HomeMy WebLinkAbout0126 FLUME AVENUE - Health 126 FLUME AVE, MARSTONS MILLS
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COMMONWEALTH OF MASSACHUSETTS
EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS
DEPARTMENT OF ENVIRONMENTAL P ED
2 n 2002
TOVVt.Ur c :., (ABLE
HEALTH DEPT.
TITLE 5
OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM
PART A
CERTIFICATION
Property Address: 126 Flume Avenue
Marston Mills, MA 02648
Owner's Name: Robert Carter
Owner's Address:
Date of Inspection: July 29, 2002
Name of Inspector: (Please Print) James M. Ford
Company Name: James M. Ford
Mailing Address: P.O. Box 49 Map: 061
Osterville,MA 02655-0049 Parcel: 010
Telephone Number: (508) 862-9400 Lot: 5A
CERTIFICATION STATEMENT
I certify that I have personally inspected the sewage disposal system at this address and that the information reported
below is true,accurate and complete as of the time of the inspection. The inspection was performed based on my
training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP
approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system:
✓ Passes
Conditionally Passes
Needs urther Evaluation by the Local Approving Authority
Fails
Inspector's Signature: Date: August 3, 2002
The system inspector shall 4submaf 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 1
Page 2 of 11
OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: 126 Flume Avenue
Marstons Mills, M4
Owner: Robert Carter
Date of Inspection: July 29, 2002
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: 126 Flume Avenue
Marston Mills, MA
Owner: Robert Carter
Date of Inspection: July 29, 2002
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 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
"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 11
OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: 126 Flume Avenue
Marstons Mills, AM
Owner: Robert Carter
Date of Inspection: July 29, 2002
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 '/z 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"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.
4
Page 5 of 11
OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST
Property Address: 126 Flume Avenue
Marston Mills, AM
Owner: Robert Carter
Date of Inspection: July 29, 2002
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:
Yes No
✓ Existing information. For example,a plan at the Board of Health.
✓ Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance
is unacceptable) [310 CMR 15.302(3)(b)].
5
Page 6 of I 1
OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
Property Address: 126 Flume Avenue
Marston Mills, MA
Owner: Robert Carter
Date of Inspection: July 29, 2002
FLOW CONDITIONS
RESIDENTIAL
Number of bedrooms(design): 4 Number of bedrooms(actual): 4
DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 440
Number of current residents: 0
Does residence have a garbage grinder(yes or no): Yes
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)): 2001 - 77,000 Qals.; 2002 (6 mos.) - 10,000 gals.
Sump Pump(yes or no): No
Last date of occupancy: Unknown
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: Never pumped-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:
July 28100-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: 126 Flume Avenue
Marston Mills, MA
Owner: Robert Carter
Date of Inspection: July 29, 2002
BUILDING SEWER(locate on site plan)
Depth below grade: Approx. 42"
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: Approx. 30"
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: ISOOgal.
Sludge depth: 1"
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: 10"
Distance from bottom of scum to bottom of outlet tee or baffle: 12"
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 were no signs of leakage. Recommend pumping every
three years. Recommend installing risers to bring covers within 6"ofgrade.
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
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: 126 Flume Avenue
Marstons Mills, MA
Owner: Robert Carter
Date of Inspection: July 29, 2002
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.):
The D-box was clean. No solids were present. There were no signs of failure or backup from the leach field.
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: 126 Flume Avenue
Marstons Mills, MA
Owner: Robert Carter
Date of Inspection: July 29, 2002
SOIL ABSORPTION SYSTEM(SAS): ✓ (locate on site plan,excavation not required)
If SAS not located explain why:
Type
leaching pits, number:
✓ leaching chambers,number: 3 Cultec 330s-per as built card- 12'x 35'
leaching galleries,number:
leaching trenches,number, length:
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.):
The leach field was not dug up. There were no signs of failure or backup in the D-box.
