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HomeMy WebLinkAbout0231 ROUTE 149 - Health 231. ROUTE 149,IYMARSTONS+MILLS A= 078 024.010 i i i 1 a �f20/-3 OWN OF BARNSTABLE LOCATION SEWAGE # VILLAGE ASSESSOR'S MAP & LOT r (/ INSTALLER'S NAME & PHONE NO. A4 A, SEPTIC TANK CAPACITY /UaC LEACHING FACILITY:(type) it'o'c� L`' (size) NO. OF BEDROOMS 3 PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNER Nc 544., -e Ccl,s-t DATE PERMIT ISSUED: /2 z/- 2 DATE COMPLIANCE ISSUED: �Iq3 VARIANCE GRANTED: Yes No w 1 ED-- �i I fjs. el�1TOWN ©P�/ao/v OF BARNSTABLE LOCATION iv. � �y� SEWAGE # 622 VILLAGE ��i-ohs s ASSESSORS MAP LOT D INSTALLER'S NAME & PHONE.NO. SEPTIC TANK CAPACITY /006/ LEACHING FACILITY:(type) /UGlw l'f (size) NO. OF BEDROOMS 3 PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNER Nc SAA.-I-e ce, 5rt DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No L l 1/k i Qz_ V' . Fimii THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH r; O� TOWN OF BARNSTABLE V lirFation for Big m ai Works Tonstrnrtinn Vamit Application is hereby made or 9ermit to Construct (1�4) or Repair ( ) an Individual Sewage Disposal System at: oca Address �r Lot No. 14 L> G • ..._.. --•-•..............•------••-•-••------•---... ..........--...................................................................................... s ner/� da' ," Address �f�' ,-� ------------------------- ----- -----.........---- ........ Installer Address U Type of Building Size Lot....J.____�3 .��{- -...S q. feet Dwelling—No. of Bedrooms............. .........................Expansion Attic (JI) Garbage Grinder (` t) Other—T e of Building L7)/+6 No. of persons............................ Showers — Cafeteria Other fixtures ............................ u j-A•---••-----••---...•••----------------------------- ----•--••-•--------•--•-----------............-----......_... .............Design Flow ...................gallons p r person per day. Total daily flow.._......._.._a?_�- 0-__-._......_-........gallons: . W u 1 , IxSeptic Tank—Liquid capaciTiameter __gallons Length.�1 Length. -.U.. Width___��-�t,__ Diameter...!-?.�P:... Depth____ ____ __ x Disposal Trench—No -___ti? ..___. Width.................. Total Length............. Total leaching area......... ... _.sq. ft. Seepage Pit No...........___------- .....6,! ... Depth below inlet.... Total leaching area.......-eTn.sq. ft. Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by-------------------- r._. 0. "S-._Ca. lr Date......!q'�"92 Test Pit No. I...... .._._minutes per inch Depth of Test Pit___-__ _ti________ Depth to ground water.. ? ©� (s, Test Pit No. 2......Z.....minutes per inch Depth of.Test Pit.......U.......... Depth to ground water..............!._.....__ a _-____------•--•------------------------ O Description of Soil......................'2® -Z.0'l ` fZ ° 110-------- � '--- - = . j---�-•----•-- - x 00,-�---------------------- "" ------'' -••---•-Q.P 24 = U Nature of Repairs or Alterations—Answer when applicable---------- 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 ks been issued by the board,4 health. Signed - ---------- 7—r Application Approved By --- - - Application Disapproved for the following reasons- --------------------------------------------------------------------------------------------------- --------------------------------- ---------------------------------------------- ---- ----------------....------------------............-------------------------------------------- Permit No. - Issued ---------_----------- -- / 0 a THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH t` TOWN OF BARNSTABLE Appliration for Elispoiial Vorkii Tonstrnrtion ramit Application is hereby made for a Permit to Construct (°A) or Repair ( ) an Individual Sewage Disposal System at: r ......................................• _. ..--•--............................... .................................... i ............................................... ocatien-Address Jr Lot No. _-0 - - ................................................ -----••••-•--•-•---------------•-•-----.......---...------....._..