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HomeMy WebLinkAbout0030 RASPBERRY LANE - Health 30 Raspberry Lane, M. Mills A= 102-100 p 1 i I TOWN OF BARNSTABLE /y LOCATION �, Q S�� C/ AV SEWAGE # `7 VILLAGE Mal ASSESSOR'S MAP& LOT " ®Q INSTALLER'S NAME&PHONE NO. EJc A q10 SEPTIC TANK CAPACITY 106�6 LEACHING FACELrrY: (type) LZALI-j# r46144# (size) jS**�GX q'1,2 NO.OF BEDROOMS BUILDER OR OWNER PERMI TDATE: r —I �Ct°7 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 1 s l / +" ao ( � .� �3 �, i g .� �. .� s � ��, �.7 F � � t '�, � �� No. !!! , ___i Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS 01pprication for Dizpooal *pztem Con5truction Permit Application for a Permit to Construct( )Repair X)Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. _70 Owner's Name,Address and Tel.No. Assessor's Map/Parcel , r` ` ' 46 0 eGAQrjtbL ev Installer's Name,Address,and Tel.No. ow#Yorz Designer's Name,Address and Tel.No. Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Aw Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) &/y 14yo-e. l4_1 ow ei wi— �4 _ /-&%dVZ6MvW 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 E viron ent Code and not to place the system in operation until a Certifi- cate of Compliance has been issued his o f p Signed Date f/11 Application Approved by Date (4Z9 ) Application Disapproved for the following reasons Permit No.T2 3 IV Date Issued i S 0 No. / �rw`; „� Fee / THE COMMONWEALTH OF MASSACHUSETTS ^" Entered in computer: sy/ Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLES MASSACHUSETTS Zipplication for Migool *pgtem Construction Permit Application for a Permit to Construct( )Repair X)Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address 7,Lot No. 0 AM9Owner's Name,Address and Tel.No. Assessor's Map/Parcel Installer's Name,Address,and Tel.No. / Designer's Name,Address and Tel.No. 40 T`WTC40 CIA Type of Building: r Dwelling No.of Bedrooms Lot Size sq. ft. Garbage Grinder( ) Other Type of Building is No.of Persons Showers( ) Cafeteria( ) Other Fixtures G Design Flow Ffo gallons per day. Calculated daily flow gallons. 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 a plicable) � mp r �" 0-fl� Q 6� �- l _j1(1_ 141i 66%q r&/%<# 60 X Xa2 F 1-�, - b o>c' Date last inspected: Agreement: �3 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 Epiroiment Code and not to place the system in operation until a Certifi- cate of Compliance has been issued his$o f H , _ Signed Date Application Approved by Date 6 Application Disapproved for the following reasons Permit No. 2 7 a Date Issued ' --------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS (Certificate of (Compliance THIS IS TOACEIF�Y, that the On-,s'te Sewage Disposal System Constructed( )Repaired k Upgraded( ) Aband ed( t O at .0 !�' Z has been cotfstructgd in accordance with the provisions of itle 5 and the for Disposal Sys em Construction Permit No. T dated — 2 Installer Designer The issuance of this permit shall not be construed as a guarantee that the system will function as designed. Date / . ') (Q ,C o-) InspectorLV ——————————————————————————————————————— No. 9 7 — —3 / f Fee 5b THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLES MASSACHUSETTS x1h9po.5ar *p!gtem Conttructton Permit Permission is hereby granted to Construrc�( )Re air( '1)Upgra e( )Abandon`�( ,) System located at S'C� ��,� r t 4 P, ilk G%f¢ and as described in the above Application for Disposal System Construction Permit. The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided: Construction must be completedwithin three years of the date of this permit. Date: t0"' 1 l •- 7 -7 Approved by r NOTICE: This Form is to be used for the Repair of Failed Septic Systems Only CERTIFICATION OF SKETCH AND APPLICATION FOR A DISPOSAL: , WORKS CONSTRUCTION PERMIT(WITHOUT DESIGNED PLANS),: hereby certify that the application for disposal:'Works construction permit signed by me dated concernmg.the property located at 70 AO� meets all of the f: following criteria: • There are no wetlands within 300 feet of the proposed septic system • There are no private wells within 150 feet of the proposed septic system • The observed groundwater table is 14 feet or greater below the bottom of the leaching facility. • There is no increase in flow and/or change in use proposed • There are no variances requested or needed. DATE: 6 SIGNED : _ . 