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COMMONWEALTH OF MASSACHUSETTS
EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS
DEPARTMENT OF ENVIRONMENTAL PROTECTION
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.BAN 0 6 2004
TOWN OF BARNSTABLE
HEALTH DEPT.
TITLE 5
OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM
PART A
CERTIFICATION
Property Address: 128 Devon Lane
Marston Mills, MA 02648 MAP
Owner's Name: Dan Mann PARCEL 3�
Owner's Address: p� n
LOX 1 1 Q fi 'I
Date of Inspection: December 5, 2003 Ev
{�
Name of Inspector: (Please Print) James M. Ford t � r lJ �� 13�'T01
Company Name: James M. Ford J'Mailing Address: P.O. Box 49 /Osterville,MA 02655-0049 Tele hone Number: 508 862-9400
P
CERTIFICATION STATEMENT
1 certify that I have personally inspected the sewage disposal system at this address and that the information reported
below is true,accurate and complete as of the time of the inspection. The inspection was performed based on my
training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP
approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system:
✓ Passes
Condition Passes
Needs Fu h Evaluation by the Local Approving Authority
F 'ls
Inspector's Signature:P g Date: December 11, 2003
The system inspector shall submit opy of this inspection report to the Approving Authority(Board of Health or
DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000
gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the
DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable,and the approving
authority.
Notes and Comments
****This report only describes conditions at the time of inspection and under the conditions of use at that
time. This inspection does not address how the system will perform in the future under the same or different
conditions of use.
Title 5 Inspection Form 6/15/2000 page I
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Page 2 of I I
OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: 128 Devon Lane
Marston Mills. MA
Owner: Dan Mann
Date of Inspection: December 5. 2003
Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D
A. System Passes:
✓ I have not found any information which indicates that any of the failure criteria described in 310 CMR
15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below.
Comments:
B. System Conditionally Passes:
One or more system components as described in the"Conditional Pass"section need to be replaced or
repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health,will pass.
Answer yes,no or not determined(Y,N,ND) in the for the following statements. If"not determined", please
explain.
The septic tank is metal and over 20 years old* or the septic tank(whether metal or not) is structurally
unsound,exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the
existing tank is replaced with a complying septic tank as approved by the Board of Health.
*A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance
indicating that the tank is less than 20 years old is available.
ND explain:
Observation of sewage backup or break out or high static water level in the distribution box due to broken or
obstructed pipe(s)or due to a broken,settled or uneven distribution box. System will pass inspection if (with
approval of Board of Health):
broken pipe(s)are replaced
obstruction is removed
distribution box is leveled or replaced
ND explain:
The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will
pass inspection if(with approval of the Board of Health):
broken pipe(s)are replaced
obstruction is removed
ND explain:
2
Page 3 of 11
OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: 128 Devon Lane
Marstons Mills, MA
Owner: Dan Mann
Date of Inspection: December 5, 2003
C. Further Evaluation is Required by the Board of Health:
Conditions exist which require further evaluation by the Board of Health in order to determine if the system
is failing to protect public health, safety or the environment.
1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b) that the
system is not functioning in a manner which will protect public health,safety and the environment:
Cesspool or privy is within 50 feet of a surface water
Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh
2. System will fail unless the Board of Health(and Public Water Supplier, if any)determines that the
system is functioning in a manner that protects the public health,safety and environment:
_ The system has a septic tank and soil absorption system (SAS)and the SAS is within 100 feet of a
surface water supply or tributary to a surface water supply.
The system has a septic tank and SAS and the SAS is within a Zone I of a public water supply.
The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well.
_ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a
private water supply well". Method used to determine distance
"This system passes if the well water analysis, performed at a DEP certified laboratory, for coliform
bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and
the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other
failure criteria are triggered. A copy of the analysis must be attached to this form.
3. Other:
3
Page 4 of I 1
OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: 128 Devon Lane
Marstons Mills, AM
Owner: Dan Mann
Date of Inspection: December S, 2003
D. System Failure Criteria applicable to all systems:
You must indicate either"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 clogged 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
✓ 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 coliform bacteria and volatile organic compounds
indicates that the well is free from pollution from that facility and the presence of ammonia
nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria
are triggered. A copy of the analysis must be attached to this form.]
