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HomeMy WebLinkAbout0349 LITTLE RIVER ROAD - Health ( 349 LITTLE RIVER ID, COTUI`I' A=038-071.001 i �I i i l i i 0217009972 05101/2001 Commonwealth of Massachusetts Form 4 System Pumping Record Massachusetts System Pumping Record System Owner System Location k'iiner W.C. erim7Ary flome, 349 Little River Rd 349 Little River Rd Cotuit, Wt, 02635 Ccit-uit, MA, 02635 (508)-428-0939 x (508)-428-0939 x Fisher W.C. Type: Emergency Routine Cesspool: No Yes Septic Tank: No Yes Date of Pumping /07 Quantity Pumped: C.Sd Gallons System Pumped By: Wind River Environmental,LLC Permit#: Contents Transferred to: Contents Disposed at: 7;j Z-j CD F- Date: z Pumper Signature: Condition of System/Other Comments 1111a.5 !-450 bep Approved Form-12/07/95 a COMMONWEALTH OF MASSACHUSETTS EXECUTIVE°OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION d v . +"d TITLE 5 f OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS t SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A { CERTIFICATION ,l Property Address: 349 LITTLE RIVER RD.COTUIT,MA 02635 M38 P71-1 Owner's Name: DEBORAH SCHILLING Owner's Address: C/O REMAX 3860 RT.28 MARSTONS MILLS Date of Inspection: 12/29/00 ����� � Name of Inspector: (please print) �JO.HN GRACI ZOOS Company Name: SEPTIC-INSPECTIONS Mailing Address: P.O.BOK 2119 TEATICKET,MA.02536SI Telephone Number:508-564-6813 FAX 508-564-7270 T�WHEp�TH DEFT. 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: l:fir{ X Passes _ Conditionally Passes. _ Needs,Fu -er Evaluation by the Local Approving Authority Fails Inspector's Signature: v. Date: 12/29/00 The system inspector shall submi a copy of this inspection report to the Approving Authority(Board of Health or DEP)within p 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 t6,t�e buyer,if applicable,and the approving authority. Notes and Comments 5,, THE SYSTEM PASSES TITLE V INPECT ION.RECOMMEND PUMPING THE SYSTEM EVERY TWO YEARS TO PROLONG THE SYSTEM'S USEFULL LIFE. ****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. Z,f'l Title 5 Imnectinn Fnrm All5/7.t1t1(1 -0 �F. Page 2 of 11 y ' OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) t� Property Address: 349 LITTLE RIVER RD.COTUIT,MA 02635 M38 P71-1 Owner: DEBORAH SCHILLING Date of Inspection: 12/29/00 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: X 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: f THE SYSTEM PASSES TITLE V INPECTION.RECOMMEND PUMPING THE SYSTEM EVERY TWO YEARS TO PROLONG THE SYSTEM'S USEFULL LIFE. 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. .t.. Answer yes,no or not determined(Y,N,ND)in the for the following statements. If"not determined"please explain. n/a The septic tank is metal androver 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: n/a 1 ` c i5 n/a Observation of sewage backup or breakout or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken,settled or uneven,distribution box. System will pass inspection if(with approval of Board of Health): tt t _ broken pipe(s)are replaced obstruction Wremoved _ distribution box is leveled or replaced ND explain: n/a n/a 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!136ard of Health): _broken pipe(s)are replaced _obstruction is removed. N0 explain: n/a t°Jlz'a Page 3 of i l ,s ' 2 OFFICIAL INSPECTION FORM -NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A