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0085 MOORING DRIVE - Health
LC Mooring drive O$uI4 125 r��L �!� No. C� ( Fee THE COMMONWEALTH OF MASSACHUSETTSrH Entered in computer: Yes .''✓ PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS 01ppricatfon for ;3t9;po.5a1 &p.5tem Congtruction Permit Application for a Permit to Construct( )Repair((/)Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. Ag" �� �/�' /� I Owner's Name,Address and Tel.No.AN OW, Assessor'sMap/Parcel tt��--�' "`mN; � �5 •ea� ' Installer's Name,Address,and Tel.No. � Designer's Name,Address and Tel.No. Type of Building: Dwelling No.of Bedrooms Lot Size 904W sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow '91W 336 .0'/ gallons. Plan Date Number of sheets Revision Date i o o_ Title F Size of Septic Tank Acoc Type of S.A.S. _el Description of Soil 3 7 Nature of Repairs or Alterations(Answer when applicable) c 4, rn 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 Env' ental C de and not to place the system in operation until a Certifi- cate of Compliance has been issued by T. oard alth. Sign d Date —< I_e ' Application Approved by Date elC Application Disapproved for the following reasons Permit No. ®©- P4 Date Issued O 0 H 1 No.��,�_ l .w. t7 / Fee E COMMONWEALTH OF MASSACHUSETTS j17 Entered in computer: Yes PUBLICHEALTH DIVISION - TOWN OF BARNSTABLES MASSACHUSETTS - 01pp[ication for 33i.5pon[ *pztem Con!5truction.30ermit Application for a Permit to Construct Repair 11 Upgrade Abandon ❑Complete System ❑Individual Components ' PP• ( ) P ( )UPg ( ) ( ) P Y P Location Address or Lot No. 65 MQ XNJ j M Owner's Name,Address and Tel.No. Assessor'sMap/Pazcel !�/� Installer's Name,Address,,and Tel.No. Q/ /� yQn� Designner''s Name,Address and Tel.No.i 4e -l!'� r Type of Building: Dwelling No.of Bedrooms Lot Size 9,04 O sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow 4 330 gallons per day. Calculated daily flow 33� . gallons. Plan Date Number of sheets t Revision Date Title Size of Septic Tank Type of S.A.S. (9c Li 6�bA1c Description of Soil Nature of Repairs or Alterations(Answer when applicable) _ co rn 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 Env ental Cade and not to place the system in operation until a Certifi- cate of Compliance has beenn ss<ued by oar all . Signed Date Application Approved by�_t Date Application Disapproved for the following reasons Permit No. Date Issued $ )0 0 y -------=_—=_�_----=------------------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS (Certificate of (Eamp[iance THIS IS TO CE FY,th t the On-site Disposal System Constructed( ) Repaired (�)Upgraded( ) Aband ned( )by ((,�� /� at g r17960jQ41/,., �ip• CCYiTl� has been constructed in accordance r with the provis s of Title and the for Disposal System Construction Permit No. 2 uo'{`Hl U dated Sc,l iiil(r V t Installer � y417E CC1157 Designer L jdf— 1 The issuance of this permit hall not be construed as a guarantee that the sy temp ill functto as desi }red. Date ~ ] 1FuLl Inspector �J�i/l.�• J No. �7,r�--=-----=----------------Fee 7 THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLES MASSACHUSETTS ]Di!5poga[ *pgtem (Longtruction permit ` Permission is hereby ranted to Construct( )Repair(Upgrade( )Abandon( ) System located at ��/21'14" IYA. CGG?/6,r and as described in the above Application for Disposal System Construction Permit. The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction must be completed within three years of the d I e of this pe i . Date:_ ce-1/010 Approved by i TOWN OF BARNSTABLE SEWAGE # Qd LOCATION S� 9`f' VILLAGE— Ttkr ASSESSOR'S eMAP & LOT o? -ia INSTALLER'S NAME&PHONE NO' .. SEPTIC TANK CAPACITY LEACHING FACILITY: ( (size)NO.OF BEDROOMS ,BUILDER OR OWNER PERMITDATE: 9'b"2 COMPLIANCE DATE: ' �' I Separation Distance Between the: Feet Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Private Water Supply Welland Leaching Facility (If any wells exist Feet on site or within 200 feet of leaching facility) Edge of Wetland and Leaching Facility(If any wetlands exist Feet within 300 feet of leaching facility) Furnished by Or. LOP- J 1000 - 6 Town of Barnstable Regulatory Services _Thomas F.Geiler,Director 8AMSU BM Public Health Division •03�. �e Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office:.508-8624644 Fax: 508-790-6304 Installer&Designer Certification Form Date: Designer: N10 D. cov&tl 13� joW p, Installer: Address: C 1RCLL Address: —IA65�?dcx On -719—cq PA1191'm was issued a permit to install a (dat e) installer septic system at_ (,rj/Q��(, DA, based on a design drawn by (address) NVt D CQbQJ A W0 WR. k� dated / (designer) V 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. -DAVID D. staller s S e co,1/,l0WR 9 ;i 1093 F @gNITA (Designer's Signature) (Affix Designer's Stamp 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/Desiper Certification Form TOWN OF BARNSTABLE LOCATION AQ SEWAGE # Q(�fl '— VILLAGE TICr�' ASSESSOR'S MAP & LOT o? " 0 INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY :LEACHING FACILITY: (type) 2:g2 . (size) f. 42�;(-Z2! NO.OF BEDROOMS `�`BUILDER OR OWNER MIA C6�,42 PERMITDATE: -J•-01 COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility (If any.wetlands exist within 300 feet of leaching facility) Feet Furnished by 1� 1 1 ' �T AO/WN BARNSTABLE L-CATION SEWAGE # VILLAGE ASSESSOR'S MAP a% (I S L- 1,0"1 INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACII.TTY: (type) l®� (size) ( i' NO.OF BEDROOMS BUILDER OR OWNER PERMTTDATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater.Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands,exist within 300 feet of leaching facility) �/ Feet Furnished by ` l., 1 t COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAI AFFAIRS John Graci DEPARTMENT OF ENVIRONMENTAL PROTECTION DEP Title V Septic Inspector ONE WINTER STREET BOSTON MA 02108(617)292-3500 P.O.Box 2119 TeaTicket,Ma. (508)564-6813 TRUDY CORE Secretary ARGEO PAUL CELLUCCI DAVID B.STRUHS Governor Commissioner SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION Property Address: 85 MOORING DR. COTUITLA Name of Owner MRS.SABINA tl Address of Owner: BOX 363 COTUIT Date of Inspection: 8/30/99 f Name of Inspector:(Please Print)JOHN GRACI I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000) Company Name: n/a loyyH o �9 Mailing Address: n/a y F NIT�IF 9,f Telephone Number: n/a � 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 sewage disposal systems.The system: X Passes The Inpection is based on criteria defined in Title V Conditionally Passes code 310 CMR 15.303.My findings are of how the system Is Needs Further Ev u ion By the Local Approving Authority performing at the time of the inspection.My inspection does _ Fails not imply any warranty or guarantee of the longgevity of the septic system and any of its components useful life. Inspector's Signature: Date:9/2199 The System Inspector sh I submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)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. . NOTES AND COMMENTS THE SYSTEM PASSES TITLE V INSPECTION. RECOMMEND PUMPING EVERY TWO YEARS TO PROLONG THE SYSTEM'S USEFULL LIFE. revised 9/2/98 Page 1 of 11 . ' SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 85 MOORING DR.COTUIT Owner: MRS.SABINA Date of Inspection:8/30/99 INSPECTION SUMMARY: Check A, B, C, or D: A. SYSTEM PASSES: I have not found any information which indicates that any of the failure conditions described in 310 CMR 15.303 exist.Any failure criteria not evaluated are indicated below. COMMENTS: System passes Title V inspection B. SYSTEM CONDITIONALLY PASSES: nLa 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. nta 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 complying septic tank as approved by the Board of Health. nta 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). _ broken pipe(s)are replaced obstruction is removed _ distribution box is levelled or replaced nta 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 revised 9/2/98 Page 2 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 85 MOORING DR.COTUIT Owner: MRS.SABINA Date of Inspection:8130/99 C. FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: Conditions exist which require further evaluation by the Board of Health in order to determine•if the system is failing to protect the public health,safety and 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 ThE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: Cesspool or privy is within 50 feet of 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 AND SAFETY AND THE 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 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 nta_(approximation not valid). 3) OTHER � I revised 9/2/98 Page 3 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 85 MOORING DR.COTUIT Owner: MRS.SABINA Date of Inspection:8/30/99 D. SYSTEM FAILS: You must indicate either"Yes"or"No"to each of the following: I have determined that one or more of the following failure conditions exist as described 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 correct the failure. Yes No X Backup of sewage into facility or system component due to an overloaded or clogged SAS'or cesspool. X Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool. X Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool. X Liquid depth in cesspool is less than 6"below invert or available volume is less than 1/2 day flow, X Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped n[a. X Any portion of the Soil Absorption System,cesspool or privy is below the high groundwater elevation. X Any portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. X Any portion of a cesspool or privy is within a Zone I of a public well. X Any portion of a cesspool or privy is within 50 feet of a private water supply well, X Any portion of a cesspool or privy is less-than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis.If the well has been analyzed to be acceptable,attach copy of well water analysis for coliform bacteria,volatile organic ompounds, ammonia nitrogen and nitrate nitrogen. X The liquid level in the SAS is over the invert pipe,is in Hydraulic Failure. E. LARGE SYSTEM FAILS: 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: 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 X the system is within 400 feet of a surface drinking water supply X the system is within 200 feet of a tributary to a surface drinking water supply X the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area-IWPA)or a mapped Zone II of a public water supply well) The owner or operator of any such system shall upgrade the system in accordance with 310 CMR 15.30412).Please consult the local regional office of the Department for further information. revised 9l2/98 Page 4 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 85 MOORING DR.COTUIT Owner: MRS.SABINA Date of Inspection:8/30/99 Check if the following have been done:You must indicate either"Yes"or"No"as to each of the following: Yes No X Pumping information was provided by the owner,occupant,or Board of Health. X 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. X As built plans have been obtained and examined.Note if they are not available with N/A, X The facility or dwelling was inspected for signs of sewage back-up. X The system does not receive non-sanitary or industrial waste flow. X The site was inspected for signs of breakout, X All system components,excluding the Soil Absorption System,have been located on the site. X 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: X Existing information,For example,Plan at B4O,H, X Determined in the field(if any of the failure