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HomeMy WebLinkAbout0194 WHITE MOSS DRIVE - Health 1 194 While I�_ oss 15rive 1 Marstons Mills r Commonwealth of Massachusetts r Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments Property Address Owner Owners Name information is0 ZGI(X� y��/ required for 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. Please see completeness checklist at the end of the form. Important:out forms A.A. General Information filling out forms on the computer, I� use only the tab 1. Inspector: key to move,your j cursor-do not G/ �, fie ,f use the return Name of Inspector key. Company Name Oj-e L44,1.z Company Address j /mil CL-1JI, /'�1 ��'s 0 City/Town State Zip Code 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. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: Passes ❑ Conditionally Passes ❑ Fens ,A�..� M CD ❑ Needs Further Evaluation by the Local Approving Authority ,r., M Inspector's Signat 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. thins-3/13 I Y i wmmvnnalth 4f Managhwette `title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments Property.Address (- Owner Ownees Name information is -1� � '.sL Q'7� r uired foreve � " 1 f 'v�'/ p� page. CityrTown State Zip Code .Date of InspeTcti not no B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: I have not found any information which indicates that any of the failure criteria described / \ In 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria.not evaluated are indicated below. Comments: B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass"section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no"or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old*or.the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. 0 Y ❑ N ❑ ND (Explain below): y : Commonwealth of Massachusetts . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments Property Address 47-Oriy A Cf Owner Owners Name information is required for every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes(cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection If(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins-3113 Title 5 official inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts _ Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments Property Address Owner Owner's Name information is �(/J ,7CwY4 J,[ / required for every t/k �C '/�'v"'✓ Q ��� y / page. City/Town State Zip Code Date of Inspection B. Certification (cont.) 2. System will fall 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: fhis 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. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate"Yea"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 dlstribution 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 thins•3193 - _ 'mo 5 umoiai inspmh—Frnm.9ubcurraco SVWa90 U10p0001 Gyatcm.P_,v 4 Vr 1T Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments e4,*1j doll Property Address Owner Owner's Name Information;s �� ��t:L.>i, required for every I _t,f -�►(Q /V�^' oec V f 5—A, page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped- ❑ (�� Any portion of the SAS,cesspool or privy is below high ground water elevation. ❑ Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ C1i �- Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ EP" 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, perfo rmed rmed at a DEP p 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 15,000 gpd. For large systems, you must indicate either"yes"or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ L7 the system is within 400 feet of a surface drinking water supply ,..�,/ PP ElL.T 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. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System.Pa08 5 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments &q (_164 '0off A— Property Address Owner Owner's Name / -information is � ,� ��Z ✓B� required for every page. City/Town 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 E/'' ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ET" 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? ^� Lam' ❑ Were all system components, ef(,di g he SAS, located on site? CY' ❑ 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? Lh ❑ 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: P4--3 4v, to.., L'7 ❑ Existing information.'For example, a plan at the Board of Health. ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms(design): 3 Number of bedrooms(actual): DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments Property Address Owner Owner's Name information is /j�i AA ��® q / required for every V `'rf; ! d JA U` /C7 �'9 0 7C�p � /� page. CitylTown State Zip Code —Date o�on D. System Information Description: Number of current residents: Z Does residence have a garbage grinder? ❑ Yes No Is laundry on a separate sewage system?(Include laundry system inspection information in this report.) ❑ Yes No Laundry system inspected? [ es ❑ No Seasonal use? El Yes 19` No Water meter readings, if available(last 2 years usage(gpd)): Detail: Sump pump? ❑ Yes j No 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: t5ins•3l13 Tifle 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 7 of 17 Commonwealth of Massachusetts MW Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments Property Address Owner Owner's Name information is �Ar `��� ll �/�.. ��Gy� required for every y page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: 14��'` 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: 4' S�"f r-e ��GBcv� 'Z Type of System: Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner)and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): l5ins-3/13 Title 5 official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 17 Commonwealth of Massachusetts a Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments Property Address _ i/t v cy ]- Owner Owner's Name — information is /� required for every 'J a� Jl� Al page. Citylrown State Zip Code Date of Iffspection D. System Information (cont.) Approximate age of all components, date installed (if known)and source of information: Were sewage odors detected when arriving at the site? ❑ Yes [e-"No Building Sewer(locate on site plan): Depth below grade: 4 J feet Material of construction: ❑ cast iron X40 PVC ❑ other(explain): jDistance 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): �f L�Depth below grade: 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: Sludge depth: Z t t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 Commonwealth of Massachusetts _ Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments Property Address i Owner Owners Name information is required for every page. CityrFown State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont,) Distance from top of sludge to bottom of outlet tee or baffle Scum thickness r , - Distance from top of scum to top of outlet tee or baffle }L y8 Distance from bottom of scum to bottom of outlet tee or baffle How were dimensions determined? e.I,-IV -— Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): �' f c s n t.-�.ti t .. /li+'A, t011 C. e..ff `{0 ' Ly"p m CP 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 t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments Property Address _ Owner Owner's Name information is required for-every �� yti �` �crC '/ C page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels.as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene y El other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes 0 No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pimping: Date Comments(condition of alarm and float switches, etc.): *Attach Copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments A 1` '� LAG.+ vJJ y,- Property Address Owner Owners Name information is 1) III A 16/,,, O tf� �--� required for every � 4� ------- page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert — _- 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.): /_ G v_i.M--�j �r"r`�G�r*�4�r to- 5G-e,� C L✓ f-�'n. !�:} fy --- 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. Soil Absorption System(SAS) (locate on site plan, excavation not required): If SAS not located, explain why: 15ins-3113 Tide 5 Official Inspection Form:Subsurface Sewage Disposal System-Page b of 17 Commonwealth of Massachusetts Title 5 official Inspection Form - Subsurface Sewage Disposal System Form-Not for Voluntary Assessments ti Property Address �Cvi tr �t > Owner Owner's Name information is required for every 44 Sri page. CitylTown State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number ----- leaching chambers number: ? 