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HomeMy WebLinkAbout0067 CRAWFORD ROAD - Health 67 Crawford Road V :) cotuit A= 005-029 No. 10339 smead-com - Made in USA V u I� l I I 4 a !I I w I I i TOWN OF BARN�STABLE LOCATION 6 �y i�,�"G, /1 SEW GE#,.�f�$ — 3 VILLAGE /��"�/f ASSESSOR'S MAP&PARCEL INSTALLER'S NAME&PHONE NO.32/7 "�!'2�" %7��✓�S3�f�� (/��f�yv�3 SEPTIC TANK CAPACITY /j 00 LEACHING FACILITY: (type) size) NO.OF BEDROOMS-3 OWNER PERMIT DATE:,,r"l y COMPLIANCE DATE: cS--/9" /8 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 GAc I � I .7 D p 1 6" 6 -- 61 31 /3 2 A 3 c33 �= No. v Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS s 2ppYication for Misposar .pstem Construction 3permit Application for a Permit to Construct V;< Repair -, pgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. 7CRhIW '-or D� O ner's N e,A dress,and Tel.No. Assessor's Map/Parcel S' Z C�Td�T � ���/�� 1 taller's N Ad ess,and Tel.No.S6B-y2o'973 Desi er's N e Address and Tel:No. 3��'?7y—7�y7 r Tom ///s o, 13 oK 1 6 R61",1Y71-'rR Type of Building: Dwelling No.of Bedrooms ..3 Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) T.W�� 19COr 1A7C1 Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. Signed Date Application Approved by Date do Application Disapproved by Date for the following reasons Permit No. 3 Date Issued L " a,", _,:...,,..-'"-J7.':....:..`:.,;ti......sue.: ..:.w',tr'[q,.:�Yt-�= '•w�Y*r'"\-`4?;. '�,... ,' , ..,::/'a-.-^..rii':'., Al 4,• .n�:. �n _ Fee /00 THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH VISION - TOWN OF BARNSTABLE, MASSACHUSETTS YTs Rpplirati.on for`MiI p68al 6pstem Construction Permit Application.for a Permit to Construct((, ` Repair Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components F A x Location Address or Lot No.� CI � �W/'Gf y -a Owner's N` e,Address,and Tel.No. Assessor's Map/Parcel �- Installer's Name,Address,and Tel.No._�W 5512 0_ 7-3 e Designer's Name,Address,and Tel'.No. -�7�'. 73 yJ O /jaX, 1 4 5 C/_^41. lf71 � Type of Building: t Dwelling No.of Bedrooms -3 Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow.(min.required) gpd Design flow provided gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil i r Nature of Repairs or Alterations(Answer when applicable) 7�,5 7/all /VL`fi A Date last inspected: s - s A-reemI The unde*rsigned'agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in f accordance with the:provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of sv. f Compliance has been issued by this Board of Health. l Signed Date Application Approved by "t _ _ Date ao 3rP L)M5*1 Application Disapproved by Date for the following reasons Permit No. f " "" �7 Date Issued - //,t/6 P THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired(e—) Upgraded Abandoned( / O-/ t9!" at /5 7- 6i K✓Gl/ /'�! � .(v�TIJ/ - has been constructed in accordance -with the provisions of Title 5 and the for Disposal System Construction Permit No QCI '� 3 dated �y Installer✓0.5~'f Designer #bedrooms 3 Approved design>tiow gpd The issuance of this permit `thall n/ot be construed as a guarantee that the rstem will func"ti onus desigtied. Date �j j Inspector No.0.:�)c ig --)LI.� Fee lee THE COMMONWEALTH OF MASSACHUSETTS `�. PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS Misposal *pstem Construction 3permit Permission is hereby granted to Construct( ) Repair Upgrade( l)- Abandon( ) System located at J!✓! r 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 pe" rmit. Date 5// / , Approved�by f Town of Barnstable Regulatory Services Richard V. Scali,Interim Director + BARN3CABM s M^� Public Health Division i639. ♦� Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Installer&Designer Certification Form Date:t5;� Sewage Permit#,g0/8-/y 3 Assessor's Map\Parcel Designer: L\ndo- Installer: o )U S'C'P l C Address: 6 0 X Address: CA MIY7 4-'( On Is-y5was issued a permit to install a (date) rr (installer) septic system at 61 C�Wt�V-a based on a design drawn by (address) CS G'�, 1r%LLY'I n dated 1I31Ji4 Ptv, (designer) —V—/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 with the terms of the RA approval letters (if applicable) �ea�,EA`T oFM- 0`r [I/y0 v� qJ c NIN ( staller's Signature) 9 o s�V[- ��F�C�S C�- LY.— Designer'sSignature) (Affix Designer t 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:\Septic\Designer Certification Form Rev 8-14-13.doe Town of Barnstable P# 3 Departiment of Regulatory Services i ,,�,�,�� a Public Health Division Date tajv 200 Main Street,Hyannis MA 02601 Date Scheduled_ I Time Fee Pd: ( 00. 