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HomeMy WebLinkAbout0192 SANDY VALLEY ROAD - Health JrF 7192�S�atidy Valley Roar( -- -- -- -- ---— A 101 —075 Marstons Mills o 9 COMMOiVWEALTH OF At,,SSAC.HUsETTs IYECUTIVE OFFICE OF EWIRON.MENTAL,AFF. DEPARTMENT OF ENVIRONMENTAL �aR• 4IO'I'`E CTI OIoT OFFICIAL INSPECTION FORMTylyrgFll®LT■E51g1pA� VOLUNTARY pp�t Tn NOT V A FOR V®L�,J j����6 6 ASSESSMENTS SSESSa.d e.'1\H S SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: /J Owner's Name: m� / Owner's Address: Date of Inspection: :ell Name of Inspector; lease print) _ -- Company Names p ) Mailing Address: �i..r v� Telephone Numbers -- 0.16<0 6O8 rn CERTIFICATION STATE � 1 certify that I have personally inspe�et�ed he,sewab below is true, accurate and complete to of the time of the inspection. The i be disposal system at this address and that the information reported training and experience in the proper function and maintenance of on site sew o inspection was performed based on my approved system inspector pursuant to Section 15.340 of Title 5(3 itT CMR a di awe disposal systems. I am a DE1P 00)� The system: _ Y Passes Conditionally Passes Needs Further Evaluation b Fails } the Local Approving Authority Inspector's Signature: The system inspector shall subinit a co Date: 6 DEP)within 30 days of completing py°f this inspection report to the A gpd or¢neater, the inspector g this inspection. If the system is a shared ystem or harovina s adesign flow DEP, P and the s stem o Authority(Board of Health or utho The original should be sent to the system opiessubmit hsentpOrt to the a of 10the authority. appropriate regional office of the to the buyer, if applicable, and the approving Notes and Comments ****This report only describes conditions at the time of ins eet' time. This tow the system will perform ' on and under the conditions Of at that inspection does not address f to the future under the same o conditions of use, p sr different Title 5 inspection Form 6/15/2000. page I Page 2 of 11 OFFICIAL INSPECTION FORM=NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE IDISPOSAL SYSTEM INSPECTION FORM PARS'A CERTIFICATION(continued' Property Address:— Ct �k Owner: Date of Inspection: a )inspection Summary: Check A,B,C,ID or E!ALLWAYS complete all of Section D A. ySystem Passes: /1 I have not found any information 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: 13• System Conditionally Passes: One or more system components as described in the"Conditional Pass"se on need to be replaced or repaired. The system,upon completion of the replacement or repair;as appro by the Board of Health,will pass Answer yes,no or not determined(Y,N,ND in the explain. for the Fo wing statements.If"not determined"please The septic tank is metal and over 20 years old*o e septic tank(whether metal or not)is structurally unsound; exhibits substantial infiltration or exfiltrati or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic as approved by the Board of Health. *A metal septic tank will pass inspection if it ` structurally sound,not leaking and if a Certificate of Compliance indicating that the tank is less than 20 year ld is available. ND explain: Observation of sewage ckup or break out or}ugh static water level in approval of Board of Hea the distribution box due to broken or obstructed pipe(s)or due to Token,settled or uneven distribution box_. System will pass inspection if(with ): broken pipe(s)are nPiaced: obstruction is removed distribution box is:leveled or replaced ND explain: T system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system pass ' ection if(with approval of the Board of Health): Y wrll broken pipe(s)are replaced obstruction is removed ND explain: Page 3 of 11 OFFICIAL INSPEC s ION FORM e NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL, SYSTEM INSPECTION F®� PART A PropertyCERTIFICATION(continued) Address: 1. .'1 / Owner: �S_t Bate of dnspection: T S �7 O- further Evaluation is Required by the,Board of Health: Conditions exist which require further evaluation by the Board of Health in or er to determine if the syst is failing to protect public health, safety or the