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0025 WILLIMANTIC DRIVE - Health
25 WILLAMANTIC`i b6lv Ma' rstons Mills 4 A = 103.— 050 i TOWN OF BARNSTABLE LOCATION 1-1""W/11/a 90i4 rl G 9/' SEWAGE# V VILLAGE 7'Oh,5,WlAs ASSESSOR'S MAP&PARCEL 1,95 =5�a INSTALLER'S NAME&PHONE NO. �50,4120-9738 ✓os-cp`i ae [�s4liryS SEPTIC TANK CAPACITY 1000 LEACHING FACILITY.(type)J -.500���`yPubZ- S (size) NO.OF BEDROOMS /y OWNER awk1 t 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 ; � u/i l li��yric Ori✓ 4 s � 37, o Commonwealth of Massachusetts M15 -'05a Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments - ^G �r 25 Willimantic Dr. 70 r t� Property Address R Edward and Janice Botelho a Owner Owner's Name information is required for every Marstons Mills MA 02648 3/30/2018 page. City/Town State Zip Code Date of Inspection I =ems 7 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. General Information �1 filling out forms on the computer, 7 use only the tab 1. Inspector: key to move your cursor-do not Paul Martin use the return key. Name of Inspector Cape Cod Septic Services r� Company Name 350 Main St Company Address W.Yarmouth MA 02673 City/Town State Zip Code 508-775-2825 815016 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. 1 am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000).The system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority 'oe � 4/9/2018 Inspector's Signature Date fi 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 Ihas 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. t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 17 / i/S �.. VS, Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments G b ,•'w 25 Willimantic Dr.. Property Address Edward and Janice Botelho Owner Owner's Name information is required for every Marstons Mills MA 02648 3/30/2018 page. City/Town State Zip Code Date of Inspection l 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: System is in working condition. B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no" or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 17 Commonwealth of Massachusetts a W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M `< 25 Willimantic Dr. Property Address Edward and Janice Botelho Owner Owner's Name information is required for every Marstons Mills MA 02648 3/30/2018 page. Cityrrown 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•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 i ' Commonwealth of Massachusetts Title 5 Official Insp ection Form Subsurface Sewage Disposal System Form -'Not for Voluntary Assessments M Syey'.� 25 Willimantic Dr. Property Address Edward and Janice Botelho Owner Owier's Name information is Marstons Mills required for every' MA 02648 3/30/2018 page. Cltyrrown State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for 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"Yes" or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than Y2 day flow t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts Title 5 O- W fficial Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 25 Willimantic Dr. Property Address Edward and Janice Botelho Owner Owner's Name is* for every very MarstonS Mills MA 02648 3/30/2018 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. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified. laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy.of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd.to 15,000-gpd. For large systems, you must indicate either"yes"or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ 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-Page 5 of 17 Commonwealth of Massachusetts H W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M , " 25 Willimantic Dr. Property Address Edward and Janice Botelho Owner Owner's Name information isequired or every Marstons Mills MA 02648 3/30/2018 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 ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil.Absorption System (SAS)on the site has been determined based on: ® ❑ Existing,information. For example, a plan at the Board of Health. ❑ ® Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15302(5)] D. System Information Residential Flow Conditions: Number of bedrooms (design): 4 Number of bedrooms (actual): 4 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 110x4= 440gpd t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 17 Commonwealth of Massachusetts u W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 25 Willimantic