4 ' LICENSED SEPTIC SYSTE STALLER IN THE TOWN OF BARNSTABLE NUM)#ER ` plan of the proposed stem.Also if the licensed installer posesses a certified plot plan, h sketch a c a system. [Attach Po P P this plan should be submitted]. o601 D i TOWN OF BARNSTABLE BOARD OF HEALTH Q ARTICLE II: MINIMUM STANDARDS FOR HUMAN HABITATION Date ' 8 �� L Time: In Out Owner(��U r� ��P Lt-rD 1� Tenant 1 C k &,t ,`►3 Address 1 J fl/lP"6iD&) 0 I c -_ Address --SID OAKSFBQ��� l}IJG,, t LAI , 1M Compliance Remarks or Regulation# Yes NO Recommendations 2. Kitchen Facilities 3. Bathroom Facilities 4. Water Supply i�M lRn+# / Tilia 'i/4VM 5. Hot Water Facilities V// 6. Heating Facilities 7. Lighting and Electrical Facilities 8. Ventilation 9. Installation and Maintenance of Facilities j PQ��)6kS ILL w" 5UIDK, ��L�C- P- 10. Curtailment of Service 11. Space and Use 0 GO L 12. Exits 13. Installation and Maintenance of Structural Elements 14. Insects and Rodents 15. Garbage and Rubbish Storage and Disposal 16. Sewage Disposal 17. Temporary Housing 18. Driveway Width 19. Number of Tenants Observed PART II 37. Placarding of Condemned Dwelling; Removal of Occupants; Demolition nt Number of Bedrooms ? Number of Vehicles Allowe Number of Persons Allowed (max) Person(s) Interviewed r� � 1 Inspector If Public Building such as Store or Hotel/Motel specify here. r . r TOWN OF BARNSTABLE BOARD OF HEALTH -" ARTICLE II:MINIMUM STANDARDS FOR HUMAN HABITATION Date D Time: In Out Owner Tenant Address L2, V0 f--r O1J) Address t7,)U 1,40 1Q L y��5 I�S r�I i c�S , Compliance Remarks or Regulation# Yes NO Recommendations 2. Kitchen Facilities 3. Bathroom Facilities ;VPMVed:: R R�I�I'y R1�.,y �_�a y� 4. Water Supply 5. Hot Water Facilities LPY 1 YW ' 6 u6 D 6. Heating Facilities ��� Q1= lr�SPCGt 1 �n1 7. Lighting and Electrical Facilities / 8. Ventilation y 9. Installation and Maintenance of Facilities 10. Curtailment of Service 11. Space and Use 12. Exits 13. Installation and Maintenance of Structural Elements 14. Insects and Rodents 15. Garbage and Rubbish Storage and Disposal 16. Sewage Disposal 3,q 3 i3, 17. Temporary Housing 18. Driveway Width 7L 19. Number of Tenants Observed N PART II 37. Placarding of Condemned Dwelling; Removal of Occupants; Demolition Number of Bedrooms Number of Vehicle w max Number of Persons Allowed(max) Person(s) Interviewed Inspector If Public Building such as Store or Hotel/Motel specify here TOWN OF BARNSTABLE LOCATION i636 SEWAGE # Q VILLAGE ASSESSOR'S MAP& LOT 00 INSTALLER'S NAME&PHONE NO. 6�t A�LaCCL qo20 SEPTIC TANK CAPACITY Ay6 LEACHING FACILITY: (type) Zz�zg r&E <# (size) is GX �r fXrZ NO.OF BEDROOMS BUILDER OR OWNER PERMITDATE: c —I �cC 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 e ���� 79-9 ��80 �G�cr� of Poc tl- � — -- _._..__BARNSTABLE -- . __3.0._Raspberr - y...Lane Septic _.__ -----------Owner--- -._ PQMPING_._HLSTORY__._-_ Gallons-... _ 0 0 COmmonweoltth of MossoChusetts John Grad Executive OfflCe Of ErMronnvir dal Affcgrs D.E.P. Title V Septic Inspector Partment of P.O. Sox 2119 Teaticket,MA 02536 Environmental Proto�tlon (508) 564-6813 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A y 1��CEIV�Q f'O CERTIFICATION 1 0 30 Rberr Lane Marstons Mills Address of Owner:if different �997hd as ry td Property Address: Date of Inspection:419197 (USDA Rural DevelopmentService �' TO HEAL H^DE��LE Name of Inspector:John Gracl Company Name,Address and Telephone Number: 