environment,- _ em a• System will pass unless Board of Health determines in accordance w' 370 C1dIR 15.303 1 system is not functioning a manner which will protect public he th,safety and the envirob that the nme _ Cesspool or privy is within 50 feet of a surface water nt Cesspool or privy is within 50 feet of a bordering vegetate wetland or a salt marsh �- System will fail unless the Board of wealth a s Public'Water Supplier,of any)determines that the system is functioning in a manner that protect a Public health,safety and environment: The system has a septic tank and soil sorption system (SAS)and the SAS is within 1 surface water supply or tributary to a Sur ce water supply.y. 00 feet of a pp _ The system has aseptic tank an AS and the SAS is within a Zone I of a ____ The system has a se tic t public water supply. p tank nd SAS and the SAS is within 50 feet offs private water supply well. The system has a septic private water supply well**, and SAS and the SAS is less than 100 feet but 50 feet ethod used to determine distance or more from a *This system passes if th well water analysis, performed at a DEP certified bacteria and volatile org is compounds indicates that the well is free d laboratory, for coliform the presence of ammon' nitrogen and nitrate ni�ogen is equal to or less than 5 from pollution from that facility and failure criteria are trio ppm, provided that no other eyed. A copy of the analysis must be attached to this form. 3. Other: 3 I I Page 4 of l l OFFICIAL INSPEC7'ION Ili O _NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE III SYSTEM INSPECTION EOM PTA:A.. CEIlgT IliiICAT'ION(continued) Property Address: �e4 j e Q /1 Owner: U �CG� Date of Inspection: 0 D. System Failure Criteria applicable to all systems: You must indicate"yes"or"no"to each of the following for all inspections: Yes No Backup of sewage into facility or system component due to overloaded or clogged Discharge or ponding of effluent to the surface of the gg SAS or cesspool clogged SAS or cesspool ground or surface waters due to an overloaded or Static liquid level in the distribution box above outlet invert due to an overloaded ed or clo gged SAS or _j4TLiquid depth in cesspool is less than 6"below invert or available volume is less than '/day flow Required pumping more than 4 times in the last year lelOT due to clogged or abstracted i e s . of times pumped p P ( ) Number —- Any portion of the SAS, cesspool or privy is below hi Any portion of cesspool or privy high gr°tea water elevation. water supply. p 3 is within 100 feet of a surface water supply or tributary to a surface Any portion of a cesspool or privy is.within a Zone I of a public well. y 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 f 00 feet but greater than 50 feet from a private water supply well with no acceptable water qualify analyos.{This system.passes if the well water.analysis, Performed at a DEP certified laboratory,for a�liform bacteria and volatile o well COMPOIMds 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 S are triggered. A copy of the analysis must be attached-tog his f rovided that no other,failure criteria (Yes/No)The system fails.I have determined that one or described in 310 CMR 15.303,therefore e of Health to determine what will be neces the system fails. T'he systemoOwner should contact the Board of sary to correct the failure: E. Large Systems: To be considered a large system the system must serve.a facility with design floc®®f 10,000 gpd. gpd to 15,000 You must indicate either"yes"or"no"to each of the following (The following criteria apply to large systems in.addition a criteria above Yes no the system is within 400 feet of a s ace drinking water supply the system is within 200 fee f a tributary to a surface drinking water supply the system is located ` nitrogen sensitive area(Interim Wellhead Protection Area—I Zone II of a public • ter supply well WPA )or a mapped If you have answered"yes' to any question in Section E the system is considered a significant threat- or "yes"in Section D abov the large system has failed. The owner or operator of large system Significant threat untie Section E or failed