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HomeMy WebLinkAbout0133 FLEETWOOD PATH - Health 133 Fleetwood Path Ma tons Mills ', A= 047 - 059 COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS . DEPARTMENT OF ENVIRONMENTAL PROTECTION RECEIVED �o l SEP 0 3 2003 TOWN O B NSTABLE TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION MAP 94�. Property Address: 133 Fleetwood Path PARCEL ; Marstons Mills LOT Owner's Name: Brian Dn f fjz Owner's Address: Date of Inspection: X-- 2--7- 473 Name of inspector:(please print) Wi l 1 jam F_ • Robinson Sr. Company Name: William E. Robinson Septic Service Mailing Address: P O Box 1089 Centerville, MA Telephone Number: ( 508) 775-8776 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 Ito Section 15.340 of Title 5(310 CMR 15.000). The system: p/Passes Conditionally Passes Needs Further Evaluation by the Local Approving Authority Fails Inspector's Signature: , i a Date: The system inspector shall submit a copy of this 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 approxing authority. Notes and Comments ****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. Title 5 Inspection Form 6/15/2000 page I I - Page 2 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 133 Fleetwood Path Marstons Mills Owner. Brian Duffy Date of inspection: Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. Syste asses :- 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. i Comments:._ ~ B. System Conditionally Passes: One or more system components as described in the"Conditional Pass"section need to be replaced or repa ed.The system,upon completion of the replacement or repair,as approved by the Board of Health,will pass. Answ r yes,no or not determined(Y,N,ND)in the for the following statements.if"not determined"please expla' . pe septic tank is metal and over 20 years old*or the septic tank(whether metal or not)is structurally unsoudd,exhibits substantial infiltration or exfiltration or tank failure is imminent.System will pass inspection if the exist tank is replaced with a complying septic tank as approved by the Board of Health. •A medal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance indicat ng 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 obstru ed pipe(s)or due to a broken,settled or uneven distribution box.System will pass inspection if(with approv 1 of Board of Health): broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced ND explain. 'e restem s required y q d pumping more than 4 tunes a year due to broken or obsisL�cted pipe(s).The system will pass inspe tion if(with approval of the Board of Health): broken pipes)are replaced obstructinn is removed ND cxplai Page 3 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 133 Fleetwood Path Marstons Mills Owner: n Duffy Date of Inspection: z5:sg.'7— U 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 fa ing 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 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 SAS and the SAS is within 50 feet of a private water supply well. _ 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 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: 3 Page 4 of I 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) PropertyAddress:133 Fleetwood Path Marstons Mills Owner: Brian Duff Date of Inspection: 8" D. S stem Failure Criteria applicable to all systems: You ust indicate"yes"or"no"to each of the following for all inspections: Yes o 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 /z Liquid depth in cesspool is less than 6"below invert or available volume is less than' 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 I00.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. (This system passes if(lie 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 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 forma (Yes/No)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: T be considered a large system the system must serve a faci!ity with a design flow of 10,000 gpd to 15,000 gP Yo must indicate either"yes"or"no"to each of the following: (Th following criteria apply to large systems in addition to the criteria above) yes no the system is within 400 feet of a surface drinking water supply the system is within 200 feet of a tribunary 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 y u have answered"yes"to any question in Section E the system is considered a significant threat,or answered "ye "in Section D above the large system has faikd.The touter a.r operator of mry large system considered a Sig 'ficant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.3 4.The system owner should contact the appropriate regional office of the Department. 