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 sewage disposal systems. The system: _ Passes This inspection is based on criteria defined in Title V code 310 CMR 15.303.My findings are of how the system Is _ Condition y Passes performing at the time of the Inspection.My Inspection does _Need/bmit her valuation By the Local Approving Authority not Imply any warranty or guarantee of the longevity of the N dl septic system and any of its components useful life. 11 Inspector's Signature: Date: 419197 J The System Inspector shall s a copy of this inspection report to the Approving Authority within thirty(30)days of completing this inspections. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the 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. F R7-31Y- INSPECTION SUMMARY: / Check A, B,C, or D: ©� " 7 A] SYSTEM PASSES: �(p 7 _1 have not found any information which indicates that the system violates any of the failure criteria defined as in 310 CMR 15.303. Any failure criteria not evaluated are indicated below. BI SYSTEM CONDITIONALLY PASSES: _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 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. (revised 11115195) One Winter Street • Boston,Massachusetts 02108 • FAX(617)556-1049 • Telephone(617)292-5500 1 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 30 Rasberrry Lane Marstons Mills Owner: USDA Rural Development Service Date of Inspection:418197 _ Sewage backup or breakout or high static water level observed in the distribution box is 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 leveled or replaced _The system required pumping more than four times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed C] FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect the public health, safety and the environment. 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER 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 of water supply or tributary to a surface water supply. The system has a septic tank and soil absorption system and is within a Zone 1 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 volatile organic compounds indicates that the well is free from pollution for that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal or less than 5 ppm. 3) OTHER D] SYSTEM FAILS: X 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 in 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 cesspool. X SAS is in hydraulic failure. (revised 11115195) 2 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 30 Rasberrry Lane Marstons Mills Owner: USDA Rural Development Service Date of Inspection:418197 D] SYSTEM FAILS(continued) 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 1/2 day flow. Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Numbers 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 1 of a public well. Any portion of a cesspool or privy is within 50 feet of a private water supply well. _ Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. If the well has been analyzed to be acceptable,attach copy of well water analysis for coliform bacteria,volatile organic compounds,ammonia nitrogen and nitrate nitrogen. E] LARGE SYSTEM FAILS: The following criteria apply to large systems in addition to the criteria: _ 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 II 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 11115195) 3 r SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECLIST Property Address: 30 Rasberny Lane Marstons Mllis Owner: USDA Rural Development Service Date of Inspection:418197 Check if the following have been done: x Pumping information was requested of the owner,occupant, and Board of Health. x None of the system components have been pumped for at least two weeks and the 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. n1aAs built plans have been obtained and examined. Note if they are not available