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HomeMy WebLinkAbout0189 CAMMETT WAY - Health 189 CAMMETT WAY, MARSTON MILLS A =J0a nor COMMONWEALTH OF MASSACHUSETTS isi Z43(0 EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS . DEPARTMENT OF ENVIRONMENTAL R-OTECT-I© RECEIVED SEP 15 2004 l i TOWN OF BARNSTABLE HEALTH DEPT. TITLE 5 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 189 Cammett Way ®O Marstons Mills Owner's Name: William Robertson Owner's Address: Date of Inspection Name of Inspector:(please print) William _ •Robinson Sr. Company Name: William E. Robinson Septic Service Mailing Address: P O Box 1089 Centerville, MA Telephone Number: _t5081 775-8776 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 Se ion 15.340 of Title 5(310 CMR 15.000). The system: Passes Conditionally Passes Needs Further Evaluation by the Local Approving Authority Fails Inspector's Signature: 4L Date: The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Heattlt'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 Qte DEP.The original should be sent to the system owner and copies.sent to the buyer,if applicable,and the approving authority. Notes and Comments "This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. Title 5 Inspection Form 6/15/2000 page 1 i Page 2 of 11 i OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued). PropertyAddrls: 189 Cammett Way j Marstons Mills Owner. William Robertson Date or lnspecti'nt Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D j i A. Syst Passes: I 1 have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 3101 CMR 15.304 exist.Any failure criteria not evaluated are indicated below. j Comments: I i i i I B. System Conditionally Passes: One or more system components as described in the"Conditional Pass"section need to be replaced or rep fired.The system,upon completion of the replacement or repair,as approved by the Board of Health,will pass. II Ans er yes,no or not determined(Y,N,ND)in the for the following statements.If"not determined"please exp) The septic tank is metal and over 20 years old*or the septic tank(whether metal or not)is structurally unso d,exhibits substantial infiltration or exfiltration or tank failure is imminent_System will pass inspection if the exist g tank is replaced with a complying septic tank as approved by the Board of Health. •A m tal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance indica ing that;the tank is less than 20 years old is available. ND ex lain: Observation of sewage backup or break out or high static water level in the distribution box due to-broken or obstru ed pipe(s)or due to a broken,settled or uneven distribution box.System will pass inspection if(with appro al of Board of Health): broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced ND xplain: l The system required pumping more than 4 tunes a year date to broken or obsuwcd pipe(s).The system will p s ins ection if with approval of the P i ( pp Board of Health): j broken pipe(s)are replaced w obstruction is=moved q .I ND exp in.� j I� I i I I j Page 3 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SU BSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 189 Cammett Way Marstons Mills Owner: William Robertson Date of Inspection: . C. Further E luation is Required by the Board of Health: Condition exist which require further evaluation by the Board of Health in order to determine if the system is failing to protec public health,safety or the environment. 