a .;: CERTIFICATION(continued) Property Address: 349 LITTLE RIVER:RI).COTUIT,MA 02635 M38 P71-1 Owner: DEBORAH SCHILLING Date of Inspection: 12/29/00 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. J<�.iq 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 soilsabsorption system(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface waterrsupply. _ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. _ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. _ The system has a septic 6nk and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method us'ed'to determine distance n/a "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: n/a ' Y 0 M t �y Page 4 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS P.. SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 349 LITTLE RhVE'R RD.COTUIT,MA 02635 M38 P71-1 Owner: DEBORAH SCHILLING,,;, Date of Inspection: 12/29/00 i4 D. System Failure Criteria applicable to all systems: You must indicate"yes"or"no"to each`of the following for all-inspections: Yes No - { - X Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool - X Discharge or ponding of effluenf'to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool X Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool _ X Liquid depth in cesspool is less thdfiW'below invert or available volume is less than ''/z day flow - X Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number of times pumped nLa. - X Any portion of the SAS,cesspool or privy is below high ground water elevation. X Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. X Any portion of a cesspool or`privy is within a Zone 1 of a public well. X Any portion of a cesspool or privy is within 50 feet of a private water supply well. - X Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis,performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from tgp"i 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.] o (Yes/No)The system fails.I'h,ave 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. You must indicate either"yes"or"no"to each of the following: { (The following criteria apply to large systeiiWin addition to the criteria above) yes no - X the system is within 400 feet of a surface drinking water supply X the system is within 200 feet of a tributary to a surface drinking water supply X 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 • �irgil 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 undee SectfAn D shall upgrade the system in accordance with 310 CMR 15.304.The system owner should contact the appropriate regional office of the Department. xl d Page 5 of I 1 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 349 LITTLE RIVER,RD.COTUIT,MA 02635 M38 P71-1 Owner: DEBORAH SCHILLING Date of Inspection: 12/29/00 Check if the following have been done. You must indicate"yes"or"no"as to each of the following: Yes No X _ Pumping information was provided by the owner,occupant,or Board of Health . X Were any of the system.components pumped out in the previous two weeks? I X _ Has the system received normal flows in the previous two week period? X Have large volumes of water.been introduced to the system recently or as part of this inspection? X _ Were as built plans of the system obtained and examined?