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HomeMy WebLinkAbout0031 TURTLEBACK ROAD - Health 34 TURTLEBACK ROAD, - --- A=047 073 /Y1gr. " L,(S,a f i it oe TOWN OF B STABLE , LOCATION SEWAGE # VII.LACE / l ASSESSOR'S MAP & LOT_�� 7-67 INSTALLER'S NAME&PHONE N0. �"''V SEPTI,c TANK CAPACITY LEACHING FACIL=: (type) -�74re�r o size) YFX NO.OF BEDROOMS B BUILDER OR OWNER PL-RMTTDATE: yp 6' COMPLIANCE DATE: "7 eparation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within.200 feet of leacNng facility) Feet - Edae'of Wetland and Leaching Faci!iity(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by 6-9 S" a t Cam! ho �`.� INN �� TOWN OF BARNSTABLE LOH ATIO I �'���� �aQ-K SEWAGE # q6 -,A V IAGE INAQ t1-1 f,�,J k`s• AA' ASSESSOR'S MAP &LOIN �''�' INSTALLER'S NAME&PHONE NO. eafk�Qw SEPTIC TANK CAPACITY 1 0 C)o °\ \�o� LEACHING FACILITY: (type) /OQ® Qtk 9 VFn (size) I X ('0 O :. NO. OF BEDROOMS BUILDER OR OWNER PERMITDATE: e a` _ COMPLIANCE DATE: r Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of ling facility) ' Feet Furnished by i I cal e s IL4 y / `�-eJ M'q 4�41 � No. L,8 ! Fee `6 THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSA USETTS 01ppYication for Miquar *pgtem Construction Permit Application is hereby made for a Permit to Construct( )or Repair an On-site Sewage Disposal System at: Location Address or Lot No. Owner's Name,Address and Tel.No. Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. I Type of Building: Dwelling No.of Bedrooms Garbage Grinder( ) Other Type of Building No.of Persons Sho,,!( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow " . . J1 gallons. Plan Date Number of sheets Revision Date .r Title ' Description of Soil Nature of Repairs qX•Alterations(Answer h n applicable) i..ow- �v t�ti Date last inspected: ,. Agreement: 4 The underrsigngd3 agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance a`tthhe.provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compl' ec n Issupoy this Board of Health. a '�. 5igl ed ca�V, ` .( Date Application Approved by - ^ �5 Application Di proved for the llowi g reasons Permit No. /� - �. `�- Date Issued to ——————————————————————————————————————— L.,o+ - "7ZUSETTS 4t d No. THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION -TOWN,OF BARNSTABLE., MASSA { k 2pplication for Xigpaar bpgtem Cougtructiou Permit Application is hereby made for a Permit to Construct( )or Repair an On-site Sewage Disposal System at: 4 ' Location Address or Lot No. Owner's Name,Address and Tel.No. , Installer's Name,Address,and Tel.No, Designer's Name,Address and Tel.No. Type of Building: Dwelling No.of Bedrooms Garbage Grinder Other Type of Building No. of Persons Showers( ) Cafeteria( ) Other Fixtures r Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date li Title Description of Soil Nature of Repairs or Alterations(Answer h n applicable) �.+ S l $b CGt( �( �Qw (�rv�`�Y 7 G 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 Certifi- cate of Compliance las been issurn�y this Board of Health. AO .•Signed lC `1-n-r. Date Application.-Approved by - ^ Application Disapproved for the ollowi g reasons 'I I Permit No. Date Issued to " 2S— 6 f THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE. MASSACHUSETTS Certificate of Compliance THIS IS TO CFATIFY, at the On-site Sewage Disposal System installed(. )or repaired/replaced(L-1 on by for WO Y-& Dtti%Ajt_1 ^4 as 0 11.7 +��- has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. _ dated Use of this system is conditioned on compliance with the provisions s orth below: 40.00 *� No. Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS Migpogar *pgtem Cow5truction Permit Permission is hereby granted to 0 CL .r l ,,._ ,,c A,-S to construct( )repair( n On-site Sewage System located at bq c-k (a V 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. All construction must be completed within two years of the date below. Date: �'� �' Approved by .