under Section D shall u ' answered 1�.304. The syste wner should contact the appropriate regional office considered a upgrade the system is accordance with 310 CMR e of the Department. r Page 5 of I l (OFFICIAL INSPECTION FORM—NOT FOR V®Ll`Tly'"i�Al<2Y SUBSL7RFACE SEWAGE DISPOSAL, SYSTEM Il®-TAR TI FORM ASSESSMENTS PART'B CHECKLIST Property Address: Sa IYt&J(e ®caner: v6 IDate of Inspection: Check_if the followin have been done. You must indicate es"or"no"as to each of the followin 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 systern received normal flows in the previous two week period Have large voiumes of water been introduced to the system recently or as part of this inspection p on . Were as built plans of the system obtained and examined?(If they were not available note as N/A) — Was the facility or dwelling inspected for signs of sewage back up? — Was the site inspected for signs of break out? Were all systeir components,excluding the SAS, located on site? K_ _ Were the septic tank manholes uncovered,opened,and the interior of the tank inspected for the condition of the baffles or tees;matey'al 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)on 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 relate is unacceptable)[310 CJ I 154302(3)(b)] d to Part C is at issue approximation of distance s Page 6 of I I OF'T'ICIAL,INSPECTION FORM_NOT FOR VOLUNTARY ASSESSMENT SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION T S FORM PART' C SYSTEM INFORMATION Property Address: Owner: Date of Inspection: t RESIDENTIAL FLOW CONDITIONS Number of bedrooms(design): N DESIGN flow based on 310 CM�.2p;�Q Number afbedrooms i�OO�s(actual): Number of current residents: _ p gpd x#of bedrooms): 33- Does residence have a garbage grinder(yes or no): jV6 Is laundry on a separate sewage system( es or no Laundry system ins ected yy 6 [if yes separate inspection required] Seasonal use: (yes or no): ( or no):RJ0 Water meter readings, if available(last 2 years usage(gpd)): Sump pump(yes or no): —0 Last date of occupancy: CX1r COMMERCIAL/INDUSTRIAL Type of establishment:Design flow(based on 310_C R Basis of design flow(seatslpersons/ `pd Grease trap present (yes or no): Industrial waste holding tank esent(yes or no): Non-sanitary waste disch 'ed to the Title 5 system (yes or no): Water meter readings,i vailabo -- East date of occupan ;use: . OTHER(descri ); Pumping Records GENERAL INFORMATION Source of information: Was system pumped as part of the inspection(yes or no If yes,volume pumped:_gallons--How was quantity pumped determined? Reason for pumping: TYE 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 technologtach a copy of the cur y. Atrent operation and maintenance obtained from system owner) contract(to be Tight tank y Attach a copy of the DEP approval Other(describe): Approximate age of all omponents date installed(if kn Q own)and source of information: Were sewage odors detected when arriving at the site(yes or no): 6 • Page 7 of 1 1 ®'EFICIAL, INSPECTI®N F® —NOT FOR VOLUNTARY SUBSURFACE SEWAGE DISPOSALSYSTEM INSPECT ON FORM ASSESSMENTS PART C SYST`EM'NFG iT`ION(continued) �w Property Address: t�t� ed Soy �� I' Owner: (3, t Date of Inspection: (k p rS 07 UILDING SEWER(locate on site plan) Depth below grade: 6 a Materials of construction: cast iron _ Distance from private water supply well or suOction line:Other(explain): Comments (on condition of joints, venting, evidence of leakage, etc): SEPTIC TANK: oe (locate on site plan) Depth below grade: p Cr Material of construction: a concrete_metal —fiberglass If tank is metal list a ---Polyethylene certificate) age-— Is age confirmed by a Certificate of Compliance(yes or no): Dimensions: �-pw ga / _(attach a copy of Sludge depth _ Distance from top of sludge to bottom of outlet tee or baffle:y y Scum thickness:-- t Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom( outlet tee or— How e: 16 How were dimensions determined: Comments(on pmnpinp recommendations, inlet and outlet tee or baffle condition,structural integrity.. as related tgoutlet invert, evidence ofleakaoe, etc.): �A-A -fbl liquid levels GREASE TRAP: _(locate on Site plan) Depth below grade:_ Material of construction:_concrete (explain): _____metal ,_fib as polyethylene_other Dimensions: Scum thickness: Distance from top ofst cum to top Of Out! tee or baffle: Distance from bottom of scum to bott Date of last pumping: of outlet tee or baffle-, Comments(on pumping reo ndations, inlet and outlet tee or baffle condition, structural as related to outlet invert,evi nce of leakage;etc.): ral integrity, liquid Levels 7 Page 8 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENT'S SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: tv V Mr Owner:_ /)'I aQ J' A Date of Inspection: . ..'