HomeMy WebLinkAbout0079 STARLIGHT DRIVE - Health 79 Starlight Drive, Marstons Mills
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. ` TOWN OF B"NSTABLE
LOCATION ]'� f�qr/`��� ?�i{�' SEWAGE# Z61Z
VILLAGE/ ASSESSOR'S MAP&PARCEL/Gf3,�?�
INSTWLLER'S NAME&PHONE NO., f
SEPTIC TANK CAPACITY /000 Go/
LEACHING FACILITY:(type) d
��s(size)
_ /?.8.3 Z-f'')'r 2 `
NO.OF BEDROOMS
OWNER
PERMIT DATE: COMPLIANCE DATE:
Separation Distance Between the: _0
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) A /� Feet
/
Edge of Wetland and Leaching Facility(If any wetlands exist within
300 feet of leaching facili j) ����� Feet
FURNISHED BY / /�/
' A
Al Loll
3 4CL I,
Fee
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
Yes
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS
ftphLation for MispoBal 6pstem Construction Permit
Application for a Permit to Construct( ) Repair((/Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components
Location Address or Lot No. Z? Owner's Name,Address,and Tel.No. 7,'y- 4�1
Assessor's Map/Parcel g!y ve- r off.
Installer' Name,Address,and Tel.No./�� ✓`'da�/�`/y Designer's Name,Address,and Tel.No.
Go ,l/evp Ca Pry AFA,
Type of Building:
Dwelling No.of Bedrooms Lot Size ;Fo map sq.ft. Garbage Grinder( )
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow(min.required) .7a gpd Design flow provided �/�' gpd
Plan Date �e�J'' Number of sheets ` Revision Date
Title +Zzs 5— fj�4e
Size of Septic Tank /'ao<� Type of S.A.S. CZ4®.. ,_E
Description of Soil :
Nature of Repairs or Alterations(Answer when applicable) �. �
-
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 of Health.
Signed Date
Application Approved by Date r�J'�'(
Application Disapproved by Date
for the following reasons
ign
Permit No. f;lo - Date Issued
No. rJ i V Fee
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes '
t
PUBLIC HEALTH DIVISION - TOWN�OF BARNSTABLE, MASSACHUSETTS
2pplication fo -M/sposal Opstem Cons trurtion Vrrmit
Abandon( [:]Complete System ❑In Indi
vidual ComponentsApplicati n for aPermit to Construct Repatrf gradet
y
Location Address or Lot No. 79 rfar/ yy / Owner's Name,Address,and Tel.No.
Assessor's Map/Parcel r,.y Zi6^ / -1 yy S odl yr`y
Installer��',,SS Name,Address,and Tel.No./�'l- ✓`Z����� Des_igller's Name,Address,and Tel.No.
�S� �,:� sr• �—. y..... . Scam-T7f-- ors 39 a '
Type of Building:
DwellingNo.of Bedrooms r' Lot Size 740 Xz' sq.ft. Garbage Grinder( )
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow(min.required) 3 FO gpd Design flow provided /y' gpd
Plan Date ��/�7 :'Number of sheets l Revision Date
Title
Size of Septic Tank Type of S.A.S.
Description of Soil �T�:•�e�. So..r
Nature of Repairs or Alterations(Answer when applicable)
.�... / r��es.��-/S -� �v� 'f � .�ci•act
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 of Health.
SSiig�ed Date
Application Approved by Date j f �-
Application Disapproved by Date
for the following reasons
Permit No. J�0 Date Issued r
------------------------------------------------------j----------------------------------------------------------- ---= ---------------
THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE,MASSACHUSETTS
Certifirate of Compliance
THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired(� Upgraded( )
Abandoned( )by
at T 5���/� j� Gar. has been constructed in acco, cep 2- t
with the provisions of Title 5 and the for Disposal System Construction Permit No.c2O ARated
Installer �,/ �.ice .._=� Designer
#bedrooms 330 Approved design flow gpd
The issuance of this permit hall not be'construed as a guarantee that the system
'wilLfuncti• e igned.
Date -� / `� Inspector
OL
----- --- I � - � �� � ------------------------------------------------------------------------- ---I --------------
No. PC) Fee
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION -BARNSTABLE,MASSACHUSETTS
Misposat *pstem Construction Vermit
r Permission is hereby granted to Construct( ) Repair(!/� Upgrade( ) Abandon( )
System located at
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:Construction must be compl` d within three years of the date of this permit.�� !
Date / Approved b "
PP y
1:7-Z4q
Town ®f Barnstable
0�INE A Re911latory Services
O�
Thomas F. Geiler,Director
+ BAMSTA13M
MAS& ,0g Public Health Division
Xhomas;McKean,Director
200 Train Street,Hyannis,NIA.02601
Office: 508-862-4644 Fax: 508-790-6804
Installer&Designer Certification Form
Dates .2 Sewage Permit# Assessor's MapWarcelIM/
. l
Designer: D(1Vi1 ( _ Kt6 C Installer: CAP660D 'off!G l�� ��� Z> t
� � i
Address: am-"-� vmc Address: 35Q WIN er 15- 2$)
1
Yk"Mi F09-1 MA 0&Z6* W OT Y rk rrtrt+,. M 62L 73
I
On was issued a permit to install a
(date) -.(installer)
septic system at 7q 529W EfT DK, Af��ij
(address) NS M(i abased on a design drawn by
'6
6
DAMIEL OJALA dated -94V 1t116y4-r NIT.
