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0099 WATERSHED WAY - Health
3 99 Waters k ed Way Marstons Mills --- --_-- - - A= 059-904 Commonwealth of Massachusetts 009—00 Title 5 Official Inspection Form e II Subsurface Sewage Disposal System Form -Not for Voluntary Assessments - -, G 4...� Property Address r} Owner Owner's NameWA information is required for every rs �s 30 rs page. City/Town State Zip Code Date o Inspe ion h 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 A. Inspector ation �� 35b/ filling out forms / on the computer, O /1��il use only the tab tl' ! /// key to move your Name of Inspector �---- cursor-do not F101t o ! �� use the return Company Name /l Q key. /0Q Company Address a�A a I Val I City/Tow /►� 1100 9V State `_vo Zip Code r� J+ 0L Yv (�G Telephone Number License Number B. Certification I certify that: I am a DEP approved system inspector in full compliance with Section 15.340 of Title 5 (310 CMR 15.000); 1 have personally inspected the sewage disposal system at the property address listed above;the information reported below is true, accurate and complete as of the time of my inspection; and the inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems.After conducting this inspection I have determined that t�Passes 1. 2. ❑ Conditionally Passes 3. ❑ Needs Further Evaluation by the Local Approving Authority 4. ❑ Fails 0 /7 111 .3611 g - - Inspector's fignature 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 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 form should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. Please note: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. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 99 G✓ 4 tolG tj Property Address Owner Owners Name information is s AU oa f.y� required for every page. Cityrrown State Zip Code Date of InOectiorf C. Inspection Summary Inspection Summary: Complete 1, 2, 3, or 5 and all of 4 and 6. 1) System ses: 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: 2) . 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): t5insp.doc-rev.7262018 Title 5 Offi cial I Inspection Form:Subsurface Sewage Disposal System•Page 2 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 99 Property Address 11114 H�es Owner Owner's Name AUC444fs ' /� oa 6�$ L1. s information is required for every page. Cityrrown State Zip Code Date of Inipectioh C. Inspection Summary (cont.) 2) System Conditionally Passes (cont.): ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. ❑ 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): 3) 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. a. 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: t5insp.doc-rev.7l M018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 3 of 18 Commonwealth of Massachusetts �d Title 5 Official Inspection Form h Subsurface SewageD9i s osal System Form -Not for Voluntary Assessments 7 6,/A4rvLd G,/G Property Address 11114,le—r Owner Owner's Name information is rs�0 h s ��• s /l,¢. p„i 6 required for every page. Cityffown State Zip Code Date of lnsp6ction C. Inspection Summary (cont.) ❑ 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 b. 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 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 must be attached to this form. c. Other: 4) System Failure Criteria Applicable to All Systems: You must indicate"Yes" or"No"to each of the following for all inspections: Yes No ❑ ckup 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 t5insp.doc•rev.7262018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 18 Commonwealth of Massachusetts �o a Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments Property Address ti4 H,� Owner Owners Name information is a/ Mf141,115 %/i oac�9 �� required for every !L page. City/Town State Zip Code Date of spect n C. Inspection Summary (cont.) 4) System Failure Criteria Applicable to All Systems: (cont.) Yes No ❑ 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 ❑ Ee 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. ❑ ny 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 water supply well. ❑ ny 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 2000 gpd- 10,000 gpd. ❑ 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. 5) 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 CA. 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 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 t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System-Page 5 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 9y 61AR Property Address Owner Owner's Name information is J� required for every JJJ 111���+,V a/►17'!'a page. City/Town State Zip Code Date of In ectio C. Inspection Summary (cont.) If you have answered"yes"to any question in Section C.5 the system is considered a significant threat, or answered"yes"to any question in Section CA above the large system has failed.The owner or operator of any large system considered a significant threat under Section C.5 or failed under Section CA shall upgrade the system in accordance with 310 CMR 15.304.The system owner should contact the appropriate regional office of the Department. 6. You must indicate"yes"or"no"for each of the following for aU inspections: Yes ❑ umping information was provided by the owner, occupant, or Board of Health ❑ Were any of the system components pumped out in the previous two weeks? ❑ as 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)] t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form �9 I Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ��// A s ho� G✓� L Property Address O (it NeS Owner Owner's Name information is A! o4SMlls � ^ 1 /_(�.