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HomeMy WebLinkAbout0029 ROSS LANE - Health 29 Ross Lane Marstons Mills A = 123 035 TOWN OF BARNSTABLE LOCATION 2 SEWAGE# 7 � lf!» -s �J VILLAGE/ 5 � /?'I�/r� ASSESSOR'S MAP&LOT 3 35 INSTALLER'S NAME&PHONE NO. f/e SEPTIC TANK CAPACITY LEACHING FACIIITY: (type) 3 7(letN,0_(I5 (size) NO.OF BEDROOMS 3''JJ -- BUILDER OR OWNER .f?7 '� nrti PERMITDATE: /0 ! 7 COMPLIANCE DATE: / IZ 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 f )qC =7 AD 37-CO C � . 22 r � G g60G No. 1 ! Fee J&CO 1 THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS 0[ppYication for -Miopogal *pgtem Construction Permit Application for a Permit to Construct(Repair( )Upgrade( )Abandon( ) A Complete System ❑Individual Components Location Address or Lot No. ! R Qy—T"r)a Owner's Name,Address and Tel.No. 7 / 30/ °f Mar6T0I)5 MiJIS Pgct� SwCty] Assessor's Map/Parcel lvvP 121 r'giCe l 3 P.a, Q O�L /2 I Y t� 1 r S Installer's Name,Address,and Tel.No. rx>8 Sqo— 3,03 Designer's Name,Address and Tel.No. GU-- N Syl 305,017 Hdive fbw✓> ea0pe Fi✓1a j, a✓io97., L✓lc. 2s7 Palms,- R✓� cf SO/ Ma,'h sr1 fu1,MO4Th Mao. a . 024-75 Type of Building: Dwelling No.of Bedrooms Lot Size 0_1 '771 sq. ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow /M gallons per day. Calculated daily flow `3 3 5r,Q gallons. Plan Date 9 77 Number of sheets Revision Date Title MCI Sewa9t* 7-12 o f LoY f 7 6RO O$rrryi rle hgxd , iMarX lws M,'03 i Size of Septic Tank 15oo. Type of S.A.S. 5-560 9a 1 Lmnh; . � / O✓�a FOPS �" 2� STO✓IB �i9��j Description of Soil Sce 904 Ln atn Ple,0 olotr 1-IS-0/7 Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construct n a ntenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of e Envir menta Code and not to place the system in operation until a Certifi- cate of Compliance has been issued by d o lth. Signed Date ' Z`^ Application Approved by Date Application Disapproved for tv following reasons Permit No. ti .�V`� Date Issued ���- r _ _ - `t J, -- No. Fee too ,R :_"_'0 4 THE COMMONWEALTH OF MASSACHUSETTS Entered in corn �• r• Yes PUBLIC H ALTH THE -TOWN OF BARNSTABLE, MASSACHUSETTS i 0(pplica On for -Mi!5po9;a1-*patent Construction Permit Application for a Pernut:to Construct(L�)Repair( )Upgrade( -)Abandon( ) CXComplete System ❑Individual Components Location Address or Lot No. ar�)�1-Gt I)E Owner's Name,Address and Tel.No. mcl'sloo5 Vv1illS 4/1 �U�Cl�/ Assessor's Map/Parcel MG1 P 2 Pu lee 1 s f' 1 C Y /? F1,.��,-r-� 5 d✓iC� ��(,C> Installer's Name, ddress,and Tel.No. �� y0- 3�< Designer's Name,Address and Tel.No. �' 3o>PP,pph it el,�✓(� ►how✓) eaee E v19),��,�.i� Z�7C, 2r7 PaIrAP, A✓G c1 3../ MOitv7 ST c7 FctjwiouTh, Mot, Yolrw,d �7 1064 , 02G75� Type of Building: ' Dwelling No.of Bedrooms Lot Size �q 7� sq.ft. Garbage Grinder( ) Other Type of Building No. of Persons Showers( ) Cafeteria( 1� Other Fixtures -4 Design Flow ?�O gallons per day. Calculated daily flow 3?�� gallons. Plan Date 'F 9 77 Number of sheets Revision Date Title D rwey2e flay? of LC7 /7 f�/�l 0�7rit i�rc� , cad tMcrv�lCY)5 ✓Vl,l�j �a 1 Size of Septic Tank �,�'O�• Type of S.A.S. C° c� r„ �� �„�,,, r J i j c7c. f R Description of Soil Sc-e O'f � ir' Pic„� r,c17P - 15 �7 Nature of Repairs or Alterations(Answer when applicable) Date last inspected: r Agreement: The undersigned agrees to ensure the 076 'on•and-m ' tenance'of the afore described on-site sewage disposal system in accordance with the provisions of Title 5viro mental ode and not to place the system in operation until a Certifi- cate of Compliance has been issued by i th. Signed Date ��-2���/ Application Approved by Date Application Disapproved for a following reasons Permit No. 6- Date Issued 9-?Z l 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 30�P NUrve at 2,7 feo55 , rnU )Otos has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. 