HomeMy WebLinkAbout0208 BRAGG'S LANE - Health J'
208 Bragg,''�s Lane
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TOWN OF BARNSTABLE o
LOCATION d-3 9. 13�u 5 g c 1-�- SEWAGE #` S�
VILLAGE ASSESSOR'S MAP & LOT °?q8 a1)
INSTALLER'S NAME&PHONE NO.
SEPTIC TANK CAPACITY /d a
LEACHING FACILITY: (type) (size)
NO.OF BEDROOMS_
BUILDER OR OWNER
PERMTTDATE: COMPLIANCE DATE:
Separation Distance Between the:
Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet
Private Water Supply Well and Leaching Facility (If any wells exist
on site or within 200 feet of leaching facility) Feet
Edge of Wetland and Leaching Facility(If any wetlands exist
within 300 feet of leaching facility) Feet
Furnished by
S
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St i
/%®/en-
Imo. If 'G6)1//G
TOWN OF BARNSTABLE
LOCATION 2 09 /394,74,e, 1,4rV(-- SEWAGE#,Xo-T-OF
VJLLAGE A icl(_ASSESSOR'S MAP&PARCEL
INSTALLERS NAME&PHONE NO. (?o ZgZ45CW SeP+ (C 368--7-75'S'77(o
SEPTIC TANK CAPACITY !logo
LEACHING FACILITY: (type)TftV3JC-((S (size) 13 54 L q;12
NO. OF BEDROOMS
OWNER rToh,,J &�QW±1F
PERMIT DATE: l�'h`7 COMPLIANCE DATE: ,31,nLo-7
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) Feet
FURNISHED BY
+ ' i
9
0
No: O �+4 ZG�C 4300 .00
THE COMMONWEALTH OF MASSACHUSETTS� Entered in computer:
PUBLIC HEALTH DIVISION - TOWN OF BAkNSTABLE, MASSACHUSETTS Yes
Zipplication for �Ngpozal �§pztEm Cow5trUction Permit
Application for a Permit to Construct( ) Repair(X) Upgrade( ) Abandon( ) ❑ Complete System Alnolividual Components
Location Address or Lot No. Owner's Name,Address,and Tel.No. 3 6 2—1 7 3 3
208 Braggs Ln, Barnstable John & Dianne Hayes
Assessor'sMap/Parcel 298/71 208 Braggs Ln, Barnstable
Installer's Name,Address,and Tel.No. 7 7 5—8 7 7 6 Designer's Name,Address and Tel.No. 3 6 4—0 8 9 4
Wm E Robinson Sr Septic Eco-Tech
PO Box 1089 , Centerville 1 43 Triangle Cir, Sandwich
Type of Building:
Dwelling No.of Bedrooms 2 Lot Size sq. ft. Garbage Grinder (ng
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow(min.required) r�U gpd Design flow provided 3 L) gpd
Plan Date Number of sheets Revision Date
Title
Size of Septic Tank 1 i 0 0 Type of S.A.S. II^^ 21
Description of Soil i✓ S�ln�'
Nature of Repairs or Alterations(Answer when applicable)
Install a new Title 5 leach
system to plans of Eco-Tech, #ETE-2562
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 H alth. F
Signed Date ✓y 07
Application Approved by 04.E. � ( Date 3--0''o'7
Application,Disapproved by: Date
-for the following reasons
Permit No. ���� ��y Date Issued ��-
Z r{s -` s _:^ 1 "-;;,� j.,y�4 �,/ T-:fi: .... -+ .. .:t;c>t •..:.�..� 8`..ii-y-.rw s:eXP�+.f�Vr•.? "�'. -`Fr-.. . -.,,-. ti
No. .v{t�U 7'• (}�,�'t' ' �j�- �F Z 0 C_ .- &10 0.00
THE COMMONWEALTH OF MA$ ACHUSETTS Entered in computer:
,,
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes k
1pprica:tion for � gpoga[ gppgtem Construction Permit
Application,for a Permit to,Construct( ) "Repair(K) Upgrade( ) Abandon( ) ❑ Complete System;N Individual Components
Location Address or Lot No. Owner's Name,Address,and Tel.No. 3 6 2—1 7 3 3
208 Braggs U'n, Barnstable John & Dianne Hayes
Assessor'sMap/Parcel 298/71 208 Braggs Ln, Barnstable
Installer's Name,Address,and Tel.No. 7 7 5—8 7 7 6 Designer's Name,Address and Tel.No. 3 6 4—0 8 9 4
E Robinson Sr Septic Eco-Tech
P ,.Box. 1089 • Centerville 1 43 Triangle Cir, Sandwfth
Type of Building:
Dwelling` No.'of Bedrooms 2 Lot Size sq.ft. Garbage Grinder 00)
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow(min.required) gpd Design flow provided 3 ?y gpd
Plan Date Number of sheets Revision Date
Title
Size of Septic Tank /b 0 0 X Type of S.A.S. b 0�^ c�`^^�°�� h Y' 'S Y.
