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HomeMy WebLinkAbout0120 COBBLE STONE ROAD - Health E12000BBLESTONE RD., BARNSTABLE _ ,r r u r • u , r � r p 2 n Commonwealth of Massachusetts rj Title 5 Official Inspection For 81 Subsurface Sewage Disposal System.Form - Not for Voluntary Assessments is 120 Cobblestone 9a© Property Address We— Tom -— 1 /�.�®! Tom Sullivan _ / Owner Owner's Name — information is — required for every Barnstable MA 02630 page. City/I own State — 5/1_6/1.7 Zip Code Date of Inspection -- Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When filling out forms A. General Information on the computer, use only the tab �07 key to move your 1 Inspector: -� cursor- not use the return Nicholas Geneseo f` key. Name of Inspector Wind River Environmental ,aa Company Name _- 46 Lizotte Drive Suite 1000 Company Address - ------------------------------_-_---- Marlborough MA 01752 — State --—-- 800-499-1682 ZIP Code. Tefeptxhieei -- -- S1 13988 License iurnber --------------------- --... - I certify that I have personally inspected the se irfformation report, below is true,accurate .disposal system at this address and that the was firmed based.on m dand�plete as of the time of the insPection.The inspe�on �disposal systems. y tray and 09m ience.in the proper function and maintenance Tale 5(310 it 5 ,tears:a DEP moved systrn inspector pursuant of on site } The system: n 15-W of basses ❑ Conditionally Passes ❑ Fails El Deeds Further Evaluation by the!off Approytg Authority Irmpect,rs si ,re Date The system inspector shall submit a Of Health copy of fhis i" has a or DEP)WiNn�0 days of completing thnsPection report to the ovint�Auto*{Board report to the aaflow Of 10,000 gpd or ter,the roan �system is a shared system or and copies appropriate final nice of'the ' The system owner shad sttbtnit the pies sent to.the buyer, if applicable,and the a original should be sent to the system owner Proving authority. ""*'Thus report only descrlbes condffl at that tinte.This"MPOCtIon does not address at the there of" 'oaa and anew tiles ttae wane or different oo how the system rivi$I - of use motions of use, in the future sander G- ��t _,70_•rev.01 c'. .._ .- ..: F rx;at:S=_bsu a,-a SesM1a ?�s�„•.e � 'em•=z,2 N Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °w 120 Cobblestone Property Address Tom Sullivan j Owner Owner's Name information is required for every Barnstable- MA 02630 5/16/17 page. 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: Tees are in place, liquid level normal, system is working properly at this time. 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. El Y ❑ N ❑ ND (Explain below): t5ins.doc-rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 Commonwealth of Massachusetts w Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °M 120 Cobblestone Property Address . Tom Sullivan Owner Owner's Name information is required for every Barnstable MA 02630 5/16/17 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational.System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes (conf.): ❑ Observation of sewage backup or,break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): , ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s).The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑-ND(Explain below): ❑ obstruction is removed ❑ Y- ;❑, N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System"-Page 3 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 120 Cobblestone Property Address Tom Sullivan Owner Owner's Name information is required for every Barnstable MA 02630 5/16/17 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 asses if the well water analysis,'performed at a DEP certified laboratory, for fecal Y P P Y, 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 y ❑ M Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface'of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool El ® Liquid depth in cesspool is less than 6" below invert or available volume is less than Y2 day flow t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts y Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 120 Cobblestone Property Address Tom Sullivan Owner Owner's Name information is required for every Barnstable MA 02630 5/16/17 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ® Any portion.of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. _ ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® : The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes"or"no" to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinkingwater supply pP Y I ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ El the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area— IWPA)or a mapped Zone II of a public water supply well If you have answered "yes" to any question in Section E the system is considered a significant threat, or answered"yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts . W Title 5 Official inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 120 Cobblestone Property Address Tom Sullivan Owner Owner's Name information is 'Barnstable MA 02630 5/16/17 required for every page. City/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? El ® 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. ElDetermined in the,field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms (design): 3 Number of bedrooms (actual): 3 DESIGN flow based-on 3.10 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 t5ins.doc-rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 w � Commonwealth of Massachusetts 1U W Title 5 Official Inspection, Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments H 120 Cobblestone Property Address Tom Sullivan Owner Owner's Name information is required for every Barnstable MA. 02630 5/16/17 page. City/Town State Zip Code Date of Inspection D. System Information Description: Number.of current residents: 3 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system?(Include laundry system inspection ❑ Yes N No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available last 2 ears usage d 250 gpd 9 ( Y 9 (gp ))� Detail: 184500/730 Sump pump? ❑ Yes ® No Last date of occupancy: current Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): i Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present?; ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 120 Cobblestone 'Property Address Tom Sullivan Owner Owner's Name information is Barnstable MA 02630 1 17 required for eve5/ 6/ 9 every 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: 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 DER approval. ❑ Other(describe): t5ins.doc-rev.6/16 Title 5 Official Inspection Form Subsurface Sewage Disposal System•Page 8 of 17 e Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 120 Cobblestone Property Address Tom Sullivan Owner Owner's Name information is required for every Barnstable MA 02630 5/16/17 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known)and source of information: 8/7/99 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on.site plan): 5' Depth below grade: feet Material of construction: ❑ cast iron ® 40 PVC `❑ other(explain): Distance from private water supply well or suction line: 35 feet Comments (on condition of joints,_venting, evidence of leakage, etc.): Joints are solid with no leaks, well vented: Septic Tank(locate on site plan): - Depth below grade: 4'feet Material of construction: ® concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain) If tank is metal,list age: years Is age confirmed by a Certificate of Corn pliance? (attach a`copy of certificate) ❑ Yes ❑ No Dimensions: 10'x5'x4': Sludge depth: 3" t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 Commonwealth of Massachusetts - W Title S Official Inspection Form . , Subsurface Sewage Disposal System Form- Not for Voluntary Assessments M 120 Cobblestone Property Address Tom Sullivan Owner Owner's Name information is required for every Barnstable MA 02630 5/16/17 page. City/Town 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, 34" Scum thickness 9,, Distance from top of scum to top of outlet tee or-baffle Distance from bottom of scum to bottom of outlet tee or baffle 14' The dimensions were determined How were dimensions determined? by sludge judge, rod, and ruler., 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 is 4' below grade with tees in place and liquid l.evel,normal. Tank appears in good condition with no leaks present. Recommend installing a filter on outlet with riser and pumping annually. Grease Trap(locate on site plan); Depth below grade: feet. Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle — Date of last pumping: date t5ins.doc-rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 17 I , u Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments w 120 Cobblestone Property Address Tom Sullivan Owner Owner's Name information is required for every Barnstable MA 02630 5/16/17 page. 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.): Tight or Holding Tank(tank must be pumped at time of inspection)(locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °M 120 Cobblestone Property Address Tom Sullivan Owner Owner's Name information is required for every Barnstable MA 02630 5/16/17 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 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.): Box is 3' below grade with 4 outlets taking equal flow. Minimal carryover present in box, and box appears in good condition with no leaks or cracks observed. 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.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ,.N 120 Cobblestone Property Address Tom Sullivan Owner Owner's Name information is required for every Barnstable MA 02630 5/16/17 page. City/Town State '.Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ® leaching chambers x number: 4 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.): No breakout observed at the time of inspection. Soil is dry around SAS and vegetation is normal. No evidence of hydraulic failure at this time.. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration -- Depth—top of liquid to.inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form , Subsurface Sewage Disposal System Form Not for Voluntary Assessments M 120 Cobblestone Property Address Tom Sullivan Owner Owner's Name information is Barnstable MA 02630 5/16/17 required for every — page. CitylTown 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.): t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form - R - Subsurface Sewage Disposal System Form Not for Voluntary Assessments 120 Cobblestone Property Address Tom Sullivan ------------------------- Owner Owner's Name information is BarnstableMA 02630 5116/17__—______-_______. required for every State Zip Code Date of Inspection page CitylTown D. System Information (cont.) Sketch Of.Sewage Disposal System "Provide a view of the sewage disposal system, including ties to at beast two permanent reference landm arks.,r .1 . chmarks. Locate all wells within 100 feet. Locate •where public water supply enters the buj dltig Check..one of the boxes below: hared-sketch ire the area below C3 drawing attached separately." A fl SC c3 t .211? 9 ,5ins.eoc•r=v.6/i o _ 3 ad}.:nss-Jk kr.: son�o.=rr Subsurface Sev ace Disposal Sysiem•Pace 15 of' Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal.System Form - Not for Voluntary Assessments °M 120 Cobblestone Property Address Tom Sullivan Owner Owner's Name information is required for every Barnstable MA 02630 5/16/17 page. City/Town 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: 12.5+ 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: 8/7/99 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: No water encountered at 12.5' in 1999. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins.doc-rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 16 of 17 Commonwealth of Massachusetts w Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ,.W 120 Cobblestone Property Address Tom Sullivan Owner Owner's Name information is required for every Barnstable MA 02630 5/16/17 page. City/Town State Zip Code Date ofAnspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems)completed ® System Information— Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins.doc-rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 17 TOWN OFC � ' LOCATION: VILLAGE• az i LOT # : q( �-n)fzeev ERMIT # : _mooINSTALLER' S NAME: INSTALLER' S PHONE # : 365_,r I LEACHING FACILTTY: (type) f= - (size) NO. OF BEDROOMS : j I BUILDER OR OWNER: pAk PERMIT DATE: COMPLIANCE DATE: i DRAW DIAGRAM ON BACK J, -i�- n ► ?1 �, I . _ ...... ' aI Lb p_ ; �-T �- No. Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Z(vuYication for Mie;pooar *pgtem Construction Permit Application for a Permit to Construct(�Repair( )Upgrade( )Abandon( ) []Complete System ❑Individual Components Location Address or Lot No. to r -A, / Z-0 �O 'er's Name Address and Tel No. ` A C-gA3c.C-_--T e � getu.►ti ^�� !q/ �11� 5VUXVAN Y2-dito - Assessor's Map/Parcel 1 O•t)bX (1 Z( i Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. �r,R.gN-0- Type of Building: Dwelling No.of Bedrooms 3 Lot Size 2d sq.ft. Garbage Grinder( ) Other Type of Building t6ieL A-4-19— No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow 141110 gallons per day. Calculated daily flow + gallons. Plan Date rl l q9 Number of sheets ( Revision Date Title 5 M 4' %5 9 WAW PI.� OF "T 'I l A42. Size of Septic Tank ,S2a Type of S.A.S. - /,�sTb►.tr- Description of Soil Answer when applicable)Nature of Repairs or Alterations( pp ) 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 provisio tle 5 of the En ental Code and not to pl e e system'Aperation until a Certifi- cate of Compliance has been is u s ofvi Signed ate •Z!• / Application Approved by Date Application Disapproved for the following reasons Permit No. Date Issued No. /�~ v ; ii= " ', ' Fee (J� THE COMMONWEALTH'.OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLES MASSACHUSETTS u 01pplication for Digo$af *pgtem Construction Permit Application for a Permit to Construct( Repair( )Upgrade( )Abandon( ) ❑Complete System El Individual C-oinponents Location Address or Lot No. L-D T q 1 l 02,waer's Name Address and Te.No. Assessor's Map/Parcel 1 G3,1 3'1 p o, Installer's Name,Address,and Tel.Teel.No.-ram '\ Designer's Name,Address and Tel.No. �T61 l i `.VI�J l -{��O/� D04Q — c.efrv`T' N �?/- 93901 1�5 MA jtil ST �T�Qv„t�r Type of Building: Dwelling No.of Bedrooms Lot Size� sq. ft. Garbage Grinder( ) Other Type of Building hf�Ic�L�c.�. No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow L71?10 gallons per day. Calculated daily flow T gallons. Plan Date t l ` Number of sheets Revision Date ,,Title -1 5E046 L P,�J Size of Septic Tank I SOO Type of S.A.S. fW a If-Fz-14,25 �5'Tb+-t t w. Description of Soil Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal systems in accordance with the provisio le of the Envir ental Code and not,to`pl e t e sys71r eratio until a G�tifi- cate of Compliance has been isluof H qSigned ate '9t• 9 Application Approved by. Date Application Disapproved for the following reasons I Permit No. Date Issued ————————————————— --———————————— ————— THE COMMONWEALTH OF MASSACHUSETTS BAh'NSTABLE, MASSACHUSETTS f Certificate of (Compliance THIS IS TO CE that the On-CAR ' ' 'e Disposal System Constructed( Repaired ( )Upgraded( ) Abandoned( at a"s een constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. " dated Installer Designer G� The issuance of pe t be construed as a guarantee that the sy f' ill function as designed. 4 Date InspectorVOL — - --- — — -- -- No.—��.��----- --- — -- —.— : .. Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLId HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS 0i.5po5al *pgtem Conotruction Permit Permission is hereby granted to Construct 1) it( )Upgrade ),Abandon( ) System located at .