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HomeMy WebLinkAbout0043 STONEWALL DRIVE - Health 43 STONEWALL D�(�VQi A = 217 50 oo;� d 1 i o } p > 0 l\ O a COlyBIONWEAL ITH OF MASSACHIJSI�: � XECUT-WE OFFICE OF r`IRO���TTAL AFF,h3Rs DEr-A-RTME T OF E1v ONMENI I`AL P-ROTECTION TITTLE OFFICLA.L INSPEMHON EO —NOT FOR VOLIs ARY ASSESSM � SUBSURFACE SEWAGE DISPOSAL SYsTE. OMECEIVED PARS'A CERITMCATION, J U N 1 8 2002 Property Address: `' TOWN OF BARNSTABL.E HEALTH DEPT. Owner's Name, 14 cru Owner's Address: roc a Nte of Irsspertion: �i I8+ 0 a g ;*farce of Inspector: (please print) Cornpanv Marne: /.dLr �l�a� Mailing Address: � a-z'sk_ — MAP 3elenbo�e uttsber: ,��� -� '7 DS PARCEL - LOT CERTIFICATION ST-ATE?VEN I certify that I have personally inspected the sewage disposal system at this address and that the iniorrn2zioit reported below is Witte,accurate and complete as of the time of the inspecaorl- i he -rspsctior was performed based orgy�y =laming and experience in the proper function and maintenance of or_site sewage disposal system-I am a DEP approved system inspector pa scant S for 15.340 of Title (310 CMI R 15_004 The system: Passes Conditionally Passes Needs Further Evaluation by the Loc2l Appr�ovma Authority Fails Date: Inspector's Signature: 9V,42 6 d� T.ie syst..ln rector shall submit a copy or thus Lrsveanor.report to the Approving Authori-ty(Board of He'aith os LEP)within��days of completing this inspection.If the syseen- is a shared systei: or has a design flow of IO; J gpd or✓-eater,the inspector and tie 5;vste'?1 owner shall submit the report co the appropriate regionaland the an ro�'1Z DEP.Ttie orx?inai should be sett to the system,ow-izr grid copies seat to thz dye: :_app-• aiiihloi iij. Notes and Con-u;sents of use at th2t **x n and under his report only describes conditions at the time of i€tspectio fu u�e under the conditions or different tir�;e_This inspenaII does trot address stow the system will perform in the -017ditions of use. i ��� � trio i de 5 slSptc-ion Fo;an ;5i2 OFFICUL L NSPE ION FOR1--N R V400INMARY ASSESSMENTS SUBSURFACE SEWAGE DL45POSAL SYSTEM ESISPECnONFORM PART A RTMCA ON(contb� Property Adder: Owner: Bate of Inspe o 6 g2 Inspection Sammaey: Check A,B C D or B f ALWAYS tompkft off of Swlbs Y�' - A. System 'asses: AL i have mot found any imho,-rr_ation w1hich:.ram dot any of the failure criteria described in 3 i 0 CIIIAR t 5.303 or in 3 10 CNM I5.304 exist Any---ailure criteria not evaluated are indicated below_ Comments: B. Systems Conditionally Passes: One or more system components as described in the"Conditional. section reed to be replaced or repaired_The system,(_Ton completion of the replacement or repair,as ap oved by the Board of Heafth,will pass_ Answer yes,no or not determined(Y,N,'+N-7)in the for the foil ing staterrfents.If"zot de<ermi_red"viease explain. the septic tank is metal and over 20 years old*or the- tic tank(whether metal or not)is structurally uasoimd,exhibits substantial inMtration or exfiltration or %ihze is imminent-System wili pass mspectimif existing tank is replaced with a complying septic tank as roved by the Board of Health, *A metal septic tank will pass inspection if it is st=-7 v sound,not lealitrig and if a Certificate of CmWfimice indicating that the tank is less than 20 years old is avai le_ ND exolai-r: Observation cf seexage backup or break oriighstanc lei in the disnib=non box due to.bmketn or obstructed pipe(s)or due to a broken,settled o uneven,dst on box_System;will pass�if approval of Board of Health): b s;ae=P a on is removed d' box is or replaced ND explain: The system required purnpin more dam4 i s a.y=-dne T-o broken cr obstr�ph*s)_T-ne syster:-t will pass inspection if(with approval o the Board of Health): broker pipe(s)are(placed obstruction ii rer7toved- N-D explain: Page 3 of 11 {3V�FICLAi.UNSPECTIO FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE rSPOS_AL SYSTEM ENSPECTION FORM P&RT A CrLR ICATION(continued) Property Address: 4/3 S-F0 na Wct�!' Owner Qi� Bate of is�ecttdn. 