Loading...
HomeMy WebLinkAbout0015 ELMWOOD CIRCLE - Health L15 ELMWOOD CIRCLE, COTUIT A= 010 030 I No. 4210 1/3 a pand US ESSELTE 10% ( S mwcod Can-lei cakw�" IL Commonwealth of Massachusetts /r�/I d�b- 030- 00..-� - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments f-0 ,M 15 Elmwood Circle 'U Property Address I n Nathaniel Fried ae der Owner Owner's Na a9 information is required for every Cotuit Ma 02635 8-24-15 page. City/Town State Zip Code Date of Inspection 1 4 .. rn Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When A. General Information filling out forms on the computer, use only the tab 1. Inspector: key to move your cursor-do not Matthew F. Gilfoy use the return Name of Inspector key. B&B Excavation Q Company Name 14 Teaberry Lane IXA Company Address Sandwich Ma. 02644 City/Town State Zip Code (508)477-0653 SI13640 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority X �A, 8-24-15 Insp or'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. t5ins•3/13 Title 5 Official Inspection Form:Subsew al S�em•Page 1 of 17 P 9 P Y g Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 15 Elmwood Circle Property Address Nathaniel Friedlaender Owner Owner's Name information is required for every Cotuit Ma 02635 8-24-15 page. Cityrrown 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. Check the box for"yes", "no" or"not determined" (Y, N, ND) for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 15 Elmwood Circle Property Address Nathaniel Friedlaender Owner Owner's Name information is required for every Cotuit Ma 02635 8-24-15 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which 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 t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 3 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °M 15 Elmwood Circle Property Address Nathaniel Friedlaender Owner Owner's Name information is required for every Cotuit Ma 02635 8-24-15 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for 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 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 '/2 day flow t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 15 Elmwood Circle Property Address Nathaniel Friedlaender Owner Owner's Name information is required for every Cotuit Ma 02635 8-24-15 page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed i e s . Number of times pumped: ppO P p ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area— IWPA)or a mapped Zone 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. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 15 Elmwood Circle Property Address Nathaniel Friedlaender Owner Owner's Name information is required for every Cotuit Ma 02635 8-24-15 page. Cityrrown State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes" or"no" as to each of the following: Yes No ❑ ® Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ❑ ® Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ❑ ® Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms (design): 4 Number of bedrooms (actual): 4 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 550 t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 Commonwealth of Massachusetts 4 W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �M 15 Elmwood Circle Property Address Nathaniel Friedlaender Owner Owner's Name information is required for every Cotuit Ma 02635 8-24-15 page. Cityfrown State Zip Code Date of Inspection D. System Information Description: Number of current residents: 3 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available last 2 ears usage d see below 9 ( Y 9 (gP ))� Detail: 2013-295GPD 2014-257GPD Sump pump? ❑ Yes ® No Last date of occupancy: current Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ,M 15 Elmwood Circle Property Address Nathaniel Friedlaender Owner Owner's Name information is required for every Cotuit Ma 02635 8-24-15 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: Owner- Last pump unknown Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): l5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ;M 15 Elmwood Circle Property Address Nathaniel Friedlaender Owner Owner's Name information is required for every Cotuit Ma 02635 8-24-15 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known)and source of information: 2003 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): 3' 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: 2 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: 1500 gallon Sludge depth: 8" t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �M 15 Elmwood Circle Property Address Nathaniel Friedlaender Owner Owner's Name information is required for every Cotuit Ma 02635 8-24-15 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle 28" Scum thickness 5" Distance from top of scum to top of outlet tee or baffle 611 Distance from bottom of scum to bottom of outlet tee or baffle 11" How were dimensions determined? measured Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): At time of inspection septic tank appeared to be in working order with liquid level equal with outlet invert. Tank is in need of pumping at this time and has a zable filter that sould be cleaned regularly. Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins•3/13 `Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 1 f Commonwealth of Massachusetts o Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �M 15 Elmwood Circle Property Address Nathaniel Friedlaender Owner Owner's Name information is required for every Cotuit Ma 02635 8-24-15 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 17 f Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ,M 15 Elmwood Circle Property Address Nathaniel Friedlaender Owner Owner's Name information is required for every Cotuit Ma 02635 8-24-15 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 0" 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.): At time of inspection D-box is in working order with no sign of back up or carry over. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No* Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): * If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 15 Elmwood Circle Property Address Nathaniel Friedlaender Owner Owner's Name information is required for every Cotuit Ma 02635 8-24-15 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ® leaching chambers number: 5-500gallon ❑ 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.): At time of inspection leaching appears to be in working order with no sign of hydraulic failure. Leaching was put in new in 2003 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 t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts w - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ,M 15 Elmwood Circle Property Address Nathaniel Friedlaender Owner Owner's Name information is required for every Cotuit Ma 02635 8-24-15 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy (locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 15 Elmwood Circle Property Address Nathaniel Friedlaender Owner Owner's Name information is required for every Cotuit Ma 02635 8-24-15 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enter%the building. Check one of the boxes below: Z hand-sketch in the area below ❑ drawing attached separately S-OU oJa1l4 n -�ac+f� A F roM O O 9 S � O Z O Qr, cnbcrs 6 +fit - 31�.5' 61- y�' 67- - 4-1" +q3 ,a 4q'- �3 Nto 1515- tip' aS. 3�' A(o - CDI.$' t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 15 Elmwood Circle Property Address Nathaniel Friedlaender Owner Owner's Name information is required for every Cotuit Ma 02635 8-24-15 page. CitylTown State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope ® Surface water ® Check cellar ® Shallow wells Estimated depth to high ground water: No Gw 144" feet Please indicate all methods used to determine the high ground water elevation: ® Obtained from system design plans on record If checked, date of design plan reviewed: Apr-16-03 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: You must describe how you established the high ground water elevation: Plan on file with BOH Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 k f Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 15 Elmwood Circle Property Address Nathaniel Friedlaender Owner Owner's Name information is required for every Cotuit Ma 02635 8-24-15 page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems) completed ® System Information— Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 TOWN OF BARNSTABLE C6CATION T tumw l F,l C_ SEWAGE # �� 43 VILLAGE. ASSESSOR'S MAP& LOT o I0 OSO-M2j INSTALLER'S NAME&PHONE NO. Woi11 bm 771 SEPTIC TANK CAPACITY V,'M . \t:LEACHING FACILITY: (type) '� .� ��� (size) � .� K LO d NO. OF BEDROOMS -BUILDER OR OWNER Ll�tank PERMIT DATE: 5 l0 a COMPLIANCE DATE: l� ,Separation Distance Between the: Maximum Adjusted Groundwater Table to the 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) ps Feet Edge of Wetland and Leaching Facility (If any wetlands exist within'300 feet of leacE�g facility � Feet Furnished by cat ty.�129a.�C' 5 NA---zD � J A.-2- 14 �7, A --3- l, �- q� , Lot (0 ., ("l.S, S2L UG P-7 , 7o` �7 '�;j No. oD FeeD THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS 01pprication for nizpozal bpotem Con!6tructfon Permit Application for a Permit to Construct(Repair( )Upgrade( )Abandon( ) omplete System ❑Individual Components Location Address or Lot No. EVV-�Cvcl C t v- • Owner's Name,Address and Tel.No. ' Lt ay a` s, Assessor's Map/Parcel 0 (�i �k c Installer's Name,Address,and Tel.No. -771-LODC7 Designer's Name,Address find Te No. Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) Date last inspected: ..4Lgreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Env' onmental Code and not to place the system in operation until a Certifi- cate of Compliance has b sue o V/0A3 Signe Date Application Approved by ,ttm Date Application Disapproved for the following re o Permit No. '"' Date Issued ----------- Fee 1 �V THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS application for Migo�al *pztem Conztructiori Permit Application for a Permit to Construct b<( Repair( )Upgrade( )Abandon( ) 4Womplete System O Individual Components Location Address or Lot No. S' Vv�,,Vc0d C i v- • Owner's Name,Address and Tel.No. Assessor's Map/Parcel C O 1/► 5 �� 1 57 O to O O-9O lS Cokut . Installer's Name,Address;and Tel.No. Designer's N�"e;Address d Tel,No. —771 ?° � ��t'i/cC� Type of Building: I Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other 'Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. t Description of Soil Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the En ,ironmental Code and not to place the system in operation until a Certrtifi- cate of Compliance has been-i�., by tliis Boii� Healthl Date Signe Application Approved by , �, � � �`' . �� �� Date 7 Application Disapproved for the following reatons / 4 Permit No. (� � Date Issued --------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS r (Certificate of (Compliance � n THIS IS TO CE ,, tha the On- ite Sewage Disposal System Constructed(k)Repaired( )Upgraded( ) Abandoned. )by U. (1, D U � at �- l mujx/l E.;Y(4 ff , FF FF as Mn constructed in accordance with the$r�ovisions of Title 5 and.the for Disposal System Construction Permit Not dated. Installer W m< <�� 1[/(� �� Designer '64),e_ �C (�141 �� The issuance of this p t hall not be construed as a guarantee that the system -i�un. 'o as 44 tie Date .� Inspector ----����—----------------------- No. La� Fee--_��1�� v THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS MiZpo!5a1 6pgtem QCon5truction Permit Permission is hereby granted to Construct` )/e air(t )UPP��Tra,,de(_ )Abandon( ) System located at ( (� . LC J ✓Vl Z and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Con truc/tion must be completed within three years of the date of thip Tit Date: J/1)7 Approved \ 1l S by TOWN OF BAMSTABLE LOCATION L� C)� IBC SEWAGE # �� a VILLAGE C T�� - ASSESSOR'S MAP & LOT 0 t0 ®3®"C07' INSTALLER'S NAME&PHONE-NO. �� � CS�S�L SEPTIC TANK CAPACITY r 1 LEACHING FACILITY: (type) (size) • x m� NO. OF BEDROOMS BUILDER OR 0 R� PERMITDATE: t o aZ, COMPLIANCE DATE: ------- Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility 1 9+ Feet Private Water Supply Well and Leaching Facility (If any wells exist Qs Feet on site or within 200 feet of leaching facility) Edge of Wetland and Leaching Facility (If any wetlands exist CZ Feet within 300 eeeet of leac g facility Furnished by i / S -N1 2� 7 V3C3, 6 _ i 00 4 ~7 Wb�-Z VA - 7 TOY" f4 -4- �� i UG k(t p -7 70' �, �7 �� Conmionwealth of Massachusetts Executive Office of Envirolunental Affairs Dept. of Environmental Protection " One winter Street Boston Ma. 02108 •Jolut Gt�ci ' D.B.P. Title V Septic Inspector P.O. Box 2119 Teaticket, MA 02536 WILLIAM F.WELD 548�-564-6813 Governor ARGEO PAUL CELLUCCI Lt.Governor AA SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FOB.ym )P& PART A SC ��I, CERTIFICATION /o Iv 91 o Property Address: 15 Elmwood Circle Cotuit Map 10 Par 30-2 Address of Owner: Date of Inspection: 8/15/98 (If different) / Name of Inspector: John Graci Dennis Gauthier �.