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HomeMy WebLinkAbout0009 WATERSHED WAY - Health 9 watershed Tay Marstons Mills Y A= 059 - 007 -016 J 01- S9 / Commonwealth of Massachusetts ? Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments cwM s 9 Watershed Way os . p Property Address /�� D Kenneth Denham Vll Owner Owner's Name information is required for Marstons Mills MA 02648 04/25/08 every page. City/Town- State -Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Important:Whenfilling out A. General Information When forms on he a computer,use { 4'y 1 only the tab key . Inspector: i z V to move your Michael Kellett # , cursor-do not Name of Inspector ,I r u' use the return �" 7 F�f key. Aardvark Environmental Inspections Company Names rl; P.O. Box 896 Company Address East Dennis MA 02641 ;�; M 0f1 Cityrrown State Zip Code 508-385-7608 S13742 Telephone Number License Number B. Certification 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 the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. 1 am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority f k"to-� 04/28/08 Inspector's Si ure 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. fail•08M Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form-Not for Voluntary Assessments u ,••'�• 9 Watershed Way Property Address Kenneth Denham Owner Owner's Name information is required for Marstons Miils MA 02648 04/25/08 every 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: ® 1 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. Answer yes, no or not determined (Y, N, ND) in the ❑ 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. ND Explain: ❑ 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 ❑ obstruction is removed fail•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 9 Watershed Way Property Address Kenneth Denham Owner Owner's Name information is Marstons Mills MA 02648 04/25/08 required for i every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes (cont.): ❑ distribution box is leveled or replaced ND Explain: ❑ 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 ❑ obstruction is removed ND Explain: 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 15.3O3(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 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. fail•o8m Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 3 of 15 l Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 9 Watershed Way Property Address Kenneth Denham Owner Owner's Name information is required for Marstons Mills MA 02648 04/25/08 every page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) C) Further Evaluation is Required by the Board of Health (cont.): ❑ 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 '/2 day flow ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. fail•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 15 i — � Commonwealth of Massachusetts F Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 9 Watershed Way Property Address Kenneth Denham Owner Owner's Name information is required for Marstons Mills MA 02648 04/25/08 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) D) System Failure Criteria Applicable to All Systems (cont.): Yes No ❑ ® 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 CMR 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 16,000 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 ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA) or a mapped Zone II 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. fail•o8w Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 15 Commonwealth of Massachusetts _ W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments .'° 9 Watershed Way Property Address Kenneth Denham Owner Owners Name information is required for Marstons Mills MA 02648 04/25/08 every page. Cityfrown 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)] fail-08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments 9 Watershed Way Property Address Kenneth Denham Owner Owner's Name information is Marstons Mills MA 02648 04/25/08 required for every page. City/Town State Zip Code Date of Inspection 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 2 Number of current residents_ Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes Z No Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available(last 2 years usage (gpd)): Sump pump? ❑ Yes ® No current Last date of occupancy: Date Commercial/Industrial 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: Last date of occupancy/use: Date Other(describe): fail•08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 15 f ' Commonwealth of Massachusetts . Title 5 Official Inspection Form si Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 9 Watershed Way Property Address Kenneth Denham Owner Owner's Name information is required for Marstons Mills MA 02648 04/25/08 every page. Citylrown State Zip Code Date of Inspection D. System Information cont. Y (cont.) 