HomeMy WebLinkAbout0187 OXFORD DRIVE - Health LCot
Oxford Driveuit
021 036
i
:. TOWN OF BARNSTABLE
LC'CATION A 7 &-rod gyre- SEWAGE #a 00.7,-/-9
VILLAGE ASSESSOR'S MAP & LOT R 1 134�
INSTALLER'S NAME&PHONE NO. tT 777- 13 3
SEPTIC TANK.CAPACITY AM
LEACHING FACILITY: (type) a" 5"00,c t1w (size)
NO. OF BEDROOMS J
BUILDER OR OWNER �41,!:�,-rale A4,11m t-i-le 9
PERMITDATE: S COMPLIANCE DATE: U�
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
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No. (J� � �/ Fee
HE COMMONWEALTH OF MASSACHUSETTS Entered in computer: V,V
Yes
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS
Rpprtcatton for Migonl bp5tem (Con5tructton Vermtt
Application for a Permit to Construct( )Repair 4 X XUpgrade( )Abandon( ) ❑Complete System ❑Individual Components
Location Address or Lot No. Owner's Name,Address and Tel.No. 18 7 O X f o r d D r i v e
187 Qxfprd Drive Cotuit ,Ma s Cotuit ,Mass . 02635
Assessor s Map/Parcel 3� �O X Richard H a mm e r s l e y
Installer's Name,Address,and Tel.No. 5 0 8—7 7 5—3 3 3 8 Designer's Name,Address and Tel.No. 5 0 8—4 2 8—3 3 5 8
J.P.Macomber & Son Inc . Bruce G. Murphy
Box 66 Centerville ,Mass. 02632 77 Spur Lane Marstoms Mills02648
Type of Building:
Dwelling XXNo.of Bedrooms 3 " Lot Size sq.ft. Garbage Grinder( )
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow 3 4 7 gallons per day. Calculated daily flow 3 X 110=3 3 0 gallons.
Plan Date Number of sheets Revision Date
Title
Size of Septic Tank Type of S.A.S.
Description of Soil
Nature of Repairs or Alterations(Answer when applicable)
Adding two 500 gallon leaching r�amhPry 25 ' X12 ' 8"X2 '
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'ron ental C e and not to place the system in operation until a Certifi-
cate of Compliance has been is'sVud by this B ar f h.
Signe , Date 5/ /0,2
Application Approved liy Dat
Application Disapprove or the following reasons
Permit No. "� �� Date Issued
t c i
17
Fee $50.00
. `f V
f HE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
�. Yes
`PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS .
Zlppticati0 for: i!5ogar *pgtent Congtructionerutit
Application for a Pen-nit to Construcf('m):Repair.�X}:Upgrade( )Abandon( ) O Complete System ❑Individual Components
Location Address or Lot No. Owner's Name,Address and Tel.No. 0 R o r d D rive
187 Oxford Drive Cotuit,Ma s 9otuit,Mass.02635 =.} i.
Assessor's Map/Paicel �Q Richard H a m in e r s 1 e y ,
Installer's Name,Address,and Tel.No. 5 0 8—7 7 5—3 3 3 8 Designer's Name,Address'and Tel.No. 5 0 8--4 2 8-=3 3 5 8 '
J.P.Macomber & Son Inc. Bruce G. Murphy
Box 66 Centerville,Masp.02632 77 Spur Lane Marstoms Mills02648
Type of Building: '
Dwelling XXNo.of Bedrooms 3 Lot Size sq.ft. Garbage Grinder( )
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow 3 4 7 gallons per day. Calculated daily flow 3 X 110=3 3 0 gallons.
Plan Date Number of sheets Revision Date
Title
_ Size of Septic Tank Tvr�, of S.A.S.
Description of Soil
' Nature of Repairs or Alterations(Answer when applicable)
Adding two 500 Sa"llon leaching chamher4. 25'X1.218' .X21
.r
Date last inspected-.
Agreement:
l The undersigned agrees to ensure the construction and maintenance of the afore described on-site sews disposal
g g sewage d sposa system
in accordance with the provisions of Title 5 of the Env., on ental C.de and not to place the system in operation until a.Certifi-
cate of Compliance has been issued by this B:az� f h.
