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HomeMy WebLinkAbout2261 MAIN ST./RTE 6A(W.BARN.) - Health 2261 MAIN ST/RT 6A, W. BARNSTABLE A= 237-034. 001 w �. r � No. 4210 1/3 BLU [mg0sm ESSELTE 10% O O 0 0 No. W- 'S-3 Fee Zme THt COMMONWEALTH OF MASSACHUSETTS Entered in computer: Ye PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS 01ppYication for Mtopooa.Y Opotem Conotruction Permit Application for a Permit to Construct( . )Repair( )Upgrade&,J'bandon( ) ❑Complete System ❑Individual Components Location Address o �� , Owner's Name,Address and Tel.No. Assessor's Map/Parcel ��� 2Z(O 1 S 02(U 660 Installer's Name,Address,and Tel.No. ' � 5_�qC�2 Designer's Name,Address and Tel.No. �9 3�l 3n;q pkm 60WRWM?OR IA16 J SOET EAlG/�7�1Ak,' 70 7 /��-60X '7 2 S P-v 0 7/3 Type of Building: ,�`�, Dwelling No.of Bedrooms Lot Size 3�4v3 sq.ft. Garbage Grinder(VX�1 Other Type of Building Res No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow 33d gallons per day. Calculated daily flow gallons. Plan Date /31 D_ Number of sheets f _Revision Date D Title Size of Septic Tank CX/ Type of S.A.S. Description of Soil; A7 7 S&WD 7 0.0 c 1) Nature of Repairs or Alterations(Answer when applicable). fieL /D-/5"u 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 provisi of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been'ss b thi d of e MSigne Date Application Appro Date 0 L Application Disapproved for the following reasons w Permit No. Date Issued 1 d h- No. C'YS-��� ; ., .. � � ,� �+; � Fee f 00 f i Entered in computer: f TH: COMIIIONWEALTH OF MASSACHUSETTS Ye PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLES MASSACHUSETTS 2pplication for ;Mfgpo.oar *pgtem Construction 3permit Application for-a Permit to Construct*( )Repair( Upgrade 4/<Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. Owner's Name,Address and Tel.No. a.g/ 6 r �� �� Br i�l s �t� -AOV/' 1�& Assessor's Map/Parcel �-� a3 oar „ls� oaro� Installer's Name,Address,and Tel:No. Designer's Name,Address and Tel.No. rj 9rj�3�a� pkn� cowrr� 7v�� /plc 50� 5-�9�3 ,EA16;INEEA11n/G C)" P6.60)c 7?S' P.O. 0 7/3 51 1 EA1 Aj/5 rng 6 c)4o l So, QFAALL /YJIq 0, (2&6 0 Type of Building: Dwelling , No.of Bedrooms .� Lot Size _3�, 4a3 sq.I Garbage Grinder(PO Other Type of Building Re's No.of Persons Showers( ) Cafeteria( ) / Other Fixtures r Design Flow 330 1 gallons per day. Calculated daily flow gallons. Plan Date 0 1 3/0 Number of sheets Revision Date 61 IF%"?a.If Title , Size of Septic Tank /000 (CXlST1/y4 ) Type of S.A.S.�A'��/</>< �/ I�iJF/L7df'�,� ✓� Description of Soil; LDAM 7 'WND 7 Ord SAti Ll) d Nature of Repairs or.Alterations(Answer when applicable) kEz2 I- •f3/)X f n/�/✓1/�r t f •1 o-�a �� s � �,/ 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 provisr ns of Title 5 of the Environmental Code and not to place the system in operation until a Certify-, cate of Compliance has been b this1B azd of Heald Signed (�� Date Application Apprc by Date I 0 Application Disapproved for the following reasons _ r Permit No. 900 5 5 '3 Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS r Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed( )Repaired( )Upgraded Abandoned( )by pll�m OMIT", R-s /k/C y at - l /t"l. f� has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No.0-00 Jr'53 tdated_ Installer, :.' !; ('Or�l7IZ C77��S, /�l/G• Designer f s ' l /V The issuance of this permit shall,not�b�e con Are as a guazantee that the system will ls ction as=delign�d. Date 1100 Inspector v 3-� THE COMMONWEALTH OF MASSACHUSETTS ' PUBLIC HEALTH DIVISION - BARNSTABLES MASSACHUSETTS '. )Diopooal 6p.5tem Con0tructfon 4erntit Permission is hereby granted to Construct( )Repair( )Upgrade([i)<bando. ( ) System located at r`�r.0 69/ Rr to/9 0=e21% F 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 co/mple/ted within three years of the datQby �'Spe - Date: / /rJ � --a Approved �+ r� FROM. :Sweetser Engineering FAX NO. :-506 398 3063 Jun. 20 2006 02:49PM P2 Town of Barnstable Regulatory Services 'Thomas F. Geiler•, Director Public Health Division Thomas McKean,Director 200 Main Street.Hyannis,MA 02601 Office: 509-867..-46J44 Fax: 508-790-6304 Installer&ne%ieiter Certification Form Date; ��/�D 6 a weii F c—_5 c:2 E Installer: I�'.le, /71 • p e*vs . Designer: Gr �� ��,y/tG-...._ ..... � rn C Address: o�`'_�2�t,.Gv�srEititc__T .__ Address: -.. . Oil septic system at Gt S (1 0! W watt issued a permit to install a date (installer) �y� 9�i� �based on a design drawn by . (address) . 1..4ftzq5 i2._5 dated_.....�lO (designer) CC 1 certify that the septic system-referenced above was insi.alled substantially according to the design, which may include minor approved changes such as lateral relocation of the di.;tribution box and/or septic tank. I certify that the septic: system referenced above was installed with ma'or changes (i.e. greater than 10' lateral relocation the SAS or any vertical relocation of any component of the septic system) but.in accor a cc with State & Local Regulations. Plan revision or _ certified as-built by designer to ll(i'w. r. �H OF A044 NJ DUMAS c (installer's Signature) ~r No.619GISTS ,l �. • S. _ s'tNf Att'� (Designer's Signature) (Affix lies rmp Here) PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DMSION. CERTIFICATE OF COMPLIANCY WILL NOT RF ISSUED UNTIL BOTH THIS FORM AND AS. BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBT JC HEALTH DIVISION. THANK YOU. Q:Health/Septich)esigner Certification Fnrm FROM :Sweetser Engineering FAX NO. :508 398 3063 - May. 11 2006 09:54AM P2 'T Town of Barnstable I t Public Health lAvision 200 Main Street Hyannis, MA 02601 Notice: This Form Is To He Used For.the Repair Of Failed Septic Systems Only PERCOLATION TEST AND SOIL EVALUATION EXEMPTION FORM 1, Robin W. Wilcox_ _ hereby certify that the engineered plan signed by me revised June 22, 2005 dated June 3, 2005 ,concetning the property located at 2261. .Route 6A West Barnstable -- _ meets all of the following criteria: A soil evaluations excavated for detailed examination(no hand augering) ands A percolation tests shall be conducted_ • This failed system is connected to a residential dwelling only. There are no commercial or business uses associated with the dwelling. • The soil is classified as CLASS I and the percolation rate is less than or equal to 5 .minuted per inch. • There is no increase in flow and/or change in use proposed • There are no variances requested or needed, • The bottom of the proposed leaching facility will be located no less than five feet above the maximum adjusted groundwater table elevation. [Adjust the groundwater table using the Frimptor method when applicable) Please complete the following: A) Top of Ground Surface Elevation(using GIS information) 