HomeMy WebLinkAbout0073 LAKE SHORE DRIVE - Health 73 LAKE SHORE DRIVE, M. MILLS
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No. 0 4'7 t Fee V
THE COMMONWEALTH OF MASSACHUSETT$ Entered in computer:
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS Yes
2pplifation for Misposal *pstrm Construction permit
Application for a Permit to Construct( ) Repair(Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components
Location Address or Lot No.73 L-I(Q f4 ore v2 Owner's Name,Address,and Tel.No.
Assessor's Map/Parcel 0_ (�Ik ' Lake are ,
Installer's
Name,Address,and Tel.No. (�p�)ya y�y h Designer's Name
Address,and Tel.No.
V 4.1 losr SD`vl e''7Rc�so. l���I/� G 5 .r, t/./�v�K/an�4/utf� i
it %aw! /`S /�/I7 f o 6y0 ��Irl�l� Y h — "'v,9%
Type of Building:
Dwelling No.of Bedrooms 3 Lot Size q.ft. Garbage Grinder( )
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow(min.required) 330 gpd Design flow provided .rya gpd
Plan Date ^7—/7 a o,99 Number of sheets / Revision Date
Title
Size of Septic Tank ,�s¢e���Os Type of S.A.S. fge--
Description of Soil
Nature of Repairs or Alterations(Answer when applicable) S« 1 O h
Date last inspected:
Agreement:
The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in
accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of
Compliance has been issued by this Board of al
Date 7-
Application ApproveC�� Date3
Application Disapproved by Date
for the following reasons
Permit No. 4:_ T Date Issued
TOWN OF BARNSTABLE
LOCATION '73 Lake.%4w e ,a-,'✓( SEWAGE#. ;?00?—.2,2 7
VILLAGEd /1S ASSESSOR'S MAP&PARCEL 030-019
INSTALLER'S NAME&PHONE NO. �'Ok
SEPTIC TANK CAPACITY
LEACHING FACILITY:(type) (size)
NO.OF BEDROOMS 3
OWNER
PERMIT DATE: ^f'--c2 3-O 9 COMPLIANCE DATE: d +7
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
C
FURNISHED BY
A
1Y
3 y
a 3 `� S
Fee
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS r`�3S
2pplitation for Mi8tl0sal *pstem Construction i3ermit
Application for a Permit to Construct( ) Repair(Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components
Location Address or Lot No.73 e rq""le Owner's Name,Address,and Tel.No.
Assessor'sMap/Pazcel 3�_ 0Jk 1 o,,,/ #,LPe4 <<''r� f -"
Installer's Name,Address,and Tel.No. '
/� 7��� /,��• 5�`/5 Designer sN�ame/,Address,and Tel.No.
�-+ 4r$w<
k p 3 7> A4,, /q 11r a G/Q 41W J /}
N J.>�:�^JU��' ✓�!f
Type of Building:
Dwelling No.of Bedrooms 3 Lot Size 3`/61f sq.ft. Garbage Grinder( )
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow(min.required) 3 3 0 gpd Design flow provided ? A gpd
Plan Date 7-/7-�0 v`1 Number of sheets / Revision Date
Title
Size of Septic Tank ff, ,s /r7E7iJ Type of S.A.S.
Description of Soil
Nature of Repairs or Alterations(Answer when applicable)
Date last inspected:
Agreement:
The undersigned:agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in
accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of
Compliance has been issued by this Board of alt
Date 7-,;7
Application Approve Date 7 A2�
Application Disapproved by Date,
for the following reasons
Permit No. �"� Date Issued G
----------------------I------------------- ------------------------------ ----------_---- ----------------------------------------------
QJ THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE,MASSACHUSETTS
Certificate of Comptiante
THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired(Z Upgraded( )
Abandoned( )by T C,
at 73 1-kF S6.wr , 4r0?o !r 144� has been constructed in accordance
with the provisions of Title 5 and the for Disposal System Construction Permit N ,JJ,, /dated
Installer J. (f- 1?4 1tv !o �//iC 7F�d h Designer 121,/r s+ ,9s5-v"„
e
#bedrooms 3 Approved desigg�n fllo�ow 3 3,2
gpd
The issuance of this permit sha 1 not be construed as a guarantee that the system will4funcfia as d') igned.
