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Home My WebLink About0024 TROTTERS LANE - Health 24 Trotters..Lane Marstons Mills A=047 - 123 3/�/0� �� Q �, I� TOWN OF BARNSTABLE f UXA 1'ION a -F,o+4 e rno SEWAGE #,900& VILLAGE m ASSESSOR'S MAP & LOTJ�19 123 INSTALLER'S NAME&PHONE NO. CU44 e I 9,`G8 I o SEPTIC TANK CAPACITY 1 O O O LEACHING FACILITY: (type) ; 6U,V- L 3G5^C)s (size) a?5 3 xla aS xo� NO.OF BEDROOMS BUILDER OR OWNER Rov ('QAy PERMITDATE: tf-y b COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility N� Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) (fQ fi Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feeW leac acii Feet Furnished by r A D ® - - c No. Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes ,�, ZippYica�tion for �Nq;po�ol �&Vw � �Con5truction Permit Application for a Permit to Construct( ) Repairo Upgrade( Abandon( ❑Complete System Xlndividual Components �II� Location Address or Lot No. p2 q (�r>•cv'J C." Iql✓9Owner's Name,Address,and Tel.No. L/�u Pvc 6 u Assessor's Map/Parcel �� 6 3 C�ec•A.,T �'7 Installer's Name,Address,and Tel.No.�C�SR d 4�` Designer's Name,Address and Tel.No. �ox (069 t)6c GNU ,fA- ,-,) ' S��l 'ldro Shut LuicA 133 —2f7 ? Type of Building: Dwelling No.of Bedrooms 3 Lot Size sq.ft. Garbage Grinder ( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 33 O gpd Design flow provided 3 y gpd Plan Date // 0 Number of sheets Revision Date n1 o N-0— Title Size of Septic Tank eX t.f-r- /00 o Type of S.A.S. 30i-b 1 n.-4j Description of Soil SP�2 �% ✓� Nature of Repairs or Alterations(Answer when applicable) _ Re /a c'A Ic-, 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. Si ® Date Application Approved by Date Application Disapprove by: Date for the following reasons Permit Nc '� ' Date Issued 1Vb �k ..� Fee D THE COMMONWEALTH`OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes ?, ZippYication for Mi!5po9;al,,qPpgtem Con5tructtonPermit Application for a Permit to Construct( ) Repair(), Upgrade( ) Abandon( ) ❑ Complete System Individual Components Location Address or Lot No. a <( I.-0#e j CAli-,— M NI Owner's Name,Address,and Tel.No., L,4� Assessor's Map/Parcel 41"7 2-3 6 1 C'y r A, T J Installer's Name,Address,and Tel.No.�o�sfi�(c� SA ' "'/ Designer's Name,Address and Tel.No. Pox 66`l �B� GnsU fA�i)./�'r5 2WYL10 S C L oz% 3 1-7 7 Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder _ Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided -? V d gP Plan Date D (o Number of sheets_ / Revision Date No N.-2 Title Size of Septic Tank SPX t rT /000 Type of S.A.S. _3 7os, /few-r.,5 Description of Soil SQ2 r°/.4 r Nature of Repairs or Alterations(Answer when applicable) i2P,o/a e--e_ ,Cl;, /plV Leo S 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 i Compliance has been issued by this Board of Health. n Si d 7 d /( d Date Application Approved b Date Application Disapprove by: / Date for the following reasons Permit No. Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS I' Certificate of Compliance lia � B THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed ( ) Repaired Upgraded ( ) Abandoned( )by i9pW r/e. I C/ ,jA 1 4-4 Jerti��2 '71v C at 1 L/ '7,67-7 er S LAr., 64 M has been c•nstoctem,,a cordance with the provisions of Title 5 and the for Disposal System Construction Permit No. dated P P Y Installer RoaSX-,e Fe,, ,ic_a2ZzDesigner 1),1C Pnli�rto�.t.r��.2 i #bedrooms 1 Approved design flow d gP The issuance of this ermit tall not be construed as a guarantee that the system will fvnctio as design . c Date 1 � Inspectors J J ———————————— ——————————— -—————————— — No. ' Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION—BARNSTABLE, MASSACHUSETTS 1=igpoga1 ,p!6tem Co !6tructiou Permit Permission is hereby granted to Construct ( ) Repair (�}' ) Upgrade ( ) Abandon ( ) System located at a y 1-o#e.,-S La 1-e /L►A,�-;eow S ✓�, l/S and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided: Const ction.m st be c mpleted within three years of the date of this p it. Date Approved by - j . . Town of Barnstable' Regiflatolry Services Thomas F.Geiler,Director snixsr.�BLE, Public Health Division Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office:.508-862-4644_ Fax: 508-790-6304 Installer Ir Designer Certification Form Date: � La Designer: 7� Installer:��%� ) I Address: . �-elrC.12. T �r � Address: � 11 On �"U1� �� was issued a permit to install a (date (installer) septic system at based on a design drawn by (address) �W l T) mIg , F6 dated_ b�• (designer) 1/ !certify that the septic system referenced above was installed substantially accordin '. g to the design, which may include minor approved changes such as latcral ii location T the clIftiribution box and/or septic tank. I certify.&. at the septic system referenced above was ins ect with major.chan es g a,e, greater than."10' lateral relocation of the SAS or any vertical relocation of any componc�t of the septi ��ysern}but in accordance with State&Local Regulations. Plan revision , certified as bir#t`by designer to follow. or .