1 TT 3 dated gyp'g T Installer 1O5e. ✓h PC4o'V Psi Designer pow l�' r /�P�'�' The issuance of this permit shall not be construed as a guarantee that the sys m ill fu cti designed. Date Z /+7 Inspector ' ——————————————————————————————————Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS Miopooa[ *p6tem Con.5truction Permit Permission is hereby granted to Construct(>0 Repair( )Upgrade( )Abandon( ) System located at .Q )y , M 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 _ , 1 TOWN OF BARNSTABLE LOCATION 7 y ?�o /117iC- SEWAGE# YII.LAGE ,ems 411� /J'I���S ASSESSOR'S MAP & LOT 3 5 `'. INSTALLER'S NAME&PHONE NO. ctr 2 SEPTIC TANK CAPACITY :::- LEACHING FACILITY: (type) I AZO W,015 (size) NO.OF BEDROOMS :.BUILDER OR OWNER I kin d42n&� PERMIT DATE: /0 "Z 12 7 COMPLIANCE DATE:_/I- I Z 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 within300 feet of leaching facility) Feet i Furnished.by :- --4 6� d� ,;. COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION ' A a RECEIVE® � V MAY 1 5 2003 TOWN OF BARNSTABLE TITLE 5 HEAL T H DEPT. OFFICIAL,INSPECTION FORM.—NOT FOR.VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address:jq—Rn/,3.0 Owner's Name' z Owner's.Address: Date of Inspection: MAP ''^^ II PARCEL . Name of Inspecto please rint) � �. IC A Company.Nam LOT Mailing Address: 0 Telephone Number: _ f 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 the inspection.The inspection was.performed based on my.' training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: Passes Conditionally Passes Needs Further Evaluation by the Local Approving Authority ails Inspector's Signature: Date: 3 The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. 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 DEP..The original should be sent to the system owner and copies sent to the buyer, if applicable,and the approving authority. Notes and Comments ****This report only describes conditions at:.the time.of inspection and under the conditions of use.at that time. This inspection does not address how the system will perform in the future under the same or different conditions of use. Title 5 Inspection Form 6/1.5/20.00 page 1 Page 2 of 1 1 OFFICIAL INSPECTION FORM.-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: IAIA 5� Owner: Date of Inspection: 00 Inspection`Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A.7stem Passes; I have not found an information y which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below. Comments: B. =System Conditionally Passes: One or more system components as described in the"Conditional Pass"section need to be replaced or repaired.The system,upon completion of the replacement or repair;as approved by the Board of Health,will pass. Answer yes,no or not determined(Y,N,ND)in the, for the following statements. If"not determined"please explain. The septic tank is metal and over 20 years old* or the septic,tank(whether metal or not)is structurally unsound, exhibits substantial infiltration or exfiltration or.tank failure is imminent.System will.pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND explain: Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken,settled or uneven distribution box. System will pass inspection`if(with approval of Board of Health): broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced ND 'explain: The system required pumping more than'4 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 ND explain: 2 Page 3 of I I OFFICIAL INSPECTION FORM -' NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property A ress: A0 Ize Owner: Lkg Date of Inspection: Q . 