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HomeMy WebLinkAbout0415 RACE LANE - Health 415 Race,Lane Ma stons Mills TOWN OF BARNSTABLE {„ LOCATION �//� ��4�c �i4�1/= SEWAGE# 2 0 i2 -- 2,S'I VILLAGE 141oy'5-1-al-15 /V, /j, ASSESSOR'S MAP&PARCEL I7(o — 7 INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY /500 4osal LEACHING FACILITY.(type) 0 Z2p,4/ �l ll (size) NO.OF BEDROOMS 3 OWNER PERMIT DATE: COMPLIANCE DATE: 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) ..�/f: Feet FURNISHED BY tZ �-� � , R�eE L.�Kr . . �. � � D��� i . r � � S `_ --- - ' � � � _ _ _ i •rr - -� .. �s� R f �- � S r O No. ( � Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS Yes Application for Oisposzk 6pstem Construction Permit Application for a Permit to Construct(Repair( ) Upgrade( ) Abandon( } ❑Complete System ❑Individual Components Location Address or Lot No. 4//S R#C- Owner's Name,Address�,and el.No. /��vStos/s !Wilt s �G,eT�'/� 4`Icf� s� Assessor's Map/Parcel ZJ—G - Installer's Name,Address,and Tel.No.,S-aB-y10- esi' D ner's Name Address,and Tel.No. �/asepGl7.e/3��s 97s8 ��y.��^ 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 Design Flow(min.required) gpd Design flow provided gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) - D 00 i r 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 Board of Health. Stgn Date l r� Application Approved by Date I v Application Disapproved by Date for the following reasons Permit No. 7 Date Issued --------------------------------------------------------------------------------------------------------------------------------------- No. Lc ai 511 e� _ Fee /[�O THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS Yes application for 30ispos X.0 ppslr i Construction permit Application for a Permit to Construct(e.<Repair( ) Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. 4115' A,4a .Z/¢O/ Owner's Name,Address and el.No. Assessor's Map/Parcel Installer's dame,Address,and Tel.No.Sob'y24- Designer's Name Address,and Tel.No. ✓asap U-e/ ���� q�3g /�1/_=yi�=!^ So� I111-le. Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures i Design Flow(min.required) , gpd Design flow provided gpd Plan Date Number of sheets Revision Date \ Title Size of Septic Tank Type of S.A.S. Description of Soil V I Nature of Repairs or Alterations(Answer when applicable) r - o DO •� i �/ 7 l i Datye last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in M 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. - Sign Date Application Approved by f Date 6 Application Disapproved.by - •-•r e*, H Date i for the following reasons r�, Y� f Permit No. C, Date Issued U ---------------------------------------------------------------------- - -- -- - % ------------------ ------------ -- -- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS (Certificate of CDmpliancr' THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( 4)- Repaired( ) Upgraded( ) Abandoned( )by �GIO� 42, at �Z 5 /ZW,-4 Zirr,0�1/= 11'4a Af,//S has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No-90 )a s, dated b ) Installer , /�;� �� /�, ��ry+,-p S Designer /Ji//=G/i=� sD�S• /Vl . #bedrooms ; Approved desi w �J.� C and The issuance of this permit shaall not be construed as a guarantee that the system ill funct'o esi ed. Date ( ?f I n` Inspector --------------- -------------------------- ---- ---- ---- ---------------- ---------------------- ------------------- No. G , ( Fee )U G THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS bisposal &pstem (Construrtion 3pErmit Permission is hereby granted to Construct( c.a Repair( ) Upgrade( ) Abandon( ) y System located at and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction m T(D tbe )ompleted within three years of the date of thisfperm it.Date , �- Approved`by Town ®f Barnstable "E' i.� Regulatory Services Thomas F. Geiler,Director ( � tiasysrns[Z 9� ""S& Public Health Division 039. oTra' �„ Thomas McKean, Director 200 Main Street,Hyannis,NIA 02601 Office: 508-862-464-d Fa: : 508-790-6304 Installer & Designer Certification Form Date: Sewage Permit# 6 2 Assessor's Ma \Parcel 12� 73 I P Designer: �{e 0e-r_4[ S�_4 S lt1t installer: t oS eVez /�4lr—o 7 address: JZsX I � address: S/ lAM OnG`a-fwas issued a permit to install a (date) f installer) septic system at L� V based on a design drawn by (address) v rVl Iu a I P '�� dated1 l'1 (designer) Y - 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 O.F tha distribution box ands"or septic tank. I certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or an, vertical relocation o any component of the septic system) but in accordance with State & Local Regulations. Plan revision or certified as-built by designer to follow. OF Mgss9C D ! �E o y'TE (In taller's Signature) � N 1140 hAl or- Ld.