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0134 SCHOOL STREET - Health
134 School Street Cotuit - A= 020-038 - -- - --- -- --- — - - - - - - F j I i s } - Oudoor.com R4YNORI Model _. FILE `DOWNLOAD PPiNT FIND LEGEN[ . } EXI. COt t NEI - r EXIST. NEW ' EXIST. DINING i ` q LJ EXIST. n' t Yf KITCHEN t E EXIST. z + r' LIVING it , tip ! t i E i i i CIElL+T CI ^^M nt A 0.1 _ - Jr d E i daUA, -Floor �s j . 108.93' i = , 2 Z . _Y 0 SHED D CONC. 42.8' FNDN. ro 20 7.-i EXISTING DWELLING ; x s ems' SQyoot - SHEET _ FOUNDATION PLOT PLAN ;2-265 P� i PREPARED EXCLUSIVELY FOR THE PURPOSE OF OBTAINING A BUILDING PERMIT, NOT FOR ANY OTHER USE LOCATION 134 SCHOOL STREET, COMM) ItiIA SCALE 13, 2014 PREPARED FOR: REFERENCE " 20 PARCEL 38 CAROL RAYNOR I HEREBY CERTIFY THAT THE STRUCTURE SHOWN ON THIS PLAN IS LOCATED ON THE . r� GROUND AS SHOWN HEREON. =.'Ei_ \ •, . 1 I oll 508-362-4541 lo: 508-362-9880 •,! ` L downcope.com down CAN engineerin.v,h7C. � civil engineers )� ' land surveyors 1__ - ___—_--__ - __ __939 Moin Street ( Rte 6A) ------ — YARMOUTHPORT MA 02575 DATE -�_. REG. LAND SURVEYOR - 3224'2 DEED RESTRICTION WHEREAS, SfeAlleolce%e��� . (pro/ l, ffa aor` y of (owner's name) _Z3� Sch o .1 �r" MA (address) is the owner of—/,3z S¢ree:A located n (address) at MA (hereinafter referred to as /3�1 Sc!�� fi�ree7L and being shown on a plan entitled "Subdivision of Land in 8a rn sA d/e. MA, Property of et at, duly recorded in Barnstable County Registry of Deeds in Plan Book cg4p5-c7o , Page 13 a Or on Land.Court Plan Number WHEREAS,S ph n �Freckc kf /v/ , ReWl7Qr as the owner of said lot has (owner's.name) agreed with the Town of Barnstable Board of Health to a restriction as to the number of bedrooms which can be included in any home built on said lot as a pre-condition to obtaining a disposal works construction permit-in compliance with 310 CMR 15.000 State Environmental Code, Title V, Minimum Requirements for the Subsurface Disposal of Sanitary Sewage; WHEREAS; the Town of Barnstable Board of Health, as a pre-condition to granting a disposal works construction permit for a septic system in compliance with 310 CMR 15.200, State Environmental Code,Title V, Minimum ' Requirements for the Subsurface Disposal of Sanitary Sewage, and authorizing the issuance of a building permit for the construction of a single family home on this property, is requiring that the agreement for the restriction on the number of Dome ructed on the lot be put on record with the arnsta �onty Reis Deeds by recording finis document, eedr aistcp3 irJwa tnrmw 0A 1/ i TOWN OF BARNSTABLE LOCATION 134 SCnad SEWAGE# 2013,i i v VILLAGE C , ASSESSOR'S MAP&PARCEL INSTALLER'S NAME&PHONE NO. &Oqk. SEPTIC TANK CAPACITY 5 ) qJaL LEACHING FACILITY.(type) A-AiLA (size) NO.OF BEDROOMS OWNER PERMIT DATE: 4 COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility(If any wells exist ow 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) y Feet FURNISHED BY I'D 11.3 1aa,v ' p i rr.G �_ !off• ( f 1I � a Ll y � s�� - TOWN OF BARNSTABLE LOCATION SEWAGE# AC 13 • 11+ VILLAGE ASSESSOR'S MAP&PARCEL J©- 3'9_ INSTALLER'S NAME&c PHONE NO. f.&i l SEPTIC TANK CAPACITY I S e o _CZ /CC LEACHING FACILITY. (type) _,F-,6 N (size) _-Vf_ k NO.OF BEDROOMS OWNER PERMIT DATE: -1_'j COMPLIANCE DATE: a�Cd Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility —S Feet Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) N( Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of-leaching facility) Feet FURNISHED BY t �O ® 1 i� r3`® �GK P LOCATION SEWAGE PERMIT NO. VILL-,AGE � o lvt A & B CESSPOOL SERVICE 128 .BISHOPS TERRACE, HYANNIS, MA 02601 BUILDER OR OWNER DATE PERMIT ISSUED q DATE COMPLIANCE ISSUED �" - �. i = �` �; b � ��� �d� — — -, _ - �;� ��� « �� 1�' 4 ,_ 9 4 a t�'' :<�_ ,' T y L ^✓s f Z f No. n O ® � Fee I THE COMMONWEALTH'OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS 9pplitation for Misposal 6pstem Construction Permit Application for a Permit to Construct( ) Repair(Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. j (4 '5e • Owner's Name Address,and Tel.No. 6'6;'— Assessor's Map/Parcel aU `3$ U� � .� p Installer's Name,Address.and Tel No qA$ 60—,' Designer's N • d Tel.No. C�Q$� e, l o Type of Building: a Dwelling No.of Bedrooms Lot Size , sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) �3�y gpd Design flow provided e`�C{g gpd Plan Date I Number of sheets Revision i Date Title is: c�I�r p�LLY► �� �� �O�i�i T ,,// / //�� Size of Septic Tank 3ey) Type of S.A.S. (7`1 au, Description of Soil 169 Nature of Repairs or Alterations(Answer when applicable) 74)S-&V i4 iU «C16 qa Qhk JA-16 jL-Ar ; ion 6oy, 4- lla Acn©o9Wju./I"(— Vnr4—s ;n a 4dLtt I�pSS Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the:Environmnental e and t to place the system in operation until a Certificate of Compliance has been issued by this Board of Hlth. Signed /" Date Application Approved by Date [ �� Application Disapproved by Date for the following reasons Permit No. 0�0 Date Issued . No. �(3 O�V Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS L 2pplitation for disposal 6pstem construction Permit , Application for a Permit to Construct( ) 'Repair(Zo)'O"Upgrade,(�4)Ab don( ) ❑Complete System ❑Individual Components