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HomeMy WebLinkAbout0116 PINEY ROAD - Health 116 Piney Road Cotuit T�- \� A = 020—074 -- - 2 TOWN OF BARNSTABLE —.LOCATION SEWAGE# VILLAGE ASSESSOR'S MAP&PARCEL �© --r IN—i--.,'TrAME&PHONE NO� SEPTIC TANK CAPACITY LEACHING FACILITY:( e)Cov�3 NO.OF BEDROOMS OWNER PERMIT DATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility 9 3 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 V L �. �N�S \�h. , l 3 C QOl3 33 (A®CPS Commonwealth of Massachusetts Title 5 Official Inspection Form Copy Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 116 Piney Road Property Address Jamie Paulas Owner Owner's Name information is CotUlt required for every MA 02635 October 3, 2013 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 filling out forms A. General Information on the computer, use only the tab 1. Inspector: key to move your cursor-do not Patrick T. Sullivan use the return key. Name of Inspector Ready Rooter Excavating Company Name P.O. Box 89 Company Address Forestdale MA 02644 C' /Town �Y State Zip Code 508-888-6055 S1 12843 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 [:]Rails ❑ Needs Further Evaluation by the Local Approving Authority A -+ C �A October 11, 2013 Inspector s Signature Date t'^ The system inspector shall submit a copy of this inspection report to the Approving Authority(Bloard of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. b 1 tis11 13 t5ins-3/13 Title 5 OffilInspect rForm:Subsurface Sewage Disposal System-Page 1 of 17 N Commonwealth of Massachusetts Title 5 official Inspection Form UVSubsurface Sewage Disposal System Form -Not for Voluntary Assessments 116 Piney Road Property Address Jamie Paulas Owner Owner's Name information is required for every Cotuit MA 02635 October 3, 2013 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: 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 2/xha *or a septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltrailtra n or tank failure is imminent. System will pass inspection if the existing tank is repla mplying septic tank as approved by the Board of Health. *A metal septic tank will pass inspes structurally sound, not leaking and if a Certificate of Compliance indicating that the tankn 20 years old is available. ❑ Y ❑ N ❑ NDbelow): t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 4 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments r ,. 116 Piney Road Property Address Jamie Paulas Owner Owner's Name information is required for every Cotuit MA 02635 October 3, 2013 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.): ❑ Observation of sewage backup or breakout 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 rsalth): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled r 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/ct the oard of Health: ❑ Conditions exist which r valuation by the Board of Health in order to determine if the system is failing to ealth, safety or the environment. 1. System will pass u of Health determines in accordance with 310 CMR 15.303(1)(b)that the s functioning in a manner which will protect public health, safety and the enviro ❑ Cesspool or pnvy 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 116 Piney Road Property Address Jamie Paulas Owner Owner's Name information is required for every Cotuit MA 02635 October 3, 2013 page. CVrown State 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 an the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS an 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 wat analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent a d the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided th 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 1/2 day flow t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 