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HomeMy WebLinkAbout0091 BRIDLE PATH - Health 91 '.Bridle Path Marstons Mills A= 149-146 TOWN OF BARNSTABLE i- LOCATION 6t I BV,00 L 9 pOrT4 SEWAGE# 2-DI O—Db4l VILLAGE I l,i.S ASSESSOR'S &PARCEL INSTALLER'S NAME&PHONE NO. JP M G D L-Eg— 4rgZD 074"o SEPTIC TANK CAPACITY G got) LEAC14ING FACILITY.(type) � �— D® (size). 07 SDI CAL L'C, s NO.OF BEDROOMS J OWNER M JkTr CCU 'rIVA ESL PERMIT DATE: D O COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility 7 12 Feet Private Water Supply Well and Leaching Facility(If any wells exist on w ( site or within 200 feet of leaching facility) N Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leachi facili D I N Feet FURNISHED BY 't" f f, Q Pi �1✓@U 37 -� 2- No. golo— b1v THE COMMONWEALTH OF MASSACHUSETTS FEE _I 50 BOARD OF HEALTH 1 OW M OF AVZ S-rVVe1,S APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT Application for a Permit to Construct ( ) Repair (io<Upgrade ( ) Abandon ( ) - N/Complete System []Individual Components 1 t� lea"1 `, I EYL /! wn is Na G� \ l l . 3`� ap/Parcel# Address' P► o:fax �o Installer's Name Designer's Name � J'4a49-fnas M 1 u�s M� ®� W� somm- Pia LI_ A 6dres0 �` Ad d �Teellephone# Telephone# Type of Building: Lot Size ZG 14'p'"3 Sq.feet Dwelling—No.of Bedrooms Garbage Grinder ( %,30 Other—Type of Building No.of persons Showers ( ), Cafeteria ( ) Other fixtures Design Flow( in.re wired) 0 gpd Calculated design flow �' gpd Design flow provided! gpd Plan: Date 110 Number of sheets _ Revision Date Title r" 9 �o; Dm' o� Description of Soi (s) Soil Evaluator Form No. Name of Soil Evaluator 1.. •►�ate of Evaluation DESCRIPTION OF REPAIRS OR ALTERATIONS b 1. The undersigned agrees to instal the above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and fu er agrees not to pla the system in operation until a Certificate of Compliance has been issued by the Board of Health. Signed Date e 2J A• M 3- 30 Inspection 1. FORM t - APPLICATION FOR DSCP DEP APPROVED FORM 5/96 gL #No. ��o� THE COMMONWEALTH OF MASSA,HUSETTS i FEE BOARD OF HEALTH OFyi APPLICATION FOR DISPOSAL SYSTEM' CONSTRUCTION PERMIT Application for a Permit to Construct ( ) Repair (,,/) Upgr`a&—(* ) Abandon ( ) - NComplete System ❑Individual Components r. �{1 6111VL*, MAr + tic4r i>Wfj r'sNam PA) ti W ap/Parcel# Address �M-►�ES (��n LUX CAP J L -a^' staller' Name Designer' ame P, o,`5o C '7o �A�Zs og iu►us�Iq 306O Telephone#'i Telephone# u3 i�.t /� '? Type of Building: Lot Size?—G A-43 Sq.feet Dwelling—No.of Bedrooms Garbage Grinder (14.)o Other—Type of Building No.of persons Showers ( ), Cafeteria ( ) Other.fixtures Design Flow( in.re uired) � � gpd Calculated design flow 7 7 gpd Design flow provided 1, gpd Plan: Date3/2 umber of sheets _ Revision Date Title 5n' Q t.S .OQ Yy171`f 1®cN Description of Soil(s) Soil Evaluator Form No. Name of Soil Evaluator LJOAXCEMate of Evaluation DESCRIPTION OF REPAIRS OR ALTERATIONS �Q�. GiTi Qi '` o ' G The undersigned agrees to install the above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and fu er agrees not to pla the system in operation until a Certificate of Compliance has been issued by the Board of Health. Signed Date 3 e Zsi /U Inspection . 1 FORM I - APPLICATION FOR DSCP DEP APPROVED FORM 5/96 No.aU 0 -ot THE COMMONWEALTH OF MASSACHUSETTS FEE I570 B�n..►Js7�#R BOARD OF HEALTH CERTIFICATE OF COLIANCE Description of Work: ❑ Individual Component(s) M''Complete System The undersigned hereby certify that the Sewage Disposal System;Constructed( ),Repaired( ),Upgraded( ),Abandoned( ) by: �k,k 5 �o at q t $2l v(.C` Pi4Td m A-l¢Sn^lS AU i id-S MA D l/ has been installed in accordance with the provisions of 310 CMR 15.00 (Title 5) and the approved design plans/as-built plans relating to application N/o+a010-016 dated 3-3d'f O Approved Design Flow 3 5 ;t— (gpd) Installer J>4w1 ES �D�.Ltr I S t��'� / 1 V -•Date �' S - /0 Designer: CA'tJRi-: �t'N D ull✓�1 f fJ� Inspector The issuance of this certificate shall not be construed as a gilatrantee that the system will function as designed. FORM 3 - CERTIFICATE OF COMPLIANCE \ DEP APPROVED FORM 5/96 No. a010 ^ t78 fo THE COMMONWEALTH OF MASSACHUSETTS FEE �5; `66rtW-STA i3 BOARD OF H E A LT H DISPOSAL SYSTEM CONSTRUCTION PERMIT } N Permission is hereby granted to Construct ( ) Repair ( ) Upgrade ( ) Abandon ( ) an individual sewage disposal system at 7344 D Lj;7 P Tf( as described in the application for Disposal System Construction Permit No. .2010 dated 30 /0 Provided: Construction shall be completed within three years of the date of this per Ald-loc(all o, 'flonsQmust a met. Date 13 - 3O-(0 Board of Health �,Z FORM 2 - DSCP DEP APPROVED FORM 5/96 FORM 1255 (REV 5/96) H&W HOBBSB WARREN TM PUBLISHERS- BOSTON ''t� Town of Barnstable fTHE� ° Regulatory Services V . o. Thomas F. Geiler, Director »I BARNSrABt E p MASS. Public Health Division 16-19. °lEorna�° Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Installer & Designer Certification Form Date: �10 Sewage Permit# Assessor'sMap\Parcel il7llltlL Designer: jE2G� Q' - tCz Installer: i��r Nir-I-y Address: �l�ddress: -Q- �X- ?PZ 3n�� o, P��irlayTi�>:� sr?��a�a e,= '3C.�"�1Ila+Rd�o�J.t /N f t.�, OZL 0 2Z— On 3 3.0 .Zd f o �i �S C V WLA, -was issued a permit to install a date) (installer) septic system at q 751W Df•,6- PRMA based on a design drawn by (address) dated`O3/Z.41Zd c C2) . / (desi er) 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 in 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. t64 oil ROGER PU 0 MICi NIEWICZ taller s S' a } No.3042o 6 CIVIL 40 (Designer's ignature) (Affix Designer's Stamp Here) PLE SE. RETURN TO B_4RNSTABLE PUBLIC 'HEALTH DIVISION. CERTIFICATE OF CO CE WILL NOT BE ISSUED UNTIL BOTH TffiS FORM AND AS-BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. ' r Q:Healfh/5eptic/Designer Certification Form 3-26-04.doc i Town of Barnstable P# Department of Regulatory Services f Public Health Division Date 3 I ? 200 Main Street,Hyannis MA 02601 Date Scheduled O Time Fee Pd. too Soil Suitability Assessment for Sewage isposal W Performed.BY: Witnessed By: �'�y, ,Sn• LOCATION& GENERAL INFORMATION Location Address Owner's Name Q_.7 9'1 `t F � C� �l 7'it?