HomeMy WebLinkAbout0442 FLINT STREET - Health 442�FLint Street w
Marstons Miilsx P
11
TOWN OF BARNSTABLE
LOCATION` q UI Z T I o t St . SEWAGE #
VILL CAWStOnS M a3 ASSESSOR'S MAP & LO
INSTALLER'S NAME&PHONE NO.-
SEPTIC TANK CAPACITY I600 QIcd L ans
LEACHING FACILITY: (type) LffichinadlQ0size)
NO.OF BEDROOMS Z
BUILDER OR OWNER Uyerl U Peru n
PERMITDATE: COMPLIANCE DATE:
Separation Distance Between the:
Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet
J g Y
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
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COMMONWEALTH OF MASSACHUSETTS
EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS
DEPARTMENT OF ENVIRONMENTAL PROTECTIC RECEIVED
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' MAR 19 2002
TOWN OF BARNSTABLE
0 HEALTH DEPT.
TITLE 5
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM
PART A
CERTIFICATION
Property Address: 442 FINT ST MARSTONS MILLS, MA 02648
Owner's Name: BEVERLY PERRIN
Owner's Address: 5300 W.IRLO BRONSON MEM. HWY KISSIMMEE FL 34746
Date of Inspection: 2/20/02
Name of Inspector: (please print) JOHN GRACI
Company Name: SEPTIC INSPECTIONS
Mailing Address: P.O. BOX 2119 TEATICKET,MA.02536
Telephone Number: 508-564-6813 FAX 508-564-7270
CERTIFICATION STATEMENT
I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is
true,accurate and complete as of the time of the inspection.The inspection was performed based on my training and
experience in the proper function and maintenance of on site sewage disposal systems. 1 am a DEP approved system
inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system:
X Passes
_ Conditionally Pa es
Needs Furthe aluation by the Local Approving Authcrity
_ Fails
Inspector's Signature: �' Date: 2/20/02
The system inspector shall submit copy of this inspection report to the Approving.authority(Board of Health or DEP)within
30 days of completing this inspecti n. 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."file original should be
sent to the system owner and copies sent to the buyer, if applicable,and the approving authority.
Notes and Comments
SYSTEM PASSES TITLE V INSPECTION. RECOMMEND PUMPING EVERT'TWO YEARS TO PROLONG THE
SYSTEM'S USEFUL LIFE.
****This report only describes conditions at the lime of inspection and under the conditions of use al Thal lime. 1,11k
inspection does not address how the system will perform in the future under the same or different conditions of use.
I
Page 2 of 1 I
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE
DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: 442 FINT ST MARSTONS MILLS,MA 02648
Owner: BEVERLY PERRIN
Date of Inspection: 2/20/02
Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D
A. System Passes:
X 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:
SYSTEM PASSES TITLE V INSPECTION. RECOMMEND PUMPING EVERY TWO YEARS TO PROLONG THE
SYSTEM'S USEFUL LIFE.
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.
n/a 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: n/a
n/a 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: n/a
n/a 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: n/a
Page 3 of
OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address: 442 FINT ST MARSTONS MILLS,MA 02648
Owner: BEVERLY PERRIN
Date of Inspection: 2/20/02
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 tile environment:
_ Cesspool or privy is within 50 feet of a surface water
_ Cesspool or privy is within 50 feet of a bordering vegetated-wet Iand 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 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 n/a
"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 ne other failure criteria are triggered.A copy
of the analysis must be attached to this form.
3. Other:
n/a
Page 4 of 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address: 442 FINT ST MARSTONS MILLS,MA 02648
Owner: BEVERLY PERRIN
Date of Inspection: 2/20/02
D. System Failure Criteria applicable to all systems:
You must indicate"yes"or"no"to each of the following for all-inspections:
Yes No
X Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool
_ X Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged
SAS or cesspool
X Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool
X Liquid depth in cesspool is less than 6"below invert or available volume is less than ''/2 day flow
X Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number of times
pumped Wa.
_ X Any portion of the SAS,cesspool or privy is below high ground water elevation.
_ X Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply.
