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HomeMy WebLinkAbout339A SEA STREET - Health 339A Sea Street Hyarmis, MA A= 306-213 �i I No. Fee 00 L/THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS ZIpplitation for Zigoml *p$tem Con5truction Permit Application for a Permit to Construct( . )Repair(Upgrade( )Abandon( ) 0 Complete System O Individual Components Location Address or Lot No. • Own Name Address andTel.No. 339119 S«► 5% /�y9n�cS e ' om " ►fWw At6 Assessor's Map/Parcel .'�,^,6 3394 S Fr) Si .70 -213 9wa, Installer's Name,Address,and Tel.Nq. Designer's Name,Address and Tel.No. �r`De �10.C.4 i1•b I.r CAGic-Sc,ry tsk,%,Y lnc- 5T c, 14AA5 ,�Sb6 RT 66 pa �<,. Ya ssa 9 4 �t w �`�' 6-a8- 36a.-8132 Type of Building: Dwelling No.of Bedrooms Lot Size.SPv'"� sq.ft. Garbage Grinder(,XIS Other Type of Building No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow 33 O gallons per day. Calculated daily flow Jy1 gallons. Plan Date X/O U•a S j QOOS Number of sheets 1 Revision Date Title Size of Septic Tank /.SOO G9. Type of S.A.S. /tj/ # c,4m ,ry Tit;7,l T-rwt G&& Description of Soil: Nature of Repairs or Alterations(Answ r when applicable) r9 �� ek is►-i C 0 0 S � Soc>6 • SF-P c'r - its,-b t' T (r ov 6--lil 3'c tV, S.-to 'soC-MUvNa%,vt 't dvl� OM`t 2�� 6r- Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issue by this Boaro of Heat . Signed Date o0 Application Approved by IV Date o Application Disapproved for the following reasons Permit No. .2( 1�� Date Issued �� 6 No. o0o 00 Fee ` THE COMMONWEALTH OF MASSACHUS&TSV �., nt red in computer: tf ti* Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS 0(pprication for Diow5al *p!tem Construction Permit , y Application for a Permit to Construct( )Repair(V)Upgrade( )Abandon'(, ) 0 Complete System El Individual C ponents 1 t Location Addressor Lot No. ,/ ' C Ownerq�'Jf/N�ame^; dddress and Tel 39tq Seri 5 /,lyailr11,5 "VAt Nr�7l JU/A/p Assessor's Map/Parcel 33q,) 31,) �i;T a 3ci6 Z.213 Installer's Name,Address,and Tel.N4 ---r'` Designer's Name,Address and Tel.No. H-41S (jx,S\er. rT Sce' 36) -Q/.3a? Type bf Building: , Dwelling No.of Bedrooms 3 Lot Size 5,95-8 sq.ft. Garbage Grinder(x/q Other Type of Building No. of Persons Showers( t_) Cafeteria,( Other Fixtures Design Flow 33O gallons per day. Calculated daily flow gallons. Plan Date X/0 v -A 5,,-200.5 Number of sheets Revision Date Title _ Size of Septic Tank DSO©GAl Type of S.A.S. T',,\F,'I 7 r (02 Description of Soil; Nature of Repairs or Alterations Answer when applicable) ?t,t 9 h eytt l"X, ctr51p0 0 _ 3 IScy 6A. SCpl1cr� 6 14,ell- (r�prlc�j Sri L10t�\`, L�r1 r. c 2`Z be Date last inspected: _ ' g Agree meAt: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system ,Lin accordancewith the provisions of Title 5 of the Environmental Code and not to-place the system in operation until a Certifi- cate of Compliance has been issued by this Board of Health?j '([ ` 9 j Signed ,lr ���: ,.� � Date ��1�f'" � 6 p Application Approved by I/c� 0"✓, .0 jc:2 .62S Date I I o 6 P' Y' Application Disapproved for the following reasons --------------------------------------- i — THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed( )Repaired LUpgraded( ) Abandoned( )by -`>Nc L_, .,` C`,,\J1— V) at 3338 5 e A S - 4\, A o ii t S has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. Uri b� � dated �`l�0 6 Installer2r C hCCO- Designer EAC` c ,c ,LC, The issuance of this perms shall n/ot be construed as a guarantee that th system 1 n tion as designed. Date Z�1i�1 Inspector -- - ------------------------------------------ -- - No. D 00 b 