� required for every VOA Q page. City/Town State Zip Code Date of Ifispecton D. System Information 1. Residential Flow Conditions: 3 Number of bedrooms(design): Number of bedrooms(actual): DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): Description: (0 D 0 &-a,Me 4 AAC _.; 0A', —A 0✓► �0 9 O Co Me CS wl S�Po N p. em Number of current residents: Does residence have a garbage grinder? ❑ Yes No Does residence have a water treatment unit? ❑ Yes No If yes, discharges to: Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes No information in this report.) Laundry system inspected? ❑ Yes R No Seasonal use? ❑ Yes No Water meter readings, if available(last 2 years usage (gpd)): Detail: Sump pump? ❑ Yes No Last date of occupancy: L4 Cr►' Date t5insp.doc-rev.7262018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 18 Commonwealth of Massachusetts �. Title 5 Official Inspection Form F' Subsurface Sewage Disposal System Form -Not for Voluntary Assessments `w 9 tvar4rs��cl c✓at,, Property Address Owner Owner's Name [ 1 L �Q information is ar-Avi s , OOP V�V �/ �0 Q required for every ��11 v page. City/Town State Zip Code Date of lnsp6ction D. System Information (cont.) 2. 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 Water treatment unit present? ❑ Yes ❑ No If yes, discharges to: 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 below): 3. Pumping Records: Source of information: r P� ` OW"` Was system pumped as part of the inspection? ❑ Yes o If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: t5insp.doc-rev.M 2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 18 cam, Commonwealth of Massachusetts �n Title 5 Official Inspection Form �I Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 441 99 14 c, Property Address (itiNl�' Owner Owner's Nam information is �' s A4 required for every A"#415 page. Cityrrown State Zip Code Date of f specti n D. System Infor ation (cont.) 4. Type of S em: 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): Approximate age of all/ L.components, date installed (if known)and source of inf mation: 4 K O Q 1 Mew `.4S _ 02�149 S�a w �' Were sewage odors detected when arriving at the site? ❑ Yes No 5. Building Sewer(locate on site plan): Depth below grade: feet Material of construction: Elcast iron 4�PVC ❑other(explain): / Distance from private water supply well or suction line: / feet Comments(on condition of joints, venting, evidence of leakage, etc.): t5insp.doc-rev.7262018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 18 Commonwealth of Massachusetts �v Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ( 10440n;Lc/ Property Address Owner Owners Nam1jV&1rS4W$1.f /� information is �' �required for every � v page. Cityrrown State Zip Code Date of IrApectioA D. System Information (cont.) 6. Septic Tank(locate on site plan): Depth below grade: feet t)1 Material onstruction: concrete ❑ metal ❑fiberglass ❑ polyethylene ❑other(explain) I If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: S X 6 Sludge depth: 3 Distance from top of sludge to bottom of outlet tee or baffle "� y Scum thickness AT Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle RAI How were dimensions determined? G�e (/ Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): V7 t5insp.doc-rev.MUM Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage D' posal System Form -Not for Voluntary Assessments -u- Property Address iN�es Owner Owner's Na information is 7/11/ek po g required for every �%lVoF J page. CitylTown State Zip Code Date of Insp ction D. System Information (cont.) 7. Grease Trap(locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑other(explain): Dimensions: j 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.): 8. 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 t5insp.doc•rev.M6=18 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form iI; Subsurface Sewage Disposal System Form - of for Voluntary Assessments v Property Address 92 Owner Owner's Name ./ information is "ram / �0 /Q required for every !!! v page. CitylTown State Zip Code Date of Ins ction D. System Information (cont.) 8. Tight or Holding Tank(cont.) 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 9. Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert ��� 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.): sod elf- Z�—.z,.c t5insp.doc-rev.RM2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 18 c Commonwealth of Massachusetts �a Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 2y 6101-�kle tVa Property Address �/ ���� Owner Owner's Name of 1v information is iW 44P required for every c� page. City/Town State Zip Code Date of Ins ectio D. System Information (cont.) 10. 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.): * If pumps or alarms are not in working order, system is a conditional pass. 11. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: Type: Do Cu/TG -f t'-"1.s4t VLe' ❑ leaching pits number: ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: t5insp.doc•rev.7/26l2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 18 Commonwealth of Massachusetts �v Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for oluntary Assessments Property Address Owner Owner's Name information is �required for every ✓�xAells / Q page. Citylrown State Zip Code Date of specs n D. System Information (cont.) 11. Soil Absorption System (SAS) (cont.) Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): �?/M� ANC �� �" �C �✓1 S t p�t,p h �h T. // 1•/ Q N zW a S t� rG L✓ ,43 O c ai 1l4M. 12. 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.): t5insp.doc•rev.7126=18 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System F-or/m_-Not for Voluntary Assessments Property Address Owner Owner's Name/kj uh information is • s A"4- " 4n*/pectiY required for every page. Cityrrown State Zip Code Date D. System Information (cont.) 13. 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.): t5insp.doc-rev.7/2 612 0 1 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 15 of 18 Commonwealth of Massachusetts �n (i-� Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -No for Voluntary Assessments Property Address 4114 ��,�/ Owner Owner's Nam information is Ala"Ov /v lX�required for every page. City/Town State Zip Code Date ofnspedfion D. System Information (cont.) 14. Sketch Of Sewage Disposal System: Provide a view 9f the sewage disposal system, including ties to at least two permanent reference landmarks enchmarks. Locate all wells within 100 feet. Locate where public water supply enters t�bu`ndrg. Check one of the boxes below: sketch in the area below ❑ drawing attached separately A loop.