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HomeMy WebLinkAbout0006 EISENHOWER DRIVE - Health Cot lit ' LA = 039 083 } f. �w. i i Commonwealth of Massachusetts L W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 6 Eisenhower Drive Property Address Walter Vaitkus Owner Owner's Name information is required for Cotuit Ma. 02635 9/05/2007 ' 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. Important: A. General Information When filling out ��C �' O�� forms on the - ,� 1 computer,use 1. Inspector: only the tab key c�n to move your Robert Paolini S 45 I 1 cursor-do not use the return Name of Inspector key. Capewide Enterprises,LLC Company Name r� P.O.Box 763 Company Address Centerville Ma. 02632 City/Town State Zip Code (508)428-4028_ _ S14454 Telephone Number License Number B. Certification 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 ma ntenance'of on�site sewage disposal systems. I am a DEP approved system inspector pursuant to Section=15.346 of Title 5(310 CMR 15.060).The system: ® Passes El Conditionally Passes ❑ Fails — rCD ❑ Needs Further Eval by the Local Approving Authority , 9/05/2007 , 1 Inspector's Signatur Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or,DEP)within 30 days of completing this inspection. If the system is.a shared system or has a-design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ""This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. 6 eisenhower dr.-08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments wM 6 Eisenhower Drive Property Address Walter Vaitkus Owner Owner's Name information is required for Cotuit Ma. 02635 9/05/2007 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: 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 toja 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 6 eisenhower dr.•08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 15 IY Commonwealth of Massachusetts W Title 5 Official Inspection, Form III Subsurface Sewage Disposal System Form.- Not for Voluntary Assessments ,M 6 Eisenhower Drive _ Property Address Walter Vaitkus Owner Owner's Name information is required for Cotuit Ma. 02635 9/05/2007 every page. City/Town State Zip Code' Date of Inspection B. Certification (cont.) B) System Conditionally Passes(cont.) ❑ 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): El broken pipe(s)are replaced ❑ obstruction is removed ND Explain: 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. s , 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 El 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 renvironment: ❑ 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. 6 eisenhower dr.•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 4„M 6 Eisenhower Drive Property Address Walter Vaitkus Owner Owner's Name information is. required for Cotuit Ma. 02635 '9/05/2007 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) C) Further Evaluation is Required by the Board of Health (cont.): ❑ 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 El ® Liquid depth in cesspool is less than 6" below invert or available volume is less than %day flow ❑. ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ JZ 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 El ® tributary to a surface water supply. 6 eisenhower dr.•06/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 15 . r— Commonwealth of Massachusetts Title 5 Official Inspection-Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments GSM 6 Eisenhower Drive Property Address Walter Vaitkus Owner Owner's Name information is required for Cotuit Ma. 02635 9/05/2007 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) D) System Failure Criteria Applicable to All Systems (cont.): Yes No ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of'a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] El ® 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 ❑ F. the system is within 200 feet of a tributary to a surface drinking water supply ❑ - ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA)or a mapped Zone II of a public water supply well If you have answered "yes"to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 6 eisenhower dr.•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments °M 6 Eisenhower Drive Property Address Walter Vaitkus Owner Owner's Name information is required for Cotuit Ma. 02635 9/05/2007 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)] 6 eisenhower dr.•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection. Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments GSM , 6 Eisenhower Drive Property Address Walter Vaitkus Owner Owner's Name information is required for Cotuit Ma. 02635 9/05/2007 every page. City/Town State Zip Code Date of Inspection D. System Information Residential Flow Conditions: Number of bedrooms (design): 4 Number of bedrooms (actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 440 Number of current residents: 2 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 d 2006:79,000 9 ( Y 9 (gpd)): 2006:Z9,000 Sump pump? ❑ Yes ® No Last date of occupancy: 9/05/2007 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: Last date of occupancy/use: Date Other(describe): 6 eisenhower dr.