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HomeMy WebLinkAbout0069 WATERGATE LANE - Health 69 Watergate Lane W. Barnstable A = 217 037 TOWN OF BARNSTABLE v LOCATION d�ar�u- G� � 4-10 SEWAGE # VILLAGE �QFr/rY4�� ASSESSOR'S MAP & LOT :1 �03' INSTALLER'S NAME&PHONE NO. �e/ � �a �isco✓ �%S 59�6 SEPTIC TANK CAPACITY O00 Gk LEACHING FACILITY: (type) 5W Cal Chia n�� �� (size) NO.OF BEDROOMS 3 BUILDER OR OWNER < X, PERMUDATE: 7/$'�d3 COMPLIANCE DATE: Oql 03 e aration Distance Between n the:p Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist Feet on site or within 200 feet of leaching facility) /G Edge of Wetland and Leaching Facility(If any wetlands exist _ within 300 feet of leaching facility) Feet Furnished by �Rvi Aida/ 1� b" i S ) 1 No. 10 0, —3 0'2 y3or i= Fee THE COMMONWEALTH OF MASSACHUSETTS .centered in computer: Yes BLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS Application for DizpoaY *p$tem Con5tructiun 3permit Application for a Permit to Construct( )Repair( )Upgrade(/)Abandon( ) El Complete System eindividual Components Location Address or Lot No. / Owner's Name,Address and Tel.No Assessor's Map/Parcel � f sl�, / IIlee Installer's ameMFI�i Ad and Tgt.No. ��� Designer's Name,Address and Tel.No. ® 4Q.r4e Z, Type of Building: Dwelling No.of Bedrooms 3 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 YX gallons. Plan Date Number of sheets i Revision Date Title Size of Septic Tank O ' Type of S.A.S. Description of Soil 21/ 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 ;AWdHe lth.SignedDate Application Approved by P"k� Date G Application Disapproved for the following reasons Permit No. aUQ 3 — 3° Date Issued d ? 'No. Fee 3 HE COMMONWEALTH OF MASSACHUSETTS <'iwered in computer: LYes l P'BLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS �) 01pprication for Miopooal opotem Construction Permit Application for a Permit to Construct( )Repair( )Upgrade Abandon( ) ❑Complete System YJ Individual Components ' Location Address or Lot No. 'Owners %�Address and�e�No, Assessor's Map/Parcel Installer's ame,Address,and TeI o.�3 Designer's Name,Address and Tel.No. G 4Wle 7J lY 7 Type of Building:._ Dwelling No.of Bedrooms 3 Lot Size sq.ft. Garbage Grinder(A�l Other Type of Building PS% l No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Fh 6� gallons per day. Calculated daily flow gallons. Plan Date Zi Number of sheets / Revision Date Title Size of Septic Tank 1eMQ:;1/ �I`/� i/9 Type of S.A.S. Z/`✓�9/n��©'� Description of Soil Z y �1' /3X Z 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 He lth. Signed Date 6A. r D Application Approved by 41_ , Date G Application Disapproved1for the following reasons Permit No. UU - 3� Z Date Issued --------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of (Compliance THIS IS TO CER IFY,that t e On-site Sewage Disposal System Constructed( )Repaired( )Upgraded( t/� Abandoned( )by _1214,�_ S a at 9 r Lfl .f has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No.DW. - 30 dated '7--,?— 3 Installer Designer The issuance o thi permit shall not be construed as a guarantee that the syste . w' n s# ig.} Date Inspector A--------------------------------------- No. ',dud 3- 3 dL Fee S� THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS 1=iOpo5ai *pOtem Con0truction Permit Permission is hereby granted to Construct( )lRepair(/' )Upgrade(✓ Abandon( ) System located at 57 / Y 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. i Provided: Construction must be completed within three years of the date of thip%vermit. Date:_ 03 Approved by _----� I J , TOWN OF BARNSTABLE LOCATION 9 A r SEWAGE # VILLAGE_ ., r / 1. ASSESSOR'S MAP& LOT 2l'7'O�' INSTALLER'S NAME&PHONE NO. �5"1'14✓ SEPTIC TANK CAPACITY LEACHING FACILITY: (type) 4W C4 C �l r.�G�., �'2 (size), NO.OF BEDROOMS 3 BUILDER OR OWNER PERMIT DATE: COMPLIANCE DATE: q �3 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) . 