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HomeMy WebLinkAbout0027 ROSEWOOD LANE - Health 27 Rosewood Lane Cotuit A = 010 03T i IJ � 1 i A F I T a TOWN OF BARNSTABLE F C- LOCATION d — SEWAGE #�DOS- g VILLAGE C Del/�� _ASSESSOR'S MAP & LOT ��3� INSTALLER'S NAME&PHONE NO.� �a s 0 .rat R� l� • S 01✓ SEPTIC TANK CAPACITY /. 0 99 O L LEACHING FACII.TTY: (type) /— �/2 (size) No.OF BEDROOMS y BUILDER OR OWNER PERMITDATE: 3 I COMPLIANCE DATE: 31 Oz Separation Distance Between the: Feet Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Private Water Supply Well and Leaching Facility (If any wells exist Feet on site or within 200 feet of leachig facility) exist Edge of Wetland and LeachingFacility (If any Feet within 300 feet of leaching facility) Furnished by 1 � l,l � • � I 1 h Ati• Q 0 cz �a� p NO. OL, �a C� Fee $5 0. 0 0 THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: V Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS 0[ppfication for �Digpool 6petem Construction Permit Application for a Permit to Construct( )RepairX X�Upgrade( )Abandon( ) El Complete System L1 Individual Components Location Address or Lot No. 27 Rosewood Lane Owner's Name,Address and Tel.No.The r e s a Hinckley Cotuit ,Mass.02635 5` Hinckley Circle Osterville ,Mass. sses�r's Map/Parcel 3 1 02655 Installller's Name,Address,and Tel.No.5 0 8—7 7 5—3 3 3 8 Designer's Name,Address and Tel.No.5 0 8—7 7 5—9 7 0 0 J.P.Macomber & Son Inc. Ronald J. Cadillac Box 66 Centerville ,Mass.02632 P.O. Box 258 W.Y. 02673 Type of Building: Dwelling X X No.of Bedrooms 4 Lot Size-� �Di WO sq.ft. Garbage Grinder( ) Other Type of Building A . No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow 455 gallons per day. Calculated daily flow 440 gallons. 5/0 2 plan Date 4/2 5/0 2 Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. 5�6 Description of Soil Sandy loam -silty loam-sandy loam-coarGP Band S �� Nature of Repairs or Alterations(Answer when applicable) A d d i n g 3-5 0 0 g a 11 o n l e a c h i n g chambers packed in 4 ' of 11111 ctnnp - 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 Certifi- cate of Compliance has been iss ed by thi Boar o alth. Signed - Date 5/2 9/0 2 Application Approved by Date I Application Disapproved or the following reasons Permit No. Date Issued '�I �2- No. Ck�� �: a . .�y ,� �• �.� L!F-c Fee $50,_( THE COMMONWEALTH OF MASSACHUSETTS r Entered in computer. V Yes - TOWN OF BARNSTABLE MASSACHUSETTS-, _,;PUBLIC HEALTH DIVISION ., 2pprtcation for �Bigpogal 6pgtem Congtruction Permit Application for a Permit to Construct( )Repair X jTUpgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. 27 Rosewood Lane Owner's Name,Addressland Tel.No.Theresa Hinckley Cotuit,Mass.02635 5` HinckleyCircle Osterville,Mass. 'r ksses�gr's Map/Parcel /. 02655 A,,-r o'�5 f J Installer's Name,Address,and Tel.No.5 0 8—7 7 5—3 3 3 8 Designer's Name,Address and Tel.No.5 0 8—7 7 5—9 7 0 0 J.P.Macomber & Son Inc. Ronald J. Cadillac Box 66 Centerville,Mass.02632 P.O.Box 258 W.Y. 02673 Type of Building: ` ,_Dwelling XX No.of Bedrooms 4 Lot Size Oyu sq.ft. Garbage Grinder( ) l Other Type of Building u9 No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow 455 gallons per day. Calculated daily flow 440 gallons. '•5/0 2 Plan Date 4/2 5/0 2 Number of sheets Revision Date Title Size of Septic Tank X`S� ��� lC�X1C� Type of S.A.S. 'S�JI� C�•-os-�I� �( f Sand Description of Soil y loam —silty loa:in—sandy loam—coarse sand k Nature of Repairs or Alterations(Answer when applicable) Adding 3-5 0 0 gallon leaching hambers packed in 4' of 1�" stone. 9 i „ 1 I 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 Certifi- cate of Compliance has been isstled by thi BoarVoHalth. Signed . Date 5/2 9/0 2 Application Approved by C_ Date <,- 1-�I (-)-? Application Disapproved or the following reasons Permit No. 2 OU c� a2� '1 ':: Date Issued S - --.---.