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) ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): Approximate age of all components, date installed (if known)and source of information: 06/05 Were sewage odors detected when arriving at the site? ❑ Yes ® No Lfz fail•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 15 commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 9 Watershed Way Property Address Kenneth Denham Owner Owner's Name information is required for Marstons Mills MA 02648 04/25/08 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Building Sewer(locate on site plan).- Depth below grade: 1.5 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: .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: 1000 gal Sludge depth: 2 Distance from top of sludge to bottom of outlet tee or baffle 30" Scum thickness 2" Distance from top of scum to top of outlet tee or baffle 5" Distance from bottom of scum to bottom of outlet tee or baffle 16" How were dimensions determined? measured fail•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 15 V Commonwealth of Massachusetts Title 5 Official Inspection Fora Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 9 Watershed Way Property Address Kenneth Denham Owner Owner's Name information is required for Marstons Mills MA 02648 04/25/08 every page. Cityfrown 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.): 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 Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): li 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): fail•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 4"M V>y`e� 9 Watershed Way Property Address Kenneth Denham Owner Owner's Name information is required for Marstons Mills MA 02648 04/25/08 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Tight or Holding Tank(cont.) 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 pumpingcontract(required). Is co attached? ❑ Yes ❑ No ) PY I� 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 fail•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 15 Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments w, 9 Watershed Way Property Address Kenneth Denham Owner Owner's Name information is required for Marstons Mills MA 02648 04/25/08 every page. CityfTown State Zip Code Date of Inspection D. System Information (cont.) 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: Type: ❑ leaching pits number: ❑ leaching chambers number: ® leaching galleries number: 3 ❑ 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 3 500 gallon drywells surrounded by 4 feet of stone. There was 3"of liquid in the bottom of chambers. fail-o8/o8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 15 i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 9 Watershed Way Property Address Kenneth Denham Owner Owner's Name information is required for Marstons Mills MA 02648 04/25/08 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 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 ❑ No 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.): fail•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments w 9 Watershed Way Property Address Kenneth Denham Owner Owner's Name information is required for Marstons Mills MA 02648 04/25/08 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. vi a� o fail-08/05 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 15 p Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 9 Watershed Way Property Address Kenneth Denham Owner Owner's Name information is required for Marstons Mills MA 02648 04/25/08 every page. Cltyfrown State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope ❑ Surface water ® Check cellar ❑ Shallow wells Estimated depth to ground water: 20 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: USGS maps show an elevation of over 20 feet fail•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 15 Town of Barnstable Of VE rO�Y Regulatory Services , ,SrAsM ; Thomas F. Geiler,Director MARK � 9`b i63� Public Health.Division Thomas McKean, Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 This septic system inspection report was completed by a private inspector who is certified by the State of Massachusetts,Department of