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Home My WebLink About0064 BRIDLE PATH - Health 64 Bridle Path Marstons Mills P �A 149 133 I SIT ) 3 55 • COMMONWEALTH OF MASSACHUSETTS u Y EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PRO ElVED h G�< I yea J U L 1 1 2003 TOWN OF BARNSTABLE HEALTH DEPT. TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 64 Bridle Path Marstons Mills MA 02648 Owner's Name: Graham Mendes MAP Owner's Address: 4925 Shady Rim Court PARCEL Las Vegas NV Date of Inspection: July 2,2003 L�� Name of Inspector: PATRICK M.O'CONNELL Company Name: SEPTIC INSPECTION SERVICES CO. Mailing Address: 189 CAMMETT ROAD MARSTONS MILLS MA 02648 Telephone Number: (508)428-1779 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: _X_ Passes Conditionally Passes Needs Further Evaluation by the Local Approving Authority Fails Inspector's Signature: Date: Q 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: System in good condition. ****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 1 Page 2 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 64 Bridle Path,Marstons Mills Owner: Graham Mendes Date of Inspection: July 2,2003 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: _XX_ 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 hot)is structurally unsound,exhibits substantial infiltration or exfrltration or tank failure is imminent. System will pass inspection if the 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 system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed ND explain: Page 3 of 11 OFFICIAL INSPECTION FORM- NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 64 Bridle Path,Marstons Mills Owner: Graham Mendes Date of Inspection: July 2,2003 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 environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(l)(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 i 2. System will fail unless the Board of Health and Public Water Y ( Supplier,if any)determines that the system is functioning in a manner that protects the public health,safety and environment: _ The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. The system has a septic tank and SAS and the SAS is within a Zone 1 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's*. Method used to determine distance "This system passes if the well water analysis,performed at a DEP certified laboratory, for coiiform 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. 3. Other: Page 4 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 64 Bridle Path,Marstons Mills Owner: Graham Mendes Date of inspection: July 2,2003 D. System Failure Criteria applicable to all systems: You must indicate"yes".or.or no to each of the following for all inspections: Yes No _X_ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool _X_ Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool X_ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool _X Liquid depth in cesspool is less than 6"below invert or available volume is less than'/s day flow _X_ Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped _X_ Any portion of the SAS,cesspool or privy is below high ground water elevation. _X_ Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. X Any portion of a cesspool or privy is within a Zone.1 of a public well. _X_ Any portion of a cesspool or privy is within 50 feet of a private water supply well. _X_ 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 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.] _No_(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 a design flow of 10,000 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 I1 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. Page 5 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 64 Bridle Path,Marstons Mills Owner: Graham Mendes Date of Inspection: July 2,2003 Check if the following have been done.You must indicate"yes"or"no"as to each of the following: Yes No _X_ _ Pumping information was provided by the owner,occupant,or Board of Health _X_ Were any of the system components pumped out in the previous two weeks? _X_ _ Has the system received normal flows in the previous two week period? _X_ Have large volumes of water been introduced to the system recently or as part of this inspection? _X_ _ Were as built plans of the system obtained and examined?