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HomeMy WebLinkAbout0475 CEDAR STREET - Health 475 CEDAR STREET, W. BARNSTABLE A o J o o Cr: TOWN OF BARNSTABLE iQCATION SEWAGE# VILLAGE Lo, .� � ASSESSOR'S MAP&PARCEL �Q j INSTALLER'S NAME&PHONE NO. E iC Z►fQ .j,)S '776-Q SEPTIC TANK CAPACITY LEACHING FACILITY: (type) dw"-s SU®cT7 (size) �2•,'� r � � NO.OF BEDROOMS N OWNER o PERMIT DATE: I COMPLIANCE DATE: Separation Distance Between e: 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 cili ,Q_ Feet FURNISHED BY � J_ Ctlr q 73- Ceckr A Ark 3? No. Fee COMMONWEALTH OF MASSACHUSETTS Entered in com titeWYes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Application for Disposal 6pstem Construction 3permit Application for a Permit to Construct( ) Repair(Upgrade Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. q]r Cca—ay- I, Owner's Name,Address,and Tel.No. LiftjC.�� Assessor's Map/Parcel 0 . Ragw,"k q7Sr "v-%I- l� ��SNd00C, Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No. -M3i I XL s► s y�o, ��7� ,ari .s � Ils;w.r�. Type of Building: Dwelling No.of Bedrooms Lot Size 3A 9 sq.ft. Garbage Grinder( ) 0 Other Type of Building Ads No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 33o gpd Design flow provided 3 q I.2,s gpd Plan Date // j5 Number of sheets Revision Date Title�r Size of Septic Tank JW 6 qA1_ Type of S.A.S. d 6� Z Description of Soil IC1n(� 14110, R.-_L4111e or Nature of Repairs or Alterations(Answer when applicable) &,bee(`, c. Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Boar a t . ? Date Ct Application Approved by MIR Date Application Disapproved by Date for the following reasons Permit No. Date Issued No. Fee T COMMONWEALTH OF MASSACHUSETTS Entered in computeWYes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS I 21ppYitation for Misposal *pstem Construction Permit !Application for a Permit to Construct( ) Repair(Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. y75, Cedar 5�-, / ' Owner's Name,Address,and Tel.No. Lin 4f Ma h Assessor's Map/Parcel (,J . 1�3v 5�.2��L H. 5� C4�ar S�• W• Y h 5�2 b�� Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No.%(�-360-331 1 felt. STf_vXNS r_o. J,4r71 Yk*45 ".s pi,►Is,WIVi A' ev15�"S'x!i b I Type of Building: Dwelling No.of Bedrooms Lot Size t/' sq.ft. Garbage Grinder( ) Other Type of Building /� yp g 1l/�4 No.of Persons 'Showers( Cafeteria( ) Other Fixtures —���" Design Flow(min.required) �� gpd Design flow provided _ . 2 — gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank 6 Type of S.A.S. ) Od Description of Soilrj Nature of Repairs or Alterations(Answer when applicable) Anbcf Date last inspected: 'yam Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board a Date 4Z 4 D Application Approved by / �,/ , ��� Date Application Disapproved by L/ `r Date for the following reasons y Permit No Date Issued -------- �"� =v�� - - =-------------- ---------------------------------------------- OMMONWEALTH OF MASSACHUSETTS __.. ARNSTABLE,MASSACHUSETTS } S� Certificate of Comp[iancr THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired Upgraded( ) Abandoned( )by J��R%C: 5T-Ur us at `yZ� = has been const cted i ac o , with the provisions of Title 5 and the for Disposal System Construction Permit No.V. ..• atedl Installer E(Q\L A j Designer IS1 Y #bedrooms Z Approved design flow gpd The issuance of his permit shall not be construed as a guarantee that the system w 1 fu ctio as designed Date �_ � Inspector Ill ----------- ------------------------------------ No Fee _3A9THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE, MASSACHUSETTS Nsposal *p8teitt onstrUttion Permit Permission is hereby granted to Construct( ) Repair( Upgrade( ) Abandon( ) System located at y7!!�- Ca-a Z. 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:X ns ction must be c m•lete ithin three years of the date of this permit. Date ...