HomeMy WebLinkAbout0065 SETH GOODSPEED'S WAY - Health 65 Seth Goodspeed's Way
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TOWN OF BARNSTABLE ec
LOCATION Jq (5 A R1 SEWAGE #
VILLAGE OS` c�l�. ASSESSOR'S MAP & LOT "61
INSTALLER'S NAME&PHONE NO. V9wV J9
SEPTIC TANK CAPACITY
LEACHING FACILITY: (type) ": (size)
NO.OF BEDROOMS
BUILDER OR OWNER
PERMITDATE: �7rc4: COMPLIANCE DATE:
Separation Distance Between the:
Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility . Feet
Private Water Supply Well Leaching Facility (If any wells exist
on site of 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
No. Fee
THE COMMONWEALTH OF MASSACHUSETTS
Entered in computer:
Yes
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS
01ppYication for Mig- aal 6p.5tem Cougtruction Permit
Application for a Permit to Construct( . )Repair Upgrade( )Abandon( ) ❑Complete System . ❑Individual Components
Location Address or Lot No. �j Q � �/ Owner's Name,Address and Tel.No.
Assessor's Map/Parcel/ -2 - el 44"
Installer's Name,Address,and Tel.No. � N P !? Designer's Name,Address and Tel.No.
old ?R&W CA �S-�-f
C
Type of Building:
Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( )
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures aa
Design Flow 33d gallons per day. Calculated daily flow J gallons.
Plan Date / l�q 17 0* Number of sheets Revision Date
Title
Size of Septic Tank /'t'Oa9 Type of S.A.S.
Description of Soil
Nature of Repairs or Alterations(Answer when applicable)
Date last inspected:
Agreement:
The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system
in accordance with the provisions of Title 5 of the ' onment de and not to place the system in operation until a Certifi-
cate of Compliance has been issued k>is$o d ealt .
Signed o Date
Application Approved by If Date
Application Disapproved for the following reaso
Permit No. Date Issued
Feeor
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
Yes
F PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS
ZIPPtication for Migoml *p5tem CCongtruction Permit
Application for a Permit to Construct( )Repair( &)Upgrade( )Abandon( ) El Complete System ❑Individual Components
Location Addressor Lot No. C—T "S L/ Owner's Name,Address and Tel.No.
Assessor's Map/Parcel /�r� y l+l tt�—Jl�7T� S&- 6JWQAC/ 5_44V 057OW466—
Installer's Name,Address,and Tel.No. BMW/9/1Qr2_f Designer's Name,Address and Tel.No.
a0 7REErvP C/A 64-),T6:�Al
�oN /)qIcL S S&2v-�F3 ti � Ti�lf ryl
Type of Building:
Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) �
Other Type of Building No. of Persons i Showers( ) Cafeteria( )
Other Fixtures '
Design Flow gallons�per day. Calculated daily flow J3� gallons:
Plan I;Wq 0 Number of sheets Revision Date
Title_
Size of'Septic Tank /DO! Type of S.A.S. 0
Description of Soil
Nature of Repairs or Alterations(Answer when applicable)
r
Date last inspected:
Agreement: t ( ¢
The undersigned agrees to ensure•the.construction and maintenance of the afore described on-site sewage disposal system
in accordance with the provisions of i ile 5 of them?' oh en de and not to place the system in operation until a Certifi-
cate of Compliance has been issued y is Bo d/d o ealth.
�� k
Signeoo fir• (" Date
/l/Application Approved by iA U� Date
Application Disapproved for the following reaso
Permit No. .— Date Issued
���/ THE COMMONWEALTH OF MASSACHUSETTS
P0 1 08r BARNSTABLE, MASSACHUSETTS
Certificate of CComptiance
THIS IS TO C TIFY, that t j�e OnJ tte Sewage Disposal System Constructed (' ) Repaired ( )Upgraded( )
Aband ned( )b f,c- r1-
at Se w 9(`U d S� 'S• ha been constructed in 'ccordance
with the provisions of Title 5 and the for Disposal System Construction Permit N _ '` ated
Installer Designer
The issuance oi this ert/mit shall not be construed as a guarantee that the s)tem wil f nction as ned
Date
S2 1D/ Inspector
_—
--
No. 7,� Fee
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS
lwi!6poml *pgtem CCon5truction Permit .