(If they were not available note as N/A) _X_ _ Was the facility or dwelling inspected for signs of sewage back up? 1 _X_ _ Was the site inspected for signs of break out? _X_ _ Were all system components,excluding the SAS, located on site? _X_ _ 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 and depth of scum? _X _ 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 r p y (SAS) determined based on: Yes no _X_ — Existing information.For example, a plan at the Board of Health. _X_ _ 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)] f Page 6 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 64 Bridle Path,Marstons Mills Owner: Graham Mendes Date of Inspection: July 2,2003 RESIDENTIAL FLOW CONDITIONS Number of bedrooms(design): 4 Number of bedrooms(actual): 4 DESIGN flow based on 310 CMR 15.203(for example: l 10 gpd x#of bedrooms):440 Number of current residents:4 Does residence have a garbage grinder(yes or no): No Is laundry on a separate sewage system(yes or no): No [if yes separate inspection required] Laundry system inspected(yes or no): Seasonal use:(yes or no):No Water meter readings,if available(last 2 years usage(gpd)): 2001-141,000 gal.2002—109,000 gal.=342 gpd. Sump pump(yes or no): No Last date of occupancy: Currently Occupied COMMERCIALANDUSTRIAL Type of establishment: Design flow(based on 310 CMR 15.203): and Basis of design flow(seats/persons/sqft,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: None Available Source of information: Was system pumped as part of the inspection(yes or no): No If yes,volume pumped:_gallons--How was quantity pumped determined? Reason for pumping: TYPE OF SYSTEM _X_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): Approximate age of all components,date installed(if known)and source of information: Compliance date:8/27/01 Were sewage odors detected when arriving at the site(yes or no): No Page 7 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 64 Bridle Path,Marstons Mills Owner: Graham Mendes Date of Inspection: July 2,2003 BUILDING SEWER: X (locate on site plan) Depth below grade: 1' Materials of construction:_cast iron _X_40 PVC other(explain): Distance from private water supply well or suction line: 35' Comments(on condition of joints,venting, evidence of leakage,etc.): SEPTIC TANK: X (locate on site plan) Depth below grade: I Material of construction:—X—concrete_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: 8' long x 5.2'wide—1000 gal. Sludge depth: 8" Distance from top of sludge to bottom of outlet tee or baffle: 23" Scum thickness: 1" Distance fiom top of scum to top of outlet tee or baffle: 6" Distance from bottom of scum to bottom of outlet tee or baffle: 14" How were dimensions determined: STICK WITH HINGE FLAP. Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): Tank in eood condition,baffles intact. GREASE TRAP: No (locate on site plan) Depth below grade:_ Material of construction:_concrete metal_fiberglass_polyethylene_other (explain): Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping: Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert,evidence of leakage, etc.): i Page 8 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 64 Bridle Path,Marstons Mills Owner: Graham Mende' Date of Inspection: July 2,2003 TIGHT or HOLDING TANK: No (tank must be pumped at time of inspection) (locate on site plan) Depth below grade: Material of construction: concrete metal fiberglass_polyethylene other(explain): Dimensions: Capacity: gallons Design Flow: gallons/day Alarm 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: X (if present must be opened) (locate on site plan) Depth of liquid level above outlet invert: 0" Comments(note if box is level and distribution to outlets equal,any evidence of solids carryover,any evidence of leakage into or out of box,etc.): Box set level no high water stains or solids carryover. PUMP CHAMBER: No (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.): Page 9 of I 1 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 64 Bridle Path,Marstons Mills Owner: Graham Mendes Date of Inspection: July 2,2003 SOIL ABSORPTION SYSTEM(SAS): X (locate on site plan,excavation not required) If SAS not located explain why: Type leaching pits,number: _X_leaching