Environmental Protection. Although the Town of Barnstable Health Division received the original/copy of this report; this Division does not warranty the functionality of the septic system in the future nor does this Division agree with any technical observation s and interpretations contained within this report. In addition,by receiving this report the Town of Barnstable Health Division does not automatically approve the number of bedrooms listed within this report. The actual number of bedrooms approved at a particular property would-be listed on the"Disposal Work Construction Permit". If you.should have any questions regarding this report,please contact the certified Septic System Inspector who conducted the inspection. TOWN OF BARNSTABLE LOCATION v- SEWAGE # 4 VILLAGE ///i//S ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. ,1041 �. �orr��rcr./MAA 5la SEPTIC TANK CAPACITY i.DoB 67C. 11 L LEACHING FACILITY: (type) 57J0 42e,1 elfa y6•►) 42) (size) /f/;t/o NO.OF BEDROOMS BUILDER OR OWNER Ary PERMITDATE: 6-3D"-ar COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility 'L 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 fee, f leaching facility) Feet Furnished by ;�urrrti � 1 No. � Fee ` THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: A � PUBLIC HEALTH DIVISION, -TOWN OF BARNSTABLE, MASSACHUSETTS Yes ZIpplication for 33ioponY *pttem C ongtruction Permit Application for a Permit to Construct( , )Repair( ✓)Upgrade( )Abandon( ) ❑Complete System "In vidual Components Location Address or Lot No. +V Owner's Name,Address and T 1.No. Assessor's Ma /PazceI e� .0 ,( Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. 36Z —Z ZZ Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( 4/4) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures A Design Flow gallons per day. Calculated daily flow J �40' G gallons.,,Oe/�� Plan Date Number of sheets evision Date Title $_ e&14' 45 41? Size of Septic Tank D n r Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued by is oar f�Ith. Si ne Date Application Approved by Date Application Disapproved for the following reasons Permit No. 0 C1 Date Issued � No. _ Fee dad THE EMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC'HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Application for Mizoogal *p!5tem Construction Permit r a Application for a Permit to Construct( . )Repair( ")Upgrade( )Abandon( ) ❑Complete System E!1 Individual Components. 9 Location Address or Lot No. 9 �(�� � f�y Owner's Name,Address and Tel. No. Ass�sso`r>'s Map/P�rce� �,Jr fGrjp�✓c �//�/s / Ke� _NOV-"f�(/. 1� Installer,'s Name,Address,and Tel. Designer's Name,Address and Tel.No. Type of Building: Dwelling No.of Bedrooms 3 Lot Size sq.ft. Garbage Grinder( ��d Other Type of Building Kf a 14VeCL'No.of Persons Showers( ) Cafeteria( ) Other Fixtures 2 Design Flow �✓ D gallons per day. Calculated daily flow gallons.,A ?/' �� Plan Date Number of sheets Revision Date Title 4w `� 5 iaGf ec y Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued b his$oard­of Iealth. Signe, Date ,6 0 Application Approved by Date Application Disapproved for the following reasons Permit No. 9W5 3 0`5' Date Issued Q5 THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On site Sewage Disposal System Constructed( )Repaired (!�)Upgraded( ) Abandoned G )by, �G��r Oy5 ' at wGr&7V,-2fi ZVI w Y 5 O'�5 / has been constructed in accord,4ncce with the provi ns�f_T,i e 5yd the for Disposal System Construction Permit No. s dated K Installer '�'�' �t/ Designer The issuance of this permits 1 not 'e construed as a guarantee that the system will`furtati, as hsigned. Date t Inspector- - ll�\��d�►1J""'�— No.� -------------------------Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS Migo�ar *pgte✓on�truction permit Permission is hereby grted � t �(/) parr( , grade ©�� %��5 System located at 3 G �(/ _ Y 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:Constructtiodmust be completed within three years of the d to of this 11. Date: �\J (3 PP 0 �� A roved b y _ 9/16/03 Notice: This Form Is To Be Used For the Repair Of Failed Septic Systems Only PERCOLATION TEST AND SOIL EVALUATION EXEMPTION FORM M Mpg e plan signed b I, �il. ✓1 hereby certify that the engineered p gn y me dated '"wb 00 concerning the property located at meets.. all of the. --� following criteria: • This failed system is connected to a residential dwelling only. Theree are no commercial or business uses associated with the dwelling. • The.soil is.classified as CLASS I and the percolation rate is less than or equal to 5 minutes per inch. The applicant may use historical data to