4 Page 5 of l l OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 133 Fleetwood Path _Marstons Mills Owner: Brian D lffy Date of Inspection: 17 G 3 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? 1//Have large volumes of water been introduced to the system recently or as part of this inspection?. t,/�Were as built plans of the system obtained and examined?(If they were not available note as N/A) C� 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 th.e 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: Yes .no 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(3)(b)] 5 Page 6 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 133 Fleetwood Path MarGtnnG Mills Owner: Date of inspection: —X' — U 3 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): 3 Number of bedrooms(actual): DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): '�U Number of current residents: Does residence have a garbage ' der(yes or no):/1-U Is laundry on a separate sewage system(yes or no):6,0[if yes separate inspection required] Laundry system inspected(yes or no):A.— Seasonal use:(yes or no):_.4,,_v Water meter readings,if available(last 2 years usage(gpd)): 2 0 01 -1 0 2,0 0 0 Sump pump(yes or no): ti 0 2 0 0 2—1 7 8,0 0 0 Last date of occupancy: $fir(33 COMMERCIA NDUSTRIAL Type of establis ent: Design flow(base on 310 CMR 15.203): gpd Basis of design fl (seats/persons/sgft,etc.): Grease trap prese t(yes or no):_ Industrial waste olding tank present(yes or no):_ Non-sanitary ste discharged to the Title 5 system(yes or no):_ Water meter eadings,if available: Last date occupancy/use: OTHER scribe): ` GENERAL INFORMATION Pumping Records Source of information: Was system pumped as part 6f the inspection(yes or no):/1,0 If yes,volume pumped:__gallons--How was quantity pumped determined? Reason for pumping: TYP, !OF SYSTEM _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 ob_tained from system owner) _Tigbi tank Attach a copy of the DEP approval Other(describe): Approximate age of all components,date installed(if known)and source of information: X-S Were sewage odors detected when arriving at the site(yes or no): 6 Page 7 of I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMMATION(continued) Property Address: 1_33 Fleetwood Path Marston Mills Owner: Rr i an 111if f Dale of Inspection: $^ 7— 03 BUILDIN EWER(locate on site plan) Depth below ade: Materials of onstruction:_cast iron _40 PVC_other(explain). Distance Go private water supply well or suction line: Comments( n condition of joints,venting,evidence of leakage,etc.): SEPTICt✓TASK._(locate on site plan) yy Depth below grade: 14 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: ( -t (� J• �— Sludge depth:_ yI- Distance from lop of sludge to bottom of outlet tee or baffle: Scum thickness: I ' t Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or battle: j�r How were dimensions determined: O 1Pi'� Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,eetc.): ,/ GREASE RAP:_(locate on site plan) Depth belo grade:_ Material of a nstruction:_concrete_metal_fiberglass_polyethylene other (explain): Dimensions: Scum thickne s: Distance frorr top of scum to top of outlet tee or baffle: Distance frorr bottom of scum to bottom of outlet tee or baffle: Date of last p mping: Comments(o pumping recommendations, inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to utlet invert,evidence of leakage,etc.): 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: 1 3 3 F 1 6et-.wnnri Path Marstnncz M; li � Owner: lari an Di-1ffv Date of lospectiom_gr^xz7_n 3 TIGIIT or HOLDING TANK: (tank must be pumped at time of inspection)(locate on site plan) Depth below grade: Material of constructi n: concrete metal fiberglass_polyethylene other(explain). Dimensions: Capacity: —gallons Design Flow: allons/day Alarm present(yes o no): Alarm level: Alarm in working order(yes or no): Date of last pump' Comments(condition of alarm and float switches,etc.): DISTRIBUTION BOX (if present must be opened)(locate on site plan) Depth of liquid level A ve outlet invert: Comments(note if box•s level and distribution to outlets equal,any evidence of solids carryover,any evidence of leakage into or out of b x,etc.): PUMP CHAMBER: (locate on site plan) Pumps in working order yes or no): Alarms in working ordc (yes or no): Comments(note Condit on of pump chamber,condition of pumps and appurtenances,etc.): 8 Page 9 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 1.33 Fleetwood Path Marstnns Mi11S Owner: Brian D r is uf f � �_— Date of Inspection: SOIL ABSORPTION SYSTEM(SAS): (locate on site plan,excavation not required) If SAS not located explain why: Type s. 