chambers,number: Three 500 gal.Chambers. leaching galleries,number: leaching trenches,number,length: leaching fields,number,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, etc.): No excessive vegetation or damp soil CESSPO OLS: No (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: No (locate on site plan) Materials of construction: Dimensions: Depth of solids: Comments(note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation,etc.): 4 Page 10 of I l OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 64 Bridle Path,Marstons Mills Owner: Graham Mendes Date of Inspection: July 2,2003 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. was 41 0 0 Page 11 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 64 Bridle Path,Marstons Mills Owner: Graham Mendes Date of Inspection: July 2,2003 SITE EXAM Slope None Surface water None Check cellar Dry Shallow wells None Estimated depth to ground water: More than 30 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: Checked with local excavators,installers-(attach documentation) _X_Accessed USGS database-explain: Town GIS and USGS Sandwich quad. You must describe how you established the high ground water elevation: Town groundwater contour map shows water to be below el. 40 and topo map shows land elevation at or above el.70. Leaving more than 30 feet to groundwater. TOWN OF BARNSTABLE LOCATION (6 �1C rE Ate SEWAGE # 0001 =1I93 VILLAGE iM�A R �6v� lMt Ll5 ASSESSOR'S MAP & LOT INSTALLER'S,NAME&PHONE NO. L bZ0, soyo SG D�t C 7 7 S-7-7"?t" SEPTIC TANK CAPACITY LEACHING FACILITY: (type) 3 -DgY(A_*A S (size) 13 A61L)q0 NO. OF BEDROOMS BUILDER OR OWNER All, cO 'j— PERMIT DATE: (Iaq I,?yG I COMPLIANCE DATE:R1,27/2be I 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 i a , o p 1 No zap q93 Fee$5 C / THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: 4/ Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS ZIppYication for Mi5pool *p.5tem Construction Permit Application for a Permit to Construct( )Repair(X )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. Owner's Name,Address and Tel.No. 64 Bridle Path, Marstons MIlls Graham Mendes Assessor's Map/Parcel `• `/aJ? Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. Wm. E. Robinson Septic Service P O Box 1089, Centerville Type of Building: Dwelling No.of Bedrooms 4 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 Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Sand Nature of Repairs or Alterations(Answer when applicable)Ti t-1 P-S 1 P,ar h system cznns I s_ ting of a D—box and 3 precast leach chambers with stone all around. Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued by this Bo of Health. Signed v Date Application Approved by Date Application Disapproved for the following re sons Permit No. 7,100 —qplj Date Issued -0 Y Ott �No.rWUI�7�� Fee$50 ./ M Entered in computer: THE COMMONWEALTH OF MASSACHUSETTS .. p ` Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS 2ppricatfon for Mi5po!ml *p.5tem Construction Permit Application for a Permit to Construct( )Repair(X )Upgrade( )Abandon( ) O Complete System EJ Individual Components Location Address or Lot No. Owner's Name,Address and Tel.No. 64 Bridle Path, Marstons Mills Graham Mendes Assessor's Map/Parcel /el 7--/ jj Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. Wm. E. Robinson septic Service P O Box 1089, Centerville Type of Building: Dwelling No.of Bedrooms 4 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 Number of sheets Revision Date ,�..k Title Size of Septic Tank Type of S.A.S. Description of Soil Sand Nature of Repairs or Alterations(Answer when applicable) Title-5 1 each cv�Am cogs; s- ting of a D-box and 3 precast leach chambers with stone all around. 