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HomeMy WebLinkAbout0036 SCHOONER DRIVE - Health 36 SCHOONER DR140OTUITi j A ASSESSORS MAP N0= .._.:0-..6' ' No. _Cy PARCEL N0: e9Ae '0 0 Z FEE c9 o THE COMMONWEALTH OF MASSACHUSETTS 'P 3 To 2� $A_R UST➢ RT F MASSACHUSEITS (XXyy trativu for Pispoeal *gstera Cganstrurttun ]Jrrrait Application is hereby made for a Permit to Construct �X.X) or Repair( ) an On-site Sewage Disposal System at: Location Address or Lot No. Owner's Name,Address and Tel.No. 4 7 7—0 0 2 3 # 36 SCHOONER DRIVE THE IRENE TRUST LOT 6 BOX 599 MASHPEE, MA Installer's Name,Address,and Tel.No. 771 -4128 Designer's Name,Address and Tel.No. 5 4 0—3 6 9 9 HICKEY CONSTRUCTION FERREIRA ASSOCIATES YARMOUTH, MA. 131 SPRING BARS ROAD, FALMOUTH Type of Building: Dwelling `No;'-of Bedrooms 3 Garbage Grinder(10) Other Type of Building No. per Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow 330 gallons per day. Calculated daily flow 355 gallons: Plan Date J UNE 13, 1996 Number of sheets 1 Revision Date none Title SEWAGE DISPOSAL SYSTEM PLAN— LOT 6 SCHOONER DRIVE Description of Soil (#1 ) 0 "-101', AP, sandy loam 10yr 3/3; 10 "-28 ",b, sandy loam 10yr 5/6; 28 "-120 ", C, sand, 2. 5y 6/4; (#2) 0 "-10 ",AP, sandy loam 10yr 313, 10 "-28 ", B, sandy loam 10yr 516, 28 "-132" C, sand 2. 5y 614. no groundwater Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the aforedescribed on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. Signed Date Application Approved by - - Date Application Disapproved for the following reasons Permit No. 216 e� Date Issued _ _ .• 1 x.�-."._, FEE ©C�•rl THE COMMONWEALTH OF MASSACHUSETTS W 19 7 a 3 MASSACHUSETTS - r s _ cNppltration for Vispusal SVeitem C onotiurttun jJrrmit Application is;hereby ma a for erm ti o'Constructf(XJoi Reparr`( )an On=sae Sewage Disposal System at: Locafion�Address or-Lot«NoF/ ' F f �� 4V Owner's Name,AddrM,and Tel.No. 4 7 7—0 0 2 3 }v� 36 SCHOONER DRIVEe THE IRENE TRUST LOT 6 I,, BOX 599 MASHPEE, MA f s� Installer's Name,Address,and Te1.No. ,. 8 \, Designer's Name,Address and Tel.No. 5 4 0—3 6 9 9 , HICKEY CONSTRUC,.TI'ON FERREIRA ASSOCIATES YARMOUTH;;,•. A ' 131 SPRING BARS ROAD, FALMOUTH Type of Building F 1 Dwetlri `N`o: f`Bedro ms_ 3. ba Gar e Grinder; Y g g �- Other Type of Building No. per Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow 330 gallons per day. Calculated daily flow 355 gallons. Plan Date JUNE 13, 1996 Number of sheets I Revision Date none Title SEWAGE DISPOSAL SYSTEM PLAN— LOT 6 SCHOONER DRIVE , Description of Soil "" 0"-10",AP, sandy loam 10yr 3/3 t 10 "-28",b, sandy loam 10yr 516; 28 "-1201', C,sand, 2. 5y 6/4; (#!) 0"-10",AP,sandy loam 10yr 3/3, 10"-2811, B, sandy loam 10yr 516, 28 "-132" C, sand 2. 5y 6/4. no groundwater Nature of Repairs or Alterations(Answer when applicable) �'�f Ay,! / � '1r f:�Jl 'LrK.�r!i /'yC.'.✓ �. .r!'*.</'f I.Y 1 Date last inspected: 7-- Agreement: Z;: The undersigned agrees to ensure heiconstruc ion and maintenance of the aforedescribed on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. Signed ��. - Date t Application Approved by _ '��%• Date Application Disapproved.for the following reasons Permit No. � - -7 Date Issued THE COMMONWEALTH OF MASSACHUSETTS MASSACHUSETTS (9.ertif rate of Tlumpliante THIS IS TO CERTIFY/thaj;he On-!0'1g Sewage Disposal System installed or re aired/placed ) on b" I v ��ailI�" at - a been constructed in accordance with the proviso s of Title 5 and tide for Dispos System Construction Permit No. dated Use of this system is conditioned on compliance with the provisions set forth below:.' J. The issuance of this certificate shall not be construed as a guarantee that the system will function as designed. This Certificate expires•ori ..• ` ' ~ DATE ` % Inspector14 THE COMMONWEALTH OF MASSACHUSETTS No. �S' fP_,� -� , MASSACHUSETTS FEE ,Disposal '�*6gstem (gonstrurtion Il rmtt Permission is hereby granted to7�- to construct`(,'or repair( )an On-site Sewage System {o'c_ated�4 at Z, e:, T 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. All construction must be completed within three years of the date below. DATE /,-- h ` 9 Approved by FORM 1255 Rev.3/95 A.M.SULKIN CO.