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HomeMy WebLinkAbout0010 FAIRHAVEN LANE - Health 10 Fairhaven Lane Marstons Mills P A = 149 033001 No. Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes Application for Migogar lq�p!tem Cootruction Perm Application for a Permit to Construct( ) Repair(gradeAbandon( ) ❑.Complete System Individual Components Location Address or Lot No. �� '44—/i-//o1e w 44e0l_ Owner's Name,Address,and Tel.No. �•�/,S 3y�i��''/wry c Assessor's Map/Parcel �LL// //� " Installer's Name,Address,and Tel.No. ���OTTTf G�'✓�� Designer's Name,Address and Tel.No. SaFr - 9 •1!l Type of Building: Dwelling No.of Bedrooms Lot Size pg® sq. ft. Garbage Grinder ( 0 Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 13-70 gpd Design flow provided 3,010 gpd Plan Date eG o0,Y Number of sheets / Revision Date Title 17 `e y/ Size of.Septic Tank #)6 �.Gvd C C Type of S.A.S. 3aJ-A L J Description of Soil a t--r f 1g Nature of Repairs or Alterations(Answer when applicable) ,r-- 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 B rd of e Signed Date r�'�/-o Y Application Approved by Date 10 2 �6 Application Disapproved by Date for the following reasons tl Permit No. Date Issued lq 2C{ op No. .2OU "��� -. :, Fee � t THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes ZIPPgication for �D* Oal *votem Con0truction Permit Application for a Permit to Construct( ) Repair(`)grade( ) Abandon( ) stem❑.Com lete Sy stem y ©'Individual Components `Location Address or Lot No. Owner's Name,Address,and Tel.No. 7 Assessor's Map/Parcel Installer's Name,Address,and Tel.No. Y��T 4��,� �js.��/, Designer's Name,Address and Tel.No. G 'aloe 471�- /JC.G< /, v>•J1I/ls� ae� S7lY �x-f�S4'/ xr�-� r7,.-,� ✓� Type of Building: ``- Dwelling No.of Bedrooms 3 Lot Size Iva, 47/0 sq.ft. Garbage Grinder Other Type of Building No.of Persons Showers( ) Cafeteria( ) i Other Fixtures Design Flow(min.required) ✓(3 gpd Design flow provided 3%0 gpd Plan Date, [/C Number of sheets / Revision Date Title —;r, Size of,Septic Tank., 000r e5'0-( Type of S.A.S.I �- 3�J� ��.�E/•,s �t ' Description of Soil ,.,- Nature of Repairs or Alterations(Answer when applicable) 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 Health. Signed W� 90,9, r - „"' Date d'//,�� ! Application Approved by 21 ---� 1 L G' /.1,/r� Date if 24 Application Disapproved by: Date for the following reasons Permit No. --( ,��^ L,/�':� Date Issued 0 Al Z/ De, THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS (Certificate of (Compliance THIS,IS TO CERTIFY,that the On-site Sewage Disposal System Constructed ( ) Repaired ( /Upgraded ( ) Abandoned( )by at 1.4- has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. nfl- yS3 dated lv 24 Installer /�,. �, 1� ���/. �✓ Designer 4,— #bedrooms Approved design flow �� / gpd The issuance of this AApermit/shall no[bbeeCgoo'nstrued as a guarantee that the system will f nccttiiojn asdesiigned. p � Date 11 / 1 //l Inspector `7 'C� No. �- 7J� 7 Fee /[/G✓ THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION—BARNSTABLE, MASSACHUSETTS Migogor 6pgtem Conw9truction Permit Permission is hereby granted to Construct ( ) Repair ( 1j') Upgrade ( ) Abandon ( ) 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.A Provided: Construction must be completed within three years of the date of this permit. Date �� / �JJ9 Approved by . 1'f FROM :down cape engineering inc FAX,NO. :150836213880 Oct. 31 2008 02:34PM P1 'Fown of Barnstable Regulatory Services a Thom 1'. (4Q:Her,Director + BAStiVSrAE[�. � 4s S. Publie lealth Division Thomas Director Zvi?-NIRian StIrewet, .HTHnlnls,.MA 02601 Office: 508-862-IW Fax: 50$-'/90 G1U4 In staffer Deshmer C'crtiflultion Form Date: #—_3,0q Sewage permraim Assessor's 1VBAsP1Y'atn-cel Designer: �d/� j kI�� ins9:aa➢lea: fir U`f} C l� , Address- �c3� C a./ q L_ .... Addrt.