3 _ 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- �' U carte of Compliance has been issued by this Bo d of Health. > Signed r Date —,r"7'7"0 Application Approved by ! Date --7- -O 1 Application Disapproved for the following re sons Permit No. ZCIO.l " Date Issued i THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Mendes (Certificate of (Compliance THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed( ) Repaired(X )Upgraded( ) Abandoned( )by Wm J E. Robinson Septic Service P Bridle Path, Marstons Mills has been constructs in acc rdance with the provisions of Title 5f and the for Disposal System Construction Permit No.ZOO — dated Z �J Installer Wm. E. Rtbinson Sr. Designer �S 'ko ko* n The issuance of this permit shall not be construed as a guarantee that the syst will function,asAdesigned. Date ><�� U Inspector_ 0 ------y-- —-------- ------------------- --- No. '7-�/-�/ 3 Fee$50 THE COMMONWEALTH OF MASSACHUSETTS Mende: PUBLIC HEALTH DIVISION- BARNSTABLE., MASSACHUSETTS li5poOf *p5tem Con0truction Permit Permission is hereby granted to Construct( )Repair(X )Upgrade( )Abandon( ) System located at 64 Bridle Path, Marstons Mills and as described in the above Application for Disposal-Sslem Construction Permit.The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. C.. Provided: Constructiop must be ompleted within three years of the date of this it. G1/ Date: C � Approved by 0 33 s_ x r3 Z G 1161" NOTICE:Tbkis Form U To Be Used For the Repair Of Failed Septic Systems Only_ C�'1'I�iC.�_TiON t3F S AND,iYP�..ICA�FOR A D1S�0&AL WORKS CONSTRUCTION PAR (WTCHOUT DESIGNED PLANS) W it l iala E. Robinson,Stay certify that the application fir disimsM works can pe=aak sped by me&wd the locate+dat 64 Bridle Path, Marstons Mills meets agofthe following criteria: • faikd systesa is+mtaaeated m a mWeadal dvaWag ady_ Thee are no commaarat ar busimm awmia d width the diw, soil is ctassifiod as CLASS t an&the peffuWaam rate is tree urn%w cqu;o to 5 minutes per inch arc no walands wa is 100 feet of the pmpo6od srpuc k-*Ncm — • aM on privuc va db wifte IJO fM of dw p mposed scptc syawl is an inacwx in Gm auNm tdlmm in»fit popsal • are no var awn tad or seeded_ banwa af'd e h=himg beft w&w&6e km d km dun five f mm abave the ta tBeth ble m m adjaswd tt devaaw ( vrster*e VOWK using the Fnmptor If the S-A-S.will be locaW with 250 fca of MW vt S=Wd w bak the boom of the proposed Ic2ch ag facAW wdl W bc,kcamd Ices than founc=1141 fW above the ttt;VWnttm add qmundwzcrabkdcvafiW Pleaw c=mpftm the ?.i Tort akGraced Sattaot:Fsevatioal(using .As wimmad nl �� Bl G.W. n ';"' +the MAX_ff0 G.W —� __ zj/,S DIFFERENCE BETWEEN N A aW 0 5 SIGNED: DATE: [Slot prooposed plan of syuaa on badci. -F b-ft AMW.,n i%' `-I ems^ . .. • M �Y i El " �+,,.,, ,zy �r'� .'' s,," 6' """}2�. -..m- +'Cvyi••-a - "�-�Y`� �* `�-.s Y '-,,•,"'�, 3 a-..fa4.Try -1-5�+�.. TOWN 05BARNSTABLE -LOCATION' _ R L SEWAGE ' VILLAGE.. 1MA2 S ibtn),S '. ASSESSOR'S MAP-&LOT R: INSTALLER'S,NANE&PHONE NO. DL i G 7 7 5 -7?6 •' SEPTIC TANK CAPACITY ,000 0. LEACHING FACILITY,.,(type) 3 1�9V (size,),. 13 7ipZ NO..:OF BEDROMMS B:UILDER:OR.OWNER PE RMITDATE: a y COMPLIANCE DATE.. bo l G Separation'Distance Between the:., Maximum Adjusted Groundwater Table to the Boftom of Leaching Facility'' Feet Private Water Supply Weil and Leactugg Facility (If any,wells east K a on site.or within 200:fe'et of]eachm•g'faclLty) : Feet Edge df Wetland4nd.Lek n Facili If an wetlands:ezist ` g ty( y within"300 feet-of Iea6 ing faci�tty Feet ) . M" :. Furnished by : 2: Y 23 :. _ .. :... of - i NoYE ...................... THE COMMONWEALTH OF MASSACHUSETTS R0AR,.Q,0F HEALTH ..........OF...... .......................... Appliration for llhiposal Workii Tomitrudivit Prrutit Application is hereby made for a Permit to Construct or Repair an Individual Sewage ........... ..... z ' 0& ........... ....C.....)..,....T.....h...ob pW.7....q or t No, Disposal yst . . J J . ................................ E...... . ......................................... oc ion T— Owner Address CK A 1-41M IV, ..UA........................................ E&T...U.9 PRN...............................................��A Installer Address Type of Building Size Lot............................Sq. feet U Dwelling—No. of BedroonLs............................................Expansion Attic Garbage Grinder ( ) P4 Other—Type of Building ft- ..................... No. of persons...._... ........__.__.. Showers Cafeteria ( ) 04 OthF fiAlures .............................................................................................................................................. gallons. Design Flow......0..:4----------_----------_---gallons per person per,day. Total it flow-------- 3R.Of ------------------- Septic Tank—Liquid capacit/19W.gallons Length.__.._.6...... Width... ......... Diameter---------------- Depth................ Disposal-Trench—No. .................... Width____................ Total Length.................... Total leaching area.'2—,&..(,.-..sq. ft. Seepage Pit No--------------------- Diameter.._......_...._..... Depth below inlet.................... Total leaching area.._.............sq. ft. Z Other Distribution box L.,'j Dosin to .............................Percolation Test Results Performed by--- r�_.`T.........I Date-1-0....11.2. Test Pit No. .__......minutes per inch Depth- of�Test Pit.................... Depth to ground water.....?q_0............ Test Pit No. 2................minutes per inch Depth of Test Pit.__........._...__.. Depth to ground water___.__.............._.._ ......................................................................................../..............................................;r................... 0 Description of Soil...4° ..... .... ........ ....... ........7.......(atAu.-a-1..................................................................................................................................................... --------------------------------------------------------------------------------1................................................................................................................... U Nature 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'I'LE 5 of the State Sanitary C The undersigned further agrees not to place the system in 'P operation until a Certificate of Compliance has be -y-sued by t oar healt Signe . ..... . ........... .... Da te Application Approved By.......... . - I ---------------------- -t-e------------- ..► . . . ................. Date Application Disapproved for the following reasons:................................................................................................................ ........................................................................................................................................................................................................ Date PermitNo......................................................... Issued..................................................... Date N ........ F�$��........�.................._ THE COMMONWEALTH OF MASSACHUSETTS BOA RO F HEALTH '� " / OF............. A! f l4lj , ✓ Appliration for Dhipoii al Workii Tonarnrtinn ramit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal • -...;� T MA" ... -----......-•------------------------------------•------------------------------. ........ catiory* dress or t.No. w r Address L Installer Address Type of Building Size Lot............................Sq. feet V Dwelling—No. of Bedrooi Expansion4ttic ( ) Garbage Grinder ( ) Other—Type of Building •---•______________ No. of persons......__.._____..._..__.__.. Showers ( ) — Cafeteria ( ) a Otlp&fimures ......................•••-----•- W Desigln,.Flow`____ ________________ ______gallons per person pef,day. Total daily flow.._.... . '"......_............gallons. WSeptic"Tank—.Liquid capacit/Q .gallons Length......!...... Width.__._...._ Diameter................ De thf............... x Disposal Trench—No..................:. Width..............._.... Total Length.................... Total leaching area___.__ ....sq. ft. Seepage Pit No..................... Diameter-___-_--_-_-___.... Depth.below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box O Dos in a ( ) j Percolation Test Res ts� Performed by. -- ' �I ---.--••_---•---_------•------- Date.... / . � 7..... aTest Pit No. 1_..:.t.' ....minutes er inch Depth of Test Pit.................... Depth to ground water.... ............_.. Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to.ground water........................ •••. 4 ►v - �yl1 __ jv l .................................................... � S f »ODescripti f �� -------•.._.. ...-----•• •--•..•-- - -------- ------------------------- ---- ------------------------------------------ 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 TITI..I 5 of the State Sanitary — The undersigned further agrees not to place the system in operation°until a Certificate of Compliance has b n ' sued by t o healt Date Application Approved BY.........* stet "' Application Disapproved for the following reasons:------••--------•---------••--•---------------•-------•------------------•-•-----------------------------•----- Date PermitNo......................................................... Issued...