(., TIGHT or,HOLDING TANK: (tank must be pum at time of inspection)(locate on site plan) Depth below grade.- Material of construction: concrete me fiberglass Polyethylene other(explain): Dimensions: Capacity: gallo Design Flow: ga ns/day Alarm present(yes or no): Alarm level: Alarm ' orking order(yes or no): Date of last pumping: Comments(condition of a and float switches, etc.): DISTRIBUTION BOX: (if present must be opened)(locate on site plan) Depth of Iiquid level above outlet invert:'I�k&t Comments(note if box is level and distribution to outlets equal,any evidence of solids carryover,any evidence of leakage into or out of box,etc.): ` /f 6 �c.�(,P'J24 u� 'F�ti_`t f 2!7 t10 r/5Gt C'CV 6_411ti1 PUMP CHAMBER: (]ovate on site plan) Pumps in working order(yes or no):. Alarms in working order(yes or no): Comments(note condition of pump c ber,condition of pumps and appurtenances, etc.): R Page 9 of I l • OFFICIAL INSPECTION F® _NOT FOR VOLUNTARY SUBSURFACE SEWAGE DISPOSA-L SyST"EM INSPECTION ASSESSMENTS PART' C S�'ST'EM INFORMATION(continued) Property Address: M PS Owner: .- a Date of Inspection: j S®IL ABSORPTION SYSTEM(SAS): (locate on site plan,excavation not required if SAS not located explain why: Ty e 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 veQe etc.): Cation, � •'� r �'-e U � ri 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 laver: Depth of scum layer: Dimensions of cesspool: Materials of construction: indication of groundwater flow(yes or no): Comments(note Condit' n of soil,signs of hydraulic failure, level of ponding, condition of vegetation etc. PRIVY: (locate on site pl Materials of construction: Dimensions: Depth of solids: Comments(note condi on of soil,signs of hydraulic failure, level of ponding)condition of vegetation,etc.): 9 Page 10 of l l OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FOR PART C SYSTEM INFORMATION(continued) Property Address: 09 Owner: �3 Date of inspection: SKETCH OF SEWAGE DISPOSAL SYSTEM 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 where public water supply enters the building. Page 11 of I 1 f OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: • c Owner:_�— Bate of inspection: STfl'E EXAM Slope e Surface water 00 Check cellar Shallow wells f10 Estimated depth to ground water 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) 0c Accessed USGS database-explain: You must describe how you established t high ground avatar elevation:. () li CATION SiW G £ PERMIT . Kfl. 0. IfT r E � ?lSTA AME A 00RE S 2 a UILDER OR OWN ER r . DATIF FEPMtT I S s u 0 ., QATE C0 M,PLIANCE I S S U E 0 � q� i3�� KS Y. 0e) Z 3. r S E A,.6.E PERMIT NO. VILLAG I R S T."l R'S NAME. IL ADDRESS CTL- IRUILDER OR OWNER DA T E PERMITf ISSUED DATE COMPLIANCE ISSUED ��j crylt , /2 E � y r . ss POP- LOCATION 1 SEWAGE PERMIT NO. 5 , . 41 L LAG E INS TA LFER'S NAME OQ'RESS D I U I L D E R OR OWNER DATE PERMIT ISSUED DATE COMPLIANCE ISSUED ��• 3Y i9 3z 2y ` 3l 3 ' v s: _r No.... _./.?tL # Fim$...15 .......... r THE 'COiGiANWEALTH OF MASSACHUSETTS n BOAR® OF HEALTH Town Barnstable O. .................. .........................O F.......................................----------.------.-.•-•--•------.-.----------•-•-•- �( ,A lira�iaatt for o os al Work, Cnomitrurtion 1hrutit Application is hereby made for a Permit to Construct (X ) or Repair ( ) an Individual Sewage Disposal System at: •Lot #13 - .Sandy Valley Rd Xia'rstons Mills i. h,A ... .___. ............................. ........•----•-----•----..............-••••-•--------•-•-•-----••....