'Coo 13) G.W.Elevation ZO . + adjustment for high G.W. = Z DIFFERENCE BETWEEN A and B � SIGNED 4,_ DATE: NOTICE -- Based upon the above information, a repair permit will be issued for bedrooms maximum. No additional bedrooms are authorized in the future without engineered septic system plans. gASeptfc\percexemp,doc SWEETSER ENGINEERING P.O. BOX 713—SOUTH DENNIS —MASSACHUSETTS 02660 TEL (508) 398-3922 FAX (508) 398-3063 LAND SURVEYING—ENGINEERING—TITLE 5 SEPTIC SYSTEMS SEPTIC DESIGN PROPOSAL PAGE 2 PROPERTY SURVEY AND FLOOR PLAN SKETCH Please fill out this form,including the floor plan sketch,and return to us with the signed proposal and retainer. This information is necessary to properly prepare your Septic System Design. IF YOU ARE PLANNING AN ADDTIION PLEASE INCLUDE THAT INFORMATION ALONG.WITH THE FOUNDATION DIMENSIONS AND LOCATION FOR THE NEW ADDITION. / Total#of Rooms " Year Round Home Seasonal Home ,VO/caner Occupied Rental `� Room/Den `/ Livin Room Dining Room L #Bathrooms 3—#Bedrooms Family Roo g g �/Washer/Dryer Dishwasher Garbage Disposal ✓ Gas Service Town Water In-ground Electric Wires* In-Ground Oil Tank* In-ground Sprinkler* C"/In-ground Gas Pipes* * Please note on sketch where located. Sweetser Engineering assumes no responsibility if in-ground co ponents are damaged during Soil Testings, Inspections, Locations of and/or Installation of New Septic System. �Q Cellar: Full Partial (Crawl) V Slab Wells: Main Use Irrigation Only (please provide location of all wells) dfj PLEASE USE THE SPACE BELOW AND THE BACK OF THIS SHEET TO PROVIDE US WITH A ROUGH SKETCH OF THE EXISTING FLOOR PLAN(ALL FLOORS). Also include any items that should be avoided,IF FEASIBLE,i.e.shrubs, trees,patios,electric lines,tanks,etc. IF YOU ARE PLANNING AN ADDITION,PLEASE PROVIDE THE LOCATIONAND FOUNDATION DIMENSIONS. 116 ✓��fig (fed 'awe? Liu Rrn Bed aq 31 t S r c, f f<[)N�N�—W` TH- OF M- ASSACHUSE 71 EXECUTIVE OFFICE OF ENVIROIN-4IE,\-T AFF_A-1RS DEPAR.TYJIF-.NT OF ENVIRONMENTAL PROTECTION TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM FARE`A CERTIFICATION V.� . '1"` Al Property Address: L i P1&; S-If w Owner's Name: r ���"t`�'._,tlt Q Owner's Address: a�t,rcame1 .2; reef, Date of inspection: Name of inspector: tease print) ���� Company Name: tL mQK'�.� r✓ts f►e�TLO ce,� I/`�� r / V Maifiitg Address: J �e Oabqt ilki\194r Tetepoae Number. t�Act--7 d��-37' CEJ TIFICATION STA MENT 00 h l� Y eertify that I have personally inspected the sewage disposal system at this address and that the information reparted below is-true,accurate and complete as of the time of the inspection.The inspection was performed based on€try training and experience in the proper fL-iction and maintenance of on site sewage disposal systems.i area a DEP approved system inspector pursuant to Section 15340 of Title 5(310 CMR 15.000). The system: Passes I I Conditionally Passes `,�Needs Further£valuation by the Local Approving Authority L'Uvf Wr,d � Fails i [-t wo,4J`T 7 r A� Inspector's Signature: 'Date: o� �� �bonY ram)) f f J ���ndT fPGI/!�. The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Healtli'or ( I DEP)within 30 days of completing this inspection.if the system is a shared system or has a design flow of 10,000 n ww gpd or greater,the inspector and the system.owner shall submit the report to the appropriate regional office of the DEP.The original should be sent to the system owner and copies sent to the buyer,if applicable,and the approving�,w authority_ ols I VJA'T vwhrl Notes and COMMMA. COMM 1 ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different V� conditions of use. Title 5 Inspection Form 6/15r2000 pane l Page 2 of 11 OF P'� CUL INSPECTION FORM—;SOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CE+RTMCATIOi*:(continued) Property Address- S� Owner. CA Date Date of Inspection: Inspection Summary: Check A R C D or E/ALWAYS comnleteall of Section D A. System Passes: I have-not found any informati ch indicates that any of the Endure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 e y fa3uree criteria not evaluated are indicated below. Comments: t B. System Conditionally Passes: One or more system components as described in the"Conditional Pass- p on eed to be replaced or impaired.The system,upon completion of the replacement or repair,as approvedy t�Board of Health,will pass. Answer yes,no or not determined(Y,N,ND)in the for th owing statements.If"not determined"please explain. The septic tank is metal and over 20 or the septic tank(whether metal or not)is structurally unsound,exhibits substantial rtfiln"mon or on or tank failure �: a is;mminent.System will pass inspection if the existing tank is replaced with a comp ' septic oved h the Board of Health. *A metal septic tank will pass tank as apprn if it is shy sound,not leaking and if a Certificate of Compliance indicating that the tank is less th -0 years old is available. ND explain: observation o ewage backup or break Olt or t4gh static water level in the distribution box due to broken or obstructed pipe(s) due to a broken,settled or uneven distribution box.System will pass inspection if(with approval of Bo of Health): broken pipes)am reps isumoved distribution box is Iwled oT replaced ND a lain: The system i�pumping more than 4 times a year due to broken or obstructed pipe(s).The slst�will inspection if(wi +oval of the Board of Health): broken pipe(s)are replaced obstruction is removed ND explain: 2 "P--age OFFICIAL INSPECTION FORUM-NOT FOR VOLUNTARY ASSESSMI EN17S SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FOR PART A CERTIFICATION(continued) Property Address: ( fi" Jt rV%A-"le Owner:�3,6- Date of Inspection: 9 e>6— C. Further Evaluation is Required by the Board of Fealth: Conditions exist which require further evaluation by the Board of Health in order to termine if the system is failing to protect public health.safety or the environment. 