criteria related to Part C is at issue,approximation of distance is unacceptable) 11 5.302(3)(b)] X The facility owner(and occupants,if different from owner)were provided with information on the proper maintenance of SubSurface Disposal Systems. revised 9/2/98 Page 5 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 85 MOORING DR.COTUIT Owner: MRS.SABINA Date of Inspection:8/30/99 FLOW_ CONDITIONS RESIDENTIAL: Design flow:-M g.p.d./bedroom Number of bedrooms(design): 2 Number of bedrooms(actual):2 Total DESIGN flow: 221 Number of current residents:2 Garbage grinder(yes or no):NQ Laundry(separate system)(yes or no): NO If yes,separate inspection required Laundry system inspected(yes or no):JIQ Seasonal use(yes or no):�LQ Water meter readings,if available(last two year's usage(gpd): nla Sump Pump(yes or no): NO Last date of occupancy: nLa COMMERCIAL/INDUSTRIAL Type of establishment: n(A Design flow: n1a gpd(Based on 15.203) Basis of design flow: n& _ Grease trap present:(yes or no):JLQ Industrial Waste Holding Tank present:(yes or no): NQ Non-sanitary waste discharged to the Title 5 system:(yes or no):NQ Water meter readings.if available:n& . Last date of occupancy: n& OTHER: (Describe) Last date of occupancy: nLa GENERAL INFORMATION PUMPING RECORDS and source of information: 1225 System pumped as part of inspection:(yes or no):NO If yes,volume pumped W& gallons Reason for pumping: n& TYPE OF SYSTEM X Septic tank/distribution box/soil absorption system Single cesspool Overflow cesspool Privy Shared system(yes or no)(if yes.attach previous inspection records,if any) I/A Technology etc.Attach copy of up to date operation and maintenance contract Tight Tank Copy of DEP Approval Other: n& APPROXIMATE AGE of all components,date installed(if known)and source of information: 1982 Sewage odors detected when arriving at the site:(yes or no) NO revised 9/2/98 Page 6 of 11 y SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 86 MOORING DR.COTUIT Owner: MRS.SABINA Date of Inspection:8/30/99 BUILDING SEWER: (Locate on site plan) Depth below grade: V 6„ Material of construction:_ cast iron X 40 PVC _ other(explain) Distance from private water supply well or suction line`. TOWN Diameter: nLa Comments: (condition of joints,venting,evidence of leakage,etc:) DLa SEPTIC TANK: X (locate on site plan) Depth below grade: i Material of construction:X concrete_ metal_ Fiberglass _ Polyethylene _ other(explain) nLa If tank is metal,list age Is age confirmed by Certificate of Compliance(Yes/No): NO WA Dimensions: L 8'6"H 6'7"W 4'10" Sludge depth: Z Distance from top of sludge to bottom of outlet tee or baffle: 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: 1L How dimensions were determined: MEASURED 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.) SEPTIC TANK AND ALL COMPONENTS ARE STRUCTURALLY Y SOUND RECOMMEND PUMPING SYSTEM EVERY TWO YEARS, GREASE TRAP: (locate on site plan) Depth below grade: Material of construction:_concrete_ metal_ Fiberglass _ Polyethylene_other(explain) nta Dimensions: nLa Scum thickness: nta Distance from top of scum to top of outlet tee or baffle:i1La Distance from bottom of scum to bottom of outlet tee or baffle n& Date of last pumping: nLa 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.) n& revised 9/2198 Page 7 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 85 MOORING DR.COTUIT Owner: MRS.SABINA Date of Inspection:8130/99 TIGHT OR HOLDING TANK: NQ (Tank must be pumped prior to,or at time of,inspection) (locate on site plan) Depth below grade: Wa Material of construction:_ concrete_ metal_ Fiberglass _Polyethylene_ other(explain) DLd Dimensions: nLa Capacity: Wa gallons Design flow: nLa gallons/day, Alarm present: NQ Alarm level:jita- Alarm in working order:Yes—No—: NO' Date of previous pumping: Wa . Comments: (condition of inlet tee,condition of alarm and float switches,etc.) nLa , DISTRIBUTION BOX: _ (locate on site plan) Depth of liquid level above outlet invert:n/a Comments . (note if level and distribution is equal,evidence of solids carryover,evidence of leakage into or out of box,etc.) n1a PUMP CHAMBER: NQ (locate on site plan) Pumps in working order:(Yes or No): NQ Alarms in working order(Yes or No): NO Comments: (note condition of pump chamber,condition of pumps and appurtenances.etc.) Wa revised 9/2/98 Page 8 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 86 MOORING DR.COTUIT Owner: MRS.SABINA Date of Inspection:8130199 SOIL ABSORPTION SYSTEM(SAS): X (locate on site plan,if possible;excavation not required,location may be approximated by non-intrusive methods) If not located,explain: Wit Type: leaching pits,number: 1000 GALLON LEACH PIT leaching chambers,number: leaching galleries,number: _nLa leaching trenches,number,length: Wa leaching fields,number,dimensions: Wa overflow cesspool,number: Wa Alternative system: nLA Name of Technology: .nLa Comments: (note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation,etc.) THE LEACH PIT IS STRUCTURALL SOUND AND FUNTIONING PROPERLY THE PIT HAS NOT HAD MORE THAN T OF WATER IN IT CESSPOOLS: _ (locate on site plan) Number and configuration: nLa Depth-top of liquid to inlet invert: n/A Depth of solids layer: n& Depth of scum layer. nLa Dimensions of cesspool: n& Materials of construction: n& Indication of groundwater: n& inflow(cesspool must be pumped as part of inspection)n& Comments: (note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.) Wa PRIVY: _ (locate on site plan) Materials of construction:n& Dimensions:n& Depth of solids: n& Comments: (note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.) nta revised 9l2/98 Page 9 of 111 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION.FORM PART C SYSTEM INFORMATION(continued) Property Address: 86 MOORING DR.COTUIT Owner: MRS.SABINA Date of Inspection:8/30/99 SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent reference landmarks or benchmarks locate all wells within 100'(Locate where public water supply comes into house) n/a R tic A QeCk 0 6G FAy�8 f � d� revised 9/2/98 Page 10 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 85 MOORING DR.COTUIT Owner: MRS.SABINA Date of Inspection:8/30199 NRCS Report name: nLa Soil Type: nta Typical depth to groundwater: nLa USGS Date website visited: nta Observation Wells checked: ML2 Groundwater depth:Shallow _ Moderate _ Deep SITE EXAM _ Slope _ Surface water _ Check Cellar Shallow wells Estimated Depth to Groundwater 12 Feet Please indicate all the methods used to determine High Groundwater Elevation: _ Obtained from Design Plans on record _ Observed Site(Abutting property,observation hole,basement sump etc.) Determined from local conditions Checked with local Board of health _ Checked FEMA Maps Checked pumping records _ Checked local excavators,installers X Used USGS Data Describe how you established the High Groundwater Elevation.(Must be completed) USGS MAPS AND CHARTS revised 9/2/98 Page 11 of 11 m _..................._.._._....... __ ...--..._..._. DATE: 10/25/95 PROPERTY -ADDRESS: 85 Mooring Drive Cotuit,Mass. ��aa22 C o t u i t,Mass . ---------- �t5l EOV E® . 02635 NOV 3 1995 ---------------------- HEALTH DEFT.- • 'roVIiN OF BARNSTABLE .On the above date, I Inspected the septic system at the above address. . This system consists of the following: 1 . 1-1000 gallon leaching pit packed in stone. 2. 1-1000 gallon septic tank. Based on my inspection,A certify the following conditions: 1 . This is a title five ' septic system. ( 78Code ) 2. The septic system is, in proper working order at the present time ,. SIGNATURt 1 _ Name: Joseph P. -Macomber Jr_-- Company: J•P.Macomber & Son Inc Address: Box 66 ;: __p_Dterv-ille ,Mass . 02632' Phone: 508-7775-3338 THIS CERTIFICATION DOES NOT CONSTITUTE A GUARANTY OR WARRANTY row Own JOSEPH` P. MACOMBER & SON, INC. Tan ks-Cesspools-Leachfields Pumped & Installed Town Sewer Connections P.O. Box 66 Centerville, MA 02632-0066 .775-3338 775-6412 Commonweatth of Massachusetts Executive Office of Environmental Affairs Department of Environmental Protection William F.Weld Governor Trudy Coxe Secretary,EOEA David B. Struhs Commissioner SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION Property Address: /Y1e-V,&, J/ �i�1Y`c f'�l��� Address of Owner: Date of Inspection: �0•-t16�9;r' (If different) Name of Inspector:•k.,ph Company Name, Address and Telephone Number:' lbrx 66, (�',N?>ekv%lete �9�gS.a��� �p-27£'—��✓� 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 sewage disposal systems.-The system: Passes _ Conditionally Passes _ Needs Further Evaluation By the Local Approving Authority _ Fails O Inspector's Signature: Date: 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: A) SYSTEM PASSES: I have not found any information which indicates that the system violates any of the failure criteria as defined in 310 CMR 15.303. i Any failure criteria not evaluated are indicated below. B) SYSTEM CONDITIONALLY PASSES: A11 One or more system components need to.be replaced or repaired. The system, upon completion of the replacement or repair, passes inspection. Indicate yes, no, or not determined (Y, N, or ND). Describe basis of determination in all instances. If"not determined", explain why not) 461 The septic tank is metal,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. i (revised 8/15/95) 1 One Winter Street • Boston,Massachusetts 02108 • FAX(617)556-1049 • Telephone(617)292-5500 A Printed on R led Paper i • f SUBSURFACE SEWAGE DISPOSAL SYSTEM-INSPECTION FORM PART A CERTIFICATION (continued) Property Address: CO%>r,/naSS, Owner: y'Y1046a Date of Inspection: ld $ss� Bj SYSTEM CONDITIONALLY PASSES (continued) 0 ,D Sewage backup or breakout orhigh static water level observed in the distribution Lox 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): broken pipe(s) are replaced obstruction is removed distribution box is levelled or replaced �(p 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 C) FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: _dam 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: 40. Cesspool,or privy is within.50 feet of a surface water .44# 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 JAND PUBLIC WATER SUPPLIER, IF APPROPRIATE) DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: The wstem ndS a seutil ldnn di-J bull db.,urppUn..syilen'i and" ii within 100 feel to a surface watt. supply c, tc a surface water supply. 4.0 The system has a septic tank and soil absorption system and is within a Zone I of a public water supply well. A f' The system has a septic tank and soil absorption system and is within 50 feet of a private water supply well. ,1/0 The system has a septic tank and soil absorption system and 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. D] SYSTEM FAILS: 1 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 correct the failure. 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. (revised 8/15/95) 2 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: -� m'�i't� Owner: Date of Inspection: ` _ Q� D) SYSTEM FAILS (continued): Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool. Liquid depth in cesspool is less than 6" below invert or available volume is less than 112 day flow. 40 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 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 of. 