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HomeMy WebLinkAbout0016 HANE ROAD - Health 16 Hane I ga--c�- J. 151-008.003 . Marstoris i J >r� TOWN F BARNSTABLE �OCATION SEWAGE# VILLAGE ^ _ASSESSOR'S MAP&PARCEL 063 NAME&PHONE NO. \'�4' S SEPTIC TANK CAPACITY O© CJ LEACHING FACILITY:(type) 1 (size) NO. OF BEDROOMS OWNER (� DATE: D COMPLIANCE DATE: ;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) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet FURNISHED BY 2_ 25l T32- Zt b 3 ' lrOM1KONfWEALTH OF MASSACHUSETTS • EXECUTIVE OFFICE OF ENVIRONME DEPARTMENT OF E NTH AFFAIRS PROTECTION lop . OFFICIAL INSPECTION FO TITLE S SUBSURFACE SEWAGE D SPOS NOT FOR LUNTARY MENTS PART A AL SYSTEFORM . CERTIFICATION Property Address: ( �� d d Owner's Name: c' , r `2 Owner's Address. `� M Date of laspection: :# Name of Inspector• le e p nt) } tvt Company Name: S Address: ® � Telephone Number: Q06 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage di below is true,accurate and co 8 disposal system at this address complete as of the ' and that the information r ��B and experience in the Proper hme of the inspection.The ' reported P per function and inspection was performed based on my approved system Inspector pursuant to Section 1�p�Titlef 3site10 sewage disposal s � CMR 15.000 • sys tems,I am a DEP The system: Passes Conditionally Passes Needs Further Evaluation b Fails y the Local Approving Authority Inspector's Signature Date: The system inspector shall su a copy of this inspection report to-the Approving DEP)within 30 days of completing this inspection.If the system is a shared Authority n gpd or greater, the inspector and the system owner shall submit the report to the aor ppropriate ty(Board of Health or DEP.The original should be sent to the system ownera design flow of 1Qhe authority, and copies sent to the buyer, if applicable,oral office r the @ and the approving � Notes and Comments \ij� \ G ""This report only describes conditions at the time of Ins ectto _ time. This Inspection does not address how the system will perform in the future P n and under the conditions of use at that conditions of use. under the same or different Title 5 Inspection Form 6/15/2000 page 1 I OFFICIAL INSPECTION FORM—NOT FOR VOLUN SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A FORM CERTIFICATION(continued) Property Address: (o Owner: Date of Inspec Inspection Summary: Check A,B,C,)or E/AL—WAyj complete Aof Sectlo 0 to uD A. System Passes: „ I have not found any information which indicates tha t any of the 15.303 or in 310 CMR 15.304 exist.Any failure not evaluatedf�ure criteria described in 310 CMR are indicated below. mi6 B. System Conditionally Passes: or more system components as described in the"Conditional Pass"section need to be L repaired. tem,upon completion of the replacement or replaced or 1e air,as approved by the Board of Heal _ th.will Pass. Answer yes,no or not de d(Y,N,ND)in explain, the for the following statements.If'bot detc ' ed" please The septic tank is metal and o 20 years old*or the septic y unsound,exhibits substantial infiltration exfiltration or c tank(whether mettat*not)is structurally existing tank is replaced with a complyingtank failure is imminent. •A metal septic tank will pass inspecti if it is tank as approved by the Bo ofo x a)�, pis motion if the indicating that the tank is less than 20 years old is a totally sound,not le g and if a Certificate of Compliance Table. ND explain: Observation of sewage backup or break out or high tatic ter level in the distri obstructed pipe(s)or due to a broken,settled or one . bution box due to broken or approval of Board of Health): eII distribution box.System will pass inspection if(with broken�pipe(s)are replaced obstruction is removed d'str'ibution box is leveled or replaced ND explain: The system requir pumping more than 4 times a year due to broken or obstructed pass inspection if(wi approval of the Board of Health): d p e(s). The system will broken pipe(s)are replaced obstruction is removed ND exp ain: C Title G i�cnarti - �err Rnn., 4/1,;rnnnn- 2 OFFICIAL INSPECTION FORM- NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: `, Y1 Owner: Date of Inspectio . n2i I p II C. Further Evaluation is Required by the Board of Health: Conditions exist which,require further evaluation by the Board of Health in order to dete is failing protect public health,safety or the environment. rnune if the s Ys tem . 