HomeMy WebLinkAbout0002 JULIE LANE - Health 2 Julie Lane, s f
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Cotuito 4p
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D ATE:2/1_.3/02----
PROPERTY ADDRESS: 2 "Julie-Lane
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Cotuit -
------------------------ 0
Mass.
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On the above date, I Inspected the septic system at the above address.
This system consists of the following:
RECEIVED
1 . 1 -1500 gallon septic tank.
2 . 1 -Distribution box. x -
3 . 6-Infiltrators. MAR 0.7 2002
i .
Based on my' inspection, I cdrtify the following conditio STOWHEOF B NSTABLE
4 . This i-s -,a title five septic system. '
5, The septic system is in proper working order
at the present time.
6 . The infiltrators are presently dry:
SIGNATURE:1
Name:-J ._ _ Hacombe-r jr-______
Company: Jo_sej)h_P. Macomber & Son; Inc . "
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Address: - Box 66----- --,
Centerville , Ma_. 02632-0066
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Phone: 508_775-3338_______
THIS CERTIFICATION DOES NOT CONSTITUTE A GUARANTY OR WARRANTY
LH P. MACOMBER & SON, INC.
Tanks-Cesspools-LeachfleldsPumped & Installed
Town Sewer Connectlons
x'66 Centerville, MA 02632-0066
775.3338 775-6412
I
COMMONWEALTH OF MASSACHUSETTS
kitEXECUTm OFFICE OF ENVIRONMENTAL AFFAIRS
DEPARTMENT OF ENVIRONMENTAL PROTECTION
TITLE 5
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM
PART A
CERTIFICATION '
Property Address: 2 Julie Lane
o ui ,Mass.
Owner's Name:James Hoover
Owner's Address:_ _438 Utterb.ack Store Road
Grp,at Falls Virginia 220-66
Date of Inspection: 3 02 ,
Name of Inspector: (please print) Joseph P.Maeomber Jr.
Company Name: J.P.Macom er & Son Inc.
Mailing Address: Box 66
Centerville,Mass_ 02632 .
Telephone Number: 508-775-3338
CERTIFICATION STATEMENT
1 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:
_/sses 1
Conditionally Passes
_ Needs Further Evaluation by.the Local Approving Authority
Fa" s
Inspector's Signatures 1 -Date:` A�
The system inspector shal bmit 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
authoriry.
Notes and Comments
This report only describes conditions at the time of inspection and under the conditions of use at that r
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 6/15f2000 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: -2 Julie Lane T
Cotuit,Mass.
Owner: James Hoover
Date of Inspection:2/1 3/0 2 5
Inspection Summary: Check A,B,C,D or /ALWAYS complete all of Section D
A. �SystemPasses:
I �in
�IC.Rl
�11.11011
�exiist.
�AAyy
hich indicates that any of the failure criteria described in 310 CMR
15.303 oailure criteria not evaluated are indicated below. -
Comments: ;
-The septic system is in proper working orders
at the tJresent time
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. j _
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:
.Vd 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 require d'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: .
t 2
Page 3 of 1 1
OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION. (continued)
Property Address: 2 Julie Lane
Cotuit,Mass.
Owner: James Hoover
Date of Inspection: 2/1 3/0 2
C. Further Evaluation is Required by the Board of Health:
A110 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:
XA Cesspool'or privy is within 50 feet of a surface water
�fff� 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:
AA 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.
�Q 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 10 fee_t'but hO feet or more from a
private water supple well". Method used to determine distance ���GQ/�
"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: ,1
d�
3
Page 4 of,l 1
OFFICIAL INSPECTION FORM —NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: 2 Julie Lane
Cotuit,Mass.
Owner.James Hoover
Date of Inspection: 2 13 02
D. System Failure Criteria applicable to all systems:
You must indicate"yes"or"no"to each of the following for all inspections: -
Yes N��Dischargelor
ackup of sewage into facility or system component due to overloaded.or clogged SAS or cesspool
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 AO/'y 7
�iquid depth in rwsspeal is less than 6"below invert or available volume is less than ''/,day flow
equired pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number
of times pumped
y portion of the SAS,cesspool or privy is below high ground water elevation..
y portion of cesspool or privy is within 100 feet of a surface water supply or tributary,to a surface
water supply.