0-( Soil Suitability Assessment for Sewage Disposal Performed-BY: nc A i, lY,n 1­3 Witnessed By: r)n a Hilo' rcy-t_4 LOCATION&.GENERAL INFORMATION Locatiron,Address Owner's Name Addresses C 0lf' }} . Assessor's Map/Parcel: ` Engineer's Name Lm j, NEW CONSTRUCTION REPAIR _Z Telephone# '*I , Land Use J Slopes(96) - f'S t/o Surface Stones Distances from: Open Water Body Possible Wct•Area N I A ft Drinking Water Well A ft Dmlhage Way 0'A ft Property Line 7 10 (t Other ft SKETCH:(Street name,dimensions of lot,exact locations of test holes&pero tests,locate wetlands-in proximity to holes) i I Parent material(geolo is AGICI ` \ o �wa_s� g ) Depth to Bedrook Depth to Groundwater. Standing Water in Hole: I 1A Weeping from Pit Fnoa Estimated Seasonal High Groundwater DETERMINATION FOR SEASONALMIGH WATER TABLE Method Used: Depth Observed standing in obs:hole: In, Depth to soll mottles: Do�th to weeping from side of obs.hole: In, Uroundwater Adjustment fk. Index Well-0 Rcading bato: Index Well level-;___w„ Adj4actor- Adj.droundwater-1 evel.,,,,., PERCOLATION TEST Date , Thud____, Hol ervetlon �r Ob e# Time at 9" II , Depth of Pero _ Time at 6" _- Start Pro-soak Time @ �'C`� Time(9"-6") ' End Pro-soak RateMin./luch . Site Suitability Assessment: Slte Passed Site Palled: Additional Testing Needed(Y/N) Original: Public Health Division Observtitlon Hole Data To Be Completed on Back---- ***If percolation test is to be conducted within 100' of wetland,you must first notify the Barnstable Consefvation Division at least one(i)week prior to beginning. Q:\SBPTIC\PERCFORM.DOC DEEP.OBSERVATION HOLE LOG Hole# Depth from Soli Horizon Soil Texture Sdil Color Sol]. Other Surface On.) (USDA) (Munsell) Mottling (Stnucture,Stones;Boulders. Ell • o tsIstency.%'Oravell • ►`I o)A M S Io`�� a1► C M LS jo Sh 9 M LS C, 'M LS 10 1-1 C2 DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Solt Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders.. Consistency, DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Solt Texture Sall Color Soil Other Surface(In.) (USDA) (Munsell) Mottling (Structure,Stones;Boulders, Flood Insurance Rate Map: Above 500 year Mood boundary No Yes Within 500 year boundary No _!_ Within 100 year flood boundary No-7 Yts Reath of Naturally Occurring Pervious Maferlal Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the area proposed for the soil absorption system? S If not,what is the depth of naturally occurring pervious material? ._...�.. Certification I certify that on 00 -(date)I havepasse'd the soil evaluator examination approved by the Department of E ironmental Protection and that the above analysis was performed by me conslstent with . the required tral 1 g,exper' e and experience described in 410 CMR 15.017. Signatur G �� Datts I`� ► Q.,WEPT1C\PERCPORM.DOC f Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ,M 67 Crawford Road Property Address Gwendolyn E. Phillips Owner Owner's Name information is required for Cotuit MA 02635 October 1, 2009 every page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When filling out A. General Information \, W5566 forms on the J computer,use 1. Inspector: only the tab key to move your David D. Coughanowr cursor-do not Name of Inspector use the return key. Eco-Tech Environmental Company Name r� 43 Triangle Circle Company Address Sandwich MA 02563 City/Town State Zip Code 508 364 0894 1328 Telephone Number License 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 S;ektion 15 40 o Title 5(310 CMR 15.000).The system: ® Passes ❑ Conditionally Passes ❑ Fails J -,n ❑ Needs Further Evaluation by the Local Approving Authority !E 3. �. RS October 1, 2009 co r i Inspector's Signature Date i 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. t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 67 Crawford Road Property Address Gwendolyn E. Phillips Owner Owner's Name information is required for Cotuit MA 02635 October 1, 2009 every page. City/Town 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: ® 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: Inspector's Note==> A septic system is deemed to pass this Real Estate Transfer Inspection if it does not trigger any of the failure criteria listed below. The septic system has been evaluated according to the conditions observed on the day it was inspected. No estimate or guarantee of system longevity is made or implied by a passing determination. Removal of garbage grinder is recommended. 