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HomeMy WebLinkAbout0062 NELSON LANE - Health 62 Nelson Lane Marstons Mills F/R A = 126 096 1 I I i 'I i 346k AfA 33 e TOWN OF BARNSTABLE 'LOCATION (o;;L MELS®eV. 4,446 ,SEWAGE# ,R®f(c) VILLAGE 1''I rOwS MILi.5 ASSESSOR'S MAP&PARCEL i INSTALLER'S NAME&PHONE NOCAF&'Ju0E SEPTIC TANK CAPACITY l 9 ®cc> G'AL .W LEACHING FACILITY:(type)`ot 5c)De AL C 44ik (size) J OL 4��` X X5 NO.OF BEDROOMS e OWNER M-4)U 9 01i4:145' M IJAP1 V PERMIT DATE: -a��o a®l(�a COMPLIANCE DATE: A0I" Separation Distance Between the: J Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility / Feet Private Water Supply Well Leaching Facility(If any wells exist on / site or within 200 feet of leaching facility) NIA Feet Edge of Wetland and Leaching Facility(If any wetlands exist within ^ 300 feet of leaching facility) -_ ,gip / IV/�°�i Feet FURNISHED BY ���(s3C�C-> ��u`CJ �S�C S C�UI, A•3 Go A ?la3Q 31 C—z — 34.4 � e i � Town of Barnstable P# l 36 Department of Regulatory Services Public Health Division -DateMAM S a 200 Main Street,Hyannis MA 02601 rfll trlltt 14 Date Scheduled Time—�--�L Fee Pd._ . s Soil Suitability Assessment for Sewaige Disposal CA Performed By: M 1eh0eI P•rnwei.4 94 [•S''F Witnessed Sy: R r LOCATION&.GENERAL INFORMATION '! Location Address ' I /�q j�d� fZ ' �dam• LV&�J O� LAME l _`" \ I Owner's Name D�'/ktV � l���Pl��4JM �I� Address �' " -IkJ 4-AJ 1 ®�1� C--AB6w,a "C &ivraw4-6 to C37-7 Assessor's Map/Parcel: ` Engineer's Name SL 20 5 eg-Z 734 NEW CONSTRUCTION REPAIR Telephone# 570 a— 7 i Land Use• f-M /� 0A e l"% Slo ca %) 0 _s �� - P ( Surface Stones Distances from: Open Water Body _ ft Possible Wet•Area ft Drinking Water Well Dmihage Way �' ft Property Line 7 10 ft Other ft SKETCH:(Street name,dimensions of lot,exact locations of test holes&pare tests,locate wetlands-in proximity holes) P tY to es) See AffucAed' S:Y'P— plan Parent material(geologic) O 641.1"'Sh al ns Depth to 9edroak Depth to Groundwater. Standing Water in Hole:_� 2 0 Weeping frolrl Plt Faoa Estimated Seasonal High Groundwater 7 1 Z 0 DETERMINATION FOR SEASONAL•HIGH WATER TABLE Method Used: 0;(ec� 06Seo1V#%f,PA Depth Observed standing in obs,hole: In. Depth to soli mottles: 7 ?Lo ln, Depth to weeping from side of obs,hole: 7 /Z 0'' 111, Groundwater Adjustment `MA—WWM ft. Index Wall-# Reading Data: Index Well level Adj,•faetor_Adj.GroundwaterLavel,,,_ PERCOLATION TEST bate -Z-13 Uwe Observation i ' Hole# Time at V _ Depth of Pere Time at 6" Start Pra-soak Time @ Time(91'41) End Pre-soak � FD[ pe�c •M-C-o, See RateMiit./Inch <Z minljocA C'ne.-(- #2270 Site Sultability Assessment: Slta Passed Sitc Palled: Additional Testing Needed(YIN) N Original: Public Health Division Observation Hole Data To Be Completed 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:\SBPPIC\PERCFORM.DOC I , DEEROBSERVATION HOLE LOG Hole# I t Z Depth from Sall Horizon Soil Texture Sdil Color Soil• Other Surface(in.) (USDA) (Munsell) Mottling (Stnueture,Stoneg;Boulders, nT rats tency.96'aravoll F41 q'36 Q L®gM y 5 and I oyR 5 6 36-/Zo.,. C- /"led-Coarse tonal 2_.5 614 00-3 o% .rave' r DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure;Stones,Boulders. Consistency. DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Sall Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders, Consistency, h DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Sall Color Soll Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stories;Boulders, Consistency, Otsvell Flood Insurance Rate Map: Above 500 year f rood boundary No Yes ,. Within 500 year boundary No^, Yes, Within 100 year flood boundary No./ its Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the area proposed for the soil absorption system? y__S____ If not,what Is the depth of naturally occurring pervious material? -- ...--.- Certification I certify that on 10-Z 7-9 9 (date)I have passed the soil evaluator examination approved by the Department of Environmental Protecti nd that the above analysis was performed by me consistent with . the required trainin ,e erns and a or once described In 410 CMR 15.017. • -Signature Date Q:WErrrlWBRCPORM.DOC No. (4 Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: es PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS 2ppfication for disposal *- pstrm Construction permit Application for a Permit to Construct( ) Repair()o Upgrade( ) Abandon( ) ❑Complete System ndividual Components Location Address or Lot No."tV Ct50l\j "AAJ Owner's Name,Address and Tel.No. t�[M DGAM-k MARt_ MOILV91 Assessor's Map/Parcel i5 S (RAJ M "S &4 Installer's Name,Address,and Tel.No.$p2-4-77-22�7 7 Designer's Name,Address,and Tel.No.5-6-9-a�3-037.1 Ct'APFw t aE E&jr&-V js; 3 e_L<_, O"C z1vc- 1153 c di S�g s Q4 e. 11tlf4yziMj" Type of Building: f / Dwelling No.of Bedrooms 3 Lot Size sq.ft. Garbage Grinder( ) Other Type of Building A4ar,[O 6xj f 4[._No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 330 gpd Design flow provided 349.q gpd Plan Date s -ao f o Number of sheets Revision Date Title 1U'aZL _) �� lid X)S P LLS Size of Septic Tank ' (��}� C%�r(_ Type of S.A.S. Description of Soil A Jb 09AV-EL Q ?,4,`f /Ses P4-44 Nature of Repairs or Alterations(Answer when applicable) f)S fc C y K_T1&X ��D &44- .. IJ ZE$q't C_ U� �- ea �1ft ID (�:�,5 can &_&Ane ) 4-96 PM" 0J177tt 4 F42EY am AG,421ZEQ4=2€ �,�atRR�fux)a[x�G 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 o ealth Sign Date Application Approved by Date Application Disapproved by Date for the following reasons Permit No. _ a(l - "c� Date Issued No. Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: ,. PUBLIC HEALTH DIVISION - TOWN'OF BARNSTABLE, MASSACHUSETTS es 21pplication for Misposal �6pstpm Construction permit Application for a Permit to Construct( ) Repair(x) Upgrade( ) Abandon( `) El Complete System ndividual Components Location Address or Lot No.(,,-,),K)C-(501\1 LA&)6 Owner's Name,Address,and Tel.No. MM DEAN 4 MAtuG-Molt:QWy Assessor's Map/Parcel ' 6-1 Af LLS'&N 4,," mok45twS iL4( Installer's Name Address,and Tel.No..56'R-*77-22`77 Designer's Name,Address,and Tel.No.$0l%-;L73"03-7- �APrwt� 1153 G u4 0-t 191�*r S EMC: e. w 4A:Eti/ m Type of Building: ,, Dwelling No.of Bedrooms Lot Size `!// ' 44 sq.ft. Garbage Grinder( ) 4 Other Type of Building !RQ&/Q 6%jrt 4 L-No.of Persons Showers( ) Cafeteria( ) i Other Fixtures li Design Flow(min.required) gpd Design flow provided d 449. gpd Plan Date g a -a O f Number of sheets Revision Date Title lob• VOZSM J C-AAX 14%-' )U& M/L.L( Size of Septic Tank O op Cs�(— Type of S.A.S.J,�,t) sm(g4c- 4.444M Bags _ Description of Soil t1r(EA- C C7/E/ZSE SALA> A4 Jb &eaAUZLQYn`/ -SeE p(ad� Nature of Repairs or Alterations(Answer when applicable) U 5 Cr it Y,/ ��(>(, b I c-, 1 74 e� Ti) iU ft"LC-) 14 ;y i) ,zox 7D Ca.) s coo 40 .) i4-;LC) C;m" ses � 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 Health Sig Date Application Approved by Date 2 3 �b �. Application Disapproved by Date ! for the following reasons Permit No. ' Ct Date Issued r j THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO C RTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired(�) Upgraded( ) Abandoned( )by CAP&-w(tAr EL.)7 A1sM5 �• at �22 Ak .Sn,y 634AAE, M M has been constructed in accordance with the,pro isions of Title 5 and the for Disposal System Construction Permit No. /6 � dated InstallerC'i4 aC E)JjjSQP41 , K �LP, Designer ZG EAjeZJL)§ -X/ 3PG #bedrooms �j Approved design flow 30 gpd The issuance of thi perm t shall not be construed as a guarantee that the system wil, u)dTv designed Date Inspector 1 I ------------------------------------------ p No. C)16 Fee /Uy THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS r Misposal 6pstem Construction 3permit Permission is hereby granted to Construct( ) Repair(�) Upgrade( ) Abandon( ) System located at X E4.5A-j) (,ME 1(�„ and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with i Title 5 and the following local provisions or special conditions. Provided:Construction ulst be completed within three years of the date of this permit. Date _ �`3/�(� Approved by /�J #4385 P. 001/001 ■ Town of Barnstable Regulatory Services Richard V. Scali,Interim Director re 19.6 Public Health Division Thomas McKean, Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Installer& Designer Certification Form Date: g 25-1(o Sewage Permit# 6-1016-�9_C ? Assessor's Map\Parcel Designer: _SG Ln�trlcucn� 4•Tj0r_ Installer: Cal'twi► e_ eii-•--cetiSe.,J Address: 2851 Cc-an\oe_rry �}i�h is Address: 153 Co,y1Mei-ctp( 54rFe.