Loading...
HomeMy WebLinkAbout0085 GROVE STREET - Health I 11 �5 Grove Street ,Cptu -- _ ----- - - -- - - A= 020 - 106 r 1ar0q 1412:48p p.1' Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments a 85 Grove Street Property Address Betty Temple Owner OwnersOwner's Name information is Cotuit MA 02635 2-28-14 required for every page. City/Town State Zip Code Date of Inspection rE Inspection results must be submitted on this form. Inspection fortes Wray not be altered in any way.Please see completeness checklist at the end of the form. Important When A. General Information filling out forms ZH' 1 OFf1yR4i�i Buse on thn Che e tab Inspector. �ter, ,_� � . key to move your �j I o: m 2 cursor-do not JamesD.Sears v (�// _ JAMES I btAK key the return Name of inspector *: y CapewideEnterprises,LLC Company Name F r N SPtG,X0" 153 Commercial Street ��ii►...,n„m„N��" Company Address Mashpee MA 02649 Citylrown State Zip Code 508-477-8877 S1623 Telephone Number Ucense Number B. Certification I certify that 1 have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection.The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority 3-3-14 ors signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ""This report only describes conditions at the time of inspection and under the conditions of use at that time.This Inspection does not address how the system will perform in the future under the same or different conditions of use. I U 15ins;3M3 Titles official pedon Form:Subsurface sewage Disposal system-Page 1 of 17 MarO� 1412:48p p.2 Commonwealth of Massachusetts Title 5 Official Inspection Form f Subsurface Sewage Disposal System Form-Not for Voluntary Assessments I 85 Grove Street Property Address Betty Temple Owner Owners Name information is required for every Cotuit MA 02635 2-28-14 page, City/Town State Zip Code Oate of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® 1 have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below. I Comments: i I tt� f t 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. l Check the box for'yes",`no"or"not determined"(Y, N, ND)for the following statements. If not determined," please explain. The septic tank is metal and over 20 years old'or the septic tank(whether metal or not)is structurally unsound, exhibits substantial infiltration.or exrritration 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. 1# *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. �ll ❑ Y ❑ N ❑ ND(Explain below): I i L5�.3M3 To 5 Official Inspection form:Subsurface Sewage Disposal System•Paga 2 or 17 Mar 0� 1412:48p p.3 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 85 Grove Street Property Address Betty Temple owner Owners Name information is required for every Cotuit MA 02635 2-28-14 page. cityrro" State Zip Code Date of inspection B. Certification (cunt.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumpstalarms are repaired. B) System Cond"-tionally Passes(cunt): ❑ Observation of sewage backup or break out'or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND(Explain below); ❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): 0 broken pipe(s)are replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins-3113 Title 5 offidal h WeWon Form:Subaurlaoe Sewage Disposal System-Page 3 d 17 ' r Mar 0.� 1412:49p p.4 Commonwealth of Massachusetts F Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments UV 85 Grove Street ' Property Address i Betty Temple Owner Owners Name information reeqqu d fnr is very Catuit MA 02635 2-28-14 j page Cityfrown State Zip Code Date or Inspection B. Certification (cont.) 2. System will fall unless the Board of Health(and Public Water Supplier,if any) l determines that the system Is functioning In a manner that protects the public health, safety and environment: 1 ❑ 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. t ❑ 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 weir". i Method used to determine distance: i I •`This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen' Is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form. 3. Other: t l i 1 D► System Failure Criteria Applicable to All Systems: i You must indicate"Yes"or"No"to each of the following for all inspections: Yes No i ❑ ® Backup of sewage into facility or system component due to overloaded or dogged 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.tt is less than 6'below invert or available volume is less than Yz day flow oL S',9Cj 6r4,G 15ins-3N3 rita 5 olFidali rnsp@diW FWM SWW"ace Sewage oispowl System-Pape 4 of 17 Mar 0� 1412:49p p.5 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 85 Grove Street Property Address Betty Temple Owner Owner's Name informations required for every Cotuit MA 02635 2-28-14 per. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed 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 fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen Is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails.I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails.The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either*yes"or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply Cl ❑ 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 11 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. 