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)
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: 126 Flume Avenue
Marston Mills, MA
Owner: Robert Carter
Date of Inspection: July 29, 2002
Map: 061
Parcel: 010
SKETCH OF SEWAGE DISPOSAL SYSTEM Lot: 5A
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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Page 11 of 11
OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 126 Flume Avenue
Marstons Mills, MA
Owner: Robert Carter
Date of Inspection: July 29, 2002
SITE EXAM
Slope
Surface water
Check cellar
Shallow wells
Estimated depth to ground water 20' +/- 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:
The bottom of the leach field to grade was approximately 6. Using the Barnstable topographic map and the Cape Cod
Commission water contours maps, the maps were showing approximately 20'+/-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
TOW of Barn.stable
belrnr(utent of llestllit,Snfety,and Cnviro.nmenlnl Services .
aF,r+E> � Public Health Division vale
367 Win Sired,I lymonis MA 02601
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'°rfOnwt"� Dale Scheduled "� "t rimeto;ce)j3s, lee I'll..--��a-- -----
Soil Si tability Assessinent for Se►vage Disposal.
I'crfonned By: � (�ie„i ili( v► Wilucssetl U.y:
L,ocnlion Address Otvner's Nmnc e
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YVtvv�s�v.4s lMlills Address Via• B<x S5
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Assessor's Mnp/Parcel: map 6,1.,. PC. to--5 Engincer's Name ��x�� t. Je G• e
NEW CONSTRUCTION. _L/^ RrPAIiI I'cicphoiic ll .�Zg I/3 .<
l mtd Use Slopes("/0) Soifacc Stones
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Dlsinlices from: Open Writer Dody. 160 Il .Possible Wel Aren - 'Il.-.urinkilig 1VnIcr.well
Drnfnnge Wny n, I!ruperly L,inc It OIhcr II
SKETCH: (Street name,dimensions of lo(,exncl locations,of Ics1 holes R pert Icsls,locnle wcllmuls in proximity Io holes)
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-11ment material(geologic) e„le r Depth to Dedruck
Depth to Groundwater: Standing Writer hi I tole: Weeping from I'll hncc
Gslimnted Sensonnl I ligh Groundwater
llX'C1ZlYXxN 'z:Z�1V X�UIt SASONAL'IZIG1
Method Used.
Depth Observed slmding in obs.hole: In. Dcplh to soil inollics: in.
Depth to weeping from side of obs.hole: in. Grrnuulwnter Ad.16simcol It.
^,^ Index Wcli H 12rndIng Dme:_ ►ndcx NVcll Ievcl Atli.factor Adl,(iroundtenlcr I;cvcl
' :::::::•.-;::.::;;:.:;:.: :.. : A::EAtt..VUM:AV1\:?11:J.:�s.Jl`';:
Observatimr
tole N fhne nt 9
Depth of Perc / Time.nt V
Stml Pre-sonk Time @ -6")
-nd Prc-sonk Uvwidt jo
Itnle Ivlht./Inch 2 w►�►^ Ia l .
Site Suitability A"essment: .Site Pnssed Site Frilled: Addilioanl Tcsling Needed(WN)
Oiiginni: Public llenith Division Observation hole Min To Be Completed on hack j
Copy: Applicant
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03Xt�VA' ' �Vt17 Y,OGrUle
Dei)tl\from Soil Horizon Soil Texture Soil Color Soil Olhcr
Surface(in.) (USDA). (Munscll) Mottling (Structure;Stones,Boulderes.
Consistency.%Gravel)
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::: ::: •lEr:'.: "z3S:VRYATX:ON:HOa.
Depth from. Sbii Horizon Soil Texture Soil Color. . soil Other.
Surface(in.) (USDA) (Munsell).. Mottling (Structure,Stones,Bouideres:.
•
e Gravel)
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it ci v►'dlrcCcvwr G "�
Depth from Soil Horizon §oil Texture Soil Color Soil Other "
Surface(in.) (USDA) (Mansell) Mottling. (Structure,Stones,•Iloulderes.
Consistency,% ravel
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:
H(..LG.:<
Depth from Soil Horizon Soil Texture Soil Color Soil Other.
