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Home My WebLink About0033 MARINER CIRCLE - Health 33 Mariner Circle Cotuit A = 023 043 3, i 1. i r Commonwealth of Massachusetts F Title 5- Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ti 33 Mariner Circle Property Address ; Carayannopoulos r' Owner's Name Cotuit ✓ MA 02635 8/13/15 City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. A. General Information 1. Inspector: Frank Nunes III Name of Inspector saa Company Name Box 841 Company Address East Falmouth MA 02536 City/Town State Zip Code 508.272.6433 Telephone Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000).The system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority 8/13/15 Inspe Sur Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. 33 Mariner Circle•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal Sy�emPogal�of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 33 Mariner Circle Property Address Carayannopoulos Owner's Name Cotuit MA 02635 8/13/15 Cityrrown State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: Pumping suggested every 3 yrs to prolong the life of the system B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Answer yes, no or not determined (Y, N, ND) in the ❑for the following statements. If"not determined," please explain. ❑ The septic tank is metal and over 20 years old*or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND Explain: n/a ❑ 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 33 Mariner Circle•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 33 Mariner Circle Property Address Carayannopoulos Owner's Name Cotuit MA 02635 8/13/15 Cityrrown State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes (cont.): ❑ distribution box is leveled or replaced ND Explain: 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 Board of Health): ❑ broken pipe(s) are replaced ❑ obstruction is removed ND Explain: n/a C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. 33 Mariner Circle•03108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 33 Mariner Circle Property Address Carayannopoulos Owner's Name Cotuit MA 02635 8/13/15 Cityrrown State Zip Code Date of Inspection B. Certification (cont.) C) Further Evaluation is Required by the Board of Health (cont.): ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: n/a D) 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 ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than %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. 33 Mariner Circle-03108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 33 Mariner Circle Property Address Carayannopoulos Owner's Name Cotuit MA 02635 8/13/15 Citylrown State Zip Code Date of Inspection B. Certification (cont.) D) System Failure Criteria Applicable to All Systems (cont.): Yes No ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes"or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA)or a mapped Zone II of a public water supply well If you have answered "yes"to any question in Section E the system is considered a significant threat, or answered"yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 33 Mariner Cirde•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Fora Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 33 Mariner Circle Property Address Carayannopoulos Owner's Name Cotuit MA 02635 8/13/15 Cityrrown State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes" or"no"as to each of the following: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ❑ ® Has the system received normal flows in the previous two week period? ❑ ® 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 ® El 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? ® ❑ 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) [310 CMR 15.302(5)] 33 Mariner circle-03108 Title 5 official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 15 