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HomeMy WebLinkAbout0220 NORTH BAY ROAD - Health (2) 220 NORTH BAY ROAD, OSTERVILLE A=073-010 o � 3- o r v �!/o'v—�o r l Fee- —`S--------------- BOARD OF HEALTH TOWN OF BARNSTABLE • �.��Cuation,for�e�Y �on�truct ion�erntit Application is herebx made for a ermit to Construct ( i,-rAlter ( ), or Repair ( )an individual Well at: y�, Location — Address Assessors Map and Parcel —/ — -- - ------ - _--- P� --- G/V Ad ress Installer Driller Address � Type of Building 63 Dwelling---------------------------------------------------- Other'- Type of Building /------------------------------ No. of Persons-----------------------------____________ Type of Well— --- --- —------- Capacity-- ' — Purpose of Well----- ------- -- ------------ Agreement: The undersigned agrees to install the aforedescribed individual well in accordance with the provisions of The Town of Barnstable Board of Health Private Well Protection Regulation — The undersigned further agrees not to place the well in operation until a ertificate of Compliance has been issued by the Board of Health. Signed —--- —-- -- —Lb-/C) date Application Approved By —} '--------- `U / date Application Disapproved for the following reasons: date Permit No. -- Issued---------------------------date - BOARD OF HEALTH TOWN OF BARNSTABLE (tertif icate ®f (!Comm " nce THIS IS T Q CERTIFY, That the Individual Well Constructed ( ), Altered ( ), or Repaired ( ) by----- ------ -- Installer has been installed in accordance with the provisions of the Town of Barnstable Board of Health Private Well /, —`'- Prot ction Regulation as described in the application for Well Construction Permit No. 4g =Dated Lam`- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORY. DATE----- - Inspector-----------__—_ —_— p` 3- 0to /f IYo.-- zlev a Fee-7=5--------------- F BOARD OF HEALTH TOWN OF BARNSTABLE.. fir. Application Ar Vell Con0ructionpermit .aw Application Is hereby, made for a�permit to Construct (c.4'Alter ( ), or Repair ( ')an individual'Well at: — = Location Addiesg t t Assessors Map and Parcel — 1 —le— jZ,//mil c � U A16) _ 4P Ow tlr Address —— Installer.— Driller Address ��/✓� Type of Building Dwelling------ --------------- ------------------------- Other'- Type of Building---------------------- No. of Persons-____ ______=------------______ -- -- - Type of Well---11�1 -' -------� - ------------ Capacity--- - -,�-----`i'�-�--------------- Purpose of Well---- Agreement: The-undersigned agrees to install the aforedescribed individual well in accordance with the provisions of The Town:of`Barnstable Board of Health.Private Well Protection Regulation - The undersigned further agrees not to place the well-ih.operation until a -ertificate .of Co pliance has been issued by the Board of Health. �b Signed � ----------- ----.. --- ----- Q date Application A roved.BY iei-"- PP. PP } - -- ---- / date �<Application Disapproved for the following reasons: ---- —=-----= - ------ --- date • .;,,.pro - Permit No. — Issued--- - - - ------ - - date is.!.4all.f:4i1e'/rLgx'!i9 Oo!!Lli9��i43 fySl6E3Ri! ?iiRi a_q_G!Rq!Pik'x!ima48,180xYi►bSGYlle:9i�iu Ai�p3lCiax•DSgNf�!ilgx6b yf.IRii!x4(.AOTnV%C7RiV9�9.�lrgml�l.`NxRitiff�q.4ire5�i9iT�9il.'Yn.!sa!^sT. BOARD OF HEALTH TOWN OF BARNSTABLE c�ertif irate ®f pomp ' ttce THIS IS TR CERTIFY, That the Individual.Well Constructed( ), Altered ( ), or Repaired ( . ) a by - -- ---- -- --- - ---------ll - Instaer -- i • has been installed in accordance with the provisions of the Town of Barnstable Board of Health Private Well/Protection Regulation as described in the application for Well Construction Permit No. THE ISSUANCE'OF.THIS CERTIFICATE SHALL'NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION.SATISFACTORY. . DATE---- = Inspector---=-- - --- —--- -- . _ '.;'_. .�" iii24su Ris.�?ESTb83TiSiAf�tRiii9a?i8i41aB7u9xJIG1RiQ!ieoa42�ieiwlGT,YSi9o4iF9iv�4afliai9i4:11�®�fx4x9a9i4�i�84. 9.a,.o?�b9i°!d"?Wa:;i?SN6? !Sr"a!&4L4alisi43.sa?S63i?$?`�*L?.% BOARD OF HEALTH TOWN OF BARNSTABLE Veil Con5truttionjermit No.-- Fee- — Permission is hereby granted ----- -----r�--- to Construct ( 1,61ter ( ), or Repair ( ) .an Individual W ll at:g No. Z /t/W K-h_��- � R;;w I street as shown on,the application for a Well Construction Permit No.- h ?<cJ tJZJ r © Dated °i' 7�?'`fw --- - - . -- - --- ----- ` -- Board of Health DATE 1 Desmond Well Drilling, Inc. �t Cape Cod Test Boring 5 Rayber Road P.O. BOX 2783 ORLEANS, MASSACHUSETTS 02653 (508)240-1000 P-0v PRoprr flu WA—L !fit & 00 �46-0-V- 'B-A-Y r COXIMON-WEALT. H OF ir1r1SShCHUSETTS �p EXECUTIVE OFFICE OF ENVIRONME_N AFF - - DEPARTMENT OF ENvIRONM ENTAL , 'OTE ,T1IIO�IV -- ONE WINTER STREET, BOSTON MA 02108;(617) 9 500�v(i 199.9 . ' 9Oy� DY CORE " a t �1 ti Secretary ARGEO PAUL CELLUCCI D B. STRUHS Governor ; = Conunissioner SUBSURFACE SEWAGE,DISPOSAL SYSTEM U_dSPECTION FORM PART A 07 of 0 CERTIFICATION � w y a Property Address: -ZD lvoa,7H 8/?Y h pU :. Name of OwnerH/Q CnI t R ,y ,Address of Owner: Date of Inspection: Name of Inspector:(Please Print) (�i(J�IQQ am a DEP approved system inspector pursuant to Section"15.340'.of Title 5(310 CMR 15.000) a ��� r r Company Name: i li�1Q� C. CJu�J•P/C_C D , MaaTing Address: tuNnp /V6 SA/UOU.1Cl/ 1774 Cu)5�3 Telephone Number: )3 CERTIFICATION STATEMENT �k 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 By;the Local Approving Authority _ Fails 19 Inspector's Signature:�� ro a`" 'Date* 77'�/�/ f F The System Inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)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 offfce-of the Department'of-Environmental:Protection: The"origi'naI should be sent to the" system owner and copies sent to the buyer, if applicable, and the approving authority. ISv � NOTES AND COMMENTS. l Sao; Gl�CC ru� S�PT�c T ?0 so�ios L?Cr�� { i , f z � 0 C. T�v µ L Enc ra C /0 h , ! 4`� rt "� �•a,r r , revised t9/2/98 ' �p '" a ragelofll a { Pnhte0 on Ri'gdea Paper y 4, f x �•s" , ,c.� I it1 �r, i n , a, ^u} , � [ .'En T i ,,r .it3 � 1 9r trl,t' - f SUBSURFACE SEWAGE DISPOSAL SYSTEM,INSPECTION FORM .. PART A CERTIFICATION (continued) s; Property Address: . euoerq g4, 2D, r. owner: D, @116'RY Date of Inspection: INSPECTION SUMMARY: Check B, C, or Al A. SYSTEM PASSES: have not found any information which indicates that any of the failure conditions'described in 310 CMR 15.303 exist. 