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HomeMy WebLinkAbout0077 EISENHOWER DRIVE - Health 77�tEisenhower�Drive TOWN OF BARNSTABLE LQCATION 1 1tS Qn h oer a7r . SEWA-e5ds,l s P VILLAGE C i ASSESSOR'S MAA/P��&PARCEL '17fly'S NAME&PHONE NO �� SEPTIC TANK CAPACITY J Sn O LEACHING FACILITY.(type) , l°�r�h-cx-� (size) NO.OF BEDROOMS OWNER PERMIT DATE: DATI 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 0A10 . 3.7 35. 16 19 ' h r r r L L L L L L \ ♦ l ♦ ' h \ h h L ♦ ♦' \ ♦ 4 4 4 h 4 r \ ♦ \ \. ♦ ♦ 4 ♦ ♦ 4 k ♦ L L r r 4 4 4 \ L 4 - . 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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 ✓� forms on the � 4/ computer,use 1. Inspector: only the tab key to move your Patrick M. O'Connell cursor-do not Name of Inspector use the return key. Septic Inspection Services Co Company Name 189 Cammett Road Company Address Marstons Mills MA 02648 �nan Cityrrown State Zip Code 508-428-1779 S1 12855 Telephone Number License Number B. Certification car 1 certify kthat 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 4- was performed based on my training and experience in the proper function and maintenance of on site cc 0� sewage;disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of LL_ 1 Title 5(31-0 CMR 15.000). The system: y - �= = ❑ Conditionally Passes ❑ Fails Passes ```' ❑ Needs Further Evaluation by the Local Approving Authority i November 5, 2009 Ins ector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. i L? o 09-234 Malen.doc•08106 Title 5 Official Inspection Form:Subsurface Sew Disposal Syste •Page 1 f 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 77 Eisenhower Drive Property Address Steven Whalen Owner Owner's Name information is Cotuit MA 02635 November 5, 2009 required for every page. Citylrown State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® 1 have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: Tank is not in need of pumping at this time, leaching system shows no signs of surcharge or hydraulic failure. 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 09-234 Whalen.doc-08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 15 Commonwealth of Massachusetts w Title 5 Official Inspection Form ` Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 77 Eisenhower Drive Property Address Steven Whalen Owner Owner's Name information is Cotuit MA 02635 November 5, 2009 required for 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): ❑ 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. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. 09-234 Malen.doc-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 77 Eisenhower Drive Property Address Steven Whalen Owner Owner's Name information is required for Cotuit MA 02635 November 5, 2009 every page. Citylrown 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 ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than_day flow ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. 09-234 Whalen.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 77 Eisenhower Drive Property Address Steven Whalen Owner Owner's Name information is Cotuit MA 02635 November 5, 2009 required for 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.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes"or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (interim Wellhead Protection Area—IWPA) or a mapped Zone II of a public water supply well If you have answered "yes"to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 09-234 Malen.doc•08106 Title 5 Official Inspection form:Subsurface Sewage Disposal System•Page 5 of 15 C Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 77 Eisenhower Drive Property Address Steven Whalen Owner Owner's Name information is Cotuit MA 02635 November 5, 2009 required for 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 El ® 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)] 09-234 Whalen.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 77 Eisenhower Drive Property Address Steven Whalen Owner Owner's Name information is required for Cotuit MA 02635 November 5, 2009 every page. City/Town State Zip Code Date of Inspection D. System Information Residential Flow Conditions: Number of bedrooms (design): 3 Number of bedrooms (actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 2 Number of current residents: Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system?