_ X Any portion of a cesspool or privy is within a Zone I of a public well.
_ X Any portion of a cesspool or privy is within 50 feet of a private water supply well.
X 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 forma
(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 Systems:
To be considered a large system the system must serve a facility with a design now 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
X the system is within 400 feet of a surface drinking water supply
X the system is within 200 feet'of a tributary to a surface drinking water supply
X the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area—1 WPA)or a mapped
Zone 11 of a public water supply well
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 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.
a
Page 5 of
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST
Property Address: 442 FINT ST MARSTONS MILLS,MA 02648
Owner: BEVERLY PERRIN
Date of inspection: 2/20/02
Check if the following have been done.You must indicate "yes" or"no" as to each of the following:
Yes No
X _ Pumping information was provided by the owner,occupant,or Board of Health
X Were any of the system components pumped out in the previous two weeks?
X Has the system received normal flows in the previous two week period`?
X 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)
X Was the facility or dwelling inspected for signs of sewage back up?
X _ Was the site inspected for signs of break out?
X _ Were all system components,excluding the SAS, located on site'?
X _ 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?
X _ Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance
of subsurface sewage disposal systems'?
The size and location of the Soil Absorption System (SAS)on the site has been determined based on:
Yes no
X _ Existing information. For example,a plan at the Board of Health.
X _ 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)]
S
' Page 6 of 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
Property Address: 442 FINT ST MARSTONS MILLS,MA 02648
Owner: BEVERLY PERRIN
Date of Inspection: 2/20/02
FLOW CONDITIONS
RESIDENTIAL
Number of bedrooms(design): 2 Number of bedrooms(actual): 2
DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 220
Number of current residents: 0
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): YES
Water meter readings, if available(last 2 years usage(gpd)):tie- Zoo( - 1 W0
Sump pump(yes or no): NO Z000- $t,000
Last date of occupancy: n/a
COMMERCIAL/INDUSTRIAL
Type of establishment: n/a
Design flow(based on 3 10 CMR 15.203): n/agpd
Basis of design flow(seats/persons/sgft,etc.): n/a
Grease trap present(yes or no): NO
Industrial waste holding tank present(yes or no): NO
Non-sanitary waste discharged to the Title 5 system(yes or no): NO
Water meter readings, if available: n/a
Last date of occupancy/use: n/a
OTHER(describe): n/a
GENERAL INFORMATION
Pumping Records
Source of information: n/a
Was system pumped as part of the inspection(yes or no): NO
If yes, volume pumped: n/agallons--How was quantity pumped determined?n/a
Reason for pumping: n/a
TYPE OF SYSTEM
X 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): n/a
Approximate age of all components, date installed(if known)and source of information:
6 YEARS BY OWNER
Were sewage odors detected when arriving at the site(yes or no): NO
f h
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Page 7 of 1 I
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 442 FINT ST MARSTONS MILLS, MA 02648
Owner: BEVERLY PERRIN
Date of Inspection: 2/20/02
BUILDING SEWER(locate on site plan)
Depth below grade: 18"
Materials of construction:_cast iron X40 PVC_other(explain): n/a
Distance from private water supply well or suction line: n/a
Comments(on condition of joints, venting,evidence of leakage,etc.):
TOWN WATER
SEPTIC TANK: X(locate on site plan)
Depth below grade: 12"
Material of construction: Xconcrete_metal_fiberglass_polyethylene other(explain)n/a
If tank is metal list age: n/a Is age confirmed by a Certificate of Compliance(yes or no): NO(attach a copy of certificate)
Dimensions: 150OG L 10' 6" H 5' 6" W 5' 8""
Sludge depth: I"
Distance from top of sludge to bottom of outlet tee or baffle:33"
Scum thickness: I"
Distance from top of scum to top of outlet tee or baffle: 6"
Distance from bottom of scum to bottom of outlet tee or baffle: 17"
How were dimensions determined: MEASURED
Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related
to outlet invert,evidence of leakage,etc.):
SEPTIC TANK AND ALL COMPONENTS ARE STRUCTURALLY SOUND AND FUNCTIONING PROPERLY.
