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0012 CARRIAGE LANE - Health
2 Carriage Lane Barnstable A=298 039 �I Commonwealth of Massachusetts a90-03q Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessmentsam� M 12 Carriage Ln Property Addressry Donaldson r� Owner information Owner's Name is required for -r every page. Barnstable MA 02630 9/1 ZIJ 7 Cityrrown State Zip Code Datd-of Inspection 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 1. Inspector: Frank Nunes III Name of Inspector saa Company Name Box 841 Company Address East Falmouth MA 02536 City/Town State . Zip Code 508.272.6433 13010 Telephone Number License Number B. Certification 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 ❑ Conditionally Passes` ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority 9/12/17 Inspect o Sig ature 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 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.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 17 r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments '< 12 Carriage Ln Property Address Donaldson Owner information Owner's Name is required for every page. Barnstable MA 02630 9/12/17 Citylrown 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: ® 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: t 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.doc•rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 f Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments , 12 Carriage Ln Property Address Donaldson Owner information Owner's Name is required for every page. Barnstable MA 02630 9/12/17 Cityrrown 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 pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ 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 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 t5ins.doc•rev.6116 Tide 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 3 of 17 i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 12 Carriage Ln Property Address Donaldson Owner information Owner's Name is required for every page. Barnstable MA 02630 9/12/17 Cityrrown 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. ❑ 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 El ® Liquid depth in cesspool is less than 6" below invert or available volume is less than Y2 day flow t5ins.doc-rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 4 of 17, Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 12 Carriage Ln Property Address Donaldson Owner information Owner's Name is required for every page. Barnstable MA 02630 9/12/17 Cityrrown State Zip Code Date of Inspection B. Certification (cont.) Yes 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. ❑ ® 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 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 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 necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes"or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the•system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply - ❑ ❑ - the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area—IWPA)or a mapped Zone II of a public water supply well If you have answered"yes"to any question in Section E the system is considered a significant threat, or answered"yes" in 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. t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 12 Carriage Ln Property Address Donaldson Owner information Owner's Name is required for every page. Barnstable MA 02630 9/12/17 Cityrrown 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. l E El 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.doc-rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 17 r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 12 Carriage Ln Property Address Donaldson Owner information Owner's Name is required for every page. Barnstable MA 02630 9/12/17 Cityrrown State Zip Code Date of Inspection D. System Information Description: Number of current residents: 0 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.) Laundry system inspected? ❑ Yes ® No Seasonaluse? ❑ Yes ® No Water meter readings, if available (last 2 years usage(gpd)): Detail Sump pump? ❑ Yes ® No Last date of occupancy: June 2017 Date Commercial/Industrial Flow Conditions: Type of Establishment: , Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes.❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins.doc-rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 12 Carriage Ln Property Address Donaldson Owner information Owner's Name is required for every page. Barnstable MA. 02630 9/12/17 Cityrrown 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: No pump history per owner Was system pumped as part of the inspection? ❑ Yes ® 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) 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.doc-rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 12 Carriage Ln Property Address Donaldson Owner information Owner's Name is required for every page. Barnstable MA ' 02630 9/12/17 Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: Original septic tank per age of home, new d-box and leach chambers 2006 per BOH record Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 18"feet Material of construction: ❑ cast iron ®40 PVC ❑ other(explain): Distance from private water supply well or suction line: >10'feet Comments(on condition of joints, venting, evidence of leakage, etc.): Septic Tank(locate on site plan): Depth below grade: 12„feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) H-10 tank appears to be structurally sound If tank is metal, list age: years Is age confirmed by a Certificate of Compliance?