��/E,e �! �/7�C_ /�R T.t-� Address —s A 1IT Assessor's Map/Parcel: /`���124 Engineer's Name cg1v4e_ NEW CONSTRUCTION 1 REPAIR _ 'L Telephone# Land Use 0 Slopes(%) Surface Stones Distances from: Open Water Body ft Possible Wet Area ft Drinking Water Well 5©Z� ft �J l'�C� a Drainage Way�ft Property Line ft Other ft SKETCH:(Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands in proximity to holes) LU Cn crs � o L Parent material(geologic) ��\/�' I`� Depth to Bedrock Depth to Groundwater. Standing Water in Hole: V Weeping from Pit Face Estimated Seasonal High Groundwater I DETERMINATION FOR SEASONAL HIGH WATER TABLE Method Used: Depth Observed standing in obs.hole: _-in. Depth to soil mottles: in. Depth to weeping from side of obs.hole: in, Groundwater Adjustment ft. Index Well# Reading Date: Index Well level Adi.factor Adj.Groundwater level,n PERCOLATION TEST Dgl� '!° )9Ane 0"--1V)Y) Observation 1 Hole# I Time at 9" Depth of Perc L� Time at 6' C Start Pre-soak Time @ Time(9"-6") End Pre-soak j Rate MinJlnch e Site Suitability Assessment: Site Passed Site Failed: .`� Additional Testing Needed(Y/N) 4 ' t Original: Public Health Division Observation Hole Data To Be Completed on Back----------- ***If percolation test is to be conducted within 1001 of wetland,you;must first notify the. Barnstable Conservation Division at least one(1)week.;pH446 beginning. Q:XSEPTICVERCFORM.DOC DEEP.OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones;Boulders. Consistency. Gravel) qV v �+ DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency,% DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Con i to c Gravel) DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consi ten 01) Flood Insurance Rate Ma p ,/ Above 500 year flood boundary No` Yes Within 500 year boundary No= Yes Within 100 year flood boundary No: t! Yes Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervious in nal exist in all areas observed throughout the area proposed for the soil absorption system? — If not,what is the depth of naturally occurring pervious material?__._......�..�. Certification • I certify that o�� �� t ' e passed the soil evaluator examination approved by the Department of •nvironme � 1�.q at th ve analysis was performed by me consistent with . trat in ex iell ¢scri in 0 CN R 15.017. the rep g, p • p RL m, Signature Date No �p 65 s E �T SS�ONAL ENG`� JR- Q:\S,EpnC\PERCFORM.DOC ! i Town of Barnstable Barnstable ` Regulatory Services DepartmentCe CRY HA.RNIMAB A iI b Pulic Health Division m 200 Main Street, Hyannis MA 02601 2007 Office: 508-862-4644 Thomas F.Geiler,Director FAX: 508-790-6304 Thomas A.McKean,CHO J CERTIFIED MAIL# 70081830000205009205 4/05/2010 Mr. &Mrs. Matthew Quitmeyer 91 Bridle Path Marstons Mills, MA 02648 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 The septic system located at 91 Bridle Path, Marstons Mills MA was last inspected on March 23, 2010, by Allan C. Taylor, a certified septic inspector for the State of Massachusetts. The inspection of the septic system showed that the system"Failed" under the guidelines of 1995 TITLE 5 (310 CMR 15.00) due to the following: • Backup of sewage into facility or system component due to an overloaded or clogged SAS. You are ordered to repair or replace the septic system within Sixty (60) days from the date you receive this notification. Failure to repair/replace the septic system within the deadline period will result in future enforcement action. PER E F HE BOARD OF HEALTH Thomas McKean, R.S., CHO Agent of the Board of Health e i <C\ Commonwealth of Massachusetts Title 5 Official Inspection Form 'Subsurface-Sewage Disposal System Form-Not for Voluntary Assessments 91 _Bridle Path Property Address w Mr.&Mrs.Matthew Quitmeyer Owner Owner's Name Information is Marstons Mills Ma. 02648 3/09/2010 required for _ _ every page. Cityrrown State Zip Code Date of Inspection Inspection.results.must be submitted.on this form..Inspection forms may not.be altered in.any way. Please see completeness checklist at the end of the form. ``e"t�When A. General Information When filling out forms on the st computer,use 1. Inspector: only.the tab key. Allan C.Taylor m;1 to move your �.;_•�I.. cursor-do not - _ use the return Name of Inspector 03 key. Canal Land Surveying&Permitting.Inc. ' Company Name . I ou 18 Route 6A Company Address t rJ rn Sandwich Ma. 2563 " Cityrrown State Zip Code 508-888-5955 812487 Telephone Number License Number B. Certification 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.16.340 of Title 5(310 CMR 16.000).The system: ❑ Passes ❑ Conditionally Passes ® Fails ❑ Needs Further Evaluation by the Local Approving Authority 3/15/2010 Insp is ignature Date The system inspector-shall submit 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. ""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. t5ins•09M r Ales official Inspection Fomt Su 29. sposal System Page 1 of 17 t Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 91 Bridle Path Property Address Mr.& Mrs.Matthew Quitmeyer Owner Owner's Name information equired for is Marstons Milts Ma. 02648 3/09/2010 required for every page. Cityrrown ._ state Zip Code Date of Inspection B. Certification (cost.) Inspection Summary:Check A,B,C,D or E/alimays complete all of Section D A) System Passes., ❑ 1 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 i e"Conditional Pass"section need to be replaced or repaired.The system, upon compl on of the replacement or repair, as approved by the Board of Health,will pass. Check the box for"yes", "no"or"not.determi d" (Y, N,ND)for the following statements. If'not determined,"please explain. The septic tank is metal and over 20 ars old*or the septic tank (whether metal or not)is. structurally unsound, exhibits subst tial infiltration or exfiftration or tank failure is imminent. System will pass inspection if the existin ank is replaced with a complying septic tank as approved by the -Board of Health. � *A metal septic tank will ss inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating t the tank is less than 20 years old is available. ❑ Y ❑ N ❑ NO (Explain below): /-- t5ins-09M Title 5 Official Inspection Form:Subsurface Sewage Disposal Systern-Page 2 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage-Disposal System Form-Not for Voluntary Assessments 91 Bridle Path Property Address Mr.