd Calculated design flow 3?sG Design flow provided 46Z gpd Plan: Date d S�a,/ �DG Number of sheets / Revision Date Title 5/72 sV 547,446E /'/S Ssf C Jt,*.c-) LOT 2 ;v 27 40A AJA14 7E 120/T Description of Soil(s) E� 1. Soil Evaluator Form No. Name of Soil Evaluator L AIi W/J- 64C4�"�/Date of Evaluation DESCRIPTION OF REPAIRS OR ALTERATIO S ' 1 _ UCJ Th ersigned agrees to install a above described Individual Se Disposal System in accordance with the provisions of TITLE 5 and further agree to not to place the syste operation until a Certificate of Compliance has been issued by the Board of Health. Signed Date fd s Inspections x f , r No./ 'rCOM��l M NW F C U ETTS +' FEE A� � +, Board of Health,AA PA," CERTIFICATE OF COMPLIANCE Description of Work: ❑Individual Component(s) ❑Complete System The undersi r,�d h y cerf that e ewa e Disposal System; Constructed ( ),Repaired ( ),Upgraded ( ),Abandoned ( ) by: m at ' has been installe in ac rda c 'th the provisions of 310 CMR 15.00 (Title 5) and the approved design plans/as-built plans relating to application No. _lute. Approved Design Fl w y(gpd) Installer Designer: Inspector: e� 0 The issuance of this permit shall not be construed as a guarantee that the sys(9 f ction as designed. No FEE COMMONWEALTH Of MASSAC14USETTS Board of Health, , MA. DISPOSAL SYSTEM 'C®1��T STRUCTION PERMIT r Permission is hereby granted to; Construct( ) Repair( ) Upgrade( ) Abandon( ) an individual sewage disposal system at as described in the application for Disposal System Construction Permit No. dated Provided: Construction shall be completed within three years of the date of this permit. All local conditions must be met. 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I Sa >r1`: .k V h A rtA Y dibrl sJ.la.2L t -.-.l .. t - !. i 1 F w +..._-S."1r + I i s�7u.:;1.1..6u .i-,a;'f �av , it r ;; . ' .,:,.,9 c y _ it - "r:. it a'SF°, +r!tF�x•1 .1,u 5','- .wx... * - -�,., - .. F F. FIRST OOR SEPTIC SYSTEM PROFILE SOILS LOG $ FL ELEVATION 78.0 FIN. GRADE FIN. GRADE OVER FIN. GRADE OVER FIN, GRADE OVER PERCOLATION TEST TOP of 321 AT HOUSE SEPTIC TANK DIST, BOX, 501E ABSORPTION SYSTEM FOUNDATION 76,0 75 5 75,0 TEST HOLE i TEST HOLE 2 ELEVATION - 77.0 :';;�• • 2% MIN GRADE 0" ELEV. 74.1 0" ELEV. 74.2 R S�ErSff 6" OF FIN, GRADE 10" /A 9" A LOAM INVERT at LOAM FOUNDATION �•_�'� -L •' - ELEVATION 72.75 2" MIN. DOUBLE WASHED 1/8"-1/2'_STONE - _ r r_"_ .-_`UB -ED -�-- LOAM ;;.. .. 3" 2 �� :-.:-.Ta ;.,,,. ..:.. .., ._....•-•-• LOAM _ IOYR 5/8 IOYR 5/8 ti:o a. b > 72.25 72.00 71.83 71.50 I= ,.