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0104 CROCKER ROAD - Health
104 Crocker Road, West Barnstable r A= �! t f �I No. 4210 1/3 BLU ESSELTE 10% G 0 O O 'Ptt ssED ( M s�c� cTI a14S a 104 Crocker Road,West Barnstable r A= :. µ a _ F u� s WMIM NNO IN WA ,., , t 'Is", 1�,fie Id t r� 't r 4 F a V �'` `.e arSfA ro ,'. s tt Al ep P r� k " ff Ar - , a s S }• � v� rid' d �s 3 r i x 'S sLH'Y Xix R'A ; t �•� y � 3A1 - f *� 1 � 6 L 1 r ,1f TOWN OF BARNSTABLE LGCATION IUy (°J'yClct! 2J SEWAGE VILLAGE W. 13e,.iA s�'b C2 ASSESSOR'S MAP&PARCEL ifU 2 Z INSTALLER'S NAME&PHONE NO. Od4,,w t dj f n yU 2 SEPTIC TANK CAPACITY /S oU ►V LEACHING FACILITY:(type) J SUC> L-C (size) 12 4 k 3 NO.OF BEDROOMS` OWNER &r%S 5"x i PERMIT DATE: COMPLIANCE DATE: ' Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility ✓`Jo if 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 e � , _2 RI i2�� AZ 2� y R3 $� s Ay 89 R 5� 8'1• y 6Z Zit• y ,3 13 ©.` 94 �v.� No. a�6 -�o R a Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes ZippYication for 3i.5pont *p!tem Cow9tructiou i3erm t Application for a Permit to Construct( ) Repair( ) Upgrade(V Abandon( ) Complete System ❑Individual Components Location Address or Lot No. 10 Lf Coo r,?4_Y- ko,"4 Owner's Name,Address,and Tel.No. Wesr 3arnsTj:�-3)e 04rres SW;FT . Assessor'sMap/parcel //p 2t— asr KeAr fZ.AC( �2 Installer's Name,Address,and Tel.No. �� �� Designer's Name,Address and Tel.No. — 163 E- le S.�,vt"ti I fe �j0F 362-9132 Type of Building: Dwelling No.of Bedrooms N Lot Size 51,35 9 sq.ft. Garbage Grinder ( ) Other Type of Building 5 NIA No.of Persons Showers( ) Cafeteria( ) Other Fixtures `J� Design Flow(min.required) _`b gpd Design flow provided `7 q gpd Plan Date 1°'�S 2oa Number of sheets Revision Date Title 1 C/o 0(Q� Size of Septic Tank `I SO o Type of S.A.S.LZ SOD /• Description of Soil j2 f 4w) Nature of Repairs or Alterations(A swer when applicable) 1 SD0 ! 'A-I t- 10 1�►� �Z �d O STLk-�. 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 Board of Health. Signe Date i— 3 t— Oo Application Approved b Date In Application Disapproved by: Date for the following reasons Permit No. ^-CJ Date Issued 1 3 No. aCo 6 "'0 O Fee Q THE COMMONWEALTH OF MASSACHUSETTS Entered'in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes ZIppYication for Migpogal *pgtem (Cow5truction Permit , Application for a Permit to Construct O Repair O Upgrade(\4) Abandon O Complete System ❑Individual Components Location Address or Lot No. C✓c,04 y- ✓I v Cf Owner's Name,Address,and Tel.No. W,0 �3 Sw FT 1 Assessor's Map/Parcel 00Z Z t,�tl Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. Z$ 3 2 { v<�, � � 36 J �fiLt t�✓v 1 11 Q WY-1 11 2 a rZ r (,k" Type of Building: Dwelling No.of Bedrooms Y Lot Size 5 b. 3 d sq..ft. Garbage Grinder ( )' Other Type of Building No.of Persons Showers( ) Cafeteria Other Fixtures Design Flow(min.required) gpd Design flow provided `7 L/ gpd j Plan Date I o' Number of sheets Revision Date x Title 1c4 COo c,KkAl- Size of Septic Tank / SO O Type of S.A.S. 2 Sv a rQ C �139 c,, S Rr__A Description of Soil 1_1�aa 2(bM Nature of Repairs or Alterations(Answer when applicable) S w !a { � 'wiCa i O S,da Date last inspected: 1 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'io place the system in operation until a Certificate of Compliance has been issued by this Board of Health. Signed Date 31 Z- U Application Approved b Date Application Disapproved by: Date for the following reasons Permit No. a0c)co ^a, Date Issued 131 ———————————————------------------------------ THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS (Certificate of (Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed ( ) Repaired ( ) Upgraded Abandoned( )by a ew � �� ✓i?C. � C L C at /U /' e d0 C lcv, fec'ej L,)',( ;�0-,rh N f-Ps/e has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. r'SD(p —O% ?- dated / Installer do, Designer i-14 r I I.,I-)e L.T' w #bedrooms Approved design MW b gpd The issuance of this permit shall not brre construed as a guarantee that the system gill functio ni).d. Date Inspector —-—————————————————————————————————————————— -. .. _ _ Fee— `J No. �� �03� - THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE, MASSACHUSETTS Mtgpool 6pgtem (Construction Permit Permission is hereby granted to Construct ( ) Repair ( ) Upgrade ( Abandon ( ) System located at 10 � s T— q S t1/-- Xf 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. ,, Provided: Cons ction must be completed within three years of the datetb s ppermi. Date Approved ..Town of Barnstable OCTHF T ' ti�P� ti� Regulatory Services Thomas F. Geiler, • BLE, • ,Director BARNSTA � "'"SS.i6gq. Public Health Division p rFD MAC A Thomas McKean,Director b 200.Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Installer& Designer Certification Form Date: ° Sewa e Permit# Zoo g (o—b 3% Assessor's MaplParcel Designer: , Installer: L A p.,,.3 j Address: Address: D, 3ox "7 G 3 Oil t 2, - 06 _ _was issued a permit to install a (date) (installer) septic system at ekrkt_ /Z-�b J-0. based on a design drawn by (address) dated /o (designer) 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. I certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system).but in accordance with State& Local Regulations. Plan revision or certified as built by designer to follow. 7`ri s 3 j ( s ;er's ign tore) �� r .s (Designer's Signature) (Affi Des' ier's Stamp Here) PLEASE'RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS- BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. QASeptic\Designer Certification Form Revised.doc SECTIONSENDER: COMPLETE THIS SECTION COMPLETE THIS DELIVERY ■ Complete items 1,2,and 3.Also complete A. Signatures item 4 if Restricted Delivery is desired. gent ■ Print your name and address on the reverse X �.� /. •2 ❑Addressee so that we can return the card to you. g., eceived py(Pri't A ame) C. Date Deli ry ■ Attach this card to the back of the mailpiece, J �� o�or on the front if space permits. D. Is delivery ddress different from item 1? ❑ es 1. Article Addressed to: If YES,enter delivery address below: R'No I Mr Christopher Swift 104 Crocker Road 'Vest Barnstable, MA 02668 3. service Type ❑Certified Mail ❑ Express Mail ❑ Registered ❑ Return Receipt for Merchandise ❑ Insured Mail ❑C.O.D. e 4. Restricted Delivery?(Extra Fee) ❑Yes 2. Article Number •• •• ' • , •�-----_ �. (Transfer from service label) 7 0 Q�1'a 3 2 0 00 0 3 6 6 5 5 5'8 7:8 PS Form 3811,August 2001 Domestic Return Receipt 102595-02-M-1540j UNITED STATES POSTAL SERVICE First-Class Mail Postage&Fees Paid LISPS Permit No.G-10 • Sender: Please print your name, address, and ZIP+4 in this box • F. Public ! ealth Division =Town of Barnstable 200 NIain Stre.et . �Iyannis, Massachusetts. 02601 I i[ ?!iiF1F-f?�1,Fl��!3i?FF IFI:!