(attach a copy of certificate) ❑ Yes ❑ No Dimensions: • ' 1000g •Sludge depth: 411 t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 12 Carriage Ln Property Address Donaldson Owner information Owner's Name is required for every page. Barnstable MA 02630 9/12/17 Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) 11 Distance from top of sludge to bottom of outlet tee or baffle '12 Scum thickness 1/2" Distance from top of scum to top of outlet tee or baffle >2" Distance from bottom of scum to bottom of outlet tee or baffle >2„ How were dimensions determined? measured Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): No adverse conditions 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.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 12 Carriage Ln Property Address Donaldson Owner information Owner's Name is required for every page. Barnstable MA 02630 9/12/17 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.): Pumping suggested every 3 years to prolong the life of the system 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: 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.): *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M sV•,y 12 Carriage Ln Property Address Donaldson - Owner information Owner's Name is required for every page. Barnstable MA 02630 9/12/17 Cityrrown 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 Oil Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc,): D-box is in very good condition, cover to 12"of grade 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.doc•rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 12 Carriage Ln Property Address Donaldson Owner information Owner's Name is required for every page. Barnstable MA 02630 9/12/17 Citylrown State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ® leaching chambers number: 2 ❑ 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.): Chambers were video inspected, they are dry at this time, no indication of past backup 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.doc-rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 17 I Commonwealth of Massachusetts Title 5 Official Inspection Form . Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 12 Carriage Ln Property Address Donaldson Owner information Owner's Name is required for every page. Barnstable MA 02630 9/12/17 Cityrrown 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.): Soils are compact and dry 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.): r t5ins.doc-rev.6116• Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 k ' TOWN OF BARNSTABLE LOCATION ��� Lh SEWAGE N D6�3�D3 �i VILLAGE 14Pn¢ � I ASSESSOR'S MA[P&LOTIP2 19 ' INSTALLERS NAME dt PHONE NO--�5 f7at./y1 ` �/bG Fa?i✓D SQS s08.�ot6 SEPTIC TANK CAPACITY 10 LEACHING FACUM-(type) NO.OFBEDROOMS .3 t , BUILDER OR OWNNER V4 na PEPM tDATE:_7;$"d rO COMPLIANCE DATE' 9 a1-0 Separation Distance Betweet}the: ✓.: Maximum Adjusted GrotmdwaterTableto the BottomofLaachingFwility 79 Feet Private Water Supply Well and Leaching Facility (If any wells exist . i an site or within 200 feet of leaching facility) Feet- Edge of Wedand and Leacbing Pwility(If any wetlands exist within 300 feet f tceching bmility) Feet Fauwwby,SKA&'r A E/aq 4 E fe✓d��!3eS a7' 6-1-39' is-.a-as' 9-3- ' Yi �! sG't., A a s A-c- ra'6•' B=c- erg• . . �-D-/V 8-01-3X $ A E--3a'G" &F-y/.,r r - P� is Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 12 Carriage Ln Property Address Donaldson Owner information Owner's Name is required for every page. Barnstable MA 02630 9/12/17 Cityrrown 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: 79'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: 2006 permit on file 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: See above Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins.doc•rev.6116 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 12 Carriage Ln Property Address Donaldson Owner information Owner's Name is required for every page. Barnstable MA 02630 9/12/17 Cityrrown 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.doc-rev.6/16 Title 5 Official inspection Form:Subsurface Sewage Disposal System-Page 17.of 17 ` TOW OF BARNSTABLE - - - LOCATION I, 6a r""Q c4e �• SEWAGE #`r 06 3?3 VILLAGE Uai!'yM ASSESSOR'S MAP& LOT-0 � 1 INSTALLER'S NAME&PHONE NO. t5 Aalc it �_ �11D� SEPTIC TANK CAPACITY '/000 &a LEACHING FACILITY: (type) CGrG�a�►62/'3 (size) SUa s NO.OF BEDROOMS ' J L BUILDER OR OWNER Vq 01Q /V t?a�e • j -PERMTrDATE:- "U COMPLIANCE DATE: 9—12 1-D (0 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 f leaching facility) _ Feet Furnished by 7ra,1�4 A c C llbc fol )I—F-37'L G- q 1611 C�tyr e L 1 No..., q3 t Fee �® THE COMMONWEALTH OF MASSACHUSETTS t E�t� ed in cot►iputer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes 2pplication for �Digoar 4pgtem Cou.5tructiou Perron Application for a Permit to Construct( ) Repair(&,/Upgrade( ) Abandon( ) ❑Complete System Individual Components Location Address or Lot No. I 6, /'r i-a ye r► Owner's Name,Address,and Tel.No. %n q GGc e ��) Assessor's Map/Parcel aq,*. 