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HomeMy WebLinkAbout0031 GALAHAD CIRCLE - Health 31 GALAHAD CIRCLE, OSTERVILLE A= 145 064 o 0 o L � o TOWN OF BARNSTABLE / LOCATION >i �ii'L- fS l�t OZC LC-S SEWAGE# 461 S=--I(, VILLAGF�L-(2_0tLL 5- ASSESSOR'S MAP&PARCEL 1 -INSTALLER'S NAME&PHONE NO. qx" SEPTIC TANK CAPACITY LEACHING FACILITY.(type) tom(-gUl_'kL (size)_30 X q-T3 �J��? NO.OF BEDROOMS OWNER PERMIT DATE: "'7 1 COMPLIANCE DATE: ( a 3 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 �psr/J �u/ts'lrir/*r"'in� ��� ���� �,,_ - �y, �36 �� ��� 386".�- -.�..� a�' � ,� ��6� �: 31 � � �� r - �� ____ No. Fee THE COMMONWEALTH OF MASSACHUSETTS Eritered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes application for Disposal 6pstem Construction VPrmit Application for a Permit to Construct( ) Repair(k/Upgrade( ) Abandon( ) ❑Complete System Vdividual Components Location Address or Lot No. �ir"� Owner's game,Address,and Tel.No. TY" vs,4ervJ!(� Z)av; / Sorelcul �I Assessor'sMap/Parcel �5 (�, ( e ®may Installer's Name,Address,and Tel.No.503. Vaf- 9.-Y- D signer's Name Address,and Tel.No. SG9' 3 &�' 6 Nr a 1d� Cor,s+rcx.�-ip�,,„c p.,<,•Ay r)©y o'�et�erir�,Zrec. f l-AZJ.7 Qc #L40,M ' Type of Building: Dwelling No.of Bedrooms J Lot Size 6' 0-1 �sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures 9 Design Flow(min.required) 3-30 gpd Design flow provided 3- ?Io gpd Plan Date_LLne-;L3 ap lS Number of sheets t Revision Date Title i i{-'�l� c5 � JPL n":� L t-ql ` C3 d( AA Size of Septic Tank c _ Type of S.A.S.4QI r �. a 5Gt3q op IlM' Description of Soil-� �, n _ Nature of Repairs or Alterations(Answer when ap licable) r aT�r=�7 -F.rTb`,"Vc 44, 6.�d Ste /Grp /an% y - Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in r accordance with the provisions of Title 5 of the Environment ode not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. Signed Date Application Approved by Z Date Application Disapproved by Date for the following reasons Permit No. 1 oL Date Issued ' 'No. / Fee O� THE COMMONWEALTH OF MASSACHUSETTS Entered incoaiputer: , ,..PUBLIC HEALTH DIVISION;-`�TO_�1,11N OF BARNSTABLE, MASSACHUSETTS Yes ° application for -91��Jo8aY �ps,tem Construction i3erm t ,i ''' f Application for a Permit to Construct( ) Repair(/Upgrade( ) Abandon( ) El Complete System [individual Components Location Address or Lot No. Q.i Owner's game,Address,and Tel.No. 05�YUt 11e- �iU;c! 7 6�LorJo-n 11kac� C r• Assessor's Map/Parcel y toS ( le-, Y14 to O ass-s- Installer's Name,Address,and Tel.No.sU$ t/,P!g Designer's Name Address,and Tel.No. JU;R-36,::) ' W i- Iv r Cons4n�{�o�,inc P o 8xr�vy ,tin G�cpoe. in��"inS =nc. �! ir + MCAr'S .S I s, a }- . AA A e3a�a � Type of Building: .. Dwelling No.of Bedrooms Lot Size 6.golfC_sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) j 30 gpd Design flow provided 3,36 p gpd Plan -Date a 23 ;;to l k Number of sheets ` Revision Date Title i��-(e 5 Sik Per v.Q �1 / J� � C`ie Us�crss,`I��e A44 1 Size of Septic Tank��( -j n11u /L t}� Type of S.A.S. d udl X ) SfX��,o G7C I71/r� Description of Soil Nature of Repairs orAlterations(Answer when applicable) �,.. � i�r� /� �_�2� ne GC _ X •k rl�. 7 Date last inspected: Agreement: s The undersigned agrees to ensure the construction and maintenance of the afore,described on-site sewag d sposal-system in accordance with the provisions of Title 5 of the Environmental-Code d�iiot to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. Signed Date Application Approved by Date Application Disapproved by Date for the following reasons Permit No.��� p�- �p Date Issued -------------------------------------------------------------------=------------------------------------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS f Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired(><' Upgraded( ) Abandoned by r- `31 �ra�a H a �' �� O�tv; at �; ��e •I_k-- has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit NoX 15 b dated -7 1-6 Installer I � ,�.y� ' Designer i T— #bedrooms _3 Approved desin�Qow t/� 3 gpd The issuance of thi permi shall not be construed as a guarantee that the system will ncttii, as designed Date � Inspector Rs, No. Fee ��U THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS Disposal 6pstem Construction Permit Permission is hereby granted to Construct( ) Repair(t_< Upgrade( ) Abandon( ) System located at f and as describedin,the ba ove Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the�followmg local provisions or special conditions. i Provided:Construction must a co pleted within three years of the date of this permit. Date Approved by\ Town,of B4,rnsfable P# � ;<Departiatient of Regulatory.Services irrABr k Public Health Diviision orate M Pin a� 200 Main Street,Hyanols MA 02601 2' R t Date Scheduled a. Time Fee Pd, Soil Suitability.As�ses►sment for Sewn' e .� t ° �ao,�al Performed-13 bat):Q 1. (71/�iQ l�P S Y' Witnessed By: �A _ 1 LOCATION&GENERAL FqFORM:ATION - Location Address 31 6 a.laO k _ f� � 1- Owner's Name / Q Qa ` lK ll' GC Address Assessor's Map/Parcel: `��/b Engineer's Name b o W„` NEW CONSTRUCTION REPAIR Telephone# O 1`G wn Sloes 96 • Land Use: I p ( ) S� �V . Surface Stones Nab Distances from: Open Water Body�l GG it Possible Wet Area ft Drinking Water Well�160 ft Drainage Way a(j ft Property Lino 3r ft Other ft SI �'CHo(Street name,dimensions of lot,exact locations of test holes&pere tests,locate wetlands-In proxin-dty'to holes) At • Ji a�n Parent material(geologic) C lat t a l G(AW as� r _ Depth to Badroclt it ?0( Depth-to Groundwater. Standing Water in Hole: W74-- Weeping from Pit PnCa Estimated Seasonal High Groundwater /V A I Method used: DEIV T W MWATION FOR SEASONAL HIGH WATER�'.