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HomeMy WebLinkAbout0023 SHERYLE'S WAY - Health 23 SHERYLE'S WAY, MARSTONS MILLS A= 046 015,002 w TOWN OF BARNSTABLE LOCATION ��3 S!�/F% Y��S L✓�y SEWAGE#g20[0 VILLAGE I), ASSESSOR'S /MAP&PARCEL C���C/�S�CCa INSTALLER'S NAME&PHONE NO. 1 , / /C�CC ll�S%r 50,5 /w SEPTIC TANK CAPACITY l 666 LEACHING FACILITY:(type)566 CN6 ('126MA?i C Z) (size) NO.OF BEDROOMS OWNER Att PERMIT DATE: COMPLIANCE DATE: ,5 o Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility feet Private Water Supply Well and Leaching Facility(if any wells exist on site or within 200 feet of leaching facility) feet Edge of Wetland and Leaching Facility(if any wetlands exist within 300 feet of leaching facility). feet FURNISHED BY GA59) �� t 31' -7 6 3 , _� 3 r 4 No. /Fee !®U.11 I THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS Yes ftol.tation for Disposal *pstem Construitiun Permit Application for a Permit to Construct( ) Repair 4 1 Upgrade( ) Abandon( ) ❑Complete System �Individual Components Location Address or Lot No. Q3 S h es�j e S W Owner's N e,Address,and Tel No. Assessor's Map/Parcel C3 q,6 L/S'^o0�9_ ,7 3 `v"�i r r /c:1 Installer's Name,Address,and Tel.No. Designet:s Name,Address,and Tel.No. Type of Building: f Dwelling No.of Bedrooms e j Lot Size Yt sq.ft. Garbage Grinder(0 Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 9 3© gpd Design flow provided r 98 gpd Plan Date 2 - 3 `:ICJ'16 Number of sheets Revision Date Title Size of Septic Tank 1606 W FX js%i,j(• Type of S.A.S. ee t^ /-a,4 C✓, Description of Soil 0., ¢�' �C�1vYt n «, tn1 � S � *�-/357 Nature of Repairs or Alterations Answer when applicable) w� e z / J� �� S4`'b C9,gr7 �J � I sra&4 F Ao-x Date last inspected: Agreement: i The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Co a and not to place the system in operation until a Certificate of Compliance has been issued by this Board f Heal d L' '�'� Date r9 ®.v2C�/G� Application Approved by �/ e Date 3 v o Application Disapproved by Date for the following reasons Permit No. �=p Date Issued 3 d e No. D I () Fee �QU THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS Yes 2pplitation for Misposal *pstem Construction Permit Application for a Permit to Construct( ) Repair(Yr Upgrade( ) Abandon( ) ❑Complete System (�dndividual Components Location Address or Lot No. 3 5 k e r,Oe s (,v y O ner's Name,Address,and Tel.No. / Sze. yrZ S'a8 M5Tvns ti:tLs 'Vries f�oP�/ M16 Assessor'sMap/Parcel O q16 O/S"ODoZ, Z3 Shr, )/eJ" Installer's Dame,Ad ess,and Tel.No. Designer's Name,Address,and Tel.No. � 360Z j�rvc� 0.r-CL irr ;J 'i' y9f� rgRi2��r /7c r� � �1�to ST- OsT. g S�t9l� �a1G C/8( noc �i a53 Type of Building: Dwelling No.of Bedrooms \ Lot Size J/•t sq.ft. Garbage Grinder(Xk Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) -3 3 gpd Design flow provided 36 96 gpd Plan Date oZ 19 -00/d Number of sheets Revision Date Title Size of Septic Tank �!��A_ X�s/�� Type of S.A.S.07-, X Description of Soil O = `046% g,q,,p !-3 8`= ,6AM _A& 3� �3a r' Ae; 3 kl Nature of Repairs or Alterations(Answer when applicable) A, Y STun c ('i '�t�s, y_5 6a x Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board 9f Heal A ed Date e,-rH 3Q dD/o Application Approved by ✓tiv le Date 3 o Application Disapproved by Date for the following reasons Permit No. .O (U -Ok� Date Issued 3 o r o :- - - - - - .---.------- ---------- ----------------------'-------------------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certifitate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired(Vj' Upgraded( ) Abandoned( )by 6 0r'/in.[ 11151. at ,23 J�I1 Pi /e� .t/r4 M /y.H,11 has been constructed in accordance with the provisions of Title 5 and t e for Disposal System Construction Permit No. 0 0/0 -U dated 7 u O Installer! (i(_ LILaGa/X 5—At2 Designer 1)wr(w #bedrooms Approved den flo/� SoZ•%8 gpd The issuance o this permit shall not be construed as a guarantee that the system well fu\tion'as design o. Date .5� D Inspector No. O o` Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION=BARNSTABLE,MASSACHUSETTS misposal 6pstem Construttion Permit Permission is hereby granted to Construct( )` lRepair(k-f Upgrade( ) Abandon( ) System located at Q2 and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Constructi,n must be completed within three years of the date of this permit. S Date ?I3° (a Approved by p L 2 _ i / PI�� �(rP fEb�Q / E,' Ill Z 11�V, � JV�F'� 4�1frfer )i ,�+ �yQ4� (�Jf� II(4o?f 9 S cc, ? L13 APPLICANT: M YVI�,UPjy ADDRESS: S Wk DESIGN FLOW: 39)b gpd REVIEWED BV: DATE: _ N/A OK Nq Le al boundaries denoted [310 CMR 15.220(4)(a)] Street, Lot, tax parcel number and lot number noted on plan [310 CMR 15.220(4)(u)] Locus Provided 310 CMR 15.2204 t Plan proper scale?(1"=40' for plot plans, 1"=20'or fewer for components) [310 CMR 15.220(4)] �( Easements shown [310 CMR 15.220(4)(b)] System located totally on lot served [310 CMR 15.405(1)(a)for upgrades]- if not, a variance is required [310 CMR 15.412(4)] Location of impervious surfaces(driveways,parking areas etc.) [310 CMR 15.220(4)(d)] X Location all buildings existing and proposed 310 CMR 15.220(4)(c)] X Location and dimensions of system components and reserve areas [310 CMR 15.220(4)(e)] x System Calculations [310 CMR 15.220(4)(0] daily flow septic tank capacity (required and rovided)• X soil absorption system (required andprovided) X whether system designed for garbage grinder x North arrow [310 CMR 15.220(4)( )] Existing and ro osed contours [310 CMR 15.220(4)( )] Location and log of deep observation holes (existing grade el. on each test) [310 CMR 15.220(4)(h)] X Names of soil evaluator and BOH representative [310 CMR 15.220(4)(h) and (i)] X Location and date of percolation tests (performed at proper elevation?) [310 CMR 15.220(4)(i)] Percolation test results match loading rate?-[310 CMR 15.242] Certification statement by Soil Evaluator[310 CMR 15,220(4)0)] Observed and Adjusted groundwater(method for adjustment given or indicated) [310 CMR 15.103(3) and 310 CMR 15.220(4)(n)] K1 Location of every water supply,public and private,_[310 CMR- 15.220(4)(k)] X Address l' VJ� j(,L�j Sheet 1 of 7 within 400 feet of the proposed system location in the case of surface water supplies and,gr4yel packed public water su 1 ` within 250 feet of the fo osed system location in the case �C within 150 feet of the proposed system location in the case . of private water supply wells Location of all surface waters and wetlands located up to 100 ft. beyond setbacks listed in 310 CMR 15.211 and any catch basins located within 50 ft. [310 CMR 15.220(4)(1)] x '� Water lines,-and dtheF:subsufface utilities located [310 CMR 15.220(4)(m) (if water line cross see 310 CMR 15.211(1) 1]) �( Profile of system showing invert elevations of all system components and the bottom of the SAS 310 CMR15.220(4)(o)] X Stamp of designer 310 CMR 15.220 1 and 310 CMR 15.220(2)] Stamp of Registered Land Surveyor(required if construction activities within 5 ft. of lot line) [310 CMR 15.220(3)] X Test Holes adequate (two in each of the primary and reserve unless trenches as permitted in 310 CMR 15.102(2) or as approved for an upgrade under LUA at 310 CMR 15.405(1)(k)] Test hole adequate to demonstrate four feet of suitable material? 