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HomeMy WebLinkAbout0006 CONAUMET ROAD - Health 6 Conaumet Road Marstons Mills 1 A= 101-0.97 �t a AO.0 . Copy rz.. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 6 CONAUMET RDDY Property Address JOE DELUCA Owner Owner's Name information is required for MARSTONS MILLS MA 02648 6/21/08 every page. _ City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Important: A. General Information When filling out forms on the computer, use 1. Inspector: only the tab key to move your JASON BURNIE cursor-do not Name of Inspector use the return key. BLUEWATER SEPTIC Company Name 350 MAIN ST Company Address YARMOUTH MA 02673 City/Town State Zip Code 508-775-2800 - Telephone Number License Number B. Certification 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 M340 of Title 5 (310 CMR 15.000). The system: ® Passes ❑ Conditionally Passes ❑ Faits i= •... t ^sw N`�����ttunuin,,� r ❑ Needs Further Evaluation by the Local Approving Authority `, `��c .(F�gss!�,N ' ego;• JA ON G% 6/21/08 = BU NlE Inspector's Sign Date z � r►1 TIF�� The Sy ste inspector shall submit a copy of this inspection report to pQ'rS ority(Board of Health or DEP)within 30 days of completing this inspection. If the sys riflal `'red 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. ` ****This report only describes conditions at the time of inspection and under the conditions of use At that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. NewT5doc.doc•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 15 1 t ti Commonwealth of Massachusetts 4 Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 6 CONAUMET RD Property Address JOE DELUCA Owner Owner's Name information is required for MARSTONS MILLS MA 02648 6/21/08 every page. City/Town State Zip Code. Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: W ® 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: go System fully meets pass criteria. B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass"section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Answer yes, no or not determined(Y, N, ND) in the ❑ for the following statements. If"not determined," please explain. ❑ The septic tank is metal and over 20 years old* or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND Explain: ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ obstruction is removed DELUCAdoc•03108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 15 t 5 Commonwealth of Massachusetts - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 6 CONAUMET RD Property Address JOE DELUCA Owner Owner's Name information is required for MARSTONS MILLS MA 02648 6/21/08 every page. City[Town State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes (cont.): ❑ distribution box is leveled or replaced ND Explain: ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ obstruction is removed ND Explain: C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. DELUCA.doc•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 15 t Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System.Form -Not for Voluntary Assessments 6 CONAUMET RD Property Address JOE DELUCA Owner Owner's Name information is required for MARSTONS MILLS MA 02648 6/21/08 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) C) Further Evaluation is Required by the Board of Health (cont.): ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for coliform bacteria indicates absent 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: D) System Failure Criteria Applicable to All Systems: You must indicate"Yes" or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool El ® Liquid depth in cesspool is less than 6"below invert or available volume is less than Y2 day flow ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. NewT5doc.doc•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 15 I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 6 CONAUMET RD Property Address JOE DELUCA Owner Owners Name information is required for MARSTONS MILLS MA 02648 6/21/08 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) D) System Failure Criteria Applicable to All Systems (cont.): Yes No ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of.a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes.if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent 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 