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HomeMy WebLinkAbout0656 PUTNAM AVENUE - Health 656 PUTNAM AVENUE, COTUIT A= 039 109 I TOWN OF BARNSTABLE LOCATION fps` /'✓R SEWAGE# 3 3 1 VILLAGE ASSESSOR'S MAP&PARCEL 03fA , [O l INSTALLER'S NAME R PHONE NO. Cam, SEPTIC TANK CAPACITY /®v U /¢ U LEACHING FACILITY:(type) L—, ,,�,e/e �( (size) NO. OF BEDROOMS q OWNER Cc r/us e4s1ro c PERMIT DATE: COMPLIANCE DATE: 0 r 6 Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility r✓yI Z 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 L'aching Facility(if any wetlands exist within 300 feet of/leaching:facility). feet FURNISHED BY '4P � •" f�—� _. ® G v 0 CO h w N cJJ vt � G � 0� r' No. Fee. TKE COMMONWEALTH OF MASSACHUSETTS Entered in computer: _ PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes 21pplicatton for Mis pp gal 6p5temc Cuwgtructiun Vermtt Application for a Permit to Construct( )\\Repair(W Upgrade( ) Abandon( ) ❑Complete System Indi vidual lCoomponents Location Address or Lot No. JJ5 LA Vi t�av+� Ace C.• Owner's Name,Address,and Tel.No. C�,(1 oS CwS Go -Q'%-t u$ta Assessor's Map/Parcel 4 9. 109 Installer's Name,Address,and Tel.No. C A LW td`� Fftk_—r ns �.h t Actr`i WQ�1G$Q e Designer's Name,Address and Tel.No. S 1P.0 15 OIL '1to3 5p 3L IT, w.LrossF+CAld Rb," s pg• y-I-�,s31 �.� m oZw Type of Building: Dwelling No.of Bedrooms Lot Size _U54%j ,3yq . sq.ft. Garbage Grinder ( )' Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures u ` Design Flow(mein.required) LAl� gpd Design flow provided LA5'`I. ' gpd Plan Date 0 `q—us Number of sheets Revision Date Title Ct 6'e QvTV�4e Size of Septic Tank bbD G iS Type of S.A.S. Description of Soil e C sk 3jt1 Nature of Repairs or Alterations(Answer when applicable) Date last inspected: `.00 / f 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. Signed Date � -L-7_tQ0 Application Approved by 90 Date 2 —0,(� Application Disapproved by: Date for the following reasons Permit No. IUD�*' � �� Date Issued P ^ 7—G ———————————————————————————— ——— THE FOLLOWING IS/ARE THE BEST IMAGES FROM POOR QUALITY ORIGINALS) I A , m / �C(�"J LI DATA i.w-+.:� ..-,....,W,,,.�,...<} .y: t"` .+:c .✓^ w'^^-'.7r+� qr,`4 ! -,.ir r'4- ,rA'^"„'.�`w s �,s �.;,/'Siir....,.-Ji.s:i,,:rrn.�.+`"'"`. sr:-{.. .,yr.�.. -•s �. R< y r �. No. GO ,: ' Fee 0 ' THE�COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION- TOWN OF BARNSTABL,E;�MASSACHUSETTS Yes 2pplication for,Mi5pogal 6p5tem Cons4ruction Permit Application for a Permit to Construct O Repair(. .Upgrade( ) Abandon( ) ❑Complete System Individual Components c 1 Location Address or Lot No. Owner's Name,Address,and Tel.No. Assessor's Map/Parcel 039 . 1 D9 Installer's Name,Address,and Tel.No. (- d`` `\` Designer's Name,Address and Tel.No. \A TA . tin )11 + Type of Building: Dwelling No.of Bedrooms 1 Lot Size ?.; 'I I J_sq. ft. Garbage Grinder ( ) 'Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(Gmin.required) gpd Design flow provided gpd Plan Date Number of sheets Revision Date 4' r Title Size of Septic Tank 1 DIED E7AL Type of S.A.S. Description of Soil 'a c' c Nature of Repairs or Alterations(Answer when applicable) Date last inspected: �OU 6 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 i g n e Date Application Approved by � 0,o Date / 0 � ' Application Disapprdved by:v Date for the following reasons Permit No. go d! � 3�. , ,^ �_y, �°;� :� Date•I;ssued �y .fir(?�0 r �f . —x t=L �• " THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS " Certificate of (66m iattce;fJ Y - ; THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed ( ) Repaired (4 ) Upgraded ( ) Abandoned( )by t ca to :. ; (�C l: > ( t. 1-21 r at has been constructed in accordance per. with the provisions of Title 5 and the for Disposal System Construction Permit No.90q- 3� dated "-7- GQ Installer .. A— Designer � ;� ,; ,., . #bedrooms Approved desi n flow V6 gpd The issuance of this permit shall not%b� nst ue as a _u oantee that the system 1 fu tion as desi .e'. . Xok ell / v t. Date Inspector ----------=—U. -------- — No.;?d6 3 / Fee 10" THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION--BARNSTABLE, MASSACHUSETTS l 1=i9;poga1 6pgtem Cougtructiou Permit V � Permission is hereby granted-to Construct ( ) Repair (�) Upgrade ( ) Abandon ( ) System located at ( ; L" f e •.,V g ti,r.. :•., Ayi r