HomeMy WebLinkAbout0277 WINDING COVE ROAD - Health 277 WINDING COVE RS.MH LS
A=075.027
Commonwealth ofWassachusetts
W Title 5 Official Inspection Form
I Subsurface Sewage Disposal System Form Not for Voluntary Assessments
277 Winding Cove Rd.
Property Address
Gallagher Mike/Melissa
Owner Owner's Name
information is required for every Marston Mills Ma 02648 12/17/10
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:When A. General Information
filling out forms
on the computer,
use only the tab 1. Inspector: VVV 111
key to move your
cursor-do not Ricky L. Wright
use the return key. Name of Inspector
B & B Excavation, Inc.
Company Name
14 Teaberry Lane
Company Address
Forestdale MA 02644
City/Town State Zip Code
508-477-0653 S14595
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 ❑ Fails
❑ Needs Further Evaluation by the Local Approving Authority
12/17/10
Inspector's Signature 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.
D
t5ms•09/08 al Inspection Form:Subsurface e e 17
Title 5 Official p S S g Disposal System•Page 1 of
F
Commonwealth of Massachusetts
W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
10 277 Winding Cove Rd.
'M
Property Address
Gallagher Mike/Melissa
Owner Owner's Name
information is required for every Marston Mills Ma 02648 12/17/10
page. City/Town State Zip Code Date of Inspection
B. Certification (cont.)
Inspection Summary: Check A,B,C,D or E/always complete all of Section D
A) System Passes:
® 1 have not found any information which indicates that any of the failure criteria described
in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are
indicated below.
Comments:
B) System Conditionally Passes:
❑ One or more system components as described in the"Conditional Pass" section need to be
replaced or repaired. The system, upon completion of the replacement or repair, as approved by
the Board of Health, will pass.
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-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 17
Commonwealth of Massachusetts
W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
277 Winding Cove Rd.
Property Address
Gallagher Mike/Melissa
Owner Owner's Name
information is required for every Marston Mills Ma 02648 12/17/10
page. City/Town State Zip Code Date of Inspection
B. Certification (cont.)
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•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Sewage Di Subsurfacee s osal S stem Form Not for Voluntary Assessments
- 9 p Y rY
;M 277 Winding Cove Rd.
Property Address
Gallagher Mike/Melissa
Owner Owner's Name
information is required for every Marston Mills Ma 02648 12/17/10
page. Cityrrown 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 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-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17
Commonwealth of Massachusetts
W Title 5 Official Inspection Form
- Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
^M 277 Winding Cove Rd.
Property Address
P Y
Gallagher Mike/Melissa
Owner Owner's Name
information is required for every Marston Mills Ma 02648 12/17/10
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•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17
Commonwealth of Massachusetts
W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
277 Winding Cove Rd.
Property Address
Gallagher Mike/Melissa
Owner Owner's Name
information is
required for every Marston Mills Ma 02648 12/17/10
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 15.302(5)]
D. System Information
Residential Flow Conditions:
Number of bedrooms (design): 3 Number of bedrooms (actual): 3
DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330
t5ins-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17
Commonwealth of Massachusetts
Wo Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
;M 277 Winding Cove Rd.
Property Address
Gallagher Mike/Melissa
Owner Owner's Name
information is Marston Mills Ma 02648 12/17/10
required for every
page. City/Town 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? [if yes separate inspection required] ❑ Yes ® No
Laundry system inspected? ❑ Yes ® No
Seasonal use? ® Yes ❑ No
Water meter readings, if available last 2 ears usage n/a
9 ( Y 9 (gpd))�
Detail:
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? ❑ 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•09/08 Title 5 Official Inspection form:Subsurface Sewage Disposal System•Page 7 of 17
Commonwealth of Massachusetts
W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
277 Winding Cove Rd.
Property Address
Gallagher Mike/Melissa
Owner Owner's Name
information is Marston Mills Ma 02648 12/17/10
required for every
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:
P 9
Source of informaUcin: Owner had tank pumped last year
Was system pumped as part of the inspection? ❑ Yes ® No
If yes, volume pumped: 1500
gallons
How was quantity pumped determined? site glass
Reason for pumping: maint.