0� C_ Further Evaluation is Required by the Board of Health: Conditions exist which requae further evaluation by the Boars}of Res Ith in order to determ; a if the system is failing to protect public hezitt,safety or the envimument_ 1_ Svstetn will pass unless Board of Health determines in accordance with 310 C R IS-M(1)(b)that the system is not functioning in a manner which will protect public health,safe and the environ t: _ Cesspool or privy i:s within S©feet of a surface water Cesspool or privy is within SQ feet of a borderinn vegetated wetisT or a salt marsh 2_ System will fail unless.the Board of Health(and Pubb Water Supplier,if any)determines that the system is functioning in 2 manner that protects"he pu c health,safety and environment: _ The system has a septic tank and soil absotp" n system(SAS)and the SAS is within, 100 feet of a surface water.supply or tributary to a surface - supply_ The system has a septic tank and SAS d the SAS is within a Zone 1 of a public water supply. The system has a septic tank and S S and the SAS is within 50 feet of a private water supply well- _ The system has a septic tank an SAS aria the SAS is less than 100 feet but Sfl feet or:nor e fro?.si a private water supply w.-T—*. tt tech used to determine distance `This system Passes if the wel water analysis,performed at a DBP certified laboratory,for coliform bacteria and volatile organic- mpounds indicates that the well is free from pollution from that facility and the presence of ammorEia n" sen and nit-ate nitrogen is equal to or less than S pprh,provided tta£no puler failure criteria are triggere A copy of the analysis must be attached to this foram. 3. Other: rage 4 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM RqS FORM PART A ;TMC A .TION(contiurned) P-roperty!address- Owner:—�'-0 C_i 1C - !;-ate of nspect- a n': a� D. System I~ailm-e Criteria applicable to all systems: You Must in�`yes'or"no"to each of the following for a$inspections: Yes Na . �[( Backup of sewage into faclzr_r-or system component due to overloaded or clogged SAS or cesspool — Y Discbarge 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 distrioution box above outlet invert due to an overloaded or clo--oed SAS or cesspool _ Y Liquid depth in cesspool is less than 6"below invert or available volume is less than' day:low 3( Required pumping more than 4 tithes m the last year�i!QT due to clogged or obstructed pi*s)-Number of times pumped V 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 l of a public well_ Any portion of a cesspool or privy:s within 50 fee,of a private water supply well- _ j7 Any portion of a cesspool or priory is less than 100 feet but greater loan 50 feet from a private water sLTpiy well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DE certified laboratory,for colifasrs bacteria and volatile organic compounds indicates that the well is free from pollution f€om that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less&an S ppm,provided that so other fsilares.6teria are triggered.A copy of the analysis must be attached to this 1'orn L] (yes/O))The system fails.I have determined dpat one or more of the above failure criteria exist as described in 310 CMR 15�03,therefor the system Ilesyste�rr av sad rt t� of Health to determine what will be necessary