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. e is tank is metal unless the owner or operator. has provided the system inspector with a co of a Certificate of _ The Sept tP Y- P PY 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 complying septic tank as approved by the Board of Health, _ 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). broken pipe(s) are,replaced obstruction is removed distribution box is levelled or replaced .:..__._ The system required pumping moie,than four timese 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 i.11 i.':iJt f It :hr ti. u) :�: I , %b Y � l:, tll - �.ep°�� ( n.1 f f t �! I � ,..., i, i:t't.f. .I- .. (.•1'. ... - ,I,i r, + �.;•..•; - . - lI ' t I revised 9/2/98 Page 1of 7rr::.t Itilri'I� : x u�. I I'I rt It: I _ jp „I�. .'i.. .i.,:i:'i r �;.o.r I Ir yl, a 111:.?4.li 41 r.:'S i N(- 1 e d Nv r l'.:I to t t QP, i • `.. R;'.li I il•, r n �rTJ 4 lii :4 I `�, ..:(i i.,J(,° :.d It:) ,I. Y.!It ,a.;! ., rs `Se I.I I`o oil -,1A4 Ut I.. I .° SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A "CERTIFICATION(continued) Property Address: , aj0 111o2TN ef�t' f�D, f Owner: D. Ei'► ez41 Date of Inspection: C. FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: Conditions exist which require further evaluation by the Board of Health in order to determina if.the system is failing to protect the public health, safety and the environment. 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES IN ACCORDANCE WfTH.310 CMR 15.303(1)(b)THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: _ Cesspool or privy is within 50 feet of surface water. M 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 AND SAFETY AND THE 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 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 aseptic 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).' r ». ... 3) OTHER r i3 I �P t ..,��•- � , �' i; 1 il(IIyJ .i1 1p6 �;IPSI 3 d: l �:, t 11�Ihf IIr iu€i.i9:( 1 1_?. W I !1 s 1 1 x y i� .-j c 11 r; 'f 1 'i 1 nii',i 'si � sl';; t i,'1 1 r .•s5 !il ..'rr . s revised 9/2/98 Page 3of11 0tl SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A I CERTIFICATION (continued) 1 , �� � . Property Address: � © NV2 r7/ Owner: Di ClneRy d Date of Inspection: D. SYSTEM FAILS: You must indicate either"Yes" or "No" to each of the following: , I have determined that one or more of the following failure conditions exist as described 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. i 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 thisurface 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 1l2 day flow. .Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).. Number of times pumped_. i 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 60 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" 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 iSystem),,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 11 of a public water supply well) The owner or operator•;of any such system shall upgrade the system in"accordance,with,310tCMR 15:304M. Please c6nsult4he local'regional office of the Department for..further,inforrmation.' I:~`!-.t-'r ''.+.i s'` .;,,' ai , r,,.,,,r,4 s. t'a!• t „ ,:,.r i,; t , L.J'rl itii�.!I•r e ,ael , v, dJ. •, 't. :7 ,:U� ;9i,� 45-;1 .,� i '::d'; 1sa ,`.l!' ( )i_J,7!' revised 94/2/9'$i pagiaof11 - .Itli .. • (n.l air ,4 I f7@ + :t � ,+ is f.t( r1 .; ;!7 t., „ i .,L re�_r ti's_:,+,., v ' •r , SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART.B CHECKLIST Property Address: 2tat O W OR 1 4 Bay Abi. Owner: Date of Inspection: ,7 Check if the following have been done: You must indicate either! Yes or No",as to eachof thefollowing. t' ' 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 buili 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.° Y _ The site was inspected for signs of breakout.., _ All system components, 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, material 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: _ Existing information. For example,,Plan at B.O.H. _ k 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)) c — The facility.owner.(and occupants, if.different from owner) were provided with information on the proper maintenance of SubSurface Disposal Systems: " V a it!A a• revised °9/2/98 llr,!, asc5ofI , F r ` d I'U11, d +; ! !j,c, I .r'P.,r, •A . :{1 I+..!I ,. T ! :1 { SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C t SYSTEM INFORMATION Property Address: ddo NO,eT/-1 64 RI) Owner: b,CMCey i' « Date of Inspection: C i FLOW CONDITIONS RESIDENTIAL: Design-flow: � g.p.d.lbedroom. Number of bedrooms(design): Number of bedrooms(actual): S Total DESIGN flow Number of current residents:_ Garbage grinder(yes or&):/No Laundry(separate system) (yes orQ AO; If yes, separate inspection required Laundry system inspected (yes or no) Seasonal use(yes or 6): + . Water meter readings,if available (last two year's usage(gpd): Sump Pump(yes or(q): Last date of occupancy: 1( OCC✓/ iUo COMMERCIAL/INDUSTRIAL: Type of establishment: Design flow: gpd ( Based on 15.203) Basis of design flow 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: GENERAL INFORMATION PUMPING RECORDS nd source of information: / olcl,- System pumped as part of inspection: (yes or 40_ „ If yes, volume pumped: gallons e . ,. Reason for umping TY�'EpF SYSTEM _ + Septic tank/distribution box/soil absorption system Single cesspool ` Overflow cesspool Privy Shared system (yes or no) (if yes, attach previous inspection teoords,it any) I/A Technology etc. Attach copy of up to date operation and maintenance contract. Tight Tank Copy of DEP Approval F i Other j +, APPROXIMATE AGE of all components, date;installed(if known)-and source'of information: yrj —6o(LT Sewage odors detected when arriving at the site:(yes-orap-&Vi. r. revised 9/2/98 Pagc6 or fi i SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C / SYSTEM INFORMATION(continued) Property Address: Icy Owner: A E41 c;,ev i Date of Inspection:.7,Z 6 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:_,K (locate on site plan) Depth below grade:�2'C'/5 Material of constructiow1concrete_metal Fiberglass _Polyethylene_other(explain) If tank is metal,list age Is age confirmed by Certificate.of Compliance_(Yes/No) Dimensions: l o�6 L k S r6"W, Sludge depth:—/rrVC� �7 Distance from top of sludge to bottom of outlet tee or baffle: Scum thickness: 0 10;(44-S Distance from top of scum to top of outlet tee or baffle4lop(OF C 101 Ur0� lucgS' Distance from bottom of scum to bottom of outlet tee or baffle op OF 0QU-N /y /fuc t-a's How dimensions were determined:' 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:) :/I/VK /S /iy V64IV 66"00 SAOPF, /UO S©LIDS f P VC TEE 01200 1?r fbr701 nF GREASE TRAP: (locate on site plan) I Depth below grade:_ Material of construction: concrete metal_Fiberglass,..yPolyethylene•''' •othdr(enplain) Dimensions: Scum thickness: Distance from top of scum-to top of outlet tee or,baffle: s + Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping: Comments: t F (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.): -` i' .:I+,•.f. Al�' � .