- c'a G•,11 i� 1 3 GlI 4 r 4.'15 C'4 He-Cf 63 - 36.3 a " -4A, Ca - 3 Y•� t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 16 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments Property Address �h es Owner Owner's Name / information is required for every � Ohs ASD� `�f i% page. Cityrrown State Zip Code Date of Insp-96ion D. System Information (cont.) 15. Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to high ground water: 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 ��Checked erved site(abutting property/observation hole within 150 feet of SAS) with local Bo2fd of Health-explain: Xarls ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: You must describe ho you e t blished the high ground water ele tion: Aw C(te QOLo 4,440- ! S' eO4r s -0- � / 4'�/ • S' t s A& o n Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5insp.dec•rev.7262018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 18 Commonwealth of Massachusetts �d Title 5 Official Inspection Form I Subsurface Sewage Disposal System Form -Not for Voluntary Assessments Property Address 144�/,n t0S, Owner Owner's Nam information is na_q�o required for every page. City/Town State Zip Code Date of sped' n E. Report Completeness Checklist Complete all applicable sections of this form inclusive of: A. Inspector Information: Complete all fields in this section. (cation: Signed & Dated and 1, 2, 3, or 4 checked C. Inspection Summary: 1, 2, 3, 5 completed as appropriate ailure Criteria) and 6 (Checklist)completed D. System Information: For 8: Tight/Holding Tank—Pumping contract attached For 14: Sketch of Sewage Disposal System drawn on pg. 16 or attached For 15: Explanation of estimated depth to high groundwater included t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 18 of 18 TOWN OF BARNSTABLE LOCATION-CL SEWAGE -= VILLAGE /-9,1a ASSESSOR'S MAP&PARCEL INSTALLER'S NAME&PHONE NO. V.Z )J g SEPTIC TANK CAPACITY LEACHING FACILITY:(type)4r 0 Ck-aJ, 4o � (size) �idA Y NO.OF BEDROOMS OWNER /C/t/4r/ PERMIT DATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility Of 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 L'Nr/�++wih! �� J/ %�' ?r 6{7�l , o`� �' � ir`s". ,�- . �-�� �N���� ::��Y _ Q W9 609-00� No. U V Fee U� T14E CO MONWEALi'H OF MASSACHUSETTS Entered;ncomputer: PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS Yes 9pphtatlon for MIspoBal 6pstem Construction Permit Application for a Permit to Construct( ) Repair(�/� Upgrade( ) Abandon( ) ❑Complete System Individual Components Location Address or Lot No. ,ems Owner's Name,Address,and Tel.No. ,,. A �`!> . mod' A�essor's Map/Parcel Ins filer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No. Type of Building: Dwelling No.of Bedrooms 9 Lot Size �l sq.ft. Garbage Grinder(A Other Type of Building ,5'/ �f�i(� No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.reguired)) ��,�0 gpd Design flow provided gpd Plan Date 614 L 1p Number of sheets 0. �p Revision Date Title 5 t ® � �s . 41( Size of Septic Tank ®©� �Q�oe� ' ` Type of S.A.S.el ��jr` Description of Soil Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of jFalth. -Si Date Application Approved by Date Application Disapproved by Date for the following reasons Permit No. U — �X Date Issued 6 h2 ✓ --------------.----- --_------------------------------------ QJ •�M / No. � � � Fee lod THE-COMMONWEALTH OF MASSACHUSETTS Entered in computer.' es PUBLIC HEALTH DIVISION -TOWN OF"BARNSTABLE, MASSACHUSETTS Z Jplitation for Disposal 6pstem (Construction 3permit Application for a Permit to Construct( ) Repair* Upgrade( )' Abandon( ) ❑Complete System Individual Components Location Address or Lot No. Owner's Name,Address,and Tel.No. E ssessor's Map/Parcel Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No. Type of Building: Dwelling No.of Bedrooms Lot Size a sq.ft. Garbage Grinder(142 Other Type of Buildings No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 312 gpd Design flow provided 7 �Jr� gpd Plan Date AA AV Number of sheets , �p Revision Date Title -4/ Zer%� ✓J . ll'�' l^�i�i !�.' ►/ lems, IZ/.///5 Size of Septic Tank/Z/_�m r�Q� ,%- Type of S.A.S. Description of Soil 0 Nature of Repairs or Alterations(Answer when applicable) Date last inspected: i Agreement: 4 N 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. P Si - Date Application Approved by Date Application Disapproved by Date for the following reasons Permit No.� U/U — /S Date Issued 7 THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired(411� Upgraded( ) Abandoned( )by O /� at /)' has been constructed in accordance �+'�•�G1/ �/�g i with the provisions of Title 5�arn�d�the for Dispos System Construction Permit No. 2 0(o— /09} dated 6 L-7,2 Installer ?o_ //&� /" Designer zbAe'w erena ' #bedrooms Approved de • flo 3CJ gpd The issuance of is pe it shall not be construed as a guarantee that the system 1 fu t n as desig d. Date 0 Inspector No. �O��� Fee Liu-- THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION- BARNSTABLE,MASSACHUSETTS Disposal *pstem Construction permit Permission is hereby granted to Construct( ) Repair( Upgrade( ) Abandon( ) System located at tT/Qn 'Xrr 5 1�eovl /`,f aif/S 5 and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction must be completed within three years of the date of this permit. Date lApproved by roC i_Il(nod/ k SA'Z, @1Ci17�j`� &,C/", lle'r �0 7 FROM :down cape engineering inc FAX N 9880 Jul. 12 2010 10:03AN P1 1 0 / l" �WU �f` J�}1_a,R Rqudatoyy 'Services Thomas F. Q'r ,ciler, Director 5Ss' �" }lnllTlMk-- 11- e,-,it th Division \~:`�ir6d7 sda � '1'1r1omaR Mcltis.:d."ann,)<9navei`.l;coo" 200 14/$40 Street,Hyaintzii�,1. U 02601 Ofl'acc; 508-862-4644 Fax: 508-790-630d tt allcr e x .fl➢e5> u4 e r6ficylion Form Date: 7 �p Sewage 1'a:u mra.nictf l } De t y.1'er: ( vJn e _ s4",r1 ]1IN'tAler: ICJDr '<�I�' ( il�4 Gr�O►ti .�1ddress: c.,3 �1 . c.J Z`` lvm aL o 1t1 � 1�✓ /_......._ ywa5 issued a permit to install a (date) (installer) septic s�stcml at wot�-*_Ad / based oil a design drawn by (address) (d.csag dr) X__ 1. ccrt;iiy that the, sc:}xic: system.r�cfcrenovd above, Was iraslaalled substalitially according to the dcsrgn, which may .wclude m1nor aapprowd chan;a;es such as lateral rel`t,c.�'ation olf t#tc di.,,.