1. System will pass unless Board of Health determines in accordance w 310 CMR 15.303(i)(b)that the system is not functioning in a manner which will protect public he th,safety and the environment: _ Cesspool or privy is within 50 feet of a surface water _ Cesspool or privy is within 50 feet of a bordering veQetat wetland or a salt marsh Z. System will fall unless the Board of Health(an Public Water Supplier,if any)determines that the system is functioning in a manner that protects public health,safety and environment: _ The system has a septic tank and soil rption system(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a s e water supply. _ The system has a septic tank an AS and the SAS is within a Zone I of a public water supply. The system has a septic d SAS and the SAS is within 50 feet of a private water supply well_ _ The system has a septic and SAS and the SAS is Iess than !Go feet but 50 feet or more from a private water supply well**.Method used to determine distance **This system passes' the well water analysis,performed at a DEP certified laboratory,for coliformi bacteria and volatil organic compounds indicates that the well is free from pollution from that facility and the presence of onia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria a triggered_A copy of the analysis must be attached to this form. 3. r: a� 3 Page 4 of l l (D IC ijSPECHON. FORD---NOT FOR i�OLUNTARY ASSESS EN';'S SUBSURFACE SEWAGE DMOSAL SMEM INSPEMON FORM PART A CERTMCAnON(continued) Property Address: aa6t a`ti -�- ®caner: Date of Inspection:- g1�' A System Failure Criteria applicable to all systems: You must indicate"yes"or"no"to each of the following for awl inspections: Yes No Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool DWchaage or ponding of eff lueM to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool — Static liquid level in the distr-ibutlon box above outlet invert due to an overloaded or clogged SAS or cesspool x Liquid depth in cesspool is less than 5"below invert or available volume is less than'h day flow oC Required pumping more than 4 limes in the last year NOT due to clogged or obstructed p4*s).iivau-ber of times pumped _ Dc Any portion of the SAS,cesspool or privy is below high ground water elevation. _k_ Any portion of cesspool or privy is within 100 feet of a su 4we water supply or sou t�tary to a surface water supply. -K_ Any portion of a cesspool or privy is within a Zone I of a public wail. Any portion of a cesspool or privy;s u.thm feet of a private water supply&tell• Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water duality analysis-IThis system passes if the well water analysis, performed at a IDEP certified taboratory,It coMfwm bacteria and volatile organic.co indicates that the well is free from m pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equat to or IM thaw 5 ppm,provided that no other failure criteria are t:'.gge:�.A copy of the analysis must be attached to this form,] (Yes/No)The system fails.I have determined that one or more of the above failure criteria exist as described in 310 CIvIR 15.303,therefore the system fails.The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E. Large Systems: to gS,Q� To be considered a large system the system must serve a facility wi design-low of ao,=gpd you must indicate either"yes"or"no"to each of the f (The following criteria apply to large systems in ad ' - the�esis above) Yes no the system is within 400 feet of a s pace drinking water supply — — the system is within 200 f f a tributary to a surface drinking water supply the system is located' a nitrogen sensitive area(Interim'Wellhead Protection Area-IWPA)or a mapped Zone 11 of a publi er supply well If you have answered es"to any question in Section E the system is considered a significant ideor ansred a� "yes"in Section D ve the large system has failed. The owner or operator of any large system significant threat• der Section E or failed ,r Section D shall urpgrade the system i accordance with 3 t 0 CAR 15.304.The sy em owner should contact the appropriate regional office of the Department. 4 Page 5 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMUNTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address• 0'1 ril Owner. Irate of Inspection:a S 1910 Check if the following have been done You must indicate des"or`�o"as to each of the following: Yes No _ Pumping information was provided by the owner,occupant,or Board of Health #f 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? _ X Have large volumes of water been introduced to the system recently or as part of this inspection? Were as built plans of the system obtained and examined?(If they were not available note as NIA) j< Was the&cihty or dwelling inspected for signs of sewage back up? — Was the site inspected for sighs of break out? _ Were all system components,excluding the SAS,located on site? f the _ Were the seotie tank manholes uncovered,opened,and the interior of the tank inspected for the condition o baffles or tees,material of construction,dimensions,depth of liquid,depth of sludge and depth of scum? _ Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the SO l Absorption System(SAS)on the site has been determined based on: Yes no Brisling Znfflrma*uen.For example,a plan at the Board of Health. Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is cceptable)i310 C—M-A 15302(3,�)) 5 I -Page 6 of's's OFFICIAL jNSFI CTION FORM—NOT FOR POLL NTAAY ASSESS"VIENI k SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM FART['C SYSTEM INFORMATION Property Address: CO" c � Owner: Ca.rtW e L _ Date of Inspection: e2 C;. FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): 3 Number of bedrooms(actual): _ DESIGN flow based on 310 CNIR 15.203(for example: 110 gpd x*of bedrooms): _ Number of current residents: Does residence have a garbage grander(yes or no):ALO Is laundry on a separate sewage system(yes or no): /JD[if yes separate inspection required] Laundry system inspected(yes or no):gW Seasonal use:(yes or no): Water meter readings,if available(last 2 years usage(gpd)): Sump pump(yes or no):IC1D Last date of occupancy: CO_tiIME R CIAIJINDUSTRIAL Type of establishment: Design flow(based on 3 30 CNR l5.203): °pd Basis of design flow(seatslpetsons/sgft,etc Grease trap present(yes or no):_ industrial waste holding tank prose es or no):_ Non-sanitary waste discharged t e Title 5 system(yes or no): Water meter readings,if avai le: East date of occupancy/u _ OTHER(descnbe _ GENERAL INFORMATION Pumping Records Source of information: Was system pumped as part of the inspection(yes or no): ? If yes,volume pumped:—_gallons—How was quantity pumped determined? Reason for pumping: -.----- TYPE OF SYSTEM Septic tank,distribution box,soil absorption system Single cesspool Overflow cesspool —ivy _Shared system(yes or no)(if yes,attach previous inspection records,if any) _InnovativelAiternative technology_ Attach a copy of the ct:rrent operation and maintenance contract(to be obtained from system owner) Tight tank _Attach a copy of the DEP approval Other(describe): Approxi•nate age of all components,date installed(if ILTiown)and source of information: O Were sewage odors detected when arriving at the site(yes or no): 6 gage 7 of I OFFICIAL INSPECTION FORM—NOT FOR VOLU TARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FO%M PARS' C SYSTEM JIN O+RNIATION(continued) Property Address: o? ( t t •�Gu cJ� Owner: Date of Inspection: b BUILDING SEWER(locate on site plan) . Depth below grade: 3c! u Materials of construction:_cast iron 44 PVC_other(explain): .Distance from private water supply well or suction line: Comments(on condition of joints,venting,evidence of leakage,etc.): SEPTIC TANK: 4 (locate on site plan) Depth below grade: _-L3`� Material of construction:_concrete_metal_fiberglass__polyethylene _other(explain) If tank is metal list age:_ is age confirmed by a Certificate of Compliance(yes or no):—(attach a copy of certificate) Dimensions: /DOD G6c,1 Sludge depth: ell i u Distance from top of sludge to bottom of outlet tee or baffle: Scum thickness: !