Description of Soil
Nature of Repairs'orAlterations(Answer when applicable) Install a new Tittle 5 leach 1
system to plans of Eco-Tech, #ETE-2562
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 H alth.
Signed //v Date (�'
Application Approved by I 4 A Date .?—&,0—7
Application Disapproved by: Date
for the following reasons ,
Permit No. 0? Date Issued 3--8--0`7
3 ��� ? � THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE, MASSACHUSETTS
Hayes Certificate of Compliance
THIS IS TO,CERTIFY,that the On-site Sewage Disposal System Constructed ( ) Repaired (X ) Upgraded ( )
'4_ Abandoned( )by Wm E Robinson Sr Septic
at 208 Braggs Lane, Barnstable has been constructed in accordance
with the provisions of Title 5 and the for Disposal System Construction Permit No. .2 0077-4 Ll dated 3-6 •D'7
Installer Designer +
#bedrooms oZ— t 3 de fa,) Approved design flow gpd
The issuance of:his permit shallno be construed as a guarantee that the system will fu��n((ct�iorn� as designed.
Date Inspector� �'C
No. '?' og -2 Me)0.00
THE COMMONWEALTH OF MASSACHUSETTS
Ha THE
HEALTH DIVISION—BARNSTABLE, MASSACHUSETTS
Migogat i§pgtem Cougtruction Permit
Permission is hereby granted to Construct ( ) Repair (X ) Upgrade ( ) Abandon ( )
System located at 208 Braggs .Lane, 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 must be completed within three years of the date of this permit'.
f�
Date 2 `0 -7 Approved by �-
Town of:-Barnstable
Regulatory.Services
• SARNSE 13M s
'Thomas F, Geiler,Director
, �� Public Health Division
'leap A Thomas McKean,Director
200 Main Street,Hyannis,MA 02661.
Office: 508-8 62-4644.
Fax: 508-790=6304
Installer&Designer Certification Form
Bate: = Sewage Permit# G t- J)J L , 2 9 8/71
Assessors MapTarcel
Designer Eco—Tech Installer: Wm. E Robinson Sr Septic.
Address 43 Triangle Circle PO Box 1089
Address:
- Sandwich Centerville
Ori_ Wm E Robinson Sr Septic
was issued a permit
(in to:install a
(date) .
staller)
septic system at 208 Braggs Ln, Barnstable
(address) based on a design drawn by
Eco.-Tech 02-26-07
date
d
(designer).
I certify.that the septic. system referenced above w
the design, as"installed substantially according to
go which and/or
septic
t minor approved changes.such.as lateral.relocation of the
distribution box and/ar'septic fank:..
I.certify that the septic system referenced above was".installed with major changes
greater than .l®' lateral relocation of the SAS or any vertical relocation of any co ponent
of the septic system)but in accordance vvitli State�c Loeal certified as-built by designer to foll€w. &Wations . Plan revision or
.�oF �ass,��tiG,�
Googol,
(Ills er's Signature)
16YDve 10,
�es Signature)
(_Affix Designer's Stamp Here)
PLEASE .RETURN. TO..-BARNSTABLE PUBLIC EALTH. DIVISION. .. CERTIFICATE
XEUE LIANCE..WILL.NOT. BE ISSUED UNTIL BOTH( THIS FORM ®F._
40
too-
RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. A1v73 AS-BUILT C�
THAI�it{YOU.
Q:Health/Septic/Designer Certification Form 3-26-04.doc
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• Town of Barnstable P#
Department of Regulatory Services
: auwsrnstE,
Public Health Division Date rE B ZOO
Mess. ;
.659. 200 Main Street,Hyannis MA 02601
Date Scheduled Time Fee Pd.
Soil Suitability Assessment for Sewage Disposal
Performed By: D kylb. ��y�H I�OWR K7 '^Witnessed By:
LOCATION& GENERAL INFORMATION
Location Address 101 �rq� h Owner's Name 1'&H l/ t,b i A-V We
g�P.uS-t#4i-E H�kE s
r d � Address �RGGS LW %0gNsT
Assessor's Map/Pare l: . - 7 , / Engineer's Name
NEW CONSTRUCTION REPAIR V Telephone#50,6 1 j(A- (9 4-
Land Use 49 t,0 E N I l A C, Slopes(% Surface Stones S O I►I e
Distances from: Open Water Body OD t ft Possible Wet Area L0 d+ ft Drinking Water We11 400 4 g
Drainage Way D t ._ ft Property Line Q f -- -ft Other - ft
SKETCH:(Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands n proximity to holes)
y� TALL Y—HO LANE
A -110.00 Ft
W GROUNDWATER ADJUSTMENT ,
��-�-- - I EXISTING GROUNDWATER LEVEL
BASED ON TOWN OF BARNSTABLE
I GIS DEPARTMENT .RECORDS.
