HomeMy WebLinkAbout0292 WINDING COVE ROAD - Health 292 WINDING COVE ROAD, M. MILLS
A= 056 057
TOWN OF BARNSTABLE
LOCATION OAL ,)- SEWAGE# �Qd�
VILLAGE /�/�� gQ �'/et_LQASSESSOR'S MAP&PARCEL
INSTALLER'S NAME&PHONE NO. -�°
SEPTIC TANK CAPACITY l('fit ate l �tkl_
LEACHING FACILITY:(type) L dC.ti-- \(size) 44 k 1 \_-'9Jk.
NO.OF BEDROOMS
OWNER r
PERMIT DATE: I- (�- _ COMPLIANCE DATE: '�2
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
FURNISHED BY
Al
o ` l
2
O
-
J3 13. \/
No. DzL 00 Fee V v l
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes
01ppIication for his osa' *pstem Construction Permit----�
Application for a Permit to Construct( ) Repair Upgrado `) Abandon( ) O'Complete Sys m Individual Components
Location Address or Lot No. a ��/o�/ Owner's Name,Address,and Tel.No.So& 7'X -.28u:1
Assessor's Map/Parcel-Te-A"7 14&m LA3 inS74 U
Installer' Name, ddress,and Tel No.<3p�$ �9�� D 'gner's Name,Address,and Tel No.�a 3Asa• VOW
�o "�rks�i'ue.�rvr� '.��i' 9��a,�r
i
Type of Buildi g:
f
Dwelling No.of Bedrooms Lot Size 7�,S/ — sq.ft. Garbage Grinder( )
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow(in' .required) ��() gpd Design flow provided 3 gpd
Plan Date Number of sheets Revision Date
Title ✓ ®2 9�2
Size of Septic Tank Type o S.A.S. - %s�/(y �[9(t � � n '�f 1`�✓��
Description of Soi1�Q.¢. G
Nature of Repairs or Alterations(Answer when applicable) /(y
Date last inspected:
Agreement:
The undersigned agrees to ensure the construction and m ' nance of the afore described on-site sewage disposal system in
accordance with the provisions of Title 5 of the Envir ental C e and not to place the system in operation until a Certificate of
Compliance has been issued by this Boar ealth.
Signe Date / A-6
Application Approved by Date
Application Disapproved by Date
for the following reasons
' Permit No. //V7ie2_ 0 d-? Date Issued
--------------------- -------------------------------------- rt
71
No' � � Fee
a THe60MMONWEALTH OF MASSACHUSETTS Entered incomputerT,
ayes ,
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS..
Nplitation for his oral 6pstem Construction 3Permit -.
t Application for a Permit to Construct( ) Repair ) Upgradefrl')' Abandon( ) !/Complete Syste`_A Individual Components Location Address or Lot No. '7 Owner's Name,Address,and Tel.No.sp�5i
�zr�Yvr-Ta'L"� `�e6,rxi.1Q+�'�9�Lc,1,l„�/��t>••a�'y� s<,
Assessor's Map/ParcelS`�,�5'',7 ✓�Gngy�a /i�za ., �. f} Uf�/F _I
Installer's Name, dress,and Tel.No.,jQ 8 - D 'gner's Name,Address,and Tel.No. j p 8 3(s.Pj` /
Type of Building , -
� � o
Dwelling No.of Bedrooms Lot Size 35�1 JI 9 -- sq.ft. Garbage Grinder( )
Other Type of Building No.of Persons Showers( )-Cafeteria
Other Fixtures !
Design Flow(min.required) 330 . gpd Design flow provided 3 r y gpd _
Plan Date
Number of sheets Revision Date
Title I t�tr_ !-/t�i. 4/f .2 1111 .l1 Lirl%e� A-1) /111444-41 , yee.t
Size of Septic``Tank�'SLb J Type of S.A.S. a7- ///U -'D
Description of Soil. ¢e ,��
s
'# Nature of Repairs or Alterations(Answer when applicable) 4/0 �! f t x , Ctr/O) -5/.YY� �•r( y
�S�, X /�) ���' 1
/�• ��-�:�.
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 Environmentalode and not to place the system in operation until a Certificate of
Compliance has been issued by this Board•of Health.
Signed ` Date 46,;0L-
Application Approved by / ,,.-^"'___ Date r'J I✓/� / { /
.� Application Disapproved by ( �' Date r
for the following reasons
±� Permit No. Date Issued J Z
THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE,MASSACHUSETTS
Certificate of Compliance
THIS IS TO CERR1TIFY,that the On-site Sewage Disposal system Constructed( ) Repaired( T, Upgraded( )
Abandoned( )byttdi lUn �4tK•� J1�M .
at "
�7 � 7&n,r Cow te) /�.ri n�,�a,3 a�i� has been constructed in accordance
with the provisions ofTitle 5 and the for Disposal System Construction Permit No. dated AP P L Z
Installer / _f sa� ti �r r�G t i Gl'� nC Designer DL J7 Oh Ap G
#bedrooms 3 Approved design flow_J 0 J gpd
The issuance of this permit s(hal not be construed as a guarantee that the system will'fu ction!as designe&
Date Inspector �� ,
c4 � y
- ------- - - ---------•------------ - ---- - - - ---- -- - - -
No. f a :�. t�U Fee Y '�
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION -BARNSTABLE,MASSACHUSETTS
Bisposal ,pstrm Construction.3permit
Permission is hereby anted to Construct Re air Upgrade Abandon
�.. System located at 01 1� l t`;Aa.,� /
and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with
Title 5 and the following local provisions or special conditions.
