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0626 RIVER ROAD - Health
626 River Road Marstons Mills P A 061 033 __ _ TOWN OF BARNSTABLE LOCATION6c?, 6'; jj Q� SEWAGE # VI�LAG E//0/'Sk12S A// ASSESSOR'S MAP & LOTG�al-O2- INSTALLER'S NAME & PHONE NO.�)4 SEPTIC TANK CAPACITY / 006 ollol?S LEACHING FACILITY:(type)/ -f 6 j (size) X /® NO. OF BEDROOMS PRIVATE WELL O PUBLIC WATER UILD R OWNER DATE PERMIT ISSUED: Xc DATE COMPLIANCE ISSUED: 17- VARIANCE GRANTED: Yes �No i i D� r T i r No.... ....378r Fizic . THE COMMONWEALTH OF MASSACHUSETTS ►� �� � BOARD OF HEALTH TOWN OF BARNSTABLE Appliratilan for Uhnp ial Wurkg Tvastrnrtinn Permit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: RIVER ROAD LOT 1 -------....................................................................... ...-----•----••........--....-•-•--------......-----•--......--------................------------ MARGARET F.I 2ef_8 161q_ 5 D INC. or Lot No. ---• ---------------------------• •---------------------------------------------------------- �� er Address W 5 MECHANICS STREET, BOSOTN, MA. Installer Address 46, 700+— Q Type of Building Size Lot........................ ....Sq. feet U Dwelling—No. of Bedrooms....................3--------------------.--Expansion Attic TO Garbage Grinder (Ng aOther—Type of Building ...__ .._................ No. of persons---------------------------- Showers ( ) — Cafeteria ( ) Q' Other fixtures ---------------------------- W Design Flow.........5.5..............................gallons per person per day. Total daily flow..........-�-__--- ....................gallons. WSeptic Tank—Liquid capacitv100,0gallons Length_l4°---0- Width.-5-1._-0". Diameter--.-.N�A.- Depth......-�.... x Disposal Trench—No. ..._bt/.A._.. Width.................... Total Length.................... Total leaching area....................sq. ft. 3 Seepage Pit No------1_........... Diameter.._..6!.-.Q.'.'- Depth below inlet-6.!_-D!'...... Total leaching area.26:7.+..•...sq. ft. Z Other Distribution box ( ) Dosing tank ( ) ~' Percolation Test Results Performed by.._BAXTER---&---N.YZ------------------------------------ Date........................................ 1.4� Test Pit No. I..... ---------minutes per inch Depth of Test Pit-----1-2......... Depth to ground waterNpT.-_-ENCOUNTERED Test Pit No. 2.....2.........minutes per inch Depth of Test Pit-----1.2.......... Depth to ground waterNpT---&N-COUNTERED ----------------------------------------------------------------------------------------------------......................................................... 0 Description of Soil_.Q..0-2...Q......LQAn...&...suas-O-IL.;----2._0.!.-5-.-0-'.CI.AY---&----FINES------_-------------------------- v ----- 5...0.--1.2..0...MEAD.IUM---S.AN.D---.&---CL-EAN-----------------------•---------------- --------------------------•--------------•---- W -------------- ------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------.............. UNature of Repairs or Alterations—Answer when applicable.-_.----.---ICl/A............................................................................ Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code —The undersigned further agrees not to place the system in operation until a Certificate of Compliance h ee issue board of health. Signed --X ...... .......... ............................... .. ..Dace ...-...-.....-. Application Approved By .......--- ----.....�..-!�„^^'^=, . ------ --------------------------------------------------- .....1.�.:-�'f...-.. .. Application Disapproved for t e following reasons- -------------------------------------- ........... - ............. ....-................................... -----------------Da"----------------------- ------ Permit No. ............... ................... Issued ............... ............. . -- Dace No.....PERK_.# 3782,_ Fia..:.....::......<.............. THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH TOWN OF BARNSTABLE Apphration for Di5puiial Workri Toaatitrnrtinin jrrmit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: RIVER ROAD LOT 1 ..................................•----...........................------------.....----•---_..... ...--------•---. ...---......•----•--------............-----------....----------•----------- MARGARET FII'15�d18'9`69 5 D,' INC. or Lot No. ---------------•-•-----•------.---- -----••----•----------...---..............-•-•--------................................ Owner ddress W 5 MECHANICS �TREET, BOSO TN, MA. •--------------------------•------•-----....----••-•---------------------------...-•------....... --------•------•-•-----......----............... . . 1.4 Installer Address d Type of Building Size Lot..-46. 700+— Sq. feet U Dwelling— No. of Bedrooms............................................Expansion Attic T0 ) Garbage Grinder (Ng Other—Type of Building .----N� -------------- No. of persons.............---............ Showers ( ) — Cafeteria ( ) P4Other fixtures ------------------------------------------------------------------------•--...---------- ---------------440----•--•----........-----•--....------ Design Flow.........5.5..............................gallons per person per day. Total daily flow................._..... WSeptic Tank—Liquid capacity100.0.gallons Length.10.!.