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HomeMy WebLinkAbout0128 CURLEW WAY - Health 128 curlew Way Cotu t F 02$"063 'P I TOWN OF BARNSTABLE LOCATION SEWAGE# -. �7-OY2— VILLAGE eZ7VI Ir-- ASSESSOR'S MAP&PARCEL INSTALLERS NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY:(type) X- 340 GI (size) NO.OF BEDROOMS OWNER PERMIT DATE: a2 COMPLIANCE DATE: 0 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 CC r q I Y q ,d No. 9D0( -0 3Z Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: i PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes ZippYication for �Biq ogal ztern Con-5truction Permit � p Application for a Permit to Construct( ) Repair( eUp'grade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. i-L-q 0-y Owner's Name,Address,and Tel.No. Assessor's Map/Parcel l-, Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. Type of Building: Dwelling No.of Bedrooms Lot Size 'q q sq.ft. Garbage Grinder A 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) 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. Sig Date Application Approved by Date Application Disapproved by: Date for the following reasons Permit No. 9 0 0-7 3 i — 3 Date Issued 1"0-7 ;Oo7-032- r . /� No. , ..'_ as Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: ' i PUBLIC HEALTH DIVISION TOWN OF BARNSTABLE, MASSACHUSETTS Yes tTipplication for 33igpogar 9p5tem Construction Permit Application for a Permit to Construct O Repair(Upgrade O Abandon O ❑ Complete System ❑Individual Components Location Address or Lot No. Los C jA-,e,., V`y Owner's Name,Address,and Tel.No. Assessor's Map/Parcel _ , Installer's Name,Address;and Tel.No. Designer's Name,Address and Tel.No. X. �•. ��.�„ Cow. ��—c�v�—sgo�-- Type of Building: Dwelling No.of Bedrooms Lot Size STi y yV sq.ft. Garbage Grinder P) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures 'li Design Flow(min.required) gpd rdDe� flow.provided gpd Plan Date Number of sheetsli / Revision Date Title '" Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) Date last inspected: F 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. 1 e Si Qe �\� � Date / 3 Application Approved b T4 Date Application Disapproved by: Y Date for the following reasons. Permit No. 02 0 07 O 3 -2— Date Issued l " 3!-071 THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS. Certificate of Compliance THIS IS TO CERTIFY,that_the On-site Sewage Disposal System Constructed ( ) Repaired ( V Upgraded ( ) Abandoned( )by 1 C 4 ,( _ .�- at aLS (�u r1 la«a C_1�1 has been constructed in accordance r with the provisions of Title 5 and the for Disposal System Construction Permit No. ,;-6o 7" O 3�` dated Installer p^ %y"Ct0�z Designer #bedrooms t3 Approved design flow gpd The issuance of this permit shall not jbe construed as a guarantee that the system will functio s esu n d. Date �/ / Inspector ---No. ——— -— -- a- 007 --------- —--——————————— ---- THE COMMONWEALTH OF MASSACHUSETTS FS IV y PUBLIC HEALTH DIVISION-BARNSTABLE, MASSACHUSETTS wigoal *pgtem Con truction Permit Permission is hereby granted to Construct ( ) Repair (� Upgrade ( ) Abandon ( ) -. System located at ( t,�� .o .� (` tr,cl-'0 and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided: Constructi n must e co pleted within three years of the date of this Date Approved by j j �4. 3'0" o m LANDRY n j 2'4" 31-4" m ° o N 0 o a o to 0 o ------------------------ o BASEMENT BUILD OUT 128 CURLEW WAY C tti COTU IT HALL 2'10" XISTING BEDROOM EEW BA H . ip (V N co 17-0° e0 ih NE CL (V � si 8i� 128 CURLEW WAY NEW BATH AND CLOSET COTUIT MA zG O 6 n Town of Barnstable Regulatory Services Thomas F. Geiler,Director '" "� • Public Health Division Thomas McKean,Director 200 Main Street,Hyannis, MA_02601 Fax: 508-790-6304 Office: 508-862-4644 Installer & Designer Certification Form Date: Sewage Permit-9 -�2-w 7 -03 Z—�Assessor's Map\Parcel � � Designer: �o��G-.