3 f d/h,yt r 41-/r d67 j Installer's Name,Address,and Tel.No. J aw`� Nr L ro Designer's Name,Address and Tel.No. C r r�Ty 6"`o'� Oq At-,j,%4-er 19f w�3SG�l��cfGVCS�e�n /9Cl `6(1�1-7167 f F4l—Cn1t t- AM e,4 ft Type of Building: (/V/� Dwelling No.of Bedrooms 3 Lot Size sq.ft. Garbage Grinder P Other Type of Building ge,5e No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 330 gpd Design flow provided 35 o? gpd Plan Date Number of sheets Revision Date Title s Size of Septic Tank �°�5*iy 1660 !9 e4 I Type of S.A.S. G,e L Gee"R cy/S 'S-66 S Description of Soil ,? ►� x� Nature of Repairs or Alterations(Answer when applicable) SC? -fi c e 4 c4 4 C 1W U r,. e 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 Bo d o eat p Signed Date Application Approved by WTI. Date Application Disapproved by: Date 'for the following reasons Permit No. 9006 �-�-1�� Date Issued Grp No. `+.a0( t.- -' °" : , € _ �-^-•�. 'Fee 00 THE COMMONWEALTH OF MASSACHUSETTS Entfs' d'incon►pater: t` -� � PUBLIC HEALTH, DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS ZippYicatibn for Migont gpp5tem construction permit Application for a Permit to Construct O Repair(�/Upgrade O Abandon O ❑ Complete System Individual Components 1 _ 1 Location Address or Lot No. r rCt P r•-r 5e 1_✓► Owner's Name,Address,and Tel.No. a,1 Gt a9� rD 9bk V '11=use 1006 Q-0 �f1 Sian /�vn LT 0437 Assessor's Map/Parcel - Installer's Name,Address,and Tel.No. 3 4 A s Name,Address and Tel.No. w� � C� �f�Y Designer' ael sE f-ar4•+,e Af': '23�'_61e471we5fe• 501-1 L// '-7167 f r4b,^U), 1~, 0,� I �"D�'3 -�311 5. iDeAn S Type of Building: Dwelling' No.of Bedrooms Lot Size s . ft. Garbage Grinder ./0 p 1 q g ( ) Other Type of Building (I QS n 7 Q/ No.of Persons Showers( ) Cafeteria( ) Other Fixtures C Design Flow(min.required) .3,3o gpd Design flow provided 3 �? gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank ex/54.iy 1660 C_j e l Type of S.A.S. &I—eal-It C a of e/S Description of Soil ? Nature of Repairs or Alterations(Answer when applicable) SG�0�� l eG c` < < (.t 9,rk We Date last inspected: Agreement: r 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. Q Signed !/ Date /, / 7 Application Approved by U'WnJ• e Date Application Disapproved by: Date for the following reasons 1" j -.-. Permit No. C9006 ^g c/ 2 J Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS (Certificate of (Zompliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed ( ) Repaired ( ) Upgraded ( ) Abandoned( r)by at t CA^10 1, l has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. ?9 7 _ dated Installer -Mr 1 r •� r� .n Designer �) t� #bedrooms 3 _ `'� Approved design flow 777 gpd The issuance of this permit shall mot be construed as a guarantee that the system wilcnctnad `ADate Inspector l osgd _ v No. 0 n 3 Fee �Uca THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE, MASSACHUSETTS 1=i5po.5a1 i§p.tem Construction Permit Permission is hereby granted to�Construct ( ) Repair (/<) Upgrade ( ) Abandon ( ) System located at 1-z Cam/ o and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to comply with Title S and the following local provisions or special conditions. Provided: Construction must be completed within three years of the date of this�p Date !(c�! Approved by U^!�P � Pl yn" �c� It vjti on r� -12� S�uw �UCk1 �j�r�v�± SA� c 7L /r lv �oQ ` � (,4 k,Pod 66e r,,Iret ,n / / j TOWN OF BARNSTABLE LOCATION Q>/ C'/Y/Cc h SEWAGE # . 06-3?3 VILLAGE_ UCi/'n 5-k�/� ASSESSOR'S MAP dt LOT l a INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY: (type) C C 0162/'S (size) 500 S NO.OF BEDROOMS 3 BUILDER OR OWNER__ �Q✓1 q lV p i/e COMPLIANCE DATE: 9 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) ri facility Feet. Edge of Wetland and Leaching_ ty(If any wetlands east within'300 fief"f leaching facility) Furnished b Feet B-� '39� �• a_a�, �_ 3� So .4 OG OF � J: Q_n_3a- g A-F 3y` F- 37'�� f� 1,1An go PROJECT DESCRIPTION: SEPTIC SYSTEM 'AS'BUILT" BENCHMARK TOP OF FOUNDATION ELEVATION 100.00 ASSUMED \ GARAGE \\ DECK v j-% • r ROAD \ V w N EXISTING DWELLING ' O V 1 C ' EXIS77NG 1000 GAL SEP77C TANK . 103' ' D 107.63' FROM WETLAND NEW SA.S. NEW D. X ® (13X 25'X 2' DEEP) E 34.95• / / VENT ELEVATIONS: OFFSET TIES: TOP OF FOUNDA77ON £LEY 100.00 AC 28.5' BC 12.4' PIPE INVERT SEP77C TANK OUTLET ELEY 90.89 AD 31.6' BD 18.0' PIPE INVERT DIST BOX IN ELEV 89.85 AE 4t 8' BE 32.5' PIPE INVERTS DIST BOX OUT ELEV. 89.66• AF 37.3' BF 342' PIPE INVERT A T S A.S. IN A T F ELEV. 89.01 AG 45.2' BG 42.4' PIPE INVERT AT S.A.S IN AT G ELEV. 89.06 AV 5t6' BV 49.0' 70P OF CHAMBER AT F ELEV. 89.79 7OP OF CHAMBER AT G ELEV. 89.80 BOTTOM OF S.A.S. ELEV 87.04 t21' LOWER APPROVED BOTTOM OF SA.S ELEV. 86.25 DIST OF BOTTOM FROM BOTTOM OF 7EST HOLE 7.45' Member ASCE. C1WG R. SHORT, P.E. y,^ a`1lj OF CASs P.O. BOX 1044 _ '' CRAIG �c� SOUTH DDWV14 MA 02660 `' SHORT V Professional Civil Engineer • So�7' £vv/uotor � CIVIL �a, 27 83 Licensed Construction Supervisor • S sp-Septic Inector Septic • Site • Piers • Structures • House Designs lS E — Office: (508) 398-8311 Fax: (508) 398-3063 b r r j li f ( f(f wt . I LY � rt. _ ? S r� ram' t �� � 'i , � �' �• ,pi, ,a• .FROM ;Sweetser Engineering FAX NO. :508 398 3063 Oct. 03 2006 02:42PM P2 Town of Barnstable Regulatory Services Thomas F.Geller, DirectOt Public Health Division { Tharnas