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0106 AMELIA WAY - Health
aY 106 Amelia W Marstons Mills P A = 148 164 4 TOWN OF BARNSTABLE LOCATION 10L 1 i cx.- Licxc l SEWAGE# 20IG •319 VILLAGE (n. /Y1;1 S ASSESSOR'S MAP&PARCEL 1/ y INSTALLER'S NAME&PHONE NO. Q �x�ya-��O n• �{'1'�- OG53 SEPTIC TANK CAPACITY Q LEACHING FACILITY:(type) 7 rcnc�.c 5 f!z) (size) Z x 3 33 NO.OF BEDROOMS 3 OWNER PERMIT DATE: 9 L- 1 G COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet FURNISHED BY r �1 Al- 11 AZ• ►3 A3- Zy 3 33- yG ' Ay- 5$ i REAR a No. �. l `31 1 Fee OV THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS 01ppfitation for his al *pstrm Coustrurtion Permit Application for a Permit to Construct( ) Repair( Upgrade( ) Abandon( ) ❑Complete System /ndiidual Components Location Address or Lot No. 104, AM&j 1.6-m"-y Owner's Name,Address,and Tel.No. Assessor's Map/Parcel j' I?p& _ "l AI l JSX k40r1 e j-ac b,,n S,9k-4w` &ZZ Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No. 64-8 EXGQVG_r00 S09-,1`77-0653 vH A5s000fC5 5094(33 0D�tl Type of Building: Dwelling No.of Bedrooms v Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.requ'red) 3 3/) gpd Design flow provided gpd Plan Date T3 Z2// G Number of sheets 2— Revision Date Title / L Size of Septic Tank'-)(►15 [)(a I DOU a"0 9 Type of S.A.S.,(�3 f)C� �k� � 'Pa����y Tllen[At Description of Soil Nature of Repairs or Alterations(Answer when applicable) O C1 -bog kp a c h,-S i a ch 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 Certificate of Compliance has been issued by this Bo Me t Signe 9 Date Application Approved by Date Application Disapproved by Date for the following reasons Permit No. o tk — 3m Date Issued ±'Y r„ ° .. No. �° 0 W' _I Fee QV THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes 0[ppliration for IStJ sar *pstrm Construction Permit Application for a Permit to Construct( ) Repair( Upgrade( ) Abandon( ) ❑Complete System ndividual Components Location Address or Lot No. /D E7 .fit VIA Owner's Name,Address,and Tel.No. Assessor'sMap/Parcel 00( ��ttj Installer's Name Address,and Tel.No. Designer's Name,Address,and Tel.No. LJ3+6 �xtovahon SOR -1-17 06533 M A55000 f e5 509 33 0,0`1f Type of Building: Dwelling No.of Bedrooms y Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided S ! gpd Plan Date R 13 j9'! G Number of sheets 2. Revision Date Title / J L Size of Septic TankeKI f1nr, 1000 - C�IIUer1 TypeofS.A.S. 21 33r�r 3 ,k, , - Description of Soil i Nature of Repairs or Alterations(Answer when applicable) N�n t( -hl,), 2 /p jrje<S C X_3 x 3 3 (!S ineg _74t r 017"10 - 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 Certificate of Compliance has been issued by this Boar of He t Signe _ Date "a., Application Approved by a d e Date G Application Disapproved by Date , for the following reasons _ Permit No. 0 a - ?/y Date Issued t THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Complianre TIES IS TO CCEERTIFF�Y,that the On-site Sewage Disposal system Constructed( ) Repaired( ) Upgraded( ) Abandoned( )by at U(„ C " ! '—� i n r j )A U. `- �!4hs been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. 0� dated Installer 2, 'j / l DesignerVfT a #bedrooms Approved design flow 3 3Q gpd The issuance of this permit shall not /e/construed as a guarantee that the system will`functi n=asp a 'geed. Date f'% �!1p Inspector (\ ---------------------------------------------------------------------------------------------------------------------------------------- .. _.-...No. �i)I�, � 2./ Fee /dU _ I THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION -BARNSTABLE,MASSACHUSETTS 33isposal 6pstem Construction Permit Permission is hereby granted to Construct( ) Repair`( ) Upgrade( ) Abandon( ) System located at U�/j ��( t i o �/!Cl v and as described in the above Application for Disposal System Construction Permit. The applicant recognized 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 permit. 4/2Date / / �� Approved by � Town of B arristable Regulatory Services Richard V. Scali, Interim Director « sARNSTABLE, MASS. Public Health Division 639. Al ►ra+ Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Installer& Designer Certification Form Date: .Sewage Permit# 2A -�/f Assessor's Map\Parcel %1TXV` Designer: lz / S5®CC� Installer: Address: v1 f 4 Address: ,7 /F'G1° G' Igo f-f4 im a "ht� 024o ' On 4 A11J was issued a permit to install a (date) (installer) s.ptic"system at��� /r� Qz lit0�� based on a design drawn by (address) _ Ism/ ATJ�d dated 00 (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. Strip out (if required) was inspected and the soils were found satisfactory. 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. Strip out(if required)was inspected and the soils were found satisfactory. I certify,that the system referenced above was construct e compliance-with the-terms f the I\A appr 1 letters (if applicable) OF s� (Installer's Signature) VON" v ,9#-1Wma a ti ITAA�P (Designer's Signature) (Affix D s' tamp 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:\Septic\Designer Certification Form Rev 8-14-13.doc l Town of B ble. P IS137 Dqartmeat of atiory Sivvkn Pablie Div DOB On D l(v �o Mafin Strom MA 02b01 o Fee r M Dge Schc&do4 cs� vt . v v ,foil Su;iiltabi&y Assessrraent for Sewage .` osal c LOCATION&GMMlkt pNOWATW Adder4 i t miles Mft y C -7, sot, • �a�S9��S��i/�S. ALA°' AMIM ,/L��Ysl�s�r1/S Anames M /����� s rn�wi ROP,►ut / taad 11ae g=� smAe a smarm ' l��v�o C OnwaterBody t eew —� Ddnw"gWdwwan . D3s.tiCi ftm SIKE 1 OL. v ' N DVMm Oedrod Dagm to coma scnsWSW aWmaud ScoondlOO OtOnOwdw D TIONFOR OkAL mGH wATWt TA "aft obL balm DCFM PERCOLA. rite Rim t�nJbrc� be cetdac Addidmd g1�ng tad tY snesu � �..