{ cask Wafetnnm B H A 6253 8 Moslnpa-e, On 9- 43 aOIC- CSeewCde_ was issued a permit to install a (date) (installer) septic system at 6 2. N&ksoyi Gao e- based.on a design drawn by (address) Au3,,sk Y Z, yo c 6 SG E�glrtcec«�� nG, dated (Qc�,( : 9-Zy-1(o � (designer) I 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. Strip out (if required) was inspected and the soils were found satisfactory. 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. Strip out(if requited) was inspected and the soils were found satisfactory. I certify that the system referenced above was construc nce with the terms of the I1A approval letters (if applicable) JOHN L CHUR ILLVIL Jit, stalle ' Sig ure) N - .1 q st r �o s PL7igner's Signal (Affix igne s St mp Here) ASEsRETU TO BAI2NSTABLE PU LIC HEA II b IS N, CERTIFICATE. F COMPLIANCE LL NOT BE ISSUED UNTIL O IS FORM AND AS- BUILT CARD ARE RECEIVED BY TUV, &A_RNSTAHLE PU C HEALTH AIVJSJC)N THANK YOU. Q.\Septic\Designer Certification Form Rev 8-14-13.doe TOWN OF BARNSTABLE LOCATION � ' �5 C&� SEWAGE#C Wy- 31'7 VILLAGE 9,01A ASSESSOR'S MAP& LOT INSTALLER'S NAME&PHONE NO.fro-"Pg,.' ;�e'-d,4wl,, %1?9-8;16 SEPTIC TANK CAPACITY Cc t` LEACHING FACILITY: (type) 32�t$C Clmf j ' �'✓ (size) /3 NO.OF BEDROOMS 3 BUILDER O WNER S i� PERMIT DA COMPLIANCE DATE: ;?.5, 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 /16N eate Y) j y16,,6. ;1 TOWN OF BARNSTABLE �L,17�C►UON /a0l% L4,s SEWAGE #o& - 3Y7 tiJLLAGE A _ - ASSESSOR'S MAP&LOT INSTALLER'S NAME&PHONE NO.40-Al�' SEPTIC TANK CAPACITY �� l LEACHING FACILITY: (type) S 4,1 1-1 4-) (size) 13 NO.OF BEDROOMS 3 BUILDER O ER 5 j l PERMTTDATE: WN �''6�® 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 fee of leaching facility) �' Feet Furnished t 4J�i��o��ias ��'� �' �s� �i` ��� -. t R �v �� {;9 �- No. 2 00 3 3 F7 r j i Fee 5 / THE COMMONWEALTH OF MASSACHVSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS 01ppYication for 30i!5pogal 6pgtem Construction Permit Application for a Permit to Construct( . )Repair(Upgrade( )Abandon( ) ❑Complete System Individual Components Location Address or Lot No. Owner's Name,Address and Tel.No. Assessor' Ma cel �c AA Installer's Name,Address,and Tel.No. ✓ Designer's Name,Address and Tel.No. CoesT &tf/rt72 �� �, Type of Building: Dwelling No.of Bedrooms 3 Lot Size sq.ft. Garbage Grinder(/90 Other Type of Building e ` Pace No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow 3 U�U gallons. Plan Date 9 1-7/0:-3r N mber of sheets Revision Date Title �Z 4 Size of Septic Tank Type of S.A.S. Z —5_�V 4PI C !1r/ s , � Description of Soil 4V Z Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued t i Bo d o eal J�o3 Signed Date Application Approved by Date Z 0 Application Disapproved for the following reasons Permit No. Z U 0 3—3&:7 Date Issued �Z U v�3 -3?7 Fee � s No. I Entered in computer:_.✓ ,, THE COMMONWEALTH OF MAS '�. .H ETTS ;' �'. Yes" PUBLIC HEALTH DIVISION'-;-TOWN OF BARNSTABLE., MASSACHUSETTS 01pprication for Migpo.5ar *pgtem Congtruction Permit Application for a Permit to Construct( )Repair(t4pgrade( )Abandon( ) El Complete System` eIndividual Components Location Address or Lot No. Owner's Name,Address and Tel.No.so # Assessor's Map cel r .. _ Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. ev 44 Type of Building: Dwelling No.of Bedrooms Lot Size�— q. g (C� s ft. Garbage Grinder /eo Other Type of Building No. of Persons Showers( )--Cafeteria( ) Other Fixtures Design Flow if gallons per day. Calculated daily flow 3 3 0 gallons. Plan Date `d 77 0 3 Number of sheets - / Revision Date Title ;� 0 6- 12 217e 9 �17 ��,0-A5e-)w /w. Size of Septic Tank Type of S.A.S. Z--- -5_iV Q45' C 4� 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'Certifi- cate of Compliance has been issued b this Bo �!� `� Signed Daie- 515121z .� ,- ApplicationApproved by �./ Date l3' 7 Application Disapproved for the following reasons ; ., Permit No. 2 V 0 3- 3 17 Date Issued ———————————— ————— ——————— ———————— — a THE COMMONWEALTH OF MASSACHUSETTS r BARNSTABLE, MASSACHUSETTS (Certificate of (Compliance THIS IS TO CERIFY, that the On-site,Sewage Disposal System Constructed( )Repaired ( )Upgraded( ) Abandoned( )by Ae G� / ��✓` at 6 Z 1W �l s x,�59 s has been construct d in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. 0�3-��7 dated �' 0 3 Installer Designer_- The issuance this a it shall not be construed as a guarantee that the syste t' s dg�i r Date / Inspector / i --------------------------------------- No. q DU 3— 3$ /-7 Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS mfi5poe at *pgtem Qtott$tructiotl Permit Permission is hereby gra ed to Constru¢t( )Repair(�Upgrade( )Abandon ) System located at (Z -.-(Ie and as described in the above Application for Disposal System Construction Permit. The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided: Construction must be completed within three years of the date of thi s rmit. Date:_ �` "0 Approved by P_ BORTOLOTTI CONSTRUCTION, INC. .765 WAKEBY ROAD,MARSTONS MILLS, MA 026 508-771-9399 508428-8926 FAX: 508428-9399 V Q f SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTIO �`flc9 titi PART A CERTIFICATION Z y1 i Property Address: 6o cn ajQ�� -0 , Date of Inspection: 0 Ins is Name: Owner's Name and Address: /U,4 00&2� CERTIFICATION STATEMENT: I certify that I have personally inspected the sewage disposal system at this address and that the informa- tion reported below is true, accurate and complete as of the time of inspection. The inspection was per- formed based on my training and experience in the proper function and maintenance of on-site sewage disposal �3'stems. The System: V Passes Conditionally Pas Needs Further ation Local Aproving Authority Fails Inspector's Signature: Dater Fri The System Inspector shall submit a copy of this inspection report to the Approving authority within thir- ty(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 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 SLTMMARY� A)SYSTF�M PASSES: t0 I have not found any hiformation which indicates that the system violates any of the failure criteria as defined 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 comple- tion of the replacement or repair, passes inspection. Indicate yes, nor,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 sep- tic tank is replaced with a conforming septic tank as approved by The'Board of Health. Sewage backkup or breakout or high static water.level observed in the distribution box is due to broken or obstructed pipe(s)or due to a broken,settled or uneven distribution box. The system will pass inspection if(with approval of The Board of Health): - 1 - r t� SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM -PAR TA— CERTIFICATION(continued) Broken pipe(s)replaced Obstruction is removed * i Distribution Box is levelled or replaced d� 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 FUNCTION- ING IN A•MANNER THAT PROTECT,THEVUBL'IC HEALtWAND.SAFETY AND THE ENVIRONMENT: M1:€ ' The system has a septic tank and soil absorpt(on-systen►Fand i' within 106 Feet to a surface water supply or`tributary to a surface:water supply:' The system his#iiptic tank and soil absorption system and is"with a Zone 1 of apublic water supply well. The system has a septic tank and soil absorption system and is within 50 Feet of a private water supply well. The system has aseptic 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 and volatile organic compounds indicates that the well is free from pollution from the facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5.ppm. 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 into facility or system component due to an overloaded or clogged SAS or.cesspool. Discharge or ndin of efluent to the surface of the round or surface waters due to an g Po g ground overloaded or clogged SAS or cess 1 gg Pce.. Static liquid.level in the distribution box above outlet invert due to an overloaded or clog- �. ged SASaor cesspool ti ,.., �.