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HomeMy WebLinkAbout0091 PIONEER PATH - Health 128 - 004 - 01 U Pioneer Path, N — 4 s 1 i ,k r �1 o i j No. 4210 1/3 BLU ESSELT 10% J ei 1 0/y/ ' � 1 t 1q , ++1 ` 7 t{ 1 o 1 1 i a 7� r 91 Pioneer Path, N _ = 128 - 004 - 014 r } v � o i f L f i A �L. s Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 91 Pioneer Path Property Address Robin Fletcher Owner Owner's Name information is required for every W Barnstable MA 02668 7/11/11 page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When filling out forms A. General Information /t on the computer, use only the tab 1. Inspector: key to move your cursor-do not Ricky L. Wright use the return Name of Inspector key. B& B Excavation, Inc. r� Company Name IL 14 Teaberry Lane Company Address Sandwich MA 02563 Citylrown State Zip Code 508-477-0653 S 14595 Telephone Number License Number B. Certification Q 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 All e sewage disposal systems. I am a DEP approved system inspector pursuant to-Section %.-340 a Title 5(310 CMR 15.000). The system: , Ln ® Passes ❑ Conditionally Passes ❑ FailsI n ❑ Needs Further Evaluation by the Local Approving Authority 7/11/11 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. ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. t5ins•09/08 . Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 17 a Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �M 91 Pioneer Path Property Address Robin Fletcher Owner Owner's Name information is required for every W Barnstable MA 02668 7/11/11 page. Cityfrown State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® 1 have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: 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. Check the box for"yes", "no" or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old* or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced'with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 a Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ° 91 Pioneer Path Property Address Robin Fletcher Owner Owner's Name information is required for every W Barnstable MA 02668 7/11/11 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ 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 ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 x Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 91 Pioneer Path Property Address Robin Fletcher Owner Owner's Name information is required for every W Barnstable MA 02668 7/11/11 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: '*This system passes if the well water analysis, performed at a DEP certified laboratory, for coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate"Yes" or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than 'h day flow t5ins-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 91 Pioneer Path M Property Address Robin Fletcher Owner Owner's Name information is required for every W Barnstable MA 02668 7/11/11 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000g pd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA) or a mapped Zone II of a public water supply well If you have answered "yes" to any question in Section E the system is considered a significant threat, or answered"yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form _ Subsurface Sewage Disposal System Form Not for Voluntary Assessments 91 Pioneer Path Property Address Robin Fletcher Owner Owner's Name information is required for every W Barnstable MA 02668 7/11/11 page. Cityrrown State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes" or"no" as to each of the following: Yes No ❑ ® Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ❑ ® Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as.part of this inspection? Were as built plans of the system obtained and examined? (If they were not ® El available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ❑ ® Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS)on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure,criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms(design): 3 Number of bedrooms (actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 I t5ins-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 91 Pioneer Path Property Address Robin Fletcher Owner Owner's Name information is required for every W Barnstable MA 02668 7/11/11 page. City/Town State Zip Code Date of Inspection D. System Information Description: Number of current residents: 0 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes ® No Laundry system inspected? ❑ Yes ® No Seasonaluse? ❑ Yes ® No Water meter readings, if available last 2 ears usage d n/a 9 ( Y 9 (gP ))� Detail: Sump pump? ❑ Yes ® No Last date of occupancy: July 2010 Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins-09/08 t Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 Commonwealth of Massachusetts - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments "M 91 Pioneer Path Property Address Robin Fletcher Owner Owner's Name information is required for every W Barnstable MA 02668 7/11/11 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: Was system pumped as part of the inspection? ® Yes ❑ No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner)and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): t5ins•09108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 17 S , Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �M 91 Pioneer Path Property Address Robin Fletcher Owner Owner's Name information is required for every W Barnstable MA 02668 7/11/11 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known)and source of information: 1998 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 19"feet Material of construction: ❑ cast iron ® 40 PVC ❑ other(explain): Distance from private water supply well or suction line: >20feet Comments (on condition of joints, venting, evidence of leakage, etc.): At time of inspection building sewer appeared to be in good shape no signs of leakage or blockage. Septic Tank(locate on site plan): Depth below grade: 1 feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 5.2x5.2x8.6 Sludge depth: 3" t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments CG9M 91 Pioneer Path Property Address Robin Fletcher Owner Owner's Name information is required for every W Barnstable MA 02668 7/11/11 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle 35" Scum thickness 5 Distance from top of scum to top of outlet tee or baffle 4" Distance from bottom of scum to bottom of outlet tee or baffle 10" How were dimensions determined? scour stick Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): At time of inspection tank appeared to be in good shape concrete baffles present no sign of back up. Grease Trap(locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °M 91 Pioneer Path Property Address Robin Fletcher Owner Owner's Name information is required for every W Barnstable MA 02668 7/11111 page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank (tank 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 per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �M 91 Pioneer Path Property Address Robin Fletcher Owner Owner's Name information is required for every W Barnstable MA 02668 7/11/11 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 0 Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): Installed new d-box as part of inspection. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ;M 91 Pioneer Path Property Address Robin Fletcher Owner Owner's Name information is required for every W Barnstable MA 02668 7/11/11 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ® leaching chambers number: 4- infiltraters ❑ 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.): At time of inspection leaching appeared to be in working order no sign of staining or hydraulic failure.Water level was 10" below invert at time of inspection. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ;M 91 Pioneer Path Property Address Robin Fletcher Owner Owner's Name information is required for every W.Barnstable MA 02668 7/11/11 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 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.): t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °M 91 Pioneer Path Property Address Robin Fletcher Owner '°� Owner's Name information is required for every W Barnstable MA 02668 7/11/11 page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view 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. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately _Lj 4 REAR eH A D O AIa3o ' _31 - )(0 ' 51 ' C2 = U G3 = 24 ' G4= 31 ' D4= 22 ' j t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �M 91 Pioneer Path Property Address Robin Fletcher Owner Owner's Name information is required for every W Barnstable MA 02668 7/11/11 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope ® Surface water ® Check cellar ® Shallow wells Estimated depth to high ground water: >10 feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date ® Observed site(abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health -explain: ❑ Checked with local excavators, installers- (attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins-09108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 4 Commonwealth of Massachusetts - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 91 Pioneer Path Property Address Robin Fletcher Owner Owner's Name information is required for every W Barnstable MA 02668 7/11/11 page. Cityrrown State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems) completed ® System Information—Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins•09108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 No. THE COMMONWEALTH OF MASSACHUSETTS FEE BOARD OF HEALTH Mwn- 0 ns (4 APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT Application for a Permit to Construct ( ) Repair ( ) Upgrade ( ) Abandon ( ) - ❑Complete System Individual Components Aon-e-py R4-4 . &,ml --Paolo --Rt+ch �V Map/Parcel#_L7 `r� � �fA�ess 2-3 P - a f>Ca 11 Telephone# A —� t Iler'sV Designer's Name 7 O, ss Address {� Telephone# Telephone# Type of Building: Lot Size Sq.feet Dwelling—No.of Bedrooms\ Garbage Grinder ( ) Other—Type of Building No.of persons Showers ( ), Cafeteria ( ) Other fixtures Design Flow(min.required) gpd Calculated design flow gpd Design flow provided gpd Plan: Date Number of sheets Revision Date Title Description of Soil(s) Soil Evaluator Form No. Name of Soil Evaluator Date of Evaluation DESCRIPTION OF REPAIRS OR ALTERATIONS The undersigned agrees to install the above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and further agrees not to lace the system in operation until a Certificate of Compliance has been issued by the Board of Health. Signed Date 7l 1S 11 FORM 1 - APPLICATION FOR DSCP DEP APPROVED FORM 5/96 _....Jrr�*''w'."s.,'�k -•..nt`r.d"{"°}r.,.rL+J'`i„tin A w./' "/r�"An�i.�+.� "1TNW'�w,�.. x"�'$t.7na"'A"jr'"�1.''iwlrrit � _ I"Y_....yy.�y�i'..r.,...+,,.,,. ` '-,.,... 1 ( � A(R�1'.• R:,l�,�./„'.'-y.^^. Wes' 'wv�R^"►.'y'�"�F'(/'1 °jYa... r � p � No. Q o(� —a 30 THE COMMONWEALTH OF MASSACHUSETTS FEE BOARD OF HEALTH /���IJo of 30in_sfr b� �U'r APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT Application for a Permit to Construct ( ) Repair ( ) Upgrade ( ) Abandon ( ) - ❑Complete System 4individual Components —00 </. , V` /LL/ � 4 Ic�c)f-'P-1 Map/Parcel# 2,3 .� � r - Lo # Telephone# 4nst Iler s N'me I Designer's Name 7 7_66 Address Telephone# Telephone# I / L-.Type of Building: ( eS r If La 1/ Lot Size Sq.feet Dwelling—No.of Bedrooms 3 "s Garbage Grinder ( ) Other—Type of Building { No.of persons Showers ( ), Cafeteria ( ) Other fixtures Design Flow(min.required) gpd Calculated design flow gpd Design flow provided gpd Plan: Date Number of sheets`"a* .. _- Revision Date Title Descripiion of Soil(s) Soil Evaluator Form No. Name of Soil Evaluator ' y�X. Date of Evaluation y DESCRIPTION OF REPAIRS OR ALTERATIONS - oX ✓( n a oQ ,# J The undersigned agrees to install the above described Individual Sewage Disposal System in accordance with the provisions of TITLE S and further agrees not to place the system in operation until a Certificate of Compliance has been issued by the Board of Health. Signed e Date 7/K5 11 f n_ec ' s_. t FORM 1 - APPLICATION FOR DSCP DEP APPROVED FORM 5/96 No. ')UfI `)J6-f/ THE COMMONWEALTH OF MASSACHUSETTS FEE BC_((( -,�TARLN BOARD OF HEALTH CERTIFICATE OF COMPLIANCE ail Description of Work: Individual Component(s) ❑Complete System The undersigned hereby certify that the Sewage Disposal System;Constructed( ),Repaired( ,Upgraded( ),Abandoned( ) by: ( LJ E,-�(-Ciy.f yin .� at 4 �I a(lP�l has been installed in accordance with the provisions of 310 C R 15.0 (Title 5) and the approved design tans/as-built plans relaU'n to application No. a°Il - dated r Approved Design Flow ffAA (gpd) Installer b ei r L1`U r, Designer: Inspectior �ice--- ^" � Date The issuance of this certificate shall not be construed as a guarantee that the system will function as designed. FORM 3 - CERTIFICATE OF COMPLIANCE DEP APPROVED FORM 5/96 I No. �GII -�3� THE COMMONWEALTH OF MASSACHUSETTS FEE �w BOARD OF HEALTH DISPOSAL SYSTEM CONS/TRUCTION PERMIT Permission is hereby granted to Construct ( ) Repair ( V) Upgrade ( ) Abandon ( ) an individual sewage disposal system at as described in the application for Disposal System Construction Permit No. d(� - � �,dated Provided: Con truction shall be completed within three years of the date of this per local co itions must be met. Date /d!