-•--•••-----.......I........-- Capricorn Real y d rust 765 Falmouth RBraT D°•Hyannis ----.......-•.................•---......-••...........-•••--..... ..........•-...................................................................................... W Steve Lebel Owner Address a ...................•-------------•--•---••--..In Installer ......................................................-•-....._........................-q........ Installer Address Type of Building Size Lot............................S feet U Dwelling—No. of Bedrooms__....................... ...............Expansion Attic ( ) Garbage Grinder ( ) No. of ersons............................ Showers Other—Type of Building Y'anC�?.............. p (2 ) — Cafeteria a ( ) 04 Other fixtures ------------------............................................................-•----------••--....•--•----�----•-------.......------•.......---••• Design Flow........55..............................gallons per person p r day. Tot d ity flow...._.._.330 ........ lgns. WSeptic Tank—Liquid capacity1.000_gallons Lengths�_ ��...... Width U'�.. Diameter................ Depths x Disposal Trench—No..................... Widt _..._..........___.. Total.Length Total leaching area s ft. g q Seepage Pit No!................... Diameter.................... Depth below inlet.................. Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosingrya�k Percolation Test Results Performed b yad24dke Engineering 11-25-81 y--••--•----- ••--------•---------•----••---•-•------------••-•----------- Date-...'.'.............................................•----•---•-- 2 0 12' None encounterd- ,.� Test Pit No. 1........... minutes per inch Depth of Test Pit..... .............. Depth to ground wate . ._ _____.__..._.__. JJ Test Pit No. VYA........minutes per inch Depth of Test PitT4/ ...=....... Depth to ground water--'��............. a --•-------•••----•--•••..............................•--•......------........------------•--.....---•--•-•----•---•---...-•-------.....------•--...._....--- O Description of Soil.........0.@._..--..2_1..........l loam &- topsoil - x 2 10 Niedium yellow sand v ..... .......... .....y W 10 - 12 med. white sandrtraces off' gravelJ`no" water' at-- 12 -•------••••-------•-•--------•--•••---••----•--•-------••-•--•--•---•-•-•••••......-•-----•-•••--------------------------•--------••---•-•---------••--------•-----------••....------......_.......... U Nature of Repairs or Alterations—Answer when applicable............................................................................................... ------------------------•--................................................................ Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITI.I4 5 of the State Sanitary-Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance irnias 9be9n issued by the boar ealth. Signed �f ....Pre....` Date 71 Application Approved By.... ,•• •-- '� Z= 7 Date Application Disapproved for the following reasons:------••------••--------------------------------------•-------....------------...------------------------------. .................•---•-----•-•-------.....--------...----•-------•......•----------.....---•-----•--------•-----------•---•••••-•------------. ......................................................... Date PermitNo......................................................... Issued............................ ........................... Date I V No.... L �- ' Fss. 11..y........- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH Town Barnstable .............................O F.......................................----............................................... Appliration for llhipao al Workli C ontitrurtioit rrattit Application is hereby made for a Permit to Construct ) or Repair ( ) an Individual Sewage Disposal System at: Lot # 13 - Sandy Valley RdMa'rstons Mills IfiA . ............ ._ ......_........._..... .. ---------•------- --....------•••---•-••-••-•........_.....•-•-••..............-•---.....................=--•-••-•-- Capricorn R�lt�YA rust 765 Falmouth Rda'dt,NoHyannis ..... - ---........ ............. ..................•..........._......