conclude this fact or may conduct deep test holes and percolation tests at the site without a health agent present. • There is no increase in flow and/or change in use proposed -- • There are no variances requested or needed. i • The.bottom of the proposed leaching facility will be located no less than fiv:efeet above the .. t table elevation. [Adjust the groundwater table using the. maximum adjusted groundwater b [_ � gr � g � F for method when applicable] �P Pp j ca Please complete the following: o r w A) Top of Ground Surface Elevation(using GIS information) �Q �Q o N 4w B) G.W.Elevation �-EJ� +adjustment for high G.W. _ (� /�' DIFFE E EN A and B SIGNED i DATE: S ZU NOTICE Based upon the above information;a repair permit will be issued for bedrooms maximum. No additional bedrooms are authorized in the future without engineered septic system plans. 4=1S eP• �P ercex the doc v �0 � ® / �P• Town of Barnstable W. r° y Regulatory Services ,' o* 4P Thomas F. Geiler,Director Y Y BARNSTABLE. • cb0.1 .®tea Public Health Division arp `'�' Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office:.508-862-4644 Fax: 508-790-6304 Installer & Designer Certification Form Date: 0 d S MtJt,(_ Designer: ' Installer: 0� �� 6W1t4C'1"9) O Address: E0 l Address: On was issued a permit to install a (date) �j � ) ((installer) �! septic system at -! Wa (54 /�jj' �"l/�,/'/ based on a design drawn by Af (address)1 a rwAky' dated (designer) XI, certify that the septic system referenced above was installed substantially according to the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. I certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system)but in accordance with State &Local Regulations. Plan revision or certified as-built by designer to follow. 9c DARREN ti 0 0 M1 E (Install ignature) N 1 �Fc TERM J gMITAR\P� � 3 esigner's $ignature) (Affix Designer's Stamp Here) PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS- BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. Q:Health/Septic/Designer Certification Form y C E. 0 GA T 10N d-A - o SE W A G E PERMIT NO. PILLAGE �G - 0D� INSTALLER'S NAME i ADDRESS -BUILDER OR OWNER DATE PERMIT ISSUED 3o 7 DATE COMPLIANCE ISSUED �� 3 'p- 6TO THE COMMONWEALTH OF MASSACHUSETTS SOAR® OF, HEALTH ..........O F...... .. .. ...........................Allp r ! Iir�ation fur Dhipoii al vrkti Tomitrurtion VarAft Application is hereby ma e f t onstruct ( ) or Repair ( ) an Individual Sewage Disposal Systems at: ...............•••---....._..._....-•--L- . ....... ........................................ , i Location-Add ss pr Lot No \ Owner i Address W �................ .................. . .. •--- 2 -••••-• •-- .............. ... r Install I Address / d Type of Buil ng w Size Lot...........______ ________Sq.`feet l. c. a, Dwelling—No. of Bedrooms.......1_.�________________________•Expansion Attic ( ) Garbage Grinder 3 p,, Other—Type of Building ____________________________ No. of persons..................._------- Showers ( ) — Cafeteria ( ) Q' Other fixtures ________. ------------------ W Design Flow-_ �_.,�___... gallons per person per day. Total daily flow...... ___...__ gallo ns. . `S®d Septic Tank Li. capacity?gip-gallons Length................ Width........_------- Diameter________________ Depth______ 'Disposal Trench No_____________________ Width....10.......... Total Length.:___6_.______.__ Total leaching area__-6.6.....sq. ft. ' Seepage Pit No:..... --------- Diameter____________________ Depth below inlet........... __._. Totallea 44v_chig area...._:............sq. ft. Z' . Other�Di�stribution box ( � ) Dosing tank �� / ~' Percolation.Test Results Performed by.. _-__- r_______________________________ Date,_.�z_........... .7..._.__.._. a - ,� Test Pif`No. 1_. --._.minutes per inch Depth of Test Pit____________________ Depth to ground water........................ • 1 44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water!....................... ---------------- O Descriptio of Soil 0_—.2.'...r�_ . `fit'.`r`� = _ „ W ••-•••• •••--•-•••.• ....-•-•- UNature of Repairs or Alterations—Answer when applicable.................................................................................................. .......................................................... f The undersigned agrees to install the aforedescribed Individual Sewage,Disposal System in accordance with the provisions of TITLE 5 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. lgn .ed �� yD--a--t-e- ------••--S D ----•----- - -APPlka'tion Approved BY------- '/ed ..... . � - r------•------ __'" to Application Disapproved for the,f ollowing reasons:................................................................................................................ --••-•---•-------•--•--•--•-----•--•-------------•-----------.._...