Permission is hereby$raj d tp,9C�o?str /ct1( Re air pg ade ) .ba'}d�n� /'�c
System located at (�.' ti.�C.� i 7t �� V`-�
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: Cons ction ynust be completed within three years of the date of th Npet4
Date:_ g/ I f7 k I Approved by i f
i
TOWN OF BARNSTABLE
LOCATION CA/jel SEWAGE #
VILLAGE '�� ASSESSOR'S MAP & LOT 2" 61
INSTALLER'S NAME&PHONE NO.
SEPTIC TANK CAPACITY A 0®Q
LEACHING FACILITY: (type) dV (size) f �
NO.OF BEDROOMS
BUILDER OR OWNER
PERMITDATE: COMPLIANCE DATE:, .
Separation Distance Bet n the:
Maximum Adjusted Groundwatr Table to the Bottom of Leaching Facility Feet
Private Water Supply Well and Leaching Facility (If any wells exist
on site or within 200 feet of leaching facility) - Feet
Edge of Wetland and Leaching Facility(If any wetlands exist Feet
within 300 feet of leaching facility)
Furnished by
RACk-
� 60� '
Town of Barnstable
•. '° .a Regulatory Services
. Thomas F.Geiler,Director
• snnxsr�s�,
MAM Public Health Division
i6J9. �e
�► � Thomas McKean,Director
200 Main Street,Hyannis,MA 02601
Office:.508-862-4644 Fax: 508-790-6304
Installer&Designer Certification Form
Date:
Designer: QkVID D. COUGH fWQWK Installer: 131R1a9/y m
Address: +7 i�W GCC C i R6LC Address:
On S�21-tom PAIN ; was issued a permit to install a
(date) (installer)
septic system at � ,��' '� based on a design drawn by
(address)
NV l D C Q(r-.,(j A Wy W R, k� dated B
(designer)
I/ 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.
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.
r -
(Installers Si We
9F
B4NIT1►A`'
(Designer's Signature) (Affix Designer's Stamp Here)
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
jib Commorwedth of Massachusetts John Grad
ExeeutNe Mce of ErMrom entot Affdrs D.E.P. Title V Septic Inspector
Department of P.O. Box 2�I9
Environmental Protection , '' 536
® /. SUBSURFACE SEWAGE DISPOSAL
ASYSTEM INSPECTION
ur CERTIFRIC�ATION t ,j99�
p
Property Address: ee
65 Seth Goods d's Way Address of Owner:
Date of Inspection:3127197 (If different)
Name of Inspector John Graci Baxter:Box 552 Centerville Ma.026 tl_
Company Name,Address and Telephone Number:
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:
X Passes This Inspection Is based on criteria defined In Titre V
_ Conditionally Passes code 310 CMR 15.303.Myflndings are of how the system Is
performing at the time of the Inspection.My inspection does
_ Needs Furth r Eval ation By the Local Approving Authority not Imply any warranty or guarantee of the longevtty of the
Fails septic system and any of Its components useful life.
Inspector's Signature: Date: 3127197
The System Inspector shell submit a copy of this inspection report to the Approving Authority within thirty(30)days of completing this
Inspections. if the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit
the report to the appropriate regional office of the Department of Environmental Protection.
The original should be sent to the system owner and copies sent to the buyer,if applicable and the approving authority.
INSPECTION SUMMARY:
Check A.B.C,or D:
A) SYSTEM PASSES:
X I have not found any information which indicates that the system violates any of the failure criteria
defined as in 310 CMR 15.303. Any failure criteria not evaluated are indicated below.
