HomeMy WebLinkAbout1355 MAIN STREET (COTUIT) - Health 1355 Main Street
+77777++,
No. Fee
BOARD OF HEALTH
TOWN OF BARNSTABLE
ZIpprication _for Yell Cow5truction Permit
Application is hereby made for a permit to Construct Alter( ), or Repair( ) an individual well at: ,
/37,5 MG , w s T Corn, T r'
Location-/Address Assessors Map and Parcel
T 7
G` •+4N� Q YV l flbW S/ /3,75 M4 fw 3 6d /G-t7— /-f q n
Owner // /� J Address
l/rNN/S 9ca ,, ur6� Hof Jeq,,&S3 /1'd 1wo,54 e Ie4 0a6Yj
Installer-Driller Address
Type of Building
Dwelling
Other-Type of Building No. of Persons
Type of Well y Capacity
Purpose of Well fiv e!!�4/I o.a
Agreement:
The undersigned agrees to install the afore described individual well in accordance with the provisions of the
Town of Barnstable Board of Health Private Well Protection Regulation-The undersigned further agrees not to place the
well in operation until a Certifi to of Compli nce as been issued by the Board of Health.
Signed f J
Date
Application Approved By ��-� -
Date
Application Disapproved for the following reasons:
J /- Date
Permit No. " - D 7`� Issued ——7
Date
-------------------------------------------------------------------------------------
BOARD OF HEALTH
TOWN OF BARNSTABLE
Certificate of (Compliance
THIS IS TO CERTIFY,that the individual well Constructed(vj, Altered( ), or Repaired( )
by - -Qea SC4wn.n,�
Installer
at !3,U Ma t-,L, ST eic i 7 et
has been installed in accordance with the provisions of the Town of Barnstabl Board of Health Private Well Pot tion
Regulation as described in the application for Well Construction Permit No. C,;L4 55 Dated 1,
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL
SYSTEM WILL FUNCTION SATISFACTORILY.
Date Inspector
No.
Fee
..BOARD OF HEALTH
TOWNrOF . BAR-NS7ABL.'E ¢ �
rr
mlicat � .}.. � n Yer��r,J F.S`9{ 1.. i .;!"+att `!'.m'P\•�.�'1'
tt 0 L�4V �0� tru�t�o /�
Application is hereby made for a permit to Construct Alter( ), or Repair O an.individual well at.
Location-/Address / Assessors Map and Parcel
G S 7- a TV i 7 iy A `
Owner / Address
�CU✓y A,.,I-I/ I!.� c I w /G.SS' C.! /'y lJ.S��`w P (�t-I
Type of Building
Dwelling
Other-Type of Building No. of Persons
Type of Well `1/ Capacity
Purpose of Well /i i/GGTi
g. Agreement:
'.
"The undersigned.agrees'to install the afore described individual well in'accordance with'the provisions of the.
. Town of Barnstable Board of Health Private Well'Protection-Reg'gulation-The undersigned further agrees not to place the
r well in operation until a Certificate of Compliance has been issued by the Board of Health.
Signed -
+ ✓„+,..,, �� Date
Application Approved By C�'' -Da 2
V r '
I Date
Application Disapproved for the following reasons:
i
s..-....,,• ..�_.._'.:..-........emu...._',. ..._.a.a-....,: ::u,� .. ,
Date
Permit No. Issued
Date y
-----------------------eke-------------------------- --------------------------------------------------
BOARD OF HEALTH
.T 9W.N. O F..x.B- R,"N,.S.�TA.,B,L�E—ti—.�--.,�, , - _
r Certificate of Compliance/ .'
THIS IS TO CERTIFY that the Indivdual.well Constructed r`` r f!
( ;. Altered( );' or Repaired
'1 by �tN�+/S SCGivrCiP/'
4' 4
{, Installer ,
at i 3 SS 7 wTu, l 114
G
/ V
s
. has been installed in accordance with.the provisions of the Town of Barnstable Board of Health Private Well Protection.
Regulation as described in the application for Well Construction Permit No. W��, i"" � Dated
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL
SYSTEM WILL FUNCTION SATISFACTORILY.
Date Inspector
_-_- __e..-®- -- -- --- -- - - - .---v_-.. ---- - --- ---�__�--.._
BOARD OF HEALTH
TOWN OF BARNSTABLE
Yell Construction Permit
No. Fee
Permission is hereby granted to .p e eusv
` Installer
io Construct(tom); Alter( ), or Repair( an individual well at:-. ' '
}; Street
as sHownon the application`fo"r a Well Construction Permit No. Dated A
t. Date t Approved By
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Colmmonwealth of.Massachusetts
> Title 5 Official Inspection Form
i Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
z t � •
1355 MAIN ST.
Property Address spa
KEENAN FLYNN t
Owner Owner's Name
Information is
required for every COTUIT MA 02635 10-11-2019 '
page. Cityrrown State Zip Code Date of Inspection
Inspection results must be submitted on this form. Inspection forms may not be altered in-any
way. Please see completeness checklist at the end of the,
form.
Important:When A. Inspector Information 61# lyaa,a
filling out forms p
on the computer,
use only the tab Douglas Brown
key to move your Name of Inspector
cursor-do not Cape Cod Septic,Services Inc.
use the return key. Company Name
350 Main St.
Company Address .
West Yarmouth MA 02673
City/Town State Zip Code
A 508-775-2825 S14297'
Telephone Number License Number
B. Certification
I certify that: I am a DEP approved system Inspector In full compliance with Section 15.340 of Title 5
(310 CMR 1-5.000); 1 have personally inspected.the sewage disposal system at the property address
listed above; the information reported below is true, accurate and complete as of the time of my
Inspection; and the inspection was performed based on my training and experience in the proper function
and maintenance of on-site sewage disposal systems.After conducting this inspection I have determined
that the system:
1. ® Passes
2. ❑ Conditionally Passes
3. ❑.Needs Further Evaluation by the Local Approving Authority
4. ❑ Fails
10
Ins or s Slgna ure —r Date
The system inspector shall submit a copy of this inspection report to the Approving Authority (Board
of Health or DEP)within 30 days of completing this inspection. If the system 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 DER The original form should be sent to the system owner and copies sent to
the buyer, if applicable, and the approving authority,
Please note: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.
t5inap.doc•rev.7/26/2018 Title 6 Official Inspection Form:Subsurface sewage Disposal System•Page 1 of 16
Commonwealth of Massachusetts
Title 5 OfficialInspection- Form
.` Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
1355 MAIN ST.
Property Address
KEENAN FLYNN
Owner Owner's Name
information is required for every COTUIT MA 02635 10-11-2019
page. City/Town State Zip Code Date of Inspection
C. Inspection Summary
Inspection Summary: Complete 1, 2, 3, or 5 and all of 4 and 6.