to gent the faihtrre. - E. Large Systems: To be considered a large system the system must srrve 4 Eacilky with a design now of 10,0W gpd to 15,000 You roust indicate eiLht `yes"or`="to each of �oulst Ong. (The following criteria apply to large systems hr dition to the uit=ia alcove) V s ii0 the system is within 400 f f a surface. ; awater supply the systern is within 20 eel of a triotmrzy to a s€-face drinking water supply tilie system is loci in a nitrogen sensitive area(Interim Wellhead Protection Area—1ATA)or a mapped Zon li or a pu' tc wager supply weii If you i ave answe ,yes"to any question in Section E ihe system is considered a significant threat,or answered "yes"in Section ove the large system has failed.The owner or operator of any large system considered a signilicarst threa nder Section E or failed Luider Section D small upgrade the system m accordance with 310 CVM 15.304.The sy en owner should contact the appropriate regional office of the Departmmert_ 4 XI Page S of I I OFFICIAL UgSPECTIfJN FORIM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B -- CBEC ,IST .s Property Address: �� fo wWwo -_, tQ Owner- Wot CA C Date of Inspect�atoato �T�76 Check if the following have been done. You must indicate`ves"or"no"as to each of the following: Yes No X — Pumping information was provided by the owner,occ paM or Board of Health X Were any of he systern components pumped om 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 _ We, as built plans of the system obtained at~td examined?(if they were not available note as NIA) — Was the facility or dwelling,inspected for signs of sewage back up' J( Was the site inspected for signs of break out? J( _ Were all syster:cornportents,excluding the S-AS,located on sit-- Were the septic tank marmoles uncovered,opened.,and the inte-ior of the;.attic inspecte i for the condi-don of the baffles or tees,material of construct-ion,dimensions,depth of liquid,depth of sludge and depth of stunt? 0� Was the facility owner(rind occupants i.f different 5-orn owner)provided with info—nnation on the proper maintenance of subsiu face sewage disposal systems'. The sip and location of the Soil Absorption System(SAS)on he site has been determined based ou: Yes no Fxistina in For example,a plain at the Board of health. x — Determined in the field(if any of the fkilure criteria related to Part C is at issue apLroxi ttatior:of distance .is unacceptable)f310 CMR I5.302(3)(b)} Page 6 of i l OFFICUL INSPECMON FORM--NOTFUR VOLtTNTARY ASS-1&3SWMNTS SI.rBSU AC'E SEWAGE DISPOSAI.SY53!EM INSPFCMON FORM PART C SYSTEMOATION Property Aaidress- 3 15%4 t W,•It 70tA t..k 0 WISH Owner. a f iraaL va rg..ia$gl'F'isciafl- -7 0 9 �+dd��AAi��g��t i .0 OW CVt�LzuxONS RESIDENMIALI Number of bedrooms(design)- 9' Number of bedrooms(ate): DESIGN flow based on 310 CMR. 15.203(for emote: 110 gpd x-#of bedrooms)_ Number of current residents: cV Hoes residence have a garbage grinder(yes or no): Is laundry on a separate selvage system(yes or no):A.0[if yes separate inspec-tion requiredl Laundry system insneeted Oyes or no)-4t� Seasonal use:(yes or no)-i Water meter readi-W.if available(last 2 years usage(gpd)'): Sump pump(yes or no): Last date of occupancy n2f a COMMERCIALM9DI3STRUL Type of establishment: Design flow(based on 310 CIVIR 15 203): Basis of design flow(seatsipersorsisgftet Grease trap present(�es or IIo): Industrial waste holding tank p yes or no):_ Non-sanitary waste discharged Title 5 system(yes or no):— Water meter readings,if a le: Last date of occupancy/ OTHER(descrbe GENERAL INFORMATION Pumping Records n Source of information: _AVo K Was system pub as part of the inspection(yes or no):_A,�p