��-- Installer: Address: Address: �— V''l On d was issued a permit to install a ( ate) (installer) septic system at based on a design drawn by (address) dated (d signer) _ I certit, 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. 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. OF A443, OJALA (Installer's Signature) CIVIL No. 30792 'P4G/s T O � t .0/ NAL ECG (Designer's Signature (Affix Designe tamp 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:Health/Septic/Designer Certification Form 3-26-04.doc i n ry LOT 5 TH-1 58,448f S.F. A � TH-2 0 0 J� EXISTING` Off\ 3 BR DWEWNG F v' 45, TOP OF QP FNDN = �� G j -_77.8' L_150 / •Op, �A w Curie Way 0 o r� 06-315 1 AS BUILT SEPTIC SYSTEM PLAN PREPARED FOR: LOCATION 128 CURLEW WAY COTUIT LINDA R YAN SCALE I" = 30' DATE FEBRUARY 7, 2007 off. 506-362-4541 � OF p,1y8 S,y fox 508-362-9880 �o` ARNE H cyG� down cape engineering, inc. o OJALA CIVIL N CIVIL ENGINEERS . 30 LAND SURVEYORS is G� 939 main st. yarmouth, ma 02675 — DA ARN ALA P.L.S., P.E. i� I FAILED INSPECTION COMMONWEALTH OF 1VAS;S��C. tlUSETTS +; �;�' r EXECUTIVE OFFICE OF ENVIRONME AFFAIRS =' ^rngi rye DEPARTMENT OF ENVI`R�ONI�IENTr�jI, +P6ROTECTION �j 1ry3gr`St N TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: (� Owner's Name: i Owner's Address: s AP Date of Inspection: rin V 4O �N CJ Name of Inspect (please print Company Nam C Mailing Address: Telephone Number: CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title.5(310 CMR 15.000). The system: Passes Conditionally Passes Needs Further Evaluation by the Local Approving Authority Fails Inspector's,Signature: Date: �3�G 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 I0,000 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 ****This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future under the same or different conditions of use. Title 5 Inspection Form 6/15/2000 page 1 Page 2 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: l� Owner: ' Date of Ins ection: / 7 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 1.5.304 exist. Any failure criteria not evaluated are indicated below. Comments: B. System Conditionally Passes:. One or more system components as described in the"Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health,will pass. Answer yes, no or not determined(Y,N;ND)in the for the following statements. If"not determined"please explain. The septic tank is metal and over 20 years old* or the septic tank(whether metal or not) is.structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will.pass inspection if the existing tank.is replaced with a.complying septic tank as'approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND explain: Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken,settled or uneven distribution box. System will:pass inspection if(with approval of Board of Health): broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced ND explain: The system required pumping more.than 4 times a year due to broken or obstructed pipe(s).The system will pass inspection if(with approval of the Board of Health):. broken pipe(s)are replaced obstruction is removed ND explain: 2 I — I ; Page 3 of I'1 T OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FOIUM PART A . CERTIFICATION (continued) Property Address: Owner: Date of In ection: C. Further Evaluation is Required by the Board of Health: Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect,public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which.will