S) 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 11115195)
One Wlnler Street • Boston,Massachusetts 02108 • FAX(617)556-1049 • Telephone(617)292-5500
1
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: 65 Seth Goodspeed's way Ostervlile
Owner: Baxter:Box 552 Centerville Ma.02632
Date of Inspection:3127197
_ Sewage backup or breakout or high static water level observed in the distribution box is 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 leveled or replaced
_The system required pumping more than four times a year due to broken or obstructed pipe(s). The
system will pass inspection if(with approval of the Board of Health):
broken pipe(s)are replaced
obstruction is removed
C] FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH:
Conditions exist which require further evaluation by the Board of Health in order to determine if the
system is failing to protect the public health,safety and the environment.
1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM IS
NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND
SAFETY AND THE ENVIRONMENT:
Cesspool or privy is within 50 feet of a surface water
Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh.
2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH(AND PUBLIC WATER SUPPLIER,IF APPROPRIATE)DETERMINES
THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECT THE PUBLIC HEALTH AND SAFETY AND THE
ENVIRONMENT:
_ The system has a septic tank and soil absorption system and is within 100 feet to a
surface of water supply or tributary to a surface water supply.
The system has a septic tank and soil absorption system and is within a Zone 1 of a public water
supply well.
The system has a septic tank and soil absorption system and is within 50 feet of a private water
supply well.
_ The system has a septic tank and soil absorption system and is less than 100 feet but 50 feet or more from a private
water supply well,unless a well water analysis for coliform bacteria volatile organic compounds indicates that the well is
free from pollution for that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal or less than 5 ppm.
3) OTHER
D] SYSTEM FAILS:
_ I have determined that the system violates one or more of the following failure criteria as defined in
310 CMR 15.303. The basis for this determination is identified below. The Board of Health should be
contacted to determine what will be necessary to correct the failure.
Backup of sewage in 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
cesspool.
SAS is in hydraulic failure.
(revised 11115195)
2
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address: 65 Seth Goodspeed's Way ostervllle
Owner: Baxter:Box 552 Centerville Ma.62632
Date of Inspection:3127197
D] 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).
Numbers 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 1 of a public well.
Any portion of a cesspool or privy is within 50 feet of a private water supply well.
Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no
acceptable water quality analysis. 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:
The following criteria apply to large systems in addition to the criteria:
The system serves a facility with a design flow of 10,000 gpd or greater(Large System)and the system is a significant threat to
public health and safety and the environment because one or more of the following conditions exist:
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 11115195)
3
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECLIST
Property Address: 65 Seth Goodspeed's Way Ostervllle
Owner: Baxter:Box 552 Centerville Ma.02632
Date of Inspection:3127197
Check if the following have been done:
X Pumping information was requested of the owner,occupant, and Board of Health.
X None of the system components have been pumped for at least two weeks and the 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.
Na As built plans have been obtained and examined. Note if they are not available with N/A.
X The facility or dwelling was Inspected for signs of sewage back-up.
X The system does not receive non-sanitary or industrial waste flow.
X The site was inspected for signs of breakout.
X All system components,excluding the Soil Absorption System,have been located on the site.
X 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.
X 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.
x The facility owner(and occupants,if different from owner)were provided with information on the proper maintenance of Sub-
Surface Disposal System.
(revised 11115195)
q
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
Property Address: 65 Seth Goodspeed's Way ostervIlle
Owner: Baxter:Box 552 Centerville Ma.02632
Date of Inspection:3127197
FLOW CONDITIONS
RESIDENTIAL:
Design flow: 220 gallons
Number of bedrooms: 2
Number of current residents: 1
Garbage grinder(yes or no): No
Laundry connected to system(yes or no): Yes
Seasonal use(yes or no): No
Water meter readings,if available: n1a
Last date of occupancy: n1a
COMMERCIAL/INDUSTRIAL:
Type of establishment: n1a
Design flow:0 gallons/day
Grease trap present:(yes or no) No
Industrial Waste Holding Tank present:(yes or no) No
Non-sanitary waste discharged to the Title 5 system:(yes or no) No
Water meter readings,if available: n1a
Last date of occupancy: n1a
OTHER:(Describe) n1a
Last date of occupancy:
GENERAL INFORMATION
PUMPING RECORDS and source of information:
System has not been pumped In the last two years.