-r. .. .. . ^� Liquid depth`in cesspool is less than 6"below rnvert or available.volume is less than 1/2 L:a., ,.5 . t r tr.(S C :I E ! .. lY. ,, r 1g *.how. e Required pumping more than 4 times m the_ last year NOT due to,clogged or obstructed i s . .Number of times um P1� pumped , .. -2- t f o I • I SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) 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 I 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 titan- 00 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 a large system in addition to the criteria above: The design flow of a system is 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 diinkingmatensupply The<system.is located in.a,nitrogen,sensitive area Interim,Wellhead Protection Area (IWPA)or a mapped Zone 11 of a public water.supply well. 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. SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST . Check if the following have been done: _Pumping information was requested of the owner,occupant,and Board of Health. _None of the system components have been pumped for atleast two weeks 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. t/As-built plans have been obtained and examined. Note if they are not available with N/A. The facility or dwelling was inspected for signs of sewage back-up. The system does not receive non-sanitary or industrial waste flow. he,site was inspected for signs of breakout. ` ./All system components,excluding the Soil Absorptioii'Systein'have been located on site. fhe septic tank manholes were uncovered,opened,and the tnteiior`of.the septic tank was in- spected for condition of baffles or tees,material of coi`'i•struction,dimensions,depth of liquid, epth of sludge,depth of scum; t The size and location of the Soil Absorption System on'th'site'has been determined based on existing information or approximated by non'intrusive methods. , -3- n fir#a� �i�. 'p�`t�. F"c�%Ji y:.t•R' . 1 Y SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST(continued) The facility owner(and occupants, if different from owner)were provided with information on the proper maintenance of Subsurface Disposal System SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM -PARTC SYSTEM INFORMATION FLOW CONDITIONS RESIDENTIAL: Design Flow: gallons Number of Bedrooms:. Number of Current Residents:_ Garbage Grinder: AZ Laundry Connected To System: UA, Seasonal Use: A)d Water Meter Readings, if av 'fable: . Last bate of Occupancy: COMMERCIALt]NDUSTRIAI,:/O f)'.:, ,,: ,,. , Type of Establishment. ,., r� ,, .:. ,, '�: �• :1. � Design Flow: aallons/day Grease Trap Present_(yes or TO _. - ---- industrial Waste Holding Tank Present: Non-Sanitary Waste Discharged To The Title V System: Water Meter Readings,If Available: Last Date of Occupancy: OTHER: Describe) Last Date of Occupancy: GENERAL INFORMATION PUMPING RECORDS and source of information: AV System Pumped as part of inspection: If yes,volume pumped: allons Reason for pumping: SeSeptic F SYSTEM: Tank/Distribution Box/Soil Absorption System Single Cesspool Overflow Cesspool Privy Shared System(If yes,attach previous inspection records, if any). Other(explain): APPROXIMATE AGE of all cQmponents,date installed(if known)and source of,.information: Y " Sew de odors detected when arriving at the site: A26 t' _ 4 r SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM' . ` . ,... . _, .w ,_. . `PART C . :; •t".; GENERAL INFORMATION (continued) SEPTIC TANK. y / Depth below grade: Material of Constnuction`. y concrete metal FRP - Other (explain) — Dimisions:/p.,!;- X S 1 Sludge Depth: 07" -Scum Thi kness: ffl Distance from top of sludge to bottom of outlet tee or baffle:-.. ,3 Distance from bottom of scum to bottom of outlet tee or baffle: 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.) .�' ,moo GREASE TRAP: 4—j6 Depth Below Grade: Material of Constniction:_eoncrete metal FRP Other (explain) — —' —' Dimensions: Scum Thickness: Distance from to of scum to top of outlet tee or baffle: Comments: (recommendation for pumping, condition of:inlet and:oudeir.tees:or baffles,depth.ofcliquid level in relation to outlet invert,structural integrity,evidence TIGHT OR HOLDING TANK:-/--J—C) ' Depth Below Grade: Material of Construction:--concrete_metal_FRPOther(explain) Dimensions: Capacity: gallons Design Flo«: gallons/day Alarm Level: Comments: (condition of inlet tee, condition of alarm and float swilches, etc.) DISTRIBUTION BOX: . Depth of liquid level above outlet invert: Comments: (note if kvel and distribution is equal, evide a of solids carryover, evidence f leak ge into or out of box,etc.) PUMP.CHAMBER: U.._.. -Pp is to working order , um . " Comments; (note condition.of.purn..p.chamber,..conditioi�.oCpinups anii'appiirtenances, etc:) -5- i SUBSURFACE SEWAGE DISPOSAL SYSTEM.INSPECTION FORM PART. i { C' SYSTEM INFORMATION (continued) SOIL ABSORPTION SYSTEM SAS (Locate on site plan,if possible;excavation not required,but may be approximated by non-intrusive methods) If not determined to be present,explain: Type: Leaching pits number: 'Leaching chambers 'mumbe : Leaching,g all ries,n m er• Leaching trenches,number,length: Leaching fields,number,dimensions: Overflow cesspool,number: Co ents: (note condition of soil;signs of drau ' failure eve] of poi ing,condition of vegetation, CESSPOOLS:__zj_C, f Number and configuration: Depth-top of liquid to inlet invert: Depth of solids layer: Depth of scum layer: Dimensions of Cesspool: 's Nbterials of construction: Indication of groundwater: Inflow(cesspool must be pumped as part of inspection) Comments: (note conditionof soilk,signs of hydraulic failure, level of ponding,condition of vegetation, etc.) PRIVY:—,&)D Material os' f construction: Dimensions: Depth of Solids: Comments: (note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation, etc.) + l -6 - SUBSURFACE SEW_AGE DISPOSAL SYSTEMi INSPECTION FORM PART C SYSTEM INFORMATION(continued) SKETCH OF SEWAGE DISPOSAL SYSTEM: Include ties to atleast two permanent references, landmarks or benchmarks. Locate all wells within 100 Feet. .0 DEPTH TO GROUNDWATER: Depth to groundwater: Z y Feel Method of Determination for Approoxiitpation: 1'� 'rexj'4v lord a,s �� lz -7- COMMONWEALTH OF MASSACHUSETTS r EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PRO RECEIVED r SEP 1 8. 2002 TOWN OF BARNSTABLE HEALTH DEPT. TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: Owner's Name: - FAILED IN Owner's Address: s Date of Inspection: `_ -743 Name ofInspecto : (please print) r ' I �� MAP I Z(0 Company Nam pjj 9�:�% ,PXIabI%"0?/M� Q I I � �q Mailing Address: PARCEL. .....:..+!. .. o�CpS�� LOT • Telephone Number: CERTIFICATIONI STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of the inspection.The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I.am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: Passes Conditionally Passes Needs Further Evaluation by the Local Approving Authority F ' Inspector's Signature: 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 approving authority. Notes and Comments ****This report only describes conditions at the time of inspection and under the conditions of.tise.