No (Yes/No)The system fails. I have determined that one or more of the above failure criteria exist as
described in 310 CMR 15.303,therefore the system fails. The system owner should contact the Board of
Health to determine what will be necessary to correct the failure.
E. Large System:
To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000
gpd.
You must indicate either"yes"or"no"to each of the following:
(The following criteria apply to large systems in addition to the criteria above)
Yes No
the system is within 400 feet of a surface drinking water supply
the system is within 200 feet of a tributary to a surface drinking water supply
the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area- IWPA)or a mapped.
Zone II of a public water supply well
If you have answered"yes"t y o an question in Section E the system is considered`y y q y a significant threat, or answered
"yes" in Section D above the large system has failed. The owner or operator of any large system considered a
significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR
15.304. The system owner should contact the appropriate regional office of the Department.
4
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Page 5 of I 1
OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST
Property Address: 128 Devon Lane
Marstons Mills, MA
Owner: Dan Mann
Date of Inspection: December S, 2003
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 ?
✓ 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?
✓ 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:
es 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 C is at issue approximation of distance
is unacceptable) [310 CMR 15.302(3)(b)].
5
Page 6 of 1 I
OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
Property Address: 128 Devon Lane
Marstons Mills, AM
Owner: Dan Mann
Date of Inspection: December 5, 2003
FLOW CONDITIONS
RESIDENTIAL
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
Number of current residents: 2
Does residence have a garbage grinder(yes or no): . No
Is laundry on a separate sewage system (yes or no): No [if yes separate inspection required]
Laundry system inspected(yes or no): No
Seasonal use(yes or no): No
Water meter readings, if available(last 2 years usage(gpd)): Unavailable
Sump Pump(yes or no): No
Last date of occupancy: Currently occupied
COMMERCIAL/INDUSTRIAL
Type of establishment:
Design flow(based on 310 CMR 15.203): _______gpd
Basis of design flow(seats/persons/sgft,etc.):
Grease trap present(yes or no):
Industrial waste holding tank present(yes or no)
Non-sanitary waste discharged to the Title 5 system (yes or no):
Water meter readings, if available:
Last date of occupancy/use:
OTHER(describe):
GENERAL INFORMATION
Pumping Records
Source of information: Pumped 2 years ago-per owner
Was system pumped'as part of the inspection (yes or no): No
If yes,volume pumped: gallons--How was quantity pumped determined?
Reason for pumping:
TYPE OF SYSTEM
✓ Septic tank,distribution box, soil absorption system
Single cesspool
Overflow cesspool
Privy
Shared system (yes or no) (if yes, attach previous inspection records, if any)
Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be
obtained from system owner)
Tight Tank Attach a copy of the DEP approval
Other(describe):
Approximate age of all components,date installed(if known)and source of information:
Aug. 15106-per as built card
Were sewage odors detected when arriving at the site(yes or no): No
6
Page 7 of 11
OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 128 Devon Lane
Marstons Mills, MA
Owner: Dan Mann
Date of Inspection: December 5, 2003
BUILDING SEWER(locate on site plan)
Depth below grade:
Materials of construction: _cast iron _40 PVC other(explain):
Distance from private water supply well or suction line:
Comments(on condition of joints,venting,evidence of leakage, etc.):
SEPTIC TANK: ✓ (locate on site plan)
Depth below grade: 12"
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)
Dimensions: 1500 gal.
Sludge depth: 2"
Distance from top of sludge to bottom of outlet tee or baffle: 30"
Scum thickness: 2"
Distance from top of scum to top of outlet tee or baffle: 8"
Distance from bottom of scum to bottom of outlet tee or baffle: 10"
How were dimensions determined: Measuring stick
Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels
as related to outlet invert, evidence of leakage,etc.):
Tees were present. The liquid level was even with the outlet invert. There did not appear to be any signs of leakage.