310 CMR 15.103(4)] Test Holes adequate to confirm adequate groundwater separation? [310 CMR 15.103(3)] X Benchmark within 50-75' of system [310 CMR 15.220(4)( )] X Materials specifications noted? [various sections of 310 CMR 15.000] System components not> 36" deep(unless Local Upgrade Approval or LUA requested){310 CMR 15.405(1(b) x Address ��` Y L'tS All M 1 'S Sheet 2 of 7 Size OK? _[310 CMR 15.223(1)] Inlet tee located ten inches below flow line 310 CMR 15.227(6)] Outlet tee 14" or 14"+5"per foot for increase ft depth [310 CMR 15.227(6)] x Outlet tee with gas baffle or approved filter[310 CMR 15.227(4)] AN Note regarding installation on stable compacted base[310 CMR 15.228(1)] Separation between inlet and Outlet tees (no less than liquid depth) 310 CMR 15.227(2) - x Inlet/Outlet elevations at least 12" above high groundwater (except as described 310 CMR 15.227(5)) or permitted for upgrades under LUA [310 CMS 15.405(1)(k)] X Minimum cover 9" (Tanks buried more than 9" must have risers on all openings and on the d-box) [310 CMR 15.2228(1) and 310 CMR 15.232(3)(f)] �C Three access covers (inlet and outlet must be 20" or greater) - middle access at least 8" (by 7/07) [310 CMR 15.228(2)] X Access to Within 6 " of grade - one port for systerrms l000gpd, two fors stems>1000 gpd 310 CMR 15.228(2)] X All at-grade covers secured to unauthorized access? [310 CMR 15.228(2)] X > 10 ft from building foundation [310 CMR 15.211(1)] X Buoyancy calculation Required/Done 310 CMR 15.221(8)] X H-20 Where appropriate? [310 CMR 15.226(3)] Setbacks from resources [310 CMR 15.211] X _ Required when other than single-family dwelling or flow>1000 d [310 CMR 15.223(1)(b)] X First compartment 200%daily flow; Second compartment 100% daily flow 310 CMR 15.224(2) and 3)] "U"pipe through or over baffle, outlet of each compartment with as baffle or approved filter[310 CMR 15.224(4)] .Address_- Wes. M, A4 1 Sheet 3 of 7 } Located at leastten feet from any water line? [310 CMR 15.222(2)] x Disposal piping at least 18"below water line (when water and sewer cross, see 310 CMR 15.211(1)[1)) Cleanouts required/provided ? [310 CMR 15.222(8)] Thrust blocks specified in force mains? 310 CMR 15.221(6)(c)] Slope of sewer line not less than 0.01 (1/8"/ft) 0.02 preferable [310 CMR 15.222( A x Proper pitch on all runs? (.005 within gravity-distributed trenches and beds) [310 CMR 15.251(9) and 310 CMR 15.252(2)(c)] �( Siphonproblem/ leachfield below pump chamber) Endca s or vent manifoldspecified? X Size and orientation of discharge holes specified? (not smaller than 3/8" not larger than 5/8") [310 CMR 15.251(8) and 310 CMR 15.252(2)(h)] X Materials specified (310 CMR 15.251(5) specifies various pipe types allowed) �( a, RtaTbl !pacted base [310 CMR 15.221(2)and 310 CMR 15.232(2)(a)] Splash.plate or baffle tee required on inlet/provided? (when pressure sewer to d-box or steep pitch of gravity sewer) [310 X CMR 15.323(3)(a)] Riser if deeper than 9" [310 CMR 15.232(3)(f)] Inside minimum dimension 12" [310 CMR 15.232(2)(b)] Minimum.sum 6" [310 CMR15.232(3)(e)] Watertight cover if<2000gpd);waterproof manhole if>2000gpd [310 CMR 15.232(3)(d)) X Capacity emer'(emergency, =( g y storage above worlang design flow)?[310 CMR 231(2)] k Proper setbacks [310 CMR 15.211 (same as septic tanks)] Watertight 20-in minium access manhole at least 20"MUST BE TO GRADE [310 CMR 15.231(5)] Service components accessible (not too deep,with piping, disconnects accessible) Alarm floats - alarm on circuit separate from pumps specified? Exceeds two units must have two pumps operating in lead-lag mode. [310-CMR 15.231(6) and (8)] Stable Corn pacted Base [310 CMR 15.221(2)] Buoyancy calculations needed ?Provided? [310 CMR 15.221(8)] Address 2,3 St!t-k%ty �MJ4 Sheet 4 of Calculations correct? 4 feet of naturally occurring material demonstrated? [310 CMR 15.240(1)] Required separation to oundwater? 310 CMR 15.212).] Aggregate specified as double washed [310 CMR 15.247(2)] System Venting required/provided? (system under driveway or >36" deep) [310 CMR 15.241) Inspection ports specified and within 3"final grade? [310 CMR 15.240(13) Breakout requirements met?(No violation of breakout elevation within 15 ft of SAS unless barrier) [310 CMR 15.211(1)[4] and X Guidance Document] Chambers and Gal. in trench configuration supplied with inlet every 20 ft. [310 CMR 15.253(6)] Each structure with one inspection manhole (if>2000 gpd must X be tograde) 310 CMR 15.253(2)] Aggregate I'minimum-4'maximum. 310 CMR 15.253(l)(b)] 2' sidewall credit maximum [310 CMR 15.253(1)(a)] >C In bed configuration, inlet every 40 s .ft. [310 CMR 15.253(6)] Width 2'minimum 3'maximum [310 CMR 15.251(1)(b)] 100 feet-maximum length 310 CMR 15.251 1) a Minimum separation 2x effective depth or width whichever eater(3x if reserve between trenches) [310 CMR 251 1)(d)] Situated along contours [310 CMR 15.251(2)] Breakout OK? [310 CMR 15.211(1)[4] and Guidance Document] minimum 2 distribution lines [310CMR 15.252(2)(a)] Maximum separation between lines 6' 310 CM R15.252(2)(d)] Maximum separation between lines and outside of bed 4' [310 CMR 15.252(2)(e)] Aggregate depth below discharge.pipes 6"minimum, 12" maximum. [310 CMR 15.252(2)(g)] Separation between beds 10' minimum. [310 CMR 15.252(2)(f)] Bottom area used in calculations only310 CMR 15.252(2) i)] Address Sheet 5 of 7 Pressure Dosed System ? Provided pump and777 calculations as re uired,. 310 CMR 15:220 4 (r Pressure dosing required on all systems>2000gplternati systems and* medial approval [310 CMR 15.254(2) and I/A Remedial Use Approvals] X If used in gravelless system - make sure jet is directed as not to scour soil interface [Guidance Document] Inspections once per year(systems<2000 gpd) or quarterly . (>2000 dgood to note on plan [310 CMR 15.254(2)(d)] x Construction in fill -Did the plan specify that the fill shall meet the specification of 310 CMR 15.255(3)? X Impervious barrier and/or retaining wall ? [Guidance Document] Impervious barrier installation must be supervised by designer [310 CMR 15.255(2)(b)] �C Retaining wall must be designed by Registered Professional ,Engineer [310 CMR 15.255(2)(a)] X Side slope not exceed 3:1 ? 310 CMR 15.255(2)] [ Breakout requirements met? [310 CMR 15.252(2)and Guidance Document X At least 5 ft. from impervious barrier to edge of SAS (10 ft. recommended) [310 CMR 15.255 (2)(e)] R Check DEP Ap proval lett ers for credit s and design co nditions 'Mons X If used with r p essure dosing do not allow pressure discharge to scour soil interface K Was DEP Approval Letter provided and/or have you reviewed the letter for conditions? X Is the technology being properly applied and does it meet all DEP Approval Conditions? Is there a note on the plan regarding the requirement for e etual maintenance a eement? Any alarms involved on separate circuits Did the applicant submit an operation and maintenance manual? Has applicant submitted a copy of a maintenance _Are the variances listed on the plan ? [310 CMR 15.220 ('4)(.)] X RLS Stamp necessary on plan if a component is within five feet of property line [310 CMR 15.412(4)] New construction or increased flow proposed - [Refer to 310 CMR 15.4141 Address 11J A - A4.1U,3 Sheet 6 of 7 Is the system in a Designated Nitrogen Sensitive Area(Zone I1 for a public supply well)? [310 CMR 15.214, 310 CMR 15.215 and 310 CMR 15.216 -also refer to Policy regarding upgrades of such X existing systems] Is the system proposed on the same lot as served by