Loading...
HomeMy WebLinkAbout0028 CAPTAIN STUDLEY ROAD - Health 28 CAPTAIN STUDLEY ROAD s Marstons Mills TOWN OF BApRNSTABLE LOCATION ';k% C4 PT S-rub" IUD SEWAGE# AO IS - LOO VILLAGE MARSTo C, M 1 L" ASSESSOR'S MAP&PARCEL INSTALLER'S NAME&PHONE NO.C"GwtoC Cp TEAM=1�� SEPTIC TANK CAPACITY 1,060 �S f_ LEACHING FACILITY.(type�dL� S 00q � j6 S (size) (� cis NO.OF BEDROOMS OWNER PERMIT DATE: 6-X9-119 COMPLIANCE DATE: 77 11-A-d(2 Separation Distance Between the:. Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility A Feet Private Water Supply Well and Leaching Facility Of any wells exist on ,e site or within 200 feet of leaching facility) /�LA. Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) A Feet FURNISHED BY 9-WanE �it& IQAQ[S N_ 3 2 Zq ' 0 l3-4 30� B-S= 3y� B_(o : -- �. R•s�.R C-S, .�.o•y, C-(, ° 'i3 No. �`" Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in compu er: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes application for -Misposal 6pstem Construction 3pPrmit Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. ?)( -�y� i�� Owner's Name,Address,and Tel.No. Assessor's Map/Parcel f �W f'lp4 cAPT- srui) k$✓f Installer's Name,Address,and Tel.No. 509-eET7- :69-n Designer's Name,Address and Tel.No. l�+QiP�icsip� f �tlSioS 1 R 1� L l�F;4iij1x R.5•_. Type of Building: Dwelling No.of Bedrooms ?L Lot Size ®® sq.ft. Garbage Grinder( ) Other Type of Building 1Q&S jZ 61T1/#l_ No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided 353 gpd Plan Date d ;L®( Number of sheets Revision Date Title #a2 0-SAP T: STU Lela ib MAP-S?' r.)-c N(L(_< Size of Septic Tank ( 10 Q &4Z.4 Type of S.A.S.(a) son ak:LLb 4AbWA6WY& Description of Soil kep CCk4A5e CZ>_ 5.3�- (0_911 Pal_ Nature of Repairs or Alterations(Answer when applicable) 1>,54C" (Z,4k1 4*) S6PT(L_ _!:bj"1=7n kna<j H-p.o 0--0 0K ,tpl-) 5oc3 9: c�rJ 14-216 Cep/ �f'���c'�2S Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Heal Signed Date Application Approved by Date ro Application Disapproved by J Date for the following reasons Permit No. �� Date Issued ��`� 4, N. (3 Fee v v THE COMMONWEALTH OF MASSACHUSETTS Entered incompufer: �9 PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes 2pplicatlon for Mispoe f r*pstent Construction Permit Application for a Permit to Construct( ) Repair( ) Upgrade( Abandon( ) ❑Complete System ❑Individual Components i Location Address or Lot No. SrVO -. Owner's Name,Address,and Tel.No. °Roza-sax V l -cs -c 1t Assessor's Map/Parcel M 2A r s u a O Installer's Name,Address,and Tel.No. p$•(��„ S> Designer's Name,Address,and Tel.No. eaP�wEp� �"�tPals�s�2� Cs�9 lfhi��z r�,s, aDA Type of Building: Dwelling No.of Bedrooms Lot Si z ,=�[�b' sq.ft. Garbage Grinder( ) Other Type of Building f E"l 7U T f 14l-. No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) �„�, gpd Design flow provided 13 4;3 gpd Plan Date /�, l 7 Number of sheets Revision Date Title St �+�A T, � � �jQriA NMAP szwj C Size of Septic Tank ���g® cl—' L_o Type of S.A.S./- Description of Soil e l ,,, Nature '�`i of Repairs or Alterations(Answer when applicable) ( �/gma 1j 4.80 C-4k/ M) SdpT � �,Date last inspected: i a Agreement- ,n The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in y accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of h Y Compliance has been issued•by this Board of Health. Signed Date -A-0(li Application Approved by ( '}NO Date Application Disapproved by ( Date for the following reasons Permit No. '07 Ql co Date Issued ------------------------ THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired(X) Upgraded( ) Abandoned( )by (UPF—k)Ib' /a 41 at /�'j' �Tu t�E11 D J✓I has been,constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. rg 01 -OOV dated Installer A-w-w Designer Sxf ent )-6kRT2 IA*20-k ,S #bedrooms ., Approved design flow 26 , gpd The issuance of this permit/shall t be construed as a guarantee that the system wild function as des gne . Date ' 7 /i 1 Inspector k"_ ----------- —-------- -- - - --------------------------- - No. 2 019 goo Fee t W THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS Misposal 6pstem Construction Permit Permission is hereby granted to Construct( ) Repair% Upgrade( ) Abandon( ) System located at and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction must bej co pleted within three years of the date of this permit.- Date 1[j a�'' t Approved by 1�+.•� ' �� ��" f Town of Barnstable Regulatory Services Richard V. Scali,Interim Director ' EgieivsrnBi.E rA g Public Health Division i639 �0 '�Fc r�r►+" Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Installer& Designer Certification Form Date: Z 16 /0 Sewage Permit# o -�CC Assessor's Ma Parcel 1. Z6 1Y1 Designer: tloLir r Installer: �Apt_., &.,,. c7n�cr,��-� ,__5 Address: 9. Le-ale, &J'£ 6,, Address: 1 3 C:o w.