1. System pass unless Board of Health determines in accordance with 310 system is n functioning in a manner which wW protect public heal CMR 15 1)(b)that the health,safety and environment: Cesspool or is within 50 feet of a surface water Cesspool or is within 50 feet of a bordering vegetated wetland or a t marsh 2. System will fail unless the Board of ealth(and Public V� ter supplier,it any)determines that the system L functioning in a manner that pro b the public eal_ t th,safety and environment: _ The system has a septic tank and soil abso do system(SAS)and surface water supply or tributary to a surface wa apply, ) SAS is within 100 feet of a _ The system has a septic tank and SAS the SA within_ thin a Zone 1 of a public water supply. The system has a septic tank and S and the SAS is an ' SO feet of a private water supply well. The system has a septic tank�.nd SAS and the SAS is less private water supply well**.Me used to determine distance 100 feet but 50 feet or more from a "This system asses if the w P ell water analysis,performed at a DFP c bacteria and volatile or c co i d laboratory,for coliform g nfiounds indicates that the well is free from llution from that facility,and the presence of ammo ' nitrogen and nitrate nitrogen is equal to or less than failure criteria are triggered.A copy of the analysis must be attached a this fo pm'provided that no other 3. Other: Tifla i (nona�linn r.nnn�;�<;�nnn 3 f OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION PART A PECTION FORM CERTIFICATION(continued) Property Address: Owner: �p Date of Inspection: p 0� D. System Failure Criteria applicable to all systems: You mi indicat's-Yee or"no"to each of the following for tinspedo : mA Yea No Backup of sewage into facility or system co _., - Disc mpoam due to overl barge or or cesspool of effluent to the surface of the ground or surface w��SAS-_or cesspool _ Jclogged SAS or cesspool to an overloaded or - Static liquid level in the distribution box above outlet invert cesspool _ due to an overloaded or clogged SAS or F Liquid depth is cesspool is less than 6" P�P� g more than 4 below invert or available volume is leas in times in the last year N �n%��Y flow Of times pumped .Xdue to clogged or obstructed pipe($)•Number Any Portion of the SAS,cesspool or Privy is below hi ground water�P Portion of cesspool or privy is within 100 feet of ahsurface water elevation. supply or tributary to a surface -- Any Portion of a cesspool or privy is within a Zone 1 of a public well. �Y portion of a cesspool or privy is within SO feet of a private water Any portion of a cesspool or privy is lest than 100 feet but fly well. . supply well with no acceptable water qualityanal greater than SO feet from a private water performed at a DEP certified laboratory, �� nib system passes If the well water an Indicates that the well is free fromPollutionry'for conform bacteria and volatile organic compounydsls, nitrogen and nitrate nitrogen is equal �than t facility and the presence of are triggered.A copy of the analysis must be attached to this form.] ammonia ppm,provided that no other failure criteria r� (Yes/No)The system faij.I have determined that one or described in 310 CM15.303, therefore the s more of the above failure criteria exist as Health to determine what will be necess Ystem f�'The system owner should contact the Board of ary to correct the failure. E. Large Systems: To be considered a large system the system must serve a facility with a design You must iodic te.either' es"or" flow of 10,000 gpd to 15,000 "Y no to each of the following: (The following criteria ppl, to large systems in addition to the criteria above) yes no _ the system is within 400 feet of a s a dog w t supply _ the system is within 200 feet of a tribu o a surface g water supply _ the system is located in a�u of sensitive area(Interim Wellhead r Zone II of a public wi Supply well lion Area—I1ypq)or a mapped If you have anew F "yes"to any question in Sect' on E the system is cons "yes"insec ' n D above the large system has failed.The owner or operator of any large system signific threat under Section E or failed under Section D shall u g e syste threat,or considered a, 15,3 4.The system owner should contact the appropriate re onal office o e System toe accordance with 310a�R � f the Department. T�fln � fnanoMinn Rn.,,,!JI Q/7Mn 4 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: Owner: Date o[Inspection. p p Check if the following have been done.You must indicate` q"or..no.as to each of the foUowin Y No ._ Pumping information was provided by the owner,occupant;or Board of He alth — Were any of the system components pumped out in the previous two weekb 7 — 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,locates on site? - _ Were the septic tank manholes uncovered,opened,and the interior of the tank of the baffles or tees,material of construction,dimensions,depth of li inspected for the condition Quid,depth of sludge and depth of scum? J _ Was the facility owner(and occupants if different from owner) rovided maintenance of subsurface sewage disposal systems-.? P "with information on the proper P . pr Pe The size and location of the Soil Absorption System(SAS)on the site has been determined based on: Ygs no _ .