HomeMy WebLinkAbout2506 MEETINGHOUSE WAY/RTE 149 - Health (2) 2506 Route 149
W.,Barnstable P
A 155 025
1
I
o - TOWN OF FsRARNSTABLE
LOCATION 'LR! SEWAGE # ZVVC,- • 1�K
VILLAGE /e�� ASSESSOR'S MAP & LOT
' INSTALLER'S NAME&PHONE NO T+eid Sa�ti flwcy e—Tey►. d/D
SEPTIC;TANK CAPACI'>*C l VV .3 .
LEACHING-FACILITY: (typeLr CA4 4%bQ ew (size)
NO.OF BEDROOMS
BUILDER OR OWNER tT6M X4CZ1P- dQdLa}
PERMIT DATE: COMPLIANCE DATE:
`Separation Distance Between the:
Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet
Private Water Supply Well and Leaching Facility (If any wells exist
on site or within 200 feet of leaching facility) Feet
Edge of Wetland and Leaching Facility(If any wetlands exist
withi 300 feet of leaching facility) Feet
TOWN OF bARNSTABLE
LOCATION SEWAGE #
VILLACE ASSESSOR'S MAP& LOT
INSTALLER'S NAME&PHONE NO.
SEPTIC TANK CAPACITY
LEACHING FACILITY: (type) (size)
NO.OF BEDROOMS
j� BUILDER OR OWNER a.
PERMTTDATE: COMPLIANCE DATE:
Separation Distance Between the:
Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet
Private Water Supply Well and Leaching Facility (If any wells exist
on site or within 200 feet of leaching facility) Feet
Edge of Wetland and Leaching Facility(If any wetlands exist
within 300 feet of leaching facility) Feet
Furnished by
♦� t(ti
�3
q� � � � t
,. .
�/ ' _ _ ;.
. ;
Io � ; , �-
9
0
,:,�-,.
�_ .�
t� 1® TOWN OF BARNSTABLE a '�
'LQCATIGN l �' SEWAGE # %MV* 1
i
gV O, AGE ! ASSESSOR'S MAP & LOT pLA/
INSTALLER'S NAME&PHONE NO/AgTfe i..Sah tr Q,yY�pY►. �-�ZO/�
SEPTIC TANK CAPACITY I t7 d� �� .$ •
LEACHING FACILM: (typex M,%AR j!:j (size) z X 1? & Zf
NO.OF BEDROOMS tr
BUILDER OR OWNER Vft 6L Ca.
'. . .r
PERMTTDATE: 3"Z I -� "' COMPLIANCE DATE:
Separation Distance Between the:
Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet
A
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
withi 300 feet of leaching facility) Feet
FurnisheA ,
� v Y
� f
3
q2
a
86
9
Q'
. COMMONWEALTH OF NjAS$ACHII3
ETT
MMCUME OFFICE OF EIVVIRO s a
ENTAL AFFp�
X z to�"ti
DEPARTIMNT OF ENVIRONV-ft- A9.. AMP
40 CT1ojq
2-005 PEAR 21 PM 12: 31 3At/or
i as
OFRC
TITLE S .,...�._��� s►o�
IAL II�iSPECTION FO
SUBSURFACE ES VAGEOR VOLUNTARY ASSESSME
DISPOSAL
SYSTEM FORM 1YTS
PART A
Property Addm.. a�i7 CERZ'IFICATI011T
_OwbW sAddreas.• Sob �r -.� Od 6 GS .P -
Date 4/�l .r -ARCS
Nature of Lta �/J -`�."--..,.�,,,-•�-..�.,..