Surface(in.) (USDA) (Munsell) Mottling (Structure,Slopes,Boulderes.
Consistelley.° r c
P.
flood Insurance Rate Man
Above 500 year flood boundary. .No. Yes
Witt iin500'year boundary No�kl Yes
Within'!00 year flood boundary-No V Yes -
Depth of Naturally Occurrutg Pervious Material
Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the
area proposed for..the soil absorption system? ��
If not,what is the depth"of naturally occurring pervious material?
-ertifAcation
I certify that on .9.5 (date)I have passed the soil evaluator examination approved by the
Department„of Environmental Protection and that the above analysis was performed:by me consistent"with
the required training,expertise and experience described in 310.CMR 15.017,
Signature Date .�� .
6 �
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TOWN OF BARNSTABLE L-11V 1
LOCATION sl a& ��u''�E �'✓�� SEWAGE
VII.T,AGE_ eJC ASSESSOR'S,MAP & LOT0G/'o�v-oo�
INSTALLER'S NAME&PHONE NO. K4Y 47L`�)")b/�onT lt'F'�-'�
SEPTIC TANK CAPACITY /moocc o,-✓f
LEACHING FACILITY: (type)
tYPe (size)
NO.OF BEDROOMS
BUILDER OR OWNER
PERMTTDATE: Z u v 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 3b0 feet of leaching fa ility�)� Feet
Furnished by I .p.
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TOWN OF BARNSTABLE
I LOCATION /a 6 f U, 7e ,�-✓�.� SEWAGE # c �8 a Z
VILLAGE_ ASSESSOR'S MAP & LOT
INSTALLER'S NAME&PHONE NO. ��� ��%z`� �� �� 929 24
SEPTIC TANK CAPACITY
LEACHING FACILITY: (type)
NO. OF BEDROOMS �t !
BUILDER OR OWNER g/,�y c,o s LjcJ,c z•
PERMITDATE: uu 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 facih ) .. Feet
Furnished by
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No.-- --- -- Fee----- --------—
OF HEALTH
TOWN OF BARNSTABLE
Application for Vell Construction ermit
Application is hereby made for a permit to Construct Alter ( ), or Repair ( )an individual Well at:
Location — Address Assessors Map and Parcel
�' � �---` Lam__— __ — YU_� �4--Ceke"- —
O er Address
Installer — Driller Address
Type of Building
Dwelling --- --- -------
Other - Type of Building No. of Persons---------—----------
Type of Well 41"ei t2 C -- Capacity-----------------------
Purpose of Well-I !
Agreement:
The undersigned agrees to install the aforedescribed individual well in accordance with the provisions of The
Town of Barnstable Board of Health Private Well Protection Regulation — The undersigned further agrees not to
place the well in operation until a Certificat of Compliance has been issued by the Board of Health.
Signed — - /0/00 -----
- date
���
Application Approved By - - --------
date
Application Disapproved for the following reasons: ---------------------- --
- — --
date
Permit No. -- Issued---- ---------------------------------
date
BOARD OF HEALTH
TOWN OF BARNSTABLE
Certificate ®f Compliance
THIS IS TO CERTIFY, That the Individual Well Constructed (,/,), Altered ( ), or Repaired ( )
by--- --------
Installer
at-----
rg IF/u K4 r CL v-e Au. W1 ,^-------- - -- -- -- --- -------
has been installed in accordance with the provisions of the Town of Barnstable B�o�a)rd of Healt12,Private Well Protection
Regulation as described in the application for Well Construction Permit No. - ated----- -------
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL
SYSTEM WILL FUNCTION SATISFACTORY.
DATE--- — Inspector------------ -- —-------
J
�D -
No.-- ------------ Fee---== --------------
BOARD OF HEALTH
• TOWN OF BARNSTABLE
0(ppfication fforlVell Con5truct ion Permit
Application is hereby made for a permit to Construct Alter ( ), or Repair ( )an individual Well at:
( Location — Address /�( Assessors Map andlTarcel
t.t ,/�. — A l(S /r'Y� a C `eG1,/ Ut —
f Address
------------------------- - ------------Installer_.—Driller Address
Type of BuLing
Dw Iling
Ot er - Type of Building-- --------- No. of Persons----------------- --- ---------
-
� -
Type of ell 41 AuC - Capacity----------------___—__
Purpose f Well-.L,-�!