Date ���GI Q r7 Inspector ' f� g
------------- ----=-=----i---- _-__'-'- �"�
_ - ----- - --- - 1 i
No. �)CO� � 49� I Fee
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION BARNSTABLE,MASSACHUSETTS
Misposal 6pstem Const union 3permit
Permission is hereby granted to Construct( ) Repair(f Upgrade( ) Abandon( )
System located at 73 SI7ri f 41,•11
and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with
Title 5 and the following local provisions or special conditions.
Provided:Construction must be comple fthin three years of the date of this permit.
Date ZAa_51ed within Approved'b3,
l
Town of Barnstable
P,,oFt"E'O�,yo Regulatory Services
(1 Thomas F. Geiler, Director
`B MASS. Public Health Division
°Teo 19. Thomas McKean,Director
200 Main Street,Hyannis,MA 02601
Office: 508-862-4644 Fax: 508-790-6304
Installer & Designer Certification Form
Date: Sewage Permit# 00i_�X 7 Assessor's Map\Parcel
Designer:
nstaller:
==��Y�
Address: aa����=:.. r; i�= � Address: J 5 c/
On _ _ �r <014,jj / _was issued a permit to install a
date) (installer)
septic system at based on a design drawn by
(address)
dated 7- 3-0`2
(desig�ier)
certify that the septic system referenced above was installed substantially according to
the design, which may include minor approved changes such as lateral relocation of the
distribution box and/or septic tank.
I certify that the septic system referenced above was installed with major changes (i.e.
greater than 10' lateral relocation of the SAS or any vertical relocation of any component
of the septic system)but in accordance with State & Local Regulations. Plan.revision or
certified as-built by designer to follow. ►►.•►�.,�
ZNOFyjq
n
DAVIDmom.
/� B. N y� c
n ( i MASON m ; ��" ►
(Inst er s Signature) c ►
9 No.1066 y
r
40
'�ANITAR�� �� ►� ��V 5� ��
igner's Signature) (Affix Designer's Stamp Here)
PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF
COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS-BUILT CARD ARE
RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. TAANK YOU.alEPHEN J. OI'LE AND ASSOCLA.TES
42 CANTERBURY LANE
j. EAST FALMOUTH,MASSACHUSETTS 02630
,Q:Health/Septic/Designer Certification Form 3-26-04.doc � _ - 608/640-2534
Town of-BarnstabYe
Departztient of Regulatory Services
' F Public Healthlhvision
• antuvernst a Date _ m
rues �+
'' p tsJ9 �6 [200 Main Street Hyannis_MA.02601 n,
Date Scheduled Time r7 � Fee.Pd._
7. 1.
Sutabily Assessment for Sewa e D osa -
1
Performed By: �� Vim.( L Witnessed By
t y LOCATION&GENERAT,IlVORMATION
Location Address
"S `fie" Owner s Name
1 ILV
z 1 . Address ..� - L..,�i�.t�.91►LvdLa
e Assessor s,Map/Parcffel '' QJ z� 4 Bngtneer's Name
1. NEW CONSTRUCTION Telephone#
c REPAIR �, ,
Land Use " "�"<•�i r 1 Slopes(9oJ" 7 r s l o e,f Surface Stones y t�
._. 1. 77
F.
Distances from,Open Water�Body ft Possible.WetjArea L—f Drinking Water Well �� ft
Drainage Way 4 __ft Property Line®. ft Other
f7 :
SKETCH-:(Street name,dimensions of lot exact locations of test holes&pere tests,locate wetlands in proximity to holes):.
1,
N
C—
r
_at
rrt
Parent material(geologic) Depthao l3edrgel{ b 1
Depth to Groundwater. Standing Water in Hole: 2. Weeping from Pit Pde6. o �1�—/,t►.r're t1�
Estimated Seasonal High Groundwater
DETERMENATION FOR SEASONAL HIGH WATER TABLE
Method Used: �.�
Depth.Obse d standing in obs:hole: ln. Depth to sgll mottles. In.