Commonwealth of Massachusetts - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 5 33 Mariner Circle Property Address Carayannopoulos Owners Name Cotuit MA 02635 8/13/15 Cityrrown State Zip Code Date of Inspection D. System Information Residential Flow Conditions: Number of bedrooms(design): 3 Number of bedrooms (actual): 3 DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): 330 Number of current residents: 0 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes ® No Laundry system inspected? ❑ Yes ® No Seasonaluse? ❑ Yes ® No Water meter readings, if available(last 2 years usage (gpd)): Sump pump? ❑ Yes ® No Last date of occupancy: 5/1/15 Date Commercial/Industrial Flow Conditions: Type of Establishment: n/a 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 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): n/a 33 Mariner Circle•03108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 33 Mariner Circle Property Address Carayannopoulos Owner's Name Cotuit MA 02635 8/13/15 Cityrrown State Zip Code Date of Inspection D. System Information (cont.) General Information Pumping Records: Source of information: No recent pumping per owner Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ 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: Original Septic Tank per age of the home and new D-Box and leach Chambers 2003 per BOH record Were sewage odors detected when arriving at the site? ❑ Yes ® No 33 Mariner Circle•03108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 15 i Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �M 33 Mariner Circle Property Address Carayannopoulos Owner's Name Cotuit MA 02635 8/13/15 CityTrown State Zip Code Date of Inspection D. System Information (cont.) Building Sewer(locate on site plan): Depth below grade: 18"feet Material of construction: ❑ cast iron ®40 PVC ❑ other(explain): Distance from private water supply well or suction line: >10'feet Comments(on condition of joints, venting, evidence of leakage, etc.): Septic Tank(locate on site plan): Depth below grade: 12"feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) compartment style tank If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No -------------------------------------------------------------------------------------------------------------------------- Dimensions: 1000g Sludge depth: 4" Distance from top of sludge to bottom of outlet tee or baffle >12 Scum thickness trace-1/2" >211 Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle >2" How were dimensions determined? Measured 33 Mariner Circle•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 33 Mariner Circle Property Address Carayannopoulos Owner's Name Cotuit MA 02635 8/13/15 Cityfrown State Zip Code Date of Inspection D. System Information (cont.) Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Pumping suggested every 3 yrs to prolong the life of the system Grease Trap(locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): n/a 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.): n/a 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): n/a 33 Mariner Circle•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments GSM , 33 Mariner Circle Property Address Carayannopoulos Owner's Name Cotuit MA 02635 8/13/15 City/Town State Zip Code Date of Inspection D. System Information (cont.) Tight or Holding Tank(cont.) Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments(condition of alarm and float switches, etc.): n/a *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 0" Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): No adverse conditions Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No 33 Mariner Circle•03108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 15 Commonwealth of Massachusetts . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 33 Mariner Circle Property Address Carayannopoulos Owner's Name Cotuit MA 02635 8/13/15 Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.): n/a 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: Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Chambers were video inspected and were dry at the time of inspection, no indication of past backup 33 Mariner Circle•03108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 33 Mariner Circle Property Address Carayannopoulos Owners Name Cotuit MA 02635 8/13/15 Citylrown State Zip Code Date of Inspection D. System Information (cont.) 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.): 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.): n/a 33 Mariner Circle-03108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 15 Commonwealth of Massachusetts - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 33 Mariner Circle Property Address Carayannopoulos Owner's Name Cotuit MA 02635 8/13/15 Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 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. QA ' a q'� C0 O q 33 Mariner Circle•03108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 15 t a Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 33 Mariner Circle Property Address Carayannopoulos Owner's Name Cotuit MA 02635 8/13/15 Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to high ground water: >12'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 ❑ 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: Per elevation of home 33 Mariner Circle•03108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 15 r TOWN OF BARNSTABLE i / SEWAGE # -012 3-1%� LOCATION -7e--�—'`!��`� � ASSESSOR'S MAP & LOT VILLAGE22 i INSTALLER'S NAME&PHONE N0. �D SEPTIC TANK CAPACITY LEACHING FACII,rN: (type) 'SOD �,l (size) NO.OF BEDROOMS BUILDER OR OWNER y_ Q 0 /fir 0 PERMITDATE: 1L COMPLIANCE DATE: Separation Distance Between the: Feet Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Private Water Supply Well and Leaching Facility (If any wells exist Feet on site or within 200 feet of leaching facility) exist Edge of Wetland and Leaching Facility(If any Feet within 300 feet of leaching facility) Furnished by I I i t i � y } TOWN OF B/ARNS'a ABLE :.O :A 1 ON SEWAGE # 2003-37E Y1 ..AGE ASSESSOR'S MAP & LOT 1.3 — y3 INSTALLER'S NAME&PHONE NO. �'D�- S'28"�/71Z Jo.S p� 0,f SEY'17IC TANK CAPACITY /000 LEACHING FACILITY: (type) 2-S'OOe (size) _ SJ X l-5 NO. OF BEDROOMS 3 BUILDER OR OWNER `YIr. Il/9Q6 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 ffacilility) Feet Furnished by_c � 4: P �7W9 2�3r 3?p No. � Fee_� THE COMMONWEALTH OF MASSACHUSMS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS 01pplitation for Zig oal *pztem Construction Permit Application for a Permit to Construct( Repair( )Upgrade( )Abandon( ) El Complete System ❑Individual Components Location Address or Lot No. % j (/1�I��"i�'J L6� C(�ne �y Owner's Name,Address and T 1�No. � Assessor'sMap/Parcel GBtVj �r�4�l�his ��J9C3lf� Installer's Name,Address,and Tel.No..5'09—Y 0— T y.7-F Designer's 11f.,Address T, No. Type of Building: Dwelling No.of Bedrooms _ Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer hen applicable) Zoak Q—,5-aa VGA/ Z__ C.d1 y .s to0)zf &roZ`r 2 PA-W 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 Certifi- cate of Compliance has been issued by this Board o Heal . Signed Date Application Approved by Date Application Disapproved for the ollowing reasons Permit No. Z�0 3�3� Date Issued e rnp / 6 t A...,.. 3 Fee J ' THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes ._PUBLIC HEALTH DIVISION 'TOWN OF BARNSTABLE., MASSACHUSETTS ricatit fo g o.5al stem Construction Permit Application for a Permit to Construct( Repair( )Upgrade( )Abandon'( ) ❑Complete System ❑Individual Components Location Address or Lot No. 3 3 k0i4/^I h L—;V Ct"4 4: Owner's Name,Address and Tel.No. Assessor's Map/Parcel G(l ✓' -V /1/ ✓ /s/- c% G/// a ,f3' /'/^ 1�?l� Installer's Name,Address,and Tel.No. f4:79—4124- 9y30 Designer's r4me,Address and Tel No. Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) t Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures I Design Flow gallons per day. Calcul ted daily flow gallons. kp Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. t+ Description of Soil Nature of Repairs or Alterations(Answer hen applicable);�,5rry// — S UO 60/ L/F,06GJ 6� *r9 Date last inspected: 1 Agreement: - The undersigned agrees to ensure.the constructiorvand 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 operationuntil a Certifi- cate of Compliance has been iss �thisoar d o Heal h. - Sig ued b Signed Date t^' Application Approved by _ S Date Application Disapproved for the following reasons - f Permit No. 2-P0 3-37? Date Issued �" 3 ------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS (Certificate of Compliance THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed(4- Repaired ( )Upgraded( ) Abandoned( )by ,Zas,-.ol 12- d-w-s-as at �l'I/ �1/'l%/P /i^G�k /P��t/i/r has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. 2003-3 7 V dated U? Installer )OSeA04 ,& I '.4zYl�'/1 Designer 3 ,t24, /,WOVr' The issuance of this permit shall not be construed as a guarantee that the system ' c Date/q- da Inspector No. 2U� 3 3��. --------------------------Fee ,,wryw••--- THE COMMONWEALTH OF MASSACHUSETTS i`. PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS 'Wi5po5al *potem ConfStruction Permit Permission is hereby granted to Construct( )Repair( 44Upgrade( ),Abandon( ) - System located at rle ^r Go Tyr 1"' 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. Provided:Construction must be completed within three years of the date of this Date:_ �" �- O 3 Approved by � w o A 33� t -ws .o 4�!CA5T Foy C a o rj LOT- 3 g LOT 3 o o U3 Le � u J f31a PLAN SNOWING. FOUNDATION z �. ..�-13 LOCATION G,OT UI T, MASSACHUSE T T S x ' VV-�, OWNED 8Y: �, _ 30, / SCALE: DATE: geP't' NORMAN GROSSMAN------ REGISTERED LAND SURVEYOR ! HEREBY CERTIFY THAT THIS FOUNDATION IS LOCATED ON 77HE LOT AS SHOWN AND CONFORMS TO THE TOWN i OF BARNSTABLE ZONING REGULATIONS REGARDING It SETBACKS FROM STREET LINES AND LOT LINES . NORMAN GROSSMAN R.L. S. DATE �^�` No........ . ........... Fimim ... THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF H ALTH QUJ ................OF........ ...................... Appliration for Disposal Works Tontrnrtion jbrmit Application is hereby made for a Permit to Construct ( or Repair ( ) an Individual Sewage Disposal •-�- System at: �L�..�1.., !� Location r rL o- Lot No. .... ...... ....... n /........._..._ s ------------_-.------------- Installer Address d Type of Building � Size Lot_IJD�d_Z��.._..Sq. feet Dwelling—No. of Bedrooms............ .......................Expansion Attic ( ) Garbage Grinder ( ) '4 Other—T e of Building a —Type g ......... .... No, of persons_._.................... Showers ( ) — Cafeteria ( ) d Other fixtures - - W Design Flow............... .................._._gallons per person per day. Total daily flow__.._...................... p......_........__..gallons. WSeptic Tank—Liquid'capacity./400--gallons Le �.n gth................ Width................ Diameter---------------- Depth................ x Disposal Trench—No..................... Width.10 ........ Total Length..., .._.....� ..Total leaching area...... q. ft. Seepage Pit No............. ....... Diameter......, '"_..._. Depth below inlet....... ...... Total leaching area..`®_........sq. ft. Z Other Distribution box (' ) Dosing to ( ) ,+ e3 '-' Percolation Test Results Performed by �'t✓ _1✓..... ------ Date----.1..� 3 =�„l ... Test Pit No. I----------------minutes per inch Depth of Test Pit.................... Depth to ground water.- f� Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water-- _.._.__..__......._. .........1--.....! -•-•....................•----•---•-•-••-.......