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HomeMy WebLinkAbout0095 FURLONG WAY - Health 95 Furlong Way C-0ui, P 4 I 4 q No. .:a00a— 5 /2 Fee 5o / THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS ZIPPricatiou for Migpogat *11//pstem Cow5truction Permit Application for a Permit to Construct( . )Repair( )Upgrade(i/)Abandon( ) &,Complete System ❑Individual Components Location Address or Lot No. Owner's Name,Address and Tel.No. 7S` �lr�® Way ®�t���l Assessor's Map/Parcel Zf 00 -013 C®,tZl r Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. Type of Building: Dwelling No.of Bedrooms 5__ Lot Size Xymo sq.ft. Garbage Grinder OY9 Other Type of Building o.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow ��� gallons. Plan Date Number of sheets Revision Date Title �� lI D �✓� /`�I,II" �� �/Lp Size of Septic Tank /, 000 Type of A.S. Description of Soil �- t t I Sc3 fir Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued b is o of.Wealth. / Signed Date 1Z/%7AZ. Application Approved by Date Q Application Disapproved for the following reasons /oZ Permit No. oZGOo1 �' �!02 Date Issued 50 No. OQa— 5 I Z Fee / THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: y Yes .�PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLES MASSACHUSETTS 01ppYication for Mie;pogar *potem Construction Permit Application for a Permit to Construct( )Repair( )Upgrade(y )Abandon( ) CH/Complete System ❑Individual Components Location Address or Lot No. Owner's Name,Address andTel.No. 7,) felt/©0, w�Y /7`(��I Assessor's Map/Parcel 0o 0G1 r Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. 7 7/- 3 , I Type of Building: Dwelling No.of Bedrooms 5— Lot Size sq.ft. Garbage Grinder(1/60 Other Type of Building of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow �✓�� gallons. Plan Date // 0.7 Number of sheets ,� Revision Date Title s%to C! d -5- /L G1/ Size of Septic Tank '74—Ap— /,,, �000er Type of .A.S. A2'1 C st�l Description of Soil 1 s � Nature of Repairs or Alterations(Answer when applicable) i J Date last inspected:.. 1 ' � /f Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued b this oar of ealth. Signed Date Application Approved by Date Application Disapproved for the following reasons Permit No. Date Issued %o�' "U Q' —————————— THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY, that the n-site Sewage Disposal System Constructed( )Repaired( )Upgraded Abandoned( )by at S (� de ulely has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No.0-00?' 5_7ca dated Installer Designer The issuance of/thip permit shall not be construed as a guarantee that the system w A tio , s d4sigjal dr% Date D 3 Inspector r --------------------------------------- No. I�ZUOoZ—15_/a Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLES MASSACHUSETTS Mi.5pogar *p5tem Congtrurtion Permit Permission is hereby granted to Construct( )Repair( )Upgrade•(-)Abandon System located at 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: Construction must be completed within three years of the date of this permit. Date:_ / / 9 — 0� Approved by TOWN OF BARNSTABLE 4 LOCATION 9'r SEWAGE # r`1- VILLAG ASSESSOR'S MAP &LOT A'6 -dl INSTALLER'S NAME&PHONE NO. ,fse-�a�e�� Lou/T/ r�✓ 5��y'Y'97 b SEPTIC TANK CAPACITY �aay CAL t �aod C LEACHING FACILITY: (type) 3-oa ll C�x.2 i Ad (size) NO.OF BEDROOMS BUILDER O *,;� PERMITDATE: COMPLIANCE DATE: D� Separation Distance Between the: Feet Maximum Adjusted.Groundwater Table to the Bottom of Leaching Facility �¢ Private Water Supply Well and Leaching Facility (If any wells exist �, on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by Daw+/ _e-.Z,gi A O Ay' yy'6" � fit'• ��' TOWN OF BARNSTABLE 1. fi':ATIOifi1 9}� o�on Lf/c SEWAGE # OOi1- S'9x VILLAGE ASSESSOR'S MAP & LOT 'C� "df4 INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY GaQU LEACHING FACILITY: (type) Sed XW Clsh.� Ad (size) /?A 60 /.0/ NO.OF BEDROOMS BUILDER O R AoH 141-.cam PERMITDATE: /11 19 d1- COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility r Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by Daw,/ e- 9r F�oN/,< YG r• i� S.ir7 O igl- 3 01 r x DATE: 4/.26/02 PROPERTY ADDRESS: 95 Furlong Way (yam ®�3 Cotuit , Mass . PARS ® 13 - ------------------------ LOT OI 02635 On the above date, I inspected the septic system at the above avE® This system consists of the following: 'MAY 0 3 2002 1 . 1-1000 gallon septic tank . . 2 . 1-Distribution box . TOWN OFBARNSTABLE 3 . 