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HomeMy WebLinkAbout0058 ACRE HILL ROAD UNIT #A - Health 58 Acre Hill Road Barnstable, MA A=297—056 d 1 d 0 r �2 Y79�-- Town of Barnstable Health Inspector Ft r Regulatory Services Office Hours r g 3' 8:30—9:30 Thomas F.Geiler;Director 3:30—4:30 wttvsrAs . : Public Health Division 039. A�m� Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 AMNESTY PROGRAM APPLICANT -SEPTIC QUESTIONNAIRE Date: September 7,2010 1. General Information: Size of Property: 1.31 acres Address: 58 Acre Hill Rd Barnstable MA 02630 Map and Parcel Number 297-056 Name: Paul S.Venditti Phone#: 2a. How many bedrooms exist at your property now? 4 2b. Are you planning to add any bedrooms?NO If yes,how many? 0 2c. How many bedrooms total are proposed at this property(including the amnesty unit)? 4 2d.Please include a copy of the floor plans for the entire property. Neatly use a straight-edge. Show all existing rooms in the home and the proposed amnesty apartment. Provide width measurements of any open doorways. Please label each room clearly. 3. Is the dwelling connected to public sewer? YES or NO id J If the dwelling is connected to public sewer,s tp questions#4 through;#9 below. . 4. Location of dwelling is INSIDE or OUTSIDE a Saltwater Estuary Protection Zone?! 5 . Location of dwelling is INSIDE or OUTSIDE a Zone of Contr' i to public supply wells? 6. Is the dwelling connected to an ONSITE WELL or to PUBLIC WATER? 7. Is a disposal-works construction permit on file? YES or NO 8. If yes,how many bedrooms were approved according to this permit? (Be xo6 JNO L9. Were any building permits obtained for construction of additional bedrooms? sEP 0or Rt10. Is there an engineered septic system'plan on file at th Health Division? YES or B ,..»---- 11. Has the septic system been inspected by a DEP certi&inspector within the last two y --�`ES or. ------------------------------------------------------------------------------------------------------------------- ` &0 FOR OFFICE USE ONLY y The Public Health Division has no'objection to bedrooms/pt this property. Special Conditions: q Signed: / Date: / 7 20 a Q:\GMD-Housing\Accessory Affordable Apartment Program\ADMIN\FORMS&LETTERS\Blank Forms amnestyapp I.DOC i Town of Barnstable Health Inspector ph THE?I Regulatory Services Office Hours 8:30—9:30 Thomas F.Geiler,Director 3:30—4:30 1 1VSTABLE, * Public Health Division MASS. 9�A 1639. A��� Thomas McKean,Director TED MA'1 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 AMNESTY PROGRAM APPLICANT— SEPTIC QUESTIONNAIRE Date: September 7,2010 1. General Information: Size of Property: 1.31 acres Address: 58 Acre Hill Rd Barnstable MA 02630 Map and Parcel Number 297-056 Name: Paul S.Venditti Phone#: 2a. How many bedrooms exist at your property now? 4 2b. Are you planning to add any bedrooms?NO If yes,how many? 0 2c. How many bedrooms total are proposed at this property(including the amnesty unit)? 4 2d.Please include a copy of the floor plans for the entire property. Neatly use a straight-edge. Show all existing rooms in the home and the proposed amnesty apartment. Provide width measurements of any open doorways. Please label each room clearly. 3. Is the dwelling connected to public sewer? YES or NO If the dwelling is connected to public sewer,skip questions#4 through#9 below. 4. Location of dwelling is INSIDE or OUTSIDE a Saltwater Estuary Protection Zone? 5 . Location of dwelling is INSIDE or OUTSIDE- a Zone of Contr' i to public supply wells? 6. Is the dwelling connected to an ONSITE WELL or to PUBLIC WATER? 7. Is a disposal-works construction permit on file? YESn� R r, o�,_ 8. If yes,how many bedrooms were approved according to this permit? `lr' ' i Bedrooms. a 9. Were any building permits obtained for construction of additional bedrooms? Y P o2 1APbC D U 10. Is there an engineered septic system plan on file at the Health Division? gy YES or NO 11. Has the septic system been inspected by a DEP certified inspector within the last two years? YES or NO FOR OFFICE USE ONLY The Public Health Division has no objection to bedrooms at this property. Special Conditions: Signed: Date: Q:\GNID-Housing\Accessory Affordable Apartment Program\ADMWFORMS&LET TERS\Blank Forms amnestyapp l.DOC )L ,,;,r , . ,.. .. .. .- „ .`..,r..•--•.r,._rp :.r+ ,...,., Y t � -•, ,r-• ...-•-ti-._ n/.-..•., ....-. ..��..'rs`w-, - - +. No. 07— -- Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH M ISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes 2pplication for Migoar *pgtemc Construction Permit Application for a Permit to Construct( ) Repair(, Upgrade( Abandon( ) ❑Complete System ❑Individual Components Locat oneiAddr A r Lot No. `` ] Owner's e,Addresr and� I.Nq� ; -1ti vV� Assessor's Map/Parcel _�nbb w S Y rc_ �A .Ns t`1 a Installer's Name,Address,and Tel.No. S� d t�C L Ob(9 1 (Designer's Name,Address and Tel.No. Q d k S.t/ v IBC Type of Building: Dwelling No.of Bedrooms 1 Lot Size sq. ft. Garbage Grinder Other Type of Building Q(„Y-(,,U } S5WJ'%% No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 3 gpd Design flow provided gpd Plan Date _ + a, (0 y Number of sheets Revision Date Title , Size of Septic Tank tsl tj Type of S.A.S. IA ],a QQ1DX r Description of Soil �6 L, �S Ion✓l l� I et Nature Nattuuree of"Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been o i=ne y this rd of Health. �p Date �l f l Application Approved Date Application Disapproved by: Date for the following reasons �,�,,� ———— Permit No. — Ou�� 19 Date Issued �,w...,,, ...�-.&M'=T+,i "�,;^ '-dam" .4✓w..•"""."""rK`9:?v`v..-�eL'-r'.y�y�,pl .,,.^ "rr'�+ .3:'a,.wv.f,'�'�"�'�`�`•-'i,"w,k,....h+•�tis�'°+�r:iyr.��,v�.+ .,,.m .e.,d. ... ..; No. Jal p& -t Fee J�Q l . '''` Entered in computer: '`•THE COMMONWEALTH OF MASSACHUSETTS p PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes ZIPWicat ott-°for �Diopo5ar 6p5tem Construction Permit Application for a Permit to Construct( ) Repair(/}' Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components , LocationAddressor Lot No. Sf� C ( ` ` Owner's N e,Address,and Tel.N . Assessor's Map/Parcel u n5 61R.