[if yes separate inspection required] ❑ Yes ® No Laundry system inspected? ❑ Yes ❑ No Seasonal use? ❑ Yes ® No Water meter readings, if available (last 2 years usage (gpd)): Sump pump? ❑ Yes ® No Last date of occupancy: Currently Occupied. 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): 09-234 whalen.doc-08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 15 r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 77 Eisenhower Drive Property Address Steven Whalen Owner Owner's Name information is required for Cotuit MA 02635 November 5, 2009 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) General Information Pumping Records: Source of information: Tank pumped 16-18 months ago. 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) ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): Approximate age of all components, date installed (if known) and source of information: Cpmpliance date: 7/31/97 Were sewage odors detected when arriving at the site? ❑ Yes ® No 09.234 Whalen.doc-08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 15 f Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 77 Eisenhower Drive Property Address Steven Whalen Owner Owner's Name information is required for Cotuit MA 02635 November 5 2009 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Building Sewer(locate on site plan): 1' Depth below grade: 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.): Septic Tank(locate on site plan): Depth below grade: 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: 10.5' long x 5.8'wide- 1500 gal. Sludge depth: 2" 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 6" Distance from bottom of scum to bottom of outlet tee or baffle 14" How were dimensions determined? Measured 09-234 Whalen.doc-08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 15 l Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 77 Eisenhower Drive Property Address Steven Whalen Owner Owner's Name information is required for Cotuit MA 02635 November 5 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.): Liquid level was found at bottom of outlet invert, tees are intact and clear. 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 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): 09-234 Malen.doc-08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 77 Eisenhower Drive Property Address Steven Whalen Owner Owner's Name information is required for Cotuit MA 02635 November 5, 2009 every page. Cityrrown 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 0 1. 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.): No solids or high stains present. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No 09-234 Malen.doc•08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 77 Eisenhower Drive Property Address Steven Whalen Owner Owner's Name information is required for Cotuit MA 02635 November 5, 2009 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.): Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: Type: ❑ leaching pits number: ® leaching chambers number: Infiltrators. ❑ 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.): No evidence of surcharge or saturation. 09-234 Whalen.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 15 Commonwealth of Massachusetts - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 77 Eisenhower Drive Property Address Steven Whalen Owner Owner's Name - information is required for Cotuit MA 02635 November 5 2009 every page. Cityfrown State Zip Code Date of Inspection 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 Depth of solids Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): 09-234 whalen.doc-08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 13 of 15 Commonwealth of Massachusetts - Title 5 Official Inspection Form A Subsurface Sewage Disposal System Form - Not for Voluntary Assessments s 77 Eisenhower Drive _ Property Address Steven Whalen Owner Owner's Name information is required for Cotuit MA 02635 November 5, 2009 _ 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. 37 35 16 19 r r r r r rrrr r r r r r r rrrr rrrrr r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r rrr r r rrr rrr r r r r r r r r r r r r r r r r r r r r r r rrrrr r r r r rrr , , r r r r r r r r r r r r r r rrr r , r r r r r r r r r rrr r r r r r r r r r r , r r r r r r r rrr r r r r r r r r r r r r r r r r r r r r r r r r r r r �, ,.