� �f,llft. t it'e.; revised 9/2/98' Page7'orll S UBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 2,?o 619 Owner: Qi L iy76-Py 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:_ s Material of construction:_concrete=metal_Fiberglass_Polyethylene_other(explain) Dimensions: Capacity: gallons Design flow: gallons/day Alarm present Alarm level: -Alarm in working order:Yes No_ Date' f previous pumping: } Comments: (condition of inlet tee, condition of alarm and float switches,etc.) I DISTRIBUTION BOX: (locate.on site plan) . Depth of liquid level above outlet invert: /T 60176)Vl 6F Pr�C� Comments: (note if level and distribution is equal, evidence of solids carryover, evidence of leakage into or out of box, etc.)' D-6a< , (Ica Y Ga"o co/voill()yo' , UVE &P 01LIE Pi PE OV7- r PUMP CHAMBER:_ (locate on site plan) Pumps in working order:(Yes or No) Alarms in working order(Yes or No) mif 1, ' Comments: i 1#1 i:i:;ts n,.ar-ltr.. ,:J 15 (note condition of pump chamber,condition,of pumps and appurtenances,etc.) _. •r. r H r 11'r,7 ,i i fl 1. ^ � - - revised '9/2 Page 8orll SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C / p SYSTEM INFORMATION(continued) . Property Address: ��2�1 DR� RJD owner: D, 01160y Date of Inspection: a q—f j4q SOIL ABSORPTION SYSTEM(SAS) (locate on site plan,if possible;excavation not required,location may be approximated by non-intrusive methods) r If not located, explain: ,. Type: j leaching pits, number,_ leaching chambers,number:_ leaching galleries,number:- leaching trenches,number, length: leaching fields, number, dimensions: overflow cesspool,number:_ Alternative system: Name of Technology: co Comments: (note condition of soil,.signs of h draulic failure, level of ponding, damp soil, condition of v etation, etc.) ��► SiCrUS 6F NYO Rc,�CI� f;9�cv�?E. site is DRY 4/6P0,v0iiu6 CESSPOOLS:_ (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) e Comments: (note condition of soil, signs of hydraulic failure,level of ponding, condition of vegetation etc.) PRIVY:_ (locate on site plan) F Materials of construction: Dimensions: Depth of solids: r i Comments: r . (note condition of soil;,signs of;,hydraulic failure,level-of ponding, condition of,vegetation,•etcP)'' I{ t i 0, . revised 9/2/98 i, ;; : Pagc9of11 „ 1 .s SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 2,20 /Lok*7z/64,v oQQ� Owner:Date of Inspection: '7-a2y`/999 SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent reference landmarks or benchmarks locate all wells within 100' (Locate where public water.supply comes into house), R i ,. AST eND 3; 3 55 ?..vJi '.I`.,. rt:.'LI i s revised- 9/2/98� Page 0of1l 3 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART,C SYSTEM INFORMATION(contiraied) Property Address: ��o UPPY �Dr Owner: .D,C-mc-gY C, Date of Inspection: NRCS Report name Soil Type_ Typical depth to groundwater . USGS Date website visited Observation Wells checked Groundwater depth: Shallow Moderate, Deep SITE EXAM Slope } Surface water ' Check Cellar Shallow wells } Estimated Depth to Groundwater Feet Please indicate all the methods used to determine High Groundwater Elevation: c Obtained from Design Plans on record,. Observed Site (Abutting property,observation hole,basement sump etc.) Determined from local conditions f Checked with local Board of health Checked FEMA Maps c. Checked pumping records Checked local excavators,installers Used USGS Data ..•. Describe how you established the High Groundwater.Elevation..(Must be completed). A H C Pugn;S. FR � U- , [/USMtL;197-101V JI ' revised, 9/2/98 rage lleru II COMMONWEALTH GF IJASSACHi SETTS 9 EXECUTIVE OFFICE OF ENVIRONMENTAL AF �p DEPARTMENT OF ENVIRONMENTAL PROTE °N 0 — ONE WINTER STREET, BOSTON MA 02108 (617) 292-5500 � AU aF 19ID - ... 'teary /US%�BLC A DAVID T UHS ARGEO PAUL CELLUCCI Governor sinner r, SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION LP Z L"t/O i PART A r CERTIFICATION 4 Property Address:2)Q Nary r RD f Name of Owner 'P,C-/17CR y p ; Address of Owner: SJ�MI' Date of Inspection: Name of Inspector:(Please Print) 6702,*eoe, I am a DEP a proved system inspector pursuant to Section 15.340 of ride 5(MO CMR 15.000) Company Name: c XXIMW Gi6,,Sf1E4 Mailing Address: CA4D.0 UcC S41yowWit *4,0 st 3' Telephone Number: 50T, S Sl C'J;?3 CERTIFICATION STATEMENT 1 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`. APasses Conditionally Passes Needs Further Evaluation By the Local Approving Authority Fails % Inspector's Signature: G < < r Date: : The System Inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP)within thirty(30)days of completing this inspection. If the system is a slimed systern 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. [AJ E57- &VO OF 606'5E NOTES AND COMMENTS Koo G 1101U H-'aD. 5EFF/C iHti41< ; /11E�.So��oS >) Gc5%U0ifr fON r. egqc N 1 t.;` I.a1:r.t` . • rs Ir'''fi u " 'Ef Ix,,t '1'Y ff•I It t s r f r r ....,.... � .. '. _ ,. 