RECOMMEND PUMPING EVERY TWO YEARS TO PROLONG THE SYSTEM'S USEFUL LIFE.
GREASE TRAP: _(locate on site plan)
Depth below grade: n/a
Material of construction:_concrete_metal_fiberglass_polyethylene_other(explain): n/a
Dimensions: n/a
Scum thickness: n/a
Distance from top of scum to top of outlet tee or baffle: n/a
Distance from bottom of scum to bottom of outlet tee or baffle: n/a
Date of last pumping: n/a
Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related
to outlet invert,evidence of leakage, etc.):
n/a
I
C
! 7
Page 8 of 1 1
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 442 FINT ST MARSTONS MILLS,MA 02648
Owner: BEVERLY PERRIN
Date of Inspection: 2/20/02
TIGHT or HOLDING TANK: (tank must be pumped at time of inspection)(locate on site plan)
Depth below grade: n/a
Material of construction:_concrete_metal_fiberglass_polyethylene._other(explain): n/a
Dimensions: n/a
Capacity: n/a gallons
f Design Flow: n/a gallons/day
M Alarm present(yes or no): N/A
Alarm level: N/A Alarm in working order(yes or no): NO
Date of last pumping: n/a
Comments(condition of alarm and float switches,etc.):
n/a
DISTRIBUTION BOX:X(if present must be opened)(locate on site plan)
Depth of liquid level above outlet invert: LEVEL WITH BOTTOM OF PIPE
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.):
D-BOX IS STRUCTURALLY SOUND. RECOMMEND MOVING TREE.
PUMP CHAMBER:_(locate on site plan)
Pumps in working order(yes or no): NO
Alarms in working order(yes or no):NO
Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.):
n/a
C
� R
Page 9 of
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 442 FINT ST MARSTONS MILLS,MA 02648
Owner: BEVERLY PERRIN
Date of inspection: 2/20/02
I
SOIL ABSORPTION SYSTEM (SAS): X (locate on site plan,excavation not required)
If SAS not located explain why:
n/a
Type
n/a leaching pits, number: n/a
CHAMBERS leaching chambers, number: 4
n/a leaching galleries, number: n/a
n/a leaching trenches, number, length: n/a
n/a leaching fields, number: n/a
n/a overflow cesspool, number: Wa
n/a innovative/alternative system
Type/name of technology: i,/a
Comments(note condition of soil,signs of hydraulic failure, level of ponding,damp soil,condition of vegetation,etc.):
CHAMBERS ARE STRUCTURALLY SOUND AND EMTPY AT TIME OF INSPECTION. BOTTOM IS AT 51.
CESSPOOLS: (cesspool must be Bumped as part of inspection)(locate on site plan)
Number and configuration: n/a
Depth—top of liquid to inlet invert: n/a
Depth of solids layer: n/a
Depth of scum layer: n/a
Dimensions of cesspool: n/a
Materials of construction: n/a
Indication of groundwater inflow(yes or no): NO
Comments(note condition of soil,sins of hydraulic failure, level of ponding,condition of vegetation,etc.):
n/a
PRIVY: (locate on site plan)
Materials of construction: n/a
Dimensions: n/a
Depth of solids: n/a
aulic failure, level of ponding,condition of vegetation, etc.):
Comments(note condition of soil,signs of hydr
n/a
Page 10 of I I
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 442 FINT ST MARSTONS MILLS,MA 02648
Owner: BEVERLY PERRIN
Date of Inspection: 2/20/02
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.
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OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 442 FINT ST MARSTONS MILLS,MA 02648
Owner: BEVERLY PERRIN
Date of Inspection: 2/20/02
SITE EXAM
_Slope
_Surface water
_Check cellar
Shallow wells
Estimated depth to ground water 12+feet
Please indicate(check)all methods used to determine the high ground water elevation:
NO Obtained from system design plans on record-If checked,date of design plan reviewed: n/a
YES Observed site(abutting property/observation hole within 150 feet of SAS)
NO Checked with local Board of Health-explain: n/a
NO Checked with local excavators, installers-(attach documentation)
NO Accessed USGS database-explain: n/a
You must describe how you established the high ground water elevation:
HAND AUGER- 12+FT.
