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0042 FRAZIER WAY - Health
'�A v+ 5�V�1 $ UYT `� L L S 1 ___1 • - - - <-� i No................8'._0 Fms..r...J......S THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ...................... ...................OF........................................... ApplirFatinit for Disposal Works Tomit.rnrtiun Vamit Application is hereby made for a Permit to Construct gr Repair. ( } an Individual Sewage Disposal System at: Z n --_.�---•--•••.................. ©------------•------.K•. ZI.L. ..... ^? ................... -Address or Lot N r.1.J �1. .!_ �� �`'( { ors. ' ..I- _..... ... . ----•----•-----..... ... ....--•----•--- _' *e 'Owner Address t4is� ............................................................. ......--------•-----•--•..............--•----•-•.......----•------.._.._.._._.._..............•... `. Installer Address Type of Building x Size Lot............................Sq. feet Dwelling,* N.O.-of Bedrooms............................................Expansion Attic ( ) Garbage Grinder (Alp '4 Other—T e of Building No. of persons............................ Showers — Cafeteria Q' Other fixtures ---------------------------•••-- WDesign Flow..........................:.................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid*capacity.l;!o 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 areal .!;?.._...sq. ft. z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by-------------------------------------------------------------------------. Date........................................ aTest Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ G%, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a .......................................... .------------ ----------------------- ... -----------------...............-------------------------------------- 0 Description of Soil......................................................................................-----------------------•---------------..........................................=--------------•••-.....-•-••-------••••- x U W x •---••••••••..--...-----•------•--------------------------------•--•---•-•--•--•----•...••------•••---••------•--............----•••-•-------------••-•••-•---•--•-•--•---•--•-•--••-•-••......----••-- 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 iITLi� 5 of the State Santa ode he undersigned further agrees not to place the system in operation until a Certificate of Compliance has en iss by the board of health. Signed.......••----= .... .. . •-••---------------------------- q Date Application Approved By.. �;rl�� ,1 _ _ ................................. ...... . "Z= Le� Date Application Disapproved for the following reasons:............................................................................................................... ............................................--.................................................................................................................. ....................................... Date PermitNo......................................................... Issued---•---•--------------------.......--•-•-•-•-------•-•. Date t� No.............. -i,-0 J V 1 F�s......3 s ----_ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ...................... .....................OF.................................... ... Appiiration for Uisvontd.:Vorks Tomitrurtinn andt Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual- Sewage Disposal System at: k Location Address or Lot N Owner Address a ----..........L__+'d =_ ................................................................. ..............................................-.................................................... Installer Address Type of Building ..rw `' Siie Lot___________________________Sq. feet Dwelling=No. of Bedrooms.... ...............................Expansion Attic ( ) Garbage Grinder (Alp aOther—Type of Building ............................ No. of persons,........................... Showers ( ) Cafeteria ( ) • Other fixtures =• ---------------------------------------------- --------------- Design Flow............................................gallons per person per day. Total daily flowj.... ....__._ g g P P P Y• Y �-- --------•---...----•---gallons. WSeptic.Tank—Liquid capacity pa0gallons Length.. id-thy.__.::= Diameter.___.........._. Depth............. Disposal Trench—No..................... Wid Total Lerkh................. x P --------------- _-j---..-__ Total leaching area-------------••••-_.sq. ft. Seepage Pit No......../------_.... Diameter... ........ Depth below inlet...6.....__._... Total leaching areas 4 jP_.....sq. ft. z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by-----;............................................................... -•-- Date-=.......................... ,4 Test Pit No. 1................minutes per inch 'Depth of Test Pit.................... Depth to ground water........................ 44 Test Pit No. 2................minutes per inch Depth of_Test Pit....-`:._......._._. Depth to ground water........................ ---------------------------------------- •...................................................--•---•••-••-•••-••-••-•....--•-••---•••-•--•--•--.....-- 0 Description of Soil.............................................. ................... ........................ ---------------------------------------- V ------------•----------•---- ----- __.....---- -----------------•- ----------......--------•-•---------......_•-----•---•---- W U Nature of Repairs or Alterations—Answer when applicable_-----__________________ ;__._._...._...___..___..___._..:._.......__.._..___..___.__..._...__. ---------------------------•-----------------------------------___,-....................................... ip -------------------• --•------------------__-•••---- Agreement- r a _. The undersigned agrees to install the aforedescribed Individual Sew ge Disposal System'�n accordance with the provisions of iTIE, 5 of the State Santa ode'; he undersigned alithw�.-- ... ther agrees not to place the system in operation until a Certificate of Compliance has a issu by the board of h >.. Signed ._...._.• -� -------------------------------- .........................._.... / Date Application Approved BY -----------•_____________•-- -------1"_ _ = .. y Xi Date �. Application Disapproved for the following reasons---------------------------•••-----------------------•------------------------------•.....-- --•------••-••••-•- ---------------------------------..............................................................-•------------•------------------- Date � PermitNo......................................................... Issued_--•---------------••------------...._........_.._--•- s -- Date Z THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ...............: (9rdif irab laf Toutplianrr THIS IS TO CZRTIFY, That the Individual Sewage Disposal System,,coristructe&('' ) or Repaired ( ) 1 t at'�Q-�•--'"t-- ----�.�"�.. ,` , •-------.. i l�-i 4aa,T 1'" t - 'a "`�' has been installed in accordance with the provisions of TTTIZ 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No------------ ......... dated_.............................................. THE ISSUANCE OF THIS CERTIFICATE SHALT. NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE................................. ---------------------------------- Inspector........P:__A.I.............................................................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH OF.......................................................................... No........ .Z y�✓ t. FEE........ �............ Dioposai Nab Tianitrnrtinit rrntif Permission is hereby granted...__!... .. _........................ .......... to Co struct ( ) it ( ) n ndivi ua Sewage Disposal Syst ~ fat Nd�°�__._�_ �. ----�-_�_..-----•............./??_..-.......?-it c-1--------•--------.......-------------••-- ---'-...'..-.- .... Street as shown on the application for Disposal Works Construction Permit No...........:.::...... Dated.z....................................... �oaroeah DATE.................... •------ ---... _ .:.._......----._..._.. FORM 1255 HOBBS & WARREN. INC., PUBLISHERS j Sit.Y�t_6 �AMtL� - 3 F3t�tzooM '•� � . • - - • LAO GAMUAGE F 9Zt f.1ocR. p�etL�! 1~t-Cw _ tto 4 s • 3so b•P•D ��t-tc -r-A�tc �s3o,. 150 °.". • Aq5 6.Pp. 92,1 USA tool 4SAL-. 100o GAi-. .1. '7 i Po5 AL tT - t7r--u/ALL AM f "'T -97 G , Icjp SF .c 2.S • 3'7S G,.PU. db v4n-M 4 AeIEA Sfl SM. t I P!T. ti SO 6.PD. i TcrrA L 'O G616W s d25 G,RD. :-: 32 f T >TA t_ 1::>A-I L-( Fr Low 4 330&PD. a,8 �Q 44 � P¢opos Pmcm&noo cz&TF : t"to 2hctw'oiz Lr:%. Wsr* 9�• El t 1 .d., i � �•. :-jam ..� .'r��,a• .` • �, . .. ._. .. •� ,. .". -ram- P:`too : . , : : • ,c� -. 98 ;• Tor F• %b • a �Y 4/ 1� N1"�' . .r! OoC .5�....: ._.. .�� . ._.. .._ .. 'sox q$.L Sync 10 i T?3- ; N. TartK'- t000 Hwy, try . , ..; _ � � • PIT . . . . . . . , . . . . .. . . � . . �cEeTtF�Ev • pLe-t- PL..,4�i� PRO�'1L� LoCATIOW (Yt�1 Tb i lV11(,LS 64 -�Z''// uc Saa.L� . . . � 3c.. GAI.0 ����•S�j �ATt✓ �_2� at1L cGtZTtF`1 TkAT' T14a :fig SNo�� pLAtJ RL-Fc�.'Et.lCE -i t~cta Gc�vt�t_�!S vVtTN TNT 51vtv.L1W� ,&Wt> 15E-TOAC-4 j'G4Uj9ZeAA&.WTS OF T"e 7o w w of L A2-Wv7TA,13 LG A►\1O I S I�oT L4t�D c P- P>L14.14 �3a l(L LoGATEb• W I T I.AI ! -r W r== FI,oOD pl-A11.1. ' 8 A XTC 1Z - uYE t..�G. �.._� RG-Gl5'CC=RED 1. wo suQVEY01Z "('1-115 l7 LAt-J IS L10"1' ZASGV U�� AN 05TECV1l.tL- o l�r{ASS. � c:./� •Tt1c:. ot=t=;�T�, St•icwt.a It•lsf et�rvtCWT '� ANPU CA,"T_k"eLo 0550 t`br Cc Ur,,CD To heTccMtN�= �'c' - I.IN�.•;� r LOCAT10N V. ' `" SEW RGE PERMIT N0. VILLAGE ; INSTA LLER'S NAME & ADDRESS ROBERT B. OUR CO., INC. RORTH HARWICH, MASS. 02645 iiU1LDER OR OWNER *. Oge vw 31ue 1Qa;1aee eS 0AlE PERMIT ISSUED DATE COMPLIANCE ISSUED y: S -TANK , (Al sox J Health Complaints 26-Mar-03 Time: 9:30:00 AM Date: 3/25/2003 Complaint Number: 3963 Referred To: Taken By: DAVID STANTON Complaint Type: ARTICLE XXXIX HAZARDOUS WASTE Article X Detail: Business Name: next to#42 Number: Street: Frazier Village: Assessors Map-Parcel: Complaint Description: A complaint from a neighbor, landscaping crew blew a hydraulic line on bobcat, approx 3 gallons of oil leaked. they put stone on it, it is still damp though. Actions Taken/Results: DS WENT TO SAID LOCATION. THERE WAS A MINIMAL AMOUNT OF OIL RESIDUE ON THE PAVEMENT. THEY HAD CLEANED UP ALL LIQUIDS PRESENT, THERE WAS JUST STAINING OF THE PAVEMENT LEFT. FIRE DEPARTMENT HAS GIVEN US THEIR FILE FOR OUR RECORDS. THERE IS OIL IN PAVEMENT NATURALLY, AND AS THERE IS NO LIQUID PRESENT, ONLY STAINING FROM OIL RESIDUE, NO FURTHER ACTION IS REQUIRED. THEY HAD PLACED AN ABSORBANT DOWN AND COLLECTED IT ALL, EXCEPT FOR THE STAINING ON THE PAVEMENT. DIGITAL PHOTOS ON FILE IN DAVIDS COMPUTER. Investigation Date: 3/25/03 Investigation Time: 3:45:00 PM 1 MAR. 25. 