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HomeMy WebLinkAbout0879 OST.-W.BARN. RD - Health 879 Osty . Marstons Mills — - --- -- ---- -- -- - - - ___�: _� A= 124— 048 J u COMMONWEALTH OF N L-ksSACHUSETTS I F EXECUTIV � \1 E OFFICE OF EZROIENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION 0 ao � TITLE 5 (IN OFFICIAL SRECTL- ORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A p�yQ CERTIFICATION Property Address: O / 7 �$ vli�/�e (jes�( � ,t ,6�e ag G!!:g V,/s /Vi4 OA6 e,4 F Owner's Name: Lethe- Owner's Address: F� 9s ✓v. / (ice ,QQ,,,,�Lu��� �� ci s ohs .' Od 6 Date of Inspection: Name of Inspector: (please print) Company Name: iL- 6) — TEG \ MailingAddress: O OTC /off Dot 6 Telephone Number{ D� CERTIFICATION STATEMENT W' •=� tom,, I certify that I have personally inspected the sewage disposal system at this address and that the information r ported below is true, accurate and complete as of the time of the inspection. The inspection was performed based onG-,,, training and experience in the proper function and maintenance of on site sewage disposal systems h;am a DER � approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: � Passes Cond' 'onally Passes Q0 P, ;;a eds Further Evaluation by the Local Approving Authorit ry Fails ON rn Inspector's Signature: Date: /9 O!> 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. Notes and Comments `-."This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future under the same or different conditions of use. Title 5 Inspection Form 6/15/2000 page 1 r Pate 2 of 1 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 0 / / QS2`pvv�� 7�'l�vS ►ems �' ,, �� �,�� Owner: /q ✓1�p Date of Inspection: 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. Com menis: B. Svstem Conditionally Passes: �(Sv /w One or more system components as described in the"Conditional Pass"section need to be replaced or repaired.The system, upon completion of the replacement or repair,as approved by the Board of Health, will pass. Answer yes,no or not determined(Y,N,ND) in the for the following statements. If"not determined"please explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not) is structurally unsound,exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A -netal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND explain: Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken,settled or uneven distribution box. System will pass inspection if(with approval of Board of Health). broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced ND explain: The system required pumping more than 4 times a year due to broken or obstructed pipe(;). The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed ND explain: Page 3 of I 1 OFFIC IAL INSPECTION FORM- NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: / Q Owner: Date of Inspection!- C. Further Evaluation is Required by the Board of Health: Conditions exist which require further evaluation by the Board of Health in order is failing to protect public health.safety or the environment. to determine if the system I. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health,safety and the environment: Cesspool or privy is within 50 feet of a surface water — Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2. System will fail unles s th e Board of Health (and Public Water ier, if any)determ system is functioning in a manner that protects the ublic health, afetyland environment: that the — 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. c — 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 laboratom. for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm. provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: i Page 4 of 1 I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORA PART A CERTIFICATION(continued) Property Address: Sr tv a r►t t� �� oel 1011 062-61�z-5' Owner: /G G Date of Inspectio D. System Failure Criteria applicable to all systems: You must indicate"yes"or"no"to each of the following for all inspections: Yes o _ ckup 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 ogged SAS or cesspool Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or esspool J squid depth in cesspool is less than 6"below invert or available volume is less than " day flow _ Required pumping