&Mrs.Matthew Quitmeyer Owner Owner's Name information is required for Marstons-Mills Ma. 02648 3/09/2010 _w Avery page. Cityrrowrn State Zip Code Date of Inspection B. Certification (cont.) ❑ Observation of sewage backup or break out or high static water level in/Jonn box e to broken,or obstructed pipe(s) or due to a broken,settled or uneven disSy will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)-are replaced ❑ Y ❑ N ❑ NDow):obstruction is removed ❑ Y ❑ N ❑ NDow):[❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ Now): ❑ The system required pumping more than 4 times a ye due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the B rd of Health): ❑ broken pipe(s)are replaced Y ❑ N ❑ ND (Explain below): C7 obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) Fu/eh ation is quired by the Board of Health: ❑ Coist whi require further evaluation by the Board of Health in order to determine if the .failin .to.protect..public.health,safety or the environment. 1. il ass unless Board of Health determines in accordance with 310 CMR 15. at the system is not functioning in a manner which will protect public health,. saa environment: ool or privy is within 50 feet of a surface water t5ins•09= Trde 5 Official Inspection Form:Subsurface Sewage Disposal System.Page 3 0117 Commonwealth of Massachusetts Tide 5 Official Inspection Form Subsurface-Sewage-Disposal System Form-Not for Voluntary Assessments 91 Bridle Path Property Address Mr.B Mrs.Matthew Quitmeyer Owner Owner's Name `- information is required for Marstons Mills Ma. 02648 3/09/2010 every page. Cityrrown state Zip Code Date of inspection B. Certification (cont.) .2. Systent will fail unless the Soeid—6 1 4�.IR11&21 Me. SupplieF 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 SA s within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has aseptic tank and SAS and the SAS is within a Zone of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less tha 00 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, p ormed at a DEP certified laboratory,for coliform bacteria indicates absent and the presence of onia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other fail criteria are triggered.A copy of the analysis must be attached to this form. 3. Other. 0). .System Failure Criteria.Applicable to All Systems: You must indicate"Yes"or"No"to each of the following for all inspections: Yes No ® ❑ Backup of sewage into facility or system component due to overloaded or dogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑. ® 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%day flow t5ins•09M Tige 5 Official Ins pection Forth:SttbsutFaee Sewage Deposal System•Page 4 of 17 Commonwealth of Massachusetts Title 5 Official inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 91 Bridle Path Property Address Mr.&Mrs.Matthew Quitmeyer Owner Owner's Name information is M_arstons Mills Ma. 02648 3/09/2010 _ required for every page. Cityfrown _ State Zip Code Date of Inspection B. Certification (cons.) Yes No ❑ ® 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 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. [This system passes if the well water analysis,performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent 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 and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ® ❑ 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. design flow of 10,000 gpd to 15,000 gpd. For.large systems, you must indicate either`yes"or"no"to each of the followin addition to_the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of dace nking water supply ❑ ❑ the system is within eet of a tributary to a surface drinking water supply ❑ ❑ the system i ated in a nitrogen sensitive area(interim Wellhead Protection Area— A)or a mapped Zone II of a public water supply well If you have answere es"to any question in Section E the system is considered a significant threat, or answered e in Section D above the large system has failed.The owner or operator of any large. system ered a significant threat under Section E or failed under Section D shall upgrade the syst In accordance with 310 CMR 15.304.The system owner should contact the appropriate Mns•MOB Title 5 Official In spection Form:Subsurface SEwage Del System•Page 6 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form -Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 91 Bridle Path Property Address Mr.&Mrs.Matthew Qgfagrer Owner Owner's Name information is Marstons-Mills Ma. 02648 3/09/2010 required for .,_._. _ every page. Cityrrown state Zip Code Date of Inspection C. Checklist 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 ❑ ® Were any of the system components pumped Win the previous two weeks? 0 ❑ 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) M ❑ Was the-facility-or dwelling inspected-for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ 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? ❑. ® 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: ® ❑ 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(5)1 D. System-information Residential Flow Conditions:. Number of bedrooms(design): 3 Number of bedrooms(actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 isins•09M Title 5 Official Inspection Form:subsurface sewage Disposal System•Page 6 of t 7 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 91 Bridle Path Property Address MrA Mrs.Matthew Quitter Owner owner's Name requir aY'fo is Marston Mills Ma. 02648 3/09/2010 required)for ..._ _ every page. cflyrrown State Zip Code Date of Inspection _ D. System Information Description: Number of current residents: 4 - -- Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system?[if yes separate inspection required] ❑ Yes ® No Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available ast 2 ears usage 2008-54,000 g (i y g (9Pd))= 2009-67.000 Detail: sump pump? ❑ Yes 0 No Last date of occupancy: occupied Date Type of Establishment: -- ---- Design flow(based on 310 CMR 15.203): Gallons (gpd) Basis of design flow(seatsipersonsisq.ft., etc.): Grease trap present? f� ❑ Yes ❑ No Industrial waste holding tank nt? ❑ Yes ❑ No Non-sanitary discharged to the Title 5 system? ❑ Yes ❑ No t5ins•09= Title 5 Official In5pacton Form:Subsurface Sewage Uisposaf System•Page 7 of 11 Commonwealth of Massachusetts Title 5 Official Inspection Form -Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 91 Bridle Path Property Address — Mr.