-iodbutiou box ancV r septic I uk., I, certify that the septic system refcre,nced above was histatlied with major c:hatragcs (i.e,- grc tc:r than 10' ht(end reloeatio.ri.of the SAS o.r any vertical ref ocati.o.R o�waxy cumjmnent of th.e septic system) bul in,0.c.cordaricc with. Statc & Local Regulations. Plaai revision or certified as-built by desig.ncr to f-Hiow_ 4 N OF IAOSS 5;7— (in lc-r's Signttlure) DANIFL, A. A JJ A No,40980, (l)csignel.,s y ter s Stamp Here) FIZA.SIE RE'I°A7 N FQ JU_4gNST AIRLE PIT i•,At_11EAL'rH DIVISION. t,T,'R '.R.aj'1C--ATL OF OI®d&'.L1/11'dQ:fN; WTU. NOT BR 1[S51 :➢'l 9.1N[-'Ba, AO.;J<.k�9__Tr1HTS, �(9RAI A�f�D AS-W,-T(,'t' CARD ras.QkE RECEIVED F3y'tHT jjAjkNS'1`.A�BL ll?�.J - t�l�_T�AI',AX"Yli 11�1i�9�F�8i�i,. 7CX3L4,MK�0U.— Q:IieaTth�sLiTtlu�a)e�l�',T}G�("cT'{.1 5011iorl•T.o1711.i-�'6-04.doc �J Town of Barnstable Pit ,>IE P Department of Regulatory Services U naRrlHr+HL e Public Health DiV SnoAl Date a 200 Main Street,Hyannis MA 02601 L y� Date Scheduled_ 6 �� y Tihie 1 1 Fee Pd `oil Suitability Assessme>t tfor Semage Disposal Perronned By: y v AA + "- `+ Witnessed By: lec LOCATION t EEN—'M-A1, ]Cl�?1[+OM,/IL4,Tf ON Locution Address Lj wqA '(1, _ J Owner's Name m/ � 'K�l V� Address Assessor's Map/Parcel: ^ Cugineer's Name l.J ba,Jrn e NEW CONSTRUCTION REPAIR Telephone It e)J 60� I Land Use, �� �''�"-7►�'i L�!_.i` Slopes(%) I Sur(aceStones f"l�� Distances From: Open'Water Body 300 ft Possible Wet Arco >k% It Drinking Water Well ft a Drainage Way ft Property Line fL Oilier f[ � 1 I SJf£Il TCJH' (SLTeeL came,dimensions of lot,exact locations of test holes St perc tests,locate wetlands in pro)ci[Iuly to holes) �L v O r pjts.m J ` Parent material(geologic) LA, Depth to Budrock Depth to Oroundwater: Standing Water in Mole:_ Weeping Imil)I,![Fal!t:e µ/ r Estimated Seasonal High Groundwater 2 �Js'Jt DE TEM/HNATION FOR SEASONAL HIGH WATER TABLE - Me!hed I.Jscd: Depth Observed standing in obs.hole: In. Depth!o s41i tllgtlLSsl „T III Depth to weeping from side of obs.hole: _ In, Grou lid wulet'Adjustment ems_fr. Index Well# Reading Date: index Well level Adl,1'LlCtor„ A�i,OrLAundwutdr UVel ]PERCOLATION TEST Observation I-Iolc# ` Tine at 9" `� N Depth of Perc ��� _ Tlnte al 6" Start Pre-soak Time @ �' _ Time(9"-6") i` End Prc-soak Rate Min./Incli "" W.,W-Ain Site Suitability Assessment; Hite Passed Sits~-Failed: Additional Testing Needed(Y/N) Original; Public Health Division Observation Hole Data To Be Completed on Back----------- ""If percolation test is to be, conducted wit➢lid➢ 100' of wedand, you must fii'sil uiotify the Barnstable Conservation Divisiou at least one (I) wee➢c prior to bega wh..ogo QAS EPTICTISR CPORM.DOC Depth from ID>]C]C][D.OItS ERITA7[ION H6L'E LOG Soil Horizon Hole # Surface(in.) Sail Texlure Soil Color (USDA), Soil Other (Munsell) Mottling (Structure,Stones,Boulders, t( Con isle c % ravel (� ellLP 5 V ------------- Depth from ONHOLFIOG Soil horizon Hole # Surface(in.) Soil Texture Soil Color (USDA) Soil O eti r (Mtmsell) Mauling (Structure,Stones, Boulders. Cons! enc %Gravel -El-ElPO-BSERVATIONHOLE LOG Depth from Sojl Horizon � Surface oil Texhire Sail Color (USDA) Soil Other (Muns�ll) Mottling (Structure.Stones,Boulders. Consist cpo Omvel__)__ a - lDEr,11D 013SERVATION HOLE, Depth fiam Soil thrill, �'®� Hole'# Surface(in.) Soil Texture Soil Color _ (USDA) Soil Other (Munsell) Mottling (Structure,Stones;Boulders, Cc ,i�tenc_ v�,y,pray I�_1 r,YQ0d r nsux*a nee Rate IVIap. Above 500 year.flood boundary No Ye.s V Within 500 year boundnry No Yes _T Within 100 year flood boundary No w ]�affi of oc�u¢raun �etvious Material Does at least four feet of naturally occurring;perviou taster gal exist in all areas observed throw tout area proposed for the soil abs the or rion s stem' '�' P Y If not, what i, the depth p h of naturally occurring pervious material`? Ce , rtfl�caflf[llon AA 661t v/� k certify that on IW� vl�(date)T have passed the soil evaluator examination approved Department of Environmental.A' PP by lire rokection'and that the above analysjs was performed b m 4Pie re Lair P y e consistent with 9 ex crtise and experience described in �10 CMR 15.017. Signature_ �' Date I` Q;1S0PT l(2APERCF0RM.DOC TOWN OF BARNSTABLE LOCATION .40T-�,o W 4r6-,-5yfb \QK1i/ SEWAGE # VILLAGE M F}K5To�s M fi�c.S ASSESSOR'S MAP & LOTV--'Q� INSTALLER'S NAME 6 PHONE NO. E LL15 VSJLcS. Co�� 3�a�-Ga37 SEPTIC TANK CAPACITY 9 Dn® (LEACHING FACILITY:(type) (size) /b 0 y NO. OF BEDROOMS 11,3 PRIVATE WELL OR PUBLIC WATER GBUILDER OR DATE PERMIT ISSUED: a• " e1 / DATE COMPLIANCE ISSUED• _l VARIANCE GRANTED: Yes No ww'I y9� _ 0 00 i 'oe�01No.--- .. _ F]Ms.............................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH p8t��b TOWN OF BARNSTABLE Apphratiou for Diopooul Wor1w Tomitr rtio Put t Application is hereby made for a Permit to Construct (V) or Repair ( ) an Individual Sewage Disposal System : �c— Locc do i-: ddr•ss 0. � �4 ......t _._ ............................ re S� = - ................ ......��7 Installer / Address -- iot VType of Building Size Lot............................Sq. feet �.. Dwelling— No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons--..--.--.------------------ Showers ( ) — Cafeteria ( ) d Other fixtures ..................... W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. . W Septic 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 ( ) aPercolation Test Results Performed by.......................................................................... Date........................................ a Test Pit No. I................minutes per inch Depth of Test Pit--..-.---- ......... Depth to ground water..--.................... 44 Test Pit No. 2................minutes per inch Depth of Test Pit.......--........... Depth to ground water........................ ;4 •--•••-•--••-----•----------••------••--------••--•--•-----••--•-••------------------------•-•..........------•-----................_......•-•--•---•-•-----• 0 Description of Soil........................................................................................................................................................................ x U ........................•------........-------•-----•••------------------•--•-----••-----------•-•••-----------•....•-•---•-•-•---------•---••••-----.