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HomeMy WebLinkAbout0067 CONSTANT LANE - Health 67 Constant Lane--- Cotuit P 039 063 YOU WISH TO OPEN A BUSINESS? For Your.Information: Business certificates (cost$30.00 for 4 years). A business certificate ONLY REGISTERS YOUR NAME in town (which you must do by M.G.L.-it does not give you permission to operate.) Business Certificates are available at the Town Clerk's Office, 1"FL., 367 Main Street, Hyannis, MA 02601 (Town Hall) DATE: 0 0/4-/ Fill in please: E,; APPLICANT'S YOUR NAME: C�fR rS7D P/�� R /�7�'.Z�K �✓ BUSINESS YOUR HOME ADDRESS: -/ TELEPHONE # Home Telephone Number S D�� g7 7- 1 NAME OF NEW BUSINESS Y1 t W9 P 0- ,'/1 a e C&j TYPE OF BUSINESS '-f7 IS THIS A HOME OCCUPATION? YES O�— Have you been given approval from the building division? YES NO ADDRESS OF BUSINESS t't� CO�y of ���J2 Grit{a;� ILA., MAP/PARCEL NUMBER 0.2 6 3 15 When starting a new business there are several things you must do in order to be in compliance with the rules and regulations of the Town of Barnstable. This form is intended to assist you in obtaining the information you may need. You MUST GO TO 200 Main St. - [corner of Yarmouth Rd.& Main Street) to make sure you have the appropriate permits and licenses required to legally operate your business in this town. 1. BUILDING COM ISSIO ER'S OFF CE This individu I h e n1nfor ed an per it requirements that pertain to this type of busin&dVST COMPLY WITH HOME- OCCUPATION RUMPS AND l CWLATION& FAIL TO Aut rizeMgnature'** COMPLY MAY HE-SUET IN FIN(W MMENT `. L 2. BOARD SHE TH This individual has Ipeen ' ff,rmed of the permit requirements that pertain to this type of business. Vj [/j MUST%MIPL`ff WITH ALL Authorized Signature** T1=F,l�.i c Rr.. n� COMMENTS: ` 3. CONSUMER AFFAIRS (LICENSING AUTHORITY) This individual has been informed of the licensing requirements that pertain to this type of business. Authorized Signature* COMMENTS: 1 c.. '/ •�� � � �L TOWN OF BARNSTABLE Date: / � TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM NAME OF BUSINESS: l I tV � C BUSINESS LOCATION: d _t OUMNVENTORY MAILING ADDRESS: SZyn e- TOTAL AMOUNT: TELEPHONE NUMBER: t509- CONTACT PERSON: 0 h/j EMERGENCY CONTACT TELEPH NE NUMBER: _ MSDS ON SITE? TYPE OF BUSINESS: Plitt INFORMATION / RECOMMENDATIO S: Fire District: Waste Transportation: Last shipment of hazardous waste: Name of Hauler: Destination: Waste Product: Licensed? Yes No NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws of MA, hazardous material use, storage and disposal of 111 gallons or more a month requires a license from the Public Health Division. LIST OF TOXIC AND HAZARDOUS MATERIALS The Board of Health and the Public Health Division have determined that the following products exhibit toxic or hazardous characteristics and must be registered regardless of volume. Observed / Maximum Observed / Maximum Antifreeze (for gasoline or coolant systems) Al Miscellaneous Corrosive ❑ NEW ❑ USED Cesspool cleaners Automatic transmission fluid Disinfectants Engine and radiator flushes Road salts(Halite) Hydraulic fluid (including brake fluid) Refrigerants iAl Motor Oils Pesticides ❑ NEW ❑ USED (insecticides, herbicides, rodenticides) Gasoline, Jet fuel,Aviation gas Photochemicals (Fixers) Diesel Fuel, kerosene, #2 heating oil ❑ NEW ❑ USED Miscellaneous petroleum products: grease, Photochemicals(Developer) lubricants, gear oil ❑ NEW ❑ USED Al Degreasers for engines and metal Printing ink 4,1 Degreasers for driveways&garages Wood preservatives (creosote) yy Caulk/Grout I Swimming pool chlorine Battery acid (electrolyte)/Batteries Lye or caustic soda dz Rustproofers Miscellaneous Combustible Car wash detergents Leather dyes Car waxes and polishes Fertilizers az Asphalt&roofing tar PCB's Paints, varnishes, stains, dyes Other chlorinated hydrocarbons, Lacquer thinners (including carbon tetrachloride) ❑ NEW ❑ USED Any other products with "poison" labels (including chloroform, formaldehyde, aint&varnish removers, deglossers hydrochloric acid, other acids) Miscellaneous. Flammables Other products not listed which you feel Floor&furniture strippers may be toxic or hazardous (please list): Metal polishes / Laundry soil &stain removers (including bleach) Spot removers&cleaning fluids f'lJ (dry cleaners) Other cleaning solvents Bug and tar removers Windshield wash WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS Applicant's Signature Staff's Initials Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments V.vy 67 Constant Ln Property Address - - T�6le- a t _J�Q5_r ld I a 2—oad Goh i I ►' IA 02635 Owner's Name Cotuit MA 02635 8/11/09 Cityrrown State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. A. General Information 1. Inspector: Frank Nunes III Name of Inspector saa Company Name 25 Deer Ridge Rd Company Address Mashpee MA 02649 Cityrrown State Zip Code 508.272.6433 .Telephone 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. I am a DEP approved system inspector pursuant to Section 16.340 of Title 5(310 CMR 15.000).The system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority 8/11/09 InspeWs Signature Date The system inspector shall submit a 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. ****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. Commonwealth of Massachusetts Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form-Not for Voluntary Assessments ,.' 