/ Board of Health FORM 2 - DSCP DEP APPROVED FORM 5/96 FORM 1255 (REV 5/96) H&W HOBBSB WARREN TM PUBLISHERS - BOSTON Town of Barnstable gARNb'fABM NAMRegulatory Services Department Public Health Division 200 Main Street,Hyannis MA 02601 Thomas F.Geiler,Director Office: 508-862-4644 Thomas A.McKean,CHO FAX: 508-790-6304 Updated July 2,2008 After Adoption of the Estuary Protection Regulation eeks a Health inspectors are instructed to apply construction permit in a Saltwater Estuary Protection Districts building permit or disposal work Zone I1, Private Well area,GP District or WP District The most restrictive regulation will be applied to each case: Regulations and Ordinances Associated With Nitrogen Loading Limitations/Enforcement Title V *No more than 440 gallons per acre per day can be discharged regardless to every Zone I1 and parcel with a private well area * If for example,the applicant owns a 1/2 acre parcel in a zone 11,no more than two bedrooms could be built. However,the applicant may be able to construct more bedrooms if an alternative-type system is proposed. *Applies to private well areas also. *Applicants for variances would need to apply to the Board of Health and to the State DEP. *Is based on one acre equaling 40,000 square feet. *Applies to All Parcels in Zone II's,Residential and Commercial Lots Town Ordinance *If the applicant owns a parcel of one acre in size or greater,no more Wastewater Discharge than 330 gallons per acre per day can be discharged *Based upon one acre equaling 43,560 square feet * There is no variance relief from this Ordinance * Applies to all GP and WP zones in Town * An applicant is allowed to discharge 330 gallons a small parcel,even if the parcel is smaller than one acre in size. *Is based upon one acre equaling 43,560 square feet *Applies to All Parcels in GP and WP Districts,Res. and Commercial *No more than 440 gallons per acre per day can be discharged; Interim Board of Health Saltwater Estuary Protection however an applicant is allowed 330 30,000 q, ft size on on a small parcel,even if the parcel is 1 *Applicant may apply for a variance from.the Board of Health *Is based on one acre equaling 40,000 square feet. * Only Applies to Residential Lots at this time,in Est.Protection Zones �oFtHVEr Town of Barnstable • Department of Health, Safety, and Environmental Services +. BARNSTABLE, , '� ��� Public Health Division iOlEn �s 367 Main Street,Hyannis MA 02661 Office: 508-790-6265 Thomas A.McKean FAX: 508-775-3344 Director of Public Health September 26, 1996 Regulations and Ordinances Associated With Nitrogen Loading Limitations/Enforcement Town Ordinance *Allows one to build three bedrooms even though he/she owns Wastewater Discharge less than a one(1)acre lot(except in Hyannis GP/WP Districts-see B.O.H.Regulation below), *If the applicant owns a parcel greater than one acre in size,no more than 330 gallons per acre per da)rcahbt diwharged * There is no variance relief from this Ordinance * Applies to all GP and WP zones in Town Board of Health * Only applies to the Hyannis area GP and WP Districts "330"Regulation" * Gives the opportunity for a person to apply for variances but one cannot exceed 330 gallons per acre per day when the applicant owns one acre or more Title V *No more than 440 gallons per acre per day can be discharged regardless of which Zone II or private well area in Town the applicant wishes to build in. * If for example,the applicant owns a 1/2 acre parcel in a zone II,no more than two bedrooms could be built. However,the applicant f could build more bedrooms if an alternative-type system is built. *Applies to private well areas also. *Applicants for variances,would need to apply to the Board of Health and to the State DEP. *Is based on one acre equaling 40,000 square feet. (' R i CERTIFIED SEPTIC SYSTEM RMUT, LOCATION 91 PIONEER PATH W . BARNSTABLE , MA MAP 128 PARCEL 004 . 014 LOT 13 PREPARED FOR SELLER MR. & MRS . THOMAS D . FOURNIER 91 PIONEER PATH W . BARNSTABLE, MA 02668 BUYER MR. MARK I . FLETCHER 345 CAMP ST . #604 W . YARMOUTH, MA 02673 PREPARED BY HILLIARD HILLER P .O . BOX 250 CENTERVILLE, MA 02832 508-778-1472 COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS C DEPARTMENT OF ENVIRONMENTAL PROTECTION ONE WINTER STREET. BOSTON. MA 02108 617-292-5500 611V 5 WILLIASI F.WELD ld3014 +OXE Govcmo: 318dN jll0 MOl c ARGEO PAUL CELLUCCI 16 DAVID B.S S Lt.Govcmor SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FO t:qt 6T T n ON mm Toncr PART A F3Avg3j Zr/y CERTIFICATION Property Address: 'a ` Address of Owner: /. Date of Inspection: (If different) Name of Inspector: I am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000) Company Name: — Mailing Address: As',A oJG jl Telephone Number: /Y7.2- 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: _ Passes Conditionally Passes Needs Further Evaluation By the Local Approving Authority a---Fails Inspector's Signature: Date: �IZ The System Inspector shall submit a copy of this inspection report to the Approving Authority within thirty (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 SUMMARY: Check A, B, C, or Aj SYSTEM PASSES: I have not found any information w gich indicates that the system violates any of the failure criteria as defined in 310 CMR 15.303. Any failure criteria not evaluated ar indicated below. COMMENTS: BI 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 o repair, as approved by the Board of Health, will pass. 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 met I, unless the owner or operator has provided the system inspector with a copy of a Certificate of Compliance (attached indicating that the tank was installed within twenty (20) years prior to the date of the inspection; or the septic tank, whet er or not metal, is cracked, structurally unsound, shows substantial infiltration or exfiltration, or tank failure is imminent. he system will pass inspection if the existing septic tank is replaced with a conforming septic tank as approved by the oard of Health. (revised 04/25/97) Page 1 of 10 DEP on the World Wide Web httpaiwww.magnet.state.ma.us/dep Printed on Recyded Paper SUBSURFACE SEWAGE:DISPOSAL SYSTEM INSPECTION FORM PART A, CERTIFICATION (continued) Property Address: 47/ Owner: i�i�j„ %��A� V. 1�1'61/l-114-4 Date of Inspection: BJ SYSTEM CONDITIONALLY PASSES (co tinued) Sewage backup or brea out 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). Desc ibe observations: brok n pipe(s) are replaced obstr iction is removed distri ution box is levelled 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 apprc val of the Board of Health): broken pipe(s) are replaced obstr ction is removed C) FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: Conditions exist which require fu her 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 BOkRD 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 wit iin 50 feet of a surface water Cesspool or privy is wit iin 50 feet of a bordering vegetated wetland or a salt marsh. 2) SYSTEM WILL FAIL UNLESS THI BOARD OF HEALTH (AND PUBLIC WATER SUPPLIER, IF APPROPRIATE) DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECTS THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet to a surface water supply or tributary to a surface w ter supply. The system has a septic tank and soil absorption system and the SAS is within a Zone I of a public water supply well. The system has a septic tank and soil absorption system and the SAS is within 50 feet of a private water supply well. The system has a septic tank and soil absorption system and the SAS is less than 100 feet but 50 feet or more from a private water supply wE II, unless a well water analysis for col'iform bacteria and volatile organic compounds indicates that the well is free from po lution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm. Method used to determine distance (approximation not valid). 