------.........•--••--•---..._....._.......................---------•••-•••-••-•-••---- ODescription of Soil....6----- ...... ......... .................................................................:................................................. .---c ----------- •.. ............••••----•--•---•-••--•-----•-•---••-----•----------•-•-•••-------------•--.--------------------------- x ---------------------------------30.7/y�-- ---- - -------------------------------------------------------......----------------...................... U Nature of Repairs or Alterations—Answer when applicable............................................................................................... -----------•...................................•........•••. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITL% 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been 'ssued by the b rd of health. Sig -. ��= ......c � D to APPlication Approved By....... ..-` ...... -- -�!.. - Date Application Disapproved for the following reasons: -------------------------- •••-----•••-----•--•••---•••----------------•---------•--•--••--------•-..........---..........-----•---•-••------------=----•------••-•-•-•-•-•-•---------••----••-•--•-----------•------•------------ Date PermitNo.......................................................... Issued-....................................................... Date N . _d. ------ Fss 34a............. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH l � 1�................OF...... �!�!.....:d..:..... ._...... Appfirtttion for Disposal Works Toustrurtion Prrmit Application is hereby made for a Permit to Construct (X) or Repair ( ) an Individual Sewage Disposal System at: Alex ,L I.l / Location-Address o t J r,Lo No. .....................t. tom. r .. C !1.... c' ` `✓!� --...-- - . ...... .......... ..... .............................. -^�,� L..P.;:iisY1AU dyre s- Installer Address UType of Building -2 Size Lot.: ..�6�....__..Sq. feet -� Dwelling—No. of Bedrooms............. -------Expansion Attic ( ) Garbage Grinder ( ) 04 Other—Type of Building /� �' l e�`i p,l yp g ..................2/---•- No. of persons.._.... ................ Showers ( ) — Cafeteria ( ) dOther fixtures..-----•.................•......-- . --------•----•----------=-----•---•--------...------------•-----•-----..•-........---•----............-- W Design Flow...............5.5......._._._..0--___gallons per person per day. Total daily flow............3 3 ....................gallons. (x Septic Tank—Liquid*capacity./-�-•�...gallons Length................ Width................ Diameter---------------- Depth................ Disposal Trench—No.•................... Width'A2 Total Length___. �....... Total leaching area_._..<<_e,-�q. ft. Seepage Pit No._-_-_.-___.�__-__-- Diameter......./._........ Depth below inlet.._........._..... Total leaching area.."�........__._Sq. ft. Z Other Distribution box ( / ) Dosing tank (, ) �- a Percolation Test Results Performed by._--_-__�L��U??:L�IC.:� A— .Date....r�.. ....»...._...... Test Pit No. I................mmutes per inch Depth of Test Pit.................... Depth to ground water.__...✓.%!_..!__ }f 44 Test Pit No. 2................minutes per inch Depth of Test Pit..............._.... Depth to ground water.._. .:.('.......... x •---------------------------------------•.....----------.....-----------........._._.................................................................. O Description of Soil....jj ...:__(I ___._. <<.f'/� x V ......•.. ......-•-•--............... ------------- •------------ .................................................. ................................................. ---------------- ------. ------•. -----•••-••------------------•---------------.._..-••••-------------•••---••-------------------•--•-••---------•--•---- ,;u Nature of Repairs or Alterations—Answer when applicable............................................................................................... ...