1. System wil pass unless Board of Health determines in accordance with 310 CMR 15.303(l)(b)that the system is n t functioning in a manner which will protect public health,safety.and the environment: — Cesspo I or privy is within 50 feet of a surface water _ Cesspo I or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2. System will fa unless the Board of Health(and Public Water Supplier,if any)determines that the system is funclioni g in a manner that protects the public health,safety and environment: _ The syste has a septic tank and soil absorption system(SAS)and the SAS is within.100 feet of a surface water s ply or tributary to a surface water supply. — The syste has a septic.tank and SAS and the SAS is within a Zone i of a public water supply. _ The syste has aseptic tank and SAS and the SAS is within 50 feet of a private water supply.well. The syst has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more frortl a private water upply well" Method used to determine distance "This syst in passes if the well water analysis,performed at a DEP certified laboratory, for coliform bacteria volatile organic compounds indicates that the well is free from pollution from that facility and the prese ce of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure c iteria are triggered.A copy of the analysis must be attached to this form. 3. Other: 3 4 Page 4 of I I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) JI Property Add ress:189 Cammett Way Marstons Mills Owner: WilliaT Robertson Date of Inspection: i D. System Failure iteria applicable to all systems: You must indicate"y '.or"no"to each of the following for all inspections: Yes No Backup of se age into facility or system component due to overloaded or clogged SAS or cesspool Discharge or onding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS r cesspool _ Static liquid I vel in the distribution box above.outlet invert due to an overloaded or clogged SAS or cesspool - _ Liquid depth. cesspool is less than 6"below invert or available volume is less than day flow Required purr ing more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number of times purr d _ Any portion o the SAS,cesspool or privy is below high ground water elevation. portion o cesspool or privy is within I00.feet of a surface water supply or tributary to a surface water supply Any portion f a cesspool or,privy is within a Zone 1 of a public well. .Any portion f a cesspool or privy is within 50 feet of a private water supply well. Any port* of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply wet with no acceptable water quality analysis. (This system passes if the well water analysis, performe 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 nitroge and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria ire tri ered.A copy of the analysis must be attached to this form.] (Yes/No) he system fails.I have determined that one or more of the above failure criteria exist as des ibed in 310 CMR 15.303,therefore the system fails.The system owner should contact the Board of Ith to determine what will be necessary to correct the failure. E. Large S stems: To be consid ed a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. You must iodic to either"yes"or"no"to each of the following: (71e following riteria apply to large systems in addition to the criteria above) I yes no I the sy ern is within 400 feet of a surface drinking water supply the sys cm is within 200 feet of a tributary to a surface drinking water supply _ the sys in is located in a nitrogen sensitive area(Interim Wellhead Protection Area—IWPA)or a mapped Zone 1 of a public water supply well If you have ans ered"yes"to any question in Section E the system is camsidered a significant threat,or answered "yes"in Sectio D above the large system has failed.The owner or operator of any large system considered a significant thre t under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304.The s stem owner should contact the appropriate regional office of the Department. 4 Page 5 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: - 1 89- Cammett Way Marstons Mills Owner: William gobertson Date of Inspection: ^� v 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 out in the previous two weeks? Has the system received normal flows in the previous two week period? ,/Have large volumes of water been introduced to the system recently or as part of this inspection?:. c/` Were as built plans of the system obtained and examined?