2003 (TUE) 14:50 CENTERV I LLE FIRE 5087902385 PACE. 1 1875 R=1e.20.Cwtmy1Hs,vA 02832 COMM REPORT 19A MID D 6 01020 CT" of Oil or other combustible liquid spill oe� 03/25/03 Ale""I 03-F-0215 2 No. 1 or ^hrsa WHITNEY FLOREN OF 42 FRAZI LOBon: 54 FRAZIER WAY Callback To,R (508)428-2930 �I0" Buslneas �•F: h0� Gifford, Jeffrey Call Rana on: Direct report to FD (verbal) ApperatusPersonnel Response: lift, '1 INVESTIGATE OIL SPILL FROM A TRACTOR Na sae 0P:ENG5 Q Rea 324 0 NO=4 04 0 RES an 0Ree08:55 0" 08:55 La 09:01 09:10 l" 09:1J�11 M 316 07 ORES 326 0 I'oo' eery. weather, CLOUDY Tamp. 38 an& SE 5 � mph 9T.300 Q BRK 31e 0 BOAT 0 BRUSH: in Clue: Coat: /4ea/ CHF 301 0 DPT a do 0 SC 321 1 $ 0 see: Cauee: other: 0 suaor T"pa of oocapaaoy; Residential street, road or residential driveway ?'arol E of Paraannsl: 1 °*ter- Pelland, Mchard&Nancy TO 54 Frazier Way, MM owners srmnt en ants Tal.a: ftd= Tonanre Te1.9; Ctassflleatlon Code COMM FIRE Form M Left with/At: e PrsaerRP Yes No Substance: EduftU YT: T' Location: Yea.r Mwel: Sertel No. MO'177R Type: Year. ; Model: 8, Slow- colon VIN 1: Ofte' Addraw R Tel.a Cp"em Address&Tel,a OTHW AGENdEt3 NOTtFIM. Contaot Person: phonw. Time: I ey: HARRAME REQUIRED Responded In 321(1)to the area of 42 Frazier Way, MM.,to investigate an oil spill in the road. Upon arrival,found an area of liquid that had been spilled on the road between#42 and#54, area has been covered with stone dust and has seeped through approx Tx 10'. 1 spoke with a rep,from a landscaping company working at#54, Jose A. Gregolitto,who states that a skid steer loader they were,using broke a hydraulic line yesterday and spilled on the road, he estimates approx. 3.4 gallons. Mr. Gregolitto works for Starboard Side Landscaping Inc., P.O. Box 6, 370 Upper County Rd., S. Dennis, MA 02660, 508-766-269e, Mr Jeff Eldredge is the owner. Mr Gregolitto stated he would clean up area. I advised him that I would notify the BOH and they will contact him as far as what needs to be done for clean up. Ret, to Qtrs. LW ff=s NRblNp WJ�➢ MLLOW Up., REPORT Eldridge, Byron D�.; 03I2S/03 FIRE CHIEF . SIGNATURE: RECWE ; SIGNATURE: r Town of Barnstable Regulatory Services Thomas F. Geiler,Director B "SrABLL 9� E.. Public Health Division 039.A'FCNu►'�° Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office:.508-862-4644 Fax: 508-790-6304 Installer &Designer Certification Form Date: �D q Sewage Permit# 2 04 9� 2/d`Assessor's Map\Parcel S �0-oo6ao y Designer: Lir d. . Pm Installer: ,/,�se�O�.��164 ra S Address: ec 203 a Address: '(r 4-& ` On was issued a permit to install.a- (date) (installer) r septic system at y24LvZ 6 Ali,T based on a design drawn by (addre I,,lr1Gh. 1� dated (designer) . .I certify that the septic system referenced above was installed substantially-according to the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. Stripout (if required) was inspected and. the soils -- were found satisfactory. . - I certify that the septic system referenced above was installed with major. changes (i.e. greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system) but in.accordance with State & Local Regulations. Plarr-revision or certified as-built by designer to follow. Stripout (if required) wa inspected and the soils were found satisfactory. LINDA J. PINTO (Installer's Signature) " CIVIL No. 46504 G/STEEi�O.1�'� FSS 0 ql ECG\ (Designer's Signature) (Affix Designers tamp Here) PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS- BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. Q:\Septic\Designer Certification Form Rev 03-09-06.doc TRANS. NO.: CITY/TOWN: APPLICANT: ('A , re tj ADDRESS: Ll Z Era Z/-e t"I DESIGN FLOW: _� gpd REVIEWED BY: DATE: -7 0 N/A OK NO 17 GENERAL _ Legal boundaries denoted[310 CMR 15.220(4)(a)] Street, Lot,tax parcel number and lot number noted on plan[310 CMR15.220(4)(u)] Locus Provided [310 CMR 15.2204 t Plan proper scale? (1"=40' for plot plans, 1"=20'or fewer for com onents) [310 CMR 15.220(4)] Easements shown 310 CMR 15.220(4)(b) System located totally on lot served [310 CMR 15.405(1)(a) for upgrades]-i not, a variance is re uired [310 CMR 15.412(4)] Location of impervious surfaces(driveways,parking areas etc.) [310 CMR 15.220(4)(d). Location all buildings existing and proposed 310 CMR 15.220(4)(c)] Location and dimensions of system components and reserve areas. [310 CMR 15.220(4)(e)] System Calculations [310 CMR 15.220(4)(f) ✓ daily flow septic tank capacity(required andprovided) soil absorption system(required andprovided) whether system designed for garbage grinder North arrow [310 CMR 15.220(4)(g) Existing and ro osed contours [310 CMR 15.220(4)(g)] Location and log of deep observation holes (existing grade el. on each test) [310 CMR 15.220(4)(h Names of soil evaluator and BOH representative[310 CMR 15.220(4)(h) and i \ Location and date of percolation tests(performed at proper elevation?) 