Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Home
My WebLink
About
0024 FORSYTH COURT - Health
124.Forsyth Court - Cotuit P A = 055 059 i i No. Fee BOARD OF HEALTH TOWN OF BARNSTABLE ZIppYication for lVell not ruction permit Application is hereby made for a permit to Construct Alter( ), or Repair( ) an individual well at: c Location JAddress Assessors Map and Parcel Owner Address Install -Driller Address OZb�1 Type of Building IJ Dwelling Other-Type of Building No. of Persons e Type of Well � Capacity Purpose of Well Agreement: The undersigned agrees to install the afore described individual well in accordance with the provisions of the Town of Barnstable Board of Health Private Well Pro ction Retulation-The undersigned further agrees not to place the well in operation until a Certificate�offia ce been ed by the Board of Health. Signed V0 111q1,—,dh. ✓ 21 Da e Application Approved By ate Application Disapproved for the following reasons: Date Permit No. Issued �/) Date -------------------------------------------------------------------------------------------------------- BOARD OF HEALTH TOWN OF BARNSTABLE Certificate of Compliance THIS IS TO CERTIFY,that the individual well Constructed , Altered( ), or Repaired( ) by I � cL " 14 )o.11 I — Installer at DL Fdv 5 V I� ,._ C_-t has been installed in accordance with the provisio s of the Town of Barnstable Board of Health Private T,Prot ction Regulation as described in the application for Well Construction Permit No. V1 16Zj-&t r Dated Z THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORILY. Date Inspector . > J No. "Ulm"'�ZS Fee �...� ~ BOARD OF HEALTH TOWN OF BARNSTABLE ZIpprication _Jor yell &Cougtructiou permit Application is hereby made for a permit to Construct Alter( ), or Repair( an individual well at:,,, 23 Location;�Addr4gs___ - _ r--Assessors Map'and Parcel: . '� - �..��•\\�\, cam.i/l � ��--� t�'��,�r� �_{ T' -_ _ � - ..� _. j tea. Owner" Address J s_e_ 1 l:`'^a 1)1/ 2..\a Installer-Driller Address V J Type of Building Dwelling w - Other-Type of Building No. of Persons 1 p Type of Well Fi�rG�� Capacity Purpose of Well A 'Agreement: i The undersigned agrees to install the afore described individual well in accordance with the provisions of the Town of Barnstable Board of Health Private Well Protection Regulation-The undersigned further agrees not to place the { - _.' I well in operation until a Certificate of Comphance�hasfbeen issued by the Board of Health. , °Signed / �� .�11..,' .-� /i /4I-z,_/ )Z1 Date Application Approved BY /� I bate P Application iDisapproved for fhe following reasons: Date Permit No. MA,.1 r M,, ! Issued ( _ Date No----------,`--e ---------- ----------- ----- ----- ------_-------------------------------------, HEALTHBOARD OF J TOWN OF BARNSTABLE Certificate of Compliance THIS IS TO CERTIFY,that the individual well Constructed(,)e"'�'/A/ltered( ), or Repaired( ) by 'Tnstaller at �c�y 5 l/ � 0+ has been installed in accordance with the provisions of the Town of Barnstable Board of Health Private Wel/l Protsection Regulation as described in the application for Well Construction Permit No. W 261.1-b-f- Dated � ,e/2 t f THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORILY. Date Inspector ----------------------------- BOARD OF HEALTH TOWN OF BARNSTABLE ' Vell Couotructiou Permit No. � ' Fee '7 Permission is hereby rantedr{o ro Installer to Construct(0, Alter( ), orp-- Repair O ) an individual well at: No. / Street as shown on the application for a Well Construction Permit No. W -' Dated Date �/ 21v/Z/ Approved By / -------- t j, r� ,Ar, TE5T HOLE) N s: M AY >cY P?79 PAUL NIVRRA:v -SNSP, FtEV. i h o a toa rt A ry o SUR56IL, /* e i-c v 7, ND WR�tR _'lvC�(ltvTEF.t a I.a,<.T.GGUl.J. t if T�IZ AVAf_,4t?1� � � - J3ufL<7/,v:�:s�73A`� 2 ,,UiL,-I've rs SC 1 .. a - 1710 �.. t Gl'Ot'��7S�Z7. kt.. SEPr/G 5`/:f,7 772(JG770N f c �f2C�Onij . ow: _ REVISED ?-/-.77� 3HRi'v C i L E(4 GL NE LTf/.rZ�GUl-AT/On/S '�Y // 'EL7 LFaCH f IeZ54.02Ci,o0"S_:U 2'.,o � �2 7%? �:,>.T"�YJD Tn ." :.: L!.?V'/UUJ Cd - N/!Ti-J !�-,.7F F/^//.5 H E:J �.�T?A✓� � TGJ F72E✓r`n/T �/n/C-� � 0 �_ ��/ r -e�/ v I S ro vE D/57- '4'�.--i'r SOX `,. Z/WiD.: �_� 3 "w v 'r �" 'a/4: f�iT: !� 1 rAlr (.'- rY i..• •4:` WA } .. /4'• .l4 FDo7': ��" M/N _.... /SUQ. ✓.. /"9 %4"/Goor".y Q4' Z'It��' /YJAS NEO CA L L O J.TO nJE /vVr.:2,T i /nivE.er F .NV � .`tir IYES� LA,c.•rt..F.cc::= C21N�',� _ �t� ' Pir `-- - -_ _....—.�__— 20•M/n1i n�Gln7. -- L.L wi� d (-�✓. � �a S/TE PL A A,/ L O A 3"/L ti. f3L ...cca71J1.,T __C�?f1 Ate_— r/c ran/.e Sc. Ct,S✓/` c292 i?�,� r�� \�y� 4��5r� eur ov-avx OGITLL AN.D L.E.AG NinrG .U/T I - kr[twr ff ..- GON �000 rX�/ l/ -3> Cl�U!�1��.G � Tft//J,� CGO•�F'�"�•_ri.eto /.� f`;.f -/o ��,4�/ivG I Y�4:42,A-1C)077./io�Ear eJ? c IY /J:;7- /-G'' vr CERT.,FY. 'TF{F.EkISTt(+6 r-t, 1TO A7fpty TO L P�',AifGn' !S CU RE( AS 5R0.j-llJ AN;, art"^' It, 17 DJE` — SE7L;9CK :zt yL'r RG v%=.!r at Town of Barnstable r# Department of Regulatory Services Public Ia~al l� Division hate ` �p r6lq 1� 200 Main Street,Hyannis MP,G2601 (IJu (re / »,f� Date Scheduled �2 2 3 , Time—A Ll/I Fee Pd. _[ Oo Soil'Suitability Assessment for Sewage Dis I oSal Performed By:— > f1P>P .. Witnessed By: ,'i/",v, w• n ' LOCATION & GENERAI,1NFORMATION Location Address t Owner's Name ry rs y-8i (u: 11 '�c,rr Ve r�, o e % Address �o }rlI Assessor's Map/Parcel: D S �_ �5�� Engineer's Name .t k C (c,.G f 1 �'H fey NEW CONSTRUCTION REPAIR _ _ Telephone# r7f�';!' S y0 77 3 V �e�e clP�-rk % {�' &nvl AO' Land Use o — Slopes(9b)___i=_ /�� Surface Stones_ r/n//r�- Distances from: Open Water Body / q ft Possible Wet Area ! �ft Drinking Water Well .__ ,[,4-.ft Drainage Way ft Property Line _f. fl Other ft SICETCII:(Street name,dimensions of lot,exact locations of test holes&pert tests,locate wetlands{n proximity to holes) Parent material(geologic) r! Y(Clu u J Depth to Bedrock Depth to Groundwater. Standing Water in Hole: _ _ Weeping fl•om Pit Face ,c ll 1 C�YCtc ✓JT Estimated.Seasonal High Groundwater {t� r/'tz.1 it i2'.}ZYt'�c d d� DETERMINATION FOR SEASONAL 111 H WATER TABLE Method Used: Depth Observed standing in obs.hole: __— ill- Depth to sotl tnoltlus: Depth to weeping from side of obs.hole: _!__ _.- _in. l3roundwut+r AJJuBttnent moo_ T. Index Well I♦ Reading Date: Index Well level___.__., v. AdJ,factor.,m.e AdJ.C)roundwater 1 aval I'ERCOIaA'I'ION'Y,'.1C+s'A' ------Datp�z /xirr►a.�l�_'�.. ' Observation / L Time'at 9" Mole# Depth of Perc Znz- t lime al 6" Start Pre-soak Time @ _ Time(9"G") /D yo l _a End We-soak Rate MinJinch Zjn r Site.I ailed: V'A:I liiinual Testing Needed(Y/N)___�.---- Site Suitability Assessment: Site 1 assed ___.... -- - Original: Public Health Division Ohset•vation 110le 7iata'i'o Iie Completed on Back-----✓- ***If percolation test is to be conducted wilLiu .IOU' of wetland,you must first notify the Barnstable Conservation Division at least one (l) week prior to beginning. Q:\SL1PTl0PERCFORM.DOC DEEP-OBSERVATION HOLE LOG Hole# / Depth from Soil Horizon Soil Texture .Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones;Boulders. • _ i ten w fJ 96 araveil n L.3 CII «� C��;,� ,� 5� a3z Z F-�/-r i iv /✓ ff DEEP OBSERVATION HOLE LOG Hole ff .� Depth from "'Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Mansell) Mottling. (Structure,Stones,Boulders. f2Q51St�11SiYY;'�_QrnYeIJ eW- -C2 DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency. DEEP OBSERVATION HOLE LOG ]Hole# Depth from Soil Horizon Soil Texture Soil Color Soli Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones;Boulders, Consistency, t Flood Insurance Rate Map: Above 500 year flood boundary No— Yes . Within 500 year boundary . No!�Yes Within 100 year flood boundary No_1-' Yes. Dekh of Nahtrally Occurring Perviolts Material Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the area';proposed for the soil absorption system? If not,what is the depth of naturally occurring per sous material? Certification I certify that on (date)I have passed the soil evaluator examination approved by the Department of Environmental Protection and that the above analysis was performed by me consistent with the required training,expertise and experience described in 310 CMR 15.017. Signature e9, tit- `-/l..i .(e l _ Date 7 . QA$E1y IC\PERCFORM.DOC ` TOWN OF BARNSTABLE 'n Ll., A LOCATION y �—� SEWAGE# O�1 �J — 0 VILLAGE G " —ASSESSOR'S MAP&PARCEL lj' .� INSTALLER'S NAME&PHONE NO. �✓;� �C1J ��I lL �� SEPTIC TANK CAPACITY LEACHING FACILITY.(type) �size) { 3 NO. OF BEDROOMS ��'�. OWNER V S✓U-4 1IMTJ PERMIT DATE: l COMPLIANCE DATE: 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 y FURNISHED BY 3 �� c► iL P _ D a� e 6 -4 )bqNo. " ° Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: �[ PUBLIC HEAD+TH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS YeS \ 2pplitatlon for ;Disposal *pstrm Construction Permit Application for a Permit to Construct( ) Repair( ) Upgrade(A Abandon( ) ❑.Complete System ❑Individual Components Location Address or Lot No. 4 Y C Owner's Name,Address,and Tel.No. Assessor's Map/Parcel GS V, V ee � / � Installer's N49.0Address,and Tel.No. J y i Desi ner's Name Address,and Tel.No. 57fJ 27 Type of Building: Dwelling No.of Bedrooms t Lot Size I� s Garbage Grinder( ) Other Type of Building !j j�L—if ,VQI( t1 No.of Persons Showers( ) Cafeteria( ) Other Fixtures ``ll Design Flow(min.required) k- V gpd Design flow provided g 4 i L# gpd Plan Date Zq [1 ni � , Number of sheets - Revision Date j 2 � // Title 5 i 4" Size of Septic Tank d t � Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) s- y�, Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Healt ,I u i d Date 3 Application Approved by Date Application Disapproved b Date for the following reasons Permit No. Date Issued 1 ---------------------- ----- . 