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HomeMy WebLinkAbout0093 STUB TOE ROAD - Health 93 STUB TOE ROAD, COTUIT A = 040105 - - - I TOWN OF BARNSTABLE ` ' L: •�r° LOCATION SEWAGE # C:?' VILLAGE Cap -l- ASSESSOR'S MAP &LOT INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY 1660 4 LEACHING FACILITY: (type) (size) NO.OF BEDROOMS BUILDER OR OWNER �/ �a- C PERMIT DATE: I a� / �� COMPLIANCE DATE: Separation Distance Between the: 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) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by c.V`- a3 ' , �� �,�� �y r 33` yy� .. v' �, r � � -�-f_ yU."G°so, ION SEWAGE W A E PERMIT NO. LO�CAT C s VGlLACE I N S T A LLER'S NAME i ADDRESS e U I L D E R! OR OWNER L O 14 R IV LP-E f 9_Cr 4 t--r V 7-9U-f 7 DATE PERMIT 19SUEED DATE COMPLIANCE ISSUED � Q �3 G 9 TA Lof 3 7 STPLE7— No..... Fss.......`1$. ..... f THE COMMONWEALTH OF MASSACHUSETTS f BOAR,® OF HEALTH ............ .....To.W.n...........OF................ ?rn.s.table Applira#ion for Diopoii al Workii Tonstrnrtion umi# Application is hereby made for a Permit to Construct ( X) or Repair ( ) an Individual Sewage Disposal System at: ...Lot 37 Sty...Toe...Road..............................•--•--- ----Cotuit....Ma............ .._..----------------------------------------------- Location-• .... .. ........ -' -Address t No-or Lo ..:...................... '�/ _. 5.. 24 Great Pond Drive, _So. Yarmouth, Ma. ... -•-- .----- ....... O r ----------------•-Address ! .......................................... ......-•-•-- Installer Address UType of Building Size Lot..2 0-f 5 5 0---------Sq. feet Dwelling—No. of Bedrooms......#.._3.............................Expansion Attic ( ) Garbage Grinder t0) Other—Type of Building No. of persons............................ Showers a YP g --------------------•----... p ( ) — Cafeteria ( ) Otherfixtures .----••-----------------•------------------...--------.••----•-•-•-••-•--••---•-----------••--••-......••............-•-•••••.....----•-.............. W Design Flow............5 5..........................gallons per person per day. Total daily flow..............3 3 0 __._ gallons. WSeptic Tank—Liquid*capacity_Q Ogallons 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....Robert E. Raymond, P.E. Date...Nov. 10,...1982 ,`�a Test Pit No. 1......2.-------minutes per inch Depth of Test Pit ...12_�...... Depth to ground water.....none ........ f14 Test Pit No. 2................minutes per inch Depth of Test Pit..--................ Depth to ground water.---.................... a ----------------------------------------------------------- ------------------------------------------------------.................-------------.....------- 0 Description of Soil...0_"-4" loam! 4"-30...._.subsoil-, 30"-144" med. sand & gravel x W UNature of Repairs or Alterations—Answer when applicable............................................................................................... .............•------•--....--------------------•-----••---•----•-•-•••------•------------•--•--.....---•-•----••... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of IIT;..; 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has beennii ued..by e b and o health ---•------_----- ------/ Signe ........... ------ ---- - -.._.... Application Approved By............... �---------•---•--------------------- ..... Date Application Disapproved for the following reasons----------------•----......-•---------------------------•----------------------------•--------•••-••....--•---. ---------••...........................•------------------•-------•--------•------•------•--------•------.--••-•-------•--•-••••--------------------••-•---•--------------•----•-----•-------•-••----•--- Date PermitNo---..............••----......._..-----------•------..._.. Issued_....................................................... Date No......a3 Fss........ !� • THE COMMONWEALTH OF MASSACHUSETTS M BOARD OF HEALTH ......................Town--......o F................Barra table......... ..-........_................ Appliration for Disposal Work, Tonstrnrtion Vprrmit Application is hereby made for a Permit to Construct ( or Repair ( ) an Individual Sewage Disposal System at: Lot 37 -5tub Toe Road Cotuit......N?kt..•--••-•-•••--•••-•••••••--••-............................... Location-Address or Lot No. Theo Construction Co. 24 Great Pond Drives So. Yarmouth, Ma. ----------------------»... --- ......... .. -----•......