�(1 _ Existing information.For example,a plan at the Boar_.d_ o. f Health. V Determined in the field(if any of the failure criteria related to Part C is is unacceptable)[310 CMR 15.302(3)(b)] at issue approximation of distance Title 9 lncnnr/inn Fnrm�cil annnn 5 r OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE.DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: Owner: Date of Inspecdo . p O RESIDENTIAL FLOW CONDITIONS Number of bedrooms(design): 3 Number of bedrooms(actual): DESIGN flow based on 310 CNR 15.203(for example: 110 gpd x#of bedrooms) Number of current residents:C_ Does residence have a garbage grinder(yea or no): r\-0 Is laundry on a separate sewage system(yea or no):LA-D [if yes separate inspection required] Laundry system inspected(yea or no):V0 Seasonal use:(yes or no).'V\.-(). Water meter readings,if available(last 2 years usage(gpd)): Sump pump(yea or noy-ro — - Last date of occupancy..ltlC� 't1 COMMERCIAL AWDUSTRIAL, Type 9,f establishment: Design now b(`ased on 310 CMR 15.203): Basis of design flowgseats/persons/sgft,etr;.): Grease trap present(yes dr-no Industrial waste holding tank pr t(yes or no): Non-sanitary waste discharged to the r em yes or no):_ Water meter readings,if available:: Last date of oecupancy/use: OTHER(descn _ GENERAL INFORMATION Pumping Records Source of information: Was system pumped as part of the inspection(yes or no):1Lr� If yes,volume pumped:_gallons—How Reason for pumping: was uanti1r�uiy�t',pumped determined? TYPE OF SYSTEM L,/ Septic tank,distribution box,soil absorption system: _ = _Single cesspool _ _Overflow cesspool Pm,Y —Shared system(yes or no)(if yes, attach previous inspection records, if any) _Innovative/Altemative technology. Attach a copy of the current operation and main obtained from system owner) tenance contract(to be —Tight tank _Attach a copy of the DEP approval _Other(describe): Approximate age of all components,date ipstalled,(if known afd our of information Were sewage odors detected when arriving at the site(yes or no):`�() Ti11s Q Tncn.rtinn Rn—4/1«,)nnn 6 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM' PART C SYSTEM INFORMATION(continued) Property Addresa: Owner: Date of Inspect! BUILDING SEWER(locate on site plan) �� tl Depth below grade: -- Materials of construction: cast iron _J40 PVC_other(eat 1 Distance from private water supply well or suction line: o -\ Comments(on edition o 'oints,venting,evidence of leaka e,etc.): _ SEPTIC TANK:_(locate on site .. - plan) � Depth below grade: r Material of construction:aconcrete_metal fib —other(explain) — glass_,polyethylene If tank is metal list age:_ Is age confirmed by a Certificate of Co certificate) t compliance(yes or no):_(attach a copy of Dimensions: Sludge depth: Distance from top of sludge to bottom of outlet tee or baffle: Scum thickness: \n®yve- - Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of utlet ee orbaffle: 1'r. �' J How were dimensions determined; �� Comments(on pumping recommends ions,inlet and outlet tee or baffle conditioq structural irate as lated to out! t invert,evidence gf leakage,etc.): o integrity,liquid levels GREASE TRAP:_(locate on site plan) Depth below e:_ Material of construe _fiberglass(explain): concrete metal— g _polyethylene_other Dimensions: Scum thickness: _ --- Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outle or baffle: Date of last pumping: --- Comments(on pumping recomPeff tions,Wet and outlet tee or baffle conditioq str�ntelas related to Outlet�rtevlii'deence of leakage, etc.): evels T:►In � fncnn�►inn F'nr.n l.�i�i�nnn 7 c aasv o Ul 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION F PART C FORM SYSTEM INFORMATION(continued) Propert4Address: �k10 � 1 Owner: Date of o TIGHT or HOLDING TANK: (tank must be Pumped at time of inspection)(locate on site plan) Depth below Material of construction: metal . iiberglasa_polyethylene o Dimensions: .e:lplai-iiy--, Capacity. >rallons Design Flow: aaLons/day Alarm present(yes or no): Alarm level: Alarm in workin Date of last pump g:_ (yes or no): Comments(condition of a and float switches,etc.): / DISTRIBUTION BOX: (if present must be opened)(locate on site plan) Depth of liquid level above outlet'inveit Comments(note if box is level and distribution to outlets equal, any evidence of solids c leakage into or O>t of box,etc.):p arryover,any evidence of P CHAMBER:+ locate o J( n site plan) Pumps in working or fY >Fno .._. Alarms in working order(yes or no): Comments(note condition of pump chamber --_"`�—�— J� �onditiomnf'Pumps d-aPPurteuances,etc.): T41. i nrm