1) System Passes:
® I have not found an information which indicates that an of the failure criteria
Y a described
Y
in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are
indicated below.
Comments:
SYSTEM IS IN.WORKING CONDITIOIN
2) System Conditionally Passes:
E 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.
Check the box for"yes", "no"or"not determined" (Y, N, ND)for the following statements. If"not
determined,"please explain.
The septic tank is metal and.over 20 years old*or the septic tank(whether metal or not) is.structurally
unsound; exhibits substantial infiltration or 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.
❑ Y ❑ N . ❑ ND(Explain below):
t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 18
Commonwealth of.Massachusetts
Title 5 Official Inspec#ion Form.
Subsurface Sewage Disposal System form-Not for Voluntary Assessments
1355 MAIN ST.
Property Address
KEENAN FLYNN
Owner Owner's Name
information is required for every COTUIT MA 02635 10-11-2019
page. City/Town State Zip Code Date of Inspection
C. Inspection Summary (cont.)
2) System Conditionally Passes(cont.):
❑ Pump Chamber pumps/alarms not operational. SyIstem.will pass with Board of Health approval if
pumps/alarms are repaired.
❑ Observation of sewage backup or break out or high static water level in the distribution box due
to broken or obstructed.pipe(s) or due to a broken, settled or uneven distribution box: System will
pass inspection if(with approval of Board of Health):
broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below):
❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below):
❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below):
❑ The system required pumping:more than 4 times a year due to broken or obstructed.pipe(s). The
system will pass inspection if(with approval of the Board of Health):
0 broken pipe(s)are replaced. ❑ Y ❑ N ❑ ND (Explain below):
❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below):
3) 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.
a. 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:
t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 18
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
1355 MAIN ST.
Property Address
KEENAN FLYNN
Owner Owner's Name
information is required for every COTUIT MA 02635 10-11-2019
page. Cityrrown State Zip Code Date of Inspection
C. Inspection Summary �(cont)
❑ 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
b. 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.
El 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 fecal
coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal
to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must
be attached to this form.
c. Other:
4) System Failure Criteria Applicable to All Systems:
You must indicate"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
t5insp.doc•rev.7/2 612 0 1 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 18
Commonwealth of.Massachusetts
Title 5 Official Inspection Form
a Subsurface Sewage Disposal System Form -Not for Voluntary Assessments .
1355 MAIN ST.
Property Address
KEENAN FLYNN
Owner Owner's Name
information is COTUIT MA 02635' 10-11-2019
required for every
page. City/Town State Zip Code Date of Inspection
C. Inspection Summary (cont.)
4) System Failure Criteria Applicable to All Systems: (cont.)
Yes No
❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded
or clogged SAS or cesspool
El ® Liquid depth in cesspool is less than 6" below invert or available volume is less
than Y2 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 water supply
well.
❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well.
❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet
from a private water supply well with no acceptable water quality analysis. [This
system passes if the well water analysis, performed at a DEP certified
laboratory,for fecal coliform bacteria indicates absent and the presence
of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,
provided that no other failure criteria.are triggered.A copy of the analysis
and chain"of custody must be attached to this form.]
❑ ® The system is a cesspool serving a facility with a design flow of 2000.gpd-
10,000'gpd.
❑ ® 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.
5) Large Systems.: To be considered a large system the system must serve a facility with a
design flow of 10;000 gpd to 15,000 gpd.
For large systems, you must indicate either"yes"or"no"to each of the following, in addition to the
questions in Section CA.
Yes No
❑ ❑ 'the system is within 4.00 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
t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 18
Commonwealth of Massachusetts
Title 5 Pfficia.lAnspoction Form
F Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
V�<<� 1355 MAIN ST.
Property Address
KEENAN FLYNN
Owner Owner's Name
information is required for every COTUIT MA 02635 10-11-2019
page. City/Town State Zip Code Date of Inspection
C. Inspection Suininary (cont.)
If you have answered."yes"to any question in Section C.5 the system is considered a significant
threat, or answered "yes"to any question in Section CA above the large system has failed. The
,owner or operator of any large system considered a significant threat under Section C.5 or failed
under Section CA shall upgrade the system in accordance with 310 CMR 15.304. The system owner
should contact the appropriate regional office of the'Department.
6. You must indicate"yes" or"no"for each of the following for all inspections:
Yes No
❑ ® Pumping information was provided by the owner, occupant, or Board of Health
Were any of the system components pumped out in the previous two weeks?
❑. ❑ Has the system received normal flows in the previous two week period?
❑ 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?
Z 0 Was the facility owner(and occupants if different from owner) provided-with
information on the proper maintenance of subsurface sewage disposal systems?
The size and location of the Soil Absorption System(SAS)on the site has
been determined based on:
® ❑ Existing information. For example, a plan at the Board of Health.
® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue
approximation of distance is unacceptable) (31.0 CMR 15.302(5)]
t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 18
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
1355 MAIN ST.
Property Address
KEENAN FLYNN
Owner Owner's Name
information is required for every COTUIT MA 02635 10-11-2019
page. Cityrrown State Zip Code Date of Inspection
D. System Information
1. Residential Flow Conditions:
Number of bedrooms (design): 3 Number of bedrooms(actual): 3
DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): 330
Description:
Number of current residents: 0
Does residence have a garbage grinder? ❑ Yes 0 No
Does residence have a water treatment unit? ❑ Yes ® No
If yes, discharges to:
Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No
information in this report.)