and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided: Construction must be completed within three years of tie date of t`hts it. Date / lD� �� 'Approved by (lam e, 08/22/2008 10:24 ~ 5084775313 . ENG:ENEERING' WORKS PAGE 01 Town of Hamstable Re my,5enkes Thomas F.GeHe`r Director Thormas Nid,ean,Dlreetor 200 3Vlaia Street,11yanate,MA 02601 Office: 508.8624644 F= 508-790.630,1 11'or-m Date: D� Sewage Permit# ;200 r 33;.1. Assessor's MaplParce _�"!0 5 Dedptr: tI i of Installers Address: I Z PJ- C.ne s -et I � Address: err:lGc, M4 Oa was sued a permit to install a O. �(i>tstallcr) septic sya am-et 5rG �e 'rt a*M" f based on a design drawn by (address) k rT'� M K+r�e P area d�' �(desigrier) I cmt.fy that the septic system ref�xenced'above was installed subatastially c ng to ft.-de which may include minor approved changes such as lateral t+etocati of the diatUkfwn box and/or septic tank. I it3► that the septic system referenced above was. ir&%Ued. with major chaps (i.e. gte 4LY�b alreiOcatiolL Of the SA"or:any vertical relocattvn of amy coaToneat € ►e n) t inaccord ince with State 8c Tracal Regulations. P'lsu rtv�sion or we ;�desi tier to f'all*W. 0F Mqa. b� PETER �. _ MGENTF- t�o.36109� ewer's Signature) (Affix Designer's Stamp Here) MASE .I92.'ifltN,.10 A&VALTA4LE ccA L rJUL xaIr s-9 ISSUED In��'x Tars kroRrt axe ns-HVD.x' 11L.ARE RECEIVES HY THE HAI�Nl3TA�LZ PUBLIC Q.HWW$ap*mtsi$w Certification Form 3-26-04.4oc n 1�0 ,r -4 r i z t+vf°.: �'rir3 .a`i '� 3•, '�'s+-c w "t.i`a Xt'"{ '� ti r.?'.c.. - -� +°� .-�i � 'A, _. Y'' "4'� -t" a#' •��v `�n1-aw «".�!�i..St Kj 4• 'ti a c k '',F .�"�� ? „. ; y., - 'yt -ts• - x,t,a°w * rs .✓ ^. �} .a- .:, 3rS` '`f -ZA vA � Yk jj - ' ti D r f• t. •� 3 y.. T L ._ ^s e, Y �1 -5. ya S �.� s p t i ? .-41 �} o 74 on F } W. ,d x A f J � � f��s0 P.�•�.,1.� �'..rt.a . �/.1� � D9TC� Dcati . TH 0;� E. <�, CERTIFIED. PLOT PLAN P } F .. a L AND 5 JUPI E)66,145 !?Y?1`!E LOCATION' ' �• 5 &Ckci 'U7!H Y�1, (.'•v r ;i cc� {tea= . Y — -- — 4 JG SCALE �` DATE PLAN REFERENCEi` `4 ( try = 'r "ti kc 2a'th0 f �,NA ti I CERTIFY THAT:THE FQV �T SHOWN ON THIS PLAN. IS LOCATED ON THE AROUND �,�/� ;: v �, :~.• " s' � AS'SHOWN HEREON;AND THAT IT CON FORMS TO r THE ZONING LAWS -OF THE TOWN OF KA HE E':.. t, ', �1�i .T�'*ems,'. CtO �+'. CGi re DATE Q ` PETITIONER : C-! R :LA O SURVEYQR Town of Barnstable P#'/ Department of Regulatory Services Public Health Division DateU( p� 200 Main Street,Hyannis MA 02601 * MRNbTABLE, MA8& 039.►�e� Date Scheduled Time Fee Pd. fD MAr - Soil Suitabi ity Assessment for Sewage D s osal Performed By: � ��A P�' 8+ CS ' Witnessed By: l�,I J. Location Address f+v Owner's Name los C�tq�qVo Address to S Co f 1-✓t ww, A&-,- U cel Assessor's Map/Par : O 3 9110�+/ / Engineer's Name C eu3: G Q�'Sty NEW CONSTRUCTION REPAIR Telephone# S O� Z Y Za l� Slopes(%) Surface Stones Arlo Land Use. -D Distances from: Open Water Body #U`/ " rft Possible Wet Area Du�� ft Drinking Water Well ft Drainage Way �`A ft Property Line 4A ft Other ft SKETCH:(Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands in proximity to holes) 1tv 1-1 1'lei J f _ Parent material(geologic) Depth to Bedrock Ga Depth to Groundwater: Standing Water in Hole: N to Ir ' Weeping from Pit Face Aa6,% Estimated Seasonal High Groundwater Method Used: Depth Observed standing in obs.hole: in. Depth to soil mottles: in. Depth to weeping from side of obs.hole: in. Groundwater Adjustment ft. Index Well# Reading Date: Index Well level Adj.factor Adj.Groundwater Level f: rry Observation Time at 9" Hole# I Depth of Perc ,,t;-ts _ Time at 6" Start Pre-soak Time Q �`� .'L,� Time(9"-6") End Pre-soak I u Rate Min./Inch 1' Site Suitability Assessment: Site Passed Site Failed: Additional Testing Needed(Y/N) Original: Public Health Division Observation Hole Data To Be Completed on Back---------- `Q:HEALTH/WP/PIRCFORM _ ..................... .....................................:.......................................... .......................... ........... ..............................: WO A Depth from Soil Horizon Soil Texture $oil Color , Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulderes. oGravel) aALI kill-m :6AO a ��tB �jP r� e—�� / a r 3-S-1 a z �, n� � " 1t� >s 9-4 l� s �J: .:I,l .:...:: ::.;;; :..:. Depth from Soil Horizon Soil Texture. Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulderes. Consistency.