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. El LARGE SYSTEM FAILS: The following criteria apply to large systems in addition to the criteria above: 94,17 The design flow of system is 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: ap the system is within 400 feet of a surface drinking water supply gyp, 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 11 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. ) (revised 8/15/95) 3 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM v PART 13 CHECKLIST -41a44jxy to )ytt, e—D rai Property Address: Owner: Date of Inspection: Check if the following have been done: Zumping information was requested of the owner, occupant, and 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. 2As built plans have been obtained and examined. Note if they are not available with N/A. 2The facility or dwelling was inspected for signs of sewage back-up. /The system does not receive-non-sanitary or industrial waste flow /The site was inspected for signs-of breakout. ZAII system components,'64cluding 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 existing information or approximated by non-intrusive methods. /The facility ov.nes Land occupants, if different from owner) were provided with information on the proper maintenance of Sub-" Surface Disposal System. (revised 8/15/95) 4 FLOW CONDITIONS RESIDENTIAL: Ilons kA d�4y : Design flow:,�ga , Number of bedrooms:,, Number of current residents:F Garbage grinder(yes or no):jo_ Laundry connected to system(yes or no):, Seasonal use(yes or no):�/ Water meter readings, if available: Last date of'occupancy:Ae COMMERCIAUINDUSTRIAL: Type of establishment: Design flow: gallons/day Grease trap present: (yes or no)_ _ Industrial Waste Holding Tank present: (yes or no)_ n-sanitary waste discharged to the Title 5 system: (yes or no)_ `,Ater meter readings, if available: ` 3 S i f i. i Last date of occupancy: OTHER: (Describe) Last date of occupancy: i GENERAL INFORMATION PUMPING R CORDS anc source of information: Ci.. L.r i i System pumped as part of inspection: (yes or no)AZ If yes, volume pumped: gallons Reason for pumping: I1�.14. TYPE OF SYSTEM i✓!Septic tank/dibtr+batierr lso:dsoil absorption system AA Single cesspool _.�,. 8 P N.A. Overflow cesspool N'A Privy 777 Shared system(yes or no) (if yes, attach previous inspection records, if any) V,!t Other(explain) 4AWAVA APPROXIMATE AGE of all components, date installed (if known) and source of information:/ v_.lQ/LO i image odors detected when arriving at the site: (yes or no (revised 8/15/95) S anal •�vr. /�, Property Address: W �rl .�i� �+�we Copt 144 ss ,• U. Owner: and RA1 S• , Date of Inspection: SEPTIC TANK: (locate on site plan) r� Depth below grade:, � Material of construction: vconcrete_metal_FRP_other(explain) Dimensions: Sludge depth:7 � Distance from t ludge to bottom of outlet tee or baffle& , Scum thickness l i Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: GYG Comments: (recommendation for pumping, condif{on of Inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert,structural integ y evidence of leakage, etc.) /' 8 'gtt GREASE TRAN&A. locate on site Ian) ( P Depth below grade:AM Material of construction: _concrete_metal_fRP _pther(explain) A/,14 Dimensions: Scum thickness: Vt Distance from top of scum to top of outlet tee or baffle:,d�d Distance from bottom of scum in bottom of outletIee or baftle:&4 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.) (revised 8/15/95) 6 F Property Address: 76. ryUd� Owner:- �✓�'�2 e✓ /i ra•�iC��lS' .. Date of Inspection: TIGHT OR HOLDING TANK (locate on site plan) Depth below grade/) Material of construction: Concrete_metal_FRP'�other(explain) Dimensions: Capacity: allons Design flow: If, allons/day Alarm level: Comments: (condition�o/inlet tee, condition.of alarm and float switches, etc.) . r DISTRIBUTION BOX:6PYG: (locate on site plan) Depth of liquid level above outlet invert: ? Comments: (noted level Ind distrilrut.ur, i,equal, evidence of solids carryover, evidence of leakage into or out of box, etc.) PUMP CHAMBER (locate on site plan) Pumps in working order.(yes or no)"• Comments: (note cond' i�pump chamber, condition of pumps and appurtenances, etc.) (revised 8/15/95) 7 y , S STEM INSPECTION FORM' P SAL Y B' 0 RF SU SU ACE SEWAGE DIS S PART C ' SYSTEM INFORMATION (continued) Property Address: 2W lMAeRJ ,4�¢lva � ia�'I�•7��, :' Owner: /1/�C♦7dr(I!?$ r4iQls . Date of Inspection: ID—oY$'�96 SOIL ABSORPTION SYSTEM(SAS):AAPM�C) n (locate on site plan, if possible; excavation not required,'but�rrtt;y be approximated by non-intrusive methods) ' If not determined to be present, explain.- Type: leaching pits, number. leaching chambers, number.,, leaching galleries, numbed„,} leaching trenches, number,length leaching fields, number, din, !on$ ' overflow cesspool, number. Comments: (note conditio of soil, signs of hydraulic failur , lev I of po,ding, condition of vegetation,etc.) CESSPOOLS: , (locate on site plan) Number and configuration: -141! Depth-top of liquid to inlet invert:,�,9.t;?, ` Depth of solids layer:OR Depth of scum layer: MA Dimensions of cesspool: Materials of construction: Indication of groundwaten0l inflow(cesspool must be pumpeds pan of Inspection) Comments: (note condition of soil, signs of,hVotaulic failure, level of ponding, condition of vegetation, etc.) 17 PRI)/Y:/it tiz (locate on site plan) Materials of construction: Af f}' f Dimensions:llG19 Depth of solids: !L& Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) (revised 4/15/95) 8 ;" . 'oo J SUBSURFACE SEWAGE DISPOSAL: SYSTEM INSPECTION FORM PART C ;. SYSTEM INFORMATION (continued)• , Property Address:Dr�! O'�i' ! Owner J1�llsi •$ � .f . _. Date of Inspection: . . . � ,. •# SKETCH OF SEWAGE DISPOSAL SYSTEM: , Include ties to at least two permanent references landmarks or benchmarks locate all wells within 100' it • x `� t.� F� f }l4.I�- Cti i'+ .a• ! • c.,,s ..��' �r �� . . w v r. 1 r ./ t s_t •. - "' a� ,.+s'-.�y�,tq� ^r�� F k�"'f'' 1, DEPTH TO GRO Depth o'groundwater.,A-L07' feet Q1 ppromethodof determination ' a rl� � �` I (revised 6/15/95) s 9 •r .. 