16$— Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facili Furnished by 0-6q 1 I S"S b• I / r I � y 1 � I i COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROT E��iFf) ^ F r u � ' d � UG 1 4 2002 zu T�WHEALTBH rDEPT. TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSU`RFACESEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 69 WATER'GATE LANE WEST BARNSTABLE, MA 02668 Z�"�Wo Owner's Name: HELEN MCCLUSKY Owner's Address: KENT WETHY 6610 TRANSPARENT CLARKSTON MI 48346 Date of Inspection: 7/16/02 FXLEM I n'`SPEC110H Name of Inspector: (please print) ``:'£, .JOHN GRACI Company Name: SEPTIC INSPECTIONS tAC, ALI C U Mailing Address: P.O. BOX 2119 TEATICKET,MA.02536 Telephone Number: 508-564-6813 FAX 508-564-7270 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of the inspection.The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: _ Passes f .i "k _ Conditionally Passes Needs Further Ev lu ion by the Local Approving Authority X Fails` Inspector's Signature: k: Date: 7/16/02 1 t; The system inspector shall submit a copy of s inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall_submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to.the;buyer, if applicable,and the approving authority. Notes and Comments SYSTEM FAILED TITLE V INSPECTION. OVERFLOW IS FULL, SAS NEEDS TO BE UPGRADED. ****This report only describes conditiens'at the time of inspection and under the conditions of use at that time.This inspection does not address'how the system will perform in the future under the same or different conditions of use. Title Inmortion Form h/I 5/,)nnn '' Page 2 of I 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 69 WATER GATE LANE WEST BARNSTABLE, MA 02668 Owner: HELEN MCCLUSKY- Date of Inspection: 7/16/02 Inspection Summary: Check A,B,C;D or.E/ALWAYS complete all of Section D A. System Passes: _ I have not found any information which'indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: SYSTEM FAILED TITLE V INSPECTION. OVERFLOW IS FULL,SAS NEEDS TO BE UPGRADED. B. System Conditionally Passes: _ One or more system components as described in the"Conditional Pass"section need to be replaced or repaired.The system, upon completion of the replacemdOt or'repair,as approved by the Board of Health,will pass. Answer yes,no or not determined(Y,N,N.D)in the for the following statements. If"not determined"please explain. n/a The septic tank is metal an'd.over 20 years old* or the septic tank(whether metal or not) is structurally unsound,exhibits substantial infiltration or exfiltra ih R iank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND explain: n/a n/a Observation of sewage backup or,break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): _ broken pipes)are replaced _ obstruction fs.removed _ distribution box is leveled or replaced ND explain: n/a n/a The s stem required um iii'�more thaifi,4 times a year due to broken or obstructed i e s . The system will ass Y 9 P P �, Y pP ( ) Y p inspection if(with approval of the`board of Health): _broken pipe(s)are replaced _'obstru lion"is removed ` l ND explain: n/a Page 3 of I I !FFy +,E OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) 4 Property Address: 69 WATER`GATE LANE WEST BARNSTABLE, MA 02668 Owner: HELEN MCCLUSKY,,, Date of Inspection: 7/16/02- C. Further Evaluation is Required_bytlie$oard of Health: _ Conditions exist which require further�evaluation by the Board of Health in order to determine if the system is failing to protect public health,safety or the�envirohment. 1. System will pass unless Board[bf;Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health,safety and the environment: �r _ Cesspool or privy is within 50 feet ofa surface water - Cesspool or privy is within,50!feet of a bordering vegetated wetland or a salt marsh 2. System will fail unless the Board of Health (and Public Water Supplier,if any)determines that the system is functioning in a manner that protects the public health,safety and environment: _ The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface:water supply. _ The system has a septic tank and SAS and the SAS is within a Zone I of a public water supply. _ The system has a septic tank and SA"� nd the SAS is within 50 feet of a private water supply well. _ The system has a septic.fank and'SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance n/a "This system passes if the'welOw"afer ahalysis,performed at a DEP certified laboratory, for coliform bacteria and volatile organic compounds Indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered. A copy of the analysis must be attached:to this-form. 3. Other: i<•: n/a 5 iE I� 4 .