� S (k(,r"t k4 w`W 1J nS Installer's Name,Address,and Tel.No. �� Ob(7 `) Designer's Name,Address and Tel.No. R p b k of 5'b t v r�.v� �o w n Ccid: j iC� (, 7 j lot) Type of Building: Dwelling No.of Bedrooms 1 Lot Size sq. ft. Garbage Grinder Other. Type of BuildingQir_, ,r,L } S�v J;d No.of Persons Showers( ) Cafeteria( ) Other Fixtures - Design Flow(min.required) 3 gpd Design flow provided . gpd Plan Date t ,t `z 1. 1 c) Number of sheets Revision Date Title Size of Septic Tank a V Type of S.A.S. 30 O GID-A LA "����ii-c" Sr Description of Soil ♦ l.�n•. . ) (� S As C P Nature of Repairs or Alterations(Answer when applicable) co F.nC Car c r f o P!!!1N ck ti S V. Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this oard of Health. f Date J 112 rt Application Approved Date / Application Disapproved by: Date for the following reasons Permit No. 1�_I i� Date Issued i)-f 7 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 r �A ";; . at (ACC�, \� �� ,`f� 1�� n S k*,�o has been constructed in accordance with the provisions of Title^5 and for Dis osaIS stem Construction Permit No. o� � �`` '�- dated Installer �Cc,� ( ' � Designer qG., C_C J #bedrooms Approved design flower gpd The issuance of this permit shall not be construed as a guarantee that the system will unction a �hgned. Date Inspector (� ———————————————————————— No.-3 1�; / / a— Fee /✓ �� THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE, MASSACHUSETTS M lkgpo5al 6p5tem Cou!5truction Permit Permission is hereby granted to Construct ( ) Repair �. Upgrade ( ) Abandon ( ) R System located at 0J _r r S i and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to comply with Title S and the following local provisions or special condit*/*ns. Provided: Constructon mu t be completed within threeyears of the dte of this�pe, . Date /�� Q p Approved L TOWN OF VARNSTABLE LOCATION \AkV, QJ Qz SEWAGsE##CX 0k' � J VILLAGE ��f�g�,��� ASSESSOR'S MAP&PARCEL of-/ 7 INSTALLERS NAME&PHONE NO. �GL r1 ��. S'T� �Sy 0u"k SEPTIC TANK CAPACITY e,�- 1 LEACHING FACILITY:(type) size 1�r si r � /p /�e" ( �5�.L. " NO.OF BEDROOMS OWNER PERMIT DATE:, 1 6 COMPLIANCE DATE: Y 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 with /in 200 feet of leaching facility) ` V /1 Feet Edge of Wetland.and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) �� Feet FURNISHED BY G.� A-ko Q $ - 914 a d ��'b �n33 I y. T �5 b TJ Aor Town of Barnstable P# v Department of Regulatory Services BAMMBMQ' Public Health Division DateRUM 0 te3q �� 200 Main Street,Hyannis MA 02601 Date Scheduled Time Fee Pd. C/ Soil Suitability Assessment for Sewage Disposal Performed By: �C9 Dl� CA�iI/�, Witnessed By: LOCATION & GENERAL INFORMATION Location Address iC Q �`// /�J• Owner's Name Address jB (,Qn-e V9//4/i/ Assessor's Map/Parcel: 0q,7 OVSI 0Engineer's Name R,J,�� /LLiQ-�� 2,S N 11cIVIO-N i o EW C ON TR ON REPAIR Telephone# Sj!v ^77S" 7a0 Land Use A-i'A I Lt900J S Slopes(%) 1 Z 5 Yo Surface Stones Distances from: Open Water Body ft Possible Wet Area—A4�ft Drinking Water Well ft Drainage Way ft Property Line Z 41 ft Other ft SKETCH:(Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands in proximity to holes) -70 lop li 1 T 3 Y o �jSPj.Od S q Ii 2 I � Parent material(geologic) t '.xu✓, Depth to Bedr0d Depth to Groundwater: Standing Water in Hole:_ Weeping from Pit Face Estimated Seasons[High Groundwater D o W N s U' PLUS per rn Af S - _ - DETE — IN , TION FOP.SEASONAL HI VV HIGH AT R Method Used: Depth Observed standing in obs.hole: in. Depth to soil mottles: __. in, Depth to weeping from side of obs.hole: in, Groundwater Adjustment ft. Index Well# Reading Date: Index Well level _ Adj.factor____..__ Adj,Groundwater Level PIERCOLA`ITI(3N VEST )Date - 7Ciltne j. I F Observation " � Hole# 2 Time at 9 . It Depth of Perc Time at 6" (., Start Pre-soak Time @ 7 Time(9"-6") End Pre-soak M> 2 Rate Min./Inch. Site Suitability Assessment: Site Passed Site Failed: Additional Testing Needed(Y/N) V tltl, Original: Public Health Division Observation Hole Data To Be Completed on Back----------- p ***If percolation test is to be conducted within 100' of wetland,you must first notify the a Barnstable Conservation Division at least one(1) week prior to beginning. - Q:\.SEPTIC�PERCFORM.DOC DEEP OBSERVATION HOLE LOG Hole# A .. Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Bo Consistency,%Gravel DEEP OBSERVATION HOLE:LOG Hole# 2 Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistenc %Gravel DEEP.OBSERVATION HOLE LOG Hole#3 Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency,%Gravel —6�i mil/ Al v S 6 25 Che <I Z, C 2 6/ DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottlin g (Structure,Stones,Boulders. Consistency, o G v 1 D-3 61' Flood Insurance Rate Map: Above 500 year flood boundary No_ Yes._ f Within 500 year boundary No— Yes�e Within 100 year flood boundary No,_,._ Yes Depth of Naturallv Occurrnna 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? ye-S C r. If not,what is the depth of naturally occurring pervious material? Certification I certify that on 3 (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 expertise a d ex fence described in 310 CMR 15.017. Signature Date z 2 d O x .y 1 ✓ti K Q:\SEPTIC\PERCFORM.DOC I .Town of Barnstable oFTHE lo,,,o Regulatory Services Thomas F. Geiler, Director ' &AL MAS BL ' Public Health Division i6;q. ��� ArF039. Thomas McKean,Director 200 Main Street, Hyannis,MA 02601 Office:;162�4644 Fax: 508-790-6304 Date: Sewage Permit#�&' 2 Assessor's Map/Parcel �� Installer& Designer Certification Form Designer: Lin OA_�de_) Installer: Address: a5� Address: On fat* was issued a permit to install a (date) (installer) septic system at 6 �) Care ,` (gJ go_rM)�4/eased on a design drawn by (address) p R dated I �� 6 0 4 (designer) I certify that the septic system referenced above was installed substantially according to the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. Stripout (if required) was inspected and the soils were found satisfactory. I certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system) but in accordance with State & Local Regulations. Plan