00b Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS Mig;pogar *p5tem Cong;truction Permit Permission is hereby granted to Construct( )Repair( V)Upgrade( )Abandon( ) System located at`�33 9 A ,,.,�2 5 J and as described in the above Application for Disposal System Construction Permit. The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided: 7nst ction must be completed within three years'of the date of t�i ��eran9 �7 Approved by � _ v 6 COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS - DEPARTMENT OF ENVIRONMENTAL PROTECTION TITLE 5 OFFICIAL INSPECTION FORM -NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION 51 Property Address: 914 S mil} S%- 9 . 026,0/ Owner's Name: 1?QAJfa c—,O Pt/eDVoV�NG Owner's Address: Me- Date of Inspection: 3c c7-, Name of Inspector: (please print) VAN A. SPEAKMAN Company Name: 'A18tiUCtI01 Nlailing Address: 15 Speak Way NCrth Harwich, i 4A 02645 Telephone Number: 1-508-432-556F CERTIFICATION STATEMENT ' /G ,7 5{ I certilj,that I have personally inspected the sewage disposal system at this address and that the information report& `> bclo%r is true,accurate and complete as of the time of the inspection.The inspection was performed basedi on my uaining and experience in the proper function and maintenance of on site sewage disposal systems. I am aIDEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: Passes Conditionally Passes Needs Further Evaluation by the Local Approving Authority ` ' Fails c� Inspector's Signature: ��.,�, - � Date: 5eP�, 2 2 Oe� 7 A. I lie system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DFT)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 DF.P. 1'he original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving aulhority. NOICS and Comments ��**This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future under the same or different conditions of use. V �• 1 itic S Inspection Form 6/15/2000 page I OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Properly Address: _3 3 `� �} SEtq S% (Nner: >jE�cJ Dale of Inspection: 9 i9 08 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D V .N.N.mcm Passes: _-1--ilavc not found any information which indicates that any of the failure criteria described in 310 CMR I.� ;03 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. ( ommcnls: R. ti\stcm Conditionally [lasses: ptJ !� One or more system components as described in the"Conditional Pass" section need to be replaced or icpaircd. I he system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Ans\\er yes, no or not determined(Y,N,ND) in the _ for the following statements. If"not determined" please rxplain. I he septic tank is metal and over 20 years old* or the septic tank(whether metal or not) is structurally unsuund. exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the cxi.stiit .tank is replaced with a complying septic tank as approved by the Board of Health. metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance in(licaim_ that the tank is less than 20 years old is available. NI)explain: Observation of sewage backup or break out or high static water level in the distribution box due to broken or ol»uucted pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced NO explain: Elie system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will jms; inspection il'(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed NI)explain: 1'aee 3 of I I OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: -j 3 9 J4 SCE :!5% , O»ncr: Date of Inspection: 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 itthc system i, Iailin-to protect public health, safety or the environment. I. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(I)(b) that the systent is not functioning in a manner which will protect public health,safety and the environment: Cesspool or privy is within 50 feet of a surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2. System will fail unless the Board of Health (and Public Water Supplier, if any)determines that the Svstem 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 teet ota 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 I of a public water supply. The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance "This system passes if the well water analysis, performed at a DEP certified laboratory, for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other Failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: I;iuc 4 of I I OFFICIAL INSPECTION FORM NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: _�3��9 SEA S- Owner: Date of Inspection: _ /9 08 D. ti}stem Failure Criteria applicable to all systems: You must indicate'yes" or"no" to each of the following for all inspections: Yes No ��ackup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ,--Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ---,.Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or Cesspool /quid depth in cesspool is less than 6"below invert or available volume is less than ;/�day flow. , Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number ol'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 ofa surface water supply or tributary to a surface water supply. ,—Any portion ofa cesspool or privy is within a Zone I of a public well. ,Any portion of a cesspool or privy is within 50 feet of a private water supply well. rAnv portion ofa 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. IThis system passes if the well water analysis, performed at a DEP certified laboratory, for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this forma (IJ(3 (Ycs;No)The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Guard of I Icalth to determine what will be necessary to correct the failure. 1'. barge Systems: /J fo be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 1•:pd. You musl indicate either"yes"or"no" to each of the following: t I lie lollo�%ing criteria apply to large systems in addition to the criteria above) CS no the system is within 400 feet of a surface drinking water supply the system is within 200 feet of a tributary to a surface drinking water supply the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area— I WPA)or it mapped /.one 11 ofa public water supply well I f rou have answered "yes" to any question in Section E the system is considered a significant threat,or ans\. Bred ..\cs" in Section D above the large system has failed. The owner or operator of any large system considered a .ionilicant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 1.5.304. 'I he system owner should contact the appropriate regional office of the Department. P'IgcSol, II OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Propertl Address: A SEj9 S%r nnfs Owner: PA,16,j / Datc of Inspection: Check iI'the following have been done. You must indicate"yes"or"no"as to each of the following: Ycs No 1-�umpinyg information was provided by the owner, occupant, or Board of Health /W'ere any of the system components pumped out in the previous two weeks I las the system received normal flows in the previous two week period " _---,I-ilvc 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 N1A) 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 balllcs 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 n1 