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•09108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17
Commonwealth of Massachusetts
W Title 5 Official Inspection Form
_ Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
277 Winding Cove Rd.
Property Address
Gallagher Mike/Melissa
Owner Owner's Name
information is Marston Mills Ma 02648 12/17/10
required for every
page. Citylrown State Zip Code Date of Inspection
D. System Information (cont.)
Approximate age of all components, date installed (if known)and source of information:
1998
Were sewage odors detected when arriving at the site? ❑ Yes ® No
Building Sewer(locate on site plan):
Depth below grade: 2.5
feet
Material of construction:
❑ cast iron ® 40 PVC ❑ other(explain):
Distance from private water supply well or suction line: >75feet
Comments (on condition of joints, venting, evidence of leakage, etc.):
At time of inspection building sewer appeared to be in good shape no signs of leakageor blockage
Septic Tank(locate on site plan):
Depth below grade: 2
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: 5.8x5.8x10.6
Sludge depth:
t5ins•09108 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
277 Winding Cove Rd.
Property Address
Gallagher Mike/Melissa
Owner Owner's Name
information is required for every Marston Mills Ma 02648 12/17/10
page. Cityrrown 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
39"
Scum thickness 2
Distance from top of scum to top of outlet tee or baffle
5"
Distance from bottom of scum to bottom of outlet tee or baffle 11"
How were dimensions determined? scour stick
Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity,
liquid levels as related to outlet invert, evidence of leakage, etc.):
At time of inspection tank appeared to be in good shape baffels present no sign of back up..
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
l5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17
Commonwealth of Massachusetts
W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
^M 277 Winding Cove Rd.
Property Address
Gallagher Mike/Melissa
Owner Owner's Name
information is required for every Marston Mills Ma 02648 12/17/10
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 ❑ 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-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 17
Commonwealth of Massachusetts
w Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
wM 277 Winding Cove Rd.
Property Address
Gallagher Mike/Melissa
Owner Owner's Name
information is required for every Marston Mills Ma 02648 12/17/10
page. Cityfrown 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.):
At time of inspection d-box appears to be in great shape no sign of carryover or leakage
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.):
Soil Absorption System (SAS) (locate on site plan, excavation not required):
If SAS not located, explain why:
t5ins•09108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17
Commonwealth of Massachusetts
W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
�M 277 Winding Cove Rd.
Property Address
Gallagher Mike/Melissa
Owner Owner's Name
information is required for every Marston Mills Ma 02648 12/17/10
page. Cityrrown State Zip Code Date of Inspection
D. System Information (cont.)
Type:
❑ leaching pits number:
❑ leaching chambers number:
❑ leaching galleries number:
❑ leaching trenches number, length:
® leaching fields number, dimensions: 11'x38'x1'(5
infiltrators)
❑ 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.):
At time of inspection leaching appeared to be in good shape . Inspected leaching pit with camara and
leaching was dry at time of inspection, no sign of staing 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•09/08 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
277 Winding Cove Rd.
Property Address
Gallagher Mike/Melissa
Owner Owners Name
information is
required for every Marston Mills Ma 02648 12/17/10
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•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17
Commonwealth of Massachusetts
: Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
M ' 277 Winding Cove Rd.
Property Address
Gallagher Mike/Melissa
Owner Owner's Name
information is required for every Marston Mills Ma 02648 12/17/10
page. Cityrrown 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
A � .