Depth to weeping from side of obs.hole: u in, t3roundwater'AdJugtmettt ft.
Index Well# Reading Date: Index.Well leYef�.»:__..�Adj,factor, ,m g Adj.drvundwnter Level.,,,
PERCOLATION LEST lute'I T me
Observation
Hole# TIme at 9"
Depth of Peiie 10.. Tlme an .
Start Pre-soak Time @ :D0 Tima(4"•6") y
End Pre-soak
RateMinJInch6
Site Suitability Assessment: Site Pass Site Failed: Additional Testing Needed(Y/N)
Original: Publi..c Health Division'. Observation Dole D3t9-T8'Be Com leted on Back
***If percolation test is to be conducted within 100'.of wetland,you"must first notify the.
Barnstable Conservation Division at least one(1) week prior to beginning.
Q:\,SEPTICIPERCFORM.DOC
DEEP.pBSERVA.TION HOL E LOG Hole#
Depth from Soil Horizon Soil Texture Sdil•Color, Soil `Other
Surface(in.) (USDA) (Munsell) Mottling` (Stiyeture Stones;Boulders.
o. iste c % vet
IA
G( % tj.tl G�c�-ice Z' `
r✓
DEEP OBSERVATION HOLE LOG Hole#
Depth from ,.Soil Horizon Soil Texture Soil Color Soil ther
Surface(in.). (USDA) (Munsell) Mottling ;-(Structure,Stones,Boulders.
AZ
n on i ten % el
kA
7a,��
t o
_ .IA WI
DEEP OBSERVATION HOLE LOG Hole#
Depth from Soil Horizon Soil Texture 1 Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders.
Consistency,%Gravel)
"
t'
E
t
DEEP OBSERV TI ole# -
A �I ,;L ` G ON OL-E O
Depth from Soil Horizon w'Soil Texture Soil Color. Soil Other
Surface(in.) �",{� (USDA) (Munsell) MpttHng� (Structure,;,Stones,-Boulders.. .
o'si n
•
Flood Insurance Rate. p
- i-
Above 500 yearfloodybounda H No,_ Yes
Within 500 year boundary No Yes
'...A rVJith►n 100yea%flood'boundary No' Yes'
Depth-of Naturally Uccucrina,Peryious.MaterialLL
Does at.least four.:feet of natgally,occurring.perviol exist in all areas observed througho.ut,tho
area proposed for the.soil absorption system?
If not,what is the,depth of naturallyoccurring.pery ous material? .
CertiScatton
t I certify that on 1 (date)I have passed the soil evaluator examination approved by the
Department of Envifon" "ental Pro coon and that:the above analysis was performed by me consistent with .
the required'training,,expertise-a experience described-'in$lo.ClviR�15.01Z.
Signature Date
Q-.%SFPnCTERCFORM.DOC
Commonwevtth of Mossochusetls
ExecutNe Office Of ErMromwintai Affairs John Grad
D.E.P. Title V Septic Inspector
Department of P.O. Box 2119
Envfronntel�tal Protection
Teaticket,MA 02536
(508) 564-6813
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION
Property Address: 73 Lake hore Dr. Marstons Mills Address of Owner:
Date of Inspection:314197 (If different)
Name of Inspector:John Graci Elizabeth D'Angelo:700 Golden Beach Blvd.#128 Venice Florida
Company Name,Address and Telephone Number:
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 inspection. The inspection was performed based on my training and experience in the proper function and
maintenance of on-site sewage disposal systems. The system:
X Passes This Inspection Is based on criteria dented in Title V
— Conditionally Passes code 310 CMR 15.303.My findnps are of how the system is
Needs F7-/f4p
Evaluation 8 the Local Approving Authority performing at the time of the inspectlon.MV Inspection does
— y pp g ty not Imply any warranty or nuarantee of the longevity of the
— Falls septic system and any of its components useful life.
Inspector's Signature: / Date: 3110197
The System Inspector shall submit a copy of this inspection report to the Approving Authority within thirty(30)days of completing this
inspections. 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 Department of Environmental Protection.
The original should be sent to the system owner and copies sent to the buyer,if applicable and the approving authority.