&Mrs.Matthew Quitmeyer Owner ._ Owner's Name information is MarstonS Mills required for Ma. 02648 3/09/2010 every page. City►rown State Zip Code Date of inspection D. System Information.(cont.) Date Other(describe below): •� General Information Pumping Records: Source of information: --- u Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank,distribution box, soft 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) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank.Attach a copy of the DEP approval. ® Other(describe): original septic pit still tied into system t5tas-09M Title 5 MOW Ins pection Form:Subsurface Sewage Dispasal System•Page 8 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form -Subsurface Sewage Disposal System Form-Not for Voluntary Assessments K -- 91 Bridle Path Property Address Mr.&Mrs.Matthew Quitmeyer Owner Owner's Name information is Marstons Mills Ma. 02648 3/09/2010 required for _.....,____ every page. cityrrown State Zip Code Date of Inspection D. System Information (cost.) Approximate age of all components,date installed (d known) and source of information: 1999-S.A.S Tank,Dlstribution box and old pit date to house construction,1984 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 1.8 feet Material of construction: ❑ cast iron ®40 PVC ❑ other(explain): .Distance from private water supply well or suction line: feet Comments(on condition of joints,venting,evidence of leakage, etc.): Septic Tank(locate on site plan): Depth below grade: 8" Material of construction: 0 concrete ❑metal ❑fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance?(attach a copy of certificate) ❑ Yes ❑ No Dimensions: 8'6"x4'10"_ Sludge depth: 311 t5ins-09= rme 5 O fidaf QeCtl4C1 Form:S11hSuANCe$ervraQe D'spOsai System•F+ege 9 of 17 commonwealth of Massachusetts Title 5 Official inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments 91 Bridle Path Property Address Mr.B Mrs.Matthew Quitmeyer Owner Owner's Name T information is required for Marston Mills Ma. 02648 3109/2010 _ every page. Citylrown State Zip Code Date of Inspection D. System Information (cunt.) Septic Tank(cunt.) Distance from top of sludge to bottom of outlet tee or baffle Scum thickness thickness 2" Distance from top of scum to top of outlet tee or baffle 4" Distance from bottom of scum to bottom of outlet tee or baffle Not measured _ How were dimensions determined? measured where noted. Comments (on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert, e 'Q evidence of leakage, etc.): Septic tank has concrete baffles,with a large crack in outlet baffle allowing solid carryover to reach the outlet pipe and distribution box and the S.A.S.. 1/2"liquid in outlet pipe; Gfeese Trap Peeate en site plan).: Depth below grade: feet Material of construction: ❑concrete ❑metal ❑fiberglass ❑ ethylene ❑ other(explain): Dimensions: �. Scum thickness - Distance from top of s to top of outlet tee or baffle - --- Distance fr ottom of scum to bottom of outlet tee or baffle Date Sins•MOB Title 5 Of W Inspechw Form:Subsurface Swmap Mposat Sysbm•Page 10 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form -Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 91 Bridle Path Property Address Mr.&Mrs.Matthew_ Quitmeyer Owner Owner's Name information Is required for Marston Mills Ma. 02648 3/09/2010 every page. City/Town� state Zip Code Date of Inspection D. System Information (cunt.) Gemments.(en pumping reeemmendations, inlet and outlet tee or baffle eondition,- liquid levels as related to outlet invert, evidence of leakage, etc.): ' Tight or Holding Tank(tank must be pumped at time of inspection)(locate o site plan): Depth below grade: Material of construction: ❑concrete ❑metal ❑fiberglass polyethylene ❑other(explain): Dimensions: /g�allons Capacity:Design Flow: per dayAlarm present: es ❑ No Alarm level: - R- Alarm in worlang order: ❑ Yes ❑ No .Date of last pumping: Date �- Comments(condition of arm and float switches, etc.): ins 09M Trite 50ffiaal Inspection Form:SuhsuRace Srftge Mposal Systan•Page 11 of 17 Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 91 Bridle Path Property Address Mr.&Mrs.Matthew Quitmeyer Owner Owners Name ' requiratfoion is Marstons Mills Ma. 02648 3/09/2010 required for _ every page. Cityrrown State Zip Code Date of inspection D: System Information (cons.) Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert level 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.): Top of D-box found sagging with severe deterioration ,signs of solid carryover from septic tank. ftrnp.ehember 0eeste an site.plan)! Pumps in working order. ❑ Yes Z Alarms in working order. ❑ Yes Comments(note condition of pump chamber,condition of pumps and appurt nces, No Soil Absorption System(SASXQocaon e plan, excavation not required): If SAS not located, explain wh . located in the field when vat for inspection f5ins•09= trite 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 Commonwealth of Massachusetts v Title 5 Official Inspection Form Subsurface-Sewage Disposal System Form-Not for Voluntary Assessments 91 Bridle Path Property Address Mr.&Mrs.Matthew Quitmeyer Owner Owner's Name information is regtrired for Marston Mills Ma. 02648 3/09/2010 every page. Cityrrown State Zip Code Date of inspection D. System Information (cunt.) Type: ❑ leaching pits number. --- leaching chambers number 2 ❑ leaching galleries number: ❑ leaching trenches number, length: -- ❑ leaching fields number,dimensions: ---- ❑ overflow cesspool number. --- ❑ innovative/altemative system Type/name of technology: —--- Comments(note condition of soil,signs of hydraulic failure, level of ponding,damp soil, condition of vegetation,etc): S.A.S is 3.5'below grade,and when opened liquid level were 40 below inside top of the facility,showing hydraulic failure. Number and configuration -- Depth-top of liquid to inlet invert --r- - Depth of solids layer - .Depth:of scum layer Dimensions of cesspool -. Materials of ction t5ft•09108 Title 5 OBicW Inspedon Form:Subsurface Smage Dispasai System.Page 13 of 17 Commonwealth of Massachusetts - Title 5 Official Inspection Form Subsurface-Sewage Disposal System Form-Not for Voluntary Assessments 91 Bridle Path Property Address Mr.