� r T014N OF A55E55OR5 MAP ` -1 ..LOT l3 ZONING: t-JIk ( �Y- OcA) / ,+ SETBACKS: FRONT 5IDE53 F?CAR is I Q 4(0 V J I co TAP Ft4 o,,j ` W \ N� O ' I �r�.lu�Nt,ti P�: ���. �o P ��1►J �a�i otil SITE PLAN - "CA4 LEGEND: Locus: ",\ CoNroues (E)(15T.) ---- REFERENCE:. t-'kd4-ST0.'5 t--' `'`'S (PROP•)--o---o--- CONC.BOUND c® PREPARED FOR: TEST 110LE SCALE: V c ",v DATE: rr :. o+ 20'MIN. .TOP OF 10'MIN. FOUND. EPTIC TANK. � DIST. BOX. LEACHING FACILITY (012 �E1�-rhT•/ [vo. 7 GJVj�r.G 'tss GrAI.. 0 5'r�Nu irl �,9 Novo vo.co � 9 Fiira. 5 loo.�io. SECTION SEWAGE p off. :o ogs.. 7�Pr9/I2 TES 7" NOL E 'LOG S DE51 GN. FOR EX SST/N�j y g�o/1IV� TEST 9Y: �0-.11 t; ►� O.1 A�4, SE PERC.RATE -1 Z M114-IIN. DATE : FLOW RATE GAL./DAY 440 W/TNE59 ga�Q-`� 5EPTIC TANK ( ) * vge'ExT'ST"SEPTIC. TANK SZ. _,jyo o � -5�- Z �•�1 LEACHING FACILITY (-I Z" o i o �--- eorToM coo Y, Io —Pi ) 4 4 TOTAL (000 5F. ='444 G g s — 45 USE , LEACHING G J 1-'1 E L 7 S(s k1.1 i� 1L5 4, 5'`v�lsr D-w D�J�J ,p GA. IviIm 51 GS' lo•ra� — 'ro2S V1i'f►� �4-' `�to►.ls'c> 56.4 aoT NOTES _ 2.SY4 1. DATUM(HGL)t TAKEN FROM 6� 15 . NA-P ?•s Y L �"�� 2. MU041CIPAL HATER It, AVAILABLE 3. DE51GN LOADING FOR ALL PRECAST U)JIT5:MSHO- Iv.4 4.PIPE ✓OINTS SHALL BE MBE VATER T1G14T. 6. CON.5TRUCTION DETAILS TO BE IN ACCORD/WCE "ITN �} CON".OF MA.5S. STATE ENVIRONMENTAL COoE TIME Y 4 uc��2 F10, 6. TN/5 PLAN FOR PROPOSED NORI(ONLY AND SHOULD NOr 13,r Da.o 8E USED FOR PROPERTYLINE STAKING. Z. kbIse 0'(so it P5 1ecf-47:J- -jo �►-tiv S��t.l►.! . °F odolwL,n cape ettglneerinq O ARNE H. CIVIL ENGINEERS J N OJALA LANID SURVEYORS f AA A H. AID., . R.4 92 N 92(a main st.Yormovth,r1a A�o� gfGISTLa- ��� bwrd of he(7 th FSSIp �NG�� DAT ,JOB NO. G L, — 1619 E: MA S7'if+' ! I }: ' - ♦ r. � } {-f•; :•' t ^., r. 'SSA 1� �4} S� 4r ,acr "4 3 r t ��y�e' �'' ':v: �:� �, y+ r� r � '�:•a�'} k� ;t,r `:SYb' }. u�a'�l r��; �'i r c •� t.' ir TOWN STABLE ,� m ti OF'BARN {"v.p ;:': ::•:'ti,; ` o ,, 'Y•-}wti ��h' t p <M ��"�����r r yf^4•>.�K4 i'�,� �. � r•, y�. { t LOC ;pH� SEW AGE VILLA�,� � S � •r+r �l,x }� v v 'ra�� q n rt}xp^.. �Y ASSESSOR'S MAP &LOTO7 ►3t� INS E TA t'S NAM G PHONE NO� n SEP :' ` CITY f ry>: r. r 44 g, �, ! ANIC CAPA Q +' ( =a � LEAS FACILIT — �T a Y:(type) - �,Ccc_�n (size) • i NO. O BEDROOMS 3 PRIVATE'WELL OR PUBLIC'WATER �� ! aMY*-f�r 1 rw' i BUIL !# fiJR O WNER Y' cJ V�VJ .� w . , , � F =' xc� - W S DATE V- 1riIT.ISSUED: -- ' �; $' ,' '_ � y�� •^' y 'r' .fi i, �. DATE O'MPLIAN :. CE ISSUE �.' VARIAiC GRANTED: Yes poi .. 4 !' 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J.. ,,•.i'K• rra`. it �'ie ,q� `�''Na F w r1F , am y .. 1. l i \..71 \�`j T '.,'�a ''sue a,n ,Nisi�';�F,r i y .•„^?' ` .? +tS y ,tr�a,tj� z tilt, �� ,t t,' • l F .ti,!' ..a:a�,r�.sF a3�.s�, hr, F� '�• ''�irr ti^ti} � , 2 r °�- a - - - 5 3-3 .L � S ' 1 y ✓ CERTIFIED SEPTIC SYSTEM REPORT LOCATION 31 TURTLEBACK RD . MARSTONS MILLS, MA 02648 MAP 047 PARCEL 073 LOT 92 PREPARED FOR PARCIINO; SELLER -.2 MR. . WARD W . DUNNING 31 TURTLEBACK RD . MARSTONS MILLS, MA 02648 BUYER MS . TESSA 1309 RACE LANE MARSTONS MILLS, MA 02648 PREPARED BY HILLIARD HILLER P .O . BOX 250 CENTERVILLE; MA 02632 508-778-1472 Commonwealth of Massachusetts Executive Office of Environmental Affairs Department of Environmental Protection WWiam F.Weld Trudy Coxe Gonnwr S--twy Arpeo Paul Celluocl David B. Struhs tL cioNmor Commsobornr SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION Property Address ,7/ 72-'�TLE9,i9 ," /�9 / h/9i�S��''S /�//GLS Address of Owner. Date of Inspection: (If different) Name of Inspector. J/1G1—/,42D HIZ,'-a Company Name,Address and Telephone Number. 