HomeMy WebLinkAbout0086 JILLIANNS WAY - Health 6
I LOT 2 ,1ILLIANN'S WAY , COTUIT
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COMMONWEALTH OF MASSACHUSETTS
EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS
DEPARTMENT OF ENVIRONMENTAL PROTECTION
TITLE 5
OFFICIAL INSPECTION FORM'- NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYS ED
PART A
CERTIFICATION
JUN 1 .4 2002
Property Address: 86Jillian's Way
Cotuit,MA 02635 TOWN OF BARNSTABLE
HEALTH DEPT.
Owner's Name: David Burke
Owner's Address: P.O. Box 541
Cotuit, AM.02635 2�
Date of Inspection: June 4° 2002
Name of Inspector: (Please Print) James M. Ford
Company Name: James M. Ford Map: 040
Mailing Address: P.O. Box 49 Parcel: 136
Osterville,MA 02655-0049
Telephone Number: (508) 862-9400
CERTIFICATION STATEMENT
I certify that I have personally inspected the sewage disposal system at this address and that the information reported
below is true,accurate and complete as of the time of the inspection. The inspection was performed based on my
training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP
approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system:
✓ Passes
Conditionally Passes
N s Further Evaluation by the Local Approving Authority
F 'Is
Inspector's Signature: Date: June 5, 2002
The system inspector shall sub a copy of this inspection report to the Approving Authority(Board of Health or
DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000
gpd or greater,the inspector and the system owner,shall submit the report to the appropriate regional office of the
DEP. The original should be sent to-the system owner and copies sent to the buyer,if applicable, and the approving
authority.
Notes and Comments
****This report only describes conditions at the time of inspection and under the conditions of use at that
time. This inspection does not address how the system will perform in the future under the same or different
conditions of use.
Title 5 Inspection Form 6/15/2000 page 1
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Page 2 of 11
OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: 86Jillian's Way
Cotuit, AM
Owner: David Burke
Date of Inspection: June 4, 2002
Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D
a
A. System Passes:
✓ I have not found any information which indicates that any of the failure criteria described in 310 CMR
15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below.
Comments:
B. System Conditionally Passes:
One or more system components as described'in,the"Conditional Pass"section need to be replaced or
repaired. The system,upon completion of the replacement or repair,as approved by the Board of Health,will pass.
Answer yes, no or not determined(Y,N,ND)in the for the following statements. If"not determined", please
explain.
The septic tank is metal and over 20 years old*or the septic tank(whether metal or not) is structurally
unsound,exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the
existing tank is replaced with a complying septic tank as approved by the Board of Health.
*A metal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance
indicating that the tank is less than 20 years old is available.
ND explain:
Observation of sewage backup or break out or high static water level in the distribution box due to broken or
obstructed pipe(s)or due to a broken,settled or uneven distribution box. System will pass inspection if (with
approval of Board of Health):
broken pipe(s)are replaced
obstruction is removed
distribution box is leveled or replaced
ND explain:
The.system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will
pass inspection if(with approval of the Board of Health):
broken pipe(s)are replaced
obstruction is removed
ND explain:
2
Page 3 of 11
OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION .(continued)
Property Address: 86 Jillian's Way
Cotuit, km
Owner: David Burke
Date of Inspection: June 4, 2002
C. Further Evaluation is Required by the Board of Health:
Conditions exist which require further evaluation by the Board of Health in order to determine if the system
is failing to protect public health,safety or the environment.
1. System will pass unless Board of Health determines in accordance with 310 CMR-15.303(1)(b)that the
system is not functioning in a manner which will protect public health,safety and the environment:
_ Cesspool or privy is within 50 feet of a surface water
Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh
2. System will fail unless the Board of Health(and Public Water Supplier,if any)determines that the
system is functioning in a manner that protects the public health,safety and environment:
_ The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a
surface water supply or tributary to a surface water supply.
The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply.
C .
The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well.
_ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a
private water supply well**. Method used to determine distance
**This system passes if the well water analysis,performed at a DEP certified laboratory, for coliform
bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and
the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,.provided that no other
failure criteria are triggered. A copy of.the-analysis must be attached to this form.
3. Other: '
3
Page 4 of 11
OFFICIAL INSPECTION.FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: 86 Jillian's Way
Cotuit, AM
Owner: David Burke
Date of Inspection: June 4, 2002
D. System Failure Criteria applicable to all systems:
You must indicate either`yes"or"no"to each of the following for.all inspections:
Yes No
✓ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool
✓ Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or
clogged SAS or cesspool
✓ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or
cesspool
✓ Liquid depth in cesspool is less than 6"below invert or available volume is less:than '/z day flow
✓ Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number
of times pumped—
✓ Any portion of the SAS,cesspool or privy is below high ground water elevation.
✓ Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface
water supply.
✓ Any portion of a cesspool or privy is within a Zone 1 of a public well.
✓ Any portion of a cesspool or privy is within 50 feet of a private water supply well.
✓ Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water
supply well with no acceptable water quality analysis. [This system passes if the well water analysis,
performed at a DEP certified laboratory,for colifor.m bacteria and volatile organic compounds
indicates that the well is free from pollution from that facility and the presence of ammonia
nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria
are triggered. A copy of the analysis must be attached to this form.]
No (Yes/No)The system fails. I have determined that one or more of the above failure criteria exist as
described in 310 CMR 15.303,therefore the system fails. The system owner should contact the Board of
Health to determine what will be necessary to correct the failure.
E. Large System:
To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000
gpd -
You must indicate either"yes"or"no"to each of the following:
(The following criteria apply to large systems in addition to the criteria above)
Yes No
_ the system is within 400 feet of a surface drinking water supply
the system is within 200 feet of a tributary to a surface drinking water supply
the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area-IWPA)or a mapped
Zone II of a public water supply well
If you have answered"yes"to any question in Section E the system is considered a significant threat, or answered
"yes" in Section D above the large system has failed. The owner or operator of any large system considered a
significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR
15.304. The system owner should contact the appropriate regional office of the Department.
4
Page 5 of 11
OFFICIAL INSPECTION FORM NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST
Property Address: 86 Jillian's Way
Cotuit, AM
Owner: David Burke
Date of Inspection: June 4. 2002
Check if the following have been done: You must indicate`yes"or"no"as to each of the following:
Yes No
✓ _ Pumping information was provided b the owner,occupant,or Board of Health
— P g P Y � P
✓ Were any of the system componentsrpumped out in the previous two weeks?
✓ _ Has the system received normal flows in the previous two week period?
✓ Have large,volumes of water been introduced to the system recently or as part of this inspection ?
✓ _ Were as built plans of the system obtained and examined?(If they were not available note as N/A)
✓ Was the facility or dwelling inspected for signs of sewage back up?
✓ _ Was the site inspected for signs of break out?
✓ Were all system components;excluding the SAS, located on site?
✓ Were the septic tank manholes uncovered,opened,and the interior of the tank inspected for the condition
of the baffles or tees,material of construction,dimensions, depth of liquid,depth of sludge and depth of scum ?
a
✓ _ Was the facility owner(and occupants if different from owner)provided with information on the proper
maintenance of subsurface sewage disposal systems?
The size and location of the Soil Absorption System(SAS)on the.site has been determined based on:
Yes No
✓ _ Existing information. For example,a plan at the Board of Health. r
✓ Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance
is unacceptable)[310 CMR 15.302(3)(b)].