private well ? [310 CMR 15.214(2)] X Are the nitrogen loads proposed in compliance? [310 CMR 15.216(1)] X Pumping to septic tank? [ 310 CMR 15.229 Shared System [310 CMR 15.290] Li:d Address �� s S V 41 A Sheet 7 of 7 Town Of Barnstable Re torn Services $ a Thomas F. Gelier,Director )Public Health Division Thomas McKean,Director 200 Main Street,Elyaaa*cIMA 02601 Office: 503-362-46 4 Fax: 503-790..6304 lr►s llcr 8c er Certitication Forma Date: Sewage Perm Assessor's Nlap\Parcel _ Designer: )o22 Insular: D,—ce Hp-cc,, Address: =yak Ql Address:On _3-30—tco �tc� c (date) {installer) was iss ued a permit to install a septic system at �3 5 V, i s f,��y �'1_6f7 - t on a e t based ti sign drown by >: �CY�� ` =_ w crated ,:�� OCcrf�3CI�': (desisner) -,& I certify that the svptic system, referenced abo, a was installed substantially according to the design. which may include minor approved changes such as lateral relocation_ of the distribution box and,or septic tank. I certify that the septic system referenced above was installed with major changes (i.e, greater than 10` lateral relocation of the SAS or any vertical relocation of any component of the septic system) but in accordance with State : Local Reeulations. Plan revision or certified as-built by designer to follow. \A OFMq o qAR E (Installer's Signature) ! On E No. 1140 4. `SgN/TARtiAN •'� (Designer's Signature) (Affm Designer's Stamp Here) r . P1.Ei�5 IBE�'URN TO B ST aU" IPUB7L1 DIV!S! N. CERTIFICATE ®F CtJMPLIANC E WILL NQT 0E ISSUED UNTIL AQT:d S FORUM AND AS-BUILT CORD ARE RECEIVEta B'Y:CUE BE NL7-ABLE PUBL'BC HEAL"I`H DIVISION. T&MIMXQU . Q:HeaEtWSeptk/Dvsiper Cenification Fetus 3d264-doc Town of Ba', table. P#� 6� Department of Regulatory Services • Public Health Division Date "A �urterest$ KAM ib3q ems$ 200 Main Street,Hyannis MA 02601 �ffD MA't� '• Date Scheduled 3 �' U Time �`�► Fee Pd. l i ,Foil Suitability Assessm*ent for ►Sewage isposal Performed By ' ` ' ' Witnessed By:_; i LOCATION of GENER151- 11VORMAT1ON Location Address• 2 Owner's Name Aa-AJ 2-3 to ���1� Al PT I Address M. M45 , AU— ' Assessor's Map/Patt:el: 0�/�f���t1' � I Engineer's Name NEW CONSiWtON REPAIR Telephone# �� �'��y Land Use �dP.vi a-� Slopes(%) L Surface Stones Distances from: Open Water Body ,>7�� ft Possible Wee Area Zooft Drinking Water Well ?: ft i l Drainage Way 5 ft Property Line b ft Other ft SKETCH:(Street name,dimensiods of lot,exact locations of test holes&perc tests,locate wetlands in proximity to holes) N63'49'32"E 285.56' OB f<4 6°/� B Oqk TOp ORItEWAY D �a1.0 DEC v O �. 1000 /W / Q•oi 0d 0,,q O CAL �3:;' ? v' 7ANIC 'OdyFeF� - / , Ceq Ir ,25.92' .B u•� G(�Nc s o ��qqK 0_H.W. k m70?5 o/ ,o pqR 1 46 o a., gRFA46/07" /D• 'Iwo s„ ,0 Oqk o N 1---- F Gel HER.. i i Parent material(geologic) L/lZt Ll/CLCSLj I Depth to Bedrock Depth to Groundwatdr. Standing Water in Hole. i Weeping from Pit Face Estimated Seasonal Vigh Groundwater DtTFAM NATION FOR SEASONAL HIGH WATER TALE Method Used: I I in. Depth to sall ttt9ttics: Jn. Depth Observed standing in obs.hole: in, groundwater AdJuetment Depth toiweeping from side of obs.hole: i Adj.{actor..,,......•..- Adj.Groundwater Level Index Well# Reading Date: Index Well level PERCOLATION TEST . D1itp� 'xJnrle' Observation I Time at 9" A -- Hole# Time at V Depth of Perc SS•n t . -... -- Time(9"-G') Start Pre-soak Time.@ Gcd e n I lSAteJ End Pre-soak J ' L 2 M1'� � � • Rate MinJInch X Additional Testing Needed(YIN) Site Suitability Assessment Site Passed Site Failed: Original:. I;ehlth Division Observation Hole Data To Be Completed on Back ***If percola#6n test is to be conducted within 100' of wetland,,you must first notify the Barnstable e6iAservation Division at least one(1) we6k prior to beginning. DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistenc %Gravel 1( tl IhMQ l�!'Y ll t l A S1 i 00 1- t� G �.5`( Z` DEEP OBSERVATION HOLE LOG Hole# Z- Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistenc %Gravel 01', th I( I I_ v •� - 2, 2 DEEP OB RVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistenc %Gravel DEEP OBSERVATION HOLE LOG Hole# Al Depth from Soil Horiz n Soil Texture Soil Color Sail Other Surface(in.) SDA) (Munsell) Mottling (Structure.Stones,Boulders. Consistency. Gravel) F Flood Insurance hate Map: Above 500 year flood boundary No— Yes Within 500 year boundary No x Yes Within 100 year flood boundary No Yes Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervious material exist.in all areas observed throughout the area proposed for the soil absorption system? If not,what is the depth of naturally occurring pervious material? Certification I certify that on (date)I have passed the soil evaluator examination approved by the Department of Environmental Protection and that the above analysis was performed by me consistent with the required- ining,expertise and experience described in 3..10 CMR 15.00. / Signature 4 !/ AL Date w �i Q:\SEPTl0PERCFORM.DOC l TOWN OF BARN STABLE rk /, ATION 3 �i�/ SEWAGE # LAGE ASSESSO MAP & LOT Q c;L INgPeMlk'S NAME&PHONE NO. rI Q q L SEPTIC TANK CAPACITY e'x� p�2- ���LG�/GK— LEACHING FACILITY: (type) L/ (size) U�J NO.OF BEDROOMS , BUILDER 0 OWNER PERMIT DATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) i Feet Furnished by j 31'6�� o, 50 �qqs ,. TOWN OF BARNSTABLE L ATIO��3 ��yt S C�//�y SEWAGE # %�— A5 f VILLAGE In, lAltt-C-1' ASSESSOR'S MAP & LOT b�06- INSTALLER'S NAME & PHONE NO. Vall!;� 3'j 9 ` SEPTIC TANK CAPACITY ION Ju.O LEACHING FACILITYAtype) (size) C,V--t0 NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER BUILDER OR "DATE PERMIT ISSUED: Q DATE COMPLIANCE ISSUED: ��-�0 v VARIANCE GRANTED: Yes Ng/ ,LS THE COMMONWEALTH OF MASSACHU TTS BOAR® OF HEALTH TOWN OF BARNSTABLE Alip tratiou for Divi-vitial Morlai Tomitrurtinn rrmt �.O� Application is hereby made for a Permit to Construct ( ) or Repair C an Individual Sewage Disposal System at: i O t 5��. — .C------- -,0e :..........................•••-- Location- -�ddre s or t No. ...:(�L� —�......�/h��.....G4-r,K] �3 cS . LES dLl/LL.I Y -- o � w +��zi LC!- ..... 7(VS-- G�A�I.>ed--y lLA Al �vl! 5 -- -- rc s In,taller Address UType of Building Size Lot............................Sq. feet Dwelling— No. of Bedrooms-----------------1 --------------------Expansion Attic ( ) Garbage Grinder (—}—,A/b ` , Other—Type e of Building ����� yp g ___..�________ No. of persons---------------------------- Showers ( ) — Cafeteria ( ) d Other fixture�- --------------------------------------------------•------------------------------ ------------------------------------------------------------- W Design Flow------------------�. ..........gallons per person per . Total daily flow-.-.-_-__-__----2 d--------- --_gallons. WSeptic Tank—Liquid capacityl.�___-gallons Length---g� _..._ Width_� _._... Diameter___._._______. Depth_.$V-5— x Disposal Trench—No. ..(__g...�. Width_...._____________ Total Length----..___-_-�_•_--_ Total leaching area....................sq. ft. Seepage Pit No------ _.\.'�>a ter----.-199-------- Depth below inlet------4__......... Total leaching area..................sq. ft. Z Other Distribution box (bCj_ Dosing tank ( ) Percolation Test Results Performed by.........................................................................- Date........................................ Test Pit No. 1----------------minutes per inch Depth of Test Pit.................... Depth to ground water_.