(designer)
I certifythat the septics stem referenced above was installed substantiallyaccording to
the design, which a include minor a roved char es such as lateral relocation of the
y PP g
distribution box and/or septic.tank.
T:;certify"that the septic system referenced above was installed with major changes ( .e:
greater than"1'0' lateral relocation of the SAS or any vertical relocation of any component
of the septic system)but.in accordance with State&Local Regulations. Plan revision or
certified as-built bydesigner to follow.
v\ Lttt0F���Sp�
`c DANICLA. b�ry
(Installer"s Signature) CIVIL
No.46502 Q
TC��O?4
(Designer's Signature) I (Affix Designer's Stamp Here)
PLEASE RETURN To BARNSTABLE PUBLIC HEALTH IDIUSION. CERTIFICATE OF
CQ WLIANCE WILL NOT "BE ISSUED UNTIL BOTH THIS FORM AND AS-BUILT CARD ARE
RECEIVED BY THE BARNSTABLE PUBLIC HEALTH]DMSION. THANK YOU.
t
Q:Health/septic/Designer Certification Form 3-26-04.doe
I
Towa of, (r
Dep arfinout of Regulaturgy Services +.K:
Public Heafth,DMMOU Date
uff�p. 200 M41&@rear,Hyannis MA 02601
1•FA ttV��' �0 ...r
Dato Schedutad / Time Fee Fd, l i
Soil Suitability Asse*s ent far Sewn 0 D�s����I
PerFcrmed•By: ��n`r�( G�'`r�Gt�V2S Witnessed Hy: `�+•- `�J �I �-!�
E
6�I S I ar(t g�� P r owner's I Timm Z O ei l I o)
AarS�n� `V1(b�"l Address
10p` Q3 3nglncer's lYamo Down C- ax bree IN=ON REPAIR. Telephone0 .- �v�R
Land Uso: L G l/l/F1 Slopes(Rb) G Sarfacc S.tvnas �G/1 e/
Distancesfrom: Open Water 13oj;� FvssibicWet•Area e It DrUcingWaterWcll ft
Drainage Way D fC Property Line ft Other ft
SI�7ETCH,.'(Street name,dimensions of lot,exact locations of test holes&.pert tests;locate wetlands-In p=xirnity to holes)
N
LU
-69®
6a,C), . c�
1?armtmaterial(geologic) �. Depth to$eCjrgnll
Depth-to Groundwater: SlandingWaterin bole: i"/r Weepingi'i'pxtl FlCktpce '11
Estinnated Seasonal kligh Graundwater_/V/� -
Dj f 1 _ERl�q.�T.�`A'zON FOR SEASONAL HIC'R W'.�`�'aE °�',�IWM.
.Method Used: L'V
Depth Observed standing in obs.hole:
Depth to wcepingfrom side of obs.hold: ln, i3�nundwatarAdJuetmant ft.
Index Wcll## Rcadkng Datc: htde:t Well laYAl . Adj.Wftr. �. ,_Ac1f.:C�lx�Uiltiwriket 7.eYa1 v
Observation
Halo 0
• /I Ir
Depth of Pere. `7 Tizrle At G"
Start Fro-soak Tirna @ __ Time
End Pro-soak
hate Mln:/I'n.ch
Slip SultabiIltyAsacssmcnt; Siw)?Assecl v Sits Failed: Additional TostingXreded(.Y/N)
Original: Public health Dlvisloa Obse6atioa Holy Data To Bo Comploted on Back---------
**"'If pe�coXado* u test is to be mad;taeted wit 100' ofwetland,you must Erst=tify the
Barnstable Coaaselpvation Division at least one(1) week prior to beginning.
Qc18F_PTIC\FF_RCFORM,IJ O C
DREP,OBSBRV&q 'ROLL LOG Hole#
Depth from Sall Horizon Soil.Texture .Sdil Color Soil Ot'hcr
Surface(in.) , (MA) (Munseil) Mottling (Structure,Stones;Boulders,
o i'ean,y,9�'�ravell '
0 - 3 •SL 16�J� y/z
DEM,1�001aSE,��&T1, 0 7 ROLI L0,G �®��� 2
'Depth from Soil Horizon S'oii Taxturo Sall Color Soil Other
Surfaco(in.) (USDA) (Munseil) Mottling (structure,Stoncs,'Souldefs.
Conalstmoy,%Grave
GTE �D
3
� y l
SY71 i% bra vp /
DEEP OBSERVATION ROLF,LOG Hole W,
Depth*om Soil-Horizon SoilTextura Soil Color Soil othar,
Surface(in.) (USDA) (Munseil) Mottling (Structure,stones,Boulders.
corsistmm lro Q a
DM OBSERVATION ITOLP,Loa Role 9
Depth from Soil Rorizon SoilTextura soil Color Sall Other
Surface(in.) (USDA) (Munseil) Mottling (Structure,Stonn,Boulders.