%N: _ 0�/ ()11 Z/&iZ'4 was issued a permit to install a (date) .ler) septic systutn at kR nt_ based on a desi.grn drawn by (address) I certify that the septic system referenced above was insUilled substantially according to the design, which.r,_bay include ininor approved changes such as .la.tera.l relocation of the distribution box and/or septic. tank. 1 certify that the septic ,,ySteM referenced above was lnstdIed with major. changes (i.c. greater i.hau 1.0' latera.l.relocation of the SA.5 or any verfic.al relocation of any component of the septic system) but in accordance with State &.Local RegWat.ions. Plan revision or ceilif..ied as-built by designer to roll.ow. �NcFn � DANIELA. ist, sSi.Tn..ata re OJt' ) " CIVIL a� s7 �0N10D n}"TONAL t (De, Igner'ti Signature) I (Affix Designer's t4uarp Derr:)__ PLEASE la1JTLA N •rc► 13.AR.N,,.CAJ3T,E PUBLIC:_'HFA9.,TI.I DIVISION. 4EKTINIC:ATE QF C;CYMPLIANCr VMA, NOT Ali; [SSIT). l_D UiNTIL BOTTj. THIS 1+'ORM AND IT CALtl'b .tllfdlIF, BA7ktNSTABLE PUBT,TC:.H.T:, L'I'ki DIVI:4Y(DN. THANK YOU Q: Lleo-,lth,'SeZ�t.i.taTlrsi aerCarlificatim Form 3-26-U4.doc t, r COMMONWEALTH OF MASSACHUSETTS � `P EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION ! s,. ..CEIVED ,f I J U N 0 2 2003 1 U+..v v, bARNSTABLE HEALTH DEPT. OFFICLaL INSPECTION FORlNi TITLE 5 — NOT FOR LUNTARY SUBSURFACE SEWAGE DISPOSAL SYSTEiv FORItiI�IENTS PART A. CERTIFICATION MAP I _. Property Address: �0 �e�, r�6ke-J cif/ PARCEL : Owner's Name: i nT . Owner's Address: O �, �AAP •wI Date of Inspection: - 7 Name of Inspector. (please print) Company Name: � / C2 C C Mailing Address: d Telephone Number. �Oa CERTIFICATION STATEMENT I certify that I have per5on3lly 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 CitiIR 15.000). The system: v Passes Conditionally Passes Needs Further Evaluation by the Local Approving Authority Fails Inspector's Signature: Date: ;4�az The system inspector shill submit a copy of this in re ng Authority (Board of Health or port to the Approvi DEP) «iehin 30 days of completing this inspection. Lf the system is a shared stistem or has a design flow of 10,0U0 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. t; Notes and Comments S7`2v`1 s /tom J / 1 �j O(9� �C�� c'i RRRR 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 s conditions of use- ystem will perform in the future under the same or different F OFFICIAL INSPECTION FORM— NOT FOR VOLUNTARY SUBSURFACE SEWAGE DISPOSAL SYSTEM IYS ECTION FORNf PART A CERTIFICATION (continued) Property Address: l0 f— I I(",11PN Z-� Owner: C 1f oil �/ d�69V Date of Inspection: S r Inspection Summary: Check A,B,C,D or E/AL�ys complete all of Section D A. Syst asses: have not found any information which indicates that any of the failure criteria described in 310 Cl\,M 15.303 or in 310 CMR 13J04 exist. Any failure criteria not evaluated are indicated below. Comments: B•/JS�•stem Conditionally Passes: —1•= One or more system components as described repaired.The system,upon completion of the replacement or repair`snapproved b}the Board of ealth Pa��"section need to beor repaired. 11 pass. Answer yes, no or not determined(Y,N,ND) in the for the follo«ina c�=r� i• a statements. If"not determined"please The septic tank is metal and over 20 years old*or the septic unsound,exhibits substantial infiltrsdon or e.�iltration ortank>�lure�(whether metal or not) is structuralh• existing tank is replaced with a complying pp trttrttinent. System%ill pass inspection if the *A metal septic tart!`«ill pass 'septic tank as approved by the Board of Health. indicating that the tarty is less than 2c0U years on if told it is s available.csound not leaking and if a Certiflcate of Compliance 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 ins inspection approval of Board of Health): R if(µith 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 'ill pass inspection if(Mdi approval of the Board of Health): broken pipe(s)arc replaced obstruction is removed ND explain: I , OFFICLAL INSPECTION FORNI - NOT FOR VOLUNTARY ASSESSN SUBSURFACE SEWAGE DISPOSAL SYSTEM Pt tSPECTIOY FORIE TS PART A • CERTIFICATION (continued) ' Property Address: T��r„yAvP� lit Owner: C Date of Inspection: C- Further Evaluation is Required by the Board of Health: �Conditians evst which require further evaluation is failing to protect public health, safety or the environment.the Board of Health