2L/Any portion of a cesspool or privy is within a Zone-1 of a public well..
�v y portion of a cesspool or privy is within 50 feet of a private water supply well'.
y portion of a cesspool or privy is less than 100:feet but greater than 50 feet from a private water -
supply well with no acceptable water quality analysis. [This system passes.if the well water analysis,
performed at a DEP certified laboratory, for coliform bacteria and volatile organic compounds.,
indicates that the well is free from pollution from that facility and the presence of ammonia • .
nitrogen and nitrate nitrogen is equal to or less than 5 ppm,'provided that no other failure criteria
are triggered. A copy,of the analysis must be attached to this form.]
,r)_(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 now 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 `
e 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.
4
Page 5 of 1 1 `
OFFICIAL INSPECTION FORM -NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B `
CHECKLIST
Property Address: 2 Julie `Lane
Cotuit,Mass. "
Owner: James Hoover .
Date of Inspection: 2/1 3/0 2
Check if the following have been done. You must indicate"yes"or"no"as to each of the following:
Yes No
_ k1 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 receive`d`no'rmal flows in the previous two week period?
t
ZHave large volumes of water been Lntroducedpto 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 signstof break out? -
Were all system components,.excludtng the SAS, 1ocated'onsite'?
Were the septic tank manholes uncovered,opened,and the interior of the tank inspected for the condition
of the baffles or tees,material of construction, dimensions,depth of liquid,depth of sludge and depth of scum ?
Was the facility owner(and occupants if different from owner .provided with information on the proper
maintenance of subsurface sewage disposal systems
4.` '- • n _
The size and location of the Soil Absorption System (SAS)on the site has been determined based on:
Yes noX
�' Existing information.Tor example, a plan at.the Board of.Health,
Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance
is unacceptable) [310 CMR 15.302(3)(b)J, m
5.
a
IL
Page 6 of 1 1
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
t .
Property Address: 2 Julie Lane u
Cotuit,Mass.
I Owner: James Hoover
Date of Inspection:2 13 0 2
FLOW CONDITIONS
RESIDENTIAL
Number of bedrooms(design): ) t Number of bedrooms(actual):
DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): `
Number of current residents:
Does residence have agarbage grinder(yes or no):
Is laundry on a separate sewage system (yes or no):.4/,0 [if yes separate inspection required]
Laundry system inspected(yes or no):A-5 -
Seasonal use: (yes or no):2
Water meter readings, if available(last 2 years usage(gpd)):2 0 0 0—1 9, 0 0 0 gallons=5 2.0 6 GPD
Sump pump(yes or no): V4 .2001 -1 3,, 00 gallons=35. 62 G_ PD
Last date of occupancy:
COMMERCIAL/INDUSTRIAL
Type of establishment:
Design flow(based on 310 CMR 15.°203): '414 gpd w
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: s°
t
OTHER(describe):
GENERAL INFORMATION
Pumping Records
Source of information: f�t�/Al�i9
Was system pumped as part of the inspection(yes or:no):
If yes, volume pumped: 0 gallons-=How was quantity pumped determined?
Reason for pumping: .f1A
TYPE OF SYSTEM M
Septic tank,distribution box,soil absorption system
j,2 Single cesspool
_41p Overflow cesspool -
Atl Privy
A)d Shared system(yestor no)(if yes,attach previous inspection records, if,any)
A),o Innovative/Alternative technology. Attach a copy of the current operation and maintenance'contract(to be '
obtained from system owner)` _
4 Tight tank A)4 -Attach a copy of the DEP approval ,
�d Other(describe): A114
Approximate age of all components,date installed(if known)and source of information:
Were sewage odors detected when arriving at the site(yes or no):
6
Page 7 of I I
OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address:2 Julie Lane
Cotuit,Mass.
Owner:James Hoover
Date of Inspection: 2/1 3/02
BUILDING SEWER (locate on site plan)
Depth below grade:
Materials of consrruction:,4&�c-st von 20 PVC-f/Dother(explain):
Distance from private water supply well or suction line.
Comments (on condition of joints, venting, evidence of leakage, etc.):
Joints appear tight-No PvjdRnnP of leakagP_mhp sytemm
is vented through the house vents.