System pumped as part of inspection:(yes or no)No
If yes,volume pumped: 0 gallons
Reason for pumping: nla
TYPE OF SYSTEM
X Septic tank/distribution box/soil absorptions system
Single cesspool
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 information:
Approximately 20 years
Sewage odors detected when arriving at the site:(yes or no) No
(revised 11115195)
5
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
P rope rty Address: 65 Seth Goodspeed's Way ostervllle
Owner: Baxter:Box 552 Centerv0le Ma.02632
Date of Inspection:3127197
TIGHT OR HOLDING TANK:
(locate on site plan)
Depth below grade: nla
Material of construction:_concrete_metal_FRP_other(explain)
Dimensions: n1a
Capacity: n1a gallons
Design flow: n1a gallons/day
Alarm level: n1a
Comments:
(condition of inlet tee,condition of alarm and float switches, etc.)
nla
DISTRIBUTION BOX:
(locate on site plan)
Depth of liquid level above outlet invert: n►a
Comments:
(note if level and distribution is equal,evidence of solids carryover,evidence of leakage into or out of box etc.)
nla
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.)
n1a
(revised 11115195)
7
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Add ress: 65 Seth Goodspeed's Way Ostervlile
Owner: Baxter:Box 552 Centerville Me.02632
Date of Inspection:3127197
SOIL ABSORPTION SYSTEM(SAS):X
(locate on site plan,if possible;excavation not required,but may be approximated by non-intrusive methods)
If not determined to be present,explain:
nla
Type:
leaching pits,number: 1,66o gallon leach pit
leaching chambers,number:nfa
leaching galleries,number: nfa
leaching trenches,number,length: nfa
leaching fields,number,dimensions:nfa
overflow cesspool,number:nfa
Comments:(note condition of soil, signs of hydraulic failure,level of ponding,condition of vegetation,etc.)
The overflow is structurally sound and functioning properly.@ was empty at the time of the inspection.
CESSPOOLS:_
(locate on site plan)
Number and configuration: nfa
Depth-top of liquid to inlet invert: nfa
Depth of solids layer: "fa
Depth of scum layer: nfa
Dimensions of cesspool: nla
Materials of construction: nfa
Indication of groundwater: nfa
inflow(cesspool must be pumped as part of inspection)
nla
Comments:(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.)
nla
PRIVY:
(locate on site plan)
Materials of construction: n►a Dimensions: nla
Depth of solids: nla
Comments:(note condition of soil,signs of hydraulic failure,level of ponding, condition of vegetation,etc.),
nla
(revised 11115195)
8
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 65 Seth Goodspeed's Way Osterville
Owner: Baxter:Box 552 Centerville Ma.02632
Date of Inspection:3127197
SKETCH OF SEWAGE DISPOSAL SYSTEM:
include ties to at least two permanent references landmarks or benchmarks
locate all wells within 100'
Dee
CA
3?
�� by
DEPTH TO GROUNDWATER
Depth to groundwater:12 feet
method of determination or approximation:
USGS Maps and Charts
(revised 11/15195)
9
N:/ SEWAGE PERMIT NO.
/777
VILLAGE
ItTLER'S AME & A DRESS
2
B U I'L D E R 09 WN ER
DATC PERMIT ISSUED
DAT E COMPLIANCE ISSUED jl ;7;
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No.--•••-•1P -•------ FEE..... ...................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD F HE L
`G --.OF. .. ...............................
. pphration -fur Bi-spuuttl World Tut union rrutit
Application is hereby'made for a Permit to Construct or Repair ( ) an Individual Sewage Dis osal
system t /"7 - v'
f`
C Locatio -Address or Lot No.