^. 'AFC/SiER``� L l� (Designer's Signature) (Affix Designer's Stamp Here) PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COYIPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS-BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU Q: Health/Septic/Designer Certification Form 3-26-04'doc I . Town of BAmstable. P# /3 26 De artment of Re atory Services P 1� 7/7A Public Health Divisio n Date 200 Main Street,Hy#nnis MA 02601 �rED M►.'f� i, Date Scheduled % ' Time [[[_� Fee Pd. I i Soil Suitability AssessM"eni fop S Disposal Performed Byt, A ��- �N�1�� Witnessed By - f,� S i LOCATION & GENERAL INFORMATION ,Q Location Address a Owner's Name P-kcvv ' M M i I ISl Address a- Assessor's Map/P4rcel: 1-26 /073 Engineer's Name�L11,.f�f NEW CONSIIZU�20N REPAIR _ Tel ephone# (� Land Use -?( rJ re1v "SL. Slopes( ® Surface Stones Distances from: Open Water Body >�0 ft Possible Wec Area `Z,00 ft Drinking Water Well htainage Way l? ft Property Linc / ft Other ft -- SKETCH:(Street name,dimcnsiods'of lot,exact locations of test holes&pert tests,locate wetlands in proximity to holes) ' I , FENCE -----—-----_—_-______ ------_-----___ZgD-bU-- •a 40T ss DRIVEWAY D + o � U,0 1.M o m POOL Uo 0 Tg o CONC.PATIO 9 e--------- ' I g9,40, /cp�K� N34'43'28'E 290.40 . I . I i I i Parent material(geologic) . it)f.10_� 61)fW A.11, i Depth to Bedrock Depth to Groundwakdr. Standing Water in Hole: i Weeping from Pit Face Estimated Seasonal i0gh Groundwater DItTERMINATION FOR SEASONAL HI Gl[T WATER TALE Method Used: I in. Depth Gb�served standing in obs.hole: n, Depth to Sall Adjustment Depth toiweeping from side of obs.hole: Itt. ©roundwntt:r tld�u Adept ! _ A ,factory_ AdJ,!]raundwnterlevdl.,,..e. Index Well# Reading Datelz Index Well level - PERCOLATION TEST Date —. xi►t�� Observation 1 Time at 9" -- Hole# 70 B I Time at 6" -- Depth of Perc f d�T✓ _ '� Time(91%6+°) Start Pre-soak Time.@ ; I End Pre-soak I a Rate MinAnch Site Failed: Additional Testing Needed(YIN) Site Suitability.Assessment: Site Passed �. Original:.Public He`tith Division Observation Hole Data To Be Completed on Back— ***If percolafiion test is to be conducted within 100' of wetland,you must first notify the ek prior to beginning. Barnstable Ni�servaticn,Di47sion at least one (1)we l I • I DEEP OBSERVATION HOLE LOG Hole Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistent %Gravel i end �d I DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. �y Consistent %Gravel) sw Ina, DEEP OBSERVATION HOLE LOG Hole# -4 Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistent %Gravel I DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency, ra I \ i I 1 Flood Insurance Rate Map: Above 500 year flood boundary No_ Yes Within 500 year boundary No Yes, Within 100 year flood boundary No Yes Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervious material exist,in all areas observed throughout the G area proposed for the soil absorption system? If not,what is the depth of naturally occurring pervl6us material? Certification I certify that on (date)I have passed the soil evaluator examination approved by the - Department of Enviro 'mental Protection and that the above analysis was performed by me consistent with 1 the required ing xpertis and experience described in 3:10 CUR 15.017it ' Signature - � � Date 2 Q:\.SEPTIC\PERCFORM.DOC it � rr T� �\ COMMONWEALTH OF IN ASSACHt•SETTS � 8 EXECUTIVE OFFICE OF E.NmRONMENTAL AFFAI A 10 •' DEPARTMENT OF ENVIRONMENTAL PROTE ON � 'C�ivEpVIA iF51 ONE HINTER STREET.'BOSTON. NIA 02)O8 W-292-5500 m AUG °8 1997 WILLIAM F.WELD TRUD Cam. Govemc• A ARGEO PAUL CELLL'CCI A S U Llz Lt.Govemor SUBSURFACE SEWALE DISPOSAL SYSTEM INSPECTION FORM ommissioner PART A �J D CERTIFICATION Property Address: 4 S GC !u ray+ _ ct�J i,.a '' -(&Address of Owner: p L Date of Inspection: �/�(� y� (If different) Name of Inspector: p I am a DEP approve system ins ct r pursuant to Secti n 1" 340 of Title 5 (310 CMR 15.000) Company Name: o u 3 Mailing Address: fk,,4 ZaZ,4_ Telephone Number: 50:41/ 4 33- /4- Zo CERTIFICATION STATEMENT I certify that I have personalfv inspected the sev`age disposal system at this address and that the information reported below is true, accurate and comDlete as of the time of inspec-oo-.. The inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposa+ systems. The system: Passes _ Conc,00naliv Passes Need ;urine, Eva!u n B\ the Local Approving Authority a:, g Inspector's Signature: Date: �( The Svstem Inspector shal' submr, a copy of this inspection report to the Approving Authoritv within thim, (30) days of completing this inspection. If the system is a shared system or ha; 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 orig:nal