Location Address or Lot No. C?J 4 ��1C)p' �(-• Owner's Name,Address,and Tel.No. {� - Assessor's Map/Parcel go 3 - � C' ,)0// a n f.t�� ' �G x o y S� t. Installer's Name,Address,and Tel.No. t16 Y P s `[S as Designer's Name,Address,and Tel.No. '>0$ _-Va 7,5-X � usa4 ��n Type of Building: Dwelling No.of Bedrooms — Lot Size 15, 3-6 sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(inin.required) 22�j[) gpd Design flow provided U g gpd Plan Date (YVA fC. 5_ Vie'?) Number of sheets Revision Date Title I ,�w S o �lltm 14 l8q �-X')-,oa l %mel 1 �� n /- Size of Septic Tank t,�;(y, Type of S.A.S. Gr(Ajkz Mes ' /4 I-Iao /7, d o 0615 1 Description of Soil -S e.r J6 o Nature of Repairs or Alterations(`Answer when applicable) l��S�� C F to , ) f-� tO I�CxS Gra �nrlac�,n k. �;fAT-,rr 1Ainn 6)t C fD P A!jA-r 4)n t jam, a uqaOLAellySs {. kwlk Qc9a 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 Cod ae nd t to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. < Signed Date 4r'1 c AppltcationApproved by JQ Date_��` / r3 Application Disapproved by Date for the following reasons Permit No' Q ' l Date Issued r ' TIR E COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired(� Upgraded( ) Abandoned by �l ,�L��;' (2r" f't Y`h, n ,Tr-, at I' y� � 5-;�-. -- ( Dom`L/ `� has been constructed in accordance with the provisions of Title 5 and the for�4-ayl osal System Construction Permit No.a o 13 -11 dated Installer �/�p�l��`E_0nr�� ( 1r C Designer DCx1)io6T43 Q_ qei t>1eP_l-r #bedrooms Approved design flow �(/Q cJ gpd The issuance of this permit shall not a construed as a guarantee that the system wi' ll fun t-on as d fined. . { Date C/ �C� Inspectors _ � 1sJ. _•^- --.. ------------------------------------------------------------------------------------------ ----------------------------'-----------_--- No._ d( 3 ` C i q � Fee ( THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION -BARNSTABLE,MASSACHUSETTS Misposal *pstem Construction Permit Permission is hereby granted to Construct( ) Repair(� Upgrade( ) Abandon( ) System located at / 3 � � l ` (11",6� 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:.Construction must be completed within three years of the date of this permit. -� Date �'� �� Approved by Town of Barnstable Regulatory Services o� Thomas F. Geiler, Director BA"STABr e. Mom. Public Health Division o � Thomas McKean,Director , 200 Main Street, Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Installer & Designer Certification Form 4125/l3 2v (_9 _U76 Date: - Designer: S '5JywC- Installer: S Address: ' "_�13jx L-72/ Address: Z 3 C _\71FL RiS t= 0�1C.Gt ,�4 Oz5-63 11�2 k�uR-i Uz6`t�'' On 3 ?' (3 �Z-�—�S (�2ys was issued a permit to install a (date) (installer) ' I septic system at Z� �t��� �T `( 15 based on a design drawn by .(address) J\hV• T:&1k9`(1-2 dated 1-4.rl244 Zo(3 (designer) I 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. 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. IN OF l fl J SC �( o� DAVID (` 1 ° D (Installer's Signature) =`t FLAHERre, JR. No: 1211 GISTER�O S�Al I TAR\P (Designer's Signa (Affix Designer's tamp Here) PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE :ISSUED UNTIL BOTH THIS FORM AND AS- BUILYCARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. Q: Heal th/Sepdc/Desiper Certification Form MAY-03-2013 10:57 From:eORTOLOTTI CONST 5Oe4289399 To:150M906304 P.1/1 FR3M :dQwM Cape en9ircering inc FAX N6. :15083629880 May. 03 2013 11:00AM P2 're w � � x aal�liaY��ra�. s .y .s Ilf-;RAJ jail: h1f Ida lth D'Ild'do hat _ 1E10'�6siiva Str�l:t��llyl�lamis, E41fA d?:��� M ico: 50R.969 40" 508-No 63()A. NStollelr A T es hmor("PrOfteli on j<'+`I;m m ;� ►� � 1Pn�muaA;'1 2-0 Lt`f Ati`vx�adt►;t'y I1N00i•" "r-cd � AddreCss � -- 41 �� Address: " Gwz 0,. �'� I 1 -3 ��0/�' iN�+1._•� Vida 1�k L1Gd E ptm-nit Lo 11 sUM Lt (ciWW (ir.ssrlellP);) uTdc,system+ at hasrri v n.avi , liruwtt by (b1�'L'IMti� , - 4& ,.,_ rued— {raw 3j,�1l;C .criify Uqt.the ae;alic' gyg,tPm re e..M3lced shrive 'way LUtaHmd R thslZr6wly aer.017,12F, U) the dmisu, w irh n;ity U' WhIcle l;ubi,or app.mved ah4nps> ;-Wh. zA Iaftral relur,r+s-m.of 7ir Jigt,;i l-mb m bor m o dkor srp'tin t-ALk. 1 C'ectify ItIT fbe SE rt:r yYsfr,-xl. referenced abuyu Wme moaned will -Lu;.4jor chargtw (i.n, bpAfPr th,ltn 10' jRtr.rRT rCIUCati(jL Of t&, S,AS or any vr,Tti,sal XnJO rlri1M (If My com.PO]IbUt of t1u,anptic s+y"AO:n) h,at in,aL urfl m.--o with State Ak Local Rugaoliot)s. ,E'lart re ::Auu or cc�x ib.td al:;��'L)' es ra to foum. of ae��� .T(ln�ltLlI�;r'a'r? 11,:) DAMIELA. OJALA rrVILFlo Ncy,46502 ?a,1 M,AR, A"1.t3'Ft�V d'Cl RnAJINS'4'Ada,; PTTA?JC C�UT�(;J T, 1•Ifi'�' 6'1,1b} i,S�IJEFY IIP�'d'11. icy ; f� .ff3'iIV� Y,T CA"_A) tlul�T,�C.-�FiY, LQ� � 6J 4 Fs--F- q oFt� Town of Barnstable P# Department of Regulatory Services Public Health Division hate /-3 BARN STABLE, - y MASS. 8 059q� 200 Main Street,Hyannis MA 02601 RFD MAt a r Date Scheduled y Time / Fee Pd. / ��• t/�/ w Soil Suitability Assessment for Se e Dis, al Performed By: Witnessed By: y = _LOCATION,& GENERAL INFORMATION Location Address / n /?