HomeMy WebLinkAbout0125 BRENTWOOD LANE - Health 125 Brentwood Lane
Barnstable P
{ A = 333 003005
y _
a
TOWN OF BARNSTABLE
LOCATION re4hednc—) //AAL SEWAGE #
VILLAGE �� ASSESSOR'S MAP & LOT 333 o3
INSTALLER'S NAME&PHONE NO.
SEPTIC TANK CAPACITY /SW (J
LEACHING FACILITY: (type) 4x` J ,T (size) /f
NO.OF BEDROOMS 3
BUILDER OR OWNER AMA s
PERMITDATE: COMPLIANCE DATE:
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 leac4g facility) Feet
Furnished by /7/P -ton T FDrc
. t
a. 3 a
3 4JIX 9,9
COMMONWEALTH OF MASSACHUSETTS
EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS
DEPARTMENT OF ENVIRONMENTAL PR TEtIVED
bur, 2 8 2003
TOWN OF BARNSTABLE
HEALTH DEPT.
TITLE 5
OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACt SEWAGE DISPOSAL SYSTEM FORM
PART A
CERTIFICATION
Property Address: 125 Brentwood Lane
Cummaquid, AM 02637
Owner's Name: James Tierney.
Owner's Address: MAP `3 3
Date of Inspection: August 11, 2003. . PARCEL„
LOT
Name of Inspector: (Please Print) James M. Ford "
_
Company Name: James M. Ford
Mailing Address: P.O. Box 49
Osterville,MA 02655-0049
Telephone Number: (508) 862-9400
CERTIFICATION STATEMENT
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 15.340 of Title 5(310 CMR 15.000). The system:
✓ Passes
Condi 'onally Passes
Needs urther Evaluation by the Local Approving Authority
ails
Inspector's Signature: Date: August 16, 2003
The system inspector shall sub 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. ,
Notes and Comments
****This report only describes conditions at the time of inspection and under the conditions of use at that
time. This inspection does not address how the system will perform in the future under the same or different
conditions of use.
Title 5 Inspection Form 6/15/2000 page 1
Page 2 of 11
OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE_ DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: 125 Brentwood Lane
Cummaguid, AM
Owner: James Tierney
Date of Inspection: August 11, 2003
Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D
A. System Passes:
✓ I 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:
I
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.
Answer yes, no or not determined(Y,N,ND) in the 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.
ND explain:
Observation of sewage backup or break out or high static water level in the distribution box due to broken or
obstructed pipe(s)or due to a broken,settled or uneven distribution box. System will pass inspection if (with
approval of Board of Health):
broken pipe(s)are replaced
obstruction is removed
distribution box is leveled or replaced
ND explain:
The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will
pass inspection if(with approval of the Board of Health):
broken pipe(s)are replaced
obstruction is removed
ND explain:
2
Page 3 of 11
OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: 125 Brentwood Lane
Cummaguid, AM
Owner: James Tiernev
Date of Inspection: August 11, 2003
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 CM 15.303(1)(b)that the
system is not functioning in a manner which will protect public health,safety and the environment:
Cesspool or privy is within 50 feet of a surface water
Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh
2. System will fail unless the Board of Health(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.
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 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, provided that no other
failure criteria are triggered. A copy of the analysis must be attached to this form.
3. Other:
3
Page 4 of 11
OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: 125 Brentwood Lane
Cummaguid, AM
Owner: James Tierney
Date of Inspection: August 11, 2003
D. System Failure Criteria applicable to all systems:
You must indicate either"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 'h 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 SAS,cesspool or privy is below high ground water elevation.
✓ Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface
water supply.
✓ Any portion of a cesspool or privy is within a Zone 1 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. [This system passes if the well water analysis,
performed at a DEP certified laboratory,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,provided that no other failure criteria
are triggered. A copy of the analysis must be attached to this form.]
No (Yes/No)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 necessary to correct the failure.
E. Large System:
To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000
gpd•
You must indicate either"yes"or"no"to each of the following:
(The following criteria apply to large systems in addition to the criteria above)
Yes No
the system is within 400 feet of a surface drinking water supply
the system is within 200 feet of a tributary to a surface drinking water supply
the system is located in a nitrogen sensitive area Interim Wellhead Protection Area- IWPA or a mapped
g ( ) PP
Zone 11 of a public water supply well
If you have answered`yes"to any question in Section E the system is considered a significant threat, or.answered
"yes" in 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.
4
Page 5 of 11
OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST
Property Address: 125 Brentwood Lane
Cummaguid, AM
Owner: James Tierney
Date of Inspection: August 11, 2003
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?
I
✓ _ 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:
Yes No -
✓ Existing information. For example,a plan at the Board of Health.