3) OTHER (revised 04/25/97) Page 2 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A 'CERTIFICATION (continued) Property Address: Owner: 1-71, Date of Inspection: D) SYSTEM FAILS: You must indicate either "Yes" or "No" as to each of the following: 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. Yes No _ Backup of sewage into facility or system component due to an overloaded or clogged SAS or cesspool. Discharge or ponding of efflu nt to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool. Static liquid level in the dist ibution box above outlet invert due to an overloaded or clogged SAS or cesspool. Liquid depth in cesspool is ess than 6" below invert or available volume is less than 112 day floe Required pumping more t an 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped _ Any portion of the Soil A sorption System, cesspool or privy is below the high groundwater elevation. Any portion of a cesspo or privy is within 100 feet of a surface water supply or tributary to a surface water supply. Any portion of a cesspo I or privy is within a Zone I of a public well. Any portion of a cessp of or privy is within 50 feet of a private water supply well. Any portion of a cess of or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water qual ty analysis. If the well has been analyzed to be acceptable, attach copy of well water analysis for coliform bacteria, vol the organic compounds, ammonia nitrogen and nitrate nitrogen. E) LARGE SYSTEM FAILS: You must indicate either "Yes" or "No" as to each of the following: The following criteria apply large systems in addition to the criteria above: The system serves a facility ith a design flow of 10,000 gpd or greater (Large System) and the system is a significant threat to public health and safety an the environment because one or more of the following conditions exist: Yes No the system is wit in 400 feet of a surface drinking water supply the system is w' hin 200 feet of a tributary to a surface drinking water supply the system is I ted in a nitrogen sensitive area (Interim Wellhead Protection Area- IWPA) or a mapped Zone ll of a public water s pply well) The owner or operator of any su h system shall bring the system and facility into full compliance with the groundwater treatment program requirements of 314 CMR 5.00 nd 6.00. Please consult the local regional office of the Department for further information. (revised 04/25/97) Page 3 of 10 SUBSURFACE SEWAGE DISPOSAL (SYSTEM INSPECTION FORM PART B. CHECKLIST Property Address: -7/ Owner: /x 7/,-/ T/2�.--, Date of Inspection: Check if the following have been done: You must indicate either "Yes" or "No" as to each of the following: Yes No _ Pumping information was provided by the owner, occupant, or Board of Health. �l _ None of the system components have been pumped for at least 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 pan of this inspection. L _ As built plan; 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. The site was inspected for signs of breakout. _ All system components,. excluding the Soil Absorption System, have been located on the site. _ The septic tank manholes were uncovered, opened, and the interior of the septic tank was inspected for condition of baHles or tees, material of construction, dimensions, depth of liquid, depth of sludge, depth of scum. The size and location of the Soil Absorption System on the site has been determined based on: _ The facility owner (and occupants, if different from owner) were provided with information on the proper maintenance of Sub-Surface Disposal System. Existing information. Ex. Plan at B.O.H. LI _ Determined in the field (if any of the failure criteria related to Part C is at issue, approximation of distance is unacceptable) (15.302(3)(b)) (revised 04/25/97) Page 4 of 10 I SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: -�9/ Owner: Date of Inspection: /l`Xfn'G�4 t FLOW CONDITIONS RESIDENTIAL: Design flow: t.p.d./bedroom for S.A.S. Number of bedrooms: Number of current residents: A Garbage grinder (yes or no):_O Laundry connected to system (yes or no):YES Seasonal use (yes or no): L4? Water meter readings, if available (last two (2) year usage (gpd): Sump Pump (yes or no):_&V Last date of occupancy: i�R�' /�,ij L y COMMERCIAUINDUSTRIAL: Type of establishment: Design flow: Qallons/day 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: OTHER: (Describe) _ Last date of occupancy. GENERAL INFORMATION PUMPING RECORDS and source of information: System pumped as part of inspection: (yes or no)&�? If yes, volume pumped: Rallons Reason for pumping: TYPE OF SYSTEM Septic tank/distribution box/soil absorption system Single cesspool Overflow cesspool Privy Shared system (yes or no) (if yes, attach previous inspection records, if any) VA Technology etc. Copy of up to date contract? Other APPROXIMATE AGE of all components, date installed (if known) and source of information: L oi- G. ,p/-,o 1//fIS`j Sewage odors detected when arriving at the site: (yes or no)Z::�2 (revised 04/25/97) Page 5 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: yj Owner: Date of Inspection: ` BUILDINJwe R: (Locate on) Depth bee:Material oction: cast iron 40 PVC other (explain) Distance ate water supply well or suction lire Diameter Commenttion of joints, venting, evidence of leakage, etc.) SEPTIC TANK: (locate on site plan) Depth below grade:Z. Material of construction: concrete _metal _Fiberglass _Polyethylene _other(explain) If tank is metal, list age _ Is age confirmed by Certificate of Compliance _(Yes/No) Dimensions �l�f X8 /'G+d� X �� O/,je!-' Sludge depth: Distance from top of sludge to bottom of outlet tee or baffle: 93 Scum thickness: Y Distance from top of scum to top of outlet tee or baffle:_ Distance from bottom of scum to bottom of outlet tee or baffle: lye' How dimensions were determined: 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.) 1-141,CS er;-TG.�% lrii9 S U�f1/Jt�l1 wi97lL.'L. GREASE TRAP: (locate on site plan Depth below grad Material of constr ction: _concrete _metal _Fiberglass _Polyethylene _other(explain) Dimensions: Scum thickness: Distance from to of scum to top of outlet tee or baffle: Distance from ttom of scum to bottom of outlet tee or baffle: Date of last pu ping: Comments: (recommendati n for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity, evid nce of leakage, etc.) (revised 0 /25/97) Page 6 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: Owner: Date of Inspection: TIGHT OR HOLDING T K: (Tank must be pumped prior to, or 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 level: Alarm in working order _Yes; _ No Date of previous pum ing: Comments: (condition of inlet tee condition of alarm and float switches, etc.) DISTRIBUTION BOX: 4-e- ov t:a (locate on site plan) �! G.�9s vu ddt2�o i�vsT��p Depth of liquid level above outlet invert: Comments: (note if level and distribution is equal, evidence of solids carryover, evidence of leakage into or out of box, etc.) 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.) (revised 04/25/97) Page 7 of 10 SUBSURFACE SEWAGE.DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: Owner: A, rf c,4,,,2s 7. Date of Inspection: 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, number:_ leaching galleries, number: leaching trenches, number,length: leaching fields, number, dimensions: overflow cesspool, number: Alternative system: Name of Technology: Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) Pn /,r.