� I am a DEP approved system inspector pursuant to Section 15.340 of Title%(310 CMR 15.000) ` Company Name, Address and Telephone Number: /�/ ` i t ' CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. The system: x Passes This Inspection Is based on criteria defined In Title V Congubmit asses code 310CMR16.303.My findings are ofhow the system is performing at the time of the inspection.My inspection does _ NeeEvaluation By the Local Approving Authority not Impyany warranty or guarantee of the longevity ofthe Fail septic system and any of Its components userul life. Inspector's Signature: Date: 9)7198 The System Inspector shallpy of this inspection report to the Approving Authority within thirty(30)days of completing this inspections. 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 Department of Environmental Protection. The original should be sent to the system owner and copies sent to the buyer,if applicable and the approving authority. INSPECTION SUMMARY: Check A, B, C,or D: e A] SYSTEM PASSES: x I have not found any information which indicates that the system violates any of the failure criteria defined as in 310 CMR 15.303. Any failure criteria not evaluated are indicated below. COMMENTS: B] SYSTEM CONDITIONALLY PASSES: _One or more system components need to be replaced or repaired. The system,upon completion of the replacement or repair,passes inspection. Indicate yes, no, or not determined(Y, N, or ND). 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. (revised 0412787) One Winter Street • Boston,Massachusetts 02108 a FAX(617)556-1049 a Telephone(617)292-5500 r SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 15 Elmwood Circle Cotult Map 10 Par 30.2 Owner: Dennis Gauthier Date of Inspection:9115199 — Sewage backup or,breakout or hiah.static water level observed.in.the distribution b.ox is due to a broken. or obstructed pipe(s)or due to broken,settled or uneven distribution box.The system will pass inspection if (with approval of the Board of Health). Describe observations: broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced The system required pumping more than four 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 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 the public health, safety and the environment. 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND 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 APPROPRIATE) DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: The system has a septic tank and soil absorption system and is within 100 feet to a surface of water supply or tributary to a surface water supply. — The system has a septic tank and soil absorption system and is within a Zone 1 of a public watersupply well. — The system has a septic tank and soil absorption system and is within 50 feet of a private water supply well. — The system has a septic tank and soil absorption system and the SAS is less than 100 feet but 50 feet or more from a private water supply well, unless a well water analysis for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presense of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm. Method usedto determine distance (approximation not valid) 3)Other 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 defined in 310 CMR 15.303. The basis for this determination is identified below. The Board of Health should be contacted to determine what will be necessary to correct the failure. Yes No — Backup of sewage in facility or system component due to an 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 cesspool. — SAS is in hydraulic failure. Irevlaed 04127/97) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 15 Elmwood Circle Cotuit Map 10 Par 30.2 Owner: Dennis Gauthier Date of Inspection:8/15198 D] SYSTEM FAILS(continued) Yes No 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 1/2 day flow. Required pumping more than 4 times in the last year NOT due 10 clogged or obstructed pipe(s). Numbers of times pumped Any portion of the Soil Absorption System,cesspool or privy is below the high groundwater elevation. Any portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. Any portion of a cesspool or privy is within a Zone 1 of a public well. Any portion of a cesspool or privy is within 50 feet of a private water supply well. Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. If the well has been analyzed to be acceptable, attach copy of well water analysis for coliform bacteria,volatile organic compounds, ammonia nitrogen and nitrate nitrogen. E] LARGE SYSTEM FAILS: You must indicate either"Yes"or"No"as to each of the following: The following criteria apply to large systems in addition to the criteria: The system serves a facility with a design flow of 10,000 gpd or greater(Large System)and the system is a significant threat to public health and safety and the environment because one or more of the following conditions exist: 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) The owner or operator of any such system shall 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 04127)97) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECLIST Property Address: 15 Elmwood Circle Cotutt Map 10 Par 30-2 Owner: Dennis Gauthier Date of Inspection:8115198 Check if the following have been done:You must indicate either"Yes"or"No"as to each of the following: _c_ — Pumping information was requested of the owner, occupant,and Board of Health. x _ None of the system components have been pumped for at least two weeks and the 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. x As built plans have been obtained and examined. Note if they are not available with N/A. x — The facility or dwelling was inspected for signs of sewage back-up. x — The system does not receive non-sanitary or industrial waste flow. _X— — The site was inspected for signs of breakout. x — All system components, excluding the Soil Absorption System, have been located on the site. x The septic tank