more than 4 times in the last year NOT due to clogged or obstructed p: e(s). Number times pumped _ _ A y 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. C�Any portion of a cesspool or privy is within a Zone I of a public well. _ Any portion of a cesspool or privy is within 50 feet of a private water supply well. c Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis,performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form.) (Yes/No) The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E. Large Systems: To be considered a large system the system must serve a facility with a design flow of 10.000 gpd to 15.000 gpd- You must indicate either"Yes"or"no"to each of the following: (The following criteria apply To large systems in addition to the criteria above) Yes / 0 — the system is within 400 feet of 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 11 of a public water supply well If you have nswered "yes"to any question in Section E the system is considered a significant threat. or ansl�ered "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. Page 5 of 1 1 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B n CHECKLIST Property Address: 7 QJ �•/ �j�h��o��� �� Owner: L /G►t�c� O Dae of Inspection Check if the following have been done. You must indicate"yes"or"no"as to each of the followins: Yes No Pum/ ping information was provided by the owner,occupant, or Board of Health v 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 Y or as p part of this inspection . Were as built plans of the system obtained and examined?(If they were not available note as N/A) Was the facility or dwelling inspected for signs of sewage back up Was the site inspected for signs of break out ? Were all system components, excluding the SAS, located on site '? Were the septic tank manholes uncovered,opened,and the interior of the tank inspected for the condition of the baffles or tees, material of construction,dimensions,depth of liquid, depth of sludge and depth of scum ? Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems The size and location of the Soil Absorption System(SAS)on the site has been determined based on: Yes Existing information. For example, a plan at the Board of Health. Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(3)(b)] Titles c r....___. Page 6 of 1 1 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: / 6L T (,/ Owner: /— /C, Date of Inspection: RESIDENTIAL FLOW CONDITIONS Nu nber of bedrooms(desigr_):,,—?— Number of bedrooms(actual):3 DESIGN flow based on 310 --MR 15.203 (for example: 110 gpd x of bedrooms): 3�a Number of current residents: O Does residence have a garbage grinder(yes or no): Is laundry on a separate sewage system(yes or no):/fi'D[if yes separate inspection required] Laundry system inspected(yes or no):IkV Seasonal use: (yes or no): /lam Water meter readings, if available(last 2 years usage(gpd)): Sur.-1p pump(yes or no): 4V Last date of occupancy: .0 14, COMMERCIALANDUSTRIAL Type of establishment: Design flow(based on 310 CMR 15.203): gpd Basis of design flow(seats/persons/sgft,etc.): Grease trap present(yes or no):_ Industrial waste holding tank present(yes or no):_ Non-sanitary waste discharged to the Title 5 system(yes or no): Water meter readings, if available: Last date of occupancy/use: OTHER(describe): Pumping Records GENERAL INFORMATION Source of information: A,- .Was system pumped as part of the inspection(yes no): If yes, volume pumped: gallons--How was quantity pumped determined? Reason for pumping: TYP SYSTEM eptic tank, distribution box, soil absorption system — Single cesspool _Overflow cesspool _ Privy _Shared system (yes or no;(if yes. attach previous inspection records, if any) _Innovative, Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) —Tight tank —Attach a copy of the DEP approval —Other(describe): Approximate age of all compcnents, date instilled(if known)and source of information: Were sewage odors detected when arriving at the site(yes or no): Page 7 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORRMATION(continued) Property Address: / Owner: L—/a&-I Date of Inspection: G 0 BUILDING SEWER(locate one plan) Depth below grade: Materials of construction:!