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HomeMy WebLinkAbout0010 PENELOPE LANE - Health LOT 59 PENELOPE LIQL , COTUIT -- - i� A=039051 i Commonwealth of Massachusetts o39- 067 `k u Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments n 10 Penelope Ln. Cotuit, MA 02635 -a Property Address i Edward Northrup PO Box 22 Owner Owners Na e information is �., required for every Cotuit MA 02635 8/24/2017 page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any . way. Please see completeness checklist at the end of the form. Important:When A. General Information t filling out forms on the computer, 7 , use only the tab 1. Inspector: key to move your cursor-donot Paul Martin use the return key. Name of Inspector Cape Cod Septic Services r� Company Name 350 Main St Company Address /camW.Yarmouth MA 02673 Cityrrown State Zip Code 508-775-2825 S15016 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000). The system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority 000- ' 8/28/20174 Inspector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,00.0 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP, The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ""This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 17 Imo" Y v Commonwealth of Massachusetts u u Title 5 Official Inspection Form A a Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 10 Penelope Ln. Cotuit, MA 02635 Property Address Edward Northrup PO Box 22 Owner Owners Name information is required for every COtUIt MA 02635 8/24/2017 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR_15.304 exist. Any failure criteria not evaluated are indicated below. Comments: System in working condition. B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass"section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no" or"not determined" (Y, N, ND)for the following statements. If"not determined,"please explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): I t5ins•3/13. Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 f Commonwealth of Massachusetts . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 10 Penelope Ln, Cotuit, MA 02635 Property Address - Edward Northrup PO Box 22 Owner Owner's Name information is required for every COtUIt MA 02635 8/24/2017 page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes (cont.): El Observation of sewage backup or break out or high.static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipes) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N, ❑ ND(Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health,safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal system•Page 3 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments 10 Penelope.Ln. Cotuit, MA 02635 Property Address Edward Northrup PO Box 22 Owner Owner's Name information is COtUIt required for every MA 02635 8/24/2017 page. Cityrrown Siate Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the.Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank.and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate"Yes" or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than '/z day flow t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts N Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 'r 10 Penelope Ln. Cotuit, MA 02635 Property Address Edward Northrup PO Box 22 Owner Owner's Name information is required for every Cotuit MA 02635 8/24/2017 page. City/Town State Zip Code • Date of Inspection B. Certification (cont.) Yes No ❑ Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times-pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any.portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well.. ❑ Z Any portion of.a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems,you must indicate either"yes" or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 20.0 feet of a tributary to a surface drinking water supply El ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection 'Area—.IWPA)or a mapped Zone II of a public water supply well If you have answered "yes"to any question in Section E the system is considered a significant threat, or answered"yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15,304. The system owner should contact the appropriate regional office of the Department. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ,•°'� 10 Penelope Ln. Cotuit, MA 02635 Property Address Edward Northrup PO Box 22 Owner Owner's Name information is required for every Cotuit MA 02635 8/24/2017 page. City/Town State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes" or"no" as to each of the following: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ E Were any of the system components.pumped out in the previous two weeks? ❑ ® Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection?- ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® El Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ® Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ED ❑ Existing information. For example, a plan at the Board of Health. ® Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms(design): 3 Number of bedrooms (actual): 2 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330pd 110gpd t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 Commonwealth of Massachusetts N Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 10 Penelope Ln. Cotuit, MA 02635 Property Address Edward Northrup PO Box 22 Owner Owners Name information is required for every COtUIt MA 02635 8/24/2017 page. Cityrrown State Zip Code Date of Inspection D. System Information Description: Number of current residents: 0 Does residence have a garbage grinder?. ❑ Yes ® No Is laundry on a separate sewage system? (Include laundry.system inspection Yes ® No information in this report.) El Laundry system inspected*? ns acted. Y p ® Yes ❑ No_ Seasonal use? ® Yes ❑ No Water meter readings, if available(last 2 years usage(gpd)): 2015=249gpd 2016=236gpd Detail Sump pump? El Yes ® No Last date of occupancy: Unknown Date CommerciallJndustrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15:203): Gallons per day(gpd) Basis of design flow (seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No I Water meter readings, if available: t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Dsposal System•Page 7 of 17 l Commonwealth of Massachusetts . Title 5 (Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments •''t 10 Penelope Ln. Cotuit, MA 02635 Property Address Edward Northrup PO Box 22 Owner Owners Name information is required for every Cotuit MA 02635 8/24/2017 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use. Date Other(describe below): General Information Pumping Records: Source of information: No Records Was system pumped as part of the inspection? ❑' Yes ® No If yes, volume pumped: gallons How was quantity pumped determined?.. Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ` 0 Other(describe): f t5ins•3113 Title 5 Official Inspection form:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection -Form a Subsurface Sewage Disposal System Form-Not for Voluntary Assessments r< 10 Penelope Ln. Cotuit, MA 02635 Property Address Edward Northrup PO Box 22 Owner Owners Name information is required for every COtUIt MA 02635 8/24/2017 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed(if known) and source of information: 1999 Per BOW records Were sewage odors detected when arriv ing at the e _ 9site?•, El Yes ® No Building Sewer(locate on site plan): _Depth below grade: 251' feet Material of construction: ❑ cast iron ®40 PVC ❑ other(explain): Distance from private water supply well or suction line: +10' feet Comments (on condition of joints, venting, evidence of leakage, etc.): Line checked with sewer camera and was found to be clean, properly pitched with no sign of root intrusion. Septic Tank(locate on site plan): Depth below grade: feet Material of construction: ® concrete ❑ metal ❑fiberglass ❑ polyethylene ❑other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1500Gal Sludge depth: 3-5" t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 10 Penelope Ln. Cotu it, MA 02635 Property Address Edward Northrup PO Box 22 Owner Owners Name information is Cotult required for every MA 02635 8/24/2017 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle Scum thickness lit Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle How were dimensions determined? Estimated Comments (on pumping recommendations, inlet and outlet tee or baffle condition„ structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): 1500Gal tank in good condition.PVC tees in place and clean.