-BOSTON,MA 1 COMMONWEALTH OF MASSACHUSETI'S EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS John Grad DEPARTMENT OF ENVIRONMENTAL PROTECTION ' DEP Title V Septic Inspector ONE WINTER STREET BOSTON MA 02108(617)292-3500 < - P.O.Box 2119 TeaTicket,Ma. (508)564-6813 TRUDY COXE f Secretary t} ARGEO PAUL CELLUCCI - DAVID B.STRUHS 3. Governor i. Commissioner SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM ti A 1.�� PART A CERTIFICATION Property Address: 36 SCHOONER DR COTUIT MAP 009 PAR 012 L 2 Name of Owner JAMES MASEREJIAN - ,LQ Address of Owner: SAME Date of Inspection: 10/29/99WNg6 19()9 Name of Inspector:(Please Print)JOHN GRACE NN37 1 am a DEP approved system inspector pursuant to Section 15.340 of Tide 5(310 CMR 15.000) ,� -QFPIi? Company Name: n/a Mailing Address: n/a ttAlry{, a Telephone Number: n/a CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of inspection.The inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems.The system: X Passes The inpectlon is based on criteria defined In Title V Conditionally Passes code 310 CMR 15.303.My findings are of how the system is _ Needs Further Evalu Ion By the Local Approving Authority performing at the time of the Inspection.My Inspection does , _ Fails not Imply any warranty or guarantee of the longgevity of the septic system and any of Its components useful life. Inspector's Signature: Date:11/1199 The System Inspector shal submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within thirty(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 Department of Environmental Protection.The original should be sent to the system owner and copies sent to the buyer,if applicable,and the approving authority. 'NOTES AND COMMENTS THE SYSTEM PASSES TITLE V INSPECTION.RECOMMEND PUMPING THE SYSTEM EVERY TWO YEARS. revised 9/2198 - - Page 1 of 11 Z- SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) r Property Address: 36 SCHOONER DR.COTUIT MAP 009 PAR 012 L 2 Owner: JAMES MASEREJIAN Date of Inspection:10129199 INSPECTION SUMMARY: Check A,`B, C, Or D: Y A. SYSTEM PASSES: I have not found an Information which indicates that an of the failure conditions/described in 310 CMR 15.303 exist.Any failure criteria not evaluated Y Y are Indicated below. rt COMMENTS: System passes Title V inspection B. SYSTEM CONDITIONALLY PASSES: Na 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. Indicate yes,no,or not determined(Y,N,or ND).Describe basis of determination in all',instances.If"not determined",explain why not. Na The septic tank is metal,unless the owner or operator has provided the system inspector with a copy of a Certificate of Compliance(attached)indicating that the tank was installed within twenty(20)years prior to the date of the inspection;or the septic tank,whether or not metal,is cracked,structurally unsound,shows substantial infiltration or exriltration,or tank failure is Imminent.The system will pass inspection if the existing septic tank Is replaced with a complying septic tank as approved by the Board of Health: m& Sewage backup or breakout or high static water level observed In the distribution box is due to broken or obstructed pipe(s) or due to a broken,settled or uneven distribution box.The system will pass Inspection if(with approval of the Board of Health). _ broken pipe(s)are replaced obstruction is removed a' distribution box is levelled or replaced n1a The system required pumping more than four times a year due to broken or obstructed pipe(s).The system will pass Inspection if(with approval of the Board of Health): broken pipe(s)are replaced. obstruction is removed r a Y -. N . revised 9098 Page 2 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 36 SCHOONER DR.COTUIT MAP 009 PAR 012 L 2 { Owner: JAMES MASEREJIAN Date of Inspection:10/29/99 } 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 the public health,safety and the environment. 