Dr. Property Address Edward and Janice Botelho Owner Owner's Name ion is required uired for every Marstons Mills MA 02648 3/30/2018 page. CityrFown State Zip Code -Date of Inspection D. System Information Description: Number of current residents: 2 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? (Include laundry system inspection El Yes ® No information in this report.) Laundry system inspected? ® Yes ❑ No Seasonal use? ❑ Yes ® No Water meter readings, if available last 2 ears usage 2016=107gpd g ( Y 9 (gPd))� 2017=79gpd Detail: i Sump pump? ❑ Yes ® No Last date of occupancy: Current 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? El 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•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 Commonwealth of Massachusetts 4 W Title 5 Official. Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments law GSM ,•°� 25 Willimantic Dr. Property Address (Edward and Janice Botelho Owner Owner's Name information is required for every Marstons Mills MA 02648 3/30/2018 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: Source of information: No records Was system pumped as part of the inspection? ❑ Yes ® No If yes,volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil-absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments Sy0'r 25 Willimantic Dr. Property Address Edward and Janice Botelho Owner Owner's Name information is Marstons Mills MA 02648 3/30/2018 required for every page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: 2014 Per BOH records Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 30"feet Material of construction: ❑cast iron ®40 PVC ❑ other(explain): Distance.from private water supply well or suction line: +10,feet Comments (on condition of joints, venting, evidence of leakage, etc.): Line was checked with sewer camera and was found to be clean, properly pitched with no sign of root intrusion. Septic Tank(locate on site plan): Depth below grade: 20"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: 1000Ga1 Sludge depth: 6-8 11 t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 Commonwealth of Massachusetts w Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M .�r 25 Willimantic Dr. Property Address Edward and Janice Botelho Owner Owner's Name information is required for every Marstons Mills MA 02648 3/30/2018 page. City/Town 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 3-5" Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle How were dimensions determined? Estimated Comments (on pumping.recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): 1000Gal tank in good structural condition. PVC tees in place. Tank at normal operating level. Inlet cover 10" below grade with outlet 20" below grade. Tank was serviced days after inspection by another company. 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•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts u . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M °F 25 Willimantic Dr. Property Address Edward and Janice Botelho Owner Owner's Name information is Marstons Mills required for every MA 02648 3/30/2018 page. City/Town State Zip Code Date of Inspection Di. 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 ❑ 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 t5ins•3H 3 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts uEERIE=W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments oc wM °p 25 Willimantic Dr. Property Address Edward and Janice Botelho Owner Owner's Name information is required for every Marstons Mills MA 02648 3/30/2018 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.): H-10 Db-3 with 1 line in and 2 lines out in good condition. Box is clean and level with minimal solids carryover. No sign of overloading or hydraulic failure. Cover 20" below grade. . 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: t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 Commonwealth of Massachusetts Title 5 Official. Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 25 Willimantic Dr. Property Address Edward and Janice Botelho Owner Owner's Name information is required for every Marstons Mills MA 02648 3/30/2018 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ® leaching chambers number: 3-500Gal ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): 3-500Gal chambers with stone in a 13'x33'x2'Trench. No standing effluent in chambers during inspection. No sign of overloading or hydraulic failure. 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 ` t5ins-3/13. Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 17 Commonwealth of Massachusetts W Title .5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments °�• °r 25 Willimantic Dr. Property Address Edward and Janice Botelho Owner Owner's Name information is required for every Marstons Mills MA 02648 3/30/2018 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy(locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 17 Commonwealth of Massachusetts N Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 25 Willimantic Dr. Prcperty Address Edward and Janice Botelho Owner Owner's Name information is required for every Marstons Mills MA . 02648 3/30/2018 page. Ciffrown 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: ❑ hand-sketch in the area below ® drawing attached separately t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 15 of 17 Commonwealth of Massachusetts W Title 5 Official Inspectionform Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 25 Willimantic Dr. Property Address Edward and Janice Botelho Owner Owner's Name information is required for every Marstons Mills MA 02648 3/30/2018 page. City.Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope ® Surface water ® Check cellar ® Shallow wells Estimated depth to high ground water: +10' 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: 2014 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: Test hole data per plan on file at BOH. Max bottom of leaching is 5'. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 16 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 25 Willimantic Dr. Property Address Edward and Janice Botelho Owner Owner's Name information is required for every Marstons Mills MA 02648 3/30/2018 page. Cky/Town State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems)completed ® System Information—Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file it t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 Page 1 of 2 TOWN OF BARNSTABLE LOCATION -, SEWAGE# w» tF VILLAGEVW3 1A111, ASSESSOR'S MAP&PARCEL Ilr3 -S'o INSTALLER'S NAME&PHONE NO. �0 y2d-g738 s cp`i l,. 6i4yr0 S SEPTIC TANK CAPACITY f 000. _ LEACHING FACILITY:(type)j 00 �14hl-"15 (size) j I NO.OF BEDROOMS y OWNER au1;4,- f/lq,97 EIha PERMIT DATE: -;t ,r COMPLIANCE DATE: /0 Separation Distance Between the: Maximum Adjusted Groundwater Table to the 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 FURMSIIEDBY t wrr�r>nr�nr�� vrivr a -3, 9u, p - p, 2 -37 3-3 &0,611 3 http://www.townofbamstable.us/Assessi _ _n /H g Mdisplay.asp.mappar-1.03050&seq 2 3/29/2018 /)/ 4110 No. Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHU SETTS 0(pplitation for Disposal bpstem Construction Permit Application for a Permit to Construct( ) Repair(,4-*LJpgrade Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No.16_40:L4./IH.V/7174- OR. Owne 's Name,Address,and Tel.No. rr �,arstn�s �ii/�s i=�cv�ry l3or�'G, Ho S� Assessor's Map/Parcel o Installer's Name A dress,and Tel.No.fOS— 28o•7752 Designer's Nime,Address,and Tel.No., ✓OSC i DC voeeO$ ti o2G S 0,45Y R1 vae rEN9'ir�.eerir,�' Type of Building: Dwelling No.of Bedrooms y Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) . Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued b is Board of Health. i d Date Application Approved by Date Application Disapproved by Date for the following reasons Permit No. Date Issued e I No. 4 Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS 1plication for ]Disposal 6pstettt construction PermitApplication for a Permit to Construct( ) Repair(Upgrade��Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No.�' SGC//LG/i?'1 L9/9 T/C ��Q, Owne�'s Name,Address,and Tel.No. Assessor's MaprPazcel U elp_ Q f��l�S �.f Gl/6�'rLJ /30 T/,G HO • Installer's Name,Address,and Tel.No.Sa?>- ?Z v• 775 Z Designer's Name,Address,and Tel.No.,S�,G-3 S=3 Y 2 G Jos-e�h 1)e 3�,4 g1455Erdyir>.�e/^ih y r = a l r o 6 Type of Building: ry: �• Dwelling No.of Bedrooms y Lot Size sq.ft. Garbage Grinder( ) „" Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures:_. f Design Flow(min.required) gpd Design flow provided gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) Date last inspected:. Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of ` Compliance has been issued b is Board of Health.. - ig d _ f' i_�,.?_ Date Application Approved by Date, Application Disapproved by i Date l for the following reasons Permit No. Date Issued THE COMMONWEALTH OF MASSACHUSETTS _ BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS iIS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired Upgraded(�.