0 ' No.+ V ' c , w�+k�q°- Fee ti /THE COMMONWEALTH OF MASSACHETTS Entered in computer: US Y s � PUBLIC HEATH-DIVISION -TOWN OF BARNSTABLE;MASSACHUSETTS L t Yication. for Mis oral strm-Cons tructlon Permit Application for a Permit to Construct( ) Repair( ) Upgrade(� Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. ) y �S Y / Owner's Name,Address,and Tel.No. Assessor's Map/Parcel # U 5 �G Vey 1 1 LtTl- Installer's Name,.Address,and Tel:No. �(� L f j Designer's Name,Address,and Tel.No. �ZIJ �7 37 WZ vl w + bA Type of Building: Dwelling No.of Bedrooms Lot Size / ,� s Garbage Grinder( ) Other Type of Building �j�Al 101 No.of Persons Showers( ) Cafeteria( ) Other Fixtures ,l Design Flow(min.required) r U gpd Design flow provided Qj Z gpd Plan Date I- 1 . Number of sheets Revision Date 3 N_ Title h r Tf e""-j Size of Septic Tank 1 t4ft4� Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) I►Xj L) T + Date last inspected-*. «-'~ Agreement: . The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health e i d / Date Application Approved by -',( / -. Date J Application Disapproved b P Date for the following reasons ,I Permit No. '-' Date Issued -j.�� -.-7 THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Qtertificate of Compliance THIS IS TO C}ERT'IFY,that the On-site Sewage Disposal system Constructed( ) Repaired( ) Upgraded( X) Abandoned( )by at 7 }n �j C� has been cons Sted in accor ance I� with the provisions of Title 5 and the for Disposal System Construction Permit No _ dated II Installer �/" �l/ tl_ DesignerLL #bedroomsjt'`P Approved design flow. gpd The issuance o thi permit shall not be construed as a guarantee that the system wi f,72 on as desigAed. nn Date Inspector l� I�S. i ` - , ------------------------- ------------------------------ - -------- -. - - --------- --- -- - No. Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION -BARNSTABLE,MASSACHUSETTS '�, r�" - �I��JDSaI �pstetn �DnstrULtlOn �ertttit - ' Permission is hereby granted to Construct( ) Repair - N aiir�( ) Upgrade( Abandon( ) System located at �t_ 5 1 TN C'T and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction u t be completed within three years of the date of this permit. Date Approved by I I 1� Town of Barnstable Regulatory Services °s Thomas F. Geiler,Director W f Public Health Division 39. Thomas McKean,Director 200 Main Street, Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Date: zo-t t Sewage Permit# Assessor's Map/Parcel Installer&Designer Certification Form Designer: -I n r I.,.ctnA e y s_ l aL La nstaller: Address: F O �--3- `Address: W e5 -r l Vh.wI, yA N y y On r_►3w- N— as issued a permit to install a (date) (installer) ` septic system at Z 1L based o1 a design drawn by (ad ress) { • dated O2 - (designer) I , — I certify that the septic system referenced above was installed substantially according to the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. Stripout (if required) was inspected and the soils were found satisfactory. I certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system) but in accordance with State & Local Regulations. Plan revision or certified as-built by designer to follow. Stripout(if re nspected and the soils were found satis actory, �W f +Nq c JQHN LANDERS-CAULEY U CIVIL (Installer's Sign a ) Na 35101 sfCIST,ERE.G1 TONAL E� (Des es Signature (Affix 1 Stamp Here) PLEASE TURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS- BUILT CARD ARE RECEIVED BY THE BARNSTABLE-PUBLIC HEALTH DIVISION. THANK YOU. gAoffice formsWesignercertification form.doc , s COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENERGY & ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION ONE WINTER STREET, BOSTON, MA 02108 617-292-5500 DEVAL L.PATRICK IAN A.BOWLES Governor Secretary TIMOTHY P.MURRAY LAURIE BURT Lieutenant Governor Commissioner MODIFIED APPROVAL OF ALTERNATIVE SYSTEMS FOR GENERAL USE Pursuant to Title 5, 310 CMR 15.000 Name and Address of Applicant: Infiltrator Systems,Inc. P.O.Box 768 6 Business Park Road. Old Saybrook, CT 06475 Trade name of technology and model: High Capacity chamber, Quick4 High Capacity chamber, Standard chamber, Quick4 Standard chamber, Quick4 Plus Standard (5.34nch invert) chamber; Quick4 Plus Standard (8.0-inch invert) chamber, Quick4 Plus Standard LP (Low Profile) (3.3-inch invert) chamber, Quick4 Plus Standard LP (Low Profile) (8-inch invert) chamber, Infiltrator 3050 (Storm Tech SC-740) chamber, Equalizer 24 chamber, Quick4 Equalizer 24 chamber, Equalizer 36 chamber, Quick4 Equalizer 36 chamber, Quick4 Equalizer 24 LP (Low Profile)(6 inch invert)chamber, and Quick4 Equalizer 24 LP (Low Profile) (2 inch invert) chamber(hereinafter the "System"). Schematic drawings of the System and a design and installation manual are attached and made a part of this Certification. Transmittal Number: X228042 Date of Issuance: February 21, 2003, Revised August 19, 2005,December 22, 2005,'July 24, 2006, July 19, 2007, Modified February 4, 2009, Modified June 30, 2009, Modified September 18,2009,Modified June 30, 2010. - Authority for Issuance Pursuant to Title 5 of the State Environmental Code, 310 CMR 15.000,the Department of Environmental Protection hereby issues this Certification to: Infiltrator Systems, Inc., P.O. Box 768, 6 Business Park Road, Old Saybrook, CT 06475 (hereinafter "the Company"), for General Use of the System described herein. Sale and use of the System are,conditioned on and subject to compliance by the Company and the System owner with the terms and conditions set forth below. Any noncompliance with the terms or conditions of this Certification constitutes a violation of 310 CMR 15.000. it J June 30,2010 Glenn Haas,Acting Assistant Commissioner Date Bureau of Resource Protection This information is available in alternate format.Call Donald M.Gomes,ADA Coordinator at 617-556-1057.TDD#1-866-539-7622 or 1-617-574-6868. MassDEP on the World Wide Web: http://www.mass.gov/dep s Infiltrator-chamber.- Modified Approval of Alternative Systems for General Use Page 2 of 7 I. Purpose 1. The purpose of this Certification is to allow use of the System in Massachusetts, on a General Use basis. 2. With the necessary permits and approvals required by 310 CMR 15.000, this Certification authorizes the use of the System in Massachusetts. 3. The System may be installed on all facilities where a system in compliance with 310 CMR 15.000 exists on site or could be built and for which a site evaluation in compliance with 310 CMR 15.000 has been approved by the local approving authority, or by DEP if DEP approval is required by 310,CMR 15.000. II. Design Standards l. The models listed in Table 1 are covered under this Certification. Table 1. Chamber Dimensions Dimensions Invert Model W x L x H Height Inches Inches Equalizer 24 15 x 100 x 11 6 Quick4 Equalizer 24 16 x 48 x 11 6 Quick4 Equalizer 24 LP (6-inch invert) 16 x 48 x 8 6 Quick4 Equalizer 24 LP (2-inch invert) 16 x 48 x 8 `2 Equalizer 36 22 x 100 x 13.5 6 Quick4 Equalizer 36 22 k 48 x 12 6 Standard Chamber 34 x 75 x 12 6.5 Quick4 Standard 34 x 48 x 12 8 ' Quick4 Plus Standard(5.3-inch invert) 34 x 48 x 12 5.3 Quick4 Plus Standard(8-inch invert) 34 x 48 x 12 8 Quick4 Plus Standard LP (3.3-inch invert) 34 x 48 x 8 3.3 Quick4 Plus Standard LP (8-inch invert) 34 x 48 x 8 8 Infiltrator 3050,or StormTech SC-740 51 x 85.4 x 30 22.25 High Capacity Chamber 34 x 75 x 16 11 Quick4 High Capacity 34 x 48 x 16 11.5 - 1. Includes Infiltrator Multiportrm invert adapter attached to the side of the end cap. 2. Includes'Quick4 Plus Periscope adapter attached to the top of the Quick4 Plus All-in- One 8 Endcap. \ 3. Only systems installed with this invert height shall be allowed to use the effective leaching area associated with this model in Table 2 I Infiltrator-chamber. Modified Approval of Alternative Systems for General Use k. Page 3 of 7 2. The System is an open-bottom leaching unit molded from polyolefin resin. It can be installed without aggregate or distribution pipe as an absorption trench in accordance with the requirements in 310 CMR 15.251 or as a bed or field in accordance with the requirements in 310 CMR 15.252. 3. The use of aggregate as specified in 310 CMR 15.247 is not necessary with the System when installed as a trench, bed or field. When designed with aggregate in accordance with 310 CMR 15.253, the System_ shall be designed in accordance with Section II item 11. - 4. The minimum separation-.between any two trenches shall be as'specified in 310 CMR 15.251. 5. The requirement that the Chamber installed in trench configuration as specified in 310 CMR 15.253(6)be provided with inlets at intervals not to exceed 20 feet is not applicable to the System. In accordance with 310 CMR 15.240 (13) a minimum of one inspection inlet shall be installed per system. The inlet shall be capped with a screw type cap and accessible to within three inches of finish grade. 