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HomeMy WebLinkAbout0135 CARRIAGE ROAD - Health 135 Carriage Road Osterville A A = 071 011009 o I� Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 135 Carriage Rd. Property Address James Mingle Owner Owner's Name information is required for every Osterville MA 02655 03/18/11 page. Cityrrown State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When A. General Information filling out forms on the computer, / � use only the tab 1. Inspector: �( key to move your cursor-do not Linda J. Pinto use the return Name of Inspector key. C Engineering Company Name P.O. Box 2030 .., ---4 �I Company Address � ._... Teaticket MA 02536 Clty/rown State Zip Code 508-299-3250 4432 V-0 Telephone Number License Number I. B. Certification i r-- rill 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 C) Inspector's Signature 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 at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. l� I t5ins-09108 Title 5 Official Inspection Form:Subsurface Sewage Dis it./pig. of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 135 Carriage Rd Property Address James Mingle Owner Owner's Name information is required for every Osterville MA 02655 03/18/11 page. Cityrrown 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: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist Any failure criteria not evaluated are indicated below. Comments: It was recommended that the septic tank be pumped and cleaned, and plans are underway at this time to comply with this issue 13) 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. Check the box for°yes°,°no"or"not determined"(Y, N, ND)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. El Y ❑ N ❑ ND(Explain below): t5ins,W= Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 2 of 17 L Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 135 Carriage Rd. -- Property Address James Mingle Owner Owner's Name information is Osterville MA 02655 03/18/11 required for every page cityrrown State Zip Code Date of Inspection B. Certification (conk.) B) System Conditionally Passes(cont.): ❑ 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 ❑ Y ❑ N ❑ ND(Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s).The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t51ns•0908 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System'Page 3 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 135 Carriage Rd. - Property Address James Mingle - Owner Owner's Name information is required for every Osterville MA 02655 03/18/11 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) 2. System will fall unless the Board of Health(and Public Water Supplier,if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: *"This system passes if the well water analysis, performed at a DEP certified laboratory,for coiiform 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. D) System Failure Criteria Applicable to All Systems: You must indicate"Yes"or"too"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool El ® 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 ❑ ® Liquid depth in cesspool is less than 6"below invert or available volume is less than%day flow We 5 ofriim 11MIM11M rGM sowrrawe sew Dmp-W Sqstm-Page 4 of 17 t5ins•09MB Commonwealth of Massachusetts Title 5 Official Inspection Form OWN Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 135 Carriage Rd - Property Address James Mingle Owner Owner's Name information is Osterville MA 02655 03/18/11 required for every page. Cityrrown State Zip Code Date of inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than times in the last year NOT due to clogged 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. ❑ ® 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 drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area—IWPA)or a mapped Zone it 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 Title 5 official inspection Form.Subsurface sewage Disposal System•Page 5 of 17 t5ins,09108 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 135 Carriage Rd. -- Property Address James Mingle Owner Owner's Name information is Osterville MA 02655 03/18/11 required for every page. Cityfrown 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)] D. System information Residential Flow.Conditions: Number of bedrooms(design): 6 Number of bedrooms(actual): 6 DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms). 