� Owner's Name (i. ' .r Address r Assessor's Map/Parcel: 02 /(3 6 Engineer's Name Ind NEW CONSTRUCTION REPAIR Telephone# Land Use Y vo�t��-�Gti( /' — Slopes(%) / Surface Stones Distances from: Open Water Body h/Nk�` ft Possible Wet AreN &- ft Drinking Water Well�ft 1 Drainage Way jA ft Property Line A. Other ft SKETCH:(Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands in proximity to holes) ruck P- r1{ d Q IX ,\9 . Parent material(geologic) �l1J�S� Depth to Bedrock Depth to Groundwater: Standing Water in Hole: N��`� Weeping from Pit Face Estimated Seasonal High Groundwater /n t DETERMINATION FOR SEASONAL HIGH WATER TABLE L Depth-Observed.tandiniz m Method Used: .. _.,._ in obs.hole: �' �k _ __m:__Depth to soil mottles:._ . -.-. in. P Depth to weeping from side of obs.hole: in. Groundwater Adjustment' I ft. Index Well# Reading Date: index Well level Adj.factor Adj.Groundwater Level 1 - _ PERCOLATION TEST bare = Time Observation _ T - V Hole# // _ Time at 9" V Depth of Perc (®D ,Time at 6" Start Pre-soak Time @ �'UU Time(9"-6") End Pre-soak Rate Min./Inch Site Suitability Assessment: Site Passed L Site Failed: Additional Testing Needed(YIN) Original: Public Health Division Observation Hole Data To Be Completed on Back- ---- .***If percolation test is to be conducted within 100' of wetland,you must fist notify the Barnstable Conservation Division at least one(1)week prior to beginning. Q:\SEPTIC\PERCFORM.DOC DEEP OBSERVATION HOLE LOG`---"L;,:';, Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency.%Gravel) .415 DEER OBSERVATION HOLE LOG , Hole# 1. .t Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency.%Gravel) /v yU DEEP OBSERVATION HOLE LOG ' Hole* Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency.%Gravel) DEEPi OBSERVATION HOLE LOG, Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency.%Gravel) Flood Insurance Rate Map: �r Above 500 year flood boundary No— Yes l\ Within 500 year boundary No— Yes Within 100 year flood boundary No— Yes Depth of Naturally Occurrine Pervious Material Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the area proposed for the soil absorption system? If not,what is the depth of naturally occurring pervious material? Certification I certify that on (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 Date ,,% 00 Q:ISEPTIC)PERCFORM.DOC SYSTEM PROFILE ALL ° BE NOTES MARKED MAGNETIC COMPARABLE MEANS FOR FUTURE LOCATION. 1.DATUM Is - (Not Td 6LHE) APPRox NGw a, ACCESS COVERS TO WITHIN a'OF FIN.GRADE NTHIN E OF FINISH PORTS TO MTN!Y Di FINISH lX1ADE 2.MUNICIPAL WATER IS EXISiMG x \ TOP FOUND. EL 50.75' - � 50.3 !.MINIMUM PIPE PITCH TO BE 1/H'PER FOOT. MINIuuM.73'OF COVER OVFp RECAST _ p $1.0 4.DESIGN LOADING FIXt All PROPOSED PRECAST Q m¢Ia OTFd UNI75 TO BE AASHO N-10 RAou, y 4'/SCHIO PVC PIPES LEVEL IST 2' 5.PIPE JOINTS TO BE MADE WATERTIGHT. LOON St' ig 4fi.0' TEE 1 SEPTICLTANK 0 TEE NTHCONSTRUCTION110 CUR MOOG DETAILS ( TO TITLE 5.) E IN ACCORDANCE COLUI✓< 8.25'• 45.89 45.62' Bay _. 7.THIS PLAN IS FOR PROPOSED WORK ONLY AND GAS BAFFLE O.B2' NOT TO BE USED FOR LOT LINE STAKING OR ANY 44.7' - OTHER PURPOSE�."4^M.LEVEL(ACME OR EQUAL); 45.83' .I• ` �4 WATERiAT 0'BO% I6 H-20 HIGH CAPACITY INFILTRATORS &PIPE FOR SEPTIC SYSTEM TO SGN.40-4'PVC. Pne /h4 ^::; Epp LEVELNESS EACH UNR:013'%1.83 X 1H'HIGH OVERALL DIMENSIONS TO OU151DE OF UNITS:25'X IIX S.COMPONENTS NOT TO BE BACKFILLED OR `•••\e'CRUS/1m STONE OR MECHANMIL B'MIN.SUMP (NO STONE PROPOSED CONCEALED WITHOUT INSPECTION BY BOARD OF COMPACTION.(15.22 [2]) I2'MIN'INI.OIM .) HEALTH AND PERMISSION OBTAINED FROM BOARD N (2-7;SLOPE) ( 1 % - - 5' OF HEALTH. - SLOPE) (�%SLOPE) - 10.CONTRACTOR(S(HALL BE RESPONSIBLE FOR FOUNDATION- 77' -SEPTIC TANK 6' D' BOX g• LEACHING AND LO RGROUND'@ LOCUS MAP _FACILITY _ - OVERHEAD UTILITIES PRIOR TO GOIAMENCEUENT OF - BOTTOM TH 2 EL 39.7' WORK. NOT TO SCALE 'THE INSTALLER SHALL VERIFY THE LOCATIONS OF ALL UTILITIES AND ALL BUILDING SEWER OUTLETS AND ELEVATIONS - It ANY uNsuirAE1E MATERIAL ENCOUNTERED ASSESSORS MAP 20 PARCEL 3a PRIOR TO INSTALLING ANY PORTION OF SEPTIC SYSTEM BENctIMAiiK:USE CONC.aoupD - SHALL BE REMOVED s'BENEATH u+D AROUND THE AT ELEVATION 50.8' PROPOSED LEACHING FACILITY. 12.EXISTING LEACHING FACILITY h WBO%SHALL BE PUMPED . - AND REMOVED - VARIANCES FOR SEPTIC SYSTEM REPAIRS WHICH MAY BE - 50x; 108 93• PROP.vFxr WITH CHARCOAL FILTER IMMEDIATELY GRANTED BY THE BOARD OF HEALTH AGENT OR I I STONE/GRAVEL wAY AND BUGSCREEN(ANAL PLACEMENT BY BY HEALTH INSPECTOR I -_ Y OLD NECK ROAD CONTRACTOR NTRACT RN`)TH HpMED1MIER SYSTEM DESIGN: PAPERWORK AND HEARING REDUCTION PROPOSALS APPROVED f s°,I GB FNp LOT AN EA: ------- GARBAGE DISPOSER IS NOT ALLOWED _ R' $036 IS,HBSi SF \ !^BROKEN CB/REBAR END.BY THE BOARD OF HEALTH REVISED DURING A PUBLIC I es � .r--.a�! - HEARING HELD ON AUG. 4, 2009 I 1' DESIGN FLOW: 3 BEDROOMS 0 110 GPD 330 GPD FAILED SYSTEMS ONLY: SOIL ABSORPTION SYSTEM USE A' 330 GPD DESIGN FLOW IN I I .so.sT - GRAVELLESS 3 BR LEACHING FACILITY INSTALLATIONS PROPOSED MORE THAN THREE FEET BELOW I •s0.+. - '� SEPTIC TANK: 330 GPD (2) =660 GRADE WITH PROPER VENTING(PIPED THE ATMOSPHERE) USE AND WITH LOADING, BUT IN NO CASE SHALL THE SAS -�� BE LOCATEDD MORE A T500 GAL. H-10 SEPTIC TANK MORE THAN SIX FEET BELOW GRADE. 