6. The total effective leaching area for any Chamber Model shall be calculated by multiplying the Effective Leaching Area per square foot of chamber times.the total length of chamber from end cap to end cap including end caps. 7. For new construction, the applicant can size the System in a trench configuration without aggregate, using the effective leaching areas presented in Table 2. No System, however, shall be designed and constructed with a soil absorption system area of less than 400 square feet of effective area. Table 2. Effective Leaching Area for New Construction 4 And Remedial Sites Effective Effective Model Leachings Leaching6 Area Area SF/LF SF/LF Equalizer 24 3.76 NA Quick4 Equalizer 24 3.90 NA Quick4 Equalizer 24 LP (6-inch invert) 3.90 NA Quick4 Equalizer 24 LR(2-inch invert) 2.78 NA Equalizer 36 4.73 NA Quick4 Equalizer 36 4.73 'NA Standard Chamber 6.53 NA Quick4 Standard 6.96 NA Quick4 Plus Standard(5.3-inch'invert) 6.20 NA Quick4 Plus Standard(8-inch invert) 6.96 NA Quick4 Plus Standard LP (3.3-inch invert) 5.65 NA Quick4 Plus Standard LP (8-inch invert) 6.96 NA f . Infiltrator-chamber. Modified Approval of Alternative Systems for General Use Page 4 of 7 Infiltrator 3050 or StormTech SC-740 NA 6.71 High Capacity Chamber 7.79 NA Quick4 High Capacity 7.93 NA 4.Effective April 21,2006,310 CMR 15.25l(1)(b)maximum trench width is 3 feet. 5. Effective leaching area is equal to 1.67(bottom width+(2x invert height))for Systems 3 feet or less in width. 6. Effective leaching area is equal to 1.0 (3-+ (2x invert Height)) for Systems with a width greater than 3 feet. 7. The maximum trench width allowed to calculate effective leaching area is 3 feet. 8. Systems installed on remedial sites shall be allowed to utilize the effective leaching areas presented in Table 2 above or additional reductions in soil absorption leaching area approved by the approving authority in accordance with 310 CMR 15.284. In no instance shall the reduction in the soil absorption' system required in 310 CMR 15.242 exceed the maximum reduction allowed for alternative systems approved in accordance with 310 CMR 15.294. 9. In accordance with 310 CMR 15.240 (6) absorption trenches should be used whenever possible. When the System is installed for new construction without aggregate in a bed or field configuration, as defined in 310 CMR 15.252, the System shall be designed using the effective leaching area for the bottom width presented in Table 3: No system shall be designed and constructed with a leaching area of less than 400 square feet of effective ,area determined in accordance with 310 CMR 15.252(2)(i). Table 3. Effective Leaching Area for Bed or Field Configuration Effective Model' y Leaching$ Area SF/LF Equalizer 24 2.09 Quick4 Equalizer 24 2.23 Quick4 Equalizer 24 LP (6-inch invert) 2.23 Quick4 Equalizer 24 LP (2-inch invert) 2.23 Equalizer 36 3.06 Quick4 Equalizer 36 , - t 3.06 Standard Chamber 4.73 -- — -Quick4 Standard. - ` Quick4 Plus Standard(5.3-inch invert) 4.73 Quick4 Plus Standard(8-inch invert) 4.73 Quick4 Plus Standard LP (3.3-inch invert) 4.73 Quick4 Plus Standard LP (8-inch invert) 4.73 Infiltrator 3050 or StormTech SC-740 7.10 i Infiltrator-chamber. ' Modified Approval of Alternative Systems for General Use Page 5 of 7 , High Capacity Chamber 4.73 Quick4 High Capacity 4.73 8.Effective Leaching area is equal to 1.67 times bottom width only. 10. The System, when installed in a bed or field configuration without aggregate,on remedial sites, shall utilize the effective leaching areas presented in Table 3 above or additional reductions in soil absorption system area approved by the approving authority in accordance with 310 CMR 15.284. In no instance shall the reduction in the soil absorption system area required in 310 CMR 15.242 exceed the maximum reduction allowed for alternative systems approved in accordance with 310 CMR 15.284. 11. The System, when installed as specified in 310 CMR 15.253: Pits, Galleries, or Chambers, shall have an aggregate base and/or be surrounded by aggregate and shall be sized as specified in 310 CMR 15.253 (1) (a) and (b), effective leaching area is equal to 1.0 times a conventional aggregate system. Effective depth can be increased up to two feet inclusive of invert of the chamber. Bottom width can be increased by two to eight SF/LF with the corresponding addition of one to four feet of aggregate per side. 12. When the System is installed as specified in 310 CMR 15.255: Construction in Fill, the finished J5 foot horizontal separation distance, item (2), shall be measured from the from the top of the chamber. III. General Conditions ' 1. All provisions of 310 CMR 15.000 are applicable to the use.of the System, except those that specifically have been varied by the.terms of this Certification. 2s The facility served by the System, and the System itself, shall be open to inspection and sampling by•the Department and the local approving authority at all reasonable times. 3. In accordance with applicable law, the Department and the: local approving authority may require the owner of the System'to cease use of the System and/or to take any other action as it deems necessary to protect public health, safety,- welfare or the environment. 4. The Department has not'determined that the,performance of the System .will provide a level of protection to the environment that is at least equivalent to that , of a sewer. Accordingly, no new System shall be constructed, and no System shall be, upgraded or expanded, if it is feasible to connect the facility to a sanitary sewer,unless allowed pursuant to 310 CMR 15.004. 5. Design, installation and use of the System shall be.in strict conformance with the Company's DEP approved plans'and specifications and.310 CMR 15.000, subject ' to this Certification. ' Infiltrator-chamber. Modified Approval of Alternative Systems for General Use Page 6 of 7 IV. Conditions Applicable to the System Owner 1. The System is approved for the treatment and disposal of sanitary sewage only. Any wastes that are non-sanitary sewage generated or used at the facility served by the System shall not be introduced into the on-site sewage disposal system and shall be lawfully disposed of. 2. For new construction, the owner initially shall size a soil absorption system in accordance with 310 CMR 15.242 to demonstrate that a conventional Title 5 soil adsorption system using aggregate, including a reserve area, can be installed on the site. The owner may then size the soil absorption system for the System. The total area required for the aggregate system, which may include the area designated for the System, and a reserve area shall be preserved and the owner shall ensure that no permanent structures or other structures are constructed on that area and that the area is not disturbed in any manner that will render it unusable for future installation of a conventional Title 5 soil absorption system. 3. The owner of the System shall at all times properly operate and maintain the on- site sewage disposal system. 4. The owner shall furnish the Department any information that the.Department requests regarding the operation and performance of the System, within 21 days of the date of receipt of that request. 5. No owner shall authorize or allow the installation of the System other than by a person trained by the Company to install the System. V. Conditions Applicable to the Company 1. By February 15`" of each year, the Company shall submit to the Department a report, signed by a corporate officer, general partner, or Company owner that contains information on the System for the previous calendar year. The report shall state known failures, malfunctions, and corrective actions taken for the System as well as the date and address of each event. 2. The Company shall notify the Department's Director of Watershed Permitting at least 30 days in advance of any proposed transfer of ownership of the technology. for which this Certification is issued. Said notification shall include the name and address of the proposed new owner and a written agreement between the existing and proposed new owner containing a specific date for transfer of ownership, responsibility, coverage and liability between them. All provisions of this Certification applicable to the Company shall be applicable to successors and assigns of the Company, unless the Department determines otherwise. 3. The Company shall furnish the Department any information that the Department requests regarding the System, within 21 days of the date of receipt of that request. F 4. Prior to an sale of the System, the Company y y shall provide the purchaser with a copy of this Certification. In any contract for distribution or sale of the System, Infiltrator-chamber. Modified Approval of Alternative Systems for General Use . 1 Page 7 of 7 r the Company shall require the distributor or seller to provide the purchaser of the System,prior to any sale of the System,with a copy of this Certification. 5. The Company shall prepare an installation manual -specifically detailing procedures for installation of its System. The Company shall institute and maintain a training program in the proper installation of its System in accordance with the manual and provide a training course at least annually for prospective installers. The Company shall certify that installers have passed the Company's training qualifications, maintain a list of certified installers, submit a copy to the Department, and update the list annually. Updated lists shall be forwarded to the Department. 6. The Company shall not sell the System to installers unless they are trained to install these Systems by the Company. VI. Conditions Applicable to Installers of the System 1. Each Installer shall install the System in accordance with-Company training on the installation of the System and the conditions of this Certification. 