` DAVID (Installer's ignature) B. g MASON Irm. v 9 WA06s. sgNITAR�P� , (llesi er's Signature) (Affixe igper's Stamp.Here) PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CER'TMCATE OF COlVII?LIANCE WILL. NO BE ISSUED UNTIIL BOTH _THIS FORM A" BUILT CARD ARE RECETVELl AY THE.BAR STABLE PUBLIC Aia7['H USIOl�I THANK YOU. Health/Se tic/Desi p finer Certification ForrYi " Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 24 Trotters Lane Property Address Danielle DeMoura Owner Owner's Name information is required for every Marstons Mills MA 02648 07/13/10 page. Cityrrown State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way.Please see completeness checklist at the end of the form. Important:When filling out forms A. General Information on the computer, use only the tab 1. inspector: key to move your cursor-do not Michael Kellett use the return Name of Inspector key. Aardvark Environmental Inspections ffi Company Name P.O. Box 896 Company Address East Dennis MA 02641 City/Town State Zip Code 508-385-7608 SI 3742 Telephone Number License Number C= O { G~j 0 ± B. Certification Q -n I certify that I have personally inspected the sewage disposal system at this address and thaNe Wv information reported below is true, accurate and complete as of the time of the inspection. TleinslXction was performed based on my training and experience in the proper function and maintenance39 ongte sewage disposal systems. I am a DEP approved system inspector pursuant to Section 1"40,-olf Title 5(310 CMR 15.000).The system: ry r ® Passes ❑ Conditionally Passes ❑ Fails 4 ❑ Needs Further Evaluation by the Local Approving Authority 07/15/10 Inspector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving,authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments a '< 24 Trotters Lane Property Address Danielle DeMoura Owner Owner's Name information is required for every Marstons Mills MA 02648 07/13/10 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass"section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no"or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not)is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND(Explain below): Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments r 24 Trotters Lane Property Address Danielle DeMoura Owner Owner's Name information is required for every Marstons Mills MA 02648 07/13/10 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes(cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh Commonwealth of Massachusetts . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 24 Trotters Lane Property Address Danielle DeMoura Owner Owner's Name information is required for every Marstons Mills MA 02648 07/13/10 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate"Yes"or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged 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 %day flow Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 24 Trotters Lane Property Address Danielle DeMoura Owner Owner's Name information is required for every Marstons Mills MA 02648 07/13/10 page. City(rown State Zip Code Date of Inspection B. Certification (cont) Yes No ❑ ® 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 SAS, cesspool or privy is below high ground water elevation. 0 Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis,performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CM 15.303, therefore the system fails.The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes"or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply El El the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area—IWPA)or a mapped Zone 11 of a public water supply well If you have answered"yes"to any question in Section E the system is considered a significant threat, or answered"yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. f Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 24 Trotters Lane Property Address Danielle DeMoura Owner Owner's Name information is required for every Marstons Mills MA 02648 07/13/10 page. Citylrown State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes"or"no"as to each of the following: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined?(If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS)on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ❑ ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable)[310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms(design): 3 Number of bedrooms(actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 24 Trotters Lane Property Address Danielle DeMoura Owner Owner's Name information is Marstons Mills MA 02648 07/13/10 required for every __ page. City/Town State Zip Code Date of Inspection D. System Information Description: Number of current residents: 2 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes ® No Laundry system inspected? ❑ Yes ® No Seasonaluse? ❑ Yes ® No Water meter readings, if available(last 2 years usage(gpd)): Detail Sump pump? ❑ Yes ® No Last date of occupancy: current Date Commercial/lndustrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 24 Trotters Lane Property Address Danielle DeMoura Owner Owner's Name information is required for every Marstons Mills MA 02648 07/13/10 page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below), General Information Pumping Records: Source of information: Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments <' 24 Trotters Lane Property Address Danielle DeMoura Owner Owner's Name information is required for every Marstons Mills MA 02648 07/13/10 page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known)and source of information: 10 years Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 1.6 feet Material of construction: ❑ cast iron ® 40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments(on condition of joints, venting, evidence of leakage, etc.):: Septic Tank(locate on site plan): Depth below grade: 0.8 feet Material of construction: ®concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance?(attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1500 gal 311 Sludge depth: Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 24 Trotters Lane Property Address Danielle DeMoura Owner Owner's Name information is required for every Marstons Mills MA 02648 07/13/10 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle 28" Scum thickness 2" Distance from top of scum to top of outlet tee or baffle 6" Distance from bottom of scum to bottom of outlet tee or baffle 16" How were dimensions determined? measured Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): The tank was sound and tight with tees in place and liquid at outlet invert. Grease Trap(locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date Commonwealth of Massachusetts upTitle 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 24 Trotters Lane Property Address Danielle DeMoura Owner Owner's Name information is required for every Marstons Mills MA 02648 07/13/10 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection)(locate on site plan), Depth below grade: Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments(condition of alarm and float switches, etc.): *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 24 Trotters Lane Property Address Danielle DeMoura Owner Owner's Name information is required for every Marston MiIJs MA 02648 07/13/10 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Distribution Box(if present must be opened)(locate on site plan): Depth of liquid level above outlet invert Even Comments(note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): The box was level and tight with no sign of carryover. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.): Soil Absorption System(SAS)(locate on site plan, excavation not required): If SAS not located, explain why: Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 24 Trotters Lane Property Address Danielle DeMoura Owner Owner's Name information is required for every Marstons Mills MA 02648 07/13/10 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ® leaching chambers number: 3 ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): This system has three infiltrators surrounded by three feet of stone. There was no sign of ponding or failure in the stones. Cesspools (cesspool must be pumped as part of inspection)(locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes 0 No Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 24 Trotters Lane Property Address Danielle DeMoura Owner Owner's Name information is required for every Marstons Mills MA 02648 07/13/10 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy (locate on site plan): Materials of construction: Dimensions Depth of solids Comments(note condition of soil, signs of hydraulic failure, level of ponding,condition of vegetation, etc.): Commonweatth of MassachusiRts Title 5 Official Inspection Form ubsurface Sewage Disposals system Form-Not for Voluntary Assessments S 9 24 Trotters Lane Property Address Danielle DeMoura Owner Owners Name information is Marstons Mills MA 02648 07/13/10 required for every City/Toum State Zip Code Date of inspection page- - D. System IntOrmation (cont.) Sketch of Sewage Disposal System. Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet Locate where public water supply.enters the building. Check one of the boxes below: hand-sketch in the area below ❑ drawing attached separately +Y 6Z ear a 37 1� I Commonwealth of Massachusetts Tithe 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments r� 24 Trotters Lane Property Address Danielle DeMoura Owner Owner's Name information is required for every Marstons Mills MA 02648 07/13/10 page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope ❑ Surface water ® Check cellar ❑ Shallow wells Estimated depth to high ground water. 4.4 feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked,date of design plan reviewed: Date ® Observed site(abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health-explain: Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: I augered to 5.1 feet and found damp sand. ladjusted to 4.4 feet. Bottom of leaching is at 3.0 feet. Before filing this Inspection Report, please see Report Completeness Checklist on next page. Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 24 Trotters Lane Property Address Danielle DeMoura Owner Owner's Name information is required for every Marstons Mills MA 02648 07/13/10 page. Cityrrown State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems)completed ® System Information—Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file a " B6-z 21877 P:934� `1\�'J '�� NOTICE: The Town of Barnstable ..recommends that the annlonnat seek legal advice to prepare a properly worded deed restriction document. DEED RESTRICTION r WHEREAS, 'DeR ,.c, C� Of (owner's name) r \ (address) is the owner of Z_L4 lro+4-e r S located m1 (address) at M0 r s 4n/-[ S N; t , MA (hereinafter referred to as and being shown on a Ian entitled "Subdivision 9 R of Land in . \ MA, Property of et al, duly recorded in Barnstable County . Registry IV) OT rN Deeds in Plan Book 02 , Page Or on Land Court Plan Number WHEREAS, as the owner of said lot has V ' (owner's name) agreed with the Town of Barnstable Board of Health to a restriction as to the number.of_be-&ooms which can be included in any home built on said lot as a. pre-condition to obtaining a disposal works construction permit incompliance with 310 CMR 15.000 State Environmental Code, Title V, Minimum Requirements for the Subsurface Disposal of Sanitary Sewage; WHEREAS, the Town of Barnstable Board of Health, as a pre-condition-to . granting a disposal works construction permit for a septic system in compliance with 310 CMR 15.200, State Environmental Code, Title V, Minimum Requirements for the Subsurface Disposal of Sanitary Sewage, and authorizing the issuance of a building permit for the=nstruction of a single family home on this property, is requiring that the agreement for the,restriction on the number of bedrooms in any house constructed on the lot be put on record with the Barnstable County Registry of Deeds by recording this document, deedr NOW, THEREFORE, n i-e does hereby place the (owner's name) following restriction on his above-referenced land in accordance with his ag_reetme t.whh-tL-P Towa.ofBacastatale� d-af-H-eaith whiehfeatmtkftzhalt run with the land and be binding upon all.successors in title: . ZL( Tro �4.r`S i e ,�t. Td�� S (�!