-•.-•• -•••.....______._.._...__.-•-•--••............._......-•----------•---•-•-•---•----..........---•- W Steve Lobel Owner Address Installer Address dType of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms...... ...................................Expansion Attic ( ) arbage Grinder ( ) pa., Other—Type of Building ranC.'1.............. No. of persons............................ Showers ) — Cafeteria ( ) aOt fixtures -----"-"---••---•---•-•......_...••............... W Design Flow................ per pers ri pgl day. Tot �c ijy�,flow._.._.___.___.___...._.._......_._____._. ,ggllons. WSeptic Tank—Liquid'capacit ............gallons Lengt ................ Width.........__... . Diameter................ Depth......_........ x Disposal Trenc. —No. .................... Wid t.._......___._.. Total Length.....b,...........Total leaching area.... 6........sq. ft. Seepage Pit No.-.-"-._---_-.__-_ Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Other Distribution box ( ) Dosinak4dde Engineering 11-25-81 Percolation Test Re It Performed by...----••-•••--• -•.._.••........ , Date-------•"...........................•--- � 2'.� 12 done encounter- 14 Test Pit No. minutes per inch Depth of Test Pi .............. Depth to ground wate .._._ .._ ea fi Test Pit No. I`4......_...minutes per inch Depth of Test Pi �/.-A............. Depth to ground water.'�r ..........._... x - -0* _ -2r -TY�i0e3diIIu&m'yteOZpTS011ODescri Description of SoilZ ---------1 �0_...- .ow•-sarid.............................................................................. W ----------- __________________110 ._.-=...1Z,-----medS.... Hite...sariiiJ`�races off' graver/rio water--a[:U -121 .....................------•----------•-•--•-••--•-•--•-•-•----------•----•-••••--••..................••--•--•------------------••---••--- .......................................................... UNature of Repairs or Alterations—Answer when applicable.......................................•......................_....__._......................... .."--"-"•--•--"-------••--•-"---......--•-""--•--•"-""""-----""-"-"""""""-"-"--"-"----".............."""........"--------------------...---.......-"-""""-"""--"-"""-"""•-........._.....••-••-•--•..... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TIT!L- 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Complian as en issmed by the boar health. ` Pres. Signed- .......................... Date Z— Application Approved By... ................ .." '. •--•....._......._ Date Application Disapproved for the following reasons:--"-----------"-----"-"•---•--"•"--•-""--"----"-----""................•--•------.---:"•---................•-•--- --•"-•"-"•-•""""--""--"-----"•--•-•-"".............."----"""-"--""-""----•................_....__...._......-•-•--......-•-•------••-•--..._..._.._...-•-----•--..............................--••-_..___ Date PermitNo.......................................................... Issued-....................................................... Date THE COMMONWEALTH *OF MASSACHUSETTS BOARD OF HEALTH Town ......O F......Barnstable .............. ............................................................................... Grtifiratr of TompfiFattrr* THIS IS TO CERTIFY That the I dividual Sewage Disposal System constructed ) or Repaired ( ) Steve Lebel by................................................ - --•-•••--•--------------------•---------------------------------------------------------------------•------...-----------------------•------- Lot 13 - Sandy.... alley Rd. Install ...... �farstons Mills , P:iA has been installed in"accordance with the provisions of TIT r 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No------- ................................ dated................................................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATI• FFACTORY. DATE. /ice { Inspector"" r `=1 THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH Town Barnstable 9 . OF................... �P ... No.... ..... FEE...- .............. �io�osttl ork� �ott�tra$rtion rrattit Steve Lebel Permission is hereby granted -"-------•"-""--......