•06/06 Title 5 official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary.Assessments ,M 6 Eisenhower Drive Property Address 'Walter Vaitkus Owner Owner's Name information is required for Cotuit Ma. 02635 9/05/2007 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) General Information Pumping Records: Source of information: Was system pumped as part of the inspection? ❑ Yes ❑ 'No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology:Attach a copy of the current operation and maintenance contract(to be obtained from system owner) i ❑ Tight tank. Attach .a copy of the DEP approval. ❑ Other(describe): Approximate age of all components, date installed (if known)and source of information: 2002 Were sewage odors detected when arriving at the site? ❑ Yes ® No 6 eisenhower dr.•08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ;M 6 Eisenhower Drive Property Address Walter Vaitkus Owner Owner's Name information is required for Cotuit Ma. 02635 9/05/2007 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Building Sewer(locate on site plan): Depth below grade: 15"feet j Material of construction: ❑ cast iron ® 40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet feet Comments (on condition of joints, venting, evidence of leakage, etc.): Joints appear tight.No evidence of Ieakage.System vented through the house vents. Septic Tank (locate on site plan): Depth below grade: 1511 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: 1 0'6"x5'1 0"x57' Sludge depth: 1" Distance from top of sludge to bottom of outlet tee or baffle 30" Scum thickness Trace Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle 14" How were dimensions determined? Measured 6 eisenhower dr.•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 6 Eisenhower Drive Property Address Walter Vaitkus Owner Owner's Name information is Cotuit Ma. 02635 9/05/2007 required for 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.): Pump tank every 2-3 years.lnlet and outlet tees are in place.No evidence of Ieakage.Tank appears structurally sound. 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: bate 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): 6 eisenhower dr.-08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �M 6 Eisenhower Drive Property Address Walter Vaitkus Owner Owner's Name information is Cotuit Ma. 02635 9/05/2007 required for every page. City/Town State Zip Code Date of.Inspection D. System Information (cont.) Tight or Holding Tank (cont.) Dimensions: Capacity: gallons Design Flow: - gallons per day Alarm present: - ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No Distribution Box (if present must be opened) (locate on site plan): Depth of liquid level above outlet invert No Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any: evidence of leakage into or out of box, etc.): Box is Ievel:Box has two laterals with equal distribution.No evidence of solids carryover.No evidence of leakage into or out of box. ` Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No P 6 eisehhower dr.•08/06 Title 5 official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 15 Commonwealth of Massachusetts F Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments, ,M 6 Eisenhower Drive Property Address Walter Vaitkus Owner Owner's Name information is required for Cotuit Ma. 02635 9/05/2007 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): 1 Soil.Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: Type: ❑ leaching pits number: ❑ leach ing..chambers number: ❑ leaching galleries number: leaching trenches number, length: 5 infiltrators 11'x39.3'x2' ❑ 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.): Sandy drt soil.No signs of hydraulic failure.No ponding or damp soil. 6 eisenhower dr.•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 15 r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments s 6 Eisenhower Drive Property Address Walter Vaitkus Owner owner's Name information is required for Cotuit Ma. 02635 ` 9/05/2007 State. Zip Code Date of Inspection every page. City/Town p p D. System Information (cont.) Cesspools(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 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. J Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): I 6 eisenhower dr.-08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 15 i s Commonwealth of Massachusetts u Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 6 Eisenhower Drive Property Address Walter Vaitkus Owner Owner's Name information is required for. Cotuit Ma. 02635 9/05/2007 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. 44 LA Lr— c 6 eisenhower dr.