-----------------••-•......:.......................... Date ' THE COMMONWEALTH OF MASSACHUSETTS BOARP.,OF HEALTH �...(AJ Q .:....OF... .... ............... CIrr#ifiratr of TuntpliFanrr . TH IS OCEUIFY, Dat t e Individual Sewage Disposal System constructed ( ) or Repaired ( ) bY--------------S1_. .. .. ...............• •-•--•--- Jjqnstaller has been installed in accordance with the provisions of MfT 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit I ..7�r.___ „�"'____________________ dated---- . _._ _� ___.__._... THE ISSUANCE OF THIS CERTIFICATE ShIA NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE......................... ........ ,/ . .......... Inspector-4C•-- .--•--•----•--------•.�t THE COMMONWEALTH OF MASSACHUSETTS BQA 7 bAHEALT OW f0.. .. .OF ....: c~............ NIA" .7;,�`".+... FEE.... Dispns ,4ork . To trudion rranit zPermissionis hereby granted............a bC ................__.....__...___.....__.___.____.__.__._.._..__...................A............... .......... to Consfi ct r,or,Repair. ( ) ark dived e e isposal at No.. �`1 ' �72.1.. !_L`. ... t f.------. --��'f..?w.�.•��t�L!- 1._ r.... ....----•-. Street as shown on the application for Disposal Works Construction P: it N ..___•_____.__. .__ Dated_.•....................................... DATE..... 3 ' ... ...----.... . FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS - i.w. I Cl ,K*' A sy t 4�' Z� Al 0 sa. Aj A 51 - ej -es r N 16 ex,-A w5w,? GA-C 14 14, Z4— it PIT OF A4 61 ROBERT 7, P. 7 BUNIKM' No'2?162 'k 10 T*J's t: 'A Ts AL `Ao sl J 7, -7 3. 7 L E G E N D j PLAW EXISTING SPOT ELEVATION OX0-' CERTIFIED' PLOT EXISTING qONTOUR c) z 7 7-0 4 • S 2?1�7 0 FlIVISHED. SPOT EL -VATIO-N A 5 " - __ 911141 I'S N E 0, CONTOUR. O M k! rl IN - V` APPRGVE�D,l, BOARD "OF HEALTH S AAA S fka !L<Z,`7'GATE AGENT E 4, 0"`SCALE E DAT "'lrrlDREDGE ENGINEERING Co, I CLIENT I., CERTIFY THAT" THE P R 0 P 0 t b GI STERE REGIST ERED, ; joa NO. 7 BUILDING SHOWN ON TH[S PLAM CIVIL LAND CONFORMS TO THE ZONIRG LAYS ," 'GINEER SURVEYOR OF BARN' ST,#BLE MASS. 33 NO..; MAIN ST 712 MAIN ST CH. By 0`O,IYARMOUTH MASS. HYANNIS MASS. SHEET OF DATk-' -w.*qEG., LAND . SURVV,(OR'.. - k /1lO7LC MIA(. %F E� TMG R ?'�F eFTiG 7'.�►A//C ®'4 _ JK - _ - 2 " TNF � /� BALD� : A 24'O/.qM ET.L�R GONCR.s�TE''Li�ER p S ROl1rv, 7, To G IqA O F.�•-i..'✓ E, ?-R� CONCaETo J 1 •¢ s�vc P/PE j,►EA�Y CA 57 R S oY,4 L L k%F USED �L /00, OP/TCN e % I COYERS. �' AB p PFR FT. COJV C.2�7 r A "•o: •,� ., - - GR.4os� -�` . CO VE'R CLEAN SANG_ �':�=; . •'. L/QIJI� LEVEL . - - _ �'; �� - _ , - • x I•d_ .-• -,, 0 2"LAYER 'c q•• CAST > v 47 o ' o pd^ /RON GAL. e • • • _ e • • bee n v� M/N.IP/TC,V • . _ D/ST. A dyA5HF0 57L�NE. SAPT/C Tt4NK - n • • e • e • • o Dn q 314 s t ;- -• . v � EFFECT/V E .e f ASHE TONs` � e • p c� '' r O S O e • O 6 f • • 0 ►. O a .I s. .:','d' _ .,.. . ,, - F ' ° e v o • • e • • p o P - PRECA S T SEE�A 6E !NVeRT EL EVAT/oN.S _ - -=- -• • ® . e _ a • op • erg i e o n o /NYERT AT BU/LD/NG -,�7 FT - 6 FT. D/AM. /NLET SEPT/C TANK. 5,5 FT. t: �-��. FT. 0/AM•___ y C CSEE Ts�BU,l�1TlON�M 4 a - DUTLET SEPT/C TA VK 2 5. 3 Fr _ //NLET-0157R/A5UTION BOX_ 7—FT. GRDuNO Nr�1TER Ti49LE _ 3'ECT/ON O F' - > O UTLET D/STR1B!/T/ON BOX 4•�1 FT - o SEW ®ISROS 1 L SY.STE:/►'1 /NZETSEEAAGE PIT a`� --aFT. L,EAC0�1//e/G �/T DIMENSION AI-ttFT .. , FT DESIGN CR/TER/A SCALE_ : '/,a = / - o/a>.Fnis/aa �� - - - _ D/MENS/ON C FT. NUMBER OF BEOROO/*�S �_ 3 • - - - - _ GAR9A6ED/5P05AL UNIT_ `.SDI L E TOTAL EST/T9.4TEL� I=1oM/_33 GgL.�D.4y SO/L TEST A'/ SO/L TEST*2 SD/L. T �T j NUMBER OFSEEP.4GE P/TS_- -1 �'ELEY. 7�� ` EL�Y._ RATE OF SO/L TEST I V` I / ? S/DE 11�4CH,f PER it/7 _SQ, PT. 1, RESULTS dVIT/VESSED BY�7c� 6UTTOM L.04CH//VG PER PIT + t$ SQ. FT a OA 4 f'ERC0LAT/OM RAE / ?i s_ M//V//NC� _ TOTAL L.EACM//YG AREA to SQ, CZ- 3 Pnvco,AT/ON RAr—=Ak2. MJN.l/NCH r REgERIiE GE,4CH/N6 AREA Z�{' SO. FT. I 4 _ - �►° -(N ter f�"10. i _ - o��h T R ER F T o ®��. e.o�!/✓�r y. No.22I62 4C� o 2 .,7/2 M /N S T.. NO,M�4/ilir S� $ /"' A 33 moo, G75`rS��r4' !/qY�`� AFVCOIJ/VT�RL4 NYAN1Vi5, MASS. ycT Y}ORMCJt/TNr.MAsS ,• S . k ONAL rR �q 7` E,L 1=1/'. w 71 •., � z� .�. .ems -�'•s- Td 7. `� `�'"=' JjY c' i ;x ... j. 's. _r 3 �- n _`� �F� p. °