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HomeMy WebLinkAbout0288 CARRIAGE LANE - Health a8$ �xns�b� a 4 � A� No. Fee BOARD OF HEALTH TOWN OF BARNSTABLE 01ppYication _for Yell Contruction Permit Application is hereby made for a permit to Construct( ), Alter( ), or Repair( ) an individual well at: OyI r;h—� / 03 Location-Addr s Assessors Map d Parcel Owe ,` Address 6,1 staller-Driller Address Type of Building Dwelling / Other-Type of Building No. of Persons Type of Well 's Capacity Purpose of Well _ Agreement: The undersigned agrees to install the afore described individual well in accordance with the provisions of the Town of Barnstable Board of Health Private Well Protection Regulation-The undersigned further agrees not to place the well in operation until a Certificate of Compliance has b e If issued by the Board of Health. Signed �p �—(Zko atD e Application Approved By Date Application Disapproved for the following reasons: Y _ } Date Permit No. 4 7, Issued �y Date BOARD OF HEALTH TOWN OF BARMSTABLE Certificate of Compliance THIS IS TO CERTIFY,that the individual well Constructed( Altered( ), or Repaired( ) by C Installer at has been installed in accorda e with the provisions of the Town of Barnstable Board of Hgat Prlvate W 11 Protection Regulation as described in the application for Well Construction Permit No. W y�e� " ated 6 THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORILY. Date _ �l /s Inspector No. Fee BOARD OF HEALTH TOWN OF BARNSTABLE k"r ftpltcatiou _for Yell Cou5tructiou Permit Application is hereby made for a permit to Construct( )4 Alter( ), or Repair( ) an individual well at:. Location-Address _ Assessors Map d Parcel + Owner �' Address 4'- v GUL C e n A (t)VJ Installer-Driller v v Address Type of Building Dwelling / Other'-Type of Building, No. of Persons Type of Well �_�Z �r �t�IIJ�� Y_ *4- Capacity Purpose of Well j A Agreement: The undersigned agrees to install the afore described individual well in accordance with the provisions of the Town of Barnstable Board of Health Private Well Protection Regulation-The undersigned further agrees not to place the well in operation until a Certificate of Compliance has beeff issued by the Board of Health. k Signed AIh G Da te Application Approved By C Date Application Disapproved for the following reasons: 4, Date W Permit No. ['/a.. lJ f Issued 1 BOARD OF HEALTH TOWN OF BARNSTABLE l CertiftcaWof Compliance THIS IS`TO CERTIFY,that the individual well Constructed( `Altered( ), or ,` Repaired( ) by a�'u C.t' 9 U)JO` Installer at (Al AAJ/I.J1 0 4A"( has been installed iri accordance with the provisions of the Town of Barnstable Board of Hea t Private Well Protection Regulation as described in the application for Well Construction Permit No. �,/�v�v G Dated �M �1c► -'THE IS�UANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THEtWELL SYSTEM WILL FUNCTION SATISFACTORILY. f 'Vate 6 Inspector --- ._sa_soa_e_»__..__a -. :__,o------------------------------------------------------ BOARD OF HEALTH TOWN OF BARNSTABLE Yell Cousstructiou Permit No. y� Fee Permission is hereby granted to ;�w V a vv Installer to Co�nsssttruct(t�;� Alter,('), orr' Repair O Gan'indivldual'well at: as shown on the application for a Well Construction Permit No. W 6 rrDated " _ 1 1- 0 Date b r Approved By —' 4 5� Commonwealth of Massachusetts Title 5 Official Inspection Formtip Subsurface Sewage Disposal System Form -Not for Voluntary Assessments I 288 Carnage Lane Propeny AdOress Ken Thurber ner Owner's Name irmation is 'fired for every Btyrr vtm ble MA 02630 6-6-17 State Zip Code Date of inspection D. System Information (cunt.) I Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks Locate all wells withiri 100 feet. Locate ' where public water supply enters the building. Check one of the boxes below: ® hand-sketch In the area below ❑ drawing attached separately I �ATI 5 A i 3 r ieP1Y>1 tOltV DPW 17 R 3 •3 ✓� '� T•dle 5 amdal ImWadan Form;Subsurface Sewage ptspoal System.Page 15 W 17 r °15imdoe°raw of18 . Jun 11 2017 20:42 HP Fax page 1 r b3 O� Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �;3 288 Cwarriage Lane t� Property Address Ken Thurbera Owner Owner's Name information is Barnstable required for every MA 02630 6-6-17 page. City/Town, State Zip Code Date of Inspection ,4 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. Important:When A. General Information filling out forms gtiuuuuugr on the computer. I I( ��r0N�,;tl OFIl4gsso,,�� use only the ta key to move you r 