------•----------........----------••-..----------:---------------------•----•----- ---------------------------------------•••-•-•--- Date PermitNo......................................................... Issued-----•---•--..-••-- -------- Date X. ............. Fms. t THE COMMONWEALTH OF MASSACHUSETTS BOARD F- HEALTH ......... ...........OF...... w, ApplirFatiun for Uhipaii al Works Tunitrurtiun ramit �w t Application is hereby made for a Permit to Construct ( ) or Repair ( );+fan Individual Sewage Disposal S.....s.t. at: ' + / e.v -e �........ ---......s A✓c.............r-A......�� rrc ........Q.___---- ____---________-----____----------l --_.........._..... Location- dd ess or Lot No A ......�Zvue �... QX............................... •_..R � 2 ..... �� n.a..✓. OWner 1 Address ................--•..... ...........•••-•.. .....•--.................-•-•._................-•-------•-•-•---- �" Install Address Type of Buil ng Sq. feet Size Lot--------------------•••-- aDwelling—No, of Bedrooms.......!'.................................Expansion Attic ( ) Garbage Grinder p, Other—Type of Building ____________________________ No. of persons............................ Showers ( ) — Cafeteria ( ) Otherfixtures ...........................:......................................... ::............................................................................. W Design Flow____. ________________________gallons per person per day. Total daily flow...... __ .___ ....................gallons. G4 Septic Tank/-Liquid capacity4d _gallons Length ______________ Width______________. Diameter................ Depth................ Disposal Trench-No_................ Width___�d.......... Tota1.L-ength.__._.as.__.________ Total leaching area_.AA+>r(t_____sq. ft. Seepage Pit No------O........... Diameter........... :.:....Depth below inlet.............. .. ota leach% area..................sq. ft. Z Other Distribution box (� ) Dosing to -( ), �' C 7. 77 Percolation Test Result Performed b J •''_"_______________________________ Date... _ .7. ___ y Ll.�S,dE 7••-•---•--- `� Test Pit No. 1_ �:---minutes per inch Depth of Test Pit____________________ Depth to ground water------------------------ G14 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 04 10. ............................................................. --------------•• ----------- O Descripti of Spil G �� ..!x�!�►�-l. kl+��h_-.=�i a�i��r'r!f ._... j1 V . '�` - .C.�` C-_044t_ ------------------------------------------------- ------------------------ ------------------•-••-------- s W ------------------------- --•---•-•-- -----------------------:---------------_...----------------------------------------------,;..---------------------------------------------------------..._._...---- UNature of Repairs or Alterations—Answer when applicable_______________________________________________________________________________________________ ti Agreement: The undersigned agrees to install the.:aforedescribed Individual Sewage Disposal System in accordance with the provisions of ilTl.; 5 of the State Sanitary Code— The undersigned furtlier agrees not to place the system in operation until-a Certificate of-Compliance has been issued by the board of health. Signed.. ---• •-•• ----•---•-•-----••----------•--- �...._... --••---••- -------------- ---------•- A /� -------------Approved _.__._..___-�_-�_ ...____ _._____. Application Date.............. Application Disapproved for the following reasons_................................................ ------•-••--------•-•••---•--•-•-•--' .........................................-----------------------------------------------------------------••-----•--•--•-••-------•••--•-•-•-•--•••-•--••--•-------------•-----•----- ----------------- Date PermitNo......................................................... Issued...................................................... Date i THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH , .........OF.. ! ( s ......................... , (Irrfifiratr of Tautp iFaatrr ��.�- ,q TO CERT , That the Individual Sewage Disposal System constructed (/#') or Repaired ( ) • Installer �-' �!X' - -----� --•- has been installed in accordance wrtli the provisions of f T j of The State Sanitary Code a described in the application for Disposal Works Construction Permit N .__...-.____._���_ _ dated:_ " `- ` .•---•--------•--- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEP;�I�WILL FUNCTION SATISFACTORY..