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES IN ACCORDANCE WITH 310 CMR 16.303(1)(b)THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT ThE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: _ Cesspool or privy is within 50 feet of surface water . r . _ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh. t) 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 AND SAFETY AND THE ENVIRONMENT: _ The system has aseptic 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 soil absorption system and the SEAS is within a Zone I of a public water supply well. ` _ The system has a septic tank and soil absorption system and the SAS Is within 50 feet of a private water supply well, _ The system has a septic tank and soil absorption system and the SAS is less than 100 feet but 50 feet or more from a private water supply well,unless a well water analysis for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and d nitrate nitrogen is equal to or less than 5 ppm,Method used to determine distance nta_(approximation not valid). 3) OTHER F, < ` Na " t revised 9/2198 Page 3 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM.. , PART A SCERTIFICATION(continued) Property Address: 36 SCHOONER DR.COTUIT.MAP 009 PAR 012 L 2 Owner: JAMES MASEREJIAN Date of Inspection:10/29/99 r :: D. SYSTEM FAILS: You must indicate either"Yes"or"No"to each of the following. 1 have determined that one or more of the following failure conditions exist as'described in 310 CMR 15.303.The basis for this determination is Identified below.The Board of Health should be contacted to determine.what"will be necessary to correct the failure. Yes No X Backup of sewage into facility or system component due to an overloaded or clogged SAS or cesspool.' X Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool. X Static liquid level In the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool. - X Liquid depth in cesspool is less than 6"below invert or available volume is less than 1/2 day flow, X Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). E ' Number of times pumped n1a. iJ „ X Any portion of the Soil Absorption System,cesspool or privy is below the.high groundwater elevation. X Any portion of a cesspool or privy Is within 100 feet of a surface water supply or tributary to a surface water supply. X Any portion of a cesspool or privy is within a Zone I of a public well. X Any portion of a cesspool or privy is within 50 feet of a private water supply well, X Any portion of a cesspool or privy is less-than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis.If the well has been analyzed to be acceptable,attach copy of well water analysis for coliform bacteria,volatile organic ompounds, ammonia nitrogen and nitrate nitrogen. X The liquid level in the SAS is over the invert pipe,is in Hydraulic Failure. ,. E. LARGE SYSTEM FAILS 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: . r The system serves a facility with a design flow of 10,000 gpd or greater(Large System)and the system is a significant threat to public health and safety and the environment because one or more of the following conditions exist: Yes No }_ X the system is within 400 feet of a surface drinking water supply X the system is within 200,feet of a tributary to a surface drinking water supply X. the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area IWPA)or'a mapped Zone II of a public water supply well) . The owner or operator of any such system shall upgrade the system in accordance with,310 CMR 15.30412).Please consult the local regional office'of the Department for further information. revised 9/2198 Page 4 of 11 L F SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 36 SCHOONER DR.COTUIT MAP 009 PAR 012 L 2 Owner: JAMES MASEREJIAN Date of Inspection:10/29199 a 3 T Check if the following have been done:You must Indicate either"Yes"or"No"as to each of the following: Yes No X Pumping information was provided by the owner,occupant,or Board of Health. X None of the system components have been pumped for at least two weeks and-the system has been receiving normal flow rates during that period.Large volumes of water have not been introduced into the system recently or as part of this inspection` X As built plans have been obtained and examined.Note if they are not available with N/A, X The facility or dwelling was Inspected for signs of sewage back-up X The system does not receive non-sanitary or industrial waste flow. X The site was Inspected for signs of breakout,,, X All system components,excluding the Soil Absorption System,have been located on the site. X The septic tank manholes were uncovered,opened,and the interior of the septic tank was inspected for condition of baffles ! or tees,material of construction,dimensions,depth of liquid,depth of sludge,depth of scum.The size and location of the Soil Absorption System on the site has been determined based on: X Existing information,For example,Plan at B4O,H, X Determined in the field(if any of the failure criteria related to Part C is at Issue,approximation of distance is unacceptable) 11 5.302(3)(b)) X The facility owner(and occupants,if different from owner)Were provided with information on the proper maintenance.of SubSurface Disposal Systems. revised 9/2198 Page 5 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM. PART C SYSTEM INFORMATION. Property Address: 36 SCHOONER DR.COTUIT MAP 009 PAR 012 L 2 ; Owner: JAMES MASEREJIAN Date of Inspection:10/29199 . FLOW CONDITIONS RESIDENTIA ; Design flow:-=g.p.d./bedrooni - Number of bedrooms(design): 3 Number of bedrooms(actual):.a Total DESIGN flow: 3,3Q Number of current residents:3 Garbage grinder(yes or no):NQ Laundry(separate system)(yes or no): N If yes,separate inspection required Laundry system inspected(yes or no):M Seasonal use(yes or no):JM Water meter readings,'if available(last two year's usage(gpd): nLa Sump Pump(yes or no): NO Last date of occupancy: nLa x COMMERCIALIINDUSTRIAL Y y s Type of establishment: nG3 , . r.s Design flow: n&gpd(Based on 15.203) Basis of design flow: n1a Grease trap present:(yes or no):JLQ Industrial Waste Holding Tank present:(yes or no): NQ Non-sanitary waste discharged to the Title 5 system:(yes or no):1LQ 4 Water meter readings.if available:n(a Last date of occupancy: nLa OTHER: (Describe) , Wit 4 Last date of occupancy: n(a GENERAL INFORMATION PUMPING RECORDS and source of information: nLd - System pumped as part of inspection:(yes or no):�4 If yes,volume pumped nla gallons Reason for pumping: n/a TYPE OF SYSTEM X Septic tank/distribution box/soil absorption system Single cesspool r ., Overflow cesspool ' Privy Shared system(yes or no)(if yes.attach previous inspection records,if any) I/A Technology etc.-Attach copy of up to date operation and maintenance contract Tight Tank Copy of DEP Approval Other: nla APPROXIMATE AGE of all components,date installed(if known)and source of Information:`^ 1999 PERMIT#96-276 Sewage odors detected when arriving at the site:-(yes or no) NO { " revised 9/2/98 - d Page 6 of 11 } SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C ' SYSTEM INFORMATION(continued) J` Property Address: 36 SCHOONER DR.COTUIT MAP 009 PAR 012 L 2 'S" Owner: JAMES MASEREJIAN Date of Inspection:10/29/99 BUILDING SEWER: (Locate on site plan) ; Depth below grade: 22" Material of construction:_ cast iron X 40 PVC _ other(explain) a Distance from private water supply well or suction line: TOWN Diameter: nLa 4 Comments: (condition of joints,venting,evidence of leakage,etc.) - nLd E; SEPTIC TANK: X h s (locate on site plan) w Depth below grade: 1S_ #' Material of construction:X concrete_ metal Fiberglass _ Polyethylene _ other(explain) �. nla If tank Is metal,list age Is age confirmed by Certificate of Compliance(Yes/No): NQ Wa , Dimensions: L 10'6"H 6'7"W 6'6" Sludge depth: L" Distance from top of sludge to bottom of outlet tee or baffle: 1E. Scum thickness: Y Distance from top of scum to top of outlet tee or baffle: 1 Distance from bottom of scum to bottom of outlet tee or baffle: 17" " How dimensions were determined: MEASURED Comments: (recommendation for pumping,condition of inlet and outlet tees or baffles,depth of liquid,level in relation to,outlet invert,structural integrity,evidence of leakage, etc.) SEPTIC TANK AND ALL COMPONENTS ARE STRUCTURALLY SOUND RECOMMEND PUMPING EVERY TWO YEARS GREASE TRAP: (locate on site plan) Depth below grade: a. Material of construction:_concrete_ metal_ Fiberglass Polyethylene_other(explain) �t y Dimensions: nLa Scum thickness: nLa " Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle,nLA Date of last pumping: n/a , z Comments: (recommendation for pumping,condition of inlet and outlet tees or baffles,depth of liquid level In relation to outlet invert,structural integrity,evidence of leakage, etc.) revised 9./2198 Page 7 of 11 i � a SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C a; SYSTEM INFORMATION(continued) Property Address: 36 SCHOONER DR.COTUIT MAP 009 PAR 012 L 2 