The undersigned agre s'to ll the aforedescribed individual well in accordance with the provisions of The
',,Town of Barnstable Board of Health Private Well Protection Regulation - The undersigned further agrees not to
place the well in operation until a Certificat of Compliance has been issued by the Board of alth.
s �j3/0o
Signed -----
date
Application Approved Bye_ t% / �+� _ ► _- -— /
date — --
Application Disapproved for the following reasons: - ------------- ----- —--
)./v 1j �_ _ --__--—---—-- ----
date
Permit No. - -- Issue --------------------------
date
BOARD OF HEALTH
TOWN OF BARNSTABLE
Certificate Of Compliance
THIS IS TO CERTIFY, That the Individual Well Constructed (►/), Altered ( ), or Repaired ( )
b —,� SCuNw l(
-----------------
Installer
at-- I�G �/U H.t p Q U /Ll . fM r ,
has been installed in accordance with the provisions of the Town of Barnstable Bpaird of Heal rivate Well Protection
Regulation as described in the application for Well Construction Permit No. #00:t- Dated----THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL
SYSTEM WILL FUNCTION SATISFACTORY.
DATE---- Inspector-------------- ----------
BOARD OF HEALTH
TOWN OF BARNSTABLE
Yell ConstructionPermit
No. -- - ----- Fee- ----------
Permission is hereby granted
to Construct ( A(Alter ( ), or Repair ( ) an Individual Well at:
No. f�u►�t Ccu-c • AA •/A '
Street
as shown o application for a PlayConstruction Permit
No.- -— `-7 ---_ Dated A- — -- ---------------
--- — - -- ----- -----------------------
DATE 103loo Board o Health
— __
�� �, ��v► n� -e C�J �
I
� ILA &J C
No. Fee
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
Yes
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS
01ppYication for Migogal *pgtem Congtruction Permit
Application for a Permit to Construct(A)Repair( )Upgrade( )Abandon( ) 'X Complete System O Individual Components
Location Address-or Lot No. 1 Z6 j=10 vv%v /�Vur Owner's Name,Address and Tel.No. 77/--/Q*cD
A rmc,ws"s M:1 l S GCtSC4a.,
Assessor's.Map/Parcel
Installer's Name,Address,and Tel.No. �(�'�_ q(r' ( Designer's Name,Address and Tel.No. 4Zk—!`/.3/
$i L o u+rt 54-. BSkrvoi f te_
Type of Building:
Dwelling No.of Bedrooms ,it Lot Size 3ji, 1 Zci sq. ft. Garbage Grinder(AA)
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow 1/0 q aJ AuJIZV1 gallons per day. Calculated daily flow 4 <1 gallons.
Plan Date 125.1 e,2 Number of sheets &*Aw Revision Date }—
Title S aF,
Size of Septic Tank Z5im lAm-S Type of S.A.S.'Aeack 66,abrvs 351K121x 2fhc7L
Description of Soil Pt c4se yam_ �61 Wr c n kt� I�d s-956,4
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 Certifi-
cate of Compliance has been issu y this B of H
Signe Date
Application Approved by Date
Application Disapproved for the following reaso
Permit No. Date Issued
4 i, Fee
No ; f V�
THE COMMONWEALTH. MASSACHUSETTS Entered in computer: Yes
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS
14
0[ppficationfor Oigpooal *pgtem tCon!5truction"Permit
Application for a Permit to Construct(JO Repair -Upgrade( )Abandon( ) *X Complete System O Individual Components
Location Address'Lot No. 1 Z6 F(urns /}�C Owner's Name,Address and Tel.No. 77/-/O 4-O
Assessor's Map/Parcel \ `�
Installer'S'Name,Address,and Tel.No. fbi_ /J((/�[( Designer's Name,Address and Tel.No. 428-f/3/
Type of Building: u
Dwelling No.of Bedrooms F �r Lot Size 3j r1 Zvi sq.ft: Garbage Grinder
Other Type of Building No.of Perso is Showers( ) Cafeteria( )
Other Fixtures
Design Flow gallons per day. Calculated daily flow 44i gallons.