.. .• ••---•..................... '
..•. .......
r Ow r st Address
--------- - -- -- - ----------- -- !
- _ __ .
nstaller Address
U Type of Building Size Lot----- f a�O_-Sq. feet
Dwelling—No. of Bedrooms--------------------------------------------Expansion Attic ( ) Garbage Grinder ( )
p, Other—Type of Building ............................ No. of persons-----------_---------------- Showers ( ) — Cafeteria ( )
a'
d Other fixtures . .
W Design Flow_....._.....`dz.. ................... allons per person per day. Total daily flow--------------------------------------------gallons.
WSeptic Tank—Liquid capaciri------------�.-ga Ions Length---------------- Width............-... Diameter---------------- Deptli-.--------_--.
xDisposal Trench—No..................... Wi� T ngth._...._........... of eaching area....................sq. ft.
Seepage Pit No.__. .�'�TSi _.....:�-=...... D� lnl ________ _____ o a eacliin g,area.-.---._------___sq. ft.
Z Other Distribution box ( ) Dosing tank ( ) Q�- �G� - /o` �'� 7l.
aPercolation Test Results Performed by....................................................................................................................... Date--_-------------------------------.----.
Test Pit No. 1----------------minutes per inch Depth of Test Pit.................... Depth to ground water..---------------...___.
f14 Test Pit No. 2................minutes per inch Depth of Test Pit.._---.--..-_______- Depth to ground water------------------------
----------------------------
O Description o Soil rO -G - 6 z - r1 - ----- - - --
U - �.Gl.. " -,1 . ¢!"` ,--------------•---------------------------------------------
W
UNature of Repairs or Alterations—Answer when applicable...---------------------------------------------------------------------------------------------
-----•------------------------------•.-------•-------..---------------_.--------•--•--------------•------------•------------------------------------•--------------------------------------------•-----
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of Article NI of the State Sanitary Code— The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has been issued b the and of health.
P P Y ---sip-------- -------
Date
Application Approved BY ✓??-° -- T-----------.
Date
Application Disapproved for the following reasons-------------_---.-.--... ............................................................ a.t,••-•••-•-------
--•••••••---••••-•--••--•-•-•---•••••••••-••-•--•-••-----------••---•--••••••------•--••-•••--••--------•----•--•-•------------•-----------------------------------------------•---•---------.........
Date
PermitNo........................................•••-••------..... Issued......................--................................
Date
•
......f 5 - ---�
Faa ........................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD,.,OF HEALTH`
:s Appliration -fair Diriporittl Marks Tolur rurtion PPrutit
1 Application is hereby'made for a Permit to Construct or Repair ( } an Individual Sewage Disposal
System t f
� C Locatioi? Address or Lot No.
a !r.._..._'.�..i.l....G... .....c......^ __. ....__ ._..f....._______...._.. —f Address__.....�.._ /Iler Address
ir
o4CJ.
U Type of Building Size Lot._.______,:.................Sq. feet
.i Dwelling—No. of Bedrooms------._49 --------------------------------Expansion Attic ( ) Garbage Grinder ( )
aOther—Type of Building ----------------_---_--- No. of persons..-__-_-----____-_--.--_-- Showers ( ) — Cafeteria ( )
Otherfixtures -s` ''1- - - _--------------- --------------------------------------------- ---------------------------
-
W Design Flow__--______-_n_�_�J_ ________________ allons per et son per day. Total daily flow________.-... .. ____.__...._. Mons.
g P P P Y Y g
W4Septic Tcuik—Liquid cauac _CT��" allons Length_-_--_-_--__--- Width._._....._._.. Diameter...:....:....... Depth.-..-_.--_._.--.
r � q '� -...---•-g` b
xDisposal Trench—No.................... W' ---._.- ------_ Toptl Length-.-.---.---_-__-.Ao;AXeaching area--------------------sq. ft.