67 Constant Ln Property Address Owner's Name Cotuit MA 02635 8/11/09 Cityfrown State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: 1 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: Pumping suggested every 3 yrs to prolong the life of the system 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 0 obstruction is removed Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments '< 67 Constant Ln Property Address Owner's Name Cotuit MA 02635 8/11/09 Cityrrown 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: 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 %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. i . Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments y< 67 Constant Ln Property Address Owners Name Cotuit MA 02635 8/11/09 Cityfrown State Zip Code Date of Inspection B. Certification (cont.) D) System Failure Criteria Applicable to All Systems(cont.): Yes No ❑ ® 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 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 serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® 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. 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 ❑ ❑ 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. I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments '< 67 Constant Ln Property Address Owner's Name Cotuit MA 02635 8/11/09 Cityfrown 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 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 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)] Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 67 Constant Ln Property Address Owner's Name Cotuit MA 02635 8/11/09 Cityfrown State Zip Code Date of Inspection D. System Information Residential Flow Conditions: Number of bedrooms(design): 3 Number of bedrooms(actual): unk DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 Number of current residents: 0 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system?[if yes separate inspection required) ❑ Yes ® No Laundry system inspected? ® Yes ❑ No Seasonal use? ❑ Yes ® No Water meter readings, if available(last 2 years usage(gpd)): Sump pump? ❑ Yes ® No Last date of occupancy: Vacant approx. 1 yr per realtor Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: Last date of occupancy/use: Date Other(describe): I , Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments yt 67 Constant Ln Property Address Owner's Name Cotuit MA 02635 8/11/09 CitylTown State Zip Code Date of Inspection D. System Information (cont.) General Information Pumping Records: Source of information: 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 ❑ 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)and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): Approximate age of all components, date installed (if known)and source of information: 1999 per BOH file Were sewage odors detected when arriving at the site? ❑ Yes 0 No Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments yY 67 Constant Ln Property Address Owner's Name Cotuit MA 02635 8/11/09 City/Town State Zip Code Date of Inspection D. System Information (cont.) Building Sewer(locate on site plan): Depth below grade: 2 feet Material of construction: ❑cast iron ®40 PVC ❑other(explain): Distance from private water supply well or suction line: >10' feet Comments(on condition of joints, venting, evidence of leakage, etc.): Septic Tank(locate on site plan): Depth below grade: 18"feet Material of construction: ®concrete ❑ metal ❑fiberglass ❑ polyethylene ❑other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance?(attach a copy of certificate) ❑ Yes ❑ No -------------------------------------------------------------------------------------------------------------------------- Dimensions: 1500g Sludge depth: 1" Distance from top of sludge to bottom of outlet tee or baffle >12 Scum thickness 1/2" Distance from top of scum to top of outlet tee or baffle >2of Distance from bottom of scum to bottom of outlet tee or baffle >2It How were dimensions determined? measured Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments �M 67 Constant Ln Property Address Owner's Name Cotuit MA 02635 8/11/09 City/Town 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 alarm and float switches, etc.): *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 level w/the bottom of the pipe Comments(note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): D-Box is 2'6"below grade and in good condition Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 67 Constant Ln Property Address Owner's Name Cotuit MA 02635 8/11/09 Cityfrown State Zip Code Date of Inspection D. System Information (cont.) 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. ^ry -S7 C- �{b 50 C- 3� �3� i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 67 Constant Ln Property Address Owner's Name Cotuit MA 02635 8/11/09 City/Town State Zip Code Date of Inspection D. System Information (cont.) 