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HomeMy WebLinkAbout0035 CONTENT LANE - Health F 35 Content Lane A= 040-044 'Cotuit No. o���tV — Is 1 + Fee 1 THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes 21ppliLation for bisposal 6pstem Construction VPCmit Application for a Permit to Construct( ) Repair A Upgrade( ) Abandon( ) ❑Complete System ,X Individual Components Location Address or Lot No. 3 Cmj,)pr,�-L j, Co-m,T Owner's Name,Address,and Tel.No. Assessor's Map/Parcel .40 c Installer's Name,Address,and Tet No. Designer's Name,Address,and Tel.No. LP+e t� S,\AY n sheer Sony �"agLA- CIB �b&-A9Lt -=�'Na8 Type of Building: Dwelling No.of Bedrooms 3 Lot Size 22, 4f60 sq.ft. Garbage Grinder(A /j�). Other Type of Building IJ errnQ No.of Persons 3 Showers Cafeteria( ✓f Other Fixtures Design Flow(min.required) �� gpd Design flow provided 39 3 .'3(o gpd Plan Date A i Number of sheets Revision Date Title Size of Septic Tank 15 m GN ype of S.A.S. — Lc(" Description of Soil Nature of Repairs or Alterations(Answer when applicable) - -, ti 1nc Date last inspected: j Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Env' 1 ode and not to place the system in operation until a Certificate of Compliance has been issued by this Board of alth. Signed Date Application Approved by Dates.—S Application Disapproved by Date for the following reasons Permit No. l6 _ 14.5 Date Issued �� 3 ' �No. ct �y F * � Fee 60 THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: * PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes 2pplication for Disposal 6pstem (Construction Permit Application for a Permit to Construct( ) Repair 00 Upgrade(') Abandon( ) ❑Complete System ,K Individual Components Location Address or Lot No. C-0 rlk(,a, C-M3,T Owner's Name,Address,and Tel.No. Assessor's Mlap/Parcel 4p �ycsf Sca��e Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No. 3kGLi- o8- :;�19'N --iI-Nq8 Type of Building: Dwelling No.of Bedrooms 3 Lot Size 22, 44)0 sq.ft. Garbage Grinder(a�r4 Other Type of Building IQ(]t1Q No.of Persons 3 Showers( v) Cafeteria(✓S Other Fixtures Design Flow(min.required) 36 gpd Design flow provided J 3�� �j . gpd Plan Date— .� \�„ Number of sheets Revision Date Title 1 Size of Septic Tank i5T 1,nc—o GG\ Type of S.A.S. 4 - LC( , 1 � Description of Soil ,��an Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Envir 1 ode and not to place the system in operation until a Certificate of Compliance has been issued by this Board of ealth. $ "' Signed Date Application Approved by Dates-7 — Application Disapproved by Date c for the following reasons "t Permit No. 9016 — 145 Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS (Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired()( Upgraded�X ) Abandoned( )by C A?__,•A 1 A Is �41 A`j — Stt�Y �C c�v,c-00 ro-�a� Iat 3 5 C C.W,.lP t,-y has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No.a616-IN S dated Installer �ccmpcl �`��o�'L Designer CI-0 #bedrooms Approved design floe and The issuance o this p!erlmit shall not be construed as a guarantee that the system w 1 r n as desig ed. Date "7 J J�, Inspector ' --------------------------------------------------------------------------- No.o"'I 1 qJ Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION -BARNSTABLE,MASSACHUSETTS Disposal *pstem Construction Permit Permission is hereby granted to Construct( ) Repair(�O Upgrade(x ) Abandon( ) System located at and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction must be completed within three years of the date of this permi� %/ C ((� ) Date Approved by // I - Towrt of Barnstable Regulatory Services Richard V. Scali,Interim Director ■ BARNSTABLE, MASS. Public Health Division i639. `0� Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644. Fax: 508-790-6304 Installer & Designer Certification Form Date: lg—T6Z- (F, Sewage Permit# o2 01(o --J q S Assessor's Map\Parcel 1T Designer: 2) Installer: Address: Address: IS On g4 was issued a permit to install a (date) (installer) septic system at 5 (I"),-n k- based on a design drawn by (address) Cc��Sn� dated (designer) I certify that the septic system referenced above was installed substantially according to the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. Strip out (if required) was inspected and the soils were found satisfactory. I certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system) but in accordance with State & Local Regulations. Plan revision or certified as-built by designer to follow. Strip out (if required) was inspected and the soils were found satisfactory. I certify that the system referenced above was constructed in , '_ ance with the terms nfl approval letters (if applicable) t�°F n�Ass CAR F, G�\ E. (In 1 i a ) S c� t t A N I Aik\ i (Designer's Signat t/ " (Affix Designe l p Here) PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS- BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. Q:\SepticTesigner Certification Form Rev 8-14-13.doc �.. TOWN OF BARNSTABLE LOCATION. 