SEPTIC TANK: Zlocate on site plan)i",,W'4lf
�i
Depth below grade: JVe /
Materialofconstruction: Yccncreteot4metalifiberglass/t(Dpolyethylene
4pother(explain) 144
If tank is metal list age: V4 Is age confirmed by a Certificate of Compliance (yes or no): VO(aruch a copy of
ccnificau)
Dimensions: /0���
Sludge depth: :;q,Aa-e
Distancc from top QLlucgc to botiom of outlet tee or baffle: J2arC.�
Scum Lhickness: /ref
Distance tom top of scum to top of outlet tee or baffle: "�-
Distancc i om bosom of scum to bosom of outlet tee or baffle: fi r
How were dimensions deten-.ned:
Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels
as related to outlet inven, ev!denc; of leakage, etc.):
Pump the septic tank every 2-3 years.Inlet & outlet tees are
in place.The tank is structurally sound and shows no
evidence of leakage.The liquid level at the outlet invert is
fifty one inches.
GREASE TRAP�(loca(. on site plan)
Depth below grade: 4-1,09
Material of consmiction:4.0concretetO metal.4Vfiberglass-:Lfflfp olyethylene"t4pother
(explain): A14
Dimensions: -414
Scum thickness A
Distance from top of scum to top of outlet tee or baffle: oe'w
Distance fiom bosom of scum io t;onom of outlet tee or baffle: 41 4
Date of last pumping: _�i 4
Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels
as related to outlet invert, cvi,:cnce of leakage, etc.):
Grease trap is nat =respot
7
Page 8 of I 1
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 2 Julie Lane
o ui , ass.
Owner: James Hoover
Date of Inspection:2 13 02
TIGHT or HOLDING TANK,g)j,/-L-'(tank must be pumped at time of inspection)(locate on site plan)
Depth below grade: VA
Material of construction: yzLC0nCTete & metal�fiberglass,�gi polyethylene �/i4 other(explain):
Dimensions:
Capacity: ,gyp gallons
Design Flow: Abf gallons/day
Alarm present(yes or no):
Alarm level: f Alarm in working order(yes or no): A
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: 4161
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.):
Distribution box has one lateral No evidence of solids
rar y over-No evidence of leakage into or out of the box
Box is structurally sound.
PUMP CHAMBE ,c/1 (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-
8
Paoe 9 of I I
OFFICIAL INSPECTION FORM —NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C ..
SYSTEM INFORMATION(continued)
Property Address: 2 Julie Lane
o ui , ass.
Owner:
James Hoover
Date of Inspection:
SOIL ABSORPTION SYSTEM (SAS): (locate on site plan,excavation not required)
6—Infiltrators. Infiltrators
If SAS not located explain why:
Located; See page 10
Type '
�eaching pits, number: a _
eaching chambers, number:�, it/yt+alO!'�
leaching galleries,number: 0
106 leaching trenches,number, length: O
leaching fields,number,dimensions: Q
ti� overflow cesspool, number: ,_,. ���
iE innovative/alternative system Type/name of technology:/i, /yG'
Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation,
etc.):
Loamy sand to sand.No signs of hydraulic failure or ponding.
Soils are dry. Intiltrators are dry.Vegetation is normal.
CESSPOOLS(cesspool must be pumped as part of inspection)(locate on site plan)
Number and configuration: 6
Depth-top of liquid to inlet invert: 4A
Depth of solids layer:
Depth of scum laver:
Dimensions of cesspool: 40
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 present.
PRIVYAttJ.0 (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.):
Privy is not present
i`
9 s
Page 10 of I
OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY.ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
A
Property Address: 2 Julie Lane
cotuit,mass.
Owner. James Hoover
Date of Inspection: 2 1 3 02
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.
. wtgTEQ
10
d '
Page I 1 of I 1
OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued) '
Property Address: 2/Julie Lane
Cotuit,Mass.
Owner: James Hoover
Date of Inspection: 2/13/0 2
SITE EXAM `
Slope
Surface water '
Check cellar -
Shallow wells
Estimated depth to ground water S feet
s '
Please indicate (check)all methods used to determine the high ground water elevation:
,14 Obtained from system desi lans on record - if checked,date of design plan reviewed:
served site abuttin roe bservation hole within 150 feet of SAS)
hec ed with local Board of Health-explain:
Checked with local excavators, installers- tta�;t documentation)
_Accessed USGS database-explain:You must describe how you established the high ground water elevation:
Used; Gahrety & Miller Model. Grond water elevation above
sea level. 12/16/94
Used; USGS;Observation well data. June 1992
Used; USGS• nn 1 an es of ground water 1 l -
Plate run
` " r
pCt ;eet
Groundwater: Feet Below Bottom of Pity High Groundwater Adjustment 1.8 ft per Frimpter Method
y f Therefore,the vertical separation distance between the botto
of the leaching pit and the adjusted- - ) groundwater table is ��
feet.