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 public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that.the system is not functioning in a manner which will protect public health,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 any)..determines that the system is functioning in a manner that protects the public health,safety,and environment: _ The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of surface water,supply or tributary to a surface water.supply. — The system has a septic tank and SAS and the SAS is within a Zone I of a public water supply. _ The system has a septic tank and SAS.and the SAS is.within:50 feet of a private water supply welL _ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a. private water supply well". Method used to determine distance "This system passes if the well water analysis,performed at a DEP certified laboratory, for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and. the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form. 3. Other: 3 Page 4 of 1 1 OFFICIAL INSPECTION FORM—NOT.FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM .PART A CERTIFICATION(continued) Property Address: n Owne&,(2� Date of Inspection: .7/0� a G D. System Failure Criteria applicable to all systems: You must indicate"yes or"no"to each of the following for all inspections: Yes Nq % Backup of sewage into facility or system component due to overloadedl or clogged SAS or cesspool _ Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogcred 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!/z day flow Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number oftimes pumped _l Any portion of the SAS,cesspool or privy is below high ground water elevation. Any portion of 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. [This system passes if the well water analysis, performed at a DEP certified laboratory, for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that faeilityand the presence:of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,.provided that no other failure criteria are triggered. A copy of analysis must be attached to this form.] (Yes/No)The system fails.I have determined that one or more of the above failure criteria exist as described in 310 CMR 15:303,therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct'the failure. E. Large Systems: To be considered a large system the-system must serve a facilitywith a design flow of 10;000 gpd to 15,000 gpd You must indicate either"yes"or"no"to each of the following: (The following criteria apply to large systems in addition to the criteria above). 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 II of a public water supply well If you have answered"yes"to any question in Section E the system is considered a significant threat,or answered "yes" in Section D above the large system has failed.The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304.The system owner should contact the appropriate regional office of the Department. 4 Page 5 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY. ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST -79 Property Address: �Q Owner: Date of Inspection: Check if the following have been done.You must indicate"yes"or"no"as to.each of the following:- Yes No Pumping.information was provided by the owner,occupant,or Board of Health. Were.any of the system components pumped out.in the previous two weeks? Has the system received normal flows in the previous two week period? ZHave large.volumes of water been introduced to.the system recently or as part of this inspection? Were as built plans of the system obtained and examined?(If they were not available.note as N/A) -lam — Was the facility or dwelling inspected for signs of sewage back up j _ Was the site inspected for signs of break.out? Were all system components,excluding the SAS, located on site Were the septic tank manholes uncovered,opened,and the interior of the tank inspected for the condition of the baffles or tees,material of construction, dimensions, depth of liquid, depth,of sludge and depth of scum? Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)or,the site has been determined based on: Yes no. Existing information.For example,a plan.at the Board of Health. Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(3)(b)] 5 Page 6 of I I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: rVQ G Owner: Date of.Inspection: FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design)::. Number of bedrooms(actual): DESIGN flow based on 310 CM 5 203 (for example: I` O gpd x 4 of bedrooms):Z Number of current residents: _ Does residence have a garbage grinder(yes or no): Is laundry on a separate sewage system :es or no • r.:[if yes separate inspection required] Laundry system inspected(yes or no) Seasonal use: (yes or nKfavta�il Water meter readings, ble(last 2 .gears usage(gpd)): D�'���,OG� ©Z"�✓`��,d�f.� Sump'pump(yes or no). y' Last date of occupancy: ' ���QiQ,L• COMMERCIAL/INDUSTRIAL l Type of establishment: Design flow(based on 310 CMR 15.203) gpd Basis of design flow(seats/persons/sgft;efc.): 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/use: OTHER(describe): GENERAL INFORMATION Pumping Records Source of information: Was system pumped as part of the'i spection(yes or no):. If yes, volume pumped: gallons---How was quantity pumped determined? Reason for pumping: TYPE OF SYSTEM Septic tank,distribution box,soil absorption system Single cesspool _Overflow cesspool _Privy _Shared system (yes or no)(if yes,attach previous inspection records, if any) _Innovative/Alternative technology.Attach a copy of the current operation and maintenance contract(to be obtained from system owner) _Tight tank —Attach a copy'of the DEP approval Other(describe): Ap roximate age of all comp nen ,date in tailed( nown)and source of information: / 79 rg Were sewage odors detected when arriving at the site(yes or no) `.�,' 6 Page 7 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY.ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM..INFORMATION(continued) Property Address: Owner: Wa Date of Inspection: BUILDING SEWER(locate on.site p.lan)A d Depth below.grade: Materials of construction:_cast iron . 40 PVC_other(explain): Distance from private water supply well or suction line: Comments(on condition of joints,venting,evidence of leakage,etc.): SEPTIC TANK: (locate on site plan) Depth below grade: Material of.construction: concrete_metal_fiberglass_polyethylene _other(explain). If tank is metal list age:_ Is age confirmed by a Certificate of Compliance(yes or no):_(attach a copy of certificate) Dimensions:S `X 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 teesor baffle: How were dimensions determined: .� e� Comments'(on pumping recomme ations, nlet and outlet tee or baffle condition,structural integrity, liquid levels elated to outlet in ,e ei erce of leakage,etc.): GREASE TRAP- cate 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(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): 7 Page 8 of 11 OFFICIAL.INSPECTION FORM—NOT FOR:VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION`(continued) Property Address: Owner�6Z Date of fnlspection: TIGHT or HOLDING TANK (tank must be pumped at time of inspection)(locate on.site plan) Depth below grade: Material of construction: concrete metal . fiberglass_polyethylene other(explain): Dimensions:' Capacity: gallons Design Flow: gallons/day Alarm present(yes or no): Alarm level: Alarm in working order(_yes or no): Date of last pumping: Comments(condition of alarm and float switches, etc.): DISTRIBUTION BOX: if resent must be'o ened locate on site plan) �l P P )( P ) Depth of liquid level above outlet invob� A*a Comments(note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of agg into or out of box, etc. PUMP CHAMBER-40— (locate on site plan) Pumps in working order(yes or no): Alarms in working order(.yes or no): Comments(note condition of pump chamber,condition,of pumps and appurtenances,etc.): 8 Page 9 of I 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: aq Owner: Date of Inspection: SOIL ABSORPTION SYSTEM (SAS): locate on site plan,excavation not required) If SAS not located explain Nyhy: Type leaching pits,number:_ leaching chambers,number: leaching galleries, number: leaching trenches, number, length: leaching fields,number, dimensions: overflow cesspool,number: innovative/alternative system Type/name of technology: Comments(note condition of soil, signs of hydraulic.failure,level of ponding, damp soil,condition of vegetation, etc Y 