Plan Date 11,61 5� Number of sheets a►w_ Revision Date
-fT r
Title 5, he
Size of Septic Tank Son pg Type of S.A.S. lwack 66,d xrs 351<i2lK 2'titrL
Description of Soil Pi«5 cc J. r.6I lQmd c�s its43
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 Certifi-
cate of Compliance has been issu this Bo of He
Sig te Date
Application Approved by Date
Application Disapproved for the following reaso
Permit No. Date Issued
---------------------------
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 s constructed in accordance
with the provisions of Title and the for Disposal System Construction Permit I d
Installer Designer
The issuance of this permit shall not be construed as a guarantee that the sve will unction as esi
Date �s ' OZc 2 ► Inspector
----------------------------------------
N ti
P Fee
THE COMMONWEALTH OF MASSACHUSETTS
b G1, 0/0_0os"' PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS
Migool Otem Construction Permit
Permission is hereby granted to Construct( Re air O Upgrade( Abandon( )
System located at Z G Xfu C4_0_ it, -144
and as described in the above Application for Disposal System Construction Permit. The applicant recognizes his/her duty to
comply with Title 5 and the following local provisions or special conditions.
Provided:Construction in
stJbe ompleted within three years of the date of this p Q
''Date: 7Z% D Approved by
TOWN OF BARNSTABLE
` A G�lO U - ✓�VC,. SEWAGE #
LOCATION
VII RAGE Al. ✓�� .S ASSESSOR'S MAP& LOT ( Of 0
INSTALLER'S NAME&PHONE/NO.
SEPTIC TANK CAPACITY 5
i
LEACHING FACILn (type) 3 " CVl (size) 33d'S /o�X
Y: 3s
NO. OF BEDROOMS
BUILDER OR OWNER R O er Ate, CA
PERMTTDATE: 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 acility) Feet
Furnished by ��� Si ku 10^
Al
,� , + e rya- �8•�
13a - to
lo a Al S�
i
i
ZONE N MIDDLE Leaching Area Requirements
LEGEND Design Schedule ELEVATION g
EXISTING PROPOSED _ A.P. POND g
RESIDENCE F TOP OF FOUNDATION _ 63.0'
Edge of Pavement - MINIMUMS
4BEDROOMS AT 110 GPD/BEDROOM = 440 GPD
g _ LOCO$ FINISHED BASEMENT FLOOR 55.3'
Sewer Pipe FRONT SETBACK = 30' AMBUIN
BOGS` FINISHED GARAGE FLOOR 62.3' ADDITIONAL 50% FOR GARBAGE DISPOSAL N.A.
Water Pipe w - SID: SETBACKS = 10' (BY SPECIAL PERMIT WAIVER) POND
�-� i P' SEWER INVERT AT FOUNDATION 60.0'
Dram i PERC RATE = 2 1 MIN. INCH (CLASS 1 )
59.8
REAR SETBACK = 10
Gas Pipe -------------G .... :::.;;;;::�:�::;. � SEWER INVERT INTO SEPTIC TANK '_ / /
Manhole Cover O -
SEWER INVERT OUT OF SEPTIC T,JK 59.5'
t Catch Basin ■ �- LIAR = 0.74 GPD/S.F.
M Water Gate N RIVER n SEWER INVERT INTO DISTRIBUTION [.SOX 59.3
f Light Pole o SEWER INVERT OUT OF DISTRIBUTION BOX 59.1' MIN. LEACHING AREA OF S.A.S.
ContourUtility s + �p . SEWER INVERT INTO LEACHING SYSU'M 57.3; 440 GPD 0.74 GPD S.F. 4S.F. MIN.