(If they were not available note as N/A) Was the facility or dwelling inspected for signs of sewage back up? Was the site inspected for signs of break out? v _ 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? _ v Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: Yes ..no Existing information.For example,a plan at the Board of Health. Determined in the field(if any of the failure criteria related to Part Cis at issue approximation of distance.. is unacceptable)[310 CMR 15.302(3)(b)J 5 t Page 6 of 1 l � y OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 189 Cammett Way Marstons Mills Owner: William Robertson Date of Inspection: FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design):,3 Number of bedrooms(actual):y� DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): . a_g:� Number of current residents:� Does residence have a garbagej der(yes or no): Is laundry onla separate sewage system(Yes or no [if yes separate inspection required] Laundry system inspected(yes or no):&� Seasonal use:(yes or no): � Water meter readings,if available(last 2 years usage(gpd)): 2003 — 47 000 Sump pump(yes or no):,&k 2002 - 54, 000 Last date of occupancy: COMMERCIIsd ND STRIAL Type of establint: Design flowl(bon 310 CMR 15.203): gpd Basis of design (seats/persons/sgft,etc.): Grease trap pre (yes or no):Industrial wastding tank present(yes or no): Non-sanitary w discharged to the Title 5 system(yes or no):Water meter regs,if available: Last date oIocncy/use: OTHER(d'escribe): `I GENERAL INFORMATION Pumping Records Source of information: 4 y---0 v/ Was system pumped as part of the inspection(yes or no): If yes,volume pumped a alions--How was quantity pumped determined? K Reason for pumping: TY OF'SYSTEM STEM Septic!tank,distribution box,soil absorption system _Single cesspool _Overflow cesspool _Privy I _Shared system(yes or no)(if yes,attach previous inspection records,if any) _lnnoyative/Alternative technology.Attach a copy of the current operation and maintenance contract(to be obtained from system owner) _Ti&II tank Attach a copy of the DEP approval I • _Other(describe): Approximate age of all components,date installed if kn wn)and source of information: Were se I age odors detected when arriving at the site(yes or no):ko I l 6 i i Page 7 of OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address:189 Cammett Way Marstons Mills Owner: William Robertson Date of Inspection: BUILDING SEWS (locate on site plan) Depth below grade: Materials of cons lion:_cast iron _40 PVC other(explain): Distance from pri to water supply well or suction line: Comments(on c ndition ofjoi nts,venting,evidence of leakage,etc.): SEPTIC TANK: ''� I ca _(o to on site plan) ya Depth below grade: Material of construction: `✓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) t V Dimensions: Sludge depth: Distance from top of sludge to bottom of outlet tee or baffle: _ Scum thickness: Distance from top of scum ito top of outlet tee or baffle:_ (� / Distance from bottom of scum to bottom of outlet tee or baffle: j How were dimensions determined: Comments(on pumping recommendations,inlet and outlet tee or baffle conditicn,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): s � . GREASE P:_(locate on site plan) Depth belo grade: Material of onstruction:_concrete metal fiberglass_polyethylene other (explain): Dimension Scum thic ess: Distance fr m top of scum to top of outlet tee or baffle: Distance fr m bottom of scum to bottom of outlet tee or baffle: Date of]as pumping: Comments(on pumping recontmendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): 7 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: 1,89 Cammett -Way Marstons Mills Owner: Wi 1 1i am Robertson Date of lnspectlon: I TIGHT or HOLDING TAN (tank must be pumped at time of inspection)(locate on site plan) Depth below grade: Material of constructiin: concrete metal fiberglass_polyethylene other(explain). Dimensions: Capacity. I allons Design Flow: allons/day Alarm present s or!no): Alarm level: Alarm in working order(yes or no): Date of la;t?mp gCommenndition�of alarm and float switches,etc.): i i DISTRIBUTION BOX: (if present must be opened)(locate on site plan) Depth of liquid level above outlet invert 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.): O PUMP CHA111BE1t: (locate on site plan) I Pumps in working od (yes or no): Alarms in working o er(yes or no): Comments(note c 4 dition of pump chamber,condition of pumps and appurtenances,etc.): i 8 i Page 9 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 189 Cammett Way Marstons Mills Owner: William Robertson Date of Inspection: SOIL ABSORPTION SYSTEM(SAS):Zoocate on site plan,excavation'not required) If SAS not located explain why: Type aching pits,number:_ leaching chambers,number: 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.): CESSPOOLS: ce( spool mu a pumped as part of tnspection)(locate on site plan) Number and configuration: Depth—top of liquid to inl invert: Depth of solids layer: Depth of scum layer: Dimensions of cess ol: Materials of cons ction: Indication of undwater inflow(yes or no): Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): PRIVY: (locate on site pl ) Materials of construction: Dimensions: Depth of solids: Comments(note condition f soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): 9 Page 10 of 1 l OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address:. 189 Cammett Way Marstons Mills Owner: William Robertson Date of Inspection: rf/4/ L' 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. i n '31 10 Page 11 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 189 Cammett Way Marstons Mills Owner. William Robertson Date of Inspection: SITE EXAM Slope Surface water Check cellar. Shallow wells Oe. Estimated depth to ground water 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) Accessed USGS database-explain: You must describe how you established the high ground water elevation: oi��S 62 11 TOWN OF BARNSTABLE . `LOCATION ,'• 4Z SEWAGE # VILLAGE .l,7YI>Z,i 61 ASSESSOR'S MAP & LOT/Aa—0&7 INSTALLER'S NAME&PHONE NO. ��'l—O'3 Y� •t/os� �e SEPTIC TANK CAPACITY 000 LEACHING FACILITY: (type) —450-0 6*1 a4e � �� (size) NO. OF BEDROOMS S BUILDER OR OWNER �%7 PERMIT DATE: "�� COMPLIANCE DATE: ���� � Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist 4 within 300 feet of leaching faccili�) Feet Furnished by ;f s {` f � 0 No. Fee / THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: V Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS ZIppYication for Mgogal *pgtem Congtruction Permit Application for a Pen-nit to Construct(e,-Yfepair( )Upgrade( )Abandon( ) O Complete System O Individual Components Location Address or Lot No. �g�f�,C�MII�LG �(//�� Owner's Name,Address and Tel.No. Assessor's Map/Parcel Installer's Name,Address,and Tel. Designer's Name,Address and Tel.No. c%s ,�� D� ��os / ✓�s�✓�L a,l��rNos Type of Building: Dwelling No.of Bedrooms Lot Size sq. ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank / Type of S.A.S. Description of Soil R i Nature of Repairs or Al rations(Answer when applicable) /i I1 15X 45,rl lC/ 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 is ued by this Board o Heal Signed ADate 9 r h'- Application Approved by ® Date Application Disapproved for the following reasons Permit N J Date Issued Y/6,17 :1 • 6 ��r �' �� '- .x� � �. "�� +�t /fir '�. f. No. Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: ` Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS 01ppYicatton for Migpogar *pgtem Congtruction Permit Application for a Permit to Construct(4ij1tepair( )Upgrade( )Abandon( ) El Complete System ❑Individual Components Location Address or Lot No. 189'C*AYW er (��� Owner's Name,Address and Tel.No. Assessor's Map/Parcel Ida oG "f $ ,s ,/ Installer's Name,Address,and Tel. - 9 Designer's Name,Address and Tel.No. Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) f"i/� kl,S'T C'f 5��i�c��4 L�//r4 !; / 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 is ued'by this oar d o Heal h. Signed r (-) Date Application Approved by n / /j'V Date Application Disapproved for the following reasons Permit No.lfl U Date Issued ——————————————————————————— - —J————————— THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of (Compliance THIS IS TO CERTIFY that the On-site Sewage Disposal System Constructed( c-).Repaired ( )Upgraded( ) Abandoned( )by .A at / 9? O b n constructed in accordance with the provisions of Title 5 and the for Disposal 6stem Construction Permit N . dated Installer Designer %/ The issuance of this�pe mi Wall not be construed as a guarantee that the s/ste will function,,as,designed0 / Date Inspector /V/// .. ., _i ii R �tA�f.10"'I CJf Ida 067 No. 530 THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS Migpogal *pgtem Congtruction Permit Permission is hereby granted to Construct( air( )Up rade( )Abandon( ) System located at /b F L,.I�s�Js�r�_.e � /2Y !'l9.rmaS 7embi S ly9i��C 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 b co leted within three years of the date oft ' s e t. Date: / IIq If Approved by � -..-,._fiyx4' SV` 32'T. s„• 3. rr-- z•.•.,-`�' ate"'"` At, �+r $• w,a+.,r� .s _ 'f ^- `°3U ...F. $'� � --"s"• `ar.";y' '..M,-' ,,... .'���'^f` RIS 3. •r 4 : TOWN OFBARNSTABLE LOCATION IF SEWAGE # VILLAGE__ 6�i��rsTo�5' !�li9i//s' ASSESSOR'S MAP&LOT i�L 7 INSTALLER S NAME&PHONE SEPTIC TANK-CAPACITY: /S0o LEACHING FACILITY: (type) (size) NO.OF BEDROOMS BUILDER OR OWNER r n PERMITDATE: $ 91 q COMPLIANCE DATE:_ Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet • Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching_facility) Feet Edge of Wetland and Leaching.Facility(If any wetlands exist within 300 feet of leaching facili ) Feet Fiuiii shed' by.. r_:�i � y .. ,r f a 0/y rL . _ r Zy ,3 •sue•-�++�•.:+w ,�: ac r4 s•..e- A.�..,.,,w.`G# •t -��".� "' ``, � s. 7` - L 4._ wc- � -N Fx `ic,��r� .,��.,.' �•�°s,••.,,,,:�-'^�..--" s..,;P',�.-.-v,.r.°�,.,•=�`-yr'�?' .;.."..*"T.-� `�`�'.��c� - .'�..,ts`�,a' �.c.z'''�-�''��""�'�`c��>�_.���� �? +K -x s h...,i: w."``�.'-�>..`_k`Y-�,-�",. � 116/99 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 UC ON PERMIT (WITHOUT DESIGNED PLAINS) I, �h,S �i /3�h�oS hereby certify that the application for disposal works construction permit signed by me dated concerning the property located at /3f ��� �� f� `�i!/ 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. G•�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 (/�e no variances requested or needed. ��Tl�e bottom of the proposed leaching facility will not be located less than five feet above the ma:,dmum 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 SIGNED : ��`Z��?/L, v���-c `.¢ DATE.- (Sketch proposed plan of system on back]. q:health folder:cert 1 1 .......... ............................ c r 0051 e TOWN OF BARNSTABLE LOCATION F R 4 SEWAGE # k9Z VILLAGE ASSESSOR'S MAP&LOT INSTALLER'S NAME.&PHONE NO. ���{ CoK SEPTIC TANK CAPACITY LEACHING FACIL=:.(type) T �� ` �'°` ©T S (size) NO.OF BEDROOMS J BUILDER OR OWNER ` OLIP r,C PERMITDATE: COMPLIANCE DATE: 44'd°' 3 Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Privaie Water Supply Well and Leaching Facility (If any wells exist --�on site or within 200 feet of leaching facility) Feet Edge o�Wetland and Leaching Facility(If any wetlands exist within 300 feet of le ching facility) Feet Furnished by 7 -74;7'!07'�� 2,340 (r�rD 33' o cc w L ��• JJJ c� NO. ��� FEE v THE COMMONWEALTH OF MASSACHUSETTS `,a>PF--NSA LamE MASSACHUSETTS �Npyfirativn for (fanstrurtion ]Jermit Application is hereby made for a Permit to Construct( Kor Repair( )an On-site Sewage Disposal System at: Location Address or Lot No. O Owner's Name,Address and Tel.No. ge- 2- 5 C lof-m r4 e,Ti Installer's Name,Address,and Tel.NV Designer's Name,Address and Tel.No. c��R-'alp�"1 COI�i S`�'(Lt���01� l tJC.. FLA-Ff c-dzT�i /�`-FRS✓/aC-�� -�+.