♦.♦.♦r♦r,.♦r,r,.,r,r,r,r,r,r,r,r,r,r,�, r r r r r r r r . . . . . . . • r r r r r r r r Water Service Eisenhower Drive Commonwealth of Massachusetts Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 77 Eisenhower Drive Property Address Steven Whalen Owner Owner's Name information is required for Cotuit MA 02635 November 5, 2009 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: 20feet 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: USGS topo map and town GIS. You must describe how you established the high ground water elevation: Town groundwater contour map shows water at el. 25 and topo map shows property at el. 50. 09-234 Whalen.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 15 of 15 HS6-:-A Iq TOWN OF BARNSTABLE � t y LOCATION L`.'�^h y a P r t VC-6 o� ��I SEWAGE # - S VILLAGE CST�'A ASSESSOR'S MAP & LOT O INS T'ALLER'S NAME&PHONE NO. cL IJAtg uy SEPTIC TANK CAPACITY I S e - k LEACHING FACILITY: (type) t(NN �- of (size) 1I x 3'1 rX i 0" NO. OF BEDROOMS 3 BUILDER OR OWNER 5�c Anan Q �`L,r, PERMIT DATE:-7 - a i t COMPLIANCE DATE: 7 n�I -9 7 Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility i" 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 �J Feet within 300 feet of leaching facility) ` Furnished by Swr-Lfi e �n.c tn��r nc v a 0 v e , i -I� :v t No................_....... s� FRz THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH TOWN OF BARNSTABLE Appliratiun for Uiupuiial urk Ton .rurttun rrutit Application is hereby made for a Permit to Construct Zor Repair pp y ( ) epai ( ) an Individual Sewage Disposal System at* ................_........_.......................... ... .... ----• --........__.....------•••-•-•--•••----•--------•--•......-••-•-•---.....--••----=---------------. Location-Address or Lot No. ----------------- _ -• .....----••-----•------............--••---- ---........---.............•---.........---... Owner Address W nn � nst er Address U Type of Building Size Lot_:�4 3l.P5-----Sq. feet Dwelling—No. of Bedrooms...........................................Expansion Attic ( ) Garbage Grinder ( a a'4 Other—T e of Buildin YP g ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) 04 Other fixtures .........................................W Design Flow--------•---------------t!�D._.:.._�gallons per person peer day. Total dai�� ow........................ R.......gal}on$f WSeptic Tank—Liquid capacity..l�...gallons Length..(-(..A'._ 'Width.....4......... Diameter................ Depth...C.. .... x Disposal Trench—No. ........I........... Width......P.......... Total Length........7Y.... Total leaching area..... k"2!52sq. ft. Seepage Pit No--------------------- iameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( Dosing tank `-' Percolation Test Results Performed by.._.z_"`.....' f - .......'..'J Date_._ W G ft.............. ,T Test Pit No. I___��._minutes per inch Depth of Test Pit___.._1-- _ Depth to ground water_-_7.�fZ. fT4 Test Pit No. 2...____________-minutes per.inch Depth of Test Pit....../Z2_.__. Depth to ground water.7../._Zz...__.. a p ------------ Description of Soil--T- ---T ......................�..... errs C'¢nJ x ------------•...• -•----. U -----•.... ...:..... ...•----------••------------.--------------------.------------------------------------------------••-------------------- W V 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 TITLE 5 of the State Environmental Code—The undersign further agrees not to place the system in operation until a Certificate of Complia a e n iss=d by the bo rd of health. I Signed ---------------- .... -- --- -- ......---. ....---............................ -L `7 . ........ Date ApplicationApproved By ............�'► V...�.- ----------------------------------------------------------------- ......... Application Disapproved for the following reasons: .............. .................. .. ......................... .............................................. .---------- ------------------- ----- ------------------------------ ---------------- ----- ------I.......................................................__...........---........ .....------------------. .................................... qDate Permit No. ..