�----------t------------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed( )Repaired X )Upgraded( ) Abandoned( )by J.P-.Macomber & Son =Inc. at. 27 Rosewood Lanp Cotuit,Mas has been'constructed accordance "" ikf h provisions of Title 5 and the for Disposal System Construction Permit No. OZD -a c)CYtated 'S t I C)�! Installer J.P.Macomber & Son Inc. Designer Ronald J. Cadillac R.S. The issuance of this permitshall not be construed as a guarantee that the syst will f nction as designed. Date ' it• Inspector 4VJ•,SNr ------------------------------------- No. °.��-l�U�' � j Fee $50.0 THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS Ii.5pogat bpgtem Congtruction Permit Permission is hereby granted to Construct( )RepairTX�Upgrade( )Abandon( ) Systemlocatedat 27 Rosewood Lane Coituit,Mass . 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 muss t be completed within three years of the date of this A it. Date: S r -,,, I f Approved b PP Y 4 t ` COMMONWEALTH OF MASSACHUSETTS z EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION y TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address 0 ia9t�0(,[ L P Owner's Name: Owner's Address: Z` -t Date of Inspection: Name of Inspector: (please print) ► �(� �+ �yeS� �' ' " Company Name: R� �RvtePco Mailing Address: jk 023-)b co rn Telephone Number: 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 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: asses Conditionally Passes r Needs Further Evaluation by the Local Approving Authority Fails Inspector's Signature, ��:��jpectionreport Date: �/�2 /� 6 The system inspector sh mit a copy to the Approving Authority(Board of Health of 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. Notes and Comments ""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. -rc.ie c T—.....t;— V..— 4/1 v,)nnn .,aQP Page 2 of I 1 OFFICIAL INSPECTION.FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: Q426,%f TUr Owner: DelmiS fyA e C XT1, Date of Inspection: 21 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. Syste asses: 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. Answer yes,no or not determined(Y,N,ND)in the 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. ND explain: 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 pipe(s)are replaced obstruction is removed distribution box is leveled or replaced ND explain: 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 obstruction is removed" ND explain: Page 3 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORMI PART A CERTIFICATION(continued) Property Address: 2 tZo wqo V f "r Owner: nni% c L 2 Date of Inspection: U 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 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 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,provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: Page 4 of I I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: '2.7 r4 54 to o o d J--A Kf tT Owner: n yti' me Date of Inspection: 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 glogged SAS or cesspool /Static liquid level in the distribution box above outlet invert due to an overloaded or clogged.SAS or _ �sspool u11 depth in cesspool is less than 6"below invert or available volume is less than''/2 day flow jZ Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number of Imes pumped ID 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 wester supply. ✓An portion of a cesspool or privy is within a Zone 1 of a public well. _ ��Portion of a cesspool or privy is within 50 feet of a private water supply well. _ _✓luny 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 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,provided that no other failure criteria are triggered.A copy of the analysis must be attached to this forma �D (Yes/No)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 now of 10,000 gpd to 15,000 gpd• You must indicate either"yes"or"no"to each of the following: (The following criteria apply to large systems