with NIA. x The facility or dwelling was inspected for signs of sewage back-up. x The system does not receive non-sanitary or industrial waste flow. x The site was inspected for signs of breakout. x All system components,excluding the Soil Absorption System,have been located on the site. x 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. x 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. x The facility owner i(and occupants,if different from owner)were provided with information on the proper maintenance of Sub- Surface Disposal System. (revised 11115195) 4 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 30 Rasberny Lane Marstons Mills Owner: USDA Rural Development Service Date of Inspection:418197 FLOW CONDITIONS RESIDENTIAL: Design flow: 330 gallons Number of bedrooms: 3 Number of current residents: 0 Garbage grinder(yes or no): No Laundry connected to system(yes or no): Yes Seasonal use(yes or no): No Water meter readings,if available: nla Last date of occupancy: n1a COMMERCIAL/INDUSTRIAL: Type of establishment: n1a Design flow:0 gallons/day Grease trap present:(yes or no) No Industrial Waste Holding Tank present: (yes or no) No Non-sanitary waste discharged to the Title 5 system: (yes or no) No Water meter readings,if available: n1a Last date of occupancy: n1a OTHER: (Describe) Na Last date of occupancy: GENERAL INFORMATION PUMPING RECORDS and source of information: System has not been pumped in the last two years. System pumped as part of inspection: (yes or no)No If yes,volume pumped: gallons Reason for pumping: n1a TYPE OF SYSTEM X Septic tank/distribution box/soil absorptions system Single cesspool Overflow cesspool Privy Shared system(yes or no) ( if yes, attach previous inspection records,if any) Other(explain) APPROXIMATE AGE of all components,date installed(it known)and source information: 15 years Sewage odors detected when arriving at the site:(yes or no) No (revised 11115195) 5 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 30 Rasberrry Lane Marstons Mills Owner: USDA Rural Development Service Date of Inspection:418197 SEPTIC TANK: X (locate on site plan) Depth below grade: 1' Material of construction:X concreate_metal_FRP_other(explain) Dimensions: L8'6'H5'7'W4'10' Sludge depth:5' Distance from top of sludge to bottom of outlet tee or baffle: zz' Scum thickness:8' Distance from top of scum to top of outlet tee or baffle:6' Distance form bottom of scum to bottom of outlet tee or baffle: 10' 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.) Septic tank and all components are structurally sound.Recommend pumping system every one to two years. GREASE TRAP: (locate on site plan) Depth below grade: n1a Material of construction: _concrete_metal_FRP_other(explain) Dimensions: n►a Scum thickness:nfa Distance from top of scum to top of.outlet tee or baffle:n1a Distance from bottom of scum to bottom of outlet tee or baffle:n1a 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.) nla (revised 11115195) 6 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 30 Rasberny Lane Marstons Mills Owner: USDA Rural Development Service Date of Inspection:4M97 TIGHT OR HOLDING TANK: (locate on site plan) Depth below grade: n1a Material of con struction:_concrete_metal_FRP_other(explain) Dimensions: Na Capacity: n1a gallons Design flow: n1a gallons/day Alarm level: Iva Comments: (condition of inlet tee,condition of alarm and float switches,etc.) nla DISTRIBUTION BOX: (locate on site plan) Depth of liquid level above outlet invert: n1a Comments: (note if level and distribution is equal,evidence of solids carryover,evidence of leakage into or out of box etc.) n1a PUMP CHAMBER: (locate on site plan) Pumps in working order:(yes or no) Comments: (note condition of pump chamber,condition of pumps and appurtenances, etc.) n1a (revised 11115195) 7 I SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 30 RasberryLane