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. Check the box for"yes", "no"or"not determined" Y N ND 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. ❑ Y ❑ N ❑ ND (Explain below): t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 67 Crawford Road Property Address Gwendolyn E. Phillips Owner Owner's Name information is required for Cotuit MA 02635 October 1, 2009 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes (cont.): ❑ 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 ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ 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 ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which Y require further evaluation b the Board of Health in order to determine if q 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 t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 67 Crawford Road Property Address Gwendolyn E. Phillips Owner Owner's Name information is required for Cotuit MA 02635 October 1, 2009 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) 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 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 t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments °M 67 Crawford Road Property Address Gwendolyn E. Phillips Owner Owner's Name information is required for Cotuit MA 02635 October 1, 2009 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory, for 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 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. t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form _ Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 67 Crawford Road Property Address Gwendolyn E. Phillips Owner Owner's Name information is required for Cotuit MA 02635 October 1, 2009 every page. City/Town State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes"or"no"as to each of the following: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? �� ❑ ® Were as built plans of the system obtained and examined? (If they were not 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)] D. System Information Residential Flow Conditions: Number of bedrooms (design): n/a Number of bedrooms (actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): n/a-no plan t5ins•09/08 Tide 5 Official Inspection Forth:Subsurface Sewage Disposal System-Page 6 of 17 f Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 67 Crawford Road Property Address Gwendolyn E. Phillips Owner Owner's Name information is required for Cotuit MA 02635 October 1, 2009 every page. CitylTown State Zip Code Date of Inspection D. System Information Description: Number of current residents: 1 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 ears usage 44 gpd 9 ( Y 9 (gpd)): Detail: 2007-2008 Sump pump? ❑ Yes ® No Last date of occupancy: current Date 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: t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 67 Crawford Road Property Address Gwendolyn E. Phillips Owner Owner's Name information is required for Cotuit MA 02635 October 1, 2009 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date j Other(describe below): 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): Septic tank and leach pit. t5ins•09/08 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 67 Crawford Road Property Address Gwendolyn E. Phillips Owner Owner's Name information is required for Cotuit MA 02635 October 1, 2009 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known)and source of information: Age unknown—system is assumed to have been installed at time of dwelling's construction in 1973 Were sewage odors detected when arriving at the site? ❑ Yes ® No 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: feet Comments (on condition of joints,venting, evidence of leakage, etc.): No evidence of leakage or backup into dwelling was observed. Septic Tank(locate on site plan): Depth below grade: 0.5 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: 8.5 ft x 5 ft x 5 ft(1000 gallon) - Sludge depth: 4 in t5ins•09/08 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System-Page 9 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ,M 67 Crawford Road Property Address Gwendolyn E. Phillips Owner Owner's Name information is required for Cotuit MA 02635 October 1, 2009 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle 30 in Scum thickness trace Distance from top of scum to top of outlet tee or baffle 10 in Distance from bottom of scum to bottom of outlet tee or baffle 14 in How were dimensions determined? 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.): Pumping not required at this time but maintenance pumping is recommended every year. Removal of garbage grinder is recommended. Tank and tees appear structurally sound and functioning as intended. No evidence of leakage in or out was observed. Tank is under deck with access to inlet cover provided. Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 67 Crawford Road Property Address Gwendolyn E. Phillips Owner Owner's Name information is required for Cotuit MA 02635 October 1, 2009 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): 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 t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �M 67 Crawford Road Property Address Gwendolyn E. Phillips Owner Owner's Name information is required for Cotuit MA 02635 October 1, 2009 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 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.): Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No 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: t5ins-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 67 Crawford Road Property Address Gwendolyn E. Phillips Owner Owner's Name information is required for Cotuit MA 02635 October 1 2009 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: ® leaching pits number: 1 ❑ leaching chambers number: ❑ 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.): Pit was uncovered and found to contain effluent to 18 inches below inlet pipe invert. No effluent contact staining was observed at cover interface or in overlying soils. Cessp ools s (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 ❑ No t5ins-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ,M 67 Crawford Road Property Address Gwendolyn E. Phillips Owner Owner's Name information is required for Cotuit MA 02635 October 1, 2009 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy(locate on site plan): Materials of construction: Dimensions Depth of solids Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins-09/08 Tide 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 17 r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 67 Crawford Road Property Address Gwendolyn E. Phillips Owner Owner's Name information is Cotuit MA 02635 October 1 2009 required for , every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view 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. Check one of the boxes below: ❑ hand-sketch in the area below ® drawing attached separately OteRcH U C K 0 ,3 -- ___ 3 ` w 1 C12AwFdR D RoAL) t5ins-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 15 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage.Disposal System Form - Not for Voluntary Assessments 67 Crawford Road Property Address Gwendolyn E. Phillips Owner Owner's Name information is required for Cotuit MA 02635 October 1, 2009 every page. Cityrrown 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: 30 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: 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: Barnstable GIS Department records _ You must describe how you established the high ground water elevation: Town of Barnstable GIS Department records indicate that the property is 30 feet above groundwater table. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 67 Crawford Road Property Address Gwendolyn E. Phillips Owner Owner's Name information is required for Cotuit MA 02635 October 1, 2009 every page. Cityrrown State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems)completed ® System Information—Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 TOWN OF BARNSTABLE LOCATIONff� 7 6rq e✓�l'o( �p SEWAGE# VILLAGE (.01 V II ASSESSOR'S MAP&PARCEL ' Z� INSTALLERS NAME&PHONE NO. SEPTIC TANK CAPACITY (UO U Q-A, a LEACHING FACILITY.(type) p t (size) NO.OF BEDROOMS OWNER. G wehd��`( � ph;1110 S PERMIT DATE: COMPLIANCE DATE: Separation Distance Between the: a 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 ®' eCH ' ,�►�S p ���1�6� Le(�H prr CK 3 35 -k 7 Z. 3 w I ZAWPORO RvR� THE COMMONWEALTH OF MASSACHUSETTS EOARD OF HEALT Appliration -fur 43hipati tl Works Cnowitrurtion Vrruift Application is hereby made for a Permit to Construct (, or Repair. ( ) an Individual Sewage Disposal Systt- ...?...a --- . -- . ......dam------- _--------- --------•------ Location ddre > or • Lot .... .......................................... ..... ... .....-•----------•......._................ ner ' Y .Address al0-=�t------------------------------- -------------------------------------------------------------------------------------------------- Installer Address Type of Building Size Lot----------------------------Sq. feet Dwelling No. of Bedrooms_________. Expansion Attic ( ) Garbage Grinder ( ) ---•-- pa, Other—Type of Building ____________________________ No. of persons............................ Showers ( ) — Cafeteria ( ) Ga Other fixtur W Design Flow__,....................... .f4", Ions per person per day. Total daily flow----------- gallons. WSeptic Tank Liquid capacit _ allons Length---------------- Width.............. ameter..........------ Depth..___----.----- x Disposal Trench— o. ............... .... idt i_--_-- _-- _-- _�' L .......- .._... of thing area--------------------sq. ft. Seepage Pit No_____ __________ Diameterl et .___.__. ._ Tot lea ping a a.._.___.__.j.__sq. ft. z Other Distribution box ( ) Dosing tank ( ) ��!%,o 7 / /7� aPercolation Test Results Performed by----------------------------------------------------------•----•-•-------- Date........................................ Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water-----------_-..-..-__-- (1 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water__.--._..__.___-_-_-_--- W -----------------------------------••---------•------•---------•------•-------------••-------. --------•--•------------------------------------------------- 0 Description of Soil------------------------------------------------------------------------------------------------------------------------------------------------------------------------ X V ---------------------•--------------------------------•-----•---------------------------------------------------------------•-------------------------------......._.........._........---------------- W ----------------------------------------------------------=------------------------------------------------------------------=-------------------------------------------------------------------------- U Nature 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 \I of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issue by e board of health. Signed - - '�3��� Date Application Approved By...... ------------ - - -- -­ ---��--- . =---- . / 7 i e � Application Disapproved for.the following reasons-..........................................------------------------------:----- -----••-----•--•-----•--------------------•---------•---------------•------•----•-•-----•---•---•--------------------------------------------------------------------- ... ... �te PermitNo.......................................................... Issued------ - - -- -- Date NO.6... '-�'� Fps .................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OAF, HEALT OF ApVfirtt#ion -fur Uiivuott1 Workii Towi#rurtion Prrmil Application is hereby made for a Permit to Construct ( ; or Repair ( ) an Individual Sewage Disposal System,It: `T "r' ---±try.....� .f__- t':e ''/ `r� 'fry' < --F"" _ . T._ E_...___._.._ q.........._ Location . ess f or I of No. zy.._ ,r ..................--- P w�rierp a `� a Address r..,l ---c c:.=- c'.__..sCT" -----•----- -----fs'' -O= •---- ---•--•---- -----•..... .......................................................... Installer Address Q Type of Building Size Lot............................Sq. feet U Dwelling No. of Bedrooms_------. ---_---_"Expansion Attic ( ) Garbage Grinder ( ) per, Other—Type of Building --"------------------------- No. of persons....____..__-_____-_____-.__ Showers ( ) — Cafeteria ( ) Q' Other fixtures.—- -__ __-_ . _ _ W Design Flow.- _._. allons per person per day. Total daily flow......... -:....._..gallons. Septic Tank Liquid capacity _ llons Length................ Width--------- . Diameter---------------- Depth--------------- Disposal Trench—No- -------------------- Width...... __..rA °o al ngthn......_.._.{.._._. o�leaching area_....".._--____.___sq. ft. Seepage Pit No _ ____-_ Diameter_.___ � `�' �E''P "� ______ �� ep h be t let_____ __f. Tot 1 leaching urea._-_.____.._.-..-sq. it. z Other Distribution box ( ) Dosing tank e�� IXt Percolation Test Results Performed by-------------------------------------------------------------------------- Date--------------------------------------- Test Pit No. 1----------------minutes per inch Depth of Test Pit-------------------- Depth to ground water--------------.___..__.. L7, Test Pit No. 2......•.........minutes per inch Depth of Test Pit"___________________ Depth to ground water------------------------ -------------------------------------------------------------------------------------------------------------------------•-•---------------------------------- 0 Description of Soil----------------...........................................................................................------------------------------------------------------------- x c.