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HomeMy WebLinkAbout1955 MAIN ST./RTE 6A(W.BARN.) - Health t i 1955 Main Street West Barnstable Y A=216 -039-001 ' No. ( P�� Fee 1. R [ THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: kes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS 2pprication for Migoal 6potem Conotruction Permit Application for a Permit to Construct( )Repair(I )Upgrade(VAbandon( ) D Complete System El Individual Components Location Address or Lot No. O ner's Name,Addreskand Tel.No. , 509 1 R 5 S iMA�+J $-t-v�ET- t� bay,�q►� ;' u( Vrtc.�I,,, 362-�8 M Assessor's Map/Parcel ;O.a py Z a� Install s Nub e,Address,and Tel.No. NEI�T�t �$9' Desi ner's Name,Address and Tel.No. G ^ 36 2... F'��rv' HOLI ,9"'n' Has - �a 747- ��M E 'osALA, a-�, '� q gq MAJ oaf O24 Type of Building: �S Dwelling No.of Bedrooms _ Lot Size .2b R -seTft. Garbage Grinder( ) Other Type of Building "16 +Awe l(No.of Persons Z- Showers( ) Cafeteria( ) Other Fixtures S gkK c -5 y� z— Design Now (6 O — 00 gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title ti + t� • Rd 6 ( Size of Septic Tank SO0 ,%c I Type of S.A.S. 3 M vim► j$Kserl Description of Soil 04-t_-) - ('_a u r Se Nature of Repairs or Alterations(Answer when applicable) 'E Date last inspected: Zvo'L DESIGNING ENGINEER MUST SUPERVISE INSTALLATION AND CERTIFY MI WRITING Agreement: THE SYSTEM WAS INSTALLED IN STRICT The undersigned agrees to ensure the construction and maintenance of the afore describedA(t430IQAN0EdTQ(R6%tem. 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 tl s Board of Health. n Signed ;�'�� -s----- Date L 2t 10 Application Approved by Date Application Disapproved for the following reasons Permit No. �� `E a` Date Issued I U.Li —�_ 4 i No. C7 C, Fee el 51 THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Ir•� fes PUBLIC HEALTH DIVISION .TOWN OF BARNSTABLE., MASSACHUSETTS "'Application-for Zigpo'ol &V!5tern Construction Permit Application for a Permit to Construct( . )Repair(I )Upgrade(',i!�Abandon( ) O Complete System ❑Individual Components Location AA `I'`ddresss�or Lot No.. 0 ner's Name,Address and Tel.No. t / p V1q 1 ll7 A.,tj St('\r. N� W� �i:r rl` G- �F�:6(. i"Gv' '{�� 1r� �✓_/ V� .e,'n ` 3(a�- Assessor's Map/Parcel ,V, (;v x 7 7 _7 6 Y a) lP �3 c� �L fc. 3�rfi � cz_ �h ���tv ��z Installer's NaWe,Address,and Tel.No. N� g�`�89 0056 Desi Designer's Name,Address and Tel.No. r tiC`II, �� �, E��M.e �t�X 7k?-3�j3 p�-aL Type of Building: Dwelling No.of Bedrooms t� Lot Size 3.V sy-ft. Garbage Grinder( ) Other Type of Building �Z c_ o�u'<'! No'.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow 6 1�a - -1 o O gallons per day. Calculated daily flow gallons. Plan Date I r o C Number of sheets Revision Date Title "I' g�h i •i cc.G ��f- ! • !r�, r >�,�, c, I Size of Septic Tank aCa G I Type of S.A.S. 3 �� ,1- Sor? Description of Soil' t � r� • e-c, S �+. •�. r a Nature of Repairs or Alterations(Answer when applicable) k/_q V �7, 1 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 to,place the system in operation until a Certifi- cate of Compliance has been issued by this Board of Health. // Signed -°, ii1'iG rl Date I Z-- l 7 i ��31 Application Approved byl d. y Date Application Disapproved for/the following reasons , 't Permit No. 90_�`I Date`Issued o —�-- ---------------- --------------- MI �1� 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 at I�,S r'1!`14-,n y4/_eV &I o d W17 f0,f `4,b1t has been constructed in,a`ccordance with the provisions of Title 5 and the for Disposal System Construction Permit No. .�fl�y I P-) dated 1'/12 !0 Installer Designer A* `1 � x The issuance of this permit shall not be construed as a guarantee that the system will function as desi .ned. Date i=1 t (4 Inspector `'1 . ------------------------- No. c�'CJU Fee 5� THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS Mi5po;al bp5tem Construction Permit Permission is hereby granted to Construct )Repair(, Up gra e( )Abando ( , ) System located at �j� �p 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:Construction must be completed within three years of.the date of this pe,` t. Date: I l �I \_Approved by TOWN OF BARNSTABLE S 6Y LOCATION /� S N1�',�✓ S/ SEW�+►GE#07® j VILLAGE S y Ra 15 TA 6LF— ASSESSOR'S MAP & LOT : 16 INSTALLER'S NAME&.PHONE NO. �RAI► f�.�c�•6.rt/ So at SEPTIC TANK CAPACITY /X" LEACHING FACILITY: (type) (size) lei NO.OF BEDROOMS BUILDER OR OWNER RtLu L PERMIT d DATE: 4 16 L COMPLIANCE DATE: �! d 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 j within 300 feet of leaching facility) Feet Furnished by M } 00 N 0 U M b N AJ N o' J Q o Town of Barnstable °Ft"E'°'y Regulatory Services ti M O� Thomas F. Geiler,Director • BARNSTABLE, MAC Public Health Division s639 �0 'O'Eo.N►o'c° Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office:.508-862-4644 Fax: 508-790-6304 Installer &Designer Certification Form i Date: Designer: v Installer: rRaof Address: IKA-ch Address: 9P,Ooo Ai.✓,3 � br34o On Y_r l — a was issued a permit to install a (date) (installer) septic system at 1 XY5 440r1 S r— based on a design drawn by (address) 1, Ac dated a- ©`4 (designer) �I certify that the septic system referenced above was installed substantially according to the design, which,may include minor approved changes such'as lateral relocation of the distribution box and/or septic tank. 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. ASH OF mA (Installer's Signature) � ARNE H S9ctic� U OJALA /qW1 Cn o . • 3 O (Designer'sSignature) (Affix N Ts: Here) S/ONAL ECG PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH . 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. Q:Health/Septic/Designer Certification Form ' A M ZTt-1 A„ 5C-A1 .E J►°.MUA2.Y IS, 1985 ZA LE 1►.1rF.�r 1 rozxy o tea.a t5 i a0 I C1>a u I 5'T"A 3 DA \ r`. �i?PTCT2- A-1 SE ..lam ....gl-.�- J�, <��� \ � � r -i�-I�. blv151G)r� .aC=' A`tt'..P.G-r �F- l�A►.l(U ,OA.1 yti/1••FIr.�-t' z ' `�+00 11 N �� f3U��6�A145 wEP (A�Jl�1►1G WHF� TF4�, SufSDiVISIc SLAW WEI.IT le ( IG+ >" G7" ,I►1 TN+< . f'OKtvu IQ VJWIC.44 I.WTb.: SE:OAe_Ai'E l dTS, rtCN,a1N S-ra i s,iu��� +:o� mA2.Y Lou 1SF- `!'oWfj �� -- Lcir S _ wr y ►.S Its 41 -d`C i 4 Grp.52 ki o - �' � Q;J/ Des. 0 ` t ..cps 0 kp 0 ~� W 1 - • ; .`�"��`�` :I ..__ S �1' i S' mod" w r r \. . , �6 •lam �� �� . 4"CIO - . � ddl _:r i - .` 1 ' JANUARY 7, 199e. CAPE COD PAVEMENT N➢11'FI 22'171DE r I` /�� 7/1S`OZ GDMMDN 17 MAIN ST (ROUTE 8A) ARNE H. OJALA PI-S. DATE COLLEGE s91•ae'la-v Naroe'1e-E?� 116.78 40A0 m 0 dr AV - N1 a uI SHOP m a � LOCUS.NAP SCALE 1'= 1000' °'° BARN FOR 11ECL9TFiY USE ONLY n i e ASSESSORS NAP 218 4 6' , M PARCELS 30-1 &38-2 /-BARNSTABLE . ZONING:RF FRONTAGE-150' I��tiCB N58'28'4B"E CB > PLANNING BOARDAREA—49,seD sF• 137.Do PPROVAL under the SUBDIVISION RESOURCB PROTECTION OVERLAY DLSTRICT ?�•y NTROL LAW NOT REQUIREDARE1- 07.120 SFdSETBACKS: FRONT•- SO' °=' .> TE: SIDE -15' R I:M w FLOOD ZONE 'C' BARNSTABLE COMI 2N 8B2 I PANEL 260001 OOU DJULT µ. o •r]I `� . 71.5' OWKERS OF RECORD: e0.0• RICHARD C. &KATHLEEN A. GRDIlI-LOT 2 s o l NOTE: AUCE 0. &PAUL L SOVO TRUSTEES OF. 17 •'in J.E.S.REALTY TRUST- LOT 1 O ' NO DETERUDIATION AS TO COLPI3ANCE WnH THE 10f:f� 1. REFERENCES: ` � ZONING ORDWANCS REgU➢M ENTS HAS BEEN MADE DEED BOOK 14e68 PAGE 135 '� 1 SHED 4I OR INTENDED BY THE ABOVE ENDORSEMENT 'DEED BOOK 14868 PAGE 138 X N c 1 DEED BOOK 12Be3 PAGE 278 DEED BOOK 6621'PACE 98 Coo 368.29'37',k, i PLAN BOOK 393 PAGE B C 3O.00•�� E (1'?6 F75YCg CH1t1yyDP c .48,30 R N gnA.4 336.43 Npm n•.ti • yam ti^! °•a t1 NI yc1. ye'ty o ' I I. 60.00' Lora O'O3'fi8•'W AREA-0+ACF t SQ.Pl. SEASONAL 2. 26O.tACla:9 rreo•G3, CB;SG'E POND N a m LOT 1 ; 'N 140,961t Sq.R. � 8.22fAC1le9 cy , C h1 1 SEASONAL _ _ • POND a 371 15'30-r Dx N Y1C1'OR� & e B1�D4 Y �"yq I + I I PLAN OF LAND IN (WEST) -BARNSTABLE, MA 'PREPARED FOR ca RICHARD C. & KATHMEN A. GPJMM AND PAUL F. & JENNIFPR E. VECCIR a� He0'E3 ® 3 cao 09 N66'20 2G - SCALE 1"= 50' DATE: JULY 15. 2002 CAPE COD COMWUNC17 COLLEGE PLAN BOOK 193 PACE 127 50 0 50 100 150 s down cape engineering, iac. CIVIL ENGINEERS LAND SURVEYORS 939 main st: yarmouth, ma ARM PIS. DATE I ...� . ..�� � ��� O 3� �O No.. Fxs..J1P........................ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH -----..-.. -r"� .�----------OF..... L-".....--------------------------------------------------- Appliratiun for DiupuuFal Vorkg Tonutrnrtw' n Famit Application is hereby made for a Permit to Construct ( ) or Repair (k<an Individual Sewage Disposal System at: .....tU-5..)N1 A N.S r---•-•---•---- dd��/ =...... ..� � e............... q /q Location-Address or Logo. .1............. Y...S ....... .........- Address Ow er 4�-N -------------- =.p 1 ---------...•.........-----....-----------...------------......----....--------------•••----...--- Installer Address Type of Building Size Lot....... 1.14L.....Sq. feet V Dwelling—No. of Bedrooms................................ .....Expansion Attic ( ) Garbage Grinder ( )►� Other—Type T e of Building ............... No. of ersons........_._.___......_______ Showers — Cafeteria Pa yP g ------------- P ( ) ( ) Q, Other fixtures .....---•-•-••-•-•-•----•------- . W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity............gallons Length-............... Width................ Diameter................ Depth................ x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No--------------------- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water........................ Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a --•-••••-•------------------••-------------------------- -------------....-----••---------•----•-------------------•-----------.----- 0 Description of Soil....................................................................................................................................................................... x U ---------•-----...••---••••---•-•••••-•••...---•••----•--•------•••-•-••-•••...•••-------•-----•----------•-•--•--•••-••-•-•---•--------------•--•-•----------------•---•-•-----•------••---•------•---. x -- ---------------------------- ------------------------------------------------------------------- --•--.....------•---------------------•----•---•-------•--•---•------•--••-•-••-•--•-----••-•------ U Nature of Repairs or Alterations—Answer when applicable_--____A0Q-----40.A-.F-...____�.ZA.C.-_l4.Lw.G.................. .....t f-Vur—A---------------•-----------------------------------•---........------------------------------------------------------------------------------------------------------------ Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TIT1Z 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. Signed...................................................................................... ....-•---••--•-----•----------• Date Application Approved By........ -e` .'�... .. ... ..................•... Date Application Disapproved for the following reasons:........................... .____.__....__..___.._..__._._._......._............ .................................•----------•--------------••-•---------------------------...-------------••-•-•--•-•-----------•---- -----------•---•--••-----•----------•----•-------••-------....._.. Date PermitNo......................................................... Issued....................................