Laundry system inspected? ® Yes ❑ No
Seasonaluse? ® Yes ❑ No
219 GPD
Water meter readings, if available(last 2 years usage(gpd)): 2017 017 211 GPD
Detail:
PROPERTY HAS AN IRRIGATION SYSTEM
Sump pump? ❑ Yes ® No
9-2019
Last date of occupancy: Date Date
I .
t5insp.doc•rev.7/2 612 0 1 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 18
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System'For m -Not for Voluntary Assessments
1355 MAIN ST.
Property Address
KEENAN FLYNN
Owner Owners Name
information is required for every COTUIT MA 02635 10-11-2019
page. Cityrrown State Zip Code Date of Inspection
D. System Information (cont.)
2. Commercial/industrial Flow Conditions:
Type of Establishment:
Design flow(based on 310 CMR 15.203): Gallons per day(gpd)
Basis of design flow,(seats/persons/sq.ft.,etc.):
Grease trap present? ❑ Yes ❑ No
Water treatment unit present? ❑ Yes ❑ No
If yes, discharges to:
Industrial waste holding tank present? ❑ Yes ❑ No
Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No
Water meter readings, if available:
Last date of occupancy/use: Date
Other(describe below):
3. Pumping Records:
Source of information: NO PUMPING RECORDS
Was system pumped as part of the inspection? ❑ Yes ® No
If yes, volume pumped: gallons
How was quantity pumped determined?
Reason for pumping:
i
t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System r Page 8 of 18
f
Commonwealth of Massachusetts
9 Title 5 Official, Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
1355 MAIN ST.
Property Address
KEENAN FLYNN
Owner Owner's Name
information is required for every COTUIT MA 02635 10-11-2019
page. City/Town State Zip,Code Date of Inspection
D. System Information (cont.)
4. 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)and a copy of latest
inspection of the I/A system by.system operator under contract
❑ Tight tank. Attach a copy of the DEP approval.
❑ Other(describe):
Approximate age of all components, date installed (if known)and source of information:
SYSTEM COMPLIANCE'DATE 12-9-15 PER AS BUILT.
Were sewage odors detected when arriving at the site? ❑ Yes ® No
5. Building Sewer(locate on site plan):
Depth below grade: 2'-9"feet
Material of construction:,
❑ cast iron ®40 PVC ❑ other(explain):
+10'
Distance from private water supply well or suction line: feet
Comments(on condition of joints, venting, evidence of leakage, etc.):
LINE CHECKED WITH SEWER CAMERA AND WAS FOUND TO BE CLEAN; PROPERLY
PITCHED WITH NO SIGN OF ROOT INTRUSSION.
t5insp.doc rev.7126/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 18
Commonwealth of Massachusetts
(P Title 5 .Official Inspection Form
Subsurface Sewage'Disposal System Form,- Not for Voluntary Assessments
z
1355 MAIN ST.
Property Address
KEENAN FLYNN
Owner Owner's Name
Information is required for every COTUIT MA 02635 10-11-2019.
page. Cityrrown State Zip Code Date of Inspection
D. System Information (cont.)
6. Septic Tank(locate on site plan):
2'
Depth below grade: feet
Material of construction:
® concrete, ❑ metal ❑ fiberglass ❑ polyethylene ❑other(explain)
If tank is metal, list age: years
Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ® No
Dimensions:
1500 GALLONS
Sludge depth: LESS THEN 2"
Distance from top of sludge to bottom of outlet tee or baffle
Scum thickness
2"
Distance from top of scum to top of outlet tee or baffle
Distance from bottom of scum to bottom of outlet tee or baffle
How were dimensions determined? SLUDGE JUDGE
Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity,
liquid levels as related to outlet invert, evidence of leakage, etc.):
TANK IS STRUCTURALLY SOUND. INLET AND OUTLET TEES IN PLACE. LIQUID LEVEL IS
EVEN WITH OUTLET INVERT. NO SIGN OF LEAKAGE.
t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 10 of 18
Commonwealth of Massac_ husetts
(P Title 5.Officia Inspection:Form
pis Subsurface Sewage Disposal System Form-Not for Voluntary Assessments .
1355 MAIN ST.
Property Address
KEENAN FLYNN
Owner Owner's Name
information is required for every COTUIT MA 02635 10-11-2019
page. Cityrrown State Zip Code Date of Inspection
D. System Information (cont.)
7. Grease Trap (locate on site plan):
Depth below grade: feet
Material of construction:
❑concrete ❑ metal ❑fiberglass ❑ polyethylene ❑other(explain):
Dimensions:
Scum thickness
Distance from top of scum to top of outlet tee or baffle
Distance from bottom of scum to bottom of outlet tee or baffle
Date of last pumping: Date
Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity,
liquid levels as related to outlet invert, evidence of leakage, etc.):.
8. Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan):
Depth below grade:
Material of construction:
❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑other(explain):
Dimensions:
Capacity: gallons
Design Flow: - gallons per day
t5insp.doc-rev.7/2 612 01 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 18
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
1355 MAIN ST.
Property Address
KEENAN FLYNN
Owner Owner's Name
information is COTUIT MA 02635 10-11-2019
required for every
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
8. Tight or Holding Tank(cont.)
Alarm present: ❑ Yes ❑ No
Alarm level: Alarm in working order: ❑ Yes ❑ No
Date of last pumping: Date
Comments (condition of alarm and float switches, etc.):
*Attach copy of current pumping.contract(required). Is copy attached? ❑ Yes . ❑ No
9. Distribution Box(if present must be opened) (locate on site plan):
Depth of liquid level above outlet invert EVEN WITH OUTLET INVERTS
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 IS IN GOOD CONDITION. BOX IS LEVEL AND OUTLETS ARE EQUAL. NO
SIGN OF CARRYOVER. NO EVIDENCE OF LEAKAGE. NO SIGN OF OVERLOADING OR
HYDRAULIC FAILURE.
t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 18
Commonwealth of Massachusetts
Title 5.0fficial Inspection Form'
i Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
a
1355 MAIN ST.
0.