� may have constructed (address) u on the lot pi house containing no more than 3 ( ) bedrooms. kI r 1 "Qzj agrees that this shall be permanent deed (owne s name) restriction affecting located on MA, and being shown on the plan recorded in Plan Books o Paged .— I�- Or on Land Court Plan For title of see the following deed: Book Page . Or Land Court Certificate of Title Number Executed as a sealed instrument day of wner's signature Owner's signature Owner's signature COMMONWEALTH OF MASSACHUSETTS Y ss 2001 Then personalty appeared above-named known to me to be the person who executed the foregoing instrument and acknowle ged the same to be fre ct and cXed, before me, } _ ; . � Notary Public My -ommilpion expires: Rig ` PAULAANNCROSBY,Notary Uy Gem, 7" YOU WISH TO OPEN A BUSINESS? 11 For Your Information: Business certificates (cost$30.00 for 4 years). A business certificate ONLY REGISTERS YOUR NAME in town (which r you must do by M.G.L.-it does not give you permission to operate.) Business Certificates are available at the Town Clerk's Office, 1'°FL., 367 Main Street, Hyannis, MA 02601 (Town Hall). ,. DATE:-I� !I 1 Fill in please: � APPLICANT'S YOUR NAME: L-)ct n Ir Je M Ourct e r r,G ncA D-c"Cu v`q rx _B,1SINEPS YOUR HOME ADDRESS: Is Lary e r ot,4 HA � � TELEPHONE # Home Telephone Nu _ -1 5 NAME OF NEW BUSINESS Pc k i n ij n 6- TYPE OF.B.USINESS Po in i q 6 Cen+ra c4,or IS THIS A HOME OCCUPATIONS YES 1\10 .. ' yo.0 iven a.Lfr..nm-t4w-buIdmg.division?._YES =_..NO ADDRESS OF BUSINES CrA e rS S Pi �tB MAP/PARCEL NU.M...BER �" oZ When starting a new business there are several things you must do in order.to be in compliance with the rules and regulations of the Towrof Barnstable. This form is intended to assist you in obtaining the information you may need. You MUST GO TO 200 Main St. - (corner of Yarmouth Rd. & Main Street). to make sure you have the appropriate pertnits and licenses required to legally operate your business in this town. 1. BUILDING COMM ONER'S OFFICE This individu h.s en4gf eft any permit requirements that pertain to this type of business. �i •Aut ou e ature** �" � COMMENT l� 1 CL 2. BOARD OF HEALTH This individual has bee nfor d of.t permit requirements that pertain to this type of busirie.ss. -Ai uthorized tignaturj* COMMENTS:-lampA//7T ,� Y�4/ D�'1 '511-e 3. CONSUMER AFFAIRS (LICENSING AUTHORITY) . This individual has been informed of the licensing requirements that pertain to this type of business. I Authorized Signature.* COMMENTS: ta... , . Town of Barnstable P# l� Department.of Regulatory Services Public Health Division Date %6 200 Main Street,Hyannis MA 02601. 2 Date Scheduled l 916-\ ',Ti me Fee Pd. SO&Suitabillity Assessment for Sewage 'sposal Performed By: ).D A'U k rA O Witnessed By LOCATION& GENERAL INFORMATION Location Address , 1 IL L A -0— Owner's Name (—A u re ei 6 o u i),_ Address Assessor's Map/ParceL Qz/ 7- ,_ .;Engineer's Name NEW CONSTRUCTION REPAIR Telephone#k 1 T �_x 3 ,1 a 7 Land Use SlopesM .Surface Stones 1 Distances from: Open Water Body ft Possible Wet Area ft Drinking Water Well ft Drainage Way ft Property Line ft Other ft SKETCH:(S t name,dimensions of lot,exact locations of test holes&Pere tests,locate wetlands�n proximity to holes) o � r � - �5 o t �� 7 .i Parent material(geologic) —`"'�� N Depth to Bedrock Depth to Groundwater. Standing Water in Hole: �-�" Weeping from Pit Face 1 Estimated Seasonal High Groundwater D MNATION FOR SEASONAL HIGH WATER TABLE Method Used: Depth Observed standing in obs.hole: - _in. Depth to soil mottles: In. —Depth to weeping from side of obs.hole: in. Groundwater Adjustment fi. Index Well# Reading Date: Index Well level Ad),factor Adj.Groundwater Level,e,q PERCOLATION TEST Date la �e.� Observation :q Hole# Time at 9" Depth of Pere V l� Time at 6" Start Pro-soak Time @ Z 'Time(9"-6") End Pre-soak Rate Min./Inch Site Suitability Assessment: Site Passed Site Failed: Additional Testing Needed(Y/N) . Original: Public Health Division Observation Hole Data To Be Completed on Back----------- l ***If percolation test is to be conducted within 100'of wetland,you must first notify the. Barnstable Conservation Division at least one(1)week prior to beginning. Q:\SEPTIOPERCFORM.DOC E DEEP.OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Older Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones;Boulders. Consistency,%Gravel) DEEP OBSERVATION HOLE LOG Hole# 2= Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA)', (Munsell) Mottling (Structure,Stones,Boulders. psis % ray rr G � j Z DEEP OBSERVATION HOLE LOG HOle# Depth from Soil Horizon Soil Texture Soil Color. Soil . Other Surface(in.) I (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency. Gravel) DEEP OBSERVATION HOLE.LOG Hole.# Depth from Soil Horizon Soil Texture - Soil Color Soil Other , Surface(in.) (USDA) (Mansell) Mottling. (Structure,Stones;Boulders. Coniistengy, r Flood Insurance Rate Map: Above 500 year flood boundary No Within 500 year boundary No K Within 100 year flood boundary No__ Yes Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervi u rial exist in all areas observed throughout the area proposed for the soil absorption system? If no what is the depth of naturally occurring pervious material?,. L..