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 number: 2 ❑ 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.): Chambers are 3'below grade and dry at this time. No evidence of prior back ups r, Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 67 Constant Ln Property Address Owner's Name Cotuit MA 02635 8/11/09 Cityfrown State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to high ground water. feet 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: 1999 NGW at 12' 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: You must describe how you established the high ground water elevation: see above � G ILI CA r 4t LIZ CQ - �- --- --------- D D LOCATION I..117`'' SEWAGE # VILLAGE IZ' Mb1J ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE.NO. A0, 4 5 eX&,4v,41`%�l SEPTIC TANK CAPACITY LEACHING FACILITY: (type) ` CtJ .(size) l3 X NO.OF BEDROOMS 3 BUILDER OR OWNER LV/ ///" FA1" � i Jn PERMTTDATE:M4L//3 K'E 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 f cili Feet Furnished by t2at',.1 r � � L36 , 193�7 s No. L r Z V rG� FEE /Q Q COMMONWEALTH OF MASSACHUSETTS Board of Health, C-F_ MA. APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT Application for a Permit to Construct(JrRepairO Upgrade( Abandon( - YComplete System ❑Individual Components Location �© � Owner's Name (—U M 2R Map/Parcel# ?� �-3 Address54 p t,)-' 09AUL, MAISUMCMh Lot# 39 Telephone# 4177_ p [,5(D Installer's Name Designer's Name AN XV r— Address Address f"(2ST1 viS Telephone# Telephone# Type of Building Lot Size ZS,o oO sq.ft. Dwelling-No.of Bedrooms Garbage grinder (�y Other-Type of Building No.of persons Showers ( ),Cafeteria( ) Other Fixtures Design Flow (min.required) 3�U gpd Calculated design flow 138 Design flow provided 3-53 gpd Plan: Date A,411/ (3,199 9 Number of sheets Revision Date Title 5 l a PL-4w ®Flmilir•s) ro?- k-A t_t..l V Y" f'1AeQ-c r0 G'TCtJ Description ofSoil(s) 5yN3>,/1,Z6Ah11G9 `d A21SF—��5c>Yyij- Soil Evaluator Form No. Name of Soil Evaluator& (fd,A rn Date of Evaluation 5 `z, DESCRIPTION OF REPAIRS OR ALTERATIONS W<.-.F The undersigned agrees to install the above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and further agre o not t p ce a tern in operation until a Certificate of ompli ce has been issued by the Board of Health. Signed Date49, Inspections ` Y ica No: COMMONWEALTH OF MASSAC14USETTS Board of Health, $A'E!131'�LF. MA. APPLICATION FOP, DISPOSAL SYSUM CONSTRUCRON PERMIT J � Application for a Permit to Construct(/)'RepairO Upgrade( O L�J Abandon Complete System ❑Individual Components Location �' p� -�A Owner's Name LL1 M 22.1 N) l7 Map/Parcel# A. 3 LD 3 Address o ff IJ Lot# �j� Telephone# 4j7?_ p (15-() Installer's Name �jn Q Designer's Name SV Vc Address Address U 5 T �IA AjrnJL_4_Ssro S r Telephone# Telephone# G, _ O O eJ 5- Type of Building Lot Size -Z5,00Q sq.ft. Dwelling-No.of Bedrooms 3 Garbage grinder Sj1J Other-Type of Building No.of persons Showers ( ),Cafeteria ( ) Other Fixtures Design Flow (min.required) 35U gpd Calculated design flow J Design flow provided gpd Plan: Date /",/ f3,19Q 9 Number of sheets �`�-' Revision Date Title 51 i c P1_4w of i-aw D. r%6 9- --Jk t.,.V f A fa\Z Q t►�:G T�tJ Description of Soil(s) 54tiD COIYozG%�--- /d4A r2S E,. , :�otM S Soil Evaluator Form No. Name of Soil Evaluator 0/WA/n Date of Evaluation _S Rr 91 w DESCRIPTION OF REPAIRS OR ALTERATIONS'} ti 1 The undersigned agrees to install the above described Individual,Sewage Disposal System in accordance with the provisions of TITLE 5 and further agrees o not t pp�ce a tem in operation until a Certificate of om li ce has been issued by the Board of Health. Signed �s-�/>tS4 C - 6,44-�, Date Inspections rt No. .� _�`�� r{ 'L_.®l�lll�ll®N V'V'�1LT� OF 1`�llASSA'L.�t1t�1JSlC:TTS FEE I t � � �^ Board of Health, MA. CERTIFICATE Of COMPLIANCE IANCE Description of Work: ❑Individual Component(s) O"Complete System The undersigned hereby certify that the Sewage Disposal ystem; Constructed ('),Repaired ( ),Upgraded ( ),Abandoned ( ) by: / - �'. t .1� li C��- Cj at has been install d in acco a with the provisions of 310 CMR 15.00 (Title 5) and the approved design plans/as-built plans relating to application No. ✓ dated Approved Design Flow (gpd) 'InstallerI t r �� kLDesigner: Inspector: ,t 'Y)/Yl,4 N� rf FYI,m ate: 64 The issuance of this permit shall not be construed as a guarantee that the system will`function as designed. / No. 19 - 2.O / FEE COMMONWEALTH Of MASSAC14USETTS Board of Health, 1AeWS1 t'GL-E_ MA. DISPOSAL SYSKM CONSTRUCTION PERMIT Permission is hereby granted to; Construct( Repair( ) Upgrade( ) Abandon( ) an individual sewage disposal system at L:C ? _--�,9 CznS�,+ L-ne as described in the application for i Disposal System Construction Permit No. 9� �� dated 5' y Provided: Construction shall be completed 'thin ithree years of the date of th' rrrl I oeal conditions must be met. qqForm 1255 Rev.5/96 A.M.Sulkin Co.Boston,MA Date �� Board of Health # J r- COMMONWEALTH OF MASSACHUSETTS d EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS a y d DEPARTMENT OF ENVIRONMENTAL PROTECTION y� y�T •1 SV O. [,:)ARr ski GEl., 6(S TITLE 5 --- OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 67 Constant Lane Cotuit MA 02635 RECEIVED Owner's Name: Shabbir Hussein Owner's Address: Same DEC 0 12004 Date of Inspection: October 26,2004 TOWN OF DEPT. Name of Inspector: PATRICK M. O'CONNELL 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 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. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: `,%tttt1ttrrr111 �H OF X Passes Conditionally Passes O •'•yG Needs Further Evaluation by the Local Approving Authority TRI :• Fails s 10' E Lco Inspector's Signatures -rv�_. bc,,,zS,4 Date: 10/26/04 '%, o.• ' NSP�G��Q�`• The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of 1l��ltttionttt10�� 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: Leaching chambers had no standing water and have never had more than 2"standing water.Tank had water only,not in need of pumping at this time. ****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 I Page 2 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 67 Constant Lane,Cotuit Owner: Shabbir Hussein Date of Inspection: October 26,2004 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 system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed ND explain: T41.;1ncnArtinn 17nrm f,ii ci)nnn 2 Page 3 of I 1 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 67 Constant Lane,Cotuit Owner: Shabbir Hussein Date of Inspection: October 26,2004 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 su_rface 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: Tit1P; inennrt:nn Rnrm 4/1 4;1')nnn 3 Page 4 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 67 Constant Lane,Cotuit Owner: Shabbir Hussein Date of Inspection: October 26,2004 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 ''/z day flow —X— Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped _X_ Any portion of the SAS,cesspool or privy is below high ground water elevation. —X— Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. X Any portion of a cesspool or privy 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 form.) _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—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. Titles G Tnenortinn P-4/1 snnnn 4 Page 5 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 67 Constant Lane,Cotuit Owner: Shabbir Hussein Date of Inspection: October 26,2004 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)] Title S T.o—t;— P—4ii vinnn 5 Page 6 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 67 Constant Lane,Cotuit Owner: Shabbir Hussein Date of Inspection: October 26,2004 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: 0 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 incl irrigation: 351,000 gal.=480 gpd. Sump pump(yes or no): No Last date of occupancy: Three weeks prior to inspection. COMMERCIALANDUSTRIAL Type of establishment: Design flow(based on 310 CMR 15.203): gpd Basis of design flow(seats/persons/sgft,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: Tank pumped 8 months prior to inspection. 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 _X_Septic tank,distribution box,soil absorption system _Single cesspool _Overflow cesspool Privy _Shared system(yes or no)(if yes, attach previous inspection records, if any) _Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) _Tight tank _Attach a copy of the DEP approval Other(describe): Approximate age of all components,date installed(if known)and source of information: Compliance date: 6/30/99 Were sewage odors detected when arriving at the site(yes or no): No Titles C Inennrtinn Fnrm All si')nnn 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: 67 Constant Lane,Cotuit Owner: Shabbir Hussein Date of Inspection: October 26,2004 BUILDING SEWER: XX (locate on site plan) Depth below grade: 1' Materials of construction:_cast iron _X_40 PVC_other(explain): Distance from private water supply well or suction line: 10' Comments(on condition of joints,venting,evidence of leakage,etc.): SEPTIC TANK: XX (locate on site plan) Depth below grade: 1' Material of construction:_X_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: 0" Distance from top of sludge to bottom of outlet tee or baffle: - Scum thickness: 0" Distance from top of scum to top of outlet tee or baffle: - Distance from bottom of scum to bottom of outlet tee or baffle: - 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.): Tank has water only,no sludge or scum lavers. Liquid level at bottom of outlet pipe.Tees intact. 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.): Titles G incnPPtinn Pnr 411 Si'71)1)0 7 f j Page 8 of I 1 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 67 Constant Lane,Cotuit Owner: Shabbir Hussein Date of Inspection: October 26,2004 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: 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.): Box set level,no solids or high stains aresent. 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.): Tifla G Tncnarfinn Fnrm All 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: 67 Constant Lane,Cotuit Owner: Shabbir Hussein Date of Inspection: October 26,2004 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: Two 500 gal drywells. 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.): Observed no standing water with a stain line 2" from bottom of chambers. 