35 Con`�er>* SEWAGE# ZQ 1 lv— 1 4�5 VILLAGE 6T\3 L-T ASSESSOR'S MAP&PARCEL 046 1004 INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY: (type) -LC Ce Cfnem (size) NO. OF BEDROOMS OWNER/ ti �P PERMIT DATE: 5- 3 - i COMPLIANCE DATE: :[p Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility J`— + Feet Private Water Supply Well 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) 7J H Feet FURNISHED BY coclr� ct 2 f _ I f M S i I `u � t r Town of Barnstable P# v Department of Regulatory Services I ,.IUAM4 & Public Health Division Date MASS. sa 200 Main Street,Hyannis MA 02601 Date Scheduled Time Iv" Fee Pd.— G� 0 � Soil Suitability Assessment for Sewage Disposal Performed By: Witnessed By: (A/ Jli�^!U� 2 LOCATION&.GENERAL INFORMATION Location Address �oc��2C7 ' M„ Owner's Name %'n,`'c �� Address Assessor's Map/Parcel: �®� Z/� Engineer's Name crxt� NEW CONSTRUCTION REPAIR Telephone# Sob Land Use' 2lj x� � Slopes(96) 5 za Surface Stones Distances from: Open Water Body NTft Possible Wet Area YJTft Drinking Water Well �1�1 ft Dm(hago Way /v) A ft Property Line ft Other SKETCH:(Street name,dimensions of lot,exact locations of test holes&pero tests,locato wetlands I'n proximity to holes) �E Rd 9Is SZ,Ntw CG , Parent material(geologic) Q U 4,__3 GE:;VN Depth to Bedrock IQ Depth to Groundwater. Standing Water in Hole:_ N cyf-'¢.C1b S Woeping from Pit Fnee r`Q 6h5WO�A Estimated Seasonal High Groundwater ( �i�. t SS i l o--,Q ` A3 SQ1V-eA DETERMINATION FOR SEA ASON•ALMIG11 WATER TABLE Method Used: Depth Observed standing In obs.hole: In. Depth to soil mottles: In Dellth to weeping from side of obs.hole: _ In, Oroundwater Adjustment Index Weil•# Reading Datc: Index Well levol � Adj,•fketor Att1.Clroundwater•Leval, _ PERCOLATION TEST Dole,,,, Uwe Observation JJ Hole# Tlma at 9" 1 •� _ Depth of Pero Time at 6" 1 Start Pre-soak Time @ —ALa O AriLi - Time(9"4") M.►n ' End Pro-soak t I .a(G NM Rate Miu./Inch Site Suitability Assessment: Sita Passed_i Sitp Failed: Additional Testing Needed(Y/N) Original: Public Health Division Observation Hole Data To Be Completed on Back--- -- ***If percolation test is to be conducted within 100' of wetland,you must first notify the ' Barnstable Conservation Division at least one(1)week prior to beginning. Q:ISEPTICIPERCFORM.DOC j�� DEEP.OBSERVATION HOLE LOG Hole# Depth from Sail Horizon Soil Texture Sdil Color Sall• Other Surface(in.) (USDA) (Munsell) Mottling (Stnucture,Stoned,,Boulders. COTtsiatency.%•anyall 3CP —13X G, T-teA a 1 S`t' w1f L-L,059- 45-7a DEEP OBSERVATION HOLE LOG Hole#. a Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(In.) (USDA) (Mansell) Mottling (Structure,Stones,Boulders. Consistency. a A �L De 3 Ij DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Sail Color Sall Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders, DEEP OBSERVATION HOLE LOG Hole,# Depth from Sail Horizon Soll Texture Soli Color moll Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stapes;Boulders, Flood Insurance Rate Map: Above 500 year Mood boundary No— Yes Within 500 year boundary No 'KYes Within 100 year flood boundary No.t,/Yes �. Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring porvio s mtiterial exist in all areas observed thrpughout the area proposed for'the soil absorption system? e If not,what is the depth of naturally occurring pervious material's Certification I certify that on IZ)-1, (date)I have passed the soil evaluator examination approved by the r ec on d that the above analysis was performed by me consistent with Department of Envlron �ntal P . the required trainin ,cxpg' ' is a d e tic cc described in�1 10 CMR 15.017. Signature Datb Q:\SEPT1C B1tCPORM.DOC i1 COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION n f s Z u � r m ti ti t TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FoRm RECEIVED PART A CERTIFICATION AUG 5' 2002 Property Address: 35 CONTENT LANE COTUIT,MA 02635 t.