1-1000 gallon precast leaching, pit . ( 6 ' X, 10 , HEALTH DEPT. Based on my Inspection, I certify the following conditions: . This is a title five septic system. ( 78 Code ) 5 . The septic system is in proper working order at the present time . 6 . Pumped the septic tank at time of- inspection . Heavy scum and solids layers were present:', 7 . Waste water is 42" below the i.nv^ert pipe of '`th leaching pit . 'SIGNATURE: Name:_J L_ Macomber Company: Joseph_P__Macomber_& Son , Inc , Address: Box 66 __Centerville , Ma , 02632-0066 , -- - --- --- Phone: 508-775-3338 - THIS CERTIFICATION DOES NOT CONSTITUTE A GUARANTY OR WARRANTY JOSEPH P. MACOMBER & SON, INC. Tanks-Cesspools-Leachfleld: Pumped' & installed Town Sewer Connectlons P.O. Box 66- Centerville, MA 02632-0066 775-3338 775-6412 , COMMONWEALTH OF M.A,SSACHUSETTS 0 EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAJRS DEPARTMENT OF ENVIRONMENTA.LTROTECTION TITLE- 5 OFFICIAL, INSPECTION FORM.— NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 95 Furlong Way - otuit Mass : Owner's Name:Janice ar e Owner's Address:—Same Date of Inspection: Name of Inspector: (please print) Joseph P .Macomber Jr . } Company Name: J . P .Macomber- Son inc . Mailing Address: Box 66 . ` Centerville .Mass . 02632 Telephone Number:508-775-3338 CERTIFICATION STATEMENT I cenify 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. l am a DEP approved system inspector pursuant.to Section 1.5,340 of TItIe-S (310 CMR 15.000). The system: /Passes K _ Conditionally Passes Needs Further Evaluation by.the.Local.Approving Authority. - Fai s Inspector's Signature; ✓ Date: " v ' The system inspector shall s mit 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 `` r eve•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 wader the same or different undiiions of use. Title 5 Inspection Form 6/15/7000 page I Page 2 of 1 1 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 95 Furlong Way otuit , ass . Owner:Janice Narte Date of Inspection: 6 0 2 Inspection Summary: Check A,B,C,D or E/'ALWAYS complete all of Section D A. Sy em Passes: 1 have not found an information. hich indicates that any of the failure criteria described in 3 l0 CMR 15.30 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: The septic system is in proper working order at the Present time , r B. System Conditionally Passes: V/) 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. V 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: �lh 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 pipes)are replaced . obstruction is removed distribution box is leveled or replaced ND explain: 4,8 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: Page 3 of 1 1 OFFICIAL INSPECTION FORM - NOT'FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued), Property Address: 95 Furlong Way otuit , ass . - Owner: Janice Martel Date of Inspection: 4 26 02 C. Further Evaluation is Required by the Board of Health: /ft 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: �Q Cesspool or privy is within 50 feet of a surface water µ. 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: 42 The system has a septic tank and soil absorption system (SAS)and the SAS is within 100 feet,of a surface water supply or tributary to a surface water supply. The system has a septic tank and SAS and the SAS is within a Zone I of 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.; R v AJ) The system has a septic tank and SAS and the SAS is less than 10 feet but 0 feet or more from a cater supple++•ell". Method used'to determine distance private + "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: r Page 4 of 1 I OFFICIAL INSPECTION FORM _ NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM 'PART A CERTIFICATION (continued) Property Address: 95 Furlong Way Cotuit , Mass . Owner: Janice Martel Date of Inspection: 4/2 6/0 2 D. System Failure Criteria applicable to all systems: You must indicate"yes"or"no" to each of the following for all inspections: Yes No / r . . . / ackup 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 ari overloaded or logged SAS or cesspool Static liquid level in the distribution box above o tlet invert due to an overloaded or clogged SAS or sspool �quid depth in ce&&pee•I is less than 6" below invert or available volume is less than 'h day flow equired pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number /of times pumped�. i� j�ny portion of the SAS,cesspool dr 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 I of a public well. — y 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 forma (Yes/No)The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303. therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure, • . E. Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 1.5,000 gpd i 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 ` i the system is within 400.feet of a surface thinking water supply -bl�mh system is within 200 feet of a tributary to a stu-face drinking water supply the system is located in a nitro en sensitive area(Interim Wellhead Protection Area— IWPA)or a mapped Y g PP Zone 1,1 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 "ves" 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. Page 5 of I 1 t ,, 1~ ' OFFICIAL INSPECTION FORMr— NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION-FORM PART-B CHECKLIST Property Address: 95 Furlong Way Cotuit , Mass r Owner: Janice Martel Date of Inspection: 4/2 6/0 2 Check if the followine have been done. You-'must indicate"yes"or"no"as to each of the following: Yes No i — 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 pan of this inspection ? }. Were as built plans of the system obtained and exam ined?.(If they were not available note as N/A) _4 _ 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,491uding 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 sewase disposal systems? ' The size and location of the Soil Absorption System (SAS)on the site has been determined based on: Yes no t/ Existing information. For example, a plan at the Board of Health. Y _✓ — Determined in the field(if any of the failure'criteria related to Pa xi C is at issue approximation of distance is unacceptable) (310 CMR 15.302(3)(b)j' 4 " r f Page 6 of I I OFFICIAL INSPECTION FORM- NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 95 Furlong Way + Cotuit , Mass . Owner: Janice Martel Date of Inspection: 4 26 02 , FLOW CONDITIONS RESIDENTIAL , Number of bedrooms(design): j— Number of bedrooms(actual): DESIGN flow based on 310 CMR 15.203 (for example: 1 10 gpd x# of bedrooms): �,� Number of current residents: Does residence have a garbage grinder(yes or no): '' Is laundry on a separate sewage system (yes or no): 0 (if yes separate inspection required) Laundry system inspected (yes or no):Yd Seasonal use: (yes or no): V0 Water meter readings, if available (last 2 years usage (gpd)): 200. 0-103 , 000 ga1lons=282 . 20 GPD Sump date of occupancy:pump(yes no): 2001-184 , 000 gallons=504 , 11 GPD. , Last �(�� COMM ERCLAL/INDUSTRIAL 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): 411 Industrial waste holding tank present (yes or no): ` Non-sanitary waste discharged to the Title 5 system (yes or no): Iil Water meter readings, if available: Last date of occupancy/use: A�l OTHER(describe): VX GENERAL INFORMATION Pumping Records Source of information: V'+,U8 Was system pumped as part of the inspection(yes or no): S If yes, volume pumped:/Oaf) gallons -- How was quantity pumped determined?�, zc�-�? Reason for pumping: zOF SYSTEM eptic tank,distribution box, soil absorption system 4Z/_� Single cesspool 424 Overflow cesspool C,jk�l> Privy /?/ Shared system (yes or no)(if yes,attach previous inspection records, if any) J ' Innovative/Alternative technology. Attach,a copy of the current operation and maintenance contract(to be obtained from system owner): . Tight tank 40 Attach a copy of the DEP approval Other(describe),: Approximate ase of all components, date installed(if known)and source of information: �r Were sewage odors detected when arriving at the site(yes or no): 6 Pagt: 7 of 1 1 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS ` SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) ' Property Address: 95 Furlong Way Cotuit ,MAss . Owner• anice Martel . . , Date of Inspection:4/2 6/0 2 BUILDING SEWER (locate on site plan) Depth below grade: _ Materials of construction:,p2&cast iron _L140 PVC mother(explain): .flip Distance from private water supply well or suction line: J r s PP y D�- P , Comments (on condition of joints, venting, evidence of leakage, etc.): . Jbints appear tight . No evidence of leakaQe . The system' is vented through the house vents R _ SEPTIC TANK: z0ocate on site plan) Depth below grade: 3� / , + Material of construction: ;/concrete,c o metal AO fiberglass polyethylene dother(expIain) If tank is metal list age: d Is age confirmed by Certificate of Compliance(yes or no);Ab (attach a copy of certificate) Dimensions Sludge depth: Distance from top of sludge to bottom of outlet tee or baffle: Scum thickness: Q Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bo om of outlet tee or baffle: How-were dimensions determined: (yrtnc��' AT ZT) IY !Al CTl7�G� Comments(on pumping recommendations, inlet and outlet tee or baffl condition, structural integrity; liquid levels as related to outlet invert, evidence of.leakage, etc.): Pump the septic tank annually . Garbage disposal is present . Inlet & outlet tees are in place The tank is structurally sound anal ' shows no evidence of. leakage. GREASE TRAP (locate on site plan) Depth below grade:4�/d '. Material of construction:4L.concrete4�y metaV/x fiberglass�polyethylene4Aothe'r (explain): -- Dimensions: 444j 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: + r Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity,liquid levels. as related to outlet invert,.evidence of leakage, etc.): Grease trap is not present — ` . s a 7 Page 8 of 1 I , i OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTIO N FORM PART C SYSTEM INFORMATION(continued) Property Address: 95 Furlong Way otuit , ass . Owner: Janice Martel Date of Inspection 4 2 6 0 2 TIGHT or HOLDING TANK4&e,(tank.must'be pumped at time of in spection)(locate on site plan) Depth below grade: A114 Material of construction: 4YI9 concrete metal fiberglass e4e polyethylene&�Lother(explain): Dimensions: Capacity: i allons t" p ry: Design Flow: IVIIgallons/day Alarm present (yes or no): A1, Alarm level: f)21 Alarm in working order(yes or no):}� " Date of last pumping: . Comments(condition of alarm and float switches,'etc.): Tight or (holding tanks are not ..present . DISTRIBUTION BOX: Zif 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.): Distributoinnbox has one lateral . No evidence of soilds carry over . No evidence of leakage into or -out ot the box . r . PUMP CHAMBER1j� (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.): Pump chamber is not present . K 8 Page 9 of I 1 OFFICIAL INSPECTION FORM!- NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) �. Property Address: 95 Furlong Way Cotuit , Mass . �° = Owner: Janice Martel Date of Inspection: 4 2 6 0 2 t. I SOIL ABSORPTION SYSTEM (SAS): (locate on site plan,excavation not required) - ' 1-1000 gallon precast 1 a h; ne nit _ ( 61 X 1o" ') _ The leaching pit- is in proper wor ing order at the present time ; If SAS not located explain why: Located . See page 10 F ` TY ri leaching pits, number: jLy� leaching chambers, number: `4 leaching galleries,number: Ai leaching trenches,number, length: 62 leaching fields,number, dimensions: a overflow cesspool, number. innovative/altemative system Type/name of technology: Comments(note condition of soil, signs of hydraulic failure,.level of ponding, damp soil, condition of vegetation, etc.): Loamy sand to fine sand . No signs of hydraulic failure or ponding . Soils are dry . Vegetation is normal CESSPOOLSk&y_(cesspool must be pumped'as part of inspection)(locate on site plan) Number and configuration: t '. Depth-top of liquid to inlet invert: kZfi Q Depth of solids layer: Depth of scum laver 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.): Cesspools are -not • pres'enY_ _ i PRIVY4tj�y (locate on site plan) - - j _ Materials of conkru6tio/n:. Dimensions: Depth of solids: Comments (note condition of soil,signs of hydraulic:,failure, level of ponding,condition of vegetation, etc.): ' Privy is not: present . 9 r LOCATION TOWN OF BARNSTA.BLE • � VILLAG- ' SEWAGE # INSTALLER'S NAME&PHONE NO. ASSESSOR'S MAP& LOT SEPTIC TANK CAPACITY 1 LEACHING FACILITY: (type) NO I � . OFBEDROOMS (size) BUILDER OR OWNER A PERMTTDATE: COMPLIANCE DATE: Separation Distance Between the. Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility. Private Water Supply Well and Leaching Facility Feet 8 ty (If any wells exist on site or within 200 feet of leaching facility) Edge of Wedand and Lea •ng Facility(If any wetlands exist Feet within 300 feet o Furnished b ty) Feet �t5 lvr 6 W a%A LS 1 Pape 11 of 11 OFFICIAL INSPECTION FORM=NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 95 Furlong Way Cotuit ,Mass . Owner: Janice Martel Date of Inspection: 4 (2 6/0 2 SITE EXAM I Slope Surface water Check cellar Shallow wells d - Estimated depth to ground water 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: Checked with local excavators, installers-(attach documentation) " Accessed USGS database-explain: You must describe how you established the high ground water elevation: Used ; Gahrety & Miller Model 12/16/94 Ground water elevations above spa level . Used ; USGS Observation wall data juna 1992 Used ; Technical R»11Ptin 97 n A nn 1 Plar #J T` anuary 1992r-Apnuai ranges Leaching Pit F a" ;eet GroundwaterP Feet Below Bottom of Pit High Groundwater Adjustment 1.