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0207 CARRIAGE LANE - Health
207 CARRIAGE iPA Barnstable - A 298 - 078 71 TOWN OF BARNSTABLE , LOCATION 0 7 e14RI?/A9Q1 40,0- SEWAGE# VILLAGE � /'yI,$'7�Jb�/o ASSESSOR'S MAP&PARCEL,�, INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY 100 LEACHING FACILITY. (type) Z # (size), s�•x 30U NO.OF BEDROOMS OWNER,f 1n/q0,4 r PERMIT DATE:6 /7--,�0/0 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 leaching facility) Feet FURNISHED BY �c�� A f3 3 �3 3 L • O No. � 7 FeW. THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION — TOWN OF BARNSTABLE, MASSACHUSETTS Yes ftplitation for Misposai 6pstem Construction Permit Application for a Permit to Construct( ) Repair(4,)r-Tpgrade(4�"Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No.zO`/r� Z_wklr Owner's Name,Address,and Tel.No. H9W411019 HIM6G5T44 Assessor's Map/Parcel "I ,3-O $ 4I.575 11 4 I taller's N e Addr s,and Tel.No.S48-y2G—E/73$ Designer's Natt�e, ddrgs ,an Tel.No Ste—3G0' 53G/ �oc,d�'1�� [� 42P4� � �ra�s ��������1�r�c, 77 Type of Building: Dwelling No.of Bedrooms y Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria(. ) Other Fixtures Design Flow(min.required) gpd Design flow provided rj eJ gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs orAlterations(Answer when applicable) - — Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. Siple ,e Date Application Approved by Date y,g Application Disapproved by Date for the following reasons Permit No.710119 Date Issued i f ,jf �' .^1..�- .-r.,'..ate. �--+b.-.^r-.-a�'...+.m'i-.. ,,.� ..y,..,.!-'...faM.--r?••1Y' ,•'e-., r1„»a�w-+J;.+',-W4., _. z e �.. .ter r'tx -, - _ - g&No..e7n/s' Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS Yes 01pplication for MispoAal 6pstrin Construction 3pPrmit Application for a Permit to Construct( ) Repair ❑Complete System ❑Individual Components Location Address or Lot No.�1 O`J<:�JQ tR/"; Owner's Name,Address,and Tel.No. Assessor's Map/Parcel `�,1a- G 737 94, ,4 j Installer's Name,Address,and Tel.No.�<J2-s d= yT�2 Designer's Name, ddress,and Tel.No. �G :l o w LS.��^ry v/1'C5/a ' r S o4 S rev C, „r Type of Building: Dwelling No.of Bedrooms y , fLoi Si;e"'V/_ sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided fj q gpd • 9 Plan Date Number of sheets Revision Date Title j 3 Size of Septic Tank Type of S.A.S. Description offSoil '� r. C 'a '1 ✓�t°Z.:`8`�`!1 �� Nature of Repairs or Alterations(Answer when applicable) !d?5>��/! /.�'/�O,x- ? `>'!�J' L..�.�! f7�-�C,� • Date last,inspected: �yAgreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been:issued by this Board of Health_/'_ ,, Signed ' "i .c2.>.��G� Date Application Approved by / ` �~ Date ` Application Disapproved by/,/ •, .� Date for the following reasons Permit No.oid- -,!13 Date Issued It I f-7 17 P .THE COMMONWEALTH OF MASSACHUSETTS ._ BARNSTABLE,MASSACHUSETTS , Certificate of Compliance THIS IS TO CERTIFY, that the On-site Sewage Disposal system Constructed( ) Repaired(ef)- � Upgraded(�)-- Abandoned( )by✓t.? ----- - at 4r Z!<+lli= 13W,,-/51-W i/Elias been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No3a 8".�B dated rl i 11 �1 Installer,.la i/J6a Z2,f t�/� GaS Designer #bedrooms Approved design flow } gpd The issuance of this permit(shall not be construed as a guarantee that the system wg�i ll functi-n asdesigned! Date �i Inspectors 1�, - .- ---.--------- - - - - - -----,- - - --- -------------•----------------------------•----------------------------- No. 26 t 8 3 93 Fee /000 THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS Nsposal 6pstettt Construction i3ermit Permission is hereby granted to Construct( ) Repair( G) Upgrade( G)_. Abandon'( ) System located at 9 _ MLO and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction must be completed within three years of the date of this per/mit. Date Approved� p) Approved by° " r� ' rom: 01/10/2019 16:18 #985 P.001/001 Town of Barnstable Regulatory Services Richard V. Scali, Interim Director ' MAJOM ' MAM Public Health Division 6,1 Thomas McKean,Director 200 Main Street, Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Installer& Designer Certification Form Date: 10 l Sewage PermL*AJ it# �®/C�'-�Y3 Assessor's Map\Parcel Designer: /"l E't� /r7 G Installer: 9-j-11 o.S Address: o 13l)C L7S Address: On as issued a permit to install a (date) (installer) septic system at_s LU 7 �: -��( based on a design drawn by (address) - - Me dated ( es gner) �V ae ,L JP I certify that the septic system referenced above was installed substantially according to the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. Strip out (if required) was inspected and the soils were found satisfactory. I certify that the septic system referenced above was installed with major changes(i.e. greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system) but in accordance with State & Local Regulations. Plan revision or certified as-built by designer to follow. Strip out (if required) was inspected and the soils were found satisfactory. I certify that the'system referenced above was constructed in compliance with the terms of the IAA approval letters (if applicable) ( staller's Signature) lea f �- esigner's Signature) (Affix ere) PLEASE RETURN TO BA TABLE PUBLIC HEALTH DI N. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS- BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. Q:\Septic\Designer Certification Form Rev 8-14-13.doc I 1 ai-�aStable, P# 'own of B / ,ttt 0' Department of Regulatory Services �/(,� J�• • • . Date. ( / Pubic Health Division �ePKEAM 200 Main Street;Hyannis MA 02601 t Date Scheduled 'Time Fee Pd. -I =X, oil' ,Suitability Assessment for Se Disposal Performed By: I witnessed By: LOCATION &GENERAL INFORMATION Location Address'. — I Owners Name a � . Address. Dk" �`�l Assessor's MapJP4rcel: �� I Engineers Name `� 1 ele hone# d NEW CONSTRUj'i10N REPAIR I T p Land Use L W�- Slopes(4') 5 U' Surface Stones ALIJ qn I Distances from: Open Water Body 2' b ft Possible Wee Area�l U 0 ft Drinking Water Well7_� —ft - i Drainage Way > D D ft Property Line }/a ft Other _ ft SKETCH:(street name,dimensions'of lot,exact locations of test holes&perc tests,locate wetlands in proximity to holes) . � �� �'���u �ti sly . , .. n� Y : • 'Q L 1*Al o of,.4/OtS� Depth to Bedrock Parent,material(gcdl6ec)� AA I Weeping from Plt FaceDepth to Groundwater. StandingWaterinHoleI Estimated Seasonal0gh Groundwater '" ! Dt TION FOR SEASONAL MGH WATER TABLE _ Method Used: In.' Depth dbsery standing ut obs.hole: Ili. Depth to soh mottlesa Depth toiweeping from side of obs.hole in. Groundwater Adjustment' Index Well#— Reading Date: Index Well lev6I facto ! Act. r.,..,_.. Adj.GroundwaterLevet,,.,., PERCOLATIOIrt TEST . Date. - Observation I Hole# - rt • c�� Time at G" _..:...�� ....-.---=-- Depth of Pere *rime(911-6') — Start Pre-soak Time,@ End Pre-soak Rate MinAnch ` Additional Testing Needed(YIN) • Site Suitability Assessment: Site Passed—4-- Site Failed:; — e Com leted on Back-- original:.Public Ile�lth Division Observation Hole Data To B . • P • ! ou must first notify the • ***If percola#6n test is-to be conducted within 100' of wetland,.,You BarnstAble C4#servation Division at least one(1) wedk prior to beginning. DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other. Surface(in.) (USDA) (Munsell) Mottling (Structure.Stones,Boulders. nsi c ve o r,^-7 123 w 3�Ole ' v l t�Q - Meg Srrlr . i DEEP OBSERVATION HOLE LOG Hole# 7/ Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones.Boulders. C nsistency.% el b - L o" �a SOVL4 a (t'3 '✓ io A^VL4Y1j o Ws N 4.4 tip- 2 .S ' l DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency. o el DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones.Boulders. ist n .r Flood Insurance Rate May: X Above 500 year.flood-boundary .No Yes __ Within 500 year boundary No�_ Yes A ` Within 100 year flood boundary No� Yes Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pe us material exist.in all areas observed throughout the area proposed for the soil absorption system? If not,what is the depth of naturally occurring pe vious material? Certification 0j I certify that on 0 I ` (date)I have passed the soil evaluator examination approved by the IL Department of Environmentaf Protection and that the above';analysis was performed by me consistent with the required t e ertise a experience described in 3,10 CMR 15.017. Signature Date l� Q\SEPTICIPERCFORM.DOC I - Town of M nstable, p# Department Of Regulatory Ser»txs - Publk Healih Divisi6DC Date b 1+ !"9) ".' �e 200 Main Street,Hyannis MA 02601 , ' I .. r r h•M1 - IC 5 Date ScheduledTime `O Fee Pd ' ►foil Suitability As essment for Se e Disposal Performed'By: V/ Witnessed ey LOCATION&GENERAL INFORMATION Location Address ©-7 Cif L owners;Name - fTj lJ-Grs 1� �J Address Assessor's Map/Percel: l C -7 9 1 f Engineer's Namei. NEW CONSIRU�' ON \ REPAIR Telephone i Land Use __ - - Slopes(%) - ! - Surface Stones Distances from: Open Water Body ft . Possible Wee Area i 4 ft Drinking Water Well` ft Drainage way ft. Property Line ft : Other ft SKETCH:($tree[name,dimensiotisbf lot,exact locations of test holes do pert:tests;locate wetlands in proxitnity to holes) T17 t Parent material(gedl4c) n Depth to Bedrock i Depth to Groundwater. Standing Water in Hole:' I Weeping from Pit Pace Estimated Seasonal1jigh Groundwater DI TEIt1VQN TION FOR SEASONAL ffiGH WATER TABLE Method Used: F �` Depth C14erved standing; obs.hole: In. Depth to sell mottles: Depth toiweeping from side of obs.hole: I in. oroui►dwater Adjustment tk• Index Well# Reading Date: index Well levotl Adj.factor...