451ns-3113 Tale 5 Official Inspection Farm:Subsurface Sewage Disposal System•Page 5 of 17 1 Mar 0$ 1412:49p p.6 Commonwealth of Massachusetts Tale 5 Official Inspection ion Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 85 Grove Street Property Address Betty Temple Owner Owner's Name information is Cotuit MA 02635 2-28-14 required for every page. Cityfrown State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes"or"no"as to each of the following: Yes No ❑ ® Pumping information was provided by the owner,occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ❑ ® Has the system received normal flows in the previous two week period? El ® 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 NIA) ® 0 Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® Q 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? Q ® Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: ® ❑ Existing information. For example,a plan at the Board of Health. El ® Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable)[310 CMR 15.302(5)1 D. System Information Residential Flow Conditions: Number of bedrooms(design): 3 Number of bedrooms(actual): 3 DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): 330 t5ins-3113 T le 5 oradel Inspection Fomt Subsurface Sevage Disposal System-Page 6 of 17 Mar 03 1412:50p p.7 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments 85 Grove Street Property Address Betty Temple owner ' Owner's Name information is Cotuit MA 02635 2-28-14 required for every page. Cfty/Town State Zip Code Date of Inspection D. System Information Description: The system is a 1500 Gal. Tank D Box and two 500 dry well's- 0 Number of current residents: Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system?(Include laundry system inspection ❑ Yes ® No information in this report.) p ) Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available(last 2 years usage(gpd)): NA Detail: Sump pump? ❑ Yes ® No NA Last date of occupancy: Date CommerciaUlndustrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(Wd) Basis of design How(seats/persons/sq.ft.,etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t9re-3r13 Title 5 OlrkM Inspection Forth:Subsurface Sewage Dlapoael System•Page 7 of 17 Mar 0� 1412:50p p.8 Commonwealth of Massachusetts . Title 5 official inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 85 Grove Street Property Address Betty Temple Owner Owner's Name informations MA 02635 2-26-14 19 required for every COtuit page. City/rows state Zip Code Date of inspection D. System Information (cunt.) Last date of occupancy/use: Dace Other(describe below): , I General Information Pumping Records: Source of information: NA Was system pumped as part of the inspection? ❑ Yes ® No If yes,volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank,distribution box, soil absorption system ❑ Single cesspool ❑ overflow cesspool ❑ Privy © Shared system (yes or no)(if yes,attach previous inspection records, if any) . ❑ InnovaUve/Altemative technology.Attach a copy of the current operation and maintenance contract(to be obtained from system owner)and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): tstm-'W 3 Ti9e 5 Offidd Mspeww Farm:Suboxfaw Sewage Dispoael System•Pape 18 of 17 Mar 03 1412:50p p.9 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 85 Grove Street Property Address Betty Temple Owner Owner's Name require tifo is Cotuit MA 02635 2-26-14 required for every pale. otylTown state Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components,date installed (if known)and source of information: 2007 Permit#2007-206 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): 3! Depth below grade: feet Material of construction, ❑ cast iron ®40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments(on condition of joints, venting, evidence of leakage, etc.): Pipeing is 4"PVC SCH 40 Septic Tank(locate on site plan): Depth below grade: 28° feet Material of construction: ®concrete ❑metal ❑fiberglass ❑polyethylene ❑ other(explain) r If tank is metal, list age: years Is age confirmed by a Certificate of Compliance?(attach a copy of certificate) ❑ Yes ❑ No Dimensions: 150 Gal. Precast Sludge depth: 1" Mns 3M 3 TiBe 5 Of ial bspecrmn Form:Subsuface Sawage Disposal System•Page 9 of 17 Mar 0� 1412:51 p p.10 Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 85 Grove Street Property Address Betty Temple Owner Owner's Name inforrnatiort is Cotuit MA 02635 2-28-14 required for every page, Cltylrown State Tap Code Date of Inspection D. System Information (coat.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle 2na Scum thickness Distance from top of scum totop of outlet tee or baffle 8" Distance from bottom of scum to bottom of outlet tee or baffle Tape Plan How were dimensions determined? Sludge Judge Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert evidence of leakage, etc.): Tank at working level.Tank and outlet cover at 28"below grade. Inlet cover at 10". In and out let tee's. No sign of leakage or over loading. Grease Trap(locate on site plan): Depth below grade: fee Material of construction: ❑concrete ❑ metal ❑fiberglass ❑polyethylene ❑other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date 01ns•W13 Tile 5 Oftal tmspeckn foam:Subsurface&swage DWposd System-Page 10 ar 17 Mar 031412:51p p.11 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 85 Grove Street Property Address Betty Temple Owner Owner's Name information is Cotuit MA 02635 2-28-14 required for every page Cltyffown State Zip Code Date of Inspection Q. System Information (cunt.) Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection)(locate on site plan): Depth below grade: Material of construction: ❑concrete ❑metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow. gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments(condition of alarm and float switches, etc.): Attach copy of current pumping contract(required). is copy attached? ❑ Yes ❑ No 15ins-3113 Title 5 0fBdel hspedion Fame Subsw1ace Sewage Disposal System-Pepe 11 of 17 Mar 031412:51p p.12 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 85 Grove Street Property Address Betty Temple Owner Owner's Name require tifo is Cotuit MA 02635 2-28-14 required for every page. cityffown State Zip Code Date of Inspection D. System Information (Cont.) Distribution Box (if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 0 Comments (note if box is level and distribution to outlets equal,any evidence of solids carryover, any evidence of leakage into or out of box, etc.): D Box is 16"x16"-40"below grade w/cover at 10". Box is clean and solid w/two lines out. No sign of over loading or solid cagy over. Pump Chamber(locate on site plan): Pumps in working order ❑ Yes ❑ No; Alarms in working order. ❑ Yes ❑ No' Comments(note condition of pump chamber,condition of pumps and appurtenances, etc.): If pumps or alarms are not in working order,system is a conditional pass. Soil Absorption System (SAS) (locate on site plan,excavation not required): If SAS not located,explain why: tins-W3 Title 501ridal h►upection Fwm Subsurface Sewage Disposal System-Page 12 or 17 Mar W 1412:52p p.13 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 85 Grove Street Property Address Betty Temple Owner Owners Name information is required for every Cotuit MA 02635 2-28-14 page. Citylrown State Zip Code Date of Inspection D. System Information (cost.) Type: ❑ leaching pits number: ® leaching chambers number: 2 ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovativetaltemative system Type/name of technology: Comments(note condition of soil,signs of hydraulic failure, level of ponding, damp soil, condition of vegetation,etc.): Leaching is two 500 Gal_dry well chambers w/4' stone. Chamber's are 44"below grade w/cover at 10". Chambers are clean and dry. Walrs like new. Cesspools(cesspool must be pumped as part of inspection)(locate on site plan): Number and configuration Depth--top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow - ❑ Yes ❑ No 151no-3113 '1109 5 Oftal hM)Wlan Form:Subsurface Sewage Disposal System•Page 13 of 17 Mar03 1412:52p p.14 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 85 Grove Street Property Address Betty Temple Owner Owner's Name inforniatrequired fo is Cotuit MA 02635 2-28-14 required for every page. Cityfrown State Zip Code Dale of Ins"Won D. System Information (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy(locate on site plan): Materials of construction: Dimensions Depth of solids Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): tshs-3113 Title 5 Officiel hspedian Form:Subsurface Sewage Disposal System•Page 14 of 17 Mar 0� 1412:52p p.15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 85 Grove Street Property Address Betty Temple Owner owners Name information is required for every Cotuit MA 02635 2-28-14 page. Citylrown state Zap Code Date of inspection D. System Information (cont.) Sketch Of Sew age a e Disposal System: Provide a view of the sewage disposal system, including ties to 9 Y 9 p Y 9 at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately Ell lie 1 EO /3 V = .3 9 L7 3 G O y t5-m'•3113 Title 5 Offidal fnvection Fomr.Subsurface Sewage Disposal System•Page 15 of 17 Mar 03 1412:53p p.16 Commonwealth of Massachusetts Title5 Official p Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 85 Grove Street Property Address Betty Temple Owner Owner's Name information is Cotuit MA 02635 2-28-14 required for every page. Cityrrown state Zip Code Daft of Inspedlon D. System Information (cont.) Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells Estimated depth t h'Igh ground water: feet 11' Please indicate all methods used to determine the high ground water elevation: ® Obtained from system design plans on record 5-15-07 If checked, date of design plan reviewed. Date Date ❑ Observed site(abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Hoard of Health-explain: ❑ Checked with local excavators, installers- (attach documentation) ❑ Accessed USGS database-explain: s • You must describe how you established the high ground water elevation: T.H. on design plan 5-16-07 no G.W.at11'. Bottom of leaching at 6'below grade. Bottom of leaching at IT above T.H.depth. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5irls 3ry3 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 0117 4 Mar0,3 1412:53p p.17 Commonwealth of Massachusetts v. Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 85 Grove Street Property Address Betty Temple Owner Owner's Flame requir required is Cotuit MA 02635 2-28-14 required for every page. city/Town State Zip Code Date of Inspection E. Report Completeness Checklist Inspection Summary.A, B, C. D, or E checked Inspection Summary D(System Failure Criteria Applicable to All Systems)completed ® System Information—Estimated depth to high groundwater Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5tns!3r13 Tltle 5 MOW Inspection Fam:Srmsurtaoe Sewage Disposal System•Page 1T or 1T TOWN OF BARNSTABLE LGCATION ('ray e ..5 x« SEWAGE# °Z Gd 7`Za VILLAGE Cct tom: ` ASSESSOR'S MAP&PARCEL- INSTALLERS NAME&PHONE NO. av�sit�'tati0.