$ft per Fnmpter.Method* Therefore, the vertical separation distance between the bottom of the leaching,pit and the adjusted groundwater table is feet. M 11 , . t . v•rTnrw•—nt irnrmr•nt'rgnrnrt .. .�,Tf+—T— i'RRf'R1t'•.T•t'•TRT:f1Y"HTTlt1R1'1{f t•m-smst TS1 .Tn•r'I-r-�-•n•-•..-..r..,' TOWN OF Barnstable BOARD OF HEALTH j SUBSURFACE TOWN DISPOSAL SYSTF,M INSPECTION FORM - PART D. - CERTIFICATION •••Tt•ITT••.••.• —T.1if.�.�TT.11t'911•.T.'1SI 1"ST 4T.i1T"r'P1'r.•.•t nlTl�i1'R101�TTmR71nf 11f7CRlnlRt'iR[ Tn11 .•'yrT'�•^. —. -TYPE OR PRINT CI.EARL1'- PROPERTY INSPECTED STREET ADDRES$ 95 Furlong Way Cotuit , Mass . ' ASSESSORS MAP , BLOCK AND PARCEL 008/013 OWNER' s NAME Janice Marcel PART D - CERTIFICATION NAME OF INSPECTOR Joseph P . Macombler Jr'. COMPANY NAME J . P .Macomber & Son I'nc rW" COMPANY ADDRESS Box 66 Centerville , Mass . 02632 Street ,Town or City State LIP COMPANY TELEPHONE (508 ) 775 _ 3338 FAX ( 508 ) 79Q - 1578 CERTIFICATION STATEMENT I certify that I have personally inspected the' sewage disposal system at this address and that the information reported is true ,' accurate , and omplete as of the time of .inspection . The inspection was performed and any recommendations regarding upgrade , _maintenance , and repair are consistent with my training and experience in the proper function and maintenance of on- site sewage disposal systems • n i ,Li;111, Chec one : System PASSED The inspection which I have conducted has not found any information which indicates that the system fails to adequately protect public health or the environment as defined in 31Q CMR 16 - 303 . Any failure criteria not evaluated, are as stated in - the FAILURE CRITERIA section of this form . System FAILED* \ The inspection which I have con ticted has found that the system fails to Protect the public, health and the environment in accordance with Title 5 , 3.10 CMR 15-. 303 , ., and as specifically noted on '.PART C - FAILURE CRITERIA ofpthis inspection form , Inspector Signature Dat: �� ne copy of this rt,ification must be provided to the OWNER, the BUYER ( Where applicable ) and the DOARD OF HEALTH. * If the inspection FAILED, the owner or"operator shall upgrade the eyetem within one year of the date of the '' inspection, unless allowed or required otherwise as provided in 3.10 .CHR 16 . 305 . partd .doc 01/31/1994 05:44 508-790-1578 J.P.MACOMBER & SON PAGE 01 JOSEPH P. MACOMBER & SON, INC. P.O.80A 66 CENTERYILLE.WA 02632-0066 7753336 7716412 FAX COVER SHEET 0 ATE: TO,Board Of Health T.O.B. Donna Marandi & Dave Stanton FAX PHONE E 508-790-6304 ff�Oma.P.Macomber & Son Inc, . FAX PHONE# 508-790-1578 Skip Macomber TOTAL i OF PAGES INCL410ING COVER: 2 - 'F r0U 00 NOT RECEIVE ALL PAGES, PLEASE CALL 508.775.3338 q` - 0 9�_>E�long�ay Cotuit�Mass SPECIAL INSTRUCTIONS OR MESSAGEI)iagram_of s stem of Put on the wrong inspection,22 Winsome Road diagram is a S.Y address. This address received the diagram for 95 Furlong Way Cotuit,Mass. Ten reports were done at this time.Thse two unfortunately were not filed properly. 01/31/1994 05:44 508-790-1578 J.P.MACOMBER & SON PAGE 02 G}vl•+. 4 70 1 � ow ,b, LS 1 \ M r TOWN OF BARNSTABLE LO,C'ATION V SEWAGE # VII LAGER. 1 ASSESSOR'S MAP & LOT ' —0 INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY 1AV 71- � LEACHING FACILITY: (type) (size) NO. OF BEDROOMS BUILDER OR OWNER PERMITDATE: 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 Leac 'ng"Facility(If any wetlands exist within 300 feet o a ty) Feet Furnished b .� ;, ,,.. �.r .. � 1 - - � �� �� _ _ - --�- �� i _ _ '�� I b, q5 L=O CAT ION S E W A G E P E R MI T N Q. VILLAGE �vTr, e r INSTALLER'S /NAME. i ADDRESS 1p I`"1 C ��.A I �-I l "c' ms 1 Cry Oo 0 S UILDE R OR OWNER DATE PERMIT ISSUED DAT E-:., COMPLIANCE ISSUED .�-� A G .r t� r �� 1 l I rt RA lU 1 � 3`� �, �t v�- �Iti ' � _ ,. �c-- .� '� ,- .•�' � --�" c,/ �lJo2�c�.0� ��/ � � � BO 8 I r •.. Town of Barnstable t L No. . QB'Z P.O. Box 534 >r ems. ••••- Hyannis, MossBoimeft0M OF MASSACHUSETTS OOY BOARD OF HEALTH rl .........,..0�i.�/4.1J . .......OF.............� �C........................... p v 13 Appliratinn for Uisvaoal Morkii Tonstrnrtiun Vamit f Application is hereby made for a Permit to Construct J) or Repair ( ) an Individual Sewage Disposal C System at: --. .. ...l w fir? ..rc • ........................co----1I jo io -Address or Lot No, r .. ,/(�✓, �..e-4C..... le.