protect public health,safety and the environment: - Cesspool or privy is within 50 feet of a surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2. System will fail unless the Board of Health (and Public Water Supplier,if any)determines that the system is functioning in a manner that protects the public health,safety and environment: The system has a septic tank and soil absorption system (SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. _ The system has a septic tank and SAS and the SAS is within a Zone I of 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 th 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: Ill Pace 4 of 11 OFFICIAL.INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: r A Owner Date of spection: D. System Failure Criteria applicable to all systems: You must indicate"yes"or"no"to.each.of the following for all inspections: Y No 7Backup 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 V 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 '/2 day flow Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number / of times.pumped Any portion of the SAS, cesspool or privy is below high ground water elevation. i Any portion of cesspool'or privy is within 100 feet of a surface water supply or tributary to a surface / water supply. _ V Any portion of a cesspool or privy is within a Zone I 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 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. The system owner should contact.the Board of Health to determine what will be necessary to correct the failure. E. Large Systems: . To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. You must indicate either"yes" or"no?'to each of the following: (The following criteria apply to large systems in addition to the criteria above) yes no. the system is within 400 feet of a surface drinking water supply the system is within 200 feet of a tributary to a surface drinking water supply the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area,—I WPA)or a mapped Zone II of a public water supply well If you have answered"yes"to any question in Section E the system is considered a significant threat,or answered "yes" in Section D above the large system has failed.The owner or operator of any large system considered a significant threat.under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR I .304.The system owner should contact the appropriate regional office of the Department. 4 I y , Pa0e 5 of 1 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: Owner^ Date of 19peUion. 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 _ ere.any of the system components pumped out in the previous two weeks? V 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: . �Ye/o • � Existing information. For example, a plan.at the Board of Health. V _ ` 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)] 5 Page 6 of 11 . OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM, PART C _ SYSTEM INFORMATION Property Address: ` A . Owner: (J Date of In pection: / � J / FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design):_�3 Number of bedrooms(actual): DESIGN flow based on 310 CMR 15.203 (for example: 11.0 gpd x#of bedrooms): Number of current residents: Does residence.have.a garbage grinder(yes or no): /()U Is laundry on a.separate sewage system(yes or no):,,Z nif yes separate inspection.required] Laundry system inspected( e or no): Seasonal use: (yes or no.) ... Water meter readings, if available(last 2 years usage (Qpd)): 0.2-—611 Sump pump(yes or no):� � . Last date of occupancy: COMMERCIAL/INDUSTRIAL Type of establishment:.. Design flow.