-------__-----_---.-_ fTq Test Pit No. 2................minutes per inch Depth of Test Pit._.__--._-._____-_ Depth to ground water........................ P4 .................... --------•--•------------------------------•-------•--.................................................................................. 0 Description of Soil........................................................................................................................................................................ x V .---------------------------------•----••----•----•-••-------------•----•--------------•------•------------•-----------•--•-----•--------•-------------------•------•-•-•••-•-------•-••................ W x --- ------------_--- ------------------------------------------- ------------------------------------------------------------------------------ --. .. U Nature of Repairs or Alterations—Answer when applicable.-.-. _ s �-_ --_......_ 0 -- --------------••-•-- 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 Compiian as been iss ed the board of health. Signed v:...-..... ................... .. ...........:..... �9/--.� Dace Application.Approved By -------------- -------------.----------------------.--------------------------- Dace Application Disapproved fcr the ollowing reasons- ----------- ---------------------------------------------------------------------------------------------------------------------- ...----................_..........------- ---_....----------------............_--------------------------- ------- ---------------....._...---------------.-----............................... -..------------------------------------- Permit No. ................ ..��- --.-./51'6-- -------------- Issued .......... � Dace Oyu - o �S" - c,o� No..F5 LIT.3 9 .................. THE COMMONWEALTH OF MASSACHUS TTS O A R D O F H E A LT H - r" TOWN OF BARNSTABLEF~ ' .Appliration for Di-t-ipoittl Mork.5 Tontrnr#ion Fermi eF'rh Application is hereby made for a Permit to Construct ( ) or Repair an Individual Sewage Disposal System` at: Ir o*��nj'/�/� 1 ( / �/f/► r ( � . Location-:\ddress or Lot No. / Fly"" ...... " - L. -i 1�1 ��.� �.5 ' 2�L e's [.c��-! ✓3� ✓LJ�L C.t' ----------------- -----------------------------.._...---------r.._._Owner _.. ............................. a ! AddreW �, 0 �-y ELb. .....................•----...---••-•-••------••-------•------ •--••-•.��•--� t � • ^ lM/� E •_._ Installer , Address .A UType of Building Size Lot............................Sq. feet Dwelling— No. of Bedrooms-------------------3---------_------.--Expansion Attic ( ) Garbage Grinder aOther—Type of Building -----/1- No. of persons----------------------__-. Showers ( ) — Cafeteria ( ) Other fixtures ---------------------------- W Design Flow................... 5f____._.___._gallons per person per day. Total daily flow--------------- d.................gallons. 1:4 Septic Tank—Liquid capacity 1 _._.gallons Length----Z_e 7 Width--:S`----.- Diameter---------------- Depth__. ' `. Disposal Trench— No. l._.. ;Width ------------------- Total Length.____._.____;___.._ Total leaching area------=:___..___....sq. ft. Seepage Pit No.______ --( 1"biameter--------.0..._____ Depth below inlet....... Total leaching area_________________sq. ft. Z Other Distribution box (bCj Dosing tank ( ) Percolation Test Results Performed by------------------- ...................................................... Date........................................ Test Pit No. I................minutes per inch • Depth of Test Pit-------------------- Depth to ground water-.---_----_____-___----- 44 Test Pit No. 2................minutes per inch Depth of Test Pit-.------------------ Depth to ground water................... r 04 .........................................•-•--•-•._...._--••..__..._._...___--•--•-•-•-.....---•-•-•--•-•----•--•-____....... ......................... i 0 Description of Soil.......................................................................................................................................................................... x w ----- --------------------------------------------------------------------------- ----------- __._._._-•••-_ . .._..:'__. . '..._ x U Nature of Repairs or Alterations— nswer when applicable----- ..._.__ - Sf/L✓ _. :.� __......_/ .._. -••---C-�.4-e�-+..-••-�.............. `;1-�"' � GJs i Cd S�j-7�5.---.................................................................. 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 Compliancelas een iss ed • the board of health. Signed ...--- -------------------------- -- :,� ---- Date Application.Approved By ... .------------------------------------------------------------------ 63" 3 Application.Disapproved fr. or the�ollowingreasons: ..... .................................. ...... . .................. . .................... ------------------------------------------------------------------------ 22 Date Permit No. ------- y-----.----/5 J-- Issued -----------f - Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNST\ABLE Certificate of Compliance THIS IS TO CERTIFY�That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) � ' by ----------_.--------------------------------------;,- ----G .�... r...GT 7-- ---- Co'-j-mow t.`-r�, t Installer ------------------_----- at ....................1;..........`...... ._ Sf '=may« G f-----------� A4 I I�..s........ has been installed in accordance with the provisions of TITLE 5 f The State E vi onmental Code as described in the application for Disposal Works Construction Permit No. -----X..6............1..�`.. dated ......_S THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. wj�;� DATE.-✓.........�. .......... _........ - .. ... Inspector;+_ THE COMMONWEALTH OF MASSACHUSETTS /t!// C/ j oO BOARD OF HEALTH CJ7 (0 I 1 � TOWN OF BARNSTABLE No..?�.... o FEE.---' a Diopooul Workii �000#rr#ion hermit Permission is hereby granted G/1 t•t1......................... --'-- ............................................................ to Construct ( ) or Repair ). an Individual Sewage Disposal System at No. -��--•----5 .. 1- ....... 1- ' �/LYA `�Yl �' . ............................ Street Q as shown on the application for Disposal Works Construction Permit NotV-P, DATE........-.��----�---�---y-�-�� ________________________________ /� Board of Health FORM 38808 HOBBS 6 WARREN,INC.,PUBLISHERS t t- AsBuilt Page 1 of 1 TOWN OF BARNSTABLE LOCATION 3 SEWAGE# VILLAGE_, ASSESSOP MAP&LOTro Q TJ4SPECT6k16 NAME&PHONE SEPTIC TANK CAPACITY LEACHING FACILITY: (type) (size)1600 Qa NO.OF BEDROOMS BUILDER OR OWNER PERMITDATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching-Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by 31'6 .O �v 5�1 �G�5 http://issgl2/intranet/propdata/prebuilt.aspx?mappar=046015002&seq=1 3/30/2010 r /B-�.NSTABLE • LOCATION r ���c �y �P6 f SEWAGE # VILLAGE ASSESSOR'S MAP & LOT INSTALLERS NAME & PHONE NO. '�OSEPTIC TANK CAPACITY /0 00 'ZZLEACHING FACILITY:(type) flecAsd (size) /00 (L NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNER f'. Le- � � ?�' � F DATE PERMIT ISSUED: DATE ,COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No )(' �- � o'��X � �� �1 I �q�C F ��� � ';ASSESSORS M AP N0: .l�, .�- PARCEL N0. --i No. ?.'7..13 Fxs:7775 ...... THE COMMONWEALTH OF MASSACHUSETTS C e` � 'J BOARD OF HEALTH ter d J� C 1...4�.W.4).............OF..._..