2. No Installer shall install the System unless the Installer has been trained by the Company on installation of the System. VII. Reporting 1. All submittals of notices and documents to the Department required by this Certification shall be submitted to: Director Wastewater Management Program Department of Environmental Protection One Winter Street- 5th floor Boston,Massachusetts 02108 VIII. Rights of the Department 1. The Department may suspend, modify or revoke this Certification for cause, including, but not limited to, non-compliance with the terms of this Certification, non-payment of an annual - compliance assurance fee, for obtaining the Certification by misrepresentation or failure to disclose fully all relevant facts or any change in or discovery of conditions that would constitute grounds for discontinuance of the Certification, or as necessary for the protection of public health, safety, welfare or the environment, and as authorized by applicable law. The Department reserves its rights to take any enforcement action authorized by law with respect to this Certification, the System, the owner, or operator of the System and the Company. 4 APPLICANT: � � j i✓q� ADDRESS: _2.4 7:;Tn { 161, DESIGN FLOW: O gpd REVIEWED BY: DATE: N/A . OK NO Legal boundaries denoted[310 CMR 15.220(4)(a)] Street, Lot,tax parcel number and lot number noted on plan [310. CMR 15.220(4)(u) Locus Provided 310 CMR 15.2204 t Plan proper scale?(1"=40'for plot plans, 1"=20'or fewer for components) [310 CMR 15.220(4)] Easements shown [310 CMR 15.220(4)(b)]. System located totally on lot served [310 CMR 15.405(1)(4)for u ades]- i not, a variance is re uired 310 CMR 15.412(4)] Location of impervious surfaces (driveways,parking areas etc.) 310 CMR 15.220(4)(d) Location all buildings existing and proposed 310 CMR 15.220(4)(c)] Location and dimensions of system components and reserve areas (310 CMR 15.220(4)(e)] � S stem Calculations [310 CMR 15.220(4)(f)] dail flow se tic tank capacity re uired and provided) soil absorption system(required and provided) whether system designed ed for garbage grinder North arrow [3'10 CMR 15.220(4)( )] Existing and proposed contours [310 CMR 15.220(4)( )] Location and log of deep observation holes (existing grade el. on each test) [310 CMR 15.220(4) Names of soil evaluator and BOH representative [310 CMR 15.220(4)(h)and(i)] �~ Location and date of percolation tests(performed at.proper elevation?) [310 CMR 15.220(4)(i)) Percolation test results match'loading rate?-[310 CMR 15.242] , Certification statement by Soil Evaluator 310 CMR 15.220(4)0)] Observed and Adjusted groundwater(method for adjustment given or indicated) [310 CMR 15.103(3) and 310.CMR - 15.220(4)(n)] FIG, Location of every water supply,public and private,.[310 CMR �- 15.220(4)(k)] Address Sheet l of within 400 feet of the proposed system location in the case Fofurface water supplies and gravel packed public water su 1 ✓ within 250 feet of the proposed system location in the case within 150 feet of the proposed system.location in thicase lof private water supply wells Location of all surface waters and wetlands located up to 1beyond setbacks listed in 310 CMR 15.211 and any catch b located within 50 f1 r310 CMR I5.220('4)(1)] Water lines and other subsurface utilities located[310 C$2) 15.220(4)(m)] (if water line cross see 310 CMR 15.211 1Profile of system showing invert elevations of all systemcom onents and the bottom of the SAS 310 CMR15 220Stam of desi er 310 CMR 15.220(1)and 310 CMR 15Stampof Registered Land Surveyor(required if constructactivities within 5 ft.of lot line) [310 CMR 15.220 3))Test Holes adequate(two in each of the primary and reseunless trenches as permitted in 310 CMR 15.102(2)or asa roved for an u ade under LUA at 310 CUR 15.405(Test hole adequate to demonstrate four feet of suitable ma rBenchmark 15.103(4)] adequate to confirm adequate groundwater separation? 5.103(3)] within 50-75'of system [310 CMR 15.220(4)( )] ecifications noted?[various sections of 310CMR V System components not>36"deep(unless Local Upgrade JAOproval or LUA requested) 310 CMR 15.405(1(b) Address 24 CO Sheet Sh 2 of 7 Size OK? [310 CMR 15.223(1)] Inlet tee located ten inches below flow line 310 CMR 15.227(6)] s� Outlet tee 14"or 14"+5"per foot for increase ft depth [310 CMR 1 .227 6)] Outlet tee with gas baffle or approved filter [310 CMR 15.227(4)] [deth) regarding installation on stable compacted base [310 CMR 8(1)] ' ation between inlet and outlet tees (no less than liquid 310 CMR 15.227(2) Inlet/Outlet elevations at least 12" above high groundwater J (except as described 310 CMR 15.227(5))or permitted for upgrades under LUA [310 CMR 15.405(1)(k)] Minimum cover 9"(Tanks buried more than 9"must have risers on all openings and on the d-box) [310 CMR 15.2228(l)and 310 ✓ CMR 15.232(3)(f)] Three access covers (inlet and outlet must be 20"or greater) - ' middle access at least 8" (b 7/07) [310 CMR 15.228(2)] Access to within 6 "of grade - one port for systems<I 000gRd, two fors stems>1000 gpd 310 CMR 15.228(2)). All at-grade covers secured to unauthorized access? [310 CMR 15.228(2)] > 10 ft from building foundation [310 CMR 15.211(1)] / Buoyancy calculation Required/Done 310 CMR 15.221(8)] H-20 Where appropriate? 310 CMR 15.226(3)] Setbacks from resources [310 CMR 15.2111 Required when other than single-family dwelling or flow>1000 d [310 CMR 15.223(l)(b)] First compartment 200%daily flow; Second compartment 100% dail flow 310 CMR 15.224(2)and (3) "U"pipe through or over baffle,outlet of each compartment with . as baffle or approved filter 310 CMR 15.224(4)] i Address Sheet 3 of 7 Located at least ten feet from any water line? [310 CMR 15.2222) Disposal piping at least 18" below water line (when water and sewer cross,see 310 CMR 15.211 1)[1)) ; Cleanouts require d/ rovided ? [310 CMR 15.222(8)] Thrust blocks specified in force mains?310 CMR 15.221(6)(c)] Slope of sewer line not less than 0.01 (1/8"/ft) 0.02 preferable [310 CMR 15.222(6)) Proper pitch on all runs?.(.005 within gravity-distributed trenches and beds) 310 CMR 15.251(9)and 310 CMR 15.252(2)(c)] Si hon roblem/ eachfield below um chamber) Endca s or vent manifoldspecified? Size and orientation of discharge holes specified?(not smaller than 3/8"not larger than.5/8") [310 CMR 15.251(8)and 310 CMR 15.252(2)(h)] Materials specified (310 CMR 15.251(5)specifies various pipe t es allowed) Stable compacted base [310 CMR 15.22](2)and 310 CMR 15.232(2)(a)] Splash plate or baffle tee required on inlet/provided?(when pressure sewer to d-box or steep pitch of gravity sewer).[310 CMR 15.323 3)(n)] Riser if dee er than 9" 310 CMR 15.232(3)(f)] Inside minimum dimension 12" [310 CMR 15.2320A,)] Minimum sum 6" [310 CMR15.232(3)(e)] Watertight cover if<2000gpd); waterproof manhole if>2000gpd [310 CMR 15.232(3)(d)] Capacity(emergency storage above working--design flow)?[310 CMR 231(2)] Pro er setbacks [310 CMR 15.211 (same as septic tanks)] Watertight 20-in minium access manhole at least 20"MUST BE TO GRADE [310 CMR 15.231(5)] Service components accessible (not too deep with piping, ' disconnects accessible) Alarm floats- alarm on circuit separate from um s s ecified? Exceeds two units must have two pumps operating in lead-lag mode. [310 CMR 15.231(6)and (8)] Stable Corn nActed Base [310 CMR 15.221(2)] Buoyancy calculations needed ?Provided? [310 CMR 15.221(8)] Address c�2� >-t4 L 9rZ Sheet 4 of 7 f Calculations correct? 4 feet of naturally occurring material demonstrated?[310 CMR 15.240(1) Re uired separation to groundwater? 310 CMR 15,212)] A e ate specified as double washed [310 CMR 15.247(2)] System Venting required/provided?(system under driveway or >36 deep) [310 CMR 15.241] Inspection ports specified and within 3"final grade?[310 CMR 15.240(13) Breakout requirements met?(No violation of breakout elevation within 151t of SAS unless barrier) [310 CMR 15.211(1)[4] and Guidance Document] Chambers and Gal. in trench configuration supplied with inlet eve 20 ft. [310 CMR 15.253(6)] Each structure with one inspection manhole(if>2000 gpd must be tograde) 310 CMR 15.253(2)] Aggregate I'minimum-4'maximum. [310 CMR 15.253(1)(b) 2'sidewall credit maximum [310 CMR 15.253(1)(a)] In bed configuration, inlet every 40 s .ft. [310 CMR 15.253(6)]' Width 2'minimum 3'maximum [310 CMR 15.251(1)(b)] 100 feet-maximum len [310 CMR 15.251(1) a Minimum separation 2x effective depth or width whichever eater{3x if reserve between trenches) [310 CMR 251 1)(d)] Situated along contours 310 CMR 15.251(2)] Breakout OK?[310 CMR 15.211(1)[4] and Guidance Document] minimum 2 distribution lines 310 CMR 15.252(2)(a)] Maximum separation between lines 6' 310 CM R15.252(2)(d)] Maximum separation between lines and outside of bed 4' [310 CMR 15.252(2)(e)] Aggregate depth below discharge pipes 6"minimum, 12" maximum. [310 CMR 15.252(2)( )] Separation between beds 10'minimum. [310 CMR 15.252(2)(f)] Bottom area used in calculations only 310 CMR 15.252(2)(i)] , Address 24 Sheet 5 of 7 f Pressure Dosed System ? Provided pump and piping calculations as required [310 CMR 15:220 4)(r)] i Pressure dosing required on all systems>2000gpd or alternative systems under remedial approval [310 CMR 15.254(2)and I/A V Remedial Use A roval.0 If used in gravelless system -make sure jet is directed as not to scour soil interface [Guidance Document] Inspections once per year(systems<2000 gpd) or quarterly v/ (>2000 d)good to note on plan 310 CMR 15.254(2)(d) Construction in fill -Did the plan specify that the fill shall meet the specification of 310 CMR 15.255(3)? Im ervious barrier and/or retaining wall ? Guidance Document) ,/ IImpervious barrier installation must be supervised by designer[310 CMR.15.255(2)(b)] Retaining wall must be designed by Registered Professional— Engineer[310 CMR 15.255(2)(a)] Side slope not exceed 3:1 ? 