-----_--•-•••-•.._...---•-•••-------•---•••-•------•---•-•---------------•-••••••••••-•••---•--...._.._.....--•• Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TIT I-E5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. Signed..�!Z'- "'- -� i�/G %/. //--9__ t ----- �j�,.� Date Application Approved BY-----. G . •- g''' -------• +1 Date Application Disapproved for the following reasons:............................--•-----................................. ....................................... •••••••-------•.........................••...---•---•--•----•-----•-•-•--....•----•--..:--•---•---•••••--••--••••-•-••--•••••---•---------•----•--••-••------------•--•------•-----•-----••---...------ Date PermitNo...................................................... Issued--•------------••---------------•--•--- .....--------.. •--------------------•--- Date a THE COMMONWEALTH OF MASSACHUSETTS _ BOARD bF HEALTH C O F....: ..... ' Tntifirtttr of Tuntplianrr THIS IS TO CER.TLFY,}That th4ZII�ndividual Sewage Disposal System constructed (, ' or Repaired ( ) C t' /t �C.�t �------- -- ---------- --- • e'j Xt, f / Installer -'at................... ..... ------•.......-•--------•--•---•-----�-•----•--------------- -------' " ' � - has been installed in accordance with the provisions of T F 5 of The StatelSanitary Code as described in the application for Disposal Works Construction Permit N ___SE _.... ............... dated........ ............ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE-----•---------..................7/..... ,l...r?,........................ Inspector--- ........................................................... { THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH OF ........ .......... .................... nn Disposal Works Tono#rurtuln rrntit Permission is hereby granted----•rid U e7 / I - � -----._Zf1.:......................................................... >r�o Construct ( ) or Repair ( ) an Individual�Sewage Disposal. stem y� --- ..... - ...'•• �` Street as'shown on the application for Disposal Works Construction Permi Board eaA lth DATE......./.m?.mP.en - 1......................................... FORM 1255 HOBBS & WARREN, INC., PUBLISHERS ` : �c -J 10 SEWAGE PERMIT NO. so VILLAGE Ad— INS IIER NA E i ADDRESS oc. ME- ROIL ER 0 0 NER DATE PERMIT ISSUED DATE COMPLIANCE ISSUED 5- S-9/ r 3� si 37 TOP OF FOUNDAT ON EL /C)n . 5S' T A ATDA RD NOTES GROUND SURFACE EL,_1 '—C'__ GROUND SURFACE AL___'�` -o_ " MIN 1) THIS PLAN IS FOR THE INSTALLATION OF A SEPTIC SYSTEN). �"IsTIA L i" OUTLET PIPE LEVEL 2) ALL INSTALLATION PROCEDURES AND MATERIALS SHALL CONFORM TO 310 CMR 15 ooa 71,6 5f ,WRONMENTAL CODE, FIRST TWO 1E'EF ' do VENT REQUIRED �'� '---�_ 3 1D •ti TOP EL TITLE 5, AND THE TOWN OY _L�1Q� ____ SUBSURFACE DISPOSAL REGULATIONS aJ LIQUID T,FVFI 3) NO DETERMINATION HAS BEEN MADE AS TO COMPLIANCE OF A VA-RAME PROPERTY INFORMATION WITH RECORDED DEEDS MIN 2' LAYER DOUBLE WASHED v 10" -BOX lie•- ii2' STl7NE OR ZONING REGULATIONS. INVERT EL 14 a Z K ' ' 4) TORN WATER SERVICES THIS PROPERTY. /5 EFFECTIVE p)0 D GAS BAFFLE AT 0UTMET INVERT EL B„ , B °�5 ♦ , h`` "` �- "' """ ' "" ` �` SIDEWALL 5) THERE ARE NO KNOWN PRIVATE WELLS ON THIS PROPERTY OR WITHIN j Q' OF THE PROPOSED SOIL ABSORPTION SYSTEM. INVERT EL INVERT EL 6) ALL COVERS OF SYSTEM COMPONENTS SHALL BE BROUGHT TO WITHIN 12" OF FINISHED GRADE, WITH O_ E COVER OF THE Q(n ►O D _ Box L,7wo SEPTIC TANK BROUGHT WITHIN 6" OF GRADE. INVERT EL 3�4'- 1 1/2' DOUBLE 6" STONE BASE' (7'yptcal} INVERT EL (fP11,W1)3e!1-s Cs ►-�r�"�'� WASHED STONE 7) ALL SYSTEM COMPONENTS SHALL REMAIN ACCESSIBLE FOR LVSPECTION. NO STRUCTURES SHALL BE LOCATED DIRECTLY /,000 Gel Septic Tank � BOTTOM EL UPON OR ABOVE THE COMPONENT ACCESS LOCATIONS, WHICH WOULD INTERFERE WITH THE PERFORMANCE, ACCESS, INSPECTION �T3'p ) PUMPING OR REPAID ical � r L - O i �x 15�JAI`'l I I a I EL 4'S�1,O 8) NO DRIVEWAY, , ,r PARJUNG OR TURNING AREA OR OTHER IMPERVIOUS AREA SHALL BE LOCATED ABOVE A SOIL ABSORPTION < I BOTTOM OF TEST HOLE SYSTEM, EXCEPT WHEN VENTING HAS BEEN PROVIDED. R 9) SEPTIC TANKS, GREASE TRAPS, DOSING CHAMBERS AND DISTRIBUTION BOXES SHALL BE PLACED ON A 6" STONE BASE I TO ENSURE STABILITY AND PREVENT SETTLING. 