_ - cr Distance from top of scum to top of outlet tee or baffle: _ r i Distance from bottom of scum to bottom of u-tlet tee or jj le:_LSL How were dimensions determined: � �ls`�rJa✓`CL{�^ Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as ref ' d to outlet invert,evidence of leakage, tc.): t 21 o2 %y, 1.4 eS e. t GREASE TRAP:_(locate on site plan) Depth below grade:_ Material of construction:_concrete_me' _ oerglass_polyetiaylene_other (explain): Dimensions: Scum thickness: Distance from top of scum to top f outlet tee or baffle: Distance from bottom of sc o bottom of outlet tee or baffle: Date of las►pumping: Comments(on pumping endations,inlet and outlet tee or baffle condition,structure!integrity,liquid levels as related to outlet inve evidence of leakage,etc.): Page 8 of 11 OFFICIAL�ISPE 0 1 FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTIOl!FORM PA3 T-C SYSTEM iF OR AT Ol`i(continued) Property Address: t}waer: Date of Inspection: O 1 TIGHT or HOLDING WANK: (tank must be pumped at time of' on)(locate on site plan) Depth below grade: Material of construction_: concrete metal fi Mass_polyethylene . other(explain): Dimensions: Capacity. �ailons Desip Flow: gallons' y Alarm present(yes or no): Alarm level: Alarm in w order(yes or no): Date of last pumping- Comments(condition of and float switches,etc.): DISTRIBUTION BOX: D- (if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: Comments(note if box is level and distribution to outlets equal,any evidence of solids carryover,any evidence of leakage into or out of box,etc.): PUMP CHAMBER: (locate on site plan) Pumps in working order(yes or no):. Alarms in working order(yes or Comments(note condition of p chamber,condition of pumps and appurtenances,etc.): 8 • e;of 1 l OFFICUL INSPECTION_ FORMI. `NOT FOR VOLUMARY ASSESSMENTS SUBSUIkFACE SE*AOE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INNFORINI i ION(continued) Property Address: 9W. c5� 6 Owner: Date of Inspection: aA l °t 05— _ SOIL ABSORPTION SYSTEM(SAS): (locate on site plan,excavation not required) If SAS not located explain why: Type br- leaching pis,number__ 4- leaching chambers,number- leaching galleries,number: leaching trenches,number,length: leaching fields,number,dimensions: overflow cesspool,number, innovative/alternative system Type/name of technology: Comments(note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation, etc.): pyc7 c !A w a-- CESSPOOLS: (cesspool must be pumped as part of ins ion)(locate on site plan) Number and configuration: Depth—top of liquid to inlet invert: Depth of solids layer. Depth of scum layer: Dimensions of cesspool: Materials of construction: Indication of groundwater inflo (yes or no): Comments(note condition o oil,signs of hydraulic failure,level of ponding,condition of vegetation,etc_): PRIVY: (locate on site plan) Materials of construction: Dimensions: Depth of solids: Comments(note condition soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): 9 Page 10 of 11 OFFICL4,1,INSPECTION FORM—NOT FOR VOLUNTARY ASSESSR`a NIM SUBS�TRF ACE SEWAGE DISPOSAL SYSTEM NSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address Maio * Owner: C04 �, Le Date of Inspection: o'L t4 O :r SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks.Locate all wells within 100 feet.Locate where public water supply enters the building. 37 . � 3 -7 - �q O 9 Page 1 i of 11 O ICI` SPECTION FORM—NOT FOR Vf LUNI TARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORT PART C SYSTEM INI -FORMATION(continued) Property Address: e?Z&( TO u-t i�ltata(.R Owner: lPi Date of Inspection:— d SITE EXAM Slope `f't"5 Surface water Check cellar Shallow wells 600 Estimated depth to around water ZU feet Please indicate(check)all methods used to dete.-tnine die high Bound:vrater elevation: Obtained from system design plans on record-If checked,date of design plan reviewed: Observed site(abutting property/observation hole within 150 feet of SAS) Checked with local Board of Health-explain- Checked with local excavators,installers-(attach documentation) Accessed USGS database-explair_: You mast describe how you established the high ground wat r elevation: US Cris go 11 k Commonwealth of Massachusetts Executive Office of Environmental Affairs Dept. of Environmental Protection .John G>I Ad One winter Street,Boston,Ma. 02108 D.E.P. Title V Septic Inspector P.O. Box 2119 Teaticket, MA 02536. (508) 564- WILLIAM F.WELD Governor ARGEO PAUL CELLUCCI i Lt.Governor �. SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM ,'.•, ,` PART A 7 CERTIFICATION ✓44 2 C+a Property Address: 2261 Main St.Barnstable Address of Owner: gFegn `9'98 D to of Inspection: 1J /97 (If different) lry�FPTrgB(f �t� Name of Inspector: JaNnAraci Nathan C.Nickerson dA 1♦ I am a DEP approved system inspector pursuant to Section 15.340 of Title%(310 CMR 15.000) Company Name,Address and Telephone Number: CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. The system: fi r� yv x Passes This Inspection Is based on criteria defined In Title V code 310 CMR 16.303.My findings are of how the system is _ Conditio Ily asses performing atthe time oftlu Inspection.My inspection does NeedsF rt Evaluation By the Local Approving Authority septicnot ytemandantyortscomtee of nethe longevitysusefultire.of the - septic system and any of Its components useful tire. Fails Inspector's Signature: Date: 111eI98 The System Inspector shall submit a copy of this inspection report to the Approving Authority within thirty(30)days of completing this inspections. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the Department of Environmental Protection. The original should be sent to the system owner and copies sent to the buyer,if applicable and the approving authority. INSPECTION SUMMARY: Check A, B,C,or D: A] SYSTEM PASSES: x I have not found any information which indicates that the system violates any of the failure criteria defined as in 310 CMR 15.303. Any failure criteria not evaluated are indicated below. COMMENTS: B] SYSTEM CONDITIONALLY PASSES: One or more system components need to be replaced or repaired. The system, upon completion of the replacement or repair,passes inspection. Indicate yes,no,or not determined(Y, N, or ND). Describe basis of determination in all instances. If "not determined",explain why not. The septic tank is metal, unless the owner or operator has provided the system inspector with a copy of a Certificate.of CoMpliance(attached)indicating that the tank was installed within twenty(20)years prior to the date of the inspection; or the septic tank,whether or not metal, is cracked,structurally unsound, shows substantial infiltration or exfiltration,or tank failure is imminent.The system will pass inspection 9 the existing septic tank is replaced with a conforming septic tank as approved by the Board of Health. (revised 007197) One Winter Street • Boston,Massachusetts 02108 • FAX(617)556-1049 • Telephone(617)292-5500 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 2261 RL BA Main St.Barnstable Owner: Nathan C.Nickerson Date of Inspection:1116197 D]SYSTEM FAILS(continued) Yes No Static liquid level in the distribution box above outlet invert.due to an overloaded or clogged SAS or cesspool. Liquid depth in cesspool is less than 6"below invert or available volume is less than 1/2 day flow. Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Numbers of times pumped Any portion of the Soil Absorption System,cesspool or privy is below the high groundwater elevation. Any portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. Any portion of a cesspool or privy is.within a Zone 1 of a public well. Any portion of a cesspool or privy is within 50 feet of a private water supply well. _ Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. if the well has been analyzed to be acceptable, attach copy of well water analysis for coliform bacteria,volatile organic compounds,ammonia nitrogen and nitrate nitrogen. E] LARGE SYSTEM FAILS: You must indicate either"Yes"or"No"as to each of the following: The following criteria apply to large systems in addition to the criteria: The system serves a facility with a design flow of 10,000 gpd or greater(Large System)and the system is a significant threat to public health and safety and the environment because one or more of the following conditions exist: Yes No the system is within 400 feet of a surface drinking water supply the system is within 200 feet of a tributary to a surface drinking water supply the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area(IWPA)or a mapped Zone II of a public water supply well) The owner or operator of any such system shall bring the system and facility into full compliance with the groundwater treatment program requirements of 314 CMR 5.00 and 6.00. Please consult the local regional office of the Department for further information. (rsvleed 04r17l971 SUBSURFAC E SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 2261 RL BA Main St.Barnstable Owner: Nathan C.Nickerson Date of Inspection:1116197 _ Sewage backup or,hreakout or hiah.static water level observed.in.the distribution box is due to a broken, or obstructed pipe(s)or due to broken,settled or uneven distribution box.The.system will pass inspection if (with approval of the Board of Health). Describe observations: broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced _The system required pumping more than four times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed C] FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: _ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect the public health, safety and the environment. 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: _ Cesspool or privy is within 50 feet of a surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh. 2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH (AND PUBLIC WATER SUPPLIER,IF APPROPRIATE) DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: _ The system has a septic tank and soil absorption system and is within 100 feet to a surface of water supply or tributary to a surface water supply. The system has a septic tank and soil absorption system and is within a Zone 1 of a public watersupply well. The system has a septic tank and soil absorption system and is within 50 feet of a private water supply well. — The system has a septic tank and soil absorption system and the SAS is less than 100 feet but.50 feet or more from a private water supply well, unless a well water analysis for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presense of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm. Method usedto determine distance (approximation not valid) 3)Other D] SYSTEM FAILS: You must indicate either"Yes"or"No"as to each of the following: _ I have determined that the system violates one or more of the following failure criteria as defined in 310 CMR 15.303. The basis for this determination is identified below. The Board of Health should be contacted to determine what will be necessary to correct the failure. Yes No Backup of sewage in facility or system component due to an overloaded or clogged SAS or cesspool. _ Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged cesspool. SAS is in hydraulic failure. (revised 04117197) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 2261 Rt.6A Main St.Barnstable Owner: Nathan C.Nickerson Date of Inspection:1116197 FLOW CONDITIONS RESIDENTIAL:Design flow: 33D g.pd./bedroom for S.A.S. Number of bedrooms: 2 Number of current residents: 2 Garbage grinder(yes or no): No Laundry connected to system(yes or no): Yes Seasonal use(yes or no): No last two 2 year usage d Water meter readings,if available:( ( )y 9 (gp ): rda Sump Pump(yes or no): No Last date of occupancy: nla COMMERCIAL/INDUSTRIAL: Type of establishment: nla Design flow:0 gallons/day Grease trap present: (yes or no) No Industrial Waste HoldingTank resent:(yes or no) No Non-sanitary waste discharged to the Title 5 system:(yes or no) No Water meter readings,if available: nfa Last date of occupancy: rda OTHER:(Describe)Ida Last date of occupancy: GENERAL INFORMATION PUMPING RECORDS and source of information: unknown System pumped as part of inspection: (yes or no)tdo If yes,volume pumped:0 gallons Reason for pumping: nla TYPE OF SYSTEM x Septic tank/distribution box/soil absorptions system Single cesspool Overflow cesspool Privy Shared system(yes or no).