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HomeMy WebLinkAbout0086 LITTLE POND ROAD - Health 86 Little Pond Road _ - — — Marstons Mills A= 065-020 y � - i I� 1 i P i Commonwealth of Massachusetts w Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 86 Little Pond Road M Property Address Francis & Josephine Salata Owner Owner's Name information is required for every Marstons Mills MA 02648 6/29/12 page. Cityrrown 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. Important:When filling out forms A. General Information on the computer, I use only the tab 1. Inspector: key to move your p cursor-do not Ricky Wright use the return Name of Inspector key. B & B Excavation,lnc. reb Company Name 14 Teaberry Lane Company Address n Forestdale MA 02644 City/Town State Zip Code 508-477-0653 S14595 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 Evaluation by the Local Approving Authority 7/2/12 nspector'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. L t5in s 11/10 Title 5 Offic al In cti Form:Subsurface Sewa Disposal System•Page 1 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 86 Little Pond Road Property Address Francis&Josephine Salata Ow-ler Owner's Name information is required for every Marstons Mills MA 02648 6/29112 page. Cityfrown 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: 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•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 86 Little Pond Road Property Address Francis&Josephine Salata Owrer Owner's Name information is required for every Marstons Mills MA 02648 6/29/12 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) 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 t5i-is•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts . Title 5 Official Inspection Form _ Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 86 Little Pond Road Property Address Francis & Josephine Salata Owner Owner's Name information is required for every Marstons Mills MA 02648 6/29/12 page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) 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 clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than '/2 day flow t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 4 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments °M 86 Little Pond Road Property Address Francis &Josephine Salata Owner Owner's Name information is required for every Marstons Mills MA 02648 6/29/12 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 Zo ne one 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-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 5 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ,M 86 Little Pond Road Property Address Francis&Josephine Salata Owner Owner's Name information is required for every Marstons Mills MA 02648 6/29/12 page. Cityrrown 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 l5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ,M 86 Little Pond Road Property Address Francis &Josephine Salata Owner Owner's Name information is requ red for every Marstons Mills MA 02648 6/29/12 pagE-. City/Town 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? [if yes separate inspection required] ❑ Yes ® No Laundry system inspected? ❑ Yes ® No Seasonaluse? ❑ Yes ® No Water meter readings, if available last 2 ears usage d n/a 9 ( Y 9 (gP ))� Detail: Sump pump? ❑ Yes ® No Last date of occupancy: cuurent 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-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal-System Form -Not for Voluntary Assessments 86 Little Pond Road Property Address Francis&Josephine Salata Owner Owner's Name information is required for every Marstons Mills MA 02648 6/29/12 page. Citylrown 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: Was system pumped as part of the inspection? ❑ Yes ❑ No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) 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•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 86 Little Pond Road Property Address Francis&Josephine Salata Owner Owner's Name information is required for every Marstons Mills MA 02648 6/29/12 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known)and source of information: 1987 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 2' feet Material of construction: ❑ cast iron ® 40 PVC ❑ other(explain): Distance from private water supply well or suction line: >20feet Comments(on condition of joints, venting, evidence of leakage, etc.): At time of inspection building sewer appeared to be in working order-no sign of leakage or blocks e Septic Tank(locate on site plan): 1' Depth below grade: 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: 6" t5ins.