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HomeMy WebLinkAbout0071 MARINER CIRCLE - Health r ]. Mar,iners Circle r Cotuit 1A= 023 — 046 1 w TOWN OF BARNSTABLE N G 1) �Z LOCATIO 1 tACxt1e�— �ir�\Q SEWAGE# / 09 Y 'i �ILLAGE CoTu t 1— ASSESSOR'S MAP&PARCEL 02_3 a�L INSTALLER'S NAME&PHONE NO. MIRNt4q RNQStp,_� �aa'93I SEPTIC TANK CAPACITY Q\ CE,4 LEACHING FACILITY:(type) __ e\�\(size) oZ(o NO.OF BEDROOMS OWNER PERMIT DATE: (a� COMPLIANCE DATE: f5l IL, tog Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility 5 Feet Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) A Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet FURNISHED BY �-ronk,.s a�T 33 �,, E I "fOW I'OF b'ARNSTABLE LOCATION d f a SEWAGE # 'VILLAGE ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY AX LEACHING FACILITY: (type) ��-�s'Stg (size) /*M NO.OF BEDROOMS --� ; BUILDER OR OWNER PERMITDATE: COMPLIANCE DATE: 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 fe o711 '"chi facility�j Feet Furnished by 0 7/ A4 lAleoc C fie, i2fNo. v ✓3 Fee (��//�� THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS es Applic tion for Migont *pgtem Con0tructiun permit Application for a Permit to Construct( ) Repaix Upgrade( ) Abandon.( ) ❑ Complete System Individual Components Location Address or Lot No. I+i 1 �"%r o_< CXK-ow, Owner's Name,Address;and Tel.No. Assessor's Map/Parcel ���l T Installer's Name,Address,and Tel.No. 9 2)10 Designer's Name,Address and Tel.No. Type of Building: Dwelling No.of Bedrooms Lot Size OOU sq. ft. Garbage Grinder (h�/h Other Type of Building N No.of Persons �- Showers Cafeteria( ) Other Fixtures La uc..�Z�i�+ k t�C Yy r, S IV71c Design Flow(min.required) ��� gpd Design flow provided 3(08.aS gpd Plan Date ; YS i ('� Number of sheets Revision Date Title �� Size of,Septic Tank ` 1`jD0 G(k Type of S.A.S. Description of Soil o14 - 04N Nature of Repairs or Alterations(Answer when applicable) �CA-) 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 tIIi§Board of th. r Signed --� Date Application Approved by �- Date Application Disapproved by: Date for the following reasons Permit No. O`*0 — Date Issued L �r �� i •} ./' Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN,OF BARNSTABLE, MASSACHUSETTS Yes ZIP lication for Dig'po.5at A*pgtern Construction Permit I A lication for a Permit to Construct Re air k� j ade a Abandon �,��,.�' I.- Application O p r,( )+ Upg O O ❑.Complete SystemA"l•J,ndividual Components Location Address or Lot No. 1 C 11`2< C K-6-e Owner's Name,Address;and TeL•No. -Assessor's Map/Parcel Ala Installer's Name,Address,and Tel.No. 9��,-�y j C) Designer's Name,Address and Tel.No. v Type of Building: Dwelling No.of Bedrooms �✓ Lot Size sq. ft. Garbage Grinder (OA Other Type of Building (11) P+ No.of Persons - Showers( y) Cafeteria( y) Other Fixtures t) Design Flow(min.re uired) 3 a>0 gpd Design flow provided 3ufl .a s gpd ��•• _ ;Flan Date �? oc1 Number of sheets Revision Date Title Size of_Septic Tank , utc) �,CN0A Type of S.A.S. Ic Description of Soil oZy - p Y­Q�� Nature of Repairs or Alterations(Answer when applicable) An C_\�) Date last inspected: .Agreement: The undersigned agrees to ensure the construction and maintenance of the afar" described on-site sewage disposal syste>�►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. I f Signed �r� Date 0! / I Application Approved by• V 7,�,.,✓i Date' Application Disapproved by: n Date for the following reasons Permit No. 900 1 - ,Z �3 Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS (Certificate of Compliance _THIS.IS TO.CERTIF-Y,.that the On-site Sewage Disposal System Constructed,(— ) Repaired ( ) Upgraded ( ) Abandoned( )by / ,� has been coonstrue ed in a ordance with the(provi kfis o"t e atrd`the for 01i pos� Const�" -r-- `�rmitNo. o`86 / �� dated Installer Designer #bedrooms (7 Approved desig flow 36 gpd The issuance f this perfill ithall not be construed as a guarantee that the system will fun�ion)as designed' Date Oil Inspector ' t --�.---No.- 00 001 '�S3 Fee OX THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION -BARNSTABLE, MASSACHUSETTS ligoal �&p!5tem congtruction permit Permission is hereby granted to Construct ( ) Repair ( ) Upgrade ( ) Abandon ( ) System located at VV­ L�✓l . Y and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to comply with Title S and the following local provisions or special conditions. Provided: Constiuction must be completed within three years of the date of this permit. 5 Date ` �� 1 r Approved by Town of Barnstable �FtHE Tp�, Regulatory Services Thomas F. Geiler, Director • BARNSTABLE, MASS900 i639. `0� Public Health Division ATFD^"0�p Thomas McKean, Director 200 Main Street,Hyannis,MA 02601 . Office: 508-862-4644 Fax: 508-790-6304 Installer& Designer Certification Form Date: 8/14/09 Designer: _Shay Environmental Services, Inc. Installer: Manny Barrows Address: P.O. Box 627 Address: West Falmouth Hwy. East Falmouth, MA 02536 West Falmouth, MA r .�On 8/12/09 Manny Barrows was issued a permit to install a ' (date) (installer) It septic system at 71 Mariner Circle, Cotuit, MA based on a design drawn by (address) Shay Environmental Services, Inc. dated 8/10/09 (designer) XX I certify that the septic system referenced above was installed substantially according to the design, which may include minor approved-changes such as lateral relocation of the distribution box and/or septic tank. I certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system) but in accordance with State & Local Regulations. Plan revision or certified as-built by designer to follow. VA, WV OF M�sS'��J 0 4 CA,R',141cN �%, (Install s Signature) ' o F. a U SHAY GO No. 1181 0 'QFGfS7�arG S � (Designer's Signature) (Affix Des? p Here) PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS- BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. Q:Health/Septic/Designer Certification Form fVM TRANS. NO.: of, CITY/TOWN: LC- APPLICANT: _� � t�1�=:`;� ��r�►� C`F' 1 ADDRESS: DESIGN FLOW: :,.� gpd REVIEWED BY: DATE: N/A OK NO ,GENLI2AL } Legal boundaries denoted [310 CMR 15.220(4)(a)] 1<' Street, Lot, tax parcel number and lot number noted on plan [310 CMR 15.220(4)(u)] Locus Provided [310 CMR 15.2204(t)] " Plan proper scale? (1"=40' for plot plans, 1"=20' or fewer for components) [310 CMR 15.220(4)] Easements shown [310 CMR 15.220(4)(b)] System located totally on lot served [310 CMR 15.405(1)(a) for upgrades]- if not, a variance is required [310 CMR 15.412(4)] Location of impervious surfaces (driveways, parking areas etc.) [310 CMR 15.220(4)(d)] Locatio-a all buildings existing and proposed 310 CMR 15.220(4)(c)] v' Location and dimensions of system components and reserve areas. [31,0 CMR 15.220(4)(e)] " System Calculations [310 CMR 15.220(4)(f)] V" daily flow septic tank capacity (required and provided) soil absorption system (required and provided) ' whether system designed for garbage grinder North arrow [310 CMR 15.220(4)(g)] Existing,and proposed contours [310 CMR 15.220(4)(g)] V Location and log of deep observation holes (existing grade el. on ' each test) [310 CMR 15.220(4)(h)] Names of soil evaluator and BOH representative [310 CMR ' 15.220(4)(h) and (i)] Location and date of percolation tests (performed at proper elevation?) [310 CMR 15.220(4)(1)] Percolation test results match loading rate? [310 CMR 15.242] �✓ Certification statement by Soil Evaluator [310 CMR 15.220(4)6)] i Observed and Adjusted groundwater (method for adjustment given or indicated) [310 CMR 15.103(3) and 310 CMR 15.220(4)(n)] i � 3 Address 1\`f CL'i w �,� �� i�i``1 Sheet l of'7 f , N/A OIL NO Location of every water supply, public and private, [310 CMR 15.220(4)(k)] within 400 feet of the proposed system location in the case of surface water supplies and gravel packed public water supply l within 250 feet of the proposed system location in the case within 150 feet of the proposed system location in the case of private water supply wells Location of all surface waters and wetlands located up to 100 ft. beyond setbacks listed in 310 CMR 15.211 and any catch basins j �J located within 50 ft. [310 CMR 15.220(4)(1)] Water lines and other subsurface utilities located [310 CMR b,z 15.220(4)(m)] (if water line cross see 310 CMR 15.211(1)[1]) Profile of system showing invert elevations of all system components and the bottom of the SAS [310 CMR15.220(4)(o)] Stamp of designer [310 CMR 15.220(1) and 310 CMR 15.220(2)] Stamp of Registered Land Surveyor (required if construction y . activities within 5 ft. of lot line) [310 CMR 15.220(3)] Test Holes adequate (two in each of the primary and reserve unless trenches as pennitted in 310 CMR. 15.102(2) or as lr approved for an upgrade under LUA at 310 CMR 15.405(1)(k)] Test hole adequate to demonstrate four feet of suitable material? f [310 CMR 15.103(4)] �f. Test Holes adequate to confirm adequate groundwater separation? 1310 CMR 15.103(3)] Benclunark within 50-75' of system [310 CMR 15.220(4)(q)] Materials specifications noted? [various sections of 310 CMR 15.000] System components not > 36" deep (unless Local Upgrade Approval or LUA requested) [310 CMR 15.405(1(b)] Address i iL�a;;Ic)Q' 1C-C\c , C-cl 1 J"1 Shcet 2 of 7 I N/A OK NO SEPTIC TANKy � � >� f �5 Size OK? [310 CMR 15.223(1)] V, Inlet tee located ten inches below flow line [310 CMR 15.227(6)] Outlet tee 14" or 14" + 5" per foot for increase ft depth [310 CMRf�f 15.227(6)] Outlet tee with gas baffle or approved filter [310 CMR 15.227(4)] V Note regarding installation on stable compacted base [310 CMR 15228(1)] Separation between inlet and outlet tees (no less than liquid depth) j[310 CMR 15.227(2)] Inlet/Outlet elevations at least 12" above high groundwater , (except as described 310 CMR 15.227(5)) or permitted for v upgrades under LUA [310 CMR 15.405(1)(k)] Minimum cover 9" (Tanks buried more than 9" must have risers on all openings and on the d-box) [310 CMR 15.2228(1) and 310 y CMR 15.232(3)(f)] Three access covers (inlet and outlet must be 20" or greater) - middle access at least 8" (by 7/07) [310 CMR 15.228(2)] Access to within 6 " of grade - one port for systems<1000gpd, ,: two for systems >1000 gpd [310 CMR 15.228(2)] All at-grade covers secured to unauthorized access? [310 CMR 15.228(2)] > 10 ft from building foundation [310 CMR 15.211(1)] Buoyancy calculation Required/Done [310 CMR 15.221(8)] V H-20 Where appropriate? [310 CMR 15.226(3)] lr`' Setbacks from resources [310 CMR 15.211] �. .. �€15.c,1` s '�r.zr✓a ta. x 7 c i ,3 Multi Compartment�Tanlcs� � � � £� t � �� Required when other than single-family dwelling or flow>1000 gpd [310 CMR 15.223(1)(b)] First compartment 200% daily flow; Second compartment 100% daily flow [310 CMR 15.224(2) and (3)] "U" pipe through or over baffle, outlet of each compartment with .- gas baffle or approved filter [310 CMR 15.224(4)] r. Address � �"':�a > .�� irc"C e , CZ')'k%) T- Sheet 3 of 7 N/A OK NO Located at least ten feet from any water line? [310 CMR 15.222(2)] Disposal piping at least 18" below water line when water and p Pp g ( sewer cross, see 310 CMR 15.211(1)[1.]) Cleanouts required/provided ? [310 CMR 15.222(8)] Thrust blocks specified in force mains? 310 CMR 15.221(6)(c)] s, Slope of sewer line not less than 0.01 (1/8"/ft) 0.02 preferable [310 CMR 15.222(6)] :Proper pitch on all runs? (.005 within gravity-distributed trenches and beds) [310 CMR 15.251(9) and 310 CMR 15.252(2)(c)] ��� Siphon problem/ (leachfield below pump chamber) ��'✓ Endcaps or vent manifold specified? Size and orientation of discharge holes specified? (not smaller than 3/8" not larger than 5/8") [310 CMR 15.251(8) and 310 tom' CMR 15.252(2)(h)] Materials specified (310 CMR 15.251(5) specifies various pipe types allowed) , � '..ay.:ts.a. Stable compacted base [310 CMR 15.221(2) and 310 CMR 15.232(2)(a)] Splash plate or baffle tee required on inlet/provided? (when pressure sewer to d-box or steep pitch of gravity sewer) [310 CMR 15.323(3)(a)] Riser if deeper than 9" [310 CMR 15.232(3)(01 Inside minimum dimension 12" [310 CMR 15.232(2)(b)] Minimum sump 6" [310 CMR15.232(3)(e)] V, Watertight cover if<2000gpd); waterproof manhole if>2000gpd [310 CMR 15.232(3)(d)] V P£VIYIiP HAMB3P;RS � � � y ftk N „ Capacity (emergency storage above working=design flow)? [310 CMR 231(2)] Proper setbacks [310 CMR 15.211 (same as septic tanks)] Watertight 20-in minium access manhole at least 20" MUST BE , TO GRADE [310 CMR 15.231(5)] Service components accessible (not too deep with piping, discomaects accessible) Alarm floats - alarm on circuit separate from pumps specified? U' Exceeds two units must have two pumps operating in lead-lag mode. [310 CMR 15.231(6) and (8)] �'�✓� Stable Compacted Base [310 CMR 15.221(2)] Buoyancy calculations needed ? Provided? [310 CMR 15.221(8)] Address � �(�?;1 1�.�4 i'`'�� �'r L�i d" Sheet 4 of'7 I , N/A OIL NO SOIL ABS I2PTI®� IS 'STEMS �SAS) gNERAL � fix` Calculations correct? 4 feet of naturally occurring material demonstrated? [310 CMR 15.240(1)] Required separation to groundwater? [310 CMR 15.212)] Aggregate specified as double washed [310 CMR 15.247(2)] V System Venting required/provided? (system under driveway or >36" deep) [310 CMR 15.241] Inspection ports specified and within 3"final grade? [310 CMR 15.24C(13)] Breakout requirements met? (No violation of breakout elevation within 15 ft of SAS unless barrier) [310 CMR 15.211(1)[4] and ' Guidance Document] Y u x x a �+" g,• s GAL]LERIES�P�T�TS CI3�M$BERS 31�0�CI1�I�R 15�2�53 Chambers and Gal. in trench configuration supplied with inlet ✓' eve ry /- ft. [310 CMR 15.253(6)] t` Each structure with one inspection manhole (if>2000 gpd must be to grade) [310 CMR 15.253(2)] 1 Aggregate 1' minimum- 4' maximum. [310 CMR 15.253(1)(b)] 2' sidewall credit maximum [310 CMR 15.253(1)(a)] In bed configuration, inlet every 40 sq. ft. [310 CMR 1.5.253(6)] I12ENCIES 31OCM1R15s251� p � ..w f.-�.r.> s.u,�....,. :,..�x"z;, '4�,.s. .s.-�...� ',,.