` Page 4 of I I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 69 WATER GATE LANE WEST BARNSTABLE, MA 02668 Owner: HELEN MCCLUSKV',; f:­ z Date of Inspection: 7/16/02 D. System Failure Criteria appiicable to all systems: You must indicate"yes"or"no"to each of the following for alLinspections: Yes No X _ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool X Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool X Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool X Liquid depth in cesspool is less than 6"below invert or available volume is less than '/2 day flow X Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number of times pumped PUMPED SEVEN YEARS AGO BY OWNER. X Any portion of the SAS,cesspool or privy is below high ground water elevation. _ X Any portion of ces"spool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. X Any portion of a cesspool or privy is within a Zone 1 of a public well. X Any portion of a cesspool or privy is within 50 feet of a private water supply well. X Any portion of a cesspool or privy iis less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from tliat facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided thaVno other failure criteria are triggered. A copy of the analysis must be attached to this X _ (Yes/No)The system fails. 1 have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails'. 'The system owner should contact the Board of Health to determine what will be necessary to correct the failure.. E. Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. You must indicate either"yes"or"no"to each of the following: (The following criteria apply to large systems in addition to the criteria above) , s yes no X the system is within 400 feet of`a surface drinking water supply X the system is within 2�00 feet of a tributary to a surface drinking water supply X the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area—IWPA)or a mapped Zone 11 of a public water supply well If you have answered"yes'.'tol,ariy question in Section E the system is considered a significant threat,or answered "yes" in Section D above Ihe`Iai pc'sy6stem has failed. The owner or operator of any large system considered a significant threat under Section E or failed under, Section D'shall upgrade the system in accordance with 310 CM 15.304. The system owner should contact the appropriate regional office of the Department. ., d s � Page 5 of I I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS. SUBSURFACE'SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 69 WATER GATE LANE WEST BARNSTABLE, MA 02668 Owner: HELEN MCCLUSKY Date of Inspection: 7/16/02 Check if the following have been done.You must indicate "yes"or"no" as to each of the following: 0. Yes No : X _ Pumping information,was provided by the owner,occupant,or Board of Health X Were any of the system components pumped out in the previous two weeks X _ 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 '? X Were as built plans of the system obtained and examined?(If they were not available note as N/A) X _ Was the facility or dwelling inspected for signs of sewage back up X _ Was the site inspected for signs of break out'? X _ Were all system components,excluding the SAS, located on site? X _ Were the septic tank manholes uncovered,opened,and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions,depth of liquid,depth of sludge and depth of scum ? X _ Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems`? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: Yes no X _ Existing information. For''e`x rple,a plan at the Board of Health. X _ Determined in the field ifany of,lie failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(3)(b)] , Page 6 of 1 n OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 69 WATER GATE LANE WEST BARNSTABLE MA 02668 P Y Owner: HELEN MCCLUSKY ' Date of Inspection: 7/16/02 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): 3 Number of bedrooms(actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 Number of current residents: 1 ' Does residence have a garbage grinder.(yes or no): NO Is laundry on a separate sewage system(yes or no): NO [if yes separate inspection required] Laundry system inspected(yes or no):,:NO Seasonal use: (yes or no): NO i._;; . , j, Water meter readings, if available(last 2 years usage(gpd)): n/a Sump pump(yes or no): NO Last date of occupancy: n/a COMMERCIAL/INDUSTRIAL Type of establishment: n/a a Design flow(based on 310'Qr0 J 5F203):'n/agpd Basis of design flow(seats/persons/sgft,etc.): n/a Grease trap present(yes or no): NO Industrial waste holding tank present.