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HomeMy WebLinkAbout0023 QUAIL ROAD - Health 23,Quail R ad -.k�wj N�k -1. .0 Oster'ville ............ 117 015, V Aw -5 A R W vy A�q r -A, W4 1 "0 7C,�'N"i 141� R" —. �N­l ,�11­q 7 zj,f ,, jv?.ga' �,z M, I", fq X'� 4 la 7414)(1 14 `7 , Y114 KA" j�" P1 1K, g"i -III I t!-Ilil MUM, "F%'j *A5�A �,;A- I� I -,-ag "voww,""I"V ,00 tw, giR­ V ,li 1M"c '&T v 's �g w 'XINQV�� V I pg P"'54 jv� V1111 . " 'p, rw n NMI N'y V If, N !p Xhl Milk IF OF r A; N1, v;, X-1, k, 1A �sg MP- A ga 'U RA 5 I TA, ILE WM� qqm o 4 &D MOR N, & T T,'A" RWI�l i I ck"i,�Mm NWVRIM, V��— 'I", "N'P gqic� N, "V T li—,Om MR, I pf Y"I AL 1 I;R f �A vo A j 4 a q 1- r�,�v U, t NA IF A — 11 11 4 � W11- I SoKif R""'Or Ile ia 44 MIN :4, M, No. �® �4 3k fr Fee ®V THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS 2pprication for 3igpozar *pgtem Construction Permit Application for a Permit to Construct( . )Repair(. )Upgrade�bandon( ) O Complete System ❑Individual Components Location Address or Lot No. Owner's Name,Address and Tel.No. qca1214 M Abt�,►�a+n� ��cl��cl,s Assessor's ap/Parcel Qv �e,30� CCC333 Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. 36a-116 Y/ Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow --gallons. Plan Date ocr-Q(,�, lc�('ie( Number of sheets 1 Revision Date Title Size of Septic Tank 0 D CAI Type of S.A.S. Description of Soil e9J64 Nature of Repairs or Alterations(Answer when applicable) :7;?0A1/ /,d D tSAI—Ti1 1" D—Z6A 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 h is ed by th' oard o e h. �Signeud,F Date A14#1-,30^�y Application Approve Date Application Disapproved for the following reasons Permit No. 4 3 Date Issued b V.1d 109 -No. o`�JD y^!O 3 c' {4e Fee Q " f; a THE-COMMONWEALTH OF MASSACHUSETTS Entered in coq�puter: t gym. Yes ,.:• PUBLIC HEALTH DIVIION -TOWN OF BARNSTABLE MASSACHUSETTS Zippfication for ;Migogal OpMem Congtruction Permit Application for a Permit to Construct( . )Repair( )Upgrade. bandon( ) ❑Complete System ❑Individual Components Location Address or Lot No./, Q CJ Owner's Name,Address and Tel.No. Assessor'sMap/Parcel :,tQS`7 - �� i iGv7�' 6d Installers Name,Address,and Tel.No. Designer's Name,Address and Tel.No. ._D5L,, 1, CAPC - g �roS 1• "tom r,l IeiS� V S08 Type of Building: Dwelling No.of Bedrooms 3 Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. Plan Date �'!" a ice, Number of sheets Revision Date Title t Size of Septic Tank /Sn2 90 641 Type of S.A.S. 3-506 6,34 Dr)j4 a/1r Description of Soil AQJ Qr � r. . Nature of Repairs or Alterations(Answer when applicable) ":C /a/� /�n�r5A< �- �1_ r3o 1, �a'1 v 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 h been is ed by this Boar of e h. Sign e - Date Ovid�O . Application Approved by _ Date O U Application Disapproved for the following reasons Permit No. 63 0 — Date Issued 1_� 3v/0%4 THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS (Certificate of Compliance THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed( )Repaired ( )Upgraded(k' Abandoned( )by SNo rr i k W, at :-03 Mjr't 1 it � �P.