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HomeMy WebLinkAbout0510 CEDAR STREET - Health p. 510 Cedar Street VV. Barnstable P A = 109 051 0 J,�v pF fla�tid?. o CERTIFICATE OF ANALYSIS Page: 1 ,,SACHUS� Barnstable County Health Laboratory Report Dated: 5/26/2004 Report Prepared For: William F. Reiland Order No.: G0425093 Reiland,William F.&Katherine W. 510 Cedar Street West Barnstable, MA 02668 Laboratory ID#: 0425093-01 Description: Water-Drinking Water i Sample 9: 25093 Sampling Location 510 Cedar St.West Barnstable NIA Collected: 5/11/2004 Collected by: W Reiland Received: 5/11/2004 Routine ITEM RESULT UNITS RL MCL Method# Tested LAB: IC Lab Nitrates 1.6 mg/L 0.1 10 EPA 300.0 5/11/2004 LAB: Metals Copper 0.2 mg/L 0.1 1.3 SM 3111 B 5/13/2004 Iron 0.3 mg/L 0.1 0.3 SM 3111 B 5/13/2004 Sodium 15 me/L 1.0 20 SM 3111B 5/13/2004 LAB: Microbiology i Total Coliform Absent P/A 0 Absent 307 5/11/2004 LAB: Physical Chemistry Conductance 190 umohs/cm I EPA 120.1 5/11/2004 pH 6.4 pH-units 0 EPA 150.1 5/11/2004 Water sample meets the recommended limits for drinking water of all the above tested parameters. Approved By: a Director) RECEIVE® ;;► :.,a i•. .r.J UN,U 1 2004 TOw8EOLTH N'STABLE Superior Court House, PO. Box 427, Barnstable, MA 02630 Ph: 508-375-6605 I !Zx CIOMIMONWEALTH 4E 1 SASS TI'S t DEPARTmEIT OF N-%qRON ENTAL PROTECTION RECEIVED 0 12004. TOWN OF BARNSTABLE TITLE 5 HEALTH DEPT. OFFICIAL INSPECTION FORIM—NOT FOR VOLUNTARY ASSESSMENTS SUBSPACE SEWAGE DISPOSAL SYSTEM FORM. PART,A CERTff1CAT10N Property Address: 71 St«t MAR Owner's Name: V. i war► �Q Owner's AddE'=ess: l U r � ° �A-4 thA 6a66� Date of Inspection: Sr a-- 101 Name of Inspector. please print) a '6� CompanyNa Me. dVd ,141L IC K41lr9wtlKV dtspecAwro, Mailinb Address 32 5neRi- EM01 Telephone Number: SZ8 ". S'7102 CERTMCATION S'TA�`E� 'T I certify that I have personally inspected the sew-agP-disposal system at this address and that the information reported below is true,accurate and complete as of the time of the inspection.The Lnspection was perforn?ed based on my training and experieace iri a proper function ai d maintenance of on site s6wage disposal systems_I tan a D� approved system inspector pursuant to Section 15-340 of"Title 5(310 C`MR 15.UfiQ), The system: X Passes Condition all Passes Needs,Fier£valti°ation by the Local Approving Authority Fails Inspector's Signature: e • _ Bate: The system inspector shall submit a copy of this won report to the Appros+iseg:authority{Board of�altlt€�r DEP)within 30 clays of completing this imsp If the system is a shared system or has a design flow of 10,€300 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. Notes and Comments ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address isow the system will perform in the future under the same or different conditions of use. Title 5 Inspection Forth 611512000 page I Page 2ofII C Ci L INSPECTION FORM-NOT FOR VOLUNTARY ASSFSS.NiMNTS r SUBSUWACE SEWAGE WSPOSAL SYSTEM INSPECTION FOR Is CERTI CATION(continued) Property Address: SIO C&Lr S c ck tamer: Date of Inspection: i -I PO . baspecdon S mmaadsy: Check A,B,C D or E/Al.WAYS compie#e an of Seen D A. System Passes: I havemot found any information which indicates that any of the fail=criteria described in 310 CMR I3.r s or in 310 CMR 15-304 exist.Any hiltue criteria not evaluated are indicated below. Comments, B. Systems Conditionally Passes: One or more system components as described in the-Conditional Passr need tar be replaced or erg-The system=upon completion of the replacement or repair,as v y the Board of Health,will pass- Answer yes,no or not determined(Y,N,ND)in the for the " g statements.If-not determined"please explain. The septic tank is metal and over 20 years old*or the tank{whether metal or mot)is structurally ii-ns und,exht-bits substantial infItration or exf h atiann or faillurre is imniment.System will pass inspection.if the existing tank is replaced with a complying septic t wed by the Board of Healtii. *A metal septic tank will grass inspection if it is sound,not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is le. ND explain: Observation of sewage backup or atit ar bigh static water level in the disc iNniam box due to broken or obstructed pipe(s)or due to a broken, cal or utter distribution box_System will pass mVectim if(with approval of Board of Health): broken p uciephced obsMicfimisrzwved distrilution box.is or replaced NrD explain: The sy�steni pumping moan than 4 times a year due to broken or obstructed pipe(s).The systern will pass inspection if approval of the lid of Head) brown pipe(s)are replaced obstruction is removed ND lain: 2 P- 3ofII OFFICIAI.