----------------.............._. Owner Address WI c�4 4.....d,;&P�........................... ........ Type of Building Address Installer• �---•----•--••-•-----•-----••--• U Size Lot___ _}.. _1t.�A '__Sq. feet Dwelling—No. of Bedrooms............................................Expansion Attic (�j E), Garbage Grinder No. of ersons____________________________ Showers a Other—Type of Building _______.!-�T¢_.___._.__: p ( ) — Cafeteria ( ) dOther fixtures ------------------------- 4U-I•A----•-•----•._.--•••-•----••-••-••--••-•••---•-••---•-••••-•._....•--•-•---•••-----••---•-.......-•---.....----• WDesign Flow.............. ...............gallons per person per day. Total daily flow...............��___._____.________gallons.T.A . WSeptic Tank—Liquid capacity___CO. allons Length.�'-_U"_ Width_.__F--_.'�?�� Diameter__-_t-�_�A_.. Depth____% d x Disposal Trench—No. ......I ..... Width.................... Total Length.................... Total leaching area....................sq. ft. 1 u I Seepage Pit No...........I ..•.__ iameter.....(r?( -__ Depth below inlet.....(?L'.__ Total leaching area...."-74_sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Pit Results Performed nch Depth No f Test Pit.......1 ......... Depth to ground water_.. EZW 0z4 Test Pit No. 2_.__._Z__._minutes per inch Depth of Test Pit.......IJ.......... Depth to ground water........................ I __ .. �......- Lapw� An>r O Description of Soil - �� -Z=-�3--------------------a__ ?gi!- Z=�-1�-� �� SM��_.at-� __C ►?. t-�... U --------------------------•---------•--•----•----------------.....__.--------------------------•---............-•--- U Nature of Repairs or Alterations—Answer when applicable._•_.______&)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 has been issued by the board of health. w Application Approved BY !.�'�l :..v... _ �,4.c , ...�1 te Application Disapproved for the following reasons- ---------- ---- --------------------------------------------------------------------------------------------------------------- ..........................--------N----o- . t q t � .-------- Permit -- --� ------------ Issued -----------� ..... ....---------- � �! THE COMMONWEALTH OF MASSACHUSETTS E BOARD OF HEALTH TOWN OF BARNSTABLE ; (gextifirate of Contylianre THISIT 0 CERTIFY hat t e�Ind =tdual Sewage Disposal System constructed ( ) or Repaired ( ) by /.1 / .�/..1 .i�. ....................... ----------- ---------------...---------- ---------- -----....-------------_:.. insAll,' n - ' at ............... � u .............. . 1. �1. A .// .. has been installed in accordance with the provisions of TITLE 5 j The State E;n/,.. ironmental Code as described in the application for Disposal Works Construction Permit No. 4... Z. ' dated ......... . . . .THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BECONSTRUED S A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. / ATE /�.7/'I"/ In t r 04,/a, I .-------- spec o ------------------------- THE COMMONWEALTH OF MASSACHUSETTS n BOARD OF HEALTH TOWN OF BARNSTABLE a / ......................... FEE./ ............... OW oantt nr D n� Ilan. Permit C� Permission is hereby granted_--- ----- to Constr'ct or •e air -an I"idSewa - Dis oral Sys pern-7at No.... ... ... . ....... --- --• -- -- ---�?_. reet as shown on the application for Disposal Works Construction Permit NoI- .___ ated__._ ��( lq ................................ .................................................. ------------------------------------ DATE.-------•-------�L-'-•�--'=�-='-�� Board of Health ., FORM 36508 HOBBS h WARREN,INC..PUBLISHERS No......................... FEE..........................._ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH 'TOWN OF BARNSTABLE Appliratinn for Diopoottl 10orkq Tmitrurtion rami# Application is hereby made for a Permit to Construct or Repair ( ) an Individual Sewage Disposal System at: } F p ..... ..-................ ^::.. . • .................................. ..................................... i No.!� ......................................... t Address JoNt� I [� 11P19L Owner Address w Installer Address Type of Building Size Lot.... t ,.