{iirFFtIFF!F!IF;13FFi51!??FiFid V7 Postage $ / C .3 Ln Certified Fee '-a `��tmark Return Receipt Fee / C C3 (Endorsement Required) O Restricted Delivery Fee S �� C3 (Endorsement Required) 6� 0 Total Postage&Fees $ ru "I Sent To AR ---------- ------- -- --td ol7C------��`'J= F ---------------- Street,Apt.No.; I or PO Box No. �U C�oc kc!' —Roo d I� City State,ZIP+ ���/�S ��-e f CIA 46 I Certified Mail Provides: o A mailing receipt O A unique identifier for your mailpiece o A signature upon delivery o A record of delivery kept by the Postal Service for two years Important Reminders: o Certified Mail may ONLY be combined with First-Class Mail or Priority Mail. o Certified Mail is not available for any class of international mail. o NO INSURANCE COVERAGE IS PROVIDED with Certified Mail. For valuables,please consider Insured or Registered Mail - n For an additional fee,a Return Receipt may be requested to Provide proof`of delivery.To obtain Return Receipt service,please complete and attach a Return Receipt(PS Form 3811)to the article and add applicable postage to cover the fee.Endorse mailpiece 'Return Receipt Requested".To receive a fee waiver for a duplicate return receipt,a USPS postmark on your Certified Mail receipt is required. �. o For an additional fee, delivery may be restricted to the addressee.or addressee's authorized agent.Advise the clerk or mark the mailpiece with the endorsement"Restricted Delivery". T' o If a postmark on the Certified Mail receipt is desired,please present the arti- cle at the post office for postmarking. If a postmark on the Certified Mail receipt is not needed,detach and affix label with postage and mail. IMPORTANT.Save this receipt and present it when making an inquiry:',, PS Form 3800,January 2001 (Reverse) 102595-01-M-1049 I t SE •ER: COMPLETE THIS SECTION • • ON DELIVERY 1 ■ Complete items 1,2,and 3.Also complete A. Signature t item 4 if Restricted Delivery is desired. gent ■ Print your name and address on the reverse X Al 1` �, •2 ❑Addressee so that we can return the card to you. g.,Received y(Pri te1(Name) C. Date175 Dery ® Attach this card to the back of the mailpiece, p or on the front if space permits. ?i ``� W - D. Is delivery ddress different from item 1? ❑ es 1. Article Addressed to: If YES,enter delivery address below: EkNo Mr Christopher Swift 004 Crocker Road West Barnstable. MA 02668 3. Service Type ❑Certified Mail ❑Express Mail. ❑ Registered ❑ Return Receipt for Merchandise ❑ Insured Mail ❑C.O.D.. 4. Restricted Delivery?(Extra Fee) ❑Yes 2. Article Number _. (Transfer from service label) C?Q,Q 1. -0320 0003 669 5 $ 7 8-- - - — -- - PS Form 3811,August 2001 Domestic Return Receipt 102595-02-M-1540, co ,i �, ; , F I Ln Postage $ Certified Fee a//'' �+ .D DvV `�e tmark 's A Return Receipt Fee Sc h 1 (Endorsement Required) s 7 p Restricted Delivery Fee r o (Endorsement Required) sG•''�,..�r ems, C3 Total Postage&Fees $ M Sent To `7 AR-------- --------Ch r'-sk)Ohc r----v -r--C_—---------------- Street,Apt.No.; � or PC Box No. ---------------------- ---------------------------------------------- t5 City,State,ZIP+4; �I e q cj--A ,6 } -- r- e °F THE Tp� Town of Barnstable * STABLE, * Regulatory Services 9 . 1639. ,0�' Thomas F. Geiler,Director , Public Health Division Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office: 508-8624644 Fax: 508-790-6304 July 13, 2005 Mr Christopher Swift 104 Crocker Road West Barnstable,MA 02668 NON-COMPLIANCE WITH STATE ENVIRONMENTAL CODE TITLE V. The septic stem owned p y by you located at 104 Crocker Road,West Barnstable, MA was inspected on June 1st, 2005 by James M. Ford, a certified septic inspector for the State of Massachusetts. The inspection of your septic system showed that your system has failed under the guidelines of 1995 TITLE 5 (310 CMR 15.00)DUE TO THE FOLLOWING: Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool. You have two years from the date of the system inspection to bring the system into compliance. If there are any questions about this reminder,please feel free to contact the Barnstable Health Department. BARNSTABLE H D ARTMENT E COMMONWEALTH OF MASSACHUSETTS r , U'ANPiSTABLE EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS rr' DEPARTMENT OF ENVIRONMENTAL PROTEC O�N 2: 00 TITLE 5 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 104 Crocker Road / West Barnstable, MA 02668 Owner's Name: Chris Swift Owner's Address: V Date of Inspection: June 1. 2005 Name of Inspector: (Please Print) James M. Ford Company Name: James M. Ford Mailing Address: P.O.Box 49 _ Osterville.MA 02655-0049 Telephone Number: (508)862-9400 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: Passes Conditionally Passes Needs F her Evaluation by the Local Approving Authority ✓ Fails Inspector's Signature: Date: June 6, 2005 The system inspector shall submi copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 1.0,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer,if applicable,and the approving authority. 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 how the system will perform in the future under the same or different conditions of use. Title 5 Inspection Form 6/15/2000 page I Page 2 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 104 Crocker Road West Barnstable, MA Owner: Chris Swift Date of Inspection: June 1. 2005 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B. System Conditionally Passes: One or more system components as described in the "Conditional Pass"section need to be replaced or repaired. The system,upon completion of the replacement or repair,as approved by the Board of Health,will pass. Answer yes,no or not determined(Y,N,ND)in the for the following statements. If"not determined",please explain. The septic tank is metal and over 20 years old* or the septic tank(whether metal or not)is structurally unsound,exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND explain: Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken,settled or uneven distribution box. System will pass inspection if (with approval of Board of Health): broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced ND explain: The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed ND explain: 2 Page 3 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 104 Crocker Road West Barnstable. MA Owner: Chris Swift Date of Inspection: June 1, 2005 C. Further Evaluation is Required by the Board of Health: Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health,safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health,safety and the environment: Cesspool or privy is within 50 feet of a surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2. System will fail unless the Board of Health(and Public Water Supplier,if any)determines that the system is functioning in a manner that protects the public health,safety and environment: _ The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance **This system passes if the well water analysis,performed at a DEP certified laboratory, for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: 3 Page 4 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 104 Crocker Road West Barnstable, MA Owner: Chris Swift Date of Inspection: June_1. 2005 D. System Failure Criteria applicable to all systems: You must indicate either"yes"or"no"to each of the following for all inspections: Yes No ✓ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ✓ Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ✓ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ✓ Liquid depth in cesspool is less than 6"below invert or available volume is less than ''/z day flow ✓ Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped— ✓ Any portion of the SAS,cesspool or privy is below high ground water elevation. ✓ Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ✓ Any portion of a cesspool or privy is within a Zone 1 of a public well. ✓ Any portion of a cesspool or privy is within 50 feet of a private water supply well. ✓ Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form.] Yes (Yes/No)The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E. Large System: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. You must indicate either"yes"or"no"to each of the following: (The following criteria apply to large systems in addition to the criteria above) Yes No the system is within 400 feet of a surface drinking water supply the system is within 200 feet of a tributary to a surface drinking water supply the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area-IWPA)or a mapped Zone II of a public water supply well If you have answered"yes"to any question in Section E the system is considered a significant threat,or answered "yes"in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 4 Page 5 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 104 Crocker Road West Barnstable, MA Owner: Chris Swift Date of Inspection: June 1, 2005 Check if the following have been done: You must indicate"yes"or"no"as to each of the following: Yes No ✓ _ Pumping information was provided by the owner,occupant,or Board of Health ✓ Were any of the system components pumped out in the previous two weeks? ✓ _ Has the system received normal flows in the previous two week period? _ ✓ Have large volumes of water been introduced to the system recently or as part of this inspection? ✓ _ Were as built plans of the system obtained and examined?