Signe /I Date 5/L/0 2
Application Approved b of Dat- f
Application Disapprove for the following reasons
6l
Permit No. ..� Date Issued
r '----- --------------------------- --------
,, THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE, MASSACHUSETTS
Certificate of Compliance
THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed Re aired:(XX)Upgraded
( )
Abandoned( )by J.P.Macomher & Son Tnc.
at 187 Oxford Drive C o t u i t.Mass. has a constructed in accordance
r with the provisions of Title 5 and the for Disposal System Construction Permit N . ated
Installer J:P.Macomber & Son Inc. Designer Bruce urphy S
The issuance of this p nrut shall not be construed as a guarantee that the syst6m�will function as de.i : ed
Date - Inspectors rk/. `A
$ 50.00
No.IJ��� -----------------------Fee
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS
ligpoga[ *pgtem Construction Permit
Permission is hereby granted to Construct( )Repair XX )Upgrade( )Abandon
i
Systemlocatedat 187 Oxford Drive
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:Constructio mu be c leted within three years of the date of th' pe it
Date: ( I Approved by
i
TOWN OF BARNSTABLE F't
LOCATION &-- fird e SEWAGE #-7 00;z-A9 t/
VILLAGE L;�u. f ASSESSOR'S MAP & LOT
INSTALLER'S NAME&PHONE NO. lT p J 3 3
SEPTIC TANK CAPACITY EY.�fi.y /DOJO A
LEACHING FACILITY: (type) .?" J�iJ®� ,�,�� (size) . a Y(.2 02
NO. OF BEDROOMS
BUILDER OR OWNER Ir ✓ r✓Im le
PERMIT DATE: S X 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
0/g T
G�✓
no 7 A ' a
L�ta.•,�if ur/_ � ,
TROY WILLIAMS
SEPTIC INSPECTIONS
Certified by MA Department of Environmental Protection �'oF 3 - 500
19 Hummel Drive y����p1T%k N
South Dennis, MA 192660
1
COMMONWEALTH OF MASSACHUSETTS $
EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS 0 [FDV
DEPARTMENT OF ENVIRONMENTAL PROTECTION
ONE HINTER STREET. BOSTON, MA 02108 617-292.5500
WILLIAM F.WELD TRUDY CORE
Governor
Sccretary
ARGEO PAUL CELLUCCI DAVID B.STRUHS
Lt.Governor SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM Commissioner
PART A
CERTIFICATION
Property Address: )g 7 U X 'J �r" c� C v 7 2J 7L Address of Owner: .
/s l y 4--4 Dc)h k I«
Date of Inspection: (If different) �
Name of Inspector: r O y Williams / 7 O x 7,5z y.,K 40—
I am a.DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000)
Company Name: Troy .Wi 11 iams Septic Insaectio.ns
i
Mailing Address: 19 Hummel Drive , South Dennis , MA 02660 0-Z63 S'
Telephone Number: T50 8T38 5-13 0 0
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:
asses
Conditionally Passes
Needs Further Evaluation By the Local Approving Authority
_ Fails
Inspector's Signature:. J/LsT7 lic/� Date: `� 45 -J -2
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.
Any failure criteria not evaluated are indicated below.
COMMENTS:
B] SYSTEM CONDITIONALLY PASSES: N /1
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 04/25/97) Page I of IQ
DEP on the World Wide web: httpl/www.mapnet.state.ma.usldep
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address:
Owner: ��Hcr— <
Date of Inspection: 15 7
B] SYSTEM CONDITIONALLY PASSES (continued) N/1�9
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
C] FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: N 1119
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:
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 (approximation not valid).
3) OTHER
I
(revised 04/25/97) Page 2 of 10
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: L
Owner: �U 1 C <-
Date of Inspection: /5 / Y -2
Dj SYSTEM FAILS: AIM
You must indicate ei;,,er "Yes" or "No" as to each of the following:
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 correct
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.
Liquid depth in cesspool is less than 6" below invert or available volume is less than 1/2 day flow.
Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).
Number of times pumped _.
Any portion of the 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.