�l�o�� SEPTIC TANK CAPACITY- LEACHING FACILITY: (type) 'Z yC 150 o (size) /j X Z 'X Z NO. OF BEDROOMS 3 OWNER # . PERMIT DATE: COMPLIANCE DATE: ,,. Separation Distance Between the: W Maximum Adjusted Groundwater Table to the Bottom`of Leaching Facility 4ft��e ,<�,� Q. Feet Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) 0 �L./rt �at�'Feet Edge of Wetland and Leaching Facility(If any,wetlands exist—,. o within 300 feet of leaching facility) Feet FURNISHED BY ` y i V •1 r 39 �4-i THE COMMONWEALTH OF MASSACHUSETTS FEE BOA D OF HEALTH OF APPLICATION FOR ISPOSAL SYSTEM CON TRUCTION PERMIT Application for a Permit to Construct ( Repair ( ) Upgrade ( ) Abandon ( ) - Complete System ❑Individual Components �rJ (1W0 9 V , GM2ff jL-2C ,1,L(ywU- G cati I Owner's Name Map/Parcel# Address Lot Ik lephone i Instal is Name Designer's Name 4/Vgofx l t. As w— Ala All Address 7 0 Sc�B q � 7777 JI-1172, Telephone n Telephone N Type of Building: Lot Size Sq.feet Dwelling—No.of Bedrooms Garbage Grinder ( ) Other—Type of Building _ No.of persons Showers ( ), Cafeteria ( ) Other fixtures Design Flow(min.required) gpd Calculated design flow gpd Design flow provided gpd Plan: Date Number of sheets ,� Revision Date Title fUW its Description of Soi (s) 0 "l a C - 1111'� s�-- Soil Evaluator Form No. Name of Soil Evaluator lav4k M—Date of Evaluation — DESCRIPTION OF REPAIRS OR ALTERATIONS _ (J) >n The undersigned agrees install the above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 furthe t to place the system' operation until a Certificate of Compliance has been issued by the Board of Health. Signed I6te -s _ FORM I - APPLICATION FOR DSCP DEP APPROVED FORM 5/96 A2NO. THE C'OWEALTH OF MASSACHUSETTS FEE BOARD OF HEALTH J" .. OF . APPLICATION FOR ISPOSAL SYSTEM CONSTRUCTION PERMIT Application for a Permit to Construct ( Repair ( ) Upgrade ( ) Abandon ( ) - Vomplete System ❑Individual Components Call/ e �J n r o Ct�ocatii ryU � � I Owner's Name t •/ •(�(J Map/Parcel# Address Lot# lephone#i Toe coo 1 InstalWr's Name Designer's NameLf Address Address 77 Telephone# Telephone# Type of Building:y Lot Size Sq.feet Dwelling—No.of Bedrooms Garbage Grinder ( ) Other—Type of Building �� No.of persons Showers ( ), Cafeteria ( ) Other fixtures ft 4 Design.Flow(min.required)�17 . gpd Calculated design flow , �1 'gpd Design flow provided gpd Plan: ate <- I tr'o 1 Number of sheets� Revision Date Title C� 0 lid J Al� � ' f Description of Soi (s) U '_ 41 o 1 1.-L,14 k) w,, q r(✓�� Ste+►' Or ��ZM �b sa--d^ Soil Evaluator Form No. Name of Soil Evaluator Date of Evaluation DESCRIPTION OF REPAIRS OR ALTERATIONS - ;The undersigned agrees to.install the above described Individual Sewage Disposal System in accordance with the provisions of TITLE S nd fu� ree t to place the system'n operation until a tertificateo ficompliance<has been issued by the Board of Health., r,. Signed _ ate FORM t - APPLICATION FOR DSCP DEP APPROVED FORM'S/96 I NO. �L'l/ / l�6 THE COMMONWEALTH OF MASSACHUSETTS FEE D oiTlbLCBOARD OF HEALTH CERTIFICATE OF COMPLIANCE Description of Work: ❑ Individual Component(s) ❑Complete System The undersigned hereby certify that Ithat the ,Sewage Disposal System;Constructed( ),Repaired( Upgraded( ),Abandoned y' ce ( ) b � t" AlAI ems' v at has been installed in accordance with the provisions of 310 CMR 15.00 (Title 5) and the approved design plans/as-built f plans relati�a plicatio No. dated ��^Y���� Approved Design Flow (gpd) Installer cM1411t 014 ll e K j Desi ner: Inspector" ns ector °l J') The issuance of this certificate shall not be construed as a guarantee that the ,ystem will function as designed. FORM 3 - CERTIFICATE OF COMPLIANCE DEP APPROVED FORM 5/96 i I A222�ct� No, THE COMMONWEALTH OF MASSACHUSETTS FEE BOARD OF HEALTH DISPOSAL SYSTEM CONSTRUCTION PERMIT Permission is hereby granted tQ,.Constru%(�) Repair Upgrade ( ) Abandon ( ) an individual sewage disposal system at O l --asidescribed in the application for Disposal System Construction Permit No dated Provided: Co structio shall be completed within three years of the date of this p , i .Ajkloc 1 onditions must be met. Date Board of Health . FORM 2 - DSCP DEP APPROVED FORM 5/96 I s. FORM 1255 (REV 5/96) H&W HOBBS&WARRENT"" PUBLISHERS— BOSTON I j , oFTHE Ta,, Town-of Barnstable Regulatory Services » mutNsrABIZ 7 1639. `g Thomas F. Geiler, Director '''fo►��°' Public Health Division Thomas McKean, Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Designer Certification Form Date: Designer: a Address: .t� Ctt,� 1��c`l1 v� ` On "Z"Z y� 1�YLS CC�C� as issued a permit to install a (date) (installer) septic system at �`J �S� based on a design I drew, (a ress) _ dated r'J `tit rp� ✓ I certify that the septic system.referenced above was installed substantially according to the design. I certify that the septic system referenced above was installed with changes but in accordance with State & Local Regulations. Revision or certified as-built by designer to follow. j , _IA Of EIiCHAfiD JAMES BERTRAND v' NO GISTS- ` S9lONAL Ems\ (Designer's Signature) (Affix tamp Here) PLEASE RETURN 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. Q:Health/Septic/Desiper Certification Form Town of Barnstable Regulatory Services Thomas F. Geiler,Director = BARNSTABLE, 9�A 1639.. �0g Public Health Division 'Fo Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office:. 508-862-4644 Fax: 508-790-6304 Installer & Designer Certification Form Date: -j' 3-07? Sewage Permit# 0 Assessor's Map\Parcel c ,Q Designer: �np]e G �, S�C�� Installer: �UI S 'c°nic Address: S. `361e Address: � eA[(?A of, Mo mo, - C C U' —��_ Pl a��t On jai--�J �Q Yt� Ck�itC� td_�was issued a permit to install a (date) (installer) septic system at $15- &WL Q St. en f u 1`- based on a design drawn by (address) -Q .5 r 5��1 K dated �5 "4 (designer) �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 required) was inspected and the soils were found tisfacto (Installer's Signature) Signature) Affix Designer's Stamp Here (Designer's g ) ( g p ) PLEASE RETURN 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. QASeptic\Designer Certification Form Rev 03-09-06.doc �o • �s- 9�o '4) CAT10N SEWAGE PERMIT NO. ?S ('Node X�4 Y9LLAGE I N S T A LLER'S NAME i ADDRESS /19 �1iiL ��ss B U I L D E R OR OWNER✓ DATE PERMIT ISSUED �7., ��- DAT E COMPLIANCE ISSUED IJ -- ►� ' �3� i L" r off` -7'0W Al .. ,Po v ��r �� � CO.7-VI L' No.... ....Q FEB. � G...... THE COMMONWEALTH.OF MASSACHUSETTS BOAR® OF HEALTH .Q.