(If they were not available note as N/A) ✓ Was the facility or dwelling inspected for signs of sewage back up? ✓ _ Was the site inspected for signs of break out? ✓ _ Were all system components,excluding the SAS,located on site? ✓ _ Were the septic tank manholes uncovered,opened,and the interior of the tank inspected for the condition of the baffles or tees,material of construction,dimensions,depth of liquid,depth of sludge and depth of scum? Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS)on the site has been determined based on: Yes No ✓ _ Existing information. For example,a plan at the Board of Health. ✓ — Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable)[310 CMR 15.302(3)(b)]. 5 �_ r Page 6 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 104 Crocker Road West Barnstable. MA Owner: Chris Swift Date of Inspection: June 1, 2005 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): 3+ Number of bedrooms(actual): 2 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 220 Number of current residents: 4 Does residence have a garbage grinder(yes or no): No Is laundry on a separate sewage system(yes or no): n/a [if yes separate inspection required] Laundry system inspected(yes or no): No Seasonal use(yes or no): No Water meter readings, if available(last 2 years usage(gpd)): Private well Sump Pump(yes or no): No Last date of occupancy: Currently occupied COMMERCIAL/INDUSTRIAL Type of establishment: Design flow(based on 310 CMR 15.203): gpd Basis of design flow(seats/persons/sqft,etc.): Grease trap present(yes or no): Industrial waste holding tank present(yes or no) Non-sanitary waste discharged to the Title 5 system(yes or no): Water meter readings, if available: Last date of occupancy/use: OTHER(describe): GENERAL INFORMATION Pumping Records Source of information: Unavailable Was system pumped as part of the inspection(yes or no): No If yes,volume pumped: _gallons--How was quantity pumped determined? Reason for pumping: TYPE OF SYSTEM ✓ Septic tank,distribution box,soil absorption system Single cesspool Overflow cesspool Privy Shared system(yes or no) (if yes,attach previous inspection records, if any) Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) Tight Tank Attach a copy of the DEP approval Other(describe): Approximate age of all components,date installed(if known)and source of information: Installed on July 25182--tier as built card Were sewage odors detected when arriving at the site(yes or no): No 6 L Page 7 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 104 Crocker Road West Barnstable, MA Owner: Chris Swift Date of Inspection: June 1, 2005 BUILDING SEWER(locate on site plan) Depth below grade: Materials of construction: _cast iron _40 PVC _other(explain): Distance from private water supply well or suction line: Comments(on condition of joints,venting,evidence of leakage,etc.): SEPTIC TANK: ✓ locate( on site plan) Depth below grade: 20" Material of construction: ✓ concrete _metal _fiberglass _polyethylene _other(explain) If tank is metal list age: Is age confirmed by a Certificate of Compliance(yes or no):. (attach a copy of certificate) Dimensions: 1000 gal. Sludge depth: 4" Distance from top of sludge to bottom of outlet tee or baffle: 28" Scum thickness: 6'" Distance from top of scum to top of outlet tee or baffle: 6" Distance from bottom of scum to bottom of outlet tee or baffle: 10" How were dimensions determined: MeasurinQstick Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): Cement tees were present. The liquid level was even with the outlet invert There did not appear to be any si nos_of leakage GREASE TRAP: ,'Vone (locate on site plan) Depth below grade: Material of construction: _concrete _metal _fiberglass _polyethylene —other (explain): Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping: Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): 7 Page 8 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 104 Crocker Road West Barnstable, MA Owner: Chris Swift Date of Inspection: June 1, 2005 TIGHT or HOLDING TANK: None (tank must be pumped.at time of inspection)(locate on site plan) Depth below grade: Material of construction: _concrete _metal _fiberglass _polyethylene _other(explain): Dimensions: Capacity: gallons Design Flow: gallons/day Alarm present(yes or no): Alarm level: Alarm in working order(yes or no): Date of last pumping: Comments(condition of alarm and float switches,etc.): DISTRIBUTION BOX: ✓ (if present must be opened)(locate on site plan) Depth p of liquid level above outlet invert: Even Comments(note if box is level and distribution to outlets equal,any evidence of solids carryover,any evidence of leakage into or out of box, etc.): The D-box was broken down and needs to be replaced. PUMP CHAMBER: None (locate on site plan) Pumps in working order(yes or no): Alarms in working order(yes or no) Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.): 8 Page 9 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 104 Crocker Road West Barnstable, MA Owner: Chris Swift Date of Inspection: June 1. 2005 SOIL ABSORPTION SYSTEM(SAS): ✓ (locate on site plan,excavation not required) If SAS not located explain why: Type ✓ leaching pits,number: I-6'x 6'(1000 alb ) leaching chambers,number: leaching galleries,number: leaching trenches,number,length: leaching fields,number,dimensions: overflow cesspool,number: Innovative/alternative system Type/name of technology: Comments(note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation, etc.): The leach pit was full. Liquid was backing up into the inlet pipe The leach nit was deep below grade A video camera was used for the inspection. CESSPOOLS: None (cesspool must be pumped as part of inspection)(locate on site plan) Number and configuration: Depth-top of liquid to inlet invert: Depth of solids layer: Depth of scum layer: Dimensions of cesspool: Materials of construction: Indication of groundwater inflow(yes or no): Comments (note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): PRIVY: None (locate on site plan) Materials of construction: Dimensions: Depth of solids: Comments (note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): 9 ' Page 10 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 104 Crocker Road West Barnstable, MA Owner: Chris Swift Date of Inspection: June 1. 2005 SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. 0 a /�S 3 as s 1 C;L9 S(O y i00 is 10 Page 11 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 104 Crocker Road West Barnstable, MA Owner: Chris Swift Date of Inspection: June 1. 