1v Q cps-b 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 -Fails Inspeotot's 81Qaatui"e - Date: S/a)/C,S The System Inspector&hall submit a copy of this inspection report to the Approving Authority within thirty(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&ball 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,019 Al SYSTEM PASSES: I have not found any information which indicates that the system violates any of the failure criteria as defined in 310 CMR 15.303. Any faihue criteria not evaluated are indicated below. Ell SYSTEM CONDITIONALLY PASSES: One or more system components need to be replaced or repaired. The system,upon completion of the replacement or repair,pass" inspection- Indicate yet,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,cracked, structurally unsound,shows substantial infiltration or exfiltration,.or tank failure is imminent. The system will pass inspection if the existing septic tank is replaced with a conforming septic tank as approved by the Board of Health. (revised 11103/95) 1 One Winter Street • Boston,Massachusetts 02108 • FAX(617)556-1049 • Tebphone(617)292-5500 • w J Pnmed on RecycW Paper SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Addreae 3/ TG/�i T G E!!AG/ iQQ I i/9iCSTv.�S h/G G S Owner. h/.-i 4-xva Date of Inspection: B)SYSTEM CONDITIONALLY PASSES (continued) Sewage backup or breakout or high static.water level observed in the distribution box is due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. The system will pawn inspection if(with approval of the Board of Health): broken pipe(s)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 pipe(s). The system will pass inspection if(with approval of the Board of Health): broken pipe(s) are replaced obstruction in 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 the public health,safety and the environment. 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM IS NOT FUNCTIONING IN A 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. 2) 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 AND 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 a 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 50 feet or more from a private water supply well,unless a well water analysis for ooliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 6 ppm. S) OTHER (revised 11/03/95) 2 f SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) property Address: 3 eq h/12Sl�vS h/GGS Owner. All^ 4�inPv !�/vvivt' / Date of Inspection: DI SYSTEM FAIL: / 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 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 U2 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 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. If the well has been analyzed to be acceptable, attach copy of well water analysis for coliform bacteria,volatile organic compounds, ammonia nitrogen and nitrate nitrogen. E] LARGE SYSTEM FAILS: The following criteria apply to 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 piety 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(1WPA)or a mapped Zone II of a public water supply well) The owner or operator of any such system shall bring the system and facility into full compliance with the groundwater treatment program requirements of 314 CMR 6.00 and 6.00. Please consult the local regional office of the Department for further information. (revised 11/03/95) 3 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Addrr— 3/ Owner. �i�ii �✓��d Ovvv,.c.G Date of Inapeot;on; lt"e Check if the following have been done: Pumping information was requested of the owner, occupant, and Board of Health. ,L-None of the system components have been pumped for at least two weeks