5 r
Page 6 of I 1
OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
Property Address: 86Jillian's.Way
Cotuit, M4
Owner: David.Burke
Date of Inspection: June 4, 2002
FLOW CONDITIONS
RESIDENTIAL >
Number of bedrooms(design): 4. Number of bedrooms(actual): 4
DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 440
Number of current residents: 2
Does residence have a garbage grinder.(yes or no): Yes -
Is laundry on a separate sewage system(yes or no): No [if yes separate inspection required]
Laundry system inspected(yes or no): No
Seasonal use(yes or no): No
Water meter readings, if available(last 2 years usage(gpd)): Unavailable
Sump Pump(yes or no): No
Last date of occupancy: Currently occupied
COMMERCIAL/INDUSTRIAL
Ty
pe of establishment:
Design flow(based on 310 CMR 15.203): apd
Basis of design flow(seats/persons/sgft,etc.):
Grease trap present(yes or no):
Industrial waste holding tank present(yes or no) _
Non-sanitary waste discharged to the Title 5 system (yes or no):
Water meter readings, if available:
Last date of occupancy/use:
OTHER(describe):
GENERAL INFORMATION
Pumping Records
Source of information: Never pumped-per owner .
Was system pumped as part of the inspection(yes or no): No
If yes, volume pumped: gallons--How,was quantity pumped determined?
Reason for pumping:
TYPE OF SYSTEM
✓ Septic tank,distribution box, soil absorption system
Single cesspool
Overflow cesspool
Privy
Shared system (yes or no) (if yes, attach previous inspection records, if any)
Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be
obtained from system owner)
Tight Tank Attach a copy of the DEP approval
Other(describe)
Approximate age of all components, date installed(if known)and source of information:
Jun. 25199-per as built card
Were sewage odors detected when arriving at the site(yes or no): No
6
• Page 7 of I 1
OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 86 Jillian's Way
Cotuit, MA
Owner: David Burke
Date of Inspection: June 4, 2002
BUILDING SEWER(locate on site plan)
Depth below grade: Approx. 32"
Materials of construction: _cast iron ✓ 40 PVC other(explain):
Distance from private water supply well or suction line:
Comments(on condition of joints,venting,evidence of leakage,etc.):
SEPTIC TANK: ✓ (locate on site plan)
Depth below grade: 20"
Material of construction: ✓ concrete metal _fiberglass polyethylene
_other(explain)
If tank is metal list age: Is age confirmed by a Certificate of Compliance(yes or no): (attach a copy of
certificate)
Dimensions: 1500 gal.
Sludge depth: 2"
Distance from top of sludge to bottom of outlet tee or baffle: 30"
Scum thickness: 2"
Distance from top of scum to top of outlet tee or baffle: 10"
Distance from bottom of scum to bottom of outlet tee or baffle: 12"
How were dimensions determined: I Measuring stick
Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity, liquid levels
as related to outlet invert,evidence of leakage,etc.):
Tees were present. The liquid level was even with the outlet invert. There were no signs of leakage Recommend pumping
every three years.
GREASE TRAP: None (locate on site plan)
Depth below grade:
Material of construction: _concrete _metal fiberglass _polyethylene _other
(explain):
Dimensions:
Scum thickness:
Distance from top of scum to top of outlet tee or baffle:
Distance from bottom of scum to bottom of outlet tee or baffle:
Date of last pumping:
Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity, liquid levels
as related to outlet invert,evidence of leakage,etc.):
7
• Page 8 of 11
OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
F
PART C
SYSTEM INFORMATION (continued)
Property Address: 86 Jillian's Way
Cotuit, MA
Owner: David Burke
Date of Inspection: June 4, 2002
TIGHT or HOLDING TANK: None (tank must be pumped at time of inspection)(locate on site plan)
Depth below grade:
Material of construction: _concrete _metal _fiberglass _polyethylene _other(explain):
Dimensions:
Capacity: gallons
Design Flow: gallons/day
Alarm present(yes or no):
Alarm level: Alarm in working order(yes or no):
Date of last.pumping:
Comments(condition of alarm and float switches,etc.):
D -
LSTRIBUTION BOX: ✓ (if present must be opened)(locate on site plan)
Depth of liquid level above outlet invert: Even
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.):
The D-box was level. There were no signs ofsolids. There were no signs offailure or backup from the leach field
PUMP CHAMBER: None (locate on site plan)
Pumps in working order(yes or no):
Alarms in working order(yes or no)
Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.):
8
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Page 9 of 11
OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C *+
SYSTEM INFORMATION (continued)
Property Address: 86 Jillian's Way
Cotuit, AM
Owner: David Burke
Date of Inspection: June 4, 2002'
SOIL ABSORPTION SYSTEM(SAS): ✓ (locate on site plan,-excavation not required)
If SAS not located explain why:
Type
leaching pits,number:
✓ leaching chambers,number: 3-500 gal. leach chambers with 4'stone(per design plans)
leaching galleries,number:
leaching trenches,number, length:
leaching fields,number,dimensions:
overflow cesspool,number:
Innovative/alternative system Type/name of technology:
Comments(note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation,
etc.):
The chambers were located,but not dug up. There were no signs offailure in the D-box. The bottom to grade was approximately
5'.