1. Inspector: 0`o2� cursor-do not =fir JAMES use the return James D.Sears = _ key. Name of Inspector Capewide Enterprises �'•. ;o o. Q Company Name 153 Commercial Street ���'' `�5 IN5pEG��1 �rrrIIUIII1l11t� Company Address Mashpee MA 02649 Cltyrrown State Zip Code 508-477-8877 S1623 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 16.000).The system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority 6-6-17 pectols Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system 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. t5ine.doc•rev.6116 Title 5 Official Ins on Form:Subsurface Sewage Dispose(System•Page 1 of 17 �V W— Jun 11 2017 20:42 HP Fax page 2 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments, 288 Carriage Lane Property Address Ken Thurber Owner Owners Name information is required for every Barnstable MA 02630 6-6-17 page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E 1 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: The system is a 1000 Gal. Tank D Box-Pit and two chambers 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.6/16 Title 5 Offidal Inspedlen Form:Subsur!ace Sewage Disposal Sys'.em•Page 2 of 17 r Jun 11 2017 20:42 HP Fax page 3 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 288 Carriage Lane Property Address Ken Thurber Owner Owner's Name information is Barnstable MA 02630 6-6-17 required for every page. City/Town State Zip Code Date of Inspection B. Certification (cunt.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes (coat.): ❑ 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 ❑ NO(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 ❑ NO(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 15lns.doc•rev.6116 Title 5 Offloial hspectlon Form:Subsurface Sewage Disposal System•Page 3 of 17 r Jun 11 2017 20:42 HP Fax page 4 Commonwealth of Massachusetts Title 5 Official Inspection Form WjSubsurface Sewage Disposal System Form -Not for Voluntary Assessments 288 Carriage Lane Property Address Ken Thurber Owner owner's Name information is required for every Barnstable MA 02630 M-17 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS)and.the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ 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 cr ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in evaspoW is less than 6"below invert or available volume is less than '/z day flow � &1 Q1/NF I5ins.doc•rev.6116 Title 5 Offioisl Inspwc on Form Subsurface Sewage Disposal System•Page 4 of 17 Jun 11 2017 20:42 HP Fax page 5 Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 288 Carriage Lane Property Address Ken Thurber Owner Owner's Name information is required for every Barnstable MA 02630 6-6-17 Page. 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: An f r . ❑ ® y portion o the SAS, cesspool o 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 20009pd- 10,000gpd. ® The system falls. 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 I I 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. 15ins.doc•rev.US Tills 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 5 of 17 Jun 11 2017 20:43 HP Fax page 6 Commonwealth of Massachusetts Title 5 Official Inspection Form IBM a Subsurface Sewage Disposal System Form-Not for Voluntary Assessments MR 288 Carriage Lane Property Address Ken Thurber Owner Owner's Name information is Barnstable MA 02630 6-6-17 required for every page. Clty/Town State Zip Code Date of Inspection C. Checklist Check if the following have been done.You must indicate 'yes"or"no"as to each of the following: Yes No ❑ ® Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? Was the site inspected for signs of break® El Was g 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: ® Cl 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)] D. System Information Residential Flow Conditions: Number of bedrooms(design): 3 Number of bedrooms(actual): 2 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 t5ina.doc•ray.6116 Title 5 Official Inspection Form:S%tsurface Sewage Disposal System•Page 6 of 17 I Jun 11 2017 20:43 HP Fax page 7 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments 288 Carriage Lane Property Address Ken Thurber Owner Owner's Name information is Barnstable MA 02630 6-6-17 required for every page. Cityrrown State Zip Code Date of Inspection D. System Information Description: The system is a 1000 Gal Tank D Box- Pit and two chambers. Number of current residents: 2 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 