HomeMy WebLinkAbout0008 PREAKNESS WAY - Health 8 PREAKNESS WAY, MARSTONS MILLS
A= 151 085
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TOWN OF BARNSTABLE
LOCATION -� � ��
SEWAGE #
VILLAGE ASSESSOR'S MAP & LOT 164;�.9� -
INSTALLER'S NAME & PHONE NO.
I
SEPTIC TANK CAPACITY '� C)
�-. LEACHING FACILITY:(type) (size)
L
'-",— NO. OF BEDROOMS PRIVATE WELL ORQPUBLIC WATE_ _
BUILDER OR OWNER Lt>v
DATE PERMIT ISSUED:
DATE COMPLIANCE ISSUED:
VARIANCE GRANTED: Yes No
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cL L17 ,
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,off
No. V �y 2 v Fee UU
I
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:;
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes
Rppricatiou for 3i5pogar *pgtem Cow6tructiou Perron
Application for a Permit to Construct( ) Repair(/Upgrade( ) Abandon( ) ❑ Complete System [�Individual Components
Location Address or Lot No. /BOSS �,(J(�r t/ Owner's Name,Address,and T�0.
As�ssors M0,5— �'`/ jS_j103 ll
Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No.
Type of Building: ��jj
Dwelling No.of Bedrooms Lot Size Gai 7 O sq. ft. Garbage Grinder (141a
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow(min.re uired) 330 gpd Design flow provided 33V gpd
Plan D Z 41iNumber of sheets Revision Date
Title fi(lC{
Size of Septic Tank o�Ql ,Li/%vim-% Type of S.A.S.
Description of Soil 91513 X 1441:2 All"Z
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 Certificate of
Compliance has been issued by this Boarj of Health.
Signed Date
Application Approved by Date ��
Application Disapproved by: V Date
for the following reasons
Permit No._ �^ �' Date Issued � ,2
� � T c^p
Fes'"^' l"
No. U . ' _
" Fee U r
t THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes
2pplication for Digoar *p!tem Cou!5tructiou Permit
Application for a Permit to Construct( ) Repair(y)/Upgrade( ) Abandon( ) ❑Complete System U Individual Components
Location Address or No. $ PJ'�°�Y/��L4�j� tc1&}/ Ow��s�e,�dress,and Tel.�Vo./A''AssessorsMap/Parcel /
Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No.
fi�r tl129�1 � 77/-9 Y Lowy
Type of Building: jj 77
Dwelling No.of Bedrooms d, Lot Size 20/F/9 sq. ft. Garbage Grinder (/ Q
Other Type of Building ` y�yG,p No.of Persons Showers( ) Cafeteria( )
v
Other Fixtures
Design Flow(min.re uired) gpd Design flow provided 3�1j gpd
Plan Date // 4 / Number of sheets Revision Date 4
Title
Size of Septic Tank �Q® V/ '6�� Type of S.A.S.
i
Description of Soil
i
F
} f
Nature of Repairs or Alterations(Answer when ap licable)
Date last inspected:
Agreement: { r
The undersigned agrees to ensure th.construction and maintenance of the afore described on-site sewage disposal system in
accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of
Compliance has been issued by this Board of Health.
Signed T L- Date (% L•(%�/J
Application Approved by / eaDate
Application Disapproved by: Date
for the following reasons
Permit No. �ao— I Date Issued �,? �L—04>'1
THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE, MASSACHUSETTS
Certificate of Compliance
THIS IS TO CERTI Y,that the On-site Sewage Disposal System Constructed ( ) Repaired Upgraded ( )
Abandoned( )by �/Yti(Q p /
" ' ,,��,,,�
at /�°CJ��'�t� Cj$ 4V,9(/ �C� has been constructed in accordance !
with the provisions of Title 5 and the for Disposal S stem Construction Permit No. 6 U C7 rl dated
Installer Designer
#bedrooms 2 Approved Bede gtt� oo �U gpd
The issuance of this pe it shall not be construed as a guarantee that the systeLll function as designe .
Date �� t) Inspector - ,
1 �J
No. ) Fee /,""al
THE COMMONWEALTH OF MASSACHUSETTS `
PUBLIC HEALTH DIVISION — BARNSTABLE, MASSACHUSETTS
]i5pogal bpgtem Corr truction Permit
Permission is hereby granted t Construct ( ) Repair ( Upgrade ( ) Abandon ( )
System located at $,5 Z&a
�v1 k l A �� f
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 thkgperna t.
Date �� (�� Approved by (( >✓
i
v� {c; r,v Sv✓� !tr S) yarCPu 7Lvr 0� �^ ( ��t
i
TO OF BARNSTABLE
LOCATION8 SEWAGE#. a
,lfrVI I
VILLAGE A�SESS R'S MAP&nPA/RCEL
INSTALLER'S NAME&PHONE NO.
SEPTIC TANK CAPACITY
LEACHING FACILITY:(type) r (size)
NO.OF BEDROOMS
OWNER ?
PERMIT DATE: 6&6 Z61 COMPLIANCE DATE: 3 v� r
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). a feet
FURNISHED BY r �'
G
r.
1- 3
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THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH _-
............OF..-.........1�'f........�.J.).`1'.(4 .........
Appliration for Disposal ork£ onstrudiun Permit
Application is hereby made for a Permit to Construct ( or Repair ( ) an Individual Sewage Disposal
System at:
............ ... ... .... ...... .�:t'.�'k� �....----•-•---_....Gor 1..... •.....................••-...