(, -----------.OF......3111�'".° .................................................... Appliration for Disposal Works Tonstrurtion Prrmit Application is hereby made for a Permit to Construct ( ) or Re air ( ) an Individual Sewage Disposal System a� e ®tl-� � - ............>�_........�.................. �.. / ..:........ .................,............................................................-----------------.•• L ats Address or Lot No ............. ... ...... .................................... •-----.......�/ ------........----------........----------------------------...------ nez Address ----- �...s..... e........_... Installer Address Type of Building Size Lot.. oR.® .....Sq. fee aDwelling—No. of Bedrooms.__._.................................Expansion Attic ( ) Garbage Grinder P4 Other—Type of Building ............................'No. of persons............................ Showers ( ) — Cafeteria ( ) P4 Other fixtures ......................................................Design Flow.............� ....................gallons per person per day. Total da'y flow..........�q2.9...................gallons. WSeptic Tank—Li uid ca acit /®OV. allons Length....Y........ Width... .......... Diameter................ Depth................ x Disposal Trench—No..................... Width.................... Total Length.....................Total leaching area....................sq. ft. 3 Seepage Pit No....f............. Diameter:._.li..Z......... Depth below inlet....3............ Total leaching area..................sq. ft. Z Other Distribution box (��� Dosing tank ( ) �" Percolation Test Results Performed bY........................................................................... Date.....................................- Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ . Pd 0 Description of Soil... .....................................................__ U ------------------------- ----------------------- •---------------------------•-•-----------•-•-----------------------------------------------------------•-------•-•--•------•--------------- W -------•-•-•---------------------------•--•-•-•-----•--•-----------•--•--------•-•-•-•------------------- �--- U N re of epair or Alterati ns—Answer whe applicable._. _._..._.le;? __ r..._ fi: /�,v� ,g . ..: ----- � ....-•---W.IAL.........AP.!R ..® 1. ......X'he-g----Ail...�M4!�----------------- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TI'A aj 5 of the State Sanitary Code The undersigned fu417r agrees not to place the system in operation until a Certificate of Compliance has been ' su d by f 1 Signed------ . ........... ............ Date ApplicationApproved By....................................... ......_.......-•----....•--•- Date Application Disapproved for the following reasons-------------------------------------------------------------••-•-------------------------•--•-•----------....-- --•-----••-------------------------•--------------------------••----••----•••-•----•-------•---........•.---------------------------------------•-•--------------------------------------•-•------------ Date. PermitNo......................................................... Issued....................................................... Date No.._.` THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ...s�W .........._OF. . . :'�: ----------------------- ,��r tlirtt ta��t f aarr �i a� tt� orkii Tonstrurtion ramit Application is hereby made for a Permit to Construct ( • ) or Re air ( ) an Individual Sewage Disposal System at �+ Y 6 W Ov'& � 1 ................--.....- --........... - ..... .............................. ......•••-- ••••••--...............--••••-•••-•.....---•••••-•-.........._...•--•--•--......--- rrr��Lo tjpf Address. /y�� or Lot No. ..--•- ••-------------------...._. �.._.. .......................... ............ r----:7. ---.........-•----•--•--..................._......-•-- er - Address 0 AKA Installer Address UType of Building Size Lot__�pz_o v.a_._._Sq. f�ee Dwelling—No. of Bedrooms___________________________________________Expansion Attic ( ) Garbage Grinder (Irk `4 e of Building a Other—T yp g ____________________________ No. of persons............................ Showers ( ) — Cafeteria ( ) Otherfixtures -----=------•---••------------------------------------••-----------------•--------•---------•----•---- W Design Flow.............. v da_____.________.____gallons per person per day. Total y flow---------- ...............................gallons. WSeptic Tank—Liquid capacity/040gallons Length----Y........ Width--. .......... Diameter.-.................... Depth................ Disposal Trench—No_ .................... Wide.----_._.--_..__ Total Length.............___.___ Total leaching area....................sq. ft. Seepage Pit No...../............ Diameter...... . Depth below inlet_...... De _p ,, .. Total leaching area..................sq. ft. Z Other Distribution box ( a*f Dosing tank ( ) Percolation Test. Results Performed b ______________________ Date........................................ Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water............44 Test Pit No. 2................minutes per inch Depth of.Test Pit..................... Depth to ground water....................._. ........................•--•• .....................................-----•••- 0 Description of Soil_._ __ V .