Seasonal use? ❑ Yes ® No Water meter readings, if available (last 2 years usage(gpd)): 2015-79,000GaIs2016-68,000Gal's Detail: Sump pump? ❑ Yes ® No Last date of occupancy: Present Date Commerciallindustrial Flow Conditions: Type of Establishment: -Design flow(based on 310 CMR 15.203): Gallons per day(9pid) 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: 151ns.dx•rev.Stl6 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 7 of 17 Jun 11 2017 20:44 HP Fax page 8 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 288 Carriage Lane Property Address Ken Thurber Owner Owner's Name information is required for every Barnstable MA 02630 "-17 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: NA 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 IlA system by system operator under contract ❑ Tight tank.Attach a copy of the DEP approval. ❑ Other(describe): 15ins.doc•rev.6116 Title 5 Official Inspection Form:Subsirtece Sewage Disposal System-Page 8 of 17 Jun 11 2017 20:44 HP Fax page 9 Commonwealth of Massachusetts RAMMERIEW Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments 288 Carriage Lane Property Address Ken Thurber Owner Owner's Name information is Barnstable MA 02530 6-6-17 required for every page. Cityfrown Sfate Zip Code Date of Inspection D. System Information,(cont.) Approximate age of all-components. date installed (if known)and source of information: NA Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: p g feet Material of construction: ❑ cast iron ®40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments(on condition of joints,venting, evidence of leakage, etc.): Pipeing is 4" PVC SCH 40. Septic Tank(locate on site plan): 4' Depth below grade: teat Material of construction: ®concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1000 Gal. Precast Sludge depth: 211 t5ins.doc•rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 Jun 11 2017 20:44 HP Fax page 10 Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 288 Carriage Lane Property Address Ken Thurber Owner Owner's Name information is required for every Barnstable MA 02630 6-6-17 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Septic Tank (cont.) Distance from top of sludge to bottom of outlet tee or baffle 28" 1 Scum thickness Distance from top of scum to top of outlet tee or baffle 12 1711 Distance from bottom of scum to bottom of outlet tee or baffle How were dimensions determined? Asbuilt TapeSludge Judge Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tank at working level. Tank at 4' below grade, Outlet cover at 40"w/outlet baffle, No sign of leakage or over loading 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.6116 Title 5 OHidal Inspection Form:Suhsur'wa Sewage Disposal Sys-em•Page 10 d 17 Jun 11 2017 20:45 HP Fax page 11 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 288 Carriage Lane Property Address Ken Thurber Owner Owner's Name information is required for every Bamstable MA 02630 6-6-17 page. CitylTown State Zip Code Date of Inspection D. System Information (cont.) Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: 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 t51nsaoc•rev.6116 _ Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 Jun 11 2017 20:45 HP Fax page 12 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 288 Carriage Lane Property Address Ken Thurber Owner Owners Name information is required for every Barnstable MA 02630 6-6-17 page. Cityfrown State Zip Code Date of Inspection i D. System Information (cost.) Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 0 Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): D Box is 16"x 16"x2' below grade wltwo line out. Box is clean and solid w/No sign of over loading or solid carry over. 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 Oflklal Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 Jun 11 2017 20:45 HP Fax page 13 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 288 Carriage Lane Property Address Ken Thurber Owner Owner's Name information is required for every Barnstable MA 02630 6-6-17 page. CitylT'own State Zip Code Date of Inspection D. System Information (cont.) Type: ® leaching pits number: 1 ® 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.): Leaching is 1000 Gal. Pit, and two Chamber's. 1000 Gal Pit(older leaching ). Pit and cover at 22" below grade dry. Two 500 Gal chamber's 3"water. No sign of over loading. Cesspools (cesspool must be pumped as part of