>"!00 (-1(4 TOWN OF BARNSTABLE HEALTH DEPT. Owner's Name: BRIAN FISKE Owner's Address: 4 WISTERIA'WAY WALPOLE MA.02081 Date of Inspection: 7/1/02 Name of Inspector: (please print) JOHN GRACI Company Name: SEPTIC INSPECTIONS Mailing Address: P.Q.130X.,2119 TEATICKET,MA.02536 Telephone Number: 508-564-6813 FAX 508-564-7270 CERTIFICATION STATEMENT 1 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 _ CoIna _ Netion by the Local Approving Authority Fa Inspector's Signature: Date: 7/1/02 The system inspector shall su inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall,submit the report to the appropriate regional office of the DEP.The original should be sent to the system owner and copies sent to the-buyer, if applicable,and the approving authority. Notes and Comments ., THE SYSTEM PASSES TITLE V INSPECTION. RECOMMEND PUMPING EVERY TWO YEARS FOR MAINTENANCE. 1•, ** This report only desedbes.condilions ul the lime of insl►eclilln and nndcr 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. i rr, ;C Title 5 Incnrrtinn Form A,/15/?0flf). I Page 2 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 35 CONTENT LANE COTUI,T,MA 02635 Owner: BRIAN FISKE Date of Inspection: 7/1/02 Inspection Summary: Check A,B,C,D or.E/ALWAYS complete all of Section D 4, A. System Passes: X I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 3 10 CMR 15.304 exist.Any failure criteria not evaluated are indicated below. Comments: THE SYSTEM PASSES TITLE V INSPECTION. RECOMMEND PUMPING EVERY TWO YEARS FOR MAINTENANCE. B. System Conditionally Passes: _ One or more system components'as'described in the"Conditional Pass"section need to be replaced or repaired. The system, upon completion of the replacement or repair,as approved by the Board of Health,,will pass. Answer yes,no or not determined(Y,N,ND) in the for the following statements. If"not determined"please explain. n/a The septic tank is metal and over 20 years old* or the septic tank(whether metal or not) is structurally unsound,exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND explain: n/a { n/a Observation of sewage backup'or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken,settled or,uneven distribution box. System will pass inspection if(with approval of Board of Health): broken pipe(s)are replaced _-'obstruction is removed _ distribution box is leveled or replaced ND explain: n/a n/a The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): T _broken pipe(s)are replaced _obstruction is removed ND explain: n/a s 3 s, 0:. 'Page 3 of I I OFFICIAL INSPECTION FORM -NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 35 CONTENT LANE COTUIT,MA 02635 Owner: BRIAN FISKE Date of Inspection: 7/1/02 {, i 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 5,0 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'sbrface 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 p,.:gate 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 n/a "This system passes if the well.water analysis,performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: n/a - .0 i # y 1 'Page 4 of I I ` k' OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE'SEWAGE DISPOSAL SYSTEM INSPECTION FORM ;i. PART A CERTIFICATION(continued) Property Address: 35 CONTENT LANE COTUIT,MA 02635 Owner: BRIAN FISKE Date of Inspection: 7/1/02 .} D. System Failure Criteria applicable;to.a,ll systems: You ming indicate"yes"or"no"to each of the following for alLinspections: Yes No X Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool X Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ' _ X Static liquid level in,the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool X Liquid depth in cesspool is less than 6"below invert or available volume is less than '/2 day flow X Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number of times pumped nLa. = ` X Any portion of the SAS,'cesspool or privy is below high ground water elevation. X Any portion of cesspool*&ivy<is-within 100 feet of a surface water supply or tributary to a surface water supply. X Any portion of a.cesspool:o.r 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 pr ivy.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.;; :, } (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`eTh6,"system owner should contact the Board of Health to determine what will be necessary to correct the failure. ti Y. 