11
i
ya•rrn�rn•r►—.•rr- rnrmr•mmrv�+n renrr.�s::�.-re�mrlirr.mirm mr..ia r.a7nueas+ .rtrrrr�r—r:..-..r—...
1 TOWN OF Barnstable BOARD OF HEALTH F
SUBSURFACE SEWACF DISPOSAL SYSTEM INSPECTION FORM - PART D. - CERTIFICATION +
-r7 ter••.-•.• —r.tr.^.-rn�srm•nrn rZ��rrr�r:�rimer�snnvr'r+rtnw.'en<rsrurrrraeT+er� ts.nrt ..�
-TYPE OR PRINT CLEARLY-
PROPERTY INSPECTED
STREET ADDRESS 2 Julie Lane •Cotuit mass.
ASSESSORS MAP, BLOCK AND'PARCEL
OWNER' s NAME James Hoover
PART D CERTIFICATION• T
NAME OF INSPECTOR Joseph P.Macomber Jr.
COMPANY NAME J.P.Macomber & Son Inc'".`
COMPANY ADDRESS Box 66 Centerville Mass.02632
Street Town or City State LIP
COMPANY TELEPHONE ( 508 ) 775 - 3338 FAX ( 508 1 790 - 1 578
R
A
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 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 .
VcSystem:
one '
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 310 CMR 15 . 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 acted has found that the system fails to
Protect the jiublic health and the environment in accordance •with Title.
5 , 3.10 CMR 15 . 303 , and as specifically noted on PART C - FAILURE
CRITERIA of this inspection form
Inspector Signature Date ,
ne copy of this t.ification must be provided to the OWNER, the- BUYER
( Where applicable ) and the BOARD OF HEAVI'II.
* If the inspection FAILED, the owner or" perator shall upgrade system
within one year of the date of the inspection , unless allowed or required
otherwise as provided in 3,10 CMR 16 . 305 ,
partd •.doc
TOWN OF BARNSTABLE
LOC�WTION X 4&,44 ZQ,6 SEWAGE #
VII.IAGEl�ll /�/� ASSESSOR'S MAP & LOT
INSTALLER'S NAME&PHONE NO.
SEPTIC TANK CAPACITY
LEACHING FACILITY: (type)0. �1 rl�l�g (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 Leaching Facility(If any wetlands exist
within 300 feet of leaching facility) Feet
Furnished by
1 _
No.
` it FEECOMMONWEALTH Of MASSACHUSETTS
Board of Health, 2 %f9/3 L� MA.
APPLICATION FOP, DISPOSAL SYSTEM CONSTRUCTION PERMIT
Application for a Permit to Construct Repair( ) Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components
Location �v� uL/t A) Owner's Name L�Nd 2rLL� Q 2
Map/Parcel# 2 j j DD pp -re)/T Address
Lot# 7OD AL28 ® /9 Telephone#
Installer's Name Designer's Name AWV-C E �v�/E �A/fUL7/�,1jT5
Address Address 04),T*.5405 I1*Ue TjL P—,p '/7t H,
Telephone# Telephone# 5-V,j- '�Z 2f 5 7i
S �. e-l/
Type of Building //V L �L Gy ��l'f Lot Size ��/S 7� sq.ft.
4 �
Dwelling-No.of Bedrooms 3 s VL Garbage grinder( )
Other-Type of Building No.of persons Showers ( ),Cafeteria ( )
Other Fixtures r�
Design Flow(min.required) 3 gpd Calculated design flow 546
7/ Design flow provided 3FG_ gpd
Plan: Date 0e T fo Number of sheets Revision Date
Title E� L 11
Description of Soil(s) , n- Di/U Lo/4H /5w 7�/ ,'1 O/L w O
W 7 Soil Evaluator Form No. /" �ZD / Name of Soil Evaluator ,�1�L°rM4 N Date of Evaluation 30
DESCRIPTION OF REPAIRS OR ALTERATIONS
The undersigned agrees to install a above cribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and
further agrees t of to place t e n until a Certificate of Compliance has been issued by the Board of Health.