Provided:Construction must be completed within three years of the date of this permit.
,
Date i 1 �_� ��Z Approved by 1,�-
JAN-21-2022 02:51 From: To:15087906304 Pa9e:1,'1
Town of Barnstable
Inspectional Services
1.' .,H. .Public Health Division
Thomas McKean,Director
200 Main'Street,Hyannis,MA 02601
I..
Office:'508=862=4644""__"'_'-.__"'.' " _.... ....._...._Fax:.508-790-630—
Installer&Designer Certification Form.
Date: lb"012Z Sewage Permit# ;&Zl- G 0") Assessor's MapXParcel -7
.. . . �W 11 ��1(1fPib1,1/l� Installer:
Desier:
gn
Address: ys^ �-
om'o0-h Po A M
02(0�5
" ' � was issued a permit to'iristall'a
(date) . (Installer)
septic system at aq 7- W I hd M9&Vt M, MaSW mill6sed on a•design drawn by
(address)
Q�. 0 tl.�'0. P&I PLS dated
( signer)
` 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. Strap 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 asbuilt 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 compliance with the terms of
the AA. p a tiers(if applicable) JJ OF 1 q
:? DANIELA. �
OJAIA "1
(Insta ees ignature CIVIL
NO.46502 z,
fit•"
(Designer's Signatur Affix Desigier :3teinp Here
PLEA E RETURN T BA STABLE P BLIC EA TH D VIS ON. CCRTI ATE
OF COMPLIANCE WYLL NO BE ISSUED TIL •BOTH T S ORM AND -
UILT ARD ARE REC VED Y T E BARNS AHLE PUBLIC EALT DIVISION.
THAN YOU.
kholAdCOAHEALMSEWRR eonnecASEPTICOesigaorCaniflcadon Pann Rev&Id-17.DOC
No�.?�. �. Ficz ..5.0.........._
THE COMMONWEALTH OF MASSACHUSETTS
BOAR® OF HEALTH /
a. ....................OF.....
r
Appliratiou for Bhgp ial Workii Tonotrurtiou Fautit
Application is hereby made for a Permit to Construct ( V-100,or Repair ( ) an Individual Sewage Disposal
System at
...................................................w � --. v .. 6� x' .......
Location-A ress or Lot Flo.
..............................
Owner Address
W
Installer Address
U Type of Building Size Lot_C 513_.._..Sq. feet
Dwelling—No. of Bedrooms............. ..........................Expansion Attic ( ) Garbage Grinder ((�
Other—Type of Building ............... No. of ersons._..-__..............._.__.. Showers
a yp g ------------- p ( ) — Cafeteria ( )
Otherfixtures ------------------------•-•--••-•-------------------•••------•-•----------•-•--------------------•---•---•---•----. ••....
W Design Flow............... ....................gallons per person per day. Total daily flow....................... i.!C ____...gallons.
WSeptic Tank—Liquid capacity_ '� Wgallons Length---------------- Width................ Diameter---------------- Depth................
x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft.
Seepage Pit No..... ..... Diameter--------1-0...... Depth below inlet...........6.... Total leaching area.....'2o.4--sq. ft.
Z Other Distribution box ( Dosin tank ( ) ,
~' Percolation Test Results Performed by. QX"j('"CLo.._ _..__ ........................... Date___---_-.
W —
Test Pit No. L-_-"'7r. ..minutes per inch Depth of Test Pit....... .... Depth to ground water........................
44 Test Pit No. 2................minutes per inch Depth of Test Pit................... Depth to ground water........................
a •-•••-•--••----------------••--•-•---•---•-••-----•--•-••-•---.....-----•-•-...........,=
0 Description of Soil...................................................................... -------•----------•----....----------------------------------------
x
W
UNature of Repairs or Alterations—Answer when applicable...............................................................................................
-------------------------------------------•----------------------------------------•----------•-----------••------------------------------------------•--------------- --------------------•-------
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of iT ,a
p 5 of the State Sanitary Code—The undersigned_ further agrees not to place the system in
operation until a Certificate of Compliance has be issued by the board of ell
�L
Signed = -.::: = 1
Date
Application Approved By_......z..... ........ �_ i
1 ) te��
Application Disapproved for the f ,l wing reasons-----------------------------•---------------•-----------------------------------•---------------------•--•------
•-•--•-•........•.............•------••-•.....--------•----•-...-----------------•--•-------•---•--•-------------.....•-••-•--•-•----••=---•-•-----------•-•---•--------•-----•-----------.............
r� da ate
PermitNo........... ....--...' �------•---------•----------.......... Issued....... `�........................
Date
FE s...............................
••� -- THE COMMONWEALTH OF MASSACHUSETTS `
• ... OF HEALTH
...................OF..... .t21JST/a_r_ '- ._
App. ir4tion for Uiipniia1 or-kii T�mitrnrfinrt ranfit
Application is hereby made for a Permit to Construct ( vY""or Repair ( ) an Individual Sewage Disposal
System at:
.............. ---...... _►Jto1 :. oVEs �✓�--•-....�� .. ---..•... ? "_ .��. ......_.................. .. .. .... ---
Location•Address / or Lot,No.