N l '4w j INDICATED GW 23.00 i
I q) t !R INDEX WELL AIW-247
Q) ti I ZONE B { HaiiTR6Ks
< I ®Q f READING DATE JANUARY, 2007
READING 23.0 1 /► c
a® r ADJUSTMENT 2.3 !l�
4 I ADJUSTED GW 25.38 �.� --`(,�
4 �
•p* 1 __
Parent material(geologic) CI ! C)Vf NR S Depth to Bedrock.
Depth to Oroundwater: Standing Water in Hole: WO t1 a Weeping from Pit Face IL041E
Estimated Seasonal High Groundwater .5ee oba✓e
DETERMINATION FOR SEASONAL HIGH WATER TABLE
Method Used: 5" 4�Qlr fe
Depth Observed standing in obs.hole:. _`_ ________ In. Depth to sail mottles: in.
Depth to weeping from side of obs.hole: in, Groundwater Adjustmeat fr.
index Weil#: -� —UReading Date: "Index Well level Adj.factor AdJ:Ordundwnter level,
PERCOLATION TEST Date Thne 12?In
Observation
Hole# ' - Time at 9"
Depth of Perc 10 - 1 h Time at 6" h
Start Pre-soak lime @ + °4 _ 'time(9"-6")
End Pre-soak 10 7 6 '
Rate Min./Inch ` ` , 2v►1 1 �/
Site Suitability Assessment: Site Passed_ Site Failed:_\'Additional Testing Needed(Y/N)'
Original: Public Health Division Observatiori Hole Data To Be Completed oWBack------------
***If percolation test is to be conducted within 100 of wetland,you must first notify the
Barnstable Conservation Division at least one(1)week prior to beginning.
Q:ISEPTIC\PERCFORM.DOC
SOIL TEST ,'LOG �T
DATE OF TEST: FEBRUARY 24. 2007
SOIL EVALUATOR:- - DAVID D. COUGHANOWR. R.S.-
WITNESSED BY: DONALD DESMARAIS. HEALTH DEPT.
PERC NUMBER: -P-11676— - , —
T E S T PIT- 1 ---NO-GROUNDWATER ENCOUNTERED
i PARENT MATERIAL: PROGLACIAL OUTWASH
PERC AT 102 to - 2 MIN/INCH IN C2 SOILS
ELEVATION DEPTH SOIL USDA SOIL SOIL COLOR SOIL
(INCHES) HORIZON TEXTURE (MUNSELU MOTTLING OTHER
90.80
0-4 0 WOOD.LOAM' 10 YR 2/2 NONE FRIABLE
4-8 A SANDY LOAM 10 YR 4/4 NONE FRIABLE
8-36 B LOAMY SAND 10 YR 5/6 NONE FRIABLE
36-84 Cl� LOAMY
e 10 YR 5/4 NONE
3.90
MEDIUM SANDFRIABLE
,
84-144 C2 MEDIUM SAND 10 YR 6/4 NONE
i �8.80 LOOSE '
! TEST PIT 2
NO GROUNDWATER ENCOUNTERED
-PARENT MATERIAL: PROGLACIAL OUTWASH
2 M IN/INCH IN C2 SOILS }
ELEVATION DEPTH SOIL USDA SOIL SOIL COLOR SOIL
(INCHES) HORIZON TEXTURE (MUNSELL)
69.90 MOTTLING OTHER
-
0-5 O WOOD LOAM 10 YR 2/2 NONE FRIABLE
i 5-14 A SANDY LOAM 10 YR 4/4 NONE FRIABLE
14-38 B
LOAMY SAND 10 YR 5/6 _ -NONE FRIABLE
38-92 C1 LOAMY 10 YR 5/4 NONE
82.23 - -- MEDIUM SAND FRIABLE
77.90 92-144 _C2- MEDIUM SAND 10 YR 6/4� NON
_ __ _ i LOOSE
Depth from
DEEP OBSERVATION HOLE LOG Hole#
Soil Horizon Soil Texture
Surface(in.) Soil Color Soil Other
(USDA) (Munsell) Mottling (Structure,Stones;Boulders, .
n ' tn
Flood Insurance Rate Map.•
Above 500 year flood boundary No_ Yes
Within 500 year boundary No . 1/ Yes,;_
Within 100 year flood boundary No V Yes .
Death of Naturally Occurring Pervious Material
Does at least four feet oft I curring pervious material exist in all areas observed throughout the
area proposed for th q . tem? K�S
If not,what is the tl ing pervious material?