McKean,Director 200 Main Street,Hyannis,MA 02601 lax: 508••700.6304 OMce: 508••86Z-4644 Installer&Deslener Certification Form Date: 0 �— ` Installer: ��--t'') �,` 17csigner: �.. _ [� ,, r ' Address: s1fw Pr - — Address: kjc1 2m—. _ I� ^�� � p (Pi'troUn g' was issued a permit to install aD( , (date) Onstahex) < a l.,ased an a design drawn by �2 ON septic system at C5, � ress)-(add : _n _�(�__jq. I —�, dated-� '3 F `+ J _ (designer) 1 certi fy that the septic system referenced above was installed substantially according to the design, which may include minor approved changes such as lateral relocation o the distribution box and/or septic tank. —Z, certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system) but In cordartce with State & l..ocal Regulations. Plan revision or rcrtified as-built by designer to follow. qCRAIG G . ORAiG �G _ SHORT �' r^ •� SHORT �^ r� (installer's Signa re) ' OVIL � crv� N No.2.7483 ( L No. 27483 9FCISTEV���`y4�`4 -- esi er's 5i (hffix tamp Here N�t� (D 1ntature) TL EASE R1 TURN TO BARNSTABLE PUBLIC HEALT "DNISIUN, CERTIFICATE, Uy� COMPLIAN E WILL NOT BE ISSUED U R TN THIS F AND AS- F=tiUIL C ARE R CE)VED BY HE$ARNSTAB , Pi1BLt FALThI DIVISION. a. THANK YOU. (2:Health/Septic/I)(,.signer Oerlincadai Form CRAIG R. SHORT, P. E. 235 Great Western Road P.O. Box 1044 Telephone(508)398-8311 South Dennis,MA 02660 Fax(508)398-3063 PROFESSIONAL CIVIL ENGINEER-SOIL EVALUATOR SEPTIC SYSTEM DESIGNS—HOUSE DESIGN PLANS—WATERFRONT DESIGN&PERMITTING TO: Thomas McKean Health Director Barnstable Board of Health 200 Main Street Hyannis,MA 02601 RE: CERTIFICATION OF SUBSURFACE SEWAGE DISPOSAL SYSTEM LOCATION OF SYSTEM: 12 Carriage Lane,Barnstable CLIENT: Neale Family Trust(Shawn McElroy-Contractor) PLAN DATE: May 26,2006 FILE#: 1-1041 DATE(S)OF/TYPE OF INSPECTIONS: 09/22/06 Inspect and Photograph Septic System&measure for As-Built I, Craig R. Short, Civil Engineer, duly licensed as such in the Commonwealth of Massachusetts, do hereby certify that this fun has visually inspected the constructed subsurface sewage disposal system shown on the referenced approved plan, and further certify that the system, as constructed and shown on the attached As-Built, generally conforms within acceptable tolerance to the regulations, as varied, set forth in 310 CMR 15.000 and the Town of Barnstable Board of Health Regulations. NOTE: The S.A.S.placed 1.21'deeper,but still more than 5'(7.45')above the bottom of the Test dole(no water encountered). A Vent has been added by the installer,at my direction. �Jli OF a� CRAI CIVIL G,C No.2748a � / 40 Z/D��A=---- IA- (?F Craig R ort,P.E.,Engineer o,��S E`er' Date `,a� A'A,E GRAIG q�y cc: File 1-1041 SHORT Client Neale Family Trust i No. 2747483 Contractor Shawn McElroy N/ST ER�� FSS/dNAL ECG\ FROM :Sweetser Engineering FAX NO. :508 39B 3063 Sep. 07 2006 01:56PM P2 Town of Barnstable i Public.teatth Division 200 Main Segel Hyannis.MA QM I Notice: This Form Is To Be Used For.the Repair Of Failed Septic Systems Only PERCOLATION TEST AND SOIL EVALUATION-EXEMPTION FORM hereby certify that the engineered plan signed by me dated --- 60 L,concerning the property located at (a Car r t 4Q Pj 1Gn, Ra ruts44 61e_ meets all of the following criteria: a • Two soil evaluations excavated for detailed examination(no hand angering)and two, percolation tests shall be conducted. • This failed system is connected to a residential dwelling only. There are no commercial or business uses associated with the dwelling. , a The soil is classified as CLASS I and the percolation rate is less than or equal to 5 minutes per inch. • There is no increase in flow and/or change in use proposed • There are no variances requested or needed. • The bottom of the proposed leaching facility will be located no less than five feet above the maximum adjusted groundwater table elevation. [Adjust the groundwater table using the Frimptor method when applicable) Please complete the followings A) Top of Ground Surface Elevation(using GIS information) B) G.W.Elevation +adjustment for high G.W. DIFFERENCE.IIETWEEN A and B SIGNED: DATE: cS� �S 4L . NOTICE Based upon the above information,a repair permit will be issued for a bedrooms maximum. No additional bedrooms arc authorized in the future without cnginecrod septic system plans. - gASeptiylp@m=w p dw FROM :Sweetser Engineering FAX NO. :508 398 300 Sep. 07 2006 01:56PM P3 Town of varn5ta[D1e r-R Department of Health,Safety,and Esvironmeatel Services Public Health Divillion Date�0 o�QrJ IW Main Sbuolr Hyannis MA 02601 am� Date Scheduled . � 2•� O� Tune FeePd. rT Soil SuitabifiV Assessment for Sewage Disposal Porforhaed lly{' Witnessed BY. , owners N.me ea j� h 5 D l Add— o� p� , . AssmwraMeplPetceh aC(i�'3�, Enslneersaieme�(�.ce, Q•Sh �•, , NP.WCONS7 cnaN REPAIR rTdephonefl Lend Uac •2 E:S I d a`�<e Slopes(9G) / Serf—St—es yG-Z Dletanua @pm: Open we" ILO-k.?—R PoadDk Wei Ares_/w-3 A Drinking WMff Welf 0!9 ft Dreieago Way Tft. Preperty Lhm .3 2 it Other ft SKETCH:(Stroet twiner dlmensiem of lot,exact looellow ortest holes&pere tcsb,locate wetatds in proximity to holes) 40 N�T2pe' ��rrirZ � . �aaC-CN� Parent metwai(geolog%) FM C P y Dim W 9edhueic o x t At pth to Croundwa[er: Samdl Ffotu in Hole, w/o n t Wetpinp,Oom Pit Face Estimated Scrtaand High OroundwaW /"T . r ° Herbed iJiD� rt�1ag ip obs•hole: '- �/� Dep>b to soil mdtlo:' ie. - - Depth m oxhepbhg flxmn sWe efoba.hob: �"'. lo. Oroundwetar Adjhextrrmht ft.' Gsxkx Wdl P_—_-.