El LARGE SYSTEM FAILS: ^114
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
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 11 of a
I 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 04/25/97) Page 3 of 10
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST
Property Address:
Owner: 01j;-N` k t
Date of Inspection: S /S /� 7
Check if the following have been done: You must indicate either "Yes" or "No" as to each of the following:
Yes i No
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.
The system does not receive non-sanitary or industrial waste flow.
_ The site was inspected for signs of breakout.
All system components, excluding 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)]
f
(revised 04/25/97) Page 4 of 10
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
ff pp /� SYSTEM INFORMATION
Property Address:
l 0 7 Q K TU�—d
Owner:
Date of Inspection: S 7
FLOW CONDITIONS
RESIDENTIAL:
Design flow: 2,3o g.p.d./bedroom for S.A.S.
Number of bedrooms:
Number of current residents: 1
Garbage grinder (yes or no):Yf-s
Laundry connected to system (yes or no): yr S
Seasonal use (yes or no): n/u
Water meter readings, if available (last two (2) year usage (gpd): 96 /y1 o�-• S 4 �/.,,5 /` S - /� �juv:;�,�, /o,,S
Sump Pump (yes or no): ^/O
Last date of occupancy:
COMMERCIAUINDUSTRIAL.
Type of establishment:
Design flow:_gallons/day
Grease trap present: (yes or no)_
Industrial Waste Holding Tank present: (yes or no)
Non-sanitary waste discharged to the Title S system: (yes or no)_
Water meter readings, if.available:
Last date of occupancy:
OTHER: (Describe)
Last date of occupancy:
GENERAL INFORMATION
PUMPING RECORDS and source of information: //� /�
g 6 42 c v r , /!7 7✓-d �t h o I L t a y✓h L
System pumped as part of inspe ion: (yes o(no) ^/o
If yes, volume pumped: gallons
Reason for pumping:
TYPE QF 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)
VA Technology etc. Copy of up to date contract?
Other
APPROXIMATE AGE of all components, date installed (if known) and source of information: f �a / /
II r - 6, • lf•
Sewage odors detected when arriving at the site: (yes or no) N O
(revised 04/25/97) Page 5 of 10
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: I ?
Owner: OU 4-1 L k ( L L
Date of Inspection: � / S
BUILDING SEWER:
(locate on site plan)
Depth below grade:
Material of construction: _cast iron _40 PVC _other (explain)
Distance from private water supply well or suction line
Diameter
Comments: (condition of joints, venting, evidence of leakage, etc.)
SEPTIC TANK:
(locate on site plan)
Depth below grade:
l �
Material of construction: :oncrete _metal _Fiberglass _Polyethylene _other(explain)
If tank is metal, list age _ Is age confirmed by Certificate of Compliance _(Yes/No)
Dimensions:_ 5 ')c 9
Sludge depth: a
Distance from top o sludge jo bottom of outlet tee or baffle:
Scum thickness: , , f c- t✓ •
Distance from top of scum to top of outlet tee or baffle:
Distance from bottom of scum to bottom of outlet tee or baffle:
How dimensions were determined: ry b' .
Comments:
(recommendation for pumping, conditi 9n of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural
integri evidence of leakage, etc.) U L « r { f .A G a `
a s i G
o c v
—��to, k
GREASE TRAP: / U�/9
(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:
(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 04/25/97) Page 6 of 10
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYST,EEM� INFORMATION (continued)
Property Address: f✓ x �^ (/�.
Owner: 0,) c,k 4C_`
Date of Inspection: g /r / 9 ,
TIGHT OR HOLDING TANK: /U��(Tank must be pumped prior to, or 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 level: Alarm in working order_Yes; _ No
Date of previous pumping:
Comments:
(condition of inlet tee, condition of alarm and float switches, etc.)
DISTRIBUTION BOX:_V.
(locate on site plan)
Depth of liquid level above outlet invert:
Comments:
(note if level an/d 4istribution is equal, evidence of solids carryover, evidence of leakage into or out of box, etc.)
u o- 1-.4— e./
PUMP CHAMBER: A 19
(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.)