inspect)on) (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 g ❑ Yes ❑ No l5ira.ax,rev.6116 Title 5 Official brepection Form:Sibsurface Sewage Disposal System-Page 13 of 17 f Jun 11 2017 20:46 HP Fax page 14 Commonwealth of Massachusetts f Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 288 Carriage Lane Property Address Ken Thurber Owner Owner's Name information required for every Barnstable MA 02630 6-6-17 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc): Privy(locate on site plan): Materials of construction: Dimensions Depth of solids Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): ISins,doc•rev.1116 Title 5 Official Inspection Form Subsurface Sewage Disposal System-Page 14 or 17 Jun 11 2017 20:46 HP Fax page 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments =f 288 Carriage Lane Property Address Ken Thurber Owner Owner's Name information is required for every Barnstable MA 02630 6-6-17 Page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately C t A-1 Is /3 °:-5- /� - - '3' �? y .3 a , #9 1 ST` b•a'M � '7''� 15ine.doc rev.6f16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 Jun 11 2017 20:46 HP Fax page 16 i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 288 Carriage Lane Property Address Ken Thurber Owner Owner's Name intonation is required for every Barnstable MA 02630 6-6-17 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells Ala Estimated depth to hii gh ground water: 2 ' feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date ® Observed site (abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health -explain: ❑ Checked with local excavators, installers- (attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: Abutting Property and area 20'+ no G.W.. Bottom of pit at 8'below grade. Bottom of pit at 12'+ aboveAbutting property. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins.doc-rev.6/16 Tito 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 16 of 17 i Jun 11 2017 20:46 HP Fax page 17 Commonwealth of Massachusetts Title 5 Official Inspection Form i Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 288 Carriage Lane Property Address Ken Thurber Owner Owner's Name information is required for every Barnstable MA 02630 6-6-17 page, CitylTown 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 t5ine.doc-rev.6116 Title 5 Otficiet Inspection Form:Subaurfece Sewage Disp osal System•Page i7 of 17 TOWN OF BARNSTABLE d' 0 LOCATION (T C A 9 R/A 6 e / eJI/+/9SEWAGE # VILL id R A R&SfA.,6fe ASSESSOR'S MAP & LOT � 2 7 [nr p - INSTALLER'S NAME&PHONE NO. Al A c a m &e, -i sold SEPTIC TANK CAPACITY _ 006 — ±LEACHING FACILITY: (type)of 0,4610 CYi4w d (size) 1�00 NO.OF BEDROOMS �J BUILDER OR OWNERc�.ey� q PERMTTDATE: =) f�-qe COMPLIANCE DATE: 7-r/�S Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by vrF / ;;r Vtb d No. ,�a � / � I /� Fee "2 THE COMMONWEALTH OF MASSACHUSETTS Entered in computer' PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes 01ppliLatlon for Misposal *pstrm Construction permit Application for a Permit to Construct( ) Repair(A Upgrade( ) Abandon( ) [:]Complete System [X Individual Components Location Address or Lot No. o`.92 C A-AkIAGoE 4A&JE Owner's Name,Adiiress,and Tel.No. Assessor's Map/Parcel o')9'7 0 3 egg 1,4KJG 0642Z r r Installer's Name,Address,and Tel.do. 5Og—q T2—'F'9?'7 Designer's Name,Address,and Tel.No. 15 0414 t.w,0&U A3� �� �� Type of Building: Dwelling No.of Bedrooms 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 gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) kC'dR(oy t✓ d CA 0 r 9 O K A?-� cofjoEC i Cat 0 6 Tt) (V6kA5?1 D-poI 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 o Q20 Signed Date Application Approved by Gw I A e Date Application Disapproved by Date for the following reasons Permit No. �— /7 —L Date Issued In —2 —/ No. Q / �a w,.b_ ..•a Fee — THE COMMONWEALTH OF MASSACHUSETTS Entered incomputer:_ Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS 01pplitatlon for 30isOosal 6pstem Construction Permit Application for a Permit to Construct( ) Repair( Upgrade( ) Abandon( ) ❑Complete System [Individual Components Location Address or Lot No. A92 CARRIIQGiA=— (,A 0E Owner's Name,Address,and Tel.No. $�72j� KENME-rH f S"R PyAj Assessor's Map/Parcel '� 3 20-2 0—AAAl Lr IUG Installer's Name,Address,and Tel.A. �a�,—y Z� .'S�?"