ComPUy Name-r'(pleasE Rrlut)
-��, •
MAULV Addres,; o
TekPhOfte Number; q f OoL•G 9,2,
CERTINCATION STAT
j certify that I EMENT
below i9 have M�n3'l�Cted the sewage di
training and ''acctaU and complete as of the ciao of tl system at this address that
�'0r�uarti The ipectioa Performed information
the atsPoctiOIL
rted
approved system imlector pursuant to Section 1 �ce of on site sewage di was rmed based on my
'�of Title 3(310 CMR 15.0 lS"I am a DEP
Passesm'
Corationally Passes
• Fails Further Evaluation by the Local APprOving Authori
Inspector's Stgaature: ty
The system inspectorshall s Date: 02-o1Y- or
DIP)within 30 ubmit a COPY of thisMid or greater,the in
days of comp(ethg this• spection report to the A
�aspector and the msMioa if the system is a Shared�e'ng Authority(Board of Health or
DER T rno system owner shall submit the report to stem or has a design,flow of
gtnai should be sent to the system owner and copies seat to the the al�opriate re 10,he
auth�ty regional office of the
buyer,if applicable,and the approving
Notes and Comments
***"This re
Port onlY describes conditions at the h
time; This iavpection doe9 nqt addregx how the s nm of ins
conditions of use. PectiOD and under t
Y'em will perform in the he conditions n use at
di that
e future paler the.yame or different
i
Pale 2 a l l -+
OFFS INSPECTION FORM_NOT FO
SURFACE SEWAGE DISPOSALR VOLUNTARY ASSESSMENTS
PART A
SYSTEM INSPECTION FORM
CERTIFICATION( ,
Owner.
Date of Iespe �o 6 6�
_ay_ a,.
b5pection Summaryl Check A4C,8 or E
_
A. Sy JAWAM complete an of Section D
1 rh"
1S 303 grip CM 15304 vmpvn which indico ft a ,of .
Com x ' n'failvm feria mt eval�� gibed in 310 a
meat:
X Sy Condhionay passe&
Otte Or more stem components as described in the"Conditional Pass
repvred,The syyry� ups complam of the MPL'ment or mP .as „Section need to be replaced or
aplxoved by the Board(if Health will pm
Answer yes,no or not detecmiaed MN,ND)in the
explain, — for the following statements,If~not determined„please
e nsound,eXbsts ;�d��2��old*or septic�( Nether me
the
# is replaced with i complying septic�or tank fa,�is unminent.System�?is hwpc�,
meW septic tank wig pass inu mply n if it is as approved by the Beard of Health. pass"' 1On if the
indicating tbat tank is less than w years old is av a °�not]caking aad if a Ce'"Mte of Compere
ND explain:
Observation of sewage backu or break
PPe(s)or due to a p out a high static water level in
approval of Board of Health); Settled or e'en lmtioa box System "nbution box�to broken or
n pass insPe wn if(with
�0�pipe(s)are replaced
obstnoon is remo,,W
distribution box is leveled or replaced
ND explain;
1_ The system required pumpmg more than 4
times
Ms inspection if(with approval of the Board of Neaitt�year due to broken or obstructed
pile(s). The system will
broken PiPe(s)are replaced
obstzvctian is removed
ND e-viair_t
Pg&Be 3 of l l
OFFICIAL INSPECTION FORM-
OR
PART A
SUBSURFACE SEWAGE I;ISPOSAL SYSTEM VOLUNTARYASSESSMENTS
INSPECTION
FORM CERTIFICATION(co,
Properly Addrem c j t1q 415
0"nerr �� 6�
Hate of fie:— � _ o S
C. Fu":
i7c
` Gn Is Rqwsed by the Board of Health;
which� furt safety'Wher theevaluation by the Board of Health in
evvileameffi. �to determine if the system
is failin� s6kheal
L System wig Face unleae Board of Health Bete
system is ect iin r rmtoea in accordance with 310 CM$1 wA public (1)(b)that the
_ C l +Y is and a*
within 50 fed of a surfer water ety
essPW or lmvy is within So feet ofa
wed n'edand or a salt marsh
4 Sy.*m win rail unley.�the Boats of Health
system is fimctionimg in a manner that protects(and
he�Water SUIPP ier,if My)determines that the
�ealtk safetY and envlro�;
���°i�a��tapk and soil abso
surface water or n3►to a snrfxe war dM m(SAS)and the SAS is within 100 feet of a
The system has a sepde tank and SAS and the SAS is within a Zone I of
— The system has a a Public water supply,
c tank and SAS and the SAS is within 50 red of a private water supply
_ The system has a septio tpzivateank��and the well.