^v. IP has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No.a d 04--4 2 dated Jd76h Installer-Ia.Ce kaer'!I;1cr' Designer�wn: Qx,.)c [-nt,✓lfc�.Installer-Ia. 6111(d The issuance of thi pe t shall not be construed as a guarantee that the s e wih f unction ads dd•esigf* Date 0�- ()Q l Inspector ��� /t- No. D00,Z—6 3`e Fee 0 G THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS Xi.5pogal *pgtem Cottgtruction Permit Permission is hereby granted to Construct( )Repair( )Upgrade(Abandon( ) System located at a�,3dv�i I (.�S 11�. and as described in the above Application for Disposal System Construction Permit. The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided: Construction must be completed within three years of the date of this t. { Date: 1� +4 Approved 5- Town of Barnstable ' _Regulatory Services Thomas F. Geiler,.Director `"RNM&`'E' Public Health Division 1 � Thomas McKean, Director 200 Main Street,Hyannis;MA 02601 Office: 508'-862-4644 Fax: 508-790=6304 Installer& Designer,Certification Form Date: O Sewage Permit# Assessor's Map\Parcel �l Designer:. � COwa_ Installer:� . Address: Address: 4rmo T On %`- 3o -.c grv�-- M �u ��S was issued a permit to install a (date) (installer) septic system at c.A.t - based on a design drawn by (a dress) ( .f✓y2 G��l� dated �� -2 o IV (designer) I certify that the septic system referenced above was installed substantially according to the.design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. l� I certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system) but in accordance with State & Local Regulations. Plan revision or certified as-built by designer to follow. �LtH OF Jfgo. s90 o yc (Insta ler's Signatu ARNE H.re) N o OJALA v CIVIL No. 30792 (Designer's Signature) (Affix D '�s - p Here) y PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS-BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. Q:Health/Septic/Designer Certification Form 3-26-04.doc ' TO�7 OF BARNSTABLE !gip LOCATION of 3 Qu,4,JI r� SEWAGE # 117 VILLAGE ®S f(f /�'i``/L ASSESSOR'S MAP &LOTS S INSTALLER'S NAME&PHONE NO.�/Y/JCG SEPTIC TANK CAPACITY LEACHING FACILITY: (type) J`aJ Ggr 2-/we/1 L3 (size) 30!.X/©` NO.OF BEDROOMS 3 // BUILDER OR OWNER A eAhO&I H,CN AfF45 PERMIT DATE: A1,9 1V.3 D'® COMPLIANCE DATE: Z 1 I I v 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 e. �. � �� � .f. ., s . ' ,. � � � � � 1 i i �, s� � W W w CO-ABION-WE-U- LH OF 1UI�S^ ACHL SEWS EXECUTIVE OFFICE OF E-\7%IRO.N_1-rE-:7T�: DEPARTIVIE-_-v. T OF EI�tiIROZv7vrE�v � 'xc:T ETIC? TITLE 5 OFFICI_AL I\TSPECTION FORM-NOT FOR VOLUNTARY ASSESS'-N;fEN i S SUBSURFACE SEWAGE DISPOSAL SYSTENj FOIZ1i PART A CERTIFICATION Property Address: c22 05 evvi' o e /ylq Od b�{� �. Owner's Name: m Owner's Address: Date of Inspection. p C1 Name of Inspector- (please print)�%arj/ �o ls���' U� Company Name: L IVVIO —7 5 Nailing Address: o 0 �1 CD ram— Telephone\lumber ,Sod tET `— CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that he forma c=renore below is true, accurate and complete as of the time ofthe inspection.The inspection vas perf�r ed?bases cn>r training and experience in the proper function and maintenance of on site sewage disposal systems.i am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CTNIR 15.000). i ne syste__: 