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 S T"anarf;— P—m Ail;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: 67 Constant Lane,Cotuit Owner: Shabbir Hussein Date of Inspection: October 26,2004 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. Constant Lane 1n�5 3Z �y 1500 gal tank Two 500 gal drywells Tit1P C Tnonontinn Rnr 411 VIAM1 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: 67 Constant Lane,Cotuit Owner: Shabbir Hussein Date of Inspection: October 26,2004 SITE EXAM Slope None Surface water None Check cellar Dry Shallow wells None Estimated depth to ground water: More than 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: Checked with local excavators, installers-(attach documentation) _X_Accessed USGS database-explain: USGS topo map and town GIS. You must describe how you established the high ground water elevation: Town groundwater contour map shows water below el.30 and topo map shows property above el.60. Tifla G Tncnurtinn l:nrm 611 ci�nnn 1 1 TOWN OF BARNSTABLE Ur,ATION Cf C.�P1 S �✓lfi n• SEWAGE VILLAGE �"rUa� ASSESSOR'S MAP & LO—Vaq 00 INSTALLER'S NAME&PHONE NO. c.+rc k- 000A/1- l SEPTIC TANK CAPACITY lS� ?-- 0 LEACHING FACU rN: (type) Z / 5cb QcJ TlrIu-9115 (size) Q>V ZS NO. OF BEDROOMS 3 BUILDER OR S�NA ww r- ?ERMTTDATE: DATE.':KiMe On I0I24104 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 L0 10 _ - z o 0 0 , O)z z ,6-Z q 1 COMMONWEALTH OF MASSACHUSETTS (� .a EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS V r � � DEPARTMENT OF ENVIRONMENTAL PROTECTION Darren Meyer,R.S.,Certified Title V Inspector,508-362-2922 TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FOR ��CEIV�'� PART A CERTIFICATION SEP 1 7 `2001 Property Address:_67 Constant Lane_ _Cotuit,MA TOWN AL BADEP-r. LE HEALTH DEFT. Owner's Name: Rajesh Mishra Owner's Address: 67 Constant Lane _Cotuit,MA Date of Inspection:_September 9,2001 Name of Inspector. (please print) Darren Mever Company Name: n/a Mailing Address: 43 Vine Street Duxburv,MA 02332 Telephone Number: 508-362-2922 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of the inspection.The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems.I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: X Passes Conditionally Passes Needs Further Evaluation by the Local Approving Authority Fails �./� W Date: /0/ Inspector's Signature.. The system inspector shall submit a copy of this inspection rt to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection.If the sy ern 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 recommend pumping of septic tank every three to four years for proper maintenance. ****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: 67 Constant Lane _Cotuit,MA Owner: Rajesh Mishra Date of Inspection:_September 9,2001 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: _YES_ 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: Leaching not uncovered due to age of system(only two years),and no sign of hydraulic failure in d-boz, and area over leaching being landscaped which would cause unnecessary financial burden. 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:Distribution box and cover need replacement with riser to grade,also PVC tee needs to be placed on outlet pipe in Septic Tank 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: Title 5 Inspection Form 6/15/2000 2 i Page 3 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address:_67 Constant Lane _Cotuit,MA Owner: Rajesh Mishra Date of Inspection:_September 9,2001 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 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. 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 5 Inspection Form 6/15/2000 3 Page 4 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address:_67 Constant Lane _Cotuit,MA Owner: Rajesh Mishra Date of Inspection:_September 9,2001 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 _ n/a Liquid depth in cesspool is less than 6"below invert or available volume is less than%2 day flow _X_ Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped _ X_ Any portion of the SAS,cesspool or privy is below high ground water elevation. n/a Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. n/a Any portion of a cesspool or privy is within a Zone 1 of a public well. _ n/a Any portion of a cesspool or privy is within 50 feet of a private water supply well. n/a 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.] 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 15,006 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 11 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 5 Inspection Form 6/15/2000 4 Page 5 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address:�67 Constant Lane _Cotuit,MA Owner: Rajesh Mishra Date of Inspection:_September 9,2001 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. _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) P 10 CMR 15.302(3)(b)] Title 5 Inspection Form 6/15/2000 5 Page 6 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address:_67 Constant Lane _Cotuit,MA Owner: Rajesh Mishra Date of Inspection:_September 9,2001 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design):_3_ Number of bedrooms(actual):_3_ DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms):_330_ Number of current residents: 3 Does residence have a garbage grinder(yes or no):_no Is laundry on a separate sewage system(yes or no):_no [if yes separate inspection required] Laundry system inspected(yes or no): n/a Seasonal use: (yes or no): no Water meter readings,if available(last 2 years usage(gpd)): 1999: 5,000 gal 2000: 140,000 gal Sump pump(yes or no): no Last date of occupancy: current COMMERCIALANDUSTRIAL Type of