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HomeMy WebLinkAbout0204 CRYSTAL LAKE ROAD - Health 204 CRYSTAL LAKE ROSTERVILLE A = 139 046 i / o j------- - - -- i a Q 1 o 0 J f Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °I 204 Crystal Lake Rd. ,�j� ' CHU Property Address Paul & Geralynn Hefferman Owner Owner's Name information is required for Osterville Ma. 02655 3/11/2008 every page. City/Town State Zip Code Date of Inspection Inspection results must,be submitted on this form. Inspection forms may not be altered in any way. Important:When filling out A. General Information forms on the . computer,use 1. Inspector: only the tab key to move your Robert Paolini cursor-do not Name of Inspector use the return key. Ca ewide Enter rises,LLC Company Name r� P.O.Box 763 Company Address y 1 Centerville Ma. :42632 � City/Town State Zip Code `-u r= (508)428-4028 S14454 Telephone Number License Number _ rss B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000). The system: ` ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority 3/11/2008 Inspector's Signat Date t 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. 204 Crystal Lake Rd.-12/07 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 204 Crystal Lake Rd. Property Address Paul & Geralynn Hefferman Owner Owner's Name information is required for Osterville Ma. 02655 3/11/2008 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary:-Check A,B,C,D or E/always complete all of Section D A) System Passes: ® 1 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: The septic system is in proper working order at the present time. B) System Conditionally Passes: ❑ One or more system components as described in the "Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Answer yes, no or not determined (Y, N, ND) in the ❑ for the following statements. If"not determined," please explain. ❑ The septic tank is metal and over 20 years old* or the septic tank (whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND Explain: ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ obstruction is removed 204 Crystal Lake Rd.•12/07 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 15 I Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments c,M 204 Crystal Lake Rd. Property Address Paul & Geralynn Hefferman Owner Owner's Name information is required for Osterville Ma. 02655 3/11/2008 every" page. City/Town State Zip Code Date of Inspection E. Certification (cont.) B) System Conditionally Passes (cont.): ❑ distribution box is leveled or replaced ND Explain: ❑ 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 ❑ obstruction is removed ND Explain: 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 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. 204 Crystal Lake Rd.•12/07 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 3 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 204 Crystal Lake Rd. Property Address Paul & Geralynn Hefferman Owner Owner's Name information is Osterville Ma. 02655 3/11/2008 required for every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) C) Further Evaluation is Required by the Board of Health (cont.): ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory,for coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate "Yes" or"No" 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 ❑ ® 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 Y2 day flow ❑ ® Required pumping more than 4 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. El ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. 204 Crystal Lake Rd.