�.,s --------------------------------------------- ---lit al._Tel-t�.a.uT..ii _f�aa-�----I'• ............. a.:s�J ss r�r-----.. poi a r�_�---------------------------------- ---------V5 Q ccl-Y or 41AV.-----.i ......./ lz.s�44AW..-1--11�-� Installer Address Type of Building Size Lot..__�t.100D...Sq. feet Dwelling—No. of Bedrooms... Attic ( ) Garbage Grinder ( ) p, Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) Other fix res ............................ W Design Flow...... ......................gallons per person y5 day. Total dailj flow............... ..........._...... llons. WSeptic Tank—Liquid capacity_I_Q3?. Length p �f.._...__.allons Len h................ Width....-.____..._. Diameter__._________-__- De th_--.__ x Disposal Trench—No.-------_____------ Width................... Total Length..__._..._.� Total leaching area....................sq. ft. Seepage Pit No..........I---------- Diameter_....�0_........ Depth below inlet..... ......... Total leaching area,.".: sctrft�r P A• Z Other Distribution box ( ) Dosing tank r( ) Percolation Test Resultg Performed by............ -.....-�� � j_ _______________ Date------- -_�6__=__ ..__.. Test Pit No. 1.....�r-_.'......minutes per inch Depth of Test Pit----__ _ _ Depth to ground water........................ GL, Test Pit No. 2.....2.......minutes per inch Depth of Test Pit----- ...... Depth to ground water........................ -------- 09;L��---*----------------*.............. ----------**----------------------------------- O Description of Soil................... x w ---------•--. --------•------••-•--------------------•-•-•--•---------------•-------......-----•••--•---•--••--------•---------••---------------•.................-•-.._......._............-----..... UNature of Repairs or Alterations—Answer when applicable................................................................................................ •------------------••----------.......--•---.......--------------------------------•---.........-•--••-•--•••-•••---•------------...•-••-•-••--•-•-----------•-------•---•••-•••--........_............ Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLL 5 of the State Sanitary Code— The undersigns further agrees of to place the system in operatio untila Cer *-cat o ompliance has been iss the boar f h ' tt,, Signed......... ... ----------- ................... --••-- - 5...., ate C ApplicatriAe�ppved By....... ---•-- •--..............................._..-- •--- . .....?_1''�-f-.---!•-•�---- Date Application Disapproved for the following reasons:.............................................................................................................. ---•------•...............••-•-----•---•------•-----------------••---•--------•-•--....---••---------------...........-•••--•----•••-----------••---------•-•--••....--••---•--------------•---------- Date PermitNo.................................................----- Issued-.....................................................- - -----------------Date---- - ----� Fns %-----•- i. THE COMMONWEALTH OF MASSACHUSETTS _ BOARD OF HEALTH .......................A oF............e i ,., Appliration for Dispsal Works Towitrnrtion ramit Application is hereby made.for a Permit to Construct O or Repair ( ) an Individual Sewage Disposal System at %ref �r.�f- i•;r1 `' /t`i�,! Location-Address or Lot No. .--••-----------------__-......--.........---•-----•--•-•--------•.............................. ..........-------•---•-••---•-------•-•----...._.....•----------.................................. w Owner Address ......... ................. Installer Address Type of Building Size Lot...... ...Sq. feet Dwelling—No. of Bedrooms............t K.? ........................... Attic ( ) Garbage Grinder ( ) aOther Other—Type of Building ............................ No. of persons...._............_.......... Showers ( ) — Cafeteria fixtures -------••----------------------•-----------------------•-••--------••••-•--.....--•-•--••---•-•••----•-•--••••-•-•••--••-----••....----......._-•---• w Design Flow.._.........5.�?..........................gallons per person per day. Total daily flow............._..: "X0.................gallons. WSeptic Tank—Liquid capacity.!. ga]Ions Length___-!�......... Width---`-j.r_..... Diameter________________ Depth 9-.1....._. x Disposal Trench—No..................... Width ............... Total Length.................... Total leaching area....... .