COT1416tongb
Y'laod7sAsutranc'of�ate'It�C��t:. / '• .
Above 500•yearfleodboundary N13 Yes . .__.
Within 500 yearhoundary. No �!+ 'Yes '
Within 100year flood boundary No•A/
Det�tl�of�ra�paYl��ccr�r�yn�-�t3rv"rorxs ZVlsfar%aY
Does at least four feat of naturally occurring pai"vious aterixl oxist itt all aretis obs-5t,ved throughout th
area proposed for the sail ahsotptibn system
If not,what is the depth of haturally occurring pervious materlal'i
�er�ti�ca�iaxr
x certify that an /�� (date)r f�avapassed the soil evaluator e7camination approved by the
Dopaitment of Environmental Protwtlon and thartho above analysis was porformed by me consistent with .
'the required traini g,expertise and experi
ce described in�10 CMR 15.017.
5ignatiire 1)atb
V
Q.19MPTlCtMCP0RM.D D C
$ 8 rr
' n
Rf��vE
Commonwealth of Massachusetts °D
Executive Office of Environmental Affairs AUG 19 1997 ►.
f000F <N
Department of
Environmental Protection
William F.weld E y Cox*
ooMnar seaanr
ArW Paul CNluccl David S'Struhs
Cortntiwbrter
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A _
CERTIFICATION f
Property Address: 7� p/ /y�}v� �/Q �HI Address of Owner.
Date of Inspection: iy��'T 7 (If different)
Name of Iniepector.�q—,'/,!J �1•• �l/!2/Vl 52
Company Name,Address and Telephone Number.
CERTIFICATION STATEMENT
I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate
and complete as of the time of inspection. The inspection was performed based on my training and experience in the proper function and
maintenance of on-site sewage disposal systems. The system:
�•�Passes
_ Conditionally Passes
_ Needs Further Evaluation By the Local Approving Authority
_ F aQ
Iospectot's Signat " Date:
The System Inspector shall submit a copy of this inspection report to the Approving Authority within thirty(30)days of completing this
inspection.'U the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the
report to the appropriate regional office of the Department of Environmental Protection.
The original should be sent to the system owner and copies sent to the buyer,if applicable and the approving authority.
INSPECTION SUMMARY:
Check A,B,C,or D:.
A) SYSTEM PASSES:
•/-,� I have not found any information which indicates that the system violates any of the Wure criteria ss defined in 310 CMR 1&303.
Any failure criteria not evaluated are indicated below.
BI SYSTEM CONDITIONALLY PASSES: '
One or more system components need to be replaced or repaired. The system,upon completion of the replacement or repair,panes
inspection.
Iadicate yes,no,or not determined(Y,N,or ND). Describe basis of determination in all instances. If"not determined",explain why not)
The septic tank is metal,crocked,structurally unsound,shows substantial infiltration or exflltration,or tank failure is
• imminent. The system will pan inspection if the existing septic tank is replaced with a Conforming septic tank as app;wed
by the Board of Health.
(revised 11/03/95) I
One,Winter Street • Boston,Massachusetts 02106 • FAX(617)556-1049 • Telephone(617)292.5500
i�Printed on Recycled Paper
e.
`t♦
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
l CERTIFICATION(continued)
PiopertyAddreae: /G���� �6S/�i• f
Owner. 7? .57p/Qi 4f,41 ly.I /P�1P25f �i/�S
Date of Inspection: `.;.1/L,5 7
B)SYSTEM CONDITIONALLY PASSES(continued)
0/7 _ Sewage backup or breakout or high static water level observed in the distribution boa is due to broken or obstructed pii
/" or due to a broken,settled or uneven distribution box. The system will pass inspection if(with approval of the Board o
Health):
broken pipe(@)are replaced
obstruction is removed
distribution box is levelled or replaced
The system required pumping more than four times a year due to broken or obstructed pips(s). The system will pass
inspection if(with approval of the Board of Health):
broken pipe(s)are replaced
obstruction is removed
C) FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH:
Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect t
public health,safety and the environment.
N/ 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM 1S NOT FUNCTIONING IN.
MANNER WHICH WILL PROTECT THE PUBLIC HEALTH 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 bordering vegetated wetland or a salt marsh.
R) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH (AND PUBLIC WATER SUPPLIER IF APPROPRIATE)
DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECT THE PUBLIC HEALTH ANE
SAFETY AND THE ENVIRONMENT:
The system has a septic tank and soil absorption system and is within 100 feet to a surface water supply or tributary to
surface water supply.
The system has a septic tank and soil absorption system and is within 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 60 feet or more from a private we
supply well,unless a well water analysis for coliform bacteria and volatile organic compounds indicates that the well is I
from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 6 p
S) OTBER
(revised 11/03/95) 2
J
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address: ,Oklllky/4eG
Owner. /�/�/y'�►4 Q/i� /�/QJ�S7�G✓dS /'d�/��
Date of Inspection: 9;" // �;,
D) SYSTEM FAILS:
I have determined that the system violates one or more of the following failure criteria as defined in 310 CMR 15.303. The basis for r
this determination is identified below. 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 an overloaded or clogged SAS or cesspool.
Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or
cesspool.
Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool.
Liquid depth in cesspool is less than 6"below invert or available volume is less than 1/2 day flow.
Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).
Number of times pumped_
Any portion of the Soil Absorption System,cesspool or privy is below the high groundwater 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 60 feet of a private water supply well.
Any portion of a cesspool or privy is less than 100 feet but greater than 60 feet from a private water supply well with no
acceptable water quality analysis. If the well has been analyzed to be acceptable,attach copy of well water analysis for
coliforni bacteria,volatile organic compounds,ammonia nitrogen and nitrate nitrogen.
E)LARGE SYSTEM FAILS:
The following criteria apply to large systems in addition to the criteria above:
The system serves a facility with a design flow of 10,000 gpd or greater(Large System)and 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 400 feet of a surface drinking water supply
the system is within 200 feet of a tributary to a surface drinking water supply
the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area(IWPA)or a mapped Zone 13 of a public
water supply well)
The owner or operator of any such system shall bring the system and facility into hill compliance with the groundwater treatment program
requirements of 314 CMR 6.00 and 6.00. Please consult the local regional oMee of the Department for ftuther information..
(revised 11/03/95) 3
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST
Property Address:
Owner.
Date of Impeotion:/✓!/'Cl/�S'�(y�5 /����' /�J/9
Check U the following have been done:
Pumping information was requested of the owner,occupant,and Board of Health. 40601V10"_
j/ one of the system components have'been pumped for at least two weeks and the system has been receiving normal Dow rate
during that period. Large volumes of water have not been introduced into the system recently or as part of this inspection.
As built plans have been obtained and examined. Note if they are not available with N/A.
k/The facility or dwelling was inspected for signs of sewage back-up.
JZThe system does not receive non-sanitary or industrial waste flow
ZThe site was inspected for signs of breakout.
lhG/vOi/�,
ZAll system components,aal.iup the Soil Absorption System,have been located on the site.
t/The septic tank manholes were uncovered,opened,and the interior of the septic tank was inspected for condition of baffles or
tees,material of construction,dimensions,depth of liquid,depth of sludge,depth of scum.
✓/_Ths size and location of the Soil Absorption System on the site has been determined based on adsting information or
approximated by non-intrusive methods.
The facility owner(and occupants,if different from owner)were provided with information on the proper maintenance of Sub
Surface Disposal System.
(revised II/03/95) 4
1
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
d / SYSTEM INFORMATION
Property Address 77 S��f1.11 rj'�/> >-�i/• ���5�d�'!s //(S
Owner.
Date of Inspection:
FLOW CONDITIONS
RRSMXNTIAU
Design flow: tau on ,
Number of bedromnsa_
Number of current residents
Garbage grinder(yes or no):
Laundry connected to syste (yes or no),Y
seasonal use(yes or no): "�6.S L^ vt!
Water meter readings,if available: 114P
Lost date of occupancy:
COMMERCI4kL/INDUSTRL4LU
Type of establishment:
Deslga flow:----gallons/day
Green trap present:(yes or no)_
Industrial Waste Holding Tank present:(yes or no)_
Non-sanitary waste discharged to the Title 5 system:(yes or no)_
Water meter readings,if available:
Lost date of occupancy:
OTHER:(Describe)
Let date of occupancy:
GENERAL INFORMATION
i
PUMPING RECORD and source of in:W-:5iv-. .1
System pumped as part of inspection:(yes or nq)_
If yes,volume pumped: gallons
Reason for pumping.
Septic taalt/dirtribution bos/soil absorption system
Single cesspool
Overflow cesspool
� Privy
.c-Shared system(yes or no) (if yes,attach previous inspection records,if any)
Other(espLlia)
APPROXIMATE AGE of all components,date installed(if known)and source of information: j q 1 /
Sewage odors detected when arriving at the site:(yes or noV7�
(revised 11/03/95)R ti
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYST--E,,Muu INFORMATION(continued)
Property Address: 7!p
Owner. /,/X�'"
Date of Inspection: aY��/9
SEPTIC,TANK/
(locate on site plan)
Depth below grade ��-
Material of construction: concrete_metal_FRP—other(explain)
Dimensions:
Sludge depth:
Distance from top of sludge to bottom of outlet tee or baff(q'�.Li�74Ld'*'*?
Scum thickness:Z Y"
Distance from top of scum to top of outlet tee or bailie:
Distance from bottom of scum to bottom of outlet tee or baMe:
Comments:
(recommendation for pumping,condition of inlet and outlet tees or baffles,depth of liquid level in relation to outlet invert,structural integrity
evidence of
leakage,etc.)