-•t►��w1 . On 4-Z9"aD l% C ,c,.,) ► L-�- ` ����was issued a permit to install a � (date) (installer) septic system at fowl lf.4, based on a design drawn by (addres &-r ,-`i , dated ( 7VN ZV 1d$`r . (designer - t/ I certify that the septic system referenced above was installed substantially according to the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. Strip out (if required) was inspected and the soils were found satisfactory. I certify that the septic system referenced above was installed with major changes (i.e. greater than 1.0' lateral relocation of the SAS or any vertical relocation of any component of the septic system) but in accordance with State &Local Regulations. Plan revision or certified as-built by designer to follow. Strip out(if required)was inspected and the soils were found satisfactory. I certify that the system referenced above was constructe nce with the terms of the IAA approval letters (if applicable) V (Installer's Signatu Designer' Si natur ) (Affix Des mp Here) PLEASE RETURN TO BARNSTABLE PUBLIC.HEALTH DIVISI.ON. CERTIFICATE OF_COMPLIANCE WILL_NOT,.BE_.ISSUED. UNTIL BOTH THIS FORM.-AND AS- BUILT CARD ARE RECEIVED BY THE BARNSTABLE.PUBLIC HEALTH DIVISION. THANK YOU. Q:\Septic\Designer Certification Form Rev 8-14-13.doc I �+� Town' of Barnstable P# ' • ply,, ' Department of Regulatory Services Public Health Division Date A,w 200 Main Street,Hyannis MA 02601 rFD MKt A co nn P�;1 Date Scheduled bhz4h ' Time Fee Pd._ n Soil Suitability Assessment for Se e Disposal "• -� Performed By: Witnessed By: LOCATION&.GENERAL INFORMATION Location Address ^ ^.�.,. � ` ^� Owner's Name Rc)berT S 1epolk=Y 4t 5S h(KICL5 Address pt�Tdl;t� MM r't c:,t'P�u'tpr' ENi'c12-tzar�� Assessor's Map/Parcel: ` �a�/0 4 Engineer's Name a<,elo t AA11,t[JE?kTdN Q,� NEW CONSTRUCTION REPAM Telephone# 7 14—a3 S— ( j Lund Use TGrI LP.yt 17f�2Q Slopes(96) ©--J Surface Stones ��0 Distances from: Open Water Body ?Z V ft Possible Wet Area >Uu/Ty ft Drinking Water Well '/jft Dralnage Way ft Property Une "�- �i� ft Other ft SKETCH:(Street name,dimensions of lot,exact locations of test holes&pert tests,locate wetlands fin proximity to holes) rx R �nrpxp 1 = c j m m i I ae _ LOT 11 AREA= 20.000± I 1 I WA%U Yl--__ --------4---- CAPT. STUDLEY ROA Parent material(geologic) Depth to Bedrock > 1 Depth to Groundwater. Standing Water in Hole: ifi-a-AIR- Weeping from Pit Face Estimated Seasonal High Groundwater DETERMINATION FOR SEASONALMIGH WATER TABLE Method Used: S' '� w dl Depth Observed standing in obs.hole: 0"11-4 __ In. Depth to Sall mottler ln, De�th to weeping from side of obs.hole: ��� ln, Groundwnter Adjuatment.-- _f). Index Well-0 Reading Date: Index Well]dvol , Adj,factor, Adj.droundwaterLevel, v L PERCOLATION TEST ba /ld /�Mtl Id Observation Hole# Tinto at 9" Depth of Pere Time at 6" &Fy1 Z 0 c Start Pre-soak Time @ V'0;" Time(911.611) Z/r End Pre-soak /.ss" Rate Mlit./Inch 4 Site Suitability Assessment: Site Passed ` Site Failed: Additional Testing Needed(Y/N) Original: Public Health Division Observation Hole Data To Be Completed on Back------ ***If percolation test is to be conducted within 100' of wetland,you must first notify the. Barnstable Conselivation Division at least one(1)week prior to beginning. Q:ISEPTICU'ERCFORM.DOC zoww V—� DEEP.OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Sdil Color Soil. Other Surface(in.) (USDA) (Munsell) Mottling (Stnucture,Stones;Boulders. ie ci•Y2 �v�=tzv I Zr1—l60 W-Cf C-7 Z- - DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color , Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. si ncv.%Oravel) Z3 -S3 L� 0 Yit Z` 41d 03rp 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, Flood Insurance Rate Man: Above 500 year flood boundary No— Yes - Within 500 year boundary No Yes Within 100 year flood boundary No. Yes Death of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the area proposed for the soil absorption system? ' 1 If not,what is the depth of naturally occurring pervious material? ...,.. Certification ' I certify that on 1,d 1 • J (date)I have passed the soil evaluator examination approved by the Department of Environmental Protection and that the above analysis was performed by me consistent with the required tr inin ,expertise x i a described in 410 CMR 15.017. Signat Date Q:1SfiPTICVBRCFORM.DOC I� �•; - Ito _ CO\IMONWE.kLTH OF I�LNSSACHUSETTS _= r, EXECUTIVE OFFICE OF ENWIRONME1TAL AFFAIRS == DEPARTMENT OF ENVIRONMENTAL PROTECTION ONE WINTER STREET. BOSTON NL4 02108 (617) 292.5500 TRUDY COX; Secre:ar 8 B. STP.::H` ARGEO PAUL CELLUCCI Governor `r SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A 6 CERTIFICATION n ✓ ���lw r0 Z%TA Ceti 1 C I 0 5 c Yh N L N Property Address: �� Ca fTN �Ua k-c-� L E�(I Name of Owner PA SANS tk� Address of Owner: 3 5 Date of Inspection:.1 V 4451 `` , T c/ "rlName of Inspector:( ease G�ct cr '%F=)EL U �40 I am a DEP approved system inspector pursuant to Section 15[340 of True 5(3e1,0 CMR 15.000) '�F Company Name: Ate. rr i A-k Mailing Address:�,n /L., 1 -3 Telephone Number / Sow ) Lt 3 /Z �o CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true. accurate and complete as of the time of inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. The system: Passes _ Conditionally Passes Needs Further Evaluation By the Local Approving Authority _ Fails Inspector's Signature- Date: The System Inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within thirty(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 Department of Environmental Protection. The original should be sent to the system owner and copies sent to the buyer.if applicable,and the approving authority. NOTES AND COMMENTS revised 9/2/98 pycs1or>I . t 6� Primed on Recycled Paper SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued ) 'roper-ty,Address: Jwner: L ,,T�j� Date of I 'ection�//�K Ch G INSPECTION SUMM RY: heck A, B, C, or D: A. SYSTEM PASSES: r:1 have,not found any information which indicates that any of the failure conditions described in 310 CMR 15.303 exist. Any failure ! 1 criteria not evaluated are indicated below. COMMENTS: ~it t B.\,SYSTEM CONDITIONALLY PASSES: One or more system components as described in the 'Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Indicate yes, no, or not determined(Y, N, or ND). Describe basis of determination in all instances. If 'not determined% explain why not. _ The septic tank is metal, unless the owner or operator has provided the system Inspector with a copy of a Certificate of • ' Compliance (attached) indicating that the tank was installed within twenty(20)years prior to the date of the inspection; or the septic tank, whether or not metal, is cracked, structurally unsound, shows substantial infiltration or exfiltration, or tank failure Is Imminent. The system will pass inspection if the existing septic tank is replaced with a complying septic tank as approved by the Board of Health. _ Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. The system will pass inspection If(with approval of the Board of Health). broken pipe(s) are replaced obstruction is removed distribution box Is levelled or replaced -- _ The system required pumping more than four times a year due to broken or obstructed pipe(s). The system will pass Inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction Is removed f/ revised 9./2/98 it SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: Owner: Date of Inspection: C. FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: Conditions exist which require further evaluation by the Board of Health in order to d ermine if the system is failing to protect the public health, safety and the environment. 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES IN ACCORDAN WITH 310 CMR 15.303(1)(b)THAT.THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEA AND SAFETY AND THE ENVIRONMENT: _ Cesspool or privy is within 50 feet of surface water Cesspool or privy is within 50 feet of a bordering vegetated wetlan or a salt marsh. 2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH(AND PU LIC WATER SUPPLIER,IF ANY)DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECTS THE PUBLIC LTH AND SAFETY AND THE ENVIRONMENT: _ The system has a septic tank and soil absorption s stem(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. _ The system has a septic tank and soil absorption system and the SAS is within a Zone I of a public water supply well. The system has a septic tank and soil ebsorptio system and the SAS is within 50 feet of a private water supply well _ . The system has a septic tank and soil absorpti n system and the SAS Is less than 100 feet but 50 feet or more from a _ private water supply well, unless a well water analysis for eoliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility d the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm. Method used to determine dis ante (approximation not valid). 3) OTHER revised 9/2/.98 rage 3oru SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) property Address: Owner: Date of Inspection: D. SYSTEM FAILS: You must indicate either "Yes" r "No** to each of the following: I have determined that ne or more of the following failure conditions exist as described in 310 CMR 15.303. The basis for this determination is identifi below. The Board of Health should be contacted to determine what will be necessary to correct the failure Yes No _ Backup of sewag into facility or system component due to an overloaded or clogged SAS or cesspool. _ Discharge or pondi g of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool. Static liquid level in th distribution box above outlet invert due to an overloaded or clogged SAS or cesspool. _ Liquid depth in cesspool less than 6" below invert or available volume is less than 1/2 day flow. _ Required pumping more tha 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped_ _ Any portion of the Soil Absorpt n System, cesspool or privy is below the high groundwater elevation. Any portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. _ Any portion of a cesspool or privy is within a Zone I of a public well. Any portion of a cesspool or