>INSPECTION FORIM-NOT FOR VOLUNN Y SSESSN- WNTS SUBSURFACE SEWAGE DISPOSAL.SYSTEM INSPECTION FOR PART A CERTIFICATION(continued) Property Address: 6/D e .d' 'mom Owner: - �Q• Date of Inspection: eft) C. Further Evaluation is Required by the Board of Health: Conditions exist which require further evaluation by the Board oft 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 15 303{l)(b)that the system is not func€ioning in a manner which will protect public health,sa y2nd the environment: Cesspool or privy is within SO feet of a surface water — Cesspool or privy is within 50 feet of a Bering vegetated and or a salt marsh the Board of Health Public Water Suppl"aer`,if aura)determines that the .» Sy-stem wall Taal unless { s r wm is ftinctioning in a manner that a public health,safety and en-w'ironment: _ The system has a septic tank and ' absogdon system(SAS)and the SAS is%rithin 100 feet of a surface water supply or tributary to a =ace water supply, The system has a septic d SAS and the SAS is within a Zone I of a public water supply. — The system has aseptic and SAS and the SAS is within 50 feet of a private v'ater supply well. _ The system has a- tank and SAS and the SAS is less than I00 feet but 50 feet or more itrn a private water supply I**.Method used to determine distance :*This system p if the well water analysis,performed at a 13EP certified laboratory,for coliform bacteria and vol a organic compounds indicates that the well is free frown pollution from that facility atad the presence o aonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided than no other failure criteri are triggered A copy of the analysis must be attached to this form_ 3. ®t 3 Pam:.4 of l l ®I CAI.LNSPECnON FOR VOLUNTARY ASSESS MUM CATION( ) Addr • X/0 L cp�ca%. der A o. Date of a' v D. System Failwiv Cnter&applicable to all sy you must is >ate`yes"or"no"to each of the following for Yes No ( Backup of sewage into Licility or sum component lose to overloaded or clogged SAS€ar cesspool Dmcbarge or gondiug of effluent to the surface of the ground or surface waten due to an overloaded Or clogged SAS or cesspool Static liquid level m the distribution box above outlet irsvert due to an overloaded or cloyed SAS or ce'spoo, I quid depth in cesspool is less than 6"below invert or available voluusrne is less thanh day flow pumping more than 4 tunes in the lag year NOT due to clogged or pipe(s).$umber Repiredoftimes 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 ssspply Or tn'butary to a surface water supply. _ Any portion of a col or privy is within a Zone I of a public Buell. Any portion of a cesspool or privy is within 50 feet of a private water su ply well. �L Any pion of a cesTs col or levy is less than 100 feet but greater than 50 feet from a}ovate water supply well wnn no acceptable water quality analysis1 m passes if the wen water-aftabysis' performed at.a DEP certified hdmratory;for bacteria and volatile indicates that the well is free from pollutirarn from that Ewility and the grew of ammo nitrogen and nitrate nitrogen is equat to Or hem than 5 lam,provided that no aver fire criteria are .A copy of the analysis must be affacited to this form.] ko (Yest'.:o)The system foals.I have determined dw one to more of the above failure criteria exist as de 'bed ha 3 lO CYa l5.303,tyre the sy fails The system owner should contact the lid of Health to determine wlsat will be necessarvy to correct the fame- F. Large Systems: to 15,E To be considered a large system the System ses�en facility with a gpd- of ld#, gpd oumust indicate either"}`es"or`ne to each of the following (The following criteria apply to jwge systems in addition akeria above) Yes no _ the system is within 400 feet &Wdng water supply _ the system is within Z of a tributary to a surfs=drinking wad SWIY the syste€r3 is I in a r€atrogen sensitive area(hft ra Wellhead prrotccwn Area—IWPA)or a mapped Zone Il of a lic weer fly well If you have arcs "yes"to any question in Section E the system is considereda significant that,or acre "yes'in D able the large system has fad The owner or opwator of any large systein c oasidered a sign' under Section E or failed under Section D shall upgrade the system in accordance with 310 CUR 15.304_ system owner should contact the appropriate regional office of the 4 page 5 of 11 VjSpE OFFICIAL CnON FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSUffACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PAR' B CHE. ST propel Address: 00 Owner: Date of ins Lion: !r- � a Check if the folla Q have been done.You must indicate �or"no"as to each of the followia.: Yes No or$ of wealth JC _ Nmpmg information was provided by the warner,occupant, Were any of the system components pumped out in the previous two weeks? Has the system received normal flows in the prMons two week period" Have large-volumes of water been introduced to the hem recently or as part of this inspection — Were as built plans of the system obtained and exam med?