---•---•--••-•-.....----•---............---------- x ----------------------------••----.....------....--------...........-------------------------------------................------------------------------.....--- .......................... U Nat of Repairs or Alterations—Answer when applicable--------- ......... _- r - ...................... ..-- ------ ..... •-•---••-----•------•--•-•--------------------------------------------------------- .................................... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental —The undersigned further agrees not to place the system in operation until a Certificate of Compl' ce as bee issued by the board of health. ined ......................... . � A .............Dare -.. Application Approved By ........ '_ � ................................ Da t.................... o Application Disapproved fo t e following reaso ....... ....... .. ........................................................................... ...................... ................................................q ... .. ........ :.... �........------..-- ---......................................--....--------. --------- .....--------------.... ........................................ Date PermitNo. ..... ..... ........................ Issued ........................................................ Dare .ate =YlS.y � r � ./ y/"'�� //���,'//y►r�.r�//.��JJf}�r � f n I j No...... .._._....... Faa...............�..,. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE y Appliration for Di.5pntiul Works Towitrnrtiun,-ramit Application is hereby made for a Permit to Construct ( ✓) or Repair ( ) an Individual Sewage Disposal System t':e-" �f - .f..��r. ..... � ! ................. . � } ..fit ��, Ll. ....1_....... �J Loccition-Address r 1 Y o. �/�l��a v� V -• ,�..g.4114.1�z t ,l �- �. la O -n'Cr A dress W ... .�._- �._..�.:....�....z�S_ .�.arv�.7L.�............... ...2��._... � ,,�,7L/�-C.............._....`/i� Installer Address Type of Building Size Lot............................Sq. feet .. Dwelling—No. of Bedrooms------------ -------------------------Expansion Attic ( ) Garbage Grinder ( ) aOther—Type 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. 3 Seepage Pit No_____________________ Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 9 ----------------------------------------------------------------------------------------------------......................................................... ODescription of Soil........................................................................................................................................................................ W U Nature of Repairs or Alterations—Answer when applicable......... .............. f - ------------------•------••--•-••--- ° ...................... ...................................... y -} Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with # r- the provisions of TITLE 5 of the State Environmental de—The undersigned further agrees not to place the ,+ system in operation until a Certificate of Compliance as been issued by the b-oaarrd�off health. Signed ``' .......t49;t, �Z�' J2-— Z-1`-r-7-2 ` .............................. .....a................. ...... re Application Approved By ..........:...44 ?..:. ' :/U / �. ---'-- �.............................. ......................................................... .................D..a c tee. .................. Application Disapproved for4 following reason .......................................................................................... ........................ ,. ................. . .... j's....---- ((//.�....:-.., ................. ! Dace y.. Permlt No. t,....1— ....................�- ----------------- Issued ....................._........................---....---........... Dare THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Cfex#ifierx#e of C omplianee THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( V ) or Repaired ( ) ....... ..................................... by 1 1L S has been ibin 11 stalled in accordance with the provisiot,s of TITLE 5 of The $tate-En ironmental Code as described in f the application for Disposal Works Construction Permit No. dated THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE(CONSTRUED AS A GUARANTEE THAT THE G SYSTEM WILL FUNCTI, N SATISFACTORY. 7../..... .... ............. ... InspectorV 1 I L� DATE_--------.._... � ... . .r... ........ .......... ._....... THE COMMONWEALTH OF MASSACHUSETTS 61 BOARD OF HEALTH No �..-'.b.� FEE.TOWN OF BARNSTABLE 1 .._.......... ......... --........ ...... Rope s Timatrudion Permit Permission,is ereby granted...... ,ems .. - to Construct o/r Repair ( ) an Individual Sewage Di al Systeem-�— at No......... - ���':.> .���,.P./1.!_..---��-�-�-'•-------/6�'-1�� � 0!. � .�_��`�..:-----/=------------------ Strcet Date ` as shown on the application for_D�sposal Works Construction �mit No�r�� mod................ ...�?.-�....._.....__ ..w .......... ='��' f... , ` � -------=-�------------------ �-5 Board of"Health LJ .......................... �. DATE........... ..._..�...------•--•---------=-------- FORM 36508 HOBBS&WARREN.INC..PUBLISHERS THE COMMONWEALTH OF MASSACHUSETTS `y BOARD OF HEALTH . wn .................o F........ � . 1................................................... Appliratiou for Bispooal Workii Tatifitror#iota Frrmit Application is hereby made for a Permit to Construct (K) or Repair { ) an Individual Sewage Disposal System at: ,Y.....�✓... . ...✓-S................. ............................... Z_`'-P 2- Location-Addres �//Q� {^j bnl i fi or Lot 1 o. = -- Owner a Address a = � WZZIA..................................... ..-•---••-----. -• Installer Address k d Type of Building Size Lot------ t ...Sq. feet U l., Dwelling—No. of Bedrooms...........1_._!'r-�...................Expansion Attic (4/0) Garbage Grinder (�� aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) a' Other fixtures .................................. W Design Flow............................................gallons per person per day. Total daily flow................. ?...............gallons. W Septic Tank—Liquid ca.pacity.L�Q._gallons Length.S.