Property Address
KEENAN FLYNN
Owner Owner's Name
information is required for every COTUIT MA 02635 10-11-2019
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
10. Pump Chamber(locate on site plan):
Pumps in working order: ❑ Yes ❑ No*
Alarms in working order: ❑ Yes ❑ No*
Comments' note condition of um chamber, condition f. ( pump o pumps and appurtenances, etc.):
* If pumps or alarms are not in working order, system is a conditional pass.
11. Soil Absorption System (SAS) (locate on site plan, excavation not required):
If SAS not located, explain why:
Type:
❑ leaching pits. number:
® leaching chambers number: 2
❑ leaching galleries number:
❑ leaching trenches number, length:
❑ leaching fields number, dimensions:
❑ overflow cesspool number:
❑ innovative/alternative system
Type/name of technology:
t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 18
Commonwealth of. Massachusetts
cp Title -5 Official. Ins.pection Form
Subsurface Sewage Disposal System Form Not for Voluntary Assessments
1355 MAIN ST.,
Property Address
KEENAN FLYNN
Owner Owner's Name
information is required for every COTUIT MA 02635 10-11-2019
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
11. Soil Absorption System (SAS) (cont.)
Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of
vegetation, etc.):
2. 500 GALLONS WITH 4 FEET OF STONE. SYSTEM WAS.DRY.
12. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan):
Number.and configuration
Depth—top of liquid to inlet invert
Depth of solids layer
Depth of scum layer
Dimensions of cesspool
Materials of construction
Indication of groundwater inflow ❑ Yes ❑ No
Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,
etc.):
z
t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 18
Commonwealth of Massachusetts
Title 5 'Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
1355 MAN ST.
Property Address
KEENAN FLYNN
Owner Owner's Name
inormation is
requiredforevery COTUIT MA -02635 10-11-2019
page. Cityrrown State Zip Code Date of Inspection
D. System Information (cont.)
13. Privy(locate on site plan):
Materials of construction:
Dimensions
Depth of solids
Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,
etc.):
t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form;Subsurface Sewage Disposal System-Page 15 of 18
Commonwealth of Massachusetts
Title 5 'Offic1al. Inspection form
Subsurface Sewage Disposal-System Form-Not for Voluntary Assessments
u
1355 MAIN ST.
Property Address
KEENAN FLYNN
Owner Owner's Name
information is required for every COTUIT MA .02635 10-11-2019
page. City[rown State Zip Code Date of Inspection
D. System Information (cont.)
14. Sketch Of Sewage Disposal System:
Provide a view 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. Check one of the boxes below:
❑ hand-sketch in the area below
drawing attached separately
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i
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I ,
c `e. AZ"S1'45
19�4
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e
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t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 18
r—
Commonwealth of Massachusetts
F Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
1355 MAIN ST:
Property Address
KEENAN FLYNN
Owner Owner's Name
information is required for every COTUIT MA 02635 10-11-2019
page. City/Town State Zip Code Date of Inspection
D. System information (cont.)
15. Site Exam:
® Check Slope
® Surface water
® Check cellar
® Shallow wells
11+
Estimated depth to high ground water: feet
Please indicate all methods used to determine the high ground water elevation:
® Obtained from system design plans on record
If checked, date of design plan reviewed: Date 2015
Date
❑ 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: .
FROM SOIL LOG ON PLAN AT BOH.
Before filing this Inspection Report, please see Report Completeness Checklist on next page.
t5insp.doc•rev.7/26/2018 Title 6 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 18
Commonwealth of-Massachusetts .
> Title 5 Officia Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
�,.• 1355 MAIN ST.
Property Address
KEENAN FLYNN
Owner Owner's Name
required for
is every
COTUIT
required MA 02635 10-11-2019
page. City/Town State Zip Code Date of Inspection
E. Report Completeness Checklist
Complete all applicable sections of this form inclusive of:
® A. Inspector Information: Complete all fields in this section..
® B. Certification: Signed & Dated and 1, 2, 3, or 4 checked
C. Inspection Summary:
1, 2, 3, or 5 completed as appropriate
4 (Failure Criteria)and 6(Checklist)completed
® D. System Information:
For 8: Tight/Holding Tank— Pumping contract attached
For 14:Sketch of Sewage Disposal System drawn on pg. 16 or attached
For 15: Explanation of estimated depth to high groundwater included
t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 18 of 18
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DeslneiSL
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Address:, �2 CAPfl� B11'�Y a u AcTc i etis +g` '`
C)n ' H/2 / " ,c_. , wati tss install a_.
.(date) (instal li'r)
septic System at 1'? ,C� h�'t ar �r'u 1-t' �s b .ed on'u cltstgn dl�tW11 by
ti
(addres '
es ion
' ' I icrTilv:"that:lhe s¢;pttc s�sicf77 tr°fcrc27cctl:abo&6, s rn iallti,saA- aniialiy
the de5tpl which_rnay 'lne ude-minor apptoved,ehanees such tzs Iatc laI relocation c T the,
dtstiihutlon,bo� �rrdlcr2 se(atic.ta"nk. Sir, out (if.reyu-ired).wts:inspeetecl and the suits
we `Found sattSfactrn;v,'
I certifv tha(the septic System.referenced above was 'nstall"e-d with inajoi'change"s (i;e,
Y �;rc aver thah=10 14tel 1 Ielocatictii U# the"'SAS or an} vci=tic al re ocati"on of anyi.co.n�poi�cnf
o#.the scptic;sysTci ) lout a accarelanee'witli State & l c .al keiidadons T'lari,,iev,ision or;
certified as'-bunt by de'si nei tci follo,v. 5_ .,,p out.(ii r`enulred)was llasj:ccted and the=soils;
Were found sali Facinrv,.
CrJ tr#} tl?at Cl'e cl Sir it Kelp Ss'Y2C 3bo ie L 5 ^;CnCGGt d Pi 3ilfvl=ur Lc,Wlkl^ tilt' r
o#.tlie' 1\ royal lcttc,rs(iCaphlri(t11,1e" - ---- d
a Of Ily4
dTUre.