� Dwelling—No. of Bedrooms.......................................Expansion Attic (d) Garbage Grinder ( 4 Other—T e of Building ►:?IA No. of persons............................ Showers — Cafeteria al Other fixtures ............................fitA............. W Design Flow............. ns r��J.............._.....gallo p)r person per day. Total daily flow...........-.. ..................gal�ons��A WSeptic Tank—Liquid'capacit ..1 allons Length. -.K7.._ Width..r=11 `. Diameter...�..__ Depth.....- . x Disposal Trench—Noel......!`.? . ...... Width.i�............. Total Length.............G�`. Total leaching area....................sq. ft. Seepage Pit No..................... lameter.....(a......-..... Depth below inlet.....`-.-..... Total leaching area.... ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by............... ts..-..Ca-SAIL,. . Date......!U.: "9 ..._....... Test Pit No. 1......7.......minutes per inch Depth of Test Pit......l.l.,_...._.. Depth to ground water..P rAx- Kn t-cr1t)►. 15 , 44 Test Pit No. 2......7......minutes per inch Depth of Test Pit.......U.......... Depth to ground water........................ 04 _ ......................................................................................... ..•-•.... ;............. ..... O Description of Soil...............• ...�'p. .....C'..�_ up_�k a,.�7.. .� ,-: L..t..Z:O " Il.D Mw: ? ..!u.�r�.C�i?rwr�, x ................... °s : ......................------..._.... .... ......... UNature of Repairs or Alterations—Answer when applicable.........N .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 has been issued by the board of health. Signed ............................................................................................................ ........................................ Date ApplicationApproved By ...................................................................................................................................................... ........................................ Dare Application Disapproved for the following reasons: ........................................................................................................................................ ................................................................................................................................................................................................................ ........................................ Date PermitNo. .................................................................... Issued .................................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE (fErtifi ate of (9IIzttyliart.CP 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. DATE........................................................................................................ Inspector .........................---.................:.................................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE No......................... FEE........................ Raposal Workv Tnno#rnr#inn "an fit 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 HOHBS at WA7REN.INC.,PUBLISHERS j S.UBS•ORyACE SZWAGE'DTSPOSAL SYSTEM INSPECTION FORK Address of property 0-00Ts ��C MAestotts MILLS owner's name cpr- t1e-ALtWv_ Date of Inspection PART A CRECKLIST Check if the following have been done: f Pumping information was requested of the owner, occupant, and Board of Health. None of the system components have been pumped for at least two weeks and the system has been receiving normal flow rates during .that period. Large volumes o:f water have not been introduced into the system recently -or as part of this inspection. ✓ As built plans have been obtained and examined. Note if they are not available with N/A. The facility or dwelling was inspected for signs of sewage back-up. ✓ The site was inspected for signs of breakout. ✓" All system components, excluding the SAS, have been located on the site. The septic tank manholes were uncovered, opened, and the interior of the septic tank was inspected for condition of baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge, depth of scum. The size and location of the SAS on the site