......................-.........-.----. .......... -•--.... --•--......... .... ..............................
Owner , r Address
W
' Installer Address
d Type of Building Size Lot.-�� ... .....Sq. feet
Dwelling - 5�.9L
—No. of Bedrooms.............J..........:__.....__..:_._Expansion Attic ( ) Garbage Grinder ( j��
p, Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( )
Q' Other fixtures •-----------•---------------•-•-
W
Design Flow......:........S.�............ .......gallons per person per day. Total daily flow...................... ._t_4._.......gallons.
Septic Tank L quad capacrty_�.'Z�X?gallons Length................ Width................ Diameter................ Depth................
T
Disposal Trencho..................... Width.................... Total Length.................... Total leaching area....................sq. ft.
Y^.
Seepage Pit No.__ ...._..�____.__.. Diameter__-__---1_�...... Depth below inlet............ .... Total leaching area.._...76.6--sq. ft.
z Other Distributio box ( Dosing tank ( )
Percolation Test Results Performed by..�.A_`.?!7�1�...r_....��`y�_#........................... Date......__Ct..ZZ-8 ----
Test Pit No. 1....71--' •.minutes per inch Depth of Test Pit........CZ-.... Depth to ground water.........." ..........
(i Test Pit No. 2................minutes per inch Depth of Test Pit-_._____.-______---_ Depth to ground water........................
a ----•------------------•--•---------••-•-••-----•-•-----•-----•---••................•-•••-............_._................-•--•...........................................................
0 Description of Soil.............................................................
----------------=•-- .....••--•-------••--------•-----•••-••••-••---......---••-•----•----------•---•---
--
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'TT y g g p y
S of the State Sanitary Code— The undersigned further agrees not to lace the system in
operation until a Certificate of Compliance has been issued by the board oAf liep1th.
Signed_._
� � •--••----------------------------- �at -
�
Application Approved By............... ••-•---•-----• .........
._ ... . . -------•--------•- ---------------------------------------
Date
. Application Disapproved for the f wing ons------------------•-------------•-----------------------•----------=-------------------..__ _-_-_-,------
........................................................... . ....................................................... ....
` Date
Permit No. Issued...._-.? ��_..:......_
ate
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
..................oF........,::n i..:/'S:`.?. .... .?................................----------..
THIS IS TO CERTIFY, Tha e In** idua Sage Disposal System constructed (�') or Repaired ( )
by-------------------- ------- -S. .t ±-
,: a q sfaller
has been ihstalled in accordance with the provisi s of ,j,T" � The State Sanitary Cod as d cribed in the
..,, application for Disposal Works Construction Permit NO._ �___--"_ ______________ ____ dated------- ..NEE
._......_...
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CO TRUE® AS A GUA THAT THE
'l SYSTEM WILL JUNCTION��ISFACTORY.
fi. ...------•-•------------•...-----.-•--_: Ins ector........ -------------- -------
THE COMMONWEALTH OF MASSACHUSETTS
----- BOARD OF HEALTH
.............
e " .�
FEE.......... ......
Vn
Permission is hereby granted..................
z�.to Construct ( � R air ( ) an Individual Sei& ge Disposal
y . AA
at No.-- i.-- r :t_ �3I - =♦
Street
as shown on the application for Disposal VVoConstruction Permit I -T.__._._ Dated......
.._..^_.�. .::_ t .--
�� �� I � ______ __________ Y extth
4; DATE--------- -
,:y -. _ FORM 1255 HOBBS & WARREN, INC., PUBLISHERS. - -
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'--' BORTOLOTTi CONSTRUCTION,INC.
65 WAKEBY ROAD,MARSTONS MILLS,MA 02e;48
508-771-9399 508428-8926 FAX: 508428-9399
,,o�SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIF CATION
Property Address —J � D
Date of Inspection: S/ d hrspec or's Sainc&Y
QWnees a and Address: _
CERTIFICATION STATEMENT:
I certify that I have personally inspected the sewage disposal system at this address and that the informa-
tion repoited below is true,accurate and complete as of the time of inspection.The inspection was per-
formed based on my training and experience in the proper function and maintcuance of on-site sewage
disposal Oems. The System:
Passes
Conditionally Passes
' Needs Further Ev tion the Local Aproving Authority
Fails
Inspector's Signature: _Date: .cVd'-- l w
A
The System Inspector shall submit copy of this inspection report to die Appro,-dag authority within thir-
ty(30)days of completing this inspection. If the system is a shared systein or h,na'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 Department of Environmental Protection. The original should be'�ent to the system owner
and copies sent to the buyer,if applicable and the approving authority.
INSPECTION SUMMARY:
A)SYS PASSES:
I have not found any information which indicates that the s.ysLcm Violates any of the failure
criteria as defined in 310 CMR 15.303. Any failure criteria.not evaluated are indicated
below.
B)SYSTEM CONDITIONALLY PASSES;
One or more system components need to be replaced or reaircd. Tote system,upon comple-
'; 'tion of the replacement or repair,passes inspection.
Indicate yes,nor,or not determined(Y,N,OR ND). Describe basis of€lelenni,:aabion in all instances. If
"not determined",explain why not.
l- 'The septic stank is metal,cracked,structurally unsound,shows subsrautial infiltration or
exfrltration,pr tank failure is imminent. The system will pass inspection if the existing sep-
' tic tank is replaced with a conforming septic tank as approval by t'lte Board of Health.