1.. ll 11' y '� )I., I`{•rt 1I .IS �.! revised 9/2/`98 Pa4et.of11 - G: t f 6ri4 - r I' ice;Prinled on Rif ydW pap& :3.n.'alll_ SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM {'{ '.PART A ( CERTIFICATION(contintiedl�� , O l Properly Address: (;. n. 13�� ' 1 r n Owner: U,emcRy 4 . ' %�1� Date of Inspection: INSPECTION SUMMARY: Check 8, C, or.D. e A. SYSTEM PASSES: P t I have not found any information which"Jrdicates that any of the failure conditions described in 310 CMR 15.303 exist. Any failure criteria not evaluated are indicated below. +' i COMMENTS: 71, 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"AND) 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(70)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 complying septic tank as approved by the Board of Health. ` _ Sewage backup or breakout or high`static water level observed in„the distribution box isdue 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). p broken pipe(s) are replaced $, ' obstruction is removed t e f r distribution box is levelled or replaced" " ar 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 e i obstruction is removed w iR 'y�l r19:, I �P� villa - 11, A s kw R 5T ' i» 3 7 'lr. y s # y ,y F R _ *' revised 9/.2/98' , o.P, �: >r Pa� 2 Of 11 I hl + C f_A zF' ' w-a 8, t X' w r` ,'' '} •. 4 t FI( 91 I'. 4 ., ; $ IP I ti t a tp q'q! i'fe .a li I `' "' a _ •. PE 1 , DI INSPECTION FORM SUBSURF ACE SEWAGE DISPOSAL SYSTEM INS S 'PART A 1 CERTIFICATION (continued) Property Address: acv ofaP-1r.{ 90 RID, Owner: Date of Inspection: 7-�y•19y� ' - 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 systern is failing to protect the public health, safety and 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 THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: _ Cesspool or privy is within 50 feet of surface water Cesspool or privy is within 50 feet of a borderingyvegetated wetland or a salt marsh. _ r ° 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 AND SAFETY AND THE 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 soil absorption system and the SAS is within a Zone I of a public water supply well. _ The system has aseptic 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 co(iform;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 t,. a i I"t revised 9/2/98 t °>Iage3of11. r .- , SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address:a 20 I'vZ)Rrf-� &4q Owner: p, /Y1cRY Date of Inspection: '7 D. SYSTEM FAILS: You must indicate either "Yes"or"No" to each of the following:' I have determined that one or more of the following failure conditions exist as described 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 ofeffluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool. y` 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 1.12 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" to each of the following: The following criteria apply to large systems in addition to the criteria above:. a The system serves a facility witha design.flow.of'10,000,gpd br grestbtl,(LargetSystem) 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 11 of a public water supply well) w . The owner or operator of any.such'system s"shall upgrade the system:in accordance"with+3101CMR.15.304(2). 'Please cdrisult-the laeal regional office of the Department for further information., r, ,J,I. I r . _, - . .+c.; + , a a::rt C <: r+ !,.• ?.V. .+.0 r.ri:Wit: i ,c dt!j + ,tE ate ,t ..i far.•`I,. a.•�" �� I {, if I ,qua ,. t: t nda r,?, J .iy�l,,. 41 1 ' ' f Irevised 9/2/98Page P a a e4fof 11 f11 i .11++' ;i! Ic.. i! s •. iy Si r _ - ,a 4 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B . CHECKLIST Property Address:a)o /NOQ1'14 Qq q R0, Owner: p,CMCRY Date of Inspection:-7._Aq-/9 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 NIA. The facility or dwelling was inspected,for signs of sewage.back,.up. — The system does not receive non-sanitary or industrial waste flow. m Y — The site was inspected for signs of breakout. — All system components, excl have been located on the site. i — The septic tank manholes were uncovered, opened, and the interior of the septic tank was inspected for condition of baffles or tees, material of construction, dimensions,depth of.liquid,depth of sludge, depth of scum. The size and location of the Soil Absorption System.on,the site has been determined based on: . x Existing information. For example, 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)] Y T.he,..facility owner..(and_occupants rf different.from owner) were provided with informatrori on the proper maintenance of SubSurface Disposal Systems. F i •t�.e } -. r ry's' i:'is a�. .,..i.i"i,I f;Y�.I 1i �;< 4;lC3Tai. - ' ,i 5•! iyg, [Ya:+i,ilhel ile 1ai.I•.f rt y i•rhM yl[.i::,• ulf t -6�. L,,7,.„>F7.- ...1 E• -Y"t fli lCaf-1 ;li i'i:, I !B :'.� ivSil'I i i't+;l �. ;:� I k.'!7G i e f ..din ti .?f�� ..i�;ly iy ,f:9 ] :I I revised 9/V98 rPagcsor,Il ,,ic<i.a . f .q�lli � ,r fli ;i' I 6.,,:'! � .?,l,�j. 11;.,4 15 .:.6! i , '�f;,I RI, t)1: . • t SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property/Address-40 /LoM 64V AD, Owner: Date of Inspection: '7 c2y-lyS I FLOW CONDITIONS RESIDENTIAL: Design flow: 110 ....g.p.d./bedroom: Number of bedrooms (design): Number of bedrooms(actual): 3 Total DESIGN flow 330 Number of current residents: i Garbage grinder(yes or 61:/Ua Laundry(separate system) (yes or&:Ajc; If yes, separate inspection required Laundry system inspected (yes or no) Seasonal use(yes or Water meter readings,if available (last two year's usage(gpd): Sump Pump(yes or®):&V Last date of occupancy:s77(L0a,,,0/E#j COMMERCIAL/INDUSTRIAL: Type of establishment: Design flow: gpd ( Based on 15.203) Basis of design flow „ 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: GENERAL INFORMATION PUMPING RECORDS and source of`nformation: H111 S /�T et`-&y a6 4160 System pumped as part of inspection: (yes or(&AY> t.,. If yes, volume pumped: gallons Reason for pumping. TYP�OF SYSTEM Septic tank/distribution"box/soil absorption system Single cesspool Overflow cesspool Privy + ` Shared system(yes or no) (if yes, attach previous inspection r'ricords,.iLany) I/A Technology,etc.-Attach copy of up to date operation and maintenance!contract - Tight Tank : Copy of DEP Approval Other APPROXIMATE AGE of all components,date installed(if known)and'source;otinformation: T/�i OLD OLUIVER Sewage odors detected when arriving at the site:(yes or&N� ' .1 .-. - - s revised 9/f/98 I,' Page 6of11 . , ( } SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address:J�io /uoQ/-/ 8/9 Owner: .D:C /Ylty2y .