_cast iron _40 PVC_other(explain): Distance from private water supply well or suction line: Comments(on condition of joints, venting,evidence of leakage,etc.): SEPTIC TANK: - loca —( to on site plan) ) f'f Depth below grade: 9, 9 Material of construction:—concrete—metal fiberglass—polyethylene —other(explain) If tank i metal list age:— [s age con certificate) e) firmed by a Certificate of Compliance(yes or no):_(attach a copy of Dimensions: S Sludae depth: (, Distance from top of sludge to bottom of outlet tee or baffle: Scum thickness: /_ (�. 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: C f How were dimensions determined: 1 l R10i Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid Is aslated to outlet invert, evidence of leakage,etc.): / N •M 2 0+ � GREASE TRAP: (locate on site plan) Depth below grade:_ Material of construction:—concrete_metal fiberglass_polyethylene other (explain): — — Dimensions: Scum thickness: Distance from top of scum to top of o!ltlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping: Comments(on pumping recommendations. inlet and outlet tee or baffle condition. structural integrity. liquid level` as related to outlet invert, evicence of leakage,etc.): T:.1_ t _ f ; Page 8 of 1 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) � Property Address: .S G✓ /�?,/ ZIK/Gas40 1 r- Owner: /t a h p Date of Inspection: 6 TIGHT or HOLDING TANK:/ (tank must be pumped at time of ins ection lcat p )( eon site plan) i Depth below grade: Material of construction: concrete metal fiberglass_polyethylene other(explain): Dimensions: Capacity: -allons Design Flow: gallons/day Alarm present(yes or no): Alarm level: Alarm in working order(yes or no): Date of last pumping: Comments(condition of alarm and float switches,etc.): DISTRIBUTION BOX: /t/"(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.): LOCH. _ v,do ke -- w PUMP CHAMBER:Zoocate on site plan) Pumps in working order(yes or no): Alarms in working order(yes or no): Comments(note condition of pump chamber; condition of pumps and appurtenances. etc.): Page 9 of 1 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFO�jRMATION(continued) Property Address: aP7 Of �� ©f� �✓ CSG..tf�G�� Owne DoLC E� r, Date of Inspection: /9 r%� SOIL ABSORPTION SYSTEM (SAS ):) (locate on site plan,excavation not required) If SAS not located explain why: Type to X ��e — 's�-- leaching pits, number: 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.): d ov, v� 4 i n 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 or no): Comments(note condition of soil,signs of hydraulic failure, level of ponding, condition of vegetation, etc.): PR V .� I Y. (locate on site plan) Materials of construction: Dimensions: Dep�ch of solids: Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation. etc.): Page 10 of 1 I OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE.SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 6W _ar77' I,,-7,7 C+•-f Owner: 1,1 e Date of Inspection: SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. S /,42- 39-1 f Page 1 1 of 1 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 0jQ EJ- G,/ ,9,,,,f _,� X�—_( �►-t4 1&,4r owner: Date of Inspection: SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water feet 0 154! Please indicate(check)all methods used to determine the high ground water elevation: Obtained ystem design plans on record- If checked,date of design plan reviewed: Ob ed site(abutting property/observation hole wjjp 150 feet of SAS) Necked with local Board of Health-explain: ✓l y!f Checked with local excavators, installers-(attach documentation) Accessed USGS database-explain: You must de ibe hovy yestablished th high?�ound water elev Town of Barnstable Regulatory Services BA"STABM s Thomas F. Geiler,Director MASS. 9`bA,Fo;9. A � Public Health Division Thomas McKean, Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 REGARDING SEPTIC INSPECTIONS BY PRIVATE CONTRACTORS DISCLAIMER A septic system inspection report was completed by a private inspector who is certified by the State of Massachusetts, Department of Environmental Protection. Althouc,h the Town of Barnstable Health Division received the original or copy of the report; this Division does not warranty the functionality of the septic system in the future nor does this Division agree with any technical observations and interpretations contained within this report. In addition, by receiving the report the Town of Barnstable Health Division does not automatically approve the number of bedrooms listed within this report. The actual number of bedrooms approved at a particular property would be listed on the Disposal Works Construction Permit. QASEPTIC\Disclaimer Private Septic Insp--ctions.DOC. v.0 cATION _ [ WAGE PERMIT Q. VILL:4GE d ' gi n INSTA LLER'S DIME i ADDRESS OR OWNER jo,,,C +' u2 DATE PERMIT ISSUED DATE COMPLIANCE ISSUED �- `��tJ 1 SY 3 -- No.