privy is w thin 50 feet of a private water supply well. Any portion of a cesspool or privy is less han 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis: If the ell has been analyzed to be acceptable, attach copy of well water analysis for •coliform bacteria, volatile organic compoun s. ammonia nitrogen and nitrate nitrogen. E. LARGE SYSTEM FAILS: You must Indicate either 'Yes' or 'No" to each of the following: The following criteria apply to large systems in addition to he criteria above: The system serves a facility with a design flow of 10.000 g d or greater(Large System) and the system is a significant threat to pub! health and safety and the environment because one or more f the following conditions exist: Yes Na the system is within 400 feet of a surface drinking wat supply the system is within 200 feet of a tributary to a surface d inking water supply the system Is located In a nitrogen sensitive area(Interim W Ilhead Protection Area•IWPA) or a mapped Zone It of a public water supply I well) The owner or operator of any such system shall upgrade the system In accordanc with 310 CMR 15.304(2). Please consult the local regiona office of the Department for further Information. revised 9/2/98 Page l,of11 I r SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: fd Owner: �4/t'Ok Date of Inspection: &/� 0 /5 Check if the following have been done: You must indicate either "Yes" or "No" as to each of the following: Yes No .L�. Pumping information was provided by the owner, occupant. or Board of Health. None of the system components have been pumped for at least two weeks and-the system has been-receiving normal flow rates- during that period. Large volumes of water have not been introduced into the system recently or as part of this inspection. As built plans have been obtained and examined. Note if they are not available with N:A. The facility or dwelling was inspected for signs of sewage back-up. The system does not receive non-sanitary or industrial waste flow. _ The site was inspected for signs of breakout. x _ All system components,excluding the Soil Absorption System,have been located on the site. The septic tank manholes were uncovered, opened, and the interior of the septic tank was inspected for condition of baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge, depth of scum. The size and location of the Soil Absorption System on the site has been determined based on: (Ar Existing information. For example. Plan at B.O.H. Determined in the field(if any of the failure criteria related to Part C is at issue, approximation of distance is unacceptable) 115.302(3)(b)) The facility owner land occupants,if different from owner) were provided with information on the propermaintena=2-of SubSurface Disposal Systems. ' I revised 9/2/98 t,PaecSoflll SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C QQ r Imo, SYSTEM INFORMATION 'roperty Address: ' Owner: Date of Inspection: �+ " FLOW CONDITIONS RESIDENTIA : Design flow: , O g.p.d./bedroom. Number of bedrooms (design):62- Number of bedrooms (actuall:_OZ Total DESIGN flow Number of current residents:of Garbage grinder(yes or no): N Laundry(separate system) (yes or no): 0y; If yes, separate inspection required Laundry system inspected Vor no) Seasonal use (yes or no): f- Water meter readings, if available (last two year's usage (gpd): Sump Pump(yes or no): �-> Last date of occupancy: e+ti� COMMERCIALANDUSTRIAL: Type of establishment: Design flow: qpd ( Based on 15.203) Basis of design flow Grease trap present: (yes or no)_ Industrial Waste Holding Tank present: (yes or no)_ Non-sanitary waste discharged to the Title 5 system: (yes or no)_ Water meter readings,if available: Last date of occupancy: OTHER:(Describe) Last date of occupancy: GENERAL INFORMATION PUMPING RECORDS and source of information: 0 System pumped as pan of inspection:(yes or no)_ If yes. volume pumped: gallons Reason for pumping: TYPE OF SYSTEM _ Septic tank/distribution box/soil absorption system Single cesspool Overflow cesspool Privy Shared system(yes or no) (if yes,attach previous Inspection records,If anyl I/A Technology etc. Attach copy of up to date operation and maintenance contract Tight Tank Copy of DEP Approval Other APPROXIMATE AGE of all components, date Installed(if known) and source of information: , Sewage odors detected when arriving at the site:(yes or no) � r I -Pa�i6oril revised 9/2/98 -.�:. SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) ,ray Aess: Owner: Date of Inspectiow e G/to cj cJ BUILDING SEWER: (Locate on site plan) Depth below grade: Material of construction: _ cast iron_40 PVC_other (explain) Distance from private water supply well or suction line Diameter Comments: (condition of joints, venting, evidence of leakage. etc.) SEPTIC TANK: (locate on site pan)' an) Depth below grade: WtA Material of construction:,concrete_metal_Fiberglass _Polyethylene_other(ezplain) If tank Is metal,list age_ Is age confirmed by Certificate of Compliance_(Yes/No) Dimensions: Sludge depth: ` Distance from top offsludge to bottom of outlet tee or baffle: Scum thickness:._ rl Distance from top of scum to top of outlet tee or baffle:_( _ t� Distance from bottom of scum to bott m of outlet tee or baffler_ How dimensions were determined: lomments: to (recommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relatio utle;inv rt. structural integrity. 