� t. P � Certification ; I certify that on `0 � (date)I have passed the soil evaluator examination approved by the Department of Enviro men I Protection and that the above analysis was performed by me consistent with the required tr ining,expertis d ex ie a escribed in 310 CMR 15.017. 2 Signature Date >� ��/ !7 61 Q:\SEPTICVERCFORM.DOC TOWN OF BARNSTABLE LOCATION�o2'y o S Zq SEWAGE # VILLAGE— K ASSESSOR'S MAP & LOT INSTALLER'S NAME &.PHONE NO. O SEPTIC TANK CAPACITY /0(5,o LEACHING FACILITY:(type)P,QE cAs_r_ _ (size) 6,4 NO. OF BEDROOMS 3 PRIVATE WELL. R PUBLIC WATER BUILDER O OWNER ._c k � a u d1 DATE PERMIT ISSUED: _ G DATE COMPLIANCE ISSUED VARIANCE GRANTED: it a ' TOWN OP BARNSTABLE LOCATION_ 2 a i rc2! L.►ft►E SEWAGE VII.I.AGE 1�25I(�/� ►�.1-5_ ASSESSOR'S MAP & LOT�� L07IZ3 INSTALLER'S NAME & PHONE NO. _ SEP11C TANK CAPACITY D®_GAUL LEACHING NACILITY:(typp),�(��L (size) N(). OF BEDROOMS E, PRIVATE WELL OR PUBLIC WATER WE BUILDER DATE PERMIT ISSUED: DATE COMPLIA.NCE ISSUED:_^ VARIANCE GRANTED- 1�� DVTI ,a 9 L`1 ` � -~=. Fimis THE COMMONWEALTH orxxAssACHussrrs - BOARD OF HEALTH , -_Jipw~+)..................OF-u � Disposal�� ^� ��«��l«r«�uiouDisposal Works T4unstrurtioKK rumit Application �� is hereby made for u Permit to Construct ( ) or Repair ( ~/ an Individual Sewage Disposal System at: Owner �""�� . � Installer Address Type vuBuilding Size feet � Dwelling--No. of Bedrooms..............3.........................Expansion Attic ( ) Garbage Grinder 914 Other—Type of Building ---'---------- No. c6 persons............................ Showers ( ) -- Cafeteria ( ) `w Other fixtures -----------_.-----'----------------.--.-.-------------------'--'-------'--' � � . � Design Flow...........................................gallons per person per^ ~v' Total dai flow' � --'-'------'------ ~gallons. Septic Tank - Length-.-----... Width,............... Diameter-...-._- Depth................ Trench--No .................... Width.................... Total Lcootb--'___'-' Total leaching area.................... ft. Seepage Pit 0o--------. Diametcc-----..--' Depth below inlet.................... Total leaching area...................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) '- Percolation Test Results Performed bv......................................................................... Date........................................ ' 1.4 Test 9d No. l................miooteuper6nck Depth of Text Pit:................... Depth to ground water.-_'----_.. 44 Test Pit No. 3................minutes per inch Depth of Test I,iL--.-----_ Depth toground water........................ c4 --------------'-_-_—'-_'-_--___----..'----'_----'------'-----'--'_'---_-___ 0 Description of Soil......................................................................................................................................................................... �� ____''''----'----_...—.-.---_---------__._-'_ . .. ' . '-- U Nature of Repairs orAltecudouo--Aoower when applicable------Iwa .......10-00.....ss.c....1� - ___'--'---.--''-_'-__-_--''-----'----____-- ' � /�grceozcot: The undersigned agrees to install theuforedescribmd Individual Sewage Disposal System inaccordance with the provisionsof TL I TL iZ 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until u Certificate of Compliance has been issued b b board of h Signed.........4°°w~~w~=� ---- ,==- ........... `� ) Date Application Approved By........ -^=_"' _____-_-__________ ___��,,_�~�'___ o"mApplication / Disapproved for the following reasons:................................................................................................................ --`-----'---`----------`---`-------------------`-`----------------`-------'-------'-------- . ~~~ � Permit ' . Date � --__' THE COMMONWEALTH OF _~,S~~'^~~^^ '= BOARD �� HEALTH � ��" �� ~o ° "��~ o xv � � �^ ------��F--'��/��?��6\ E __ | .°� � ��ppliratxon for 11hipasal Works TonstrurtKon Prrutit Application is hereby made for a Permit to Construct ( \ or Repair ( °� an Individual Sewage Disposal System at: . /. Owner P Address Installer Address Type of Building Size Lot- g. feet � Dwelling--No. of Attic Garbage Grinder � \ � Other—Type of Building ............................ No. m6 persons............................ Showers ( ) -- Cafeteria ( ) � ^w Other fixtures ----._---_.---'-__'_-__'__'_--''__-'-.-'_-'-___--__--_'------'---- Deuign Flow............................................ per person per day. Total daily flow............................................ Septic Tank--Liquid capacity............ Length................ Width................ Diameter................ Depth................ Disposal Trench--No..................... Width.................... Total --'------' Total leaching area....................sq. ft. Seepage Pit Nu------.-.. Diametcc_-.-.---. Depth b6mvio�t----'----_ Totu l�u6' area-.-----'-'sq. �. �� Other [)�tr�ot�v� box ( ) Dosing tank ( 1 ~~ Percolation Test Results Performed bv-.--'................................................................. Dute-------------------. Test Pit No. l................minutes per inch Depth of 3emL Pit.................... Depth to ground water........................ 44 Test Pb No. 2................minutes per inch Depth of Test PiL---_----- Depth to ground water........................ 9 ----------------------------------- -------------- ..... ---------- . ......................................................... 0 Description cf Soil...............................................................................-'------'--'''--------'---------'------ _________________________________________________________---------- ------------------ ---------------- ------ ____ -_--------.----.------...'