310 CMR 15.255(2)] Breakout requirements met? [310 CMR 15.252(2)and Guidance Document] At least 5 ft.from impervious barrier to edge of SAS (1OR. recommended) [3X0 CMR 15.255 (2)(e)] Check DEP Approval letters for credits and design conditions If used with pressure dosing do not allow pressure discharge to scour soil interface Was DEP Approval Letter provided and/or have you reviewed the letter for conditions? Is the technology being properly applied and does it meet all DEP Approval Conditions? Is there a note on the plan regarding the requirement for 1perpetual maintenance agreement? Any alarms involved on separate—circuits Did the applicant submit an operation and maintenance [manual?- 14as licant submitted a coy of a maintenance Are the variances listed on the plan ?[310 CMR 15.220 RLS Stamp necessary on plan if a component is within five feet of ro erty line MO CMR-15.412(4)] New construction or increased flow proposed- [Refer to 310 CMR-15.414] Address 4-17 Sheet 6 of 7 Is the system in a Designated Nitrogen Sensitive Area(Zone II fo a public supply well)? [310 CMR 15.214, 310 CMR 15.215 and 310 CMR 15.216- also refer to Policy regarding upgrades of such existing systems] Is the system proposed on the same lot as served by private well ? 310 CMR 15.214(2)] Are the nitrogen loads proposed in compliance? [310 CMR 15.216(1)] Pumping to septic tank ? 310 CMR 15.229 Shared System 310 CMR 15.290 Address L9 Sheet 7 of 7 COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PR ffWNVED SEP 2 5 20OZ TOWN OF BARNSTABLE HEALTH DEPT. TITLE 5 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 24 Forsyth Court Cotuit, MA 02635 Owner's Name: William Alexander X Owner's Address: Same Date of Inspection: September 17, 2002 Name of Inspector: (Please Print) James M. Ford Company Name: James M. Ford Map: 055 . Mailing Address: P.O. Box 49 Parcel: 059 Osterville,MA 02655-0049 Lot:46 Telephone Number: (508) 862-9400 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: ✓ Passes Cond' 'onally Passes Nee4 rther Evaluation by the Local Approving Authority Fails Inspector's Signature: Date: September 22, 2002 The system inspector shall sub ' 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. Notes and Comments ****This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future under the same or different conditions of use. 0 Title 5 Inspection Form 6/15/2000 page 1 Page 2 of I 1 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 24 Forsyth Court Cotuit, MA Owner: William Alexander Date of Inspection: September 17, 2002 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: ✓ I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B. System Conditionally Passes: One or more system components as described in the"Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair,as approved by the Board of Health, will pass. Answer yes,no or not determined(Y,N,ND) in the for the following statements. If"not determined",please explain. The septic tank is metal and over 20 years old* or the septic tank(whether metal or not) is structurally unsound,exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND explain: Observation of sewage backup or breakout or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if (with approval of Board of Health): broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced ND explain: The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed ND explain: 2 Page 3 of 1 1 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 24 Forsyth Court Cotuit. MA Owner: William Alexander Date of Inspection: September 17, 2002 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. _ 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 and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: 3 Page 4 of I 1 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 24 Forsyth Court Cotuit, MA Owner: William Alexander Date of Inspection: September 17, 2002 D. System Failure Criteria applicable to all systems: You must indicate either`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 ✓ Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped_. ✓ Any portion of the SAS, cesspool or privy is below high ground water elevation. ✓ Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ✓ Any portion of a cesspool or privy is within a Zone 1 of a public well. ✓ Any portion of a cesspool or privy is within 50 feet of a private water supply well. ✓ Any portion of a cesspool or privy.is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form.] No (Yes/No)The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E. Large System: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd• You must indicate either`yes"or"no"to each of the following: (The following criteria apply to large systems in addition to the criteria above) Yes No the system is within 400 feet of a surface drinking water supply the system is within 200 feet of a tributary to a surface drinking water supply the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area- 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. 4 Page 5 of I I OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 24 Forsyth Court Cotuit, MA Owner: William Alexander Date of Inspection: September 17, 2002 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: Yes No ✓ 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(3)(b)]. 5 Page 6 of 1 I OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 24 Forsyth Court Cotuit, MA Owner: William Alexander Date of Inspection: September 17, 2002 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): 3 Number of bedrooms(actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x 4 of bedrooms): 330 Number of current residents: 2 Does residence have a garbage grinder(yes or no): Yes Is laundry on a separate sewage system (yes or no): No (if yes separate inspection required] Laundry system inspected(yes or no): No Seasonal use(yes or no): No Water meter readings, if available(last 2 years usage(gpd)): Unavailable Sump Pump(yes or no): No Last date of occupancy: Currently occupied CO MMERCLUJINDUSTRIAL Type of establishment: Design flow(based on 310 CMR 15.203): gpd Basis of design flow(seats/persons/sgft,etc.): Grease trap present(yes or no): Industrial waste holding tank present(yes or no) Non-sanitary waste discharged to the Title 5 system (yes or no): Water meter readings, if available: Last date of occupancy/use: OTHER(describe): GENERAL INFORMATION Pumping Records Source of information: Pumped in September 2002-per owner Was system pumped as part of the inspection (yes or no): 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: A newer pit was added in 1992 -per as built card Were sewage odors detected when arriving at the site(yes or no): No 6 Page 7 of I I OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 24 Forsyth Court Cotuit, MA Owner: William Alexander Date of Inspection: September 17, 2002 BUILDING SEWER(locate on site plan) Depth below grade: Materials of construction: _cast iron _40 PVC _other(explain): Distance from private water supply well or suction line: Comments(on condition of joints,venting,evidence of leakage, etc.): SEPTIC TANK: ✓ (locate on site plan) Depth below grade: 6" Material of construction: ✓ concrete _metal _fiberglass _polyethylene _other(explain) If tank is metal list age: Is age confirmed by a Certificate of Compliance(yes or no): (attach a copy of certificate) Dimensions: 1500 gal. Sludge depth: 1" Distance from top of sludge to bottom of outlet tee or baffle: 31" Scum thickness: 0" Distance from top of scum to top of outlet tee or baffle: 10" Distance from bottom of scum to bottom of outlet tee or battle: 14" How were dimensions determined: Measuring stick Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tees were present The liquid level was even with the outlet invert. There were no signs of leakage. GREASE TRAP: None (locate on site plan) Depth below grade: Material of construction: _concrete _metal _fiberglass _polyethylene _other (explain): Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping: Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): 7 0 Page 8 of I I OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 24 Forsyth Court Cotuit, MA Owner: William Alexander Date of Inspection: September 17, 2002 TIGHT or HOLDING TANK: None (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/day Alarm present(yes or no): Alarm level: Alarm in working order(yes or no): Date of last pumping: Comments(condition of alarm and float switches,etc.): DISTRIBUTION BOX: None (if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: Comments(note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box,etc.): PUMP CHAMBER: None (locate on site plan) Pumps in working order(yes or no): Alarms in working order(yes or no) Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.): 8 Page 9 of 1 I v OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 24 Forsyth Court Cotuit, MA Owner: William Alexander Date of Inspection: September 17, 2002 SOIL ABSORPTION SYSTEM(SAS): ✓ (locate on site plan,excavation not required) If SAS not located explain why: Type ✓ leaching pits,number: 2-6'x 6'w/T stone(per design plans) leaching chambers,number: leaching galleries, number: leaching trenches, number, length: leaching fields, number,dimensions: overflow cesspool, number: Innovative/alternative system Type/name of technology: Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil,condition of vegetation,etc.): The original pit (0) had approximately T of water on the bottom The cover was approximately Y below grade. A newer pit (44)was dry. The scum line was approximately 6"up from the bottom There were no signs of failure. The bottom to grade was approximately 9' CESSPOOLS: None (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 or no): Comments (note condition of soil, signs of hydraulic failure, level of ponding,condition of vegetation, etc.): PRIVY: None (locate on site plan) Materials of construction: Dimensions: Depth of solids: Comments(note condition of soil,signs of hydraulic failure, level of ponding, condition of vegetation, etc.): 9 Page 10 of 1 I OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 24 Forsyth Court Cotuit, MA Owner: William Alexander Date of Inspection: September 17, 2002 Map: 055 Parcel: 059 SKETCH OF SEWAGE DISPOSAL SYSTEM Lot: 46 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. L �n I � Al - �y a3 a y AA- Qa- a� 63. 