if yes,volume pumped: gailor+s—How was auanxity pub determined-? Reason for pumping: TYPE OF SYSTEM X Septic tank,distribution box;soil absorption system Single cesspool Overflow cesspool _Privy Shared system(yes or no)(if yes,attach previons bmTectkm rids,if any) Innova'ive/Alternative technology_Attach a copy of the=Mmm operadon aad maintenance cot-tract(to be obtained from system owner) y Tight tank _Attach a copy of the DEP approval Other(describe'; ` Approximate age of all components,date installed(if known)and source of information: Were sewage odors detected when an ivzng at the site(yes or Flo): 1`0 Yage / oI I I 0 3F � DivSPECTION FORM—RIOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL C �ISTEIvf INSPECTION�'O�Z�ri SYSTEM MI ORNLkTION(continued) Property Address:. owner. W C Date of Inspection: 6 a G 'BUILDING SEWER(locate on site Pia?) Depth below grade: ?Materials of consmcccotl:_cat iron r 40 t PVC—O =(explain): Distance from private water supply well or suction line: Comznenu(on condition of jeislts,ventln&evidence of leakage,etc.). SEPTIC TANK: X (locate on site plan) R Depth below grade: l , eth lease +lateral of colls1ctioL:�corete metal*ibeT'lass�Po-Y Y other(explain) {atrac?I a t o v of if tank is metal list age:__ is age confirmed by a Certificate of Comp-lance(yes or no,: P, --ertificate) DImensions- Sludge depth: of Distance-Orn top of sludge to bottom of outlet tee os baf=1e: �� SCikni uIiClKneSS:�— __ �i of outlet tee or baffle: Distance from top of scrim to top Distance Bore_bottom of WJM to bottom of outlet tee r bade: 18 How were dimensions determined- �l y � Comments(on pumping reconuriendations,inlet and outlet tee or baffle condition,structural irite�rity,Liquid levels as related to ojztlet invert,evidence of.leakage,etc.): W4.9 Soot4 C6 tea. "E f CREASE TRAP:: _(locate on site plan) Depth below grade: Material of cotlsuilction: concrete,m fiberglass_polyethylene other (explain): Dimensions: Scum thickness: Distance froil tOP of scum to to Ot outlet fee aT baffle: Distance from bottom of sc to bottom of outlet tee or baf;Ie: Date of last purnpin': endatious,inlet and outlet tee or baffle condition,structural integrity,liquid levels Comments(on puTnpin recottim as related to outlet err,evi ence of leakage,etc _):as F rage60I ti oFFICIAL LISPECnO FORM—NOS LUNI T a'ASS S N17S SUBSURF,kCESF DIS AL SYS M INS I)�I �'O PART C SYSTEM INFORIMATION(rtm-riw cl) Property Address: 5�(c►�cwatl ,l�l�-;V{ e arras roC�. tamer: C. Date of TIGHT or HOI DING Tk (tank mmust be p time ofjm�-X%69t on site plant) Dot below grade Material of consvuction- c, oncrete nlerglass___polyethylene athe:(explain): Dimersious: capacity- Design loss Flow: onslday Alarm present(yes or Ito): alarm level: A t in wow order(yes or no): Date of last pt�ing: Comments(conditi a:alarm and float switches,etc.)- DISf MBU— E)i+i �€3X: X (ii present mast lie apened}(locate an site plan} Death of liquid level above outlet invert_ 4 d_O Comments(note if box is level and distibution to owlets equal,arty evidence of solids carryover,&iy evidence of leakage into or out of box,etc-)- f. boa wcs l�ue `� �c.l� � � v�c� t o PUMP CHAiBE : (locate o site plan) Pumps in wo-king order(y tsr t�): Alarms in wore garde or no): Canulneltts(note c ;tion of p€tttln chamber, ofpmnps andappurtcaarxM.etc)= r - Pa'e 9 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENT'S SIUJBSI}WACE SEW AGE DISPOSAL SYSTEM INSPECTIONT FOB h- RTC . SYSTEM INFORMATION(continued) Property Address: ��- e� r Owner- (.A:)0� Date of Inspection: (y a 6,-4 SOT—T ABSORF 10N SYSTEM(SAS): X (locate on site plan,ezcavatior not required) if SAS not located explain