•., AdJ•OltntedtNOtttrLevel PERCOLATION TEST Date,,,_,..,,..., TIPW Observation Hole# �Tims pt 9" . Depth of Pere - Start Pre-soak Time.0 Z'$4kJ1 End Pre-soak Rate MmJlnch. Site Suitability Assessment: Site Passed Site Failed: Additional Testing Needed(YM)._,='* original:.Public Health Division Observatiol Hole Data ToiBe Completed on Back ***If percolal;ion test is to be conducted within 100' of wetland,,you must first notify the Barnstable'C44servation Division at least one(1)wedk prior"to beginning. DEEP OBSERVATION HOLE LOG ' Hole# Soil Other Depth from Soil Horizon Soil Texturere Soil Color. (M nsell) Mottling (Structure,Stones,Boulders. .Surface(in.) onsistenc gb Grave b s lb ea, t Lj I►� s�2-, DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Mottling (Structu Other re,Stones,Boulders. Surface(in.) (USDA) ( l) Consistenc %O el DEEP OBSERVATION HOLE LOG Hole# Other Depth from Soil Horizon Soil Texture Soil Color Soil n (Structure,Stones,Boulders. Surface(in.) (USDA) (Muosell) g Con isle c o vel DEEP OBSERVATION HOLE LOG Hole# SoilOther Depth from Soil Horizon Soil Texture Soil Color Moulin (Structure,Stones.Boulders. Surface(in.) (USDA) (Munsell) g Consist Flood Insurance Rate Map: J Above 500 year flood boundary No es Within 500 year boundary No Yes Within 100 year flood boundary No_ Yes Depth of Naturally Occurring Pervious_Material Does at least four feet of naturally occurring pervious aterial exist,in all areas observed throughout the area proposed for the soil absorption system? �. If not,what is the depth of naturally occurring pervious matertal? Certification I certify that on �O q (date)I have passed the soil evaluator examination approved by the Department of Environ ental Protection and that the above analysis was performed by me consistent with the required training,a is d enence describe�iin 3,10 CMR 15.01 . Signatur Date , Q:%SEFTIC%PERCFORM.DOC Town of Bkmstab e. P# Department of Regulatory Services. s ''OII Bate AB(F. Public Health Divisl< 261 ems$ 200 Main Street.Hyannis MA 02601 C;+ Date Scheduled v 'Time Fee Pd. oil Suitability Assessment for Se Disposal �. 1 Mdh Performed By: I i Witnessed By LOCATION& GENERAL INFORMATION Location Address•p�� `Owner's Name , /�i t,/ �" 1,7 Addr+essi S+Vie, ' Assessor's Map/P41rcel: fa?q I. , Engineers Name J , l NEW CONS7RU!tON REPAIR j Telephoie# �d� 33 1 Land Use ��-s L{ �" �! " Slopes(96) `_ U .r Surface Stones Distances from: Open Water Body �"d ft 'Possible Wee Area ft NDrinking Water We117��ft Drainage Way >/O b ft. Property Line y 'n. ft Other ft SKETCH:(Street name,dimensions'of lot,exact locations of test holes&pert tests;locate wetlands in proximity to holes) Ot Parent material(geologic) A.1 "t�- i Depth to Bedrock J I I iftom Pit Face Depth to Groundwak& Standing Water in Hole:' t Weeping. Estimated Seasonal f#igh Groundwater i D TION FOR SEASO!W NAL HIGH WATER TAr3LE Method Used: Depth Olverve standingiin obs.hole ia. D th to call motdwa in° Depth toiweeping from side of obs.hole: i iut. atGutidwntt7 AdJuattnent ! Adj.faetar•�..•�_. Adj.Groundwater Leval.— Index Well# _-� Reading Date: - Index Well level._;._:....... i , PERCOLATION TEST! Date--..-- xl Observation Time at 9" Hole# �rl 5 Time at 6" Depth of Perc ,- �'�"• ��� _ Start Pre-soak time.Lib G� 1 Time(9'.'•G') ,_.....:.' End Pre-soak ` Rate MnJlnch i Site Suitability Asseosment: Site Passed Site Failed; !Additional Testing Needed(Y/N) Original .Public lieaith Division ,Observation Hole Data To Be Completed on Back— ***If percolaitin testis to be conducted within 100' of wetland,you must first notify the tyk prior to beginning. Barnstable NOservation Division at least one(I we v DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,stones,Boulders. Consistency.%Grave 0"^-7 " ate► 7'— N '� w f� �o. Moo :2 DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. C nsistenc %Gra el b . �a S a I31/ 0 lv`t--35 '' S o as S DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. onsistenc %Gravel DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Sall Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. C nsisten I .t Flood Insurance Rate Map: x 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 pe v' us material exist.in all areas observed throughout the area proposed for the soil absorption system? If not,what is the depth of naturally occurring pe vious material? Certification 1 I certify that on l U (date)I have passed the soil evaluator examination approved by the Department of Environmental Protection and that the above analysis was performed by me consistent with the required tr 1i rertise a experience described in 3,10 CMR 15.017. Signature V Date o l� Q:\.SEPTICVERCFORM.DOC Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M �< 207 Carriage Ln Property Address Dean Owner's Name Barnstable MA 02630 3/1/13 Cityrrown State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. A. General Information 7 I 1. Inspector: �D 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 Telephone Number B. Certification I certify that I have personally inspected the sewage disposal system at this add Qes and thane o information reported below is true, accurate and complete as of the time of the in-, ction. The insretion was performed based on my training and experience in the proper function and;ma ntenanc 'gf on�si e sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 16.000).The system: PC ® Passes ❑- Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority u 3/1/13 inspecto s S1g atureAV_ Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. 