Seepage Pit No.--- - )i __--._ Itk►✓^ inl ---•--------- o eaching area------- ----------sq. ft.
z Other Distribution box ( )���� Dosing tank (
O /d` /f- 9-/
~' Percolation Test Results Performed b --------- --�-- ------------------------------ Date--..--------------------------------....
�
a Test Pit No. 1----------------minutes per inch Depth of Test Pit...----------------- Depth to ground water------.------.---..-----
f� Test Pit No. 2----------------minutes per inch Depth of Test Pit-------------------- Depth to ground water------------------------
-------------------------------------------------------------
Description of Soil-------- rt --. �' ------ � �' ---------- ..
/} .. .. /
--------
x ---------------------------------------------------------------- -------------------_ ---------------------- --------------
V Nature of Repairs or Alterations—Answer when app4cable.-----------------------------------------------------------------------------------------------
----------------------------------------------- ------------------------------=° -------- =----------------------------------------------------------------------------- -----------------------------
Agreement
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of Article XI of the State Sanitary Code— The undersigned further agrees not to place the system in
operation until a Certificate of ,Compliance has been issued by the b and•of health.
' ✓sr-gip �°.
Signed ----- ems .
Date ,` r
Application Approved By._._-• -- __-- •- •-- - ._:.�.'...----_
/(" Date ,;a
Application Disapproved for the following reasons:----------- --------------------- ---------------------------------- --------------=-
Date
PermitNo. ........................................ Issued --------------------------------..........
Date
THE COMMONWEALTH OF MASSACHUSETTS
-- BOARD OF HEALTH
t1tt. ............OF.�f,/� '.............`.... �..............................
r �rrtif irate of TompliFalta --
TH S IS TO CERTIFY, That th Individual Sewage Disposal System constructed or Repaired ( )
by 1 '
-------- - --------- -------------------- -- -
�f� � r -----Installe�
at.. �. Y'.....----• --•-•-----••-�----`----- ..............................................................
has been installed in accordance wit q,,the provisions of r 'cle XI of`_?he State Sanitary Code as described in the
app�fcation for Disposal V .oak Construction Permit_________________________ dated. �_�' ................
THE ISSUANCE OF THIS CERTIFICATE SH LL NOT RE CONSTRUE® AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY l {�,--
DATE........r .............. ,! Inspector.....)- s
!� THE COMMONWEALTH OF MASSACHUSETTS
i
---'`" BOARD .OF HEAL iH
1� t
.. �'
0 F
l� - ......•.... _ FEE_ .
ttI Markii TTon!, r;rti, t .Vamit
Permission is her-ell granted____--_<''_: �.._......_.._ . �- __ ______
-------------------------------------------------
to Construct 4�r Repair ( ) 1n Ind' idual�ewage Di posal Sy§tem
l/ `.' � � �s�•�" tree
as shown on the application for Disposal Works Construct' ermit :.._��__ DatedS_4__-77...............
DATE.---•_Z..----7A 77 ard of
FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS
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tT�a B A)(TEPZ 4 ► -(E I wc_
REGIS'i'V-JZED LA W'o 5U7-vcY014S
TWS V'LAW IS WOT 15ASE'O ON AN O-STERVILLE o /I,C,ASS,
4455 UAAEWT 5OiZV6=,-( -k TNI= dFCSr--TS eI4oww:>qL APPLI CAI�IT
WCtT BE U5EO To t)e:TE2M1NF-- LOT LIWaS G PG- �tT�[r (�E:�/• �p .