�'� ��•tC"� -7 C0>7 `jr9-�05C i '5 N I O'7�Co G o cr t�2 3(v 0 ~Z Type of Building: 771 Dwelling No. of Bedrooms Garbage Grinder( ) Other Type of Building No. per Persons Showers( ) Cafeteria( ) Other Fixtures Design Flowd gallons per day. Calculated daily flow -3 --3 ® gallons. Plan Date / CrIp Number of sheets Revision Date Title Description of Soil -'"� CF fps o� ti . U f/� Nature of Repairs or Alterations(Answer when applicabl ,IVIL t. . nI 9 0 TEP Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the aforedescribed on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance ha be issued y t oar of alth. Signed Date Application Approved by �— Date Application Disapproved for the following reasons Permit No. Date Issued ' No. Z ` FEE I � THE COMMONWEALTH OF MASSACHUSETTS pr(z S;Tpr 3 L MASSACHUSETTS c kyy ration for Tonott-urtiort jhrmit Application is hereby made for a Permit to Construct ( Xor Repair( )an On-site Sewage Disposal System at: Location Address or Lot No. Owner's Name,Address and Tel.No. P�oX �s 3 csZCoVe/-�-r►'�i✓t ��I T (� ,�5 Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. C'60 SVZ- C;n 00 l ► c., FC-04 5;7rF/9x//444-A444e-*ie­A✓, tit i O'ZCa Lq0 G o rJ , f Z 36 0 7 -2 '7 7 r — q Vy Type of Building: Dwelling No. of Bedrooms Garbage Grinder( ) i Other Type of Building No. per Persons Showers( ) Cafeteria( # ) Other Fixtures k Design Flow ­t> L� 1> gallons per day. Calculated daily flow -3 3 © gallons. Plan Date 2'/Z Z IC�CO Number of sheets / Revision Date Title O! ty Description of Soil ts i o � o BRACKEN, CIVIL Nature of Repairs or Alterations(Answer when applicabl Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the aforedescribed on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance hambeen issued by hoar of ,alth. Signed '' - Date Application Approved by - Date Application Disapproved for the following reasons _a r Permit No. Date Issued I THE CO MMO EALTH OF MASSACHUSETTS ASSACHUSETTS (JCTPrtifiratr of Compliance THIS IS TO CERTIFY, that the On-site Sewage Disposal System installed'(•) or repaired/replaced( ) on by for at 1 q c?nn n, , M, M((( S w` has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. 9 to 7 Z dated Use of this system is conditioned on compliance with the provisions set forth below: v. The issuance of this certificate shall not be construed as a guarantee t a the system will function as designed. This Certificate expires one `JfJ DATE �� Inspec THE COMMONWEALTH OF MASSACHUSETTS No. ! , MASSACHUSETTS FEE ,Disposal 01ligstPm CZonstrur#ton jJPrmtt � APermission is hereby granted to to construct ( ) or repair( )an On-site Sewage System located at 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. = All constructio mus compl wit inthree years of the date bel%b _,`­ FORM . DATE '�'� � Approved 1255 Rev.3/95 A.M.SULKIN CO.-BOSTON,MA .1 y� f PLAN : / LOCUS PLAN . SCALE 1„=30� N TP N0. 1 TP NO. 2 .� / GRD. EL. 99.0 GRD. EL. 99.0 �,�" Q u e� ° / GW. EL. All 0 0 NONE cw. EL. NONE e o p -,.q, E 2 1 LOT 42 -a• � a'� ~ '� 00 �� / O/A O/A m� 1 0 LOAMY SAND LOAMY SAND LOT 120-2 5 �.�` / 1 .o� ia�� {�•. ate, r�l �' ,p,, W E 10 YR 3/1 ., 10 YR 3/1 3 / SS 9 9 N�\ `s ars36ns = 1 .p / yob B B C l� LOAMY SAND LOAMY SAND a Z� q T- ---=-= So1L ' � I C ' - - 10 YR 7/6 10 YR 7/6 �_ ;o « �, °` • ? I _ J OJT A �0.. ) t" n _ o ���/ If COARSE SAND COARSE SAND °';= ��, LO�141-2 20-30% 30%+ %' cam- °' n GRAVEL GRAVEL " 4�560 S.i . °• / 0' ZONING REQUIREMENTS 5 101 ZONE: . RE 12' a10 12, R?,o SIDE 15' 0 / -1°. 