in order to determine if the s}stem 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 n•etland 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 1 of a public water supply. The system has a septic tank and SAS and the SAS is «ithin 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 laboratorv, 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 chart 5 pprn, prodded that n failure criteria are triggered. A copy of the analysis must be attached to this form. o other 3• Other: OFFICIAL LYSPECTION FORM— NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORj%y1 PART A CERTIFICATION(continued) Property Address- / Gt rs o✓2sDot 6� Owner: i c o Date of Inspection: D. System Failure Criteria applicable to all systems: You must indicate"yes-or"no" to each of the following for all inspections: Yes NO ; 71//ackup of sewage into fscilitti•or system cozaponent due to overloaded or clog t— _:1 TCO--- Statichorge or ponding ed SAS or cesspoo� g of effluent to rife surface of the ground or surface waters due to an overloaded or ed SAS or cesspool liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or esspool quid depth in cesspool is less than 6"below invert or available volume is less than V,day flow Required pumping more than -i times in the last ear NOT due to clog /df times pumped y clogged or obstructed pTC(s). Number I/ Any portion of the SAS,cesspool or privy is below high Any portion of cesspool or privy is within 100 feet of a surface Alater supplytor tributary to a surface 11,11'11�•ater supply, P rtion of a cesspool or privy is within a Zone 1 of a public well. v 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, Nl-rformc.' DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates t::... :ne 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 future criteria arc triggered.A copy of the analysis must be attached to this form.) (Yes/No) The system fails. I have determined that one or more of the above failure criteria exist described in 310 CINIR 15.303,therefore the system fails.The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E. Large Systems: To be considered a large s•stern the system must serve a facility gpd. with design fluty of tO,iH)q gpd to 15,04)i) 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 pp� If you have answered"yes" to any question in Section E the system is considered a significant threat. or answered .yes" in Section D above the Ir-'e 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 CN R 15.304.The system owner should contact the appropriate regional office of the Department. OFFICML LNSPECTION FOR1N1- NOT FOR VOLUNTARY SUBSURFACE SEWAGE DISPOSAL SYSTEN, INSPEION FORINI. S PART B CHECKLIST / Properly Addrrs3: 62 G y Owner: Date or Inspection: Check if the follo«ine have been done. You must indicate`�•es"or"no" as to each of the following: Yes o Pumping formation was provided by the owner, occupant, or Board of Health V Were any of the system components pumped out in the re,.Zo P us two weeks ' /Has the system received normal flows in the previous two week period v" Piave 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?(L'they-were not available note as N/A v — Was the facility or dwelling ) inspected for signs of sewage back up Was the site inspected for sib of break out Were all system components, excluding the SAS, located on site Were the septic tank manholes un v of the co erect opened and the interior of the tank inspected for the condition of 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 Yes on: 0 Existing information. For example,a plan at the Board of Health. Determined in the field if is unacceptable) (310 CNN 15.30? any of the failure trite is related to Part C is at issue approximation of distance c(3)ro)� OFFICLA-L LNSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTENI INSPECTION FORlti1 PART C / SYSTEM LNFOPLNIATION ss Property Address- / _/ Fc3rr /TGve� �y Owner: I�! 