�� E�� .� DATE ! �Q "»� w _ .M y'� minspector 0-C ............................. . 4 }f T�l••�rt R •,rn L� 1 'f: p"�r ?,�''�"4`w "� �,R. 71' f' r�I ^^ �iY 4 *��4�wS •r�yk Y 6 1z '+(.:;jrN (-,ky�f'�... - THE COMMONWEALTH OF"MASSACHUSETTS BOARD OF: HEALTH "' it1...........OF........_.. `. ......`'t '� ?..Y ...................................... — No._.......'�f� .." FEE........................ Mops urkii TDu nr#ivat permit µ. Permission %�reby granted-:�--••- a ..... ------•-••-• ..................................... Cons uct ( or R air ( ) an I dividu Sewage iVpos Syrtem at No.. �1;-�`1f G ,c? � _.. r'•1 ,« it .- -•---------------------------------------•--------------•--------.... 4.» Street as show on fhe application for Disposal Works Construction Per`'%t N � �F ,��-✓ ------ Dated---1� ..1.�------------------•---...... y% Board of alth DATE....-• . .._ ....................................... r ✓"��v V %�/ Leo FORM 1255 HOBBS & WARREN,.INC., PUBLISHERS "' ' +ry f:CI'� �9id:,. ; S..'.: .--z� r �+.� a al.,—'— ..F..v-.1, '—_. �•rf yt �,�d -�� n.,+ � ._ _.�.—r�. k:pl„w. ��� �ij: ! '�� �I � .:.-a f.,� ° k4 '.4 z..,' ! �,.� . - 'x kr - '!e'.r r •e• . �*!� yl`ae r k #-' ''� ,. f r M1a." rx f l: 5;.. �S'.t•-s'r {�> s }t...x e�, `'° r !^. °' 4 i a � 'r; '1. �♦ �a,`' � 7 „ - rut f f.. J �., b.�'¢' � ' � _` r � �P3 !�ea < ai `.'e, `i O�/ (/''/'� t x'"n �' t 1: k t pr J• ! 4- y/��� row, y ' k s<,� a h,f'•. ik e t o,rF'.' �^ O• v d.' '� •+ Y ., 7 c d`/ �.S.S. e %-� ,�f •F'�l �i�' � i, k - „ � r �,., rf x�y AA Vti V. '�''Y ilrt •J f�. t �07 [ V •,e !f lei. \ Jik,' ts. r .1. ,'• S ,:� - ' Yyy'�� 67,9e.,sl F.• 3 }t p k- ." ` 141 IL 43 f2 `ZV �j ,pc�• +"'� ' a y' �.�5 l f' lk +ep� ti M.4 l}. 'S• e, ,Z-,I o O H `) �� r e, r:"14 pLp Of V k�:4 1q,. �✓I Y � L " 7. a __i,:'- , .. '*TRF l t �r:.:�..•�r•:iG --�•---`—�,,;,. g 1 :rC At, � '' '\ ;sy. .r .s,��c�k' el y a8 r .T^,l � r a r'V' ,9 V' -./�, /•�"'-�-.-.. \ v ' F Y,L- � i, 4;' - �d.'� *� 4 {! !'. "s t, !°jt w}. i__t .. '9P -, �"Q pi rly`" �--. yi • tom{ .':c 4a"n °• %`'; ,� �,�� �" i l "S �'' ,ti "1. „�,r• _y .Ia' .. -:.Y - ' f••.,T nzp "'t� .��i. < P� - LEGEND w.' � tr,•I � +,� .^ >:�+� ry CERTIFIED PLOT PLAN EXtST_ING_ SPOT ELEVATION. Ox0 `'�a 1G 111:f 1 I lr ti C V IU I O u ri - - 'V -• f� � "' _. Ck:.,;/C I V FINISHED 'SPOT ELEVATION P FINISHED CONTOUR ' A\ t r' APPROVED- BOARD OF .HEALTH s� ` _='' �� 2 A 9 h S fA2 4 UArse DATE AGENT ' .. - _ 1E,��1� SCALE: . :/ '40" DATEt'4c 7�72: LDREDGE ENGINEERING CO ING� _ CLIENT M4°ooX I CERTIFY THAT THE PROPOSED EGISTERE REGISTERED JOB NO. 77 L� BUILDING. SHOWN . ON THIS, PLAN CIVIL LAND CONFIRMS TO THE ZONING LA10YS ENGINEER SURVEYOR DR:.BY :' � OF BARN ST 8LE �10A S. h�j-Y 33 NO MAIN ST 712 MAIN ST CH i' S YARMOUTH MASS: HYANNIS MASS. I -- 0 SHEETT'L OF ;DATE, REG. LAND SURVEYOR, lq-e -r,.4,,o V -9 7 ak 77- '71 C000VCMJlr 714r v _7 bi 4 SWA 4 46,6 9 AP4700Y 7-='rO 4,TA 40,eZ _7',leA C& A614 V Y CA S 7- /l?O/V CfO z-L., ak� V S Z—.D wCoRerre Mol L>/?/V,-- ,;OV,4 Y co PleN-s__ % CC)I'll"Erc? C Z 4CA;V eA C.,�.= Z_4 zlw. I-< 4"CAS 2"/AY�Eft -MVAI JP,:17'CY m; P&M D157. , SAffPTIC TA AIM 0 9 elf BOX a v WASAEP S70NE',' � 104E)D7," o too * 0 0 a 4 v 0 0 0 6 DRECA 5 r SA-.A SCA;' 6 p a its!# * a 0 0 1 6 a R17 4OA? 4EQL11V­ AT ZR7 r SZP"rIC 7. 3 r F7 401,4^�.� —LO- c r!SEE TABULATION, -OVJ��7'SZP7*IC 7-ANH 30, 3 =r- BOX O� 7 GROuVo WA7-EW 94E -TEC7-/O.,V 0,4C- Mlrl_,-7-,&157-R4&ur10N Bay-2,7.g-' FT hV4s9-r ASSPACnE A:V 7- 7 f--�L FT ILRACAflIV6 *=/7'- 7A SCALE Y4 0hV=N_Tf6AI A CR 7 EM 1A AO/AIK-M-5 0 NUMBER OF 4&e N511401V "Co F7, GARBAGE DISPOSAL ulov/r -SO/Z- �1-0& r b 7A' Z-i M!r r-,,^IA-r 'TEST - SO/11- 7WSr 6-44.1,OA Y SO/L -7,55 7- #/ S011- 7,-iFS-F#2 NUA18EAP 0-Ir SEAMCA&Z q/7:s 2- fFLEV _T-s i SIDZ Z�-A CA4 1,V6 .49:05,lt AP/7- JV. -7. 37-0 �0A7-Zr0.F- .S0,1j_17'ZS7' — 12-../7-,,./ -7 7, If AV.177Al&5S_-P ay 7? p.A?ay.,A-,i-S 4510r7*0^1 4,64CHIAIC-A:,Ejqt p1r_L_sq. Ar AD-'�'At C 0.4 A 7-10,pv RA ro 0 r,4 4 LEACHING A,T_=A T_ /,V 5rl L' PENCO L.A 77/0 IV RAIrAr A Z 6) ��44 C,R��Vn 2. veq ROBERT V7 BUNIKIS W'A W A > a FN&/VAWAP1,Vrff CC No.a162 L_j,C-4 7- -s W2 'IIV $7. 33 -t H40.MAIN [NYANIV/.3,,N0 *V,4 r&&,ArAICOUm;r," sr G V, A 14) Ma, kV.4 IWToql A 7 dole No. *7SHEET OF Z L7­ LQCATION SEWAGE PERMIT NO. L v f ;r 37 VVLLAGE ul ATa:i2 j'tiod LLA }e7yTD 5 NlIL� i sIHSTALLER'S NAME ADDRESS 12 U I L D E R 0R OWNER j 3P1 rro feoOM5 %off 11 DATE PERMIT ISSUED DATE COMPLIANCE ISSUED I � 3 ' --_- � � � N=-w1- al- THE comMowxvEALr* oFmASsxo*ussTrs | B���� U� U� BOARD " � �m' \ ---' �«���----OF—� � Appliration or Disposal ~ amit Application is hereby adefor u Permitto Construct ~'( ~) or Repair ( ` \ an Individual Sewage Disposal System at: Installer Address ' Type of Building Size Lot Dwelling—No. of Bedrooms_____���_-_-__-- Attic ( ) Grinder ( ) 04 Other—Type of Building ............................ No. cfyecaooa----------.---' Showers ( \ -- Cafeteria ( ) 114 (Jtbcr fixtures ' ----_------_-----_—...-.—_________________. Design per person per day. Total duJv flow.......................... � 04 Septic Tank--Liqui}' lonm Length................ Width................ Diameter................ Depth................ iameter.........t7Z_ Depth below inlet.... .... Total leaching area...ZCS..sq. ft. Z Other uistrioutmobox ( e Dosing � ^ . ^� Percolation Icat Results I,*dbrozcd bv--^_������N��.~,�� �� ----_-- D�e---mPn('Q:�07.... —.� Test Pb No. l--����..00inuteu per inch Depth of Icut Pit.----1-�� Depth tv ground water-.77�---_- � �14 Test Pit No. 2................minutes per inch Depth of Test I`ic-.------_ Depth to ground water........................ .- ---_--_--._'-_-__'__--_-_-- ...................-.............. 0 Descriptionof Soil... � -t—' _-----_..__'--_-__---__--.._-'-'_..__-'-------'--'--'-'--~°~~�.-'~~~~~---'_----_--------'_---'------ � � �� -------------.----_---.--.—'-------_-__-_-------'---_.__'__'-_--_-_--_---_--'-_--' � U Nature of Repairs or Alterations--Answer when applicable............................................................................................... '----'---'---'---'--'------------------------'------------^-------'---'-----------------'---- ' Agreement: The undersigned agrees to install the uforedeaccibcd Individual Sewage Disposal System inaccordance with I THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ...... TOWN..............OF..... .f=.►t rJt 'f !? .. . .....-----...........---......_...----• ApplirFaiion for Disposal Works Tonstrurtiun Frrutit Application is hereby made for a Permit to Construct ( �r Repair { ) an Individual Sewage Disposal System .. .. ....................................... .C _.. .......................... ........•_••• T �.s���:...---��A:.j. ..t t 4M ,.Location address/ "� �,' T_A or Lo�,.,No. •-•-.....-•••........---- ---......_.. .................... ..... •••........_...._..... .................... a v �?(©dd . L • '......................•• ••...... Installer Address dType of Building Size Lot.... ;:a_ ......Sq. feet U Dwelling—No. of Bedrooms.................��......................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria- ( ) Ga Other fixtures ... W Design Flow....................5..�.._ gallons per person per day. Total daily flow.._............_..........�.33..L?...gallons. WSeptic Tank—Liquid capacity..`�2)gallons Length................ Width................ Diameter................ Depth................ x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No.-_--•_`-.-.._-__.. iameter........17Z-... Depth below inlet....-�: �.... Total leaching area...r24-:�..sq. ft. Z Other Distribution box ( Dosinqnk ( ) "" Percolation Test Results Performed by....... a. `C�.-. ..�!...�..t/F........................ Date....... ...i.d.. _ --------- Test Pit No. 1._..�l^':'..minutes per inch Depth of Test Pit.........t-?---^ Depth to ground water.._ 7" ............ Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ •---....-•------------------------••----•---..................................._•-••-••-•••••••..-_.........•----••-••-•••-----•-..........----•-•-•--••----- 0 Description of Soil...........- --. ....••• ------ -•-------- •-----------------•------•-------•--•------------ ...................91'?.r'�- j::� ................................................ ------•-- --••--•----------••-••--------- 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 TITLE 5 of the State Sanitary Code—The undersigned further agrees not to place the system in oper/tiA unti C tificate of Compliance has been issued by the board of health. r Signed... 1. ..�.. - = ...... D to Application Approved By.................... °-�-----------------•--•-•-•------ ------....a.-. y_-�55f..... v Date Application Disapproved for the following reasons:.............................................................................................................._ -----•----•-....-•--••-------•---•----•--•---------•-----•.............•---•-----.............------..........-•---------....--------------...---...---•------------------------•---•-•--•--•----.---•-- Date PermitNo......... ..-.. ----••-•••-•--•..... Issued_....