2005 SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water 20+/- feet Please indicate(check)all methods used to determine the high ground water elevation: Obtained from system design plans on record-If checked,date of design plan reviewed: Observed site(abutting property/observation hole within 150 feet of SAS) ✓' Checked with local Board of Health-explain: topographic and water contours maps Checked with local excavators,installers-(attach documentation) Accessed USGS database-explain: You must describe how you established the high ground water elevation: Using Barnstable topographic and water contours maps the maps were showing approximately 20'+/ to ground water at this site. This report has been prepared and the system inspected and failed as of the date of inspection. This report is not a warranty or guarantee that the system will function properly in the future. There have been no warranties or guarantees, either expressed, written or implied,relating to the system, the inspection and/or this report. 11 Commonwealth of Massachusetts ' Executive Office of Environmental Affairs Dept. of Environmental Protection One winter Street, Boston,Ma. 02108 .Tole Seed D.E.P. Title V Septic h>spector P.O. Box 2119 Teaticket,MA 02536 WILLIAM F.WELD (508) 56 •(TA 13 Governor ARGEO PAUL CELLUCCI Lt.Govemor PP t SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORMRIC6I PART AGCERTIFICATION 81997WN0F8ARNST Property Address: 104 Crocker Rd.W. Barnstable Address of Owner: H�LTHpEpTABLEDate of Inspection:7131/97 (If different) Name of Inspector:John Graci Kerry Duffy:Box 275 W.Barnstable Ma.0266 1 am a DEP approved system inspector pursuant to Section 15.340 of Title%(310 CMR 15.000) y Company Name,Address and Telephone Number: E CERTIFICATION STATEMENT 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: X Passes This inspection is based on criteria defined in Title V _ Conditionally Passes code 310 CMR 15.303.My findings are of how the system is Needs F rther valuation B the Local Approving Authority perrorminq at the time ofthe inspection.My inspection does — Y PP 9 tY not imply any warranty or quarantee of the longevity orthe — Fails septic system and any of its components useful life. Inspector's Signature: v Date:8/6197 The System Inspector shall ubmit a copy of this inspection report to the Approving Authority within thirty(30)days.of completing this inspections. 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: X I have not found any information which indicates that the system violates any of the failure criteria defined as in 310 CMR 15.303. Any failure criteria not evaluated are indicated below. COMMENTS: 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. Indicate yes,no,or not determined(Y, N,or ND). Describe basis of determination in all instances. If "not determined", explain why not. The septic tank is metal, unless the owner or operator has provided the system inspector with a copy of a Certificate of Compliance(attached)indicating that the tank was installed within twenty(20)years prior to the date of the inspection; or the septic tank,whether or not metal, is cracked, structurally unsound, shows substantial infiltration of exfiltiation,of 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 04127/97) One Winter Street 9 Boston,Massachusetts 02108 • FAX(617)556-1049 9 Telephone(617)292-5500 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 104 Crocker Rd.W.Barnstable Owner: Kerry Duffy:Box 275 W.Barnstable Me.02666 Date of Inspection:7131/97 _ Sewaae backup or.breakout.or hiah.static water level observed.in.the distrihution box is due to a broken. or obstructed pipe(s)or due to broken, settled or uneven distribution box.The system will pass inspection if (with approval of the Board of Health). Describe observations: broken pipe(s)are replaced obstruction is removed distribution box is leveled 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 C] FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect 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 PUBLIC WATER SUPPLIER, IF APPROPRIATE)DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: The system has a septic tank and soil absorption system and is within 100 feet to a surface of water supply or tributary to a surface water supply. The system has a septic tank and soil absorption system and is within a Zone 1 of a public watersupply 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 the SAS is less than 100 feet but 50 feet or more from a private water supply well, unless a well water analysis for coliforin bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presense of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm. Method usedto determine distance (approximation not valid) 3)Other D] SYSTEM FAILS: You must Indicate either"Yes"or"No"as to each of the following: 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. The Board of Health should be contacted to determine what will be necessary to correct the failure. Yes No Backup of sewage in facility or system component due to an overloaded or clogged SAS or cesspool. Discharge or ponding of effluent to the surface of the ground or surface waters dl.ie to an overloaded or clogged cesspool. SAS is in hydraulic failure. (revised 04,/27/97) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 104 Crocker Rd.W.Barnstable Owner: Kerry Duffy:Box 275 W.Barnstable Ma,02668 Date of Inspection:7/31/97 D) SYSTEM FAILS(continued) Yes No Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool. Liquid depth in cesspool is less than 6"below invert or available volume is less than 1/2 day flow. Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Numbers of times pumped 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 1 of a public well. Any portion of a cesspool or privy is within 50 feet of a private water supply well. Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. 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: You must indicate either"Yes"or"No"as to each of the following: The following criteria apply to large systems in addition to the criteria: The system serves a facility with a design flow of 10,000 gpd or greater(Large System)and the system is a significant threat to public health and safety and the environment because one or more of the following conditions exist: Yes No the system is within 400 feet of a surface drinking water supply the system is within 200 feet of a tributary to a surface drinking water supply the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area (IWPA)or a mapped Zone II of a public water supply well) 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. (revised 04/27197) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECLIST Property Address: 104 Crocker Rd.W.Barnstable Owner: Kerry Duffy:Box 275 W.Barnstable Ma.02668 Date of Inspection:7/31/97 Check if the following have been done:You must indicate either"Yes"or"No"as to each of the following: _y_ — Pumping information was requested of the owner,occupant, and Board of Health. X None of the system components have been pumped for at least two weeks and the 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 as part of this inspection. X — As built plans have been obtained and examined. Note if they are not available with N/A. X — The facility or dwelling was inspected for signs of sewage back-up. x — The system does not receive non-sanitary or industrial waste flow. _X_ — The site was inspected for signs of breakout. X All system components,excluding the Soil Absorption System,have been located on the site. X The 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. X _ The size and location of the Soil Absorption System on the site has been determined based on The facility owner(and occupants, if different from owner)were provided with information on the proper maintenance of Sub-Surface Disposal Systens. X Existing information. Ex. Plan at B.O.H. X Determined in the field(if any failure criteria related to Part C is at issue, approximation of distance is unacceptable)[15.302(3)(b)] (revised 04127/97) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 104 Crocker Rd.W.Barnstable Owner: Kerry Duffy:Box 275 W.Barnstable