•12/07 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 4 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments 204 Crystal Lake Rd. Property Address Paul & Geralynn Hefferman Owner Owner's Name information is required for Osterville Ma. 02655 3/11/2008 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) D) System Failure Criteria Applicable to All Systems (cont.): Yes No ❑ ® 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 ❑ El Area system is located in a nitrogen sensitive area (Interim Wellhead Protection Area— IWPA)or a mapped Zone II of a public water supply well If you have answered "yes"to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 204 Crystal Lake Rd.•12/07 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 5 of 15 j Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ° 204 Crystal Lake Rd. Property Address Paul & Geralynn Hefferman Owner Owner's Name information is required for Osterville Ma. 02655 3/11/2008 every page. City/Town State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes" or"no" as to each of the following: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ❑ ® Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] 204 Crystal Lake Rd.•12/07 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ,M 204 Crystal Lake Rd. Property Address Paul &Geralynn Hefferman Owner Owner's Name information is required for Osterville Ma. 02655 3/11/2008 every page. City/Town State Zip Code Date of Inspection D. System Information Residential Flow Conditions: Number of bedrooms (design): 4 Number of bedrooms (actual): 4 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 440 Number of current residents: 2 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 Seasonaluse? ® Yes ❑ No 2006:17,000 Water meter readings, if available (last 2 years usage (gpd)): 2007:46,000 Sump pump? ❑ Yes ® No Last date of occupancy: Date 008 Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow (seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: Last date of occupancy/use: Date Other(describe): 204 Crystal Lake Rd.•12/07 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments I ° 204 Crystal Lake Rd. Property Address Paul & Geralynn Hefferman Owner Owner's Name information is Osterville Ma. 02655 3/11/2008 required for every page. City/Town State Zip Code Date of Inspection . D. System Information (cont.) General Information Pumping Records: Source of information: J.P.Macomber Was system pumped as part of the inspection? ® Yes ❑ No If yes, volume pumped: 1500 gallons How was quantity pumped determined? Measured Reason for pumping: Maintenance 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) ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): Approximate age of all components, date installed (if known)and source of information: 1999 Were sewage odors detected when arriving at the site? ❑ Yes ® No 204 Crystal Lake Rd.•12/07 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 204 Crystal Lake Rd. Property Address Paul &Geralynn Hefferman Owner Owner's Name information is required for Osterville Ma. 02655 3/11/2008 - every page. City/Town State. Zip Code Date of Inspection D. System Information (cont.) Building Sewer(locate on site plan): 1' Depth below grade: feet Material of construction: ❑ cast iron ®40 PVC ❑ other(explain): Distance from private water supply well or suction line: 20'+ feet Comments (on condition of joints, venting, evidence of leakage, etc.): Joints appear tight.No evidence of Ieakage.System vented through the house vents. Septic Tank (locate on site plan): Depth below grade: 1 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: 1500 Sludge depth: 4„ Distance from top of sludge to bottom of outlet tee or baffle 28" Scum thickness 6" 5"Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle 101, How were dimensions determined? Measured 204 Crystal Lake Rd.