--O• Width..5-l. 0'— Diameter.....NI.`... Depth�....-�.... x Disposal Trench—No. -. R/.A....... Width.................... Total Length.................--- Total leaching area....................sq. ft. 3 Seepage Pit No......1............ Diameter.....Fi'.-_0."._ Depth below inlet-6-!..O -.._.. Total leaching area.2.6.7.+..._..sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by...BAXT-FR.... -UYE•.................................... Date..........--............................ ,`4a Test Pit No. 1.....2---------minutes per inch Depth of Test Pit.....1.2.!....... Depth to ground waterNO T....ENCOUNTERED Test Pit No. 2.....,2........minutes per inch Depth of Test Pit-----1.2.1....... Depth to ground waterNOT-••ENCOUNTERED .............................................-.............................................................................................................. O Description of Soil.-Q.,Q-2-..Q.,._..LQAIAl...&...suB.S.O.IL.;....2..0.!--n5. 0.!-CLAY...&-...E-INES................................... V �`...Q-.1.2..Q...MED.IUM...S.AN -D- &...CLEAN...----•------------------•--•------•--••--------...---.............-----------•--•--•. W ------------------------- ......................................................................................................................................................................... VNature of Repairs or Alterations—Answer when applicable............R/-A...................................................•__••______......--•••-•• ------ - ---- - -- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliant as been iss d the board of health. Signed ......_........... g ..................... ................�.e................. ApplicationApproved By ..................... ............................................... ........................................................................ .................D..a.re.................... Application Disapproved for the following reasonr: ................................................................ ...................................................................... .................Da[e.................. PermitNo. ................................... ......... ...... ....... Issued .................................................................... Dare —__--__—_.----.— ____— _—_. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE k"LlPrtiftrate d C�oxaylinure THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) by ...................................................................................................................... ...................................................................................................................Installer at .................................. ................................................................................................................................................................................................................ has been installed in accordance with the provisions of TITLE 5 of The State Environmental Code as described in the application for Disposal Works Construction Permit No. ................. dated ............................................... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. ¢ ............Ins Inspector ....... ..................DATE.........' . .. ..... _........._........... .......... - THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE No....... FEE........ Diipnutt nr T o n-�--•t---....1ixn Famit . ....................................................................................-•---------•---------.._._...............Permtsston is hereby granted----------- -- -- ----- ------------- to Construct ( ) or Repair ( ) an Individual Sewage Disposal System atNo....................................................................................................................... • ---- Street as shown on the applicat• n for Disposal Works Construction Per o. . ..� .. . ated........................................... . ..... ..... Board f Health DATE...-----... --- --- .......... ....... ............. FORM 36508 HOBBS&WARREN.INC..PUBLISHERS No......:.:............... _ Fim.............................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Appliratiou for Big oottl Worlai Tomitrur#ion famit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: .....----•-•--••--'------'-'----------------------- "--'---...'-----.........•---------------'--'-- '------'----•-'--------'--.....------.......'- - -'•--'-----...--'--'----'---'•-'-•----...--------- Location Address or Lot No. .................._.......................................................................... --•••-•-••-•---------------........'--•...'---'-..........-----'•--'-...._........................ owner Address W Installer Address dType of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms.............................. . . _Expansion Attic ( ) Garbage Grinder ( ) ____________________________ No. of ersons____________________________ Showers — Cafeteria p`�,,, Other—Type of Building p ( ) ( ) a' Other fixtures _______________________________ _ _ i W Design Flow--------------------------------------------gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacitv._-._______gallons Length________________ Width_-_.