9 SytA t w r C v evidence of leakage,etc.) ti � V�.✓� �V ' 1 ry GREASETRAP. CS? (locate on site plan) Depth below grade: Material of construction:_concrete_metal_Fiberglass _Polyethylene_other(ezplain) Dimensions Scum thickness:__ Distance from top of scum to top of outlet tee or baffle:_ Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping: Comments: vert, structural integrity, (recommendation for pumping,condition of Inlet and outlet tees or baffles,depth of liquid level in relation to outlet in evidence of leakage,etc.) revised 9/2/98 rdge7orIt SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) property Address: Owner: A Date of Inspection: �/!�� TIGHT OR HOLDING TANK: JkZ> (Tank must be pumped prior to, or at time of, inspection) (locate on site plan) Depth below grade:_ Material of construction: _concrete _metal_Fiberglass _Polyethylene _other(explain) Dimensions: Capacity:_gallons Design flow:_ gallons/day Alarm present Alarm level: Alarm in working order: Yes _ No_ Date of previous pumping: Comments: (condition of inlet tee, condition of alarm and float switches, etc.) DISTRIBUTION BOX:*S (locate on site plan) Depth of liquid level above outlet invert: kI O4� � ��K� Comments: note if level and distrib do is equal, evidence of solids carryover,t idence of leakage into or out of box, etc.) PUMP CHAMBER4Z (locate on site plan) Pumps in working order:(Yes or Not Alarms In working order(Yes or No) Comments: (note condition of pump chamber.-condition of pumps and appurtenances, etc.) revised 9/2/98 Page apr>ti SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (contirwed) 4operty Address: at ln�' Owner: + 64aYe>K� Date of Ins4ection: r b � / dam/ / SOIL ABSORPTION SYSTEM(SAS): (locate on site plan, if possible: excav tion not required, location may be approximated by non intrusive methods) If not located, explain: Type: leaching pits, number: �� leaching chambers, number:_ leaching galleries. number: leaching trenches, number, length: leaching fields, number, dimensions: overflow cesspool, number: Alternative system: Name of Technology: Comments: (note condition of�il, s�ns of hydraulic failure, level of ondin , damp soil, con 'lion o egetation, etc.) nU l►V 1 CESSPOOLS: V`V (locate on site plan) Number and configuration: Depth-top of liquid to inlet invert: - 9epth of solids layer: )epth of scum layer: Dimensions of cesspool: Materials of construction: Indication of groundwater: Inflow (cesspool must be pumped as part of inspection) Comments: (note condition of soil, signs of hydraulic failure,level of ponding, condition of vegetation, etc.) PRIVY: (locate on site plan) Dimensions: Materials of construction:. - Depth of solids, Comments: (note condition of soil, signs of hydraulic failure,level of ponding, condition of vegetation, etc.) revised: 9/2/98 pigegern SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORM-ATIIO•_N (continued)) 'roperty Addressf4, ,Cc e t, �`�(�,�� /lL[i( - GY-�Y//��'-3 / Lt•I.CS owner: 9 -� er OIL — Y — Date of Inspection: oo�-//61� SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent reference landmarks or benchmarks locate all wells within 100' (Locate where public water supply comes into house) L g Pa �3 3 2� t� revised 9/2/98 Page 10of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C ®SYSTEM INFORMATION (continued) / roperty Addr ss: Owner: Ar� r/af, 4 g/ Date of Inspection©6"///•` / / NRCS Report name (/ - — ---- -- — Soil Type_ --------- ------- Typical depth to groundwater_____ _- USGS Date website visited ►1A) Observation Wells checked Groundwater depth: Shallow Moderate Deep __--_ SITE EXAM Slope (J" Surface water kJ-0 • Check Cellar t) A Shallow wells qAA-r Estimated Depth to Groundwater '-"feet , Please indicate all the methods used to determine High Groundwater Elevation: Obtained from Design Plans on record Observed Site (Abutting property. observation hole. basement sump etc.) Determined from local conditions Checked with local Board of health Checked FEMA Maps Checked pumping records Checked local excavators. installers Used USGS Data Describe how you established the High Groundwater Elevation. (Must be completed) revised 9/2/98 Pace 11of11 � THE COMMONWEALTH OF MASSACnuSE/'S U����� U��� �����"" ~ 01 $?F HEALTH ... -.''y'���%^�&--'OF--.. ............................. � =�������� �f�° ���o�^� ��'��� ����t���i�� ����iG� - -r�---- —~ —�� -~ --�~- �- ~��--- � `- Application is berebv-omdefor u Permit Co Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: --_--'-- ----'�*����-'�������"��y�Y�- ---- ---'-----'---'--_' Ad or Lot No. _-_----'-------_-'__'-~-----'----'.