Sewage backkup or breakout or high static water level observed in the distribution box is due
to broken or obstructed pipe(s)or due to it broken,settled or uneven distribution box. The
system will pass inspection if(with approval of The Board )f Health):
- 1 -
1
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Broken pipe(s)replaced
Obstruction is removed
Distribution Box is levelled or replaced
The System required pumping more than four times a year due to broken or obstructed pipe(s).
The system will pass inspection if(with approval of The Board of Health):
Broken pipe(s)are replaced
Obstruction is removed._ _ _ a__.. . .,, , , _ . • ,
C)FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH:
Conditions exist which require further evaluation by The Board of Health.in,orde Ito determine,if
the systenk is,failing to protect the public health,safety and the environment.
1)SYSTEM-WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE
SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE .
PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT:
Cesspool or privy is within 50 Feet of a surface water
Cesspool or privy is within 50 Feet of a bordering vegetated wetland or.a salt marsh.
2)SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH (AND PUBLICWATER
SUPPLIER,,.IF APPROPRIATE)DETERMINES THAT THE SYSTEM IS FUNCTION-
ING IN A MANNER THAT PROTECT THE PUBLIC HEALTH AND SAFETY AND THE
ENVIRONMENT::
,The,systemhas a,.septic tank and_soil absorption system and is within:100 Feet to:a surface
water supply or tributary to a surface water supply.
i The syAcm.has.a septic tank and soil absorption system and is with a Zone I of a public ;
i - water:supply well.
The system has a septic tank and soil absorption system and is within 50 Feet of,a private
water supply well.
The system has a septic tank and soil absorption system and is less than 100.Feet but 50; '
Feet or more from a private water supply well,unless a well water analysis for coliform
bacteria and volatile organic compounds indicates that the well is free from po lution.from
the facility.and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less
,._ ..
D)SYSTEM FAILS: ,
I have determined that the system violates one or more of the following failure criteria as defined
in 310 CMR 15.303. The basis for this determination is identified below.r The Board of Health
should be contacted.to determine what will be necessary to correct the failure.
Backup of sewage into facility or system component due to an overloaded or clogged SAS
or cesspool.
Discharge or.ponding of elluent to the surface of the ground or surface waters due,to,an
overloaded or clogged SAS or cesspool.
.;Statc, lqud level in the distribution box above outlet invert due to an overloaded or clog-
�:;
:LiquidAepth,ipcesspooI is less than6"below invert or available volume.is less than 1/2
day flow,, t,
yRequired pumping more than 4 times in the last year NOT,due to clogged or obstructed
pipe(s). Number of times pumped
-2-
a1; �� k c eat t 9 St o e Sit .;
f fir •! s dj t art t'�a's �7,[ ty, 4 a i Y 4' ,t n, x W;
.:, �? f ' ,j '1A81y�:. '�• �i°`-Yf u 2" i'Y€'dJaL3 r ;• "` ;.a `3�yt _' ;'� i..
i v 5 - �.m•r,� � s�� t .,i..
Ww"
u
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Any portion of the Soil Absorption System,cesspool or privy is below the high groundwater
elevation.
Any portion of a 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 I of a public weK
Any portion of a cesspool or privy is within 50 Feet of a private watr:r 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. If the well has been analyzed
to be acceptable,attach copy of well water analysis for coliform bacteria,volatile organic
compounds,ammonia nitrogen and nitrate nitrogen.
E)LARGE SYSTEM FAILS;
The following criteria apply to a large system in addition to the cri!lana above:
The design flow of a system is 10,000 gpd or greater(Large System)and ttie system is'a sign-11- t=
- threat to public health and safety and the environment because one or Plore of the following c is .
+� conditions exist:
i The system is within 400 Feet of a surface drinking water v.upply A>
' The system is within 200 Feet of a tributary to a surface drinking water supply f
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. l
The owner or operator of any such system shall bring the system and facility into fiill oomphance withthe
groundwater treatment program requirements of 314 CMR 5.00 and 6.00. Pler;;a consult the local *
regional office of the Department for further information.
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST
Check if the following have been done:
kl'PNmping information was requested of the owner,occupant,and Board offHealth.
7None of the system components have been pumped for atleast`.wo wee-:k,;and the system'has!.� r
been receiving normal flow rates during that period. Large vclumm of water`have not:been.'
introduced into the system recently or as part of this inspection..
L-"*1_As-built plans have been obtained and examined. Note if they are not.available with N/A
_ The facility or dwelling was inspected)for signs of sewage back-up..
The system does not receive non-sanitary or industrial waste il' w. 3
J�Thd site was inspected for signs of breakout. "P
_,V-LAII system components,excluding the Soil Absorption System,have(gin located on site
The septic tank manholes were uncovered,opened,and the inter tar u7 the septic tank was44 ` a.
spected for condition ofbeffles or tees, material of constructi on,dimeiisions,depth of liquid.