�Pr,�°_::_� spa • , .� ...;:...._ t ti3v,�oa �Absar Ro1�Da�aT©BsC�± '�If ereols Qn test fs to Wed vvtti>dtn 1DA' mast Bra now P on DYvidon at least one tl)we&Prior to le C� � . arnstab B • Z a �S DEEP OBSERVATION HOIXIWG HWO# SORTUAW Sailomw Sail ' Odor %Oman Mang a� ti dAll r DEEP QBSERVATION HOLE LOG Sell# Depthfiom Solt S�I'tRmure ShcQobr Soft Older Swfl�ee(IO.) Mt DA) tMwuoW MotdWs (Suucw%SAS'8oa1ftm. as 4e S,, y y DEEP OBSERVATION HOLE LOG Hole# Dw*fro Ud No&m soil Ta t= wi cww " I outer PWA) MoWam (ftu me,Sm m Houmm DEEP OBVATION HOLE LUG Hole# Dapm firom SdiftimSoi!'l�xaae sdt tb1Dr Bait (Smuaaxto. Sadace toaes.tlou Abuic SW year flood boundary No_ Ya� Witldu year No "---,Yes,, Wtdft 100 year fbod b000*ry D?elof)ljett�i�lly g Pe�n►lous Mamrlel Does at least foie fw of>}a oaxnR ing pervlOtts al exist.in all arm observed dnuWwut d10 am proposed for the soil absmpdon system? If UDL what is the&qA of.Dannelly mmb g pervious aurtertalT „_.... I ear* I (da��I have passe,"soil evaluator eaan finadon�by the . DegatCme t of BnvmmumW Pmtesd m and that tie above a�siysis was p�by mo rd 'with Me mgWrai exp +a and :�d �in U Q(MR 1SA1�, S'tgnat►pe - --- hl'!'L1CATiUN FOR PERCOLA` 10N `i'ES`1' AND OBSERVATION PITS V LOCATION /� ,�1��'�/,� t1 `�4.51 N0. �`�� VILLAGr B?� APPLICANT �. 3' P _ —DATE� ADDRESS FEE� �sy 4v* PHA1 NO. (Non-refundable ENGINEER / 1 �� TEL PHO 0._ DATE SCHEDULED pplicant's signature) ASSBSS0*A'S9AP'& LOT N0 . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . 00 . . . . . . . . o . . . . . . . . . . . . . . . SOIL LOG SUB-DIVISION NAME . V, << '� 4_ DATE `� �, TIME �� EXPANSION AREA: YES NO " �'72 ENGINEER t: TOWN WATER /✓PRIVATE WELL BOARD OF HEALTH EXCAVATOR SKETCH: (Street name,etc. ,dimensions of lot, exact location of test holes and percolation tests, locate wetlands in proximity to test holes) NOTES: E �Ir N V N PERCOLATION RATE: TEST HOLE NO: ELEVATION: TEST HOLE NO: ELEVATION: 3 2 3�` 2 3 4 4 5 5 6 7 6/1�1 ic��y 6 8 S 8 9 9 10 10 11 11 12 �SdY 12 13 13 14 .. �vo ����� 14 15 15 16 16 SUITABLE FOR SUB-SURFACE SEWAGE: LEACHING FIELD LEACHING PITS LEACHING TRENCHES UNSUITABLE FOR SUB-SURFACE SEWAGE. REASONS: NOTE: ENGINEERING PLANS MUST SHOW NUMBER ASSIGNED ON PERC TEST APPLICATION ORIGINAL: COMPLETED IN ENTIRETY BY P E AND RETURNED TO BOARD OF HEALTH COPY: RETAINED BY APPLICANT Town of Barnstable • rr A'�s HAMM 1 Board of Health 200 Main Street, Hyannis MA 02601 Office: 508-862-4644 Susan G.Rask,R.S. FAX: 508-790-6304 Sumner Kaufman,MSPH Wayne Miller,M.D. May 24, 2004 Mr. Frank and Mrs. Laurie DePietro 106 Amelia Way Marstons Mills, MA 02648 �f� 106Ar�e�ialNa�/ fit®� "�'_ ..-s„ea ,,'�<�<<.. ,.as,.�,.,, ,orb.� ksrg),.a1sxa .�v�a:�.�i����csn':.,,.?�e. c ?.. .,ar�.z,.a.a�s,,:�.. w Sicb:.s.�.a.�.y:."-� se�,,, ..c•e..rau'�a� ,..�,.,,' Dear Mr. and Mrs. DiPietro, You are granted a conditional variance to construct an addition to the home in close proximity to the septic tank at 106 Amelia Avenue, Marstons Mills. The variance granted is as follows: I 310 CMR 15.211 (1). The septic tank will be located seven (7) feet away from the foundation wall, in lieu of the ten (10) feet minimum separation distance, required. This variance is granted with the following conditions: • A polyethelene liner shall be properly installed in the ground in between the septic tank and the new foundation wall. This variance is granted because the Board is of the opinion that maintaining the existing septic tank in it's present location along with the installation of a polyethylene liner should not adversely affect the health or safety of the occupants in the home. Sincere yours, I Watir Miler, M.D. Chan DePietro I �o I TO F�Odt IV PS Pc9YPoo n H07- J O � r P` ��/L�G''L�` .` C�Ds� �c�E7' �/ �3>- , '� ��� � �®� I 1 �, �� � �v ��� � � �� 4 DATE: TOWN OF BARNSTABLE �7 F88: 24 APR 12 Ali 9: 2 I MA' R$C. BY ' Tom_of Barnstable Ste. DATE: I N Board oD�`ne alth 200 Main Street,Hyannis MA 02601 Office: 509-962-4644 Susan G.Rask,R.S. FAX: 509-790-6304 - Sumner Kaufman,M.S.P.H. Wayne A.Miller,M.D. VARIANCE REQUEST FORM Property Address: Assessor's Map and Parcel Number: I � , /6y Size of Lot: Wetlands Within 300 Ft. Yes Business Name: No r/ Subdivision Nam: wo--- APPLICANT'S NAME: Frank [/ -Lai= T Phone Did the owner of the property authorize you to represent him or her? Yes -Lonn�► ej) No PROPERTY OWNER'S NAME CONTACT PERSON /Dl Name: y l�f U_ g4ayne .J- U,6ry Name: Fr K E or- td tine J l�fl-,kto Address: 11)6 Aw(w mja4 � ,,s Address' 106 RMAR tOW l!► k5ws 91tis Phone: 4a0-k),;O, Ste_ �l�� Phone: ,qt- VARIANCE FROM REGULATION(last ite&) REASON FOR VARIANCE(May attach if more space needed) .3/0 al& /,57a >S ,3" rIKle h 6k& kwe NATURE OF WORK: House Addition 0= House Renovation Repair of Failed Septic System Checklist (to be completed by office staff-person receiving variance request application) Please submit copies in 4 separate completed sets.- Four(4)copies of the completed variance request form _ Four(4)copies of engineered plan submitted(e.g.septic system plans) _ Four(4)copies of labeled dimensional floor plans submitted(e.g.house plans or restaurant kitchen plans) _ Signed letter stating that the property owner authorized you to represent him/her for this request _ Applicant understands that the abutters must be notified by certified mail at least ten days prior to meeting date at applicant's expense (for Title V and/or local sewage regulation variances only) Full menu submitted(for grease trap variance requests only) _ Variance request application fee collected (no fee for lifeguard modification renewals, grease trap variance renewals [same owner/ieasee only], outside dining variance renewals [same owner/leasee only], and variances to repair failed sewage disposal systems [only if no expansion to the building proposed]) _ Variance request submitted at least 15 days prior to meeting date VARIANCE APPROVED Wayne A.Miller,M.D.Chairman NOT APPROVED- Sumner Kaufman,M.S.P.H. REASON FOR DISAPPROVAL Susan G.Risk,R.S. OWN OF BARNSTABLE LOCATION / � 1 //d.L S SEWAGE # iS `d':LLAGE ,T—ASSESSOR'S MAP & L -T�11 � INSTALLER'S NAME&PHONE NO )GG SEPTIC TANK CAPACITY LEACHING FACILITY: (type) (size) NO.OF BEDROOMS BUILDER OR OWNER PERMPTDATE: '= '�`7 9, 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 lleaching facili ) Feet Furnished by S�' LF Vj 412, Z; - i � 33 8 � ' - 3 • No.