Marstons Mills Owner: USDA Rural Development Service Date of Inspection:418197 SOIL ABSORPTION SYSTEM(SAS):X (locate on site plan,if possible;excavation not required,but may be approximated by non-intrusive methods) If not determined to be present,explain: Na Type: leaching pits,number: 1,000 gallon leach pit leaching chambers,number:n1a leaching galleries,number: n1a leaching trenches,number,length: Na leaching fields,number,dimensions:n1a overflow cesspool,number:n1a Comments:(note condition of soil,signs of hydraulic failure,level of ponding, condition of vegetation, etc.) System shows signs of liquid being over the cover.Sas Is In hydraulic failure. CESSPOOLS: (locate on site plan) Number and configuration: n1a Depth-top of liquid to Inlet invert: n1a Depth of solids layer: Ma Depth of scum layer: nfa Dimensions of cesspool: n1a Materials of construction: n1a Indication of groundwater: n►a inflow(cesspool must be pumped as part of inspection) n1a Comments:(note condition of soil,signs of hydraulic failure,level of ponding, condition of Vegetation,etc.) nla PRIVY: (locate on site plan) Materials of construction: n1a Dimensions: n1a Depth of solids: n1a Comments:(note condition of soil,signs of hydraulic failure,level of ponding, condition of vegetation, etc.) n1a (revised 11115195) 8 i f SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 30 Rasberrry lane Marstons Mills " Owner: USDA Rural Development Service Date of Inspection:418197 SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent references landmarks or benchmarks locate all wells within 100' �j &LC{— Aj) IS ' l DEPTH TO GROUNDWATER Depth to groundwater:12 feet method of determination or approximation: USGS Maps and Charts revised 11115195) 9 O Y ' o� l 0 : S'87° 00 �Ov "i t '- /00,00 .Az - v-. _ o0 Qj_' = _ LvTB.I qo0 S, .'T _ 100.0 1f8-7 0 0 D':00 '! _ : CERTIFIED • PLOT PLAN LOT .97 RR s PBERp_Y ►✓E NEW'..CONSTRUCTION ONLY= _ -: i9T�STO�✓S MJGLS TOP OF FOUNDATION IS �— FEET _ fN AID OVE: .LOW POINT OF ADJACENT ROAD. : SCALE.- 1'•= 30' DATE: 7/1,P/78' LOREDGE ENGlNEERlN6 COIN PACEy. i CERTIFY THAT THE Fau�Y� T'°Al CLIENT SHOWN ON T19 PLAN IS LOCATED E6ISTERED RE8ISTEREQ :; -7So Zo CIVIL LAND .; J05:NO. :pN THE GROl(I�0- AS INDICATED A11D ENGINEER SURVEYOR DR.BY� •A• �"� QONFORM3 T0.•'!Tt1E ZONING LAWS _. , QF BARNST t ItAAS 33 NO_ MAIN'ST 712 MAIN STD 1�1 SO. :YARMOUTH, MASS. HYANNIS, MAsi$ —`. SHEET l OF DATE RkEB. LAND SURVEYOR 4 TOWN OF BARNSTABLE CATIONTD-;�Q-d CA.�.� Qu SEWAGE # V�FLLAGE ASSESSOR'S MAP &LOT INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY 4LEACHING FACILITY: (type)' (size) NO.OF BEDROOMS C7 — BUILDER OR OWNER PERMITDATE: 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) Feet Furnished by - a Page 10 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C f SYSTEM INFORMATION(comirm d) Property Address: 20 Rascally Rabbit Road Mmmoos Mills Owner: Russell Berg Date of Impection: 8/162005 1 SKETCH OR SEWAGE DISPOSAL SYSTEM j Provide a sketch of the sewage disposal system including ties to at least two pesmanent refemum landmarks or `I benchmarks.Locare all wells within 100 feet.Loans wbere public water supply inters the building. I I 1^ O LZ a I S 1 I I Ov A3= Sa' 35 r D3= sue' f � 3 C N LO• 'ATION SEWAGE PERMIT NO. V I L'7G E® . !')')A R 5 7-0 IV.S INSTALLER'S _NAME & ADDRESS B U I'L D E R OR OWNER wJv . DATE PERMIT ISSUED 7 1 , - DAT E COMPLIANCE ISSUED ��_ 71 P649-a cat qo t _ . THE COMMONWEALTH OF MASSACHUSETTS BOAR® O HEALTH - / f ..............OF................... • 5...—�- v .................-•---....... Appliration for Dhipmal Works Tamtrnrtinn ami# Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: ao�* ati . dre�ss� or Lot No... ..:: ��- ------- ------------ ..........-=................................. --------------------------------------••---......... Owner Address •...........................••---.......---......