� Designer's Name,Address,and Tel.No. ��Cwt�C E�'Tf�04.t5tis ,�r S Cowl AU S`r KA444GEr Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterationk(Answer when applicable) Rem OQ 6 d LD D~ 1;0 X AW b c000c L106 TD lVOAAQI D Date last inspected: ; Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. Signed Date (.,—I—X0 I*7 Application Approved by Date /, -- � — /'7 Application Disapproved,by Date for the following reasons Permit No. 0 —7 — j -7 Date Issued f — 9 THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance r Q THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired( Upgraded( ) Abandoned( )by QAPF—wcuE 'bj7iEw G$ 3 at 199 CAe?.ki4eiis (AOE &y-i/ - has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. )0 1?-/7.aated Installer C'401D�1JLJ.6 Designer NA � #bedrooms /.J�/j Approved design flow I III gpd The issuance of this permit shall not be const ed as a guarantee that the system will fun ct ionas designed. Date Inspector - • r ------------- ----------{-------- No. d 7 Fee — � 7� �J THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-.BARNSTABLE,MASSACHUSETTS Misposal 6pstent Construction Permit Permission is hereby granted to Construct( ) Repair( Upgrade( ) Abandon( ) System located at L*Xks J—B 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:Construct on must be completed within three years of the date of this permit. /f Date 7 /! Approved by C, L'�/� No. �� -6 4 q Fee 5 0.0 0 THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS Yes 01ppYication for Mi!6poe;ar *pgtem Construction Permit Application for a Permit to Construct( )Repair(XX)Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. Owner's Name,Address and Tel.No. 288 Carriage Lane Barnstable,Mass. John J. Deasy Assessor'sMap/Parcel !A F '7 0 3 �1 288 Carriage Lane Barnstable,Mass. Installer's Name,Address,and Tel.No. 5 0 8—7 7 5—3 3 3 8 Designer's Name,Address and Tel.No. 5 0 8—7 7 5—3 3 3 8 .P.Macomber & Son Inc. J.P.Macomber & Son Inc. ox 66 Centerville,Mass. 02632 Box 66 Centerville,Mass. 02632 Type of Building: Dwelling XXXNo,of Bedrooms 3 Lot Size sq. ft. Garbage Grinder(qO) Other Type of Building RES No.of Persons 2 Showers( ) Cafeteria( ) Other Fixtures Design Flow 3 3 0 gallons per day. Calculated daily flow 3 x 1 1 0 gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Existing 1 000 Type of S.A.S. 2-500 gallon chambers Description of Soil Loamy sand to clay mix to medium sand. Nature of Repairs or Alterations(Answer when applicable) Adding two 500 gal lon chambers packed in four feet of 12" stone. 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 Certifi- cate of Compliance has been issu d by this B d Signed Date 8/2 6/9 8 Application Approved by Date 9-.11.— Application Disapproved or the f4o_W4 reasons Permit No. — Date Issued i TOWN OF BARNSTABLE LOCATION 42 YSEWAGE # — 1" VILLAGEA P./11 TA h/® ASSESSOR'S MAP & LOTS INSTALLER'S NAME&PHONE NO. C SEPTIC TANK CAPACITY LEACHING FACILITY: (type) 16 4j C A(A1, NO.OF BEDROOMS 3 P&:57 (size) BUILDER OR O77L� PERMITDATE: � COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facty l Private Water Supply Well and Leaching Facility (If any sells exist Feet on site or within 200 feet of leaching facility) Edge of Wetland and Leaching Facility(If any wetlands exist Feet within 300 feet of leaching facility) Furnished by Feet i I No. C? Fee 50.0 0 THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: j Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS ZIppYication for ;Diq'ogar *poem Construction Permit i Application for a Permit to Construct( )Repair(KX)'Upgrade( )Abandon( ) El Complete System ❑Individual Components Location Address or Lot No. Owner's Name,Address and Tel.No. 288 Carriage Lane Barnstable,Mass. John J. Deasy Assessor'sMap/Parcel r� {,•" O ' 288 Carriage Lane Barnstable,Mass. Installer's Name,Address,and Tel.No. 5 0 8—7 7 5—3 3 3 8 Designer's Name,Address and Tel.No. 5 0 8—7 7 5—3 3 3 8 .P.Macomber & Son Inc. J.P.Macomber & Son Inc. ox 66 Centerville,Mass....02632 Box 66 Centerville,Mass. 02632 Type of Building: Dwelling XXXNo.of Bedrooms 3 Lot Size sq. ft. Garbage Grinder(NO) Other Type of Building RES No. of Persons 2 Showers( ) Cafeteria( ) Other Fixtures t Design Flow 330 gallons per day. Calculated daily flow 3x1 1 0 gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Existing 1000 Type of S.A.S. 2-500 gallon chambers Description of Soil Loamy sand to clay mix to medium sand. -� Nature of Repairs or Alterations(Answer when applicable) Adding two 5401;.,,g3Tlon chambers packed in four feet of 11" stone. X, Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance 4the-a€er"escribcd on-site sewage disposal system in accordance with the provisions