ten;lncc of subsurlace sewage disposal systems File sire and location of the Soil Absorption System (SAS)on the site has been determined based on. Yes no I:xisting 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 i,, unacceptable) (310 CMR 15.302(3)(b)j i n c nnnn 5 I'a_r 6 oI' I I OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Properly Address: CM SEjq S% y!I 0%�ner: C✓�lcJ/ Date of Inspection: FLOW CONDITIONS RESIDENTIAL Number ol'bedrooms(design): -;S_ Number of bedrooms(actual): Z- D[I SIGN Ilow based on 310 CMR 15.203 (for example: 110 gpd x H of bedrooms): 3 3 0 Number of-current residents: __Z Does residence have a garbage grinder(yes or no):_�O Is laundry on a separate sewage system(yes or no): A210[if yes separate inspection required] Laundry system inspected (yes or no): — Scasonnl use: (yes or no): &Uo \atcr muter readings, if available(last 2 years usage(gpd)): __ Sump pump(yes or no): Last date of occupancy: �rc'ESC % (1)N1ME'RCIAL/IN1)l1STRIAL I\pcol'cstablishment _AJ Design tlow (based on 310 CM 15.203): Boris ol'design flow(seats/persons/sgft,etc.): (.incase trap present(yes or no): Industrial waste holding tank present(yes or no): Non-sanitary waste discharged to the Title 5 system (yes or no): _ Watcr meter readings, if available: ---------- ------- Last date of'occupancy/use: _ -- — OTHFAZ (describe): GENERAL INFORMATION Pumping Records Sourcc of information: Was system pumped as part of the inspection(yes or no): AJO II'�cs. volume pumped: _—_____gallons-- How was quantity pumped determined? Reason for pumping: ..........._-----.-_.-- l'YPF: F SYSTEM 'optic tank, distribution box, soil absorption system Single cesspool Overllow 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) Fight tank Attach a copy of the DEP approval Other(describe): Approximate age ol'all components, date i stalled (if known)and source of information: ___................--- — ..._ L. 2 001 '� \k ere Sewage odors detected when arriving at the site(yes or no): AJ0 i:.r.. : i.,, .,•. :,.., r:,,.• Airv1)nnn 6 Pa_�c7ofII OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) ProperiN Address: A SEA 5 i, Date of Inspection: BUILDING SEWER (locate on site plan) Ihpth hehiw grade: I- Materials ol,construction: t iron 40 PVC other(explain): — I)istencc From private water supply well or suction line: ( ommenls(on condition of.joints, venting, evidence of leakage, etc.): / �� �oVQiTiOoJ SEP I TANK: �(,Ocatc on site plan) I)cpth helow grade: - Matcrial of constmdion: rncrete ___metal _fiberglass—__polyethylene other(explain) - -- Ifiank is metal list age: -._. Is age confirmed by a Certificate of Compliance (yes or no): (attach a atp� of cellilicale) Dimensions: 1500 6i4l Sludge depth: I)i>tancc from top of sludge to bottom of outlet tee or baffle: 3/ SCUM thickness:Distance from top of'scum to top of outlet tee or baffle: G= Distance from bottom of scum to bottom of outlet tee or baffle: I low were dimensions determined: PjEASv reECj Conunenis(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert,evidence of leakage, etc.): 67. GREASE TRAP:%1(locate on site plan) Depth below grade: Material ol•construction: concrete-_metal - _-fiberglass____polyethylene _—other I�: plain): I)intentions: Scum thickness: _-.--- Distance from top of'scum to top of outlet tee or baffle: Distance front bottom ol'scum to bottom of outlet tee or baffle: Date of Iasi pumping: Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid ICVCI:t as related to outlet invert, evidence of leakage, etc.): „i., c i,,, .,,. ,,, is .