5yr-2 4. /❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions' Li 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.): j / t, 1` C << I_ 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 LRtns.3H3 Tltw 0 QVIO l Inwgctton Form:Sumurriw Svwwo M99 wi SYCtvm-Page IS 9f 11 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments Property Address ��•w A f Owner Owner's Name information is required for every _ z 6L page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy (locate on site plan). Materials of construction: Dimensions Depth of solids Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): c5ins-3113 Title 5 Official Inspection Form:Subsurface Sc=gc Disposal System•Pope 14 of 17 � y Commonwealth of Massachusetts _ Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form-Not for Voluntary Assessments Property Address Owner OwnersWme ,,�/ information is �Gf-r[AJ /. /f/�+�IT( ��,� 6A(,Kr-.' t1�/.�—��y required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.). Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: Frllh'-and-sketch in the area below ❑ drawing attached separately .A A - 1 31- 3 ' f© t0 73- t Z S 4 3 ❑ Nr lu 1)4 cX ' C) C t5ins•3/13 Title 5 Official Inspection.Fonn:Subsurface Sewage Disposal System•Pogo 15 of 17 1 f Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments Property Add re fhf Owner Owner's Name information is required for every — page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: (Check Slope 53,--§urface 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 ❑ 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: Before filing this Inspection Report, please see Report Completeness Checklist on next page. 15ins•3/13 Idle 6 Official Inspection Fort:SubswucO Sewage Dlsp6sal System•Prtpn I nr 17 Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal.System Form-Not for Voluntary Assessments 19g 4,�l i- yosj Property Address t, jA !r/y1' '- Owner Owner's Name information is required for every page. Cityrrown State Zip Code Date of Inspection E. Report Completeness Checklist [,Inspection Summary:A, B, C, D, or E checked [-Inspection Summary D (System Failure Criteria Applicable to All Systems)completed 9?tystem Information—Estimated depth to high groundwater 05--gkCetch o'Sewage Disposal System either drawn on page 15 or attached in separate file t5ins•3/13 Me 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 No. Ill !I /� / -y Fee UU THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: f� PUBLIC HEALTH DIV'ISIONY-TOWN OF BARNSTABLE, MASSACHUSETTS es �V 01pplitatlon for Disposal *pstem Construction Permit Application for a Permit to Construct Repair( ) Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location dress or Lot No. Iq q ✓k)Ki- Q MOSS r• Owner's Name,Address, d Teil,N-�. vicFa r �h� s Assessor's ap/Parcel D �' � ,� Installer's Name Address and Tel.N De igner's N Ad ess, d Tel . Pe X 1�e� jbLtr)T. & Type ofBu'ding: Dwelling No.of Bedrooms 3 Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) `�30 gpd !Design flow provided gpd Plan Date Number of sheets Revision Date Title II Size of Septic Tank 1000 ��,�, Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable),-p-,.6"bp� J/a 0�paeA e—A m �L � 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 Heal ed �\ P Date zol Application Approved by Date Application Disapproved by Date for the following reasons Permit No.? o/a Date Issued 0 X No. 0 -0a k , -^"-` Fee UU - THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVIS'161t- TOWN OF BARNSTABLE, MASSACHUSETTS es nv 2ppYication for Misposal Opstem Constritctiou 'Vermit Application for a Permit to Construct Repair( ) Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. �� j,< h1�Q 1G�aS �Jr• Owner's Name,Address,and Tel.No. Assessor's ap/Parcel D62 .Installer's-Name,Address,and Tel.N Designer's N e;Address,and Tel No. ma Le,&A--R trnc�tr)T. c 1e C rrr ka tr. row �S Po x I as ��{-Fs3� -�a` A � , }u Type of Building: Dwelling No.of Bedrooms r"t� Lot Size sq.ft. Garbage Grinder( ) Other Type of Buildings ! No.of Persons Showers( ) Cafeteria( ) Other Fixtures , a' Design Flow(min.required) gpd 'esign flow'Provided ... ..... . . . ... ..... ., gpd _ t Plan Date 1 Number of sheets Revision Date I Title { Size of Septic Tank IOU() rk* Type of S.A.S. Description of Soil A i f I Nature of Repairs or Alterations(Answer when appl cable)-,5720 H-/D lea l'X y 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 Heal f - ed Date ` 1 ?.Ot Zf r Application Approved by <, Date i PP 7 's Application Disapproved tby ii Date for the following,reasons f i Permit No.� (� -D V Date Issued r F ------------------------ ------------------ - =----_-.-.-.-----:--.;-----.