-,,f.... Width_.'4�71i) • Diameter__-.,__ Depth_451' `.. x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No......00c------- Diameter.....f®.`....... Depth below inlet--_--........... Total leaching area..n,_26,6....sq. ft. Z Other Distribution box (X Dosing tank ( ) Percolation Test Results Performed by..R,._O,1i. lx�afcwt �... xfnc. .11sY ... Date_ � _.- � � ,.a Test Pit No. L.___Z-------minutes per inch Depth of Test Pit.....1.4$_....... Depth to ground water Gz, Test Pit No. 2................nunutes per inch Depth of Test Pit.................... Depth to ground w er ..`'.." If Descriptionof Soil......-ii_. _..v......_...�.... �.�._..........t-1.............................................................� U W -•---••----•------------------------••-•-----••-•••-•--•--••--•••-•-•---•---•...... --•---•-•--••------•------••--•-••-••••-•--•-•••-••--••---•-------•-•-•-•---•_... N. U Nature of Repairs or Alterations—Answer when applicable............................................................... �.,�•'�--�' »�� '� OIJA Agreement: 6 27-fsIr The undersigned agrees to install the afore crib Individual Sewage Disposal System in accordance with (^iT r•1'+' the provisions of TTLE' 5 of the State Sanitar Co —The rsi ned 'urth agrees not to plac the syje� > operation until a Certificate of Compliance ha n issued by e b z- // Signd------- ------- -•--- --- ------`---- ------------------•--•---- .... -r = Date Application Approved By............ Date Application Disapproved for the following reasons------------------------------------------------------------------------------•-•-------.._...-••--•--.....-•---- --------------•--•---•-•-----------._....•--•------•--•--••---------•----•--•-•-------........------------•-------------------••------•-------•--••---••-----•-----•------•••-----•----•----••--------•- Date Permit No........ ...._ ............................... Issued....... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH . .........0F......s ? rv'�S`T.�9 ................... C-5rdifiratr of TompliFatarr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed Z) oror Repaired ) ( by......... ..... a' '°------------------- ------------------------------------------------------------------------------------------------------ Installer has been installed in accordance with the provisions of TIT14..5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No......... �._..... dated__ --- �_` THE ISSUANCE OF THIS CERTIFICATE SMALL ..0 AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE................................................................................ Inspector.................................................................................... 1..in —n"'i Y a1: `� l,+a t .a ♦aft �f �. N®.__.`r... ... Fps............................_ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ---------/ v«•, .................O F.......... ................................. App iration for Dispatial Works Totw4rurtion ramit Application is hereby made for a Permit to Construct ( X) or Repair ( ) an Individual Sewage Disposal System at: ..._,fir _ ''"—CAS"'-L-Ae�flee.So-•----•----------------•-- Lo 7 2-o ....................................................... Location_Address or Lot No. .....................................................+a �/�/rr rh-�G (-c1-K-`- -------------------- ........................-------- -•--•..... Owner / Address Installer Address t d Type of Building Size Lot------.o2f_1.5t`t...Sq. feet Dwelling—No. of Bedrooms............ Y� ..................Expansion Attic (A4 Garbage Grinder (46 A,,, Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) Q' Other fixtures ............................ Design Flow.................................�--_gallons per person per x day. Total d aily .................. . q� Septic Tank—Liquid ca acity...�. allons Len th _$L.6. Width.. �- . Diameter..._..... Depth.. ... al t. Disposal Trench T� ridth.................... to Lengthleaching ..s ./....... -2.CSeepage PtNo._ .Ue_____.. Diameter ' Deplbelow > let.... . . Totalleachmg area._ 6...sq. ft. Z Other Distribution box ( A) Dosing tank ( ) `4 Percolation Test Results Performed by ��'-jC/<ch����G.�� z f.•.i xlTr_•�'••�/}yc•• Date.-k-Y.!4 ---------- �. Test Pit No. 1......!-?�i------minutes per inch Depth of Test Pit------1.44--....... Depth to ground (s, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to groun ----- .. -••------/-•-.---.•.•.-.-----•--•-•-•---•---•----------•---••--•••...................••---.....--._...----...-• `�.... O �hi/Description of Soil.....--O-_ 'd--- ------.� --•-----------------------------------------------•----•-• -----.A,•-•`L .... .s=.J ..... 14'`... • GrcweQ --------------------------------------------------•------- �---•-- W ............------------ -------------- .........................................................-•-----------------------------•-•-----•---------------•-------- UNature of Repairs or Alterations—Answer when applicable_______________________ •-•----•----•-------••••--••--------•-----------------•--••-----•----------•-----•------------------•------------•-----------•-------••---------••-------•-- ay.. Agreement: cis co-d 7`B?" The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of T1 T _is p 5 or the State Sanitary Code— The undersigned further agrees not to place the system in -' operation until a Certificate of Compliance has been issued by the board of health. Signed------- ...... =�------•4a:-............................... --------- / Date Application Approved By ------------- .(..................... .... f Date Application Disapproved for the following reasons---------------------------------------------------------------------------------•-----------------••-.....------ --••••-•-...-•----------------•--............._....------------------------------------••-•••-•----......-------------•-••••••---••------•-----------•---•-----------•---•-•-----•--•-••--••----•---•--- 85� - 676, Date PermitNo........................................................ Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .... .0 d; ?. /..........0F........ ........................ vEntifiratr of Toutplitattrr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( V1 or Repaired ( ) by----------�`` =' ; -------- = `=--------------------------------------------•-----••----•---------------.