revision or certified as-built by designer to follow. Stripout (if required) was inspected and the soils were found satisfactory. (Installer's Signature) (Designer's Signature) (Affix Designer's Stamp Here) PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS- BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. gAoffice forms\designercertification form.doc �pTHE Tpk, Town of Barnstable Regulatory Services HAR9 MA�Mg Thomas F. Geiler, Director �A 1639. ♦� TfDMA�a Public Health Division Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Designer Certification Form Date. 5 [2- 1 � c� �r A4A Loog` 172- - Designer: l.. p y'i L_l..ftL j p(„� 1�0 , Address: � BOY,2S OnA LJY C- was issued a permit to p install a (date)v (installer) septic system at 4�G R ''t-1 R a based on a design'I drew (address) X1P C dated P1" 22 2®O 8 x N I certify that the septic system referenced above was installed su antiallyz according to the design. co P I certify that the septic system referenced above was installed with change,`:but in accordance with State & Local Regulations. Revision or certified as-built by designer to follow. OFM,�S9C RONALD s JAMES m o CADILLAC v9 #1060oy S�C/sTEP a 'QNI T06'. (Designer' gnature) (Affix Stamp Here) PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS-BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. Q:Health/Septic/Designer Certification Form TOWN OF BA.RNSTABLE :.M-0N _=:S9 �A,rce. HI II 19J. SEWAGE # 0 - ,;6 y ASSESSOR'S MAP & LOT 27 L 05'& .iNSTALLER'S NAME'&PHONE NO. 6.Ro6;fscA Se rn :!/✓ice Sal SEPTIC TANK CAPACITY I WO LEACHING FACILITY: (type) 3x 52)C, Qr�e"e i �°'b (size) `36 x 0 x P NO.OF BEDROOMS BUILDER OR OWNER 11Pr►c:��a r PE.RMITDATE: 7/.97/n;'T COMPLIANCE DATE: Separation Distance Between the: f , Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility / Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) . Feet Edge of Wetland and Leaching Facility(If any wetlands exist' _ within 300 feet of leaching facility) - Feet Furnished by TOWN OF JARNSTABLE j SEWAGE# f�.! ION LOCAT r� rr VILLAGE � .r ASSESSO R'S MAP&PARCEL 7 l h 1 INSTALLERS NAME&PHONE,NO. SEPTIC TANK CAPACITY �. �c� r� r(size)J T S" L X /Q Ic (type) 7 k� LEACHING FACILITY: e) NO.OF BEDROOMS f OWNER e r". L i I L X : COMPLIANCE DATE:" PERMIT DATE: Separation Distance Between the: Feet. Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility ` Private Wat N 1 Feet er Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) Edge of Wetland and Leaching Facility.(If any wetlands exist I ��r� Feet � within 300 feet of leaching facility) FURNISHED BY_ �Q Cti� J A A as A 19 CAJ w 9A4COY d r0ttosroz 3.3 ® �Cj su, f i o ; l TOWN OF BA.RNSTABLE >. �rrc^ I(�111 �.�. SEWAGE # ems"' 36 V CATION = %NyZ GE z_` ,1A Sie bile- �ASSESSOR'S MAP & LOT 37 7" 05 INSTALLER'S NAME"&PHONE NO. Qok,)A!; r Se?A2 -264 c S-Z8 77FRW6 SEPTIC TANK CAPACITY IODo LEACHING FACILITY: (type) .3X S2>5 1!4wrill H� (size) 36 z l3 X R NO.OF BEDROOMS 3 BUILDER OR OWNER-VeA d PERMITDATE: 7 f 65- COMPLIANCE DATE: 7`ag-OS Separation Distance Between the: f 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 withir 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist _ within 300 feet of leaching facility) Feet Furnished by 4 13ACv< of HOOSC dz a TANS It 3q 3 84 A•d' 59 j,3"a` 3a' �a SAs A•3= 'a 136 3: 3�' No. O F4 1 0 0 0 0 THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS ZIpplication for Miq u al b otem Can5truction Permit Application for a Permit to Construct.( . )Repair(X )Upgrade( )Abandon( ) O Complete System ❑Individual Components Location Address or Lot No. Owner's Name,Address and Tel.No. 3 6 2—0 3 5 5 58 Acre Hill Rd, Barnstable Paul Vendetti Assessor'sMap/Parcel J 297/056 58 Acre Hill Rd, Barnstable Installer's Name,Address,and Tel.No. 7 7 5—8 7 7 6 Designer's Name,Address and Tel.No. 3 6 2—5 0 3 6 Wm E. Robinson Sr Septic Ed Kelley PO Box 1089, Centerville PO Box 51 Cummaquid Type of Building: Dwelling No.of Bedrooms Lot Size 57155 sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons 2 Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date_ Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) Install a new Title 5 leach system to plans of Ed Kelley. 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 fo place the system in operation until a Certifi- cate of Compliance has been issued by this Board.AeQ10L Signed Date Application Approved by UJA Date Application Disapproved for the following reas s Permit No. Date Issued 3 't No. d 1 0.0_n 0 � .. � V` AO Fee THE COMMONWEALTH'OF MASSACHUSETTS Entered in computer:. ,Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS * 1 r ZIpprication for Mie;pool *p�tem Con,gtruction Permit Application for a Permit to Construct( . )Repair(' 4 Upgrade(` )"Abandon( ) O Complete System El Individual Components f Location Address or Lot No. Owner's Name,Address and Tel.No. 16 2—0 3 5 5 56 Acre Hill Rd., Barnstable Paul Vendetti ''- Assessor's Map/Parcel 297/056 58 Acre .Hill Rd, Barnstable Installer's Name,Address,and Tel.No. 7 7 5—8 7 7 6 Designer's Name,Address and Tel.No. 3 6 2—5 0 3 6 WE Robinson Sr Septic Ed Kelley. PO Box 1089, Centerville PO Box 51 Cummaquid Type of Building: f�° Dwelling No.of Bedrooms _ Lot,Size 57155 sq.ft. Garbage Grinder( ) Other Type of Building No. of Persons 2 Showers( ) Cafeteria Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. Plan-Date Number of sheets Revision Date Title Size of SepticTank Type of S.A.S. G� Description fl Soi Nature of Repairs or Alterations(Answer when appplicable) Install a new Title 5 leach system to plans of Ed Kelley. 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 this Bo 'of,;I=lealth.