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH f�....e. �.OF..........r :... .. ................... (9rdifiratr of TompliFaurr TH TO CERTI , That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) by----------- ------ ....... " ..._------...----•--•-------- ..............------------------------.......-•---............---------•......---•-----•- Instal� �`Y at------ - 1 - ,� •=® .../ =s ------ -- - ---------------------- has been installed in acc ance with the provisions of TIT 5 of The State Sanitary Co)Ae as described in the application for Disposal Works Construction Permit No ... _.> �____-. dated__-.-__. "__'-.f�'--7-�.-........... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE....................................••--.........--•---•--•---•----••---••..--.. Inspector.................................................................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD O HEALTH o {��.........OF......... . �L`............................................... ems/ NO.. �.. FEE........................ Disposal orku Tone ion rrnti� Permission is hereby grante _. ' �_ to ConstruuA ) or Repa• J( a Individua' ewage osal S steem No._-e-- :-M -------0-4-_;i. .---- --�1{� + t --------- at Street �y as shown on the application for Disposal Works Construction Permi o...__ ted.__:_1...�� `7_C........... �j f o� Boar of Health DATE - .......... -----•--•--------------------•-•-••------ FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS "4 r .-......_._..---.. FEs....�. ....._......... • THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH •----- V-l' ------.....OF...... .. ..C1'L+y. ......... Appliration for Disposal Murks Tonstrudion Vamit Application is hereby made for a Permit to Construct ( ) or Repair ( an Individual.Sewage Disposal System at: ��/ ,�" �--. • ................... 1 ..,.. �, : ............... Location-Address or Loto. _..........al. .�.k.----••.................................•. ..........-_..--•-•---•-•-----•-------•.... r.............-----....................._.---- Ow er Address ------------- ----------------•-------•••-•- --••---•--•------------------ --------------------------------------------------••-- Installer Address dType of Building Size Lot-------IA.C_..........Sq. feet U Dwelling—No. of Bedrooms................................ .....Expansion Attic ( ) Garbage Grinder ( )H `4 Other—Type T e of Building .._ No. of persons............................ Showers W YP g ------------------------- P ( ) — Cafeteria a � Other fixtures .....................................................................................----............................................................. W Design Flow............................................gallons per person per day. Total daily flow.............................................gallons. WSeptic Tank—Liquid capacity............gallons Length................ Width................ Diameter................ Depth................ x Disposal Trench—No..................... Width.................... Total Length_:.--:____--___-_--_ Total leaching area....................sq. ft. Seepage Pit No..................... Diameter..................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date........................................ a Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water........................ fi Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ x oDescription of Soil........................................................................................................................................................................ W U Nature of Repairs or Alterations—Answer when applicable______-Arxo.....40...kF-------UA5__9 A.P.:(__________________ ---:"t. .f�.. . . ..........................................................-................................................................................................................ Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITM 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. Signed...................................................................................... .........•--.............._..... � P Date Application Approved By----- 1 :! !'' :... �" ` _Date Date Application Disapproved for the following reasons:............................................................................................................... -••------------------------------------------------------•--••-------------------........--•-------•-•-----------------•--------•...._._.....---...-••--••-•-----------•---•••--••---•-••••------.._..._ Date PermitNo......................................................... Issued_....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ............... i OF.... 5�� .... .......................... (Intifirttte of Tomplionrr TM . TH IS TO CER I That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) by P - . x �+�' Install at......a. ........... . . -. ,•-lam•-t+""*---- --I--- -- has been installed in acci4fdance with the provisions of TITkE 5 o,ffr�Tyyk�e tate Sanitary Co.e as described in the application for Disposal Works Construction Permit No.'•;,: .......f<_! .�...... dated-_...__ `!. �__'_.7�.......___. PP I � THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE................................................................................ Inspector.................................................................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ... f No5s.7 FEE....... ............ Disposa 10orkii (tons t -to f grunt n Permission is hereby grantedw ............................................................ to Constr or Rep ' ( ndu j v vage s osal S at No•-, -<''1 f-. _ _;V -•-'•-• . .. u '----------•--•--•----•-- � --- ...__ Street i-..._...-- as shown on the application for Disposal Works Construction Perm•N o. t__f_,.{��Hated_...1 z ........._.. DATE..... .?'.._1_7 . Board of Health FORM 1255 HOBBS & WARREN. INC., PUBLISHERS THE COMMONWEALTH OF MASSACHUSETTS 0��/()() l BOARD OF HEALTH _._.. .,44 6`'.. ......OF.......15,1�!./r` �►r`�. L..'t............................................. - Applirution -fur Biquutti Morks Towitrurtiutt Pumit Application is.hereby made for a Permit to Construct ( ) or Repair (},) an Individual Sewage Disposal System at: ..... ft%k._.S- ........ 11.a5.1.....X.6UMS`i1'ZUi......--'--'------- ------'-----------------------------------------------------------------------------•----------- Location-Address or Lot No. hkA.Qt_TAA......_E.......OUii-LA...--•- -----------------'------ .-------------------------------'---•------.......-•------------------------........---'---- Owner Address Installer Address U Type of Building Size Lot...AllCe-S_R -_-Sq. feet Dwelling—No. of Bedrooms---------Z...............................Expansion Attic ( ) Garbage Grinder ( ) aq Other—Type of Building --._---_._-_______________ No. of persons_--____---______---.-__-.-- Showers ( 1 ) — Cafeteria ( ) Other fixtures .....-f- --nc ......t----SI N k-------•-•-- --------- -------- W Design Flow---------5700-------------------------gallons per person per day. Total daily flow........._5.©Q-----------------.----gallons. WSeptic Tank—Liquid capacitv.1000_gallons Length....1�2 ..... Width...:E� ........ Diameter_-_----.-_-__ Depth.: __-.----- x Disposal Trench—No- ____________________ Width-------------------- Total Length_----__---__.-.-__. Total leaching area--------------------s . ft. 3 Seepage Pit No........I....._..._.. Diameter_2Q_��e.4tvDepth below inlet..`1.�.-A...... Total leaching area.- 'YIP ft. Z Other Distribution box (X) Dosing tank ( ) aPercolation Test Results Performed by........Av..A-k...... -_________________'_-_____.____.-.- Date___L1-�.�- 1�- Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water..._4?_--------------- rXq Test Pit No. 2----------------minutes per inch Depth of Test Pit-------------------- Depth to ground water__.-_:_-___--_-.-___---- P4 ------------------- ------------------------------'-----'---'-----'-•'-•-•-•-'-'--•'-""---'--.............................................................. 0 Description of Soil-------E.tNk--.- 5A_M.0-=---. .----UIRC.f--------Q Si 1-----------------------------------------------=--------------- x V ------------------------------------- ------------------------------------------------------------- ---------------------------------------------------------------------------------------------------- W - x -------------- ----------------------------------------------------------------------------------------------------------------------------------------------------------------- ........ U Nature of Repairs or Alterations—Answer when applicable.--_.Q��►:NcLC_�_-___:;�t-ext.S.'E_1.xi. -------.c_e.f.sp0PIS--&_R141r.) tit. ?......... SYs"tEY1/i u ...........A1Q(2t 2---------t-�' ------- - .LL' .12 1-1`iC L Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Article XI of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. Signed ..._ .............................................. ... Date ApplicationApproved By............................••----••'-•--------------------•--------...........--'--•--........... •-------•-----------.-..---------------- Date Application Disapproved for the following reasons----------------------------------------------------------------------------------------------------------------- •----•--------------------•-----------------------------------'-'-------------------------------------------------------------------------------------------------------------------------------------- Date Permit No............7_1-7......'-----------"-'•---"-'--.. Issued.......//-X- -� --------------------- Date : . No......d -z. ..... F��.. ..r.. ........ THE COMMONWEALTH OF MASSACHUSETTS BOARD, OF HEALTH f ......_.OF......./,�.. !ks `h' G .. ° s5 � �irttt�ua� -fur Miipuuttl Works Towitrurtion j3prutit ,,. Application is hereby made for a Permit to Construct ( ) or Repair (X) an Individual Sewage Disposal System at: :Wim 5 ' _._. e�y,�, Location:°=Addressrs �np t or Lot No. ..._M.A JS�1J'.!' A..._._...�.w..at....�f�lllLtl. ..----.....•.......•.......•....... .................................................................................................. Li Owner Address Installer Address Q Type of Building Size Lot_._A.ft9..MS__Sq. feet U Dwelling—No. of Bedrooms._-_-.-__.Z.................:....... ....Expansion Attic- ( ) Garbage Grinder ( ) pa, Other—Type of Building ............. .............. No. of persons---------------------------- Showers ( I ) — Cafeteria ( ) Other fixtures ..... 5Y R�t.r.1..._rCJC? .__. _.. _.r1 iV tG--------------- - W Design Flow----------- ........................gallons per person per day. Total daily flow..........,ta --------------------..gallons. USeptic Tank—Liquid capacity._0.90gallons Length----4 d_..__. Width_._..----.... Diameter----------...... Depth._-_ .____.._.-. xDisposal Trench—No_ ____________________ Width-------------------- Total Length.................. Total leaching area--------------------so. ft. Seepage Pit No........I------------ Diameter__`14f !Wepth below inlet..' 1^'........ Total leaching arca._:#W.NP ft. z Other Distribution box Dosing tank ( ) ~' Percolation Test Results Performed by--------Ar- i--.-_- -------------------------------------- Date---11VOI -__-__-------. aTest Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water....4Z-_--_------- f� Test Pit No. 2----------------minutes per inch Depth of Test Pit.