CESSPOOLS: None (cesspool must be pumped as part of inspection)(locate on site plan)
Number and configuration:
Depth -top of liquid to inlet invert:
Depth of solids layer:
Depth of scum layer:
Dimensions of cesspool:
Materials of construction:
Indication of groundwater inflow(yes or.no):
Comments (note condition of soil, signs of hydraulic failure, level of ponding,condition of vegetation,etc.):
PRIVY: None (locate on site plan)
Materials of construction:
Dimensions:
Depth of solids:
Comments(note condition of soil',signs of hydraulic failure, level of ponding,condition of vegetation,etc.):
9
Page 10 of 11
OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 86 Jillian's Way
Cotuit, AM
Owner: David Burke
Date of Inspection: June 4, 2002
Map: 040
Parcel: 136
SKETCH OF SEWAGE DISPOSAL SYSTEM
Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or
benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building.
A-4 L
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10
Page 11 of 11
OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL_ SYSTEM INSPECTION FORM
PART C
i
SYSTEM INFORMATION (continued)
Property Address: 86Jillian's Way
Cotuit, MA
Owner: David Burke'
Date of Inspection: ' June 4, 2002
SITE EXAM
Slope
Surface water
Check cellar
Shallow wells
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: 5199
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:
The bottom of the leach-field to grade was approximately 5'.- The design plans on file show no water at 10'when the system was
installed.
This report has been prepared and the system inspected and passed as of the date of inspection. This report is
not a warranty or guarantee that the system will function properly in the future. There have been no warranties
or guarantees, either expressed, written or implied, relating to the system, the inspection andlor this report.
11
TOWN OF BARNSTABLE�
LOCATION o ��,I �n� (NAY SEWAGE # �I Ct ' oi5�
VII.LA& C GTV tT ASSESSOR'S MAP & LOT-0-V-0 /_VP
v
INSTALLER'S NAME&PHONE NO.
SEPTIC TANK CAPACITY S6D
l
LEACHING FACILITY: (type) 3" S4�D C�A�►�crS (size) 4/ STOr�
NO.OF BEDROOMS (� {�
BUILDER OR OWNER I)AV, Bu/ t—
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 Leaching Facility(If any wetlands exist
within 300 feet of leaching (facility) Feet
Furnished by �,�✓�S e C5l t n �Or
A ,
Q CPO.+ti' q
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r33- as.q
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LOT NO. :±_ADDRESS
OWNERS NAME: jAq t 1C l..r �Jl Cave I,
SEWAGE PERMIT NO. � ,',?.I�NEW:.k REPAIR:
DATE ISSUED '�;F'DATE INSTALLED:'Z- i.
INSTALLERS .NAME
INSTALLATION OF": 1! 0� iSn1< -3 U01 �1 Le�cl. cLge^4cf5
WATER TABLE..: FINAL INSPECTION
DRAWING OF INSTALLA T ION"ON REVERSE SIDE: (//�
P
a57r9`'� r
vp TOWN OF BARNSTABLE
LOCATION 0 J 1 1I"AAJ �W �I SEWAGE # —
VILLA (o�''` ASSESSOR'S MAP& LOT
INSTALLER'S NAME& PHONE NO.
