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HomeMy WebLinkAbout0046 STONEWALL DRIVE - Health 46 Stonewall Drive W.'Barnstable P . A _ . . _ 217 050001 - .. - r ' i n a �b TOWN OF BARNSTABLE �L LOCATION ' S°�°" w �J �°� SEWAGE # �� 217-050- 001 VILLAGE � �►,'.f ►�jC� ASSESSOR'S MAP & LOT INSTALLER'S NAME & PHONE NO. r_ v_ SEPTIC TANK CAPACITY LEACHING FACILITY:(type) S�/�S "�' � :� (size) NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNER hl" Caves DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: {I I2o�20e 1 VARIANCE GRANTED: Yes No A a d No , Vol ��lJ FEE 1C COMMONWEALTH Of MAS�ACH�SEITS--, Board of Health, 13AjKkj5-rAnL, - APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT Application f r a Permit to Construct( ) Repair( ) Upgrade( ) Abandon( ) Complete System ❑Individual Components LocationLO'` Owner's Name t. Map/Parcel# 77 0 i✓t% Address P, CpeL Lot# O , Telephone# 0 2)9 4--7177 Installer's Name 1 I��o,ti«�7 i Designer's Name CA}1.rAr L. L-J,- Jq 3vRve1V1js56 Address +Address 346 01.b r1lWW M RP $ Telephone# �j8 j �j�C�� Telephone# T,'�g SSW— Type of Building Lot Size sq.ft. Dwelling-No.of Bedrooms Garbage grinder (w0 Other-Type of Building No.of persons Showers ( ),Cafeteria ( ) Other Fixtures Design Flow(min.required) A► 400 gpd Calculated design flow= Design flow provided gpd Plan: Date J Z- 115'0 2400 Number of sheets Revision Date Title 116 Description of Soil(s) Soil Evaluator Form No. Name of Soil Evaluator Date of Evaluation 1. 5 DESCRIPTION OF REPAIRS OR ALTERATIONS V a d P nrlmAert The undersigned agrees to install the above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and further a e�to t o plac th steminy operation until a Certificate of Compliance has been issued by the Board of Health. Signed Date 4+- �` `Zo®r �� No.. 4 �F `�" m - FEE �• a - y� - - f,I(_'� F •f�V _ a �Ir• �Jt�J�t�� �\�//��� ,(\� .�fr��Jt���lt 7,(\� ��-\'1��+,• l.® � .LL.�JL 1L �F 1' AStS CIlJL`lJ l.l' lJ� ..d+w�.� BoaofHealth, !, t1:�C,""1' [' Z,� 1 SYSTEM CONSTRUCTION PERMIT APPLICATION FOP, DISPOSA Application or a Permit to:Construct( ) Repair( ) Upgrade( Abandon( Complete System ❑Individual Components !&cationLD`�' �, l.s 3�-L,� 1CjFZ)V M► G.�1-�e'l_,,,. �O t..1 OwneUs Name Map/Parcel# ' (il%� Address Lot#& Q 1 Telephone# 0 o 9 4:7 6 Installer's Name �ter- --Z>0V­A` ( Designer's Name C �..,�, Address �t�T� i�Ci� �a.►�. �w�t Address ,3 06 O L b )NLYMIV-4) R Pl t3) e xj 11 Telephone# 8 S r U Q Telephone# Sd $ov— j` Type of Building Lot Size �+�"`.sq.ft. Dwelling-No.of Bedrooms 4- Garbage grinder (1 LX() Other-Type of Building No.of persons Showers ( ),Cafeteria( Other Fixtures Design Flow (min.required) -4�° gpd Calculated design flow Design flow provided gpd /Y Plans Date Number of sheets Revision Date Description of Soil(s) ,d Soil Evaluator Form No:� Name of Soil Evaluator SO- , s � Date of Evaluation 2 S DESCRIPTION OF REPAIRS OR ALTERATIONS �� ( G U L,,U t ' ~�• j\' t� 1Z�a The undersigned agrees to install the above#e)lcribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and further agree to not to place the ystem;ul operatidn until a Certificate of Compliance has been issued by the Board of Health. Signed Date ls)Lco COMMONWEALTH F A H SETTS{ FEE Board of Health, MA. _ CERTIFICATE