—T:2 7-17'IE CESSPOOLS: _ (locate on site plan) Number and configuration: Depth-top of liquid to inlet nvert: Depth of solids layer: Depth of scum layer: Dimensions of cesspool: Materials of construction: Indication of groundwater: inflow (cesspool Tust be pumped as part of inspection) Comments: (note condition of soil, sig s 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, si s of hydraulic failure, level of ponding, condition of vegetation, etc. (revised 04/25/97) Page B of 10 i SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: I/ Owner: 1�j/�i f/fr/�i/� �� ��•e� Date of Inspection: SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent references landmarks or benchmarks locate all wells within 100' (Locate where public water supply comes into house) o _ _ _ � y� 3 � � I R�fl'lL �i 6r;'/l6IGk= II I (revised 04/25/97) Page 9 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C., SYSTEM INFORMATION (continued) Property Address: f,�✓�.Q.o-5r� G Owner: Airy %/�✓/�i/ls G y�v2.c�/,�'.L !� le Date of Inspection: Depth to Groundwater odd Feet Please indicate all the methods used to determine High Groundwater Elevation: Obtained from Design Plans on record Observation of Site (Abutting property, observation hole, basement sump etc.) -Determine it from local condition (,-'Check with local Board of health z,-Al Zc- Check FEMA Maps Check pumping records Check local excavators, installers _Z"Use USGS Data Describe in your own words how you established the High Groundwater Elevation. Must be completed) /S /y3�vT C i i /✓//-/-',�'iZ.L",�.G,�. /.�C J'4i�,t,v /��,� 4iJy lc:. Sal.£' /�.zo iHC wo25{ Cog vs' GS 3 y� $. 7sr — /3 5 - �7Fl. (revised 04/25/97) Page 10 of 10 TOWN OF BARNSTABLE ��%�� LOCATION l /�/8!/Cl� d��T�� SEWAGE # I?3 4r-,'Y,ewy VILLAGE ASSESSOR'S MAP & LOT o1- /3 ^`rc NAME&PHONE NO. /A 72,F SEPTIC TANK CAPACITY l�o psi' LEACHING FACILITY: (type) A T (size) NO. OF BEDROOMS 3 W.96PEP,AR OWNER �;�.� i �� G�- s= �'•���� PERMITDATE: COMPLIANCE DATE: >L��s Separation Distance Between the: Maximum Adjusted Groundwater Table and 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 leachi g facility) Feet Furnished by / 1 M i C � C q Q TOWN OF BARNSTABLE (w LOCATION 9/ / ��IP�B/ ��✓s� SEWAGE # 7' 7,5 7 VELI.AGE lit/, �JCl/'r/5 4��to ASSESSOR'S MAP & LOT/Z INSTALLER'S NAME&PHONE N0. SEPTIC TANK CAPACITY I.11r00 6.L LEACHING FACILITY: (type) r��'6 .��.� (y� (size) /O n ?s NO. OF BEDROOMS 3rr BUILDER OR�� PERMPTDATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and 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) AAA Feet Furnished by 3 r ® tj, r ' � No. /'1"/T7 - Fee SV_I -- THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: - Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS �1 S 01ppYication for Digooal *potent Conotruction Vermit n lication for a Permit to Construct( )Repair(/Upgrade( )Abandon( ) ❑Complete System i Individual Components Location Address or Lot No.�� �/JI��Lo�p� ,�/��•-� Owner's Address and Tel.No. 70 Assessor's Map/Parcelj,> /Q .f—�,�/� Installer's Name,Address,and Tel.No. ✓ Designer's Name,Address and Tel.No. 7I-q�3 9 Type of Building: Dwelling No.of Bedrooms 3 Lot Size sq.ft. Garbage Grinder( � Other Type of Building No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow f/4 gallons per day. Calculated daily flow 361!� gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank /®OD ,� `a Type of S.A.S. / aZ 3 o 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 this Bo d ofdHealt Signed Date Application Approved by Date /Z--2,94 4 Application Disapproved for the following reasons Permit No.Tom] Date Issued --------------------------------------- No. -�'7�7 �( ���m Fee - - ,�?;•._�....a Via' . THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Ze' f) a PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLES MASSACHUSETTS b Zf prtc'ation or Miqu ar *pgtem Congtruction j3ermit n lication for a Pernuf`to Construct( )Repair(/Upgrade( )Abandon( ) El Complete System d Individual Components Location Address or Lot No. Owner's ame,Address and Tel.No. Assessor's Map/Parcel Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. 7113 9 Type of Building: 7 - - Dwelling No.of Bedrooms 7 ' Lot Size sq.ft. Garbage Grinder(/�© Other Type of Building /' . No.of Persons Showers( ) Cafeteria( ) r Other Fixtures Design Flow ZZ 4!� gallons per day. Calculated daily flow 3 c�� gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. /2 X1 34i1'Z 3 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 dispos4 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 .y this BSW oUlealt Signed Date ��-/2y( - .> Application Approved by Date /2= g".S 7 Application Disapproved for the following reasons ..... w .. ..».�. Permit-No: �- 7 � ���� - - DateIssued--._ . _ __ �`�..-•- THE COMMONWEALTH OF MASSACHUSETTS ,.BARNSTABLE, MASSACHUSETTS Certificate of (Compliance THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed( )Repaired( ''' Upgraded( ) Abandoned( )by 167t7`b f G4/9�5�`.' r"' at l/ 140,veel, qp,Y- ��� dI'I9S�` �t!. has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. 7 7-5717 dated Installer Designer The issuance of this permit shall not be construed as a guarantee that the syste Xfuncet�ssigned.- Date f .e Z_ . M Inspector w --------------------------------------- No.27 — 737 j2- -004©��ee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLES MASSACHUSETTS Migpool *pgtem Congtruction Permit Permission is hereby granted to Construct( )Re air( Upgrade( )Abandon( ) System located at / ��/7L"�!� 7Q}�- 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 musts be completed within three years of the date of this t. Date: /Z z 9" / 7 Approved by 10/9/97 NOTICE: This Form Is To Be Used For the Repair Of Failed Septic Systems Only. CERTIFICATION OF SKETCH AND APPLICATION FOR A DISPOSAL WORKS CONSTRUCTION PERMIT (WITHOUT ENGINEERED PLANS) I, hle/t ;-Z 001-t4�e i , hereby certify that the application for disposal works construction permit signed b me dated L Z�Z��� , concerning the cons p g Y property located at �i �� ���'� Ap,4e�e2��ff,*ile meets all of the following criteria: ✓ here are no wetlands located within 100 feet of the proposed leaching facility ere are no private wells within 150 feet of the proposed septic system There is no increase in flow and/or change in use proposed /There are no variances requested or needed. If the proposed leaching facility will be located within 250 feet of any wetlands, the bottom of the proposed leaching facility will=be located less than fourteen (14) feet above the maximum adjusted groundwater table elevation. Please complete the following: A)Top of Ground Elevation(according to the Engineering Division G.I.S. map) �j Q B)Observed Groundwater Table Elevation(according to Health Division well map) SIGNED: DATE: LICENSED SEPTIC SYSTEM INSTALLER IN THE TOWN OF BARNSTABLE NUMBER [Attach a sketch plan of the proposed system.Also if the licensed installer posesses a certified plot plan, this plan should be submitted]. q:health folder:cert i F,n;oed9�� 70) 000 i � I 3 f r-� i j 1 ©�al, ar ti f• TOWN OF.BARNSTABLE LOCATION .9� ��B�GE/ Q SEWAGE# 7' 75 LAGE lnI, 17ar1i✓`1LA�le, ASSESSOR'S MAP &LOT�1���DIY ::INSTALLER'S NAME&PHONE NO. 1904 4W)4,1045;r 7V/ :SEPTIC TANK CAPACITY I.QOD 'Ga L t,Fs,ACHING FACII.ITY: (type) * n+�13 (size) /O iA )/ NO .OF BEDROOMS 3 M-.DER 0 '�,"ITDATE: COMPLIANCE DATE: d U,Z Separation Distance Between the: M aximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet onyaii Water Supply Well and Leaching Facility (If any wells exist :'ott;site or within 200 feet of leaching facility) �S'D _^�' Feet Edge of Wetland and Leaching Facility(If any wetlands exist #//300 feet of leaching facility) Feet uiushed by 7 3 1 �01 H 3 .I o :1 . i" d,., li 1 SMUKt i te7aCic , ILI �J e i E � f i { r 4f TO `l �Lt .d,�- L�t�T iNC-► nL NO flo 1-0 �xs G � E® � GYQ, VA � . � �Ua I I t TOWN OF BARNSTABLE LOCATION _ J��� �� 1,� 7�1 SEWAGE� � I VIdAGE_ S R7�tV%S�wYJ� ASSESSOR'S MAP & LOT/2— g'UO .