and the system has been receiving normal flow rates during that period. Large volumes of water have not been introduced into the system recently or as part of this inspection. ZAs built plans have been obtained and examined. Note if they are not available with N/A. The facility or dwelling was inspected for signs of sewage back-up. L The system does not receive non-sanitary or industrial waste flow The site was inspected for signs of breakout. All system components,4cluding the Soil Absorption System. have been located on the site. - The septic tank manholes were uncovered, opened, and the interior of the septic tank was inspected for condition of baffles or teas, material of construction,dimensions, depth of liquid, depth of sludge,depth of scum. ZThe site and location of the Soil Absorption System on the site has been determined based on existing information or /approximated by non-intrusive methods. vThe facility owner(and occupants, if different from owner) were provided with information on the proper maintenance of Sub- Surface Disposal system. (revised 11/03/95) 4 f SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 3/ Tl/�TGEGf G.r iP9 .�if/iCSfvvs hits Owner. Date of Inspection: FLOW CONDITIONS RESIDENTIAL:. Design flow:gallons Number of bodrooms:3 Number of current residents: -3 Garbage grinder(yes or no):JCS Laundry connected to system(yes or no):_Lf=�' Seasonal use(yes or no):J�0 Water meter readings, if available: �1`/� 7 7� 6/1 G 8 7 G/9� Last date of occupancy: 1� z-y COMMERCIAL/INDUSTRIAL Type of establishment: Design flow: saallons/day Grease trap present:(yes or no)_ Industrial Waste Holding Tank present: (yea or no)_ Non-sanitary waste discharged to the Title 5 system: (yes or no)_ Water meter.readings, if available: Last date of oc=pancy: OTHER:(Describe) Last date of occupancy: GENERAL INFORMATION PUMPING RECO and source of information: 7 a y�8� 7/�/SG a s s/ 7Zi2/ys' System pumped as part of inspection: (yes or no) If yes,volume pumped: gallons Manson for pumping TYPE OF SYSTEM y Septic tankAlistnbution box/soil absorption system Single cesspool Overflew cesspool Privy Shared system(yes or no) (if yes,attach previous inspection records, if any) Other(explain) APPROXIMATE AGE of all components,date installed(if known)and source of information: 'CWL1 Sys, /a/f /Al '1;1 Sewage odors detected when arriving at the site: (yes or no)L (revised 11/03/95) 6 r SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address Owner. h/A7 Ge/�/�D Date of Inspection: SEPTIC TANK !� (bcate on site plan) Depth below grade:1Z Material of construction: 6,66ncrete_metal_FRP—other(explain) Dimensions: X 7 1' Sludge depth:_ /O" Distance from top of sludge to bottom of outlet tee or baffle: X Scum thickness: /7 Distance from top of scum to top of outlet tee or baffle:_((_ Distance from bottom of scum to bottom of outlet tee or baffle: /y 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.) (3ItF.ASE TRAP: (locate on site p ) Depth below Qrade: Material of construction:—concrete_metal_FRP—other(explain) Swim thieknees: Distance fsvm 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,etc.) (revised 11/03/95) 6 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 3/ 77/•Q j /S�yG r �p Owner. Date of Inspection: 5/5/yam TIGHT OR HOLDING TANK (locate on site plan) /7 Depth below grade:_ Material of construction:_concrete_metal_FRP _other(explain) Dimensions: Capacity: sallons Design flow: gallons/day Alarm Level: Comments: (condition of inlet tee,condition of alarm and float switches, etc.) DISTRIBUTION BOX// (locate on site plan) Depth of liquid level above outlet invert: " Comments: (Dote if level and;distribution is equal, evidence of solids carryover, evidence of leakainto or out of box, etc.) IMT 702 -- pL PUMP CHAMBER:_ (locate on sita plan) Pumps in working order-.