Of COMPLIANCE Description of Wo�rrk:• 0 Individual Comp nent(s) O_Complete System The undersigned hi reby�certify that the SewagejDisposal System; Constructed Repaired ( ),Upgraded ( ),Abandoned ( ) at We S+cbtk)r7Q has been installed i c o dance witb-the proVrisi n pf 310 CMR 15.00 (Title 5) and the approved design plans/as-built plans relating to application Nb G� dated i / Approved Design Flow. LA o (gpd) Installer 4,fi, Designer: Inspector: � r7 I/I��I/ 1J' ate: ) / 0,1 The issuaermit shall not be construed as a guarantee that the system will function as designed. FEE LXJ COMMONWEALTH OF MASSACHUSETTS Board of Health, / MA. DISPOSAL SYSTEM CONSTRUCTION PERMIT IT �F t Permission"is hereby granted to; Construct Repair ) Upg.ade( ) Abandon( ) an individual sewage disposal system b at J►v'`� Y• ® RAW 4 Ze6 as described in the application for Disposal System.Construction Permit No dated y/ . Provided: Construction shall be completed wi in t ree years of the date oft erm't. 11 ocal conditions must be met. Form 1255 Rev.5/96 A.M.Sulkin Co.Boston,MA Date Board of Health U 2AL all _o' CD A• CD 6 Q.. .r _ � 1 n o 5rue, im a o � GAt�, G�.t�AGE g . .t,.4 PO IT t+saaowsp��_ wl A II at, �A -4' O p 2'4Q•P.Aw9Ya<p y O I Y o it U W w S nn ♦♦on J j u '1- •� ® I• M I.11 GOMr- WTfc 451`A.5, �- • F ( M � •'1• TW I w.w.C � ' G' r J j p e - c,l.�I-- 7<Gt y STEED.-. L'.tA1.A ABwc O l i lost O O t J 3 _� i° O o rd c •> a O 122x 1G' ` O 4 _ p,OP 5E� F3E�IpENCE FOP: DOTES P.A.\..ow, �TE,ld ; q•LOr•tyo _ qq LAt-L G fo7S�p,uGTio�! SIISLy���6s ,w CrO,W- --.--- Fo����.,���E g"Ta,� �Li,,l-a».l a a o '•o b'-o" e,_ o'• �._o. �'-o° F=IPS`:+T Ft._.00FL PLl+►1.J 11L L �IMiJ.I ic1*1 sl.L. Ott ve^IF,PrO S1-toy' ti'-�•' 01�stawW try I�wc•�.1„�p M.M,c►F•INIEW1c:- \'t9C OIJ1;16�r 'Td TW E °S'YIa9'�T pi' 1R�a-r' tz-L00FN ffLAN vAr� t_zool l r- r. 12•- � 2co'e o" � 24� p.. �4 © O � � i ST01J4 FIREPLd�GE — O 0 0 I G s ao y 4.'Lit Q c q I f O • j � OFFICE 0 I O �®AUGOu`t 1.Go�t 14x 1-1 - `p t LLl 10 7 G" 4'o4u 1-�, r,_o' E'_6° 4'.iO° -B K 1-4' 6'-2' ' Q1� 1 <t- i-. Tw1aK 41 - Polr LU _ o _ I Ia107-E S _ �:;, 4- o• 4 0 i ..... ... .. — -►•,1. LON�STEiN 1� M: L01J'10 I. ALL GOQITRUG IOtJ SNAu_SEI►.1 CC*4- LU 1�OMMp.►-i w THE Mr.'�,A.CWU.SETTS �/ STBe.P,►JST�6t�z �M.IS,sGKuS ST�TE.SUILo1N cone Aawc> A%."" L.OGAL. SEGONO FL.QQP) PLAN Tow:.l cofJES 2.•k,LL p1MF_W 10PJ'� 5NL►LL BE vEP.IFtEC. 8•-O' Vj,-p' e'-O` 8t-0' fY Ty[. Ow�u;v,5 AIJG C�IhIL-Fad.t_ GON , oq►WN ®v Pwy-NC. 'r► GoNSYc;uc-'I 10�1. 4.M.MIG►-u. EwlcZ SECOND FLOOR, PLAtJ SCALE 4" ' 1'•0" I Y pPILtW TO' — -- t5u t--iO W . ... ...._ N ....... .. ... N 77 s faUAa�D V.A tI t1 - �� a � I. ALL. GOLIST-RUG-r'IOw! 1—t._ twl .'•`Nf':�Y.MA�i�b: •4 o I �, ':I. t I im Lw. ' .'i _9 .a�T1al w�'A�hA LN\Iy�N'�� ��rtaTt 0•.i!:.C..tl.l :'c�Ok A�_IO CIO) ® 2- DtMEwr,pN�r IiNl*�� JW1.11•F'. IrS' C�LO.yy swc.L.al'Eo :.TNFT OF G(.nN•,--v.'t:'.,-•.•>p1. �j Hower, 1 � 1 N jT_•�.1t:.Wq. �._ UY.IVL 1 5 - O o WG4T 2 n�.n1 ;•,_e t 1 reia'::�.: 11 1- , TFIIF�� FL—(OOP, Pl._Ah! Fr l-00 Fa) P t_ A N A M AAI(6J t.i1C--W iCG.. SGAL—r. 14.n�1,_Ou vATE: .