- Signed Iv rl Date Application Approved by '� v _ ' Date Application Disapproved for the following reaso ; ri s Permit No. Date Issued -------------------------- - THE COMMONWEALTH OF MASSACHUSETTS Vendetti BARNSTABLE, MASSACHUSETTS ; Certificate of Compliance THIS IS TO CERTIWFmY, 4atA e1&0 riso ewgy Disposal soalSystem Constructed ( )Repaired ( X)Upgraded( ) Abandor5j( A8 ye - Septic at a� a ha ben nstructed in accordance with the provisions of Vtll 5 and the for Disposal System Construction Permit No. led Installer 1"A, Designer v The issuance of this permit shall not construed as a guarantee that a syste ncro as designed. Date 7 �, e Inspec _ _ 1 ____ No. r1 .. Vendetti THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS Digoat *pgtem ComAruction Permit Permission is hereby granted to Construct( )Repair( ))Upgrade( )Abandon( ) System located at 58 .Acre Hill Road, Barnstable 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 m be c ipleted within three years of the date of ihi it /2S Dater_ (�� Approved by 1 4 oF1 Tom,, Town of Barnstable HE yP� Regulatory Services Thomas F. Geiler, Director BARNSTAUM 6'& Public Health Division ArEO"U'� Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Installer & Designer Certification Form Date: Designer: Ed Kelley Installer• Wm E Robinson Sr Septic Address: PO Box 51 Address: PO Box 1089 Cummaquid Centerville On Wm E Robinson Sr Septa issued a permit to install a (date) (installer) septic system at 58 Acre Hill Rd, Barnstable based on a design drawn by (address) Ed Kelley dated 1 1 -04-04 , '(designer) certify that the septic system referenced above was installed substantially according to the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. I certify that the septic system referenced above was installed with major changes (i.e. eater than 10 lateral �' r 1 relocation of the SAS or any vertical relocation of any component of the septic system) but in accordance with State & Local Regulations. Plan revision or certified as-built by designer to follow. v" (Installer's Signature) � Of ` EDWARD KELLEY, No. 2010D (Designer's Signature) " ( mp Here). PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS- BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. Q: Health/Septic/Designer Certification Form Commonwealth of Massachusetts Executive Office of Environmental Affairs ' �J, Department of Environmental Protection William F.Weld Argeo Paul Celluccl David B.Struhs, Lt.Governor cornrnhdorw SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION Property Address: 58 AcredHill Rd. , Barnstable AddressofOwner. Mary Archibald Date of Inspection: 12-1 3-9 6 (If different) Name of Inspector. W.E. Robinson SR Company Name,Address and Telephone Number. ( 5 0 8) 7 7 5-8 7 7 6 W.E. Robinson Septic Service P.O. Box 1089 Centerville MA CERTIFICATION STATEMENT I oertify 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-s ite disposal systems. The system: s _ Conditionally Passes _ Needs Further Evaluation By the Local Approving Authority _ Fails Inspector's Signature: �� ` Date: /,�z /3 ` G 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 D: AJ SY�STFiM PASSES: I have not found any information which indicates that the system violates any of the failure criteria as defined in 310 CMR 15.303. Any failure criteria not evaluated are indicated below. B) SYSTEM CONDITIONALLY PASSES: One or more system components need to be replaced or repaired. The system,upon completion of the replacement or repair,passes inspection. Indite yes,no,or not determined(Y,N,or ND). Describe basis of determination in all instances. If"not determined",explain why not) The septic tank is metal,cracked,structurally unsound, shows substantial infiltration or exfiltration,.or tank failure is imminent. The system will pass inspection if the existing septic tank is replaced with a ponforming septic tank as approved by the Board of Health. (revised 11/03/95) 1 One Winter Street • Boston,Massachusetts 02108 • FAX(617)55&1049 • Telephone(617)292-5500 ir,Printed on Recycled Paper SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(oontinued) PropertyAddross: 58. Acres Hill Rd, Barnstable Owner. Mary Archibald Date of Inspection: 1 2-1 3-9 6 B)SYSTEM CONDITIONALLY PASSES (continued) Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed pipe(s) or due to a broken,settled or uneven distribution box. The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed distribution 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 approval of the Board of Health): broken pipe(s)are replaced obstruction is removed C) FUR ER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: nditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect the blic health,safety and the environment. 1) STEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM IS NOT FUNCTIONING IN A WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: _ Cesspool or privy is within 50 feet of a surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh. 2) STEM WILL FAIL UNLESS THE BOARD OF HEALTH (AND PUBLIC WATER SUPPLIER,IF APPROPRIATE) D INES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECT THE PUBLIC HEALTH AND S AND THE ENVIRONMENT: The system has a septic tank and soil absorption system and is within 100 feet to a surface water supply or tributary to a surface water supply. The system has a septic tank and soil absorption system and is within a Zone I of a public water supply well. The system has a septic tank and soil absorption system and is within 50 feet of a private water supply well. The system has a septic tank and soil absorption system and is less than 100 feet but 50 feet or more from a private water supply well,unless a well water analysis for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm. S) O II (revised 11/03/95) 2 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 58 Acres: Hill Rd, Barnstable Owner. Mary Archibald Date of Inspection: 12-13-96 D] SYSTEM FAILS: I have determined that the system violates one or more of the following failure criteria as defined in 310 CMR 15.303. The basis for this determination is identified below. The Board of Health should be contacted to determine what will be necessary to correct the failure. _ Backup of sewage into facility or system component due to an overloaded or clogged SAS or cesspool. _ Discharge or 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 bog above outlet invert due to an overloaded or clogged SAS or cesspool. Liquid depth in cesspool is less than 6"below invert or available volume is less than 1/2 day flow. Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped Any portion of the Soil Absorption System, cesspool or privy is below the high groundwater elevation. Any portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. Any portion of a cesspool or privy is within a Zone I of a public well. Any portion of a cesspool or privy is within 50 feet of a private water supply well. Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water.supply well with no acceptable water quality analysis. If the well has been analyzed to be acceptable, attach copy of well water analysis for ooliform bacteria,volatile organic compounds, ammonia nitrogen and nitrate nitrogen. E]LARGE YSTEM FAILS: e following criteria apply to large systems in addition to the criteria above: system serves a facility with a design flow of 10,000 gpd or greater(Large System)and the system is a significant threat to public and safety and the environment because one or more of the following conditions exist: the system is within 400 feet of a surface drinking water supply the system is within 200 feet of a tributary to a surface drinking water supply the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area(IWPA)or a mapped Zone II of a public water supply well) The owner or for of any such system shall bring the system and facility into full compliance with the groundwater treatment program requirements of 14 CMR 5.00 and 6.00. Please consult the local regional office of the Department for further information.. (revised 11/03/95) 3 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Addrem 58 Acres Hill Rd, Barnstable Owner. Mary Archibald Date of Inspection 1 2-1 3-9 6 Check if the following have been done: /Pumping information was requested of the owner,occupant, and Board of Health. _None of the system components have been pumped for 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 part of this inspection. LI/As built plans have been obtained and examined. Note if they are not available with N/A. The facility or dwelling was inspected for signs of sewage back-up. The system does not receive non-sanitary or industrial waste flow The site was inspected for signs of breakout. _ A system components,excluding the Soil Absorption System, have been located on the site. _L,-The septic tank manholes were opened, and the interior of e Pt uncovered, o red, pe h septic tank was inspected for condition of baffles or tees,material of construction,dimensions,depth of liquid, depth of sludge,depth of scum. t/i'he size and location of the Soil Absorption System on the site has been determined based on existing information or approximated by non-intrusive methods. _4/1he facility owner(and occupants, if different from owner)were provided with information on the proper maintenance of Sub- Surface Disposal System. (revised 11/03/95) q j � SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 58 Acres Hill Rd, Barnstable Owner. Mary Archibald Date of Inspection: 1 2—1 3—9 6 FLOW CONDITIONS RESIDENTIAL Design flow:_3 3 Q gallons Number of bedrooms:yL Number of current residents: / Garbage grinder(yes or no):L o _ Laundry connected to system(yes or no):y S Seasonal use(yes or no):L u Water meter readings,if available: 1995 — 32, 000 gallons 996 — 21 , 000 gallons Last date of occupancy: ! —/ COMMERCIAL/INDUSTRIAIz Type of establishment: Design flow:_gallons/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)_jL, e If yes,volume pumped: gallons Reason for pumping: TYPE OF SYSTEM C ptic tank/distribution box/soil absorption system Single cesspool Overflow cesspool Privy Shared system(yes or no) (if yes,attach previous inspection records,if any) Other(explain) APPROXIMATE AGE of all components,date installed(if known)and source of information: I 17 Sewage odors detected when arriving at the site:.(yes or no) AL 0 (revised 11/03/95) 6 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(oontinued) Property Address: 58 Acres Hill Rd, Barnstable Owner. Mary Archibald Date of Inspection: 1 2—1 3—9 6 SEPTIC TANK- (locate on site plan) Depth below grade: Material of construction:_concrete_metal_FRP--other(explain) Dimensions: Sludge depth: Distance from top of sludge to bottom of outlet tee or baffle: Scum thickness: 1—•' _ Distance from top of scum to top of outlet tee or baffle:_ Distance from bottom of scum to bottom of outlet tee or baffle: 1 41' 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.) )a k- 1� !ti- 6 a G a ,. A j 9'IY)'1 r I i ram 61 A--�I�12 i7'6 C 24 1 L-T Iq 060 ,0, G TRAP:_ (locate on ite plan) Depth belo grade: Material o construction:_concrete_metal_FR.P--other(explain) Dimensio Scum ess: from top of scum to top of outlet tee or baffle: Distan m bottom of scum to bottom of outlet tee or baffle: Comments: (recommen tion for pumping,condition of inlet and outlet tees.or baffles,depth of liquid level in relation to outlet invert,structural integrity, evidence of ,etc.) (revised 11/03/95) 6 a SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 58 Acres Hill rd, Barnstable Owner. Mary Archibald Date of Inspection: 1 2—1 3—9 6 TIGHT OR HOLDING TANK:_ (locate on site plan) below grade: Mate ' of construction:—concrete_metal_FRP_other(ezpLun) Dimensions: Capacity: ons Design flow: ons/day Alarm level: Comments: (ooadition of et tee,condition of alarm and float switches,etc.) XVV L.X DISTRIBUTION BOX: (locate on site plan) 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.) Z,� PUMP C BER:_ (locate on plan) Pumps in rking orden(yes or no) Comments: (note conditi n of pump chamber,condition of pumps and appurtenances,etc.) (revised 11/03/95) 7 S e SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM . PART C SYSTEM INFORMATION(continued) PropertyAdd,,w- 58 Acres Hill Rd, Barnstable Owner. Mary Archibald Date of Inspection: 1 2—1 3-9 6 SOIL ABSORPTION SYSTEM(SAS):—L,—/ (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: Comments: (note condition of soil, signs of hydraulic failure, level of pond ng,condition of vegetation etc.) — CS 6 0 4 r i ✓.