2
c
SEPTIC TANK CAPACITY
LEACHING FACEL=: (type)
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 Leaching Facility(If any wetlands exist
within 300 feet of leaching facility) Feet.
'Furnished by
No. Fee _
,gyp �� 3 THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
11 Y
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS Yes
0(ppYication for �Digozal 6pgtem Comgtruction Vermit
Application for a Permit to Construct(x)Repair( )Upgrade( )Abandon( ) ElComplete System ❑Individual Components
BraiLocation Address or Lot No. �o 7-0) _f j L_d- ,q fF� Owger;sWe di ss Noo/n7( �G'�
A s sor's a cel 607w, T /, ��`j ��/J!/� a A44nol
Gam/
I aller' Ad ess,and Tel.No. ���— Designer's Name,Address and Tel.No. j�•y �
-� .�°was G,oE -,P ct /v c..
Type of Building:
Dwelling No.of Bedrooms Lot Size Z 3. 3 Z sq.ft. Garbage Grinder( )
Other Type of Building No. of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow gallons per day. Calculated daily flower gallons.
Plan Date Number of sheets l Revision Date
Title L 2 z �✓
Size of Septic Tank /S a Type of S.A.S. J64N• r-,14,on
Description of Soil �l1�
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 'tl the Environmental Code and not to place the system in operation until a Certifi-
cate of Compliance has been issued, s oard of Health. Date 5 ��
Signed
Application Approved by Date� 1 d=Q!F
Application Disapproved forte following reasons
Permit No. - o Date Issued
- -
Fee
�� � ,��TjF_COMMONWEALTH OF MASSACR6'§ETTS Entered in computer:
y Yes V
`-PUBLIC HEALTH b.IVISION - TOWN OF BARNSTABLE., MASSACHUSETTS
4
f= ZfppYiration for Mtgosml *pgtem Congtrurtion Verntit
Application for a Permit to Construct(x )Repair( )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components
Location Address or Lot No. /�*T Z64
, n ti/„r S C✓�� OR s�N�mG���ess a9d No. n�7��J��y �1T
ss ssor's a cel a r�// r - ff r�, �a, li/l �!//�y/ yyy !./1 .
14,, v �
tal�le"r' Ad ress,and Tel.No. �3- Designer's Name,Address and Tel.No. j�
J' `1
G� ,
Type of Building:
Dwelling No.of Bedrooms Lot Size 2 3. 3 Z sq.ft:"y Garbage Grinder( )
Other Type of Building No. of Persons Showers( ) Cafeteria( ) `
Other Fixtures 1
Design Flow 4,44.y gallons per day. Calculated daily flow �s gallons.
Plan Date 5 r1 _Number of sheets Revision Date a✓
Title t5,176 L A*,/ ) �✓ �v 7f
Size of Septic Tank /S"rr.� Type of S.A.S.-3°'���-• ��N• �i/��, ��
Description of Soil
Nature of Repairs or Alterations(Answer when applicable)
a
Date last inspected:
Agreement: i
The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system
in accordance with the provisions of Witl5the Environmental Code and not to place the system in operation until a Certifi-
cate of Compliance has been issued oard of Health. C�
Signed -Date.-
Application Approved by JU Date o�i"-/n.