� N
o D. inCertification U -{
I certify n e �NC� aR � .
ve passed the soil evaluator examination approved by the
Department of En �� nd that the above analysis was performed b me consistent
the r o Y stent with .
equired training,i g
. fi fence described in 310 6MR'15.017.
Signature Date F4 24, W0 7
Q.%$EMCIPERCFORM.DOC
F5
TROY WILLIAMS
SEPTIC INSPECTIONS
Certified by MA Department of Environmental Protection (508) 585-1300
19 Hummel Drive
South Dennis, MA 02660
\ COMMONWEALTH OF MASSACHUSETTS [P%7
EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS 1 O
J 9 1�i
DEPARTMENT OF ENVIRONMENTAL PROTEC
ONE WINTER STREET. BOSTON, MA 02108 617-292•5500
WILLIAM F.WELD 1104,,10,
J �T �{DY CORE
Govcmor � �95]scrctan••.
ARGEO PAUL CELLUCCI S /
�F'�blD B.STRUHS�
Lt.Govcmor SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM Commissi`o`n
PART A �✓
CERTIFICATION
Property Address: ozd is ��r'`� ��S L'^ 13"&"k%5'�& S�t• Address of Owner:
Date of Inspection: �o 3 yy (If different) Kc ✓v+ �� ' S
Name of Inspector: Troy W i 11 i a m s
I am a DEP approved system inspector pursuant to Section 1S.340 of Title S (310 CMR 1S.000)
Company Name: T r o y W i 11 i a n s Se Pt i c I.n S P e C t i on S lJce✓n 5 AZI LJ / ItA
Mailing Address: 19 Hummel Drive , South Dennis , MA 02660
(
Telephone Number: 50 8T38 5-130 f) v-� 3 v
CERTIFICATION STATEMENT
I certify that 1 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 o(on-site sewage disposal systems. The system:
Passes
_ Conditionally Passes
_ Needs Further Evaluation By the Local Approving Authority
_ Fails Q
Inspector's Signature: J � �+-✓- Date:
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, 8, C, or D:
A) SYSTEM 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.
COMMENTS:
BI SYSTEM CONDITIONALLY PASSES: A11
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.
Indicate yes,no,or not determined(Y, N, or ND). Describe basis of determination in all instances. If'not determined',explain why not.
The septic tank is metal, unless the owner or operator has provided the system inspector with a copy of a Certificate of
Compliance (attached) indicating that the tank was installed within twenty(20)years prior to the date of the inspection; or
the septic tank,whether or not metal, is 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 conforming septic tank
as approved by the Board of Health. -
(r—i—d 04/1S/97) Paq• 1 of 10
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address:
Owner: 04-1 ( S
Date of Inspection: !O / 3,>
B] SYSTEM CONDITIONALLY PASSES (continued) Al1,�►
Sewage backup cr 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). Describe observations:
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
CJ 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 the
public health, safety and the environment.
1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER
WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT:
Cesspool or privy is within 50 feet of a surface water
Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh.
2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH (AND PUBLIC WATER SUPPLIER, IT APPROPRIATE) DETERMINES THAT
THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECTS THE PUBLIC HEALTH AND SAFETY AND THE
ENVIRONMENT:
The system has a septic tank and' soil absorption system (SAS) and the SAS is within 100 feet to a surface'water supply or
tributary to a surface water supply.
— The system has a septic tank and soil absorption system and the SAS is within a Zone I of a public water supply well.
The system has a septic tank and soil absorption system and the SAS is within 50 feet of a private water supply well.
The system has a septic tank and soil absorption system and the SAS is less than 100 feet but 50 feet or more from a
private water supply 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. Method used to determine distance (approximation not valid).
3) OTHER
(revised 04/25/97) - Pace 2 of 10
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: 2 O ✓!.e`��S S !.� .
Owner. J�J + 5 C
Date of Inspection:
DI SYSTEM FAILS: All', �
You must indicate ewer "Yes" or "No" as to each of the following:
I have determined that the system violates one or more of the following failure criteria as defined in 310 CMR 15.303. The basis
for this determination is identified below. The Board of Health should be contacted to determine what will be necessary to correct
the failure.
Yes No
Backup of sewage into facility or system component due to an overloaded or clogged SAS or cesspool.
Discharge or ponding of 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 112 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
coliform bacteria, volatile organic compounds, ammonia nitrogen and nitrate nitrogen.
E] LARGE SYSTEM FAILS: IV14
You must indicate either "Yes" or "No" as to each of the following:
The following criteria apply to large systems in addition to the criteria above:
The 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 health and safety and the environment because one or more of the following conditions exist:
Yes No
the system is within 400 feet of a surface drinking water supply
the system is within 200 feet of a tributary to a surface drinking water supply
_ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area- IWPA) or a mapped Zone Il of a
public water supply well)
The owner or operator of any such system shall bring the system and facility into full compliance with the groundwater treatment program
requirements of 314 CMR 5.00 and 6.00. Please consult the local regional office of the Department for further information.