•.. n c»nnn 7 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Properf} Address: 5 6i9 .ST Dme of Inspection: _ / o 5 ICHT or HOLDING TANK:A) (tank must be pumped at time of inspection)(locate on site plan) l)cpth below grade: -- Matcrial 0I'constructi0n: concrete metal fiberglass ___polyethylene._._ other(explain): I)inicnsions: - ( apacity: - gallons t)csicn HOW gallons/day -- -- larm present (yes or no): __--_ Alarm level: Alarm in working order(yes or no): 1)atc ol,last pumping: _ -- t onuncnts(condition of alarm and float switches, etc.): I)ISTR113UTION BOX: present must be opened)(locate on site plan) Dcplh of liquid level above outlet invert: Q__ comments(note if box is level and distribution to outlets equal, any evidence of solids carryover,any evidence of' Icaka,c into or out of box, etc.): ..l�.D-x--�-S--jot) �ODQ Cyxi �i0� — CLEs)� fG�"fit-_ PUMP CHAMBER: A4 (locate on site plan) Pumps in working order(yes or no): _ Alai ms in working order(yes or no): Comments(note condition ol'pump chamber,condition of pumps and appurtenances,etc.): Page 9 of 11 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 3 3 9 i4 S&/,3 5 Owner: DHIc of Inspection: .S011, ABSORPTION SYSTEM (SAS): ovate on site plan,excavation not required) Il SAS nut located explain why: leaching pits, number:_ ./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, CP.SSPOOLS: d�(cesspool must be pumped as part of ins ection loca • P )( to on site plan) Number and configuration: DeWli top of'liquid to inlet invert: Depth of solids layer: Depth ol'scum layer: Dimensions of cesspool: t Mducrials of construction: Indication of groundwater inflow(yes or no): Comments(note condition of soil,signs of hydraulic failure, level of ponding, condition of vegetation,etc.): PRIVY: 4(locate on site plan) Materials of construction: Dimensions:Depth ol'solids__ Comments(note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation,etc.): i vagv'I U of I I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Prupero Address;� 33 4 j SfA S% =4a.1� �S Owner; /J 4 ow,of inspeetloa: 7 7i 9 o8 NKI'•rctl OF SEWAGE DISPOSAL SYSTEM 11nwi4e u skeleh of the sowaga disposal iyitsm Including ties to at least two permanent reference landmarks or Wnchmarks.LOM all wells within 100("t, l.o w what public water supply enters the building. . „ems P PO2' -.........-..._. 5 i 3 1 -- --- - ---- 1 IS 1 / 3 2d 5 38-emu 22 ' •�•; �., c In.wrwli.►�t:nnw I�/I�l'1MA 10 i I',rcc I I of 11 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) 1'roperty Address: 0h%net-: P wNi'-V� Dale of Inspection: S I'll: E.XAM s I„hr '`urlacr C heck cellar tih,rl1mv wcllS I:slinialed depth to ground water 5 feet Please indicate(check)all methods used to determine the high ground water elevation: ()brained from system design plans on record - If checked, date of design plan reviewed: 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: 0��4/�1P0V ' Town of Barnstable 0FtHE Tp �. Regulatory Services . *�P��� O* Thomas F. Geller,Director-SAANSTO O DM Ass. Public Health Division U Thomas McKean,Director 200 Main Street,Hyannis,NIA 02601 Office: 508-862-4644 Fax: 508-790-6304 Installer & I)esizner Certification Form Date: i Designer: S—ICP L!f-D PG Installer: �Bcwcre__ h0_e' [ 1if r Address: q 2 3 A&,v7E &A Address: 8 �(orva it 90o6- 006 On Sf�.Q � ry ec. ftQ:P l �s 2 was issued a permit to install.a (date' (installer) septic system at 337A �C-A- S d H t' t S based on a design drawn by (address) r ` dated a r 2 01 (designer) AZI certify that-the septic system referenced above was installed substantially according to the design, which may include minor approved changes sudh 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. � gS 