= _ �_ -= r ic, 72.50 3/4" _ I-1/2rJ . I%'L; i _� DOUBLE WASHED STONE 69.50 GAS BAFFLE ON OUTLET TEE 0 �. T v i- _ 1. JCOARSE SAND D I S I . B 0/� a'-o�` 5 s 6 5' _ 3- 4'-0" IOYR 5/8 t +? 3 1 • 1500 GALLON Cr a `n 39.25' TOT. EFF,LENGTH •'�•' � H-(0 LOADING � 10.83' T,EFF. H 78" C I SEPTIC TANK gg BASEMENT FLOOR �° � - IQ LOADING TO BE SET ON A 1 = �`_ �- L e:�' ELEVATION .,. a:•. •::•• ..,:...;...,•,,.,..;�.• :.,, �,,;.. ► . .,.: 6" CRUSHED STONE 69.2 17 CRUSHED STONE BASE BASE ( ACME DB-3 OR APPROVED EQUAL ? ;�-. -1 MEDIUM SAND MEDIUM SAND SEPTIC TANK SET LEVEL AND TRUE TO GRADE • ,,. IOYR 5/6 2.5Y 6/4 ON 6" CRUSHED STONE BASE ON ( Pro file not to scale I c x 1%� 1 C " C MECHANICALLY COMPACTED NATURAL MATERIAL I ,. 12©" 64,1 120 2 642 OBSERVED GROUND WATER: 42.1 INFILTRATOR DETAIL ADJUSTED GROUND WATER: rJOT TO SCALE PERCOLATION RATE: _S_5_._ MIN,/INCH SOIL CLASS: I EFFLUENT LOADING RATE: 0.74 GPD/SF SOIL EVALUATOR: J. E. LANDERS•-CAULEY CERTIFICATION NUMBER: # 1 WITNESS: DONNA M i BOARD OF HEALTH, TOWN OF BARNSTABLE DESIGN DATA DATE OF TEST: 12/22/99 4 k9 ! a m NUMBER OF BEDROOMS 3 / a G.P.D./ BEDROOM 110 G.P.D. GENERAL NOTES TOTAL DAILY FLOW 330 G.P,D. FLAGGED B.V.W. / GARBAGE ,DISPOSAL N / GVD DATUM. LEACHING REQUIRED 33_0 G.P.D. 1. ELEVATIONS BASED UPON N 4ox2 4zx/ 5 ° '_4 '• LEACHING PROVIDED 463 G.P.D.. 2. ELEVATIONS AND 'LOCATIONS SHOWN ON THIS PLAN w / 0 SEPTIC TANK REQUIRED 1500 GALLONS ARE NOT TO CHANGE WITHOUT WRITTEN APPROVAL ic) / SEPTIC TANK PROVIDED 1500 GALLONS OF THE ENGINEER AND THE TOWN HEALTH AGENT. 1 - J l �, j J SIDEWALL AREA = 200.3 S.F. 3. ALL SYSTEM COMPONENTS ARE TO BE INSTALLED IN . � o � 401 T I C r s �" =n .-- / i BOTTOM AREA 425,I S.F. ACCORDANCE WITH S.E.C. TITLE V AND LOCAL HEAL H 6 o WI 0 "' %9 ��/ �� / / / TOTAL PROVIDED- 625.4 S.F. x 0.74 462.8 G.P.D. RULES AND REGULATIONS. "31,500j! 462,8 G.P.D./TRENCH NC I - 462.8 4. ALL PIPES ARE TO BE CAST IRON OR P.V.C. SCH. 40. G.P.D,/ E H x TRENCHES _ G.P.D. 72 74 5. THE BOARD OF HEALTH AND/OR ENGINEER TO BE 44_ �� r_ �---f� ,�i f / NOTE: EXCAVATE TO EL. OR LOWER AS SOIL NOTIFIED WHEN SYSTEM IS COMPLETELY INSTALLED 4�- _ _ r _ CONDITIONS REQUIRE TO REMOVE ALL TOPSOIL, SUBSOIL, AND READY FOR INSPECTION. �'10 _ DECK CLAY OR OTHER UNSUITABLE MATERIAL BENEATH THE 6, NORTH ARROW IS NOT TO BE USED FOR SOLAR _ __ -- / i 4�1 -__. ____ ---� j j/ - LO_ INLET INVERT OF THE SOIL ABSORPTION SYSTEM FOR ORIENTATION. 