••-••••... -•----.._._.......................•. .........- o Address a .1.A.......................................... ••.................---••......-•-----•-••....................•---•.....-••••••.........•••••••---- IIIStaller Address Type of Building Size Lot...20-,550- Sq. feet ►-, Dwelling—No. of Bedrooms....... __.3-------•---_...............Expansion Attic ( ) Garbage Grinder ( ) p Other—Type T e of Building� yp g ............................ No. of persons............................. Showers ( ) — Cafeteria ( ) Other fixtures W Design Flow.............5...................___....___.gallons per person per day. Total daily flow....._..._-._._33�....................gallons. WSeptic Tank—Liquid capacity.-lo�.�allons 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 b -- RObeYt E. Raymond,. Nov.�---•--••-----•-- • - none Test Pit No. 1................mmutes per inch Depth of Test Pit.................... Depth to ground water.................... .__. fir Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ rr� 11 -•-- rA A --- .• tr,r lr D Description of Soil.........._`....._10am, ..-. -3� subsoil;:..10 _�'14 mecl:"»sand""&"gravel""' .... . --• .. .._-. ..--• --•• . •• •••----•••••-•--•--•------•••........•••-----•••...-•----------------•-- V ..............................................-----....••-••••-----•----•--......-----•••----•-•-•--------•••-----•--•-----••-•---•--••••-•••-•-•-•••--••---.._......_..--••••-----.._.....••...__...•-- W ---•--------------------------------------------------•--•---------------------------------••-•--------------------------------------------••------•-------........•-•--------••-•--••--•••......---•-- U Nature 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 TIT" p 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. Signed...................................................................................... .........•-•-••...........».... Application Approved By............... t�.._. -`------------------------------------- �---.---------- Date ..............» Application Disapproved for the following reasons:................. ......................................•--.........-•-----•---......------....----•---...........-----••-••--••••-•--•-•----••••••••----------•••...--•------........................................... Date PermitNo..............................•-•••-•-••---••••••-...... Issued-....................................................... Date -THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH Town........oF......:..Barnstable ... .................................................... (9rrtifiratp of ToutpliFancr THIS IS TO CERTIFY hat the Individual Sewage Disposal System constructed ( ) or Repaired ( ) bY...............,..�.. ,�•el�. ..... ....................•--------.....-----•-----•---.......--.---------------...........----..................-----.....----.-------•--------•--- at.......... 3 � '' staller ------------------------------•----------------........................•... has been installed in accordance with the provisions of TITLE j of The State Sanitary Code as described in the application for Disposal Works Construction Permit No..__t �-'�_.�4Y............ dated--.............................................. THE ISSUANCE OF THIS CERTIFICATE SHALT. NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE...................................................... .... » J ` Inspector.................................................................................... F THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH Town Barnstable ....................®F....................... ...................... ................................................... No....�a ..- �. FEE....... p.......... Disposal Works Tonotrnr$ion rrmit Theo Constru �. �r Permission is hereby granted.. ..--------•- ----..-. :--r-�.--•-•----------------......- ✓ to Construct ( or R a r ( 1 au-Individual Sent e Ibis osal System Lot 7, S ub Tore RCL. , Cotui Pta. y atNo..• - .::.........•-•- Street as shown on the application for Disposal Works Construction Permit No..................... Dated.......................................... DATE. ---.....--•-•.............•-•-•----•-••----•--•-..........................