All j/7nnn a •ob`Y USA l OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY 1 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPEC ON PART C FORM SYSTEM INFORMATION(continued) Property Address: Owner: Date of Inspectlo . SOIL ABSORPTION SYSTEM(SAS): (bate on site plan,excavatlon not regWred) If SAS not located explain why: _ J leaching pig.number: Inching chambers,number• l7 b O 1 f f (o 31 S 3,,ne 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, etc n imp soil.condition of vegetation, \ 1 V CESSPOOLS: (cesspool must be Pumped as part of inspection)(locate on site plan) Number configuration: Depth—top o k d to inlet invert: Depth of solids lay Depth of scum layer. Dimensions of cesspool: Materials of construction: Indication of groundwater inflow(yes or Comments(note condition of soil,signs of hydtaulic failure,level of p-�on"dinegC condition of vegetation ,etc.): PRIVY: (locate on site plan) Materials of construction: Dimensions: Depth of solids: Comments(note ndition of soil, signs of hydraulic failure, Level of pondin condition ikon of vege 4 etc.): Title C incnortinn rnr.n 4/1 9 • Page 10 of l l - OFFICIAL INSPECTION FORM NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM-INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address:, Owner. Date of Inspectio : 130 SXETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at least two permanent refa+ence landmarks or benchmarks.Locate all wells within 100 feet T ocaLe where public water supply eaters the building. t _ - - _ AcL in r r OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: to o Owner: . Date of Inspectio a = SITE EXAM Slope Surface water Check cellar Shallow wells = Estimated depth to ground watery 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.- Checked with local excavators,installers-(attach documentation) Accessed USGS database-explain: . W -ZS-2, Q(�� CS t Y u most describe how you establisheA the hl ground Ater elevatlp : v v T �.IA J T�fla C lncnantinn Rnrm �ii«�nnn 1 l TOWN OF BARNSTABLE LOCATION&' // ,C�/�e S' SEWAGE # VILLAGE/�l�?psys AXIS ASSESSOR'S MAP & LOTXl •60�•D®3 I INSTALLER'S NAME & PHONE NO. r G t4 fi'� 8 !� SEPTIC TANK CAPACITY /�DU ,LEACHING FACILITY:(type) G /".�� (size) NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATERT�� , ! .BUILDER OR OWNER DATE PERMIT ISSUED: ^ 17- DATE COMPLIANCE ISSUED: ' VARIANCE GRANTED: Yes No o • � ,�C®©off-- ©off _ � j No... ...�.. FEz........ ........... THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH TOWN OF BARNSTABLE . ppliration for Disposal lVorks Tonstrnrtion Fermi# Application is hereby made for a Permit to Construct ( ) or Repair X an,Individual Sewage Disposal System � ! ....---.�w. --------------------------- - 5 Lo or N/ ..d ... ! /A• ... ....... .. =�:`.... ��- ✓,a:va`m G s � e er Address ...........I _ ....................................... ��,��.��� `��'...������. Ins t er Address d Type of Building Size Lot............................Sq. feet U Dwelling No. of Bedrooms............................................Ex Expansion Attic a g— p ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) POther fixtures ------------------------------------------------------•-••----------------•-------•-... ............................................................. Design Flow............................................gallons per person per day. Total daily flow.............................................gallons. WSeptic Tank—Liquid capacity............gallons Length................ Width................ Diameter---------------- Depth................ x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No--------------------- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) ~4 -Percolation Test Results Performed by------------------------------------------------••--•-----•------------- Date..........................-............. a ,.a Test Pit No. 1................minutes per inch Depth of Test Pit..................... Depth to ground water........................ �Z4 Test Pit No. 2................minutes per inch Depth of.Test Pit---:................ Depth to ground water........................ 9 --------------------------------------------------------------------------------------------•--•-•••............................ X Description of Soil ......................... x x ..........................-...................................................................................--•------ -- _............ U Nature of Repairs or Alterations—Answer when applicable.__ 1__- 1 G! .._. 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 f ther agrees not to place the system in operation until a Certificate of Compliance een issued t boar f health. n Signed ... ... ..... ....... .. .... .. ........................ ..------ ------ . Application Approved By �. Application Disapproved for the following r ons: ....................................................... ............................ ------ ; -------------------------------- -------------------------------- Date ................... _ PermitNo. ---- ---� ...................... Issued -----�.--��.-- '---- ------...---.......----------- ate { No._ — ....__.... F$s__ 3 THE COMMONWEALTH OF MASSACHUSETTS - BOARD OF HEALTH TOWN OF BARNSTABLE Appliration for Disposal Works- Tufilihvdivit F. mit Application is hereby made for a Po"fnii"to ICoiisti uct ( ),'or, Repair ( an Individual Sewage Disposal System al_Z__ _,Cliff_ _.- ----- Addr �/ /• No.. '_� '� or, ��-�P r er Address � Insta�fer Address U Type of Building Size Lot Sq. feet {-{ Dwelling—No. of Bedrooms--------------------------------------------Expansion Attic ( ) Garbage Grinder ( ) aP4 Other—Type of Building No. of eisons____________________________ Showers YP g ---------------------------- P ( ) — Cafeteria ( ) d Other fixtures -------------------------------------------------------------------------------------------------------------------------------- -� W Design Flow--------------------------------------------gallons per-person per day: Total daily flow------------------------------------------_gallons. WSeptic Tank—Liquid-capacity------------gallons Length---------------- Width---------------- Diameter----------------Depth--------------- x Disposal Trench—No--------------------- Width--------------------Total Length-------------------Total leaching area-------- ft Seepage Pit No--------------------- Diameter-------------------- Depth below inlet------------------- Total leaching area---,---:____-sq. ft. z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by------------------------------------------------------------------------ Date------------_-____--_---_---- a � y ; MTest'Pit No. 1________________minutes per inch Depth of Test Pit------------------- Depth to ground water------------=___________ 44 Test`Pit No. 2----------------minutes per inch Depth of Test Pit_________-_________ Depth to ground water________________________ . x ------------------------------ -- --—---—---------— ODes"tion'of Soil-----------------------------------------------------------=------------------------------------------------------------------------------------------____ - -' 1 -- ----------------------------------------------------------- -----:---------------------------------- ------------------------ ------ W - -- ---------------------------- ------------------------------------------------------------------------------------ -- - ---- - - - - - U Natur of Repairs or Alterations—Answer when applicable__�� �-cam-t---------------------- - -`- ----------------------------- Agreement: 10, 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 n issued t `boar f health. Signed /A d-------------------- --/---- ---------------------- -�----- A lication Approved B B �! PP PP y = _ - - - -� - - - Application Disapproved for the following r ons: - - -------------------------------- - ------- -------------- ---------- -- - ------------- --- --- - - In_ - ----------- Permit No. >~ -- - __ ._ -_- -------_ ---- Issued. . . nun• , THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE (9ertiftrate of (19 X6nre THIS IS T ?C0_ RTIF t the Individual Sewage Disposal System constructed ( ) or Repairedby----------- ----1 ---- 0 at _ -W Q -1�_- t111has been installed in accordance with the Wovisions of TITLE of 7he ate avironmental Code as described in the application for Disposal Works Construction Permit No. Z _ -'"-- __ __ datedTHE ISSUANCE OF THIS CERTIFICATE SHALL NOT &NSTR D AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. - � DATE------------------- 1 ----------------- Inspector ------V -�----------------------------- r THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH -` TOWN OF BARNSTABLE No._ o -- --- — Ebliasalrmw_ T fermit Permission ------------------------------------------------- --- ----- ` to Construct /\j ° 'R ndivid 4_1 at No. -- - - -C. f Q f � � .. _ 1_ - - Street - ----------- /f as shown on the app'cation for Disposal Works Construction No - __!Dated___(_! -— - ---- ----- � - ---------- Board of HeaitPh FORM 365M HOHBS Q MARIUM MIC_PUBLISHERS '•` b s-�,`�4 �ti"���Cx� t.�i tFiir�# '_� i {fir, ' .. ;.: 't..'' tW- • / � I l��Y zj'{ i +T ! S•f'3.` 5�1iy O ^,' '$,f .# - t ,Y 4 � a s `` a s��r 9,�C ;'+"'Gt Fts n. ,a 4�S'� `�5 �:� r-.`. . Y ... • jk Jv- c4 . k sf 01 J 140 { •. c mot'S 0 13 4y \ IZO,i :� f LE.9C y �f 00 �� ; o j _moo i V ZONING DATA z0NE : _ o� ,v LEGEND REQUIRED AREA ' _ _ 435- , � TEST HOLE LOCATION REQUIRED FRONTAGE : ego EXISTING REQUIRED — — �/Sa) 37S� SPOT ELEVATION FRONT SETBACK :, ,30� EXISTING CONTOUR REQUIRED 30' SIDE SETBACK /S PROPOSED CONTOUR REQUI RED' /o'er .