INSPECTION SUMMARY:
Check A, B.C, or D:
I
A] SYSTEM PASSES:
X I have not found any information which indicates that the system violates any of the failure criteria
defined as in 310 CMR 15.303. Any failure criteria not evaluated are indicated below.
B) SYSTEM CONDITIONALLY PASSES:
_One or more system components need to be replaced or repaired. The system,upon completion
of the replacement or repair,passes inspection.
Indicate yes,no,or not determined(Y, N,or ND). Describe basis of determination in all instances. If "not determined",explain why not.)
— The septic tank is metal,cracked,structurally unsound,shows substantial infiltration or exfiltration,or tank failure is
imminent. The system will pass inspection if the existing septic tank is replaced with a conforming septic tank as approved
by the Board of Health.
(revised 11115195)
One Winter Street 9 Boston,Massachusetts 02108 9 FAX(617)556-1049 9 Telephone(617)292-5500
1
I
f
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address: T 3 Lakeshore Dr.Marston MOIs
Owner: Elizabeth W Angelo:700 Golden Beach Blvd.#128 Venice Florida
Date of Inspection:314197
_ Sewage backup or breakout or high static water level observed in the distribution box is due to a broken,
settled or uneven distribution box. The system will pass Inspection if(with approval of the Board of Health):
broken pipe(s)are replaced
obstruction is removed
distribution box is leveled or replaced
_The system required pumping more than four 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
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 the public health,safety and the environment.
1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM IS
NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND
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 APPROPRIATE)DETERMINES
THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECT THE PUBLIC HEALTH AND SAFETY AND THE
ENVIRONMENT:
_ The system has a septic tank and soil absorption system and is within 100 feet to a
surface of water supply or tributary to a surface water supply.
The system has a septic tank and soil absorption system and is within a Zone 1 of a public water
supply well.
_ The system has a septic tank and soil absorption system and is within 50 feet of a private water
j supply well.
_ The system has a septic tank and soil absorption system and is less than 100 feet but 50 feet or more from a private
water supply well,unless a well water analysis for coliform bacteria volatile organic compounds indicates that the well is
free from pollution for that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal or less than 5 ppm.
3) OTHER
D] SYSTEM FAILS:
_ I have determined that the system violates one or more of the following failure criteria as defined in
310 CMR 15.303. The basis for this determination is Identified below. The Board of Health should be
contacted to determine what will be necessary to correct the failure.
Backup of sewage in facility or system component due to an 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
cesspool.
SAS is in hydraulic failure.
(revised 11115/95)
2
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: 73 Lakeshore or.Marstons Mills
Owner: Elizabeth W Angelo:700 Golden Beach Blvd.#128 Venice Florida
Date of Inspection:314197
D]SYSTEM FAILS(continued)
Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool.
Liquid depth in cesspool is less than 6'below Invert or available volume is less than 1/2 day flow.
Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).
Numbers of times pumped
Any portion of the Soil Absorption System,cesspool or privy is below the high groundwater elevation.
Any portion of a cesspool or privy is within 100 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. If the well has been analyzed to be acceptable,attach copy of well water analysis for
coliform bacteria,volatile organic compounds,ammonia nitrogen and nitrate nitrogen.
E] LARGE SYSTEM FAILS:
The following criteria apply to large systems in addition to the criteria:
_ The system serves a facility with a design flow of 10,000 gpd or greater(Large System)and the system is a significant threat to
public health and safety and the environment because one or more of the following conditions exist:
_ 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)
The owner or operator of any such system shall bring the system and facility into full compliance with the groundwater treatment program
requirements of 314 CMR 5.00 and 6.00. Please consult the local regional office of the Department for further Information.