(revised 04/25/97) Paga 7 of 10
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
c/ SYSTEM INFORMATION (continued)
Property Address:
Owner: �✓ ` k L
Date of Inspection:
SOIL ABSORPTION SYSTEM (SAS):_z
(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.b C_ 6 X L c ti� >< wr
leaching chambers, number:_
leaching galleries, number:
leaching trenches, number,length:
leaching fields, number, dimensions:
overflow cesspool, number:
Alternative system:
Name of Technology:
Comments:
(note condition of soil, si ns of hydraulic JJfailure, level of ponding, condition of vegetation, etc.)
(N cti�c,r/ S uv1 J. I..J•ih
CESSPOOLS: _
(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 (cesspool must be pumped as part of inspection)
Comments:
(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.)
PRIVY:_
(locate on site plan)
Materials of construction: Dimensions:
Depth of solids: -
Comments:
(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.)
(revised 04/25/97) Page 8 of 10
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: <6 7 U x 7<,',) 0,
Owner: �✓n L k C e e
Date of Inspection: G
SKETCH OF SEWAGE DISPOSAL SYSTEM:
include ties to at least two permanent references landmarks or benchmarks
locate all wells within 100' (Locate where public water supply comes into house)
-4 c./ I i_c T
6,1
s...r��
per�,1'
fe. s•h..y
17 '
3�
(revised 04/25/97) Page 9 of 10
SUBSURFACE SEWAGE DI
SPOSAL SYSTEM INSPECTION FORM
PART C
1 SYSTEM INFORMATION (continued)
Property Address: / 7 K r�` a .
Owner: DJn C-k e -
Date of Inspection:
Depth to Groundwater Feet adjusted high groundwater level
Please indicate all the methods used to determine High Groundwater Elevation:
Obtained from Design Plans on record
Observation of Site (Abutting property, observation hole, basement sump etc.)
Determine it from local conditions
Check with local Board of health
Check FEMA Maps
Check pumping,records
Check local excavators, installers
Use USGS Data
Describe in your own words how you established the/High Groundwater Elevation. (Must be completed)
^7
fJ, S U -N" 4-�y
f � Gr h �
(revised 04/25/97) Page 10 of 10
LOCATION C SEWAGE PERMIT NO.
VILLAGE
I N S T A LLER'S NA E & ADDRESS
B UI'LDpE R OR OWNER
DATE, PERMIT ISSUED
DAT E COMPLIANCE ISSUED `-7 7
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V�
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TOWN OF BARNSTABLE
LOCATION _9 2 k Or• SEWAGE# c�.
VILLAGE a 'f" ASSESSOR'S MAP &LOT _
INSTALLER'S NAME&PHONE NO. 19,im
SEPTIC TANK CAPACITY /"V U l
LEACHING FACILITY: (type) fi (size)
NO.OF BEDROOMS .�
BUILDER OR OWNER /t—
PERMPTDATE: //y 127 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) p Feet
Furnished by-=�w' t t%u- • C1 r ��—
ci M
` D �.r�
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NV
Y'
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THE COMMONWEALTH OF MASSACHUSETTS
0-2,1/03 BOARD F HEALTH
`t ! OF.....X.CtA,.40 ......------------------- -----
Appliratinn -for Diaposal Workii Tnnfitrurtion Permit
Application is hereby made for a Permit to Construct Y) or Repair ( ) an Individual Sewage isposal
stemat ' -------•-•------------------••-•-•-••--••-• -•--•-•---•--••-••......-•--••-----•••---
or
Location 4dcjrq4s
............................................ Lot No.
caner Address
...........................2!Z ...
Installer Address
d Type of Building Size Lot____________________________Sq. feet
Dwelling Building
of Bedrooms-------P.<...............................Expansion Attic ( ) Garbage Grinder ,(
Other—Type of Building No. of persons____________________________ Showers Cafeteria
dOther xtures --------------- --------------------------------------------------------- --------------------------------------
Desi n Flow........... ______________ -_ Mons per person per day. Total daily flow....._..a�0.._.__....._-_-._.._._ Mons.
W g ._.Q ------- g� P P P Y• Y ---- g�
WSeptic Tank-t Liquid capacity/oagallons Length................ Width................ Diameter................ Depth----------------
x Disposal Trench—No. .................... Width-------------------- Total Length.................... Total leaching area--------------------sq. ft.