-•R�adirteDeDe:--,__„__ indmr Wdl laud, Adj,faaor A$1.t3ropndwe[crLe.cl—_ Observation Hole e Depth offtc 78 I�ieeat6 ' �29:�f' Slat Presoak Tires � issee, End Pie-soak °Cw••3� Rate MlnAnch �• ny Site Suitability Anessrnem SIM Posed Site Failed: Additional Toff Nccded(YIN) Original:Public Health DivW= -Observation Hole Date To Be Completed on Rack--- bePtli f. Soo Horizoa Sa Tedvro ScU Colas : Soo Oster Svrfaae(in.) (USDA (Moi M tNaaltag (Struoturo,Samee,Bouldaw. Zo Gam. . P So l Odwo 9 11 So Cmor we 0 Surface On-) (USDA) (MURSOID M ift (SMKRUr,Saones,Boulderea. 2 Oe 3 AJO IZ goes •Z• `_" - per( 'V D Depth fom Horbmn Soil a rtrue .Sox Color- S Oilier Surface(le.) (USAA) @tt WSO Moalfsg (Structure.Stooes,Boulderee, -Carvigum%Gravel) h., IIom So Horl>7oa Otbu . Sarfcc(m) (< ) & S (ShaM Stmua,eoutdeeM , r Above 500 yew flood boundary No_ Yes widdn S00 ycwboundary No Yes WWn l0tl yew flood boundary No__,_ Yes_ Depth of Naturally Occurring Pervious Material t Does at least four feet of naturally occurring pervious mateiial exist is all areas observed duwghouf the area proposed for the soil absorption systwO If not,what is the depth of neurally occurring pervious material? CMENCOMMU I fY that tm A/e.. 9 (date)I have paused the sell evaluator exatnicadon approved by the Department of Eayhonmental Protection and that the above analysis was performed by me consistent with the required training,expertise and experience daudbed in 310 CMR 15.017. SignaQlte Dated ��'•3-fl+` - • L tvd WdLS:To 9OW 1_0 'ilia i9w 136E 809: 'ON X(id 6utJaaui6u3 .aaS4--S: tnHA Town of Barnstable Public Health Division 200 Main Street Hyannis,MA 02601 Notice: This Form Is To Be Used For.the Repair Of Failed Septic Systems Only PERCOLATION TEST AND SOIL EVALUATION EXEMPTION FORM Cc,L(I i� •S ko 4, �� ,hereby certify that the engineered plan signed by me dated 2 6 o C,concerning the property located at 101 CcA r r t a q i &ne, r�n rins4-n b JC_ meets all of the following criteria: • Two soil evaluations excavated for detailed examination(no hand augering) and two percolation tests shall be conducted. • This failed system is connected to a residential dwelling only. There are no commercial or business uses associated with the dwelling. • The soil is classified as CLASS I and the percolation rate is less than or equal to 5 minutes per inch. • There is no increase in flow and/or change in use proposed • There are no variances requested or needed. • The bottom of the proposed leaching facility will be located no less than five feet above the maximum adjusted groundwater table elevation. [Adjust the groundwater table using the Frimptor method when applicable] Please complete the following: A) Top of Ground Surface Elevation(using GIS information) 9 2. B) G.W.Elevation +adjustment for high G.W. DIFFERENCE BETWEEN A and B SIGNED : DATE: NOTICE Based upon the above information, a repair permit will be issued for a bedrooms maximum. No additional bedrooms are authorized in the future without engineered septic system plans. gAVSeptic\percexemp.doc e i 1VVY11 V11 "IHaLaMIZ YFF Department of Health,Safety,and Environmental Services o� Public Health Division Date 0 W Main Street,Hyannis MA 02601 II eARNETAer$. Date Scheduled �3��S��Ec�i1AAr Time Fee Pd. Soil Suitability Assessment foie Sewage Disposal Performed By: • O-tr'�, (,. Witnessed By: :»:>:>:::«:»<:_:>::> :. ' 4 ....::.............................................. Location Address I d- 1 mar rr t a,3 e— i _l� e? Owner's Name N�e 6 c,ja i �U��,as j- �0.r►�5--a. I� Q 1 Address i' �J Assessor'sMap/Parcel: a�8"/3G� Engineer'sName�� 111 NEW CONSTRUCTION REPAIR Telephone# /-50�r-J q 8-e-3 I ' Land Use oe.5./c�.c ti c c Slopes(%)_ L�. Surface Stones yc s Distances from: Open Water Body /0-3 ft Possible We Area o 3 ft Drinking Water Well A11,4 ft Drainage Way /t1 A ft Property Line .3 2- ft Other ft SKETCH:(Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands in proximity to holes) Nr4 ��ASP�.cJ i? 4n Z d0 I'I N � Q D wcGL n �..ST"Arz Q u I Parent material(geologic) ff"C f J ► -1 e v 1'-1 Depth to Bedrock Depth to Groundwater: Standing Water in Hole__�m-1 C Ob Weeping from Pit Face ,/ !7.t mot" Estimated Seasonal High Groundwater / ...:...:..:.,:...,.,;.;.....;>.:.......;:,:;..:.;....:�..:�..•.;.y,..y,.;.......:;:...�...y.:;:....:..::;.;........:....>::.....;.:,:..::...,;...:.»:.>:.;:..;:•::•::a>:•»;:;;:•:: Method Used: ... ... �i :. :>:•:<•»:•:.:..:::;<:• _:<•>:•;:...............:::::. Depth Observed standing in obs.hole: � / In. Depth to soil mottles: in. Depth to weeping from side of obs.hole: in. Groundwater Adjustment ft. Index Well#__..._._ ,Reading Date: __ Index Well level...____ Adj.factor__ Adj.Groundwater Level :.::::::::::.. ................::::::..::::...............:..:.:::::::.:::::..............................MN.�`���`.:::::::::.::::. Observation Hole# 01 Timei at V 5ttf .';.3 Depth of Pere 79 Time at 6" `7'� q•�r Start Pre-soak Time @ Time(9"-6') r End Pre-soak RateMin./Inch 2/N.,. Site Suitability Assessment: Site Passed Site Failed: Additional Testing Needed(YIN) Original: Public Health Division Observation Hole Data To Be Completed on Back-� Copy: Applicant :. :: : ::: :::::::.:::::.::::. : :::::::.:::.:::.:.::: :: ::::::.: :. Depth from Soil Horizon Soil Texture Soil Color SoilOther Surface � •������ ���������"'`' Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulderes. Consistency.