establishment: Design flow(based on 310 CMR 15.203): gpd Basis of design flow(seats/persons/sgft,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: Was system pumped as part of the inspection(yes or no):_no_ If yes,volume pumped: --How was quantity pumped determined? Reason for pumping: TYPE OF SYSTEM _X_Septic tank, 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 T Other(describe): Approximate age of all components,date installed(if known)and source of information: 2 years—System installed in August of 1999. Were sewage odors detected when arriving at the site(yes or no):—no— Title 5 Inspection Form 6/15/2000 6 I Page 7 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 67 Constant Lane _Cotuit,MA Owner: Rajesh Mishra Date of Inspection:_September 9,2001 BUILDING SEWER(locate on site plan) Depth below grade:_approx. 36" 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.): Joints and piping are in good conition,no sign of hydraulic failure. SEPTIC TANK: X (locate on site plan) Depth below grade: 22" Material of construction: X_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:_Typical 1,500 gallon tank(I I'Lx 6'W x 5'D) Sludge depth: 8" Distance from top of sludge to bottom of outlet tee or bale: 18" Scum thickness: 3" Distance from top of scum to top of outlet tee or baffle: 7" Distance from bottom of scum to bottom of outlet tee or baffle:_10" How were dimensions determined:_field measurements—tape measure Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): PVC tee's are in good condition,tank in good condition,no sign of hydraulic failure,liquid levels at bottom of outlet pipe,no sign of tank leakage. GREASE TRAP:,n/a (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.): Title 5 Inspection Form 6/15/2000 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: 67 Constant Lane _Cotuit,MA Owner: Rajesh Mishra Date of Inspection:_September 9,2001 TIGHT or HOLDING TANK:_n/a (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: X (if present must be opened)(locate on site plan) Depth of liquid level above outlet invert:_n/a 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.): d-box is level and in good condition,liquid level is equal and at bottom of outlet pipes,no solids carryover,no sign of leakage. PUMP CHAMBER:_n/a (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.): Title 5 Inspection Form 6/15/2000 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:_67 Constant Lane _Cotuit,MA Owner: Rajesh Mishra Date of Inspection:_September 9,2001 SOIL ABSORPTION SYSTEM(SAS):_X (locate on site plan,excavation not required) If SAS not located explain why: Leaching not uncovered due to age of system(only 2 years old),no sign of hydraulic failure.in d-box,and area over leaching being landscaped which would cause undue financial burden. Type leaching pits,number: _X—leaching chambers,number: 2_ 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:): CESSPOOLS:_n/a (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:_n/a (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 5 Inspection Form 6/15/2000 9 Page 10 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address:_67 Constant Lane _Cotuit,MA Owner: Rajesh Mishra Date of Inspection:_September 9,2001 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. I i S J Title 5 Inspection Form 6/15/2000 10 Page 11 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address:_67 Constant Lane . _Cotuit,MA Owner: Rajesh Mishra Date of Inspection:_September 9,2001 SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water_>30_feet-BSG(below surface grade) 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 Bard of Health-explain: Checked with local excavators,installers-(attach documentation) X Accessed USGS database-explain: You must describe how yok established the high ground water elevation: Observed site characteristics,Utilized USGS maps and charts. Title 5 Inspection Form 6/15/2000 l l TU �} L4'f'ATION�� 3� � dJ� ��4�� Ly1, SEWAGE # "' C�8l VILLAGE111&_' /'/_ 13s41P�'JS���QJ��ASSESSOR'S MAP& LOTh�Q0 INSTALLER'S NAME&PHONE NO.1-204 S r1 U,41VM!� 4/7 7 a 1 7'7 SEPTIC TANK CAPACITY ISW LEACHING FACILITY: (type) .(size) 13 0� , NO.OF BEDROOMS 3 LUILDER OR OWNER 171 1r F4rr PERMTTDATE:M)94//3 STIF 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 f cili Feet Furnished by¢ R ` r k / 141 7` - � ' 3 46 ' Town of Barnstable Department of health,Safety, and Environmental Services Plibi:c Health Divis:^n Di to 367 Main Street,Hyannis MA 02601 It t anaxar NA rA / '�� Date Scheduled Time Fee Pd. ( O 0 IqlAf Soil SuitabZi�'oe5a*+J. tey Assessment jo:- Sefva�e Disposal Performed By: �V n� Witnessed By:_'Y V�� Y3_O44 l9 LOCATION & GENERAL INFORMATION Location Address C(�Y�SC�ti� Cart✓ Owner's Name l 1" Co „r M R Address 6 �o h v.