�' Approved by _ i Town of Barnstable Regulatory Services Richard V. Scali,Interim Director KAM public Health Division Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4544 Fax: 508-790-6304 Installer&Deiiager Certification Form Date: fd I Sewage Permit# Assessors MaplParcel a Designer: Installer: - Address: Address: _ �d " ou D- was issued a permit to install a dat (installer) septic system at 7 ( W B "ased on a design drawn by address �1S r dated_ (designer I certify that the septic system re `erenced 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. neater 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 constru fiance with the terms of the I1A approval letters(if applicable) ,t1+OF 17 E er's Signature) M 140 0 1 �Nts kA I (Desigixer's Signature) (Affix tamp Here) PLEASE RETURN TO BARN LE PUBLIC HEALTH DIVISION. CERTIFICATE OF CO TUANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS- SUILT CARD ARE RECExVED BY THE BARNSTABLE PUBLIC REALTH DIVISION. THANX YOU. Q:15eptic\Designer Certification Form Rzv 8-14-13.dm 10/T0 39Vd SNOS GNV d3A3W 89b6ETVVLLT WdL9:0T 9TOZ/ZO/OT i Town of B A rnstable. Department of Regulatory Services 77/ • Public Health Division Date S 4rABM KAM i63q ems$ 200 Main Street.Hyannis MA 02601 G t/�/ ,..._ Date Scheduled Ti Fee Pd.me - cjj � Y'ti7 Soil ,suitability Assess r' ent fog- Sewage Disposal i Performed By: Witnessed By: c i LOCATION & GENERAL INFORMATION Location Address Owner's Name YJ W • �jp�LaJ STI�-FJLI—:- � I Address q 1 Q CE'00re- TT Assessor's Map/P4rcel: 0 / 61 7 I Engineer's Name KEY,�' -b 5-V-J-5 NEW CONSIRU REPAIR Tel ephone# Land Use 'v✓ � �I Slopes(%) • I •/ Surface Stones Distances from: Open Water Body ?' ft Possible Wet Area �b ft Drinking Water Well ft i Drainage Way ft. Property Line CIO ft Other ft SKETCH:($treet name,dimensions of lot,exact locations of test holes&pere tests.locate wetlands in proximity to holes) plt4yl i k l Parent material(geologic) d e,S f Depth to Bedroc 'r '"� Depth to GroundwaKdr. Standing Water in Hole:' - i Weeping from Pit FACE ,~.A Estimated Seasonal.bgh Groundwater N, ------ DtTERMINATION FOR SEASONAL HIGH'WATER T""' Method Used: I in. Depth td soll motfies: in, Depth dbserve standing in obs.hole: - I in, aroundwnter Ad)uetment tk- Depth tolweeping from side of obs.hole: ; A {aetar. .� AcQ.Groundwater)evel.,,,,�, Index Well# Reading Date Index Well level — PERCOI,ATION TEST' Dnte_,_,.r__ Tone* Observation ( Time at 9" N -.--- Hole# y Time at 6" -- Depth of Pere `!6� Time(9"-61 Start Pre-soak Time.C� End Pre-soak hate MinJInch Site Failed.' Additional Testing Needed(Y/N) Site Suitability Assessment: Site Passed�� ` ., Original:.Public k;e$ith Division Observation Hole Data To B eCompleted on Back— ***If percolajion test is to be conducted within 100' of wetland,you must first notify the Barnstable C4.0servation Division at least one(1) wedk prior to beginning. i/ s Y • e DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. onsistenc 8'o Gravel Mir '7 37 &YP- -3-711 =490 1- �wjo DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Co enc %Gravel) b`t- T' 0L'� N AM Mg . �r) it DEEP OBSERVATION HOLE LOG Hole# N 11-4 Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency,%Gravel t L DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. C nsisten ra I Flood Insurance Rate May: Above 500 year flood boundary No_ Yes _ Within 500 year boundary No V Yes Within 100 year flood boundary No Yes Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervi us material exist.in all areas observed throughout the area proposed for the soil absorption system? e If not,what is the depth of naturally occurring p vious material? Certification I certify that on (date)I have passed the soil evaluator examination approved by the Department of Envir mental Protection and that the above analysis was performed by me consistent with the required tr ' 'ng xpertise and experience described in 3.10 CMR-15.017. Signature %/ Date �� t { f •. Q:\SEPTICVERCFORM.DOC r c�-75 LOC&TION SEW&C,E PERMIT UO. - T .s.3 Cvic3 . 'VILLAGE -S - _INSTNLLER'S U& E-4 -ADDRESS -YOE uAv--L- - - - - - DN.TE -P_ERW-7T -1.55UED-• t=_ _,.D o,SE COMPLI-&IlACE_ ,: _ � � �x � �� No..3- Fay .................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH _... Town............OF.......Barnstable .................................... - ------ Appliratiun -for Uiipuial Works Tunotrurtion,Vrrmit Application is hereby made for a Permit to Construct ( ) or Repair ( } an Individual Sewage Disposal System at: '!Trailview"1 West_Barnstable Lot___53 Cedar Street -Address or Lot No. Sea= e O 'B9xs _9>1 -----------------------------------•--------• ......RQute.