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""'ho"•to each of the following: (The following criteria apply to large"systems in addition to the criteria above) yes no X the system is within 400 tfeet of a surface drinking water supply X the system is within 200 te'et of'a f lbutary to a surface drinking water supply X the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area—1 WPA)or a mapped Zone 11 of a public wate'r''supply yell If you have answered"ye`s"�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 and 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 uwuer should contact the appropriate regional office of the Department. ti 4 l I j 4 Page 5 of I 1 OFFICIAL INSPECTION'FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 35 CONTENT LANE COTUIT,MA 02635 Owner: BRIAN FISKE Date of Inspection: 7/1/02 Check if the following have beeir donet'You must indicate"yes"or"no"as to each of the following: Yes No t' 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? `J,', s '' 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 manhole4§'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'ekample; 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)] 9 7 f' r `Page 6 of 1 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 35 CONTENT LANE COTUIT, MA 02635 Owner: BRIAN FISKE Date of Inspection: 7/1/02 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): 3, Number of bedrooms(actual): 3 DESIGN flow based on 310 CM'R,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): NO Seasonal use:(yes or no): NO Water meter readings, if available (last 2 years usage(gpd)):-nfa- Sump pump(yes or no): NO a S✓ Last date of occupancy: 8/31/01 COMM ERCIAL/INDUSTRIA,L Type of establishment: n/a �11, Design flow(based on 310 CMRfI•j.,20j3):.n/agpd Basis of design flow(seats/persons/sgft,etc.): n/a Grease Grease trap present(yes or no): NO Industrial waste holding tank pres-.nt(yes or no): NO Non-sanitary waste discharged to the, 7 tle'5 system(yes or no): NO Water meter readings, if available: n/a Last date of occupancy/use: n/a OTHER(describe): n/a GENERAL INFORMATION Pumping Records Source of information: n/a Was system pumped as part of the inspection(yes or no): NO If yes,volume pumped: n/agallons--How was quantity pumped determined?n/a Reason for pumping: n/a TYPE OF SYSTEM X Septic tank,distribution box,soil absorption system _Single cesspool _Overflow cesspool _Privy _Shared system(yes or no)(&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 th& EP approval Other(describe): n/a Approximate age of all components;date installed(if known)and source of information: 1973 Were sewage odors detected when.arrivaing at the site(yes or no): NO Page 7 of 1 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 35 CONTENT LANE COTUIT,MA 02635 Owner: BRIAN FISKE Date of Inspection: 711/02 BUILDING SEWER(locate on site;p,lan) Depth below grade: 22" ,_ Materials of construction:_cast iron,;=40 PVC Xother(explain): 20 PVC Distance from private water supply well or suction line: n/a Comments(on condition of joints,venting,evidence of leakage,etc.): TOWN SEPTIC TANK: X(locate on sits plan) Depth below grade: 14" Material of construction: Xconcrete_metal_fiberglass_polyethylene other(explain)n/a If tank is metal list age: n/a Is age corifir►ied by a Certificate of Compliance(yes or no): NO(attach a copy of certificate) Dimensions: 1000G L 8' 6" H 5'.7" W 4'.101" Sludge depth: 2" Distance from top of sludge to bottom of outlet tee or baffle:32" 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: n/a How were dimensions determined: MEASURED Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): SEPTIC TANK AND ALL COMPONENTS ARE STRUCTURALLY SOUND AND FUNCTIONING PROPERLY. RECOMMEND PUMPING'EVERY`TWO YEARS TO PROLONG THE SYSTEM'S USEFUL LIFE. GREASE TRAP:_(locate on sioi plan) Depth below grade: n/a Material of construction:—concrete—'metal_fiberglass_polyethylene_other(explain): n/a Dimensions: n/a Scum thickness: n/a Distance from top of scum to top of outlet tee or baffle: n/a Distance from bottom of scum to bottom of outlet tee or baffle: n/a Date of last pumping: n/a Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.)' n/a Page 8 of 1 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 35 CONTENT,LANE.COTUIT,MA 02635 Owner: BRIAN FISKE Date of Inspection: 7/l/02 t TIGHT or HOLDING TANK: (tank must be pumped at time of inspection)(locate on site plan) Depth below grade: n/a Material of construction:_concrete_metal_fiberglass_polyethylene_other(explain): n/a Dimensions: n/a Capacity: n/a gallons Design Flow: n/a gallons/day ..g. Alarm present(yes or no): N/A , Alarm level: N/A Alarm in working order(yes or no): NO Date of last pumping: n/a Conunents(condition of alarm and float switches,etc.): n/a DISTRIBUTION BOX:_(if presept p?ust 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.): NONE PUMP CHAMBER: _(locate on site plan) Pumps in working order(yes or no): NO Alarms in working order(yes or no):NO Comments(note condition of pump chamber,l condition of pumps and appurtenances,etc.): n/a ' H ,t 1 'Page 9 of I l OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 35 CONTENT LANE COTUIT,MA 02635 Owner: BRIAN FISKE