�BL Depth Observed standing in obs.hole: !p, Depdt,(o s411 mott(cs: Depth to weeping from side of obs,hole: In, Groundwater Adjuatment . Index Well# Reading Date: lndox WeI11aYo1 , Adj,Actar_Adj.,GroutltlwtlterLe4+a1— Observation RER.COLAT1,0N TEST 7)Ake��^, x�i=n___T_M_ '� - Hole# Tim_ oat 9" /1 Depth of Pezc. ` Time At 6" Start Pro-soak Time @"`"" Time(9"-6") End Pro-soak Rate Min./luch Site Suitability Assessment: Site Passed 5itg Felled: Additional Testing Needed CYIN) . Original: Public Health Dlvisiou Observatlon Hole Data To Be Completed on Back-- ***If percolation test is to be conducted within 100' of wetland,you insist first notffy tliar. Barnstable Conse)'vataon Division at lest one(I)week prior to begin g. Q:\SEPTIC\PERCFORM.D OC DEEP.O]BSERV:[T-ION]SOLE LOG. Role# / Depth from Sail Horizon Soil Texture Sill Color Soil•. OFhcr Surface(in.) (USDA) (Mansell) Mottling (Structure, Stoned;Boulders, o 1 to y,9b'Cravdl _132 C r 5 t DE+EROBSER V-AT]CON ROLE LOG Role# 2 Depth from Soil Horizon Sail Texture Soil Color Sail' Other Su;facc(in.)\ _ (USDA) (Munscll) Mottling (Structure,Stones,Boulders. Consistency,co G ve t 3Z C DEEP OBSERVATION ROLE LOG. Hole#. Depthfrorr Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munscll) Mottling (Structure,Stones,Boulders. Co i to o G c DEEP OBSERVATION]SOLE LOG. Hole# Depth from Soil Horizon Soil Texture Soil Color Sail Other Surface(in.) (USDA) (Munscll) Mottling (Structure,Stones;Boulders, Co s' ton b , ' 9 Flood InsuranewRate_Map: Above 500 year;flood boundary No— Yes Withln 500 year boundary No 1/, Yes ' Within 100 year flood boundary No-7 -Yes Denth of 1' turally.Occurring pervious Matarial Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the area proposed for the soil absorption system? Y e S If not,what is the depth of haturally occurring pervious material? Certification �./1 I certify that on `Z (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�10 CMR 15.017. - Datb 012 3 Signature l �S ' Q:�s.>?rT1c�r�l�croRM.noc ' JUL-28-2015 21:55 From: To:150e7906304 Pa9e:1/1 FROM :down cape e9ng 1 neer i ng Inc FAX NO-. :150E 3629880 Jul. 2a 2015. 09:17AM P1 I'awn of'Barnstable Rectory SeZA- fi 3'hu'>�la�lYl����m,��:tmeclorr ' 200 blil a 9trect..Uyauid4d,MA 02601 Offiay. 548-962•-44644 Pam: 548-790-63(A • . . Imete4�s•61,g?e���uiy�� e��»&'ran'�a, . ]�l� e: / Sewage�Pll7[IDXI�ir "a�1�e$ipS &�D �irQ } InstaUin �e o'ndrM&L was ij7necl a pc�mitta install a 1� r $r is 3L a�(ahc,.� r Ar,4 baqea ft ii.dcdp dr&wm by (a,drlcoda) GL t1I 0`dil I zt fp th, 111c septr: +sk=iefmnirzd elove waq i�, aillcd ENAP iall,Y awarding b tbt dc%sign,-which- ray i=-hLdz trignor applav x9, Chaagea mwh as latstal rr 0611 rm W!i$e lr Eift on bal.and/or se0r-trink. I cu^rtify that Chi srsptir, Wa Pm :�rdaooeilaed above wan ingtallod,with.ripJc�r, clean as (a.,E, p►;eate tlasn 10' 1,atand relocation of flu,SAS(.c UW vvtusl rrloratioa of any cumlloTJ=L of t}.W ewpa(;spste )jMt in.aj Uorclkince with St$te� :'C.aeul, lIatio�s. 'Nall rNvigioa ar cta'tified e t dPsignm:tc,fnligw- ra OF,�g DANIEL A. OJALA No.46502 a �9s�ONAL ISM 17RTX9X •® C. �I9I�CL. ,.,e..,i� '. D5 �,�TF+.j) rTi�171 cA 1) A E 1 D° C � w Hazardous Materials Inventory Sheet Checklist ; f 5(S g Date i �---Physical Street Address-Check database to ensure it 6x'ts Working Phone Number " Actual Amounts-( ie. gas being used to fuel machines, thinner to clean brushes all count as hazardous materials) Storage Information - location of storage, how long is storage for? J^ If none, note that. Disposal Information -where and who? If none, note that. Applicant Signature - understand i noted pp 9 d stand what s listed and of Staff Initial -any questions, know who to ask Vehicle Washing/Rinsing? -provide a vehicle washing policy and `explain it- note that it was given —b}�/Attach the Business Certificate with your sign off and comments **The inventory form should explain what the business consists of and the procedures th v are doino. Notes need to be left to explain what you discussed with them. YOU WISH TO OPEN A BUSINESS? For, Your Information: Business certificates (cost$30.00 for 4 ears). A business certificate ONLY REGISTERS YOUR NAME in town (which you must do by M.G.L.-it does not give you permission to operate: Business Certificates are available at the Town Clerk's Office, 1"FL., 367 Main Street, Hyannis, MA 02601 (Town Hall) r DA I 1 v Fill in please: J47, APPLICANT'S YOUR NAME/S: bw-6( BUSINESS YOUR HOME A^DD,yR�ESS:y �l, /C=� TELEPHONE # Home Telephone Number T)L1 UPS w NAME OF CORPORATION: NAME OF NEW BUSINESS ;� �_ ` xl t�d'i C"\ TYPE OF BUSINESS G.`f-ox)c IS THIS A HOME OCCUPATION? ��YE5,� NO ADDRESS OF BUSINESS;S� ,\ � i1 \� Ap/PARCEL NUMBER 9 y 5 ^ _4__(Assessing) When starting a new business there are several things you must do in order to be in compliance with the rules and regulations of the Town of Barnstable. This form is intended to assist you in obtaining the information you may need. You MUST GO-To_200-Ma_ in St.