�.,� ..n'�„�� i i �, ,r.; '. , k ^:x .. -' a z , � TOWI�f (SF°"BARN( , '.f _ LOCATION SEWAGE S { VILLAGE .' f� C K►�jL� ASSESSOR'S MAR& LOT - 7 . CNSTALLER'S'NAME & PHONE..NO ,SEPTIC`TANK-CAPACITY .. . . ,, . . . a:.,�` LEACHING FACILITY:(type) %� `� (size) NO OF BEDROOMS. PRIVATE WELL OR PUBLIC WATE ra �c e ,.,,.::: ' ., �-',...x , , - � , s _ �•'�+"^^�'�i-fir: BUILDER'OR OWNER / io./�:C^j° •2- Gott-9 t DATE`PERMIT ISSUED:' y�l$/0 � r ,• ,, �; ,�;: t, DATE COMPLIANCE ISSUED��[ .26e i VARIANCE GRANTED Yes No a r t S f L F."Y = s x -E s y j. _ 42t tee$ X."s_-=tFc..4�s 'r 6d _ J f TITLE 5 OFFICIAL INSPECTION FORM—NOT YOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION RECEIVE Property Address:46 Stonewall Dr S E P 2 4 2 0 02 West Barnstable,MA OMU Owner's Name:Michael Longo TOWN OF BARNS AEiLE Date of Inspection:9/5/OZ HEALTH DEPT. Name of Inspector:Eric Lenardson Company Name: Statewide Environmental Services,ine. t Mailing Address:2750 Harkney Hill Rd. Coventry,RI 02516 MAP PARCEL : Telephone Number:(401)392-6906 LOT CERTIFICATION STATEMENT I certify that I have personalty 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 fimction and maintenance of on site sewage disposal systems. I am a REP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: x Passes Conditionally Passes Needs Further Evaluation by the Local Approving Authority Fails Inspector's Signature: vac Date* 9/9/02 The system inspector shall submit a copy of this inspection deport 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 DER The original should be sent to the system owner and copies sent to the buyer,if applicable,and the approving authority. Notes and Comments ""This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system wig perform in the future under the same or different Conditiioos of use.- . 1 PART A CIERTMCATION(contimted) Properly Adds:46 Stonewaa IN West BarnstaW MA 02W Owdees Dame:Michael Longo Date of inspection:9/5/02 Inspection Summarr: Cheek A,B,C D or E/ALWAYS complete all of Section D A. System Passes: _x I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMIt 1$.304 exist.Any failure criteria not evaluated are indicated below. Comments: & 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, wilt pass. Answerer yes,no or not determined MN,ND)in the for the following statements.If"not deter' please- explain-The septic tank is metal and over 20 years old*or the septic tank(whether metal or not)is shucturally unsound,exbibits substantial m tration or eaftwon or tank failure is imminent. System will pass inspection if the existing tank is.replaced with a complyiuyg septic tank as approved by the Board of Health. "A metal septic tank will pass inspection.if it.is structurally sound,not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND explain: 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(g)are replaced obstruction is removed distnl)Wou box is leveled or replaced ND explain: The system.required,pumping more than 4 times,a year due to broken or obstructed pipe(s).The system will pass inspection if(with approval of the Board of health): broken pipe(s)are replace obstruction is removed ND explain 2 I i OFFICIAL,INSPECTION FORM-NOT FOR.VOLUNTARY ASSESSMENTS SUBSURFACE SWAGE DISPOSAL SYSTEM INSPECTION FORM PART"A CERTIFICATION(continued) Properly Address:46 Stonewall Dr West Barnstable,MA 02"t Owner's Name:Michael Longo Date of Inspection:9/s/02 C. Further Evaluation is Required by