Application Disapproved forte following reasons
i
,
p Permit No. Date Issued
1, ----------------------- ------- — ------
THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE, MASSACHUSETTS
Certificate of Compliance
THIS IS TO CER that th_ On-site Sewage Disposal System Constructed�,e)Repaired( )Upgraded( )
Abandoned )bb�
at tJ i l^�f1'!9! 111 has been constructed in acco nce
with the provisions of Title 5 and the for Disposal System Construction Permit No. - dated e 77
i
Installer' Designer
i
The issuance of t4is permit shall of be construed as a guarantee that the systeO will function a igne
e Dat Ai `i7 Inspecto
d
{
t ---------------------------------------
No. Fee to
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS
Mtgoal *p.5tem Con.5truition Permit
Permission is hereby granted to Construct(S,-)Repair( )Upgrade( )Abandon( )
System located at Lt1u g- c
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. f"
Provided:Construction must fbe mpleted within three years of the date of ft t.Date: �' Approved by 6�'
I -
SEPTIC PROFILE TEST HOLE LOGS
T.0.F, AT EL. 63.5', -
ACCESS COVER TO WITHIN 6" OF FIN. GRADE (NOT TO SCALE)
R ACCESS COVER (WATERTIGHT) TO ENGINEER:
AH OJALA, PE
WITHIN 6" OF FIN. GRADE/62.5' JERRY DUNNING �
MINIMUM .75' OF COVER OVER PRECAST 2� SLOPE REQUIRED OVER SYSTEM 62 0` 5' I �
T 11/5/97
WITNESS-
RUN PIPE LEVEL 2' DOUBLE WASHED PEASTONE DATE:
� M7;
FOR FIRST 2'
PROPOSED 3' MAX. PERC. RATE _ < 2 MIN/INCH
60.14' GALLONSEPTIC .89' 60.23' GLASS I SOILS p# 9043
TANK (HAS
AFFLE 59.67' o000Z'
��52i .50' �,o�
o 0
( 2 % SLOPE) 0 59.40 0 0 0 4' 0 sides Q 90
\_6" CRUSHED STONE OR MECHANICAL ob 2' [ 0 57.4Q' ELEV. ELEV. LOCUS �� 1�
4' COMPACTION. (15.221 [21)- oo `o ooa „
DEPTH OF FLOW = ( 1 SLOPE) ( 1 SLOPE) O 62.3 O Qa
TEE SIZES: „ 3/4 TO 1 1/2 DOUBLE WASHED STONE O & A
INLET DEPTH 1� i LS
14„ 4 OYR 5/1 LOCATION MAP
OUTLET DEPTH — 1
LEACHING 5.1 ' E
FOUNDATION— 18' SEPTIC TANK 22' D' BOX 12' FACILITY 11 LS ASSESSORS MAP5W PARCEL
g,, 1 dYR 5/2
ZONING DISTRICT: RF (OPEN SPACE DEV.)
YARD SETBACKS:
Bw FRONT = 30'
LS SIDE = 15'
24" 7i.5YR 5/6 60.3'
52.3' REAR = 15'
PLAN REF. - 533/41
\ FLOOD ZONE: C
SF'F'G
1 �� C
OPEN \� I CP
MED/COS
i \\ I 1 6YR 5/6
N \ LOT 2
\23,432 S
co % 12' /��\` 51 \ �� 120" 52.3'
NOTES:
` \� '0 NO WATER ENCOUNTERED
LOT 3
I APPROXIMATED FROM COTUIT QUAD
\ �\ 17' SEPTIC DESIGN: (GARBAGE DISPOSER IS NOT ALLOWED ) 1 . DATUM 15
�a ._ __--- r, i ��,��En IS AVAILABLE
TH1 \ DESIGN FLOW: �_ BEDROOMS (110 GPD) = 44U GPD 2. M'UiNTCIPA� ����
20 GAR. USE A 440 GPD DESIGN FLOW 3. MINIMUM PIPE PITCH TO BE 1/8 PER FOOT.
SLAB EPT = 4. DESIGN LOADING FOR ALL PRECAST UNITS TO BE AASHO H- 10
`\ \ o SEPTIC TANK: 440 GPD
( 2 ) 880 5. PIPE JOINTS TO BE MADE WATERTIGHT.
\ USE A 1 500 GALLON SEPTIC TANK
6. CONSTRUCTION DETAILS TO BE IN .ACCORDANCE .WITH MASS.
PROP: LEACHING: ENVIRONMENTAL CODE TITLE V.
.d .� DWELL. = 7. THIS PLAN IS FOR PROPOSED WORK ONLY AND NOT TO BE
r^Z - 63.5' � Cn co � ry SIDES: 2(33.5 + 12.83) 2 (.74) 13�
TF— USED FOR LOT LINE STAKING.