Date of Inspection: 7/l/02 SOIL ABSORPTION SYSTEM (SAS):.:X (locate on site plan,excavation not required) If SAS not located explain why:' n/a Type 1000 GAL 6' X 6' leaching pits, number: 1 n/a leaching chambers, number: n/a n/a leaching galleries, number: n/a n/a leaching trenches, number, length: n/a n/a leaching fields, number: n/a n/a overflow cesspool, number: n/a n/a ,innovative/alternative system Type/name of technology: n/a Comments(note condition of Oil,"signs.of-hydraulic failure, level of ponding,damp soil,condition of vegetation,etc.): THE LEACH PIT IS STRUCTURALLY SOUND.THE PIT WAS EMPTY AT THE TIME OF INSPECTION.THE STAIN LINES INDICATE THE PIT HAS BEEN 1'TO PIPE. THE BOTTOM IS AT 9' CESSPOOLS: (cesspool must be pumped as part of inspection)(locate on site plan) Number and configuration: n/a Depth—top of liquid to inlet invert: n/a Depth of solids layer: n/a Depth of scum layer: n/a I Dimensions of cesspool: n/a Materials of construction: n/a Indication of groundwater inflow(yes or no): NO Comments(note condition of soil,signs of'hydraulic failure, level of ponding,condition of vegetation,etc.): n/a PRIVY: (locate on site plan) i Materials of construction: n/a Dimensions: n/a Depth of solids: n/a Comments(note condition of soil,signs`of hydraulic failure, level of ponding,condition of vegetation,etc.): n/a k t ' , Page 10 of I I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 35 CONTENT LANE COTUIT,MA 02635 Owner: BRIAN FISKE Date of Inspection: 7/1/02 SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage dispasal 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. &x peC A AR 3� a x :, Page 1 I of I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 35 CONTENT LANE COTUIT,MA 02635 Owner: BRIAN FISKE Date of Inspection: 7/l/02 SITE EXAM _Slope _Surface water _Check cellar Shallow wells Estimated depth to ground water 12+feet Please indicate(check)all methods used to determine the high ground water elevation: NO Obtained from system design plans on record- If checked, date of design plan reviewed: n/a YES Observed site(abutting property/observation hole within 150 feet of SAS) NO Checked with local Board of Health-explain: n/a NO Checked with local excavators;installers-(attach documentation) NO Accessed USGS database-explain: n/a You must describe how you established the'high ground water elevation: HAND AUGER- 12+ FEET • '1 �. 11 I TOWN OF BARNSTABLE LOCATION C3S VL Q SEWAGE # li VILLAGE Eb AM/ ASSESSOR'S MAP & LOT `1 INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY: (type) e (size) l J G a I�o Z I NO.OF BEDROOMS y J BUILDER OR OWNER J�jr X PERMITDATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) i �� � IdZ Feet Furnished by `��1� e 1 � A OeejL Fl � 37 r THE COMMONWEALTHOF MASSACHUSETTS Fps. BOARD Q H EALT-H I-ld A-------- OF.......... ... .... Appliration for Disposal Works onstrudion Urrmit at Application is hereby made for a Permit to Construct ( or Repair ( an Individual Sewage Disposal Systemat, .... -- ------=---- ---------------.._...__. ...... ti or Lot . . .. . ... .. < . .. --- Lo on. r ss -� rr --•- Ow er Address pnstalle Address Lot. S . feet a d Type of Buildtltg� q U Dwelling—No. of Bedrooms•---"•----_----.. "-•----------------Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................. No. of persons............................ Showers ( ) — Cafeteria ( Other fixtur W Design Flow --......--•••••. I ns per person per day. Total daily flow......... ....... ..........gallons. W Septic Tan�Znch Liquid capacity_ ons Length................ Width................ Diameter................ Depth................ Disposal T —No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No..................... Diameter.................... Depth below inlet-.:., ............ To 1Xlei a� ..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) a �-' Percolation Test Results Performed by................................................. ... Date........................................ aTest Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ (i Test Pit No. 2................minutes per i Depth of Test Pit.................... Depth to ground water........................ R+ ....... ----- ----"--"---"--------------------•--•------------------------------------------------------------ ODescription of Soil........................... "---•--•-•--------------------------------------•---------••--•-----•----••----••-•--•-••-__---- U -•-----------••-•-•••-•-•••••.............••-•-•-••--........•-•-•-•••--•-•----•-••---•................_.....-•••-••••-•-•-••-•-•--•---••--••--•-------••--•••---•••-•-•-•-•--•.........._......