(based on 310 CMR15.203): gpd Basis of design.flow(seats/persons/sgft,etc.): Grease trap present(yes or no): Industrial waste holding tank present(yes or no):_ Non-sanitary waste discharged to the Title 5 system (yes or no):_ Water meter readings, if available: Last date of occupancy/use: OTHER(describe): GENERAL INFORMATION Pumping Records _ Source of information: ��S Was system pumped as part of the i spection(yes or ): If yes, volume pumped: gallons =How was quantity pumped determined?' Reason for.pumping: TYPE OF SYSTEM tic tank,distribution box,soil absorption system Single cesspool _Overflow cesspool Privy _Shared system(yes or no)(if yes,attach previous inspection records, if any) _Innovative/Alternative technology.Attach a copy of the current operation and maintenance contract(to be. obtained from system owner) _Tight tank _Attach a copy of the DEP.approval Other(describe): Ap roximat e of all components, date installed(if known)and source of information: P Were sewage odors detected when arriving at the site(yes or no): 6 Pate 7 of 1 1 OFFICIAL INSPECTION FORM —NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 6 Owner: Date of I pection: 5, �. BUILDING SEWER(locate on site plan)/* Depth below grade: Materials of construction:_cast iron 40 PVC_other(explain): Distance from-private water supply well or suction line: Comments(on condition of joints,venting; evidence of leakage, etc.): SEPTIC TANK:4(;1ocate on site plan) 40 r/ Depth below, Grad Material of construction: concrete metal_fiberglass polyethylene —other(explain) If tank is metal list age:_ Is age confirmed by a Certificate of Compliance(yes or no):_(attach a copy of certificate) Dimensions: Sludge depth: fJ Distance from top of sludge to bottom of outlet tee or baffle: J Scum thickness: 0 - G 1/ Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom 9f outlet tee,or baffl :�p How were dimensions determined: Comments (on pumping recommen ations, nlet and outlet tee or baffle condition, structural integrity, liquid levels � ,a�r�elated to outlet invert, evidence of leaka�e, etc.): / I1s` n p61 c /Z ,4 p GREASE TRAP; (locate on.site plan) Depth below grade: Material of construction:_concrete_metal_fiberglass polyethylene_other (explain): Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet.tee or baffle: Date of last pumping: Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): 7 Page 8 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property AddressVA' A- Owner:, Date of I spection: TIGHT or HOLDING TANK:/-)d (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: Qallons Design Flow: &allons/day Alarm present(yes or no): Alarm level: Alarm in working order(yes or no): Date of Iastpumping: Comments(condition of alarm and float switches, etc.): DISTRIBUTION BOX: (/ (if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: ,vU`�C Comments(note if box is level and distribution�to outlets equal, any evidence of solids carryover, any evidence of akage into or out of box tc.): /i — axw 7 �2t� PUMP CHAMBER: X-�O(locate on site plan) Pumps in working order(yes or no): Alarms in working order(yes or no): Comments (note condition of pump chamber, condition of pumps and appurtenances,etc.): 8 Page 9 of I 1 OFFICIAL INSPECTION FORM=NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) . Property Address: /) (. - Owner:Zr/ Date of In ection: 7 SOIL ABSORPTION SYSTEM (SAS): &,-ffocate on site plan,excavation not required) If SAS not located explain why: TYPe leaching pits,number: 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, ctzi CESSPOOL (cesspool must be pumped as part of inspect ion)(locate on site plan) Number and conf guration: Depth-top of liquid