14;1 0�.6Date of Inspect RESIDENTIAL FLOW CONDITIONS Number of bedrooms(design):--Z Nurribcr of bedrooms(actual): 3 DESIGN flow based on 310 CN R ,5.203 (for example: 110 gpd x R of bedrooms): Number of current residents: Does residence have a garbage grinder(yes or no); /l%O Laundry system inspecte Is laundry on a separate sewao oe system (yes or no):/V� (if yes separate inspection required] d(yes or no): /f!O Seasonal use: (yes or no): Water meter readings, if available(last 2 years usage(gpd)): SUMP Pump(Yes or no): 1/-o Last date of occupancy: u i„e,,-,�— CO MMERCIAL11ND USTRLkL Type of establishment: Design flow(based on 310 CNN 15.203): Basis of design flow(seats/persons/;gttetc.): 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 Wnipancyluse: OT ER :: x): Pumping Records GENERAL IINFOP"NUTION P b Source of information: /�U Was system um ����c � If yes,volume Pumped:P�of the inspection(yes or no):LVO `� oZ P ped: ,gallons—How was quantity pumped determined? Reason for pumping: T.��F SYSTEM(V/Septic tank distribution box, soil absorption system Single cesspool Overflow cesspobl _ivy _Shared system (yes or no) (if yes, attach previous inspection records, if any) _Innovative/Alternadve technology, Attach a copy of the current operation obtained from system owner)' and maintenance contract to be —Tight tank _Attach a copy o the DEP approval Other(describe): Approximate age of all components, installed(if known and source of iafortrradon: 1 U1 Were sewage odors detected when arriving at'he site(yes or no):�p OFFICIAL INSPECTION FORM— NOT FOR VOLUNTARY ASSESS, M SUBSURFACE SEWAGE DISPOSAL SYSTE I INSPECTION FORMYTS PART C SYSTEM LYFORNIATTON(continued) Property Address: P gawk?Owner: lG � Ot Date of Inspection: BUTLDLNG SEWER (locate on site plan) Depth below fie: 3/ Ltaterials of construrtio❑: 1/�ion / or suction line: Distance from private — well �Pvc—:other(explain): Comments(on c condition of jo nttsl venting,evidence of leakage, etc.): SEPTIC TANK: (locate on site plan) Depth below grade: 421S � Material axplain) — construction: vonczete _other(e metal fiberglass_polyethylene If tank is metal list age:_ Is age confirmed by a Certificate of Compliance es or no : certificate) (Y ) —(attach a copy of Dimensions: Sludge depth: Distance from top of slud�j to bottom of outlet tee or baffle: 07- / Scum thickness: Distance from to of scum to top of outlet tee or baffle:—� Distance from bottom of adore to botto f outlet e or baJ313�: How were dimensions determined: 41 �/ _ Comments(on pumping recommendations, inlet ou tee or baffle condition,structural irate as laced to outlet invert,evidence of leakage,etc.): wry•, liquid levels eti �e i�, om�✓ GREASE TRAP'(locate on site plan) Depth below grade:_ Material of construction:_concrete metal fiber (explain): — — gass —polvethylene_other Dimensions: Scum thickness: Distance from to—p o f scum to 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,stru as related to outlet invert, evidence of leakage, etc.): integrity, liquid levels r OFFICIAL LNSPECTION FORM—NOT FOR VOL UNTARY SUBSURFACE SEWAGE DISPOSAL SYSTEINI INSPECTION FORT INrS PART C SYSTEM INFORINIATION(continued) Property Address: Q Owner: Date of Inspection: TIGHT or HOLDDIG TANK:Z1/ (tank must be pumped at time of Depth below grade: i nsFection)(locatc on site plan) Material of construction: concrete metal ; fiber ass Z _poly Dimensions: ethylene other(explain): Capacity: Design Flow: gallons Alarm present(yes or no): gallons/day Alarm level: Alarm in working order(yes or no): Date of last pumping: Comments(condition of alarm and float switches,etc.): DISTRIBU i v Lpy; (if Present must be opened)(locate on site plan) Depth of liquid level abo%.. .. invert: 14�i��/ Comments(note if box is Ic•.e! s;:d distribution to outlets a;e �any eNzdence of solids carryover,any evidence of le�o into or out of l Lam/ ) —roll C/6r �a PUMP COMER: locate on site plan) Pumps in working order(yes or no): Alarms to working order(yes or no): Coments(note condition of pump chamber,condition of ps.etc.) m umps and appurtenance : OFFICUL LNSPECTION FORIti 1— N SUBSURFACE SEWAGE DISPOSOAL SOYSTE 1 TYSpECI'ION ARY p�E NTS PART C RI 1 SYSTEM LYFOPUNIATION(continued) Property Address: G� Owner. J /C ® �� /�/�� 61)6lcf Date of insp nono G SOQ,ABSORPTION