(yes or no): NO Non-sanitary waste discharge`d',,w theiTitle 5 system(yes or no): NO Water meter readings, if available: n/a ' r. Last date of occupancy/use: n/a OTHER(describe): n/a i GENERAL INFORMATION Pumping Records Source of information: PUMPED SEVEN YEARS AGO BY OWNER Was system pumped as part of the inspection(yes or no): NO If yes, volume pumped: n/agallonst','How.was quantity pumped determined?n/a Reason for pumping: n/a 1 Y TYPE OF SYSTEM X Septic tank,distribution box,soil absorption system _Single cesspool _Overflow cesspool _Privy _Shared system(yes or no)(if yes,attach previous inspection records, if any) _Innovative/Alternative technology..Attach a copy of the current operation and maintenance contract(to be obtained from system owner) _Tight tank Attach a copy of the DEP approval Other(describe): n/a Approximate age of all components,date'installed(if known)and source of information: 1972 BY OWNER Were sewage odors detected`wlien arriving at_the site(yes or no): NO A f , F. Page 7 of I I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE iSEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 69 WATER GATE LANE WEST BARNSTABLE,MA 02668 Owner: HELEN MCCLUSKY Date of Inspection: 7/16/02 BUILDING SEWER(locate on site plan) a ( 5 Depth below grade: 22" Materials of construction:_cast iron =40 PVC Xother(explain): 20 PVC Distance from private water,supply well or.suction line: n/a Comments(on condition of joints,venting, evidence of leakage,etc.): WELL WATER q SEPTIC TANK: X(locate on site plan) Depth below grade: 16" 1 Material of construction: Xconcrete metal fiberglass_polyethylene other(explain)n/a If tank is metal list age: n/a Cs'ageicbnfirmed,by a Certificate of Compliance(yes or no): NO(attach a copy of certificate) Dimensions: 1000G L 8' 6" H•5',;7'�,W 4' 110,',"' Sludge depth: 1" Distance from top of sludge to bottom of outlet tee or baffle:33" Scum thickness: 1" ' Distance from top of scum to top of outlet tee or baffle: 6" Distance from bottom of scum to bWoin of outlet tee or baffle: 17" How were dimensions determined:MEASURED Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): SEPTIC TANK AND ALL COMPONENTS ARE STRUCTURALLY SOUND AND FUNCTIONING PROPERLY. RECOMMEND PUMPING EVERY TWO YEARS TO PROLONG THE SYSTEM'S USEFUL LIFE. GREASE TRAP:_(locate on site plan) Depth below grade: n/a Material of construction:_concrete_metal_fiberglass_polyethylene_other(explain): n/a Dimensions: n/a Scum thickness: n/a Distance from top of scum to top of outlet tee or baffle: n/a Distance from bottom of scum to bottom of outlet tee or baffle: n/a Date of last pumping: n/a I,. rr- Comments(on pumping reconut,gendations, inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert,evidence of leakage;}etc.)` n/a '9 • e �i 7 Page 8 of 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 69 WATER GATE LANE WEST BARNSTABLE, MA 02668 Owner: HELEN MCCLUSKY Date of Inspection: 7/16/02 TIGHT or HOLDING TANK: (tank must be pumped at time of inspection)(locate on site plan) Depth below grade: n/a Material of construction:_concrete. metal fiberglass_polyethylene_other(explain): n/a Dimensions: n/a ' Capacity: n/a gallons Design Flow: n/a gallons/day Alarm present(yes or no): N/A Alarm level: N/A Alarm in working order(yes or no): NO Date of last pumping: n/a Comments(condition of alarm and float switches,etc.): n/a DISTRIBUTION BOX:_(if present must,be opened)(locate on site plan) Depth of liquid level above outlet invert: n/a 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.): n/a I PUMP CHAMBER:_(locate on site plan) Pumps in working order(yes or no): NO' Alarms in working order(yes or`no):NO Comments(note condition of pump chamber,.condition of pumps and appurtenances,etc.): n/a ;I e. R Page 9 of 1 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 69 WATER GATE LANE WEST BARNSTABLE, MA 02668 Owner: HELEN MCCLUSKY Date of Inspection: 7/16/02 SOIL ABSORPTION SYSTEM (SAS): X (locate on site plan,excavation not required) If SAS not located explain why:. n/a Type n/a leaching pits, number: n/a n/a leaching chambers, number: n/a n/a ` leaching galleries, number: n/a n/a leaching trenches, number, length: n/a n/a leaching fields, number: n/a 6' X 6 BLOCK CESSPOOL ' overflow cesspool, number: n/a innovative/alternative system -j,, Type/name of technology: n/a Comments(note condition of