has been determined based on existing information or approximated by non-intrusive methods. ✓1 The facility owner (and occupants, if different from owner) were provided with information on the proper maintenance of SSDS.' 10 1 d � 12 1995 N c �r w � � I SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B SYSTEM INFORMATION PKc-t - 06-13a FLOW CONDITIONS If residential 3 number of bedrooms number of current residents Ho garbage grinder, yes or no- laundry connected to system, yes or no 140 use, yes or no If nonresidential, calculated flow: `fir Water meter readings, if available: V6,000 COL. OCC�P��D Last date of occupancy GENERAL INFORMATION Pumping records and source of information: O wNt+� System pumped as part of inspection es if yes, volume pumped Y or no 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 ins ection records, if any) ' p Other (explain) Approximate age of all components. Date installed,information: if known. Source of Sewage odors detected when arriving at the site Yes or no SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B SYSTEM INFORMATION continued CN - 8�30. �N PEPTIC TANK: " (locate on site plan) depth below grade: l lo�1_ material of construction: concrete metal FRP other(explain) dimensions: 0/s sludge depth 34%' distance from top of sludge to bottom of outlet tee or baffle Zi" scum thickness �tV distance from top of scum to top of outlet tee or baffle cVle distance from bottom of scum to bottom of outlet tee or baffle Comments: (recommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity, evidence of leakage, recommendations for repairs, etc. ) DISTRIBUTION BOX: v (locate on site plan) " 0 — depth of liquid level above outlet invert Comments: (note if level and distribution is equal, evidence of solids carryover, evidence of leakage into or out of box, recommendation for repairs, etc. ) PUMP CHAMBER: . (locate on site plan) pumps in working order, yes or no Comments: (note condition of pump chamber, condition of pumps and appurtenances, recommendations for maintenance or repairs,etc. ) I SUBSURFACE SZWAGE DISPOSAL SYBTEM INSPECTION FORM PART B T t{cT - s7 3 C7 BYBTElI INFORMATION continued SOIL ABSORPTION SYSTEM (SAS) : (locate on site plan, if possible; excavation not required, but ma be approximated by non-intrusive methods) y If not determined to be present, explain: Type_ leaching pits and number leaching chambers and number leaching galleries and number leaching trenches, number, length leaching fields, number, dimensions overflow cesspool, number Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, recommendations for maintenance or repairs,etc.) CESSPOOLS (loc ate ate on site plan) : number and configuration depth-top of liquid to inlet invert depth of solids layer depth of scum layer dimensions of cesspool materials of construction indication of groundwater inflow (cesspool must be pumped as part of inspection) Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, recommendations for maintenance or repairs,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, recommendations for maintenance' or repairs,etc. ) I SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART H SYSTEM INFORMATION continued SKETCH OF SEWAGE r=SPOSAL SYSTEM: include ties to at least two permanent references landmarks or benchmarks W locate all wells within 100 ' 0Ao FLLC, 13e- �o • LOT 8 Q HouSE �r �9 0 see �y R t `'h I All VK DEPTH TO GROUNDWATER OJ6. - « depth to groundwater method of determination or approximation: O`C t -TelST lko-,-gs to ` 0 " ` 7 v SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C FAILURE CRITERIA • Indicate yes, no, or not determined (Y, N, or ND) . Describe basis of determination in all instances. If "not determined", explain why not) Backup of sewage into facility? NDischarge or ponding of effluent to the surface of the ground or surface waters? Static liquid level in the distribution box above outlet invert? JL Liquid depth in cesspool <6" below invert or available volume< 1/2 day flow? tRequired pumping 4 times or more in the last year? number of times pumped ,_ Z` metal?Septic tank is me ? P cracked. structurally unsound? substantial infiltration? substantial exfiltration? tank failure imminent? al Is any portion of the SAS, cesspool or privy: �Y below the high groundwater elevation? within 50 feet of a surface water? within 100 feet of a surface water supply or tributary to a surface water supply? within a Zone I of a public well? N within 50 feet of a bordering vegetated wetland or salt marsh (cesspools and privies only, not the SAS) ? `V within 50 feet of a private water supply well? 