5�v CESSPOOLS(cesspool must be pumped as part of inspection)(locate on site plan) Number and configuration: Depth'—top of liquid to inlet invert: Depth of solids layer: Depth of scum layer:. Dimensions of cesspools Materials of construction: Indication of groundwater inflow(yes or no) Comments(note condition of soil,signs of hydraulic failure, level of ponding, condition of vegetation,etc.): PRIVY_ `J�_(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.): h 9 I Page 10 of 11 OFFICIAL INSPECTION FORM NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM.INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: Owner• Date of Inspection: Q� SKETCH OF SEWAGE DISPOSALSYSTEM Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet.Locate wherepublic water supply enters the building. z - it y �0a q) 044 10 Page 11 of 11 OFFICIAL INSPECTION FORM_NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: IQl Owner: Date of Inspection: 61 SITE EXAM Slope Surface water Check cellar Shallow wells - Estimated depth to ground water 2 feet Please indicate(check)all methods used to determine the high ground water elevation: Obtained from system,design plans on record-If checked,date of design plan reviewed: Observed site(abutting property/observation hole.within 150 feet of SAS) Checked with local Board of Health-explain: Checked with.local.excavators, installers-(attach documentation) Accessed USGS database-explain: You must describe how you established the high ground water elevation: /`nr wyw S, 11 I Permit Number: Date: Completed by: HIGH GROUND-WATER LEVEL COMPUTATION Site Location: [ �s Lot No. Owner. 5a Address: Contractor: j P �/ Address: Notes: Cj'/�� C7/t STEP 1 Measure dept-,to water table • N to nearest 1/10 ft. ................................................. ................:......... .Date month/day/Year STEP 2 Using Water-Level Range Zone and Index Well'Map locate site and determine: OAppropriate index well..............................:....✓` 0 Water-level range zone ..................................................... STEP 3 Using.month y report"Current Water Resources Conditions" determine current depth to water level for index well .......::.................. ®` ®�" month/year STEP 4 Using Table of Water-level Adjustments for index well (STEP 2A), current depth to water]eve: for index well (STEP 3)., 'and water4,.el zone (STEP 2B) determine water-level adjustment.............................:.............................................................. , STEP 5 . Estimate depth to high water by subtractirg the water- level adjustment(STEP 4) from measur=_d"depth to water level at site (:STEP 1) ........ ........................................................................................................ Figure 13.-7Reproducible computation form. 15 l®(1 py ..... Ell lJ G F s3 S-do�Q/ Town of Barnstable P# Department of Health,Safety,and Environmental Services Public Health Division Date j _ -?7 367 Main Street,Hyannis MA 02601 annxarnarA MAM ea Date Scheduled [ - I 9 Time Fee Pd. (8� Soil Suitability Assessment for Sewage Disposal Performed By: —Do6�tJ aJ As L-A , l%'C Witnessed By: .T 6-PkT Y 3>Vhj N lei 6— (?,0 4) LacATION1& G N:IRAt,nit O 1vt ION Location Address &oT 3 5 L!✓ Owner's Name �,# MN L-m (,j RoffieS . �T I-1 '�13 2Ss�P(r2'7 Address �'}"`(A Nh!t S Assessor's Map/Parcel: 123/35 Engineer's Name �p W IV (.1� �N �N` NEW CONSTRUCTION -I' REPAIR Telephone# -3 to Land Use \IA-c t`'r� Slopes(%) _ Surface Stones Distances from: Open Water Body Tft Possible Wet Area ft Drinking Water Well ft Drainage Way ft Property Line 4 ft Other ft SKETCH:(Street name,dimensions of lot,exact locations of test holes&pere tests,locate wetlands in proximity to holes) jZ-o S ci 10.00 v � � 0* '30 -m7 - to 0 Parent material(geologic) Depth to Bedrock Depth to Groundwater: Standing Water in Hole: Weeping"-'from Pit Face ^/ Estimated Seasonal High Groundwater � y A N 6 Q ' `4 UA)VW��� T VN . . . bETER1VHNATrOlr1 tG'Ott SEASOI�TAL HYGR'�?VTER<T1BT� Method