Seepage Pit No..________�...._.. Diameter.. �/� Depth belo inlet____________________ T tal le II area------------------sq. it.
z Other Distribution box ( ) Dosing tank (. ) .P 6 1.7 9 / ws •
Percolation Test Results Performed by------- ----------------•-------••-•-•-•----••---•----••-•............... Date--_---------------------- ------------
Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water..-.____.-_.-__.-_._-.-.
rZ4 .:Test Pit No. 2................minutes per inch Depth of Test Pit-------------------- Depth to ground water--.--.---_--_-____---.
Ix -•-••-•- e.........--------•--- --•--- --f ---------+............e------•--------- --- ------------- ----
O Descri tion f Soil —A......
------. -
w •
---- ------------------------------------- ----------------------------------------------------------------------------------------- --------------------------------------------------------------
V --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 Article NI of the State Sanitary Code—The undersigne further agrees not to place the system in
operation until a Certificate of Compliance has bee ssued by th and
'
tgned-- .. ...
Date
Application Approved BY......--- ---- --- --•••---- ------- ------# 00!T_77
Date
Application Disapproved for the following reasons------------------------
----------------
------------------------------------------------------------------------
-•--••-•••-•-••--•-•-•-----------------------------------------------------------------••--------------•------------------------------------------------------------------------------------------------
T Date
PermitNo......................................................... Issued.-----f--. --7................
Date
------------------------
_ F
THE COMMONWEALTH OF MASSACHUSETTS
BOARD QF HEALTH
'Ape rtttion -for Uhipmal Workii Cott�#rttrfiott rrotit
Application is herebymade for a Permit to Construct O or Repair ( ) an Individual Sewage Disposal
Svistem,at A? .A 0�w� .o -v e. 71,---------- .................................................................................................
N �
Locatron- d eSs or Lot No.
Vio
T 'e- -----• ----•--------- ------
w/
wner �r Address
W aI
a
Installer Address
UType of Building, Size Lot----------------------------Sq. feet
Dwelling_No. of Bedrooms._-__ .......................Expansion Attic ( ) Garbage Grinder ,(
a`q Other—T e'-of Building -_-_ ...
YP g ........:........ No. of persons---._...:---------_---___--- Showers: ( ) - Cafeteria ( )
d --- ----•- ------ ----------- -_............................................
.._...._..---- ------'---...._..._•
Design Flow_._ _____ gallons per person per day,. Total duly flow......... ------------------_...gallons.
Other K res
W
WSeptic 'Tank Liquid c ip tcit�,tlgallons Length _.__ Width .._. Diameter....... . ...... Depth-.-.---.- ......
x Disposal Trench—No ;,Nvvidtl Total Length Total leaching area_____________ _____sq. ft.
Seepage Pit No.___-_---- DiameterDepth belo inlet....._ Thal leacng arert_._..__...:_:.,sq. ft.
Other Distribution box D sifig tank
Percolation Test Results Performed by -----------------........................................................... Date............._._._._...---_---------
Test
Pit No. 1----------------minutes per inch Depth of Test Pit_ _--__-_:______-_ Depth to ground water.._--_. --_-.. ._
(Z, Test Pit No. 2................minutes per.inch Depth of Test,Pit-._--_.__:______-_ Depth to ground water.-.-.--..____----_-....
:_ _ - 3 .......
G l �% f ti
Description f Soil .`"� t �
UrvV
------------------------------------------- ------------t -- -- ----
=
W --
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 Article XI of the State Sanitary Code... The.undersigile urtl er agrees not to place the system in
operation until a Certificate of Compliance has be sued by i and
igned
Date e
�''"Application Approved BY --_-- ._...._P�'� -w� �L •. - `w r
Date
Application Disapproved for.the following. reasons:_________ __________:__---_::.: _
----------- ..............................................................
-----------------------------------------------------------_--------------•---•-----------•-•---------•--------------------------•--•-----•-------.._-__--•--------------- -----------___---••----------
qq Date
Permit No. =' Issued l--�----7...................