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RECEIPT
Printed:07-17-2002 s 13:57:45
BARNSTJOHN F LIMEADE, REGITY STER DEEDS
Trans#: 184185 Oper:PEGGYF
Book 15375 Page: 17 Inst# 62004
Ctl#: 1193 Rec:7-17-2002 ® 1:56:15p .
BARN 442 FLINT STREET
(� DOC DESCRIPTION TRANS-AMT
1 CRUMB, THOMAS
RESTRICTION 10.00
10.00 rec fee
Surcharge CPA $20.00 20.00
Total fees: 30.00
Ctl#: 1194 Rec:7-17-2002 s 1:56:15P
DOC DESCRIPTION TRANS-AMT
POSTAGE FEE 50
Mail per page fee
x �c Total charges: 30.50
CHECK PM 1035 30.50
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/� TOWN OF BARNSTABLE /�
1,61C A7_� �d� : fA FlAd 'rf k SEWAGE # -'" F,
VILLA6E,��/G�r�'40& ,l�i��� ASSESSOR'S MAP&LOT J6 ; - a'
INSTALLER'S NAME&PHONE NO.�4`7'd 1 d-1 C�M- wiz - g 9.2 6
SEPTIC TANK CAPACITY /-1-20-0
LEACHING FACILITY: (type) %�t. pvd c�J O� ( y� (size) 'X /
NO.OF-BEQROOMS 3
BUILDER OWNER C a rL" l,C.I�H�
PERMITDATE: ,%-2� COMPLIANCE DATE: - Z.&
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
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THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE
Appliration for Diopooul Warkg omitrur#ion runtit
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System at
y. ....-.. �.�.N r. r----------------------------•---•---- ..........................................T--!!---•----t ���-
Location-Address or Lot No.
......................
_fib . Y1 ►Ltd- ------------------------------------- --- --------- ['czo- s... Y.f = =.........
owner Address
Installer Address
U Type of Building Size Lot..............
).............Sq. feet
Dwelling— No. of Bedrooms___ __________________________________..-Expansion ttic (L�e) Garbage Grinder •(L
04 Other—Type of Building _-Ill �________.______ No. of persons___----►J�_A__-_____- Showers ( ) — Cafeteria ( )
44 Other fixtures .------ � � p`
W Design Flow--------------1_:�) ..__.____-__----____gallons per person Rer �ay. Total dAily low._____..____._......_- ____ Depth_. Ml 1
x t Disposal Trench—No. ------------ Width....... Total Length....4a-------- Total leaching area----4ED......sq. ft.
Seepage Pit No--- .A.__._._. Diameter____________________ Depth below inlet.................... Total leaching area..................sq. ft.
Z Other Distribution b x ( ) Dosing tank ( )
'-' Percolation Test Results Performed b �}-a�.-.4►•1�_ 3r-.___.L-!�. -_-_ Date___-_.I� 03-qS
Y
Test Pit No. I-----2 .......minutes per inch Depth of Test Pit-----Rr.....__-__. Depth to ground V1.water1 ►e.........
44 Test Pit No. 2...... .......minutes.per inch Depth of Test Pit---.--IZ---------- Depth to ground water_ nc&"nle-rrA
19 ---- -------- ---
V Description of Soil_-0?.:'_'5?.�._l,.ear►�
------...Gm-w"NA........ ----••---
U erations—Answer'when applicable------ ------------------------. -----.-------•-------...--------------------------••-...-----
---------........`�'.�Low.�►�F.us��s_. �?'�--...4..C-----5 0&4------okp__s-a'..t_4-..�.__.._t�Nns
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TITLE 5 of the State Environment 1 Code The nder igned further agrees not to place the
system in operation until a Certificate of Comp ' ce e i ue y t oard of health.
Signed ... .. � Z�.
Application.Approved By . ... ` .. `_.....G'?��? �------- ... ------/
..... -- --- ----
Dace
Applications Disapproved r he following reasons- ------ --------- ---------------------- ----------------------------------------------------------------------------------------
------------- ---------------------------------------------------- --------------------.............