....Loc ion:Address ....... .: .� f..Z_.s............. .�5.... L.lL,,.t............................-----
ccO��wnerY // j xAd sSr-
4
- . . ................. E X. .. ........................
G.! Installer Address q
Type of Building Size Lot.. .l_.7�...._Sq. feet
.. Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder
wo
Wa Other—T p e of Building No. of persons............................ Showers
YP g ....-•....................•- P ( ) — Cafeteria ( )
dOther fixtures .----•--•-•.................................•-•----.._......--•---•--•----......---•---...._..__......---...-•-
W Design Flow...........,ll.(,?.....................�allons per person per day. Total daily flow---........_.. 3Q. .-_--.....--gallons.
WSeptic Tank—Liquid capacity. ........gallons Length.__8.�. . Width:�g._-__ Diameter________________ Depth._. ..1�
x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft.
i
Seepage Pit No__________ _____..... Diameter...../P........ Depth below inlet.......��__........ Total leaching area._Z.7.A, sq. ft.
ZOther Distribution box ( ) Dosing tank ( )
p/
Percolation Test Results Performed by............/%1.__.��T,�i�� ................... Date.....
,��.C1E�.........
1.4 Test Pit No..l... ...minutes per inch Depth of Test Pit.... __. Depth to ground water.......
Test Pit No. 2...-,5.-.m?—.-minutes per inch Depth of Test Pit....e _(.. Depth to ground water...... -6_
c� ............. - -----------------•---•- .....................................
O Description Soi .' ......1C1��=_ .............
"._.::ly. l?....
................................................................••----------._._..___......-----.._......------•-•--_-----•---._..............---•._ ...._. .........
U Nature of Repairs or Alterations—Answer when applicable......................................... .5.........................................2
Aft t. .......
`The tt ersi gees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provislo :I'L LZ 5 of the State Sanitary Code—WThhendersigned further agrees not to place the system in
operation until a Certificate of Compliance has bee i sue d of health.
Signed... d. ... . ................. . 7............................... .t .._....
ate
ApplicationApproved By.............................................................................•--...............--- ........................................
Date
Application Disapproved for the following reasons:.......................................a....................................................................
••..................................^_-_......_...J-••--•----...................---........_............:.............._-•--•-••--•----_._....._...._................._.-.......Date............_
l_ I
PermitNo.......... .v �.t ._.�.............___ Issued-.......................................................
Date
No... .... r ? `fires............._...........
THE COMMONWEALTH OF MASSACHUSETTS
_ BOARD OF HEALTH
............f �.... .........OF............ 1!6�......
Appliration for Di-sposal, Work, Zonstrurtion Permit
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System at:
Location Address or Lot No�
•..................••-••••.... .............--..... :a,•f ,- J .........................._._.....
w Owner Address
a - .. ..� ...... ............ ��: :�2.!............... ' r l°T ............................ ', . �� � /r.......................
Installer Address �Q
Type of Building Size Lot.......I...... Sq. feet
.. Dwelling—No. of Bedrooms.......................•..._._.._._._...........Expansion Attic ( ) Garbage Grinder
aOther—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�e�galIons Length.....z/L... Width: . Diameter................ Depth..d.Zr!
x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft.
3 Seepage Pit No.. ...... Diameter..... �..... Depth below inlet.._.... ..... Total leaching area..e.7K Znsq. ft.
Z Other Distribution box ( ) Dosing tank ( )
Percolation Test Results Performed by............... �� �..7frrf Date....
a ...--- -..--••-•-•-• ,........................,
e Z p Depth / . Depth ground,.a Test Pit No. 1................minutes per inch D th of Test Pit......�....... D th to ound water..............:..�`..
Get Test Pit No. 2._:55�' _..Lnutes per inch Depth of Test Pit...Z55 .. Depth to ground water.....9?/..
x _7�z 1:5a/y ---------------- ---- -----------------=---------------•--......_........................------•.........................................................
O Description of Soil......< .. �r lt�✓� J v%3 ScJ/,'. i —/S6 "� r n ..l.:r. /. •_.�, A,1,2
............... -`1,c ... f7 7 • :_/,........................................�% �!..........................' �i/F./7 .. !i.�•�'-.......... / 7
..................................•-.•----•-----•------••----•-----•••--•---•..._..•--•......................------------......-----•••-• ............................................
U Nature of Repairs or Alterations—Answer when applicable.................................. ? S � -....2-
___
Agreement�:�""�
Z--The undeZgnefdf agrees to ins'�tall the aforedescribed Individual Sewage Disposal System in accordance with
the provisions-6 A ITLZ 5 of the State Sanitary Code— The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has been i/su d/by he bda d of health.
Signed.....` /. _ ; . ......._....
'Date
ApplicationApproved By................................................................................................ ..
Date
Application Disapproved for the following reasons:......................0..•.................--•-•---••--.....----•-.......---..................................._
..................................