3? 10 Page 11 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 24 Forsyth Court Cotuit. MA Owner: William Alexander Date of Inspection: September 17. 2002 SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water 35' +/- feet Please indicate(check)all methods used to determine the high ground water elevation: Obtained from system design plans on record-If checked, date of design plan reviewed: Observed site(abutting property/observation hole within 150 feet of SAS) ✓ Checked with local Board of Health-explain: topottraphic and water contours maps Checked with local excavators,installers-(attach documentation) Accessed USGS database-explain: You must describe how you established the high ground water elevation: The bottom of the leach pits to grade was woroximately 9' Using the Barnstable topographic map and the Cape Cod Commission water contours map, the maps were showing approximrgtely 35'+/-to around water at this site This report has been prepared and the system inspected and passed as of the date of inspection. This`report is not a warranty or guarantee that the system will function properly in the future. There have been no warranties or guarantees,either expressed written or implied,relating to the system, the inspection and/or this report. I 11 TOWN OF BARNSTABLE .. �M,a.4 LO%� SON �;- Por_s'-4f� c Uurr SEWAGE # LAGE �u+� ASSESSOR'S MAP & LOT Crs-r ar INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY J LEACHING FACILrrY: (type) o�` A 7s (size) f UUti Gad. NO.OF BEDROOMS 3 BUILDER OR OWNER IJ i I PERMTTDATE: COMPLIANCE DATE: 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 leacNng facility) Feet Furnished by Ford- aI- a3 a AA- iq A3- 133. 33 TOWN OF BARNSTABLE r ' LOCt�i' 10N �, �oYT���C� Cc���� SEWAGE # g24 `-( VILLAGE (_df'u tiT ASSESSOR'S MAP & LOT - 66'9r INSTALLER'S NAME & PHONE NO. yp, L,p,slip ScQc�C SEPTIC TANK CAPACITY A&yo LEACHING FACILITY:(type) (size) 6-ok � NO. OF BEDROOMS PRIVATE WELL O PUBLIC WA R� B.VILDER OR OWNER DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: ti a VARIANCE GRANTED: Yes No ?L` t O1J�'-ttUZ� i No..,<..ca� - � .. Fxa. ... THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH �D �'�OWN OF BARNSTABLE7-T U r V __ � F COICT Ap lication is hereby made for a Permit to Construct ( ) or Repair (a--ran Individual Sewage Disposal System at M.-- -N- _ ' ..`.. . - ..�` .�rn.. o� V ' ...... ....----- (J+ Loca'on-Address or Lot No. �� ..._..... �' `. - -------•------•------------------•----••------- Owner Address --------------('.. -. ?.... .----- --------•----- C�k... .a.. �G, -------•----.................--- Installer Address � Type of Building Size Lot...........................S q. feet V Dwelling No. of Bedrooms ................. .....Ex Expansion Attic� g— --------- p ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) Otherfixtures .................................................................................................................................................... Design Flow........._-_<.. .-..............gallons per person per day. Total daily flow......... .................gallons. WSeptic Tank—Liquid capacity............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 Distribution box ( ) Dosing tank ( ) 1.4 Percolation Test Results Performed by.......................................................................... Date.----------------......---------------- Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 9.4 Test Pit No. 2................minutes per inch Depth of.Test Pit---:................ Depth to ground water........................ a ---•----•-•-••---------------•----------------------------------•--•----------......._..............-•-••...-----------••-•----•......---. --•----•-••••---- 0 Description of Soil...............................................................................------------------------------------•----------------------- ...................... W w x -------------------------------•---•---------------•---•-------------------- ---•--------------•-----------. ----------•--•- -------- U Nature of Repairs or Alterations—Answer when applicable------- Y-'"=�1 7 - ---- � r� --------------. - -------- - ------------ 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 urther agrees not to place the system in operation until a Certificate �hasbee issue th. Signe ......... ..... . I ....... Date Application Approved By ................... " ... �,,.�.�.�.. --- ..................................................................... Date Application Disapproved for the fol owing reasons: --------- ------------------------------------------------------------------------------------------- ---------------------- --------------------------------- -- ---- -- -- ------------------------------------------------------------------------ -- ------------- Date No. ------f ... L�/.7Permit .. . - -- - --------------------- -- Issued ........................................................ Date NO-72. Fz z THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH 0, - - a y JOWN OF BARNSTABLE 1- A-plication plutttuln for Dtspnsal Works Tons�r�t ftu rrmi# is hereby made for a Permit to Construct ( ) or Repair (,--`ran Individual Sewage Disposal System at: -on-Address or Lot No. own Address a --- -- _ vt � � ---- --�--' �~-- - d Type of Building Addressding -�- Size Lot-- Sq. feet V Dwelling-No. of Bedrooms---_- -,��_--------------------------------Expansion Attic ( ) Garbage Grinder ( ) `4 Other-Type of Building No. of sons---------------------------- Showers a YP g ---------------------------- Fes' ( ) - Cafetena� ) dOther fixture --------------------------------------------------------------------------------------------------------------------------- _ - Design Flow--------- -------------------gallons per person per day. Total daily flow------_7 3 _-gall WSeptic Tank-Liquid-capacity------------gallons Length----------------Width---------------- Diameter----------------Depth------------ x Disposal Trench-No_____________________ Width-------------------Total Length-------------------Total leaching area--_---------- ft. 3 Seepage Pit No------I------------- Diameterl_12------------ Depth below inlet--_ Total leaching area z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by---------------------------------_--------------_----_------__-_-- Date----- M Test Pit No. 1----------------minutes per inch Depth of Test Pit_____________•_---_ Depth to ground water-------------------__- 44 Test Pit No. 2---_----------minutes per inch Depth of Test Pit_-.----;i---------- Depth to ground water-----_-___-_______ a ------------------------------------------------------------------------------------ ------------ - - 0 Description of Soil------------------------------------------------------------------------------------------------------—-----_--- x v ----------------------------------------------------------------------------------------------------------------------------------------------------------------------- ---------- w ------------------------------------------------------------------------------------------- --- -- -- -- ------- U Nature of Repairs or Alterations-Answer when applicable---- c s'Z`�t,/._____-_ 42:z_?2�_--- '------------------- —�=-=�=----�� --- 1-J F �------------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 o mpliance-has been issued, y I'e board;&-health. Signed`''-`=_5 - - - - ------------- -� - ApplicationApproved BY 1�--------------------------------------7-------'-------------- --------------------------------------- Application Disapproved for the following reasons- --------------------------------------------------- ------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------ ------------------------------------------ --------------------------------- Permit No. y/ Issued ------------------------------------------------- � n ------------ km THE COMMONWEALTH OF MASSACHUSETM BOARD OF HEALTH TOWN OF BARNSTABLE GPl'ttftrz& of G"lianrE THIS IS TO CERTIFY That the Individual Sewage-Disposal System constructed ( )or Repaired ( G)� by---------------------------------------------------------�---f=�--- -`''` 9 -- /)7-f - ----- -------------------------------------------------------------------- 4;2 at - --L(-- -r` U✓ - (-�` - �- - '--------------------------- C77U -- has been installed in accordance with the provisions of TITLE 5 of The State Environmental Code as described in the application for Disposal Works Construction Permit No- ------------------------------------------------ dated ------------------------------____-- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE------------------- I- ---------------------------- Inspector ------------ - - --------------------- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE No. - Q� � FZE____� Disposal Works Tnn wiiun rrmff Permission is hereby granted------------- __ 1�` (-`6"''6 to Construct ( ) or Repair ( Individual Sev�age Disposal System at No.