Dace
Permit No. �- ` .... Issued --------------- 6 x
. ............. .........
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE
Applirntivit for Diti-pniittl WAr1w Tatuitrnrtinn amit .
Application is hereby made for a Permit to Construct (v) or Repair ( ) an Individual Sewage Disposal
System at:
1.1.N 1....si. ...T.......................................... ..................... L -� =-- h �_
Location-Address No.
......................-.- �... vC J t 1S orLot �1 M nib 8
Owner Address
Installer Address "
d Type of Building Size Lot_____ )-............Sq. feet
I (�� Garbage Grinder (kj ,
a Dwelling— No. of Bedrooms____ _____ _____ _____________Expansion Attic
Other—Type e of Building _Nq�C__ ___ ___ ____ No- of e-rsons---_____►--- -A -_-- Showers
a"'�.�, YP g �-- ! p ( ) — Cafeteria ( )
d Other fixtures f'' 'f--------------- ------- ------------------------------------------•-•--
W Destgn Flow..............��_________._________gallons,per person Rer+y. Total daily
x _. :
Pow_
-a-- D _m.._e________..___ e.pt__. -Mlont�WSeptic Tank—Liquid ca acity,5= alIons Len th._! --�___ Width...(� iater_._ A
Disposal Trench—Noe ..-....... Width______ _________ Tottal Length -s.
Total leaching area..__:��?.____sq. ft. ..
See a e Pit No i�.JR__._... Diameter-_.___� p g _ _ --.-- __._-.._,_`.__ Depth below.inlet-------- ........... Total leaching area..................sq. ft. �
z Other Distribution box ( ) Dosing tank ( )r r, n
aPercolation Test Results Performed by----- .!��i C4I. u��- ------------ Date______"water
Pit No. I.....�------- . P Depth ` �-� P ground 1�.r�d
mmutesp er inch Deptli of 'Test Pit______Z Depth to g ound e neo}fin----
(4 Test Pit No. 2__._._2____.._mmutes er inch De th of,Test Pit__.___-z-_________ Depth to round water_
O -------------- -- ----------•t---...- ....__.....................................
x Description of Soil... 3_�__l_norn_. '�' -tq _•Lo�tmT BAN a----}_.lo.
V .._..._._.(-V.A!2-�1G-_._._�AnN.�P.e--._.._.._ _
it - 4• - �---------•-•-
UW -•••---�•------------•------------ ---- 1-t
Nature-of-Repairs-ar Al erations—Answer when applicable.-----------------------------------------------------------------------------------------------
.......�-�".t•• W.DI F F_haS. --�-----��oN ----- "' S+�t._.t_4_..vtt► 4Nes
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TITLE 5 of the State Environmental Coded The nder igned further agrees not to place the " +
system in operation until a Certificate of Comp Ice as-be fi i ue-�b� t board of health.
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Application.Approved BY ----- ---- -----------------------I............................................................... - r 4. -�
Dace
Application.Disapproved f?�r he following reasons- ----------------------------------------------------------------. ----------- ....
-------------------------_---------------------------------------._..._--------.........,_-------------------------. -------------------
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Permit No. �'�2� �O aG/��
------------ ---------- ---------------- Issued ---------------
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Dare
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THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE
Ge>r#ifira e of Tomplian e
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( A7 or Repaired ( )
by ------------ -- 6�-o i
----------------------------- ---------- --------------------------------------------------------------------- ------------------------------------------------------
at ................._........----- � / h.,. -
Lod / /e n-------_S'-f-re�. .
has been installed in accordance with the provisions of TITLE 5 of The State Environmental Cody as de cribed in ' �I
the application for Disposal Works Construction Permit No. — /
9.5......���..7.......... dated ../0.,�-rv.�l`>-......... k;
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE......................................��----- ------------------_--------- Inspector ......�\0..:. - - '
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
q TOWN OF BARNSTABLE �d� vD t
No...__..�':�_.-I2V_2 FEE.....