--sq. ft. 3 r i Seepage Pit No.......... ..._...... Diameter.................... Depth below inlet......-..-....... Total leaching area.......__._.._...sq Z Other Distribution box (�) Dosing tank ( ) _ J '-' Percolation Test Results Performed b ..._.._.__-1(_P!/1A_): ! Y - __•.. (_•__---. Y ----- - ...... --••••----•------•- Date------...: --- f Test Pit No. 1.... .:..._minutes per inch Depth of Test Pit....1__ .."`�_._ Depth to ground water........................ _ (� Test Pit No. 2.._..._ .......minutes per inch Depth of Test Pit....J.4.`�•_-... Depth to ground water........................ 9 -•••----••................................................................................................................................................. 16 D Description of Soil...................Alk...------------ ') --'------••----------------------------------------------------------------------------------------•- x U ---...---•-------------••--•-•--------•-••••--•--•---------------•----••••--••---•--•--•-....•-•••-.._...-----•-•-••••-----------•-••-•------......--------•••-----.......-----------...----..........._ w UNature of Repairs or Alterations—Answer when applicable---------------------------------------------_................................................. ..-------•------------------------------------- .............................................. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLL 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operatio until a C ifica Compliance has been issued by the board of health. Signed...................................................................................... Date Application A. roved By-•-•--•---'- . x"i ,_. 'N�. -------.----•-•-•------------------ - ' Application Disapproved for the following reasons:................................................................................................................. ................•--------------•-----...----•---•-•••----•------.........------•......._..................••-----•-•---••••-••-•-••-----•----•-•--•............................................... Date PermitNo......................................................... Issued....................................................... Date r• l f� THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........................................OF..................................................................................... Trrtifiratr of Tamplionrr -- THIS.IS T0.CERTLFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) by---•- .: . ....../� ... �� _ d ............... •-------••--------....---•--.....------------................---------------•--••----....... _ .... 7 a -•i ... �-- Installer at.................................................. = In tall = has°hcen L&sjiLled' yn,ac o�rd nce with thefiprov> >ons of TITLE e� to Sanitary Cod . de Cr*45�i the application for Disposal Works Construction Permit"Nb!__... !...... .................. dated................................................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE.......................11...................................................... Inspector.......... ......... --•-------•--•-•---- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .....................................OF -...................._....................... p, No...�0.,�-' ...�� FEE---.. --. �t��ru�ul ur�� Cnon�� timrn anti# ...... Permissio is hereby granted...�:y F -._._......n. ��%` to Construc ) orRepair ( ) an Individualt Sewa&*Disposal System --------•-^----'-x, ii - .........1%;---------------,f i/�1 ri 4r a�_,fi,,�.f._ L.B_.n.. '��------......_..---- it or ems! € ti„r +a3 - e r s' + Street , f as shown on the application for Disposal Works Construction Permit N .._�`�':�'�� ated...... ...... ... d / --------------------------- .... i' •�,,,,, Board o Hea •- _••- --•------ DATE FORM 1255 A. .is KIN INC., BOSTON } E PROJECT TITLE tj y ------- I A. L00 X. oo __._..._... .. PREPARED FOR i t i Irc OIL ' Central Construction Compan t Steve Devlin •President 261 Blackthorn Drive•Marstans Miih,MA 02648.508-42 SCALE - I N i 0 DATE DWG NO. t DESIGN CHECK DRAWN v JOB NO. SHEET .. - .. � _.. .. ,.,,a +,;� ,f " V• aTi (14 4 7 .00 xF} ,e _ - - ---- --- - ---- _ _ - - - ---- --- —— - XL M 5 A I Sd TE-ti1h f- L L f4 LPL/GH BLE -------- e X 15f'irlc� around P,-o file ,.. _ G ^ / S /9 L E� / = i o` — -- S L.._. C T / O / - --- - V E- ,2 T S C �9 L E- : / " = i O !"