207 Caniage Ln.-03108 a,,<' Tide 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 207 Carriage Ln Property Address Dean Owner's Name Barnstable MA 02630 3/1/13 City/Town State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® 1 have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: Pumping suggested every 3 yrs to prolong the life of the system 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. 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: n/a ❑ 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 207 Carriageln.•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 15 r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 207 Carriage Ln Property Address Dean Owner's Name Barnstable MA 02630 3/1/13 Cityrrown State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes(cont.): ❑ distribution box is leveled or replaced ND Explain: n/a ❑ 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: n/a 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 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. 207 Carriage Ln.-03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 15 r Commonwealth of Massachusetts Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M ' 207 Carriage Ln Property Address Dean Owner's Name Barnstable MA 02630 3/1/13 Citylrown State Zip Code Date of Inspection B. Certification (cont.) C) Further Evaluation is Required by the Board of Health (cont.): ❑ 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 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: n/a 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 %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. 207 Carriage Ln.•03108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 15 Commonwealth of Massachusetts _ u Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 207 Carriage Ln Property Address Dean Owner's Name Barnstable MA 02630 3/1/13 Cityrrown State Zip Code Date of Inspection B. Certification Cont. D) System Failure Criteria Applicable to All Systems (cont.): Yes No. ❑ Z 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. 207 Carriage Ln.•03108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 5 of 15 r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 207 Carriage Ln Property Address Dean Owner's Name Barnstable MA 02630 3/1/13 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. ® ❑ 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)] 207 Carriage Ln.•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 15 I r - Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 207 Carriage Ln Property Address Dean Owner's Name Barnstable MA 02630 3/1/13 Cityrrown State Zip Code Date of Inspection D. System Information Residential Flow Conditions: Number of bedrooms (design): n/a Number of bedrooms(actual): 4 DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): 440 Number of current residents: - 2 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes ® No Laundry system inspected? ❑ Yes ® No Seasonaluse? ❑ Yes 0 No Water meter readings, if available(last 2 years usage(gpd)): Sump pump? ❑ Yes ® No Last date of occupancy: Occupied Date Commercial/Industrial Flow Conditions: Type of Establishment: n/a 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: Last date of occupancy/use: Date Other(describe): n/a 207 Carriage Ln.-03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M ,••'' 207 Carriage Ln Property Address Dean Owner's Name Barnstable MA 02630 3/1/13 Cityfrown State zip Code Date of Inspection D. System Information (cont.) General Information Pumping Records: Source of information: No history given 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): No D-box Approximate age of all components, date installed (if known)and source of information: 1974 per age of the home Were sewage odors detected when arriving at the site? ❑ Yes ® No 207 Carriage Ln.•03/08 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 8 of 15 r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 207 Carriage Ln Property Address Dean Owner's Name Barnstable MA 02630 3/1/13 City/Town State Zip Code Date of Inspection D. System Information (cont.) 