\
318 8. PIPE FOR SEPTIC SYSTEM TO SCH. 40-4" PVC.
\ J
BOTTOM: 33.5 x 12.83 (.74)
9. COMPONENTS NOT TO BE BACKFILLED OR CONCEALED WITHOUT
455 GPD TOTAL. 615 S.F.
5 .44 Q INSPECTION BY BOARD OF HEALTH AND PERMISSION OBTAINED
_ USE (3) 500 GALLON ACME OR EQUAL LEACHING FROM BOARD OF HEALTH.
o CHAMBERS WITH 4 STONE ALL AROUND
10. CONTRACTOR SHALL BE RESPONSIBLE FOR VERIFYING THE
--- ' i Z LOCATION OF ALL UNDERGROUND & OVERHEAD UTILITIES PRIOR
N co 6 li Q TO COMMENCEMENT OF WORK.
. 12 ,
47, "�� ! I I I , J
0-, `O � 5 ' � 00 � � �' � �',,�, I , _, LEGEND D
/ g �, i SITE AND SEWAGE PLAN
I ( N I \� I I I I I 10Q.0 PROPOSED SPOT ELEVATION OF
(3) ( �\ \\ I I { LOT 2 J I LLIAN N ,S WAY
1 I I I 100x0 EXISTING SPOT ELEVATION
IN THE TOWN OF:
BENCHMARK: CATCH BASIN ON _ 100 — PROPOSED CONTOUR (C OTU IT) BARN STABLE
i � 1
CUL DE SAC AT EL. 45.97'
' LOT 1 — — 100 — - EXISTING CONTOUR PREPARED FOR:
MARKWOOD CORPORATION
BOARD OF HEALTH
APPROVED DATE MA SCALE: 1" = 30' DATE: MAY 4, 1999
off 508-362-4541
fox 508 362-9880
���1N Uf Mgs ��N Oi
down cape engineering, 1 n C. moo`' ARNE ��yG g ARNE H.
; OJALA 6-4
CD
CIVIL ENGIR tERS
OJALA CIVIL e s
No.2 48 " Na 30/82
LAND SURVEYORS <97
/OVAL
97-343-2 939 main st. yarmouth, ma 02675 --- — --- —DATE
ARNE H. OJALA, ., P.L.S. DATE
CURVE RAD!US LENGTH DELTA
C1 1905.00' 11.28' 00'20'22"
t-
L T 63
cr r o� 27
CHAIN LINK FENCE 55„E •�--""o -
N81 o LIGHTLY WOODED
17-7.20 OAKS AND PINES
22.7' DESIGN DATA:.
D I 0
' TOTAL 6 BEDROOMS
55„E 0, NO GARBAGE GRINDER
Na n 22.5 1
16.3
n 11 x11 BUILDING AVE DAILY FLOW: 6 x 110 GPD = 660 GPD
i 48.56 - 0 32.5
n 1 2 22.7
' 23.4 SEPTIC TANK = 660 GPD x 150% = 990 GPF
1,�E o 11 USE 2000-GALLON TANK
N81 06 0 11
24.2 23.7 0 w ,
49 99 E-Ts 8
0 ASK ,- q x w
o DESIGN CAPACITY:
24 n
OU ET O
ig C y
z 0USE 5-PRECAST GALLEY CHAMBERS H-20
o N o
22.7 z y -n 4-FEET STONE ON SIDES
23.6 z o
° m C. 2-FEET STONE ON ENDS
o �, .o soli PIPE
10T 1.16_ 2 .s Ij z
w 1; o r C:) BOTTOM AREA: 24' x 12' = 288 SF
w 22.8 22.3 C N 8
a 23.5 - rn CAPACITY. 288 0 1.0 = 288 GPD
46,887 SF f r J Z N
p co SIDEWALL AREA: 2(24 + 12) = 72 LF
1.08 ACRES f .P un , ' _
3.8 1 18.2 72 LF x 4 - 288 SF
o CAPACITY: 288 ® 2.5 = 720 GPD
24.4 3;e$'f.8 21.9 -P, ,
1:'
2 .6 a ., N .. , / .