10) OUTLET DISTRIBUTION LINES SHALL REMAIN LEVEL FOR A MINIMUM OF THE FIRST TWO FEET OF THEIR LENGTH. 11) ALL SYSTEM COMPONENTS SHALL BE CAPABLE OF WITHSTANDING H-10 LOADING UNLESS THEY ARE UNDER OR WITHIN 10' OF DRIVEWAYS OR PARKING OR TURNING AREAS, IN WHICH CASE H-20 COMPONENTS SHALL BE USED. EXCAVATION NOTES 12) ALL BUILDING SEWER LINES SHALL HAVE AN INNER DIAMETER OF 4" AND SHALL BE CAST-IRON OR SCHEDULE 40 PVC. I) EXCAVATE ALL MATERUL ABOM SOIL HORYON C (SGE DEEP 0B9ERVA77ON 13) THE DEPTH OF THE TOP OF ALL SYSTEM COMPONENTS SHALL NOT EXCEED 36" UNLESS VENTING HAS BEEN PROVIDED. / HOLE LOG) AT APPROXIMATE ELEVAT70N FOR A LATERAL DISTANCE OF 5' �CNP / (nMRE POSSIBLE) QV ALL DMECTIONS BEYOND THE OUTER PERIME= OF THE LEACHING AREA 14) IN THE AREAS OF EXCAVATION, EXISTING GRADES SHALL BE REESTABLISHED UNLESS NOTED AS PROPOSED CONTOURS 2) FILL MATERNAL SHALL CONSIST OF CLEAN GRANULAR SAND, TRKE FROM ORGANIC MATTER AND OTHER DELZs'7'ERIOUS SU3STANCE:9 A7i1CH MEETS THE' TEXTURAL 15) T SOILS ARE ENCOUNTERED DARING THE EXCAVATION OF THE SOIL ABSORPTION SYSTEM, THAT DIFFER NOTABLY FROM / ENGINEER BEFORE PROCEEDING. / \\ cRrrERIA PUT FYDR7N L4•.SECTION 16.,25s(s) OF ?17ZE' s. THE DEEP OBSERVATION HOLE LOG CONTACT THE, / \ \ S) SCARIFY THE BOrMN SURrAGE OF THE EXCAV.47?ON PRIOR TO PLACEMENT 16) CONTRACTOR TO VERIFY LOCATION OF ALL UNDERGROUND UTILITIES. • / / • , OF FILL INM THE RETAIMNG STRUCTURE 04 \ 4) PLACE FILL ONLY WHEN BOT7i7M SGRFACE IS DRY. / �� wt�_. DESIGN DA TA DEEP OBSERVATION. PROPOSED LEACHING FACILITY Number of Bedrooms: \ � HOLE LOG Two 4. 6' x 8. 5' x �' deep Garbage Grinder: NO (EL Hole #1 0 oQ �, concrete chambers (or. similar Design Flow: '3>0 eo` 3oi1 � sou, ou \ , \ \ w7 th 4 stone g Nr T`rt� Horizon �� &111 \ d, `3 (Total Area = 05' x 1R. 6) (110 Gal/BR/Day x Number of BR) , (�, CC�R7 �.�eptic. Tank: ► , �o Prop -z� ��,o f oA �`�M� ��r�� y / (Minimum = Design Flow x 200%) f� � �,oA �o GQ+� \ D—Box �� 2�"- q3,s d rke $ 5� Leaching Area: �4 �oY� �Ga 1� y1 o. '� 60PasK� z,5Y'/q Z°/ 6C4v�.� �. 1 5idewall: ` (, 5� Ex G ✓!�'t•,®�,� (Z Sidewalls x 1 _Ft x 'Z''—Ft) + �- Deep oba Hole Date: \ Soil Evaluator. e0* \ ��_____ 33 �� .1 � �"C� T'1 5 ( Z. Endwalls x ( '�_Ft x __-_'Ft) Witnessed By: Err✓ s�vM� Pero Rate: Bottom: Soil survey Description: E :b, I `1 CARVER �. �, 2 , Geologic Material- OU77ASH y i Exist - _ 5_ x L`�2�`t) H p g 1 000 Gal , J Depth to Weeping hater. rJ y Depth to Standin Water, N �'1,a� S-Tank Jl ! Depth to xottling(color). NA Long Term Acceptance Rate (LIAR): 0. 74 PIP �0\' l . Est Seasonal High GW: NA.' '• \ USGS Observation Well: NA �� Leaching Area Design Capacity: 3 `{`� Date or last Measurement NA Pump and fill existing �" I comments. \ leach pit as required t 1� ��' (Sidewall Area + Bottom Area) x LTAR Goo Q 4 `, r 1y 0l� lob •1 �� tiM 0� w►ridw sp t ^1' (� PROJECT LOCATION �j ►'� A P�..i �l �'-R- G�--�t,-- ASSESSORS MAP LOT 4` APPLICANT d �t5�� 11. ��---- ✓vl c its y M &i i"e, CS ( tv"� / �► QI � 0 Ir 17 s� 5� PREPARED BY A & M Land Services 15 Sunset Drive South Yarmouth, MA 00664 (508) 394-2723 SCALE / = zv DATE / ��o i LOCUS MAP REV. 3 r z MA z u DWG. NO. 3 o SHEET 1 OF - !"I"llp III I - '----7�� '�' .-- �t,, �!� ""� - �" - - I-I�� " ""i, " i-- � � .......i,�� I 11� - �'-, ,,�;�-"" , �, , - -, I - .. '� ",.Y.T"-:---1 7,,, I :-'�`�'ii,I - --- --- - , I I 11,�I I I I � I �;� .'I I -i � ' , '."' " ,� � I , , � -1 ,. 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