} Abandoned( )by / at 5� //%i;// /4i�y j%/ /,j^. /�h�>;�;w • %J�has been constructed' acc rd e with the provisions of Title 5 and-the for Disposal System Construction Permit No ed Installer ��r_ , rl #bedrooms y Approved design w /� gpd — 1 / ` The issuance of this permit shall not b con e as a guarantee that the system�3i f�inc designed t% Date -Inspector -----------9---------------- - --------------------------------------------------------------------------------------------- No. Fee —'�" THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS MispoSal 6pstem Construction Permit Permission is hereby granted to Construct( ) Repair Upgrade( L) Abandon( ) System located at 64l71Wr 5 L;I ti dy-,-,— v 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. Pfovided:Construction must be co le ed within ee y azs of the date of this permit. } Date r fi Approved by ; Septeriber 8, 2014 Donald Desmarais,R.S. Barnstable Health Department 200 Main Street Hyannis, MA 02601 RE: Janice Botelho 25 Willimantic Drive(map 103,parcel 50) Marston Mills,MA Dear Don: Thank you for the time you've spent reviewing the plans for our new septic system. For the record, our house has been a 4 bedroom home since my husband, Edward, purchased it in 1978. Thank you for your attention with this matter. Sincerely, - CO Janice Botelho Town of Barnstable .� ' .�.� Regulatory Services i s Richard V. Scali,Interim Director MAM• 3ARNWrABLE. • Public Health Division Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Installer& Designer Certification Form Date: Sewage Permit# 0 —3 Assessor's Map\Parcel 03 SO Designer: 1-H o n1AS M UEuAN �.f. Installer: � o Q Address: BOX 110 Address: P,. DENIV15. /n A Dug i On 11-2-4h �o -` ,64CO �-Swas issued a permit to install a (date) (installer) septic system at Z5 W 1LLIMAN1 i c-- OF-105 based on a design drawn by (address) 'THO aAC MQt EIIPN dated (designer) 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. Strip out (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 Regulations. Plan revision or certified as-built by designer to follow. Strip out(if required)was inspected and the soils were found satisfactory. I certify that the system referenced above was constructed in com liance with the terms of the IAA approval letters(if applicable) 1 L�1 (In ller's 'gnature) (Designer's U, ature) (Affix Designerys%-Omp Here) PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS- BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. Q:\Septic\Designer Certification Form Rev 8-14-13.doc Town of Barnstable P tt Department of Regulatory Services ^ RL&MSrAB� E Public Health Division DateMABEL 20 Street,Hyannis MA 02601 • t&!t MF.V 2A10 Date acaeduleti —� Time Fee I'd. O I IScpil Suitability Assessment f'or Sewage Disposal Performed By:JNomnS InC e"f j p t e Witnessed BY: S L,O ATJON& GENERAL INFORMATION e Location Address �-L /// // p/'f� Owner's Name M/Vr�ol�s j C' Address Assessor's Map/Parcel: /�� -"���✓ - Engineer's Name O NEW CONSTRUCTION REPAIR Teleph one# 59b Land Use ^ ,0� Slopes(96) I , Surface Stones 'V Distances from: Open Water Body_ -_ft Possible Wet Area.—"-D ft Drinking Water Well "0 ft Drainage Wu /� t g Y 0�ft Property Line �� ft Other ft SEETCH:(Street name,dimensions of lot,exact locations of test holes&pere tests,locate wetlands to proximity to holes) to Zael a - �p T� Z \o e� AVE 3 Parent material(geologic) �f VZ►✓/.) Depth 19 Bedrock, /VA Depth to Groundwater. Standing Water in Hole:ltl_tl/'s Weeping fl-ont Plt Face (UD/ 1� Estimated Seasonal High Groundwater 32 DETERMINAnON I+OIL SEASONAL.NIGH WATER TABLE a'bietitod Used: — �` Depth Observed standing in obs,hole: /V9/LIt lu, Depth to loll mottles; /ll ltt, Deptir to weeping from side of obs,hole: Np/1r III, Groundwater Adjuah e.111 ft. Index Well t# Reading Date: Index Well level_ _ Ac(f,t'tCtor..,,,,��_ At(�,C3ltlundwufer level , PERCOL,ATI.ON TEST Date� Tlttte Observation Hole# `Clete at 9" Depth of Pero Time a[G" Start Pre-soak Time @ Time(9"-6") End Pre-soak PE i C� Ho N 1o/,/ A? T1,7?£ 6F CONSTR-0Qn-i otv Rate Min.�Iuch / Site Suitability Assessment: Site Passed V Site Palled: Additional Testing Needed(Y/N) Original: Public Health Division Observation Hole Data To Be Completed on Back----------- *"If percolation test is to be conducted Within 100' of Wetland,you niu><st first notify the Barnstable Conservation Division at least one (1) Week prior to beginning. Q:\S Ernc\rr1RCrORM.DOC =5 DEEP OBSERVATION HOLE LOG Hale#Z_ Depth from Soil Horizon Soil Texture .Sdil Color Soil . Other Surface(in.) (USDA) (Munsell) Mottling (Stnucture,Stones;Boulders. onsi [ency q6(Iravell 6" 4 Ar S-&V ,6l 41', N SaN. , ,� n b 2. 