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HomeMy WebLinkAbout0318 OLD MILL ROAD - Health 318 OLD MILL'd,�,MARSTONS MILLS Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 318 Old Mill Rd Property Address Boulay, David and Riahanon a+ Owner Owners Name information is required for every Marstons Mills ( Barnstable) ✓ Ma 4/5/2016 page. Cityrrown State Zip Code Date of Inspection .. ®. BCD 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, use only the tab 1. Inspector: key to move ycur cursor-do not Chad Hathaway use the return Name of Inspector key. H.P.S. � Company Name P.O.Box 151 Company Address Forestdale Ma 02644 City/Town State Zip Code 774-274-2581 12866 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 4/5/2016 Inspectors Sign atu Date The syste inspector shall submit a c y of th inspection report to the Approving Authority(Board of Health or DEP)within 30 days of mpletin this inspection. If the system is a shared system or has a design flow of 10,000 gpd or reater, a inspector and the system owner shall submit the report to the appropriate regional o Ice a 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. t5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 318 Old Mill Rd Property Address Boulay, David and Riahanon Owner Owner's Name information is required for every Marstons Mills( Barnstable) Ma 4/5/2016 page. CitylTown 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: ® 1 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: tank in good condition tees in place. Dbox good condition no visable leaks or cracks no high stainnig to indicate past failure. Camera inspected leaching chamber through dbox. leach chamber has estimated 6"of water in bottom with no staining above that point to indicate past or present 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•3M 3 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 2 of 17 Commonwealth of Massachusetts w Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 318 Old Mill Rd Property Address Boulay, David and Riahanon Owner Owner's Name information is required for every Marstons Mills( Barnstable) Ma 4/5/2016 page. City/Town 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•3113 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 ,M 318 Old Mill Rd Property Address Boulay, David and Riahanon Owner Owner's Name information is Marstons Mills Barnstable Ma 4/5/2016 required for every ( ) page. City/Town 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 tc 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 ❑ E 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•3113 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 4 of 17 I� Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 318 Old Mill Rd Property Address Boulay, David and Riahanon Owner Owner's Name information is Marstons Mills Barnstable Ma 4/5/2016 required for every ( ) page. Citylrown 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•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts u Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M s 318 Old Mill Rd Property Address Boulay, David and Riahanon Owner Owner's Name information is Marsons MillsBarnstable) Ma 4/5/2016 required for every ( B tbl ) 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): 4 Number of bedrooms(actual): 4 DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): 440 t5ins•3YI3 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System-Page 6 of 17 I� Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments w 318 Old Mill Rd Property Address Boulay, David and Riahanon Owner Owner's Name information is Marstons Mills Barnstable Ma 4/5/2016 required for every ( ) page. Cityrrown 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: current 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/'3 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 318 Old Mill Rd Property Address Boulay, David and Riahanon Owner Owner's Name information is Marstons Mills Barnstable Ma 4/5/2016 required for every ( ) page. Cityrrown 