in addition to the criteria above) yes no the system is within 400 feet of a surface drinking water supply the system is within 200 feet of a tributary to a surface drinking water supply the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area—IWPA)or a mapped Zone 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. l Page 5 of I 1 OFFICIAL. INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL. SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 2 N100 Jt O V 1T Owner: r1nts mC Cfi'hr- Ey Date of Inspection: -1 ��1'n L Check if the following have been done.You must indicate"yes"or"no"as to each of the following: Yes o Pumping information was provided by the owner,occupant,or Board of Health 'v 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) v Was the facility or dwelling inspected for signs of sewage back up s/ Was the site inspected for signs of 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 l maintenance of subsurface sewage disposal systems The size and location of the Soil Absorption System(SAS)on the site has been determined based on: Yeo / 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(3)(b)] Page 6 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 27 i6 R� T Owner: 1:�-t'i'tVtu Date of Inspection: • FLOW CONDITIONS /• RESIDENTIAL Number of bedrooms(design): Number of bedrooms(actual): tl P rrD� DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): L V SS co {' J Number of current residents:. 0 Does residence have a garbage grinder(yes or no): Is laundry on a separate sewage system(yes or no): nU [if yes separate inspection required] Laundry system inspected(yes or no): Seasonal use:(yes or no): 11 ��� �� r �! b�® ����, Water meter readings,if available(last 2 years usage(gpd)): Sump pump(yes or no):Llq z 00!C Last date of occupancy: COMMERCIALANDUSTRIAL Type of establishment: Design flow(based on 310 CMR 15.203): and Basis of design flow(seats/persons/sgft,etc.): 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/use: OTHER(describe): GENERAL INFORMATION Pumping Records Source of information: (VLjV t-V.— Was system pumped as part of the inspection(yes or no):alp If yes,volume pumped: gallons—How was quantity pumped determined? Reason for pumping: TYP 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) Tight tank _Attach a copy of the DEP approval _Other(describe): Approximate age of all components,date installed JJ(if known)and source of information: n �1 (o �- k4 v�� ttsslat OZ_ ZoaWere seages o ors detec dwhen arriving at the site(yes or no):_ r M% Page 7 of 1 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 2. l—&me 1"` Owner: L>tnwij r Date of Inspection: 0(0 BUILDING SEWER(locate on site plan) Depth below grade: _ Materials of construction:_cast iron _40 PVC_other(Explain): Distance from private water supply well or suction line: Comments(on condition of joints,venting,evidence of leakage,etc.): SEPTIC TANK:_(locate on site plan) Depth below grade: Material of construction:_concrete_metal fiberglass_polyethylene _other(explain) If tank is metal list age:_ Is age confirmed by a Certificate of Compliance(yes or no):_(attach a copy of- certificate) t t Dimensions: 19 b itX S y tt X -s Sludge depth- q11 Distance from top of sludge�to bottom of outlet tee or baffle: Scum thickness: 0 -- / i1 Distance from top of scum to top of outlet tee or baffle:�_ Distance from bottom of scum to bottom of outlet tee or baffle: / �� r How were dimensions determined: /"iaxi5 io i-•iA A T A,.7— y �°'t a /T Comments(on pumping recommendations, inlet and outlet tee or baffle condition,stru al integrity, liquid levels as related to outlet invert.,evidence o leakage,etc.): y�w�,� Sst�'�•� 0.r1 i� Iyt,►``1'��,+, Lt n00r S o f Q iuz �TG�_c_.�� .�rA.2.r�.., �a.. -�o ��\ y�o,n"tH.S oar Cnn�•�nwicl Wlu.:�.