`- (corner of Yarmouth Rd. &Main Street) to make sure you have the appropriate permits and licenses required to legally operate your business in this town. 1. BUILDING COMMNER'S,017171%This individu I ln ' permit requirements that pertain to this type of business. MUST COMPLY WITH HOME OCCUPATION RULES AND REGULATIONS. FAILURE TO Au iz ig_na e** COMPLY MAY RESULT IN FINES. OMMENT ` f edg 2. BO D OF HEALTH This individual ha infor a pe it req ' tents that pertain to this type of business. Authorized Si nature** IHAZARDOUSMUSTMA MATERIALS REGULATIONS COMPLY WITH ALL COMMENTS: ULATIONS 3. CONSUMER AFFAIRS FNSING AUTHORITY) This individual hasin a of the licensing requirements that pertain to this type of business. Authorized Signature* COMMENTS: µt a, TOWN OF BARNSTABLE Date: TOXIC AND HAZARDOUS MATERIALS ON-SITE INVENTORY NAME OF BUSINESS: BUSINESS LOCATION:-_J `�1d �: C ��o �� ���� -�t`(�PC INVENTORY MAILING ADDRESS: SO v-so� - TOTAL AMOUNT- TELEPHONE NUMBER: `�" !AS3 CONTACT PERSON: (AS7 03Q� L,0_2C_" GG EMERGENCY CONTACT TELEPHONENUMBER:_� (-A MSDS ON SITE? TYPE OF BUSINESS:6-ioa 1 l�C1 INFORMATION/RECOMMENDATIONS: Fire District: Waste Transportation: Last shipment of hazardous.waste: Name of Hauler: Destination: Waste Product: Licensed? Yes No NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws of MA, hazardous materials use, storage and disposal of 111 gallons or more a month requires a license from the Public Health Division. LIST OF TOXIC AND HAZARDOUS MATERIALS The Board of Health and the Public Health Division have determined that the following products exhibit toxic or hazardous characteristics and must be registered regardless of volume. Observed/Maximum Observed/Maximum Antifreeze (for gasoline or coolant systems) __ Misc. Corrosive NEW USED Cesspool cleaners Automatic transmission fluid Disinfectants Engine and radiator flushes Road Salts (Halite) Hydraulic fluid (including brake fluid) Refrigerants Motor Oils Pesticides NEW USED (insecticides, herbicides, rodenticides) Gasoline, Jet fuel, Aviation gas Photochemicals (Fixers) Diesel Fuel, kerosene, #2 heating oil NEW - USED Misc. petroleum products: grease, Photochemicals (Developer) lubricants, gear oil NEW USED Degreasers for engines and metal Printing ink Degreasers for driveways &garages Wood preservatives (creosote) Caulk/Grout Swimming pool chlorine Battery acid (electrolyte)/Batteries Lye or caustic soda Rustproofers Misc. Combustible Car wash detergents Leather dyes Car waxes and polishes Fertilizers Asphalt & roofing tar PCB's Paints, varnishes, stains, dyes Other chlorinated hydrocarbons, Lacquer thinners (inc. carbon tetrachloride) _. NEW Any other products with "poison" labels Paint &varnish removers, deglossers (including chloroform, formaldehyde, Misc. Flammables hydrochloric acid, other acids) Floor&furniture strippers Other products not listed which you feel Metal polishes may be toxic or hazardous (please list): Laundry soil & stain removers (including bleach) Spot removers & cleaning fluids 1 (dry cleaners) �C Other cleaning solvents Bug and tar removers Windshield wash WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS f LOT 3216 \ \ \ LOT 37 C-5 \ ,20 65.0 �,• ,� _ \ I LOT 33 ............ , \ �, ti \ ... Y LOT 18 s 0� �y N89 7 7 016..E 140. 01 LOT 34 11 RES. ZONE.- 'RF This MORTGAGE INSPECTION Plan is For FLOOD ZONE- "c" T04Y'N: _QS�'�'P Banc; Use Only 1�4 _____ . R EG[S'I'R Y OWNER: CQ�VST.9NCE LL 4 67TT----------- *DATE: °DEED REF: _�' '. _��t�l, ---- --BUYER: 1-4-V11_,k_C�RQL ° ,�--------_�/�[/��_____ __ PLAN REF: _�c ��so SCALE i"=-30___FT. HEREBY CERTIFY TO PlY�Qs116!Lb1Q1'T��.E CQLI�pq,�VJ' �i�� yANKEE SURVEY ___THAT THE BUILDING SHOWN ON THIS PLAN IS LOCATED ON THE GROUND AS h CONSULTANTS SHOWN AND THAT ITS POSITION DOES _— C ON,F0R�i TO THE ZONING LAW SETBACK REQUIP.ENIENTS OF THE 40B (SUITE 1) TOWN OF ___84h'NST4 E_________ —__AND THAT r�' I-'DUSTRY- ROAD IT DOES_ NOT LIE WITHIN THE SPECIAL FLOOD HAZARD lq �o�' MARSTON'S MILLS, MA 026-48 AREA AS SHOW, ON THE H.U.D. MAP DATED 4ZZ 9YA Su TEL 42 _ � 8—0055 Lp'� onit --Pa ?�0001 0015 C FAX. 420-55-5.3TH[S PLAN SOT MADE FROM AN IISTRUMEVT ri A. k7lE 1,rHEW PI --"'—r' :zL'R�'F..1'. SOT TO BE t:SED FOR FF.��CES. ETC 24 11 CB 24-01W - W-0 UB' t2' 17-7 SIB' A 5n 2W JM 13n -2 ttnb'�}�z•-8T•}-� -B tsn LLJ 7 I I I 1 - 1 � - I � I I - I 1 p o 9 I I o 0 I ^� o I I aaa I I \ I �3' r-0 sna eA $-BA7H sv tr��7k E— t W-3I P ----- KITCHEN ----- i^� FAMRV �'Q V I GARAGE i i@ ---- --- -- ------ -----YS-H•s J.Y--- --- --------- Il7v2r4rg I S LIDV `-`'J � - i I DECK I it I I I - as:Ja• I � 1 ` I I I - - - - UVINGAREA 'WORD I - t`t e- i �Rop0 55- LAI45 1N 3 COMMONWEALTH OF MASSACHUSETTS j EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIR. DEPARTMENT OF ENVIRONMENTAL PROTECTI ONE WINTER STREET, BOSTON MA 02108 (617) 292-5500 �A �o yJ WILLIAM F.WELD boo �v� tUDY CORE Secretary Governor ARGEO PAUL CELLUCCI DAVID B. STRUHS Lt. Governor Commissioner SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM P PART A CERTIFICATION ` 1 Property Address: 3 1e��`0.- I \�'�- Address of Owner: Date of Inspection: 18 l�` %cO (If different) Name of Inspector: tom` 1e _tic k CN I am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000) Company Name: C L Mailing Address:-p -i X a.