---• (_l,l7--. . ......-----.................----..`...................................---•--.........................•......... .Dau............_
PermitNo... •••. ------------- - Issued.•-••-•--••--.......................................................... 3
Date
i'79��•F4r:En pgrr-r nn5_�gY a.+. ♦L-.n+J.t3Pl�ilL..�E$C'3�F'!-+@�B!!'£-r'`.:v 1Zr.4 FF4 paQwna nnw e.*nn�..n,i:•z8 rr�4�-Y'ui?'iSfV�s??ttr?°i.iF,-'5f$A yq�p H.:�fi,i t.It c.A�E!�+ARrv.sw�i
THE COMMONWEALTH OF MASSACHUSETTS
. /L,\ BOARD OF HEALTH
}
1....... ... ...................OF...r. '.f.. ...........' i.' t..,..1 ..................
f9rdifutt#r of f�omplittnrr
THIS .IS TO CERTIFY,.That the Individual Sewage Disposal System constructed (Y_) or Repaired ( )
.�'+ ' In;taller / )
_ ........
. +1=
at. .......... .�........L�_.�.......... I' ..�..1.� kl.��f:' %..1..... .. ::.. .��r�............ f�� �r...��.t��......�:f.�{.!�� r_
has been installed in accordance with the provisions of TITLE 5 of_The State Sanitary Code as described in the
----_•.... dated------- ��--- a �' -�'-'
application for Disposal Works Construction Permit No.. .... ..N ti .,...........
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE........... �:�:..:'�.....................•................. Inspector....................................................................................
P..a..+'w.../+.R 8rF^:.+<::: _yr,i^W ;,tlF.!Y+Yi*tit:S'••2.r !nx+M 4i¢•r[^u Fi.M✓.N_. .'.?PM nd!:h.!re HM1 iKF<r FC.I:f.[-Acrtp!•CYOY•MYPBa.bB+A.•.w.wY.ni.
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
......... ....OF............; '��. ):..).'..t��. ...... ...............
No FE$........................
Disposal .Works Tonotructiort Permit
Permission is hereby granted........ !'f--- =`�-.`��......a!-----1., = ..`::.' ........
to Construct ) or Repair ( ) an Individual Sewage Disposal System
at No............. :.1 r t .�..' t :...'� ,j.% :''.' .... : �.�1........... . f_?.� ..{.. L.:�....
. ••... . .: ....
Street
as shown on the application for Disposal Works Construction Permit No. _�.... ... Dated..........................................
Board of Ilealth
�C:_.._...
DA ...:..:TE.. :..... �.._......
W` v
TOWN OF BARNSTABLE
L('-'.=ATION .2)Q02� /. )a" SEWAGE #
�fLLLAGE � ��S ASSESSO 'S MAP&LOT/ 2f CABS
NAME&PHONE NO.ar41c)he er. ���—���7 "
SEPTIC TANK CAPACITY
LEACHING FACILITY: (type) �i iL C� � (size)
NO.OF BEDRO M&—��
BUILDER 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 fee of leachi facility) Feet
Furnished by ' b
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8BORTOLOTTI CONSTRUCTION,INC.765 WAKEBY ROAD,MARSTON§MILLS,MA 0264D
508-771-9399 508428-8926 FAX: 508-428-9399
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION
Property Address:
Date of Inspection: r's Name:
Owner's Name and Address:
�7r
CERTIFICATION�TATF.MFNT•
I certify that I have personally inspected the sewage disposal system at this address and that the informa-
tion reported below is true,accurate and complete,as of the time of inspection. The inspection was per-
formed b n my training and experience in the proper function and maintenance of on-site sewage.
disposal tems. The System:
Passes
Conditionally Passes
Needs FurthSEytion B ie ocal Aproving Authority
Fails
Inspector's Signature: Date:_ le -719(0
The System Inspector shall submit a copy of this inspection report to the Approving authority within thir-
ty(30)days of completing this inspection. If the system is a shared system of figs 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 Department of Environmental Protection. The original should be sent to the system owner
and copies sent to the buyer, if applicable and the approving authority.
INSPECTIONSUMMARY-
A)SYSTPM PASSES:
I have not found any information which indicates that the system violates any of the failure
criteria as defined in 310 CMR 15.303. Any failure criteria not evaluated are indicated
below.
B)SYSTEM CONDITIONALLY PASSES;
One or more system components need to be replaced or repaired. The system,upon comple-
tion of the replacement or repair,passes inspection.
Indicate yes,nor,or not determined(Y,N,OR ND). Describe basis of determination in all instances. If
"not determined",explain why not.
The septic tank is metal,cracked, structurally unsound,shows substantial infiltration or
exfiltration,or tank failure is imminent. The system will pass inspection if the existing sep-
tic tank is replaced with a conforming septic tank as approved by The Board of Health.
Sewage backkup or breakout or high static water level observed in the distribution box is due
to broken or obstructed pipe(s)or due to a broken,settled or uneven distribution box. The
system will pass inspection if(with approval of The Board of Health):
-1 -
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SUBSU
RFACE RFACE SE
WAGE DISPOSAL SYSTEM INSPECT
ION FORM
PART A
CERTIFICATION(continued)
Broken pipe(s)replaced
Obstruction is removed
Distribution Box is levelled or replaced
The System required pumping more than four times a year due to broken or obstructed pipe(s).
The system will pass inspection if(with approval of,The Board of Health):
Broken pipe(s)are replaced
Obstruction is removed
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 the public health,safety and the environment.
1)SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE
SYSTEM IS NOT FUNCTIONING IN A MANNER WH
ICH WILL PROTECT
THE
PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT:
Cesspool or privy is within 50 Feet of a surface water
Cesspool or privy is within 50 Feet of a bordering vegetated wetland or a salt marsh.