-_.____- ________- Depth to ground water-_--_._--__--_-____-.._. Ri ----------------------------------------------------------------------------------------------------------------------------------------------------------- D Description of Soil-------lt1Nt-....r"-8~•0.....W-vt-!4.......t ;AC-1a-------0-9:---SII"-t------------------------------------------------ -------------- x U W U Nature of Repairs or Alterations—Answer when applicable _-pme_q-16-----.__% ._4'XS_4'S Y)_ {--.---. 4���Qn.�.st. F*444) sts7+.tA!t_.. ° Yttca S. ►:kLcr......... ----------------- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Article \I 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. Signed--- �Av*,71................................................ ---.... ` Date ApplicationApproved BY................................................................................................... ---------------------------------------- Date Application,Disapproved for the following reasons:--•----•---•------••-----•-•-•--•-••---•---•---•-------•--------•--•--•.............•-•--......-------•--------- - - ------------------•--- Date 'M I Permit No. ....-�---'------------------------- Issued --=- "' = ------ 5 Y- r Date ?' e THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH �� twsv OF......... .. f9� J',ft?',>e���. .............. �rrtif irttt�e of f�um�rltttnr� ' " THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) by. .. &65 k n--- ---••-••-••--••------ -- ----------------------------------------------------------.......................................... Installer has been installed in accordanceii t the provisions le oft ttcle Ifof The State Sanitary Code as described in the t application for Disposal Works Construction Permit No.._._._!1.;1'7 ___________________ dated-------11`.._t'.-:7,3__.----___-----••--- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. 4 `, . , .. ` `'' t ' z Inspector-•-- DATE_.. z ---•fti ,_ .........-• ?614 -- q j THE COMMONWEAL�R kvY!-r: f;.;�i.ASSACHUSETTS BOARD OF HEALTH 77... .. . ot� - ..of.... , , , . �. CjIJ No.......... FEE .....................�1��-l� � t u ttt urk� ( at tar �n,,prrmit Permission is hereby granted..........lT_C!--..-...... 'f-----'------------------------------------•------------ ... to Construct ( or Repair an Individual Sewa e Disposal System at t-••- --._%!...---... �e- ii/Fi •k / ° 'h es --- ------ ---------------- ..: � fly�v as showiipop.,the application for Disposal Works Construction .Permit No ___*7"17.. Dated"-_-. __,_4..��;..... . ......: ^�-�,,- ................ ---- 11r�w y Board of Health DATE. av y a .�1. s{,y _ �< FORM 1.255 gHOSSS & WARREN: tN.b RUDLISHERS 'A_ - e • � -4. M. <�4r ��-Y3"�$vl- '.1i..�: ° t::w...w::.,:•�K,.}.r r.,.,-a �°�a.c..:.1. n+ a: 3 w ' � 1 �ae,ivS_T!� . z WEI.� �o 1606 G46 M7 1000 r , r . nl'1'L1t;A'1'lUIJ 1 UR 1'LRCOLATION 111ST AND OBSERVATION PITS LOCATION - VILLAGE APPLICANT ADDRESS SS' S FEE / TELEPHONE NO. (Non-refunds le ENGINEER TELEPHONE NO. DATE SCHEDULED ��- ' LbyNb: 0 0 0 0 6 0 0 0 0 0 0 a 0 0 (Applicant's signature SUB-DIVISION NAME . DATE EXPANSION AREA: YES_ No TIME �f..�� G ENGINEER TOWN WATER PRIVATE WELL ` BOARD OF HEALTH EXCAVATOR SKETCH: (Street name,etc. ,dimensions of lot, exact location of test holes and percolation tests, locate wetlands in proximity to' test holes) NOTES t 7 QL 6�c PERCOLATION RATE t �_.jM //��# TEST HOLE NO: C ELEVATION: TnBST HOLE NO: ELEVATION: 1FZ1 3 2 4 1 ( `/ 4 _ Pam.�rol 5'1 ) Sc''�'`L7 504 7 ' L 6 , e � 9 co . 10 10 12 12 13 1 13 , 14 14 e t 15, 15 16 SUITABLE FOR SUB-SURFACE SEWAGE: 16 LEACHING FIELD EACHI G PITS y LEACHING TRENCHES_ UNSUITABLE FOR SUB-SURFACE SEWAGE. REASONS: NOTE: ENGINEERING PLANS MUST SHOW NUMBER ASSIGNED ON PERC TEST APPLICATION ORIGINAL: COMPLETED IN COPY: ENTIRETY BY P AI•' R TURff9 TO BOARD OF 11 AI`T11 RETAINED BY APPLICANT - - No. v Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS ZIpprication for �Di!5pool *pttem Cow6tructiou Permit � Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) O Complete System O Individual Components Location Address or Lot No. /� r ) /1 Owner's Name,Address and Tel.No. n rMfnrA IT �A_rvt1 Fc-rL- J �o -� UQ Assessor's Map/Parcel Q IN � ,�-, GtJ, f�t.wn Installer's Name,Address,and Tel.No. �,9 _�3 00 L /& Designer's Name,Address and Tel.No. 61✓� �+ Type of Building: 0 Z3 Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) 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 Health. Signed Date Application Approved by Date Application Disapproved for the following reasons G n, 'C,C 7j z Permit No. Date Issued No. OFFICE OF THE BOARD OF HEALTH OF THE 3B)"INSTA 17f "AGO.ME. TOWN OF BARNSTABLE, MASS. 039. Ak joy -------T------ 19 SEWAGE DISPOSAL PERMIT 4 Permission is granted to ---------- to construct ----_______-___--- Upon the Premises of Sketch ------------ ---------------------------------- In the village of t 0, 1 1, 2- 100 or more feet from any source of water supply 20 feet from building 10 feet from property line Health Off r. No L�l/ 1 1 �,, Fee 7 ;' THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS 2pplication for Di5po.5af *wem Con5truction Permit Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) El Complete System ❑Individual Components Location Address or Lot No. ' 5� b�^ f / 4 Owner's Name,Address and Tel.No. n VQ Assessor's Map/Parcel IN. f9S� Installer's Name,Address,and Tel.No. Q aOO� �N Designer's Name,Address and Tel.No. Ai MA //JJ Type of Building: 0 Z Z. Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.'of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow. gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) 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 Health. Signed Date Application Approved by Date Application Disapproved for the following reasons J )yr 0 ca jr,41nm . Mt r MCP ;z4 Permit No. t Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CE TIFY, that the On-site Sewage Disposal System Constructed( )Repaired ()<)Upgraded( ) Abandoned( )by 1 r at 1 S 1r+ *T I CA 1 s c4- c,�� �� � has been constru ted ' accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. 2 Uo — ��a dated L;/ 0 el Installer r4 p Designer 41'o e �N The issuance of this p rmitl not be construed as a guarantee that the S(Ypte ill function a designed. Date�� �� Inspector k V No. Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS Digonl *p5tem Con.5truction Permit Permission is hereby granted to Construct( )Repair( )Upgrade( )Abandon( ) System located at 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: Construction must be completed within three years of the date of this permit. Date:_., Approved by f TOWN OF BARNSTABLE I LOCATION WAGE # Od E sRr.! 5 i R nL..iy SE & LOT 2 1�' VMLAG .� INSTALLER'S NAME&PHONE NO. iPAw � �.gc��6,e.�/ 56a7t �y> >778 SEPTIC TANK CAPACITY �-s•• ll LEACHING FACILTY: (type)I Llg,4cH"'16 (size) Ai w Pj lI Sysrr. r 6 a CrLt NO.OF BEDROOMS 1 s 1- z z, v'/ _ BUMDER OR OWNER L + BEN% Er- eeell' PERMITDATE: H ., r C` COMPLIANCE DATE: 5111le Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by J o � h t Ln LW Ir\ i h h � \ N N N r � M N NlNI. !V ,� s rJ M THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate Of Com�riacnce r THIS IS TO CE TIFY,t at the On-site Sewage Disposal System Constructed( )Repaired()C)Upgraded( ) Abandoned( )by ` at S rN z has been constru ted ' accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. 2 00 — oZ dated Installer 1 '... Designer n e The issuance of this p rmit hall not be construed as a guarantee that the s ill function a designed. Date [ �/ Inspector .' I U ~I THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CE TIFY, that the On-site Sewage Disposal System Constructed( )Repaired(Y)Upgraded( ) Abandoned( )by ` at AIA10 has been constru ted ' accordance 4 with the provisions of Title 5 and the for Disposal System Construction Permit No. •o —YZA dated ' Installer Designer n e 1 .4 The issuance of this p rmit hall not be construed as a guarantee that the s i11 function designed. Date Inspector :- own of Barnstable k Regulatory Services f C, 01 Thomas F. Geiler,Director �qe • 1ARMSTASM. t--- - �6 "• ' Public Health Division Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 = 4:. Office:.508-862-4644 Fax: 508-79"- 3011P -p- E I Installer &Designer Certification Form Date: D$ - -bQ -//// � Designer: �� Installer: /i4RNF 14141�/6QAI �c � 1 a 'P INQ P�{ Address: V1'((X(h ell Address: �.✓i yc�-rvr�ou'lam. neat C�2��� �T b t3 6C On Y-r / - d /CQtov Azzo-C-fAl was issued a permit to install a (date) (installer) septic system at /P.SS ovU tf s T based on a design drawn by (address) JtrvKJ*,, dated (&-signer) �I certify that the septic system referenced above was installed substantially according to the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. 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. MA (Installer's Signature) SN ofSsgc moo`' ARNE H y�N ' U OJALA CIVIL N No. 30792 (Designer'sSignature) (Affix 4 Here) S/ONAL ECG PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH 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. Q:Health/Septic/Designer Certification Form No. ;�ou-1 • 1:92 Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE„ MASSACHUSETTS . DESIGNING ENGINEER MUST SUPERVISE -Miopooal *potent Con traction JW#WION AND CERTIFY IN WRITING THE SYSTEM WAS INSTALLED IN STRICT , Permission is hereby granted to Construct )Repair UpgrAoe( )Abapd�o ( )� ACCORDANCE T L PLAN. System located at 9 5S r+` 1 "��`�r�'�g ' ��k' — 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: Construction must be completed within three years of the da(eof this Date: T�a/ U�l ._Approved by TOWN OF BARNSTABLE LOCATION ��SS ��''� SI SEWAGE # VILLAGE pRRrl 5►A fat i ASSESSOR'S MAP & LOT 1CA A_ / ,y,� t/6 Ate/ sd a >y> 77.78 INSTALLER'S NAME&PHONE NO. �I�r•� SEP'ITC TANK CAPACITY /-s" p c LEACHING FACILITY: (type) L"-,4u-) (size) NO. OF BEDROOMS sT Z zi s EAT-s BUILDER OR OWNER L + BEN%�« - PERMITDATE: COMPLIANCE DATE: Separation Distance Between the: Feet Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Private Water Supply Well and Leaching Facility (If any wells exist Feet on site or within 200 feet of leaching facility) Edge of Wetland and Leaching Facility (lf any wetlands exist Feet within 300 feet of leaching facility) Furnished by z1,i /9 L Zv•Z 35,8 q 6 2 S�3 are � C P ' r y 193 s r5o9 — Ta�l b lSdJ D E - ZL` y y ►+ 2 .9 3P.3 .3 17? 232. z3i.st 12.4 5 I 3Y TOWN OF BARNSTABLE � LOCATION SFWAGE # r VILLAGE Sou $i 4 6 MJYISE R . & LOT INSTALLER'S NAME&PHONE NO. �iPA�� /�'�•4<<�d Ate' SO$ �5�� 7»8 ee SEPTIC TANK CAPACITY - LEACHING FACILITY: (type) ZILL,"e' C/VAMB-es (size) Ad NO. OF BEDROOMS Sy� r.E z� 5 FifTS ' BUILDER OR OWNER PtLu L + n7EN1WE2 PERMIT DATE: H JL 1 C L COMPLIANCE DATE: �! G Separation Distance Between the: Maximum Adjusted Groundw,ter Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or.within 200 fect f leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by A ' 3 LC , YSr�z/,/ /y 2�.28 .' -3 5d se. S Z j ��.�ELc; y ia�s Tait M���� 14 _3 /7? 23.Z a z5. Iz/ Z 1.5— 5 CoAONvT'YEALTIi OF MASSACHUSFT5 .�+ G`€.TT- OFFICE OF ' `jTVIRON A L A`"F_ RS DF-PARTW-E1gT OF E..-VIROl�T hTAL PRUMCPIOIv TIM TMLE 5 2� OFFICIAL INSPECTION FORM-NOT FOR VO _ y ASSESSKENTS SUBSI1T-RFo.0 -SEWAGE DISPOSAL SYSTEM FORM PART A RECEIVED CERTIFICATION Property Address: SS ►n S-t JUN 1 8 2002 Owner's Name: -4 'o„cs 1 lse�r JO_ TOWN OF BAR ABLE HEALTH DE TPT.. Owner's Address: -q I er � Date of Inspection: I 3.7 z ame of inspector: (please print) F4.Jae+.