•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System.Page 14 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 6 Eisenhower Drive Property Address Walter Vaitkus Owner Owner's Name information is required for Cotuit Ma. 02635 9/05/2007 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope ® Surface water ® Check cellar ❑ Shallow wells ' Estimated depth to ground water: Bottom.of leaching 40' feet Please indicate all methods used to determine the high ground water elevation: ® Obtained from system design plans on record 2002 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: As-Built Card Checked with local excavators, installers- attach documentation ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: Used: Gaherty& Miller Model 12/16/94 ground water elevations. Used: USGS Observation well data June 1992. Used: Technical Bulletin 92-000-01 plate#2 Annual ranges of ground water elevations. 6 eisenhower dr.•08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 15 Town of Barnstable Op 1HE 1pk Regulatory Services ,,,S,AB Thomas F. Geiler,Director MASS. 9� 1639 Public Health Division ArFD��p Thomas McKean, Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 This septic system inspection report was completed by a private inspector who is certified by the State of Massachusetts, Department of Environmental Protection. Although the Town of Barnstable Health Division received the original/copy of this report; this Division does not warranty the functionality of the septic system in the future nor does this Division agree with any technical observation s and interpretations contained within this report. In addition, by receiving this report the Town of Barnstable Health Division does not automatically approve the number of bedrooms listed within this report. The actual number of bedrooms approved at a particular property would-be listed on the "Disposal Work Construction Permit". If you should have any questions regarding this report,please contact the certified Septic System Inspector who conducted the inspection. TOWN OF BARNSTABLE SEWAGE# 3-S' .�a 5 . II LOCATION � bT`� _ASSESSOR'S MAP &LOT VILLAGE [ co 'S NAME&PHONE NO. IS INSTALLER 00 A 1 I K CAPACITY SEPTIC TAN � �i-rtaTe�t (size) LEACHING FACILITY: (type) !;!( fra y NO.OF BEDROOMS ,U E &OD t 0OL BUILDER OR OWNER LIANCE ATE: � p COMP I PERMIT DATE: Feet Separation Distance Between the: Facility Maximum Adjusted Groundwater Table and Bottom f f Leachingany ells gust /,f.fi, Feet 1 Well and Leaching Facility (I Private Water Supply on site or within 200 feet of leaching facility)Wetlands exist �� n Feet Edge of Wetland and Leaching Facility(Ifany within 300 feet f leaching facili tv Furnished by o c Y7 D 11ate TOWN OF BARNSTABLE LOCATIONtC `� SEWAGE # 0 7 VILLAGE CS t t-� i� ASSESSOR'S MAP&LOT c � INSTALLER'S NAME&PHONE NO._OE M?es C Am SEPTIC TANK CAPACITY 1..1!�-60 LEACHING FACELIrTY: (type)-�^�fr f rr,T r- (size) NO.OF BEDROOMS ` BUILDER OR OWNER La OD t PERMIT DATE: COMPLIANCE ATE: 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 1100 feet Pf leaching facili .- Feet Furnished by ISO AAf�� ci 3 ti p � o L-ePJaf,oEj Mole No. t FFE Q w t COMMONWEALTH OF MASSACHUSETTS 01 64,JrBoard of Health, /��S ,b/� MA. APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT Application for a Permit to Construct Repair( ) Upgrade( ) Abandon( ) - Womplete System ❑Individual Components Location a Joy S 1%F,1� Owner's Name Map/Parcel# 3 2 Address -Ip,0 ��X ��5� c, Lot# �-5 Telephone# ,06 7 -7 Installer's Name ��• tee-'l tU Designer's Name ✓C/h Address PA Address - �'� O S-1 Telephone# a 8.�� _oD8 Telephone# 7 6 Type of Building S- /,Iy/e —0,11/Z Lot Size 2,5-12 sq.ft. Dwelling-No.of Bedrooms Garbage grinder ( ) Other-Type of Building No.of persons Showers ( ),Cafeteria ^ ( ) Other Fixtures _ ,.�-r C �t ze 6IAM2, � Design Flow (min.required) "T � gpd Calculated design flow� Design flow provided-r— gpd ��yy t c 44 Plan: Date L/e oZOOZ-. Number o/f�sheets Revision Date �.�?* Title <� d���-i) b��� ` /�/ _ 31 Description of Soil(s) of 0, v CHRISM)Pvr, vrr -- Soil Evaluator Form No. Name of Soil Evaluator �� Date of Eval io A, !R• CIVIL DESCRIPTION OF REPAIRS OR ALTERATIONS9F�iST aEo SS��kAL t,,V,��v The undersigned agrees to install the above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and further agrees to not to place the system'nuoperation until a Certificate of Compliance has been issued by the Board of Health. Signed A 0 0M Date Inspecti -- QAd A— t aani Stl No. FE I l -64 ' 0 �,jrBoard of Health, "MA. Ot' APPLICATION FOR DI,SPOSAL SYSTEM CONSTRUCTION- PERMIT Application for a Permit to Construct Repair(,_) Upgrade( ;) Abandon( - )KComplete System D Individual'Components Location--, ,- � ;/��',�/�pl Owner's Name Map/Parcel, ..,, n 4+w Address `?d 13dr1( -a1f Lot# Telephone# fO8 .•+d O Installer's Name Desi ner's`Name Address i , ki", MA Address 33 ` o w A/, s,& A.4 Telephone# 508�-53�-�0!