��'�� rl!r Telephone Number: n �—��1 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true. accurate and complete as of the time of inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. The system: Passes Conditionally Passes _ Needs Further Evaluation a Local Approving Authority _ F 'is t Inspector's Signatur Date: The System Inspector shall submit a copy of this inspection report to the Approving Authority within thirty (30) days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the Department of Environmental Protection. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. INSPECTION SUMMARY: Check A, B, C, or D: A] SYSTEM PASSES: I have not found any information which indicates that the system violates any of the failure criteria as defined in 310 CMR 15.303. Any failure criteria not evaluated are indicated below. COMMENTS: 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. Indicate yes, no, or not determined (Y. N, or ND). Describe basis of determination in all instances. If"not determined", explain why,not. The septic tank is metal, unless the owner or operator has provided the system inspector with a copy of a Certificate of Compliance (attached) indicating that the tank was installed within twenty (20) years prior to the date of the inspection; or the septic tank, whether or not metal, is cracked, structurally unsound, shows substantial infiltration or exfiltration, or tank failure is imminent. The system will pass inspection if the existing septic tank is replaced with a conforming septic tank as approved by the Board of Health. (revised 04/2S/97) Page 1 of 10 N Printed on Recycled Pacer r ` 9 > SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) . Property Address: Owner: Date of Inspection: BJ SYSTEM CONDITIONALLY PASSES (continued) _ Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. The system will pass inspection if(with approval of the Board of Health). Describe observations: broken pipe(s) are replaced obstruction is removed distribution box is levelled or replaced The system required pumping more than four times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): broken pipe(s) are replaced obstruction is removed C) FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect the public health. safety and the environment. 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM IS NOT FUNCTIONTs;G IN A • MA.N'NER WH'CH "'ILL PROTECT THE PUBLIC HEALTH AND 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 APPROPRIATE) Y D DETERtiIINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECTS THE PUBLIC HEALTH Al SAFETY AND THE ENVIRONMENT: The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet to a surface water supply or tributary to a surface water supply. _ The system has a septic tank and soil absorption system and the SAS is within a Zone I of a public water supply well. _ The system has a septic tank and soil absorption system and the SAS is within 50 feet of a private water supply well. _ The system has a septic tank and soil absorption system and the SAS is less than 100 feet but 50 feet or more from a private water supply well, unless a well water analysis for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm. Method used to determine distance (approximation not valid). 3) OTHER (revised 04125197) Page 2 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: Owner: Date of Inspection: D] SYSTEM FAILS: You must indicate either "Yes" or "No" as to each of the following: I have determined that the system violates one or more of the following failure criteria as defined in 310 CMR 15.303. The basis for this determination is identified below. The Board of Health should be contacted to determine what will be necessary to correct the failure. Yes No Backup of sewage into facility or system component due to an 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 1/2 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 Soil Absorption System, cesspool or privy is below the high groundwater. elevation. Any portion of a 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 I 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. If the well has been analyzed to be acceptable, attach copy of well water analysis for coliform bacteria, volatile organic compounds, ammonia nitrogen and nitrate nitrogen. E] LARGE SYSTEM FAILS: You must indicate either "Yes" or "No" as to each of the following: The following criteria apply to large systems in addition to the criteria above: The system serves a facility with a design flow of 10,000 gpd or greater (Large System) and the system is a significant threat to public health and safety and the environment because one or more of the following conditions exist: Yes No 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 II of a public water supply well) The owner or operator of any such system shall bring the system and facility into full compliance with the groundwater treatment program requirements of 314 CMR 5.00 and 6.00. Please consult the local regional office of the Department for further information. (revised 04/25/97) Page 3 of 10 r v SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 31 Owner: (S.c. %1 V. Date of Inspection: g1�1cle Check if the following have been done: You must indicate either "Yes" or "No" as to each of the