�'E GREASE TRAP:_(locate on site plan) Depth below grade: Material of construction:_concrete_metal_fiberglass__polyethylene_other (explain): Dimensions: Scum thickness: t` Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping: Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): P- Page 8 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: w C vJ ' M`y Owner: _ hK� EY1- Date of Inspection: TIGHT or HOLDING TANK: (tank must be pumped at time of inspection)(locate on site plan) Depth below grade: Material of construction: concrete metal fiber&ss._ polyethylene other(explain): Dimensions: Capacity: gallons Design Flow: gallons/day Alarm present(yes or no): Alarm level: Alarm in working order(yes or no): Date of last pumping: Comments(condition of alarm and float switches,etc.): DISTRIBUTION BOX: (if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: D 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.): ` �' ,'A9 d Cy vLd t7-�o-iec�;n 1 It PUMP CHAMBER: (locate on site plan) Pumps in working order(yes or no): Alarms in working order(yes or no): Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.): Page 9 of 1 I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM ���� INFORMATION(continued) Property Address: 27 ES� rq rT � Owner: 11 Kit C-l1-111 Date of Inspection: 2 SOIL ABSORPTION SYSTEM (SAS):zoocate on site plan,excavation not required) If SAS not located explain why: Type aching pits,number:_ aching chambers,number: 3 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.): _ Oo toA t[v►-k CkA P,t 4X)2_7 W 1- L, ' of S` V -c -�=0 r� A i it l 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 or no): 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.): Page 10 of I 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 17 P479L Owner: tkeftfkcj ffle ir1� Date of Inspection: 2 to SKETCH OF SEWAGE DISPOS L SYSTEM Provide a sketch of the sewage dis sal system including ties to at least two permanent reference landmarks or benchmarks.Locate all wells with' 100 feet.Locate where public water supply enters the building. bj5+ AC-e-S 71e `fii411 y i Z8, Z wo (3 -t03 � ,ro y = by ' f400 0 to If 0 v y i ��o0w, -1:1- Z t$ .1" 3 is 3� Y Q - (er ��hD� �e�J�cp L H Page I 1 of 1 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 27 aRA Sop EM (� NIP— Owner: 2 .1 n0 Date of Inspection: (2kr-111-( SITE EXAM J Slope Surface water Check cellar Shallow wells Estimated depth to ground wateru feet Please indicate(check)all methods used to determine the high ground water elevation: / v Obtained from system design plans on record-If checked,date of design p plan Observed site(abutting property/obse rvation 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: //�1�, ,g �c � eQ e �c S oe ab 6Zan/ �( C'�ifJ� Yi St�q le r I r r ' TOWN OF BARNSTABLE c- LOCATION va /"7 RO Se WO ®rL 1-,4Ale- SEWAGE 0061- .2-T P VILLAGE C QLL/Z- ASSESSOR'S MAP & LOT U 'd 3-7 INSTALLER'S NAME&PHONE NO. C O 41t/Fe X r SEPTIC TANK CAPACITY / 00 0 O L,d• LEACHING FACILITY: (type) /'/2 f W e/G S (size) /3>1 3 NO. OF BEDROOMS y BUILDER OR OWNER PERMITDATE 3 1 COMPLIANCE DATE: 3 1U,Z Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet ' Private Water Supply Welland Leaching Facility (If any wells exist - on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility (If any wetlands exist within 300 feet of leaching facility) Feet Furnished by _ 0 �..:.� •tip � / . rn TOWN OF BARNSTABLE LOCATION SEWAGE # AA01 INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY: (type) NO. OF BEDROOMS BUILDER OR OWNERS- ��G�y PERMITDATE: - COMPLIANCE DATE: + Separation Distance;3etween 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 Wetlan d king Facility(If wetlands exist within 300 f o acili Feet Furnished ` u , 7 ? L?oSe wvd /n 7 LEI) INSPECTION 3 a � Ai- 32' Z-Z`1 3- zip`' y_ �9 071 . No.