&Mrs.Matthew Quitmeyer _ Owner Owner's Name information is required for Marstons Mills Ma. 02648 3/09/2010 _every page. C+t crown state Zip Code Date of Inspection D. System Information (corn.) etc.): Privy(locate on site plan): Materials of construction: Dimensions — - —---•=.Depth of solids Comments(note condition of so',signs of hydraulic failure, level of ponding, condition of vegetation, etc.): (Sins•OM Me 5 Official fnspectiaa Form:Subsurface Sewage Disposal System•page 14 of 17 Commonwealth of Massachusetts -- Title 5 Official Inspection Form Subsurface Sewage Disposal System Form•Not for Voluntary Assessments 91 Bridle Path Property Address Mr.&Mrs.Matthew_Quitmeyer Owner Owner's Name Information is Marstons Mills Ma. 02648 3109/2010 required for � _ every page_ City/Town state Zip Code Date of Inspection D. System Information (cons.) Sketch Of Sewage Disposal System; Provide a view of the sewage disposal system,including ties to at least two permanent.reference landmafks or,benchmarks..Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately 9� i C A —C Es- C = 16 .0 ' OLT> A-� = zS.3t NOT' A-� - 49 S r Lo CRTE.7 t5ins•OWM Title 5 official inspection Form:subsurtace sewage obpoaal System,Page 15 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 91 Bridle Path Property Address Mr.& Mrs.Matthew Quitmeyer Owner Owner's Name information is required for Marstons Mills Ma. 02648 3/09/2010 every page. City/Town State Zip Code Date of Inspection D. System Information (coat.) Site Exam: ® Check Slope ® Surface water Z Check cellar ❑ Shallow wells Estimated depth to high ground water: 20-25' feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date ® Observed site (abutting property/observation hole within 150 feet of SAS) ® Checked with local Board of Health -explain: town file on locus contains document dated 1/15/99 for repair to system at that time. ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: Observed observation hole for new system design,and made reference to the document on record 1/15/99 with the Barnstable board of health Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface-Sewage Disposal System-Form-Not-for Voluntary Assessments UV 91 Bridle Path Property Address Mr.&Mrs.Matthew Quitmeyer Owner owner's Name information is required for Marstons Mills Ma. 02648 3109/2010 every page. Cityrrown state Zip Code Date of Inspection E. Report Completeness Checklist ® inspection Summary:A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems) completed ® System Information—Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file tsns•(Wo Tide 5 Official Wspedon Form:Subsurface Selvage Disposal System•rage 17 of 17 TOWN OF BARNSTABLE � � LOCATIONq/ iPi®`2 �Q SEWAGE # V LLAGE/17gf ASSESSOR'S MAP & LOT lV 7e 1 y� INSTALLER'S NAME & PHONE NO. A & B CANC:O 775-6264 SEPTIC TANK CAPACITY AW (�i41(224 f if4r-l# LEACHING FACILITY:(type)oT lw d.*( ,<S (size) NO. OF BEDROOMS .PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNER 141-411 4nr? d DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No v f�GoicGLS�E'i u �2 J,L,r, , LGrCATION SEWAGE PERMIT, O. V1, LLAGE �I I N S T A LLER'S� NAME & ADDRESS 8 UILDE R 0 OWNER DATE PERMIT ISSUED DATE COMPLIANCE ISSUED f No. .w Fee : Entered in computer: THE COMMONWEAL OF MASSACHUSETTS YeC ` PUBLIC HEALTH DIVISION -*TOWN OF BARNSTABLE., MASSACHUSETTS 01pplication for Zigo$af *pztem Con5trurtion Permit . Application for a Permit to Construct( )Repair( j Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. 9( 3 rj A,I `{ Owner's Name,Address and Tel.No. IUl&rs'4s W�,;0 Lyn n r.,( Assessors Map/Parcel / / -,j / /, C �� Installer's Name,Address. �.No. 1� Designer's Name,Address and Tel.No. ANCO 350 Main Street 4)J Type of Building: Dwelling No.of Bedrooms 3 Lot Size sq. ft. Garbage Grinder( ) Other Type of Building No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank 160 RX iS�i n4 Type of S.A.S. Sdo 9AI, /eaeA eAgm bars Description of Soil Nature of Repairs or Alterations(Answer when applicable) 1 n 34411 d — S'Oo qA�_ )ete cl� CGiAmbePS CJJ Y $1�dl�c-� Gf� PX(S{i/Loi lOna Q.ei_ 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 Boaki o alth. Signed Date Application Approved by Date Application Disapproved for the following reasons Permit No. Date Issued �' 7 ;. No. �� Fee So THE COMMONWEALT OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLES MASSACHUSETTS ZIpprication for Migponl *p!5tem Construction Permit Application for a Permit to Construct( )Repair(, Upgrade( )Abandon( ) El Complete System ❑Individual Components Location Address or Lot No. 7 (j t^r v(a( PA 11 Owner's Name,Address and Tel.No. Assessor's Map/Parcel '! , O Installer's Name,Address,and Tq" B CANCO Designer's Name,Address and Tel.No. tr f 350 Main Street %`a W. Yarmouth, MA 02673 Type of Building: Dwelling No.of Bedrooms .3 Lot Size sq. ft. Garbage Grinder( ) Other Type of Building No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank tvo ej 41x f; Type of S.A.S. 5oo 6,41. /Pcc/ Description of Soil Nature of Repairs or Alterations(Answer when applicable) 1 (1 S A A — YO(., ea,4 t )P cc c 0i"74,1-112ef.5 C,)/ 7 SIDl� l t�.�t� � ilc, / ��i . Al ,r �t.iA)i 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 e lth. Signed Date Application Approved by Date /,l Application Disapproved for the following reasons Permit No. 2cl Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of (Compliance THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed( )Repaired ( --) Upgraded( ) Abandoned( )by U at / 131,.clg/ •f q,, AA has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. ^;6 dated Installer Designer The issuance of this permit shall not be construed as a guarantee that the system will function as designed. Date C9 cy Inspector I No. � ----------'Fee �U THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLES MASSACHUSETTS Dt.5p0ar *pgtem Construction Permit Permission is hereby granted to Construct( /)Re}�air( ..