Ma.02668 Date of Inspection:7/31/97 FLOW CONDITIONS RESIDENTIAL: Design flow: 220 g p•d./bedroom for S.A.S. Number of bedrooms: 2 Number of current residents: 1 Garbage grinder(yes or no): No Laundry connected to system(yes or no): Yes Seasonal use(yes or no): No Water meter readings,if available:(last two(2)year usage(gpd): n/a Sump Pump(yes or no): No Last date of occupancy: n/a COMMERCIAL/INDUSTRIAL: Type of establishment: n/a Design flow:o gallons/day Grease trap present:(yes or no) No Industrial Waste Holding Tank present: (yes or no) No Non-sanitary waste discharged to the Title 5 system: (yes or no) No Water meter readings, if available: n/a Last date of occupancy: n/a OTHER: (Describe) n/a Last date of occupancy: GENERAL INFORMATION PUMPING RECORDS and source of information: System was last pumped on July 12 1997 System pumped as part of inspection: (yes or no)No If yes,volume pumped: 0 gallons Reason for pumping: n/a TYPE OF SYSTEM X Septic tank/distribution box/soil absorptions system Single cesspool Overflow cesspool Privy Shared system(yes or no) ( if yes, attach previous inspection records,if any) I/A Technology etc. Copy of up to date contract? Other: APPROXIMATE AGE of all components,date installed(if known)and source information: 1982 Sewage odors detected when arriving at the site: (yes or no) No (revised 04/27/97) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 104 Crocker Rd.W.Barnstable Owner: Kerry Duffy:Box 275 W.Barnstable Ma.02668 Date of Inspection:7131197 SEPTIC TANK: X (locate on site plan) Depth below grade: 1' Material of construction:X concreate metal FRP_Polyethylene_other(explain) If tank is metal, list age is . Is age confirmed by Certificate of Compliance No (Yes/No) Dimensions: L 8'6'H 5'7'W 4'10' Sludge depth:0 Distance from top of sludge to bottom of outlet tee or baffle: 0 Scum thickness:0 Distance from top of scum to top of outlet tee or baffle:6" Distance form bottom of scum to bottom of outlet tee or baffle: 0 How dimensions were determined: Measured Comments: (recommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert,structural integrity, evidence-of leakage,etc.) Septic tank and all components are structurally sound.Recommend pumping system every year for maintenance. GREASE TRAP:_ (locate on site plan) Depth below grade: n/a Material of construction: _concrete_metai_FRP_Polyethylene_other(explain) Dimensions: We Scum thickness:n/a Distance from top of scum to top of outlet tee or baffle:n/a Distance from bottom of scum to bottom of outlet tee or baffle: n/a Date of last pumping,/, Comments: (recommendation for pumping, condition of inlet and outlet tees or baffles,depth of liquid level in relation to outlet invert, structural integrity, evidence of leakage,etc.) n/a BUILDING SEWER: (Locate on site plan) Depth below grade: 1'6' Material of construction:_cast iron X 40 PVC_other(explain) Distance from private water supply well or suction lin0own Diameter: 4' (nramments:(conditions of joints,venting, evidence of leakage, etc.) (revised 04/27/97) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 104 Crocker Rd.W.Barnstable Owner: Kerry Duffy:Box 275 W.Barnstable Me.02668 Date of Inspection:7/31/97 TIGHT OR HOLDING TANK: (locate on site plan) Depth below grade: n/a Material of construction:_concrete_metal_FRP_Polyethylene_other(explain) Dimensions: n/a Capacity: n/a gallons Design flow: n/a gallons/day Alarm level:—n/a Alarm In working order?_Yes_No Date of previous pumping: Comments: (condition of inlet tee, condition of alarm and float switches, etc.) n/a DISTRIBUTION BOX: (locate on site plan) Depth of liquid level above outlet invert: n/a Comments: (note if level and distribution is equal,evidence of solids carryover, evidence of leakage into or out of box etc.) n/e PUMP CHAMBER: (locate on site plan) Pumps in working order:(yes or no)No Alarms in working order(yes or no)_Yes Comments: (note condition of pump chamber,condition of pumps and appurtenances, etc.) n/a (revised 04127/97) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 104 Crocker Rd.W.Barnstable Owner: Kelly Duffy:Box 275 W.Barnstable Ma.02668 Date of Inspection:7/31/97 SOIL ABSORPTION SYSTEM (SAS):X (locate an site plan,if possible; excavation not required, but may be approximated by non-intrusive methods) If not determined to be present, explain: n/a Type. leaching pits, number: 1000 gallon leach pits leaching chambers,number:n/a leaching galleries, number: n/a leaching trenches,number, length: n/a leaching fields,number, dimensions:n/a overflow cesspool, number:n/a Alternate system: n/a Name of Technology:_n/a Comments:(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) The overflow is structurally sound and functioning properly.lt was 1/2 full et the time of the inspection.Pit shows signs of being 3/4 full. CESSPOOLS:_ (locate on site plan) Number and configuration: n/a Depth-top of liquid to inlet invert: n/a Depth of solids layer: n/a Depth of scum layer: n/a Dimensions of cesspool: nla Materials of construction- n/a Indication of groundwater: n/a inflow(cesspool must be pumped as part of inspection) n/a Comments:(note condition of soil,signs of hydraulic failure, level of ponding, condition of vegetation, etc.) We PRIVY:_ (locate on site plan) Materials of construction: n/a Dimensions: n/a Depth of solids: n/a Comments:(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) n/a (revised 04r7/97) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 104 Crocker Rd.W.Bamstable Owner: Kerry Duffy:Box 275 W.Bamstable Ma.02668 Date of Inspection: 7/31/97 SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent references, landmarks or benchmarks locate all wells within 100'(Locate where public water supply comes into house) i� 0 (revised 04/27/97) Pogo 0 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 104 Crocker Rd.W.Barnstable Owner: Kerry Duffy:Box 275 VV.Barnstable Ma.02668 Dale of Inspection: 7131/97 Depth to Groundwater 12+ Feet Please indicate all the methods used to determine High Groundwater Elevation: Obtained from Design Plans on record Observation of Site IAbuning property, observation hole, basement sump etc.) Determine it from local conditions Check with local Board of health Check FEMA Maps Check pumping records Check local excavators, installers x Use USGS Data Describe in your own words how you established the High Groundwater Elevation.(MUST be completed) USGS Maps and Charts (revised 04/27/97) page 10 of 10 ;NCI -L4O CAT ION ,� gay SEWAGE PERMIT t90• d'IL LAG E INSTA- LLER'S NAME i ADDRESS 9. tAcm-� 6UIL0E0 OR ON►NER DATE_ PERMIT ISSUED DATE COIAPLIAN-CE ISSUED- aZf tz 9 �Ntio 1��' 1L5 he oil laa 6 35.00 Fms.......................... THE COMMONWEALTH bF MASSACHUSETTS BOAR® OF HEALTH Town Barnstable ........................................ ...OF............................--.......................................................... O Appliratiun for BiipuuFal Workfi Tomtrnrtiun Vvrrmit Application is hereby made for a Permit to Construct (X ) or Repair ( ) an Individual Sewage Disposal System at: Crocker Road W. Barnstable Ma. #99 . .................._.............................-----------•-•-------------•--................... ---------•-•----•------•---------------......------------------------------------............--... K. Darigan Address 1687 Main E:r ,. rinis, 19a. ......................-.......................................................................... -----....-------------••••-•-----------........_..........---........................•........ .... Owner Address w . �C..:........�Vz r_.