GREASE TRAP: None (locate on site plan)
Depth below grade:
Material of construction: _concrete _metal _fiberglass _polyethylene _other
(explain):
Dimensions:
Scum thickness:
Distance from top of scum to top of outlet tee or baffle:
Distance from bottom of scum to bottom of outlet tee or baffle:
Date of last pumping:
Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels
as related to outlet invert,evidence of leakage, etc.):
7
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Page 8 of 1 I
OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 128 Devon Lane
Marstons Mills, MA
Owner: Dan Mann
Date of Inspection: December 5, 2003
TIGHT or HOLDING TANK: None (tank must be pumped at time of inspection)(locate on site plan)
Depth below grade:
Material of construction: _concrete _metal _fiberglass _polyethylene _other(explain):
Dimensions:
Capacity: gallons
Design Flow: gallons/day
Alarm present(yes or no):
Alarm level: Alarm in working order(yes or no):
Date of last pumping:
Comments(condition of alarm and float switches,etc.):
DISTRIBUTION BOX: ✓ (if present must be opened)(locate on site plan)
Depth of liquid level above outlet invert: Even
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.):
ihe D-box was clean and no solids were present. There did not appear to be any signs of failure.
PUMP CHAMBER: None (locate on site plan)
Pumps in working order(yes or no):
Alarms in working order(yes or no)
Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.):
8
Page 9 of 11
OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 128 Devon Lane
Marstons Mills, MA
Owner: Dan Mann
Date of Inspection: December S, 2003
SOIL ABSORPTION SYSTEM(SAS): ✓ (locate on site plan,excavation not required)
If SAS not located explain why:
Type
leaching pits,number:
leaching chambers, number:
leaching galleries,number:
✓ leaching trenches, number, length: 4'x 2'x 60'(per as built card)
leaching fields,number, dimensions:
overflow cesspool,number:
Innovative/alternative system Type/name of technology:
Comments(note condition of soil, signs of hydraulic failure, level of ponding,damp soil, condition of vegetation, etc.):
There did not appear to be any signs offailure. The bottom to grade was 4.0'.
CESSPOOLS: None (cesspool must be pumped as part of inspection)(locate on site plan)
Number and configuration:
Depth -top of liquid to inlet invert:
Depth of solids layer:
Depth of scum layer:
Dimensions of cesspool:
Materials of construction:
Indication of groundwater inflow(yes or no):
Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.):
PRIVY: None locate on site plan)
( P )
Materials of construction:
Dimensions:
Depth of solids:
Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.):
9
Page 10 of 11
OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 128 Devon Lane
Marston Mills, MA
Owner: Dan Mann
Date of Inspection: December 5, 2003
SKETCH OF SEWAGE DISPOSAL SYSTEM
Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or
benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building.
B
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10
~ J v Page l l of 11
OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 128 Devon Lane
Marstons Mills, MA
Owner: Dan Mann
Date of Inspection: December 5, 2003
SITE EXAM
Slope
Surface water
Check cellar
Shallow wells
Estimated depth to ground water 25 +/- 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: topographic and water contours maps
Checked with local excavators, installers-(attach documentation)
Accessed USGS database-explain:
You must describe how you established the high ground water elevation:
Using the Barnstable topographic map and the Cape Cod Commission water contours map,the maps were showing approximately
25'+/-to ground water at this site.
This report has been prepared and the system inspected and passed as of the date of inspection. This report is
not a warranty or guarantee that the system will function properly in the future. There have been no warranties
or guarantees, either expressed, written or implied, relating to the system, the inspection and/or this report.
11
TOWN OF BARNSTABLE
LOCATION as bCVO^ L,AAt SEWAGE #
VILLAGE ASSESSOR'S MAP & LOT
INSTALLER'S NAME&PHONE NO.
SEPTIC TANK CAPACITY S�
LEACHING FACILITY: (type)TiC Ck (size) y A-a'k GO
NO. OF BEDROOMS 3
BUILDER OR OWNER
PERMITDATE: COMPLIANCE DATE:
Separation Distance Between the:
Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet
Private Water Supply Well and Leaching Facility (If any wells exist
on site or within 200 feet of leaching facility) Feet
Edge of Wetland and Leaching Facility(If any wetlands exist
within 300 feet of leaching facility) Feet
Furnished by �nS C47#�1 FOt�D
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30
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TOWN OF BARNSTABLE
LOG,-kTION i.d'V ffi&V t3 SEWAGE #
VILLAGE- ''
�/ S �� SOR'S MAP& LOT
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INSTALLER'S NAME&PHONE NO. M- e-X.12�1 tJu�,ST- 0-0, :16 C. 11 W t"
SEPTIC TANK CAPACITY ! �
LEACHING FACILrI'Y: (type) ize) YYJ� Y9—
NO.OF BEDROOMS 4`
B D R QWNER
PERMITDATE: -/r COMPLIANCE DATE: .