(revised 11115195)
3
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECLIST
Property Address: 73 Lakeshore Dr.Marstons Mills
Owner: Elizabeth D'Angelo:700 Golden Beach Blvd.#128 Venice Florida
Date of Inspection:314197
Check it the following have been done:
x Pumping Information was requested of the owner,occupant, and Board of Health.
x None of the system components have been pumped for at least two weeks and the and the system has been receiving normal
flow rates during that period. Large volumes of water have not been introduced into the system recently or as part of this
Inspection.
x As built plans have been obtained and examined. Note if they are not available with NIA.
x The facility or dwelling was inspected for signs of sewage back-up.
x The system does not receive non-sanitary or industrial waste flow.
x The site was inspected for signs of breakout.
x All system components,excluding the Soil Absorption System,have been located on the site.
x The septic tank manholes were uncovered,opened, and the Interior of the septic tank was inspected
for condition of baffles or tees,material of construction,dimensions,depth of liquid,depth of sludge, depth of scum.
x The size and location of the Soil Absorption System on the site has been determined based on existing information or
approximated by non-intrusive methods.
x The facility owner(and occupants,if different from owner)were provided with information on the proper maintenance of Sub-
Surface Disposal System.
i
i
(revised 11115195)
4
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
Property Address: 73 Lakeshore Dr.Marston M819
Owner: Elizabeth D'Angelo:700 Golden Beach Blvd.#128 Venice Florida
Date of Inspection:314197
FLOW CONDITIONS
RESIDENTIAL:
Design flow: 330 gallons
Number of bedrooms: 3
Number of current residents: 0
Garbage grinder(yes or no): No
Laundry connected to system(yes or no): Yes
Seasonal use(yes or no): Yes
Water meter readings,if available: n1a
Last date of occupancy: summer use
COMMERCIAL/INDUSTRIAL:
Type of establishment: nla
Design flow:0 gallons/day
Grease trap present:(yes or no) No
Industrial Waste Holding Tank present:(yes or no) No
Non-sanitary waste discharged to the Title 5 system:(yes or no) No
Water meter readings,if available: Na
Last dare of occupancy: Na
OTHER:(Describe) n1a
Last date of occupancy:
GENERAL INFORMATION
PUMPING RECORDS and source of information:
System has not been pumped In the last two years.
System pumped as part of inspection:(yes or no)No
If yes,volume pumped:9 gallons
Reason for pumping: n/a
TYPE OF SYSTEM
X Septic tank/distribution box/soil absorptions system
Single cesspool
Overflow cesspool
Privy
Shared system(yes or no) (if yes,attach previous inspection records,if any)
Other(explain)
APPROXIMATE AGE of all components,date installed(if known)and source information:
1976
Sewage odors detected when arriving at the site:(yes or no) No
(revised 111115195)
5
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 73 Lakeshore Dr.Marstons Mills
Owner: Elizabeth D'Angelo:700 Golden Beach Blvd.#128 Venice Florida
Date of inspectlon:314197
SEPTIC TANK: X
(locate on site plan)
Depth below grade:4'
Material of construction:X concreate_metal_FRP_other(explain)
Dimensions: L 8'8'h 5'7'W 4'10"
Sludge depth:5'
Distance from top of sludge to bottom of outlet tee or baffle: 22"
Scum thickness:0
Distance from top of scum to top of outlet tee or baffle:r
Distance form bottom of scum to bottom of outlet tee or baffle:0
Comments:
(recommendation for pumping,condition of inlet and outlet tees or baffles,depth of liquid level in relation to outlet invert,structural integrity,
evidence of leakage,etc.)
Septic tank and all components are structurally sound.Recommend pumping system every two years for maintenance.
GREASE TRAP:
(locate on site plan)
Depth below grade: nla
Material of construction: _concrete_metai_FRP_other(explain)
Dimensions: nla
Scum thickness:n1a
Distance from top of scum to top of outlet tee or baffle:nla
Distance from bottom of scum to bottom of outlet tee or baffle: nla
Comments:
(recommendation for pumping,condition of inlet and outlet tees or baffles,depth of liquid level in relation to outlet invert,structural integrity,
evidence of leakage,etc.)
Na
(revised 11115195)
6
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 73 Lakeshore Dr.Marston Mills
Owner: Elizabeth D'Angelo:700 Golden Beach Blvd.#128 Venice Florida
Date of Inspection:314197
TIGHT OR HOLDING TANK:
(locate on site plan)
Depth below grade. Na
Material of construction:_concrete_metal_FRP_other(explain)
Dimensions: Na
Capacity: n1a gallons
Design f'ow: Na gallons/day
Alarm level: rda
Comments:
(conditicn of inlet tee,condition of alarm and float switches,etc.)