---'--'--'-'_'- _---------'----------_-------.----------_'-'-'-_ ��nOwner �a�"� --__----'���^*z���-__'�^'^^^��.^.-'_-.-----'---' ---_-_----------'-----------.-----....------.. �a� ��� � T�y� ofBoU6' Size Lot----------------------------Sq. feet D�cl�����~. o[ D�dr000ns---�~��~.---------I�zyaos�m f\t6c /��� Cu,�u0� Grinder ) 04 Other--Type of Building ---------------------------- No. of persons. Showers ( ) -- Cafeteria ( ) "* ()Cher fixtures ----.------_--.-_--. ............................................................... ` Design Flow.-..-'\5.��----------g�)oo» per person per day. Tota daily flow---.'��%��.-.-----�a)oo,. SepticIznk�-I.' oi6 capacity/.VY-G,,Onos Loogt6._-__' Width....... Diameter----- Depth------ Disoosu Trench—No. ------- Width-------------------- Total Leuct6---.---' Total leaching area--'----'sq. h. Pit l�o.1------' D�mcoc.���k/�. below iWe ~^" T leaching area----.--sq. [c �s Other Distribution �oo6ox ( ) Dosing �o ( ) �Jy /-� - �7 + ~~ Percolation Test Dcsv}ta Performed by--.-------------��'���/������-_~-i�ut�-.--------.---' Test Pit No. l................n'iuutesyezioc6 Depth of Test PiL------- I)ent6 to -round water-------- � (Z4 Test Pit No. 3................minutes per inch Depth of Test P6L--._---. Depth to uroou6 water--------' � [> �- . � Description of S"" '= � -------'�r~~-v�"--c��'~�-~~=*-''��-~-~--�--��''~--~n«��-�----'--'-'-------'----------- Z --------------------------------------------_--_._-.-._-____-------_---_.-_----------------_' U Nature of Repairs or Alterations—Answerwhenapplicable--------------------------------------------------------------------------------- ------------- ------------------------------------------------------------- `---`--------`---`-------------------'------'----------'-------------------------------'���������������- agcccmcot: The undersigned agrees to install the aforcdexcribed Individual Sewage Disposal System ivaccordance with | the provisions of Article }{I of the State Sanitary Codo--The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issue b the boar�pf Yh. ------------ -------------------------------- ^ . Application Approved Dr-..� - x��,'--. Date � �r �6x rxu�o�x' - � Application- - Disapproved ' '_-_.�`, -------''-------_--'_---------_--------- --'--_--.---'''--'---__-'_-_.--''_''-.-------._-.--__'-___-_-----------'__-_'-- �r�� --- ' � w"� Pero6t _ � o"m �---'_----------------------------------- --------------^---__-----'--_--''---'''------'-'---_- No......................... F��.... �.. ...... THE COMMONWEALTH OF MASSACHUSETTS BOARD F HE LTH n t _._.....1... OF..................................... ................ ......................... ApVfirtttinn -for Ui,ipoiial Works Tomitrurtinn Prrutit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: `.'1... '�'� -•••--.....���Ils ��UJ �----------------------------------------------- Location-Address / or Lot No. -----CQi7 ------------ --••--....----•---------•-'---•---._...-------•-----•----•------•--'-......---•--•----.... owner Address 0 Installer Address Q Type of Buildipe Size Lot............................Sq. feet U Dwelling—No. of Bedrooms----------;;-n.............. .Expansion Attic (AU) Garbage Grinder (�) aOther—Type of Building ---------------------------- No. of persons---------------------------- Showers ( ) — Cafeteria ( ) a' Other`5_ yllres . W Design Flow/...............................j. 40gallons per person per day. Total daily flow-----------------------------------.........gallons. WSeptic Tank—Liquid capacity------------gallons Length---------------- Width................ Diameter---------------- Depth----------._..-- x Disposal Trench I-No. .................... Widit_U_q_��..... Total Length-------------------- Total leaching area---.---_--.-.-__--sq. ft. 3 Seepage Pit No--------------------- Diameter-------------------- Depth b6lrw iy31 %,__ ----.-• _ T-otal Ipching area.--_---_-_.__--_sq. ft. z Other Distribution box ( ) Dosing tank ( ) � .� aPercolation Test Results Performed bY.......................................................................... Date.......................... ------------ a Test Pit No. 1----------------minutes per inch Depth of "Pest Pit.................... Depth to ground water.------..-----_--.------ G� --------..._. "P� ----- p - << --- •----5- ._..... ._. Test Pit No. 2.............Onunu�s per�� Depth of Test Pit_.__________�.