�Ft/V 14 O L- E C O V L-R S TO c�rounc/ Pr-ofrle I2 C7F F�tvtS /-1EZ> %4.. pe'- `SCHcD. 40 P. V. C. 0,42 OIAJ x E O U19 L Ti C �m i rn i rn urn rner Ej— LA �3 D/ST. Box Sump e � ° e e /000 r - G H L. - E PT/C -T,9,v,� � -F /4 -- 3G OOOS - _ -- - ---------- cva5�ed 560 �. ; S 1 s� B C De O 0/`-7 l l O u 5 C D A 7-E : 3-l _ ' T C S T B 1 44J /T/V E S S" c1. ,1f1 cOB s:[Z CL_.C{ S� �-\ ,`_ �a..n`bc� J / *,; , �_ �;N. /,if _ _ `T I i ,2 A?'� NAB— x /. 5 = 495 e/ 56.5 #r O " G3.B #2 ©r E r9 CH P/ T el. 54.5 5uasoiL e� 6/'8 Su�35C7/L Sl�c- rz��LL =5-7,LS s 2 54 ' slo ' / c- / �] n Pt2oPoSEZ7 o,v THE'• G�2C)UAJD [�V C G__ �7 / v 8 150 = 05. S 3 S,,--/O LA-1 ti/ O n./ TN/ 5 PL �n./ D O C S F O E� : L o 7- l/ �-- PL/9&j .C3o o,- 2&6 1=P/9 G E `r7 COAJFO,eM TO ��,� � ` / ti../� BJiLD 125 SNowA.1 r�RT� s---9as P �7 /� rl u _ ,eEv• ! 0' 00 exis-tinq e /eva ��on BLDG• S�7BF�C,L / t o. 00 Proposed e /evc.tion con fours Side = 15 f�F�P,20,VC- _ — r-�Qr - /S BOF-3,2D o,� HEALTH _ — 43"1�N Tr9e4-5Mf�SS. t TOP FNDN, AT EL, 46.1' SYSTEM PROFILE TEST HOLE LOGS ACCESS COVER TO WITHIN 6' OF FIN. GRADE (NOT TO SCALE) AH OJALA, PE ACCESS COVER (WATERTIGHT) TO ENGINEER: /F4401' MINIMUM .75' OF COVER OVER PRECAST WITHIN 6' OF FIN. GRADE 2% SLOPE REQUIRED OVER SYSTEM DAVID STANTON 37.0' WITNESS 2' DOUBLE WASHED PEASTONE 11/20/02 �- RUN PIPE LEVEL DATE I y 42.4' FOR FIRST 2' 9j 3' MAX. PER(. RATE _ < 2 MIN/INCH AOPOSED 1500 � GALLON SEPTIC 41,75' ITEE 34.0' CLASS I SOILS P# 10,373 42.0 SANK (H 10 ) GAS ,� BAFFLE 38.0' o r7 I--] a o o 0 . oaa MIN 33.17 o a 4' AROUND LOCUS C % SLOPE) 6' CRUSHED STONE OR MECHANICAL go ELEV, �P COMPACTION. (15.221 121) $ 2 a ED o F � ED 0 �� 0 31.17' 0# 36.5' DEPTH. OF FLt1= 4' ( 18 % SLOPE) C 25 % SLOPE) � A TEE SIZES: 3/4' TO 1 1/2' DOUBLE WASHED STONE INLET DEP+H = 10" LS PROVIDE SPLASH PADS OUTLET DEkH = 14 UNDER EACH INLET PIPE 4„ 10YR 4/4 LOCATION MAP NTS B LEACHING FOUND.ATION- 12' SEPTIC TANK LS ASSESSORS MAP 8 PARCEL 13 20' D' BOX 21' FACILITY 4' 16" 10YR 5/4 35.2' C 27.17'* MED/COS 2.5Y 8/4 *CONFIRM SUITABLE SOILS FOR 4' BENEATH LEACH FACILITY PRIOR TO INSTALLING ANY PORTION OF SEPTIC SYSTEM I REPLACE EXISTING 1000 GAL SEPTIC TANK WITH A 1500 GAL. SEPTIC 108" 1 27.5' TANK 41.1 NO WATER ENCOUNTERED NOTES: + 455 SEPTIC DESIGN: (GARBAGE DISPOSER IS NOT ALLOWED ) 1. DATUM IS ASSUMED ® _)`_SIGN FLOW, 5- BEDROOMS (L Q C;PI)) = 530 GPD 2. MUPJICiPAL WA I ER IS ^' 3.7 + 47.6 + 46.8 USE A 550 GPD DESIGN FLOW 47 3. MINIMUM PIPE PITCH TO BE 1/8' PER FOOT, LOT 11 1ss.6 4. DESIGN LADING FOR ALL PRECAST UNITS TO BE AASHO H- 10. -----� � SEPTIC TANK, 550 GPD ( 2 ) = 1100 36,000t SQ. FT. 47 p - 5. PIPE JOINTS TO BE MADE WATERTIGHT. _ -2 .5 37.6 `y- USE A 1500 GALLON SEPTIC TANK 6. CONSTRUCTION DETAILS TO BE IN ACCORDANCE WITH MASS. 45. 46 G R=2 .0 d LEACHING ENVIRONMENTAL CODE TITLE V. G •3 + 4 .5 SIDES. 2(42 + 12.83) 2 (.74) = 162 7, THIS PLAN IS FOR PROPOSED SEPTIC SYSTEM ONLY AND IS NOT _ G f TO BE USED FOR ANY OTHER PURPOSE. (' S, 45.5 �°` 433 36. 35.9 BOTTOM: 42 x 12.83 (.74) = 398 8. PIPE FOR SEPTIC SYSTEM TO SCH, 40-4' PVC. ' A2 / T❑TAL 758 S.F. 561 GPD 9. COMPONENTS NOT TO BE BACKFILLED OR CONCEALED WITHOUT DECK PA D DRI 4 4 USE (4) 500 GAL. LEACHING CHAMBERS (ACME OR INSPECTION BY BOARD OF HEALTH AND PERMISSION OBTAINED )5.1 FROM BOARD OF HEALTH. L EQUAL) WITH 4' STONE ALL AROUND 10. PUMP & REMOVE (OR FILL W/CLEAN SAND) EXISTING LEACH PIT .� 7 /34.6 L EXISTING 45 + 452 •5 --+ a.a REMOVE ANY CONTAMINATED SOILS WITHIN 5' OF NEW FACILITY DWELLING TF = 46.1' (r �r .7 / v` '' ° ° 3 �// �� LEGEND TITLE 5 SITE PLAN INV OUT =42.4' 7' 2.8 yo BENCH MARK - CTR OF CATCH 9 �,• / �' BASIN ELEVATION = 35.1 100.0 PROPOSED SPOT ELEVATION OF / �. 95 FURLONG WAY 7' 100x0 EXISTING SPOT ELEVATION / IN THE TOWN OF: 39.0 / PROVIDE APPROXIMATELY 60' OF 40 25 MIL LINER, 5' OFF STREET SIDE OF DD PROPOSED CONTOUR ( COTUIT) B A R N S TA B L E W 6' 'S` SYSTEM, AS SHOWN. TOP AT EL. / 34.0', BOTTOM AT EL. 30.0' 100 EXISTING CONTOUR PREPARED FOR: BORTOLOTTI •4 + r/ CONSTRUCTION/FONTAINE 0.0 / 20 0 20 40 60 4.3 // SEP RE-ROUTE WATERLINE TO BE MIN. 10' FROM BOARD OF HEALTH TS MA SCALE: 1 = ZO DATE: NOVEMBER 20, 2002 3 EDGE SHRUBS/LAWN APPROVED DATE 315'f 3 � g, 28.6 off 508-362-4541 fox 508 362-9880 OF down cape engineering, Inc.SEPTI AF1NE . �G a RIVER( SYSTEM IS GREATER THAN 200' TO SANTUIT ARNE H / OIALA a. H. CIVIL ENGINEERS U CIVIL ti Ell %� OJALA 9 o. 3 792 LAND SURVEYORS , No:2834� 'O p �' 'ffCISTERE. Qa ' • 939 vain st arrlouth, rla 02675 �,2--364 . y A OJALA, P.E., P.L.S. DATE