-12/07 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 15 { i Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 204 Crystal Lake Rd. Property Address Paul & Geralynn Hefferman Owner Owner's Name information is required for Cisterville Ma. 02655 3/11/2008 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Pump septic tank every 2 years.lnlet and outlet tees are in place.No evidence of Ieakage.Tank appears to be structurally sound. Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ 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 Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): t 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): 204 Crystal Lake Rd.•12/07 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 15 I i Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 204 Crystal Lake Rd. Property Address Paul &Geralynn Hefferman Owner Owner's Name information is required for Osterville Ma. 02655 3/11/2008 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Tight or Holding Tank(cont.) Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No Distribution Box (if present must be opened) (locate on site plan): Depth of liquid level above outlet invert No 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.): Box is Ievel.Box has one outlet Iateral.No evidence of solids carryover.No evidence of leakage into or out of box. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No 204 Crystal Lake Rd.•12/07 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 15 „ Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 204 Crystal Lake Rd. Property Address Paul & Geralynn Hefferman Owner Owner's Name information is required for Osterville Ma. 02655 3/11/2008 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 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: Type: ❑ leaching pits number: ® leaching chambers number: 6-Infiltrators w/4' stone ❑ leaching galleries ,number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: t ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Sandy dry soil.No signs of hydraulic failure.Hand dug down to stone.Soil and stone were clean and dry. 204 Crystal Lake Rd.•12/07 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 15 Commonwealth of Massachusetts W Title 5 official Inspection Form Subsurface Sewage Disposal System Form.- Not for Voluntary Assessments 204 Crystal Lake Rd. Property Address Paul &Geralynn Hefferman Owner Owner's Name information is required for Osterville Ma. .02655 3/11/2008 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): 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.): 204 Crystal Lake Rd.-12/07 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 15 -Map Page 1 of 2 Town of Barnstable Geographic Information System Parcel Viewer Custom Map Abutters Map Size ® Zoom Out !, J 4 M1 In 7 \, 1 4 } 4,3 ...,n f S2 kF L , MV- f 1 . i rt #`I t �IJ r X tk`j Llr 1y � � 4f Tm UR gg +, .2 0 , , 0 2 Feet Set Scale 1" _ 20 I Aerial Photos f nmJrinhf 9l111F_9(1M Tn�.m of Rornefohlc KAA All rinhtc roconJ� http://www.town.bamstable.ma.us/arcims/appgeoaP p/m4p.4spx?propertyID=13 9046&map... 3/12/2008 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 204 Crystal Lake Rd. Property Address Paul & Geralynn Hefferman Owner Owner's Name information is required for Osterville Ma. 02655 3/11/2008 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope ® Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to high ground water: Bottom of leaching 15' 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: 1 Daatete ❑ Observed site (abutting property/observation hole within 150 feet of SAS) ® Checked with local Board of Health -explain: As-Built Card and plans on file. ❑ Checked with local excavators, installers- (attach documentation) ❑ Accessed USGS database -explain: You must describe how you established the high ground water elevation: USED:USGS Observation Well Data.USED:Technical Bulletin 92-000-01 Plate#2 annual ranges of groundwater elevations. 204 Crystal Lake Rd.