___. Depth to groundwater -_.' Description of So11 -------------------- - .... ---- --------------------------------------------------------- x -- �' G W -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- VNature of Repairs or Alterations—Answer when applicable------------------------------------------------------------------------------------------------ ---------------------------------------------------------------------------------------------------------------------------------------------------------------- ---------------------- --------------- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Article YI of the State Sanitary Code— The undersigi ed�Wlth. rthe - agre s not to place the system in operation until a Certificate of Compliance has been . �b the boar of Sgned-----`----_------ -- ............................................................. ............D -------------- Date Application Approved B -- ate Application Disapproved for the following reasons----------------------------------------------------------------------------------------------------------------- -----------------------------------------------------• ------------------------------•--------------•-----------•--'----•-------""-----•------"-'-----•'•'-------•-----•---------------------••------ Date PermitNo......................................................... Issued......................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH uIrdifiratel/offunlutpliaurr T IS S T :C TIFY, That the Individual Sewage Disposal System constructed ( or Repaired ( ) by ' - ---------------- -------•-------------------------------------------------- ......... ..... .................................................. Installer h r 1 )e I�of The State Sanitary Code as described in the has been installed m a cordance with the pr visions of y6 e S y application for Disposal Works Construction Permit o--- ---•-mot /----------------__ dated..1F___;k_-4- ?-�------.----.---•. THE ISSUANCE OF THIS CERTIFICATE SHALL. NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE-----------------------------------------------------------:.................... Inspector.................................................................................... THE COMMONWEALTH OF MASSACHUSETTS 76 BOARD 9,F HEALTH !... ..OF...... ..G� . ..................................................... No.-—4/..-'" FEE----/ �--� ttl r 2�1, Permissio i hereby granted-'--. (} -' -.------ �- / ----------------------------------------•----- to Conuct , ) or epairt( y a di dal Sewage Dispos stelra' ---------•- •-------- ------ -- � as shown on the application for.,Disposal Works onstruction Permit No--------------------- Dated__ _.- _lJ_ _ ...... .............................................. -----....--------- .....................................- Board of .ealt DATE.........................................................................-- L� FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS fir- s © � r.9' N Q /1 L, 0 L 6b� T STU.�.� C E R T i F f E D PLOT PLAN '""Tt s.� rA/Ty S y s r� S/i�U c u'✓ d -7—AV/ S L•v L O C AT 1 O W. SCALE* �' '30 DATE: .9!/Cj S. Z`�7{0 REFERENCE: �'E�ti � �� �� D A T E I { I HEREBY CERTIFY THAT THE BUILDING R G. L-AND SURVE OR SHOWN ON THIS PLAN IS LOCATED ON THE GROUND AS SHOWN HEREON AND THAT IT ZONING BY — LAWS-1 — CONFORM TO E �F AWS OF THE TOWN OF SNM�ss9� /�iq/2�/ST'4BG WHEN CONSTRUCTED . tiN JOSEPH M. y MONAHAN.,JR. y C M S ASSOCIATES, INC . �F �o REGISTERED ENGINEERS 8 LAND SURVEYORS TE�yp�` MID -CAPE OFFICE BUILDING - 1265 ROUTE 28 N� SUR��' SOUTH YARM O UTH, MASS. 02664 f ' #21 CAPT. BAKER ROAD #19 CAPT. BAKER ROAD 126-038 126-039 town water 25 T. WIDE ACCESS EASEMENT town water SITE P LA N N 125.00' SCALE: 1 ", = 20' D� o ITE B.M. . 10 0.0 6 (ASSUMED) ON Q �, Capt. S dley Rd. septic Setback CORNER OF BULKHEAD t. De un T +t 4" SCH 40 PVC VENT 5$ 9g. c 10' T.H. #2 T.H. #1 PROPOSED SAS °0°0000-0-00 `'-'-' :::' "MARSTONS MILLS" °o� , „ ^ oo $ 2 H-20 500—gal chambers o RESERVE 000 - o' 9� with 4' stone all around . in LOCUS °o�<AREA�°o°0 25' x 13' x 2' leach trench. NO SCALE 99 °, "0°0°0 <: GENERAL NOTES 0 1. ADDRESS: #28 CAPT. STUDLEY ROAD, MARSTONS MILLS 0 2. ASSESSOR'S NUMBER: MAP 126 PARCEL 047 3. DEVELOPER'S LOT: LOT ##11 4. TOPOGRAPHIC INFORMAT16N WAS COMPILED FROM AN ON THE GROUND INSTRUMENT SURVEY. 5. TOWN WATER IS PROVIDED TO THE SITE & SURROUNDING PROPERTIES. b = N 6. NO WETLANDS ARE LOCATED WITHIN 150 FEET OF PROPOSED SAS. w N 7. REFERENCE PLAN: PLAN BOOK 274 PAGE 34 deck 9g0`L 8. UTILITIES LOCATED BY DIGSAFE. D 0 `.................. ............... ......99 9. THIS DESIGN PLAN IS TO BE UTILIZED FOR SEPTIC REPAIR PURPOSES ONLY. 2 i; 99... ..^............ Og cellar � ��• 0 10. THE PROPERTY IS LOCATED WITHIN A GP GROUNDWATER PROTECTION ZONE/ZONE II. Q EXISTING j/°II o ir - v O Fir /DWELLING First Floor elev.=100.90 0 r- m o � Cfl O `— O o v O cn co c N It v no. a �- o .1 a .. o Q , SHE Local Upgrade ' Approval p� I �le 310 CMR 15.405(1)(b) - A variance is requested to allow the proposed o� 0- SAS to be constructed 5.4' from grade in lieu of the required three feet. �y ( � 6 A vent and H-20 components are proposed to mitigate the variance. LEGEND 0 9.... .......................••. PROPOSED SEPTIC SYSTEM REPAIR -- Test Hole Location PREPARED FOR qj LOT 11 g�' {{ CAPEWIDE ENTERPRISES, INC. ¢ir I —GAS— Approx salinelocation AT o AREA— 2 0,O O 0 FF —w— Approwaiatgnleocation #2$ CAPT. STU D LEY ROAD GRAVEL „ ........18........ Existing contour (MARSTONS MILLS), BARNSTABLE, MA I o O Ex.1,000 gal. H-10 loading 3 septic tank OWNER: ROBERT J. HICKS, JR. ET UX PREPARED BY. :..............................:.. ......... 97 `1 ( Existing Leach Pit R.S. b & backfllle Glen E. Harrington, . 96.................. edge of pavement — — ........... .......................... .. ............ .. .... .... _.... .. 951$ .. 96 / / P 9 Leda. Rose Lane 1 to a pumped — — — — — — — — — — — —— 6,--*-- - — - - - - - - - - � �_ i Marstons Mills, MA 02648 GJ ojJ90 ro5 Tel: 774-238-1813 CAPT. S T U D S EY ROAD � _ Email: ghorr88®hotmcil.com SCALE: 1"=20' DRAWN BY: GEHRS DATE: 26 JUN 2018 40 FT. WIDE DATUM: ASSUMED ILENAME: 28CAPTSTUDLEI SHEET 1 OF 2 1 � 4" dia. SCH 40 PVC Existing Dwelling SYSTEM PROFILE VENT WITH CARBON FILTER First Floor Elev.= 100.9' PROPOSED Not to Scale 3 HOLE H-20 DIST. BOX i Existing Grade = 99't Finished grade over system=2% slope away Existing Grade = 99.4't CELLAR Septic tank covers must be D-Box cover shall be " " + One chamber cover shall be Min. 2"-1/8"-1/2'' Double-Washed Stone WALL S = 0.02' ft, within 6 of finished grade within 6 of finished grade within 6" of finished grade or geo-textile filter cloth S=0.01'/FT Level for 2' S=0.01 ft/ft To of Peastone Elev.=94' EXISTING 1000 GAL. 34' 13, . Invert E v.-93 5 ' SEPTIC TANK ® ® ® ® ® to EXISTING H-10 = 9' Bottomf ch Facility Elev.=91.50' Install Gas Paf le t. 2® 8'-6" = 17' Ex.—=- 96.24' od a P=95.65' 2 3/4"-1%" Double-Washed, Crushed Stone 5'.Min. (5.45' PROVIDED) 6" OF 3/4"-11/2" STONE H—20 Bottom of Te t Hole Elev.=86.05' 6" OF 3/4=„/2" STONE .' LEACHING CHAMBERS Design Calculations Number of Bedrooms:- 2 EXISTING Garbage Disposal: Not allowed with this design Septic Tank Capacity Required: 1,500 gallons (min. per Title V) Septic Tank Capacity Provided: Existing 1,000—gal H-10 septic Tank Leaching Capacity Required: 330 gpd x LTAR= 446 SF Req'd Area Long Term Application Rate for <2 min./inch = 0.74 gal/sq. ft. CONSTRUCTION NOTES Proposed Leaching Structure: 1-25'x13'x2' Leaching .Trench Bottom Leaching Area Provided = 325 Sq.Ft. �N 1 . Contractor is responsible for Digsafe notification Side Leaching Area Provided = 152 sq. ft. and protection of all underground utilities and pipes. Total Leaching Area Provided = 477 sq. ft. > 446 sq. ft req'd. Leaching Capacity Provided =477,.sq. ft X 0.74 gal/sq.ft.=353 gpd. 2. The septic tank and distribution box shall be set level on 6„ of 3/4 —1 1/2 stone. 70 3. Backfill should be clean sand or gravel with no SOIL EVALUATION & PERK TEST I (,P15691 stones over 3" in size. Date of SOIL EVALUATION & PERK TEST: 14 JUN 2018 - 4. This system is subject to inspection during installation Evaluation Performed By. Glen E. Harrington, R.S. qN/TAR P by Glen E. Harrington, R.S. Witness: Donald Desmarais, R.S., BOH Agent Excavator: Bruce, Capewide Enterprises, inc. 5. The contractor shall install this system in accordance Percolation Rate:< 2 mpi with Title V of the Massachusetts Environmental Code and local Board of Health Rules and Regulations. i Test Hole Test Hole 6. If, during installation the contractor encounters any No. 1 No. 2 PERK RESULTS soil conditions or site conditions that are different 12"-9"=3 min 11 sec PROPOSED SEPTIC SYSTEM REPAIR DEPTH SOILS ELEV. DEPTH SOILS ELEV. d n 9 ,-6 = 4'min 20 sec. from those shown on the soil log or in the design, A, Ls ` ° A. Ls Use <2 mpi for PREPARED FOR the installer shall halt installation and immediately notify 6" 10YR4/2 98.88' 4" 10YR4/2 99.07' design purposes. CAPEWIDE ENTERPRISES, INC. Glen E. Harrington, R.S. Bw I Bw AT loamy sandloamy son 7. No vehicle or heavy machinery shall drive over the 24" 10YR5/4,� 97.38' 23" 10YR5/4 97.48' #28 CAPT. STUDLEY ROAD septic system unless noted as H-20 septic components. Firm LS Firm LS (MARSTONS MILLS) BARNSTABLE MA 69" 10YR5/6 93.63' 53" 10YR5/6 94.98' "8. Install Tuf—Tite gas baffle or equal on septic tank outlet tee. C2 t C2 68 OWNER: ROBERT J. HICKS, JR. ET UX 9. All piping shall` be SCH 40 PVC. friable 2m-c5% friable m y Bond, 2596� sand, ZSR a. 86" 10. No Wells are located within 150' of proposed SAS. 120" f-m gravel• 9.38' 120" '-m grO1� 89.4' PREPARED BY: looselm-c loose. M-e Glen E. Harrington, R.S. 11 . Provide 1 H-20 DB-3 distribution box and 2 H-20 500-gal. sand, 15x1 sand- . 15X 9 Leda Rose lane chambers by Wiggin Precast or equal. 160" ' sna"ax 86.05' 160" f s grovel86.oT Marstons Mills, MA 02648 12. The existing leach pit shall be pumped and backfilled. NO Observed Ground, Water Tel: 774-238-1813 Soil Evaluation Certification Email: ghorr88®hotmail.com 13. Provide a 4" diameter SCH 40 PVC vent with carbon filter, as shown. 1, Glen E. Harrington, hereby certify that on October, 1995. I passed the soil evaluator examination approved by the DEP and that the analysis was performed by SCALE: 1"=20' DRAWN BY GEHRS DATE 26 JUN 2018 me consistent with the required training, expertise and experience described in 310 CMR 15.017. DATUM: ASSUMED FILENAME: 28CaptStudleyl SHEET 2 OF 2