SYSTENI (SAS): (locate on site plan,excavation not required) If SAS not located e.,cplain why: Type leaching pits,number: t7( leaching chambers, number.leaching galleries,number: Wleaching trenches,number, Iength: � leaching fields,number, dimensions: overflow cesspool,number: innovativelalternative system Type/name of technology: Comments(note condition of soil, signs of hydraulic failure, level of ndin� etc.): Po '.damp soil,condition of vegetation. ®� / n -/ _ r... CESSPOOLS• = — (cesspooi must be pumped as part of i -Pectiow7 locate on site plan) Number and configuration: _: Depth—top of liquid to inlet invert: beptn 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.): PRIW: (locate on site plan) Materials of construction: Dimensions: Depth of solids: Comments(note condition of soil, signs of hydraulic failure, level of ponding,condition of vegetation,etc.): r ` OFFICIAL IINSPECTION FORi-,1—NOT FOR VOLUNTARY ASSESSMENTSSUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM LNFOR1 ATION(continued) Property Address: A� C[✓ _ nisi dr//// /�/ Owner: Date or Inspection: 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 nester supply enters the building. �/.1✓ �� /fOr1$ �ise✓ — S00 I a 1, s,��,� v r �t �. _. ��. ., . - •.�, �� Thy I-So v �l10 r Page I I of I I OFFICIAL INSPECTION FORD[— NOT FOR VOLUNTARY ASSESSMENTS • SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM LNFORNIATION(continued) Property Address: /� �et�� / ✓eo G,v Owner. Z G Date of Inspection: p SITE EyLkNI Slope Surface water Check cellar Shallow wells 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: _1ebserved site(abutting properrf/observation hole within 150 feet of SAS) V Checked with local Board of Health-explain: �S Checked with local excavators, installers-(attach documentation) Accessed USGS database-explain: You must de ri ow you established th high round water elevation: �Ptiti y A o2/ ® io un w�• q Toy �o ?e — C 9,3 0 oG oo 000 b .0 0 Q° 0 0 0 0 v 0 D O O A G cJ > LL_ J v 2 ( 0 Vq tit (4 TOWN-OF BARNSTABLE LOCATION f, I'j ��� L e+/ SEWAGE # •� �� VILLAGE f�M'.IC ASSESSOR'S MAP&LOT INSTALLER'S NAME&PHONE NO. el5�`: SEPTIC TANK CAPACITY 1 S(3b LEACHING FACILITY: (type) `1, .SQ !2-51 (size) NO.OF BEDROOMS BUILDER OR OWNER 121 AAA PERMTTDATE: _COMPLIANCE DATE: C/ 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 facility) Feet Furnished by qqST 13, 3 v i No.. - 2A LAf00 Z Fizz ; THE COMMONWEALTH OF MASSACHUSETTS L/1 BOAR® OF HEALTH TOWN OF BARNSTABLE Appliration for Diripatial Work,i Tomitrurtion Prrmit Application is hereby made for a Permit to Construct (i/) or Repair ( ) an Individual Sewage Disposal Sy st a -- ../... ...+.fi :crti� ... .. 2 Lo , ion-Ad res r t No. .................... . dress i W .................. ---- - ------- --------------------- --des - ----------------------...-------------•------....... ---_'''(1- 4ot'Ko7�II !9 llYt. Address C UType of Building � Size Lot..__.qjg&....Sq. feet 7�[ Dwelling—No. of Bedrooms __._._.... --------____-._.Expansion Attic (Al() Garbage Grinder (wp) aOther —Type of 13uildi1iA6Vr/..r No. of persons---------------------------- Showers ( ) — Cafeteria ( ) dOther fixtures . - -------------------- ------------•--•'...."--•-•----•--------"-'...._---.-----.. Design Flow.................. /0----_-_----__-_gallons per e'r day. Total daily flow.-_.......:3 30 ........gallons. W g -- g� P P Y• Y - -- --------- WSeptic Tank—Liquid capacity............gallons Length---------------- Width_-------------- Diameter..-.------------ Depth................ x Disposal Trench--No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing t,,��n�1j� Percolation Test Results Performed b :tF:. Z ................... Date........q1! l�v Test Pit No. 1................minutes per inch Depth,,of Test Pit.................... Depth to ground water........................ GLl Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water..................... Description of Soil------------ -------... ....... ---- • V ----------- ---------------------- ---.---.