(If they were not available mote as NIA} g( Was the facility or dwelling inspected for sips of sewage back up? Was the site inspected for signs of break out`' _ Were all system components,excluding the SAS,located on site? and the interior of the tank inspected for the condition t _ Were the septic tank manholes uncovered,opened. of liquid,depth of shame and depth of ? of the baffles or tees,material of construction,dimensions,d qm — Was the facility Owner(and occupants if diffaea from owner)provided with mforasaation on the proper maintenance of subsurface sewage disposal systems The size and location of the Sod Absorption System(SAS)on the site has been determined based€ Yes no at the Board of Health. -4- lxisagffcartraatiot:.for example,a plaaa Determined in the field(if any of the fail=criteria related to Part C is at ism approximation of distance is ptable)[310 CMR 15302(3)(b)j 5 Page 6 of I I OFFICL&L INspECTION FORM-NOT FOR VOLUNTARY ASSFSSM ENTS SUBSURFACE SE VAGF DISPOSAL SySTEm INSPECTION FORT PART C SYMM INFORANTION Property Address. 3,o Owner- ItgN Bate of Inspection- 5, FLOW CONDITIONS RESIDENTIAL � Number of bedroouas(design}:� �+lrarriber of bedrooms(aortal}: DESIGN`flow based on 310 CMR 15.203(for exaanple: i io gpd x#of bedrooms):�5 Number of current residents: a Does residence have a garbage grinder(yes car no)- is laundry on a separate sewage system(yes or no):& jif yes separate inspection required] Laundry system inspected(yes or no), Seasonal use:(yes or no):-bLO ii Water ureter readings,if available(last 2 years usage(Y�d)): W ek` Sump pump(yes or no):0 Last date of occupancy:LAz-1rC48LW COMMERCIAIjINDUSTRIAL Type of establishment: Design flow(based on 310 CNIR 15.203). d Basis of design flow(seatsluersozssllsgftsete-): Crease trap present(yes tar no):— Industrial%ms€e holding tank present r no): Non-sanitary waste discharged to itle 5 system(yes or no):_ Water meter readings,if availab . :East date of ocxupancy6use: OTHER(describe): GENERAL ENTFOR-MATIOIN Pumping records Source of information: 00 P t &JI2 Was system pumped as pars of the inspection(yes or no): If yes,volume pumped: Qallons—How Was quantity pumped determined? Reason for pumping: TYPE OF SYSTEM —Septic tank,distribution box,soil absorption system Single cesspool _Overflow cesspool _Privy _Shared system(yes or no)(if yes,attach Pltviom inspection records,if gray) _t-movativefAlternative technology.Att-2A a copy of the current operation and maintenance contract(ro be obtained from system owner) —Tight tank —Attach a copy of the OEP approval Other(descry-be): Approx.imate age of all components,date- stalled if known)and source of information: Were sewage odors detected when arriving at the site(yes or no): 60 6 t _ b . Page 7 of I 1 OFFICIAL INSPECTION'ION FORM— T FOR VOLUNTARY SI SIISEWAGEDISPOSAL SYSTEM INSPECTION FORINI PART C SYSTEM INF RNI T ION,(continued) Provertd Address: /Q Ce Owner: Date of Inspec�r.: BUILDING SEWER(locate on site plan) . fB Depth below grade: 51 Materials of construction: cast iron ,( 40 PVC Other(explain): Distance frorn private water supply well or suction line: . Comments(on condition of joints,venting,evidence of leakage,etc.)- SEPTIC TANK: K (locate on site plant) r Depth below grade: Material of construction: concrete metal fiberglass_volvethylene other(expsain) - If tank is metal list age:_ Is age confirmed by a Certificateof Compliance(yes or no):_(a�clt a copy of certificate) j Dimensions: /<w !itv6 Mudge depth: 6L° a- Distance f em top of;(edge to bottom of o et ter or baffle: Scum thickness: 3 - a Distance b'om top of scum to top of outlet tee or baffle: 'Y r, Distance from bottom of scum to both f outlet tmor baffle: It. How were dimensions determined: MeaAveea Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integFity,liquid levels as related to outlet invert,evidence of e,et e e � CREASE TRAP- (locate on site plan' Depth below grade:_ Material of