GREASE TRAP:_
(locate on site plan) '
Depth below grade:_
MaterW of construction:—concrete_metal_FRP—other(explain)
Dimensions:
Scum thickness:
Distance from top of scum to top of outlet tee or baffle:
Distance from bottom of scum to bottom of outlet tee or baffle:
Comments:
(recommendation for pumping,condition of inlet and outlet tees or baffles,depth of liquid level in relation to outlet invert,structural integrity,
evidence of leakage,eta.)
i
(revised 11/03/95) 6
J
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
>- J SYSTEM INFORMATION(oonUnued)
Property Address �' �!j C1�ih- '�/9s2S�l�J /�� /�
Owner.
Date of Inspection:
91'l TIGHT OR HOLDING TANK:_
A (locate on site plan)
Depth blow grade:
Material of construction:_concrete_metal_FRP_other(e:plain)
Dimensions:
Capacity: saUons
Design flow: sallons/day
Alarm level:
Comments:
(condition of inlet tee,condition of alarm and float switches,etc.)
DISTRIBUTION HOX: /1.��
(locate on site plan)
Depth of liquid level above outlet invert:
Comments:
(note if level and distribution is equal,evidence of solids carryover,evidence of leakage into or out of box,etc.)
""JA PUMP CHAMBER:_
(locate on ails plan)
Pumps in working order:(yes or no)
Comments: .
(note condition of pump chamber,condition of pumps and appurtenances,etc.)
(revised li/03/95) 7
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
,�i SYSTEM INFORMATION(continued)
Property Address l�/ �L ""c'I'�-/ yyvl S�LZ'r S �/��
Owner. ?9 S�/9�'�d�j�� f�/l /'�
Date of Inspection:
SOIL ABSORP71ON SYSTEM(SAS):4e
(locate on site plan,if possIDk;excavation not required, but may be approximated by non-intrusive methods)
If not determined to be present,explain:
Type. lesching pits,number:_
leaching chambers,number:_
leaching galleries,number:
leaching trenches,number,length:
leaching fields,number,dimensions:
overflow cesspool,number:
Comments:(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,eteJ 40
CESSPOOLS:_
(locate on site plea)
Number and configuration:
Depth-top of liquid to inlet invert:
Depth of solids layer:
Depth of scum layer: '
Dimensions of cesspool:
Materials of construction:
Indication of groundwater:
inflow(cesspool must be pumped as part of inspection)
Comments:.(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.)
40 PRIVY:_
(locate on site plan)
Materiels of construction: Dimensions:
Depth of solids:
Comments:(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.)
(revised 11/03/95) 8
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: / ,� ✓i o�/L�//
Owner. 79
Dale of Inspection:
SIW=R OF SEWAGE DISPOSAL SYSTEM:
include ties to at Ieart two permanent references landmark)or benchmarks
locate All Welk within 100' jf��' ,/��d�� L�� ,* l /17 /�✓�
C
r 9y o
� i000 ��►�/o� sr
P
Z!9 "
r d2fl' G', i
DEPTH TO GROUNDWATER
�Depth to Vroundwate . teat
method c determination or approximation:
y
i
r
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address:
Owner: 7:% ,—G>y
Date of Inspection:
Depth to Groundwater_Fee/ t
Please indicate all the methods used to determine High Groundwater Elevation:
Obtained from Design Plans on record
Observation of Site (Abutting property, observation hole, basement sump etc.)
✓Determine it from local conditions
heck with local Board of health
Check FEMA Maps
Check pumping records
Check local excavators, installers
_Izuse USGS Data
Describe in your own words ho establishe t High Groundwater Elevation. Must be completed)
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X11V ;Oct
7 �.
70
(revised 04/25/97) Page 10 of 10
. i
2tirA
TOWN OF BARNSTABLE
LCJCATION cS'� /��c SEWAGE #
VILLAGE ASSESSOR'S MAP & LOT
INSTALLER'S NAME 6i PHONE NO
't
SEPTIC TANK CAPACITY
LEACHING FACILITY:(type) (size)
NO. OF BEDROOMS PRIVATE WELL OR LIC WA
BUILDER OR OWNER 6aIJ l.I. fW
DATE PERMIT ISSUED:
DATE COLIPLIANCE ISSUED: Ile,
q
�
VARIANCE GRANTED: Yes No
i
� �
��
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
.......................................
Appliration for Disposal Works Tonstrurtion 1hrmit
Application is hereby made for a Permit to Construct ( ) or Repair (A4:1 an Individual Sewage Disposal
System at:
.._.--- - ---»--��-----».... . ..... ......... .��.��- .......... ��_1 �- s...�.�� s........ ..................
Location-Address or Lot No• .
_....1 �. 1 . »t t
......--.r .� .......-••-----.. ... om {- Q 'af ......-�.�-..��. ...
Add
.......... .................. �•' ....
Installer Address
Type of Building Size LoA :.....»fi.Sq. feet
.........................Ex an Garbage
Expansion Attic Grinder
a Dwelling—No. of Bedrooms.............. p ( ) g ( )
04 Other—Type of Building .........A4�..... No. of persons............................ Showers ( ) — Cafeteria ( )
a' Other fixtures ..-----••----•• .....................................-----.--
W Design Flow........................ ` ..__.....gallons per person per day. Total daily flow..........C. O...................gallons.