why: Type leaching-pits,number:_ leaching chzmoers,number _ leaching galleries-number- leaching,trenches,*cumber,Ten rh: X 514, Ieaching fie-ds,number,dimensions: overflow cesspool,number imsovativetalternafive system T;petname of technolocv: Cot,�rsents(note condition of soil,si7 s ofhydtaulic failure;level of ponding,damp soil,condition of vege ion, etc-'- CESSpool_S (crsspeol must tie purnged part of inspectionxlocate an site plan) Number and config,=ration: DeDLh—toD of litluid t0 inlet invert: Depth of solids layer: Depth of sctrn layer Dimensions of cesspool: ; Miaterials of construction: Indications of groundwater ow(yes or no): r t po n&condition of ve'etation,etc.)_ Corsv-nents(note conditio ff soil,suss of hydraulic ,assure, level of ndi PRIVY: (locate on site plan) ;`Materials of,consauc`tion: Dimensions: Depth of solids: Comments(Hate conditio f soil,sites of hydraulic failure,level of por_ding,condition of vegetation,etc. 9 i, Page 10 of I I OFFICL4j,LNSPECTION FORM--NOT Y-ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM HgSPOON FORM PAR' 'C SYSTEM ITNFORIMA' O ' ) Property Address: 5 � �vA �D�- e V Owner- \0 a a.► ZSAEe Q3 a B' SKi T--'1H OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system eluding ties to at least two permanent reference landmarks or benchmarks-!-,ovate all wells withm 1.00 fe--Locate where pu-bhc aster supply enters the - a d --...40 Page 11 of I I VOLUNTARY ASSESSMENTS I� CIA�INSPECTION FORM—NOT FOR �� SUDSTJRFACE SEWAGE DISPOSAL SYSTEM SPE O F ORI PART C SYSTEM LNFO MATIO?N(continued) Property address: €caner. {jo`(A r rrQEE o`lnspealflo is V T SrrE FMAIM slope Dows..) AV $tkg L*Lq Surface water 0 G Check cellar �46 Shallow wells tp E,Lrmated depth to g:otm water do feet Please:ndicate(check)all methods used to determine the high found water elevation: Obtained from system d-sign plans on record-If checked,date of design plan reviewed: Observed site(abutting propertyloaservarion hole within I50 feet of SAS) Checked with oca€Board of 14--alth-explaim. Checked with local excavators, installers-(attach documentation) Accessed USGS database-explain: You must describe how you established the high ground water elevation: (� SG.S g TOWN OF BARNSTABLE . LOCATION / STC C Ak Se I y C SEWAGE # 1 If S� VILLAGE ASSESSOR'S MAP & LOT Z I?-5® -Z INSTALLER'S NAME&PHONE NO. L'/1 y' O•�C gt ��®'��a'QO SEPTIC TANK CAPACITY ®��� L LEACHING FACILITY: (type) CV/+CC f V,,) (size) J Z X S7 NO.OF BEDROOMS BUILDER OR OWNER C. PERMIT DATE: 6 —J f �� COMPLIANCE DATE: .3 J - l o o0 Separation Distance Between the: f Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Z Feet Private Water Supply Well and Leaching Facility (If any wells exist N/ on site or within 200 feet of leaching facility) / Feet Edge of Wetland and Leaching Facility(If any wetlands exist IVIIA within 300 feet f le c� hing facility) Feet Furnished by 331 0 w, No. 7- � ie ,i Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS 01pprtcation for 3Bigo5al *pgtem Construction permit t Application for a Permit to Construct(X)Repair( )Upgrade( )Abandon( ) IX Complete System ❑Individual Components Location Address or Lot No. 43 D�-vc Owner's Name,Address and Tel.No. lrbi �irs/®6/� �cr or va wcs�c t k 3 k�c R-if E.j Assessor's Map/Parcel 1 t1 SU- �i��ivNsfi/?nj D d Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. 4 2$-`!/3 �a►c/zY E il/Jc ..ZU $IZ marK S+ z S Type of Building: Dwelling No.of Bedrooms V6u>- Lot Size SZ!L sq. ft. Garbage Grinder(Alt) Other Type of Building No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow _4 6,ayr,,ma K /!b gallons per day. Calculated daily flow gallons. Plan Date AMc y XG,/9F2 Number of sheets Revision Date °— Title Si A: e26w - 4 3 S,k-Lecia// ©rivc Size of Septic Tank /Sots G,-/lc..S Type of S.A.S. "c-1k Ckc,.,lx&s a 54'x t 2')c 2 r Description of Soil PLc.c-st reA= . 