--------------------------- ____________________________r___-_________________.-_.______•__.._._._____...__-____.__________.__.___.-________--._ __________________--.------....-_.--------_.-.___.__._.___.-_._...-_._-.---. ....-_______-•.__.___............................... - .... U Nare of epair or Alteratio s—Answer when applicable ..-_---,r!1� ,�-+� 7 Agreement: The undersigned agrees to install the aforedescribed Individual'Sewage Disposal System in accordance with the provisions of TIT121 5 of the State Sanitary Code he undersigned fu r agrees not to place the system in operation until a Certificate of Compliance fias.been ' su Signed.'....., � ' ,Date: Application Approved BY........................................ ...... Date Application Disapproved for the following reasons: = -----------------------------•--•--•---------------------•-----......................... . •••--------------------•--••--------•----•---•--••-----------•--•-•-------•------•------•...-----------••'--------------------•-- ........................................=............................. Date PermitNo............................................-•--•--_..... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........................................OF............................................. ........................................ Tatifiratt of Ta mplittnrr THIS IS TO CERTIFY, That the Individual Sewage Disposal System'constructed ( ) or Repaired ( ) bY•---•---•-• •••••-••••••••-•-•-•••---------•••-•--------•••-•••-••••-••------------•- - :.. Installer at..................................................................... { has been installed in accordance with the provisions of TITLE 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No......................................... dated.......................................:........ THE ISSUANCE OF THIS CERTIFICATE SHALT. NOT BE CONS RUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE................... ......g_:...........••••--•---•--••--•••.....••-••-•_. Inspector--------------- - _. .... ................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH pv Nor................. C.� FEE......`. ........... Dtopaxoat nrkv Tarn tr ilan ami# Permission is hereby granted :.-.. _ � --------•--------•------------------•-------•-•-----..._.__..__...........�� to Construct ( ) or Repair A an Individual Sewage Disposal System at No-------------•------••1�ts..-----•-----_....6 j9A.II_-a---------5t - -C7. v r tt ._..._......... Stree as shown on the application for Disposal Works Construction Permit tNo._�7 Dated._-_____..f0."`t- _ .g -- --••- - q �......... oar j -- ! d of Health i DATE.........--- ---------- ,R ................ FORM 1255 HOBBS & WARREN, INC.. PUBLISHERS - d _. � 1 • r 'dam•" . THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH 1.0.vjt. A................:OF...........' g2t�i�21Apj..(Z....---.......................... Appliratiun for Diipuual lVorks Tunitrudiun Errant Application is hereby.made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at ................__ ?7 ----------------- ......... ........ . location Address r Lo{ ................ ...�. r�_.-.l.�k ws.........:-----•------.... ........------.. ---------------.... ............. ....... C Owner AddrEss - W .............. '4- . ...I al ...... .••..-- Installer Address 1 Type of Building Size Lot...1�Q t . .......Sq. feet Dwelling—No. of Bedrooms.........-3............................Expansion Attic ( ) Garbage Grinder WD aOther—Type of Building.............................. No. of persons............... Showers ( ) — Cafeteria ( ) dOther fixtures................................... � ......................:..........-•--------•-•-------.........--•--•--....................------..••... W Design Flow...........110.......................gallons per penen per day. Total daily flow...............-3-?.0................galloRns. WSeptic Tank—Liquid capacity bUO...gallons. Length._>5.(0u..._.. Width;5.4-..... Diameter.. +-_(D............... Depth ...... x Disposal Trench—No. .....:.............. Width............•...... Total•Length..........C........ Total leaching area........___:._....sq. ft. Seepage Pit No........II .... Diameter......g Depth below inlet.... . ...... Total leachingareaID�t.0 s ft. Z Other Distribution box Dosing tank ( ) . e ww 6 , U✓ fCrf t4-0.4 IQ .a Percolation Test Results Performed by.... . WMC. ..EK&Itl��JJA-4 y......... Date......... b.-. ..... ..1 Test Pit No. 1............I....minutes per inch Depth of Test Pit_A.-3.b........ Depth to ground water...6,nl� ..... .� (� Test Pit No. 2....:!��_?-.minutes per inch Depth of Test Pit.... ..... Depth to ground water...W�Uf.... •----•-•------=--------------4.....-............................................. ....-- ---......................................................... 0 Description of Soil.. .. `. ...................•-------•-- UNature of Repairs or Alterations—Answer when applicable......................................2........................................................ Agreement The, undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of JITLZ 5 of the State Sanitary•C — Th un rsigned further agrees not to place the system in operation until a Certificate of Compliance has be i s d y th d of health. Oc,7-b .� fined. ... /�� .1..�,�. Application Approved By................... .... . .... �. ................. Date Application Disapproved for the follo i g reasons:.................................................................................................................. ........................... .....:................._... Date.......:.....:. • Date PermitNo...... .... �=................... Issued---------............