water ANY well*•.1�hod used to ?sue lQQ feet but So feet or more from a
**This system
Passes if the well water
bacteria and volatile or�wic $is,PerfOMW at a DEP eedi fled IaWrato for lif
the Presence of ammonia aitro 3ndisates well is free from PDlution ry' qrm
failure criteria gen and nitrate nitro en is eguai to or less than S from that facility and
feria ale triggei,� A spy of the aaaiysis to this f�' �that no other
3• Other,
P094ofll
OFFICLAL INSPECTION FORM—NOT FOR SUBS Y
URFA OL CE S UNT
SWAGE DLSpOSgL SYSTEM ARY ASSESSMENTS
PART A INSPECTION FORM
CUTWICATION(rontinued)
Ps"o Addrew
E3wner. �ti
D. Sy.*m Fapane Criteria applicable to all You mn, a•yes-or i_ to each of the folio ws'
Yes No/ �8 for a„Q o,.
of sewage into fWW
or
�xh es or Winding of 0'" Systmen coMponent d Overloaded or c
surface of the surface w wed SAS or cessp°OI
a cid level is the distribution en dM to an av4d0aded or
button box above outlet invest due to an overloaded or clogged SAS or
Requ qm$"is less than 6-below invert
1mpe dBred pmVin 'times is the last year oT due to c! lesq than, 'flow
p wdm of the SAS, o8ged or obstructed Pape(s�Number
Any portion of cesspool o or XV is below high 8round water elevation
/w� Privy is within 1�fco of a
v porficRL fa a water sup*or tributary to a surface
— �porton of a pool or privy is within a Zone l of a
�°0l 4i P�vy is within S0 feet�a Public well
Pp1Y well withof a al or privy is less water supply well.
no acceptable water q�ty a 1Q0 fcet nWyj. gt tce than SO feet fmm a
in�dic�tbA d at a e we ces free laborato �system Passes d the well analysis,
the well!s tr+ee fate water
rom rY�for ber k and volatile o
autrngen and.nitrate nitrogeB is pollution from that facility and thePresence�¢comRounds
are trigger.A c e9ua1 to or less than S ppws provided that n ther fai of lure
Cr
Apy of the analysis must he attached to this form,)
M(Y�io)The system to ft I have
described in 310 CMR 15.303 mmined that one or,ms.ore of the above failure Grit
Health to determine w � 1erefore'to
correct the fa l system owner shoo ccoon��Board of
hat will
u�
L Lagp systems:
To be considered a urge�s�m.the system must serve a tacil'1ty with'
a des'
gpd.
You must indicatc Dither aga now of 10,(HN►gpd to 1510"
(The following ����or��"to each of the followin
criteria apply to large systems in addition to the criteria above
Yes no )
system is within 400 feet of a surface drinking water supply
thesystem is within 2�feet of a tributary to a surface drinkirg water su
the system is located in a nitrogen sensitive rply
•one!l of a public water sappiy Weil area(Interim Wellhead Protection Area—IWpq)or a mapped
If you have answered"yes" to
"yes"in Section D above th a la any�stron m won E the
ge system failed, system is considered a significant threat,or answered
signil icant thyst under Section E or failed The owner or operator of any lar
i5.304, Ike system owner should contact thew ion D shall upgrade or ge system considered a
ppropriate regional olftcc of the system in accordance with 310 CNM
l�a[tnten�t,
r
Paw 5 of I 1
OFFIC L INSPEt; FnON FORM-NOT FOR
SUBSURFACE SEWAGE DLspO VOLUNTARY ASSESSMENTS
NOT
SYSTEM INSPECTION FORM
PART H
CHECKLIST
PtOWity add oZ r..0 6 W�- /5`
Owner.