Signed Date
Ip�artinnc_
k
r PICK
C]�,, n
i
i�i K
�1)^ LSTcP Si d
i
TOWN OF BARNSTABLE -y
LOCATION J(�(— AL SEWAGE #
VILLAG ASSESSOR'S MAP & LOT
INSTALLER'S NAME&PHONE NO. D 1:�d 4 t 10 v
SEPTIC TANK CAPACITY
LEACHING FACILITY: (type)-" (size)
NO.OF BEDROOMS
BUILDER OR OWNER -
PERMITDATE: '7 -52 -f T!� COMPLIANCE DATE: It"i_�'
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 .
9
Edge of Wetland and Leaching Facility(If any wetlands exist
within 300 feet of leaching facility) Feet
Furnished by
No. FEE -
COMMONWEALTH OF MASSACHUSETTS
Board of Health, -64 R 5 72113 L 45- , MA.
APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT
Application for a Permit to Construct Repair( ) Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components
Location /'v/ -O J UL l Owner's Name L !S�/ia 2/2L D(J
Map/Parcel# 2 / / 00 Zo 7 0.1 Address
Lot# 7 p0 ,� 2,8 Telephone#
Installer's Name Designer's Name AVV t 1- S'P VE
Address Address U,V I)*S14v Pj /pP i)s T,? e,D -/yt
Telephone# Telephone# �j Z Z 5 7i
f--
Type of Building ��N L L �i�/`� L Z �w C �� Lot Size ¢jiS sq.ft.
Dwelling-No.of Bedrooms UZ. S Garbage grinder ( )
Other-Type of Building No.of persons Showers ( ),Cafeteria( )
Other Fixtures p
Design Flow(min.required) 3-3 gpd Calculated design flow Design flow provided gpd
Plan: Date q Number of sheets Revision Date
TitleG/
Description of Soil(s) 7 S UilD /o10"Y J/`f� oya7/01L-
Soil Evaluator Form No. /-n 92- 6 / Name of Soil Evaluator 0 L I e-�e srW4 11 Date of Evaluation
DESCRIPTION OF REPAIRS OR ALTERATIONS
The undersigned agrees to install Ve above cribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and
further agrees t t to place t on until a Certificate of Compliance has been issued by the Board of Health.
Signed Date
/ No. FEE
�
COMMON LALT14 OF MASSACHUSETTS
Board of Health, MA.
CERTIFICATE Of COMPLIANCE
Description of Work: ❑Individual Component(s) Complete System
The undersigned hereby certify that the Sewage Dis o System; Constructed A Repaired ( ),Upgraded ( ),Abandoned ( )
by:
at 2 1 9,/E6 /DU Jt l- Z
has been installed in accordance with the pr 'si ns o 310 CMR 15.00 (Title 5) and the approved design plans/as-built plans relating to
application No. 9,V- dated Approved Design Flow (gpd)
Installer
Designer: Inspector: Date: L)
The issuance of this permit shall not be construed as a guarantee that4,
system will function as designed.
No. N FEE AQU/ r�
COMMONWEALTH Of MASSACHUSETTS
Board of Health,
DISPOSAL SYSTEM CONSTRUCTION PERMIT
Permission is hereby granted to; Construct(/�- Repair( ) Upgrade( ) Abandon( ) an individual sewage disposal system
at HIV 2 L /A/rG GL_ /D U Jr Z2 4/Z �6�D JULiC L� � as described in the application for
Disposal System Construction Permit No. 975/'/ ,dated
Provided: Construction shall be completed within three years of the date of this
sppermit.
.�All local conditions must be met.
Form 1255 Rev.5/96 A.M.Sulkin Co.Boston,MA Date J ��" Board of Health .� 1
� c
SgJZ �� T O ARNSTABLE °� ` "``"'- '1►'
LOCATION
rSEWAGE # 6
VILLAGE 6►C 1— ASSESSOR'S MAP & LOT
INSTALLER'S NAME&PHONE NO.