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: 1'feet Material of construction: ® concrete ❑ metal ❑fiberglass ❑ polyethylene ❑other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) El Yes ❑ No -------------------------------------------------------------------------------------------------------------------------- Dimensions: 1200g per BOH record 2" Sludge depth: 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 >211 Distance from bottom of scum to bottom of outlet tee or baffle >2" How were dimensions determined? measured 207 Carriage Ln.•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 15 Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 207 Carriage Ln Property Address Dean Owner's Name Barnstable MA 02630 3/1/13 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 yrs to prolong the life of the system Grease Trap(locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): n/a 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 Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): n/a 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): n/a 207 Carriage Ln.•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 207 Carriage Ln Property Address Dean Owner's Name Barnstable MA 02630 3/1/13 Citylrown State Zip Code Date of Inspection D. System Information (cont.) Tight or Holding Tank(cont.) 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.): n/a *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No Distribution Box(if present must be opened) (locate on,site plan): Depth of liquid level above outlet invert n/a 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.): Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ 'No 207 Carriage Ln.•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 15 Commonwealth of Massachusetts a Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments '< 207 Carriage Ln Property Address Dean Owner's Name Barnstable MA 02630 3/1/13 Citylrown State Zip Code Date of Inspection D. System Information (cont.) Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.): n/a Soil Absorption System (SAS)(locate on site plan, excavation not required): If SAS not located, explain why: Type: ® leaching pits number: 1 ❑ 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.): Leach Pit is V below grade, it has 6"of effluent in it at this time, no indication of past backup 207 Carriage Ln.•03/08 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 12 of 15 Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 207 Carriage Ln Property Address Dean Owner's Name Barnstable MA 02630 3/1/13 CitylTown State Zip Code Date of Inspection D. System Information (cont.) 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 Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy(locate on site plan): Materials of construction: Dimensions Depth of solids Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): n/a 207 Carriage Ln.•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 15 Commonwealth of Massachusetts . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments . M ' 207 Carriage Ln Property Address Dean Owner's Name Barnstable MA 02630 3/1/13 Cityfrown State Zip Code Date of Inspection D. System Information (cont.) 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. -- c) C\) o� ' qo 207 Carriage Ln.•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 15. Commonwealth of Massachusetts . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 207 Carriage Ln Property Address Dean Owner's Name Barnstable MA 02630 3/1/13 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: >12' feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date ❑ Observed site(abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health-explain: ❑ Checked with local excavators, installers-(attach documentation) ® Accessed USGS database-explain: per elevation of home You must describe how you established the high ground water elevation: see above 207 Carriage Ln.-03108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 15 �f/�liz-�,� � - �- 1 /h 4 6 �A`Ud <j 7 2 I i I I 7 i AsBuilt Page 1 of 1 t L/►af11 A 4�y rE-- r z .-----� o - - C. iI 1 http://issgl2/intranet/propdataJprebuilt.aspx?mappar=298078&seq=1 12/20/2012 Qy�FTHET��y TOWN OF BAR.NSTABLE . ! r i EAWSTABLE i oaYa BUILDING YIHSPECTOR APPLICATION FOR PERMIT TO ........................ .... .... �......... ........... TYPE OF CONSTRUCTION ......h�F.E-t...-.............. ... 7` ..c c ................................................................ .YL..c....cam .. ..................1 TO THE INSPECTOR OF BUILDINGS: Q The undersigned hereby applies for a permit according to the following informa ' / Location ... T. .7. LL o .. .. � .. .. ProposedUse ....... .; 4.,.. G.'. ......... ....................................................................... ....... ........................... Zoning District ...... ......................................................Fire District .... Cfw� s?r� ......................... C�C� �� / Name of Owner .......... .................... ......I........