and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large 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. For large.systems, you must indicate either"yes"or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA) or a mapped Zone II of a public water supply well If you have answered "yes"to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. NewT5doc.doc-03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 6 CONAUMET RD Property Address JOE DELUCA Owner Owner's Name information is required for MARSTONS MILLS MA 02648 6/21/08 every page. City/Town State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes" or"no" as to each of the following: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? . ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ❑ ® Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ❑ ® Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] DELUCA.doc-03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 15 l Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �,. 6 CONAUMET RD Property Address JOE DELUCA Owner Owner's Name information is_required for MARSTONS.MILLS MA 02648 6/21/08 every page. City✓Town State Zip Code Date of Inspection D. System Information Residential Flow Conditions: Number of bedrooms (design): unknown Number of bedrooms (actual): 2 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): unknown c Number of current residents: Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? (if yes separate inspection required] ❑ Yes ® No Laundry system inspected? ® Yes ❑ No Seasonal use? ❑ Yes ® No �- � P Water meter readings, if available (last 2 years usage (gpd)): C�� 1 � i°� & Sump pump? ❑ Yes ® No current Last date of occupancy: Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap-present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: Last date of-occupancy/use: Date Other(desc-ibe): DELUCAdoc-03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 15 Commonwealth of Massachusetts F Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments w 6 CONAUMET RD Property Address JOE DELUCA Owner Owner's Name information is required for MARSTONS MILLS MA 02648 6/21/08 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) General Information Pumping Records: BLUEWATER SEPTIC-PUMPED DURING Source of information: INSPECTION Was system pumped as part of the inspection? ® Yes ❑ No. If yes, volume pumped: 1000 gallons How was quantity pumped determined? PUMP TRUCK Reason for pumping: MAINTENANCE Type of System: -!� ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ (N0) 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) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): Approximate age of all components, date installed (if known) and source of information: OWNER HOUSE BUILT IN 1984 Were sewage odors detected when arriving at the site? ❑ Yes ® No DELUCAdoc-03108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 15 I Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 6 CONAUMET RD Property Address JOE DELUCA Owner Owner's Name information is required for MARSTONS MILLS MA 02648 6/21/08 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Building Sewer(locate on site plan): — Depth below grade: vo- 17"feet Material of construction: ❑cast iron 0 40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet - Comments (on condition of joints, venting, evidence of leakage, etc.): Building sewer is in good condition. No evidence of leakage. Septic Tank(locate on site plan): Depth below grade: -�-10 12 11 feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No ------------------------------ ----------------- ------------------- ------------------------------------=---------------- Dimensions: 1000 Sludge depth: 0 Distance from top of sludge to bottom of outlet tee or baffle 27" Scum thickness 0 Distance from top of scum to top of outlet tee or baffle 7" Distance from bottom of scum to bottom of outlet tee or baffle 17" How were dimensions determined? Sludge Judge DELUCA.doc-03108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 6 CONAUMET RD Property Address JOE DELUCA Owner Owner's Name information is required for MARSTONS MILLS MA 02648 6/21/08 every.page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): --� Inlet and outlet tees are in good condition. No evidence of leakage in or out. Tank appears to be structually sound. Liquid level is normal. Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank tank must be pumped at time of inspection) locate on site plan): 9 9 ( P P P ) ( P ) Depth below grade: Material of construction: ❑ concrete El-metal ❑ fiberglass ❑ polyethylene ❑ other(explain): DELUCAdoc•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 6 CONAUMET RD Property Address JOE DELUCA Owner Owner's Name information is required for MARSTONS MILLS MA 02648 6/21/08 every page. CitylTown State Zip Code Date of Inspection D. System Information (cont.) Tight or Holding Tank(cont.) Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes 0 No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments(condition of alarm and float switches, etc.): *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 011 Comments(note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): The distribution box was found in good condition. No evidence of solids carryover. No evidence of leakage in or out of box. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No - DELUCA.doc•03108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 15 r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 6 CONAUMET RD Property Address JOE DELUCA Owner Owners Name information is required for MARSTONS MILLS MA 02648 6/21/08 every page. City(rown State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: . Type: -- ® leaching pits number: ❑ 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.): b The leaching pit was found with 2' of standing water in it. Leaching pit is 6'x 6' and is 18" below grade. Bottom of the pit is 7'-6" below grade. DELUCA.doc•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 15 Commonwealth of Massachusetts - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 6 CONAUMET RD Property Address JOE DELUCA Owner Owner's Name information is required for MARSTONS MILLS MA 02648 6/21/08 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No Comments (note condition of soil, 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 of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): DELUCAdoc 03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 6 CONAUMET RD Property Address JOE DELUCA Owner Owner's Name information is required for MARSTONS MILLS MA 02648 6/21/08 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 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. I ' I J i 1 C ` Q P1 b- fir,' C= a e, " 3 i o o D 00D S NewT5doc.doc•03108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form _ Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 6 CONAUMET RD Property Address JOE DELUCA Owner Owner's Name information is required for MARSTONS MILLS MA 02648 6/21/08 every page. CitylTown State Zip Code Date of Inspection Do System Information (cont.) Site Exam: ® Check Slope ❑ Surface water ® Check cellar ❑ Shallow wells Estimated depth to high ground water: -low 14+ feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on.record If checked, date of design plan reviewed: Date ❑ 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-explain: Vp- SDW-252 ZONE B 2-3 WATER LEVEL 46.8 .9 X 12= 11"ADJUSTMENT You must describe how you established the high ground water elevation: FROM GRADE TO BOTTOM OF SAS IT IS 7'6".WE DID AN AUGUR HOLE DOWN TO 14'AND FOUND NO WATER. IF YOU ADD THE 7'6"+A 4' SEPERATION AND THE ADJUSTMENT OF 11" YOU HAVE A TOTAL OF 12'5". YOU ARE OUT OF GROUNDWATER BY AT LEAST 1'6". DELUCA.doc-03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 15 of 15 --- --- 24t' 1 T ----- ---------- ---------- ............. ----------_- r ' I I , ! f I t I I I F I --�- I -I - ( -! --f - -I �-- I- -I -r----i -- - � i I I ---- ---------L ------- ------------ --------- ------------- 1600l --- -------- A-1 &6, t4 to& Pvt ---------- ------ ------------ ------ ------- i.l -_-N��� _Um . Fok It ........ IJY_ cl, J ------ ............ ........ ... .......... ----------- i. ....... F . Regulatory Set-vices BARNSTABLE, : Thomas F. Geiler, Director v 6� `erg, �ArEa �a Public Health Division Thomas McKean, Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 REGARDING SEPTIC INSPECTIONS BY PRIVATE CONTRACTORS DISCLAIMER This septic system inspection report was completed by a private inspector who is certified by the State of Massachusetts, Department of Environmental Protection. Although the Town of Barnstable Health Division received the original or copy of the report; this Division does not warranty the functionality of the septic system in the future nor does this Division agree with any technical observations and interpretations contained within this report. In addition, by receiving this report the Town of Barnstable Health Division does not automatically approve the number of bedrooms listed within this report. The actual number of bedrooms approved at a particular property would be listed on the "Disposal Works Construction Permit".. If you should have any questions regarding this report, please contact the certified Septic System Inspector.who conducted the inspection. Q:ISEPTIMisclaimer Private Septic Inspections.DOC 0(-2D? ✓" LO CAT IO SEWAGE PERMIT NO. � VILLA f .O N� j frc5 6 c 1 • l� � L"'f" E S M A D E S S R UILDER OR OWNER DATE PERMIT ISSUED ,d DAT E COMPLIANCE ISSUED �� / '�Y6 E3 �9C �4 Zs I� ' 9 3 Zg �9 r No14.�.. 2- Fps.. ... ............._ F� THE COMMONWEALTH bF MASSACHUSETTS BOAR® OF HEALTH Town Barnstable ...._._..".................................O F........................ ............... Application is hereby made for a Permit to Construct ) or Repair ( ) an Individual Sewage Disposal System at: Lot # 46 - Black Oak Rd. , Wlarstons Mills I, 11A ................_: __............................-•-•----•-••------------.....------..--•-• -••----••--..-----;••••--........_.....------•--•--........... Loc ti n-A�r ess ............apricorn-Rea�fy 'Trust 765 Falmouth R6ra&#"Oiyannis •.........................•-........----......------• •.....---•-••---.............................................................................. _ Steve Label Owner Address a ................•••._.......••-•......................._....•-•--••.._.....-•---•------•--...... ----••••.....--•-----._......................••-••--•--....................--••••----•-----...•--- Installer Address U .Type of Building Size Lot.................... .....Sq. feet Dwelling—No. of Bedrooms..........................................Expansion Attic ( ) Garbage Grinder ( ) WOther—Type of Building rA;!5 h.............. No. of persons............................ Showers (2 ) — Cafeteria ( ) Otherfixtures .----•----------••------------------------------------.------•-------------•-•------------------...-- 0...... W Design Flow........ :.................1000 gallons per person got day. Totgl iilflow..____._33_.__.____.____.. :._.____._._g cons. WSeptic Tank—Liquid'capacity-._-------,.gallons Length............... Width_........._..... Diameter................ Depth............ x Disposal Trench—No. .................... Widt �..__..._._.._._... Total Length_____._.i .......Total leaching area----- _ _ sq. ft. 6 266 Seepage Pit Not___________________ Diameter..... Depth below inlet............_...._.. Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosin to,,ilke ( ) `" Percolation Test Results Performed bldredge Engineering 11-25-81 by...... .........-- --......................... Date........................................ Test Pit No. 1.2 D......minutes per inch Depth of Test Pit..1............. Depth to ground wate>none encounter— p .. - - ci fz Test Pit No. AN A.........minutes per inch Depth of Test PitP__A_......_.... Depth to ground water../..k.............. N .............•-------....-----..............-------------•-•----•-••------.......---•--------------.......................................................... 0 Description of: Soil......_._0.9.....- 2' loam & topsoil ... ...... ••• ----- x 2' - 10' dium ellow sand -----------•--•-•-••----------- v ..............•--•------•-•-•------------•-•-----........-•-•-•.................................... W 10 - 12 med. white sand traces o� gravel--no water aU• 12 U Nature of Repairs or Alterations—Answer when applicable............................................................................................... ----------------------------•------.......--•-------•------•-•-•--------•---••--•--•-•------•---•--...-----------------------.....-------•---•-••------ ................................. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TIT12 5 of the State S nitary Code— The undersigned ther agrees not to place the system in operation until a Certificate of Complian e has _bjen i>asu d by the board o ealth. igned re...... 2184 3� "D.. -•----------- Application Approved By. ... •---••--•----•--------------••-..............