---./.1,�........5577---------------------_-- Issued ....... - Date q� Fps....... ...... THE COMMONWEALTH OF MASSACHUSETTS ��� BOARD OF HEALTH TOWN OF BARNSTABLE Appliratilan for Diipusn1 ivorkg Tomitrurtinn runat Application is hereby made for a Permit to Construct ( I/) or Repair ( ) an Individual Sewage Disposal System at, -• .... ._..... ............... .................s...... - ...-----... ....._..-•-•-- Location-Address or Lot No. ................... ----------------------.------ --...................--•-^•---- wOner W (� Address ......... ................. ............. _......._.__._.;......._.--.(..f1_._.eq:._...-- tnstaler Address J UType of Building Size Lot_.. (-.' ::A_V<�-.... feet .-� Dwelling—No. of Bedrooms....................•------____--_-..___-__-Expansion Attic ( ) Garbage Grinder (�� Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) Q' Other fixtures ........................ . . W Design Flow........................//-1-------------gallons per person per day. Total daily flow........................ " .U.......gallons. x Septic Tank—Liquid capacity._A'U allons Length..�c.. _ '.. Width---- Diameter______________`Depth--- Disposal Trench—No..._....._i.......... Width.....___i.!...._._.. Total Length.........?`".... Total leaching area..... _sq. ft. Seepage Pit No--------------------- Diameter.................... Depth below inlet.................... Total leaching area....•.............sq. ft. Z Other Distribution box Dosing t k ( ) / / �c v�Tf�.2 .�� i.� zf.2r�✓� /U/ �>// Percolation Test Results Performed by -------------------- ----- =Y; Date ,---------•----•-•;; a Test Pit No. 1.... ___.----minutes per inch Depth of Test Pit___._..�2 .__ Depth to ground water.._../-..6_. - G4 Test Pit No. 2----G•.'-__minutes per inch Depth of, Test Pit....... ...... Depth to ground water__ ...._'._ ...... a ---_--------------------- O P .G'� �...... .... -••--..._... ------------------------- Description of Soil.__ . ...?_�'•5!-------------•------�........�'CJ C— �S�-�" �'� ���� V .............................................--•-----•••-•-------------•------•----•-••••-••--•--------•--•-•--•---•-----•---•-•••-•--•-----•---•-------••-------- W ----------------•-•-•----------------------------------------------------•-----------------••-----•------•----------•------------------------------------•---•-•---•----•---•••---------••-••-••._...•. U Nature of Repairs or Alterations—Answer when applicable.-----------------------------•---.._ ..................................""-.--._........ -•-----------------------------------------------------------------------------•----......-----.....---------•------------------------•--------•--------------------------------•--•-1................. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Complianceel?ias Ke'qnn issu by the bo rd of health. Signed - ... ------- - - -� - . Date ApplicationApproved BY (\ ..-�.. - ... ------------------------------------------------------------------- ------4_ -et--- Dat Application Disapproved for the following reasons• -------------------------...............................-- ----------- ------------ --------- ------------------------ - ------------------------------------- ................. ------------------ D. Permit No. ....... ..-"----.5�?----------------------- Issued ------------------ - e Date 1THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Certificate of C�uraylia ><.ce THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed or Repaired ( ) by....................................................... at ----------- has 9C ....... � Installer cam C (� . S ... �r-------------------------------------------------------------------------------- been installed in accordance with the provisions of TITLE �,of The State Environmental Code as described in the application for Disposal Works Construction Permit No. -. ..1..-.�,- �5;. .-.---...... dated' THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE....................... --------- -------------------------------------- Inspector ------......... ... ...................... t -4 --1 s, THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE FEE......l.r?.. ... Disposal Work.5 Tonntrudilan rrntit Permissionis hereby granted.............................................................................................................................................. to Construct (. or Repair ( ) an Individual Sewage Disposal System atNo........ ........ F�c � r ., --•--•-- � = '-----••--•------•---------•---------------•--•--•--.........-- Street GG r as shown on the application for Disposal Works Construction Per_it No._'/-�_� Dated......................................... �- % ... . ....-.----------•--^�--......--------•- . � f Board of Health DATE........------------.....--•-------'-----...... -•---...�--•--•------------••--- FORM 36508 HOBBS h WARREN,INC..PUBLISHERS f• TQWN OF BARNSTABLE G, LOCATION �- ay SEWAGE# S VILLA C��, ASSESSOR'S MAP&LOT a ��c wr -INSTALLER'S NAME&PHONE NO. i 5- ;SE'PTIC TANK CAPACITY II Sc�O :.7.EACHING FACILITY: (type) 16\At (size) lI X tily 10, NO.OF BEDROOMS BV.ILDER OR OWNER .PERMITDATE: �" 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 Feet on site or within 200 feet of leaching facility) N Edge of Wetland and Leaching Facility(If any wetlands exist qJ Feet '. within 300 feet of leaching facility) ' furnished by .. s , a Svs�1� 1 , 0 D v l K r�' ��7� No.. _....... Fsu...E0............ lop Og THE C MMONWEALT OF MASSACHUSETTS r;, rz,� BOAR® OF HEALTH '1 T 'Z ..... ................... .........OF........................................ ApplirFation for BiipnsFal Nforks (futwuurtinn Frrutit Application is hereby made for a Permit to Construct ( ) or Repair ( } an Individual Sewage Disposal System at: -- ... -- Location-Address or Lot No. ..... L 4 k.. .. �..4.co L c2................•---....--------•------------- at....1)jvl v�'.!t�,�Z,�--.-��_.......a<,r,p�t_���Q Owner p Address ... •• . .... �.W ....................................••---.......-•--•--- Installer Address d Type of Building Size Lot e/,�._C ..........Sq. feet U Dwelling .:3No. of Bedrooms..........NU.........................Expansion Attic ( ) Garbage Grinder ( ) Other—Type of Building ---------------•--••---•---- No. of persons........4 ---------------- Showers ( ) — Cafeteria ( ) a Other fixtures -- - - .................................................. W Design Flow....6.08-..?-b...............gallons per person per day. Total daily flow......_.3.Q._............__._....gallons. WSeptic Tank—Liquid capacity./CW..gallons Length................ Width................ Diameter________-___--_ Depth................ x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area--------------------sq. ft. Seepage Pit No...ftrl)------ Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box (L-,� Dosing tank ( ) `-. Percolation Test Results Performed by.......................................................................... Date........................................ aTest Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water_-_-_•_____-_-__-__-__-. Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water-------................. Ar' ODescription of Soil.......S4.A)b........................................................--•--------•--•••-•... -•-•-- -------------.---•---..-......._..._. x V ..............................................--•--••-•••-••---.....•••••-••....-•-------••----•-•-••-••----••--•------------•-------•-••-----••••••-----••••--------•.................••---•••-------- W ---------------------------------------------------•------------------------------------------•---------------•-------------------------------------------------------------------------•---•••-........ UNature 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 TITLZ 5 of the State Sanitary Code— The undersi ed further a s not to place the system in operation until Certificat ompliance haYbi y bo of liealth. . ........••-----•--••-••a- .... •••. Dat Application A proved EY---- - ------. � s• Date Application Disapproved for the following reasons:................................................................................................................ -------------------------------------------------------------------------------------------•--------...----------•-----••---•-•••---•-••-----•-•-------•••-----••••-----•-----•---••-•-••-•---------•--- Date Permit No.------. �.. ----•--------•----•--- Issued--------------- Z.. Date C - ' THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ........................................OF.......................... Applirati.on for Disposal Marks Tonstrnrtion ramit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: (� Location,Address ..................................... f✓_JVi�f!4 ....h...or Lot N Owner Address �QNZ........................................... h ._ ------------------------••----..............