�&Y--------------------------------------- --------------------------------------- ........................................... Installer Address as 56 398 d Type of Building Size Lot____.....y________________Sq. feet U Dwelling—No. of Bedrooms...... i. .................................Expansion Attic ( ) Garbage Grinder ( ) 04 Other—Type of Building ................�........ No. of persons__..._.3.................. Showers ( ) — Cafeteria ( ) a Other fixtures - ------ ---••-••-•---•-•- 15 WDesign Flow.............. S___.__.___.___..._.__ ..gallons per person per day. Total daily flow..........l6......................_._..._gallons. WSeptic Tank—Liquid*capacity!PPq•gallons Length._!K� Width.4 Q! ... Diameter......_-...... Depth..S.S....... x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No......... Diameter................ Depth below,inlet....... ......... Total leaching area..2:�.....sq. ft. Z Other Distribution box ( ) Dosing tank ( 1-4 Percolation Test Results Performed by.....C .................. Date.......!-I. 1 1 Ss1 Test Pit No. 1..N�A._.____minutes per inch Depth of Test Pit..._.. -.._.. Depth to ground water-___�!%E�____...:__. (s, Test Pit No. !CA....minutes per inch Depth of Test Pit....... 1......_.. Depth to ground water-----NSA........... •-••---------------------------------------•--•-••-•---•--------•-------•--..........----•--•--••............................................................ 0 Description of Soil.......Q-'?-L....LOAM 1:TO01!r_._..... --•-------------- ...----•-------•----•--- (xj •--•-•---•••••--...---••---------.--• .1/------...!IEDi..�n-To__f''�_S!'!"'�....---•-------------- l TriCl. - F W ......................................-1-1_1L.....-.FIIJE-SA►.r0 Ir!1"M.. R S GLA`_I------- -------•----------•------•----•-----........................•.... UNature of Repairs or Alterations—Answer when applicable............................................................................................... -------------------•--•-•------.....-----------------...--•----------------•-------•-•------•--.....---.....------------------------•----•---•------------------------------•-••-.................--•- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System"in accordance with of IT the provisions of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been,issu ,by the board of health. Signed:_.... ................ Date Application Approved BY ------- .............................- Date Application Disapproved for the following reasons---------------------------------------------•----------•---•----•---------------•---------------.............--- ..............••-•--••----...........-----•----------••------._...••••••.....----------------•-•.......--•--•---•-•-•-•-•--•-•--••----------•-••....................................................... Date PermitNo....................................................... Issued-....................................................... Date 35-00 No.... '3* Fizz ...................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .........T.o.wn.... .......-OF.........Barnatabl.e................................................. Appliration for Disposal Works, Tonstrurtion rumit Application is hereby made for a Permit to Construct (X ) or Repair an Individual Sewage Disposal System at: ..... -Crock pgZ_R -Q.&d...... ...................................#99.................................................... Location-Address or Lot No. K. D.aliOinl....................1�................................. ..1687.. ....B. ........... 0.4-14............... Owner Address ........................................ .......................................... .................................................................................................. -ja Type of Building ------Installer Size Lot....56P3 8............ .........Sq. feet 2 Dwelling—No. of Bedrooms............................................Expansion Attic Garbage,Grinder Other—Type of Building ......9'R!A§��....... No. of persons........3................. Showers (1 ) — Cafeteria Otherfixtures ....................................................................................................................................................... Design Flow_____________ gallons p er,Person per day. Total daily flow._........��5..........................gallons. 04 Septic Tank—Liquid'capacity.tnn-ja.gallons Length_-S'Ac':..... Width.-A'je---)"...- Diameter__.__-_--:._..... Depth.."k'9 Disposal Trench—No..................... Width......_......_...... Total Length.._....--...___..... Total leaching area....................sq. ft. Seepage Pit No........t............ Diameter.......%......... Depth below inlet....._(r.......... Total leaching area..!�?�......sq. f t. z Other Distribution box Dosing tank ( ) 0-4, I... -��i-!.... -�.- '-I.................. Date...... ..........4 ...... Percolation Test Results Performed by.....Test Pit No. I...u)..�.......minutesperinch Depth of Test Pit......L«.ml i....... Depth to ground water-----t /_A------------ 44 Test Pit No. minutes per inch Depth of Test Pit.......1i......... Depth to ground water......�A 1�........... ........................................................................................................................................................... 0 Description of Soil.......-'=A.........Lr:;a *-.'.I-"r-.C,'-, , --- -----------...........................................:•............................ ................................. ........................ 7 ............... ............. ........ . .. ................... ...I"-"..*'.!�.................. U ............. ...... ............. -------- ........................................1---JA........ ------------i................................................................. U 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 TTTIL- 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issup&by the board of health. Signec.-:4 ..z Att............................................ .... Application Approved BY--------------- --- - ---------------------------- .......... Application Disapproved for the following reasons:................................................................................................................ ..............................................................................................................................................................w......................................... Date PermitNo......................................................... Issued........................................................ Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ............T.own..................OF..........�Parnstable ..... ...... ....................................................................... Trrtifiratr of Tompliaurr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed (K ) or Repaired by................................................................................................................................................................................................... In W Lot #99 Crocker "Road '91er 6rnstable Via. at................... - - - --- - - - -------------- Via. ............................................................... has been instilled in accordance with the provisions of TITLE 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No.,,AP I..'>X tt ............... dated------------------------------------- vee ; f THE ISSUANCE OF THIS CERTIFICATE SHALL NOTTE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE.............................S17..)..........-9-. /................ Inspector..........r.. .......................................... . THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH Town OF................Barnstable ..................................................................... FEE..'