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 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•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form I a Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 318 Old Mill Rd Property Address Boulay, David and Riahanon Owner Owner's Name information is (required for every Marstons Mills Barnstable) Ma 4/5/2016 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: 1997 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 1.5' 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.): 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: 1500 gal Sludge depth: 3" t5ins•31-.3 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 L- Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments °M 318 Old Mill Rd Property Address Boulay, David and Riahanon Owner Owner's Name information is required for every Marstons Mills ( Barnstable) Ma 4/5/2016 page. Cityrrown 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 1 Distance from top of scum to top of outlet tee or baffle 4" Distance from bottom of scum to bottom of outlet tee or baffle 16" How were dimensions determined? tape and sludge judge Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): pump every 2-3 years as maint. to protect leaching 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 s 318 Old Mill Rd Property Address Boulay, David and Riahanon Owner Owner's Name information is required for every Marstons Mills( Barnstable) Ma 4/5/2016 page. CitylTown 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.): *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 L Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments G1M 318 Old Mill Rd Property Address Boulay, David and Riahanon Owner Owner's Name information is Marstons Mills Barnstable Ma 4/5/2016 required for every ( ) 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 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.): clear of carry overs no visable cracks or leaks 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: camera inspected. estimated 6"of wate in bottom of leach chamber. 1'6" reserve out of 2'tall chamber t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 l Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �t 318 Old Mill Rd a,. Property Address Boulay, David and Riahanon Owner Owner's Name information is required for every Marstons Mills( Barnstable) Ma 4/5/2016 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ® leaching chambers number: 3 500 gal L.0 ❑ 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.): 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•3113 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 318 Old Mill Rd Property Address Boulay, David and Riahanon Owner Owner's Name information is Marstons Mills( Barnstable) Ma 4/5/2016 required for every 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 _ o Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 318 Old Mill Rd Property Address Boulay, David and'Riahanon Owner Owner's Name information is required for every Marstons Mills( Barnstable) Ma 4/5/2016 page. City/Town 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 .14 � 0/ e� I J �ll a� P3- 9v 3s q K- l J t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 15 of 17 I _ - Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 318 Old Mill Rd Property Address Boulay, David and Riahanon Owner Owner's Name information is Marstons Mills Barnstable required for every Ma 4/5/2016 ) page. Citylrown 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: greater then 10'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: supplied topo maps on barnstable website You must describe how you established the high ground water elevation: used asgs barnstable topo maps back yard is at el. 60'spot el. across street is at el. 50. bottom of leaching is 5.5' below grade 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 IIM Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M , ' 318 Old Mill Rd Property Address Boulay, David and Riahanon Owner Owner's Name information