$ Telephone# '� d Type of Building -,-V "./y Lot Size/ ,�'�9 sq.ft. � f"" I Dwelling-No.of Bedrooms a, Garbage grinder"('-)"""""""- -Other-Type of Building "No.of persons Showers ( ),Cafeteria ( ) Other Fixtures _ 4f 6o�ra .c -Design Flow(min.required)© gpd Calculated/design flow Design flow provided gpd Plan: Date Gf C ,;©d't... Number,off sheets s f Revision Date Title ,ly G O�J-?,01`�C / f7 `i`/!S'h�IJ�Q�-� G Description of Soil(s) Soil Evaluator Form No. Name of Soil Evaluator s. t Date of Eval a v JOHIV 4-0-'DESCRIPTION OF REPAIRS OR ALTERATIONS I ,! ,J 7�/", CHI?A f-VOMER y N6S,A t 7 Y! ' J CIV 'WSTERtV �Q s r Ar sstnh,9 L The undersigned agrees to install the above;described Individual Sewage Disposal System in accordance with the pr ns _ 5 and further agrees to not to place system' 'operation until Certificate of Compliance has been issued by the Board of Health. Signed i � r r Date 101 Inspect o s v "sa . No. L Yoe FEE/�V / COMMONWEALTH OF MASSAC14USLITS Board of Health, ►rhJ ��/�''` MA. CERTIFICATE OF COMPLIANCE Description of Work: ❑Individual Component(s) ± Complete System The undersigned hereby certify that the Sewage Disposal Systems Constructed Repaired ( ),Upgraded ( ),Abandoned ( ) by: 01 a at has been installed in accordance with the pr vis ons of 310 CMR 15.00 (Title 5) and the approved design plans/as-built plans relating to application No. 11Adz-q4 , dated 5 k 03 Approved Design Flow 6a (gpd) � Y ' Installer , Designer: Inspector: • K5 Date: s 63 The issuance of this permit shall not be construed as•a guarantee that the system win function as designed. No.:;? Z y FEE COMMONWEALTH OF MASSACHUSETTS Board of Health, %Jd i r7,S'? " MA. ; DISPOSAL SYSTEM CONSTRUCTION PERMIT Permission is hereby granted to; Construct Repair( ) Upgrade( ) Abandon( ) an individual sewage disposal system at �� h�/l �� ����� as described in the application for Disposal System Construction Permit No. add `Ye , dated !/y Provided: Construction shall be completed within three years of the date of this per it. All local conditions must be met. 1 " r. n Form 1255 Rev.5/96 A.M.Sulkin Co.Boston,MA Date 5 10/ Board of Health ' �```���/ i�_Si CS of\�is� C0%1%4O AVEALTH OF M4SSACHUSETTS a } s�* EXECUTIVE' OF ENVIRONMENTAL AFF AIRS 1, DEPARTM T OF»E'��-IRO�ME\TAL PRO CTIO. ����� ,. ONE WINTER STREET. BOSTON. MA 02106 61" 292-i` G� �r E - 1 WILLIA�t F.V►7:LD 99T 7R�LDS C0 OFggR J c_rca GovCrnC 3... ,, - t+ t2 p1rA8tf�. ARGEO P.4L1 CELLL'CCI ._.. :-o��•r D.� D� STRC1-S Lt.Governor SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORkI 9Commissionr r:.PART A CERTIFICATION . :4 Property Address; tl�, t_\,06 Address of Owner CaL\ Date of Inspection ;�, "1 (If different) O.$1( gQSo� Name of Inspector: I (E,.DC am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000) Company Name:14}II(a`► 1'.c CA r1*rf-,j•R Mailing Address: ]2O /3ox e_37P!�4 . 1HA9,w-A 2Q /-� © 26'!�51 _ Telephone Number: r5e2�2 C,& o CERTIFICATION STATEMENT ceriii that I have personally inspected the seAize d!sposal systern a; this address and that the information reported beloNis true, accurate and complete as o-the time of inspec;,o The rnspec.on was performed baser on my training and experience in the proper ,functior, and maintenance o;on-s-te sewage d:sposa 5�stems The wsreT " .'�tl :w ._- " 1: ... .} ,?,.,-} rr,t � -s y . Concit,onait% Passes Neecs Furthe Ev 8� the.Local Approving Authority Inspector's'Signature: 'Date: z+ ' T:ie Svs:e-r Ins. o• sha!' subm a copy of this inspen report to the Approving Authorih within them (301 days of completing e: �; ct,o this inspection. It the s\stem is a shared system o' ha, a design floes. of 10,000 gpd or greater, the inspector and the system. owner shall submit the report to the appropriate regional office of the Depar.ment of Environmenta' Protection. The orig:na! should be sent to the system owner and copies :-n; to the buver, if applicable. and the approving authority. INSPECTIO% SUMMARY:—-Check At: B, C, or D: Al SYSTEM PASSES: I have not found any information which indicates that the system violates any of the failure criteria as defined in 310 CMR 15.303. Any failure criteria not evaluated are indicated below. COMMENTS: BI 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. Indicate yes, no. or not determined (Y, N, or NDr. Describe basis of determination in all instances. If"not determined",explain why not. The septic tank is metal, unless the owner or operator has provided the system inspector with a copy of a Certificate of Compliance (attached) indicating that the tank was installed within twenty (20) years prior to the date of the inspection; or the septic tank, whether or not metal, is cracked, structurally unsound, shows substantial infiltration or exfiltration, or tank failure is imminent. The system will pass inspection if the existing septic tank is replaced with a conforming septic tank as approved by the Board of Health. L , (revised 04/25!97) Page 1 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM r. PART CERTIFICATION (continued) = Y idt b s> # i L 7 e rgf 6N spas �r yf ti -N' *4-1 Property Address kd ", t 3' NK -* `41 Owner. * Date of Inspection: '. 