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS ! BOARD OF j�HEALTH �v...............OF.................l .h6.. IT C Tertifiratr of f omplianre j THIS 1 TO CERTIFY, That the Individual Sewage Disposal System constructed ( �orepaired ( ) by... ..Z c� r,c�tJ �i�US .......................................................................................................................... ;� Installer 1 // at....- U. �'' ..... .................� /f .. ...•--••-�-�.`....._�....1l .�a_%s S.. .�.1. �. . •--------- has been installed in accordance with the provisions of TITIE �of The State Sanitary Code as described in the application for Disposal Works Construction Permit No.......If IL-.1. 7.......... dated................................................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRU D AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE................................................................................ .. Inspector... .....d.........._......................................................... THE COMMONWEALTH OF MASSACHUSETTS 4 BOARD OFHEALTH ...............0-Wo............OF......... ..................... No..... FEE...., -5. Disposal/ Vorks Tonstrudion Prrmit Permission is/hereby granted.-•-•--•1(.-�e.t V . N..�?.......r-..��--•�(-..�............................................................................ to Construct (✓) or Repair ( ) an Individual Sewa a Disposal`System at No...... Ll .11 i L f ..� ��... ...._ 7 &.... l:a��------� L ........... Street f as shown on the application for Disposal Works Construction Permit No...8&J3 - Dated.......................................... --•--•--•---•--•--....--•-------------------------------•-----------•-...........------....••-•••.•---._ DATE...............r— FY -•• � Board of Health 13- --•-- -------------------------------••-•--••------•---•- FORM 1255 HOBBS & WARREN. INC.. 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I - Lf t - -- -- f- , , - - -'- 1 1 _ ,,u'.. w i ASSESSORS MAP : NOTES: TEST HOLE. LOGS PARCEL : ��I bl� 1) THE INSTALLATION MUST BE IN SUBSTANTIAL COMPLIANCE WITH FLOOD ZONE: LION RkIAW SOIL EVALUATOR:1)•mN,t.+' QS• 656 THIS PLAN, BOARD OF HEALTH REGULATIONS.1995MAR TOWN OF 4 WITNESS : Nor U1"�0 ��j� 1nr�� REFERENCE:BK- Wi DATE: Mau aI ZOOS 2) THE INSTALLER SHALL VERIFY THE LOCATION OF UTILITIES, PERCOLAT ON RATE:: G N►I+J _ SEWER INVERTS AND SEPTIC COMPONENTS PRIOR TO ' a RSS S 7l 1.e7 I✓Ti�-0,_7 4 q p ��ly INSTALLATION. SIjEr TH- I EL: 90,04 TH-2 . 3) THIS PLAN SHALL BE USED FOR SEPTIC SYSTEM INSTALLATION ,p-G� Or— �NO �j > i ONLY, AND SHALL NOT BE USED FOR PROPERTY LINE �.♦ ♦t f �ILL_ DETERMINATION. ♦ i7j I 4) ALL PIPING TO BE 4" SCHEDULE 40 @ 1/8 "/ FOOT. (UNLESS A aAJM w SPECIFIED OTHERWISE) LOCATION MAPe ms) 5)29n nH N THE DESIGN OF THIS SYSTEM DOES NOT ALLOW FOR THE USE OF A p Low 1*ys A GARBAGE DISPOSAL. b4,' ��•�� 6) SEPTIC TANKS AND DISTRIBUTION BOXES (WHEN INSTALLED) BENCH MARK (' tVN► MUST BE PLACED ON A MECHANICALLY COMPACTED BASE OR ON A BASE OF 6"OF CRUSHED_STONE. TOP OF WATER GATE S 2 b = GZ 30 7 E /�Ti N� ELEVATION - 70.92 � —�-- � \ � T BARNSTABLE GIS DATUM � $" T 3 'r —Gfl 3y 9 P �i , - v✓ 1 WATER' � \ �\ N0 (/V-B�jE�v 6LC _ .� �_v _. GATE \ Fp I � --- /'F e f SEPTIC SYSTEM DESIGN L6"O� TO (o3•$y ar�-Tb _ _C-r-..� c FLOW ESTIMATE MATE q• -NO t�.INvwJ Q PVATa_weLt, W W 15 OF t� Z � �' _ "� LOT 16 �\ v BEDROOMS AT IIO GAL/DAY/BEDROOM 'J?JD GAL/DAY 10• D We+ d Of e/ AREA - 13582 s{ +- \ � 1_ h S��►�J-��___1P— r SEPTIC TANK 11.) 40 VA14 tNte5- ft0M 17 T-e V p{L -J?lwAl a F- 13,A)W5. _ � 33+0 GAL/DAY x 2 DAYS VP GAL us nv 0 1214 1e- 1�. 1.8_ m It eo foe- ENG. ioiol ezcl. - p E ( 0 GALLON SEPTIC C TANK- "aL vv / Sov 6a11�� F o F S F- n� k- Fp'1LE F », DXtAkQEo /ST ,� / •% SOIL AE�SORPT I ON SYSTEM 0-f- _ \ _ N , (Ft,�</r�G ��au nN JVG Ld { C - �3 'cNoN �F� � ` tf f I d t-2�+•!�c!- b t-G 11 �-k 0.7 :. SIDE AREA. EX �� BOTTOM:.AREA 14-x 10 4- lox 46 222 4a 6 PI) - 340 - .® 22�, Ys �E PSM NT SEPTIC SYSTEM SECTION > 33oGp� r 'd \ 72 �E7 L. 3-(o 7476 Tb F �r 011(tjpr!7) / 74 jr"' 504Nj COVfkS TD W11,j ,¢ 9 76 ' 124 {t IA Id Ihs11 +7 „s B0{fk 70.22 � S n Q Q C1 � N 72 7 Cyq3 �� 8•� I D GAL -7O lo. D-BOX fo 1, l� t WafLr frsf 2s �1 Cl L �G,2!r - SEPTIC TANK l �� �'C,��n�S1 • 3 '' I '' Ex sn 4 bg.3 � /�--I � Dwi�- 1.2s, v m shed tom-- 6 91 o o For" o� ?�STtto L� C S 1, 34 10 i r 16 SITE AND SEWAGE PLAN ' O 3 / ', ���yZH OF M S 37s 14' D " LOCAT ION : 9 WATE-i2G/ vJA(10 YER N /tn�Z�7T�/V�l <✓��7 No. 1140 2 to �•�5 '�F��STE��o PREPARED FOR : kNf\1cT+--pENh1A1fv1 . '94NITAR\Pa d SCALE: 1 - a DARREN M. MEYER, R.S. —�— o DATE: MK P.O. BOX 981 EAST SANDWICH, MA 02537 DATE HEALTH AGENT Ph: (508) 362-2922 W A k f