%Gravel) t &IA3 loS ��I i SL�-iao f,o rA .......................................................... Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulderes. Consistency.° Gravel) - ::....:. Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulderes. Consistency,° Gravel) R Flood Insurance Rate Mangy Above 500 year flood boundary, No_ Yes Within 500 year boundary No— Yes Within 100 year flood boundary No— Yes Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervious material exist in all areas observed throughoutthe area proposed for the soil absorption system? Ve-3 If not,what is the depth of naturally occurring pervious material? Certification 1 certify that on'44 1 �( (date)I have passed the soil evaluator examination approved by the Department of Environmental Protection and that the above analysis was performed by me consistent with the required training,expertise and experience described in 310 CMR 15.017. Signature �t?f � Date U� Commonwealth of Massachusetts Executive Office of Environmental,Affairs y �� Department of A'°R r, Environmental Protection '°**°F v 199 y�lrBgA ,, - William F.Weld Goremor ° r Trudy Coxe Secretary,EOEA 11 David B.Struhs t Commissioner SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION Property Address:(ps(, P4Z'r�!>f-1v1 N j� �j- ,,jI Address of Owner: Date of Inspection: $Z -7 (if different) Name of Inspector: e�." •� Company Name, Address an Telephone Number: oto 6llivercq- 77c�=Z6Fcj CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on-site se ge disposal systems. The system: Passes _ Conditionally Passes _ Needs Further Evaluation By the Local Approving Authority Fails Inspector's Signal _ Date: The System Inspector shall submit a copy of this inspection report to the Approving Authority within thirty (30) days of completing this inspection. If the system is a shared system or has a design flow of i0,000 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 oricinal should oe sen: :^.e system owner and copies sent to the buyer, if appiicabie and the appro�ing au:hori,y. INSPECTION SUMMARY: Check A, B, C, or D: A] SYSTT PASSES: Y 1 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. B) SYSTEM CONDITIONALLY PASSES: . One or more system components need to be replaced or repaired. The system,upon completion of the replacement or repair, passes inspection. Indicate yes, no, or not determined (Y, N, or ND). Describe basis of determination in all instances. If"not determined", explain why not) _ The septic tank is metal, cracked, structurally unsound, shows substantial infiltration or exfiltration, or tank failure_is imminent. The system will pass inspection if the existing septic tank is replaced with a conforming septic tank as approved by the Board of Health. (revised 8115195) One Winter Street a Boston,Massachusetts 02108 a FAX(617)W6.1049 a Telephone(617)292-5500 "Printed on Recycled Paper r SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: f ''7. 40) AVr �fU—r of Owner: W AL4251MP Date of Inspection:�.� B]SYSTEM CONDI 10 L Y PASSES (continued) Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. The system will pass inspection if(with approval of the Board of Health): broken pipe(s) are replaced obstruction is removed distribution box is levelled or replaced _ 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 i C] FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: / Y 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 withini 50 feet of a bordering vegetated wetland or a salt marsh. 1) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH (AND PUBLIC WATER SUPPLIER, IF APPROPRIATE) DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: i _ I hp system nay a S M1, tan, anu soli absorption system anu is witnni iO3 icci iu o suNN') or trib;;ta`� to a surface water supply. _ The systen, ha: a septic tank and soil absorption system and is within a Zone I of a public water supply well. _ The system has a septic tank and soil absorption system and is within 50 feet of a private water supply well. _ The system has a septic tank and soil absorption system and is less than 100 feet but 50 feet or more from a private water supply well, unless a well 'water analysis for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm. D] SYSTEM FAILS: _ 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. Backup of sewage into facility or system component due to an overloaded or clogged SAS or cesspool. Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool. (revised 8/15/95) 2 4 I s 1 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address:(p j�p AIT IYAM AV e. CD j(Il 7- Owner: Date of Inspection: DJ SYSTEM FAILS (continued): /'4 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. E] LARGE SYSTEM FAILS: The following criteria apply to large systems in addition to the criteria above: The design flog+ of system is 10,000 gpd or greater (Large System) and the system is a significant threat to public health and safety and the environment because one or more of the following.conditions exist: _ the system is within 400 feet of a surface drinking water supply the system is within 200 feet of a tributary to a.surface drinking water supply _ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area (IWPA) or a mapped Zone II of a public water supply well` The owner or operator of any such system shall bring the system and facility into full compliance with the groundwater treatment program requirements of 314 CMR 5.00 and 6.00. Please consult the local regional office of the Department for further information. (revised 8/15/95) 3 i i SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: �S� P77NY}VV\' i4V-t_. Owner: V�ctrS�A Date of Inspection: Check if the following have been done: Pumping information was requested of the owner, occupant, and Board of Health. _None of the system components have been pumped for at least two weeks and the system has been receiving normal flow rates during that period. Large volumes of water have not been introduced into the system recently or as part of this inspection. /� 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. t/AII system components, excluding the Soil Absorption System, have been located on the site. iJThe septic tank manholes were uncovered, opened, and the interior of the septic tank was inspected for condition of baffles or tee , material of construction, dimensions, depth of liquid, depth of sludge, depth of scum. ✓The size and location of the Soil Absorption System on the site has been determined based on existing information or Zappr,ximated b� non-intrusive me,thod's. f-o : ov,ner:' v,-ere provided with information on the proper maintenance of Sub- Surface Disposal System. (revised 8/!5/95) 4 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: (054? "4-" CaT%-/� Owner: Date of Inspection: �✓'•. 1 6-fit 7 FLOW CONDITIONS RESIDENTIAL: Design flow: allo s Number of bedrooms: Number of current residents: Garbage grinder (yes or no):-ZY Laundry connected to system (yes or no): Seasonal use (yes or no):L Water meter readings, if available: ' z Last date of occupancy:���+�1 COMMERCIAUINDUSTRIAL: Type of establishment: Design flow: allons/day Grease trap present: (yes or no)_ Industrial Waste Holding Tank present: (yes or no)_ Non-sanitary waste discharged to the Title 5 system: (yes or no)_ Water meter readings, if available: Last date of occupancy: OTHER: (Describe) Last date of occupancy: GENERAL INFORMATION PUMPING RECORDS and source of information: nn System pumped as part of inspection: (yes or no)_ If yes, volume pomne gallons 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) Other(explain) !/?Vo D r—»-CVN�'t ��' a� ri Y- �� APPROXIMATE AGE of all components, date installed (if known) and source of information: C �/✓� Sewage odors detected when arriving at the site: (yes or no) (revised 8/15/95) S SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: !!O S6 P.;T 140 viev, NV e CoTV N Owner: 5�_" Date of Inspection: 36-6-�i 7 SEF W—TAUV. (locale on site plan) Depth below grader / Material of construction: l'concrete _metal _FRP _other(explain) Dimension Sludge depth:_ ri Distance from top of sludge to bottom of outlet tee or baffle?G 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: 7 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.) rc�ati-\c>i--,\dl.