_--__---.-____._---- - . _ � U Nature of Repairs or Alterations--Answer when �J.�l/�1�-- -. � ` ' .... - ...............--_--__-_'-----..''-----_-..._--__.--_-_.----_--'-_--- '-m'~`-.... k- Tbe undersigned agrees to install the uforedeucribod Individual Sewage Disposal System in accordance with the provisions of TIT 1Z 5 of the State Sanitary [ode--The undersigned further a8cces not to place the system in operation until u Certificate of Compliance has been ixsuc6by �b� bouolm6� l � 8 ' Sig�xel---��.!°.c�'l'�-'��'^---k/ ___ .................9)' � / ` ' ` —'- �'------ Application /�pproved I�y'---' -�`=� ----------'--_____ �-_L� ___��=��'=_ Application Disapproved � ~� � �� for the following reasons:................................................................................................................ ------`---------`-----------`--------------`--------`-----`-`--------'----`-------Date Permit No........Fo'-�_'��c�'�L--------- Issued....................................................... Date _______________________________________________________-___ THE COMMONWEALTH ormAssAcHussrrs B �� OF HEALTH ' �� ' .......... =--OF.---- ............................... Of Toutpliattrr ,~- THISJS TO CERTIFY, Installer � . ut___--�=�'.--. ----��'ua�u�-----'--- -----_--_.----__-------'---------- has been installed in accordance with He pmviokmo of TITPT7 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No_..YfH''�-'��'��.��....... date6------.-.--.----..---. THE ISSUANCE 01" THIS.CERTIFICATE SHALL NOT BE CONSTRUED AS AGUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. � D/�IGL'------'-�-�-�'��----'--'--'_--'--_'-- -'- '=l' �------------------------------------- '...... -......... � --------------------------------------------------__________________ r*sooMwomvvsALr* orwxssAu*ussrTs BOARD OF HEALTH � � m� ----OF............ 'n»a.------_----� ........... � Ropsal W herebyPermission is - - ' `J ............................................................. ---- to Construct ( ) ]� Individual Sew Disposal System u1I�o_---r\ ' /--.- ____ ................ - . ~ Street uo shown oothe application for Disposal Works Construction Permit Dated.......................................... �� . CV) It No......... --�...'� FIcH....�✓`.................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ... ..-. _. .. . ... ............. .OF.......16,1 4. ...•--.................................................... Appliration -for Bhipofial Works Tonitrnrtion Vantit Application is hereby made for a Permit to Construct (K or Repair ( } an Individual Sewage i osal System at: r r' Loca'o Address or Lot No. a v®:7��c.... �5 - -1 ee l�......................... Addres s W • - ------- ------ ------------- Int]�r� w!E• Address d Type of Building / �[ W Size Lot.,r.®� ------- feet U Dwelling �No. of Bedrooms________�-.-•______________________-----Expansion Attic (a� Garbage Grinder aOther—Type of Building ---------------------------- No. of persons............................ Showers ( ) — Cafeteria ( ) A' Other fixtures .._.. ------------------------------ W Design Flow 5.9.............._._._�� gallons per person per day. Total daily flow..... gallons. � Septic Tank Liquid capacity_)_.____kallons Length................ Width................ Diameter_--_-----..--__ Depth...--.----...--- xDisposal Trench—No- -------------------- Widtlii__..______.�___�► Total Length.................... Total leaching area-------------- .....sq. ft. Seepage Pit No....../_- --__-- Diameter.1845._._* epth below inlet........ ........ Total leaching area-------.----------sq. ft. Z Other Distribution box ( ) Dosing tan ) (f �L . a Percolation Test Results Performed by.- -_ !dell`. �(l _=; .� 2(. Date----. Test Pit No. 1______________-minutes per inch Depth of Test Pit.........._......... Depth to ground water.___..______._____..... f� Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water------------------------ r4 O Description of Soil-----------6— �... 4�-�° - !w�_..._ __ x p r � - --------------------------------------- a _ W ---------------------------------------------------------------------------- UNature of Repairs or Alterations—Answer when applicable.-.--__----------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------- •-------•----------------------------•--------------------------.. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Article XI 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. 10 Signe -•-•-••- -•--••----•--••----•-•----------------- �------------19. ------------- Date Application Approved By------ -�` -------------- ---•- ---- - -- -- -- ....-••-•-••-••-•-- ......2 Date Application Disapproved for the following reasons---------------------------------------------------------- ------------------------------------ ................ ..............................-.......................................................................................................................................................................... Date PermitNo......................................................... Issued........................................................ Date No.................... / — F n ic...1., ....::::�.�....... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH. ..............OF.... ,I 6:Z APPliratiutt -fur Bi-qVugttl Workii Towitrurtion Permit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: ----- ............... ra' &erg . --4.b............ A Locaf Address / • -- ._ .rs W Owner A ress - ed •- a � Installer ._. •-•--•--•---••---...----••-- Addr s U Type of Buildin Size Lot-----------------------_--.Sq. feet Dwellinge No. of Bedrooms.............3...................