✓ _ 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(3)(b)].
5
Page 6 of 1 I
OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
Property Address: 125 Brentwood Lane
Cummaguid, MA
Owner: James Tierney
Date of Inspection: August 11, 2003
FLOW CONDITIONS -
RESIDENTIAL
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
Number of current residents: 0
Does residence have a garbage grinder(yes or no): No
Is laundry on a separate sewage system(yes or no): No [if yes separate inspection required]
Laundry system inspected(yes or no): No
Seasonal use(yes or no): Yes
Water meter readings, if availabe(last 2 years usage(gpd)): Unavailable
Sump Pump(yes or no): No
Last date of occupancy: Weekend use
COMMERCLUJINDUSTRIAL
Type of establishment:
Design flow(based on 310 CMR 15.203): gpd
Basis of design flow(seats/persons/sgft,etc.):
Grease trap present(yes or no):
Industrial waste holding tank present(yes or no)
Non-sanitary waste discharged to the Title 5 system(yes or no): -
Water meter readings, if available:
Last date of occupancy/use:
OTHER(describe):
GENERAL INFORMATION
Pumping Records
Source of information: Pumped in 2002-per owner
Was system pumped as part of the inspection(yes or no): No
If yes, volume pumped: _gallons--How was quantity pumped determined?
Reason for pumping:
TYPE OF SYSTEM
✓ 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)
Tight Tank Attach a copy of the DEP approval
Other(describe):
Approximate age of all components,date installed(if known)and source of information:
Sep. 23194-per as built card
Were sewage odors detected when arriving at the site(yes or no): No
6
Page 7 of I 1
OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 125 Brentwood Lane
Cummapuid, MA
Owner: James Tierney
Date of Inspection: August 11, 2003
BUILDING SEWER(locate on site plan)
Depth below grade:
Materials of construction: _cast iron _40 PVC other(explain):
Distance from private water supply well or suction line:
Comments(on condition of joints,venting,evidence of leakage, etc.):
SEPTIC TANK: ✓ (locate on site plan) r
Depth below grade: 30"
Material of construction: ✓ concrete _metal _fiberglass _polyethylene
_other(explain)
If tank is metal list age: Is age confirmed by a Certificate of Compliance(yes or no): (attach a copy of
certificate)
Dimensions: 1500 gal.
Sludge depth: 2"
Distance from top of sludge to bottom of outlet tee or baffle: 30"
Scum thickness: 4"
Distance from top of scum to top of outlet tee or baffle: 8"
Distance from bottom of scum to bottom of outlet tee or baffle: 12"
How were dimensions determined: Measuring stick
Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity, liquid levels
as related to outlet invert,evidence of leakage,etc.):
Tees were present. The liquid level was even with the outlet invert. There were no signs of leakage.
GREASE TRAP: None (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:
Date of last pumping:
Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels
as related to outlet invert,evidence of leakage,etc.):
7
Page 8 of 1 I
OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 125 Brentwood Lane
Cummaguid, AM
Owner: James Tierney
Date of Inspection: August 11,2003
TIGHT or HOLDING TANK: None (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: gallons/day
Alarm present(yes or no):
Alarm level: Alarm in working order(yes or no):
Date of last pumping:
Comments(condition of alarm and float switches,etc.):
DISTRIBUTION BOX: ✓ (if present must be opened)(locate on site plan)
Depth of liquid level above outlet invert: Even
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.):
The D-box was level. No solids were present.
PUMP CHAMBER: None (locate on site plan)
Pumps in working order(yes or no):
Alarms in working order(yes or no)
Comments(note condition of pump chamber,condition of pumps and appurtenances, etc.):
I
II
8
Page
9of 11
s OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 125 Brentwood Lane
Cummaguid AM
Owner: James Tierney
Date of Inspection: August 11, 2003
SOIL ABSORPTION SYSTEM(SAS): ✓ (locate on site plan,excavation not required)
If SAS not located explain why:
Type
✓ leaching pits,number: 6'x 6'(1000 QaL)
leaching chambers,number:
leaching galleries,number:
leaching trenches,number, length:
leaching fields,number,dimensions:
overflow cesspool,number:
Innovative/alternative system Type/name of technology:
Comments(note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation,etc.):
The pit was dry. There were no signs offailure. The bottom to grade was approximately 9. The cover was Y belowgrade I
used a video camera to conduct the inspection.