�•s� �x•<6..tt .,;`Q ,,..Width 2'minimum T maximum [310 CMR 15.251(1)(b)] 100 feet - maximum length [310 CMR 15.251(1)(a)] k Minimum separation 2x effective depth or width whichever greater (3x if reserve between trenches) [310 CMR 251(1)(d)] Situated along contours [310 CMR 15.251(2)] ' Breakout OK? [310 CMR 15.211(1)[4] and Guidance Document] BIND S ASS MI , si'zeofbe"d or field 5000, gpd) ', � r u' , , q minimum 2 distribution lines [310 CMR 15.252(2)(a)] V' Maximum separation between lines 6' [310 CM R15.252(2)(d)] iZ Maximum separation between lines and outside of bed 4' [310 CMR 15.252(2)(e)] �"✓ Aggregate depth below discharge pipes 6" minimum, 12" ,,- maximum. [310 CMR 15.252(2)(g)] Separation between beds 10' minimum. [310 CMR 15.252(2)(0] Bottom area used in calculations only [310 CMR 15.252(2)(i)] Address �` 1(`,. t�lC: 3 (C_�� . �>i f`S r" t Sheet 5 of 7 i N/A OK NO Pressure Dosed System ? Provided pump and piping calculations as required [310 CMR 15.220(4)(r)] Pressure dosing required on all systems >2000gpd or alternative systems under remedial approval [310 CMR 15.254(2) and I/A Remedial Use Approvals] If used in gravelless system - make sure jet is directed as not to r' scour soil interface [Guidance Document] Inspections once per year (systems< 2000 gpd) or quarterly '' (>2000gpd) good to note on plan [310 CMR 15.2.54(2)(d)] L Construction in fill - Did the plan specify that the fill shall meet v the specification of 310 CMR 15.255(3)? Impervious barrier and/or retaining wall ? [Guidance Document] lrrrpervious barrier installation must be supervised by designer [310 CMR 15.255(2)(b)] Retaining wall must be designed by Registered Professional ✓'' Engineer [310 CMR 15.255(2)(a)] Side slope not exceed 3:1 ? [310 CMR 15.255(2)] U` Breakout requirements met? [310 CMR 15.252(2) and Guidance Document] At least 5 ft, from impervious barrier to edge of SAS (10 ft. ' recommended) [310 CMR 15.255 (2)(e)] Gtcev�ellAess,�S'ys�terai��I/�AI�P. vaZ,�:�etteYa^5J�ti,s 3° ".� .., ta�� ,� . `����� � ��..:� _.....✓'` , Check DEP Approval letters for credits and design conditions V If used with pressure dosing do not allow pressure discharge to scour soil interface Alter Was DEP Approval Letter provided and/or have you �. reviewed the letter for conditions? L Is the technology being properly applied and does it meet all DEP Approval Conditions? Is there a note on the plan regarding the requirement for , perpetual maintenance agreement? Any alarnns involved on separate circuits V' Did the applicant submit an operation and maintenance manual? T /Has applicant submitted a copy of a maintenance Ll . ., Are the variances listed on the plan ? [310 CMR 15.220 (4)(q)] RLS Stamp necessary on plan if a component is within five feet of property line [310 CMR 15.412(4)] ` New construction or increased flow proposed - [Refer to 310 CMR 15..41.41 Address Sheet 6 of 7 i N/A OK NO NI�k L'7? Se71SLtLUe 1�12QS � � � rig s a &Is the system in a Designated Nitrogen Sensitive Area (Zone H for a public supply well)? [310 CMR 15.214, 310 CMR 15.215 and 310 CMR 15.216 - also refer to Policy regarding upgrades of such existing systems] Is the system proposed on the same lot as served by private well ? [310 CMR 15.214(2)] Are the nitrogen loads proposed in compliance? [310 CMR 15.21.6(1)] �,.. lilscellzi- eoccs M 4 { Pumping to septic tank ? [ 310 CMR 15.229] ✓ Shared System [310 CMR 15.290] ,w ►� 7 Address I ��?�,� i �.Ea , sLl �''� Sheet 7 of 7 No. r' Fee od THE,COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes ZIppYication for Di,5pogal *paem Cou5tructiou permit Application for a Permit to Construct( ) Repair(✓� Upgrade( ) Abandon( ) ❑ Complete System E= Individual Components Location Address or Lot No. 3 Q r ' Owner's Name,Addrreesssj,and �Teeell.No. Assessor's Map/Parcel co/-I// , tz: Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. Type of Building: �j Dwelling No.of Bedrooms 13 Lot Size // sq. ft. Garbage Grinder (141 Other Type of Building g e �� -eO e& No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 3 3 gpd Design flow provided 3_52�11 � gpd Plan Date 7 11 Number of sheets RRision Date Title ✓i IV W 0 Size of Septic Tank7 f0Q® Type of S.A.S. �� i Description of Soil 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 Boar f He t igned Date v �✓ Application Approved b Date Application Disapproved by: Date for the following reasons Permit No. 3�' Date Issued No. �'"-.�i9� + a. µFee DV E. THEj1'COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTKDIVISION - TOWN-OF BARNSTABLE, MASSACHUSETTS Yes 'ZIpplication for Digw6al *pgtem Cou5tructiou Permit Application for a Permit to Construct( ) Repair(1/j Upgrade( ) Abandon( ) ❑ Complete System Individual,Components �iio old r r } Location Addressor Lot No. 1!3 J. °h Owner's Name,Address,and Tel No. ,fvAssessor's Map/)�el I 47/ �'Installer's Name,Address,and Tel.No. Designers Name,Address and Tel.No. k. hto1-111Y Gee51X. 77�� Ddrv�Cq c° 36Z-�S-y/ Type of Building: Dwelling No.of Bedrooms Lot Size 21113 sq. ft. Garbage Grinder (/w/ Other Type of Building t?,3) I'4 4V No.of Persons Showers( ) Cafeteria( ) Other Fixtures a Design Flow(min.required) 3 3 gpd Design flow provided ✓-©i gpd Plan Date 7 D Number of sheets ^Rw ision Date Title Size of Septic Tank �Q©� ,�X/✓�J& Type of S.A.S. e /� �v,J`29/-3 Description of Soil �� ,•' 3�� yX��Z�X Z / 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�thisBoard-f He t .igne Date 157 v O Application Approved by Date lff O Application Disapproved by: Date for the following reasons Permit No. Date Issued D THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of (Compliance THIS IS TO CERTIFY,that the On-site Sew a a Disposal System Constructed ( ) Repaired ( Z) Upgraded ( ) Abandoned( )by at J 6,e4 �/ has been constructed in accordance with the provisions of Title 5 and th for Disposal System Construction Permit No. ?^1344 dated Installer Designer 0 \ot, tcx, #bedrooms a Approved des�i n flow(� V ' gpd The issuance of this permit s all not be construed as a guarantee that the system 14 11 fun•tion as designed. _O t, _ Inspector / It,/ Date 51_ 1 _ _.. - - - . ._ . No. r��� -- / Fee �lf v THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS Migoal *p.5tem Construction Permit Permission is hereby granted ated to Construct ( ) Repair ( V11 U grade ( ) Abandon ( ) System located at and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to comply with Title S and the following local provisions or special conditions. _ Provided: Const ructioij,must be completed within three years of the dat'0' this p t. Date �10 Approved I F� TRANS. NO.: CITY/TOWN: Go,z < < -; APPLICANT: �✓�. aw�,r�,��c,�+ �„ �-,fi r ADDRESS: IL 3 crt'6eNA V _' DESIGN FLOW: ba gpd REVIEWED BY: DATE: N/A OIL NO Legal boundaries denoted [310 CNM 15.220(4)(a)] Street, Lot, tax parcel number and lot number noted on plan [310 CMR 15.220(4)(u)] Locus Provided [310 CMR 15.2204(t)] Plan proper scale? (1"=40' for plot plans, 1"=20' or fewer for components) [310 CMR 15.220(4)] Easements shown [310 CMR 15.220(4)(b)] �- System located totally on lot served [310 CMR 15.405(1)(a) for upgrades]- if not, a variance is required [310 CMR 15.412(4)] Location of impervious surfaces (driveways,parking areas etc.) [310 CNM 15220(4)(d)] Location all buildings existing and proposed 310 CMR 15.220(4)(c)] Location and dimensions of system components and reserve areas. [310 CNa 15.220(4)(e)] System Calculations [310 CMR 15.220(4)(f)] daily flow septic tank capacity(required and provided) soil absorption system(required and provided) whether system designed for garbage grinder North arrow [310 CMR 15.220(4)(g)] Existing and proposed contours [310 CMR 15.220(4)(g)] Location and log of deep observation holes (existing grade el. on each test) [310 CMR 15.220(4)(h)] Names of soil evaluator and BOH representative [310 CNM 15.220(4)(h) and (i)] Location and date of percolation tests (performed at proper elevation?) [310 CMR 15.220(4)(i)] Percolation test results match loading rate? [310 CMR 15.242] Certification statement by Soil Evaluator [310 CMR 15.220(4)0)] Observed and Adjusted groundwater (method for adjustment given or indicated) [310 CMR 15.103(3) and 310 CMR 15.220(4)(n)] Address Sheet 1 of 7 I N/A. OIL NO Location of every water supply, public and private, [310 CMR ✓' 15.220(4)(k)] within 400 feet of the proposed system location in the case of surface water supplies and gravel packed public water supply within 250 feet of the proposed system location in the case within 150 feet of the proposed system location in the case of private water supply wells Location of all surface waters and wetlands.located up to 100 ft. beyond setbacks listed in 310 CMR 15.211 and any catch basins located within 50 ft. [310 CMR 15.220(4)(1)] Water lines and other subsurface utilities located [310 CMR 15.220(4)(m)] (if water line cross see 310 CMR 15.211(1)[1]) Profile of system showing invert elevations of all system components and the bottom of the SAS [310 CMR1 5.220(4)(o)] Stamp of designer [310 CMR 15.220(l) and 310 CMR 15.220(2)] Stamp of Registered Land Surveyor (required if construction activities within 5 ft. of lot line) [310 CMR 15.220(3)] Test Holes adequate (two in each of the primary and reserve unless trenches as permitted in 310 CMR 15.102(2) or as approved for an upgrade under LUA at 310 CMR 15.405(1)(k)] Test hole adequate to demonstrate four feet of suitable material? [310 CMR 15.103(4)1 Test Holes adequate to confirm adequate groundwater separation? [310 CMR 15.103(3)] Benchmark within 50-75' of system [310 CMR 15.220(4)(q)] Materials specifications noted? [various sections of 310 CMR 15.000] System components not> 36" deep (unless Local Upgrade Approval or LUA requested) [310 CMR 15.405(1(b)] Address .4 Sheet 2 of 7 N/A OK NO Size OK? [310 CMR 15.223(1)] Inlet tee located ten inches below flow line [310 CMR 15.227(6)] Outlet tee 14" or 14" + 5" per foot for increase ft depth [310 CMR 15.227(6)] Outlet tee with gas baffle or approved filter [310 CMR 15.227(4)] Note regarding installation on stable compacted base [310 CMR 15.228(1)] Separation between inlet and outlet tees (no less than liquid ✓, depth) [310 CMR 15.227(2)] Inlet/Outlet elevations at least 12" above high groundwater (except as described 310 CMR 15.227(5)) or permitted for upgrades under LUA [310 CMR 15.405(1)(k)] Minimum cover 9" (Tanks buried more than 9" must have risers / on all openings and on the d-box) [310 CMR 15.2228(1) and 310 CMR 15.232(3)(f)] I Three access covers (inlet an -ou ust be 20" or greater) - middle access at least 8" (b 7/07) 0 CMR 15.228(2)] Access to within 6 " of grad - one port for systems<1000gpd, two for systems>1000 gpd [310 CMR 15.228(2)] All at-grade covers secured to unauthorized access? [310 CMR 15.228(2)] > 10 ft from building foundation [310 CMR 15.211(1)] , Buoyancy calculation RequiredlDone [310 CMR 15.221(8)] H-20 Where appropriate? [310 CMR 15.226(3)] Setbacks from resources [310 CMR 15.211] litYnlfl �o'mpaitnen`iganks " t+* r, Required when other than single-family dwelling or flow>1000 gpd [310 CMR 15.223(1)(b)] First compartment 200% daily flow; Second compartment 100% daily flow [310 CMR 15.224(2) and(3)] "U" pipe through or over baffle, outlet of each compartment with gas baffle or approved filter [310 CMR 15.224(4)] Address Sheet 3 of 7 N/A OK NO Located at least ten feet from any water line? [310 CMM 15.222(2)] Disposal piping at least 18" below water line (when water and sewer cross, see 310 CMM 15.211(1)[1]) ✓ Cleanouts required/provided? [310 CMM 15.222(8)] Thrust blocks specified in force mains? 310 CMR 15.221(6)(c)] ✓ Slope.of sewer line not less than 0.01 (1/8"/Pi) 0.02 preferable [310 CMR 15.222(6)] t� Proper pitch on all runs? (.005 within gravity-distributed trenches v/ and beds) [310 CMR 15.251(9) and 310 CMM 15.252(2)(c)] Siphon problem/ (leachfield below pump chamber) Endcaps or vent manifold specified? Size and orientation of discharge holes specified? (not smaller than 3/8" not larger than 5/8") [310 CMM 15.251(8) and 310 CMM 15.252(2)(h)] Materials specified (310 CMM 15.251(5) specifies various pipe types allowed) Stable compacted base~[310 CMR 15.221(2) and 310 OM 15.232(2)(a)] Splash plate or baffle tee required on inlet/provided? (when :q_ pressure sewer to d-box or steep pitch of gravity sewer) [310 CMR 15.323(3)(a)] Riser if deeper than 9" [310 CMM 15.232(3)(f)] Inside minimum dimension 12" [310 CMR 15.232(2)(b)] Minimum sump 6" [310 CN M15.232(3)(c)] Watertight cover if<2000gpd); waterproof manhole if>2000gpd [310 CMR 15.232(3)(d)] Capacity(emergency storage above working--design flow)? [310 CMM 231(2)] Proper setbacks [310 CMR 15.211 (same as septic tanks)] Watertight 20-in minium access manhole at least 20" MUST BE TO GRADE [310 CMR 15.231(5)] Service components accessible (not too deep with piping, disconnects accessible) Alarm floats - alarm on circuit separate from pumps specified? Exceeds two units must have two pumps operating in lead-lag mode. [310 CMM 15.231(6) and(8)] Stable Compacted Base [310 CMR 15.221(2)] Buoyancy calculations needed ? Provided? [310 CMR 15.221(8)] Address Sheet 4 of 7 N/A OK NO Calculations correct? 