------Expansion Attic ( ). Garbage Grinder ( ) Other—Type of Building --.------------------------- No, of04 persons---------------------------- Showers ( ) — Cafeteria ( ) d Other fixtures -.. W Design Flow............................................gallons per person per day. Total daily flow---------------------------------------------gallons. WSeptic Tcttik—Liquid capacity........--.gallons Length................ Width.............-. Diameter................ Depth........._...... x Disposal Trench—No. .--_--------------- Width-----------_------ Total Length.....---- .......... Total leaching area--------------------sq. ft. Seepage Pit No..................... Diameter.. ...-...:------- Depth below inlet-------- _-_.... Total leaching area........._..------sq. ft. Z Other Distribution box ( ) Dosing tank ( ) �,CG�` -- `Ls 1 a Percolation Test Results Performed by .I-- - < -15P-( Date. Test Pit No. l...............minutes per inch Depth of Test Pit......-.-..--------- Depth to ground water......,.........__...... Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 0 ---------------<<---_------) -- O Description of Soil........... ... ----fir- x / -� -._ . 3 � r ... /-------------- ------------------------ x ----------------------------------------------------------------------- U Nature of Repairs or Alterations—Answer when applicable.------------------ ------------------------- ----------------------------------------------------------------------------------------- ----------------------------------------- ------------------------------------- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Article \I 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. Signe t Application Approved BY---- v ..- .y.:Da7_Z_ Date -------------------•-----•-----••--•------•-----••------•-------------....-------•--...-----...---------•-•-••- Application Disapproved for the following reasons- 7. .......................................................................................................................................................... PermitNo.........................•.---------•-------•-----•----- Issued..----------------- ..----------- Date Date I THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH j 0 �..........OF ... .................................................... Irrtifiratae of f"a ntpliatta , T "IS TO C TIFY . iat the Individual Sewage Disposal System constructed ( or Repaired by---• -•='f- - -•- --- - ---------------- � tiller --------'---------------- ----------- -has been installed in accordant ith the provisions of : rtic 1I of The State Sanitary Code asC described in the application for Disposal Works Construction Permit N ---2----...3.f! ------------ dated._. f THE ISSUANCE OF THIS CERTIFICATE SHA L NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL F CTION SATISFACTORY. i DATE---------------- ----- f f 2-- --- Inspector--- 2SETTS THE COMMONWEALTH OF MASSAC BOARD OF HEALTH ......OF............Gv.�� .................. No............... FEE....--!t�--•------•---- i� u 1 ar,),.,!e trurtion Permit Permissio i h eb granted----- -. .. _ __ to Construc or�Re pair dividup System `--- -- ---- - at No.--- f Gf'- � --- �� - ------•---•---•--- Street / as shown on the application for Disposal Works Construction Pe rxxi No.. ..-. Dated..- /1.get--------------------------------- DATE Boar of Health -----------------------------------••------------------------------------------- FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS i t } r 4,16 r y /y ? �h M f �y /00 ,r 4 w ; yaa k 0 , i A". { . 154 yyELL 3 T 7- j /T . i CERTIFIED PLOT PLAt� -' ROBERT / L} x;; r BRUCE =�+ /— �G'T TG h'S NEW CON ONLY = $ . ELDREQDE ?AA '.TAP OF FOUNDATION IS . ./ FEET hp� , IN , ; '. E10VE LOW POINT OF ADJACENT Q�st6¢� A.8� AND. ; o `RA®, su, SCALES DATE �,/� 3 ;' " p �L�hGE ENGINEERING COIN I CERTIFY THAT THE f"D 'Nf��4 CLIENT A2LQ- SHOWN ON THIS PLAN IS LOCATED ' el,' 1�+61gT E REGISTERED / y'7 ON THE AROUND AS INDICATED AI��;, LAND JOB NO. r+•. .. CIVIL I CONFORMS TO THE ZONING LA1�YB EN®INEERV SURVEYOR DR.BY: OF BARNSTABLE , AS { ,33 NO. MAIN ST 712 MAIN ST. # 5 3.iYARNIOUTH, LASS. HYANNIS, MASS. SHEET�° OF . - DATE R G. LAND 1URYE 0 ft. t 'Y-•iTTa �7�,`„]k+-_ .e` �6. .-._^t ., `:.g .V.3 'S"Y- ..II.' _ R .�+" V-z --``j �''- � s-> � �--_ - sy �• s,- --i;,. .i_ ..w �t+w _ rv.r �+� YF..�„W. '�, Lrt'S' •'w Sbk, hx"j .;:YB� T.. -:: -.'$4 h.•.x• ,�. t .�. ,„ •_. s�-�. ." - �..�' ._ _....,F� I:1.,. -Eh ik- - .S- `. '.. •2'L � � *"Y G: -�.r-a� _�,...•'.'� s .� � `y .y - :,.4r �J:`i Y+s +a,. ✓ �+,eYR °E' - - '' ,2' :5�` -d ~':•�FC> - ..r. -- - ^�-� - '- _ - 2*rp•a� - 411 pVC P► CLEAN SAND - CONCR£TE MIN �_' • - COVERS .. f 1/8'• PER H ' Ft. CONCRETE W - _ ,► COVER LIQUID LEVEL f' , A S -in.-. O 1 LAYER ! T . , F ! 3/81/ -e ' e `�lIN 'ITTCCM : A SEPTIC TANK ° ° , e WASHED STONE 1/4i1R FT S N DIST. . . . ° - ° •° ° a . BOX - ° 11 " xa , . .' EFFECTIVE' 3/4 - I i/2 DEPTH • ° ' . I WASHED STONE ° 1 • •I • • • • i . 1 1 ' •� • • • . . PRECAST SEEPAGE • • • . . • ° PIT OR EQUIV. • INVERT -ELEVATIONS - - L �� 6 A 10 FT. 1�-A. -. �-C (SEE,-TABULATION INVE ;ITT G.UILDiNG- FT _ _ IN-LET S£PTIC TANK FT GROUND WATER TABLE- OUTLET: , SIrPTIC" -TANK FT SECTION OF, _ 'y WLET DISTRIBUTION BOX SEWAGE DISPOSAL SYSTEIUI �s 3 _,dT DISTRIBUTION BOX FT. SCALE: 114 = I -O ET SEEPAGE P.IT FT. . _ TABULATION'S DESIGN CRITERIA DIMENSION A _ 3 FT. _ DIMENSION B <- FT. NUMBER OF BEDROOMS -� DIMENSION C`� FT GARBAGE DISPOSAL UN-IT �I!Or1/E- - TOTAL ESTIMATED FLOW _ oo GAL_/DAY SOIL LOG SOIL TEST. NU4S= OF SEEPAGE PITS �_ ELEVATION �� DATE OF SOIL TEST , 2 �7 SIDg -LEACHING PER PIT (83sSQ. FT. "�ovn� RESULTS WITNESSED BYY ry) BOTTOM LEACHING PER PIT ?