__.. Fmic........��� THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Apphratiun for Diij-puuttl ]VnrkB Tnnutrnr#inn 1hrmit Application is hereby made for a Permit to Construct ( 41 or Repair ( ) an Individual Sewage Disposal System at ..-.---•--- =`�' �-- a -------------- tiot -�Id r• Lot No. --•- A res -------------- ,�iQ�TZ 1 c_C S Installer Address e,� Type of Building Size Lot_ --,11�-.Sq. feet Dwelling—No. of Bedrooms............ -_-_-_-_-._--------------Expansion Attic ( ) Gauge Grinder ( ) 0er4 Other—Type of Building a Tz----'-I�o. of persons---------------------------- Showers ( ) — Cafeteria ( ) Other fixtures _______________________________ ___ WDesign Flow.............. ...................gallons per person per day. Total daip flow-----------3--��_.-.�.._._........gal�ons. WSeptic Tank—Liquid capacit/Qef_v_gallons Length-_�-----.. Width_..._ -------- Diameter________________ Depth..lf__..___.... x Disposal Trench—No. .................... Width_-_-_._.�___.___-_ Total Length.................... Total leaching area_________.. ...._._sq. ft. Seepage Pit No.......,/............ Diameter.....IZ>...... Depth below inlet...�v.......... Total leaching area.S ,7 Z Other Distribution box ( �� Dosing tank ( ) Percolation Test Results Performed by._Gt1CGZ. _. �... Date_ ....2:�/.... ......... ll Test Pit No. I.��`Zminutes per inch Depth of Test Pit/ ___,Yy_._ Depth to grou water. 44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ _...---•----•-----••--•-----•--•-•-...--••--•••-•......-•-------••---•--•---- x D Description of Soil.. E .._. !f �- ------•--•----- -- -•-••--------•---•----••-•---•----------.-•-- W VNature 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 TITLE 5 of the State Environmental Code—The undersigiyd further agrees not to place the system in operation until a Certificate of Compli ce been i ued by th rd of health. r Signed - f - - -------. ..:------------- ---_ --7i ...... � ^ • to Application.Approved By ---..0 ./ Y�....... ----- - �.� .........-"L.�-. --------....-------- .............. Date Application Disapproved for the following reasons: ....................... .............................................. ............. ......... ..--...... -------- --------------------------------------------------------------------------------------------------------------------------------------------------------------------------- --------------- ........................................ Qlr j/� / Date Permit No. J y / ----------------- ---------------------------------------------- Issued ... ..-..--- - -------------------------------------------- Due _________ ______________________________________________________________ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Clertifira#e of Graylianre T' IS 0 CERTIF hat the Individual Sewage Disposal System constructed ( V ) or Repaired ( ) by ... . -- ---,,---- ---------------------------------------....----- - ........ • -------- IZ 4 sr.Jlcr has been installed in accordance with the provi ions of TITLE 5 of The State Environmental Code as described in the application for Disposal Works Construction Permit No. ,.-S el l-// _.-....._.. dated ..._ �.s.�.�- 1 ...-. PP P . ---------- -- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE----- ��-.".... ... -------- ----------------------..------ Inspector .:.. - - ..- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE No.......g -`•--y FEE......1��......... 19isps �nr^ k- wu Tnn trLtd it �rrinit Permission is ereby granted-•--A. 9��•• --------------------------------------- ...................................................... to Constr ct l)or R air ( ),an I�ndi}'idual Sewa'�"ey�D�isposal Sys .- . �................ Street as shown on the application for Disposal Works Construction Permit No---!.C� ./1.`_�_r_ VDated__-..-__-�__r�...-�-f...... ..............•--•---------------------•------------------------------------------------------------•-•- Board of Health DATE................................................................................ FORM 36508 HOBBS&WARREN.INC..PUBLISHERS -4, , t THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Appliration for Bi.rVaiial Hlorkti Tomitriartion rantit 4" or Application is hereby made for a Permit to Construct ( Repair ( ) an Individual Sewage Disposal System at: 106 `-�-. cation-A dre S " or Lot No. - -------- - ---- ----- ••--- • - owner - -•---•---------•--•----------------------------------•------E----------------•- Installer Address e 2 d Type of Building Size Lot-�--- .�-✓..Sq. feet Dwelling—No. of Bedrooms.--_.-_--_-3-------------------------Expansion Attic ( ) Garbage Grinder ( ) Other—Type of Building .�q1 :F '-No. of persons---------------------------- Showers a g ' -----------------------�--- ( ) — Cafeteria ( ) dOther fixtures ---------------•--------- •--------------------------•---................------------------.....---•--•----------------- W Design Flow.............. --_.--_.--_._-...-_gallons per person per day. Total daisy flow............