•_--•... W •-------------........................................-................................................................................................................................................ VNature of Repairs or Alterations—Answer when applicable................................................................................................ ............................................................--"-"------"---""•---•---•----"---•-""•"--.....-"-"-------"-------------•--"---"-"----"-"--------"--------"----•---•---••......._.......... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Article Xl of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has b ed by the d af-hplth. k igned..... _ =" .ate Application Approved BY •---•-•-- •-••... " .....� .D. Application Disapproved for the following reasons-................................................--___-•-....................................................... . -•••........--•.....................................••••......_..-•-••-•........._..............._............_•-•--......_ Date PermitNo......................................................... Issued....................................................... Date 0' Fimim ........................ THE COMMONWEALTH OF MASSACHUSETTS BOA FAD Of� H EA 79 .. . .... .. . .... ........ . ...... ... . ............OF.........*0.. Appliration for Ditiporial VorkiiZomitrudiott Vrrutit Application is hereby made for a Permit t Construct or Repair an Individual Sewage Disposal Syst at:- 4 . . ............... ............................................... . .... . ion- 7 'L.o It,o ss .... ... ... ..... -- ------ 0 er ------- ....... .7.-.Ldress v ........... ........ ... . ................................................................................................ nsla Address Type of Buildg Size Lot............................Sq. feet U Dwelling—No. of Bedrooms_______________ .......................Expansion Attic Garbage Grinder ----Other—Type of Building ------- ----------------- No. of persons_.___.____.____._______.__.. Showers Cafeteria P-1 Other fixtures............ ...................... ............................................................ .............. .. ............... Design Flow ................. Ions per person per day. Total daily flow ,.... ..010- ...........gallons. 0 n 9 Septic Tank Liquid capacity ons Length................ Width................ Diameter................ Depth................ D 2c'1h—No. .................... Width..................... Total Length.................. Total leaching area....................sq. f t. Seepage Pit No--------------------, Diameter______-____----------Depth below inlet___.. To t$I I le iing . ...............sq. f t. . ......... Z Other Distribution box Dosing tafik ......................................... Percolation Test Results Performed by............................................................................ Date Test Pit No. 1................minutes per inch Depth of Test Pit._.____._____.__.___ Depth to ground water__.___..______.__._.._.. Test Pit No. 2................minutes per ily Depth of Test Pit____.__._______._... Depth to ground water_________._.__._.__._._. ............... ................................................................................................ ......................................................................................... 0 Description of Soil.................I......... -----------------------"--------------- ------­*-------------*------------------- ------------------*--------------------------------------------*-------------------------*--------------------- ........................................................................................................................................................................................................ U Nature of Repairs or Alterations—Answer When applicable------------------............................................................................. I ................................................................:....................................................................................................................ii,................ Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Article XI of the State Sanitary Code—Xi4e.uhndersigned further agrees not to place the system in operation until a Certificate of Compliance has s ed by the -PiMadof"lI ,,jigned._ .........;��............................. ...... 4-1 1 . ....... Application Approved By....... . .. ..... . .. ...... .. .............................. . ......