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. SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART D CERTIFICATION Name of Inspector Company Name Can � oc 6� � \V%(_, Company Address Z-kct Ge�-1 �L_ok-o!k ONO_ Certification Statement I certify that I have personally inspected the sewage disposal system at this address and that the information reported is true, accurate and complete as of the time of inspection. The inspection was performed and any recommendations regarding upgrade, maintenance and repair are consistent with my training and experience in the proper function and manitenance of on-site sewage disposal systems. CheQk one: V I have not found any information which indicates that the system fails to adequately protect public health or the environment as defined in 310 CMR 15. 303 . Any failure criteria not evaluated are as stated in the FAILURE CRITERIA section of this form. I have determined that the system fails to protect public health and the environment as defined in 310 CMR 15. 303 . The basis for this determination is provided 'in the FAILURE CRITERIA section of this form. Inspector's Signature Date `Z �Z -d5 original to system owner Copies to: Buyer (if applicable) Approving authority 800-662-6696 MEMBER OF i 617-449-6991 `,,���Ouu►i�����: a i HomePro Northeast Inc °j"""`°°�`` PROFESSIONAL INSPECTIONS PAGER ANSWERING ROB NWDUX, 800-222-5742 Inspector REFER TO#50225 I 0Vly. SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM Address of property 3k �, `AR `,' 1 ' -s or, Owner's name Date of Inspection PART A CHECKLIST Check if the following have been done: V/' Pumping information was requested of the owner, occupant, and Board of Health. None of the system components have been pumped for at least two weeks and the system has been receiving normal flow rates during that period. Large volumes of water have not been introduced into the system recently or as part of this inspection. V As built plans have been obtained and examined. Note if they are not available with N/A. The facility or dwelling was inspected for signs of sewage back-up. The site was inspected for signs of breakout. All system components, excluding the SAS, have been located on the site. The septic tank manholes were uncovered, opened, and the interior of the septic tank was inspected for condition of baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge, depth of scum. The size and location of the SAS on the site has been determined based on existing information or approximated by non-intrusive methods. The facility owner (and occupants, if different from owner) were provided with information on the proper maintenance of SSDS.• L SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B SYSTEM INFORMATION FLOW CONDITIONS If residential '3 number of bedrooms number of current residents �O garbage grinder, yes or no* ' S laundry connected to system, yes or no LO seasonal use, yes or no Re�1,�� If nonresidential, calculated flow; Water meter readings, if available: l8�ao0 Last date of occupancy GENERAL INFORMATION Pumping records and source of information: ,, v LSystem pumped as part of inspection., if yes, volume pumped yes or no Reason for pumping: TjTe 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) Other (explain) Approximate age of all components. Date installed, if known. Source of information: Sewage odors detected when arrivingat the site, yes or no 9 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B SYSTEM INFORMATION continued SEPTIC TANK: - (locate on site plan) depth below grade: `= material of construction: concrete metal FRP other(explain) dimensions• 12 -( 4 15 C7 (`/v\l