O
0
i
3_T_
P\2 7 301 "
A3 - 39 ,
B3 - 5o ' 10
Al = 52. 2„
B4 '
t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17
Commonwealth of Massachusetts
W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
277 Winding Cove Rd.
Property Address
Gallagher Mike/Melissa
Owner Owner's Name
information is required for every Marston Mills Ma 02648 12/17/10
page. Cityrrown 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: >15feet
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.
t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 16 of 17
Commonwealth of Massachusetts
W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
c�M 277 Winding Cove Rd.
Property Address
Gallagher Mike/Melissa
Owner's g
Name
information is required for every Marston Mills Ma 02648 12/17/10
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
® System Information— Estimated depth to high groundwater
® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file
t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 17
TOWN OF BARNSTABLE
all
LOCATION e mk:oikk� C�7� l SEWAGE # 9-7Z
VILLAGE jM gbZC Lebdjt 141t ASSESSOR'S MAP & LOT 75= J-1
INSTALLER'S NAME&PHONE NO. e ,Z-drL�At CzufS`� Z71-e.
SEPTIC TANK CAPACITY t 32� &k1_._.
LEACHING FACILITY: (type) -iZz e-t-F- � t t_, We 0 c-J
NO.OF BEDROOMS
BUILDER
PERMIT DATE: / -o��_ COMPLIANCE DATE: -tf
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) 1f/ok Feet
Edge of Wetland and Leaching Facility(If any wetlands exist
within 300 feet of leaching facility) t� Feet
Furnished by
,
•
�_ � �JL
No. qT_ 7 FEE l B t;;,
_ a�
COMMONWEALTH Or
Board of Health, AK NN�-J" ``e ' , MA.
APPLICATION FOP, DISPOSAL SYSTEM CONSTRUCTION PERMIT
Application for a Permit to Construct(L-rlEepair( ) Upgrade( ) Abandon( ) Q<omplete System ❑Individual Components
Location A W,,-, U (M 6- C0Vf— /Z I ) Owner's Name VA)(,1414 ) S iq u- f2
Map/Parcel# 75 Address
Lot# a-7 44 Telephone#
Installer's Name el— Ze 0, , Designer's Name 4-e-e Su/Ve CU-USL/--7J4^)t
Address (,�G,c' Address 70 9 2 Pb u�tRV A0 r41
Telephone# v Telephone# yd8— 00�;s
y o=�-
Type of Building Lot Size 3 o
f sq.ft.
Dwelling-No.of Bedrooms 3 Garbage grinder WO
Other-Type of Building No.of persons Showers ( ),Cafeteria ( )
Other Fixtures
Design Flow (min.required) J gpd Calculated design flow 3 3 o Design flow provided J U gpd
Plan: Date /i -E-44' Number of sheets -D, Revision Date
Title S,4-C -t- 54L-J� c ,qa 14 A)
Description of Soil(s) 5-0� 42
p,4 N
Soil Evaluator Form No.0t 7 �O Name of Soil Evaluat rUC-e� ()WNA ate of Evaluation
DESCRIPTION OF REPAIRS OR ALTERATIONS !21 "7
The undersi agrees to install the above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and
further agree to e t o e a Certificate2 pl'�nce has been issued by the Board of Health.
Signed Date r/� _
Inspections
e
No.��g 1 _ a „;u R
7 �, .. f FEE 10 U
j� J i
�} Board of Health, AA K+N S�Q < e MA
APPLICATION FOP, DISPOSAL SYSTEM CONSTRUCTION PERMIT
�x
Application for a Permit to Construct(I-) kepairO Upgrade( Abandon( hJ'Complete System 0 Individual Components
Q
Location �7 \V i V<b �N G" Cove- R17 Owner's Name /A 1c l0 R.-i�) S!9 w Y
Map/Parcel# 7S Address Y,
_ Lot# a`7 Telephone#
Installer's Name d DesigneVs Name RNk Su/Ve C_UAJS(_C 4N'1S
Address „` / ` .�! , Address /`v
Telephone# Telephone# W 8— 00 Ss
r , =�`
Type 3 1 of Building Lot Size J oho sq.ft.
