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Home My WebLink About0059 LIBERTY LANE - Health M 59 Liberty:Lane Matstons Mills A _124 ,004;013 i ! _i_ i I i I i : i , CE I _ i i HM Ell- LU Lo i 1 !- I { a 7W^ Commonwealth of Massachusetts �.�` I ° Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 59 Liberty Ln ub Property Address X Raymond Pancallo Owner Owner's Name information is required for every Marstons Mills MA 02648 5-25-15 page. Cityfrown State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. t A. General Information 1. Inspector: Shawn Mcelroy • - Name of Inspector Upper Cape Septic Services Company Name P.O. Box 73 Company Address E. Falmouth MA 02536 Cityfrown State Zip Code 1-508-495-0905 S13971 Telephone Number License Number B. Certification 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 ❑ Fails ❑ Needs Further valuation by the Local Approving Authority 5-25-15 Inspector's Signature' Date 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 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. ****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. �� vs t5ins•3/13 Title 5 Official Inspection Form:Subsurface Swage Disposal System•Page 1 of 17 i f Commonwealth of Massachusetts ` w Title 5 Official Inspection Form Subsurface'Sewage Disposal System Form -Not for Voluntary Assessments w M 59 Liberty Ln Property Address Raymond Pancallo Owner Owner's Name information is uired for eve Marstons Mills r eq every MA 02648 5-25-15 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) 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: System is in good working order with no sign of failure. 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. Check the box for"yes", "no"or"not determined" (Y, N, ND)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. ❑ Y �❑ N ❑ ND (Explain below): t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 17 i Commonwealth of Massachusetts Title 5 Official Inspection .Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 59 Liberty Ln Property Address Raymond Pancallo Owner Owner's Name information is required for every Marstons Mills MA 02648 5-25-15 page. Citylrown State Zip Code Date of Inspection B. Certification (cont.) _ . , , ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes (cont.): ❑ 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 ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ` ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ 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 ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): 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 t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 3 of 17 Commonwealth of Massachusetts w Title 5 Official Inspection Form ^ Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 59 Liberty Ln Property Address Raymond Pancallo Owner Owner's Name information is required for every Marstons Mills MA 02648 5-25-15 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) r 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 fecal coliform bacteria indicates absent 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: 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 El ® clogged SAS or cesspool - . x ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool El ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than %day flow t5ins•3M 3 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 i Commonwealth of Massachusetts fn Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 59 Liberty Ln Property Address Raymond Pancallo Owner Owner's Name information is required for every Marstons Mills MA 02648 5-25-15 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® 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 fecal coliform bacteria indicates absent 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 and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® 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. For large systems, you must indicate either"yes"or"no"to each of the following, in addition to the questions in Section D. 