Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Home
My WebLink
About
0099 BOULDER ROAD - Health
I 99 Boulder Road Barnstable A= 046-004 c a. } No. "� Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS application for Disposal *pstem Construction Permit Application for a Permit to Construct( ) Repair(.K Upgrade( ) Abandon( ) ❑Complete System 3 Individual Components Location Address or Lot No. �q Lll Owner's Name,Address,and Tel.No,D6•aw- / 9$ ('�er,Sl�ble SvSar-) =�j g4 & a Assessor's Map/Parcel l� 9 p--vp o Installer's Name,Address,and Tel.No.658''7`7!-9 3 S q Designer's Name,A dress,and Tel.No. 26- 36 a S541 ��nc b S'i�dt+ Eve iivvo'r y f—VA/so, l� Type of Building: Dwelling No.of Bedrooms -3 Lot Size /5 — sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided 30 gpd Plan Date MOO, ��l,as/Ln Number of sheets i Revision Date Title �� St TJLLtriC}-Q D—Arr)-GoAAt Size of Septic Tank Type of S.A.S.oZ /�/U sCD�,, t�S�d�J� la 93X_�k.s Description of Soil Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. Sign Date Application Approved by Date Application Disapproved by Date for the following reasons Permit No. r ���D _�Gs! Date Issued J / -- -- ---------- - No. d"%lY `"7 Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS ftptication for Disposal *strm Construction Permit Application for a Permit to Construct( ) Repair(*� Upgrade( ) Abandon( ) ❑Complete System PrIndividual Components Location Address or Lot No. l �ju�c Owner's Name,Address,and Tel.No.50- 8-.3G?• / S&5/ Susan OL Assessor's Map/Parcel3 j$ �� r nS�.ble � � 19 cQ. Installer's Name,Address,and Tel.No._526$-'�'�/ 9 3$g Designer's Name,A dress,and Tel.No. 24- 36 P • VS YI �r}olo C'vns(-ruc ,Tnc ,c�W)Cf�./;ze �} J%�p�f/'r f 9WAA /;,?JS►4- VA csrU!'II MA mac.� 9� A 03&75" Type of Building: f Dwelling No.of Bedrooms -3 Lot Size /5 JF'�7(, I/ - sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ). Other Fixtures Design Flow(min.required) 330 gpd Design flow provided 3419 gpd` Plan Date MOO. 3 1. 90/& Number of sheets � Revision Date s Title `Size of Septic Tank r.".y:511 i r^ {l i 6o,r Type of S.A.S.PZ 1 83x a5 / Description of Soil _ P � ' � , �Yr 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 Certificate of Compliance has been issued by this Board of Health. - Signed Date -7k d Appli cation Approved by Date- f Application Disapproved by Date 's for the following reasons Permit No. "1-0/6 "��'� � Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS (Certificate Of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired( �4 Upgraded nn ( ) Abandoned( )by lr at [` 211 P4�4o A jq-) �r�� �R L� has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit Nam1k-yIy I dated / Installer l��ral r� c�i� l'�C t-/11Y� �Y>L • Designer�ry f m l i� �� �,a_n r � L #bedrooms Approved design flow A gpd The issuance of�this _pe, it shall not be construed as a guarantee that the system wCi12�f?rt do as designed n� Date � ' 1�7 �// Inspector ------------------------------------------------- --------------------------------------------------------------------------------------- No. fib / l Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION- BARNSTABLE,MASSACHUSETTS Disposal *pstrm Construction Permit Permission is hereby granted to Construct( ) Repair(X Upgrade(� ) Abandon( ) System located at t ,//1' and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction must be c mpleted within three years of the date of thisCb Date � �9//� Approved TOWN OF BARNSTABLE LOCATION -Zo�L b L4Z SEWAGE# 4-6{1--,-44I VILLAGE ASSESSOR'S MAP&PARCEL INSTALLER'S NAME&PHONE NO. 50S-77� SEPTIC TANK CAPACITY LEACHING FACILITY.(type) (size) NO.OF BEDROOMS -3 Z;�-- !�b �A-L C4"tL 7 OWNER 6 PERMIT DATE: COMPLIANCE DATE: .) 7 6 Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility - - _Feet ,Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) N Feet FURNISHED BY r W � � i N �, �I © � .�� � � � � � � ,�, � .� c � �' � 'r,. A � .� � � q C_ Q�� :. TO �lF 13AltN8TABLE g pCArncl -- V7LGAr"sE �` XSSE550R'S 1V1AP&1LtYt' INSTALLER%IdA VM&p1HC)PtE AIp SfiF'I'�C TAIYi{CA3Pf1C>Tk /gJ e f� daza ROOM LEACHING 1�,�C1LI't°Y (gyps) '- • , p . 1 OR co FIERiV(rFT~3�.TL+ �.. Sopuft on TTseuaae 13stvieeta' ritlax{tt►um Hctjas�etl GiaundwterTabla to the i3attamgFXxaehin �su:iitY feet PiivaB 'i�t�cwpply VJc@titl g„ett�4�ingagaltty ►y�vetls cxlst g cb,setc oe vlthia 2100.f aE i-djW flg FAel, I?si u c,F d a AL eac�uni l aatlj f.(Yk:doy wEtland5 exesa rl4{att�'� 1 fee let;cltin tea ; ,...�._.Fee �urnil3bed by - I 1 fi r r ' L"J - C �1. S ^ C - J SSESSQ 'S TAP N0. 3 1 S PARCEL PE KMI VIRY. .IHSTAlL- ER'S NAME IA ADDR 9SS ` 8 UIlDER DR DWNEA DATE PERMIT ISSUED DAT E COMPLIANCE ' ISSUED � o Qj V a j FEB-04-2017 06:5e From: To:150e7906304 Pa9e:1,'1 f :Town of Barnstable Regulatory Services - Thomas X Geiler,Director Publie Health DIViSion Thomas McKean,Director 200 brain 8ftet,Hyalnnis,MA 02601 Of5ce- 509-8(2-4644 Fax: 548494-6304 mealier,&Desianer CertiSca ' a Farm Date; a� 17 Sewage Permit# Aeaessor'a MaplParcel 3 Desigaer. LQVJ rneed Inrttalter: or-�ldl� Address: 3 cr rpe Address! /0 160 71W L MGrll EMI On a 9 / r. Aler smas issued a pemut to installdate) in septic system at �4 a.IOL. based on a design drawn.by (address) r; ( Pre dated abi� esiper) r ,I Certify that the septic. system referenced above was installed substantiallyy according to. ' the design, which may include minor approved chaages such as lateral r_elacation of tie ' distribution box