3 �; .5,, �:r x M ., 1 ,.k lk .s B] SYSTEM CONDITIONALLY PASSES (continj�-d- k r r •r broken v i i n x i a r e o obstructed Sewage backup or breakout o. high static water level observed m the d str ut o box s du to b o pipes) or due to a broken, settled or uneven distribution box. The syste will pass inspection if(with approval of the Board of Health). Describe observations: �,r� ,t.,,•. broken pipe(s) are replaced obstruction is removed distribution box is levelled or replaced The system required pumping more than four times a year due to roken or obstructed pipe(s).-The system will pass inspection if twith approval of the Board of Health): broken pipets) are replaces „ rt obstruction. is removed r k t - i C] FURTHER EVALUATION 15 REQUIRED BY THE BOARD OF HEALTH: ` " '"' ' - _- r Conditions exist which require furthe•evaluation by the Board of ealth in order to determine if the system is failing to protect the public health, saie:v-and the environment. 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMI ES THAT THE SYSTEM 15 NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND SAF AND THE ENVIRONMENT: Cesspool or prn-, is within 50 feet of a surface w er . F z Cesspooi or priv\ is %%ithin 50 feet of a borderin vegetated wetland or a salt marsh. 2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH ND PUBLIC WATER SUPPLIER, IF APPROPRIATE) DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECTS THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: .., . _ _ The system has a septic tank and soil abso tion system (SAS) and the SAS is within 100 fee, to a surface water supply or tributan• to a surface water supply. The system has a septic tank and soil ab rption system and the SAS is within a Zone I of a public water supniv well. The system has a septic tank and soil a sorption system and the SAS is within 50 feet of a private water supply well. The system has a septic tank,and $oil sorption system and the SAS is less char. 100 feet but 50 feet or more from a private water supply well, uniess a w !I water analysis for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from hat facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm. Method used to etermine distance (approximation not valid). 3) _ OTHER (revised 04:25/9-) Page 2 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTIO'%FOR.'N Y= PART A CERTIFICATION (continued) w...:� Property Address: Owner: Date of Inspection: ` .. D] SYSTEM FAILS: ` You must indicate either "Yes" or "No' as to each of the following I have determined that the system violates one or more of the following failure criteria as fined in 310 CMR 15.303. The basis for this determination is identified below. The Board of Health should be contacted to'`d ermine'what will be necessan` to correct the failure. Yes No Backup of sewage into facility or system component due to an overloaded r clogged SAS or cesspool. Discharge or ponding of effluent to the surface of the ground or surface' aters due to an overloaded or clogged SAS or cesspool. Sta:ic hcu d level in the distribution boa above outlet invert due to overloaded or"'clogged SAS or cesspool. a Liquid depth in cesspool is less than 6" below invert or available olume is less then 1/2jdav`flov. Required pumping more than 4 times in the last year NOT due o clogged or obstructed pipe's . ~umber o!times pumped _ Anv pon,on of the So:! Absorption System, cesspool or priv is below the high groundwater eieyanon Am por::on of a cesspool or privy is within 100 feet of a urface water supply^or tributary to a surface water supply. Any por:ion of a cesspoo' or pri,.ti• is within a Zone I o'a public•well. An,. pciic- cf a cesspool or pri\,1 isvN•uhin 50 feet a private water supply wel! Am po^-or o'a cesspool or privy is less than 10 feet but greater than 50 feet from a private Hater supply well with no acceotable mate, qualm analysis. If the well ha been analyzed to be acceptable, attach cope of well water analysis for cohform bacteria. volatile organic compounds, mmonia nitrogen and nitrate nitrogen.' E] LARGE SYSTEM FAILS: You must indicate either "Yes' or "No- as to each of the Poll ing. The fo!ioN',rg cnter,a apply to large systems in.ad 'tion to the criteria above: The system se-ves a facilm with a design flow 10,000 gpd or greater (Large System; and the system is a significant threat to public hea!th and safet} and the environment cause one or more of the following conditions exist: Yes No . the system is within 400 feet of surface drinking water supply the system is within 200 feet f a tributary to a surface drinking water supply the system is located in a n' rogen sensitive area (Interim Wellhead Protection Area -IWPA) or a mapped Zone II of a public water supply-well) The owner or operator of any such system all bring the system and facility into full compliance with the groundwater treatment program requirements of 314 CMR 5.00 and 6.00. Please consult the local regional office of the Department for further information. (revised 04/25/97) Page 3 of 10 