�._..._.....1.. ... Fps...... ....._............... ac6 THE COMMONWEALTH OF MASSACHUSETTS o BOARD OF HEALTH H ® ----------------------------------------------------•-•-- Appliration for Disposal Workii Tonstrurtion ramit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: .... 4 .__. ................ P> �a%«�` �•.../3 ,�,�ss.............................�r�--------------------------------------------------------------canon-Address ----••••••••-••••••or Lot No. ...... .... . W "-L..! Address a ......................•-• ••••-•••...._...----•-•. _. Installer Address Type of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) -,Other—T e of Building No. of persons................__.......... Showers — Cafeteria Q' 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--------------------- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) '-� Percolation Test Results Performed by ..................................................... Date............................ `------ aTest Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water............ ........ (i Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a -••--------------•--------------------._...----------------•---•••••----.._.._..._••••--•••••_••-•••......................................................... 0 Description of Soil....................................................................................................................................................................... W U ------------------- •-•------------------------------------------------------------------------------ •----------------------------------------- ---------------------------------- ---••-------- W ----------------•-•---------•----•--•--------------------------•----------------------------------------------------------------••--------...-•--------------------•---------------------------•••-•---- 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 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. Sig ---------------------------•---------------.._._....-----•------------•••---------••- --•----- ' X Application Approved BYIthefollowing rl ,� - � � •-----. Date Application Disapproved f o reasons----------------•------•-----------•--------------...----------•-------------------••----------------------•--- --------•-----•-----.....-•----------•-------------------•---.....-------......_.........._..--------------....---- ------------------------ -- --- --------- -- Date PermitNo......................................................... Issued_....................................................... Date No9.3........r.7r- Fimic ..e........... THE COMMONWEALTH OF MASSACHUSETTS BOAR ,021. .� 3 ® O F- HEALTH LT I-� • .........................................OF........................................... = Allpfiratiou fur Ui ipoii al Works Tonstratrfioat Prrutit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal Syst�,�' at ....!S..Q. .... 1 ............... ull1 d ......�'.• `.� S A 1 r'. 'a........----•------•--•------• --..... ..3 ZL cation-Address or Lot No. .................. - `- ... 1.. e+ 4-------------------------------- ..........-_-................................. _.__.._.......................... ... -...-- aOwner Address Installer Address Type of Building Size Lot............................Sq. feet aDwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons............_..___.......... Showers ( ) — Cafeteria ( ) Otherfixtures ------------------------------------•-••------------...------------....---------------....._..-----------...------...-----------•-----••-•------------ 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--------------------- 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........................ 