� REAR SETBACK : PROPOSED WATER SERVICE - �,`' PROPOSED c Off, PROPOSE D /����' GA3 007- SERVICE ELEC, a TELE ` — E , 3 U I L D I NG INSPECTOR APP ROYAL DATE H. WITN ESSED -,BY T H©n�As /►� �kr.9. / �. ©. ' 5;C AFL E*# E•( ' 2 �ScJG c)/ z F'L 12G,0 24" v_• .. .:�/� FL /2.j,'� ...... . Ic/NE S z —TY >. t 1f�• i``ag' �4 yJ32 FL 1 17,0 132" Z ELEV. TOP OF MANHOLES AND COVER TO BE BUILT TO FOUNDATION WITHIN 12�� OF FINISHED GRADE °B ¢-FINISHED GRADE MIN. 2% SLOPE 4" DIA. - _ 4DIA. PIPE FIRS 2'Ml --- PI P E _ .':'" ;,. MIN.PITCH I FT, 'LEVE 0 _- MIN. 2' LAYER OF MIN ITCH P —�• I� PEASTONE o• O '/ .ww. .8 /4/FT' IN'VE-RT 6"sc INVERT ~ GALLON `� '•.(a N mom• ,� I I /2S,2S' SEPTIC TANK! /2 oct OIST.12'},So '',&13,Sv m . • �4 �2 DIA. .! . 1 N VE R T INVERT Box, o• WASHED STONE • INVERT • .'�� W Q m ' ALL AROUND PLACE ON , r .® W M" /2---►-1 F 1 R M BASE ' �----- 4 ---�•� `� - , °' �1 ®:• BOTTOM A T E L E V. / 2/, 0 I • MIN ` 4, NO GARBAGE <( 2O' MIN.) - Ty GRINDER . 1.¢ 15- ELEV. / / G.o PROFILE OF GROUND WATER TABLE -2 TM SANITARY DI�SPO. S,AL SYSTE M } ( NOT TO SCALE ) t. DESIGN DATA 9, 3 CTION OF `SANITA�RY Dk,SPOSAL" BEDROOMS - SHALL CONFORM TO,.'THE MASS. DESIGN FLOW 33(D GAL/DAY I':`M'E is T A-L C ODE T I T L E TC . � A c � �1 . /I N D T=1=7TI A b T-HE' ' TOWN OF �cACI� 4p"� `E. l+ �°�., .N �.. 'TA�jLE' HEALTH REiGULATIONS. gREQUIRED LEACHING CAPACITY : 330 TANK, DISTRIBUTION BOX AND LE=A►GbT -�, PROPOSED- AL/DAY IT TO BE OF REINFORCED CO-NCRETE , ;'.. 2•s(3,s;r19') t /• � .. CONCRETE STRENGTH• 3000P.S.I• ,:• --... �`REQUIR;ED SEPTIC ._ TANK : / 002 Grr�C• :'STEEL STRENGTH • 20,000` PS.I `= Es ' t _" `3'3ox �•� .. DESIGN LOADING : Y 7/0PROPOSE;D� SEPTIC TANK: /00� g�`• AYS NOT TO BE LOCATED OVER SYSTEM 'H20 DESIGN LOADING IS USED PES AND FITTINGS TO BE WATERTIGHT BE OF CAST IRON OR APPROVED P.V.C. HEALTH AGENT APPROVAL- DATE SITE PIr.aAN $ ROWING PROPOSED CONSTRUCTION LOCATION : FOR Lf-ef - s0LL0vv nEV, Gorz'P- DATE ' R FERENCE ' 1- oT ;�5 st)OWIV L5D REVISIONS /e/28L7 r �yN /3Ay1?n/ ,2f•G,. aF /�Fr� S 9 27/8 8 y ' �•� �1AN �/'c 424 PG 4 ae SCALE . . G RAI G R . SHORT, P. E. PROFESSIONAL CIVIL ENGINEER 131 OLD ROUTE 132 HYANNIS . MA. 02601 FILE NO. , ITgLE*� 7 .34.2-94// SHEET / OF r '- VFW OWN OF ARNSTA/By� /7 LOCATION SEWAGE # f 5 -4 VILLAGE MSMSSRbIAP & LOT / INSTALLER'S NAME & PHONE NO.[ c�5 SEPTIC TANK CAPACITY ^LEACHING FACILITY:(type) ,�,/ T �p � (size) NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATERAO& 40g i 54.1m4 BUILDER OR OWNER ��J call�p DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No , • 2 y To 1! Fss ........................ THE COMMONWEALTH OF MASSACHUSETTS f BOAR® OE HEALTH .....77 ►Nit ...... ........... -- - - - --•- AptirFatiun for DiupuuFai Works Tonstrnr#iun Prrutit - Application is hereby ma4e jor a Per mj�t,Construct _( or Repair ( ) an Individual Sewage Disposal System at: /1/ � ��� CAI �� ... .: .1...3 .. -----••----- ................ .- Location-Address VAS / or I�t o �� /� ...... --•• .......-......... ..............•-----•••--••--. - ............................. .......- .! .�... . (� \ ........ Oy r ..j .. Address /L- ---.................. --•-------------t..i. ----------- 1 3 Installer Address U Type of Building Size Lot.- Type . ..�..........Sq. feet Dwelling—No. of Bedrooms.. Expansion Attic--('f Garbage Griu4er-f�'f �___.. _ .... No. of ersons.._.._. ............... Showers — Cafe p., Other—Type of Building .. p ..(�f— term Q' Other fixtu -- ---------------------------------------•-------•---•------------...--•-----•-•------..............--••-...............----- d W Design -Flow....................................gallons per person per day. Total daily fl�w.............�._�..�'..............gallons. ft WSeptic Tank—Liquid capacity L.@®Ogallons Length_R...G..... Width...4...!n.. Diameter................ Depth_��._-__:.R x Disposal Trench—No..................... Width._.._ _�._..__._.. Total Length.................... Total leaching area....................sq. ft. Seepage Pit No..____.__.1...__:__._ Diameter.___.�._�...... Depth below inlet....�7.' .... Total leaching area....�_�.?..sq. ft. _7 47-0 Z Other Distribution box ( Vf Dosing tank-(�� 1 ®I•-+� �sM �6,rca�1-i `I�3e��tfo � � Z Percolation Test Results Performed by.._� ----------------------------•-------.-----.-._...._......_... Date.... Percolation ----__... ..__..___...--__--.. as Test Pit No. 1.....!U2.minutes per inch Depth of Test Pit...... ...... Depth to ground water-____l��_f_"`---__. fs, Test Pit No. 2................minutes per inch Depth of Test Pit------U......... Depth to ground water......1____ .. •. . ODescription of Soil......... �= ` ✓ ' .. ............................................................................... .