1� GZ ,0 2.f'1 S L d DLLP 013SF-RVATION HOLE LOG Hole#k 'L— Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. onsisten %Gravel) 214~ SANVJ VA 5 O 61 Sl bi un ,S DLLP OBSERVATION MOLE LOG Mole# Depth from Soil Horizon Soil Texture Soil Color Soil Other surface(in.) (USDA) (Munsell) Mottling (Structure,Slones,Boulders. Con i to cy,9a Oravcl)- ' t DLLP OBSERVATION HOLE LOG Dole#k Depth from Soil horizon Soil Texture Soil Color Soil Olhcr Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders, Consistency, 6 a Flood Insurance Rate Mall: Above 500 year flood boundary NO— Yes _ Within 500 year boundary No Yes Within 100 year flood boundary No� Yes ]tenth 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 absorption system? _ If not, what is the depth of naturally occurring pervious material? Certifiication 4 I certify that on t (date)I have passed the soil evaluator examination approved by the Department of Environmental Protection and that the above analysis was performed by me consistent with . the required trai ng,expertise and experience described in)10 C1vM 15.017. Signature Date 9--7- Q:\S EPTIC\Pl]RCPORM.DOC YOU WISH TO OPEN A BUSINESS? For Your Information: Business certificates [cost$40.00 for 4 years). A business certificate ONLY REGISTERS YOUR NAME in town (which you . must do by M.G.L.- it does not give you permission to operate.) You must first obtain the necessary signatures on this form at 200 Main St., Hyannis. Take the completed form to the Town Clerk's Office, 1 st FI., 367 Main St., Hyannis, MA 02601 (Town Hall) and get the Business Certificate that is required bylaw. DATE: Fill in please: APPLICANT'S YOUR NAME/S: �7 �' l� ✓� BUSINESS _ �� �YOUR HO E ADDRE � � Z6 2O- TELEPHONE # Home Telephone Number �`8. - 4�'��' GO 5 NAME OF CORPORATION: NAME OF NEW BUSINESS TYPE OF BUSINESS IS THIS A HOME OCCUPATION? ;g YES NO ADDRESS OF BUSINESS i ! �� �' MAP/PARCEL NUMBER �U 0 (Assessing] When starting a new business there are several things you must do in order to be in compliance with the rules and regulations of the Town of Barnstable. This form is intended to assist you in obtaining the information you may need. You MUST GO TO 200 Main St. — (corner of Yarmouth Rd. & Main Street) to make sure you have the appropriate permits and licenses required to legally operate your business in this town. 1. BUILDING COMMISSIONER'S OFFICE This individual has been informed of any permit requirements that pertain to this type of business. Authorized Signature** COMMENTS: 2. BOARD OF HEALTH This individual has been in6(me�(pthe permit requirements that pertain to this type of business. MUST,,,LIMPLY WITH ALL . l� (' 1 �/ I iV2ARD00 h':.AT[�RIA!S R`.=GIA1 A*Ti Authorized Signature* COMMENTS: 3. CONSUMER AFFAIRS (LICENSING AUTHORITY) This individual has been informed of the licensing requirements that pertain to LI its Lype of business. Authorized Signature** COMMENTS: Dateio/z5w/ TOWN OF BARNSTABLE RE9' TOXIC AND HAZARDOUS MATERIALS OWSITE NAME OF BUSINESS: Lie zkCl--- BUSINESS LOCATION: K,—� ��� /' INVENTORY MAILING ADDRESS: TOTAL AMOUNT- TELEPHONE NUMBER: '`7741 - 2-0e — �i q 7 CONTACT PERSON: --qGr/1 k __,Sw&- z,- r EMERGENCY CONTACT TELEPHONE NUMBER: 107�� MSDS ON SITE? TYPE OF BUSINESS: INFORMATION/RECOMMENDATIONS: Fire District: Waste Transportation: Last shipment of hazardous waste: Name of Hauler: Destination: Waste Product: Licensed? Yes No NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws of MA, hazardous material use, storage and cisposal of 111 gallons or more a month requires a license from the Public Health Division. LIST OF TOXIC AND HAZARDOUS MATERIALS The board of health and the Public Health Division have determined that the following products exhibit toxic or hazardous characteristics and must be registered regardless of volume. Observed / Maximum Observed / Maximum Antifreeze (for gasoline or coolant systems) Miscellaneous Corrosive ❑ NEW ❑ USED Cesspool cleaners Automatic transmission fluid Disinfectants Engine and radiator flushes Road salts (Halite) Hydraulic fluid (including brake fluid) Refrigerants Motor Oils Pesticides ❑ NEW ❑ USED (insecticides, herbicides, rodenticides) l Gasoline, Jet fuel,Aviation gas Photochemicals (Fixers) ©i Diesel Fuel, kerosene,#2 heating oil ❑ NEW ❑ USED .Miscellaneous petroleum products: grease, Photochemicals (Developer) lubricants, gear oil ❑ NEW ❑ USED Degreasers for engines and metal Printing ink Degreasers for driveways &garages Wood preservatives (creosote) --aulk/Grout Swimming pool chlorine Battery acid (electrolyte)/Batteries Lye or caustic soda Rustproofers Miscellaneous Combustible Car wash detergents Leather dyes Car waxes and polishes Fertilizers Asphalt& roofing tar PCB's Paints, varnishes, stains, dyes Other chlorinated hydrocarbons, Lacquer thinners (including carbon tetrachloride) ❑ NEW ❑ USED Any other products with "poison" labels (including chloroform, formaldehyde, Paint&varnish removers, deglossers hydrochloric acid, other acids) Miscellaneous. Flammables Other products not listed which you feel Floor&furniture strippers may be toxic or hazardous (please list): Metal polishes Laundry soil &stain removers (including bleach) Spot removers&cleaning fluids (dry cleaners) Other cleaning solvents Bug and tar removers Windshield wash - WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS Applicant's Signature Staff's Initials TOWN OF BARNSTA.BLE t' LOr,_ATIONcy5 l),-/l0irW,9 /, ' &,,&C SEWAGE # 7 VILLAGE Aaj5 knts 117)'1/lS ASSESSOR'S MAP & LOT INSTALLER'S NAME & PHONE NO !'D�/®J�v�,' SEPTIC TANK CAPACITY LEACHING FACILITY:(type 4 i242?2L S' e� (size) G ' k lJ? ` NO. OF BEDROOMS_ PRIVATE WELL OR UBLIC WATER BUILDER OR WNER�� V,-,JA6 DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: L7.K' VARIANCE GRANTED: Yes No�) I ASSESSOR'S MAP NO. O PARCEL Q 5-0 L ►` C AT ION SEWAGE PERMIT NO. V LLAGE INS T A LLER'S NAME & A 0 D A E S S rrcc.4 rt'5 9 Ko&, l`T +!9E R OR OWNER DATE PERMIT ISSUE .0 DATE C0MPLIA #SCE ISSUED L L I koJ �. ►,PPROVED No. ii`'' 1 F>�s.....'�0............. fist 19Consefvato Dee THE COMMONWEALTH OF MASSACHUSETTS pl- BOARD OF HEALTH ;gnu Date TOWN OF BARNSTABLE Appliratiun fur Diupuuttl Wor1w Tomitrnrtinn ramit Application is hereby made for a Permit to Construct ( ) or Repair ( ) .an Individual Sewage Disposal System at: Location -t\ddres or LottZtoo . C' ` �^t M Nc ih- d --------------------- aV--.•-•-- -------------------------••....._ ..._...... Owner ..................... ddress ....7 •. �•--- y s Installer Address � Type of Building = _ Size Lot____________________ ._....S q. feet ,., Dwelling— No. of Bedrooms-___-=_---�------------------__.__Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ____________________________ No. of persons---------------------------- Showers ( ) — Cafeteria ( ) a Other fixtures_,... --------------------------------------------------------------------------------- -----------------------------------------------•••-.......... W Design Flow......................-7- _._._........_.gallons per person per day. Total daily flow_._____®_.........._...._..__gallons. WSeptic Tank—Liquid capacity.l0-4___galIons - Length_______________ Width---------------- Diameter................ Depth................ x Disposal Trench—No. --------2........ Width____ ___________ Total Length-----.-9-___- Total leaching area..................._.sq. ft. Seepage Pit No..-_____----__.___. Diameter____________________ Depth below inlet..... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) ►" Percolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. I................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........................ RS --------------------------------------------------------------------------------•-----------................................................................. 0 Description of Soil........................................................................................................................................................................ x c, x •••----------------------------------------•--- -------------- ........................................................ -------------------------------------- --------------••-- U Nature of Repairs or Alterations—Answer when applicable._._/ � '___ ��Sf' __� >s' r.T +^' - Q-ram..>_.. CY.... .........40...........� �T�l c.T' �CS--- ---�`f �!J ...................................................... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance�bben ue y t oard of health. oe Signed ........ ------------------------ .................................................. -------,��...�/............�...... Dace Application Approved By ............. -- ..\0..............." � .