� w� Company N=e: A ,ASV r Mailing Address: T.��� io MAP �1 V?. .?,m Telephone Number: ,5' 8 399!5r- 7 G 8S PARCEL . Qi 0 CERTIFICATION STA T ESN-' LOT - cert=_fy, that I have persoraily inspected the sewage di_posai:ysteim at this address and that the inibrtnador,reputed beiow is true,accurate and complete as of the time of the inspection.The inspection was performed based on my training and experience in the groper finc ion and maintenance of on site sewage disposal systems.I-am a DEP approved system inspector pursuant to Section 15340 of Title=(310 CMI R I5_000)- 'rhee system: Passes Conditionally Passes Needs Further Evaluation by the Local Approving Au horny .' Pails Itseztor Spa toe: Date: �a The system inspector shalt submit a cosy of this inspection report to the Approving Authority(Board of Health or DEP)within'30 days of completing this ituspeoiion.if the system is a shared system or has a design flow of 10,000 gpd or g"eater,the inspector and the system owner shall submit tie report to the appropriate regional office of the DEP-The original shm'd be sent to the system own.er and copies sent to the b;aver,if appiicaable,and-the approvi auahtomy Dotes and Co=.rinents report or iy describes conditions at the time of inspection and under the conditions of use at that time-This inspection does not address haw the system will perform in the future under the same or di#xerent arariitioz�s of use . o Page 3 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUN-NARY ASSESSMYNT'S SUBSURFACE SEWAGE DISPOSAL SYSTEM WSPECTION FORM PARS`A CERTIFICATI€3N(continued) Property Address: _ }�$__� &A;n S+ l�tJes���rvk (e Owner: 'S o r 4 Nte of Iistaectiorz: C further Evaluation is l� aired by the Board of Health: Conditions exist which recauire further evaluation by the Board of Health in order to determin zte system is fair to protect public health,safety or the environment 1. System will pass unless Board of Health determines in accordance with 310 Ca 15-403(l)(b)that the system is not functioning in a manner which will protect public health,safety sad the environs £: _ Cesspool or privy is within 50 feet of a surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland a salt marsh 2_ System will fail unless the Board of Health(and Publi ater Supplier,if any)determines that the system is functioning in a manner that protects Line pub'" health,safety and environment: _ 7-he system has a septic tank and soil absorp system(SAS)and:he SAS is within 100 feet of a surface water,supplyor tribunary to a surface w supply- The system has a septic tangy,.and SAS d the SAS is within a Zone I of a public water supply- _ Tire system has a septic tank and S and the SAS is within 50 feet of a private water suopiv wed _ The system has a septic tank SAS and the SAS is less dian 100 feet but 50 feet or mo-e froD5 a private water supply well".Meth used to determine distance ;This system passes if the we water analysis,performed at a l3P certified laboratory, for col=ffor= bacteria and volatile org—ar€ic mpoun&indicates that the well is free froze-.pollution from that facilt-W and the oresence of ammoIia ni g and nitrate nitrogen is etuai to or less tl a 5 ppras,;rovided that-o other failure c;iteria are trigg . A copy of the anzalysis must be attached to this forte. I Other: rage 4 or i 1 S SU"RFACE SEWAGE DISPOSAL SYSTEM nespFcmN PART A CERTIFICATION(cartinxed) Property Address. t g� MA,`w St .We6l'- r Owner: Stir d0 Date err l"pecdan: D_ System Failure Criteria applial le to all systems: You must indicate"dyes"or`ne to each of the folkmring for a�sous: Yes No / i Backup of sewage into facility or system component date to overloaded or clogged SAS or cesspool Discharge or ponditng 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 distrt tion box above outlet invert due to an overloaded or clogged SAS or cess'Pool ?lgmd depth in cesspool is Iess than 6"below invert or available volume is less than%2 day flow Its pmnpan a,more than 4 times in the last year NOT due to rloaged or obstnatted pipe(s�ivuuftb-_ of times pumped Any portion:of the SAS,cesspool or privy is below high ground water elevation. _4 Any portion of cesspool or privy is within 'ZOO feet of a surface water simply or tributary to a surface wa-wT amply. — Any portion of a cesspool or privy is within a Zone I 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 ttan 100 feet but greater than 50 feet from a private water supply welt with no acceptable water quality analysis.[This system passes if the well water analysis, performed at a DEP certified Tabora€ory,for coliform bacteria grad volatile organic compounds indicates that the well is free from ponution fr'€aaa that tgcihty and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less flum 5 pp es,provMed that ne rather faflarecriteria are triggered-A copy of to analysis must be attacked to this foran-1 W (Yes/No)The system fails.I have determined that one or more of the above failure cxiteaia exist as described in 3 10 CNhR 15303,*.I±eresr the system iis. e sy-.item aver sh,ssaisi zxL l of Health to determine what will be necessary to cease j 1he faihn-_ L Large Systems:ag , To be considered a tar ge system the system must serve a&rility with a design Dow,of MAN gpd to 15,000 gpd- Yong must indicate either"Yes-or"rro"to of the following: (The following criteria apply to large s erns in additions to the criteria above) yes no — tine systetn is wi ' 00 feet of a s' drinking war supply — — the systerta thin 200 feet of a,trey to a smfaoc da-irk water simply — , the syst is located in a nitrogen sensitive area(Interim Wellhead Protection Area-IWTA)or a mapped Zone of a public water supply.we'll ifyou have eyed"yes"to any question in Section E the system is considers a sigtaificant threat,or answered "ves"in lion D above tl:e large system has failed.The owner or operator of any large sysrern considered a signif t doeat under Section£or failed under Section D shall ec de the s I53t34 e S y uP't� system in accordance with 3 t0 CNLR sy5tean owner should contact the appropriate region.,al office of the Deoarranert 4 Page 5 of I I • OFFICUL INSPECTION FORM--NOT FOR VOLUNTARY ASSESS NTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPEC' ON FORM PART B CBT-C MIST Property Address: 141SS '- f ©wiser: S Hate of inspection: Oo'"L Check if the following have been none- You mast htdicate'"yes"or"to"as to each of the followi : Yes No 5( — Pumping information was provided by the owner,occupant,or Board of Health Were any of the system components pumped out in t<=e previous two weeks Has the system received normal flows in the previous two week period' Have large volumes of water been intx oduced to the system recently or as part of this inspection? _ Were as built plans of the system obtained and exam?(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 ail system components,excluding the SAS,located on site PC ixlere the septic tank manholes uncovered,opened,and the interior of the tank inspected for the contrition ofthe 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 trlaintenance of subsurmce sewage disposal systems The size and Iomtion of the Soil Absorption System(SAS)on the site has been determined based on: Yes no _ Existing information-For example,a plats 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)j310 C% 15302(3)(b)J ` Page 6 of I I • • OFF ICE,INSPEC710N FORM-l TTOR VOLUNTARY�SMXINTS STIBSURFACE SEWAGE DISPOSAL SVS3XM INSPECTION FORM PART C SYSTEM INFORMATION PMperty Address. /9 SS" 1 q sf e Owner: .So rfro Date o ius"�,cii or: FI:.OW CONDMONS RESIDEN'' TAL Number of bedraoms(design).-_Q limber of bedrooms(actual): a DESIGN flow bases on 310 CMR 15203(for exansple: 110 gpd x K of bedrooms): Number of current residents: _ Does residence have a garb W grmder(yes or no): AJO Is Iaundry on a separate sewage system(Yes or no): AD[if yes separate inspection required -- dry system inspected(yes or no)-,t/0 Seasonal use:(yes or no):An Water muter�,i ffa�occupancy: ie(last 2 years usage(gpd)}: Sump pump(yes a = Last dare of occupancy: COMMERCIAL/INDUSTRIAL Type ofestablis hem Design flow('based on 3 10 CN M 15-203): Basis of design flow(seatslpersotrsl Grease nap present{yes or no): Industrial waste holding tank t(yes or no): NI On-sanitary waste discharg to the Title 5 Water meter read f system(yes or no}:_ �,i -fable: Last date ofoccupan e: OTHER{des }: Ptttmmpnug Records GENERAL INFORMATION - S=u a o;information: Was system pumped as part of the inspection(yes or no):_oVo If yes,volume pumped: gaUons—1?ow was Reason for pumping: 4�y Pumped determ;.�-t? "TYPE OF SYSTEM —XSeptic tank distribution box,soil absorptimr System ----Single cesspool Overflow cesspool __-_Privy Shared system(yes or no)(if yes,attach Weviom 1nnovative/Altein technology-Attack a c ative technolo °II rer ,if any) obtained from system owner) opy of the=rr=operation and�tenancee contract(to be ---Tight tank Attach a copy of the DEP approval Other(describe): ApprOX11na€e ate of all components,date installed(if known)and some of it o atisrn: Were sewage odors detected when arriving at the site(yes or no): ljo I page i of I I O FICLA ,INSPECTION FORM--N€ T FOR VOLL. �RY ASSESS '_�TS SUBSURFACE SEWAGE DISPOSAL SYSTEM IISPE ON FOR-AM PART C SYSTEM INF0 ATION(continued) Property A.ddress: f ---�- �e t�atr-5' � Owner. So(' '0 Date of Inspection: c1 0 BUILDING SEWER(locate on site purl) Depth below grade: Materials of consm=ion: cast iron Y 40 PVC_o1her(.exp1ain3: Distance from private water supply well or suction line: Comments(on condition of joints,venting,evidence of leakage,etc.): S£PTIC TANK:i(locate on site plan) Depth below grade: Z# _ Material of construction: X concrete mere fiberglass polyethylene `other(explain) If tank is metal list age:_ Is age confirmed by a Certificate of compliance(yes or no):_(atrach a copy of Certificate) Dimensions: lono J Sludgy depth: .,7 I Distance from Fop of slydge to bottom ofroutlet zee or baffle: 30 Scum thic)zrIess. 