manholes were uncovered, opened, and the interior of the septic tank was inspected — — for condition of baffles or tees,material of construction, dimensions, depth of liquid,depth of sludge,depth of scum. x — The size and location of the Soil Absorption System on the site has been determined based on The facility owner(and occupants, if different from owner)were provided with information on the proper maintenance of Sub-Surface Disposal Systens. x Existing information. Ex. Plan at B.O.H. x Determined in the field(if any failure criteria related to Part C is at issue, approximation of distance is unacceptable)(15.302(3)(b)) (revised 04/27197) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 15 Elmwood Circle Cotult Map 10 Par 30.2 Owner: Dennis Gauthier Date of Inspectlon:8115198 FLOW CONDITIONS RESIDENTIAL: Design flow: = g•p•d./bedroom for S.A.S. Number of bedrooms: 3 Number of current residents: t Garbage grinder(yes or no): No Laundry connected to system(yes or no): Yes Seasonal use(yes or no): No Water meter readings,if available:(last two(2)year usage(gpd). nia Sump Pump(yes or no): No Last date of occupancy: nia COMMERCIAL/INDUSTRIAL: Type of establishment: nla Design flow:0 gallons/day Grease trap present: (yes or no) No Industrial Waste Holding Tank present:(yes or no) No Non-sanitary waste discharged to the Title 5 system:(yes or no) No Water meter readings, if available: nia Last date of occupancy: n1a OTHER:(Describe) rda Last date of occupancy: GENERAL INFORMATION PUMPING RECORDS and source of information: nia System pumped as part of inspection: (yes or no)No If yes,volume pumped:0 gallons Reason for pumping: rda TYPE OF SYSTEM x Septic tank/distribution box/soil absorptions system Single cesspool Overflow cesspool Privy Shared system(yes or no) ( if yes, attach previous inspection records, if any) I/A Technology etc.Copy of up to date contract? Other: APPROXIMATE AGE of all components, date installed(if known)and source information: System Is 9 Years old. Sewage odors detected when arriving at the site: (yes or no) No (revised 04127)97 I SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 15 Elmwood Circle Cotutt Map 10 Par 30.2 Owner: Dennis Gauthier Date of Inspection:9115198 SEPTIC TANK: x (locate on site plan) Depth below grade: 1' Material of construction:x concreate metal FRP Polyethylene_other(explain) If tank is metal, list age Ala . Is age confirmed by Certificate of Compliance No (Yes/No) Dimensions: L8'6"h5'7'w4'10" Sludge depth:3" Distance from top of sludge to bottom of outlet tee or baffle: 31" Scum thickness:1" Distance from top of scum to top of outlet tee or baffle:6" Distance form bottom of scum to bottom of outlet tee or baffle: 17" How dimensions were determined: Measured Comments: (recommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity, evidence of leakage, etc.) Septic tank and all components are structurally sound.Recommend pumping system every two years. GREASE TRAP:_ (locate on site plan) Depth below grade: nla Material of construction: _concrete_metal_FRP_Polyethylene_other(explain) Dimensions: nla Scum thickness:nla Distance from top of scum to top of outlet tee or baffle.n1a Distance from bottom of scum to bottom of outlet tee or baffle: Na Date of last pumping;,,- Comments: (recommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity, evidence of leakage, etc.) rda BUILDING SEWER: (Locate on site plan) Depth below grade: r's" Material of construction:_cast iron x 40 PVC_other(explain) Distance from private water supply well or suction line?o— Diameter: n1a_ q, mments: (conditions of joints, venting,evidence of leakage, etc.) (revised 04127197) I { E SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 15 Elmwood Circle Cotuit Map 10 Par 30-2 Owner: Dennis Gauthier Date of Inspection:8115198 TIGHT OR HOLDING TANK: (locate on site plan) Depth below grade: nfa Material of construction:_concrete_metal_FRP_Polyethylene—other(explain) Dimensions: nra Capacity: nra gallons Design flow: rda gallons/day Alarm level:_nra Alarm in working order?_Yes No Date of previous pumping: Comments: (condition of inlet tee,condition of alarm and float switches,etc.) nra DISTRIBUTION BOX: (locate on site plan) Depth of liquid level above outlet invert: nra Comments: (note if level and distribution is equal, evidence of solids carryover,evidence of leakage into or out of box etc.) rda PUMP CHAMBER: (locate on site plan) Pumps in working order.(yes or no)No Alarms in working order(yes or no)_Yer, Comments: (note condition of pump chamber, condition of pumps and appurtenances, etc.) rda (revised O4127)97) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 15 Elmwood Circle Cotuit Map 10 Par 30-2 Owner: Dennis Gauthier Date of Inspection:8175fsfi SOIL ABSORPTION SYSTEM (SAS):x (locate on site plan, if possible; excavation not required, but may be approximated by non-intrusive methods) If not determined to be present,explain: nfa Type: leaching pits,number: to00 gallon leach pit leaching chambers, number:Na leaching galleries, number: rda leaching trenches, number,length: rda leaching fields, number, dimensions:nla overflow cesspool,number:nle Alternate system: nra Name of Technology:_nra Comments: (note condition of soil, signs of hydraulic failure,level of ponding, condition of vegetation, etc.) The leach pit Is structurally sound and functioning properly.The pit had V of water In It. CESSPOOLS:_ (locate on site plan) Number and configuration: Na Depth-top of liquid to inlet invert: rda Depth of solids layer: rda Depth of scum layer: n)a Dimensions of cesspool: rda Materials of construction: Ma Indication of groundwater: n)a inflow(cesspool must be pumped as part of inspection) rds Comments: (note condition of soil, signs of hydraulic failure,level of ponding, condition of vegetation, etc.) nfa PRIVY:_ (locate on site plan) Materials of construction: We Dimensions: nla Depth of solids: rda Comments: (note condition of soil, signs of hydraulic failure,level of ponding, condition of vegetation, etc.) rda (revised 04/17)97) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) 15 Elmwood Circle Cotuit Map 10 Par 30-2 Dennis Gauthier 8115198 SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent references, landmarks or benchmarks locate all wells within 100' (Locate where public water supply comes into house) Q d 30 (revised 041NW) Pay f of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) 15 Elmwood Circle Cotult Map 10 Par 30.2 Dennis Gauthier 8115198 Depth of groundwater 12 Please indicate all the methods used to determine High Groundwater Elevation: Obtained from design plans on record. Observation of Site(Abutting property, observation hole, basement sump etc.) Determine it from local conditions Check with local Board of Health Check FEMA Maps Check pumping records Check local excavators, installers X Use USGS Data Describe in your own words how you established the High Groundwater Elevation.