- --------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,t at the On-site Sewage Disposal system Constructed( ) Repaired( Upgraded( ) Abandoned( )by L L•t%1 at I Ot 1/ I, �1- '1 l �, has been constructed in accordance r / !j with the provisions of Title �5-'and the for Disposal System Construction Permit Na dated / .yam ' Installer 1�/��/ / Designer (2W. 11 h��.; ,�/lf(q / U #bedrooms Approved design flow v 376 f� / gpd? The issuance o this perm't shall not be construed as a guarantee that the system will function as designed. Date oi— Inspector / 7 �/ P i _= = _ *------- ----------------------- No. _o t Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION'-BARNSTABLE,MASSACHUSETTS 33isposal *pstem Construction 31ermit Permission is hereby granted to Construct( ) Repair ) Upgrade( ) Abandon( ) System located at { 47 Ili i i 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 m 7 st be completed within three years of the date of this perm,I. Date Approved by 1 Town of Barnstable �. Regulatory Services Thomas F. Geiler,Director Public Health Division i6 9..`� Thomas McKean,Director 200 Main Street, Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Date: t I`1 ��= Sewage Permit# Assessor's Map/Parcel ©L(6 /q 6 Installer&Designer Certification Form Designer: • /ApV I k-rJ0`1, Installer: NP L-abuie— uW`�-to Address: LPdpA- ►Gdk Address: PO lSX 1712-- On l d2m /I//P_ b u was issued a permit to install a (da e) (installer) septic system at 0 Pie._ r) k 111/117 based on a design drawn by (address) �r&,4 G. t rri' RS, dated ! l LZdZ_ (design ) I 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. Stripout (if required) was inspected and the soils were found satisfactory. 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 R ions. Plan revision or certified as-built by designer to follow. Stripout (if requ' ted and the soils were found satisfactory. �y�PLp GLEN G'y� ERI H.ARRINGTON � (Installer's Signature) No.1070 O (Desi er's igna ) (Affix Desi p 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. gAoffice formsWesignercertification form.doc � • i Town of Barnstable P# . 13 6 V Y Department of Regulatory Services Public Health Division DateMASS 1639• ,b 200 Main Street,Hyannis MA 02601 Date Scheduled I bTithe _ Fee Pd. D G Soil Suitability Assessment for Sewage Dispo al Performed-By: fly i , eS, Witnessed By: LOCATION& GENERAL INFORMAT�O Location Address \\ri Owner's Name ��✓ lam c. A//5 Address / / / "11 '_I T ' Assessor's Map/Parcel: o� * � Engineer's Name NEW CONSTRUCTION REPAIR V Telephone# Land Use � �+�• �� Slopes(goo) `S Surface Stones Distances from: Open Water Body Ft Possible Wet Arta ft Drinking Water Well Nti ft Drainage Way �� ft Property Line Q ft Other ft SKETCH:(Street name,dimensions of lot,exact locations of test}toles&perc tests,locate wetlands in proximity to holes) am 9-L eo11va °► _ IL e M. i a[ i 19 aar 1} 25.788t sq ft n n s,aoa 3Lmw 7s' s a M9 Parent material(geologic) L) Depth to Bedrock • Depth to Groundwater. Standing Water in Hole: QD®11 1?— Weeping from Pit Face Estimated Seasonal High Groundwater Method Used: DETERMINATION FOR_SEASONAL HIGH WATER TALE Depth Observed standing in abs.hole: in. Depth to sell mottles: Depth to weeping from side of obs.hole: in, Groundwater Adjustment ff. Index Well# Reading Date: Index Well level Ad1,factor—Adj.Groundwater Level_ NEWCONSTRUCrION REPAIR Telephone# —07 Land Use AAj �T7- Slopes(% S Surface Stones Distances from: Open Water Body ft Possible Wet Area�ft prinking Water Well {eft Drainage Way / O ft Property Line ft Other ft SKETCH:'(Street name,dimensions of lot,exact locations of test holes&pert tests,locate wetlands in proximity to holes) Al <01 dmt M Isom V � 1 01 i 19 = 25,78ft sq R n n .t" 7V M Parent material(geologic) &f Depth to Bedrock �a C) Depth to Groundwater. Standing Water in Hole: /,� V it I?- Weeping from fait Face Estimated Seasonal High Groundwater Z/ + A' f DETERMINATION FOR.SEASONAL HIGH WATER TABLE Method Used: Depth Observed standing in obs.hole: in. Depth to soli mottles. ` /ti`- in, Depth to weeping from side of obs.hole: in. Groundwater Adjustment ft. Index Well# Reading Date: Index Well level. Adjj.factor, m, Adj.Groundwater)-evr l,,,o PERCOLATION TEST Date_ T n e Observation / Hole# Time at 0" Depth of Perc Time at 6" Start Pre-soak Time @ Time(0-6") - End Pre-soak Rate Min.Mch Site Suitability Assessment- Site Passed Site 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 wrtbin 100'of wetland,you must first notify the. Barnstable Conservation Division at least one (1)week prior to beginning. Q:X.SEPTICIPERCFORM.DOC , i I DEEP.OBSERVATION:HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Sw ace(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. ConsistcncX,%Gravel) SA - `DEEP OBSERVATION HOLE LOG 'Hole# - Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. _Consistency,%Gravel) .tie ° '- C l A-G f Pi C1 1+3 'fig p n� Y Aid, DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency.%Gravel) DEEP OBSERVATION HOLE LOG Hole# Depb from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency.%Gray1 t Flood Insurance Rate Man* A linve 500 year flood boundary No_ Yes -/3 LT 5��..,� l-� T/, tip , a DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture - Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Co si to c Gravel DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. onsi en 1 Flood Insurance Rate Map.• Above 500 year flood boundary No Yes — - Within:011 year boundary No Yes — - -- -- --- - - Within 100 year ficed boundary No— Yes.,,_ - Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the area proposed for the soil absorptidn system? —, If not,what is the depth of Naturally occurring pervious material? Certification ' I certify that on C f �d ( ate)I have passed the soil evaluator examination approved by the Department of Environmental Protection and that the above analysis was performed by me consistent with . the required trai br ise and peri nce described in 310 CMR 15.017._ Signature Date f` I Q:%SEPnQPERCFORM.DOrC E . t TOWN OF BARNSTABLE fir. 19 LOCATIONZO / l q ,wkre iv 5 !A tfz SEWAGE # c� 7- �2Y I r VILLAGE ASSESSOR'S MAP & LOT 3 C i STALLER'S NAME PHONE NO. J T (�f21SCnI .SOPTIC TANK CAPACITYACHING FACILITY:(type) I-ea.i NO. OF BEDROOMS PRIVATE WELL OR �UBLICWAT - BUILDER OR OWNER 0t e-n,D 1z/e o,C (,.�t tl G!?R� DATE PERMIT ISSUED: �� / P7 I' DATE COMPLIANCE ISSUED• VARIANCE GRANTED: Yes No .�� •,\ :7 �� ��� � � �� � � �`� � I i � 3 � i r `t ASSESSORS MAP NO: 0, ` No �?..-z � PARCEL NO.. `�.._......_ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH �1.� ............... O-4)o--.....O F........L.6.t am•4� v�- .•................... u�4 � Apli iration for Dh4pooMi Marks Tonsirur#ion amit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at, - ...................... L n-.Add, s , or Lot No. . ._. i� . '.1 .. ....�� :...-•.................. ...... ..................X. .---..� caner � ..•- -•••-•-.Address ---------------•--............. Installer Address Type of Building Size Lot ....Sq. feet U ,.� Dwelling—No. of Bedrooms............................................Expansion Attic (Jvd) Garbage Grinder (fdb) aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) Q+ Other fixtur s .-•-•----------------••-•------•--•-••---••--- W Design Flow.............. __._.__.___??..........gallons per person per day. Total daily flow--......_..... 0................gallons. WSeptic Tank—Liquid capacity.Y0...gallons Length................ Width................ Diameter................ Depth................ x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No..................... Diameter.........--..--..... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) � '"' Percolation Test Results Performed by.../�l`jt' ... ..... ( .._ `'`' Date...........�..�f�,6�..b........ 14 Test Pit No. l....... ....minutes per inch Depth of Test Pit.................... Depth to ground water...--..--............---. Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ --------------- - ... - O f !J Descriptionof oil-----•••• 1 �� --.......................................................... U -------------------------- �� = 2. W ---•---------------------•-•--------------......•--••----••-------•-•----•..........-----------------•--••---•-----...-•------•--•----------••-••----------------•---................................. VNature 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 L I'= 5 of the State Sanitary Code The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. j Signed........... / .... •- ............ Application Approved By------------- A .......... Date'_._..... 4 1 Date Application Disapproved for the followin asons:.•••--...---•-•---------------------•-----------••.......------------•-------------•--------••-•--...--•--...... --•------------------•--•-----•--------------------------------•-•---------•--•-•---------------•----•------._._....._.....•-------------------•---------------------------------•••••.....•----...----- Date PermitNo...................................................- - Issued_....................................................... Date JA No.--_Wit._•_....._....... - ` Fi3s.......__.._...._._ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ...............L r`Q)A)..--....0F......... .'f'�3��,!