•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 86 Little Pond Road Property Address Francis&Josephine Salata Owner Owner's Name information is required for every Marstons Mills MA 02648 6/29/12 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 31" Scum thickness 3" 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? scour stick Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): At time of inspection septic tank appears to be structurally sound. No sign of back-up but pumping is recommended 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•11/10 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 86 Little Pond Road Property Address Francis&Josephine Salata Owner Owner's Name information is required for every Marstons Mills MA 02648 6/29/12 page. City/Town 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: ❑ 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.): �I *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts w Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 86 Little Pond Road Property Address Francis&Josephine Salata Owner Owner's Name information is required for every Marstons Mills MA 02648 6/29/12 page. Cityrrown 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.): At time of inspection d-box appears to be in good condition. 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.): Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins•11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 I Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 86 Little Pond Road Property Address Francis&Josephine Salata Owner Owner's Name information is required for every Marstons Mills MA 02648 6/29/12 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: ® leaching pits number: 1 ❑ . leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments (note condition of soil,signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): At time of inspection leaching was dry and appears to be in good condition. No sign of hydraulic failure 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••11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °M10 86 Little Pond Road Property Address Francis &Josephine Salata Owner Owner's Name information is required for every Marstons Mills MA 02648 6/29/12 page. Cityrrown 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.•11/10 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 86 Little Pond Road Property Address Francis&Josephine Salata Owner Owners Name tion isrequired for every Marstons Mills MA 02648 6/29/12 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 Qi= 1y t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments uM °� 86 Little Pond Road Property Address Francis&Josephine Salata Owner Owner's Name information is required for every Marstons Mills MA 02648 6/29/12 page. Cityrrown 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: >12'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 groundwater elevation: Before filing this Inspection Report, please see Report Completeness Che cklist on next page. t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 86 Little Pond Road Property Address Francis &Josephine Salata Owner Owner's Name information is required for every Marstons Mills MA 02648 6/29/12 page. CitylTown 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••1 Ill 0 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 ksBuilt Page 1 of 1 C/ W_j ^V •-V . TOWN OF BARNSTABLE 1 j LOCATION& ((Zr�l t400�_XrlAdl SEWAGE # b YILLAGE� 6y� /LIi7rS ASSESSOR'S ,MAP & LOT INSTALLER'S NAME & PHONE NO. 6£S SEPTIC TANK CAPACITY LEACHING FACILITY:(type)--k size) NO. OF BEDROOMS. 