Uhipvntt1 lVorkii Tomitrurtinn unfit
Permission is hereby granted------..... fUlOf 7 ! ----------- -----------------------------------------------------------•------•-----••--•--•---
to Construct ( or Repair ) an Individual Sewage Dispossa System
at No. .�0---•--•---��----••-- /-i-!1-�.......5 ------ 1)�
Street s
as shown on the appli tion fo Disposal Works Construction Pe rt o._.7___.____/-_____"Ua2 d _.._ �_ ._.._.
s / //jI Board of Healtfi
DATE................ •• .. .. --.. -- .....---
FORM 36508 HOBBS&WARREN.INC..PUBLISHERS
229. 84.
,tea I „E, _ .
C.B. N87 461.8
i
100 I P EASEMENT
----------
BENCHMARK.
LOT 11 {
TOP OF C.B.
„ ELEV."=100.,23' (ASSUMED) 45,OOOfS.F.
O IQA�
60 3, / PLAN REF.- 353175
�. 10 39. 7' RES. ZONE.' „RF,,,
ASSESSORS MAP 102/217
6.0 `D �� TOWN WATER AVAILABLE
6 3, w O'
rn PROPOSED 23. 7
o HO USE 2 0
99 0 GAR ' GRAPHIC SCALE '
30.0' 16. 0 \ 30 15 30 60 120
l
0 1500
GAL IN FEET )��-�
TANK?e � LOT 10
�
1 inch = 30 ft.
U �\\ \ I
PROJEC T L OCA TION
LOT 11 FLINT STREET
U.POLE I ; i U� Q,84tt MARSTONS MILLS, MA.
UTILIT
i I ~ q�
`\ 101 E . A . �SS10% A PPL I CA N T.-
A JOB VA UGHJV
1� -- pR pp �'
�j\ ,- YA WET- SUR VE Y CONSUL TAN TS
P. O. BOX 265
Jow g UNI T. 5, 4OB INDUSTR. Y ROA.D
cm � MARS TONS MILLS, MA. 02648
PH. (508)428—0055 — FAX(508)420—5553
°` '�70R�t Ems` SCALE. 1 "=30' [DA TE: 10113195
REV. REV i
JOB 'NO. 50825 SHEET 1 OF 2
U.POLE C. \
F.F. ELEV.= 101_5
20' ..MIN.
ELEV.= 102E` ,
S 4" CAST IRON OR CONCRETE COVERS ELEV.= 99_8f
`
SCHEDULE 40 P.V.C. l\ E
4z
I
,�► DIST.= 17'-_ SLP.= 0.01_ INVERT SLP.= 0.01_ 2.9'f MIN. 1. LAYER of
1./8"-1 2
CONCRETE COVER DIST.=21 __ WASHED STONE
FLOW LINE DIST.=25__ CONCRETE
= 0.01 „-°
ELEV.= 97_05 96.88 -- INVERT ELEV.= 96.0 °
ELEV.'=____ -- °° o000000 0000 00 0000000 °°°�°
10" MIN. 19" 96.65 _ 4 TO 1-1
ELEV.=__ _ ELEV.= 96_38 -' ELEV.= 96_21 0 0000000 0000 0 0000000 000� / /2"
4" CAST IRON OR0 0 0 v O v 0 O O 0-0-
4" O O O O O O O O O O O O C WASHED STONE
SCHEDULE 40 P.V.C. CAST IRON OR n O O. O O O O O O n O n O n O O O„O O O O
SCHEDULE 40 P.V.C. ELEV= 94_5
DISTRIBUTION BOX 0. 65�
1500 GALLON SEPTIC TANK TO BE PLACED ON 6" of 5 PRECAST FLOW DIFFUSORS
TO BE PLACED ON 6" OF STONE OR MECHANICALLY 6.5'
STONE OR MECHANICALLY COMPACTED SOIL. USE STONE TO LEVEL
___
COMPACTED SOIL. _
TO BE WET TESTED IF THE BED AS NEEDED____________________________
MORE THAN ONE OUTLET. BOTTOM OF TEST HOLE OR USGS PROBABLE WATER TABLE ELEV =88_0
USE SEPTIC TANK WITH 3 COVERS. SOIL TEST DONE BY: J.E. LANDERS-CAULEY P.E.