•-••-•--........- Z tea / ......... ri Date Application Disapprov f or he following reasons:... --•-------------------------------------•---------•------••------------••----------------------------- -•-•-•-•••--••••---•.......................•-•-•.....----•-...••--•-••----•--•••-•-•••••--...••-•-........-•-•--•-------...•------•----------•---•-------•------•-------•- Date PermitNo......................................................... Issued................................. Date No.......... ...s - Fns.............................. THE COMMONWEALTH d"F MASSACHUSETTS BOARD OF HEALTH Town Barns t abl e .................... .......------...O F.......................... ......... Appliration for Disposal Murks Tunstrurtion rrinit Application is hereby made for a Permit to Construct (X ) or Repair ( ) an Individual Sewage Disposal System at: .Lot # 1_y6 - Black Oak Rd. , Marstons Mills ;, 14A __.. ... ..........• -•--•- -----........ ....................=----•---------••-------••-----•-..........-••--------..........---•-•--...... Capricorn R� Y°�j�'d ust 765 Falmouth Rdfa- I °-Hyannis • ...... -.................. ......................................... _._......------------.....:--•--•-•-•-......_.._...--•-------•••---------------........__...------ W Steve Lebel Owner Address � Installer Address UType of Building 3 Size Lot----------------------------Sq. feet Dwelling—No. of Bedrooms............................................Expansion Attic jarbage Grinder ( ) Other—Type T e of Building ranch No. of persons............................ Showers '" a YP g -------------• P ( ) — Cafeteria ( ) Othe fixtures --------•-•---•-----•---•-----•- W Design Flow--------------..................1000.gallons per persV,Wy,day. Total,4j16,pow....--------•------------....------...... gi1Rns. WSeptic Tank—Liquid capacity............gallons Length..S............... Width................ Diameter---- Depth._...._...... x Disposal Trench-No..................... Widt�_r.......---_.-.--- Total Length...... Total leaching area...._�S_6____._.sq. ft. 3 Seepage Pit No--_----------------- Diameter.................... Depth below inlet.................... Total leaching area_.:...............sq. ft. Z Other Distribution box ( ) Dosin1­4 -Etlandkredke Engineering 11-25-81 a Percolation Test Res 1ts Performed by.......................................... r Date........................................ .0 1.2 none encounteK- 1.4 Test Pit No. �/A_.......minutes per inch Depth of Test Pit ........... Depth to ground water..,/A...----. --- e fs, Test Pit No. _._-.._.__.minutes per inch Depth of Test Pit--../................ Depth to ground water........................ O Description of Soil- �._... ._fir-r-----•Yoam & topsoil........... .... x Z - 1-0 ------yji idr uri-yellow sariii----------------------------•---------------------•-------------.----------- W ---------------------------------------iP----------1'2-0-------med:---wYi te-_sand/traces---of••gr8:;Vel/YYO---WP:- •1 -at-- 12' . x •----•-----•.......-•••-----••••--•-•-•-----•------•-------•-----••---•-•--••-•--•-----•--------•-------•--•-•-------------•--•••••---•----------•--•-------••-•--•...-••---------.....--------•--...... U Nature of Repairs or Alterations—Answer when applicable............................................................................................... ----•--••-•-----------------•------•----.....---------------------------------------•-••--•--------•----...-•----------------------------------•-------•------=-------------------------•-------•••----- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of T I T iZ 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Complianc has been issued by the board of health. Signed.,: Pr..a. 31� Application Approved By. ....... _l• � ------------------- ------- ------- Date Applica.tion Disapprove for a following reasons-----------------------------•--------------------------•-----------•------------•-•-. --•-------•-•--------••- ......-•----•--••---------------------------•-------•----••----•------•----------•••-•-•-------•-•--------•----•-...• ......•...------ Date PermitNo......................................................... Issued_....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH Town................o F........Barns t abl e .. ..................................