Owner: JAMES MASEREJIAN Date of Inspection:10/29/99 TIGHT OR HOLDING TANK: NO (Tank must be pumped prior to,or at time of;inspection) ` (locate on site plan) Depth below grade: Na Material of construction:_ concrete_ metal_ Fiberglass _Polyethylene_ other(explain) j Dimensions: n1a Y r x, b Capacity: n& gallons Design flow: nla gallons/day Alarm present: NQ Alarm level:jilL Alarm in working order:Yes_Nc NQ f Date of previous pumping: nLa01 Comments: (condition of inlet tee,condition of alarm and float switches etc) { n/a DISTRIBUTION BOX: X (locate on site plan) j } Depth of liquid level above outlet invert:.LEVEL WITH BOTTOM OF PIPE Comments: (note if level and distribution is equal,evidence of solids carryover,evidence of leakage into or out of box,etc.) DISTRIBUTION BOX IS STRUCTURALLY SOUND *" PUMP CHAMBER: NQ ; (locate on site plan) F " i 3 f _ Pumps in working order:(Yes or No): NO 2 Alarms in working order(Yes or No): NO Comments: d (note condition of pump chamber,condition of pumps and appurtenances.etc.) ` s revised 9/2/98 Page 8 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C ' SYSTEM INFORMATION(continued)- Property Address: 36 SCHOONER DR.COTUIT MAP 009 PAR 012 L•2 " Owner: JAMES MASEREJIAN Date of Inspection:10/29199 SOIL ABSORPTION SYSTEM(SAS): (locate on site plan,if possible;excavation not required,location may be approximated by non-intrusive methods) If not located,explain: e ; Na , Type: leaching pits,number: nLa leaching chambers,number: -n& _ s leaching galleries,number: .,nla leaching trenches,number,length: 2TRENCHES-4'X2130' leaching fields,number,dimensions: n!a : overflow cesspool,number: nLa Alternative system: nla Name of Technology: # Comments: _ (note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation,etc.) THE SAS IS FUNCTIONING PROPERLY_, CESSPOOLS: n (locate on site plan) Number and configuration: nh 4 " Depth-top of liquid to inlet invert: n s la ., a Depth of solids layer: nLa, Depth of scum layer. n1a Dimensions of cesspool: nLa ^_ Materials of construction: nhi Indication of groundwater: m& inflow(cesspool must be pumped as part of inspection)nLa ry' Comments: signs of hydraulic failure level of ponding,condition of vegetation,etc. (note condition of soil, g yd po g, g ), ' ' - PRIVY: _ h (locate on site plan) it Materials of construction:nla Dimensions:nLn r Depth of solids: nla Comments: (note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.) ;. Dla revised 9/2198 Page 9 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM' PART C SYSTEM INFORMATION(continued) f r Property Address: 36 SCHOONER DR.COTUIT MAP 009 PAR 012 L 2 Owner: JAMES MASEREJIAN Date of Inspection:10/29/99 r, - o SKETCH OF SEWAGE DISPOSAL SYSTEM: 4' , Include ties to at least two permanent reference landmarks or benchmarks locate all wells within 100'(Locate where public water supply comes into house) Ail- ... 4• a • •Y - revised 9/2/98 Y Page 10 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 36 SCHOONER DR.COTUIT MAP 009 PAR 012 L 2 Owner: JAMES MASEREJIAN r m. Date of Inspection:10/29/99 z' . NRCS Report name: Y �< Soil Type: nla Typical depth to groundwater: n/a `h t USGS Date website visited: nta Observation Wells checked: NQ ' Groundwater depth:Shallow Moderate Deep g�, : '•' ' SITE EXAM _ Slope _ Surface water _ Check Cellar " Shallow wells ' Estimated Depth to Groundwater 12 Feet Please Indicate all the methods used to determine High Groundwater Elevation: , a _ Obtained from Design Plans on record , t _ Observed Site(Abutting property,observation hole,basement sump etc.) f ' _ Determined from local conditions - _ Checked with local Board of health ' - Checked FEMA Maps _ Checked pumping records i _ Checked local excavators,Installers . X Used USGS Data Describe how you established the High Groundwater.Elevation.(Must be completed) USGS MAPS AND CHARTS-12+FEET ,. revised 9/2/98 Page 11 of 11 . No.... 13.':7/4 FRis.............................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ...................OF........................................................................................... AVVfirafion for M-4potial Workii Tonotrurtion Prrmit Application is hereby made for a Permit to Construct or Repair an Individual Sewage Disposal System at: il 4� r ... ....