------------------------------------------- •---------- ••--'------ ----------------- •--------- •-------------------------------------------------- UW .........................................................•-•-----....-----------.--..........----........----..........................:_......................_._...................................... , Nature of Repairs or Alterations—Answer when applicable........................_...__.___................._.__.__..._._._...._.._...................... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance'has been issued by the board of health. Signed ... ----- ( .. .... .'f6..: .. .:.. re Application Approved BY --------. -- `�i-.u�,.�---- -------- ----------- --------------------------------------------- ..... :-3g ..tY... Application Disapproved for the following reasons: ...................................... .. . . .. .. ........... ...................--- -- -- :....... ....................................... ............................. ...........................---........................ ........................................ Permit No. .........._v._.......,,,t7-6.f 57-6.1........ Issued ......................................................... ce Daze r F• 33- 1 N �.... - riI Ul Fizs...... THE COMMONWEALTH OF MASSACHUSETTSLJ t I 'J/ BOARD OF HEALTH /60 TOWN OF BARNSTABLE Apphratinit for Uiripwiai Wnrkii Tontitrnrtiun ramit Application is hereby made for a Permit to Construct (V) or Repair ( ) an Individual Sewage Disposal o System at: ((�, - fi a��� .....m..... --•-___•_..........•--•..._..... '('tom -p ------.... ------•--•---------•-•-------------------• Lori lon-Ad res t No. .._... -- ...............................................A................................................ Own d lress W � I ( l� �•-.._...... _ •---- Installer- ----• -- ....�_. . /IS�IjC1L! /LAC Address3 oa Type of Building Size Lot..___..._s... ............Sq. feet 6Yy �., Dwelling—No. of Bedrooms---_-------_____ -----Expansion Attic (/✓C' Garbage Grinder (vo) i a Other—Type of Buildiuga/0V. ."�.. !-_.1 of persons---------------------------- Showers ( ) — Cafeteria'( ) Other fixtures --------------------------------- --•-- /g g P peNo P Y Y 1- W Design Flow..................:..�ja._.___.._.._._..__gallons er. -er, ora- er day. Total dill flow_.___._.._...__ ....................gallons. tic i 'Disposal Trench—Tank—Liquid capacity--......_dthns Length Total Length idth............-_'Tootal leaching area__ Depth.......sq. ft. 3 Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tan ( ) 1 Percolation Test Results Performed by���.��QP!i.. .. .:.-----------------" Date........g ......r..��.q....._.. P P P g't' r�r� '-_ Test Pit No. I................minutes per inch Depth of Test Pit._._____.._._......_ Depth to ground water........................ (% Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground-water........................ P41 -----------•-----------------------------------•--------------•-•-•_••-------•_--•-•-•---•--•---_•---••--............--------------. O --Description tton of Soil... ..: aW►..............................................----------------...--------•--------------------•----•--•-----.....-•----•-•--- W ..............................................._..................................................... ' •--- -----•-------------------------------•----------•--•---------------------...--•-•••-----•---•------------•---------•---•-•---•--••••-----------•-----•-•-•-•--•----•••......•-••••-•-....----•---• . U Nature of Repairs or Alterations—Answer when applicable-------------------------------------------*.................................................... -•...................................••--•--•---.........._..._..........-•-•--•-•--•---......_......_...-•--•--•-•------•---•-""-•-------•-----.............._._........--•••••••••••••................ ' Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been is}�sue�d�by the board of health. Signed .../Xt //`�..G�° = .. .. C. J. 1<a......6.` .. .... t Application Approved B ................ V.. _...........................-....................... .........-..3.c^a...�-. -..-.... PP PP Y . .. ..................... .