�__----_�_..........--gallons. WSeptic Tank—Liquid capacity �6Jgallons Length._-�--J.--- Width---'5-1/ Diameter_------------- Depth..,. ........--.. x Disposal Trench—No. ............ ....... Width-------------------- Total Length.-----..------------ Total leaching area.................... ft. Seepage Pit No---------/...--..... Diameter...... C->--.-.- Depth below inlet...Z ......._. Total leaching area.?� ,7.sq-ft- Z Other Distribution box ( �-)'� Dosing tank ( ) ly- _LD Percolation Test Results Performed b l-�� _. 5_ 9Z Y Date--� ....7 .� S�_.-.. a Test Pit No. 1_7! -minutes per inch Depth of Test Pit,ll�Y.......- Depth to ground water.�� - Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water....................... ---------------_-- ........................................................... Description of Soil....._ ......... �'' ��� v� x -----------------------------------------------------------------------•---------------- V ....•-•-•---•----------------•---•----.._... •-----------•------•----------------------•------------------------------•---•---------••-----------•-...---------•-•--•-----------.......---------------- W VNature 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 TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. Signed ----------------------- -.................................. - S.;a� —e ..-. Al >�, Dare Application,Approved By ...... ........ .c-�........:: - . -,................,.......................................c r:> .. .. ------ ---------- Application Disapproved for the following reasonr: ... ....................... .--------------------------.-.-----------------..---------------------.--- ------------------------------------ --------------------------------------------------------- ------------------------------------- ------------------------------------------------------------------ -------------------------------------- 5+ C/ // Dace Permit No. ...... ................... ............. Issued `--7 S Dace THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Gertif rate of Tomplian e THIS.IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ✓) or Repaired ( ) by UJ /� �: ...... .....xI----------------- ------------ ---------------------------- -- -----------------... ----------------.:. _ ...Installer ......_-.-.._....._................_-......._-....._.........-...-........---..- at ...... ' ....-q.------ .....- ..... - .... ... - has been installed in accordance with the provisions of TITLE 5 of The State Environmental Code as described in the application for Disposal Works Construction Permit No. -` _'..�-y/.........___- dated THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. �-- DATE. f.._...............�'` �`' ... - Inspector -..... �*.,< �/' --- --------------------.---_._----.--..-- -----•---n--------.--_-_,-,------ , ------ -.-- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE No....... FEE---... �....----• Dispomt orkii Tomitrudion rrmit Permission is hereby granted----. -•----------••-•-----•------•------•---------------------•-•-------•------••-----......... to Construct_(, V� or Repair ( ),an Individual Sewage Disposal System atNo... 1-'C.......q...... ........ -------------------------------.................................... r Street as shown on the application for Disposal Works Construction Permit No.-.9S r..VIVDated--------- --......----•--•-•-----•-•--••-----------------••...---------------------•-•--•--•-•--•---------•-•.... Board of Health DATE............................................................... ----------------- FORM 36508 HOBBS&WARREN.INC:-PUBLISHERS c2 3? COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS a DEPARTMENT OF.:ENVIRONMENTAL PROTECTION V TITLE 5 OFFICIAL INSPECTION.FORM-NOT FOR VOLUNTARY:ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL'SYSTEM FORM PART A CERTIFICATION Property Address: OD( Owner's Name: Owner's Address: Date of Inspectio Name of Inspector: (pleaseprint)* t�- L�g5 Company.Nam. ` G Mailing Address: JA N Telephone Number: 5 � i 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 the inspection.The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: 10 Passes Conditionally Passes Needs Further Evaluation by the Local Approving,Authority ails i nature; Date: inspector's S /� �o g The system inspector shall submit a copy of this inspection report to the,Approving Authority(Board of Health or DEP)within 30 days of completing this inspection.If the system.is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP..The original should be sent to the system owner and copies sent to the buyer,if applicable,and the approving authority. Notes and:Comments. - ****This report only describes conditions at.the time of inspection and under the conditions of use at that time.This inspection does.not address how the.system will perform in the future under the same or different. conditions of use. Title 5 Inspection Form 6/15/2000 page I Page 2 of I I r OFFICIAL INSPECTION FORM NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: /6 `P Owner: r� Date of Inspectio ®' Inspection Summary: Check A;B C;D or E./ALWAYS complete:alfof Section D A. System Passes: .I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist.Any failure criteria.not evaluated,are indicated below. Comments: B. System Conditionally Passes: One or more.system components as described in the"Conditional Pass"section need to be replaced or. repaired.The system,upon completion of the replacement or repair; as approved by the Board of Health,will.pass. Answer yes,no or not determined(Y,N;ND)in the for the following statements. If"not determined"please explain. The septic tank is metal and over 20.years