2� _PRIVATE WELL OR UBLIC WATE BUILDER OR OWNER_ .fln DATE PERMIT ISSUED: b� DATE COZiPLIANCE ISSUED:Zb 12 9� VARIANCE GRANTED: Yes No r � a p � i 1 .f ttp://issgl2/intranet/propdata/prebuilt.aspx?mappar=065020&seq=1 5/29/2012 1 _ THE COMMONWEALTH OF MASSACHUSETTS ��e� LN• BOARD OF HEALTH -• ��� �V TOWN OF ARNST B E � A ie� . Applirati#n for Dispasal 10orkg Toustrudion ramit Application is hereby made for a Permit to Construct ( ) or Repair (V�an Individual Sewage Disposal System at: 1�4------------------------------------- -•--•-----•-•-----------•-----•----•------•. -----------------------------............••--- LQc�tion-Address or Jq No. aL� O ner Address , .� r� S�,�s � ................................ _. Installer Address d Type of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms-----.�'f..................................Expansion Attic ( ) Garbage Grinder ( ) Other—T e of Building No, of persons............................ Showers — Cafeteria a Other fixtures .........................................-•-- W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity............gallons Length................ Width................ Diameter---------------- Depth................ x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area---_................sq. ft. Seepage Pit No------I............. Diameter.._... ......... Depth Depth below inlet---(a___._._.._.. Total leaching area,................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) PercolationTest Results Performed by.......................................................................... Date........................................ Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water........................ Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water---_•_-__-_•___•----___. a -••-••••------------•-------•••-••----••••••-••••••••-••--•-......-••---•---...••---•----•------------------------------••---------------•-•-•--•-----••-- 0 Description of Soil...............................................................................--------------------------------------------------------------------------------•-•-••-- x U •••-•-••••••••---•-•-••-•-•••••••••---•-----••••-•--••-•-••••••--•••-••••--••••••••••--------------•......•••---•--•••••••••----•••-•----•-•---•-•-••••••-•••••••-••••-•-•-•---------•--............•••. ------------------------------------------------------------------------------ --------•---------------------------------...-------------------•----............--......._...... ...-.--•------------ U Nature of Repairs or Alterations—Answer when applicable_......18'.0-0-..____.(a sC(a...1�.LT...._ ._ z,.,�- 01� . , ---------------------------------------------------------------------------........................................ Agreement: Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the bNrd of health. - _ c Signe ---------------------------------------------- �..--.0........T. ------------ ------------- -------------------- Date Application Approved B ..... PP PP Y Dare Application Disapproved for the following reasons- -------------------------------------------------------------------------------------................................................. .......................................................................................... ..-----..........--........................--------................................................ ................ ................. Date PermitNo. ------....���-- . ...........------------- Issued ........................Date------------------------------------------- No... l� - 3 FIIs....l ......._ THE COMMONWEALTH OF MASSACHUSETTS (( d BOARD OF HEALTH Nq ' ,�TI9W NjO B A�R S;,^I ,B�L EyU 7 Appliration f of Dispersal Works Tonstrnrtion ramit Application is hereby made for a Permit to Construct ( ) or Repair /an Individual Sewage Disposal System at: - ` d'G ,(�7`t/� �oH�✓ - R ............................ oc lion-Address or� No.5........--•--------•---•-•--•--•------•----.--•-- ----------�'-�---°..-!-�-�/ ------•and...................................... Ow /en Address -----------------•-----•....... Installer Address �. Type of Building / Size Lot----------------------------Sq. feet Dwelling—No. of Bedrooms___---`_---f-----------------------------------Expansion Attic ( ) Garbage Grinder (, ) '4 Other—Type of Building _____-- No. of persons............................ Showers — Cafeteria dOther fixtures - - W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity............gallons Length................ Width................ Diameter---------------- Depth................ Disposal Trench—�No..................... Wid�l�.t._-_._._-_-_-_ Total Length_... Total leaching area--------------------Sq. ft. ---Seepage Pit No--_J--------------- Diameter-___-__.____-__-.... Depth below inlet--------............ Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. 1................minutes per inch Depth of Test Pit--_-___-___-____-• Depth to ground water........................ Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water---_--__-__-___--__-_-_. n+' ----•-----•-•-••-----------------------------•----•--•---------•---•--------------------------------......................................................... 0 Description of Soil........................................................................................................................................................................ - U0 ----------•----•-------------------------------•----•---------------------------------••-•-•------------------------------------------------------------•----------------------------------------------- UNatu® f Repairs ox��A�lt r tion —Answer when applicable______ -____-__r0-}`�---�-7....... . .�....��Old/. -, -----�-------- ----- �---�----•------------------------------------------------------•-----------------------------.------......---------•-•. 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 ofplianceas ee issued-by-the 'hard of health. _ t,� Signed �---------------------------------------------------------------------------------- ` a d Application Approved By .---- - �u .... ..• `�`e/— 1�G Dace Application Disapproved for the following reasons- ---------------------------------------- --- -------- ----------------------------------------------------------------....... ...... ........................ Dare PermitNo. --------------------7---------------------------- Issued -------------------------= ---............---------------------- Dare THE COMMONWEALTH OF MASSACHUSETTS ) BOARD OF HEALTH (` TOWN OF BARNSTABLE C�ertifi ate of CITontyliance THIS I,� TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired (X r) by----------------------► -------- P 'r------------------------------------------------------........----------------------------------.----------------------------- ------- -- ---------- Qt� Installer err G. .� '� -----......... �1. . .. ----------- -- ....................................... ------------------ t.9 has been installed in accordance with the provisions of TITLE o Th &a e Environmental Codee as described in the application for Disposal Works Construction Permit No. _ ...................................`� r - .---- dated ----�. � ---- THE ISSUANCE OF THIS CERTIFICATE SHAH NOT BE CONSTR E`�D AS A GUA ANTES THAT THE SYSTEM WI L-F NCT `'ON SATISFACTORY. _ - /� r ,r DATE............... / 1/... - - Inspector ,�, THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH NO2U .. FEE.. - a 3 9 TOWN OF BARNSTABLE •.--.. .. .............. ..... frurtinn mii Permission is herebyDisposal��l .Zi �It� rr/ -..............=.................................................................. to Construct ( or Repair, ...............) an Individual Sewage Disposal System at No..... C _ i 7` ,/�'------- M..------. ..................71 Y.11 r- Street as shown on the application for Disposal Works Construction Permit No.. .......'.� . Dated.......................................... J J �L/ _ P'� Board of Health DATE........................................=....................................... FORM 36508 HOBBS A WARREN,INC..PUBLISHERS nips-Ga® �- TOWN/OF BARNSTABLE LOCATION T(l�� �� / SEWAGE # VILLAGE �� IZ-11 ASSESSOR'S _MAP & LOT INSTALLER'S NAME & PHONE NO. daz SEPTIC TANK CAPACITY LEACHING FACILITY:(type) I NO. OF BEDROOMS PRIVATE WELL OR UBLIC WATE BUILDER OR OWNER co DATE-PERMIT ISSUED: DATE CO5mPLIANCE ISSUED:--,}o to VARIANCE GRANTED: Yes No � ,D _e i r �j zo, t _ Y FEB No----?.. .... ? D fl 7 THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH = TUI..c.KI........... ...OF.. «, Appfitation for 14s noal Works Tomitrnrtinn ramit Application is hereby made for a Permit to Construct (X) or Repair ( ) an Individual Sewage Disposal System at: L1 'LCRA.