- .....---................................-p...ice...-..�y Application Disapproved for the following reasons: jPermit No L/----...-- ....................... Issued -- ....--..............................................D�....... Dace THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Tiertifirate of Tompliance G T�, S IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ✓) or Repaired ( ) by ---\......------------------------------------------------------------ at III l.S �. - ..- .........�4-U.T......../_V".....r19.he.H_ffV /(J.- --A. .......... .................Y�I..�L�.S.................... .............. ... has been installed in accordance with the provisions of TITLE 5 of The State Code as described in the application for Disposal Works Construction Permit No. -...-� -.-....._._--.---_--._....-. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE C NS UE AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE................................-_... .. ................._.--------..---.------... Inspector ..._ .......................................:.............................-----------....----- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ~`*. TOWN OF BARNSTABLE / No._ FEE...�L. 1 ...... �is�r�a�tt1 nrk� �>an�tr�trtti�an �erntit Permission iss hereby granted.... /L(.Q�C�! ,✓---•----------------------------•-•-------------------•-•----------•----•-.--.-..-..----•--- to Construct (-y ) or Repair ( ) an Indivir ual Sewage Disposal System at NO..- C--- = ..-.. ri P street �� �� as shown on the application for Disposal Works Constructloermi tNo. ..._- __ �-__ Dated........................................... ..............................-------.....-.......................... ................................... ----•---••--•-•--••--_•--.- Board of Health i DATE..------•-----------•---•---•---•---•------••-•••••. FORM 36508 HOBBS&WARREN.INC..PUBLISHERS TOWN OF BARNSTABLE• LOCATION SEWAGE # VIITGE M Dw'.(( ASSESSOR'S MAP& LOT 1 - _ INS:tAiLER'S NAME&PHONE NO. SEPTC:TANK CAPACITY 1 S?z LEACWNG FACII.ITY: (type) 5bo IV (size) NQ`OF BEDROOMS 3 BM"DER OR OWNED I rA n l;0e"' o PERIwiUDATE• COMPLIANCE DATE: Sepacati6' Distance Between the: Mai mqm Adjusted Groundwater Table and Bottom of Leaching Facility Feet Pri: ate,Water Supply Well and Leaching Facility (If any wells exist on?sS`e,or within 200 feet of leaching facility) Feet Edge;of We and Leaching Facility(If any wetlands exist �Pkhi i:300 feet of leaching facility) Feet Furnished by ; . D of S. M =h- i 4' t T _ I Map 149 pcl 33 # Test pit #P-8279 ,j - -Made 9 22 94 ; x ' Barnstable Falmouth Road - • _- _ _. • - _ -•- -. __ .._ -_ ._ . ._1___ ._ Wit. Ed_.Barry -- �� No. water encountered :, Perc. less 2 min per - 1" E4: .. t _ Cor l4 Su it So IL 10 Ya i.r,have , =z` _ S A�.,a 1 han'e 11 � . ¢,.� :G !Sao 4o- wide8 0___.._ I -- _�.N Gsr,.-_�.__ _. .. _ _ _. - a i _ I N�Rop. 0-g' Septic design No. bedrooms 3 `-- Req. leashi ng_.- 330 ..gpd ---A eq. tan 1 g k :Leachinq • 12X25-3.201x. 74 2.3'7 qS x2'=1'Si x. 7 4 = 11;2 r 0 (_ Total leaching 349, 0 qpd 16 , I Profles no scale- Z'oV IJ,�: ra U PiL` UQV TL 4�} ,Al h5 N Ca 2 p raJF 560 S j ,+ f*lb 6A.5o'raNJBg,. r. ._l_ _ .. _U G9 4 Gl G C7Cj__.,..._..�� / I. ✓t. (. / r l_ J� 5`�y'� ? c.,�c..?i , '� St'v v 'Use 2� ` - - _ 4 '. :gal legs OvT�.dr= ArtI- f ?with A of stone {�r not.ra r . 1 i �u�d ;units. t_ - ; Not =_•-firJ4 work toor>i�form �.- ; � 'to it,he + finmum requirements [ .Je / i ..�_1-! _I ' _ JG�"c�dcr�•z.� �/SCIZ� � ��1!g� i ,. I iv •. /Y" ;GPj , .__ j, A r.tJ a.j.c3+xr a`?; 41 1 irt' I ` I �1_. ` L -- - - — ---- - f - - - -- - �- � Site gran o �abd 'in Aha-rs-ton .Mil ls� MA _ r 1 posti f7. -� Being lot 14 asishown in bk 487 pg 66 . . ._ : .- , E1e'vations 'are n, NGVD Date :Agent Barnstable .board 'of Health . j Scare =1 -50 ,Date 1:2-26-97 _. �. I All Capp .Engin4erinq r _ 49 ;Harbor_ Road . . I a s_ - A _ - - ' Hy nni .M G2b�01 1.Z�OF� av• 8i d 1 _� a f o`' ROBER7 ,�� ia- •y i_L.: _ . : FITZGERALD jA + GI IL E _ j . _. : 1 i .39791 J - _� _ I � , t , I w.. i SYSTEM PROFILE MARk MARKED WITHCMAGNETICTTAPE OR SHALL BE NOTES (NOT TO SCALE) COMPARABLE MEANS FOR FUTURE LOCATION. 