� .. f ^ Dare Application Disapproved for the following rearonf- --------------------------------------------------------------------------------------------------------------------------------- ................................................................... --------------- ------------------------------------------- Dare Perm;.t No. g---k- �. .. ...................... Issued ...................... -- ._... . .._..... ............ Date / Finc THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Appliratiun fur Diripuiittl Wor1w Tnnutrnr#inn rand# Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: ------v i�--------------------- ------------ -----------------........................................................ Location-Address or Lot No. . -• Owner ddress v ._`_. t.�s-�--------..._. Cow w - ,C� � e.4_74..r-..✓✓7-i t C_.s Installer Address Type of Building Size Lot............................Sq. feet .� Dwelling—No. of Bedrooms------------ ------------------------Expansion Attic ( ) Garbage Grinder ( ) Pk Other—Type of Building ---------------------------- No. of persons---------------------------- Showers ( ) — Cafeteria ( ) 04 Other fixtures --------------- ---------------------------------------------------------------------- ---------------------------------------------•----------- d Design Flow-------------------------_--_-_-_------____gallons per person per day. Total daily flow-------- .....................gallons. w Tank—Liquid ca acity.APeO.._gallons Length................ Width---------------- Diameter...-.._--___-__- Depth_._..__..___.... W Septic 9 P g � g � x Disposal Trench—No. .______.Z.___.... Width....Z.__________ Total Length.......,2..... 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. 1----------------minutes per inch Depth of Test Pit-------------------- Depth to ground water........................ Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ -----------------------------------------------------------------------------------------------------•-•--•---........................................................... / 0 Description of Soil........................................................................................................................ r x c., W ............................................. --------------- ------------------------- ----------------------------------------------------------------------- U Nature of Repairs or Alterations—Answer when applicable.---/ I rS%! 5—__/�- f�US(r/.�..—Ss'. .............................c�... U.x..... ....... .........../ c�If—=..•c:,T 1-iO✓ZS-- .._...`.'....J_.� --------��i...1�..-----------...-----. Agreement. The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has ben issued by the"board of health. i �� �y Signed .............1Y..... ......._.......... --------� -` --------------------------- Application Date ApprovedB �.�__\-D- .----- ... ------------ ---------------------------------------- ------- Application Disapproved for the following reasons: ... .... .... ........................................................... ......................... .................................................. ................. qDate PermitNo. 1- y ( ..2...................... Issued ...................................................... --- . Dace THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Gertifirate of Complinure THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( � ) L.•—�, L-7 G� ui r Go v �i iu� IM111ie. at ......................................................... ---- --w-------)------�-----'�`-A-.,.---------c, p --------------------------------------------------------- hasl ..-. been installed in accordance with the provisions of TITLE 5 of The State Environmental Code as described in the application for Disposal Works Construction Permit No. ..- ---V-------/-f��---------- dated .._.-------------------- ---------------- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION, SATJ.SFAC,TORY. 1 DATE...... 1��--.�-------- - .............�-------------------------------------- Inspector ------- .----------_-- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH tr TOWN OF BARNSTABLE 36 No... FEE........................ Permission is hereby granted---------------------......................... -------------•-----------------•-•---------......-----•--- to Construct ( ) or Repair Y,/ an Individual Sewage Disposal System at No. ! `'�t'g-"�?j7- .......... G�.t..------....� ' �-/c_. S Street qq n , as shown on the application for Disposal Works Construction Permit No..1.�-_1. -- Dated-----..-.�_'_�r_�..�_�./.