- Date of Inspection: 'T)M-/yYG < Y 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: (locate on site plan) 1. Depth below grade:)Mct -CIVi:R. 4 - Suppllc6 Material of construction:Xconcrete_metal_Fiberglass _Polyethylene_other(explain) - If tank is metal,list age_ Is age confirmed by Certificate of Compliance_(Yes/No) � _�� r. . is fie', „. • . Dimensions: /D; rl L X Sludge depth: qoyc!j " Distance from top of sludge to bottom of outlet tee or baffle: ��fNCKS Scum thickness: (A;4:/-6 ' Distance from top of scum to top of outlet tee or baffle:3� �1s Distance from bottom of scum to bottom of outlet tee or baffle:ISIOWY5 How dimensions were determined: 'Tf4PFh9E/9SU2F 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.) ' /•AX SCyMO. 13C CLEM1t IV '7-,Y6' /L'E.rTT YC11.135 (,fS67 X ST/C N ? C-5 LIQiJrD A'T v'r?an� p'F OL7-Lcf piP6 i (Qo0 coniotpoN � � I GREASE TRAP:- (locate on site plan) { Depth below grade:_ Material of construction:_concrete=metal_Fiberglass}¢�Po(yethylene,._other�(explam) )'i N, Dimensions: Scum thickness: Distance,from top of scum to top ofoutlet the or baffle: Distance from bottom of scum io bottom ofoutlet tee or baffle: Date of last pumping: I 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.) ,�.I i•1 i+ �-.4 ;1!:f. F!1'tl__rS; � :':i i1 i `a 1 int.ej revised 9/2/.98 page 7ofIt 3 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM .. PART C SYSTEM INFORMATION(continued) Property Address:,�rt ll;O R714 68.y R o.. Owner: Date of Inspection: TIGHT OR HOLDING TANK: 1 I (Tank must be pumped prior to, or at time of, inspection) (locate on site plan) Depth below grade: P h lene other ex lain metal ' Pol et y ( p ) Material of construction: concrete _Fiberglass Y _ Dimensions: Capacity: gallons Design flow: gallons/day (M Alarm present _ s Alarm level: Alarm in working order:Yes_. No Date of previous pumping: Comments: } (condition of inlet tee, condition of alarm and float switches, etc.) f, � w DISTRIBUTION BOX: ( (locate on site plan) Depth of liquid level above outlet invert: 4 r 0)7M,t'J Comments: (note if level and distribution js equal, evidence of solids carryover, evidence of leakage into or out of box, etc.) C?rUj�- PPP 7 flu 0/bot'PWC- OL)'T /'v S000 PUMP CHAMBER: (locate on site plan) Pumps in working order:(Yes or No) gal •Y' I'.j 34 1,..' `.7f�. ;:H11 r. :i.=I '"' Alarms in working order(Yes or No) "F'•`I` I Comments (note condition of pump chamber,condition of pumps and appurtenances, etc.) revised 9/2`/96 • ,, Page 8 0[11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM .. PART C SYSTEM INFORMATION(continued) ' Property Address: DO /vOP714 gat( ,PD, Owner: D,E�J rr R y Date of Inspection: SOIL ABSORPTION SYSTEM(SAS) (locate on site plan,if possible;excavation not required,'location may be approximated by non-intrusive methods) If not located, explain: Type: leaching pits, number:_ leaching chambers,number leaching galleries,number:_ ; leaching trenches,number,length: T. leaching fields, number, dimensions: overflow cesspool,number:_~ t ' Alternative system: Name of Technology: CUl'T�C Et4CN°CNA/�Bc'kS C�/ Comments: (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.) /'O SIGIUS or NYDRIU .!Z t CESSPOOLS:_ (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 a,s part of,ins ection) Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation etc.) :.i il.lj - ,,'jj , PRIVY _ (locate on site plan) +: Materials of construction: °. k me Di nsions: Depth of solids: Comments: }r> (note condition of soil, signs of,hyd aulic failure, level of ponding, condition of vegetation,�etc 1,.I„# revised 9/2/98 L ' ; :l t, J [,age9 of 11 .111 1 uI SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C 1' SYSTEM INFORMATION.(contimed) Property Address: 2)® 111dRTN 1314y RD , owner: p.C14CR7i' Date of Inspection' m SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent reference landmarks or benchmarks. locate all wells within 100' (Locate where public water supply comes into house) ' :N ot�SC 1 If -Pa 10 of I1 revised 9/2/'98 1 � . SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C �1 p SYSTEM INFORMATION(continued) Property Address: 12D N6 R'j11 Owner: D �/j1Elp Date of Inspection: � r NRCS Report name Soil Type_ Typical depth to groundwater USGS Date website visited t Observation Wells checked Groundwater depth: Shallow ; Moderate Deep SITE EXAM Slope Surface.water Check Cellar Shallow wells Estimated Depth to Groundwater Feet Please indicate all the methods used to determine High Groundwater Elevation: L XObtained from Design Plans on record Observed Site (Abutting property, observation hole, basement sump etc.) Determined from local conditions. Checked with local Board of health Checked FEMA Maps Checked pumping records Checked local excavators, installers Used USGS Data Describe how you established the High Groundwater Elevation. (Must be completed) FRO IN perM/s OF /457f1L(,A71c 11v 0 • H,rta��1�� 'i'ili ¢ 7 i�Alps � ;,ie�;i[I a i :i-11 x. revised 9/2/98 ra�e11or i l 9 is C i � 1 j TOWN OF BARNSTABLE\0, Y00),OCATION `�` Wo A SEWAGE # r 'VILLAGE O S [-Ru J ASSESSOR'S MAP&LOT 0 Y b I� INSTALLER'S NAME&PHONE NO.g—f V M0+1S SEPTIC TANK CAPACITY LEACHING FACILITY: (type) 91`a—, s (size) C X ��OG NO.OF BEDROOMS BUILDER OR OWNER Kg N N E � �tl►� S R, PERMITDATE: COMPLIANCE DATE: 6 Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility tgPq -1 16' 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 eaching facility) _ Feet Furnished by 61 5o� - 6`�/ ��iro TOWN OF BAKISTABLE :.f?CATION SEWAGE # VILLAGE— O.s orvrde_ ASSESSOR'S MAP & LOT 472 'OtO INSTALLER'S NAME&PHONE NO. 1201tWYOSL- `4Is7 L 14 aA Si Y10 SEPTIC TANK CAPACITY A00 111. LEACHING FACILITY: (type) CQ1�C CiJA"7 t �J. (size) :x o. NO.OF BEDROOMS BUILDER OR OWNER C PERMTTDATE: p q— 76 COMPLIANCE DATE: ' Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within.300 feet of leaching facility) Feet Furnished by �- i ' dF'41C ` TOWN OF BARNSTABLE LOC!•_ 'iON c�0 SEWAGE # � � ' _ VILLAG Ilk ASSESSOR'S MAP&LOT � -10 INSTALLER'S NAME&PHONE NO. (50/2d'0 n ,&!!U4 i — SEPTIC TANK CAPACITY /,�®0 6-6 /, 'LEACHING FACILITY: (type) Qom'Of (size) NO.OF BEDROOMS BUILDER OR OWNER N/,,4 e 51nt-P L PER1vITTDATE: 7 `'-i -Z COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by - G'ARA � r r � I l I IA5 135 • ; � �6' C�Ir�'s ' � 1 } No. _ � t, Fee O THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS 0(pprtcatton for �Digpozal *paem Con5tructton Permit Pf�¢-ADS Application is hereby made for a Permit to Construct or Repair( )an On-site Sewage Disposal System at: Location Address or Lot No. i Owner's Name,Address and Tel.No. Z'Z O Qb TiA St,.00 14.p tom. oN AL c> 90e ©x 31O Installer's Name,Address,and Tel.No. 41-119�(y�f� Designer's ame,A ress and el.No. f 'OAxree-4 Kl'i C- ILXC Type of Building: Dwelling No.of Bedrooms� Garbage Grinder( X) Other Type of Building No. of Persons Showers( ) Cafeteria( ) Other Fixtures It Ge ibvee= °3M+45= 33 033o�P9 Design Flow e5 &i to= 5_4;0 G f Q gallons per day. Calculated daily flow Z 560 61'9 gallons. Plan Date J)tv E '271 199(o Number of sheets \ Revision Date lAo►..)L; Title 'SITC i�LAtj &F o 1902 1>6s-5AL-V Etti E2,*-/ Description of Soil CL,A�S Nature of Repairs or Alterations(Answer when applicable) 'TD C-Q M PLC/ \4.t t-71A i99S �E�tlSib c.a . 