660 rroe 5 Official irspection Forth.subsurface Sewage Disposal System•Page 6 of 17. t5irs•09108 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 135 Carriage Rd Property Address James Mingle Owner owners flame inforrnation is Osterville MA 02655 03/18/11 page. required for every Cityrrown State Zip Code Date of Inspection Pa D. System Information Description: 4 Number of current residents: 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)): Detail: 2010: 100,000 gallons 2009. 101,000 gallons Sump pump? ❑ Yes ® No Current Last date of occupancy: Date Commercial/industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day ON) 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: Title 5,offidal Inspection Forth:Subsurface Sewage Disposal System-Page 7 of 17 •t5ins•09l08 Commonwealth of Massachusetts ' Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 135 Carriage Rd Property Address James Mingle -- Owner Owners Name information is OstefVille MA 02555 03/18/41 required for every page. Cityrrown State Zip Code Date of Inspection D. System Information (cunt.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: Was system pumped as part of the inspection? ❑ Yes 0 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 ❑ 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 I/A system by system operator under contract ❑ Tight tank.Attach a copy of the DEP approval. ❑ Other(describe): TNe 5 Official lnspecfion Forth:Subsurface Sewage Disposal System•Page 8 of 17 t5ins•09108 I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 135 Carriage Rd. Property Address James Mingle Owner Owner's Name information is required for every Osterville MA 02655 03/18/11 page. Cityrrown State Zip Code Date of Inspection D. System Information (cost.) Approximate age of all components, date installed(if known)and source of information: Approximately 10 years per Permit#2000-705 Were sewage odors detected when arriving at the site? ElYes ® No Building Sewer(locate on site plan): Depth below grade: feet Material of construction: ❑cast iron ®40 PVC ❑other(explain): 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): 10 Depth below grade: 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: Sludge depth: Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 9 of 17 t5ins-09M8 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 135 Carriage Rd Property Address James Mingle Owner Owner's Flame information is Osterville MA 02655 03/18/11 required for every page. Cityrrown State Zip Code Date of Inspection D. System Information (cunt.) Septic Tank(cunt.) Distance from top of sludge to bottom of outlet tee or baffle 20" 14" Scum thickness 4,. Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle 6 How were dimensions determined? Tape Measure Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outset invert, evidence of leakage,etc.): The structural integrity of the septic tank appears sound. The liquid level is at the outlet invert and there is no sign of backup or leakage. The septic tank needs to be pumped and cleaned and plans are underway at this time to comply with this issue. Grease Trap(locate on site plan): Depth below grade: feet Material of construction: ❑ concrete El metal ❑fiberglass ❑ polyethylene ❑ other(explain): 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 t5ins•081W Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 10 of 117 Commonwealth of Massachusetts Title 5 Official Inspection Form. Subsurface Sewage Dismal System Form-Not for Voluntary Assessments 135 Carriage Rd. Property Address James Mingle Owner Owners Name information is Osterville MA 02655 03/18/11 required for every page. Citylrown State Zip Code Date of Inspection D. System Information (cons.) Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage,etc.): 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): 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.): "Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No Title 5 official inspection Fomr.Subarrface Sewage Disposal System•Page 11 of 17 t5ins•09MB Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface sewage D"esposal System Form-Not for Voluntary Assessments 135 Carriage Rd - Property Address James Mingle - Owner Owner's Name information is OsterviNe MA 02655 03/18/11 required for every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Distribution Box(if present must be opened)(locate on site plan): Depth of liquid level above outlet invert 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.): The distribution box is possibly under the paved driveway and was not able to be inspected at this time. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order. ❑ Yes ❑ No Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.): Soil Absorption System(SAS)(locate on site plan, excavation not required): If SAS not located, explain why: TiBe 5 Official Inspection Form:Subsurface Sewage Disposal System'Page U of 17 [sins•09108 Commonwealth of Massachusetts Title 5 Official Inspection Fong Subsurface Sewage Disposal System Form-Not for Voluntary Assessments <.r 135 Carriage Rd Property Address James Mingle Owner Owners Name information is required for every Osterville MA 02655 03/18/11 page. City/Town p State Zip Code Date of Inspection C' D. System Information (cont.) Type: ❑ leaching pits number: ❑ leaching chambers number: ❑ leaching galleries number: — ❑ leaching trenches number, length: ® leaching fields number, dimensions: 2.4'x 37.5' ❑ overflow cesspool number: ❑ innovativetaltemative system Type/name of technology: Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation,etc.): The stone appears clean and damp and there is no sign of hydraulic failure in the area of the SAS. — 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 th 09108 Title 5 Official Inspection Form Subsurface Sewage Disposal System•Page 13 of V Commonwealth of Massachuseft -- Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments .a 135 Carriage Rd Property Address James Mingle Owner Owner's game information is required for every Osterville MA 02655 03/18/11 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy(locate on site plan): Materials of construction: Dimensions Depth of solids Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins•09108 Title 5 Mist inspection Form:Subsurface Sewage Disposed System•Page 14 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments V0 0_ 135 Carriage Rd. Property Address James Mingle Owner Owner's Name informatrequired is Osterville MA 02655 03/18/11 required for every — page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view 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. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately UisviNIG & 13E©aooA t DWEt_,t-trJG . D-Box P►e L--D a . t5ins,09108 Title 5 official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 Commonwealllft of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System form-Not for Voluntary Assessments ,.. 135 Carriage Rd. Property Address James Mingle Owner owner's Name information is Osteryille MA 02655 03/18/11 required for every State Zip Code Date of Inspection pegs Cityrrown D. System Information (cons.) Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells 13' Estimated depth to high ground water. 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: Date ❑ Observed site(abutting property/observation hole within 150 feet of SAS) ® Checked with local Board of Health-explain: Permit#2000-705 ❑ Checked with local excavators, installers-(attach documentation). ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: The Groundwater countour for this area is approximately EL=3+/-and the elevation on the site is approximately EL=20+/-. The bottom of the SAS is approximately W b.g. so there is a 13'separation to groundwater approximately. Before filing this Inspection Report,please see Report Completeness Checklist on next page. Title 5 official tnspection Forth:Subsurface Sewage Disposal System-page 16 of W [sins•09= A, Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments „ 135 Carriage Rd. Property Address James Mingle Owner Owner's Name information is Osterville MA 02655 03/18/11 required for every State Zip Code Date of Inspection page- city/rows E. Report Completeness Checklist ® Inspection Summary:A, B, C, D, or E checked ® Inspection Summary D(System Failure Criteria Applicable to All Systems)completed ® System Information—Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file Title 5 Official inspection Form:Subsurface sewage Disposal System•Page 17 of 17 t5ins-09108 T07WINT©FBARNSTA.BLE A` v LOC.A.-nON.,ice x�l�b�X.