old*.or the septic tank(whether metal or not)is structurally unsound,exhibits substantial infiltration or exfiitration.or.tank failure.is.imminent:System,.. .. will pass inspection if.the, P existing tank is replaced with-a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND explain: Observation.of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken,settled or uneven'distribution box:System will pass inspection if(with approval of Board of Health): broken pipe(s)are replaced obstruction is removed distribution box;is leveled or replaced ND explain: The system required pumping.more than'4 times a year due to broken or obstructed pipe(s).'The'systeiti will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed ND explain: 2 f Page 3 of 11. OFFICIAL INSPECTION FORM -.NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPO;SAL SYSTEM INSPECTION' FORM PART A CERTIFICATION(continued) Property Address:. Owner: 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.determine if the system is failing to protect public health, safety or the enviromnent. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health,safety and the environment: _ Cesspool,or privy is within 50 feet of a surface water Cesspool or privy is within 50 feet.of a bordering vegetated wetland or a salt marsh 2. System will fail unless the Board of Health(and Public Water Supplier,if any).,determines that the system is functioning in a manner that protects the public health,safety and.environnieiit: _ The system has a septic tank and soil absorption system.(SAS)and the SAS is within 100 feet of surface water supply or tributary to.a surface water supply. _ The system has a septic tank and SAS and the SAS is within a Zone I of a public water supply. The system has a septic tank and SAS and the SAS is.within 50 feet of a private water supply well. _ The system has a.septic tank and SAS and the SAS is less than.100 feet.but.50 feet or more from,a. private water.supply well**. Method used to determine distance **This system passes if the well water analysis,performed at a DEP certified.laboratory, for coliform bacteria and volatile organic compounds indicates that the well is free fi•orn 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. 3. Other: 3 Page 4 of 1 l. OFFICIAL INSPECTION FORM—:NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM _ `PART A : . CERTIFICATION(continued) Property Address: _�L�/o 6AY04.. i Owner: J. If Date of Inspection D. System,Failure Criteria applicable to all systems:.. You most indicate'"yes"or"no'to each of the following for.all inspections: Yes Nib _ i/I Backup of sewage into facility orsystem component due to overloaded or.clogged SAS or cesspool _ V Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool Static,liquid level in the.distribution box above outlet invert due to an overloaded orclogged SAS or 7 cesspool Liquid depth in cesspool is less than 6"below invert or available volume is less than'/z day flow Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number of times pumped Any portion of the SAS,.cesspool or privy is below high ground water elevation. Any portion,of cesspool or privy is within:TOO feet of a surface water supply or tributary to a surface f water supply. V1 . Any portion of a cesspool or privy is within a Zone l ofa,public well. Any portion of a cesspool or privy is within 50 feet'of 6 private water supply well. Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facilityand the presence of ammonia nitrogen.and nitrate nitrogen is equal to or.less than,5,ppm, provided that no other failure criteria aretriggered. A copy of the analysis must he attached'to this form.] (Yes/No)The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails.The system owner should contact the Board of Health to.determine what will be necessary to correct the failure. E. Large Systems: To be considered a large System the system must serve a facility~with aAest n flow of I0 000.Y g gpd-to 15,000 gpd• . 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) yes no the system is within 400 feet of a.surface drinking water supply the system is within 200 feet of a tributary to a surface drinking water supply _ the system is.located in a nitrogen sensitive area(Interim Wellhead Protection Area—IWPA)or,a mapped Zone II of a public water supply well If you have answered"yes"to any question in Section E the system is considered a significant threat,or answered "yes"in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed.under Section D shall upgrade the system in accordance with 310 CMR 15.304.The system:owner should contact the appropriate regional office of the Department. 4. Page 5 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM 'PART B CHECKLIST. Property Address: r Owner Date of Inspection Check if the following have been done You must indicate"yes"or"no"as to each of the following: Yes No Pumping,information,was provided by the owner,occupant, or Board of Health VWere,any of the system components pumped out in the previous two weeks .? Has the system received normal flows in the previous two week period? , Have large.volumes of water been introduced to.the system recently or as part of this inspection? Were as built plans of the system obtained.and examined?