`at That ti 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 6/15/20.00 page 1 Page 2 of I I OFFICIAL INSPECTION FORM=NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A // CERTIFICATION (continued) Property Address: CO . ,4 GI� R, Owner: Date of Inspection: /O o"aU0 Inspection Summary: Check A,B;C;D or E/ALWAYS complete.all of Section D. A. System Passes: I have not found any-information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15,304 exist.Any failure criteria not evaluated are indicated below. —i , r .,. B. System Conditionally Passes: —One-or-more system components as described in the"Conditional Pass"section need to be replaced or repaired.The system,,upon completion of the replacement or repair;as approved by the Board of Health,will pass. Answer yes,no or not determined(Y,N,ND)in the for the following statements. If"not determined".please explain. The septic tank is metal and over 20 years old* or the septic tank(whether metal or not)is structurally unsound,exhibits substantial infiltration or exfiltratiori or tank failure is imminent:System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND explain: 6bservation.of-sewage backup or break out or high static water level in the distribution.box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced ND explain: The system required pumping more than'4 times a year due to broken or obstructed pipe(s).The system will. pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed ND explain: 2 Page 3 of I I OFFICIAL INSPECTION FORM NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE.SEWAGEDISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 129 ixi Yrk Owner: 44mi� ► Date of In pection: , C. Further Evaluation is Required by the Board.of Health: Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System'will pass unless Board of Health determines in accordance with 310 C.MR 15.303(1)(b)that the system is not functioning in a manner which will protect public health,safety and the environment: _ Cesspool or privy is within 50 feet of a surface water _ Cesspool or-privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2. System will fail unless the Board of Health (and Public Water Supplier,.if any).determines that the system is functioning in a manner that protects the public health,safety and environment: _ The system has a septic tank and soil absorption system(SAS)and the SAS is.within 100 feet of surface water supply or tributary to a surface water supply: _ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well _ 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 11 OFFICIAL INSPECTION FORM-.NOT FOR V LUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL.SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: Owner: Date of In pection: /U) (�,DOQ D. System Failure Criteria applicable to all systems: You must indicate"yes"or"no"to each of the following for all inspections: Yes No Backup of sewage into facility or,system component due to overloaded or clogged SAS or cesspool _ Discharge or ponding of effluent to the surface of the ground.or surface waters due to an overloaded or clogged SAS or cesspool i/ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool " JLiquid depth in cesspool is less than 6"below invert or available volume is less than '/2 day flow Required.pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number ' _ Jof times pumped Any portion of the SAS,cesspool or privy is below high ground water elevation. Any portion of cesspool or privy is within 100 feet of.a surface water supply or tributary to a surface water supply. _ Any portion of a cesspool or privy is within a Zone i ofaepublic well. _ Any portion of a cesspool or privy is within 50 feet of a.private water supply well. Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for 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.] (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: To be considered a large system the'system must serve a facilitywith a'design flow of 10,000 gpd to 15,000 gpd• You must indicate either"yes"or"'no",to each of the following: (The following criteria apply to large systems in addition to the criteria above) yes no _ — the system is within 400 feet of a'surface drinking water supply _ the system is within 200 feet of a tributary to a surface drinking water supply the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area—IWPA)or a mapped Zone II of a public water supply well If you have answered"yes"to any question in Section E the system is considered a significant threat,or answered "Yes"in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 4 Page 5 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: ' D ooXo�/+� Owner: Date of Inspection: Check if the following have been done. You must indicate"yes"or"no"as to each of the following: Yes No __Le-- Pumping.information was provided by the owner,occupant, or Board of Health t✓ Were.any of the system components pumped out in the previous two weeks? ✓ _ Has the system received normal flows in the previous two week period? Have large volumes of water been introduced to the system recently or as part of this inspection? p✓_ Were as built plans of the system obtained and examined?(If they were not available note as N/A) Was the facility or dwelling inspected for signs of sewage back up? _ Was the site inspected for signs of break out? Were all system components,excluding the SAS, located on site ✓_ Were the septic tank manholes uncovered,opened, and the interior of the tank inspected for the condition of the baffles or tees,material of construction,dimensions,depth of liquid, depth.of sludge and depth of scum? Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems The size and location of the Soil Absorption System(SAS)on the site has been determined based on: 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) [3 10 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: Q� Owner: Date of In p ection: l0 a FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): ,._-� Number of bedrooms(actual): DESIGN flow based on 310 CMR 15.203 (for example: 11.0 gpd x#of bedrooms): Number of current residents: Does residence have a garbage grinder(yes or no) � y,•. - Is laundry on a separate.sewage system (yes or no [if yes separate inspection required] Laundry system inspected(yes or noZ. Seasonal use: (yes or noLZA& Water meter readings, if available(last 2 years usage(gpd)): Sump pump(yes or no)z'40 Last date of occupancy: v��-ir '- G? /iJ /��� ✓C � COMMERCIALANDUSTRIA.L`� Type of establishment:. . . Design flow(based on310 CMR 15.203): gpd Basis of design flow(seats/persons/sgft,etc.): Grease trap.present(yes.or no): Industrial waste holding tank present(yes or no):_ Non-sanitary waste discharged to the Title 5 system (yes or no): Water meter readings, if available: Last date of occupancy/use: OTHER(describe): GENERAL INFORMATION Pumping Records Source of information: P'U'Qx'oxz� C-p.p� 000 a Was system pumped as part of the inspection(yes orGL_,� If yes, volume pumped: gallons--How was quantity pumped determined? .Reason for pumping:. TYPE OF SYSTEM �ptictank, distribution box, soil absorption system Single cesspool _Overflow cesspool _.Privy _Shared system(yes or no)(if yes,attach previous inspection records, if any) _Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) —Tight tank —Attach a copyof the DEP approval ..Other(describe): proximate a e ofall co ponents, date instal] .�(if--known and source of information: Were sewaae odors detected when arriving at the site(yes or no): 6 Page 7 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM.INFORMATION(continued) 'Property Address: ' Owner: Date of Inspection: BUILDING SEWER(locate on site plan) Depth below.grade: Materials of construction:_cast iron. _40 PVC_other(explain): Distance from private water.supply well or suction liner Comments(on condition of joints,venting,evidence of leakage,etc.): SEPTIC TANK: locate on site plan) Depth below grade: Material of construction:_zconcrete_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: Sludge depth: Distance from top of sludge to bottom of outlet tee or baffle: Scum thickness:_ Distance from top of scum to top of outlet tee or baffle: 3 Distance from bottom of scum to bottom of outlet tee or baffle: /Z How were dimensions determined: Comments(on pumping recomme ations, inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert, evidence of leakage,etc.): �r GREASE TRAP:iy k (locate on site plan) Depth below grade: Material of construction:_concrete_metal_fiberglass_polyethylene_other (explain): Dimensions: Scum thickness: _ Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping: Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity,liquid levels as related to outlet invert, evidence of leakage,etc.): 7 Page 8 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: �/>4 Owner: Date of In pection: /O,Q)DOa TIGHT or HOLDING TANK:wank must be pumped at time of inspection)(locate on site plan) Depth below grade: Material of construction:. concrete metal . -fiberglass_polyethylene other(explain): Dimensions: Capacity: gallons, Design Flow: gallons/day Alarm present(yes or no): Alarm level: Alarm in working order(yes or no): Date of last pumping: Comments (condition of alarm and float switches, etc.): DISTRIBUTION BOX:.