CESSPOOLS: None (cesspool must be pumped as part of inspection)(locate on site plan)
Number and configuration:
Depth -top of liquid to inlet invert:
Depth of solids layer:
Depth of scum layer:
Dimensions of cesspool:
Materials of construction:
Indication of groundwater inflow(yes or no):
Comments (note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation, etc.):
PRIVY: None (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.):
9
Page 10 of 1 l
OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 125 Brentwood Lane
Cummaquid, AM
Owner: James Tierney
Date of Inspection: August 11, 2003
SKETCH OF SEWAGE DISPOSAL SYSTEM
Provide a sketch 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.
A r
a
� ao.b ag
a 3
3 � a9
10
I
Page I 1 of 11
S '
OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 125 Brentwood Lane
Cummaauid, AM
Owner: James Tierney
Date of Inspection: August 11, 2003
SITE EXAM
Slope
Surface water
Check cellar
Shallow wells
Estimated depth to ground water 60 +/- feet
Please indicate (check) all methods used to determine the high ground water elevation:
Obtained from system design plans'on record-If checked, date of design plan reviewed:
Observed site(abutting property/observation hole within 150 feet of SAS)
✓ Checked with local Board of Health-explain: topographic and water contours maps
Checked with local excavators, installers-(attach documentation)
Accessed USGS database-explain:
You must describe how you established the high ground water elevation:
Using the Barnstable topographic map and the Cape Cod Commission water contours map the maps were showing approximate
60'+/-to ground water at this site.
This report has been prepared and the system inspected and passed as of the date of inspection. This report is '
not a warranty or guarantee that the system will function properly in the future. There have been no warranties
or guarantees, either expressed, written or implied, relating to the system, the inspection and/or this report.
11
TOWN OF BRNSTABLE c
LOCATION lWfM,e-J SEWAGE # '4/ �
VILLAGE ASSESSOR'S MAP & LOT
INSTALLER'S NAME & PHONE NO. . �; 0, a�
SEPTIC TANK CAPACITY / Zr
LEACHING FACILITY:(type) t (size)
NO. OF BEDROOMS PRIVATE WELL ORBLIC WATER
BUILDER OR OWNER
C
DATE PERMIT ISSUED: 2"7
DATE COMPLIANCE ISSUED:
VARIANCE GRANTED: Yes No Al
eAVy y. w
A
i
674
�3 zi0�
No. ._. Fas, -.��Z�
THE COMMONWEALTH OF MASSACHUSETTS
BOAR® OF HEALTH
TOWN OF BARNSTABLE
Apphratiou for Dhipwial �Tii irks C owartirtion lirrutit
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System at
........... ------ -------------------------------------- f =
Location-Address r or LotNo.
--------------^............................... ------• � � �" 6 � -P�tt�`w_& ..... ..........
O c cr Address
a ......-••--••---------- •-•------------------•-...--------..._--_...
Installer Address
Type of Building r� Size Lot...`�i.�. "Ga�'t.....Sq. feet
t-, Dwelling—No. of Bedrooms...............21----- -----._--......--Expansion Attic (pb) Garbage Grinder (vo)
04 Other—Type of Building ..---A4)A.............. No. of persons..........................-. Showers ( ) — Cafeteria ( )
Q' Other fixtures ------------..........................................
Design Flow.........H.O.-...L..------_-.-_ Mons per person per day. Total daily flow.........3--D........................
W g --g� P P 1; �� P Ygallons.
R: Septic Tank—Liquid capacity1�Q.8gallons Lengtli_Jj-'__0.--.. Width.67--j..... Diameter---AJ4...... Depth..112-.6..
Disposal Trench--No. ------N.jO..... Width. .,1v1.14------- Total Length........----_------ Total leaching area....................sq. ft.
Seepage Pit No--------&---.---- Diameter. - -. Depth below inlet... Total leaching area.40,r.......sq. ft.
Z Other Distribution box ( ) Dosing tank ( )
Percolation Test Results Performed by.-------. !----_--------------_ Date----
Test Pit No. I.....S.......minutes per inch Depth of Test Pit---1j_.�r------ Depth to ground water. ......tj......,.4......
Test Pit No. 2................minutes per inch Depth of Test Pit..........---------- Depth to ground water----
le
W ----•---••----------------•---------•---........••••--............--------••-•---•--.........................................................................
10 Description of Soil....... -----.-51- .4 nadj--xou J44_.
v .....--••----•••-------•----•.............•---8.�.3 - /. .�� � .- -a.,d------------------------------------•----------------------------------
W
--- .........---............................................................................................................................................. ..........................................
0 Nature of Repairs or Alterations—Answer when applicable......................................•.....--...-..................----------.-----............
............................•------.....-------------------•--------------------------------------------------------------------------------------------------------------------------...._.......---•--
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal.System in accordance with
the provisions of TITLE 5 of the State Environmental Code— e under urther agrees not to place the
system in operation until a Certificate of Compliance h be . ued b and of health.