following: Yes No Pumping information was provided by the owner, occupant, or Board of Health. None of the system components have been pumped for at least two weeks and the system has been receiving normal flow rates during that period. Large volumes of water have not been introduced into the system recently or as part of this inspection. As built plans have been obtained and examined. Note if they are not available with N/A. The facility or dwelling was inspected for signs of sewage back-up. _ The system does not receive non-sanitary or industrial waste flow. The site was inspected for signs of breakout. All system components, excluding the Soil Absorption System, have been located on the site. The septic tank manholes were uncovered, opened, and the interior of the septic tank was inspected for condition of baffles or tees, riaterial of construction, dimensions, depth of liquid, depth of sludge, depth of scum. —The size and location of the Soil Absorption System on the site has been determined based on: The facility owner (and occupants, if different from owner) were provided with information on the proper maintenance of Sub- Surface Disposal System. l� Existing information. Ex. Plan at B.O.H. _ Determined in the field (if any of the failure criteria related to Part C is at issue, approximation of distance is unacceptable) [15.302(3)(b)] (revised 04125/97) Page 4 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: ?j � ,�• 1 Owner: Date of Inspection: FLOW CONDITIONS RESIDENTIAL: Design flow: 3O p.d./bedroom for S.A.S. Number of bedrooms:O�j Number of current residents:OS - Garbage grinder (yes or no): t-1w Laundry connected to system (yes or no):� Seasonal use (yes or no): IJ Water meter readings, if available (last two (2) year usage (gpd): N Sump Pump (yes or no): tJ Last date of occupancy:4.-JT COMMERCIAL/INDUSTRIAL: Type of establishment: Design flow:_ allons/day Grease 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)_ Water meter readings, if available: Last date of occupancy: OTHER: (Describe) Last date of occupancy: GE\'ERAL INTOR.MATION PUMPING RECORDS and source of information: I '--,- System pumped as part of inspection: (yes or no) INV If yes, volume pumped: Gallons 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) I/A Technology etc. Copy of up to date contract? Other APPROXIMATE AGE of all components, date installed (if known) and source of information: ± ���g Sewage odors detected when arriving at the site: (yes or no) 1`' (revised 04/25/97) Page 5 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 3 Owner: y W;T Date of Inspection: BUILDING SEWER: (Locate on site plan) Depth below grade: Material of construction: _cast iron_40 PVC _other (explain) Distance from private water supply well or suction line Diameter Comments: (condition of joints, venting, evidence of leakage, etc.) 'SEPTIC TANK:�C S (locate on site plan) Depth below grade: Material of construction: ,concrete _metal _Fiberglass _Polyethylene —other(explain) If tank is metal, list ace_ Is age confirmed by Certificate of Compliance _(Yes/No) Dimensions: C�OC.) g 10% 1 Sludge depth: Distanct from top of sludge to bottom of outlet tee or baffle: Scum thickness: Yl Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: �y How dimensions were determined: OA jL "•ti. Comments: ffl (recommendation for pumping. condition of inlet and outlet tees or baes, depth of liquid level in relation to outlet invert, structural integrity. evidence of leakage, etc.) _ ov i GREASE TRAP:- r (locate on site plan) Depth below grade: 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: Comments: (recommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity. evidence of leakage, etc.) (revised 01125/97) Page 6 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: Owner: Date of Inspection: TIGHT OR HOLDING TANK:_ (Tank must be pumped prior to, or 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/day Alarm level: Alarm in workine order_ Yes, _ No Date of previous pumping: Comments: (condition of inlet tee, condition of alarm and float switches, etc.) t'ISTRIBLMON BOX: _ (locate on site plan) n Depth of liquid level above outlet invert: �tj JI wk 0%,TA-c:T Comments: no level and distribution 's equal, evidence of solids carryover, evidence of leakage into or out of box, etc.) -%C, - Cy.rjz5, ♦ Lc�12�2 PUMP CHAM 3ER:_ O (locate on site plan) Pumps in working order: (Yes or No) Alarms in working order (Yes or No) Comments: (note condition of pump chamber, condition of pumps and appurtenances, etc.) (revised 03/ZS/97) P2ge T of 10 L SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: \ ►���� Owner: (Qt,,,,,i 1TT Date of Inspection: g A'-t\4 j SOIL ABSORPTION SYSTEM (SAS): (locate on site plan, if possible: excavation not required, but may be approximated by non-intrusive methods) If not determined to be present, explain: Type: leaching pits, number:111"k . leaching chambers., number:_ leaching galleries, number: leaching trenches. number,length: leaching fields. number, dimensions: overflow cesspool, number: Alternative system: Name of Technology: Comments: (n to condition of soil. signs of hydraulic failure, level of ponding, condition of ve tat,o , etc.) CESSPOOLS:..1ti� (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 (cesspool must be pumped as part of inspection) 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.) (revised 04/25/97) Page 8 of 10 • A � SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C 4 SYSTEM INFORMATION (continued) Property Address: 31 L-71!'A�V-O—A Owner: La-ca.