the Board of Health: Conditions exist which require further evaluation by the Board ofHealth in order to determine if the System is fa&g to protect public health safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15 303(2)(r) that the system is not functioning in a manner which will protect public health,safety and the environment: — Cesspool or privy is within 50 feet of a surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2. System will fail unless the Board of Health(wind Public Water Supplier,if any)determines that the system is functioning in a manner that protects the public health,safety and environment: _ The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of surface water supply or tributary to a surface water supply. The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. _ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. _ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply welt**.Method used to determine distance "This system passes if the well water analysis,.performed at a DEP certified laboratory,for conform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammoma nitrogen and nitrate nitrogen is equal to or less thm 5 ppm,provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other. 3 f OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION{continued) Property Address:46 Stonewall Dr West Barnstable,MA 02"S [vmWs Name: Mkbaea Longo Date of Inspection:9/5/02 D. System Failure Criteria applicable to all systems: You most indicate"yes"or"no"to each of the following for aLm tions: Yosti No _ x Backup of sewage into facility or system component due to overloaded or dogged SAS or cesspool _ x Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool —x— Static liquid level in the distribution lox above outlet invert due to an overloaded or clogged SAS or cesspool x Liquid depth in cesspool is less than G'below invert or available volume is less than'h day flow x Required pumping more than 4 times in the last year NQr due to dogged or obstructed pipe(s). Number of times pumped x Any portion of the SAS,cesspool or privy is below high ground water elevation. x Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. _ x Any portion of'a cesspool or privy is within a Zone 1 of a public well. x Any portion of a cesspool or privy is within 50 feet of a private water supply well. x 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 wen water'analysis,'performed at a DEP eettifu d laboratory,for eoliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and aitrate 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'forrn.] No(Yes/No)The system fails.I have determined that one or more of the above failure criteria exist as described in 310 CUR 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. You must indicate either"yes"or"no"to each of the following: (The following criteria apply to large systems in addition to the criteria above) yes no — — the system is within 400 feet of a surface drinking water supply the system is'within 200 feet of a tributary'to a surface drinking water supply — — the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area—IWPA)or a MAPPed Zone II of a public water supply well If you have answered"yes"to any question in Section E the system is considered