4 feet of naturally occurring matcrial demonstrated? [310 CMR 15.240(1)] Required separation to groundwater? [310 CMR 15.212)] Aggregate specified as double washed [310 CMR 15.247(2)] System Venting required/provided? (system under driveway or >36" deep) [310 CMR 15.241] Inspection parts specified and within 3"final grade? [310 CMR / 15240(13)] V Breakout requirements met? (No violation of breakout elevation within 15 ft of SAS unless barrier) [310 CMR 15.211(1)[4] and Guidance Document] 'E SPITMMMUMS; 3,101,clv�� Chambers and Gal. in trench configuration supplied with inlet every 20 ft. [310 CMR 15.253(6)] Each structure with one inspection manhole(if>2000 gpd must / be to grade) [310 CMR 15.253(2)] V/ Aggregate I'minimum- 4'maximum. [310 CMR 15.253(1)(b)] 2' sidewall credit maximum [310 CMR 15.253(1)(a)] In bed configuration, inlet every 40 sq. ft. [310 CMR 15.253(6)] Width 2'minimum 3'maximum [310 CMR 15.251(1)(b)] 100 feet-maximum length [310 CMR 15.251(1)(a)] Minimum separation 2x effective depth or width whichever greater (3x if reserve between trenches) [310 CMR 251(1)(d)] Situated along contours [310 CMR 15.251(2)] Breakout OK? [310 CMR 15.211(1)[4] and Guidance Document] J � _ (YI"ain�um size o e o fi I` SUOOd) a 4.0 minimum 2 distribution lines [310 CMR 15.252(2)(a)] Maximum separation between lines 6' [310 CM RI5.252(2)(d)] Maximum separation between lines and outside of bed 4' [310 CMR 15.252(2)(e)] Aggregate depth below discharge pipes 6" minimum, 12" maximum. [310 CMR 15.252(2)(g)] , Separation between beds 10'minimum. [310 CMR 15.252(2)(f)] h Bottom area used in calculations only [310 CMR 15.252(2)(i)] Address Sheet 5 of 7 N/A OIL NO � IL `1TII�trO7 Pressure Dosed System ? Provided pump and piping calculations as required [310 CMR 15.220(4)(r)] Pressure dosing required on all systems>2000gpd or alternative systems under remedial approval [310 CMR 15.254(2) and I/A Remedial Use Approvals] If used in gravelless system-make sure jet is directed as not to scour soil interface [Guidance Document] Inspections once per year(systems<2000 gpd) or quarterly (>2000gpd) good to note on plan [310 CMR 15.254(2)(d)] Construction in fall -Did the plan specify that the fill shall meet the specification of 310 CMR 15.255(3)? Impervious barrier and/or retaining wall ? [Guidance Document] Impervious barrier installation must be supervised by designer [310 CMR 15.255(2)(b)] Retaining wall must be designed by Registered Professional Engineer [310 CMR 15.255(2)(a)] Side slope not exceed 3:1 ? [310 CMR 15.255(2)] Breakout requirements met? [310 CMR 15.252(2) and Guidance Document] At least 5 ft. from impervious barrier to edge of SAS (10 ft. recommended) [310 CMR 15.255 (2)(e)] Gra , ess �s em � P�`o a eM t a a.�:.. ,. Check DEP Approval letters for credits and design conditions If used with pressure dosing do not allow pressure discharge to scour soil interface Was DEP Approval Letter provided and/or have you reviewed the letter for conditions? Is the technology being properly applied and does it meet all DEP Approval Conditions? Is there a note on the plan regarding the requirement for perpetual maintenance agreement? Any alarms involved on separate circuits Did the applicant submit an operation and maintenance manual? Has applicant submitted a copy of a maintenance )ia 7,,,_eu a,r r w.. ariances listed on the plan ? [310 CMR 15.220 (4)( RLS Stamp necessary on plan if a component is within five feet of property line [310 CMR 15.412(4)] New construction or increased flow proposed- [Refer to 310 CMR 15.4141 Address Sheet 6 of 7 i F v •p N/A OK 1. N 'bin 'f, �rt, ti^�s t{ r a oai.' L & �t,y ,,,�.LtY® BIZ Seilslfll?BF1�y2Cds s .i7tF4 V Is the system in a Designated Nitrogen Sensitive Area(Zone II for a public supply well)? [310 CMR 15.214, 310 CMR 15.215 and 310 CMR 15.216 - also refer to Policy regarding upgrades of such existing systems] Is the system proposed on the same lot as served by private well ? [310 CMR 15.214(2)] ✓ Are the nitrogen loads proposed in compliance? [310 CMR 15.216(1)] P' 141cscella ieouss �'pw7s.F�,.¢ s '� y'�wy+ `' `'.FI Z:F�. .� .. Pumping to septic tank ? [ 310 CMR 15.229] Shared System [310 CMR 15.290] Address Sheet 7 of 7 Town of Barnstable Regulatory Services Thomas F. Geiler,Director * BARNSTABLE, « MASS.. ,�c�' Public Health Division �F®16,�.i�' Thous McKean, Director 200 Main Street,Hyannis,IA 02601 Office: 508-862-4644 Fax: 508-790-6304 Installer & Designer Certiilcation Form Date: Sewage Permit# ®dQ-- Assessor's Map\Parcel d 3 Designer: W 4 W✓% G�e Installer: 6"G 0 l � Address: 9Ct l v\. JV Address: On ✓ //gl�� ®�/`���'i ?�p�l was issued a permit to install a (date) (installer) septic system at_ I� /J'f--74 pu, based on a design drawn by (address) /J a, vwr Q pcX� dated r 2 —o (design I certify that the septic system referenced above was installed substantially according to the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. I certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system) but in accordance with State & Local Regulations. Plan revision or certified as-built by designer to follow. ----..- ZH OF Mgssgc DANIELA. (Instal Signature) o OJALACIVIL f: A No.46502 SS/�NAL EN (Designer's Signature) I (Affix Designers Stamp here) PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE ALL NOT BE ISS FtD N T 1L BOTH TIIIS FORM AND AS-BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. Q:Health/Septic/Designer Certification Form 3-26-04.doc a .` Town of Barnstable P# 2 l �y� Department of Regulatory Services �` : HARMST"L& Public Health Division Date a MAE& 200 Main Street,Hyannis MA 02601 � Date Scheduled 0 Time Fee Pd. Ga Soil Suitability Assessment for Se ge 'sposal Performed By: Witnessed By: AV W f_40_77� 0 "r� LOCATION& GENERAL INFORMATION Location Address t-1 ` M 0,0%(-)-1eC5^ Owner's Name Tc mP__s COT V t T', M Address Sacr)-q__ Assessor's Map/Parcel: a 3 '14 v' m Engineer's Name Caemen NEW CONSTRUCTION REPAIR .,XTelephone# 539—�+Q Wle Land Use �c5\ ON Slopes(%) r 90 Surface Stones_ Distances from: Open Water Body ,\\ ft Possible Wet Area ft Drinking Water Well 1" ft Drainage Way YV G- ft Property Line Q f ft Other ft SKETCH:(Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands in proximity to holes) 5D' t>_e�3 7? Parent material(geologic) l )�`Tw � Depth to Bedrock N�� Depth to Groundwater. Standing Water in Hole: N T.-e I a- Weeping from pit Race Estimated Seasonal High Groundwater 3a o� Nssmvy� C) DETERARNATION FOR SEASONAL HIGH WATER TABLE Method Used: Depth Observed standing in obs.hole: in" Depth to soil mottles: in" y„ Depth to weeping from side of obs.hole: in, Groundwater Adjustment # ft. rt Ln Index Well# Reading Date: a;:dex Well level Adj.faetor_ Adj.Orvundwater.11!evel T 10 ""I PERCOLATION TEST bgtp WTItne o .ors Observation Hole# � Time at V Depth of Perc 64 Time at 6" Start Pre-soak Time @ 'i ' Time.(9"•6") End Pre-soak >� Rate Min./InchM P� Site Suitability Assessment: Site Passed Site Failed: Additional Testing Needed(Y/N) Origi nal: m p mil: '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 Barnstable Conservation Division at least one (1)week prior to beginning. Q:\SEPI'ICVERCFORM.DOC �. � <i v j _k l DEEP OBSERVATION HOLE LOG Hole# J Depth from Soil Horizon SoilTexture Soil Color Soil Other Surface(in.) r,", , " ' (USDA) (Munsell) Mottling (Structure,Stones,Boulders. bConsistency,% ravel �-l3a C V/y Lo� I-��e DEEP`OBSERVATION HOLE LOG Hole# It Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA),, 9 . ,(Munsell) Mottling (Structure,Stones,Boulders. C nsisten % ravel ' 3 N , CAD ;S b A. Al JS 3 CC � r DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon- Soil Texture Soil Color Soil Other Surface(in.) ' _ (USDA) (Munsell) Mottling (Structure,Stones,Boulders. r a Consistency,9, Gravel a 1 DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture So il Color Soil Other Surface(in.) .(USDA) (Munsell) -Mottling (Structure,Stones',Boulders. Consi tenSj Flood Insurance Rate Map: Above 500 year flood boundary No— Yes Within 500 year boundary No Yes Within 100 year flood boundary No Yes Depth of Naturally occurring Pervious Material Does at least four feet of naturally occurring pervi m terial exist in all areas observed throughout the area proposed for the soil absorption system. 5. If not,what is the depth of naturally occurring pervious erial7 _- Certification I certify that on 1. date)I have passed the soil evaluator examination approved by the Department of Enviro me rot c ' and that the above analysis was performed by tre'consistent with the required traini ,e ertise and xp ience described in 310 CMR 15.017. Date Signature r Q:\.S.EPTICVERCFORM.DOC Bk 21,822 Ps 22 4r -12F 12634 B]1.,3-02-200 7 a 0 2 : 52s3 1 ` . NOTICE: The Town of Barnstable ..recommends that the applicant seek legal advice to prepare a property worded deed restriction document. DEED RESTRICTION WHEREAS, , e �/�� �j of (owners naf e) MA 7�T �T (address) ' is the owner of_ ,� / G�i� located address at MA (hereinafter referred to as and be'n shown on a plan entitled "Subdivision of Land in MA, Property of , et al, duly recorded in Barnstable County Registry Of12 Deeds in Plan Book 1�� , Page ; Or on Land Court Plan Number WHEREAS, as the owner of said lot has (owner's name) agreed with the Town of Barnstable Board of Health to a restriction as to the number.of bedrooms which can be included in any home built on said lot as a pre-condition to obtaining a disposal works construction permit in compliance with 310 CMR 15.000 State Environmental Code, Title V, Minimum Requirements for the Subsurface Disposal of Sanitary Sewage; WHEREAS, the Town of Barnstable Board of Health, as a pre-condition to granting a disposal.works construction permit for a septic system in compliance with 310 CMR 15.200, State Environmental Code, Title V, Minimum Requirements for the Subsurface Disposal of Sanitary Sewage, and author!4, .L` the issuance of a building permit for the construction of a single family home;.5 ••.`t% thisproperty, requiringagreement is re uirin that the for the restriction on the • �+ •.� < °- bedrooms in any house constructed on the lot be put on record with the ti Barnstable County Registry of Deeds by recording this document, deedr �• ,• r Bk 21822 P9224 12634 133-02-21 fi 17 a"i !i2 : 521:1 NOTICE: The Town of Bamstable .recommends that the applicant seek legal advice to prepare a Properly worded deed restriction document DEED RESTRICTION WHEREAS, (owners n e) a Of (address) . is the owner of address located at t MA(hereinafter referred to as and being shown on a plan entitled "Subdivision of Land in �QL MA, Property of et at, duly recorded in Barnstable Cou of nty Registry 12 Deeds in Plan Book _���, fi , Page Or on Land Court Plan Number WHEREAS, _ ? (o t as the owner of said lot has — wners name) agreed with the Town of Barnstable Board of Health to a restriction as to the number.of bedrooms which can be included in any home built on said lot as a pre-condition to obtaining a disposal works construction permit in compliance with 310 CMR 15.000 State Environmental Code, Title V, Minimum ' Requirements for the Subsurface Disposal of Sanitary Sewage; WHEREAS, the Town of Barnstable Board of Health, as a pre-condition to granting a disposal works construction permit for a septic system in compliance with 310 CMR 15.200, State Environmental Code, Title V, Minimum Requirements for the Subsurface Disposal of Sanitary Sewage, and author the issuance of a building »L permit for the construction of a single family ho n,6. ""'••. 't1 y�. this property, is requiring that the agreement for the restriction on the numb bedrooms in any house constructed on the lot be put on record with the Barnstable County Registry of Deeds by recording this document, = ` deedr ' 1 COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION a ) TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: / o ,r G l� " a Owner's Name• 0016kl Sl. Owner's Address: , o' 3 Date of Inspection: /3 0 Name of Inspector:�PPlease print) Company Name: C/G�!//U T—L C Mailing Address: O IVy Telephone Number(-,gjg.2 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of the inspection.The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP' approved system inspector pursuant �to�Section 15.340 of Title 5(310 CMR 15.000). The system: Passes Conditionally Passes Needs Further Evaluation by the Local Approving Authority Fails Inspector's Signature: 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. Notes and Comments ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. Page 2 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 9/ M a v l ee,, ' Ci r o dot 3 j Owner: A;;,- Date of Inspection: / Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. Syste asses: I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below. Comments: B. System Conditionally Passes: One or more system components as described in the"Conditional Pass" section need to be replaced or repaired.The system,upon completion of the replacement or repair,as approved by the Board of Health,will pass. Answer yes,no or not determined(Y,N,ND)in the for the following statements.If"not determined"please explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not)is structurally unsound,exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND explain: Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken,settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced ND explain: The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed ND explain: Page 3 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: / z C�`✓' Owner: Date of Inspection: / C. Further Evaluation is Required by the Board of Health: Z—k/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. The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well".Method used to determine distance "This system passes if the well water analysis,performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered A copy of the analysis must be attached to this form 3. Other: Page 4 of I I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS • SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: W Owner: Ts, A' Date of Inspection: / p D. System Failure Criteria applicable to all systems: You must indicate`yes"or"no"to each of the following for all inspections: Yes No/ �O 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 I/ Liquid depth in cesspool is less than 6"below invert or available volume is less than'/z day flow -_41 Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number _ _✓ of times pumped Any portion of the SAS,cesspool or privy is below high ground water elevation Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. _ ✓ Any portion of a cesspool or privy is within a Zone 1 of a public well. Any portion of a cesspool or privy is within 50 feet of a private water supply well. Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for 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.] (Yes/No) The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails.The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E. Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. You must indicate either"yes"or"no"to each of the following: (The following criteria apply to large systems in addition to the criteria above) yes no _ the system is within 400 feet of a surface drinking water supply the system is within 200 feet of a tributary to a surface drinking water supply the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area—IWPA)or a mapped Zone II of a public water supply well If you have answered"yes"to any question in Section E the system is considered a significant threat,or answered "yes"in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304.The system owner should contact the appropriate regional office of the Department. Page 5 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: a ei r 6711— r � C of635 Owner: T.�,'li�'G►o Date of Inspection:' z 0 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 available note as N/A) Was the facility or dwelling inspected for signs of sewage back up v 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: Yes,,,-no xisting 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(3)(b)] Page 6 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C /`� SYSTEM INFORMATION Property Address: / a"1'1✓i pN- Ci V, r Owner: Date of Inspection: -127 If I FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): �— Number of bedrooms(actual): DESIGN flow based on 310 CIR 15.203(for example: 110 gpd x#of bedrooms). Number of current residents: Does residence have a garbage grinder(yes or no): 100 Is laundry on a separate sewage system(yes or no): LP'O[if yes separate inspection required] Laundry system inspected(yes or no): I(�oV Seasonal use: (yes or no):.t�_P5 Water meter readings,if available(last 2 years usage(gpd)): Cc4 Ile C " /�'� 4✓I S We Sump pump(yes or.no):A'0 Last date of occupancy: COMMERCIALANDUSTRIAL - - Type of establishment: Design flow(based on 310 CMR 15.203): 2pd Basis of design flow(seats/persons/sgft,etc.): Grease trap present(yes or no):_ Industrial waste holding tank present(yes or no): Non-sanitary waste discharged to the Title 5 system(yes or no):_ Water meter readings,if available: Last date of occupancy/use: OTHER(describe): GENERAL INFORMATION Pumping Records / / Source of information: ,�c � Vie_ cl I G S 7` ��,��, �( c��rs — (� L✓�e i�-- Was system pumped as part of the inspection(yes or no):_v If yes,volume pumped: gallons--How was quantity pumped determined? Reason for pumping: TYP OF SYSTEM _Septic tank,distribution box, soil absorption system _Single cesspool Overflow cesspool —Privy _Shared system(yes or no)(if yes,attach previous inspection records,if any) _Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) Tight tank _Attach a copy of the DEP approval Other(describe): Approximate age of all components,date installed/(if known)and ource of information: Were sewage odors detected when arriving at the site(yes or no): Ma Page 7 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) � r Property Address: // / a.ir V ✓+ Owner: Si 4-4 Date of Inspection: BUILDING SEWER(locate on site plan) Depth below grade:_�/�� Materials of construction: st iron (/40 PVC_other(explain): Distance from private water supply well or suction line: Comments(on condition of joints,venting,evidence of leakage,etc.): SEPTIC TANK:_(locate on site plan) Depth below grade: Material of construction: concrete_metal_fiberglass_polyethylene _other(explain) If tank is metal list age:_ Is age confirmed by a Certificate of Compliance(yes or no):—(attach a copy of certificate) �7 Dimensions: Sludge depth: Distance from top of sludge to bottom of outlet tee or baffle: �t Scum thickness: /" 21", Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to botto of outlet tee or baffle: How were dimensions determined: /�c�le- Comments(on pumping recommendations,inlet and outlet tee or baffle condition, structural integrity, liquid levels /Plated to outlet invert/evidence of leakage,etc.): / 'tit vet 1 n 6 00 T 06'&c4e cj e 4- j ✓�1 C�. 4�, c�.� fx,�!�/r'S ✓f 7r e /V0 GREASE TRAP: (locate on site plan) Depth below grade:_ Material of construction:_concrete_metal_fiberglass_polyethylene_other (explain): Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping: Comments(on pumping recommendations,inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): Page 8 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: / /�!/Gi✓�✓I r ✓ Owner: r-s OoZ Date of Inspection: 10/ 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/day Alarm present(yes or no): Alarm level: Alarm in working order(yes or no): Date of last pumping: Comments(condition of alarm and float switches,etc.): DISTRIBUTION BOX: (if present must be opened)(locate on site plan) Depth of liquid level above outlet invert:1 ✓"►r_, / Comments(note if box is level and distribution to outlets equal,any evidence of solids carryover,any evidence of leak3oe into or out of box,etc.): PUMP CHAMBER:/V (locate on site plan) Pumps in working order(yes or no): Alarms in working order(yes or no): Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.): Page 9 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: / '111'a ✓JPv. ' C t ✓� Owner: 71j ir4>1 Date of Inspection: SOIL ABSORPTION SYSTEM(SAS): (locate on site plan,excavation not required) If SAS not located explain why: 17 TYP o x b JAII / �I�jtrte 1/ leaching pits,number: / leaching chambers,number: 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.): 014)(/H ; i/ — L i/0 I_`-r h/- � i�' h 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 or no): Comments(note condition of soil, signs of hydraulic failure,level of ponding,condition of vegetation,etc.): PRIVY:k(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.): Page 10 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: / 1/ap" dl Pi, C� ✓� Owner• Sr h, Date of Inspection: SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks.Locate all wells within 100 feet. Locate where public water supply enters the building. A- 3,9f Ar - LU 3 � if 0 r Page 11 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS • SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: a r'I✓i PN Owner: �Si Date of Inspection: ,2 p SITE EXAM Slope Surface water Check cellar Shallow wells , Estimated depth to ground water ay-•3feet Please indicate(check)all methods used to determine the high ground water elevation: Obtained from system design plans on record-If checked,date of design plan reviewed: _,Observed site(abutting property/observation hole within 150 feet of SAS) 1/Checked with local Board of Health-explain: /j'la�4�s Checked with local excavators,installers-(attach documentation) Accessed USGS database-explain: You must despribe.how you established the hi h round water elev hop / i 2 ,9 'P/O / / l/ /iJ H.r�✓I.vA Sdr�- d_3 1-3 ToF @ 0 i a v A � �'•� ' `Ict 0 0 'o �` l. r n o 00 ;r 100v �`. �Y , 0 0 0 0 ��� 1{•`r Y 0 Q o 0 X i 1 .i 91 10 P7 limo VVI ho#o r`7 o f A4 h,S h !,ru in„clwo7cr c� 0?0 y �o r,✓ h�7���"-� 07� P-�' ✓ r`O h n w�► /` �dj IS l�.l V + - D(l�V e DATE:7/24/98 PROPERTY ADDRESS:7•1 MarliTer Circle ' Cotuit;Mass. 02635 On the above date, I inspected the septic system at the above address. This system consists of the following: 1 . 1 -1000 gallon septic tank. 2 . 1 -Distribution box. 3 . 1 -1000 gallon precast leaching pit. 6 'x8 ' m In rxctlon I certlf the following condltlons: eased on y e y g 4 . This is a title five septic system':"''='78 Code' ) 5 . The septic system is - in proper' working order at the present time. SIGNATURr,: Name J P Macomber Jr_, i - --- - Company:J• P_Macomber- & Son'_Trrc .. • ' 0 rp Address:_ ------ RECEIVED Cente�r_vill,e LMass__02.632 ` AL 30 1998 N AWN OF BARNSTABLF Phone:---50&�3J.5-.3338------- '• 1 � ,t ►-IATLH0EpT THIS CERTIFICATION DOES NOT CONSTITUTE A GUARANTY OR WARRANTY rJXOSEPH'P. MACOMBER & SON, INC. Tanks-Ceupools-Leachflelds . I'ump+d & Instilled Town Sewer Connections P.O. Box 66' Centerville, MA 02632.0066 77.5-3335 775-6412 r COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION ONE WINTER STREET, BOSTON, MA 02108 617.292.5500 WILLIAM F.WELD TRUDY COXF Govcmor Sccrctan ARGEO PAUL CELLUCCI DAVID B.STRUM Lt.Govcmor SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM Commission PART A CERTIFICATION Property Address: 71 Mariner Circle Cotuit,mass. Address of Owner: Date of Inspection?/2 4/9 8 (If different) Name of Inspector: Tospp h P-Macomber Jr. I am a DEP appproved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000) .Company Name: J.P.Macomber & Son Inc. Mailing Address: Box 66 Centerville,Mass . 02632 Telephone Number: 508-779-3338 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 inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on-site se age disposal systems. The system: Passes _ Conditionally Passes Needs Further Evaluat'on By the Local Approving Authority Fails c, Inspector's Signature: r Dater" The System Inspector shall submit a copy of this inspection report to the Approving Authority within thirty(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 Department of Environmental Protection. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. INSPECTION SUMMARY: Check A, B, C, or D: AI SYSTEM PASSES: 1J— I have not found any information which indicates that the system violates any of the failure criteria as defined in 310 CMR 15.303. Any failure criteria not evaluated are indicated below. COMMENTS: BJ 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. Indicate yes,,no, or not determined (Y, N, or ND). Describe basis of determination in all instances. If"not determined", explain why not. The septic tank is metal, unless the owner or operator has provided the system inspector with a copy of a Certificate of Compliance (attached) indicating that the tank was installed within twenty (20) years prior to the date of the inspection;,or the septic tank, whether or not metal, is cracked, structurally unsound, shows substantial infiltration or exfiltration, or tank failure is imminent. The system will pass inspection if the existing septic tank is replaced with a conforming septic tank as approved by the Board of Health. (revised 04/2S/97) Page 1 of 10 DEP on the World Wide Web: http:/twww.mapnet.state.ma.us/dep {�j Printed on Recyded Paper U SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 71 Mariner Circle Cotuit,Mass . Owner: John Conlon Date of Inspection: 7/2 4/9 8 B) SYSTEM CONDITIONALLY PASSES (continued) �D Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. The system will pass inspection if(with approval of the Board of Health). Describe observations: broken pipe(s) are replaced obstruction is removed distribution box is levelled or replaced The system required pumping more than four 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 CJ -FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: z_ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect the public health, safety and the environment. 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND 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 APPROPRIATE) DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECTS THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: i!I_Q The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet to a surface water supply or tributary to a surface water supply. The system has a septic tank and soil absorption system and the SAS is within a Zone I of a public water supply well. The system has a septic tank and soil absorption system and the SAS is within 50 feet of a private water supply well. The system has a septic tank and soil absorption system and the SAS is less than 100 feet but 50 feet or more from a private water supply well, unless a well water analysis 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. Method used to determine distance ,C�q (approximation not valid). 