and/or septic tank. 1 certify that the septic system referenced'above was installed'with major cbaawges (i.e. greater than l O' ataml relocation of the SAS or any vertical relocation of any component of the se em)but in accordance with State&Local Regulations. Plan revision or curb as uilt by designer to follow. DAM--L/; er'sSignature) . C1VII.. VA 46,502 (Desipex's Signature) (Aim Designer's tamp ere) PLEASE RETURAi TO HARNSI'ABLE Pi3BL)Ec WALTH 'P ION. CERTIFICATE OF COMPLIANCE WILL NU JIF, Map JW& BM THIS'P'OR1MI AND A&BUILT CARD ARE RECEIM RY T BARNS ABLL PUBLIC HEAMM DIVISION. TM KK Y_QVI . Q Heel �UM)ci8�. er CeeMcWoa Fwm 3-26,04.doe bG�'J -lHli it cT�� P3 00 L;5 rt_I'd UG 3-13H1'3hdH3 Town ®f Barnstable P ' � pa erierit of Health,Safetyt,anf'd Envaa onmen.tdi Seaweca��> x V P�ublic�i�realth Dar��isib, -Date, /0 31 A t 367 Mam`Stieet,Hya:rnis MAr026 " anawarABM ►a ,� l Fee Pd. l 0U.-�Date Scheduled l� � tv Time�_ - _ W Soil Suitability Assessment f®�° Disposal s n Performed By: t/ `_CLOIq° ��1'���t Witnessed By: �^✓r ✓ J, W- t_ _. Location Address Cjp ,(� Owner's Name O tL �0.tt.�� ►"v`.. _ . ,rA4ddress �+: ;�•F� Assessor's Map/Parcel: 3I�1 9 Engigeer''s'Name ,Al'^ e NEW CONSTRUCTION REPAIR Telephone# cJ�U) 6a — �S p Land Use Slopes(%) � Surface•Stones ("e—,' 1 )aj— s Distances from: Open Water Body 4?,c 4 ft Possible Wet Area�,—C +It Drinking Water Well ft Drainage Way ft. Property Line _ft Other ft SKETCH:(Street name,dimensions of lot,exact locations of test holes&pert tests,locate wetlands in proximity to holes) md, �. _ •.}, K w'•,� .. �s f'r`«' b�ft�,�.�` s r�"E.�C. tf. _ "y:.i. - '� 4 Parent material(geologic) & � Depth.to Bedrock C [,, _ " Depth 4o Groundwater: Standing Water in Hole: Weeping-from Pit Face " Estimated Seasonal High Groundwater_ _ y� (Yy Ll.::Y.9 (� 'Lilhr •Mettiod�Used:':>:::••::;;•.::�t�.•.:•:.::.::::::::::.................... Depth Observed standing in obs.hole: in. Depth:to4soiPmottles: Depth to weeping from side of obs.hole: in. Groundwater Adjustment �• Index Well#___"_._ •Reading Date:_,___ Index Well level,•;_' A(J 0factor "^' %Adj:Groundwater Level_ >:;:::;i..... :i ::'•'•af i?3:iE:::::' <: ?: ::>> 'Si'::::::.,"";:?>:`.':`„<a'" ,,";,.,.:..;,.'y:•:::::::;.'..'.'. '•''' `:<.�<>:`: ':;s,<i:>;?. >�•;o-:` ............................................................................................. .................................................................................. Observation Time.ak9'yj Hole# r.. Depth-of Pere •Time Start Pre-soak Time® End Pre-soak 01 f Rate Min./Inch G0,'�/"t rti Site-,Suitability Assessment: 'Site Passed Site Failed:aw. k Addi tgnaal,,TesUng,Needed(Y/N) •_ Alt Original: Public Health Division 06;ervation Hole Data To Be;doartpleted on Tack Copy: Applicant v, i;• ;...a:., .e ... ttS'oil(Golor';, t„ Soil Other 'Depth from Soil Horizon Soil'Tex•tdr" '1 ° (USDA), (Munsell) _ Mottling (Structure,Stones,Boulderes. i .Surface(in.) e ° ;a t �.� t® - -- R�= s� �',�'. .'►�`�a.�l' x� ��.. �b"��; �`�a,.J��•mot _ ..._ _ :.:.:::.:;:::;::::::::.:.::::.:::::::::: :: Other Depth from Soil Horizon Soil Texture Soil Color Soil ,S--face(in.) (USDA) (Munsell) Mottling' (Structure,Stones,Boulderes. o n °°Gravel) jqel . .............. ........:.::::.::.:::::::::.::.::::::.:.. :.:::::::: :::::::::::::::::::: :::::: ::::;::: ::::::::::: ::::: : : . WIN :.:.:,:•: ::::.:.::::. .:.::. srY: :: ::::::::.:::.:::::: ::::.::.::::::::.:.::.:::.::.::::::::::::::::... ........:..................:............. Other �pepth from Soil Horizon Soil Texture Soil ns or of Surface(in.) _ (USDA) (Munsell) Mottling (Structure;Stones,Boulderes. o i tle °o r el Depthulderes. from Soil Horizon Soil Texture $oil Color Soit Other (USDA) (Munsell) Mottling (Structure,Stones,Bo Surface(in.) onsi en Gravel) iFlood�hnsuram�ce..Rate�lVlan:- • • • to Above 500 year floodpboundary.-No_ Yes s _ ..•,. ��tx � Yes Withim5d0 yearvboundary No _It within'-I00 ear fly—d1d qundary No;,.� i. Y 0611th of Naturgily®ccurriny Pervious IVfateria9 Does at least four feet of naturally occurring per�v•/ aterial exist in all areas observed throughout the area proposed for the soil absorption system? t — ff:not,what is the depth of'iiatural'ly occurring pervious material? CFertification I1certify that on (date)I}five passed the soil evaluator examination approved by the Department of-Eiivi onitientalProtection_and.thatthe•above analysis was per by�me•consistent.w;ith ,,the required,training,,expertise and experience,described in 310 CMR 15.017. / Date Signature _ Town of Barnstable Barnstabte THE T . �° Regulatory Services Department mmm1dcac j + IARNSTABLLMAn I ��� Public Health Division m Fa " 200 Main Street, Hyannis MA 02601, 2007 Office: 508-862-4644 Richard V.Scali,Director FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL# 7012 1010 0000 2847 8018 October 14, 2016 s Susan O'Leary F 99 Boulder Road Barnstable;MA 02630 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE,TITLE 5 The septic system located at 99 Boulder Road, Barnstable, MA was inspected on 09/27/2016 by Shawn Mcelroy, certified Title V Septic Inspector for the State of Massachusetts. The inspection of the septic system showed that the system"Fails" under the.guidelines of 1995 TITLE V (310 CMR 15.00) due to the following: • Leaching pit or cesspool with high liquid level,<12" below inlet (per Town Code 360-9.1). You are ordered to repair or replace the septic system within two (2)years from the date you