�_ .X ... .... Date Application Disapproved for the following reasons:............................................................................................................. ........................................................................................................................................................................................................ Date PermitNo......................................................... Issued........................................................ Date THE COMMONWEALTH OF MASSACHUSETTS BOARD HEALTH ..... .... ................... .....OF......... . ............. .................................... (Intifiratr of Tomptiattrr THIS 1, JTO CEj?TIFY.,,yhat th IndivIdual Sewage Disposal System constructed or Repaired by----------------f/AA&&i.-me......... --------------------------------------- --------------------"---------------- --------- V Installer vOjO V at.................. ................. ........eo..... .................................................................... has been installed in accordance with the provisions of Article.Xj of The State Sanitary Code des bed in the application for Disposal Works Construction Permit No.______!J....7-4.7_................. dated........... __Zt4(r/73............. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE................................................................................ Inspector................................................................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD QF HEALTH .....OF........ ...................................... . . ......................... No..... ........ FEE......................... it Permission is hereby granted____________ StUr, ,,.I ............................................ a 10'sa to Construct or epa r an IndivldtE!1 Sewage Di al 5W ........4240%. at No......... ..401 .... _11:2�.....................................4 Street as shown on the application for Disposal Works Construction Permit No.....!��ated.............. ................................................................................................... Board of Health DATE................................................................................ FORM 1255. HOBBS & WARREN. INC., PUBLISHERS ` `^L' .tea• u j � a jba � o a SAS TO BE COVERED WITH VENT PIPE �® Least 24 inches tau) FILTER FABRIC. *NOTE: ALL PIPES ARE TO BE 4" SCHEDULE 40 P.V.C. Schedule 4 PVC w/Charcoal Odor Filter 10' min. from SECTION A -A house to septic tank SAS cover must be EXISTING Foundation SepUe tank covers must be D-BOX cover must must have riser and be within 8" of GRADE PROFILE VIEW OF LEACHING SYSTEM y within AT finished grade within 6 in. of finished grade Grade over Septic Tank - 97.00 Grade over D-Box- 96.00 rode over SAS - 96.00 Lift /�• to r r/e • raenea erwsea seen. •of r/a•- r/Ie• raeAed Peaetone S 0.02 ee to be placed In dbox 3 HOLE H-10 INSPECTION cover must be GIST. BOX TOP OF SAS - 93.00 within 6 in. of finished grade S-0.01 A EXIST. PIPE t0 to EXIST 1nr , e�, O O O Q O O o FROM FOUNDATION d' SEPTI25, � 20' cm O �—• O O O O O O CO Qt omi Hrn ,� = C3 o C3 0C3CONCRETE FULL FOUNDATIO y II II ` a � E„• SYSTEM PROFILE d > , �� s' P OVIDED y 4 Units 6 ' 24' Not to Scale — c c °' 4' 4•1 4D 4 2' fII—Effective width 6 in.of 3/4"-1 1/2• S n z8' NOTE: ALL COMPONENTS MUST HAVE RISERS TO WITHIN 6" BELOW GRADE compacted stone v e Effective Length •6 m S❑IL ABSORPTION SYSTEM (SAS) ��ottom oti-7esFl�oie-i- ev. 8 .00 LC-6 H-20 LEACHING UNITS / WIGGINS PRECAST Not to Scale 2-18• DIAM. ACCESS MANHOLES P E R C 0 LAT I 0 N TEST DISTRIBUTION' OUTLET BPDX AL THE 12" _ CONCRETE COVER 8' SET LEVEL FOR AT LEAST 2 FT. :::r '''L>-. '—•� •" Date of Percolation Test: APRIL 5, 2016 - - 3 - 5• ouTLeT 2 • '' c Test Performed By: CARMEN E. SHAY, R.S., C.S.E. f �`� .' KNOCKOUTS TL Results Witnessed By.DAVID STANTON (BARNSTABLE BOH) - — -1s.5• � T •'' 12• INLET -`' / EXCAVATOR: CARMEN SHAY r ;: 6• 6 Percolation Rate: Less Than 2 MPI ® 48" ,.F: 2 `` OUTT 15.5" 4" — SCH. 40 Te 1.7s4 THE ACCESS COVERS FOR THE SEPTIC TANK, N Test Hole Test Hole _ ., DISTRIBUTION BOX AND LEACHING COMPONENT No. 1 No. 2 PLAN SECTION CROSS—SECTION •' ;, ,—••^•'^ :,^;. T�.» �' SET DEEPER THAN 6 INCHES BELOW FINISHED "'" •' '"" `''' '` GRADE SHALL BE RAISED TO WITHIN 6. OF M FINISHED GRADE. DEPTH SOILS ELEV. DEPTH SOILS ELEV. 3 HOLE H-10 DISTRIBUTION BOX STEEL REINFORCED PRECAST CONCRETE 0 96.00 0 96.00 NOT TO SCALE PLAN VIEW INSTALL TUF-TITE GAS BAFFLES OR EQUALS Sandy Sandy Loom Loam 3-24• REMOVABLE COVERS 10 YR 3/2 11 10 YR 3/2 0"_ 6" A° 95.50 D 6» PLOT PLAN 3-min. clearance Ih. oamyLoamy 8" min.T 2" min. Inlet to outle 3' INLET"Y • Sand Sand_ ____ _�______ OF PROPOSED SEPTIC SYSTEM UPGRADE F7 Liquid everL4" ouTLEr 10 YR s/6 10 YR s/6 6"— 36" Bw 93.00 6"— 36"s -7• ---- s' -7• s3.00 PREPARED FOR Med. Med. t: E g 4'-0• min. Sand Sand K I M B E R LY FA U L H A B E R .J 02 v sea Dwe .