(ravlaud 04/2S/97)
Page 3 of 10
SUBSURFACE_ SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST
Property Address:
Owner: 011-U' c)
Date of Inspection:
Check if the following have been done: You must indicate either "Yes" or "No" as to each of the following:
Yes No '
Pumping information was provided by the owner, occupant, or Board of Health.
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.
As built plans have been obtained and examined. Note if they are not available with N/A.
v _ The facility or dwelling was inspected for signs of sewage back-up.
The system does not receive non-sanitary or industrial waste flow.
_ The site was inspected for signs of breakout.
_ All system components, excluding the Soil Absorption System, have been located on the site.
_ The septic tank manholes were uncovered, opened, and the interior of the septic tank was inspected for condition of
baffles or tees, material-of construction, dimensions, depth of liquid, depth of sludge, depth of scum.
The size and location of the Soil Absorption System on the site has P Y been determined based on:
_ _ The facility owner (and occupants, if different from owner) were provided with information on the proper maintenance of
Sub-Surface Disposal System.
�YL _ Existing information. Ex. Plan at B.O.H.
]C _ Determined in the field (if any of the failure criteria related to Part C is at issue, approximation of distance is
unacceptable) (15.302(3)(b))
(reviaad O4/25/97) P -
Page 4 of 10
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
Property Address: y S L
Owner: �0 ) -S
Date of Inspection: j o /70
FLOW CONDITIONS
RESIDENTIAL:
Design flow:aka g.p.d./bedroom for S.A.S.
Number of bedrooms: o�
Number of current residents:
Garbage grinder (yes or no):—�— S
Laundry connected to system (yes or no): Y�S
Seasonal use (yes or no):-/—^,/Q
Water meter readings, if available (last two (2) year usage (gpd): 5G y 7 = 6 3 a� o v 4jj0 a s `S--y 6 0
Sump Pump (yes or no): No
Last date of occupancy:
COMMERCIAUINDUSTRIAL• /11119
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:
/7,i, o�— ✓.�c f . o.,� � S >✓-ze.. �-.-c c/t �.. � y H. U cam.%�,-c✓.
System pumped as part of inspection: (yes or no)�l0 r
If yes, volume pumped: gallons
Reason for pumping:
ySeptic
SYSTEM
tank/distribat;er�-�e*/soil absorption system
Single cesspool
Overflow cesspool
Priv
y
Shared system (yes or no) (if yes, attach previous inspection records, if any)
VA Technology etc. Copy of up to date contract?
Other
APPROXIMATE AGE of all components, date installed (if known) and source of information:
Sewage odors detected when arriving at the site: (yes or no) A10
(revised 04/25/97) page 5 of 10
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: '2 Z3 r` f`� -S
Owner: o� S
Date of Inspection: f 3 •' Y 7
BUILDING SEWER:
(Locate on site plan)
Depth below grade:
Material of construction: _cast iron _40 PVC _ other (explain)
Distance from private water supply well or suction line
Diameter
Comments: (condition of joints, venting, evidence of leakage, etc.)
SEPTIC TANK:
(locate on site plan)
Depth below grade: /
Material of construction: JZC'Oncrete _metal _Fiberglass _Polyethylene _other(explain)
If tank is metal, list age — Is age confirmed by Certificate of Compliance —(Yes/No)
Dimensions:_ '�'�-/ ��'c /UU o
Sludge depth: ,
Distance from top of sludge to bottom of outlet tee or baffle: v2 �
Scum thickness: / CA
Distance from top of scum to top of outlet tee or baffle: (o
Distance from bottom of scum to bottom of outlet tee or baffle: /Y
How dimensions were determined:
Comments:
(recommendation for pumping, condition of inlet and outlet tees or baffles, depth of li id level in relation to outlet invert, structural
integrity, evidence of leakage, etc.) C.h
At cam. �v SAY✓� �LL1/✓G�. G(.G rslc( �.�4
+ u H C/(
GREASE TRAP:—,A—///9.
(locate on site plan)
Depth below grade:
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: a
Date of last pumping:
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.)
Y
(rwised 01/25/97) Page 6 of 10
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: p)
Owner: n /
Date of Inspection:Q/a"
TIGHT OR HOLDING TANK: (Tank must be pumped prior to, or at time, of inspection)
(locate on site plan)
Depth below grade:
Material of construction: _concrete _metal _Fiberglass _Polyethylene —other(explain)
Dimensions:
Capacity: gallons -
Design flow: gallons/day
Alarm level: Alarm in working order_Yes; _ No
Date of previous pumping:
Comments:
(condition of inlet tee, condition of alarm and float switches, etc.)