1)eSi�ner ti.Slildlilt( �a r 1
PLEASE RETURN TO.AARI STAR I P1;13'L1( .:NEAI;;I'1I D1��I�If1N ,CE}2TiF'1.CA'T.it_:
OF COMPLIANCE. b'T?'ILL NOT. BE`<.1SSUED.'UNTII :BOTH'THIS:;FORM AND-AS-
13tiLLT.' CART) ARIA, RECLIVE.D RY TH.E" ARVMBLE PIIBLIC'JJEAL;:TB DIVISION. .
T'RAN:K.YOU
i1'iSenn�`t)esi nei Ccr$itic*non Form Re 3=1^-1 3Aw
TOWN OF BARNSTABLE
LOCATION _� '�� C�i i1 ��' SEWAGE# 10 5-`'U` J�
VILU;kGE ASSESSOR'S MAP&PARCEL 019 — 121
`INSTALLERS NAME&PHONE NO. � Cl;,�G• 1t"J(�
SEPTIC TANK CAPACITY ®ON
LEACHING FACILITY:(type) � K bC-5 (size) ACC M
NO.-OF BEDROOMS 3
OWNER Jt M I
PERMIT DATE: .2 3 tE 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
kA
C
A
p,-A - 'All ;�� 5
/f
No. �j o�" Fee t%
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes
21pplitation for -Misposar *pstem Construction permit
Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon( ) Complete System ❑Individual Components
Location Address or Lot No. j 3 5 5 A4,4 1-A/ S- �, Owner's Name,Address,and Tel.No. a 5 S L L L
C O ;cA.s 7, A-f 4. � 3 S>
Assessor's Map/Parcel 19
staller's Name,Address,and Tel.No ® '—`1.3-00 Designer's Name,Address,and Tel.No. 02
� �— �.3
i /9 '374, A55 co C.i.A ik S
lii�A, -
Type of Building:
Dwelling No.of Bedrooms Lot Size 7 sq.ft. Garbage Grinder( )
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow(min.required) 33 ® gpd Design flow provided 3 gpd
Plan Date // 02 D IS Number of sheets I Revision Date
Title � �
Size of Septic Tank J j •2. Type of S.A.S. ix
Description of Soil C J j a 7,
Nature of Repairs or Alterations(Answer when applicable)
Date last inspected:
Agreement:
The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in
accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of
Compliance has been issued by this Board of H!,A /
Signed Date I /-
Application Approved by - Date f I J
Application Disapproved by Date
for the following reasons
C
Permit No. 1 Date Issued 0 :2 3— 15
'�. . .. -. .._ ... c� 'ik_t.,..`.+a..r t.,..,.:i w....y,;.,vA�ry'T xtJ^`riY.r^'.e;�{},'Rj�.,�i..f-i'Sw.�r.;. .. • . .. .. - ._
Fee F D V
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
PUBLIC HEALTH DIVISION OF BARNSTABLE, MASSACHUSETTS Yes
N
2pplication for MispoSal Epstein Construction Vffmit
Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon( ) ETComplete System ❑Individual Components
Location Address or Lot No. / 5 5 IH,4.%.tJ .s 7-i Owner's Name,Address,and Tel.No. � Sr S L L_..
C TGl s i arc l.
Assessor's
!-O/3 . 9 3<9
Map/Parcel /9 — /�4,
t
Installer's Name,Address,and Tel.No. � `/3 00 Designer's Name,✓Alddrre�ss,and Tel.No.
�7� Jm to -E��Y sc[t e�r 7 / � - �✓�J y� -& A55o C 1 A l L S
Type of Building: �j
Dwelling No.of Bedrooms Lot Size �2,` 7�sq.ft. Garbage Grinder( )
Other Type of Building W-16, , No.of Persons Showers( ) Cafeteria( )}
w;Other Fixtures /
Design Flow(min.required) ✓ 3 CO gpd Design flow provided g gpd
Plan Date ///A/ o't O /.5 Number ofsheets I Revision Date
Title
Size of Septic Tank / $D Cri' "-' Type of S.A.S. 1 �X /07
Description of Soil
t
Nature of Repairs or Alterations(Answer when applicable). y /ZAA 4- J„
Date last inspected: f.
Agreement:
The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in
accordance with the provisions'of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of
Compliance has been issued by.this Board of Health l
V l v7.5 /
i Signed` ' '+., .,,. Date �,�I /
3
_- .Application Approved-by-:=. ,_ _ ;' - .:_ - _...x __ t Date ! '_I
Application Disapproved by Date
for the following reasons
Permit No. C ;'o Date Issued v J"' 1
THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE,MASSACHUSETTS
Certificate of Compliatta
THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed Repaired( ) Upgraded( )
Abandoned( )by 10.,__ ..?�...e_
at / 3 v.r has been constructed in accordance
with the provisions of Title 5 and the for Disposal System Construction Permit No.066-q)O dated 1 I`,23"1S
Installer LZ - e- Designer
v o
#bedrooms Approved design flow 73 gpd
The issuance of thisgrinit shall not be construed as a guarantee that the system will notionasdesignedl.
- Af f
Date ;� 1 �r a Inspector �,/�° �M
. _- ---------------- -------------.------------ ---_--------- ---------------------------------------
No.... L� _
O --- Fee
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS
Misposaf 6pstern Construction 3permit
Permission is hereby granted to Construct(✓) Repair( ) Upgrade( ) Abandon( )
System located at /3 11�
and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with
Title 5 and the following local provisions or special conditions.
Provided:Construction must be completed within three years of the date of this permit:�,,.�^
Date I c�
Approved by i
V i
FROM (TVE) 4 B 2018 14:37/ST. 14:38/14o.8000700850 P 7
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Town of Barnstable
o, Reg>t>Ilatory Services _-
4 Richard V. aii Interim Di
Sc
rector
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He
alth
l h DIVI
S 10 ]
Thomas McKean,Director
- --
_
200 Main Street,Hyannis,MA 02601,
Office: 508-86'-46 4
Fax: 508-790-6304
Installer& Desisiner Certification Forin
Date: Wiz_.,• Sewage Permit# _ Assessor's 1Iap1P;?reel` t — t
Designer: Installer:
Address: EAST 42 CAN`tRB S0*' Z§ress;-F v01 A, vSA HS� Ef75 02s�
..