(If they were not available note as N/A) X _ Was the facility or dwelling inspected for signs of sewage back up? ¢Ei X _ Was the site inspected for signs,of break out.? X _ Were all system components,excluding the SAS,located on site? X _ Were the septic tank manholes liihcovered,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? X _ Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems? °!t' The size and location of the Soil Absorption System(SAS)on the site has been determined based on: Yes no X _ Existing information.Fd`trample,a plan at the Board of Health. X _ 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)] Ma t, cP Page 6 of 11 " ,p OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C ''. SYSTEM INFORMATION Property Address: 349 LITTLE RIVER RD.COTUIT,MA 02635 M38 P71-1 Owner: DEBORAH SCHILLING,. Date of Inspection: 12/29/00 „FLOW CONDITIONS RESIDENTIAL ;, Number of bedrooms(design): 4" Number of bedrooms(actual): 4 t. 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): NO 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 „• t Water meter readings,if available(last 2 years usage(gpd)): n/a Sump pump(yes or no): NO Last date of occupancy: n/a 4 COMMERCIALANDUSTRIA L Type of establishment: n/a Design flow(based on 310 CMR 15.203): n/agpd Basis of design flow(seats/persons/sqft,etc.): n/a Grease trap present(yes or no): NO Industrial waste holding tank present(yes or no): NO Non-sanitary waste discharged to" a Title 5 system(yes or no): NO Water meter readings, if available:'q%a Last date of occupancy/use: n/a OTHER(describe): n/a ij 'GENERAL INFORMATION Pumping Records 4r' Source of information: n/a Was system pumped as part of the inspection(yes or no): NO If yes,volume pumped: n/agallons--How was quantity pumped determined?n/a Reason for pumping: n/a TYPE OF SYSTEM X 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): n/a ;>; Approximate age of all components,date installed(if known)and source of information: 1996 Were sewage odors detected when arriving at the site(yes or no):NO - ;,, A 1 Page 7 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 349 LITTLE RIVER RD.COTUIT,MA 02635 M38 P71-1 Owner: DEBORAH SCHILLING Date of Inspection: 12/29/00 BUILDING SEWER(locate on site plan) ' ' Y Depth below grade: 18" .Materials of construction:_cast iron X40 PVC_other(explain): n/a Distance from private water supply well or suction line: n/a Comments(on condition of joints, venting,evidence of leakage,etc.): TOWN WATER ' SEPTIC TANK: X(locate on site plan) Depth below grade: 12 P Material of construction: Xconcrete_metal_fiberglass_polyethylene other(explain)n/a If tank is metal list age: n/a Is age confirmed by a Certificate of Compliance(yes or no): NO(attach a copy of certificate) Dimensions: 150OG L 10' 6" H 5' 6"W 5' 8"" Sludge depth: 1" Distance from top of sludge to bottom of outlet tee or baffle:33" Scum thickness: 1" `.' Distance from top of scum to top of outlet tee or baffle: 6" Distance from bottom of scum to bottom of outlet tee or baffle: n/a How were dimensions determined: MEASURED Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): THE SEPTIC TANK AND ALL COMPONENTS ARE STRUCTURALLY SOUND.RECOMMEND PUMPING EVERY TWO YEARS TO PROLONG THE SYSTEM'S USEFULL LIFE.' GREASE TRAP:_(locate on site plan) Depth below grade: n/a Material of construction:_concrete_metal_fiberglass_polyethylene_other(explain): n/a Dimensions: n/a Scum thickness: n/a Distance from top of scum to top of outlet tee or baffle: n/a Distance from