�Iy...........-d..................................................................... 4( ............. N Location-Add or Lot No ........ CCL..C_._�hx . ......41. ... Owner Building. . ....... .............. Installer Address C11 Type f Size Lot............................Sq. feet U Dwelling—No. of Bedrooms............................................Expansion Attic Garbage Grinder ( 04 Other—Type of Building ............................ No. of persons........................---. Showers Cafeteria ( 04 Other,fixtures tures ............................................................I.......................................................................................... Design Flow.................:..........................gallons per person per day. Total daily flow.....2311:9.........................gallons. 1:4 Septic Tank—Liquid capacity./oVA.gallons Length................ Width..--..........-- Diameter.............._. Depth................ Disposal Trench—No. .................... Width.................... Total Length--.................. Total leaching area....................sq. f t. > Seepage Pit No--------------------- Diameter.............--..... Depth below inlet.................... Total leachino,area...................sq. f t. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. I................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----.................... 04 .....................................................................................................................................................I......... 0 Description of Soil........................................................................................................................................................................ x U ......................................................................................................................................................................................................... ---------------I........................................................................................................................................................................................ U Nature of Repairs or Alterations—Answer when applicable................................ .............................................................. ...............I....................................................................................................................................................................................... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TL 114 LE 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compli nce has been issued by the board of health. 0.....'4.."Si ed... . ........ ... .......... . ...... . ApplicationApproved B ----- ---------- ........................ . ................................................ ...i. ---- Date for a I ........................... Application DisapproOed for the following reasons:................................................................................... I ......................................................................................................................................................................................................... Date PermitNo....................................................... IssuedL........................................................ Daft ---------------­­-­------------------------------- ------ --------- AV No;.......:.... Fmc.............................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ................. -_ ...................OF..............................-........................................................... t Appliratiun for Mipuiittl Workii Tonarnrtiun amit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: C ,I dam.------ .......: Location-Add Z.......; es ...• or Lot No. ..... ...........G. . .--.. _.. _. ...�:.... /.......................... Owner Addre a _&_-f?._...�.�.-----•........................ ......... Installer Address d Type Building' � Size Lot............................S q. feet U Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) pal Other—Type of Building ............................ No, of persons............................ Showers ( ) — Cafeteria ( ) Q' Other fixtures .--•-•-••---•-• •-••---•-•----- .... W Design Flow............................................gallons per person per day. Total daily flow....,� .........................gallons. -W Septic 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 ( ) i Dosiri,�/faik'( ) a Percolation Test Results e(liful ormed,,,by: ''.. Date.. 4 Test Pit No. 1 ...�.... es per inch Depth of Test Pit.................... Depth to ground water........................ L� Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ ----•---------------------------------------•--------...............------.............•----•-----•.......................................................... 0 Description of Soil........................................................................................................................................................................ x U --------------------------------------------------- -•-------------------------------- ------------ ..----------------- ----------------------- •--------------------.-..-..--------•-••------ 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 TITLE 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Com 'ance has been issued by the board of heat h L 7"" Application Approved �Y-. ......................................../ tTl..?'._ ..... Date Application Disapproved for the following reasons-------------------------------------------------------------------------------•--•---•-..................... --•--•----••--••-•---•--••---••-•-•--•••......_.....•--------------•-----.......----•-......_.....................••••-••------------•--•-----•-••----•••••....---------- •--••----------•---•--... Date PermitNo......................................................... Issued.............................. Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........................................OF........................I.,.......................................................... Trrtifiratr of (t amplittnrr T T CER FY, �atd* id 1 Sewage Disposal System constructedol( ) or Repairedby -f.�ta4 -----------------------------------------------------------... ------- Installer at....................................................................................7 been installed in accordance with the provisions of TITL- /5 of The State Sanitary de .s described in the application for Disposal Works Construction Permit3_.".. (�.. ................... da y.� -- .--__ ...................... THE ISSU NCE OF THIS CERTIFICATE SHALL NOT BE CONST AS A G ARANTEE THAT THE SYSTEM W FU _'TION SATISFACTORY. DATE..... .:.1�---------------•----•---•-•----•--••---...-•---- Inspector......--• -•-•••------•-•-----••--.............•••---•........................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH �,, .................................... OF.............................................._...................................... Io........ .....�.... 1W...................... Diu.... rl o �onotrnrtion amit Permissio s hereby grante ----...-•-•--•-- to Constr, or Repair ( ) a dividual Se ge Disposal System atNo.•---•---. ..----........-••--•..... .............................................:........•----------------•••-•--•------••-......._........-•••--••--•--•-••••....-••-••-•---•... Street as shown /thepli ' n for Disposal Works Construction Permit No...... .:.. .....': Dated...........___...._.............._........ ......--•........ r!' ----------------------------------------------------•-..__....Board of Health DATE FORM 1255 A. M. SULKIN, INC., BOSTON L O C A T 10N r��' S E W A G E PERMIT N0. VILLAGE INSTALLER'S -- NAME i ADDRESS VJ;<,, A 'D ail -t-a e U I L 0 E R OR OWNER Jd AAl Z%z Sh�� GATE PERMIT- J_SwSVED DATE COMPLIANCE ISSUED i— Il .,p3 i TO`JVN OF BARNSTABLE LOCATION CGS C / SEWAGE# 99 VII,LAGE CA�U 1 ASSESSOR'S MAP&LOP 41V 00 P_ INSTALLER'S NAME&PHONE NO. OkCJKL-� CQnJsT_ -77/ �eI Z9 SEPTIC TANK CAPACITY LEACHING FACILrrY: (type) _T A NO.OF BEDROOMS OR OWNER 301A2-t Copmop RMITDATE: 2.e. `1 COMPLIANCE DATE:-4P Separation Distance Between;hc: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) V " Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leachin acility) Feet Furnished by ` � � /oa G r• 6 a 02� ' AREA PL AN SCALE: 1 ,.