•12/07 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 15 THE Town of Barnstable �F Tp� Regulatory Services S,,,B Thomas F. Geiler,Director 9� 1639. pTEDnw'�s Public Health Division . Thomas McKean,Director 200 Main Street, Hyannis, MA 02601 Office: 508-8624644 Fax: 508-790-6304 This septic system inspection report was completed by a private inspector who is certified by the State of Massachusetts, Department of Environmental Protection. Although the Town of Barnstable.Health Division received the original/copy of this report; this Division does riot warranty the functionality of the septic system in the future not does this Division agree with any technical observation s and interpretation_ s contained within this report. In addition,by receiving this report the Town of Barnstable Health Division does not automatically approve the number of bedrooms listed within this report. The actual number of bedrooms approved at a particular property would-be listed on the"Disposal Work Construction Permit". If you should have any questions regarding this report, please contact the certified Septic System Inspector who conducted the inspection. c TOWN OF BARNSTABLE LOCATION / / SEWAGE # VILLAGE_ INSTALLER'S N ASSESSOR'S MAP& LOT/-? b AME&PHONE NO. d�!v� y6 SEPTIC TANK CAPACTIy L LEACHING FACILTTy: (hype) i i NO. OF BEDROOMS (size)l y X yo x JL BUII DER OR OWNER CSC �a PERMTTDATE: 7— 99 COMPLIANCE DATE: '7 l Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Private Water Supply Well and Leaching Facility ty Feet on site or within 200 feet of leaching facility) any wells exist Edge of Wetland and Leaching Facili Feet within 300 feet of leaching facilityty(�anY�'edands exist Furnished by �/4.4.4, o6�� Feet �h , ge h T r . �P9 C 0 � I 1 l- l -- TOWN-OF OWNOF BARNSTABLE � LOCATION �y�d 1����y/S r�-r la tie i2� SEWAGE # L A, 7 VILLAGE VS Te L i l�2 ASSESSOR'S MAP &LOT! l e ,0eK INSTALLER'S NAME&PHONE NO. 3d�h g (40 iN SEPTIC TANK CAPACITY 1L LEACHING FACILITY: (type) /dl.4�I)--t LS (size) /v ►K.Yol A a� NO.OF BEDROOMS BUII.D- OR OWNER ��Y �y! PERMIT DATE: 7— COMPLIANCE DATE: c Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist 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 41'-4�y PV-0V 4 { *• eY ♦ / 6v9�Gr 3 3s/ r No. ' ,. _Fee L� THECOMMOWWEALTH OF ASSACHUSETTS PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLEg NIASSACHUSETTS Apprtcattott for &zpozaY�*pgteru Cougtructtor� �ermtt Application is hereby made for a Permit to Construct(`1)or Repair( )an On-site Sewage Disposal System at: Location Address or Lot No. Owner's Name,Address and Tel.No. z0� GR��srA%- l,.AV- Q4 C:::, XL-L.S. Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. STEPHEN J. DOYLE & ASSOC. A A Lf0 42 Canterbury Lane East Falmouth, MA 02536 Type of Building: Telephone: 508/540-2534 Dwelling No. of Bedrooms Garbage Grinder( ) Other Type of Building No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow `T"�� gallons per day. Calculated daily flow `T gallons. Plan Date '`l- 9 9 Number of sheets I Revision Date Title 51rS. ?iA�% c� D tN (DSrr--Q_Vk kz )A.A r&IL K'T-6LL7=-12 1�1D�w1C� Description of Soil '%1=7_ 'SkTL PLA.'t4 Sul Ufj 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 Title 5 of the EnvirDwrtental Code and t to place the system in operation until a Certifi- cate of Compliance has been issued by this Board o ea �g Signed Date! Application Approved by Application Disapproved for the following reasons i Permit No. Date Issued ——————————————————————————————————————— THE FOLLOWING IS/ARE THE BEST IMAGES FROM POOR QUALITY ORIGINAL (S) I A- DATA / r t � � ✓ t r7 'Fee r p / THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLEs MASSACHUSETTS ZIPPiication for Migozal *p.5tem Cou!5truction Permit Application is hereby made for a Permit to Construct(V)or Repair( )an On-site Sewage Disposal System at: Location Address or Lot No. Owner's Name,Address and Tel.No. Zoe GR.