•-•. ............................... -------------- ------------------------- /� t.,v............................... Board of Health DATE---------------------`..�.---5=--...�--•-'-(--�`•f FORM 36508 HOBBS R WARREN.INC..PUBLISHERS AsBuilt Page 1 of 1 TOWN /OF BARNSTABLE LOCATIONSrC(1i'��Q�y)C�!?Q�i' , �Q/_ �(j,e SEWAGE # 9 7/-���� VILLAGE_�ajsp�jya y /j),//S ASSESSOR'S MAP & LOT INSTALLER'S NAME & PHONE NO,�('DUIQI ,' SEPTIC TANK CAPACITY /0000 LEACHING FACILITY:(tgpe���;��kr5. (, (size) NO. OF BEDROOMS- PRIVATE WELL OR UBLIC WATER BUILDER OR NE-k- DATE PERMIT ISSUED:_ SL DATE COMPLIANCE ISSUED: G7'K -W VARIANCE GRANTED: Yes Nu J I 1 0 yi http://issgl2/intranet/propdata/prebuilt.aspx?mappar=103050&seq=1 10/15/2013 LOCUS N KEY: ExISTINGcoNTouR:---- SEPTIC SYSTEM DESIGN SEPTIC SYSTEM SECT( ON,mob PROPOSED CONTOUR:••••••••••••• 2"PEASTONE OR FILTER FABRIC EXISTING SPOT ELEVATION: 25.5 FLOW ESTIMATE: COVERS WITHIN 6" 3/4"-1 1/2" 4 PROPOSED SPOT ELEVATION:25.5 4 BEDROOMS AT 110 GAL/DAY= 440 GAL/DAY 102.35 OF FINISHED GRAD WASHED STONE TEST HOLE: FOUNDATION "" "\ INSPECTION PORT f a\m% UTILITY POL -o- ma' SEPTIC TANK: ELEV.=95.5 FENCE LINE: HYDRANT: 440 GAL/DAY x 2 DAYS= 880 GAL m m, TON 3'MAX. WILLINGE RETAINING WALL:® 100.1 COVER USE 1000 GALLON SEPTIC TANK (EXISTING) (1'MIN) HARTFORD ELEV. 'a 98.25 AVE LEACHING AREA: ELEV. (EXISTING) 98.05 97.88 USE 3-500 GALLON CHAMBERS(8.5'x 4.8'x T EFF.DEPTH)WITH 98.5 ELEV. ELEV. 92.5 ELEV. e o ° 0 O e H ELEV. LOCATION MAP a (6"STONE UNDER) 4 LOT 88 (26,723 SF) 4'OF STONE ALL AROUND (33.5'x 12.8'x 2'DEEP) 1000 GAL < 33.5'x 12.8' ASSESSORS MAP:103 PARCEL:50 SEPTIC TANK PLAN BOOK:157, PAGE:97 SIDE AREA: (33.5'+12.8')x 2 x 2=185 SF (0.74)=137 GAUDAY TEE SIZES:(TO BE CONFIRMED) 94.5 3-500 GALLON CHAMBERS WITH BOTTOM AREA: 33.5'x 12.8'=429 SF 4'OF STONE ALL AROUND (0.74)=317 GAUDAY OUTLET:6"UP31�DOWN ELEV. (33.5'x 12.8'x 2'DEEP) CAPACITY=454 GAUDAY GAS BAFFLE (TO BE VENTED) AT OUTLET TEE (H-20) TH-1 101.5 TH-2 101.5 N O/A HORIZON ELEV. O/A HORIZON ELEV. BED BED TEST HOLE LOGS SANDY LOAM SANDY LOAM ROOM ROOM 10" 10YR 4/4 100.7 7" 10YR 4/4 100.9 ENGINEER: THOMAS McLELLAN,P.E. B HORIZON B HORIZON WITNESS: DON DESMARIS,R.S. SOYR Y OAM SANDY 5/SOAM 24" 99.5 24' 99.5 DATE: 3-7-14 Cl HORIZON Cl HORIZON 2nd FLOOR PERCOLATION RATE: <2 MIN/IN SILT LOAM SILT LOAM 84" 2.5Y 6/3 94.5 84" 2.5Y 6/3 94.5 C2 HORIZON C2 HORIZON DECK ME 15UM/6 SAND 2 MEDIUM SAND 144" 89.5 132" 90.5 bh N(O GROUND WATER ENCOUNTERED KITCHEN R MAPS BATH BED SHOW GROUND WATER ATGROUND WATER U32 DEEP) RM. LIVING BED NOTES: ROOM RM. S 84°. 0, E / 1.VERTICAL DATUM: ASSUMED 1072 zicN 1st FLOOR \ N`e 2.MUNICAPAL WATER IS AVAILABLE. 0'x EXISTING FLOOR PLAN 3.SCHEDULE 40-4"PVC PIPE TO BE USED THROUGHOUT SEPTIC SYSTEM. 4.ALL PRECAST UNITS SUBJECT TO TRAFFIC LOADS TO CONFORM WITH AASHTO H-20 SPECIFICATIONS. 5.PIPE PITCH= 1/4" PER FOOT(UNLESS NOTED OTHERWISE). 6.FIRST T OF PIPE OUT OF D-BOX TO BE SET LEVEL. 1° �Q 7.THE SEPTIC SYSTEM HAS NOT BEEN(DESIGNED TO ACCOMODATE THE USE OF A GARBAGE DISPOSAL. LEFT�p�Oo BENCHMARK AT ��•�6` \ OF BUL�HEAD 8 ALL CODEO(T TLE FICVTION DETAILS ARE TO E)AND LOCAL HEA©H E IN REGULOATIONS.ANCEW(TH THE STATE OF MASS.ENVIRONMENTAL 101.3 ELEVATION=102.40 9.CONTRACTOR TO VERIFY LOCATIONS OF ALL UTILITIES PRIOR TO CONSTRUCTION. X Shea 10.GROUND COVER OVER ALL SEPTIC SYSTEM COMPONENTS NOT TO EXCEED 3',(6,WITH VARIANCE). w 11.FIELD SURVEY PROVIDED BY TERRY A.WARNER,P.L.S.,HARWICH,MA. 00 12.THIS PLAN REQUIRES THE REVIEW SAND APPROVAL OF ONE OR MORE TOWN DEPARTMENTS AND o W IS SUBJECT TO CHANGE UNTIL SUCH TIME. 0 o rH_1 6' 'Ao9°.� > 13.EXISTING INFILTRATOR LEACH FIELD IS TO BE ABANDONED. Z X o rH 2 101.7 .o ,r / \ Q 14.D-BOX TO BE WATER TESTED TO ENSURE LEVELNESS AND EQUAL FLOW. existin `� 101 - 15.DESIGN ENGINEER TO PERFORM PERC TEST IN C2 HORIZON AT TIME OF CONSTRUCTION, 101.7 1000 gallon _V X sePtic tank / 167HIS DESIGN REQUIRES THE REVIEW AND APPROVAL OF THE FOLLOWING VARIANCE sr bh / F- FROM TITLE 5,SECTION 15.221 (7):(PROPOSED LEACH AREA TO BE GREATER THAN 3' / Z BELOW GRADE,(VARIANCE OF T). EXISTING 3 tl .f 4 BEDROOM `�� Deck oP nd=NO2.35 w- // SITE PLAN / �co 101.6X L_j E T / w J LOCATION: zt 25�jr LIMANTIC DR.,MARSTONS MILLS,MA 6 a ved Drive ® _` INT EXISTING LEACH AREA A PREPARED FOR: (SEE NOTE13) � Pa_-___� 0 1. w EDWARD & JANICE BOTELHO CDp 165.89, P°�'20� DATE:3-11-14 SCALE: V,=30' N 84°56'00"W Edge of Pavement 101� . . BASS RIVER ENGINEERING HARTFORD AVENUE LKTH40MAS J. McLE AN, P.E. P.O.BOX 1163, EAST DENNIS,MA 02641 508-385-3426 OR 508-364-9048 M 14-07 i I I