%1 Date of Inspection: S ky`ol, SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent references landmarks or benchmarks locate all wells within 100' (Locate where public water supply comes into house) Z 16 �L\ (revised 0312S/97) P2gc 9 of 10 n - SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 31 Uw14,aj Owner: C9. V lTJ Date of Inspection: 1 , .,. , Depth to Groundwater !�et Please indicate all the methods used to determine High Groundwater Elevation: Obtained from Design n Plans on record g Observation of Site (Abutting property, observation'hole, basement sump etc.) Determine it from local conditions Check with local Board of health Check FEMA Maps Check pumping records Check local excavators, installers Use USGS Data /Dtes_c'ribe in your own words how you established the High Groundwater Elevation. Must be completed) (revised 04125/97) P2ge 10 of 10 TOWN OF BARNSTABLE LOCATION S C.aA j,cja.cA t-�X1_ SEWAGE # VILLAGE �� �L�V L �.— ASSESSOR'S MAP& LOT INSTALLER'S NAME&PHONE NO. ESEPTIC TANK CAPACITY LEACHING FACILITY: (type) mPtrt' (size) 1C)0Q 2,A14 NO.OF BEDROOMS 3 BUILDER OR OWNER Gl Ul PATE: `'� I � COMPLIANCE DATE: Separation Distance Between the: . Maximum Adjusted Groundwater Table an 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 �� '�'� s;ks g�— LOCATION SEWAGE PERMIT NO. _% p 1 33 f 44 e i rC "7� �l 0 VI L L A G E I N S T A LLER'S NAME & ADDRESS Co HA W.Ic� B U I L D E R OR OWNER i DATE PERMIT IS LIED DAT E COMPLIANCE ISSUED � �a�_ 7 ���,,� 3Act A� 31' s4 � �T 4 AP . No....... ............ 0�q THE COMMONWEALTH OF MASS HEA CHVSETTS BOARD F L,/TH T ............................. V., 0% --—------ OF..... AVV tration for Ditipaual Works Tonstrurtion jhrutit 4— Application is hereby made for a Permit to Construct (e—r'®rRepair an Individual Sewage Disposal Syste5ali ,X ,;&, ... ................... .a, "'t ....................................... ... .. ... Loc;.io ddr.ess pr Lot No. .................................. .............. . . ....... ................ Address �, A,9�;Per Ad ress ... ............. d ................................... ........rur...7:.- ............/P re 7 4-010-7 rS-q. feet Installer Address T of Building Size Lot.._.../1-4............... Dwelling—No. of Bedrooms........_3-------------------------------Expansion Attic Garbage Grinder Other—Type of Building ............................ No. of persons............................ Showers Cafeteria Otherfixtures .....o�v�- �_ ------_----_-_----------------------------------------------------------------------------------------------------- Design Flow...............r-,d--------------_-----gallons per person per day. Total daily flow.............13. _Q_-----_--------gallons. Septic Tank—Liquid capacit/Z% ----�a Ions Length---------------- Width........._...__. Diameter._____________-- Depth......_.._...... Disposal Trench—No. .................... Widj ------------------3. Length_._......�-/------ .�iwal Le h otal leaching area....................sq. f t. 4do ?_001F Total leach Seepage Pit No jjritz�--------- g ea.->.O.S.....sq. ft. Z Other Distribution box Dosing tank I g �_4 .::......4.. . t................ Date._3.—(F.:n,?J*............... $4 Percolation Test Results Performed by---�.Z Test Pit No. I................minutes per inch Depth of Test Pit.____......_........ Depth to ground water.._........__._.......... Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water....._.............._._. ..................................................... 0 Description of Soil - On__9��--- W - - '** "Z7, " ... .... .. ..... U ­*Y ....0....... /lkw kz- J ---------------------------------------------------------------------------------------------------------------- .......................... ........................................................................................... ................................................................................. U Nature of Repairs or Alterations—Answer when applicable............................................................................................... ....................................................................................................................................................................................................... Agreement: ,-I The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TLITU 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. Sig ...... .......... ........................ Date Application Approved By........ ...... yw! ... .................... ----------jF.-7C.............. Date Application Disapproved for the following reasons:............................................................................................................... ......................................................................................................................................................................................................... Date PermitNo................................................... Issued-------------------------------------------------------- Date olk'l No.