` L depth 2.5 Y 7/4 2.S Y 7/4 36"— 132 Ct 85.00 36"— 132 C, 85.00 ,. AT 6._a» .4'—10 .. .. 35 CONTENT LANE CROSS SECTION END—SECTION ASSESSORS PLAT 40 PARCEL 44 Po TYPICAL 1000 GALLON SEPTIC TANK COTU IT MA Design Calculations Number of Bedrooms: 3 Equivalent to 330 Gal. Day 330 Gol. Day per Title V g Garbage Grinder: No PREPARED BY: Leaching Capacity Proposed: 330 Gal./Day Minimum (Min. Per Title V) Septic Tank - 2 x330 Gal./Day = 660 USE EXIST. 1,000 GAL. Septic Tank. SHA Y ENVIRONMENTAL SER VICES Perc #1 SOIL ABSORPTION AREA: Using percolation rate of <2 min./inch Depth to Perc:36" to 54" 1 1 I Bottom Area: 0.74 gal/day/sq. ft. x 30 sq. ft. = 227.92 gallons/day Perc Rate= 2 MPI ASSUMED o Sidewall Area: 0.74gal./day/sq. ft. x 156 s ft. = 115.44 alion da Groundwater Not Observed. q• 9 / Y FG,Sz P.O. Box 1576 Providing: allons .=343.36 da No Observed ESHWT 9 / y ADJUSTED H2O Elev. = None Sa4NiT: MASHPEE, MA 02649 TEL/FAX : 508-294-7498 Use: (4) LC-6 H-20 CONCRETE CHAMBERS, HAVING A 1' EFFECTIVE DEPTH, SCALE: 1 "=20' DRAWN BY: CES DATE: APRIL 23 2016 (3' W x 6' L) TO BE USED WITH 4' OF WASHED STONE ON THE SIDES AND 2' OF WASHED STONE ON THE ENDS AND 1 FOOT OF STONE UNDER . PROJECT#35 Content St FILENAME: 35 Content.dw SHEET 2 OF 2 I• r N 62D 48' zo"E GENERAL NOTES PE 1. Contractor is responsible for Digsafe notification, Verification of Utilities 140.00' and protection of all underground utilities and pipes. 30d8d0 2. The septic tank and distri ution box shall be set - U level on 6" of 3/4 —1 1�2" stone. 3. Backfill should be clean sand or gravel with no stones over 3" in size. w i E 4. This system is subject to inspection during installation C o, 0 by Carmen E. Shay — Environmental Services. : y.0 5. The contractor shall install this system in accordance Y E a, with Title V of the Massachusetts state code, the approved plan m S and Local Regulations. 58 5' t O J 6. If, during installation the contractor encounters any 6: LL- y108 soil conditions or site conditions that are different 'o from those shown on the soil log or in our design Ld� N ° 4308 0 installation must halt & immediate notification be O o made to Carmen E. Shay — Environmental Services. \ 0 E m 7. No vehicle or heavy machinery shall drive over the TEST HOLE #2 u o E septic system unless noted as H-20 septic components. TEST HOLE 1 IY U) 0 o ELEV.= 96.00 # m o 0 8. Install Tuf—Tite gas baffles or equals on all outlet tee ends. ELEV.= 96.00 w _�``94 m d 9. All Distribution Lines shall be 4" diameter Schedule 40, NSF PVC pipes. \ 25' 28' FAILED O q M 10. All solid piping, tees & fittings shall be 4" diameter _—I FAr_l ..P1L___ O O O O SITE LOCUSSchedule 40 NSF PVC pipes with water tight joints 11. Municipal Water is Connected to ALL OF The Residence and Abutting .. .. 'y.' ,, • O �--_ � p Vent ` O Properties Within 150 Feet. A .w �� Pipe THE PROPERTY LINES ARE APPROXIMATE AND D—Boz --___ 9 to COMPILED FROM THE SURVEY PLAN BY CHARLES N. SAVARY, INC. ENTITLED: "Subdivision Plan of Land in COTUIT MA" EXIST. �'"1 DATED SEPT. 1, 1949. CERTIFICATE #51 121, PLAN #408-81 26' 1000 gal. ' � Septic Tan PATIO - AND IS NOT INTENDED TO BE A SURVEY PLOT PLAN PROJECT BENCH MARK IT SHOULD BE USED FOR NO PURPOSE OTHER THAN TOP OF FOUNDATION THE SEPTIC SYSTEM INSTALLATION. X EXISTING Leach Pit TO BE PUMPED OUT AND FILLED IN PLACE ELEV. = 100.00 (Assumed) 98_ DECK ;� NOTE: ANY STRIPPED OUT SOIL CONTAINING LEACHATE — _ '. FROM THE EXISTING CESSPOOL/LEACH PIT TO BE DISPOSED SHED CO OF AS PER BOARD OF HEALTH SPECIFICATIONS. aCb LOT #79 EXISTING 3 BEDROOM GARAGE i LOT #81 PLOT PLAN HOUSE �\ 0 #35 ,- OF PROPOSED SEPTIC SYSTEM UPGRADE PREPARED FOR KIMBERLY FAULHABE.R AT LOT #80 ASPHALT o0 35 CONTENT LANE J I L I 1 ASSESSORS PLAT 40 PARCEL 44 22,400 Square Feet +/— � DRIVEWAY i �-----� C OT U I T MA 1 00—' ------r-------�— �tGrovel i c� OF MASS 140.00' /� i ; IDRIVEWAY �� 4 ;I PREPARED BY: � I s N 62D 48' 20"E i I > SHAY ENVIRONML'NTAL SERVICES ----------------------------------------------=--I---------- ---------------------- 0!11'>3 b �FGISTE��v P.O. Box 1576 0 20 40 50 S.4NItAR'\P� MASHPEE, MA 02649 C'®1V TENT .E.A.1VE TEL/FAX : 508-294-7498 (40 FOOT RIGHT OF WAY) SCALE: 1 "=20' DRAWN BY: CES DATE: APRIL 23 2016 SCALE: 1 "=20' PROJECT#35 Content St FILENAME: 35 Content.dwo SHEET 1 OF 2