should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. INSPECTION SUMMARY: Check A, B, C, or D: AI SYSTEM 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. COMMENTS: BI 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. Indicate yes, no, or not determined (Y, N, or NDj. Describe basis of determination in all instances. If"not determined", explain why not. The septic tank is metal, unless the owner or operator has provided the system inspector with a copy of a Certificate of Compliance (attached) indicating that the tank was installed within twenty (20) years prior to the date of the inspection; or the septic tank, whether or not metal, is cracked, structurally unsound, shows substantial infiltration or exfiltration, or tank failure is imminent. The system will pass inspection if the existing septic tank is replaced with a conforming septic tank as approved by the Board of Health. (zavioad 04/25/97) Pay 1 of 10 DEP on the world Wide Weti http.rrwww magnet.state ma.uWaec 0 Printed on Recycled Paper e � I I n 1 F SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION S ECTION FORM PART A ' CERTIFICATION (continued) 1.. r Pro nPrn Address: Owner: r. Za_.. S Date of Inspection: it_, f r, IF-At aez . gINA 10 Bj SYSTEM CONDITIONALLY PASSES tcontin„-d ,�k Zee- ge backup or breakout or high static water level observed in the distribution box is due to broken or obstructed t pipets) or due to a broken, settled or uneven distribution box. The system will pass inspection if(with approval of the Board of Health). Describe observations: broken pipe(s) are replaced obstruction is removed distribution box is levelled or replaced i 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, safer\ and the environment. 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: Cesspool or pm-, is within 50 feet of a surface water Cesspool or pnv, 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 FUNCTIONING IN A MANNER THAT PROTECTS THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: i The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet to a surface water supply or tnbutary to a surface water supply. The systern has a septic tank and soil absorption system and the SAS is within a Zone I of a public water supnly well. The system has a septic tank and soil absorption system and the SAS is within 50 feet of a private water supply well. _ The system has a septic tank and soil absorption system and the SAS 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 that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm. Method used to determine distance (approximation not valid). 3) OTHER I irevisad 04/25/97) Page 2 of 10 I i I i SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION. FORM PART A CERTIFICATION (continued) Property Address: 14 5 92-cs._cx=L I o,, , _ r e� �s �.; S. Owner. ;: -- �- Date of Inspection: DJ SYSTEM FAILS: You must indicate either "Yes' or `moo' as to each of the following: I have determined that the system violates one or more of the following failure criteria as defined in 310 CMR 15.303. The oasis for this determination is identified below. The Board of Health should be contacted to determine what will be necessary to correct the failure. Yes No Backup of sewage into facility or system component due to an overloaded or clogged SAS or cesspool. Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool. Static !tduid level in the distrjbution boa 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 112 day flov.. Reduved pumping more than 4 times in the last year NOT due to clogged or obstructed pipe s. Number of times pumped _. Am ponion o'the Soil Absorption System, cesspool or privy is below the high groundwater eievanon An, portion of a cesspool or pnv� is within 100 feet of a surface water supply or tributar to a surface water supply. Any portion of a cesspoo' or pri%� is A ithin a Zone I of a public well. Am po^ion o-*a cesspool• or pri,.1• is &ithir, 50 feet of a private water supply well Anv pon+or: o`a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable eater qualm analysis. It the well has been analyzed to be acceptable, attach cope of well water analysts for coliform bacteria. volatile organic compounds, ammonia nitrogen and nitrate nitrogen. EJ LARGE SYSTEM FAILS: You must indicate either "Yes' or "'so" as to each of the following: The iolio";ng cnter;a.apply to large systems to addition to the criteria above: The system serves a facilm with a design flow of 10,000 gpd or greater (Large System; and the system is a significant threat to public health and safer and the environment because one or more of the following conditions exist: 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 11 of a public water supply well) The owner or