2)SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH (AND PUBLIC WATER
SUPPLIER,IF APPROPRIATE)DETERMINES THAT THE SYSTEM IS FUNCTION-
ING IN A MANNER THAT PROTECT THE PUBLIC HEALTH AND SAFETY AND THE
ENVIRONMENT:
The system has a septic tank and soil absorption.system and is within 100 Feet to a surface
water supply or tributary to a surface water supply.
public
The stem has a septic tank and soil absorption system and is with�a Zone I of a p
system . .
water supply well.
The system has a septic tank and soil absorption system and is within 50 Feet of a private
water supply well.
The system has a septic tank and soil absorption system and is less than 100 Feet but 50
Feet or more from a private water supply well, unless a well water analysis for coliform
bacteria and volatile organic compounds indicates that the well is free from pollution from
the facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less
than 5 ppm
D)SYSTEM FAILS:
I have determined that the system violates one or more of the following failure criteria as defined
in 310 CMR 15.303. The basis for this determination is identified below. The Board of Health
should be contacted to determine what will be necessary to correct the failure.
Backup of sewage into facility or system component due to an overloaded or clogged SAS
or cesspool.
Discharge or ponding of efluent 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 clog-
ged SAS or cesspool.
Liquid depth in cesspool is less than 6"below invert or available volume is less than 1/2
day flow.
Required pumping more than 4 times in the last year NDX due to clogged or obstructed
pipe(s). Number of times pumped
-2-
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Any portion of the Soil Absorption System,cesspool or privy is below the high groundwater
elevation.
Any portion of a 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 I 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. If the well has been analyzed
to be acceptable,attach copy of well water analysis for coliform bacteria,volatile organic
compounds,ammonia nitrogen and nitrate nitrogen.
E)LARGE SYSTEM FAILS:
The following criteria apply to a large system in addition to the criteria above:
The design flow of a system is 10,000 gpd or greater(Large System)and the system is a significant
threat to public health and safety and the environment because one or more of the following
conditions exist:
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.
The owner or operator of any such system shall bring the system and facility intdfull compliance with the
groundwater treatment program requirements of 314 CMR 5.00 and 6.00. Please consult the local
regional office of the Department for further information.
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST
Check if the following have been done:
Pumping information was requested of the owner,occupant,and Board of Health.
_None of the system components have been pumped for atleast two weeks and the system has
been receiving normal flow rates during that period. Large volumes of water have not been
introduced into the system recently or as part of this inspection.
As-built plans have been obtained and examined. Note if they are not available with N/A.
The facility or dwelling was inspected for signs of sewage back-up.
I/The system does not receive non-sanitary or industrial waste flow.
__Zfhe site was inspected for signs of breakout.
_ All system components,excluding the Soil Absorption System,have been located on site.
_e-The septic tank manholes were uncovered,opened,and the interior of the septic tank was in-
spected for condition of baffles or tees, material of construction,dimensions,depth of liquid,
depth of sludge,depth of scum.
PThe size and location of the Soil Absorption System on the site has been determined based on
existing information or approximated by non-intrusive methods.
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SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST(continued)
✓The facility owner(and occupants, if different from owner)were provided with information on
the proper maintenance of Subsurface Disposal System
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART IC
SYSTEM INFORMATION
FLOW CONDITIONS
RESIDENTIAL
Design Flow: -gallons Number of Bedrooms: Nuiubcy of Current Residents:
Garbage Grinder: Laundry Connected To System: 9S Seasonal Use: D
Water Meter Readings,if ilable:
Last Date of Occupancy:
COMMERCIALMDUSTRIAi:
-Type of Establishment:
Design Flow: gallons/day Grease Trap Present:(yes or no
Industrial Waste Holding Tank Present:
Non-Sanitary Waste Discharged To The Title V System:
Water Meter Readings,If Available: Last Date of Occupancy:
OTHER: Describe)
Last Date of Occupancy:
GENERAL INFORMATION
l I rf
PUMPING RECORDS and source of informatii W , CO72X' _�%L' 76q's' /C)✓
System Pumped as part of inspection: if yes,volume pumped: gallons,
Reason for pumping:
TYPE(Mi SYSTEM:
, Septic Tank/Distribution Box/Soil Absorption System
Single Cesspool
Overflow Cesspool
Privy
Shared System(If yes,attach previous inspection records, if any)
Other(explain):
APP OXIMATE AGE of all c In nents,date installed(if known)and source of information:
Sewage odors detected when arriving at the site: /V-6
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SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
GENERAL INFORMATION (continued)
SEPTIC TANK: ✓
Depth below grade: rs Material of Construction: t--�Concrete metal FRP_Other
(explain)
Dimisions: 6- Sludge Depth: Scum Thickness: (�
Distance from top of sludge to bottom of outlet tee or baffle: 3 �'
Distance from bottom of scum to bottom of outlet tee or baffle:
Comments: (recommendation for pumping,condition of inlet and outlet tees or baffles,depth of liquid
level in relation t ,o 02191utlet invert, structural integrity, evidence of le age,ete.)�� 0 /CilrL
j
GREASE TRAP:
Depth Below Grade: Material of Construction: concrete metal FRP Other
(explain) — — — _
Dimensions: Scum Thickness:
Distance from top of scum to top of outlet tee or baffle:
Comments: (recommendation for pumping,condition of inlet and outlet tees or baffles,depth of liquid
level in relation to outlet invert,structural integrity,evidence of leakage,'etc.)