2 rs°.bz I � � � 1 LEACHING: z I /, •s'z�� / 4.73 SF/LF x 6.25'LENGTH - 29-56 SF PER ( oo• HIGH CAPACITY INFILTRATOR UNIT d sIm - 330 GPD/0.74 GPD/SF= 445.9 SF LEACHING TEST HOLE LOGS l 5 E° a REO'D .. O E L� oa> .0 0 20 ENGINEER: ARNE H. OJALA, PE, SE D 1� rem - \� O' .50 4 - - 445.9 SF/29.56 SF/UNIT= 15.1 UNITS WITNESS: DON DESMARAIS, RS 1 9f �\ o a. THEREFORE,USE GRAVELLESS SYSTEM OF(16) DATE: 3/11/13- I to EXIST. Tools ' '.eT .5y H-20 HIGH CAPACITY UNITS IN FIELD I I: DI STONE \\ - CONFIGURATION OF 4 ROWS OF 4 UNITS - - PERC. RATE _ < 2 MIN/INCH 1 I^ :" STON ) EXIST. w.J " 01 }}`� su Da PAnO �N 16 UNITS X 29.5 SF= 472 SF>445.9 SF CLASS 13884 SOILS Pd - �6�e.TY-. aol.��- (ivl s cs .0.5. - 472 SF(0.74) = 349 GPD(OK) . 4 ELEV. ELEV. I X 1+S.a9 a 96 ona a B2 NOTE REMOVE EXIST.LEACH PIT, 50.7 •50. o T a'BOX h SEPTIC TANK. 4- .2 50.7• IK z so.o •' - A A I se a • - P APPROVED DATE- BOARD OF HEALTH MA' SL SL PROPOSED PATIO W PLACE OF 1 OYR 3/2 •^ EXIST.DECK 10YR 3/2 - e. �s 6+ 6" `L DECK 9 W-W-W PROVIDE C/O - I I E APPROX.WATEMUNE MS 4a..)E 1 TITLE 5 PLAN � ;I DWELLING. g^ 1OYR 5/2 TD- 1OYR 5/2 �+4 TO Mm. o.Ts •49,64 46 .----8 3/.0 50.75' e e +6.59��� 134 SCHOOL STREET 40` ) CIS END. _ x LS LS _ 1 OYR 5/6 10YR 5/6 DMH \�\ suI ro CiOTU)T ' 47.4' 40" 47.4' ;e.. \I�I I GAS ISO. 49 44 PREPARED FOR UUEc 1.d' �O G METER e.°�'-'f; DATE: MARCH 15,2013 aa2 _ k e ffI S cs r Off 5 . O.Af.IEL •.�� JAMIG_A y9 A. v�p foX 50R-1B2-9HB0 . _ QIA.A .. D dow nca e D�nLAIWO p.c m g 1 120" 2.5Y O/4 - SCH Eo, I'A6Y + FNB wC4"az 8.40 ° _ _ oo� F P �„� p . rape engineering hm 77TT�� ,°r' NO GROUNDWATER ENCOUNTERED Scale:1'=20' S�ITfeT 4 OgfgH 'a9`" " �; T z Civil engineers 49.23 3�i��1"S ° land surveyors 939 Alain Sheet (Rte 6A) l Z-26S DAT 0 f:: 2O J0 JG 50 FEEr E DANIEL A. OJALA,P.E., P.LS, Y,4RA40U7HP0Rr AfA 02675 12-265 RAvn10R.OWG Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not foryoluntary Assessments 134 School St. M/P Property Address Sabin Owner's Name '* MA 02635 6/1/12 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. A. General Information 1. Inspector: Frank-Nunes III Name of Inspector saa Company Name Box 841 Company Address East Falmouth MA 02536 City/Town State •Zip Code 508.272.6433 Telephone Number B. Certification' I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000).The system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority 6/1/12 Inspect . Sign tur Date The system inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP) within 30.days of completing this inspection. If the system is a shared system or has a design flow of 10,000 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 a at that time.This inspection does not address how the system will perform in the future under " the same or different conditions of use. 3 A 134 School St.doc•03108 Title 5 Official Inspection F rm:Subsurface Sewage Disposal System•Page 1 of 15. Commonwealth of Massachusetts w Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 134 School St. Property Address _ Sabin Owner's Name Barnstable MA 02635 6/1/12 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:'_ 01 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: ' Pumping suggested every 3 yrs to prolong the life of the system 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; n/a ' ❑ 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 134 School St.doc•03108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ,M 134 School St. Property Address Sabin Owner's Name Barnstable MA 02635 6/1/12 City/Town State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes (cont.): ❑ distribution box is leveled or replaced ND Explain: n/a The system required Ely q d 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: n/a 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 El 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: 134 School St.doc•03108 Title 5 official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 15 . r Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ,M 134 School St. yVe'< Property Address Sabin Owner's Name Barnstable MA 02635 6/1/12 City/Town State Zip Code Date of Inspection B. Certification (cont.) C) Further Evaluation is Required by the Board of.Health(cont.): ❑ 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 indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form: 3. Other{ ^ n/a D) System Failure Criteria Applicable to All Systems: You must indicate "Yes" or"No"to each of the following for all inspections: Yes No El ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool 0 ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded.or clogged SAS or cesspool El ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool 0 ® Liquid depth in cesspool is less than 6" below invert or available volume is less than 'h day flow ® Required pumping more than 4 times in the last year NOT due to c logged'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. 134 School St.doc•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 15 I Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments °M 134 School St. Property Address Sabin Owner's Name Barnstable MA 02635 6/1/12 City/Town State Zip Code Date of Inspection B. Certification (cont.) D) System Failure Criteria Applicable to All Systems (cont.): ' Yes No El ® 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 400 feet of a surface drinkingwater supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ El . the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area— IWPA) or a mapped Zone II of a public water supply well If you have answered 'yes"to any question in Section E the system is considered a.significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate ' regional office of the Department.. 