Na
DISTRIBUTION BOX:
(locate on site plan)
Depth of liquid level above outlet invert: n►a
Comments:
(note if level and distribution is equal,evidence of solids carryover, evidence of leakage into or out of box etc.)
Na
PUMP CHAMBER:
(locate on site plan)
Pumps in working order:(yes or no)
Comments:
(note condition of pump chamber,condition of pumps and appurtenances,etc.)
Na
(revised 11115195)
7
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 73 Lakeshore Dr.Marstons Mills
Owner: Elizabeth D'Angelo:700 Golden Beach Blvd.#128 Venice Florida
Date of Inspection:314197
SOIL ABSORPTION SYSTEM(SAS):X
(locate on site plan,if possible;excavation not required,but may be approximated by non-intrusive methods)
If not determined to be present,explain:
n1a
Type:
leaching pits,number: 1,000 gallon leach pit
leaching chambers,number:n1a
leaching galleries,number: nla
leaching trenches,number,length: n1a
leaching fields,number,dimensions:nfa
overflow cesspool,number:n1a
Comments:(note condition of soil, signs of hydraulic failure,level of ponding,condition of vegetation, etc.)
The overflow was empty at the time of the inspection It Is structurally sound.
CESSPOOLS:
(locate on site plan)
Number and configuration: Ma
Depth-top of liquid to inlet invert: nla
Depth of solids layer: nia
Depth of scum layer: n1a
Dimensions of cesspool: n1a
Materials of construction: Na
Indicatioi of groundwater: n►a
inflow(cesspool must be pumped as part of inspection)
nla
Comments:(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation, etc.)
nla
PRIVY:_
(locate on site plan)
Materials of construction: n1a Dimensions: n1a
Depth cf solids: nla
Comments:(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation, etc.)
n1a
(revised 11115195)
a
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 73 Lakeshore Dr.Marstons Mills
Owner: Elizabeth D'Angelo:700 Golden Beach Blvd.#128 Venice Florida
Date of Inspection:314107
SKETCH;OF SEWAGE DISPOSAL SYSTEM:
Include ties to at least two permanent references landmarks or benchmarks
locate all wells within 100'
G 6
g A
Rg 3a
AC fi
c`
DEPTH TO GROUNDWATER
Depth to groundwater:12 feet
method of determination or approximation:
USGS Maps and Charts
(revised 11115195)
9
yl-
L�0 C 9 T � � ` SEWAGE PEA IT NO.
3
I N S T A LLER'S NAME i ADDRESS
® U I L D E R OR OWN ER
I .
DATE PERMIT ISSUED
DATE COMPLIANCE ISSUED
i
�i
n '
Olt
e
v
L0>CATION SEWAGE PERMIT NO.
3 Z-4 A- &'�Z-L 4pYl
VILLAGE
INSTALLER'S AM & ADDRESS
BUILDER OR OWNE
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DATE PERMIT. ISSUED
DAT E COMPLIANCE ISSUED �`�-�
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T.O.F. = 86.75' � I I
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FINISHED GRADE EL. 84'f r)
6„ 6„ cr- 0---
20" RISER 20" C U J
Dia. Dia. W <
of W C/) U
SHORE INV EL n Of 0 0
, M\OE EXISTING 0LOCUS <C
TO REMAIN
Z =
FIN. GRADE EL. 79't < 00
�z 10 Min. �`'= � �t�r.
FINISHED GRADE EL. 79'f J J o
INV EL -- -- - INV EL �� EL
�aac m 81 .6 Below Flow Line 81.35' 6
POND Liquid Level 4B" ADD G� RISER �
BAFFLE EL. 76.0' < Q
POND __._ 15' - NO BREAKOUT m -J Z `-
INV ELLINV. �L.