���$..P.-..1 �$ C --E�..� ........-......_. ��es �^ r w S� ��. Y -App tration for Baipnaal Works Tomitrurtuan amild � Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: _ . �� � �!4•-----•--..� .� -............ ...................... -- ------------- ---------------------.........-------•- cation•Add Lot Noe yo . n/ /y 1 �{ W / ow r A Address � Installer Address d Type of Building Size Lot__t1_-__C(dO...Sq. feet V Dwelling—No. of Bedrooms............ ............__ _Expansion Attic Garbage Grinder 00 04 Other—Type of Building No. of persons____________________________ Showers — Cafeteria Q' Other fixtures ________________________________ _ W Design Flow_.________�,/_40....................gallons per person per day. Total daily flow........3-3i0....................gallons. 1:4 Septic Tank—Liquid capacity/&f)---gallons Length S6!J. Width__ "_4Q. Diameter________________ Depth__,5. �_.'_ Disposal Trench—No_ ____________________ Width.................... Total Length.............. Total leaching area--------------------sq. ft. Seepage Pit No---------/........ Diameter...../0. ..... Depth below inlet_____.__........ Total leaching areas_41...sq. ft. Z Other Distribution box ( ) Dosing tank ( P" Percolation Test Results Performed b R.!T__C .?g4�>✓_.__. _. Date_______________________________Y `, �( Test Pit No. l___�__aA_.minutes per inch Depth of Test Pit_.__.__1.7...... Depth to ground water.....IV.f'L....-_. Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water------------------------ --------------------------------------------------------------------------------_---••- -----------•--•--------------•--- ...... •�-•_____________•-•...------__---- Description of Soil_-•.1 'y-•-----,-- , --'lr`-- � Q� = �� .............. Description VNature of Repairs or Alterations—Answer when applicable----------------------------------------------------------------------------_................... ........... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with •4tm the provisions of L i I, i.E, ; of the State Sanitary 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 -•-.'�...� ............ = 7.` ..._ VAIton Approved By......... ----• =---------............--.......................................... .......... Date Application Disapproved for the following reasons:---------•-••----------------•--••-•--••--•--•------•-•-------------•---------•---------------------..._.....» -----------------------•--------------------•------••----•---------------•--•---------.......--------...-••-••••-•----••---•-••-••••--•-•••••---•••••--•----•-••-•--•----••---••••••-------••••--------- Date Permit No..........` .. .... ....... Issued........................................................ Date iA Now .`7.13 FEs............:;i"........... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..................... ...................OF....I Applira#ion for M-4potittl Works Tontrudion rnmit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: / Location-Address or Lot, No. j _.......................... 2/, �-P/.eJi.�.-f��..lS�'/r(.��..........!Q.Z�gl.7.e�4 =••—_!.. ..!l.e..........4_z e.&............................... ..... <.s�. K..�e�' Address ......................... Installer Address d Type of Building Size Lot_ ./. _O_ ...Sq. feet V Dwelling—No. of Bedrooms............. ........................Expansion Attic WD Garbage Grinder #/0) aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) Q' Other fixtures -----------------------------••• . . W Design Flow..........//0.....................gallons per person per day. Total daily flow...........3-3.�_Q_................gallons. 9 Septic Tank—Liquid capacity/�00gallons LengthS.-�. _. Width.V"ZO. �_ Diameter Depth. � /-._ Disposal,Trench—NTo..................... Width.................... Total Length............. -.... Total leaching area....................sq. ft. Seepage Pit No---------/-------- Diameter........`, .._.. Depth below inlet.....k.......... Total leaching area.j;A ---sq. ft. Z Other Distribution box ( ) Dosing tank ( ) ~' Percolation Test Results Performed by__ __*M..Q iwellal. ......._.--•------.-••_--. _ a Date ---- -- .--- Test Pit No. I-----.aminutes per inch Depth of Test Pit_._ y___..... Depth to ground water__ fZ, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ O Description of Soil------�-1-......-- ... ---...���` '�-�11.�__��r-l----�---------- --------- -- �� ri�G�-^-, w7-�11 e s4 /.( ..... / e.. ........................................................ x --------------- ---------------------------••-••-•----------------------•-------••••••--------•----•---••--•-•••--•-----•-•---•-••-•------•--•------•----•-•------••-•-••-••-•---••-----•--------------- U Nature of Repairs or Alterations—Answer when applicable.............................•_.____._.._.........__.._.__.._.............._....___..._........ ---------------------------------------------------------------------------------------------•--------------------------------------•-•-------------------------------------------------............•--- Agreement: The undersigned agrees to install the afor edescribed Individual Sewage Disposal System in accordance with the provisions of 11 p of the State Sanitary Code—The undersigned furtl er agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. Signed .� A-2 IR-( Application Approved BY [! ........... f ---- .....G--------- Date Application Disapproved for the following reasons----------------------------------•---------------------•-------------------------•-•--•••--••---......•--._..._ .............------••---•-------------------------------•-•--------------...--------------•------------.._..--•--------•-------------------------------------------------------------------••-•--------- Date PermitNo................. ...... ...... Issued_....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS ��-- BOARD OF HEALTH �� NS Trrfifiratr of Tompliancr THIS I TO CERTIFY, That the Individ a Sewag Disposal System constructed ( ) or Repaired ( } That JInstaller has been installed in accordance with the provisions of TimYr r of The tate Sanitary Code as described in the application for Disposal Works Construction Permit No..... ...................... ... dated..._._ _. __.�'__-- _L�_____________ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT YHE SYSTEM 19+/1�. U �TION SATISFACTORY. DATE........ �...... ...` - ................................................ Inspector--.•---l =---!.................---••-------•-------....._......-•--•---•-•.._..---- � l, ( THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH -: 6Iv —7 1''j ...........................................OF....................._.................... _................................. �i N tio..... ..... .......... FEE.....A.—I.......... tl��td� l ,orru Permission is herebyanted......: !'�. / c ,. -•--.--•--••--------------------•_.......-••-••-------•-..........-•--------.................- :_.. to Construct ( ) or Repair ( ) an I dividu Sevc�a a Disposal System �a *- �- ati�TO...-'___..____._•................... ...... C:)v �C ._1 ........................................................ Street -)/_ 1 /'� •�'- (� as shown on the application for Disposal Works Construction it N _______ ated.._..•.................................... Z — Board of Health DATE ............................