SL'BSLIRFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM 4 , M. PART B . _ .. CHECKLIST Property AddEess: Owner. %A Date of Inspection: Check if the following have been done: You must indicate either "Yes" or "No" as to each of the following: Yes '-t No Pumping information was provided by the owner, occupant, or Board of Health. None of the system components have been pumped for,at least two weeks and the system has been receiving normal flow rates during that period. Large volumes of water have not been introduced into the system recently or as part of this inspection. As built plans have been obtained and examined. Note if they are not available with N/A. i - The fac:lim or dwelling was inspected for signs o!sewage back-up. _ The wstem does not receive non-sanitan, or industrial waste flow. _ The site %%as inspected for signs of breakou:. _ All systen, components, excluding the so-1 AosorptionrtSystem, have been located on the site. - - The septic tank manhoies were uncovered. opened. and the interior of the septic tank was inspected for condition of r"C bafiies or tees. material o' construction, dimensions, deptn of liquid, depth of sludge, depth of scum. The size and locat,on of the Sol! Absorption SN-stern on the site has been determined based on: The facdiv, o)..ne• iano occupants. if difteren: from owners were provided with information on the proper maintenance of Sub-Surface Disposal System. Existing information. Ex. Plan at B.O.H: X _ Determined in the field 1i an,. of the failure criteria related to Part C is at issue, approximation of distance is T� unaccepiabie (t 5.302:3+;b'? S (ravioad 04/25/97) Page 4 of 10 • _r-.R t SUBSURFACE SEWAGE DISPOSAL•SYSTEM INSPECTION FORM PART C �N SYSTEM INFORMATION t ' Propertm Addtess_:'6SSS wi�Gr.� ram{ ( R�{ 'j'A Owner. �� !, ,�. l Date of Ihspection: FLOW CONDITIONS ' RESIDENTIAL: Design floes .p.d.,bedroom for S.q�S Number of bedrooms t Number o'current residents- Garbage g•, der (yes or not:--s Laundry co-^ected to syste (yes or no) Seasonal use ryes or no Water meter readings. if available !last two ?2 year usage (gpd): Sump Pump (ves or no): Lai: date o'occupancy COMMERC i'AUI!NDL'STRIAL: Type of establishmen: Design fio„ _gahonsida% r, , Crease trap present. tees or no Indus-ma! \'taste Holding Tani; present. Ives or no_ - ':on-samta-% waste discnargeci to the T!tie 5 system. ,ves or no \later meter readings. if ayailabie Las:Pave o, o OTHER: .De_cribe Last date of occ:oanc. ... GENERAL INFORMATION ,, PUMPING RECORDS and source of information - System pumped as par, of inspection: (,,es or no._�'N If yes, volume pumped _ ¢allons Reason for purnpmg TYPE F SYSTEM Septic tank/distribution box/soil absorption system Single cesspool Ovenlow cesspool Shared system (yes or no) (if yes,'attach previous inspection records, if any) . .- I/A Technologv etc. Copy of up to date contract? Other APPROXIMATE AGE of all components, date installed (if known) and source of information: 10TC Sewage odors detected when arriving at the site: (yes or no) (revised 04/25/91) Page 5 01 10 - a SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORNA ^.PART CiT x ..-.-` SYSTEM INFORMATION (continued) ,CAS Property Address: 9AM Qwf--� At L S Owner. Date of Inspection: BUILDING SEWER: (locate on site plan) Depth below grade. Material of construction. _cast iron _40 PVC _other (explain` Distance from private water supply well or suction li-t Diameter Comments: (condition of joints, venting. evidence of leakage, etc.) SEPTIC TANK:t,I1Z� (locate on site p&.n Depth belov,, grade 5/�N Material of construction: concre:e _meta _Fioergiass _Polyethylene _othenexplain If tani, is metal.��hs::,age _ Is age cor.:.rmec o-, Ce^;tica;e o: Compiiance _(Yes"No ~' Dimensions rbo lld l _...� Sludge depth /) (_ Disiance from top : $Iudee to boro of ou:ie: tee o• ba^le Scum thickness_6 Distance from top o: scum to top o` outlet tee or bale _ u Distance from bottom of scum to bo- n o,oale:tee crbar.e _J_�•__ how dimensions vvere determined 0, Comments y trecommendation for pumping, ronditl �. o nle: a. d outlt tees or ffles�depth of liquid level n relation to utlet,invert, strue ural integrity, evidence of leakage, e:c.i I i GREASE TRAP:�U (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: (recommendation for pumping, condition of i,ilet and outlet tees or baffles• depth of liquid level in relation to outlet invert, structural ,integrity, evidence of leakage, etc.; (re%,ised 04!25:9-,) Page 6 of 10 o ' SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM SYSTEM INFORMATION (continued) AA Propert. Addvess:-65S SftM)Q-5G ON ner. 1 Date of Inspection: ivLlU (G� n TIGHT OR HOLDING TANK: do 7ank.must be pumped prior to, or at time, of inspections (locate on site plan, ' Depth below grade: Material of construction. _concrete _metal _Fiberglass _Polyethylene —other(explain) Dimensions: Capacm­: galions ._ Design floe galtoris.da, Alarm level Ala m in „ork.ng orde• _ Yes: _ No Date of previous pu`nping Comments , (condition of inlet tee. condition o- a'arr, and float switches, etc.) DISTRIBUTION BOX: ' S (locate on site pa De,-th of liquid level aoo,,e outie: ime" W CUI &A Comments (note ;f vel and_.distributoor is ea- a eg.