Separation Distance Between the: -
Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet:.
Private Water Supply Well and Leaching Facility (If any wells exist
on site or within 200 feet of leaching facility) Feet
Edge of Wetland and Leaching Facility(If any wetlands exist
within 300 feet of leaching fa ility) Feet
Furnished by �,/
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NO. PARCI ft. - � � 3 f FEE
THE COMMONWEALTH OF MASSACHUSETTS
Barnstable MASSACHUSETTS
�jjpliration for Disposal �*Vstrnt (gunstrurtt`un ferntit
Application is hereby made for a Permit to Construct (X) or Repair( )an On-site Sewage Disposal System at:
Location Address or Lot No. Owner's Name,Address and Tel.No.
Lot #7 Devon Lane i The Norman Trust
House #128 � i/� � y/ d Box 599, Mashpee, MA 02649
Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No.
Ferreira Associates
131 Spring Bars Rd. , Falmouth
Type of Building:
Dwelling No. of Bedrooms 3 Garbage Grinder(n 9
Other Type of Building No. per Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow 5 5 gallons per day. Calculated daily flow 330 gallons.
Plan Date 7-1 2—9 6 Number of sheets 1 1 Revision Date
Title _Sewage Disposal System Plan prepared for The Irene Trsut
Description of Soil Zest #1: 0"-2" (0), 2"-5" (E) sandy loam, 5"-28" (B) sandy loam, 28"-120" (C) sand
TLst #2: 0"-2" (0), 2"-5" (E) sandy loam 5"-24" (B) sandy loam__, 24"-120" O sand No grmudwater.
Nature of Repairs or Alterations(Answer when applicable) sew- Pl1
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 has been d by this of Health. 11
Signed ._ Date CM
Application Approved by _ ' Date
Application Disapproved for the following reasons
Permit No. ��� ,'? b. Date Issued
-
No. i5 r Y t FEE
t THE COMMONWEALTH OF MASSACHUSETTS- ="
I
Barnstable MASSACHUSETTS
�Vplirativn for Pisposal , gs#Pzrt �IInS#x�xr#tun Frrmit
Application is hereby made for a Permit to Construct (X) or Repair( ) an On-site Sewage Disposal System at:
Location Address or Lot No. i Owner's Name,Address and Tel.No.
Lot #7 Devon Lane i The Norman Trust
House #128 Box 599, Mashpee, MA 02649
Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No.
Ferreira Associates
131 Spring Bars Rd. , Falmouth
508
Type of Building:
Dwelling No. of Bedrooms 3 Garbage Grinder(n q
_Other. -,,,-Type of Bullding4 No,per Persons. _ Sho_wers-( Cafeteria(
e' Other Fixtures _ — -
Design Flow 55 gallons per day. Calculated daily flow 330 gallons.
Plan Date 7-1 2—9 6 Number of sheets 1 Revision Date
Title _ Sewage Disposal System Plan prepared for The Irene Trsut
Description of Soil 7UM #1: 0"-2" (0), 2'1-5" (E) sandy loam, 5'1-28" (B) sandy Iowa, 28'1-120" (9) sand.
Test #2: 0-2" (0), 211-5" (E) 3aTJdy Ioaen, 5"-24" (B) mWy loam, 24"-120" (C) scrod No 4Z+o m&a3ter.