---•-----------------.-------.-.----------------- ff .y�wm� /`' y Installer yy pp/( p/'g �{ }f f .....y.F..a� C^A' i...G 1- ....LY'X.".k•:_` .....,PSeT fen-,"M-R.:4..Y.!3�d.'--11. ...__.`':L li P/' y"I at. '' --- has been installed in accordance with the provisions of TITIJ.5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No...........................6.......... dated--..--_--.-.--_--------........................ THE ISSUANCE OF THIS CERTIFICATE SHALT. NOT BE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE................................................................................ Inspector.................................................................................... THE COMMONWEALTH OF MASSACHUSETTS Q / BOARD OF HEALTH OF........... e ................... No......................... FEE.;.;�Z...._•----•--- Disposal, orko Twiptru cart anti# Permission is h eby granted-----• . 4�stem t _ "..._ m * ............. to Construct ( sposa or Repair ( ) an individual Sewage Dil -• 1' .............................................. Street as shown on the application for Disposal Works Construction Permit N .�1�...�±.•. Dated.......................................... ........................................................................................................ Board of Health DATE................................................................................ FORM 1255 HOBBS & WARREN. INC., PUBLISHERS � � 19. ,_ �5�'0 � o c R 06S :_..::�---. �•-• O PAN SSA �. �°per , • i.: �Npw1, l�c3LEt7t.! GOw�pt-�s w.ITtii tNls SeT-'3I+cIL tk3gvlrt�w. NrS .vF •-r}�l TDtV'� Op -BAIL►JST'ne" •AId, .'s ' .War. `ocAaTW�) W 1 rW I W -t.t a ':tovr> PLA 11:1 -:` TANK. 6A Prr �• yl OIL ` 90 .. c6�A^ r• . . to- 7�•gg • t tow AM,U Y 4 ?LA14 1�0: T.�SPOSA[.- t �lls� P-ow4 3xtly - 330 GpD AAA2sTe1 l S MLLS - IvA4A.SEPn I , . d TA Qv-,- LV515 (Doo 4,AC., ..1/�AA ES (�. , '�l,�i� I ` SAC. 'Pr•1' - v5� ( 000 �,d,r-, t D/�1'�; C-J Dt wAL.,L- ,4J'7Z A 1 g 5�� 8 L F3 >G L,S. w 4-1 D (r r-0» h1`�ci !1JG i i 'j 43 X D -76 442 D GI�/I L� (=111(c 11J 3Zs 7drA4- Zn� 1414 446 pp a s�szurl,:Lc �(/1a�5 = `1.?:r O -A-TI cW (ZAM I I1��1 ZA-A 14 'D,T!, d2L lgg ALL SYSTEM SYSTEM PROFILE MRC D WITHCOMPONENTS TAPE OR BE NOTES (NOT TO SCALE) COM?ARABLE MEANS FOR FUTURE LOCATION. PROP. VENT PROVIDE MIN. 20" DIAM. WATERTIGHT 1. DATUM IS APPROX. NGVD ACCESS COVERS TO WITHIN 6" OF FIN. GRADE TOP FOUND. EL. 77.2' PROVIDE INSPECTION PORT TO WITHIN 3" OF FINAL GRADE 2. MUNICIPAL WATER IS EXISTING 3. MINIMUM PIPE PITCH TO BE 1/8" PER FOOT. MINIMUM .75' OF COVER OVER PRECAST 2% SLOPE REQUIRE OVER SYSTEM 4. DESIGN LOADING FOR ALL PROPOSED PRECAST PROP. TEE �j UNITS TO BE AASHO H-10 ' 4"OSCH40 PVC 2" DOUBLE WASHED PEASTONE 74.76 5. PIPE JOINTS TO BE MADE WATERTIGHT. PIPES LEVEL 1ST 2' i OR GEOTEXTILE FABRIC Wo rshed �, o s 72 6 / 6. CONSTRUCTION DETAILS TO BE IN ACCORDANCE to 10" EXISTING 14" WITH Locus TEE SEPTIC TANK TEE 73 3'f* ��� 310 CMR 15.000 (TITLE V.) 000000000000 0 72.1' 000 /''',I�es o j o GAS BAFFLE* �-000 o 2' o 00 7. THIS PLAN IS FOR PROPOSED WORK ONLY AND o a pogo noo 70.1 NOT TO BE USED FOR LOT LINE STAKING OR ANY r.-'r o 4' UQ. LEVEL (ACME OR EQUAL) 72.29 72'12 000 0 000o OTHER PURPOSE. H-20 3050 INFILTRATORS 6" MIN. SUMP 8. PIPE FOR SEPTIC SYSTEM TO SCH. 40-4" PVC. 12" MIN. INT. DIM. 3/4" TO 1 1/2" DOUBLE WASHED STONE 9. COMPONENTS NOT TO BE BACKFILLED OR 6" CRUSHED STONE OR MECHANICAL V (1 .221 [2]) CONCEALED WITHOUT INSPECTION BY BOARD OFCOMPACTION. ' HEALTH AND PERMISSION OBTAINED FROM BOARD Vs oute 1 % SLOPE) ( 1 X SLOPE) 4'340'tOF HEALTH. 1 EXIST. SEPTIC TANK 11 D' BOX 4' LEACHING 10. CONTRACTOR SHALL BE RESPONSIBLE FOR FOUNDATION FACILITY CALLING ER FYING ITTHE LOFE CATION OF ALL UNDE AND RGROUND & LOCUS MAP *THE INSTALLER SHALL VERIFY THE LOCATIONS OF ALL **INSTALLER SHALL CONFIRM MINIMUM SEPTIC TANK SIZE AT OVERHEAD UTILITIES PRIOR TO COMMENCEMENT OF NOT TO SCALE UTILITIES AND ALL BUILDING SEWER OUTLETS AND ELEVATIONS 1000 GALLONS AND ITS SUITABILITY FOR RE-USE. REPLACE BOTTOM & FOUND 65 8' WORK. PRIOR TO INSTALLING ANY PORTION OF SEPTIC SYSTEM WITH 1500 GALLON H-10 SEPTIC TANK IF NOT SUITABLE (OR H-20 NO GROUNDWATER F FOUN 11. ANY UNSUITABLE MATERIAL ENCOUNTERED SEPTIC TANK IF IT WILL BE SUBJECT TO VEHICLE LOADING). G-W ESTIMATED AT EL. 30't HALL BE REMOVED 5' BENEATH AND AROUND THE ASSESSORS MAP 59 PARCEL 9-4 AS PER TOWN MAP PROPOSED LEACHING FACILITY. _ SITE IS WITHIN WP DISTRICT 74.81 12. EXISTING LEACHING FACILITY SHALL BE PUMPED AND REMOVED OR PUMPED AND FILLED WITH CLEAN VARIANCES FOR SEPTIC SYSTEM REPAIRS WHICH MAY BE {74.94 SAND. Y IMMEDIATELY GRANTED BY THE BOARD OF HEALTH AGENT OR / ^° 0 74. 1 7 BY HEALTH INSPECTOR 72,4 ' k.0 N �• 10.2 PAPERWORK AND HEARING REDUCTION PROPOSALS APPROVED 7 BY THE BOARD OF HEALTH REVISED DURING A PUBLIC / HEARING HELD ON AUG. 4, 2009 75 03 s 26 0 SYSTEM DESIGN. 3) FAILED SYSTEMS ONLY: SOIL ABSORPTION SYSTEM ' INSTALLATIONS PROPOSED MORE THAN THREE FEET BELOW � J` 0 " C GRADE WITH PROPER VENTING (PIPED TO THE ATMOSPHERE) GARBAGE DISPOSER IS NOT ALLOWED AND WITH H-20 LOADING, BUT IN NO CASE SHALL THE SAS �jo / 75.56 BE LOCATED MORE THAN SIX FEET BELOW GRADE. 75.09 '`� DESIGN FLOW: 3 BEDROOMS ® 110 GPD =330 GPD 0(� / 75. 6 75.78 - P x 7s o7 USE A 330 GPD DESIGN FLOW 75.89 �0 75.23 h 76.16' SEPTIC TANK: 330 GPD (2) - - 660 ^� OUTER DIMENSIONS OF STONE rl,' 76.4^ SURROUNDING 3050'S RE-USE EXISTING SEPTIC TANK �75.40 p` �\ PAVED DRIVE x-!�6�75.51 P��`� 1" = 20' LEACHING: \ 76.56 PERIMETER: 103 LF x 1.85 (0.74) = 141 GPD TEST HOLE LOGS 76.3 x 7 BOTTOM 412.5 SF (0.74) = 305 GPD \ 76.52 76.58 0 �9 PROP. VENT WITH CHARCOAL FILTER TOTAL: 602 S.F. 446 GPD LOT 20 DANIEL A. OJALA, PE, SE /° \ 6ao- AND BUGSCREEN (FINAL PLACEMENT BY ENGINEER: 77,D0 CONTRACTOR WITH HOMEOWNER DAVID STANTON, RS 20,199f S.F. �6.45 ° CONSULTATION) USE (5) 3050 INFILTRATOR CHAMBERS IN WITNESS: \° CONFIGURATION SHOWN DATE: JUNE 14, 2010 PAVED DRIVE \ BENCH MARK - CORNER OF PERC. RATE _ < 2 MIN/INCH 76.75 ° DECK ELEVATION = 77.8' EXIST. 