° Gravel) -57 ........... K"W'o De th from :.::::..:::::::::::::::.::;.:::.;:::•;«.:<•:;,:•:;,;:.;.s>:•:>::>;>:><z<::»::M» .:.,.,.«:::>e:::>:»>::>:;;;: ;:;:;;;::>::»: p Soto Honzon Soi)texture Soil Color Soil Other Surface(in.) (USDA) (Mansell) Mottling (Structure,Stones,Boulderes. e ° e 2 A 3 3 z�t` ,� -� ��'� ,pro _ �y•e ID �a-7 1 .:i::::!i�]:::::i:::::l.::i.::::i:%:i; ...yy.�;;.:_...:'.:.•:::�:'. '�::'.: ........::...�...,. .;::'.::.i}::':•{:.:: •.•i?.�.:::..,'�....::i::i :i::::i::::i:�::.:�.....::::"•i:tiP:':}i}i::::::::::::::::::::i:::.:......:........:.... ..... �'.j�I({',�y„!{.:::}: ::: '. .S {;�♦ {��j{,', r: :'ii}:G:•'rS$;i?:•i<:?;:: '�•:::..:�';:::isi:::::�::::ii::i:�:ii:ii:::::}i;iSi?it i.i:::i::i::¢ji;::. ,, .' 1:\.': li}: .::::::::::iii:}::iii: Depthfrom';:.:�.:•;••;::....::::;:::;:::.�:.,,;;:.:;:�:::.:.:;:.::•;>::::::::.�:.:: ..:..::::•;::,:•;»;:•;>:•;:::»:•;:;;•>;•:::•>:,>;;:<:•;:•<:>::>::;»:::•::;::;::... p Soil Horizon Soil Texture . Soil Color Soil Other Surface(in.) (USDA) (Munsdll) Mottling (Structure,Stones,Boulderes. _Cgrisi e c ° ra e �''r ?i' :�%:\} .:: ::.•;::: ? E•: ..: ;..: .:i ?. i f::: ': i: # ::iE:::• :::.;i. f:•'•s 3 6::is .....: :....:......... .............,............:::.............................:.:::::::.::........................:....:...:::..:...................... :.:r.;;:.;::.;:::;:.;:.;::.;:.::::::.;:;.:::;.;:.;;:;.; Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulderes. Flood Insurance Rate.Map: Above 500 year flood boundary No_ Yes Within 500 year boundary No= Yes Within 100 year flood boundary No_ Yes Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the area proposed for the soil'absorption system? _ If not,what is the depth`of naturally occurring pervious material? Certification I certify that on ¢ (date)I have passed the soil evaluator examination approved by the Department of Environmental Protection and that the ab ove analysis was performed b e P Y p y m consistent with the required training,expertise and experience described in 310 CMR 15.017. Signature Dated THE COMMONWEALTH OF MASSACHUSETTS BOARD ?F HEALTH .................Z4 illill, Appli.r.-ation -for 4%ivoiial Work#4inuitrurtion Vamit Application is hereby made for a Permit to Construct (/--.,)-Or Repair an Individual Sewage Disposal Owner Address Design Flow................ __Callons per person per day. Total daily flow............. P4 Septic Tank/-Liquid capacitv S_:�A�otal Length.................. . -ire, Seepage Pit No------7--------- Diameter .- epth elow inlet.................... Total leaching , I------------------sq. f t. Other Distribution box ( ) Dosing tank ( ) Z. � Agreement:` The undersigned ogcccx to install the uforodescribod Individual Sewage Disposal System in accordance with | the provisions of Article -- of -- State Sanitary- --- ' | operationnntu a Certificate mCompliance hasIt � --'- -'' ' --'' ate ' p,-_--'- Approved By_��^v.�� __--'_-_-� -._-~-__ ___-..�,-____-'' Date Application Disapproved for the following reasons:................................................................................................................ .._ '......._____.._............'......__...............................................'.............'...........'��� Date ----------------------'-'----''''' ' No......: ..s---- Fps.............................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ---- --.OF...... ......... " INVpliration -for 4%ipoiial Workii Tonotrurtion Prrutit Application is hereby made for a Permit to Construct (4-110T or Repair ( ) an Individual Sewage Disposal 17 Systeriq4at 1r - ...............0. ::.............. ........................ '/o)cation-Addres ay ,-�,._ofiXdt No. f,•/ ... . ._'.R._°?&. :' .. !'!.+......__..•e-^?X_'_"1--_--------- // Owner Address (� Installer Address y.d Type of Building Size Lot..� �........., .� .... q. feet U Dwelling k No. of Bedrooms__.____.............._----------------_____Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ---------------------------- No. of persons---------------------------- Showers ( ) — Cafeteria ( ) a' Other fixtures .................................................. W Design Flow......................_ __....... Mons per person per day. Total daily flow_____________ __ .._y...gallons. WSeptic Tank Liquid capacityf._________gallons Length---------------- Width................ Diameter-----.---------- Depth.----_.-_.-.._- xDisposal Trench—N - -------------------- Width...........rn/-Total Length------------------_ Total leaching area_._..._____..__-_-sq. ft. Seepage Pit No.___ ________- Diameter/ef., __�Deptlow inlet.................... Total leaching area---------------_sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by-------- ----------------------------------------------------------------- Date--------------------------------------- `! Test Pit No. 1................minutes per inch Depth of Test Pit-------------------- Depth to ground water------------------------ Li, Test Pit No. 2----------------minutes per inch Depth of Test Pit.................... Depth to ground water-_.__.-..___-_-----_.-.. P4 -•----- .4 ----------------P. -----------.....