3) OTHER '0 2A yi¢ (revised 04/25/)7) Yap• 2 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 71 Mariner Circle Cotuit,Mass . Owner: John Conlon Date of Inspection: 7/2 4/9 8 D) SYSTEM FAILS: You must indicate ei;i.er "Yes" or "No" as to each of the following: _A16 I have determined that the system violates one or more of the following failure criteria as defined in 310 CMR 15.303. The basis for this determination is identified below. The Board of Health should be contacted to determine what will be necessary to cornea the failure. Yes No Backup of sewage into facility or system component due to an 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. - f, "Ig �r Liquid depth in caupsei-is less than 6" below invert or available volume is less than 1/2 day flow. i _ Required pumping more th4n�4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped _ Any portion of the Soil Absorption System, cesspool or privy is below the high groundwater elevation. Any portion of a 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 I 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. If the well has been analyzed to be acceptable, attach copy of well water analysis for coliform bacteria, volatile organic compounds; ammonia nitrogen and nitrate nitrogen. E] LARGE SYSTEM FAILS: You must indicate either "Yes" or"No" as to each of the following: The following criteria apply to large systems in addition to the criteria above: The system serves a facility with a design flow of 10,000 gpd or greater (Large System) and the system is a significant threat to public health and safety and the environment because one or more of the following conditions exist: Yes No 40 the system is within 400 feet of a surface drinking water supply 422 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) The owner or operator of any such system shall bring the system and facility into full compliance with the groundwater treatment program requirements of 314 CMR 5.00 and 6.00. Please.consult the local regional office of the Department for further information. (ravlaad 04/25/97) Dap! 3 o1 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 71 Mariner Circle Cotuit,Mass. Owner: John Conlon Date of Inspection:.7/2 4/9 8 Check if the following have been done: You must indicate either "Yes" or "No" as to each of the following: Yes No ,i 1/ Pumping information was provided by the Owner, occupant, or Board of Health. None of the system components have been pumped for at least two weeks and the system has been receiving normal flow rates during that period. Large volumes of water have not been introduced into the system recently or as part of this inspection. As built plans have been obtained and examined. Note if they are not available with N/A. — The facility or dwelling was inspected for signs of sewage back-up. X/ The system does not receive non-sanitary or industrial waste flow. — The site was inspected for signs of breakout. — All system components, 44luding the Soil Absorption System, have been located on the site. — The septic tank manholes were uncovered, opened,and the interior of the septic tank was inspected for condition of baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge, depth of scum. —The size and location of the Soil Absorption System on the site has been determined based on: The facility owner (and occupants, if different from owner) were provided with information on the proper maintenance of Sub-Surface Disposal System. Existing information. Ex. Plan at B.O.H. — Determined in the field (if any of the failure criteria related to Part C is at issue, approximation of distance is unacceptable) (15.302(3)(b)) (revised 04/25/97) Day• 4 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION' FORM PART C SYSTEM INFORMATION Propeny Address: . 71 Mariner Circle Cotuit,Mass . O"ner: John Conlon Date of Inspection: 7/24/98 FLOW CONDITIONS RESIDENTIAL: Design flo%. = R.p�dibed(oom for S.A.S. Number of bedrooms: -umber of current residents: Caroage grinder (yes or no).A-T5 Laundry connected to Sysstteefn es or no)., y9�:�c p�,p C� uf��>7 S G�P. D. Seasonal use (yes or no). / Water meter readings, if available (last two (2) year usage (gpc): �OrD06 !�G G •Pr _ $vrnp Pump (yes or no):, ;asi date of occupancy COMMERCIAUIN'DU$TRIAL: Type of establishment: Design flow: V& allonVday Cease trap present: (yes or no)� industrial waste Holding Tank present: (yes or no)ALA .'%on-sanitity wasle discharged to the Title S system: (yes or no)�/ Water meter readings, if avail ble— � last date or occupancy. OTHER; :Describer AAA List date or occupancy*_ /U/r GENERAL INFORMATION PUMPING RECORDS and source of information. System pumped as pan of inspection: (yes 6t no),do If yes, volume pumped: d gallons Reason for pumping TYPE Of„SYSTEM Septic lank/distribution box/soil absorption system �(2 Single cesspool Overflow cesspool Privy AMShared system (yes or no) fit yes, anach previous inspection records, it any) VA Technology etc. Copy of up to date contrast Other ly,4- . APPROXIMATE AGE of all components, date installed (if known) and source of information: Se..agc odors detected when arriving at the site: (yes or no) P.ye s of 10 r �7% Customer Data Entry Screen 7127198 Name: John Conlon 428-4865 Address: 71 Mariner Circle jcon cC�e Town: Cotuit State:MA Zip:02635 !t Wing aadr�aa: 71 Mariner Cir Cotuit MA 02635 Tel Te12 Notes: 916189 pump T 105.00 916189 511196 pump T 145.00 513196 V SUBSURFACE SEWAGE DISPOSAL.SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 71 Mariner Circle Cotuit,Mass. Owner: John Conlon Date of Inspection: 7/2 4/9 8 BUILDING SEWER: (Locate on site plan) N ' Depth below grade: 10'� Material of construction. VCast iron_L.,14/0 PVC_other (explain) Distance fro�m,private water supply well or suction line _Ii-4 Diameter r ' Comments: (condition of joints, venting, evidence of leakage, etc.) Joints appear tight, No ev;c3ennp of leakage-a-System is vani-ar9 through the house vent. SEPTIC TANK:-'!PO 5�/MMVs (locate on site plan) )1 Depth below grade: Material of construction: concrete _metal _Fiberglass _Polyethylene _other(explain) If tank is metal, list age Is age confirmed by Cenificate of Compliance,f (Yes/No) Dimensions:_ �� ���r 6�� Sludge depth: Distance from to of Judge to bottom of outlet tee or baffle:Z;Z , Scum thickness:_&�_ Distance from top of scum to top of outlet tee or baffle:,d!��-C.,— Distance from bosom of scum to bo m of outlet ee or baffle:,2"-.1 How dimensions were determined: Comments: (recommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity, evidence of leakage, etc.) Pump tank eypry 2_1 yim;;rG Inlet & outlet tees are in Place-Liquid level at the outlet inrart is fifty one inche s. me tank is structurally sound and Shows no signs of 1Aakagz GREASE TRAP: (locate-on site plan) Depth below grader Material of con struction:N6concrete444metalo!LViberglass,() 41`olyethyleneAlother(explain) Dimensions: Scum thickness:N_ Distance from top of scum to top of outlet tee or baffle: /1�/rn Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping: Comments: (recommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity, evidence of leakage,-etc.) Grease trap is not prRspnt (revised 04/25/17) Peg* 6 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 71 Mariner Circle Cotuit,Mass. Owner: John Conlon Date of Inspection: 7/2 4/9 8 TIGHT OR HOLDING TANK:�(Tank must be pumped prior to, or at time, of inspection) (locate on site plan) Depth below grader Material of constructionw,4-concrete4AmetaIV,4Fiberglass&Polyethylene/aother(explain) AIN Dimensions: VA Capacity: gallons Design flow;gallons/day Alarm level: Alarm n working order Yes4- 4 No j Date of previous pumping: Comments: (condition of inlet tee, condition of alarm and float switches, etc.) Tight or holding tanks are not =rPspnt DISTRIBUTION BOX:, (locate on site plan) Depth of liquid level above outlet inven:A Comments: (note if level and distribution is equal, evidence of solids carryover, evidence of leakage into orNout of box, etc.) Distribution box has one lateral;No .evidence of solids carry over; No evidence of leakage into or out of the di -,t-ri htit-i nn hox_ PUMP CHAMBER:ALOL (locate on site plan) Pumps in working order: (Yes or No)- 9 Alarms in working order (Yes or No) Comments: (note condition of pump chamber, condition of pumps and appurtenances, etc.) Pump chamber is not present. (revised 01/75/)7) Page A of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C. SYSTEM INFORMATION (continued) Property Address: 71 Mariner Circle Cotuit,Mass . Owner: John Conlon Date of Inspection:7/2 4/9 8 SOIL ABSORPTION SYSTEM (SAS): (locate on site plan, if possible; excavation not required, but may be approximated by non-intrusive methods) If not determined to be present, explain: Type: leaching pits, number: leaching chambers, number: leaching galleries, number: leaching trenches, number,length: d leaching fields, number, dimensions: overflow cesspool, number: Alternative system: -94 . Name of Technology: Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) Loamy sand to fine sand;No signs of hydraulic failure or ponding•A11 vegetation is normal CESSPOOLS: 22ME, (locate on site plan) Number and configuration: Depth-top of liquid to inlet invert: JA Depth of solids layer: AW Depth of scum layer: 69 V Dimensions of cesspool: Materials of construction: Indication of groundwater: inflow (cesspool must be pumped as part of inspection) Cesspools are not present Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) Cesspools are not present PRIVY: (locate on site plan) Materials of constru on: /(� Dimensions: Depth of solids: Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) Privy is not present Oj (zovlied 04/25/97) P&90 8 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Propeny Address: 71 Mariner Circle Cotuit,Mass. Owner: John Conlon Oale of lnspcction: 7/24/98 SKETCH Of SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent references landmarks or benchmarks oshouse) locale all wells within 100' (locate where public water supply comes 1�k � fN C ------ 7/ ,M or JS »t a6y.r.9 or 10 SUBSURFACE SEWAGE DISPc .:,1 SYSTEM INSPECTION FORM P.,i:T C SYSTEM INFOR;,', .PION (continued) Property Address: 71 Mariner Circle Cotuit,Mass . Owner: John Conlon Date of Inspection: 7/2 4/9 8 Depth to Groundwater Feet Please indicate all the methods used to determine High Groundwater Elevation: Obtained —from Design Plans on record ✓�Qbsl ervation of Site (A in property observation hole, baser*ie-r*sump etc.) Determine it from local conditions Check with local Board of health Check FEMA Maps ck pumping records Check local excavators, installers Use USGS Data Describe in your own words how you established the High Groundw rer•Elevation. Must be completed) Used Water Contours Map. Gahret & Miller Model 12/16/94 r b (revised 04/25/97) Pag. '100t 10 a•wnn r-+.-nrrrr-..T,-ern.mr•nasn�Tewnnnwn�.•.*.srr+++.*.rmn rrsr�ti n.-.a.sn ne .. TTTmeR*ena-v.rn-rrr.vrrtr-:.tr.r '1'UNN OF Barnstable BOARD OF HEALTH ti- .T,-.••.-...-T'�wSUBSURFACE SEWAGE DISPOSAL ,SYSTEM IN9h�CT108 FORM -- PART D •- CERTIFICATION -TYPL OR PRINT CLEARLY- PROPERTY INSPECTED STREET ADDRESS 71 Mariner Circle Cotuit,Mass . '. ASSESSORS MAP, BLOCK AND PARCEL # C) 3 Q OWNER' s NAME John Conldn PART D - CERTIFICATION NAME OF INSPECTOR Joseph P.Macomber Jr. COMPANY NAME J.P.Macomber & Son Ine-.' COMPANY ADDRESS Box 66 Centerville,Mass. 02632 Stravt Town or Clty state C!P COMPANY TELEPHONE ( 508 775 - 3338 FAX (508 ) 790- 1578 a CERTIFICATION STATEMENT ' I certify that I have personally inspected the sewage disposal system at this address and that the information reported is true , accurate , and ,f complete as of the time of inspection . The inspection was performed and any recommendatloils regarding upgrade , maintenance ) and repair are consistent with my training and experience in the proper function and maintenance of site sewage disposal systems , on- Check one : Systeui PASSED The inspection which I have conducted has not found any information which indicates that the system fails to adequately protect public health or the environment as defined in" 310 CMR 15 . 303 , Any failure criteria not evaluated are as stated in the FAILURE CRITERIA section of this form , System FAILED* The inspection w1►ic), I have con cted has found that the system fails to Protect the public health and the environment in accordance with Title 5 , 310 CMR 15 . 303 , and as specifically noted on PART C - FAILURE CRITERIA of this inspection form . Inspector Signatur Date 7/24/98 One copy of this rtification must be provided to the OWNER, the BUYER ( where applicable ) and the DOARD OF IIBAL111. If the inspection FAILED, th'e owner or oporator shall upgrade ayetem. otherwissee as providCd within oP the inspection , unless allowed or required in 3.year of the date 10 CMR 16 . 306 . partd . doc a < W s THE . COMMONWEALTH OF MASSACHUSETTS DEPARTMENT OF ENVIRONMENTAL PROTECTION BE IT KNOWN THAT Joseph P. -Macomber, Jr. Has satisfied the Department's qualifications as required and is hereby authorized to use the title CERTIFIED TITLE 5 SYSTEM INSPECTOR as provided in 310 CMR 15 .340 and Section 13 of Chapter 21 A of the General Laws. Issued by. The Department of Environmental Protection. lunc X. 1995 Acuity, Director of tlic l) ion ul Watcr Pollution Conlrol '� I r- ! 4A r � r - r ! ! r f _ ^' c ; CA v 0 v N ! [,r N i! 39 1� IO 479 0 �il . *1 No...._... �.... \ Fss... .d............. THE COMMONWEALTH.OF MASSACHUSETTS BOAR® OF HEALTH I Appliration for Uhgpoii al Works Tonstrnrtinn famit Application is hereby made for a Permit to Construct (X) or Repair ( ) an Individual Sewage Disposal Sy �..1 at-,,,,, .. .......�Cf®. 2c^ --`.............. .------•---.............................. .Loca' A Lot N d e or ._ ---- --------- �� ----------- . Owner _. j .......................... '�::..4 . ...•.............................. .......•-•---•----•---..................................... Installer Address Type of Building Size Lot_. ^ 4 ......Sq. feet �-� Dwelling—No. of Bedrooms..._.__..:............................Expansion Attic ( ) Garbage Grinder ( ) Other—T e of BuildingiWe,e��.._ �. W Other—Type �y[ .. No. of persons...........:.............. Showers ( ) — Cafeteria ( ) Other fixtures .......................... • -•••••-•---..._....-----•......_.._...._.._..-•••-••••....••••-•-••-•...........--•••-....--_..... Design Flow........... a....................gallons per person peril ay. Total dai}y flow........ "_.:� gal W // �`-�-�..................... Ions. WSeptic Tank—Liquid capacity.,/ gallons Length./Q�...... Width.S-.......... Diameter................ Depth................ x Disposal Trench—No. .................... Width.................... Total Length........`_._.. ...Total leaching area.__.._' _ __..sq. ft. Seepage Pit No........ ........... Diameter.._.. _..__.._.. Depth below inlet... .. ....... Total leaching area. .............sq. ft. Z Other Distribution box (/ ) Dosing tank-( ) / Percolation Test Results Performed by....... __.,s � _ ���'� Y 1,.... Date Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water----- Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water "..' a O Description of Soil---�� ..... "l' t :ter U Nature of Repairs or Alterations—Answer when applicable........................................................... S.................................... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLL 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been 'sued by the b rd of 1 ealth. ; Sig ... � z =,�c� Application Approved BY------•-•-6�<" -- •••--.. .......••• • ----.. .... • Date Application Disapproved for the following reasons:.......................... . ..