to inlet invert: Depth of solids layer: Depth of scum layer: Dimensions of cesspool: Materials of construction; _ - Indication of groundwater inflow(yes or no): Comments(note condition of soil, signs of hydraulic failure,-level of ponding, condition of vegetation,etc.): PRIVYq. &(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.): 9 Page 10 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE:SEWAGE DISPOSAL SYSTEM INSPECTION FORM: PART C SYSTEM INFORMATION(continued) Property Address:. Owner: At Date of Inspection: U Ax, C' SKETCH OF SEWAGE DISPOSAL.SYSTEM Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. I � J �a 4S 3It It V. ecy- Loco r C 10 Paae 1 1 of l l OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: c/ c Owner: t Date of In pection: / SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water �fee[ Please indicate(check)all methods used to determine the high ground water elevation: Obtained from system design plans on record- If checked, date of design plan reviewed: Observed site (abutting property/observation hole within 150 feet of SAS) Checked with local Board of Health-explain: �hecked with local excavators, installers-(attach documentation) 9JAccessed USGS database-explain: You must describe how you established the high group water elevation: I1 i } J r � Permit Number: Date: t�y Completed b a !,!GH GROUNtD,- f.,k ER LEVEL COMPUT/-`'.TlON...................................... lyf ' Sate Location: Gti Lot No. r y Owner: C. A IIYIf Address: Contractor: Addres.:_�__ STEP 1 Measure depth to water table to nearest 1/1:0.ii. . .................... ............................................... . .Data month/day/year >'- STEP 2 Using Water-Love! Rance Zone and Index.Well Map locate site and dcterm.ine: Appropriate rode;:weld................................ ✓F — C Water-level ranee zone .................... 1 1 I S T EP 3 Using monthly report "Current WaterResources.ConCli'ilo :5' � . determine current depth to water level for Index well STEP 4 Using Table of Water-level ;Adjustments for inde),well (STEP 2A), current depth to Water level for index well (STEP 3), and water-level zone (STEP 2B) determine water-level adjustment ..............:...... STEP 5 Estimate depth to high water by subtracting the water- level adjustment (STEP 4) from measured depth to water level at site (STEP 1) ............................................................ ��! !-it'i,11,, 14,--!iepro. L ble Icomputaiio l form, ar V,a TOWN OF BARNSTABLE LOCATION' _ SEWAGE. VILLAGE ASSESSOR'S MAP & LOT-:IJ� INStALLER'S NAME&PHONE NO. &-�rO 10 fti Cftlsftuc (br) SEPTIC TANK CAPACITY 147M 4 41 F f- LEACHING FACILITY: (type) DI'� lI Vi j oe q NO.OF BEDROOMS BUILDER OR OWNER b\-dLMP0Q bi) e-t-S PERMUDATE: 7— 7'6/" COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and 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 �J"a/4e t, 31 C ` TOWN OF BARNSTABLE g LO ATION ®�sS fZ 16 C 4ell& (✓0 y SEWAGE # !�7�— yo VILLAGE G® /* ASSESSOR'S MAP & LOT OZ S"43 INS`iALLER'S NAME&PHONE NO. �� sGflf Col�S�` SEPTIC TANK CAPACITY ®QO 91:71 LEACHING FACILITY: (type) d ©��Ql i��T (size) YXal NO.OF BEDROOMS 3 J�D BUILDER OR OWNER PERMUDATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and 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 �V �'�`� zq ''rV 3� �l 0 , 1 �� 063 No. 2 Fee THE COMMONWEALTH OF MASSACHUSETTS NLW P BLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS 0(ppYication for ]igpool *pgtem Cougtructiou Permit Application is hereby made for a Permit to Construct( or Repair( )an On-site Sewage Disposal System at: Location ress or Lot o. Owner's Name,Address and Tel.No. God G urn Gvrx y Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. Type of Building: Dwelling No. of Bedrooms Garbage Grinder Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow aJ® ®� gallons per day. Calculated daily flow )1L91�l' 4 �� gallons. Plan Date 5— 2 9 Number of sheets Revision Date Title Description of Soil lUe _ L/V/t,4e` .5; eamel Nature o5 Re 4irs or Alter#tio s(Answer w en applicable) �Do�l�� X&r e— � Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued th. Signed Date Application Approved by 0 Application Disapproved for the following reasons , Permit No. Date Issued No. ! Fee 1�!/ 11 THE COMMONWEALTH OF MASSACHUSETTS P BLIC HEALTH DIVISION -TOWN OF BARNSTABLE. MASSACHUSETTS 1 01p�plicatton for Mtgaal *p!56m Con!Aructton. Permit i Application is hereby made for a Permit to Construct( or Repair( )an On-site Sewage Disposal System at: Location Address or Lot o. Owner's Name,Address and Tel.No. Lc7-6 C I/r iv w,0 y Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. �Dr*�Gor� Ge,7:0 ` 77/-4W3 7 Type of Building: Dwelling No.of Bedrooms � Garbage Grinder Other Type of Building /CeCe No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow JUG 00 gallons per day. Calculated daily flow M42le'K gallons. Plan Date 5— 2 !� Number of sheets Revision Date Title Description of Soil Nature o1 Replirs or Alter4tio s(Answer w en applicable) / ®�9�� �� ✓ d"��� 4/ ,�/ r wr�� 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§ystem in operation until a Certifi- cate of Compliance has been issued o th. r Signed (Date ;A7 Application Approved by n Application Disapproved for the following reasons Permit No. / Date Issued -- -- — — -- — — �.. —� THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS Certificate of (Compliance THIS IS TO C FTIFY,tha the O -site Sewage Disposal System installed( or re aired/re laced )on by !��7`�7I o�zs for P P as ha be onstructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. dated Use of this system is conditioned on compliance with the prov' 'ons set forth bel . ---=�— ,� -------- --------------------- ___✓ . No. Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS Mi5pogar *p! tem Construction Permit Permission is he by granted to /' o t/ �Dy5/. to construct( )repair( )an On-site Sewage System located at L/✓ L�Lt/ and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. All construction st b com leted within two years of the date below. Date: Approved by .1JE51GN - ATA {G. SI��G Fib'✓IILI 3 $c.✓F<.��M� 4 x/ v 1 s r{:: r�� 6A13A(,E l�RIIJDE>Z �. , F ' FLOW - 3xllo.:33� 6- k` "4 �^ �s• Y SE"Prl C TAtl� ��i7 �(Ij�U` 41i5 LSD ^� IN 04 G . to a ti D1, Pm6A PIT GAL 3 S'twa /� n 1 ✓� 51 DEWdLL MBA =12 SF X 2•S' - 330 CPU, ,.�; � �� � / � BOTTOM AQF� 113 5F ,x ti TbML'e516N - 2-4-3 6f.P- ' OrAL VAI LY F'orJ = GpD " —'wAT" / ,Y PE2C V LATI ON 2A7E �� tc 48 � ��� 3 r . . or PETER.; k A�+aRo SULLIV41444 K:u� a No. 29733"`. " L BAXTEA `s No yma0i8 �p �FcIsTEP�O '1•IG•85 TF 5t; PVC• idr• aQ p fi Ih.7o '72, wsv�-ro I i'KT,vr �Nr. GAL 7/4 - — ✓ B`K sr fir.` eprIC F, Goo ro v 48.•7 9 q GAL _ TANL L 66. iy y� WA69EP '`�1�. QtL 5i"QuCruRE3. 5�r a^. it 44AVq_ 5ET �r Bc�w u►JS�ItAgt,� Sa�L. . x � u CC�1-I —I® Ply' "DNEIop� 'PlzvFl L�-,� LII �Ld tJ ct. — o ION Y go sGAL� L D70 rr 4a;t.Erd; t CFY[1 FY T#(AT T�{E FoyvA'1 Tati1 t PLAN �ERF�JCE� � l N�2eaN �oat'PLy�S wIr�4 -I�t:L I ELtIJE dT"QZ0PE-`f>I004L�LAW-D SuPa/EyatzS 79K; FLA NGT F3A/,ED oN nN 1�15T�c7�4tE1J'T" c / �w <_ E�JGI N EEt�s ,v(z�, / AIJD TNT oF�SEi"S Uz7C To ESTQBLISF� OPE��<'3r�,:�+J� 5�rzvILL� titASS . S AP LIG, P A N`r' z E v L1Yz -.i atz j �U r I I � c , SYSTEM PIROF LE [COTES LEGEND TOP FNDN. AT EL. 77.8' y ACCESS COVER TO WITHIN 6" OF FIN. GRADE