�epth of sludge,depth of scum.
e size and location of the Soil Absorption System on the site has&.Tn determined based on
existing information or approximated by non-intrusive methods. -
-3
j
Y
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
R CHECKLIST(continued)
The facility owner(and occupants,if different from owner)were provided with information on
the proper maintenance of Subsurface Disposal System
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
:.PART C
SYSTEM INFORMATION''
FLOW CONDITIONS
BESIIZE
Design Flow: allons Number of Bedrooms: Nu r of Current Residents:
Garbage Grinder: Laundry Connected To System l Seasonal Use:/7�l
Water Meter Readings,if. ailable:
Last Date of Occupancy -
'COMMERCIAIANDuCTRIAL:
Type of Establishment.
Design Flow: %gallons/day ,Grease Trap Present: (yes or no)
Industrial Waste Holding Tank Present: '
Non-Sanitary Waste Discharged To The Title V System:
Water Meter Readings;If Available: Last Date of Occupancy: '
OTHER: Describe)
Last Date of Occupancy:
GENERAL INFORMATION
PUMPING RECO RDS and source of information: /`►'
System Putnped,as part of inspection::�)O If yes,volume sniped:
Reason for pumping:
TYPE OF SYSTEM: ,
__jZS�eptic Tank/Distribution Box/Soil Absorption System
Single Cesspool
Overflow Cesspool
Privy
Shared System(If yes,attach previous inspection records,if any)
Other(explain):
APPROXIMATE.AGE'of all co ponents,date installed(if knowb)and source of information:
Sewa odors.detected when arriving at the.site:
« -4
r
1.
�SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
GENERAL INFORMATION (continued)
SEPTIC TANK:
Depth below grade: IS"' Material of Construction: concrete—metal FRP Other:..,
Dimisioas: / Sludge Depth: ' Scum Thickne I: �r'
Distance:from top otiludge to bottom of outlet tee or baffle: 7,
Distance,from bottom of scum to bottom of outlet tee or baffle:
Comments:(recommendation for pumping,condition of inlet and outlet tees or baffles,depth of liquid
1 in relatio to o (let inve structural integrity,evidence of leakage,sac.)
it
O
GREASE TRAP: A&)
Depth Below Grade: Material of Construction:_concrt;te_nietal_FRP Other
(explain) —-
Dimensions: Scum Thickness: __.__
Distance from top of scum to top of outlet tee or ba(11e:
Comments:(recommendation for pumping,condition of inlet and outlet t,cs o.:tai'lles,depW.of ligtud s
level in relation to outletinvert,structural integrity,evidence of leakage, :Ic.i__
TIGHT OR HOLDING TANK:
Depth Below Grade: Material of Construction:_concrete_mcoal_ FRP_Other(explain)
Dimensions: Capacity: gallons Design Flow:___gallons/day
Alarm Level:
Comments: (condition of inlet tee,condition of alarm and float switches,
DISTRIBUTION BOX:
Depth of liquid level above outlet invert: b
Comments:(note if 1 el and tlistribu ion is equal,evid ice of solids carryove:,'evviden of leakage into
or out pf box,etc.) "!
PUMP CHAMBER '
Pomp is in working'oidei:
Comments:(note condition of pump chamber,condition of pumps and a:-ijuru n.Ances,etc.)
e
'SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
S01L ABSORPTION SYSTEM(SAS):JZ 1
(Locate on site plan,if possible;excavation not required,but may be approxintated.by non-intrusive'
methods) :If not determined to be present,explain:
Type:
"Leaching pits,number:Leaching chambers, number: Leaching galleries,number
Leaching trenches,number,length:
Leaching fields,number,dimensions:
Overflow cesspool,number:
Comments,:(note condition of soil,signs of h drau ' failurelpvel of poll ing,condition of vegetatioN .,
.e _ �UU /
,;CESSPOOLS:
Number and configuration: Depth-top of.liquid to inlet invert.
Depth of solids layer: Depth of scum layer: Dimensi®ns+of�CesspooL
'' Materials of construction: Indication of groundwater:
Inflow(cesspool must be pumped as part of inspection)
Comments: (note condition of soilk, signs of hydraulic failure, level of ponding,rcondition of vegetation,
etc.)
k4..
PRIVY: 1 0
Materials of construction: Dimensions:
Depth of Solids:
Comments:(note condition of soil,signs of hydraulic failure, level of ponding,condition ofyegetatron„
etc. i W-
4 i
`+ r
-V- 7tr t r
i
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (coMitmed)
SKETCH OF SEWAGE DISPOSAL SYSTEM:
Include ties to atleast two permanent references, landmarks or buchmarks.
Locate all wells within 100 Feet..
2
1
-I S
1
1
1
DEPTH,,TO GROUNDWATER:
Depth to'groundwaterr
Methoo of rmination or Approximati n: l J /i!? J��% --.. _r %'B�*l C�•S
-7-
.3
ry.
T $ENDER: Complete items 1,2,3 and 4.. .
C Put your addrrssin the"RETURN TO—space on the
3• reverse side. Failure to do,this will prevent this card from
OWD ,being,;eturned to you.The return receipt fee will provide
you the nRLne of the person delivered to and the date of
—� deliver For additional fees the following services are
�I available. Consult postmaster for fees and check boxes)
<
for service(s) requested.XX
1. ❑ Show to whom,date and address of delivery.
00
W .-
2. p'Restricted Delivery.
1,_I• _3"A"icle'Addressed to:
Mr: Haskell-Haskell Construction Co.