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. t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 5 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 59 Liberty Ln Property Address Raymond Pancallo Owner Owner's Name information is required for every Marstons Mills MA 02648 5-25-15 page. City/Town State Zip Code Date of Inspection C. Checklist 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: ® ❑ 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(5)] D. System Information Residential Flow Conditions: Number of bedrooms (design): 3 Number of bedrooms (actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 t5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 59 Liberty Ln Property Address Raymond Pancallo Owner Owner's Name information is required for every Marstons Mills MA 02648 5-25-15 page. City(rown State Zip Code Date of Inspection D. System Information Description: Number of current residents: 2 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonal use? ® Yes ❑ No Water meter readings, if available (last 2 years usage (gpd)): Detail: Sump pump? ❑ Yes ® No Last date of occupancy: 5-2015 Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? , ❑ Yes ❑ No Water meter readings, if available: t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 59 Liberty Ln e o Pr ert Address Property Raymond Pancallo Owner Owner's Name information is required for every Marstons Mills MA 02648 5-25-15. page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: Owner--pumped 9-2013 Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Maintenance 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) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank.Attach a copy of the DEP approval. ❑ Other(describe): t5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 17 i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 59 Liberty Ln Property Address Raymond Pancallo Owner Owner's Name information is required for every Marstons Mills MA 02648 5-25-15 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: 1991 I Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 48"feet Material of construction: ❑ cast iron ® 40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments(on condition of joints, venting, evidence of leakage, etc.): Good condition. Septic Tank(locate on site plan): Depth below grade: 40"feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1000 gal Sludge depth: 12" t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 59 Liberty Ln Property Address Raymond Pancallo Owner Owner's Name information is required for every Marstons Mills MA 02648 5-25-15 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Septic Tank (cont.) Distance from top of sludge to bottom of outlet tee or baffle 20" i Scum thickness 1 Distance from top of scum to top of outlet tee or baffle 6" Distance from bottom of scum to bottom of outlet tee or baffle 15" How were dimensions determined? Tape Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tank is in good condition with baffles installed and no sign of leakage. Grease Trap (locate on site plan): Depth below grade: feet 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: Date t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 17 Commonwealth of Massachusetts -' Title 5 Official Inspection Form. Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 59 Liberty Ln. Property Address Raymond Pancallo Owner Owner's Name information is Marstons Mills MA 02648 5-25-15 required for every page. CdyTrown State Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank (tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: i ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments(condition of alarm and float switches, etc.): Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 59 Liberty Ln Property Address Raymond Pancallo Owner Owner's Name information is required for every Marstons Mills MA 02648 5-25-15 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 0 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.): Good condition with water at working level and no sign of back-up from pit. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No" Alarms in working order: ❑ Yes ❑ No* Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): " If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 59 Liberty Ln Property Address Raymond Pancallo Owner Owner's Name information is required for every Marstons Mills MA 02648 5-25-15 page. Cityrrown State Zip Code Date of Inspection D. System Information (cunt.) Type: ® leaching pits number: 1-1000 gal ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number,dimensions: ❑ overflow cesspool number: ❑ innovative/altemative system Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding,damp soil, condition of vegetation, etc.): Leach pit in good condition and holding 6"of water with stain line at 24" off bottom of pit. Cesspools (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 ❑ No t5ins•3/13 Tide 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 59 Liberty Ln Property Address Raymond Pancallo Owner Owner's Name information is required for every Marstons Mills MA 02648 5-25-15 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy (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.): t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M , 59 Liberty Ln Property Address Raymond Pancallo Owner Owner's Name information is required for every Marstons Mills MA 02648 5-25-15 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view 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. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately G ek - J 43 , A ._316 " 22- 3,,"`;� t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M y 59 Liberty Ln Property Address Raymond Pancallo Owner Owner's Name information is Marstons Mills MA 02648 5-25-15 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to high ground water: 204 feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date ® Observed site (abutting property/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: USGS and town maps show groundwater at greater than 20'. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 16 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form ° o Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �M 59 Liberty Ln Property Address Raymond Pancallo Owner Owner's Name information is required for every Marstons Mills MA 02648 5-25-15 page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary:A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems) completed ® System Information—Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 TOWN Of B STABLE L cATroi Lp ' SEWAGE# ASSESSOR'S PW:cat LOT IINTSTALLER'S SrpvnC'T'ANK-C;. ACITY f dL (sued LEACi]ING:PACI�iT"� ,( ) -�---- NO:(�I~BFI31i;PJOI�iS� 3 - - BtTiLDER OR OWFIER Pt? i"FDA'i CONtPLlA1�ICE lDfa . S pairatton I3tstance Between the MaXimuen Ad}ustea]Groundwater Table to&Bottom of Leacheng Fa Iity iFeet PnYate stater Supply' 611 and I.eaclung Facility .ff any urn exist an site,drvnttein Zt�feet of leadnng fact�ety) Tweet�: Bdge.of Wedand and Leadung 1Yaal�ty(If.any wetlands exist within 300 feet of leaching f�cslity} / , Feet;: � Furdshed by �; �`r aG 6k � o a 3i6 37�� `5 ' TOWN OF BARNSTABLE LOCATION A-6EWAGE # ZLLAGE �A.� ASSESSOR'S MAP & LOT IINSTALLER'S NAME & PHONE NO. 0,, l n fism-� `.SEPTIC TANK CAPACITY 1600 LEACHING FACILITYAtype) I fl" rr (size) I NO. OF BEDROOMS � PRIVATE WELL O PUBLIC WATER BUILDE OR OWNER /! (/5 ' ZM/ 'DATE PERMIT ISSUED: 'DATE COMPLIANCE ISSUED: `V.ARIANCE GRANTED: Yes No a � 10 V� u e lz�{- OOY-013 THE COMMONWEALTH OF MASSACHUSETTS _ BOAR® OF HEALTH ..----..--.1MV-0.............OF........... t.1,A 15T .-Ob. Appliration for llhipos al Works Tonstrnrtinn ramit Application is hereby made for a Permit to Construct ('<10"r Repair ( ) an Individual Sewage Disposal "I System at: -..... ........ y Locat' d s o Lo .....�.. �. , ....... ............................... .......... ..._......