0," - -` vTttnsret•nlTsr't'rr'arnram+trmrrtr�ertawrrternr'get•�++sTrr+rR+rmnT+rrn�unse+rtsntvn .. .rrn-r�.7TnR•+rtR.r•. '1'UNN OF Barnstable BOARD OF HEALTH SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM - PART D•- CERTIFICATION i �•••4t•ITT•:•Lt�T.Tt7i�T.T7'f7RT7q'ti.'TfrJ TiTi'Rt7fAi�fR1'T�1R.tinR� 9fiTiCT"TTITfITCRPI1RT0117R.C7�7i7 flnfl 1T11•1•t�'T•'1I•••.• -TYPE OR PRINT CLEARLY- PROPERTY INSPECTED STREET ADDRESS _, 85 Mooring Drive Cotuit.Mass'. ` ASSESSORS MAP, BLOCK AND PARCEL # ` OWNER's NAME Nicholas" Morris PART D - CERTIFICATION " y NAME OF INSPECTOR Joseph P. Macomber Jr. COMPANY NAME J.P.Macomber & Son Inc. ' 1 COMPANY ADDRESS Box 66 `Centerville ,Mass . 02632 Street Town or City -state. : ZIP COMPANY TELEPHONE (508 ' ) 775 3338 FAX (.508 ) 790J -1 578 CERTIFICATION STATEMENT . I certify that I have personally inspected the sewage dispose- . system at j this address and that the information reported is true, accurate, and U complete as of the tilne of. inspection . The inspection was performed and any recoanmendations regardilig upgrade , .maintenance, and repair are consistent with my training and experience in the proper function .and maintenance of on- site sewage disposal syu' tems . Check one: , i XXXXX System PASSED , The inspection which I have conducted has not found any information which indicates that the system fails to adequately protect public health or the environment as defined in 310. CMR' 15. 303. Any failure .; criteria not evaluated are as stated in the FAILURE CRITERIA section of. this form. System FAILED* The inspection which I have conducted 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 .0 - FAILURE CRITERIA of this inspection form. 10/30/95 Inspector Signature ,;61,ze r Date One copy of this certification must -be provided to the OWNER, the BUYER (where applicable) and the 130ARD, Or IIZALTJI. * It the inspection FAILED, thb owner or operator shall upgrade 'the system within one year of the date of the inspection, unless allowed or required otherwise as Nrovided. in 310 CMR 16 . 305 . i W THE COMMONWEALTH OF MASSACHUSETTS DEPARTMENT OF ENVIRONMENTAL PROTECTION + BE IT KNOWN THAT Joseph P. Ma comber,acomber, 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 21A of the Generale Laws.. Issued by The Department of Environmental Protection. June 8, 1995 Acting Director of the ' -ion of Water Pollution Control f � '. ••ram; • • .... ` I . Coris'ervatiori :. • SATMEI TYps CHECK FOR LEAKS • Water Loss N-Gallons Due to Leaks- J Leak , this loss Per Day , , ,loss Per Month • ',120 ' 3,600 �' � • • � 360 10,800 ' • 693' .20,790 ' • . 1,200 30,000 • 1,920 57;600 r • • 3,096• 82;880• , • 8,9,84 '• 20Q,520 . .'8 424 . 252,720 . 8,868 ,296,040 ® , 11,324 339,720 12,720 .361.000 14;952 448,500 ' ue 40'4 i LQ-tATION SEWAGE PERMIT NO. /0 7 2&L�-� VIL-LACE INSTA LLER'S NAME i ADDRESS BOLDER OR OWNER DATE PERMIT ISSUED DATE COMPLIANCE ISSUED _. � ,S cr. � � v�1 � � W � • ,;, T&Ue WN OF BARNSTABLE LCCATION SEWAGE# VILLAGE ASSESSOR'S MAP& LOT INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY:-(type) (size) 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 feet of leaching facility) Feet Furnished by S . 40N � .J� r THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH .............Toil..................OF.......AAx'a.Qt.01a......--.-------------•---....._......................... Appliration for Di-opnsal Narks Tomitrurtinn JIrrutit Application is hereby made for a Permit to Construct ($ ) or Repair ( ) an Individual Sewage Disposal System at: Lot 107 Mooring Drive, Cotuit, Ma ................_... ...-------.............. ...- ......................... ----.......------................--•----------.................._..- •------.......... Location-Address or Lot No. ..........CeadrY....Ift' l t.-•----------------•---------. .......... .............................................................. Owner Address W3per®_.Zheoharidis---- •----•-• .............................................................. a Installer Address d Type of Building Size Lot...209000-----------Sq. feet V Dwelling—No. of Bedrooms................. .Expansion Attic ( ) Garbage Grinder ( ) Other—T e of Building D*elli49......... No. of ersons.._....6............. . Showers — Cafeteria a YP g P ( ) ( ) dOther fixtures ------------------------------------------------------.------......--••---•-•-•---------------------------•----------------........--•---•--.....•--•• W Design Flow.................55......................gallons per person �er day. Total daily flow........',��............................gallons. WSeptic Tank—Liquid capacrty140 _._gallons Length..:..._...... WidthA.0._...._ Diameter--------------.. Depth................ x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No------ ------------ Diameter......... Depth below inlet...V.3.......... Total leaching area...,?05.........sq. ft. Z Other Distribution box ( 1 ) Dosing tank ( ) Percolation Test Results Performed by...Nomm-Arasaman.................................. Date.12/1.5/,79-.-------__---_.--.. Test Pit No. 1.............:..minutes per inch Depth of Test Pit.................... Depth to ground water....no............... Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water.....nO.............. a ••--••-••-•••-••••--•--••-•----------•------•-•-----•-•.........................•---..............--.........................................................0 Descriptionof Soil........................O.:b..Leaf__mt11Ch.....................•----•---------------•--...----•-•-•--...................:............................... v -N--leat..mul.,ch--- -------------- ------------------ W ................................................. -1 1 ditam..Sand----•--------------------------------------------------------•-•-----------------------------•--......