---"-. ---to Constru ox Re air ( an I ividual Sewa e Disposal S stem at No...T p `�r 1 j -pZi d� valley ha. , jarsPtons yMllls , i+',A .---_... -•-- -- -- --•--• --•• . •---- Street as shown on the ap ratio or Disposal Works Construction Permit No..................... Dated.......................................... .... -••••--•........................................... Jam/ I Board of Health DATE.....fP_. ..---•--............ .......................................... Ft�RM 1255 HOBBS & WARREN. INC.. PUBLISHERS !l1111--- l 4,ti7 % . AID` f VA 4-4,4L-7,v TR/ vA Tc 5to ►-r/ivE. IZ ti v \� b n:, LOT r z- �J I 0 3 M 1 L9 M N 7- ri , 3 S N N $ K u SE,.. N -- 6. /00 L&A c P,7- i S 4 �N i�Lzyr 5 i Zc— - r4K2t S , 9 PJU7-E: — 1 T�s� f}s sure c o7 Przc�c TA41N FSY S '°4' CERTIFIED PLOT PLAN OF MAS Off' � s ,R RQE3ERT (� !}f/�9 fG S 7 U/V S .a ' c ARSE —ILD Ep ua ,p No.10951(QO : IN A _ SCALES DATE , -7'�7��¢ 1�71LDREDGE ENGINEERING Ca IN RAMC•`' w CLIENT I CERTIFY THAT THE PROPOSED E(3JSTERE REGISTERED BUILDING SHOWN ON THIS PLAN JQ8 NO.. ..........,.. CIVIL .LAND CONFORMS :TO THE ZONING LAWS OR.BY, 'r'9 ' M As . ENGINEER R Y �F BARNSTABL E 712 MAIN S.T.REET CH. ;�/� ., 'N.YA N N>I .S- � MA ',��!''''.�-�� �•.."" "_"'-'. . ,;r $HEET..1aOF' A . E4 RE4. LAND SURVEYOR R« - k w Permit Number: Date' � Completed by HIGH GROUND-WATER LEVEL COMPUTATION 2•`_: . Site Locat on: Lot No. /J — Owner:_ -�,� Address: — Contractor: Address: Notes: STEP 1 Measure depth to water table to nearest 1/10 ft. . . . . . . . . . . . . . . . . . . . //�// °�� �O,O a date STEP 2 Using Water-Level Range Zone and Index Well Map locate site and determine: S.p A) Appropriate index well . . . . . . . . . . . . B) Water-level range zone STEP 3 Using monthly report"Current Water Resources Conditions" ---- determine current depth to water level for index well . . . . . / mo yr STEP . 4 Using Table of Water-level Adjustments for index well STEP 2A) , current depth to water level for index well (STEP 3) , and water-level zone (STEP. 28) determine water-level adjustment STEP Est i1:1ate depth to high water by subtracting the water- level adjustment (STEP 4) from measured depth to water C � � level at site (STEP 1 ) /YOT.E /F E/TNG°R TWe SEPTIC TANK OR 20 FT. M/N- LEACH1ivG P/T ARE )YORE TNA.,V I2"QELOW /O Pr p!/N. c5;AAP&j A "-V1A,"ETEL' CONCRETES COV&A- SHAL &, 0-W0VOR7' TO GA .�'4,V E q'PVC PlPI EA'T.�A CONCRETE M/N. P/TCN h►E.4VY CAST /RON CO!/Z—R SYALL DE USFO f' C'OYERS '�PFR FT /F/N DRIVEWAY IT _ .... .. 2 MiN. CONCRETE :o G .noE COVER CLEAN SAND " = ' - UQII/D LEVEL - _ =. •; -•, C.gST - __- !.an . zLAYER IRON P/PE /U O D G/IL. o Q coo, CIE -'� a. M!!V.P/TCN p/ST, • � � • • • • • • 1 1 ' •4 WASHFD 570AIZ V4'pArx tr7: SEPTIC TANK Bvx „ • • • • • • 1 1 ,•e 0 1 • •EFiECTIVE • a, • 1 • • pEPTH ' • • • WASHED STONE„ O 377 S • • 11 • • • • • / 1 03 . e. , ' p PRECAST SEf..H46E lwYeR'T ELEI�AT/GWs n�T ��-�A�,�-y L�i'0 GAL/�Ry � : ., 1 • . . . • 1 • .d • 0 P9 OR EvuIv._ Sl3,S G FT D/AM. /iVYERT AT O/JILD/NG FT. /EiVL ET .SEPTIC TANK SB.O FT, : l Z FT O/i4!►'1. C(-WETy1B1/L4T)0N� d J?LET SEPTIC 7-ANK 58.0 FT , yZ.c/AR�Cli►r�►r IWLET D/STR/B!?iON BOX 57•0 FT. SECTION OF GROUND J44TER TAALZ g. 007L TD/STR/BUT/ON BQ�' F7: !//LET' LZACNlMG =V7' SU, FT. SEWAGE O/SP4�SA t SY.ST�M -rA�WJAT/ON LEACH/NG -P/T DIA EN-TION A 85 RT. SCALE /=D DESIGN Cft/TER/�l D/�•fEws/oN 49 =T• j N'/i+A9BER OF BEOROO/NS 3 D/MENS/ON C 4 FT. M/"l' GARd4GE'D/SPO5A4 UN/T 0 A.1E SOIL LOG ST!/rf rrEG FLo Av 3`3 v SOIL TEST T©TA L E GE4L.�0.4Y SO/L TEST �! SOIL 71cSTlIf2 i NG/MBER QF 4E°ACMJ/V0 PITS ELEY. ELlrJ/, DATE OF SO/L TEST SAME.LrACHING PER P/T 15D,A 5a PT. fi _3 r dY RESULTS iVITNESSED 13� `JA C-.08/ 6'®TTOM LC�IG'N/NG PER P/T / SQ. PT. j L�.r PERCOLAT/Oly *VATAr j* LtVs MIMlJlt-CH TOTAL LEACHING AREA �SQ. FT. s ui3 c 14- AERCOLAT/oN RATE 2 RESERVE LEACNlN6 AREA SQ. FT. 3 '_ /p ' Z' &D;CJM SU/L TEST P- Z7�Z 7 I�ff LE?� !2 LD. / 3 �6'�s { v. "ram, TN OFM 1A.R.S tlJrtc� - '` FA. rn 149ORSE wR' EL DREDGE E)VGIAIjW)?IA(G CQ,1. �> ,f� e ,p Ala 1 1 Q 7t2 MAIN 9T.1 PYANN/9, MASS._ yV � [j NO GROUND YYi4TtsR ENCDUNTEREG' CL/EENT: �lp_A oV co (2� GT0UN0 LV.4TER i4T ELEV. -3 -5 .IOB Mo. 83 Zs SIdE�1' zOF a