Dwelling-No.of Bedrooms 3 Garbage grinder WO
Other,-Type of Building No.of persons Showers ( ),Cafeteria( )
Other Fixtures ,
Design Flow.(miri:"re°quired) 3 3 0 gpd Calculated design flow 3 3 0 Design flow provided gpd
Plan: Date `S-q Number of sheets 2 Revision Date
Title S,'Ir f Sv- c //St A)
Description of Soil(s) , p qDQ (t
Soil Evaluator Form No.04 �a�U Name of Soil Evaluat r�e `M UkPtl'W ate of Evaluation 1 0 .A7 / I
DESCRIPTION OF REPAIRS OR ALTERATIONS lie
The undersign agrees to install the above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and
further agree to oft a e th�system in—op aVCertiftcate of Co npl�nce has been issued by the Board of Health.
Signed Date
Inspections
i
No. Joe
C®�l[I� ONWEALT14 ®F I�'ASSACHUS ETTS FEE
Board of Health,
CERTIFICATE OF COMPLIANCE
Description of Work: ❑Individual Component(s) Lk—o—kiplete System f"__
The undersignedphereby c�erti that the;Sewage Dis sal System- 'Constructed 0--y',lepaired ( ),Upgraded ( ),Abandoned ( )
at k77 wI Nb11JG- GOt1Q A-> i
has been installed in accordance with the provisions of 310 CMR 15.00 (Title 5) and the approved design plans/as-built plans relating to
application No. dated Approved Design 114.
'w3 (gpd)
Installer C< a
Designer: YA NkYL 51/Ve-�)C.C.S-1f AN,nspector. _A -y� Date:
The issuance of this permit shall not be construed as a guarantee that the system�,.X function as designed.
No. / / FEE 10 a
Board of Health, ( f S �l MA.
DISPOSAL SYSTEM CONSTRUCTION PERMIT
Permission is hereby granted to; Construct(C4--Repair( ) Upgrade( ).. Abandon( ) an individual sewage disposal system
at ).77 1,11) NU" COVE - as described in the application for
Disposal System Construction Permit No. dated
Provided: Construction shall be completed within three years of the date of this-permit. All local conditions must be met.
form 1255 Rev.5/96 A.M.Sulkin Co.Boston,MA Date �;I oard of Health �i
f
TOWN OF BARNSTABLE
LOCATION �!� i.i w�i D.t Lath- I SEWAGE # :197.70
VILLAGE !'V k,zC o e i -C ASSESSOR'S MAP & LOT 75= - l
INSTALLER'S'NAME&PHONE NO.�SctiZ�crZc-i'i t C...Jt —, "I71-e.3,11
SEPTIC TANK CAPACITY i &A-L
LEACHING FACILITY: (type) -_�ZextGt-� is Cwtt_�'zjiie 0 c J � 1
NO.OF BEDROOMS
W
BUILDER{92Q � 1Z+C��
PERMTTDATE: l J COMPLIANCE DATE: '
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) 016— Feet
Furnished by
01 Or
,+
j� -it ►, �, -T `4k
9 IT F -.
- 95.0' REAR WALL I
TOP OF FY)UNDATION
20' MIN.
i II 10' MIN. CONCRETE COVERS 4" SCHEDULE 40 P. VC
A y MIN. PI7rH 118 PER FT. 2"LA YER OF
� WASH ED1S710NE
MAXENT
6MAX —� CONCRETE COVER
EL=93.0
EL= 92.0 4" CAST IRON PIPE
(OR EQVA�2 MINIMUM
� PI7rH 114 PER FT CLEAN SAND 9"
FLO W LINE MIN.