receive this notification. Failure to repair/replace the septic system within the deadline period will result in future enforcement action. PER ORDER OF THE OARD OF HEALTH c can, R.S:, CHO Agent of the Board of Health QASEPTIC\Letters Septic Inspection Failures or Future Ev1U9 Boulder Road Bamstable.doc -4-— `" f - ` "� Town of Barnstable i ' • HA1tCIS1'AHI,E, 6 9. ,�� Regulatory Services Department Public Health Division 200 Main Street, Hyannis MA'02601 Office: 508-862-4644 Richard Scali,Director FAX: 508-790-6304 Thomas A.McKean,CHO Feb 6, 2007 ' Rev. 5/11/16 DEADLINES TO REPAIR FAILED SYSTEMS (Town Code §360-44 and Title V: 310 CMR 15.000) An"x"marked in the❑ is the failure criteria and associated repair deadline 60 DAY DEADLINE CRITERIA o Discharge or ponding of effluent to the surface of the ground o Pumping more than 4 times during the last year not due to clogged or obstructed pipe. ❑ Backup of sewage into the house due to an overloaded or clogged SAS or cesspool ONE (1)YEAR DEADLINE CRITERIA. ❑ Static liquid level in.the distribution.box above outlet invert'due to an overloaded or clogged SAS or cesspool ❑ Any portion of the SAS, cesspool, or privy below high groundwater elevation ❑ Any portion of the cesspool within a Zone 1 to a public well ❑ Any portion of a cesspool within 50 feet of a.private water supply well with no acceptable water quality analysis. (This system passes if the water analysis indicates the well is free from pollution). TWO (2)YEAR DEADLINE CRITERIA ❑ Single Cesspool ❑ Any"conditionally passed systems" (broken cover,relocation of a pipe, relocation. of a driveway due to H-10 components, etc) eaching pit or cesspool with liigh liquid level;<12" below inlet(per Town Code 360-9.1) I ❑ Leaching facility with standing liquid level at or above the invert pipe (per Town Code §360-20 h) OTHER 0 Repair deadline: Q:\SEPTIC\DEADLINES TO REPAIR FAILED SYSTEMS.doc L _ 3/5-61 � . Commonwealth of Massachusetts . # Title 5 Official Inspection Form A Subsurface Sewage Disposal System Form:-Not for Voluntary Assessments `- ' 99 Boulder Rd t J' Property Address r. a Susan O'Leary t Owner Owner's Name . r information is required for every Barnstable MA 02630 9-27-16"%. s. page. City/Town 4 State Zip Codef Date of Inspection f,a FM. r i Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. - A. General Information - t �1: Inspector:, I .� .^ f ,' t •, , t , f .� Shawnf Mcelroy Name of Inspector Upper Cape Septic Services s, Company Name P.O. Box 73 Company Address E. Falmouth MA 02536 City/Town State Zip Code 1-508-495-0905 S13971 Telephone Number License Number B. Certification i I certify that I have personally inspected the sewage disposal system at this'address and that the information reported.below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 16.340 of Title 5 (310 CMR 15.000):The system: °' ❑, Passes ,• ❑ Conditionally Passes ,r, =; ; ,-®f Failss Ja I ❑ Needs Further Eval ion by the Local Approving Authority.. .,, • : , , 9-27z 16'_ Pfispector's Signature " ' "Date The system inspector shall submit a'copy of this inspection report to the Approving Authority (Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 17 Commonwealth of Massachusetts - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 99 Boulder Rd Property Address Susan O'Leary Owner Owner's Name information is required for every Barnstable MA 02630 9-27-16 page. City/Town• State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ❑ 1 have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B) System Conditionally Passes: ❑ One or more system components as described in the "Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health,will pass. Check the box for"yes", "no"or"not determined" (Y, N, ND)for the following statements. If not determined," please explain. The septic tank is metal and over 20 years old* or the septic tank (whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y , ❑ N ❑ ND (Explain below): t5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 17 l Commonwealth of Massachusetts .z ►r r _ : t► w , - w . Title 5 Official Inspection Form' rl Subsurface Sewage Disposal System Form Not for Voluntary Assessments ;_�_4!✓ 99 Boulder Rd Property Address , Susan O'Leary 1 - Owner Owner's Name , information is Barnstable -t r. A MA 02630 9-27-16- • required for every - page. City/Town . k,' State Zip Code Date of Inspection , B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if ` pumps/alarms are repaired.' B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out•or high static water level in the distribution box due to broken'or obstructed pipe(s) or due to a broken, settled or uneven,distribution box. System will 'pass inspection if(with approval'of Board of Health): - ❑' broken pipes) are'replac4 ' 4❑ Y ❑ N t ❑-'ND (Explain below): } El -obstruction pis removed ❑' Y t ❑` N J❑"ND (Explain below): ❑ distribution box is leveled or replaced ❑' Y "❑ N `-❑ N-D(Explain below): 1,f -i , f i , t f :4; f r t.. -�s ` ` �:r. - i 1 �f<•-�"a• . ,.:� +, . .d '.? t� fit' j' [,e< `r'♦ - ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation is Required by.the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. - ' 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the_system is not functioning.in a;manner which will protect public health, 'safety and the environ'ment:' ❑' Cesspool or privy is within 50 feet of a surface water ❑ Cesspool'or privy'is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts lay Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for,Voluntary Assessments 99 Boulder Rd Property Address Susan O'Leary Owner Owner's Name information is Barnstable MA 02630 9-27-16 required for every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water'supply. ` ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. i ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate"Yes"or"No"to each of the following for all inspections: Yes No ® ❑ Backup of sewage into facility or system component due to overloaded or clogged.SAS or cesspool' . ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ® ❑ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than Y2 day flow t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 I Commonwealth of Massachusetts a Title 5 Official Inspection Form r f - �, iI Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 99 Boulder Rd � r Property Address k: '• �+ Susan O'Leary _+ ' Owner Owner's Name + information is Barnstable - .' ' required for every MA 02630 9-27-16 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) •Yes-i No. - ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: .. ❑. ® *_ .Any portion of the SAS, cesspool or privy is below high ground water elevation. Any,portion of cesspool or privy is within 100 feet of a surface water supply or ❑ `' ® 'tributary to a surface water supply. ❑ v• ® rAny portion of a cesspool or,privy,is within a Zone 1 of a'public well. ` ' '' ❑ ® Any portion�of a cesspool or privy is within 50 feet of a private water supply well. j ❑ r, ® "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 "�•' r , (=L system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence °w of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ❑ ® � The system is a cesspool serving a facility with a design flow of 2000gpd- '10,000gpd. ' ', The system fails. I have determined that one or more of the above failure ® ' ❑ criteria'exist as described in 310 CMR 15.303,therefore the system fails. The system owner should contact the Board of Health to determine what will be 7> , 3necessary to correct the failure.,,,, E) Large Systems: To be considered a large system the system must serve a facility with a design flow,of 10,000 gpd to 15,000 gpd. , For large systems, youimust indicate either"yes" or."no"to each of the following, in addition to the questions in SectiowD.`, kzi t n. t r- 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 " E]' rL❑ T, ,the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area= IWPA) or a mapped Zone Il of a public water'supply well If you have answered es"to an y y y question in'Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. r t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 5 of 17 Commonwealth of Massachusetts f Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments a% 99 Boulder Rd Property Address Susan O'Leary Owner Owner's Name information is required for every Barnstable MA 02630 9-27-16 page. City/Town State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate "yes" or"no" as to each of the following: Yes No ` ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ❑ ® Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were•all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ❑ ® Existing information. For example, a plan at the Board of Health. ® t Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms*(design):' 3 Number of bedrooms (actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 t5ins•3/13 - Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 1 Commonwealth of Massachusetts • , ;-by:' ' - ,- +a'I Title 5 Official Inspection Form 1�1 Subsurface Sewage Disposal System Form -Not for Voluntary Assessments- • � . t 99 Boulder Rd Property Address Susan O'Leary Owner Owner's Name information is Barnstable: r~ _5 MA 02630 9-27-16' ?#' required for every • •� page. City/Town Ir `! *`: State Zip Code Date of Inspection D. System Information ff ': � : . _ _ ,• Description: Number of current residents: Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) r Laundry system inspected? ' ' �_;I r ,• El Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available,(last 2 years usage (gpd)) Detail: Sump pump? ❑ Yes ® No 9-2016 Last date of occupancy: '�� T-•- 3 "• � Date Commercial/Industrial Flow Conditions: r Type of Establishment: Design flow(based:on.310 CMR 15.203):+ . Gallons per day(gpd) r+ r Basis of design flow(seats/persons/sq.ft ; etc.): , Grease trap present? a _+. r " i� ❑ Yes ❑ . No Industrial.waste holding tank present? '� . o-it !01 ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 • Commonwealth of Massachusetts �a=1 Title 5 Official Inspection Form G: . I Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 99 Boulder Rd Property Address Susan O'Leary Owner Owner's Name information is required for every Barnstable MA 02630 9-27-16 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: Owner--pumped 2 yrs ago Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Maintenance Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology.Attach a copy of the current operation and maintenance contract (to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval.. ❑ Other(describe):, t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 f Commonwealth of Massachusetts :a=1 Title 5 Official. lnspection Fora r �_• i;.l Subsurface Sewage Disposal System Form-Not for,Voluntary Assessments 99 Boulder Rd s � Property Address r r' Susan O'Leary 1 - Owner Owner's Name information is Barnstable ' ': f. i .