�(STAL LrA1Ls. Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. STEPHEN J. DOYLE & ASSOC. l 42 Canterbury Lane a mouth, MA 02536 Type of Building: �,phone: 5 0 8/5 4 0-2 5 3 4 Dwelling No. of Bedrooms Garbage Grinder( ) Other Type of Building No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow `A0 gallons per day. Calculated daily flow gallons. Plan Date - 9 R Number of sheets I Revision Date Title 5t1'1:-� 1OLAt3 'off LAID tt4 (___sY1PQ_\/k LLe .' 1-AA t=Ett_ K-9-0U_T;�tX_ Description of Soil "PL Ak-1 s.tatt_ t_-)(.S 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 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 Signed�a�. '�=� Date Application Approved by A GI /�� '�' r'• 1 Application Disapproved for he following reasons r Permit No � r �! i Date Issued �I THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLEs MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System installed( )or repaired/rep]aced( )on I. t_ by r for as -. has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No.t lL/-7l1,-0 dated Use of this system is conditioned on compliance with the provisions set forth below:` ----- No. �! "I'.•� Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLEs MASSACHUSETTS lwi,5pogal *pg;tem Con6truction Permit Permission is hereby granted to r t� to construct( )repair( )an On-site Sewage 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. All construction must be completed within two years of the date below. Date: Approved by - Town of Barnstable PH- Department of Health,Safety,and Environmental Services lqq oF� Public Health Division Date 6 367 Main Street,I Iyannis MA 02601 HARMMADM PtAHS J Date Scheduled ffora►�+� ,Time Fee Pd. Soil Suitability Assessment for Sewage Disposal Performed By: ✓6y L�= Witnessed By: I�OC�ATIQI & it;Nl'�RA1,LN1+OR1tiIATON Location Address .... ... .....: .. Owner's Name" Al�vitliL{� tz�cq Nln�t=LZ wer2 ( 1/` Address " ,7iTo►�,a T3c;! t �L Assessor's Ma /Parcel: �`�9 —©Gf�� STEPHEN J. DOYLE ASSOC. ---� / // Engineer's Name 42 Canterbury Lan NEW CONSTRUCTI REPAIR Telephone# East Falmouth, MA 02536 -2534 Land Use ��� ;�� Slopes(%)_ �, Z Surface Stones Distances from: Open Water Body l 0 tl Possible Wet Area iy/hl R Drinking Water Well _ft r \ Drainage Way. N A R Property Line 1U R Other R SKETCH:(Street name,dimensions of lot,exact locations of test holes&perc tests,locale wetlands in proximity to holes) ORIGINAL l0q ' ,Y �--= 4r s zV7 t 11D C(Z:ys—AL, L.atL1, 2oAq, Parent material(geologic) Depth to Bedrock Depth to Groundwater: Standing Water in hole: p VV'_-VL_ Weeping from Pit Face . p. a Estimated Seasonal High Groundwater ... : ::::>:>::;>:: DTItNAT)U1V:: ':(�Tt; ASUN AL: G1T:.WA ' _ Method Used: �Y\A p�.r..t Depth Observed slanding In obs.hole: in. Depth to soil mottles: in. Depth to weeping from side"of obs.hole: in. Groundwater Adjustment It. (nrtex Well# 'Reading Dater_ Index Well level...--_ Adl.factor Adj.Groundwater Level_ TI+;ST Observation Hole# _ Time at 9" Depth of Perc d _ � Time at 6" Start Pre-soak Time® '00 Time(9"-6") End Pre-soak l`;u(o .Z.A (: MM_ QSL�-ScOI� , Rate Min./inch G'Z. Site Suitability Assessment: Site Passed Site Foiled: Additional Testing Needed(YIN) Original: Public Health Division Observation Hole Data To Be Completed on Back j Conv: Analicant llr b13 »�>iY'VA'TX(11Vtb LCI 4«: Depth fr Soil Horizon Soil Texture Soil Color Soil Other er Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulderes. a 0it Gil XI D SL 10 -_4 p�,,: Loo 5v-- �Ao (o 30it 'b �S �oy�, 5lb toy 10tl_ `I \[_p-f-►u- Z�5 [o Lpe S% L�o�{ DEEP.OBSERVA- I N.ROL� L,OG.. Dole;# Depth from Soil Horizon Soil Tex lure Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulderes. a Ir �/J' u �L.- toyQ� 3J Ivb� L c,5i,1yp ko �At1- k5Z cep- Z,� ��Sr toli'=l, ...._ . . ....... .. ........ ... ...... .. . . .. .. .. . _. . . . . .. HSERVA Holt Deplh froim " ' 4 ( Soil'tlorizon Soil Texture Soil Color Soil Other +Surface'(in) �4 (USDA) (Munsell) Mottling (Structure,Stones,Boulderes. o t: DEEP.OBS RVATION.HOLD 06 Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulderes. % e i Flood Insurance Rate Maw / Above 500 year flood boundary No_ Yes V A Within 500 year boundary No_ Yes Within 100 year flood boundary No_ Yes Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervi us material exist in all areas observed throughout the area proposed for the soil absorption system? t If not,what is the depth of naturally occurring pervious material? Certification I certify that on �(5 (date)I have passed the soil evaluator examination approved by(lie Department of Environmental Protection and that the above analysis was performed by me consistent with the required training,expertise and experience described in 310 CMR 15.017. Signature � --�— Date 3- Z-q� i 7z i' �331lz i 5 7 It IL r--- 10 17� T.FV7r\ SC�wNED IN PORCH k i ,— MASTER BEDROOM . - - L331r-l-571 �3'1 t A Bg ----1z—m> 21'1 32 i 3' 'I S1 I - - 224 -'-�AID" in - - k-2 19'4 3' 2- 3't— --B2 i _,17, :666 64--`{ 4'11. —y _ 'SQ,ED OJf Tub-IeALKN n 7 om I b— 11 I s mm s —Y. to- eas LEI' F—3a—'i I � o / BATH tz— rn rtt BREAKFAST NOOK O Ki i GuEN STUDY .4. ❑ G E h rf %( �2 carzx,7s mb6 c9, a CAR GAGE ve carnos„ rv' 76669111E � � I FARMERS PORCH TT 1 i - I in fi h M 37 4'1 37 LiVNG ROOM ra m I G GNiNG ROOM bbb I I I a� L Ld f 9><7 WEM.�D'ACC 9kTG�H6FMtAR , �lA[AKK 7DIEN�0 P —f• ; F1cr X Ia Gom* n I n :y4'A flb. ;� :u6 7LYA 1w Jub iz l^ 1sTR=aa, KJOLLERRESIDENCE VALE 3A6sT DATE CUM 36 lPhat 6 . GD DES"aR15 -5Li4.395-7f;85 - ..r.t�esodue,/md DRAWN BY Ay M .. . • OMTAL LAM-OST6tVkJ.F-Kl y 1 t J t � Y AM e RJ ttt y, f ' 1 rr 731 17 20 ty s y yam*1 } C �� tr Lac r 14,1 �—S6 — 7 24310 24310 KN�L= 11�1 Av�- KN � L � r a BATH ' 0 k.; 3' 32. VE I V.^ EAVE x 1666 S 1 R 11V G /��%� HALL } l — BEDROOM # 2co --- m Q �, N . m _ 2v t� ONE STEP DOWN /�e'B.F 1 BPS o o i a'BF� 6'B.F. a "�/ `> CLOSET CLOSET 0 2a 17 — it 7Z , KJOLLER RESIDENCE v._T »;ZAVM V.-_9 7Pa1 Qi1 BtAL tu> •051FRV0.1F tt� CAD OES&S -B6-365-76M ww cyrad..Vmd MAUM ff . n 1 GENERAL CONSTRUCTION NOTES 1. ALL WORKMANSHIP AND MATERIALS SHALL CONFORM TO D.E.P. TITLE 5 AND THE TOWN OF _ '-.t 5�� RULES AND REGULATIONS FOR THE SUBSURFACE DISPOSAL OF SEWAGE. 2. AT LEAST ONE ACCESS PORT OVER TANK TEES SHALL BE ACCESSIBLE WHITHIN SIX INCHES OF FINISH GRADE WITH ANY REMAINING ACCESS PORTS BROUGHT TO WITHIN TWELVE INCHES OF FINISH GRADE. 3. ALL COMPONENTS OF THE SANITARY SYSTEM SHALL BE CAPABLE OF WITHSTANDING H-10 LOADING UNLESS THEY ARE UNDER OR WITHIN 10' OF DRIVES OR PARKING. H-20 LOADING SHALL BE USED UNDER OR WITHIN TOP FOUND. Et_ 3A•D 10' OF DRIVES OR PARKING UNLESS NOTED. 4. THE EXCAVATOR/CONTRACTOR SHALL VERIFY THE LOCATION OF ALL j- aa:. ;�� �.°✓ ;.�, 0�( 2. Is - �.ti Lc°�tT o�s � ----5 SITE UTILITIES PRIOR TO ANY EXCAVATION. 4 V . . .: ��..__ , ., �, Mu°�\. ., ', •, �, ti °--:_,_ ., .,,�•__� _�._ ..�__..� __....w. _----_._ __.�:... ,_.:_.. __.__ _.,_. . R PIPES SHALL BE 4 SCHEDULE 0 PVC LAID AT 0.02 SLOPE. 5 SEWER -y- -- WATER TIGHT COVER 6. ANY MASONRY UNITS USED TO BRING COVERS TO GRADE SHALL BE • MORTARED IN PLACE. II 7., FINISH GRADE SHALL HAVE A MINIMUM SLOPE OF 0.02 FEET PER FOOT. I� INV. EL 3�, �----2 t.EVFa.----� 2" MIN. - 1/8" TO 1/2" WASHED STONE _ ''•' FLOW LINE 1cr MIN. n t►dV V'EL. 3o .O 1 INV. EL. SUMP INFILTRATOR 10' MIN. LIQUID DEPTH - o t, D 3/4 1 1/2" WASHED STONES EFF. EPTH INV. EL. 3a ,�1 INV. EL 1• D INV. EL. +M1 ( V 1 _____--._._ - .,•• -•,.......W..__._-_-_... S.A.S. LONG x 'Z , ,. : ....._._.._�___.__...__._ - .��WIDE x_EFF. DEPTH :•,y�'• � ' ',{{ •§yp.� :,GAF i g c 1r°.}` �'.,..