------•--........------.......................... •--•---••••----••-•-•-•-•-•-•------•.............._..................• .......................... Installer Address Type of Building Size Lot.-/y � _____Sq. feet aDwelling—No. of Bedrooms.............3......._....................................Expansion Attic �( Garbage Grinder Q, Other—Type of Building ............................ No. of persons---------------_------------ Showers ( ) — Cafeteria ( ) a Other fixtures -------------------------------•- - W Design Flow.........................gallons per person per day. Total daily flow-------- .....:................gallons. WSeptic Tank—Liquid capacity/'gallons Length................ Width................ Diameter---------------- Depth................ x Disposal Trench—No.�.`................. Width._... _..._........ Total Length............ ...... Total leaching area....................sq. ft. Seepage Pit No............1--___-- Diameter----------;/, _ Depth below inlet__...._ .._... Total leaching area..�_.�,�-sq. ft. z Other Distribution box ( ) Dosing tank ( , ) ,��!/ Percolation Test Results Performed by.--.. _ -jKuW..............•......................... Date._--,g=--_"a.�7�� aTest-Pit No. 1. ..._.minutes per inch Depth of Test Pit.................... Depth to ground water_-_-_-_-_____--.-_.----- rZq Test Pit No. 2................minutes per inch Depth of Test Pit.................... IPepth to ground water........................ R+' , -----------•------• . .----- ............ i Description _ c� escription of Soil-'•-•---0. .. l.E.! . -- ---------•------------•----------•••------------•---•----- V --------------- --------- ------- -------•----•-------•----------•---------------------------•-------- W •-•-••----------- -------------------------------- ---•••---------'--•---•••-----•-•-•-•----••••-••----•------------------------------••----•••------•-----•--•--••••-••-•---•--•-----•-•--•-•----...... UNature of Repairs or Alterations—Answer when applicable................................................................................................ -•-'----•-------------------------------•-••'---------'---'•-------------------•----•-------------------••---•-----------------------••......----------•-----------------......_..---•-..............._. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has beep,issued b e board o We . Signedf... ./ ................----•"----------- ------- ..... Application Approved B . ..........._ e 7 Date Application Disapproved for the following reasons----------------------------••--••------------------ ---•---•--------------•-•---------------••-•------------•--- ......•---•••-•••---•---......••-------------•-••--••----•---.................--••-----...--••••------•------'-•-•---••--•----•••-•--------•------'---------------•------------------------------------- Date Permit No................. Issued .............°.' ._ Date ..............ate THE COMMONWEALTH OF MASSACHUSETTS �,- BOARD0.,F HEALTH Appliratinn for Uhip a al Workii Tnnitratrtinn thrmit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: .�.�?.....e L.. ..... ._ �c .... ----•---•---------• --••- ..................................... or Lot No. Owner Address ............................... Installer Address d Type of Building Size Lotft�,�? ..._..Sq. feet U Dwelling—No. of Bedrooms.......-�c-�.--•........................Expansion Attic) Garbage Grinderp Other—T e of Building No. of persons............................ Showers Cafeteria aOther fixtures -----------•... ••••-•••-•---•••••-••••--•••••......•••-••••••••---•--------•-••-•-......--••-- W Design Flow...... :f—---•-•-••--_--...___gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid gapacity ..gallons Length................ Width.__- __.___-___. Diameter................ Depth................ x Disposal Trench—Nth.................... Width/d-_-_.-_-_-_-- Total Length._.