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.): ✓ CESSPOOLS. (cesspool must be pumped as part of inspection)(locate on site plan) Number and config ation: Depth—top of liquid o inlet invert: Depth of solids layer: Depth of scum layer: Dimensions of cesspo I: Materials of constructi n: Indication of groundw ter inflow(yes or no): s Comments(note condi ion of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): PRIVY: (locat on site plan) Materials of cons tion: Dimensions: Depth of solids: Comments(note ondition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): 9 Page 10 of I 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 1 3 3 Fleetwood eetwood Path Marctnnc Mi11g Owner: Rri an niiffc7 Date of Inspection: 6-1.7—4r 3 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. �1�3 v J� a 10 Page 11 of I I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address:133 Fleetwood Path Marstons Mills Owner. Brian puffy Date of inspection: —;-7- Q'3 SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water feet Please indicate(check)all methods used to determine the high ground water 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: 0 617 Checked with local excavators,installers-(attach documentation) Accessed USGS database-explain: You must describe how you estabiished the high ground water elevation: 11 U TOWN OF BARNSTABLE Op A a# ✓ LOCATION SEWAGE # VILLAGE /KQ y7�4 CIS ASSESSOR'S MAP & LOTC�J'.-�0 INSTALLER'S NAME & PHONE NOS rV61(}94 `"02n. � SEPTIC TANK CAPACITY /`AV Q LEACHING FACILITY:(type) NO. OF BEDROOMS PRIVATE WELL UBLIC WATER BUILDER O OWNER ! / DATE PERMIT ISSUED: ;���/195� DATE COMPLIANCE ISSUED: 4f- - VARIANCE GRANTED: Yes No ��� o-� �; � � �� � . , � �' i .� �� 0 (r7 -OS? C Fa$.....�. cl........... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Appliration for Diripoiul Work Towitrurt"ion ramit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: , ..•�3 7-�� �11�1 ------------------•--_-_--------•-----•-----1 LY------------__---------_______--__-_--- S• or Lot No. d. ..�� , lr. g4 n�ds� ..w. 7. _ :?..rr ._....._ y _, ,14 Onncr �-nr er- 70�s_C�J�/ ns �A Installer Address .r7C C d Type of Building Size Lot..GG_--:,t._:-..___•__•-_...Sq. feet Dwelling—No. of Bedrooms--------------------------------------------Expansion Attic ( ) Garbage Grinder (A�O aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) 04 Other fixtures ----------------------------------- ------------------------ ----.--..--------•----------------•-----•---._•__------_----. d -_gallons per r Total dail w-- W Design Flow............... g� P P� � de1Y }'� Q 'ply WSeptic Tank—Liquid capacitvl gallons Length _..... ..... Width.`------- Diameter----------------- Depth....?..... tal x S Trench—�/•-_ /Diameter idthl•�--- Depth obelowinlet.._......&...... Total area.JZ�.� ft. Disposal ✓ Lengthg q � Seepage Pit No-- _ p g sq. Other Distribution box ( ) Dosing tank �) c a, cz 0.4 a Percolation Test Result Performed b `-_l.`.�..5 ��' �� ��— �" Z c� I Y--- -•- --....�-�it-------------- Date------ -------..�1..._.....;,. 4 Test Pit No. I................minutes per inch Depth of Test Pit._.__-__��_ .----- Depth to ground water_�'.l�_.��.- Gi. Test Pit No. 2..G -...minutes per inch Depth of Test Pit--.l. .Z:___. Depth to ground water.�71Z ?........ 94 ..............?---------------•-----• . --...........--........... e......... ..j.'r-..............•--••-- 0 Description of Soil. ��-• .�.. `� L L y...... 0�) S�' z of,,Soil ---------- > 7 -` 9� d -------- 61 W UNature 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 TITLE 5 of the State Environmental ode—The undersigned further agrees not to place the system in operation until a Certificate of Compliance a be iss d the,,bjzrd of health. Sined ......... ............. -------- -------- .............._............................ ............ ...............�/...... �: re ` Application Approved ............ Ihre Application Disapproved for the following reasons: .... ....................... .............................................................................. ............. .............................................. -- ... .............. . ...... ... . ............................ .. . .............................. ........................................ U Permit No. ....C7---..1. ._2 ` //............. ..... Issued ........................................................ .....................Dace............ Dare LfOS<? '6 C N 0--.'/... ....... FEz.....lo..............o .. ......... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Appliration for Diripwml Worbi TowAr' urtion romit Application is hereby made for a Permit to Construct (V) or Repair an Individual Sewage Disposal Sy§tern at: 4t / �7 7 ................................................................................................. ................................................................................................. LOCI 1'011­�l id or Lot No. ... . ...... ....- -_----------- 0v�.(&Itl................. Dal ------------------- --------------------------------- I Address "'JA/Z'Fa L ' Cr _61&777 -0 44� 44 L.S ................................................................................. ............... 7c�----(............................................................................... Installer Address Type of Building Size Lot-.O.O r,.C/r_07__P..Sq. feet U ............... �_4 Dwelling— No. of Bedrooms............................................Expansion Attic Garbage Grinder (/-t)/U 14 aOther—Type of Building ............................. No. of persons........................--- Showers Cafeteria Otherfixtures ----------------------------------- ........................................................................................ Design Flow................ ................gallons per -3, -3 peE5o_u_j)I;r day. Total daily flow.............................9...........g�allons. 04 Septic Tank—Liquid capacitv�_�_' gallons Length_,'�-'_h..'.. WidthJ.../-0--- Diameter... ............ Depth_.S.Y' Z Disposal Trench—No. .................... Width........_._..__.__.. Total Length.-...._............. Total leaching area....................sq. ft. Seepage Pit No........./........ Diameter........ Depth below inlet_........&...... Total leaching area.._3 t.Z sq. ft. Z Other Distribution box Dosing tank Percolation Test Results Performed by..... *.......... .... Date....Y-/Z. ........ ............ .. Test Pit No. I....4..Z- ..minutes per inch Depth of Test Pit_-___ ... Depth to ground water._1;?7../X9__/'. 44 Test Pit No. ..._minutes per inch Depth of Test Pit---- Depth to ground water_/_T_2../."_ ............................................................................... ................. ----------- 0 Description of Soil..�42.- /VY .............................................................................. U .........................................................................7.......................---------------- .................................. W ....................................................................................................................................................................I.................................... 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 TITLE 5 of the State Environmental Code —The undersigned further agrees not to place the system in operation until a Certificate of Compliance h,a4,$ been issued by theboard of health. Signed ......... .... .......5 ..... ............... Due Approved- ............................................................Application Ap Application Disapproved for the following reasons: ......................................................................................... ............................................................................................................................................................................................................ ........................................ Dare PermitNo. .............................. Issued .................................................................... Dace THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Certifirate of Compliance THIS IS TO CERTIFY, That_tbe-I.nd-iv idual Sewage Disposal System constructed or Repaired Repaired .. by ............A............... -- -------- -------------- ---- ------------------------------------------------------------------------ . at .......... - - ------------------------------------- --------------------------------------- .. .. has been installed in accordance with the provisions of TITLE 5 of/The State Environmental Code ased�e ,�.Vd in X2the application for Disp I -psal Works Construction Permit No. ............. dated .......fS THE ISSUANCE�PF THIS CERTIFICATE SHALL NOT E CONSTRUED AS A GUARANtEETHAT THE SYSTEM WILL FUNCTION SATISFACTORY. ..............DATE...........A<............. Inspector ....... �' ---------------------- THE COMMONWEALTH OF MASSACHUSETTS- ZEIOARD OF HEALTH 9 N ..o7Z .........