construction:_concrete_metal ass_polyethylene caber (explain): Dimensions: Scum thickn Distance froip of scum to of outlet tee or baffle- r Distance from bottom of to bottom of outlet tee or baffle: Date of lasst purr_pingr Comments(on pu Cr recommendations,inlet and outlet tee or baf€1e condition,structural irate zity,liquid levels as related to out invert,evidence of Rage,etc.): 7 t Page 8 of I I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY Y ASSMMENTS SUBSURFACE D � INSPECTION FORM I C Property Address• V Q Ce t• Sk Mek e cn der' ate of inspection: 57(Q01 0 TIGHTor HOLDLNG TANK: (tank must be pumped at �on�tocate on site plate} Depki below grade: material of construction: Mcrae met-al glass-___polyethylene other( Dimensions: Capacity- .aeons Design Flow: Flo y Alarm presentCves or no): Alarm level: Alarm in order(yes or no): Date of last Pimping: Comments(condition of and float switches,etc.): Dl- UTIO oT BOX: be- (if present must be opened}(loc'are'ou Site plan.} Depth of liquid level above outlet inverr-_A?jjV evidence of Comments'(note if box is level and distribution to outlets equal,any evidence of solids carry > ' leakage to or out of box,etc.): �a x- t� � � c.�tn. �''�' _toms n o s c� v► o� �0.�OM pUMEP CHAMBER: (locale on site plan, Pumps in wonting order fives or no}:. Alarms in w orl ing order(yes or no): Comments(note condition of lam,condition of pumps and�nces> g Page 9 of i 1 OFFICE.INSPEC0 FORM-SOT FOR YOLL-N-TARY ASSESSMENTS SLBSUP2FAC]f SE*A,CF-DISPOSAL SYSTEM INSPECTION PQR�� PART C SYSTEM INFO - TION(continued) Property Address: 67140 C v- C' et 1 r+ 'g Owner: ��V�.dt c � Date of Inspection: 5-1JL0t b`{ SOIL ABSORPTION SYSTEM(SAS):y(locate on site plan,excavation not required) If SAS not located explain why: Type pits,number., __C__leaching chambers,nutnbet= leaching galleries,number_ leaching trenches,number,length: leaching fields,number,dimensions: overflow cesspool,number: innovativelalternative system Type/n me of to nvIV&: Comments(note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation, JIL s A� c b aO"*VU � t 3 a7 s aaQ CESSPOOLS: (cesspool trust be pumped as part of' ovate on site plan) Number and configw ation: Depth—top of liquid to inlet invert: Depth of solids laver- Depth of scum layer. Dimensions of cesspool: Materials of construction: Indication of groundwater in (yes or no)- Comments(note conditio f sod,signs of hydraulic fa`ture,level of ponding,condition of vegetation,etc.): /r PRIVY: (locate on site plan) Materials of construction: Dii ne_sion& Depth of solids: Comments(note ronditio f soil,signs of hydraulic failure,level of pondin&condition of vegetation,etc_): 9 I Wage 10 of I I OFFICIAL INSPEC11ON, FORM—NOT FOR VOLUNTARY ASSESS {` ' S SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORIM PART C SYSTEM IN-FORMATION(continued) Property Address: 510 C r der. �eolc.y. Date of inspection: SI Zy 0`4 S 7TCH OF SEWAGE DISPOSAL SYSTEM u �t 1 .rode a sketch of the sewage�system ittclu�g tees to at t two�aneat reference Ianrl€nartcs or benchmarks_Locate all wells within 100 feet_Locate rdhere public water supply enters the$ ildmg. -C� too�� s3 6s- an f page 1' of l OFFICL4L LNSI'FCTION FOIL -NOT FOR VOLUNTARY-ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM SPEC 0I FOIE PART C SYSTEM TF I&T ION (continued) Property Address: 0,wner: �s late of Inspection: SITE EN-11 Slope 'at� surface Check cellar ect, Shallow wells ilk Estin d depth to ground water b feet Tease indicate(check)all methods used to determine the high mound water elesratiow Obtained ft o€n system design plans on record-If checked,slate of design plan reviewed: Observed site(abutting property(observation hole within 150 feet of SAS) Checked with local Board of l Iealth-explain Checked with local excavators,installers-(attach documentation) _A Accessed raj SGS database-explain: You must descrftre how you established a high ground water t� n: Q T xc fh - I ll ti _ y? , TOWN.,4 BENS,ABLE :LOCATION J�D Dom- SEWAGE# Q r7 ;ZS2 VILLAGE�L��'a SyMOLLS ASSESSOR'S MAP&LOT/d 9 :.::INSTALLER'S NAME&PHONE NO. :SEPTIC TANK CAPACTTY IAI-V� CAME 44- e ;LEACHING FACILITY: (type) '« �e� ��U OF BEDROOINS • ,. I :BUILDER O <:pERMTTDATE 9 COMPLIANCE DATE: ? :!Separation Distance Between the: >'.":Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet } .-Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet :Ed'ge of Wedand and Leaching Facility(If any wetlands exist within 300 feet of le hi facility) Feet Furnished by •Nk bJ TOWiv OF BAZINS':ABLE LOCATION �® SEWAGE# �rZ z a> rya,h4S�0 VILLAGE � ASSESSOR'S MAP& LOT Id 9' INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY: (type) T41ewe1N rj H7.4 I gfo � 3� 5� NO.GF 3EDROO,MS BUILDER OWNE PERMITDATE: 9 COMPLIANCE DATE: f% .: i '�- 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 Wedand and Leaching Facility(If any wetlands exist within 300 feet of leS,chifacility) Feet i� Furnished by _ ___ ;�� i � -�°'�; a + t1 �� �� •.�� �a 1 � ' ��; .\ O� i\ _ .� � �� L<. „��. _ -�- No. —252 r u, �y 1. Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS Zippiication for Oigaal 6pgtem Con.5truction Permit Application for a Permit to Construct( '04epair( )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. S1 p U&k r street Owner's Name,Address and Tel.No. Assessor's Map/Parcel I V 9 _ I S/U &44r St-ra- - lv-&r-,15?tL6te, m.4 Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. 41cwey 60u5TlZc�(770A/ DdW.4 CA-PC "t71N6Ef_1AJb Ro�t� A/u6 N /�itJtil/5 yaamVLC N a -s— Type of Building: Dwelling No.of Bedrooms Lot Size 23,/'13 sq. ft. Garbage Grinder(AIIJ) Other Type of Building No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow 55D gallons per day. Calculated daily flow gallons. Plan Date ' 117 Number of sheets Revision Date Title Size of Septic Tank 14.Uoyt Type of S.A.S. Description of Soil M Nature of Repairs or Alterations(Answer when applicable) 1 9C t 1 5e- 10021 ►p1 ,rpw �oD�t cl S'1 � lie Date last inspected: C��tS�iyC.l�Q01 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 Certifi- cate of Compliance has been issued by this Board of Health. Sign - Date Application Approved Date Application Disapproved for the following reasons 77 Permit No. Date Issued No 9"17 THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION—TOWN OF BARNSTABLE.,, MASSACHUSETTS Applicatiou for Migo,gar *p5tem Conotruction Permit Application for a Permit to Construct( �4epair( )Upgrade( )Abandon( ) ❑Complete System .:❑Individual Components Location Address or Lot No. .S 1 U CQ d u r stfeet Owner's Name,Address and Tel.No. WRY nyllec 6u,1l,a �. gA�c�i5rg8lE 11'1 .,• � Assessor's Map/Parcel l Vq/ S/U CPC/n , Jf�'G2 M4 lc�•�avrl�fiab4 , Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. H I(Wel oov5T2a(7-1oV b61t)ti/ 0APE -.1/h1AJEf,IA O 1 V!�A2L /-AAIE i N AN,k11 mA�m urri Y , mA Nsti I Type of Building: �.- Dwelling No.of Bedrooms Lot Size B 3,1'73 sq.ft. Garbage Grinder Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow 5 5v gallons per day. Calculated daily flow gallons. Plan Date �' 2 Z Number of sheets Revision Date Title Size of Septic Tank 5 _D .'� ✓t Type of S.A.S. _T_1 r--s:- Description of Soil M �� Nature of Repairs or Alterations(Answer when applicable) C SePoo/ 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 Certifi- cate of Compliance has been issued by this Board of He lth. ( � Sig ed�"""� dam- �`� Date Application Approved Date .T Application Disapproved for the following reasons Permit No. k 5 Date Issued ——————————————————————————— t —-——--- '. THE COMMONWEALTH OF MASSACHUSETTS ', BARNSTABLE, MASSACHUSETTS • Certificate of Compliance THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed(--Repaired ( )U gra a "("— Abandoned( )by at 0- j r CAS has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. CA dated- Installer Designer The issuance of this permit shall not be construed as a guarantee that the system will function as designed. Date Inspector No. ^2��2---------------------------FeetY THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS Migo5af -gym Con.5truction Permit Permission is hereby ranted to C struct( )Re�—)-UpLgrade( )Abandon System located at f o �lr ---�' t wQ-�r �A5`'`'v�'' and as described in the above Application for Disposal System Construction Permit. The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. /1 r Provided:Construction must be completed within three years of the date of this p rmit. Date: -7 Approved by ` � t -701 qf No---------- Fps..../J�.................. THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH -•-7o__w_.n-L..............OF........a Appliratiou for Big naaa1 10orkii Tonotrnrtiun ramit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: ...... ....... ..... .... --. .. �.............. ....... ocation-Add s r Lot No. ... ..... ..........C ...km......� car p------------- 7.._/ .......... Owner Address - ._... - -----------------• -•---•- -------------.....----•- � Installer Address Type of Building Size Lot_.4 � 1. Sq. feet U Dwelling—No. of Bedrooms................... _....Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) Q' Other fixtures ........._--•-• •-------------- . W Design Flow......................11 ...................gallons per person per day. Total daily flow............33_P'.....................gallons. WSeptic Tank—Liquid capacity! j?..gallons Length................ Width................ Diameter................ Depth................ x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. 3 Seepage Pit No----------- ... Diameter.........r.......... Depth below inlet........A....... Total leaching area..................sq. ft. Z Other Distribution box (1�10 Dosing tank ( ) '—' Percolation Test Results Performed by........ ._..__l __._JOAd ....... Date....... 17.7 1.4 Test Pit No. I...Z.__......minutes per inch Depth of Test Pit--- ._ Depth to ground water.__l�laf'Wit_ Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ Q+' --••---•---------•--••----••---- -•••••---------••--•-•.....---•-------•..................................................................................... O Description of Soil.......1.=:.vZ1A.r...4Ke0.1.U1A._.DP c-_PMV Si. G4- �?ct+1 .. 3 A� ) -•-•---------------- V - ---------------------- SYu11XLk.aci&:�3�: 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 TIHE 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. J Signed-------- . --- ------- -------...........--....... Application Approved By........ bar=- c ' Date Application Disapproved for the following reasons------------------------------------------------------------------•------------•--•--------- -------•--•-------. •...............•----•---------•------........_...•----------.............-----•-•-..........-------•----'•--------•-----------•----------------•-----•-•---•-•--•---------------•-••-••---•-•-------•--- Date PermitNo......................................................... Issued_....................................................... Date --•................... Fss............._............. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .............OF.......... 'aeboi? ............................... Appliratwu for Disposal Works Tonstrurtion Famit Application"is hereby made for a Permit to Construct ( ) or Repair ( } an Individual Sewage Disposal System at ......... ? ."_. ` ..... 4 .. '! .... .�"�- s� ! #"7"r 'lf t�� "°.....RDA ..0 Y" ' f / r3r' -- -. .... } capon-Addr + rr Lot No. c ty ---• Owner- Address W ----------------------- -----------•--------------- Y Installer Address Q Type of Building Size Lot.._ ,.2 Sq. feet U Dwelling—No. of Bedrooms............... .......................Expansion Attic ( ) Garbage Grinder ( ) ............................ No. of ersons...._................._._... Showers — Cafeteria p`�-, Other—Type of Building p ( ) ( )� a � Other fixtures -------------------------------•------•---------------.--------------------------------------------------------------------.._.....------------------- W `- .,Design Flow..................... A................gallons per person per day. Total daily flow.............1,10....................gallons. WSeptic Tank—Liquid"capacity_�.j�_..�_gallons Length................ Width................ Diameter................ Depth_........._..... x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No...........J------- Diameter.......... Depth below inlet.........A...... Total leaching area..................sq. ft. Z Other Distribution box ( Dosing tank ( ) '-' Percolation Test Results Performed by..•-•-_______An4t_4 .4..... ..... /�f��Date---•----�-----...--•---•------......... as Test Pit No. 1....;?�_.......minutes per inch Depth of Test Pit....[4t._rtr, Depth to ground water....T 107 _Ojc_* Test Pit No. 2................minutes per inch Depth of Test Pit..............._.... Depth to ground water........................ a ---------•------- ---•--. --- '-'-------------- ......-•----.._..._...----- -----•-•------....--••••---•--....._----- O Description of Soil k='i 4ff"111!P� s11.5 "> }--------------------------•-•-- V .....--•----------------------------------"�_.Aily1 ! ,€t1 1� s` - � t.,!' �...-------- VW ---------•-•-----------------•---------------•---•----------------------•----------•--------•----------------•---•----------•---------•-•----•---•----•-----•-•----••------------------•-•-------------- Nature of Repairs or Alterations—Answer when applicable............................................................_................................... ------------------------------------------------------------------------------------------------------•-....