Used: Depth Observed standing in obs.hole: in. Depth to soil mottles: in. Depth to weeping from side of ohs.hole: in. Groundwater Adjustment ft. Index Well# Reading Date: Index Well level Adj.factor Adj.Groundwater Level_ PERCOLATION TEST Hate Trtrt Observation Hole# 7 Time at 9" Depth of Pere �� Pam'c e--LA LN i' Time at 6" Start Pre-soak Time Q 2 k &A i^ G • I 0 Time(9"-V) End Pre-soak Rate Min./Inch Site Suitability Assessment: Site Passed_� Site Failed: Additional Testing Needed(Y/N) Original: Public Health Division Observation Hole Data To Be Completed on Back---� Copy: Applicant DEEP OBSERVATION HOLE ,OG Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(m.) (USDA) (Munsell) 1* Consistency,Mottling Structure,Stones,Boulderes. % p— SL -7,6'fti3/z �-30 3 L. 5 toYn-�lg Y-71'3 DEEP OBSERVATION HOLE L;OG .... Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(m.) (USDA) (Munsell) Mottling Structure,Stones,Boulderes. % 6 9-S -FIrA t .. DEEP. MERVATtON HbLE I.OG �ol+e# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(m.) (USDA) (Munsell) Mottling Structure,Stones,Boulderes. o' o Gravel) DE R ELL BAOHE .EPO e Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulderes. % DEEP O$SER A'PIb,1tT HOLE EOG PY0 #. Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(m.) (USDA) (Munsell) Mottling (Structure,Stones,Boulderes. ! Consistengy.o ' i 4 h , `+ y y e, ; & fi y fir• y ! S nTIC PROFILE TEST HOLE LOGS + T.O.F. AT EL. E ACCESS COVER TO WITHIN b' OF FlN, GRADE IMM TO "LEI ACCESS COVER (WATERTIGHT) TO ENGINEER: p` �� r WITHIN er OF FIN. GRADE WITNESS: ,� t�`✓ ' I, t 1( ('" ✓ {y� MINIMUM .75' OF COVER OVER PRECAST 2% SLOPE REQUIRED OVER SYSTEM t RUN PIPE LEVEL 2' OOUBIE WASHED PEASTONE DATE: v 3.O _ FOR FIRST 2' PROPOSED -- 3' MAX. PERC. RATE GALLON SEPTIC ,, w CLASS SOILS P# TANK (H- 10 ) GAS C Y BAFFLE E3C oa o0EDa ! " COOOED CD OOOO y1� �� : f ( x SLOPE) d" CRUSHED STONE OR MECHANICAL , C70 � C3 O 00CD0 ELEV. Ems• COMPACTION. 15.221 2 1 [ h, DEPTH OF FLOW d ( [ l) 2 O 0 ED O O 0 CD O � �"I• Y � � _ .o x SLOPE,) TEE SIZES: ( 3/4" TO 1 1/2" DOUBLE WASHED STONE Cr y A INLET DEPTH m 1.y k� -r U _� "C/L '' ---- SCALE 1" OUTLET DEPTH a _ LOCATION MAP vo 0 FOUNDATION— i SEPTIC TANK - -``' D' BOX — LEACHING h ASSESSORS Mlle �v3 PARCEL FACILITY �� i o y,2 �f8 - '. --------- - - ZONING DISTRICT: YARD SETBACKS: FRONT — Rio (o ' f Y� :�,o \l t:�E•r. 4 SIDE = a� �TPt4,ti n�.r r: ,s T,tea► .. �, -t o =a'y`' REAR = t PLAN REF. — � ( a } -7��.7 Sv, q -I I h f I f FLOOD ZONE: v 1 I - _.—_.10 / w ` --- \` _ NOT SEPTIC DESIGN: (GARBAGE DISPOSER is �+ A -- aI-Jf L 1 . DATUM IS DESIGN FLOW: _ BEDROOMS ( _GPD) _ �''0 GPO 2. MUNICIPAL WATER --- !1 JSE A GPD DESIGN F LOW 3. iv3i���tviJAh r �P� 1 1�..1 TO B� 1 $ PER FUOT. _SEPTIC TANK: GPD _ _ 4. DESIGN LOADING FOR ALL PRECAST UNITS TO BE AASHO H— _-_-- _� � - -- (-- ) 5. PIPE JOINTS TO BE MADE WATERTIGHT. USE A -_ GALLON SEPTIC TANK 6. CONSTRUCTION DETAILS TO BE IN ACCORDANCE WITH MASS. ----- -- --- ._ \ } `' _LEACHING: ENVIRONMENTAL CODE TITLE V. \. SIDES: 7. THIS PLAN IS FOR PROPOSED WORK ONLY AND NOT TO BE USED FOR LOT LINE STAKING. BOTTOM: - ' {' Ir •yl - ' 8. PIPE FOR SEPTIC SYSTEM TO SCH. 40-4' PVC. �,� �j GPD 9. COMPONENTS NOT TO BE BACKFILLED OR CONCEALED WITHOUT I TOTAL: '� S.F. INSPECTION BY BOARD OF HEALTH AND PERMISSION OBTAINED FROM BOARD OF HEALTH. z 10. CONTRACTOR SHAH BE RESPONSIBLE FOR VERIFYING THE Q '• '�� r �. ii i �-�� A T LOCATION OF ALL UNDERGROUND do OVERHEAD UTILITIES PRIOR TO COMMENCEMENT OF WORK. �; -► _ _ � y V LEGEND S17E AND SEWAGE PLAN 100.0 PROPOSED SPOT ELEVATION OF C� Ili �I �` ; � : . 100x0 EXISTING SPOT ELEVATION IN THE TOWN OF: '` \ — + 00� PROPOSf:D CONTOUR j ! I -. ✓'� __ EXISTING CONTOUR *� f let — 100 — -- PREPARED FOR: I ���' ✓ ` wood BOARD OF HEALTH I / --- MA SCALE: l DATE: APPROVED DATE off SW362-4e41 ftm 508 362-OW down cape engineering, inc. + `AME�'�"<r CIVIL ENGINEERS �^ LAND SURVEYORS Bowe 4 Qom~ fv JOB 939 main st. yarmouth, ma 02675 q AI,A P. ., .L.S. DArl