� ----------------------------------------------------------------------------------------------------- ----------------------•------------------------------------------------------------------------ W UNature of Repairs or Alterations—Answer when applicable----------------_------------------------------------------------------------------------------- ----------------------------------------------------------------------------------------------------------------------------------------------------------------------- .............. --------------- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance-with thelprovisions of Article NI of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health., �? Stgned_^ . --• -- -------- ---- - ------------------ f / u Date Application Approved By--- ,y�Y.------ � _ � ate Application Disapproved for the following reasons------------------------------------------- --------------------•----------------- -------------- -------------- Date PermitNo......................................................... Issued..------........--------------------------------------- Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH -� ? ,-' - �'r y ................o F.- •�t. .- .... ................ err#ifira e of 01.111whaurr T4M IS TO C� CFIFY,That the Individual Sewage Disposal System constructed ( ' ) or Repaired ( ) by----�r r -------- ,�; all* A Insytal*, �j ��_a. ---------- has been installed in ccordance with tfie provisions of Article of h State Sanitary Code as des b d.,,in the application for Disposal Works Construction Permit No------------- dated. . '' _. __.... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM W L .FUNCTION SATISFACTORY. DATE-_ --- 7r5---------------------•-----•-----•------- Inspector.--`------- -------- --- t THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH No....Z2. FEE---- �i��u�tti urk,� �uu��rur�iugt �rroti# . Permissionis hereby granted--------------------------------------------------------------------------------------------------------------------------------------------- 0-1 to Construct (, ) or epair ( ) an Individual Sewage Disposal System , at No.----- Street - ,• as shown on the application for Disposal Works Construction Permit No__________________- Dated_: -. _:- ---� .....--•--- ------ - - --- -----------•---•--------•-- C� ------------------------------ Board of Heal DATE--------- ------� �. ._. FORM 1255 BBS & WA REN. INC.. PUBLISHERS 1 - - _ ...r.r..+u.�.rn....nr.�aa.•n.��:�.�.v�....�.--�-...n.+-..—����w p � ter•®�s•^+�+�e.+wawsr•n. cizig cc.� F CJ R. 6 dc) 04J AIC i • 4 � �r,�1. dui E ` 7 S dfJ .S i f• 4 a r 1 • to . c7 cm WINDOW 5CNF-pUl-r _ a 5YM. MAMP. 5T)-LE TYPE RO OPENING ° 1 C1 A�N W0019MAacw VVPW4s6 'Z' 6 /8"X V-81/8" 400 SEIaES DOIBLE HlJr (� AJdMR-WN WOIODVVRICW CW235 . 40-9"X V-5•s/8" v .. 400 5em5 CASEMENT N Q-- OC ANDEIZSEN WO 017NAaQif Wgi2646• 2'-7 5/8"X 4' B 7/B" _ x _X 400%M5 1901BLEIiNG - _ .. . _ {.- ._....,NOP FwDER5EN A1F4014- 112ANSOM 3'-II1/4"XI'-31/4" r 400 5EK'IES ANt25R5EN.. DOU6LE HUNG,• fv1ATCN 51ZE TO EXISTING --... 400 SEKIE5 DEDROOM WINDOW p00F TAMING f'I,AN 3 82 3 5 9-32 4 72" 5CALE:1/4;,-1'-0" y TO PF-CK GL E•f 05 � i i i V I i MA51 � i 2X12 AS i Y. (Al yy C -, i , v � , �•IOWER BATHCNN (L • 1 �. I c9 I6"IO.G. � I i �'_e".s EXI nNG 28 i I Q Exi5TLNG pouwE-HUNG KIE1'CHF-N "OOM. NEW WINDOW TO MATCH - BATH DINING - �12AIV�ING M-AN j ExISnNG Ewsnwv . . MA5TE� PF-Pk SCALE:I/4"r 1.-0„ \ EwSnNG Q ! GAS 0 - EwSfING - to ' 6'-O" Ib'-O" +,,ii �ic�i� i iiiiii ii i iia/i ii �,i i ii i •i�ii/J'iai ii, r i %iin.ac6• call. ii , N N IZO c - J 95/. CO�MPACPDACKFILL,TWICALi ` '• =' PM91zOOM UVI EwGSPNG OM • Q 1, u6 r�rMJZ DRILLED,HAMMERED >EXI5nNG: Pr;t2l200M >.. „. AND GROUPED INTO EXISTNG N ' 1 FOUNDATION a 12"ON CENTER -1N -� "I 'PROVIDE ACCE55 FROM h I EX15nNG MENT ' EX15nNG FOUNDATION WALL-/ FIf?51- FL-0012 PLAN 7E P _ O 2 b 12 24 FOUNPA110N pI,AN �--� EwSmNa wa 1 �' 2 EXI5vNG GEARING WALL SCALE:I/4"=1'-0" 5CALE:I/4"-1. '-0" CD ®NEW GON511a.ICTION Al r ` 12 • ' •. • • ' •.. MAtfil E%15i1N4 fd7W 9tlN0.E5 r COMM A iya On O ` Moral E%ISTING SIGINw .q .. 0 .. t•RX' ROQC A.N L I6'-0" W-Ake MF-VA'nON EXI511NG wmoN snnmoN i 51t2r ELEVADON sc"I ro nwra•I EwSnNcl C MA-54ER OW) DEE [�FEII —_ — --_ rrper MLAOR_CLCVNI--------------- _ -- A.NMIOPI ____.__—____.—_—__ _ -____ rAP 1O''3" I _ a�vmON Exl� FROW F-i-t VAnoN 5C/'Ll;�I/4u�1"Au 51t2F-.F-LXVA,noN O 2 6 12 24 scN Wl II /4-0" w2 12 242 MWIM a 1611 O+C. 5 W/51MP50N -2.5A HUMICANM CLIPS 50 YR,A5PHALT 5HINOL1�5 TO MATCH -- W/HIJIMICANM NAILING PATTMRN 2XB COLL-AR TIMS c� l6'! O°C° 15 LP,PUILPIN6 FMLT 5/0" 053 PANML W/INTMORATMI2 M015TLM PARRIMR(TAM: %AM5>' MIN R-37IN5ULATION Sd NAIL-5c�6" O.C.MI7GM & FIML12 VAPOR PAla21MR 6TF_K —_IN Ix 5TRAPPIN6 PATH r � 2 x 6 5TUn5 1/2" 05D PANML W/INTMORATMI2 M015TUI2M PARRIMR C TAP. 5.AM57 MATCN MXISTINO FIRST F:LOOI2 MLMVATION 1! 