Date of><nspeedos; _
Check if the"lowing have been done.yo
u mast indicate es„or yam,•as to each of the followin
Y�
�mformI was Provided by theowner,occurant orBoard of Hicaith
� _ mere
my of the*+stem Pmped out in the XcWous two weeks
remved normal sows is rho previous two week Period
a vnimmes of w-Uw.bem iced to the system recently or as Part ofthis.
Were asbuip piaos of Me system obtained inspection
� (If they wac not fable note as N/A)
Was the facility or dwelling m
. f eted or si
gns of
sewage back up
Was tht-site inspected for signs of break out
Were all
system coaWORWA wing the SAS,located on site
Were the septic teak manholes
of the or toes►finial of construe, friar of the t hy�ted for the condition
9u4 depth of sl'dse and depth��,m
Was the ow
e cf ( eveand OCMPHft if nt From owner
Provided with information on the proper
The size and location of the&W Absorption Syste®(SAS)on the ste has been
Yes no ncd based on
ZExisting information,For example,a Plan at the Board of Health,
Wined is the Geld(if any of the faihue criteria related to Part C is�issue a
is unacceptable)1310 CAM 15.302(3)(b)l
PProximation of distance
I
- . Page 6 of 11
- OFFICIAL INSPECTION FORM—NO SUBSURFACE T FOR VOL CE SEWAG UNTARY
E DISPOS ASSESS
AL MENT
PART SYSTEM INSPECTION FORM S
C
SYSTEM 2001tMATION
Pz'%"Addrem 0?-50 b
Q4- /z
Date of bvecdj%,
owner.
0
lRJLM
zmUL FLOW CONDMONS
Number of bodr00=3(design):
Nsa W'W don 310 Ch%1.203(�W *.. j ms(aaual): 3' ��✓ ��4
Does O : 110 x# �J�FO 60 �► �,/e
Is L' dty►on a vftp! ow or no): � h j /
us or sYm(yes no):Ta I yes sep�r meson ®1 7`��.c�e C
Water metfting� ava%1a (fast 2 requ,r�
Ppaa�(Yes osao): Y��p
1.asat doe of
occupy:
CO
TYPe of egab)l IISTRiAI,
mt
D,eaip now(hawed on 310 Chi l3 2 33
Basis of ):
Grmase�U( persons/sc�etc.):
(Yes or
dal waft-haldog.twk
Waft p (yes of no) _
water meta dings,� to ati'aulable:" Tqtic s sysWm(,es or
La 0 date of occtgmq/nse:
OT=R(describe):
PumptaB Res. GENERAL INFORMATION
If Yes,vohmre Pm Of
pumper won(yes or no); Pw t
Reason for pig ---9d10m—How was quangt,pm�
&ftmined7
�YSTE11�
— �d��bution box,
°�oo1 sort absorption System
p�Overt low Spool
shued
Inaowativ�t�ive techW�mach�018 if
°bta'ned hom System g3''Aua�a copy of
�O1 res'°r`� any)
TightWtart owner) ant operation and mairrtenance conUW—A�a copy of the DEp approval (to be
0dWr(describe):
App�ate age of all co
�° �'date (if known)arrd sou i
j� nformation:
Were sewage odors detected when arriving at the site J
(Yes or no):/l/'�
� U
pulp 7 of i I
' OMG7AL INSPECTION FORM_
• MKNTS
SUBSURFACE L4L"i"'R NOT FOR VOLUNTARY SEWAGE DISPOSAL SYSTEM INSPECI'I �SR51
PART C ON FORM
SYSTEM FORMATION(oomin,.M
01
O ftr. Ot�(t G rpit /C/ �02 6G�
Daft of bVft loa: _ Y- o
BURRING SEW=pocate on site
1hn)
Depth below grade; 31 '(�
Materials ofconstnai���
neon PVC'
Di�'stanoe from private Rates a pply well a�suction 1_:�(evn)�
(On ooaditian of joints,venting evidence of leakage etc.):
SEPTIC TANG_" (10 on
site plan)
I,/
DePhbelowvade: as�
a
—«hc ) 'nets'-- �lyethyle�
is mew
list age"— b ague confirmed by Certificate of
a
Dfinen X /O COS(yes or no):_(attach a copy of
depth; cc �r
=p��udge to bottom eoutlet tee or baffle.