Oil Was issued a permit to install a
(date) (in�tallcr)
septic slysten at t3ZC, - -,z� ! �' _based on a design di
a�tin b}-
(addres)
— s� _ _ s��az- dated Lj
(telesi;nerj
I certify that the septic system rcferenced above was installed substantially accordine to
the design, which may include minor approved changes such as lateral relocation of the
✓✓ distribution box and./or septic tank. Strip out (if required) was inspected and the soils
were round satisfactorv.
1 Gerd#v that the septic system refe:•enced above .vas installed x ith ma or changes (i.e. .
greater than 10' lateral relocation of the SAS or any vertical relocation of any component
of the septic system) bt:t in accordance with State k, Local Regulations. flan revision or
certified as-built bydesigner to follow. Strip out(if required)was inspected and the soils
\were !ound satisfactory.
_ I certify that the sy stern referenced above xv s constructed in compliance with the terms
of the 1\A approval letters (if•applical-)le) -
',`
i I—nstailer's Signature}
"#� •r i ;tit.., . 'S , � �' _ � - . '
"f 17t IJner S S1�Ilallire p
f Desi'finerner's Stamp-]tltFreJ`'�.-���
PLEASE RETURN TO BARNSTA.BLE PUBLIC HEALTH DIVISION. CERTIFICATE
OF C'OMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FWAI AND AS-
BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC REALTH DIVISION.
THANK YOU.
4 `- ej)E1C`:DtS1�r.erCuttificarion Fami Rev 3-14.13.doc
,tla '
Town of Barnstable >P
Department of Regulatory Services
Public Health Division on Date
t4gp. 200 Main Street, ola MA 02601
rill Ml► jj
Date Scheduled •
TfimB ' �j/�-6,,,
� . Fee Pd. l:oo---'
Sail •�
Suitability As esSment for Sewage isposal
Performed By:— !' �lr_�
wlmessea By:
LOCATION& GENERAL INFOR MATION
Location Address 1 3�
�✓ t�i�lvla-be,T Owner'eName
Addrest
Assessor's Map/Parcel: 8 — t'Z(o —avr_tz 1-AA'
Engineer's Name
NEW CONSTRUCTION ' Lr
• _� REPAIR
Telephonc.8 p -Z 3
Land Use �C�rc , f, i t Slopes(96) w.i
--�- Surface Slone9
Distances Rom: Open Water Body�l�p R possible Wet,Areu �t-'�•k
ft Drinking Water Well
Dniihage Way kr� _R property Line r
• �R Otlter. fc
SIMTCH:(Street name,dimensions of lot,exact locatlons of test holes&Pere tests,loeato wetlands 1'n proximity to holes '
)
8G`ci
y'Z/ e-17Z 0
N0. A
s` I! N
Parent matedal(geologic) Q
Depth to Bedrock
Depth to Groundwater. Standing Water In Hole:
_ Weeping 11'otn Pit Face
Estimated Seasonal High Groundwater
DETERMWATIO-NIFOR SEASONAL-$I WATER TABLE,
Used; —L�o � t.K 11!-k't" TC;�
Depth Observed standing In obs.hole:
DcA to weeping from side of obs.hole:
Reading Dato: In. Depth to troll 1noRlest
index Wetl�? In, Grnttndwater Acquat ---- !n,
- Index Well teVol • fit•
Aid.thetor. .�. _ Adj.Groundwater Level
Observation PE+RCOLATION TEST ]outs Z 'xtn�� ►i tc,
Hole IF
Time at 9"
Depth of Pere ^�AL 40 k "
Tlme'at G"
Start Pre-soak Time
• Timo(9"-G"
End Pre-soak
Rate Min./luch , ,L Z,_ lt1-t'd ►� L�. 'Irp,
Slte Sul lability Assessment: Site Passed 9itc Failed:
Additional Testing Needed(Y/N)
Original: Public Health Division. (� Observation Hole Data To Be Completed on Back
***If percolation test is to be conducted within 100° of wetland,you must first notify the
Darnstable Conservation Division at least one(1)weep;prior to beginning.
Q:\S EPTIC\PERCFORM.DOC
DEEP.OBSERVATION HOLE LOG Hole# i
Depthfrom Soil Horizon SoilTexture Sdil Color Soil. er
Surface(in.) (USDA) (Munsell) Mottling (Slucture,Stoner;Boulders.
CIE
1 to cy.96'(3ravc1l
CJ (c A 5\► \o�t� �Z
- Za LS
1=1 r-4
13Z G.. �. _ z•.'� Lr. l..00 Srz `�.�k`t7 �
VZ-
DFYP O SER• A$ V TION HOLE'LOG' Bole# -Z
Depth from Soil Horizon. Soil Texture Soil Color Soil Otl►or.
Surface(In,) (USDA) (Munsell) Mottling (9tructure,Stones,Boulders;
4 h-1 a Su
l-i t ! N Z,<- L W $ v
DEEP OBSERVATION HOLE LOG Hole#
Depth from Soil Horizon Soil Texture Soil Color Soil Olhor
Surfsee(lu.) (USDA) (Munsell) Mottling (Structure,Stoncs,Boulders.
Consistency- Oravoll
6 `Z L--`Z' lc `t Lt i cc�z�.t34.c�
_1 G SOPz 671 W
DEEP OBSERVATION HOLE LOG Hole# A
Depth from Soil Horizon Soil Texture Soil Color Soil . Other
Surface(in.) (U$DA) (Munsell) Mottling (Structure,Slopes;Boulder,
• j
s
flood Insurance Irate Map:
Above 500 year.f food boundary No_ Yes—
Within 500 year boundary No V!, Yes
Within 100 year flood boundary No-4z Yes,,
Depth of Naturally Occurring Pervious Materlal
Does at least four fetit of naturally occurring pervious material exist in all sl•eas observed thrpughout the
area proposed for the-soil absorption 4ytitem7 •
If not,what Is the depth of haturally occurring pervious malarial`?