-)<Pgrade( )Abandon( ) System located at��/�i-,,,�4 / /9.4 f 1e GtS��;I� and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction must be completed within three years of the date of this it. Date: �' � ��Approved b t s TOWN OF BARNSTABLE LOCATIONq/ / 4' SEWAGE # 1'- 0 VILLAGE/-jASk,,/,5 1-7.11 f ASSESSOR'S MAP & LOT t+j Q_ y 6 INSTALLER'S NAME & PHONE NO. A & B Qb= 775-6264 SEPTIC TANK CAPACITY /,00 l4A112,94 f LEACHING FACILITY:(type),:;Z (,�f( <_d�vc.tS—(size) NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNER HAl/ DATE PERMIT ISSUED: l - •� ' DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No ��,lt5e , 1/6/99 NOTICE: This Form Is To Be Used For the Repair Of Failed Septic Systems Only. - CERTIFICATION OF SKETCH AND APPLICATION FOR A DISPOSAL WORKS CONSTRUCTION PERMIT(WITHOUT DESIGNED PLANS) ( l4ll" A , hereby certify that the application for disposal works construction permit signed by me dated 1 /J- , concerning the property located at 9� (j/t 1;:'4 (,i4�` meets all of the following criteria: • The failed system is connected to a residential dwelling only. There are no commercial or business uses associated with the dwelling. • The soil is classified as CLASS I and the percolation rate is less than or equal to 5 minutes per inch. There are no wetlands within 100 feet of the proposed septic system ,/ • There are no private wells within 150 feet of the proposed septic system ✓• There is no increase in flow and/or change in use proposed There are no variances requested or needed. The bottom of the proposed leaching facility will not be located less than five feet above the maximum adjusted groundwater table elevation. [Adjust the groundwater table using the Frimptor method when applicable] • If the S.A.S.will be located with 250 feet of any vegetated wetlands, the bottom of the proposed leaching facility will not be located less than fourteen(14)feet above the maximum adjusted groundwater table elevation, Please complete the following: A) Top of Ground Surface Elevation(using GIS information) B) G.W.Elevation +the MAX.High G.W. Adjustment. DIFFERENCE BETWEEN A and B V SIGNED : 1, DATE: 9 [Sketch proposed plan of system on back]. q:health folder:cert I - c�fl ,F� . a ON MAA l�<<� LF GaT� Z � 33 N i O L O.0 A ; cl L ,� }� tJ j D•� Tc C £ f' ITI F?' 7rlA7 rP. E .FoUN,014rtCA, S J-'C. w T /,'aT JT ODES 040 FC� R .�: TC TfrE .7 OFfagr REOUIREMCA( rS OF s THE' 'r•dJ ail of- G�J RGE �Ln c, LOW,AL U -� N !C H LOW Y A Pf 0 41 T H, Af A SS. TOWN OF BARNSTABLE LOCATION-//',f � �' , 1 SEWAGE # VILLAGE/-/r'j f !-,- ASSESSOR'S MAP Sz LOT lij INSTALLER'S NAME & PHONE NO. A & B CANCO 775-6264 SEPTIC TANK CAPACITY Mo dwom LEACHING FACILITY:(type) ,��, �'.�� 'C1,c :.0 S (size)a�x l 'NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNER W-411 i. DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED; VARIANCE GRANTED: Yes No r AX , I �-� O � 32 IeAl- ' THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH I Appliratiun for lliupunal Works Tonntrnrttun ranfit Application, is hereby made for a Permit to Construct ( ) or Repair. ( ) an Individual Sewage Disposal System t• �/ . • .. Locati •, ddddre'ss. or NP W Owner Aj�ress lG ...� 1 U. ..... ---------•-- ....._... I /.. ._/CYx)r c.. ..............................••••... Installer Address // U Type of Building Size Lot to.Y#3.......Sq. feet Dwelling c—�No. of Bedrooms.........3.............................Expansion Attic ( ) Garbage Grinder �1 04 Other—T e of Building ... No. of persons............................ Showers X.) — Cafeteria 44 44 Other fixtures -------------- ---------------------------•--------- - .................................. W Design Flow................ ..................gallons per person per day. Total daily flow....... ®.__......................gallons. WSeptic Tank t Liquid capacity............gallons ength................ Width. ____......... Diameter................ Depth................ x Disposal Trench—No..................... Width__..._.. ...... Total Length....... ........ Total leaching area....................sq. ft. Seepage Pit No.../b' ....... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box (yC) Dosinnk ( ,) z aPercolation Test Results Performed by._. _ $_�.-_-�-�rl�'6?'��............. .!.S �.... Date...3�_��__'��------- Test Pit No. 1...... ..._minutes per inch Depth of Test Pit.................... Depth to ground water........................ 0�4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water---_.................... P4 -------------------------------------••---------....--••-------.....----......................••... O Description of Soil ® ) .. .. lds�c .. W ciS I��/yam //'�� r W ----------- •.....................7,2"... .J.. jgzzo.4s ........................................................................................................................................................................................................ .............•-----•-•------••-----•---..........__.._..---•--------•--.........._.........._..._..._............C_...._...------....--•---......_._.................................................... U Nature of Repairs or Alterations—Answer when applicable______________________......................................................................... -------•---------------------------•--•---•---------------•---•--••-----------•-------••---••••-------•---••-•--------------------------------•--•----------------........-------------•-•••......•---- Agreement: The undersigned agrees to install the aforedesc , ed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Sanitary Co e The unders' ned further agrees not to place the system in operation until a Certificate of Compliance has been i ued by t b d of hea A� Sign --• •-- •- --- ---� --- -•---- ----------------- --••---•----- ................. Date Application Approved By--- ....7eim -- ---•--- ---- -- . . . . ... . ............... -------y`---- ..... ° Date Application Disapproved for the following reasons:-------•------••-•-------------•-------•----•---------------•--------------............. ...................... .........--•---•...................•-•--•----------•---------......-----------•------•-----•--.....--------------------•....--------------------...----------------------------------------------------- Date PermitNo......................................................... Issued........................................................ Date . 