� Assessor's Map/Parcel: Engineer's Name nAi` � r i�A-r1�4 cc Nj(ee NEW CONSTRUCTION 2. REPAIR Telephone M Land Use tA4A . Slopes(%) b 3 Y/1, Surface Stones VAJ r% Distances from: ,Open Water.Body AVAL—ft Possible Wet Area_AoLft Drinking Water Well Drainage Way _l Property Line 2 tt Other R SKETCH: (Street name,dimensions of lot,exact loc^tions of!est holes&perc test;,local:.!wetlands in proximity to holes) _ o l�lA-7�� Z J-F I T 3s -,_0 30 EL r - /0, I Z,S' ky G a A13 i ?" Z_/_7.Aj IMft5,� �- Parent material(geologic) i ✓ Depth to Bedrock De,in t0 Gl OUnd'.:�t. Sta t(cu;'� i iii f N, / "d _ " •�•• •! __ S �F E G ' 4 -- w"[r 3 G 1N4 vO Sir Estimated Seasonal High Groundwater o i/P --3 . DETERMINATION FOR SE,�SONAL HIGH WATE TABLE Method Used: Depth Observed standing in ohs.hole: _in. Depth to soil mottles: in. Depth to weeping from side of ohs.hole: in. Groundwater Adjustment ft. Index Well# Reading Date: Index Well level Adj.factor__ Adj.Groundwater Level_ .'ERCO_ATION i EST Uate 5�2#JTime Observation I ?j hole k Time at 9" Depth of Perc 3�i��� ,11�' Time at 6" Start Pre-soak Time Q 1 T Time(9"-6") End Pre-soak Rate Min./Inch L 7 Site Suitability Assessment: Site Passed._..2�_ Site Failed: Additional Testing Needed(Y/N) Original: Public Health Division Obserlation Hole Data'rj Be Co npleted on Copy: Applicant DEEP OBSERVATION HOLE LOG Hole # Depth from Soil Horizon Soil Texture Soil Color Soil'` Other Surface(in.) (USDA) (Munsell) Mottling Structure,Stones,Boulderes. % 0-3 0 L� S�/D /o ,t� z s vL (A)�v'G 3 /9,0 AMP /6 2 IT 7 1 D lt/o LA) 47e� &-A) G DEEP OBSERVATION HOLE LOG Hole # 2 Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling Structure,Stones,Boulderes. . %Grave h tj DEEP OBSERVATION HOLE LOG Hole # Dept from Soil Ilurizon Soil Tcxture Soil Color Soil Other Surf" (in.) (USDA) (Munsell) Mottling Structure,St s,Boulderes. 0 DEEP OBSER "'.:)N HOLE T G Hole # l;cpt;t ! Soil t^ri C• t Sail ''c>a:re So Color I Soil Other Surface(in.) (l'S ,(�teaseil) P.'ottling (Structure,Stones,Bouldcres. LConsistency,o f DEEP BSERVATION HOLE LOG Hole # Depth from Soil F orizon Soil'vexture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottlin (Structure,Stones,Boulderes. ( sistency.%Gravel) r ,. ' E' I CERTIFY THAT. THIS SURVEY AND PLAN: WERE.'MADE BARNSTABL HSE_ - IN ACCORDANCE WITH THE PROCEDURAL AhD TECHNICAL STANDARDS FOR THE PRACTICE OF LAND SURVEYING IN THE / MMONWEALTH OF MASSACHUSETTS. LOT 40 PA UL A. MERITHEW, .L.S. AT ob N59%2255"W 000. 00' 6 LOT 39 � ASSESSORS LOT 03 \ �- � LOCUS AREA = 25, 000 S. F. / I Q)_ —1 LOCUS MAP BENCHMARK I DEED REF. CTF.117031 ~ �I.SOF 100 0r��DJ O ASSESSORS MAP: 39, LOT 63 Q W 22 0' PLAN REF. 22824 D SH.3 �� w WAY o 0� I I RES. ZONE: RF» �. DRIVE' \ GAR FLOOD ZONE: C o W q ti - � COMMUNITY PANEL 250001 0021 D LOT DA TED: 7102192 wl ~ MY O � I 45 �C o 000 10.42. , I 49. 0 g p I SITE PLAN OF LAND o �� � — w v � �o LOCATED AT C� � 15.3' 9we 13. 6 3 3' N w LOT 39, CONSTANT LANE 'p" 5 3' o (COTUIT)BARNSTABLE, MASS. PREPARED FOR. WILLIAM FARRINGTON 12. �� MA Y 13, 1999 �� - M OFM ®. N N59;2255"W 200. 00' gssq - � ��. ; . UTILITIES � � ' o� cy \'°�► �•�i�nt� I �� WILLIAM rtP*+ LIEBE39?1 ti YAWEE SURVEY CONSUL TAN`TS`'"" LOT 38 � No. 'L397; �9 GRAPHIC SC Q' T���� P. O. BOX 265 c9 ALE `` �oNAL ENG UNIT 1, 408 INDUSTRY ROAD 20 0 10 20 46 so MARSTONS MILLS, MA. 02648 PH.(508)428-0055 — FAX(508)420-5553 _ ( IN FEET ) i inch 20 ft. ✓OB NO. 51906 DCB ' EL. =_102__ TOP OF FOUNDATION 20' MIN. —10' MIN. CONCRETE COVERS �i - 2"LA YER OF 4" SCHEDULE 40 P. V.C. WASHED S717NE 4. EL= 101.5 EL= 101 MIN. PITCH 1/8 PER FT. EL=101 4" PVC PIPE , ♦ / ((OR IsTQUAL,l MINIMUdf / / / ♦ / / / / / ♦ / / 70 7'I7CH 1/4 PER FT CLEAN SAND 3 " i FLOW LINE 8 15' MAX EL=9 . 1 10" 14" INVERT INVERT MIN. e�u� ° p p p p p p p o°m� °o EL.= 98.75 - GAS I�'�'�' EL.= 9_8.4 INVERT ° ° BAFFLE EL.= 99.2 EL °°= 9_8.15 ° ° p p p p p p p ° Cb INVERT LNG ° °�° EL= 96 EL.= 9e_55 _ DISTRIBUTION EL. 9e 4.O' 4.0' (TO BE PLACED ON FIRM BASE) BOA' 12.8' X 25' X 2' TRENCH IroRA(AYON MECHANICALLY COMPACTED OR 6" OF MUM 70 BE WATER TESTED 1,500 GAL. IF MORE THAN ONE OUTLET 'tq SEPTIC TANK 7V BE PLACED ON s S710NE SOIL ABSORBTION (H-10 LOADING) S j (STE 1�` /SAS) PROFILE OF BOTMM OF TEST HOLE ELEV= 91.o SEWAGE DISPOSAL SYSTEM NO OBSERVED WATER NOT TO SCALE OBSERVATION HOLE I ELEV.=_101 OBSERVATION HOLE 2 ELEV=_101 _ PERCOLATION RATE �_ MIN./ INCH AT jE:F 8� INCHES PERCOLATION RATE �_ MIN./ INCH AT j fle INCHES DEPTH HOR0 TEXTURE COLOR MOTT. OTHER DEPTH HORIZ TEXTURE COLOR M07T. OTHER ¢ 0-3" O/E SANDY 10YR3/2 NONE WAAEU0-4" O/E SANDY 10YR3/2 NONE 3'-19" B SAND 10YR5/8 NONE COARSE 4"-22" B SAND IOYR518 NONE COARSE 9"--120 C SAND 10YR6/3 NONE OME F 2'-120 C SAND 10YR6/3 NONE SOME PEBBLES PEBBLES GENERAL NOTES NO GROUNDWATER ENCOUNTERED NO GROUNDWATER ENCOUNTERED 1) ALL WORKMANSHIP AND MATERIALS SHALL CONFORM TO D.E.P. TITLE 5 AND THE TOWN OF B_A_RNST_A_B_LE___ RULES AND REGULATIONS FOR THE SUBSURFACE DISPOSAL OF SEWAGE. DATE OF SOIL TEST 5/12/99 2) ONE COVER ON SEPTIC TANK SHALL BE BRO UCHT- TO WITHIN 6" OF FINISHED CRADE, OTHERS WITHIN 12" WITNESSED BY: DONNA MOIRIANDI BBOH 3) ALL COMPONENTS OF THE SANITARY SYSTEM SHALL BE CAPABLE OF WILL[AM LIEBERMAN WITHSTANDING H-10 LOADING UNLESS THEY ARE UNDER OR WITHIN SOIL TEST DONE BY SOIL EVALUATOR DESIGN CALCULA TIONS: 10 FT. OF DRIVES OR PARKING AREAS. H-20 LOADING SHALL BE NUMBER OF BEDROOMS . 3 USED UNDER OR WITHIN 10 FT. OF DRIVES OR PARKING AREAS 4) ANY MASONARY UNITS USED TO BRING COVERS TO CRADE SHALL GARBAGE DISPOSAL . . . . . . . . . NO BE MORTERED IN PLACE. INSTALL TWO(2) H-10 ACME TOTAL ESTIMATED FLOW 5) NO DETERMINATION HAS BEEN MADE AS T19 COMPLIANCE WITH 500 GALLON LEACHING ( _110 _GAL/BR/DAY x --!I- BR) 330 GAL/DAY DEEDED OR ZONING REGULATIONS. OWNER/APPLICANT IS 719 CHAMBERS WITH FOUR FE,E' REQUIRED SEPTIC TANK CAPACITY 1500 GAL OBTAIN SUCH DETERMINATION FROM APPROPRIATE A UTHORITY. �' i 6) UTILITIES SHOWN ARE APPROXIMATE ONLY, EXCAVATION CONTRAC719R STONE SIDES AND DS SOIL CLASSIFICATION . 