310 CMR 15.220(4)(i) Percolation test results match loading rate? 310 CMR 15.242] � Certification statement by Soil Evaluator[310 CMR 15.220(4)6)1 I'erc T'e S r1 Observed and Adjusted groundwater(method for adjustment 's given or indicated) [310 CMR 15.103(3) and 310 CMR 15.220(4)(n)] 7 Address / Z�� tt/ Sheet'l of 7 N/A OK NO Location of every water supply,public and private, [310 CMR 15.220(4)(k)] within 400 feet of the proposed system location in the case of surface water supplies and gravel packed public water supply within 250 feet of the proposed system location in the case within 150 feet of the proposed system location in the case of private water supply wells Location of all surface waters and wetlands located up to 100 ft. beyond setbacks listed in 310 CMR 15.211 and any catch basins located within 50 ft. 310 CMR 15.220(4)(1)] Water lines and other subsurface utilities located [310 CMR 15.220(4)(m)] (if water line cross see 310 CMR 15.211(1)[1]) Profile of system showing invert elevations of all system components and the bottom of the SAS [310 CMR15.220(4)(o)] Stamp of designer 310 CMR 15.220(1)and 310 CMR 15.220(2)] Stamp of Registered Land Surveyor(required if construction activities within 5 ft. of lot line) 310 CMR 15.220(3) Test Holes adequate(two in each of the primary and reserve unless trenches as permitted in 310 CMR 15.102(2)or as approved for an upgrade under LUA at 310 CMR 15.405 1 (k) Test hole adequate to demonstrate four feet of suitable_material? 310 CMR 15.103(4)] Test Holes adequate to confirm adequate groundwater separation? 310 CMR 15.103(3)] Benchmark within 50-75' of system 310 CMR 15.220(4)( Materials specifications noted? [various sections of 310 CMR 15.000 System components not>36" deep (unless Local..Upgrade Approval or LUA requested) 310 CMR 15.405(1(b)] A rMn-ce ChPPt 2 of 7 �z �—rk Zf er �� N/A OK NO -- -K _ •�-,t. _ Gi` Z_� K��Iz.''"-"�-- _ g-'__ 1. Size OK? [310 CMR 15.223 1 Inlet tee located ten inches below flow line [310 CMR 15.227(6)] Outlet tee 14" or 14"+5"per foot for increase ft depth[310 CMR 15.227(6)] Outlet tee with gas baffle or approved filter[310 CMR 15.227(4)] Note regarding installation on stable compacted base [310 CMR 15.228(1)] Separation between inlet and outlet tees(no less than liquid f depth) 310 CMR 15.227(2)] Inlet/Outlet elevations at least 12"above high groundwater (except as described 310 CMR 15.227(5))or permitted for upgrades under LUA 310 CMR 15.405(1)(k)] Minimum cover 9" (Tanks buried more than 9"must have risers on all openings and on the d-box) [310 CMR 15.2228(1) and 310 ✓, CMR 15.232(3 Three access covers(inlet and outlet must be 20" or greater)- middle access at least 8" y 7/07) [310 CMR 15.228(2) Access to within 6 " of grade -one port for systems<1000gpd, two for systems>1000 gpd 310 CMR 15.228(2)] All at-grade covers secured to unauthorized access? [310 CMR 15.228(2)] > 10 R from building foundation[310 CMR 15.211(1)] ` Buoyancy calculation Required/Done 310 CMR 15.221(8)] H-20 Where appropriate? [310 CMR 15.226(3) Setbacks from resources [310 CMR 15.211] �Iul'4NCompa-" men��anks� �� _ _ Required when other than single-family dwelling•or flow>1000 d [310 CMR 15.223(1)(b)] First compartment 200%daily flow; Second compartment 100% daily flow [310 CUR 15.224(2)and 3 "U"pipe through or over baffle,outlet of each compartment with gas baffle or approved filter[310 CMR 15.224(4)] 4 rirlrvec Cf 7 (/W Rhept I of 7 w .■!lh!eaa=�a CC NTTN',,�� N/A OK N O JD Located at least ten feet from any water line? [310 CMR 15.222(2)] Disposal piping at least 18"below water line(when water and sewer cross, see 310 CMR 15.211 1)[1 ) Cleanouts required/provided? 310 CMR 15.222(8)] Thrust blocks specified in force mains? 310 CMR 15.221(6)(c Slope of sewer line not less than 0.01 (1/8"/ft) 0.02 preferable [310 CMR 15.222 Proper pitch on all runs? (.005 within gravity-distributed trenches and beds) [310 CMR 15.251(9)and 310 CMR 15.252(2)(c) Siphonproblem/(leachfield below pump chamber Endca s or vent manifoldspecified? Size and orientation of discharge holes specified? (not smaller than 3/8" not larger than 5/8") [310 CMR 15.251(8) and 31.0 CMR 15.252(2)(h)] Materials specified (310 CMR 15.251(5) specifies various pipe f types allowed Jt- Stable compacted base [310 CMR 15.221(2) and 310 CMR 15.232(2)(a)] Splash plate or baffle tee required on inlet/provided? (when pressure sewer to d-box or steep pitch of gravity sewer) [310 CMR 15.323(3)(a)] Riser if deeper than 9" 310 CMR 15.232(3)(f) Inside minimum dimension 12" [310 CMR 15.232(2)(b) Minimum sum 6" [310 CMR15.232(3)(e) Watertight cover if<2000gpd);waterproof manhole if>2000gpd [310 CMR 15.232(3)(d)] P GHA11V,tea Capacity(emergency storage above working—design flow)? [310 CMR 231(2)1 Proper setbacks 310 CMR 15.211 (same as septic tanks)] Watertight 20-in minium access manhole at least 20"MUST BE TO GRADE 310 CMR 15.231(5)] Service components accessible(not too deep with piping, disconnects accessible Alarm floats-alarm on circuit separate from pumpsspecified? Exceeds two units must have two pumps operating in lead-lag mode. [310 CMR 15.231(6)and(8)] L� Stable Compacted Base[310 CMR 15.221(2)] Buoyancy calculations needed?Providded?� [310 CMR 15.221(8)] Address Z- A/ Sheet 4 of 7 OK NO Calculations correct? 4 feet of naturally occurring material demonstrated? [310 CMR 15.240(1)] Required separation to groundwater? [310 CMR 15.212)] Aggregate specified as double washed 310 CMR 15.247(2)] System Venting required/provided?