&c or solids carryover, evi rice of leaka, into or1put of box, etc.) ' iv PUMP CHAMBER: (locate on site plan. Pumps in working order: (Yes or No, Alarms in working order (lees or No Comments: (note condition of pump chamber, condition of pumps and appurtenances, etc.) (revised 04/25/97) Page 7 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C j! SYSTEM INFORMATION (continued) Property Addr-ss: WSS Owner: Date of Insperuon: a� � SOIL ABSORPTIONS �EM ISAS): (locate on site_pian, if possible; exca,. tjon not required, but may be approximated by non-intrusive methods) If not determined to be present, explain: Type: � leaching pits. number. �oX� w 4 Y leaching chambers, number._ leaching galleries, number: leaching trenches, humber,length: A leaching fields, number, dimension ,;; ,rt •w;}� � overflow cesspool, number � .., �...�w.. ,. Alternative system Name of Technologt Comments in,: condition of so '. s!grs`i hydraulic failure,-lev ' of ponding. c drttion getppn, etc.! a CESSPOOLS: (locate on site play Number and configura:-or Depth-top of liquid to inlet Inver, Depth of solids lave- Depth of scum layer. Dimensions of cesspoo: Materials of construction Indication of groundwate inflow tcesspool must oe pumpeC as par, of inspections Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) PRIVY:_�V (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.) (revised 04/25/97) Page 8 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORA' PART C SYSTEM I%FORMATION (continued) u Propert} Address: Owner:�ti l Date of Inspection: SKETCH OF SEWAGE DISPOSAL SYSTEM: 4 include ties to at least two permanent references landmarks or benchmarks locate all wells within 100' (Locate where public water supply comes into house) 4 [� 3 V 5 V Ay tie t 63- �i 6q- (revised 0{'25!57) Page 9 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) s Properh Addres. S�Mp �rlt�� k Owner: Date of Inspection: Depth to Groundwater feet - a R Please indicate all the methods used to determine High Groundwater Elevation: Obtained from Design Plans on record Observation of Site (Abutting property, obsemation hole, basement sump etc.) Determine it from local conditions Check +-ith local Board o- neaar Chec'K FE.titA maps N Check pumping records Check local exca,aiors. installers t_se L,crc Dana Desc:,ibe in vou,.oN% v-oro= ro%% %o:: established the Groundwater Eievanon. (Must be comp_ leted- U 1, 4 Cj I c- (rev.ud 04,'2519". Page 1C of 10 SOIL LOC SOIL LOC s PO N O TL'ST PIT it L'LBY.-48.2 O TL'ST PIT f'2 R. JOHN �., Q O - - -- 46 N `` �... FARREN � � .- - - -- TOPSOIL �• 7nPsolz &No. 33590 SUBSOIL SUBSOIL 48 �... � w. E. 24' ELEP.=46.2 24' .i Y.=470 CilEDIU�V SAND .YL'DIU.V SAND ELE / � M / p PERC TEST PERC TEST sR 17 J / �0lS 10cS / 156" ELrY.=35.2 158" ELEY.=36.o S NON0 No zo P-7324 2 ,C9 p hpp N �C ' p� PERC TEST CONDUCTED 2/15/90 BY CAPE & ISLANDS SURVEYING CO., INC. �►� ,` �' p�, WITNESSED BY ED BARRY, BARNSTABLE BOARD OF HEALTH. Q p �Oj �h. / PERC RATE: <2MIN/INCH. IN / y � DESIGN COMPUTATIONS 3 BEDROOM HOUSE - DESIGN FOR 4 BEDROOMS C3 'O I NO GARBAGE DISPOSAL •01 FLOW RATE 4(110) = 440 GPD „� oQ SEPTIC TANK SIZE:" 440X200%= 880 GAL. USE 1 ,500 GAL. TANK \/ �o�• I TITLE V MINIMUM � 6.0 46.0 / L.T.A.R. = 0.74 PD./S.F. PERC RATE = <2 MIN./INCH 0 0 6.4 SIZE OF S..A.S. REQUIRED 440/0.74 = 595 S.F. d 20.0 SIZE OF S.A.S. PROVIDED (10.83X39.25)+(50.08X2)2=625 S.F. > 595=OK U-) I v o 2'0 p 20 n "�" eox CAPACITY PROVIDED 625XO.74=462 GPD>440=OK W co • � 0 ' n o0., M o 0 0.3 �#, I w m w ri DECK CNJ o o NOTES 1i 0 M II 1500 GAL.�X2 1 . Installation and materials to conform to 310 CMR 15.000 (Title V-1995), Ln W w zo u- 0 12'0 S.T. Town of Barnstable Regulations and approved plan. o �, n- 2 0 � C 2. Inlet and Outlet covers of septic tank and cover of D box to be o -'- o a d' extended to within six inches of finished grade with extensions if needed. o N20 RICH CAPACITYINFILTAMR CNAAMER 3. Eighteen-inch minimum cover over S.A.S. and nine-inch cover over septic tank. N �2) O I END YIE1lN.T.S. 4. Contractor shall grade site to maintain a maximum of three feet of cover over \ e'7#2 �p1' I 4" sch! 40 P.1!c. S.A.S. Grading shall direct water away from house and away from S.A.S. 49x6 24.0 •'� 5. All stone used for S.A.S. shall be double washed. 