SOIL TEST L O G DATE OF TEST: MAY 12. 2004 '
WSOIL EVALUATOR:
REQUI EMENTAWAI VID EDD. CONOHVARIANCES SOUGHT DESIGN CALCULATIONS
NO GROUNDWATER
`
TEST PIT I PARENT MATERIAL: E ROGLACIALDOUTWASH i
ELEVATION - *-
PERC AT 78 in : 2 MIN/INCH IN C SOILS DESIGN FLOW: 2 BEDROOMS X 110 GPD - 220 GPD - USE 330 GPD (MINIMUM PER CODE)
SEPTIC TANK:TANK: 330 GPD X 2 DAYS - 660 GALLONS
DEPTH SOIL USDA SOIL SOIL COLOR SOL OTHER
(14CHES) HORIZON TEXTURE SMUNSELL) MOTTLNG USE EXISTING 1000 GALLON SEPTIC TANK IF IS SOUND STRUCTURAL
0-7 FLL CONDITION. IF NOT. INSTALL 1500. GALLON SEPTIC TANK (MINIMUM ALLOWED)
7-10 A LOAMY SAND 10 YR 3/3 NONE FRIABLE DISTRIBUTION BOX: USE 3 OUTLET D-BOX.-,
10-36 B LOAMY SAND 10 YR 5/6 NONE FRIABLE - -
SOIL, ABSORBTION SYSTEM:rt.A 24- .ft x 12.5 ft. x 2 ft LEACHING, GALLERY CAN LEACH
36-144 C MEDLIM SAND 10 YR 6/4 NODE LOOSE. IO. GRAVEL
Abot - ( 24 x 12.5 ) 300 of
Asdw - ( . 24 •' 24 _.+ 612.5 + 12.5 `) 'x 2 . - 146 sf
Atot - 446 of
Vt 0.74 x 446 330.04 . GPD
GROUNDWATER ". , USE. A 24 fi x 12.5 ft -x 2 ft GALLERY. Vt 330.04, GPD > 330 GPD REOUIRED
ADJUSTMENT
fl ,
- EXISTING GROUNDWATER LEVEL
BASED ON BARNSTABLE GIS
DEPARTMENT RECORDS a T
_
OBSERVED 24.0
LEACHING GALLERY
INDEX WELL:: MIW-29 W-
ZONE: D
READING: APRIL 2004 , . CONSTRUCTION DETAIL
LEVEL: 7.8 ,r .
ADJUSTMENT: 2.8 ft R F DRYWELL UNIT
ADJUSTED GW: 26.8 `. 8•-6-x 4•-10"x 2=9-' STONE
2 ft EFF. DEPTH
24.0 ft q
'NOTES
..
1) GARBAGE GRINDER NOT ALLOWED WITH THIS DESIGN
.` in
LA
2) ALL LINES TO BE SCH 40 PVC AND PITCH AT 1/8 INCH PER FOOT MINIMUM. 'n a J _
N _ .
3) ALL COMPONENTS INSTALLED SHALL MEET THE MINIMUM REQUIREMENTS 4.
OF MASSACHUSETTS TITLE 5 SEPTIC CODE (310 CMR 15)
4) INSTALLER TO VERIFY LOCATIONS OF ALL UNDERGROUND UTILITIES s '8.5', 8.5' 3.5'
BEFORE EXCAVATING FOR SYSTEM.
' 3.
24.0 f 1 NOT TO
5) EXISTING CESSPOOL AND LEACH PIT TO BE PUMPED. COLLAPSED. AND FILLED. OR REMOVED SCALE
6) ALL STONE TO BE DOUBLE WASHED AND FREE OF IRON. _FINES AND DUST IN PLACE
7) LINES EXITING D-BOX TO RUN LEVEL FOR 2'-0- BEFORE PITCHING DOWN _
8) ECO-TECH ENVIRONMENTAL RECOMMENDS THE INSTALLATION OF LOW FLOW FIXTURES,,.