(system under driveway or >36" deep) [310 CMR 15.241) Inspection ports specified and within 3"final grade? [310 CMR 15.240(13)] Breakout requirements met? (No violation of breakout elevation _ within,15 ft of SAS unless barrier) [310 CMR 15.211(1)[4] and Guidance Document] GALLER3ES S C A20— 31 ---253- �� � x w a _ _ wR , :r �_ . .. _ . . Chambers and Gal. in trench configuration supplied with inlet every 20 ft. [310 CMR 15.253(6)] Each structure with one inspection manhole(if>2000 gpd must be to grade) [310 CMR 15.253(2)] Aggregate I'minimum-4'maximum. [310 CMR 15.253(1) 2' sidewall credit maximum 310 CMR 15.253(1)(a) In bed configuration,inlet every 40 s . ft. [310 CMR 15.253(6)] GHES 0 tEAR- Width 2'minimum 3'maximum [310 CMR 15.251(1 100 feet-maximum length[310 CMR 15.251(1)(a)] Minimum separation 2x effective depth or width whichever greater(3x if reserve between trenches) [310 CMR 251(1)(d)] Situated along contours [310 CMR 15.251(2)] Breakout OK? 310 CMR 15.211(1)[4] and Guidance Document :BED SASS(1VIaaumu�size-of_=bedorfre�d�000 `` �_ __ __ _ _� _ minimum 2 distribution lines 310 CMR 15.252(2)(a)] Maximum separation between lines 6' 310 CM R15.252(2)(d Maximum separation between lines and outside of bed 4' [310 CMR 15.252(2)(e Aggregate depth below discharge pipes 6"minimum, 12" maximum. [310 CMR 15.252(2)(g)] (/ Separation between beds 10'minimum. 310 CMR 15.252(2)( Bottom area used in calculations only 310 CMR 15.252(2)(i)] n aa.e,., �/v Rhi-et 5 of 7 N/A OK NO Pressure Dosed System ? provided and i in -,�- "`��� y s PAP P P g L� calculations as r aired 310 CMR 15.220 4)(r ] Pressure dosing required on all systems>2000gpd or alternative systems under remedial approval [310 CMR 15.254(2) and I/A Remedial Use Approvals) If used in gravelless system-make sure jet is directed as not to scour soil interface rGuidance Document Inspections once per year(systems<2000 gpd) or quarterly (>2000 d)good to note on plan [310 CMR 15.254(2)(d)] Construction in fill -Did the plan specify that the fill shall meet the specification of 310 CMR 15.255(3)? Impervious barrier and/or retaining wall ? Guidance Document Impervious barrier installation must be supervised by designer 310 CMR 15.255(2)(b)] Retaining wall must be designed by Registered Professional Engineer 310 CMR 15.255:(2)(a)] Side slo a not exceed 3:1 ? 310 CMR 15.255(2)) Breakout requirements met? [310 CMR 15.252(2) and Guidance Document At least 5 ft. from impervious barrier to edge of SAS M ed [310 CMR 15.255 2 DEP A roval letters for credits and design conditionswith pressure dosing do not allow pressure discharge to scour soil interface Altextratc 'ysfemPPj 'alefters� :, _ Was DEP Approval Letter provided and/or have you s ' - � reviewed the letter for conditions? c� Is the technology being properly applied and does it meet all DEP Approval Conditions? v Is there a note on the plan regarding the requirement for e etual maintenance agreement? Any alarms involved on separate circuits LDid the applicant submit an operation-and maintenance anual? Has applicant submitted a copy of a maintenance Are the variances listed on the plan? [310 CMR 15.220 r { 4) RLS Stamp necessary on plan if a component is within five feet of property line [310 CMR 15.412(4)] New construction or increased flow proposed- [Refer to 310 CMR 15.414] Address r Z ��Z! Sheet 6 of 7 N/A OK NO Is the system in a Designated Nitrogen Sensitive Area(Zone H for a public supply well)? [310 CMR 15.214, 310 CMR 15.215 and 310 CMR 15216 -also refer to Policy regarding upgrades of such existing systems Is the system proposed on the same lot as served by private well ? [310 CMR 15.214(2) Are the nitrogen loads proposed in compliance? [310 CMR 15.216 1 .: ..:s eac.T, ..__ ...�:1'_�f4T.-.•__., ..� ..—'3t`,�a�� _^'? ��.��'$+�-'c': `�,Y+aF.«.e'F'4 ..� ';. -.. - _ Pumping to s tic tank? [310 CMR 15.229 Shared System [310 CMR 15.290] AAA- qhi-P.t 7 of 7 No. �DD 1 �iJ Fee 1 f�0 THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS Yes ftpliLation for disposal *pstrm ConstCULtion 3pErmit Application for a Permit to Construct(lX Repair(yam(pgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Addr or Lot 14 Z/j;y9 (,�/1�1� Owner's Name,Address,and Tel.No. •Jvl _ Assessor's p.,n�a)rcel i, �' 00 0e7 i¢yr/ Installer's N e,Address, d Tel.No.$-09-16d 77.5 2 Designer's Name,Ad ess,and Tel.No.5';09- 737-/777 �S�l�'1/,C�S Type of Building: Dwelling No.of Bedrooms 3 Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 3 gpd Design flow provided gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank /Da0 Type of S.A.S. 2 elill e-:7 Description of Soil Nature of Repairs or Alterations(Answer when applicable) / tellT� -Sl��/ 19!"atii�c 9n/�4c' 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 / `/'/ � Date Application Approved by ,.S , Date 7^ Application Disapproved by Date for the following reasons Permit No. Date Issued 7—Z 0 Z OD0( No. 2 0Q Ll— 2/J 1 Fee 16 0 /i 'THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: / PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS Yes apputatlon for Misposal *pstrm Construttion 3permit Application for a Permit to Construct(1,�- Repair(-)-fJpgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Addr s or Lot No. tO, Owne 's Name,Address,and Tel.No. a 1'�1�y f rely Assessors a arcel �1 -ao6av Installer's NAe,Address,artd Tel.No. 77S Z Designer's Name,Address,and Tel.No. 1-49- 7f7-/7177 g/ VW. .e 777 Type of Building: Dwelling No.of Bedrooms 3 Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) ' gpd Design flow provided gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank /"goo Type of S.A.S. `Z " S229 aj 4e• �'/�9�'J�/ft l••/��N�r Description of Soil _Nature of Repairs or Alterations(Answer when applicable) // - OU 60 lyi 'TGi Date last inspected: .y,_ 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. 