�1-n1� INSTALLER'S NAME & PHONE NO. S Okyk SEPTIC TANK CAPACITY, 1 ,060 '' 'm' _ LEACHING FACILITY:(type) ttcAc,�% �� (size) NO. OF BEDROOMS �j PRIMATE WELL R PUBLIC WATER BUILDER OR OWNER �2ti10 �`e� ��¢J�\. CC?f DATE PERMIT ISSUED:____� �8 DATE COLiPLIANCE ISSUED: VARIANCE GRANTED: Yes No 4 C „ �� � • r ,,RR { � � � 'i •�. �o�'� l� (�`�3�.t�1� / -----�-•�� Fee BOARDOF HEALTH TOWN OF BARNSTABLE ZipplitatiouforlVeff Con5tructioupffmit Application is hereby made for a permit to Construct ( ), Alter ( ), or Repair (1,Wn individual Well at: �Ctin> cl1- -------------- Locat' n — Address Assessors Map and Parcel "_________________________ '°_ - '`�=-C �'----------------------- -- � s�----vim---D _L'__ J---�---t--�cam_--��z__ wner Address ----- ------6402C----- Installer — Driller I Address Type of Building Dwelling W?'�--C4an c- �° ----------- Other - Type of Building----------------------------------- No. of Persons--------_-_---------_---------- ' i - - Ca acit - - ------------------------------- Type of Well------------- � E'=-�=-------------- P Y------------------------ --- - Purpose of Well--- h'L-IS ------------------------------ Agreement: The undersigned agrees to install the aforedescribed individual well in accordance with the provisions of The Town of Barnstable Board of Health Private Well Protection Regulation - The undersigned further agrees not to place the well in operation until a Certificate of Compliance has been issued by the Board of Health. G. - --- q- 7'-P Signed--�G{�-� -------�--------- -- - ---- -----1--------------------------- date Application Approved By----------(� St- date Application Disapproved for the following reasons:-----------____________________—------______--__--------------------------- ------------------------------------------------------------------------------------------- ------------ ---------------- --------------------------------------------------------- date (l , ----- j � Permit No.-�--`-"- - -------------------------------- Issued-------------------------------------------------------------------------------------- - --- - -- date BOARD OF HEALTH TOWN OF BARNSTABLE Certificate ®f Compliance THIS IS TP CERT FY, That the In ividual Well Constructed ( ), Altered ( ), or Repaired ( ) -- -------------------------------------------------------------------------- / Inst)er �,�/ at---------- —� ------ `1��f�_--— 4:------------ K r =—— a'€`� ----------------------------- has been installed in accordance with the provisions of the Town of Barnstable Board of Health Private Well Protection Regulation as described in the application for Well Construction Permit N J(--S ---Dated--------------------------- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORY. DATE----------------------------------------------------------------------------- Inspector-------------------------- No.- - ----+�- ► Fee--- BOARD OF HEALTH TOWN OF BARNSTABLE Zpprication-ftIftl Cwtructionj3rrmit Application is hereby made for a permit to Construct ( ), Alter ( ), or Repair (L.�an individual Well at: !`a Per �J_/t , ).d aol) ---------------------------—- -- -------------------------------------------- r Location Address Assessors Map and Parcel j• Owner " �l l Address Installer'- Driller Address Type of Building Dwelling ,10 u� n S v _ '0 ------------ .-c Other - Type of Building ---- No. of Persons-------------------------------------------------- Type of Well- - 4 i �. ems- _�_ '----------------------- Capacity Purpose of Well-- - 41k - - Agreement: The undersigned agrees to install the aforedescribed individual well in accordance with the provisions of The Town of Barnstable Board of Health Private Well Protection Regulation — The undersigned further agrees not to place the well in operation until a Certificate of Compliance has been issued by the Board of Health. Signed - date p- __ _4 T Application Approved By----------�"+.�-�.�- --"'--------- ------------- ------- ---------------- tJ �+ date r Application Disapproved for the following reasons:-------------------------------------------------------------------------------------------_-__---------- ------------------------------------------------------------------------------------=------ ---------------------------- ---------------------------------- (�, date PermitNo.-`tom-"- - Ar --------------------- Issued--------------------------------------------------------------------------------- -- J t date t' BOARD OF HEALTH TOWN OF BARNSTABLE Certificate Of Co mpriauce THIS IS TO CERT�JIFY, That the Individual Well Constructed ( ), Altered ( ), or Repaired ( ) by - P .� 1�1 �Q . Y ^�e.Q_� - -" -----------------------------ri__ 6-_____-_. _ ----------------------- __--_-___---_--_---_-----_--__--_--_---_--_ Installer PA at--------- G' -— -/ _ ' '. _ z - _ - ¢ ----- ^=--+�"' 11®1 - ` - ----------------- has been installed in accordance with the provisions of the Town of Barnstable Board of Health Private Well Protection Regulation as described in the application for Well Construction Permit No -- -��--Dated--------------------------- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT.THE WELL SYSTEM WILL FUNCTION SATISFACTORY. -------------------------------------------------------------- Inspector-------------------------------- ---------------------------- DATE---------------------- --------------------- BOARD OF HEALTH TOWN- OF BARNSTABLE Vefr Con5truct ion Permit No. -- -- -==-- ,�-- Fee--- Permission ZD is hereby granted -��?-- - �'�1-- .I/1) -al-------------- to Construct (,,, Alter ( ), or Repair ( ) an Individual Well at: No. - - �` �"- - - - a. 2 .r-----ao t -T - --_---- -.o—' -i---------------------------------------- eUet as shown on the application for a Well Construction Permit No.- - - �'`-r - ��✓'--p ------- Dated--------------- ---------------------------------- ----------------------------- f — ------------------- Doard of Health DATE---—-------------- - --- - - ----= - M� 1 �-/S, ��titiitiltiiiQitiiililiitifilliltilflilliitit►tiit1111fliltiiltillilililitliiiiiiitttlititilltitiliiliilttoil►itiitillltitiiiiiititiltittiiiilflilifilitiitit►itlliitititiititililiiitttti►tlliltititiittit►ili►ti111tititil111111tI1ititititlhr� ENVIROTECH LABORATORIES E3 449 Route 130 Sandwich, MA 02563 • (508) 888-6460 I CLIENT: Green Brier Development LOCATION: Lot 13 Pioneer Path ADDRESS: Box 51 Barnstable, MA Centerville, MA 02637- COLLECTED BY: D. Muckey SAMPLE DATE: 11/3/89 TIME: 10:30 AM BE D.A. Scannell Well DATE RECEIVED: 11 3 89 SAMPLE [D: ET 526 Af ; ;~ JOB #: New Well WELL DEPTH: 101 ft RESULTS OF ANALYSIS: E Parameter Units Recommended limit Result c Coliform bacteria/100 ml (MF Method) 0 0 PH pH units 6.0-8.5 6.48 Conductance umhos/cm 500 62 Sodium mg/L 20.0 8.7 Nitrate-N mg/L 10.0 .03 Iron mg/L 0.3 _ <.05 x_ Manganese g mg/L 0.05 Hardness mg/L as CaCO 3 500 Sulfate mg/L 250 Potassium mg/L 20.0 Alkalinity mg/L 200 Chloride mg/L 250 Turbidity NTU 5.0 .