WSeptic Tank—Liquid capacityll�gallons Length................ Width................ Diameter................ Depth................
x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft.
3 Seepage Pit No....... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft.
Z Other Distribution box ( ) Dosing tank ( )
04 Percolation Test Results Performed by...........................
...
t Pit.................... Depth to ground water........................
Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
a ....................... ---------•.......................•-------••------•---•-•-••---•-•........---._...........---....----......................--•-•••--
0 Description of Soil.................................................................................................=......................................................................
.....................................-.......................................................................................................
U Nature of Repairs or Alterations—Answer when applicable- I-A& ......... QQ _. U ..........
?�1 .......... .......... '. .� �ffr------......................
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of L I - 5 of the State Sanitary Code—The undersigned further agrees not to place the system in
operation until a Certificate of;Compliance has been ue by the bo rdof health.
1"2Signed_.__,Application Approved By-_----• ------------•---... ......------.------ ------------------------------•----.----•• .........
Da
Application Disapproved for the following reasons:............................................................................................................
••........................••••-----•....----------^ ----------------.....--------•-----..........--•----• ----------------------------•-....•----------------------------------•---- .........-•---
Date
Permit No....��--`•-17S.......................... Issued......---------...--------..............---............
Date
+' '+....-�..�,-_, ...wi.rr`t1„R^vTt`^`.`-.r.�� *_+.�^...^ti-.:-r4.�-...,•..*t n .''ti"•,.. ..T 1.., _..•J..p'.tfiYli" r.�_..i ,`.
No .....
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
�(/.. ..............OF
Appliratiun for Disposal Works Tonutrurtiun Prruat
Application is hereby made for a Permit to Construct ( ) or Repair ,ken!I /'v dual Sewage Disposal
System at:
_}
� ..._...- . __ ��/�:.......... ...... ..��f cs.�_.�..........
Location Address
...... �! 1 � � or Lot No.
' � .......��� 1.......•.... .-----......•.... .
Owner Addres
-- ---- ---- -
pq Installer Address
6 Type of Building Size Lo t feet
Dwelling—No. of Bedrooms............: ........................Expansion Attic ( ) Garbage Grinder ( )
Other—T e of Building
a Other—Type g ...__.... - _:S o of persons---------------------------- Showers ( ) - Cafeteria ( )
Other fixtures ..............................................................
----•------•-•-----•-•----------------------•-------...........-•-----••••-•••........
W Design Flow.........................�-..--.gallons per person per day. Total daily flow.......... ?O...................gallons.
WSeptic Tank—Liquid'capacityZzAQQgallons Length..............:. Width................ Diameter................ Depth................
x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area...................sq. ft.
3 Seepage Pit No.._.... .... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft.
Z Other Distribution box ( ) Dosing tank ( )
0-4t Percolation Test Results Performed by.......................................................................... Date........................................
py s
Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water........................
Grr Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
9 ..............••---•--•--•---...._..............•--...-----••--......-•••--•--•••-••----•----......•.........................................................
0 Description of Soil........................................................................................................................................................................
--------------------
-----...---•------------------------------------------------------------- ------•-•-•-.......------------------•----•--•-•-----...---....--•---------•.... ..... ---•--...---..------------
U Nature of Repairs or Alterations—Answer when applicable /f , ��2 �)-•-------
��/. . .......... ��D - '' ..._ ......................
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of ilTLE 5 of the State Sanitary Code— The undersigned further agrees not to place the system in k r
operation until a Certificate of Compliance has been
�issue A by the bo rrdd�of�health. �
Signed.-_ - --•---
� Dae
-----------
Application Approved By.............1!�............... Y?.�--..—.. [
Da e
Application Disapproved for the following reasons:............................................................................................................
.......--•-•.............•------------.....------......-----------•------....------.............-----......-----•------------....-•-----------•-----•----•--•--...------....-•-•••----•---••----•••••-•---
Permit No. - b.-..!_.?::�. _.-.. Issued_-... -
-----^---...Date......
Date
THE COMMONWEALTH OF MASSACHUSETTS t
BOARD OF HEALTH.
...... ....... ..OF.. .. .. . . . .n......................................
farrtif iratr of faumphunrr
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired (A0
by............................C, ------4'0 ---- ,"' ; �a-- --1/Z
•.�! '- ......................
Installer
at................................�....._...�_ s .r;` .... ........................
has been installed to accordance with the provisions of TI_L:. , >of The State Sanitary Code as described in the
application for Disposal Works Construction Permit No._!�?22.4.... ................. dated................................................
. THE ISS�U/-NCEOF TH�1S CERTIFICATE SHALL NOT BE CONST AS A GUAR TEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE.........��C.'�. .- ..........................•- ••-- •-- Inspector......... .- - ............
--.............
THE COMMONWEALTH OF MASSACHUSETTS
BOARD O HEALTH
N .1..l:..S ..............OF... .<.......... . A,
...J...
FsE.