134 School St.doc•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 5 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form _ - Subsurface Sewage Disposal System Form -Not for Voluntary Assessments G M 134 School St. Property Address Sabin Owner's Name Barnstable MA ' 02635 6/1/12 City/Town . State . Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate "yes" or"no" as to each of the following: Yes No ❑ ® Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ❑ ® Has the system received normal flows in the previous two week period? ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? - ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ 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)] a 134 School St.doc-03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 134 School St. Property Address Sabin Owner's Name .Barnstable MA 02635 6/1/12 City/Town State Zip Code Date of Inspection D. System Information Residential Flow Conditions: Number of bedrooms (design): Number of bedrooms (actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 116 gpd x#of bedrooms): 330 Number of current residents: 0 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes ® No Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available (last 2 years usage (gpd)): Sump pump? ❑ Yes ® No ' 4/2012 Last date of occupancy: Date Commercial/Industrial Flow Conditions: ' Type of Establishment: n/a Design flow(based on 310 CMR 15.203): Gapons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: Last date of occupancy/use: Date Other(describe): n/a 134 School St.doc•03%08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 15 P 9 P Y 9 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 134 School St. - Property Address Y, Sabin Owner's Name Barnstable MA 02635 6/1/12 City/Town State Zip Code Date of Inspection D. System Information (cont.) 3 General Information Pumping Records: Source of information: no history given Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank,distribution box, soil absorption system ❑ single cesspool . . s ❑ 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 VA system by system operator under contract ❑ Tight tank.Attach a copy of the DEP approval. ❑ Other(describe): -Approximate age of all components, date installed (if known) and source of information: 6/8/84 per as built , Were sewage odors detected when arriving at the site? ❑ Yes ® . No 134 School St.doc•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 8 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form _ Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 134 School St. Property Address Sabin Owner's Name Barnstable MA 02635 6/1/12 City/Town State Zip Code Date of Inspection . D. System Information (cont.) Building Sewer(locate on site plan): 12 Depth below grade: feet Material of construction: ❑ cast iron ® 40 PVC ❑ other(explain): >10' Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): Septic Tank(locate on site plan): • 6" - , - Depth below grade: m 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: 1000g 3" Sludge depth: Distance from top of sludge to bottom of outlet tee or baffle r >12 Scum thickness trace'"` >211 Distance from top of scum to top of outlet tee or baffle >2'� Distance from bottom of scum to bottom of outlet tee or baffle How were dimensions determined? measured 134 School St.doc•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 15 Commonwealth of Massachusetts ti. W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments G 13 ,M 4 School St. S'0y`0 Property Address Sabin Owner's Name Barnstable MA 02635 6/1/12 City/Town State Zip Code y Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Pumping suggested every 3 yrs to prolong the life of the system Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): n/a Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): n%a Tight or Holding Tank (tank must be pumped at time of inspection) (locate on site plan): Depth.below grade: Material of construction: ❑ concrete- ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): n/a 134 School St.doc•03108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 134 School St. Property Address Sabin Owner's Name Barnstable MA 02635 6/1/12 city/Town State. Zip Code Date of Inspection D. System Information (cont.) Tight or Holding Tank (cont.) 