-.6A,..Bandw.i.ch,...Maas....02563-------------•---- Owner Address a Norman._1�!Qtte............................. ..... ----------- Installer Address QType of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms----Two.-.z__4d---____--_----•_Expansion Attic (x ) Garbage Grinder ( ) aOther—Type of Building ____________________________ No. of persons..________-___-_.._---__-_- Showers ( ) — Cafeteria ( ) Q' Other fixtures ----------•---•-•--•---------- - ---------------------------- W Design Flow............................................gallons per person per day. Total daily flow-------------------------.------------------gallons. WSeptic Tank—Liquid capacity------------gallons Length------_------- Width................ Diameter---------------- Depth....-.__.------ x Disposal Trench—No________________--- Width-------------------- Total Length.................... Total leaching area ----- --�__.__.-_--.-sq. ft. Seepage Pit No--------------------- Diameter.................... Depth below let ;_ Total leaching ''- 3 sq. ft. z Other Distribution box ( ) Dosing tank ( ) a Percolation Test Results Performed by----Al.an.-K --.June.s-------------------•--.--.•----•------ Date__Augast---20,-_._1_9T5.. Test Pit No. 1________________minutes per inch Depth of "Pest Pit.................... Depth to ground water........................ t? Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water------------------------ ------------------------------------------------------------------------------------------------------•-------.----•-••-•-•-•---•------------------•--------- O Description of Soil----------Sea_attached--Pexcalatian--Test.-Report----------------------------------------------------------------------- x W -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- UNature of Repairs or Alterations—Answer when applicable._.--------------------------------------------------------------------------------------------- -------------- ----------------------------------------------------------------------------•----------------------------------------------------------------------------------------------------------.. Agreement: The undersigned agrees to install the aforedescrib ndividual Sewage Disposa stem in accordance with the provisions of Article \I of the State Sanitary Code e u dersig e further a es not lace the system in operation until a Certificate of Compliance has been is 17�y�t , arV-1 ealth. S e ake 0orp:iy pT: T;yr.;Pre Date j Application Approved By--- -- ----- ------- % e ""Application Disapproved for the following reasons------------- ` ................................------------------------...... Date..------•••--- -----------------------------------------------------------------------------------------------------•--.•--------•-•----••-••---••. ---------- -- - ------ - - - - ----- Date PermitNo......................................................... -•--••-•--•- I Date I. . . ................... V........... THE COMMONWEALTH OF MASSACHUSETTS v BOARD OF HEALTH _..... ...Town.... ........OF .. . Barnstable ApplirFation -fur Db5pmFal Norko Tutu trurtion Vantit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: '!Trailview",_hiest Barnstable Lot 53 Cedar Street " Location-Address or Lot No. Sea-Lake_-Corporat .... ��1,... a sl�t�.eh; a?aas• Q25�3 Owner Address allorman Avotte .....j SaXslXi.Gh,...Mass-....025- 3. Installer Address d Type of Building Size Lot----------------------------Sq. feet Dwelling—No. of Bedrooms.--Two - and Expansion Attic (X ) Garbage Grinder ( ) aOther—Type of Building ---------------------------- No. of persons---------------------------- Showers ( ) — Cafeteria ( ) dOther fixtures .....--•--------------------------------------------------------------------------------------------------------------------------------------------- W Design Flow............................................gallons per person per day. Total daily flow--------------------------------------------gallons. WSeptic Tank—Liquid capacity------------gallons Length---------------- Width-------._-..... Diameter-_----.------- Depth.--.---__-_--- x Disposal Trench—No..................... Width-------------------- Total Length.................... Total leaching area.----------..----_--sq. ft. Seepage Pit No--------------------- Diameter---------------.