( if yes,attach previous inspection records,if any) i/A Technology etc.Copy of up to date contract? Other: APPROXIMATE AGE of all components,date Installed(if known)and source Information: Inllutrators were Installed In 12.19.1996 by Bortolotd,septic tank and leach pH are approxlmately20 years. Sewage odors detected when arriving at the site:(yes or no) No (rerlssd 0412797) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECLIST Property Address: 2261 Rt.6A Main St.Barnstable Owner: Nathan C.Nickerson Date of Inspection:1116197 Check if the following have been done:YOU must indicate either"Yes"or"No"as to each of the following: _c_ — Pumping information was requested of the owner, occupant,and Board of Health. x None of the system components have been pumped for at least two weeks and the and the system has been receiving normal — flow rates during that period. Large volumes of water have not been introduced Into the system recently or as part of this inspection. x — As built plans have been obtained and examined. Note if they are not available with NIA. x The facility or dwelling was inspected for signs of sewage back-up. x _ The system does not receive non-sanitary or industrial waste flow. _t_ — The site was inspected for signs of breakout. x All system components,excluding the Soil Absorption System, have been located on the site. x The septic tank manholes were uncovered,opened, and the interior of the septic tank was inspected for condition of baffles or tees, material of construction, dimensions, depth of liquid,depth of sludge,depth of scum. x The size and location of the Soil Absorption System on the site has been determined based on — — The facility owner(and occupants, if different from owner)were provided with information on the proper maintenance of Sub-Surface Disposal Systens. x Existing information. Ex. Plan at B.O.H. x Determined in the field(if any failure criteria related to Part C is at issue,approximation of distance is — — unacceptable)[15.302(3)(b)] (revised 041271971 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 2261 Rt.BA Main St.Barnstable Owner: Nathan C.Nickerson Date of Inspection:1116197 TIGHT OR HOLDING TANK: (locate on site plan) Depth below grade: rda Material of construction:_concrete_m eta l_FRP_Polyethylene—other(explain) Dimensions: rda Capacity: rda gallons Design flow: rda gallons/day Alarm level:_wa Alarm In working order?_Yes No Date of previous pumping: Comments: (condition of inlet tee,condition of alarm and float switches,etc.) rda DISTRIBUTION BOX: (locate on site plan) Depth of liquid level above outlet invert: n1a Comments: (note if level and distribution is equal,evidence of solids carryover,evidence of leakage into or out of box etc.) rda PUMP CHAMBER: (locate on site plan) Pumps in working order.(yes or no)No Alarms in working order(yes or no)_ve: Comments: (note condition of pump chamber,condition of pumps and appurtenances, etc.) rda (reylaed 04127197) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 2261 RL BA Main St.Barnstable Owner: Nathan C.Nickerson Date of Inspection:1116197 SEPTIC TANK:X (locate on site plan) Depth below grade: 3.6 Polyethylene_other(explain) Material of construction:x concreate_metal_FRP_ If tank is metal, list age o . Is age confirmed by Certificate of Compliance No (Yes/No) Dimensions: Le•e"rle•7•w4.10" Sludge depth:4" Distance from top of sludge to bottom of outlet tee or baffle: 23 Scum thickness:s" Distance from top of scum to top of outlet tee or baffle:4" Distance form bottom of scum to bottom of outlet tee or baffle: 1s" How dimensions were determined: Measured Comments: (recommendation for pumping,condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity, evidence of leakage,etc.) Septic tank and all components are structumRy sound.IReeommend pumping now and then maintained every year. GREASE TRAP: (locate on site plan) Depth below grade: rda Polyethylene_other(explain} Material of construction: _concrete_metal_FRP_ Dimensions: rva Scum thickness:nla Distance from lop of scum to top of outlet tee or baffle:nia Distance from bottom of scum to bottom of outlet tee or baffle: rda Date of last pumping;,i_ Comments: (recommendation for pumping,condition of inlet and outlet tees or baffles,depth of liquid level in relation to outlet invert, structural integrity, evidence of leakage,etc.) rea BUILDING SEWER: (Locate on site plan) Depth below grade: 4• Material of construction:_cast iron X 40 PVC_other(explain) Distance from private water supply well or suction line?^ Diameter: 4"_ Qmments: (conditions of joints,venting,evidence of leakage, etc.) (revieed 042747) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 2251 Rt.6AMainSt.Barnstable Owner: Nathan C.Nickerson Date of Inspection:1116197 SOIL ABSORPTION SYSTEM (SAS):x (locate on site plan,if possible;excavation not required,but may be approximated by non-intrusive methods) If not determined to be present,explain: rda Type: leaching pits,number: 1 wgallonleachpit leaching chambers,number:4tnnutrators leaching galleries,number: rda leaching trenches,number,length: nia leaching fields,number,dimensions:rva overflow cesspool,number:rue Alternate system: rda Name of Technology:_nra Comments: (note condition of soil, signs of hydraulic failure,level of ponding, condition of vegetation, etc.) The leach pit was full at the time of the Inspection.The Ingutrators were unaccessable because they are 9'down In the ground,system passes because the Innutrators were Installed 2 years ago,and appear to be functl- CESSPOOLS: (locate on site plan) Number and configuration: Na Depth-top of liquid to inlet invert: rda Depth of solids layer: rda Depth of scum layer: nla Dimensions of cesspool: nfa Materials of construction: rda Indication of groundwater: rda inflow(cesspool must be pumped as part of inspection) rda Comments:(note condition of soil,signs of hydraulic failure,level of ponding, condition of vegetation, etc.) rda PRIVY:_ (locate on site plan) Materials of construction: Na Dimensions: rva Depth of solids: rda Comments:(note condition of soil, signs of hydraulic failure,level of ponding,condition of vegetation, etc.) nfa (revised 0412T197) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) 2261 Rt.6A Main St.Barnstable Nathan C.Nickerson 1116197 SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent references, landmarks or benchmarks locate all wells within 100'(Locate where public water supply comes into house) A � O 4A Faye ! of 30 (revised 04127197) f SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C I SYSTEM INFORMATION(continued) i 2261 RL GA Main St.Barnstable Nathan C.Nickerson 1116197 Depth of groundwater 12 Please indicate all the methods used to determine High Groundwater Elevation: Obtained from design plans on record. Observation of Site(Abutting property,observation hole, basement sump etc.) Determine it from local conditions Check with local Board of Health Check FEMA Maps Check pumping records Check local excavators, installers X Use USGS Data Describe in your own words how you established the High Groundwater Elevation.