�e`1� C.CJ QX l g�r-- �;u�i.SEViWAGE � 70 VILLAGE "t(,�.1�-1 L�� ASSESSOR'S MAP & LOT V1 D (09 INSTALLER'S NAME&PRONE NO eI3,q';5!7e SEPTIC TANK CAPACITY . LEACHING FACII,l7l: (type) &AJ%,,lt4 ,c=�� (size) 2 41.;V 7 NO.OF BEDROOMS �O BUILDER OR WNE Mi,fl!aLe—S PERMITDATE: COMPLIANCE DATE: ' Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility S Feet Private Water Supply Welland Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by C 4 0 ,► No. Gs �d i' �r a Fee THE COMMONWEALTH COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS ZippYication for Migoml *p5tem Con.5truction Permit Application for a Permit to Construct(V)Repair( )Upgrade( )Abandon( ) El Complete System El Individual Components Location Address or Lot No. 1 Owner's Name,Address and Tel.No. Assessor's Map/Parcel � - ov6 OF Installer's Name,Address,and Tel.No. Designer's Name` H]ffl'®I,Nj)0yLE & AS60C, `,411 Z� East Falmouth,LMAe02536 - - 534 Type of Building: 32-51r756 . Dwel ' No.of Bedrooms Lot Size 9�'O sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow e_ca(a gallons per day. Calculated daily flow 6(y 0 gallons. Plan Date \k-IA- Number of sheets I Revision Date Title `Lt Size of Septic Tank 1 5",*Of> c4XU 12i" Type of S.A.S. �Mt Description of Soil 2 Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the cons ction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title o vironmental Code pd not to place the system in operation until a Certifi- cate of Compliance has been issu t f 2eh. D Signed Date Application Approved b - Date Application Disapproved for the following reasons Permit No. Date Issued ;ss1.ti.,,.,,.• ,.. ,:l„n,; .1: .a...,.5> ;e.,,- }.«-.li r .r «x,.. �..n Y:�,# ., ... .-�^r. s ., -.� _ . .. w•- ... .. .."'-+..� g r f, ems• ' i Fee .t A THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC-HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS . Z[ppYication for Oigpozal *pgtem Construction Permit �r • -A hcation for a Permit to Construct V)Re air Upgrade )Abandon El Complete System El Individual Components g PP� ( P ( )UPg ( ( ) P Y P ►3 Location Address or Lot No. Owner's Name,Address and Tel.No. S �cic��nc�r 20 Assessor's Map/Parcel Installer's Name,Addre�a-ndl.No. Designer's Name, pHWe�No.DOYLE & ASSOCA,/gyp C �� ,UZE 42 Canterbury Lane ,,,,� ,�i, /f CCAVATbQ East Falmouth, MA 02536 a Type of Building: Dwel' ,No.of Bedrooms 4 Lot Size -sq.f6\ Garbage Grinder( ) . Other Type of Building No.of Persons `- Showers( ) Cafeteria( ) Other Fixtures Design Flow G Ca la gallons per day. Calculated daily flow 4,40 gallons. Plan Date Ik-Zq- 'ZoOD Number of sheets I Revision Date Title 5 13 5-- VIA. L< Size of Septic Tank l 5"'o L Type of S.A.S. `dye L'T Description of Soil Sic= S% L-Oa L 1 ,f t Nature of-Repairs or Alterations(Answer when applicable) 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 Ti le of y vironmental Code nd not to place the system in operation until a Certifi- :' cate of Compliance has been issue t f Heath. .j Signed Date Application Approved b F 7 Date -;F Application Disapproved for the following reasons Permit No. W ae- �` �+� Date Issued �� ' THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS `. Certificate of Compliance THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed( )Repaired ( )Upgraded( ) Abandoned( )by , at `� 'f2 ," 13 r/?/Zhas been constructed in accordance !� with the provisto snof Tide=5.and the for D salwC�System-Construction Permit No -,5 dated �,'` Ttl r�C - �. Installer � ��''/� r�I�',:-�`�' , u�t C ).Designer- ,;���.4�-V' �i The issuanvi 0 y�i�permit shall 'not be construed as,a•guar' tee that the sP.��tion as desig�e DateInspector — --------=---------------------- No. 'lOGo / Fee /THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS lwizpogaf *p.5tem Cone truction Permit Permission is hereby granted to Cons ct( )Repair( )Upgrade( )/Abandon, )¢ System located at 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. i Provided:Construction must be completed within three years of the date of thi emut. / ! �✓ ` :• Date: I e�LO is/D l ' Approved by c�-lf41L1 r ' TOWN OFBARNSTABLE F�.c 0 LOCATION: �r�(c.�19 , [.�J � �� �sEWAGE O 70 A VILLAGE 5 ''r��� ASSESSOR'S MAP & LOT FO INSTALLER'S NAME&PHONE NO. y�r1. c�-�r�i �y�t���- SEPTIC TANK CAPACITY 15oo LEACHING FACILITY: (type) ft I� (size) NO.OF BEDROOMS z - BUILDER OR WNE E PERMITDATE: 7 v COMPLIANCE DATE; Z�07 ®R Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply Welland Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by C -------------- G.(r a i I 15— 5 I r o I i i Town of Barnstable P a 5 2 S)O Department of Health,Safety,and Environmental Services �Im Public Health Division Date L-1 _ p Q, 367 Main Street,Hyannis MA 02601 RMANA 039. Date Scheduled Time' Fee Pd.- 10 C Soil Suitability Assessment for Sewage Disposal Performed By: �1=1�� GULL. VA" Witnessed By: �1 ���► t�A � ►—�.