���` .11.2 Appliratiun for Disputittl Works Tonlitrurtion Prruti# Application is hereby made for a Permit to Construct ( or Repair ( ) an Individual Sewage Disposal System at:e� d . -------- -------6- -------•--- L anon Addre or Lot N _ - a � & V • ------- -----------•-. ....... Owne XAddfess 1r ..---... ..------••---•••••••••-••••....... ....... ._.......----_ dd --.........•-•--...••••...---•••••-••---••••- Installer ess Type of Building Size Lot.......2.., 7.� ..Sq. feet Dwelling No. of Bedrooms._... ..........:....................Expansion Attic .(_No Garbage Grinder (At) Other—Type T e of Building No. of ersons____________________________ Showers 114 YP g ................•----------• P ( ) — Cafeteria ( ) d Other fixtures -------------•------------ Design Flow............... I._________ ..__.gallons per person per day. Total daily.flow................: ................gallons. Septic Tank—Liquid capacity- �t3 __gallons Length................ Width................ Diameter................ Depth................ W 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 ( ) l aPercolation Test Results r� Performed by :V:-_. ....; 4 ,... Date...................�1.jj1� .. Test Pit No. 1.........?—..minutes per inch Depth of Test Pit.................... Depth to ground water........................ rX, Test Pit .No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ � _ l D Description of Soil...-•-----.....�••---..__.�'L...----•--- ••-• ---- �,_�__.-------------- ------------ ................................................ .........-! !-------• �� :•--•-•----------•--•---•---•-•---------- .._..--•-••-------------------•----••-••----•------••---------•---------------••......-------•--•-•-----------------•-----------•-•-----•-•---------------..............--------.....•-••-•--•-••---•••- V Nature of Repairs or Alterations—Answer when applicable............................................................:.................................. ....---•...................••------•-•-------•---------•----••--•-•--•-•-••-••-•••--_-_••--••-•-•-......._. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITI1 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 Signed.. ....................r ' . tit : a' Da... Application Approved BY----•-•---•---�- !dl.1?r� ..�....'.�-----••------•----......--•-----.. .._..------�-M- '.,.:. Date Application Disapproved for the f ollowinj`Jasons:-•...•---•••-•-•--•-•-•----••--•-•--•-.....---••....---•----•••••--•-•-•------•-•-•••--•--•••-•=-•••••••------ ..........................•••-•-•-••----••---__--••--•••--•••--...•-•-••-•-•---••-•••••-•.....-•-••-_-_......•••-••-••-...-•-----•--•••••-•-••--••••---•••...••--•-•--•-••-.....__..__-______.....•-••--- Date PermitNo...................................................--- Issued_..................................................... _ Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH -r� r ` ' OF......... _.. �..s...A ............................... wrtif irtt#r of Tontlrlittnrr THI TO ERTI Y, That the Individual Sewage Disposal System constructed or Repaired ( ) by_......1. ' ...... � a. .T ••-••_..... --•-•------•-----•-.....--•-•-----•-•••••-••-•........... .............•-•-_. . ...._ InInsAtst �... has been installed in accordance with the provisions of TIT_ _5,of.The9 State Sanitary Code a Oescr�bed in the t � application for Disposal Works Construction Permit No.__._:;�,M =_..__._?.?............... dated THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WIW FUNCTION ISFACTORY. DATE....•-.......... •-•-•-•t....-•- -••.. .....•-•--------------••-••••-_. Inspector..................... n THE COMMONWEALTH OF MASSACHUSETTS I BOARD OF HEALTH it ..... s .....OF.........1 �'` 1 .. .................... No.._.-.................... Fn--•-••••._--__----_----- 19iiipoonl Works Tottofrttr#iou prrntit Permission is ereby granted............ f �: ....--J"' ...2.0 •6�...............................................................--- to Construct ( t or Repair ( )` an Individual Sewage Disposal System at NO....... 6r1_ .....e t.�... L• ..._... r r. . ... ............ ,. y... Street as shown on the application for Disposal Works Construction Perr ut No.__:, .�..._�_ 'Dated..... .._............................ lC.. ------------------------------------— r Board of Health ------••--•--.....••-•---•...............................•--------....._..... r_<x FORM 1255 A. M. SULKIN, INC., BOSTON 1 ifk i� F a 77 . 