---- ._....... Fim............................_ THE COMM0114WEALTH OF MASSACHUSETTS BOARD PF HEALTH ..........7Z�......Of ........................... J�Vplira#ion for Dig as al Works C omtratrtion thrmit Application is hereby made for a Permit to Construct (4- or Repair ( ) an Individual Sewage Disposal System at f ----- ------•---------- ...................e�2 ....................................... Locatio�ddress r Lot No. Y'?1..�':.. ..e.�.''." :................................• ----•------.:....�^.._ .... t................................................. er Address t Installer /` Address Type of Building / Size Lot____r.................. q. feet U .. Dwelling—No. of Bedrooms........_. ---------------------Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ........................... No. of persons............................ Showers ( ) — Cafeteria ( ) Q' Other fixtures -____ d - - -------• •••••••-•••---•--••--•-•--•-•••-•......-•••••......--•-•.................•--••............ ------------------- W Design Flow...............r-6-.-.--.----.---•-_-gallons p -:-•r person per day. Total daily flow._._._......_ . . .......................gallons. WSeptic Tank—Liquid capacity/ a Ions Length................ Width................ Diameter................ Depth................ j x Disposal Trench—No. .................... Widt tal Length .... otal leaching area....................sq. ft. Seepage Pit No 1.�- Hia� . - ..eal' gya . � ----�------- -«-------- . is+iar�to of � � �®- q• .__s ft. Z Other Distribution box ( ) Dosing ta41 N ` _ 7, .- Percolation Test Results Performed by...... ':. __ `" _.•_•........ Date........................................ Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water......................... (% Test Pit No. 2................minutes per inch Depth of Test Pit .............. Depth to ground w ter ................................. f W O Description of Soil..........n....(,_ ,t ? _:" . Ux " 1�sP....Et.?Itt UW ------------------------------------------------------------------------••••••---- -•--••......-•••-•;-•-•••••••--------------••----•-••••--•-•••---••••-••--•--••=••---••••••......--•--•-•••--•----••- Nature of Repairs or Alterations—Answer wl en applicable------------------------------------------------_................................................. .......................................... -----------------------••-•................. Agreement The undersigned agrees to install the af`redescribed Individual Sewage Disposal System in accordance with the provisions of TITiE 5 of the State Sanity y Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has een issued by the board of health. healt gne ;&� ...... �....t.�...�---- Application Approved By..... • ------------- .. ••-•-•............-•---••-•-•--•-- Date Application Disapproved for the following real ns:........................................•------•---•-••----•••••-•-•-•--••••.............•-•••••.......•. -----------------j-•-••-••--.........•••---••••----•-•-•-----••••-•--••••--••-••---••----•-••••-•;-.........------ Date Permit No................................ . Issued--------------...... . -------------- ----- Date -•-----••----......-•-•------- THE COMMO WEALTH OF MASSACHUSETTS ` BOARD OF HEALTH (9rrfifi att.of (91intpliFanrr THIS 1 TO at t th div ual Sewage Disposal System constructed or Repaired ( ) byx ,... ,r ------------------- 11,0 --- has been installed in accordance with the provis ons of TITLE yr-"`f e,,State Sanitary Codey_d*crib n,the application for Disposal Works Construction Pe mit No---------—-----------�.1`.._... dated---------- ................... ------------------ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE............................................................................---- Inspector................................................................................... THE COMMO WEALTH OF MASSACHUSETTS BO RD OF HEALT 7� a. -t0 ... .... . {_ '....................... No.. Jf• FE :5^.... Bio�roo�tl o ko Cho tr ion anti Permission is h granted .: ... c•G ........r, ._ to Construct Repair Indivl 1 S .wage Dispos System P ... treetat `. . as sho on the application for Disposal Works Construction Per ______________ D e 4-- 0 �` —/ Board of Health DATE...... ----•• «! VVVV FORM 1255 HOBBS & WARREN. INC., PUBLISHERS ' '• 3 L- G1U,Gl_� Z ill�.�{ FLoW I Ib >< 3 t 330 G��• � �i 7' `�� . . . .4 ���rlc `r'ta,,,►� = 330.. Inc % = 45�5 6.Pv. � , ; . ; 'O,r ,.,� . . , USE= 100c- 64,1-.. 3 f ' TOT,&L -u;,e-S16►J r- 4'L5 f 7C>Ta 1- 330 F,•PU. s GEfdGDI.�TIOtJ QATE sw I-MIW• 02 LE�I�i i I t ('c _ •V ` 9 1I I , t �-:' �4P�� ''t{5��. I t � M ' ( t { !-,_(.. i + �' I• I.,t.,l t i, I � OF � v /'f k. � RICHARD ts�� f qG� ^M AN °v �) tP y I s i t tK t c� BAXTER No.2404R ry . 1 I Tom Fwv. { %7,00 - in...iiri.. r : .- _ . �j��PivE . -• .__.,._. .._-_.cam.,,. iydO 4 IW. CG�,ory 9C•7d. { '• k ! 11�I ci iT r } . '% •r0/V + ' A5 JG�"1.fr.. - .1. 1 L • ! t/ ' .t{ 1 Y i 9S,ga Iwvif T'AWK j i loop 9Soa lad' :. I,lv' Meta GAL. 1 ; 1 t Yf L f t i 1/�/ITLa � � 7 i �.,.�. a .q . I l E ! t ` ( •f _ ._y I "4 t, � ., i Woo ,1 fA% lz , I i�t..../1h.1 I y , i•. ' Ptizo�-1�.� � i �� -�.. LorAT1O"". .OSTERYI LL-E I h ,5�A L k= L N.f GO, FT it 3 :NO wAl'ER IL/Lo/77 PRuPos a l> r GGiZTI h -,I TI4A-r" TkG P:ovN PA-Tlo)-X 5taotiuW T WZ-2 t-_tSoJ' 4fC�&%Pi.