(yes or no) Comrents: (note condition of pump chamber,condition of pumps and appurtenances, etc.) (revised 11/03/95) 7 f SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address 3/ %v/1 i Gk-/3 Owner. /�t/h Lvf�,Q1J Dr/.lir/i,vG Date of Iaspeotion: A;A- SOIL ABSORPTION SYSTEM (SAS): (locate on sits plan,if possible;excavation not required, but may be approximated by nos-intrusive methods) If not determined to be present,explain: Type: leaching pits, number:_ leaching chambers,number:_ Lashing galleries, number: laaching trenches,number,length: bach;ng fields,number,dimensions: overflow cesspool, number: Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation etc.)._ CESSPOOLS: (locate on site plan) Number and ocaf9guration: Depth-top of liquid to inlet invert: Depth of solids layer: Depth of seem 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.) 1pRIVY:� i Qocate ha site plan) Materials of construction: Dimensions: Depth of solids: Cammsats:(nots condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation,etc.) (revised 11/03M) 8 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: Owner. /71iyj Gt//9/lU 17UG vi.vl� Date of Inspection: SE3MH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent references landmarks or benchmark8 locate all wells within 100, �\ /0 8 � I DEPTH TO GROUNDWATER Dspth to Roundwater:^feet owtbod of determination or appra dmation: f} h'OG l /✓/g-� eCs/f/Z.h y QGw// %y G/�0�.�0��r9i�i�7 i ifE P/r T///Z GS G S G���. �GTi � f/GTei? (�✓ S 2vl�ec� B !/Si,�G' f�.E s�/L <0 4irf%,C/C L v.0 L T (revised 11/03/95) 9 rfia 7 E . s3 TOWN OF BARNSTABLE LOC'ATIOI�?, 31 ?y/ZTGl�� X iPo SEWAGE# al/-9E VILLAGE ASSESSOR'S MAP &LOT,9y7 a7 L `,%L INSTALLER'S NAME&PHONE NO, /3/ o y77 SEPTIC TANK CAPACITY LEACHING FACILITY: (type) /JIT (size) NO.OF BEDROOMS 3 9tM;DER OR OWNER 4,-1Xa l7Giril�/�/G PERMTTDATE: ^a7-9/ COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility v a•yJ Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by i I 1 , y� s i R ,Q;g I i Iql � iv TOWN OF BARNSTABLE LOCATION Z ! l.�,r,'Y `04CyL SEWAGE # ` ��7 VILLAGE _ ``V1 d`\S ASSESSOR'S MAP & LOT��f INSTALLER'S NAME & PHONE NO.Ca C l\pw \�uJ�C4�L�S (177.d 8� i SEPTIC TANK CAPACITY 106 D LEACHING FACILITY:(type) LCaen P` T (size) 60J NO. OF"BEDROOMS PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNER w vo `� vo _ DATE PERMIT ISSUED: (o - DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No a8 I t� e � a� . 47 N'j, fir A � �3 _. ... THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH TOWN OF BARNSTABLE Applira#ilan for Uispnaal Works Tomitrnrtinn Urrmit Application is hereby made for a Permit to Construct ( ) or Repa�iir__(( an Individual Sewage Disposal System at:S � �� ` l G'C C1,� OC�. d < J 1 .......................... ..........• -`-....e-� ----••• - - - .................................................. ..._.. tt n-Address , ! ��� or No. ^ � .......A...k:fp.......... ...... .............X .. .. ......... ---------------------------------.............\.. .................. .......... cc�..... ......... .... .......t...................M- Installer Address Type of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms______ _____ ____________________________Expansion Attic ( ) Garbage Grinder ( ) 04 Other—T e of Building No. of ersons____________________________ Showers a YP g ---------------------------- P ( ) — Cafeteria ( ) dOther fixtures ------------------------------------•-•--------------------•------•--------•--•----••---•-----•-----•-•---....--•...••-•---••._.....•--••---------•-• w Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—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 ( ) '~ Percolation Test Results Performed bY............