bottom of scum to bottom of outlet tee or baffle: n/a Date of last pumping: n/a Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert,evidence of leakage,e`kc.): n/a i 7 Page 8 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 349 LITTLE RIVER RD.COTUIT,MA 02635 M38 P71-1 Owner: DEBORAH SCHILLING Date of Inspection: 12/29/00 TIGHT or HOLDING TANK: (tank must be pumped at time of inspection)(locate on site plan) Depth below grade: n/a Material of construction:_concrete_metal_fiberglass_polyethylene_other(explain): n/a Dimensions: n/a Capacity: n/a gallons Design Flow: n/a gallons/day Alarm present(yes or no): N/A Alarm level: N/A Alarm in working order,(yes or no): NO Date of last pumping: n/a Comments(condition of alarm and float switches,etc.): n/a IN DISTRIBUTION BOX: X(if present must'bg opened)(locate on site plan) Depth of liquid level.above outlet invert: LEVEL WITH BOTTOM OF PIPE 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 DISTRIBUTION BOX I&STRUCTURALLY SOUND. PUMP CHAMBER:_(locate on site plan) Pumps in working order(yes or no):'1'V'O Alarms in working order(yes or no):NO Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.): n/a r „ ( j 1 ,t 1�C R Page 9 of 1 I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 349 LITTLE RIVER RD.COTUIT,MA 02635 M38 P71-1 Owner: DEBORAH SCHILLING Date of Inspection: 12/29/00 SOIL ABSORPTION SYSTEM(SAS): X (locate on site plan,excavation not required) If SAS not located explain why: n/a Type n/a leaching pits, number: n/a FLOW DIFFUSERS leaching chambers, number: 5 n/a leaching galleries, number: n/a n/a leaching trenches, number, length: n/a n/a leaching fields, number: n/a n/a overflow cesspool, number: n/a n/a innovative/alternative system Type/name of technology: n/a w Comments(note condition of soil,signs$of hydraulic failure, level of ponding,damp soil,condition of vegetation,etc.): THE FLOW DIFFUSERS APPEAR TO BE FUNCTIONING PROPERLY.SYSTEM SHOWS NO SIGNS OF FAILURE. CESSPOOLS: -(cesspool must be pumped as part of inspection)(locate on site plan) Number and configuration: n/a , Depth—top of liquid to inlet invert: n/a Depth of solids layer: n/a ! - Depth of scum layer: n/a Dimensions of cesspool: n/a Materials of construction: n/a Indication of groundwater inflow(yes or no):'NO Comments(note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation,etc.): n/a PRIVY: (locate on site plan) Materials of construction: n/a r Dimensions: n/a Depth of solids: n/a Comments(note condition of soil,signs'of hydraulic failure,level of ponding,condition of vegetation,etc.): n/a 9 I Page 10 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 349 LITTLE RIVER RD.COTUIT,MA 02635 M38 P71-1 Owner: DEBORAH SCHILLING Date of Inspection: 12/29/00 R - 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. '+F`A 6 n . CIA 13AQ it l� e1 f i: �n __ l Page 11 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 349 LITTLE RIVER RD.COTUIT,MA 02635 M38 P71-1 Owner: DEBORAH SCHILLING Date of Inspection: 12/29/00 SITE EXAM _Slope _Surface water _Check cellar Shallow wells _ t Estimated depth to ground water 12+feet Please indicate(check)all methods used to determine the high ground water elevation: YES Obtained from system design plans on record-If checked,date of design plan reviewed:7/28/95 NO Observed site(abutting property/observation hole within 150 feet of SAS) NO Checked with local