41�_ Passes _ Conditionally Passes 'Needs Further Evaluation by the Local Appro:-mc 4u`nor _ Fails Inspector's Signature: &L { : Date. �,tJ The system inspector shall submit a copy of this inspection report to the Approrting Au*nor, , (13 cf 1-T:= 0 DEP)within 30 days of completing this inspection.Uthe system is a shared system or has a drsi�f o of 0,' 4: gpd or greater,the inspector and the system owner shall submit the report to the appropr later Tonal of,DEP.The original should be sent to the system owner and copies sent to the boner,if applicable. and`_e a_ ro: authority. _ Notes and Comments '"This report onlc describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same er di ells conditions of use. Title 5 h2spection Form 61,512000 nano i Page 2 of 11 OFFICIAL INSPECTION FOR'AT-I OT FOR tiOLU T,Ry ASSE SSZMN TS SUBSURFACE SEWAGE DISPOSAL SYSTEM LV SpEf- -F()�'T-op PART A CERTIFICATION(continued) Property Address: �3 LA Od(�fy Owner Date of Inspection: y .zi ply Inspection Summary: Check A.B.C.D or F/AL-N AyS complete all o€Section D A. SV Passes: 3 hare.not found any information which indicates that any of the fill ure cr_'ter a de_c sec 31 CN_ 15.303 or in 310 C-a 15.304 exist.Any failure criteria not evaluated are indicated below. Comments: B. /System ConditionaIiv Passes: A One or more system components as described in the"Conditional Pass"sect±oD need=n?�e replaced o_ repaired.The system,upon completion of the replacement or repair;as approved by the Board of Hem_h.rill:ass. Answer yes;no or not determined(Y,\.'NTD)in the for the foLow-:ng statements. Zf"not deter- -e�=';ease explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or no )is s-c -a11y unsound,exhibits substantial infiltration or exfiltration or tank failure is imminent. Svsten �<11 pass ins-ec-,-;=- existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound,not leaking and if a Ce:n f cate of Co=har_ce indicating that the tank is less than 20 years old is available. ND explain: Observation of sewage backup or break out or high static water level in the dis7mbution box due tc broke- obstructed pipe(s)or due to a broken,settled or uneven distributionbox.System will pace approval of Board of Health): broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced ND explain: The system required pumping more than 4 tames a year due to broken or obs-ucred =efsl. _- --_ pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed ND explain: T;tlo c T„o _+;,n %i crnnnn rake=of I I OFFICIAL INSPECTION FOR�iI-NOT FOR vOLL1-r-4R-1"'ASSEer NEEN- s SUBSURFACE SEW-AGE DiSPOs n L SYSTEMJNspECTIO-N FOR:'�r PART A CERTIFICATION(continued) Property Address: il)-3 VjarI-/ �QC] Owner: 44 l 614 Date of Inspection: C,.