---------------•-----••---------------...-•--••••-----••...........------•--•--.......----•- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with' the provisions of TITL2 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. r r� Signed' . :r -� l _, r " a:,• ?"- Application Approved By - U -- Date Application Disapproved for the following reasons-----------------------------•-----------------------•---------•----------------•------------••-•-----.....•---•• .......................................................-................................................................................................................................................. Date PermitNo......................................................... Issued....................................................... Date ` THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ............... Lf !t..OF............ ./ t,............. (9rrtifiratr of Tontplittnrr THIS 0 CE IFY, That the Individual Sewage Disposal System constructed by ( or Repaired ( ) ..... .............. ------..._.....---------•------...-- ---_... ---- --•---------------. --•------------ �} nstaller/ /' } at.. d� _..--f--/._._.. %EEO r. _ ... .....s ._t_.._ has been installed in accordance with the provisions of TI6.4� 5 of The /State Sanitary Code as described in the application for DisposalWorks Construction Permit No...., . ..._a -_L2_T-� dated &MIA `'''02v II=-_-__-7-7-------------- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE................ Z ............... .... Inspector.::. r� - THE COMMONWEALTH OF MASSACHUSETTS Y yy BOARD QF HEALTH . . ....... '' .......OF...... �a2....................:...............•---............ No.----... FEE...zi- .......... Disposa or %Rono#rudian rrntit Permission s hereby granted." L?r.;- --••--------------------•-•---------•---•---------------------......-------•---•...... to Constr if t ( '' orb air ( ) an Ind' ,'. '}fal ew Disposal Systemf� at No.. -��'.... ��_ �t.a G .................................................. Street as shown on the application for Disposal Works Construction Permit. f ._._ D ted....�d�- +: •........ -..-------- C , ��-�&'�r.or................. Board oar of Health ,. DATE - le- ................................................ FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS �'�'Y-�y�•"^r... �✓s f �'�pJ��4.G�{/�'�••�'•i S;,it Mv�-�•L`""i''{ �"Yi� =`-_--- ems•-!�'�.s� �.. u x / `K .` „r L `f 4i'rt n �C. 'y�• �.' °•."tom r'�r rlyt ,.yi_.^(,y_„yam,} A��.••�.•. �! � �� r �, .' `I e.. J°�. t �'�?Ti ,"�� lam' - y.�.•+" ��^^vti 1 rT is"� 5�, ~'f '�.�� - �y�S}�p•..+'d=L�*ai'i'-st6�. x t'�•G�tt,ter .... 2 f ?t H - J� '� �``a �� I�LTa f�1iC..-�1�.• CFI' i�lJ7't��� ��/j;� � g.•i•,� � . Ys '' l�vr^•'Ot`. T11. "� �1 °4•� EJ("�`�.,,,,,_. Wr'�..j�ri��' .. ..�. .� _ el" � e_- +� , I Y' "'�✓ �-•9� 1 i � � tom✓ �'�!fir/� ....'..�.�.�� � ��-'�• �f�.�v � ��� 4 �rC'�t'x.�c'���C J.r• of Itiv. rC' T�*t-�.• ai��• � t -- Wit': �.-*� .. � != �R �•�#%�'`✓��'�. piT fit.• ('=r��% - jg�TCr �i3WA MonFx pNo G' -j'or - E VM''"-" v 1� L7i ��^�': 'F77J� -'�} �'� rt�"' - '�. �.e�t=:t�s• Town of Barnstable F,# 70 v Department of Health,Safety,and Environmental Services Public Health Division Date 3 `7 367 Main Street,Hyannis MA 02601 BABNMBM KAM rECMx+h\� Date Scheduled 7 Time 11 A�wr Fee Pd. .(0 U WJ-Q- Soil Suitability Assessment for Sewage Disposal r\(� (I1 �Iy yN Perfo ed By: �C�e(tp Q049Pt", rWitnessed By: LOCATION & GENERAL INFORMATION . Location Address y J Cj� at- Owner's Natty. �\ `111 Address 5 /L3 c-- art Assessor's Map/Parcel: ' \ S b S� �L �°'��/ Engineer's Name NEW CONSTRUCTION REPAIR Telephone# aj(aZ-Lltj'-1 Land Use r2P es GLUT/ Slopes(%) —/0 Surface Stones AtezJ Distances from: Open Water Body N�` ft Possible Wet Area ft Drinking Water Well ' Drainage Way ft Property Line ft Other 51— ft SKETCH:(Street name,dimensions\Qf lolaexd�t locatiens af-tegt_holes&�perd testyt locate wetlands in/proximity,to hole I r r I I i , 1 I r l l � r.rlrJ \�\ ,'�'•,'•'°v`"�r \ \ � �-/`^ ,�5�y� �..