1 IS TO CALL DIG- SAFE AT 1-800-322-4844 AT LEAST 72 HOURS 25 X 12.B X 2 j OF 4f S' DESIGN PERCOLATION RATE . . . . . < 5 MIN./IN. PRIOR TO COMMENCING WORK ON SITE. z� s90 EFFLUENT LOADING RATE . 74 CAL�DA Y�S.F 7) CONTRACTOR IS TO VERIFY GRADES AND ELEVATIONS AS WELL AS �° tiN LEACHING CAPACITY (AREA X RATE) 338 GALIDAY SITE CONDITIONS PRIOR TO COMMENCING WORK ON SITE. WILLIAM ^` ' 8) PARCEL IS IN FLOOD ZONE___"C" LIEBERMAN y RESERVE LEACHING CAPACITY 338 GAL/DAY 9) LOT IS SHOWN ON ASSESSORS MAP _39_ AS PARCEL 0. z3y" o c,sTE��v (25 X 12.8 X . 74)-f(254-25+12.8f12.8 X . 74 X 2) �ss�°MAL tiNG� SHEET 2 OF 2 JOB NUMBER_ 51906 61 HSE = 1 CERTIFY THAT THIS SURVEY AND PLAN WERE MADE BARNSTABLE IN ACCORDANCE WITH THE PROCEDURAL AND TECHNICAL - - - - - - - - - - STANDARDS FOR THE PRACTICE OF LAND SURVEYING IN � A0. 9 G� � THE MMONWEALTH OF MASSACHUSETTS. � LOT 40 PA UL A. MERITHEW, .L.S. bAT N59%2255"W 200. 00' LOT 39 ASSESSORS LOT 63 LOCUS AREA = 25, 000 S. F / I p F LOCUS MAP to o I \ -4 BENCHMARK l DEED REF. CTF.117031 i Q�~ 9t7P OF I�AT R V4 (E I o ASSESSORS MAP: 39, LOT 63 LEV.=100.OASSUJIBD) o W � 22 0. PLAN REF. 2282� D SH �� W WAY o O I I RES. ZONE.• RF�. o DRIVE \ CAR q FLOOD ZONE: C COMMUNITY PANEL w l 'N I 250001 0021 D ° 12.8' o /�y LOT DATED.- 7102192 0 � 'w � 45 000 Z I I 10.4' Q��� I 0 I o _ w �, �, SITE PLAN OF LAND I LOCA TED A T. 1 r 33 13. 6 ' ' W LOT 39, CONSTANT LANE I yr 5.3' �o (CO TUIT)BARNSTABLE, MASS. I c f PREPARED FOR: WILLIAM FARRINGTON 12 �' 0� MAY 13, 1999 'K CbI-A OF N o >, - 200. 00' Mess No6 32 59 22 55 W _ UTILITIES —� o� gcyG ��, �•�,;�=,E�°'' I C9 N Vs/p r _o g WILLIAM �i -REl! LIEBERMAN y yANKEE SUR I/EY CONSUL TANTS LOT 38 � A ,p No. 'L397 i O � �g GRAPHIC SCALE � �G'�T��� � f'• O. BOX 265 c9 �S oNAL ENG� UNIT 1, 408 INDUSTRY ROAD ` zo o 10 20 '° 80 PH.(508)428 00055 I L L SFA X(508)420—5553 ( IN FEET ) 1 inch 20 ft JOB NO. 51906 DCB _ _ _ EL. =_102__ TOP OF FV UNDATlON 20' MIN. f--10' MIN. CONCRETE COVERS 2 L A YER OF ` 1/B" 1/2• 4" SCHEDULE 40 P. VC WASHED SMNE EL= 101.5 EL= 101 MIN.. PFIM 1/8 PER FT. / EL=101 4" PW PIPE (/OR AV UAV MINIMUM 6- 3 pI7CH 114 PER " 8, CLEAN SAND FLOW LINE 15 X 110" EL=9 . INVERT MIN. 14" INVERT Q O °m o 000 — 98 75 EL.= 9-8.4 a's� INVERT a �° ° o 0 0 0 ° 00 0 EL.— ---- cAs I^' ' BAFFLE EL.= 99.2 EL.= 9B.15 o O O O O O r O °d a m om = 96 INVERT BxTS77NG -- o o° o EL.= 9e 55 — DISTRIBUTION EL gB 4'O' 4.O' (7V BE PLACED ON FIRM BASE) BOX 12.e' X 25' X 2' TRENCH FORMA 7Vff MECHANICALLY COMPACTED OR 6" OF S7VNE 70 BE WATER 7ES7L'D 1,500 GAL. IF MORE THAN ONE OUTLET h SEPTIC TANK 70 BE PLACED ON 6" SMNE SOIL ABSORBTION (H-10 LOADING) Cv STEM �r jPROFILE 0 F �J l [ (SABO�.TTo/M OF TEST HOLE ELEV.= 91.0 SEWAGE DISPOSAL SYSTEM NO OBSERVED WATER NOT TO SCALE _ - 101 _ OBSERVATION HOLE I ELEV.=_101 OBSERVATION HOLE 2 ELEV.-_ PERCOLATION RATE <2- MIN./ INCH AT 3�'�le INCHES PERCOLATION RATE �_ MIN./ INCH AT _3_6+IB" INCHES h DEPTH HORrZ TEXTURE COLOR MOTT. OTHER DEPTH HOR0 TEXTURE COLOR AIOTT. OTHER I 0-3" OIE SANDY 10YR3/2 NONE WASW 0-4" OIE SANDY IOYR3/2 NONE WAAF =� 3"-19" B SAND OYRS/B NONE COARSE 4"-22" B SAND 10YR5/8 NONE COARSK 9"-120 C SAND 10YR6/3 NONE COARSE 2"-120 C SAND IOYJW13 NONE p�E PEBBLES PEBBLES GENERAL NOTES NO GROUNDWATER ENCOUNTERED NO GROUNDWATER ENCOUNTERED I) ALL WORKMANSHIP AND MATERIALS SHALL CONFORM 7b D.E.P. TITLE 5 AND THE TOWN OF __ B_ARN_STA_B_LE___ RULES AND REGULATIONS FOR THE SUBSURFACE DISPOSAL OF SEWAGE. DATE OF SOIL TEST 5/12/99 2) ONE COVER ON SEPTIC TANK SHALL BE BROUGHT 719 WITHIN 6" OF FINISHED GRADE, OTHERS WITHIN 12" WITNESSED BY: DONNA MOIRIANDI BBOH 3) ALL THSTANDING H-10 LOADING UNLESS THEY ARTEM E UNDER OR WITHIN SOIL TEST DONE BY OILBE CAPABLE OF E LIEBYOR DESIGN CALCULA TIONS.' SOIL EVALUA7I�R 10 FT OF DRIVES OR PARKING AREAS. H-20 LOADING SHALL BE USED UNDER OR WITHIN 10 FT. OF DRIVES OR PARKING AREAS. NUMBER OF BEDROOMS . . . . . . . . 3 4) ANY MASONARY UNITS USED TO BRING COVERS TO GRADE SHALL GARBAGE DISPOSAL . . . . . . . . . NO BE MORTERED IN PLACE. INSTALL TWO(2) H 10 ACME TOTAL ESTIMATED FLOW 330 GAL/DAY 5) NO DETERMINATION HAS BEEN MADE AS TO COMPLIANCE WITH 500 GALLON LEACHING ( _110 _GAL/BR/DAY x --!I- BR) DEEDED OR ZONING REGULATIONS. OWNER/APPLICANT IS TO CHAMBERS WITH FOUR FE� REQUIRED SEPTIC TANK CAPACITY 1500 GAL OBTAIN SUCH DETERMINATION FROM APPROPRIATE AUTHORITY. 6) UTILITIES SHOWN ARE APPROXIMATE ONL Y, EXCA VATION CONTRACTOR STONE SIDES AND DS ( (� SOIL CLASSIFICATION . . . . . . . . 1 IS TO CALL DIG- SAFE AT 1-800-322-4844 AT LEAST 72 HOURS 25 X 12.8 X 2 t OF Mqs DESIGN PERCOLATION RATE . . . . . < 5 MIN./IN. PRIOR TO COMMENCING WORK ON SITE. e� s90 EFFLUENT LOADING RATE . . . . • 74 GALIDA Y/S.F. 7) CONTRACTOR IS TO VERIFY GRADES AND ELEVATIONS AS WELL AS. tiN LEACHING- CAPACITY (AREA X RATE) 338 GAL/DA Y �rllSITE CONDITIONS PRIOR TO COMMENCING WORK ON SITE. � WILLIAM � B) PARCEL IS IN FLOOD ZONE___'�C"_ LIEBERMAN N RESERVE LEACHING CAPACITY 338 GAL/DAY 9) LOT IS SHOWN ON ASSESSORS MAP _39_ AS PARCEL _ 63 . ��. L39i ° �o FG� �� ��, (25 X 12.8 X . 74)+(25f25+12.8f 12.8 X . 74 X 2) STE � Fssi°Inv tiNG� SHEET 2 OF 2 JOB NUMBER__ 51906 -___-_