EXISTING 1000 GALLON TANK TO REMAIN �JNEL _ _ END cAa 0 J71v,.29' .09' 75.(69' MED. MED. U
LC> C' LJ,�' MAP REQUIRED CAPACITY - 330 GALLONS AT 200� 6" Stone SAND SAND a_ <
LIJ
1000 GALLON TANK TO REMAIN DISTRIBUTION BOX 6 _ 6" U)Tees shall be constructed of Schedule 40 PVC and shall extend a T37 5' EL. 74.67' <„ PRECAST DISTRIBUTION BOX NOTES: 38.5' O
minimum of 6 above the flow line of the septic tank and be on
the centerline of the septic tank located directly under the USE SPLASH PLATE OR BAFFLE TEE
ASSESSORS MAP 30 PARCEL 18 clean-out manhole. INSTALL ON A STABLE COMPACTED BASE
The inlet pipe elevation shall be no less than 2" nor more than 3" MINIMUM WALL THICKNESS = 2" USE THREE ROWS OF (6) HIGH CAPACITY INFILTRATOR CHAMBERS
DEED REFERENCE. 10736-216 above the invert elevation! of the outlet pipe. TOTAL CHAMBERS = 18
Septic tank shall have a minimum cover of 9 . MINIMUM INSIDE DIM. = 12"
PLAN REFERENCE: 222-157 Two 20" manholes with readily removable impermeable covers MINIMUM SUMP = 6"
of durable material shall be provided with access ports.
The outlet tee shall be equipped with gas baffle. OUTLET INVERTS SHALL BE EQUAL TO EACH OTHER AND AT
ZONING DISTRICT: RF 2" MINIMUM BELOW INLET INVERT.
OVERLAY DISTRICT: THE DISTRIBUTION LINES FROM THE DISTRIBUTION BIOX SHALL
RPOD, GP & MA ESTUARY Z.O.C. ALL HAVE EQUAL INVERTS AS DETERMINED BY FLOODING THE:
DISTRIBUTION BOX TO THE HEIGHT OF THE DISTRIBUTION LINE
LOCUS DOES NOT LIE INVERT AFTER ALL LINES HAVE BEEN SEALED IN PLACE.
IN A FLOOD HAZARD ZONE INVERT ADJUSTMENTS SHALL BE MADE BY FILLING \WITH
DURABLE AND NONDEFORMABLE MATERIAL PERMANENTLY
FASTENED TO THE LINE OR RECONSTRUCTING THE LINES
3.6 GENERAL NOTES:
UNTIL ALL INVERTS ARE OF EQUAL ELEVATION.
\
�5 \
WITHIN
1. ALL THE WORKMANSHIP AND MATERIALS SHALL CONFORM TO DEP AND I.P. WITH SCREW TYPE CAP 3" OF FINISHED GRADE (3 T TO
TO
// \\ THE TOWN OF BARNSTABLE RULES AND REGULATIONS FOR THE SUBSURFACE GEOTEXTILE FABRICK SEE PLAN VIEW. cn
\ DISPOSAL OF SEWAGE. z
\\ 2. ACCESS PORTS OVER TANK TEES SHALL BE ACCESSIBLE WITHIN 6" FIN. GRADE = 79'f o
i OF FINISHED GRADE. >
�' N E E N �' 3. ALL COMPONENTS OF THE SANITARY SYSTEM SHALL BE CAPABLE OF EL. 76.0' w�
EXIST. LEACH PIT / \ WITHSTANDING H-10 LOADING UNLESS THEY ARE UNDER OR WITHIN 10' tip
TO BE ABANDONED `\ OF DRIVES OR PARKING. H-20 LOADING SHALL BE USED UNDER OR WITHIN 16 O
10' OF DRIVES OR PARKING, UNLESS NOTED. F
EXISTING HYDRANT s 4. THE EXCAVATOR/CONTRACTOR SHALL_ CALL "DIG SAFE" AND VERIFY THE LOCATION EL. 74.67' �
OF SITE UTILITIES PRIOR TO ANY EXCAVATION, ,AND SHALL BE RESPONSIBLE FOR 34" CLEAN MEDIUM SAND o
80 - EXISTING CONTOUR Q��i d'\\ ALL MATTERS RELATING TO ELECTRIC AND/OR GAS EASEMENTS. 6" SEPARATION BETWEEN ROWS (TYP.)