(MUST be completed) USGS Maps and Charts (revined04n71B7) page IQ of 10 TOWN OF BARNSTABLE 1,0i An6N SEWAGE # VILLAGE Q L ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY: (type ceta��'( �-- (size) NC,OF BEDROOMS BUILDER OR OWNER lS �1 PERMUDATE: COMPLIANCE DATE: Separation.Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facilityC- Feet Furnished by g AA '� /4 i9 y R 3G A ate" 6-2 TOWN OF BARNSTABLE ,.NATION SEWAGE # ®�. VILLAGE cgv/ ri ASSESSOR'S MAP LOT 616-030 INSTALLER'S NAME & PHONE NO. 0 SEPTIC TANK CAPACITY /4040 � LEACHING FACILITY:(type re«3� ®�ereG�lsize) ADO NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER f'rsb/i r- ZOO l� � it BUILDER OR OWNER N DATE PERMIT ISSUED: `0 DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No Z/ tea' ul � �' s IVo --d Fs- . .. THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH ---- �, Y -------------0F.. C 1 �` �� .... ........................ Appliratinn for KlWpaaal nrk-,Tomitrurtion ramit Application is hereky made for a Permit to Co struct ( or Repair ( ) an Individual Sewage Disposal System at: , rl'I(� 1�61m W®®,D LkAYLM. .----A Ad� :.................... ..........•---•-----•---------.............. --•---------.....--•--------------• - W .. . .._,_. .. .. :-eLocation-.,CA.,YdL/dlre.r:e1s!/!s ............................................L .No........................................... Owner Address a Installer Address Type of Building Size Lo ,� Z .......Sq. feet Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons.._..6.................. Showers ( ) — Cafeteria ( ) d Other fixtures W Design Flow..........._r`7__.��...................gallons per person Ver day. Total daily}' flow-----S3t:,.......................gallons. WSeptic Tank—Liquid'capacity]r!�12(2gallons LengthR...tz A... Width_-:..1)...']Diameter................ Depth.. `.).11 x Disposal Trench—No..................... Width....... ......... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No..........I----____. Diameter..I.�..o.... Depth below inlet._1en__o Total,leaching area.`�.-�-�_....sq. ft. Z Other Distribution box (v) Dosing tank ( ) 7 tol 03 Percolation Test Results Performed 0.Ipth C�?vc Test Pit No. 1___.�....___minutesperinch of 'rest Pit.l4'" r .._...__.. Depth to ground wate _______________ fa, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water------------------------ P4 .---••-•-•---------------------•---•----------•-••-•---•-...•-•--•-•-•-•--..._......--•-•-------•---......................................................... O Description of Soil"= 24.l!_ .S:t _ .......... - (� -----------------------..._.Z ' ��. . `�C i�t ................................................................................ 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 iITL U 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by t oard of 1 � Si .�! ?J? --•----•- --- -------------------- ------------ � ate Application Approved By `. ---------- Date Application Disapproved for the following reasons:................................................................................................................ ---•...--•---.Dam-••••...-•---- `i�E - 702. PermitNo..... ---•••---••---••-------•-------------•------------ Issued...•.. ---------------- Date No ........... - THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..............OF.. GULYI/J E _ AVVliratilan for, Disps al Wor a Tonstratrfivat Vamit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: pt- l..t::.►_�. ..... c lg�.-------------------- ---------------------------------------------------------•----------....--------------------.----- . `} Location- ddress or Lot No. .... �a_ttLi��;r rL --- ... - -- ...... Owner Address W Installer Address UType of Building Size Lot_.1�� v---_---Sq. feet 4 Dwelling—No. of Bedrooms............................................Expansign Attic ( ) Garbage Grinder ( ) Other—T e of Building No. of persons............................ Showers a Other—Type g -------------•-------------- P ( ) — Cafeteria ( ) Otherfixtures -----•-------------------------------------------------•-•-----------•---•---•-------------- .....-- W Design Flow...........-�-�---��......................gallons per persoi} per day. Total daily flow.._.. _....____ _ gallons. WSeptic Tank—Liquid'capacity,_Qv2Q allons Length._-...Leo... Width.`!q.J.Q'biameter................ Depth... �. x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area........-.-.7_ sq. ft. Seepage Pit No.___---_-1---------- Diameter..A L..�_.... Depth below inlet...L...0..... Total leaching areaQ!�_1_.__sq. ft. z Other Distribution box (`'' Dosing tank ) T>-to l0� aPercolation Test Results Performed by1C,- 1_4Test Pit No. 1....Z-______.minutes per inch Bepth of est Pita ."__..____ Depth to ground water.............. rZ, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ ---.......................................................................................................................................................... P4 'Description of So ;:-.— lG Slb .i�_. - -- ----------••-----------•--------------- W ------------------------------------------------------------------------------------------------•--------------------------------------------------------•-•--------------••--•---------•-•------------ .0 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 TIT12 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. 1 ------ ----------•-----------------------------•-----------------------•-.--- ................................ Application Approved By............................. �'' _ `"l � �... Date Application Disapproved for the following reasons---------------------•--•---...--••--------------------••------•--------------•-•-------•---••--•-----....._... ........ .... ......••-•--------.....-•-------•...••-------••---•-----•-•-.....