DISTRIBUTION BOX: ' 111-9
(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.)
Sk1 !le--:.( / ;i. �, o c� — �, o� ✓�. �Q .
PUMP CHAMBER:
(locate on site plan)
Pumps in working order: (Yes or No)
Alamo in working order(Yes or No)
Comments:
(note condition of pump chamber, condition of pumps and appurtenances, etc.)
P
(revised 04/25/97) Pay 7 of 10 .
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: I? Orz'r 5 S Lh .
Owner: OCA�✓' S
Date of Inspection: /a / 3 v /9
SOIL ABSORPTION SYSTEM (SAS):_
(locate on site plan, if possible; excavation not required, but may be approximated by non-intrusive methods)
If not determined to be present, explain:
Type:
leaching pits, number: 011
leaching chambers, number:_
leaching galleries, number:
leaching trenches, number,length:
leaching fields, number, dimensions:
overflow cesspool, number:
Alternative system:
Name of Technology:
Comments:
(note condition of soil, signs of hydraulic fail u e, level of ponding, condition of vegetation, etc.)
G. ` 'Z. O 7'
vh C S ..� i u 4.
CESSPOOLS: _,A/�11
(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(cesspool must be pumped as part of inspection)
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.)
(revised 04/25/97) p Page 8 of 10
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
�2 SYSTEM INFORMATION (continued)
Property Address: U
Owner: 0p-J S
Date of Inspection: /D ' 3 v 9
SKETCH OF SEWAGE DISPOSAL SYSTEM:
include ties to at least two permanent references landmarks or benchmarks
locate all wells within 100' (Locate where public water supply comes into house)
�dUO yG,J(eti
(revised 04/25/97) p Page 9 of 10
Y
f
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: '?V !K
Owner: 0-• 5
Date of Inspection: o el3'' / ? 7
I
Depth to Groundwater Feet — adjusted high groundwater level
Please indicate all the methods used to determine High Groundwater Elevation:
Obtained from Design Plans on record
Observation of Site (Abutting property, observation hole, basement sump etc.)
V Determine it from local conditions
Check with local Board of health
Check FEMA Maps
Check pumping records
Check local excavators, installers
Use USGS Data
I
Describe in your own words how you established the High Groundwater Elevation. (Must be completed)
1 4—
(revised 04/25/91) r, Page 10 0! 10
SOIL_ TESL LOG _ f ._ F Y. ` DESIGN. C. A-LCULATIONSJ /
DATE OF TEST: . FEBRUARY 24. 2007 •- DESIGN FLOW: 2 BEDROOMS X liO GPD = 220 GPD
SOIL EVALUATOR: DAVID D. COUGHANOWR. R.S. SEPTIC TANK: 220 GPD X 2 DAYS = 440 GALLONS
WITNESSED BY: DONALD DESMARAIS. HEALTH DEPT. USE EXISTING 1000 GALLON SEPTIC TANK IF IN SOUND STRUCTURAL
PERC NUMBER: P-11676 CONDITION. IF NOT. INSTALL 1500 GALLON SEPTIC TANK (MINIMUM ALLOWED) »
NO
GROUNDWATER ENCOUNTERED
D
OUTWASH DISTRIBUTION BOX: USE 3 OUTLET H-20
TEST PIT 1 -BOX.
SOIL ABSORBTION SYSTEM: A 24 ft x 12.5 FL x 2 ft LEACHING,•GALLERY CAN LEACH
PERC AT 102 in - 2 MIN/INCH IN C2 SOILS
Abot = ( 24 x 12.5 ) = 300 sf
Asdw = ( 24 + 24 + 12.5 + 12.5 ) x -2 = 146 sf
ELEVATION DEPTH SOIL USDA SOIL SOIL COLOR SOIL OTHER ALc3L = 446 sf