1 ---- e Distance from top of scum to top of outlet tee or baffle: 9 ,. Distance from bottom of scum to bottom of outlet tee�r baffle: How were dimensions determined: y r1t Corn merits(on pumping recommendations,inlet and outlet tee or baste condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc. - 0 GREASE TRAP: (locate on site plan) Depth below grade: Material o€construction: concrete Zf er-lass_�olyethyiene otz`�er (explain): Dimensions: Scum thick-Tess: Distance;r on top of scum tot of outlet tee OF baffle: Distance from bottom of sc�• .to bottom of outlet tee ar baffle: Date of last pumping. Comments(on pump recommendations,inlet and outlet tee or bade condition,structurai integrity,liquid Ievels as related to outlet ert,evidence of leakage,etc.): OFFICIAL INSPECTION FORM--NOT M VOLUNTARY ASSESSWN1 S SUBSURFACE SEWAGE DISPOSAL SYST"EM INSFECnON FORM PART C SYSTEM INFORMATION(continued) Property Address: gS✓� i w Owner: So O Date of Impeefion: TIGHT or HOLDING TANK: (tank;m7Mo=erg-lass time Isf an site plan) Depth below grade: Material of construction: concrete _polyethylene othe;(evlain): Dimensions: kr- n Design Flow: onslday Alarm mvsent(yes or no): AlartTt level: wog order(yes or no): Date Of last pu�ptttg: Comments(condition of arm and float switches,etc.): IDISTfRIBUTION BOX: (if present must be opened)(locate on site plan) Depth of liquid level eve outlet invert: Comments(note ifbox is level and distribution to omles equal,any evidence of solids carryover,any evidence of leakage into or out o�C�c)_ e4� PUMP CHAMBER- (locate on site fps in working order(yes or- _ Alarms in working order(yes no): Comments{note conditio pxu chamber,caadifim of pti and rage 7oi :t • OFFICIAL INSPECTION FORIM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PARTC . SYSTE LN-FORMATION(continued) Property Address: �fASf Owner_ _ or(/O Date of Inspection:,� d a SOL.ABSORPTION SYSTEM(SAS): (locate on site plan,excavation not required) If SAS not located explain why: Type Ieaching.pirs,number I leaching chambers,trnmber. leaching galleries,number- leaching trenches,number,length: leaching fields,number,dimensions: overflow cesspool,number: inn ovativ&alterrative system Typef iame of technology: Comments(note condition of soil,signs of hydraulic failure,level of ponding, clamp soil,condition of vegeation, etc.): CESSPOOLS: (cesspool mist be pumped as p t inspectionXIocate on site plan) Number and configuration: Depth—top of liquid to islet invert: Depth of solids layer: Depth of scum layer- Dimensions of cesspooL- Material-s of constructionXsciL Indication of groundwateor no): Comments(note conditios of hydraulic failure,level of ponding,condition of vegetation,etc-}: PRIW: (locate on site plan) Materials of construction: Dimensions: Death of solids: Comments(note condition of 1I,signs of hydraulic failure,level of ponding,condition of vegetation,etc_): Page 10 of l i � • OFFIciAL iNSFEcnGN FoRm-Nor F AR'AssESS Emrs SUBSURFACE SEWAGE DISPOSE SYS7Md 1gWE ON FORM PART C SYSTEM LNFOR TION' z ) Property Address: I MS' fivgt C e tamer: S Drft Date of aaspection: O SKETCH OF SEWAGE DISPOSAL SYSTEM Pmvide it sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks.Locate all;ueIIs within 100 feet Locate where public water supply enters the buildm Cto�5e t I Page I I of 1 i • • OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SL-BSUR—FACE SEWAGE DISPOSE..SYSTEM LNSPECTION FORM PARS' C SYSTEM INFORMATION(continued) Property Address:_1 q S G ,.A-5 t Ps Owner: S nr d Date of inspedion: 01 a SITE EXAM Slope 00 Surface water NO Check cellar No CALO ' Shallow wells I" Esti,mateci depth to ground water 30 feet Please indicate(check)all methods used to determine the high ground water elevation: Obtained from system design plans on record-lf'checked,date of design plan reviewed: Observed site(aia_nting propertylobservation hole within 150 feet of SAS) Checked with local Board of Health-explain: Checked with local excavators, installers-(attach documentation) ►f Accessed USGS database-explain:: You must describe how you established the h h;round water elevation: L (w4j CO ON E-As.� OF MASSACHUSE �, rl-N ExECL'?7VE OFFICE OF ENTVMONI N1TAL AFF_AH S t D-EPARTjN N-T OF EN-VIRONrAIVENT L PROTECTION w s> =E 5 �-d6 TS ®FFICI-A.L INSPECTION FORM-NOT FOR VO PINTARC' A.SSESSNMAN Sjj—BS-u ACE SEW-kGF-DISPOSAL SYSTEM FOR' PART A RECEIVED CERTUICA ON rty Address:Pro �n Sf aA �e7) JUN 1 8 2002 TOWN OF BARNSTABLE � 're+'S Name Q� HEALTH DEPT. ;owner's Address 15 pd Q � a Bate of Inspection: z4arne of Inspector: (piease print) ' .a '� company Name. Ags4e. 41!4.r$C ar!W-a«eg, ^i s Mailing Address: "A 6 - R A -)ARCE` i elephone Number: ��' -20 -'? &$ �• CERTMF CA x'IONi S3-4 T E Ml MINT s cert fy that i have pv sonally inspected the sewage disposal�jrsterri at this address and that the information repomd beiow is true,accurate and complete as of the time of the inspection..The inspection was performed—based on aiy training.and expe:-ieiac� n fire proper function and maintenance of on site sewage disposal system -I am a DEP Approved systerh inspec€or pu-suant to Section 15340 of Title 5;(310 CviR The system X Passes Conditionally Passes Needs Further Evaluation by the Local Approving,Authcst•ity ` Fails ` ���� ciG!4� 1T Inspector's S%saZ'iata3l'Q_ �'aete. CJ T:Re s4Jzerti s--vector shall submit a copy of this impection report to The Approvirg AL'tshvrity(Board of Health or %EP)within 30 days of completing this inspection_lithe system is a shared system or has a desig;i flow of IG,UG0 'fd or g eater,the ins-v---and t`?e system owner shall submit the report to the appropriate regional office of tag 0 DER ER Tile on-auial sh-miiu�e sent to the system owner and Copies sent to line buyei, if applicable,and the approving e u`ioniv. Notes and Co r netts *'"This report wnly describes conditions at the time of inspection and urger the conditions of use at that time.T his inspection does not address gout the system will perform in the€u--rs under the same or difereat c0z?d'-oas of ase, a-litre.5 . a it'1L 6,15270 0 1+�`�*7• i I f OFFICE,WSPECTION FORM—NOT TOR vOL-UNT Ly_ASSE:SSIMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM EWSPEC110N FORM PART A CERTIFICATION(coMMUed) Property Address: Egrt Chvner: Soy vo Date of Inspection: Inspection Sum€€ary: Check AACD or B/ALWAYS co let-all of Sectige 1D - A System Passes: a 1 have not found any mfortnation wbkh Ln that any of the&Bm--afteria described m 3 10 CNM l 5-2,fla or in 3 10 Cl�a {53fi4 exist Any criteria not evaluated are indicated below. Comments: Sys;em Condifionaliv Passes: One or more system components as descnbed is the=`Conditional lass"section need replaced or epaired_'a he systems upo-,z comVietion of the replacement or repair,as approved by the and of?dearth,wilt pass_ Answer yes,ro or not determined(Y,Nl,ND1 )in the for the following s emenrs.If"not deterntine(r*please explain. Tile septic tank is metal and over 24 years olds'or the septi :ank(whether metal or not)is mucturalty utsound,exhibits substmaial infiltration or exfiltration or tank is imminent System wiff pass inspe. j'the existing tank is replaced wide a comp;ying septic tank as by the Bid of Health. A metal septic ta-ttC:vill pass E don if=t is stt_an-al sound,not.leaking and ifa Certificate of a=pliat ce indicating that the tank is less than 20 years old is avail le. ND explain: - Observation of sewage backup or or high sn water level in the distribution box due to.bra or obstr=ed pipes)or due to a broken,seta uneven boa bm system wii pass approval&Board ofi-Iealt): insnec bro P*W� o' etion is removed istraabuden box is le��d or rrp ared ND i lie system required :ping more imm4 6m s a.y=r due m broken or ob cte&ph*s).The system hriil pass inspection if(with ap oval of the Board oftleahh); 'ttioken pipes)are replaced obmuction ii removed- ND explain_ Page 3ofII • • OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESS_ 'v`TS SLTSURFACE SEWAGE DISPOSAL SYSTEM IM'iSPECTION FORM PART A CER T MCATION(continued) Property Address: 1 Q S S' TAo:%V\, S'% lames 'Fry. -1o\e owner. So r v O Date of Inspection: u �'artheY�val�atior, is Re�tiir�by tl�Board ofare2�h: _ Conditions exist which require N-_ther evalumlion by the Board of Health in ord -to determine if the system is failing to protect public health,safety or the envirorhanent- 1. System will pass unless Board of Health determines is accordance h 310 CMR I5-M3(€')(Is}that the system is not ftmcdoniug in a manner which will protect public Itch,safety and the environt t- — Cesspool or privy is within 50 feet of a surface water Cesspool or privy is within 50 feet of a bordering veg wetland or a salt marsh ?_ System will fail unless the Board of Healt and Public Water Supplier,if any)determines that the system is functioning in a manner that Prot the public health,safety and environment: _ The system has a septic m k and it absorption system(SAS)and the SAS is within 100 feet of a surface water_supply or tr?ofata-y to surface water supply. The system has a septic last' and SAS and the SAS is within a Zone I of a public water supply_ The system has a septic 1c and SAS and the SAS is within 50 fit-et of a private water supply-dl_ _ i^e sa-tem has a se ::c tank and SAS and the SAS is'less than 100 fee,but 50 feet or more&o.-d a private water supply w .`_Method used to determine distance 'This system. if the well water analysis,performed at a D�certified laboratory,for colif'or bacteria anti vo organic compounds indicates that the well is free f orn pollution frog that faciI?ry and the presence o€ammoZia nitrogen and nitrate nitrogen is equal to or less than 5 pp-.n,provided that m. other failure criteria are 4 iggered.A copy of the analysis must be attached to this form_ 3. Qther: Y3g£4 or 11 OMV CR INSPECTION i OKMI SU"WACE SEWAGE DISPOSAL SYSTEM ENSPECTtONFORM PART A RTMCATI ION(continued) Property Address. S.S `%h s,, tZS17 ar ha _fie Owner: c V a Date Of l-specua--:- 6" q O D. System Failure Criteria applicable to all systems.* You must indurate llyes"or`no"to each of the fonowing for A moons: Yes No 9C ;3ada:p of sewage into faciiiTy or system component due to overloaded or clogged SAS or c esswel Discbarge or ponding of awent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool K Static li=-d level in the distrib 'on box move outlet invert due to an overloaded or clogged SAS or cesspool Liquid depth in cesspool is less dean 6"below invert or available vuhnne is less than'/z day flow Rimed pumping more than 4 dines Ln-the last year kLOT due to cloaked or obstructed p-Te(s)_Number of tunes pumped k Any portion of the SAS,cesspool or privy is below high ground water elevation- Any portion of cesspool or IS7=vy is widiir• 100'feet of a sm face water supply or tn�tary to a surface water amply Any portion of a cesspool or privy is within a Zone I of a public well. Any portion of a cesspool or privy s within 50 feet of a private water supply well. — Any portion of a cesspool or privy is less fnan 100 feet bun greater than 50 fee:from a private water supply well with no acceptable water quality analysis.[This system passes if the well water analysis, performed at a DE''certified laboratory,for colifom bacteria and volatile organic compoundsindicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate aitrogeu is equal to or less alum 5 ppmm,provided that uo outer failure criteria are triggered_A cs;lay of the analysis must be attached to this fora Ll (YesfN1o)The system fails_I have determined that one or more of the above failure criteria exist as descries in 310 CIvfR 15303,thereffmee the system s o sly ccsuasxrl�Hof Heaetit to determine what will be necessary to correct the fzi.-ha £ Large Systems: To be considered 2 large system the system t serve a&ci€ily with 8 design floes+of 1 -,,td to 15,000 gp - You must'indicate eirlier"yes"or"no" of the folly it g: (The fol-lowing criteria apply to lar ystems in addition w tte criunia.above) res no the systens is wi' ' 400 feet of a stifioe drinking per supply the systeur,is tom.200 feet of a tributary to a stiff drWang water supply — the syste is located in a Hitt open sensi ve area.{Interim Wellhead Protection Area-1A PA)or a mapped Zone Il f a public water supply we l if you have '"yes"to any question in Section E the system is considered a sianif c am threat,or a-rswe.ed "Yes"in Sec an D above the large system ims failed.$he owner or operator, of ar:y large srste,n considered a sigr_ifican? eat ua,der Section E or failed under Section D shah upgrade the system in accordance wife 3I0 trIVM 15304. e sy'stenn owner should contact the appropriate r4oral office of the DetrartMent. 