-----------------------.....---••-------------......--------••--------•--------•-•-------•----. Date Permit No....... .......................................... Issued-........: - c Date THE COMMONWEALTH OF MASSACHUSETTS BOARD,��""- HEALTH N c ......D.`'J.`�....................OF..................................................................................... Tntifirtt#r `of (Xongtfi anrr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) by--.----.---•---•---------------•----.-------------.-------..--------------•-•-----------•--------- ---•--•------•----•-•--••---•---•------------------------------------------------•------------- r. Installer at.................... `>1-•--•- •L- I'Irk , I,C ------ ---------•---------------•----...---•------------....-----------_..... has been installed in accordance with the provisions of TIT7E 5.. oaf The--,State Sanitary Code s escrabed in the application for Disposal Works Construction Permit No........................ ............... dated--------- � �.._._._....___.__.. THE ISSUANCE OF THIS CERTIFICATE SHALT. NOT BE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE...---%'` •..... ....... inspector........[a .' THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH 1> ) Z ........................`�...............OF............ .......... k ( ......._................. ^e� �- - No.. ...............nFEE........-:.._.......... Disposal Works Tonstrnr#ion Rpmit Permissionis hereby granted.......................................................................................................................................... to Construct ( ) or Repair ( ) an Individ/ual Sewage Disposal System at No........k!7: ---- . .....4_ _.s AA na-.......4 .•-• Street _ as shown on the application for Disposal Works Construction Permit No_w_.'.'. _ Dated...... ......... 1......�, ------•.......................... ...:................ .�_.... _ DATE------------------------------�-:f7---}-..I..---•-----••-•------ ........ Board of Health FORM 1255 HOBBS & WARREN, INC.. PUBLISHERS D!d-03-& TOWN OF BARNSTABLE aiC.ATION �L� // GG SEWAGE# 0aZ- VILLAGE (ro 00 D ASSESSOR'S MAP&LOT_g' 0-D0 O INSTALLER'S NAME&PHONE NOC OA15�tyG��ON ���S�7 SEPTIC TANK CAPACITY /DO® LEACHING FACILITY:(type)_ e['RS �sacYeO�isize) dd0 1 0� NO.OF BEDROOMS PRIVATE WELL OR PUBLIC WATER v BUILDER OR OWNER ,Oea.yiS DATE PERMIT ISSUED: � DATE COLIPLIANCE ISSUED- .40 VARIANCE GRANTED: Yes No L� do gas r F TOP FNDN. AT EL.36.8' _ SYSTEM PROFILE TEST HOLE LOGS ACCESS COVER TO WITHIN 6" OF FIN. GRADE (NOT TO SCALE) //� /— ACCESS COVER (WATERTIGHT) TO ENGINEER: DOYLE ENGINEERING 31.O• MINIMUM .75' OF COVER OVER PRECAST { WITHIN 6' OF FIN. GRADE 2.'G SLOPE REQUIRED OVER SYSTEM 29 O' WITNESS' DONNA MIORANDI, RS ?�' DOUBLE WASHED PEASTONE\ DATE: 3/29/88 j a RUN PIPES LEVEL 3• MAX. PERC. RATE _ < 2 MIN/INCH EUN 000 OR FORPROPOSED 1500 26.13' GALLON SEPTIC 26 0' CLASS 1 SOILS P 6903 �„ 26.2V Locus � \ C 3 E 3 m 0 0 0 0 TANK (H- t0 ) cAs �75.4.6_ "• BAFFLE 25.65' a o 0 o CI o 0 0 cl E3 r 0000 C3 000o ualss. MIN27.Of' ` 6" CRUSHED STONE OR MECHANtG4L g 2- 0 ED 0 0 0ED M � ED 3•COMPACTION (15.221 [21) 4 27 5' ELEV. Q5 R SLOPE) 4 3/4" TO 1 1/2" DOUBLE WASHED S- O" 26.0' O" _ DEPTH OF FLOW (1 9. SLOPE) ( 1 � SLOPE) �- TEE SIZES: INLET DEPTH = 10" ' p TOP & SUB TOP & SUB LOCATION MAP NTS OUTLET DEPTH 14 LEACHING 24' 24.0' 24" 25.5' FOUNDATION— 38' SEPTIC TANK 35' D' BOX 20' FACILITY 9.3• ASSESSORS MAP 10 PARCEL 30-2 ZONING DISTRICT: RF YARD SETBACKS: :THIS IS A PROPOSED INVERT OUT. CONTRACTOR TO DETERMINE FEASIBILITY 61 Op o FRONT = ' 5 1 PRIOR TO INSTALLATION OF ANY PORTION OF �� /I SIDE = ' SEPTIC SYSTEM. o� // / EL. 14.0' MED. SAND MED. SANG REAR = 15' , ��. & GRAVEL & GRAVEL FLOOD ZONE: C KLIMM CIRCLE / / _ AP/GP DEMARCATION FROM TOWN GIS u \ f M I If/ / � N � z 144" j 14.0' 144" 1 S S' NO GROUNDWATER ENCOUNTERED NOTES: �� / SEPTIC DESIGN: (CAReAeE DISPOSER Is—NOT ALLOWED ) I. DATUM IS ASSUMED PRpTIC l'5 0 039 //�/ DESIGN FLOW: 5 BEDROOMS (1 1 O GPD) = 550 GPD 2. MUNICIPAL W R ATL ID t'•IS "�`� - z e Op• 3�i � /� USE A 550 GPO DESIGN FLOW 3. MINIMUM PIPE PITCH TO 6E 1/8" PER FOOT- ~ a .I 6 PROX. TERUN ' C 4. DESIGN LOADING F(GR ALL PRECAST UNITS TO BE AASHO H- 10 ' SEPTIC TANK: 550 GPD ( 2 ) = 1100 5. PIPE JOINTS TO BE MADE WATERTIGHT. i� GRAVE RIVE cgneoy'/-sF USE A 1500 GALLON SEPTIC TANK 6. CONSTRUCTION DETAILS TO BE IN ACCORDANCE WITH MASS. W 1 W - ENVIRONMENTAL CODE TITLE V. o - -T 1 I _ -- tp LEACHING: v m _ - 35 2(47.5 + t0.83)2'(.74) = 172 7. THIS PLAN IS FOR PROPOSED SEPTIC SYSTEM ONLY AND IS NOT 1n � SIDES: 70 BE USED FOR ANY OTHER PURPOSE. ATv 47 5 x 10 83 (.74) = 380 8• PIPE FOR SEPTIC SYSTEM TO SCH- 40-4" PVC. I� N XI L CH IT W h ' BOTTOM: TOTAL: 746 S.F. 552 GPD 9. COMPONENTS NOT TO BE BACKFILLED OR CONCEALED WITHOUT Q o v INSPECTION BY BOARD OF HEALTH AND PERMISSION OBTAINED USE (5) 500 GAL. LEACHING CHAMBERS (ACME OR FROM BOARD OF HEALTH. `tom ry�P ENS N ~ c� 'yam EQUAL) WITH 3' STONE AT SIDES AND 2.5' AT ENDS 10. PUMP & REMOVE (OR FILL W/CLEAN SAND) EXISTING SEPTIC SYSTEM n% EXIST.DWELL. �� 0.A. /00' TOP FNDN - 1NNER RIP,1RyW 20 E rn 1DECK PLUMBING PROPOSED TO ,�/ ♦6/11 , BE RE-ROUTED LEG N TI TL E S SITE PLAN DECK PROPOSED SPOT ELEVATION OF 15 E LM W OO D CIRCLE `\ a EXIST. 1000 GAL. SEPTIC TANK 100x0 EXISTING SPOT ELEVATION P (SEE NOTE o) IN THE TOWN OF: ^ n a MO PROPOSEDCONTOUR (COTUIT) BARNSTABLE n WATERLINE SHOWN AS ro APPROXIMATE. RE-ROUTE AS lop EXISTING CONTOUR PREPARED FOR: THOMAS AND KRISTIN LANMAN REQUIRED IN AREA OF ADDITION. WATERUNE MUST BE SLEEVED 1 N o FOR 10' EITHER SIDE OF f CROSSING WITH SEWER LINE, OR it 30 0 30 60 90 1 N a, '� 100•v1+ZONE ' RE-ROUTED TO BE MINIMUM 10' cr Ou1ER RIPAR FROM SEPTIC COMPONENTS BOARD OF HEALTH N , 1 1 MA SCALE: 1" = 30' DATE: MARCH 3. 2003 I APPROVED DATE i i � � BENCH MARK - TOP OF CONCRETE BOUND � 11 509-382-1541 ELEVATION = 20.4 (ASSUMED) I I—5W 362-9660 down cape engineering/ inc. �r��rRNe l a`� ARNE H. H CIVIL ENGINEERS H OJALA a s orALA � VI + p LAND SURVEYORS 939 wain st. yarwouth, ma 02675 *'AMM H. OJ , , P.L.S. DATE 02-045 i rxov WO: y U Hm � O t. rV/g�1 U vvmtlm R I OU�30 jMIM M LaXt 1.6 Fmm 1 II I III . III $ ° III h ".