�,* `'..Address - . , ,?.......................................................... Nameof Builder ....................................................................Address .............................................::..................................... Nameof Architect .............:....................................................Address ..........................................................,......................... Number of Rooms ....�4 c... . ..:.. .................Foundation ........: � ..................,........:...... Exterior .... ...................+ Roofing ......./!5�/ i'9 L.�........... .................................... Floors ...... � e e . Interior ../..................................... Heating ........(` ............. f.r.............................Plumbing . f x�—'%-�-~--- �►r-tea ....... 1..................... ......... ..... , Fireplace �5...................................................................Approximate Cost �v��f.UpC?................................. .: ... ... .� Definitive Plan Approved by Planning Board ___ _ _z`f Diagram of Lot and Building with Dimensio' s e SUBJECT TO APPROVAL OF BOARD OF HEALTH L F-4 2V co z � QwoV � � : co .' o ¢ \ ` LLJ ISO � . `t`—'o c_`'i c 0 i Qa O W I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. � r CC/�'?` Name .. ...................... crd No... -63 9 _ Fes$.. ...................... THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH mj+p a®� AjYptiration for Disposal Works Tonstrurtion rrrutit Application is hereby made for a Permit to Construct ( or Repair ( ) an Individual Sewage Disposal system t fi ..... - ddr or Lot IQ . O r r ••••-•_•-•---•---.-..-Address a --- --------- - - -------- _.........-----•-• -•-•---- Installer Address UType of Building y /Le�.►� Size Lot-_ -----Sq. feet 14Dwelling—No. of Bedr ms............................................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ___________________----_-_ No. of persons---------------------------- Showers ( ) — Cafeteria ( ) Q' Other fixtures ...................................................... W Design Flow.............................A�_D� ._gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity _gallons Length................ Width................ Diameter---------------- Depth................ x Disposal Trench—No..................... Width............ _��Total Length.................... Total leaching area....................sq. ft. 3 Seepage Pit No..................... Diameter .X. _ ___. _._ "Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box (A ) Dosing tank ( ) aPercolation Test Results Performed by.......................................................................... Date------------------------------------ Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water_._.--.___---________-_- f� Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water....................... a' --•-••-••-----------------•--------•------------•--------•---•-••••••-••----•--•-•---•-•-----••-•••.......................................................... O Description of Soil___________ ___ x � ---------- U --••---------------------------•-------•••••-- ----------------- W ------------------ ----------------------------------------------------------------------------------------------------------••-----------.------------------------------------------------------------ V 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 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 iss by the bo o ealth. Signed = --------------------------- 1� -�----- Application Approved B _`:'.__ ::C �f /l/L✓! ---------------•---Date-------------• Date Application Disapproved for the following reasons-------------------------------------------------------------------------------------------------------•--•.---•- ---------------------------------------------------------------------------•----------......-----•-•-••-•-•••••-•----------------------•-•-•----•-•----------------•-•-------•-••------------•- Date Permit No. /.l Issued. Date v� .r No...... .................. .... ..... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH I ,fig ........O F........1�,1,�.>A l r z ....................... i ,Apure#inn for Uhiposal Works Tomitrur#ion runfit Application is hereby made for a Permit to Construct ( ') or Repair ( ) an Individual Sewage Disposal Syst t: _......�-__---- -------- - -------------------- -- ------------- L tioraa ddrr�s�^ or Lot NoJ �f �^ ..F •- .................. O ( Address In taller Address Q Type of Building Size Lot-----Tnr^r, �3 Sq. feet Dwelling—No. of Bedro ms........ ................._____.__..Expansion Attic ( ) Garbe-Grdei ( ) aOther—Type of Building ............................ No. of persons---------------------------- Showers ( ) — Cafeteria ( ) Other fixtures ------------------------------------------------------ W Design Flow.......................................