4 Signed Date 7' 2 O - 2 Application Approved by fz.s Date -7^ Z O " Application Disapproved by Date for the following reasons` Permit No. d D Date Issued 7- Z 0 oo� THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certifitate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed(t-+ Repaired(�' Upgraded( ) Abandoned( )by r/D.S��`i D6 /�44'O s at lvi T has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No2,00(-Z/ dated 7 - 2 d- 0 5 Installer ae �,d`l�CIS Designer { >= K/J �/�17f�'V/C,e.S #bedrooms Approved design flow*) 3 3o gpd The issuance of tyhiape',j it shall not be construed as a guarantee that the system w 11 f/tiibnpas designed, �J Date / ►u 1 Inspector / !J ✓„� 1 , -- -------- ------ No. 20C)� -- /S Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION BARNSTABLE,MASSACHUSETTS Misposal 6pstrm Construttion 3permit - Permission is hereby granted to Construct Repair((ir Upgrade( ) Abandon( ) System located at 7vi7- and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Cons ction ust be completed within three years of the date of this permit. n Date 7 2 7� 15 Approved by / ��J V/ TOWN OF BARNSTABLE �-'�'.{JCATION �°� �i^�4 ZIT' Gf/�+� SEWAGE VILLAGE T ASSESSOR'S MAP&PARCEL _�T— 006,01 ` INSTALLERS NAME&PHONE NO. 508-y2o—q��8 Jpscp� �G j3g�„-�r,� SEPTIC TANK CAPACITY /0O0 LEACHING FACILITY:(type) Q ;SOO -L1,V?HJt--5 (size) ,2YX l3 NO.OF BEDROOMS _ OWNER 1��1Ti9 G� ��Or�19 PERMIT DATE: 7— 2O —d 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 i. within 300 feet of leaching facility) Feet FURNISHED BY � � Fro z ier � o s �W COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS u DEPARTMENT OF ENVIR.ONMENTAL,P.ROTECTION TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY,,ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATIONif -- Property Address: y Owners Name: D pnr e' Qil/)4✓yf /' Owner's Address: .d; c9 � 1 Date of Inspection: Name of Inspector: lease rint 7 V a r;bhAZ Company Name: Mailing Address: -, Telephone Number:1s_(3t � 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 PEP approved system inspector pursuantto Section 15.340 of Title 5(310 CMR`15.000). The system: _Z— Passes Conditionally Passes eds Furth Evaluation by the Local Approving Authority, ails 11 Inspector's Signatures' DaI�: f ��G The system inspector shall submit a copy of this inspection report to the-Approving Authority(Board of Health or DEP)within 30 days of completing this inspection.If the system is a shared,system or has a design flow of F0,000 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 l l OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM. PART A CERTIFICATION(continued) Property Address: G �� Owner: 7z Date of Ins ection: Inspection Summary: Check A;D,C,D or E/ALWAYS complete al'I of Section D A. yytem Passes: I have not found any information which indicTtes.that,any of the fail>>re, -iteria.d:acrabed ii-i°31M1✓1R�.r 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: D. 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 2.0 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,se tic tank as approved P pp 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`tiox 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: Owner: Date of Inspection: Z1/s2Z QU 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 rot func+coning in=a manneS which will,proteet 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. su_rface 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 Char'5 pp-ai,Provided that no.other failure criteria are triggered.A copy of the analysis must be attached to this form. 3. Other: 3 r Page 4 of 11 M OFFICIAL INSPECTION FORM_NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 50 ".4 �Owner: JA.Y" 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/ . 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 t0 Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or / cesspool _ V Liquid depth in cesspool is less than 6"below invert or available volume is less than '/2.day flow Required pumping more than 4 times:in the last year NOT due to clogged or obstructed pipe(s).Number / of times pumped V 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 1 water supply. V Any portion of a cesspool or privy is within a Zone l 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 Systems: 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 I 1 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS. SUBSURFACE-SEWAGE DISPOSAL SYSTEMOINSPECTION FORM PART B CHECKLIST Property Address: �✓ owner: Aw lj,4 alzuU7er Date of Inspection: Check if the following have been done.You,must indicate"yes"or`.`no"as to ea&of the following: Yes o Pumping information was provided by the owner,occupant,or Board of Health 1/ _ Were any of the system components pumped out in the previous two weeks r/ _ Has the system received normal flows inthe previous two week period? r✓ _ Have large volumes of water been introduced to the system recently or as part of this inspection? L — Were as built plans of the system obtained and examined?