----......................................................... r•- O Description of Soil •'� °''"°� ' ' .....x V ---------------------------------------•-------------------•---•--•------------•-••----------------------•-----------------------•-------------•---------------------------- W ----------------------------------------------------------------•-------------------------------------------------------------------••-----•----• ----------------------------------------------------- VNature of Repairs or Alterations—Answer when applicable..--------------------------------------------------------------------------------------------- -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Agreement: ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Article XI of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issxred by "e�ho�ard of heal'tl g ...``..................... ,..------- -------------------------- ate A Application Approved B ate' .. - _ 1 f -- .-•--•---------- '�D° PP PP Y o= 4 Date d �----- ----------------------------------•-----------..........-•-•- Application Disapproved for the following reasons_________________________________ --------------------------------------------------------------------------------------------------------•----------------------------------------------------------------------------------------------- Date PermitNo.......................................................... Issued........................................................ Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OP HEALTH ..............OF..... ....�..............µ':....................... Trrtifiratr of Toutplialtrr w THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed or Repaired ( ) i ..' Installer s, ��( ----- 1. has been installed in accordance with the provisions of Article YI of The State Sanitary Code as described in the application for Disposal Works Construction Permit No..----.-._�x____�-Y'.............. dated,`__.. —---------- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE................... ............................................................ Inspector------------------------------------------------------•----------------------------- THE COMMONWEALTH OF MASSACHUSETTS I BOARD OF HEALTH n No..........l ......... FEE i.................. %sVwia1 oxkii Clouitrttrtiog Prrutit �r « t �w Permission is hereby granted- ----------------------------------- u r__ �--1 to Constut ( ar an ndivtdurSe! ge Disposal Sysem at No.. '' ......... 1/1sGs7 ra l '.•� '. Street �S ..7, as shown on the application for Disposal Works Construction,Rermrt/N�...__ _________-- Dated_... !�----- _�......__.._..... Board of-He lth DATE................................................................................ FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS ,e2Y/73V . SEPTIC SYSTEM MUST BE J INSTALLED IN COMPLIA ` e. . WITH ARTICLE II STATE 'SANITARY CODE AND • TO NN iMe J ® 1N , OF "ARNSTAR' ONS t< d DAUSTAML MAO& �j (� �j (l *Y '�' enra`� t u '•f �� � �,® � p11� HOSPEC Il ®It➢ `w 4 `" R j APPLICATION FOR PERMIT T S l / Jr / ` 'KTYPE O CONSTRUCTON „ • S` p At TO THE'INSPECTOR OF-BUILDINGS� �., t `The'undersigned hereby.'.-a'pplies for a 'permit 'according to the following information: ' 1 2p Location �?T.# Z. /� .�- . . .A:AJ ....... v:l u FN,k, Proposed Use Zoning Distract �/... ........................Fire District Name of Owner .�© . aI'�G Cl,� S. /...�.L .dress .... 4-. z.�, !!.... n 7��tt Name of Builder Address Name 'of Architect Address • Number of :Rooms i Foundation . Out Ev tiC Exiei for !!�J.� sl yt,i.'�+GSI,.��� ,f�/,,4/�9�, ?. Roofing N d�4 ' .: t Floors J.4 A 12,P• 4!��?.4? ,�,� .. :Interior / S���oG(�f," E a'4t Heat.ing p' Ft �.� � .:.wd4 it Plumbing . .......... :e '�.1� .. /F ...... �f On F .. . S ..... .:.. :.:.. . .......' p. p. . tw � f z Flfeplace ArOXlm t .. r ,z ` «. PP a e Cost >3 �..• A W, ' r r' Yy�'ry Definitive Plan Approved by Planning Board _ _19 -: ;� ;O Zp�G, r t Diagram of Lot•and Building with Dimensions ai SUBACT;TO APPROVAL"'OFBOARD 'OF HEALTH v` ;Z ZI) �. ('qoo A� ridtN 5i6� 7, A ....,:...�� j" � ) L,,, nt'� r ��'• s' +.,...,�„.." , -• t'.+{ x # ply u t t �' .;it+ �• w."'•".'."'""^' 4Y� it .+��� � " �',.,i i a �" f., �� r n• � - ��i� ^�""r .a t = t t e Y 4 is 1'.`...x -.. � s��: -�fp'-"�._':,•�^.1;,.,-,...� d,.�._;,:�e,.. _;.�... '�%. s �i-. 4Y err �'.,{ b r� S •.C r•1 ,` k ,•��"��,.*.^--^••-r„ � .,.� f �s,U' ° - - �r�«, / 3 ;k�y� ~' .:. ��4r _ fk� 1 iw:.�4 t t; 4 F t ^�."��^� . 'Y - - •� tiJ t X 14, a q � hereby 'agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above u construction. x G'� Name ......,�i�X ........ ............. r,,._.... ^�. '.. Y � F r BENCHMARK SOIL TEST #1 SOIL TEST #2 TOP OF FOUNDATION 20 FT. MINIMUM FROM CELLAR OR CRAWL SPACE .SOIL TEST DONE BY CRAIG R. SNORT. P.E. it 100 00 10 FT. MINIMUM 10 FT. MINIMUM FROM SLAB ELEV. = DATE OF SOIL TEST �25106 _WITNESSED BY ]3 Ad,� QAN_L �3I r__� (assuMED} CONCRETE OBSERVATION HOLE 1 ELEV.=__94.17 OBSERVATION HOLE 1 ELEV.