3 BR 20' CLASS I SOILS p# 12969 DWELLING 76.42 75.92 TOP FNDN = DECK SHED ELEV. ELEV. 77.2' SEPTIC SYSTEM SHOWN PER AS-BUILT CARD ON Ott 4 I TH FILE AT HEALTH DEPT. oft 4 A q 75.85 �So O MA /LS UNSUIT. /LS UNSUIT. ° x 76.5 75:68 APPROVED DATE BOARD OF HEALTH 6» 10YR 3/2 6" 10YR 3/2/ O 5.94 DECK 6.63 S��G o TITLE 5 SITE PLAN 0// B B P G �� °J75.71 OF LS UNSUIT. /LS UNSUIT. x 76 10YR 6/6 10YR 6/6 x 76.46 LP P 36" 73.3' 3s" 73.3' 99 WATERSHED WAY 0 NOTE: EXIS C1 C1 6.43 HATCH FORT' �°`y j°� MARSTONS MILLS SL UNSUIT. SL UNSUIT. FOR PUM NGT 5�0� //o .33 G /x�6.02 PREPARED FOR 2.5Y 6/12.5Y 6/1 Q ° 46 72.4 469972.4 x 76 40 /°/ ���s"oFMgssgc ����j"°FM�S0- URTOLOTTI CONSTRUCTIONMUNES DANIEL ti�m o�� DA A- G� C2 /o ti� o JUNE 16, 2010 C2 lr 619 fig. OJA REV. JUNE 22, 2010 (4 BR TO 3 BR) PERC q 4� °53th S ��2-(� downcope.com o s ctS4 P off 508-362-4541 M/CS M/CS s G s � 1 Aba fax 508-362-9880 UR i n°' I u JALA ' 2.5Y 7 3 2.5Y 7/3 q No.40980 down cape engineering Inc. / » �°p�s 1 126" 65.8 126 65.8 �q ©� k civil engineers 8600' "°S �� \' land surveyors NO GROUNDWATER ENCOUNTERED Scale: 1"= 20' �.'Z 1•�J t �-� 939 Main Street ( R to 6A/ 0 10 20 30 40 5o FEET DATE DANIEL A. OJALA, P.E., P.L.S. YARMOUTHPORT MA 02675 O_ '24 10-124.DWG L SYSTEM PROFILE �SYSTEM yyM}{COMPONMAGNE N T SHALL BE NOTES (NOT TO SCALE) COMPARABLE MEANS FOR FUTURE LOCATION. PROP. VENT APPROX. NGVD PROVIDE MIN. 20" DLAM. WATERTIGHT 1. DATUM IS ACCESS COVERS TO WITHIN 6' OF FIN. GRADE & I TOP FOUND. EL. 77.2' PROVIDE INSPECTION PORT TO WITHIN 3' OF FINAL GRADE 2. MUNICIPAL WATER IS EXISTING \ MINIMUM .75' OF COVER OVER PRECAST 2% SLOPE REG'UIR OVER SYSTEM 3. MINIMUM PIPE PITCH TO BE 1/8" PER FOOT. 4. DESIGN LOADING FOR ALL PROPOSED PRECAST PROP. TEE n/ UNITS TO BE AASHO H-M 74.76' 4"0SCH40 PVC 2" DOUBL WASHED PEASTONE PIPES LEVEL I ST 2' 5. PIPE JOINTS TO BE MADE WATERTIGHT. ed * OR GEOTE�CTILE FABRIC 72.6 Wate�sh 6. CONSTRUCTION DETAILS TO BE IN ACCORDANCE 10" EXISTING 14" _ WITH Locus TEE SEPTIC.TANK TEE 73.3'f* °° 0 72.1 �� 310 CMR 15.000 (TITLE V.) Ele�es �� `q. 00 GAS BAFFLE:.; 0 _ o°° °°°°°°° 80 2 7. THIS PLAN IS FOR PROPOSED WORK ONLY AND Lin o 4' UQ. LEVEL (ACME OR EQUAL) .': 72.29' 72.12o �� 70•1' -OTHER PUR OSE NOT TO BE D FOR LOT LINE STAKING OR ANY o ': • H-20 3050 INFILTRATORS I 6" MIN. SUMP 8. PIPE FOR SEPTIC SYSTEM TO SCH. 40-4" PVC. ' ,r' MIN. INT. DIM. 3/4" TO 1 1/2" DOUBLE WASHED STONE lf � 6' CRUSHED STONE OR MECHANICAL 9. COMPONENTS NOT TO BE BACKFILLED OR R COMPACTION. 15.221 2 ) CONCEALED WITHOUT INSPECTION BY BOARD OF ( � ) 4 3' HEALTH AND PERMISSION OBTAINED FROM BOARD in��slr� oute (9.1 % SLOPE) ( 1 X SLOPE) 40'2F HEALTH. V FOUNDATION EXIST. SEPTIC TANK 11 °` D' ' BOX " 4' LEACHING CA CONTRACTOR SHALL BE RESPONSIBLE FOR FACILITY VERIFYING LLING ITHE LOCATION OF ALL UNDERGROUND & LOCUS MAP *THE INSTALLER SHALL VERIFY THE LOCATIONS OF ALL **INSTALLER SHALL CONFIRM MINIMUM SEPTIC TANK SIZE AT OVERHEAD U11UTlES PRIOR TO COMMENCEMENT OF NOT TO SCALE BOTTOM TH-1 & FOUND 65.8' UTILITIES AND ALL BUILDING SEWER OUTLETS AND ELEVATIONS 1000 GALLONS AND ITS SUITABILITY FOR RE-USE. REPLACE WORK. PRIOR TO INSTALLING ANY PORTION OF SEPTIC SYSTEM WITH 1500 GALLON H-10 SEPTIC TANK IF NOT SUITABLE (OR H-20 NO GROUNDWATER FOUND SEPTIC TANK IF IT WILL BE SUBJECT TO VEHICLE LOADING). G-W ESTIMATED AT EL. 30'1: 11. ANY UNSUITABLE MATERIAL ENCOUNTERED ASSESSORS MAP 59 PARCEL 9-4 AS PER TOWN MAP ALL BE REMOVED 5 BENEATH AND AROUND THE PROPOSED LEACHING FACILITY. SITE IS WITHIN WP DISTRICT 14 61 12. EXISTING LEACHING FACILITY SHALL BE PUMPED AND REMOVED OR PUMPED AND FILLED WITH CLEAN VARIANCES FOR SEPTIC SYSTEM REPAIRS WHICH MAY BE 74.94 SAND. IMMEDIATELY GRANTED BY THE BOARD OF HEALTH AGENT OR BY HEALTH INSPECTOR 72.46.' °o 7 10.2' J CIV In PAPERWORK AND HEARING REDUCTION PROPOSALS APPROVED BY THE BOARD OF HEALTH REVISED DURING A PUBLIC / 7�c � =- HEARING HELD ON AUG. 4, 2009 J SOIL ABSORPTION SYSTEM 5.26 SYSTEM DESIGN: 3) FAILED SYSTEMS ONLY: P INSTALLATIONS PROPOSED MORE THAN THREE FEET BELOW 75.03 GRADE WITH PROPER VENTING (PIPED TO THE ATMOSPHERE) c` -' AND WITH H-20 LOADING, BUT IN NO CASE SHALL THE SAS t�O GARBAGE DISPOSER IS NOT ALLOWED BE LOCATED-MORE THAN SIX FEET BELOW GRADE. 75 r 75.09 �'`�• DESIGN FLOW: 3 BEDROOMS ® 110 GPD =330 GPD 75. 6 75.76 USE A 330 GPD DESIGN FLOW 75.23 `� 76,16 S TIC TANK: 330 GPD (2) = 660 � • EOUTER DIMENSIONS OF STONE ' h° _.'�76.40 -__ _ �- .� _ ._ .�,. SURROUNDING 3050'S RE-USE EXISTING SEPTIC TANK ** - _..f"-"-'f; PAVED DRIVE ` �6� ,-75.5 P 1" = 20' LEACHING:t � I . ` \ 76.56 PERIMETER: 103 LF x 1.85 (0.74) = 141 GPD TEST HOLE LOGS x 7 \ 76.5276.3 BOTTOM 412.5 SF (0.74) = 305 GPD.5 .s8 ' ' r9� � PROP. WENT WITH CHARCOAL FILTER BY ,.. TOTAL. S.F., .. 76 602446 GPD ENGINEER: DANIEL A. OJALA, PE, SE LOT 20 oo AND BUGSCREEN (FINAL PLACEMENT 77.00 CONTRACTOR WITH HOMEOWNER DAVID STANTON, RS 20,199f S.F. \ 0 45 CONSULTATION) USE (5) 3050 INFILTRATOR CHAMBERS IN WITNESS.. CONFIGURATION SHOWN DATE: JUNE 14, 2010 PAVED DRIVE BENCH MARK - CORNER OF PERC. RATE _ < 2 MIN/INCH 76.75 o DECK ELEVATION = 77.8' CLASS I SOILS p# 12969 I EXIST. I NG BR f 20 76.42 LI DWEL 75.92 TOP FNDN I DECK SHED ELEV. ELEV. 77.2' SEPTIC SYSTEM SHOWN PER AS-BUILT CARD ON r---, I TM 6 FILE AT HEALTH DEPT. 0 76.3' 0 76.3 / S �. x A V/AA / / Q 75.85 CO x 76.s 7_38 APPROVED DATE BOARD OF HEALTH MA UNSUIT. UNSUIT. /LS /LS 6" 10YR 3/2 6" 10YR 3/2 s.94 6.63 DECK TITLE 5 SITE PLAN B G `° 7s.7 OF �S UNSUIT. V��LSUNSUIT. x 76. /� 10YR 6/6 10YR 6/6 x 76.46 LP " 99 WATERSHED WAY 36" 73.3' 36" 73.3' NOTE: EXIST. MARSTONS MILLS C 1 C 1 6 43 HATCH FOR ACCESS �� ro VY L UNSUIT. �SL UNSUIT. FOR PUM IP Nc s.o2PREPARED FOR 6 1 2.5Y 6 1 Q 38 33 G" 46 / 72.4 46 / 72.4 �ZN OF o �ZN OF k9s x 7s.4o 0�DANIELSs9cy� ��DA I A `�� ORTOLOTTI CONSTRUCTION/NUNES .60 2 C2 o OJA N� _ L JUNE 16, 2010 C - .I U f v PERc REV. JUNE 22, 2010 (4 BR TO 3 BR) clbp t 9 A q,i Q" p \° s s� /S7ER �\ = off 508-362-4541 M . r fax 508-362-9880 /CS M/CS G �, o sUR\J i downcope.com JALA q No.40980 down M.Pe eagineering, inc. 2.5Y 7/3 2.5Y 7/3 , 126„ 65.8 126 65.8 �q ` o� orYF,, "r NFes ° -i.s civil engineers os , ..,a land surveyors NO GROUNDWATER ENCOUNTERED Scale: 1"= 20' a6.00' �_'Lt-�J �'1 �i 939 Main Street ( R to 6A) 0 10 20 30 40 50 FEET DATE DANIEL A. OJALA, P.E., P.L.S. YARMOUTHPORT MA 02675 0- >24 10-124.DWG I