'.29'56dRoute 28
CISTERVILLE MA 02655
4. Type of Seniice: Article Number
�f
Registered ❑ Insured P 522 444 246
�$Certified ❑ COD
❑ Express.Mail
Always obtain signature of addressee or agent and
DATE DELIVERED,
O k6.
Signatur Ajdres'ssee
y. Signature- Agent
1
X .
7. Date of Delivery
m
-4
W S. Addressee's Address(ONLY ifreqUeStedgnd fee paid)
ITR
a
UNITED STATES POSTAL SE CEP
OFFICIAL BUSINESS 16 F E[i .,�aT n M
SENDER INSTRUCTIONS / 6 5 --•
Print your name,address,and ZIP Code. "'" IL
space below.
• Complete items 1,2,3,and 4 on the reverse.
article• Attach tO frOM Of It apace permits, PENALTY FOR PRIVATE
otherwise affix to back of article. USE,$300
Endorse article"Return Receipt.Requested"'
adjacent to number. +
RETURN
TO, BOARD OF HEALTH TOWN OF BARNSTART
,,(Name of Sender)
91 ( o.en treat;Aqt.,Suite,P.O.Box or H.D.No.)
m'` s
t , P Code)
P . 5�22 444 246
KCEIO* FOR CERTIFIED MAIL
NO INSURANCE COVERAGE PROVIDED
NQT FOfl INTERNATIONAL MAIL
(See Reverse)
senWr: Haskell - Haskell
Street and'No. . onstruction Co.
P.O.,State and ZIP Code
Cj
a:
c� Postage $
vi
Certified Fee
Special Delivery Fee
Restricted Delivery Fee
Return Receipt Showing
to whom and Date Delivered
N Return receipt showing to whom,
W) Date,and Address of Delivery
oTOTAL Postage and Fees $
U. 1.55
g Postmark or Date
is
E Mailed 2/14/85
0
U.
N
a
STICK POSTAGE STAMPS TO ARTICLE TO COVER FIRST CLASS POSTAGE,
,TCERTIFIED MAIL FEE,AND CHARGES FOR ANY SELECTED OPTIONAL SERVICES.(see front)
1.If you want this,receipt postmarked,stick the gummed stub on the left portion of the address side of the article
Ieavi;,glhe receipt attached and present the article at a post office service window or hand it to your rural carrier.
�(nAxtra charge)
2. If you do not want this receipt postmarked,stick the gummed stub on the left portion of the address side of the
article,date,detach and retain the receipt,and mail the article.
3. It you want a return receipt,write the certified mail number and your name and address on a return receipt card,
Form 3811,and attach it to the front of the article by means of the gummed ends if space permits.Otherwise,affix
to back of article. Endorse front of artile RETURN RECEIPT REQUESTED adjacent to the number.
4. It you want delivery restricted to the addressee, or to an authorized agent of the addressee, endorse
RESTRICTED DELIVERY on the front of the article.
5. Enter fees for the services requested in the appropriate spaces on the front of this receipt.If return receipt is re-
quested, check the applicable blocks in item 1 of Form 3811.
6.Save this receipt and present it if you make inquiry.
f �•f
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VIA:CERTIPIBD'I�IAIL s r*.rx i1-
ebruary i"4, 1985
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lHOM111 Construction Company, " ; , : 4 b 1 ' �' {.y
2956'It/�u " S r 1 x-t-.. ., ,x _ r�-1+ C 4 sT . y'•-r ,
M to 28 �)'fe`:r•... ' :'�.+M+.m � � n, � ',�� a^•C'� � i. ,:�, r A.t t'J:.•X r J F.a T'7.."► Y*{ r r. ' ��
C)stervilte,?MA. 02655 `' '♦�
rs .:x t `c' F - {^ ,+1'.... .` r .r+vv t;'k,�yw•.. r .$ ` fatal C� p :'`� •,, r�' 4"�k,r.-�a yf 4-• r .x :.�j,'-
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ear Mr � f Jf C3 t.,
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1'r-�r' •.' <..r�A.. r-.'�" t ' .� +i'a ... ''I' i w"..d�' ' .• ' -� .Ia^v t^i t `x`a ..
.On��January'3,'19,85,a.Disposal'. Works=Construction Permit,pNa, 85=4,
was appiedfor�at the,Towhof.Bainstable Health'Dopartiient '^ ✓ ` . ' '
n 4 l � k ^c a'� �:S` r .F . -,a � � .•. `� w rr ' -r ` r.. i' -•• r ''' t..
�. t r 'b R ...t t i i' fir.,- � .i : .'Sri ^.,; {' • K t'` r �'� .t r:er x. • a "
An .agreement -to install at ;indiv_idual t:sewage disposal;syrieiii" under
,,the%State •Envi de, T 5,' signedpl y Stephen C".,W, e,
r it r {
ronittental Co itie' u►as
the applicant did not pkq`the"required'$50.p0 fee.
a.� � ��� e `k! .Y ♦x } \ t } b. � ;#� a � a;. �- iw, {• i�F 1 �a� p -'< ba
! .. .c: .�'� � �" � �p.�x". Fj �:k .ar � `'t �y • �; + +� 'yr4"f ''r'a•-
r r k r '4 i• ar °The ` ti .k ♦
permit:twill not be issued.toinstalt this'.system`until pay x ¢inent :is
eceivedr In addition,;if ;payment,Js note ieceived°afteit ecei t ofi this
p
a , ' letter;a stop=order for constructioir will`be requested
�� Z ., X" "ir 1. .1 ✓••:�'� ° aA*'''�'�,t t "Iv r .. ..1 a.x�` kJ' � r �..•� i. ""i [E_.. ✓ x 4. .y �' :1 Jt f 1� � i :
-,Very truly. yours, r R'L w't x = ii. .r. ♦ .r 1�f r ° . 'r T• . "'�y _ +,.