-----•-----••-----------------•---....----•-------............---•------•-------•-----.............-------•-•-----------•----....................-................................................... Date Permit No.............................................. .. Issued.-•--....d —) ._.... -------------• .. Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH CGFi-'---1-----------------OF.........�C riit�J ��2..._...... Appliration for Disposal Works Tonstrnrtinn Frrmit Application is hereby made for a Permit to Construct (X) or Repair ( ) an Individual Sewage Disposal Syst....at.' ...... - - Coca'o -Ad esSr Y lj ...�Y _ Gc/1.. ..... - f or Lot No. ................ -f --• - - ...• ]` �� �) Owner �6 W ..- . .... /� :'. / ................................ ........................... Installer Address UType of Building Size Lot_..: P,o ......Sq. feet Dwelling—No. of Bedrooms.........3.•............................Expansion Attic ( ) Garbage Grinder ( ) �P4 Other—Type e of Building a t8 yp g ,(J__:`...:........ ....... No. of persons............._.............. Showers ( ) — Cafeteria ( ) d Other fixtures ...................... . ----------------------------•-----------•-•--••---••••••---•••••••-•---•----••-••------•....--•......•--•---••........-•-------------- W Design Flow............. .................._...gallons per person per day. Total daily flow........__3 d.._...____.._..._._._gallons. WSeptic Tank—Liquid capacity_.� gallons Length_/�.�^.._-__ Width..S. __._... Diameter________________ Depth................ x Disposal Trench—No..................... Width.................... Total Length...............1... Total'leaching area---- ......sq. ft. Seepage Pit No..................... Diameter.....12........... Depth below inlet.. --3_....... Total leaching area .............sq. ft. Z Other Distribution box Dosing tank/( ) '-' Percolation Test Results Performed by.____../.Z ' :...�' �._._ Date...�� s 0-7 -----•--..---- Test Pit No. I................minutes per inch Depth of Test Pit...._........._.__.. Depth to ground water---- .-•.. rX4 Test Pit No. 2........:.......minutes per inch Depth of Test Pit.................... Depth to ground water./.��.�G O . R.................•-___•_•_•__•_•_•_•___......._.....__-__......_•__•_•__......................_........_....._.........._...._..__..........._......... Description of Soil....__0�.'_._ ':...----� t'r': f � --------------------------------- 0_ `� -------`t Cct' � = 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 TITHE 5 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 bo rd of health. r Sign ----•---- •.- .............. -6 ....... Application Approved By.......... / Date Application Disapproved for the following reasons-.......................7"'.""*" - - --•••--••---•--•-•------------•••---....••-- ---•-..........--- --•-•-•.............•-----.............------•-----------•---•-----------------------•-•---•-----•-........----------------------•--•------------•------------------------------•--•---••....----- Date PermitNo.......................................................... Issued----................................................... Date Y THE COMMONWEALTH OF MASSACHUSETTS BOARD2X) OF HEALTH,...: •,:.,,>,w,, ,, :_=�; .,.... / .... ...... ��e, ifirtt#le ,af faunt�rltttnr�e ITHIS TO C ....-IFY hat r hndi'vidual Sewage Disposal System constructed (4 or Repairedby.. :..r ..... ..........--?-•.............•-•--- st ler � rAk t- at - � 1 ` L (,U. - f --.......................... has been installed in accordance with the provisions of T + }}�°s-5 of The State Sanitary Code as describe-' ip the application for Disposal Works Construction Permit No.. .......Jz1...__...._.. dated_._._.. �""_: 0!___�-----------.... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE....:!V.�...79H.................................................... Inspector-- -•-•--•---------:........---......---•--•---...... THE COMMONWEALTH OF MASSACHUSETTS BOARD-OF HEALT ..../�C,G...l�............oF......%,j.�/�� --••••••f7-.`..... .�� No.......... .............. l FEE................... ... Disposal Works Tonstr to ", n nti# Permission is hereby granted....--�t-r ��_..... ...... .�'... ----- 1__________.......................................... to Construct ( Re air ) an'Individ al Se Tage Disp�o S i '9 atNo. �� -----••-------------•---•...... ------------- Street P ated ------•-----------------•--.----- as shown on the application for Dis Disposal Works Constructions t o... o - - - .--- - -------­----------- DATE �.: Board of Health --------------------------------•---•---.........----•-•----•••-•...-----•.----- FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS xF� b No........( :I. Fss.. ............. THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF F-1 ALTH DZ3- Dy lv ..............OF......Z>......................... 1 Applirattion for Uispnsaal Works Toustr.urtUaat Prruat Application is hereby made for a Permit to Construct or Repair ( ) an Individual Sewage Disposal System at• t --•---�Loc n- . \/ � Lot No Own --•-......•••••.................. ..............................................•••.................._......................._.._.. rye Installer Address vt 'T,ype of Building 2 Size Lot--L76�_.000...Sq. feet 0; Dwelling—No. of Bedrooms;__.___.. _.•_T.....................Expansion Att}}'c� ( ) Garbage Grinder ( ) Other—T e of Building No. of ersons..__ ._._(Q __.____ Showers — a Other—Type g - p -_ ( ) Cafeteria ( ) dOther fixtures ......... ---------------------------------------------------•----------------•--------------------•-.......--------...._.------ Design Flow..............i.s.........................gallons per person per day. Total daili flow.................._........._....._..._.---- gallons. Septic Tank—Liquid capac>ty/OOD.gallons Length.fJ/�...df1.._.. Width...,___..... Diameter................ Depth.............__. W Disposal Trench—No..................... Width............ Total Length............. Total leaching area..... q, ft. Seepage Pit No.......____.�____- Diameter....... ......... Depth below inlet.....?........... Total leaching area.. --._.sq. ft. Z Other Distribution box (® ) Dosing tank�, ) Percolation Test Results Performed by Date ..v f �1�7............... aTest Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water.._._ _ /� �Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water. .__......__._....____ a' /� / -- -.. ... . Descraption of Soil L!....BL! j� � �=® ---------... - -._........ .. . ............. x -------------------------------- ........__ --j U x �� ----------------------------------------------------------------------------------------------------------------- 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 iITI.% 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has bee issued by th and of health. Sign --_ -- i� '�`-_ //. d. �/at;e Application Approved By----- .. .. 1 J✓�......................... /)- - -------- Date Application Disapproved for the following reasons:.............................................................................................................. --------------------•-•-•---•----------------.......-------•----------------------------------------------------------------------------------------------------------------------------------•--_..--- Date PermitNo..................................................0...... Issued-....................................................... I_ Date NoPP J.... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HIi ALTH ....../ ui --------------OF.......r/...it �ri........#'� ................................................. ApplirFation for Bitipostal lgorkii Tontrnrtion ramit Application is hereby made for a Permit to Construct (Xj or Repair ( ) an Individual Sewage Disposal System at: .....-- 66 .. /.� /Loca:lo'n-A d'ss ..�.. ----- ..............( fc <_C ?. ��" �C (..... \/ or Lot No W • Own --------------------------------------------- ------------------------------- ..... des'---------------------------------.--------- ✓ Installer Adrs W - Type of Building Size Lot.. y 000...Sq. feet Dwelling—No. of Bedrooms.......... --.�3...................Expansion Attic ( ) Garbage Grinder ( ) 'k Other—T e of Building ..� _. No. of ersons....._ __ ........ Showers ( ) — Cafeteria ( ) Other fixtures ------------------------• WDesign Flow...........�_ .........................gallons per person per day. Total dai17 flow............................:...............gallons. WSeptic Tank—Liquid capacity /�'62.gallons Length_/?�.%.--.. Width-_S......_. Diameter................ Depth................ x Disposal Trench—No. .................... Width...h..._........_.... Total Length..............._._ Total leaching area....� _ -^�q. ft. Seepage Pit No............/....... Diameter.._............. Depth below inlet.................... Total leaching area...............J...sq. ft. Z Other Distribution box (f ) Dosing tank_ ) / Percolation Test Results Performed by..........� ��"'�Nr��i�{-' ✓ /�� ----- -----•---•------------------•------------•---••------ Date.....--�1-•.-•----���-------------- Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water./�i _�� well 04 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water...................___. - - J �C-1 •- D Description of Soil t. ....P ..-•--•.-------- 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 TITLi; 5 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 theA and of health. Signe _. ------------------ -------- ---•------- � -. Application Approved By....... . ...................... ..... �l�tL -- Date Application Disapproved for the following reasons-----------------------•----•---------------------------•----------------•-------•-•-•-••••......•-•-•-----••---- .................•-•---•--....•--...-•••......-•-----•••-••••--------••-•-••--••-----........•-----•...•-•••-•••--...••••••----•-•--•••-------•-•--.................................................... Date PermitNo......................................................... Issued-....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ...., ;11�'�............OF..... 't�l�J ............................................................................ %untifiratr of Tomplianrr TF I S TO ERTIFY, 7li2!- e Indi tal Sewage Disposal System�cconstructed ( or Repaired ( ) by -. . ,/..............................j ../. - - - `` �01t- ? !1_._.. -r .( at �-r"`� / ��'1�1i� &.�i'i-,C Installer. Gv� ...........�.:R�.......ar. ................ ✓.•-•••-•----------- ------------------------ has been installed in accordance with the provisions of TIT 5 of The State Sanitary Code as desc 'be in the application for Disposal Works Construction Permit No ....... dated_`. .._. ............. THE ISSUANCE OF THIS CERTIFICATE SHALT. NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE...............................................��/�.X. �........ Inspector....------../�.�T_..'.................................................. THE COMMONWEALTH OF MASSACHUSETTS BOARD, F HEALTH No.....CJV/ FEE...................... �i��o��a1 or�,� �o�,�,trnrti�an rrartit Y Permission is hereby granted.... '�� ._ ��_..._ to Construct (,>0 or Repair ( ) an Individual Sewage Disposal System at No.. r`- �� ✓1���....._.:.._.�---�-�',�- - .... fit ._`��� ------------ ------_� as shown on the application for Disposal Works Construction Permi o.___.._:__.j._.__. ted.._...//----•�'�----- v-.-- 'DATE.........��`!`-.:-t�--"-��.................................... Board of Health FORM 1255 HOBBS & WARREN. INC., PUBLISHERS 'fi,. ,r • a Y9-Z/V* so i \ ' I a 0 t i f Ii1 oa ---, S o. i t � F: I f eol OR -0 KIP I OD � I �• � I x°p i. 1 1 7 I lit n. 10 ! ! /ides j 1 I � �it!i1p ix�/Y�1h ' 1.J � r . � tioa,u�Illla�3r�I Dio�il' r Q HATc44 r-=2otjT � w � �7 TrA a op y o � NIL � � o I 3 i � �o�'7 dY E � a�6'19Xc° oz I . .'I/y01 �I J(�J I NO f 100 1-7 c i STUD �-161 c'H ? 4 � x \ tt RP c4b a. f h ! n i o i i i r i { l aa 4/0 i � PYA cpb ;70 dl�► . t)Ix6 o 400 �z,/,,aof ,r 919 04 1 g --- - -_ - - - -- ..•1 C-ZE-QE7V-4L. N OTES Y�A.SE t� o►J U S G .5 O,ecr,-)" P L�,-j E ♦"♦ - P 1 tG N A tr I v E s. 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R 0 PO S E � 5 Eel '(fit SPOSA'` S%f STt� lt` 1 1+,3t!:- _ C.I TC-Lc. � nJuMr�E2 OF Z3Ev>Zc�ti1 , (oG�t t F-x�sT- SPd-T- I�� E./ �-OT � * PE Q.Sc�► J 3 f"E�' BE c���Nt -- - --�`�Xd t't��P SPoz- �.�...,E,� vA LI..C_)#,J 5 PE2 PeVSD►J Pam" 0AY ' M ASS l .r _6� ® C)gSEIZ✓A'("to� 1 T��T t-1C`,�,E !_�C'�T t I1�4 �f`� ('L1�.� 1� lil I . `Qt �-oP�SE� I..EAc.«�►.iC-� PIT SC AL_E � A5 ►JO"�EO DATTc : f�i.r,v, 1� � �iaJ Stty �.. ._ _. _ a -; ' /5..SIG. .::. L: •".�.T�/ T�-k.1 `ST PLOT- P L � -ram ,.� _ o . F IN AN �C 1JGc t ac E = K3OiZ Ma.r•S ( (cc)sSN'1 A►J, PE.. �s c_A l-rt 1 .. , r�ROSSA4i� '� Ly 15t C.�wl\j <3Aj PC.^J3 ic;-7 S*4ct7r 1_OT SNGW•J QJ ���-TUC',t� ICe-7 0,� 6 SYSTEM PROFILE ALL SYSTEM COMPONENTS SHALL BE MARKED WITH MAGNETIC TAPE NOTES Rd. FTOP�. N. AT EL. 54.6' PROVIDE IF NEC., 20" MIN. DIAM OR COMPARABLE MEANS FOR FUTURE LOCATION `nd�5tt� ACCESS COVERS TO WITHIN 6" OF FIN. GRADE (NOT TO SCALE) 1. DATUM IS APPROX. NGVD (GIS SPOT EL.) ACCESS COVER (WATERTIGHT) TO PROVIDE INSPECTION PORT TO WITHIN 3" OF FINAL GRADE MINIMUM .75' OF COVER OVER PRECAST WITHIN 6" OF FIN. GRADE 2. MUNICIPAL WATER IS EXISTING 2% SLOPE REQUIRED VER SYSTEM 53.2' outo 2 P RUN PIPE LEVEL 3. MINIMUM PIPE PITCH TO BE 1/8" PER FOOT. deuce FOR FIRST 2' " EXISTING 100p 2 DOUBLE WASHED PEASTONE 4. DESIGN LOADING FOR ALL PRECAST UNITS TO BE AASHO 05 C OR GEOTEXTI FABRIC H- 10 GALLON SEPTIC 50.5't* 50.5' o Locus o TANK (RE-USE)** GAS �o c' rt BAFFLE 49 9, �� 49.73 007;7 5. PIPE JOINTS TO BE MADE WATERTIGHT. o 6" MIN. SUMP 49.73' a 12". MIN. INT. DIAM. 6" CRUSHED STONE OR MECHANICAL go 2' 6. CONSTRUCTION DETAILS TO BE IN ACCORDANCE WITH COMPACTION. (15.221 [2]) $ ooc 47.73' MASS. ENVIRONMENTAL CODE TITLE V. DEPTH OF FLOW = 4' 7. THIS PLAN IS FOR PROPOSED WORK ONLY AND NOT TO TEE SIZES:INLET DEPTH " 3/4„ TO 1 1/2 DOUBLE WASHED STONE BE USED FOR LOT LINE STAKING OR ANY OTHER PURPOSE. = _ OUTLET DEPTH = 14" ( 1 % SLOPE) OVERALL DIMENSIONS TO OUTSIDE OF STONE = 30.4' x 10.25' 8, PIPE FOR SEPTIC SYSTEM TO SCH. 40-4" PVC. FOUNDATION EXIST. SEPTIC TANK 60' D' BOX 2' LEACHING 5•2' 9. COMPONENTS NOT TO BE BACKFILLED OR CONCEALED LOCUS MAP FACILITY WITHOUT INSPECTION BY BOARD OF HEALTH AND PERMISSION *THE INSTALLER SHALL VERIFY THE **INSTALLER SHALL CONFIRM MINIMUM SEPTIC TANK SIZE AT OBTAINED FROM BOARD OF HEALTH. NOT TO SCALE LOCATIONS OF ALL UTILITIES AND ALL 1000 GALLONS AND ITS SUITABILITY FOR RE-USE. REPLACE BUILDING SEWER OUTLETS AND ELEVATIONS WITH 1500 GALLON H-10 SEPTIC TANK IF NOT SUITABLE. 