----•---......................................................... r -a, C. . s J 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 TL ITAU 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued boar �1; ...- Signed..... Jl c / Application Approved B I. ..1�� PP PP Y = G Date Application Disapproved for the following reasons:........................................................................................................._.._ ...------•----•................•--•--........._.......--••----.........-----------••-•-----......-----•----------------.....--•--•-•--•---•-----------•-------------------------•--- --•-••••••••-- Date PermitNo..---- ....................... ----- Issued........................................................ Date � r THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH P J W.,,-'� OF......3c' o, f­5T',,9� L .... .... ................... ........'............._._........---------------._...-----.................._....---• Appliration for Disposal Works Tonstrnr#iun Vprrmi# Application is hereby made for a Permit to Construct (Y)ro Repair ( ) an Individual Sewage Disposal System at: I 1 ( Location ddress or o --• ............................................... --•-......•--•••-•--•••-•-......_••...... .........7.-•-� -----------�,�....---�,-----------..........�_` c /� �� Ow er Address 7 a .................................. ------------------ .-------------- --= ----------- --------------------.... ...............•-------.-.-.-............_............. Installer Address ,G / O , Type of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms..............................................Expansion Attic"'(� Garbage Grinder() '4 Other—Type of Building �__._. ._._:`_-1.'..._ No. of ersons_...._..�'............... Showers '''�- Cafetefia a YP g P ( ) ( ) Q' Other fixtures ................•.-------------------........---•--..-------•••---•--•--•---•----•-------...._...-----.......•--_.. 1 .5 .." �j'........................ W Design Flow...........................................gallons per person per day. Total daily flow................................................ G� Septic Tank—Liquid capacity.�.00c,allons Length....-...._.. Width.-'!..... ... Diameter...•.........._. Depth_`:'..._.. Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area.....................sq. ft. 3 Seepage Pit No..................... Diameter......1....�...... Depth below inlet.....'.'.`'.... Total leaching area.... 7....sq. ft. Other Distribution box O Dosing tank- PS 44 (`""`) _ : .!--.......!_______________Percolation Test Results Performed by..... �...':�'. `$ �l �. r Date___._._ .. � � 1.1., � . Test Pit No. 1...............minutes per inch Depth of Test Pit.......____.......... Depth to ground water......_...:............ f=1 Test Pit No. 2....11—'_..e"..nunutes per inch Depth of Test Pit.................... Depth to ground water........................ ........................A.................................................................................................................................. DDescription of Soil ..__...... -�-•�••-- -�--�-j-=....................-----------------....---------------------------.............-•------------- U •-•--••-•-•-••-----•-------...--•-------•r... -------•----------•---•---•----••....._. W U Nature of Repairs or Alterations—Answer when applicable._.............................................................................................. ...................................Z:...,........... Agreement: \D i The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITIE 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued b�board-.of Ii a � Signed_. `_.. .::.. ............ Application Approved By.........7.............. - .......... t/._ ../ y £ Date Application Disapproved for the following reasons:.............................................................................................................. --------------•------•--....--------.......-•------------......--•-------••-------•--------•-----•-•----.._...........---•-----------------------------------------•--•••------------•••-•--•---•.•••••- te Permit No..... ---•-------•-�-�---- --------- Issued_-----....------.....----•-•--••-•-----......a-•------ Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH v� ✓� �- / ' ....ter 7.? , l s•�jj Z-,E- ........... .........I....................O F..................................................................................... Tntif iratr of ft omplianrr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed (� �)or Repaired ( ) -�........ --•--•--.-• --------•--- ------- -----•-------•----• • -------�. 