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TOWN OF ARNSTABLE ✓
LOCATION GU SEWAGE #
VILLAGE f� �� ASSESS 'S MAP & LOT At,33'�
D6P(,—co',?S NAME&PHONE N 02
SEPTIC TANK CAPACITY 4210
LEACHING FACILITY: (type) (size) 160
NO.OF BEDROO
BUILDER OWNER'
PERMITDATE: COMPL 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
�icm✓ 6F k�'"` Paz.. �,�r
3i
45-7 cn
"LO CAT eION � � '33 SEWAGE PERMIT NO.
VILLAGE
INS A' L.LER'Sp NAME ADDRESS
DE R OR "NER
DATE PERMIT ISSUED
DATE COMPLIANCE' ISSUED
PIT'
F
ire
43
LOCATION 3,3 SEWAGE PERMIT NO.
1p �1 � s
VILLAGE
a
I N So A LLERIs NAME II' ADDRESS
R DE R" OR "NER
7" W;�Rak c
DATE PERMIT ISSUED ��
DAT E COMPLIANCE ISSUED
a
i
II
G r
i
' I
i
TOWN OF NSTAB
ARLE
LOCATION
S� GCJ SEWAGE #
VILLAGE ASSESSqfS MAP & LOT �,ea.� G9
Di5P&ZW,fS NAME&PHONE N
SEPTIC TANK CAPACITY
LEACHING FACII,TTY: (type) (size) /d 00 AiP -_
NO.OF BEDROOMS
BUILDER OWNER t>
PERMITDATE: COMPL 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
� Y
I7
�4I/soy
�i 60 i
t ;
SYSTEM PROFILE MARKED WITHWIITHCOMMA NEnCrT E o BE NOTES 8
COMPARABLE MEANS FOR FUTURE LOCATION.
(Nor To scALE) e 2
Ro
ACCESS COVERS TO WITHIN 6" OF FIN. GRADE CONCRETE COVERS TO WITHIN 3" GRADE 1. DATUM IS NAVD 88
2" PEASTONE OR GEOTEXTILE
\ TOP FOUND. EL. 55.8' FILTER FABRIC OVER STONE
2, MUNICIPAL WATER IS EXISTING
o� a
2% SLOPE REQUIRED OVER SYSTEM5 a
54.0' MINIMUM .75' OF COVER OVER PRECAST 3.0'-52.0' ti°
3. MINIMUM PIPE PITCH TO BE 1 8" PER FOOT. Qo �e
PRECAST H-10 WATE IN. 2 WALL'BOX FOR LEVELNESS PRECAST 4. DESIGN LOADING FOR ALL PROPOSED PRECAST F e O
MIN. 2" WALL THICKNESS UNITS TO BE AASHO H-2Q
RISERS (rrP.) 4"OSCH40 PVC MORTAR ALL
51.83 INVERT IN 49.0
PIPES LEVEL 1ST 2' COMPONENTS
4' -
4'
ENDS (NP) SIDES 50.0 5. PIPE JOINTS TO BE MADE WATERTIGHT.
a•�o ,000000 � a
10" EXISTING 14" '°° °°°° ®®®® ®®®® ® ®_ "ME,
o° ° 6. CONSTRUCTION DETAILS TO BEIN ACCORDANCELocusTEE SEPTIC TANK** o 0 6" MIN. SUMP ®®®®®®®®®®® ® ®®®®® d
TEE 50.5f'* WITH 310 CMR 15.000 (TITLE 5.) A BaxterJ49.81'
°0°a° o°o` 12" MIN. INT. DIM. ° ®®�A� 00 0 0 0 0 ° ° °GAS BAFFLE o..a. N �o°o°°O°O ®®®®®®®® ®®®®®®® ,0000°o°°
0 0°0°0
49.63' 47.0' 7. THIS PLAN IS FOR PROPOSED WORK ONLY AND
NOT TO BE USED FOR LOT LINE STAKING OR ANY
OTHER PURPOSE.
3/4"-1-1/2" DOUBLE WASHED STONE 4' MIN.LH-20 500'GAL. ;LEACHING CHAMBERS BY ACME PRECAST OR EQUAL.
0
ALL AROUND PRECAST STRUCTURES (2) UNITS REQUIRED 8. PIPE FOR SEPTIC SYSTEM TO SCH. 40-4" PVC.