*., ---—----- Disposal Works T-FaInstrurtion Upamit Permission is hereby granted--------- ...............k.-e..... ................................................... to Construct (X ) or Repair an Individual Sewage Disposal System Lot #99 Crocker Road VV. arnstab)le at No.................. ......................................................................... ...........................Ift.............................................................. Street as shown on the application for Disposal Works Construction Permit No..................... Dated.......................................... • ............................................ r Health DATE.................................... . ............... FORM 1255 HOBBS & WARREN, INC.. PUBLISHERS ,-• �, 4�, Coo S.�: J (/ oO � .J i •rear � •4: J Dr- _7 x/000 $ rEsr dT. � x 00.0 M. 't 4 TEST- h A Y. In _r 9et,o x 2 q' ' TcPo�l'r•,C.. I D2v Ate/ wn e¢ OF Q�� L �= i�l•.94 ,b•��� 52�, 1 I o� qL , o MORSE . / oo W/61 + - I. [sue o PNo.10951 0 ? C J i 3 ��7oP of BA.nC 90 �G l s-f �r } 100 OJ�oft• �. 1 . �� NAi �/ ,r LEGEiVD c�C-A77ACHEDSH��r SdOF EXISTING SPOT ELEVATION OxO CERTIFIED PLOT PLAN EXISTING CONTOUR -0 --- °aN t -r- _►�i _ c � R�t� ' FINISHED SPOT ELEVATION H FINISHED CONTOUR 0 I �•,--- , APPROVED BOARD . OF HEALTsu DATE AGENT SCALE.= I -DATE -D�c 14,E i LDREDGE ENGINEERING CO. IN f , CLIENT I CERTIFY THAT THE PROPOSED 'RiEGliTER REGISTERED JOB N0. '�12o4 BUILDING SHOWN ON THIS PLAN ` CIVIL LAND-,- . CONFORMS TO THE ZONING LAWS %ENGINEE SURVEYOR DR.BY OF BARNSTAB , h S. t. 712 MAIN STREET CH. By AkM HYANN I S, -MASS.• 3 - - - - SHEET.L OF. DATE R ,LAND • SURVEYOR NOTE /F E/7NER THE SEPT/C 7A V OR ?D FT. .MIN. L6ACN/�G P/T AitE MORE .THAJV /2"JELOW /D I7: M/N &RAOF, ,4 24"O/AM ETER CONCRETE EOMeM, sNALL $E BROUGHT TO GMAJIVIE.�AN EXTRA CONCRCTE q"PVC P/PL ti+EA3YY CA ST/IPO/Y COVER SfN.4LLL 49E US�Lo M/ COVERS N. P/TCN lF//V OR/VEy1/A Y �,. �g"PEeQ 40=7: 2 Jq• MIN. CO/VCRE•TE A e c3ltnoE COVER CLEAN .SAND &ACfCFILL -- _ _ _ L1Qt//D LEVEL .. '• �. c_ .• ; .. 2*4AYER �^ +4"CAST , ,._ ! . e OF IRON P/PE i i o 0 0 a 0 p e G11L. • 1 • . . • • • • pe i WASHED 570NE K D/S7 s • •• + R/T PT/C TAN a t S,E . P/4 � e pOX v • � 8 • •. • • • N • b . s 1 • • + • 34 - �2 ECT VC • ♦ EFR r D . a= DEPTH . •� • • H� HED STOiYE.� ► • • • e . AS D . LrR4 E T E dr .a • • • • • • • • d •rp • a v • • • •- • • . • • e o P/7 DR EQUIV. /N!/ERT CLEY.47'1,0NS Ig�.� x 2.0 3-a� �,P.D. ► • e — EL -ig• � INVERT AT OL/!LD/NG g`� o FT. �8 5 x O. 3 - !m 5 E,•P.4 • f�ST N° 3 INLET SEPT/C TANK %7•o. Cr ^ y- 10 F7: O/AM.. C SEE TABIJLATION� ,. P17 CAPAC IT _4-'4E r=-P, D. 40U7LET SEPTIC TANK g�•g .. FT. INLET D/STR/8!/T/ON BOX $4 SECT,/ON OF' GROuNO JITE TADLE _ OUTI�TD/sTR/Btrr/ON BOX g4 3 F� ` SEAVAGE P SP&SA L SYSTEM /NLE7' LEACH/NG PIT '24-. I Fr " Ti4BlJLAT/D/V LEACfH/I1/G P/T. DIMENS IO N A 3 FT - DES/GN CR/TER/A scAL E .: %s /"D p/AFENSJON $ FT. N[/MBER OF BEDROOMS 'Z DIMENSION_;; C 4 _FT M+N G/1R9AGED/SPOSAL UNIT SOIL. LOG • TOTAL E3T/M�tTEO F-Low 2� GaL.1A0Ak SO J L TEST A So/L 7ES7*2 SOIL TEST .,j NUMBER QF LEACHING /D/TS i f"ELEY. 'I rELgY. 90 4' ;DATE OR- SOIL. TEST. - �. S/OE LEACHING PER P/T f g� SQ. PT. o'-�" roPsol t LCWM RL-SUJ-rS N//TNESSED' BY -Jg o' 2' PERCOLATION MATE LIE M!/V�/ING! 60TT0/•!LC�4CN/NG PER PI T $Q. FT. d H 16H�Y� _ -�pP•�pI L A'`t i - LEACHING ARE Asp.A FT. - n°"��D FffjeCOLAT'/O RATE AZ RA AZ � TOTAL MIN. INC, i �f 4 RESERVELEj4CNlN6AREA =-�� $Q. FT. ' -'4-,O St� Stl�£ CLAf _ g1�Tl 3oF 3 �t Z 7_ �fA{�QiAI 501E LOG tN of _�����H OF MAss9Oti i-to'z s�„U,`c ,�� LnT g9: - LoA- ?OHN ON LB �` e FINE' wlr- T P TA . BERh p y S 10 i GLA`( SN.rO o.iossi��o�� EL-1e:,c. ELDRrEDGE ENGINEERING GO,IA -17.¢ 712 MA/N ST. su F`rs/4NAt�� ® IyO GRO[!ND Yf�i�iTER ENCOU/VTEREO HYsfNN/s, 'r1.4SS_ Q: GROUND,,WATER A7 .,L�LEt/. . :JOB NO . $I_204 'SHEE:T�OF ry . r µ /Y07"E : /F E/TNER THE SEPT/C TAN/C DR 20 FT. M//V. GEi4CNIiYG P/T ARE MORE THAN /2''BE1-OIN � _ /D /� M/�/ GRAOF� A 24'O/AMETER CpNCR.�T� COIi�'R SNALL eE BROUGHT TO 4RAOZ.,AN EXTRA CONCRCTE g'PVC OJPE JHE:4VY CAST /IPO/Y CO(/ER Sf/.44L !3E G/SFO coERS MiN. P/TCN /F/,,V 17R/VE.WAY F L-q L 0 �gIVPEW F7. 2 q CONCRETE G1�AoE CO VER CLEAN SANG ' A � BACK/=ILL i - � _ z r LAYER i IRON AP/PE i OJO 6A 4. ' o I • • . • • • • • > 0,5& WA5HPO 5701VC { ~'a MIN.P/TcN D/ST Q . %4 PER TT. SEPT/�' TANK Dayo A I • . •. • • • ♦ 1 S6 • �- . o I ♦ •EFFECT/✓C / r o 3�4 - �2 ° A 1 • • • • ♦ 1 • o WASHED STONE DEPTH � v ' �:�Q;• p O 1 • • • • • • 1 I p o • iC ::e• i O� ' 1 • • • • • • • • p •��, PRECAST SEEPAGE III • P17 OR EgLIIV. o �0 1 • • . • • . • 1 ' e o INNPRT,L'LE✓ATIONS _. a `� — el= i4• i ' /NYERT AT av/LD/NG FT. t 6�T: D/AM. INLET SEPT/C T.4NK FT. ® FT O/,414. C SEE TgBI/L.4TJON� OUTLET SEPTIC TANK '�� FT. INLET DISTR/BL?IDN BOX FT. SEG'T/ON OF' GROuNo WATE TADLE 0CJ7LE7-D15TR/BIl7"/0N BOX L FT SEWAGE O/SPOSA L SYSTEM INLET LEACHING /�/T 0 FT TABIJLATIDN LEACH//VG P/� DJMENS/ON A FT. DESIGN CRITERIA sc.ntE /� ,p/ $ FT• NUMBER OF BEDROOMS t3�5 5'01 L D/MENS/ON G 4- FT. GARBAGE DISPOSAL UNIT SOIL LOG SD/L TEST TOTAL E1T/MA749FD FLOW LA GA4.1DAy SOIL TEST *3 SOIL TEST**4 i1(/JMBER OF 44CACHINCr P/r.S FL W 126, 1 ELFV. �3.� OA7"E OF SOIL TEST t toy I� �t (Pam) SID,=4,-AGHING PER P/Y - —SQ, FT. ,orw� RESULTS N/ITNESSED 8Y ����OB�, ��P CH N P P/T FT. T�p�;� -� PE,vcoAATJON RATE A LESS BOTTOM LEA / G ER S4 ---lt — 3 ,�N Nc A FT. AEhCOL.4T/ON RATE J�� � / G R A _11L—S TOTAL LEACH N E Q. f aH RESERVE LEACNJNG AREA_SQ. FT. MI=D- / FILE St�/tti� A tN Of L=3T 9q ` c QocKE2 �R1=. - O o� LBBE�RT �� , FINS 2 WEST TA4 LC RSE 10951 OI� of `� ,ELOREDGE ENGINEER/JVG CO,i` EL= (�•B 7/2 MAJN ST. E L:74. I �ND SVR FSS�ONALE� ND GROUND YYATER ENOOv/VTEREO HYANNi3 A MASS:' Q GRD LJ/VD N/A TER AT ELE✓.. .JOB NO. i_�4 SHEET 3 OF 1 � O r(7 -f-LFr- rqm 3CP wLAJ o >J N ` CV O ` rp C: s { rp CC, _3 7- c OWN OF BARNSTABLE LOCATION /0� Croll- R�. SEWAGE # ILLAGE 134t/IJ&4 • . ASSESSOR'S MAP & LOT INSTALLER'S NAME&`PHONE NO. SEPTIC TANK CAPACITY r/IN 10D LEACHING FACILITY: (type) (size) NO. OF BEDROOMS�v1•- _ a---- BUILDER OR OWNER Ti®� PERMITDATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leachin;facility) Feet Furnished by /1 r, C /b•n �0/ e y l31� t r ri aq s(o ivo is I No.------------ ----9- Fee---- ---------------- BOARD OF HEALTH TOWN OF BARNSTABLE Application for Melt Con5tructioni3ermit Application is hereby made for a it to Construct Alter or Repair ( lefan individual Well at: /0 y- el 0 C-He t A J, Lj -permit Location — Address Assessors Map and Parcel SC4_>'r-T fid, _� ner Address 0 C) -—-------—- --------------------- Installer — Driller Address Type of Building #0 S C' Dwelling----—---——--------------------------------------------- Other - Type of Building No. of Persons-------------------- T �/ Capacity ype of Well Purpose of Well c --------------- Agreement: The undersigned agrees to install the aforidescribed individual well in accordance with the provisions of The Town of Barnstable Board of Health Private Well Protection Regulation — The undersigned further agrees not to place the well in operation until a Certificate . C pliance has been issued by the Board of Health. Signed-(DLe" 4A A A date 47 Application Approved By date Application Disapproved for the following reasons- ............ U-9R �_ q �;4r--------- date Permit No. Issued -------------------------- at ------------- BOARD OF HEALTH TOWN OF BARNSTABLE (Certificate Of (Compliance THIS IS TO CERTIFY, That the Individual Well Constructed Altered or Repaired by 0 k&_2f�_ff_ at— jID C e-✓'C.