operator of any such system shall bring the system and facility into full 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. (revised 04/25/97) page 3 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 4 2�Ce Gam- i_ • �r• �C `I Owner:4;� � Date of Insp Lion. Check if the following have been done: You must indicate either "Yes" or "No" as to each of the following: Yes No Pumping information was provided by the owner, occupant, or Board of Health. None of the system components have been pumped for at least 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 bull,. plans have been obtained and examined. Note if they are not available with N/A. The fac.lit,, or dweliing was inspected for signs of sewage back-up. The system does not receive non-sanitary or industrial waste flow. The site .%as inspected for signs of breakout All system components, excludine the Soil Adsorption System, have been located on the site. -- _ _ The septic tank manholes were uncovered, opened. and the interior of the septic tank was inspected for condition of baffies or tees, materiai. o-' construction, dimensions, depth of liquid,,depth of sludge, depth of scum. The size and location of the Soil .Absorption System on the site has been determined based on: The facilm o%%ne• Banc occupants. )'different from owneri were provided with information on the proper maintenance of Sub-Surface Disposal System. Existing information. Ex. Plan at B.G.H. Determined in the field .r an,. of the failure criteria related to Part C is at issue, approximation of distance is unacceptable (15.3023i b'] (revised 04/25/97) Page 4 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Propert% Address: 4- ( $ Owner:' Date of Inspection: FLOW CONDITIONS RESIDENTIAL: Design floes 7-j6Qg.p.d./bedroom for S.A.S Number of bedrooms 02-) Number o-'current residents�7- Garbage g,; der (yes or no:,:AIN Laundry co.—ected to system (yes or no)�49S Seasonal use Ives or no,: Water meter readings, if available (last two i2i year usage (gpd): Sump Pump Ives or no): . Last date o`occupancy gmffiosq(Xtl X114+ COMMERCI40NDUSTRIAL: Type of establishment. Design fioN% li n- _ga o �da\ Crease trap present. Ives or no' Industna! Taste Holding lank present ves or no Non-sanitan waste discnarged to the T!tie 5 system ;ves or no_ \later meter readings if a�ailabie Las:date of o .::p2nc, OTHER: Describe Last pate of occuDanc. GENERAL INFORMATION PUMPING RECORDS and source of informatior. S!�SZwn W--X L'V�A�(ta 's►�►t� System pumped as par, of inspection: Ives or no. If yes, volume pumped eallons Reason for pumping TYQE OF SYSTEM il _ Septic tank/distribution box%scid absorption system Single cesspool Overflow cesspool Prf\,)- Shared system (yes or no) (if yes, attach previous inspection records, if any) I/A Technology etc. Copy of up to date contract? Other APPROXIMATE AGE of all components, date installed (if known) and source of information: o Uts c Sewage odors detected when arriving at the site. tyes or no)_ (revised 04/25/91; Dig• 5 of 10 l I SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: `-f� s �a e Cc+...—e / 1 c�-�-ls' 1'p �. S 1 t� S Owner: 0 Date of Inspection` Z ' ate/ 5�- BUILDING SEWER: (Locate on site plan!, Depth below grade. Material of construction: _cast iron _40 PVC _other (explain' Distance from private water supply well or suction li-t Diameter Comments: (condition of joints, venting, evidence of leakage, etc.) SEPTIC TANK: (locate on site pl n Depth below grade Material of construction: •,Iconcre:e _meta _F bergiass _Polyethylene _othenexpla n' If tank is metal. list age _ Is age confirmec o, Ce•t;f:cxe of Compuance _(Yes.! o Dimensions Sludge depth _ ►t Distance from top of sludge to bottom of outlet tee or ba^e Scum thickness_k"' _ s Distance from top of scum to top of outlet tee or ba^ie �_ y Distance from bottom of scum to bo-o^n of outlet tee er bane _ How dimensions Here determined Comments: (recommendation for pumping, cond it ion of inle• and outlet tees or baffles, depth of liquid level in`relation to dull invert, structural integrity evidence of leakage. etc.i i 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 outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping: Comments: (recommendation for pumping, condition of ii1let and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural ;ntegrity, evidence of leakage, etc.; g (r•.•is•d 04.'25:9') P• • 6 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) I Properh Address: (¢ l S /�—a c� ._ C. Owner. Date o of I spectionF�"--,— C' TIGHT OR HOLDING TANK: Tank must be pumped prior to, or at time, of inspection) (locate on site plan, Depth below grade: Material of construction. _concrete _metal _Fiberglass _Polyethylene _other(explain) Dimensions: Capacrn: galions Design floN. galions,da. Alarm level Alarm in „orking order _ Yes, _ No Date of previous pumping Comments: (condition of inlet tee, condition o• alarm and float switches, etc.) DISTRIBUTION BOX: Q (locate on site plan Depth of liquid level above ou)le: in�er� Comments: (note rf level and distribunor. is evidence of solids carryover, idence of leakage into or out f box, etc.) c;t, o PUMP CHAMBER: (locate 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.) (ravimad 04/25/97) Page 7 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: / S Z u•S P`Q L LS , Owner: F ZQr Date o ns ection: SOIL ABSORPTION SYSTEM (SAS): LkS (locate on site plan, if possible; exca.a io"n not required, but may be approximated by non-intrusive methods; If not determined to be present, explain: Type: leaching pits, number.A1v S6 leaching chambers, number: leaching galleries, number: leaching trenches, number,length: leaching fields, number, dimensio.^.s. overflow cesspool, number Alternative system name of Technology. Comments: )note;ondition of soil. signs of hydraulic failure, level of ponding, co� nory,of vege ion, tc.) CESSPOOLS: L0 (locate on site plan- Number and configura;,on Depth-top of liquid to inlet m,•er, Depth of solids layer Depth of scum layer: Dimensions ot.cesspool: Materials Of construction Indication of groundwater inflow (cesspool must De pumped as part of inspection) 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.) (revised 04/25/97) Page a of 10 , SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Properri Address: iq j S Pe .CQ S Owner:lnspe� Date orctioT SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent references landmarks or benchmarks . locate all wells within 100' (Locate where public water supply comes into house) �2 A( - qo R Z �Lk - 3$ -73 (revise: 04'25!57) page 9 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Propert% Address: Owner: L`° S Date of Insp ction: FOOL �—'- 07j-- Depth to Groundwater]L�eet Please indicate all the methods used to determine High Groundwater Elevation: Obtained irom Design Plans on record Observation or Site (Abutting property, observation hole, basement sump etc.) Determine it from local conditions Check with Iota! Board o: nealtn Cheri FE.MA neaps Check pumping records Check local excavators. installers l se L SGS Data Describe in voir own %%oral nog% \o:; e5tab!-shed the High Groundwater Elevation. (Must be completed: Izav:aed 04,25J9,. Page 10 of 10 L0 C A T ION 10t /0' �H. SEWAGE PERMIT NO. •_, //s" 9-S- � VILLAGE INSTALLER'S NAME & ADDRESS JOHN A. AALTO BACKHOE SERVICE �^ West Barnstable, Mass. 02668 ® U I L D E R OR OWNER Tao n4 ser DATE PERMIT ISSUED DAT E C 0 M P L I A N C E ISSUED w �� � � � i � r � r '`� � / / � a / I 3r � � ` • ' � i � � ' �/2 � � , , ' , ~ ' ^ �u� ` ' ' � THE COMMONWEALTH oFwAseAcHuSsrTs ' �� y /o73~- = ����J� ���� ���� ������U -���' ��=~^"" ��° �~" " "�~"~�~ " " " �����������...OF.......................................................................................... � Appliration for Application is hereby made for u Permit to Construct ()~) or Repair ( ) an Individual Sewage Disposal System at: --------------------'-'--'------'--'------'---- ---' -----------------------'- ,Owner -Add Installer Address Dwelling of8edroon,o-.-^��--.---------_—_'��puoo�m �t6c ( ) Garbage Grinder ( ) 114 Other—Type of Building -±%Jde----..-' No. of persons.......2_------------- Showers (2) -- Cafeteria ( ) `4 Other fixtures ...................................................................................................................................................... Design Flow.........'3._�....................gallons per person per day. Total daily 8onc-- ----'.gallons. Septic Tank--Liquid' ICW..gulonm Length................ Width................ Diameter................ Depth................ � Disposal Trench--No..................... Width.................... Total Length.................... Total leaching area....................sg. 8. Seepage Pit Nu.--_—._. Diameter.....................Depth below inlet.................... Total area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) ~~ Percolation Test Results Performed bv.......................................................................... Date....................................... Test Pit No. l................minutes per inch Depth of Test Pit.................... Depth toground water........................ � -Test Pit No. 2................minutes per inch Depth of Test I'iL.--.--_--- Depth to ground water........................ � P4 ... ------------------------------------------------------- - ----------------------------------- ...... ----- .... __--_-______-.- � 0 ueocrgnn000f Soil...................................................................... ................................................................................................ _----'---.— ................................................................................................................................................................................. -.............. ....................................................................................................................................................................................... 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 ' km of TL ZTi U 5 of the State Sanitary Cod The u6 ' oi further agrees to place the system in � "p=a`^^"^ until ^ Certificate= of °"`^^p^^"`"'" has been ^s"" _7~ ----------' .......................... --- Date Application Disapproved for e for1lowing reasons:................................................................................................................ m. Date .............. Ne.. .5_ sa Fux .......... THE COMMONWEALTH OF MASSACHUSETTS /;Lc/o73 BOARD OF .,HEALTH ................. ....... .....OF_...................................................................................... Appliration for Disposal Works Tonstrurtion famit Application is hereby made for a Permit to Construct (X) or Repair an Individual Sewage Disposal System at: HAt2s , .......... ToNs.................................6J. ............................................... ...... =-.�Q.h. i q ......R...' IW U . ...... .s.H. *-I-g w.... ......Or . -4Own 4. ...... .... DNVE.......ZA�VA.j. . . . .... IN.02 ...... ............. .HA. . ....... Installer Address Type of Building Size Lot......__!_ ......Sq., feet Dwelling—No. of Bedrooms-----*3........................_.._......Expansion Attic ( ) Garbage Grinder a "Other—Type of Building _EIDAE------------- No. of persons...___-.._._.._._...... Showers Cafeteria Other fixtures .................................................. ------*----------------------------------- IN'6-----Cipb ......._...all ."---------*--------- Design Flow..........S.250.....................gallons per person per day. Total daily flow............................................gallons. 1:4 Septic Tank—Liquid capacity.10.00..gallons Length................ Width........_._..... Diameter..._......__.... Depth...._........... Disposal Trench—No..................... Width............._...... Total Length..................... Total leaching area....................sq. ft. Seepage Pit No..................... Diameter.............__..... Depth below inlet..................... Total leaching area..................sq. f t. Z Other Distribution box Dosing tank Percolation"Test Results Performed by.......................................................................... Date................................... �4 Test Pit No. I................minutes per inch Depth of Test: Pit.................... Depth to ground water........................ fXq Test Pit No. 2................minutes per inch Depth of Test Pit.........._...._._.. Depth to ground water....................... ................................................................................................................................... ....*---------- 0 Description of Soil------------------------------------------- ..................... ............................................. --------------------------------------*----------------------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------*------------------------ 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 IE 5 of the State Sanitary Code—The undersigned further agrees of to place the system in operation until a Certificate of Compliance has been issued by the board of healt� .5 -7 Sign ............. ......................... .......................... Date Application Approved By----- .... .... ......4.... n$ ....... ........................ .......1.....1.6. -'s........ Date Application Disapproved for e�following reasons:................................................................................................................ .................................................................................................. ................................................................................................ Date_ ...... P-1--D--------------- Permit No Issued................... 7 Date THE COMMONWEALTH OF MASSACHUSETTS BOARD 0% IF� HEALTH 09 F............... ......0. .............. ....................................................... wrtifirate of Toutplitturr THIS IS TO CERTF,, That �at tbR­IndL*v_id_ua1 Sewage Disposal System constructed or Repaired by.............. 111.y.......................................................... .................................................................. ---------------------- ........... —e 38 Installer y� .at........r...,............................................................ ......,----------------- has been installed in accordance with the provisions of TIT LF' ,-5 of T e State Sanitary Code as de!!�rjbed 1 the application for Disposal Works Construction Permit No......................................... dated----------------------------------------------- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE.... . 1.5........ .... --- ................................. Inspector............. .............. ...&J-A.41.................... THE COMMONWEALTH OF MASSACHUSETTS BOARD 0,F19 HEALTH ot 6 ............. .....OF..........P�=&'."f—M_,I I--& 0 t.7. ........................ ..................................................................... No......................... FEE........................ Disposal I rks ftngtwdiolt "pautit .......a._­� ............................................................................................................. Permission is hereby granted '1�0 to Cotr r NRew-r idual e age Disposal tem .4— atNo........................................................... ---- Street f., k as shown on the application for Disposal Works Construction P mit No------X5 ad- ....................................... I W te - .... .. . .. ............................. Board of Health DATE'4--T----- ..... FORM 1255 A. M. SULKIN, INC., BOSTON -- FAA 4 roti u.1_.ID __1 1: :a'1,F*4:1'1�0.-r 1 1._1_ C it-li a=!h FC.1:3'T d�d" ;� i'1: :=1.._f._E3 i'l eth �. 99.6 FOR BRUCE FRASER E:L.LI:S tt THULIN, INC. lq7£I ROUTE: 6A, EAST SANDWICH, MA. OF M,�s. .c`. � 1 2ESE2VE Of fit .p DFs to W ft 28814 +I Q Oho suIRN�{ i I- �o 21 77 2L.5 8.-/ N 2�} ` P2.pP HSE HSE 5`=TF��.GIL IA 7 0 P P"KID 101.0 ,i 1.0 W 22.9 NS E SF-7MALK 22 Z- N d- Lo i 17 � � W 0; a NI i - N -- S 55" III, 32' L — Oy 4197 �� ��N l= -0- , '• w s \ SCALE DAVID G 2 --- - -- - - lav,7z - 01 C. s 1 THUUN PL.AN F E:r E;F•.'EN('E;Y L.0 i z o 391) N°• 29_9 NOT.E..'# —ALL. SEPTIC SYSTEM PIPI,NG SHALL E:E /4._.. 1)lf)_SC.III 10 _IF VC ' (1L L�SYSTE M COMP"'C)iIE:N rS, AND COi'IC;T!`il1CT I0�! .tl SAl_L ._ -- �, C,0MF'ORM TO T:I'rLE 5 CUMM. OF MASS , COT Af*"'El = '1435-60 Si C Al r_ / / /B5 A t..C,S 0.... I_.Cl r N to ._...._..__.....---.____....._.___V.._.._.—_._ SI-II::'E:T a 0F 2 T - -„`' �=,. A:__.t.-.° li•"._IL_1:__ 9:.a�'u'" ;':=��, _U._ 6:__i'•'fi C��9::_�:�,;�" IC:� i' �, d'"'U Fi:'1'1d�;_ -B'"d o 1=: L_1'W= i•® e'�e���; �- i'�� ; i''�3T L_!L $ FOR BRUCE FRA5ER t EL.L.IS R THULIN, INC. 478 ROUTE 6A , EAST SANDWICH, MA . I' DESIGN DATA*. TEST_PITS•. DATE NOV 26, 1979� STRUCTURE S:INGI_E FAMILY RESIDENCE EXCAVATOR DAILY FLOW E,.O.H AGENT MURRAY ' 3BDRM X 1_10GPD= 330GPD ENGINEER AL.AN JONE*S NO GARBAGE GRINDER _ T P N O. I� E L._ 99.- _ T P N 0. E:1. SE:_PTI_C TANI: p ---------------- _________________ 330X1 . J=:49JL_USE 10 0 0_GAIN I I-nAM G SU3SO11__ I I I PERCOLATION RATE 2 MIN/IN LEACHING ROTES I. I BOTTOM AREA 1 . OGPD/SF SIDE AREA 2.5GF'D/SF i GohnPP,4_7 I ! I LEACHING STRUCTURE ! SANr�Y ! 6'X 6'D•IA . PIT W/2' STONE BOTTOM 10 X 3.14/4 = 78 ( ( ! SIDE: 10 X 6 X 3. 14 = 188 CAPACITY POTTOM 113SF X 1 . 0= 78GPQ SIDE 2*2bSF X 2.5- 470 I I 1 total 548GFPD 141 '! -__ ! I----------------- • No wa: TOP .FND lol•U 97.5 (IT—i I 9G 95 L ! I IJ-- i 9c�•� I ! � L• S'I 97•Z i QDU i !°i bIST-. PAX i G6»3 l .W _Z.'snN�.._. . . g �! ! ! i I •. �- .•1 D I I I I I I I I 9o.3 _.._..__.__-._ _-------_--_-_..----___»__-___-__-_.«__.__-______«____ ________ -IZ ga �- OF Mq SECTION THIRD SEPTIC SYSTEM o - S' CAL l- „�io_I-10RIZ . !."'..»c-�._...PERT . eius \\ i �o.29874 a 4, `\1 F :.'�. '�, I'H E E:T 2 Or:' L MARSTONS MILLS LEGEND UPOLE PROPOSED CONTOUR F Locus o ` ® PROPOSED SPOT GRADE —— 98 —— EXISTING CONTOUR + 96.52 EXISTING SPOT GRADE 68 PLDC LANE E . , r` ' —W— EXISTING WATER SERVICE � 00 TEST PIT LOT 15 j SHUBAEL Z POND S j 70 O Exl5t. Leaching (see note 10) F -� G � LOCUS MAP Q LOCUS INFORMATION Pam' '00 ��� � PLAN REF: LCP 12034D SH.5 TITLE REF: CTF# 145508 TREE .� / O PARCEL ID: MAP 126 PAR. 73 ZONING: "RF" G FLOOD ZONE: "C" COMMUNITY PANEL: 250001-0015- C DATED:08/19/85 TREE -t HOLLY •••' �• // // " SEPTIC SYSTEM S ° - a REPAIR PLAN 66 - o �� ' -' /' LOT 16 ° ' AREA=43,560t S.F. LOCATED AT: #415 \ 6'� g' 415 RACE LANE 61, 0 TOF=69.00 LOT 56 �' , MARSTONS MILLS, MA. TBM: PREPARED FOR COR BLHD TK ss.00 o �� _ CHARLES P. , JR. & -- ' CAROL A. ANDRADE AUGUST 2, 2012 6 s PGG� �� EX15T. 1 ,000 GAL OF M 6 P��G �' SEPTIC TANK 2°G `� gsf9�y � � � A R N M. G 114 ' 9EG1sl �S 66. LOT 17 LOT 58 ' . MEYER 8c SONS, INC. GRAPHIC SCALE 30 0 15 30 60 120 P.O. B O X 981 EAST SANDWICH, MA. 02537 c IN FEET (508)362- 2922 1 inch = 30 ft. SHEET 1 OF 2 J 1452 R ,l ELEV. TOP FOUNDATION NOTE: METAL RINGS AND COVERS TO GRADE OVER ALL COMPONENTS (Existing) FINISHED GRADE (67.0) = 69.00�••�F.G.EL: 67.50 F.G.EL: 67.3 F.G. EL: 67.0 • MAINTAIN 2% MIN SLOPE OVER LEACHING AREA a .v 2" OF 3/8" DOUBLE WASHED 3/4" - 1-1/2" .• . STONE OR FILTER FABRIC DOUBLE WASHED STONE 6 i 4" SCH 40 PVC to"I 14„ 6 IINV.64.67 1 (MIPF. ®®®®®®®®®®® !' TEE'S ARE TO BE INV.64.87 ®®®�®®®®®®® :r 4" SCH 40 PVC 2 DEPTH ®®®®®®®®®®® INV.65.17 l Tq' 2 X 8.5' 4' GAS J P - EXISTING OUTLET BAFFLE PROPOSED DB 3 DISTRIBUTION BOX EFFECTIVE LENGTH = 25' INV. 65.42 INV. ELEV.= 64.00 EXISTING 1 ,000 GALLON SEPTIC TANK GAS BAFFLE TO BE INSTALLED ON ���` OF Algs39�' BREAKOUT OUTLET TEE AS MANUFACTURED BY o� DAFRE M ys ELEV.= 65.0 TUF-TITE, ZABEL, OR EQUALLY TOP CONC. ELEV.= 65.0 NOTES: 1) CONTRACTOR SHALL VERIFY ALL EXISTING N 1 INV. ELEV.= 64.0 ® 0 ®® " PIPE INVERTS PRIOR TO CONSTRUCTION ®®®®®®® 2) D-BOX SHALL BE SET LEVEL AND TRUE To '�C/$iE ®®®®®®® GRADE ON A MECHANICALLY COMPACTED SIX SANITAR�a� BOTTOM EL.= 62.0 3.75' ®®5 FT®® 3,75' INCH CRUSHED STONE BASE, AS SPECIFIED IN lw - 310 CMR 15.221(2) 3) REPLACE EXISTING 1,000 GALLON SEPTIC TANK SEPARATION 5.80 FT. EFFECTIVE WIDTH 12.5' WITH 1500 GALLON SEPTIC TANK IF FAILED, SEPTIC SYSTEM PROFILE DAMAGED, NOT H2O LOADING, OR UNDERSIZED. SOIL ABSORPTION SYSTEM (,SECTION 4) INSTALL INLET & OUTLET TEES W/ BOTTOM OF TESTHOLE EL: 56.2 - GAS BAFFLE AS REQUIRED (500 GALLON LEACH CHAMBER) GENERAL NOTES: 1• ALL CHANGES TO THIS PLAN MUST BE APPROVED BY THE LOCAL SOIL LOGS DESIGN CRITERIA BOARD OF HEALTH AND THE DESIGN ENGINEER. P#: 13704 2. ALL WORK AND MATERIALS SHALL CONFORM TO THE REQUIREMENTS NUMBER OF BEDROOMS: 3 BEDROOOM OF THE STATE ENVIRONMENTAL CODE, TITLE V, AND ANY APPLICABLE LOCAL RULES AND REGULATIONS. DATE: JULY 24, 2012 SOIL TEXTURAL CLASS: CLASS I 0.74 GPD SF 3. THE SEWAGE DISPOSAL SYSTEM SHALL NOT BE BACKFILLED PRIOR SOIL EVALUATOR: DARREN MEYER, R.S., CSE #1614 DESIGN PERCOLATION RATE: <2 MIN/IN TO IGN NSPE 11 NEER D APPROVAL BY THE BOARD OF HEALTH AND THE WITNESS: DONALD DESMARAIS, BARNSTABLE B.O.H. DAILY FLOW: 110 G.P.D. X 3 BR = DESIGN FLOW: 330 G.P.D. 4. ANY CONDITIONS ENCOUNTERED DURING CONSTRUCTION DIFFERING GARBAGE GRINDER: NO (not designed for garbage grinder) FROM THOSE SHOWN HEREON SHALL BE REPORTED TO THE DESIGN SEPTIC TANK: 330 d x 200% = 660 d, USE EXIST. 1,000 GAL. SEPTIC TANK 9P 9P ENGINEER BEFORE CONSTRUCTION CONTINUES. Elev. TP-1 Depth Elev. TP-2 Depth 5. ALL ELEVATIONS BASED ON ASSUMED DATUM. 6. THE DESIGN ENGINEER IS NOT RESPONSIBLE FOR THE FAILURE OF 67.20 0" 67.20 0" (330) = 445.94 S.F. A LOAMY THE CONTRACTOR OR OWNER TO NOTIFY THE LOCAL BOARD OF OYR SAND A LOAMY SAND LEACHING AREA REQUIRED: HEALTH FOR PROPER INSPECTIONS DURING CONSTRUCTION. 51.18 7" 51.18 1OYR 3/1 8" .74 7. WATER SUPPLY PROVIDED BY TOWN WATER SERVICE. B B USE TWO (2) 500 GALLON PRECAST LEACH CHAMBERS W/ 4' 8.ALL AREAS DISTURBED DURING CONSTRUCTION SHALL BE RESTORED LOAMY SAND LOAMY SAND TO A CONDITION AGREED UPON BETWEEN OWNER AND CONTRACTOR. 64.03 1DYR 6/8 38" 64.12 70YR 6/8 37" STONE ON SIDES & 3.75' STONE ON SIDES: 25' L x 12.5' W x 2'D 9. IT SHALL BE THE RESPONSIBILITY OF THE CONTRACTOR TO VERIFY THE C C BOTTOM AREA: 25 x 12.5= 312.5 SF THE LOCATION OF ALL UNDERGROUND UTILITIES, PRIOR TO BEGINNING CONSTRUCTION. SIDE AREA: (25 + 12.5) X 2 X 2 = 150 SF 10. EXISTING LEACHING TO BE PUMPED, CRUSHED AND REMOVED PER TITLE 5. FINE-MEDIUM FINE-MEDIUM REPLACE WITH CLEAN MEDIUM SAND PER TITLE 5 SPECIFICATIONS. PERC ® EL. 62.38 SAND SAND TOTAL SQUARE FEET PROVIDED = 462 vs. 445.94 REQ'D 2.5Y 6/6 2.5Y 6/6 DESIGN FLOW PROVIDED: 0.74(462 S.F.) = 342.25 G.P.D. vs. 330 G.P.D. req'd 11. 48 HOUR NOTICE FOR ENGINEER CERTIFICATION 12. THIS PLAN IS TO BE USED FOR SEPTIC SYSTEM PURPOSES ONLY PROPOSED SEPTIC SYSTEM UPGRADE PLAN AND IS NOT TO BE CONSIDERED A PROPERTY LINE SURVEY 13. NO PRIVATE WELLS WITHIN 150' OF PROPOSED LEACHING. 56.20 132„ 56.20 132" 415 RACE LANE, MARSTONS MILLS MA 14. NO WETLANDS WITHIN 100' OF PROPOSED LEACHING. 15. ALL PIPING TO BE 4" SCH 40 O 1/8"/Fr (UNLESS SPECIFIED) PERC RATE <2 MIN/IN. ("Cl" HORIZON) Prepared for: Andrade NO GROUNDWATER OBSERVED Engineering by: Surveying by: SCALE DRAWN ' MEYER&SONS,INC. 1, Darren M. Meyer, R.S., CSE, hereby certify that i am currently approved by MADEP pursuant to 310 CMR 15.017 MacDougal DMM • l Survey N.T.S. to conduct soil evaluations and that the above analysis has been performed b me consistent with the PO BOX981 P y requirements of 310 CMR 15.017. I further certify that I have passed the Soil Eval. Exam in October, 1999. EASTSANDW/CH,MA02537 (508) 419-1086 DATE CHECKED SHEET NO. 508362Z922 08/02/12 DMM 2 of 2 f