Distance 5om �vm to 4 scum to�Ofototutld ftee or belle: 6 �i
H OW
�� � d. mole et�°rl
Comments(o°Pumping r000� q e14 C e
�`, to a„_utlet i0va CZeaoe of 1 e� tee or baffle condition,
g� SntY,liquid levels
TQ aH �' RG -/k
h-Q /^ �o car
GREASE TRA��ocate on site plan)
Material of construction_�
(e�'n)- _mew--fiNW=--polyethylene_other
Dimensions.
Scum thiclanj;_
Distance from top scam to top of Outlet
tee or baffle:
Di to o of l from bottom of scum to bottom ofl outet tee or baffi.—13ate f last s _
Comments(on pumping oommendatio
as related to outlet-Pmg evidence of lei inlet and outlet tee or baffle condition,guttural ire
�•): sty, liquid levels
r
1tA0 8 of if
OFFICIAL,INSPECTION FORAM—NOT FOR VOLUNTARY• SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPE ON FOR
PART
TC
SYSTEM INFORMATION(continued)
Addan a3 ,6
Dana ec� = -- 4-3
TIGHT or HOLDING TANWL (tank must be
pumped at time of inspocuon)(locate on site plan)
Depth below grade:
Material amYolt co metal
fibez&n_Mlyeftlene
---------------
Capacity:—
Design Flow:
At Present
(yes or no):
Alarm —
Date amTlast pumiping Harm"'—
W working order(Yes or no):
COS(Conmw iia*=and float smkim ;etc.):
DISTRIBUTION BOX- (ifPICSIMmust be o
l�ened)(locate on site plan)
DePth Of hgwd level above outlet invert:!f
Cotes(note if box is level and distribution to outlets equal,any evidence of solids
leakage Into���X,etc.), carryover,any evidence of
PUMP CHAMBER (Iocate on site plan)
fps in worlong order(yes or no):
Alarms in working order(yes or no):
Comments(note condition of pmnp dumber,condition of pumps and
appurtenances,etc.):
I
y Pose 9 of l l
;i
• OFFICIAL INSPEeO
j' N FORM—NOT FOR yOL
SUBSURFACE SEWAGE D�
POSAL SYSTEMC�O ESSM�S
SYS T C N FORM
PIMP"Aditm 02� 6 �� RMATI011T(oo
Date of
SOII,AMRMON SYSTEM(SAS);
: — (locate on ske pia,4
if SAS not locided explain whr
Type
ftuch
-147-
�` ' S '
k
overfbwM=bw moons:
�spoo number:
) a Aftonof� °t, booy:cttm .- gn of
level of
oa,C✓,�.t �� s-/ ' ponce damp soil,condition of vesoadon,
7�+ Cr d „
CES!"O '-d (wool must
be N and Coffi on: limped as Pert of inspwdon)(locaw on site plan)
Depth top of li"W to inlet
oP�ofsoltds lays rmmert:
Depth Di of sc=layer.