= Color APC units 15.0 ice: Background bacteria COMMENT: ;= YES NO WATER IS SUITABLE FOR DRINKING PURPOSES FOR PARAMETER ESTED. AAA ❑ DATE !llliillllitiill!l111illl111!!lllitliatilll111lllUililllU1i1111i11 tilillillllU�lillllillll1.ltitl,3,al11ildllliiil,lta,1111i,lllltlitiiiillliiillitliitillifullitlllfllll111iiliiliitll1111U111iiii1lil111U1i1111Ul11111U111111i11�� nnr� No.--- =- y- Fee---- ---------- BOARD OF OF HEALTH TOWN OF BARNSTABLE Z.ppfication-*rlVerY Construction ermit Application is hereby made for a permit to onstruct ( �j, Alter ( ), or Repair ( )an individual Well at: -- - -- --- -------------------- Location —!! Address D Assessors Map and Parcel LD B-;e S/O e.., /Owner Address ---------------------------— �' — Installer — Driller Address Type of Building Dwelling & e Other - Type of Building--------------------------- No.-of Persons---------Y--------------------- Typeof Well--�� --�� ----------------------------------------- Capacity------------------—-- ----—_-- --------------- Purpose of Well 3 %4L- -- - - — - - Agreement: The undersigned agrees to install the aforedescribed individual well in accordance with the provisions of The Town of Barnstable Board of Health Private Well Protection Regulation — The undersigned further agrees not to place the well in operation until a Certificate of Compliance has been issued by the Board of Health. Signed—"�/1� - - --------- �� --`��o� — Jc� a 7 date Application Approved By--- / - date Application Disapproved for the following reasons:------------------------_--------_----------______--- ------------ --------------------- ------- date PermitNo.-- = ----------------------------------------- Issued---------------------------- ---- ——--- - -- date BOARD OF HEALTH TOWN OF BARNSTABLE C ertif irate Of Compliance THIS IS TO CERTIFY, That the Individual Well Constructed ( , Altered ( ), or Repaired ( ) by-------------- Q - �f�° -•--- - - ---- --- - Installer at------------ ----------- ' . --------- ----------1�-------- ----------- - - - - has been installed in accordance with the provisions of the Town of Barnstable Board of Health Private Well Protection Regulation as described in the application for Well Construction Permit No. -----Dated----------------------- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORY. - - - --DATE----------------------------------------------------------= ------------- Ins --- Inspector--------------------- ------- - - -- BOARD OF HEALTH TOWN OF BARNSTABLE t ApplicatioulorlVell Congtruct ion Permit a. _ .Application is hereby made for a permit to.Construct ( �, Alter ( ), or Repair (' )an individual Well at: ------------------------------------------- ( Location — Address q `_ '`n Assessors Map and Parcel ehfiut ,, LVO/ Owner Address SArtoN�,c/� w e/,-10✓ I, C- — _C�--- U poX `l6(, �.ta 5 L1�1s ��G y y — ------------------- ---- — — — —!i — — Installer — Driller / Address 11L e Type of Building tlou�e ` \ Dwelling ------ - = - Other - Type of Building `7" ''. �='"����*-�, r �.No o,f Persons-------------------------- ---------- �;_::-...::.:..._ Typeof Well- -q A ----------------------------------------- Capacity------------------------------------------------------------------------------------ Purpose of Well-- u� P�7%�— — ---- -- Agreement: - The undersigned agrees to install the aforedescribed individual well in accordance with the provisions of The Town of Barnstable Board of Health Private Well Protection Regulation — The undersigned further agrees not to place the well in operation until a Certificate of Compliance has been issued by the Board of Health. d// ��Ju t,u.r=--- ��- -vS a w� 77/& Signed - date Application Approved By_____---- C� V—� — - - - �'- =-:�,o date Application Disapproved for the following reasons:----...=----------------------------------------------------------------------- date PermitNo.------ -------------------------------------- Issued-----------------------—--------------------------------------------------------- date x ti BOARD,,.O•F HEALTH TOWN OF BARN TABLE , Certificate Of Compliance THIS IS TO CERTIFY, That he Individual Well Constructed (V-�, Allered ( ), or Repaired ( ) by - - a - -`--- - - — - staller f at------------ d 1 _/ ----------it" lJyiAe --- - --------- Y__ - ---- - ----------------------------------------- has been installed in accordance with the provisions of the Town of Barnstable Board of Health Private Well Protection Regulation as described in,the application for Well Construction Permit No. -Al ` --bated-- --------I---------- y THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORY. DATE--------------------------------------------------------------------------------- Inspector-------------------------------------------------------------------------------- BOARD OF HEALTH T,�OV,UN,, ,OF, BARICISTAB..LE _,,,.., .`_*,S4—.R�„iv,. �+ �.,�.r^��w4 -.. .r�ncS -.'ti:1_+.'l+v:..,.._.Yn.�.a'�tS..r�P.�'�,`�..�o.. �,,..«rr�G.?rar'°• s...._.J .,�-._.�..•�sn..,..,- .. lVerr Congtruct ion Permit No.It_ --=-- ----- Fee-- = --------- Permission is hereby-granted----------- 1)A ---------- r------------------ to Construct ( ��)., Alter ( ), or Repair ( ) an Ind' id ua 'Well at: --- Street as shown'on the application for a Well Construction Permit No.— --- --—---- _—____ - __—-- --— Dated - - - ------- - - - - — -- — - - e /A . g AABoOard of Health DATE------------ �`---1---------------------------_____--------- ,. - BARNSTABLE COUNTY HEALTH AND ENVIRONMENTAL DEPA TMENT �p SUPERIOn COURT HOUSE � �' r BARNSIAEILE, MASSACHUSETTS 02630 �lA S5/ PHONE: 362.251 -'"- EXT. 330 VOLATI1.E ORGAIIIC C01lP0tJIIDS REPORT LAS337 —,---- - - — ---- ---- CLINIC 340 Client: Greenbriar Developm . Collector: Sean O ' Brien Mailing Address: Route 28 Type of Supply: private well Centerville , MA Date Collected: 11/3/89 Telephone : 02635 Date Received: Sample Location: ant #13 Pioneer pa .1i Analyst: S . Williams West -Barn able . MA Date Analyzed: 11/6/89 LOCAT1011 E630 COMPOIRID Lot # 13 Pioneerl Path W . Barnstable ,M Chloroform 5 . 3 �j cc Barnstable Board of Health All values are in micrograms per liter (equivalent to parts per billion, or ppb) . EPA Method 502.1 was used and only those compounds listed above were detected. Attached is a list of chemicals which the method is capable of detecting . Detection limits*for these compounds are stated on the attachment. Chloroform is commonly found in Cape Cod ' groundwater at levels ranging from 0.2 to several ppb. The drinking water limit for i Total Trihalomethanes , of which chloroform is an example , is 100 ppb. A'A NOTES: � INTERCHANGE kpA 5 20' MINIMUM OR AS INDICATED ON PLAN 1. ALL WORKMANSHIP AND MATERIALS SHALL CONFORM TO D.E.Q.E. OSIER SWAgLE RD W g p,RN TITLE 5 ; THE TOWN OF --BARNSTAB E __ RULES AND VAUE- REGULATIONS FOR THE SUBSURFACE DISPOSAL OF SEWAGE; WHITE BIRCH WAY 1D MI"' AND THE REQUIREMENTS OF THIS PLAN. 10' MINIMUM PIONEER PATH 2. ALL COVERS TO SANITARY UNITS SHALL BE BROUGHT TO LOCUS T.O. FOUNDATION SACKFILL WTI WITHIN 12" OF FINISHED GRADE. o s• MIN. �— CLEAN SAND MASONRY 3. ALL MASONRY UNITS USED TO BRING COVERS TO GRADE w00D5jDE Q �Rl X . SHALL BE MORTARED IN PLACE. 