-2 TOWN OF BARNSTABLE .... FEE-....................... Permission is hereby granted.................... ........... ............................................................ to Construct or Repair. an Individual'idual Sewage D* al System 'I :�� �t �ff 15------ ----------------------------------------------------------------------------- at No..... --------- ------- v, ._ .'-P I Street as shown on the application for Disposal Works Construction Permit No Dated-__-- .............. -----------------*.......... ..................................................... DATE.................... C;7 Board of Health --------------------------- FORM 38508 H0198S&WARREN.INC..PUBLISHERS APPLICATIC-)N FGR TEST` A:"'l) C S ERVATI.OI., PITS ,OCATION C- C`-% f/ C-� or�:�,v a NNoe- 'ILLAGE c ,fir 'uS / /� DATE .PPLICANT ,�/_�7 V14-S Co Ci �, tea% S FEE ,DDRESS/ �� ,TELEPHONE NO. (Non-refundable) ;NG WEER . ��/�=c��7Z /v c TELEPHONE )A S HEDULED �6AF —/ , /T C / < (A plic nt s signature . O O O O O . O . O O O O O . . . . . . . O O O . O . . . . . . . . O . . . . . . . . . . . . O . . . . . . . . . . O . . . . . . . . . . . . . SOIL LOG 6UB-DIVISION NAME �X_ V'\7- DATE ` 2/ C2 TIME 0� rXPANSION AREA: YES VINO OuD L G!�ELLE�. ,�/JG ENGINEER 'OWN WATER PRIVATE WELL ;( j=;/ BOARD OF HEALTH _T EXCAVATOR KETCH: (Street name,etc. I dimensions of lot, exact location of test holes and percolation tests, locate wetlands in proximity to test holes ) NOTES: / A co f � ` N O / qj , �r i / ERCOLAT ION RATE: <�_11 'EST HOLE NO: -�- LEVATIOi`: -- TEST HOLE_ NO: ELEVATION: 2 2 5 5 L- 6 6 7 7 8 1 8 9 9 10 C c i,(}� S�f iJ t� 10 11 11 12 l /�! .� 12 13 13 14 /vo Gc��%�� 14 15 C/JC0�1 15 16 16 UITABLE FOR SUB-SURFACE SEWAGE : LEACHING FIELD LEACHING PITS LEACHING TRENCHES NSUITABLE FOR SUB-SURFACE SEWAGE . REASONS : OTE : ENGINEERING PLANS MUST SHOW NUMBER ASSIGNED ON PERC TEST APPLICATION F,IGINAL: COMPLETED IN ENTIRETY BY P . E . AND RETURNED TO BOARD OF HEALTH F ;,T`; BY z:PPT..ICAN'T 20 FT. MINIMUM SOIL TEST TOP OF FOUNDATION DATE OF SOIL TEE T P� L- 26 ELEV. _ ._, 10 FT. MINIMUM CLEAN SAND WITNESSED By136 _ TE PERCOLATION RATE -5 1-- UIN.,ANCH. V�R� C SCHEDULE 40 PVC PIPE 2" LAYER of 0J3S'ERVATION HOLE 1 OBSERVATION HOLE 2 - MIN. PCTCH 1/6" PER FT. 1/r TO 1/2 ELEV.= p.Ev.=.,9 7 WASHED STONE 0". ry Q " 12 MAX. TOP AND � 4 CAST IRON PIPE ' - (OR EQUAL) MAN�tUM 30'�� PITCH 1/4" PER FT. C v•4! > FLOW LINE ,4 10 rf o '.__. l , r.v ELEV. ELEV MIN. 19" ELEV. _ � . ;� . . o a (C. ,r- 2 p o o �� 1 LEVEL ELEV. o 00 = ELEV = O 00l p ob ° p WATER AT-L.Ky— EL.- 5'!� WAA770 ATE EL= i DDISTRIBUTION ELEV. _ �,G� p ° ° 1D ° DESIGN CALCULATIONS 3/4" TO 1 1/2" 000 v p 17 B O X WASHED STONE 00 m-O ° 1� NUMBER OF BEDROOMS TO BE WATER TESTED ° O a". _ _.._._. GARBA©E DISPOSAL UNIT 1000 G A L L aN IF MORE THAN ONE OUTLET o TOTAL ESTIMATED FLOW SEPTIC TANK J , ( —UP—GAL/BR./DAY x _ BR.) GAL./DAY PRECAST LEACHING 6' DIA. 3 REQUIRED SEPTIC TANK CAPACITY GAL. BASIN OR EQUIV. - ' ACTUAL SIZE OF SEPTIC TANK GAL. I ZONE LEACHING AREA REQUI I2. 01,Y INDEX SIDEWALL AREA 7 GAL/S.F. SEWAGE DISPOSAL SYSTEM PROFILE �� ADJ"ST----- BOTTOM AREA GAL./S.F. � ��- NOT TO SCALE LEACHING CAPACITY (BOTTOM + SIDEWALL) _ GAL/IDAY BOTTOM OF TEST HOLE OR USES PROBABLE WATER TABLE ELEV. = ��' � RESERVE LEACHING CAPACITY GAL/DAY OBSERVED WATER TABLE ( / / ) ELEV. = f 1. AU WOINWANSHIP AND MATERIALS SHALL COWORM TO D.E.P. TITLE 5 AND THE TOM OF 1V R^''f 718iL 4r RULES AND LEGEND: REGULATIOW FOR THE FACE DISPOSAL OF SEWfAGE. EXLSTWG SPOT ELEVATION -- 2. ALL COVERS TO SANITARY UNITS SHALL BE BROUGHT TO EXISTING CONTOUR ----00---- WITHIN 12 OF FINISHED GRADE." FINAL SPOT,ELEVA71ON t 3. EXISTING AND FINAL GRADES SHALL REMAIN ESSENTIALLY THE SAME. G y' FINAL CONTOUR 4. ALL COMPONENTS OF THE SANITARY SYSTEM SHALL BE CAPABLE OF SOIL TEST LOCATION VIA'IMSTANDING H-10 LOADING UNLESS THEY ARE UNDER OR W11 MI UTILITY TOWN WATER �W-0- 10 FT. OF DRIVES OR PARKING AREAS. H-20 LOADING SHALL BE 1. L' , / 1 USED UNDER OR W[11�11N 10 FT. OF DRIVES OR PARKING AREAS. 1 CATCH BASIN Q!" 5. ANY MASONARY UNITS USED TKO BRING COVERS M GRADE SHALL BE MORTARED IN PLACE S. NO DETERMINATION HAS BEEN MADE AS TO COLD LMCE VAIH OBTAINT IS TO SUCH DETERMINATION 'FROM APPRO/PRIAA EU A wUTHORITY. J !ig Eb ro� 7. �Q ✓ �� ' "d r, 1 ... - 'i fir' �'� ft p'G- � t, 1. SHORT .. APPROVED: BOARD OF HEALTH 41 rY t DATE AGENT PROPOSED PLOT PLAN t /� , FOR �y PRQECT LOCATION L v W. Qvi I PR � Fr 385-6478 02660 '/. SCALP �� : �� i-,-_.... p/�'� �'/�iQ � Z G �✓ �� LOCATION MAP ] j [" No-0927-4=o / OF