�/Further Evaluation is Required by the Board of Health: /►� Conditions exist which require further ecaluar."on by the Board of Health in order to dete—tee is failing to protect public health,safety or the environment. i. System will pass unless Board of Health determines m accordance with 310 CxIR 11 -0 ����1 43 at rt s}stem is not functioning"in a manner which will protect public.health.safety-and the en,'ironmerr, Cesspool or prey is within 50 feet of a suifece water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2. System will fail unless the Board of Health(and Public Water Supplier,if any-)determines that the system is functioning in a manner that protects the public health.safety and environment: The system z has a septic tank and soil absorption system(SAS)and the SAS is surface water supply or tributary to a surface water supply. The system has a septic tank and SAS and the SAS is w7,hin a Zone 1 of a ruble The system has a septic tank and SAS and the SAS is within 50 feet of a _ The system has a septic tank and SAS and the SAS is Iess than 1001 feet but 50 feet or met- pr.'vate rater supply w min ell**.Method used to determine distance -* 'his system passes if the well water analysis.performed at a DEP certified lab -. bacteria and volatile organic compounds indicates that the well is free from-,olio on=.y_-?,�t the presence of ammonia nitrogen aad.nitrafe nitroQ "_ c" 2` en is eouaI to or less han�„-- Ile— failure criteria are triggered.A copy of the analysis must be attached to this f 1 orm. 3. Other: j Page 4 of 11 OFFTCTA.L INSPECTION FORIM, —NOT FOR VOLL7-N--T-9,RY 4,SSESS IE-TS SUBSURFACE SEWAGE DISPOSAL SYSTEM 1rxspECTroz PIVR,r a CERTIFICATION(continued) Property Address: O22 f^a! ! 9d .S rv, Oot b Z4�{ Owner: i e a e Date of Inspection: d 0� D. System Failure Criteria applicable to all systems: You must indicate"yes"or"no"to each of the following for all inspections: Yes \'o/ Backup of sewage into faciLty or system component due to overloaded or clogged S a S or cesscoo_ Discharge or ponding of effluent to the se dace of the ground or s�rrfare xvatet-due tc a o ti erloa�ed e- logged SAS or cesspool Static liquid level in the distribution box above outlet invert due to arz overloaded or clogged S=_S^c cesspool " _ Liquid depth in cesspool is less than 6"below invert or available volxr.,-:s less t_a-.':=.da° f10-- Required pumping more than 4 times in the last vear NOT due to clogged or obsmrc_ed /of tunes pumped V A,ny portion of the SAS,cesspool or p ivy is below high ground water elevation. Any portion of cesspool or privy is within 100 feet of a surface water supply or t-:buta, to a surface water supply. _ 11-*'Any portion of a cesspool or privy is within:a Zone 1 of a public w-et_1. v portion of a cesspool or privy s within 50 feet of a private water supply w:a_,. r Any portion of a cesspool or privy is less than 100 feet but greater Than 50 feet from a private t,a-e- supply well with no acceptable water quality analysis. [This system passes if the well rater analysis. performed at a DEP certified laboratory.for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form.] /y 0(Yes,'lo)The system fails.l have determined that one or more of the above failure ems"as described in 310 CNIR 15.303,therefore the system fails.'Me system owner sho-uld contact t_.-B-are _ Health to determine what will be necessar-to correct the failure. E. Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15.000 gPd• ou must indicate either"yes"or"no"to each of the following: e followins criteria apply to large systems in addition to the criteria above) „ vs _ the system is wtithin 400 feet of a surface drinking water supply _ the system is within 200 feet of a tributary to a surface drinking water apply the system is located in a nitrogen sensitive area(1pterim V%e'lhead Prete= on Area—::{-D-i_l Zone II of a public water supply well If you have answered"yes"to any question in Section E the system is considered a si car.,71n7e€' :0- "yes"in Section D above the large system has failed.The owner or operator of any Iarg;;s-.0 d= 3 significant threat under Section E or failed under Section D shall I 15.304. T'ne system o. upgrade the system 1n acce-�,:e .-=-�Tyner should contact the appropriate regional office of the Departulen V Page 5 of I O CL4LINSPECTION FORINI—IIQTFORVOLLI T-ARY_ASSESS:TENTS SUBSURFACE SEIAGE DISPOSAL SYSTE'tl3NesPECTTO FOR-NY PART B CHECKLIST Address:Property P ss. 0 3 0,wner: C Date of Inspection: Check if the following have been done.You must indicate"yes"or..no as to each of the folloT 7. e: yes o Pumping information was provided by the owner-occupant or Board of lllealrh �'i•e.r e anv of.he system co _— / mponents pumped out i��e previous two wee'L the system received normal flows in the pre,!O s to o week period? — Have tare volumes / of'water been introduced to the system recently-or as of- s�mzDec-o= ✓— Were as built plans of the system obtained and examined?(If they were not available note as�A' v Was the facility or dwelling inspected for sites of sewage back up V — Was the site inspected for siens of break out Were all system components,excluding the SAS,located on site? b/— Were the septic tank manholes uncovered,opened,and the inteiior.of the tank i=sr�-cted fer of the baffles or tees,material of construction,dimensions;depth of liquid,depth of sludge and depth A L u Was the facility owner(and occupants if diff rent from owner)provided Rath jnfo=nion _n nth maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the si has beer a`-e-,;tee,;ha,=d Yyes�no Existing information.For example,a plan at the Board of HealdL v — Determiried in the field(if any of the failure criteria related to Part is unacceptable)f310 ( )lb)) Cis at �i ) CULTZ I5.302 3 - - -----__ T;rJo in e'Anti n-i L'.,-,r 411 az t,)AAA Page 6 of 11 OF)F'ICIAL INSPECTION FORM—NOT FOR VOLLT'I'_4.Ry ASSESSATENTS SUBSURFACE SE`VAGE DISPOSAI,SYSTEM I'SPECTrO-F"OR11 PART C SYSTEI I INFORMATION Property Address: E Q+,"c,'/ A'-J' Owner: t G Date of Inspection: FLOW CONDMONS ��a RE SID .NT EI_4,L v7 amber of bedrooms(design): Number of bedrooms(actual): DESIGN flow based on 310 CIVZR 15.203(for example: 110 gpd x=*of bedrooms): le-OV-%tj Number of current residents: 0 Does residence have a garbage grinder(yes or no):41V /^ Is Iaundry on a separate sewage system(yes or no):&p cif yes separate inspection:eauir ed? Y Laundry system inspected(yes or no):&V Seasonal use:(yes or no): Water meter readings,if available(last 2 years usage Surw pump (gpd)): . {yesorno)• _ _vast date of occupancy: CONMERCIAL/Ir'DL?S�TRII'ALA Type of establishment: Design flow,(based on 310 CMR 15.203); gpd Basis of design flow(seats/persons/sgftetc.): Grease tap present(yes,or no): industrial waste holding tank present(yes or no):_ Non-sanitary-waste discharged