4 \ Page5,of I i • • OFFICLkL RNSPECI'ION FORM—NOT FOR VOLUNTARY ASSESSNMNTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPEC' ON FORM P_ RT B CHECKLIST Property Address: t qssM 6h 1 ©weer: S c a t le Date of Inspection: t (j Check if the following have been done. You trust indurate''ves"or`bo"as to each or the following: Yes No K , Pumpin-information was provided by the owner,oc=nant,or Board of Health X 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 cif this inspection? Were as built plans of the system obtained and examined?(if they were not available note as NIA) X Was the facility or dwelling inspected for signs of sewage back up X Was the site inspected for signs of break out? Were all s rsteni components.excltdizig the SAS,located on site? oot _ Were the septic tank manholes uncovered,opened,and the interior of the tank irspedxed for the condition the fees or tees,material of construction,dimensions,depth of liquid,depth of sludge and depth of scum? Was the facility owner(and occupants if different horn owner)provided with info rnation on the proper mau=_tenance 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. x _ Determined in the field(if any of the fQihre criteria related to Part C is at issue approximation of distance is unacceptable)(310 CvLR 15302(3)(b)l Page 6 of I I • OFFICIAL INSPEJMON FORM—NOTTM V(3LtTqTART A S AMN7S SUBSPACE SEWAGE DISPOSAL SYMMA INSPECTION FORM PARS'C SYSTEM INFORMATION Property Address: }a 5 S o,t V. 5'1 Owner: o r d o 5 ejT o►C vas (e Date 3i in3pewis'n: 5- FLOW CON DI'T'IONS RESIODEN-'1€'f L Number of bewooms(designs): Nmrrber (ice: DESIGN flow based on 3 10 CNiR I52{!3 example: 110 gpd x fi of bedrooms):Number of current residents: Does ice have a garbage (yes or no):Is laundry on a separate sewage (yes or no):— [if yes separate inspection requiredj Laundry system inspects(y or no):_ Seasonal use:(yes or no)- Water meter-readings ' available(Iasi 2 years usage(gpd)): Sump Pump(,Ves 3-_ Last date of occ COMY1ERCIALTq Due Type Of establishraer B,<gA y Design flow used on 3I0 CINM 15.20 ): 1j�!10 and Basis of design flow(seatsilers;o�nsjesgf�otE-)= Grease*.rap pr.:serit(yes or no):_!_�'+i Industrial waste holding tank present(yes or no): VO 0 Non-sanitary waste discharged to the Title 5 system(yes or no):rjo Water meter readings,if available: Last date of occupancytuse: 9 0 0 OVER(describe): _ CENTERAL INFORMATION Pumping Records Source of information- Was system pumped as part of the inspection(yes or no):W 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 Pnvy Shared system(,yes or no)(if yes,attach previous won records,if any) InnOvative/Alterriative technology.Att;x.La copy of the==erit operation md ttitenance contract(to be obtained from system owner) _Tight rank Attach a copy of the DEP approval _Other(describe): Approximate age of all components,date installed(if known)and source of information: a-0 Were sewage odors detected when arriving at the site(yes or no): . rage / vi :t • OFFICE INSPECTION FORM-NOT FOR VOLMNTkRY ASSESSIVMNTS SUBSPACE SEWAGE DISPOSAL SYSTEM INSPECTION F£?RNI PART C SYSTEM INFORAIATION(continued) Property;address: Q 5 5 o f Owner: SOc�d Bate of Inspection: S�ag(oa BUILDING SEVER(locate on site plan) u Depth below made: materiak of construction:jLcast mm 40 PVC_ocher(explain): Distance from private water supply well or suction line: Comments(on condition of Joints,venting,evidence of leakage,etc.): SFIMC TANK:—(lute on site plan) Depth below grade: Material of cons-action: concrete metz berlas$volyethylene oche(explain) _ If tank is metal list age:_ Is age coif ertificate of Corsnpliance fives or rio)_ (attach a copy of certificate) Dimensions: Sludgy depth:_ Disw.ce from top of sludge to otn of outlet ree or baffle: Scum thicicress: Distance from top of scum top of outlet tee or baf;.le: Distance from bottom of urn to bottom of outlet we or baffle: How were dimensions etrniFned: Cortunernts(on pum g recomrnendations,inlet and outlet tee or baffle condition,strucn3al integrity,liquid levels as related to o tle vert,evidence of_leakage,etc.): GREASE'TRAP: (locate on site plat.) Depth below?zade:_ Material of construction:,concrete metal fiberglass polyethylene other (explain): Dimensions: Scum thickn--ss: Distance frorn top of scum to p of outlet tee or baffle: Distance from bottom of s .to bottom of outlet tee or baf le: Date of last punnpia& outlet or baffle condition,strucr,tral integrity,liquid levels Comments(on punnping rnmendations,inlet and as related to outlet inv , evidence of leakage,etc.): rage a 07 E r , OFFICL4L LNSPECTION FORM—NOT 7M VOLUNTARY ASSESSWNI TTTS SUBSURFACE SEWAGE DISPOSAL SYSTEM I SPE4MON I~ORMI PART C SYS'I-lam INFORhLATION{caadmied} Property Address: Ma,t-St (ijes --Rgr Owner- S orve Date of Inspection: gV TIGHT or HOLDING TANK: (tom be pmnped at t Me af m5pec ib�xlocft on site plan) Depth below grade: Material of cartstruction: metal fiberglass polyethylene athet{explain}: Dimensions: CapacitY- gaUem Design Flow: Z::Vons/day Alarm t(yes or no Alarm level: lams m working order(yes or no): Date of last ga�ntg: Canunems(candid of alarm and float switches,etc.): DISTRIBUTION BOX: (if ent must be opened)(locate on site plan) Depth of liquid level abov/etc) t invear. Comments(note if box is lnd distribution to outlets equal,any evidence of solids carryover,any evidence of leakage into or out of bo PUMP CHAI'i B (I a on site plats) Pumps in working order or no): Alarms in working onl Or no): Comments(stole cortdi on of pump chamber,cxm ofpanIPSa etc.}: Page 9 of 11 0 OFFICIAL INSPECTION FO��-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM rNFOR-RATION(continued) Property Address: t Ot 6'5- a t% S`� L, —'tea+isle Owner: n r%lb Date of Inspection. Sot;ABSORP=tON SYSTEM(SAS): (locate on site plan,excavation not rewired) If SAS not located explain why: Type leaching.pits,number- leaching chambers,n4=ber: leaching galleries,number: leaching wenches,number,length: leaching fields,mmnber,dimensions: X overflow cesspool,nwnber irnovativet-alternative System a ypelname of technology: Cotrmnents(note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation, etc.): CESSPOOLS: (cess-looi must be pumped as part of inspection)(locate on site plas-n) Number and configuration: Depth-top of liquid to inlet invert: Depth of solids layer: Depth of scum layer: Dimensions of cesspool: Materia's of construction: Indication of g oundwater inflow(yes or no): Comments(note condition of soil,signs of hydraulic failure,level of pondiag,condition of vegetation,etc_): PRIVY: (locate on site plan) Mat---Ws of constmct o n: Dimensions: Depth of solids: Comments(note condition of soil,signs of hydraulic faihre level of ponriitig,condition of vegetation,etc.): Page 10 of 11 • OFFICIAL INSPEC-11ON FORM—NOT FOR W WUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL-SYS17KM RE9PEMOIN FORM $ART G SYSTEM LNFGRMA'I ION Property Address:. I g a ACI o, d t Owner: ef'VO D2te of b2specdon: Z O SXETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of d-.e sewage disposal system including ties to at least two permanent reference landmarks or benchmarks_Locate all welts within 100 feet-Locate where public water mropiy enters the bm xu o i �l �5 99 7� r d Page 11 of 11 OFFICIAL. INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM L€SPECTION FORD PART C SYSTEM INFORMATION(continued) Property Address: a:iL t Owner: a r 48 Date of inspection .�7&9 10-;?_ SITE EXAM Slope S t ti kT SurrAce water ts� Check cellar W C Wse*eAk Shallow wells .j FS Estimated depth to ground water 26 feet PIease indicate(check)all.methods used.to determine the high ground water elevation: Obtained from system design plans on record-If checked,date of designs plan reviewed: Observed site(abutting propertylobservation hole within 150 feet of SAS) Checked with local Board of Health-explain: Checked with local excavators, installers-(attach documentation) f Accessed LSGS database-explain: You roust describe how you establish d the high ground water elevation: sa SG.s s ,.,��,-,c,�.-�-�e a.� ��a�a'h•�,. 5� � rea�__�4_� t ` � 1 {�. i� t ! } - R� ' � t • +_ f 7 1 ��� �����.� i ,� � I w 1 a a ��� ��� r o . K . - 1 _--- { ACCESS COVER (WATERTIGHT) TO �! MINIMUM .75' OF COVER OVER PRECAST /� WITHIN 6" OF FIN. GRADE t 2" DOUBLE WASHED PEAS r� ry RUN PIPE LEVEL FOR FIRST 2' PROPOSED 1500Ll 7 4.3 0 GALLON SEPTIC �7 4.0 5 - TANK (H- 1 O ) GAS r `- L ''�3.L�1 ' BAFFLE ( 3.5 �oo"oo'c+�s� 0 a o 0 0 a 2 SLOPE) "C> 7 3.00� 0 0 0 0 0 0 ( �6" CRUSHED STONE OR MECHANICAL 0 0 0 0 0 0 4' COMPACTION. (15.221 [21) �0 2' O 0 O a a DEPTH OF FLOW = ( 2 % SLOPE) ( 2 % SLOPE) TEE SIZES: 3/4" TO 1 1/2" DOUBL41 INLET DEPTH = 1 0„ 1 OUTLET DEPTH = 14" FOUNDATION- 20 SEPTIC TANK 24' T D' BOX 20Ile 3.31 v NA] � y BAR L J DWELLING -��76 • At \ C 9 FLOOR=77.7, TH 78 HOP DWG. LOT I AREA=3.23± AC. 00 ti J1 V ✓ Yll Fi JOB �6', i •_ I 1 TEST HOLE LOGS . FIN. FLOOR 77.7't SYSTEM 1 PROFILE ENGINEER: ARNE OJALA ACCESS COVER TO WITHIN 6" OF FIN. GRADE (NOT TO SCALE) 2% SLOPE REQUIRED OVER SYSTEM WITNESS: ED. BARRY locus ACCESS COVER (WATERTIGHT) TO FEB. 9, 1995 /�77± MINIMUM .75' OF COVER OVER PRECAST WITHIN 6" OF FIN. GRADE ACCESS COVER (WATERTIGHT) TO /-74't DATE: WfrHIbI 6- OF FIN. gRADE PERC. RATE = 5 MIN IN. L 2" DOUBLE WASHED PEASTONE C COD ! RUN PIPE LEVEL CLASS ► SOILS P# 8393 c0�> rU ITY ; 74,7' FOR FIRST 2' o 3 MAX. GE PROPOSED 1.500 GALLON SEPTIC 73.05 71.0 73.30 TANK (H- 10 ) �s ELEV. oo� 71.40 DEPTH ELEV. DEPTH BAFFLE or� oo 0 0o0o r� 4 Pag 0 70.17 a o G7 G7 0 0 M o Q" 74.0' 76.0' 4° ° ( 2 x SLOPE) \__6" CRUSHED STONE OR MECHANICAL 0 0 _� (MIN) COMPACTION. (15.221 (23) 2' 41 M O 0 0 0 0 o a CI :A 68.17 TOP TOP .. . DEPTH OF FLOW - 4 ( 2 x SLOPE) ( 2 x SLOPE) $ &SUB LOCUS MAP SCALE 1 = 2000 TEE SIZES: (MIN) (MIN) 3/4" TO 1 1/2" DOUBLE WASHED STONE 36" &SUB INLET DEPTH - 10" 71.0' 36" 73.0' ASSESSORS MAP 216 PARCEL 39-1 OUTLET DEPTH - 14" i 7.17 FINE FINE FLOOD ZONE: C FOUNDATION 20' SEPTIC TANK 24' D' BOX 20' LEACHING LOAMY FACILITY SAND LOAMY � 61.00 84" 67.0' SAND PERC. 5 MIN/INCH MED. COARSE - SAND & GRAVEL SLAB EL. 73.5't SYSTEM 2 PROFILE ACCESS COVER To WITHIN 6" OF FIN. GRADE (NOT TO SCALE) 2x SLOPE REQUIRED OVER SYSTEM 74.0' ACCESS COVER (WATERTIGHT) TO {{{ MINIMUM .75' OF COVER OVER P CAST /� WITHIN 6" OF FlN. GRADE ACCESS COVER (WATERTIGHT) TO �-83't NOTES " OF FIN. GRADE a` RUN PIPE LEVEL 2" DOUBLE WASHED PEASTONE 156" 61.0' 168" 62.0' NGVD 1929 1. DATUM IS �-- FOR FIRST r AVAILABLE * PROP. GREASE PROPOSED 1 500cfl 3 MAX. NO WATER ENC. 2. MUNICIPAL WATER IS TRAP GALLON SEPTIC 70.0' ,aIL4 80.0' ' 3. MINIMUM PIPE PITCH TO BE 1/8" PER FOOT. 70.25 TANK (H- 10 ) GAS 79.50'100o cAl 'CAM Cl C7 f� C] O 0 0 o o SYSTEM 1 4. DESIGN LOADING FOR ALL PRECAST UNITS TO BE AASHO H- 1 H-10 BAFFLE79.67 x PE TONE OR MECHANICAL o 79.17' a 0 0 0 0 (Q o 0 0 0 ( 5. PIPE JOINTS TO BE MADE WATERTIGHT. 