--•-•-------••-------........•----- Q� r Address .............. ......-.......................................... ............... /_....1 . ............................................................... Installer Address Type of Building Size Lot...... 1,1 1....Sq. feet Dwelling—No. of Bedrooms______________ .........________________Expansion Attic ( ) Garbage Grinder ( ) Other—Type e of Building ............... No. of ersons.....................__.._.. Showers — Cafeteria a YP g ------------- P ( ) ( ) Other fixtures ,--------------------------------------------------- W Design Flow........................ _._..__._-__gallons per person per day. Total daily flow.............................S.3.0..gallons. WSeptic Tank—Liquid capacity-.,16 gallons Length................ Width................ Diameter................ Depth................ x Disposal Trench—No. -------------------- Width- . ............. Total Length.................... Total leaching area....................sq. ft. Seepage Pit No.............I------- Diameter........... --- Depth below inlet.........6...... Total leaching area.._..7-0.0q. ft. Z Other Distribution box (✓) - Dosing tank ( ) ~' Percolation Test Results Performed by......... "�" ___L_____ t ":_.�.!�� Date........... Test Pit No. 1... ------minutes per inch Depth of Test Pit------10....... Depth to ground water.......'.'- ......... ral Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a -----------------------------------t i 0 Description of Soil----•--------------0. ..I ..--...---.lr�? x w - 1� It +tomes UNature of Repairs or Alterations—Answer when applicable............................................................................................... ------------------------------------------------•-•----------------------------•--•----------------------------•------------•--•--•-----•------------••---•• ........................................... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Compli h�.e.. the board of health. Signed . — .. . ...................................� Dace �y Application Approved By .......... ... ,7� ' l Date Application Disapproved for the reasons: ..................... .... ... ........................................................ . ....................-... ... .......................................................... ............ ......... ............... .... ... ..................................................................................... ........................................ pDare PermitNo. .......... -------------------------- Issued ..........---.........---------- --. -- ----.......----- r�A Daze E A _r THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH Xpli iration for Dispnsttl Works Tnnitrurtion .eruti# Application is hereby made for a Permit to Construct ( '"<or Repair ( ) an Individual Sewage Disposal System at: _ I ........ _...-••••--_....... . `"= `� ._._... . ............ .•._..._--••---- --...•-• .. - ..............._.._................ Locatio Addy p f �- 9 o Lot r y / f d e„�-*'• f .... .........:.. ..: ............................. ............ .�,-� ................. W { w r� / Address ................................................... ........... .......................................................... Installer Address dType of Building Size Lot._.__� ...�_Sq. feet Dwelling—No. of Bedrooms.............................._.............Expansion Attic ( ) Garbage Grinder ( ) 'PL4_l Other—T e of Building ............................ No. of persons........._.................. Showers — Cafeteria QI Other fixture ,, �; W DesignFlow________________________________________ gallons per person per day. Total daily flow....._._.___.__.______...._.._. _ 0._ lons, � � --g P P P Y• Y -� - 1� WSeptic Tank—Liquid capacity. (__jDgallons Length................ Width................ Diameter-_--_-______-__ Depth................ x Disposal Trench—No..................... Width... ....... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No-------------j------- Diameter____________ _____ Depth below inlet......... Total leaching area....... ft. z Other Distribution box ( *!r) Dosing tank Percolation Test Results Performed by.................N..............................l J.14L-i.....L!A Date............. aTest Pit No. I...17!'`......minutes per inch Depth of Test Pit._.__.'`. ._......... Depth to ground water........................ (i Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a' ..................................... - -_.r.ti---.._...--... �------------------ -------- •------------- _ ........................ , ODescription of Soil----•----•----•--...( ).. .2..------- ) ... 0k. .*�^ - ............. W ••••-•-----•-----------•-•---------------------•-•---------•-••--•-•---••-•-•--••••.-•---•----•-•--•---•-•--•...--••---•--••-••------••----•••••-•-----•-••-••-••...•--•-•-•--.._...-••-...-••--•_..... VNature of Repairs or Alterations—Answer when applicable______________________•---_-_•----•___---_•-_-----_-__-•-----_---_-•_---__._--.-____________-- -•---•-------------•--•-••--••••---••••••-•---•----••-••••-••----•....__.___.._••-•.._......•••-••••-••-•....••••-•••.--------••-•----------•--••••---•-•---•-----••-----•••......-•--••--••-...__-•--- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Compli has�been issued b the board of health. Signed .. r v Dare Application Approved By ------------- .. .. .t--------------------------------------------------------------------------- I?are Application Disapproved for the following reasons: ..--------- ---------------- --------------------- ---------------------------------------------------------------------------- - - - ------------------------------------------------------------- ....---------------.......-- ........................-- ...................--------- ----- ---------.............................. Permit No. ?/ / _'�3 Issued -.-..... Date... ............................................ .... Date THE COMMONWEALTH OF MASSACHUSETTS .�.- BOARD--OF HEA�LT it,./:.� d'• OF ------.............. ............ .......................................... TPrttfirate of Tontylin re IS"�O CERT �', That the Individual Sewage Disposal System constructed O or Repaired ( ) bJVS ------------------------ - - ---------------------------------------------------------------------------------------- y f,----.-t-�y-------��----.....-� .. Instal iJ'J � A,r r` r at --�----------------------------- ----'_3 sl c ......J.. ?......... ......... --------------------------------------.............----- -- -- ..............---......--- -- -- has been installed in accordance with the provisions of TITLE 5 f The State Environmental Code as described in the application for Disposal Works Construction Permit No. ......f.�.-,�3. ............... dated -------------............................ ISSUANCE OF HIS CERTIFICATE SHALL NOT BE CON, UED AS A GU RANTEE THAT THE SYSTEM WILL FUNC SATISFACTORY. DATE-----------------------------------_---- I-q.1....... Inspector . ............................................... �-- ..--.. THE COMMONWEALTH OF MASSACHUSETTS _ ?BOARD OF HEALTH ' �` d....OF.. ../.. si2 a rG {Y FEE....��_d......... i la �t nr Tvn# iatt "rrutit Permission is hereby �pgranted).an Individual Sewage Disposal System --------------------------------------------------------------------to Construct or R air ----- --•--•-- -------------•-•--•--•••-•-••-•-••--•-••---•--•-•-•---------•--••--••----...._-••••- at No...... ....I---•l"" 1 1 { ''= Y` Street n as shown on the a 'application for Disposal Works .Construction Permit '',�j PP P �`!p•- 31-2........ Dated-----..;Z'•"--1&-----�r-Z.... .................... ........................ ............................. 