Nature of Repairs or Alterations(Answer when applicable) Sew&0 14 1
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 has been nedby this"B'o"' of Health. 1
Signed _ Date D
Application Approved b / Date
-Application Disapproved for the following reasons ct
Permit No. __ �' .� � Date Issued / ''
.r
THE COMMONWEALTH OF MASSACHUSETTS
MASSACHUSETTS
(fern ttrate of 0.10mytinurr
THIS IS TO CERTIFY, that the On-site.Sewage Disposal S stem installed repaired/replaced ( )on
by _ udNr a e ,.e_
at ' 1e_ C' ' a bee con ted in
accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. '' dated
Use of this system is con •oned on compliance with the provisions set forth below: '
t The issuance of this certificate.shall noVbe construed as a guarantee thatahe system will function,as-designed.This
Certificate ex res on 1 Y
DATE Inspect .Z�"y '' /� _���' .�
r� /V
r� THE COMMONWEALTH OF MASSACHUSETTS
No. �'' ✓ � .f'.,�E.a , MASSACHUSETTS FEE
Visposal Sgstrra (fanstrurtion Ferro
r
Permission is hereby granted to '( G vt S {2 oc 10 ,
to construct( or repair( )an On-site Sewag ystem located at UCJ CD vi
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 construction must be completed within three years of the date below.
DATE F" `� Approved by.
FORM 1255 Rev.3/95 A.M.SULKIN CO.-BOSTON,MA
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Board of Health
Town of eamstable
P.O.Box 534
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Hyannis,Massachusetts 02601
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GENERAL NOTES:
A.I.Scion,final Drawings and Speealutlom are leauad for
congructlon,they shall be submitted to all governing building C
agencies to mauve their compaance with all appilcable local and
national codes.If code dlecropandea in Drawings andlor
Specifications appear,the Designer am,be notified of suc1h
N
discrepancies In writing by Sullder or bulding ofadal,and
allowed to AltDrawings Drange and Specifications,so to comply LLJ
wth governing codes before contraction begin.
v>>t
2.Upon written receipt of approval from the gmemmg official. W
Approved final Drawings and SpodNcatlans shall be submlaed
to the sunder by the Designer.
8.N code dienepandea are discovered dunng the construction
process,Designer shell be notified and allowed ample Wn to
remedy said discrepancies.
4.An work pedomred shall comply with all applicable local,state STEP TO GRADE
and national building codes,ordinances and regulations,and 3ty-0`
All other authoralea hating JuHadldion.Following is a partial
ust of appllable codes In brae: a'-av°
A.Nassadna;etia male" Code,711WMR,gth edltion,
3/1"
8.AN cowactors,subcarNaAota,suppliers,and fabHcffiors,shall be 114A48 46 2-3'-0' 48 46
responsible for the content of Drawings and Spedflcatlane and for _. _.. -._ _ ...................................__...........� m
the Supply and design of appropriate matedala and work
penormance. OFNEW
C.As mdhufadured arlidea,matstWle and equlpmem shall be applied, -Installed,eroded,used,cleanedandconnditlonedin�Ictaccordanwbh manutadurers racommendagons�D.All altsrnloe are at the Dyson of the BWldar and shall 6e at the Builders request,consiruded m addition to W In peu of thet f " ' ° ; mlypleel eonseudion,m Indicated on Drawshgs. 2-3
NEW PATIO AREA
4 SEASON ROOM
—EXISTiNO WALLS m NEWWAU,a^ 'h2g Vz
`?E WINDOW
UNDRY ITRIM ENING
3 G V-v ; ca Z } 0
o a'
P.A. iv
KITCHEN
0
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ROOM
2 CAR GARAGE '.'- -- 0
LU
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c
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DINING ROOM O V
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FIRST FLOOR PLAN CL = a CQ
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a
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!--- - -- --_ - - BUILT-INS
PEMOVE WINDOW BENOVB WINDOWS Y IL
OPEMOVE WIND _ _ ? m 0
O BATH - ------- -- --------- ----------- , Z
BATH �`, - a
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X O SITTING AREA
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' CONT.CONC.FOOTING
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- --- i N BASEMENT I oej
' •' Q w , q •
' I
N i 1.4-NCRETE S
14' G S A DAYS
. 3 AGGREGATE 1.
®=E%ISTINO WALL8
=NEW WALLS
tq
EXISTING BASEMENT �"—� o
In
I
FOUNDATION PLAN
o m
Z
2X10 FLOOR JOISTS @ 16"O.C. 4 in
m W
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LLJ
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FIRST FLOOR FRAMING PLAN A4
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i �" —• ZX70 FLOOR JOISTS EXISTING
i
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FINSHGAD E '. ,,.