•........... FORM 1255 HOBBS & WARREN. INC., PUBLISHERS 11041 10 j99 -; FglTyg9N�T lF 8 � BOR'1'OLU'f'I'1 CUN$TRUCTION, INC. 765 WAKEBY ROAD,MARSTONS MILLS, NIA 02648 508-771-9399 508-428-8926 FAX: 50"2hN 9399 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION Property Address: Date of Inspection: _ aspect N. nc: Owner's Name and Address: CERTIFICATION STATEMENT! I certify that I have personally inspected Lite sewage disposal system at th is;address and that the informa- tion reported below is true,accurate and complete as of the time of inspa:.tic-:n.The inspection was per- formed based on my training and experience fit the proper function and i wi; ►!enance of on-site sewage disposal stems. The System: Passes Conditionally Passe Needs Furtlier.E f tion tl Local Aproving Authority Fails / Inspector's Signature: Date:__. The System Inspect shall submit a copy of this inspection report to the ;:ri roving authority within thin- - ty(30)days of completing this inspection. if the system is a shared sys:o�m ar has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report l`:�the appropriate regional office of the Department of Envirompenlal Protection. 'fhe original shcutl be sent to the system owner and copies sent to the•buyer, if applicable and the approving authority. ]�SPECTIO 4 SUMMARY! A)SYSTJ�M PASSES: \ff I have no(found any information which indicmes that ille sv&'r in violates any of the failure criteria as:defined in 310 CMR 15.303. Any failure criteria r-,)t evaluated are indicated below. B)SYSTEM CONDITIONALLY PASSES; One or more system components need to be replaced or repai-;od. The system,upon comple- tion oflhe replacenieni of repair, passes inspection. i Indicate yes,nor,or not determined(Y,N,OR ND). Describe basis of dO.,Tmination in all instances. If "not determined";explain why not. The septic tank is metal,cracked,structurally unsound,shw;� s substantial infiltration or exftltration,or tank failure is imminent. The system will fay q inspection if the existing sep- tic tankis replaced with a conforming septic tank as approve-1 by The Board of Health. Sewage backkup or breakout or high static water level obscr/ol in the distribution box is due to broken or obstructed pipe(s)or due to it broken,settled.c.r j Leven distribution box. The system will pass inspection if(with approval of The Boai iA iij wealth): - 1 - SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPEC 1'ION FORM PART A CERTIFICATION(continued) , Broken pipe(s)replaced Obstruction is removed Distribution Box is levelled or replaced The System required pumping more than four times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of The Board of Health): Broken pipes)are replaced { y Obstruction is removed C)FURTHER EVALUATION 1S REQUIRED BY THE BOARD OF HEALTH: Conditions exist which require further evaluation by The Board of Health in order to determine if the system is failing to protect the public health, safely and the environment. 1)SYSTEM WILI,.PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE } PUBLIC HEALT,Ii AND SAFETY AND THE ENVIRONMENT: Cesspool or.privy is within 50 Feet of a surface water Cesspool or privy is within 50 Feet of a border ing vegetated wetland or a salt marsh. 2)SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH (ANT.?UBLIC WATER DSUPPLIER,I #PROPRIATE)DETERMINES THAT THE SYSTEM L5 FUNCTION- f a ; ING IN A M A*ER THAT PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT• The system,.ho a septic tank and soil absorption system and'k, ,�4hin 100 Feet to a surface water supply or tributary to a surface water supply. The system has a septic tank and soil absorption system and is with a Zone I of a public water supply well. The system has a septic tank and soil absorption system and is within 50 Feet of a private water supply well. The system has a septic tank and soil absorption system and is less than 100 Feet but 50 Feet or more from a private water supply well,unless a well eater analysis for colifonn bacteria and volatile organic compounds indicates that the weil'ys free from pollution from the facility end'lhe presence of ammonia nitrogen and nitrate+litiogen is equal to or less than 5 ppm. D)SYSTEM FAILS: I have determined that lheKsystenr violates one or more of the followidk'Failure criteria as defined in 310 CMR 15.303. The basis for this determination is identified Wdw. The Board of Health should be contacted to determine what will be necessary to correct the'failure. Backup of sewage into facility or system component due to in overloaded or clogged SAS or cesspool. Discharge or ponding of elluent to the surface of the grouud.,or Surface waters due to an overloaded or clogged SAS or cesspool. Static Nuidaevel-in.the distribution box above outlet uwert dui to_an overloaded or clog- r ged•SAS of cesspool. -Liquid`dep&in cesspool is less than G"below invert or available:volume is less than 1/2 day flow. Required pumping more than.4 times in the last year N-M dde to clogged or obstructed pipe(s). Number of times pmnved -2- �F SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART' A CERTIFICATION (continued) An portion of the Soil Absorption System,cesspool or privy is below the high groundwater y elevation. Any portion of a cesspool or privy is within 100 Feet of a surface water supply or tributary to a surface water supply. Any portion of a cesspool or privy is within a Zone I 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 Fat from a private water supply well with no acceptable water quality analysis. If the well has been analyzed to be acceptable,attach copy of well water analysis for coliform bacteria,volatile organic compounds,ammonia nitrogen and nitrate nitrogen. E)LARGE SYSTEM FAILS: The following criteria apply to a large system in addition to tl►e criteria above: The design flow of a system is I0,000 gpd or greater(Large System)endd,the system is a significant threat to public.health and safety and the environment because one or more of the following conditions exist The system is within 4UU Feet of a surface drinking water u' p��y rinking water supply The system is within.200 Fat of a tributary�to a,surfaced The system is located in a nitrogen sensitive area interim V,1e to ad.Protection Area (IWPA)or a mapped Zone Il of a public water.supply well. The owner or operator of any such system shall bring the system and facility ir:to full compliance with the Is of 314 CMR 5.00 and 6.00. Ptzase consult the local groundwater treatment program requiremen regional office of the Department for further information. SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Check if the following have been done: !Pumping information was requested of the owner,occupant,and Beard of Health. _None of the system components have been pumped for atleast two,.veeks and the system has been receiving normal flow rates during that period. Large volumes of water have not been introduced into the system recenily or as part of this inspection. ►/As built plans have been obtained and examined. Note if they are rot available with N/A. ___L,:�1'he facility or dwelling was inspected for signs of sewage back-up. The system does not receive non-sanitary or industrial waste flow. V 6 site was inspected for signs of breakout. system components,-excluding the Soil Absorption System,have been located on site. 