(MUST be completed) USGS Maps and Charts (revised04r27197) page 10 of 10 TOWN OF BARNSTABLE LOCATION /�/77Z'- G. - Ia?MAQ S'r SEWAGE # VILLAGE \� 61t4GJ52746 't ASSESSOR'S MAP & LOT,07'd3y--001 INSTALLER'S NAME & PHONE NO. cam ( c&.JC i Y,,2F— tea- SEPTIC TANK CAPACITY 100,$ .Q Gor sill& !N s�L,'r4A-"'VYT J LEACHING FACILITY:(type) R D O l.J (size) V Wj� -- NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER BUILDER O �NE DATE PERMIT ISSUED: - `xo(5 � DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes To--- 3CG 4 3�4q s � 237— 63`-1. ®�1 No... ��y=- J' /FR13 ... THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH TOWN OF BARNSTABLE Appliration for Bi_nVa13a1 Workii Towitrurtion itumit Application is hereby made for a Permit to Construct ( ) or Repair an Individual Sewage Disposal System at: ...................................................................'"" -- .......... -•-""-'-'--'- . -'••----'--'--•---•-'-----------• Af`/*46-1LSDA1jLocation-Add ss r Lot No. -............-.......................................................................... ------ Own ,.................................................. , �...,tS ress Installer Address Type of Building Size Lot............................Sq. feet ., Dwelling—No. of Bedrooms------------ --------------------------Expansion Attic ( ) Garbage Grinder AA3 aOther—Type of Building ---------------------------- No. of persons---------------------------- Showers ( ) — Cafeteria ( ) Otherfixtures ---------------------------------------------------------------------_------------- .............................................................. Design Flow................ ........................gallons per person per day. Total daily flow---------------�<)-------------.gallons. W 1:4 Septic Tank—Liquid caacity P` /go d-.-- gallons Length---------------- Width-.-------------- Diameter--.------------- Depth---------------- x Disposal Trench— No. -..-.--/.......... Width......`7--------- Total Length-.-_- _9------- Total leaching area....................sq. ft. Seepage Pit No..........(-------... Diameter------10...----- Depth below inlet........1....... 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------..--_-_.-.-------. 4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ P4 -•--'•""---•---------------•--•-•"••--'•"-'•"-"•'-'•'•---•'•"".....-•-•••-••'-------.................•----"'-'------'•".......--'-'-'----•---.-"-- 0 Description of Soil........................................................................................................................................................................ x U x ----------------------------------------------------------------------------------------------------------------------- --------------------- U Natur of Repairs or Alterations—Answer when applicable..._.__. .____. ..._.. ��.. ....�..1....�....©.E J �...../.t .�-Ti l!9-j orC ----- 44--�— ----- iSl ,---------------•--' ---..........------•--------•-----------'--------•------- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmenta Code —The undersigned further agrees not to place the system in operation until a Certificate of Compliance s ben issued t board of health. Signed .... ........................... .... ......................... .... 7 / Application.Approved By ...... -- � 3.r4-^..7'5..... Date Application Disapproved for the following reasonr- -------------------------------------------------------------------------------------------------------------------------------------- ----------------------------------- ----------- --------------------- --- - ....... ................ q• Date Permit No. ......f...�~^...'. S.v�J� Issued .. J..-...���.%-- J ................ Date ------------------ III i No.._.J.��.:..�1: ..�/ /FE Z .J ... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE ApplirFation for Di-tipa!3 al Work.i Towitrnr#ivi rrmit Application is hereby made for a Permit to Construct ( ) or Repair (>4:)Y an Individual Sewage Disposal System at: ,4 .................................................... ..------•------•-•-•.... -- ............................................................. -:\ddr•ss � r Lot No. AJ ..................................................... o.ner Address" ......./, S 7� -.f-4- t3 12�j '�1 , ,�1 J l S � Installer Address UType of Building Size Lot............................Sq. feet I-•, Dwelling— No. of Bedrooms----------- --------------------------Expansion Attic/ ) Garbage Grinder E---) POO aOther—Type of Building ---------------------------- No. of persons---------------- ---------- Showers ( ) — Cafeteria ( ) Aa Other fixtures ------------------------------- -- W Design Flow.............51�_--____________-gallons per person per day. Total daily flow---------------7270..............gallons. WSeptic Tank—Liquid capacity60 0....gallons Length Width................ Diameter---------------- Depth................ x Disposal Trench—No. ......./-.......... Width......:7......... Total Length.--_c 9-L.2...... Total leaching area....................sq. ft. Seepage Pit No--------_/---------- Diameter------/O....... Depth below inlet..__..Co...._..... 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........................ L14 Test Pit No. 2................minutes per,inch Depth of Test Pit-------------------- Depth to ground water........................ a 0 Description of Soil.....................................................................................------------•---------------------------------------------------------------•--•-. x U .....................-....................... ------------------------------------------.......----------------------------------------------------------------......__...---•---------••--------••----- W .............................. -----------------------------------------'---------------------•------------------------------------------ -- U Nature of Repairs or Alterations—Answer when applicable-------- ------ _...........-.__._;171 �.-.d'9_._.` ___� !:...D.Et a " . -----------------�n� .c`�-7t� ......----f�+�l_ - ,.......:S.Ti� -------------...--------------..........---------•--------------------------------. Agreement: 1 The undersigned agrees to install the aforedescribed Individual'Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code —The undersigned further agrees not to place the system in operation until a Certificate of Compliance 1=I s be In issued b t board of health. Signed Signed -------�1---- -------------------_..... .._ -U2`" w Dace Q Application.Approved BY ----------c J .l �----------------------------------_------..._...----------------- ��-�� ! .5...... Date Application Disapproved for the following reasons: ----------- ------- -------- ----------------------------- -----------------.........------------------------------- ................._...--- -- ---- --------------...----------.............---...............---.......----...-----.................-------------------- --------------------------------------------- ;---.