•. ------•-- Installer Address q Expansion Attic g S feet Type of Building Size Lot?!1.�.. Dwelling.3 No. of Bedrooms.._...... No. of persons _ ( ) Cafeteria Grinder ( ) per, Other—Type of Building ............................ p ......._.... Showers Q' Other fixtures ------------------------- -- w Design Flow...IR.046_.4.?6...............-gallons per person per day. Total daily flow-------- : .- ......................gallons. WSeptic Tank—Liquid capacity/1 :.gallons Length................ Width................ Diameter---------------- Depth................ x Disposal Trench No. ... Width.................... Total Length.................... Total leaching area__:__._______._...._sq. ft. Seepage Pit No...� Diameter.:.-._,,............. Depth below inlet..................... Total leaching area..................sq.ft. z Other Percolation DistributionT st Results Dosing tank Performedby -(----)--------•--•---------•-•-------------------••------ Date............................... a Test Pit No. 1................minutes per inch Depth of Test,Pit.................... Depth to ground water........................ Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ O Description of Soil........S -A`).6............ x w UNature 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 TITLF; 5 of the State Sanitary Code//.— The undersi ed further es not to place the system in operation until Certificat ompliance has b 8ue by bo of health. r �. Signed.. . `-- -- r g ...: .... ..:...: : ................ .. -- A ication roved B ` �• Date : = Date Application Disapproved for the following reasons---------------••-•------------------------------------••------•-------------------------------•------•.......... --•------------------------------------------• ----------------•-•---------•-------......----•-•---------•-------••-•---------------•• -----•---------------•-----•--------•---------------------...---- Dat Permit No. e - .`.- ....................... Issued_........................................................ Z—gs Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........................................OF Tatifiratle of TvmpliFanrr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) by ,,.,. ...................... ..._-•--- ...--._• -------- --•-----------•...... -•------•---•-•--•----•-_-- ..................•.......------------ ----- -- % + f Installer ............................... has been installed in accordance with the provisions of TITLE, j of The St to Sanitary Code as described in the - { application for Disposal Works Construction Permit No......... ............................ dated ..................... x THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE.... Inspector_..... --------------•--------------- + xt g ITHE COMMONWEALTH OF MASSA HUSETTS BOARD OF HEALTH r ...........................................OF No .::......-•-•• FEE........................ i �r �ttl nrkil Tnnstrnrtivit rrutit -----.----•-••---------------------------------- � .. Permission is hereby granted............................................-........._.------- �-._.....-•---•-•--- to Construct ( ) or,Repair ( ) an Individual Sewage Disposal S stem «� at No---- ---------.-Xr 1a-lk ty0_��: r . ..- e ............................................................. Street •• as shown on the application for Disposal Works Construction Perrxrrt n............. Dated.... J.. 1 ............................................ ............................................................ Board-of Health DATE........... r FORM 1255 A. M. SULKIN, INC., BOSTON - - or l �•4/LY .�La k/ /�QX� � �� G Pt� I �j SCI�T%G T•4N� ?" 33??C, ? .S 1 � � I Ca.. L. !J_i, ,EO/SPy3gL-R/-T�---(�S� './O�a _G.4G- �/a/ • � l o ' / � To-aL rocs/ /� �i 77E!:;,T44 .04//- .." .CLok/:p 350 ro, LYs...✓Gx! f-�G•�G.R,4.TG' : /"{�/ 2_.fil/.xt/.�.�C'�S � �'�Jo ;; ' - ; 45, It _ 1 Tyr r, --- X r Ft- y .7._.L � I ; .._ x- + -T �"t-�T i.�� i � ;._.�..�... �...I �•. >I r � --�I f I- -I t I , _t._.L. 1.-�' ; i''-�-'r `..f r-i _,-r_� r•-r--jf- � �- �-+_+.nl 1 t.� 1 � r 1 i I"_�� � � + ' I 1 I r I ., t ' +. I I � - -� ,-t I. � n •�/ys ,�'�- �/off - � „ .,. ..