94 BOTTOM OF LEACHING SYSTEM 55.3 / / 59 S Spot Grade 200.0
Test Pit WATER TABLE 41.3' '
PROPOSED SYSTEM . SIDEWALL (12+35)(2)(2) = 188 S.F.
LOCUS MAP BOTTOM 12' X 35' = 420 S.F.
SCALE I = 2,000'
TOTAL = 608 S.F.
ASSESSORS
MAP 61
PARCEL 10-5
{
•�' GENERAL NOTES: !
ALL SYSTEM COMPONENTS SHALL BE INSTALLED IN ACCORDANCE WITH
TITLE V OF THE STATE SANITARY CODE DATED
MARCH 31, 1995 & ANY LOCAL. RULES APPLICABLE.
`'
`r` ANY CHANGE TO THIS PLAN MUST BE APPROVED IN WRITING
t`P 1-1.5 WASHED STONE BY THE DESIGNING ENGINEER.
•
•. 112' ` CONSTRUCTION IS COMPLETED PRIOR TO BACKFILLING,
O �� H2O y :: :��:.,•.:;:.,:�::;:: NOTIFY THE ENGINEER & BOARD OF�HEALTH AGENT
P � �
9 35' FOR INSPECTION.
9 0 9 9
O'` G DIST. PLAN OF LEACH CHAMBERS FOUNDATION ELEVATION MUST BE CHECKED WHEN COMPLETED.
•Q _ BOX �F NO SCALE
SF THESE ELEVATIONS MUST NOT BE CHANGED WITHOUT WRITTEN
O F n -
I APPROVAL BY THE DESIGNING ENGINEER.
T 4A �► 1 10
q
tio , , _ ,
min h
3 12 ALL SANITARY DISPOSAL SYSTEM PIPING 70 BE 4 PVC.
> o
s 3
S ,
T
F FINISHED GRADE
R PLACE ALL UNSUITABLE MATERIAL SURROUNDING
O , EXCAVATE"AND E
\ \ \ \ \
� _ / /\/ / / / y / / / ,; . COMPACTED FILL
6 36 MAX.. 12 IN. ,/ / / / �`/ / /\/ / / /�, SURROUNDING .THE LEACHING FIELD FOR A DISTANCE OF 5 , PER
�c o GAT \ \/\\ /\\/\\/\\/\\/\�/\\/\\/\\/\\/�
p F _.i
2 310 CMR 15.255.
Li.l ,, � z �� � � -- � .. ,� PEASTONE -
1 #2 �O I » - '' ; . - 3/4" TO 1 112 "
CD 30.5 0' :; ! DOOBLE PRIMARY BENCHMARK N.G.V.D.
,�
� � � •• ` � - .'• � PROJECT BENCHMARK : TOP OF SPINDLE HYDRANT #1106
a � J WASHED STONE
m n, L -" 20.09 J SOUTH SIDE OF FLUME AVE.
� 05 EL. = 71.80 N.G.V.D.
0 LIJ
SECT10.14
00 -� C .--- LOCATION OF UNDERGROUND UTILITIES ARE APPROXIMATE AND
Ln rO ^ NO SCALE SHOULD BE VEP,IFIFD IN THE FIELD BY THE APPROPRIATE
Cn
t, cow UTILITY COMPANY PRIOR TO ANY CONSTRUCTION.
L'-r
� � gyp.
o z LOT 5A .
R
AOP
39, 129 s .
OF 41�
1
;?? / LEACH SYSTEM WI17i INFII TRATGIt DESI(iiy00
.1
�v o v+�
Q- •O ALL PIPES 70 BE SCHEDULE 40 PVCAD N "
4 . 29M7A
�iS ( USE 1 - 4" DISTR1t3UTION LINE !N 3 RECHARGES UNITS �"•^ cisTt °�e���
00. I V° / r No 36216 v g
J � u��
�, � IN A 12'X 35' WASHED STONE TRENCH AS SHOWNLIJ
�4F t��oT�F ���,�
IG
(� O� idAL
O -
OQ '�
5��$
Septic Design
$ I .CERTIFY TO THE BEST OF MY KNOWLEDGE THAT THE PROPOSED FOUNDATION SHOWN IS
SCA!':: 1"= 20' IN COMPLIANCE WITH LOCAL ZONING BY-LAWS (WITH RESPECT TO SETBACK REQUIREMENTS At #126 Flume Avenue
1�J 20 0 i 20 40 ONLY) AND DOES NOT FALL WITHIN A SPECIAL FLOOD HAZARD AID A.
a
- Mills,Marstons assachusetts
SC ...