__.._-______ Diameter--..------------ Depth................ x Disposal Trench—No. .................... Width-------------------- Total Length.................... Total leaching area....................sq. ft. Seepage Pit No-_----_---_----- Diameter-------------------- Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by-------- .......................................... ...................... Date........................................ 1.4 Test Pit No. I................mmutes per inch Depth of Test Pit------------------- Depth to ground water........................ 0-4 44 Test Pit No. 2................minutes per inch Depth of Test Pit........ ........... Depth to ground water........................ P4 ....-•----••----••-•......•----•-••--------•--•----•--•-•••----------•....... ........'----.._...•..----'-'-'-"'........................---------------'---- 0 Description of Soil..................................................................................... --------•------•-------•-•-•-••---•-----•-----•---••-•...----••......------------• U ...............•--......•----••--•-----------•--..-•- ---------------------------------.....................----- ------•-•---••---•••---•----••••---••---------•---•-..............--•-•-'-••'----•-- W •-•-••--------------------_ ----- ------------------------------------- ----------------------- U Nature of Repairs or Alterations— nswer when applicable._____ ----- ___ . ._. t.:......................................... Agreement: The undersigned agrees to install the aforedescribed ' dividual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Env' onmental C de—The undersigned further agrees not to place the system in operation until a Certificate of Comp 'ante has een issued by the board of health. Signed .............. `...... .................. ..... ....................... .. '-•-----..... ..........:...... Date ApplicationApproved By . ............................ ....... . ... . ................................................. ........................................ Dare Application Disapproved for the following reasonr ........ ....................... . ....................._....................................... .-- ..... . ... .........--..................---------------------------------..........---....................... .................. ----.------------...._....................................................... ................. .................. Date PermitNo- ----------------------------------------------------- ........ Issued .................................................................... Dace ^ - THE CO MONWEALTH OF MAS CHUSETTS OARD OF HEALS H TO N OF BARNSTA E ertifirate of Clomplian THIS IS TO CERTIFY, That th• Individual Sewage Disposal System cons cted ( ) or Repaired by -------------------------------------------------------------------------_.------.-------------------:--------------- ---. -- ..................................... Insrdler at .....:............_.......:..._....._......._....._..._........:......................................_.................._....... has been installed in accordance with the provisions of TITLE 5 of The State Environmental Code as described in , the application for Disposal Works Construction Permit No. ................................................ dated ... ...... ----------:.. . _........ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE...... . ............................ ......... .. .. .......... Inspector ............................................... ...... ..... ...... ...... .................................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE No......................... FEE........................ �i��nottl or�� �oa��tr�tr#ilan ��erutif Permissionis hereby granted---------------_----------_--•---------------------------------------------------------------------------------------•--•---.------------ to Construct ( ) or Repair ( ) an Individual Sewage Disposal System atNo............................---•-----------•-•----------------•------•---------------•------------------------•••------------------------------------------•-•-----------------.-•---------- Street as shown on the application for Disposal Works Construction Permit No---------_--------- Dated........................................... ..........................