--$RR�nISTR 4 j.i1!�A. ..�-oT'..I�_�-.LITME.__PONR F-STA-rES ....................... Location_Address or Lot No........... A T. `.T Rk � .................. ...........►Tf'LE 'PoN ....------------------------------------.......--- ------ --^�-� O ner Address a r,�ll✓�"' f.. R,/^STABb.CC! fZ DI 5.!'K-�L . > Installer GO' Address ^ �, U Type of wilding ` �d� Size Lot_.____.�P.j_-�+�'-Sq. feet I., Dwelling—No. of Bedrooms..........3.............................Expansion Attic (ado) Garbage Grinder (NO) Other—T e of Building No. of persons............................ Showers — Cafeteria a' Other fixtures ...................................................... W Design Flow.........a................................gallons per person per day. Total daily flow-----330..........................gallons. WSeptic Tank—Liquid"capacityll00.0.gallons Length-8........... Wldth.4-'1b". Diameter---------------- Depth.�r' x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No------I............. Diameter.lP............ Depth below inlet_-r_&-/..... Total leaching area.2.57...sq. ft. z Other Distribution box (X) Dosing tank ( ) aPercolation Test Results Performed by AP _5 �__ 411�V ._ KSu�-T Date....4_-7. Test Pit No. 1...2•.........n inutes er mch Depth of Test Pit----___1_4-4.... Depth to ground wa - �s��� fz, Test Pit No. 2................minutes per inch Depth of Test Pit..-:----::--__._-_- Depth to ground v S i E°H..... a p to -u ....-•--••--•---••-•---- ..• -------- O Description of Soi1T �- T.1.1.._._�?��-5�u . OPIt-.-------_ - AL.LYy �`su5oi L U .-r_.4'•-----��... ST.Rpm n1 ED_..:_ •---- ........... .. !^)1L td W •--•-•-••--------------------------------=----•---•----•-•------------------•--------•------•-----•------------••- ................................... U Nature of Repairs or Alterations—Answer when applicable.---________________________________________________•-------_--_-. `�SSIONAC��� --- ------------•-•-•- Agreement: cra« 3-4-87 The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITHE 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compli nce n issu d by e o of health. Sign .. ....----. ..f.. ��� / Date ,Application Approved By_ .�_ __....______ -- Date Application Disapproved for the following reasons-...............................................................<=----------------------•---•------•---=--••----- -------••-----•------•--------------------------------------•----//---------------------•---...-------••--------•------------------•-•---------......-- ------............---------------••---•._...._ Permit No._. . ......... .6 v ..' ". .. _...`(�.�--------------- Issued...........----•----------•--------------Date-•---- ate k, L4` Z ( 0 No......- - --- F vs............._.... ... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH �Qv ....�.al.................oF..... PAR}+1-5TA.�''.a.LE'_......------.........__......... Appliratinn for Disposal Works Tnnitrurtiun ramit Application is hereby made for a Permit to Construct (A) or Repair ( ) an Individual Sewage Disposal System at: I TT"LEG)N© �5 ATE�:�T[:...... _:cat�Q..R �. A ,► +s 'A��.G,.>+�lA. ..►-c T'...la,... ......- . ... Location-Address or Lot No. �APRaOARt�!_ .At."i" "................ L�-r1"4C... N o_.R .� .. O net t Address - X -S...MILIZ).&Af. Installerj� ! Address + U TTyyppeof wilding Size Lot_�r' ?t_4�2 -Sq. feet Dwelling—No. of Bedrooms----------a.............................Expansion Attic (No) Garbage Grinder (Np) aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) dOther fixtures ------------------------------------•------------------------•---------------------------- W Design Flow.........,V_'..-�-�''...........................gallons per person per day. Total daily flow-------530.........................gallons. WSeptic Tank—Liquid capacityllQ00.gallons Length.WV._... Width.4-10 Diameter---------------- Depth-S.i c6a x Disposal Trench—No..................... Width.................... Total Length.................. Total leaching-area---__-•-_._---__-_sq. ft. Seepage Pit No------1............. Diameter._f_0............ Depth below inlets_&.7..... Total leaching area.25.7...sq. ft. Z Other Distribution box (X) Dosing tank ( ) aPercolation Test Results Performed bye.'F1M.0 QA..5llR1/FLf.___2.2.N1SUM.NMDate...4.-T!n (Q......... a Test Pit No. 1...2.........minutes per inch Depth of Test Pit___.__.14-4".. Depth to ground wate _... 4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground w O,,_n;,_. a' --------•----------------------•----.........• •---------••------•••---.............••......_..._.._.............•..... O Description of Soi1TP!.1--..C�".1.(.....�"_" �{'N:T ?F? ?1�- tB. l_ ..................... l V .1.44..._���!'t'�l.F ..---------------------- •--•--------•--.....................................................---------........................................................... .... _ U Nature of Repairs or Alterations—Answer when applicable.-__________________________________________._....._._.._.._. ?, e; � --------•------------------------------------------•------•---------------------•-----•••••--•-----•----•-•------------------------------------------------------------- Agreement: �c vie. The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITIE 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. Sign J l�"r G -------------•- -•---------------.-------------- Application Approved By., _ � . Date A Date Application Disapproved for the following reasons-----------------------------------------------------•--------•----------....................................... .............••-------------------••--Q....---------•--------...-----------•------•-----.....-----...-------•----------••------------------------------------------------•---------------------•-------- Permit No.---.0.--�- --.3/ ------------- Issued-.....J e Date ' ^-•---•-- ._• Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH OF.............. '! ...-�.'........-................. ......... ........... Trrtifiratr of Toutpfittnrr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ()oC) or Repaired ( ) by----•----••-•......� ----------•.......................••-------•..........•---••--••-----�--------...----•--•-•......`----•--�------........_,(....------...-------------••----- In let has been installed in accordance with the provisions of TI T IE 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No.-D------- h ............... dated..... --------------------- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE . ...... ..V.........................•. Inspector-----...----------- ............................................... ns' J THE COMMONWEALTH OF MASSACHUSETTS BOARD OF -HEALTH 1�� ,� _ N0 �:-.���' ...........................................OF..........�r`�I--�-...................................... ` FEE �l! ..... Dispa1 al Marko Tandrudion famit Permissionis hereby granted-............................................................................................................................................. to Construct (1) or Repair ( ) an Individual Sewage Disposal 4S stem at No. L fit•- � .A . -I��• 1 = ! ................................................... Street q. �..� `-7� as shown on the application for Disposal Works Construction Pe mit N Q.�./_t______________ ated..____..____.....__.___......'.............. .•--. � : �. , __ -------••-----•-----------------•----•- Board of Healt DATE-------•-•----------------------•--•-•-•----•----•-------.......-----------•---- FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS 71 SOIL TEST PIT. DATA: SEPTIC TANK DETAIL: 17 00 0 DISTRIBUTION BOX DETAIL: LEACHING PIT ' DETAIL: REVISION& INDICATES INDICATES PERC. OBSERVED NOT TO SCALE NOT TO SCALE NOT TO SCALE P- 5545 TEST GROUNDWATER NO DATE NOTES: 1. SEPTIC TANK SHALL BE STEEL 4. INLET AND OUTLET TEES TO BE CAST IRON, NO. OF OUTLETS: MANHOLE COV I ER 8 SEED 15 LOAM TP I-orr H TP TP TP REINFORCED CONCRETE. SCHED. 40 PVC OR CAST-IN-PLACE CONCRETE, TEES BROUGHT TO FINISH 'GRADEi OR PAVEMENT TO BE CENTERED UNDER MANHOLE COVER. NOTES- _ff L I GRD. EL. GRD. EL. GRD. EL. GRD. EL. 2. SEPTIC TANK TO WITHSTAND H-10 LOADING 1, T7 T W. EL. W.' EL. GW. EL. GW. EL. UNLESS UNDER PAVEMENT, DRIVES OR 1. DIST BOX TO WITHSTAND H-10 LOADING 2 M'Nr OF 1/8" TRAVELED WAYS.WHEREIN H-20 LOADING UNLESS UNDER PAVEMENT, DRIVES OR TO 1/2" T 12"MIN. FILL SHALL'APPLY, PRECAST TRAVELED WAYS WHEREIN H-20 LOADING WASHED i.