>. A IN FEET
N a
` , ,�OPERTY LINES.
I'
� THIS PLAN IS N07 TO BE RECORDED OR USED TO ESTABLISH
OPEN SPACE' A
PREPARED FOR
12 = Ica- t 9qi�
BAYS IDE BUILDING CO.
G1STE ED PROFESSIONA L LAND SURVEYOR DATE
TITLE
Sanitary Disposal System
J.K. HOLMGREN & ASSOCIATES R L.
SOIL LOGS DATE: 11-IMI'''
ENGEVEFR: BOARD OF� ��ALTH AGENT
Finished Grade = 62�f TYPICAL SYSTEM PRO :� E Stephen A. Willso P.E. Donna M oia»di, Barns. Health he t. B�,XTER NYE & HOLMGREN INC.
P P
CONSTRUCT ACCESS NOT TO SCALE - -- TEST PIT 1 TEST PIT2 Registered Professional
Proposed MANHOLE OVER INLET G.S.E. = 58.0 P- 9 5 6 4 _ G.S.E. - 59.5 Engineers and Land Surveyors
Top of To TANK To AT LEAST
TOP
= 63.0' WITHIN 6" FINISH GRADE
.i�' „0„ 812 Main Street, Osterville, Ma. 02655
0
FINISHED GRADE OVER TANK = 62'f Phone -(508)428-9131 Fax - (508)428-3750 "
FINISHED GRAD;: JIVER D. BOX = 61't .. .. �»
FINISHED GRADE OVER LEACHING TRENCH = 59't 2"
T j
4" SCH. 40 PVC FIRST 2' (To BE LEVEL) t2� (min) cover „ Ap �,P 10 YR. 4 3 40
SANDY LOAM SANDY LOAM
' (TYPICAL) - min. - 4" SCH. 40 PVC - / 20 20
s•(min.) OL? (ntn) 36 (max) Cover 8 10 YR. 3/1 1
PVC or
GAS BAFFLE f 6" 9unpp 4" SCH .40 PVC I SCALE IN FEET s
Proposed �o• C► tees r Y / B SANDY LOAM B SANDY LOAM
Finished L._ 2„La er 1/8°tot 2„ » »
Basement "
Peastone LEACHING CHAMBERS 24"
Floor = 55.3' ..: ... .:.'__ r
y " ' Slope = 0.005 (min ) 24" 1�OYR 5/6 - 10YR 5/6 SCALE: 1"= 20' DATE: l 2/15/99
Reinforced Concrete 4" V
6" CRUSHED
•. :. ,: STONE BASE PVC
FOOTING O O O O O O O O O O "C 1 " MEDIUM SAND "C" MEDIUM SAND REV. DATE: REMARKS
O O O O O O O O O 72" 1OYR. 5/4 132" 1OYR. 6/3
B - NO 'WATER ENCOUNTERED
0 oM ELEV. 55.3• „C2» MEDIUM SAND PERC�`� - 48"
10 YR. 7/2 DRAWING NUMBER
14.0' 132' .
RAl f-= e 2 MIN/IN
1500 GALLON SEPTIC TANK DISTRIBUTION BOX
TO BE INSTALLED ON A LEVEL STABLE BASE TO BE INSTALLED ON A LEVEL STABLE BASE
� - H:\Drowings on 'Holm ren2_nt' 1 997 ` 97012
SEPTIC TANK TO BE INSPECTED &"CLEANED ANNUALLY
Adjusted Groundwater Elevation = +'1.3' Lot 13.
LEACHING SYSTEM
97012CSP-5