- -- -- --- ``! !) ,may� "C_Gl _ t� �6 - - ---� -- --- ------ � - ----- - - Street as shown on the application for Disposal Works Construction Permit No J?__ Dated------------------------__-----_.� ------------------------- --i--------------------------------------- -- -__- �1 Board of Health DATE_—_--------�-��-----e-�--_-------------------------------____ FORM 36508 HOBBS Q WARREN,tNC-PUBLISHERS LOCATION SEWAGE PERMIT NO. j VILLAGE INSTA LLB EERR'S NAME i ADDRESS BUILDER OR OWNER DATE PERMIT ISSUED 7 13 . 7!2 DATE COMPLIANCE ISSUED � y� 7 � y,� V 17 3� l N0..0...'�?!...... Fmc 3 g:..©U.... THE COMMONWEALTH OF MASSACHUSETTS m BOAR® OF HEALTH ..........OF..... ji�/�.A�.�T.., '. --------------------------- a� Appliration for Disposal Warks Cnnnttrnrtinn rantit Application is hereby made for a Permit to.Construct (� or Repair ( ) an Individual Sewage Disposal System at: .t_T........ ............... ....... ------..........------------. ...--------- Location ddress or Lot No. !elf::!1 ..*..1_.�: ....... 1.� e�,l? ' 'Sf...._/ 5�[ .. ... .C. 'cdx 1. ..... Ow er . Ad re s Installer Address . �s d ..Type of Building .� Size Lot/!f.7---_-----fit U Dwelling—No. of Bedrooms............ ..?...........................Expansion Attic (wo) Garbage Grinder Other—T e of Building __-.--- No. of persons............................ Showers — Cafeteria Other fixtures . ------- - � ---•------------ ----••-•-----------••--•--•----------•-------------.....------........----------...•• ••-•-_.. W Design Flow........./l_C�......................gallons per AQA"per*day. Total daily flow.........--Z10.....................gallons. WSeptic Tank—Liquid capacity.150Dgallons LengtheiP_rt9°..r" Width-_- Diameter________________ Depth_.`_W.:?�. Disposal sposal Trench—No. .................... V�idth.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No........,, ........ Diameter..../®.___.... Depth below inlet......._............ Total leaching area..2.-;.?O._sq. ft. Z Other Distribution box (LI- Dosing tank ( ) 0-4 Percolation Test Results Performed by..X01.VA_.C,,.1>.....AR_6-l-e.6;15,PA-6..../Z S- Date.-..MAY....ZQ�-C��9 Test Pit No. l._ Z.....minutes per inch Depth of Test Pit../A;........... Depth to ground water.._/_Vm.n e.___. fT4 Test Pit No. 2--- -z--...minutes per inch Depth of Test Pit-l..._..._._. Depth to ground water---Alo m. !'-____ 04 -•------•--•--•r..:----•--------------------•••--------------.................-•---•---•-------............................................................. 0 Description of Soil .. ._..... .RAry------SCI-.N.5,0&.......... .r-•-- 5^4n1� ----------------- . ...---------------- l1lL- -/L C'D./��.t?�T.l -S-•--------h.--------a:� ' `ST �`Yf�� . U Nature of Repairs or Alterations—Answer when applicable.............................................................................................. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of iI I 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. Signed.............•. ........ ..--........................................................... ........................... Date Application Approved By...... '......... F --•.................•------ .....7.,.... `r� 9.... Date Application Disapproved for the following reasons----------------•-•--------------•-----------------------------•-----------•-•---------------- ............_. .......................................................------------------•-----•-----....-•----•-------------------•------•----.....-•--...----••------------------------------------------•----------- Date PermitNo......................................................... Issued......=................................................ Date 4 h:. Non........��.© F>�s... d.�.0.©..... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH r0_c,.k>) ........._0F..... , }1 . s- "e' �---------------------------- Appliration for Disposal Works Towitrurtion ramit Application is hereby made for a Permit to Construct O or, Repair ( ) an ,Individual Sewage Disposal System at • ti 'e--a! .L!Zw.....i:0--L-.!_il:.......C 1. ,o_/..t�......... .............. T .. ..`�' �.. - = .......... Location Address or,Lot No. -----61.•4 X ?2I — `--------•-------- �4Y.._..0 A..6 .,.[6,.e _A-•_r +adress /d�AC�.L.�,./. _�►..... ,04J Installer ....... ={ �Jtv.TT..�-----..AaiCA1'0 ..... l.S..... .1 y UType of Building Size.Lot,/±Z"` .____._." / t Dwelling—No. of Bedrooms............. ...................:......:Expansion Attic (oio) Garbage Grinder $qe)` '4 Other—T e of Building No. of,persons____________________________ Showers — Cafeteria Other fixtures ..............................................................d6 . - -----••--•-------••-•-•---_---- W Design Flow_______.�`t'_Q........................' gallons per per day. Total daily flow.__;_ 3 ........._............gallons. WSeptic Tank—Liquid capacity/.5DjQ_gallons Length/0. a_:0_ Width._:,___"t ".. Diameter_____ _________ Depth.5. _.`.°_. x Disposal Trench—No_____________________ Width......r............. Total Length...........i....... Total leaching area....................sq. ft. 4 Seepage Pit No._._._.,,,-I.__._.__ Diameter__,��_:_______ Depth below inlet-.j6............. Total leaching areaa' _r,,r►:_sq. ft. Z Other Distribution box (b Dosing tank ( ) - W Percolation Test Results Performed by X40iV__+s-_0.....A 5-/,6-iAAt ?__. -. ... Date___/ X.....ew _9>1( Test Pit No. L ......minutes per inch . Depth of Test Pit/;:'......... Depth to ground water_.A,/V c;�'__.. (r4 Test Pit No. 2_'1��-___-_minutes per inch Depth of Test Pit.?'Z•._`.......... Depth to ground water..-&AA�A__.._... 1r O Description of Soil ---- -a...•--•--e.,pwzy.y.......SLc' --------•-ram !` rt'le+' G+,? ,�p" W -----•-•--••------ --------51w1 L.! .&...----- t _l � '1� t ------- ti t ' ' '' 'S?..... 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 TITLE 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. _Signed......................................................................... --- ---•------ ---.....--------- Date Application Approved By..... --•----- tin - Date Application Disapproved for the following reasons:----••--------•-----••-•---•---•------------------------------•-------------•--•----------------------••-•••--� ----•--•...••---•---•..................•---••-•••----•••-••...---•--------•---------------•-------------• Date PermitNo....................................................... Issued........................................................ Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH a.. .......................OF........ .a�..f` ...................... Trrtifiratr of Tontplittnrr THIS If TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) by................jT.V.. J6.A._...__.N,61_11 . ---------------------•---- nstaller at ` ........ ''.'.� ° 1� .......Cay.10-...................................................................................... has been installed in accordance with the provisions of TIT 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No ____ ........I?Y The, State dated................................................ THE ISSUANCE OF THIS CERTIFICATE 'SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE................................................................................ Inspector......................................................................... .._._... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH . `...t1�. oF....... ..!............................... N 7. ....... FEE........................ Disposal Worko Tonotrudion rriltu Permission is hereby granted......A.&7."4_4-xL.__.... ` I-----•••-•-----------•---......................................................... to ConstrucRe air an Individual Sewa a Disposal stem� P ( ) P l System at No........ -------- v Street as shown on the application for Disposal Works Construction Permit-N9�y�i.___ Dated n � ..---..-:.._::.-.:_.� /�^ / 9 Boardofff .•Health DATE.....................----•-•---•-••... .............................•---- FORM 1255 HOBBS & WARREN, INC.. PUBLISHERS j f _ LOT 4 (o �r TEST I-10LEs MAY PALL M(URRAY -aNSa, (; i �. D- a LOAM AND f SUs so/L.. . � b ,2 a a �� N1ED�UM Ot. w IN, { � COTUiT SAND IV) C Y1 O ELE V. t� ND GJR T /Q �} tf` v TOWN CAjA T-R AVAr -A 64.IEQ a • fir .;; `�'`. .3 M i AJ/^4 U it// ;1 �u/L-o/.�r s-7-,5A c� ,ec-c-�a/,e�M�vrs S C-4 - T�.4I'a P2O,�O SED SE P T/G 5 y5 TAM CONS T2 UC T/ON SHALL L On/FOlZM To N!A 55 C7�5/G A/ �L O�t/ � (, GAL Q,1 y ;�XIST/NG CN✓/.�OAiML-A/TA.L COOS TITLE. 17 le pF L -,RNS /E •i5FP7 �7£ LG4 G �/ 2� TE G � /n/. f/ 7 /OS REQU/2EO L,EACXI Ze!54�3NEA L T 0)�9 TOT-' P2 0�0 5 2 "OF TEE a S TOn/� OIL 6 MAA//-/0LE co✓ETA 7-0 E-:hTEA/ZD 7-p m/pEI2✓/0 ✓F- 1 TO ,a2E Vf NT / r,-//A/ /' OF F/n/�Ss/�r� 6�,nz�� c5 F2o.� 7/Za 7i.V:� I /D �4 c..asT 3ox %I Z/ ,W/06 av"e PIT /A/ n j✓ - M AJ , 3"M/N 4„ D/A ATE.�Z FA.Ow L/NE M/ _iL 4., O/d. /O Lq 4'/FOOT N %FDo7 M/n/ /�/rc fi �G� ^ a•. 3 /i2 D/A. or ' . YVAS Ec7 2 ?o ti Cl- T Y /NVE.eT � /N VEAc.T -- --- -- - - ,-- 20' M �/A./i.A4 U7 - — - C� ✓ .J LO A7./o/v L F rtPq� P.9G s•E p/ / �A A�,�/ r�%s rrz a a Ti o.v e o ti J� NALD f ,_ � 0U7-e-'— AND LE,4C—A11 VC =>/7- l--OJ . AGtfttLft -44 O �3� OF ,t2�in/F�2GED CO�/GT�ET� ` 1 Gl r(-Cl F.D No 60, C7NC2E TE ST2E t/v%W 5000 ;Rs/ y' �d(,+ /'1r co /O LOA D/n/G t— '�!7 T l'6 L r.' n/"O 7- TO 8� Y,; .�007 //0AF7- 0, .5,�`.�_ /��s�,�-4�`/r F d✓�G_5y'��T�nil CUAJLE_ f/- _'C7 t S CERT,,FY THE Ex ►.�"1-(NG DATOo t ;v <�L� UXAT/ON l.5 CtORREC� T AS 5HO!,-)N ANi N Tk� P-,bkD— v6 0 4 TI SE73/9C•�K �c�r, or UARA' c� 'TA2, NE11L'7.L/ 4C�-5.