------..----....................... q• Dace Permit No. L.. - �J Issued ..........3. - 4- Date THE COMMONWEALTH OF MASSACHUSETTS Z37—,!�3/� OOl BOARD OF HEALTH _!j TOWN OF BARNSTABLE Trrfifictt#e of Com}aliance THIS IS TO CERTIFY-That the Individual Sewage Disposal System constructed ( ) or Repaired (r_X_1 ) L,GTJ ... -.....�N.s�-IL-u cam► 7 VV J by - -............ 1....G/L `0--..... -------------------- ----------------------------- -------------------------------------------- �y Installer / ' ,/ C at ------------------------------------------; _.... has been installed in accordance with the provisions of TITLE 5 of The State Environmental Code as described in the application for Disposal Works Construction Permit No. ._ ------ dated ..__ _' PP P S�.-.mod S-_: .� �� �57' THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE IfONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY.,,- DATE---------- ° .....� .. Inspecto�...�4. - '. �. (� r - THE COMMONWEALTH OF MASSACHUSETTS 37--D ✓ /i CJ� BOARD OF HEALTH TOWN OF BARNSTABLE No.......��..�.-�_.jj FEE---�6 Uispim al orko Tonotrairtion Permit o�-�%-'? .`.s`7�vc�Ja ti Permission is hereby granted ------- to Construct ( ) or Repair an Individual Sewage Disposal System at No................................... r �' S LJ t �14V.41:/.$l '4 = -- It Street ,r. as shown on the application for Disposal Works Construction Permit Nol $5:5-1_ Dated----�_a�n_cl.-P�4�............ DATE. ...... - �f. ................... Board of Health FORM 36506 HOBBS 6 WARREN.INC..PUBLISHERS TOP OF FOUNDATION 20 FT. MINIMUM FROM CELLAR ELEV. 100.00 10 FT. MINIMUM 10 FT. MINIMUM FROM SLAB OR CRAWL SPACE (ASSUMED) CLEAN SAND 2 $_ CONCRETE COVERS INSPECTION PORT.- .4" SCHEDULE 40 PVC PIPE LOAM AND SEED a_ � 8 � MIN. PITCH 1/8" PER FT. _- _�84 J_� ` Q 2".LAYER,OF I \J \■-84,0 a�3.6 'r Q 1/8" TO 1 TO » WASHED STONE I �' -� 4 27" 4" CAST IRON PIPE ^ 89.00 MAX VENT OR EQUAL) MINIMUM 96•75 LON• NOT REQUIRED 84.7 " 8�?�4.2 PITCH 1/4" PER FT. Z FLOW LINE 96.00 _. ELEV. _ 97,75 MIN. o 0 o O ._ -- \ LEV. 94.67 87.1 ` •R2.\ \ 85:1 = 96.00 VEL ° o �o oa s� Iwo 6.7\ ELEV. _ � _ ADD ELEV. = 95,75 6" SUMP ELEV. _ _95.�58_ ° °o�p o ELEV. `\ BAFFLE o ° -o� o` °Vo o=oo °._; °= ° ° i 0 - DISTRIBUTION O ° ° ° ° ° ° ° °14 ° ° °e _9150 V `14"UPL. \ r / 93 \\ `\\ 'r� ;8 LIQUID LIOUIDTLET BOX ELEV. ° 0 0 0 ° o ° o o 'e ° o ELEV. q03 \k 24 MPL. 12. 4-FEET 14 INCHES DEPTH TE (EXISTING) TO BE WATER TESTED 96 � ' ( \\ 5 FEET 19 INCHES IF MORE THAN ONE OUTLET 35i4fPZ 6 FEET 24 INCHES �000 GALLON 14) H,16H CAPACITY hVR0RATORS WTH STONE Z WELL N/A J " 8 / 3.8 ^ 95 \ ` 1 87.4 8 FEET 34 INCHES .7EPTIC TANK (TO BE PLACED ON FIRM BASE) IN AN IV X 30'X 24 ' 7R£NCH FORMA •00 ZONE Y \ \ 1 3/4 TO 1 1/2- CLEAN :� INDEX / I DOUBLE WASHED STONEADJUST- FREEI OF FINES & SILT SOIL ABSORPTION 89.2 SYSTEM (SAS) 7 j 9 SEWAGE DISPOSAL SYSTEM PROFILE �/ ' \ " I 1 NOT TO SCALE USGS PROBABLE WATER TABLE ELEV. - _ 99.1 \ '9 �" 93.9I /, OBSERVED WATER TABLE ( / / ) ELEV. - i DESIGN CALCULATIONS BOTTOM OF TEST HOLE ELEV. = ,� 92.4 / 99.2 •�8.6 1' I I i / NUMBER OF BEDROOMS \ / 99 5 , I I ( „ GARBAGE DISPOSAL UNIT SOIL TEST l TOTAL ESTIMATED FLOW 99 7 I I I ( 110 GAL/Bk/bAY X 3 fit.) _�4_ GAL/DAY DATE OF SOIL TEST ,ZVN 3 5 BDRM. •98. I I ( 89'9 REQUIRED SEPTIC TANK CAPACITY _�4_ GAL. SOIL TEST DONE BY 5AEEI�E�ElYSa1JyEERING a I / / 93.9 I ACTUAL SIZE OF SEPTIC TANK (EMSTING) ,�000 GAL WITNESSED BY SOIL CLASSIFICATION OBSMVAYtON HOLE 1 ELEV.= 99.50 DESIGN BTH. ` I i N I I �9�J\ EFFLUENT PERCOLATION -4- GAL%DAY/S.F.N. PERCOLATION RATE < a MIN./INCH AT 68 INCHES ■ 9F.4 BDRM. ! a / BTN. fi ---� .,_,_„� I I � LEACHING AREA '�4•� SQ. FT. - DEPTH HORiZ TEXTURE COLOR MOTT. OTHER t� (l l X30)+(49=) / BDRM. UV.RM. / ' ( I ' LEACHING CAPACITY (AREA X RATE) .;�5M GAL/DAY 0-8 A LOAMY SAND 1DYR5/3 NO ROOTS ' I / I o 494.00 X 0.74 99.2 94.? ; / RESERVE LEACHING CAPACITY _N9W GAL/DAY 8-40 8 LOAMY SAND 10YR6/6 ROOTS & 99.3 COBBLES , ' 40-102 Cl LOAMY SAND 10YR7/2 COBBLES C.PAD Kt T o / NOTES: 02-168 C2 MEDIUM SAND 2.5Y8/3 1. WORKMANSHIP AND MATERIALS SHALL CONFORM TO D.E.P. • 9 9 / 99.7 �"� fl ` / / _ TITLE 5 AND THE TOWN'S RULES AND REGULATIONS FOR r / ` ~_``� o I j / THE SUBSURFACE DISPOSAL OF SEWAGE. I qp wr 99. 1 � �� 91 7 / 2. ALL COVERS TO SANITARY UNITS SHALL DE BROUGHT TO J j j WITHIN 6" OF FINISHED GRADE. i ! 1 �'p I 3. ALL COMPONENTS.OF THE SANITARY SYSTEM SHALL BE CAPABLE OF y j 00.0 WITHSTANDING H-10 LOADING UNLESS THEY ARE UNDER OR WITHIN j DECK0 ',` � .� , j 10 FT. OF DRIVES OR PARKING AREAS. H-20 LOADING SHALL BE / f/� � , I\1 �, / USED UNDER OR WITHIN 10 FT. OF DRIVES OR PARKING AREAS. NO WATER ENCOUNTERED AT _168" ELEV. _ __85.50 l ja SPRC.1 4. ANY MASONRY UNITS USED TO BRING COVERS TO GRADE SHAH BE MORTARED IN PLACE. / 1000 GALL 5. NO DETERMINATION HAS BEEN MADE AS TO COMPLIANCE WITH SEPTIC TALC DEEDED OR ZONING REGULATIONS. OWNER / APPLICANT IS TO D �� / i , I ( � ^' ( / OBTAIN .SUCH DETERMINATION FROM APPROPRIATE AUTHORITY. / 6. UTILITIES SHOWN ARE APPROXIMATE ONLY, EXCAVATION CONTRACTOR IS TO CALL "DIG-SAFE" AT 1-888-344-7233 AT LEAST 72 HOURS f� / ! p*�99.51 PRIOR TO COMMENCING WORK ON SITE. p ! / 7. CONTRACTOR IS TO VERIFY GRADES AND ELEVATIONS AS WELL AS 24iN' SITE CONDITIONS PRIOR TO COMMENCING WORK ON SITE. ANY VARIATION " 98.3 STONE D t P 0 !12"MPL I I) IS TO BE BROUGHT TO THE ATTENTION OF THE DESIGN ENGINEER IMMEDIATELY. 99 I( ( / 8. PARCEL IS IN FLOOD ZONE C 9. LOT IS SHOWN ON ASSESSORS MAP 237 AS PARCEL 34-1 ST \` 10. EXISTING LEACH PIT AND DIFFUSORS ARE TO BE PUMPED •�� _ I I I AND REMOVED ALONG WITH ANY POLLUTED SOILS. BOARD R F HEALTH fl R LIMIT OF 5 I / 11. ALL UNSUITABLE MATERIAL SHALL BE REMOVED FROM UNDER AND APPROVED: [BOA D O 99.1 31 R `v, {'Y OVERDIG � ) / FOR A MINIMUM OF 5' AROUND SOIL ABSORPTION SYSTEM AND " 98•� �� •7 ,r , 1 !, +2.8 / BE REPLACED WITH SAND AS SPECIFIED IN 310 CMR 15.255.-(3). 40 wrcw. , I ' I DATE AGENT 1 / PROPOSED SEPTIC DESIGN 1 ' FOR OF Aill RAILROAD JRApIS DAVID CARTMILL 9 2261 ROZJ"1'E BA . LOC . , 3.7 I } 99.7 ; i. \ �\ K - ♦�► TE (� ~ �, 71 �7 1 BARNS TABLE,.r., ��t1i�7S. ! 1 ,_��1 f � �99.8 �� . 100.9 �i I ; \ �� • 90.1 ?, SEER lWG G l LOT I I ` I � � � _ q, � 235 GREAT WESTERN .ROAD -< vi 508- P. 0. BOX 713 \• / JJ 404.J �' 5.f. 1 SOUTH DENNIS, MASS. 1 �� �� � ; 398-3922 026`60 ` l I 20 LEGEND: 100.5 EASEMENT EXISTING SPOT ELEVATION 00,0 DATE SCALE 101.2 ` EXISTING CONTOUR 00---- low us JUKE 3, 2D05 1" = 20' I 1S¢!B' '♦ I FINAL SPOT ELEVATION "-- FINAL CONTOUR SAIL LEST LOCAl10N REV. J08 N0. U11UTY POLE -0- JUNE 22, �� 2005 G196�-00 TOWN WATER -W�W- CATCH BASIN ®� GAS LINE G REV. CESSPOOL � O C.P. . LOCATION MAP SHEET 1 OF 1 CLEANOUT --.___e� aO. C.• S8 PRal 6196-00 dw 6196-scs.DWG 02005 SWEETSER ENGINEERING I