-............................................................. Date........................................ a Test'Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water........................ fZ4 Test Pit No. 2................minutes per inch Depth of.Test Pit.................... Depth to ground water........................ a Description of Soil_._.__ � - x w ------------------------------ ------------------------- Na&aMture of Re air or Alterations—Answer when a �i able._.._..__`T'—�_` :. ` e t.� 1 .......... - --•-- . . . •--•- ... Agreemer SC� 9—G fyj The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Envipfamental Code—The undersigned further agrees not to place the system in operation until a Certificate of Co plia, ce been i$ y b rd of health. Q r f ed . ----- -- �.^ --�-^--►-- --.--.------'- J --------'----------------------- -- Dat Application Approved BY ....--..- ------------------- -------- '`' -.-. .... ........ � Date Application Disapproved for the following reasons- ....................................................... ................................................-------------------------- - ---------�----------------------------------------------------------------------------------------- Permit No. �� // ................. Issued ... ^ 4`' - 9 ( -- Date ......-. . + Dare -7 ...Z�.;��;�7 ( 11 b 7-3 S.D-0Z THE COMMONWEALTH OF MASSACHUSETTS . t BOARD OF HEALTH -- �'- TOWN OF BARNSTABLE Appliration for Disposal Works Tonstrur,tion Permit Application is hereby made for a Permit to Construct ( ) or Repair �an Individual Sewage Disposal System at:� ' -- \.` G't C`� - d �"' 1 ..... ...._. ..---_._ ..... ....---•- ----- ............ ..... ..... 3 tion-Address �� ' C"'t"-- or t No. c.LYJ V�. l - a_�-----��------------------------------------------- ----•-�------•--------- `...... . ... ...........................�. ....__.... wngr --�- d ss ................ .... � ..._ _ mom._ ........... .. Installer Address d Type of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms_______,............................Expansion Attic ( ) Garbage Grinder ( ) Other—T e of Building No. of persons____________________________ Showers — Cafeteria Otherfixtures -------------------------------------------------------------•-----•-•-----------•---------------•------•----....._..-------._....._..---....--_------ W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—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 ( ) Percolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water......................... rX4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water----_................... N --- --........................................................................................................................ ODescription of Soil ......4_•--... �� .V... �------------------------------------•-------------------------•-•------•----------...--- x W x --------- ----- U �" Nature of Repair or Alterations—Answer when a p* ble._-_____- _. g_ ". '�e_�_______________ 1 C ej Agreemq.:-� SCh.t- q-G The undersigned agrees to inst4ll the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance plia�n�ce as been issued byZX d of health. ed --------- ----- - -------------------------- a . / Date ApplicationApproved By ....... ........ ....... .......................................... --....-- -------- ----..........................---- ----- ' Dare Application Disapproved for the following reasons- ................................................................................................... .............................. -----------------------------------------------------------------------------------------------------............ - - -------------- ---------------------------------------- Permit No. .....J./`�... .. �7 ---...... Issued --------- a` t- Date Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Gerttfirate of Tantyliance THIS,,I�O CERTI YF� , That the Individual Sewage DisposAll Stem constructed ( ) or Repaired') � b ... �� `s-` ' I • Installer t `� --- -- has been installed in accordance with the provisions of TITLE, of The . Environmental Coe as described P E the application for Disposal,Works Construction Permit No. ..- ��........ ............ dated .... ....2........`... j THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM FUNCTION SATISFACTORY. DATE 71,LL - ---- .................................. - Inspector THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE FEE.`�......© No.... .. ..... ......_. _... ...... . ` iol- rks nrn #rUan r�ruti�`� Permission is hereby granted..........(..... ___C__`______�7___Jc�c___......l............................`r to Construct ( ) or Rep ,}Lan Individual Se rage Disp ,S,ystein at No.................... � _ ��- ,'4 c-t�( � 1�Y/ (/ ' l r I I S t + ................................................... Street A?�7 as shown on the application for Disposal Works Construction Permit No _ _________ _ Dated..... (.....--7......... �- �- th DATE......._-- ----f-•-- •--•--- . FORM 36508 HOBBS&WARREN.INC.,PUBLISHERS 1 f SOIL EVALUATOR&PERCOLATION TEST FORMS' Town of Barnstable Page 1 of 4 BA NSTABLE' ` Department of Health, Safety, and Environmental Services 9�A i639. tEo, , Public Health Division 367 Main Street,Hyannis MA 02601 Office: 508-790-6265 FAX: 508-775-3344 Soil Sultah&ty Assessment for Sewage D ' osal NO. A- "-Y �. Dater' Yec Date: ^"1 �"��� Performed By: ' �!p✓ &tztw'/U Witnessed By: 'ram aA1Z-" C30 H Location Address -If- Je 4ACI1 Owner's Name y,/Asd .�! 11.���'�ar 7 �'s✓ i✓ Lot#: LdT-O- c:D2 LC-f —5075) Address,and i oz446 Assessor's Map/Parcel: f Telephone# y Z 13 4-7 35 NEW CONSTRUCTION LL REPAIR Office Review Published Soil Survey Available: No Yes Year Published Publication Scale :75'000 Soil map unit 6�C.75 Drainage Class Soil Limitations Surficial Geological Report Available: No Yes Year Published Publication Scale Geologic Material(Map Unit) Landform kM Flood Insurance Rate Map: / Above 500 year flood boundary No Yes ✓ Within 500 year boundary No Yes Within 100 year flood boundary No Yes Wetland Area: National Wetland Inventory Map(map unit) Wetlands Conservancy Program Map(map unit) Current Water Resource Conditions(USGS):Yonth Range: Above Normal Normal Below Normal Other References Reviewed: DEP APPROVED FORM-12/07/95 FORM 11 - SOIL EVALUATOR FORM Page 2of3 Location Address or Lot tgo.A'MF, 04-7 / 0-73 On-site Review Deep Hole Number T")_ Date:. 6 g(`16 Time: DAM Weather 75 r, . cwY Location (identify on site plan) 5 .1 .:._ MED. . Land Use Slope M p-SV Surface Stones rroNV Vegetation WOObED Landform 0VTW^51t PLA11 Position on landscape (sketch on the back) Distances from: Open Water Body feet Drainage way feet Possible Wet Area feet Property Line feet Drinking Water Well feet Other DEEP OBSERVATION HOLE LOG* r -Tol- }}off irLf--v. Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface (Inches) (USDA) (Munsell) Mottling (Structure,Stones,Boulders,Consistency, 'fb Gravel L_S -75r,1,5/1 — LA-Z 6 L_S )OYF-4/4 2 6 - 51 C- s�� )0yfl, -- so.ha '_I i UDIES REQUIREDc R _ L AREA Parent Material (geologic) DepthtoSedrock: Death to Groundwater: Standing Water in the Hole: Weeping from Pit Face:_ Estimated Seasonal High.Ground Water: e 1. 5L ,-79 —4L P,�'"3 f t') Dk:P APPRO%TED FORM-12107/95 f FORM 11 - SOIL EVALUATOR FORM Page 2 of } 7 10 Location Address or Lot No. G� M 09 �73 N On-site Review Time: ..o RM Weather -75°Fj L� Deep Hole Number—T-9 Z Date:... , Location (identify on site plan) ° 1 Surface`Stones ` (V 0 N G" Land Use Woo D61U: 1 Slope ( /0) O- rj c t= y/ Vegetation ,..