---•----7yJ--- Fug..... ....... THE COMMONWEALTH OF MASSACHUSETTS BOARD O HE TH Appliratiutt -fur Bhipowd Workil Towitrurtiou Ppruid Applicationris hereby made for a Permit to Construct ( or Repair ( ) an Individual Sewage Disposal System at: Qf E ' a----------4.4 e4l—v r ----��______ (­ // L n•Address r Lot No. Owner p- ddress ;. Installer Address Q Type of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms-------------------------------------------ExpansionAttic Wcj Garbage Grinder ( aOther—Type of Building --------------------------•- No. of persons-----Z................. Showers ( ) — Cafeteria ( ) dOther fixtures --•-------------••---•-•------•----•---------------------------- ..... _ w Design Flow...._.._�")------__•---------------gallons per person per day. Total daily flow-__-________-s&.QQ......._-------gallons. WSeptic Tank—Liquid capacitylVO-gallons Length_-,............. Width.----.--- ...... Diameter_....--------- Depth---............. x Disposal Trench—No..................... Width-------------------- Total Length................ Total leaching area--------------------sq. ft. Seepage Pit No...... iameter._,!!�_X&---.-. Depth below inlet................... Total leaching area-.---..----.----.-sq. ft. Z Other Distribution box ( Dosing tank,( ) oh- — /-e- -77 '-, Percolation Test Results Performed by--------------------------------------------------------------------------- Date---•-----------------•-.----- Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water..... _---.--.- rXq Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water-------.-------.-------- --------a O ------------ Descri tion of Soil--.--.__�_ 3.�_._: xro_ '----- ------- - " - ? --,� y w UNature of Repairs or Alterations—Answer when applicable..--............................................................................................ --------------------------------------------------------------------------------------------------------------------------------------------•--------------------------------------------------------:. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Article XI of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued bx the board of health. Sign d�° _�J�2G/ r f ,�`— Application Approved By....... - Date Application Disapproved for the following reasons:-------•-----------------------------•-.._........----------•-•-••••----•---------••-•----......•---..-••---•... ---------•-•-••••----------••...•-----•--•--------------•••-------------•-------•••••--•----••----•••------------•------•--•-----------•---•---•••-•--------•-----------------•-•------------•-•---•-•-- Date PermitNo......................................................... Issued........................................................ Date r 17� l /5_ G � '•�/ Fmicr THE COMMONWEALTH OF MASSACHUSETTS �- BOARD OF HEALTH ....... "... ...'.'.-- OF ............ ,1>. !/. %'' .......................- L{ G.........*.......... Atiptiratiun -fur Bhip oal urko Towitrurtion Prrniit Application is hereby made for a Permit to Construct ( or Repair ( ) an Individual Sewage Disposal System at --------------------------............................ T J Locstaon Address Lot l o. Ile 1 Owner ddress 4 Installer Address d Type of Building Size Lot----------------------------Sq. feet U Dwelling—No. of Bedrooms............................................Expansion ttic Garbage Grinder (Ir 'Ur per, Other—Type of Building _........................... No. of persons..... ........._---_--_- Showers ( ) — Cafeteria ( ) Q' Ott-ter fixtures _______________________________ _ _ W Design Flow--------- C........................gallons per person per day. Total daily flow__.._....___.&1 0-_._............gallons. 9 Septic Tank—Liquid capacity/.� allons Length................ Width---------------- Diameter.........------- Depth................ Disposal Trench—No- ___________________ Width_�y_._....___....._.. Total Length......-............. Total leaching area--_-_._.___-.-__-._sq. ft. I!54 Seepage Pit No________ __________ iameter._ ----- Depth below inlet.................... Total leaching area---------.--------sq. ft. z Other Distribution box ( Dosing tank ( ) 4�✓' l/��`G`` - `/' G` aPercolation Test Results Performed by............ ............................................................. Date------------------------................ Test Pit No. 1----------------minutes per inch Depth of Test Pit-------------------- Depth to ground water-------- ._......... rX, Test Pit No. 2_---------------minutes per inch Depth of Test Pit.................... Depth to ground water--.--.------------------ o ----•-------------------------------------- G Description of Soil. - 7 '?---------- '------ --------------------------- W UNature of Repairs or Alterations—Answer when applicable..................._........-•._..._.....-_..._......•._................._......_............... •------------- - -=------------------- -=------------•-----------•---•------------•-•••-•••••...... ----------------------------------------------------------------------------------------------- Agreement The,-undersigned, agrees"to install the afore4escribe&Individual Sewage Disposal System in accordance with the provisions of Article XI 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 lLalth. �,� Da Approved BY .,rJl� - _ �. L(�2%J-a;L�------------------------------- ........................� (/ Date Application Disapproved for the following reasons----------------------------------------------------------------------------------------------•----------------- ----------------------------------------•----•--.......:.-----------------------------------------------•----------------------------------------------------------------------------------------------- Date PermitNo................................=........................ Issued---_--------------------------........................ Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ......1..0.�ab(I................OF_..... Trrtif irate of 101,11ntliliatta THIS IS TO C ,RTIFY That the ndividual Sewage�is�sal ystem constructed ( �or Repaired ( ) by . . •-•-••_ ---• '-••••-•------- . Installer r - at_... .�.? .....�Xo Z t ,.(�_ 1 '�--r-------• 7"C r!............................................... has been installed in accordance with the provisions of A''t-le XI of The State Sanitary Code as described in the application for Disposal Works Construction Permit No. ... `l .................. dated..-___l�---_- t,_:7................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE..................... �-1__-� �/___- ----------•-------- Inspector---�_ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH 0-7;1 — j , 7.� .........7r ,................ OF..--......1.., � l.Y.....✓.. � _ rJ No.-----•-•---•--••-------• FEE... ......... Dirivolitti ' rk� C un tr�trtiun rrut - Permission is hereby granted------------ ---•-=--=--- ---=----•--- ............................ ................... Dsposa stem to Construct ( or Repair ( ) an Individual Sewage Sy ` at No. ,.'' 'c � ids } Q4�- ------------C-0-1 .. _ St as shown on the application for Disposal Works Construction Permit-No.-................. Dated--_ ................ Board of�Health DATE................................................................................ FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS 06-C AT ION SEWAGE PERMIT NO. V6LLAGE INSTALLER'S NAME & ADDAESS B U I'L D EE R OR OWN ER DATE PERMIT ISSUED 9-77 DAT E COMPLIANCE ISSUED y11,F17 ; i• t�D S Lame ��p F-r _ P. W";7�11 �r . .1 . . -� f �' - r. - . . - _ - � . J - - r Z,9.:.t" `"I ..?;ram. ,--•, y .,, _ ' d., ..t' ,' - . • r a, t t•P ,. t t j`y-[ y� r ,{ i -E a�,. ry `�..' ,'"y`"#'S'•t 4' �•j j r i /�, ,�i/y tt 5E C//.Att t[. 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Ofi y��� OVE:2 5.�'S r�wJ Cu/v[ E s 5 -h/ 20 . /�`` . :, DES/GAY LOAD/�G -/S:IJSe_D. , f�� i NA e-\' . . -M - { Cl�FOI(D N1 _ _ . 1 Vc. 3 . ', - _ fC1$TEp g . _ �� � !as�f .SATE HE♦C1LL774 A<Ggff /T L f �� J f / / r t � p I pp JOB NO. B02-02 38,13 NOTES Hinckley.dwg 1. LOCUS IS A.M. 10, PARCEL 37. 2. ELEVATIONS SHOWN ARE ASSIGNED. O 3. LOCUS IS IN FLOOD ZONE C ON FIRM DATED JULY 2, 1992. 