SEPTIC TANK CAPACITY
LEACHING FACILITY: (type),5ZVRJZrt-(; (size)
NO. OF BEDROOMS ~
BUILDER OR OWNER
�P
PERMIT DATE: 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.*.'
eet `
Edge of Wetland and Leaching Facility(If any wetlands exist
within 300 feet of leaching facility) Feet =
Furnished by
T
�C
i
lac f
s
0
� f
v
r
114' _
TOP OF FOUNDATION LOCUS_
20' MIN
kEL
10' CONCRETE CO VERS 4" SCHEDULE 40 P. VC 113, MIN. PI7LH 1/�.PER FT 2"LAYER OF LEWIS POND ROAD
/ /_7 EL. 112' — CONCRETE COVER WASHED STONE y
Q i
(�v 4" SCH. 40 PVC 12
(OR EQUAL) MINIMUM 9
PITCH 1/4 PER FT ____ — 16 RISER 36'MAX CLEAN SAND _
/ FLOW L5NE —_____ — 12 I MIN SCHOOL STREET
l 96 Q INVERT co i 10" INV. EL=107
lUPOLE �" w 109_ MIN 4L INERT LEVEL o 0 00000°°00 INVERT EL._ 108.25' INVERT INVERT o 0 0 ° o°oo o— 108.5" EL.= 107 5_ EL = 10_7.25' o ° LOCUS
EL.—__—. (TO BE PLACED ON FIRM BASE) DISTRIBUTION ° ° =1os
1b, MECHANICALLY COMPACTED OR 6' OF STONE BOX 10.0
CALLONS TO BE WATER TESTED 11' X 38' TRENCH FORMATION — PERVIOUS
SEPTIC TA NK IF MORE THN ONE PLACE ON BA STONE 0 UTLLET 4/� MA TER/AL
i 1 s—TONE" SOIL ABSORPTION
�� � � PROFILE OF 3WAS XED SYSTEM (SASS
SEWAGE DISPOSAL SYSTEM BOTTOM OF TEST HOLE NO OBSERVED WATER (7130198) ELEV. =_96_0 RES. ZONE. "RF"
NOT TO SCALE OFFSETS.'
PROBABLE WATER TABLE EL. 78f FRONT 30
(USGS TOPO AND CC WATER TABLE CONTOURS) SIDE' 15'
REAR 15'
/ \ FLOOD ZONE- "C"
ASSESSORS MAP 21
PARCEL 100
PLAN REFERENCE
284/98
ASSESSORS
LOT 1
OBSERVATION HOLE I ELEV=_ 111 -
/ w� / / �93 O, PERGOLA TIDN RATE <�- MIN./ INCH A T 4B"±t "INCHES OBSERVATION HOLE 2 ELE V=_ 108
DEPTH HORIZ TEXTURE COLOR OTT. OTHER PERCOLATION RATE <2 MINI INCH A T 4B" "L1VCHES
0 DEPTU HORIZ TEXTURE COLOR OTT. OTHER
NO WETLANDS WITHIN o"-10" A LOAMY SAND IO YR/3/2 MED.SAND
/ r,S Ej > 50 0' OF S. A. S. 10"-30" B SAND 10 YR/6/6 FINE/MED o —1�l 11 A LOAMY SAND 10 YR/3/2 MED.SAND
/ R " " C1 SAND MEDIUM/
1 o '-30 B SAND l0 YR/6/6 FINE/MED.
W /30 48 10 YR7/6 NONE 10 YR7/6 NONE MEDIUVI
COARSE C� 30"-48" CI SAND
48"-120" C2 SAND 10 YR/8/3 NONE COARSE WITH W /
SOME PEBBLES 48"-120" C2 SAND 10 YR/813 NONE COARSE WITH
/ =110 �- � ,20"-144" C3 SAND 1 SOMI PEBB_r�s
10 YR/8/1 NONE COARSE
120 144" C3 SAND 10 YR/8/1 NONE COARSE
NO WATER ENCOUNTERED
6''1 11 a. - - � , �� i SOIL TEST
0
/ 2 _-- - \ --- - - --- SOIL TEST --- - --
w 10 00
-PROP-
3 _ _ _
i
/ - BEDROOM 10
/ b -_- O US SO N
E -2 0
H cA
WITNESSED BY;TEST MR. DUNNING B.B. O.H. EXCAVATOR- TORRI�Y�ONSTRUCTIONMAN - SOIL EVALUATOR
,�00 0. - ;___= ASSESSORS
lU`04C. 0 5.w2.0 - ---- LOT 100
DES N CA.G A
B.