�- �'k �a� WITH HIGH CAPACITY INFILTRATOR CHAMBERS PR ECAST ECAST REINFORCED CONCRETE �' ,+ l;� • • r,�y(,•,,.Ic �� "�,•a� �- '- 1500 GALLON PRECAST REINFORCED CONCRETE SEPTIC TANK DISTRIBUTION BOX r MINIMUM CONSTRUCTION MATERIALS PER 310CMR 15.226(2) INSTALL ON A LEVEL BASE MINIMUM WALL THICKNESS = 2" '� East Bc TEES SHALL BE CONSTRUCTED OF SCHEDULE 40 PVC AND L SHALL EXTEND A MINIMUM OF 6" ABOVE THE FLOW LINE MINIMUM INSIDE DIMENSION = 12" 99 OF THE SEPTIC TANK AND BE ON THE CENTERLINE OF THE y pp SEPTIC TANK LOCATED DIRECTLY UNDER THE CLEAN-OUT OUTLET INVERTS SHALL BE EQUAL TO EACH OTHER AND AT 2 MINIMUM BELOW INLET INVERT. THE DISTRIBUTION LINES !FROM THE DISTRIBUTION BOX7_.Z 3.0rcus 1- -• ;Y THE INLET PIPE ELEVATION SHALL BE NO LESS THAN 2" NOR t ,a.! ;..,,t,,•, ,�.�, ,M,,��.� . v MORE THAN 3" ABOVE THE INVERT ELEVATION OF THE SHALL ALL HAVE EQUAL INVERTS AS DETERMINED BY FLOODING x n i OUTLET PIPE. THE DISTRIBUTION BOX TO THE HEIGHT OF THE DISTRIBUTION ' . Ire LINE INVERT AFTER ALL LINES HAVE BEEN SEALED IN PLACE. . INVERT ADJUSTMENTS SHALL BE MADE BY FILLING WITH DURABLE SEPTIC TANK SHALL BE INSTALLED LEVEL AND TRUE TO GRADE AND NON-DEFORMABLE MATERIAL PERMANENTLY FASTEND TO THE CB FND. t..t S CZS L.O�t_\S t-ANP ON A LEVEL STABLE BASE THAT HAS BEEN MECHANICALLY LINE OR RECONSTRUCTING THE LINES UNTIL ALL INVERTS ARE OF ---- COMPACTED AND ON TO WHICH SIX INCHES OF CRUSHED STONE EQUAL ELEVATION. HAS BEEN PLACED TO ENSURE STABIUTY AND TO PREVENT SETTLING. 33.0 CB NOTE: EXISTING AND PROPOSED GRADES SHALL ✓ ' SEPTIC TANK SHALL HAVE A MINIMUM COVER OF 9". F'ND. REMAIN ESSENTIALLY THE SAME UNLESS N OTHERWISE NOTED. ru THREE 20" MANHOLES WITH READILY REMOVABLE IMPERMEABLEj0 ep35 v~' • COVERS OF DURABLE MATERIAL SHALL BE PROVIDED WITH ACCESS X 33.2 T� 91 $5 A PORTS BEING PLACED AT THE CENTER AND OVER THE INLET AND _ - 1$,715 s it. � '� DENOTES EXISTING SPOT ELEVATIONS. OUTLET TEES. q' THE OUTLET TEE SHALL BE EQUIPPED WITH GAS BAFFLE. Proposed S.A.S. Infiltrator Trench X 3.6' X 33.2• �° i �� X 31.T th �' 61, 1S, ogv ' tp X 33.2' X 33,6' roposedl DESIGN DATA: ��� P Gallon Tank 00 X 33.2' D/Box Y , �j, STRUCTURE r,, , ? a7 �6 existing O O X 33.6' TYPE. N0. BEDROOMS GARBAGE DISPOSAL O v ZONING DISTRICT: RF-1 DESIGN FLOW _•...- , dwellIng , l2� X 33.2' 7� l� _ Ca ' -� a ai 1ST UJ BUILDING SETBACKS: porch FRONT - 30' X 32.8 REAR - 15' �\ *� SIDE - 15' a a f X S7. OVERLAY DISTRICT: AP SEPTIC TANK AAy � ��O - i_60 5� 1�Do ~wi-u1", p REFERENCE CERT/ITLE: .� # 135382 LEACHING FACILITY _ a q ASSESSORS DATA: CQ PROPOSED h �4G65TfRfp• � MAP 139 - 46 �Z1 OF iygs� _ . � -'--- � ._ .� STEPa1EN an � S = ",bey i - X 33.0 --4 BEDROOM DWELLIN ` a " DOYLE v STREET ADDRESS: BM: TOP CB EL-30:0' _ `i ' t , #204 CRYSTAL LAKE ROAD wtt uAM a ao t 4 OD` cs " A _ No. 37559 0 DATUM: NGVD a �. A �� �, LIE13ERMAN ESS% �,. FEMA DATA: No. 23971 O X 31.6 _ q ,r - - l�IVD SU \1 ZONE "C" PANEL 250001 0016 D _ PROPOSED ,i p MAP REVISED- JULY 2, 1992 Fss/OVAL 0 REFERENCE MAP: a DRIVEWAY �` i SOIL OBSERVATION DATA: `: 1)� ;b `3 CAPE COD WATER TABLE CONTOURS AND :: x 31a� x 31.6 GRAPHIC SCALE TEST DATE 3_ -t' PUBLIC WATER SUPPLY Cq WELLHEAD PROTECTION AREAS X 31.4 3 S»`+� ,�1.C, 6EFTEMeER Tags EXISTING 20 0 10 20 40 so SOIL EVALUATOR �` EVERGREEN WATER RESOURCES OFFICE i - ,a.� •,.:,. :. �.%s.a:`'..„.,r3 B.O.H. AGENT S`�o� : � CAPE coo COMMWON CB FND. Proposed Water Service .i a• EXCAVATOR A-'- D _ ( IN F'EE"P 1 w ^edge - V nl/P0� f 1 inch = 20 ft. PERC/RATE _ C 29.13 _ R Plan Vim w Of_ L,r 09 89,�E39 B3, hs L:/ r -- ol� T4 51. t4r 0 101 �r 5L 'd t011, 11 !L'.z' 29.81 130 EXISTING HYDRANT `` IN 34 a' 4y` C `3 q _ - _ �� r�_� iL 1L �. �� �_e II �t� T"o -Z.5�' Z.S-� DEPICTING THE PROPOSED p -t•t, c Scale: As Shown Date: March 9, 1999 Prepared By:, Stephen J. Doyle and Associates 42 Canterbury Lane, East Falmouth, MA 02536 Telephone: 508/540"2534