5
INVERT 1 I •. 14" EL=89.0
MIN. —z p•�
� EL= 90_5 CAS INVERT / 6 SUM LE VEL o 00°
O INVERT BAFFLE EL.= 89. 75 INVERT INVERT oo °c
EL.= 90.0' EL.= 89.50 EL.= 8_9.25_ °°° ° ° EL.=87.5'
(TO BE PLACED ON FIRM BASE) DISTRIBUTION
MECHANICALLY COMPACTED OR B" OF STONE BOX
1500 --GALLONS TO BE WATER TESTED 11' X 38' TRENCH FORMATION
SEPTIC TANK IF MORE THAN ONE OUTLET O
PLACE ON 6" STONE 3�4" To SOIL ABSORPTION �
PROFILE OF T3'ASHED STONE S
SYSTEM (SA )
SEWAGE DISPOSAL SYSTEM BOTTOM OF TEST HOLE OR USGS PROBABLE WATER TABLE ELEV.=_80.5 _
NOT TO SCALE NO OBSERVED WATER TABLE (10127/98) ELEV. = 60.5 _
OBSERVATION HOLE I ELEV.=_ 92.0
PERCOLATION RATE MIN./ INCH AT -48" INCHES OBSERVATION HOLE 2 ELEV.=_ 92.5
DEPTH IHORIZ TEXTURE COLOR MOTT. OTHER DEPTH HORIZ TEXTURE COLOR MOTT OTHER
0"-10" A SANDY LOAM 10YR5/1 0"-10" A SANDY LOAM I0YR5/1
10"-36/54" B LOAMY SAND 10YR6/8 10"-36" B LOAMY SAND 10YR6/8
GENERAL NO TES 36/54"-138"Cl MEDIUM SAND IOYR7/4 PERC 36"-144 Cl MEDIUM SAND IOYR7/4
1) ALL WORKMANSHIP AND MA TERIAI S SHALL CONFORM TO D.E.P.
TITLE 5 AND THE TOWN OF _$ARNSTABLE---- RULES AND NO WATER ENCOUNTERED NO WATER ENCOUNTERED
REGULATIONS FOR THE SUBSURFACE DISPOSAL OF SEWAGE.
2) ONE COVER ON SEPTIC TANK SHALL BE BROUGHT TO SOIL TEST SOIL TEST
WITHIN 6" OF FINISHED GRADE, OTHERS WITHIN 12" DATE OF SOIL' TEST 10127198 SOIL TEST DONE BY BRUCE G. MURPHY, R.S.
3) ALL COMPONENTS OF THE SANITARY SYSTEM SHALL BE CAPABLE OF WITNESSED BN.': JERRY DUNNING, B.O.H.
WITHSTANDING H-10 LOADING UNLESS THEY ARE UNDER OR WITHIN DESIGN CALCULA TIONS.'
10 FT. OF DRIVES OR PARKING AREAS. H-20 LOADING SHALL BE
USED UNDER OR WITHIN 10 FT. OF DRIVES OR PARKING AREAS. P # 9268 NUMBER OF BEDROOMS . . . . . . . . 3
4) ANY MASONARY UNITS USED TO BRING COVERS TO GRADE SHALL GARBAGE DISPOSAL . . . . . . . NO
BE MORTERED IN PLACE. TOTAL ESTIMATED FLOW GAL/DAY
5) NO DETERMINATION HAS BEEN MADE AS TO COMPLIANCE WITH ( 110--GAL/BR./DAY x 3__- BR.) 330
DEEDED OR ZONING REGULATIONS. OWNER/APPLICANT IS TO TOP LOAD REQUIRED SEPTIC TANK CAPACITY 1500 GAL
OBTAIN SUCH DETERMINATION FROM APPROPRIATE AUTHORITY. 5 INFILTRATORS WITH STONE SOIL CLASSIFICA TION . . . . . . . . 1
6) UTILITIES SHOWN ARE APPROXIMATE ONLY, EXCA VA TION CONTRACTOR j j' ,�' ,3f�' DESIGN PERCOLATION RATE . . . . . < 5 MIN./IN.