••• Board of Health FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS I TROY WILLIAMS SEPTIC INSPECTIONS Certified by MA Department of Environmental Protection AN (508) 760-1819 40 Old Bass River Road South Dennis,MA 02660 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM Address of property 9 3 —Fo 7 Owner's name& Mailing address PO X lcl y Date of Inspection ld 1 a21 /9 S PART A ' y CHECKLIST Icy . Check if the following have been done: s � Pumping information was requested of the owner, occupant and Board of Health. V None of the system components have been pumped for at least two weeks and the system has been receiving normal flow rates during that period. Large volumes of water have not been introduced into the system recently or as part of this inspection. As built plans have been obtained and examined. Note if they are not available with N/A. The facility or dwelling was inspected for signs of sewage back-up. The site was inspected for signs of breakout. All system components, excluding the SAS, have been located on the site. 1/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 SAS on the site has been determined based on existing / information or approximated by non-intrusive methods. lJ The facility owner(and occupants, if different from owner)were provided with information on the proper maintenance of SSDS. Page 1 of 7 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B SYSTEM INFORMATION FLOW CONDITIONS If residential —o number of bedrooms a number of current residents Ho garbage grinder, yes or no M� laundry connected to system, yes or no t,tt, _seasonal use,yes or no If nonresidential, calculated flow: Water meter readings, if available: 9 41 1 q 6� 0 00 S,ft . e a. Last date of occupancy GENERAL INFORMATION Pumping records and source of information: 6 N b System pumped as part of inspection, yes or no If yes,volume pumped Reason for pumping: Type f system Septic tank/distribution box/soil absorption system Single cesspool Overflow cesspool Privy Shared system(yes or no) (If yes, attach previous inspection records, if any) Other(explain) Approximate age of all components. Date installed, if known. Source of information: -�� Jz, //c d z H Ny Sewage odors detected when arriving at the site, yes or no Page 2 of 7 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B SYSTEM INFORMATION continued SEPTIC TANK: V (locate on site plan) depth below grade: / material of construction: v1 concrete metal FRP other(explain) dimensions: ' X 'X r. 3 sludge depth _2Q ' distance from top of sludge to bottom of outlet tee or baffle 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 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,recommendations for repairs,etc.) CO k c rG 4—C_ 'S -Ar / /.G7,- 6/ o f-4-4e It A I i �. moo✓ !G: y o✓aev �/o SiS � S d� xe c. cAL d� l CA.. ri S� DISTRIBUTION BOX: t/ (locate on site plan) /"<- // . depth of liquid level above outlet invert Comments: (note if level and distribution is equal,evidence of solids carryover,evidence of leakage into or out of box, recommendation for repairs,etc) q &-- cCk S Jc--A I-G(J ti 4-� Ate. a i oi�.`,/ V L p614 Cam. CGS O7"' O J: CA r PUMP CHAMBER: N✓/,t (locate on site plan) pumps in working order, yes or no Comments: (note condition of pump chamber,condition of pumps and appurtenances, recommendations for maintenance or repairs,etc.) Page 3 of 7 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B SYSTEM INFORMATION continued t nued SOIL ABSORPTION SYSTEM(SAS): (locate on site plan,if poss.;excavation not required,but may be approximated by non-intrusive methods) If not determined to be present,explain: Type: leaching pits and number 1, leaching chambers and number leaching galleries and number leaching trenches, number, length leaching fields, number, dimensions overflow cesspool, number Comments: (note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,recommendations for maintenance or repairs,etc.) 0('a✓ l-C 1 '.