�•••'�\�p��\'VF \ E// [�n5t /// �l 1 !l l 1 l I r'�( •�'�'`•;Y;,��\� i � r.i.n- a. .r .r (i \�I O\ // T t .ii-'p�: It vie". \1✓�/ / l l fiat C. �\ :Lo\\ �\ 6 no rMorC414-- DithtoBedrock` �COt Parent material(geologic)-`��/�/� - — .Depth to Groundwater: Standing Water in Hole:blbNir>r.. Weeping from Pit Face Estimated Seasonal High Groundwater R/A " DETERMINATION FOR SEASONAL HIGH VL'ATER TABLE Method Used: Depth Observed standing in obs.hole: A16 P"r- in. Depth to soil mottles: /WADE in. Depth to weeping from side of obs.hole: A/JtiE in. Groundwater Adjustment A/01-•AM- ft. Index Well# Reading Date: Index Well level Adj.factor Adj.Groundwater Level_ PERCOLA.TtO,N TEST ': b). te2 G 7 '►'ittn Observation t Time at 9" Hole# Depth of Pere G° Time at 6" Start Pre-soak Time© It ,3o Time(9"-6") End Pre-soak it:y!57 Rate Min./Inch �Z M I Site Suitability Assessment: Site Passed X Site Failed: Additional Testing Needed(YIN) Original: Public Health Division Observation Hole Data Td Be Completed on Back---� Copy:. Applicant DEEP OBSERVATION HOLE LOG Hole# I Depth from Soil I lorizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulderes. Consistency,° 1 oyaVZ' /Vd yy_ 76 Gr C—L&r5.0-5gn /a`/It23�f /Ud 4v�r jVC)eel -e i ccJvvt DEEP OBSERVATION HOLE LOG Hole# 01 - Depth from Soil I lorizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulderes. y mac_ Cons istengy,° v 3-7 13 54. 13Z-/5G G Z. M'J—s-x'f Z•5 Y7 f AN C44 DEEP OBSERVATIM HOLE LOG Hole Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulderes. -Consistency,Y2 Gravel) DEEP OBSERVATION HOLE LOG Hole# Depth from Soil I lorizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones.Boulderes. t i n %gravel) Flood Insurance Rate Map: / Above 500 year flood boundary No_ Yes y Within 500 year boundary No— Yes Within 100 year flood boundary No_ Yes Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the area proposed for the soil absorption system? If not,what is the depth of naturally occurring pervious material? Certification I certify that on Dk-c— l9g`/ (date)I have passed the soil evaluator examination approved by the Department of Environmental Protection and that the above analysis was performed by me consistent with the required training,expeerttii e and experience described in 310 CMR 15.017. /� ' Cam— - 4 Date -t I- 7 �1' Signature __ __ ..___. _..�_— �� lI 7 SEPTIC PROFILE TEST HOLE LOGS T.O.F. AT EL (NOT M SCALD ACCESS COVER TO WITHIN Ir OF FIN. GRADE Access COVER (WATERTIGHT) TO e� ENGINEER: �'• �SO`Va, , ItZ - IZ3)/ 1 Z MINIMUM .75' OF COVER OVER PRECAST IN e' OF FIN. GRADE 2% SLOPE REQUIRED OVERY�/� � I WITNESS: ��' RUN PIPE LEVEL y' �vJbL c,-1.S1S�FIEOvr�'�= DATE: Z'-___.q T I 8 Z .o (Df ) FOR FIRST 2 PROPOSED (Soo _ f C `h P GALLON SEPTIC PERC RATE l I cl.10 TANK (H JZ) I l 6f 1 - r�'♦ t, 1 (01 life 'l"" CLASS _ SOILS P# L � "' L�` _ ^J�'- 1"rY' Oo,ic�+-�-t,Jr.�Jc�J hTr�..►� - Ux SLOPE Ir CRUSHED STONE OR MECHANICAL DEPTH OF FLOW - COMPACTION. (15.221 [2]) TEE SIZES: (_,x SLOPE) �x SLOPE) 0' INLET DEPTH OUTLET DEPTH - 3 I LOCATION MAP 1' LEACHING �+ 4 d ~ �. ASSESSORS MAP I ✓`l PARCEL FOUNDATION '` Z, SEPTIC TANK - -7 D' BOX �" LEACHING FACIUTY 1+ Lei V 1 S FLOOD ZONE G�trT r04�-f I o4.� S�� I } 5 `( BUILDING ZONE: 41 G' LA � SETBACKS: (yT T�! l ���.5 FRONT - EL f0 S } ,�+0 _ �t,►•(�t,. I?i� (o�t�.. �s/v t I � SIDE - w REAR - '�i►Or \ ., �► I �.�• GZ PLAN REFERENCE: �. 3 ISO �o `I yes. '� .,/ v. `' " ', Z•� 7•• �/4 09 / NOT S 1. DATUM IS I-►E��/ y� - N=aS-JNr- J Qv�; -��l t C„A•,,i,r. _ A .. pA► . S PTIC DESIGN: (c.nRahGE DiSPOS .IS ►�-'r .�+�'��;�: MUNICIPAL u!aTEp IS / 3. MINIMUM PIPE P!T H T_ C O BE 1/8 PER FOOT. DESIGN FLOW: S BEDROOMS (J O_ GPD) = 5>�GPD <r / ! 4. DESIGN LOADING FOR ALL- PRECAST UNITS TO BE AASHO-HL�?._ l USE A GPD DESIGN FLOW 5. PIPE JOINTS TO BE MADE WATERTIGHT. SEPTIC TANK: � � GPD ( ) = I I o Q GALLONS 6. CONSTRUCTION DETAILS TO BE IN ACCORDANCE WITH MASS. A N SEPTIC ENVIRONMENTAL CODE TITLE V. USE C c GALLON SE C TANK L / I �O '�` ✓ / !� 7. THIS PLAN IS FOR PROPOSED WORK ONLY AND NOT TO BE LEACHING: USED FOR LOT ISTAKING.\ — L L NE / SIDES: ti�5�.7�+b h z ( ) _ �`�� ' GPD 8. PIPE FOR SEPTIC SYSTEM TO NCH. 40-4 PVC. o ro f BOTTOM 5m �� ,�p,.h ( � _ 7 — "'�° GPD 9. COMPONENTS NOT TO BE BACKFILLED OR CONCEALED WITHOUT TOTAL: (�'�' S.F. 5��4' `� GPD INSPECTION BY BOARD OF HEALTH AND PERMISSION OBTAINED FROM BOARD OF HEALTH. u4 �•---� . / 10. EXISTING �Eac.� f t a s� / \ r, / �., � ,- EX S , To �.�� c�.�+,-1 ram►-► � 6, , Ta� _ SITE AND SEWAGE PLAN OF a i1- To 114 h T Foe �.. , �yi��' o DY- tv �---� / � �0.01 vy, IN THE TOXIN OF: _ �f BOARD OF HEALTH ►^+ `� .r C��( t�L7 t ` /f`` f�� PREPARED FOR: 11,v k p I A APPROVED DATE a 0 a Fed - I � 0 �' J SCALE: 1 = 3o DATE: � 7- + °i 6.v.jiti► htJ . �sv down : cape engineering, inc. " Of «�' �ti Of RECEIVED CIVIL ENGINEERS "�"e .�� LAND SURVEYORS s C ��' � APR 2 1997 1 FAX 508 62 69880 41. ��-�.` 'nw�:1w z t2-`1(`tl ARCHITECTUKAL UtSiuit PAC. 939 main st. yarmouth, ma JALA rr DATE JOB q c. - 38