4. ALL COMPONENTS OF THE SANITARY SYSTEM SHALL BE CAPABLE 'to 4• SCH. 40 PVC PIPE OF WITHSTANDING 'H-10 LOADING UNLESS .THEY ARE UNDER OR MIN. PITCH 1/8• PER N 2• LAYER Of WITHIN 10 FT. OF DRIVES OR PARKING AREAS. H-20 LOADING OPp QQ�' 3 MIN. FLOW LINE 1/8- - 1/2- SHALL BE USED UNDER OR WITHIN 10 FT. OF DRIVES OR R v WASHED STONE PARKING.60.0 G�WPOE TFLp S9. S LEVEL (L 5. CAST IN PLACE CONCRETE TEES ARE SPECIFICALLY DISAPPROVED. 0 4'-0' 2. ul" S8.8 SANITARY TY'S WHERE INDICATED ARE REQUIRED. LIQUID 3/4' - 1 1/2- WASHED STONE LEVEL DISTRIBUTION `8 6. EFFLUENT PIPING FROM DISTRIBUTION BOX SHALL ENTER LEACH PIT BOX THROUGH SIDEWALL OR TOP ONLY. ENTRANCE THROUGH MASONRY LOCATION MAP SZ.S EXTENSION WILL NOT BE ALLOWED. 1000 GALLON SEPTIC TANK Lz I I z i z 7. NO DETERMINATION HAS BEEN MADE AS TO COMPLIANCE WITH DEED RESTRICTIONS OR ZONING REGULATIONS. OWNER/APPLICANT SHALL I- /0 - k OBTAIN SUCH DETERMINATION FROM THE APPROPRIATE AUTHORITY. SEWAGE DISPOSAL SYSTEM PROFILE v 8. HORIZONTAL AND VERTICAL CONTROL, SEE LEVY, ELDREDGE NOT TO SCALE BOTTOM OF TEST HOLE 4G,0 OR USGS PROBABLE HIGH WATER LEVEL ti & WAGNER FIELD NOTEBOOK #_2S7 60 64 r ' j I\ p CURRENT ZONING INTERPRETATION: DESIGN CALCULATIONS 60 -- 40 MIN. FRONT SETBACK 3o FEET 3 NUMBER OF BEDROOMS MIN. SIDE SETBACK S FEET GARBAGE DISPOSAL UNIT 060E MIN. REAR SETBACK t FEET TOTAL ESTIMATED FLOW �O ,,� ( 110 GAL./BR./DAY X BR.) 330GAL. j/DAY 2.7 9 1 REQUIRED SEPTIC TANK CAPACITY 495 GAL (SO, ACTUAL SIZE OF SEPTIC TANK 1000 GAL. LEACHING AREA REQUIREMENTS SIDEWALL AREA 2.5 GAL./S.F. PERCOLATION SOIL TEST BOTTOM AREA 1.0 GAL./S.F. ���r�P� 60 , r �, ,` . � , ' LEACHING CAPACITY (BOTTOM + SIDEWALL) SSO GAL. 62 , �tK �,/ / s `'�� , i ( I �` J' ``_`` LDS \/ DATE OF SOIL TEST 71z4 8� PTA P 73757 27T( (0/2)( 6, )(2.5) +TT( (0 /2) (1.0) SSv GAL. 9" ✓ ' r' 70 �` `�0' '�C -WlT�lESSED BY R uttJ�ti)lam- _ ___ RESERVE _LEACHING _CAPACITY 66' �x� i , �4.a -i / . , , , - l SAME �j • I r' ; ,' r ! PERCOLATION RATE MIN. INCH OBSERVATION HOLE 1 OBSERVATION HOLE 2 ELEV.= ELEV.=----- 70 7-0P ,1 5u3 s01 BREAKOUT CALCULATION: , I .S 2j,55' ' sq. ft,� gp L-' -'-- - 64 �� �. c , , , , 66.-' �� �� , , , ' /' �J� �� '�._7a MED SAOb LEGEND: .70 ,-'- 1 %_ EXISTING SPOT ELEVATION 00 o a EXISTING CONTOUR-------00----- X FINAL SPOT ELEVATION 00.0 �` cP� � � � , ,' ,' ; . • j '>� ,, <_ FINAL CONTOUR r , I I r / �� / ,� ,i , ___ " WATER AT ELEV.__ _ WATER AT ELEV._ I --_74 ---- SOIL TEST PIT -LOCATION TOWN WATER W W — I 62 I i i i i i i I ' ,� ' I N ► SEPTIC TANK [� WATER LEVEL ADJUSTMENT: O /R DISTRIBUTION Box o 4, 60 , , I PRIMARY LEACHING PIT 1 1 I � J I ' W. ; ; RESERVE LEACHING PIT ,' 1 ► , ' r ► TEST DATE WATER LEVEL INDEX WELL WATER LEVEL RANGE ZONE 1 8/2.3 89 INITIAL ISSUE 70�.' WETLANDS DEPTH TO WATER LEVEL FOR INDEX WELL NO. DATE DESCRIPTION BY r ', \ �111c FOR THIS MONTH _ SITE PLAN & SEPTIC DESIGN WATER LEVEL ADJUSTMENT DEPTH To HIGH WATER -- LOT 13 PIONEER PATH IN $0-r- --- BARNSTABLE, MASSACUUSET'TS ------ 101 .44 1. f FOR ------ -------------------- IL- GREENBRIER DEVELOPMENT CO. INC. APPROVED: BOARD OF HEALTH SCALE: 1" = 40' JOB NO. 1120 1120-13 SITE PLAN LEVY, ELDREDGE & WAGNER ASSOCIATES INC. DATE AGENT Dwo ARm'P$CTS PLmm LARD SURVEYORS i 889 WEST MAIN STREET CENTERVILLE MA 02632 I O NOTES: INTERCHANGE TABLE RD s� 5 1. ALL WORKMANSHIP AND MATERIALS SHALL CONFORM TO D.E.Q.E. BARNS 20' MINIMUM OR AS INDICATED ON PLAN I TITLE 5 THE TOWN OF yBARNSTABLE----- RULES AND V1LLE""w • ASTER WHITE BIRCH WAY REGULATIONS FOR THE SUBSURFACE DISPOSAL OF SEWAGE; 10' MIN. AND THE REQUIREMENTS OF THIS PLAN. PIONEER PATH C 10' MINIMUM 2. ALL COVERS TO SANITARY UNITS SHALL BE BROUGHT TO LOCUS BACKFILL WITH WITHIN 12" OF FINISHED GRADE. I T.O. FOUNDATION 8' MIN. CLEANS D CUN AT 3. ALL MASONRY UNITS USED TO BRING COVERS TO GRADE WOOS/pE �- MASONRY SHALL BE MORTARED IN PLACE. ORI►�- ��s' _ 4. ALL COMPONENTS OF THE SANITARY SYSTEM SHALL BE CAPABLE PITCH a SCH. 40 PVC PIPE OF WITHSTANDING H-10 LOADING UNLESS THEY ARE UNDER OR 1/4 PER FT. MIN. PITCH 1/8 PER NWITHIN 10 FT. Q� %.� 3 Flow urrE 2MIN. ' LAYER of SHALL BE USED OF DRIVES OR WITHIN K1N0 FT.AREAS. DRIVES OR ADING GE ROpO VP 1/8 1/2 10* . WASHED STONE PARKING. OLD 2'-0- < 5. CAST IN PLACE CONCRETE TEES ARE SPECIFICALLY DISAPPROVED. Q r MIN. LEVEL o < SANITARY TY'S WHERE INDICATED ARE REQUIRED. "8 LIQUID S�.0 g• 3/4' -- 1 1/2, LEVEL r F WASHED STONE 6. EFFLUENT PIPING FROM DISTRIBUTION BOX _SHALL ENTER LEACH PIT DISTRIBUTION �� � " LOCATION . MAP BOX THROUGH SIDEWALL OR TOP ONLY. ENTRANCE THROUGH MASONRY J SZ' s EXTENSION WILL NOT BE ALLOWED. IC00 GALLON SEPTIC TANK z I I.2_i z 7. NO DETERMINATION HAS BEEN MADE AS TO COMPLIANCE WITH DEED - RESTRICTIONS OR ZONING REGULATIONS. OWNER/APPLICANT SHALL l /o OBTAIN SUCH DETERMINATION FROM THE APPROPRIATE AUTHORITY. SEWAGE DISPOSAL SYSTEM PROFILE BOTTOM OF TEST HOLE v 46.0 8. HORIZONTAL AND VERTICAL CONTROL, SEE LEVY, ELDREDGE NOT TO SCALE OR USGS PROBABLE HIGH WATER LEVEL & WAGNER FIELD NOTEBOOK # 257 _. 60 64 DESIGN CALCULATIONS Ile o CURRENT ZONING INTERPRETATION. 60 `- \00 MIN. FRONT SETBACK 30 FEET -3 NUMBER OF BEDROOMS Na r.1E' MIN. SIDE SETBACK t FEET GARBAGE DISPOSAL UNIT TOTAL ESTIMATED FLOW MIN. REAR SETBACK t S FEET ( 110 GAL./BR./DAY X _3 BR.) _] 3I GAL. /DAY 2.79' �S '`���` REQUIRED SEPTIC TANK CAPACITY 4ct GAL. �o r IX rSo .,�` LEACHING AREA REQUIREMENTS ACTUAL -SIZE OF SEPTIC TANK IoOo_GAL. D . 8 L SIDEWALL AREA _2.55 GAL./S.F. _ BOTTOM AREA �_� GAL./S.F. q/�� , ! ��� L� �, PERCOLATION SOIL TEST LEACHING CAPACITY (BOTTOM + SIDEWALL) SSo GAL co* 60 , ' r 2 62 �,,1� p �� �/ r I ; �\ i �/ DATE OF SOIL TEST 7 z4 8`z PTA P73757 2Tf( I0/2)( & )(2.5) +7T( 10 /2) (1.0) SSoGAL. ` 70��.��`�'�, .10 Q WITNESSED BY _jERRy� Duo010G RESERVE LEACHING CAPACITY 66' ��x� :'Op. / I I rt r' r' r + ��� I PERCOLATION RATE - MIN./INCH SAME 0 i 41' / �� �' ��`�� OBSERVATION HOLE 1 OBSERVATION HOLE 2 �o ELEV.=_— -ELEV' ti _0.00 BREAKOUT CALCULATION:� su .O , 2 ,55V sq. ft-.± 80 I .s 64 5• , , , 66, \ �� �. _— -78 LEGEND: 701 EXISTING SPOT ELEVATION OOXO EXISTING CONTOUR------ 00----- Fl FINAL SPOT ELEVATION 00.0 i I cP ,' ,' FINAL CONTOUR ,P �' , ,/ ��� i i , WATER AT ELEV._� WATER AT ELEV. ---- \ -,P l.__ rJ, I'. TOWN WATER W W r SEPTIC TANK C� 62 , r r I r , , / , r I , N , DISTRIBUTION BOX O , I r ,,I,¢ Ut ; WATER LEVEL ADJUSTMENT: 0 /A PRIMARY LEACHING PIT O RESERVE LEACHING PIT TEST DATE --- — WATER LEVEL INDEX WELL WATER LEVEL RANGE ZONE 1 8/z.3 89 INITIAL ISSUE 70,•' WETLANDS DEPTH TO WATER LEVEL FOR INDEX WELL NO. DATE DESCRIPTION BY � .-' ,.-' ,. ,' ► ; `, `, ', � � � FOR THIS .MONTH SITE PLAN &-- SEPTIC DESIGN t , WATER LEVEL ADJUSTMENT DEPTH TO HIGH WATER LOT 13 PIONEER PATH AL 1N --- - ----------- BARNSTABLE, MASSACUUSETTS 101 .44 � ,• ��4�� s — FOR u� o? P A v � GREENBRIER DEVELOPMENT CO. INC. z A. I \ o LEV cn No.l a o = 40' JOB NO. 1120 1120-13 APPROVED: BOARD OF HEALTH ��\��`� SCALE: 1 SITE PLAN ° LEVY, ELDREDGE & WAGNER .ASSOCIATES INC. DATE AGENT z4 Iat\Gll�Lla11J LMCO A PILTM L SUI��aI� ; 889 WEST MAIN STREET CENTERVILLE MA 02632 Fr -- -- -- —