------•-•-----------•-...................................................... Board of Health DATE-------------------------------------------------------------------------------- FORM 36508 HOBBS 6 WARREN.INC..PUBLISHERS CO%j%10\«-EALTH OF M.ASSACHUSETTS M ;: EXECUTIVE OFFICE OF EN- iIRONMENTAL AFFAIRS DEPARTMENT OF EN-VIRONNEITAL PROTECTION 1 10 ONE WINTER STREET. BOSTON. MA 02105 61'_-=4=•�:OG ��( f %%ILL1A%1 F.WELD :•.. . , 9'p - - aSe:.: Governs• ARGEO PAUL CELL1.CCI19 Corruriss;arr_. LAt.Governor SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FO �C PART A " :,: : V _� wV lF CERTIFICATION ~�c _ s Property Ad res Ods,6a4; 6v... L Qoff, 4ts1w %4r t(s Address of Owner: ,flA113t �'�•® Date of Inspection: a S i`�� C7Z(aLl *(If different) "s Name of Inspector: - am a DEP ap roved system inspector pursuant to Section 15.340 of Title S (310.CMR 13.000) Company Name:&i�a M_rt 4r E� a'','r'� Mailing Address: 2O 731794.4 H tI"C7 e—C4-q Telephone Numbim r f-e T Cj_4�P— o CERTIFICATION STATEMENT I cen:fj that 1 have pe•sonally inspected the sewage d!sposal system a; this address and tha: the information reported be!o% is true. accurate and comole�e as of the time of inspect a The �nsper:on was pe^ormed based on my training and experience in the proper fueeicn and maintenance o;on=sae sewage disposa: systems. The system: Pastes _ Coricit-onaii% Passes Neec: Furthe• Eva!uano- Ev t -i Approving Authorm _ Fa.,t 1 Inspector's Signature: Date: S T::e 5%•s:e-r Insre_o• sha" subm:r cop, of this inspection reocr, to the Aporaving Authority within th:m, (301 da%s of completing this inspection. It the system is a shared system e- ha- a design flaN. of 10.000.gx or greater, the inspector and the sysre•r. owner sP zll submit the repo- tc the appropriate regiona► o.lice of the Depa-ment of Enyircnmenta' Frotection. The crig-na! should be se-it to the systern o ne and copes s-•t: to the buyer, ii applicable. and the approving authorir� INSPECTIC', SUMMARY: Check A, B, C, or D AI SYSTEM PASSES: have not found any information which indicates that the system violates any of the failure criteria as defined in 310 CMR 15.303. Any failure criteria not evaluated are indicated below. . COMMENTS: BI SYSTEM CONDITIONALLY PASSE5: One or more system components as described in the 'Conditional Pass- section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Indicate yes. no, or not determined (Y, N. or NDj. Describe basis of determination in all instances. If'not determined-, explain why not. _ The septic tank is metal, unless the owner or operator has provided the system inspector with a copy of a Certificate of Compliance (attached) indicating that the tank was installed within twenty (20) years prior to the date of the inspection; e the septic tank, whether or not metal, is cracked, structurally unsound, shows substantial infiltration or exfiltration, or tanl failure is imminent. The system will pass inspection if the existing septic tank is replaced with a conforming septic tank w approved by the Board of Health. t0 t SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Addcass: Owner: Date of Inspection: Bj SYSTEM CONDITIONALLY PASSES (conunu,!,d Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed pipes) or due to a broken, settled or uneven distribution box. The system will pass,inspection if(with approval of the Board of Health). Describe observations: broken pipe(s) are replaced obstruction is removed distribution box is levelled or replaced The system required pumping more than four times a year due to broken or obstructed pipe(s)._The system will pass inspection if twith approval of the Board of Health): broken pipets; are replaced obstruction is removed C FURTHER EVALUATION 15 REQUIRED BY THE BOARD OF HEALTH: l Q Conditions exist which require furthe•evaluation by the Board of Health in order to determine if the iystem is failing to protect the public health. safer and the environment. 1) SYSTEM WILL PA55 UNLE55 BOARD OF HEALTH DETERMINE5 THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: Cesspool or prn-� is within 50 fee: of a surface water Cesspoo! or prn- 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) DETERMINE5 THAT THE SYSTEM 15 FUNCT1Oti1tiG N A MANNER THAT PROTECTS THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT:- _ The s,.,stem has a septic tank and soil absorption system (SASi and the SAS is within 100 fee: to a surface water supply or tributary to a surface water supph•. _ The system has a septic tank and soil absorption system and the SAS is'within a Zone I of a public rater supriry we!l. The system has a septic tank and soil absorption system and the SAS is within 50 feet of a private water supply well. The system has a septic tank and soil absorption system and the SAS is less char. 100 fee: but 50 feet or more from a private water supply we!1, unless a we!l water analysis for coliform bacteria and volatile organic compounds indicates that the we!l is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm. Method used to determine distance (approximation not valid). 3) _ OTHER (revis4d 04:15/!7) Page 2 of 10 < Ly SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: Owner: Date.of Inspection: DJ SYSTEM FAILS: You must indicate either "Yes" or "No' as to each of the following: I have determined that the system violates one or more of the following failure criteria as defined in 310 CMR 15.303. The bans for this determination is identified below. The Board of Health should be contacted to determine what will be necessary to correct the failure. Yes No Backup of sewage into facility or system component due to an overloaded or clogged SAS or cesspool. Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool. Static ha.uid levei in the distribution boa above outlet invert due to an overloaded or clogged SAS or cesspool. Liquid depth in cesspool is less than 6" below invert or available volume is less than 1/2 day floe. Required pumping more than 4 times in the last year NOT due to clogged or obstructeo pipes:. Number o' times pumped _. Anv portion of the Soil Adsorption 5vstern, cesspool or priv�• is below the high groundN-ate, elevation An% por.:on of a cesspool or privy is withir, 100 feet of a surface water supply or tributar to a surface water supple. And porion of a cesspoo' or privy is N rthir a Zone I of a public well. Am pc^io- o-a cesspool or prnti• is ,%-rthin 50 feet of a private water supply well Any por,or o:a cesspool or prnv is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable Nate, qualit% analysis. If the well has been analyzed to be acceptable. attach cope of well water analysis for coliform bacteria volatile organic tornpounds, ammonia nitrogen and nitrate nitrogen. E] LARGE SYSTEM FAILS: You must indicate either "Yes" or "No" as to each of the following; The iolioN:ng criteria appi% to large systems in addition to the criteria above: The system serves a facilin with a design flow of 10,000 gpd or greater (Large System; and the system is a significant threat to public hea!th and safes and the environment because one or more of the following conditions exist: Yes No . the system is within 400 feet of a surface drinking water supply the system is within 200 feet of a tributary to a surface drinking-water supply the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area - IWPA) or a mapped Zone 11 of a public water supply well) The owner or operator of any such system shall bring the system and facility into full compliance with the groundwater treatment program requirements of 314 CMR 5.00 and 6.00. Please consult the local regional office of the Department for further information. i (revised 04/2s/97) Page 3 of 10 n y SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address:DI 12t✓(IG v Owner: Date of Inspection: 1 G Check if the following have been done: You must indicate either "Yes".or "No" as to each of the following: Yes No_ Pumping information was provided by the owner, occupant, or Board of Health. None of the system components have been pumped for at least two weeks and the system has been receiving normal flow rates during that period. Large volumes of water have not been introduced into the system recently or as part of this inspection As bull: plans have been omained and examined. Note if they are not available with N,A. The facdir� or dwelling %%as inspected for signs o;sewage back-up. The system does not receive non-sanitary or industrial waste flow. i The site %%as inspected for signs of breakout. All sv5terr• components. excludine.the Soil Aosorption System, have been located on the site. y The septic tank manholes were uncovered. opened. and the interior of the septic tank was inspected for condition of baffies or tees. materia' o' construction, dimensions, depth of liquid, depth of sludge, depth of scum. The size and location of the Soil Absorption Svstem on the site has been determined based on The facdjvn ovine, ano occupants. if dirteren; trom owneri were provided with information on the proper maintenance of Sub-Surface Disposal Svsterr.. _ Existing information. Ex Plan at B.O.H. X _ De-,ermined in the field !r an,. of the failure criteria related to Part C is at issue, approximation of distance is TT unacceptable (13.302.3t:bi! (revised 04/25/5?) Page 4 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 6'Z(, IUziE Owner: Date of Inspection:A WIT FLOW CONDITIONS RESIDENTIAL: Design ilo%% 2-g p.d./bedroom for S.A�S Number of bedrooms Number o-'current residents Garbage g•: der (yes or m:jSj Laundry connected to system (yes or no! Seasonal use (yes or no,: _�J Water meter readings, if available (last two Q vear usage (gpd): �4 Sump Pump lves or no) Lai, date o-occupancy -paw(V� COMMERC IAL'INDL'STRIAL: Type of establishment Design fio�% Rahonsba% Grease trap present tees or no Induscrta! \baste Holding Tani; present Ives or no ':on-sanitan Haste dscnarged to the T+tie 5 system eves or no_ \%ater meter readings. if a%ailabie Las:pace o: o Cu.21c. OTHER: .De:cnbe last sate of occuoanc. GENERAL INFORMATION PUMPING RECORDS and source i inform tior, System pumped as par, of inspection: Ives or no. If yes, volume pumped Rallons- Reason for pumping TY SYSTEM li --/�—�F— Septic tank/distribution box'soil absorption system Single cesspool Overflow cesspool Shared system (yes or no) (if yes, attach previous inspection records, if any) I/A Technologv etc. Copy of up to date contract? Other APPROXIMATE AGE of all components, date installed (if known) and source of information: , ) Sewage odors detected when arriving at the site. (yes or no) N� (revised 04/25/9"7) page 5 of 30 SUBSURFACE SB AGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: Owner: Date of Inspection: 2lSl 1� BUILDING SEWER: (Locate on site plan) Depth below grade. other (explain! 