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 isstVd by Boaz f He Sign - Date �y Application Approved by Application Disapproved for the following reasons Permit No. Date Issued +ii� I.ry,,.--. ,#. +^' T�_1 ....p.w.:rtii...'S,ta'.. +F{�t r:.•.. f^...i. 7..• ,,,.f Wit. ��-_ -r'"y^�.. ._. it j M Ate I0 7 �j Y !-L rL,C. E C... r,. No. e u,.THE COMMONWEALTH OF MASSACHUSETTS. PUBLIC HEALTH DIVISION:- TOWN OF BARNSTABLE, MASSACHUSETTS-1 01pprication for Xigpogal 6pgteut Con!5truction 30ermit VYG�zF��� 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. lam. (�Ia A�t7 1;_.t••�l c 2.�( n050A 3ko ZZ ® , Q(fzT" A A,--e o;-4.0 G/ �Zb6C=BLS ��A�21V P r2 1 t_ E _ 11 Installer's Name,Address,and TeL No. Li,�j:B_,{y t`ti Designer's ame,Ad rests and Wl.No. Q hAKi � 4 ^,0��^-,�?3V rv�- W , \%.51 _ lv-mil Arm-►c��. Q��Z �Pt\YU���2�/1 L.LC 'I{ Type of Building: Dwelling No. of Bedrooms Garbage Grinder Other Type of Building No.of Persons Showers( ) Cafeteria( Other Fixtures I pcC'_= 3M%43,Z 330 330G_�:,S> Design Flow S to I to= 550 G?Q gallons per day. Calculated daily flow Z 55-0 G'Ft7 gallons. Plan Date Ju o C 'Z-7, 19 94P Number of sheets ,_Revision Date .. ?:1 o N G Title--'Si rc.FL Au of L^rm o yo 2 17n co A L-V, EPA «� Description of Soil t s��S AA Ate.\A l_ �`U��2�."ate E. 1 " Nature of Repairs or Alterations(Answer when applicable) -tz:> C-00A PLC/ \Q I S - . Date last inspected: - y;, Agreement: I The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- care of Compliance has been iss4d by t ' Boar f He Sign ~!% Date Jet Application Approved by. � Application Disapproved for the following reasons Permit No. Date Issued 4 { THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System installed( K)or repaired/replaced( )on by GO(z, <,n .r D.U3 for as Z 0 cXL\ = "- q(/7--Aq.Tconstructed in accordanc with the provisions of Title 5 and the for Disposal System Construction Permit No. dated "' Use of this system is conditioned on com liance with the provisions set forth bel No. Fee ,�� � THE COMMONWEALTH OF MASSACHUSETTS 1 PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS 1 xigpogal *pgtem Cottgtructiou 3permit Permission is hereby granted to Q/c'-!au I y s to construct(x)repair( )anOn-siteSewageSystenliocatedat, 22 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 7 Approved by vol� Commonwealth of Massachusetts Executive Office of Environmental Affairs RECE�IIl�� ? Department of MAY 2 0 1996 Environmental Protection William F.Weld o � Gowmor /Coxe `` �y t S-1T111 �OEA ! V ar s) David B.Struhs Commissioner SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION 4�enneC� Wnt_s,�e. Property Address: .�ao N.?AT 1?nl. Gs Address•\1C Address of Owner: Date of Inspection: M,j L3\qqb (If different) Name of Inspector: Gp2.aoY. F.3vrr.p -S Company Name, Address and Telephone Number: p(-eta, Gi':1er-oA 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: V Passes Conditionally Passes _ Needs Further Evaluation By the local Approving Authority _ Fails Inspector's Signature: (� Date: The System Inspector shall submit a copy of this inspection report to the Approving Authority within thirty (30) days of completing this inspection. li 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 tiie buyer, if applicable and the approving authority. INSPECTION SUMMARY: Check A, B, C, or D: AJ SYSTEM PASSES: 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. B) SYSTEM CONDITIONALLY PASSES: One or more system components need to be replaced or repaired. The system, upon completion of the replacement or repair, passes inspection. 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, 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 8/15/95) 1 One Winter Street a Boston,Massachusetts 02108 a FAX(617)556-1049 a Telephone(617)292-55W A C' Printed on Recycled Paper r r SUBSURFACE SEWAGE DIS O SRA7 SYSTEM INSPECTION FORM CERTIFICATION (continued) 10t� c - Property Address: adL'N'-�"�7 Owner: �tenncrt� 11�nc) SR, Date of inspection: BI SYSTEM CONDITIONALLY PASSES (continued) _ ion box. The system will pass inspection if(with approval of the Sewage backup or breakout or high static water levbeutobserved in the distribution box is due to broken or obstruct pipe(s) or due to a broken, settled or uneven disc Board of Health): 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 br keBen pipde(s1 are r f Health): eplaced obstruction is removed CI 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 T AND THE ENVIRONMENT: FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND _ Cesspool or privy is within 50 feet of a surface water tland or a salt marsh. C p vegetated we _ Cesspool or Privy is within 50 feet of a bordering 2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH (AND ROTECTPUBLIC THE PUBLIC HEALTH AND SAFETY AND DETERMINES THAT E THE SYSTEM IS FUNCTIONING IN A MANNER THAT P ENVIRONMENT: _ i1 absorption system and is within 100 reel to c surface water suPP y 1 or tri�utaly i6 a The system has a septic tank and so surface water supply. tion system well. _ The system has a septic tank and soil I absorption on system and s within 50 feet of a privatecwater rsupply well. _ The system has a septic tank ands P than private water. _ The system has a septic tank and soil absorptior on system orm bacteria is les andsvolatile0organiccompoundsrindicaterss I the well is supply well, unless a well water analysis free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than ppm. D) SYSTEM FAILS: ure I have determined that the system violates one or more following fail tcontacxed criteria to detrm defined twhat willbe necessary to co reef for this determination is identified below. The Board of Healthshould the failure. _ 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. 