TIGHT OR HOLDING TANK:14-16
Depth Below Grade: Material of Construction:_concrete_metal_FRP_Other(explain)
Dimensions: Capacity: gallons Design Flow: gallons/day
Alarm Level:
Comments: (condition of inlet tee,condition of alarm and float switches,etc.)
DISTRIBUTION BOX: r/'
Depth of liquid level above outlet invert: l'"
Comments: (note ifleyel and distributio 's equal,evideiece of solids carryover,evidence of leal
pge into
or o t of box,etc.,
PUMP CHAMBER:
Pump is in working order:
Comments: (note condition.of pump chamber,condition of pumps and appurtenances,etc.)
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SUBSURFACE SEWAGE AL SYSTEM INSPECTION O
G E DISPOSAL FORM
C
PART C
SYSTEM INFORMATION (continued)
SOIL ABSORPTION SYSTEM(SAS):
(Locate on site plan, if possible;excavation not required,but may be approximated by non-intrusive
methods) If not determined to be present,explain:
Type:
Leaching pits,number:Leaching chambers, number: Leaching galleries,number:
Leaching trenches,number, length:
Leaching fields, number,dimensions:
Overflow cesspool, number:
level f ndin condition of vegetation,
hydraulic failure eve o
• n condition of soil signs of ,
Comments. ( ote co gg, g ,
etc.)"7`,L;c /� 1%/�i / -/y7.i _ '
CESSPOOLS:
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(cesspool must be pumped as part of inspection)
Comments: (note condition of soilk, signs of hydraulic failure, level of ponding,condition of vegetation,
etc.)
PRIVY: 11,16
Materials of construction: Dimensions:
Depth of Solids:
Comments: (note condition of soil, signs of hydraulic failure, level of ponding,condition of vegetation,
etc.)
-6 -
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
SKETCH OF SEWAGE DISPOSAL SYSTEM:
Include ties to atleast two permanent references, landmarks or benchmarks.
Locate all wells within 100 Feet.
(P
�s
Eo"
DEPTH TO GROUNDWATER: ,
Depth to groundwater: 3 S Feel
Method of Determination or Approximation:
-7-
FROM :dawn cape engineering ire FAX NO. :15083629880 Aug. 11 2009 09:36AM P1
/az/
Town of Barnstable
Regulatory Services
"Thomas F. Geilcr,Director
�e39• ,
Public Health Division
Thorn&%McKean,Direetor
2001%fain Street,Hyannis,MA 02601
Office: 508-862-4644 Fax; .508-790-6304
Installer&Designer Certification Form
Date: k_�0 Q Sewage hermit# C�o —X .Assessor's Map\Parccl
Designer: �UUw v�. 2 / Lusgalier:
_ .....--- -... - ---- .
Address: 93 9 Jt- Address: �"� fax 7,0,e l
Oil. a4i i Was iS5'it0d A permit t0 install a
(&L6___ (installer)
sc tic s stem at ea based on a design drawn b
p Y __. Y
(address)
�( 't h/d 4 , IQ3 dated I4
........... --. ...
signer)
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 tame..
I certify that the septic system referenced above was installed with major changes (i.e.
greater than 10' lateral.rehx;ation of'-the SAS or any vertical relocation of any component
cif the septic system) but in accordwice with State & Local Regulations. Plan revision or
certi tied as-built by designer to follow.
�H OF�1
_ DANIELn. �r
_. {ins lcr's Signature) - o�.aLA ;
s' CIVIL "'
T � No,46502
jr �A, 0181 ER�c����4
(Designer's SigitatYr� (.lttix Designer's Stamp Isere)
PLEASE RFTtJRN TO BARNS'I'ABLE PUBLIC HEAr,TH DlVI510Ni. CERTIFICA.T:F t)F
C'OMPLIANCF WILL NOT BE ISSUFD UNTIL HOTH THIS FORM A.N.n .Ati-BUILT CARD ARE
RECEIVED BY THE IIARNSTA-RI..F.PUBLIC HEALTH.DIVISION. THANK YOU.
Q:Hevlih/Septic/Designcr CertiGuiuirm}corm 3.26-04Aw;
I oI d ti TOWN-,.OF,�W,5 /V,5W/-i�.-"A55E 55OR5 M AtP LOT
20'MIN. 2 PST ►6 l ZONING : fr
Top of 'MIN- '
FOUND. 10 ZS LEAC IN FACILITY 5ETBACKS: FRONT= 51DE5= 1 S'REAR- (S
SEPTIC TANK le� DI--,T. E30X.
` ---------- — pM/nlGROUNDGOvF2—�— ---
u1 134�4SGa
GAL. q Z ;., ? �- / / ,•` Z
1� j 1. poi
1,�A.o a
SECTION- SEWAGE I 1 GOT 80 �. _ . r"- 9
e0 0 1.4-. L I 10i -
TEST HOLE LOGS DESIGN FOR 5 P5S0I?047M61/00 014PP.