40 P�C o p f n tr ion: cast iron _ Material o co s uct _ _ Distance from private water supply well or suction Ii-� Diameter Comments: (condition of joints, venting, evidence of leakage. etc.) SEPTIC TANK: (locate on site plan Depth below grade lL�� Material of construalon K concrete —me-.a _Fioerglass _Polyethylene _othertexplarn If tank is me:al. Its: age _ Is age confumec o� Cen,fica:e of Compuance _(les.,No Dimensions Woo-( Sludge depth„ _ Disiance from top o: s!udee to bosom o' outie: tee o, ba.;;;e Scum thickness--(,I if Distance from top of scum to top of outlet tee or bay Distance iron bottom of scum to bo, o•n o;outte: tee e• bar7 e How dimensions Here determined fit. COLLUo.td-_ Comments trecommendation for pumping. .condition of iniet -no tlet tees or baffles, depth of liquid level in relation to outlet invert, struct ral integ�ity e.idence of leakage, etc.) ) t P + L tit 11-7 T GREASE TRAP:—f—it. (locate on site plan; Depth below grade: Material of construction: _concrete _metal Fiberglass _Polyethylene —other(explain) Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle. Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping: Comments: (recommendation for pumping, condition of i!ilet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity, evidence of leakage, etc.; (rev:.sed 01/35,17) Page 6 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Propem Address: w(' &t/efe, ON ner: Date of Inspection: TIGHT OR HOLDING TANK: kJb Tank must be pumped prior to, or at-time, of inspection) (locate on site plan, Depth below grade Material of construction. _concrete _metal _Fiberglass _Polyethylene _other(explain) Dimensions: Capacm, gallons Desig^ flo" gal)ons;da. Alarm level Alarm in working order _ Yes. _ No Date of previous pumping Comments (condition of inlet tee. condition o- a!a,m and float switches. etc.) DISTRIBUTION BOX: S (locate on site pa- } Death of licuid le%el aoo�-e oune: .me^ Comments II (note if leve! and distributior � e :ua' e"'derce of solids carryover evid n e of leakage into o out f box, etc.) 1 PUMP CHAMBER: (locate on site plan. Pumps in working order: (Yes or No` I Alarms in working order (l es or No, Comments: (note condition of pump chamber, condition of pumps and appurtenances, etc.) (revised 04/25/97) Page 7 of 10 I • •. V SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Addr-ss: Cr'46,VL, Owner: Date of Inspection: kb SOIL ABSORPTION SYSTEM (SAS): (locate on site_plan, if possible; exca, on 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,iength: leaching fields, number, dimensjons overflow cesspool, number Alternative system Name of Tecnnoiog" Comments. inote condi c,n of soil, s gn.s of hydraulic failure, leve' of pondin . con do f vegetation, etc.) try' ti A VtAn CESSPOOLS: (locate on site plan. Number and configura:,on. Depth-top of liquid to inlet Inver, Depth of solids Jaye, Depth of scum layer. Dimensions of cesspool Materials of construction Indication of groundwate- inflow• (cesspool must De pumper as par, of inspection: Comments. (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) PRIVY: (locate on site plan) Materials of construction: Dimensions: Depth of solids: Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) (z.va..d 04/25/97) page 8 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C t� �A SYSTEM INFORMATION (continued) Property Address: Owner: Date of In,pection: 1� SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent references landmarks or benchmarks locate all wells within 100' (Locate where public water supply comes into house) � z 63 h W - 3G � - a Ys (revised 04!25!5') Page 9 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C / SYSTEM INFORMATION (continued) Property Address• rdZrrb Owner: Date of Inspeciton:���� Depth to Groundwater Feet I• Please indicate all the methods used to determine High Groundwater Elevation: Obtained iron Design Plans on record Observation of Site (Abutting property, observation hole, basement sump etc.) Determine it from local conditions Cnec'k %+rth loca! Board o• nea!tr Chec'K FE.ti1A naps Check pumping records Check local eaca.ato,s. installe•s xlse LSCc Da--a 7�'ram• Describe in you, o%%-. %••oro- r.o,.% %o:: es:ab!!5hed the Hiigh Groundwater Elevation. (Must be completed: V- - I (revised 01;25'9- Page 10 of 10 1 U RP ✓TOWN OF BARNSTABLE 6)) ,LOCATION SEWAGE #A10 6" " V 1,I AGE AS S 10 t/-$ flil� � ( s ASSESSOR'S MAP & LOT��I O 3 IN§5TALLER'S NAME&PHONE NO. Sawed t — 'q"0�_ y g ycr SEPTIC TANK CAPACITY L8ACHING FACILITY: (type) �Ss 0 (size) /j Off' CY �!Q i NO:OF BEDROOMS BUILDER OR OWNER R©lt S A PERMITDATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet o I aching faci j' ) Feet Furnished by i �3� , air No. / Fee 50 THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS 2pprication for Mtopogar *p5tem Congtruction Permit Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. Owner's Name,Address and Tel.No.