116 Piney Road Property Address Jamie Paulas Owner Owner's Name information is required for every Cotuit MA 02635 October 3, 2013 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. ❑ ® 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 4 feet of a surface drinking water supply ❑ El the system is with" 200 feet of a tributary to a surface drinking water supply ❑ the system is I ted 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 a or in Section E the system is considered a significant threat, or answered "yes" in Section above the large system has failed. The owner or operator of any large system considered a signifi nt 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 Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 116 Piney Road Property Address Jamie Paulas Owner Owner's Name information is required for every Cotuit MA 02635 October 3, 2013 page. Cityrrown State Zip Code Date of Inspection C. Checklist Check if the following have bee n done. You must indicate"yes" or no"as to each of the following: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined?(If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? W® El Was the site in signs ofr b inspected for si � p g break out. ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms(design): 3 Number of bedrooms(actual): 3 DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): 330 GPD M t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 f Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments r 116 Piney Road Property Address Jamie Paulas Owner Owner's Name information is required for every Cotuit MA 02635 October 3, 2013 page. City/Town State Zip Code Date of Inspection D. System Information Description: Number of current residents: 3 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? (Include laundry system inspection information in this report.) ❑ Yes ® No Laundry system inspected? ❑ Yes ❑ No Seasonal use? ❑ Yes ® No Water meter readings, if available(last 2 years usage (gpd)): 2012=134 GPD Detail 2013= 123 GPD Sump pump? ❑ Yes ® No Last date of occupancy: Current Date Commercial/Industrial 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., et Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present ❑ Yes ❑ No Non-sanitary waste discharged t he Title 5 system? ❑ Yes ❑ No Water meter readings, if avail le: t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 116 Piney Road Property Address Jamie Paulas Owner Owner's Name information is required for every Cotuit MA 02635 October 3, 2013 page. City/Town 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: Owners records: Pumped 2011 Was system pumped as part of the inspection? ® Yes ❑ No If yes, volume pumped: 1500 gallons How was quantity pumped determined? Site tube on truck Reason for pumping: Maintenance Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner)and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): t5ins•3/13 Title 5 official Inspection Form:Subsurface Sewage Disposal System•Page 8 of W Commonwealth of Massachusetts Title 5 Official Inspection Form Subs urface Sewage Disposal _ 9 p System Form Not for Voluntary Assessments 116 Piney Road Property Address Jamie Paulas Owner Owner's Name information is required for every Cotuit MA 02635 October 3, 2013 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: System installed 05/18/2009. Certificate of Compiance on file at Health Dept Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 4'6" feet Material of construction: ❑ cast iron ®40 PVC ❑ other(explain): Distance from private water supply well or suction line: n/a feet Comments(on condition of joints, venting, evidence of leakage, etc.): Septic Tank(locate on site plan): Depth below grade: 4 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: 10'6"X 5'X 