sludge depth 4`/"" distance from top of sludge to bottom of outlet. tee or baffle KN scum thickness distance from top of scum to top of outlet tee or baffle distance from bottom of scum to bottom of outlet tee or baffle Comments: (recommendation for pumping, condition of inlet. and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity, evidence of leakage, recommendations for repairs, etc. ) (5 y 46�71 �Ft lS cot C,rQ$-LP DISTRIBUTION BOX: (locate on site plan) `T 4 depth of liquid level above outlet invert Comments: _(note if level and distribution is equal, evidence of solids carryover, evidence of leakage into or out of box, recommendation for repairs, etc. ) PUMP CHAMBER: A , (locate on site plan) pumps in working order, yes or no Comments: (note condition of pump chamber, condition of pumps and appurtenances, recommendations for maintenance or repairs,etc. ) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B SYSTEM INFORMATION continued SKETCH OF SEWAGE rISPOSAL SYSTEM: include ties to at least two permanent references landmarks or benchmarks locate all wells within 100 ' Itto W�iL�-S �o v" ey U� DEPTH TO GROUNDWATER / depth to groundwater method of determination or approximation: 1c1 e� ®�hl O •T5 ct Z $ 12 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C FAILURE CRITERIA Indicate yes, no, or not determined (Y, N, or ND) . Describe basis of determination in all instances. If "not determined", explain why not) 1�1 Backup of sewage into facility? Discharge or ponding of effluent to the surface of the ground or surface waters? Static liquid level 1 in the distribution boxabove outlet invert? Liquid depth in cesspool <6" below invert or available volume< 1/2 day flow? Required pumping 4 times or more in the last year? number of times pumped Septic tank is metal? cracked? structurally unsound? substantial infiltration? substantial exfiltration? tank failure imminent? ALIs any portion of the SAS, cesspool or` privy: below the high groundwater elevation? within 50 feet of a surface water? within 100 feet of a surface water supply or tributary to a surface water supply? within a Zone I of a public well? within 50 feet of a bordering vegetated wetland or salt marsh (cesspools and privies only, not the SAS) ? within 50 feet of a private water supply well? less than 100 feet but greater than 50 feet from a private water supply well with no PP Y acceptable water � P alit analysis? If quality Y 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. 13 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART D CERTIFICATION Name of Inspector (�o g `' �''�CZQ K Company Name Company Address Certification Statement I certify that I have personally inspected the sewage disposal system at this address and that the information reported is true, accurate and complete as of the time of inspection. The inspection was performed and any recommendations regarding upgrade, maintenance and repair are consistent with my training and experience in the proper function and manitenance of on-site sewage disposal systems. Chepk one: t/ I have not found any information which indicates that the system fails to adequately protect public health or the environment as defined in 310 CMR 15. 303 . Any failure criteria not evaluated are as stated in the FAILURE CRITERIA section of this form. I have determined that the system fails to protect public health and the environment as defined in 310 CMR 15. 303 . The basis for this determination is provided in the FAILURE CRITERIA section of this form. Inspector's Signature Date Original to system owner Copies to: Buyer (if applicable) Approving authority 1 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B SYSTEM INFORMATION continued SOIL ABSORPTION SYSTEM (SAS) : (locate on site . plan, if possible, excavation ation approximated by non-intrusive methods) not required, but may be If not determined to be present, explain: Type. leaching pits and number leaching chambers and number leaching galleries and number leaching trenches, number, length leaching fields, number, dimensions overflow cesspool, number Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, recommendations