� III rxima II I 111 Pam' B- q,T II II '� k I -7 AD.FRYr. 29n N 2� a /wiI.Bns W NTV090IIIRN2rBOM0 I , xi^xOnotl. r2uvsaw--------- 6cmataal ncxe wwtAa»� ex xEco re SAWAa 6 a6tt I.B:fAlf W/ N1200 NN.M2 (JSFgmpa 517CN W/la CQiIrtlJSWwBY RWIAW( ILw1D 5 40 x.BPll OAM b t P.mBEDgwO W/ 19xSfbOr. ou+w2oE+Ea5 2rwa 2102 M2 2%2 2992 solncAassvc wionlsavNs x sow 6a850LV rev Y4' 64VT IOS w'4 iBA®r IMB® Am- V:_- =mom= 6MAf WOM vMOaWzas».rs Raosr I I 9"900PN21 i.5r Z ? 66rn`c6vPwi . W.A nxvAnops Oaas vOw III ntndoe �S � rw. Q P/NfFVMVMVWL 9OR 11 b'95/M'1 ? /3? 9YDVT I D'il l/1' IL BCmmanoc I I 5 Fx6RG4Jb / 1 ✓ § Z R 0.03f V�I LLIICC 1 •40V 64V �' \/ - r— V A2 5OLL-1/4"-f R aff 5ive .UVA110N ex Go. zw ow X WP. w — > W"FaV 0 Q J LAv. 2,66 wa_ 2.n mupwex6ms Ex. a� U)W o a LLJ —1 ZanBu26o'Eb ' MA �14 S"SMPOD2f O m Y.. iWrx ma n O 1 Ava 5• 2852 Y 2m Z �c O ISM.MIFMM S/B w2 w/t bm FWOIELS1rL� a J j cc — w2w wr>acro i tears w I LLJ ?v I Q. a•-B" r w Z ,W^I— v rWl bai ISu.iRrvaS:S/B•OR nWaw/'Irma Ps I 2q.p. at/O ^ AMC z.nsoW°oc �U W J I 69 RrAVl SffOYM.M 10 BANfANYlNOY. / AfCAW5Am9.L179 12 / 2.6 GQ!/% , nFMCIIARW CONSMMM Ir'OG /Y6/PffOVR WlINL76 I zz iHhR'm N9L. 9Kd°OIrASa11GBr WW, XJ'1E:1/9"-1'-0" VT=MVWW,S //// VROOM V=MSZMaLN2 21A2 �IC?Sf FLOOR MIM f V2• N9WIAr //// KAW9DR00¢ OIFD tNNEp� - N!W RfLI•D Tr 1%BIId61W/ 1rtPMao nuA amecr Os. pls!� seax mN5 I I SfAIW Ia 5LVM .16° 91E/rING VT N040e16"OG I I DATE- CHECKED DA WIWW. n.sar, v W. 20OL4axnAsm I I s/z Ts 6• I l OVA BammimC0arernw ; 6MAf ROOM � *i�R'i'° I I ew CWR9P4=1 Wcn,NVO s M UCISMIMAWJM MOVA"otwm B0mw^ h 114*mxrr I.i RROW P M I/TCVXMrA V2MM RWWA209HRAR M?OOG��� M%M2.4-.WAW.IPOL/ aLm. ID 9rA&M -1aBP6.rEw1 cxi5>9r1{RROh56NAtAYw smnlaarrorJOlrnx DATE FtEVMMM PN:yia MNIND9�B"R4RM60.15 / mxNSresr' 2aBIS.brO:JWlS ����� --I Is812 lwtvsap 10 W/V4.wvas2i 0f-%vm5 A60.fWD aW'OL OOSP E/OI.x1dr 2aBPLI1At8 fAxT11A66a6 WOWn3f 5VY a9 V?'V(16M/ML.VL. I I ' 1'tT1arVVeYrKTsa-OreCaMi� I I Ww l 2oocABrnBw6 N_ AevWE'FI-0Y0E9"IIBm AV O OfZt Ew l4 FLE AMS sr O2� 5/B'LOrm.ON KrCCNLBFO"AXN AWt0LW6 M1RwIotp"s1x* 7-60.0. Pi FOO" SHEET NO. M. I I vu brarawa:mb:P�i oPJ4FD 2P.10"fQJM016 (YKtAVtE�AOIAJOI M.) ' roarnasroar � `coaaarwB�b . 6•mBEnssat wo / �NL A2 6 owws w'IDNIR i WLs fO a fAZW2FD 5za• I r A2 w,x:Vr-14' ecfloN - 4�A2 :NsS• NGI�C(AL CKrRAMI I 0 g U ffiq' ]B4 � WON4 d•iV4 f179MiBM E1C%PY.97L� rhVT 3 � I ————— ————————— sa�aeobad ozim am to s mrwxeav cm 11 , reye PAqr usaro+ OVWOFFm W Ovfmof �� 1!lDIDOM O:MY[rV/BNlGfO �,e maw r— - I I IL L__J : I xoovwaw � ,�,� 5 MISBI'M1tlR o e B'+fVY g'-OV4 NMV? 9v 4g6BRf. 9P1E: o�ilFD /�\ � 1.�IRN9YiWaL � I \ LNCrr•(r ogvwm 5MV1 ( \\ Z saws — u�tx 1 --- --=----- i � t c.. W J i , B Z _ Lu U0 N Lj O / ------------------- ----------- a[ 0 g W l I --------------`------- Z 3 I I Sao aaa' �---- --- Z W F— U i a U LLI U) I/M w+e:vY'-r m' 5ECOM9 FLOOD PLAN Z/A4fi I XJU,1/+^-P-a' SECOND FLOOR MAMMA PLAN I DATE- CHECKED STD s/"/w T.S. DATE- HEMONS i k FLE NAME, M 0213 r SHEET NO. SON G-) _ I t o E Z A f -- I--' i: 1 fiY.6 as 6X9 ! D. ape- t DINING ! - SEAT L/C � _ •-' t i i ' t3-6'X15--6 � i 96• CL BR. O f •8J(9 PANTR _8_DO;_I gXo'; '24Xy6_' SHELVING _—_— - - - -- -- — 8XB _— �; � I 6X6 BA'_CGitY UNE ! -"'- •'•,.. _ • - - KPJL Ii 6X6 --------�;--- -.- --;�-------- `` �I • - I • . t 1 1 ;, III � s � $RIDY 1e i t ------ ! ----- i i i 1 a 1 W 6'-0-R.O.ZZ lip, 18• = _ t6•: { e 4 SKYWINDOW 1 t SKYWND011 t i j�Y.Y'lG7JDO Y 1 1 1 W v>1{ - 1 N Q I 6X9 _ 111 S � t — !S GREAT ROOM R, f - t . • +i � 2�-6 X75'-6' i t i i 5• � i r--•- -+ W1 G S 9' • _ _ •i - _ - _ I t $XS QW '_ iL _ 08 6X6 1 6X6 6Xa 6 1 _ ___-: _ T_----[7--__ _- - _ �%6 4X6 X9 S 9X9 �j _ A l 1R I f I A SUNROOM s SKYWNDS FARMERS PORCH; I 12'-O'X26'-0' 4• { i H' - = ON P.T. DECK s € 9 ram---- - 6X9 - EL 1 t X6 SX6 F IRST FLOOR PLAN !� .J. _ i;.• i_°�•.• s- •t:'r f: mot._ _. - -;�, E. _, ___—___ _____— " SCALE 1/4"= i.,. r _ rR£V{510N5 DRAWN BY: OFFICE NO. -z; .,-f• ;•; - j1jW:.!; - - -- -- - - - - -� _-- APPROVALS - - I QU/WTY CUST061 DESIGNS INC ! � i ^1�: •' _ - _ -�ai''i+a, ! CLIENT T CONST.------Illr r _ ._ ' �# ►: _ tt: ��M�1� _ POST & BEA'1 .� 1 I DATE I SHEET '' �M NO. F .- _, OP' CAPE- COD OCTOBER 26. 1488 }! HAYfrOIDI4IC -`-•- X, ISO'--- t2' F 2'-1 1/YA tE BE A --- --- — r "X6 = — - -- -6X6I [ i1;' •tc'Xo 6X6 ', 6X6 r j I u r FULL BATH ri" tip 7 i • �Gt1 ' . r f © -.�� •i.� BEDROOM MASTER BATH ri WALK-IN i ' IT-10 tY t s 9'-6•X1S'--6" f r , 1 , I BEDROO.A $3 , - : _ ___ __. I 16'-1 1/2- 1/2- DO t 16' 1/2' t 8'-6'X1S'-6' �-- [ UP r ii yygg O �OXso l + ! I - - - —- �•- ---6•—-- 1� - - -- ----— - --- 14• ---- f -1O'— j A i f Y-3• i 6X6------ -- -- _ _ 6X_6------- 6X6• ---- ----- -- _ -_xs ----------------------------- —6X6 — I - - - _ ----------------------- ' f RAIL- - --- ---- MASTER BEDROOM t j f --- --i - 13'-6"X19°-6" l --- IBOPEN TO BELOW ELOWI l ' ( 16'-1 1/2' I+ !` SKY4�INDOWI i SKYWNDO j ! rSKYh1ND0`t� ( / �1 , i--- 16'-i 1/2' 1 13'-10 1/2• f I I t [ l ! t f I I �, ( r I --- i'-'---•- ----•„-- - -- ---- - --- - - - --- ---I t-•-• E . 1r II r I[ [[ tl It WAND I K t - l _ L ! I 5 5 26'-3•--- ------- -- ----2° -----10'- r — SECOND FLOOR PLAN p SCALE 1 /4"=1'—D" CLIENT BUILDING TYPE --�— ---— — --APPROVALS REVISIONS DRAWN BY. OFFICE NO. CAVALUNI / GAUTHIER RESIDENCE 32X40' CUSTOM CAPE W/ DORMER __ _ _ + CLIENT CONST QUALITY cusrolA DESIGNS INC. !COTUIT. MA. 4'X32' GARAGE CONNECTOR l� IfAjj�jE POST & BED DATA: 5">�r "o' G ' AND SUNROOM 1�/j of C a con t OCTOBER 26, 1986 BAYCOI-ONY SYSTIiIM INC. i f TOP FNDN. AT EL. 3s.8' _ SYSTEM PROFILE TEST HOLE LOGS ACCESS COVER TO WITHIN 6" OF FIN. GRADE (NOT TO SCALE) ACCESS COVER (WATERTIGHT) TO ENGINEER: DOYLE ENGINEERING 31 .0' MINIMUM .75' OF COVER OVER PRECAST WITHIN 6" OF FIN. GRADE 2% SLOPE REQUIRED OVER SYSTEM DONNA MIORANDI; RS 29.0 WITNESS: 2" DOUBLE WASHED PEASTONE .r. DATE: 3J29/88 RUN PIPE LEVEL o / FOR FIRST 2' 3 MAX. PERC. RATE = < 2 MIN/INCH ELMW000 CiR PROPOSED 1500 26.13' GALLON SEPTIC 26.0' 26.25 CLASS I SOILS p# 6903 CORI-" �--�'- .:.: .. TANK (H- 10 ) GAS Cl C� C] C7 O C� C] CJ C7 Loc7!MEUSSA _-_____` BAFFLE 25.65' 0' m C7 L7 m C7 0 [� m CJ \27.0±1 g���, oaoo m oaac) " go$8 2 m � M C] 0 C1 0 0 111 o� 3. 