52� I8 _� PROPOSED -' A DISTANCE OF 5' MIN., AND BACKFILL WITH CLEAN 5� ��-4-5" / PROPd E 44 N 56 58� 3 ROOM o o' SAND, PER 310CMR 15.255:3. WELLING . - 60 z° ,� /, -�,�/ /� t LOT 2 - ,4�`� j � �+ � 76.0 38 z --- ' / 00 GAL. LOT 28 - S. T NK / N It N 76x0 64 - - i� D-BO 66------ - N I ERE � ' to f o , ., wwl� 1 JTH 06/02/00 MOVE DWELLING LOCATION Lo/ L/ --l� REV BY DATE DESCRIPTION - - -- cn 50. - 75x7 ' Q a 70 N 54 37' 45" E SITE 8 SEWAGE DISPOSAL PLAN 72� 73x2 7,3x7 74k2 74,tC LOT 29 # 27 BOB WHITE RUN BOB V HITE RUN ._� � � � LOCUS `�'� BARNSTABLE, MA° 1 � �r A ? 2a M APPLICANT: WILLIS MICHAELSON ADDRESS: � osc�ssa.�+ o RTE' 473 PINE STREET ' , `` � ' ' CENTERVILLE, MA. 02632 ENGINEER: NORMAN LOCUS MAP --- SCALE: I" ; 000' GROSSMAN, R.P.E.10 MARSH VIEW ROAD ZONING DI5T. FLOOD ZONE i ELEVATION MAP NO. EAST FALMOUTH, MA. RF C --- 508-546-1920 PLAN REFERENCE: MAP SEC PCL LOT HSE SCALE DATE DWN. BY / CK'D BY PLAN NO. SARNST. CNTY. REG. PLAN 8K PG SITE PLAN---SCALE 1" - 30, 24 52 1 # 27 AS NOTED MAY 31 2000 N G ° - 40 . JT / N H SEPTIC SYSTEM PROFILE SOILS LOG & FIRST FLOOR ELEVATION 78.0 FIN. GRADE FIN. GRADE OVER FIN. GRADE OVER FIN, GRADE OVER PERCOLATION TEST TOP of AT HOUSE SEPTIC TANK DIST. BOX SOIL ABSORPTION SYSTEM FOUNDATION 7 _ 75.0 TESL HOLE I TEST HOLE 2 ELEVATION 77.0 a;;;:: 76.0 75.5 0" ELEV. - 74,1 0" ELEV. = 2% MIN GRADE 74.2 R SER S INVERT of o :�o.' 6" OF FIN. GRADE 10„ •,/A LOAM 9 A LOAM FOUNDATION . ::.,-L - ELEVATION _ r Z" MIN. DOUBLE WASHED IY8" I/Z" STONE 72.75 2. �:_;,:_.-,--- :;--=�1= r,----��.--. LOAM LOAM 3„ _. .. . .. IOYR 5/8 �•;+ s a. _ a.:-.rii 391, B IOYR 5/8 32" B 72.50 o > 72.25 72.00 71.63 71.50 I?. ::�: - - _ - - - - ••.�:;:Iv .�., ; - W �_ - °.•�;: 3/4" - 1-1/2 ;: ':.; �.`N •� _ .- 1 -- DOUBLE WASHED STONE -°=. •=►:. GAS BAFFLE ON OUTLET TEE o p �/ 1 69.50 • D ti DIST. BOX/� 4'-0"• 5 S ® 6 25' = 31.25 4'-0" OARSE SAND f J? .3" I �00 GALLON ' IOYR 5/8 Cr ;� 3925' TOT. EFF•LENGTH 10.83' T, EFF. H H-10 LOADING T - 78" CI SEPTIC TANK 16' H - 10 LOADING 1 � L •v •�_ TO BE SET ON A = _ BASEMENT FLOOR ELEVATION '�1 ::.: .;;....,,:r..;...,�,.;..;,.. .,...., •. ,..,. 6" CRUSHED STONE 69.2 _ .4'' 6" -CRUSHED STONE BASE---' BASE ' ( ACME D B-3 O R 4 •I.�.: :. . .;L.iL•`..•:.,,,,;,j :.. :yi...:: -�•. ,.ti. . !%,.