Board of Health-explain: n/a NO Checked with local excavators,'installers-(attach documentation) YES Accessed USGS database=explain: n/a You must describe how you established the high ground water elevation: USGS MAPS AND CHARTS- 12+FEET 3 11 TO F BARNSTABLE LOCATION I SEWAGE # VILLAGE �� \ ASSESSOR'S MAP & LOT �� — -I I—1 INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY: (type) (size) NO. OF BEDROOMS BUILDER OR OWNER �^ PERMTTDATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by . H - C A A� l� A$ �ig l�C a fb (SC `6� TOWN OF BARNSTABLE ,,G o� LOCATION_ I �7 I q Z4-tT/.0 `�i of h AAEWAGE# �-�' /VU VyLLAGE ASSESSOR'S MAP&LOT INSTALLER'S NAME&PHONE NO. R 6/J 41,21 0 SEPTIC TANK CAPACITY Uh Q 1 LEACHING FACILITY: (type) n r�. C`� P C (size)l el io x Ya NO.OF BEDROOMS BAR OR.OWNER AVl1 PERMI TDATE: 9�®'"!P-5-'COMPLIANCE DATE: Ale' r Separation Distance Between the: Maximum Adjusted Groundwater Table and 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 -� qq a a 7 i - ASSESSORS MAP Na,. Q 9 �P > PARM fiN 6 7 J , ��� / No. L<✓� FEE ;THE COM Or WEALTH OF MASSACHUSETTS nS 1'-7f.— , MASSACHUSETTS �1yylirativn for �t� IIS�tX 5g8#PZItf� YtStrixCttIIrc jhrmit Application is hereby made for a Permit to Construct ( ep 1 )an On-site Sewage Disposal System at: Location Address or Lot No. wner's Name,Address and Tel.No. � has o�� ram.(.v,�•;� ya8-y q$�j Ins alley ame,Address,and Tel.No. Designer's Name,Address andiTel.No. 77 S��r C-N A re—,-ro i% r1111/ a 0 It Type of Building: Dwelling No. of Bedrooms 3 Garbage Grinder( Q Other Type of Building No. per Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow 330 6-PP gallons. ���,L Plan Date 8—I RNumber of sheets Revision Date Title Description of Soil Ge--, N Nature of Repairs or Alterations Answer when applicable) TyNe Pox -tyet,t< e- ca,,,s, 4 "'J e ' 0 Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the aforedescribed on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance h ee 'ss by is Board of Health. Signed � � "f� Date r_// ev��r Application Approved b Z-2- z1h Date Application Disapproved for the following reasons Permit No. ���rl"�U 7� Date Issued ..vayw, w�A. �'��y. y` .rYKi'i �� 1b k 1 PJy ' y W � Y • ! r. t... r.. No. 6 FEE Z/ f/ y!� THE COMMO WEALTH OF MASS'ACHUSETTS -MASSACHUSETTS '40ratton for Visposal *Votent � nstrurtton jJerntit Application is hereby made for a Permit to Construct( '°"� ep i d�)an On-site Sewage Disposal System at: Location Address or Lot No. N nw er's Name,Address and Tel.No. Gl7lL�'RIV� �� i��y�► c �1�� G~'l .Nc`�e/�1 , a o�C) Fc.in�,�`�-, 6 4/d8-6l17SCy. Installer's Name,Address,and Tel.No. Designer's Name,Address an4 Tel.No. �i��C cGyc�G�f'i race & Mu(10"/ ydoa-3 -8 77 5 or LN Type of Building: Dwelling No. of Bedrooms Garbage Grinder({� Other Type of Building No. per Persons Showers( ) Cafeteria( ) Other Fixtures t Design Flow gallons per day. Calculated daily flow 3 30 &P;> gallons.l,[� Plan Date 8 Number of sheets Revision Date y-y� ( �'^1r Title 5eL�X°_ - g 14 v / o� 7 9S— Description of Soil �>c'-e Y.7/b�/y • � �Ir��»�53� Nature of Repairs or Alterations(Answer when applicable) �rn�`/c.. 7`�INc� �l . goX �7✓P�� �t yo ��•+�, �i'c�`�' e a �-�r/� N Date last inspected: Agreement: sr The undersigned agrees to ensure the construction and maintenance of the aforedescribed on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of has