- SHALLAPPLY. STONE ; — DIST. I 3. ALL PIPE CONNECTIONS AND CONCRETE MANHOLECOVER 2. PROVIDE INLET TEE OR BAFFLE WHERE SLOPE OF CONSTRUCTION TO BE WATERTIGHT. BROUGHT TO FINISH GRADE BOX INLET PIPE EXCEEDS 0.08 FT/FT OR IN PVC INLET PIPE 0 C= C= t= C= CM ED 93 PUMPED SYSTEM. or :SU4B SO/ 12-= -.0 L41 q3 a �//1 GENERAL NOTES: COVER 3. FIRST TWO FEET OF PIPE OUT OF DIST C2 C= C= CM C3 0 -rb NOTE. r BOX TO BE LAID LEVEL. LEACHING PIT TO PLAN VIEW 1. THIS PLAN IS FOR DESIGN AND WITHSTAND H-10 LOADING CONSTRUCTION OF THE SEWAGE r C= c= cm cm C3 5CI.P1 REMOVEABLE 0 V UNLESS UNDER V NORMAL WATER LEVEL DISPOSAL FACILITY ONLY. COVER PRECAST PAVEMENT,DRIVE OR I= C= C= c) cc 3/4"TO 1-1/2 - - --- - - - - -- > TRAVELED WAY WHEREIN 2. ALL CONSTRUC,rION METHODS AND LEACHING PIT r iz 61 DOUBLE H-20 LOADING SHALL MATERIALS SHALL CONFORM TO MASS. PROVIDE WASHED c=r C= t= a APPLY. D.E.Q.E. TITLE 5 AND LOCAL BOARD INLET TEE WATERTIGHT STONE ID PE:PC- JOINTS(t p.) gl* L OF HEALTH REGULATIONS. Ik: I.L. LU (no fineil x><j PRECAST 4 0 MIN. OUTLET Jr--i C3 cm co C3 C3 0 3, ALL PIPES LOCATED UNDER PAVEMENT SEPTIC LIOUII) DEPTH TEE At' NOTE 2 A Do' I -_=�wi /0 . : - - I IL OR TRAVELED SHALL BE SCHEDULE TANK 4 INLET i) r= ;7/ WOUTLET I Q t= 171 M C3 0 13 40 OR EQUAL. -2, Y L---------- mcr-> 'um — L Aj cc, 06�b BOTTOM ON LEVEL STABLE BASE --BOTTOM ON DI A, LEVEL STABLE BASE Z>AAJ 0 CROSS-SECTION DIA. PLAN VIEW CROSS-SECTION VIEW 144eg _W o "/ATr R(1 '�q CF(.TInN DATE: DATE, DATE: LOT19 N115 CONSTRUCTION NOTES: DATE- (13 6, INVERT , ELEVATIONS: L07;1 /0 CAPRICORN REALTY TRU9� 14"57"E 1. IF ENCOuNTEREo,"ALL UNSUITABLE SOIL 582 TEST B Y: TEST BY: TEST BY: TEST BY: oe 4 REEMOVEO WITHIN A WI:E T 17 tmALL BE R_ 'S_rE VE' MLSO#J 67-, 9-7 4`v INVERT AT BUILDING A� 258.34" Z ZON E AROUND THE LEACHING FACILITY WITNESSED BY: WITNESSED BY: WITNESSED BY: G- .77 AND SHALL BE I REPLACED WITH CLJ� 4 WITNESSED BY: 4" INVERT AT SEPTIC TANK(in) OM M C_KEA" SAND AND,GRAVEL IN ACCORDANCE WITH, 4v INVERT AT SEPTIC TANK(OU0 64- SZ PERC. RATE: PERC. RATE: TITLE 7. PERC. RATE: PERC. RATE: "oer MIN./INCH MIN./INCH MIN./INCH MINJINCH 4" INVERT AT DIST. BOX(in) INVERT AT DIST. BOX(out) DATUM. INVERTS AT LEACHING FACILITY: 001 ZTt4. 4� ASSUYED VERTICAL DATUM: X 4�. z_rF A C 14 P 17' (1 t4) 7 I N VEX�T A LU Is. BENCH MARK USED: SEE PLAN j -0t,A or- 4EI6,C14 P rr bc)TT 5(0 If 10 . j Ln OBSERVED GROUNDWATER 1c), K"5-HOVA CL LOTL 14 ELEVATION 41 ro, j X'' -ZONE.-RFL ' rc),p ,,,a F z.. SETBACKS; E L Cc) FRONT - 30' 7% r7"9 I A X L 0V Qz -_ `1�7 - Ii r ,cll Q_ SIDE 15' N � 24, (b REAR - 15':, DESIGN FLOW: DROOMS AT I C� .110 G.P.B./D Zi BE O-G.P.D. 4. he EISC Group, IT REQUIRED SEPTIC TANK: X_ C) 0 G A L. OTES. / / / / Q� 0 N SEPTIC TANK PROVIDED: PROPERTY LINES SHOWN HEREON WERE COMPILED Cape Cod Survey Consultants - .L I I : / , -- / ­ -- -.[R /,000 GAL. C)I SIZE OF LEACHING FACILITY REQUIRED: > -FROM A PLAN RECORDED AT THE BARNSTABLE UF1 L cA64 f :S,F + I LITTLE DESIGjN PERC. RATE: 3261 Ma'n Street REGISTRY OF DEEDS IN PLAN BOOK 429 PAGE 58 2 MINJINCH wa MAO AND DOES NOT REPRESENT AN ACTUAL SURVEY ON F� 0,29 4- A— C) cz. P. 01 Route 6A 08 THE GROUND. Barnstable Village MA 'TOT 4�4 f A­ ILU 02630 THIS ,TOPOGRAPHIC SURVEY WAS MADE ON N 617 362 8133 THE GROUND BY TRANSIT AND STADIA METHOD ON MAY,/970 PROJECT TITLE: -SIZE OF LEACHING FACILITY PROVIDED: 7� 55 SEWAGE DISPOSAL SYSTEM DESIGN 178 ��;,F7\ X 44S C, B07 7<� 55 _�ED. FOR a� Y3 % -rO ft. Z5 7 5 ,r LOT v LITTLE POND ESTATES SCALE: LOCUS PLAN: IN B.M.EL.-100.001 - C.8.11D.H. AT N.W. BARNSTABLEMA WARSTONS WILLS) N COR.OF LOT 7. 12 co NI 7 F CAPRICORN REALTY .TRIST PREPARED 1`4: CA11L DATE PROPESSIONAL ENGINEER LOCUS CAPRICOR EAJ-TY TRUST L2 =LE POND 71L RACE LAIVE N C. FRA Of WHIT) Z7, 1987 DATE. MYSTIC LAKE t COMP/D ESiGN, CHECK. s, A W, PLA' N VIEW DRAWN:F, /7.A,W/L 14. DATE PROFESSIONAL LAND SURVEYdR -63.811 C.BID.H. AT N.W. FIELD: W.B. SCALE: 1" 8,V.EL COR. OF )OLISKIN LOT. 3,5 6 06 15 5 2,0 FILE NO: 0 10 21 (00 FEET DVVG. NO. 10,f�7_9 SHEET JOB NO OF 0z HT yp) C ----------