=50 • S YS TEM PROFIL E FINISH GRADE NO T TO SCAL E FINISH GRADE FINISH GRADE OVER TANK SOIL EVAL UA TIONS TOP FND OVER TRENCHES S 7. O EDWARD BARR Y TOWN OF BARNS TABL E SCH 40 PVC .•.o � ° t .► '�' .5'V 4. OR ..i .... :. CAST IRON TEES 5 Y '' ��' S4 44 �.� ° a0 °o 0 00 o aO0°° ' 000 oa Goo o0 0, o TEST f�l!'LE 1 TEST HOLE 2 6.•; f � o o�:r=: BSM'T FL t °o0o a:o n°°4 o ao CAP ENDS p• .-_ �.�--- - -------- ----- 0. so, ..r ° % >i:J GAL. t �', EQUAL IZERS '�4 Z O °p°o o° °`°° c o 0 00 °o.n o, ° 0 0° o AT ELEV. _ r'.':; �;. REINFORCED • °°°o a;a �o o ° °°° °o a o o°'o DIST.BOX SANDY LOAM SANDY LOAM °. �• o�� .eo° o o AP — AP .. •.•... CONCRETE >.. .\ GAS 10YR 3/3 10YR 3/3 i. o•o ° . , �. BAFFLE o o°!Q o a o o•o TO BE INSTALLED ON A p o o °. o 0 oo• o oov :o° 10• SEPTIC TANK LEVEL STABLE BASE �°°°° °0°0 ° ° 0 0v ° ;, -- --- - - — - -- -— 5 i 'v C TRENCH L ENGTH SANDY LOAM SAND B LOAM TO BE INSTALLED DNA 1 0YR 5/6 10YR 5/6 LEVEL STABLE BASE 2B• -- - '— - — �' NO TE: DO NO T RUN HEA V Y EQUIPMEN T 0 VER S YS TEM 4 'MrN.HEIGHT ABOVE OBSERVED GROUND WA TER SAND SAND N/F 2.5Y 6/4 2.5Y 6/4 L EA CHING TRENCH SEC TION 120• NOT TO SCALE SOIL AND PERCOLA TION DATA __- - sss° FOR FINISH GRADE APPLICATIAN AV. P-0703 PERC'D A r 72' SEE SYSTEM PROFILE -...--. --- --- NO GROUNOMA TER PERC. RA TE 5 MIN/IN 12"MIN. TAKEN BY RICMM FERREIRA WITNESSED BY EDWARD BARRY DA TE4'"DIA.PIPE T MIN.2" - 118'1/2" EST PTV ELEV 1 57.3 WASHED STONE TEST PIT ELEV. 57.0 --NATURAL SOIL-- 2'MAx. EFFECTIVE 'o DEPTH N 3/4"-1 1/2" 12-0` NOTES.' WA SHED S TONE // I i MIN. - 3X 1 . EL EVA TIONS BASED ON USGS K/F EXCA VA TED SIDEWALLEFFEC T�' E WIDTH PC M 1 ROBERT M. JENSEN 4'-0' 2. FL 000 ZONE" C OR DEPTH 3. TOWN WA TER ON SITE N/F EFFEC TI VE WID TH NUMBER OF TRENCHES 4. GROUNDWATER EL EVA TION 22. 0 HOLY GHOST SOCIETY K r. N '57'57APE \ 337. is 26'L rMc r s 256 S. F. SIDEWALL AREA . 74 GAL S/SF 189 GALS. DESIGN DA TA f•J00 iAG PB'LLi'1�1, 1'MI�2'OEEP -- ----- �.rC 7AM j (9EE~.ri v.. NO.OF BEDROOMS 3 69•��— _ 224 S. F. BOTTOM AREA • 74 GALS/SF 166 GALS. DISPOSAL AV o-�air z` i9 EST. TOTAL DAIL Y EFFLUENT _"O GALS. A uj 480 S. F. TOTAL AREA 355 GALS. SEPTIC TANK 1500 GAL. LOT 6 W v t+j b LOT 7 43, 561 S. F. _ . __ GENERA L NO TES N- �o PROP=OWO 01 PAD. o NOTE.' LOT 5 t'eE s"" - 45'- - y 1 . ALL SYSTEM COMPONENTS SHALL BE INSTALLED IN 137 EXCAVATE TO Et.EV » FOR LOWER AS REQUIRED ACCORDANCE WITH TITLE 5 OF THE STATE SANITARY CODE S I TO REMOVE ALL LOAM AND CLAY CONTAINING DATED MARCH 1995 AND ANY LOCAL RULES APPLICABLE 45 MATERIAL BENEATH THE LEACHING AREA.REPLACE 2. ANY CHANGE IN THIS PL AN MUS T BE APPRO VED DRAINAGE EASE.aENl I = EXCA VA TED MA TERIAL WITH CLEAN, CLA Y FREE GRA VEL S 86°45'00'W J00.0� - - - -j - ` t - �- `4 MECHANICALLY COMPACTED IN PLACE BY THE BOARD OF HEALTH 1. 150. 0 - __ _ 3. WHEN CONSTRUCTION IS COMPLETED, PRIOR TO BA CKFIL L ING s es°45'oo`W _ z NO TIFY BOARD OF HEA L TH FOR INSPEC TION -- - 4. FND. ELEV. MUST BE CHECKED WHEN COMPLETED SCHOONER (w•oo MIDE) DRI VE LEGEND 5. THESE E'E V. MUST NOT BE CHANGED WI THOU T ---- - - --- ---- ---- THE BOARD OF HEAL TH APPROVAL EXIST.GROUND ELEV. 6. BOA RD OF HEA L TH INSPEC TION REG 'D WHEN EXCA VA TED -•- --' `'� - --- FINISH GROUND EL EV.UNDERL INEO s s o PIPE INVERT ELEV. 'n SEWA GE DISPOSA L S YS TEM PL AN S TEST PI T L OCA TION PREPARED FOR LINE BEARING DISTANCE E-il SEPTIC TANK ° 1309 THE IRENE TRUS T J N 03°15'00-W 5. 00 �❑ DISTRIBUTION BOX O T 6 SCHOONER DRIVE 4 rC•I.OR SCH 40 PVC BA RNS TA BL E (CO TUI T) - MA SS. 4'BIT.FIBER PIPE—TIGHT JOINTS •►+•••��4 QSN.JF M,�. fII - PROPERTY L INES ,!�s`Chaxlee D. a DESIGNED : SAP OA TE : . 1$ l99�6 m JLI' MIN.COOS DISTANCE ` ` S�HR w w FERREIRA ASSOCIA TES 9 12 6 36 � No.T468 DRAWN : hF SCALE.'AS SHOWN 131 SPRING BARS ROAD FALMOUTH - MASS. MAP SEC IPCL LOT HSE _ ��,� o CHECKED : CDS DRAWING NO. 061396 Is ys �-.E�-r ,o,p o..C--« J- .vo EG S'L?S "' " F/N/S.�/ �RF70E o✓ER OAS?- BOX .__ .J .min//.SN GRq•0E OVE.E� .. .® S'E/oTIC 77.4/V.r �/ D ------ _ - — L E•QCf,I/NG 0017— 777 /2 M/N COVER 1-c:'1PEC.9S 7 COA/C 0A, 36 RE/Nf'ORCE!> —� dR/CA yam' MO.PTi4ip TO CONCIPE TE CO✓ER >r /,Z BEG OW Ci RAA0E wT /00 oU TL E T P/.oE LEVEL _ - } M/N_ <, , „p . c b . r v �S - /� I✓.V S.vEU oo! 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