� CESSPOOLS (locate on site plan) : /4/4-9 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 (cesspool must be pumped as part of inspection) Comments: (note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,recommendations for maintenance or repairs,etc.) PRIVY: (locate on site plan) materials of construction dimensions depth of solids Comments: (note condition of soil, signs of hydraulic failure,level of ponding, condition of vegetation,recommendations for maintenance or repairs,etc.) Page 4 of 7 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B SYSTEM INFORMATION continued SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent references landmarks or benchmarks locate all wells within 100' l�c I'l Oq a� 3� gyp' U-Qox DEPTH TO GROUNDWATER 5u 1.1o,j depth to groundwater — adjusted high groundwater level method of determination or approximation: � 4-1, 2 L6 Page 5 of 7 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C FAILURE CRITERIA Indicate yes, no or not determined(Y,N, or ND). Describe basis of determination in all instances. If"not determined", explain why not) -1 Backup of sewage into facility? _/,/ Discharge or ponding of effluent to the surface of the ground or surface waters? Al Static liquid level in the distribution box above outlet invert? e Liquid depth in cesspool<6"below invert or available volume< 1/2 day flow? _i Required pumping 4 times or more in the last year? Number of times pumped Septic tank is metal? cracked? structurally unsound? substantial infiltration? substantial exfiltration?tank failure imminent? Is any portion of the SAS, cesspool or privy: /U below the high groundwater elevation? (_within 50 feet of a surface water? within 100 feet of a surface water supply or tributary to a surface water supply? AJ within a Zone I of a public well? _within 50 feet of a bordering vegetated wetland or salt marsh(cesspools and privies only, not the SAS)? A//_within 50 feet of a private water supply well? _less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis? If the well has been analyzed to be acceptable, attach copy of well water analysis for coliform bacteria,volatile organic compounds, ammonia nitrogen and nitrate nitrogen. Page 6 of 7 r SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART D CERTIFICATION Name of Inspector: Troy Williams Company Name: TROY WILLIAMS SEPTIC INSPECTIONS Company Address: 40 Old Bass River Road, South Dennis, MA 02660 Certification Statement I certify that I have personally inspected the sewage disposal system at this address and that the information reported is true, accurate and complete as of the time of inspection. the inspection was performed and any recommendations regarding upgrade, maintenance and repair are consistent with my training and experience in the proper function and maintenance of on-site sewage disposal systems. Check one: have not found any information which indicates that the system fails to adequately protect public health or the environment as defined in 310 CMR 15.303. Any failure criteria not evaluated are as stated in the FAILURE CRITERIA section of this form. I have determined that the system fails to protect public health and the environment as defined in 310 CMR 15.303. The basis for this determination is provided in the FAILURE CRITERIA section of this form. Inspector's Signature Date / v2 �' A S Original to system owner Copies to : Buyer(if applicable) Approving authority PROPERTY ADDRESS: Qi3 S�6 mot �� A4 Page 7 of 7 C4 kJKl LEV -AL t E t.C-L` Nc,w &.j A4 4c tat ray.: SEA E s1EL. -� esASr D ca.-i ✓4 � i7C:1..1 A,.-L LiWF� A- F MrU,1Mv?�) b l�j..jiF;'-- T ��--U#4 L.C'S`- C3T'NE C'`*-l9 gill�-C-1 V l E r 3� __------- r+?S' - J L O( <._• hd __ .__ .. 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R, O ZL*O*dE P yT e►aJi �[�.JFGccen co.1c �� 0tST �c1y� t O W� O .1 cj E PT+C_ TA t.l 1C`\� ESE V c '-;„•- "e `-F r.}oT T o SLA t.E . , �- t N +aco GA4- �/� � 69seTK TAAI•�; 1y° � l f}' � Q t,1 h c.�T2e0 txo lb 'It14 `�t 1 - 1 �'-EnAl _ l, t ._ .,r i sT C'avTOc,6C tN 0 F N,q �� `�9c PtzOPOSI.� Dv�CLLIt�tC� LOCATIOt�.j ti ROE. � PROPOSE.0 SF-wAGm DISPOSAL- SY-5-r -fir( AI✓A4 tl cAe OF dE0 Qc�urvT j 3 :� Ex/77" `SAT �LFi� RAYMOND Z::' _ y-U A—r� 7 7 �• � b» `" �_ / �'EC 30/s/5 �F.t' t�E O QOO M _ "��J �'�QCW. df L�1-61/ U No. 19875 ` ti._t:' / �S / - � /`=c'' .'� _'--' Ate a )k'ZQ Llle6G PT- �o,�'�FCISTE�` - A 2�STD �--� GC7T'v �T . A 55 . ,fit ZA-Ae-.,11A1G A e. a V/ors "•r..ate i FSSlONAI E�Gj C J� (05 , .� f ..✓�"� J 1 .d.P Pt.l c.,wt,r- : E wtC,I CIEDQ Jn N.A\ n,i`✓10 r.i Fp,1, a 4s �.. Zd' G...exT no o CJ C 1v5 3,9 s 41P,6rz ROBERT IV Sol` o. YAa P�{ XJT -Ir A M c rAit s t o E. L. a�+C ' �10.2 t�)�4�(, �. 2,5) " RAYM 583 . � � 3 I�' C>s P O No.215ss ' � SCALE GATE: SHEET t�T'rowl A@I .A, r �g>�C I ,�� Sd ® l �ISTER`� �� ► O O 3 Is- IF / E �t=• ,ram �.t�1�L 1(l A.11 I C�t.i �Q� ' �o ` CJ�A( .42.E y P D .4iIRV DRAWN BY CHKO BY: APPO 8Y: PLAN NO.