4PW .... ................... r •`� THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH T Qw/U......... OF.......... .. ----------------------------- Appliratilan for Disposal Works Tomlrurffon Prrmit .`Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual, Sewage Disposal system t: 1 �.r --....... 1,r 4 •-•----... ...---•..............................t................... ..................................#_a? ...................................... Locati Address _; "` —� or Lot Owner � / Addr s W .............�I i =..... .. 1 Z�........---•----••--••-•--•........• --•---•-----. Installer Address ` Q Type of Buildir3g� Size Lot.�b.7:_`�_-..Sq. feet V Dwelling+'—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder Att') ►� a`4 Other—Type of Buildin ._..... No. of persons............................ Showers YP g;,,=-----------;------ P ( ) — Cafeteria ( ) Other,fixtures '.................................................................... ----------------------------------•--•---• ------ W Design Flow_ ....... ..................:.gallons per person per day. Total daily flow................. _ D..I......._.....gallons. , WSeptic Tan l Liquid capacity............gallons Length................ Width................ Diameter................. Depth__..._._____.._. x Disposal Trench—"No. .................... Width......--------- Total Length----�---------- Total leaching area....................sq. ft.- 3 Seepage Pit No--------------------- Diameter......................Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box.( ) Dosin tank' ) '-' Percolation Test Results- Performed b .�1�A1._�/_ _ .... Date___ -- _ -..... Test Pit No. 1.....`;--------minutes per inch Depth of Test Pit.................... Depth to ground water--_________-___----_-__. 44 Test Pit No. 2.............s :minutes per inch` Depth of Test Pit.................... Depth to ground water........................ Descnption f Soil . "' j i. ...._._.rbzst2l G- � -- `. - . .4A�i1 W U Nature of Repairs or Alterations—Answer when applicable.....................;_.__.............___............,.........................._.._......._.. -------------•---••--•----.._...----•------•----•-.._.........._....--•---........................... a............................................... Agreement: The undersigned agrees to install 7the aforedescribed Individual Sewage Disposal System in accordance with the provisions of T I T M 5 of the State,�San/beengl The undersigned furtl.er agrees not to place the system in operation until a Certificate of Com lia4e h by the boar healt s Signe Joe.................. "Date Application Approved By._".-•-• •-- Application Disapproved for the following reasons:........................•-•----•••----•••--•••-•---••--------•••-•••--•--•--------•-•-----... ....:...: ----•-----------------------------------------.-.....--•-------------------------•---•-----................_..........--•---------•--------•-•---••------------------------------------........ Date PermitNo......................................................... Issued-------•---•--------------....._...----•------•----.... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH O F... rdifirtt 1. THeal— C TIF That the Individual Sewage Disposal System constructed (` ) r Repaired ( ) b - ---------------•------ --- -- ------------•-------•--•---------- Y- 1 Installer has been installed in accordance with the provisions of >of The State am ary Code as described in the application..f6r Disposal.Works Construction Permit,N .__V-_- ................. dated_..... �. �---_ ---------- THE,;ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A G�ARANTEE THAT THE SYSTEM' WILL FUNCTION SATISFACTORY. DATE............ l '-----••--------------•---. Inspector _._ .......:... __....... . THE COMMONWEALTH OF MASSACHUSETTS79 Gry�/" �•� BOARD OF HEALTH ...�. .. ..............OF..... ... .. .......................... No..... `.....---.... �............... FED--:�'•�Y....... to CPermisslep,4e hereby grantett-. .--•-- •-- ........................... ...................................... o�c or Rep ' ( , ) n iv' 1 w eispos st t e '� 4 as shown on the application for Disposal Works Construction VtMIN .... ..... Dated/_ .. . .............................- // 0 0 - . DATE.._.:��..-.--.••---•- FORM 1255 HOBBS &.WARREN. INC.. PUBLISHERS .Y1 GENERAL NOTES: I. AIL CONSTRUCTION METHODS,MATERIALS AND 6. NO DETERMINATION HAS BEEN MADE AS TO INVERT ELEVATIONS: MAINTENANCE FOR THE SEPTIC SYSTEM SHALL COMPLIANCE WITH DEED RESTRICTIONS OR ZONING INVERT AT BUILDING 97.25 CONFORM TO TITLE S AND LOCAL REGULATIONS.IT SHALL REMAIN THE OWNER'S RESPONSIBILITY INVERT AT PROP.ADDITION 97.00 BOARD OF HEALTH REGULATIONS, TO OBTAIN ALL REQUIRED PERMITS,SPECIAL.PERMITS, INVERT IN AT SEPTIC TANK 96.88. 2.ALL SEPTIC SYSTEM COMPONENTS SUBJECT TO VARIANCES,ETC.FOR THIS PROJECT. VEHICLE LOADING(ie.UNDER DRIVEWAYS.ETC..) 7.IT SHALL REMAIN THE RESPONSIBILITY OF THE CONTRACTOR NOT INVERT OUT AT SEPTIC TANK 96.63 SHALL BE DESIGNED TO WITHSTAND H-20 LOADING. TO DISTURB ANY EXISTING STRUCTURES AND OR UTILITIES, INVERT IN AT DIST.BOX 96.53 3. ALL SEWER PIPES SMALL BE SCHEDULE 40 OR INVERT OUT AT DIST.BOX 9.6.36 APPROVED EQUAL INVERT IN AT SAS. 96.25' 4. BEFORE STARTING CONSTRUCTION CALL DIG SAFE 1-800-322-4844 FOR LOCATION OF UNDERGROUND BOTTOM OF S.A.S. UTILITIES. ADJUSTED GROUNDWATER 5: DATUM IS ASSUMED. OBSERVED GROUNDWATER _ INSTALL A GAS BAFFLE IN OUTLET TEE ACCESS COVERS MUST BE WITHIN 6° OF FINISH GRADE. FINISH GRADE 100.0 OVER S.A.S.EL.=97.5 (ASSUMED) =1 S=I% 9653 96.36 3' S=1% MAX. rxAymop, 97.25 WAXEI& S=1% 96.25s W"S�D STOP 96.63 4'MINIMUM SW-tvrMA C� LIQUID WASH STONE 7 DEPTH DIST. h BOX EXISTING S.A.S. 97.00 RELOCATE PROPOSED 96.88 1500 GAIdAN EXISTING CRAWL,SPACE SEPTIC TANK FOUNDATION (H-10) N 4305010811 E 125.09' LOT 32 * NOTE: 26,443± SQ. FT. EXISTING S.A.S MUST BE INSPECTED TO INSURE THAT IT IS IN GOOD WORKING CONDITION,AND EXISTING SEPTIC THE INVERT AT THE S A.S. K,TAN D-BOX,& rnl INLET MUST BE VERIFIED TO OLD LEACH PIT ri TO BE NO HIGHER THAN THIS TO BE REMOVED ASSUMED-INVERT ELEVATION. EXISTING DECK TO BE REMOVED W '-' 98 r+ o' BED PROPOSED o N 0 N ADDITION00 PROPOSED 98 1500gal. '�- TEAN�& ` o PROPOSED D-BOX(H-10) 44.8 ' 32.2±' EXISTING DWELLING p0 #91 LEGEND: 916 —98— EXISTING CONTOUR _[T81 PROPOSED CONTOUR S 41°3961 ' 125.00' 96 BRIDLE PATH SCALE 111_-30' 0' 30' 60' 90, OF ' ASSESSORS MAP 149 PARCEL 146 P U PLOT PLAN Ma[MQ. '� z SHOWING PROPOSED ADDITIONS .0, C & SEPTIC SYSTEM ALTERATIONS # 91 BRIDLE PATH BARNSTABLE, MA PROFESSIO SURVEYOR PROFESSIONAL EN INE (CIVIL.) Cam'LAND SURVEYING&PERMITTING INC. 18 ROUTE 6A,SANDWICH,MA ISO W� 1(, (508)-888-5955 canalsurvey@Verizon.net DATE` DATE Scale: l.'