0' 6 CRUSHED STONE OR MECHANICAL ] ELEV. Q MIN COMPACTION. (15.221 [2]) ( 1,5 % SLOPE) DEPTH OF FLOW = 4 (1 % SLOPE) ( 1 % SLOPE) 3/4" TO 1 1/2" DOUBLE WASHED ;NONE 0" 26.0' p" 27.5' TEE SIZES: 10" INLET DEPTH = ' OUTLET DEPTH 14" TOP & SUB TOP & SUB LOCATION MAP NTS FOUNDATION--- 38' SEPTIC TANK 35' D' BOX 20' LEAC-LING 24" 24.0 24" 25.5' FACILITY 9.3' ASSESSORS MAP 10 PARCEL 30-2 ZONING DISTRICT: RF *THIS IS A PROPOSED INVERT OUT. YARD SETBACKS: CONTRACTOR TO DETERMINE FEASIBILITY rso / FRONT = 30' PRIOR TO INSTALLATION OF ANY PORTION OF 01 , SEPTIC SYSTEM. �% / SIDE = 15 EL. 14.0' MED. SAND MED. SAND REAR = 15' o,• / & GRAVEL & GRAVEL FLOOD ZONE: C KLIMM CIRCLE AP/GP DEMARCATION FROM TOWN. CIS u N � /W / O / / oo N 2 4't -I i 144" 14.0' 144" �89 NO GROUNDWATER ENCIOUNTERED NOTES: SEPTIC DESIGN: ASSUMED Q J PR 15 K AL. p 9 (GARBAGE DISPOSER 1S NOT ALLOWED ) 1 . DATUM IS a x PTIC �$ �� // a DESIGN FLOW: 5 BEDROOMS ( 1 10 GPD) = 550 GPD 2. MUNICIPAL WATER IS EXISTING _' o ` h I —37 °' ''.JSF A 550 GPC DESIGN FI_(?W ,Ja i.__r\A�n'I�,�jk _PIPF_.PIT`'I-4 jr). - y 1 /R" Pr^ -�i^,r I H. _. TH PIP() rERLI -- �` 4. DESIGN LOADING FOR ALL PRECAST UNITS TO BE AASFiO H— 1 .:J � _ _ — , SEPTIC TANK: 550 GPD ( 2 ) = 1100 o r - - ---GRAVE RI j. 5. PIPE JOINTS TO BE MADE WATERTIGHT. GRAVEL RIVE rt USE A 1500 GALLON SEPTIC TANK W — — — 6/� 6. CONSTRUCTION DETAILS TO BE IN ACCORDANCE WITH MASS. 1 /, � LEACHING: — ENVIRONMENTAL CODE TITLE V. W 117 / A` — 35 2(47.5 + 10.83 2 .74 172 7. THIS PLAN IS FOR PROPOSED SEPTIC SYSTEM ONLY AND IS NOT ' SIDES: ) ) TO BE USED FOR ANY OTHER PURPOSE, O N ADQN. ATV L CH IT BOTTOM: 47.5 x 10.$ .74� — 380 8. PIPE FOR SEPTIC SYSTEM TO SCH. 40-4" PVC. Q / // TOTAL: 746 S.F. 552 GPD 9. COMPONENTS NOT TO BE BACKFILLED OR CONCEALED WITHOUT w ti°` INSPECTION BY BOARD OF HEALTH AND PERMISSION OBTAINED �- � '1 P TENS N y°� �-- EQUAL) WITH 3' STONE AT SIDES AND 2.USE (5) 500 GAL. LEACHING CHAMBERS (ACME OR 5' AT ENDS FROM BOARD OF HEALTH. EXIST. DWELL. 0 r 10. PUMP & REMOVE (OR FILL W/CLEAN SAND) EXISTING SEPTIC SYSTEM 100' b° / 4 D1 INNER RIPgR' p,ry TOP FNDN (DECK ZO PLUMBING PROPOSED TO DECK BE RE—ROUTED LEG E N.� TITLE 5 SITE PLAN f °` 100.0 PROPOSED SPOT ELEVATION OF 15 ELMW00D CIRCLE EXIST. 1000 GAL. SEPTIC TANK 100x0 EXISTING SPOT ELEVATION o` (SEE NOTE o) IN THE TOWN OF: 100 PROPOSED CONTOUR (COTUIT) BARNSTABLE n WATERLINE SHOWN AS APPROXIMATE. RE-ROUTE AS 100 EXISTING CONTOUR PREPARED FOR: THOMAS AND KRISTIN LANMAN .1 REQUIRED IN AREA OF ADDITION. WATERLINE MUST BE SLEEVED o FOR 10' EITHER SIDE OF C CROSSING WITH SEWER LINE, OR 30 0 30 60 90 Z RE-ROUTED TO BE MINIMUM 10' 0 OVTER RIPPI"NoNE FROM SEPTIC COMPONENTS BOARD OF HEALTH N N MA SCALE: 1 " = 30' DATE: MARCH 3, 2003 APPROVED DATE ti BENCH MARK — TOP OF CONCRETE BOUND off 508-362-4541 ELEVATION = 20.4 (ASSUMED) fox 508 362-9880 \v OF M down cape engineering, inc, ARNE tN OF MgsJ9� ��y�Eg9� o ti� ARNE H. ✓ OJALA `n CIVIL ENGINEERS U OJALA y VI LAND SURVEYORS 9��� zss4o a 792 93q chain st. Y armouth, mo. 02675 O2--04S H. OJA , ., P. L.S. DATE . . ,.K,..:- .eY..:,7...vr>r,....�..,•F��a„n> ,.•..,.. ,•..-.;.., .-.,. .a...a ,�,- ...-�,-.,..,n. ..,.f:,•, .x.,,•...., n+..,.., .,.-.... -,.,...,..,.,..,m ..r.e. .9..,m-. .e,�.,,..H..,,. . . .,.. .•.,=....o. a... ..ae....s,....,,.,... .. ., ....m _ NOT TO SCALE Po - TOP FC'f^'. FINISH GRADEg 1=�j FINISH GRADE OVER k EL g 2U 4 FINISH GRADE OVER DIST. BOXY �,g FINISH GRADE OVER SEPTIC TANK LEACHING PIT 2 b".••:p: VARIES 71,17 a .e'•.. — fl_ o:o' a.'o' .D..o,'. .•e o.e. ..°•..e:• .o :O ...D.:a•i :s;0•':.I• 'O:' O.'t; •.e'0 3" OF 1/8" 1/2" 12" MAX :►. . o;:i p..°.,.:, a :.e:..'.e:.•. . .. .o. ::.: ..:•. .o :. e;d.e.• o PRECAST CONC. OR ' .e ASHED PEA STONE o. o BRICK 6 MORTAR OUTL ET PIPE LEVEL TO 12" BEL OW GRADE FOR 2 FT. MIN. A...Q:.• .a�•:Q: .� e� ;a b. O O l�:o. 9. '0• a .� .. . .'.T,.T..f".•, I, •�p': '6. � .. :e :o• e:::�:°ems•; �o.'o;.A'.•,o:.o:o:o: :a b. ..e, Q.s,.,•o..o.e 83.28 C. I. OR PVC TEES : • 'o;'•. .'D . . fie• . c �. BSMT. f-LR. %o.p. ., �. 1000 GALLONEL . 46 �' N BOX � D S TRIBUTIO j -:;.4°�:°° •'� PRECAST CONCRETE a INSTALL ON LEVEL BASE .�/� TO 1-1/2" as E ' PRECAST I o..•.0•..0; :'o: ° .°.•o..°:. ; WASHED D I e CONCRETE H-- /0 REINFORCE CRUSHED ' Ii .. Q: a: @ -- 0.°.O' :A-0.q•.o,..�:b'•:Oo-:O,o•,D.p•p•,•p• :Q:p'Q•A::.::.j'::6 •D.•• 40: STONE .b',O,•O. b..q.p�.O:O A•,O,ip O.,•4••O•;O.b'••'p•O O':O.O•.• .6..'O;.•O'b:°. •• 'Q Q! ,'�..1 O H— l0 REINF" 8 .50TANK o, i ° INSTALL ON LEVEL BASE ~' i NOTE.' EXCAVATE TE TO EL EV, 72'-� DR o• •° r L OWER TO REMO VE A L L IMPER VIOUS ° ° — MA TERIAL BENEA TH THE L EA CHING AREA 2 '-0 " 2 * -0 " " VA REPLACE EXCA VA TED MA TERIAL WI TH 6 '-0 " 4CL EAN. CLA Y FREE SAND 10 •_0 " ��� it- EFFECTI VE DIAMETER GE `� E�` NOTES L EA Cf/,I'NG PIT INSTALL ON LEVEL BASE 1. ALL ELE11A '•IC' i SH001 APE BASED 'CAI 5Y OT�(E7 25 LOT I 2. ALL PIPES I/ SHE SYSTEM MUST BE CAST IRON } OR SCHEDULE 4 � PVC. . A � S R_V_ A TION PIT �< �L"AL TM ra,457 BE NOTIFIED p_ 03 ;'C'�Y' I70YLE ENC� . QSSOC. j i'IHE11+' CC7,`.' r . :_ C 'IDN IS � OMPLET E PRIOR TO BA CK IL L.i t v�.y PERCOL A TION RATE: _ C> 4. ANY CHANGES It THIS PLAN MUST• BE'APPROVED 2 MIN./IN. �`• rr ��' BY THE BOARD z�'F HEALTH AND CAPE 6 ISLANDS WITNESSED BY* E3U ` V SURVEYING CU,., ,li C. �. � 1n12nE.1D l 7 g gq 8Co 5. MA TERIA L S ANC !INS TA L L A TION SHAL L BE IN 4 i RCS-LA&EBRO. OF HEALTH DESIGN DA T COMF'LIAN�FE• f H, THE STATE SA DATE: _C'lAi2 ,1�2� CODE - TITLE '>' -�AND LOCAL APPLICABLE r I ' NUMBER OF BEDROOMS' 3 70 RUL ES AND RECL°; A TIONS RECORD PLANS AND " MT*1 Ct *z � 87-0 6. NORTH ARROW h� FROM RE O 0 \ \' IS NOT TO BE 143ED FOR SOLAR PURPOSES GARBAGE DISPOSAL NO TOPSOIL 6 330 GAL . 7. FLOOD HAZARD .7-,ONE C DAILY FLOW _ SUBSOIL - 1000 GAL .' e. WA TER SUPPLY TOWN WA TER 24,^ SEPTIC TANK REfl D. %�_� SEPTIC TANK PROVIDED 1000 GAL . LEA CHING REQUIRED " %' f'1EDIUI'l SIDEWALL AREA = 188 S. F. - --;r- 2 �.` / r 4<o c `R •-f' 4' " 188S. F.X 2. 5 G/S.F. = 471 GPO r f<oOr _ ZOO=-- 10 BOTTOM AREA 79 S. F. L +7� D 7.9 S. F. X 1. 0 G/S. F. - 7.9 GPO r, LEACHING PROVIDED 550 GPO ' 47, c T '�` , - � ARtrDSEr� "Lt V TION "i E��. i . 0 Z� "Z fit:'70.0' -20 -�F PRECAST CONCRETE _._90 —'-- t_rs: ?. TING CONTOUR LEACHMS PIT SINGL E FA MIL Y RESIDE-NCE di r I<A 'VA TION PIT f k 'C 1000 GALLON 0 DI;17RIBUTICN BOX i + I PRECAST CONCRETE ',, . / y PROPOSED SEWAGE DISPOSAL S YS TEM I I ;f SEPTIC TANK I Q L E�'CHING PIT /,'. PREPARED FOR 1 '� � o o sEf=Tlc TANK DENNIS GA UTHIER G YVONNE lf. CA VAL L INI + ` LOT 2 KLIMM CIRCLE ! i R P 1 RE�ERVE ' 1S r, +s \ R/* , BARNS TABLE — MASS. 83.50 PIAH INVERT ELEVA TION 75 „o �� DA TE.• r CAPE C ISL ANDS SUP VEY�c NG, INC. - 0 PLOT PLAN T rsrF?` P. O. BOX 334 7z SCALE AS NOTED _ " nr ,�.,, 70 = (4 SCALE: 1 40 f „ : `AFC � *- HSF w sB !EKE MASS ,...w.. A N NO Co`.'� i