(If they were not available note as N/A) V� Was the facility or dwelling inspected for signs of sewage backup Was the site inspected for signs of break out? Z_ Were all system components,excluding the SAS, located on site? _V"'- _ Were the septic.tank manholes uncovered,opened and the interior.of the tank inspected for the condition of the baffles or tees,material of construction,dimensions, depth of liquid,depth,of sludge aid depth of scurn? _V_ Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil.Absorption System(SAS)on the site has been determined based on: Yet no s, V Existing information.For example,a plan.at the Board of Health. _ Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable)[310 CMR 15.302(3)(b)] 5 Page 6 of 1] OFFICIAL.,INSPECTION.FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION'TORM PART C SYSTEM INFORMATION Property Address: Owner p �`► Date of.Inspection: (� FLOW CONDITIONS RESIDENTIAL ' Number of bedroo,ms(design);i� Number of bedrooms_(actual): DESIGN flow based on 310 CM 15.203 (for example:110 gpd x#of bedrooms): ( Number of current residents: Cp- , Does residence have a garbage grinder(yes or no)�1,0- Is laundry on a separate sewage system (yes or no') if yes separate inspection required] Laundry system inspected(yes or no�. Seasonal use: (yes or no)i_ . Water meter readings, if available(last 2 years usage(gpd)): Sump pump(Yes or no): f /'G Last date of occupancy: - U� , COMMERCIAL/INDUSTRIALt-! Type of establishment: Design flow(based on 310 CMR 15.203): gpd Basis of design flow(seats/persons/sgft;etc.) 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/use: OTHER(describe)' GENERAL INFORMATION Pumping Records Source of information: fi_ 1 Was system pumped as par of the inspection(yes or If yes,volume pumped: gallons--How was quantity pumped determined? Reason Tor primping: TYP F SYSTEM Septic tank,distribution box,soil absorption system _Single cesspool _Overflow cesspool Privy _Shared system(yes or no)(if yes,attach previous inspection records, if any) _Innovative/Alternative technology.Attach a copy of the current operation and maintenance contract(to be obtained from system owner) _Tight tank _Attach a copy:of the DEP approval -Other'(describe): pproximate age of all components,date insta ed if known an urce of information: Were.sewage odors detected when arriving at the site(yes or no)�! 6 Page 7 of I I OFFICIAL-INSPECTION-FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM-INFORMATION(continued) Property Address: 0 Owner: ` Date of Inspectio • � O BUILDING SEWER(locate on site plan);` Depth below grade: Materials of construction:_cast iron _40 PVC other(explain): Distance from private water supply well or suction line: Comments(on condition of joints,venting,evidence of leakage,etc.): SEPTIC TANK: (locate on site plan) Depth below grade: c�(' Material of construction:_z6oncrete_metal_fiberglass polyethylene _other(explain). If tank is metal list age:_ Is age confirmed by a Certificate of Compliance(yes or no):_(attach a copy of certificate) Dimensions: - (p 'Y Sludge depth: Q'' - Distance from top of sludge to bottoni.of outlet tee.or baffle: 7 Scum thickness: 6 / i! Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum.to bottom o outlet tee or baffle, Z How were dimensions determined: Comments(on pumping recommend ions, i let and outlet tee or baffle condition,structural integrity, liquid levels related to outlet invert,evidence of leakage,etc.) /I— e o ,�_f„ eltltivt-;� ��c����y���9 �--7�,•Q� Gem :�U��n�� GG6��� GREASE TRA�ocate on site plan) ' Depth below grade:_ Material of construction:_concrete_metal_fiberglass_polyethylene_other (explain): Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffler 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, structural integrity, liquid levels. as related to outlet invert,evidence of leakage,etc.): 7 y Page 8 of 11 OFFICI.AL INSPECTION FORM—NOT,,FOR VOLUNTARY ASSESSMENTS SUB;SURF4ACE SEWAGE=DISPOSAL>SYSTEM INSPECTION FORM PART C . SYSTEM INFOfiMATI"ON(continued) Property Address: 16 Owner: Date of Inspection. c�)Z TIGHT or HOLDING TAN ,,ank must be pumped at time of inspection)(locate or%site plan) Depth below grade: Material of construction: concrete metal fiberglass polyethylene other(explain): Dimensions.` Capacity. gallons Design Flow: gallons/day Alarm present(yes or no): Alarm level: Alarm in working order(yes or no): Date of last pumping: Comments(condition of alarm and float switches,etc.): DISTRIBUTION BOX: if present must be opened)(locate on-site plan) Depth of liquid level above outlet invert:&2 Z � Comments(note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of 1 aka.ge into or out of box,etc.): PUMP CHAMBER ('locate on site plan) Pumps in working order(yes or no): -.. Alarms in working order(yes or no.): Comments(note condition of pump chamber,condition of pumps and appurtenances;etc.): 8 r , Page 9 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION:FORM PART C SYSTEM INFORMATION.(continued) Property Address: Owner:-- Date of Inspectio . pQ n Q SOIL ABSORPTION SYSTEM (SAS):-6l(locate on site plan,excavation not required) If SAS not located explain why: Type _.. _Teaching pits,number: leaching chambers,number: leaching galleries,number: leaching trenches, number,length: leaching fields,pumber,dimensions: overflow cesspool,number: _ innovative/alternative system Type/name of technology; Comments(note condition of soil,signs of hydraulic failure, level of ponding,damp soil,condition of vegetation, r CESSPOOLS: Al`(cesspool must be pumped as part of inspection)(locate on site plan) Number and configuration: _ Depth'—top of liquid to inlet invert: Depth of solids layer: Depth of scum layer: Dimensions of cesspool: Materials of construction: Indication of groundwater inflow(yes or no): Comments(note condition of soil,signs of hydraulic failure;level of ponding, condition of vegetation,etc.): PRIVY {locate on site plan) Materials of construction:. Dimensions: Depth of solids: Continents(note condition of soil, signs of hydraulic failure, level of ponding,condition of vegetation,etc•): 9 Page 10 of 