10. CONTRACTOR SHALL BE RESPONSIBLE FOR CALLING ASSESSORS MAP 39 PARCEL 143 PRIOR TO INSTALLING ANY PORTION OF DIGSAFE 1 888-344-7233) AND VERIFYING THE LOCATION SEPTIC SYSTEM BOTTOM TH 2 EL 42.5 OF ALL UNDERGROUND & OVERHEAD UTILITIES PRIOR TO NO NEW CONSTRUCTION PROPOSED (SEPTIC COMMENCEMENT OF WORK. UPGRADE ONLY) LEGEND 11. EXISTING LEACHING FACILITY SHALL BE PUMPED AND SITE IS WITHIN AP AND ESTUARINE PROTECTION DISTRICTS x 54. 3 REMOVED OR PUMPED AND FILLED WITH CLEAN SAND. 100.0 PROPOSED SPOT ELEVATION 12. ANY UNSUITABLE MATERIAL ENCOUNTERED SHALL BE +100.00 EXISTING SPOT ELEVATION REMOVED LEACHING FACILITY.' BETH AND AROUND THE PROPOSED 100 PROPOSED CONTOUR x 55.42 SYSTEM DESIGN. 100 EXISTING CONTOUR x 52.89 GARBAGE DISPOSER IS NOT ALLOWED 73S x 53.59 DESIGN FLOW: 3 BEDROOMS ® 110 GPD = 330 GPD S3 - CA USE A 330 GPD DESIGN FLOW x 3 , SEPTIC TANK: 330 GPD (2) = 660 x 53.43 53.20 RE-USE EXIST. 1000 GAL. SEPTIC TANK ** 3 POND • 53.21 \� E � LEACHING: SH x 55. 5 LP 3.22 0 54.13 "� LOT 41 SF 50.08 SIDE'S:(30.4 + '10.25) 2 (.74) = 120.3 GPD TEST HOLE LOGS 2. 1 2.1 BOTTOM 30.4 x 10.25 (.74) = 230.6 GPD 530 / ENGINEER: A. H. OJALA, PE o x 53.85 TOTAL: 474 S.F. 350.9 GPD v WITNESS: DAVID STANTON, IRS ^�O oEo�` �o� USE (4) 3050 INFILTRATOR UNITS MAY 7, 2009 BENCH MARK - CORNER OF 5�.36 53.10 PPP WITH 1' STONE AT ENDS AND 3' AT SIDES DATE: BULKHEAD ON WOOD 53.11 / PERC. RATE _ < 2 MIN/INCH ELEVATION = 53.5 53.45 53.22 12549 x 5 .12``' 1 / 3.29 CLASS SOILS P# 52.91 / Q• Q MA APPROVED DATE BOARD OF HEALTH 1 ELEV. 2 ELEV. TOPw NDN. 54.6'ST. DWELL / -- W W 52.42 W W 4 X co / Aw� p" � 53.5' p � " � 53.5' � � p p �?• TH 2 2y, c 52.42 1.83 3 0 TITLE 5 SITE PLAN �� x 51.22 OF 3 3 52.20 x 51\ c E E TH 1 49.93 y FS FS x 52.02 113 EISENHOWER ROAD 10YR 7/1 10YR 7/1 491 4" TUIT B B �2• ��°° �a949 PP SL SL PREPARED FOR 28" 51.2' 10YR 4/6 28" 51.2'10YR 4/6 x 51.8 / � x 49.66 BORTOLOTTI CONSTRUCTION/ _ - 120. x 51.5 , FITZGERALD -- PERC C PERC C -52. 3 �� 31 , R�-J(:) rpC 49.71 - 51i _ x 51. 4 F-5 / MAY 7, 2009 CS CS - _ �.64 �� -i14 �jN OF Mq3 9.83 � , 51s� 5� s9c N OFMgs off 508-362-4541 / / rRUM �o� DANIEL �� `� SqC� fax 508 362-9880 2.5Y 6 4 2.5Y 6 4 AN L,gNE A. DANIELA. 124" 43.2' 132" 42.5' Noo..J40980 �CIVIILL N down cope en gin e erin g, inc. aP No.46502 ' Cl VIL ENGINEERS NO GROUNDWATER ENCOUNTERED Scale: 1"= 20' qNo � o`� o�� \�� 1sF A L �o LAND SURVEYORS 939 Main Street - YARMOUTHPORT, MASS. 09-085 0 10 20 30 40 50 FEET DATE DANIEL A. 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" I.: I ,� � : � I - - � ' r I � I I � ,�-�--77*2-apl-EM 7- '­r�_Ll� it I � I 1. � I I I � . - . � � ,- I -1 . - ­ � I - *NOTE: ALL PIPES ARE TO BE 4" SCHEDULE 40 P.V.0 I I I � � � I � I I - \ - I-,� I I � I I. . I I � � L . � I , -Z � _1 �, I �� I - .''�1 11, i , I I I 11 I., VENT PIPE�*Least 2!4 Inches tail)' I I I ,� I � _ ­ , - - : � 1, � _. , I _.� .� I I PVC w/chorcool 0dor Filter I � � I � -I � � I �� - � � I � . � r r Schedule � r .I I - 11 . ., � I- . I . r - r I r � , . . . . . 1::-�I 1. ., -�� rr ''. '. -� L �­ min. -am I . �11 I 1. � . r r . I I �. : _, . - I 11 �. I � .,r I I ­ I 1 . � � � r r ' I . .....11 . ., I . . . . , , . I fr - � , I I � . - . � . � I �. - - I 1:11 � - . I .1 . I I r . 1. I I 0 . I I . ; I ,r' F :� r 'T�7 16' . 11 - i I I - . I ,�� � I :, I . ,� r- - I ­ I ­ I � I � . -ESTABLISHED WOETATIVE COVER I Itf , � r I r r . . . I � I- . .- * � _ , , ­ � , , r I OU I r � � I . I � ,, il I r. : - . I I I I � . I I I- � I I I � � I , , , , .Aisting Foundaii I ,. , -, _ . _ r I � I � � 'r " - il I - I .1 I . I I I I I . .. - 11: . � . , , ' I I � I I 1 I L I� , � ion r so to septic tank , :��, . -, L�. . �- I I I . � 11,1.11 � , I r I I., I I. .I I - r Ir I I I I � I I � r, ­ I, ,� :�, , " , . ,r I I I . r ,L: � . I r I : b . I I I I . . I 1, I 11 I I . I 1, D_9OX Ca"W Must in 1. 1� I r I � r I I I 11 I I I I I "r � I I � I I I I . .. I I � . . . . .. � I � .y r ! I I­ . . iuu.uu . I I I� I I- I I . . , . I I � : I� I lr�, : 11 I r � , 11 1, '' I I- r ,, I I I � � I ­ - � r . I I I I ' ", , , � I I I ,r I I , . \ - r I - r ) " '�, . I I I I r , 6 1 �:�" , , � , r " I . 1,�'r�, � I ,I r I I. .1 11 � r 11 I I I I , , .� I 4 . . I :1 r I I � , I I I I . I r I . � I I . r I , ,,,.:� "' I I � r 11 �_� I .I I . r 11 - � � . I � r I r I I � I ,� I I �I n r I . r I . . . . . I � . . . . � ; I I r r, ,, . - I I 11 . I r� 11 I 1.� I. I �- I r . I 11 r �r I r . I I � 1. . � r I � .1 I I -- - I I I I I . ;r � . I I � . I � I � I .A k I . � I ; �� X_O&OO '_ I r SAS' - . I I � I *4 - . r .1 - _ I 1 4 1 . � I � �.1 : I r . r ' - I - . � � I r I L . I 1, I . � . "*%w&*tb Tark IWOO 1 17 aver _9&00 r. -r ,r I 1. - � I ,� r - � . ,� I I I I 11. 11 _r, I 11 . r I I . . .I .. .� .r. I - , , I. . �. I .. . .., 1- . . 11 � I I I � .. I - 1. � . _ I I 11 � - . . - I � I--- . r � ', I ­ � I ' *10 - - - ' Givile over O-Bo � � - 151XIN.��,1.11 I" �� , In 11 I r BAWU I"I CLEAN SAND I . . .: " . - I r.. I 011 I . � ..�yl- i . r r - � �t � r I - I I � r. _�, � r, I �I I . I - I r. ,r, r, r r - I ". r - I r I r � - r I r I I I� . � I ' . ." .. 71:1. _ ... -- . INLET . . I r I I . I 1. 1.� I I .I . ., : ­ . , , I I � � I ';� � r . ., L . I I - rl.W - .1.�- I I I I - . I . - I . � . I - I � . I I� r . r I . � . r . -, ..'I .. '.� il I �..;, .,,,#' ..% -,'i......��'... .. �..".. :o4, .. .-1. . I . I . I I . ,4sr ilisssieIlssiiii -�, . 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'.I . . � . -- . I . 11 I : 11 - ---:�- r , I I I .. I i A A - .-..,- ` I I � I . . . . I I . ­ � � , r�� I . I I � : I I . I _1� I_� -, , , - I I . � � r r, I r, I W I-'. - %. ., .... ,.,�'..': ;%,.. :,%*;;i..';V,.:,-, ,#. I I I I � . . . . . . . , . . I � . I . . . . . i � 11 � I � I . � I r I . . ;4,-.---� ,�* , .. I , " ,J".",W.1 sii� . I r I I � I . I . I I I �, � � - ' . ,� I � � , I, - :�-v.e.il%,":* .. . -":. I .."Q­ . I I . . - . . . . . . . , ?A . I I I I- . 1� I . - - I 11 1, ,'r - - 3- 0.02 r, r I I 5 HOLE M-10 , 1,­ r I I, - r I I r 1! ,� I I . � �-...., ,;. - I."-"C .-%.-..*;.t:v;.-,".:�1­.*11:.."� :.,.*, .. ..-4'..4. ...,-; '. '. � I F� . I . r� . .� . ..'��, I . . .� r . I I � . I 'r I r S.G.Of � , r . ST. Box I I I . � I . . r r � I - I I - !*1!..'--.%..."4,., �.8 ,-I- .;, , .. .. * ..,... " �,._A-.,.- I I . I 1. .1 THE ACCESS COMS FOR THE SUTIC TANIC, I I . �� � . � I I !% . .. .I I ,.,....." %. r. I .",eo I . . M03olfflum ower . TOP OF UNIT ELEVA11UN - V0.20 .. ."", '%,,4 4­%.-:,-.­y -1 y ,..,,I.-y."I 7.V'.N,­;- .,%,.*.,, I I . . � _. rr I ,I . EXISTI : ::�� r V .I _.�_.%� - -,;....,;., I , ,"I. . . -.I .,.�) N - otmourom BOX AM UACHING COIIJPONENT I � . I 1. , .1. ..'.'-'.',...'.�-- .... ... .-1..'..:.s.,':.;, . I I � I - - ' � � I . . . , I I . I . . I . . . � % I .S�3 . - I 11 I , 1�, - . . I . . .I I � I I - I - , . --r�*1, � � - .--- - *r - 3 -� -V� I . . I I I ! I I � I I r I . I 11 12' 1 - I r PVC (CA"W)INSK00N MRT TO K ' r � I .1 , , �� , . . . -t- .. I � I I SET DEVER THAN 6 INCHES BELOW FINISHED ! I I 1, . �� Mtt PPE I I I 11 ie 1000 CAL 1, ,­ . � I I 1 ,­ I I Ir I I INSTALLED AND 70 K WHIM e or I I . ,� ­ , � I ;,-,... '......- -% .%... I ..'".."1"' .* - . � I I 11 , ..!!f In.1 7.47M�;,0 r7�7 .L - I GRADE SMALL BE RAISED TO VATHIN r OF , I , ; . � I .� . . �. ' ' I � I � I I I FMMDATMN � 11, I � I 1," I , - �: . 1. . . . � . � . . . I f I I . / 8 , Per foot I � I I - I � INV. ELEVATION - 94.75 , .;. ...,4,*,;,-1- ..,-.. .. . , 1. I . I - I , - I I I � � - . . I � I I I I I FR I(IN EXM I T. . I ,. mi . Wr I it.; TANK � 9 I - . �.�I � I ­ 8 � I I � I., .I 1, - , � . , I ....%.I I . STEEL REINFORCED PRECAST CONCRETE FHSMED GRAM I ., . I-! . .. . . . .. . .. . ., . .. � � I � � ,I � I I I � � I I .1 - & .* . I . � � . . . . . . I i I 0 1 � I . � . - I . - - I - . . � � . - I I (a � I I I I I ­ , I . . . . . . . . I I , �. '.. - � ! I I � I I � I .. 11 I 01 . I- I I I 9 , i I IS Ir I I .I I � � I I .- I %. :...r: ,, ­! I I I I I I I I : INSTALL Wir-TITZ GAS Unin OREQUALS *._&.tV* I/. .. . .. . � . . I . . . . . . . . i i � 11 I � . _ , N H-10 60 I . - Wi � � . - .. �, , I , I PLAN VIEW , I I I - ' ' ' ' ' ' ' ' � ! I I I I . I CONCRE!_ - I I . I tri 0 ­I 1�I I .. . . I ­ I - �11­. I . ' - ' . . ' � . � * . � I I . 1 , 1, I �I I I , I . I � I I I I I I L 0 �. r I L � I I 'i -�. mmum, I I BOTTOM ELEVATION .- 94.0-0 1 L V' A I " - - I I I I I - I I I .. . . . � L . �I , . I *I . , ,. , *. i . � I I I - ii I IMIMAMIMIMINN------ I I 1 3-24*REMO COVERS , I I I . . I . � I . .. ... . I. �� ., .. .. .. .. �" .. .. .. -. .. .. : �. 11 I I I - I I � � I I I I I - I I I I . I ­ I I I 4111n, _\ I I . . . .WA t . I I � , . � . � I I I I I 9 , � I - 11 I I , 11 I - I I I - vtm - I I , , � � 11 � I 1,I 11 11 . , I 'a � N . to I 11 I 1. I I . , , � . � 9 I 6 Kof 3/4*-1 1/2'- ,' 15, ,� � . I I II ,� 9 . � ,: P% 69 I / . . . t , � - - I � I ,� I .. . r I I - 11 I I 1 .4 1 1 1 1 1 1 1 I � I 1, 11 I � I - I I I - r.__1 I - .1, I � I . ;1 I I � , I � C3 :� $ 1 . � 'a - (111 4 IM OF 6 UNITS AT 4'/tMT+2 DO CAP$-2IL01Y I 1 "4 -'"4 , � - I -J - 1)1-, ... . . I ,. I I . ocrWeted stone � 9 I. i � - . I I I I I 1% -, I 11 � I - .5 I � I I I -4 � . . I , I � I I I � 1 5' MIN ABOVE BOTTOM OF I � I ," .. :.".-% 3--:.1.7 f&,I . . I I I 11 � >; I ­ I I I � :1: I I I I I �- � I I I - .� 0 % �7_VQ.tll. _J�Z ?,4-.-!, . I I I I . i i + I � - I I Z I I I 9 : � .S � 1 $ �,� , ,, ''I I � ­ I � TEST PIT OR GROUND WATER 11 I I 11 I I I I �", I I I I �- mm. dearanos I I 0 � I � � . I i i I I,;, . SYSTEM ROFILE ' � I I I 1 , I I I ­ c 1711 . \ 4 . I .. OW . GENERAL NOTES � . 1 I I 11 I �, � I � I -'r I . ONYINO SUTABLE MATERIAL , . I ..Ir Ir'*' i . I I I �I I I I I - I I ., - .� .- � "a -EAVJF. WID TH 12.70' I I I INLET 11 JTS rnin I r rnh inlet to auest S.#" -f ,. I I I I I I I I I Not to Scale 6 Kof 3le-I 1/2* . I I Bottom of Test Hole I Elev.= 88.50 GROUNDWATER NOT OBSERVED I . . - - ` 177 Lq=14yer- I OUTLET ... - 1. I. Contractor is responsible for Digeofe notification, VERIFICATION � I I � I 1. $ 1 - I I I L I � I � 11. I r. I . � - � I compacted stone I a I GROUNDWATER NOT OBSERVED . 0 Mot 51-1-11, 1 r I - 11 � I I 11 1- I I I 1 10 �.. � . ;N T and protection of all underground utilities and pipes. 1 1 1 1 � I I I I NOTE- , ALL COMPONENTS MUST HAVE RISERS TO WITHIN r BELOW GRADE I I I I 1, I . I . I I I . S' -7* � . . .-� I 1, r I , I r I - I I � I 11 I I I I I I I I � I 11 I . I � I .00 SOIL ARSEIRPT113N SYSTF! � 1�1 I I . I -1 .0. ' :. V -7' 1 1 2. The septic tank a74 dist% I � I I I I I I � . I I . � � I I I I is I 1 � I I 11 I . I -_ I . I I I I I I I V ' :, level ,.#ion box shall be set . ; � I I . � ! 11 .1 4!-Cr I on 60 of ', I � I � I � ESHWT - NO GROUNDWATER OBSERVED 0 132' : Min. . 4 2 stone. . , I � � I 1. . I I I . � I . I � I . I I . . - INFILTATROR QUICK 4 . (H-io LOADING)/ GEORGE O'BRIEN I I "O I on � dVth � . 1 3. Backfill should be clean sand or gravel with. no � i . I I I I -_ 0! . I � I I . I I . I - � I . . 1. . . . I . I I � I I . � I I - ,� i I � � I I � 11�- . , stones over 3" In size. I � - � I I � � I I I I I I I I I � (OR EQUIVALENT) I I I I I I I � � . I I .1 I I I I � - � I 11 -� I I .11, I . � 4. This I I ,. . I I I I . I I I I I I I . � I "I I V.. . �,I � I I I - I 11 11 11 I I . I I I I � . I I I I - I . . - - Caystern is subject to inspection during installation � I I I . � � I , I � - ,.' � *.l::.!:,-,I#'.'... I I I - OVERALL HEIGHT OF INFILTRATOR IS 12* a , . I I � I I I I � I � I I I I I 1 . I � I I NOTE. I . - I_J'�,;,'.L.P.�''?4';�� 1� - by Orman E. Shay - Environmental Services, Inc. I I I iI . � , I I I 1 . I . I - 11 . 11 . I _ -41-01 � _,V -IQ------j I I . : i . - . . . I . - I I . 11 I,- I i I I I - I I I � I CROSS SECTION , " r, , I - I 5. The contractor shall install this system�in accordance , r .1 . I ; I - . . .1 I . . � I � I I I � I I I I I I . 1 I - I I I I I I I i 1 I I I � � . I . I . 11 I I 11 I I I . 11 I I I . I . I I I I I 11 I I � I -SECTION , � , L r withritle V of the MaseachUsetti state code, the approved plan I I I � I I I � I I � � . I I I I . . I � I I I I � I I I L ENL I 1 -1 ! : I I � � I � I - : - I 11 � - . I I I � I I � I 11 � I I I I I 1. . - - I - I I . I - � I . I , � I � 11 .1 ­ . I I .- I � - I - . I I � � I I I I - I I I I I I I I � I - � . and Local Regulations. � ' . ­ � 11 . I � I qI � I I r . I � I . � I I I i - 11 . I . I - I I . - I .1 I 11 . � � � � I - . � I I I I I . � - � I . I � . . � I I I � -1 . I I - . � " � I � � I I I � � __ I I I . � � - I . I I .1 . . I . � -_ I I % 1.1 6. If,' during Installation the contractor on6ounters any I . I I � I I . . � r � I I . I � I . I I I I 1, � I I � TYPICAL 1 000' GA LON -SEPTIC TAN . I I soil conditions or site conditions that are different - 11 ; I I ; I I I " . I I , I I � I 11 . I L K � . I I I I I II 11 I � I 1, � . I . I I I I 11 I I I I I I I I . 11 I I I � I I - I I I � I 11 I I I � I I � .1 I ­ I - . I � . ; � I I � . I I I I 1. , I ­ I I . 11 I 11 I I . 1. . . I I � . �, NOT TO SCALE ,: I 11 I I . frorn ,those shown on the .soil ldg'or,in our design , I � I � I . � I � I I � I I I - . . � I � I I I , I I 1­1� I I . I - � �� I I .I . I � � I I I . 1. - -� I I 1. . I i . - � - I . I I I I .� I . -I_.� , I � � . I � . I "� � I I I I I . ,; � I I �_.