---- Depth below 'nlet-... .. Total area_Z--- ----------sq. ft. z Other Distribution box ( ) Dosing tank ( ) 1�`-''�--� aPercolation Test Results Performed by....A_1an.A:'..-__ arieS....................................... Date_A?9g:►:?st-_-2C.I,---1-975... Test Pit No. 1................minutes per inch Depth of Test Pit-------------------- Depth to ground water------------------------ f14 Test Pit No. 2----------------minutes per inch Depth of Test Pit.................... Depth to ground water-..--------------_---... tx ----------------•----- --------------------•------•-•---------............................................................................................. 0 Description of Soil-------- SQa--a.ttaorelj PPscnlatic?n-Re_ot.-Roro-r--±------------------------------------------------------------------------ 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 Article XI of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. /S'Lg. n Application Approved BY--- --=-t'e � J .... "Gv3° :iiy--:-i--ii- -------Lyt r2 s� Dat7 J '� tG/, �' Date Application Disapproved for the following reasons:---------------- .............................................................................................. ---•-•.-•-------------•-•••-----•---....------------------------........----------•-------•----•---........ --•----....-•----- Date PermitNo......................................................... Issued........................................................ Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH p �..... .......OF........... -................................ Cnrrtifiratr of T'llutpliatta T IS IS TO CERTIFY, That,the In ' a Sewa e Disposal System constructed or Re aired - ...............- ------ I - - - ------- nstal - •--- at... � -t �/ j --- --- ---------&.. ---- _ ----•------=V---- - -/ bas been installed in accordance with the provisions of •i`ti le XI of The State Sanitary Code as described in the application for Disposal Works Construction Permit /------------------ dated....f------�-z--------?.._.):....... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE................................................................................ Inspector.................................................................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD I� F HEALTH 7J ....... FEE/. .............. 1 lVarkii To - rurthl -Vrrmit Permi ion 's ereb ranted--- ....-- =-----------------1--..�------- Y g7 -- -------------------------••--.--••-- to Cons cor Re ai O an In vi Sewa e osaSystem Street .� as shown on the application for Disposal Works Constructi/ Pe In"t No.Z! ,- Dhted.. -.:.:2- - c - ---- ------_----_ Board of Health FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS I f _ y I _ ' I • :�off- a 7 ,._ ��_�_•I .:'� — c � .+ 1 �, � � , _ V; souls°I i•� _� '. p � ; W.€-I.C L LA a I • � L Y 1 � „ I - y 4 `• r I I ! • i i t� Tyw • • L I '- -_ yi i\' ! 1�[ I 6 I ! , # _ _, � 4. t- , i -• ! } _ t t E- d_,, a '_ ..:i ��i try i r'1 1 4i 1 �? -i-- F s 5 4 1 A- L he , *a--ov t,y'. y>-IT e.; °tE.)a'F p @i Cs t ,7'rx, - r . R i L. ALAN W. JONES & ASSOCIATES �.NKE CORA CONSULTING ENGINEERS . ��Q' RECEIVED Carleton Drive East Sandwich, Mass. 02537 Telephone 888-3154 QU� TEST PIT AND PERCOLATION TEST `OFRS ' CoN��P 20 August 1975 To: Sea-Lake Corporation Personnel Present: Norman Ayotte Route 6A & Tupper Road Paul Murray Sandwich, Mass. 02563 Alan W. Jones Re: Lot #53 Test Location: 130' into lot from Cedar Street Cedar Street layout Pest Barnstable, Mass. 0'Off Ground surface 0' 6" Topsoil Sub-soil 4,101# Firm, fine to medium, yellow sand ,0„ Average Percolation Rate: 1" drop in less than 2 min. 810" Firm, fine, white sand P�ZN of q 1210" LA No water encountered 0;V r Note: A test hole was excavated in an expansion area 40' west with similar results as above. LcD 2 i - Commonwealth of Massachusetts ! J U N 6 1996 Executive Office of Environmental Affairs Department of Environmental Protection 4, Wllllsm F.Weld Governor Trudy Coxe Saeretary,EOEA David B.Struhs Commissioner SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION Property Address: 7 Ce-d A e S+ (.V IZA2 nl, Address of Owner: Date of Inspection: / 7/ /°/ 9 (If different) Name of Inspector: T al q /Z' tv Company Name, Addr ss.and Telephone Number: �� i'I'►c>2/� y�� fi S-- /oo r� �,�e�, 3 c 2-30 (o C) CERTIFICATION STA EMENT 