11 OFFICIALINSPECTT.ON FORM=NO,T'I+dR VOLUNTARY ASSESSMENTS SU$3SURFACE SEWAGE DISPOSAL SYSTEM-INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 166 / '1 Owner: Date of Inspection: SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks.Locate all wells within 100 feet.Locate where public water supply enters the building. ?3 ` 10 Page I 1 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address /220 : Owner: 0 G L Date of Inspection. jp� SITE EXAM Slope Surface water Check cellar Shallow.wells Estimated depth to ground water q feet 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 reviewed: Observed site(abutting property/observation hole within 150 feet of SAS) Checked with local Board of Health-explain: -VChecked with.local.exzavators, installers-(attach documentation) Accessed USGS database-explain: You must describe how you established the high ground water elevation: 1] �0.F � julg1� j �� Completed b � y: HIGH GROUND-WATER LEVEL-COMPUTATION Site Location: 0 ��� �n ��J � e )l / &/_15M� //5 Lot No. Owner:_ f� y�� Address: ��6���✓�fg � y Contractor: �r� ®D, l C� 57` Address: Notes: STEP 1 Measure depth to water table to nearest 1/10 ................................................... .Date !/% oZ� ,7 , month/day/year STEP 2 Using Water-Level .Range,Zone and Index Well Map locate site and determine: OAppropriate.index,well.................... (� Water level range zone....:................................................ L� STEP.3 Using monthly report "Current Water Resources Conditions" . determine current depth to water level for index,well ..........................• month(/year ' STEP 4 Using Table of Water-level Adjustments for index well (STEP 2A), current depth to water level for index well (STEP 3), and water-level zone (STEP 23) determine water:level adjustment ......_............:::..................................................................... 173 STEP 5 Estimate depth to high water by subtracting the water- level adjustment (STEP 4) from measured depth-to water level at site (STEP 1) � I Figure 13.—Reproducible computation form. " 15 TEST ROLE LOG P.SzC5Z_ TEST BY: WELLER&ASSOC. WITNESS:_�L�D PERC RATE:.. 2 ti!/h/ilk=fi! p� N` SZ A �.e. C/=w In OI\ l N 3,lEi�i y8 2 N V I DESIGN DATA I I I DAILY FLOW: -/,/,> -- SEPTIC TANK:-- .3.30. x 150%= y9J V 7,5 t . USE:-lOCx� �i�-. 5� SC�T/GT9nG� I y8 LEACHING FACILITY: CAPACITY: SIDEWALL:-/B S.s X 0,5 Y7� y&,�s TOTAL: 7 l PIPE TO BE LAID 2"LAYER OF 3/8"PEASTONE LEVEL FOR. 2' OUT OF OVER 3/4"-1 1/2" WASHED DISTRIBUTION BOX STONE ALL AROUND TOP OF FOUND. @ EL: 53.5 0. ' 10" - 14" z. ALL PIPE TO BE 4"DIA.SCH 40 PVC 2' Cv ' RAISE ALL APPLICABLE MANHOLE COVERS TO WITHIN 6 OF FINISH, GRADE THIS SYSTEM IS NOT DESIGNED FOR THE USE OF A GARBAGE DISPOSAL SEWAGE SYSTEM PROFILE SCALE: 1"=1.0' r�. GENERAL NOTES 1. CONTRACTOR TO BE RESPONSIBLE FOR THE LOCATION OF ALL UTILITIES,ABOVE AND SITE-SEWAGE PLAN UNDER GROUND,PRIOR TO ANY CONSTRUCTION FOR �.-�- - 40.6"� OR EXCAVATION. / /� 9 2. INSTALLATION OF SEPTIC SYSTEM TO BE IN COMPLIANCE WITH 310 CMR 15.00: TITLE V. PREPARED FOR THIS PLAN IS NOT TO BE USED FOR PROPERTY erg 3. E �H OF ,�4rrq LINE DETERMINATION. SCALE:;93"iV4,77- d-___DATE: .�1.9T� _G�_-/��s. ------ �y d; ,�� A � & ASSOCIATES WELLER P. O. BOX 119 YARMOUTHPORT, MA. 02675 (508) 362-8131 APPROVED BY: TEST HOLE LOG DATE;_...,5��T 2.Z /99� PB� z_ TEST BY:WELLER&ASSOC. WITNESS:=_<:EE D: 5,ql210`>' PERC RATE: 2 / /ifs 533 y3 sy3 s—__ ✓ /yya 38.s > ��n +v �U r DESIGN DATA c l DAILY FLOW:-�3).6_1>C0+ / SEPTIC TANK: 3 <- x 150%= t USE: ' >Cx> • G.a57 SCf�T/CTAni,� LEACHING FACILITY: CAPACITY: SIDEWALL:. BOTTOM: 7&. TOTAL: \ E > �s PIPE TO BE LAID 2"LAYER OF 3/8"PEASTONE _ LEVEL FOR 2' OUT OF OVER 3/4"-1 1/2" WASHED DISTRIBUTION BOX STONE ALL AROUND TOP OF FOUND. @ EL. -53.50 —{ " 10" 14" � X ' ALL PIPE TO BE 4"DIA.SCH 40 PVC RAISE ALL APPLICABLE MANHOLE COVERS TO WITHIN 6" OF FINISH GRADE THIS SYSTEM IS NOT DESIGNED FOR THE USE OF A GARBAGE DISPOSAL SEWAGE SYSTEM PROFILE SCALE: 1"=1.0' / { GENERAL NOTES CONTRACTOR TO BE RESPONSIBLE FOR THE LOCATION OF ALL UTILITIES,ABOVE AND SITE-SEWAGE PLC UNDER GROUND,PRIOR TO ANY CONSTRUCTION FOR OR EXCAVATION. �© -T 9 ~ C�i���/�S '` '? �Q'� 2. INSTALLATION OF SEPTIC SYSTEM TO BE IN COMPLIANCE WITH 310 CMR 15.00:TITLE V. PREPARED FOR ��. 3. THIS PLAN IS NOT TO BE USED FOR PROPERTY ��. 5/,! �- /C-�7f� � ' /:�✓c �P�tH of q�� LINE DETERMINATION. G � SCALE:j;�s,�✓���_.-._DATE: WELLER & ASSOCIATES P. O. BOX 119 YARMOUTHPORT, MA. 02675. 3 -ci A 5 (508) 362-8131 APPROVED BY: 1 � � f 6 rr` g, �'��'' �Y p ��� 6�� oMp dtwj�^d,F �.�..... v� aw �'"�•ir'"v wi'N �p""� �•f^� �+ � � s %Ma t °atic R ift r 5 L R \� z � k° ....._ _.._._.. .. __ 4 y d \ lj 1 • LOCUS-,,,, ASSESSOR'S MAP: 148 GENERAL NOTES: Race Lone\Race Lane PARCEL: 164 REFERENCE: PL. BK. 487 PG. 66/L.C.P. 15666-B 1. VERTICAL DATUM: Assumed_________ 3° d 2. MUNICIPAL WATER �S AVAILABLE. FLOOD ZONE: X Town of Barnstable 3. SCHEDULE 40 PVC PIPE TO BE USED THROUGHOUT o\�Fa #25001 C0542J (07/16/14) SYSTEM UNLESS OTHERWISE NOTED. 2 4. ALL- PRECAST UNITS TO CONFORM TO AASHTO: H=10 & 20__ 5• PIPE PITCH-1/4" PER FOOT UNLESS OTHERWISE NOTED. 6• ALL CONSTRUCTION DETAILS TO BE IN CONFORMANCE BENCHMARK: USE COR. WITH MA ENVIR. CODE (TITLE 5) AND LOCAL LOCUS MAP N.T.S. CONC. BULKHEAD AT Zi}$.55 7 REGULATIONS. ELEV. 52.6 ASSUMED Sy£� 53.54 CONTRACTOR TO VERIFY LOCATIONS OF ALL UTILITIES FFDG>r c� p,RW ( PRIOR TO CONSTRUCTION. 51.78 4 53.50 3.64 w LEGEND: 51.71 PROPOSED CONTOUR 1'72 to 3 UTIL. RISERS .. •;:a:: '�>'`PPp -Y` AREA DRAINS * .46 PROPOSED SPOT GRADE iy51. -2 / 90 ;., � 40 EXISTING CONTOUR r /� X 30.23 EXISTING SPOT GRADE TEST PIT 57 DBL FRUIT co �'' ® EXISTING WATER SERVICE C, GAR. SLAB ' TREE �'<"' 4.78 o X o WORK LIMIT LINE ` EL. 53.0' 3 �' 552.35 . 