TE5T 8Y: C, PERC.RATE Z-Z MIN.//N. \10
DATE : FLOW RATE 1 tOGAL./DAY/8C ' .E'J — ---- �
WITNESS U l� 5EPTIC TANK'W (I.15) Ag5s1
r �
REQ'D. SEPTIC TANK 1,900 rq ✓�_ 1 >�
�Qc IPA LEACHING FACILITY ,Qom',
5/0E WALL I 011(p -G/U
l VA0+ eorroM Wit:, ZB,S (1,o)- 1$.6GIo
5U6 p �e TOTAL 7,(07,0 5F. 1 CXID / 1�
' USE OL115 LEACHING ell
IIA1JI X (d Ems. OCE71-0, D_
VIOL
SAQD
NOTES �\ �
I. DATIAJ(MSL)t TAKEN FROM QUADRANGLE 1yAP \
2. MUNICIPAL WATER 14,7 AVAILASLE
it Q 3. DE516N LOADING FOR ALL PRECAST WITS:AASNO-R-ID-44 \ -�-`�
0 + 1a�D 4. PIPE JOINTS SHALL OF MADE 1JA7ER T1614T. / ✓�D
5. CONSTRUCTION DETAILS TO BE 1N ACCORVANCE y,IITH
uc W'af-�7v- COMM.OF MA55. STATE ENVIRONMENTAL CODE T1TCE 'Z �-10� �----
E ro. TH15 PLAN FOR PROPOSED IJORK ONLY A14P 5r/ov-o AIOT
.OF O
8E USED FOR PROPERTY: LW. STAKING. '
' t"cq0 WEI WetF v—TD NageZ1e� SGfv,M.1 EL
ce/cl►FY C,oUSTrIu CItto o . Ems. n To OF_ 2ENl0V EV A.1.10
'e.�Gt.�n w� ME1D. Sa�..t✓�
�M of � OF -pIZ Ifs' Aeo to L)E� 10 • =-SITE ...AND.-,-5EIJAGE PLAN
so ARNE y r ARNE �cy�,�, (yow 7 cape, eYIC�lnee/'/nCJ LE�sEND: x 1 —__— LOC�/5 : LOt St ti I L L N 1,1
JALA H. = CIVIL ENGINC-6RS CONTOUE5 (E 5r)
C?� --- --- LAND SUR�/EYDRS
II (PRof'•)'�"�—" REFERENC'E:
CIv L OJALA CONC.BOUND . CB PREPARED FOR:#26348 �/
.E rr i'k gzro Main st.YQrrrTovth,MlCl TEST KOLE
�' 10MA1
board of health SCALE : /"_ 5z PATE 7171, i
JOB NO. = APPROVED: DATE: BA ��T _G ,MA
�/. 1->I la I 8C�
1tr
f
II TOWN MAF'W LOT
•� ZO'MIN. 2 PEAS 1f ZONING :
TOP OF S I '
FOUND. IO'MIN. SETBACKS: FRONT= 5/DF-go SREAR=
SEPTIC TANK l� p1-�T. BOX. ZS LEAC IN FACILITY
� >✓l'MIN GROVrVD GovE2
1� '(o I OoOGAL. ,qz c
SECTION- 5EG4AGE ,f ► I GOT
14FA51A.1c / �v pox
TEST HOLE L065 DESIGN FOR 3 13tiri COO 14sIwo plaw i'
TEST eY: PERC.RATE
DATE : FLOW RATE 1106AL./DAY* Cl
W/TNE55: !J,EAV�T�Kl 00tA 5EPT/C TANK 150 (I.ti) Qq5 G
�0�✓Z -REQ'D. SEPTIC TANK
S
�Qc �PJ LEACHING FACILITY
-lam 510E WALL (2,5 )_ 411.z- wD
- LoaMt - 1,oaO+ 00rTOM WI , ME
Sue, /��r TOTAL Zfo7,O
5F.
- i:: �y
- - - - , U5E ale LEACHING Ell `•. / '
- 6L-F-A I = M�� 10'OFF. 'DAM Y- <' er--r-. DEPTH
(yv,
�O
-' �i►.1 E. -' ,� � � cal
20 q106
6AQD I
NOTES
1. DATUh1(HSL)r TAKEN FROMAt.li.i15 QUADRANGLE MAP \ \ f
2. MUN/C/PAL \— WATER I� AVAILABLE �� .`,♦ �`L`
II I IG��i�� S. DE516N LOAD/MG FOR ALL PRECAST UIJITS:AAS140'
i5�p Iq ,10 q. PIPE JOINTS 5"ALL BE MADE WATER TI6H7, / ✓��
5, CONSTRUCTION DETAILS TO BE/N ACCORDANCE WITH \ ♦� / P��
kt4TE� COMM.OF MA55. STATE ENVIRONMENTAL CODE TIME s[
F*1 0uMTEV_f_�D ' 6. TH15 PLAN FoR PROPOSED."RK ONLY AND 540UL0 A/OT
STAKlW
o f
BE USED FOR PROPERTY° L1J. G. ✓ � /
vel-A 124" E-L�t etv_-o I ALL uksu ITAPx.e Ncw_ej eA_ SeTv.3eE*1 fry .1'60.V
G�rZ't�>FY C,Ex12-t�.i.t tr-rtoal . o- To gE MEV
tN lop N OF -OIZ � keoiuoG� x«tc - TE ...AND-:':$EIJAGE PLAN
i� ARNE ARNE �cyG,l, down cape englneerrinq LECJENO: —.-_- LOCUS : LOr �(ti I 1 Lt_ �N 5
JALA H. �, CIVIL ENGR-JEERS CONTOUQS (EXIST.)