Certification
I'cerdfy that on (date)I have passed the soil evaluator examination approved by the
Department of Environmental Protection and that the above analysis was performed by me consistent with .
the required training,exper a and experience described in�1 10 CMR 15.017.
Signature Datb
Q:\SBP'n0PBRCF0RM.D0C
�x l
i
a
i
TOP OF BLOCK SUPPORTS ±23.2' FINISHED GRADE EL. 17.I'± t- 12.83' COTUIT
7- 6» I I 6» 34 'T + -a-WAN- 2
•4a• 4 NICKERSON RD Q
Ill FIN15HED GRADE EL. 21.01± 58" TOPSAIL
atu
`��' - -- -- PROPOSED RISER 711TT I/&TO I/2"DOUBIr WASHED STONE @ 3"THICK OR GEOTMILE FABRIC PROPOSED LEACH TRENCH-END VIEW
j DWELLING INV. f��•5� RISER TWO R15M PER TRENCH NUMBER OF TRENCHES = ONE
(CRAWL SPACE) f'I$.S
1.F.WITH SCREW TYPE CAP TO WITHIN NUMBER OF UNITS PER TRENCH =TWO
-�-= FINISHED GRADE(ONE FM TRENCH) INSTALL TWO 500 GALLON UNITS
INVERT EL INVERT EL FINISHED GRADE EL. 19.5'-21.0'± WITH FOUR FEET OF DOUBLE WASHED ONE c j
g.30' GAS 18.Q5' INVERT E�. S'�m6` INVERT EL 1 III I 1 pllllllllllllilllll111l111I 6"IIIIIIIIII 1 111111/llll AT SIDES AND AT EACH END,
LOCUS
' Liquid Level 48 BAFFLE 17.7 .,. 17.5 r.-- g,5'
_
.;:•:; 0
5 NO ORK/OUT-
oo J�
INV. EL. a•• o- o_oo a
1 USE WIGGINS PRECAST DB-3 OR EQUAL _ d 1 EL. 15.17' I ��
r t 17.17' 3/4" - 1 1/2"
DOUBLE WASHED STONE �JO
j PROPOSED 1500 GALLON TANK DISTRIBUTION BOX NOTES: 25' _
INSTALL ON A LEVEL BASE Ui
(330 GPD @ 200%-USE 1500 GALLONS) PROPOSED CHAMBER TRENCH
MINIMUM WALL THICKNESS = 2" NUMBER OF TRENCHES = ONE LOCUS MAP
NUMBER OF UNITS PER TRENCH = TWO
MINIMUM IN51DE DIM. = 12" PLAN LEGEND
SEPTIC TANK NOTES: OUTLET INVERTS SHALL BE EQUAL TO EACH OTHER AND AT BOTTOM OF TEST PIT EL. 10.0'
NO GROUND WATER OR FEATURES ENCOUNTERED ORPHIC TIP ASSESSORS DATA:
1 TEES SHALL BE CONSTRUCTED OF SCHEDULE 40 PVC AND SHALL EXTEND A 2"MINIMUM BELOW INLET INVERT.
MINIMUM OF G"ABOVE THE FLOW LINE OF THE SEPTIC TANKS AND BE ON THE DISTRIBUTION LINES FROM THE DISTRIBUTION BOX SHALL SOIL TEST PIT MAP 16 PARCEL 12G
THE CENTERLINE OF THE SEPTIC TANKS LOCATED DIRECTLY UNDER THE ALL HAVE EQUAL INVERTS AS DETERMINED BY FLOODING THE
SYSTEM DESIGN DATA: W REPORTED DWELLING WATER LOCU5 ADDRESS:
j CLEAN-OUT MANHOLE. DISTRIBUTION BOX TO THE HEIGHT OF THE D15TR13LMON LINE THREE BEDROOMS= 3 x I 10 GPD = 330 GPD REQ. FLOW SERVICE LINE #1355 MAIN ST., COTUIT
ANY AT-GRADE COVERS USED SHALL BE SECURED TO INVERT AFTER ALL LINES HAVE BEEN SEALED IN PLACE. USE ONE CHAMBER TRENCH, 1 2.83'W x 251 x 2'EFF. DEPTH
SIDE WALL:(25+25+12.83+12.831 x 2.0= 151 SF ---._OWt- OVERHEAD WIRES
UNAUTHORIZED ACCESS. INVERT ADJUSTMENTS SHALL BE MADE BY FILLING WITH BOTTOM: 12.83 x 25 320 5F REFERENCE DEEDS: 28094-185
THE INLET PIPE ELEVATION SHALL BE NO LESS THAN 2"NOR MORE THAN 3" DURABLE AND NONDEFORMABLE MATERIAL PERMANENTLY 471 x 0.74 = 348 GPD TOTAL DESIGN FLOW PROVIDED G50-3G
1
FASTENED TO THE LINE OR RECONSTRUCTING THE LINES NO GARBAGE DISPOSAL ALLOWED `Q> UTILITY POLE
ABOVE THE INVERT ELEVATION OF THE OUTLET PIPE. ;REFERENCE PLAN: 309-22
i UNTIL ALL INVERTS ARE OF EQUAL ELEVATION.
THE SEPTIC TANKS SHALL BE INSTALLED LEVEL AND TRUE TO GRADE ON A LEVEL, ANY AT-GRADE COVERS SHALL BE 1'22-- EXISTING CONTOUR
SECURED TO UNAUTHORIZED ACCESS.
STABLE BASE THAT HAS BEEN MECHANICALLY COMPACTED AND ON WHICH N79° 1 4PROPOSED CONTOUR ZONING D15TRICT: RF
G"OF CRUSHED STONE HAS BEEN PLACED TO ENSURE STABILITY AND 40"(�/
TO PREVENT SETTLING. 96' +22.4 EXISTING SPOT GRADE OVERLAY DISTRICTS: AP � RPOD
V6 PROP05ED 5.A.S.