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 inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. The system: Passes _ — Conditionally Passes _ Needs Further Evaluation By the Local Approving Authority Fails , Inspector's Signature: Date: t. The System Inspector shall submit a copy of�this inspection report to the Approving Authority within thirty (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 Department of Environmental Protection. The original should be sent to the system owner and copies sent to the buyer, if applicable and the approving authority. INSPECTION SUMMARY: Check A, B, C,or D: A) SYSTEM �PASSES: 1 have not found any information which indicates that the system 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 repaired. The system, upon completion of the replacement or repair, passes inspection. 'w Indicate yes, no, or not determined (Y, N, or ND). Describe basis of determination in all instances. If"mot determined", explain why not) _ The septic tank is metal, cracked; structurally unsound, shows substantial infiltration or exfiltration, or tank failure is imminent. The system will pass inspection if the existing septic tank is replaced with a conforming septic tank as approved by the Board of Health. (revised 8/15/95) 1 One Winter Street a Boston,Massachusetts 02108 a FAX(617)556-1049 a Telephone(617)292-SM 40 Printed on Recycled Paper a. , SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: Owner: Date of Inspection: BJ SYSTEM CONDITI ALLY PASSES (continued) _ Sewage ckup or breakout or high static water level observed in the distribution box is due to broken or obstructed pipe(s) or ue to a broken, settled or uneven distribution box. The system will pass inspection if(with approval of the Board of H Ith): broken pipe(s) are replaced obstruction is removed distribution box is levelled or replaced _ The system required p ping more than four times a year due to broken or obstructed pipe(s). The system will pass inspection if(with appro I of the Board of Health): broken pipe(s) are replaced ; struction is removed f ICJ FURTHER EVALUATION IS REQUIRED BY THE B RD OF HEALTH: Conditions exist which require further evaluation b the Boar of Health in order to determine if the system is failing to protect the public health, safety and the environment. 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH D E INES THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH A SAF AND THE ENVIRONMENT: _ Cesspool or privy is within 50 feet of surface water Cesspool or privy is within 50 feet f a bordering vegetat wetland or a salt marsh. 2) SYSTEM WILL FAIL UNLESS THE BOA OF HEALTH (AND PUBLIC TER SUPPLIER, IF APPROPRIATE) DETERMINES THAT THE SYSTEM IS FUNCTIONING IN MANNER THAT PROTECT THE PU IC HEALTH AND SAFETY AND THE ENVIRONMENT: _ The system has a sep is tank and soil absorption system and is within 100 • t to a surface water supply or.tributary to a surface water sup p . _ The system ha, septic tank and soil absorption system and is within a Zone I f a public water supply well. _ The system ha a septic tank and soil absorption system and is within 50 feet of a private water supply well. _ The system as a septic tank and soil absorption system and is less than 100 feet but 50 feet or more from a private water supply we , unless a well water analysis for coliform bacteria and volatile organic compounds indicates that the well is free fro pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm• } DJ SYSTEM FAILS: I have termined that the system violates one or more of the following failure criteria as defined in 310 CMR 15.303. The basis for th' determination is identified below. 