to tLe Title 5 system(yes or no):— Water meter readings,if available: Last date of occupancy/use: OTHER(describe): GENTER L INFORMATION Pumping Records Source of information: /f/C t-✓ S �--JI-1 t17 Was system pumped as part of the inspecti n(yes or no):/ If yes;volume pumped: galllons--Hoty was quantity pumped determined`' Reason for pumping: TYP SYSTEM Septic tank, distribution boat,soil absorption system _Single cesspool _Overflow cesspool _Privy Shared system(yes or no)(if yes,attach previous inspection records;if any) _InnovativeiAlternative technology.Attach a copy of the current operation and m ienanct obtained from system owner) _Tight tank —Attach a copy of the DEP approval Other(describe): Approximate age of all components,date installed(if known)and source of info---nzt' oZ OU — c Were se%•age odors detected"hen arrivino at the site(yes or r_o):yam 'Title� in cncrtinn Ln..w f.ft GJnnnn J Page 7 of 11 OFFICIAL nL SPEMONFORM-NOT FOR VOLLI-ARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTE-m r-%SpECTrO�FORzr P A.RT C SYSTEM BTO�RIMATION(continued) Property-Address:_if;� Ae'- ! OS 2r yi' :/ Oumer Date of Inspection: .2i O BUILDING SEWER(locate on site plan) ccyy �� Depth below grade: 02 Materials of construction: /cast iron _. PVC_other(explain): Distance L-om private water supply well or suction G; Comments(on condition of joints,venting;evidence of leakage,etc.): SEPTIC TANK:_locate on site plan) Depth below,Qrade: V12te;ial of constriction:—frete_metal_fiber4lass polverhvlene —other(explain) If tank is metal list age:_ Is age confirmed by a Cerd,'ficate of Con:phance(yes or no): (a-ach a cop of certificate) — Dirnensions: X Sludge depth: / ' Distance from top of sludge to bottom of outlet tee or baffle: Scum thickness: . e Distance from top of scum to top of outlet tee or baffle: 6 9 Distance from bottom of scum to botto of outlet tee r baffle'. _ How were dimensions determined: I le- Comments(on pumping recommendations.inlet and oeeet tee or baffle condition-str uc` ral mte_g-=_:_-!ia� as�lated to outlet invent, evidence ofle g ,etc.): vi.M �n• /1 o QP G�- ��'1 t T t��. Ci.n�j p h. �e :� o �ti •oh 9 Lem �s GREASE TRAP:44locate on site plan) Depth below grade:_ Material of corrstruction:—concrete_metal_fberg ass--poivetyviene of er (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(on pumping recommendations;inlet and outlet tee or baffle condition. s-ac-u_al as related to outlet invert.evidence of leakage;etc.): Page 8 of i 1 OFFICIAL INSPECTION FORM—NOT FOR VOLL"'\-T-ARY ASSES SAIE SUBSURFACE SEWAGE DISPOSAL SYSTEM I1NTSP£CTio\ FC�RZI PaxT C ? SYSTEM Il\TFORMATION(contipuedl Property Address: C-�J vtct, /�' Owner: 1411 c o% Date of Inspection: LE xl d TIGHT or HOLDI'\G'I'A-'N'K:/V(tank must be pumped at time of ispection)(locate on s=te nlz-r Depth below grade: Material of construction: concrete_metal_fiberglass_polyethylene o-},e-(�� Dimensions: Capacity: gallons Design Flow: eallons!dav Alarm present(yes or no): Alarm level: Alarm in working order(yes or no): Date of last pw-nping: Comments(condition of alarm and float switches,etc.): DISTRIBL-TION BOX:Z(ifpresent must be o ened ocate on p )(1 site