1 Lcn4A C,6n Ple, P c(377 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 by VB\V He th.Signed Date �' q Application Approved by _ Date Application Disapproved for the following reasons Permit No. r s� Date Issued 6 1 i TOWN OF BARNSTABLE !�` LOCATION SEWAGE # 0 111156 VILLAGE AZIV 511144. IC ASSESSOR'S MAP & LOT 3 Ly .1�. _ INSTALLER'S NAME& c/fX o3ct_PHONE NO. y c- �.� � SEPTIC TANK CAPACITY LEACHING FACILITY: (type) z � (size) NO. OF BEDROOMS BUILDER OR OWNER �9 . PERMITDATE: I COMPLIANCE DATE: 1 - 10co 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 f j� within 300 feet f leaching facility) Feet Furnished by ;' ✓ � :_... , —1V Fee No. / r �•�fe.-�.-�; i THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes, "PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS 0(pplication for ;Digpotal *pgtem Construction Permit Application for a Permit to Construct(X;)Repair( )Upgrade( )Abandon( ) Complete System ❑Individual Components Location Address or Lot No. 43 Owner's Name,Address and Tel.No. 4,ftj 3cruma We-j6 k (, 3 lJ c�Rtf{�N L q—e Assessor's Map/Parcel .e Installer's Name,Address,and Tell.No. Designer's Name,Address and Tel.No. t x- i3a�r�rr �/vyc _V_r_ $12 YVlotr. Sf- s S Type of Building: - Dwelling No.of Bedrooms %our- Lot Size 5:2 632L sq.ft. Garbage Grinder(A/4 Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow 4 -pc //c7 gallons per day. Calculated daily flow gallons. Plan Date "k% aG_14-F Number of sheets Revision Date Title Si!- 42&W — 4 3 5Jr�ierwc.// ,drbet Size of Septic Tank h5ran G.//os Type of S.A.S. Leo►, �x 12'x 2� De es eiption of Soil Cal e,�,st ire x, i,, so, 1 1 St 3 7 7 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 by oa,!§f Heath. I q Signed' Date 3 Application Approved by Date 0//-9111CP Application Disapproved for the following reasons Permit No. Date Issued 6 --------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS 217 - S-D Certificate of Compliance THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed( L11 Repaired( )Upgraded( ) Abandoned( )by at 3 S V, Q.• n _ _ has been constructed in acco rdance with the pr visions of Title Ian the for Pisposal System Construction Permit No. 3 � dated 6'/1" Installer �V Designer The issuanc o this p shall no be construed as a guarantee that the system will function as designed. Date Z��ob 1 �,Qv Inspector r c ' --------------------------------- No. ---------------------------- ----/—/f—J/— No. 77 r 3S0 Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE: MASSACHUSETTS 217- ED- Z Xigpoar tem Construction Permit Permission is hereby granted t. Construct(V)Re air( )Upgrade( )Abandop ( ) System located at 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 this permit. Date: Approved by ,.y Town of Barnstable pit Department of Health,Safety,and Environmental Services ��t+e Public Health Division Date qq St, 367 Main Street,Hyannis MA 02601 BARNarABI$ .. •✓V�Date Scheduled Time14Q� Fee Pd. Soil. uitability ssessment for Se"ge Dis sal m Performed By: Witnessed By: ....... .... .. ... . . ........ }1 t t*t ��( 7 *t .. :............:............. ....;:,; ..................................:...................... .. Location Address 3 S �4t 1. Dr�� Owners Name 13ov nk,lar. Address Assessor's Map/Parcel: M&? 