5�P rc.__TA n�_K,__.__�___ AREA 43,560 S.F o / _� N o w A T>✓,Z. N b v�/A-t R REAR : 15' �_ �3vy 14 µhp FRONT . 30 DATE: 2/20/96 N / / °• 9 SOIL EVALUATOR: D. BRACKEN CERT# IOIx O 97 /� Qoco� 2 x --cI-IIMwE`{_- PERC. RATE: < 2 MIN INCH // o x._ SOIL TEXTURAL CLASS: I • WITNESSED BY: ED BARRY NOTES. N& ` / / / gyp• 6 INVERT PRIMARY: ' O INVERT RESERVE: 9�'7D 1. BENCHMARK TOP.;OF CONCRETE BOUND PO BOTTOM PRIMARY: ¢ D V BOTTOM RESERVE: 9 ¢ 7 ELEVATION 100.00 tx MAX. GROUND WATER E:LEV.= 27 P SToa ' METHOD OF DETERMINATION: 06,6 S. 6140,A-0 WAM4� ' A-c LE 2. ,METHODS AND MATERIALS TO CONFORM TO TILTE p �6 FUTURE \ , ,► M 3/93 V AND THE TOWN OF BARNSTABLE GARAGE J BOARD OF HEALTH REGULATIONS. LOT 41-1 �o I p�• DESIGN CALCULATIONS: 4 / � 3. WASHED STONE TO"BE FREE OF ALL DUST AND FINES. �o GP 4. NO FIELD MODIFICATION TO THE SYSTEM SHALL BE MADE z J o SOIL TEXTURAL CLASS: I � � /WITHOUT PRIOR WRITTEN'APPROVAL OF THE ENGINEER 97.5 PERC. RATE. LESS THAN 2 MIN./INCH AND BOARD OF HEALTH. NO. OF BEDROOMS: _- AT 110 GAL/DAY/B.R. 5• ALL JOINTS TO BE WATERTIGHT. BENCHMARK gg TOP OF CONC. BOUND DESIGN FLOW REQUIRED: 330, GPD r ELEV.=100.00 SEPTIC TANK SITE: 1500 .GALLONS- . O -,GARBA_G E_.ORINDER) 6. THE CONTRACTOR SHALL BE RESPONSIBLE FOR VERIFYING (AS5UMED) LEACHING PROVIDED: THE ACTUAL LOCATION OF ANY EXISTING-UTILITIES"' x of 10' WIDE X 30— LONG X 2' DEEP INFILTRATOR SYST. BOTTOM AREA= 3�00 S.F, 7. A CERTIFICATE OF COMPLIANCE MUST BE OBTAINED .PRIOR Za BRAACK L�F. yG� �3.�9 �8 SIDEWALL AREA= 160 S.F. TO BACKFILLING SYSTEM. EN,JR. LOADING RATE =, 0.74 GPD SF CIVIL- C. 5/ TOTAL= 460 S.F. / 8. OWNER APPLICANT No.37071 q �o Q GOMES REALTY TRUST CHAMPION BUILDERS 340 GPD P.O. BOX 553 300 OAK ST., #155 " Nb•1Y5 : L eoc_05 14� N1 >T- WIT41N Zon1G 11 A MARSTONS MILLS, MA. PEMBROKE, MA. W3/4" TO 1 1/2" 9• PROPERTY LINE INFORMATION TAKEN FROM: G 0 15' MIN. WASHED STONE jN OF Mass FINISH MIN. 2% FINSHED GRADE PLAN BK. 487• PG. 9 GRADE � 2" — 1/8" TO 1/2" 3 WASHED STONE 10. CONTRACTOR SHALL NOTIFY ENGINEER IMMEDIATELY V NI 1 36" MAX. COVER 12" MIN. IF SOIL OR SITE CONDITIONS DIFFER FROM THOSE .219 - - - - - - - SHOWN. 0"rssio"P_ MINIMUM OF 1 ACCESS PROFILE SURVE ,gam `� 15" 11. THE DESIGN IS INTENDED TO MEET THE TITLE V Np � K 1✓" 2'DEPTH INFILTRATORS 9» PORT AT TOP OF SYSTEM AND OTHER APPLICABLE REQUIREMENTS. THE o O 1�_3" PREPARATION OF THIS PLAN DOES NOT GUARANTEE NOT To SCALE 20 MIN. THAT THE SYSTEM WILL BE INSTALLED AS DESIGNED, ' 34"10' MIN. NOR DOES THIS PLAN GUARENTEE THE OPERATION —EXISTING GROUND 43" OF THE SYSTEM. 10' T.O.F.= 101.0 S FLAHERTY, STEFANI & BRACKEN, INC. 20" ACCESS MANHOLE AS CROSS—SECTION`OSS—SECTION ,o MIN, (TyP•) NOT To SCALE 67 SAM OSET STREET ? FINISH GRADE = Ivc� , 3 - PLYMOUTH, MA 02360 d 36" MAX. CONC. g"MqX » L' fl p� S _j (508) 747-2425 COVER RISER COVER 36 MAX. _ 4" SCH.40 P.V.C.i 4" SCH. 40 P.V.C. S=2.00% - 4" SCH. 40 P.V.C. OVER FIRST 2' SET LEVEL 36" MAX 12" MIN. COVER 2 5, OJ LIQUID LEVEL S=,.OD9! MIN. STONE ® ENDS SEWAGE DISPOSAL SYSTEM / IN INV.= .tp a INV.= g�4C4C 14"MIN. INV.= z TOP = 9, 555 MARSTONS MILLS ° o t GAS —f tNvBAFFLE .= INV. o,• a, o,., ot• INV.= 9 tO- 10 Pre = 4 INFILTRATOR UNITS, 6.25 PER UNIT Pored For:: -� o•,. ot• OR CULTEC UNITS OF EQUAL AREA CHAMPION BUILDERS 6" COMPACTED STONE — o., o.. o., o.. •., ' BASE ON COMPACTED ng,191 I R19P1 99iI,Ij���Q1Q,r,,,•�IQiQ,, I9ii fnn INV.= a..et• o•. e•.. a•• o.• a,. oi• a,. o'• o., a,. a,. o:• o.. o'• 1 1 1 1 1 1 1 1 1 1111 111 � 1 11 n1 BOT.= PARCEL 41 -2 MAP. 78 SUBGRADE 9 8, O c� 1 t 1 1 1 1 1 1 1 1 1 1 n n 1 1 u 1 1 n , _ 1500 GALLON PRE-CAST 189 CAM M ETT ROAD SEPTIC TANK-WATERTIGHT DISTRIBUTION BOX 10, X 30' z 2" MIN. INSIDE DIM. H-20 IF SUBJECT TO TRAFFIC 1 H-10 LOADING, » 6 MIN. SUMP in DATE 2/22/96 REVISED TANK TO BE EMBOSSED WITH PRE-CAST CONC. GROUND WATER ® EL. ASTM STANDARD C 1227-93 SEAL WATERTIGHT 7 �11 o DRAWN BY DF,j CHK. BY: 36 9