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.): n/a *Attach copy of current pumping contract (required). Is copy attached? ❑ Yes ❑ No Distribution Box (if present must be opened) (locate on site plan): Depth of liquid level above outlet invert Level w/the bottom of the pipe 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.): D-Box 2'6" below grade an in average condition for its age Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No 134 School St.doc•03108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 134 School St. Property Address Sabin Owner's Name Barnstable MA 02635 6/1/12 City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): n/a Soil Absorption System(SAS) (locate on site plan, excavation not required): If SAS not located, explain why: Type: ® leaching pits number: 1 ❑ leaching chambers number: ❑ 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.): . Leach pit 16" below grade, dry at this time, high stain_ line on sidewall to within 10" of inlet invert, no. , evidence of backup 134 School St.doc•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 15 i Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �^M 134 School St. Property Address Sabin Owner's Name Barnstable MA 02635 6/1/12 City/Town State Zip Code Date of Inspection D. System Information (cont.) 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 Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): r 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.): n/a 134 School StAoc•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 15 i ' Commonwealth of Massachusetts W Title 5. Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ,M 134 School St. Property Address Sabin Owner's Name Barnstable 'MA 02635 6/1/12 City/Town State , Zip Code Date of Inspection D. System Information.(cont.) Sketch Of Sewage Disposal System: Provide a sketch 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. . a DIL A 134 School St.doc•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 15 Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 134 School St. Property Address Sabin Owner's Name Barnstable MA 02635 611/12 City/Town State Zip Code Date.of Inspection D. System Information (cont.) Site Exam: ❑ Check Slope i ❑ Surface water - ❑ Check cellar ❑ Shallow wells Estimated depth to high ground water: >12 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: pate ❑ Observed site (abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health -explain: ❑ ` Checked with,local excavators, installers- (attach.documentation) ❑ Accessed USGS database- explain: You must describe how you;established,the high ground water elevation: Per elevation of home to nearby surface water 134 School St.doc•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 15- No.....,'i D . ... FFs..........$_15.00 THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH Town Barnstable ...-•.... .. ..... . .............--- OF........................................... Allp iration for Diipniiaal Workii Tnnitrurtinn runfit Application is hereby made for a Permit to Construct ( ) or Repair (x ) an Individual Sewage Disposal �. System at: .134.. �hQnl.st.xe t.,...C.atuit, MA......----•--•.............. .................................................................................................. Location-Address or Lot No. .James__0_Qban-------- --------------------------------------------------------- Ra..Il_.__#_1_.-.. .15A,...Rratbl�boxo,.._VT..... 01 Owner Address W A---&_-B.. --------------------------------------•------ 128--Bishops_.Terrace.,---Hyann!a,.-A.....0.26Q1...... Installer Address Type of Building Size Lot............................Sq. feet .� Dwelling—No. of Bedrooms........................�.................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons.........2................ Showers ( ) — Cafeteria ( ) dOther fixtures -------------------------------------------------------•••-•••••-•-•-----•---•------------•---••••••••-•••-•••-••••••-•-......-••••--•••.......•.-•-- W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity............gallons Length................ Width................ Diameter................ Depth............. x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No..................... Diameter..............-..... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ Test Pit No. 2................minutes per inch Depth of Test Pit..................... Depth to ground water........................ x 0 Description of Soil......Sand-....................................................................................................................................................... x U ............................................................•--...-•••----•-••••••••....-----.............••-••••••-•-......•-•-•-•----•......•-•-•-.....................................------------- w x ...... U Nature of Repairs or Alterations—Answer when applicable...installation of .. 1,000 gal . septic tank, distribution box and a 1,000 gallon pre-cast, stone paced leach pit (overflow}_____________ ----------------------------•----•-•••-•-••••-••-••- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITI 1Z 5 of the State Sanitary Code—The undersigned further agrees2nollolace the system in operation until a Certificate oIfollowing be issued by t e board h.R. ------a-•••.••._... •--••-••......•••. . ------3r-/04./8 _------ Application Approved By..... 5/84184 Date ApplicationDisapproved f o asons-------------------------------------------------------------•---------------------------------------------_........................ .... .. •-•---•------•--•••••••-•---•-••-•---••-••-•-••---•••---- .•--•-•-••-•-----••-••-••••-••------•---•••-•--•-•-••---•---- Permit No...8 Date 4---.-••••-••---••----•------•----•------------- Issued................... 