5'4" 1500 gallon Sludge depth: 6' t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form m Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 116 Piney Road Property Address Jamie Paulas Owner owner's Name information is required for every Cotuit MA 02635 October 3, 2013 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 32 Scum thickness 8" inlet 2"outlet Distance from top of scum to top of outlet tee or baffle 6 Distance from bottom of scum to bottom of outlet tee or baffle 12 How were dimensions determined? Tape measure and dip tube Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Inlet and outlet PVC tees in place. Liquid level at outlet invert. Tank was pumped and cleaned after inspection. Risers bring covers within 6"of grade Grease Trap(ilocate on site plan): Depth below grade: feet Material of construction: ❑concrete ❑ metal ❑ iber lass 9 El polyethylene ❑ other(explain): i Dimensions: i I Scum thickness l Distance from top of scum to top f outlet tee or baffle Distance from bottom of scu o bottom of outlet tee or baffle Date of last pumping: Date t5ins-3/13 f Title 5 Official Inspection Form:Subsurface Sewage Disposal System-page 10 of 17 f Commonwealth of Massachusetts Title 5 Official In ' spection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments ug 116 Piney Road l — Property Address Jamie Paulas Owner Owner's Name i information is required for every Cotuit MA 02635 October 3, 2013 page. Cityrrown State Zip Code Date of Inspection D. System Information (coni.) Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): i Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal i ❑fiber I ss 9 ❑ polyethylene ❑ other(explain): i Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): i I i I 1 *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No i t5ins•3/13 iTitle 5 Official Inspection Form:Subsurface Sewage Disposal System•page 11 of 17 f L Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 116 Piney Road Property Address Jamie Paulas Owner Owner's Name information is required for every Cotuit MA 02635 October 3, 2013 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 liquid level above outlet invert 0.1 Comments(note if box is level and distribution to outlets equal, any evidence of solids carryover,evidence of leakage into or out of box, etc.): any One inlet, one outlet. D-box is H-10 5'below grade. No solid carryover. No sign of leakage. No high water staining over outlet invert. Riser brings cover within 6"of 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,/itionpumps 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: t5ins•3/13 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 12 of 17 ;r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 116 Piney Road lug Property Address Jamie Paulas Owner Name information is Owner's required for every COtuit page. City/Town MA 02635 October 3, 2013 State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ® leaching chambers number: 2-500 gal ea. w/ 4'of stone. ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Camera used to locate and inspect leach chambers. Liquid level 1.5' below invet. Clean stone visible through side wall. No sign of past hydraulic 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 Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 116 Piney Road Property Address Jamie Paulas Owner Owner's Name information is required for every Cotuit MA 02635 page. Cityrfown October 3, 2013 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 hydra is failure, level of ponding, condition of vegetation, etc.): i t5ins-3/13 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•page 14 of 17 Commonwealth of Massachuseft Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 116 Piney Road 9 — Property Address Jamie Paulas Owner Owner's Name information is wired Cotult required for every MA 02635 tate October 3, 2013 page. Cityfrmn S Zip Code Date of Inspection D. System Information (corn.) 