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. k _ Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool. (revised 8/15/95) 2 L_ SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: C'e dA-2 S w 1�- 9 2 tu, Owner. G eNS/C Date of Inspection: D)SYSTEM FAILS(continued): Static liquid level in the distribution box above outlet invert due to an overloaded or dogged SAS or cesspool. uid depth in cesspool is less than 6"below invert or available volume is less than 1/2 day flow. Requ pumping more than 4 times in the last year NOT due to clogged or o ed pipe(s). Numbe f times pumped Any portion o he Soil Absorption System, cesspool o is below the high groundwater elevation. Any portion of a ce ool or privy is wi • 00 feet of a surface water supply or tributary to a surface water supply. An onion of a cess oo i i within _ y p p ivy s t in a Zone I of a public well. Any portion o sspool or pr is within 50 feet of a private water supply well. portion of a cesspool or privy is ess than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. If th well has been analyzed to be acceptable, attach copy of well water analysis for coliform bacteria, volatile organic compo ds, ammonia nitrogen and nitrate nitrogen. E) LARGE SYSTEM FAILS: The following criteria apply to large systems in addition to the iteria above: The design flow of system is 10,000 gpd or greater (Large System) a the system is a significant threat to public health and safety and the environment because one or more of the following conditions xist: 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 upply 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) The owner or operator of any such system shall bring the system and facility into full compliance with the groundwater treatment program requirements of 314 CMR 5.00 and 6.00. Please consult the local regional office of the Department for further information. I (revised 8/15/95) 3 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 4/7S C e6lA-4Q Owner: Ge_"Ja,Q, Date of Inspection: s- 7-96 Check if the following have been done: �mping information was requested of the owner, occupant, and Board of Health. t-Ko'ne of the system components have been pumped for at least two weeks and the system has been receiving normal flow rates during that period. Large volumes of water have not been introduced into the system recently or ag part of this inspection. �As plans have been obtained and examined. Note if they are not available with WA. C- facility or dwelling was inspected for signs of sewage back-up. e system does not receive non-sanitary or industrial waste flow el he site was inspected for signs of breakout. _All systemcomponents, excluding the Soil Absorption System, have been located on the site. _�he septic tank manholes were uncovered, opened, and the interior of the septic tank was inspected for condition of baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge, depth of scum. �he sire and location of the Soil Absorption System on the site has been determined based on existing information or approximated by non-intrusive methods. `-'The facility ov.ner (and occupants, if different from o�%ner) were provided with information on the proper maintenance of Sub- Surface Disposal System. (revised 8/15/95) 4 f I SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: Owner: Date of Inspection: -7 FLOW CONDITIONS RESIDENTIAL: Design fl �llons ow: Number of bedrooms: Number of current residents: 2 Garbage grinder(yes or no):, Laundry connected to system (yes or no): Seasonal use (yes or no): /V Water meter readings, if available: Last date of occupancy: OC &Pled COMMERCIAUINDU TRIAL: Type of establishment: Design flow:_gallon ay Grease trap present: (yes or n Industrial Waste Holding Tank pre : (yes or no)_ Non-sanitary waste discharged to the Tit s stem: (yes or no)_ Water meter readings, if available: Last date of occupancy: OTHER: (Describe) Last date of occupancy: GENERAL INFORMATION PUMPING RECORDS and source of information: System pumped as part of inspection: (yes or no)�Q� If yes, volume pumped �G�O allonc 7J�� Reason for pumping: TYPE OF SYSTEM L"'Septic tank/distfibntYon-�soil absorption system Single cesspool Overflow cesspool Privy Shared system (yes or no) (if yes, attach previous inspection records, if any) Other(explain) IL APPROXIMATE AGE of all components, date installed (if known) and source of information: 12 7 6 /-wIt/ 4S y!l Sewage odors detected when arriving at the site: (yes or no)Lo (revised 8/15/95) 5 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 4 7 S Co-dq-,P­ Owner: Date of Inspection: S_v SEPTIC TANK: (locate on site plan) Depth below grade: Material of construct ncrete _metal _FRP—other(explain) Dimensions: Sludge depth: Distance from top of sludge to bottom of outlet tee or baffle: - 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: Comments: (recommendation for pumping, conditio o islet and otjtlet tees or b les, de