°f spool:
consir�4
lndicabion of
mmou(non _
Co
0°�hon°f soil,signs of hYdraWic fail
level ofPb &condition ofvegetatio4
pli< m,C=(locate on site an
)
Materws of
c°n*Wtion:
Dqxh of
solids:
Come(ate condition of soil,signs of hYdraWic fur,,level ofpond,,c°ndition of Vegctadoq etc):
�� 1
PARR 10 of 11
' OFFICIAL INSPECTION FORM_
.. SUBSURFACE SEWAGE DISPOSAL SYSTEM jNSpE ASSESSMENTS
PART C CTION FORM
SYSTEM INFORMATION(continued)
PrOPertyAddrew c ,� AD wner: H c �i �� r
ate d
SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the
benchmark.Locate ' f Louie wl_�to at p�aert refer laQdmarks or
c water suPP1Y enters the building,
yd-
1 — 33 '
63- 9 c, o
d
�v�✓ ry
page 11 of 11
OFFICIAL INSPECTION FORM T NOT FOR VOLUNTARY ASSESSMENTS
• SUBSURFACE SEWAGX DISPOSAL SYSTEM INSPECTION FORM
PAR?C
SYSTEM INFORMATION
P�Periy Addy e SO 6 Q4
a
pwner.
Date of hupea nu
SM LX,%M-
Slope
s�srfaoe water
cued cellar
S11a11aw wells S�
Estimated depth to ground water 3 feet 60,A 4o w- 3�c
Pl C/it a(fig)all methods used to determine the high ground water elemo L
SY design plans on record-If checked;date of design plan reviewed
s�( 8 property/oWavation hole within 150 feet of SAS)
Chocked with local Boardo[Healtit-explaia I---' �pf
Checked with local excavators,installers-(attach documentation)
Accessed USGS database-vTWn.
YCFU must rde�¢n pho�w you e:s�al �tu•�ground water�devati� l0 �
H
/ ,�/ 4e,
6-C; G7 G C
t/yO�• ASSESSORS MAP: � - TEST HOLE
PARCEL: '�� .ZJ�D,ZU'S/J
SOIL EVALUATOR:'
FLOOD ZONE: rr xl WITNESS: W
-+' ouT� !'(g G- REFERENCE DATE:
' 1 l�-�
' ] PERCOLATION RATE
;.K.d.�.� TH-1
L �IHI� �tD
LOCAT ION MAP(4-1.-5
rolp
119 YAW
ILI
EIL
� o
$ - lot&7,00 SEPT I C
,' rt?ir l Ydlj�(Q jo? / � V `S FLOW ES
I 1 BEDI
l I SEPTIC
\ 1 0 �GAI I \
` I . USE 151
( q , '
"S01 L AB
o UJ�
S
Bf
,�- c l
SEPT I C
� n �
10
\
9i/ �
d7
LOGS ,
2 IwSI — _ �
J4
/yfikl
�Knpl,_1 o� vrl�mr✓5, 5�wlr� 1�1Y5
�THH_2
. ✓_ Foil-._ _._ _. UNJt�z� -�>kL
� s
141
o F_'�t>✓.�1.?,oRn� �i�c...ifs»
SYSTEM DESIGN
1-r-
TIMATE
• —._.�b,3 �._ FI l_�.._. WTT1-1._GL�4�.�''q�'
ZOOMS AT I10 GAL/DAY/BEDROOM -5D GAL/DAY
rnal�l House. I��u� o� 9 Zk_16PAeo� &oCz 7D OZ
TANK-
_/DAY x 2 DAYS - ADD GAL cSy�1
90 GALLON SEPTIC TANKLL
�ORION WPTSYSTE����
M
}' Sibwc as/t>l'oet-,> E 3'6.s mwas, _ _
IDE AREA: ZXC9/c XZX U,-7 /74,6
)TTOM AREA: 'X /3 X 0r7 S
�/7 4p�,
SYSTEM SECTION(4T,S)
6`uR6 t1aX, q100
4t,
D
1500 GAL 97,
SEPTIC TANKS59
-�� may_ I I ��Tivt?R.i'E.(A! S {�'STa• —
416
SITE AND SEWAGE :PLAN
im
LOCATION: #�'�qS -RmTm I 0
PREPARED FOR: ► eLZA}
�, Si4wDt�IcI-}� MKl
SCALE:
DAV I D B. MASON►6 DATE: �-
DBC ENVIRONMENTAL DESIGNS
DATE HEALTH AGENT EAST SANDWICH. MA
(508) 833-2177