6 1�- a 0 -�� S2 2.48 0 yc, p _ l 52:22 EXISTING ��_ Existing Septic Tank to DWELLING -T j remain. Pump and 55.16 TOP FNDN. backfill failed leach pit. ELEV. 53.4' b�ctr-•- \ ■53.81 N 51.70 JS� x�._ 52.23 cStsa.`9---W 52.43 55.86 W _ 1.78 ■54.63 s CA LINE \ / 52.58 1.2 1.7? 2 , NOTE: This plan is to be used for septic � -' .66 system purposes only and is not to be DBL FRUIT used for any other purpose. TREE LOT 9 43,996t SF 106 AMELIA WAY 57 V MARSTONS MILLS, MA 50.20 253 OF Mqs S9 associates PREPARED g g Excavation AMY L. f9�ys Inc SYSTEM DESIGNS FOR: a n d VON HONE 320 Cotuit Road y Sandwich, MA 02563 Laurie Jacobson NO. 1068 508.833.0041 CONC. BND. 96 $TER�� 106 Amelia Way FND Surveying by. M a rs t o n s Mills MA AHOjala Surveying Arne� H. P.L.S.Ojala,P.L� l DATE REVISED SCALE SHEET N0. -] 211 Maple Street Ia West Barnstable, MA 02668 08/30/2016 1 to = 30' 1 of 2 Provide Riser over D-box NOTE: All components to be marked with NOTE: To prevent breakout, final T.O.F.. (Full) to within 6" of final grade magnetic tape or similar prior to final cover. grade; of EL. 49.5 to be carried EL. 53.4 out a minimum 15' beyond edge (Cover to be watertight) Y 9 ` F.G. EL: 52.0-52.6J: F.G. EL: 52.0 Maintain Min. 2% slope over leach facility to of leach facility. Regrade;, as F.G. EL: 52.5 �� F.G. EL: 52.5 Existing) Elev. Existing 3� �� >revendin needed to maintain maximum 3' of cover. to be Install risers w/covers over inlet and Min. 2" of 1/8" - 3/4" Washed Stone or confirmed as outlet to within 6" of final grade .' � Geo�textile Fabric Inspection Ports within 3" to grade needed. L=18' (Access rovers min. 20" diam. per Code) �'' 3/4" - 1 1/2" Double Washed Sto e 4" SCH 40 P -• L=17 , �S= 1%MIN �t ' 4" SCH 40 PVC L=10' Top of F'eastone or Geotextile Fabric EL 49.5 4" SCH 40 PVC 0.005% slop ' @S=1.0% 1 , - - - 14 6 Cc9S=1.0� 0.5%.MINCap Ends EL. 49.:35f ' 12 � WT:2- Effective Depth :Q EL. 49.6f Install Gas Baffle EL. 49.17 EL. 49,0 Q. PROPOSED DB-3 EL. 48.9 Use 2 Trenches 75c4, ttom EIL. 46.9 --�-* H-20 DISTRIBUTION BOX 33 Long x 3' Wide x .2 Deep _ spaced 6' apart: 44 (Install PVC Inlet & Outlet Tees) Watertest for levelness SEPTIC SYSTEM P R 0 F I �E b-- EXISTING 1000 GALLON if more than one H-10 SEPTIC TANK outlet EL. 41.5 N.T.S. Bottom of TH-1 NOTE: Confirm minimum 1000 ADDITIONAL D I TI 0 N A L NOTES TE S gal. Replace with minimum 1500 - D E c'I G N CRITERIA SOIL L O G gal. if undersized or damaged. 1. Contractor to confim soil suitability prior to installation. Contact BOH and Design Sanitarian in the event of varying soils from original Number of Bedrooms: Existing 3 Bedrooms SOIL EVALUATOR: AMY VON HONE, R.S. S.E. #2517 soil test. INSPECTOR: DAVID STANTON, R.S., BOH Soil Type: Class I DATE: AUGUST 30, 2016 11:00 Alin 2. Pump and back;fill Failed Leach Pit. Any contaminated materials Percolation Rate: PERMIT: #15137 <2 min/Inch PERCOLATION RATE:<2 MIN,/INCH IN (11 within 5 of proposed Leach Field to be removed. Pump, crush, and remove existing Septic Tank. Daily Flow: Design Flow: 110 G.P.D./Bedrm x 3 =330 G.P.D. TH - 1 TH - 3. Water line to be sleeved at any sewerline crossings and within 10' 330 G.P.D. (Min. Required) EL. 53.0 EL. 52.3 of any septic components, as needed, per Water Department Garbage Grinder: Not Allowed A A requirements. Contractor to verify location of water line prior to Loamy Sand Loamy Sand construction. Leaching Area (330)/0.74 = 445.94 S.F. g" 1 OYR3.2 10YR3.2 Required:52.25 g" 51.55 4. Existing Sewer Line elevation exiting foundation to be verified prior B B to start of construction., Septic: Tank Required: 330 G.P.D. x 200%n = 660 G.P.D Loamy Sand Loamy Sand Minimum 1000 Gallon (Existing) 10YR5/8 10YR5/8 18" 51.5 24" 50.3 5. Distribution Box to be placed on 6" crushed stone or3,compacted, Use 2 Trenches: Sch. 40 Perf. P IC with 2X Washed Stone: Perc C1 C1 level base. / 33' Long x 3' Wide x 2' Deep spaced 6' mart ® Coarse Sand Coarse Sand S1 45" 2.5Y5/4 2.5Y5/4 Bott Sidewall Area: 4'(33'+3;) x 2 = 288.0 S.F. 20% Cobbles 20% Cobbles �� � � (33 x 3 ) x 2 = 198.0 S.F. Bottom Area: 84" 46.0 84" 45.3 , Total Area: 486.0 S.F. c2 c2 GAR. SLAB 23 Desi n Flow Provided: 0.74(486.0 S.F.)= 359.64 G.P.D. Medium Sand Medium Sand EL. 53.0' ° 106 A M E LI A WAY 2.5Y6/4 2.5Y6/4 y --- 4 ° V ff � IVI A R S 7.0�MILLS, MA SEPTIC -TIES ° EXISTING 1 associates PREPARED B & R Excavation DWELLING , FOR: 138" 41.5 120" 42.3 TOP FNDN. _ o Ea ' SEPTIC SYSTEM uESlaes No Groundwater Observed ELEV. 53.4' dc�;`= a n d r _T� 320 Cotuit Road Sandwich, MA 02563 Laurie Jacobson <9" ® 4:25 minutes PERC RATE: <2 MIN/IN. ( C1 & C:Z Horizon) 508.833.0041 106 Amelia Way I, Amy L. von Home, R.S., hereby certify that I am currently approved by Surveying b. Marstons Mills MA the DEIP pursuant to 310 CZAR 15.017 to conduct soil evaluations and AW Qfala Sur►rneying that the above analysis has been performed by me consistent with the ` AmeH. Ojala,P.L.S. DATE REVISED SCALE SHEET requirements of 310 CMR 15.017. 1 further certify that I have i 211 Maple sit successfully passed the Soil Evaluators Exam on November, 1994. west Barnstable, MA 02666 08/30/2011 1" = 30' 2 of 2 M i �• _ is _ ; 1DOz<,,1/)ZfZ —,'�!' � w, I 5. 7 ,Z WS 71 J` f�►r7G� ��i'�crr fl�, ! �, s I `� I I � t� �. °� 1-t i.! � I � 1 # 1' �I 1`(_------- I f i t d t ,t ��•�'. i I Rp >= Six►sza�+1 .�' :- �_. A 'I y dLlj� �4,s � J^t` k q > � Z I m'a r� . } i r ( a.•.. t i...; — « :5.1< I ! :. S T E : - € 2 f 1 f? t —_— { AWAY!, i 7. , sit 1 t 1= ffF --- I� (-7777- I i :. r r f I __� - i. 1 t � I l [ I 5 . 11 4 LIN Q. , . 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