•l;r'....rl •-v' l65d'-- IO'-6" APPROVE EQUAL ) l"-T'I MEDIUM SAND MEDIUM SAND r. IOYR 5/6 2,5Y 6/4 SEPTIC TANK SET LEVEL AND TRUE TO GRADE ON 6" CRUSHED STONE BASE ON ( Profile not to- scale MECHANICALLY COMPACTED NATURAL MATERIAL �� I ,.I 12 L C 1 64.1 120" 1 C 2 a 64.2 OBSERVED GROUND WATER: 42.1 INFILTRATOR DETAIL ADJUSTED GROUND WATER: NOT TO SCALE PERCOLATION RATE: <5 MIN./INCH SOIL CLASS: I EFFLUENT LOADING RATE: _0.74 GPD/SF SOIL EVALUATOR: J. E. LANDERS-ZAULEY CERTIFICATION NUMBER: 1 WITNESS: DONNA M 1 BOARD OF HEALTH, TOWN OF BARNSTABLE 1 DESIGN DATA DATE OF TEST: 12/22/99 4 9 NUMBER OF BEDROOMS 3 0 GENERAL NOTES G.P.D./ BEDROOM 110 G.P.D. TOTAL DAILY FLOW 330 G.P.D. GARBAGE DISPOSAL NQ- FLAGGED B:V•W, - I ELEVATIONS BASED UPON NGVD DATUM. 42z1 / e - / �/ LEACHING REQUIRED 3-Q_ G.P.D. ELE 0 S D . 4ox2 5 4 LEACHING PROVIDED 463 G.P.D.. 2. ELEVATIONS AND LOCATIONS SHOWN ON THIS PLAN w i 30 OXCI / SEPTIC TANK REQUIRED 1500 GALLONS ARE NOT TO CHANGE WITHOUT WRITTEN APPROVAL SEPTIC TANK PROVIDED 1500 GALLONS OF THE ENGINEER AND THE TOWN HEALTH AGENT. o / N o � 40�( / / � i L�T I / z C, SIDEWALL AREA = 200,3 S.F. 3. ALL SYSTEM COMPONENTS ARE TO BE INSTALLED IN w 6 _._ _ • / BOTTOM AREA = 425.1 S.F. ACCORDANCE WITH S.E.C. TITLE V AND LOCAL HEALTH pr)M �9 -- / �1500TOTAL PROVIDED- 625.4 S.F, x 0.74 0462.8 G.P.D. RULES AND REGULATIONS. / � _- / 462.8 G.P.D./TRENCH x 1 = 462.8 4. ALL PIPES ARE TO BE CAST IRON OR P.V.C. SCH. 40. � Q cn .. '!__•i � � ,, � p .,' / / 72 TRENCHES G.P,D. 5. THE BOARD OF HEALTH AND/OR ENGINEER TO BE '� _J �/ i l / 74 EXCAVATE TO EL. OR LOWER AS SOIL NOTIFIED WHEN SYSTEM IS COMPLETELY INSTALLED i co NOTE. EXC E 44 fs_r -��/ / CONDITIONS REQUIRE TO REMOVE ALL TOPSOIL, SUBSOIL, AND READY FOR INSPECTION. 4 i�:o /' DECK 7' 3 CLAY OR OTHER UNSUITABLE MATERIAL BENEATH THE 6. NORTH ARROW IS NOT TO 8E USED FOR SOLAR i ORIENTATION. _ in INLET INVERT OF THE SOIL ABSORPTION SYSTEM FOR PROPOSED 44' w A DISTANCE OF 5' MIN,, AND BACKFILL WITH CLEAN ate_ 5 3 DROOM o N SAND, PER 310CMR 15.255:3. N WELLING � 4 60��_ ego �3), � 38, Z LOT 2 % 2; T60"500 AL. +� , LOT 28 II S. T NK •• � I N / N 76x0 64 - �� / / 0-BO 15,+ ss- --- I. fESER E ' t ;f �4,/�, I JTH 06/02/00 MOVE DWELLING LOCATION �nj � - se- - -� torr) ����� REV BY DATE DESCRIPTION N 5e 37' 45" E I ' A• - - / 3� 70 SITE B SEWAGE DISPOSAL PLAN -- 73X2 - ---- --� - 74Xz I All � z LOT 2 # 27 BOB WHITE R U N B O B H I T E RUN � `� Y� �. � LOCUS {f�� � a� Q BARNSTABLE, MA. APPLICANT: WILLIS MICHAELSON ADDRESS: 473 PINE STREET CENTERVILLE, MA, 02632 ENGINEER: NORMAN GROSSMAN, R.P.E. LOCUS MAP --- SCALE: i" = 000' 10 MARSH VIEW ROAD ZONING DIST, FLOOD ZONE ELEVATION MAP N0, EAST FALMOUTH, MA. RF C --- 508-548-1920 PLAN REFERENCE: MAP SEC PCL I LOT HSE SCALE DATE DWN. BY / CK'D BY PLAN NO. BARNST. CNTY. REG. PLAN BK PG SITE PLAN---SCALE 1" = 30' 24 52 1 # 27 AS NOTED MAY 31, 2000 JTH / NG H- 240