2 (revised 8/15/95) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A I CERTIFICATION (continued) Property Address: c� U No RJ 1�' S 1env l' Owner: V-,zN^A N.;.c� -&Q, Date of Inspection: DJ SYSTEM FAILS (continued): 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. El LARGE SYSTEM FAILS: The following criteria apply to large systems in addition to the criteria above: The design flo%+ of system is 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: 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 8/15/95) 3 , f SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM. PART B CHECKLIST Property Address: a u N��11,_Z1, ') I. C�•1 ler. Owner: Date of Inspection: Check if the following have been done: _L,-rumping information was requested of the owner, occupant, and Board of Health. -1--Kone 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. system does not receive non-sanitary or industrial waste flow The site was inspected for signs of breakout. ZAll system components, excluding the Soil Absorption System, have been located on the site. y The septe-tank manholes were uncovered, opened, and the interior of the septic tank was inspected for condition of baffles or tees,material of construction, dimensions, depth of liquid, depth of sludge, depth of scum. V The size and location of the Soil Absorption System on the site has been determined based on existing information or approximated by non-intrusive methods. The facility o Nnc: (ancl occupants, if different from owner) were provided with information on the proper maintenance of Sub- Surface Disposal System. • (revised 8/15/95) 4 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: r'f� JAB 0,7 Owner: ��e�net� �{ �e 3 Date of Inspection: . kci4c FLOW CONDITIONS RESIDENTIAL: Design flow: SSD_gallons Number of bedrooms: Number of current residents: y ° Garbage grinder (yes or no): NO Laundry connected to system (yes or no):,��.S Seasonal use (yes or no): NO Water meter readings, if available: /6 1 3C) Last date of occupancy:Q(? .SZo• COMMERCIAUINDUSTRIAL: Type of establishment: Design flow: gallons/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: GENERAL INFORMATION PUMPING RECORDS and source of information: MV7t FQ f't'COI'O System pumped as part of inspection: (yes or no)_� If yes, volume pumped / 00 a►Ions , Reason for pumping: Ct,55 ov 1:r ecTu�i a i ae,,- TYPE OF SYSTEM Septic tank/distribution box/soil absorption system Single cesspool _ I Overflow cesspool Privy Shared system (yes or no) (if yes, attach previous inspection records, if any) Other (explain) APPROXIMATE AGE of all components, date installed (if known) and source of information: 046 SCy3 ei�� e Sewage odors detected when arriving at the site: (yes or no) /�0 • (revised 8/15/95) S SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Adcress: Owner. �Ce��ne`f� �w�c1ZfZ, Date of Inspection: l0,c SEPTIC TANX._��Cc ss poo 1 (locate on site plan) l r� Depth below grade: Material of construction: concrete _m�tal FRP other(explain) f .r , Dimensions: b `ia' >y E}`DrCn Sludge depth: 11--7•- j Distance from top of sludge to bottom of outlet tee or baffle: Scum thickness: 6 Distance from top of scum to top of outlet tee or baffler_ Distance from bottom of scum to bottom of outlet tee or baffle: 6 Comments: (recommendation for pumping, condition of inlet and outlet tees or 4affles, depth of liquid level in relation torosu`eC invert, structural 90 integrity, evidence of leakage, etc.) GREASE TFAP:_ (locate on site plan) Depth belt:+ grade: Material of construction: _concrete _metal _FRP _other(explain) Dimension Scurry thic',,ness. Distance from top of scum to top of outlet tee or baffle: Distance from bottom nl <rrim r,, bottom of outlet tee or battle 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 ) 6 (revised 8/:5/95) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C (lSYSTEM INFORMATION (continued) Property Address: �.�Q A/.36 � �9S�w �'- Owner: fTenn��t Ci,nr>'�2. Date of Inspection: 1, ci o TIGHT OR HOLDING TANK:_ (locate on site plan) Depth below grade: Material of construction: _concrete metal _FRP —other(explain) Dimensions: Capacity: gallons Design flow: gallons/dav Alarm level: Comments: (condition of inlet tee, condition of alarm and float switches, etc.) DISTRIBUTION BOX: i(/UN� " (locate on site plan) Depth of liquid level above outlet invert: Comments: (note if le e! and datribut:. ee,.:2' e•.idelre cf solids c?•rynver, evidence of leakage into or out of box, etc) PUMP CHAMBER:_ (locate on site plan) Pumps in working order:(yes or no)__ Comments: (note condition of pump chamber, condition of pumps and appurtenances, etc.) (revised 8/15/95) 7 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: �A0 jq-(A �Ar Owner: Date of Inspection: A,�6J (oioi 6 SOIL ABSORPTION SYSTEM (SAS):_ C'e 5 5 7oC/ y roximated by non-intrusive methods) (locate on site plan, if possible; excavation not required, but ma be apP If not determined to be present, explain: Type: leaching pits, number:_ leaching chambers, number:_ leaching galleries, number: leaching trenches, number,length:__._ leaching fields, number, dimensions: overflow cesspool, number: condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,etc.) �C vb%11 Comments: (note y��f'3i/"�C CESSPOOLS: (locate or site plan) _ r Number and configuration: Depth-top of liquid to inlet inert: Depth of solids layer. Depth of scum layer: Dimensions of cesspool: X Materials of construction C'oncne/d r r'ir E _ Indication of groundwate . Nu ���,�.,-,��,�/�•2 inflow (cesspool must be pumped as part of inspection) Comments: (note condition of soil, signs of hydraulic failure, level of ponding, o�ndition of vegetation, etc.) vo� ,� PRIVY: _ (locate on site plan) Dimensions: Materials of construction: Depth of solids: Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) 8 (revised 8/15/95) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C i SYSTEM INFORMATION (continued) Property Address: AaO K(G y l�\` P,J W.— Owner: \KK- Date of Inspection: SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent references landmarks or benchmarks locate all wells within 100' - C\ Z 3 Ir DEPTH TO GROUNDWATER / l Depth to groundwater... �e feet Trc� rvl v��'y� �` Crssfov method of determination or approximation: fo _- ' (revised 8/15/95) 9 , GREAT BAY - _ ` LOCUS 4 RESIDENCE F-1 -1.8 _ 5.2 MINIMUMS BRIDGE ST. AREA = 43,560 S.F. 5.8 O� J' FRONTAGE = 20' o WIDTH = 125' LI TTLE / >- ISLAND . FRONT SETBACK .