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 %A,- C a fit®L;PS �. : 4,, Ir A � = Ltd f b"•3h3 Title 5 OWcal kq w bon Force Sof"bm&-age -Pap 15 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Y Not for Voluntary Asse ssments 116 Piney Road Property Address Jamie Paulas Cwvner Owners Name information is required for every Cotuit MA 02635 page. City/Town October 3, 2013 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: '3 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: May 2009 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: www.terraserver.com ma.water.us s. ov You must describe how you established the high ground water elevation: Test hole in 2009 found no ground water at 11'. Base of chambers 8' below grade. Accessed local ground water contours and topo mapping No high ground water in area of system Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 116 Piney Road Property Address Jamie Paulas Owner Owner's Name information is required for every Cotuit MA 02635 October 3, 2013 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 TOWN OF BARNSTABLE h )CATION /IG R Act SEWAGE # 9009 - /19 VILLAGE Coluil ASSESSOR'S MAP & LOT PO 7y INSTALLER'S NAME&PHONE NO. B 13 EXca ycd on - ,SO$- ,Y)7- 0#6-3 SEPTIC TANK CAPACITY ISD0 gal JZ10 LEACHING FACILITY: (type) Sao!Ra I chamS (z) (size) QX PSx; NO. OF BEDROOMS 3 BUILDER OR OWNER 0 -Tarn;c 'Pay 1a5 PERMIT DATE: S-9-0 9 COMPLIANCE DATE: S-19 -0 9 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 A► AZ _q� B2 B3 U C3 -`I(o%, c y Bs AL Rcar iJwc0;n9, A33 a 0 d � � s s No. Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer. PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS Yes flplito.tlon for M18po8AY *pstrm Construction J)Prmit Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. 114-P I n£y 1 6AD Owner's Name Address,and Tel.No. '1 1) _ g 3 _g y$9 To m l assessor's Map/Parcel /A q y Installer's Name Address,and Tel.No. -n -Db Designer's Name,Ad ess,and Tel.No. 2bbeee-r- � Foy- 6-t Ex Lim) lan -bwn Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 33 (-) gpd Design flow provided 3 3 U gpd Plan Date Jr�Jr' Jo Number of sheets i Revision Date Title 71}1 P.S S I t e-Tta c) Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. S' a t� Oo , Date g I O 9 Application Approved by ev Date Application Disapproved by Date for the following reasons Permit No. Date Issued -57 f""""�..r n.r•.-.r�«ey.r,ty".e,.s,,,,r,.:r�r,w-,..«w+�... �: ..,..._.... �..i5.,.-�.« .. ,. ,- ...� r.�,.M^`•a+wxw:s.*a..r.�s---:�,C,%��.;��.y*vv+".^��:+ ..,,,..�.:,.. _..ua_:.,,.;,, y - No. !J '1 Fee �. THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS Yes application for Misposal 6pstent Construction Permit 4 f Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. I 1 G h i n ey r o A D Owner's Name,Address,and Tel.No. '1"}�1 _ 3 (6)1u I r To rn} e_ TCIVICIS " A'ssessor's Map/Parcel M q p � T C;r r_P I 4 I / P 1 1 1Z.t) A u r T Installer's Name,Address,and Tel.No. (�S 1-1 7-7 - b&— S Designer's Name,Address,and Tel.No. 0c�WC)( c,.j }()6,E.c n,, CA a�1 � � � '4 �\ /-,� -i� �t h Type of Building: Dwelling No.of Bedrooms�3 Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 330 gpd Design flow provided 3��_) gpd Plan Date 51510I Number of sheets t Revision Date i Title I I ( If Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: _ The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in r accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. / b 01 In Date gig �U9 Application Approved by ( p / ,/ j� ,�/ ® �` Date Application Disapproved by Date v for the following reasons XN Permit No. �/I Date Issued . THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance ,1 THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired( ) Upgraded( ) Abandoned( by B i a E X L n\I(,A I at 1?0 l/ : f i ) i has been constructed in accordance,-. t with the provisions of Title 5 and the for Disposal System Construction Permit N4c' , )0q_// atedInstaller t.