CIV L v N I _ REFERENCE:
OJALA (DROP)
� 0MUS LAND SURVEYORS CONC.80UND CB PREPARED FOR:,, {{LL
DAfr E F s1 -- ,E ,, r�T�a�° q2r Main st.YQrrnouth,110 TEST HOLE ♦ �L<" ��NV J 'I
s/OXAL E ° °�41 T►O board of heglth ` SCALE : DATE 7�7
JOB No. 85=�9 APPROVED= DATE: ��T � ,MA
ALL SYSTEM
SHALL
SYSTEM PROFILE MARKED WITH MAGNETICTAPE OR BE NOTES
(NOT TO SCALE) COMPARABLE MEANS FOR FUTURE LOCATION.
PROVIDE WATERTIGHT MIN. 20" DIAM. 1. DATUM IS APPROX. NGVD (,GIS SPOT EL.)
ACCESS COVERS TO WITHIN 6" OF FIN. GRADE CONCRETE COVERS TO WITHIN 3" GRADE
2" PEASTONE OR GEOTEXTILE 2. MUNICIPAL WATER IS EXISTING __-
\ TOP FOUND. EL. 133.1' FILTER FABRIC OVER STONE
MINIMUM .75' OF COVER OVER PRECAST 2% SLOPE REQUIRED OVER SYSTEM 133 3. MINIMUM PIPE PITCH TO BE 1/8" PER FOOT.
4. DESIGN LOADING FOR ALL PROPOSED PRECAST
BLOCKS OR UNITS TO BE AASHO H-j_Q 6
31.3' 4"OSCH40 PVC MORTAR ALL PRECAST RISERS 5�ae °ne
PIPES LEVEL 1ST 2 COMPONENTS H-10 5. PIPE JOINTS TO BE MADE WATERTIGHT. ooa ddler L
4 0, 3' 6. CONSTRUCTION DETAILS TO BE IN ACCORDANCE °
C. EXISTING _• ENDS (�) SIDES 5
10" 1000 GAL H-10qE �.
SEPTIC TANK + °°°°°°°° o 0 0 o i� o c °�` o o 0 0 0 0 >°0°0°0°0 Joe Tho on
TEE ** 129.9f* ° ° 00�� C��CJ o oo°,r a��o- Joao o°°°°°°° 310 CMR 15.000 (TITLE V.)(RE-USE ) 0 00000000 °o°°°o°° . ���QD��OODi °°°°°° 000a��oaaoa ° ° o ° O
0oO00000 0 0 0 0 0°0°0° °0°0°0°0
GAS BAFFLE ° ° ° ° ° ;°0°0°0°0 aa�aoo�aoo® 00.0. oaaa�oo�a®a ° ° 0.
° T
° ° 7. THIS PLAN IS FOR PROPOSED WORK ONLY AND
o„o_ o ° o ° o00 ° ° o ° °
N >°o°o°o°o as®aoo�c�o® 00000 aao�oa00000 ;00000000 Locus a
129.48' 129.31 0°0°0°g° . °6 °°°°°°°° 127.01 NOT TO BE USED FOR LOT LINE STAKING OR ANY
° ° ° ° °°° ° ° ° °
OTHER PURPOSE.LLLJ
6" MIN SUM
INT. DIM.
H-10 00 GAL. LEACHING CHAMBER BY ACME PRECAST OR EQUAL. 8. PIPE FOR SEPTIC SYSTEM TO SCH. 40-4" PVC.
* 3 4"-1-1 2" DOUBLE WASHED STONE � 2) UNITS REQUIRED e Lone a%
THE INSTALLER SHALL VERIFY THE LOCATIONS OF ALL / / 9. COMPONENTS NOT TO BE BACKFILLED OR Ro s�
6" CRUSHED STONE OR MECHANICAL CONCEALED WITHOUT INSPECTION BY BOARD OF
UTILITIES AND ALL BUILDING SEWER OUTLETS AND ELEVATIONS OVERALL DIMENSIONS TO OUTSIDE OF STONE: 30' x 9.83' 0G`
PRIOR TO INSTALLING ANY PORTION OF SEPTIC SYSTEM COMPACTION. (15.221 [21) fjo HEALTH AND PERMISSION OBTAINED FROM BOARD
y/. ✓ p\ OF HEALTH.
"INSTALLER SHALL CONFIRM MINIMUM SEPTIC TANK SIZE AT a
1000 GALLONS AND ITS SUITABILITY FOR RE-USE. REPLACE CONTRACTOR SHALL BE RESPONSIBLE FOR
CA LOCUS MAP
WITH 1500 GALLON H-10 SEPTIC TANK IF NOT SUITABLE. CALLING DIGSAFE (1-888-344-7233) AND
122.0' BOTTOM TH-1 VERIFYING THE LOCATION OF ALL UNDERGROUND & NOT TO SCALE
( 1.1 % SLOPE) (� SLOPE) NO GROUNDWATER FOUND OVERHEAD UTILITIES PRIOR TO COMMENCEMENT OF
LEACHING WORK.
FOUNDATION EXIST. SEPTIC TANK 36' D' BOX 16' FACILITY 11. ANY UNSUITABLE MATERIAL ENCOUNTERED ASSESSORS MAP 151 PARCEL 85
SHALL BE REMOVED 5' BENEATH AND AROUND THE
PROPOSED LEACHING FACILITY. AP DISTRICT
SITE IS OUTSIDE OF ESTUARINE PROTECTION DISTRICT
12. EXISTING LEACHING FACILITY SHALL BE PUMPED
142 AND REMOVED OR PUMPED AND FILLED WITH CLEAN
LEGEND VARIANCES FOR SEPTIC SYSTEM REPAIRS WHICH MAY BE SAND.
1q0
IMMEDIATELY GRANTED BY THE BOARD OF HEALTH AGENT OR
99 _ EXISTING CONTOUR BY HEALTH INSPECTOR
X ss.� EXIST. SPOT ELEV. PAPERWORK AND HEARING REDUCTION PROPOSALS APPROVED PRO138 ANDP. SCREEN (CHARCOAL
FILTER BY
BY THE BOARD OF HEALTH REVISED DURING A PUBLIC
99 PROPOSED CONTOUR HEARING HELD ON MARCH 10, 2009 CONSULTATION HOMEOWNER SYSTEM DESIGN.
[98.4] PROPOSED SPOT EL.
3) FAILED SYSTEMS ONLY SOIL ABSORPTION SYSTEM 136 GARBAGE DISPOSER IS NOT ALLOWED
TH1 INSTALLATIONS PROPOSED MORE THAN THREE FEET BELOW 134
TEST HOLE GRADE WITH PROPER VENTING (PIPED TO THE ATMOSPHERE) �6 DESIGN FLOW: 3 BEDROOMS ® 110 GPD = 330 GPD
Y AND WITH H-20 LOADING, BUT IN NO CASE SHALL THE SAS /� -
2� SLOPE of GROUND BE LOCATED MORE THAN SIX FEET BELOW GRADE. TH 2 /, LARGE WHITE PINE USE A 330 GPD DESIGN FLOW
NEW
UTILITY POLE TH 1 ! '
3.08, SEPTIC TANK: 3. O GPD (2) = 660
13 1' --_
FIRE HYDRANT .43 7 /�\l 133.6s **PP'-USE EXISTING 1000 GAL. SEPTIC TANK
NOTE: NOT ALL SYMBOLS MAY APPEAR IN DRAMANG --
�OO 3C95 -{�132.58 o �► LEACHING: ,
o 2. �9' C SIDES: 2 (30 + 9.83) 2 (.74) _ 118 GPD
TEST HOLE LOGS // 32.41 °' 132.61 SLAB 131. 3 GAR. BOTTOM 30 x 9.83 (.74) = 218 GPD
�' �'�/ 132- r�aP�/1
ARNE H. OJALA PE, SE 132.c�o 1 31.79 TOTAL: 454 S.F. 336 GPD
ENGINEER: / 32.40 SUN \
� ��"
DAVID W. STANTON, IRS f V-10 "^`� +� 31.17 - ROOM +1�1.70 USE (2) 500 GAL. LEACHING CHAMBERS (ACME OR EQUAL)
WITNESS: ( 1 1 + +
DATE: 6/1 09 & 6 20/09 (TEST HOLE ON 6/1/09 FAILED , \� ��� 131.98 9`vti\ +'30. WITH 2.5 STONE AT SIDES, 4 AT ENDS AND 5
SILT LOAM / JG / 131.7 \ N EXISTING 131.61 ��
< 2 MIN/INCH ) 1 DWELLING �� 13181 BETWEEN UNITS
PERC. RATE = i 11 TOP FNDN. 1 \
CLASS I SOILS NEW TH'S 1 & 2 /*1 9 /* 33.10 130.60 13�1. 6 ELEV. = 133.1' 1
11 1 �131 2 poi
l ) / `+ 31. 8 1 +'31.27,-1
P# 12577 / VED /9 13 66 _-+\ .008 132.28 +4131.78
VE /
1f D I VE
H ELEV. ELEV. / 131.63 13183 132.30 1+11 11:�g _ MA
p 133.0' p `�' 133.7' /*128.4 31.90 -F1 131.92 APPROVED DATE BOARD OF HEALTH
�1
O/A O/A / 1.Q5 1.10 +128.23
/ 1.2113
17
SL SL � -{�126. -�127.2 � -{- .27 30.
+� 10YR 2/1 10YR 2/1 UTILITY 81 �
6 4 CLUSTER +128.70 TITLE 5 SITE PLAN
B E 127.22 /'�'6 ��
LS FS I 2 +'z9.48 0 v�/ BENCHMARK
LKHEA
OF
COR CONC. BU
36" 1 OYR 5/4 130.0' 8" 10YR 4/2 / ELEV. = 132.3' t
� 8 PREAKNESS WAY �
B /0 128.63 ���j FAILED TH , E
C 0 00 LS LOT 81 Op PREPARED FOR
PERC 36„ 1 OYR 5/4 X' 'f� s o00. 20,970 SFf 16�' �Jw r
,o ARNE H. ��N °� ARNE Scy�s BORTOLOTTI CONSTRUCTION/LYDON
a OJALA
CMS C s U CIVIL
079 6348 O JUNE 23, 2009
Lfi v 7� � �P
2.5Y 7/4 �. ST off 508-362-4541
CM "2 S j S I fax 508-362-9880
F
v� Af4 // - cti downcope.com
NE H. 9G �o ARNE GN •
2.5Y 7/4 {o OJALA A N down cope enpheering, iac.
CIVIL 0 2 s civil engineers
132 122.0 120 123.7 No. 30792
NO GROUNDWATER ENCOUNTERED Scale: 1 20' a \��� ST S land surveyors
0 939 Main Street ( R to 6A)
O n_ O� 0 10 20 30 40 50 FEET DATE "r OJALA, P. ., YARMOUTHPORT MA 02675
�7 09-104.DWG(SBO)