= 30' x _SIDE SETBACKS 15' a j 19.3 REAR SETBACK = 15' GRAND WEST BUILDING HEIGHT = 30' C.B. BAY ISLAND (OR 2.5 STORIES IF LESS) �As ,�'\k 0 22.7LOCUS MAP / � \ / SCALE 1 : 25,000 ASSESSORS 188 6.3 x 25.7 MAP 73 PARCEL 10 -1.8 ZONE 20.9 A.P. t-6.3 , 23.0 6.3 BCD / �O �O� x 26.8 D- F •1&2 N 0 ' 22.9 / X126.2 -1.47. / x•18.9 x 22.1 22.3 O / Z18.5 �� x 28.3 26.2 x 28.7 0 23.2 ).1 •2 / x -; ,/ / SYSTEM #2 s _ / - / x 2 .5 ' � / • G� • ' 30 / l 18.3 / •x 25.7 �28.1 BOX - . O - • _ `OQ \� 30.4 ,p 'n A. x 31.3 . awnJ FAA -0.2 / 1 oak -x 25 3' 30• �•°� 9�s/ x t9.8 12" ak in � 26.9 6 x 2 O,y I 6 17. : .5 �L 29.8 9 04 9 � � J •• 8.9 ? F o c. • etaining Wal 30 29.8 �. t5. '�.� / flags ne walk L 31.3 x `L x 0.2 31.CO 2 132 28* h/ LL 32.7 �� n jh x .4 ^��' 1 � �� �� tij / 2.1 / 14.4 ` " 28. L p ine 32.2 LL 33.3 G ��. p woods / C.B. m x t9 5.0 f lawn / \�,��� ��0 / C.B. , - pirieq \ -Oto b` filled ce r 2 p ne 324 L TS 1, 154, & 156 G_, N ex' tin p � � town x 32.5 x 30 Uj• - �• \ ptit cover 7.6 1, P 2 3 �, C.B. `I0 8 3. 7.3 30.0 31. ; F y / 70,827 S,F, 5:2 'rn x 16.5 r 46 ce or 31.0 < ��' 1 1,63 Ac, x 20.3 � 14 tx " 6 �� 30.2 �.� x' :g \ j 33.5 " die ��✓ : '\Q ® -0 X T . h f 6.7 oil drain lawn Op, 12" ak 28. oR ' 30:5 �v 33.) _ L. 31.14' 2 %.4 28 o ,� x ^3 25. X 2 .3 x 7.9 ,� 1.8 Porch 32.6 8 C.B. FND. O GIST. 27.8 6.3 8.1 BOX �o� % 31.8 7 \29.0 C.B. x c 31.8 1.$ 26.3 slab / " oak C; x 3 �lb P 1.5 ce at �' , 22.5 28.6 0� �� x 3 5 �a _� 31.3 , / / 30.6 � 29. 25.8 - h Q 29. 7 /co /� / % C.8 -1- 3 \ 25.3 x 252 w SYSTEM 1 8 �31.7 - _ '� .. x 2¢6 Iliber wall SYSTEM #1 °�, ,���,�,o -� z. /22.7 ��SINGLE FAMILY- 1 BEDROOM & KITCHEN 32,s SYSTEM #2 WITH GARBAGE GRINDER x 1.9 \ r oG 27.0 / DESIGN FOR 3 BEDROOMS AS PER TITLE 5 DESIGN DATA x paved dri / s� I? DAILY FLOW = 110 X 3 330 G.P.D. 33.0 \ 30. f / L�o� 3�XZ21_6 7 SINGLE FAMILY- 5 BEDROOMS SEPTIC TANK 330 X 200% = 660 x 28 NO GARBAGE GRINDER USE 1500 GAL. 2 COMPARTMENT SEPTIC TANK C.B Q DAILY FLOW = 110 X 5 = 550 G_P.! -B, . - 1ST. COMPARTMENT CONTAINS 750 GAL. BENCHMARK / ELEV. = 34.19' � woods I SEPTIC-- TANK 550 X 200% = 1100 330 X 200 = 660 GAL_ REQUIRED /- x- z 2 USE 1500 GAL. SEPTIC TANK SEE NOTES j CULTEC LEACHING CHAMBER DESIGN 3247 21.2 RECHARGER 330R 2 l I A �� ��,� CULTEC LEACHING CHAMBER DF)IZN 7-1fenc„f s �ALL PIPES TO BE SCHEDULE 40 PVC PERFORATED 2s.1 x 24 Q/ RECHARGER 330R , USE 1 - e DISTRIBUTION LINE IN 6 RECHARGER UNITS o - S � ALL PIPES TO BE SCHEDULE '40 PVC PEF ,"IF'A IN A 12'X 40' WASHED STONE FIELD AS SHOM � � V_� WITH CAPPED ENDS 28,}� USE 1 - 4' DISTRIBUTION LINE IN 7 RECF� -fir LEACHING AREA REQUIRED 1 / / x �.6 - 21.6 1N A 12 X 49 ,WASHED STONE FIELD � 330 G.P.D./.74 = 44.6 S.F.+ 50 = 66S S.F. �� `��'� 2(40+ 12) X 2 = 208 S.F. SIDEWALL AREA LEACHING AREA REQUIRED /(12 X 40) = 480 S.F. BOTTOM AREA 550 G.P.D./.74 743 S.F./ 2(49+ 12) X 2 = 244 S.F. SIDEWAI .L'IIEA 688 S.F. TOTAL PROVIDED / � J / (12 X 49) = 588 S.F. BOTTOM ! / '/ PLAN 832 S.F. TOTAL PROVIDED6 TOTAL. UNITS 1 STA.RTER,1 E D, & 4 INTERMEDIATES C.B_ X 25.3 ` 330S e P. 3301 33CC '23.C� � 7.5' 6.25x,/ i 210 40 6 25' I f SCALE: 1" = 20' 7 TOTAL. UNITS 1 STARFER,1 END. & 5 IN7'DWMm IAA 12.00 330S TYP. 33Ot 330E 7.5' 6.25 6.25' 40.00' PLAN \AEW SCALE: 1" = 20' 44'-11" - 49.00' PLAN VIEW = ' • _4" P.V.C. PIPE SCALE: 1" 20 , 4 HEAVY DUTY METAL FRAME VENT AND COVERS LOCATED TO FINISH GRADE i F.G.-28.5 GARAGE FLOOR = 27.00 F.G.- 26.8 F.G. 28'f a 15DO GAL 24.5 LEACHING CHAMBERS M .N INV. 2 COMPARTMENT 4' DtAM�R T INV. = 1 12' 25.3 LE P. SEPTIC TANK . C. T.v T r 3G'O iPA jsA BOXU FxL 25.1 's: 2 -7 INV.2 .3'TT o0o 0 0 a a o a o 0H2O 2 TVT SEE NOTES 'VT o o O O O O O O O O O O , O !!v c PEA: S'W .w.•.•s.... v v D 6 +ITV VT TVV♦VT T T TTTVTTTTTT � 4 :*ST ,T:. •...... . ::. - - _ - - - - vTi - vvvvvvvvv TT9TTTTT ,314 - . .-�,.. ..---:s.�.- Y-_, .. ....._ -- '. - ;... .,.:':.,,. .-.:. _ - _ _. -__ ._.- -. - � ♦vvTlvTT TlTTTTTT _ v BOTTOM_ELEV.-EL.=22.3 SYSTEM l }� vTvvvT WASHED PROFILE l 0 52 i NO SCALE N M.H.W. 1.5 END `SECTION NO SCALE COVERS LOCATED 0 WITHIN T - _ 12" OF F.G. F.F. ELEV. = 35.5 ELEV.- 34.0 cs 30'f TOP OF FOUNDATION 1500 GAL. INV. _ , a, 30.0 -INV. - """ 4" OtAf�29 T DtSL 40 P.V.C. A ICHAMBERS.8 S'EP= TANK INV. - SCHEDULE LE AC NG 29.6 INV. -29.4 Box SEE NOTES ..... ...:; wv -29.2 INV. 29.0 0 0 0 o 0 o a a o a o 10.00 a 0 0 0 a a a SITE PLAN OF LAND) MIN. a o a a a o a O c o 0 IN BOTTOM ELEV. EL = 27.0 (OYSTER HARBORS) SYSTEM #2 to ui NOR°CAS BARNSTABLE , MA\ � N M.H.W. = 1.5 FOR NOTES NOTES: D O N A LD EMERY E 2. 1 FOR ;ALL ASPECTS-OF-THE SEPTIC SYSTEM .THE CONTRACTOR 1 REMOVE UNSUITABLE SOILS $EtvEATH_P<OPOSED SYSTEM BACKriLL SCALE: AS NOTE DATE. JUN O - 9� �}:TH CLEAN GRANULAR MATERIAL FILL T R � : _ s , - -- E L L� O BE G ADE. ,,� FO.,LC'R�._ NOT SHALL COMPLY WITH ALL GOVERNING CODE ANREGULATIONS. _ .- - - REV. JULY- 3,1-996 - REV.. JULY T /g`�� S D MORE THAN .1 S% RETAINED.,ONI-Nc.,4 SIEVE .._NnT...DDE';:�.Hm'l RETAINED IN PARTICULAR 310CMR 15.000 THE STATE ENVIRONMENTAL CODE TITLE 5, ON No. 50 SIEVE, OF FRACTION PASSING No. 4, 10% OR LESS TO PASS No. BAXTER & NYE INC. THE TOWN OF BARNSTABLE BOARD OF HEALTH REGULATIONS PART VIII: 100 SIEVE AND 5% OR LESS TO PASS No. 200 SIEVE, SOIL TO BE APPROVED ON-SITE SEWAGE DISPOSAL REGULATIONS AND THE BOARD OF HEALTH BY ENGINEER FOR COMPLIANCE PRIOR TO PLACING ON SITE. OF REGISTERED LAND SURVEYORS RECOMMENDATIONS FOR ACCEPTED PRACTICE. (2) LOCATION OF UTILITIES NOT SHOWN ON THIS PLAN, AT LEAST 72 HOURS t� CIVIL ENGINEERS PRIOR TO ANY EXCAVATION FOR THIS PROJECT CONTRACTOR SHALL h."AKE � P SULLIVANL E MASS. O2 TWO COMPARTMENT SEPTIC TANK REQUIRES 2 WEEKS OF LEAD TIME _ � N - THE REQUIRED NOTIFICATION TO DIG _SAFE 1-800=322-4844 -.AND . -.TE ).. - ,, - TO ORDER FROM SUPPLIER:_- _ � ;. - - - - - N0.29T33 ❑ ERVI L GbATEF D!�TR(CT TO DETERMINE UTILITY LOCATG a . - ON S.. AxTER c� CIYtI THE SEPTIC TANK'S FIRST COMPARTMENT SHALE .BE SIZED FOR 750 GALLONS MIN. THE SECOND COMPARTMENT SHALL BE SIZED FOR 750 GALLONS MIN. ALL N I A CCORDANCE WITH 31OLMR 15.224 MULTIPLE COMPARTMENT TANKS. p ' TWO TANKS IN SERIES MAY BE SUBSTITUTED SUCH THAT THE FIRST TANK IS 1500 GALLONS & THE SECOND TANK IS 1000 GALLONS AS PER 15:225. 48