�., , ��rL �. w / 1 46 j?t/ /,�/✓ GAL.: . o L G4[r. o Soo Px�X � SL- G � s IAIV - I,i/45�1ED S Z •� f?L�T" RL.cin/ t9�OF "A Ll 70.o a�' oy. .: _ —/dGA C ;Z©7W.1 ►.(�W4RbAR�BAi : ow�,y �ewl-" �La�lC�El2 �/GG' M SgouaL �� L o77 SOIL ' TEST MINIMUM FROM CELLAR G l . TOP OF fdUNDATIQN ._,..�..... _ _..,.._ DATE OF SAIL TEST MUSES_EN NEE°RI , 10 FT. MINIMUM FROM SLAB OR CRAWL SPACE SOIL TEST'DONE BY GI NG �� 3O FT. MINIMUM _ .; o L TE - 1=LEV. CLEAN SAND - WITNESSED BY �ditz f"l CONCRETE ,c^ - _ / a COVERS LOAM AND SEED ELEV. 9 OBSERVATION.MOLE 2 ELEv. » OBSERVATION HOLE . ,1 _��____ _ 4 SCHEDULE 40 PVC PIPE + & " �-`f MIN./INCH INCH AT 60 INCHES PERCOLAfidN RATE G L MIN. NCH AT � INCHES MIN. PITCH 1/S PER "FT. PERCOLATION RATE N / + 2 LAY'L"R OF , ' » Tor DEPTH HORIZ TEXTURE COLOR MOTT. OTHER DEPTH HORIZ TURE COLOR MOTT. I OTHER. 4 WASHEC, STONE VENT » 1A _. _ _ :4 CAST IRON PtPE .- 7�?__.. .._.__ ._... .._.._.....,..-_:;.: .+ _.�_.._�_ _ NOT REQUIRED OR EQUAL MINIMUM 7 C . T. OF ✓'i ` PITCH,1`4,. PER FT. _ t CU F �" u�t CONCRETE g. 3 7 .J ANCHOR ,►} SA FLOW:UNE .. _.. � .' L c�st.mot y l i� a _T t 7 ? ,v J ELM MIN. » O a ,, "� ,A.✓ ++ F+ � R , s f 9 S`4 2 a H a , ,oa /�yJ '7 ELEV. - if5i o'rar� i'aN ado s�v=•9`.. r �.' / .. LEVEL o r »mc.I,�- , , i '� a:. ,, ELEV .. » .��x , ������_,'�c r R., art�,Y `1k 1 6 SU P Y 7 _L tr. ELEV. -'t3 X T GAS ELEV. � �`�_9 ELEV. � II � // '�,� ,�' a BAFFLE fG' /6 R U ON - : - DLST IB TI ;� ELEV. l {a�i�S� I y OU'TLET i r ? tZ LIQUID p ��- _. INFILTRATORS WITH STONE IN AN y j 12A �'2 6"" "� � z BOX „at� f1 f2 �q„ t, Z 29✓ Z. (TO BE PLACED ON FIRM $ E) i w r 4 FEET 14 INCHES TO BE WATER TESTED 1 R �I ��Y � 0 TRENCH FORMATt.?N T 19 INCHES AN ON OUTLET ---� - 5 .FEE IF MORE,TN E TLE , . ,� 20 7,9 a ��2� 7 24 INCHES 1500 GALLON /' 6 _FEE . , c WELL �� WATER ENCOUNTERED AT / ELEV. � � /� WATER ENCOUNTERED AT ELEV. 7 FEET 29 INCHES (TO BE PLACED ON FIRM BASE) SOIL ABSORPTION � 8 FEET 34'1NCHES S EP`n C TANK f ZONE 3/4" TO 1 1/2" SYSTEM (SAS) . -, INDEX l WASHED STONE ADJUST LEGEND: DESIGN CALCULATIONS *" S WATER TABLE ELEV. - EXISTING SPOT.ELEVATION . 00,0 NUMBER OF BEDROOMS -. U�C�S PROBABLE lAT>_ SEWAGE DISPOSAL SYSTEM PROFILE OBSERVED WATER TABLE ELEV. _ _ EXISTING CONTOUR --�-- DO--•-- GARBAGE DISPOSAL UNIT NOT TO SCALE BOTTOM (OF TEST HOLE ELEV. . 7 FINAL SPOT ELEVATION : �0, TOTAL ESTIMATED FLOW FINAL CONTOUR ( /fib GAL/BR:/DAY X _ BR:) GAL/DAY SOIL TEST LOCATION �j REQUIRED SEPTIC TANK CAPACITI GAL. o fs UTILITY POLE SOILUAL SIZE OF CLASS CLASSIFICATION TIC TANK GAL ' t,t" ed TOWN WATER W �- W ( \ < 5 MIN. t .��r�"EC��i� � CATCH BASIN `�� DESIGN PERCQLATIQt`I RATE fiN. gin0 GAS LINE G EFFLUENT LOADING RATE 0.74 GAL/DAY/S.F. y 100, LEACHIN AREAtZ) 2 SO. FT. LEACHING CAPACITY (AREA X RATE) '� " Z.GAL./DAY RESERVE LEACHING CAPACITY GAL./DAY r :. �-.. NOTES: 1 TITLE SRANDNTHEPTOWN OF fTALS srLnCO FORULES ANDP. f L AND MATE , REGULATIONS FOR THE SUBSURFACE DISPOSAL OF SEWAGE. 2. ALL COVERS TO SANITARY UNITS SHALL BE BROUGHT TO WITHIN 6" OF FINISHED GRADE. (© .Z 3. ALL COMPONENTS OF THE SANITARY SYSTEM, SHALL BE CAPABLE OF / WITHSTANDING H-10_LOADING UNLESS THEY ARE'.UNDER OR WITHIN / 10 FT. OF DRIVES OR PARKING AREAS. H-20 LOADING SHAD. BE ! USED UNDER OR WITHIN 10 FT. OF DRIVES OR PARKING AREAS. TO GRADE SHALL 4, ANY MASpNARY UNITS USED TO BRING COVERS , BE MORTARED IN PLACE. 5. NO -D9fERMINA1ION HAS BEEN'MADE AS TO COMPLIANCE WITH �' J DEEDED OR ZONING REGULATIONS. CWNER / APPLICANT IS TO I� -! OBTAIN SUCH DETERMINATION FROM APPROPRIATE AUTHORITY. t\1 / b�„ ✓`1 6. IS TO CALL LITIES 4D G"DIGWN ARE -800—22MATE L-4844 AT LEAST EXCAVATION CONTRACTOR PRIOR:TO COMMENCING WORK ON SITE, At � �$'1 7. CONTRACTOR IS TO VERIFY GRADES AND ELEVATIONS AS...WELL AS dA c SITE CONDITIONS PRIOR TO COMMENCING' WORK ON SITE. 8. PARCEL IS IN FLOOD ZONE ��, --�� 9. LOT IS SHOWN ON ASSESSORS MAP � AS PARCEL _.9.G._._. r , :' 12 2,�i t g � 1 p'ra G`rts `, t { .' q,` ('fit (�. i".9' clklPL of "rt b X P`' i # v.27 �" 4 APPROVED: BOARD OF HEALTH .rr_ DATE AGENT I ..._. .� � � PROPOSED - SEPTIC DESIGN FOR Ally I C�lb ' PROJECT LOCATION ~��~ _, - b ' b S W E'.E`TSER ENGINEERING 235 GREAT WESTERN ROAD P. 0. BOX 713 SOUTH DENNIS, MASS. 398--3922 0256tJ / DATE SCALE w REVISED JOB NO. REVISED LOCATION MAP SN EET / `OF C� i -01996 :SWEETSER ENGINEERING