01 at Installer =...................................................................................... has been installed in accordance with the provisions of TITLE 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No._�" -�.___��_.L_D.. dated__________ ____r.. ,5;.�,_......... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUAR NTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE................................................................................ Inspector.................................................................................... THE COMMONWEALTH OF MASSACHUSETTS _ BOARD OF HEALTH_ 23,� ..........................................OF..................................................................................... <-- ...................... FEE..--...Lam.......... Disposal Works _Tonstrurtion rrmi# Permission Is ereby granted. -------------------------------• ..................................................... to Construct or`Repair-( �) an/Individual Sewage Dispol, Syst7 —e--, atNo... ....................................... ...... -•----•-•-•-•---------•-•--•---••-•-•-•-......-•-•-••------•--••......•-•............. �•r Street // as shown on the application for Disposal Works Construction Permit No:l= ......'��.. D ed..__._._.©. --.`-1. �..... /- . Board of Health 't1b, vD ag� -------------------------------------------------- DATE................ ..................................I FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS BENCH MARK sP/ K / A/ Po `ra ,G 19 �.= i c y , 1 3 3. 9 2 n.� �l,✓.17 TE ST HOLE RESULTS � P4*- z ` DATE : IB , WITNESSED BY ' TH©Ml) S 13, C3. H. • . . °IjC 7- © P ? 'rV7 - Or E@o scr`3L ,IIy 0 4-i-Y) ,c•S r C 1"2 j'Ml . �'N G . ,� '� .�„ 2 7/3o/8u L Q w>Jw l - L lri r ' 4 Sur,.: ::r; m F'L 1 2 G •Ca 24", 'E , • . h a v_aTE.....- ©v r 1� �Ti o�11 4 5 i �. o S 7 /32'' F'1 ,07. Q l32" 41� _ 'L _ N, X00 MANHOLES AND COVER TO BE BUILT TO N ►3 ; ''C� i � ♦ 12 FINISHED GRADE :� ELEV• TOP OF WITHIN 11 OF INIS ED DE .. M, � G / •'• FOUNDAT10iN FINISHED GRADE MIN. 2% SLOPE DIA. - -«. 4 DIA. PIPE FIRS 2M1 --- 11 _. ,n�,w --- --• MIN. 2 LAYER OFti 1� r -PI P E _j-h, ,�. : MIN.PITCH I FT. 2 LEVE 1/ ► 2, M 9� pa —>z . • P E A S T 0 N E MIN. P ITCH /o�•a1.K ��' j •••D t \a t 2 5.So 1/4 F T. oo M'W 125' 8 - 124.83 Q ,, 2g. asp• / 't'S :'` INVERT :. GALLON I N V E R T C, swrtP INVERT ,�® N m.�• _ V $ / 12 S,Oc7� I A -. /2ur25� EPTIC TANK DIST• /24:Sa ''.� Sv u m • . /2`- D q8 :•! I N V E` T_• c T '1• © `3 t+.t '•.L E _Y _ . - . • .:. � INVERT 0 WAS STONE a / \ ALL AROUND �9 0X- � IPLACE ON , ;,� , •. � �! m --y �r �• r � ' _! BOTTOM AT CLEV. / ' C • �[ .• • FIRM BASE S E 4 22 .•l /.. j`� oC '` `` MIN. � -s c GARBAGE p 4 n �o 5 \ � 2 , q�. i M I N.� 12E'SE2i/fi GRINDER Z0T'. 0� " F ELEV. / / G = i ! t f WATER A E ��ovv 1 �� • - ,, / PR 0 F I• L E OF GROUND TAB \�2 SY STE M SANITA.R 'Y DISPOSAL ( NOT' TO SCALE DESIGN DATA ._.�,... ,• r 3 BEDROOMS o� l !r ' 1, �' .• �� oT 3 • CONSTRUCTION OF SANITARY DISPOSAL � 21, Qg3 + s SYSTEM ' SHALL CONFORM TO THE MASS. DESIGN FLOW ' GAL�DAY t ENVIRONMENT C /. ... -- . _...�. .,...._r. �-.�. ,.. ..: Q' _ AL CODE TITLE 3z LEACH RATE MIN �IN H t 0 33© c w ." �^' �' .. •. Q REVISED • 7 I 77) AND THE TOWN OF '°' p ! ' REQU 'IRED ' LEACHING CAPACITY : -0 �lco ` " - HEALTH REGULATIONS. • SEPTIC TANK, DISTRIBUTION BOX AND LEACH PROPOSED �' �38GAL/DAY. of - ING UNIT TO BE OF REINFORCED CONCRETE : 2 .5<3.67�14`) t �• °�"r(7� MIN. CONCRETE STRENGTH In 3000PS.1.• RE�313 IRED SEPTIC TANK : � o�'� SAG• MIN. 'STEEL STRENGTH _ 20,000 P. S. I. ©x �,5 ._. �c ,1 v� i MIN. DESIGN LOADING : h` -IC� PROPOSED SEPTIC TANK: /ooC714•AL., DRIVEWAYS NOT TO BE LOCATED SYSTEM UNLESS H2O DESIGN LOADING IS USED • ALL PIPES AND • FITTINGS TO BE WATERTIGHT AND TO BE OF CAST IRON OR APPROVED P.V.C• HEALTH AGENT APPROVAL- DATE NG PROPOSED CONSTRUCTION SITE PLANsHowl ZONING DATA LEGEND FOR : � x� -4 sca �. L� 'w � 'v° � 1 P- DATE : �//a/aG ZONE _ - o n/ .5, ;�c 12F• TEST HOLE LOCATION4- Ilof �s EFEREN CE )-- Q7 3 � ,s S�/owe'V CD REVISIONS is/z2z 7 REQUIRED AREA .�3 .5rCa �© a9a ' EXISTING SPOT ELEVATION 17.6 �• o� cRAi cy 17 SH `s REQUIRED FRONTAGE :_ (�Sv� 3y5 ' EXISTING CONTOUR 16 cy�. �� / .�/ �2,4n/ etc •qG f o b4� GB rs �� SCALE • 27483 REQUIRED FRONT SETBACK : (30 3O' - ��f# ,� PROPOSED CONTOUR 16 � ,. � � REQUIRED SIDE -SETBACK �/ 1° PROPOSED WATER SERVICE -W- ` AL AR SETBACK : f/ - /S' PROPOSED GAS SERVICE -G it��`g8 - � REQUIRED - RE Q Q �- P�l�� p'[..�3,n.�'i•//�.e'�� �3 c��; 1� V'©T-� o� ��.�t��� PROPOSED E L E C. B� T E L E E a T �j 1 �1 A I G 1 � • `SHORT , P. E . PROFESSIONAL CIVIL EN 0I N E E R BUILDING INSPECTOR APPROVAL DATE - 131 OLD ROUTE 132 ', HYANNIs . 'MA. 02601 FILE No. �,rV-l_F /7) 342- 94 /i SHEET o OF 1