1. DATUM IS APPROXIMATE NGVD � ACCESS COVERS TO WITHIN 6" OF FIN. GRADE 2. MUNICIPAL WATER IS EXISTING TOP FOUND. EL. 63.5' PROVIDE INSPECTION PORT TO WITHIN 3" OF FINAL GRADE Ramie Zone \ 62.0' 2% SLOPE REQUIRED OVER SYSTEM 62.0' 3. MINIMUM PIPE PITCH TO BE 1/8" PER FOOT. MINIMUM .75' OF COVER OVER PRECAST 4. DESIGN LOADING FOR ALL PROPOSED PRECAST PRECAST H-10 UNITS TO BE AASHO H-1Q RISERS (TYP.) �r 2'0 4"OSCH40 PVC Shubael +.a• :SCH40 PVC 61.1 'f PIPES LEVEL 1ST 2' 2" DOUBLE WASHED `PEASTONE 5. PIPE JOINTS TO BE MADE WATERTIGHT. **EXISTING 1000 GAL OR GEOTEX7I I E' FABRIC 59 86' POD 6. CONSTRUCTION DETAILS TO BE IN ACCORDANCE *EXISTING 10" SEPTIC TANK 14" �' WITH 310 CMR 15.000 (TITLE V.) 'y EXISTING TEE TEE *59.7'f o��o°tr cococ000coco 000 0 r--2. 7. THIS PLAN IS FOR PROPOSED WORK ONLY ANDCD GAS BAFFLE::; '200o�o01? 0 59.36 AT SIDES NOT TO BE USED FOR LOT LINE STAKING OR ANY \aOTHERPURPOSE.59.54' 59.37' 2' AT ENDS F, ° ;•';:' 57.36' 8, PIPE FOR SEPTIC SYSTEM TO SCH. 40-4" PVC. :,. •� a t DEPTH OF FLOW = 4' 9. COMPONENTS NOT TO BE BACKFILLED OR TEE SIZES: 6" CRUSHED STONE OR MECHANICAL 3 4 TO 1 12 DOUBLE /" " WASHED STONE CONCEALED WITHOUT INSPECTION BY BOARD OF / HEALTH AND PERMISSION OBTAINED FROM BOARD INLET DEPTH = 10„ COMPACTION. (15.221 (21) 0 OF HEALTH. r� OUTLET DEPTH = 14" `° 10. CONTRACTOR SHALL BE RESPONSIBLE FOR CALLING DIGSAFE (1-888-344-7233) AND LOCUS MAP VERIFYING THE LOCATION OF ALL UNDERGROUND (k ( 1 9e SLOPE) ( 1 SLOPE) 51.0' BOTTOM TH-1 OVERHEAD UTILITIES PRIOR TO COMMENCEMENT OF SCALE 1"=2000'f NO GROUNDWATER FOUND FOUNDATION EXISTING SEPTIC TANK 16' D' BOX 3' LEACHING - - 11. ANY UNSUITABLE MATERIAL ENCOUNTERED ASSESSORS MAP 149 PARCEL 152 FACILITY SHALL BE REMOVED 5' BENEATH AND AROUND THE *THE INSTALLER SHALL VERIFY THE LOCATIONS OF ALL **THE INSTALLER SHALL CONFIRM MIN. PROPOSED LEACHING FACILITY. LOCUS IS WITHIN WELLHEAD PROTECTION AND ESTUARINE WATERSHED PROTECTION DISTRICTS. UTILITIES AND ALL BUILDING SEWER OUTLETS AND ELEVATIONS SEPTIC TANK SIZE AT 1000 GALLONS 12. EXISTING LEACHING FACILITY SHALL BE PUMPED PRIOR TO INSTALLING ANY PORTION OF SEPTIC SYSTEM AND ITS SUITABILITY FOR RE—USE AND REMOVED OR PUMPED AND FILLED WITH CLEAN SAND. . I LEGEND 1 99_ EXISTING CONTOUR X 99.1 EXIST. SPOT ELEV. SYSTEM DESIGN: � PROPOSED CONTOURLOT 3 \ 198.41 PROPOSED SPOT EL. 135 39 20,010t SF GARBAGE DISPOSER IS NOT ALLOWED TH1 \ DESIGN FLOW: 3 BEDROOMS ® 110 GPD = 330 GPD TEST HOLE \ USE A 330 GPD DESIGN FLOW 2� SLOPE OF GROUND �' SEPTIC TANK: 330 GPD (2) = 660 UTILITY POLE CQ, FIRE HYDRANT �.� _ �,__ �. _ ,_ . __. , , _**RE-USE ..EXISTING 1000 _GAL. SEPTIC -TANK NOTE: NOT ALL SYMBOLS MAY APPEAR IN DRAWING \ LEACHING: \ SIDES: 2 (30 + 10) 2 (.74) = 118 GPD TEST HOLE LOGS = BOTTOM 30 x 10 (.74) = 222 GPD PAVED \ ENGINEER: DAVID FLAHERTY, R.S., SE2755 23'1 +';. DRIVE TOTAL: 460 S.F. 340 GPD DONNA MIORANDI R.S. TH-2 • jig' w� \ USE (4) STANDARD "3050" INFILTRATORS , WITNESS. OCTOBER 1 , 2008 . WITH 0.8 STONE AT ENDS AND 2.8 AT SIDES DATE: 62 ' w PERC. RATE _ < 2 MIN/INCH TH-1 20 0 ` EXISTING CLASS I SOILS P# 12370 2 .0, 3 BR MA DWELLING \ APPROVED DATE BOARD OF HEALTH � ' \ ELEV. ELEV. TOP OF\ FNDN 2 \ 0„ 4 62.0' 0" 62.0' EL.163.5' \ o A A \ ❑ O O TITLE 5 SITE PLAN LS LS OF / / 10YR 3 2 10YR 3 2 NU' PLAY SET DECK 6 $ Eqo IRHAVEN LANE LS -� �r��s � e B 6� M. 41 FA MILLS) BARNSTABLE, MA 62 � 10YR 4/4 59 6, „ 10YR 4/4 , BENCH MARK — CORNER OF - (0� \ PREPARED FOR 29„ 30 59•5 CONC. BULKHEAD EL. = 62.6 BOTOLOTTI CONST./ C C - ELAINE KELLEY PERC DATE: OCTOBER 3, 2008 MCS MCS 13a 35 off 508-362-4541 fax 508-362-9880 2.5Y 5/6 2.5Y 5/6 �� ���XOFM,18. ��NOFM,gSSq I downcape.com 5% GRAVEL 5% GRAVEL fi° DANIELA.9°yGN °� DANIEI_ (P " o OJALA o A. uoW/! cQpB edgi/lee�ing, Me. CIVIL " OJALA "' civil engineers No. a No.4098 land surveyors 132" 51.0' 126" 51.5 °�F��ssreR Gnaw tq fi� �� 939 Main Street ( Rte 6A) NO GROUNDWATER ENCOUNTERED Scale: 1"= 20' �nl �� YARMOUTHPORT MA 02675 p DATE DANIEL A. OJALA, P.E., P.L.S. o 10 20 30 40 so FEET LICE #OU-23� 08-233 BORTOLOTTI_KELLEY.DWG (DDF) Tr