✓7 .i lilt^ C: CESSPOOLS:_ (locatjoite lan) Numbnfiguration: Depthuid to inlet invert Depthlayer.Depthayer: Dimenesspool: Materstruction: Indicaouadwater: (cesspool must be pumped as part of inspection) Comments: ( condition of soil,signs of hydraulic failure, level of ponding, condition of vegetation,etc.) PRIVY:_ (locate an ate plan) Materials of co n: Dimensions: Depth of solids: Comments:(n condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.) • (revised 11/03/95) 8 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) PropertyAddrese: 58 Acres Hill Rd, Barnstable Owner. Mary Archibald Date of Inspection: 1 2-1 3-96 SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent references landmarks or benchmarks locate all wells within 100' w I Jl DEPTH TO GROUNDWATER Depth to gmmndwater._L,!�___faet method of determination or approximation: )3 d l J v (revised 11/03/95) 9 L OF'C I,ON_ S E W A PERMIT N0. VIL',LAGE INSTALLER'S NAME & ADDRESS . l)rlroX(7/xo /1/?b 5 ,AAr4, B U I'l D E R OR OWNER DATE PERMIT ISSUED 3 -;21 - 7D DATE COMPLIANCE ISSUED 3 - - � r ��.� r Q `' i, 6 /b`(�' `� I THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .......-�QWp.. -----OF.....1-).PY.R S_.1AaL. ......... Appliratinu -fur Uiipuiittl IV park Tatuitrurtiou Prmi�a Application is hereby'made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: �L-:.2oFiD....�R2..JS-�Ra y Location•Address or Lot No. 1T.+i----------------------;---------------•---. .......�.(�R► S A&Lc._.... ------------------------------ Owner Address w UETOc�-...... � 25-----•-•-------------- A2-Ns"�- 3�E Installer Address Q Type of Building Size Lot........5-L.A.55_Sq. feet V Dwelling—No. of Bedrooms------3:.___ ..._.Expansion Attic ( ) - Garbage Grinder ( ) `- p., Other—Type of Building ............................ No. of persons.......AP----------------- Showers ( ) Cafeteria ( ) a Other fixtures ------------•---•----------•--•-------- - Design Flow--------_5�. ............................gallons per person per day. Total daily flow----------- gallons. .W Septic Tank—Liquid capacity_l-LMOgalions Length...... ...... Width...-$....... Diameter................ Depth------_-_-_.._. x Disposal Trench—No ----------'_._______ Width.__ __ _____________ Total Length........./. ........ Total leaching area...... Q ----- ft. Seepage Pit No------/------------ Diameter---------- Depth below *nlet____._!ft____..... Total le chin area-----------------sq. ft. Z Other Distribution box Y< Dosing tank ( ) �/l-/1 /�3�" 7�' �G� �" Percolation Test Results Performed by..._y. .i_.,____�.e.1`.,�`111^g�•...._., __X .... Date...1`3l.'__7 -_____.__.... a Test Pit No. 1......a------minutes per inch Depth of "Pest Pit------!3-____-_-. Depth to ground water________________________ (_, Test Pit No. 2......!:�......minutes per inch " Depth of Test Pit.....1: ........... Depth to ground water------------------------- V ---------------------------------•--..--------•----------•-----------•-------------------------------------------------------------•-•-----------•--------- O Description of Soil..... -"-fib..----..k-0RO-----4-60bSooL- �.�-•i2o__..��►�SC F �j�� �-(�IJ ------ <x © t --- D! 5 E SIN -----------------------•------------------------------------------------------------------------------- W Q Nature of Repairs or Alterations—Answer when applicable.----------------------------------------------------------------------------------- r :.: ----------------- -------------------------------------------------------••--------------------------------------------------------------------------------------------------------------------------- 1 Agreement The undersigned agrees to 'install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Article NI of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. g � ., the ... `App lication Approved.B % �"E Date .:.r.-.,z: - Date _ Application Disapproved for the following reasons:................................................................................................--------------- -----------:....................•-----.._...--:-•--------------•-----••-------------•-------•--•--..........---------------------------------------------•--------------•--- --------------------------- .; � p�^ Date Permit No ..................................... Issued._ ...........V_ 7� _ � _ i •2 Q v.:lPa�F�� � � � � ..� � .. i Date F' 76,No...... ../......,R....7 ....... FEE:...e ................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .....t LO N..3............OF..... ..... .... ................. .......... Appliration -for 43iquatial Works Towitrurtion Vautil. Application ishereby'made for a Permit to Construct or Repair an Individual Sewage Disposal System at: ................................ ........ .............................................. ............................................................................................ Location-Address — or Lot No. 7, , _tt� - _k................................................. . r �_- �� I fxR L ............................. ...rt......................................... ......... .... ..... Owner Address Ut ................................................................................................. .......... j i............................................................................... Installer Address < Type of Building Size Lot_..._.-:`.. . . feet %.0 .. .... Dwelling—No. of Bedrooms-------I............................ -----Expansion Attic Garbage Grinder Other—Type of Building ............................ No. of persons...._._k�................. Showers Cafeteria P4Other fixtures ------------------------------------------------------ -------------------------------- ....................... ------------------------------------- Design Flow----------- .............................gallons per pet-son per day. Total daily flow_______-_ ......................gallons. P4 Septic Tank—Liquid capacity_!_-_O_ ::gallons Length_____.`._..____ Width....�_---__ Diameter................ Depth.-.--_--_-.----. xDisposal Trench—No...................... Width:_____-______--___._ Total Length.___.__._...