`-its CIZ14rO s rew ar,+ Assessor's Map/Parcel O G f 675 h1- (o a (a Y�l v eg— R"t, Installer's Name,Address,and Tel.No. G l�— 9 7 q p Designer's Name,Address and Tel.No. ke V,, m o c l e N 14 07Z R- 1 N C -'o Y4 e- 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 X O D 4a / Type of S.A.S. Description of Soil 1 Nature of Repairs or Alterations(Answer when applicable) �P M a V o Am /O 0 0 q eg- t 'E 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 th Board of)Jealth. Signe Date Application Approved by Date Jr Application Disapproved for the following reasons Permit No. :t00A1 9-/7 Date Issued 5 —D`( THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS (Certificate of (Compliance THIS IS TO CERTIFY, that the On-si e Sewage Disposal System Constructed( )Repaired( )Upgraded( ) Abandoned( )by a at has been constructed in accordance with the provisions of Title,5 and the for Disposal System Construction Permit NoQPQ q —J-7 dated h Installer( Designer The issuance f his pe t shall not be construed as a guarantee that e syste �Iuh ion designed. Date Inspecto ———————————————— ————————————————————— No. ��� Fee 5o THE COMMONWEALTH OF MASSACHUSETTS r Entered in computer: Yes _ PUBLIC HEALTH DIVISION =TOWN OF BARNSTABLE, MASSACHUSETTS 2pplicdtion for Mtgpoga.r *p! tem Congtruction Permit _f Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components (� Location Address or Lot No. f '� �t J L Owner's Name,Address and Tel.No. Assessor's Map/Parce1 b ✓1�- M t ��s Vt2�(0 S re W Q x+ oG/ 3 (,a (_ Vr-g-- Cab. I Installer's Name,Address,and Tel.No. sr��,z/— Z/)�/V Des ner's Name,Address and Tel.No. /fie ✓i/,/ 5/"o//rx C I e N 1`f 41e k I�`' C -r 0 x/ q. flt°q/ s �1� Fr �Rlr„Ou �� pA/-155 9 I-eoI4 ka5e � �✓e 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 Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) A,v ti JP— 149 /G 0 o q( 1 /1/y/J �i'P � 7e-a V 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 t �is�Boardofealth. Signe Date Application Approved'by Date S !v o Application Disapproved for the following reasons Permit No. ^ a Date Issued 5 THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of (Compliance THIS IS TO CE TIFY, that the On-sit Sewage Disposal System Constructed( ) Repaired (V,)Upgraded ( ) Abandoned( )by ,V ,inn at (n a to B >m YY\ has been constructed)n���o dance with the provisions of Title 5 and the for Disposal Sysiem Construction Permit No. G 41 '4�1 77 dated Installer WzK Designer_..---, The issuanceyliis t,iL!�hall not be construed as a guarantee that he system i fi action a designed. Date Inspector No. pKiCJL� _ O-'(^7( ------------------------Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS xigpogat *pgtem Construction Permit Permission is hereby granted to .struct�)R a_i�g )Upgrade )Abandon( ) System located at (")c� � CoZ oQ ►— j D �_, 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: Constru 'ion ust be completed within three years of the date of this rm . Date:_ � � Approved by U(� lip TOWN OF BARNSTABLE �` LOCATION fz SEWAGE #c- �o " VILLAGE W t A'Z S IQ r'f Al, ( ( s ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. S n,d t SEPTIC TANK CAPACITY I �'A e7 LEACHING FACILITY: (type) 7"Oft) Cc P`0 (size) f, 00 CO c� NO.OF BEDROOMS BUII.DER OR OWNER PERMITDATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet o 1 ching faci j' ) Feet Furnished by {I 11 e� Town of Barnstable oFt"E'°w Regulatory Services " Thomas F.Geller,Director G RjjSTABLE �I,}y9ti BARNSCABLE, MAC. `0$ Public Health Division i0len►�'�° Thomas McKean, Director 2%SAY e 3 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Installer& Designer Certification Form Date: 7i /lOj- Designer: tx(,an•E. E fa,r✓_cn5 to y Installer: �(P,yCv� .�tM.o`��✓ Address: �l Wog- fro I- rt Address: �`� �'�3's <o d 04 M 5bq'w5 /0 F41 �o� fy►�rj o 2, fT On �C �� �h to1�� was issued a permit to install a (date) (installer) septic system.at 2 b (Ztv�,r 2� /� ` based on a design drawn by '-(address), �p„vvL VJ� h �• S dated_ ' o ` ddsigner) - _. ✓ I certify that the septic system referenced above was installed substantially according to the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. I certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system)but in accordance with State & Local Regulations. Plan revision or certified as-built by designer io follow. OF�gGLEN s�9cti ERIC G ( aller's Signature) 5HARRINGT4N co No.1070 0 sgANTA.. (Designer'-s Sigii� re)- - (Affix Design tamp Here) PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE _W-ILL NOT .BE`ISSUED UNTIL BOTH THIS FORM AND AS- BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. Q:Health/Septic/Designer Certification Form Town of Barnstable Regulatory Services Thomas F. Geiler,Director • BARNSiABM MASS. g Public Health Division �,e a6gq• �� Thomas McKean, Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Installer& Designer Certification Form Date: 42? VO-1- Designer: Cr&..,E. J�xr✓-t!jL� Installer. J(P,vcv) Suti.O 1Jer Address: Of Lc v,- ISO ye �- h Address: "Cf'2"5 ~�� /of'di �^ ,(1 f Iv.L, On �� "` �irla �� was issued a permit to install a (date) (installer) septic system at_ (9 2 b �tv4,y 2� / 4 114 based on a design drawn by (address) I yp�vvt �o� �- .�� dated 4 r I'l0 y designer) I certify that the septic system referenced above was installed substantially according to the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. I certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system) but in accordance with State & Local Regulations. Plan revision or certified as-built by designer to follow. OF Mgss9cy GLEN ERI �+ (In taller's Signature) HARRiNGTON CO No.1070 0 �gNIT ARk\ (Designer's Sign re) (Affix Design tamp Here) PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS- BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. Q:Health/Septic/Designer Certification Form T 'd esa :90 so ao Rew TOWN OF BARNSTABLE LOCATION �ye 1IL . 