--- UNature 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 L 1 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been ' ued by the brd heal . , Date Application Approved By--- •---•- ........ �'�------------------------ !/ Date Application Disapproved for the following reasons:............................................................................................................. -••----•--•----------•-----------------------•--...--------------•---•----•-•--------------•-............-•-------------------•------•-•-••-----...------•--••••••-••••-•--••••-•...----••-••----------- Date PermitNo......................................................... Issued-... 0............................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH `i'OwM...................OF......B9.?01,1b. Q.......---------------•--------.............._........... Appliration for Biipnsa1 Workii Tnnitrnrtiun rrmi# Application is hereby made for a Permit to Construct (X ) or Repair ( ) an Individual Sewage Disposal System at: Lot 107 Mooring Drive, Cotuit, Ma ............................................. ...........................•----••-......._....._. _..----•-•.................•-•...----•-------•............-•-•-------•.....-•-........._........-- Location-Address or Lot No. ..........Ceddr AcreS•-Rga,lty Trust S•. Yarmouth ........................................... ..._._....-- .d....... .............•-••..... .--------•------•----....... Owner Address W Soero Theoharidis S.- Yarmouth .............................•-•-••-----•--......------............---•-•-•---•......----•------ ---- ............. Installer Address Type of Building Size Lot..29.a 000 Sq. feet ........... U Dwelling—No. of Bedrooms.................3............ .Expansion Attic ( ) Garbage Grinder ( ) �+ '4 Other—Type of Building Dwellimg No. of persons.......6.................. Showers — Cafeteria atOther fixtures ------------------------------------•------•----.--.--_---------------------------------------------..-------------•---•---------•-•-----------.----- d W Design Flow................55.......................gallons per person per day. Total daily flow........J�.............................gallons. W Septic Tank—Liquid capacity!Q2a.._gallons Length�__�___..... Width.�=__ ._..... Diameter................ Depth................ . n t rt x Disposal Trench—No..................... IA�idth.................... Total Length.................... Total leaching area....................sq. ft. ft Seepage Pit No _____________ Diameter.._.....8......... Depth below inlet..T..3........... Total leaching area---.`a2 .......sq. ft. Z Other Distribution box ( 1 ) Dosing tank ( ) Percolation Test Results Performed by.._No.rl_?xl... traasrna.................................. Date.1.2/15"/,oZ.................... Test Pit No. 1...............minutes per inch Depth of Test Pit.................... Depth to ground water....T10............... f� Test Pit No. 2................minutes per inch Depth of Test Pit..............._.... Depth to ground water----1-19............... Q+' ---••---•--------------------------•--------------------............------............_-------_................•--•----••------........---.........----••---- O Description of Soil........................ -6.. 'r _.n1b?lcXa.............•--•...----------------------------------------••----••••--.............---------............._._ U 6- ..fie: ._mlgh................................................................................................. .------------- W ._30=16$..... edium..S�nd.............................................................................. 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'LIT T LIE 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.board of health. ........................ -r . � S' rie .-...._ _ � r ................. .•------------------............ �r�A�M Date Application Approved By.._ *`.... .......................... Date Application Disapproved for the following reasons:................................................................................................................ ...-------•---•--------------------•-•--.............-------•------------•-.......---..........---•---•-•----------------------------------...------------------------------------- ------•••--•--Date PermitNo....................................................... Issued-..................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..............TQk?i1................OF.....I3 ..................................................... Tat firatr of Tomplittnrr THIS IS'TO CERTIFY, That the Individual Sewage Disposal System constructed (X) or Repaired ( ) b Spero Theoharidis Installer at!.................. Q1o©rin _.Dr Y.2.,..f.atuit, M" - ------------------------------------------------------•-•--------------------••--------------- has been installed in accordance with the provisions of j of The State Sanitary Code as describe in the application for Disposal Works Construction Permit N .. ____________________ .......... NY THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILLL FUNCTION SATISFACTORY. DATE2� . ................................................... G� `�. ---•----•---•.............•••••--•-----•------•-- Inspector... j� lU THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH `Gown Barnstable QOF..................................................................................... ,,''""�,//ff .1:.. ........ FEE..4�.... ........... Disposal Worko T in Prrutit Cedar Acres Realty `'rust Permission is hereby grantedll ..........................................-............................................................................................... to Construct (X c r 16�aiho�riri��'nrive ua(;otui ; zPosal System atNo.................................................................................................................................................................... Street ^ . as shown on the application for Disposal Works Construction Pe ' ---t No._______ ______f'Dated--. `__?,P___-._..._- ........... Dr w oar d of Health ATE---'..