7_21SEPTIC DESIGN: GARBAGE DISPOSER Is NOT ALLOWED ) 6. CONSTRUCTION DETAILS TO BE IN ACCORDANCE WITH MASS. i SLOPE) �6' CRUSHED S 0 0 0 0 0 0 0 0 0 COMPACTION. (15.221 (23) 0 2' 0 0 0 0 0 0 0 0 CI o 77.17' DESIGN FLOW: 6_ BEDROOMS (110 GPD) = 660 GPD ENVIRONMENTAL CODE TITLE V. *THE INSTALLER SHALL VERIFY THE DEPTH OF FLOW - 4' ( 2 x SLOPE) ( 2 x SLOPE) �$ USE A660 GPD DESIGN FLOW 7. THIS PLAN IS FOR PROPOSED SEPTIC SYSTEM ONLY AND IS NOT LOCATIONS OF ALL UTILITIES AND ALL TEE SIZES: 3/4" TO 1 1/2" DOUBLE WASHED STONE TO BE USED FOR ANY OTHER PURPOSE. BUILDING SEWER OUTLETS AND ELEVATIONS INLET DEPTH - 10" SEPTIC TANK: 660 GPD ( 2 ) = 1320 8. PIPE FOR SEPTIC SYSTEM & BLDG. SEWER TO 6E SCH. 40-4" PVC. I PRIOR TO INSTALLING ANY PORTION OF OUTLET DEPTH - 14 1500 { 9. COMPONENTS NOT TO BE SACKFILLED OR CONCEALED WITHOUT SEPTIC SYSTEM 16.1 ]' USE A ____ GALLON SEPTIC TANK PROVIDE GRAVITY FLOW PUMP LEACHING LEACHING: INSPECTION BY BOARD OF HEALTH AND PERMISSION OBTAINED TO GREASE TRAP FOUNDATION 10 GT 3 ST 1 CHAMBER 9 D BOX 32 FACILITY 2x136 = 272 S.F. x 0.74 = 201 G/D i SIDES: FROM BOARD OF HEALTH. 10. PUMP & REMOVE (OR FILL W/CLEAN SAND) EXISTING SEPTIC SYSTEM BOTTOM: 620 S.F. x 0.74 = 660 G/D WHICH SERVES MAIN HOUSE ONLY. /le, 61.0' TOTAL: 892 S. x 0.74 = 670 GPD 11. CONTRACTOR TO VERIFY BUILDING SEWER ELEVATION •' � �' 3'• STONE 4 PRIOR TO _INSTALLATION OF SEPTIC SYSTEM,- _ USE (6) 500 GAL AMBERS WITH 12. OBTAIN C,___./SAFE CLEARANCE PRIOR TO ANI�CCAVATION. ON SIDES & 2.5 AT END _ PROP. 1500 GAL. SYSTEM 2 i 'EPTIC TANK \ SEPTIC DESIGN: (GhGE DISPOSER IS NOT ALLOWED ' 3;�A1' c \ \ PROP 1000 GAL RESTAURANT 21 SEATS 035 GPD/SEAT = 700 GPD FLOW \ PUMP CHAMBER KITCHEN FLOW 15 GPD/SEAT = 300 FOR GREASE TRAP 0f - PROP. 1000 GAL. Q�•'/ 0 ` \ GREASE TRAP I SEPTIC TANK:_700 GPD ( 2 ) = 1050 ' r 1 ri 72 USE A 500 GALLON SEPTIC TANK 177r LE 5.' ;�7l Pl��lY � F `cam \ ` I USE A 1 0 GALLON GREASE AP OF 00 R TRAP 1955 MAIN ST. '���/ ��• YST?: , 1 i \ \ - LEACHING: IN TH 7 / BENCHMAk�: NAIL SET E TOWN OF: AT ELEVA-.ON 75.5' SIDES: 152.2 x 2 = 304.42 x:.74 = 225 GPD \ \ - (WEST) BARNSTABLE �/' �\ F?•`1 Pv�s� `�o \ \ BOTTOM: , 688.5 SD FT. x .74 GPD SF = 509.5 GPD : ��• \ 6\ TOTAL: 992.5 S.F. 734.5 GPD PREPARED FOR: PAUL & JENNIFER VECCHI USE (7) 500 GAL CHAMBERS WITH 3 STONE TH O# \;,4 1 ` SQoo`•S \.o \ ON SIDES & 2.5' AT ENDS 20 0 20 40 60 �°�• �� SCALE: � "=2 0'l \ DATE:E: SEPTEMBER cal 20 2/ 0 1 P� \ c'►`i4o�° BARN \LF \ 03 . (slab) \��'/- \ REV. 2/19/04 DWELLING 76 \ \ REV. 4/14/04 FLOOR-77.7' \ 1 � TH#2 \ \ �M of PUMP AND 6 ARNE He REM OJALA EXIST. N��� \\ , '�� SYSTEM 2 't� \\ \ ARNE H. SEPTIC TANK C+ / � VENT � CIVIL / 1 OJALA H No. 30792 4 No,26348 I PROP. 1500 \ GAL. SEPTIC TANK ` Q 78 "', " 5 ALARM AND CONTROL PANEL I �o� `*Q s a�o��`` y c TO BE INSTALLED INSIDE FSS� s} L f PROP. 1000 -- - 84 SEPARATE CIRCUIT FROM PUMP RM TO BE ON INV. IN � » GAL. GREASE TRAP �� 1600 GAL. H-20 T 2 PRESSURE: LINE ARNE H. OJALA, ., � P.L.S. D TE SHOP - 80 700 GAL.+ SLOPE TO ORAIN BACK 70 PC J FLOAT SWITCH ALARM ON RESERVE WEEP HOLE & DWELL bib SETTINGS: PUMP " CHECK VALVE 8" WORKING� 8" ZOELLER "WASTEMATE" e SUBMERSIBLE MODEL M282 1/2 HP PUMP _ 12 SYSTEM (OR EQUAL) 84 90 000000 00 0000 0000 ' I >36 G E N D ago PUMP CHAMBER Q (Nor TO SCALE) 100-01 PROPOSED SPOT ELEVATION LOT 1 AREA-3.23t A 100x0 EXISTING SPOT ELEVATION 100 PROPOSED CONTOUR off 508-362-4541 fox 508 362-9880 - 100 - - EXISTING CONTOUR I cl:� down cape en 1 I P g neering, Inc. . F CIVIL ENGINEERS LAND SURVEYORS 939 main st. Yarmouth, ma 02675 03-099 0404.DWG { I. ' } I , K R TEST HOLE LOGS t I , FIN. FLOOR 77.7't �IYSTEM 1 PROFILE ARNE OJALA ENG!NEER �ou�E fsn �. (NOT To SCALE) r- WITNESS: ED. BARRY s 0 ) LOCUS OC N. GRADE REQUIRED OVER SYSTEM L OF FIN. % SLOPE REQ ACCESS COVER TO WITHIN 6 2 L ACCESS COVER (WATERTIGHT) TO ACCESS COVER (WATERTIGHT) TO 76 t FEB. 9, 1995 . DATE: MINIMUM .75' OF COVER OVER PRECAST WITHIN 6" OF FIN. GRADE �WITHIN OF FIN. GR ADE PERC. R RATE 5 M INI N � ;1 2„ DOUBLE WASHED PEASTONE CLASS 1 SOILSP# 8393 CONMU rrY RUN PIPE LEVEL CO G 74.7' FOR FIRST 2' 3' MAX. /- . PROPOSED 1500 GALLON SEPTIC ! 74.05' 73.83' 0 1� -p-�- ELEV. ' < 7 4:3 , DEPTH H EL EV. TANK (H- 10 ) GAS 73.40 DEPTH BAFFLE 73.57 oc'oc og 0 0 0 0 0 0 F «� 2 Orr Q. 74 0' Q" � 76.0' - Fov,�.e ` d 73.00' o0a0 o ac] c� E� Q - -- ( 2 % SLOPE) �6" CRUSHED STONE OR MECHANIC/i_ 0 0 (� E 0 0 � 0 [� COMPACTION. (15.221 [21) '� ` $ 2' E a a E a E 0 C] C7 0 71.00 TOP TOP t5 _ 4 &SUB LOCUS MAP SCALE 1" = 2000 ' DEPTH OF FLOW - ( 2 % SLOPE) ( 2 % SLOPE) rr 36„ &SUB 71 .a' 3�j" 73.0' I I TEE SIZES: 3/4 TO 1 1/2 DOUBLE WASHED STONE ti INLET DEPTH 10 ASSESSORS MAP 216 PHI�t:EL . 39- 1 x 14 , I OUTLET DEPTH - 1 O FINE LEACHING LOAMY I I FINE FL`�r,� �r ��L, C FOUNDATION 20 SEPTIC TANK 24 D BOX 20 FACILITY SANT" r)A SAND PERC x 61.00 840) 67.0' 5 MI.N,'"-`CH a MED. + COARSE k SAND & I GRAVEL { YSTEM 2 PROFILE } SLAB EL 73: '5 t ACCESS COVER TO WITHIN 6" OF FIN. GRADE (NOT TO SCALE) 2% SLOPE REQUIRED OVER SYSTEM i "' /-- ACCESS COVER (WATERTIGHT) TO WA RTIGHT TO V R T ACCESS COV ER E 74.o cE (WATERTIGHT) 83 t NOTES. MINIMUM .75' OF COVER OVER P CAST WITHIN 6" OF FIN. GRADE /�- I F FIN. GRADE I m r >, , 2" DOUBLE WASHED PEASTONE 156 61 •0 16$ ,- - - RUN PIPE LEVEL 62.0` NGVD 1929 1, DATUM IS FOR FIRST 2' 3' MAX. T AVAILABLE 1 ; PROP. GREASE PROPOSED 1500 a N0 WATER ENC. 2. MUNICIPAL WATER Is A AILABL�, J 80.0' 3. MINIMUM PIPE PITCH TO BE 8" PER FOOT. TRAP GALLON SEPTIC a `TEE 70.0 I 1/ 70.25` 4 4. DESIGN LOADING FOR ALL PRECAST UNITS TO BE AASHO H- '�] 10 1000 GAL. TANK (H- 10 ) / GAS , 79.50' SYSTEM H-10 BAFFLE 79.67 o E E 0 a O 0 C-1 E C] og .5. PIPE JOINTS TO BE MADE WATERTIGHT: a 79.17 C3 M E E CD 0 E O C] SEPTIC DESIGN: (GARBAGE DISPOSER Is NOT ALLOWED 6. CONSTRUCTION DETAILS TO BE IN ACCORDANCE WITH MASS. j ( % SLOPE) �6" CRUSHED COMPACTION, S15 2210R2 jECHANIC�L_ g© r 0 0 CO E a 0 C� C7 G 6_ - ENVIRONMENTAL CODE TITILE V. 4' COM ( [ ] 2 [� a C7 C� C7 M� (� C7 0 77.1 7 DESIGN FLOW: _ BEDROOMS (110 GPD) - 660 GPD *THE INSTALLER SHALL VERIFY THE DEPTH OF FLOW ( 2 % SLOPE) 2 % SLOPE)"" g' USE A660 GPD DESIGN FLOW 7. THIS PLAN IS FOR PROPOSED SEPTIC SYSTEM ONLY AND IS NOT TO BE . USED FOR ANY OTHER P;JRPOSE. LOCATIONS OF ALL UTILITIES AND ALL TEE SIZES: 3/4" TO 1 1/2" DOUBLE WASHED STONE SEPTIC TANK: 660 GPD ( 2 ) = 1320 ` BUILDING SEWER OUTLETS AND ELEVATIONS INLET DEPTH = 10" SEWER TO BE 5CH. 40-4" PVC. I Z3. PIPE FOR SEPTIC SYSTEM: & BLDG. SE PRIOR TO INSTALLING AN71' PORTION OF OUTLET DEPTH = 1400 USE A 1500_ GALLON SEPTIC TANK 9. COMPONENTS NOT TO BE BACKFILLED DR CONCEALED WITHOUT SEPTIC SYSTEM 116.17' PROVIDE GRAVITY FLOW PUMP 95' D' BOX 32� LEACHING LEACHING: INSPECTION BY BOARD OF HEALTH AND PERMISSION OBTAINED c FOUNDATION- 10' GT 3' ST 1' OM BOARD OF HEALTH. ` CHAMBER FACILITY 2x 136 272 S.F.S.F: x 0.74 = 201 G/D , TO G` EASE TRAP SIDES: 10. PUMP & REMOVE (OR. FILL W/CLEAN SAND) EXISTING SEPTIC SYSTEM BOTTOM: S.F. x 0.741• = 660 G/D 620 WHICH SERVES MAIN HOUSE ONLY. 1 1 . C ONTRACT:)R TO VERIFY 9UILDING a�`SEER ELEVATION I i 6 1.01 TOTAL: $92 S.F. x 0.74 = 670 GPD PRIOR TO 'NSTALI_.ATION OF SEPT"- USE 1 -" i 1f g�R 'WITH 3' STONE_: ,6)�50C GAL. CRAM S rt Oti SIDES ?� AT ENDS 2.5, , , s PROP. 1500 GAL SYS 1 EM 1 \ \ SEPTIC TANK \ SEPTIC DESIGN: (GARBAGE DISPOSER Is NOT ALLOWED ) /. � \ � GPD/SEAT SEAT = 700 GPD FLOW , a s I _ / i�-o 33.3; c \ \ PROP 1000 GAL RESTAURANT 21 SEATS 35 C / ,o ` \ PUMP CHAMBER KITCHEN FLOW 15` GPD/SEAT = 300 FOR GREASE TRAP \ cad0f ,. �° `\ '.\\ PROP. 10000 GAL. SEPTIC TANK: 7�0 GPD ( 2 ) i050 \ .i - GREASE T 0 \ 5 SITE -PLA11'1� ��,� \ \ - - USE A 15_Q GALLON SEPTIC TANK i `Ci \ \ USE A 1000 GALLON GREASE TRAP OF 1955 MAIN ST. SYSTEM 1 ` LEACHING: I V10. / \ \ BENCHMARK. NAIL SET IN THE TOWN OF: 152.2 x 2 = 304.42 x.74 -•- 225 GPD 1 W EST BAR N STA B L.E AT ELEVATION 75.5' SIDES: BOTTOM: 688.5 SO FT. x .74 GPD/SF = 509.5 GPD \ PREPARED FOR: gyp, \ TOTAL: 992.5 S.F. 734.5GPD PAUL & JENNIFER VECCHI `I \ USE (7) 500 GAL CHAMBERS WITH 3 STONE 0 20 40 60 ` 20 H#� l / \\,o\\ ON SIDES & 2.5 AT ENDS SCALE: 1 =20 DATE: SEPTEMBER 20, 2003 �� \ 4o a BARN I "76 slab DWELLING 1 \ TH 2 \ FLOOR=77.7' # \ \ PUMP AND ��`�� \ 1 �- _ "1 SYSTEM 2 REMOVE EXIST. SEPTIC TANK PROP. 1500 GAL. SEPTIC TANK­ PROP, _ - \ ARNE .H. OJA.,-A, P.E., P.I.S. DATE i I PROP. 1000 -� _ _ _...- 84 h SAL. GREASE T' JJ SHOP - �o --- LEGEND i & DWELL 8 �. N T ELEVATION 100.0 PROPOSED SPOT ELE cb Op 0.1 100x0 EXISTING SPOT ELEVATION 90 100 8 �> 09 0 .Co PROPOSED CONTOUR n - - 100 -- - EXISTING CONTOUR I a LOT 1 AREA=3.23t A i off 508-362-4541 fax 508 362-98W 4� down cape engineering, ine. �� f� CIVIL ENGINEERS - ' LAND SURVEYORS �j .939 main st. Yarmouth, ma 02675 c� i 9 s-099 i TEST HOLE LOGS FIN R 77.3 t FLOOR SYSTEM 1 PROFILE ENGINEER: ARNE OJALA A gpU'iE s .., ACCESS COVER TO WITHIN 6" OF FIN. GRADE (NOT TO SCALE) 27 SLOPE REQUIRED OVER SYSTEM ED. BARRY WITNESS. LOCUS V (WATERTIGHT) T0 ACCESS COVER ERTI E w G ( , . FEB. 1995 ACCESS COVER WATERTIGHT 70 AT 77t (WATERTIGHT) DATE: � MINIMUM .75 OF COVER OVER PRECAST 74 t � WITHIN 6" OF FIN. GRADE R WITHIN FFN. GADE PERC. RATE = 5 MIN11N. r� RUN PIPE LEVEL 2 DOUBLE WASHED PEASTONE C COD I , 8393 CLASS I P v rrY SO L o 74.7 FOR FIRST 2' A S ,� C CO GE PROPOSED 1500 3 MAX. ` _ GALLON SEPTIC 73.05 71.0 73.3 TANK H- 1O ( ) GAS 71,40ELEV DEPTH ELEV. BAFFLE 71 .57 ��" [� 0 M 0 O C7 M CO C7 1 DEPTH 2 " 10:0.177 a [� [� [� o [� [� [� CI 0„ 74 0' 0„ 76.0' U1Ee 2 % SLOPE TON OR MECHANICAL H S E 6 CRUS ED _MPACTION. 15.22 2 CO ) ,t ](MIN) ( 2 [� [� Cl [� [� C7 C7 [� [� A 68.17 TOP TOP DEPTH OF FLOW ( 2 SLOPE) ( 2 % SLOPE) LOCUS MAP SCALE 1" = 2000' TEE SIZES: (MIN) MIN 36' &SUB &SUB �• ) 4 TO 1 1 L WASHED STONE ( ) ( 3 2 DOUB E 71 .0 7 1 3.= 0 0 INLET DEPTH 14„ 36 ASSESSORS MAP 216 PARCEL 39-1 OUTLET DEPTH - 7.17 { FINE FLOOD ZONE: C FOUNDATION--- 20' SEPTIC TANK 24' D' BOX 20' LEACHING LOAMY FINE FACILITY SAND LOAMY 1 SAND 61.00 84" 67.0' PERC. 5 MIN/INCH MED. COARSE SAND & GRAVEL SYSTEM 2 PROFILE _ SLAB EL. 72.6't ACCESS COVER TO WITHIN 6" OF FIN. GRADE (NOT TO SCALE) 74 2% SLOPE REQUIRED OVER SYSTEM 74,0' ACCESS COVER (WATERTIGHT) TO JJ" �" WITHIN 6" OF FIN. GRADE ACCESS COVER (WATERTIGHT) TO 83'tWITHIN 6" NOTE MINIMUM .75' OF COVER OVER P CAST F FIN. GRADE m RUN PIPE LEVEL 2" DOUBLE WASHED PEASTONE 1 . DATUM IS Q FOR FIRST 2' 3' MAX. 156' 61.0' 168 62.0' N G VI) 1929 PROP. GREASE PROPOSED 1500 a1 NO WATER EMC. 2. MUNICIPAL WATER IS AVAILABLE TRAP GALLON SEPTIC 70 0' TEE $Q,0' 3. MINIMUM .PIPE PITCH TO BE 1/8" PER FOOT. 1000 GAL. 70.25' TANK (H- 10 ) GAS 79.50' H-10 BAFFLE 79.67' �"� 0 0 [� M O a a o a SYSTEM 1 4. DESIGN LOADING FOR ALL PRECAST UNITS TO BE AASHO H- 10 79.17' p C] 0 0 p Q [.' Q 5. PIPE JOINTS TO BE MADE WATERTIGHT. ( % SLOPE) \____6" CRUSHED STONE OR MECHANICAL [� M = = C3 O C3 0 C7 SEPTIC DESIGN: (GARBAGE olsPosER Is NOT ALLOWED ) 6. CONSTRUCTION DETAILS TO BE IN ACCORDANCE WITH MASS. 4 COMPACTION. (15.221 t2]) 0 2' p p p p a a I� [� 0 77,17' DESIGN FLOW: 6_ BEDROOMS (110 ]GPD) = 660 GPD ENVIRONMENTAL CODE TITLE V. *THE INSTALLER SHALL VERIFY THE DEPTH OF FLOW = 2 % SLOPE 2 % SLOPE) LOCATIONS OF ALL UTILITIES AND ALL TEE SIZES: ( ) ( ,� USE A66 GGPD DESIGN FLOW 7:' THIS PLAN IS FOR PROPOSED SEPTIC SYSTEM ONLY AND IS NOT BUILDING SEWER OUTLETS AND ELEVATIONS INLET DEPTH = 10 ,. 