----•----......................... Date THE COMMONWEALTH OF MASSACHUSETTS _ BOARD OF HEALTH-, a 0.u.2Q.................OF........... i�`,Zh,1. � Lk��JI F ........ Applirttiiun for Diupuuttl Workii Tunitrur#iun jlr6ii# Application is hereby made for a Permit to Construct O or Repair ( ) an Individual Sewage Disposal System at: 1_i .... ............... `. ......... 4. lL .:---... Location•Address LoE Nyb I F- La _... : ?�..i w..-------------•------------- .......------ ' � !_u 1.. C. ]� Owner l Address Installer Address Type of Building � Size Lot..._.k i:1 r?8......Sq. U feet Dwelling—No. of Bedrooms....... ' .............................' Expansion Attic ( ) Garbage Grinder J� xr � • Pao Other—Type of Building..........:.................. NO of of persons............................ Showers ( ) — Cafeteria ( ) W Other fixtures ................gallons per person per day. Total dail-- flow...........-...1�•-�---�......_........Design Flow. •-•llons. a W Septic Tank—Liquid*capacity:t�}2_..gallons Len th.. �°__.. Width: A....... Diameter................ Depth l�.�_..... x Disposal Trench—No. ............:....... Width.................... Total Length......._._.f........ Total leaching area------------------- ft. Seepage Pit No........ .. Diameter......P2...._..... Depth below inlet..... Total leachingarea.. !... s ft. Z Other Distribution box ( ) Dosing tank ( ) (�(72.��61f e 0(_ ? . { / Percolation Test Results Performed by....ia)t ?ICI(APB-, .f rl .P.�.l.M..T7. ...-_., Date......��2�l� 5.......... .a p P Depth ground Test Pit No. 1................mmutes per inch Depth of Test Pit..i.'.��.�......_. D th to water Test Pit No. 2---_< ...minutes per inch Depth of Test Pit....i.r _`�_.. Depth to ground water._. «. .L...... P+.t .... '.............6e...............•••................................ ._...................••-•--^---- •.... Description of Sotl..61i� ..........--••-- O � Mt F r �� 7 '' I I F 5AN!?W t ASS Ut CtA� ...�.� � ......��.?_........�1.---...!��... � 1.2 .� l`-'�E...��.}�...................�_...11� W '�.)....!���••'�7��G'�t1'���l i�� rr �. � *lF,---------�-p-•----------------------- -----------•-•------•-- ..... xr .... �-< �- y: ..................................•................. 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 AITLL 5 of the State Sanitary Co Th unde•Tsigned further agrees not to place the system in operation until a Certificate of Compliance has been s>.e h '� d of health. I Application Approved By...................... . .... ... !......... mo) { � Date Application Disapproved for the f olloiuing reasons:---...:-•-----•-••----••............................•----------•--------------••-•......._:.................... J ' . ............................................................................................................................_.............:.................................................._........... - qq►► Date PermitNo..... ....................................... Issued..................................................... Date ....... t.., _.. ....t._<..,..._.............a..��.:...:. .1 ..._..._................................... :.. �N.�o .......-._ . THE COMMONWEALTH OF MASSACHUSETTS BOARD,,QF HEALTH (Irr#if utt#i of Tout rliattre THIS IS TO C��TIFY, That the Individual Sewage Disposal System constructed (�—dr Repaired ( ) by.........•-- 1��l''7 r`�--•-•-.�fu k 1�/:/ = ' rr /1/,�"f............. ---........................•---........................... Installer�- e!. .... P � has been installed in accordance with the provisions of TI I*P 5 of The State Sanitary Code as described in the - application for Disposal Works Construction Permit No.__.....�-..�":t.:':.... dated._ . .....�i.:�_.j. ?.'T::.......... y. 1 ._. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM W . ... ILL FUNCTION SATISFACTORY. _ DATE................. ! fn ..•---••--................. Inspector.--•- M-----•---------•--...........------........... .................. .Y. ............a........M...c4a.rar.+v..a+.r �.�n. u �a•r.r w...................d• - ' •' .•. u.•e.b'b n ..' r' ,. ... .•1 r+- M,�i..t n i.Y..-.a.r. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH f No.. ........ �. F> ........................ ... 13iupnuttlNor-kii ono#r nt�n rrnti# Permission is her ranted !�.' ... ._.. Yg r to Construct lj''�Repair ( ) Individual Sewa Disposal System :. at .No.......--••-- _-G> }'�1` ...... .1 •. ...... Street as shown on the application for Disposal Works Construction Permit No No.._-15 .3-Dated...................-.........................._.. ................................ ............... flealth DATE......... �:`..... ' _ •. r SECTION " SEWAGE I f -SEPTIC TANK- S -"D"BOX - �" -LEACH (7 _ TOP 1OF FOMN 1 !L k uD(MSL)a —"2..OF tie TO y,.. WASHED STONE IN.• OUT• *, IN• OUT• IN• LOH � 1lLy"_ t�5,6 SEPTIC I ELEV. TANK �� -to S, �O ELEV, ELEV. ELEV. I oh•43 1165.16 ELEV. ELEV. / n OF 11 WASHED STONE 10 \v•- W�`` es Z �" �' Iles 4�0_ TEST. HOLE" LOG �t�z tc� hole-t c = 5,L . �, -L o _ T74-1 !� -TF�'t2 pow�1G�PE r-4 J GOIJ two 1� ejy.N, ` HIV TEST BY G1 ' WITNESS r. ';'16 TEST DATE 3 L BE HOUSE ■• d.— ` :_ `• \ . , ` .� DESIGN T.H:. 1 T.H. 2NO \� 1 \ \ _ ELEVA(Z,1 ELEV \ II 3 I AYI 5 LPa, Tbh S1S IL sin L 2 DISPOSER DISPOSER 2 _ �t 2 PERC RATE MINAN. 10(D' - : FLOW RATE: 3� (GALJDAV:) hl- SEPTIC'TANK 72 10(o��1 h�(ED� Ni REO'DSEPTIC TANK SIZE 1 C100 LEACH FACILITY " �i ��� ti oC,- SIDE WAL tDTGCo= l �.`�(2,bY ��L j_ G/D. �i T fT�'1GF� BOTTOM /?