6. Contractor shall install tees at septic tank in compliance with 310 CMR 15.227 s��• _� including Zabel-1801 HIP OUTLET FILTER. � AO 34'_�_ 1✓. tK �. PL�4N OF SEPTIC SYSTL'N \ PLAN VIEW: 1 =20 IN BAR STABL.L, (COTUIT) JU SSUCHUSETT F A REVIEW OF FLOOD INSURANCE RATE MAP COMMUNITY PANEL I NUMBER 250001 0015C DATED 9/19/85 LOT 14 EfSffArHONTR .DRIVT HAS BEEN CONDUCTED AND TO THE BEST OF MY INTERPRETATION, THIS PRE'P4RTO BY JOHN C. TlDUCKA, JR. DWELLING IS IN FLOOD ZONE C AND IS NOT LOCATED � SOO WITHIN A SPECIAL FLOOD HAZARD ZONE. PROFESSIONAL �NGIN�'ER 33 PROSP�'CT S'TRE'Tr IMYMSTON, NA 02364 (781) 585-4646 \ 48 Scales as shown October 4,,200,2 V l hereby certify that the lot comers, dimensions elevations, and setbacks to the proposed building or structure, including any outside protrusion `-- 46 LEl2'L 2' TfIEN such as decks, steps, bulkhead, overhang, chimney T.LF. = 50.00 INSTALL A-1B01 MArL ALTER (NIP) SL. 1/8"/FT MIAr 4" C.O. LOCUS IS ASSESSORS MAP 39, LOT ect., as well as the foundation as shown on this plan I:C.=49.0 F.0 48.8 FINISNED GRADE[4,ff 5�X.4.Y ® CJ?ADC�' PREPARED FOR: LADD & COMPAW are correct and conforming to the Town of Barnstable 1". 06T = 4720 � 4 o scfl 40 P.VC. P.O. BOX 1015 �� c ' sq�y /FT XIN BUZZARDS BAY, MA 02530 By-Laws and Regulatio2 1 4» D" BOX Y CHRISTOI hER O 1500 CAL. .SEPTIC TANX INP. IN=48.00 5- X20 LOfLOINC �( V OHN �` 11I7N SANITARY TL'L''S INY OUT=45.83 �O.2523 XIGX CAPACITY INFILTRATOR CMAOMRS �, C I V L c INLET TEE f0" BELOF FLOF LINE 8" STONE OVER COA(PACTED CEASE UNDER INT' IN = 45.5 N J J 1")90 � INY. IN - 46.85 BOTTON OF STONE= 43.D INY. OUT = 48.40 s vLE WA ti s 6" STONE OWR COA04CM0 BASE UNDER 3" _1/8" TO I DOUBLE 1lASfIED STOIC&' R S.A.` ,& I 48" 3/4" TO 1 1/.Z" DOUBLE KASXI'D STONE'ALL AROUND PROFILE' 14"- 3/4" TO 1 1/Z" DOUBLE' AASfIFD STONE BL'NL MAr Date Professional Land Surveyor Ar.TS. i ,SOIL LOG SOIL LOC 'JVA of&f O N TEST PIT it Ti'ST PIT #2 ^ � O L'LBY.=48.2 O dZBY.=49.0 JOHN ``�,, U - - 46 R. m /''� TOPSOIL & MPSOIL & FARREN ` _„-,- SUBSOIL SUBSOIL No. 33590 48 W. E. 24, ELr =46.2 24' ELrv-470 pk _� XEDIUX SAND XL•DIUX SAND PERC TL'ST PL'RC TL'ST / 00 M V 6 J s5r f [D X 456" Y.ELB =36.2 166" rLrV.-36.0 °�`�.��` / S NO H0 ND r0 P-7324 "J pp �pc �� PERC TEST CONDUCTED 2/15/90 BY CAPE & ISLANDS SURVEYING CO., INC. WITNESSED BY ED BARRY, BARNSTABLE BOARD OF HEALTH. �. Off' PERC RATE: <2MIN/INCH. DESIGN COMPUTATIONS - D / w / 3 BEDROOM HOUSE - DESIGN FOR 4 BEDROOMS C� -O NO GARBAGE DISPOSAL .O, / .0 FLOW RATE 4(110) = 440 GPD SEPTIC TANK SIZE 440X200%= 880 GAL. USE 1 ,500 GAL. TANK O TITLE V MINIMUM v� 6.0 o ' L.T.A.R. = 0.74 GPD. S'.F. PERC RATE = <2 MIN./INCH 46.0 SIZE OF S..A.S. REQUIRED 440/0.74 = 595 S.F. 2 0.0 SIZE OF S.A.S. PROVIDED (10.83X39.25)+(50.08X2)2=625 S.F. > 595=OK = 2.0 0 CAPACITY PROVIDED 625XO.74=462 GPD>440=OK U O 20.0 � "�" sox o o 0 /0�3 -P� NOTES w m o DECK o o I I o 0 w _ 4 ''' 0 `- 1500 GAL. 48X2 1 . Installation and materials to confo�,tt'sn. ,to; 310, CMR .15.000 (Title -V-1995) o o zo � 12•0 S.T. Town of Barnstable Regulations and approved plan. cn � 2 N o 2. Inlet and Outlet covers of septic tank and cover of D box to be o �`'� o i-- I extended to within six inches of finished grade with extensions if needed. O MO RICH C9PACITYJNFlLTJ?�ITOR CfIAXBER 3. Eighteen-inch minimum cover over S.A.S. and nine-inch cover over septic tank. O �� do-' rvl END YIPFN.T.S. 4. Contractor shall rode site to maintain a maximum of three feet of cover over N ' ��, O I 4 o scfl 40 P..P.c. g II direct water away from house and away from S.A.S. S.A.S. Grading shall d ec y y 7#2 4. asxo 24,p �'�� 5. All stone used for S.A.S. shall be double washed. �tK �0 6. Contractor shall install tees at septic tank in compliance with 310 CMR 15.227 including Zabel-1801 HIP OUTLET FILTER. V°� p s� P.1�4N OF S�'PTIC SY�SyZ7 7M PLAN VIEW: 1 "=20' IN S BA14NSTABLL; (COTUIT) JaSS44ChtUSZTTS A REVIEW OF FLOOD INSURANCE RATE MAP COMMUNITY PANEL T >¢ BIS.�'N1�Oh��'R 1�RIY r'' {� 919 85 L y NUMBER 250001 0015C DATED / / 0 .76 HAS BEEN CONDUCTED AND TO THE BEST OF MY INTERPRETATION, THIS PR�P14R 47,.V BY �.fOHN C. VMV 6j 4, JR. O DWELLING IS IN FLOOD ZONE C AND IS NOT LOCATED PROFESSIONAL �NGIN�'M? O WITHIN A SPECIAL FLOOD HAZARD ZONE. 33 PROSPECT S'TRETr fljV6 ON, NA 02364 \ t1781) 585-4646 48 Scales as shown October 4,2002 l hereby certify that the lot comers, dimensions \ elevations, and setbacks to the proposed building or structure, including any outside protrusion 4F) INSTALL A-fBOf ZABBL FJLTL'R �AIPf s�f/8/FTEXIN 4" CO. LOCUS IS ASSESSORS MAP 39, LOT such as decks, steps, bulkhead, overhang, chimney T.a F = 50.00 F.a=48.0 F C.=48.8 FINISHED CRADE 48.5.tXax. ® CR.4DE PRE PARED FOR: LAD D & CO M PAID � ,L111 . 4? ect., as well as the foundation as shown on this planAzz are correct and conforming to the Town of Barnstable INV OUT = 4720 4 o SCH 4o P Yc P.O. BOX 1015 s'�tit By-Caws and Regu/atio � a SL = f/4"/ ' ArIN. BUZZARDS BAY, MA 02530 cj!Ri�apm R �. s, of MA ' 0' BOX sue ' f500 CAL. SEPTIC T"Z' INV IN-46.00 5- IL20 L64,01W �1 V NO 25 23 7� ICHN t� O MITH SANITARY TEES JAW. OUT=45.83 fllCfl CAPACITY INFILTRATOR CHAXBERS i CIv L n N '' INLrT TEE f0" BELOF FLOF LINE 8" STONE OI2'R COMPACTED R4SE UNDER INP. IN = 45.5 1". M = 46.65 BOTTOM OF STONE= 43.0 No. 3 `90 0� 1Ar OUT = 46.40 . Ry s U LEA B" STONE OVER COMPACTED BASE UNDER 3" -f/8""TO f/2" DOUBLE' 1UMMSff STONE R S.A. , PROFILE' f4"- S14" TO f f%2" DOUBLE' #Ar SHED STONE B NEATXND y AL 4 Date Professional Land Surveyor N.TS.