V ,•.,
LU T S L A A ION S I E
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:. FINISH GRADE
FINISH 6AADE.
APPLICAT_ NO : H 78 .. 59 d ,a
,•: , $:.
OVER TANK
-
OVER TRENCHES; .Q _ >,
•. - ( '
APNIL J99�S r /r
TOP FND i i i� :> r ,,;
,
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SCH 40 P. C :e 4� �
° / ,�j
TEST ! TEST2 / / .
• •. � _y,
ON r - -
o ?.50 OR
ti .,.
s. '.
.: t CAST IRON TEES ''
0. D F.-'a. , I a•de°yQoc0e�00oo 000. ...
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.. -,- .. ,..:. . . • ':I.t.. ' Q "p:°.d 0.0 p.Q d..90 •.O••r.j `I :' St'
2 2 ;•. O a
•it 5G�.94 3V•4�V 1...� ..r O�:p ge a�o'0 4 0 �:0 (.AP END.C! •'.., '" r;":.
BSM'T FLR s, � *� C n .. t° •o° o• o
r .E, , 1;. {' E AALiI.G�w7 opo°.a0Q ,,, o o0Y OAT ELEV. a x,;
E•. i.'_ :• tsoa GAL. � 57�0 5Q oa ♦ o 00 a 0 0 0.'° °,
SAMOY LOAM SANDY LOAN 53.0 �,.• REINFORCED ' 000v,aoq boo ♦ v•°no-o.�. d
2.sY Z� sA5 DIST BOX p o o p e p o
2.3Y 9/i ,.. : CONCRETE a0.��'o p • o p.� o ,�..{
,,
. x . . O Q p. Q Qoo - • : ..,:
♦ • N .. ...I ► o• a ..
s. s. •...,.,... !.. TO BE_INSTALLED ON A oQ 'o° O e a p e
•B•
LEVEL STABLE BASE fl�ao Q o a o 0.aape.d: °°. #±
sANDrLD,N sANOr coAM SEPTIC TANK
54.50
I0YR s/s lora 5/6 TRENCH LENGTH ,
TO BE INSTALLED_ ON A 60 .
2e• 24' LEVEL STABLE BASE
„_ . I
*c we. 4'MIN.HEIGHT ,
SAAV SAN NO TE. DO NOT RUN HEA V Y EQUIPMENT OVER SYSTEM ABOVE OBSERVED -
tOYA 7/4 loYR 7/4
' GROUND NA TER
.
120'
1201 LEACHING TRENCH SECTION
,vII,Ir 1,II�:II1ki ILI.-,._II 1"�';L1I 1_I��.6"�1I III�1,,II I'1c,4 I II,IL.I�j I.I I.1-.�I 9I-I IIL IIL-9�"�Ia 1I1 ILI I�q�.I1,,I I1 II:II1 1I�,,I:,I-I,,.I�1.,I_IIl��1,I I�III�l-I�II-,4 I i I.1 II�I'�l1�III�L I0_I I/1I.1_1l.I.,",I�,I"Il-II-,,I lIL I,I-I�I II-�-I
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NO 6ROUMDMATER
NOT TO SCALE SOIL AND PERCOLATION DATA . � :,, ',
(PERC'D AT 39'- 2NJn/in)
�._,.I�_%I��"I"��1"I-1,-L.�,�II,I1���_,l 1����I I N1_.6,I,.4jII4..I r.IL"�II'-I I rI L'I,:I,__''�j II.,I*I l�I.`�I-I II I I I III I II/I��I�.I �II III I II II L
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-"I�7�-1�,;L,'z,L:_L L1.1I"'-'�,,-I''-,1,�,",I!�,k',
FOR FINISH GRADE
- APPLMA T3O�V AV. P-W78 - ,SEE SYSTEM PROFILE :: "4, ,
{
PERC RA TE <5 .MIN/IN
, z
. �tR
12"MIN. TAKEN 8Y Rllat#.IAD fEA�#E?RA
„ ,A-
..,.:,, :.