='� MA 02630 9-27-16 required for every - - page. City/Town •' , State Zip Code Date of Inspection D. System Information (cont.) , • . Approximate age of all components, date installed (if known) and source of.information: 1978 Were sewage odors detected when arriving at the'site? ' " ❑ Yes ® No Building Sewer(locate on site plan): - • . , - :* f, , s Depth below grade: -; ;, ; ,t:, ,,:� feet 18t @tank inlet ' � ' Material of construction: ❑ cast iron r { ;® 40 PVC ''" ' ❑f other(explain): I Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): Good condition. Septic Tank(locate on site plan): Depth below grade: 12' feet Material of construction: ® concrete ❑ metal ❑ fiberglass ;-.❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy'of certificate). ❑ Yes ❑ No Dimensions: _ 1500 gal 12" Sludge depth: t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 17 Commonwealth of Massachusetts la'1 Title 5 Official Inspection Form ='l Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ._�!.. 99 Boulder Rd Property Address Susan O'Leary Owner Owner's Name information is required for every Barnstable MA 02630 9-27-16 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle 20" Scum thickness 1" Distance from top of scum to top of outlet tee or baffle 6" 15" Distance from'bottom of scum to bottom of outlet tee or baffle .. How were dimensions determined? Tape Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tank is in good condition with baffles installed and no sign of leakage. Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 17 Commonwealth of Massachusetts �•., i _r .7 a=1 Title 5 Official Inspection �rrn � Subsurface Sewage Disposal System Form Not for.Voluntary,Assessments-,-: �� •+ ," i ,.... w"• ��;.�.;3!✓ 99 Boulder Rd Property Address Susan O'Leary Owner Owner's Name information is Barnstable ;w n required for every MA 02630 9-27-16 . .r page. City/Town , State Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert','evidence of leakage, etc): Tight or Holding Tank (tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ' ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons' Design Flow: r '.} gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): r *Attach copy of current pumping contract (required). Is copy attached? ❑ Yes ❑ No t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17. Commonwealth of Massachusetts : gal Title 5 Official Inspection Form .-1 Subsurface Sewage Disposal System Form -Not for Voluntary.Assessments 1 ��4 J!✓/ 99 Boulder Rd Property Address Susan O'Leary Owner Owner's Name information is required for every Barnstable MA 02630 9-27-16 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 0 Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): D-box has stain lines above outlet invert. Pump Chamber(locate on site plan): Pumps in working order: ❑ .Yes ❑ No* Alarms in working order: ❑ Yes ❑ No* Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): * If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 i Commonwealth of Massachusetts a=1 Title 5 Official Inspection-- Fora Subsurface Sewage Disposal System Form -Not.for.Voluntary-Assessments 99 Boulder Rd Property Address , Susan O'Leary Owner Owner's Name information is Barnstable f ti-r '' MA 02630 9-27-16 s.. required for every - page. City/Town IState Zip Code Date of Inspection D. System Information (cont.) I ® leaching pits number: 1-1000 gal ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number,%dimensions: " ❑ overflow cesspool -number:- , . s ❑ innovative/alternative system Type/name of technology: Comments (note condition of soil; sign's of.hydraulic failure,1evel of ponding,-damp soil, condition of vegetation, etc.): Leach pit holding 24"of water at inspection with stain lines above inlet invert. Cesspools(cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth —top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins•3/13 ti Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts f Title 5 Official Inspection Form Jil Subsurface Sewage Disposal System Form =Not for Voluntary Assessments �_;� ✓ 99 Boulder Rd Property Address Susan O'Leary Owner Owner's Name information is required for every Barnstable MA 02630 9-27-16 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy (locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 I Commonwealth of Massachusetts a=1 Title 5 Official Ins ection, Form, i-'I Subsurface Sewage DisposaUSystem Form =Not for Voluntary Assessments ' .r,• ' 99 Boulder Rd ' Property Address . Susan O'Leary _ " r ii- Owner Owner's Name - information is bl tae Barns .t required for every MA 02630 9-27!16 - . page. City/Town �� State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal,system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately 13,J 9 f, O li • fL'A Y./ w�. Y r Y tl �t V A-3 — 35.6 6.3_ a3� t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 , Commonwealth of Massachusetts gal Title 5 Official Inspection Fora R' 4 Subsurface Sewage Disposal System Form -Not for Voluntary Assessments n_�}! 99 Boulder Rd 't J Property Address Susan O'Leary Owner Owner's Name information is required for every Barnstable MA 02630 9-27-16 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ~ ❑ Shallow wells Estimated depth to high ground water: 20'+ feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed- Date ® Observed site (abutting property/observation hole within 150 feet of SAS) ® Checked with local Board of Health -explain: ® Checked with local excavators, installers- (attach documentation) ® Accessed USGS database - explain: You must describe how you established the high ground water elevation: USGS and town maps show groundwater at greater than 20'. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments 99 Boulder Rd Property Address Susan O'Leary Owner Owner's Name information is Barnstable MA 02630 9-27-16 required for every _ page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems)completed ® System Information—Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 No................. .7E+C✓............................ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH' OF......................................................................................... �. Appliratiou for Mir mal Works.Zonlitrurtiuu Frrind Application is hereby made for a Permit to Construct ( ) or Repair (V�an Individual Sewage Disposal System at: • .......Bokmcfer.ml. �s 1� ?t.--•-,a r�.................................................... Location-Address o t No . 1. �_.. .f Jr 1......... .........1 __. _.... ..: eras...........-- OW Address Install Address d Type of Building Size Lot___3 s a .f jk �?�'- Dwelling—No. of Bedrooms-_' .................................... Attic ( ) Garbage Grinde�� " Other—Type of Building No. of persons...a.................... Showers / — Cafeteria dOther fixtures ..../. IA-- --------------------------------- ----------•---------------------••-•---•------ ..................... W Design Flow __:__._.__ Mons per person per day. Total dailyflow........... '._........gallons. WSeptic Tan —Liquid'capacity/_ _. Ions Length.............•.. Width................ Diameter---------------- Depth................ x Disposal Trench—No. -._--_------__ --- Width................... Total Length............... Total leaching area..._...._._.�u_sq. ft. Seepage Pit No......�...... Diameter.__ _._.._. Depth elow inlet...... ....... Total leaching areal/__Y_3 _t. Z Other Distribution box V J Dosing to _ '-' Percolation Test Results Performed b Y-- Date ... - Test Pit No. 1--- ...minutes per inch Depth o Test Pit___________ _______ Depth to ground water........................ Gz., Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ O ----/ :._ ............ -•I-- •---... ---•----------•-------------••-- x Description of of _:._�.�..1� */ �� ...-- -- •-----• - V --- - •--�-- ----------- ---- -•-- W ---•-•-•--------------•-. ------•-------------- •--------•--------------------------•---• ••--•---- ----------------------•...-------•-•-•----•--------•--•-----•-••-------- VNature of Repairs or Alterations—Answer when applicable.-------------------------------------------•__-____-___------_----------------------_0......... ---------------------------------------------------------------•--------------------------••--------------------------------------=----------------------------------------------------...........------ Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of iI'i I is 5 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. Signed- ------ ----- - ............................................................... ................................ Date Application Approved By........ 47—--------- -`-� Date Application Disapproved for the following reasons---------------------------------------------------------------------------------------------•-•--••--.......---- ---------------•-•-•--------•-•-•------...-•--------------------------•••-•••---._.........-•---••-••••----••---•---•--•-------•--•-------•----••-----•-•--••----------------•-------•-------•--------- Date Permit No......................................................... ...-----•--•-•--••--------•-------•--••--- Issued ---�=-=--------------------••----._..._ Date -7 Fjcjc::............................ No.... .... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ....................OF......................................................................................... Applir4fiou for Disposal Works Tonstrurtion Vrrmit hereby an Individual Sewage Disposal Application is h eby made a Permit to Construct or Repair System at: ........................ .................lot.... ....................................................... Aogflp -Add.r.ea Np.1 ............. .... ....................... Owner Address .............. ............................. .........................................................--------------*---------- Addr' Tjof Building Size eLot............................Sq. feet Dwelling—No. of Bed ................................Expansion Attic Garbage Grinder ia04 Other—Type of Building*............................. No. of persons...c2.................... Showers Cafet P4 'V Other fixtures ..;VLIV............................... ......................................................................................................... Design Flow.............................................gallons per person per day. Total daily flow............................................gallons. 1:4 Septic Tank—Liquid 4;ppaejty._..._.....gallons Length................ Width................ Diameter-, -,.-6)eVth................ No .. Total Length.................... Total leachi g areZ..................sq. ft. Disposal Tren 7.... ---------------- Seepage Pit to...................... Diafffeter.................... Depth below inlet.................... Total leaching area..... ............sq. ft. Z Otffer Distribution box ) Dos t:ank-,( -Alt Performed ............ .............. Date............4_ PercolAtion Test Results ........ ..... r inch e De ---7 Test Pit IN gitl Depth to ground/4*4 [0..1 inut�s pe Test Pit No. 2........Itminutes per.,inch Depth of st Pit............. Depth to ground 'water..._._..............._._ ........................................................................................................................... --------------------- 0 Description of Soil................................... .......................................................................................................... U . .............................................7;7 ---------- ------------- ........lot........... --- - -- --------- .................................... ... ...... ---------------------------------------- ............. "Nature of Rep�z U S.r.%Zr Alt tions Answe whXappDA(a e............................................................................................. ........................................................................................................................................................................ ............................... Agreement: The undersigned iigrees',to install the aforedescribed Individual>Sewage,-Disposal System in accordance with the provisions of T I T La, 5 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. 4-;Signed...................................................................................... ................................ Date ApplicationApproved By....... . ...... --- ............................................. ........................................ Por.,tte Application Disapproved for t 0 ...... ............. .............. ..... ..............Lr rot ...........................................w...................................................................................------------------------------------------------------------------------ Date PermitNo..........................................ef,............. Issued_....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .................. OF..............-. .. ............................................................ V trtffiratr THISlfs TO CERTIFY, That the Individual.Sewage Disposal System constructed or Repaired by.... W---- ----------- - ------------------- .... -----*-----------------------------------"......"---------------*-------*---------------------------------------- Installer -------�-."as"de'scr'ib'ed"in"t'he, .../State y- ------ ---- ------------ --- ---- . ...... �r at... .../411f ............... S 45y' ....... . ..........s 11h a ta has been I se � AcJ wit7 theepr 6f application for.Disposal Works Construction Permit No. .............. dated_--.. ----------- '&STRUED AS A GUARANTEE HAT THE THE ISSUANCE OF THIS CERTIFICATE SHAL 0 BE SYSTEM WILL FUNCTION SATISFACTORY. ti-- - ----------**...... cS Yc'�wi� ----- --------- 1XB LkOT DATE............................................................................... ector.................................................................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ....................... ....OF.......... FEE... `..5 ;Disposal Works Tonotrurtion Vamit Permission is hereby L-ranted.... ---- - ................... .........I................................................................................ to Constr ct ( j(��®r Repair t�kn -v-i u ewag Isp Syst atNo..... ...............!=I&- .. .... .......... --------- . .. . ..... . .............. as sholon the application for Disposal Works Construction Permit No..................... Dated........:. .. ...._... ... .......... . . ................. ................... DATE............ 7f ............................................................ FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS SHOT /. o F .Z SHTs i i f Pta° / /1 i I ��83 FCB9�sF� oQ°h/f / n\n i.-jj MMQUID, . 02637 d u / 9 e � e y:' 1E IisriuG 9',:I i ,c"?t 'k 's 1, c � I Qg.S NorE-EZbvq'Tioivs BgSED o�v AsSusrd^D 1)i9�vy 1411 CERTIFIED PLOT PLAN LOCATION D•9 evs>�4ecE M.gsS. SCALE . . . DATE �\ PLAN REFERENCE 11VOWAi ,A/ y loe flV f=a2 � � 99SQ ,_' �� EDWA/2D E. .fCEGG�/• . f1�!D ,.eEC0,2D�D• . VI A I CERTIFY THAT THE p. .. 6 SHOWN ON THIS PLA 1 N THE AROUND AS SHOWN HERE IT CONFORMS TO THE SETBACK R 'OF THE TOWN OF . . . . . . . . . . . WHEN CONSTRUCTED. Jon/A r7•/4 A/ P 6,2/r ro A/ G'Tu x' DATE . . .. . . . . . . . . . . . PETITIONER: w&sr 14yANN/JPo,277 MASS. REGISTERED,.LAND SURVEYOR S*A/&z-T TOP OF FOUNDATION , CONCRETE . COVER CONCRETE COVERS s o 4` CAST IRON 12"MAX. P 12"MAX PIPE (OR 4"ORANGEBURG(OR EQUIV.) EQUIV.)— MIN. PIPE MIN. LEACH ' PITCH I/4"PER. PITCH 1/4 PER.FT PIT PRECAST NVERT o a ...`: LEACHING EL. SZ... INVERT INVERT o. a i' PIT OR c , SEPTIC TANK DIST. �r8o ; • w ';' EQUIV. 7 EL. ¢. . . ELB..•.... INVERT BOX �,So.Q. .. .. GAL. INVERT . INVERT w w o: ;�• 3/4"TO 11/2 EL&3,97 WASHED , w a• a e EL83.3o, e. � �: �:,. o w STONE 6'DIA, —+-) —t o'/� • ��— /O' DIA.----►-I No NE PROR LE OF GROUND WATER TABLE SEWAGE DISPOSAL SYSTEM NO SCALE r,no ���/JVU�LIVL►=�]� !] SOIL LOG WITNESSED BY : DATE !y9g: 7./?78... TIME. q:3o A.�l. �4�G '`�u lf-'IFAy . . . . . . BOARD OF HEALTH TEST HOLE I TEST HOLE 2 7r?