a significant threat,or answered"yes"in Simon D above the large system has failed.The owner or operator of any large system considered a significant threat under Section E or fair under Section D shall upgrade the system in accordance with 310 CNR 15.304.The system owner should contact the appropriate regional office ofthe Dept. 4 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CREECKUST Property Addrea8:46 Stonewall Dr West Barnstable,MA 026U Owner's Name:A+fichael bongo Date of Inspection:915/02 Check if the futloroft have been done. You must indicate"yes"or'W as to each of the following: - I I- Yes No x Pumping information was provided by the owner,occupant,or Board of Health x Were any of the systern components pumped out in the previous two creeks? x_ Has the system received normal flows in the previous two week period? _ -x Have larp volumes of water been introduced to the system recently or as part of this inspection ? _x_ Were as built plans of the system obtained and examined?(If they were not available note as N/A)— x ___ Was the facility or dwelling inspected for signs of sewage back up? x Was the site inspected for signs of break out 7 x _ Were all system components,excluding the SAS,located on site? _ Were the sepEic flank usanholes uncovered;opened,and the interior of the tank inspected fat the condition of the bares or tees,material of construction,dimensions,depth of liquid,depth of sludge and depth of serest? Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systerres 7 Tlie size add 16e6tioa of the SoiJ Absoeptiad Systeau(SAS)im the site has lfth deteiinined based on- Yes no x _ Existing information.For example,a plan at the Board of Health. _ x Determined in the field ref any of the failure criteria related to Part C is at issue approximation o<rdisW is unacceptable)1310 Cat 15.302(3)(b)] 5 f OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address:46 Stonewall Dr West Barnstable,MA 02669 Owner's Name:Michael Longo Hate of Inspection:9/5M FLOW CONDITIONS RESIDENTIAL Number ofbedroonrs(design):4 Number of bedrooms(actual):4 DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms):440 Number of current residents:2 Does residence have a garbage grinder(yes or no):no Is laundry on a separate sewage system(yes or no):no (if yes separate inspection required) Laundry system inspected(yes or no): n/a Seasonal use:(yes at no):no Water meter readings,if available(last 2 years usage(gpd)):new Sump pump(yes or no):no Last date of occupancy:current COMMERCYAI-MgDUSTRTAL Type of establishment: Design flow(based on 310 CMR 15.203); gpd Basis of design flow(seats/persons/sgft,etc.): Grease trap present(yes or no): Industrial waste holding tank present(yes or no): Non-sanitaq waste discharged to the Title 5 system(yes or noy Water meter readings,if available. Last date of occupancy/use: OTHER(describe): GENERAL INFORMATION Pumping Records Source of information: new Was system pumped as part of the inspection(yes or no):no If yes,volume pumped:____,gallons--How was quantity pumped determined? Reason for pumping: TYPE OF SYSTEM x Septic,tank,distribution box,soil absorption system —Si a cesspool _Overflow cesspool —privy Shared system(yes or no)(if yes,attach previous inspection records,if