_, r,_ ' 1 �:h cI,O ) a 1� G1a. i p� TOTAL to1.2 15�� I USE: Orlt✓ LEACHING PtT _ E>' CAE i-"T-H WATER ENCOUNTERED f�� v2pt� ItJ� NOTES: (UNLESS OTHERWISE NOTED) 1.DATUM(MSL)*TAKEN FROM `64\11II1ZZZIIC Ll QUADRANGLE MAP �cTE:I/s 7� 2.MUNICIPAL WATERr..L AVAILABLE �ZN OF y�rG�C)U G'j I J� J I : JtZKOUT 3.PIPE PITCH:W"PER FOOT Fg'c T, 3 c LS 4.DESIGN LOADING FOR ALL PRECAST UNITS:AASHO• •44 ARNE H. G 5.MIN.GROUND COVER OVER ALL SEWAGE FACILITIES:(2)FT. OJAIA 6.PIPE JOINTS SHALL BE MADE WATERTIGHT '� 7_CONSTRUCTION DETAILS TO BE ACCORDANCE WITH COMM.OF MASS. CIV!!_ H � I �'-� S�I �� A STATE ENVIRONMENTAL CODE TITLE 5 No. 347 1 SITE— �L $. TNta r�LAaJ FOL 7'�,p'i't7R�c7 �ortiC c�u`.� �+.-�a _>u4c_„'a 9Er ;G P�H LOCUS: I�O�-(!�. .P�i�'.�� b�I� •- Ts� � ARNE sr9�G'\ i.l , E5,&F'i iC7Ae- LEr R ESSIONALENGINEER to H, '. L' ' 1 G ✓� G•�I OJALA REF: } ' down cape en�ia�eeein� #2 8 PREPARED FOR: L-�f3E �d LLOI,.1 'PF T� CIVIL ENGINEERS BOARD OF HEALTH RE VEYOR. LAND SURVEYORS II I 1�28 MBiA 8t, SCALE MA Y�di.Am ROPOSED)-O-O-O DATE CONTOURS P -O- APPROVED DATE VII\K-_I� i , SYSTEM PROFILE NOT TO SCALE TOP OF FOUNDATION FINISH GRADE FINISH GRADE OVER FINISH GRADE OVER EL. 77.9 EL. 76.8 SEPTIC TANK 76.7 DISTRIBUTION BOX 76.7 FINISH GRADE _ o OVER TRENCHES 76.7 _RISERS TO 6" o �o .� OF FINISH GRADAI PRECAST CONCRETE 500 GALLON DRYWELLS °_ RISERS TO 6"--� _ . , Ql�MIN. _ OUTLET PIPES LEVEL H-10 REINFORCED LOADING OF FINISH GRADE ( ) :o M1N.SLOPE 1% 31, o FOR 2'( MIN.1% SLOPE TRENCH LENGTH= 25'-0" 6" ° MIN.SLOPE 1% BEYOND - MIN Q i DRYWELL LENGTH= 8'-6" i r p �o > ' J 13 MLN. 14 _ 6 SUMP _ �_ . he. - �_ . _ . " 74.45 74.20 MIN. _ '. oTt� , , '°. ,. -o� 73.95 73.77 0 �-� - .4_ :1 �li. 'q tO:' PVC OR CAST IRON TEE _•� _� ;;_ � :� +bl,. ,mow•ao,��,:, '1 ,,o: �b b�,o:l =, �,:..��=bo i --`-fir-.-�+10 ;. _®. GAS BAFFLE\6 - DISTRIBUTION BOX 72.90 i +1 .. '+1 O.1 1 O:1 ,1 = ,• a MINIMUM INSIDE DIMENSION 12" 3/4"- 1-1/2" DOUBLE � o y.D 1500 GALLON J �A OUTLET INVERTS 2" BELOW INLET INVERT WASHED CRUSHED 3/4,, - 1-1/2i DOUBLE 4, PRECAST CONCRETE -a " WASHED CRUSHED _ .° " MINIMUM CONCRETE WALL THICKNESS 2 STONE :o:• _�_ �. STONE _ ,_� � :_\ INSTALL ON COMPACTED LEVEL BASE H-10 REINFORCED BSMT.FLR. ;o,_;o-,�. 6 _ �. NOTE: EXCAVATE TO =C= STRATUM IN ORDER TO ' ELEV. 70.4 ;0 1, CD _ . , 40_� �, _ _._ _.. .- ba-�,�° REMOVE ALL =A= & =B=IMPERVIOUS MATERIAL ' '� L• °O• WITHIN 5' OF THE SAS. REPLACE WITH CLEAN, TRENCH SECTION i=�o:, ; ,h.} ,.r ,1 ., .. ,1 �.^'., /. ,•I\ .`•1� 1..,'11 ,,- ( 1..1 11 11 =' '1 Ih Y °• 1.'� I.d 1 \ �,, . 1\�1, . 1 p1,.. 1® , . 11 . ,ip , . ,Ipl.`°. 1.`m y r O 1 �0 1 p - .Q,:1 Y S. - .H. CLAY FREE SAND SEPTIC TANK 3 OF 1/8 - 1/2 INSTALL ON COMPACTED LEVEL BASE u t ,•" ] 0 9" MIN. DOUBLE WASHED PEASTONE bl 36" MAX. OR GEOTEXTILE FABRIC w a :h_•. :p landing 4" DIAM. cotuit HS E•NO.85 ,. 15 189 -SF ,0_,' s >e, e' n • • •g , ; a ,; ,� ,. �., 3/4 1-1/2" DOUBLE WASHED CRUSHED • . ¢, STONE • TRENCH WID OBSERVATION PIT 13'-211 NUMBER OF TRENCHES 1 #2 r -- - -1 ,/ a� ,��°°1° ° --- - BY GLEN HARRINGTON RS NUMBER OF DRYWELLS 2 e IDIwV�M1.WIMIOLs•4ar.1[MIM LwppY'WC+ M ___--___- _--. ' -. .SN I.WM 1bJI W Dw. GA1 5.2 ( ' ,eserve I, P-11781 'I I , -- - PERCOLATION RATE-: < 2 MINAN la' WITNESSED BY: D.MIORANDI EXISTING SEPTIC >s �� •� r--25- tie t GENERAL NOTES: BARNSTABLE BOARD OF HEALTH COMPONENTS `� �\�_��, I,;, TO BE PUMPED, , '�, � °Y DATE: MAY 15 2007 • "BOTTOM TH#1 EL.65.7 _<- 1. ELEVATIONS SHOWN ARE BASED ON ASSUMED ' CRUSHED&FILLED , ( ' - #1 y 2. ALL PIPES 1N THE SYSTEM MUST BE CAST IRON OR SCHEDULE 40 PVC. Oil TH#1 EL.76.7 oil TH#2 DESIGN DATA W 91 z 3. HEALTH AGENT/CAPE ISLANDS ENGINEERING =A= LOAMY SAND FILL o 0 20' N o MUST BE NOTIFIED WHEN CONSTRUCTION IS 10 YR 5/1 6" 0 o O N COMPLETE PRIOR TO BACKFILLING. 511 =Ab= LOAMY SAND O W � 4. ANY CHANGES IN THIS PLAN MUST BE APPROVED 10 YR 5/1 NUMBER OF BEDROOMS 3 O BY CAPE & ISLANDS ENGINEERING AND THE BOARD =6w= LOAMY SAND 1211 GARBAGE DISPOSAL NO y y , OF HEALTH. 10YR 5/8 =Bw LOAMY SAND DAILY FLOW 330 GPD. 5. MATERIALS AND INSTALLATION SHALL BE IN EL.74.3 10YR 5/8 SEPTIC TANK REQUIRED 1500 GAL. COMPLIANCE WITH THE STATE SANITARY CODE 291130 SEPTIC TANK PROVIDED 1500 GAL. x [TITLE V] AND LOCAL APPLICABLE RULES AND 46„ _ PERC TEST EL.72.9 _ LEACHING REQUIRED 330 GPD. REGULATIONS. =C1= MEDIUM SAND p A ysF' 6. NORTH ARROW IS FROM RECORD PLANS AND IS 2.5Y 6/4 EXISTING NOT INTENDED FOR SOLAR ENERGY PURPOSES. 60 =C1= MEDIUM SAND SOIL ABSORPTION SYSTEM CALCULATIONS: 3 BDRM.HSE. 7. WATER SUPPLY:MUNICIPAL WATER SYSTEM. =C2= MEDIUM SAND 2.5Y 6/4 y71 1st FLR.EL.78.9 8. FLOOD ZONE C [NON-HAZARD] 2.5Y 7/4 SIDEWALL AREA = 152 SF. > 9. THIS PROJECT DOES NOT INVOLVE ANY PHYSICAL 152 SF. X .74 G/SF. = 112 GPD. GROUND DISTURBANCE OR VEGETATION REMOVAL BOTTOM AREA = 329 SF. >> ;� > >��' WITHIN 100' OF WETLANDS,INLAND OR COASTAL NO GROUNDWATER EL.65.7 NO GROUNDWATER 329 SF. X 0.74 G/SF. = 243 GPD. ysF � BANKS OR FLOOD HAZARD ZONES. 132" 120" LEACHING PROVIDED = 355 GPD. f LEGEND ri �] \ 52 PROPOSED CONTOUR a •8, >> SEPTIC SYSTEM REPAIR ---•52---• EXISTING CONTOUR d \ OBSERVATION PIT ���w of A: PROPOSED SEWAGE DISPOSAL SYSTEM >, PREPARED FOR ❑ DISTRIBUTION BOX c> 6 'qc colvc.BD. BETTY TEMPLE NO U �+ EL.76.1 i ` o 0 0 '¢^ �� HSE. .r , �, N0 85 GROVE ST. > s � 90.33' ? COTUIT,MASS. `eo'" °Q� 50°o0'20"E > 23 U SOIL ABSORPTION SYSTEM ` PLAN N0. 051607 SCALE: AS NOTED A" °�' Fo�7' EDGE MINT °A" RESERVE RESERVE AREA FILE N0. 225ABA DATE: MAY 16,2007 F0 OF >d pp,� SEPTIC FILE NO.77 PCS FILE: grovest85 Fo 22.26 PIPE INVERT ELEVATION /off n� 0 0 0 CAPE&ISLANDS ENGINEERING PLOT PLAN >: L/� �w 20 106 137A 85 N 800 FALMOUTH ROAD, SUITE 301C SCALE: 1" =20` A o, MASHPEE,MA 02649 (508) 477-7272 MAP SEC PCL LOT HSE