+/�(if present must be opened)(locate on site plan) Depth of liquid level above.outlet invert:1 _ Comments(note if box is level and distribution to outlets equal, any evidence of solids carryover,any evidence of leakage i to or out of box, ete.): _ i PUMP CHAMBER(locate on site plan) Pumps in working order(yes or no): Alarms in working order(.yes or no): Comments(note condition of pump chamber, condition of pumps and appurtenances,etc.): 8 Page 9 of I 1 OFFICIAL ]INSPECTION FORM—NOT FOR VOLUNTARYASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM.INFORMATION(continued) Property Address: Owner: 5 Date of In ection: /O cep a SOIL ABSORPTION SYSTEM (SAS): t/(locate on site plan,excavation not required) If SAS not located explain why: Type ............ . �-Iea.ching 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.): _ q, jonn adJhx., �i o• CESSPOOLS (cesspool must be pumped as part of inspection)(locate on site plan) Number and configuration: Depth—top of liquid to inlet invert: Depth of solids layer:_ Depth of scum layer: Dimensions of cesspool: Materials of construction: Indication of groundwater inflow(yes.or no): Comments(note condition of soil,signs of hydraulic failure, level of ponding, condition of vegetation,etc.): PRIVY(locate on site plan) Materials.of construction:. Dimensions: Depth of solids: Comments(note condition of soil,signs of hydraulic failure, level of ponding, condition of vegetation, etc,): 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 Inspection: SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet.Locate where public water supply enters the building. i i 10 r 600 ta i a xo.. mL? LOT 9P Fimz..... THE C MMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH V!; ° ... . ...............0F...... .A9.Ia51.Ty6L .................................. Appliration for Disposal Works Tons#nu#ion Irani# Application is hereby made for a Permit to Construct (K) or Repair ( ) an Individual Sewage Disposal System at: M ....3....11�4�L:. Ila;, t ;t , !.:►: ! ... S..!.:X LJO......................��.............................................._.......... Locatio a •-•-or_Lot No. ....._. �F_ ..... '�� t� -•----- •------ ------..................................._._.._ Owner .........................Address .. a ._..�__ -....................... ................. ---------------: Installer Address Type of Building Size Lot.ALI ....Sq. fget Dwelling—No. of Bedrooms._..�...................................Expansion Attic Ab Garbage Grinder ( ib Other—Type e of Building No. of persons...................... Showers a yP g -•-------------------------• P ------ ( ) — Cafeteria ( ) G4 Other fixtures .................. Design Flow---------5...........................gallons per,person �er day. Total daily flow.......... J3._ ....gallons,_ Septic Tank—Liquid capacityl .gallons LengthB--rz'rc.:Width_4�-10 . Diameter''—, ..,.� DepthS_�—.5.... W Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area..--........__......sq. ft. x ..'Seepage Pit No.........I.......... Diameter....i-T.......... De t 1 below inlet.3t5 ........ Total leaching area._�A .....sq. ft. Z Other Distribution box Dosi tank ( ® 4 Percolation Test Results Performed by /k-R4.91.e---I ML................. Date.' .@'. `. �?.._.__... ,� -• -•-- ,.a Test Pit No. 1.Gz-.......minutes per inch Depth of Test Pit----.�K.......... Depth to ground water.._GT_.F-�49S.4c�k Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a .........•-----•- ......................................................-••••---------------- O Description of Soil.....O?.i�- . ... $ G--- 1'�til.S W V •------------- ...........•----------••-•-----------••----------------------•-••-----•------------•-•--------------------------------•-•-------- ---•-----•------------•--------•---------•---------- 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 TITIE 5 of the State Sanitary Code—.The undersigned further agrees not to place the system in VAitcati u mil a ertificate of Compliance has been issued by the board of health. Signed........ -----•-• •.•--------------•--•-•........ •----•. at'V r .. ppl Approve By-- ate Application Disapproved for the following reaso :..-----••-------------•----------........---•--------------.......---------••----------•---•----••----......-- ...............................••-----•--------------------•------•------•-------•-••---..................------------.......--------------------•-------•---------------•••............................ Permit -------------------- Issued............................ ..............Date....... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .......:. ( l�(J1U........OF.. I o�� ... ...................... Tutif irate of Toutplittnrr TH;S, S bj TO.0 RTIFY, That the Individual Sewage Disposal System constructed (X) or Repaired ( ) at....o . ...N ! '-ci;;.� �•t .r! - -- -------------------------------•--•-•-------.....----.... has been installed in accordance with the provisions of TIT IZ 5 State Sanitary C in the application for Disposal Works Construction Permit No.. -' ---•---• dated. ............. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE -•-• .. ...........•----- ---..._..... Inspector--•---.......•-------..............•...................--•---........._._......-- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF�H�E/ALTtf _. ........1.... ..`.:"....................OF... .................... �. NO .v..-0!.Y? Fss...l...'.-2..... .. �ioostt r s n #rtu#ionrrtntf Permission is hereby granted. ,.<1 l•. l.............................. .... ................................................_...... to Constr ct or 'r ( ) an Indiv'd alMew a Disposal S st . 0 at No... .. y -. .........�////.'.......--- Str ini Q p as shown on the application for Disposal Works Construction Perini Nd..2. Dated.._, .... .C� -----•--------------- - •-...-�... .........__........---...._...._.................. ...._ DATE..................�_:.-�----�.�....--•...............:........... Board of Health FORM 1255 A. M. SULKIN, INC., BOSTON TOWN OF•-BARNSTABLE LOCATION L 0 Z Qzj SEWAGE # VILLAGE �f, � �. L/UAJSESSOR'S MAP & LOT � INSTALLER'S NAME & PHONE NO. lei l L4 cep / t SEPTIC TANK CAPACITY K LEACHING FACILITY:(type) P1� (size)- -- NO. OF BEDROOMS � PRIVATE WELL OR PUBLIC WATER_ d BUILDER OR OWNER DATE PERMIT ISSUED: �> . DATE COMPLIANCE ISSUED; VARIANCE GRANTED: Yes . No a sp a� q �� °DES I G N DATA SINGLE;FAMILY - 3 BEDROOM SNIT' NO GARBAGE DISPOSAL DAILY FLOW = 110 x 3 = 330 P.P.D. SEPTIC TANK = 330 x 150% = 495 G.P.D. USE 1000 GAL. TANK 1000 €' 'FLA 0 6 �3AUL DISPOSAL:PIT - USE ( 1.) SIDEML AREA = 13'7-S.F. I31- .:S.F s'2.5 = S16)13.P.D. BOTTOM AREA =I h'3 S.F. 106 S.F.'x LO - 11-SG.P.D. TOTAL! DESIGN c 4�:-B G.P.D. TOTAL' DAILY FLAW = 330 G.P.D. PERCOLATION RATE : I" IN 2 MIN. OR LESS 4..is I . TEST E HOLE # P =7o Ez= 70.8 F.G. _ `I o , j F.G 1 r � .c ii o TOP FND.��Z. c • o P.V.C. • + 4" SCHED. 40 1000 INV. 2 0 'ems.GAIN . 6'1 l DIST. �7,9 INV. GAL. INV. LEACH PI �-Ih BOX ���( SEPTIC o° WITH $� TANK �.tgo col � 3/4" TO INV. INV. `�" of bfgs� ytiPETER WASHEDSTONEl4;y:; ;� ULLIVAN,.�� ROFILE 1 � �,c��-.,, _. �� No. 29133 � NO SCALE Oi y xit:c ' k f,.. '1STfpv �cvQ FSc���1 C E�yG � Y l,G, CERTIFIED PLOT PLAN I CERTIFY THAT THE PROPOSED FOUNDATION LOCATION IV P?61-oO-5 AA lu, SHOWN HEREON COMPLYS WITH SCALE I = 4- DATE �5/Z3/ue THE SIDELINE AND SETBACK REQUIREMENTS OF THE TOWN OF PLAN REFERENCE BARNSTABLE AND IS NOT LOCATED iv •p WITHIN THE FLOODPL.AIN1Zo3d- DATE : = G V� BAXTER 8 NYE, INC. THIS PLAN IS NOT BASED ON AN REGISTERED LAND SURVEYORS INSTRUMENT SURVEY AND THE OFFSETS CIVIL ENGINEERS SHOWN SHOULD NOT BE USED TO OSTERVILLE, MASS. DETERMINE LOT LINES. APPLICANT JEFF �►2C; iJ v��� A - Y s� va3 e L pep I � o�qQ -ct.) a . . 3 � S !'