WITNESSED BY: _ J DUNNING 8584-------
PROFILE OF PERCOLATION RATE: _ 2 __MIN/INCH
TEST HOLE 1 DATE: _110_3L95 ELEV._99.5___
SEWAGE DISPOSAL SYSTEM DEPTH .HORIZON TEXTURE COLOR MOTT. OTHER
NOT TO SCALE J" y
uwnr`asrwc�� '
0 3" 0 LOAM - CIVK
Na 35101
3"-10" A LOAMY/ 2.5Y 4/4
SAND
6
10"-26" B LOAMY/ 10 YR 5/6 OKAI
SAND
26"-144" C COARSE 2.5YR 7/3 NO WATER
SAND ENCO UNT
GENERAL NOTES: ERED
DESIGN DATA:
1. THIS PLAN IS FOR THE CONSTRUCTION OF A NEW SEWAGE DISPOSAL SYSTEM.
2. PLAN REFERENCE 353/75 LOT 217 BARNSTABLE REG. OF DEEDS.
3. THIS PLAN IS FOR THE INSTALLATION /REPAIR OF SEPTIC SYSTEM TEST HOLE 2 DATE: 1095 ELEV._ 100 ___ NUMBER OF BEDROOMS _ THf�4 ___
AND NOT TO BE USED FOR SURVEYING AND ZONING PURPOSES. GARBAGE DISPOSAL
4. ALL WORKMANSHIP AND MATERIALS. SHALL CONFORM TO D.E.P. DEPTH HORIZON TEXTURE COLOR MOTT. OTHER
TITLE 5 AND THE TOWN OF BARNSTABLE RULES, AND REGULATIONS TOTAL ESTIMATED FLOW __1, 3Q____ GPD
FOR THE SUBSURFACE DISPOSAL OF SEWAGE. LOAM
5. ALL COVERS TO SANITARY UNITS SHALL BE BROUGHT TO WITHIN 0" 3" 0 ( 11Q__ GAL./BR./DAY X _J___ BR. )
12" OF THE FINISHED GRADE.
6. EXISTING AND FINAL GRADES SHALL REMAIN ESSENTIALLY THE 3"-12" A LOAMY/ 2 5Y 4/4 SEPTIC TANK CAPACITY -150-0--QAL_
SAME, UNLESS NOTED BY FINAL CONTOURS. SAND
7. ALL COMPONENTS OF THE SANITARY SYSTEM SHALL BE CAPABLE 12"-32" A&B LEACHING AREA REQUIREMENTS
*(48f 6)=54x2=108x1. 7=192
OF WITHSTANDING H-10 LOADING UNLESS THEY ARE UNDER OR SIDEWALL AREA _L92*_ GAL./S.F.
WITHIN 10' OF DRIVES OR PARKING AREAS. H-20 LOADING
' BOTTOM AREA _ $$**_ GAL./S.F.
U 32 -
SHALL USED UNDER OR WITHIN 10 OF DRIVES OR PARKING " 144" C COARSE . 2.5YR 7/3 O WATER **
AREAS UNLESS NOTED. � 6x48=288
8. ANY MASONARY UNITS USED TO BRING COVERS TO GRADE SHALL SAND ENCOUNT LEACHING CAP. (BOT. & SIDEWALL) _360 _ GAL.
BE MORTARED IN PLACE. ERED
9. NO DETERMINATION HAS BEEN MADE AS TO COMPLIANCE WITH RESERVE LEACHING CAPACITY __360 __ GAL.
DEEDED OR ZONING REGULATIONS. OWNER/APPLICANT IS TO y
OBTAIN SUCH DETERMINATION FROM , APPROPIATE AUTHORITY.
10. THE EXCAVATOR/CON TRACTOR SHALL VERIFY THE LOCATION OF APPLICANT: JOE- VAUGHN DATE: OCTOBER 23, 1995
ALL UNDERGROUND UTILITIES PRIOR TO ANY EXCAVATION. ' SHEET 2 OF 2 JOB # 50825