`�fl f '` (� 1 4 /, Designer {1 �^e _ (�}G i I 1-P t�f f) C J � #bedrooms 3 —� Approved design flow A ( _ gpd The issuance of his permit shall not be construed as a guarantee that the system will(fi`mction as designed} r Date Inspector y �!n �=t"" .:. No. Iwo t/ / Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION BARNSTABLE,MASSACHUSETTS Bisposal bpstem Construction J)ermit Permission is hereby granted to Construct( ) Repair( Upgrade( ) Abandon( ) System located at �o � C) D 1 and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Constructi must be bmpleted within three years of the date of this permit. j t�s Date �61 ,���� Approved by 1%' ,.� " 11 / MAY-20-2009 03 :05 AM P. 01 'down of Barnstable Regulatory Services Thomas F. Geiler, Director " Public Health Division tda Thomas McKean, Director 200 Main Street, Hyannis, MA 02601 Office: 508-862/4644 Fax: 508-790-6304 Date: 5 l9/O9 Sewage Permit# oh)Q9—�11.9 Assessor's Map/Parcel 20--1 Installer cox Designer Certification Form Designer: 1 r� Installer: t 8 gEXC Address: q 3q mQ its -3 Address: . 2A rrV _n_t__ Va r mouth �±, � On 519 J69 _Bt 13 EY-LO-40 4 wn was issued a permit to install a (date) (installer) septic system at L 4 Q based on a design drawn by dress -3)pW oUq?� G 1 Ibex 1 t1' dated 6 L.5 I.D (desipwy XI 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. Stripout (if required) was inspected and the soils were found satisfactory. 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. Stripout(if requir as inspected an oils were found satisfactory. gkA OF Mgss oaf DANIELA.9cy� ° DUANIEt. o OJALA 01ALA s ler's Sign } CIVIL � � No,40980 q No.46502 �0-F�GhSTE�OGa�t,�' SS/ONAL E (Designer's Signature) (A ix Designers 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 BYTHE BARNSTABLE PUBLIC'HEALTH DIVISION. THANK YOU. . q.bfl•>ce formsldesignermnification fbrm,doc PROP. VENT LEGEND SYSTEM PROFILE ALL SYSTEM MARKED WITHCMAGNETICTTAPE SHALL BE NOTES q SYSTEM DESIGN. WATERTIGHT (NOT TO SCALE) COMPARABLE MEANS FOR FUTURE LOCATION. 1. DATUM IS APPROX. NGVD (GIS SPOT EL.) 99 - EXISTING CONTOUR ACCESS COVERS TO WITHIN 6 OF FIN. GRADE CONCRETE COVERS TO WITHIN 3" GRADE `° X 99.1 EXIST. SPOT ELEV. GARBAGE DISPOSER IS NOT ALLOWED TO �� 2" PEASTONE OR GEOTEXTILE 2. MUNICIPAL WATER IS EXISTING P FOUND. EL. 47.1' FILTER FABRIC OVER STONE 4 Schoo/ \ 3. MINIMUM PIPE PITCH TO BE 1/8" PER FOOT. �S 99 PROPOSED CONTOUR 4'6•o MINIMUM .75' OF COVER OVER PRECAST 2% SLOPE REQUIRED OVER SYSTEM 46.0 Locus �o DESIGN FLOW: 3 BEDROOMS ® 110 GPD = 330 GPD [98.41 9g 4 8" MIN DI AM. PRECAST H-10 BLOCKS OR 4. DESIGN LOADING FOR 500 GAL. PRECAST UNITS � CO�� 1 PROPOSED SPOT EL. USE A 330 GPD DESIGN FLOW ' RISERS (TYP.) PRECAST RISERS TO BE AASHO H-M D TH1 4" C.I. 4"�SCH40 PVC MORTAR ALL H-10 Ba PIPES LEVEL 1ST 2' �ENDS 4'- COMPONENTS 5. PIPE JOINTS TO BE MADE WATERTIGHT. .y SEPTIC TANK: 330 GPD (2) = 660 WITH(TYP•) INV'S EL. 41.37' 4'TEST HOLE SIDES EL. 42.4' 6 CONSTRUCTION DETAILS TO BE IN ACCORDANCEerr She//Ln B/vff 2% SLOPE OF GROUND USE A 1500 GAL. SEPTIC TANK *42.5' 10" 14" p00000000 ° ° 310 CMR 15.000 (TITLE V.) `y' ' TEE 1500 GAL H-10 TEE 41.85' 42.10 (EXIST) SEPTIC TANK ° °6" SUMP >°o°o°o°o oao�aa000aa oaaaooa0000 7. THIS PLAN IS FOR PROPOSED WORK ONLY AND NOT TO Pine 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 o C� 4' LIQ. LEVEL ° °o°o°o°o°o°o o°12" MIN. INT. DIAM. '°°°°°°°° o 0 0 0 0 0 o 0 0 0 o 0 0 0 0 0 '°°°°o°°° o GAS BAFFLE .. o o°o°o°000°o° °c °o°o°o°o �00�0000�0❑ ao���a®oaao °°°°°o°° / e a UTILITY POLE LEACHING: ACME QR EQUAL ° °°°o°o°°°° N 00000000 �a00�aao�a0 ®����oDa�Da °o°o°o°o BE USED FOR LOT LINE STAKING OR ANY OTHER 9 0 FIRE HYDRANT SIDES: 2 (25 + 12.83) 2 (.74) = 112 GPD 41 .64' 41.47' °°°°°°°° PURPOSE. o�Cyrl ` EL. 39.37' 8. PIPE FOR SEPTIC SYSTEM TO SCH. 40-4" PVC. o NOTE: NOT ALL SYMBOLS MAY APPEAR IN DRAWING BOTTOM 25 x 12.83 (.74) = 237 GPD o000000000000c H-20 500 GAL. LEACHING CHAMBER BY ACME PRECAST OR EQUAL.. 