Compliance een i sue b t.is�Board of Health. C p � y /0// �/'�� Signed Date Application Approved b Date r T Application Disapproved for the follow.jn leasons 1� Permit No. '' Date Issued T COM,MONWEA TH OF MASSACHUSETTS IMP MASSACHUSETTS `(ferttftrate of Otintyliartrie THIS IS TO CERTI , that the On-sitee6ewage Disposal System installed( or repaired/r aced ( ) on by I 6 for Maze- C'l4G.9.e ,eep at 107 Iq UP 2/ has been constructed in accordance with the provisions of Titlefi�and the for Disposal System Construction Permit No. %1 dated Use of this system is conditioned on compliance with the provisions set forth below: The issuance of this certificate shall not be construed as a guarantee that the system will function as designed. This Certificate expires on DATE �"" '�- Inspect �I E COMMONW ALTH OF MASSACHUSETTS `, No.�_-�� ' � � a '�'� 1e+ , MASSACHUSETTS FEE ,Bisposat ,$Vstent (fortstrurttort 1exmtt _ Permission is hereby granted to 1&A iCKc-a—�w( r�, to construct r repair( , aOn-sjtg`ewwaa_geeSyste ylo�ca,ed 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. All construction must be ompleted within three years of the date below. ni 1 " r DATE b t Approved by -. /y FORM 1255 Rev.3/95 A.M.SULKIN CO.-BOSTON,MA r - i�l'1'Llt;l1'1'lll(J 1 Ult: 1'l;(tC;UL11'1'lUN '1'LLa, AND UlJbhicVAl.luly r"l 5 V/ LOCATIONAALv'-_rTL_F_, 1 N�• : .. ViLLAGE - DATE 1 5' , � • FEE APPLICANT A _ t'o ADDRESS a /�i ELEPHONE NOJ�O `Non-refundable ENGINEER a LA►�14E S A19LE.�i _TEL ON N® DATE SCHEDULED Ap icant'a signature • . • • • • • • e o e ee • • ee • • • eee • eee • � o • • esee � e • s •e • • • e'eeeee �'�'6eeeeee0e.ee ee• • e • • • ' As§A§ddA s Al d Lb No: 06 SOIL L� SU B-DIVISION �AME . DATE .�-d7�Z TIME EXPANSION AREAL YES O1_ _, _ "/ R�S ENGINEER U. TOWN WATER�RIVATE WELL 1)`oAp- ✓ `9 BOARD OF HEALTH �[� EXCAVATOR SKETCH: (Street name,etc. . di:mensions of lot, exact° location. of test holes and percolation teats, locate wetlands in proximity to test holes) v NOTESe , - v rVe 1 PERCOLATION RATE: TEST HOLE NO: -- ELEVATION: TEST HOLE NO: + ELEVATION: 2 t,• - ,/, ,� 2 .4 4 6 6 ►� � I Q a 9 j �j yi. 10 1 1� 11 12 _ 12 13 13 14 14 15• 15 - 16 16 SUITABLE FOR SUB-SURFACE' SEWAGE; LEACHING FIELD LEACHING PITS LEACHING TRENCHES UNSUITABLE FOR SUB-SURFACE SEWAGE* REASONS: NOTE: ENGINEI�RING. 'PLANS MUST SHOW NUMBER ASSIGNED ON PERC TEST APPLICATION ORIGINAL: COMPLETED IM ENTIRETY DX P. E - AND RETURNED TO BOARD OF HEALTH COPY: RETAINED BY. APPLICANT t- L R Zs 0.oo. BENCHMARK TOP OF CONC. BOUND CP 06/ �c9e ELEV.=100.0(ASSUMED) B. 49• o01.6 999 PLAN REF 17287E 1,00/91 RES. ZONE: RF I B_ \\ \ 68/ yip ASSESSORS MAP 38/71-1 TOWN WA TEFL A-VAILABLE 99 9 O OF w I 1 LOT 19 AREA=62,BB1 S.F.-� : \\ \o URPHY _ j � g I �\ f I � \ \ \ d o 8• .\ _ — — �.a 0 cry.. •`� � c.749� s `I ,,O L �. \ 2.0, 0 �\ 9B6 ° d I \ \ 1 \\ \ N #zg�, o \\ PROJECT L, ION \ ( LOT 19 LITTLE RIVER ROAD COTUIT, MA. APPLICANT . - 1 Ma cEAC . h . s HERN & SCHILLING c \ cl OF W I ��,• ,T �3 O PAULA. Naga \ \ \ MERirHEw YANKEE SURVEY CONSULTANTS LO T A 20 � No.32098 y ; `. UNIT 1;- 4 0B-IND USTRY ROAD A9oF. P P. 0. BOX 265 �q fssioN MARSTONS. MILLS, MASS. 02648 \ I N�SURVE��P TEL- 428-0055 FAX 428-5553 BRUCE G. MURPHY R.S. ; ENVIRONMENTAL CONSULTANT GRAPHIC SCALE 77 SPUR LANE ,r MARSTONS MILLS, MA. 02648 40 20 40 80 160 PH. (508)428-3358 SCALE.' 