=30' Date:01/18/10 DWG:BRIDLE Drawn:P.D.R. Checked:R.J.H Job: 10-001 a..� , LOCUS ye 1ER .: • +4-- y t i, dr.F.I. REMOVE UNSUITABLE SOIL BENEATH AND WITHIN A S WIDE ZONE AROUND THE S.A.S.DOWN TO THE C SOIL STRATA AND REPLACE N 43050'08"E WITH CLEAN SAND PER THE REQUIREMENTS OF TITLE`. 12S.09' - LOT 32 +, 26,443-±- SQ. FT. An PROPOSED RESERVE S.A.S. AREA 32.0±' +� — - x ti PROPOkD 1500gah L—— —SEgfi� 9� TP 1 TP 2 TANK D-BOX EXISTING DECK O TO BE REMOVED EXISTING SEPTIC SYSTEM '+ W TO BE PUMPED N CLEAN AND REMOVED \ ° D PROPOSED �k ADDITION 00 98 PROPOSED DECK -- _ - -- - - - 0 N 44.8 32.2±' EXISTING 'BENCHMARK DWELLING TOP OF EXISTING ' 00 #91 FOUNDATION LEGEND: i EL. = 100.00(ASSUMED) EXISTING SEWER INVERT @ W EL.97.25 r-- 9$ —98— EXISTING O —'--�`� CONTOUR W it N ap� 97x8 EXISTING SPOT GRADE 41°3 ' ,� . re S 1 1 / I 961 125.00' a 6 - ------ - - 9 ---------i-------- EDGE OF 96�" VEMENT BRIDLE PATH - SCALE 1"=30' 0' 30' 60' 90' ASSESSORS" 149 PARCEL 146 o� ft°G SITE PLAN nn " ' SHOWING PROPOSED ADDITIONS V & SEPTIC SYSTEM REPAIR DESIGN VOL e # 91 BRIDLE PATH BARNSTABLE, MA CANAL LAND SURVEYING&PERMITTING INC. PROFS IO AL LAND SUR VEYOR PROF ,SSIO AL ENG ER(CI� 306 OLD PLYMOUTH ROAD,SAGAMORE BEACH,MA , NAn Y 0 (508)-888-5955 canatsurvey@veriwn.net DATE DATE Scale: 1"=30' note:oxmtio rev;-a 3n9no DN'VG:BRIDLE Drawn:P.D.R. Checked:R.J.H Job: 10-001 SHEET 1 of 2 PROPOSED 4"DIA.PVC PERFOTED PIPE, ALL ACCESS COVERS MUST BE INSPECTION PORT W/ 31 WITHIN G" OF FINISH GRADE. SCREW CAP.SET WITHIN MlN.2U"IJIA. MIN.8"DIA. MIN.20"DIA. MINIMUM OF 9" OF EARTH COVER 3"OF FINAT,GRADE. CONC RISER CONc RISER CONC RISER FINISH GRADE 100.0 COVER AND COVER, AND COVER OVER ALL SEPTIC SYSTEM COMPONENTS. OVER S.A.S. EL. = 97.8 (ASSUMED) .=2 95.74 °aN�RMER 31 @ ;~ MAX. 95.57 co EXIST. � ; .' S=Zq g MAX 2°LAYER OF , DWELLING , r,, 97.25 _ ° 1/8"-11T DIAL 10" - ,� S=2% wAsxEDE STONE R14 96.20 95.37 4'MINIMUM 3/4"-1 1/2"nIA LIQUID 12"MIN.INSIDE DOUBLE Z WASHED STONE DEPTH CONCRETE DIMENSION ANDA 93.37 L�'. `ti•1 rw l... 47t;lif W. :,u .'��' DIST. BOX MIN.6"SUNUP. ° 93.37 96.81 ( H- 10 ) PROPOSED INSTALL A GAS BAFFLE PROPOSED S.A.S. Y; PROPOSED1500 GALLON IN OUTLET TEE. TWO SOOgaI. CONC. LEACHING STRUCTURES CRAWL-SPACE CONC. SEPTIC TANK �SEPARATION BETWEEN INLET AND OUTLET (H- 10 ) ! 87•SO FOUNDATION (H- 10) TEES(NO LESS THAN LIQUID DEPTH). SOIL LOG SOIL LOG soz-roMOF TEST PIT DATE: MARCH 19, 2010 DATE: MARCH 19, 2010 SOIL EVALUATOR: HARRY LANTERY PE SOIL EVALUATOR: HARRY IANTERY PE WITNESS: HAD STAON WfMESS: �A1IDN STNTON GENERAL NOTES: DESIGN CRITERIA: TP 1 7HOEPrH DEPTH TP 2 I. ALL CONSTRUCTION METHODS,MATERIALS AND DESIGN FLAW: INVERT ELEVATIONS: 97•s0 0' 0' 97.ao MAINTENANCE FOR THE SEPTIC SYSTEM SHALL 3 BEDROOM DWEI I ING @ 110 GAL/DAY PER BEDROOM LAW CONFORM TO TITLE S AND LOCAL EQUALS 330 GALS.PER DAY: (NO GARBAGE GRINDER) INVERT AT BUILDING 97,25 1 O1'R 4/2 FOR 4 BOARD OF HEALTH REGULATIONS. SEPTIC TANK 97.13 g' 10' 96.97 REQUIRED: 330 x 2.0=660 INVERT AT PROP.ADDITION 96�81 @ g 2. ALL SEPTIC SYSTEM COMPONENTS SUBJECT TO SEPTIC TANK PROVIDED:1900 gaL(pROPOSED) INVERT IN AT SEPTIC TANK 96.45 VEHICLE LOADING(Le UNDER DRIVEWAYS.FTC.) SIZE OF LEACHING FACIITI Y REQLnRPD INVI3RT OUT AT SEPTIC TANK 96_?A LOAMY g�0 '0 R 6/4 AND SHALL BE DESIGNED TO WITHSTAND H-20 LOADING. DESIGN PERC RATE<SCIL T 3• ALL SEWER PIPES SHALL BE SCHEDULE 40 OR 330 er da INVERT IN AT DIST.BOX 95.74 P Y INVERT OUT AT DIST.BOX 95.57 APPROVED EQUAL SIZE OF LEACHING FACILITY PROVIDED: 93.80 � � 93�.R6C3 4. BEFORE STARTING CONSTRUCTION CALL DIG SAFE TWO 50bga1 CAPACITY CONCRETE STRUCTURES w/4'OF STONE INVERT IN At SA.S. 9$.37 ¢PERC 1-800-322-4844 FOR LOCATION OF UNDERGROUND SIDEWAL L 152sf.x 0.74=112 G.P.D. UTILITIES BOTTOM 325sf,x 0.74=240 G.P.D. BOTTOM OF S.A.S. 93.37 Ml/ NES M�W/FlNES 5. DATUM IS ASSUMED, TOTAL 477sf,x 0.74=352 G.P.D. i ADJUSTED GROUNDWATER N/A sR GRVL SR GRVL 2.SY 5/4 2.SY S/4 6. NO DETERMINATION HAS BEEN MADE AS TO ONE ACCESS MANHOLE PER OBSERVED GROUNDWATER COMPLIANCE WITH DEED RESTRICTIONS OR ZONING N/A 87.80 120' 120 87.80 REGULATIONS.IT SHALL REMAIN THE OWNER'S RESPONSIBILITY LEACHING STRUCTURE PERC RATE <8 MIN IN. (C" HORIZON) TO OBTAIN ALL REQLT RED PERMITS,SPECIAL.,PERMITS REQUIRED. REMOVE UNSUITABLE SOIL BENN ATH.AND WITHII3A S WIDE ZONE NO GROUNDWATER ENCOUNTERED VARIANCES,ETC.FOR THIS PROJECT. AROUND THE S.A.S.DOWN TO THE C SOIL SfRATAAND REFI.AG'E 24 GALLONS DRAINED IN 8+ MINUTES 35l WITH CLEAN SAND PER THE REQU OF TITLE 5,110 CMR 15255(3) CONTRACTOR NOT 7.TT SHALL REMAIN THE RESPONSIBILITY OF THE r8 TO DISTURB ANY EXISTING STRUCTURES AND OR UTILITIES. 8.THE ENTIRE LOCUS IS LOCATED IN ZONING DISTRICT"RF% X25'X: SITE PLAN 9.THE ENTIRE LOCUS TS LOCATED IN GROUNDWATER OVERLAY R°�ER . PAtJ1,PROTECTION DISTRICT"GP". : + MBCHN{E6'yOCZ 10.AIL SEPTIC SYSTEM COMPONENTS SHALL BE INSTALLED ' N0.30420 SHOWING PROPOSED ADDITIONS ONA STABLE COMPACIED BASE ,;;.�,, w IL & SEPTIC SYSTEM REPAIR DESIGN TH >: �,_____ BARNSTABLE,A PROPOSED MA ' :•�: .` .. �'� _ �„-�, D-BOX CANAL LAND SURVEYING&PERMITTING INC. PRONESSfONAL ENGI. ER(CIVIL) 306 OLD PLYMOUTH ROAD,SAGAMORE BEACH,MA x X- A sgmk (508)-888-5955 canalsurvey@verizon.net PROPOSED S.A.S. DATE Scale: 1"=30' Date,03/24/10revised3/29/lo DWG: BRIDLE (NOT TO SCALE) Drawn:P.D.R. Checked:R.J.H Job: 10-001 SHEET 2 of 2 - .. — r i I ' -r- -- - - -- - i ----- - ---- j 1 P,-,- TLrlr c_ i. f oNT. � PTiG?t 1 - E1J'QDDiTION = t� wl ADDIT101.1 t f j 1 • 1114. got IF I- AD tronf ` { �Fb Atg>-cn Ql�LS_Lam �,..l=�(A Ur- MA . A cin4.a�b�_ �FAN�P�c]�rMMNL.�r#1 t tJ►i�-o hO — - �U - l - FA 00 f -- --. -` I .L<Z � .PATH t — — — AZ 115 ,MA STCa1J D l , i - ��x OL �4 �s..0�tuN.c3 Wk�i--s.. Icy �Cz�,bn-lit-�kR 2N — — - Zo o -r - -emu yFRIrY -- — j� D 7 ELT w E IST. . i L—1 LU — . 7.1 Y caL>=s r � t' EL-1bT ' o IN -SPAWN -7 ��.::' �/✓P�l�fc. 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