011 IBoard of Health DATE ---.....: - - -------------------------------------- FORM 1255 HOBBS & WARREN, INC., PUBLISHERS r DESIGN DATA LjB�'h'Ty L N SINGLE FAMILY- 3 BEDROOMS 5 00, R= 1 0 4 .2 NO GARBAGE GRINDER DAILY FLOW = 110 X3 = 330 G.P.D. LOT '7 6� SEPTIC TANK = 330 X 1507. = 495 G.P D. USE 1000 GAL. 17,798 S,F, / DISPOSAL PIT - USE 1000 GAL. a �� SIDEWALL AREA = 150.F. 150 S.F. X 2.5• = 375 G.P.D. 6 (o �O BOTTOM ARE = 50 S.F. AR �� 50 S.F. X 1.0 = 50 G.P.D= ,� 0? TOTAL DESIGN = 425 G.P.Q. TOTAL DAILY FLOW = 330 G.R.D. PERCOLATION RATE: Q oo �,�N gyp• 1 INCH IN 2 MINUTES OR LESS. 24:0*1 T ° P OF PETER 700 W of SULLIVAN 0 ro� R 2 W O RECHARD F t9o. 29733 LOT 8 piT 014.FkA ° _ 5'00' o I SAXIM 31,911 o '8 60 o, AC t o N 81°56143p E 87.42' OPEN.. SPACE PAN 7/18/91 SCALE; 1"= 40' P-7782 TEST PI ELEV..= 64.0 I —0 F.G.=63.0 TOP OF 1 LOAM FOUNDATION & F.G.=62.0 I SUB SOIL pVC• .-2 p1AMETE"R 1000 GAL. INV. =6 1.0 4 j40 SEPTIC TANK INV =60.8 j SCHp• DIST. INV. =60.6 1000 GAL.' BOX INV. LEACH =60.4 MEDIUM PIT INV. 60 0 NV. - 60.2 10.00' SANDPIT 1' OF - 3/4" :•< TO WASHED STONE PROFILE CERTIFIED PLOT P A s4.o LAN NO SCALE -10 - ELEV. 50.0 8.0 LOCATION NO WATER LOT 7 LIBERTY LANE MARSTONS MILLS I CERTIFY THAT THE PROPOSED FOUNDATION SHOWN'_.HEREON _ DATE: COMPLYS WITH THE- SIDELINE AND SETBACK REQUIREMENTS OF 7 24 91 THE TOWN OF BARNSTABLE, AND IS NOT LOCATED WITHIN 'THE PLAN REFERENCE FLOODPLAIN, L.C.C. 42122E DATE: `91 CP R.L.S. BAXTER NYE'INC. LAND SURVEYORS,&CIVIL ENGINEERS OSTERVUZ,MA.SS. THIS PLAN IS NOT BASED ON AN INSTRUMENT SURVEY AND THE APPLICANT: OFFSETS SHOULD NOT BE USED TO DETERMINE LOT LINES. BAYSIDE BUILDERS U ' 12 EXIST. S CONT.RIDGE VENT co '12 f°L1_LJ°I NEW AB TSG9NGLESI LINES OF BUILDING r-� _ - 12 1 1 r,-1 j TO MAT LISTING i BEYOND NEW GARAGE12 - ~ a xCD j1I 1 I°I I C] Q �-L1 J. 6 / .. �♦ j NEW FASCIAB MATCH E - .. BOARDS TO MAT EXIST. i TOP OF PLATjF r-i-r� _ . - - NEW CORNER BOARDS - Lr - TO MATCH EXIST. - - .� m - - NEW W.C.SHINGLE SIDING " - - - - TO MATCH EXISTING - --- TOP OF FOUND. lord' - - ..(ADDITION) - - C i a t B NOTES: A A o EXIST- 1:) CONTRACTOR IS TO VERIFY ALL EXISTING CONDITIONS 9 Z 13-7 &DIMENSIONS IN THE FIELD 'o I—-1 2.) CONTRACTOR TO VERIFY ALL INTERIOR&EXTERIOR MATERIALS, O EXIST. I I DETAILS,&FINISHES IN THE FIELD WITH OWNER % O � BATH I I 3.) ALL CONSTRUCTION TO CONFORM TO 780 CMR MASSACHUSETTS Ija. I STATE BUILDING CODE,SEVENTH EDITION NEW L=_) 4.) 110 MPH EXPOSURE B WIND ZONE,1.25 ASPECT RATIO FOR NEW ADDITION ONLY SCREENED NEW 5.) ALL SHEETS OF PLYWOOD WALL SHEATHING TO BE INSTALLED VERTICALLY -- PORCH M GARAGE F 6.) THE NAILING SCHEDULE ON SHEET A4 TO BE FOLLOWED WITH NO EXCEPTIONS. yt� (VAULTED CF�uNG) (r CONC.SLAB Q DEVIATION FROM THIS SCHEDULE WILL REQUIRE ADDITIONAL METAL HOLD DOWNS&STRAPS O y PITCH 2 TO O.H.DOORS) 7.) SEE CERTIFIED PLOT PLAN FOR ALL DETAILS ON THE EXISTING PROPERTY. 1`�1 EXIST. X LT 8.) FOLLOW ALL MANUFACTURER'S SPECIFICATIONS FOR INSTALLATION OF ALL SIMPSON COMPONENTS ~^'~ ��. ID 2Vx68 9.) ALL CONCRETE USED FOR FOUNDATION WALLS,FOOTINGS&SLABS �+ 1 HR.FIRE TO BE 3000 PSI Q RATED - 10.)VERIFY ALL PLUMBING&ELECTRICAL DETAILS W/OWNERS ON THE SITE DURING FRAMING CONSTRUCTION �-r INSTALL 516'TYPE r FIRECODE - . GYPSUM BOARD ON THIS WALL ONLY a CEILING 1+1 - B 97 x 7V O.H.DOOR - WITRANSOMABOVE MARK A. N EXIST. w Me KF 12 w V J STUDY - CIVIL / aNEW P.T.6 x 6 POST W/ APRCo-ON - - - - - . :AZEK 1 x 711 x 8 CASING USE SIMPSON BCS2-= _ USE APA WOOD NARROW WALL . .' POST BASE ANDERSEN GR - FRAMING TECHNIQUE FOR PORTAL - Errs,,;,,ni E'P' SCALE: u CENTERED ON GABLE WALLS(SEE DETAIL) �'q FLOOR PLAN DATE: EXIST. - THE DESIGNER SHALL BE NOTIFIED IF ANY 9/�2008. ERRORS OR OMISSIONS ARE FOUND ON _LEGEND` THESE DRAWINGS PRIOR TO START OF CONSTRUCTION.THE BUILDING CONTRACTOR WILL BE 10d 18'd - N THESE DRAWINGS IF CONSTRUCTKIN IBLE FOR THE CONTENT DRAWING NO.: . (ADDITION) (ADDITION) COMMENCES WITHOUT NOTIFYING THE " - Q EXISTING WALLS. DESIGNER OF ANY ERRORS OR OMISSIONS. CONSTRUCTION TO BE REMOVED THESE DRAWINGS ARE SOLELY FOR THE USE ON THE PROPERTY NOTED.ANY OTHER USE OF . NEW CONSTRUCTION .. - THESE DRAWINGS REQUIRES THE WRITTEN - . - - - - CONSENT OF THE DESIGNER THESE DRAWINGS .. - ARE PROTECTED UNDER THE ARCHITECTURAL . ' COPYRIGHT PROTECTION ACT OF IBM. i N T1 0 0 v olz m v 9 Z. c . V — y. 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