44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 94 •---•------------------------------•----••------•----------......-•----.....-----•--•--•--....-•----......................................................... 0 Description of Soil................................................................................................................•-•---------......................................... W V ............................••------••---•....__....-----•---•---••••-•--•-•--......--•••••.....-•--•-••-•----------•----•-•-----•-•-•---------•-•-•-----•-----•------••----•--••--••-•-----•--••-------- W x ...........................................-....................................................--------------------........-----•-•-----------------------•------••---------------•---.....--••-•----- U Nature of Repairs or Alterations—Answer when applicable............................................................................................... ----•------------------------- ..............-.....................................................=.................................................................................................... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of T IT LE 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate lfo�llowing ce has been issued by the board of health. ign .--------•••---•--------••••-•-•--••-.........-•-----•••-...--•--•---------•----•---. Application Approved By Date Application Disapproved or reasons---------------------------------------------------------------•------------------------------•--•----••-•••..._ F ....................•--------•---.........---------------•-----------•----••-----•---------•---......-------•-••----••-••--------•...------------•----------------•--------•-•---•------------••-•----- Date PermitNo......................................................... Issued_....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........................................OF..................................................................................... (9rdifirair of Toutph attrr- IS TO RTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) by.---....--•. ... ..................... ........... .... -. a r /Q ---•--... . .. ..•------------•------•------•-------- ....................has been installed in accordance with the provisions of TITLE 5 of The State Sanitary Codatleg ribed in the application for Disposal Works Construction Permit No......................................... dated_...'; �.:. m __---------------- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUN_ I SATISFACTORY. DATE.....•-•�= _'.�.._(:..... ..... Inspector............ ... -----•-----••------••-------••---•---•-••-•--•---••.. Awl THE COMMONWEALTH OF MASSACHUSETTS --.,BOARD OF HEALTH No.................... FEE........................ �t��tu ``f fur a �ottu n �ermi� a Permission is hereby granted._.:_t __ -------------------- .-- to Constru K orkepair *'r n I ldua ewa 4_1 stem�� o atNo.. -- _ --•-- . -•--..-- -•. .. ......... ........ ...•- Street as shown on the application for Disposal Works Construction Permit No.................?__ Da�ed.;_. -._.__ �...:........... rj it - ---------------------------------------------- `"`------------------------- ----------............. - /��)` / Board of Health DATE.. =--..................... ................................... FORM 1255 HOBBS & WARREN, INC., PUBLISHERS t gEE SHEET :.:r=:pIli ff ! �l�Tl � c� c N LEI Oki LA[3WE IJ5o' UNDEE ALI-i- Z, `riApT'. v . 1,161E : 40,000 nl , -- *_ , "" AfJD- �� ' X / R S.�MItJIMvM LOi ( n111t'�� Ll. 1=E. `y L. �T S SIZE 70 sup ol:-T, 'L WELL$ s P iK sY�TE i ' 27 / 7 ¢ S,F' WANE-0 111 f�Af us. t 1 l��• &a/+L U of 11EAL'ila C (�� $ (-TEAM i AC E-: � pLgK °� r RT LaA'now PCQ'.o r� x VCQAAf[.WEII C34 AATKI A5r1 ecvXf),150'+ 9q \ t a SYSXI�A oT 59- 1 4 ppo�pt.c 1 NO BOOS b / Sp�iigy��� '• ) � P � /,P�'nX I MhTc tEPGti,NL � ', Pfr LOCATIOM DF-Q- ool OF PA VEi�CN1 o`er-4.q7� \ r�► C ' • M,y ; Lo ��✓s�� ,� Z suc+NE` F_ 7 L, .4 VAC�j'jT�� LEGEND CERTIFIED PLOT PLAN 'EXISTING SPOT ELEVATION OsO ��NOF;� %EXISTING CONTOUR --- 0 --- ���'� n�ss+� _ Lv 7- S R 05-F. w.: AK'N:". �r>, 'FINISHED SPOT ELEVATION 02 AL tR N � ;~yL7�. 