arty) T_InnovativelAhernadve technology.Attach a copy of the current operation and maintenance contract(to be obtained from system owner) Tight tank _Attach a copy of the DEP approval _Other(describe): Approximate age of all components,date installed(if known)and source of informaation 11/20/01 asbuilt Were sewage odors detected when arriving at the site(yes of no):no 6 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address:46 Stonewall Or West Barnstable,MA 02"S Owner's Name:Michael Longs► Date of Inspection:9/5/02 BUILDING SEWER(locate on site plait) Depth below grade:22" Materials of construction; cast iron _x 40 PVC other(explain): Distance from pm m water supply weft or suction line: Comments(on condition of joints,venting,evidence of leakage,etc.r Tight joints no evidence of leakage SEPTIC TANK:_(lode on site plan) Depth below grade: 16" Material of construction: x concrete metal fiberglass_-polyethylene .;+other(explain) If tank is metal list age:_ Is age confirmed by a Certificate of Compliance(yes or no):,(attach a copy of certificate) Dimensions: 1500 gallons Sludge depth:0 Distance from top of sludge to bottom of outlet tee or baffle:34" Scum thickness:0 Distance from top of scum to top of outlet tee or baffle:6" Distance from bottom of scum to " bottom ofouttet te e or batHe: 19 How were dimensions determined:In the field Comments(on,pumping,recommendations,inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.):Inlet/outlet are in good condition and fiinctioning properly. Septic tank shows no evidence of leakage and appears structurally sound. GREASE TRAP:(locate on site plan) Depth bellow grade:i Material of construction; concrete metal fiberglass___polyettryiene otfser (explain): Dimensions, Scum thickness: Distance from top of scrim to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping; Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural imegrity, liquid levels as related to outlet invert,evidence of leakage,etc.): 7 f OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address:"Stonewall Dr West BarstaW MA 02"4 01smer's Name: ii &ael Y.ongo Date of Inspection:9/5M FIGHT or HOLDING TANK.-_(tank must be pumped at time of inspectionxlocate on site plan) Depth below grade: Material of construction: concrete metal fiberglass—Polyethylene other(explain)• Dimensions: Capacity: altons Design Flow gallons/day Alarm present(yes or no): Alarm level: Alarm in working order(yes or no): Date of last pumping: Comments(condition of alarm and float switches,etc.): DISTRIBUTION BOX: _ (if present must be opened)(locate on.site plan) Depth of liquid level above outlet invert: 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.):D-box is level and distribution of flow equal. No evidence of solid carryover or leakage into or out of D-box. 