---......-'....---- --- FORM 1255 HOBBS & WARREN, INC.. PUBLISHERS _ FLOW PROFILE ' RAISE COVERS TO WITHIN TOP OF FOUNDATION 6 in OF FINAL GRADE veNr Ppe t ,7134 +- ONE INSPECTION RISER FOR LEACHING GALLERY I"u 5 F Y LAYER OF 1/8- D-BOX . 1/2' STONE 3' DROP H-20 FLOW LINE L` TEE 48' GAS�� PRECAST 3/4--1 V4_ BAFFLE DRYWELL ',`:� . STONE OF 6 in SOILBOTTOM ABSORPPON 67.15 +- STONE 64.12 LEACHING SYSTEM EXISTING BASE a�TNo 64.25 GALLERY EXISTING 64.50 5.00 ft EXISTING (END VIEW) 62.50 1000 GALLON OWING SEPTIC. TANK 26 al 5 ft 12.5 ff �$-5 1 14 ft ESTIMATED 4, 38.4 SEASONAL HIGH GROUNDWATER 0m-v m u'y Z 3?C - r• �nw 3 ' z rn . y-4v 3 n, z w 0 NApU' z ? m Zr O y �u N 0009, - 000, o • N -90 n �\ cnm wJ r z o 4 \ -- g `n m r3D -n o>z m 7 v M r Ln Z m � / m m m s � �� ti � � 0009" rn . O Z 0 ® r . v V • Q 3m Zx k Y-I-I n r Zz _ rrnm o ' O m y T z ' C. rTl =C)>N -+ w f11 v' m m k rTl m=a m .� I Z p = W r . y O O C G7--4 W, rri I I :- � �*(v�0 pp m >m � Omn " �' < � vTnN N" W n m m x =3�KAn N 0) m Z j >. 0 <n v O -� (— m m v I Z �L7 G) <17 C g q Qi �' co O o —G S „� o �, C o its 3-;4 (00Z m � p � �y om_4 Se _ 3 O r- 3 N '� 8W n c NO Z C O Z � � A Z� O �0 � y. N m `x O Ln Q, r 3- {; p .-,t,r....,uU?.e.rk....•«-+'. ., a•. ., �'. +,.,:e`t fir•-, .4 r .. DAT F TEST: SOIL TEST LOG SOILEEOVA EVALUATOR: DAV Dj}DI. COUGHANOWR, RS WITNESS REQUIREMENT WAIVED - NO VARIANCES SOUGHT DESIGN C_A_' CULATIONS -, NO GROUNDWATER ENCOUNTERED =. DESIGN FLOW: 3 BEDROOMS X 110 GPD 330 GPD TEST PIT I PARENT MATERIAL: PROGLACIAL OUTWASH ELEVATION - 69.50 +- P.ERC AT 96- .in 2 MIN/INCH IN C3 SOILS SEPTIC TANK: 330 GPD X 2 DAYS - 660 GALLONS' DEPTH SOIL USDA SOIL SOIL COLOR SOIL OTHER USE EXISTING 1000 GALLON SEPTIC TANK 1F IS SOUND STRUCTURAL (INCHES) HORIZON TEXTURE (MUNSELL) MOTTLING CONDITION. IF -NOT. INSTALL 1500 GALLON SEPTIC TANK (MINIMUM ALLOWED) 0-8 Ap LOAMY SAND 10 YR 2/2 NONE FRIABLE DISTRIBUTION BOX: USE 3 OUTLET D-BOX. 8-40 B MEDIUM SAND 10 YR 4/6 NONE FRIABLE SOIL ABSORBTION SYSTEM: A 24 ft x 12.5 ft x 2 ft LEACHING GALLERY CAN LEACH 40-60 Cl MEDIUM TO 10 YR 5/4 NONE LOOSE A b o t - ( 24 x 12.5 ) - 300 s f COARSE SAND A s d w - ( 24 - 24 12.5 - 12.5 ) x 2 - 146 s f Atoi - 446 sf r� 3 60-78 C2 SILTY MEDIUM 10 YR 5/1 NONE FRIABLE V t 0.74 x 446 - 330.04 G P D SAND 78-132 C3 MEDIUM SAND 10 YR 6/3 NONE LOOSE USE A 24 ft x 12.5 ft x 2 ft GALLERY. Vt_ - 330.04 GPD > 330 GPD REOUIRED GROUNDWATER ADJUSTMENT LEACHING GALLERY EXISTING GROUNDWATER LEVEL BASED ON BARNSTABLE GIs CONSTRUCTION DETAIL DEPARTMENT RECORDS INDICATED GW: 32.0 �—H-20 DRYWELL UNIT STONE 2 ft EFF. DEPTH INDEX WELL: SDW-253 $'- 4 -i ZONE: C \ 2 f 24.0 f i READING: JUNE. 2004 . LEVEL: 50.6 ADJUSTMENT: 6.4 ft �t M i - ADJUSTED GW: 38.4 _ 0--GARBAGE GRINDER NOT ALLOWED WITH THIS .DESIGN 2)' LPL' `LINES ;TO BE SCH 40 PVC AND PITCH AT I/8 INCH PER FOOT MINIMUM. 3) AL`01 C_OMP6NENTS INSTALLED SHALL MEET THE MINIMUM REOUIREMENTS 3.5' 8.5' 8.5' 3.5' OF- ASSACHUSETTS TITLE 5 SEPTIC CODE (310 CMR 15) NOT TO 4) INSTALLER TO VERIFY LOCATIONS OF ALL _UNDERGROUND UTILITIES 24.0 ft SCALE BEFORE EXCAVATING FOR SYSTEM. 5) EXISTING LEACH PIT TO BE PUMPED, COLLAPSED. AND FILLED. OR REMOVED 6) ALL STONE TO BE DOUBLE WASHED AND FREE OF IRON. FINES AND DUST IN PLACE 7) LINES EXITING D-BOX TO RUN LEVEL FOR 2'-0' BEFORE PITCHING DOWN 8) ECO-TECH ENVIRONMENTAL RECOMMENDS THE INSTALLATION OF LOW FLOW FIXTURES AND APPLIANCES. AND BIANNUAL PUMPING OF THE SEPTIC TANK SEWAGE DISPOSAL SYSTEM PLAN 9) SYSTEM IS NOT DESIGNED TO WITHSTAND VEHICULAR LOADING. DO NOT -TO SERVE EXISTING DWELLING PARK OR DRIVE VEHICLES OVER SEPTIC SYSTEM. - 10) INSTALLER T'O OBTAIN DISPOSAL WORKS PERMIT BEFORE STARTING WORK. & MARGARET CROWLEY 111) SEPTIC TANKS..SHALL BE INSTALLED LEVEL AND TRUE TO .GRADE ON A LEVEL �ARTHUR STABLE BASE. THAT HAS BEEN. MECHANICALLY COMPACTED AND ON TO WHICH. 85- MOORING DRIVE COTUIT, MA SIX..'INCHES :OF, .CRUSHED. STONE HAS BEEN PLACED TO MINIMIZE UNEVEN SETTLING ,: 1,2) -SEPTIC 'TANK TO BE ;-PUMPED DRY AT TIME OF SYSTEM REPAIR AND CHECKED _ ECO TECH ENVIRONMENTAL =x FOR STRUCTURAL INTEGRITY. INSTALL PVC OUTLET TEE FITTED WITH GAS BAFFLE. 13) UNSUITABLE SOILS ENCOUNTERED WLTHIN THE :SOIL REMOVAL AREA ARE TO BE 43 TRIANGLE CIRCLE SANDWICH MA' 02563` = REMOVED DOWN TO _THE C3 SAND STRATUM AND REPLACED WITH CLEAN 1.. MEDIUM `SAND AS PER TITLE 5 REQUIREMENTS. k-.. ETE-1735 JULY 21, 2004 2/2 ' mF, - F.FL. ELEV.= F:,S:—, GRADE =72 ,'0 FINISH GRADE FINISH GRADE TOP OF FOUND. OVER TANK = OVER PIT = n ELEV. = 4 CHIMNEY BLOCK BACKFIL � \ 3" PEAS TONE --- 4�� C.I. 4° V.C. _ WHERE NEEDED DWELLING - 4 V.CI 7-p, C O oo C` 0 O Q O o � 3/4" TO 1-1/2" C7y� GALLON CELLAR FLOOR c ° u o o Q O o °�� c CRUSHED STONE ELEV- = �' `� REINFORCED GONG. a � o . o O Q o o a ,� V \/ o \ b °"? o o O o O o ' QJ �Z e o '9 FIST. 80X , � c. 0 O o o 0 o A \I I � � o O o O o 4 , ° '/ ,. (TO BE LEVEL 0 0 0 Q O o � e \ BOTTOM OF PIT SEPTIC TANK --r-- a o 0 0 0 0 a ° a �� ELEV. = --i- AND STABLE) /� SYSTEM PROFILE ` ( NOT To SCALE) LEACHING FAIT DESIGN CRITERIA NUMBER OF BEDROOMS = -._. __ ----�- ----- -- --___- - - vC s _o GALLONS PER DAY GAF.'F3AGE GRINDER TOTAL DAILY FLOW = GPIU 1 `' _ LEACHING AREA PROVIDED= StvE�a ate,►. ZyCK ��'.`1 5xa.5 Ass 4po $O7TZ)►� b.11.�>�. 3 `yt"�{����- x I d _ SO 4n !! � �- {, .�` IrI +t, y � n\ SOILS LOG OR ELEV. s 7© Pam ` .. . � ' a Mmvt.V M A ?1 - PROPOSED SWAGE DISPOSAL SYSTEM ;> u v, <, � PROPOSED DWELLING • tM$PECTE© BYE � ;+ --�-�+ �/� bA I.S`3 ` CIT MASS. DATE - `tn-% - SCALE AS NOTED DATE ►�: t5 PERCOLATION. RATE HIND INCH Ire- coo a Y von,- •. f - 6 ' 'c NORMAN GROSSMAN PE., R.L.S. 296 HOLLY POINT ROAD CENTERVILLE, MASS: { y. a . , -+_ I u