5 �Lj/L-LS `FINISHED CONTOUR 0 o RSE r' IN N No.10951 Q APPROVED , BOARD OF HEALTH �' - t.`` g' e aa FSS/ONAI.Eat ivts of• 1•a5 AGENT SCALE, / ~_ -o DATE /o /�e2- DATE ;•: LDREDGE ENGINEERING CQ /N CLIENTL/'¢ I CERTIFY THAT THE PROPO,�ED EG I SSTERE REGISTERED JOB NO.� BUILDING SHOWN, ON THIS PLAN CIVIL LAND t �_ �s- CONFORMS TO THE ZONING LAW ENGINEER URVEYOR DR.BY �' 1' OF 13ARNSTA E , ASS•-�-AsNo G 712 MAIN STREET CH. ®Y� "I osk H YA N N I S, MASS. SHEET-1— OF 3 ATE G. LAND SURVEYOR M /VOTE /F E/TNGR TNESEPTJC TANK ORJj 20 FT. MIN P. /E/4CHJNG /T ARE MORE TN,9.•/ /2••BELO 1RA DES A 24"O/A M E TER CONCRETE /O Fr MIN SWALL BE BROUGHT To 4MAL7E.6-+/✓ EXTRA CONCRQTG q"PYC PJPl �f E,4 V y CAST /RO/N C O✓ O'T Sf/A L L L3 E M/N. PITCH /F//V DR/1/EN/AY EL= I oo.5 C01iERS /B PFR CD/�ICR�TE �'' 2 • M/N. G ^oE corER CLEAN SANG eA C le)= Z'LAYER _ - ' - •+ ��uQ� AyIP Q• �r F 9• '��e 4 4 CAS? UDO . < o • • . • • ► ► p /RCN P/PE � GAL• I • •o yti/ASHFO 5T27NE 7'GIII M I Al.o/ D I ST. •�s • • • • • • • ► ► ♦ • • • Arm . SEp7'/C TANK Bax • • B • • • • • � •'� • , ° r • • DEPTH/' ' •v 11/.43h►ED STONE � o r • • • • • • 1 1 a d o • • • • • • . • • • • • ► o p o PREG45 T SEEPAG E • a. • P/7 OR EWL/JY, 5.7 11 x 2.5 = S14. a 6 /D a ►• • • . • • • . • ► a 8-1.5 o o IAIV4wK ' CLE ? E VATIDNS D - • EL=8.5 x I. o 18. Ca /.VY, RT AT Qv/LD/NG 92.5 FT.- C(SEF Ts+BuLAT�ON� INLET SEPTIC TANK 92,S FT, FAT cAPac l-n' 3�2. 8 v/D Fr: I . • O/JTLET SEPTIC 7AH 5�!_F�' GROUND HrATER Ti40LE //VLET DISTR/E!/T/ON BOX `� 1•9 � SECT/ON OF' ou7LETD/STR/BI/7ioN BOXY_FR .SEWAGE O/SROSA L SY TEM TABULATION //yLET LEACHING PI�' 91 . 5 FT. L E�4CN/NG P/T ''��`��, e r,�,IL 141 DIMENSION A 8 FT. S•tALE Y4 M s /- O i�er P_�cw rdoT""' O/,y,FNS/ON $ FT. �E DESIGN CRITERIA � H4..b oar r e ,,, G?au,+CwA�Q��'T D/HENS/ON C?— NLJ,NQER OF BEDROOMS 3 r�wee GitRQAGEDISPOS,4L UNIT �os�C SOIL LOG SO/1- TEST • TaTAt E.?TIJ�►tATEO FLOW 3 3 O G.4L.IDAY SOIL TEST Al SO/L 71EST0it'2 ,{!UMBER aF LEACNIJV4 P/TS_ f`Ey�✓ 98�a ELEY. 3 ,DATE OF SOIL TEST F.a SIDE LEACHING PER PIT IS 1 54t PT Q_ Z © _ RESL/LTS yV/TNESSED dY 18.5 PERCOLAT/ON RATE �I L�S� MJNI/NCH 90T'TOM 4"CH/NG PER P/T 54.. FT va' ; S�/a S � ` Po"ec . AT/oN RATE AZ TorAL LEACHING AREA ZL -.2 ,,S(� Z_-rU RESERVE LEAC/V//V6 ARE,4 204''- SQ. FT. ZN OF OF A4S Q, ? �� p2 ALBERT� TZ?/✓ _ � d. N MORSE v, " No.10951 0 '• EL D RED GE ENG/NEER/JVG CO,/NG. 21i74 p ,o L, 7S 7/2N S, Ss,� �I ObT��vpt � \� FSS�ON^ E'/!. /Y A'D S11GROINNr7 yy,4TER ENCOUIVTEREO C.4I E NT: AN=°/ s DRTE r-i rvn I,.vn LVATER AT EL.E✓. — inA w/�• Ft/�S 2_ _ SHEET 3 OF 3 y TOWN OF BARNSTABLE Lr6CATION 9 S";W d`� 6y�Lsd'13�61nSSEWA #aoG,, 3G VILLAGE NHS ��ll ASSESSOR'S MAP&PARCEL INSTALLERS NAME&PHONE NO. 130-0 (3C-Th d C 1nSJ-• Cm 3 (0d Ga37 SEPTIC TANK CAPACITY /5-g 0 LEACHING FACILITY:(type) moo® Co. r-A/vW b size) NO.OF BEDROOMS OWNER PERMIT DATE: COMPLIANCE DATE: ��7 Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet FURNISHED BY G 13 No.. 200 o Fee 1o' v THE COMMOOWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes ZippYication for �Bi5po5al 14pgtem Cougtruction Vertu Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No.g'f 0s 1/✓� + orb" ref Name,Address,and Tel.No. dy,�fJ��►r� . �j rn Q �7�j OSdr-evv i Assessor's Map1parcel Installer's Name,Address,and Tel.No. IF I I is /3r&J70,,s CCh siesigner's Name,Address and Tel.No. 3 /z,ft,;Mrr�-r�tr/r �cinw�. Gs►/�-1 /f4,.k / Type of Building: Dwelling No.of Bedrooms 3 Lot Size sq.ft. Garbage Grinder ( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures **��q� gpdDesign fl c /C� Design Flow(min.required) l/U d 1�) ow provided 3 �( [ gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. SC C �5 yeah Z.Palw22 (S6f,,,,,_� Description of Soil S'� a (_o t It �SJ'��G g !I 411^ 1 Nature of Repairs or Alterations(Answer when applicable) S e , 'Ce"o- e or-c6„ Date last inspected: Agreement: The undersigned agrees to ensure t nstruction and maintenance of the afore described on-site sewage disposal system in 5 accordance with the provi ons of Ti o e Environmental Code and not to place the system in operation until a Certificate of Compliance has been issue and of Health. Si Date Application Approved by - Date 71- Application Disapproved by: Date for the following reasons Permit No. �LO 0 y 310 Date Issued }7—0 40 No. . Qo .r `1 „ ., y Fee+ ; THE 601WAO&EALTH OF,MASSACHUSETTS ' Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes ZIppYication for TDf5po9;al .6p5tem Con.5tructiori Permit Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon( ) ❑Complete System -]Individual Components Location Address or Lot No. 9-7 OF 0s l4i I Address,and Tel.No. / V L A7i/P ,;)) � , e c�r7y OS rt/o�l (,,..f� /35r,�I✓ i3/ /� Assessor's Map/parcel ; r Installer's Name,Address,and Tel.No. /:7 j I I S 13,r o jl�fS CCn, Designer's Name,Address and Tel No. 3 (,d 4t St l / S� 3 G 3 7 3 /F it r r it�f' 0Cwh C w /` `-� f AL 10 Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder ( ) Other Type of Building _� No.of Persons . Showers( ) Cafeteria( ) Other Fixtures " t Design Flow(min.required) /j U 5� ;"" gp flow provided 3 Y� gpd Plan Date c Number of sheets Revision Date Title `^w Size'of, eptic Tank 1 S Oe� n Type of S.A.S. CC _C� !t��, t' Description of Soil M �` c Nature of Repairs or ibns'(,Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure t e•cgnstruction and maintenance of the afore described on-site sewage disposal system in Jen accordance with the provi ons of Tit e Environmental Code and not to place the system in operation until a Certificate of 'Compliance has been is wed�b, t ' o rd of Health. Sigma Y Q�+--� Date Application Approved by `` p - Date 7 Application Disapproved by: u Date for the following reasons ! 7 .� Permit No. a-00 5L-' L1 7� Date Issued ` 17-0 }� -------------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS (Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed ( ) Repaired ( ) Upgraded ( ) Abandoned( )by at _ `7 C/ 0 Sie c(i, 69.14 .Qq,/)/4as bpScbfnstru din accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. t70 _ t- '(o dated �I` X 7-0 7 Installer t i S (3 GG J + 5 Designer 13,Q ffAl l C q,7-s #bedrooms 3 Approved design flow 3:!!�) gpd The issuance of this permit shall not be construed as a guarantee that the systemfwilll n•tio d' signed. Date /3ZV` Inspector ------------------------------------------------ No. ado ^LI 3 h7 Fee 10.(' _ THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE, MASSACHUSETTS Migoal 44p.5tem Construction Permit Permission is hereby granted to Construct ( ) Repair ( ) Upgrade ( ) Abandon ( ) System located at O /p r i _ 1. _� C! , , 1 - is�� A—,�'kh and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or'special conditions. Provided: Construction must be completed within three years of the date of this,peerrm_it.. i Date 4] 2�' 0 y Approved by �--� i f Town of$arnstable Regulatory Services Thomas F.Geller,Director j Public Health Division Thomas McKean,Director 200 Main Street,Hyannis,MA 02601' I Offics:.509-962-4644 i Fax: 5M790-6304 Instatter&Designer Certi0malon Form j Date: I OIS10 7 Sewage Permit# and-,_ `-?(?Assessor's Ma-P4A ce1. 1;L L4 'q F' Designer: LI)M v, t— Address: Address: 12 Xa Iva I on [ M. l o y I F I I I's 30d�-a4 was issued a permit to install a (date) (installer) septic system at *7 9 k,-'JO- 0Gqr^0%19kbe sbd on a desigf n drawn by (address) } O-v' 4dated (desi ) I certify that the septic system referenced above was installed substantially according to the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. Stripout (if required) was inspected and the soils were found satisfactory_ I certify that the septic system referenced above was installed with•a�ajor changes (i.e. greater than 14' Iateral relocation of the SAS or any vertica] relocation of any component of the septic system)but in accordance with State Bt Local Regulations. Plan revision or certified as-built by designer to follow. Stripout(if required) was inspected and the soils were found satisfactory. 4 ,z1A OF,,� ARNE H. OJALA ( , tlsw errs Signature) CIVIL f Z No 30792 IQ'�' (Designer's S ture) (Affix Designe p Here) gE O B pj, P LIC HEALT DIVISION.I CERTIFICATE COMPL CEASE 1F B& OT B I 'UED F RM MB T B LE C HEAL DIM ION. XOU. Q:1Sepdel wdper Certification Form Rev 03-09-M.dw f I _ j i f y�yT6 ro �� r aci D N T . j UP 26 0., cxw ,y Cxw I y _UB FIN- p �u I r r" e CURB ATTIC �n c 2x 12' !o O. C. j , -- -- * 3-6 --- -- -- ; -A SYSTEM PROFILE NOTES TOP FNDN. AT EL. 68.5' NOT TO sCAt LEGEND ACCESS COVER TO WITHIN 6` OF FIN. GRADE : ACCESS COVER TO WITHIN 3` OF FIN. GRADE 1.. DATUM IS APPROXIMATE NGVD ACCESS COVER (WAMMGHT) TO 100.0 PROPOSED SPOT ELEVATION WITHIN 6` OF FIN. GRAIDE 67.0 MINIMUM .75 OF COVER OVER PRECAST 2% SLOPE REQUIRED OVER SYSTEM 2: MUNICIPAL WATER IS EXISTING Shubwsl o 6s.0 o- t OOxO EXISTING SPOT ELEVATION " Pond r. RUN PIPE LEVEL 2` DOUBLE WASHED PEASTONE 3. MINIMUM PIPE PITCH TO BE 1/8 PER FOOT. OR GEOTEXTILE FABRIC ALL SYSTEM COMPONENTS SHALL BE *63.1't FOR FIRST 2 . MARKED WITH MAGNETIC-TAPE-OR 100 .. 