for maintenance or repairs,etc. )p irs,etc. ) CESSPOOLS (locate on site plan) : �c number and configuration ,~ depth-top of liquid to inlet invert depth of solids layer depth of scum layer dimensions of cesspool materials of construction indication of groundwater inflow (cesspool must be pumped as part of inspection) Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, recommendations for maintenance or repairs,etc. ) PRIVY: (locate on site plan) P- materials of construction dimensions depth of solids Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, recommendations for maintenance or repairs,etc. ) 99.5 ra 6 20 MIN __ P TOP OF YV UNDATION CONCRE7Ts COVERS 2"LAYER OF• •- 2' level 1/8=1�� GROUND EL=..97.0E, 95.5E 9 Asti'ED SToNE :'. / � . i / �4 .95/T fJ4b11� / / � ?fiTT � / � . ., i` i✓ ♦'�' •� 2 0.t OR SCHEDULE 40-1.Q'f • P. V.C. -PIPE -4, 7 PITCH 114" PER FT D=10' 4' SCHEDULE 40 P. V.C.DL575f D=21'S=0.03 PIPE - m . Box FLOW LINE' D=S; 5=0.03 PITCH 1/e" PER FT. - 83 0 PRECAST INVERT 1 19' e °° ° EL. LEACHING : . EL._`�?L 2© T CRVS= °o 0 0 / 1 a, vlv�z.�N� OR sTolra . ........ a Ev vERT INtiER q a J : INVERT EL _ .3Z. p c EL = w. n 87.0 � :� oC EL. �jo:ST -- Q• o . a �' 6, 314' TO 1-112" 0 ' • c WASHED STONE a SEPT�VC TANIr EL.=_. ` E? 17 -- : log M11U, 1000 GALLONS o w C; 770 LEACH PIT 10' ' `104J ' BOTTOM OF TEST HOLE OR USGS PROBABLE WATER TABLE EL= 72 2 OBSERVED WATER TABLE ( J / ) EL=none,encoun to N LOT 6 - Ic v PROFILE OF LOT 7 ' _ r SEWAGE DISPOSAL SYSTEM '' \ TEST PIT 2 Q 03,41 0 I loo --� ` O ,D� NOT 'TO SCALE s 1 3 8 6 ALL ELEVATIONS ARE ASSIGNED ' w •` LOT 8 13600E sf r I2' : �� 1 .� SOIL LOG 000 gal. � � MR. DUNNING 13 septic tar P N0. 7951 P N0. 7952 WITNESSED BY: P I _ 2 10-06-92 HEALTH OF- F/CER DA a I 1 TA' -10 06 9 DATE r 5' � � TEST HOLE 2 TEST HOLE 1 . TO of _B�1RN�,TAKI•F� 3� AREA box EL= 12 2 EL.= 89.0 JOHN E. HERS-CA L1LE'Y,P.E� � .. 1s\ i TEST PIT 1 4' _---- --�- 2-"... 89.0 r - _ 2.0 1s>>, q, 0r777 o.0 - PE�'R�.OLATION RATE -- MIN./ INCH 6 r 1 LOAM LOAM and SUBSOIL wsernice / / / 2.0 ii 81.2 2.0 870 T y r w D.�sxi\ .DATA. ,�J� ' / MEDIUM - MEDIUM NUMBER OF BEDROOMS THREE fp� TWO WATER GATES SAND SAND 1=dr7 ,may t� and GRA VEL and GRAVEL GARBAGE DISPOSAL NONE LOT 23 s � 330 GPD $E'�' js- �` c POLE NO. 70/9 _11.0 71. 2 11.0 78.0 TOTAL ESTIMATED FLOW GRAM D U fs 0 ( I10 GAD/BR./DA Y x DATE'- BR.) SEPTIC TANK CAPACITY000 LEACHING AREA REQUIREMENTS NO WA TER ENCOUNTERED NO WA TER ENCOUNTERED SIDEWALL AREA 188.5 GAL./S.F 188.5x2.5=4 71 C.REDD �'��-.� & H BOTTOM AREA . , GAL./S/,F 78.5x1.0=78.5 LEACHING CAPACITY ( BOTTOM & SIDEWALL) 549- GAL. RESERVE LEACHING CAPACITY' _549 _ GAL, GENERAL NOTES 1. THIS PLAN IS FOR THE CONSTRUCTION OF A SEWERAGE SYSTEM PROJECT LOCATION- 2. PLAN REFERENCE ; LOT 8 .ROUTE 149 ' MARSTONS MILLS, MA. 3. THIS PLAN IS FOR INSTALLATION/ REPAIR OF SEPTIC SYSTEM )OH AND NOT TO BE USED FOR SURVEYING OR ZONING PURPOSES APPLICANT" JOHN McSHANE 4. ALL WORKMANSHIP AND MATERIALS SHALL CONFORM TO D.E.P / P. O. BOX 679 TITLE 5 AND THE TOWN OF BARNSTABLE RULES AND REGULATIONS � 0,5TERVILLE, MA. FOR THE SUBSURFACE DISPOSAL OF SEWAGE. _ r 5. ALL COVER TO SANITARY UNITS SHALL BE BROUGHT TO WITHIN 12" OF FINISHED GRADE. EXISTING AND FINAL GRADES SHALL REMAIN ESSENTIALLY THE �' � � YANKEE SURVEY CONSULTANTS 6. EXIST P. O. BOX 265, 143 ROUTE 149 SAME, UNLESS NOTED BY FINAL CONTOURS. MARSTONS MILLS, MA. 02648 7. ALL COMPONENTS' OF THE SANITARY SYSTEM SHALL BE CAPABLE ��``�L �� `� H. 50 4 8- 055 - F 508 420-5553 OF WITHSTANDING H-10 LOADING UNLESS THE,Y ARE UNDER u s APPRO VED: BOARD Off' HEALTH OR WITHIN 10' OF DRIVES OR PARJUNG AREAS. H-20 LOADING � � MERE'nJ � SCALE. [DATE. SHALL BE USED UNDER OR WITHIN 10' OF DRIVES OR PARKING.. �� P10• s � 1"=30' OCT 26,1992 UNLESS NOTED. a �a %N 8. ANY MASONRY UNITS USED TO BRING COVERS TO GRADE SHALL REV. REV. BE MORTARED IN PLACE. F9. NO DETERMINATION HAS BEEN MADE AS TO COMPLIANCE` WITH DEEDED OR ZONING REGULATIONS. OWNER/APPLICANT IS TO JOB NO DA TE AGENT OBTAIN SUCH DETERMINATION FROM APPROPRIATE AUTHORITY. LOCATION MAP 50093-8 SHEET 1 OF 1. 10. ALL PIPE TO BE 4" SCH 40 PIPE