Date
THE COMMONWEALTH OF MASSACHUSETTS
�. BOARD OFoj-IEALT,H
..... ..............................OF.......... ..............----.... .......,'
T.rrtifiratr of 'ant.liam
THhS S'TO CFpRfIFYIhat the Individual Sewage Disposal System constructed ( ) or Repaired ( )
----
bY ......... ' --------------- ---------------- -----
T
at t 4 t -----------------------------------------------------------------------------
4
has been installed in accordance with the provisions of #ptbcle XI of The *tate Sanitary Code as described in the
application for Disposal Works Construction Permit No 'T-____Z__AF- ......... dated' /Y._.. '4_ ...........
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE Inspector._.. --- --------------------------------•-•-----
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
' . ..._.of...... ......: +
No__________ ____________
l ,Mork CIT, witrurtion jorrmit
Permission.> , hereby granted_:_._,. ." ___ __
,.�
k --------------- .........................................
to Contru ( or Repair r( ) a Ind ideal Sewa DisP i 1 System
atNo.` .p -----•• �" ` `. " ---:-t, '�t +-'--------------------------------------------- ---------- -------------------
Street N rmit a a
as shown on the application for Disposal Works Construction P; :. -- s-� �_.. Dated_._ -'�- -----------------
Board of Hea
✓ Ith _
DATE.---•-----`�---`
FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS _
ZOT /4
150
+¢3.
Nj
ro
�X 8 C 7'
VV/T1-/ 1 s-r c
STONE
JI T
/OOC G'AL O
S�hT/C _
1_GT 2 N ��Nr LoT 22
�F7 ' _
?a,
- - c3)4. 0-9 32.00
- A t
40' W/9
�`i i O` F Af
.de
�5 H O fO E 4
f
RICHARD `; , j pr
JAMES w "r RICHARD yG
cai O'PEARN =i I /U JAMES
No. 27971 ~ U 0 'EARN I / j�
/ �F�� �� No. 696 0 ti CER l y-/F!f�D PL®T PLAAI IN
�SUR��cam/ S ,� .
kNIT ' a LOT ' 2J_7 D/`lVF
I CERTIFY THAT THE PIC14ARD J. OWEARAl, R.L.S., R. S.
ShVWN ON T141S PZ AIV /S LOCATED 191 MA/N ST. (RTE. 2 8)
ON THE GROUND AS INDICATED AND WEST DENNI5 , MASS .
CONFORMS TO THE ZOA//HG LA WS
SCALE.
2. J043 NO. 0 7/ CLIE/VT."
DATE ;'DREG. LAND SURVEYOR DR. BY: �• !i%:� SHEET ,` OF J
• �G� !='�' /t/�ice/
CLEAN SAND -
M/N. CONCRETE
CONCRETE
- _
COVERS COVER
777
L/Qula 2" LAYER
LEVEL OF ye- 3181"
4wCAS7- /ROA( 0 0 WA514ED STONE .
a •PIPE— MIN. SEPTIC DIST. K j 0 3 "
f�/TC/�/ 'PeE/4 FT. BOX o 0 o �� —/�T_ ill
TANK o 0 WASHED ,STONE
c W o ' PRECAST .SEEPAGE
o k O v o PIT OR EQU/Y..
o 4 C a
SFr 1-21,19
�GP,OUND WATER TABLE
SECTION! OF
.SEWAGE DISPOSAL SYSTEM goy RIC ARi ES
A/O T TO SCALE O'HERN
INVERT E L E!/ .
`. ., No. 27971 v>
/NVERT AT BUILDING FT. v,✓Fc/STt����4
INLET SEPTIC rAN� FT. SOiL LOG �SUR`!�
- ;-
OUTLET SEPTIC TANKFT. _
INLET DISTRIBUTION BOX FT. DATE OF SOIL TEST P`IHOF�gs i
OUTLET DISTRIBUTION ,BOX FT WITNESSED BY Tr,i✓^� of ��i^� �E��• �� s��, � I
INLET SEEPAGE PIT FT. PERCOLATION RATE MIN.//NCH g�`� RICHARD 9G�`
ELEVATION O HE JAMERN C^'�
No. 674 Q
DESIGN C):?1 'E)q iA — �F_is7tX`
NUMBER OF BEDROOMS 2 SA'ITAR1��,
GARBAGE DISPOSAL UNIT N�N�
TOTAL ESTIMATTE-D FLOW ?' 'O GAI-IDAY.