5. SEWER PIPES SHALL BE SCHEDULE 40 PVC. (4 DIA. UNLESS OTHERWISE NOTED) 10.5' <
�/ \\ 6. ANY MASONRY UNITS USED TO BRING COVERS TO GRADE SHALL BE -19
MORTARED IN PLACE. n z
v 7. FINISH GRADE SHALL HAVE A MINIMUM SLOPE OF 0.02 FT. PER FOOT.
i \ 8. EXISTING SYSTEM COMPONENTS - IF ANY - SHALL BE ABANDONED PER USE THREE ROWS OF (6) HIGH CAPACITY INFILTRATOR CHAMBERS
/ O TITLE 5 REQUIREMENTS.
TOTAL CHAMBERS = 18
9. THE EXCAVATOR/CONTRACTOR SHALL BE RESPONSIBLE TO CONTACT DOYLE
i AND ASSOCIATES 24 HOURS PRIOR TO ANY REQUIRED INSPECTIONS. BOTTOM OF SOIL PIT = EL. 68.5'
/ 10. ALL COMPONENTS SHALL BE MARKED WITH MAGNETIC TAPE OR NO GROUND WATER OR
COMPARABLE MEANS IN ORDER TO LOCATE THEM ONCE BURIED. REDOXIMORPHIC FEATURES OBSERVED
= \Fdo 11. SYSTEM COMPONENTS SHALL HAVE NOT MORE THAN 36 COVER.
/ cy /
LOT 123
/ 39,698± S.F. ( ,
DESIGN DATA: TEST DATE: 07-10-09
_ EXISTING THREE BEDROOMS - NO INCREASED FLOW
3 x 110 = 330 GPD REQUIRED FLOW SOIL EVALUATOR: S. DOYLE
(APPROVED 3/95) w
o USE 18 HIGH CAPACITY INFILTRATOR CHAMBERS >
51��� � `` IN FIELD CONFIGURATION WITHOUT AGGREGATE HEALTH AGENT: DAVE STANTON o
T.P. #1 PERC <2 M/INCH T.P. #2 PERC <2 M/INCH
i `\\ 18 x 6.25 x 4.72 SF/LF = 531 SF EL. 78.5' 0" EL. 78.5' O» jj Ld
531 x 0.74 = 392 GPD T01TAL DESIGN FLOW (n 0 J
�\ "A" SL 1OYR 3/2 "A" SL 1OYR 3/2 W
GARBAGE DISPOSAL NOT ALLOWED 6" 6" Cn
"B" <
LS 1OYR 5/6 "g" 1OYR 5/6 C] w
86
w LS
w < 0
wq \\\ 26"(EL. 76.3') 26" (EL. 76.3')� <
-j V)
OP cy \tip C MED. C MED. w � <
84 SAND SAND �
PERC ® 54 0
EXISTING DWELLING
2.5Y 6/6 2.5Y 6/6
w _ 80 EL. 68.5'
82 �� 1 20 EL. 68.5' 120"
1/ NO G/WATER OR NO G/WATER OR
V REDOXIMORPHIC FEATURES REDOXIMORPHIC FEATURES (I) U
Q0
EXISTING DECK � 78 O
�� . . EXISTING 1000 GAL/TANK O � � I•t')
WITH POOL 4; \ TO REMAIN " � �\ � ZN Of,�j4ss (, O Ua
M
\ o l \\ pw DAVID �s O Ln
ff` 0Q� ��� o MASpN m01)
106 w w 15
o v . No. 6 -,, < C/) -p
P p ° � o F O G'i Q to
L
g ° o -,
BM: HYD. SPINDLE `a ,q P 0 J =
ELEV. 80.70' N RI z ?- U
82 DATUM: GIS± ry < n
T W m u! In
76
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PROPOSED S.A.S. -''"
78 -" INFILTRATOR CHAMBERS 0 O
/ z
- 78 o WBTHOUT AGGREGATE '►►►...a�� <
0 �� �GiS'Eq 4 � 00
NUO
corn STEPHEN ► In
J 76 - --- o r^1 J. : Z J
GRAPHIC SCALE - ----" _ 397.S9J 00 oo P _ z
20 0 10 20 40 80 O� •
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76 S81`53'20"E 1 D.E. D.E. • (n W Lv
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( IN FEET ) lO.OGi 10.00
1 inch = 20 f$. � ~