2 t'� �pav c,,R S o 2., Engineer's Name ��,�{c. � hj�a T-A-r— NEW CONSTRUCTION REPAIR Telephone# ,42,%—ell 3 t Land Use 1! la �r.n/4lid Slopes(%) Surface Stones � ' Distances from: Open Water Body R Possible Wet Area ��� R Drinking Water Well R Drainage Way R Property Line R Other R SKETCH:(Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands in proximity to holes) a •. zo - �o N �o ,✓,/ W ^ n o c o., .._.8 FFFa %. } ^ Id N _ S 09'1T58"E .. . . ..-S 09'22'30'E^ 126.52' 148.09' n Parent material(geologic) IW&10bbco �Jc�osi�s Depth to Bedrock Depth to Groundwater: Standing Water in Hole: Weeping from Pit Face Estimated Seasonal High Groundwater ..... ...... : .. :....<:» TERMI NATrt?lttt..S �SONA . G .'lA' : t.TATL��.<>> >>.< <>: «od Used:>::»:............. F................................................................... Meth Depth Observed standing in obs.hole:. in. Depth to soil mottles: in. Depth to weeping from side of obs.hole: in. Groundwater Adjustment it.. Index Well#_,_•_•_ -Reading Date: _ index Well level.-.___ Adj.factor Adj.Groundwater Level <:<;PER+ OLATT+CIY:TET .... <:> niztc' �;<>;7ittiet1r ::: Observation Hole# 3 Time at 9" Depth of Perc �G Time at 6". Start,Pre-soak Time Q Time(9"-6") End Pre-soak Rate Min./inch 10,0, l incA C1-4-5S ZZ 50/4 / p Site Suitability Assessment: Site Passed t/ Site Failed: Additional Testing Needed(Y/N) 3 Original: Public Health Division Observation Hole Data To Be Completed on Back j DEFY' OBSEVA `t�iOE E00 Depth from Soil Horizon Soil Texture Soil Color ,. Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Doulderes. Consigenny % b -/O/' f},� S/ 'Ga�.� /0 ye 31Z /0<-.36� /0 y2 '5/4 36 !off" C G/li �?S Y2/ S�_ CZ BEEP QBSERVATION Ht�LE ECG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Doulderes. Consistency,%drivel) 50`: Q S/// Loa.h . /o yte �Q i_ /'f�'1 / _ ,•" Sq lqc(fk G/4 XA f 4 L 1 ?�-S.r 0:71 r rs wa T 5o/rej i3l DI1J C) #SEYtVA�`Ip1 L.UC:> <'::>.:: dote# <, :>, Depth from Soil Horizon Soil Texture Soil Color • Soil Other Surface(in, (USDA) .(Munsell) Mottling (Structure,Stones,Doulderes: <� e 16 ZA �` 9G P-case. Sa Q 5 UItk S1C4WJ r.obbLQ DEEP OBSERVATION IIOL LCG: Hls Depth from Soil Horizon Soil Texture soil Color . Soil Other ' Surface(in.): (USDA) (Munsell) Mottling (Structure,Stones,Doulderes. Comigency.0 Flood Insurance Rate Man: Above 500 year flood boundary. No_ Yes t/ Within 500 year boundary No V/ Yes Within 100 year flood boundary No Yes 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? s If not,what is the depth of naturally occurring pervious material? Certification I certify that on S (date)I have passed the soil evaluator examination approved by the Department of Environmental Protection and that the above analysis was performed by me consistent with. the required training,expertise and experience described in.310 CMR 15.017. Signature - Date 5 3c�LT . tW . A2N s�jA� L 3 0 1 AA%TC-ie LaFf ou C,,NTILEVER 4' E-a o E�vw j 7 �0 2�41 z I 00 O O 0 L- l V i ti 6 �.v<-Z SHELVES (-JIN6 W D i - - ------ �1 i---------------------------� Tr ------------ _— r. a ____ a --- -------- - =---------=- ------ � J - ---------------- r I I I I I I I I I I I I I I I I I j I I I I I I I I I I I I I -_ ----------------J I r--------------------------- I I I - I I L--------------------J I I II __ L----------------------L- ----------------------, I I ------------------ , r------------------- I I I I I I I I I I I r-------------------------J----------------- -J I I I I 1 I I �-- ---- I I I I I I I I I I I L--------------------- I I I I I I ----� I I I I I I I I I I I I I I I I I I I I I I I I I I 1 I I I I I I I I I I I I I I I I I I I I I I I I I I I I I L--------------------J I I L_ J I ------------------_ I L-----------------------� L---------------------- -------------------------� --------------------- -J r - ----- r 4 _ 1 • 3 77 -UNE•_TABLL r !UNE LENGTH BEARING L1 7.73 S7429'12'W - r a I3EEP.fJBSEIYy.