6F (Instal er s Signature) t i y� (Designer's Signature) (Affix esi er's Stamp Here) PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL *BOT%f THIS FORM' AND AS- BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUIRLIC HEALTH DIVISION. THANK YOU. Q:Health/Septic/Designer Certification Form IlIVERS M&S T lE W, IV Z 6 N S GRAt I97 87 0,F P NSPEC TI ON EASTbIVE' . ..... ACCESS''co LE VA T] 0 Ns D E TER,,] -WERA L "N HIN VER­`T_i" E Puff NVER T ATB L I NO 0.54 DtA FIRST 2 DES I GN:FLOW MNIMUM. :AT �4 -�PER -CON$3 BED 00 Pi'ANJS"FOR, TH ESIGN,'AND:,,., lAr LEVEL -*4XIMUW COVER ''BE SEP T I C TANK 5 R MS, 10 G.'P.D.J , Dblj$LE�NASHED�STONE THE,,-,$EW4 GE,,��D ISPO$A L S'YS rEM Oft`Y�INVER r,OUT 97.2 330 O0M,EO&ALS-4" kiM 64 INVERT IN DW A OX.' I A AT I 9!k 7 `:N0 BAGE GRIINDER�`� V tt 'OUT:"D S T tBOX.1 INVER tfLtT APOR BARRIER TOR BOTOM:OF`�,LEACH CHAMB TANK,R UIA SEPTIC 'ED-40.MILL,-i OLY CHAMB 1 N L EA CH, ER P INVERT�'� 96.63�' 01 G.,P D.ADJUS TED�- ROUND WA TER N;,'A-6 Hl&f`CAPACI TY-JNFIL V,00 .3 A L-BOX W�J*,± �STONE AROUND' 60 L..3 PROVIDED;,4500--GAL,,-�MIN,' MAI A SEP T I C,�,S YS TEM,4H,SEPTIC CO NF 0 R M TO M4$S ,D E P T I 1 L E �A NO CA WA TER,-00 6A O"d IOBSERVED GROUND N tSEPTI C TAN BOA"A­9M OF­TEST,H0 E,*I.-, P ON K CRU§)4tD 'S TONI; Qf( BOTT RO;�0 H M, R&OUI RED ACTD,��AS SO//-- BSORPTION-ZoT It REGULATI DESIGN�PERCiRA INIIN H S Y$TEM 5 EfTle,�-,,-T XTURAL-,CLA,5, I-w6i'T "Y HICUL-A�-TO FAS� SUB-)IECT�ARE "E O SCALE�P60F ;EFFLUENT LOADING'RATE ' 6#0.74 IilIN�DEP 30 'GPD O.L 74�:GPDISF 46 . REOUIRED I MAN J tH-4kALL­Bt�WABLE"OF W'F IW4"::�STANDING,,H-'20 LOADS i _HiG '�CAPA I iDED"- 6,' C TY INFILTRATOR-�'thAMBERS WIJ �$ 'SHALL, BE'$ ulb i4u` K r ON AibU 341 GPD 40 5 'O'.�74 A OVED PPA T4�,,PRECAST,CONCRETE ND,W a T A TERT,T 'AND �D�-, X',5HALL-�.t6,,5:0 L ,,TE S T "BE 04 TER FO tEVEL`�,WHEK RE�ES TED -TO"CHECK TE 1 N40'CA T S R VED ERCOLATION::�plyu I CA::lES T TER IP 0 I 15� 7. E, RE:,CONSTR CTION AE'8 CAL TP rP #2 D`�THE:l OCAL XA TER,OEP7 IOR, LO(RIZON LEXTURE,. EXTURE COLOR COLOR RIZON 99.'8 0 � LOA Y�IOYR ,,CAPACI TY,,:,,, OAMY1 : ; M STONE AROUW TIC 5 YS TEA(:�10 TA 'SHAL-LTRATOR CHAMBERS , �, ?I I I I I Z,_ . —11, ,, - 8 ' "','SEP 0 S SAND �4 DESIGN F) 7TO COM,AND 412 -WIj I I 0 : AYS,�PRIOR SRUCTI;...........2 CHLVULI NUI'OF,"�*iTHE, ,,ALLOW�FOR:, OYR IOYR LOAAI� CON$ RUCTION'INSPECrIONS"SAND 5 SAND 16 28* :97.5 34* . ...... 0 9 EX I S r NG CtSSP b "ED DR Y,AW,MED I UR SAND IOYR IME I14 SAND !OYR ,� OOL_' AND GRA VEL `518 HA(;At*I L AND GRA VEL- 51B��BA(-CORNER 46F STEP WOOL EL 00-GALLON 40 MILL POL Y VAPOR sipTiC TANK Tpo I BARRIER t48*— 56"—NO WATER NO WA TER 88.5 132" '88.8,,��41v 84 DA TE SEP TEA48ER 3. 2005 I "eD*00Af TEST B Y: ,S 7PHEN' HAA S WITNESSED BY: DONALD DESMARAIS,PERC PATE: 2 MINIINCH �v r__ Rl A NCES R'AREA-5858± 'S.F. EQUIR SECOND FLOOR PLAN........... -MINIMUM SETi, ACX ,DISTANCES TI TLE 5, MAXIMUM FEASIBLE� COMPLIANCE ECTION 15'.21t.,tt)6,5 6ftm'ZL�00 6 S.REOUIRED ED:Iv 80 'BETWEEN THE VID 0) -S YS A 4 _ VARIANCE" 1$,'REOUESTED, -�THIS IS ,FAILED TEM� `AN ,BARRIER HAS �BEEN;,PROPOSED FORtM1 TIGATION cx clo u 4t' T (�:7 15 "N5 ,TZE 3 a-9 A s��A S T R E'jE,T "A :',-P,A R G RA RIVS, 77A 'S A ItI EGEND 0 M CON&(ET'E'BOUND tIWA TER LINE S�CA L �,2 0 0 �VE R 0 0 tLO�us �ST 1HYDRANT.-,05 iL' E 6 GAS A�G URVEY :N F OHW 0 VER HEAD' RES 2 � ,, Rou A 0,2 5 7 5.""1UNDEROROUND ELECTRIC L INE',UNDtR OUND � PHONE L" E TEL E 5 8�A-3 9 iLIONT POST GR 3 _3,�UNDERGROUND -C48LEVISION CTV— L INt�HYANNIS HARBOR -SPOT ELEVA T 0+40.4 ICONTOUR EXI STING UR PROPOSED CONTO 'NO 0 CF 0 L olclus_, Jos �05 JEE iIili