'he septic tank manholes were uncovered,opened,and the inr.eri:a of the septic tank-was in- r tees, material of construc�ioii,dimensions,depth of liquid, spected for condition of baffles o pth of sludge,depth of scum. hee size and location of tire Soil Absorption System on the sit;,hi.s been determined based on existing information or approximated by iron-intrusive niet'vods. , -3- SUBSURFACE SEWAGE,DISPOSAL SYSTEM INSPECTION FORM PART B .. CHECKLIST(continued) The facility owner(and occupants, if different front owner)were provided with information on the proper maintenance of Subsurface Disposal System SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM n_ _ PART G SYSTEM INFORMATION FLOW CONDITIONS �Ji'4iDF.NT 'AI'_ Design Flow: Ilona Number of Bedrooms:� Number of Current Residents: Garbage Grinder: AM. Laundry Comiccted To Syslcm �: sensonAI Use: Water Meter Readings,if ilable: �J Last Date of Occupancy — _. ._._. COMMERCI_AIJINDUSTRIAI ,)d Type of Establishment: Design Flow: _gallons/day, -Grease.Trap:Present: (yes or no) Industrial Waste Holding Tank Present: _ ... Non-Sanitary Waste Discharged To The Title V System: Water Meter Readings,If Available: Last Date of Occupancy: 4 OTHER: Describe) ' Last Date of Occupancy: GENERAL INFORMATION, PUMPING RECORDS and source of information:. � f� ` System Pumped as part of inspection:_ If yes, `volume puiipcd:`' gallons Reason for pumping: TYP"F SYSTEM: l/ Septic Tank/Distribution Box/Soil Absorption System Single Cesspool Overflow Cesspool Privy Shared System(If yes,attach previous inspection records, if any) Other(explain): - ROXE"TE AGE of all components,dale installed(if lutown)and source of information: � v __ . 9 Sewage odors detected.when arriving at the site: SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C GENERAL INFORMATION (continued) SEPTIC TANK: G� Depth below grade: /S Material of Construction: "concrete--metal FRP_Other (explain) ----, Dimisions:8',S'XLo 'Y IS _Sludge Depth: '� Scum Thick�r:ens: a �� Distance from top of sludge to bottom of outlet tee or baffle: 3- _. Distance from bottom of scurn to bottom of outlet tee or baffle: Comments:(recommendation for pumping,condition of inlet and outlet U es•or affles,depth of liquid 1pyl in lation tlet invert,structural integrity, vidence of leakag :tc. iz- px �? - 6",9 GREASE TRAP:x)a Depth Below Grade: Material of Construction:—concrete_ metal FRP_Other (explain) - - Dimensions: Scuiu"Thickness: _.... _ Distance from top of scum to top of outlet tee or baffle: Comments: (recommendation-for-pumping,condition of iniet.and outlet,C,,cf:yr baMbs depth of liquid level in relation to outlet invert,structural integrity,'evidence of leakage,�zic.i ' TIGHT OR HOLDING TANK: Depth Below Grade: Material of-Construction:_concrete_mc°ati... .. FRP Other(explain) Dimensions: Capacity: gallons Design Flow:— , gallons/day Alarm Level: �. 'Comments: (condition of inlet tee;"co, is of alrron aa:d float.-switches, ell- DISTRIBUTION BOX: Depth of liquid level above outlet invert:-a Comments:(note if jioyeland distribution is Tual,evid ce of solids carryover evidence of I a into or oft of box,"etc.) _ - � ItXA (PUMP CHAMBER:` ,. -Pump is in working order: " Comments: (note condition of pump chamber,condition of puiups and ti it ii,i tenances,etc.) d A i SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION CORM PART C SYSTEM INFORMATION (con(inued) SOIL ABSORPTION SYSTEM(SAS): (Locate on site plan,if possible;excavation not required,but may be approximated by non-intrusive methods) If not determined to be present,explain: Type Leaching pits,number:_Leaching chambers, number: Leaching galleries,number: Leaching trenches,number,length: Leaching fields,number,dimensions: Overflow cesspool,number: Co'mments:(note condition of soil, si us of by rauli ilure lev of pondit ,condition of ve relation, etc.) ' /r CESSPOOLS-._AV 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 soilk, sighs of hydraulic failure, level of ponding,condition of vegetation, etc.) i PRIVY: } Materials of construction:.. Dimensions: Depth of Solids: Comments:(note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation, etc.) e R -G i� SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM . 11ART C SYSTEM INFORMATION (conlimivd) ' SKETCH OF SEWAGE DISPOSAL SYSTEM: Include ties to adeast two permanent refercuccs. landmarks or benchmarks. Locate all wells within 100 Feel. 3q 3� r 130, I WV � m I �l DEPTH TO GROUNDWATER: i Depth to groundwater: Z 9 Feet n Method of Determination o Approxi nation: o a /.'' *4 Byfr^o �4! -7- yyc��}Yk:�, .TOWN OF BARNSTABLE' L(xATION c1'�9�lLvt S SEWAGE #� fS3� :VILLAGE 10 yI'1 Uuj ASSESSOR'S MAP LOT 6V6.—G/S46,� .':INSTALLER'S NAME & PHONE NO.�� � S:EPTIC:TANK CAPACITY /GGD �uO N� .(size) Ce 0 LEACHING FACILITY:(type) 2 . <;..: . OF BEDROOM313 _pR1VATE WELL OR.PUBLIC ATE N:�` :::;.:UILDER OR .L..,:R ,PATEPERMIT ISSUED: ::BATE COMPLIANCE ISSUED: 's::VARIANCE GRANTED: Yes I`I . PIS I .. Kph I '.�,� ''� �,• ,: _ . h SURVEY REFERENCE: MARSTONS MILLS PLAN OF LAND BY R.J. O'HEARN, SURVEYOR DATED: OCTOBER 25, 1985 CB/DH SCNOo� Sr. PARCEL ID: 046/015-001 oLOCUST �0 0 rV 39.9 RJVER $ 00 pR1W AY ' o ''E "•'••,,,"' �► LOCUS MAP Co rn ,,, I .� LOCUS INFORMATION SILL ,,,,,,,,, I N E1.=104.52 I C.BA I. ,,,,,, SSSSS: 1 ? i PLAN REF: 410/18 " i O UPOLE TITLE REF: 1 1 561/329 """eele ' ' PARCEL ID: MAP 046 PAR. 015-002 ell TOP OF TANK 3 M PARCEL IS IN ZONE II EL.=101.02 ;;;' ;;, O r1 w� FLOOD ZONE: "C" 8"OAK „3—BED.,,, 1 COMMUNITY PANEL: 250001-001 5-C DATED:08/19/85 10."0 0 l bWELLN' f 0 :::5:555':S:S: ` 8"PINE 0 GPNK """"'""' �'�' a SEPTIC SYSTEM P ,,,,,,,,,,, N ar—.� --- 1 "oAK / leleelee o N \,;, REPAIR PLAN s a '� 0-1 N N. LOCATED AT: SPIKE BENCHMARK: 46.0' 23 S H E R YLE'S WAY EL-101.65' ®TH— COR. BLHD. ° 1 EL.=102.50'GI HYDRANT MARS TONS. MILLS, MA. �d c� PREPARED FOR TH-2 I 811OAK 10 OAK DANIEL J. 8c ELIZABETH A. PARCEL as ��._ � HORN 045/019D ��, �ze•92 _ _ 00pS �N!te 10�eochplt MARCH 23, 2010 6� OF PARCEL ID: �� Mgs�9� 045/049 DAR s o M ' No. 1140 CB/DH PARCEL ID: Ci E ° 046/015-002 $HI TAR�a� � AREA=43,601 f S.F. 0 � L DARREN M. MEYER, R.S. to90 P.O. BOX 981 PARCEL ID: C� 045/004 EAST SANDWICH, MA. 02537 (508)362- 2922 SHEET 1 OF 2 J 1226 ELEV. TOP FOUNDATION NOTE: MAGNETIC TAPE TO BE PLACED OVER ALL COVERS (Existing) = 104.52� �F.G.EL: 102.0 F.G.EL: 102.0 � F.G. EL: 102.0 FINISH GRADE= 102.0,W MAINTAIN 2% MIN SLOPE OVER LEACHING AREA MAX. COVER OVER LEACHING = 3.0 FT. COVERS TO WITHIN 6 OF GR7DE 2° OF 3/8" DOUBLE WAS ; '' • . .. . . 4, STONE OR FILTER FABRIC 3/4" - TONE DOUBLE • '� WASHED STONEs 4" SCH 40 PVC4 SCH 40 PVC (MIN )0 10" 14 S= 1� (MIN.) ®e ® S= 1 MIN.11 ®®®®® ®®®®®TEES ARE TO BE ( )4" SCH 40 PVC 2' EFF. DEPTH ®®®®®®®®®®®INV.99.86 INV.99. INV.99.30 EXIST. OUTLET GAS PROPOSED DB-3 4" 2 X 8.5' 4' BAFFLE DISTRIBUTION BOX EFFECTIVE LENGTH = 25' INV. 100.11 EXISTING 1,000 GALLON SEPTIC TANK of Mgss INV. ELEV.= 99.13 GAS BAFFLE TO BE INSTALLED ON 9y BREAKOUT OUTLET TEE AS MANUFACTURED BY MEYE TOP CONC. ELEV.= 99.63 ELEV.= 99.63 TUF-TITE, ZABEL, OR EQUAL No. 1140 INV. ELEV.= 99.13 ®® NOTES: 1) CONTRACTOR SHALL VERIFY ALL EXISTING 3) REPLACE EXISTING 1,000 GALLON SEPTIC p '�f6/ E FWE33E33IE3E3E3E3E3 ®®®®®® PIPE INVERTS PRIOR TO CONSTRUCTION TANK WITH 1500 GALLON SEPTIC TANK ®®®®® 1M 2) D-BOX SHALL BE SET LEVEL AND TRUE TO IF FAILED, DAMAGED, OR UNDERSIZED. SANITAR�a BOTTOM EL.