0000000000000000000000 c TOTAL: 472 S.F. 349 GPD o0000000000 3/4"-1-1/2" DOUBLE WASHED STONE 4' MIN. (2) UNITS REQUIRED 9. COMPONENTS NOT TO BE BACKFILLED OR CONCEALED n n n n n n n n n n r ALL AROUND PRECAST STRUCTURES WITHOUT INSPECTION BY BOARD OF HEALTH AND 6" CRUSHED STONE OR MECHANICAL OVERALL DIMENSIONS TO OUTSIDE OF STONE: 25.00' X 12.83' COMPACTION. (15.221 (21) USE (2) 500 GAL. LEACHING CHAMBERS (ACME OR EQUAL) M PERMISSION OBTAINED FROM BOARD OF HEALTH. *THE INSTALLER SHALL VERIFY THE WITH 4' STONE ALL AROUND LOCATIONS OF ALL UTILITIES AND ALL 10. CONTRACTOR SHALL BE RESPONSIBLE FOR CALLING LOCUS MAP DIGSAFE (1-888-344-7233) AND VERIFYING THE BUILDING SEWER OUTLETS AND LOCATION OF ALL UNDERGROUND & OVERHEAD UTILITIES NOT TO SCALE PRIOR TO COMMENCEMENT OF WORK. PORTION OF SEPTIC SYSTEM ELEVATIONS PRIOR TO INSTALLING ANY ( 2 9; SLOPE) ( 1 % SLOPE) ( ! X SLOPE) 11. ANY UNSUITABLE MATERIAL ENCOUNTERED SHALL BE ASSESSORS MAP 20 PARCEL 74 MA 34.0' BOTTOM TH-1 APPROVED DATE BOARD OF HEALTH FOUNDATION 20' SEPTIC TANK 21' D' BOX 12' LEACHING REACH LEACHING ' BENTEYATH AND AROUND THE PROPOSED NO CONSTRUCTION PROPOSED FACILITY NO GROUNDWATER FOUND EMOVED 12. EXISTING LEACHING FACILITY SHALL BE PUMPED AND SITE IS WITHIN ESTUARINE PROTECTION DISTRICT & REMOVED OR PUMPED AND FILLED WITH CLEAN SAND. AP DISTRICT 108.55' TEST HOLE LOGS 45.21 ENGINEER: DANIEL A. OJALA, PE, SE WITNESS: DAVID STANTON, IRS DATE: 5/4/09 45.17 cO < 2 MIN/INCH PERC. RATE _ �G 5.47 5.45 0 CLASS I SOILS P# 12547 � -9� Po x 45.60 y ELEV. ELEV. 0" 46.0' 0" 45.8' 6.06 45.940 0� A A x 46.1 3�8g, LS LS PROVIDE C.O 10YR 3/2 1OYR 3/2 �Gg LOT AREA 12" 1290 , 46.07 C' .25 22,605 SF t PROP. VENT WITH CHARCOAL FILTER AND BUGSCREEN (FINAL PLACEMENT BY LS LS CONTRACTOR WITH HOMEOWNER .06 CONSULTATION) o- p 36" 10YR 6/6 43.0' 36" 10YR 6/6 42 8' 74 OO 1�' ALTERNATE BENCHMARK: 4 .16 EXIST. DWELLING USE TOP FNDN. THIS TOP FNDN. AREA AT EL. 47.1' x 46.04 47.1' tiN C C PERC x 46.14 61 x 46.51 M/COS M/COS p� " 4 45.92 6 6 2.5Y 6/4 2.5Y 6/4 46.32 16X 5 \ TH1 45,75 x 45.25 \ 46.17 4" IFE \ (JA 5" M. INE 45.9 x '�. 45.65 / �ti 144" 34.0' 138" 34.3' \ 3 CONIFERCp 4 44 64 NO GROUNDWATER ENCOUNTERED \\ TWIN 12" OAKS BENCH MARK - TOP OF CONC. BOUND EL. = 46.6 �P��/ ��'`, GR \ ly/ x 45.24 \ .�45.83 J� \ 46.21 .54 TITLE \1(45.9 OF \ x/5. x 45.49 Z 45.95 116 PINEY ROAD \ 42 / VARIANCES FOR SEPTIC SYSTEM REPAIRS WHICH MAY BE COTUIT \ 45.76 IMMEDIATELY GRANTED BY THE BOARD OF HEALTH AGENT OR \ BY HEALTH INSPECTOR PREPARED FOR PAPERWORK AND HEARING REDUCTION PROPOSALS APPROVED \ � BY THE BOARD OF HEALTH REVISED DURING A PUBLIC B&B EXCAVATION/J. PAVLAS HEARING HELD ON MARCH 10, 2009 yY0 3) FAILED SYSTEMS ONLY - SOIL ABSORPTION SYSTEM \ 5.7o INSTALLATIONS PROPOSED MORE THAN THREE FEET BELOW MAY 5, 2009 \ 44.91 GRADE WITH PROPER VENTING (PIPED TO THE ATMOSPHERE) � AND WITH H-20 LOADING, BUT IN NO CASE SHALL THE SAS Scale: 1"= 20' BE LOCATED MORE THAN SIX FEET BELOW GRADE. 0 10 20 30 40 50 FEET ,IHOFM,y Mg ssq of off 508-362-4541 DANIEL cyG � gsgc fax 508-362-9880 A, �a �� DANIELA. yGN I downcape.com pJALA v N g OJALA down cope engineering, /dC. " No.40980 CIVIVILL �' e- �F,� S\ No.46502 ��, civil engineers gNOSu v S e't° G' S G``' land surveyors SOON L / �� 939 Main Street ( Rte 6A) DATE DANIEL A. OJALA, P.E., P.L.S. YARMOLITHPORT MA 02675 09-083 09-083.DWG(SBO)