/T l IP , cn 2� , �Z f '7 '71 _ ht 2' 9 I ! . t 4t�5L.SO�1 I , � -i SOP .� ��--�-.- . � �. ��� y. -��.�. ��� ��� �.- ___�._,� ®� �� � ��S �� � �- .� � : { ., _. . . . -ESiGN DATA SINGLE;FAMILY - 3 BEDROOM Su�sT 1 vt 'Z NO GARBAGE DISPOSAL DAILYFLOW = 110 x 3 = 330 (P.P.D. SEPTIC:TANK = 330 x 150% = 495 G.P.D. USE 1000 GAL. TANK 1000 SEE pLAW 09 5A4L ��pF DISPOSAL'PIT - USE ( I ) 'lam-. �- 5o1J (,A NC- SIDEWAI-L..` AREA = 13'2-S.F. 132LS.F: x1.5 = SW OG.P.D. BOTTOM AREA =I U-1 S.F. liz S.F.l x LO = 1 1!3 G.P.D. TOTAL` DESIGN =44-3,G.P.D. TOTALS DAILY FLAW = 330 G.P.D. PERCOLATION RATE : I" IN 2 MIN. OR LESS TEST HOLE # P-22'70 e:lrs/es Ez-- 70.8 F.G. - 7 0 +� ♦ /1 /,711T, . F.G 7 ♦_ �t♦i. ;o' TOP FND.'�2 if/a c i t /c . — 4.. SCHED. 40 1000 P.V.C. `,: INV. GAL. DIST. G'Lq INV. GAL. INV. 'LEACH PIT IN 6-�S G, BOX �S�I SEPTIC ' 3 • ' • WITH TANK "„ ,;�;� 3/4" TO 8 INV. INV. � j" OF n'gss' 5d $ WASH D PETER cyG�+ �+2A✓t>;L.• STONE ° Nssd 5�4 SULLIVAN 3 PROFILE =r ,C,�,, :, s ha. 19733 y .: NO SCALE IS T I.- x, -� �t!f rOrr C e v. a G is CERTIFIED PLOT PLAN I CERTIFY THAT THE PROPOSED FOUNDATION LOCATION SHOWN HEREON COMPLYS WITH SCALE W= ,tl DATE THE SIDELINE AND SETBACK REQUIREMENTS OF THE TOWN OF PLAN REFERENCE . BARNSTABLE AND IS NOT LOCATED LOT' 21 WITHIN THE FLOODPL AIN �J. D : `Hg G 9,L BAXTER 8 NYE, INC.ATE THIS PLAN IS NOT BASED ON AN REGISTERED LAND SURVEYORS 8 INSTRUMENT SURVEY AND THE OFFSETS CIVIL ENGINEERS SHOWN SHOULD NOT BE USED TO OSTERVILLE, MASS. DETERMINE LOT LINES. APPLICANT JE�--F L/,a-`et-J vivo`b 1 s vT3AeLo24 PaND I�v� Q �s r. : h 70 . - i 3,SlvC SF . . :. (I ell j A t f �� , bW'rit.L.aIJL -__7Z 46GHAf�p _.4 2.ow. ` t- 1 �H tag v r l��_ ALBANL-fC E rgu,� aE t r.r, i Ci 3c�3.t .4 .. _,..._.. .,,._ .. ... TOWN OP-BARNSTABLE LOCATION Z Afb 1�ovi Lc�,eSEWAGE #_ VILLAGE (t,` !}( SESSOR'S MAP 6t LOT INSTALLER'S NAME & PHONE NO. J/ LG 3xL SEPTIC TANK CAPACITY L _ 1 LEACHING FACILITY. ©�� �k (size)_ _ G� NO.-OF~BEDROOMS PRIVATE WELL OR PUBLIC WATER( 13UILDER OR OWNER Tf I f irr_ rf(d 16 o '. DATE PERMIT ISSUED: V DATE COMPLIANCE ISSUED; VARIANCE GRANTED: Yes No L ' r 1 i ' I r 11 CL6r Flcs....��`No.. _, ......_a39P THE C MMONWEALTH OF MASSACHUSETTS _ BOARD OF HEALTH .._..... w4--U.......__....OF..;.FWZM'6T .. ..Cs .................................. Appliratiun for Uiupuual Workii Tonstrur#iun thrmi# Application is hereby made for a Permit to Construct or Repair ( ) an Individual Sewage Disposal System`at: .._......�14=L5 ki L&1�1. _.... ITX�S i1.1 1 I • -----------------------•----------........................__. Locat10 a or Lot No. > ,r �.. ......... - - --.- ----- ..._.. Address Owner ------------------------------ ----------------------- - - Installer Address PQ el Type of Building Size Lot..' _��� __..SQ. fcet aDwelling—No. of Bedrooms____�...................................Expansion Attic ( ()j Garbage Grinder (Rib 04 Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) a Other fixtures --------------------------•--- . W Design Flow.........sG..S........................•._gallons per person per day. Total daily flow.._..._._.�.�J.... _ .. ............gallons. rr rr r e WSeptic Tank—Liquid capacity .gallons Lengthex.,fit_.--__ Width,.--1_�__. Diameter----- -. DepthS.-.5-_-. x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No.........I---------- Diameter....A.Z......... De th below inlet_3.t.5 ....... Total leaching area.-�A-��- ....sq. ft. Other Distribution box �iI Dosi tank (N� _ i Z Percolation Test Results Performed by. f�k A1.ta..-1 ML................. Date_a.`-e. S5 ,aa Test Pit No. 1.G Zs.......minutes per inch Depth of Test Pit-____V .......... Depth to ground water..$AC—t Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a --- •-----. ••.....................•-.....•--....._..-•••-••-•--.........----...._.. ------- ----- _ ----- O Description of Soil...... . �.. 4:�. ._Su Still 2 --.i-t-.-•-�V----6!+` V.. .. (---------- x c, 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 TITL% 5 of the State Sanitary Code—.The undersigned further agrees not to place the system in rati P u til a ertificate of Compliance has been issued by the board of health. Signed........ -•-••---• •----•-•........---•--... --•........................... /�f A ApplicatiVAppWrovlyl — ._...- •----• 4�09 ,Pn' Application Disapproved for the following reaso :....---••--------------•-•-----•----•----•-------•-•--•-------•---•-----------------••-•--...--•.....---------- --•--•...-•---•--••-•••................•-•••-•--••-•--•-••--•....----•----...---•-••••-••--•--••---•-••----•••-•-•--••.....-••---•-•----•-••-.......................................................... Date PermitNo....... ....... . -----------------------. Issued.._._..-----._...-------------••--•---------•---•-•----- Date 67 6 THE CLMM90N"WEALTH OF MASSACHUSETTS BOARD OF HEALTH ....OF.�7 ...............3C..'- ................................... Appliration.for Disposal Works Tanstrurtion 11trutit Application is hereby made for a Permit to Construct or Repair an Individual Sewage Disposal System at: L.catio A or I Dt No. .......... F . ............q ..... . ......... . ......................................................................................... Owner Address .......................1�� -—------------------------- ..... . ...... .... .................................................................................................. Installer Address Type of Building Size Lot..-'�.....I Sq. feet U Dwelling—No. of Bedrooms....3.................I................_...Expansion....................Expansion Attic (A()) Garbage Grinder (�,O) N Other—Type of Building ............................ No. of persons............................ Showers Cafeteria Otherfixtures ........................................................................................................ Design Flow........ .......:...................gallons per person per day. Total daily flow..............................................gallons.. 9 Septic Tank—Liquid capacity.v.'_� gallons WidthJ.'-.!Q'... Diameter=====. Depth'->.'...�J Disposal Trench—No..................... Width..--........._...... Total Length.................... Total leaching area..................sq. Seepage Pit No.........j........... Diameter....1Z........... Depth below ........ Total leaching area.-` .' ......sq. ft. Other Distribution box Dosipg>tank Percolation Test Results Performed by_t !-�.?�i 77-L;A 11\�I( -------- ----------11_1'Z.................. Date..' .................. Test Pit No. 1.!��........minutesperinch Depth of Test Pit.....A�........... Depth to ground Test Pit No. 2................minutes per inch Depth of Test Pit.................__. Depth to ground water.............._......... Ri ............................................................................................................................................................. 0 Description of Soil...._ ...lC'�V'- t �T �_ ........................................ ........................................................................................................ ----------------------­---"-----------------------------­----------*---------**--------*-----­------------­_1-----I------*-,-*------I—---- ----"-------*----*--------------- :31 ....................................................................................................................................r.................................I.................................. U Nature of Repairs or Alterations—Answer when applicable................................................................................................ ........................................................................................................................................................................................................ Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal Systemin accordance with the provisions of T I TALE 5 of the State Sanitary Code—.The undersigned further agrees not to place the system in ratli itil a kertificaee of Compliance has been issued by the board of health. u Un Signed........ ......... ............................. ........................... ----- ........... at I t OD Approve Byy...4 .... ...... .........-- Application ica i (......... g....... . .... e Application Disapproved for the following reaso2:..............................................................................................ate ....................................................................................................................................................................................................... Date Permit No..'?.f".—A2ap................... Issued.................................................. Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .............................. Tprtifirate of Toutpliana THI.SSAS TO CERTIFY, That the Individual Sewage Disposal System constructed or Repaired by- X) ........................................................................................ ----------*...... ................................ al at.. A/6- ..................... .................................................................................. has been installed in accordance with the provisions of TITIJE 5 f Xbr-State Sanitary Co as in the application for Disposal Works Construction 27. ........ dated- Permit No..-- r�;............. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE......................................................................I.......... - Inspector................................................................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALT� ...... ........ .......OF.A.—....,......... ....................... No Fzz...17 ......... 'Bilipjasa r s TAnstrudian errant Permission is hereby granted. Zj --------------------------------------...................................................to Constr ct' or pairan Indiv.-Idlial Sewzge Disposal S St e at No...... ........ Street ----------- as shown on the application for Disposal Works Construction Per' NoU?.O?�X Dated._ ....... � ......0............... ...1�D.............................................................. DATE.................. .................................... Board of Health FORM 1255 A. M. SULKIN, INC.. BOSTON . LOCATION Ille/ q ,� _ NO. z270 VILLAGE' DATE O -„2=p' 3 ,. APPLICANTt G FEE ' ADDRESS} a ,L� `. TELEPHONE NO.?>�'�j,�J' on-refundable ) s ENGINEER a TEL O. DATE SCHEDULED : t . n ( p is tv s signature) • • • •'• ••O o 0 o O o • o • o O o o tr • • .. • . 0 0• o • • •>••• • o • • • • • • e • • • • o • • • • • • • • • O• •-• • •o i• e • • �'• -k� �� ate' SOIL LOG _ SUB-DIVISION NAME �� `i. �� DATE TIMEf EXPANSION AREA b YES NO A ENGINEER 1,,- , TOWN WATER 4�PRIVATE WELL . . . ��O AIJ, iN C-O N ` BOARD OF HEALTH t FJ vet *� L EXCAVATOR SKETCH: (Street name,etc. ,dimensions of 1%ot, 'exact location of test holes and ,3percolation tests, locate wetlands. in proximity to test holes) NOTES : ' rq t - °2�� >00 PERCOLATION RATE: ' TEST HOLE NO: ELEVATION: TEST HOLE NO: -ELEVATION: 2 L"f S 2 , 3 Z -. 3 ' S S - 6 SAS y 6 . 7 7 84d g 9 9 10 10 11 11 12 12 13 ! 13 14 ._ 14 15 15 - 16 16 AA V ._ SUITABLE FOR SUB-SURFACE SEWAGE: LEACHING FIELD _LEAC I G PS LEACHING TRENCHES UNSUITABLE FOR SUB-SURFACE SEWAGE . REASONS: NOTE: ENGINEERING PLANS MUST SHOW NUMBER ASSIGNED ON PERC TEST APPLICATION ORIGINAL: COMPLETED IN ENTIRETY BY P . E. AND RETURNED TO BOARD OF HEALTH COPY: RETAINED BY APPLICANT r 4'7'-b" u 14'-9" Q_F- — — — — — — — — — — — — — — — — — — — — — — — -- — — — 3068—.._1.i+�EJ2. > +.c,. — — — - w C�V E . .I I I I O O Ov IlkE W3333 W3333 W3333 � ' � W 33 W2733 DCW2433 I - � O V .N 3DB 8 B39 3D618 3D6 1 BC833 i O Z N - - � - - —� L— - - - � - -I I I L _ MAIN DRAWRAI NI � 1�'-b" I I 2� � V i r + GI A - _ m av p ...�.a... - ^ N B LKH AD I I STORAG n I u 3 o - m I � I m V v I i o I N t � N 3cc b I r co e I Q,� x N N vC 4) 111•c ,� I c`pv m I N I 3 I ry I .UTILITY 3l'-4" = AREA --------- -4„ I i 21"DEPTRAT 3'-6" ENTERTAINMENTGTR TONATER T BASE CABINETS MAIN I G E211, B B4021- TB302tTB2721LT84827N `°I IEP I W2154 - - - -ELECTRIC — — — — — — � r — ry — — — — — — — — — — - - Date: PANEL I I b-20-13 — — — — — —j Revisions: Final Plans: FINISHED BASEMENT PROP05ED 1 BUILDER TO CONFIRM ALL GONDITION5 AND DIMEN51ON5 ON 51TE Note: These plans are for the sole purpose and use of Gapizzi Home Improvement and are not ' to be distributed or used for construction other 20 than by Gapizzi Home Improvement. PROP.VENIT NTH CHARCOAL FILTER TO ABOVE GRADE T.O.F. EL.= 70.5'± FINISH GRADE OVER D-BOX= 68.2± FINISH GRADE OVER CHAMBERS= 675 - 68.0' GENERAL NOTES REMOVABLE WATER-TIGHT COVER OVER SLOPE @ 2% MIN. OVER SYSTEM 3/4"TO 1-1/2"DOUBLE WASHED PROVIDE EXTENSION RISER STONE TO CROWN OF PIPE WITH COVER OVER INLET& RISER TO WITHIN 6"OF FINISHED GRADE UNLESS OTHERWISE NOTED, ALL SYSTEM COMPONENTS AND CONSTRUCTION 4"SCHEDULE 40 PVC INSPECTION PORT WITH ACCESS METHODS SHALL BE IN ACCORDANCE WITH TITLE 5 OF THE STATE ENVIRONMENTAL FINISH GRADE OUTLET TO WITHIN 6"OF F.G. MIN SLOPE 1% BOX TO F.G. (SEE NOTE 21) 2"'OF Iff"TO 1/2" DOUBLE WASHED 69.6'± F.G. OVER TANK EL.= 69.4'± 5"DIA OUTLET(S) STONE OR GEOTEXTILE FILTER FABRIC CODE AND ANY APPLICABLE LOCAL RULES. @FND. EL.= 2. ANY CHANGES TO THIS PLAN MUST BE APPROVED BY THE' BOARD OF HEALTH AND THE PLACE FRISERS ON ALL DESIGN ENGINEER. TOP OF SAS= 65.50' 1 MIN- 9"MIN. 3 4"SCHEDULE 40 PVC PIPE WITH WATER TIGHT JOINTS SHALL BE USED IN DISPOSAL PROPOSE04" 9 M CHiAMBERS WITH �7 V Z, SCH. 40 PVC 4"PVC TEE 36" AX 64.501 36'MAX. INLET PIPES TO 6" OF 5.00 BREAKOUTEL= 6 SYSTEM UNLESS OTHERWISE NOTED. SEWER PIPE FINNIISHED GRADE 4. TO PREVENT BREAKOUT, THE PROPOSED FINISHED GRADE SHALL NOT BE LESS THAN 6#' 3" 3"DROP MAX 3" 9" L=107 I - - DROP MIN MIN,SLOPE 9D I% PROVIDE WATERTIGHT ELEVATION= 65.00' FOR A DISTANCE OF 15" AROUND THE PERIMETER OF THE SAS. UNLESS A JOINTS (TYP.) 5 -12 &Rib- 40 MIL GEOMEMBRANE LINER IS PLACE AT LEAST FIVE FEET FROM S.A.S. AND THE TOP OF PVC IN FR1 M T4 0 14" 67.0'± SEPTIC TANK 4" PVC OUT TO 0 = r 0 0:> 0 THE LINER IS NOT LESS THAN THE BREAKOUT ELEVATION. C LEACHING FACILITY 9z), 5. SLOPE ALL SOLID PIPE AT 1.0% MINIMUM. CONTRACTOR TO PROVIDE 00 0 SPECIFIED DROP BETWEEN CDP- 6. THIS SYSTEM IS NOT DESIGNED FOR A GARBAGE DISPOSAL. 00 12" 6c,:��11 CONTRACTOF C)C�� INLET AND OUTLET CONTRACTOR tSHALL 64.87' MIN. 1 64.70' 2' 00 ITION OF OUTLETTEE SHALL VERIFY SIZE 4�- VERIFY COND 7. LOCAL BOARD OF HEALTH AND DESIGN ENGINEER TO BE NOTIFIED PRIOR TO BACK 00 AND CONDITION OF EXISTING TEES 0 GAS BAFFLE 6" CRUSHED STONE FILLING WHEN SYSTEM IS NEARLY COMPLETE AND READY FOR INSPECTION. SYSTEM IS C), CD 00 5D AND REPLACE AS EXISTING SEPTIC OVER MECHANICALLY f 1- NOT TO BE BACK FILLED WITHOUT FIRST OBTAINING APPROVAL FROM BOARD OF HEALTH TANK NECESSARY COMPACTED BASE of AND DESIGN ENGINEER. 8.5. (TYP) 4. 1 -4.0'- 1 4.0' 3 4.83' (TYP.) .............. 70.00'ESTABLISHED ON THE CORNER OF BULK HEAD, AS SHOWN ON PLAN. BENCHMARK OUTLET DISTRIBUTION BOX 8. ELEVATIONS BASED ON APPROXIMATE M.S.L. DATUM. BENCHMARK#1 ELEVATION OF TO BE INSTALLED ON A LEVEL STABLE 25.0' BASE. FIRST1WO FEET OF OUTLET GROUND WATER ELEV.= < 58.00' #2 ELEVATION OF 69.26' ESTABLISHED ON CORNER OF CONCRETE PAD. 62.50' 12.83' PIPES TO BE LAID LEVEL. 9. CONTRACTOR SHALL VERIFY ALL UTILITY LOCATIONS PRIOR TO CONSTRUCTION 5f MIN.-/ EXISTING 1500 GALLON CONCRETE SEPTIC TANK 2 - 500 GALLON H-20 CHAMBERS CHAMBER END VIEW THROUGH DIG-SAFE AT LEAST 72 HOURS PRIOR TO COMMENCING WORK ON SITE AT CROSS SECTION VIEW TYPI(AL CHAM11BER PROFILE 1-888-DIG-SAFE AND ANY OTHER APPLICABLE AGENCIES. REPORT ANY DISCREPANCIES SEPTIC TANK PROFILE H-20 DISTRIBUTION BOX DETAIL H-20 CHAMBER DETAILS TO THE DESIGN ENGINEER. NOT TO SCALE NOT TO SCALE NOT TO SCALE ------- 1 10. ALL JOINTS WHERE PIPE ENTERS AND EXITS CONIC.STRUCTURES SHALL BE MADE WATERTIGHT. TEST PIT 1,1ATA 11. NO DETERMINATION,HAS BEEN MADE AS TO COMPLIANCE WITH DEEDED OR ZONING NOTES:. 