______.. Total leaching area...... ----sq. ft. Seepage Pit No_____________________ Diameter._.__.__.__._....... Depth belowynlet.................... Total leAching area------------------sq. f t. Other Distribution box Dosing tank Percolation Test Results Performed by....!!t. ....... .... Date._. ............ Test Pit No. I-------a------minutes per inch Depth of Test Pit-.----_-____-__-_-.------- Depth to -round water---------------------_ f� Test Pit No. 2-------a------minutes per inch Depth of Test Pit----- ............ Depth to ground water------------------------ tx -------- 0 Description Iof So-il. ----.---------------.--.--.-.- -------.--.--.--.----S------;o-.-.--..-.-..-.-.-----------. .------------.-.-.--.-.-.-.-.----------------.-..-.-.-.-.-.-.-.-.-.-.-.-.-.._....--.-.-.-.-.-.-.-.-.­..----.F-.-.-.-.t-.-o.-.-....-.------­S--------0-------L----)---i--)-- -------------.-- )0....... -- --------CDi_01a........ . . ..... . D... ....... ...... ......... ......... ......... -------- .................0 .. W .-- .-.-.- Z --------------- --------- --------------------------------------------------------- ---------------------------------------------------------------------------------------------------­--------------- U Nature of Repairs or Alterations—Answer when applicable--------------- ........ -------------------------------------------------------------------- ------------------------------------------------------------- -------------------------------------------------------------------I----------------------------------------------------------- ---- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Article XI of the State Sanitary Code—The undersigned further.agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. eigned., --------------...................-------------­--­----------- -------------------------------- Date Application Approved By........... ­1-------4- --- ........ ..... ;7- Date Application Disapproved for the following reasons:................................................................................................................ .........................................................................................................-------------­-------­---- -­-----­------------------ --------- ------------------------ Date Permit No. -------===._=='-==-------•----------•--_: Issued-----------------------------------='L.................... Date THE.COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ............. P 1 .9).........OF......... J) C�' LC.:.............................. .................................................. T.rdifiratr of Tilutpliatta THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed (k/or Repaired ............................................................................. ...................................................................................................... - -------- Installer staller at..........-C-T------5...... )CZC _PQ )-I-:-------- - 0-lL-C.................................... ------- ..... has been installed in accordance with the provisions of A�+7, XI of The State Sanitary Code as described in the application for Disposal Works Construction Permit No.-(_ 0PL�L­7------------ ated.....& ... ..... ...... .................. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILJL FUNCTION SATISFACTORY. DATE--------- ................................... Inspector_._.._.. ------- --- --- ----------- ---------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH C .........OF...... ............................ No............ 7... .............. :2 57 FEt........................ %sVasal lVarks QIonstrurtion Vrrmit Permission is hereby granted------k�-_}�r�_ ....... ------ ------- .................................................... to Construct 17) or Repair an Individual Sewage Disposal System at No__'­='-.J.....................1�Q.ZF.....I l 1 L.(......... Ev�------------- .7�� Street as shown on the application for Disposal Works Construction Perini t.4To-------------- Dated---- .. .... ................ -------------------------------- Board of Fle, DATE..... ---Tf- ----------------------------------------------------------- FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS I 3 f I I ey>.-...m •�+'� -. - a�•-+R+w��.T- ..-.,-�.>��+.=_�=+,�.rr ._. ..---n�•-a-. 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I 1 I j 1 I i { ST . H- / nor _SAS 3 197 "5._ . LOT 14 /T '�- rNSPFCTQR V. EX M�a ®f� aE 350 EST r. EL AV, 16,00 � TEST 6 �a ss�r��$�fin+ `� LD't`A � • . `,. NYDR,�ce 'x , • sx 4 A4//V/A44�//i / �. e)U/LD/ArG S•ET,0ACA:f ,P-JW U1.� y A 01 SEPT/c 5V57-4M CONST!2OCTLOA/ SHALL: CONF02M TO MA ssJAL o w AI-/PA Y• E/V VAe 0&/ME/V TA[. .COLNE• T/r4- EX; _. r;/r1� � -S .E R L sac 9 C i �. . / - 41 A'�7".�1 TZ GU�A T7'O.AI �". .�? A' .3 �. *�'��.���'��"� , k MA VAlOLE ca✓E �x:r nry -r0 !Mp� ✓t4 5 o v TCO' p�E l/ ram" . 1N -5 WI Ts-11V /' OF F/A//5N � GSAD » 'gyp BOX Z/Y%VrDE b vs SST +Z M/N/MUn/ - 6 AA 1 AJ 3"M iV Q , D/q WA �4ry FaOT M/N A M/N pYl �' '{ /4" �9'/Poor PiT '°/�2 D/a. �00 MASH CO 5 STO IVE /NV,E2T CA PA G/ TY .4'IZOU O- �$ a CWA 7GTz T/G N 7) /, 8C,7T�l d� IN VE ZT NO GA2,5A6E_ G,eI1vZD 2 EFE 2��lC� Cifi`1N -LOT 1 ry 4 ,., = , Se•,aT1G TAAJA:f, 17/6T-.�/BUT/ON 80X Stiok1N IN P AN ' Z QDK 3// P/� P .// .l: 9. ; �3 OIJTLET.S� .4ND LE.a,c�a/wG �/T . n3 :. tJAMF C� �• p i �.#i` °. ' CONG`i2ETE S7.0E�/GT� 2 000 P5/ 1!J/N. ..3 STEEL 0000 H- /0 LOAD/n/G 9 ' /4- -57 Cr = ma x -0k_- - WAY NOr To BE LOC.4TEZD V'A a A t�4.17w oe?`, o v ,e S yS TE M UNL E.S> A/- 20 f DE•SI.G/V LOA.a/wG 1S US&Z> I' 14E�EBY CERTIFY 7#A.T 7//F EX15�'/*Sl S HOtdN AND DOES CON AoRM W/TH TJy . ' ; I�,4 TE NE,L!L 774 AGE:v 7 , EL 4 60G 5 r TOP OF FOUNDATION Ps A/ Dili- Qox CONCRETE COVERS o.EE.v� �ccn t ,o/_GrA 1.:• a J7Prx-- / ccuT OFF YeVC oc 7Lc--r iNVE72� �;'� OR SCHEDULE 4 9 - . 2/.So 4"SCHEDULE 40 P.V.C. (ONLY ) ` ' ;- _�•. P.V.C.FIFE MIN. PIPE -MIN. PITCH 9" MIN PITCH V4■PERFT LEACHING TRENCH ( )REQ. 1/4" PER.FT. F'Q GFv�c 1/8"- I/2" WASHED STONE 36"MAX. 1) /NVERT GAS BAFFLE � � ,1 G" IZZ � SEPTIC TANK INVERT 23 STONE INVERT "� Q Q y,� INVERT iaoo EL. ...:........ ELn6 EL.i6. I NVERT ■ :.. . .. .. . . . GAL. INVERT D15T. �• - I EL BOX . . �"CRUSHED STONE _.... ' EL iG:2a WASHED STONE rC i¢.oe. /o I N FI LTRATOR PROFILE 0 F SOIL LOG SEWAGE DISPOSAL SYSTEM GROUND WATER TABLE DATE TIME NO SCALE 3/4„- I I/2 TEST HOLE I TEST MOLE 2 WASHED STONE-7 ELEV ELEV. DESIGN DATA ((�� /// Lonri / NUMBER OF BEDROOMS TOTAL ESTIMATED FLOW 32• ��� —L C /!Lo GALLONS/DAY � � ' •• (�o a 24•, BOTTOM LEACHING AREA SQ.FT. / TRENCH / 3As SIDE LEACHING AREA �9'5I•.9Z SOFT./TRENCH ✓wS�/zvcTiUN ���T�: CX/�7��/� Gc-�u�/ PIT 7Fr57 GARBAGE DISPOSAL A/1- L (50% AREA INCREASE ) 4'3" TOTAL LEACHING AREA �1.`}r•. vo SOFT. 2 � I2//T�/ CLC.AN �fJ�,L�if�L . f PERCOLATION RATE .�E-�-`'. !N��/ Z �1%�/ ` ML"A. PER. INCH D<AC `r LEACHING AREA PER PERCOLATION RATE.4.7..4/ ESQ. FT. APPROVED . . . BOARD OF HEALTH GROUND WATER TABLE WATER ENCOUNTERED DATE . . . . . . . .J/ 7 L �J /�� Z�/ 5/- /2N,S'/ /���;�L� Mom , WITNESSED BY AGENT OR INSPECTOR BOARD OF HEALTH SHOF ��t�,P�' �SS Y ENGINEER SS f�c2c- //i� c eas�7� �� STETSO s- - - �9U 5, VL-nvD/-TT/ PETITIONER Zoo ter- SC�JGL /I S AIo7'G' EVAONP i tDln/F�2D � �L LGLy 1 ✓&/7 � ln , 23' 24 oA-` 1 LtAcu � Q ` O a1.1 toN or DEG1� iJ z Ll,so L3 v O � Y �TN 1 lop°f g. 2,f.LS / /ZT�� OF NSs9cyG EDWAr E./ K`ELLEYh v' No. 26100 +� '2fCISTiR�� �s/ANAL LAND S� JOB NO. B08-05 NOTES Venditti.dwg Bragg's Ln. 1. LOCUS IS A.M. 297, PARCEL 56. 2. ELEVATIONS SHOWN ARE ASSIGNED. 3. LOCUS IS IN FLOOD ZONE ON FIRM DATED JULY 3, 1986. 0 4. ALL PIPES TO BE 4" SCH •10, AND PITCHED AT 1/4" PER FOOT. (UNLESS NOTED) BENCH MARK--WHITE SPOT ON 5. MUNICIPAL WATER IS AVAILABLE. LOTS WITHIN 100' ARE ON TOWN WATER. _ CONC. DECK PIER=91.61 ASSIGNED 6. COMPONENTS TO BE AASH-O H-10, UNLESS NOTED. N/F 7. INLET TEE TO PROJECT DONN 13", OUTLET TEE DOWN 14". Q m MILLER 8. IF TWO OR MORE LINES, WATER TEST D-BOX FOR EQUAL FLOW N/F D-BOX EXIT PIPES TO BE _EVEL FOR FIRST TWO FEET. NOT TO N/F OSI M 0-CLOU TI ER 9. DEPTH OF COMPONENTS NOT TO EXCEED 3', OR VENTING MUST BE PROVIDED. SCALE COVERS: BUILD UP COVERS TO 6" BELOW GRADE--2 ON TANK, 1 ON D-BOX, 1 ON LEACHING PROU TY , 10. STONE TO BE DOUBLE WASHED 3/4 TO 1 1/2" WITH 2" MIN. 1/8 TO 1/2" PEA STONE ON TOP. LOCATION MAP N 8T12'50" E -- � X X 11. IF UNSUITABLE SOILS, OR SOILS DIFFERING FROM THE SOIL LOG ARE FOUND, X ~X- X CONTACT THE BOARD OF HEALTH, OR R.J. CADILLAC. 77 102 12. IF AN OVERDIG IS CALLED FOR BELOW, FILL MATERIAL FOR 5' AROUND AND UNDER LEACHING IS TO BE CLEAN GRANULAR SAND MEETING SPECIFICATIONS OF 310 CMR 15.255(3). �- 94 r 702 13. PUMP AND FILL ANY EXISTNG CESSPOOLS. REMOVE ANY CLOGGED SOIL, BLOCK, AND STONE IN g� 06 \o :.,� '� LEACH AREA, AND DISPOSE OF AS DIRECTED BY HEALTH AGENT. / 92 90,E --9 ; :� 100 14. ALL CONSTRUCTION TO MEET TITLE 5 AND LOCAL REGULATIONS. g6 „� .. � 98,2 + :1 � 100 7 9bc98,3 �8 TEST HOLE DATE: April 15, 2008 PERFORMED BY: Ron Cadillac, Soil Evaluator Ln 90 9106INGROUN*C �,� 9TO RS WITNESSED BY: Donald R. Desmarais,94 96 97 95 86 PERC RATE: <V-15"/inch (C layer-TH 2) 44, 100.0 SOIL SURVEY(1993): Eastchop loamy fine sand 94.5 Top Found. GEOLOGIC MAP(1986): Sandwich moraine deposits 899.0 Invert 93.40 Invert 92.87 4 HIGH CAPACITY 8 .� . 9T6 95 3 Pr posed--REPLUMB Use Gas BaffleINFI RS ..: R 0 �, UI J ;t 9 S 94.1 95 o us H--20 Invert 92 00 H-20 .... C)UIPMD,1T & STOR\E o Proposed >� o JS RUCTION 99 z N 9 m n. cover 30 Cover z ' YARD 94.5 S=1 /4 ft - 92.5 VTAJ H 20 N/F �' 1 / � TH 3 0 C N FProposed S=1/2"/ft Top Units@ Filter Cloth 46 o LOT 5 :: q,�5 �I Invert =9,31'2 150) Gal.HILL � 90,4 " 01 • --------- o Z "� HART i Proposed Septc Tank O �� 90,4 ::1 7'5 TH 4 �� .z 100�� i 10 1/4 1 . 31 ACRE Ov01 100.E I ,�::. ` i::� 104 ? CP O ,1 9��4 ;�\0 9 .4 94.3 96 �p2 i Invert 92.17 ��91.15 r� Invert 92.00 I «- " , Ii - I r- I 6.95 B ottomProposed6" Stone or com act Proposed90 26 -3" 2 ..... �� 014 104.E 14� 17 o P) 10 42 3t- 45 o Bottom TH1=84.2 DISCONNECT o Ln PAVED 5 866 , `s DESIGN DATA I R E PARKING : tK �::.!. 25 � 1o ,6O vTo H 1 BEDROOMS: LEACH AREA0 d�' i GARBAGE GRINDER: No REQUIRED CAPACITY: 330 GPD USE 4 HIGH CAPACITY INFILTRATORS WITH 4' OF STONE ON SIDES AND 2' 103 4 � SEPTIC TANK: 1500 GAL. �_.�R--- 05.4 5_37 88.1�� DR1�E n, 10�.� y BOTTOM LEACHING AREA: 379.0 SF OF STONE ON THE ENDS, AS SHOWN, N 87-12'50" E - '"" �• - - i' � p p,VEO �� x _ �, -. / , , FOR A 55' X 10'-10" BY 10 1 /4" z 350.00' - �_ �� '�� �"'I ° 97 [(35 X 10.83 )] DEEP LEACH AREA. DRIVE _ o PAVED STONE PARKING " SIDE LEACHING AREA: 77.9 S.F. -�-� - - - - - - - [2(10.83'+ 35') X 0.85' DEEP) _ �__ _ -moo. ----�-� 0 0 -- - -- -! - 695.94' ''j DESIGN CAPACITY: 350 GPD S 87*12'50" W [(379 SF + 77.9 SF) X .74 GPD/SF] BENCH MARK--TOP OF MAG. NAIL INSPECTION SCHEDULE SET IN PAVEMENT=89.66 ASSIGNED CALL R.J. CADILLAC TO INSPECT PRIOR TO BACKFILL. N/F a BEDARD BARNSTABLE PERC N0. 12175 TEST HOLE 1 TEST HOLE 2 TEST HOLE 3 TEST HOLE 4 DEPTH (inches) ELEV.(feet) DEPTH (inches) ELEV.(feet) DEPTH (inches) ELEV.(feet) DEPTH (inches) ELEV.(feet) 0 95.2 0 95.0 0 94.2 0 95.0 Fill Fill 611 Fill Fill 18" 93.7 24" 93.0 B layer 10yr 5/6 36" 92.0 sandy loam � 36" 91.2 a� 40"°" C layer 2.5y 6/4 C layer 2.5y 6/4 C layer 2.5y 6/4 loamy sand 84' (w/30% gravel) C layer 2.5y 6/4 med. to fine sand medium sand 87.2 (clean) (with traces silt) C layer 2.5y 6/4 medium sand medium sand (with traces silt) (w/20% gravel) (with traces silt) 132" no water 84.2 126„ no water 84 5 132„ no water 83 2 126" no water 84.5 SITE PLAN FOR THIS PLAN IS A VALID COPY ONLY IF IT BEARS AN ORIGINAL RED STAMP AND SIGNATURE. PAUL S . VENDITTI LOT 5, 58 ACRE HILL ROAD, BARNSTABLE, MA G N i APRIL 22, 2008 SCALE: 1 "= 20' GADILLAC CADILLAC � TH 1 TEST HOLE LOCATION, NUMBER 4 1060 V #3c>776 �� WG/STEF�O .�` ESS O Q WATER LINE E UNDERGROUND ELECTRIC GAS METER Z ` I RONALD J. LS RS P.C.� CADILLAC,� � � J 8.7 EXISTING & PROPOSED ELEVATIONS ('X' MARKS POINT) PROFESSIONAL LAND SURVEYOR & REGISTERED SANITARIAN EXISTING CONTOUR P.O. BOX 258 PROPOSED CONTOUR WEST YARMOUTH, MA 02673 FENCE (IF SHOWN, NOT ALL SHOWN) (508) 775-9700 TREE (IF SHOWN, NOT ALL SHOWN) HEALTH AGENT APPROVAL DATE PAGE 1 OF 1 C 2008 BY R.J. CADILLAC