(If they were not available noteas N/A) bl_ 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? —L---/ 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 Z_ Existing information.For example,a plan at the Board of Health. L-, _ 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 7 Page 6 of I 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: Owner: Date of Inspection: y77 FLOW CONDITIONS RESIDENTIAL .. Number of bedrooms(design): Number of bedrooms(actual)'.' DESIGN flow based on 310 CMR 15.203.(for example: 1.10 gpd x#of bedrooms): 2336) Number of current residents: Does residence have a garbage grinder,(yps.6r no):/Z0— Is laundry on a separate sewage system(yes or no)r -[if yes separate inspection`required] Laundry system inspected(yes or no):� Seasonal use: (yes or no): Water meter readings, if aflilable(last 2 years usage(gpd)): Sump pump(yes or no): r10` Last date of occupancy: COMMERCIAL/INDUSTRIAL/-,2 Q)-- Type of establishment: Design flow(based on 310 CMR 15.203): and 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: � d Was system pumped as part of the inspectio yes or no If yes, volume pumped: gallons--How was quantity pumped determined? Reason for pumping: TYPF,,OF SYSTEM eptic 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 aee of all compoppents a installed(if known)and source of information: Were sewage odors detected when arriving at the site(yes or no): 6 •.,Page 7 of I 1 OFFICIAL:INSPECTION FORM,-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM.INFORMATION.(continued) Property Address: q0 104ztd Owner: Date of Inspection: BUILDING SEWER(locate on site plan) Depth below grade: Materials of construction:_cast iron _40 PVC_other(explain): Distance from private water supply well of suction liner Comments(on condition of joints,venting,evidence of leakage.etc.): SEPTIC TANK:_: (locate on site plan) Depth below grade: 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: /d's k CD' ?C Sludge depth: Distance from top of sludge to bottom of outlet tee or baffle: r� Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to botto . of outlet tee or baffle: How were dimensions determined: � ,��� y. h Comments(on pumping recommendations, ifilet and outlet tee or baffle condition, structural`integrity, liquid levels As-felated to outlet invert,evide ce of leakage;etc.): / 4 Of Y/A-W GREASE TRAP• - ocate 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 11 OFFICIAL INSPECTION FORM—.NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C. SYSTEM INFORMATION(continued) Property Address: Vor Owner: ,P/ Date of Inspection: Zz Z-p i zo6 TIGHT or HOLDING TANKAto bilk 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�� . Comments(note if box is level and distribution to outlets equal;any evidence of solids carryover,any evidence of akage into gr out of bo)i,etc. PUMP CHAMBER1/(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 I f OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: Owner: Date of Inspection: SOIL ABSORPTION SYSTEM(SAS):--c"oocate on site plan,excavation not required) If SAS not located explain why: I Type —d� leaching pits,number: f leaching chambers,number: leaching galleries,number: leaching trenches,number,length: leaching fields,number,dimensions: overflow cesspool,number: innovative/altemative system T-ype/name of technology: Comments(note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation, eVMlyal) �w L .. f - / /" CESSPOOL n esspool 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.?j( 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 i Page 10 of I 1 ' OFFICIAL INSPECTION FORM_NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: Owner: Date of Inspection:_ a'40j/m 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. �° 33� 10 i ra6v, 1 I ut t i OFFICIAL INSPECTION FORM—NOT FORYOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C /. SYSTEM INFORMATION(continued) Property Address: c� f Owner: ' Date of Inspection: � � SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water 2— 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 propervy/observation hole within 150 feet of SAS) Checked with local Board of Health-explain: Checked'with local excavators, installers-(attach documentation) Accessed USGS database-explain: You must describe how you established the high ground water elevation: I/L!5 j 11 STANDARD NOTES 1) THIS PLAN IS FUR THE INSTALLATION/REPAIR OF A SEPTIC SYSTEV 2) ALL INSTALLATION PROCEDURES" AND MATERIALS SHALL CONFORif TO 310 CA& 15.000, THE STATE ENVIRONAfENTAL CODE, 717P OF Raise covers to within 6" of TITLE' 5, AND THE TOWN OF Barnstable - SUBSURFACE DISPOSAL REGULATIONS: FYILINDATTON finish grade install risers as needed Raise one cover to Within 6" of 3) NO DETERMINATION HAS BEEN MADE AS TO CO"LIANCE OF AVAILABLE PROPERTY WFURVATION WITH RECORDED DEEDS EL 105.5 (Min 20- Width) finish grade install risers as needed OR ZONING REGUI 4TIOXS. /M.G. 101.9 GROUND SURFACE EL 98.6 4) THIS PROPERTY b5' SERVICED BY 7VWN WATER Proposed 5) THERE ARE NO "OWN WELLS WITHIN 200' OF THE PROPOSED SOIL ABSORPTION SYS W To 100.7 D - Box ;N 6) ALL COVERS OF SYSTEM COMPONMVTS' SHALL BE BROUGHT TO WITHIN 6- OF F7MSHED GRADE DH 3 MIN it LAYER DOUBLE WASHED MIN a LAYER DOUBLE WASHED 7) ALL SYSMAf CO"ONENTS SHALL RF,MAIN ACCESSIBLE FVR INSPECTION. NO STRUCTURES SHALL BE LOCATED DIRECTZY Fro iis'- v2• STONE Lis'- 112• STONE UPON OR ABOVE THE COMPONENT ACCESS LOCATIONS WHICH WOULD INTERFERE WI77I THE PERF10RAfANCE, ACCESS, INSPECTION 100.6E 2"AUN-3"MAX TOP EL 96.25 INVERT EL Install PUMPING OR REPAIR 9.62 Instal! 9 ..... ......... ..... ...... .. ...... .. ...... .. ...... .. .. ...... .. .. .. .. .. ... .. DVy 10" Tee : 14~ Tee ¢ - - - - - - - - - - - - EF C77VE �q~ 8) NO DRIVEWAY, PARKING OR TURNDVG AREA, OR OTHER IMPERVIOUS' AREA SHALL BE LOCATED ABOVE A SOIL ABSORPTION INSTALL INV EL :;;;:;:r;:;;;;; ; - i ;`(;:::;: - - - - - - - - - - - ;`. I.SIDEWALL SYSTEJL EXCEPT WHEN VENTING HAS BEEN PROVIDED CAS 95 715 r 3!MW J� 9) SEP71C T",W GREASE TRAPS, DOSING CHAMBERS AND DLSTRIBUNON BOAES' SHALL BE PLACED ON A 6" STONE BASE BAFFLE' INV 95.58 95.50 0 m 3/4'- 1 112' DOUBLE Y19 ENSURE STABILITY AND PREVENT SETTLING. INV EL INV EL -Two- 500 Gal Cone (H-10) WASHED STONE 10) OU7ZET DL'STRLBUTION LINES SHALL RKNADV LEVEL FOR A All AMN OF ThW FTRST TWO FEET OF THEIR LENGTH e' Chambers with -pstone all around o� 11) ALL S'YSTEV COMPONENTS SHALL BE CAPABLE OF WITHSTANDING H-10 LOADDVG UNLE55 ?7LE'Y ARE UNDER OR WI77MV 10' 3/4'- 1 112' DOUBLE (4-10 x 8-6 x 2' ) a, f WASHED STONE i 93.50 Existing (H-10) BOTMA( EL OF DRIVEWAYS OR PARKING OR TURNING AREAS, IN WHICH CASE H-20 COMPONENTS SHALL BE USED. o 4000 Gal Septic Tank ci 'Q 12) ALL BUILDLWG SEWER LINES SHALL HAVE AN INNER DL4AfETER OF 4" AND SHALL BE CAST-IRON OR SCHEDULE 40 PVC. 14.5 (To remain) S = 0.15 sS0.01 13) TAW DEPTH OF THE YOP OF ALL SYS'T" COWPOAW4S SHALL NOT EXCEED 36~ UNLESS VEN27NG HAS BEEN PROVIDD.E S = 0.067 1 25 1 8- 14) IN THE AREAS OF EXCAVAT ON, EXSTDVG GRADES SHALL BE REESTABLISHED UNLESS NOTED AS PROPOSED CONMURS. Existing To Remain EL 88.3 Bot Test 15) IF SOILS ARE ENCOUNTERED DURING TE EXCAVATION OF THE SOIL ABSORPTION SMW,, THAT DIFFER NOTABLY FROM SAS (12-10n x 25-0') 1 Pit 2 77LE DEEP OBSERVATION HOLE LOG, CONTACT A & M LAND SERVICES AND 7VWN BOH BffVIRE PROCEEDING 16) CONTRACTOR 70 VERIFY LOCATION OF ALL UNDERGROUND UMffES. PRIOR YV CONSTRUCTION DESIGN DA TA 17) CHANGES OR REVISIONS TO SEPTIC DESIGN RAVUBW NO777C42YON TO A & AI LAND SERVICES'AND 7VWN BOH FOR REVIEW AND APPROVAL Number of Bedrooms: 3 18) CONMCMR SHALL NOTIFY TOWN AND DESIGN ENGINEER AT LEAST ) Garbage Grinder. NO 19) MAGNETIC TAPE 7V BE INSTALLED ABOVE ALL COA[PONENTS Design Flow. 330 (110 Gal/BR/Day z Number of BR) Septic Tank: (Existing To Remain) 1,000 (»imam - Design r1ow= 20M) Gal DEEP OBSERVATION DEEP OBSERVATION Leaching Area:Sidewall: HOLE LOG HOLE LOG i (2 Sidewalls z 25LO n z 2 n) + NIF (2 Endwall, Z12_83� _ _z r,) 151.3 SF e� Test Hole �1 Test Hole #2 Bottom 320. 7SF Pa ul Ne vosh (EL = 98.6 E) (EL = 98.6 f) 25.0 m Map 57 Parcel 006003 IVY, �`ft Hoorizzon Texture Color 'Upy, r >=. n Textureson son 12.83 vt : ) 472. SF (USDA) (Munson) (USDA) (Munson) Long Term Acceptance Rate (LTAR): 0 74 1v 0 - 8" 98.0 A LOAMY SAND IOYR412 0 - e" 98.1 A LOAMY SAND IOYR412 (Sidewall Area + Bottom Area) z LTAR 4f 0. NIF 8" - 26" 96.4 B LOAMY SAND 10YR516 6" - 24" 96.6 B LOAMY SAND toYR5/6 Leaching Area Design capacity. 349 GPD t� Dacey Brian T Trs 26" - 120" 88.6 C COARSE SAND 2.5Y7/4 24" - 124" 88.3 C COARSE SAND 2.5}714 ,77,5 y'0.3 " Yap 57Parcel 005007 WIVRAVEL WIVRAVEL 349 GPD Provided - 330 GPD Required = 19 GPD Reserve N ig1 3�\ Prop SAS , Dee Obs Hole Date: 6115109 Deep Obs Bole Date: 6 15 9 Found P �' co Soil Evaluator. li'D STONE Soil Evaluator. ED STONE CB/DH _ - Witnessed By. DAVID STANTON Witnessed By. DAVID STANTON > __ - Pere Rate- < 2 YINI'IN A 66' Pere Rate: < 2 YIN/IN A 66" ```• __; 01JLS o= ' Cameo Survey Description >CARVER Soil Survey Description: CARVER Hole 1 ,'� (gas) De logic Material: Hater: ALICLL 00TWASR JORMIJIJ' Geologic e logo o Material• Rater. NOLJCIAL 0MASJH AVP-W�R Pere Test 1A `$ro `'��, Depth standing p tending _ Depth to Keeping hater. NA Depth to Heaping water: Nd (fie Depth to Moming(Color): NA Depth to MottUng(Color): NA a yet Est Seasonal High Glr NA Est Seasonal High GW NA ` `. Gr �, 9' USGS Observation Well:* NA USGS Observation hell: NA Basement Level , 00.00) _, TBM EL 100.00 2 2j,5 Date of Last Measurement.. NA Date of last Measurement: NA (1 _--- Comments: Comments: ��_�� �� , r` Top Brick Ret Wall Pro `` (gag' 1� gg D-BOX Obs Hole .� .ter,' 2 TBtb -- (y8 6) NIF 5 7 006004 29 10�0 Gal Dacey Brian T. Tix ASSESSORS MAP PARCEL Unfinished o � � Yap 57 Parcel 005008 S- Tank\ Bdr .. 3 Bedroom (�� o _ To Remain f #3 r TOF = 100.00 =i`� - - _ NOTES.' G ��- =�-j1" ,SI t o/Sep tl c Pla n � Remove � � \ Parcel not within Zone II Contribution D-Bo�g 1 � % D-Box __ Owner of Record in 91� Whitney H. & Melissa J. Koren o Deck Exist LP to be crushed Barnstable MA pumped, o Deed Reference [Ale 4 (laze) and filled per Title 5 Cert. 160506 Located At Bdr th Bth Kitchen ' 4- Plan Reference I r� L C. 38112 A #1 I I Lot 4 42 Frazier Way Family Garage j'" " Co t ul u t, MA Rm Garage 1 Bdr Living -- - Prepared For Room ; I I Gravel of 4 Whitney Floren D/ 21,1033� Sq. Ft. I yy / '__ 42 Frazier Way I 1 / 1 __J `-__� 1 1 L -_J _ 1 L---'� ' ' --- - ti 1st Floor 1 --------------------------- (I�>at otuit, MA / Ctrs ;----'- - pf iNDA SCALE:- 1 " = 20' DATE.• July 2 2009 L S 86'04'40" E INDAPINTO. ASSSWORS MAP 57 pgWn 006004 16589 � CIVIL No.46504 PREPARED BY LOCUS MAP tip°' �o�FFGISTe�4G��a� A & M Land Services N.TS. �0 NIF Found /ON E 618 Main Street Unit 3 Richard and Nancy Pellend Iron Pipe West Yarmouth, MA 02673 � o Map 57 Parcel 006005 Ph. (508) 737-1777 Email- anmlandPcomcast.net o,�te 2 o GRAPHIC SCALE Do.en 20 0 10 20 40 so � a ( IN FEET ) ��A LOCUS 1 inch = 20 ft. Dw e'. ,ir 6018.dw E'