�TION1IgLE;LOG '` hole# -.. Depth from Soil Horizon Soil Texture Soil Color Soil Other 0 _ - - - Surface m. - USDA Munsell Mottling _{' ) (USDA) ( ) g (Structure,Stones,Boulderes. • l C, p (70 /0'=36r 13 Si//f Go�m /0 '12 S�la o SOo k, 13t eLOCUS e O S Y/Z 6// s/ 6e S.1i sLo,e1 11 tie, y2vo 0 FINISH GRADE 0 p II '� • B o _ • o MAY BE REPLACED o � • o . t • io COMPACTED FILL 3' MAXIMUM MAY INSITU MATERIAL B o DO e dO •�O _ 1/2. DEEP OBSERVATION. HOLE:`LOG Hole# ' °ao - .: PEAST N .,: .. ... Depth from Soil Horizon Soil Texture Soil Color Soil Other /'��� IF ENCOUNTERED REMOVE .a Surface(in.) - (USDA) (Munsell) Mottling (Structure,Stones,Bouldcres. �OCA�NtIr �I UNSUITABLE MATERIAL TO INSURE THE t, e• 3/4• - 1 1/2' REMOVE UNSUITABLE MATERIAL _ LOCATION MAP SIDEWALL AREA OF SYSTEM IS IN o a DOUBLE. FOR 5-FEET IF APPLICABLE r, S./ L ec.., -'IL CLEAN MEDIUM SAND OR FILL PER '� d. ° WASHED /0 ye 310 CMR 15.201 - 15.293 a - HYANNiS QUADRANGLE :. CULTEC 330 ..- STONE : f01,- SO.1 Q Si/ Gan /0 �/IZ G/G w/s� SCALE: 1:25,000 c. r wn� Gk 52_ zsy� 7// s/,jet ASSESSORS 5. 12' 46• 5. M MAP 217 PARCEL 50-2 CROSS-SECTION OF CHAMBER d rLsr Pi is .va r d r9 c r` . ZONES: NOT TO SCALE AQUIFER PROTECTION OVERLAY DISTRICT Go M DEEP UBSERVATIONIIOLIisY OG Hole - - - Depth from ---�Soil Horizon Soil Texture Soi%l Color Soil- Other ZONING DISTRICT: RF - Q Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulderes. Consistency,%Gravel) MINIMUMS M . 11 s .- - AREA = 43,560 .S. F. a �, �. /0YR /L ,/ _ FRONTAGE = 150' 'Loa., /o Yet //o J zr t� g �K, :}4� ro6!-Lc4 WIDTH = N/A a yG, /6 ve5-14. - . I ecle . � FRONT SETBACK = 30' SIDE SETBACK = 15' REAR SETBACK = 15' FLOOD ZONE C FIRM COMMUNITY PANEL P RC r�RTc , TP ' 3 to MIh/inck No. 250001 0003 D REVISED: JULY 2, 1992 _ THIS P IS ,ASSUMED DATUM FOR LAN N/F GUSTAFSOPI T'HOMAS A. ` UX. ET �Jcsl f� Dr�-,•-r�. � L'cc�rcao,-,.� I (oosc � fJo G2�r17n�c. Grtna(.c`v- 4 5,kr., x I l0 ,�Ei r'D � 0drrn c -i 'a 0 G(J see 1�c ark t A4-') x 206�d �3C �al lcv,s Cha.N.YscrS • I21'X S4 x 2' hr (n 1 Q2 '--:3A 2� - r'leq � 1� Tc» A 1- = �112 51 CB/DH FND EL _ 96.63' _ PK FND 96.6 EL 95.96 • 96.0 - cs, FT. I t G. F PAVEMENT Tol,�yJ car SPtR1.�s-rr�6�� Z5 EDGE 0 Fram 06GS OvacD `lticc. N F WITH BERM l�r�proxr talc GrfTvci�on o� Srlc I� / \ EDGE WETLANDS I 1 SC- SS, Fv-crn t2 101- w �v\cQ�.ra}r Cvn�vr Mae �I44 Z) ARM AND J. AUCLAIR, ' ET UX. � • G ���,�+�" r�a���� I ,z1v, ff 2,0 - zs. 6.7 1' 98 7.4 90.9 CTRIC ETER 98 AL 97.5 97.9 S 87*1248' W 10 AL �7,gg C 135.21' �t38.4 x 100.7 tv box �D � 9&2 98.6 9 TELEPHONE Op L .O T 2 .�' PK FND 90.9 T R E E S & B R U S H ELEC TRANSFORMER EL 100.00' 52,632 Square Feet t 100.0 T� o{ rdn i2lo 1.20 Acres f x � fbt.5 99.9. per record plan x 100.3 x 1 .2 1 6. 101.2 10Q.2 _ CB/DH rFND� : x 1-00.4 EL 99.97 t � 102 - - N x 1 .8x 10 F6 loL.d l"G /io.s � )eo. o - 102 x 107.11023 cn u? ' 103.6 x s S Foek �Vcrc�tq Iv1 ?cco�c�c. tcc t..� th N_ cA C L E A R E D 144 `_ \o CJccltu� 15.2 55 ��) m x 105.3 i 2 ot.3 3�x o a 50O C7a I l oF+ LIcX.p - 5� �Cp+K_Ta k 106 ° 1 x-1 105.9 541 !- x 04.3 106 x 1U6.. � r�rn � �, �� -in ' YvTo ,y 1 i Co S+v"(- ease 11, A ' 3�+ x 106. 108 108 08.3 10. ' 1 18' MAPLE 110 x 109.3 v,/ S�'ST'�I�'1 S�ROFI L>✓ 112 112.1 x111.3, TR E RUSH 1 112 " , x 112.E TP i Pt • A pad" n pry r` EDGE OF PAVEMENT 114 7",4�It .� _ WITH BERM x 1 .6 x 114.3n t z t.o � 114 Ln 116 o 118 4. CID 115.4 �` x 19jL' 116 o x 119.0 119.4 119. � x 11 9 rn 12 F. 11 - x122.4 TREES & BRUSH 122 i 124 1 x 125.0 N 4.2912 � 126 26.3 N "1 150 00 01 0 o Z W 0. 71 1 - _ `X \�ERSt t 1: C.c.r}t•4-`S TV�c. 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