AND APPLIANCES. AND BIANNUAL PUMPING OF THE SEPTIC TANK
9) SYSTEM IS NOT DESIGNED TO WITHSTAND VEHICULAR LOADING. DO NOT
PARK OR DRIVE VEHICLES OVER SEPTIC SYSTEM, ..- -' ---'- ,, SEWAGE DISPOSAL SYSTEM PLAN
10) INSTALLER TO OBTAIN DISPOSAL WORKS PERMITBEFORE-.STARTING WORK. -TO SERVE EXISTING DWELLING
11) SEPTIC TANKS SHALL BE INSTALLED LEVEL74AND TRUE TO,'GRADE ON A LEVEL
STABLE .BASE THAT HAS BEEN MECHANICALLY, COMPACTED AND ON TO WHICH
SIX INCHES OF CRUSHED STONE HAS BEEN PLACED •TO MINIMIZE UNEVEN SETTLING W CHARLES PATRICIA MEDCHILL
12) SEPTIC TANK TO BE PUMPED DRY AT TIME OFZSYSTEMoREPAIR AND CHECKED _. 65 SETH GOODSPEEDS WAY OSTERVILLE. MA
FOR STRUCTURAL INTEGRITY. INSTALL PVC OUTL'L,:r TEE FITTED WITH GAS BAFFLE.
ECO-TECH ,ENVIRONMENTAL
43 TRIANGLE CIRCLE SANDWICH MA 02563
ETE-1671 : `MAY._I7 °200.4 2
/2
t..
-a - o PLAN REFERENCE CONTOURS L°o OSTERVILLE. MA
r WAY 5
H
LL= LAND COURT PLAN 32225-B EXISTING - - - - - - - 60 v JONA
°H SHEET 2 OF 3 MINIMAL GRADING PROPOSED c
o<w ASSESSOR'S MAP: 122 N
�Jv�i m LOT: 61 0 -m
WNW oc N N Y
lw "' NAT14ANS WA
T6 M BENCH MARK m
>
M" _� TOP OF DRAIN v RourE;.28
o�< 24 ft x 12.5 ft x 2 ft ELEVATION 60.75
w ° �Z o L Eft CHING GALLERY USGS DATUM ASSUMED �- LOCUS N1 A P
o N NOT TO SCALE
00 ° F<o
WN wo(D 6.3
<
<`" Q >- 150.00 ft
J Z O�
N V3 U J >
c
p < Sj)
z NI—
IL
J C7 w '^
zW I N
f Q EN PAVED DRIVEWAY LEGEND
c 22.0 r► 6 �J
tL EXISTING
O (� �} ° 2ts r' 1000 GALLON o 0
1— J L� o n-
2 J N p SEPTIC TANK
W ,°c o V 4 Q D-BOX 0
WATER LiNc
O LL a= w �O I O (� z —fib 0 TEST PIT
(�� �� zw O I o o � � Z p +
Zw o O I z J I o 0 EXISTING
°� m I— J LL o �.J LEACH PIT O
0
o X ao , UTILITY POLE -�
n Q JW
' m N 12-0 DRAIN
m ' o _
TREE
IV WaES.LETTER 6 IuVhBER REfRS TO DUIM TER 18-P.
-
/ Q O-O N�PLE P-P�ES TYPE
W � Z o LOT 12 I �
Y / - +-
w O z 6 AREA 15000 sf
J
LL 3 << Z — — — — — SEWAGE DISPOSAL SYSTEM PLAN
oco
p a � X (' �150.00 ft -TO SERVE EXISTING DWELLING
ry Z w o w CHARLES & PATRICIA MEDCHILL
+ O cn a oAvo 65 SETH GOODSPEED$ WAY OSTERVILLE. MA
Z N o PLAN , CC? �DNOWRECO—TECH ENVIRONMENTAL
5 cq .�i ,9 # 1.093 p
O o lD y _ SCALE: 1 in - 20 ft e� TpA`�a 43 TRIANGLE CIRCLE SANDWICH MA 0256
2 508 364 0894
ETE-1671 MAY 17. 2004, I/2
THIS PLAN IS TO BE CONSIDERED A DRAFT:PLAN UNLESS IT
T
���D� BEARS THE PAW AND SIGNATURE''OF THE-DESIGN ENGNEE
R Y
' 4 V '` ORIGINAL PLANS NTENDED FOR,SUBMRTAL TO,,TFf-BOARD
OF HEALTH°W�L BE SIGNED N-BLUE~AND:STAFFED IN:RED..