S A N D AR EA 32 21.9 30.5
?a BOTTOM CAPACITY: 288 GPD
SIDEWALL CAPACITY. . 720 GPD
CLIMBING BARS
N
, . 2000-GAL
20 s H_ S. T. N C TOTAL CAPACITY: 1008 GPD
d� ....*
,
d. ° 24.4 �� 21.6 to
D
23.8 B N cNi",
to -
u -P
if) 24.
22.8 ..•
rn
8 10 B x UIDLING
o` (5) H-20 PRECA TI
24.1 N ,C;` CHAMBERS ,
23. W �, 4 x �4 GALLEY CHAR ,.
2 co N 4 STONE ON SID S; ;' ' •ti:. t
° 24.t PHONE .. s °
s
BOOTH U, ..:,:.:
W 23.9 •Pry�� 2 STONE ON END'.; `
24.0 WATER FOUNTAIN 4.0 0 2 GRASSED AREA ,:�:•
�i$
CLIMBING BARS
Q •6 24.0
V ANIMAL RIDE 24.0
0
z
M
ROOFED.
2 .0
..
4 21.9
DECK :' 7
L T 19
N ° 2 O - 22s 0
}.., j L, 2 .5
LOT 1 _ °? 24.6 CLIMBING BARS
' 24.0 24.7 .�
cn
P:.
o �
2 .5 ANIMAL RIDES 24.2
Q LADY BUG RIDE 43,560 SF +
„ TREELINE `
i
(3 0 6.
24.4 1.00 ACRES +
24.6 2 .
`i IMBING BARS PLATFORM 21.8
0 24.6 °
24 22.2
.7 21.8
6 2 •7 24.4
22.6
246
• 21.
Q ° CLI BIN BAR - SNAIL 24.7F24.6
®23.8 22.4
J PLANE RIDES 22
SPRINKLER CONTROLS .0
24.7
24.7 3.1 23.1 °
2 s 24. 2 22.9 20 9
23
,8 JUNGLE o
° 24.9 23.2
SPHERE
24.8 2 °
O - 22.4 .t-- n
•--24.6 24.2 2..5 6',09 N/
WATER FOUNTAIN ®2 .8 S8511
SEESAW ATE
•
1x4 ELEC PANEL BOX • 24.7 _ o
0 16 0.38'
4.7 0'_ STONE
o
----.o .. -__�_�._- PARKING
° ELEC METER �----- C1
Q4:' GATE
- -�-�
GA ®24.6 �...�---••
POLE R=19p5
•00 ---
• 24.6
' .198.6C
L
•
ce/DH FND. _ I T E P L AN
CB DH FND. "
S E A P U I T R I V E R R O A D
IN
V 16;2 & . 172 SEAPUIT RI ER ROAD
GE OF P V M T EDGE A E EN _
BA NSTAB
OYSTER HARBORS, R LE, MASS.
FOR
WIA LLI M KOCH
3 1-18-95 DATION/ STEM UN S Y JRE
FO S AS BLT
1-10-9 W
GRAPHIC SCALE 2 5 ` RECONFIGURE DRIVEWAY Y JRE � » ,�,•• :
SCALE. 1 -� 20 NOVEMBER 28 1994
20 0 10 20 ,a
eo 1 ?2-22-94 HSE D1MS/DRIVE CONFIGURATION JRE
NO. DATE DESCRIPTION BY 11A OF NOTE REVISIONS AT LEFT
IN FEET aQ PETLVAN
R .�
1 inch = 20 ft.
No. 29733 B AXTER & NYE, INC.
REGISTERED LAND SURVEYORS
& CIVIL ENGINEERS
AL OSTERVILLE, MASS.
$477 PLO2.DWG
I
_ � I