NUMBER OF SEEPAGE PITS �o T '23 - QX
SIDE LEACHING AREA 15 / SQ. FT. PMAS '.
,BO t TOM LEACHING AREA ��� SQ. FT. �f�f'n/ST�Jj3 C r=
TOTAL. L.EAChIING AREA 30 SQ. FT. RICHARD J. O'HEARNJIR.L.S., R.S.
RESERVE LEACHING AREA 3 / SQ.FT. 191 MAIN ST.
WEST DEMAII Sip MASS .
JOB NO. lJ 7� CLIENT �i�7J Ti`�Al D
Q4rE: G� �7 7 S'NEET OF 2
IRON V .
POST
' ASSESSORS MAP 21 LOT 36
I / PLAN REF: 281/82
41 I FLOOD ZONE "C"
A. M. 21/ I i COMMUNITY #250001-0021-D
I i o Ss�o DATED 7/2/92
; A BBE Y o
�t7 I I I 6'Q REFER TO MORTGAGE LOAN
GATE o INSPECTION PLAN DATED. 10110197
I ' °' I , A' M. 21/37 OTTE & DWYER, INC. SURVEYORS
SA UGUS, MA.
� � I o •
I I
=�--GARAGE:
9N �o. ` r - - -� - -_--_--=-_--_ -_ �
A. M. 21/28 o , SEPTIC REPAIR PL AN
TP \ r:.:
FOR
�✓/ 96 ° j?o; HOUSE_= _ �s'�
-�-- - - - �� �9l RD AND CAROLE'
LEACH PIT� i ___ ,�187 \\ .fG .?� , RICHA
�l
TO BE PUMPED AND _ _ °(,� HA MIIIE'RSLE'Y
REMO VED / � � -- -_----_-- -= D� •�� � rwJDRIVE
� 9a BENCHMARK-=--�•. ` ` � #187 OXFORD
TOP OF SILL- l CO T UIT, MA.
I / _ - -
100. 1 2 `� moo!
APRIL 15, 2002
_ C
w SCALE. 1"=20'
A. M. 21/36 o PREPARED BY
t NOTE. HEALTH DEPT. TO INSPECT AREA=21,852f SF �/ BRUCE G. MURPHY, R S
OLD LEACH PIT REMOVAL PRIOR 0
TO BACKFILLING � O �� 77 SPUR LANE
BRUCE � MARSTONS MILLS, MA. 02648
R. PH.- (508)428-3358
A. M. 21/35 � � M�RPHY
No.749
/ "At/TAR P SHEET 1 OF 2 J# 53087
EL. = 10758'
P OF FCJI/NDATION
20' MIN.
10' MIN. CONCRETE COVERS 4" SCHEDULE 40 P. VC 2"LAYER OF
ADD 2 RISERS MIN. 1/B PER FT WASHED STONE
STONE
WALKOUT 99.3
/ / / , � ♦ / / , , , , , / / / / , —T / � � NCRETE COVER
6' MAX a MA ♦ / / / • ♦ / / , EL=99.5 EL.=100.3
4" CAST IRON PIPE 6»
(OR EQUAL MINIMUM 6 AlAX 9„
I7rH 14 PER FT. CLEAN MIN.
FLOW LINE SAND EL=96.8
\.