of Title 5 of the E vironmental Code an t to place the system inoperatioi until a Certifi- Cate of Compliance has been issu d by thisJBd alt . •�d f Signed Date 8 2 6 9 8 6 Application Approved by Date 91-:1 Application Disapproved or the tgowi4 reasons Q Permit No. 179 - Date Issued ———————————— —— —————— — THE d��;bNWEALTH'OF'MASSA,&USE� 6S BARNSTABLE, MASSACHUSETTS Certificate`of (Compliance THIS IS TO CERTIFY, that the On-site Sewage"* System Constructed( )Repaired,KX )Upgraded( ) Abandoned( )by J.P.Macomber & Son Inc. at 288 Carriage Lane BaY1lrtable`- _ has been constructed in accordance with the provisions of Title 5 and the for•Disposal_System Construction Permit No. dated' Installer J.P.Macomber & Son Inc. Designer'J:P---Macon a _ & Son Inc The issuance of this pe shall not be construed as a guarantee that the system will function as designed.. Date - Inspector C - No. 7,e- s ? Fee $ 50 .00 THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE,, MASSACHUSETTS' li!6pogar *pgtem Construction Permit Permission is hereby granted to Construct( )Repair(kit)Upgrade( )Abandon( ) System located at 288 Carriage Lane Barnstable,mass. and as described in the above Application for Disposal System Construction Permit. The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction must be completed within three years of the date of this permit. Date: Approved by u i 10/9197 • I To Be Used For the Repair-Of Failed NOTICE: This Form s p Septic Systems Only. CERTIFICATION OF SKETCH AND APPLICATION FOR A DISPOSAL WORKS CONSTRUCTION PERMIT (WITHOUT ENGINEERED PLANS) l, Joseph !P.Macomber Jr,_, hereby,certify that the application for disposal works construction permit signed by me dated 8/26/98 , concerning the property located at 288 Carriage Lane Rarn1Gt.abi e.,Mass. meets all of the following criteria: • There are no wetlands located within 100 feet of the proposed leaching facility , There are no private wells within 150 feet of the proposed septic system • There is no increase in flow and/or change in use proposed • There are no variances requested or needed. If the proposed leaching facility will be located within 250 feet of any wetlands, the bottom of the . proposed leaching facility will pat be located less than fourteen(14) feet above the maximum adjusted groundwater table elevation. Please complete the following: x A)Top of Ground Elevation (according to the Engineering Division G.I.S. map) B) Observed Groundwater Table Elevation(according to Health Division well map) A S SIGNED : DATE: 8 126 1918 LICE D SEPTIC SYSTEM INSTALLER IN T E TOWN OF BARNSTABLE NUMBER (Attach a sketch plan of the proposed system. Also if the licensed installer posesses a cerii(ied plot plan, this plan should be submitted). q:hcalth foldcr:cen i - /``� f V I Y s+ e �� LOCATION SEWAGE PERMIT NO. VILLAGE ASSESSORS MAP NO: 2 9- U}Ezw jXV,16.5 PARCELNO:_ 0 7__-- - INS LLER'S NAME & ADDRESS ELLS Q�(Zo�i. BUILDER . OR OWNER DATE PERMIT ISSUED DATE COMPLIANCE ISSUED 3 2 i ✓�� Ai I J' .00, n J "Noll vG-. _V � Fi$....7.;-.�............ THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH .�© .�...................OF....... N: Appliration for 11ispos al Works Tum4rn.rtion 1hrmit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: --•••--••---......................... . ••-••-............-- ----------- �� ..d q. ................ ... ............. Location A ress or Lo No ... / Owner Address ...........4f s...... = wNS t- Installer Address d Type of Building Size Lotl!�:,,'731......Sq. feet U Dwelling—No. of Bedrooms........... -.........................Expansion Attic ( ) Garbage Grinder (No) Other—T e of Building No. of persons............................ Showers — Cafeteria Pa g Other fixtures ................................ ••• --•------- --•---•• •-•-••--•---------. ------•----•-••••--•...� .�................�....... w Design Flow.................Gam...._____.._.____gallons per person per day. Total dailyflow..............-_---•---------_ .____.... Ions. WSeptic Tank—Liquid*capacity./.gallons Length....5(...:... Width..... Diameter________________ Depth.... -----_ x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No---------_--_------ Diameter.................... Depth below inlet.................... Total leaching areaAA.42.....sq. ft. Z Other Distribution box ( ) Dosing tank ( ) ` ~' Percolation Test Results Performed by--- .......�.��................... Date......./ � �........__. aTest Pit No. 1........I_c.....minutes per inch Depth of Test Pit-_J_--.