plan) Depth of liquid level above outlet invert:A91'I'l ; 1-- Comments(note if.box is level and distribution'to outlets equal any evidence of solids care o•-er, a-- leakage ' o or out of ox,etc.): /SOX /11 p PUMP CHAMBER: 'Y (locate on site plan) Pumps in working order(yes or no):_ Alarms in working order(yes or no): Comments(note condition ofpump chamber,conditior ofpumps and appurtenances.etc.'': Tirlo�T..cnontintt L' v Page9of11 OFFICIAL INSPECTIO\7 FOR-Al-NOT FOR vOLUNT-ARC ASSESS--VIENTS SLTBSL?RFACE SEWAGE DISPOSAL SYSTEM i-N-SPECTI4 P(3R € P_ART•C SYSTEM INFORMATION(continued) Property Address: 1�13 (^ i�d Owner: / G eke { Date of Inspection: oZ Q�j SOIL ABSORPTION SYSTEM?(SAS):_(locate on site plan,excavation not required) If SAS not Iocated explain why: 3 Type e � leaching pits;number: 'S 00 _:eaching chambers,number:_ leaching galleries,number:_ U__ _leaching trenches_number.lei h: teaching fields,number;dimensions: pa overflow cesspool,number: innovative/alternative system Type/name of technolo"Y Comments(note condition of soil;signs of hydraulic failure,level of ponding,dame soil. condit etc.): p 0 h Cl h /too S; -.2 1!51�2 r CESSPOOLS: /y (cesspool must be pumped as pa_t of inspection)(locate on site plan) Number and configuration: Depth—top of liquid to inlet invert: Depth of solids laver: Depth of scum laver: Dimensions of cesspool: Materials of construction: Indication of groundwater inflow(yes or no): Comments(note condition of soil,signs ofhvdraulic.failure.level ofponding,co_:diL on o-vec,'Ta__ PRIVY: /li (locate on site plan) Materials of construction: Dimensions: Depth of solids: Comments(note condition of soil,signs ofhydraulic failure,IeveI of ponding,condiro=of:e_= 4 Page 10 of 1 I OFFICIAL n-TSPECTIO\ M - - FOR_'�7_NOT FOR ti'OLLNT.A-RY LSSZIE�1-0 ASS SUBSURFACE SEWAGE DISPOSAL,SYSTE'NT n-.SPECT7 S S SS:UE Pr1RT C SYSTEM INTFOkNTATION(continued) Property Address: 3 Ol ✓v.' P� 6ot 6 U4 Owner: 11 CGGiG. Date of Inspection: Al Q SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at least tvvo permar_ent ref_rence benchmarks. Locate a •eIIs vithin 100 feet.Locate where public water su-ply euters the L-mY , I c 3 - l'f-1 T;cT-e T.e,nnr;nn �n.,r ail ci7nnn �n Page 11 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLU-NT-AP SSEccA. E- rs SFBSLRFACE SEWAGE DISPOSAL,sYSTEAI n- SIEti 77C)_—r[7R X:I PART C SYSTEM INFORMATION(continued? Property Address: vZ aQ� � ev ,/ Owner: /�� G � f Date of Inspection: al/ 0/ SITE EXAM SIope Surface water Check cellar Shallow wells i AIV fte Estimated depth to ground water �� feet Q�a H j'' F Please indicate(check)all methods used to determine the high ground water elevation: Obtained from system design plans on record-if checked,date of design plan rezmezzd: Obs -ed site(abutting property/observation hole within 150 feet of SAS) Necked with local Board of Health-explain: ��<•+-�r — /�l ,o Checked.n-,h local excavators,installers-(attach documentation) Accessed US—US database-explain: You must_�cri how you established the high ound water elevation: vh o711 6le l G,/ 7 TOP FNDN. AT EL. 23.75' SYSTEM EM PROFILE TEST HOLE LOGS' _ ACCESS COVER TO WITHIN 6" OF FIN. GRADE (NOT TO