/^ CHAMBER TRENCH += PROPOSED SPOT GRADE FEMA DATA: ZONE "X" (NON-HAZARD)
1 THE SEPTIC TANK5 SHALL HAVE A MINIMUM COVER OF 12",WITH TWO
20"MANHOLES HAVING READILY REMOVABLE `�
IMPERMEABLE COVERS _ - '� N79° /T PROPOSED MAP: 25001 C0752J
OF DURABLE MATERIAL PROVIDED WITH ACCESS PORTS. `14� R\ 29/i80�'W 1500 GALLON MAP EFF. DATE: JULY I G, 2014
18 EXISTING CESSPOOLS
THE TANKS OUTLET TEE SHALL BE EQUIPPED WITH A GAS BAFFLE.
S6/og/ \ �„ j 9•0 BASEMENT TO BE ABANDONED
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BM:SILL EL. 24.3 TEST DATE:09-24-15 p ��. ;/i N ;�� L� /
/ / / DATUM: NAVD88
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\\ �' // // 501L EVALUATOR:5.DOYLE(ON95) .// `�� `Ilk, `"%, \��. \ / .0^ -,co
501L /- 12 WITNE55ED BY:DAVID STANTON,IRS ^/ �� 6 . � 1 ryry °
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/ EL.21.a EL.21.O' -26- `�'�__ '-`��`_-- -�- ! 166 SEPTIC UPGRADE PLAN
0.
- - - - NG-10-4 P 30"W / " A 5L I OYR 2/2 A 5L I OYK 2/2 � <�/b�C �y � /�/ � � ; PREPARED FOR
-14 10.2G'
Bw L5 1 OYR 4/G Bw L5 I OYR 4/6 �`�� v ;/ i N �' # 1355 MAIN 5TREET
�CV EXISTING i N `; %!
28" EL_ 18.G 28" EL 18.6' DWELLING
c FINE / , � ! / COTUIT-BARNSTABLE, MASSACHUSETTS
Rcaa c
snip i DATE: NOVEMBER 21 , 2015
SAND
O j /Y17.4 /
2.5Y 6/6 2.5Y G/6
SCALE: 1" = 30'
S6 O .,3 / '/ i 32" EL I O.a 132" EL I O.O'
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GENERAL NOTES: Orr ZO' i NO GROUND WATER OR NO GROUND WATEROR \ / /
F ZZi/ REDOXIMORPHIC FEATURES OBSERVED REDOXIMORPHIC FEATURES 1055ERVED !
� / 0 30 gp PLAN.REVISIONS:
1. ALL THE WORKMANSHIP AND MATERIALS SHALL CONFORM TO DEP / % i Feet
TITLE V AND THE TOWN OF BARNSTABLE RULES AND REGULATIONS
SCALE: 1" 30'
FOR THE SUBSURFACE DISPOSAL OF SEWAGE. k- TP3 =
2.ACCE55 PORTS OVER TANK TEES SHALL BE ACCE55113LE WITHIN 6" / 2 PERC RATE<2 WI-C LAYER TF4
Of FINISHED GRADE. EL. 21.0 EL. 2I.a
3.ALL COMPONENTS OF THE SANITARY SYSTEM SHALL BE CAPABLE OF 9.THE EXCAVATOWCONTRACTOR SHALL BE RESPONSIBLE TO CONTACT DOYLE 0" O"
WITHSTANDING H-10 LOADING UNLESS OTHERWISE NOTED.
AND ASSOCIATES 24 HOURS PRIOR TO ANY REQUIRED INSPECTIONS. G. A St_ IOYR 2/2 6" A 5L ®p a�e� ,
4. THE EXCAVATOWCONTRACTOR SHALL CALL"DIG SAFE'AND VERIFY THE LOCATION 10. ALL COMPONENTS SHALL BE MARKED WITH MAGNETIC TAPE OR ��H 8F�r4�+ ►D �N nF nj�)SS���
OF 517E UTfL1TtES PRIOR TO ANY EXCAVATION, AND SHALL BE RESPONSIBLE FOR Bw L5 I OYR 4/G Bw Ls �
COMPARABLE MEANS IN ORDER TO LOCATE THEM ONCE BURIED. Z DAVID
ALL MATTERS RELATING TO ELECTRIC AND/OR GAS EASEMENTS- 28" EL 18.6' 28" EL. 18.6' 4
j I I.WHERE A WATER SERVICE LINE IS LOCATED LESS THAN TEN FEET � B vy -' STEPHEN
j. 10,
5.SEWER PIPES SHALL 13E SCHEDULE 40 PVC (4"DIA. UNLE55 OTHERWISE NOTED) FROM ANY SYSTEM COMPONENT OR CRO55E5 A SEWER LINE,SAID MASON m 4 ,
o .., DOYLE � 5TEPHEN DOYLE AND A550CIATE5
G. ANY MASONRY UNITS USED TO BRING COVERS TO GRADE SHALL BE WATER SERVICE LINE SHALL BE SLEEVED IN PVC. C FINE ��� C FINE J p NO.1066 a NO.37559 42 CANTER13URY LANE
MORTARED IN PLACE. 12.ANY AT-GRADE COVERS SHALL BE SECURED TO UNAUTHORIZED ACCESS. SAND 2.5Y G/6 SAND 2.5Y GIG �O� A l�°F Ss�o�`� �:` EAST FALMOUTH, MA55ACHU5E75 0253G
1 7. FIN15H GRADE SHALL HAVE A MINIMUM SLOPE OF 0.02 FT. PER FOOT.
q� D`'�'✓� f'I'v� ' TELEPHONE: 508 540-2534
8. EXISTING SYSTEM COMPONENTS-IF ANY-SHALL BE ABANDONED PER EL. 10.0 EL. 10.0'
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TITLE 5 REQUIREMENTS.
NO GROUND WATER OR NO GROUND WATER OR
{ REDOXIMORPHIC FEATURES OBSERVED R.EDOXIMORPHIC FEATURES OBSERVED
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