-2 oV1,:( Imo'' c-,caw —i .V, �f noan disk-S -- GREASE TRAP: (locate on site plan; Depth below grade: Material of construction: concrete _metal _FRP _other(explain) Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: r)itt2nre from hott^m n, cr rim to hnnnm ni C.11tlpt tee of b2t1IP' 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 8i:5/95i 6 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION.FORM PART C SYSTEM INFORMATION (continued) Property Address: 4 'P JT HAw\, t4V-e. C,11 7— Owner: VYVA„5`h„, Date of Inspection: TIGHT OR HOLDING TANK:rI (locate on site plan) Depth below grade: Material of construction: _concrete _metal _FRP—Other(explain) Dimensions: Capacity: gallons Design flow: gallons/day Alarm level: Comments: (condition of inlet tee, condition of alarm and float switches, etc.) DISTRIBUTION BOX: (locate on site plan; Depth of liquid level above outlet invert: Comments: mote if ievei anu ciistnuut,�,!. eq�a , e-6crice of su,id: co::,o,er, evidence of leakage into or out of box, etc.) PUMP CHAMBER:! (locate on site plan) Pumps in working order:(yes or no) Comments: (note condition of pump chamber, condition of pumps and appurtenances, etc.) (revised 8/15/95) 7 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: s(Q f`i'N0MIL Owner: Nuf S�.: Date of Inspedion5`I 6--,i 7 SOIL ABSORPTION SYSTEM (SAS):_ (locate on site plan, if possible; excavation not required, but may be approximated by non-intrusive methods) If not determined to be present, explain: Type: leaching pits, number: leaching chambers, number:_ leaching galleries, number: leaching trenches, number,length: leaching fields, number, dimensions: overflow cesspool, number: Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,etc.) - o!j 7-0 571 -e-- ✓�o� D�-y c� v ov/J I 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 ground�%atc . 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 8/15/95) 8 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: *Nte- Cp`r�,i Owner: Date of Inspection: 3(7-k7 SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent references landmarks or benchmarks locate all wells within 100' DEPTH TO GROUNDWATER Depth to groundwater: Id feet method of determination or approximation: c ITr wl e�� SySTt'vt "I S (1.\0A I C)" f Ov-Vv- SSG'Aa ia".11 11 lh y.1AMt UL f�'i�STV�n�►�CS (revised 8/15/95) 9 • V ' .s ' NO.. -7/......... Fms..........��:..0 . loqTHE COMMONWEALTH OF MASSACHUSETTS Q BOARD OF HEALTH Appliration -fur M-4puiial Workii Towitrurtiuu Pumit Application is hereby'made for a Permit to Construct () or Repair ( ) an Individual Sewage Disposal System at: q .� ---- ---------- ` i ocatio .ddress � or LaL.No. Owner dress Installer Address Q TypeCluilding ,{ Size Lot.. )_S.�_3--- Sq. fe t V Dwelling—No. of Bedrooms________________'T_-__-_______.___--•.Expansion Attic Yj45 Garbage Grinder (� a Other—Type of Building ____________________________ No. of persons.......15............... Showers (� — Cafeteria (No Other fix d tures --•-----------------------------------------•-----•--------..-...------------•-------.-..--.---.------------.-...--••----------------- .... w Design Flow--------------------------------------------gallons per person per day. Total daily flow........_-'-0.0......._...._.._.._..gallons" WSeptic Tank—Liquid capacityllaso-gallons Length---------------- Width---------------- Diameter-----........... Depth---------------- x Disposal Trench—No- ------------ Widtl ______ __________ Total Length--_-_____--_.._---.- Total leaching area--------------------sq. ft. Seepage Pit No..�_Ap?.Q.2n Diameter-_____ o_ TDept below inlet.71�.J�?.`I�BSTotal leaching area.-J�._3 sq. ft. Z Other Distribution box (Y, .�j Dosing nk ( �A%j L_C, Mkje9-4 4"'~ Percolation Test Results Performed by----- A_ ..... L.1..,{?lr4„(. . ................. Date-----A5 __ - Test Pit No. 1................minutes per inch Depth of Pest Pit-----UM TDepth to ground water....._Q.T_._ QTGJ> fX4 Test Pit No. 2................minutes per inch Depth of Test Pit..__----_..____-____ Depth to ground water-_.-.---------.--....___ 9 . ------------------ ...................................................................................................... Description of Soil----- C --- Tmcad3?--- Q.l"1. i--a --------------------------------------------------------------------------- x w . . VNature 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 4K4@h�of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has bee ssued by the board of health. Signed---- ------ ------- - _ d?At ✓ •-- ---•-----•--------• ----------- �� J ------ Date Application Approved By------ � L-•-•----•----------------------------------------------•---•-----•--- ....................Da ..