04/84 Date ......•.. ........... k. Nock". ... ,F�s......... ._�.S,�.QQ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH , ---------Town.........OF.......Barnstable Appliration for Uhipaao al Workii Taamitrurtiaan tranit Application is hereby made for a Permit to Construct ( ) or Repair (x ) an Individual Sewage Disposal System ayt,,: 1 , y'' 1 A U4. '-s+,...�k••w� -4.9--.rsl :!rp-. .l+y............................. ......................... Location-Address or Lot No. aA!!.^s.ZOhe.'1-....................................................................... T� r�_,._:;�d�,..---._r ....�--"3- -�=arvt�.4�4Vi^.43 ..�1-.....���01 Owner ----a-�c p o-y ' Address A.. B__Ges pao1..:Sea-,r3-ca--•---------•---------------------•--------- 1�s3• Rim :� TrY� �ce .. ['f"r'vy 3 .?. ��...---- Installer Address U Type of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms.......................2......._..........Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons........2................. Showers ( ) — Cafeteria ( ) Other fixtures ---------------------------------------------------- W Design Flow.............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity............gallons Length................ Width................ Diameter---------------- Depth................ x Disposal Trench—No. .................... Width.................... Total Length.................... Total.leaching area....................sq. ft. Seepage Pit No_____________________ Diameter.............. fil Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ fT4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ Ix ••---••--•-•--••-••---------•-----------------•--••-•••-....-•-•--........_........-••-•.....------.._.......-•---------........-----------......................................................... O Description of Soil...... and._....._. k W ..................-•......•-•---•----•••--••---...•--•-••••--•-•-•-...••-•-------•••-------..............-----------••---•--••--••--•-•----•....-•--..._..-••-•-•••----•----......--•---......-----..... a W U Nature of Repairs or Alterations—Answer when applicable._in#allat j on of a •1,000 gal . se p,ie tank, -- ---- ------ -------------- dis}rlbution•box and a 1 000 gallon ..................ecast stone �aee leach ` zi, ove 'low ,� . / - - i Agreement: I The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance as bee -issued by th e board of'li�1'th. __.. r a� J Ygne c%l-� C ,..... ._. "`......._...:[ -j-[plat a/� `. /•---- Application Approved By... ------------------------------------------------•----••---••----........-••----_.. ............5/ /-{�- Date Application Disapproved f thl following reasons:................................................................................................................ .. .-------•----•-••--....------••---••--•------------•••---•••--•••---•-•-••••-5�0 /� ---•••.....................- __ PermitNo......................................................... Issued---------..--.........................................Date Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH mown.........OF.........FaMstable ................ .................................................................. Tntifiratr of. TaampliFatt ae THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired (x ) byA..&..B--.Cess_r�aral.. sx�rt^.e,.._.i?._ ..?3horS...`"exxa�a>;t urxir�•a,- 'A•-...f1? �2, Installer at.........1�E..:Sah>7oL.aSt.._s -tLotu{t_}...UA...... .-r-,nes_C.a1Mj has been installed in accordance with the provisions of TITLE 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No.84-2,� ! _ THE ISSUANCE OF THIS CERTIFICATE SHALT. NOT BE- CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE.....................................................i! Inspector........-i—•---------------.------•--••---------------••---.------- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH T own ........,0F..........Tlar1stable f ...................."......------•-•--•....................... No FEE... eQ .... Eliapaau al Marks Tnnitrnrtiaan famit A & P Cesspool Service Permissionis hereby granted.....................................................•••-•--••••••-•-•-••----••-•---••••-••-•••-•-••••..............••••••..........._------ to Co u (( ll o e a an divid 1 Sew e Dis osal S stem cho61 �" .Pou +, F`lA' - 'dames olbnp y atNo................................-•-----•-•--....••.............•-•--••--•-••--••....--•-------. Street 5/04/Ol, as shown on/theai tion for Disposal Works Construction Permit ..o"ry... -....��Dated------------ -------------•...---------•--. r_:......---••----•••------•••------•••-•---•......-••................•----Board of Health DATE-•-•-- --------------------------••••---•----••••••-- FORM 1255 A. -. SU KIN, INC., BOSTON SYSTEM PROFILE ALL S'fSTEM COMPONENTS SHALL BE NOTES MARKED WITH MAGNETIC TAPE OR (NOT TO SCALE) COMPARABLE MEANS FOR FUTURE LOCATION. 1. DATUM IS APPROX. NGVID o% 0 ACCESS COVERS TO WITHIN 6" OF FIN. GRADE PROVIDE INSPECTION PORTS TO 2, MUNICIPAL WATER IS EXISTING WITHIN 3" OF FINISH GRADE o a \ TOP FOUND. EL 50.75 3. MINIMUM PIPE PITCH TO BE 1/8" PER FOOT. 50.3' MINIMUM .75' OF COVER OVER PRECAST 2% SLOPE REQUIRED OVER SYSTEM 51.0' Q PRECAST H-io 4. DESIGN LOADING FOR ALL PROPOSED PRECAST UNITS TO BE AASHO H-]Q Schoo/ ` RISERS 2'0 4"0SCH40 PVC Sf. PIPES LEVEL 1ST 2' 5. PIPE JOINTS TO BE MADE WATERTIGHT. Locus " 46.0' 6. CONSTRUCTI co>tUlt ON DETAILS TO BE IN ACCORDANCE 10» 1500 GAL H-10 14» WITH 310 CMR 15.000 (TITLE 5.) 