soil,signs of hydraulic failure, level of ponding,damp soil,condition of vegetation,etc.): OVERFLOW IS FULL.SAS NEEDS TO BE UPGRADED. CESSPOOLS: (cesspool must be pumped as part of inspection)(locate on site plan) Number and configuration: n/a Depth—top of liquid to inlet invert: n/a Depth of solids layer: n/a Depth of scum layer: n/a Dimensions of cesspool: n/a Materials of construction: n/a Indication of groundwater inflow(yes or no): NO Comments(note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation,etc.): n/a PRIVY: (locate on site plan) Materials of construction: n/a Dimensions: n/a Depth of solids: n/a Comments(note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation, etc.): n/a i 4 Page 10 of I I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 69 WATER GATE LANE WEST BARNSTABLE, MA 02668 Owner: HELEN MCCLUSKY Date of Inspection: 7/16/02 SKETCH OF SEWAGE DISPOSACSYSTEM 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. SUNROOM � 8 Nkl�2 e 0 s s 'r in Page 1 1 of I 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 69 WATER GATE LANE WEST BARNSTABLE,MA 02668 Owner: HELEN MCCLUSKY Date of Inspection: 7/16/02 SITE EXAM _Slope �. _Surface water _Check cellar Shallow wells Estimated depth to ground water 10+feet Please indicate(check)all methods used to determine the high ground water elevation: NO Obtained from system design plans on record-If checked,date of design plan reviewed: n/a YES Observed site(abutting property/observation hole within 150 feet of SAS) NO Checked with local Board of Health-explain: n/a NO Checked with local excavatois, insfallers-(attach documentation) NO Accessed USGS database-explain: n/a You must describe how you established the nigh ground water elevation: HAND AUGER- 10+FT. =F 11 i/'. 1 ASSESSORS MAP : ! - -_- --__.- ___-_-------_----__-- - TEST HOLE LOGS PARCEL: --___"__o J7 . _____- _ NOTES: FLOOD ZONE: P- k}p�L�(� � SOIL EVALUATOR : ofiYir) M�a ICS� WITNESS : �.WUI(, •"�i l: REFERENCE: _ � - �3v' � _?7 DATE: r, ZOC7 1) The xnsta,�at:on shall comply with Title V and Town of Barnstable Board of / �•� ' PERCOLAT ION RA E: iL ►I'll Health .*Iemdations. q2 1 I f,. ` L 31� 2) The installer shall verii�f the location of utilities, sewer inverts and septic fG ff 7 -Y' � components prior to installation. - �- TH-- I TH-2 3) All septic pij;ing to be 4 inch Sch 40 PVC at 1/8"per foot. Y 5 4) Existing leach pits to be pumped and backfilled per Title V abandonment v, / /• Ib procedures. 5 t,obcvnM .— 5) This plan is :;aot to be utilized for property line determination nor any other � I purpose other than the proposed system installation. LC � Nb I 6) All septic components must meet Title V specifications. LOCATION MAPC �, ) lJ�� � � I �l 1T 7) Parking shall not be constructed over H10 septic components. 8) The property is bounded by property corners and property lines as depicted. l 9) The property owner shall review design considerations to approve of total number of bedrooms to be considered for design. Receipt of payment for the plan and installation based on the plan shall be deemed approval of the number of bedrooms. ( j ,i Z (a I Z :t 10)Existing wel, location based on best available information. If the well is less than ` A 2��0 U�L {. 1.1 150', the well is to be moved 150' away. dK. Ar t 1) g 1 Excavate 5' around SAS and below to approx. elevatio 30.1/Med. Coarse Sand -'�- 1 =--- and fill with clean washed sand per Title V specifications. S E P T 1 ( SYSTEM DESIGN 12)Existing tank- to be utilized if the tank is a minimum of 1000 gallons. Size is to be Alt` verified at tirie of installation. If less than 1000 gallons a 1500 gallon tank is to be installed. ` FLOW EIT1MATE l I / BEDROOMS AT 110 GAL/DAY/BEDROOM - GAL/DAY__ SEPTIC TANK 1 - -- l �j17 GiiL/DAY x 2 DAYS - WD GAL T USE ICOb GALLON SEPTIC TANKW (6-UACOL WT A(5-) 01L XISORPT:ON SYSTEM 2 ° 3' x�x o, �} - lay. x i'DE AREA: xC -F- I 51 . . OTTOM AREA: Z`1 1J 0 Z?l�►C�g i SEPT I SYSTEM SECT I ON \, / ✓✓ \T YZ V) fcJ2 of fWHD 7�00 Jl a PV o0 /oOC7 GAL ,I SEPTIC TANK \ �' • �`� ti �JS V. S 1 TE AND SEWAGE PLAN 0 0 G DO 1 b joss L.00AT I ON : �,� �� ` r `—� � 2_,,,¢ .. ) a��' T ,,q� _ Y� (J✓� �• " G��1f 1�':�h ✓�'L� � ■"1' t (� f PREPARED FOR : _ 4ki'l "GC,t�Yj�L �Viv✓� M W�1�( F SCALE: 0 DAV I D B . MASONRY DATE:a \ DBC ENVIRONMENTAL DESIGNS z EAST SANDWICH . MA W 1A � DATE HEALTH AGENT ( 508) 833- 2 1 77 W oZ