IS TO CALL "DIG- SAFE" AT 1-800-322-4844 AT LEAST 72 HOURS
PRIOR TO COMMENCING WORK ON SITE. EFFLUENT LOADING RATE . . . . . . • 74 GAL/DA Y/S.F.
7) CONTRACTOR IS TO VERIFY GRADES AND ELEVATIONS AS WELL AS INSTALL LEACHING IN "Cl " LEACHING CAPACITY (AREA X RATE) 381 GAL/DAY
SITE CONDITIONS PRIOR TO COMMENCING WORK ON SITE. HORIZON OF MEDIUM SAND RESERVE LEACHING CAPACITY . 381 GAL/DA Y
8) PARCEL IS IN FLOOD ZONE __"C" ___. (38 X 11 X . 74)+(38*38*11+11 X . 74)
9) LOT IS SHOWN ON ASSESSORS MAP _75 _ AS PARCEL _27 . "'
SHEET 2 OF 2 JOB NUMER____51729 ___--
_ -- HSE. -
\ \ \ \ ,\\ \\ ASSE:55SORS o u T E
MAP ,76 R �
4
� J LOCUS
S76 06'56'E' / 1 `� ` ,LOT t)2
110 a 206. 64 �
R = 360.00 ` 0 '06 �p`I
L = 21.08' W
� G
�. c'�C -� // // 1p �p1 ,pp 99' '/ � � 11 '� ,.00 N y 4�
Ga ' \"\ 96 95 Cam.
C.B. '�+ �\� /' ,� ,� i / � � �
/ VEND' `� ASSESSORS �
CA7VH / ` / / , co' .' —, ; — `� �o MAP 76
BASIN. �\ / �' �� r✓J'� jf' , 26.0' / //' �•'IL 1- \� \� LOT 63 LOCUS
y i P
C.B.
BENCHMARK C cfl ' i / 1 i O / s i 1 4 ! q CH RES. ZONE.- "RF"
EL=104.5 tj ���� i ,'� , 9. / ,/ ► i i �' �' i OFFSETS.-
CENTER CATCH BASIN / / Li
�h
a / DRIVE , IOf , .� , FRONT 30o', UNDER I �L �, '. �s� ' s, � f` � d • �. SIDE 15'
41 ,
i 45 ` ► 86.8' G
39.2 , , 1 19 � �, ��� REAR 15'
ZI / / ._ / 1 1 ► a � 3R ay s r } G. v I 'i'.
,-_� �1• / �..rc�f 1 1 q,+S; H A J FLOOD ZONE.- C
BOX
PLAN REF. 272/30
TP
01) ASSESSORS MAP 75
ASSESSORS
' 0 /' MAP 75 •
LOT 27 / ~ PROJECT L 0CA T/ON
BA IN ,� c�le ,� LOT 27 WINDING CO VE RD.
ASSESSORS
BASIN , \\ �\ rs, i AREA=31,090 SQ. FT\�
MAP 75 BARNSTABLE, MA.
92 - LOT 29 (MARSTONS MILLS)
BENCHMARK Q' / — gt ' —
EL=100.0 i ; APPL/CAN T.-
TAG BOLT ON • �, ,, go ,- RICHARD SAWYER
HYDRANT \ � / � . ,.-.� ,
YANKEE SUR VEY CONSUL TAN TS
� 7 —
HSE. - ,. r'o -' .' a ti P. O. BOX 265
UNIT 1, 403 INDUSTRY ROAD
MARSTONS MILLS, MA. 02648
ASSESSORS — g54 PH. (508)428—0055 — FAX(508)420—5553
MAP 75 _ f)4 -'a [SCALE.• I"=30' EDA TE.—]1 11/U5%91f
LOT 28 ASSESSORS
MAP 75 REV.• AF/-?EV.•
GROUNDWATER PROTECTION LOT 28+ JOB NO. 51729
OVERLAY DISTRICT "AP" SHEET 1 OF 2