th of IV'quid level in relationto outlet invert, ctural inte ri evidence of,leakage, e .) GREASE TRAP:_ (locate on site plan) Depth below grade: Material of construction: _concrete _metal _ RP —other(explain) Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom ni,.rum to hottom of outlet tee or b Comments: (recommendation for pum v ondition of inlet and outlet tees or baffles, depth liquid level in relation to outlet invert, structural integrity, ev' nc eakae, etc.) (revised 8/15/95) 6 l . r SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C n/ SYSTEM INFORMATION (continued)Property Address: 5 �,Giv S'�s- UC1 Owner: G eN5 I211 Date of Inspection: TIGHT OR HOLDING TANK:_ (locate on site plan) Depth below grade: Material of construction: _concrete_metal _FRP—other(explain) Dimensions: Capacity: gallons Design floe: eallons/day Alarm level: Comments: (condition of inlet tee, condition of alarm!andfloat itche<etc. DISTXlevel (loca Dept invert: Comments: (note if level and distribution. is equal, evidence of so!ids carryover, evidence of leakage into or out of box, etc.) PUMP CHAMBER:_ (locate on site plan) ' Pumps in working order.(yes or no) Comments: (note condition of pump chamber, condition of pumps a urtenance , . I (revised 8/15/95) 7 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: � 7 s 6-0e&2 Sf �. Owner: S pa)S.�e.IZ. ` Date of Inspection: SOIL ABSORPTION SYSTEM(SAS))-= (locate on site plan, if possible; excavation not required, but may be approximated 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: Commgno: (note condition of soil, igns of hydrauli failure, level of ponding, condol9p of vegetation,etc.) CESSPOOLS: _ (locate on site plan) Number configuration: Depth-top of id to inlet invert: Depth of solids la Depth of scum layer:"'-- Dimensions of cesspool: Materials of construction: 1-1 Indication of groundwater: inflow (cesspool must be pum as part of ins Comments: (note condition of soil, signs of draulic ' ure, level of ponding, condition of vegetation, etc.) PRIVY/condition (locateMateri Dimensions: DepthCommn of soil, signs of hydraulic failure, level of ponding, conditio�fion, etc.) •(revised 8/15/95) 8 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: Owner. (j e ti$12 it Date of Inspection: SKETCH OF SEWAGE DISPOSAL SYSTEM: . include ties to at least two permanent references landmarks or benchmarks locate all wells within 100' 1 � ' . 13 � o � O 3- o - i 3 DEPTH TO GROUNDWATER Depth to groundwater:—�6__feet methpd of Sletermination o roximation: s 4- if (revised 8/15/95) • 9 WEST BARNSTABLE LEGEND y, c N ST PROPOSED CONTOUR 9� PROPOSED SPOT GRADE • -- 98 -- EXISTING CONTOUR sr + 96.52 EXISTING SPOT GRADE O EXIST. I ,000 GAL WELL W— EXISTING WATER SERVICE f TEST PIT SEPTIC TANK o FF LOCUS r \\ LOCUS M Ar WELL S1°EwA� � C� '� LOCUS INFORMATION r TITLE REF: BK 10368 PG 183 144•56' EDGE OF PARCEL ID: MAP 108 PAR. 015 p 70.. WELL _------ AVEMENT _ ------ 700 ft FROM L 9236- SEPTIC SYSTEM -'r- ---------- _ ___------------- REPAIR PLAN ,- -- _ - ------- � PARKING - ------ - LOCATED AT: _ - -70 / AREA G - --- -----------72 / 475 CEDAR STREET 0 72 I PAVEO OR 1 ,' ;' " - L_O ' 57 ' WEST BARNSTABLE, MA VEwAY AREA = 38245 sf+ PREPARED FOR PLAN BOOK 301 PAGE 99 ASSR MPP108 PCL , s LINDEMAN --- = ti'ELL/N 78 `\ TO ' ' -1- 74 z r OF S DARREN M. 0 N ME R� c .� 0. fI tli�J& Q N I TARP 76 I I I � } 00,1) ) o I ZH- -cA�u7i �G� eoU BENCH MARK ��� TOP OF FOUNDATION MEYER & SONS INC. Z:f73.83 P. O. Box 981 78 8O `80 - - ' BARNSTABLE GIS DATU 7 I E. SANDWICH , MA 02537 WELL 100 ft FROM WELL 78 253.36' 80 - _ - - ------JI P H. (508)36 0—3311 P LA N SCALE: 1 in = 30 ft fax (774)413-9468 EXIST. 1 ,000 PIT meyerandsonstitie5©gmaii.com www.meyerandsons.com (see Note 1 O) SCALE 1"=30' SHEET 1 OF 2 J#1491 i ELEV. TOP FOUNDATION NOTE: PLACE MAGNETIC MARKING TAPE OVER ALL COVERS + (Existing) BRING ALL COVERS TO WITHIN 3" OF FINISH GRADE FINISHED GRADE (73.6) = 73.83 � F.G.EL: 73.50 F.G.EL: 73.43 F.G. EL: 73.60 MAINTAIN 2% MIN SLOPE OVER LEACHING AREA : 2" OF 3/8" DOUBLE WASHED 3/4" - 1-1/2" F.G.EL: 71.33 STONE OR FILTER FABRIC DOUBLE WASHED STONE 1 a 6" 4" SCH 40 PVC /77 101 6" ®®®®. 0 ®®®® 14" S= 1% (MIN. ®®®®®®®®®®® :Q 4'ErSCHR 40T PUCE I N V.69.9 2 ) 2 EFF. DEPTH ®®®®®®®®®®® 0 A: I NV.70.05 INV.69.751 4' 2 X 8.5' 4' EXISTING OUTLET BAFFLE PROPOSED DB-3 . �� EFFECTIVE LENGTH = 25' :....._„ ..,... . . . . :. .. DISTRIBUTION BOX INV. 70.30 (H20) INV. ELEV.