1 "=40' DA TE 7/28/95 { IN . FEET ) .. _ 1 inch 40 ft. REV. REV.' 8114/95 JOB NO. 50780 SHEET 1 OF 2 a EL. = 99. 00 TOP OF FOUNDATION._ c 20 MIN. —= 10" MIN. .. � . CONCRETE COVERS f 4" SCHEDULE 40 P. V.C. MIN. PIYrH 118 PER FT. 2"LAYER OF VENT NOT 1�8 2" REQUIRED / i. ,, i. i / i i i /6•✓� / CONCRETE COVER WASHED STONE EL.=98. 5 4" CAST IRON PIPE 12" MAX T (OR EQUAL, MINIMUMPITCH 114 PER FT. CLEAN SAND 12MIN sk 7-7 FLOW LINE 1 EL.=96_0 t INVERT 1 10" 19» ■ee•r. ■w.�. r — 97. 00 EL.------- INVERT /j/ LE`�L o 00 0 00 0 0 0 0 0 0 0 0 0 0 o I UMS 0 0 0 0 0 0 o �- INVERT EL.= 96_50 INVERT/ 6 S INVERT o 0 0 0 0 0 0 0 0 0 0 0 0 0 EL.=96. 75 EL.=96_00 EL.=95_75 0 0 0 0 0 0 0 o 0 0 0 0 0 C\2 cm DISTRIBUTION INVERT o 0 0 0 (TO BE PLACED ON FIRM BASE) 6"" STONE —,9�5 50 o 0 o 000- o OR MECHANICALLY COMPACTED BOX EL.—____ o 0 0 0 ° o 0 0 °0 0 ° o EL,�3 25I 1500 —__GALLONS 11 TO BE WATER TESTED 40' ,SEPTIC TANK "G IF MORE THAN ONE OUTLET PLACE ON 6" STONE SOIL ABSORPTION OR MECHANICALLY COMPACT 3TYASHED STONE PROFILE OF SYSTEM (SA S) . INSTALL 2 TRENCHES 40' LONG, 4' WIDE & 2' DEEP .. SEWAGE . DISPOSAL SYSTEM BOTTOM OF TEST HOLE OR USGS PROBABLE WATER TABLE ELEV. = 87. 00 NOT TO SCALE ( — 87 00 NO OBSERVED WATER TABLE 7/271 95) ELEV. —_____ -a OBSER VA TION HOLE 1 ELEV.=_99. D OBSER VA TION HOLE 2 ELEV.=�9�9.0 PERCOLATION RATE ____r MIN./ INCH AT —— INCHES PERCOLATION RATE _<_5_ MIX/ INCH AT Ad— INCHES. DEPTH HORIZ TEXTURE COLOR MOTT. OTHER DEPTH HORIZ TEXTURE COLOR MOTT. OTHER 0-6'" A LOAMY SAND 7.5YR311 0-6" A LOAMY SAND 7.5YR311 6"-27" B SANDY LOAM 7.5YR518 6"-27" B SANDY LOAM 7.5YR5/8 27"-36" Cl EDIUM SAND 27"-36" Cl MEDIUM SAND GE'NL�RAL NOTES WITH GRAVEL 7.5YR516 WITH GRA VEL 7.5YR5/6 36"-132" C2 MEDIUM SAND IOYR7/4 36"-144' C2 MEDIUM SAND IOYR7/4 PERK WHITE ! WHITE 1) ALL WORKMANSHIP AND MATERIALS SHALL CONFORM TO D.E.P. TITLE 5 AND THE TOWN OF _BARNSTABLE RULES AND NO WATER NO WATER REGULATIONS FOR THE SUBSURFACE DISPOSAL OF SEWAGE. R 2) ALL COVERS TO SANITARY UNITS SHALL BE BROUGHT TO 1 SOIL TEST WITHIN 6" OF FINISHED GRADE. DATE OF SOIL TEST JULY 27 1995 SOIL TEST DONE BY BRUCE G. MURPHY R. S. 3) ALL COMPONENTS OF THE SANITARY SYSTEM SHALL BE CAPABLE OF WITNESSED BY: FDWARD BARRY WITHSTANDING H 10 LOADING UNLESS THEY ARE UNDER OR WITHIN 10 FT. OF DRIVES OR PARKING AREAS. H—20 LOADING SHALL BE DESIGN CA.L,C ULA TION,S.' USED UNDER OR WITHIN 10 FT. OF DRIVES OR PARKING AREAS. NUMBER OF BEDROOMS . 3 4) ANY MASONARY UNITS USED TO BRING COVERS TO GRADE SHALL GARBAGE DISPOSAL . . . . . . . . . NO BE MORTERED IN PLACE. y; TOTAL ESTIMATED FLOW 5) NO DETERMINATION HAS BEEN MADE AS TO COMPLIANCE WITH ( _110_GAL/BR./DA Y x —A—_ BR.) 330 GAL/DA Y DEEDED OR ZONING REGULATIONS. OWNER/APPLICANT IS TO REQUIRED SEPTIC TANK CAPACITY 1500 GAL OBTAIN SUCH DETERMINATION FROM APPROPRIATE AUTHORITY. SOIL CLASSIFICATION . 6) UTILITIES SHO WN ARE APPROXIMATE ONL Y, EXCA VA TION CONTRACTOR �' DESIGN PERCOLATION RATE < 5 MIN. IN. IS TO CALL "DIG— SAFE" AT 1-800-322-4844 AT LEAST 72 HOURS / PRIOR TO COMMENCING WORK ON SITE. EFFLUENT LOADING RATE . . . . . 74 GAL/DAY/S.F. 7) CONTRACTOR IS TO VERIFY GRADES AND ELEVATIONS AS WELL AS LEACHING CAPACITY (AREA X RATE) 496 GAL/DA Y SITE CONDITIONS PRIOR TO CO�,tAf� 'NCING WORK ON SITE. RESERVE LEACHING CAPACITY . . . 4.96 GAL/DA Y 8) PARCEL IS IN FLOOD ZONE___C . G 2©(40f40*4+4X. 74X2)*(4OX4X 74) 9) LOT IS SHOWN ON ASSESSORS MAP 38 _ AS PARCEL JOB NUMBER 50780 SH.2 OF 2