*.._jallons per person per day. Total daily flow--------------------------------------------gallons. WSeptic Tank—Liquid capacity.� `__'_gallons Length................ Width---------------- Diameter----.----------- Depth--_-__-_------.. x Disposal Trench—No....................:._'T-Mth.................... Total Length.................... Total leaching area....................sq. ft. 3 Seepage Pit No........ "....... Diameterl__',8....... Depth, below inlet.................... Total leaching area------------------sq. ft. z Other Distribution box ( ) Dosing tank (t) aPercolation Test Results Performed by...................... __...__.... Date........................................ ,.� Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water...--_.-------_-__-----. fq Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water_-_-______-_-__-..--.--. W •••----•••-•------------------------------------•--•----•••••-••-•---•-----•-••-•••-•-----.....-------•--•----•••••--••-------•••-------••----=••---------- 0 Description of Soil_._..------_^_....._._... V ------------------------------------ ---=e���`-°^` ------------...------------------------------------------------ - - - - W ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- V 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 Article XI of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued.by the boardf f ealth. Signed -..{ ` 1 .n ,�:�R _11 _ Date Application Approved BY = =- ..............................................................----------- Date Application Disapproved for the following reasons:........................................................................ --------••--•-----•---••---•--••••••-- .............................. "..F •----------•-------•-•-------------------•------••--•-..................------------• ---•--------------•----Date--•----------- Permit No.......................................................... Issued.... p •• -- --- Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ...........:.........s�...............OF. ��YF ' THIS IS TO CERTIFY, That the Individual KSeage Disposal S- tensc nstructed (,, fir Repairedby--------- ••-•••.... Inst er at 'Y" ---------_- -�--11 . ..: F �I. r" w t�� has been installed in accordance with the provisions of Article XI of The State Sanitary Code as described in the application for Disposal Works Construction Permit No._, I`........................... dated __................ THE ISSUA CE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM W L UNCTION TISFACTORY. DATE --�--�--- -------- --------- -•••----------- Inspector--------- ................................... } THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ...... '( e f ................OF....:r� t E /fir,. : 4t ............................. xt , No. r-- s FEE.......-. Permission is hereby granted j ....... - -------------------------------------------............... Construct ( r Repair ( ) an Individual Sewage Dts oral System � ,P at No... �" ---•-----/ r� _ `I` •- -------- •t t•ta*- r Street as shown on the application for Dis osal Works Construction Permit :_` ' .___- ted_____ .:.'"! _` 1...........:.... 17:2 =•-•-••-• ....... ------------------------------ Board of IIealth DATE....•- ............................. I FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS BARNSTABLE OROUTE 6A ", C�v —104 / .. ------------------ / r� / G SO•�6• _ � �<v / v / / --------- ----------- -106 O�PGG r Id W ___ _------__ _ LOCUS / - / a / a � 411, ,-'� ` 11O LOCUS MAP 'mil Q /O f % �///� RETA�N�NG ----- - w t / WA`` LOCUS INFORMATION -112 PLAN REF: 260/042 ``O , TITLE REF:. 27190/177 PARCEL ID: MAP 298 PAR. 078 FLOOD ZONE: NOT IN FLOOD ZONE "PROPERTY NOT IN A ZONE II/ZONE OF CONTRIBUTION —114 /0 / TP-1i// 'i 20 ft O Tp-4 ? zo ;N SEPTIC SYSTEM / REPAIR PLAN P- j®2 ; k�� o�' LOCATED AT: I I �u 207 CARRIAGE LANE Q LI I BARNSTABLE, MA PAVED DRIVEWpy I Ir_-__.___— PREPARED FOR AMANDA HINGSTON EXISTING 1,000G SEPTIC TANK SEPTEMBER 30, 2018 REV: NOVEMBER 8, 2018 GENERAL NOTES: LOT 57 1. ALL CHANGES TO THIS PLAN MUST BE APPROVED BY THE LOCAL _ I I I I I AREA = 35200 sf+- OF BOARD OF HEALTH AND THE DESIGN ENGINEER. 104 I i i I 9 PLAN BOOK 260 PAGE-42 2. ALL WORK AND MATERIALS SHALL CONFORM TO THE REQUIREMENTS 10�-I I I Assr MAP 298 PGL 78 OF THE STATE ENVIRONMENTAL CODE, TITLE V, AND ANY APPLICABLE r�_` I o DARt�EN M / LOCAL RULES AND REGULATIONS. 1 O8 110 �—I # O� M 3. THE SEWAGE DISPOSAL SYSTEM SHALL NOT BE BACKFILLED PRIOR 112 TO INSPECTION AND APPROVAL BY THE BOARD OF HEALTH AND THE DESIGN ENGINEER. 1 j 14 4. ANY CONDITIONS ENCOUNTERED DURING CONSTRUCTION DIFFERING _____ �/sl FROM THOSE SHOWN HEREON SHALL BE REPORTED TO THE DESIGN �NITAR�P� i ENGINEER BEFORE CONSTRUCTION CONTINUES. _ 1�5. ALL ELEVATIONS BASED ON ASSUMED DATUM. 