-Tank at normal operating level. Covers 16" below grade. t Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts W W Title 5 Official Inspection Form "s Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 10 Penelope Ln. Cotuit, MA 02635 Property Address Edward Northrup PO Box 22 Owner Owners Name information is required for every Cotuit MA 02635 8/24/2017 page. CitylTown State Zip Code Date of Inspection D. System Information (cont.) Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): r Depth below grade: Material of construction: ❑concrete ❑ metal ❑fiberglass ❑ polyethylene ❑other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑`Yes ❑ No Date of last pumping: pate Comments (condition of alarm and float switches, etc.): "Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No I t5ins•31113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 10 Penelope Ln. Cotuit, MA 02635 Property Address Edward Northrup PO Box 22 Owner Owners Name information is required for every COtUIt MA 02635 8/24/2017 page. City/Town State Zip Code Date of Inspection D. System Information (cont.). Distribution Box(if present must be opened) (locate on site plan): Depth of liquiid level above outlet invert 0" Comments(note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): H-10 DB-3 with 1 line in and 2 lines out in good condition. Minimal solids carryover. Box is clean and level. No sign of overloading or hydraulic failure Cover 22" below grade. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No" Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.): " If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: f t5ins•3H3 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 Commonwealth of Massachusetts G W Title 5 official Inspection Form a Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 10 Penelope Ln. Cotuit, MA 02635 Property Address F Edward Northrup PO Box 22 Owner Owners Name information is required for every Cotuit MA 02635. 8/24/2017 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: 0 Teaching chambers number: 2-500Gal ❑ teaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments (note condition of soil, signs'of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): 2-500Gal chambers with stone in a 10.8'x28'x2'trench. Chambers found dry at time of inspection. No staining. No sign of overloading or hydrauilc failure. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration- Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins 3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts v: Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 10 Penelope Ln.Cotu it, MA 02635 Property Address Edward Northrup PO Box 22 Owner Owners Name information is required for every COtUIt MA 02635 8/24/2017 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 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.): G t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System,•Page 14 of 17 Commonwealth of Massachusetts u W Title 5 Official. Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 10 Penelope Ln. Cotuit MA 02635 Property Address Edward Northrup PO Box 22 Owner Owner's Name information is required for every COtUIt MA 02635 8/24/2017 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ❑ hand-sketch in the area below ® drawing attached separately t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 15 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 10 Penelope Ln. Cotuit, MA 02635 Property Address Edward Northrup PO Box 22 Owner Owner's Name information is required for every Cotuit MA 02635 8/24/2017 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: Check Slope .. ® Surface water ® Check cellar, ® Shallow wells Estimated depth to high ground water: feet feet Please indicate all methods used to determine the high ground water elevation: ® Obtained from system design plans on record If checked, date of design plan reviewed: 1999 Date ❑ Observed site(abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health-explain: ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS.database-explain: You must describe how you established the high ground water elevation: Test hole data per plan on file at BOH. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•3/13 Title 5 Official Inspection Form;Subsurface Sewage Disposal System•Page 16 of 17 Commonwealth of Massachusetts w Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 10 Penelope Ln. Cotuit, MA 02635 Property Address Edward Northrup PO Box 22 Owner Owner's Name information is required for every COtUIt MA 02635 8/24/2017 page. City/Town State Zip Code Date of Inspection- E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems)completed ® System Information—Estimated depth to high,groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 , Yage 1 of 2 LOCATIONLYel /-&lit SEWAGE# VILLAGE _C =U;T° ASSESSOR'S MAP&LoTDaWasi INSTALLER'S NAME&PHONE NO. 77A_a yW� SEPTIC TANK CAPACITYaar LEACHING FACILTIY:(typo)PR c,w_-r 2-svv GfL AtY.O(size) ze'x /o:d+ x�' NO.OF BEDROOMS 3 BUILDER OR OWNS Q \'�► PERMTTDATE: 6 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) Feed') Edge of Wetland and Leaching Facility(If any wetlands.exist within 300 feet of leaching facility) Feet Furnished by 6TOC-2C' 8 7o 0-z3' 9 Te 6-yy'.< 8 7zr r-36_' . A To F _�y. Ova F_ 3'1' a - j hq://www.townofbamstable.us/Assessing/HMdisplay.asp?mappar=039051&seq=l 8/23/2017 0 OWN OF BARNSTABLE LOCATIO �Ac SEWAGE # 9 y 9YS VILLAGE C e7"v;T ASSESSOR'S MAP & LOT7 INSTALLER'S NAME&PHONE NO. C3 . C .j ? Is,—o y g4 SEPTIC TANK CAPACITY Art y„jsaW LEACHING FACILITY: (type) PACcAsr 2e Soo G,#L (size) -as"X /0.g if 2" NO.OF BEDROOMS BUILDER OR OWNE tK,� PERMTT DATE: COMPLIANCE DATE: _ �/ - Zoom 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) Feetn Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by N N of t, a l� N m m � em a G ^i a a m i v ' � 0 oql s��,A/r- �v�- f TOWN OF BARNSTABLE LOCATIONi�'1 L SEWAGE # 99 Sys VILLAGE C oT v i7ASSESSOR'S MAP & LOT L7 INSTALLER'S NAME&PHONE NO. 7 78 o I y4 i SEPTIC TANK CAPACITY /Soo a 4-r LEACHING FACILITY: A2y��ls- (type) PRsr,&sr 2- soo c,vL (size) NO.OF BEDROOMS ,3 BUILDER OR OWNS PERMITDATE: COMPLIANCE DATE: -Z - 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 -3� d7 d a A To C _ 39 BTo C -26' To 0-Z3' ATa �-_ y�, �7ToF -S8. u BTaF- 3y' i E s No. 7 It 6— "'" ,,,,. Fee , mil' ?j -tHE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS 0[ppYication for 3koo.5al *pgtem Construction i3ermit Application for a Permit to Construct )Repair( )Upgrade( )Abandon( ) ❑Complete System O Individual Components Location Address or Lot No. Owner's Name,Address and Tel.No 5q Pp� opt; � � carpiY Assessor's Map/Parcel 9 ibi, Ins er's N ddress,and Tel.No. Jp�� Designer's Name,Address and Tel.No. t,•¢. -PEMA2�S e ��/►�.�E1.1,0.�/ �/vF,-In/�t✓�I+✓lr );off 4b!5 W. N)S o'W70 399.1)71v Type of di Dwelling No.of Bedrooms 3 Lot Size , sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow 3io gallons per day. Calculated daily flow gallons. Plan Date l a,g-cl q Number of sheets etJ& Revision Date Title SYf t; jr-00 S 1 1? 6 P f LAt") Size of Septic Tank 150 Type of S.A.S. `L-500 CAI. rJ4J4M5Mr Description of Soil 0-3K A-J3 30N-)716" M C_h SAP, Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provijns of Tit of the En ' n al Code and not to place the system in operation until a Certifi- cate of Compliance has beensue t s Bo e , Signed ate Application Approved by Date =53'- Application Disapproved forte following reasons Permit No. & - 7 Date Issued 6 'F Fee "__ "-;4'HE}COMMONWEALTH OF MASSACHUSETTS W--. Entered in computer:9. Yes PUBLIC HEALTH.,DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS ficat_ion for Mi_4possar *pgtern Construction Permit Application for a Permit to Construct(X)Repair(f )Upgrade( )Abandon( . ) El Complete System ❑Individual Components Location Address or Lot No. Owner's Name,Address and Tel.No. bol 59 PEI-JeupE Assessor's Map/Parcel 1 Inst Her's a ddress,and Tel.No. Designer's.Name,Address and Tel.No. DC/''I4'2E✓51' M(f L£llAn/ y63 u1, sox ►��Nr�Is oz.G�U 3qS-�7�v Type of Building: Dwelling,- • No. of Bedrooms J� Lot Size ZO sq. ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow 396 gallons per day. Calculated daily flow 338 gallons. Plan Date I o Number of sheets 0N6 Revision Date Title S'1'ft Owe St wAGF� PLAN -Size of Septic Tank 15(y Type of S.A.S. - Soo Description of Soil D-30 A' 30''- 126' Mr'� SnND Nature of Repairs or Alterations(Answer when applicable) Date last inspected: - - Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Titl 5 of.the Env' n�� al Code e and not td place the system in operation until a Certifi- cate of Compliance has-been issued Bo ea Signed C C ateff ^� Application Approved by ~= Z Dated Application Disapproved-for thV following reasons Permit No. �/ - 7 y k w Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CER ,tha,�t/he Onjsite Sewage Disposal System�Constructed( )Repaired( )Upgraded( ) Abandoned( )by,_ l7 �1 A At C, -I N C-:4 at L ' 1 has been constructed in accordance with the provisions of Title 5 and the for Disposal ystem Construction Permit No. yam/- 7 4V,5^dated Installer Designer A The issuance of this permit shall not be construed as a guarantee that the sys em will function as designed�� �©� V Date �� � // Inspector ���! �. �� ��h r f�� 1 'ej 1-7 < <' — ; _ No. 7 L c, � � Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS Mizpogal *raem Construction Permit Permission is hereby granted to Construct( )Repair( )Upgrade( )Abandon( ) System located at' C- r .5-,2 10.e c,n_Q I_ i,,_*__ and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction must be completed within three years of the date of this permit. Date: l(- Q - ff Approved by '1' C"� N ASSESSORS MAP. _ 9 WEST HOLE LOGS NOTES: PARCEL: 51 - 1. VERTICAL DATUM: ASSUMED FROM QUAD (NGVD +/-) D�Tt 28 �oi CURRENT SETBACKS: WITNESS R,DONNATHOMAMIR NDI, R.S. E 2. MUNICAPAL WATER IS AVAILABLE. R �,� 3. SCHEDULE 40 4 PVC PIPE TO BE USED THROUGHOUT SEPTIC SYSTEM. F: 30' S: 15' R: 15' DATE:_ 9-23-99 4. ALL PRECAST UNITS TO CONFORM WITH AASHTO H-10 PERCOLATION RATE: < 2 MIN/IN LOADING SPECIFICATIONS. p - FLOOD ZONE: C N 5, PIPE PITCH = 1/4" PER FOOT, (UNLESS NOTED OTHERWISE). TH -1 TH-2 52.5 54.0 6. FIRST 2' OF PIPE OUT OF D-BOX TO BE SET LEVEL. • ELEV. ELEV. 7. THE SEPTIC SYSTEM HAS NOT BEEN DESIGNED TO ACCOMODATE THE O/A HORIZON 0/A HORIZON LOAMY SAND LOAMY SAND USE OF A GARBAGE DISPOSAL. Locus 11" I 1oYR 2/1s fo" 10YR 2/1 53.2 8. ALL CONSTRUCTION DETAILS ARE TO BE IN CONFORMANCE WITH THE B HORIZON B HORIZON STATE OF MASS. ENVIRONMENTAL CODE (TITLE FIVE) AND LOCAL LOCATION MAP LOAMY 10YR 5 8 ND 1LOAMY R 8 ND HEALTH REGULATIONS. LOT 59 3�_ / 50.0 32" / 51.3 C HORIZON C HORIZON 9. CONTRACTOR TO VERIFY LOCATIONS OF ALL UTILITIES PRIOR (20,476 SF) MEDIUM SAND MEDIUM SAND zsY 7,14 2.5Y 7/4 TO CONSTRUCTION. 10. GROUND COVER OVER ALL SEPTIC SYSTEM COMPONENTS NOT TO EXCEED 3.0'. 42.0 120 11, D-BOX TO BE WATER TESTED TO ENSURE LEVELNESS AND EQUAL FLOW. 126„� " 144.0 NO CROUNDWATER ENCOUNTERED 53 SEPTIC SYSTEM DESIGN 52 1 54 FLOW ESTIMATE. 3_ BEDROOMS AT 110 CAL/DAY/BEDROOM = 330 GAL/DAY 1 PROPOSED 55 SEP.'IC TANK: 2x 3 BEDROOM �0 CAL/DAY x 2 DAYS = 660 CAL DUELLING 2� L1: E 100 GALLON SEPTIC TANK Gam' 2' .sa. 51 , )� f d 6' 4i 14' 14' >8' UTILITY LEACHING AREA: { PROPOSED DWELLING iSE 2- 500 GALLON CHAMBERS WITH 3' OF STONE �s", . \ • -56 55 4 I LL AROUND AND 5' BETWEEN (28' x 10.8' x 2' DEEP) 50 s� w SIDE AREA: (28 + 10.8)2 x 2 = 155_(.74) = 175 GAL/DAY A A , 1 BOTTOM AREA: 28' x 10.8' = 302 SF (.74) = 223 GAL/DAY d � 155 CAPACITY = 338 GAL/DAY 49 �P !' CI 00 r`�' '"`'� SEPTIC SYSTEM SECTION 54. 8 2" PEASTONE 49 \ \ s� � ' �\ i 6� 11 � ' y COVERS WITHIN 12" OF O 54.0 FINISHED GRADE 3/4 - 1 1/2 ' ONE INSPECTION COVER TO BE WITHIN 6" OF GRADE) WASHED STONE TOP OF FOUNDATION771 50 � �� \ ELEV.= 50.8 51 ' ` . 50.4 51. 0� 53. 5 5 ELEV. _ ® o A,�2 Sg ' 50.65 1500 GAL D-BOX 50.09 _ 47.9 53 ELEV. SEPTIC TANK 50.26 (6" OF ELEV. 3� 3 ELEV. - - - ' 52. 7 51.0 (6" OF STONE UNDER OR ELEV. STONE F" 28' 51. 9 52 BENCHMARK AT ELEV, MECHANICALLY COMPACTED) UNDER) 2- 500 GALLON CHAMBERS WITH 3' OF CONCRETE BOUND TEE SIZES: 49.9 STONE ALL AROUND AND 5' BETWEEN ELEVATION = 54.1 GAS BAFFLE INLET: 6" UP, 13" DOWN AT OUTLET TEE ELEV. (28' x 10.8 x 2 DEEP) OUTLET: 6" UP, 14" DOWN KEY: SITE AND SEWAGE PLAN EXISTING CONTOUR: - APPROVED BY: DATE: PROPOSED CONTOUR: L 0CA TION.' EXISTING SPOT ELEVATION: 25.5 PROPOSED SPOT ELEVATION: �4 :, = LOT 59 PENELOPE LANE 25 TEST HOLE: � I .� � j"��ss�c COTUIT, MA UTILITY POLE: -0- Z. FENCE LINE: Ma.Bdq�o DEMAREST,JR. N PREPARED FOR: HYDRANT: q No. 36M, DM 4�fE$$,o?P REEF REALTY RETAINING WALL: ® � ry TREE: DEMARE'ST-McLELLAN ENGINEERINt l �"� - 'rkvE SCALE: 1"= &T DATE: 10,18199 0 24 SCHOOL STREET P.O. BOX 463 WEST DENNIS, MASSACHUSETTS 026 a REFERENCE: LAND COURT CASE #22824D SHEET 1 Dy 99-119_ PHONE & FAX : (508) 398-7710 flTHOMAS McLELLAN, P E. JOHN Z. DEMAREST JR., P.L.S. En y , y v tt w :.. ._. r. ��' . � _ . ,....... £., ..