43,578E SQ. FT. NUMBER OF BEDROOMS . . . . . . . . 3
GARBAGE DISPOSAL . . . . . . . . . NO
/ , TOTAL ESTIMATED FLOW 5� _-__-__-_ GAL D
( 110--GAL/BR./DAY x -3_-- BR.) 330 A�'
_ _ _ _ _ LEGEND.' TOP LOAD
I � � N _ _ - - - - 01' 5 INFILTRATORS WITH REQUIRED SEPTIC TANK CAPACITY _ 1500 GAL
CD- _ 7 O,- - 2 67 \ 4' STONE SIDES
X 38'AND ENDS SOIL CLASSIFICATION . . . . . . . . I
1 cv N � = 2 112 PROPOSED DESIGN PERCOLATION RATE . . . . . < 2 MIN./IN.
BENCHMARK 110 CONTOURS
EL= 105.3 � �� � \ � � � EFFLUENT LOADING RATE . 74 GAL/DAY S.F.
(ASSUMED) �, �y i LEACHING CAPACITY (AREA X RATE) 382 GAL/DAY
TOP OF CONCRETE RESERVE LEACHING CAPACITY . 38,2 GAL/DAY
�\ BOUND ' �� "31,�5''W (38XIIX 74)+(38+38+11+11 X . 74) p NUMBER-__
9201_____
ASSESSORS
LOT 101
CA7CH\ ' Q / r ♦� i \
BASIN
r\ y Vsj
Vow
s s WILLIAM s
A. fir; *'3 a t
j
GENERAL NOTES
HSE.
< 4- \ �► N 1) ALL WORKMANSHIP AND MATERIALS SHALL CONFORM TO D.E.P.
�, <P �O _ = TITLE 5 AND THE TO WN OF _BARNBTABLE---- RULES AND
REGULATIONS FOR THE SUBSURFACE DISPOSAL OF SEWAGE.
2) ONE COVER ON SEPTIC TANK SHALL BE BROUGHT TO
\ WITHIN 6" OF FINISHED GRADE, OTHERS WITHIN 12" PROJECT L OCA T/ON
3) ALL COMPONENTS OF THE SANITARY SYSTEM SHALL BE CAPABLE OF SANTUIT ROAD
WITHSTANDING H-10 LOADING UNLESS THEY ARE UNDER OR WITHIN BARNSTABLE MA.
10 FT OF DRIVES OR PARKING AREAS. H-20 LOADING SHALL BE
USED UNDER OR WITHIN 10 FT. OF DRIVES OR PARKING AREAS.
4) ANY MASONARY UNITS USED TO BRING COVERS TO GRADE SHALL A PPL I CA N T
BE VORTERED IN PLACE.
5) NO DETERMINATION HAS BEEN MADE AS TO COMPLIANCE WITH LENO CORREDORA
DEEDED OR ZONING REGULATIONS. OWNER/APPLICANT IS TO
OBTAIN SUCH DETERMINATION FROM APPROPRIATE AUTHORITY.
6) UTILITIES SHO WN ARE APPRO UMA TE ONL Y, EXCA VATION CONTRACTOR YA NKEE SUR VE Y CONSUL TA N TS
IS TO CALL "DIG- SAFE" AT 1-800-322-4844 AT LEAST 72 HOURS I P. O. BOX 265
PRIOR TO COMMENCING WORK ON SITE. UN/T 5, 408 INDUSTRY ROAD
7) CONTRACTOR IS TO VERIFY GRADES AND ELEVATIONS AS WELL AS MARSTONS MILLS, MA. 02648
SITE CONDITIONS PRIOR TO COMMENCING WORK ON SITE. PH. (508)428-0055 - FAX(508)420-555J
8) PARCEL IS IN FLOOD ZONE __C______
9) LOT IS SHOWN ON ASSESSORS MAP 21 _ AS PARCEL -L00 --.
� SCALE_.- 1 "=20' F,9A TE.- 8/4/98
NOTE'' TOWN WATER IS AVAILABLE REV. i R
JOB NO. 51648 SHEET I OF I