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.): S OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Addrvm 46 Stonewall Dr West Barnstable,MA 02"S Owner's Name: N icbaei Longo Date of Inspection:9/5/02 SOIL ABSORPTION SYSTEM(SAS): (locate on site plan,excavation not regnh ed) if SAS not located explain why: ��— "—`•'—" Type leaching pits,number: yx,leaching chambers,number.3/500 leaching galleries,number: leaching trenches,number,length: leaching fields,number,dimensions: overflow cesspool,number: innovative/alternative system TypeJname of technology: Comments(note condition of soil,.signs of hydraulic failure,level of ponding,damp.soul,condition of vegetation,etc.): No signs of ponding or hydraulic failure. System on the surface is functioning properly. After examining tank,D-box and surrounding area the system appears to be futnnctionutg properly. CESSPOOLS: (cesspool must be pumped as part of inspection)(locate on site plan) Number and configuration: Depth—top of liquid to inlet invert: Depth of solids layer: Depth of scum layer: Dimensions of cesspool: Materials of construction: Indication of groundwater inflow(yes or no). Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation, etc.): PRIVY: (locate on site plan) Materials of construction: Dimensions: Depth of solids: Comments(note condition of soil,signs of hydraulic failure,level of pon ft condition of vegetation; etc.): OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address:46.Stonearall Dr West Barnstable,MA 02668 Owner's Name Michael Longo Date of Inspection:9/Sl02 SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at feast two permanent reference landmarks or benchmarks.Locate all wefts within 100 fect.Locate where public water supply enters the building. i _ v9 `r - '%ram G o s Y. SY OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS, SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address:46 Stonewall Dr West BarnstaW MA 02668 Owner's Name:Michael Longo Date of Iaspsction:9/5M SITE EXAM Slope Surfacae water Check cellar Shallow wells Estimated depth to ground water 1.2+ feet Please indicate(check)all methods used to determine the high ground water elevation: x_Obtained from system design plans on record-If checked,date of design plan reviewed:01,414 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 44t e-explain, You most describe how you established the high ground water elevation:Plans on rec'd I1 ACCESS COVERS MUST BE WITHIN 9" MINIMUM, INVERT T EL EVA T l ONS DESIGN CRITERIA : 6' OF FINISH GRADE • - 3' MAX IMUM UM COVER 51.0 INVERT A 47.0 . FIRST 2' TO T BUI LDING: /LAG• DESIGN FLOW. BE LEVEL MIN 2' OF PEASTONE INVERT IN SEPTIC TANK: 46.25 4 BEDROOMS AT /10 G.P.D. PER N INVERT OUT SEPTIC TANK: 46.0 BEDROOM EQUALS 440 G.P.D. 4' D/AM PIPE 3/4' - l l/2" DIA. LOCUS INVERT IN DIST. BOX: 45.67 Z o�- 45.5NO GARBAGE GRINDER $a 47.0 46.0 45.5 SA 2 IF 1 �° DOUBLE WASHED STONE INVERT OUT DI ST. BOX: r 0 6 A GAS o ° 1 21 43.0 INVERT 45.0 46.25Z 9AFFLE 45.67 45.0 ERT I N LEACH CHAMBER: ROUTE SEPTIC TANK REQUIRED: 3 OUTLET 3-500 GAL Z:EACHkNC� CHAMBERS BOTTOM OF LEACH CHAMBER: 43.0 c W/4' STONE AROUND: -12.8'X 33.5'X 2' ADJUSTED GROUND WATER: N/A 440 G.P.D. X 200x - 880 GAL. D-BOX SEPTIC TANK PROVIDED: 1500 GAL. MIN. 1500 GAL OBSERVED GROUND WATER: N/A SEPTIC TANK 6" CRUSHED STONE OR BOTTOM OF TEST HOLE *1: 26.8 SOIL ABSORPTION SYSTEM REQUIRED: N COMPACTED BASE DESIGN PERC RATE C 5 MIN/I NCH PROFILE : NOT TO SCALE SOIL TEXTURAL CLASS - I I� EFFLUENT LOADING RATE - 0.74 GPD/SF 440 GPD / 0.74 GPD/SF - 595 S.F. REQUIRED L OCUS MAP PROVIDED: J-500 GAL LEACHING CHAMBERS W/4' STONE AROUND. A-614 S.F. 614 S.F. x 0.74 - 454 G.P.D. SOIL TEST PIT DA TA INDICATES 7 INDICATES PERCOLATION OBSERVED TEST GROUND WA TER P*5228 Tps I TPs 2 GRND EL.46. 