Signed .............. --- --- -- ---
� Dace
Application Approved B -- ......._....... ..... .' _
a Q.
Dare
Application Disapproved for the following reasons: ..................................................... ...........................................................................
.............................................. .. .
� .....................................................
e
PermitNo ...... Issued .................................................... -0
Dare
..�,,.k-Ur+N"1r+-�,,....:�ti,���vr..��.._.,,r..._..�, W`"-'_`�`+..+'......�...r,•:_. _v:..�,..,,_ .-.� vW;.��. .-; .,_,..,sr- \r-��..+'-a.�y-�.�✓r,.vwra w.+✓v o... �. ,
ti-
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE
Applira#ion for Di►ipooal Wi ork,i C atustrnrtiton ramit
Application is hereby made for a Permit. to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System at: /
1 .►,J 13 rc.1 sue:_r. .C�.._..-----�...��'•!�/� L`°T ....!S:7� ...
Location-Address or Lot No.
......... ----------------------------------- -------- .....Pkktex...... man"' 1
Owner Address
W
Installer Address
Type of Building Size Lot... .....Sq. feet
Dwelling— No. of Bedrooms_______________ _________________________Expansion Attic (,up) Garbage Grinder (v0)
aOther—Type of Building .....A?1A.............. No. of persons____________________________ Showers ( ) — Cafeteria ( )
04 Other fixtures ----------------------------- ---- ------------ •--------- *.-----------•...-----.............--•----•-•---•-------•--................-----------_--
W Design Flow.........1.1.0-------2..................gallons. per person per day. Total daily flow.._.._.._..3__7D........................gallons.
WSeptic Tank—Liquid capacitv1S_' D.gallons Length__1 l-.Q�: Width-!;'-.�_____ Diameter._. g�._..._ Depth____'-_b..
x Disposal Trench--No. ...... Width. eW.6....... .Total Length.................... Total leaching area....................sq. ft.
Seepage Pit No---------&_..._-. Diameter.---(v--!J_ --. Depth below inlet___ Total leaching area_,S12,.�.__.._.sq. ft,
Z Other Distribution box ( ) Dosing tank ( )
Percolation Test Results Performed by---------- . - .___ a-_ .�,�-,�!........................ Date-__.�?-_ _-.1_L�_-_
aTest Pit No. 1------5 ......minutes per inch Depth of Test Pit.... .-_.-__ Depth to ground water. ......... .....�..
f1 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water......
W
--------------------------------------------------------- --------------
•-•----------- ---------------------------------
_......... --•--_-----
_-
O Description of Soil...... -----.- --�Q-- -c�,_ �_. lter-- el, A_,�� Ra�c.lL..�..
W
-- •------------------------------------------------------------------------------------------------ -------------------------------------------------------•----•-•--•---••--•--••-•-•--------•-•-----
U Nature of Repairs or Alterations—Answer when applicable................................................................................................
------------------------------------------------------------------------------•-----------------._...---••---------------------------------------...------------------------------------................
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TITLE 5 of the State Environmental Code—The undersi- :ned-further agrees not to place the
system in operation until a Certificate of Compliance has�ben'sued by�rhe bard of health.
SigneSigned / -�. _
d .............__... - -- - - -<,�. "_'.. ........ ..................... �-
Da e
Application Approved B .............. . .. . .. ._..... --.Y . . < N . ....'. `" '..- 7�-�Z
.--------`--------------------- Dare
Application Disapproved for the following reasons:f.....
................................................... .................._.. . ....... .... . . . ............_ ........................................
Permit No. ............ .....:..........--.-. --.....-.. Issued ......�..........'�'.. .�."......�.�...f.
Dare
——- —o-- -w--..._-.. ———— q.._,.- — .-,--me-ate.- ------- ._:..0--r----
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE
Qlertifi atrt of (fomplianCE
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed (Utw ) or Repaired ( )
/by _...... �. '. -. ..-.. -r'rl .r�✓ 'o ... - - _....... ................................ -
...... -------- ------------------------------ ------
m.�aue
at ....1.. ? .... .5........... .. .5-........ r.f.r.r .�cr.asd---�'�-''•'�- r- ..r�.n�-R-�J.a.�.----------------
has been installed in accordance with the provisions of TITLE 5 of The State Env' onmental Code as described i
the application for Disposal Works Construction Permit No.9.. .. �c..Zukw
... ......... dated
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CO A AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE............._.....? ___ .;-.........C�.... - . Inspector ...:... '�T
C
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
No..c�il'l`'.•���`�`��' TOWN OF BARNSTABLE FEE_ �
�i��raxottl a1rk� �a�n��rion �pruti�
Permission is hereby granted---------------------------------------------- •_---••••-----
to Construct ( ) or Repair ( ) an Individual Sewage Disposal System
atNo..... .......... C... -------------------------------------- ---------------------•-•---....._.