20.IN5L9.ATION : _--- ------- VAPOR PARRIMR Sd NAIL-5 a 6" O.C.MtJGM 12 L. OI 5 I ".O :. 12" O.C.FIMLt2 51PIN6 110 MATCH C 2>4*-4 WMI3AR WITHIN 12" OF TOP OF r-OUNI2ATION e G ANCHOR 30LT5 c 45'' O.C. . �w✓Mf�NT 4" 6 MIL. a �VAPOI?PAMIMR s <2)#4 RM13AR WITHIN 3" IL OF 13OTTOM'NOF rOUNI2ATION C 3>#5 MPAR WITHIN 31 _ OF Perri-oM OF FOOTING •'• QO 20" i 5�GT10N A3 TOP OF FOUNDATION 24'diameter concrete covers COTUIT, EL=5 I.8 raised to within C'of hmsh grade MA (or as noted) 2 5' EL=49.7(mm) t2=49.6± EL=5aQmax) 4' 8.5' 8.5' 4' > �% v Gore R� m 48.9t Chambers v 4B.5t 47.6_+ a m mF LOCUS z c0 � �) v GEOrD(TILE I A13RIC in (INP1.�ICEOF 114"-1121PE45rONE) },-,/-� 48.3_ 47.75s l /� i ✓� _ 47.00 3/4"- 1-1/2"STONE J 0 R 47,50 47./7 = 4E.90 ,p N N n1 y� Gas Baffle v i 44.90 D-Box N eta TWO(2)5H0REYPRECA5T 500 N 27-}° }-- 32 Long9t Run GALLON LEACH CHAMOER5 WITH y 4+ _D DB-6 4'OP5TO/VEALL AROUND PLAN VIEW FL /500 GALLON (1-1-20 Rated) (ENO VIEW) 5fPTIC TANK D-BOX �` LfpA� �p5 SCALE: I" = 10' SITE LOCUS EL=36.5�-Bottom of Test flo% NOT TO SCALE (1HA/V1�,�/� F LOW PROF I LE 1 .) As5e5sor'5 Map 5 Parcel 29 CONSTRUCTION NOTES NOTTO5CALE INSTALLER TO VIE RIFYTHE LOCATION OF ALL 2.) Deed Book 24155 Page 295 TE5T HOLE LOGS UNDERGROUND AND OVERHEAD UTILITIES 3.) Plan Book 223 Page 39 LOT G2 PRIOR TO THE START OF ANY EXCAVATION 4.) Thl5 property is not in a Zone 11 of a Public 1.)ALL WORK SHALL CONFORM TO THE STATE ENVIRONMENTAL CODE,TITLE 5 (3 10 CMR )5.000): PLAN BK 223 PG 39 ACTIVITIES AND RELOCATE AS NECE55ARY Water Supply STANDARD REQUIREMENTS FOR THE SITING, CONSTRUCTION, INSPECTION, UPGRADE,AND Test Hole#1 (EL=50.0±) (SEE NOTE #�15) 5,) Flood Zone: C EXPANSION OF ON-SITE SEWAGE TREATMENT AND DISP05AL SYSTEMS AND FOR THE TRANSPORT AND DISPOSAL OF SEPTAGE, AND THE LOCAL BOARD OF HEALTH REGULATIONS. Depth Layer Soil Cla55 Soil Color Comments O� 2.) ANY SEPTIC SYSTEM COMPONENT INSTALLED IN A LOCATION WHERE THERE 15 POTENTIAL FOR VEHICLES OR HEAVY EQUIPMENT TO PASS OVER IT SHALL BE DESIGNED TO WITHSTAND AN H-20 I G" 7" O/A Medium Sandy Loam I OYR 211 �� ���� BH c LBth LOADING. IF UNDER AN IMPERVIOUS SURFACE, SYSTEM SHALL BE VENTED TO THE ATMOSPHERE, 17"-22" E Medium Loamy Sand I OYK 5/2 LOT 70 3.)TO MINIMIZE UNEVEN SETTLING, SEPTIC TANKS SHALL BE INSTALLED ON A STABLE 22"-28" B Medium Loamy Sand I OYR 5/G PLAN BK 223 PG 39 MECHANICALLY-COMPACTED BASE ON SIX INCHES OF CRUSHED STONE. 28"-52" C I Medium Loamy Sand I OYR G/8 Perc @ 4G" Bth 52"-138" C2 Medium Sand I OYR G14 Bdrm Kitchen Dining 4.) COVERS OVER THE INLET AND OUTLET TEES OF THE SEPTIC TANK,THE DISTRIBUTION BOX, AND DATE OF TESTING: OGI1 7/14 P#14395 Existing Leach Pit to be L� Garage THE 901L ABSORPTION 5Y5TEM SHALL BE RAISED TO WITHIN G"OF FINAL GRADE. LEACHING SOIL EVALUATOR: LINDA J. PINTO, P.E., C5N ENGINEERING Abandoned(5ee Mote #2I) FIELDS, TRENCHES, AND OTHER SOIL ABSORPTION SYSTEMS WITHOUT ACCESS MANHOLES 5HALL BOARD OF HEALTH AGENT: DONNA MIORANDI, BARNSTABLE HEALTH DEPARTMENT Bdrm HAVE AT LEAST ONE(1) INSPECTION PORT CONSISTING OF PERFORATED 4"PVC PIPE PLACED PERCOLATION RATE: LE55 THAN 2 MIN/INCH IN "C"LAYERS y Bdrm Living VERTICALLY TO THE BOTTOM OF THE SOIL ABSORPTION SYSTEM WITH A CAP,TIED WITH MAGNETIC MARKING TAPE, ACCESSIBLE TO WITHIN 3"OF FINAL GRADE, NO GROUNDWATER ENCOUNTERED LOT G3 5.) PIPING SHALL CONSIST OF 4"SCHEDULE 40 PVC OR EQUIVALENT, PIPE 5HALL BE LAID ON A S, 9' PLAN BK 223 PG 39 MINIMUM CONTINUOUS GRADE OF NOT LE55 THAN 2%FROM THE BUILDING TO THE SEPTIC TANK, I CERTIFY THAT I AM CURRENTLY APPROVED BY THE ' AND NOT LESS THAN I%OTHERWISE. DEPARTMENT OF ENVIRONMENTAL PROTECTION 8"tree i LOOKPLAN PURSUANT TO 31 O CMR 15.017 TO CONDUCT 501E S� ,r 7 y>i G.) DISTRIBUTION LINES FOR THE SOIL ABSORPTION SYSTEM 5HALL BE 4"DIAMETER SCHEDULE 40 EVALUATION5 AND THAT THE SOIL ANALY515 HAS h6 2G tree .. PVC(OR EQUIVALENT) LAID AT 0.005 FT/FT. UNLESS OTHERWISE NOTED. LINES SHALL BE CAPPED BEEN PERFORMED BY ME CONSISTENT WITH THE �1 NOT TO SCALE AT END OR AS NOTED. REQUIRED TRAINING, EXPERTISE, AND EXPERIENCE DESCRIBED IN 310 CMR 15,017. 1 FURTHER 7.) LINES FROM THE DISTRIBUTION BOX TO BE LEVEL FOR THE FIRST TWO(2) FEET BEFORE CERTIFY THAT THE RESULTS OF MY SOIL EVALUATION 50\ � 8"tree 1 2 tree PITCHING TO THE SOIL ABSORPTION SYSTEM, D15TPJBUTION BOX SHALL BE WATER TESTED TO AS INDICATED ON THE ATTACHED SOIL EVALUATION ASSURE EVEN DISTRIBUTION. FORM, 4RE ACCURATE AND IN ACCORDANCE WITH �' ° ° 3 10 Cqk 15.100 THROUGH 15.107 14"trees a p 8.) GROUT TO BE USED AT ALL POINTS WHERE PIPES ENTER OR LEAVE ALL CONCRETE STRUCTURES ° 4 IN ORDER TO PROVIDE A WATERTIGHT SEAL. fa ` ~\ LEGEND 'xta LOT 69 9.) HEAVY EQUIPMENT SHALL NOT BE ALLOWED TO OPERATE OVER THE LIMITS OF THE SEWAGE Linda J. Pinto, Certified Soil Evaluator °'' 14"tree twin Area=2 1 ,344 S.F.