1 GRND EL. 42.8 G.W.EL. N/A G.W.EL. N/A 0' 46. 1 O" 42.8 WOODL OAM WOODL OAM SUBSOIL SUBSOIL CLAY CLAY !0• 32.8 r ' MEDIUM �;. ,.> -- - _ i 5 16 _ r. • : _ WHI TE 12' .D I-U ....... 34. 1 12" SAND MEDIUM I WHI TE SAND 35.19 BM CB/DH FND 16. NO WATER JO.1 16 NO WA TER 26.8 EL-36.13 LOT I DATE: DECEMBER 16. 1985 1.5 f AC. TOTAL TEST BY:EDWARD E. KELLEY 0 W!TNESSED BY:JAMES CONLON R 1 PERC RATE: ( 2 MIN/INCH 35.57 IN MED J UM SAND LAYER I T \ \ \ \ 30.85 , E IVW s5 v ° 1 1 GENERAL NOTES : 1. THIS PLAN IS FOR THE DESIGN AND CONSTRUCTION �- 1'-• \ t / OF THE SEWAGE DISPOSAL SYSTEM AND PERMITTING ONLY. / 2. VERTICAL DATUM IS NGVD. FOR BENCH MARKS -'" l I •.,•' I SOLATED VEGETATED WETLAND ✓ '' / / / J SET. SEE S I TE PLAN. J. ALL CONSTRUCTION METHODS AND MATERIALS AND MAINTENANCE OF THE SEPTIC SYSTEM SHALL IX �- /� / � � '� / � CONFORM TO_MASS. D.E.P. TITLE 5 AND LOCAL BOARD OF HEALTH REGULATIONS. r ►VW.#4 -31.01 / / / / / / �2 4. ALL SEPTIC SYSTEM COMPONENTS LOCATED UNDER / - - 1VW •3 AREAS: SUBJECT TO VEHICULAR TRAFFIC OR GREATER 1 .... / THAN 3' IN DEPTH SHALL BE CAPABLE OF WITH- STANDING H-20 WHEEL LOADS. SM CB/DH FND EL-39.42 1� - - 1�- / / s� t p6 5. ALL SEWER PIPE SHALL BE SCHEDULE 40 OR 1 y - --- 34 / / / / / / aF7A�Nj�' / ' / / / / APPROVED EQUAL. / ,j f P/ /, 0 6. SEPTIC TANK AND D-BOX SHALL BE REINFORCED � / / / / / / / / PRECAST CONCRETE AND WATERTIGHT. D-BOX SHALL ,1,t�� „ o BE WA TER TESTED TO CHECK FOR LEVEL WHEN THERE . �. 38-- - / / / / ., � ►=NK!"C£/ / / w� y 1 S MORE THAN ONE OUTLET. �� \ LlyitT CALL 1�i U-JHlC -888-DIG-SAFE AND THE LOCAL WATER DEPT. -� _ 4� FOR LOCATION OF UNDERGROUND UTILITIES. REMOVAL / A8 ° 1/�J EDGE SEE NO TE aA � T`•"'! 8. ALL UNSUITABLE MATERIAL !TOPSOIL. CLAY. ETC. ) y / TPA / / BRICK pAri� / / �" DE �pvER / A' / / ��`' of ENCOUNTERED BELOW THE INVERT OF THE LEACHING �� FACILITY TO BE REMOVED FOR A DISTANCE OF 5' 3-500 GAL AROUND AND REPLACED WI TH SAND IN ACCORDANCE LEACHING CHAMBERS WITH TI TLE 5. -- - - --- / ✓ �__ W/4• STONE AROUND ,Rt Or r 9. NO DETERMINATION HAS BEEN MADE AS TO 4D�LL 1 _ �'' _;` °� _ /,,= COMPLIANCE WITH DEED RESTRICTIONS OR ZON/NG _ 5 _a SiaKADE fE REGULATIONS. IT SHALL REMAIN THE CLIENTS _ �D-Box gO RESPONSIBILITY TO OBTAIN ALL PERMITS. SPECIAL 48 _ l 4 _ ^�� - -' PERMITS. VARIANCES ETC. FOR THIS PROJECT. -.SEPTIC TANK -- --�__ /0. IT SHALL REMAIN THE CLIENT'S RESPONSIBILITY - -50- - - GARA� -` _ 'a _ _ _ -"� r 52 TO HAVE THE PROPOSED BUILDING FOUNDATION DESIGNED TO ACCOUNT FOR THE EXISTING GRADE _ AND SOIL COND l T I ONS AT THE L OCA T l ON OF THE 52� PROPOSED BUILDING. J _ _ _ /I. ANY RETAINING WALL SHOWN ON THIS PLAN lS FOR �' -� - - _ ••�. - 5 0 � � LOCATION ONLY AND SHALL BE DESIGNED GNED IN 4 _ _ L ,� _ ACCORDANCE WITH STANDARD PRACTICE. s1.45 I m 1'�° 12. THE WORK LIMIT IS TO BE ESTABLISHED WITH A SILT I 1 ! 56 FENCE AND/OR STAKED HAYBALES PRIOR TO CONSTRUCTION. � 1 / 1/0. t / EXISTING I WELL 6 55.65 t �� �H OF,;9gss9� PR L yG .32448 Z A5 No. 4U1 i�� q Qy / c) SE/' T / C S YS TE-All DES / ( IV a ° LOT STONEWALL OR ✓ VE . MAP 2 / ;; , PARCEL SO WEST e � R / s TA B E I SCAL E : / - 20 �ECEMBER / S 2000 CANAL LAND SURVEYING J06 OLD PL YMOUTH ROAD , BUZZARDS BAY , MA PROJECT NUMBER 00 - 160 II 0 /0 20 40