1 l_07 19 - a a [v i ;00P � f � o cy . ri 32n3 f f- t '9� �c9 7 VE- LEGEND EXISTING SPOT ELEVATION 0 PROPOSED SPOT ELEVATION ' EXISTING ,CONTOUR ---0—-— ' i�h OF,ygs PROPOSED CONTOUR 0 ROtN .NOTE:`THE LOCATION OF ANY UNDERGROUND P A u i ' cyc w• SEWERAGE,WELLS, OR OTHER UTILITIES SHOWN ON. Lp o i1 1 j,1 w THIS PLAN IS APPROXIMATE ONLY AS DETERMINED, LEVY FROM RECORDS AND/OR VERBAL INFORMATION. No.10050 O 4STE w THE CONTRACTOR IS RESPONSIBLE FOR THE Aoc ta9�`•4 VERIFICATION OFF°THE EXISTING LOCATIONS III THE FIELD. y . E i N I I R AND SURVE , ilY 8t ELDREDGE ASSOCIATES,INC. {... L .. CLIENT � ,, , ENGINEERS— LANDSCAPE ARCHITECTS J08, 0. ' / PLANNERS — LAND SURVEYORS : ®�. Y: 1W s . 59 WEST MAIN STREET CHKD.BY: ,e �< ®1 ;CENTERVILLE,.MA. 02632 SHEET.,.,L4F 2_ SCALE= DATEl9_ r3 / TOWN OF BARNSTABLE 'r LOCATION R L/ W�"i` 1/110% Z, -,We- SEWAGE # VnXLAGE ASSESSOR'S MAP & LOT 044, l Slf� M` INSTALLER'S NAME&PHONE NO. n) P Lya Ldc 4.Co Lod s�l9 SEPTIC TANK CAPACITY 1 LEACHING FACILITY: (type) 1e"6"l (size) NO. OF BEDROOMS _ BUILDER OR OWNER V ��- � 2-n�'L� `� I^: 00, PERMIT DATE: I g ?,0 i Z COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by 4-2 -i Z(o 3 aLq IS -3 svi2 KS-5 b 3 D d'9.y, .t.:b ..;A... ;,.5. c 3....,h.a. ps..,g'?7. .?.v �.-.an, F..-:.,HP.m.^v+!sYy4ry. '-.'4,�.mw. h, a•...i. L. g .J �..- t' ':1^-: .���y»t� i�`�¢.`L ..,. «. _, , ,v..•4v..a: i.�aurra+ias:M4i#� , ^wiR.i.,.�k'x*.b A � „`-+! wi.aw: .�'. '� .�. s: .,,._.�`",,...,,,., ft*',•. Cap K /VOTE E/TMER 7-XE.SE 'AN/C P71C 7 OR _ /F G-,4CN/�O 9-/T ARE` MORE TNA,,V /2"8Z1-0J&t/ 4uD/9. GR.4O-, A ,24",0/sRA4.ET.��' COI,/C.�E• 7E CO .00 SJ+►•e9 L L BE -e RO&CFN T TO G/?A®,-.-�AN EX7 R/q co/vc,��r� . Pvc. P/PAr h�E,�any -AST /•eoiv C®�/E� sh+.�aLL c�E US-o M/M. P/YCX COYE/�.S m /f'/N DR/VIEWA y . ' YB 'Pow F•T. M i�l. CONCRE T� � ; T r►m-T.T.:..m.n $OLAYER Val--Ylsb 1�f1N.®/TC/�• 2000 GAL. D/S7: oe ♦ ° e e e • o �40 WA5H.ED 57VIYE BOX m : v q - s o t •e DgPTN ° o ! � ° o li/ASt1ED .5'7•®�SIL� '/ 1�, � �Aj� o mm a • e ® e o mo • • Dofp PRECASTS� P14G� � s a ® e • ®. e ♦ e � � • ® o rP/T OR E�1!/V. /NYE. AT &U/1-DI'ver .: .10,30 c r pi 7^ /k G� �=`� 90• `� CT'T�,� 6 F7 p114A1. zlova�•'r S�•��"'oC 7�.�F/iW. 9Z.90 cr /2 FT PlAm. (®(S�- 7 1/L.sl7"!oh/) 40V74ET'SEP�T/C I'A/VK /✓T. l T D157"R® de/lo9v �oX yZ,/D sE�7"ioN ®�' GROuMD 1,7.61T 7B1-�E BOX9i..70 //-f 7". ACq1fvf ®iT 11,30 FT SEWAG& ®14SR 'A 1- SKS714=AjOMATIDAI,11 LEACHI"C -10/7" -SCALE %p /=®" DeMEM,S10Al A 3.7 x7- ®1�1�Ar�1®a A11AMSE•R 3 DJ/d9gMS1®N G FT. 707iAL ES'TY/�9.�7-,0 -LOA-V 33d GAL./DAB' SO11- TEST A/ SO/L T.Es7- *,Z . '®ldC. a'E57" NUA°FRLh' OF GE,4C/ldKS P/TS / �`FLEi/. `"°EiGj! ,D.� Te Off" SO/L 7E a7" / , I• P�OTTO/�!►ds�9C/'1/A�Cr AR P/7" �/ O 2. ToP R�'SU.L.TS dr/1TN�SSED S ' P' s v soic: P��C®tom rian+ � / 2 M/�1)VCH T07A4 LmAC'K/NG AREA SO f7': POVCALA-r/0/V RA7EA2 /+y1N�lNCH ;�i° Er�6�£LC'i>/IYG fdREA -?e S.P. FT. coRF�s� so//- -ES 7 - -(tA OFAq�ss9 0. C /P A U L ��� RaCKy LO'7" IQ— W/4iT� McLsS,_� '1V A..' . rn LEVY SFt No.iooso LEVY & ELDREDGE ASSOCIATES. INC. 15 E� ��� 'r L: g✓� 3 889 WEST MAIN STREET CENTERVILLE,MASSACHUSETTS 02632 C F SON,L�N6 "I -oCwO[/Nl7 ;,V,47°'eM EZ/VCOC/NT�R O CLi.EA17 �7�'- g1ti. 51Z`,*W,47-E 11.3 Goo UA"Z> W✓4 7-Z-A- A 7- �L Ede JOb NO. 2 of SITE SITE PLAN SCALE: 20' G E N E RAL NOTES 1 . ADDRESS: #194 WHITE MOSS DRIVE, MARSTONS MILLS ti B.M.= 100.00 (Assumed) ON TAGBOLT x 103.60' 2• ASSESSOR'S NUMBER: MAP 046 PARCEL 146 o` � 1460 ON HYDRANT. DEVELOPER'S LOT: LOT #19 4, TOPOGRAPHIC INFORMATION W1AS COMPILED FROM AN ON THE °3 GROUND INSTRUMENT SURVEY. NN 103.76' X 5. TOWN WATER IS PROVIDED TO THE SITE & SURROUNDING PROPERTIES. o• eet 6. NO WETLANDS ARE LOCATED WITHIN 150 FEET OF THE PROPOSED SAS. �� Sch°o\ Str 7. REFERENCE PLAN: LAND COURT PLAN 37857-6, SHEETS 1 -49 s 8. UTILITIES WERE LOCATED BY 'DIGSAFE CONFIRMATION #201034100119 Asa Me\ o°a 102 roN 103.14' Patio With "MARSTONS MILLS„ trellis Pro sed SASLOCUS CO 2 H- 500 gal. chambers deck wit 4' of stone all around 1° Design Calculations NO SCALE 13' Number of Bedroorr�: 3 Equivalent to 330 Gal./Day 'oo j°� o Garbage Disposal: qo x 1 .9s' ® 1 2 �' Leaching Capacity Fequirecl: 330 Gal./Day ° B. �� . P T.H #2 �, ��, Application Rate for <2 min./inch 0.74 gal/sq. ft. ° o X 100.97 r areae p Septic Tank Capaciy: 1,50U11 -gal. req d. Ex. 1,000 gal. H-10 (OK for Repair) 0' 0 a 100 v Proposed Leaching Structure: 1-25'xl3'x2' Leaching Trench 97.ss4�, O o Bottom Leaching Aea Provided = 325 Sq.Ft. 01.92' (sting leach pit T.FI. #1 -� Z --� x Side LeachingArea Provided 152 s ft. 1771 1� p s.80' x 101.39 to be removed Total Leaching Arer Provided = 477 sq. ft. o =477 s ft X 0.74 al s .ft.