-.. - ......... Total leachir are ?' . -----sq. ft. Seepage Pit No--------------------- Diameter.................... Depth 1 1 v jp�e<t.. . ... ....<Total l acl�6 area..................sq. ft. z Other Distribution box ( ) Dosing tayk ( ) I Percolation Test Resul Perform _y*4,m ? ...--•--•---------------------------------------------- Date........................................ Test Pit No. 1 -......_..minutes r inch Depth of Test Pit-______-.-_-_.__.. Depth to ground water........................ Test Pit No. f...............minutes per inch Depth of Test Pit.................... Depth to ground water........................ ----- r ..... Descri Description of Soil lA.G�se1...... -----••••-------------••-•-•=--••-•-•-••••••--• ••---•--•••--------------••-•.....••••-•••••••-•••---••------------------••-----•----••---••-••••-•••-••••-----•......-•-............• ................ UNature of Repairs or Alterations—Answer when applicable--------------------------------------------------_............................................. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has be_e4 Gissued s by r .thec Gboard h ..th. Signed.. ....- r .., .� // De •.fa Application Approved BY ............... Da Application Disapproved for the following reasons:...............................••............................................................................ •---.....•....--•----------••----•------....--•-------------------------------------------•..-----•------.••••--•--••-....•--•••-••••----•-----•-•-•----•-•----•-•-•............••••---••--•••--•--•--•-- Date PermitNo......................................................... Issued-....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD F HEALTH ............ (9rdifirate of ToutpliFatta THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed fJ/) or Repaired ( ) bY-•--••..... . .......••--......••••.---- •........-•-••-••--• ........-•••--•--•---- -- ------ .-- --- -----------..---------------- .-------------•- --- "Oe el ';-C -----X-1 has been installed in accordance�6vith the pr isions of I�L• 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit 1 �. ...._.., .............. dated_ -_�.—.�?_ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE................................................................................ Inspector........................-........................................................... % THE COMMONWEALTH OF MASSACHUSETTS ((( } BOARD OF HEALTH C7f) .............OF..... .. -l„�/I ,.........._............--------.......................w. ,��O�lJ- ..._ FE�.rS. r Dispolial Vork,5 0.11omitrnrtion anti# Permissi n is ereby granted........................................................................................ to Const ct or Rep -rr ) an In vidual Sevi�ag isposal System G��''. at N ---- .....� ,�!.;. . �g al.. ...... ...�..� --- -�//X✓/ -///----- -- Street as shown on the application for Disposal Works Construction Permit No. _____________ __ Date .-................ f ----...----. f it �• ---------•---------------------- Bo�of ea th�� DATE................................................................................ FORM 1255 HOBBS & WARREN, INC., PUBLISHERS - I ot B;7,n 0 0 D O C /010.00 goo% , 3 D Ex pit iu�i one � , if 0 4 N 0 86 a boo o GAL, M" _ LEA CN.PIT / 0000 N &7 ' oo' _ I . ,. t x ROBERT s S,. P. r, BUNIKIS -IN Na 221G2 .0 LEGEND EXISTING SPOT ELEVATION OX0 CERTIFIED PLOT PLAN _ r EXISTING CONTOUR -- - 0 -- LOT 8/ 7?4SP CRR-y, C•AIVC— >: FINISHED SPOT ELEVATION 10.01 FINISHED CONTOUR' .-- 0 —=-'-. - --- ,$= 2=5T®N f I Pl. APPROVED :, BOARD OF HEALTH DATE AGENT'------ SCALE : I =.3o DATE _ ¢//7 /74k- fLDREDGE ENGINEERING CO. ING� CLIENT _PACC� I CERTIFY THAT THE PROPOSED t EGISTERE REGISTERED JOB N0. 7�_d _�_ BUILDING SHOWN ON THIS . PLAN CIVIL DR. BY LAND CONFORMS TO THE. ZONING LAWS 'i- A. A-:_M_ ENGINEERSY hSURVEYOR_ OF BARNISTABLE , MASS. 33 NO MAIN ST 712 MAIN ST. CH. BY; S0. YARM04iTF1, MASS. HYANNIS, MASS. SHEET' / OF ? DATE REG. LAND SURVEYOR • NO-7 La ./F' E/Ti°/E'R.