-(G ►.l<r Aua. SEA t�yn�t�. . aAAEl"Ty oir -r 4e,'O Q'S �1✓ ��v I 8 A.)(T E P, � � , i .. , � '_ RC.GIS•t•CtZED i.AIJG 5U2V�YaILS aN'p e- 9- �[ DEK Etr GQ•. L•-c U-�s✓i� ►G l7r''}.l'_:Cit,�1 1,; LC� l l�tt=- _,�.i;..-a,...,v.._._.. i:.-.� I r _.j' C NOTES SYSTEM PROFILE ALL SYSTEM COMPONENTS SHALL BE MARKED WITH MAGNETIC TAPE OR PROVIDE MIN. 20" DIAM. WATERTIGHT (NOT TO SCALE) COMPARABLE MEANS FOR FUTURE LOCATION. 1. DATUM IS ASSUMED orlisle ACCESS COVERS TO WITHIN 6" OF FIN. GRADE 2" PEASTONE OR GEOTEXTILE CONCRETE COVERS TO WITHIN 3" GRADE 2. MUNICIPAL WATER IS EXISTING Locus \ TOP FOUND. EL. 43.0' FILTER FABRIC OVER STONE 3. MINIMUM PIPE PITCH TO BE 1/8" PER FOOT. Route 28 MINIMUM .75' OF COVER OVER PRECAST 2% SLOPE REQUIRED OVER SYSTEM 37.5' 4. DESIGN LOADING FOR ALL PROPOSED PRECAST - , UNITS TO BE AASHO H-LQ PRECAST H-10 NOTE: MIN. WALL THICKNESS 2" BLOCKS OR RISERS (1YP•) PRECAST RISERS 5. PIPE JOINTS TO BE MADE WATERTIGHT. 35.86 4"OSCH40 PVC MORTAR ALL w PIPES LEVEL 1ST 2' COMPONENTS - ° y�o 4 (TYP•) 7' 2.5' 6. CONSTRUCTION DETAILS TO BE IN ACCORDANCE y �� 5 :..• ENDS SIDES 4.5 ° 5 10" EXISTING 14 r WITH 310 CMR 15.000 (TITLE e°.°. TEE SEPTIC TANK TEE o°°°000° 0 000 0' °°°°°000° + : ## f p• p p o o°o o p O >°o°o°o°o gumP$ 34.46t * O®a® ®:Rn 0 °° °�° ®®� -���® ° ° ° ° 7. THIS PLAN IS FOR PROPOSED WORK ONLY AND> 0 0 0 0 0 0 ) O G O O .. O O O O O O °O°O°O°O � OC°°U O ® O ° 000 000OOOO 0 0 O O O G O OO O O O OO O G ° ° ° ° ° ° G ° NOT TO BE USED FOR LOT LINE STAKING OR ANY GAS BAFFLE::: °o°o�0�0�04 °°°°°°°° aaoommE1m ® °<°°°° a®a® oa®oao .°°°°°°°G>°°°°°°°G °0O°O° °° O°°°O OTHER PURPOSE.>o°o°o°o° oo�oor�a® � °o ®®oa oMMa®a °0°0° U� s 7. 34.29 34.12 ° ° O O °7°°° G_G_°_° 31.67 Ro s' MIN. SUMP I 8. PIPE FOR SEPTIC SYSTEM TO SCH. 40-4" PVC. t2" MIN. wT. DIM. L H-10 500GAL. LEACHING CHAMBER BY ACME PRECAST OR EQUAL. 9. COMPONENTS NOT TO BE BACKFILLED OR 3/4"-1-1/2" DOUBLE WASHED STONE (2) UNITS REQUIRED CONCEALED WITHOUT INSPECTION BY BOARD OF 6" CRUSHED STONE OR MECHANICAL OVERALL DIMENSIONS TO OUTSIDE OF STONE: 30' X 9.83' HEALTH AND PERMISSION OBTAINED FROM BOARD OF HEALTH. COMPACTION. (15.221 [21) N 'ci 10. CONTRACTOR SHALL BE RESPONSIBLE FOR (4.3 % SLOPE) ( 3 % SLOPE) CALLING DIGSAFE (1-888-344-7233) AND LOCUS MAP VERIFYING THE LOCATION OF ALL UNDERGROUND - FOUNDATION EXIST. SEPTIC TANK 4' D' BOX 17' LEACHING OVERHEAD UTILITIES PRIOR TO COMMENCEMENT OF NOT TO SCALE FACILITY 26.0' BOTTOM TH-2 WORK. *THE INSTALLER SHALL VERIFY. THE LOCATIONS OF ALL **INSTALLER SHALL CONFIRM MINIMUM SEPTIC TANK SIZE AT NO GROUNDWATER FOUND 11. ANY UNSUITABLE MATERIAL ENCOUNTERED ASSESSORS MAP 145 PARCEL 64 UTILITIES AND ALL BUILDING SEWER OUTLETS AND ELEVATIONS 1000 GALLONS AND ITS SUITABILITY FOR RE-USE. REPLACE SHALL BE REMOVED 5' BENEATH AND AROUND THE PRIOR TO INSTALLING ANY PORTION OF SEPTIC SYSTEM WITH 1500 GALLON SEPTIC TANK APPROPRIATE TO SITE PROPOSED LEACHING FACILITY. CONDITIONS IF NOT SUITABLE 12. EXISTING LEACHING FACILITY SHALL BE PUMPED AND REMOVED OR PUMPED AND FILLED WITH CLEAN LEGEND SAND. 99 - EXISTING CONTOUR X 99.I EXIST. SPOT ELEV. MAP 145 \ PARCEL 63 y,/ 5�E0 \ 99 PROPOSED CONTOUR \ SYSTEM DESIGN. \ MAP 145 198.41 PROPOSED SPOT EL. 52' / \ PARCEL 68 B P rH1 EXISTING GA MAP 145 \ GARBAGE DISPOSER IS NOT ALLOWED srocKAOE y. PARCEL 64 � �� TEST HOLE FENCE (TYP.) \ DESIGN FLOW: 3 BEDROOMS C°? 110 GPD = 330 GPD 0.42 AC/ \ USE A 330 GPD DESIGN FLOW 2� SLOPE OF GROUND " 0 ' / \O \\`n�`��2� r CTI) UTILITY POLE P Q \ SEPTIC TANK: 330 GPD (2) = 660 k. FIRE HYDRANT / \ \\ ** RE-USE EXISTING 1000 GAL. SEPTIC TANK NOTE: NOT ALL SYMBOLS MAY APPEAR IN DRAWING / 10" \ / AK \ LEACHING: SIDES: 2 (30 + 9.83) 2 (.74) = 118 GPD TEST HOLE LOGS s�E� I 1 ��� \ �� \ BOTTOM 30 x 9.83 (.74) = 218 GPD 0 �° TOTAL: 454 S.F. 336 GPD ENGINEER: DANIEL E. GONSALVES, SE #13587 44 PINE ��� o USE (2) 500 GAL. LEACHING CHAMBERS (ACME OR EQUAL) DAVID STANTON, IRS ,� �' �S" �, �� p% \ , WITNESS: `, 6 23 15 � ��oQ � F W \ � WITH 2.5 STONE AT SIDES,, 4 AT ENDS AND 5 DATE: / / BETWEEN UNITS I TH2 � � � �� PERC. RATE _ < 2 MIN/INCH � � N � � d d., T 1 CLASS I SOILS P# 13729 w_ ELEV. ELEV. �`'' -� M A " 37.5' 37.0' �' i h�. F APPROVED DATE BOARD OF HEALTH ' MAP 145 r PARCEL 49 FILL FILL � � TITLE 5 SITE PLAN 22pp 42 OF B B � 140.01 f ,� LS LS 5' REMOVAL OF UNSUITABLE SOIL REQUIRED EXISTING 31 GALAHAD CIRCLE 1 OYR 5/8 1 OYR 5/8 AROUND PERIMETER OF LEACHING FACILITY, TREE LINE 371f 34.4 48 33.0 DOWN TO SUITABLE SOIL,LAYER. .REPLACE � � O S T E R V I L L E MA WITH CLEAN MED. SAND, �TO MEET 7 SPECIFICATIONS OF 310 CMR 15.255(3) PREPARED FOR C BENCHMARK.- NAIL PERC SET IN TREE BORTOLOTTI CONSTRUCTION EL.=42.40 (NAVD 88) FS FS o� JORDAN DATE: JUNE 23, 2015 2.5Y 6/4 2.5Y 6/441H of Mgss�c � �(N OF MgSS9�y �ZH OF MgSS y� o DANIEL Gs �`� 9Cy off 508-362-4541 MAP 145 0 DANIELA. N /se G _ P .° OJALA �o A. o DANIE ��, fax 508-362-9880 PARCEL 65 / ;� OANI -A CIVIL " OJALA A. N downcope.com ®JAl�t No.40980 OJALA No.46502 0 • 32" civil o �� �< �� � °� ��,� �No.40 cape engineering, inc. 26.5 132 26.0' P!®, �_ °+sTb �``'. ti EsR' y� Ess� o SURV� . lq��o SURv civil engineers NO GROUNDWATER ENCOUNTERED Scale: 1 = 20 C y 9 �� . . � land 939 Main Street ( R to 6A) LICE # 15- 122 0 10 20 30 40 50 FEET DATE DANIEL A. OJALA, P.E., P.L.S. YARMOUTHPORT MA 02675 15-122 BORT-JORDAN.DWG