/o.ys :5-. dCCLG ENGINEER ELEV. .,94,811 fzD bu V�oDGeqy DESIGN ' DATA • spa-sa,� ¢ ac" 4z„ NUMBER OF 'BEDROOMS CoAesE �QGaA� - TOTAL ESTIMATED FLOW 4`'t�. . GALLONS/DAY T`+N PAW., BOTTOM LEACHING AREA 78.Via. . . SQ.FT. /PIT. �rsT FINE FiwC SIDE LEACHING 'AREA SQ.FT./ PIT SAivD SRn/D GARBAGE DISPOSAL AREA INCREASE) izo TOTAL LEACHING AREA y.S;3¢-oo SQ.FT 3�1iv Jo sNc• PERCOLATION RATE . . . MIN/INCH 144 LEACHING .AREA PER PERCOLATION RATE `f 3. SQ.FT. No .WATER ENCOUNTERED NUMBER OF LEACHING PITS FWNAdy LLEYCO- ENGINEERS—SURVEYORS _ APPROVED . . . . . : . . . . . . BOARD'OF HEALTH � S?N�• . 346 LONG'P`OND DRIVE oti ,4�c sia&-s SOT.ITH YARMQ TH,.MASS. DATE 02664 AGENT OR'INSPECTOR EDWARD E. KELLEY CUMMAQUID, MASS, 02637 �OF MAss9 *of k$#ski �23 TH o H .n .24266 ,�utis}7t/Rv f? Be/TT-.v . t 9o�FG/STAL �4 /� L6aNA2D l72./✓E @ S a PETITIONER.: WEsT,yyrq,v�is�oo�7- /'7Ass � 'I I SYSTEM DESIGN: SYSTEM PROFILE NOTES LEGEND ALL SYSTEM COMPONENTS SHALL BE MARKED WITH MAGNETIC TAPE OR GARBAGE DISPOSER IS NOT ALLOWED COMPARABLE MEANS FOR FUTURE LOCATION. PROVIDE MIN. 20" DIAM. WATERTIGHT (NOT TO SCALE) 1. DATUM IS NAVD 88 0 99— EXISTING CONTOUR ACCESS COVERS TO WITHIN 6" OF FIN. GRADE CONCRETE COVERS TO WITHIN 3" GRADE X gg EXISTING 3 BEDROOM DWELLING 2" PEASTONE OR GEOTEXTILE 2. MUNICIPAL WATER IS EXISTING O �� EXIST. SPOT ELEV. FILTER FABRIC OVER STONE F —[99]— PROPOSED CONTOUR DESIGN FLOW: 3 BEDROOMS © 110 GPD = 330 GPD SLAB EL. 131.2 MINIMUM .751 OF COVER OVER PRECAST 2% SLOPE REQUIRED OVER SYSTEM 128 3. MINIMUM PIPE PITCH TO BE 1/8" PER FOOT. USE A 330 GPD DESIGN FLOW NOTE: 2" MIN. WALL 4. DESIGN LOADING FOR ALL PROPOSED PRECAST UNITS v oufe 6 [98.41 PROPOSED SPOT EL. THICKNESS REQUIRED BLOCKS OR TO BE AASHO H—LQ 4"�SCH40 PVC MORTAR ALL PRECAST RISERS poi/r000 m �' air/� TH1 PIPES LEVEL 1ST 2' COMPONENTS H-10 5. PIPE JOINTS TO BE MADE WATERTIGHT. e SEPTIC TANK: 330 GPD (2) = 660 ..{. :- s" MIN. SUMP �ENDJS 4' INV'S EL. 124.2 4'TEST HOLE t2" MIN. INT. DIM. (NP•)USE EXISTING ,150 GAL. SEPTIC TANK SIDES 125.03' 2� SLOPE OF GROUND TEE "` TEE ®®®® r -®®®O o000006. CONSTRUCTION DETAILS TO BE IN ACCORDANCE WITH' 310 CMR 15.000 (TITLE 5.) 10" 14" o°o°o°o° ;o°o°o°o°EXISTING. SEPTIC TANK *125.1 0 00 0 000° °° o0P11-1 o®a �®000000® °°°°°°°°LEACHING: * °o°°oozo°000° WATERTGHT D'BOX o >o°o 0 0 0 0 0 0 0 0 0 0 0 0 0 'o°o°o°o° ZUTILITY POLEV.I.F. o 0 0 0 0 0 0E]®E�OE2E2En®�O� OD o0007. THIS PLAN IS FOR PROPOSED WORK ONLY AND NOT TOSIDES: 2 (25 + 12.83) 2 (.74) = 112 GPD cAs BAFFLE �_o�oOo 0 0_. FOR LEVELNESS N ;0000g000 pOp�00000®®® P®DOO��O� ;oogog000 rc rag s a ° ° ° ° ° ° ° ° BE USED FOR LOT LINE STAKING OR ANY OTHER9 o r FIRE HYDRANT 124.47 124.30 °°°o°o°° °°°o°°°0 122.2' PURPOSE. BOTTOM 25 x 12.83 (.74) = 237 GPD :,.......•- : ,.•;. = :: I I NOTE: NOT ALL SYMBOLS MAY APPEAR IN DRAWING a 8. PIPE FOR SEPTIC SYSTEM TO SCH. 40-4" PVC. a 500 GAL. LEACHING CHAMBER BY ACME PRECAST OR EQUAL. TOTAL: 472 S.F. 349 GPD 3/4"-1-1/2" DOUBLE WASHED STONE 4' MINTH-10 (2) UNITS REQUIRED 9. COMPONENTS NOT TO BE BACKFILLED OR CONCEALED Locus ALL AROUND PRECAST STRUCTURES WITHOUT INSPECTION BY BOARD OF HEALTH AND 6" CRUSHED STONE OR MECHANICAL OVERALL DIMENSIONS TO OUTSIDE OF STONE: 25.00' X 12.83' Route 6 USE (2) 500 GAL. LEACHING CHAMBERS (ACME OR EQUAL) COMPACTION. (15.221 [2]) N PERMISSION OBTAINED FROM BOARD OF HEALTH. WITH 4' STONE ALL AROUND LO 10. CONTRACTOR SHALL BE RESPONSIBLE FOR CALLING *THE INSTALLER SHALL VERIFY THE DIGSAFE (1-888-344-7233) AND VERIFYING THE LOCATIONS OF ALL UTILITIES AND ALL LOCATION OF ALL UNDERGROUND & OVERHEAD UTILITIES LOCUS MAP BUILDING SEWER OUTLETS AND 117' BOTTOM TH-1 PRIOR TO COMMENCEMENT OF WORK. ELEVATIONS PRIOR TO INSTALLING ANY ( 1 % SLOPE) ( 1 7. SLOPE) NO GROUNDWATER FOUND T 11. ANY UNSUITABLE MATERIAL ENCOUNTERED SHALL BE SCALE 1 =2000 f MA PORTION OF SEPTIC SYSTEM LEACHING REMOVED 5' BENEATH AND AROUND THE PROPOSED ASSESSORS MAP 315 PARCEL 9 APPROVED DATE BOARD OF HEALTH FOUNDATION— EXIST. SEPTIC TANK 24 D' BOX 12' FACILITY LEACHING FACILITY. **INSTALLER SHALL CONFIRM MINIMUM SEPTIC 12.�'EXISTING LEACHING FACILITY SHALL BE PUMPED AND TANK SIZE AT 1000 GALLONS AND ITS SUITABILITY REMOVED OR PUMPED AND FILLED WITH CLEAN SAND. FOR RE—USE. REPLACE WITH 1500 GALLON V SEPTIC TANK APPROPRIATE TO SITE CONDITIONS IF NOT SUITABLE Q O Q D J 4 � O m TEST HOLE LOGS ENGINEER: CRAIG J. FERRARI, SE #13871 `'VZE 9 DAVID W. STANTON IRS,2, WITNESS: DATE: 1 1/23/2016 138 PERC. RATE _ < 2 MIN/INCH CLASS I SOILS P# 15204 �r- r; 136D� ELEV. ELEV. p" 129' 099 129' --135 A A LS LS L T 9» 10YR 2/2 6» 10YR 2/2 15 ,964± S.F. 733 B B LS 1 OYR 6J4 10,• R"6/4 28" 126.7' 24„ 127' C1 C1 VFS VFS 5' EMOVAL OF UNSUIT LE SO REQUIRED 10YR 6/2 10YR 6/2 A UND PERIMETER 0 FACILITY, 60" 124 54" 124.5' D TO SUITABLE SOIL LAYER. REPLACE TH CLEAN MED. SAND, TO MEE SPECIE A NS OF 310 CMR 15.255(3) IRT DRIVE 7�3 � PERC C2 C2 ,30 —71.6' TH2 742 F/M S F/M S TH 1 � �: 10YR 7/4 10YR 7/4 , O o O 144 117 144 117 BENCH MARK — SILL T NO GROUNDWATER ENCOUNTERED WALKOUT DOOR. EL. = 1 1.2 0.5' i NC) p \ O O D� EXISTING TITLE 5 SITE PLAN DWELLING 1D OF #99 BOULDER ROAD DECK BARNSTABLE, MA 137 0 PREPARED FOR BORTOLOTTI CONSTRUCTION / O'LEARY � 139 0 N 0 BARN DATE: NOV. 29, 2016 Scale: 1"= 20' D0 10 20 30 40 50 FEET PN° sa� � � q�? off 508-362-4541 fax 508-362-9880 UANIEI_A.9c \�, DANIEL Sim downcape.com OJALA A. CIVIL f OJALA 098 down cope eI18'%17LOLO '%IT kc. 02 rdo.409�0� � civil engineers R G1S E l q ASS, ENS' bl ROE�. � � land surveyors �'" ,NAL 939 Main Street ( Rte 6A) DCE # 6-382 D �D DATE DANIEL A. OJALA, P.E., P.L.S. YARMOUTHPORT MA 02675 16-382 r t A