�EAJ/J y A .sue s I' sM - �t X'� �J✓f+L r r •A4 rf, LOT 47 a C\t rn , 314.99 I / / � ti / •�• Ism / �' co � �� �b � 1 00� /cam VAS - \ � dO Ile,' i _• _ � jls� � � � � _ , Qe i � � ► / $�cv ,p E RD IVE�IVAY qq, o �W oco( �. 1 00 SI �'` fit W ,� �.i .. �; 00.1• � � �� � I N o�w OBSERVATION PORT �\ : ,�'� � / ►� �,y. ►-, o LOT 46 �. o� W o_ 49,387.9 S.F. c'�� 00 H / OF i ) o 7 HN G r _ t i, 68 1 \,y� (i� S•CAULEY 51 O .35101 L-r ► �/ , � S 4008 20 t » E 312.0 ' SITE PLAN I PREPARED FOR NOTES: LOT 45 / VERA LEE SULLIVAN / OF 24 FORSYTH COURT THE EXISTING TANK SHALL BE LOWERED TO ALLOW FOR PROPER COTUIT, MA / FLOW OF EFFLUENT. I / THE EXISTING LEACHING PITS SHALL BE ABANDONED, PUMPED AND J. E. LANDERS—CAULEY, P.E. FILLED WITH CLEAN INERT MATERIAL. CIVIL ENVIRONMENTAL ENGINEERING / THE PROPOSED FINISHED GRADE OVER THE S.A.S. ,SHALL BE DETERMINED BY THE P.O. BOX 364 WEST FALMOUTH, MA 02574 LANDSCAPE DESIGNER AND/OR GENERAL CONTRACTOR. ,. 508 .540 — 7733 0 15' 30' 45' 60 / / - 508 540 - 3344 fax THE HOUSE HAS 4 BEDROOMS. i ASS.#55-059 DATE: 02115111 SCALE: 1" = 30' { SCALE: I", = 30 DRAWN BY. JDR i 'REV.03 24 11 JDR JOB NO. 1981 SHEET: 1 OF 2 � 77 *THE PROPOSED FINISHED GRADE OVER THE S.A.S. + F.F. ELEV.=115_24 r `_, SHALL BE DETERMINED BY THE LANDSCAPE DESIGNER 5 20'MIN. 113 AND/OR GENERAL CONTRACTOR. ELEV.= __ 114t covers to within 114_0* 4" CAST IRON OR 6" of finish grade. ELEV.-_ SCHEDULE 40 P.V.C. CONCRETE RS 9„ min. 4" CAST IRON OR " DIA SCHEDULE 40 PLASTIC PIPE SCHEDULE 40 P.V.C. f „DIST.=12.5' 1 MIN. _ SLP.=_03 SLP.= 0_005 INVERT CONCRETE COVER DIST.= 9_2 FLOW LINE DIST.-24.9 ELEV.= 112_.73 ELEV.= 112_3 .- SLP.=0_00661NVERT - -- ELEV.=111.73 10" MIN. 19" 112.13 111 0 THE LENGTH OF ELEV.= ELEV. 111_94 ELEV. 111.77 ELEV. Ill.OUTLET TEE I3 - proposed nETExeHrlEn BYDEPTH THE 4" CAST IRON OR 11TNKK UED. SCHEDULE 40 P.V.C. DISTRIBUTION BOX existing �3 T AT RIGHT) IF MORE THAN 4' OF COVER. ** LENGTH OF USE H-20', LOADING USE STONE °c (�V1500 GALLON SEPTIC TANK LIQUID DEPTH BELOW OUTLET FLTOW�LINE TO BE WET TESTED IF TO LEVEL THE 32 "QUICK4" INFILTRATORS 7.6' ✓11 TO BE PLACED ON 4 FEET....:...14 INCHES MORE THAN ONE OUTLET. 5 FEET.... BED AS NEEDED. 6 FEET.... 6" OF STONE OR ....2 INCHES INCHES TO BE PLACED ON 1 ....2 1 MECHANICALLY COMPACTED SOIL. SEE 310 CMR 6 OF STONE OR 15.227 (6) MECHANICALLY COMPACTED SOIL. BOTTOM OF TEST HOLE OR USGS PROBABLE WATER TABLE ELEV USE A TANK WITH THREE COVERS. The rear lot is 15-18' vertically SOIL TEST DONE BY: J.E. LANDERS-CAULEY P.E. *** Y lower than USE H-20 LOADING WITNESSED BY: S. STANTON __ __ ______ the design lot and hasn't any standing water. IF MORE THAN 4' OF COVER. PERCOLATION RATE: __2---MIN/INCH P# 12905 I CERTIFY THAT I AM CURRENTLY APPROVED BY THE * THE TANK IS TO BE RESET, DEPARTMENT OF ENVIRONMENTAL PROTECTION PURSUANT TEST HOLE 1 DATE: 0123�11_ ELEV._1 3___ TO 310 CMR 15.017 TO CONDUCT SOIL EVALUATIONS PROFILE OF AND THAT THE ANALYSIS GIVEN HAS BEEN PERFORMED , i1, L DEPTH HORIZON TEXTURE COLOR MOTT. OTHER BY ME CONSISTENT WITH THE REQUIRED TRAINING, SEWAGE DISPOSAL SYSTEM EXPERTISE,FURTH AND ER ERTIIFY THAT THE RESULTS ONCE DESCRIBED IN 310 F NOT TO SCALE 114.1 MY SOIL EVALUATION, AS INDICATED ON THE ATTACHED Opp-14" B SANDY LOAM IOYR 5/8 - - SOIL EVALUATION FORM, ARE ACCURATE AND IN _ ** SIZED BY CONTRACTOR. ACCORDANCE WITH 310 CMR 15.000 THROUGH 15.017. 111.8 top of p rc. GENERAL NOTES: 111.3 " PRIMARY AREA CALC'S 14"-60" C1 M-C SAND IOYR 6/6 34.66 x 4 x 4.72 = 654.38 1. THIS PLAN IS FOR THE REPAIR OF AN EXISTING SEWAGE DISPOSAL SYSTEM. 654.38 x .74 = 484.24 2. PLAN REFERENCE Bk 292 Pg 27 LOT 46 BARNSTABLE REG. OF DEEDS. 3. THIS PLAN IS FOR THE INSTALLATION /REPAIR OF SEPTIC SYSTEM AND NOT TO BE USED FOR SURVEYING AND ZONING PURPOSES. 104.3 60"-132" C2 F-M SAND IOYR 6/4 NO H2O DESIGN DATA: 4. ALL WORKMANSHIP AND MATERIALS SHALL CONFORM TO D.E.P. } ENC'D TITLE 5 AND THE TOWN OF BARNSTABLE RULES AND REGULATIONS FOR THE SUBSURFACE DISPOSAL OF SEWAGE. TEST HOLE 2 DATE: 23�11_ ELEV._114_5 __ NUMBER OF BEDROOMS -4 ) (#Qur _-_- 5. ALL COVERS TO SANITARY UNITS SHALL BE BROUGHT TO WITHIN GARBAGE DISPOSAL -N0M (9�_____ 12" OF THE FINISHED GRADE. DEPTH HORIZON TEXTURE COLOR MOTT. OTHER 6. EXISTING AND FINAL GRADES SHALL REMAIN ESSENTIALLY THE ! TOTAL ESTIMATED FLOW _44D----- GPD SAME, UNLESS NOTED BY FINAL CONTOURS. w••�: -GAL./BR./DAY 7. ALL COMPONENTS OF THE SANITARY SYSTEM SHALL BE CAPABLE 114.1 0,.-14„ ++ GAL /BR./DAY X � B SANDY LOAM IOYR 5/8 OF WITHSTANDING H-10 LOADING UNLESS THEY ARE UNDER OR SEPTIC TANK CAPACITY J.5 WITHIN 10' OF DRIVES OR PARKING AREAS. H-20 LOADING 111.0 (required 2x440=880gp d�` � s u��Y in. BE USED UNDER OR WITHIN 10 OF DRIVES OR PARKING top of p rc. LEACHING AREA REQUIREM AREAS UNLESS NOTED. 109.5 0.35101 8. ANY MASONARY UNITS USED TO BRING COVERS TO GRADE SHALL 14"-60" C1 M-C SAND 10YR 6/6. SIDEWALL AREA BE MORTARED IN PLACE. BOTTOM AREA _** ,�. ONA! 9. NO DETERMINATION HAS BEEN MADE AS TO COMPLIANCE WITH ------ DEEDED OR ZONING REGULATIONS. OWNER/APPLICANT IS TO OBTAIN SUCH DETERMINATION FROM APPROPRIATE AUTHORITY. LEACHING CAP.(BOT. & SIDEWALL)_**_-_ GAL. 10. THE EXCAVATOR/CONTRACTOR SHALL VERIFY THE LOCATION OF 103.5 60"-132" 'C2 F-M SAND 10YR 6/4 NO H2O ** ALL UNDERGROUND UTILITIES PRIOR TO ANY EXCAVATION. ENC'D RESERVE LEACHING CAPACITY __----- GAL. APPLICANT: VERA LEE SULLIVAN DATE: 02/28/11 REV.03/24/11 JDR --TSHEET 2 OF 2 JOB # 1981 L _ L.r. - _ - -=--_ -- -_-- - - O Pimcbf r,� 20 12 -------- - --- -- - --- , - --- -_ ---- - -- _ O N 4 ' JUL JUL rf`O Q 6 - I.I.W - c� }y EXISTING REAR ELEVATION PROPOSED REAR ELEVATION o w SCALE: 1/4" - V-O" SCALE: 1/4" V-O" Q O 4 ---- - -- - — — ---— - -- LU z O _A V �- > ® lu J Z (n Ll Q [Y > O 11 L� L El J LL � N N SWEET ¢ LEFT ELEVATION RIGHT ELEVATION SCALE: 1/4" - V-O" SCALE: 114" - V-O" JOB: 1002 DRAWN BY: KW DATE: 7/2/10 e, _ Q J D z O o G EXISTING STRUGTURE EXISTING BP5EMENT ( 1 L _ V X � L SLIDER —— �GREATE m O ACCESS U ALIGN O ALIGN ————— p 1 1 WALLS WALLSI 1 l9 Y; p 1 i z I 3 I— � / YL RAIL DROP WALL 15' 1(2) 9 1/2' LVL GIRT 1- / It DROP WALL 150 O STEP 36�k12' STEEL c Glwy zasa \\ \\\ I I !j/ 2W2 I " 1 2�CR A DUST GAP 1 I f r2� RCONCRETEBAR p #i30T j _ v WALL 10 x16' CONTINUOUS FOOT o p[ ry r FWH 31611 I -- ------ --------- 3052 1 1 (2) 91/2" LVL GIRT / 1 I N Q Q ! ------ ---------- I ------{--®- } ----- I a w 2e62 25152 5/80EANC4OR BOLTS EMBEDDED 7" ° ; I I U1 li i SPACED 32" O.G. 12" FROM CORNERS v II 3 = WASHERS 3"x3"xl/4" J 1 (s-+ co 0. _x \ ASONRY MASONRY // p �_ Q VENT VENT M2 FWH &*II 2M2 --------------- [� < 4-0 14-011 4-0 4-0 14'-0" 41-011 Z 22'-0" 22'-0" W 0 �- Z ul U Vw 0. Z c) < _> O J N � FIRST FLOOR PLAN FOUNDATION PLAN SCALE: 1/4" 0 1'-O" SCALE: 1/4" . 1'-0" SHEET A w F„ JOB: 1002 DRAWN 8Y: KW DATE: 7/9/10 ZN .T o � 0) f � W � z o I I'-o" I 61 cp _ 0 5'-811 5-8:: N — FLAT W/ NRUBBER MEMBRANE 12 (3) q 1/2' LVL WW PLYWOOD SHEATHING/ \`,J\ CD O \\ ROOFING v� v FRAME 'B' q ASPHALT SHINGLES \ (3) 9 I/2' LVI, MATCH IXISTINGIz \\\ /// MATCH EXISTING—- ------- POLY ISO FOAM TOP PLATE — — NO VENTING 2x10s INFILL \ \\ \\ // / 10s INFILL TYP_ EXTERIOR we L > 2x6 EXT. STUDS 9 16' O.G./ U 3-SEA50N 1/2' PLYWOOD SHEATHING/ WW FRAME B ADDITION TYVEK WRAP/W.C. SHINGLES F G A, S 0 l9 \ IXISTING FIRST FLOOR -- ---- lq INSULATION Q 0 i/ \\ BUNRODM FLOOR— - 2x1Oa& 16'O.C, w (14 2XIOs INFtL // \\, 10s INFILL lq INSULATION 2 q 1/2' LVL GIRT 3 1/2' LALLY COLUMN l� 1(1 DRAWL SPADE 1 �LDATION W Z P.T. BILL ANCHORED 32' O.G. 3 0 S'X460 CONCRETE WALL G=-1 rO d 3 =-' (2) #5 REBAR TOP 0 BOT 0" DAMP PROOF BELOW GRADE O FRAME A 10'x*0 CONTINUOUS FOOTING 4 221-011 Q j Z Lu ROOF FRAMING SECTION z w SCALE: 1/4" - 1'-O" SCALE: 1/4" I'-O" Q NU N. < 0. > O J Z) (4 N SWEET A3 �. JOB: 1001 ~ DRAWN BY: KW DATE: 7/q/10 r U z o .� Q Li W � 0 �1 O col 1 JOINT DESCRIPTION NUMBER OF NUMBER OF NAIL SPACING O COMMON NAILS BOX NAILS ROOF FRAMING STAGGER NAILIN BLOCKING TO RAFTER (TOE NAILED) 2-5d 2-I0d EACH END INTO BOTH PLATES N(N RIM BOARD TO RAFTER (END NAILED 2-lbd 3-16d EACH END 2x6 DBL TOP PLATE r� WALL FRAMING TOP PLATES AT INTERSECTIONS (FACE NAILED) 4-16d 5-16d AT JOINTS STUD TO STUD (FACE NAILED) 2-16d 2-Ibd 24" O.G. J HEADER TO HEADER (FACE NAILED) 16d 16d 24" O.C. ALONG EDGES ' U ry FLOOR FRAMING w VERTICAL {W_— JOIST TO SILL, TOP PLATE OR GIRDER (TOE NAILED) 4-6d 4-I0d PER JOIST STRUCTURAL PANEL U l9 BLOCKING TO JOIST (TOE NAILED) 2-8d 2-I0d EACH END NAILED 8d COMMON BLOCKING TO SILL OR TOP PLATE(TOE NAILED) 3-16d 4-16d EACH BLOCK 0 3" O.G. EDGE AND 12" IN FIELD pLQ O LEDGER STRIP TO BEAM OR GIRDER(FACE NAILED) 3-ibd 4-I6d EACH JOIST rT, JOIST ON LEDGER TO BEAM(TOE NAILED) 3-8d 3-I0d PER JOIST W OL BAND JOIST TO JOIST (END NAILED) 3-16d 4-16d PER JOIST Zj ) BAND JOIST TO SILL OR TOP PLATE (TOE NAILED) 2-16D 3-16d PER FOOT ROOF SHEATHING w W, WOOD STRUCTURAL PANELS ~fw O RAFTERS OR TRUSSES SPACED UP TO 16° O.C. Sd IOd 6" EDGE/6" FIELD d RAFTERS OR TRUSSES SPACED OVER 16" O.C. 8d IOd 4° EDGE/6" FIELD GABLE ENDWALL RAKE OR RAKE TRUSS w/o GABLE OVERHANG 8d 10d 6" EDGE/6" FIELD GABLE ENDWALL RAKE OR RAKE TRUSS w/ STRUCTURAL 8d 10d 6" EDGE/6" FIELD OUTLOOKERS GABLE ENDWALL RAKE OR RAKE TRUSS w/ LOOKOUT BLOCKS Sd IOd 4" EDGE/4" FIELD CEILING SHEATHING GYPSUM WALLBOARD Bd COOLERS - 7" EDGE/10" FIELD WALL SHEATHING WOOD STRUCTURAL PANELS STUDS SPACED UP TO 24" O.C. 8d IOd 6" EDGE/12" FIELD _J AND 1%0" FIBERBOARD PANELS Sol - 3" EDGE/6" FIELD Q GYPSUM WALLBOARD 511 COOLERS - 7" EDGE/10" FIELD FLOOR SHEATHING Lil (� WOOD STRUCTURAL PANELS 1" OR LESS 8d 10d 6" EDGE/I" FIELD GREATER THAN I" IOd 16d 6" EDGE/6" FIELD SWEET A4 JOB: 1001 DRAWN BY: KW - — — - DATE: