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HomeMy WebLinkAbout1028 RACE LANE - Health 1018 RACE LANE MARSTONS MILLS i� r 9 TOWN OF BARNSTABLE �. LOCATION /0/8 SEWAGE# 141dilal WILLAGE 1 l//� � ASSESSOR'S MAP&PARCEL ®�3 INSTALLERS NAME&PHONE NO. �r/a SEPTIC TANK CAPACITY /S�d LEACHING FACILITY.(type)06�tl� A04tX(size) NO.OF BEDROOMS OWNER r,C 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) /S Feet Edge of Wetland and Leaching Facility(If any wetlands exist " within 300 feet of leaching facility) Feet t FURNISHED BY Dpb>.J C„/ 5 y�° U{41) , dr,�' No. . �oo� l/ Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes Zipprf cation for �M aY 6p9tem Cottgt ction Permit Application for a Permit to Construct O Repair( upgrade( Abandon( ) Complete System ❑Individual Components Location Address or Lot No. loll kfQG_e Guh'G Owner's Name,Address,and Tel.No. Assessor's Map/Parcel / 14�1 09 3_ o 6 6 T y _7/4S— / 'WN Installer's Name,Address,and Tel.No. &Jr Designer's Name,Address and Tel.No. � far. t �' ��yfd;i /17i/ //1� 2)f' 62'yy-��� N'1✓q Type of Building: t Dwelling No.of Bedrooms ✓ Lot Size •�y0 — sq.ft. Garbage Grinder e Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 33D gpd Design flow provided �76 gpd Plan Date Al, 23 ��� Number of sheets Revision Date 5rp /Oj ezg Title 3 t ,�lr� !y r� lerl f /�QGt LQ%�e 14/j Size of Septic Tank P/Y'Dd G.�.G Type of S.A.S. Gr) .30 iC 5".r ­J Description of Soil Nature of Repairs.or Alterations(Answer when applicable) . 14u fw 1l ///e-,r1 yj S� 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 Boa f al Signed Date Z Application Approved by Date el — IX - of T Application Disapproved by: Date for the following reasons Permit No. OO iL CIO to Date Issued ~ I s O J�, vi No. Fee Fee v _ Entered in ` THE COMMONWEALTH OF MASSACHUSETTS computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS f 2pplication for 0i,5poal �&pgtem Cott�tr coon Permit Application for a Permit to Construct O Repair(gradeAbandon O Complete System ❑Individual Components Location Address or Lot No.�{/°Q/-? A-1 e, le,,i-e Owner's Name,Address;and Tel.No. �ishq riL YL *Assessor's Map/Parcel J. a$3- 0 6 sag: s��a-3i�r �l1191;/1s. -w,4f Installer's.Name;'Address,and Tel.No./3i,;�vl 61.)1. r Designer's Name,Address and Tel.No. Type of Building: Dwelling No.of Bedrooms � Lot Size r .7 y0 —' sq.ft. Garbage Grinder �e Other`~ Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 330 gpd Design flow provided gpd Plan Date AWE 23 Number'of sheets / Revision Date /(;2107 Title 'S t phn d lerl X X of ze n- A0,J4-i A//) Size of Septic Tank /M Gp/L Type of S.A.S. 6f 3d ft S.r 1ro••J a r 1'� r�� ftaiiv s•P/ Description of Soil Nature of Repairs or Alterations`((Answer'when applicable) / �. \Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Boa., of ealth!^ Signed AA .; � Date;„ 17 Application Approved by Date _ 11 - O f� Application Disapproved by: 0 Date for the following reasons Permit No. ��� r b Date Issued 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 / W' e at /D/l pfp« Zo.*-e /17///r -has been constructed in accordance 7 with the provisions of Title 5 and the for Disposal System Construction Permit No. adn�' `�1 Cb dated ` 12 -, /. Installer gpr /Q�j/� (�j.���iyr���,✓ Designer_ L/,) ec r 4;tKj .••••rr #bedrooms 3 Approved design flow -7 - gpd The issuance of this pe s 11 not be construed A64 guarantee that the systemRav/,/7 ctio design O Date Inspector P` II • r l v V ` No. C) 01 _ L160 Fee C� THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION—BARNSTABLE, MASSACHUSETTS ;Digpogal *p,5tpm eo 5trUction Permit Permission is hereby granted to Co struct ( ) Repair ( ) U grade ( ) Abandon ( ) System located at /Q�� � e✓ �e t �� a 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 permit. Date Approved by f FROM :down cape engineering inc FAX NO. :15083629880 Sep. 19 2007 03:50PM P1 Town of Barnstable Regulatory Services „ Thous F. GeDer,Director '�"AM Public Healtb INN"isian 0*a� Asa art` Thomas 1MCKem,Director 200 Main Street,Hyaunis.MA,02b01 Offices 50E-862-4644 Fax, 508-790-63t4 Installer& pesi ner'Cerfifiration Form Date: l / d Sevrage Permits .7(X�Assessor's IV aplParcel r Designer: "e�'7" xastallez~ TD l u' e GA'S --Cfi&f,\/ Address: f 3 Address: 4/Ej,,2 47 4&0-(�rff- oyL&- A/)V//�f� N'/�- _ On - 6�2)L, wz-z issued 2 permit 10 install a (date) (installer) �q'A sep:ic system at l rr 0/y IC6 r �` 6 based on a design drown by (additess) dated 3 D �e-rV; r4fD I certify that the septic. sys=,referenced above was installed substantially according to the design; which may include minor approved chanties such as lateral reloov�on of the distribution box and/or septic tank. cenify 'that the septic system referenced above was incallyd %Kith major changes (i.e. seater than 1 W lateral relocation of the, SAS or any vertical relocation of any component of fne septic system.) but in accordance -with State d* Local Regulations. 'Dian revision or certified as-built by designer to follow. - kAscy -_ - DANICLA. � OJALA (Installer's Signaiurd) CIVIL 4 No.46502 -GISTS r� �IU /�f SSIONAL�N (Designer's Signature) (Affix Designer's Stamp 1-lere) PLEASE RETURN; TO BARNSTABLT" PUBLIC HEALTH DIVISION- CERTII~ICAT- OF COMPLIANCE WILL NOT BE 1SSUM UNUIL BdTH THIS FORM AND AS-BUILT CARD ARE RECEIVED BY THE'BARNSTABLE T-UT LIC HEALTH DIVISION- THANK YOU. d:14ea1,JVScn6uDtsiPncr Celificatinn Form 3.26-Kdoc t , COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION ONE WINTER STREET, BOSTON, MA 02108 617-292-5500 DEVAL L.PATRICK IAN A.BOWLES Governor Secretary TIMOTHY P.MURRAY ARLEEN O'DONNELL Lieutenant Governor Commissioner MODIFIED CERIFICATION FOR GENERAL USE Pursuant to Title 5, 310 CMR 15.000 Name and Address of Applicant: Presby Environmental, Inc. 143 Airport Road Whitefield,NH 03598 Trade name of technology and model: Presby Enviro-Septic® Leaching System (Hereinafter called the "System"). The "Massachusetts Enviro-Septic® Wastewater Treatment System Quick Reference Guide" including schematic drawings of typical Systems, a technology checklist, and a System Installation Form are part of this Certification. Transmittal Number: W055433 Date of Issuance: November 21, 2005, Revised May 22, 2006, Revised June 5, 2006, Revised March 20, 2007 Date of Expiration: November 21, 2010 Authority for Issuance Pursuant to Title 5 of the State Environmental Code, 310 CMR 15.000, the Department of Environmental, Protection hereby issues this Certification to: Presby Environmental, Inc., 143 Airport Road, Whitefield,NH 03598 (hereinafter"the Company"), approving the System described herein for General Use in the Commonwealth of Massachusetts. Sale and use of the System are conditioned on compliance by the Company and the System owner with the terms and conditions set forth below. Any noncompliance with the terms or conditions of this Certification constitutes a violation of 310 CMR 15.000. r March 20, 2007 Glenn Haas, Acting Assistant Commissioner Date Bureau of Resource Protection Department of Environmental Protection This information is available in alternate format.Call Donald M.Gomes,ADA Coordinator at 617-556-1057.TDD Service-1-800-298-2207. MassDEP on the World Wide Web: http://www.mass.gov/dep ��a Printed on Recycled Paper Modified Certification for General Use Presby Enviro-Septic Leaching System Page 2 of 7 I. Purpose 1. The purpose of this approval is to allow General Use of the System in Massachusetts with the necessary permits and approvals required by 310 CMR 15.000. 2. With the necessary permits and approvals required by 310 CMR 15.000, this Certified for General Use authorizes the use and installation of the System in Massachusetts. 3. The System may be installed on all facilities where a system in compliance with 310 CMR 15.000 exists on site or could be built and for which a site evaluation in compliance with 310 CMR 15.000 has been approved by the local approving authority, or by DEP if DEP approval is required by 310 CMR 15.000. This Certification does not allow the use of the System on facilities for nitrogen reduction in a Department designated nitrogen sensitive or limited area as defined in 310 CMR 15.214 and 15.215. This Certification does not allow the use of the System with any reduction to estimated high groundwater or any reduction in naturally occurring pervious material. 4. The System is approved for use at facilities with a maximum design flow less than 10,000 gallons per day(GPD). II. Design and Construction Standards 1. The System is a subsurface unit that replaces a soil absorption system(SAS)designed in accordance with 310 CMR 15.000. The System consists of an 11 5/8-inch diameter corrugated,high-density plastic pipe with a 9.5-inch interior diameter and a length of 10 feet. The exterior of the pipe has ridges on the peak of each corrugation. The pipe is perforated with eight holes equally distributed around its inner circumference. Each hole has a plastic skimmer extending inwards. The exterior of the pipe shall have a minimum of two layers of material. The inner layer shall be a thick layer of coarse, randomly oriented polypropylene fibers. The outer layer shall be a non-woven geo- textile polypropylene fabric. The pipe shall be installed in a concrete system sand bed and surrounded on all sides by a minimum of six inches of system sand. Depth to the high groundwater elevation shall be measured from the bottom of the system sand underlying the pipe. 2. The System sand shall meet ASTM C-33. 3. Systems shall be installed with a differential venting for aeration and inspection at end of each run of pipe, section or serial bed and whenever the System is installed under impervious surfaces. The differential venting shall consist of at least two vents, one located at the end of a pipe run and a second vent at the discharge from the distribution box. Modified Certification for General Use Presby Enviro-Septic Leaching System Page 3 of 7 4. The System shall be designed and installed using distribution boxes for inspection ports. The pipe between the distribution box and the System shall be installed at a minimum slope of 0.02 feet/foot. 5. Serial distribution laterals shall be limited to no more than 500 gpd. Multi-level systems shall not be allowed. 6. The System shall be installed in a bed or field configuration, as defined in 310 CMR 15.252. The effective leaching area shall be the bottom area(length times width) of the field or bed as presented in the Company's "Massachusetts Enviro-Septic® Wastewater Treatment System Quick Reference Guide". 7. Effluent loading rates adjusted to reduce the soil absorption system by 40 percent shall be in accordance with 310 CMR 15.242. No System shall be installed with a leaching area of less than 400 square feet. 8. Systems with design flows of 2000 gpd or greater shall not require pressure distribution in accordance with 310 CMR 15.231. III. General Conditions 1. All provisions of 310 CMR 15.000 are applicable to the use of this System, the System owner and the Company, except those that are varied by the terms of this Approval. 2. All sample analysis must be conducted by an independent U.S. EPA or DEP approved testing laboratory, or a DEP approved independent university laboratory. It is a violation of this Approval to falsify any data collected, to omit any required data or to fail to submit any report required by such plan. 3. The facility served by the System and the System itself shall be open to inspection and sampling by the Department and the local approving authority at all reasonable times. 4. In accordance with applicable law, the Department and the local approving authority may require the System owner to cease operation of the system and/or to take any other action as it deems necessary to protect public health, safety, welfare and the environment. 5. The Department has not determined that the performance of the System will provide a level of protection to public health and safety and the environment that is at least equivalent to that of a sewer system. No System shall be installed, upgraded or expanded, if it is feasible to connect the facility to a sanitary sewer, unless as allowed by 310 CMR 15.004. When a sanitary sewer connection becomes feasible, the Modified Certification for General Use Presby Enviro-Septic Leaching System Page 4 of 7 facility served by the System shall be connected to the sewer, within 60 days of such feasibility, and the System shall be abandoned in compliance with 310 CMR 15.354, unless a later time is allowed, in writing, by the approving authority. 6. Design, installation and operation shall be in strict conformance with the Company's DEP approved plans and specifications, 310 CMR 15.000 and this Approval. IV. Conditions Applicable to the System Owner 1. The System is approved for the treatment and disposal of sanitary sewage only. Any wastes that are non-sanitary sewage generated or used at the facility served by the System shall not be introduced into the System and shall be lawfully disposed. 2. For new construction, the System owner initially shall size a soil absorption system in accordance with 310 CMR 15.242 to demonstrate that a conventional Title 5 soil adsorption system using aggregate, including a reserve area, can be installed on the site. The System owner may than size the soil absorption system for the System. The total area required for the aggregate system,which may include the area designated for the System, and a reserve area shall be preserved and the owner shall ensure that no permanent structures or other structures are constructed on that area and that the area is not disturbed in any manner that will render it unusable for future installation of a conventional Title 5 soil absorption system 3. The System owner shall at all times properly operate and maintain the on-site sewage disposal system. 4. The System owner shall have the System inspected annually by an operator trained by the Company and shall submit the results of that inspection, on a technology checklist, to the local approving authority. 5. The System owner shall furnish the Department any information that the Department requests regarding the operation and performance of the System,within 21 days of the date of receipt of that request. 6. No System owner shall authorize or allow the installation of the System other than by a person trained by the Company to install the System. V. Conditions Applicable to the Company 1. By January 31st of each year, the Company shall submit a report to the Department, signed by a corporate officer, general partner or Company owner that contains information on the System, for the previous calendar year. The report shall state: the number of units of the System sold for use in Massachusetts including the installation date and date of start-up during the previous year; the address of each installed System, the owner's name and address, the type of use (e.g. residential, Modified Certification for General Use Presby Enviro-Septic Leaching System Page 5 of 7 commercial, school, institutional) and the design flow; and for all Systems installed since the date of issuance of this Approval, all known failures, malfunctions, and corrective actions taken and the address of each such event. 2. The Company shall notify the Director of the Watershed Permitting Program at least 30 days in advance of the proposed transfer of ownership of the technology for which this Approval issued. Said notification shall include the name and address of the proposed new owner and a written agreement between the existing and proposed new owner containing a specific date for transfer of ownership, responsibility, coverage and liability between them. All provisions of this Approval applicable to the Company shall be applicable to successors and assigns of the Company, unless the Department determines otherwise. 3. The Company shall develop and submit to the Department: an operating manual, including information on substances that should not be discharged to the System and a recommended schedule for maintenance of the System essential to consistent successful performance of the installed Systems within 60 days of the effective date of this Approval. 4. The Company shall make available, in print and electronic format, the referenced procedures in paragraphs 3 above to owners, operators, designers and installers of the System. 5. The Company shall institute and maintain a training program in the proper design, installation and inspection techniques of its System and provide a training course at least annually for prospective designers, installers and inspectors. The Company shall certify that installers and inspectors have completed the Company's training class, maintain a list of certified installers and inspectors, submit a copy to the Department, and update the list annually. Updated lists shall be forwarded to the Department. 6. The Company shall furnish the Department any information that the Department requests regarding the System,within 21 days of the receipt of that request. 7. The Company shall include copies of this Approval and the procedures in Section V (3)with each System that is sold. In any contract executed by the Company for distribution or re-sale of the System, the Company shall require the distributor or re- seller to provide each purchaser of the System with copies of this Approval and the procedures described in Section V (3). 8. The Company shall comply with 310 CMR 15.000 and all Department policies and guidance that apply and as they may be amended from time to time. 9. If the Company wishes to continue this Approval after its expiration date, the Company shall apply for and obtain a renewal of this Approval. The Company shall Modified Certification for General Use Presby Enviro-Septic Leaching System Page 6 of 7 submit a renewal application at least 180 days before the expiration date of this Approval, unless written permission for a later date has been granted in writing by the Department. This approval shall continue in force until the Department has acted on the renewal application. VI. Conditions Applicable to Installers of the System 1. Each Installer shall install the System in accordance with Company training on the installation of the System and the conditions of this Certification. 2. No Installer shall install the System unless the Installer has been trained by the Company on installation of the System or the installation is overseen by a Company representative(s). 3. Installers shall complete the System Installation Form and forward a copy to the Company and the local approving authority. 4. The System installer shall provide the System owner and the local approving authority with a bill of lading certifying that the sand fill meets ASTM C-33. VII. Reporting 1. All notices and documents required to be submitted to the Department by this Approval shall be submitted to: Director Watershed Permitting Program Department of Environmental Protection One Winter Street - 6th floor Boston, Massachusetts 02108 VIII. Rights of the Department 1. The Department may suspend, modify or revoke this Approval for cause, including, but not limited to, non-compliance with the terms of this Approval, non-payment of the annual compliance assurance fee, for obtaining the Approval by misrepresentation or failure to disclose fully all relevant facts or any change in or discovery of conditions that would constitute grounds for discontinuance of the Approval, or as necessary for the protection of public health, safety, welfare or the environment, and as authorized by applicable law. The Department reserves its rights to take any enforcement action authorized by law with respect to this Approval and/or the System against the owner, or operator of the System and/or the Company. IX. Expiration Date Modified Certification for General Use Presby Enviro-Septic Leaching System Page 7 of 7 1. Notwithstanding the expiration date of this Certification, any System installed prior to the expiration date of this Certification, and approved, installed and maintained in compliance with this Certification(as it may be modified) and 310 CMR 15.000, may remain in use unless the Department, the local approving authority, or a court requires the System to be modified or removed, or requires discharges to the System to cease. I I F , Section J Venting Requirements General rule Low and high vents are required of all systems to ensure that air is drawn completely through the entire Enviro-Septic° system. No additional vents may be located between the high vent and low vent. The opening of the high vent must be at least 10 feet above the opening of the low vent. High vents must provide at least the same flow capacity as low vents. Connections within the system must also have similar flow capacities. Purpose: Venting design, installation, and maintenance must ensure that every linear foot of Enviro-Septic°pipe in all serial beds, sections, or lines receives oxygen to accommodate natural biologic activity. Low vent Low vents are installed through an offset adapter at the end of each locations . serial system or bed • section of a combination system • line of a distribution box system. High vent High vents are installed in a variety of locations based on the system design. locations • The roof vent will function as the high vent if there are no pumps, restrictions, or other vents between the low vent and the roof vent. • If a restriction is placed between the low vent and the roof vent, a high vent is required through an unused distribution box outlet. • In pumped systems a high vent is required through an unused distribution box outlet. High vent on This diagram shows a high vent installed in a D-Box. This configuration is D-Box required in pumped systems or when other restrictions or vents are installed between the low vent and the roof vent. DIFFERENTIAL VENTING (TYPICAL-NOT TO SCALE) HIGH VENT MIN.10, SUPPORT LOW VENT FINAL GRADE D-BOX Continued 33 :SEP `s (/ I tl EED TROY WILLIAMS 3 1996 0SEPTIC INSPECTIONS H DCPT. TM ARNSTABLE Certified by MA Department of Environmental Protection (508) 760-1819 40 Old Bass River Road South Dennis,MA 02660 1iCommonwealth of Massachusetts /;=Z1OFV Executive Office of Environmental Affairs Department of Environmental Protection WUlsam F.Weld Trudy Coxe Gowmw Argeo Paul Celluccl e.cnury LL Governor David B.Struht C4rrwNw10ner SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION Property Add.- 10 18 1201 c 4- /41"- sAN' /Lt: i I s [/ Address of Owner. Co'-/N h 2 7G ilto,,✓l Date of Inspection: 611a 9 /4 G (If different),.o �ores lid Name of Inspector.� - tt�� W� 1 �i�.-w,jr o�a Company Name,Address a�hd Telephone Number. ado S 1 /A/ Al d�983 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on-site sewagedisposal systems. The system: V Passes Conditionally Passes Needs Further Evaluation By the Local Approving Authority Fails Inspector's Signature �J / DateAwl The System Inspector shall submit a py of this inspection report to the Approving Authoritywithin inspection. If the system is a shared m or has a des' flow of 10,000 or an (the days of completing this system design 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. INSPECTION SUMMARY: Check A, B,C,or D: A] 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. B1 SYSTEM CONDITIONALLY PASSES: k/1,9 One or more system components need to be replaced or repaired. The system,upon completion of the replacement or repair,passes inspection. Indicate yes, no,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 enfiltration,or tank failure is imminent. The system will pass inspection if the existing septic tank is replaced with a ponforming septic tank as approved by the Board of Health. r (revised 11/03/95) 1 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (oontinued) Property Address: Owner. e 4-o, Date of Inspection-: B]SYSTEM CONDITIONALLY PASSES (continued) Sewage backup 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): broken pipe(s)are 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: NI-� 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 WHICH 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 FUNCTIONING 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. The system has a septic tank and soil absorption system and is within a Zone I of a public 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 that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 6 ppm. 3) OTHER (revised 11/03/95) 2 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: /Q Owner. Date of Inspection: �� D) SYSTEM FAILS: Nl 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 effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool. Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool. Liquid depth in cesspool is less than 6"below invert or available volume is less than U2 day flow. Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped Any portion of the 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 eoliform bacteria, volatile organic compounds, ammonia nitrogen and nitrate nitrogen. El LARGE.SYSTEM FAILS: /JI,y The,following criteria apply to large systems in addition to the criteria above: The system serves a facility with a design flow of 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 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 11/03/95) 3 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: O t Owner. Date of Inspection: ��aq /9b 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 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. IV14 A.built plane 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. ZThe system does not receive non-sanitary or industrial waste flow ZThe site was inspected for signs of breakout. All system components, excluding the Soil Absorption System, have been located on the site. /JL4 The septic tank manholes were uncovered, opened, and the interior of the septic tank was inspected for condition of baffles or tees, material of 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 existing information or approximated by non-intrusive methods. ZThe facility owner(and occupants, if different from owner)were provided with information on the proper maintenance of Sub- Surface Disposal System. (revised 11/03/95) 4 f SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: /6 <a c,e- L.. Owner. Date of Inspection: YGGh RESIDENTIAL- FLOW CONDITIONS Design flow:�ns Number of bedrooms; 9 Number of current residents:02 Garbage grinder(yes or no):_tVb Laundry connected to system(yes or no): S �drr w a h Seasonal use(yes or no): Y'e S Water meter readings, if available:_ 9 6 = 8 oJJ //6., S Last date of occupancy: O Lc.✓� COMMERCIAL/INDUSTRI .L:/1/1,i4 Type of establishment: Design flow:_--gallons/day 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: OTHER: (Describe) Last date of occupancy: GENERAL INFORMATION PUMPING RECORDS and source of information:j /Uo f4un+� ��.. r'L c a✓� a✓a.1 4.10�c System pumped as part of inspection: (yes or no) If yes,volume pumped: gallons Reason for pumping TYPE OF SYSTEM Septic tank/distribution box/soil absorption system Single cesspool (I C -Ss/.as I + l dryW�l(� . Overflow cesspool Privy Shared system(yes or no) (if yes, attach previous inspection reoords, if any) Other(explain) APPROXIMATE AGE of all components, date installed (if known)and source of information: �r I u, i a /9 y,2 Sewage odors detected when arriving at the site: (yes or no) �d (revised 11/03./95) b SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C I SYSTEM INFORMATION(continued) Property Address; Owner. Ye-} 01 Date of Inspection: SEPTIC TANK:_N119 (locate on site plan) Depth below grade: Material of construction:_concrete_metal_FRP—other(explain) Dimensions: Sludge 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: 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 to outlet invert,structural integrity, evidence of leakage, etc.) GREASE TRAP:. /Q (locate on site plan) 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: 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 to outlet invert,structural integrity, evidence of leakage, etc.) (revised 11/03/95) 6 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: lo t X-,L e- 4 h . Owner. Date of Inspection: 8/� i TIGHT OR HOLDING TANK /NI,9 (locate on site plan) Depth below grade: Material of constriction:_concrete_metal_FRP_other(explain) Dimensions: Capacity: ¢allons Design flow:_ gallons/day Alarm level: Comments: (condition of inlet tee, condition of alarm and float switches, etc.) DISTRIBUTION BOX:/J�, (locate on site plan) Depth of liquid level above outlet invert: Comments: (note if level and distribution is equal, evidence of solids carryover,evidence of leakage into or out of box,etc.) PUMP CHAMBER,A//4 (locate on site plan) Pumps in working order:(yes or no) Comments: (note condition of pump chamber,condition of pumps and appurtenances, etc.) (revised 11/03/95) 7 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: a �a e L h , Owner. UC ��N Date of Inspection: 7 SOIL ABSORPTION SYSTEM (SAS):_V (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: Ovadew cesspool, number:_L Sep•.-�.�e drr t-e It Aar /Comments: (note condition of soil, signs of hydraulic failure, level of ponding,condition of vegetation,etc.) Lu.+•. ✓ dS ho�- r,S _ .er [�u t+�t 61.J to G✓. r W t,/ j,J J�/ �dl ✓r.�. l 1 0 .n ,/�ci O H. G � o L w o !.� d !�✓' t G O J I� 0-F- �. �'�-t.v vh. N .d 1�•.o v � G cti 1/ --�" r+ 5'i 2 tt o� C� y v ) eJl•y t�.I G � i f w�P.-v�. G c�e� X 6 � a( :� w, fo�.- �ti� ar`, or i f, , r,w u�( e_r .cEssPooLs:i/ (locate on site plan) Number and configuration:tion: 6 H c- I2,o•h S�� L G G S-Soo a ( . Depth-top of liquid to inlet invert: $ Depth of solids layer. AID)VC Depth of scum layer -.Al Dimensions of cesspool: { -G!° X 7 r C&64,. Materials of construction:_ C e-S 6r: c,k Indication of groundwater: /VO A if inflow(cesspool must be pumped as part of inspection) G'eS S o d o` S d h A s ( 0 u �-c✓ ovti S ctip, -✓' Comments: (note condition of so' signs of hydra 'c failure, level of ponding, condition of vegetation, etc.) 0:ina .< �. vc� N!or A- oratG6— G.J Gc_s S p>a Lv a 5 /�i iJn ti r y uI✓'7 o h b-► S�o� y PRIVY: A///9 / (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 11/03/95) 8 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: /D/ 9 f�a�� L, . Ownec: Date of Inspection: ye-IL kil�`0 SKETCH OF SEWAGE DISPOSAL SYSTEM: indude ties to at least two permanent references landmarks or benchmarks locate all wells within 100' i3a�k. /,;t0.;� �jo-r4-f� L DEPTH TO GROUNDWATER Depth to groundwater: — feet adjusted high groundwater levelI method of determination or approximation: /-A;0 rN c S % Jild,1-e- o �. N 7 w hn %/� . tz,yN-• tYk ✓O e I L, (�✓G/ 0, PCs. a PC,-. O L-cL 4�. CA 1e-.J v� 9 OR • ASSESo W No. - lJ�r' _. P ,nn� !1 - Fee---� _---------------- --- --== BOARD OF HEALTH t TOWN OF BARNSTABLE •1(�/ Apphcation-*rVell Cootruction Permit Application is hereby made for a pe it t ns ct (Alter ( ), or Repair ( )an individual Well at: / o/Location — Address Assessors Map and Parcel Owner �y Address ------------- Installer — Driller AcXrjss Type of Buil mg Dwelling --- ---------------- Other - Type of Building - No. of Type of Well=J _ — - Capacity---- Purpose of Well----- --- ------ — Agreement: The undersigned agrees to install the aforedescribed individual well in accordance with the provisions of The Town of Barnstable Board of Health Private Well Protection Regulation - The undersigned further agrees not to place the well in operation unti Certi 'cate ce has been issued by the Board of Health. Signed date Application Approved -z"-kv6 date Application Disapproved for the following reasons: ------- ---------- ------- -- —______-----____—_------date --- �A r Permit No. �`y r��-� � �- — Issued-----�----- -------- -- ----- date BOARD OF HEALTH TOWN OF BARNSTABLE Certificate Of Compliance THIS IS TO CERT That the Individual Well Constructed ( Altered ( ), or Repaired ( ) by -- Installer at--1 U' CT /? --_—_---- -- -- --- -------------- has been installed in accordance with the provisions of the Town of Barnstable Board of Health Private Well Protection Regulation as described in the application for Well Construction Pwit Co. ------------Dated--------�� � THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORY. DATE--- Inspector a Fee--� ----- BOARD OF HEALTH TOWN OF BARNSTABLE - 0pplicat ion-for Vell Congtruct ion Permit Application is h by made for ape it t ons ct (✓), Alter ( ), or Repair ( )an individual Well at: l Location — Address Assessors Map and Parcel / Owner _ ---- _--__-- Address Installer — Driller Ad ress Type of Bui ding Dwelling _---- ------ -- l Other - Type of Building--- _________ No. of Persons-------------------_—_______ i Type of Well Capacity-- Purpose of Well-.- —___-- —__-- Agreement: The undersigned agrees to install the aforedescribed individual well in accordance with the provisions of The Town of Barnstable Board of Health Private Well Protection Regulation — The undersigned further agrees not to place the well in operation uW,,aCert c to �o p ' , ce has been issued by the Board of Health. Signed — _— ---- ------- -� date Application Approved en� � date Application Disapproved for the following reasons: -- --___. -- -- --------_________-------__--_______-- /,�! �� date Permit No. �'�/ 6_v� ' -- Issued "�� - ®1 ---------- date BOARD OF HEALTH TOWN OF BARNSTABLE Certificate Of Compliance f , THIS IS TO ERT a the I dividual Well Constructed (� Altered ( ), or Repaired ( . ) —_—_---------------------------------- - -------___—_------- Installer a � /1,¢ce_ �,✓V _ has been installed in accordance with the provisions of the Town of Barnstable Board of Health Private Well rotection Regulation as described in the application for Well Construction P it o. -------Dated----- ------ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORY. DATE---- —- —— Inspector------ —- ----- —----—- BOARD OF HEALTH TOWN OF BARNSTABLE .well Congtruct ion Permit �!/` l�d ��" ,�y Fee— No. -- — ��C,/_ � Altery granted p ---- -----_---------------- Permission is hereby to Construct ( � ( ), or Re air ) an Individual Well at: No. --/jazir Xf-c"e . street i as shown onthe application for a Well Construction Permit No._ _ '�.✓ . --_ Dated ----- —�+ -..----- DAT.E - '�` ��., — Board of Health nn TOWN O,FnBARNSTABLE N )U 15�R�C� L4A) F- SEWAGE # ',S`5,AGE �l S7nks A PIS ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY: (type) (size) NO.OF BEDROOMS BUILDER Ol�`� /v/ID��I G PERMTTDATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by Zs'6`' ceg6jo�e 'fown OI Mariis e P tablit SEA 18 ENtro � pep Department of Health,Safety,and Environmental Services a� Public Health Division Date 0 367 Main Street,Hyannis MA 02601 ! BARN MOM AM . �lEbtAKI� Date Scheduled > �� I0 ) .Time � 0 Fee Pd.. r " Soil Suitability Assess»le>fit for Sewage Disposal Performed IIy.. 7DA N(E L (,, 1 ` A ` � :. Witnessed By: T�( 'tC11; t1EIZ , T1 �1tt11 `ttN... : . . .. ... Location Address Owner's Name �TGVC-N 1315 F+�('rLl L A n1& L AANC .7 AA,M Address —PowN CAPE E3�1G W InI Assessor's Map/Parcel: g -J l t t D O 3 00 F' Engineer's Name q P\A NtJ SS po(t7- NEW CONSTRUCTION REPAIR Telephone# Land Use Slopes(%) ©"` { Surface Stones' NOM tl— Distances from: Open Water Body R Possible Wet Areat`_0/A R Drinking Water Well )60 R Drainage Way R Property Line s ` )^ R Other ^— R SKETCH:(Street name,'dimensions of lot,exact locations of test holes&perc tests,locale wetlands in proximity to holes) ;;ate o- 55 t} 110 WOOD —� 2r-olopP i� 1 .-7 0 A`-r'�S I L-col-) /gyp 70, �• L/F\A�_ W V � �C_Et_.HrParent material(geologic) r_L_Ar Depth to Bedrock Depth to Groundwater: Standing Water in Hole: 11J11 ' Weeping from Pit Face IVAA Estimated Seasonal High Groundwater N 0 6rL&J"J*PWAt=Tr—Y1t­-T-OVND :.::.... .........:...:....;:..,...: ........::....:.....:.......,....:.;....::.:...:..::....:.:.: .......;;;;:.;...... >.<::: t; EITATICJi: ':U.Yt.SASUACH..:......::..::::::::.:::::::::::::::::..::.:::.:::::::.:..::::::::::::... ... ::> . . .Me t h od Used: Depth Observed standing in obs.hole: Z A in. Depth to soil mottles: in. Depth to weeping from side of obs.hole: in. Groundwater Adjustment IVIII R. Index Well N___"_•_ •Reading Date: Index ell level...__ Adj.factor Adj.Gro nd stet]Level `;: . I'ER "C11LATC��'�1 TEST « '>? '<Ufl<> . .... .1..ribs ...Iv:::..:.;... Observation Hole H �2 a Time at 9" Depth of Perc Time at 6" Start Pre-soak Time Q 0` Time(9"-6") End Pre-soak ;yv 5tC- 6 A•L- Rele Min./inch Pj�J(L� L 2 M Ito 4IN L, Mt r� �0 -6 � Site Suitability Assessment: Site Passed Site Failed: Additional Tes(ing Needed(Y/N) A V Original: Public Health Division Observation Hole Data To Be Completed on Back Copy: Applicant oft; 2EN�ov�' vNSu v-)? t - Soft_ `7,5 Ss DC--ml _Tb� u-cAN SAND A C Ott: UI3R' AYbl � (1 HnlC:# 1 . I Depth from Soil Florizon Soil Texture Soil Color Soil Oilier Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Doulderes. % a !L3/1 t 2 G V r714T LoAN� 2=5y �'� ' T 3 ':_ ,[.01�5 SANDY LAW 2.5Y5 3 3��0 UNSu1T11 31l.!✓ 5APb '2 ....... .-. ...-... .. ............. ... ........ DELP UBSER VA�. ...... T1.0N H0LE L�DG _Hole## .. Depth,from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Ioulderes. % 72.- 10" 5A01 LVWA 2-�1 5/3 Q5 0'b6V-4 -LA5Vaft-E- F-E:AWE MlG SAND 2 -5`/�l3 10% y-^Vt ... DEED U # CRVA'I' UN Y1UY.E .0 dole# Depth`frotn; Soil llonzon `Soil fcxdire "Soil Color Sail Other` Surface(tn.) _.-_.__ --(USDA) _ (�dunsell) ottling (Structure,Stones.Dot lderes I DEEP OBSE VATIOIV HALE LOG..Riol� . -. _. Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Stnicture,Stones,Doulderes. a Flood Insurance Rate Man_ Above 500 year flood boundary No Yes Within 500 year boundary No V Yes Within lo0 year flood boundary No✓ Yes Depth of Naturally Occurring Pervious Miterial Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the area proposed for the soil absorption system? Y—E If not,what is the depth of naturally occurring pervious material?_/✓//� Certification ; I certify that on NOt/ � (date)I have passed the soil evaluator examination approved by the Department of Environmental Protection and that the above analysis was performed by me consistent with the required training,expertise and experience described in 310 CMR 15.017. Signature �,`� Date 2 TOWN OF BARNSTABLE r // -2 O, I.00.ATION 1��$ �'G`�```� 6 - ��rdl SEWAGE k d°°ILLAGE AZt Te �rl& ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. &��`o�� SEPTIC TANK CAPACITY LEACHING FACILITY: (type) 2- ✓LOO 'wl� (size) NO.OF BEDROOMS ,Q f BUILDER O OWNER PERMITDATE: /���0� COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility). Feet Furnished by r 3-7�4 a � No. —G�C/� I C ` Feed ' THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Ye� PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS 21pprication for Mioozar *p.5tem Con!5truction Permit Application for a Permit to Construct( )Repair( )Upgrade(Y)Abandon( ) l Complete System ❑Individual Components Location Address or Lot No. /Ol n Owner's Name,Address and 1.No.- �s�ro�rlc- Assessor's Map/Parcel 1VQ ors, e,5 f 1,S Installer's Name,Address,and Tel.No. /// //Gbh Designer's Name,Address and Tel.No. 7 Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder(4!� Other Type of Building ANo.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow Ile gallons per day. Calculated daily flow 3 3e9 gallons. Plan Date Number of sheets / Revision Date Title f Size of Septic Tank `�5�('�l Type of S.A.S. ZlO� Description of Soil Nature of Repairs or Alterations(Answer when applicable) ziul ;h` 'Z� (MtZT�-b ' -f wl r ' J_1_eZrj,?1 'O/K Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued by this Bo xd ofHealth. / Signed Date Application Approved by Date 6 Z L G Application Disapproved for the following reasons Permit No. Date Issued Z C.'�v .�. "'� '�''.� -�-t � 5 6 �.� �s "�3� z`�.,r 1..,u§ �rii{�yr�''�^ g���•'�� -"., TOWN OF BARN STABLE. _ Q/ r LOCATION`l hS Al e `4, . dpwy SEWAGE # D�-y/Z //�� VILLAGE 1LJ04/ 97`DdLS /111-1 ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. '77/. J?� SEPTIC TANK CAPACITY I37D� LEACHING FACII.ITY:(type) W> (size) NO. OF BEDROOMS BUILDER O OWNER PERMITDATE: COMPLIANCE DATE. Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom.of Leaching Facility Feet Private:Wate poly.r SuW. ty. (� a ell and Leaching Faci'li, ny wells.exist::_ . on;site or within 200 feet of leaching facility)'. Feet .Edge of Wetland and Leaching Facility(If any wetlands exist t within 300 feet of leactung facility). Feet Furnishe:d.by o �af� h z. No. ( � Fee "1 'r.. i_ (,� .fir"L. _.�_.g. ,w THE COMMONWEALTH OF MASSACHUSETTS Entered in computer. • � Yes / PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS ZIppYication for Oigpotar *p5tem Construction Permit Application for a Permit to Construct( )Repair( )Upgrade(✓)Abandon( ) LMComplete System ❑Individual Components Location Address or Lot No. 1016 J6 1 ��C /� Owner's Name,Address and T .No. , Assessor's Map/Parcel t Ale tons i11,2 Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. �¢ _ Type of Building: Dwelling No.of Bedrooms Lot Size sq. ft. Garbage Grinder( lJ' Other Type of Building %/I'Ri? No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow Ile gallons per day. Calculated daily flow D gallons. Plan Date 14, /�/ Number of sheets / Revision Date Title r // Size of Septic Tank /5%1� Type of S.A.S. ��a �34/ G laO�e!4 gel Description of Soil Nature of Repairs or Alterations.(Answer when applicable) !f ' 41*, xl� 'h Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued by this Bo d of ealt. / Signed Date Application Approved by Date 6 2 L 0/ Application Disapproved for the following reasons Permit No. �y l - Date Issued Z Z o ______________ ———————— THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE MASSACHUSETTS (Certificate of (Compliance , THIS IS TO CER ,,,,that the On-site Sewage Disposal System Constructed( ) Repaired( )Upgraded( ( ) Abandoned by at 0 � °rP �'�'sJ�s� / has been constructed in accordance with to provisions of Title 5 and to for Disposal System Construction Permit No. 7.<Jv -`1 i ''dated 6 Z 7- a / Installer Designer The issuance of this p mut hall not be construed as a guarantee that the sys ill fu �,tio desi n�G4 Date 11 6 Ito Inspector No. �`�( .'... �r��----'-----------0 �'�/� ---------Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS 1=i.5poga16potem Construction Permit Permission is hereby granted to Construct( )Repair( )Upgrade(✓)Abandon( ) System located at ,/ /� �°�t' d1. !��'i'S D'�"i-S �I//1- and as described in to above Application for Disposal System Construction Permit. The applicant recognizes his/her duty to comply with Title 5 and to following local provisions or special conditions. Provided:Construction must be completed within three years of the date of this t. Date: G/Z�G� Approved by /�J s tel.(508)362 4541 939 main street rt 6a fax(508)362-9880 yarmouth port mass 02675 dOW4 Cape en fineerinl civil engineers& land surveyors structural design Arne H.Ojala P.E., P.L.S. RECEIVED Daniel A.Ojala, P.L.S. land court x surveys July 13, 2001 JUL 1 9 2001 i site planning TOWN OF BARNS[ABLE HEALTH DEPT. Thomas McKean, RS sewage system Director, Barnstable Health Department designs 367 Main Street Hyannis, MA 02601 inspections Re: 1018 Race Lane, Marstons Mills permits Dear Tom: On July 13, 2001, Down Cape Engineering, Inc. performed a soils inspection as required on the approved plan at the above-referenced location. This is to certify that- the soils removal was completed satisfactorily. If you have any questions, please do not hesitate to call e. Your truly. lam-' Arne H. Ojala, PE, -PLS Down Cape Engineering, Inc. cc: Bortolotti Construction b r i ASSESSORS MAP NO: 9 9 -o PARCEL NO: G Fee---- BOARD OF HEALTH TOWN OF BARNSTABLE Appiicat ion ArVeil Con5tructionPermit Application is 1 reby made for a permit to Construct ( ',Alter ( ), or Repair ( )an individual Well at: Location — Address Assessors Map and Parcel /Oy Address /lGCi 2 � ----------- c� 1"� /J�en �d ��ao - --------— -- �� ------ Driller - - $- - - Installer — ler Addres/ Type of Building Dwelling----=------------------------------------------------------- Other - Type of Building--------------------------- No. of Persons--------------------- YP of Well Type �� Y----------- Purpose of Well --— -- —- ----— ---- Agreement: The undersigned agrees to install the aforedescribed individual well in accordance with the provisions of The Town of Barnstable Board of Health Private Well Protection Regulation — The undersigned further agrees not to place the well in operation unt' Certificat f om iance has been issued by the Board of Health. Signed 1-t7o,-2-` - �atl Application Approved -- - - - - I date Application Disapproved for the following reasons: —------ ---------- — -- ---- ------------------------------- -------------------- date Permit No.—� ' — ---- Issued----��--�-`� Z— - date BOARD OF HEALTH TOWN OF BARNSTABLE C ertif irate ®f Compliance THIS IS C RTIFY, That the V ividual Well Constructed (Altered ( ), or Repaired ( ) . CC<,�o2 by--� --------------- ----------- Installer at /lie Z../ has been installed in accordance with the provisions of the Town of Barnstable Boar of Health Private Well Pr kecti n Regulation as described in the application for Well Construction Permit N � Dated— � THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORY. DATE-- 2 4 0-�- -- Inspector-- —------- - 0 dt�- 9 � � - No.-------------------- Fee--------------------- BOARD OF HEALTH TOWN . .OF BARNSTABLE 0(pplitatioft-*rMelt Cootrurtionpermit App ication is hvreby mad for a permit to Construct( Alter,( ); or Repair ( )an individual Well at: "Location - Address ---- — _— — Assessors Map and Parcel --- r - ------------ -----. Address Sd ?ov ---r�� -- ------- — ------ - j Installer - Driller- Address/I Type of. Building I FDwelling=--------------------------------------- -------=-:- Other - Type of Building--- ---------------------------- No. of Persons---------------------------— ---- Cy 2- - - -— — -= Ca acit - -- -------------— p' Type of Well —-- P Y-— Purpose of Well - - - --- --- -- Agreement: The undersigned agrees.to install the aforedescribed individual well in accordance with,the provisions of The { Town of Barnstable'Board-of Health Private Well Protection Regulation — The undersigned further agrees not to place the well in operation.u iance has been issued by the Board of Health. 5 �6 Signed nti Certificates f om-. ------ -- dad i Application Approved B - -- --- IF date Application Disapproved for the following reasons:. _ date Permit No. Issued f dater s -- — ` a++dl.Tw!:Toenli�:l6eiMiseTessay.�u9wCA,tr,SdPrTe9:lo48T-'e+@:RZ'Pd4reiou7�aer/r�.eases!iSierpd9n4asa%s�efa:4:e0e64�K�yvoS+lstieinle,li.!aTLeafetiJ�w:sxGea�i!!:a84i:Y..i1[6u4�4:•sY.�'. BOARD OF HEALTH TOWN OF BARN`STABLE Cert firate Of Comphance THIS IS C RTIFY,: That the V ividual Well Constructed (Altered.( ), or Repaired ( ) CC Installer s - o at- has been installed in accordance with the provisions of the Town of Barnstable Boar of Health ^Private Well Protection Regulation as described in the application for Well Construction Per NgV�Y,*w? Dated—7 THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A.GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORY. DATE—--- - — Inspector--------------- —- : ..�:4nY:ea+:+aera+ae:s':e.er:v:K� sieMcea"�R:rir�icwsw�oi,a�.'-!,�s�.:#:ta�aa�osss�s�s'a �i+io++c:s.aa.:e�w_raa�:=ra?a=��:r✓a<uss�:.raea�ars�aTc+ae:,+�ti�a.._oeYew�,:v�.r.+� BOARD OF HEALTH TOWN . OF BARNSTABLE Melt Congtruct ion 3ermit . No. Fee Permission is hereby granted to Construct (X)', Alter ( ;), or Repair,( Incid Ial We No. —/�f f -c •----- Street: - - - - - - as shown on f a !cation or a Well Construction Permit 0. Dated -{— - ---- a(, C Board of Health DATE— f f t O �G R- 1 E SYSTEM PROFILE TEST HOLE LOGS ACCESS COVER TO WITHIN 6" OF FIN. GRADE (NOT TO SCALE) ACCESS COVER (WATERTIGHT) TO ENGINEER: D.A. OJALA, SE / 9g 3' MINIMUM .75' OF COVER OVER PRECAST WITHIN 6" OF FIN. GRADE 2% SLOPE REQUIRED OVER SYSTEM GLENN HARRINGTON, RS 99.4' WITNESS: 2" DOUBLE WASHED PEASTONE \ / /01 RUN PIPE LEVEL LOCUS DATE:,5 31 (' FOR FIRST 2' PERC. RATE _ < 5 MIN/INCH PROPOSE D �� 97.47' I & II 9990 oc��`4 CC AIRPORT GALLON SEPTIC SLAB = 99.4' 97.20' 96.95' CLASS SOILS P# TANK (H- 10 ) GAS �0000 96.66' C� (� O C� 0 a [� Cl Rq BAFFLE 96.83 0 96.64' [� Q [� [] C] Ci Cl 0 4' AROUND -- Q CF �ANf --- aaao a oc� oro �o L97.40' CRUSHED STONE OR MECHANICAL o $ 2 94.64' Q� COMPACTION. (15.221 [21) 4 ELEV. Ep Q ( 2 SLOPE) ( 1 SLOPE) ( 1 q SLOPE) 3/4" TO 1 1/2" DOUBLE WASHED STONE 0" 99.4' 0" 99.3, DEPTH OF FLOW = 4 Ap Ap TEE SIZES: - 10 _ SL SL INLET DEPTH - 12" 10YR 3/2 12" 10YR 3/2 LOCATION MAP NTS 1 OUTLET DEPTH = 14" B B i FOUNDATION- 10' SEPTIC TANK 12' D' BOX 4' LEACH 'JG SL SL ASSESSORS MAP 83 PARCEL 19 FACILITY 7.34 24" 2.5Y 6/6 24" 2.5Y 6/6 Cl Cl + 99.6 SILT LOAM UNSUITABLE SILT LOAM UNSUITABLE f 2.5Y 6/3 '1 87.3' 72" 72„ 2.5Y 6/3 C2 C2 + 99.8 9 SANDY LOAM UNSUITABLE SANDY LOAM UNSUITABLE + .6 BENCHMARK - CTR OF go" 2.5Y 5/3 =` CATCH BASIN 99.4 96" 2.5Y 5/3 91 4' 91.80' EL. = 99.1' C3+ 99.7 perc C3 �g 5' REMOVAL OF UNSUITABLE SOIL M/C SAND / o REQUIRED AROUND PERIMETER OF M C SAND EXIST. BARN TH1 LEACHING FACILITY, DOWN TO 99.9 919 SUITABLE SOIL LAYER. REPLACE 2.5Y 7/3 DIRT SLAB = 99.4 �s / WITH CLEAN MED. SAND. ENGINEER 144" 87.4' 144" 2.5Y 7/3 87.3' TO INSPECT AND CERTIFY REMOVAL NOTES: \ / NO WATER ENCOUNTERED 100.4 + 99.6 / �90 m0-►,99.5 ss. SEPTIC DESIGN: (GARBAGE DISPOSER Is NOT ,ALLOWED ) DATUM IS APPROXIMATED FROM QUAD MAP 1 . ' 99.5 ._.__--_-- ----- TH + DE SIG FLOW: �'_ BEDROOMS ( 110 GPD) = 3.30 GPD 2. MUNICIPAL WATER IS NOT AVAILABLE .11 99 USE A 330 GPD DESIGN FLOW 3. MINIMUM PIPE PITCH TO BE 1/8" PER FOOT. 10 / �100.8 91 SEPTIC TANK: 330 GPD ( 2 ) - 660 4. DESIGN LOADING FOR ALL PRECAST UNITS TO BE AASHO H- 100.9/ 1 + 99,4 - 5. PIPE JOINTS TO BE MADE WATERTIGHT. a + 99.8 1 USE A 1500 GALLON SEPTIC TANK sM. -- 6. CONSTRUCTION DETAILS TO BE IN ACCORDANCE WITH MASS. / LEACHING: ENVIRONMENTAL CODE TITLE V. SIDES: / �` 0 1 15°' 1 2(25 + 12.83) 2 (.74) = 112 7. THIS PLAN IS FOR PROPOSED SEPTIC SYSTEM ONLY AND IS NOT + 99.4 + 99.2 25 x 12.83 (.74) = 237 TO BE USED FOR ANY OTHER PURPOSE. + 99.6 I BOTTOM: 8. PIPE FOR SEPTIC SYSTEM TO SCH. 40-4 PVC. I 101.6,r 101.6 EXIST. ELL TOTAL: 472 S.F. 349 GPD 9. COMPONENTS NOT TO BE BACKFILLED OR CONCEALED WITHOUT USE (2) 500 GAL. LEACHING CHAMBERS (ACME OR INSPECTION BY BOARD OF HEALTH AND PERMISSION OBTAINED 1 FROM BOARD OF HEALTH, `- r EQUAL) WITH 4' STONE ALL AROUND / 65 QO o+ 99.9 + 99.4 + 99.8/ LEGEND TI TLE 5 SI TE PLAN + 99.8 100.0 PROPOSED SPOT ELEVATION OF 1018 RACE LANE LOT 4 1 GOX0 EXISTING SPOT ELEVATION IN THE TOWN OF: / 20' ROW'S TO 74056+/- SO. FT. 100 PROPOSED CONTOUR (MARSTONS MILLS) BARNSTABLE / RACE LANE 1.70+/- ACRES / 100 EXISTING CONTOUR PREPARED FOR:O BORTOLOTTI CONSTRUCTION/BISHOPRIC ` S � / 40 0 40 80 120 BOARD OF HEALTH APPROVED DATE MA SCALE: 1" = 40' DATE: JUNE 8, 2001 of( 508-362-4541 fox 508 362-9880 �tH OfOf down cape engineering, Inc. qs � o�� ARNE y� o ARNE �� E H. CIVIL ENGINEERS OJALA 04 LAND SURVEYORS ��,� Na 28348 Na 9 939 vain st. armouth ma 02675 _ Al IA10 - F"�1 O 1 - 1 O 1 Y ARNE OJALA, P. ., S. DATE ACCESS COVER TO WITHIN 6" OF FIN. GRADE SYSTEM PROFILE NOTES LEGEND TOP FNDN. AT EL. 100.6' (SEE VENT NOTE ON PLAN) SUPPORT (NOT TO SCALE) PROVIDE INSPECTION PORT (BETWEEN UNITS) TO WITHIN 3" OF FINAL GRADE APPROXIMATE NGVD ACCESS COVER (WATERTIGHT) TO 1. DATUM IS 100.0 PROPOSED SPOT ELEVATION 100.0' R OVER P WITHIN 6 OF FIN. GRADE E M"T f 99'0' (SEE VENT NOTE ON PLAN) 2. MUNICIPAL WATER IS EXISTING 100x0 EXISTING SPOT ELEVATION 7. * FDOR�FlRSTU2' (2% MIN. PRESBY) GEOTEXTI FABRIC 3' MAX. 3. MINIMUM PIPE PITCH TO BE 1 8" PER FOOT. LOCUS 100 PROPOSED CONTOUR 97 4 PROPOSED 1a13" // 4. DESIGN LOADING FOR ALL PRECAST UNITS TO BE AASHO GALLON SE6 75' _ d 96.68' H- 10 100 EXISTING CONTOUR 97.0' TANK (H- � 6 SUMP ' AFFLE 96101� .01' �� 95.84' ENVIRO-SEPTIC PIPE 5.18' 5. PIPE JOINTS TO BE MADE WATERTIGHT. W EXISTING WATER PIT -SAND , 95.76' Race Cone ( 2.5% SLOPE) �s" CRUSHED STONE OR MECHANICAL 6. CONSTRUCTION DETAILS TO BE IN ACCORDANCE WITH COMPACTION. STONE [2]A MASS. ENVIRONMENTAL CODE TITLE V. DEPTH OF FLOW = 41 7. THIS PLAN IS FOR PROPOSED WORK ONLY AND NOT TO C P EXISTING CESSPOOL TEE SIZES: O O „ 7 18' BE USED FOR LOT LINE STAKING OR ANY OTHER PURPOSE. INLET DEPTH = �.Q_ Mys* OUTLET DEPTH = 14 ( 1 % SLOPE) ( 2 % SLOPE) 8. PIPE FOR SEPTIC SYSTEM TO SCH. 40-4" PVC. lakes 16' SEPTIC TANK LEACHING 9. COMPONENTS NOT TO BE BACKFILLED OR CONCEALED FOUNDATION 74, D' BOX 4' Ft-CILITY WITHOUT INSPECTION BY BOARD OF HEALTH AND PERMISSION BOTTOM TH-2 EL. 88.0' OBTAINED FROM BOARD OF HEALTH. LOCUS MAP 10. CONTRACTOR SHALL BE RESPONSIBLE FOR CALLING *THE INSTALLER SHALL VERIFY THE t EXISTING WELL DIGSAFE (1-888-344-7233) AND VERIFYING THE LOCATION SCALE: 1" = 2,000'f LOCATIONS OF ALL UTILITIES AND ALL OF ALL UNDERGROUND & OVERHEAD UTILITIES PRIOR TO oo BUILDING SEWER OUTLETS AND ELEVATIONS COMMENCEMENT OF WORK. ASSESSORS -MAP 83 PARCEL„WJ PRIOR TO INSTALLING ANY PORTION OF SEPTIC SYSTEM 11. EXISTING LEACHING FACILITY SHALL BE PUMPED AND LOCUS IS WITHIN FEMA FLOOD ZONE C REMOVED OR PUMPED AND FILLED WITH CLEAN SAND. AS SHOWN ON COMMUNITY PANEL #250001 0015 C DATED AUGUST 19, 1985 12. ANY UNSUITABLE MATERIAL ENCOUNTERED SHALL BE REMOVED 5' BENEATH AND AROUND THE PROPOSED LOCUS IS IN GP OVERLAY DISTRICT / LEACHING FACILITY. 65 p0 13. INSTALLER MUST HAVE COMPLETED THE ENVIRO-SEPTIC CERTIFICATION TRAINING COURSE OFFERED BY PRESBY ENVIRONMENTAL, INC. AND FOLLOW ALL THEIR INSTALLATION TEST HOLE LOGS METHODS AND REQUIREMENTS. 14. SYSTEM SAND SHALL BE ASTM C-33. ENGINEER: DAVID FLAHERTY, R.S. WITNESS: DONNA MIORANDI, R.S. DATE: MAY 10, 2007 PERC. RATE _ < 2 MIN/INCH I 100 CLASS I SOILS P# 11738 ELEV. ELEV. p" 99.0' 0" 99.0' BENCH MARK - COR CONC SYSTEM DESIGN. A A BULKHEAD ELEV. = 101.0 GARBAGE DISPOSER IS NOT ALLOWED 'S �'S 1OYR 3/3 10YR 3/3 LAWN AREA DESIGN FLOW: 3 BEDROOMS CAD 110 GPD = 330 GPD 12" 98 0' 12" 98.0' o `,o USE A 330 GPD DESIGN FLOW S S SEPTIC TANK: 330 GPD (2) = 660 10YR 7/6 10YR 7/6 00 �o� CEDARS 26" / / / 96.8 28" 96.7' USE A 1500 GAL. SEPTIC TANK 1/ /j 1 FLAGSTONE 00 PATIO LEACHING: = UNSUITABLE MATERIAL SILT LOAM SILT LOAM 5' REMOVAL OF UNSUITABLE SOIL SIDES: N/A REQUIRED AROUND PERIMETER OF " 94•2 2.5Y 6/4 „ 2.5Y 6/4 SHRUBS LEACHING FACILITY, DOWN TO BOTTOM 13.5 x 34 (.74) = 340 GPD 58 62 93.8 SUITABLE SOIL LAYER. REPLACE WITH CLEAN MEDIUM SAND. TOTAL: 459 S.F. 340 GPD OO RUBS PROVIDE VENTS WITH CHARCOAL FILTER USE (6) 30' SECTIONS OF PRESBY ENVIRONMENTAL ENVIRO-SEPTIC C2 O O SHRUBS LAWN AREA AND E WASTEWATER TREATMENT SYSTEM SET 1.5' CENTER TO CENTER �P AND EIUGSCREEN (FINAL PLACEMENT WITH � MCS PERC MCS P�Q I HOMEOWNER CONSULTATION) IN A BASIC SERIAL FASHION AS SHOWN WITH 2.5 SAND ON SIDES i Apo DBOX HIGH VENT SHALL BE 10' MIN. AND 2' OF SAND AT ENDS TO CREATE A SAND BED OF 13.5' X 34' 2.5Y 7/3 2.5Y 7/3 Q EXISTING 3 BR HIGHER THAN SAS LOW VENT � DWELLING ,: � 6 10 NOTE: NO STONE IS TO BE USED IN ANY PORTION OF THE LEACHING FACILITY. % L 5% COBBLES P ��. 61 TOP OF FNDN �' ' '• `�s, F 120 89.0' 132" 88.0' EL 100.6' w � GQ-P I I T 1 -2 000 NO GROUNDWATER ENCOUNTERED S 9g M A TITLE 5 SITE PLAN 61.s' _ •-� �°`' �y APPROVED DATE BOARD OF HEALTH /� gg OF 1018 RACE LANE LOT 7 (MARSTONS MILLS) BARNSTABLE, MA 54,240f SF / 1.2f AC. PREPARED FOR BORTOLOTTI CONSTRUCTION STEPHEN BISHOPRIC DATE: MAY 23, 2007 \ REV. DATE: SEPTEMBER 10, 2007 (DBOX VENT C�`O Scale: 1"= 20' �s. \ 7g 0 10 20 30 40 50 FEET toff�� \ \ 508-362-4541 \ fax 508 362-9880 \ \ N F MASSgcyG ����jN OF MgSS9cti �o DANIELA. �o DANIEL G� down Cope engineering, Inc. \ o OJIVLA u; O AA. LA \ 6,( No,465020 No.40980 Cl VIL ENGINEERS SC NAL OLEN\�� l4NF SS Q ► LAND SURVEYORS \ DATE DANIEL A. OJALA, P.E., P.L.S. 939 Main Street - Y,gRMOU THPOR T, MASS. DCE #01- 101 01-101 B0RT0_BISH0PRIC_(2).DWG DDF