--------------- Date Application Disapproved for the following reasons---------------------------------------------------------------------------------------------•------------------- ...............••--••----•-----------•----••--•---------------------•--•-------......._..•--•------------------•-••-------•-----•--------•------•--•--------------------•......---------•------•--••-•-. Date Permit No....4 21----------------------••----- ....... Issued...-i— --1-7�-----•----------......... I,?ate i No..:...................... Fizic............................ THE COMMONWEALTH,OF MASSACHUSETTS BOARD OF HEALTH __ OF..............................'---------------._..................-... Applirnthnn -fur Dispniitt1 Earks Tonstrnrtinn Vattift Application is hereby'made for a Permit to Construct X or Repair ( ) an Individual Sewage Disposal System at ocati ddress or No. _&d.0 _-� - .. .. . ................... ..................... SUM Ad ress W / `f.60_N_15_ AS .................................. Installer Ad ress U Type of Building Size Lot_.20. 3S_3._._Sq. f t Dwelling-No.,of Bedrooms________________�---------------.-----Expansion Attics Garbs ge Grinder `l Other—Type a ype of Building No. of persons..._-•�................ Showers (Z.) — Cafeteria Otherfixtur S -------------------------------------- -._.------------------------------------------------------------------------------------------------------ W Design .Flow ..................................Q-_-______-____-_gallons per person per day. Total daily flow-__-_____-+OQ----------------------gallons. P4 Septic Tank—"Liquid capacityI250--gallons Length-------------_- Width------.......... Diameter-------.-------- Depth..-.--__-.----- xDisposal Trench—No.......:..... ....... ���idt i___._ _. Total Length-------------------- Total leaching area..-.--.-____-______sq. ft. -Seepage Pit No. _P44_D�.Diameter------1O TDept below inlet_1O_(M_S.4Z5 Total leaching area-53'4'_'__sq. tt.} Z Other Distribution box Y45 Dosing ank (a ?Av I. ViZRAli Test Pit No. I________________minutes per inch Depth of Test Pit..._.�.�... _ �e th to round waiie Percolation Test Results Performed by.... 1. ._ DoiL.�Q.. Date..______ P P - P a r-----Q'C"--Qp-T�..� f� Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water------------------------ ----- ---------------------- -•--•---------------------••••---•--••......................................................... D Description of Soil-_-_. Clo..___ `a'_'�1�� {-G�•_-- ip l_1`,___ _.o_G- x 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 =of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. Signed-------------------------------------------------------------------------------------- -------------------------------- Date Application Approved B .- --•--= ----------•-•••----•--•-----•-----•----••-....--••----------•--•------ PP PP Y-------------- . --------------------D -------------- Date Application Disapproved for the following reasons:-..--------•--•---•------•-----•--------------•-------•----------•-•---•-----------•-------•----------------- ..__.._...-•-----•..............•---•-•---•--•-----•-•--•------•-•-..__...--•--------•-•------••----------------•----------•----•-••-----•-•------•------•••--------------••-•-••------------•......... Date PermitNo..... ........................................ Issued........................................................ f. Date THE COMMONWEALTH OF MASSACHUSETTS " BOARD OF .'HEALTH- .......:•.................................OF............:... ... ....... ............................................... W. rrtif irate"' f m11lianrr THI AISC�ERFY, That the InOlylduall e tsp 1 Syste onstructed ( ) or Repaired ( ) by3. ' Z •---- !' �`� Tnst-tller� e% '"` a i has been installed to accordance with the provisions of-IrArticle XpI df/Fhe State Sanita4 Code as described m`�the t,?application for Disposal Works°Construction Permit,'No---.----._•___ --------------------------- THE ISSUANCE. OF THIS CER'TIFICAYE SHALL. NOT BE CONST UE® AA G ANTEE,THAT THE SYSTEM WILL FUNCTION SATISFACTORY. �wTC LY M �F t57$ L�4-4 FJyr fJ� +dkM 4NP4if F�tFMB hi h(_DATE_ ✓�.'•- fs.-aiCG..�.. . .. . � ;.. �. . . - 1 �sr.� ;x � �.F � s x a �'a s,° o H.,�+' 'a.•'� rr THE COMMONWEALTH OF MASSACHUSETTS { BOARPOF HEALTH , ,i_ . . ................4::: OF .............................---------------------------•----------........--_.... No.