ACCESS COVER TO WITHIN 3" OF FlN. GRADE ACCESS COMER (WATERTIGHT) TO 1. DATUM IS APPROXIMATE NGVD 100.0 PROPOSED SPOT ELEVATION WITHIN 6" OF FIN. GRADE /76.0- MINIMUM .75' OF COVER OVER PRECAST /` 2X SLOPE REQUIRED OVER SYSTEM 2. MUNICIPAL WATER IS EXISTING 76.5 10Ox0 EXISTING SPOT ELEVATION b 2" DOUBLE WASHED PEASTONE " LOCUS \*EXISTING FOR FIRST 2 OR GEOTE�rItE FABRIC3. MINIMUM PIPE PITCH TO BE 1/8 PER FOOT.POSED CONTOUR /r PRO ., **EXISTING 1000 3 MAX. 4. DESIGN LOADING FOR ALL PRECAST UNITS TO BE AASHO Oahe Zg *7 4, 100 EXISTING CONTOUR *EXISTING GALLON sEPTIC TANK H- 10 73. 2' ��- °�{e G GAS O ' 72.96' 7 '79' 5. PIPE JOINTS TO BE MADE WATERTIGHT. 3 000a 0001 W - EXISTING WATER LINE r72.72;"-, 0 p 0 a E__1 r_1 O O 0 6" CRUSHED STONE OR MECHANICAL p O 3 m M O E3 E3 6. CONSTRUCTION DETAILS TO BE IN ACCORDANCE WITH EXISTING GAS LINE COMPACTION. (1s.221 [z}) 2' p p C] Q 0 f C� C] a 70.72' MASS. ENVIRONMENTAL CODE TITLE V. stab G ' DEPTH OF FLOW = 4' Y TEE SIZES: 3/4" TO 1 1/2" DOUBLE WASHED STOKE 7. THIS PLAN IS FOR PROPOSED WORK ONLY AND NCT TO BE USED FOR LOT LINE STAKING OR ANY OTHER PUf;POSE. INLET DEPTH = ,0" OUTLET DEPTH = 14" ( 1 % SLOPE ( 1 X SLOPE) 8. PIPE FOR SEPTIC SYSTEM TO SCH. 40-4" PVC. 44' D' BOX g' LEACHING 5.72' 9. COMPONENTS NOT TO BE BACKFILLED OR CONCEALED T FOUNDATION EXISTING SEPTIC TANK FACILITY WITHOUT INSPECTION BY BOARD OF HEALTH AND PERMISSION OBTAINED FROM BOARD OF HEALTH. LOCUS MAP *THE INSTALLER SHALL VERIFY THE **THE INSTALLER SHALL CONFIRM MIN. LOCATIONS OF ALL UTILITIES AND ALL SEPTIC TANK SIZE AT 1000 GALLONS AND 10. CONTRACTOR SHALL BE RESPONSIBLE FOR CALLING SCALE 1"=2000't BUILDING SEWER OUTLETS AND ELEVATIONS ITS SUITABILITY FOR RE-USE BOTTOM TH-1 EL. 65.0 DIGSAFE (1-888-344-7233) AND VERIFYING THE LOCATION PRIOR TO INSTALLING ANY PORTION OF OF ALL UNDERGROUND & OVERHEAD UTILITIES PRIOR TO ASSESSORS MAP 25 PARCEL 63 SEPTIC SYSTEM COMMENCEMENT OF WORK. LOCUS IS WITHIN WP OVERLAY DISTRICT \ 11. EXISTING LEACHING FACILITY AND DBOX SHALL BE PUMPED AND REMOVED OR PUMPED AND FILLED WITH CLEAN SAND. 6, 12. ANY UNSUITABLE MATERIAL ENCOUNTERED SHALL BE TEST HOLE LOGS a' REMOVED 5 BENEATH AND AROUND THE PROPOSED . cs . LEACHING FACILITY. ENGINEER: DAVI'D FLAHERTY, R.S. WITNESS: DON DESMARAIS, R.S. DATE: JANUARY 26, 2007 0_ PERC. RATE _ < 2 MIN/INCH �- CLASS I SOILS P# 11599 yA o ELEV. ELEV. F 0" 4 77.0' 0" a 77.0' co SYSTEM DESIGM A/E A/E ram. LS LS GARBAGE DISPOSER IS NOT ALLOWED 1OYR 3/1 1OYR 3/1 DESIGN FLOW. 3 BEDROOMS 0 110 GPD 330 GPD 76.of USE A 330 GPD DESIGN FLOW B B LS LS N SEPTIC TANK: 330 GPD (2) = 66D 40" 1OYR 6/6 73.7' 48" 1OYR 6/6 73.0' **RE-USE EXISTING 1000 GAL. SEPTIC TANK -� LEACHING: Cp - SIDES: 2 (25 + 12.83) 2' (:74) = 1i GPD, C C ' ,_ PERC LOT 5TH-� `L�'I ��y BOTTOM 25 x 12.83 (.74 = 237 GILD a S.F., _ A� c - - -q MCS MCS TOTAL: 472 S.F. 349 GPD TH �- o q Fq BENCH MARK - CORN. OF USE (2 500 GAL. LEACHING CHAMBERS ACME OR EQUAL) m ui. CONC. BULKHEAD EL. 77.2 � ( WITH 4� STONE ALL AROUND 2.5Y 7/4 2.5Y 7/4 P N � CD U' 4 MA 144" 65.0' 126" 66.5' APPROVED DATE BOARD OF HEALTH NO GROUNDWATER ENCOUNTERED dam` 3XBR ISTING QP��/G DWELLING �� 3UA TOP DN F 77.8' .cS Curdew Way a TITLE 5 SITE PLAN OF 128% CURLEW WAY (COTUIT) - -k3- MA PREPARED FOR LINDA wHm*"'YAN _ DATE: JANUARY 26, 2007 Scale:1"= 30' PEW ploft , 0 15 30 45 60 75 FEET 2�1 73 \ off 508-362-4541 fax 508 362-9880 �ZN OFtf4, I�A OF U 9� I ARNE �c ,,/ ,ylb ��o� ARNE H H. m U own c cep e en g ire e erin g, in c. o OJALA OJALA cn� civil 0.26348 No. 30792 Cl VIL ENGINEERS E 0��TAR U LAND SURVEYORS J O.a�FG D t D TE ARNE H. OJALA, P.E., P.L.S. 939 Main Street - YARMOU THPOR T, MASS I)CE 0 -3 >5 06-315 RYAN.DWG (DDF).