15133 REGULATIONS. OWNER/APPLICANT IS TO OBTAIN SUCH DETERMINA71ON FROM PERC NO. APPROPRIATE AUTHORITY. -airg ou INSPECTOR: David W. Stanton, R.S. 1.) MAGNETIC MARKING TAPE SHALL BE PLACED ALONG THE TOP EDGE OF --ELECTRIC AND EACH SEPTIC SYSTEM COMPONENT. CABLE PDXES 12. ALL SEPTIC SYSTEM COMPONENTS SHALL WITHSTAND H-10 LOADING UNLESS LOCATED EVALUATOR: Michael Pimentel, EIT, C E UNDER MORE THAN 3 FEET OF COVER OR LOCATED UNDER PAVEMENT, DRIVES, OR 2.) CONTRACTOR SHALL VERIFY SOIL CONDITIONS IN THE LOCATION OF C.S.E.APPROVAL DATE:__ Oct. 1999 TRAVELED WAYS IN WHICH CASE THEY SHALL WITHSTAND H-20 LOADING. THE PROPOSED LEACHING FACILITY TO ENSURE CONSISTENCY WITH TEST August 16,2016 f DATE: ! 13. DOUBLE WASHED CRUSHED STONE SHALL BE FREE OF ALL DIRT, DUST AND FINES. PIT DATA SHOWN ON THIS PLAN. REPORT TO ENGINEER AND LOCAL ,,,,--ELECTRI Cl METER BOARD OF HEALTH IF SOILS ARE NOT CONSISTENT WITH TEST PIT DATA. k , TEST PIT#: 14. WHERE REQUIRED, CONTRACTOR SHALL REMOVE ALL LOAM, SUBSOIL AND UNSUITABLE _0 -7 00, MATERIAL IN AREA BENEATH AND FOR 5 FT. ON ALL SIDES OF LEACHING FACILITY. *A ELEV TOP 6& REPLACE ALL UNSUITABLE MATERIAL V41TH CLEAN COARSE SAND FREE FROM CLAY, 3.) ENTIRE PROPERTY IS LOCATED WITHIN A DEP APPROVED ZONE 2,THE ELEV WATER < 58.00' FINES OR OTHER UNSUITABLE MATERIAL IN ACCORDANCE WITH 310 CMR 15.255(3). GROUNDWATER PROTECTION OVERLAY DISTRICT AND THE ESTUARINE WATERSHEDS. <2 min./inch* PERC RATE= I to # 15. CONTRACTOR SHALL NOTIFY DESIGN ENGINEER OF ANY DISCREPANCIES FOUND IN SITE CONDITIONS FROM THOSE SHOWN PRIOR TO CONTINUATION OF WORK. 54" DEPTH OF PERC 36" W Benchmark# 51�1 _ I , I 1 zt .0 . . 1 16. PROPOSED PROJECT IS LOCATED WITHIN. MAP 126 Comer of Bulk Head - ----- TEXTURAL CLASS: 1 LOT 95 el ASSESSOR'S MAP 126 LOT 96 40 ZONE 2 Perc test done by Baxter&Nye on 8-2-83 10 &_\ Elev. 70.00' Approx. M.S.L. 4 (y) 40 Perc reference#2270 OWNER OF RECORD: DEAN R. & MARIE MURPHY oil 0a i* LOCUS 01�1111 1 6 68.00' 0 z Fill ADDRESS: 62 NELSON LANE 4�1 67.67' z MARSTONS MILLS, MA 02648 h 'a e k - Loamy Sand B 1 OYr 5/6 FEMA FLOOD ZONE X 1< COMMUNITY PANEL# FM25001CO542J & 36 65.'001 13 4 17. DEED REFERENCE: L.C.C. 170049 Perc 54" 63.50' 18. PLAN REFERENCE: L.C. PLAN No. 12034-D(SHEET 5) #62 19. ALL DISTURBED AREAS SHALL BE RESTORED TO ORIGINAL CONDITION. EXISTING R -Coarse Sand 3-BEDROOM Med. 20. PROPERTY LINE INFORMATION IS ONLY APPROXIMATE. THIS PLAN IS TO BE USED ONLY 2.5Y 6/6 DWELLING FOR SEPTIC SYSTEM UPGRADE. JC ENGINEERING WILL NOT ASSUME ANY LIABILITY 20-30% Gravel 46 C FOR USES OF THIS PLAN OTHER THAN ITS INTENDED PURPOSE. TOF=70�5± 21. A 4" PERFORATED SCH. 40 PVC PIPE SHALL BE PLACED INA VERTICAL POSITION TO A A ARAGE V­ DEPTH OF THE BOTTOM OF THE SAS AND EXTEND TO WITHIN 3"OF FINISH GRADE. A REMOVABLE THREADED CAP SHALL BE PLACED ON THE TOP TO ALLOW FOR INSPECTIONS. SLAB=69.4 LOCUS PLAN CHILDREN PLAY AREA Benchmark#2 SCALE: T' 1000' Y S 1 T D R 1 V E,;'%!A 11 c. Pad INVI- Comer of Con 120" ' 58.00, Elev. =69.26' No Mottling, Standing or Weeping Observed ,Approx. M.S.L. P F DESIGN DATA TEST PIT DATA LEGEND 4 CID <; PERC NO. 15133 rA t17 EXISTING SPOT GRADE 500' i-cl INSPECTOR: David W. Stanton, R.S, PROPOSED 2-500 GALLON NUMBER OF BEDROOMS(DESIGN) 3 EVALUATOR: Michael Pimentel, EIT, CSE 50 EXISTING CONTOUR H-20 LEACHING CHAMBERS 110 DESIGN FLOW -__QAUDAY/BEDROOM WITH AGGREGATE C.S.E.APPROVAL DATE: Oct. 1999 14, TOTAL DESIGN FLOW 330 GAUDAY 50 PROPOSED CONTOUR August 16,2016 DATE: 501 PROPOSED SPOT GRADE 660 GAUDAY r TEST PIT#: 2 DESIGN FLOW x 200 % 6" 12" 241 USE EXISTING 1,500 GALLON SEPTIC TANK 68.00' TP i ELEV TOP EXISTING GAS LINE 68xO' <58.00' ELEV WATER -20 D-BOX E/C E/r---- PROPOSED H EXISTING UNDERGROUND UTILITIES 'FREE TP2 PERC RATE (TYP) 6" 14 EXISTING WATER LINE 65 1 INSTALL 2 - 500 GALLON H- 20 CHAMBERS 68xO'\ P� SWING-TIES DEPTH'OF PERC CP & W/ AGGREGATE TEST PIT LOCATION GC-1 GC-2 TEXTURAL CLASS: 1 A, DESCRIPTION SIDEWALL CAPACITY EXISTING 1,600 GALLON SEPTIC TANK MAP 125 CORNER OF STONE(1) 43.4' 29.4' (LENGTH + WIDTH) (2 SIDES) (ZHIGH) (0.74 GPD/S.F.) GAUDAY LOT 72 CORNER OF STONE(2) 64.4' 42.5' (25.0'+ 12.83')(2) (2') (0.74 GPD/S.F.) 112.0 GAUDAY oil 68.00' PROPOSED 4" SOLID SCHEDULE 40 PVC PIPE CORNER OF STONE(3) 71.0' 52.1' BOTTOM CAPACITY 4"1 Fill 67.67' PROPOSED DISTRIBUTION BOX CORNER OF STONE(4) 52.8' 42.0' (LENGTH x WIDTH) (0.74 GPDI GAUDAY Loamy Sand (25.0'x 12.83') (0.74 GPD/S.F.) 237.4 GAUDAY B 1 OYr 5/6 PROPOSED 500 GALLON H-20 LEACHING CHAMRPP SWING-TIES SKETCH SCALE: 1 20' 36" 65.00' MAP 126 JC JLC PR. INSPECTION PORT 8-24-16 Added Existing S.A.S. Location LOT 96 TOTALS: RI DESCRIPTION 43,634 S.F. GARAGE TOTAL NUMBER OF CHAMBERS 2 �Hv I SLAB=69.4'± TOTAL LEACHING AREA 472.2 SQ.FT. k! i ' PROPOSED SEPTIC SYSTEM UPGRADE %0 _)F PROPOSED 4"PVC VENT; LOCATION GC-1 TOTAL LEACHING CAPACITY 349.4 GALJDAY 0 F PREPARED FOR: TO BE DETERMINED BY OWNER Med.-Coarse Sand JOHM -A W" CHURC J IV, CAPEWIDE ENTERPRISES 2.5Y 616 C IL 20-30%Gravel N 41807 18T� LOCATED AT GC-2 0 T 62 NELSON LANE MARSTONS MILLS, MA 02648 SCALE: 1 INCH 20 FT. DATE: AUGUST 22, 2016 120 . 58,00' 80 (4) 0 10 20 40 FEET No Mottling, Standing or Weeping Observed 110" WEI= ------- PREPARED BY: RESERVED FOR BOARD OF HEALTH USE JC ENGINEERING, INC. 0 2854 CRANBERRY HIGHWAY (2) EAST WAREHAM, MA 02538 (3) 508.273.0377 SITE PLAN Drawn By: JC Designed By:JC Checked By: MCP No.3577 SCALE: 1 20' =JOB T T IF A SYSTEM PROFILE O ISH GRADE ROVINNON PORT TO WITHIN 6" TEST HOLE LOGS TOP FNDN. AT EL. 73.1 ' (NOT TO SCALE) ACCESS COVER TO WITHIN 6" OF FIN. GRADE BAXTER & NYE a ACCESS COVER (WATERTIGHT) TO ENGINEER: MINIMUM .75' OF COVER OVER PRECAST WITHIN 6" OF FIN. GRADE 2� SLOPE REQUIRED OVER SYSTEM 71 ,8' WITNESS: BARNS. BOH 2" DOUBLE WASHED PEASTONE DATE: $/18/$3 EL 71.0' RUN PIPE LEVEL FOR FIRST 2' 3' MAX. PERC. RATE = < 2 MIN/INCH R4CE LAW EXIST. _1_000 GALLON SEPTIC * 69 5 CLASS I SOILS p# 2270 69.6 f TANK (H- 10 ) GAS 6$.83' (� 0 0 0 0 CI r o ' (RE-USE) BAFFLE 69.0' ��`' 0 68.69'` p p 0 0 0 0 C> M 17 o z O E D G7 CO E__1 CJ 0 Q ELEV. "0 6" CRUSHED STONE OR MECHANICAL >o�d 2' Cl C7 O Cl C] C7 00 0 0 66.69' °R COMPACTION. (15.221 (2]) LOCUS DEPTH DEPTH OF FLOW = 4 ( 1.5% SLOPE) ( 1 % SLOPE) 3/4 TO 1 1/2 DOUBLE, WASHED STONE TEE sltEs: " LOAM & INLET DEPTH = 10" SUBSOIL OUTLET DEPTH 14 LOCATION MAP NTS " 24 69.7' FOUNDATION-- EXIST. SEPTIC TANK 41 ' D' BOX 16' LEACHING ASSESSORS MAP i26 PARCEL 96 FACLITY 5.99' *THE INSTALLER SHALL VERIFY THE LOCATIONS OF ALL UTILITIES AND ALL BUILDING SEWER OUTLETS AND ELEVATIONS PRIOR TO INSTALLING ANY PORTION OF COARSE SEPTIC SYSTEM SANDY 60.7' GRAVEL BENCHMARK: USE TOP FNDN \/P / HERE AT ELEV. 73.1' A\ 132" 60.7' N - CLAY NO GROUNDWATER ENCOUNTERED NOTES OF EXIST. 1000 GAL. SEPTIC TANK 1 . DATUM IS ASSUMED (RE-USE) SEPTIC DESIGN: (GARBAGE DISPOSER IS NOT ALLOWED ) 0� 2. MUNICIPAL WATER IS EXISTING DESIGN FLOW: 3 BEDROOMS ( 110 GPD) = 330 GPD . n_'INln�tlr,t PIPF PITCH Tn RF 1 /8" PER FOOT. / r USE A :)30 GPD DESIGN FLOW W 4. DESIGN LOADING FOR ALL PRECAST UNITS TO BE AASHO H—_I0 \ SEPT IC TANK: 330 GPD ( 2 ) = 660 5. PIPE JOINTS TO BE MADE WATERTIGHT. EXIST. LEACH PIT USE A _1000 / \ (SEE NOTE 10) ___ GALLON SEPTIC TANK (RE-USE EXISTING) 6. CONSTRUCTION DETAILS TO BE IN ACCORDANCE WITH MASS. ENVIRONMENTAL CODE TITLE V. LEACHING: 7. THIS PLAN IS FOR PROPOSED SEPTIC SYSTEM ONLY AND IS NOT t EXIST. DWELL. \ 2(30 + 9.83) 2 (.74) = 118 TF = - TO BE USED FOR ANY OTHER PURPOSE. 73.1' SIDES: BOTTOM: 30 x 9,83 (.74) _ 218 8. PIPE FOR SEPTIC SYSTEM TO SCH, 40-4" PVC. 9. COMPONENTS NOT TO BE BACKFILLED OR CONCEALED WITHOUT F � TOTAL: 454 S.F. 336 GPD INSPECTION BY BOARD OF HEALTH AND PERMISSION OBTAINED USE (2) 500 GAL. LEACHING CHAMBERS (ACME OR FROM BOARD OF HEALTH, / i EQUAL) WITH 2.5' STONE AT SIDES, 4' AT ENDS AND 5' 10. PUMP & REMOVE (OR FILL W/CLEAN SAND) FAILED LEACH PIT BETWEEN UNITS i� LEND L TH , LEGEND TITLE 5 SITE PLAN r 100.0 PROPOSED, SPOT ELEVATION OF / / -- -- -� 62 NELSON LANE 10Qx0 EXISTING SPOT ELEVATION IN THE TOWN OF: PROPOSED CONTOUR (MARSTONS MILLS) BARN STABLE 100 EXISTING CONTOUR PREPARED FOR: BORTOLOTTI CONSTRUCTION/SMITH / °'. 30 0 30 60 90 / C) BOARD OF HEALTH 04 / MA SCALE: 1 " = 30' DATE: AUGUST 7, 2003 APPROVED DATE LOT 21 I 1.0t ACRE / ��/ off 508-362-4541 fox 508 362-9MD / down cape en Bering, inc. �`� of 144S �����H of Mq c ,6q / p . or AANE b�J� � AOJALA � CIVIL ENGINEERS VA. p 1A a CIVIL 6348/ ¢ No.3uM / LAND SURVEYORS 2 DAB+ 939 main st. yarmouth, ma 02675 A 03- 183 .. I