:
...-',:... ...�.
NI TNESSED BYAAD BAA4Y"
.: %
_ ,, , DATE ;API�iIL:2B� J98B.
' - MIN.2 - ? B -1 2 ;•a
4 DIA.PIPE / ,,,t.
i✓ASHED STONE
TEST P .T ELEV, d97
A ,
. TEST PIS'`ELEV. o.4 -" . -
Y a
U -NATURAL SDIL- 2'MA V r , ; '`-.., lac f X EFFECTI E f�
N PT
,rq DE H NOTES k
I ;
�y // N Nh
l 4 ...
O 3/ -1 1/2
y a
J. ELEvA rIpW�S`BASED ON .s:t; „ x
_ WASHED STONE .`•- , „ „_ ;
6� 2B MIN:= gX 2. TOW KA'TER';& $STD ' ,
-. :�
+ '
,r & ,.
Jp9 E EFFECTIVE WIDTH . :
.? _ EXCA VA TED SIDE; L L 4 - 0 _ � y'>
`� 4 6iA�Ol� 6jm TER ,fLEYA T OW 20.'7 ,OR DEPTH I
"'. ,
V W , , .,y
,._ DATA EJ4l?M TEST MlUS '
.,>
FFECTI E IDTH
L : E_. IN 5jAW.rvISSON
f a
--.. NUMBEFI OF TRENCHES
-�--. ,
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DESIGN DA TA , a ar: � t
sET,e �- ,. 256 S. F. SIDEWAL L AREA _ 74 GAL S/SF I89 GAL S. ,' r �
Q '� `A <r, '� NO.OF BEDROOMS 3
2 > : ,x
Q ` - ;^'°�c ti .i 78 DISPOSAL �n ' _.
: c__ r 240 S• F. BOTTOM AREA . 74 GALS/SF GALS. T ,., f. .: 4 .- '„$
ES . TOTAL DAILY EFFLUENT JAW'• GALS
a `
.. �� OAT ...,w
.E ae SEPTIC t TANK _ GAL
4 6 S. F. TOTAL AREA 367 GALS.` e
LOT 7
W
- A
;
W
57 359-`SF ~
- - . •` • * ' r $
GENERAL NO TES :
B0 .
s,
�;
I.
NO TE• q<
'� ,-- -�o I. ALL SYSTEM COMPONENTS `SHAL`L BE .INSTALLED ,SN ., , r
y W ��'
ACCORDANCE: WI TH TLTLE 'S OF THE STA TE-,SANITARY.CODE ,;
.4 EXCAVATE TO ELEV.5 .O OR LOWER AS REQUIRED -°
i TO REMOVE ALL LOAM AND CLAY CONTAINING
DA TED MARCH 1995 AND ANY LOCAL 'RULES APPL�'CABL E
,
_ ^- ATER AL NEA7H THE.LEACHING AREA.REPLACE 2 Y CHAN N_THIS LA UST PPROV D "n' , „;- 4jt `'::Z,
o M I BE AN GF .I P N M BE A E w ,
t o �,,, -
tc� EXCA A TED MATERIAL I TH CLEAN, CLAY FREE GRA VEL B Y'' THE'B0�4 RD `OF HEAL TH
-3 ZS' :•. D - O I a , n ,aim ,
ts� MECHANICALL Y COMPACTED IN PLACE
�``� , , _,2. 3. WHEN CONSTRUCTION ;IS COMPLETED, PRIOR TO ,BA CKFILL ING
•+ N nXL B8k'T ___._j
• NOTIFY BOARD OF HEAL TH FOR INSPECTION " _'
LOT 8 IV "` '`g _ &I 4. FND. EL EV.MUS T 'BE. CHECKED WHEN'COMPL E ED
} 'g rand BAG PALPRSED (1I
,-
2 I . SEPUC rAW LEAMXM 7REMW 5. THESE ELEV.MUST NOT BE CHANGED k/ITHOUT ,°
40- ; , 00'Lays�411.rm 2• S LEGEND
I
I.
s� s' (SEE mrLE1 I THE BOARD OF HEAL TH APPROVAL „' � ': , -
` �.
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