••------------ FEE_..................... Biip i?xks,jC anitrurti u, r, Permission is hereby gratffe _:____-'_-_._._-__--- -------- to Construct ( ) oP Repair.( ) an In a a�1w,Se�wage Dispo al System l l f ,,ryry r 1 �//i 1 e t+ L� ----- ' .. Street - as shown on the application for Disposal' Works•Construction Pe 't No ._ .._ ._,_,__ Dated---------------_----.__-_-____________._ 4W ',` ------------------------------- DATE----- r" '"r ` Board of Health ' FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS Y LOT 0 { t Ld > o THLSMAS E. KEI:I,t? Cds CERTIFIED PLOT PLAN I LAND SURVEY022$ C o`C� i 246�LONG 'POND.DftivE +, LOCATION � SOUTH 'Y`ARMOUT14, MASS.' SCALE �.��t. . . . DATE ir OF � PLAN REFERENCE .5 HOW W. A6 .LOT. �p� T►jQFillk- �'� $ mow, is dtuy .o ONAI �ys I CERTIFY THAT THE 1".C?t3" 7r t ? SHOWN ON THIS PLAN IS' LOCATED ON THE GROUND F '�tWt TY j�+t;,�.' T AS'SHOWN HEREON AND THAT IT PON FORMS TO T E ZONING- LAWS -OF THE TOWN OF N", S TA 'a �. .. . . . *. H N St UCTED,AN IS, �`�' . DATE .N aV•, l 1 � �{ �4 k PETITIONER : � ����� RD SURVEY , Y I l t Mv L.4 E4 0 i Sup 5 w z W • W m ' 3fc,'• i o-ropm Aver CTu 'TSS. ' eCpK't l E`.y F pig..ia.Y.iz-h\\a Fn -131 :a Cz— Co rQ6 e- I' -76 1 � V � ' i W W a a 0 0 m U -- LEGEND N Za N `16'05'18" E _-�8-ar—?—E t 0 98 .... ._ T ® e �4 __-••.--- � x EXISTING CONTOUR Fso�t P t A. A 8 'I o �� °Z, Q. n I 29,25' — — le��e"� 90m.11' } x 100.98 EXISTING SPOT GRADE e c ar er, Q EXISTING LEACH PIT �r`K '' 0�1 0 °j l o c� �, o °` •v TO BE PUMPED, FILLED W/ o o`�'0 1 p o`o N ° W EXISTING WATER SERVICE �c o Qa ° SAND & ABANDONED �, N �� {'� TEST PIT Q �-' ! '` L " TBM NO. VENT BENCHMARK .tea 0. SCREW SET TOP STEP s�Ore 002 S E4Pti^/-I r 3EL.=100.00 Assumed eo+Qr ' LPr-; S c �am CL �0 3 goy O,. s Neck Rd TBM N0. 2 r J r �, 5_ _r-� �oT'� � _� � N;x°' Ave SCREW SET BOTT. STEP EL.=96.91 Assumed h,� . ,['[......! !" /, 96.03 I;`-26'�--I U w CL EXISTING SEPTIC TANK LOCUS TOP OF TANK, EL.=97.48t 1 DECK LABOVE a INV.(OUT)=96.15t NOTE: SAS BELOW CELLAR LOCUS MAP FLOOR ELEVATION I i •y. 2 b ;, ,,' ' � : `ter �ii ;' � NOT TO SCALE a f/ '�EXISTI G/�'� /// °— TP-1 }+ GENERAL NOTES: iHOUSE (#656)fi j ;, / ��'� o T.O.F..=103.24t' ' ® P' 1 SIGNBENG NEEAPPROVED BY THE LOCAL ALL CHANGES TO THIS PLAN MU TP-2 BOARD OF HEALTH AND THE DE I CELLAR FL. EL.=96.21 j 2. ALL WORK AND MATERIALS SHALL CONFORM TO THE REQUIREMENTS / ` i , "'^;OF THE STATE ENVIRONMENTAL CODE, TITLE V, AND ANY APPLICABLE dam- //j�jj ice/ Z O�^ LOCAL RULES AND REGULATIONS EXCEPT AS REQUESTED BELOW: 14 M / //% / / / i — p —310 CMR 15.405 1 (b): / ¢� a , /// / 1 A 1' variance to the 3' max murn cover requirement, for 4' of up IIE r�'1r oe / ,�.. I Ln W ) 9 00 GI RAGE UNDER �N Oo max. cover. S.A.S. shall be vented. 04's are rated for 4' cover. 5 � 3. THE SEWAGE DISPOSAL SYSTEM SHALL NOT BE BACKFILLED PRIOR t� PORCH 0 01 W TO INSPECTION AND APPROVAL BY THE BOARD OF HEALTH AND THE z DESIGN ENGINEER. 4. ANY CONDITIONS ENCOUNTERED DURING CONSTRUCTION DIFFERING FROM THOSE SHOWN HEREON SHALL BE REPORTED TO THE DESIGN r ENGINEER BEFORE CONSTRUCTION CONTINUES. i 5. ALL ELEVATIONS BASED ON ASSUMED DATUM: 6. THE DESIGN ENGINEER IS NOT RESPONSIBLE FOR THE FAILURE OF X ' THE CONTRACTOR OR OWNER TO NOTIFY THE LOCAL BOARD OF HEALTH FOR PROPER INSPECTIONS DURING CONSTRUCTION. a 1 7. WATER SUPPLY PROVIDED BY TOWN WATER SERVICE. `� i li pF Nlq 8. THERE ARE NO WELLS WITHIN 150' OF THE PROPOSED S.A.S. 9. ALL AREAS CLEARED FOR CONSTRUCTION SHALL BE RESTORED AS LOT 7 O yG AGREED UPON BY OWNER AND CONTRACTOR OR AS OTHERWISE 1 v o PETER T. DIRECTED BY THE APPROVING AUTHORITIES. APN 039-109 ! ` '; o M CIVILEE "' 10, IT SHALL BE THE RESPONSIBILITY OF THE CONTRACTOR TO VERIFY 20,303t No. V L THE LOCATION OF ALL. UNDERGROUND UTILITIES, PRIOR TO BEGINNING CONSTRUCTION. £C/SZE��� `�� 11. WHERE REQUIRED, CONTRACTOR SHALL REMOVE ALL UNSUITABLE SOILS IN THE AREA BENEATH AND FOR 5' ON ALL SIDES OF THE S.A.S. AND 1 F REPLACE WITH CLEAN SAND AS SPECIFIED 1N 310 CMR 255(3). yt� r (JA(� 12, AREAS REQUIRING STRIPOUT OF UNSUITABLE MATERIALS SHALLBE (e V" INSPECTED BY HEALTH DEPARTMENT PRIOR TO BACKFILL. j 13. THIS PLAN IS TO BE USED FOR SEPTIC SYSTEM PURPOSES ONLY AND I 1 IS NOT TO BE CONSIDERED A PROPERTY LINE SURVEY. — L=140.41' � PLAN REFERENCE: LAND COURT PLAN 36608B (LOT 7) R=2636.03' PROPOSED SEPTIC SYSTEM UPGRADE PLAN I 1 656 PUTNAM AVENUE, COTU IT, MA PUTNAM AVENUE Prepared for: Carlos Castro, 656 Putnam Ave., Cotuit, MA 02635 Engineering by: SCALE DRAWN JOB. NO. (6 0' WI D E) Engineering Works ,"=20' P.T.M. 218-08 - ---........