1 6. THE DESIGN ENGINEER IS NOT RESPONSIBLE FOR THE FAILURE OF THE CONTRACTOR OR OWNER TO NOTIFY THE LOCAL BOARD OF HEALTH FOR PROPER INSPECTIONS DURING CONSTRUCTION. 7. WATER SUPPLY PROVIDED BY TOWN WATER SERVICE. SCALE: 1"=30' w S.O A CONDITION DISTURBEDAGREEDURING BETWEEN OWNER SHALL BE�R�OR m M E YE R . & SONS, INC. 9 IT SHALL BE THE THE LOCATION OF ALL PUNDERGRO ND UTILITIES,, PRIORONSIBILITY OF THE TO BEGINNING TO VERIFY E LEGEND P.O. B 0 X 981 CONSTRUCTION. 10. EXISTING LEACHING TO BE PUMPED, CRUSHED AND FILLED PER TITLE 5. PROPOSED CONTOUR EAST SANDWICH, MA. 02537 11. 48 HOUR NOTICE FOR ENGINEER CERTIFICATION BENCH MARK ® PROPOSED SPOT GRADE 12. THIS PLAN IS TO BE USED FOR SEPTIC SYSTEM PURPOSES ONLY PH: (508)360-3311 AND IS NOT TO BE CONSIDERED A PROPERTY LINE SURVEY 'TOP OF FOUNDATION -- 98 -- EXISTING CONTOUR FAX: (774)413— 9468 13. NO PRIVATE WELLS WITHIN 150' OF PROPOSED LEACHING. 115. 70 + 96.52 EXISTING SPOT GRADE 14. NO WETLANDS WITHIN 100' OF PROPOSED LEACHING. meyerandsonstitle5®gm ail.com 15. ALL PIPING TO BE 4' SCH 40 O 1/8%FT (UNLESS SPECIFIED) BARNSTABLE GIS DATU W EXISTING WATER SERVICE TEST PIT SHEET 1 OF 2 J 2024 4 ELEV. TOP NOTE: PLACE MAGNETIC MARKING TAPE OVER ALL COVERS DROP FND. BRING ALL COVERS TO WITHIN 3" OF FINISH GRADE (Existing) FINISHED GRADE (108.0) 115.70� F.G.EL: 114.3 F.G.EL: 114.7 F.G. EL: 111.0 a MAINTAIN 2% MIN SLOPE OVER LEACHING AREA i. 2" OF 3/8" DOUBLE WASHED 3/4" - 1-1/2" F.G.EL 113:59 PLACE SANITARY TEE STONE OR FILTER FABRIC 6" • ~ IN D-BOX DOUBLE WASHED STONE " 4" SCH 40 PVC 10"I e• ®®®®®M®®®®® TEE'S ARE TO BE 14 ® 5= 1% (MIN.) ®®®®®®®®®®® 4" SCH 40 PVC INV. 2 EFF. DEPTH 10®®®131®®®®®® INV.1 12.25 INV. 107.30 4' 2 X 8.5' 4' GAS PROPOSED DB-3 EFFECTIVE LENGTH = 25' EXISTING OUTLET INV. 112.5 BAFFLE DISTRIBUTION BOX AM M (H20) INV. ELEV.= 104.0 EXISTING 1,000 GALLON SEPTIC TANK GAS BAFFLE TO BE INSTALLED ON OF ' ss9 BREAKOUT OUTLET TEE AS MANUFACTURED BY ELEV.= 105.00 , , NOTES: TUF-TITE ZABEL OR EQUAL o DARE M. TOP CONC. ELEV.= 105.00 1) CONTRACTOR SHALL VERIFY ALL EXISTING ME PIPE INVERTS PRIOR TO CONSTRUCTION o. INV. ELEV.= 104.00 ® ®® 2) D-BOX SHALL BE SET LEVEL AND TRUE TO ®®® ' ®®®®®®® GRADE ON A MECHANICALLY COMPACTED SIX ®®®®®®® INCH CRUSHED STONE BASE, AS SPECIFIED IN `T1NITAR�aa BOTTOM EL.= 102.0 ®®®®®®® 310 CMR 15.221(2) t 3.75' 5 FT. 3.75' 3) REPLACE EXISTING 1,000 GALLON SEPTIC TANK b L WITH 1500 GALLON SEPTIC TANK IF FAILED, EFFECTIVE WIDTH = 12.5' DAMAGED OR UNDERSIZED. SEPARATION 5.00 FT. 4) INSTALL INLET & OUTLET TEES W/ SEPTIC SYSTEM PROFILE SOIL ABSORPTION SYSTEM SECTION GAS BAFFLE AS REQUIRED BOTTOM OF TESTHOLE EL: 97.0T ( (500 GALLON LEACH CHAMBER) DESIGN CRITERIA SOIL LOGS P#: 15674 SOIL LOGS P#: 15821 NUMBER OF BEDROOMS: 4 BEDROOM DESIGN (3BR EXIST./1 BR PROP.) DATE: JUNE 6, 2018 DATE: NOVEMBER 7, 2018 SOIL TEXTURAL CLASS: CLASS I (0.74 GPD/SF) SOIL EVALUATOR: DARREN MEYER, R.S., CSE #1614 SOIL EVALUATOR: DAVID B. MASON, R.S., CSE DESIGN PERCOLATION RATE: <2 MIN/IN WITNESS: DON DESMARAIS, BARNSTABLE HEALTH DEPT. WITNESS: DON DESMARAIS. BARNSTABLE HEALTH DEPT. DAILY FLOW: 110 G.P.D. X 4 BR = 440_ G.P.D. GARBAGE GRINDER: NO (not designed for garbage grinder) Elev. TP-1 Depth Elev. TP-2 Depth . TP-3 Depth Elev. TP-4 Depth SEPTIC TANK: 440 gpd x 200% = 880 gpd, USE EXIST. 1,000 GAL. SEPTIC TANK 110.1.10 0" 110.29 0" 10825 A 0" 107.00 0. A LOAMY SAND A LOAMY SAND LOAMY SAND A LOAMY SAND LEACHING AREA REQUIRED: (440)/0.74 = 594.59 S.F. 1 OYR 3/2 - 10YR 3/2 107.92 B 1 GYR 3/1 4" 106.67 1 OYR 3/1 4„ 109.52 B 7 109.46 B 10" B USE THREE (3) 500 GALLON PRECAST LEACH CHAMBERS W/ 4' LOAMY SAND LOAMY SAND 1 SAND LOAMY SAND STONE ON ALL SIDES: 33.5' L x 13' W x 2'D 10YR 6/6 10YR 8/6 6 10YR 8/8 106.94 38" 107.04 39" 106.58 20" 105.33 20" BOTTOM AREA: 33.5 x 13= 435.5 SF C C C - rt C - ` FINE/ FINE/ SIDE AREA: (33.5 + 13) X 2 X 2 = 186 SF PERC TEST MEDIUM MEDIUM PE'RC.TEST FINE FINE O a. 105.35 SAND SAND O EL 105.35 p SAND TOTAL SQUARE FEET PROVIDED = 621 vs. 594.59 REQ'D 2.5Y 6/6 2.5Y 6/6 2.5Y 7/4 2,5Y 7/4 DESIGN FLOW PROVIDED: 0.74(621 S.F.) = 459.91 G.P.D. vs. 440 G.P.D. req'd 98.10 144" 98.29 144" 98.25 120" 97.00 120" PROPOSED SEPTIC SYSTEM UPGRADE PLAN PERC RATE <2 MIN/IN. (-Cl- HORIZON) PERC RATE <2 MIN/IN. CC1- HORIZON) 207 CARRIAGE LANE, BARNSTABLE, MA NO GROUNDWATER OBSERVED NO GROUNDWATER OBSERVED Prepared for: Amanda Hin ston Design and Site Plan by: SCALE DRAWN DATE • I. Darren M. Meyer. R.S.. CSE, hereby certify that 1 am currently approved by MADEP pursuant to 310 CMR 15.017 MEYER&SONS,INC. N.T.S. DMM 09/30/18 to conduct soli evaluations and that the above analysis has been Wormed by me consistent with the PO BOX981 REV GATE CHECKED SHEET N0. requirements of 310 CMR 15.017. 1 further certify that I have passed the Soil Eval. Exam in October. 1999. EAST SANDWICH,MA 02537 508-3622922 11/08/18 DMM 2 of 2