�a`�:' 9/ /d �J /Z , cc-e, J 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 piovisions or special conditions. Provided: Construction must be completed within three years of the date of this t. Date: / f— 2 / Approved by ' 1 i 1 __- -- - } Gt;`i fl !1. I ! -. J_jr 4-T - r ` f -- - - I f I . APPROVED BY f'_•-� SCALE: ,r;�-� / DRAWN BY, DATE: REVISED DRAWING NUMBER �/ �q vz I ......... ..... Ir U I ---------------T_ i I r ' I SCALE: I,-4_ I'C/ APPROVED BY: DRAWN BY�r'..,.q r Y' /j DATE: REVISED i DRAWING NUMBER 70- -Pik 17�;>05;p or 7`1 Io , � f it ii ef dwoe, APPROVED BY' SCALE: -RAWN B�� DATE: REVISED DRAWING NUMBER T.O.F. AT EL. 82.0' SEPTIC PROFILE TEST HOLE LOGS ACCESS COVER TO WITHIN 6" OF FIN. GRADE (NOT TO SCALE) ACCESS COVER (WATERTIGHT) TO ENGINEER: M. FARIA, SE RTE. 6A 80.0' MINIMUM .75' OF COVER t7VER PRECAST WITHIN 6" OF FIN. GRADE DONNA MIORANDI RS 2% SLOPE REQUIRED OVER SYSTEM 7>3 ,,0' WITNESS: I � RUN PIPE LEVEL 2" DOUBLE WASHED PEASTONE DATE: AUGUST 5, 1999 79.0' " _'�=-= FOR FIRST 2' < 5 MIN/INCH (CLASS I) m RAILROAD '\1 PROPOSED 3' MAX. PERC. RATE = cRANIrE GALLON SEPTIC 76.75' I & III 9488 W 77.0' FLO DIFFUSORS 75.0' CLASS SOILS P# o Locus TANK (H- 10 ) GAS 75.0' BAFFLE. 75.17 0000rw `^ ` 74.5' 0 M M [] a a o a o 3.5.0 SIDES ( 4 % SLOPE) �6" CRUSHED STONE OR MECHANICAL 0 COMPACTION. (15.221 [21) 80 0.96' M a d 0 � = ED a 0 73.5' r-1 ELEV. ELEV. DEPTH OF FLOW = 4 ( 5 % SLOPE) Q�� c Q" `V" 76.0' Q" 78.0' TEE SIZES: 1 Q„ 3/4' TO 1 1/2" DOUBLE WASHED STONE INLET DEPTH = 3„ 0 3„ 0 OUTLET DEPTH 14 9' A SL A SL LOCATION MAP - „ 10YR 4/2 FOUNDATION-- 50' SEPTIC TANK 30' D' BOX 20' - LEACHING g" 10YR 4/2 6 ASSESSORS MAP 316 PARCEL 63-1 FACILITY BENCHMARK: FIRE 10YR 58 24" B LS ZONING DISTRICT: RF-1 CATCH BASIN / HYDRANT 64.5' 24" / 74.0' 10YR 5/8 76.0' YARD SETBACKS: ELEV = 67.22' Cl F/M Cl F/M FRONT = 30' tea, 3 6pp 2.5Y 6/6 73.0' 36" 2.5Y 6/6 75.0' SIDE = 15' 64' C2 REAR = 15' / N SILT LOAM C2 - PLAN REF. -- 439/41 SILT LOAM 60" 2.5Y 6/4 71.0' 2.5Y 6/4 FLOOD ZONE: C �SFM-1 F 72„ 72.0' C 3 T Al2 LOT 88 F/MED C3 NOTE: 5' REMOVAL OF F SAND /MED UNSUITABLE SOIL REQUIRED / AROUND PERIMETER OF LEACH / �o 2.5Y 6/4 SAND FACILITY DOWN TO FINE/MED. ' SAND LAYER. REPLACE WITH / �3�, 138" 64.5' 150" 2.5Y 6/4 65.5' CLEAN MED. SAND A11 NO WATER ENCOUNTERED/NO MOTTLING NOTES: Q / APPROXIMATED FROM QUAD MAP �`T1C Is NOT A DESIGN: (GARGAGE sls^0^E!? L.I.OWED 1 . DATUM IS � 70 A10 _ DESIGN FLOW:/ 3_ BEDROOMS (110 GPD) = 330 GPD 2. MUNICIPAL WATER IS AVAILABLE LOT 91 13,051 SF WETLAND USE A 330 GPD DESIGN FLOW 3. MINIMUM PIPE PITCH TO BE 1/8" PER FOOT. A9 � 4. DESIGN LOADING FOR ALL PRECAST UNITS TO BE AASHO H- 10 / Co 44,158 SF UPLAND �/� SEPTIC TANK: 330 GPD ( 2 ) = 660 A8 57,208 SF TOTAL 1500 5. PIPE JOINTS TO BE MADE WATERTIGHT. i� USE A GALLON SEPTIC TANK 6. CONSTRUCTION DETAILS TO BE IN ACCORDANCE WITH MASS. 61) 4, EDGE OF WETLAND �`L A8 A7 LEACHING: ENVIRONMENTAL CODE TITLE V. Q / 7. THIS PLAN IS FOR PROPOSED WORK ONLY AND NOT TO BE AA = 330/.75 = 440 SF Q USED FOR LOT LINE STAKING. 4 / (1 + 37) x (1 + 1 1) = 456 SF (OK) ©/ A6 Al O 3� YP,o• 8. PIPE FOR SEPTIC SYSTEM TO SCH. 40-4" PVC. �/ / TOTAL: 456 S.F. fad GPD 9. COMPONENTS NOT TO BE BACKFILLED OR CONCEALED WITHOUT 0� A5 72 USE 4 FLO DIFFUSORS WITH 3.5' STONE AT SIDES INSPECTION BY BOARD OF HEALTH AND PERMISSION OBTAINED FROM BOARD OF HEALTH. A4 A3 A2 AND 2.5' AT ENDS 10. CONTRACTOR SHALL BE RESPONSIBLE FOR VERIFYING THE LOCATION OF ALL UNDERGROUND & OVERHEAD UTILITIES PRIOR 74 TO COMMENCEMENT OF WORK. Op S��T 11. ROOF RUN-OFF TO BE DIRECTED TD DRYWELLS ,l 72 �F 76 LEGEND / �cF 4 s¢. 70 50 100.0 PROPOSED SPOT ELEVATION SITE AND SE WFA G`E' 7 78 -L.AN Cp W WORK LIMIT LOT 91 COBBLESTONE ROAD E 100x0 EXISTING SPOT ELEVATION OF TH1 cy 80 100 PROPOSED CONTOUR IN THE TOWN OF: GAR_ �4 PROP. HAYBALES BACKED BY 100 EXISTING CONTOUR BARN STAB L E �� SLABSILT FENCE IN HOUSE AREA �s 81.5' PREPARED FOR: THOMAS ,ADD LINDA SULLIVAN / PROP. 3 BR $2 ` DWELLING / 1 TF - 82.0' BOARD OF HEALTH 30 0 30 60 90 , 8f PATlO ?o• MA o APPROVED DATE eo 84 SCALE: 1„ = 30' DATE: AUGUST 17, 1999 R RVE / `\ off 508-362-4541 LOT 92 fax 508 362-9880 LOT 85 1`' � down cape engineering, inc. ����H OF MR� 1 ARNE �yG �� ARNE H. R S o H. OJALA CIVIL ENGIrTEE • OJALA CIVIL y .. No.26348 LAND 8URVEY01t5 ACCESS/UTILITY EASEMENT IS PROPOSED OVER o� �``GISTE4�� Qw f 98_.,44� EXISTING DRIVEWAY ON LOT 92 IN FAVOR OF LOT 91 939 main st. yarmouth, ma 02675 A OJALA, \. .5.� DATE