is required for ever, Marstons Mills( Barnstable) Ma 4/5/2016 page. Cityrrown 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%i3 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 17 Lot 15'0 TOWN OF BARNSTABLE •'j LOCATION 12 6��+/1X I / A* SEWAGE # 4� (' VILLAGE +� �.s /N���' ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. �• P✓/L c co tiff G OA/• '433 S�P99 SEPTIC TANK CAPACITY /Soo LEACHING FACILITY: (type) Sao eel [saltk 44n&A(size)41, /•Z. �3 5 NO.OF BEDROOMS_ UII: R OWNER PERMITDATE: ? COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) :Feet Furnished by •ii A 0 /A.. AP Ll Ay Lot 1 S,o TOWN OF BARNSTABLE LOCATION 1 /h' SEWAGE # VILLAGE .ryt+r,Al�� 4 �r/�1C' ASSESSOR'S MAP & LOV-JK 1r foZ INSTALLER'S NAME&PHONE NO. GOIV• U3 -VM SEPTIC TANK CAPACITY /Iw o LEACHING FACILITY: (type) SQa ce/ 4sz&i r 44w&-A(size) NO.OF BEDROOMS � I. UIL R OWNER PERMITDATE: & " f 7 COMPLIANCE DATE: -7' Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist . . within 300 feet of leaching facility) Feet Furnished by �JCrUt A v 30 I ' /s'6 AY {� r No. ,Fee l J THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS ZIpplication for W5pog al *p5tem Con5trUttion Verna Application is hereby made fora Permit to Construct( )or Repair( )an On-site Sewage Disposal System at: Location Address or Lot No. `j 16 - Owner's Name,Address and Tel.No. vc-p A4 i z.t K Rv_-Z 4 � l Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. KN1oW � g'33. S/f?9 J�3 f�'�hr-�C' GA, °�i�,a-....�Bz.'.7-+A�--T 4?2. a/3Z. Type of Building: Dwelling No.of Bedrooms Garbage Grinder(PO) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow 4® gallons per day. Calculated daily flow q` o gallons. Plan Date 3- L-6 9-7 Number of sheets I Revision Date Title vd:'P"5- 5 e,5?Z:,-7 'D&s614 A--> -11rc 80L&� 4:46�7-- C?Q. Description of Soil Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issuef by this Board of H Signed - D to Application Approved b i CA Application Disapproved for the following reasons Permit No. 9 1 — 2 1 1 Date Issued o& / ——————————————————————————————————— —— �-Jt�.e........-r.-w•. _ .Yfi ,F...-,,.,.�....r. � a.. _ � a °w.a•.,� • �- ,, .. - . Qv-. , .,-�. S ?-. � w ...:,.. .t..n _ .- .. . 2 No. r�ee Z _THE COMMONWEALTH OF MASSACHUSETTS y � " -PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS ti ZppYication for �igpogal *pgtem Congtrti�ction ertnit Application is hereby made for a Permit to Construct( )or Repair( )an On-site Sewage Disposal System at: Location Address or Lot No. 3 8 Owner's Name,Address and Tel.No. P f f OL b A.e�4 t.G' ,�—� H A-P DV& pint-c d-e- $z- ,• Installer's Name,Address,and Tel,No. Designer's Name,Address and Tel.No. fin, it •...•l ,. ',• 41£�c/ 9 �Z 9'+1/.3 ,-Type of Building: Dwelling No.of Bedrooms °`� Garbage Grinder(fly Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures / Design Flow `�U gallons per day. Calculated daily flow y�� gallons. Plan Date S Z 3 9'7 Number of sheets Revision Date Title 5 fY.S 76-4 a&61 S A-> 0--� &a*_)S7 �o. Description of Soil �• .�.__ _ /•/C� - Nature of Repairs or Alterations(Answer when applicable) I Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system ' in accordance with the provisions of Title 5 of the Environmental Code and not to place the.system in operation.until a Certifi- cate of Compliance has been issue by this Board of He ' j - Signed D e Application Approved ' Application Disapproved f�Or the following reasons Permir.No. - 2 ( 1 1 : Date Issued lGJ 2 IL THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS Certificate of Compliance �.. THIS IS TO CE that the On-site Sewagy disposal Syst m installed( )oorr repaired/replaced( )on by a .6 P1 t I&d 01 1' has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. -,2 2/ dated b- ? 