(INCHES) HORIZON TEXTURE (MUNSELL) MOTTLING V,t 0.74 x 446 = 330.04 GPD
90.80 USE .A 24 FL x 12.5 Ft- x 2 FL GALLERY. Vt 330.04 GPD > 220 GPD REQUIRED
0-4 O WOOD LOAM 10 YR 2/2 NONE FRIABLE
4-8 A SANDY LOAM 10 YR 4/4 NONE FRIABLE
NOT TO
8-36 B LOAMY SAND 10 YR 5/6 NONE FRIABLE
LEA CHI LI G GALLERY SCALE
36-64 Cl LOAMY 10 YR 5/4 NONE FRIABLE USE SHOREY PRECAST 500 GALLON LEACHING DRYWELL (H-20 LOADING)
83.90 MEDIUM SAND
84-144 C2 MEDIUM SAND 10 YR 6/4 NONE LOOSE CONSTRUCTION DETAIL 500 GALLON DRYWELL
76.80 DIMENSIONS AND DETAIL
DRYWELL UNIT STON USE H-20 UNIT
NO GROUNDWATER ENCOUNTERED u INSTALL o WITHIIN INSPECTION
TEST PIT' . 2 _ N
PARENT MATERIAL: PROGLACIAL OUTWASH 24.0 ft � INCHES OF FINAL GRADE
2 MIN/INCH IN C2 SOILS a m� ONDAS-BUILTEPLANATION
M`` 4I
� L -
ELEVATION DEPTH SOIL USDA SOIL SOIL COLOR SOIL OTHER �Q �Q m Lq
(INCHES) HORIZON TEXTURE (MUNSELL) MOTTLING N N p 33
89.90 ; M. 000� o OOOp In -
o0000000000 0000
0-5 O WOOD LOAM 10 YR 2/2 NONE FRIABLE m 00 6.5 ft 8.5 ft .5 Ft o000000000ao 0�� S�
5-14 A SANDY LOAM 10 YR 4/4 NONE FRIABLE 24.0 Ft ) �0
14-36 B LOAMY SAND 10 YR 5/6 NONE FRIABLE 102 1"
36-92 Cl LOAMY 10 YR 5/4 NONE FRIABLE
62.23 MEDIUM SAND CROSS SECTION VIEW
92-144 C2 MEDIUM SAND 10 YR 6/4 NONE LOOSE 2 in PEASTONE 2 in,PEASTONE
?�.90
26 3/4 in TO 24 in -
EFFECTIVE 3/4 in26
NOTES
• In 1-1/2 in GRAVEL DEPTH 1-1/2 in GIn -
INSTALLER MAY ELECT
STITUTE AN
1) GARBAGE GRINDER NOT ALLOWED WITH THIS DESIGN. APPROVED GEOTEXTILE
46 In 5B In 46 In FABRIC IN PLACE OF
2) SEPTIC TANK TO BE PUMPED DRY AT TIME OF SYSTEM REPAIR AND CHECKED THE 2 in. PEASTONE.
FOR STRUCTURAL INTEGRITY. INSTALL PVC OUTLET TEE FITTED WITH GAS BAFFLE. 150 in, LAYER SPECIFIED.
3) ALL ` COMPONENTS INSTALLED SHALL MEET THE MINIMUM REOUIREMENTS -
OF MASSACHUSETTS TITLE 5 SEPTIC CODE (310 CMR 15). _
4) INSTALLER TO' VERIFY LOCATIONS OF ALL. UNDERGROUND UTILITIES
BEFORE EXCAVATING' FOR SYSTEM.
5) EXISTING LEACH PIT TO BE PUMPED. COLLAPSED. AND FILLED OR REMOVED. GROUNDWATER ADJUSTMENT
6) ALL STONE TO BE DOUBLE WASHED AND FREE OF IRON. ,FINES-,AND DUST,_, IN PLACE.
Z) LINES EXITING D-BOX TO RUN LEVEL FOR 2'-0". BEFORE PITCHING',DOWN' _ EXISTING GROUNDWATER LEVEL SEWAGE DISPOSAL SYSTEM. PLAN
BASED ON TOWN OF BARNSTABLE
-
6) ECO-TECH, ENVIRONMENTAL RECOMMENDS THE INSTALLATION':OF ,LOW_ G
FLOW\ FIXTUR GIS DEPARTMENT RECORDS. ,-
—TO SERVE EXISTING DWELLING
AND 'APPLIANCES. AND 'BIANNUAL PUMPING OF THE :SE.PT.;IC�`'. ANK wI` � ( `- ' INDICATED W 23.00
`T si INDEX WELL A1W-24� JOHN AND DIANNE HAYES
9) -SYSTEM ' IS,:NOT DESIGNED TO WITHSTAND VEHICULAR LOADING. DO NOT. �; ZONE PARK OR°DRIVE VEHICLES OVER SEPTIC SYSTEM. "^ , ` n;` , READING DATE BJANUARY. 200� 208 BRAGGS LANE r BARNSTABLE MA
10) INSTALLER ,TO OBTAIN DISPOSAL WORKS PERMIT. BEFORE STARTING WORK. READING 23.0
*''„ ADJUSTMENT 2.3 _
»_ , ADJUSTED GW 25.30 ECO TECH ENVIRONMENTAL 11) SEPTIC TANKS SHALL BE INSTALLED LEVEL AND TRUE TO GRADE ON- A LEVEL
STABLE 'BASE, THAT HAS BEEN MECHANICALLY 'COMPACTED ,AND ON TO WHICH 43 TRIANGLE CIRCLE a SANDWICH MA 02563
SIX INCHES- OF CRUSHED STONE HAS BEEN PLACED -TO, MINIMIZE' UNEVEN-'SETTLING.