= 69.60 EXISTING 1,000 GALLON SEPTIC TANK GAS BAFFLE TO BE INSTALLED ON ���` �F 'Ass BREAKOUT OUTLET TEE AS MANUFACTURED BY 3``PD E 9�y ELEV.= 70.60 TUF-TITE, ZABEL, OR EQUAL TOP CONC. ELEV.= 70.60 NOTES: 1) CONTRACTOR SHALL VERIFY ALL EXISTING o . INV. ELEV.= 69.60 �am "am" S , PIPE INVERTS PRIOR TO CONSTRUCTION a0a0aaa 2) D-BOX SHALL BE SET LEVEL AND TRUE TO SEC/51E mmE3m0m0= GRADE ON A MECHANICALLY COMPACTED SIX \P� BOTTOM EL.= 67.60 ®®®0mm0®®®® INCH CRUSHED STONE BASE, AS SPECIFIED IN NITAR � 3.75' 5 FT. 3.75' 310 CMR 15.221(2) l , 3) REPLACE EXISTING 1,000 GALLON SEPTIC TANK SEPARATION 6.10 FT. EFFECTIVE WIDTH = 12.5 WITH 1500 GALLON SEPTIC TANK IF FAILED, DAMAGED, NOT H2O LOADING, OR UNDERSIZED. SEPTIC SYSTEM PROFILE 4) INSTALL INLET & OUTLET TEES W/ BOTTOM OF TESTHOLE EL: 61 .50 SOIL ABSORPTION SYSTEM (SECTION) e GAS BAFFLE AS REQUIRED (500 GALLON LEACH CHAMBER) GENERAL NOTES: SOIL LOGS DESIGN CRITERIA 1. ALL .CHANGES TO THIS PLAN MUST BE APPROVED BY THE LOCAL P#: 14782 NUMBER OF BEDROOMS: 3 BEDROOMM BOARD OF HEALTH AND THE DESIGN ENGINEER. 2. ALL WORK AND MATERIALS SHALL CONFORM TO THE REQUIREMENTS DATE: AUGUST 19, 2015 SOIL TEXTURAL CLASS: CLASS I (0.74 GPD/SF) OF THE STATE ENVIRONMENTAL CODE, TITLE V. AND ANY APPLICABLE DESIGN PERCOLATION RATE: <2 MIN/IN LOCAL RULES AND REGULATIONS, EXCEPT AS FOLLOWS: SOIL EVALUATOR: DARREN MEYER, R.S., CSE #1614 DAILY FLOW: 110 G.P.D. X 3 BR = DESIGN FLOW: 330 G.P.D. BARNSTABLE TITLE 5 REGULATIONS- WITNESS: DAVID STANTON, BARNSTABLE B.O.H. ALLOW LEACHING TO BE 100 Fr. FROM PRIVATE WELL VS. REQUIRED 150 Fr. GARBAGE GRINDER: NO (not designed for garbage grinder) 3. THE SEWAGE DISPOSAL SYSTEM SHALL NOT BE BACKFILLED PRIOR SEPTIC TANK: 330 gpd x 200% = 660 gpd, USE EXISTING 1,000 GAL. SEPTIC TANK TO INSPECTION AND APPROVAL BY THE BOARD OF HEALTH AND THE Elev. TP-1 Depth Elev. TP-2 Depth DESIGN ENGINEER. 74.75 0" 74.50 0" (330) = 445.94 S.F. 4. ANY CONDITIONS ENCOUNTERED DURING CONSTRUCTION DIFFERING A LOAMY SAND A LOAMY SAND LEACHING AREA REQUIRED: FROM THOSE ENGINEER BEFO ESHOWCONSTRUCTION ONTINUESHEREON SHALL BE ORTED TO THE DESIGN 74 17 1 OYR 3/1 7„ 73 85 10YR 3/1 7" 74 5. ALL ELEVATIONS BASED ON ASSUMED DATUM. B LOAMY SAND B LOAMY SAND USE TWO (2) 500 GALLON PRECAST LEACH CHAMBERS W/ 4' 6. THE DESIGN ENGINEER IS NOT RESPONSIBLE FOR THE FAILURE OF 71.67 C 10YR 5/8 37" 71.33 C tOYR 5/8 38" STONE ON SIDES & 3.75' STONE ON SIDES: 25' L X 1 2.5' W X 2'D THE CONTRACTOR OR OWNER TO NOTIFY THE LOCAL BOARD OF HEALTH FOR PROPER INSPECTIONS DURING CONSTRUCTION. BOTTOM AREA: 25 x 12.5= 312.5 SF 7. WATER SUPPLY PROVIDED BY TOWN WATER SERVICE. +� 8. ALL AREAS DISTURBED DURING CONSTRUCTION SHALL BE RESTORED SIDE AREA: (25 + 12.5) X 2 X 2 = 150 SF TO A CONDITION AGREED UPON BETWEEN OWNER AND CONTRACTOR. PERC ® EL. 70.0 MEDIUM SAND MEDIUM SAND 9. IT SHALL BE THE RESPONSIBILITY OF THE CONTRACTOR TO VERIFY THE 2.5Y 7/3 2.5Y 7/3 TOTAL SQUARE FEET PROVIDED = 462 vs. 445.94 REQ'D THE LOCATION OF ALL UNDERGROUND UTILITIES, PRIOR TO BEGINNING DESIGN FLOW PROVIDED: 0.74(462 S.F.) = 342.25 G.P.D. vs. 330 G.P.D. re q'd CONSTRUCTION. 10. EXISTING LEACHING TO BE PUMPED, CRUSHED AND REMOVED PER TITLE 5. PROPOSED SEPTIC SYSTEM UPGRADE PLAN REPLACE WITH CLEAN MEDIUM SAND PER TITLE 5. 11. 48 HOUR NOTICE FOR ENGINEER CERTIFICATION 61.75 156" 61.50 156" 475 CEDAR STREET, WEST BARNSTABLE, MA 12. THIS PLAN IS TO BE USED FOR SEPTIC SYSTEM PURPOSES ONLY AND IS NOT TO BE CONSIDERED A PROPERTY LINE SURVEY PERC RATE <2 MIN/IN. (-C" HORIZON) Prepared for: Lindeman 13. NO PRIVATE WELLS WITHIN 150' OF PROPOSED LEACHING. NO GROUNDWATER OBSERVED Engineering and Survey by: SCALE DRAWN 14. NO WETLANDS WITHIN 100' OF PROPOSED LEACHING. MEYER&SONS,INC. N.T.S. DMM 15. ALL PIPING TO BE 4" SCH 40 ® 1/8"/FT (UNLESS SPECIFIED) • 1. Darren M. Meyer, R.S., CSE, hereby certify that I am currently approved by MADEP pursuant to 310 CMR 15.017 PO BOX9B1 to conduct soil evaluations and that the above analysis has been performed by me consistent with the DATE CHECKED SHEET NO. requirements of 310 CMR 15.017. 1 further certify that I have passed the Soil Evol. Exam in October, 1999. EAST SANDWICH,MA 02537 508-362-2922 09/1 1/15 DMM 2 of 2