3/4 TO 1 1/2 DOUBLE WASHED STONE TO BE USED FOR ANY OTHER PURPOSE. SEPTIC TANK: 660 GPD ( 2 ) = 13520 8. PIPE FOR SEPTIC SYSTEM & BLDG. SEWER TO BE SCH. 40-4" PVC. PRIOR TO INSTALLING ANY PORTION OF 14 OUTLET DEPTH 16.1 7 USE A SEPTIC SYSTEM ' 1500 GALLON SEPTIC TANK 9. COMPONENTS NOT TO BE BACKFILLED OR CONCEALED WITHOUT INSPECTION BY BOARD OF HEALTH AND PERMISSION OBTAINED PROVIDE GRAVITY FLOW PUMP � LEACHING LEACHING: ; TO GREASE TRAP FOUNDATION-- 10 GT 3 ST 1 CHAMBER 95 D BOX 32 FACILITY 2x136 = 272 S.F. x 0.7�4 = 201 G/D FROM BOARD OF HEALTH. SIDES: 10. PUMP & REMOVE (OR FILL W/CLEAN SAND) EXISTING SEPTIC SYSTEM BOTTOM: 620 S.F. x 0.74 = 660 G/D . WHICH SERVES MAIN HOUSE ONLY. c 61.0' , { 11. CONTRACTOR TO VERIFY BUILDING SEWER ELEVATION TOTAL: 892 S.F. x. 0.74 670 GPD PRIOR TO INSTALLATION OF SEPTIC SYSTEM:' 500 GAL CHAMBERS 11VITH .3' STONE 12. OBTAIN DIG SAFE CLEARANCE PRIOR TO ANY EXCAVATION. .USE 6 , SIDES & 2.5 AT .ENDS _. \ \ PROP. 1500 GAL SEPTIC TANK ,< SYSTEM 2 i i \ SEPTIC DESIGN: (GARBAGE DISPOSER Is NOT ALLOWED 7'I \ \ PROP 1000 GAL i `G \ PUMP CHAMBER RESTAURANT 21 SEATS @ 35 GPD/SEAT = 700 GPD FLOW KITCHEN FLOW 15 GPD/SEAT = 300 FOR GREASE TRAP O \ / 0f PROP, 1000 GAL. _� \ GREASE TRAP SEPTIC TANK: 700 GPD ( 2 ) = 105(0 2 \1� 1 �\ \\ I' USE A 1500 T 5 Sl l.G PL!`il� . \ /''f 2`i, `Cp \ \ ____ GALLON SEPTIC TANK USE A 1000 GALLON GREASE TRAP OF \ 1955 MAIN ST. jo. YSTEM 1 LEACHING: I, BENCHMARK: NAIL SET IN THE TOWN OF: `5A ro \ \ AT ELEVATION 75.5' SIDES: 152.2 x 2 = 304.42 x.7�4 = 225 GPD BOTTOM: 688.5 SO FT. x .74 GPD/SF = 509.5 GPD ( WEST) BAR N STAB LE 00' \ \ TOTAL: S.F. 734.5 GPD PREPARED FOR: 76 992.5 PAUL & JENNIFER VECCHI j TH �O. � �, lF/ \ \ USE (7) 500 GAL CHAMBERS WITH 3' STONE � S * \ 1 ° \9 \ ON SIDES & 2.5' AT ENDS 20 0 20 40 60 1 �c� t`i \��i\\ SCALE: 1 »=20' DATE: SEPTEMBER 20, 2003 � BARN \LF \ ' \�9 REV. 2/19/04 BENCHMARK: GAS GATE 76 (slab) .� \ DWELLING \ \ \ REV. 4 14 04 AT ELEVATION 74.9 FLOOR= 77.3' \ / / TH#2 \ 9cn \ 1 \ \\ BENCHMARK: STK. SET; REMovE Exlsr. ���� 1 --- - SYSTEM 2 ti0 \ \ AT ELEVATION 85.3' SEPTIC TANK VENT \ \ �ZK OF ygSsq PROP. 1500 1 GAL. SEPTIC TANK \ 7$ E y�N to ALARM AND CONTROL PANEL -+ _ - _ -- -, TO BE INSTALLED INSIDE PROP. 1000 FLOOR= 77.9' `- - - BUILDING. ALARM TO BE ON 2„ PRESSURE LIME ARNE Pow®ETA ,L P.L. f-DA--TE GAL. GREASE TRAP 84 INV. IN SEPARATE CIRCUIT FROM PUMP 1500 GAL. H-20 /T SHOP - 80 700 RESERVE+ WEEP PHOLE DRAIN BACK TO PC tcs SJp�AI EN ALARM ON FLOAT SWITCH & DWELL $� SETTINGS: PUMP ON CHECK VALVE s" WORKING RANGE 8" ZOELLER "WAS?EMATE" 00 6" SUBMERSIBLE MODEL M282 1/2 HP PUMP' 84 N�1 ' PUMP OFF 12" SYSTEM (OR ]EQUAL) $h 90 � Q00000 �c000 DODO DODO a$ PUMP CHAMBER LEGEND i 90 O (NOT TO SCALE) 100.0 PROPOSED SPOT ELEVATION LOT 1 O I AREA=3.23t AC 100x0 EXISTING SPOT ELEVATION 100 PROPOSED CONTOUR off 508-362-4541 C> fax 508 362-98W 100 - -- EXISTING CONTOUR i c� down cape en gin eering, inc. ^+ CIVIL ENGINEERS 10 LAND SURVEYORS 939 main st. armouth ma 02675 cS` Y 03-099 0404.DWG i 1955 Main Street W. Barnstable/Ojala i i t- TOWN OF BARNSTABLE Bpi TH E raw ��P ♦� OFFICE OF ` = BA"STAHL i BOARD OF HEALTH NAM � �p 1639. \� 367 MAIN STREET HYANNIS, MASS.02601 March 30, 1995 Andrew Ojala 1955 Main Street West Barnstable, MA 02668 RE: Food Establishment/1955 Main Street, W. Barnstable Dear Mr. Ojala: You are granted temporary variances to utilize the existing septic system and to utilize the existing toilet facility for the operation of a food establishment at 1955 Main Street, West Barnstable. The temporary variances granted are as follows: Regulation#10 Plumbing To utilize the existing septic system without an inground grease trap as required. Regulation#11 Toilet Facilities To utilize the existing restroom in lieu of required separate male and female toilet facilities for male and female patrons which are conveniently located for the customers. The variances are granted with the following conditions: (1) These variances expire on December 31, 1995. An inground grease trap and two separate toilet facilities for patrons shall be provided prior to opening for business in 1996. A food permit will not be issued for 1996 until after the toilet facilities and grease trap are provided. (2) Prior to opening for business for 1995, the existing cesspool shall be converted into a grease trap by constructing the required inlet and outlet tees in the cesspool. This conversion work shall be conducted by a. licensedinstaller after he/she obtains a disposal works construction permit from the Health Division Office. ojala55 i "1 3 This variance decision letter shall be posted on the wall adjacent to the ( ) P l food permit in an area which is easily accessible to be read by a health inspector anytime routine inspections are conducted. (4) This variance is not transferable to anyone other than the applicant and may be revoked anytime unsanitary conditions are observed. These variances are granted because the applicant testified that he will install a 1,000 gallon grease trap and additional bathrooms prior to opening the food establishment in 1996. At this time, the applicant testified that he does not possess sufficient funds to complete the required work. Sincerely yours, oseph C. Snow, M.D. Acting Chairman BOARD OF HEALTH TOWN OF BARNSTABLE cc: Jerry Dunning • I ojala55 I i NO. o`T v TOWN OF BARNSTABLE DATE x-e 6 . Z �f OFFICE OF FEE 'a"'TIn BOARS RRUNECEIVED OF HEALTH I ED BY 367 MAIN STREET HYANNIS.MASS.02601 VARIANCE REQUEST FORM i ALL VARIANCES MUST BE SUBMITTED FIFTEEN (15) DAYS PRIOR TO THE SCHEDULED BOARD OF HEALTH MEETING. NAME OF APPLICANT ,4/l)-#,9 TEL. NO. — /L ADDRESS OF APPLICANT /?!ZE /YA//(J 57 (U ' &Ig l� (�c /P"- NAME OF OWNER OF PROPERTY&j-�2&-!1 j�- SUBDIVISION NAME DATE APPROVED ASSESSORS MAP AND PARCEL NUMBER oZ��p /-07— LOCATION OF REQUEST l 5 SIZE OF LOT .1�6' - WETLANDS WITHIN 200 FT.YES VARIANCE FROM REGULATION(List Regulation) OrPa sg. NO fi�� REASON FOR VARIANCE(May attach if more space is needed) &a e'? rr7U'-2-e y PLAN - FOUR COPIES OF PLAN MUST BE SUBMITTED CLEARLY OUTLINING VARIANCE REQUEST. VARIANCE APPROVED ' NOT APPROVED REASON FOR DISAPPROVAL BRIAN R. GRADY, R.S. , CHAIRMAN SUSAN G. RASK, R.S. JOSEPH C. SNOW, M.D. BOARD OF HEALTH TOWN OF BARNSTABLE L � TOWN OF BARNSTABLE VARIANCE REQUEST I am requesting a temporary variance (6 months) to operate a foodservice establishment without an in-ground grease trap and with only one restroom for the public. I have obtained plans, which are on record with the Board of Health, which show the required septic system upgrades which I will have constructed in the Fall of this year, bringing the systems to full compliance. Both the kitchen and dining room systems have existing in-line grease traps which are cleaned regularly. Both systems will be completely removed and replaced with Title V systems in the Fall of this year. Both systems will be pumped dry at the beginning and end of the season. My reasons for the variance request are as follows: Due to heavy expenses accrued in opening the restaurant (inventory, repairs, new equipment and appliances) I will not have the funds needed to construct the systems and restrooms. Lacking a current financial track record I would be unable to obtain financing from other sources to perform the work. The systems are currently well-functioning, and will ultimately be replaced, so that in the unlikely event the systems are damaged by grease it will not matter. Nj Ill►. Mwii Or UAHNSTABLE a/ iPUA 1F,�.� orrlcE or FE fA�t1111L� ! BOARD OF HE 04h 1-1 F0 BY Pon ^ --- --- - ^�� ieJ9 �r 361 MAIN SUIEET OCT 6 1��J 7/ �ti ref IIYANNI3,MASS.026 It- ��� /l VARIANCE REQUEST FO ` ALL VARIANCES MUST BE `lU111 4TTTFD F.IEEN 1 )5 DAYB PRIOR TO _-.__.FT_._—L— '1•ill; 'SCHl;i)11111;D 1101\II1) OF iII;AL'I'll MEETING. NAME OF APPLICANTS M. NO. ADDRESS OF APPLICANT NAME OF OWNER OF PROPERTY ��,y LIJ SUBDIVISION NAME DATE APPROVED ASSESSORS MAP Alit) PARCEL NUMBER 2 /(o — © 37 — J LOCATION OF REQUEST_ / 9 5 S Mh 1/j S SIZE OF LOT SQ.FT WETLANDS WITHIN 200 FT.YES NO VARIANCH FROM REGULATION(Ust Regulation) SX TENS I\j y t- VIP,/,IlvC REASON FOR VARIANCE(May attach if more space is needed) PLAN - FOUR COPIES OF PLAN MUST 13B SUBMITTED CLEARLY OUTLINING VARIANCE REQUEST. VARIANCE APPROVED ' NOT° APPROVED REASON FOR DISAPPROVAL BRIAN R. GRADY, R.B. , C11AIRMAN SUSAN G. RASRr R.S. .,JOSBP11 C. SNOW, M.D. HOARD OF REALTR TOHN OF BARNSTABLS f OJALA FARM RESTAURANT Schedule for Proposed Phasing of Compliance Due to the intricacy of the overlapping uses of the separate buildings and septic disposal facilities and utility services, a complete upgrade in one phase of construction for buildings, disposal systems, new utilities, park- ing and surface drainage, plumbing fixtures and landscaping would be so costly as to necessitate institutional financing far beyond the repayment capabilities of both the owner (Martha E. Ojala) and the proprietor (Andrew Z. Ojala). As the proprietor is not the owner of the property and this cannot be for family reasons, the business has no collateral to obtain such financing and must approach construction of the required structures as funds become available. Further difficulties are apparent, in that the small capacity of the lunch- room dictates the amount of business, and one season of operation indi- cates that full compliance by the end of the 1996 season would be very difficult--if not impossible. Ojala Farm has been a favorite spot to many for a great number of years. The business has always generated enough revenue to pay the property taxes and provided a livelihood for family members. We wish to continue as we always have--paying as we go--and not attempt to increase the size of our operation so as to endanger our business and financial security. PHASE I In-ground grease traps for restaurant and bakeshop systems. Title V upgrade for main house system. PHASE R Handicapped-accessible restrooms for the public in the restaurant. NOTE Additions to the building require compliance with the Zoning Board of Appeals, Old Kings Highway Historic, and Engineering regulations. This will mean substantial expense for planning and construction of parking and site surface drainage. i 1 I �1 r I I]� 1 OJALA FARM RESTAURANT Schedule for Proposed Phasing of Compliance Due to the intricacy of the overlapping uses of the separate buildings and septic disposal facilities and utility services, a complete upgrade in one phase of construction for buildings, disposal systems, new utilities, park- ing and surface drainage, plumbing fixtures and landscaping would be so costly as to necessitate institutional financing far beyond the repayment capabilities of both the owner (Martha E. Ojala) and the proprietor (Andrew Z. Ojala). As the proprietor is not the owner of the property and this cannot be for family reasons, the business has no collateral to obtain such financing and must approach construction of the required structures as funds become available. Further difficulties are apparent, in that the small capacity of the lunch- room dictates the amount of business, and one season of operation indi- cates that full compliance by the end of the 1996 season would be very difficult--if not impossible. Ojala Farm has been a favorite spot to many for a great number of years. The business has always generated enough revenue to pay the property taxes and provided a livelihood for family members. We wish to continue as we always have--paying as we go--and not attempt to increase the size of our operation so as to endanger our business and financial security. PHASE I In-ground grease traps for restaurant and bakeshop systems. Title V upgrade for main house system. PHASE H Handicapped-accessible restrooms for the public in the restaurant. NOTE Additions to the building require compliance with the Zoning Board of Appeals, Old Kings Highway Historic, and Engineering regulations. 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