7 ' Use of this system is conditioned on compliance with the provisions set forth below: (_ t No. / —Zl 1Y "C Fee— - tiY THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION- BARNSTABLE, MASSACHUSETTS =tgpogar *pgtem Congtruction Permit Permission is here granted to C kj:5t to construct(­,o repair( )an Ona-site Sewage System locat d at 1 r-L :l and as described in the above Application for Disposal System Construction Permit.The applicant recognizes-his/her duty to comply with Title 5 and the following local provisions or special conditions. All construction must be completed within two years of the date below. Date: 7? Approved by vim. --------------------- Wl 7 7' 717-" 7' INVER, �_:g MINIMUM. TES -MUST BE WITHIN -NERA L T­ EL EVA T,I 'ONS DES I GN: CR I TER [A 'INVERT:AT.BUILDI G:, , DESIGN:FLOW: ACCESS COVERS, 6 OF FINISH.MD N ' 100, 0 ,,-' S-PLAN ,IS 6N AND CONS -D. t'PER MA)(IMUM CO VER FOR ,7HE DES] TROCTION G P. INVERT, IN: SEP TIC TANK: 92.5 tDRboms AT F1 PS T TO THE',SEW46C DISPOSAL',SYSTEM'Ok Y. , BE LEVEL MIN,2" OF PEASTONEI: BEDROOM EOUA L S -440: G.�P. D. , [NVERr OUT SEPTIC -TA NK --09.'25 'ALL' CON$ A ND 2' tRUCftbY-METHODS ND-A4A TERfAL S-A� P,yc INVERT WDIST 9 . 17 'n BOX: -314* 412' D IA. INI'ENA)VCE`6F -THE.-sEpr,rc SYSTEU�ISWALL 'NO GARBAGE "GRINDER MA �$C HEDULE 40, N\q WASHED STONE ' 99. 0 CON, ORM OWASS. DX.p. '-,TITLE,5 ANDIOCAL INVERT "OU' T, DIST. BOX, w� BOA RD, -)�tA L TH REGUL A r 10 JNVERTJN LEACH CHAMBER: 98 .!�FFLE -ANK TI C:j REQUIRED 3-500 OAL LEACHING CHAMBERS CHAMBER': L BOTTOM OFlEACH OUTLET 96.75 D 440 3.�4 AL COMPONENTS LOCATED UNDER _pOX W14' STONE"AROUND. IP.87 33,5'.k 2" .,P.�D. 20ox , EPTIC'�SYSTEM GAL . GAL NIA A FA -VEHICULAR TRAFFIC R,'GREATER :1506 ADJUSTED GROUND WA TER: R SUBJECT. To SEPTIC, TANK ,PROVIDED: GAL. , THAN DEPTH SH� SEP T/C TANK 'i5 CRUSHED STME OR, IN, 'LL: BE CAPARLE,OF W1 TH- NIA OBSERVED' GROUND WA TER: -ST MECHA N I CA L L Y�'COMPA C TED BASE ANDING H-20 HEEU LOADS., W -91 . 6 TE14 REQUI RED: BOTTOM OF TES T HOLE *2: SOIL 'ABSORPTION SYS PROF LE,: NOT 'TO SCALE 4. -ALL SEWtR P I PE 'SHA L L RE SCHEDUL E 46, OR DESION�PERC RA TE: MINIINCH ­ APPROED EQUAL. SOIL TEXTURAL ' CLASS, �EFFLUENT LOADING RA TE 12, S. ei5PORE'-CONSTRUCT ION CALL- *D16-SAFF%, 440 6PD 0. 74 GPDISF 59-5 S.F. 4844 Aw-THE LO AL WA TER'D&T. FO R 6C4 TI ON OF UNDERGR OUND U T IL I TIES ED: 3 00 , GAL CHI 0 C M S PROVID -,,,,,6,,�:,,,�YERTICAL 'DA'rU)W ASSOMED W 4 * ST -AROUND. A-614 S� -ON F. -7.�,' 4ENCH MARKS,SET.: SEE'SITE, PLAN. y NO 'D' ETERM1 NA T I ON,HA S BEEN MADE AS TO SOIL TESIT P:I T DATA C014PL IANCE WITH DEED RE$TR ICTIONS�OR ,ZONING TS IND I C4 TES �REGULATIONS',�,��ir:�SHAtL'.;RtMAIN'�HE CLIEN bm IND CA TFS PERCOLATION'' _-OBSERVED 'SPECIAL GROUNDWATER. RESPONSIBILITY To OBTAIN ALL PERM I TS. TEST -VARIANCES ETC. FOR THIS PROJECT. PERU I T$.' TP 2 -102.6 Gj?Nj) EL 101'.6 GRND Et. LOT NIA - NIA 01 W.EL. G.W.EL. 24.2001S.F HORIZON TEXTURE �COLOR - 0 THER HORIZON TEXTURE COLOR 0 THER', q 0 . 102.6 JOI .6 fO7.4 . .............................. ........ 2- 10�.4 2. . ................I............................................. 101.4 L OAMY IOYR LOAMY IOYR SAND 212 A SAND 212 +104 02.4 4- — -----------------I............................................ 102.3 7' ......................................................... /01.0 LOAMY L OAMY 5YR 5YR SAND 314 Ile SAND 314 eOe\: 20*. ............ .......... ..........I.............. ......... 100.9 24*. ........................................................... ME -COARSE 10YR SOME -COARSE IOYR SOME kED SAND 716 COBBLES SAND 716 COBBLES 54" 105 + f + Jr-POO OAL TIC'TA)YK aA CH ��M //W14 8 NO WATER ' NO WA TER 12 92.6 : 6 , + 104, Nolr 140,10, -15 1997, 100.4+ DATE' MA Y oir ID TES T 8 y.- S TEPHEN HAA S .0 to - WITNESSED 8 Y._ JERRY DUNNING cp ' PERC RA TE: 2 MINIIN'CH + q 11 1. 9.51 8;_4 )4 0/1 , 0 S _P T S Y S , TE_M,' D E 10 v 9.23 e- OA Af L L R OA D "A P -4 e5 1::>A R 0,EL 6�2 ��OL 0 AlfA )? S TO/V s I— L 5 CA D I 9AS RIM PIN. S A RIVS TA S, L E" ILV.4 CA TCH WIN .30 -RIM - 99.06 -PA RIE-D 0 R PR E E-IV 0 IV S. T R U0 0 IV- (7 0 10 Cl, UTEP kit R 0 U TiE' S U - 7 AA 5 TOMS Ll ' LOCUS HUI f4AAC 6; 5 CAL iT 0 "A Y' 17 .51 zldx? V. __Jr V 45! _.E V(5!.dr VIE _lvc7 . "A 67 i5 ................. J681� No. 9 25 FIELD CFWITA :SAOCFW=CHECK ' DRN: SAH 2 7 W CALC-- 15 ��jo 60