_.... I -- 12 West Crossfield Road, Forestdole, MA 02644 DATE CHECKED SHEET NO. edge of pavement (508) 477-5313 8/4/08 P.T.M. 1 Of 2 l . i r NOTE: TO PREVENT BREAKOUT, THE PROPOSED K FINISH GRADE SHALL NOT BE < EL:92.5 EXISTING TAN v INSTALL RISER WITH COVER AND SET FOR A DISTANCE OF 15' AROUND THE VENT i IN AS NEEDED, AND SET TO WITHIN 6"STALL RISERS WITH COVERS OVER INLET & OUTLET, TOP OF OF FINISH GRADE TO WITHIN 6" OF FINISH GRADE PERIMETER OF THE S.A.S. FOUNDATION EXISTING EL.101.3t F.G. EL: 96.6t F.G. EL.: 96.5(MAX.) " (EXISTING) .4 MAINTAIN 2% MIN SLOPE OVER LEACHING AREA a.. u. a o L = 23' L = 12'(MAx) INSPECTION RISER PIPE 6" 4" SCH 40 PVC 4" SCH 40 PVC T. 10" 14" 0 S= 1% (MIN.) 6- ® S= 1% (MIN.) 8" TO 5 48" LIQUID INVERT _ 9 LEVEL �INV.=96.15± PROPOSED ° EXISTING GAS BAFFLE (EXISTING) D=BOX INV•=92.17 5 ROWS OF 6 UNITS AT 4'/UNIT + 2'(END CAPS)= 26.00' INV.=.92.47 w/INLET TEE INv,=92.30 SOIL ABSORPTION SYSTEM (PROFILE: EXISTING 100Q GALLON SEPTIC TANK 5 OUTLETS MINIMUM N.T.S ESTABLISH VEGETATIVE COVER } BACKFILL WITH CLEAN SAND (NATIVE OR PERC SAND) NOTES: 1) CONTRACTOR SHALL VERIFY ALL EXISTING PIPE INVERTS PRIOR TO INSTALLATION.R BREAKOUT EL.=TOP OF UNIT 2) D—BOX SHALL BE SET LEVEL AND TRUE TO GRADE ON A SIX INCH MECHANICALLY TOP OF CHAMBER EL.=92.5 COMPACTED CRUSHED STONE BASE, AS SPECIFIED IN 310 CMR 15.221(2). INV.ELEV.=92.17 —\ 3) INSTALL INLET & OUTLET TEES AS REQUIRED. BOTTOM ELEV.=91.50 4) GAS BAFFLE TO BE INSTALLED ON OUTLET TEE. ,,,I "—EXISTING SUITABLE 21" 5-4" POLYSEAL OUTLETS 2.83' MATERIAL 1-4" POLYSEAL INLETS 5' MIN. ABOVE BOTTOM OF 2., 2� T.P. EXCAVATION OR G.W. EFFECTIVE WIDTH=14.2' SEPTIC SYSTEM PROFILE USE 5 ROWS OF 6—QUICK4 STANDARD INFILTRATOR CHAMBERS . NO G.W. ENCOUNTERED, EL.=85.3 _ wITH NO SEPARATION BETWEEN EACH RGW & NG STONE O O N.T.S. N TYPICAL SECTION o `n co L - ....... PORCH DESIGN CRITERIA N Top View Section "; SOIL LOG . f; / f NUMBER OF BEDROOMS: 4 BEDROOMS D—BOX '70///,/ /;/ / /" / DATE: AUGUST 4, 2008 (REF#12,310) - SOIL TEXTURAL CLASS: CLASS I ; f .'` '; ,/�% SOIL EVALUATOR: PETER McENTEE PE .EXISTING'`. /, WITNESS: DONNA MIORANDI R.S. DESIGN PERCOLATION RATE: <5 MIN/IN %'HOUSE (#656),;,`/ HEALTH AGENT DAILY FLOW: 440 G.P.D. ,/T.O.F.=103.24t f/ ELEV. TP— 1 DEPTH ELEV. TP-2 DEPTH DESIGN FLOW: 440 G.P.D. CELLAR FL. EL.=99.21/ 95.3 0" 95.3 O" GARBAGE GRINDER: NO LOAMY SAND LOAMY SAND EXISTING SEPTIC TANK: 1000 GALLON CAPACITY_ (TO REMAIN) / 1 OYR 4/2 10YR 4/2 — 94.8 6" 94.7 7" LEACHING AREA REQUIRED: (440) = 594.6 S.F. ty 20. ' E BSAND E SAND 74 INSPECTION PO M ��' 7:5YR 5/1 7.5YR 5/1 52" c, q� 94.s e 9a.5 9 USE 5 ROWS OF 6—QUICK4 STANDARD CHAMBER UNITS WITH NO TOP VIEW �' 2 rL4c B i $ . ,,34 W" �1 ' t —; -- — LOAMY SAND LOAMY SAND STONE FOR AN S.A.S. HAVING THE DIMENSIONS: 14.2 x 26.0 8 INVERT 48 E D CAP ^ 10YR 4/6 10YR 4/6 EFFECTIVE LENGTH) PrN: 04STDE - . _ CO' 92.4 - 35" 90.8 54" BOTTOM AREA: (GENERAL USE APPROVAL FOR 4.72 SF/LF OF INFILTRATOR) END VIEW -------�� C PERC L 6 UNITS + 2 END CAPS PER ROW 26.0 FT g ' MULTIPORT END CAP 5 ROWS x 26.0' x 4.72 SF/LF = 613.6 SF ill PROPOSED 53'° MED. SAND MED. SAND DESIGN FLOW PROVIDED: 0.74 613.6 S.F. = 454.1 G.P.D. SIDE VIEW NOMINAL CHAMBER SPECIFICATIONS IV S.A.S. ( ) 2;5Y 6/4 2.5Y 6/4 SIZE(WxLxH)............................34"x48" x12" EFFECTIVE LEACHING AREA: ��------�--- PROPOSED SEPTIC SYSTEM -UPGRADE PLAN N {F----26.0'--I BED.............................................PER CODE 85.3 120" 85.3 120" 656 PUTNAM. AVENUE COTUIT MA TRENCH.................................................PER CODE f 1 34" INVERT ELEVATION..................................................8" PERC RATE <2 MIN/IN. ("C" HORIZON) FRONT VIEW STORAGE CAPACITY PER UNIT....................44.4 CAL NO GROUNDWATER ENCOUNTERED Prepared for: Carlos Castro, 656 Putnam Ave., Cotuit, MA _02635 QUICK 4 STANDARD INFILTRATOR CHAMBER Engineering by: SCALE DRAWN JOB. NO. NOTE: SOIL CONSISTANCY AT LOCATION OF S.A.S. Engineering Works NTS P.T.M. 218-08 En INFILTRATOR CHAMBERS S.A.S. LAYOUT SHALL BE VERIFIED PRIOR TO INSTALLATION. g� g 12 West Crossfield Road, Forestdale, MA 02644 DATE CHECKED SHEET NO. N.T.S. (508) 477-5313 8/4/08 P.T.M. 2 Of 2