•--.............---- %rrtifirate of TI-Im tianr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed (X) or Repaired ( ) Steve Lebel - by........... ....... ............------•----•••.••-- ._..------•----•--•-•-----•-•-----......----------•--• ---------------------•••--...--••--.............-- Installer at Lot _#46__ lack•_Oak._hoe_d,___________________••--__Marstons Mills , VIA has been installed in accordance with the provisions of TI" ri oaf Jhe State Sanitary Cj a, , jt led in the application for Disposal Works Construction Permit No......................................... dated................................................. . THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL U Of. SATISFACTORY. i .....7.....x.,l------------------------•----•---------•---------- Inspect or........(for - = THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH v"� ......Town Barnstable ....................................OF...........................-..... 3 No......................... FEE........................ Disposal Works Tonstrurtion rrntit _.. I Permission is hereby granted Steve Lebel . -••----------------•••-•--.--•••---•-----------•-•--- to Construct (r ) or Repair ( ) an Individual Sewage Disposal System at No......Lot__1 6_._-.... . , Marstons Mills , MA ...... Street as shown on the Iplicatio, for Disposal Works Construction Permit > . Z......... Dated-.-._ ...._.. ........................... .................. ----------•---------------------•---•-----••----••-...--••-....... L/ Board of Health DATE_...._..----- ----........................................................ '_ .. FORM 1255 HOBBS & WARREN, INC.. PUBLISHERS (141 w 60 Soy . ►� _ : - �`y�. lip 5 i 's 7.. Z. J 241:996�Sr / PROP, r✓avpos!4��Asa r 5� y Tn G\ jo, p' F3tiUCECl 1- J I :��o suar� � �-n��: x / • y `4- 147 NO TtU(� . ] O c r,.47i.��/ /S G ost (�✓ i�,.!•+r'j t=-r:.� fh-�.:� N Yr G/i 7�i1 � . �� '� �, � �i 13 g BY G v41 BER6 y a fi LEG END FSS�orrA EXISTING SPOT ELEVATION x0:,.'} CERTIFIED PLOT, PLAN EXISTING CONTOUR --- poNA M/S t FINISHED SPOT ELEVATION FINISHED CONTOUR 0 14'et : ` t Ni/�12S7oN M �v 5 . r: E IN. APPROVED BOARD OF NEALTN 1. . GATE A®ENT :r SCALEi` "r 30 ®ATE�`•:3: r� , y LOREDGE CNQNVEERiNt CQ i CLITrre i CERTIFY THAT THE EWSTERL RE013TEREfl J0® _ISO. 8. UILDIp0 SHO�IN ON TW S 01"1' CIVIL LAND CONFOfFMB TO THE ZONINS ,L AVS EN® E % • t �eR:®Y, ,, - OF BARNSTABL E, MASS. 712 MAI N STREET CK By . H Y A N tV l S,. M A'S S,. /. ,�, � SWLET.1_'OF - ATE ` REA. LAND SURVEYOR .. M//V._ /VOTE /F EITHER THE SEPTIC TANK OR LEAC/+/i�/G PIT .4RE /yORF. THAN /2"BEL0iV JG �. M/,�/• .�rRAOF, � 2ii'�/AM ETEL' COiyfRETE COYER` , SHALL B.F B0006M7' TC GRAOE.CAN EXTRA r� <�o CONG4�E •q OYC P/P� xvEAV y Cif ST //..'ON C L L 8z: USEO CODERS M/v PITCH /F/N OR/VA-- WAY $ ..a••.• �8 oFR FT. d _ CyR•�oE. Cd VER CLEAN SANO BACX,=/L L -�. . UQu/o LEVEL - • 4"'CI1ST a LAYER IRON P/PB GAL. o -alp .b M/N.O/Ttld D/ST. o� • • • • • •• • s •„ WA5"eo 5MNE %4 PBR/rT. SEPTIC TANK B • . • • • • • e • �• _ OX a e • � � ee • e •• � . o •� 314 • • • DEPTH • • • • 0 WA5AFP STGNE `f71�r� i a: • • e e e • •• . o �� PREC/6ST SE.MAIGL'' /N!/� L"LFNAT/OWS. 79 S� 1, - 7� � i. • • • •. • . • • • e a P/7 DR E4u/V. INVERT AT &Z'1 D/JVG (o/.5 FT �Y9 GPI 6 f7:D/AI�t. , . l c FT o/AA0. C(SEE uL.�tr O/v�,< JNL ET .SSE7flT/C TANK ," 40t17LZr SEPTJC TANK AFT; /JVLET D/ST/4/SLOT/DN BOX`jr FT . . ' SECT"/®N 4/r GROUND 1TER Ti4�LE 4 :0U7ZErD/STRIBTl7YOIV'BAiX 6a•7 FT. . /NL ET LEAC///NG. PIT 5 FT, SE1.t/At GE O/Sf0SA L SY.ST'"WM -rAJIJLAWON 4 LCAV/NG P/T oiMENS/ON A ,ArT DES/Cs'/+r CR/TEMIA se.nLE : /s D/�lE�l3/oN so 6°o FT; NtlMSER OF®EDROO/+!S - D/MgNS/O/1/ C q- FT �+Rea�E®/sPoswL uv/r �� SOIL LOG S®/L 7-Ar37' 'I TarAL E3Tt^fATEv FLo*v 336 0.4t.1,0Ay SOIL TFST!ft/ SO/4 7.XrS7-.O•2 A(UMBER QR 4eACXlN& p/TS l fELEK ��a LEY, DATF OR- SOJL TEST Jam- S/OE LEACH/NG DER P/T SOt -r RES(JLTS W1TNE55ED BY F-r 1• J'4C� BOTTOM LE�iG'i,//NG?ER P/T $Q. RT. s L" ` COL AWOW RAT6r At/ < Z AIJA JNCH TOTAL LEACH/WG AM--A 2-47 SQ. FT. sv3s�" PENCOLA770AeRATEA2 MJN�/NCH RESERYE4E4L'N/)V6 AREA 2A.7 SQ. FT. OF LO r 46 RGBEIRT !. P V'4 s BRUCE 0, VV l ERG CA ELDRE \ o sss o � ' ELORED6�EIV&/N.VR/AW.czt j*YC. 7/2MAIN ,57 YANN/9 MASS. NO GROUND yy,4TER AWCOUW7AREo CLIENT, ��0 DATE= s C� GROUND Y✓ATER AT 64Ei/. .IOB N1D. ' ZG� $HST:OP' z i