=__91.39 COVERS 4" SCHEDULE 40 PVC PIPE PERCOLATION RATE <2__ MIN./INCH AT _6B_78 _ INCHES PERCOLATION RATE _< 2 MIN./INCH AT _1A__ INCHES , MIN. PITCH 1/8" PER FT. DEPTH HORIZ TEXTURE COLORFNO OTHER DEPTH HORIZ TEXTURE COLOR MOTT. OTHER LOAM AND SEED 2" LAYER OF1/8" TO 1/2- FILL 12w A LOAMY SAND JOYR 3/2 NO ROOTS 1 6" MA CLEAN SAND WASHED STONE 39- AM LOAMY SAND ROO 4" CAST IRON PIPE 6" MA • TOP OF 6" MAX. V. 94.0 MA MA 92.0 MIN / (OR EQUAL) MINIMUM _ 51" C1 FINE SAND 10YR 6 6 ROOTS PITCH 1/4" PER FT. TANK < ELEV. ZABELDDLTER 92.37 ;,� 120" C2 FlSAND� OYR 7 4 NO FINE TO FLOW LINE 91.00 / LARGE ROCK 142 C MEDIUM SAND 10YR 7/4 NO LARGE ROCK ELEV. = EXIST_ 10" ° ° ❑ ❑ ❑ ❑ ❑ 0 ❑ ❑ ❑ ❑ ❑ o AT BOTTOM AT BOTTOM ° ° 5' MIN �TMIN ELEV. _ _91.00 LE' L� o ° ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ °'o ° NO WATER ENCOUNTERED AT �' ELEV. _ _ 4.1.Z NO WATER ENCOUNTERED AT 11.8�_ ELEV. _ __7R a9_ (EXISTING) ----- 6" SUMP __ ° o \ ELEV, s91_25±1 GAS V. _ _90_67 ELEV. _ _90.50 0°0 °0 40 MIL VINYL LINER DESIGN CALCULATIONS DI STR I BU TI ON ELEV. _ ° ° ° ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ° ° SEE PLAN NUMBER OF BEDROOMS _ LIQUID OUTLET _90•��_ ° °° ° ° ° ° ELEV. _ _88.25_ GARBAGE DISPOSAL UNIT N0. NOT-ALLOWED �� BOX TOTAL ES77MA TED FLOW DEPTH TEE- A` 4 FEET 14 INCHES TO BE WATER TESTED 66' (110 GALA$R.AbAY X�_ BR.) AL./DAY 5 FEET 19 INCHES 1000 GALLO IF MORE THAN ONE OUTLET 2-500 GALLON DRYWELLS WITH STONE REQUIRED SEP77C TANK CAPACITY Iwo L. 6 FEET 24 INCHES T /N AN 13' X 25' X 2'TRENCH FORMA LION z WELL N A ACTUAL SEP77C TANK CAPACITY AL�,t 7 FEET 29 INCHES ( 0 BE PLACED ON FIRM BASE) ZONE X SOIL CLASSIFICATION _ 8 FEET 34 INCHES SEPTIC TA 3/4" TO 1 1/2" CLEAN SOIL ABSO PTN INDEX X DESIGN PERCOLA77ON RATE �5- MIN./INCH (EXISTING -DOUBLE WASHED STONE SYSTEM &S? ADJUST X EFFLUENT LOADING RATE _0.74_ GAL/DAY/S.F. FREE OF FINES & SILT BOTTOM OF TESTELEV = '79.59 LEACHING AREA 477 SO. •FT. (13'x25')+(76'x2') ._` USGS PROBABLE WATER TABLE ELEV. _ _j�J,/A_ LEACHING CAPACITY 352 GAL.AAY SEWAGE DISPOSAL SYSTEM PROFILE OBSERVED WATER TABLE ( / / ) ELEV. _ _LI,IA_ 477 X 0.74 NOT TO SCALE RESERVE LEACHING CAPACITY NA_ GAL. DAY .:i 97.3 97.8 NO TES: 1. ALL WORKMANSHIP AND MATERIALS SHALL CONFORM TO D.E.P. TITLE 5 AND <;1 THE TOWN RULES AND REGULATIONS FOR THE SUBSURFACE DISPOSAL OF L_ 99.7 -� RIB v SEWAGE. 1' �? Z LEGMD: ALL COVERS TO SANITARY UNITS SHALL BE BROUGHT TO WITHIN 6" OF 101,%1 g TOWN WATER-w -w -w - FINISHED GRADE. I I 101.8 WATER SHUT-OFF 4 J. ALL COMPONENTS OF THE SANITARY SYSTEM SHALL BE CAPABLE OF \\ WATER VALVUE �® WITHSTANDING H-10 LOADING UNLESS THEY ARE UNDER OR WITHIN 10 FT. OF I GAS LINE-GAS-GAS-GAS- DRIVES OR PARKING AREAS. H-20 LOADING SHALL BE USED UNDER OR WITHIN \�102.1 GAS METER ® 10 FT. OF DRIVES OR PARKING AREAS. LOT 12 4. ANY MASONRY UNITS USED TO BRING COVERS TO GRADE SHALL BE MORTARED 94.7, 23,326 S.F. t LARGE ROCK �'�, GAS VALVET \ ELECTRIC LINE E -E IN PLACE. I 0 \ 5. NO DETERMINATION HAS BEEN MADE AS TO COMPLIANCE WITH DEEDED OR ELECTRIC METER ®• 1 7 ELECTRIC BOX ZONING REGULATIONS. OWNER / APPLICANT 1S TO OBTAIN SUCH DETERMINATION FROM APPROPRIATE AUTHORITY. I O 102.1 ELECTRIC MANHOLE . . . . ® 6. UTILITIES SHOWN ARE APPROXIMATE ONLY, EXCAVATION CONTRACTOR IS TO 99.9 { CATCH BASIN �®_v CALL "DIG-SAFE" AT 1-888-344-7233 AT LEAST 72 HOURS PRIOR TO 99.9 m 99.5 �# � ,� CESSPOOL Q COMMENCING WORK ON SITE. lllllf LEACH PIT Q 7. CONTRACTOR IS TO VERIFY GRADES AND ELEVATIONS AS WELL AS SITE CLEANOUT CONDITIONS PRIOR TO COMMENCING WORK ON SITE. ANY VARIATION IS TO BE 92.1 99 9 99.7 EXISTING SPOT ELEVATION x 0.0 BROUGHT TO THE ATTENTION OF THE DESIGN ENGINEER IMMEDIATELY. EXISTING CONTOUR (0.0) 8. PARCEL IS IN FLOOD ZONE 9. LOT IS SHOWN ON ASSESSORS MAP AS PARCEL \ �y 101.6 FINAL SPOT ELEVAl10N ® --29$-- ---39' \ LARGE ROCK / to A'_L UNSUITABLE k!A'rER!AL ,SHALL BE RC►dO"FED FPCM ��NL AND FOR A. \ 96.2 11020 FINAL CUN tUUR MINIMUM OF 5 FEET FROM AROUND THE SOIL ABSORPTION SYSTEM, AND BE \ 0 g FLAGPOLE REPLACED WITH SAND AS SPECIFIED IN 310 CMR 15.255: (3) (I.E. TITLE 5) IF 95.4 95. •'�2.0 HYDRANT ENCOUNTERED BELOW S.A.S. PIPE INVERT. (ie ELEV 90.25) \ GARAGE LIGHTPOST EXISTING SEPTIC SYSTEM TO BE PUMPED AND FILLED WITH SAND OR REMOVED. \ 90.2 DECK ! MANHOLE O &A ZABEL A1800 FILTER IS TO BE INSTALLED. A ' OBS. WELL CONTRACTOR TO PROVIDE SHORING AS NEEDED TO PROTECT BUILDING AND I 93.3 99.4 � I� SEWER LINE-s -s - PROPERTY LINE SEWER MANHOLE QS TP 14. CONTRACTOR TO UNCOVER TANK OUTLET TO CONFIRM ELEVATION BEFORE \ INSTALLING S.A.S. / SOIL TEST LOCATION- Q!) - A \\ 0 1 l TELEPHONE BOX . . . 89.4 \ 99.3 U1ILITY POLE . . . . . . . . . .�. . . . . M w w i \ 99.4 ) ' \\ 2.1 EX/S77NG 99.4 DWELLING `ZH 0 It.!S \ O \ 99.7 \ cV 1 \ 99.4 j a ROB114 \ i \ 2.1 92.4 I 7 ��Q,��d V!LI.IA! m i i ORAIG y\ z. f1 C SHORT P� APPROVED: BOARD OF HEALTH \ ` 100.0 BENCH MARK !' ; t�' CIVIL 6 ASSUMED of No. 2 6 ©77.5 \ 2 , � ELEV 100.00 5.21 , o ^� ras--- * - $ ffi J/ J#2889 DATE AGENT 77a3 , ' 93.5 187.6 EX/snNG 1 PROPOSED SEPTIC DESIGN \\ TA C FOR WE7ZAND FLAGS BY \ �- -r P\ G TEST I ,03' SHA AW McELROY LISA HENDRICKSON + r 9 fs 8`--- , 98.1 WETLAND 5ClEN77ST _ 0,9� ,3' 109' LOC. D BOX 1,2 CAR.RIA GE LANE NOTE 'l 6A �` A 76.3 / f 2 �'-i RE-PIG-SAFE-PIG-SAF RT �r j �,7 ] j ., lYlA 40 MIL BREAK BARNS TABLE'/'� Vl 1�/�H G� 041T BA / ' SITE PLAN 10 20 LOCUS a MARASPIN RD. CRAIG R. SHORT, P. E. L S A H = Q R TERN ROAD / l \ cob/es 'I SCALE 1 INCH 20 FEET w J 235 GREAT WESTERN 32.1' Q to oft. P. O. BOX 1044 fox. STAKED S77ZAW9ALE ' OVERDIG J�too, 508.398.8311 SOUTH DENNIS MASS 02660 508.398.3063. / & FK TER FABRIC / AS REOU/RED J Q / & WORK LIMIT SEE NOTE /10 6.8 DATE �ArAY 26, 2446 SCALE 1 '" = 20' ROUTE 6 / / REV. JOB NO. 1-1041 . 87.4 / 11 Y 91.2 LOCATION MAP REv. SHEET 1 OF 1 / 100.00' 01-1041 McEIroy_R1.dwg 02006 CRAIG R. SHORT, P.E.