•
Disposal Works Tunstrurtiun Frrutit
Permission is hereby granted......... ��i r ��1� � C ' ...................
to Construct ( ) or Repair (,-,<j an Individual Sewage Disposal Sy tem
at No......................... ................. �f ?` Y,,E........... GJ1rt.15 1!J/ S
Street i
as shown on the application for Disposal Works Construction Permit No_ Dated.._.t2�."" .. y ..........
..................................... _...._ __._..
DATE:,. I ....................................................
SYSTEM PROFILE ALL SYSTEM MARKED WITH COMPONENTS
SHALLPE OR BE 4" SCH40 VENT WITH NOTES
MAGNECOMPARABLE MEANS FOR FUTURE LOCATION. CHARCOAL FILTER AS
(NOT To SCALE) SHOWN PLAN VIEW 1. DATUM IS NAVD 8
ACCESS COVERS TO WITHIN 6" OF FIN. GRADE CONCRETE COVERS TO WITHIN 3" GRADE
PITCH BACK TO SAS, n fee
2" PEASTONE OR GEOTEXTILE NO LOW POINTS.
FILTER-FABRIC OVER STONE 2. MUNICIPAL WATER IS EXISTING �oj
TOP FOUND. EL. 75.2 a�
74.0' MINIMUM .75 OF COVER OVER PRECAST 2% SLOPE REQUIRED OVER SYSTEM 74.0 3. MINIMUM PIPE PITCH TO BE 1/8" PER FOOT. A
WATERTEST D'BOX FOR LEVELNESS BLOCKS OR-
PRECAST H-10 MIN. 2" WALL THICKNESS PRECAST RISERS 4. DESIGN LOADING FOR ALL PROPOSED PRECAST Locus
RISERS (TYP.)
4"0SCH40 PVC MORTAR ALL UNITS TO BE AASHO H-20 p
PIPES LEVEL 1ST 2' COMPONENTS INVERT IN 69.30'
t.. ENDS (TYP') SIDES 70.3' 5. PIPE JOINTS TO BE MADE WATERTIGHT. a
..........
.•.. .' .pea�•e�ee�eoeo...' '. .. '. -. e e°a°o a ve a^.. '
V ' O O O .. ,'' .. .. - .. O-O O O
10" EXISTING 14' E '°°°°°°°° o 0 0 0 0 0 6. CONSTRUCTION DETAILS TO BE IN ACCORDANCE
TEE SEPTIC TANK TEE
ss 70.6'* 6" MIN. SUMP 0 ° o ®®®��00®®®® ®�®'��0��®�� °0000000
°° °°° ° ° ° WITH 310 CMR 15.000 (TITLE 5.)
O°O°O°O°O 12" MIN. INT. DIM. o°°°O°°Oo° ®�®®���®��® ®�®M®FP®M��EN oo°°°°°° '
° ° °^°^°_ ° O o Q
GAS BAFFLE ::' ""° °D Moo ®®®0��®®�®® ®®�J�O®®��0 ;00000000
69.57' 69.40' ) °0 67.3' 7. THIS PLAN IS FOR PROPOSED WORK ONLY AND
NOT TO BE USED FOR LOT LINE STAKING OR ANY
OTHER PURPOSE.
3/4"-1-1/2" DOUBLE WASHED STONE 4' MIN. H-20 500 GAL. LEACHING}CHAMBERS BY ACME PRECAST OR EQUAL. a�
ALL AROUND PRECAST STRUCTURES (2)!UNITS REQUIRED 8. PIPE FOR SEPTIC SYSTEM TO SCH. 40-4" PVC.
6" CRUSHED STONE OR MECHANICAL OVERALL DIMENSIONS TO OUTSIDE OF STONE: 25.00' X 12.83' Route 28 south
COMPACTION. (15.221 [2]) _ 9. COMPONENTS NOT TO BE BACKFILLED OR �000' Co`'�f
ti CONCEALED WITHOUT INSPECTION BY BOARD OF y
(1.5 % SLOPE) ( % SLOPE) b HEALTH AHD PERMISSION OBTAINED FROM BOARD
OF HEA
R I
FOUNDATION EXIST. SEPTIC TANK 71' D' BOX 12' LEACHING
FACILITY 10. CONTRACTOR SHALL BE RESPONSIBLE FOR
CALLING DIGSAFE (1-888-344-7233) AND** LOCUS MAP
VERIFYING THE LOCATION OF ALL UNDERGROUND &
* INSTALLER SHALL CONFIRM MINIMUM s3.2' BOTTOM TH-2 OVERHEAD UTILITIES PRIOR TO COMMENCEMENT OF
THE INSTALLER SHALL VERIFY THE SEPTIC TANK SIZE AT 1000 GALLONS + NO GROUNDWATER FOUND WORK. SCALE 1 =2000,±
LOCATIONS OF ALL UTILITIES AND ALL AND ITS SUITABILITY FOR RE-USE. INSTALLER TO VERIFY NO
BUILDING SEWER OUTLETS AND REPLACE WITH 1500 GALLON SEPTIC VARIANCES FOR SEPTIC SYSTEM REPAIRS WHICH MAY GROUNDWATER DOWN TO AN 11. ANY UNSUITABLE MATERIAL ENCOUNTERED SHALL ASSESSORS MAP 100 PARCEL 36
ELEVATIONS PRIOR TO INSTALLING ANY TANK APPROPRIATE TO SITE BE IMMEDIATELY GRANTED BY THE BOARD OF BE REMOVED BENEATH AND 5' AROUND THE
PORTION OF SEPTIC SYSTEM ELEVATION OF 62.3'
CONDITIONS IF NOT SUITABLE HEALTH AGENT OR BY HEALTH INSPECTOR PROPOSED LEACHING FACILITY. SITE IS LOCATED- WITHIN A ZONE II
PAPERWORK AND HEARING REDUCTION PROPOSALS (G,um c�,.. � f-�C-CL MA Pp
APPROVED BY THE BOARD OF HEALTH REVISED 12. EXISTING LEACHING FACILITY SHALL BE PUMPED
DURING A PUBLIC HEARING HELD ON DEC. 10, 2.013 AND REMOVED OR PUMPED AND FILLED WITH CLEAN
SAND.