± EXISTING SPOT GRADE DISPOSAL FIELD DURING THE COURSE OF CONSTRUCTION OF THE SYSTEM, ( ��1 a . 0 24x5 PROPOSED SPOT GRADE 10.) IN ACCORDANCE WITH 3 10 CMR 15.22 1, ALL SYSTEM COMPONENTS 5HALL BE MARKED WITH EXISTING CONTOUR •O, a } = 34"tree 0 24- PROPOSED CONTOUR MAGNETIC MARKING TAPE. T 1 1.)THERE ARE NO KNOWN WELLS WITHIN I00'OF THE PROPOSED 501L ABSORPTION SYSTEM, 8 tree %\T m� w WATER SERVICE LINE 8 4 twin ° O OVERHEAD UTILITY LINES O u UNDERGROUND UTILITY LINES 12,) FROM THE DATE OF THE INSTALLATION OF THE SOIL ABSORPTION SYSTEM UNTIL RECEIPT OF S N 1 (f THE CERTIFICATE OF COMPLIANCE,THE PERIMETER SHALL BE STAKED AND FLAGGED TO PREVENT vj i G GAS SERVICE LINE USE OF THE AREA THAT MAY CAUSE DAMAGE TO THE SYSTEM. O JN OF,y� " Existm 5 is Tank i j EDGE OF CLEARING 8 �4 twin 9 � J � � TP-1 q to be Abandoned 1 �� J FENCE 13.) THE DESIGNER WILL NOT BE RESPONSIBLE FOR THE SYSTEM A5 DESIGNED UNLESS �� L+ l x �► CONSTRUCTED AS SHOWN ON PLAN. ANY CHANGES SHALL BE APPROVED IN WRITING BY THE �� LINDA J. ti� 1� (see Note#2/) ( Q�� a n a TEST HOLE LOCATION DESIGNER, 6 PINTO � �` ST SEPTIC TANK L sl �j J! ��` �� �� DB DISTRIBUTION BOX 14.)THE BOARD OF HEALTH REQUIRES INSPECTION OF ALL CONSTRUCTION BY AN AGENT OF THE 46 32 tree SAS SOIL ABSORPTION SYSTEM BOARD OF HEALTH AND THE DESIGNER. THE DESIGNER SHALL CERTIFY IN WRITING THAT THE -P -p 1/ )r'ti` a�wrc�m O �,�;�� SEWAGE DISPOSAL SYSTEM WAS INSTALLED IN ACCORDANCE WITH THE TERMS OF THE PERMIT ©� �G ' F `� 1 r AND THE APPROVED PLANS. 48 HOURS ADVANCE NOTICE 15 REQUESTED. SS1ONAt �. j �w ado ' ((r �o J OO 15.) LOCATION OF UTILITIES IS APPROXIMATE AND CONTRACTOR SHALL BE RESPONSIBLE FOR �Ill O 1 � �_ h DETERMINING THE LOCATION OF ALL UNDERGROUND AND OVERHEAD UTILITIES PRIOR TO COMMENCEMENT OF ANY WORK. THI5 INCLUDES, BUT 15 NOT LIMITED TO, REQUESTS TO DIGSAFE, l r (' .\°� O� REVISION 1 1/30/17: Replaced ADS units with Concrete Chambers, ANY PRIVATE UTILITY COMPANIES,AND THE LOCAL WATER DEPARTMENT. �A I� lqi_\�A Addition 15 Existing. I G.) CONTRACTOR SHALL VERIFY THAT ALL WA5TELINES ARE CONNECTED BY WATER TESTING LOT G8 50 1 �\ REVISION 09/OG/I G: Added Addition WITHIN THE DWELLING PRIOR TO INSTALLATION OF ANY SEPTIC COMPONENTS. PLAN BK 223 PG 39 ti /R �SC J 17.) CONTRACTOR SHALL VERIFY EXISTING INVERT ELEVATIONS PRIOR TO INSTALLATION OF ANY Prepared for:S2o � �' n.. Q SEPTIC SYSTEM COMPONENTS. S'% �� David * Susan Whelan 18.) INSTRUMENT SURVEY CONDUCTED FOR PROPOSED WORK ONLY. SITE PLAN SHALL NOT BE 5Y�TE M DES 1 G N CALCULATION 5 G7 Crawford Rd- Cotuit, MA USED FOR STAKING, OK ANY OTHER PURPOSES. SEWAGFDE51GN1=LOWREQUIRED.3BEDROOMDWELLING@ IIOGPD/5EDROOM Proposed Site * sewage D15po5a1 5y5tem 19.)THIS PLAN DOES NOT CERTIFY, GUARANTEE OR WARRANTY COMPLIANCE WITH DEEDED OR =ZONING BYLAWS, SPECIFICALLY, BUT NOT LIMITED TO,SIDELINE SETBACKS AND BUILDING HEIGHT 330GPDREQU/RED BENCHMARK 67 Crawford Ind., COtUIt, MA RESTRICTIONS. OWNER IS RESPONSIBLE FOR OBTAINING SUCH A DETERMINATION FROM THE 1 To Corner Concrete APPROPRIATE AUTHORITY. 5EWAGEDE5IGNFLOWPROVIDED: 7W0(2)500GALLCIV LEACHCHAMOER5 W/TH I p 4'OP5T0NEALLAROUND I Exi5tmg Bulkhead Prepared by: EL=50,00(Assumed Datum) 20.)TEST HOLES COMPLETED PER STATE ENVIRONMENTAL CODE,TITLE 5. SOILS CAN BE L- - - - -- --- -i VARIABLE AND TEST HOLE DATA IS NO GUARANTEE OF SOIL CONDITIONS IN OTHER AREAS. IF At=!(25.Dx l2.83) f 2(25.0 f /2.83)x2Jx.74 S ITE PLAN CSN SOILS DIFFER FROM THOSE SHOWN IN THE SOILS LOG5, DESIGN ENGINEER 15 TO INSPECT THE =349.3 GPD PROV/DED SOILS PRIOR TO PROCEEDING WITH INSTALLATION OF ANY SEPTIC COMPONENTS. 349 CPO PROVIDED>330 GPD REQUIRED SCALE: I" = 20' 21.}EXISTING SEPTIC COMPONENTS TO BE LOCATED, PUMPED DRY, FILLED WITH CLEAN SAND AND SEPTICTANKCAPACI7YR 0L11RE0: 3.30 CPO X200%a =660GF29REQU/Rff7 , ABANDONED IN PLACE, AREA TO BE COMPACTED TO MINIMIZE SETTLING. 5EPTICTANKCAPACI7YPROVIDED. l500 GALL ON PRO VIDED INSPECTION NOTE: 20 40 6d ENGINEERING A 6ARBAGEDISP05AL 15 NOT PERMITTED W 71Y 7HI5 DESIGN FLOW PRIOR TO FINAL INSPECTION BY THE ENGINEER,SYSTEM SCALE I "=20' NEEDS TO BE COMPLETE INCLUDING BUILDUP FOR COVERS, P.O.Boz201, Brewster,MA 02631 Phone:(508)274-7347 C:\Ocean5ide\05-Crawford\05-Crawford-5DS Plan.dwg [Dte,07131114 Scale: A5Shown I By: LJP I Check: MLA Project No.0514049