Street 9 --�• /'
as shown on the application for Disposal Works Construction P Nol "� D.fajted_____la. �y .'.-•5�
..............
��� Board of Health
'i DATE........ -------------- ---------
FORM 36508 HOBBS Q WARREN,INC.,PUBLISHERS
�-
No.-----------=----- - Fee--Z��
-------------------
BOARD OF HEALTH
TOWN OF BARNSTABLE
Application-*r Melt CootructionAermit
Application is hereby made for a permit to Construct (:-I, Alter ), or Repa' ( )an idividu4il W 11 tinn 0
Location — Address Assessors Ma and Parcel
— -- ---------- =C--'------,�- - --------------------_------ --F—� -------—- L---- t) ---D!------------------------------
Vwner Address
------------------ -- �._��__-x----�------o- G��-� -- --------------------
Installer — Driller Addre s _
Type of Building
Dwelling------------------------------------------------------------------
Other - Type of Building ----------- No. of Persons-------------------------------—-----__-______
r�
Type of Well-------- - —------:--------------- ---- - --- Capacity--------------------— - -- -
- -- -----------------------
Purpose of Well JtZ__4�_7_jpf---..---------------------------------------
Agreement:
The undersigned agrees to install the aforedescribed individual well in accordance with the provisions of The
Town of Barnstable Board of Health Private Well Protection Regulation — The undersigned further agrees not to
place the well in operation until a Certificate .of Compliance has been issued by the Board of Health.
1 -,�-
Signed__� --- �Gu�.(/-------------------------- __11_ -7 --� - ------
date
Application Approved B --- -- -� --------- --- —��'� `'
date
Application Disapproved for the following reasons:-------------------—---------------------_—_—--------_—__________--________
----------------------------------------------------------------—-------- date-----—
=1<- -------------- Issued--- -- z --� - - ---------------------
Permit No. --- ---- date
BOARD OF HEALTH
TOWN OF BARNSTABLE
(Certificate ®f (Compliance
THIS IS TO CERTIFY, That the Individual Well Constructed ( �J, Altered ( ), or Repaired ( )
bY------------------ =� ..,w _f_ -.1
- -------------------------------------
Installer ,
at —� Pn_���Z(• __�/_ C c t vk M cx Q u---------`
------------------------------
has been installed in accordance with the provisions of the Town of Barnstable Bjoarrd:of Health Priv_aILWell Protection
Regulation as described in the application for Well.Construction Permit No! -------��,-- ted---
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL
SYSTEM WILL FUNCTION SATISFACTORY.
DATE----------------------------—------------------------- — -- Inspector-----------------------------------------— -- -----------
No.--------------r------ Fee-
BOARD OF HEALTH
- TOWN OF BARNSTABLE
Cicat ion-foorWeil CongtrurfionPermit
-
Application is hereby made for a permit to Construct {aij, Alter ( ) or Repau (-*jan individual Well at
tom., },r !o ` ) ^�
---� --- J!!t_n. 4/oV�----- /---------`- M-�`—�- GCj
-------------l-T ( ^-`-..e-j l�___Af `)
�g Location - Address / Assessors Map.and Parcel'
-------1 � ----- --t---- -�� - 1�/C+ Iu+G7J - - -- --- --------
n( Owner- . ! Address
yr_��__ '� - — —= _ �X --7 U su-�f� ` -`---- -------
Installer - Driller Addre
TYPe of Building
Dwelling
Other -Type of Building ------------ No. of Persons---------------- --------------------------
Type of Well--.,,
ell— ------------- — - Capacity-- e----- - —— — - - ---
Purpose of Well /!=rf� ��k - -- ;}
Agreement:
The undersigned agrees to install the aforedesciibed individual well in accordance with the provisions of The €
Town of Barnstable Board of Health Private Well Protection Regulation — The undersigned further agrees not to
place the well in operation until a Certificate .of Compliance has been issued by the:_B.oard of Health.
Signed = �'�c- - -- - - - -----� - ���� �'- --
i date
'} Application Approved By=-��' -- —'_— date - a
l Application Disapproved for the following reasons:-
---------— -- ---- - =-- --- ----- -
date
Permit No. �' -- � — - Issued —--
r date
i
BOARD OF HEALTH
TOWN OF BARNSTABLE -
Certifirate ®f (compliance
THIS IS TO CERTIFY, That the Individual Well Constructed ( Altered( ) or Repaired ( )
b -OA- .,w --- -- ------ ------- --------- -----------------------_-----------------
Installer
at- i P "1 � -=- _- C -r="u- -u'--� `ti --------- --has been installed in accordance with the provisions of the Town of Barnstable Board of Health Private Well Protection
Regulation as described in the application for Well Construction Permit.No ;O " 'aIed= -------- 'r
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL k�
SYSTEM WILL FUNCTION SATISFACTORY.