L E G E N D
2) FOR ALL SYSTEMS THAT HAVE NO INCREASE IN
FLOW - SYSTEM COMPONENT INSTALLATIONS
99- EXISTING CONTOUR PROPOSED MORE THAT THREE FEET BELOW GRADE
X 99•1 AND WITH PHR 20 LOADING,
VENTING IPBUT ED TN NOT CASE O THE SSHALL) SYSTEM DESIGN.
EXIST. SPOT ELEV.
-[991- PROPOSED CONTOUR THE SAS BE LOCATED MORE THAT SIX FEET BELOW GARBAGE DISPOSER IS NOT ALLOWED
GRADE.
198.4] PROPOSED SPOT EL.
TH1 \� �1 EXISTING 3 BEDROOM DWELLING
D
rEsr HOLE Q S� DESIGN FLOW: 3 BEDROOMS @ 110 GPD = 330 GP
USE A 330 GPD DESIGN FLOW
2%
2_ SLOPE of GROUND
COL) UTILITY POLE \ 160 OU, � SEPTIC TANK: : 330 GPD (2) = 660
FIRE HYDRANT BENCHMARK x **RE-USE EXISTING 1000 GAL. SEPTIC TANK
NAIL SET IN TREE
NOTE. NOT All SYMBOLS MAY APPEAR IN DRAWING EL. = 75.85'
LEACHING:
1h
SIDES: 2 (25 + 12.83) 2 (.74) = 112 GPD
TEST HOLE LOGS BOTTOM 25 x 12.83 (.74) = 237 GPD
TOTAL: 472 S.F. 349 GPD
ENGINEER: DANIEL E. GONSALVES, SE #13587 LOT 50 USE (2) 500 GAL. LEACHING CHAMBERS (ACME OR EQUAL)
DON DESMARAIS, RS 20,800± S.F. WITH 4' STONE ALL AROUND
WITNESS:
�
DATE: 8/7/17 0 LP ,
PERC. RATE _ < 2 MIN/INCH
0 M A
CLASS I SOILS P# 15456 , J�, ,
� APPROVED DATE BOARD OF HEALTH
ELEV. ELEV. SANDBOX
4 4 , DECK EXISTING
O" 73.7 0" 73.7 DWELLING
TOP OF FNDN N
A A k EL. 75.2 Q
SL SL O TITLE 5 SITE PLAN
1OYR 4/2 1OYR 4/2 PATIO / OF
3�, 4�, x �.-,1 0
ALP , o 79 STARLIGHT DRIVE
B B w
SL SL MARSTONS MILLS, MA
„ 1OYR 6/6 1OYR 6/6 , 9 O qt, w
28 71 .4 30 71.2 °R cq° PREPARED FOR
TH1
x TH2 N C40 CAPE COD SEPTIC/
C C
11k4 PETRUCCI
PERC
MS MS PROP. VENT WITH C RCOAL FILTER k � / <A- ENOFHs DATE: AUGUST 11, 2017
AND BUGSCREEN ( INAL PLACEMENT BY rijNo r Sic REV.: AUGUST 23, 2017 (H-20, VENT)
CONTRACTOR WITH 0 EOWNER 60 00' �s�`� S t;" (3' DANIEL yG�
2.5Y 7/4 2.5Y 7/4 CONSULTATION) 'off DATlELA. n /s A. m�
110 OJALA �i� OJALA `� off 508-362-4541
CIVIL i fax 508-362-9880
No.40980
4` No.46502 �! �� downcape.com
Job SGIg �N�SURI6 down C41 a en ineeri4 inc.
126 63.2 126 63.2 �3 civil en in eers
land surveyors
NO GROUNDWATER ENCOUNTERED Scale: 1"= 20' _Z�_�-� / y
J 939 Main Street ( Rte 6A)
0 10 20 30 40 5o FEET DATE DANIEL A. OJALA, P.E., P.L.S. YARMOUTHPORT MA 02675
BI C'E' # > '�'-24 9 17-249 CAPE COD SEPTIC-PETRUCCI.DWG