10"
'MIN. 14" _2.0'_ ° 8�° o Cl 0 0 0 0 0 °°°O°p° 2'
ADD GAS INVERT 6 SUM LEVEL ° 8 8 0°o o a o a o 0 0 °°o =94'
INVERT BAFFLE EC = 96.85 INVERT INVERT —
EL.= 97.1 EL.= 96.5 EL.= 96.25_ INVERT 4 I 4
_ loon__GALLONS
DISTRIBUTION EL.=96
PROFILE OF
EXIST. SEPTIC TANK TO BE BA TER TESTED 12.8' X 25' TRENCH FORMA NON——
COc�
SEWAGE DISPOSAL SYSTEM IF MORE THAN ONE OUTLET
PLACE ON 6" STONE 3/4" 7YJ 1-!iz" SOIL ABSORPTION �
NOT TO SCALE DOUBLE WASHED STONE SYSTEM (SAS
0" ELEV.=_98_
ABBEY GATE ROAD ELEV._ 81.2
TALL TWO (z) ACME BOTTOM OF TEST HOLE/
INSTALL
GALLON LEACHING CHAMBERS PILL NO OBSERVED WATER TABLE (4/15/02) ELEV.=_86.0
WITH FOUR FEET OF DOUBLE "
. 36
WASHED STONE SIDES AND ENDS
25' X 12.8' SOIL TEST
48„
1 OBSERVATION HOLE 1
60" PERCOLATION RATE S2__ MIN./ INCH AT _ 72_ INCHES
GENERAL NOTES
72" DATE OF SOIL TEST 411512002
1) ALL WORKMANSHIP AND MATERIALS SHALL CONFORM TO D.E.P. PERC SOIL TEST PERFORMED.BY- BRUCE G. MURPHY, R.S.
TITLE 5 AND THE TOWN OF _RARNSL BLE____ RULES AND C (10YR8/3)
REGULATIONS FOR THE SUBSURFACE DISPOSAL OF SEWAGE.
2) ONE COVER ON SEPTIC TANK SHALL BE BROUGHT TO DESIGN CALCULA TIONS.'
WITHIN 6" OF FINISHED GRADE, OTHERS WITHIN 6" 144" 144"
3) ALL COMPONENTS OF THE SANITARY SYSTEM SHALL BE CAPABLE OF NO GROUND WATER NUMBER OF BEDROOMS . . . . . . 3
WITHSTANDING H-10 LOADING UNLESS THEY ARE UNDER OR WITHIN GARBAGE DISPOSAL . . . . . . . NOT ALLOWED _
Y 10 FT. OF DRIVES OR PARKING AREAS. H-20 LOADING SHALL BE TOTAL ESTIMATED FLOW 330 GAL/DAY
USED UNDER OR WITHIN 10 FT. OF DRIVES OR PARKING AREAS. NO TES.' ( 110 GAL/BR.IDA Y x 3--- BR.)
4) ANY MASONARY UNITS USED TO BRING COVERS TO GRADE SHALL EXISTING SEPTIC TANK CAPACITY 1000 GAL
BE MORTERED IN PLACE.
5) NO DETERMINATION HAS BEEN MADE AS TO COMPLIANCE WITH *LEA CHPIT PUMPED AND REMOVED SOIL CLASSIFICATION . . . . . . . . I
DEEDED OR ZONING REGULATIONS. OWNER/APPLICANT IS TO DESIGN PERCOLATION RATE . . . . . < 2 MIN./IN.
OBTAIN SUCH DETERMINATION FROM APPROPRIATE AUTHORITY. *HEALTH DEPT. TO INSPECT EFFLUENT LOADING RATE . . . . • 74 GAL/DA Y/S.F.
6) UTILITIES SHOWN ARE APPROXIMATE ONLY, EXCA VA TION CONTRACTOR OLD LEACH PIT .REMOVAL PRIOR LEACHING CAPACITY (AREA X RATE) 347 GAL/PA Y
IS TO CALL "DIG— SAFE" AT 1-800-322-4844 AT LEAST 72 HOURS TO BACKFILLINC RESERVE LEACHING CAPACITY . . . 347 GAL/DAY
PRIOR TO COMMENCING WORK ON SITE. *IF FILL IS ENCOUNTERRED 25 X 12.8 X . 74)+(25 + 25 +12.8+12.8 X . 74 X 2)
7) CONTRACTOR IS TO VERIFY GRADES AND ELEVATIONS AS WELL AS 5' AROUND LEACHING IS REQUIRED
SITE CONDITIONS PRIOR TO COMMENCING WORK ON SITE. HEALTH DEPT. Try. INSPECT
8) PARCEL IS IN FLOOD ZONE—_"C'" . PRIOR To BACKFILLING
9) LOT IS SHOWN ON ASSESSORS MAP __21 AS PARCEL _36___. SHEET 2 of 2 JOB NUMBER _ 53087_____