DATE- --- - ——— -- — - — f Inspector-- ---------------------------------------------------------—
BOARD OF HEALTH
TOWN OF BARNSTABLE
Veil Congtrurtionpermit
o.N --- - �
=� Fee- `�-�--
n
//
Permission is hereby,granted---��=�^—"�'-- --
---------------------------------
to Construct (✓) Alter ( ), .or Repair ( ) an Individual Well at
No. ----- L�= - r�' f_sw rl-- •' C- n�t_sti G Ccz u r c✓ ------------------ ----------------------
Street
as shown on the application for a Well Construction Permit
No. ----- Dated--- - - - -
f -
f-- — - ------ -- Board o Health -
DATE-—., -- - -
_(q`f10 LaJ V
AZ
w O
fi-n'A FU T'IG G L �. � O
.61. cz
o0 0 ..
T.H.E.
.'X
.�'%� \\ �rvc�.�rrcr=.4 -.' `_� y
�
� � � _-- \ qJ I.a6 PY�GIA ..
.
(?. B<
I
v, 7roeT d i I. I ! I •o�slvaal�3NP61 TJ '� - p
LL
LL—
EAST ELEVATION NORTH ELEVATION DETAIL 1
1/4" = 1'-T ,1_/4"=1'-0"
® €'
/ Iz - - I ix Tlrlr-•I or+ 1 rl-Y•— JI
%
/ L I7� �7 \�to .........- -- - --- - — _ y
-A ._ _ r` o .LIGHT, z - - F I
SRIJIW-6 Lr'rILIT( � � O
. � TO I"'WJCnNV L/Y�TGRN. y
ry i ^J
J —.... 12 ' Zw(o fc C.TPrBr+6D--. vZ Q
lz LU
Z Q
z 0 Z
- I _]AriD 1n(/H Q1 G�PL lOrp O
LU m
LU
L•
!
job I —97
no.: -
date z.V!l
I
I I I I I � ! ,I I I •.,.. drawn J.A. -.
------------------------------1 ram.
ram.
WEST ELEVATION SOUTH ELEVATION DETAIL
1/4"=1' 0". 1/4"=1'-0" 1'-0.1 2� � A-2
copyright 2000
x
-. y I I I I L—�Gor�le PCCJe3�t"L.LL--L. I i - i- � '.�2.r.•'w+�e't�oola L�i1.
I I 1 F� o zoxlz rvr c. 1
IVKa-e "N
't.
4
_ _ I �Q V -N I •5z x4z,.Iz ca-Ic. I I I
-�--- __"_- _ Q Q .
N J I -1' I I ,�. P JTMC.r W i K.a-IS I I ` y [�oc TcT 1•.'_T'U.�
N I 1 i G V .e pa eww- G•..wi.Y I I .. .. 5 r � � P Y+I�o -r.rin -
I I(i i-Cvw ToP
►r crr.l.w.L- i I f I ! O
5F I!_ I i I I _ 1 .Z � 1rD-�TW.Pru•.O IL Zx1DUL VENT--... .___. _... _-- .
'' ) L(z:rr.z.al � �, i I I I �. I •• :� ; �srHr.LT saNr�-.GSTr-1.�.—__._—__ —.. �t � �
'" Gox vLYI-loon 'U:.
1 u {.� LO
F LD VU-
FoUT RxJI'Gr. , I 1 n .. P J $4)T,t4 L•r'I..IceO - _ - U 'I`J
�'�• I 1. I7'-OI I i ' I i - r II ''FP/rC�i.i~`GUL_Cr-III�L�e - 19 .o w6u . yJl-9t 12 , L
s } F
.
J� Q
•1`------.". T. I . .. ..._.. ... I _ I 4D'
• l ! I V � I � srsetu+.W Co)zxlo r+�osaz IrJ o•-rn cue U'. S
I I i '� J• I I I � rR.w rm�o ... __ _ < � to 3
4.1 ..
I" - - 'I r•rv.w a Pal-rG vs �-+v Ic o Im'c�c.. _ -
I
IT.
. I I P'G'-OI O.G. I - Cix6• rbaT L•� I GrCIJc.CL.�P��
I I --DROP TOP cr I 1 I Ix�r r-L�,t+o
. .. I I FoL,NwaloN w..u-. I I - -.. � .• � :.. .�.