'ACC SEWAGE# VILLAGE Mt&!2k�C (V\L i k5 ASSESSOR'S MAP &LOT k INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY 1 Mb S118A LEACHING FACILITY: (type) (size) NO.OF BEDROOMS �pp BUILDER OR OWNER` Ob�►.�� Pffltl9fffDATE: � S\ t ----.COMPLIANCE DATE: Separation Distance Between the: t 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 QAZ—R- 7 o � A k 51 �1 1 �3 0`23 try " 30 6q- A' .- . 11- "E N 6 0 6 POLE / LOT 1 VIC 46, 700fsf >: \ "E 54 332 06 / �53 4645 I �` POLE ESER / AREA / #4B44 w / w ' p 1111OF .� �9gs�giy POL'E .., ` JOHN y� . _ LANDEC CIVIL AULEY . CAP No.35101 \ ACH RIVE - 0 12 L G 33 '' .for GIST EE k`L� \�Dq21° 0'0N / / F'6'bNAl TEL. o - - '- 10,0 G L M.H. \ \ rn _26_� SE TIC TAN / t� 0 / o rn / /� � � 0 / .o / PROJECT L OCA TION .. o / � LOT 1 R`I I VE'R ROAD i w ,/ / / / / 0� � BARNSTABLE; MA �p POLE BENCHMARK #47A E�y� A PPL lCA N T. 5 DINC.IN TOP OF TAG BOLT 1 ° Ly 5 MECHANICS ST. ASS EL.=50.0 BOSTON, MA YANKEE SURVEY CONSULTANTS P. O. BOX 265 UNIT 5, 40B INDUSTRY ROAD MARS TONS MILLS, MA. 02648 PH.(508)428—0055 — FA X(508)420—5553 SCA L E.• 1"=4 0' DA TE. DEC. 6, 1:9:9:3:]l REV.• NO V 29, 1994 REV.- JOB NO. 50414 SHEET 1 OF 2. NSITE PLAN "Marstons Mills" N SCALE: 1"=20' BENCH MARK ON CORNER OF CONCRETE 0 o )COO BULKHEAD, ELEV.=100.00' (ASSUMED) 60' 90 O �i+ 00, O 0 Joshua's I T Pond I �32 omestea ; LOT 1 AREA = 46,700t SQ.FT. -LOCUS NO SCALE X 103,74' X 98.73, 97.84' PROPOSED LOCATION OF RELOCATED SEPTIC TANK O O (INSTALL 1.500 GAL H-10 S.T. IF EXISTING S.T. IS INACCESSIBLE OR STRUCTURALLY UNSOUND) X 9944' fY'99 01. �• � _,,fie�b Od__ grovel driveway 5(. a� 0. NCj sea. °G O ing SAS ay1� .tap R 00.16' at p JQaet9taVn �w.�. 99.40' X 10322' GENERAL NOTES 1. ADDRESS: #626 RIVER ROAD Aa 2. ASSESSORS NUMBER: MAP 061 PARCEL 033 ap 3. DEVELOPER'S LOT: LOT 1 4. TOPOGRAPHIC INFORMATION WAS COMPILED FROM AN ON THE GROUND INSTRUMENT SURVEY ' t,. - .._�_. .-.... _ 5 rr'1R1>.. 4 7 r -1.S_.- OVIDZrr PRO! "P'T", �A 6. REFERENCE PLAN: PLAN BOOK 311 PAGE 55 7. NO WETLANDS ARE LOCATED WITHIN 100 FEET OF SAS. 0 8. NO POTABLE WELLS ARE LOCATED WITHIN 150 FEET OF SAS. O a CONSTRUCTION NOTES c 1. Contractor is responsible for Digsafe notification O - 3-W DAM.ACCM YMMOM and protection of all underground utilities and pipes. 2. The septic tank and. distribution box shall be set 1a -o• level on 6 of 3/4'-11/2 stone. 3. Backfill should be clean sand or gravel with no stones over 3" in size. 4. This system is subject to inspection during installation • by Glen E. Harrington, R.S. KU 5. The contractor shall install this system in accordance with Title V of the Massachusetts Environmental Code and the Regulations of the Town of Barnstable. ::k•- '••:.•_ 6. Provide an Acme Precast H-10, 1,500 gal septic tank (if necessary), .STEEL REINFORCED PRECAST CONCRETE and 1 H-10 5—hole Distribution. box or equal PLAN VIEW 7. No vehicle or heavy machinery shall drive over the 3-20"11DWASIX oovmseptic system unless noted as H-20 septic components. 1 8. Install gas baffle or equal on septic tank outlet tee end. _ ;, .,.,,, �• •►:. 9. All existing inverts and site conditions shall be verified by contractor. n1m.dowar" hr sea T 10. Existing leach pit to remain. sREr a mMh. r min.Mot to W" Ir �-�T 11. If existing septic tank is inaccessible or structurally unsound after relocation, sue• ° ""A" : s -o" install new H-10, 1,500 gallon septic tank per Title V. otts e� iX-Inv.� (� I�AOF�yq� PROPOSED SEPTIC TANK RELOCATION J •,' •' 'i s PREPARED FOR C-0' CROSS SECTION END—SECTION E CRAIG W. STEWART ET UX H-10 1500 GALLON SEPTIC TANK " RI Iy AT NOT TO SCALE LEGEND 1 U o #626 RIVER ROAD USE ACME PRECAST OR EQUAL �' `cO1S�E � O EXISTINGREMAINEACH PIT qN/TAFt1 BARNSTABLE (MARSTONS MILLS), MA Existin Dwelling `10' min. from *NOTE: ALL PIPES ARE TO BE 4" DUI. SCHEDULE 40 P.V.C. 9 g house to septic tank *NOTE: INSTALL GAS BAFFLE OR EQUAL ON SEPTIC TANK OUTLET TEE. Septic tank coven must be Finished grade over system=2x slope away PREPARED BY: First Fl. EI.=101.45' whin 6"of frdshed grade cellar JOIN. EXIST] DE D s.Box Existing Grade Elw.-]OVA 0 0 o H-1100SED 1,500 SEPTIC TANK GAL. GLEN E. H A R R I N GTO N, R.S. wall D-Box cover must be Min. 2"-1/8*-1/2" 1 clamber cow must be 2•min. 9 LEDA ROSE LAN E within 6"of ished gads double washed stons within 6" finished grade •max, X 104.46 DENOTES EXISTING Raise invert to . MLevel far 2' SPOT GRADEMARSTONS MILLS, MA 02648 proposed dev-g7.69 PROPOSED 23. s 01 TEL: 508-428-3862 1.50015 95 EXISTING CONTOUREn3f SEPTIC TANK _H-10 $ = === = GAs M 0 o APPROX. LOCATION FAX: 508-428-3862 > _ ___ _ • EXISTING WATER LINE 6"OF 3/4"-11/2" STONE O a o 0 0 0 � o 0 00 =0 1 APPROX. LOCATION SCALE: 1"=20' DRAWN BY: GEH APRIL 11, 2004 EXISTING WATER LINE SYSTEM PROFILE e•OF 3/e-It/2• STONE FILE: FRUEAN SHEET 1 OF 1 Not to Scale EXISTING LEACH PIT DATUM: ASSUMED Wb'6tr L0 l L trOf�lltr- l �Jb'd L ���70W Nvin'ii -._.