SCALE) PROVIDE INSPECTION PORT WITHIN ACCESS COVER (WATERTIGHT) TO 6" OF FINISH GRADE ENGINEER: A.H. OJALA, PE 23.0 MINIMUM .75' OF COVER OVER PRECAST /� WITHIN 6" OF FIN. GRADE LOPE REQUIRED OVER SYSTEM 2 o s o 23.0 WITNESS: DAVID STANTON, RS � f*f RUN PIPE LEVEL 2" DOUBLE WASHED PEASTONE DATE: 10/27/04 o _q�� 1 .0 '*t - FOR FIRST 2' \'' 3' MAX. PERC: RATE _ < 2 MIN/INCH C Locus �3$ rr 20.90 PROPOSED 1500 GALLON SEPTIC 20.1' 1 W QUAIL 20.25 CLASS SOILS P# t b 4- 0 3 20.50' 3 TANK (H- 1 ) GAS -, BAFFLE 19.49' �� 19.32' 0 0 CD 0 0 0 0 i;� og MIN C> 19.23' p p 0 o a o a I� BAY LANE ( 2 % SLOPE) �6" CRUSHED STONE OR MECHANICAL $o M I� ELEV. COMPACTION. (15.221 [21) 0 2 I'� coo 17.23' 0» , 23.0 DEPTH FLOW = 4 ( 2 % SLOPE) ( 1 % SLOPE) 3/4" TO 1 1/2" DOUBLE WASHED STONE A TEE SIZES: : INLET DEPTH = 10" LS OUTLET DEPTH = 14" 8„ 1OYR 4/2 LOCATION MAP NTS IN FOUNDATION 16' SEPTIC TANK 38' D' BOX 11' LEACHING ING B ASSESSORS MAP 117 PARCEL 15 16' 5.2,3'--- ' LS 10YR 5/6 �°= *THE INSTALLER SHALL VERIFY THE 30" 20.50' LOCATIONS OF ALL UTILITIES AND ALL BUILDING SEWER OUTLETS AND ELEVATIONS PRIOR TO INSTALLING ANY PORTION OF . SEPTIC SYSTEM g,0A Mcs I•{ �� PERC ��A I 21 2.5Y 6/4 # 19.4 95 i 0.5 r 4771- \ 0 i �I�18.2 132" 12.0' -cis.o 1 \ r I NGWE NOTES: 1-IT9 a= \ ` 22.1 0 APPROX. NGVD 1 1 21.8 0 SEPTIC DESIGN. (GARBAGE DISPOSER IS NOT ALLOWED ) 1. DATUM IS 1 1 DESIGN FLOW 3_ BEDROOMS ( 1 10 GPD) = 330 GPD 2. MUNICIPAL WATER IS EXISTING 1 \ 330 F _ 3, MINIMUM PIPE PITCH TO BE 1/8" PER FGOT. 1 1 � c� I USE A C�NU LiE.SIGN FLOW I LOT 12 I i 0 _ 660 4. DESIGN LOADING FOR ALL PRECAST UNITS TO BE.AASHO H- . 1 1 23,320f SQ. FT. \ SEPTIC TANK: 330 GPD (�) - 5. PIPE JOINTS TO BE MADE WATERTIGHT. 1 1 i 23.4 USE A 1500 GALLON SEPTIC TANK 6. CONSTRUCTION DETAILS TO BE IN ACCORDANCE WITH MASS. 1 .4 LEACHING: ENVIRONMENTAL CODE TITLE V. 1 I 2(30 + 9.83) 2 (.74) = 117 7. THIS PLAN IS FOR PROPOSED SEPTIC SYSTEM ONLY AND IS NOT 1 I SIDES: TO BE USED FOR ANY OTHER PURPOSE. 30 x 9.83 (.74) = 218 3.1 BOTTOM: 8. PIPE FOR SEPTIC SYSTEM TO SCH. 40-4" PVC. i TOTAL: 452 S.F. PD 335 9. COMPONENTS NOT TO BE BACKFILLED OR CONCEALED WITHOUT I 16" OAK . INSPECTION BY BOARD OF HEALTH AND PERMISSION OBTAINED 1 2 21,8 EXISTING DWELLING + 2 .3 USE (3) 500 GAL. LEACHING CHAMBERS (ACME OR FROM BOARD OF HEALTH. TOP FNDN = ` 29 23.75' + 24� N EQUAL) WITH 2.5' STONE AT SIDES AND 2.25' AT 10. PUMP & REMOVE (OR FILL W/CLEAN SAND) EXISTING SEPTIC SYSTEM 22A 3.1 I ryry 'ENDS ro Gh I GARAGE (SLAB) _ LEG EN D PAVED `� N _ TITLE 5 SITE PLAN DRIVE 3.2 \ + 1 C 16„ W.PINES 100.0 PROPOSED SPOT ELEVATION or 1 ,A- 23 .o + 23 QUAIL ROAD I �9 23 100x0 EXISTING SPOT ELEVATION IN THE TOWN OF: 2 + 100 EXISTING CONTOUR 0 STE RVI LLE BARN STABLE -,/2 •8 12" 5„ H PREPARED FOR: ABRAHAM MICHAELS N MITZI GOLUB N + 20 0 20 40 60 BOARD OF HEALTH + 23.7 23 / APPROVED DATE MA SCALE: 1" = 20' DATE: OCTOBER 27, 2004 150.00' off 508-362-4541 fox 508 362-9850 BENCH MARK - TOP OF CONC. BND. EL. = 21.5 I � H oF,kgs�cy otM of Mgs��s down cape engiIneertIng, rnc, ARNE ARNE H. aN H. �` OJALA CIVIL ENGINEERS 0j" CIVIL N •e No.26348 No. 30792 4 LAND SURVEYORS 04-326 939 vain st, yarmouth, ma 02675 AR OJALA, P.E.,° . .S. DATE