9 3 MAX. 4. DESIGN LOADING FOR ALL PRECAST UNITS TO BE AASHO _ PROPOSED CONTOUR - PROPOSED 1500 COMPARABLE MEANS FOR FUTURE LOCATION. � _Ts GALLON S1 C 62.59' 63.0' H- 10 100 EXISTING CONTOUR :62:.81�1/ TANK (H- 10 1 ` BAFFLE 62.44' �� 62.27' 0 E3 0 0 O 0 0 0 0 5: PIPE JOINTS TO BE MADE WATERTIGHT. 11 0 62.2'- E00 0 0Q0 o 6. CONSTRUCTION DETAILS TO BE IN ACCORDANCE WITH o DEPTH OF FLOW 4' �6` CRUSHED STONE OR MECHANICAL 0 0 0 C� 0 0 a MASS. ENVIRONMENTAL CODE TITLE V. TEE SIZES: COMPACTION. (15.221 [21) 2' 0 0 0 0 � ED a a o 60.2' S �: INLET DEPTH = 10` 7: THIS PLAN IS FOR PROPOSED WORK ONLY AND NOT TO " 3/4" TO 1 1/2" DOUBLE WASHED STONE ouTl�T DEPTH = 14 BE USED FOR LOT LINE. STAKING OR ANY OTHER PURPOSE. MIN. (-16 SLOPE) ( 1 % SLOPE) I( 1 % SLOPE) 8. PIPE FOR SEPTIC SYSTEM TO SCH. 40-4" PVC. LDCUS LEACHING 5.6' 9. COMPONENTS NOT TO BE BACKFILLED OR CONCEALED FOUNDATION 10' SEPTIC TANK 15' D' BOX 9' FACILITY WITHOUT INSPECTION BY BOARD OF HEALTH AND PERMISSION OBTAINED FROM BOARD OF HEALTH. LOCUS MAP 10. CONTRACTOR SHALL BE RESPONSIBLE FOR CALLING SCALE: 1" 2,000'f *THE INSTALLER SHALL VERIFY THE BOTTOM TH-1 EL. 54.6' DIGSAFE (1-888-344-7233) AND VERIFYING THE LOCATION LOCATIONS OF ALL UTILITIES AND ALL OF ALL UNDERGROUND & OVERHEAD UTILITIES PRIOR TO ASSESSORS MAP 124 PARCEL 48 BUILDING SEWER OUTLETS AND ELEVATIONS COMMENCEMENT OF WORK. PRIOR TO INSTALLING ANY PORTION OF 11. EXISTING-SEPTIC- SYSTEM -SHALL BE PUMPED AND - LOCUS IS WITHIN WELLHEAD PROTECTION SEPTIC SYSTEM REMOVED OR PUMPED AND FILLED WITH CLEAN SAND. OVERLAY DISTRICT (WP -ZONE) 12. ANY UNSUITABLE MATERIAL ENCOUNTERED SHALL BE REMOVED 5' BENEATH AND AROUND THE PROPOSED LEACHING FACILITY. 13. LICENSED PLUMBER TO VERIFY FEASIBILITY OF TEST HOLE LOGS RE-ROUTING INTERIOR-SEWER -LINE TO LOCATION AND ELEVATION SPECIFIED PER PLAN PRIOR TO INSTALLATION OF ANY COMPONENT. ENGINEER: A. H. .OJALA, PE WITNESS: DONNA MIORANDI, R.S. DATE: AUGUST 28, 2007 PERC. RATE _ < 2 MIN/INCH 25886, CLASS I SOILS P# 11884 SYSTEM DESIGN: LOT 5R ELEV. 27,181 f SF GARBAGE DISPOSER IS NOT ALLOWED " ELEV. " 0.6f AC. _ alb 0 65.6 0 `V' 66.1 DESIGN FLOW. 3 BEDROOMS ® 110 GPD = 3'30' GPD q A USE A 330 GPD DESIGN FLOW /SL SL SEPTIC TANK: 330 GPD (2) = 660 1OYR 4/4 10YR 4/4 4" 65.3 3" 65.8' 65 1 USE A 1500 GAL. SEPTIC TANK jS, j rn LEACHING: �f /�S� SIDES: 2 (25 + 12.83) 2 (.74:,)' = 112 GPD 36" '' 7.5Y 6/4 62,6' 32" 7.5Y 6/4 63.4' r BOTTOM 25 x 12.83 (.74) = 237 GPD n C1 j 1 5' REMOVAL OF UNSUITABLE SOIL REQUIRED AROUND PERIMETER OF 67 *a' "_ TQTA!_:� 472 S.F. 349 GPD ! + LEACHING AROUND DOWN TO O j UNSUITABLE MATERIAL L� /MCLS SUITABLE SOIL LAYER. REPLACE �2$ 84" ��4mcl Y 5/4 58.6' 84 10YR 5/4 59.1' .Y '� USE (2) 500 GAL. LEACHING CHAMBERS (ACIME OR EQUAL) WITH CLEAN MED. SAND. E'lGINEER ,. / _ OVER HEAD UTILS TO INSPECT AND CERTIFY - - - NTH 4 STONE ALL AROUND O ��•" O !RE-ROUTE �•� - -. WI A R � .� REMOVAL t O p EXISTING / " " _ INTERIOR T 2 _�Q�• / SEWER LINE- ! PERC C2 C2 LICENSED .•� O p ? p PLUMBER TO • - VERIFY ! , MA 20. FEASIBILITY ! / MCS MCS s APPROVED DATE BOARD OF HEALTH v' (SEE NOTE/ #13) 1OYR 7/4 1OYR 7/4 3�S EXISTING p / 132" 54.6' 120" 56.1'' DWELLING / TOP of FNDN NO GROUNDWATER ENCOUNTERED <oO EL. 68.5' �* P 0 EXISTING SEPTIC SYSTEM / �� (SEE NOTE #„) � TITLE 5 SITE PLANT PAVED OF DRIVE a' � y _ BENCH MARK - COR OF - 879 OSTERVILLE-WEST BARNSTAB E RD CONC PAD AT GARAGE ELEV. - 68.3H (MARZO'kTONS - MILLS) BARNSTAr-%LE-, MA PREPARED FOR oy ETHEL LIANGOS DATE: SEPTEMBER 10, 2007. / Scale:1"= 20'. 0 10 20 30 40 50 FEET off 508-362-4541 fax 508 362-9880 own c qp e erg g ire e eril� g, in c. �°F Mgss9�ti o� DANIELA. yam �� DANIEL oiAIA �, o A. Cl VIL ENGINEERS LA Q No.46IL v No. sQ, L AND SUR VE YORS �. DATE DANIEL P.L. q��suRV� 9 Main -- Street - YARMOU THPOR T, MASS. 07-177 LIANGOS.DWG (DDF) DCE #07- 177 i i