-L 1(,/ Installer —----- has been installed in accordance with the provisions of the Town of Barnstable Boarctof eal Private Well Protection Regulation as described in the application for Well Construction Permit No. Dated THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORY. DATE Inspector - - - - - - - - - - - - - ----- - -- - - - --- - - - - - - - - - - - - - - - - - - - - - - - - - - - -- - - - - - - - -- - - - - - - - - --- -------- r• /. o No.------------ ---9-0-- Fee---- ---------------- ' BOARD OF HEALTH TOWN OF BARNSTABLE t zippCix-a*nAl Ivell Congtruct ion Permit Ap lication is hereby made for a p�eirmit to C nstruct ( ),-Alter ( ), or Repair ( "fan individual Well at: L/ H. / W -�-y- ------ - w --- - ----- =- - - - -- - - -- - ---- 6o ahon tAddress' f .Assessors'Map�and Parcel Owner ' Address Installer — Driller Address Type of Building Dwellin N��4 c Other -.Type of Building -=- --- No. of Persons----------------------------- --- Type of Well- -------= ,-- ---=--- Capacity---- - - ---------------— Purpose of Wellw��s 7`�-`-- --- - --t—= Agreement: � The undersigned agrees to install the aforedescribed individual well in accordance with the provisions of The ot4W ofAarnstable Board of Health Private Well Protection Regulation The undersigned further agrees not to place the well in operation until a Certificate .t C pliance has been issued by the Board of Health. Signed — -- 1s9---=- ---- to - R�pplication Approved By --- - -- — date Application Disapproved for the following reasons: -- date ----- ------------------------ ------ ----- ------_------------- Permit No. — Issued-- - -t x..�+,:s�.avaa+za�eew�:a..aece:e�,►o�:eboev��r�e gse:«..w-.�o�-�caeea=oasire,ra�sa�ea:��:na�aa�s�essr�.maaeaeaeaane::aae:,sessoas�-�a—ao.��sa<asaw:�aeaea»ras�aanss:o:esar:eaeroiratr BOARD.OF HEALTH i TOWN OF BARNSTABLE Certificate Of Compliance THIS IS TO CERTIFY, That the Individual Well Constructed ( ),'Altered ( ), or Repaired (41 by gel, ,� —_ �_?�---_ —--------------------------------------------------- Installer- _ ----- ----- has been installed in accordance with the provisions of the Town of Barnstable Boar ofeal Private Well Protection Regulation as described in the application for Well Construction Permit No. WO-11-1-Dated---- ----- �i THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORY. DATE-------- — - -- Inspector-- -------------------------------- .�wla visa eiea ea+ieawawaswea»•aeaes�++,roe:sasee.ec�eeawcs»a.se:+:casaei;e.a•aaoa�we�.ayersaeaeCa:wasee+wwawsae•aassaew?aessi':!o+a±:Ts*.:a,►ta�asaseeaea,. as•6!a�nta�atasa�sews+,•:s... BOARD OF HEALTH TOWN OF BARNSTABLE Yell Con5tructionPermit No. -- A)qq11 I n Se / Fee- - --- Permission is hereby granted '� �'` ""k' --_— to Construct ( ), Alter ( ), or Repair (1*1 an Individual Well at:A Street ---------------------------- as shown on tea plication for a Well Construction Permit No. - - Da•e - -- /J/J - ------------------------- ------ Board of Healb DATE— I -- �`o Ll CL� " C S O RS MUST BE WI - AC ES _,COVERS B UM 9 MINIM = / !`� V ERT ELEVATIONS . DES ] CRI T A . . . ..:''6'. OF-FINISH -GRADE E N ER l GENERAL NOTES ' ENV E AT BUILDING: _ 3.5 MlN DESIGN FLOW.MAXIMUM COVER FIR 2 : T ' - < G.P.D. I. '`THIS PLAN l S FOR THE DESIGN AND CONSTRUCTION t NV T N P TANK: '930 4 BEDROOMS AT 110 PER .. .. s , . .. ER I SEPTIC TA BE LEVEL - , . MiN 2 OF PEA3TONE , OF H S WA DISPOSAL S S M ONLY.,N� 92. 75 BEDROOM EQUALS 440 G.P.D. THE E GE D S Y TE • _, _ PERT OUT SEPTIC .TANK 4. elf Av 1 _ 0,4 3/4 ! l/2 D A. .NVERT 1N DIST. BOX / ASSUMED. M , NO GARBAGE. GRINDER 2. VERTICAL DATUMIS A SU ED. FOR .BENCH ARKS 3 '. N ER OUT QIST. BOX 9 WASHED STONE _ --�---_ ---r B� a 'DOUBLE W S ED ;75 .: . , .:. .5 92 0 2 � SET. ,S SlT PA rAs E �E E PLAN. ' g3;0 90.4 O 88.2 NVERT IN LEACH CHAMBER. 90.2 AFFLE SEPTIC TANK REOUI RED: ,, 'O T M F A HA 88.2 2 SOO;GAL LEACHING CHAMBERS J. ALL-CONSTRUCTION METHODS AND MATERIALS AND 3 .OUTLET : 440 G.P.D. X 200x 880'GAL. ADJUSTED GROUND WATER: N/ _ S EDG UDW _ W/4 . STONE AROUND. !2:8 r x 33 ! x 2 MAINTENANCE OF THE..SEPT I C SYSTEM SHALL :. .: D BOX :, `SEPTIC TANK PROVIDED:- I500_GAL.....MIN. 0 GAL IS , _d ., ,._. ,, _ I_BSE.RVED GROUNDWATER. _CONFORM TO MASS. D.E.P. TITLE 5 AND LOCAL EPT C 'TANK. 5 f CRUSHED TONE OR _ . 6 C S 5 �?OTTDM F S HOLE #I: 81.2 BOARD OF HEALTH REGULATIONS. ,0 TEST LE SOIL ABSORPTION SYSTEM REQUIRED. COM ACTS BASE w . .. DESIGN R R TE t 5 MIN/INCH, 4 S MCOMPONENTS ' OA UN R .,. . ,_ - ALL SEPTIC SYSTEM LOCATED TED DE -' SOIL TEXTURAL. CLASS - l • :. •. - CA PROFILE,:" l L E • NO t, TO SCALE A' AR TRAFFIC R A R - f-' EFFLUENT LOADING RATE - 0.74`GPD/SF - AREAS SUBJECT TD VEHICULAR TRA lC OR G E TE 440 GPD 0.74 GPD/SF., 595 S.F. REQUIRED THAN 3 IN DEPTH SHALL BE CAPABLE OF W/TH- .�: .. _-. . _ - -_STANDING H 20 :WHEEL>LOADS. A \ PROVIDED: 2 500 GAL LEACHING CHAMBERS �o 5. ALL SEWER. PIPE SHALL BE SCHEDULE 40 OR STONE-AROUND: A-605 S.F. _ . •. APPROVED EOUAL: L� \ b05 S.F. x 0�74_. 448 G.P,D. \ � . LOCUS ,., ,:�, � ,. �._ ,� :'�.. ;: 9 PSI P b T � � _ � \ 6. SEPTIC TANK AND D-BOX SHALL BE REINFORCED _. . Q.J SOIL , TEST P I f DA TA - PRECAST CONCRETE AND WATERTIGHT. D-BOX SHALL _ OR W NTH R_ BE WATER TESTED TO F LEVEL HE E E INDICATES l CATES 1 ND 1 CA TES , \ _ 4 3 \ PERCOLATION OBSERVED l5 MORE THAN ONE OUTLET. �+ \ TES T - - GROUNDWATER TtNG try \ BUT _ f0 F t TPs ea 0 7. BEFORE CONSTRUCTION CALL O J G SAFE ...... . e \ P 11076 TP l TP . 2 l 888 DIG-SAFEAND THE LOCAL WATER DEPT. a FOR LOCATION OF UNDERGROUND UT1L I TIES: HOR! ON TEXTURE COLOR HOR I ON TEXTURE COLOR I E E C L ;•. \ 0" 91.2 D. Z TE E 93.0 LOAMY IOYR : LOAMY : IOYR _....\ r 8. SEPTIC 'SYSTEM INSTALLER SHALL NOTIFY THE PIT ; A AND SAND ,.. •.. . S 4/2 4/2 2 Soo cattoN �, _ \ '_DESIGN ENGINEER TWO 'DAYS PRIOR' TO CONSTRUCTION. 1 t \ ♦. I LEACHING CHAMBERS � \ .� 9/.0 3 .. ..: .,. ........ ....... 92.$ _ LOCUS MAP \ \ V: 1 OF THE SYSTEM TO ALLOW FOR SCHEDUL ING OF THE t, wi+• STONE AROUND \ ` \� � -LOAMY IOYR LOAMY �lOYR B B CONSTRUCTION INSPECTIONS. - SAND '5/8 SAND 5/8 ................... ...... ---- ........................ 9. EXISTING SEPTIC SYSTEM TO BE ,PUMPED DRY AND - _ MED I UM IOYR J MED I UM IOYR _ e!�(ELE \ 1 C SAND 6/4 C SAND 6/4 BACKFILLED. # ALL UNSUITABLE MATERIAL (A A B HORIZONS) ENCOUNTERED BELOW THE INVERT OF THE LEACHING ee 52- _ FACILITY TO BE REMOVED FOR A DISTANCE OF 5 ' AROUND AND REPLACED WITH SAND IN ACCORDANCE Qz + I SANDY 2.5Y SANDY 2.5Y C2 C2 If I. NO DETERMIN.aTION HAS BEEN MAD_ AS TO LOAM 5/3 LOAM 5/3 COMPL 1 ANC£ W J TH DEED RESTRICTIONS OR ZONING 11 I �� 1 20 81.2 132' 82.0 NO WATERNO WATER lS00 GALLON �`. REGULATIONS. IT SHALL REMAIN THE CLIENTS 1 SEPTIC TANK " \ DATE: AUGUST 23. 2005 RESPONSIBILITY TO OBTAIN ALL PERMITS. SPECIAL 1 EXISfiNG z . PERMITS. VARIANCES ETC. FOR THIS PROJECT. " t TANK \ m TEST 8Y. STEPNEN HAAS WITNESSED BY: DONALD DESMARAIS PERC RATE-• C 2 MIN/INCH 12. IT SHALL REMAIN THE CLIENT'S RESPONSIBILITY >, TO HAVE THE PROPOSED BUILDING FOUNDATION BM.COMER BULKF)EAD DESIGNED TO ACCOUNT FOR THE EXISTING GRADE t AND SOIL COND l T IONS AT THE LOCH T I ON OF THE PROPOSED BUILDING. AGE t GAR t , ' ED t G - p45 LIN \ P�0 1 t XISTING Ig Lam(\) - • i•i , F \ f Nv P L A / V O � L_ A / V O It 104 ' CROCKER R0,4D . M.QP / / O , PARCEL 22 L 0T 99 \ -- l ICES T RA RATS TA L. � . "A 56.398- S. F. \ J, to cp LF .E D.. /-I R / S S ITV / T ■ CB CONCRETE BOUND t \ .. 1 ,.. , 20 OC TO BE .2-5 2005 O HYDRANT G GAS LINE V/ N I NC OHW-- OVER HEAD WIRES � AGL� E � l.Jf� EYI G . 40.00, \ 923 Flo u t e 6A LIGHT POST 53 OS _ 2 W � ,r \ Ya rrnou t h o r t MA 02675 38•I � E ,JNDERGROUND ELECTRIC LINE' P 4 7 :SIDEWALK--q EwaLK // 508 362-8132 �89 -T UNDERGROUND TELEPHONE L I NE _ - -� . • CTV- UNDERGROUND CABLEVl510N LINE �# � ( 5 0 8 � 4 3 2 5 3 3 3 K „ I 40.4 SPOT ELEVATION X ONTO R pt V 40- EXISTING CONTOUR R S DES p;0, MOM4�01 PROPOSED CONTOUR 0 IO _2 0 40 . 0 F ` WEEK CAL C. SAH/CFIN CHECK. CFW DRN SAH r , ,. JOB NO 5 068 /ELD CF