I I. .1 Id t-ilA.ccrlc.eovcruet ._... -
- - I � �----..... ,., __. ,_ _. � I .... r0. .. I-y.2d o✓..D.ea�u,-rmr _'; -
FOUNDATION PLAN�ZI-v
1/4"= V-0'I SECTION
SE� N SE
t21_ol - Zt I_oU 1l-OII 1411� �O
' SECTION
Z
s
WINDOW & DOOR SCHEDULE
I.IN. aw
. ._ LIP ISR LL� I 5A-1,r•IOOEL NQ 066GF PI-ION I�OtJ(aFl OPCNIrr OW11L�S/1-IISC.'Q7}! J '�
v-Uv-ve Y IIIr YOT` 'S
Tw.Z4410 -n LT OCL.HL - Z'-4Ya1 x SI-11'41 G/lo S : 4 'd
J' --_._. a � _ _ r 1 � J - c D T•Z4'1Z TFAhJ:_orn ZI-!et'!s1 x 1 I < �.2 II"g c
S
STORAGE .-_.. ��� �wEv-I—.),
A"� •.�` i ,� - 3. N � � ��. , I `•- ' � -1./ I � 0 c Aw•z,St fwWml cr ZI-4�b1 x Z'-4ve' 'Mix Zr-1 t < 'S 3 J°1 3� E
N E 'A• a z'-oS'e1 x LI-o5bl zw x Z-H
L—_. Z7
2
A N STUDY I D I GASEi•n�r,T 2-0- ' x 4' $-O I -Zw x4H;RHR•+G. 1
�II../•�G-.. 1 J �I 10 AI 1. c {`L (�� 7MRQ•1 n G L t04$' x GI-t� LGFrHMOIN'SH I W Q
I Np Z x v
61
6
GARAGE IY ,'1_ _ 0 _•� _ I C O.I ', _ w Z
a
Ix fir. � I t J
yll_,gl c)I_pl I ?51_1 17-0 17-0 �l ' II /
'7 I
4' S -
• I
- - -= —- LU o
1 -7
^Q � � T clrr m cw•�s (D V - Aq J' j 'r � I ., I _ ._.�. _� ..... _— __-.-_I _—_ _ , __ _G✓ _W
•S,
LL N QQ
N `ra fc.a 4 ors yr w..li fTN s - I -
t.l C'GEJ LIhItr STNR
I 1
1.
job no.:
REC,ROOM
I i
J�C�� I � I � i I i I date : Z•17 "01
acale
I
•
FIRST FLOOR PLAN SECOND FLOOR PLAN
•wpydght 2000 -
BENCHMARK
TOP OF TAGBOLT Y190
ON F. HYDRANT /
r ELEV. =50. 00'(ASS)' I
'+ K
UTILITIIES.•
T
� CABLE EIC. TEL.
_ '
pA W
R 5
Y 39
0 LOT 4
2
0
WOOD
1
� 0 sr
� / PLAN REF. 430160, 400182
/ _ SERV�' � pc � _
R E 0 F 5EA �5'E; ZONING: RF 1
Y 1 / �/ TOWN WATER A VA ILA BLE
EDGE 85,
R=225.0 0 �B o S' 0 211 SLOPE /
r
LOT 5 / ,, �Io Ck
, �56.
„/ ,,,,,, ,,, /,/ 0
REA: 43,568 S.F22 SB"
A.M. 333 39S
CIS
PROJEC T L OCA TION
_
� 9 LOT 5, BRENTWOOD LANE
44
06 I CUMMAQ UID, MA.
- s
48 — — sr� 1 APPLICAN •
� � 1
T.
sr JIM TIERNEY
ofy CUMMAQ UID, MA.
52 ) 1 ¢ JOHN
~ / u!�` -�
,, �� DERS- tf EY �`
/ �9109111
w .I� � YANKEE SUR VEY CONSUL TAN TS
� 1tle.35101 TRIOS o �Q P. O. BOX 265
s DIS r Fc/STE� �,�. UNIT 5, 403 INDUSTRY ROAD
FIRE ANE 63p Ss�oNAL E"'G MARSTONS MILLS, MA. 02648
LOT 6 �,ApL EY'S A. 02 t ,E4k 1,1 1 PH. (508)428-0055 — FAX(508)420-5553
: - c
ARN p14IN BLE :,L r • �w >P ,> >
B TA � , —
sT v , ,.. 4� ash G, , SCALE. 1 —30 FDA TE.• 5112194
_ ARN
V. 511919 4 d RE
}
d
5/,v v•
'.e
JOB NO. 50481Z SHEET I OF 2.
r
I
=_4_9.0 :'I,OP SED G
TOP OF FOUNDATION
r
2 0' MIN.