48.25'* 46.14' '' TEE SEPTIC TANK TEE 45.89' 45.62' Bay ° ° ° °'° 7. THIS PLAN IS FOR PROPOSED WORK ONLY AND °°°°°°° GAS BAFFLE" '°°�°0'°°0°° 0.92' NOT TO BE USED FOR LOT LINE STAKING OR ANY e�� She// 6iuff .` 4' LIQ. LEVEL (ACME OR EQUAL) 4.5.83 45.66 44.7' OTHER PURPOSE. •`' ` ` 16 H-20 HIGH CAPACITY INFILTRATORS 8. PIPE FOR SEPTIC SYSTEM TO SCH. 40-4" PVC. �- '• 00000000000°i°o°o°o°o°o°o�•i°o°o°o°o°o°oL WATERTEST D'BOX EACH UNIT: 6.25' X 2.83 X 16" HIGH fine i gE v °°°°°°°°°°°°°°°°°°°°°°°° °°°°°°°°°°°°° FOR LEVELNESS ^�^ ^!^ ^�^ OVERALL DIMENSIONS TO OUTSIDE OF UNITS: 25 X 11.3' 9. COMPONENTS NOT B A K ILL 6" MIN. SUMP (NO STONE PROPOSED) CONCEALED WITHOUT INSPECTION BY BOARD OF 6" CRUSHED STONE OR MECHANICAL 12" MIN INT. DIM HEALTH AND PERMISSION OBTAINED FROM BOARD c COMPACTION. (15.221 [21) 5' OF HEALTH. (2.7 % SLOPE) ( 1 % SLOPE) ( 1 % SLOPE) 10. CONTRACTOR SHALL BE RESPONSIBLE FOR CALLING DIGSAFE (1-888-344-7233) AND LOCUS MAP LEACHING VERIFYING THE LOCATION OF ALL UNDERGROUND & FOUNDATION 77' SEPTIC TANK 6' D' BOX 6' FACILITY OVERHEAD UTILITIES PRIOR TO COMMENCEMENT OF NOT TO SCALE BOTTOM TH 2 EL. 39.7' WORK. *THE INSTALLER SHALL VERIFY THE LOCATIONS OF ALL 11. ANY UNSUITABLE MATERIAL ENCOUNTERED ASSESSORS MAP 20 PARCEL 38 UTILITIES AND ALL BUILDING SEWER OUTLETS AND ELEVATIONS SHALL BE REMOVED 5' BENEATH AND AROUND THE PRIOR TO INSTALLING ANY PORTION OF SEPTIC SYSTEM BENCHMARK: USE CONC. BOUND PROPOSED LEACHING FACILITY. AT ELEVATION 50.9' 12. EXISTING LEACHING FACILITY & D'BOX SHALL BE PUMPED AND REMOVED VARIANCES FOR SEPTIC SYSTEM REPAIRS WHICH MAY BE 50..r§ iiiiiiiiiiiiiiiiiiiiiillillililllllllllllllIIIIIIIIIIIIIIIIIIIIIIilillilillillIIIIIIIIIIIIIIIIIIIIIIilililllllllllllllllllillillillillilllllllll111111111111lllllllo8.93I PROP. VENT WITH CHARCOAL FILTER SYSTEM DESIGN. AND BUGSCREEN (FINAL PLACEMENT BY IMMEDIATELY GRANTED BY THE BOARD OF HEALTH AGENT OR I I STONE/GRAVEL WA CONTRACTOR WITH HOMEOWNER BY HEALTH INSPECTOR 1 - - -x�o.5.7- �-5orso.__ OLD NECK ROAD CONSULTATION)I -`- - - GARBAGE DISPOSER IS NOT ALLOWED I CB FND LOT AREA: x�128 PAPERWORK AND HEARING REDUCTION PROPOSALS APPROVED i 50.p1 50.86 15,883t SF -�- - -, BROKEN CB/REBAR FND. BY THE BOARD OF HEALTH REVISED DURING A PUBLIC f 5 85 0 -x 51.49 DESIGN FLOW: 3 BEDROOMS 0 110 GPD = 330 GPD HEARING HELD ON AUG. 4, 2009 I h�� USE A 330 GPD DESIGN FLOW I 3' 3) FAILED SYSTEMS ONLY : SOIL ABSORPTION SYSTEM I I SEPTIC TANK: 330 GPD (2) = 660 INSTALLATIONS PROPOSED MORE THAN THREE FEET BELOW I x so.44 x 50.67 GRAVELLESS 3 BR LEACHING FACILITY GRADE WITH PROPER` VENTING (PIPED TO THE ATMOSPHERE) _ I USE A 1500 GAL. H-10 SEPTIC TANK AND WITH H-20 LOADING, BUT IN NO CASE SHALL THE SAS I N BE LOCATED MORE THAN SIX FEET BELOW GRADE. O j`50.b2 LEACHING: x 50,54 2 D I x 51.27 0.78 4.73 SF/LF x 6.25' LENGTH = 29.56 SF PER HIGH CAPACITY INFILTRATOR UNIT 0 <I x 71 �0.0' SHED 330 GPD/0.74 GPD/SF = 445.9 SF LEACHING 3 SHED x so. 0.78 REQ'D TESTHOLE LOGS /� I NI x50.37 0.43 0 x 50.29 0.21 O 1 I 1.,1 \ 50. P. 445.9 SF/29.56 SF/UNIT = 15.1 UNITS ENGINEER: ARNE H. OJALA, PE, SE 9, s \�50.40 0 so z1 4 96 THEREFORE, USE GRAVELLESS SYSTEM OF (16) WITNESS: DON DESMARAIS, RS I to 1. \\ 50.15 1x o 3 �0' CONFIGURATION H-20 HIGH OFTY UNITS IN 4 ROWS OF 4IELD UNITS i EXIST. '� 07 x 50. DATE: 3/11/13 I I STONE I 49. 7 X 04 DRIVE EXIST. < 2 MIN/INCH I I 0 16 UNITS x 29.5 SF = 472 SF > 445.9 SF PERC. RATE = 0 50.oa _. PATIo 13884 4 73 472 SF (0.74) = 349 GPD (OK) I CLASS SOILS P# 149 -x so.o7 ; LP 1 x 50 05 0.34 49.89 96 48 92 NOTE: REMOVE EXIST. LEACH PIT, ELEV. ELEV. I gag x 50. D BOX & SEPTIC TANK. 'V Ott p" 50.7' I I I 82 50.0 X 50.17 A A I l x a x .as MA I PROPOSED PATIO IN PLACE OF SL SL APPROVED DATE BOARD OF HEALTH 49' i EXIST. DECK 78 6" 6„10YR 3/2 10YR 3/2 14 9 DECK ' PROVIDE C/O w w W E E I i APPROX. WATERLINE 9 7 49.23 EXISTING TITLE 5 SITE PLAN _ MS MS I I DWELLING OF x 49.64- X TOP FNDN. 8*� 10YR 5/2 1 pt$ 10YR 5/2 148. 7 34.0' EL. = 50.75' 0.75 49.5956 134 SCHOOL STREET B B I I CB FND. A, rn COTUIT .83 O LS LS DMH I I 51.11 CO I OYR 5/6 1 OYR 5/6 I 1s ,, ,#�� ��� PREPARED FOR � „ , 48.4 � � ��� 40 47.4 40 47.4 4 GAS .01 ?2 Y's, E•r �NO�n I 0 ME R x 49.44 �N OF�\ ELEC � ?� �J 9� CAROL RAYNOR 47. METER pica ,ri tiG �O QANI[ L Ln�a �At1 �_A. m �o A C C S 8.02 ��' W I L 6, c!'dIL t �A� U4 n,j DATE: MARCH 15, 2013 PERC 48.OE48.556 14 75 C /+ 8.22 94 72 (5 ( off 508-362-4541 y CS CS w�,v1 ^ ��" `sG `•% -, f � ctiG� fax 508-362-9880 v� •� s, 2 �,�` OJAIAA fjo A s, downcape.com 3 " GI`�iL !�.0 OJALA �I S sit) 4�R��KEN CB FND No.465,G2 / e' down ca < <n hnoe/'�/! i/1c. No.�.D / „ 2.5Y 7/4 CHO fOGE of q ASK �x 49.71 \�'o e, c/Q� Aln �� 132" 2.5Y 7 4 39.7 120 40.7 Ot S P ® cv` - s cF z\e civil engineers �c 49.42 /STE i Scale: 1"= 20' TREE Rem °/ 8 land surveyors NO GROUNDWATER ENCOUNTERED T 49.23 3A �Y5 �• r y 939 Main Street ( R to 6A) /� 0 10 20 30 4o so FEET DATE DANIEL A. OJALA, P. P.L.S. YARMOUTHPORT MA 02675 # 12-265 12-265 RAYNOR.DWG f