�SSQ. FT a"� TOTAL LEACHING AREA 2107 S0 FT. PERCOLATION RATE MIf1SIlIN -- o f 3l0', StJf3 l L ; y - RESERVE LEACHING AREA 7 SQ. FT c.s.4nvw cl-y+;} . _ " � ,sG� ' K t3E \'\ �� PHIUP s� L 07' 2, •Tg>��T 5 LA/VE� i; is,, - `"". i'. I ;; � Y NBERG tie. ! Q QE y -LDFZMGE ENi7INtM`3 ` •1NCO > c � a.,. .,t`f �5. , af;•ss... �s - 33 fi1@. MAIN ST IAIN S -r,; =�.,�;-� ��.�,•,,,�.. .- r: :4�y� ��,; _ , _ �oNa>i-E _,, �' `'-� x • �'. YAf2M0I;3TH RiASS cr' ` .ri"��,e ' 7f w ?z � a JOB Nq -- �4F"� •� .,, - .,.q•, - •� J f�- ems;. %, _ n A i¢HA4 -k'11 y. . __�io!�T e�iz,�:��r.�-� ,�✓ice��.fi,,, �,�, N �jY >rn E ,r sz . bj b A &44r /000 y �q' a i• 3yft ' x Ry. at WELL ! IL r.' q 5 4Z Y d Alt CERTIFIED PLOT PLAN t:.Y ROBERT G _ I } .r BRuct 70TTi` L-LIA14E N`E* CONSTRUCTION ONLY : $ ELORSOGE y IN '"` r x@�YTOP OF FOUNDATION F S 2. 1 AD ADJACENT OVE LOW POINT �Nn sub ,.ROAD. SCALE: DATE:( � Lf�R DGE EN CO.IN CLIENT U�c� I CERTIFY THAT THE ,• SHOWN ON THIS PLAN IS LOCATED q ft EelSTERED REGISTERED S'; ON THE GROUND AS INDICATED Ali ' LAND JOB NO.,E� CIVIL I CONFORMS TO THE ZONING LAWS' , OF BARNSTABLE , ASS. "* : ENGINEER SURVEYOR DR.BY: — h . 33 .NO. AGAIN ST 712 MAIN ,,T. ��=�'r'!/ � I .5U YARMOUTH, MASS. HYANNIS, MASS. SHEET OFF DATE R G. LAND SURV9*OR=` rri X- tiJ'. Y'^ +- rd. ,•csl•;''nv A. . t '- r.'aO f ; PVC' PIPE --, t EAN SAND ` : - _CONCRETE � MIN PITCH_ COVERS --A 1/8" PER 'FT ! CONCRETE7 COVER A A 10" 1 LIQUID LEVELS `£AST _ 2" LAYER OF WASHED„ STONE PfPE E :. M1N, BITCH= SEPTIC TANK •DI T ' , ' ' , •? • • • 1/4 S , , . R FT. BOX ° ° - B . . , , „ . .� EFFECTIVE' — 3/4 - I 1/2 DEPTH • • ' ' ° � WASHED STONE • • • • • , ° ° PRECAST SEEPAGE 1 . • ' • • . . . ° PIT OR EQUIV. . VERT_ ELEVATIONS ; 1, 6 FT DIA. -T s �p - SEE TABULAT 10 FT' OIA V FFTTINLET SEPTIC TANK.—*—. _ —GROUNDTABLE !! QUIET SEPTIC TANK . __ FT „SECTION OF WATER i IsV ;9T- DISTRIBUTION sox FT." SEWAGE - DISPOSAL SYSTEM f T DISTRIBUTION BOX ' FT SCALE _//4 / -O- W- T SEEPAGE PIT FT - - TABULATION'-- T DIMENSION A 3 FT. DESIGN CRITERIA DIMENSION B_ <— FT NUMBER OF BEDROOMS 3 DIMENSION C Y FT GARBAGE DISPOSAL UNIT TOTAL ESTIMATED FLOW 300 GAL/DAY SOIL LOG SOIL TEST NU 7R OF SEEPAGE PITS Z ELEVATION DATE OF SOIL TEST 6 2 7 7 SIDE LEACHING PER PIT --S0. FT. J � RESULTS WITNESSED BY. BOTTOM LEACHING PER PIT �g-SSQ. FT o PERCOLATION RATE MIN/1140 TOTAL LEACHING AREA zG7 S0. FT a .3�'`su8sor.L ' RESERVE LEACHING AREA zGZ SO. FT.Aw .o i �sA�vvv cc9v? 407 Ala o WEINBERG ; ' Sf�/V!� '.a _ 366. •3 i tJfli r Q„ >_ = fi __ ENi�iNERiAI ' rT s. �` of Q �a.<t : Et..®REDGE- p� :�- i.ey '*„1,Y--_"�: ` :�.' ^}� .-«�` - V [ . M _ ,..:`•'r "°"" ''Cz -Y:z•s,... �s^ Y ,;i+ - MAIi�F".5_ [ F _ Y 1 1 AI 71�y } ,»� tr .+ti..-.c.^<fsa.Ya.'.: Ns•,� _ '''' .y5'-`i'�l: •ramvci i�/ i. �r'h�'�. -•T:.,r."'.. -,e A,:V#Y' n+`?"'°``t` '>s.',`�'s.'raj3•'*,,a a:4'''•+:'w .x YA a L TH 7- a Fs3;- .`T .TM_ma NI 1�' S TAfro �„-, � � �,.`° ""� �•,g"'a' �.tc: �� u�r{� ,.�4Y. «i C.1�. �� ° � - - VY �,. E a8 N ? a SHEET 0 OF �= r- ` a - - ' .. i- �f Moo _ - .Y Yr-rfs..gym,:-.�r.3��..._.k•Ad a..4.,4�-.ax' wt;,-.._r95..:.:..�z,-xc.,-,....-�.�,-' x•C--....-..,.. �' c - ASSESSORS MAP: �'7 � - �, TEST HOLE LOGS - �- PARCEL: '� 1Z3 NOTES: SOIL EVALUATO , W* J%, FLOOD ZONE /lO/ WITNESS REFERENCE: ap9a DATE• pP 1) The installation shall comply with Title V and Town of Barnstable Board of PERCOLA I ON RATE: Health Regulations. CffAQLy� U '� ZI 5 2) The installer shall verify the location of utilities, sewer inverts and septic (f �� ' / • components prior to installation and setting base elevations. TH-I TH-2 3) All gravity septic piping to be 4 inch Sch 40 PVC at 1/8"per foot. The first wo two feet out of the dbox to the leaching shall be level. IckidAN 4) This plan is not to be utilized for property line determination nor any other p purpose other than the proposed system installation. 5) All septic components must meet Title V specifications. bjp5,7,$ .► li IbS 6) Parking shall not be constructed over H10 septic components. OCAT I ON MAP(40) "t J 7) The property is bounded by property corners and property lines. 8) The property owner shall review design considerations to approve of total - ,�7 I G� N • design flow and number of bedrooms to be considered for design. Receipt of N o .E ___� ? :_ �! payment for the plan and installation based on the plan shall be deemed �c3 . 't S 23 14 . # �� approval of the design flow by the owner. \ 9) The existing leaching or cesspools shall be pumped and filled with material per Title V abandonment procedures. Those within the proposed SAS shall be �b pp�- removed along with contaminated soil and replaced with clean washed sand per Title V specs. 10)System components to be 10 feet from water line. Sewer lines crossing the . I! S E P T I SYSTEM DESIGN water line shall be sleeved with 4 inch SCH 40 PVC with ends grouted if -l—��!'i1• "v. %,,3� applicable. ►. . 11) Ifa garbage grinder exists it is to be removed and is the responsibility of the y ,t, Ok"�IUIM �� FLOW EST I MATE owner to ensure such. ` 12)The installer is to take caution in excavation around the gas line if applicable. - -BEDROOMS AT IC) GALIDAY/BEDROOM - CAL/DAY SEPTIC TANK - _ GAUDAY x 2 DAYS GAL USE IUD GALLON sEPT1C 3011- ADSORPTION SYSTEM. Z .r Z�X Zvi , I , � O S 1 DE AREA: 3 + lZT�i x Zx.? a i l 2. I.Z X • - 9 . 0 ? _ OL�'O'�TOM AREA: g 10 - `� SEPTIC SYSTEM SECTION aT�, yl-j�11 �. -Lull ilia / .f164 + 1- tl 0 � �- 106.7 � S _ t 7 0 � , p o o /03� I 1 SEPTIC TANK 10525 f ZN OF _ DAVID U N N -- -- o.joss o g� SITE AND SEWAGE PLAN � QIaTEAE Zor � �6 --; a LOCATION : 4 I PREPARED FOR iX: +1eA,0t2A �-1n - O S LE• DAV I D B . MASON'R5 DATE. DBC ENVIRONMENTAL DESIGNS DATE SANDWICH . MA ATE HEALTH AGENT t508) 833-2177