•---....... Depth to ground water.A/-APr ...... 44 Test Pit No. 2................minutes per inch Depth of Test Pit...M.g....... Depth to ground water........................ a ---------------•--------•----------------------------•--......_..--•-------.....................•............................................................ 0 Description of Soil.....�!!V 7.-P)...?V.f'D/c�.&.!&/W V�.............................................................................................. x c., w VNature 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 ilTl1 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has bee sue y the b and o eal . Ak— tki:�5( tit ke, .��Date Application Approved BY;rt --- �4�l�-- ------------------- __.........-- -- ...,.............. yt-fQ--/------.......................... Date Application Disapproved f e f ollowing redsons: Date PermitNo.......................................................... Issued_....................... r,.e " No....:3 !._ 1.. IA F�$...l ................ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH , pphrtttiun for Dispatial Works Tonstrurtiun permit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: .................... .. .....----------------------------•----LOT- ................ - •--`�. 1..---------...._._..--------- .....-------------•-------.....----------- Location-Address or Lot No. �_ - r 2 L— ��. -._ -•---.....7---------- •••-- --•-------------------•----_--•----- .!Y Owner Address Installer Address Type of Building Size Lot_541, , _ __%`_......Sq. feet U Dwelling—No. of Bedrooms..........._p�___..........................Expansion Attic ( ) Garbage Grinder Q40) P4 „Other—Type of Building ____________________________ No. of persons.....................------- Showers ( ) — Cafeteria ( ) a _ Other fixtures d ------------------------- ............................................................................................................................ W Design Flow___________________ __ _________________ gallons per person per day. Total daily flow.................. -�......__...............gallons. W Septic Tank—Liquid capacityl� _gallons Length___.�..._.___.Width______�._... Diameter________________ Depth____- -------- xDisposal Trench—No_ ____________________ Width.................... Total Length____________....____ Total leaching area....................sq. ft. Seepage Pit No--_---------------- Diameter.................... Depth below inlet.................... Total leachingarea..k( sq. ft. Z Other Distribution box ( ) Dosing tank Percolation Test Results Performed by.._�____��. t_r `_ _�_________________�__.__._. �f'� % ___---_._. Date h ,--a Test Pit No. 1____�-......mmutes per inch Depth of Test Pit__:!____,f'__. Depth to ground water_,A/z,>ti=.____... Test Pit No. 2................minutes per inch Depth of Test Pit__ ......... Depth to ground water...!V _ a --••------------------------••-•-•--------•--------------...._......._._..-----...-------•--•--••---••-•-- ---------•........---........-...... D Description of Soil----DZ.''....T`=... `?=?_%j�c'!� =f_ _ ?_n�.:!?_....-•----------------•-----------------. x •-----------------------------••---•-•_.. V ------------- •--------------------------- ------------------------------------------------------------ -------------- •------------ •----------------------------------------------- ------------- ••- W -----------------------------------•---•-•._._....•--------------...----•••••--.._..-•-------------------••---------------------....------------------•---•--•-•------------------------•...---••---••-- UNature of Repairs or Alterations—Answer when applicable............................................................................................... --------•-------------------•----------------------•----•-----------------------------•------.......-••-------••••-•-•---------•-----••-----•-•-----•••-•••-•-•••••••••-•-••-----------------••----•••-- Agreement: The undersigned agrees to install`the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has I n 1 d by the boar f h lth i 71 ........................ Date ----• Application Approved B Date Application Disapprove f o the following reasons:_____:___________•_____________________________________________................................................. --••-•-•-•-•---------•-------------------•--•---------------......_......--••----•-------------._...-•---'---•----•-----.._..----....---------------------------•----------- ............................ Date PermitNo.................................................-----... Issued....::---••-------------- Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........................................OF..................................................................................... ` �er#if irtt#e of f�uttt�littnre S TO CE IFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) by..-- •--= -•• _...............Z01............................................................-...................................................................... Installer at. j t -•---------T---------------•................................................................................ has been installed in accor nce with the provisions o TI_LE r of The State Sanitary �de.As described in the application for Disposal Works Construction Permit __________________________ da THE ISSUAt4CE OF THIS CERTIFICATE SHALT. NOT BE CONSTR M AS A GUARANTEE THAT THE SYSTEM W UNCTION SATISFACTORY. DATE..................................••--••-•••--------•---. Inspector /------------------------------------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH /Y7 ..........................................OF..................................................................................... No......................... 1�ii..__-__.............. t urkv Donor ion rrmit Permion is hereby ra ...................----------------------------------------•---_..-.•----•---••--•-----•-------------._.........---------...._..-•--•--•-•--. to C ( ) r e s i ( ) an I• iduaI Sewage Disposal System o at Qp Street as shown on the application for isposal Works Construction Permit N9. 4_� .............................. ---• = ==-=-------------.......................................................... �.j Board of Health DATE....................•... .... vim. ---------------- �I FORM 1255 A. M. SULKIN, INC., BOSTON w f SECTION - SEWAGE 1�Z . 3-�' 114 Igo i -SEPTIC TANK - - "D" BOX - - LEACH t s r TOP OF FDN (MSL) 1�Ni o��- .o•�..� u rJ S U I T'A t'S LE r•,,�.-c�z��.�. i � \ �� � I I, a •1F02 A bISTAr�GC 0ti= 10 �+. A�c�UF �17 -"2•'OFI/aTO112" Y G>JTIi_,v LGAG-+ T�ir A rtiko WASHED STONE 1 GLep,• ,A I C1)P.L'SE. 1 L a: . x IN .n OUT . \ I ^ (U IN OUT -y l I '. '�-.'.."'- �N CII" O 0 P G IV/ 1� /�r \ r -- L�/ Q +, r ,�rr R Cy'•�'{ �^ Ia .S SEPTIC tc��.o5 / I / `�Z `��-t t �'• —/ TANK �_.. CJ- - - / 2 ELEV. ELEV. ELEV.— ELEV. icaS.gS t45�.8 ',' .��.a' CID\ ELEV. ELEV. \\ \\ W.`a=`6� SQ-R.V{c_G i WASHED STONE d TEST HOLE LOG 0 (08 �� i\ p /` II % I.1 /11r I, TEST BY TWITNESS Z UA \ \ . �p } TEST DATE r DESIGN ----BEDROOM HOUSE S.T / T.H. 1 T.H. # 2 \ ~.\ ; \� r /� V+ Q Q G 3 :�_. E �.S'f r'. _J 3 00' ELEV. C�f>" .�-�_ ELEV. NO -tt \� Z4'� L H Yp n DISPOSER POSER -. \\\ ` �PERC RATE _MIN/IN. -_ Cn.I FLOW RATE �zr (GAL./DAY ) ( /Ir �. I f SEPTIC TANK ZL G> (1.51= ( �i=ion., / 1.,,� I,, ,,, �„�,,� ,rya.. •,yr.., REO'D SEPTIC TANK SIZE I c' lii 'IZ." � - s���.�> ��."-�,-- _--•�-- loz._.i LEACH FACILITY --- -_ -----_..— -••__ I LL -r�.r1�(!�.o) l�c>�' SIDE WA IZ.� 1 = 4c�G: G/D. ~ i Per Avu on icw•r BOTTOM -L4 ` G) . - c v� _ (� TOTAL Z.;� .-1 � � = 4SCn.-1 G�17 . 4-9 U. --it,9 cj. t'•T. /I0� USE: .— v~'`__--__.LEACHING 1�0 C rt c)epf Y Cn_C>— -dlc.._ v� I_C> r�r a.aE-.�__.._._W A T E R ENCOUNTERED ------- ....------- - - _ Lr i NOTES: (UNLESS OTHERWISE NOTED) 11 l 1 1 DATUM(MSL)'TAKEN FROM k�'ANuD{�� _ ._-._QUADRANGLE MAP _ _____L� '�''b`�•' t ` ��'j 4�"' �- �L'i 2.MUNICIPAL WATER •-------------�---------------••-------AVAILABLE /4, C� !ia`' d � 3.PIPE PITCH: V."PER FOOT 'G\ J.; 4. DESIGN LOADING FOR ALL PRE-CAST UNITS: AASHO -44 5. MIN. GROUND COVER OVER ALL SEWAGE FACILITIES: (1) FT. 1,A}»)[ \ �r RNE H. c. , - 0--- DISTANCE AS CERTIFIED 6. PIPE JOINTS SHALL BE MADE WATER TIGHT `� }; ` � QrALA 7.CONSTRUCTION DETAILS TO BE ACCORDANCE WITH COMM.OF MASS. �j1;1(_j� c..+ C'V,! �'i I HEREBY CERTIFY THAT THE BUILDING SITE PLAN �'. '`� rG ip792 SHOWN ON THIS PLAN IS LOCATED ON THE STATE ENVIRONMENTAL CODE TITLE 5 J " (_f3f Cf.�.21AG LA G�� 1 GROUND AS SHOWN HEREON &THAT IT - LOCUS:. w�.<C" CONFORM TO THE ZONING BY LAWS OF THE i(1JI nN� TOWN OF Sl) � _ G. PRO tE11`li9L. .fNEER WHEN CONSTRUCTED. DATE - 'r `IV►�^� I � REF: --Pk. 1611c.. ci. 4'7 down c ' ape eft glneering PREPARED FOR: { CIVIL ENGINEERS _--_-_------ 13GX LAND SURVEYORS BOARD OF HEALTH REG. LAND SURVEYOR CONTOURS (EXISTING) ------ �3F`�ZN5TA3L-c- SCALE C� (PROPOSED) -0-0-0-0- APPROVED `_ DATE - —_-�_ MA Yarmouth&Orleans,MA DATE �� `> .I