� tCATION& G {�1iRA lrit♦ORIY�ATIt�N ... . Location Address .................... ... . .................:...:......:...: �35 eA/'/'/A�-E RD Owner's Name PAZ/L /3'IE'LLGu-,� 0S-fE/7/ILLE g5y0 fY1/GL /IEEE 2� Address ��PEi2V�L L�/ �✓/¢ Assessor's Map/Parcel: 7// f— 9 Engineer's Name NEW CONSTRUCTION X REPAIR Telephone# ;$—Q — 33 14 Land Use U NDe!yE ohED Slopes(%) — P' F Surface Stones �t Distances from: Open Water Body 750 R Possible Wet Area AA It Drinking Water Well 41a _R Drainage Way NO R� Property Line �90 R Other SKETCH:(Street name,dimensions of lot,exact locations of test holes&perr es) �--� � aO4 N0150,00 1 o27 i;-O one s�oeo. _ QT P s o. Parent material(geologic) Depth to Bedrock Depth to Groundwater: Standing Water in Hole:WA/u 611A4WuAJrD Weeping from Pit Face 00/✓L Estimated Seasonal High Groundwater LEs s --f,A/V EL. ....... ............ . .. <><> NATIC?1 �t.SEASONAt.:HYGU.'VVATEY2 TAB «<>< ur ', � IMethod used?a[tl%y O�' f'3I3rN5*A�ctt tr U+N � Depth Observed standing in obs.hole: Wo A15 in. Depth to soil mottles: /1/lW/ in. Depth to weeping from side of obs.hole: 1140111,149 in. Groundwater Adjustment Al pA/Gr R. 4ndex Well#___•_._ -Reading Date:_. Index Well level•_,__ Ad.l.factor Adj.Groundwater Level_ .::.........:... ...... E11�A TEST ;.;>:;pate :::f ` >Tiiri / :.. ....; "" , ...............:. ... 2- 5 /lLLo s L ss '-ithR V Observation Hole# Time at 9" Depth of Perc (DQ Time at 6" Start Pre-soak Time® Time(9"-6") End Pre-soak RateMin./Inch :. MIA-, Site Suitability Assessment: Site Passed Site Failed: Additional Testing Needed(Y/N) /rs Original: Public Health Division Observation Hole Data To Be Completed on Back—� Copy: Applicant 3gig .. nle�. Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulderes. % t_ u Pl/�/�NEEDLE O Q� L- a Awn /� 3 1M C O t�S �„_ 3 3 g YAn as�avn lU yR s ` 2% C a���L✓� Lf, yet-.Srnv 33 -�2D o rsF sr�iv9 '/ 1Z (� Sl IX-)C.LC I Iccsr.) r5� DEEP OBSERVATION HOLE LOG Hole#: ..... . Depth from Soil Horizon Soil Texture Soil Color Soil Other ' Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulderes. o . �►vrr N�DLc O ,, �• rsE if 1Z s�3 CoA�pSR/j'D ® J1 sL Sal v►n i= *�S ,. „ L�• jl�l,pw 33-110 C (3r A%-- IP/2 / � H - ( DEI✓I'OBSRA' ON. OL .0 Tole ....:. .:. Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulderes. % ....... ...__..._. _.....:. ::...::.:::..... ::::::::::::::::::..::.::.:.:::::..;:::::.;::.;::..; DEEP OBSERVATIOI�tpLE LOG Hole.# .... Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulderes. % Flood Insurance Rate Man: �( Above 500 year flood boundary No_ Yes Within 500 year boundary No X Yes Within 100 year flood boundary No**4 Yes Depth of Naturally Occurring 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? E5- If not,what is the depth of naturally occurring pervious material? Certification I certify that on kPe.l t_95 (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 Rate OFI- LE VIE W1 X T S10 Total Field Length .05 - 1/2" Peastone :: � :: PROPOSED S.A.S. FIELD SECTION ---- 00° 314" -• 1-1/2" Washed Crushed Stone fig,$ 3/4" - 1-1/2' Washed Crushed Stone El zo•S ' 2" of 1/8' - 1/2" Peastone .�. 0 No. of Fields No. of Distribution Lines each Field a ° ° - �� 3`f I �o o o� Length of Distribution Lines °°� ° og8 El. Field Width 24 C:v'Z-Utz `vlATrz: L L El.. �orescnL, Eff. Depth of .Field e~ 2s FEMA Zone: "C" Panel 250001 0018D (July ,92) (z - - r i - I - 3 J� arhrlrn -; � u � R tt11 • posed Pro .. �° _.._. ... . t ANo ItL, ND' tour I,. ends 35a. r,_r.-----,. 1 , � �.•- � ' �e If r tt�l taar' •, ( rl ',e,♦ ... .. 1 Zoning District: RF-1 Building Setbacks: Front 30' Side 15' C" Rear 15' Overlay District: AP Patio r 26 Reference Plan: Land Court #15354-131 39.6 Lot Coverage: Proposed Dwelling - 5,615 sq.ft. i Proposed Pool. - 648 sq.ft. N Proposed Tennis Court - 2808 sq.ft. l Bedroom Dwelli °� Total Cover = 17% I. 400 P rch -25 � - o 1 -� - •�5 •s � � r ` Exist/Hyd. pro TP 4 yyater _ — — , i Fener pose c , 21 - ' ��•37'S 22 ' r-- w � , - � .-- Locus Address., 135 Carriage Road P�MEN� Assessors Data: 71/11-9 Plan Revised• 03105101 P AD � G util/pole ,za �. E3 irrE I LAN O IT" T IANID �� �N p,r ram. c� nn In G1SiEkfo ��'c+ OS JL ER��IL,LE— 13ARNSTABI-,E+ , MA (� �1 EPHEN v, �- OQYLE N Prepared For - NO.37559 j LOT 228 CARRIAGE ROAD GRAPHIC SCALE Depicting The Proposed `u wp1���Zlt OF Atq S-'� 20 0 10 20 40 80 ;�t% \ MINGLES RESIDENCE WILLIAM N Rem= u>=G[RnJAr, Scale: As Shown Date: November 29,2000 ( IN FEET vp�rau, l;s�,�° �� Prepared By: 1 inch = 20 1t. oFScp a E , Plan View ,-,--•r Stephen J. Doyle and Associates 42 Canterbury Lane, East Falmouth, Massachusetts 02536 Telephone: 508/540--2534