� I � .I � I I .I I I ,��I _�, I I 11. .11 -I I -I L 11 11 1- '1­ . 11, � r .� I . :.,� 1,�r installation muit-holt & immediate notification be * I I � I I . I i -_ ­- - 11 I I I I ''I . , . - I I I I �. ,� . I . i I I � � 1. I I � I - made to Carman E. Shay "-,,Envircin mental Services, Inc., I I 1! . I I I I . . . I . I � . I I - � � I � � I I - I I I I I I . 11 I I I I - � I I I I I I ..1,, 11, ' ' ' I I I � . .1 I - 11. 1� I I- I I I I � . ; ­ . ��..� �, I . . I . i ' � I � � �I 11 � . � � I I I I � I I I I I � . . I ­ I I I � � ­ . 11 .1 ­I � I I 11 -, I I I I I �, � I ­ I �.�� I I I � ,- I � � 11 11 ­7., No' hlcli,�or h' "" moc nory, 8 .11 r 1, I I � I � . I I� I I I I I I I I I I I I . I I I I . � I � I . .. ve � hi h drive' over the-: � , I I i I . I � . � � � � � I � I I I I I 11 I . I PERCOLATION TEST 1 1 1 , septic system unless,noted as H-20 septic components.. ' : I I , I I � . . . -1 � I I . I I I � . I I I I � - . .1 I � I I - I I i � � I I I . . . - - I � 11 I., . 1 8. Install Tuf-Tito goo baffles or equals on',oll outlet too ends. I � � � I . I I . � � , � I I I I - 11, � I I I � I I 11 I 11 ­ r ' - , I I I �, � I I I I � I I I I I . I . I � I I . . � - I " 11 � . I I � : ... � � . . I I I I I I I I � . _... - . I I I - : I I � 11. I � .1 � , I I� I I I � . I .;-- I I I I .. �� I Date of Percoilaticini Test.' AUGUST 3, 2009 11 I I I .. I 9.' All Distribution Unos�shall''be 4* diamets,r Sc'h. -40 NSF PVC pipes. I , I , I . � � � I I I I I � �Test Performed B)r CARMEN E. SHAY, R.S., C.S.E. I 1. � � � � . I . I I I I . I - � I - � 10.,All solid piping, tees & fittings shall bc 4" diameter I I I I � � . ; `�, .1 . I I I I . I �, - . I I I I Results Witnessed By. DAVID STANTON - arnstable BOH . ' � - I . . I . I I I � I - . . . I � � , .. I . i I I r I I I I I I I I I I I I I I EXCAVATOR: Shay Env. Svcs. I I I . Schedule 40 NSF PVC 'pipes with water tight joints. 11 I iI � I - � I -r I I - I . I I � 11 ,. . I I I I - i I I I � ­ I I . � I � , I .Z . � . . I Percolation Rate: <2 MPI 0 36* . . � I I I Z ; � � .Z I I I I � I .1 � � I � � � - I I I - I I I I I..,. MUNICIPAL 'WATER IS AVAILABLE TO THE SITE and Surrounding � I . I I I I I � . I 11 I I I I I I .. I . � . �- . I,� � I - � 1. . . - �. I i . - I I -. 1. - I - � I . � I . L I I � I I . 11 I I . . I I I I I I I I I 1. 1. 1. . � . I . � I., I I I Test Hole" � ��I r I.,I I � I I I - - I 1. .I - I Properties. , NO'PRIVATE WELLS WITHIN 150 ,FEET of PROPOSED SAS I � I � I I _1 I I I I L . I '' I - I I 11 � � � I I I I. I � I I I Test�Hole � , � "' r' � r I 11. �;" .1 .� I 11 � r . � I I I . r � � I : I - I . I 1, I , . ' I�; . I r 11, I ' ll I . I I I I : I I I �, I I L . I I . � I I I I I I I I � I I I I.. I I � 1. � I � I � No. 1 ,,,' . ,��. , � No. 2 ) - 1� � . I . .. ;_:� � �, � , I� I I I I I .1 - . - : L � I � I I I I - I I I I I . .- DEPTH ' - - I � I I ,� - I � . � - . . I I . � - I 1. � 11 � I . I - - WLS- ELEV. , DEPTH SOILS EMY. I � � I I . ­ � � � 11 �,�,� I . � I . I I : -11 I , I . I � . I � I I - . I 9&00 r 0 I i, NOTE: � Ir. ,� I "I - I I L "I I I I � I r I I � . I ,. I . I . - I I I �� 0 1 . �, I 98.00 , 11 1. .11 �. I- I I I I I I I I . . I I I . - I I I I I � I � . I I I I I I I 11 I I I I I I - I I .�� Sandy Loam - - I I I I I� I I . "�. I � I .THE,,PROPERTY LINES-ARE APPROXIMATE AND I � ­ . � I I I -1 I � � I I . � . .� , .. I I �. I I � I I I I . �, � I I I I � .I . 1. I �,�'.. I I I Sonldy,Locirn I -1 I -1., COMPILED FROM THE PLAN BY NORMAN GROSSMAN, RLS L I - I ' : . I � - I I I I I . I � . I I 1� .. 11 11 I � I II - - � � I I . 1 � I 1� . . I � . I., I I � I I I I . . I � � � �� I I I � I . . . . I 10 YR 3/2 I- I I .. I � 11 � . . . � MA,, ENTITLED "PLOT PLAN,OF, LAND OF LOT 40 MARINER CIRCLE, i � . � I I � I i � I I � I I I , . � . I ­ ,, I I , I 10 YR 3A � . . � I I ,, I : � I I I I I I .1 I I I I I I I 11 "', � I I 0-6. ,,""', I I I W.�e ,, I I 'I, go. I I r . I _r �I , I . I I : . I - 11 I . I . I I . . I � I I I I I I I I I 11� I I I I : 0 ,� A. 90.50 , , �� I A. I � ;'. COTUI[Tv MA",,DATED:OCT.� 20, 1980'� ­',,�,r',��, ',I ,L��, ,", " �� � I -� I I I � ! ' � I I I I � I I I� . 1 I . I I I � . I � I I I : I I I I I I I I I I - I I I I I I I - , . �� I I " ' ' "" ' 1 1 1 11 I . I I � I I I - I - . I . . � I � - I I I - . I I . I I I � � I , � . I �� AND IS NOT INTENDED:TO Bi A SURVEY PLOT PLAN � . I I I t . I I ., I� � I I � � � 11 . . � I I � I I 11 � . I I . I � I I I I I . � .1 � .I � I . I� Loamy Sand , I I � . � � I � . I I I I I . . . 11 . I I I I I I . I � I 1; I I . 11 ­­ I� �'. I � - I I I . IT SHOULD.BE, USED FOR NO PURPOSE OTHER THAN - . I � I . I � 11 L. I � I I� I I I . I I I I I I I I ... � I � I . '. I I . 11 .-_ 11 I I 1, ,THE SEP71C SYSTEM INSTALLATION., . . I I . I ­ � I I . I I I 11 I I I � I I � I I I 10 YR 8/4 - , - ., I 10 YR 6/0 , I . ":, , I � . I I � � I � I I 11 I � I � . I I 1 I � I I 1,I I I I I I . I .11 . I I I I - I . I I I I "I � � I I � 1, I 0 .� I - I I� . . , , I 1, � I - -, �_ .. I 1, I 11, �1.,.,. I I , I I� I I � � L I � I I . I I I I I , � I . . I I � I . 11 I 0 1 �. :1 . I � I - '' . I 11 I I � i � �11 � - I . r . I I I I I I -1 � I I I . I � I . I 11 I'll 1.I I I . I I 1� 6,- 36 � 9 95= ,I I r- 3e ' 9 1 05.001 1 - ­ .. I .1. -.1 .. I ., : , IL 1. �:1 I I 1� I � I . 11 I 11 I . . . . I I L . I I I I - � . I 1. I � I I I 1. I �.- I - .. I I � - I �, - ...- � �I I L �� � -, . :�� � , - 111. � I� 11 I I I I L I . I - - I - � r I I � , ., . : � ,�, �,­__',I . _r : . e,i - � � . I ,I I I I � . L I I I I I I N 15D 40' 45" E I . I I . .1 . I I . .. Mod Coanm '. - � - I I Mod-CO" I- I - I , . I Z _ I I , �': � � , 11 I I I - . . I . k � � I � � . I � r , . � 1� . I I � I . . � . . .. I � � . I - � 1". - I . I .- I I � ,, - I 1, 11� � , . I" 1, . �'.." _ I�: ,, . ' I ,.� ,�', 11� , I �,�_I .1, � ! I . I I I . I - L . I I L I I I I 11 1 I . I I .1 . , I I I ,�.� �, ; r � I I I I I . I � I I I � - I I I I 11 I I I ; I ­ � I ,� � I - I I - Sand I I L 1. ��, �, � I I � �,,, Sand _� I 7 , I�­ , NOTE.''I ANY,STRIPPED OUT'SOIL CONTAJNING�LEACHATE L , I , _I P , I � . I . I . I I L I I 11 . . I �I I I I I - I . . , , ,,, �� . � I ","". I . , - _ I I 1 I � . � , . I . 11 � . � � I . . . � I I I I 11 � � . I I . I � � A ft� I � . I I � � ,I I I 'I" I I I � I -. -I I . I I I �I �w � I ,2A y 7/4 .. � Z5 Y 7/4 : � I !�` FROM THE EXISTING LEACH PIT TO'BE DISPOSED ' , ', � . �. t� ' '1� . I ��,� I .I I I I I I . . � - I I � ­ -1 � I � I � I . I . . � _ I � . I I - Ci ' 87.001 , , :1, _� i I I - I 11 � 100.00 I � I � - I I I . 1. I - 36*- 132 � 1 360- 132' C, 87.00 1 . . ­ OF AS PER BOARD OF HEALTH SPECIFICATIONS. 1, I . L� I I 11 �, I I I I I I . I L I � I : � : I � � � : I I I . I I I - I - I . I . I I . . ­ I � I � � I . I � I � I 1 . � ,_:, I � I � . I � � I I . , I I I � I I I I � � I I I I I I I ; 11 I I I I I -1 I- I � I I I . � �,t - 11 � � I I � I I I I �, � . I I . � I I I I . I I I I � I ,� I I � 11 .1 , I I 11 I- . I I I I � I � � I I I I I I � I I - I I .1 I . I I I I . I - . � I �. I . I I � - � I 1. I�I . -� r I I 1, ­ I � I I I 11 I . . . I ,�. I 1.1. . iI I � . I ,�I � .1 - I . � I I I I � 1. ' I I . I iI . � � - I I I . . . I I I I I FILLED IN PLACE � I I . . � " I I I - I . � . I . I . I I � I I I I . 11� . I , � 11 . ... I I � I I I ­ I I I e I I ­ I � I I I . 1 I I I , : � I I � I - - . 11 I , I , I I I � I I . . i - � - � to I . I I I, � I - � . � - I � - - - 4 1 � . I I I I� LOT #40 - I � ' i - . I I . ASSESSORS MAP 02 1 � . I � I I 11 I I I � . I I . I � I I I I I I - I i I I � , I I IR91", . � 1 20,000 Square Feet +/- � ,- �� I I " I I I - I I I ______ - I 1. I I i L I 11 � I - I I I I 11 ­ I - RESIDENTIAL - , - � I I I I � I Vent I . - I - ZONING . . , I � . �. I � Perc #1 � . . . I � I I � 1% - � I I � I . I I � I � � I � � TEST HOLE I Pipe � , � . Depth to Perc: 36" to 54* 1 .1 I I I � I I I I I I I I . I . � I I � -- ,,,� I � I I . - 98.10 . I I � � � "I I I I . I I . .I Porc Rate-, <2 MPI ': ;1. �,.I� - � ,� . "r, 11 . �I , . � 1� I I � i Ir I � � I 11 . �-1- I I I I 1, ELEV. � . � � I I � I.- - I I I � I 1. 11 I I I I . i � I � I . I . � L I --- . � � I . � ., . 11 . � I . - � I � I I NO Groundwater Observed 0 1132"� , , I I .�. . I I � � I � . � . . I I �� I � I ��____ I I 05 I 11 . I I � I I . I I I . .I _ ' , �,� I -,- � . �� 11 � I -, , . .1 1� I . . � . I .1 - ., f � I - . . I I I I ADJIUSTMENT � 6 NONE -, -_ . �14 - - I I . . I I I I I � I I I I I ­ . - L . . = 11 I I ,� �-,, I 11, ­ .11 � . ,,I � N r ,� 1: 1 . I 1, 11 . . . , ­1:1 ., , :.� I I I I ____ �I I� � ­ - - .1 I I I r 11 I . I I . � I I 1. ' ' 11,­,­,� ­ I I I . 0 WETLj44 S ARE.LWJJED� WITHIN A 2005� RAUIUS I � L I � .1 . I . I -_ D-Box I � 1, � I � � I I I I I 11 11 � I No Observed ESHWT ,L � , , , , �, , I _ P . r I I I I I I I : I , __ I : I - I I., I I I I I � 11 � I 1. �.. � 1 ��j,��t,�,_'' '', . ""I,,�,'­'�,,...:. , - ,��, _I',­', -� I I � : �,i�l" I I .1 I I ,:L 1, I 11� � I I -, I 1 11 I I , , , 1�1 I n 17'' � I I " �,�, I � �� I 1� . 1 I ­ - � I I I � I I "I I 1,� � I I I I ,� I ''I I �_ � , � 1,�, - . .1 I 1� � . 11 I 11� i I I I I I.- � r I I I I - I 11 � ." � .�, . . I I I �� 11 . . �� , ", , 1,r", , I-,: ,�, I , I ,L� ,� . I 1 1 1 1 ,, , OF THE PROPERTY - ', ' :­� ;-, I i � I - . I � . I I . I I I ,I � --- T f 7' TEST'HOLE #2 ,: I I I I � � I I I I I I I ,, ,r- I� I .11 I " I, . . 1 � " I � I I I I I � �11 , .; . I I� _� I �, � - I � . I . I . � I I I ��I i I I I I � __ I - � . � 11 � I I � I I - 1� I I 11 I "I .� ,� ,� �. ��1 : ,­i I I 1�1 I ,�1, %� I ., I I I -- 11 � . I , I I- � . I- . I . . I - � � � I I I I I r II I I . I I L I I . -_ I 11 I I I � - �I � I I I I � I I . I� I �,I 7 I - I " I I � ;­��". , � � I I . I � � -a 1. - 1. -- I . � , .11, . I I I I I ­ I r I I � I .1 I - I � I� .1 I I I .- I . ELEV.- 98.00 � _ . I I . I I . I . � I I ,� I I - 11 .1 .� . . 11 � I..1, '.��_ , . � - �_ .� � t I 1. , I I I . " . :- '' � , I - -. I- I � 1�­ � � I I . . - I . I I I -1 . I _ . , - I I . . � 1. � � . . ­ I - I I _ I :, �. _,' '�:;. , � .1 I I � ,, I 1, 1. - I 1. I . �I - . I� - �. . ­ - � � 11 I 1. I . � . � 11 I I I 1, I I I I - I I '� . I I -11 I � I . - � I 1 " � . I - � � , . I . I I � I I I I j . � Foiled . 1 . . � I� I � I � I � . L I ,� � . I I ' 'I . 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I , _1 I .' ;, I 1 . - 97----- I--97',':, , EXISTING CONTOUR I I I � I I I � . 11 , I I I I I ,� I . 11 . I � I I I�� ,1. ' ' � � i . I I I I � 1* I ­ - " I ­ ,­1 I I I 1, I i I I . I \ N I .., I Design Calculation . ,� - 11-1 I I . 11 . � I - . 1 I . 1 � I I I I GAMON -7 � - HOUSE \ I I I ­_ � . - � I ,� � I I I I I 11 I , � , I -1-__­ � , . . :.1 .,- I. I I I � - I � I . . I I I I ��_ , - % . - I I I I I I ., I . . I. I : . . I ,� � I I � I I . r.: ..I � I I . 1. . I - I � � I I-I � I . I -I. I I 11 I . I I ) :4 . I . 11, -I I'll I . � I __,I � �L 11�I I ­1 I 11 � . I I � . � - 11 11 I I 11 I I I L � - . I I I I I . �_ I I� I I L HOLE & _ I � iI I ­ I I 1,� 1 # � / I I I � I I . I - . I . I I I ; I r I I 1 I 1, I 11 I -1. � ­ I . I I �, .1 I I I I I .1 I . I I I . 11 I ! 11 I I� I , / ,� I I I I .1 . . - .1� I I i � I . . I I . I I . PERCOLATION TEST LOCATION . � i . � I . I . - I - � � I I // I I I I I � � I I Number,of Bedroorn*: 3 Equivolon.t to 330 Gal�.1boy - . � I I � : I � I ! I I . Garbage Grinder No , I . I I � . I � � � I I I I 1 . I I I : / � � I � I I � I - I I � 11 . Leaching Capacity Proposed: 330 Gal./bay Minimum (Min. Per Title,V) �, I . ----* � FENCE I � I I � , I . I � I � 0 1 � I I I I I I / I i : I 1 . I � I I � I I / � 11 Septic Tank : -�2 x 330 Gal./Day - 660 USE EXIST. 1,000 GAL Septic Tank. � I I � � � I I I I I I . . I I . I I I � . i / , I � I SOIL ABSORP71ON AREA. Using percolation' rate of <2 min./Inch . - I I I � i I � I I � � - I I � I I I � I I � I , � I/ I I I r I � � I I 11 I',, I � 11, Bottom Area: 0.74 gal/sq. ft. x 490.88 sq.,ft.' ­, 363.25 gallons I � - I 1. . J� I PRIVATE DRINKING WATER WELL ! � � I I I , I � I I * - � I I . / � I I I I I I EXIST. . � I � 1 . Sidewall Area: NOT USED . � I I . � . � I I I � 11 DRIVEWAY 11 N __J Providing: - 363.25 gallons REVISIONS i 3 I I I I � I i � I I I I - � I i . I I I I I I 0 t _____ I I I 11 � I I I ,-" I - I Use, 4 ROWS OF S-OUICK4 STANDARD CHAMBER UNITS WITH NO i I I I I I ff d=_�__� � NO. DATE: . DEFINITION I I I I - ---a � STONE FOR AN SAS HAVING THE DIMENSIONS: 12.7' x 26.0' 1 ! . 1 98--- - ---- rn �� I � : I I I I . I I I . I ! . I Bo I i I . I I f ttorn Area: (General Use Approval for 4.72 SF/`LF of INFITRATOR � : I I I � I I I A . � 6 UNITS + 2 END CAPS per ROW - 26.0 FT � � � I I I � . . I � I ! � I 100.00' I I I I 1 4 ROWS x 25.0 x 4.72 SF/LF - 490.8a 11 I I I I 3 - I I I .� I I i i W .P.-E � I DESIGN FLOW PROVIDED: 0.74(490.88 S.F.) = 363.25 GPD I I I � � . I I I I I 9 I - . ! . I I 1 N 15D 40 45" E i I . / I . . i � I / \ . . � ! .1 � I . i I � � , I i . I � M.A_Z?_F.ZV_A0_Z? C_F_1? CZ_.,,_0 . PREPARED FOR - i � , * I ; . (40 FOOT RIGHT OF WAY) : i : DISPOSAL SYSTEM i � . . ! I OF i I I . I I . JAMES DANFORTH , #71 MARINER CIRCLE ! . � i I . I i COTUIT, MA i Bedroom #71 MARINER CIRCLE I . ; I I � ) i ; I COTUIT, MA 02635 1 1 . I PREPARED BY: � .. -,NA OF MA : I 9i - - - 11 <1 .14 , i I �I .. � i I :S .:::�;. CAR.MM V E. SHAY- 0 W (8 DEN <.,, - . I I � ., 0 ENVIRONMENTU SERVICES, PVC ; I 0 20 40 50 1� 0. 1 i I I 1 I 1 Living Bedroom I 6 1. 10 i � Room = I , Is S � = ." I I I - . , MASHPEE, MA 02649 1 - C2 , I � "JIVIT Vk\ \' i � � 1 `!,I I ; I SCALE: 1"=20' TEL/FAX : 508-539-7966 . i 3 BE HOUSE FLOOR SCHEMATIC I i � (Description Provided By Owner) SCALE: 1"=20' DRAWN BY: CES DATE: AUGUST 10, 2009 . : I I 1 1 1 1 FILENAME: SD1151PP.DWG SHEET1 OF 1 1 ; I � I I . . .h J." . . . .Y. ,- I ., - "I . � "-" .1 . r 275 --`-],� .. . ,�, .� WADE , . - I I I 04 4 � . .1 j-'-*,1 . . . ... a^[ / I 4 / x __ - , I i I I I . i , I I . - . I—- ­­­-- I,___ --11� �_ � -_. I --- I � I - I I I I - I -1 i I - -1 -- I- I __ - ------ ___ I - i ­ - __ __ � � - - ­ __