= 97.13 GRADE ON A MECHANICALL COMPACTED SIX 4) INSTALL INLET & OUTLET TEES AS REQUIRED 5 FT. 4' INCH CRUSHED STONE BASE, AS SPECIFIED IN 310 CMR 15.221(2) SEPTIC SYSTEM PROFILE SEPARATION 5.83 FT. EFFECTIVE WIDTH = 13' N.T.S. BOTTOM OF TESTHOLE EL: 91 .30 _ SOIL ABSORPTION SYSTEM (SECTION) GENERAL NOTES: SOIL LOGS (500 GALLON LEACH CHAMBER LOADING) 1. ALL CHANGES TO THIS PLAN MUST BE APPROVED BY THE LOCAL P#: 12864 DESIGN CRITERIA BOARD OF HEALTH AND THE DESIGN ENGINEER. 2. ALL WORK AND MATERIALS SHALL CONFORM TO THE REQUIREMENTS DATE: MARCH 16, 2010 OF THE STATE ENVIRONMENTAL CODE, TITLE V, AND ANY APPLICABLE. SOIL EVALUATOR: DARREN MEYER, R.S., CSE #1614 NUMBER OF BEDROOMS: 3 BR DESIGN (PROPERTY IS IN ZONE II) LOCAL RULES AND REGULATIONS. WITNESS: DAVID STANTON, BARNS. B.O.H. SOIL TEXTURAL CLASS: CLASS 1 3. THE SEWAGE DISPOSAL SYSTEM SHALL NOT BE BACKFILLED PRIOR DESIGN PERCOLATION RATE: <2 MIN IN TO INSPECTION AND APPROVAL BY THE BOARD OF HEALTH AND THE / DESIGN ENGINEER. Elev. TH-1 Depth Elev. TH-2 Depth DAILY FLOW: 110 G.P.D. 4. ANY CONDITIONS ENCOUNTERED DURING CONSTRUCTION DIFFERING 102.4 0" 102.3 0" DESIGN FLOW: 330 G.P.D. FROM THOSE SHOWN HEREON SHALL BE REPORTED TO THE DESIGN A LOAMY SAND A LOAMY SAND SEPTIC TANK (VOL. REQUIRED): 330 gpd x 2 = 660 gpd (USE EXIST. 1,000G SEPTIC TANK) ENGINEER BEFORE CONSTRUCTION CONTINUES. 101.90 10YR 3/2 6" 101.80 10YR 3/2 6" GARBAGE GRINDER: NO (not designed for garbage grinder) 5. ALL ELEVATIONS BASED ON ASSUMED DATUM. B B LEACHING AREA REQUIRED: 330 gpd/0.74 = 445.94 S.F. 6. THE DESIGN ENGINEER IS NOT RESPONSIBLE FOR THE FAILURE OF LOAMY SAND LOAMY SAND THE CONTRACTOR OR OWNER TO NOTIFY THE LOCAL BOARD OF 10YR 5/8 10YR 5/8 USE TWO (2) 500 GALLON PRECAST LEACH CHAMBERS HEALTH FOR PROPER INSPECTIONS DURING CONSTRUCTION. WITH 4 FT. ON ALL SIDES: 25'L X 13'W X 2'D 7. WATER SUPPLY BY TOWN WATER SERVICE. 99.23 38" 99.13 38', BOTTOM AREA: 25 X 13 = 325 SF 8. ALL AREAS DISTURBED DURING CONSTRUCTION SHALL BE RESTORED CI C1 TO A CONDITION AGREED UPON BETWEEN OWNER AND CONTRACTOR. SIDE AREA: (25 + 13) X 2 X 2 = 152 SF 9. IT SHALL BE THE RESPONSIBILITY OF THE CONTRACTOR TO VERIFY THE PERC TEST 0 EL. 97.83 MEDIUM MEDIUM TOTAL SQUARE FEET PROVIDED = 477 vs. 445.94 REQ'D THE LOCATION OF ALL UNDERGROUND UTILITIES, PRIOR TO BEGINNING SAND SAND CONSTRUCTION. 2.5Y 7/4 2.5Y 7/4 DESIGN FLOW PROVIDED: 0.74(477 S.F.) = 352.98 G.P.D. vs. req'd 330 GPD 10. EXISTING LEACH PIT TO BE PUMPED, CRUSHED AND FILLED. 11. 48 HOUR NOTICE FOR ENGINEER CERTIFICATION PROPOSED SEPTIC SYSTEM UPGRADE PLAN 12. THIS PLAN IS TO BE USED FOR SEPTIC SYSTEM PURPOSES ONLY 23 SHERYLE'S WAY, MARSTONS MILLS, MA AND IS NOT TO BE CONSIDERED A PROPERTY LINE SURVEY 13. NO PRIVATE WELLS WITHIN 150' OF PROPOSED LEACHING. 91.40 132" 91.30 132 Prepared for: Horn 14. NO WETLANDS WITHIN 150' OF PROPOSED LEACHING. PERC RATE <2 MIN/IN. ("C" HORIZON) NO GROUNDWATER OBSERVED Engineering by: Surveying by: SCALE DRAWN JOB. N0. 15. ALL PIPING TO BE 4" SCH 40 0 1/8-/FT (UNLESS SPECIFIED) DARRENM.MEYER,R.S. AfaoDo&W&U Survey N.T.S. DMM 16. PROPERTY IS LOCATED IN A ZONE II. ' I, Darren M. Meyer, R.S., CSE, hereby certify that I am currently approved by MADEP pursuant to 310 CMR 15.017 PO BOX981 (774) 238-6797 to conduct soil evaluations and that the above analysis has been performed by me consistent with the E41STSANDWICH,MA02537 DATE) CHECKED SHEET NO. requirements of 310 CMR 15.017. 1 further certify that I have passed the Soil Evol. Exam in October, 1999. 508262 2922 DMM 2 of 2 T j x % J b 2-0 FT. MIN. ,:0 OF - .,FOUND TOP TFST '.' SOIL� 7 b E L 10, FT., MIN. 4, CONCRETE VAT 40 PVC OBSERVATION 'HOLE,,, 1` �, OBSER 1O.Nl HOLE. OBSERVATION HOLE ' 4" SCH" COVERS ,, DATE ..br TEST OF� TEST, DATE 'OF TEST CLEAN SAND CONCRETE 71E'7'/AT- ­`WITN 'SE'D ' 'BY NESSED BY PITCH PIPE- MIN. WlTNE88ED ,' BY: ES, WIT 1/8" PER FT C.'- "RATE.-, Z : '-MIN./ INC�H �,"PERC-:,,RATE �MIN./INCH PERC. `R'ATE MINJINCH COVERS PER CAST IRON (OR V. 'ELEV 12"MA LE LEV = EQUAL) .Pip,E- M IN X Ri. ' PITC H'. 1/4 '.1 PER FT 2% �MIN LEVEL (3 FLOW LINE cli rn 14AMBL INS t 14A%IWAY EL= E L -EL= '9!1'0 EL= :S4;z EL 40 0 P E_ L= DIST AG BOX V '0.,WATER 'AT,� EL = WATER EL = LOCATION MAP AT � J + :,_,'-WATtR , AT 112 Qn- G A L PRECAST LEACHING SEPTIC EL= 61 LEGEND: BASIN OR EQUIV. TAN K TING SPOT ELEVATION OOx0 EXIS --00— — EXISTING CONTOUR ELEVATION FINAL SPGT FINAL CONTOUR PROFILE OF' -D E R SOIL TEST LOCATION 9%0�0"V r WAT EL BOTTOM OF TEST HOLE SEWAGE! DISPOSAL , '� SYSTEM A GROUND WATER '-TABLE EL -0- DJUSTED" TELEPHONE POLE NOT TO SCALE (> 4, TOWN WATER W_ W CATCH BASIN fm COVER SHALL FRAME BE SET WITH MASONRY UNITS ARE 70 BE MORTARED CLEAN SAND WHICH I N PLACE GENERAL NOTES L_J F 1. ALL WORKMANSHIP AND MATERIALS SHALL 1/8"- 1/Z WASHED 2" LAYER 0 STON E CONFORM TO D.E.Q.E. TITLE 5 AND THE �'T 1=ARLE RULES a REGULATIONS TOWN OF 6AEA FOR THE SUBSURFACE DISPOSAL OF SEWAGE 4!11-o ;i�/A Ir t;:" 2.ALL COVERS TO SANITARY UNITS SHALL BE 45 t, BROUGHT TO WITHIN 12" OF FINISHED GRADE 0 3/4" 1/2' I 3.EXISTING AND FINAL GRADES SH�LL REMAIN > 0 . ESSENTIALLY - THE SAME j p 4.NO DETERMINATION HAS BEE N MADE BY THIS LLJ Ld U_ --LEACHING OFFICE AS TO COMPLIkNCt 'MITH U_ PRECAGIF��- ------- _2 -OR A EQUIV X ------- ONING--REGULATION'S. --OWNER APPLICANT IS, 2 4" , DIA. COVE S Fl -,PRIATE AUTHORITY. 113 2 6 TO OBTAIN SUCH DETEFiMINATION FROM R C� APPRC 0 5. THIS PLAN IS VALID ONLY IF IT IS STAMPED 41 PLAN VIEW ,, AND SIGNED IN RED. THIS OFFICE ASSUMES NO RESPONSIBILITY FOR INFORMATION CONTAINED s a , COVERS SHALL W� FRAME ON COPIES WHICH DO NOT HAVE ORIGINAL BE SET WITH 'MASONRY UNITS STA'MPS� AND SIGNATURES. TO BE MORTARED I -WHICH ARE, 6. ALL COMPONENTS OF THE SANITARY SYSTEM IN PLACE % SHALL BE CAPABLE OF WITHSTANDING H-10 LOADING UNLESS THEY ARE UNDER OR WITHIN INLET LEACHING PIT DETAIL 40 OUTLET 10 FT OF DRIVES OR PARKING AREAS. NOT TO SCALE A LOADING SHALL BE USED UNDER OR 6"MIN. H-20 MIN. 0? t 0��o FLOW LINE WITHIN tv REMOVEABLE COVER 10 FT OF DRIVES OR PARKING AREAS MI N. OUTLET , PI S P OUTLET ­TE E 10"MIN. S REQUIRED A. LIQUID DEPTH TEE DEPTH A� BELOW FLOW LINE IA, U 4 FT 14 INCHES MIN. FRONT SETBACK 0" _V3 Olt N OUTLET MIN. REAR SETBACK 5 ' W MIN. SIDE SETBACK % 4 FT MIN. NEI INLET 5 FT 19 INCHES %FLO 6 FT. 24 INCHES tj r LIQUID C4 7 FT. 29 INCHES DEPTH 8 FT 34 INCHES C 6" APPROVED : BOARD OF HEALTH DATE AGENT INLET TEE - PROVIDED ER SECTION 15.10.2 P TITLE 5 PROJECT LOCATION* L i VE 0 T .2 KIA L OA DR NO. "OF OUT LETS-- Is AS& CROSS SECTION VIEW m/l PIE TON'S MILLS M APPLICANT: I ST. BOX DETAIL �:_l S S D SEPTIC TANK DETAIL; tA 0 T<r k_� K Y,!C--' S.W7 S V,�l?I NOT TO SCALE c.; NOT TO SCALE A. N. H" (j. OHEARAI /A/c 1p 0 Reg Sanitarians Reg. Land Surveyors P, 0 S Ai I-L i W_ CALCUL-ATIONS 35 ROUTE 1,34 UNIT 2 - DESIGN P 0. 160)( 2,37 Ro rA QNos-R., SOUTH NA. DENNIS NUMBER OF BEDROOMS VA C-1 TZ � GARSAGE DI!SPOSAL UNIT�, TOtAC ESTIlMAT GAL BR./DAY x SR. GAL./DAY �wl 7 ANK PAC TY REQUIRED SEPTI C GAL. �ACTUAL-: SIZE OF SEPTIC TAN K 1 0 0 52 GAL. LEACHING AREA. REQUIREMENTS AREA 2.5 GAL./S.F SIDEWALL `0 -AR EA. "I.-e-1 - GAL./S.F. TZ BOTTOM 4bT OF r Or Ax, -7, 5749,�j GAL. LEACHING BOTTOM '- - SIDEWALL) CAiPACITY., 6- A�6j'A V5 154 #1 Al, REVISIONS J. SCALE- DATE- JAMES RICHARD GAL, O'HEARN 7*TER7 RESEfVE..,LEACHING "CAPACITY 911 V MAKIN t I AVIEL ST. Zu C. No.694 0.. DR. BY P APPD. BYt ­c�vn �,s LNVQ _S41 JOB NO. a TLL OF \3/GO-02 SHEE Y 4� FORM I ts 0 r Z ------