` ETE-2562 FEBRUAR-Y 26, 20071212
I -
;W � `r r BARNSTABLE. MA
} CONTOURS
m = z t
0'Tu o .,T 4, / 4�� ' EXISTING - .- .-. -t- - - 50 N
w0w�' --af
1�_,s2 ® PROPOSED 50 T
m 70 b 00 O \ M��C/. ` LOCUS 9<<}
W m H C V ;Olt,
y
w� -iL=i�m �m� m 5 E of P/ "'�
> <cn<� oor N ��' LEGEND
~ °F tiF
m Ul Ul mmEXISTING
m 5 �� i I IVY. ` 000 CALLON
—A SEPTIC TANK
C7 m H-20 D-BOX ❑
=w PIT TEST/ / 14 \0
mJ< \ � ® LOCUS MAP
w« /� \ EXISTING O NOT TO SCALE
(n Z❑ /
(nOZ LEACH PIT O
... m � 'm
O c 7 W _)Q p / B2� \ / p \�84 UTILITY POLE
O ?p / m wcr
cy OQ m(� 336A �i� \ DRAIN
W l-J W / j \ TREE
W //''� > 84 / \H -NUMBER REFERS TO
/�^ J O rn�1 Fm � �" 3 -I(\\'�/ \ LETTER DENOTES TYPE. IB-P
J z LL \ _ - .DIAMETER IN INCHES.
J m W LLJ w Z B6 \ m O-OAK M-MAPLE P-PINE
�Z ZW NWT U J > O m \ \ 86 O.
>e �Z LO ``X- ILp W w I_ \ EXISTING
of Lo 1 v W es�� 2 BEDROOM
w w w� m ° \ DWELLING
LOT 72 `
Lc � m0 J m �\ TOP OF FNDN AREA = 35946 sF +- \
O O J O O EL = 90.09+-LL
-
mom m ; ;88 Z
wz Z W J� �
U LLu LL w ir LL zz X m '' \ 50
m
CL� O Z LL N m m Lo N 90
m � d
coJ W 1-0� O = m 0 -0 \0
Z Z IB-o -h
Cc)~ Z wwU 0
W — (D=O 24FLx125Ftx2Ff-
\ \
O x z Z J w FCD
LEACHING GALLERY TP-] \
LIJ Z U) w..w ~ VENT PIPE O `90
z Z m Q rP- 1
W O z 07 u SOIL REMOVAL AREALu
\ t \
W ~ J=0 3 ft \
co 3 ��z
1-3 4J
0
O m0z N / 1
LLl Z O z 043
(V \ 92
w
O pi
CC) \ /
W u W _
w 92�- m; / �� 94
—_
_—eft�--� ®� TES SEWAGE DISPOSAL SYSTEM PLAN.
LL w w O
z J (� 1g5.00 -TO SERVE EXISTING DWELLING
`' J JOHN AND DIANNE HAYES
3 Q Q Z �--� EST
0 O m U OWNERS OF RECORD
cn CD
z o �° d 208 BRAGGS LANE
i I� m W W BENCH MARK �,4�HOFMgss�cy � ZNOF�ass9c ��� 1995 ��� BARNSTABLE. MA
�a TOP OF CONC BOUND PLAN , o DAVID ti
s o DAVID G RON�� PROPERTY ADDRESS
O + ELEVATION = 92.91 s
Ol . M BARNSTABLE GIS DATUM o D' -� o D. ASSESSORS MAP 298 PARCEL 7 1
O m SCALE: 1 in = 30 f t COUGHANOWR �' �,COUGHANOWR 43 TRIANGLE CIRCLE
0
� � se 0 30 �, 60 No. 1093 SANDWICH MA 02563 PLAN BOOK 2.6 0 PAGE 4 2 F-2
o " z F ;� ��orsrE�`�`� �O �ICENSE� pQ` 506 364-0894 DATE: FEBRUARY _26. 2010
N Ln x B 18 20 30 �4 E V L JOe #E T E-2 5 6 2 PAGE 1 OF 2 VERSION.•
0 Lu w w w GARBAGE GRINDER NITA
IS NOT ALLOWED THIS PLAN IS BASED ON AN INSTRUMENT SURVEY AND IS INTENDED
SOLELY FOR INSTALLATION OF THE PROPOSED SEPTIC SYSTEM
WITH THIS DESIGN.
Ce� IM� ic �� 2-o Q 7 DEPICTED HEREON. FOR ANY OTHER CHANGES TO PROPERTY INCLUDING
! V,` PLACEMENT OF ADDITIONS. SHEDS. FENCES OR SWIMMING POOLS. OWNER
SHOULD CONSULT WITH A MASSACHUSETTS REGISTERED LAND SURVEYOR.
i