=353 d. Capacity Provided gp '.<:»::>«> ><: :: Leaching Ca q 9 / q x P Y + 1 .13 9 7. 4 .............. 0::1 2.89 a s rn :.:.......8....740 ..............•:::::::::r::::::: . .......... "'`.................................:...:...:....:.:.i ...{t.... ... . . .......... ....... .. ° ..::::.:::::::: . .........................:...:...... ...:...:.:.... 19CONSTRUCTION......::.: : ::::::::::::::::::::.:........:cn . / NOTES ....:>»:> : :.. . A_ 25,788f sq. ft. 99.87 en ` 97.0 1 . Contractor is responsible for Digsafe notification (D cn vrde i and protection` of all underground utilities and pipes. a X 100.68' 2. The septic=;tank and distribution box shall be set level.. on 6 of 3/4 -11/2 stone. X 100.39' 249.79 o '• 3. Backfill shoi.ild be clean sand or gravel with ,no 96.7 c° „ . stones over 3 In size. M , c° �O d ..._This. systerr ,is cp o #194 Wrii TE MOSS DRIVE to Glen E. liarrington, R.S. _4 046-145 5. The contractor shall install this system in accordance SOIL EVALUATION & PERK TEST : P 13044 Town water' - with Title V 'of the Massachusetts Environmental Code. 6. If, during installation the contractor encounters any Date of SOIL EVALUATION: SEPTEMBER 1, 2010 soil conditions or site conditions that are different Evaluation Performed By. GLEN E. HARRINGTON. R.S. Excavator: Eric Stevens from those shown on the soil log or in our design Percolation Rate:< 2 mpi assumed, (P#6135, 9/11/86, T. MCKEAN, WITNESS) the installer'shall halt installation and immediately notify Witness: )avid W. Stanton, R.S., BOH Agent Glen E. Harrington, R.S. Test Hole Test Hole 7. No vehicle car heavy machinery shall drive over the No. 1 No. 2 septic system unless noted as H-20 septic components. j DEPTH SOILS ELEV. DEPTH SOILS ELEV. 8. Install Tuf-Tite gas baffles or equal on septic tank outlet tee. 0 00.97 0 101.0' 9. All piping shall be SCH 40 PVC. LS 4" 1 LS 0YR2/2 00.64 6" 10 A. 100.5' 10. No wells are located within 250' of proposed SAS. B s 11 . Install a 4 dia. SCH 40 PVC observation port with screw cap. oamy sanc cam can v 10YR5 6 / CBUT1ISET �'t MA'I.Lk:ASt.•2LE'T• within 3" of grade as shown. 10YR5 6 24" 98.97' 18" 99.5' pta1T�^36J1tt;N �3t3K Swat..,.#�� C1 C1 .'.••� x,�.i ¢ 12. Install 2 H-l 0 500-gal. Acme Precast chambers, or equal. M-C sand M-C sand Soil Evaluation Certification ~ 5 V ouTET 51" 10YR4/2 s7r 48" 10YR4/2 970• - '"; K4a,�w ., ;;:` 13. The Contractor shall notify the Board of Health and the Designer I certify that on October, 1995, 1 have passed the soil evaluator C2 C2 examination approved b the DEP and that the' anal sis was performed b sss• r'; r.l .. le INLET at least 24 houirs in 'advance to inspect and certify the system. M-C sand M-C sand PP Y Y P Y CUTLET 1oYR7/3 1oYR7/3 me consistent with the required training, expertise and experience described e" $. :. 132" [19.01132" so.o in 310 CMR 15.017. a.: .,.,,...:. ; No Observed Ground Water _............. " .. � •. ' 2u PROPOSED SEPTIC SYSTEM REPAIR. • Glen E. Harrington, R.S. -Date r P S ::C;TI N CROSS......SE ;•1•I0N l.. jN- REPARE FOR D 15 LE DISTRIBUTION Box F VICTOR J . ENRIGHT ET UX SYSTEM PROFILE NOT TO SCALE AT Existing Dwelling Note to Scale Use Wiggin Precast H-10 5-Hole D-Box for equal 194 WHITE MOSS DRIVE First FI.=105.25' WGGIN PRECAST OR EQUAL 5 HOLE H-10 (MARSTONS MILLS) BARNSTABLE DIST. BOX Existing Grade 102.25' Finished grade over system=2% slope away Existin2 Grade = 101'f CELLAR Septic tank covers must be D-Box cover shall be One chamber cover shall be Min. 2"-1/8"-1/2" Double-Washed Stone LEGEND �NOF/uj�{ WALL = within 6" of finished grade within 6" of finished grade within 6" of finished grade or geo-textile filter clotht�P � PREPARED BY: S .02 _ � • " ' S==.01 To of Peastone Elev. 99.5't �- Approximate location p 11t Glen E. Harrington, R.S. Level for 2' S=0.01 ft ft gas ne 20' EXISTING Inv 1 v.= 00 Approxi at location G 1000 GAL. 30 1z' ® Q CM " - water une Leda Rose Lane SEPTIC TANK p_gg,43' 24 le- Existing contour �( arstOnS Mills, MA 02648 H-10 0' ® ® ® � FBottom acility Elf Leac.0 ® s - � Tel: 508-428-3862 f 6 Inv. elev.= 100.35 Install Gas Baffle � ept cn a k 00 gal. FGI � �,� Fax: 5108-428-38 2 � 1 100.15' or equal.... P=99.60 (TAR Inv. elev.= 3/4"-1 k" Double-Washed Stone ' 5' Min. (7't provided) Existing leach pit 8 . 6" OF 3/4"-11/2" STONE LEACHING CHAMBERS (to be pumped & removed) SCALE: 1"=20' DRAWN BY: GEH DATE: NOV. 12, 2010 Bottom of O.p. Observation Port 6" OF 3/4"-11/2" STONE Hole #1 Elev.=89.97 DATUM: ASSUMED FILE. ENRIGHT SHEET 1 OF 1