4. ALL PIPES TO BE 4" SCH 40, AND PITCHED AT 1/4" PER FOOT. (UNLESS NOTED) S 5. MUNICIPAL WATER IS AVAILABLE. LOTS WITHIN 100' ARE ON TOWN WATER. 6. COMPONENTS TO BE AASHTO H-10 UNLESS NOTED. ° 7. INLET TEE TO PROJECT DOWN 13", OUTLET TEE DOWN 14". 3 4 a IF TWO OR MORE LINES, WATER TEST D-BOX FOR EQUAL FLOW ao \ O D-BOX EXIT PIPES TO BE LEVEL FOR 'FIRST TWO FEET. c 4 O 8.9. DEPTH OF COMPONENTS NOT TO EXCEED 3', OR VENTING MUST BE PROVIDED. SNOT TO CALE �o 38 0 BUILD UP COVERS TO WITHIN 1' OF GRADE. MORTAR CHIMNEYS IN PLACE. Rte 28 x 0 ONE COVER OF TANK TO BE WITHIN 6" OF GRADE. LOCATION MAP 4 , 10. STONE TO BE DOUBLE WASHED 3/4 TO 1 1/2 WITH 2 MIN. 1/8 TO 1/2 PEA STONE ON TOP. 40.7 f 11. IF UNSUITABLIt SOILS, OR SOILS DIFFERING FROM THE SOIL LOG ARE FOUND, 41,4 S 6 CONTACT THE BOARD OF HEALTH, OR R.J. CADILLAC. 12. IF AN OVERDIG IS CALLED FOR BELOW, FILL MATERIAL FOR 5' AROUND AND UNDER LEACHING TEST HOLE 1 ?Spp, IS TO BE CLEAN GRANULAR SAND MEETING SPECIFICATIONS OF 310 CMR 15.255(3). \� 13. PUMP AND FILL ANY EXISTING CESSPOOLS. REMOVE ANY CLOGGED SOIL, BLOCK, AND STONE IN DEPTH (inches) ELEV. feet 3 LEACH AREA, AND DISPOSE OF AS DIRECTED BY HEALTH AGENT. ( ) 14. ALL CONSTRUCTION TO MEET TITLE 5 AND LOCAL REGULATIONS. 0 A layer 2.5y 3/2 41.2 x 41.0 40 40.8 40,7 • 40,00 TEST HOLE DATE: March 21, 2002 9" sandy g1 layer loom 5 6 PERFORMED BY: Ron Cadillac, Soil Evaluator 41.1 WITNESSED BY: 30" silt loam E PERC RATE: <2'-00"/inch (C layer) B2 layer 2.5y 5/ x 41 7 L 0 T 28 3 x 40,4 i x 412 SOIL SURVEY(1993): Enfield silt loam " sand loam 40 2 / GEOLOGIC MAP 1986 Mash pee pitted lain deposits 45 (20% gravel) ( ) P P P P 37.45 22, 365± S. F. 40.8 / � Top & Center=39.92 Invert 38.50 3 DRY WELLS 60"a N/F Use Gas Baffle Invert;56.90 C layer 2.5y 6/6 COHEN // Propoied coarse sand 40,5 E / x 4L8 Top Conc.=37.5 40.9 4/ / Existing S=1/2"/ft Top Peastone=37.2 (15% grovel) 1000�G Gal. 41.7 -- ,/41,3 24 132„ no water 30.2 � `�-� / - - - T ti E 41,6 41.1 QP / �Aryry� 8 // ���� // Invert 37.07 Invert 36.70 4 5, 34.7 6 Stone or compact Proposed Proposed I Bottom BENCH MARK--S.W. CORNER OF EX� / CONC. BULKHEAD=42.56 ASSIGNED G 1 I N 1 2' $jl N FIQ(�S 4L4 // �`O 41,6' I---34 I I I 9' Bottom TH1=30.2** . ND E / DESIGN 27 DATA ** Groundwater is 34' down from grade �41,5 ��� \ / ti0 S� (see Perc Exempton Form) 40,8 /� J 41.4 :;` Q3`SF- BEDROOMS: _ 4 __ --_ �1L8 "`- 1 9 GARBAGE GRINDER: No l Deck l \ 1.3 REQUIRED CAPACITY: 440 GPD LEACH AREA 97 EXISTING SEPTIC TANK: 1000 GAL. USE 3 DRY WELLS WITH 4' OF STONE c3= 38,0 41,48� 42.0 BENCH MARK--TOP & CENTER OF BOTTOM LEACHING AREA: 429.8 SF ALL AROUND FOR A 33'-6"' LONG BY �g• ' a WOOD STAKE= 41.97 ASSIGNED [(33.5' X 12.83')] 12-10 WIDE BY 2 DEEP LEACH AREA. � � SIDE LEACHING AREA: 185.3 SF 40.6 i 1'- ` 7 ��'�`� [2(12.83'+ 33.5') X 2' DEEP)] `7:-. -•-f�'�`e ::. 40,9 \` / / 1,3 11 N/F DESIGN CAPACITY: 455 GPD FRIEDMAN [(429.8 SF + 185.3 SF) X .74 GPD/SF] 41.2 4 0.5 >>> REDUCE GRADE BY 1/2 FOOT TH 1 ABOVE LEACHING, AS SHOWN. / 40.7 / .. x 40,7 40.5 1.4 40A 0 0.5 x 41.2 SITE PLAN 4,Sg��o FOR N/F 9-1 THIS PLAN IS A VALID COPY ONLY IF IT BEARS ' ZEGLEN AN ORIGINAL RED STAMP AND SIGNATURE. THERESA G. HING Li, k 0.7 ; ��"°FlyAss LOT 28, 27 ROSEW00 LANE, TUIT, MA LEGEND Ep q �PL�"°F MASSq ems° RO LD R :N A N . (�IV-1 4', `) �} TH 1 TEST HOLE LOCATION, NUMBER AI'" RIL 25, 2002 S�+.ALEk 20' � JA S � : o M ;� W WATER LINE MARKINGS o ( ` �, #35779 1 ra E OVERHEAD ELECTRIC WIRES (IF SHOWN) `��isTER`` oe x 9.5 X 8.7 EXISTING & PROPOSED ELEVATIONS ('X' MARKS POINT) SA�7_A R Ljk� . EXISTING CONTOUR RONALD J. CADILLA6 P•L� RS g PROPOSED CONTOUR PROFESSIONAL LAND SURVEYOR & REGI "ERED SANITARIAN UTILITY POLE (IF SHOWN) P.O. BOX 258 ® EXISTING DRAINAGE CATCH BASIN WEST YARMOUTH, MA 02673 x - FENCE (IF SHOWN, NOT ALL SHOWN) 0 TREE (IF SHOWN, NOT ALL SHOWN) HEALTH AGENT APPROVAL DATE C (508) 775-9700 2002 BY R.J. CADILLAC PAGE ` 1 OF 1