(? ES t►�.. Landform .:.... Position on landscape (sketch on the back) % Distances from: feet Drainage way Open Water Body feet Possible Wet Area feet Property Line .. . . ..... Drinking Water Well . feet Other ....::....:::....:.::.:.:.:.::.::. + DEEP OBSERVATION HOLE Loa 1(615 SEr ) 14 oue 11'':t 'i'otfl8r Soil Depth from Soil Horizon Soil Texture Miunselloll Mottling (Structure,Stones,G avleljrs, Consistency, °� Surface(Inches) O (�f`e�y.N L) Go•urk 3�/o ssi�T(L}1�/�l� a T 5 qr�r�Sil?- 2.5 I1Z Zav�d. �, yy-F if t"1?ii' I tilt 4! •s,:St} viz if 1 Id a r� t pp 1:C.irEt'f. I _ Depttttoaedrock: Parent Material(geologic) Weeping from Pit Face: — De9th to Groundwater: Standing Water in the Hole: Estimated Seasonal High Ground Water: C'l° 5G,14 DEP APPROVED FORM-11/07/9S , I FORM 11 - SOIL EVALUATOR FORM Page 2 of 3 Location Address or Lot fqo. A55, MP. 0'-1-1D-1'S l�R��''� On-site Review Deep Hole Number I+cLE' Date:.G ! G Time: 6 PM Weather $��r� 5VAI Location (identify on site plan) - Land Use (L(aS 00EN(.E Slope 0-rj°b Surface Stones rretiG Vegetation Gvoo'DE� Landform 0u7w Pry)i — -4\N Position on landscape (sketch on the back) Distances from: Open Water Body feet Drainage way feet Possible Wet Area feet Property Line feet Drinking Water Well feet Other DEEP OBSERVATION HOLE LOG* a �• -my- Avg il+oz CL.Ev. = 6414 Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface (Inches) (USDA) (Munsell) Mottling (Structure,Stones,Boulders,Consistency, go Gravel) 0—Z 0-5av%�C. 5�)fi — �G�rr G' Goore 2,57M16/ 5a rd , y -b t;vs� 75 l t'3,5 wa��r env. = 51+y4 i � �iR rs Parent Material (geologic) DepthtoSedrock: V. a«r it - Death to Groundvveter: Standing Water in the Hole: 62- Weeping from Pit Face: Estimated Seasonal High Ground Water: 1)£P APFRO\'ED FOIZ4 f-t 7/ c 20 4 f i FORM 11 - SOIL EVALUATOR FORM Page 3 of 4 LocAtion Address or Lot No. A% Mt-' CH-7 ,� o-7 Determination -for Seasonal High Water Table Method Used: 21 Depth observed standing in observation hole...... inches ❑ Depth weeping from side of observation hole..... .. inches '® Depth to soil mottles `18.A..: inches ElGround water adjustment ................... feet 56 HH ZONE 'v Index Well Number�.2 53 Reading Date Index well level ......... rR l Adjustment factor ....S,.o..� Adjusted ground water level .... :...... et`v.. ` .'`�y BSc -t^015 t-6S C `18'LA" (e). S56-14 Depth of Naturallv Occurring Pervious Material Does- at least four feet of naturally occurring pervious material exist in all areas observed throughout the area proposed for the soil absorption system? YE S If not, what is the depth of naturally occurring pervious material? Certification I certify that on lQQV 'I (date) I have passed the soil evaluator examination approved by the Department of Environmental Protection and that the above analysis was performed by me consistent with the required training, expertise and experience described in 310 CMR 1 15.017. • } ' � `' Signature Date DEP APPROVED FORM•12/07/95 n c� Q A\JWz- TIC I _q `7o L le� �n-,SI V5 tiT TIi2 P LI- �� — --� P(,t-• '73 yo T�..n Locuin is L ' FORM 12 - PERCOLATION TEST Page 4 of 4 Location Address or Lot No. A OW ?C-L 0�3 COMMONWEALTH OF MASSACHUSETTS Massachusetts Percolation Test' Date: Time:, .....l o..8.M.. Observation Hole # , Depth of Perc —V C 5_7 Start Pre-soak ` 0 End Pre-soak ; Z-7 Time at 12" Time at 9" Time at 6" M)N Time (9"-6") Rate Min./Inch Minimum of 1 percolation test must be performed it both the priniary area ,AND reserve area. Site Passed 0 Site Failed ❑ Performed By: i--*)A N t C-L- 0-SA A Witnessed By: Comments: ...::.:.. .::::: DEP APPROVED FORM-12WI95