-TME SFPT/C 7-AV/C OR n' r4CallitfG !�/T' A RE TMN A /2"eELJ� . O t R� MO Y IO,.PT MIN.. -_. 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FT SE'�f/A1 GvE ®/SR4"A L .SKST&M LEACH//VG P/T 7A49ZILATl40/V scAL E %s _ - D" O/ME1V-T1ON A FT. DES/G!a/ CR/TER IA NUMBER OF BEVRooMs 3 D/%�IEN�iaN C _F7' A-1 r N GARBAGEO/.SPOSAL UNIT SOIL LOG TOTAL EST/M.•(TED FLOH/ 3 d 0 GAL.IDAY- SOIL TEST !. SOIL TEST740' TEST ' CUMBER QF 3FER9GE PITS _�_ fELEY. A`-ALLY• G ,DATE OF` SOIL TEST s�Z 7 P /OE.�EACHlNG PER PIT 1 79 sQ �T d RE�[/LTS N/ITNESSED, BY TC j� l' v r.'�i�i S ®OTTOM La4CH/A7Cr PER PIT �� p�- PERCOaLAT/O!V JCATB �1�f/ 2. '= /y/NI NC/Y TOTAL LZ4CH/NG AREA S F7^ , �- 4 _ F�EJ�COLAT/ON RATE�2 MIAI. !INCH R.ESER✓E LEACNI Vdr AREA -1-�..b SQ. FT, — 3 OF \ coA r<s` �y X(H Klass s�. vim IDA moo`' RoeERT, ?,`„ .57p 3�R 2 y --A->V'E- P. - U BUNrrtrs �,,vim AM R.STp>v s /yl /LL S No.22152 �� E�. :EevGiw�Ri�Gwv eewe. '$ ® NO GROUND 1NAM"A' EJVCOU1V7ZrMEO , MASS,;`, So. Y.4R/r90z/77;Mass. GIQO UA/D LV.4 AT GLEN. JOB /V ?o.Ar 3_ t `yo .5 87 ��Uo 40 t z4 ' CPA/ t . . oh ► o, N . 0 _ � 0 40 /0 o 0 6A L. M OA CH...PIT k-12'- 0, o O • '\ S, OE�aa f o ROBERT. r P. `t BUNIKIS t 9 Ni.221G2 O ��r 1Ni'+1��•('l'i LEGEND EXISTING SPOT ELEVATION OxO CERTIFIED PLOT PLAN EXISTING CONTOUR - O _ __. L oT 6?/ PkAS1p13t-9R J n/6 FINISHED SPOT ELEVATION FINISHED CONTOUR -----: 0 - /v)/ ,R570N-S ILLS_ I APPROVED : BOARD OF HEALTHf b 1 MASS* DATE AGENT SCALE : 3o # DATE ►ELDREDGE ENGINEERING CO. lNei ^' CLIENT .j)AC[=y_ I CERTIFY THAT THE PROPOSED EGCISTLREC 'REGISTERED JOB N0. /3 U 2- 0 BUILDING SHOWN ON THIS PLAN ` LAND CONFORMS TO THE ZONING LAWS ENGINEERS,! �SU.RV__EYOR_ DR. BY ` /I -A /17. ___ OF BARNSTABLE , MASS. 33 NO MAIN ST I12 MAIN ST CH. BY SO. YARMOU i H, MASS. HYANNIS, MASS' - SHEET__ _ OF _.- DATE REG. LAND SURVEYOR 20 FT. M/N NO'r "E /F E/TNER THE SEPT/C.TA-V AC- OR /D P'T. M/N.. .. . ` L �iYG P'/T.4Rr MDRL°� TIy^N /2"QELOiV d/1 GN ORA DE,:f1 24'O//I M ETER CONCRETE COvd'AP 4'i'YC P/Pl SJVALL. Slr BQOCAGrHT TO. G ACE' �4N R � EXTRA CONCAlETE h►E.a vy C�1.9 li�� SIS+'4 L L_ USED D O, COYERS M/N. P/TCN /B w P1riQ FT. '. !F/l O V R/t/EJ�tiA y BE 2% At IN. CD/VCRL�'TE G AVE Cc�►DER CLEAN SANp 4 4"CAST . LAPUID . ' ' • ,�•• •' Z LAYER /RON P/PE i � 0 6 O p. o�o a •o Q� �•_':�d'tr� MMI. PirCir GAL• VF P.A-M rr S.EPT/C TANK D IS7. o o I • . . • . • ► e �4` WA SHIED S70MC �.? BOX o • o • F 8 • ► • � • • .°a •• ` O' e ♦ p I ' OFFPECT7VE • . ` 3l4'- ��2~ •• DEPTt/ • • • • • 0 WAX WED STONE: s c o • I • 1 • • • • ► ' O o v. a •'• • • t • • • • p • v PRECAST SEEPAGE /N!/eRT �LEt/A7"/DNS - • v o o r • • • • • • • ' ' a `o P/T OR,EQU/V.' . /NYERT AT Q[//LD//VG `�G. FT. G I-r: D/AM. INLET CPT/C 7.4NK `I s S FT, FT O/X?M. I O.U'7LET SEPTIC TANK / 5.3 FT. ?� !! C SEE TMblL.4TION, r INLET OISTR/DUT/ON BOX 4 8 FT. GiQOuNo WA7&cr f TAAMLE OUTLETD/STR/BIIT/ON BOX 9 4,-7 Fy SECTION OF /NLET.SEEPAGE PIT i4 L fr. SEWAGE ,01SA4AS'A1 SYST4F'/�? TABIILATIDN LEACH//VG 0/7' DESISN CR/TER/A .TCAL_E o" DIMENSION A FT. DIM.-N.S/O/V 8-16_ FT. NUMBER OF 8e.DR0p/ys 3 D/MENS/ON C 4 FT' J�" N GAReA GAF D/SPOS.4L U/V/T SO/'L LOG TOTAL EST/MATE.D FLOH/ S c' o G.aL:1oay SOJL TEST / SOIL TESTS SDAL TEST CUMBER-DF.SEER4GE P/rs l f`FL�Y ELt�Y.. '� G ,DATE GF SOIL TEST S Z 78. to S/OE LEACH/NG PER P/T 7c� sQ, PT G Te P- �s OOT'TOM L.E�gCH/NG PER P/T L o A M RESULTS n/ITNESSED AY S4. FT. PER COL AT/O!v MATE jE/ 2. 0 MIN. I NCH TOTAL. LEACN/NG AREA 2- sq. Fr. _ 3� .' sue'-.;so�� AE/tco1.nrioN R.47E�2 Mlw. /wcsr RESERI/E LE4CNlN6 AREA 2 '_ g 5Q !=T. I p r F� l z/; sF�2,�=fl 2 ROBERT i �( BUNIKis !P. /LI,4RSTDN,S IV LLS .. ` No.22152 O w mLi 7/2 AtA/N ST.• 33 NO,MAIN ST NOGROUNP W�4TL'R ENCOUIVTEICEO WYANN/J, MAjTa. Sp. - RMOV7W,ntAS -1. C-3 GROUND JOB ND. 7_8 O , SHE.ET?O/r