6" CRUSHED STONE OR MECHANICAL OVERALL DIMENSIONS TO OUTSIDE OF STONE: 25.00, X 12.83,
COMPACTION. (15.221 (2)) ;r, 9. COMPONENTS NOT TO BE BACKFILLED OR NU h
N CONCEALED WITHOUT INSPECTION BY BOARD OF
( 7 % SLOPE) (6.3 % SLOPE) - HEALTH AND PERMISSION OBTAINED FROM BOARD
H-20 OF HEALTH. Bay
FOUNDATION EXIST. SEPTIC TANK 10' D' BOX 12' LEACHING
FACILITY . = 10. CONTRACTOR SHALL BE RESPONSIBLE FOR
CALLING DIGSAFE (1-888-344-7233) AND LOCUS
OC S MAP
/� p
34.5' BOTTOM TH-1 VERIFYING THE LOCATION OF ALL UNDERGROUND & L �.1V�7 �V�/`'�I�
*THE INSTALLER SHALL VERIFY THE **INSTALLER SHALL CONFIRM MINIMUM OVERHEAD UTILITIES PRIOR TO COMMENCEMENT OF
LOCATIONS OF ALL UTILITIES AND ALL SEPTIC TANK SIZE AT 1250 GALLONS NO GROUNDWATER FOUND WORK. SCALE' 1"=2000'±
BUILDING SEWER OUTLETS AND AND ITS SUITABILITY FOR RE-USE. 11. ANY UNSUITABLE MATERIAL ENCOUNTERED SHALL ASSESSORS MAP 56 PARCEL 57
ELEVATIONS PRIOR TO INSTALLING ANY REPLACE WITH 1500 GALLON SEPTIC
BE REMOVED BENEATH AND 5' AROUND THE
PORTION OF SEPTIC SYSTEM TANK APPROPRIATE TO SITE PROPOSED LEACHING FACILITY. LOCUS IS WITHIN FEMA FLOOD ZONE X
CONDITIONS IF NOT SUITABLE
12. EXISTING LEACHING FACILITY SHALL BE PUMPED (AREA OF MINIMAL FLOOD HAZARD) AS
AND REMOVED OR PUMPED AND FILLED WITH CLEAN , SHOWN ON COMMUNITY PANEL #25001CO543J
LEGEND SAND. DATED 7/16/2014
99- EXISTING CONTOUR
X 991 EXIST. SPOT ELEV.
-[99]- PROPOSED CONTOUR v
SYSTEM DESIGN:
198.4] PROPOSED SPOT EL.
TH1 GARBAGE DISPOSER IS NOT ALLOWED
L66TIONABLE TEST HOLE E THISCARE,q fl DESIGN FLOW: 3 BEDROOMS 110 GPD = 330 GPD
2 SLOPE OF GROUND
LOT 33 D USE A 330 GPD DESIGN FLOW
�> UTILITY POLE 34,519± S.F. �n
SEPTIC TANK: 330 GPD (2.) = 660
R� FIRE HYDRANT **RE-USE EXISTING 1250 GAL. SEPTIC TANK
NOTE: NOT ALL SYMBOLS MAY APPEAR IN DRAWING - --
/ LEACHING:
S' SIDES: 2 (25 + 12.83) 2 (.74) = 112 GPD
c� PAVED AiVO- BOTTOM 25 x 12.83 (.74) = 237 GPD
TEST HOLE LOGS - DRIVEWAY s
DANIEL E. GONSALVES, SE #13587 C / TOTAL: 472 S.F. 349 GPD
ENGINEER: USE (2) 500 GAL. LEACHING CHAMBERS (ACME OR EQUAL)
WITNESS: DAVE STANTON � � / �� d�
1 1/29/21 O � EXISTING01
�// WITH 4 STONE ALL AROUND
DATE: F� DWELLING = / `'� `w 4C
PERC. RATE _ < 2 MIN/INCH
40
CLASS I SOILS P# 21 -299 o AREA
ELEV. ELEV. DECK -------�' ° ��- - MA
� � � C hti APPROVED DATE BOARD OF HEALTH
p„ 45.5' p" 46.0'
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FILL CsL W WG TITLE 5 SITE PLAN
10YR 3/1 AiV h� p PRO IL LINER �
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sL S� ° TH1 46 TH2 292 WINDING COVE RD.
„ 10YR 5/4 „ 10YR 5/4 , 4-7 �� CAUTIO b MARSTONS MILLS, MA
30 43.0 28 3.67 _ 4S GAS LI N E
BENCHMARK: PREPARED FOR
SPK SET
/ iC1 =53.3' NAVD8g 5' L OF UNSUITABLE SOIL EQUIR BORTOLOTTI CONSTRUCTION/
C1
L CSiL AROUND PERIMETER OF LEACHIN FACILITY
66" 2.5Y 6/4 40.0 66 2.5Y 6/4 DOWN SUITABLE SOIL LAYE . REPLACE tea® 4�"� KENNETH LEONARD
„ 40.5 �- WITH CLEAN
AN APED. SAND, TO EET
PECIFICATION F ` F
toF� fa, ca� DANIEL
C2 C2 �� �� �� � f �N ofkc DATE: DECEMBER 7, 2021
PERC
��ANIE�` Elf« �GJ,`T�� off 508-362-4541
M/CS M/CS S I � A 4i �c�P �' fax 508-362-9880
% 6' downcape.com
2.5Y 7/3 2.5Y 7/3980
FSS,��F. down cope engineerhq, Inc.
132" 34.5' 132" 35.0' Scale: "= 20 ` �°��-
civil engineers
UNSUITABLE
land surveyors
NO GROUNDWATER ENCOUNTERED SOIL 0 10 20 30 40 50 FEET < )
939 Main Street Rte 6A
DATE DANIEL A. OJALA, P.E., P.L.S. YARMOUTHPORT MA 02675
LICE #2 ' -409 21-409 BORTOLOTTI-LEONARD.DWG
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