10' min CONCRETE COVERS
48.5 PROPOSED 51.5E EXISTING
i 51.5E EXISTING
CONCRETE COVERS
4" CAST IRON 12'ibfAX ' ' ' ' / i / / i i i i
50.0f EXISTING
OR SCHEDULE 40 / / ' ' ' 2"LA YER OF
P. V.C. PIPE 4" SCHEDULE 40 P. VC
S=0.02, D=13' B x MN 3.0 f WASHED
FLOW LINE S'=O.01 WASHED STONE
D=11.5'
1 10„ S=0.01, D=11 :- C
PRECAST
MIN. 19" LEACHING
EL.= 46.40 _ EL.= 45_89- 2' I W EQUIVALENT
`a �o
EL.=46.14 LEVEL oc
o, aL4 c,
EL.= 45_78 EL.=_45.61 - 45.50 0 8 v o` 3 S TO 1-1/2"
EL.-_____ t O WWASHED STONE1500 GALLONS o�SEPTIC TANK W c
EL.=_37.5
i I LEACH PIT I - ---_
6, 3'
PROFILE OF 12'DIAM. -
SEWAGE DISPOSAL SYSTEM
NOT TO SCALE BOTTOM OF TEST HOLE OR USGS PROBABLE WATER TABLE EL= 33.5 _
ALL ELEVATIONS ARE ASSIGNED
OF
SOIL LOG
EDWARD E. KELLY, PE JOHN G
WITNESSED BY: LANDEHS-CAULEY `
JERRY DUNNING �� cavil
�. Z
P# 6386 No. 35101
GENERAL NOTES PERCOLATION RATE _6__ MIN./ INCH �ssocISaER�G\����
AL E
1. THIS PLAN IS FOR THE CONSTRUCTION OF A NEW SEWERAGE DISPOSAL SYSTEM.
2. PLAN REFERENCE BOOK 430 PAGE 60, LOT 5, BARN. REG. DEEDS. DATE 03-16-87 DATE - -
3. THIS PLAN IS FOR INSTALLATION/ REPAIR OF SEPTIC SYSTEM TEST HOLE I TEST HOLE 2
AND NOT TO BE USED FOR SURVEYING OR ZONING PURPOSES. DESIGN DA TA.-
EL. = 45.0E EL. _
4. ALL WORKMANSHIP AND MATERIALS SHALL CONFORM TO D.E.P. -
TITLE 5 AND THE TOWN OF FALMOUTH RULES AND REGULATIONS 45.0 r
FOR THE SUBSURFACE DISPOSAL OF SEWAGE. NUMBER OF BEDROOMS THREE
5. ALL COVER TO SANITARY UNITS SHALL BE BROUGHT TO WITHIN TOP SUB
12" OF FINISHED GRADE. soIt GARBAGE DISPOSAL NONE
6. EXISTING AND FINAL GRADES SHALL REMAIN ESSENTIALLY THE 41.0 4
SAME, UNLESS NOTED BY FINAL CONTOURS. [ TOTAL ESTIMATED FLOW 330 GPD
7 ALL COMPONENTS OF THE SANITARY SYSTEM SHALL BE CAPABLE FINE SAX0
AND ROCKS ( 110 __GAL./BR./DAY x _3 BR)
OF WITHSTANDING H-10 LOADING UNLESS THEY ARE UNDER P
OR WITHIN 10' OF DRIVES OR PARKING AREAS. H-20 LOADING 36.5 8.5' SEPTIC TANK CAPACITY _1500__
SHALL BE USED UNDER OR WITHIN 10' OF DRIVES OR PARKING. SILTY FINE
UNLESS NOTED. SAND LEACHING AREA REQUIREMENTS
8. ANY MASONRY UNITS USED TO BRING COVERS TO GRADE SHALL 33.5 11.5' t SIDEWALL AREA 301 _ GAL S.F.
. BE MORTARED IN PLACE.
9. NO DETERMINATION HAS BEEN MADE AS TO COMPLIANCE WITH BOTTOM AREA 112_ GAL/S/F
i DEEDED OR ZONING REGULATIONS. OWNER/APPLICANT IS TO LEACHING CAPACITY (BOTTOM & SIDEWALL) 488_GAL.
OBTAIN SUCH DETERMINATION FROM APPROPRIATE AUTHORITY.
10. THE EXCA VA TOR�CONTRACTOR SHALL VERIFY THE LOCATION OF ALL RESERVE LEACHING CAPACITY 488
UNDERGROUND UTILITIES PRIOR TO ANY EXCAVATION. _ GAL.
SHEET 2 OF 2. JOB NUMBER _50481Z