HomeMy WebLinkAbout0383 COMMERCE ROAD - Health 383:CommerceRdX(Barnstable)
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COMMONWEALTH OF MASSACHUSETTS
EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS
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DEPARTMENT OF ENVIRONMENTAL PROTE.� CTION
t J ,
91v-59/
TITLE 5
OFFICIAL INSPECTION FORM—NOT
S FOR_VOLUNTARY-ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM
z PART A ,
Q CERTIFICATION
Property Address: U p n
k P✓'CQ /`mil
Owners Name:_ �¢,(jf •
Owner's Address.
Date inspect,on. , _ Y, -
Name of Inspector: lease
a print)
Company
P ny Name•
Mailing Address:
gOW7 /} `T
Telephone Number D E • �_ t
CERTIFICATION STATEMENT
�� , M .
I certify that I have personally inspected the sewage disposal system at this address and that the information report
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 SSeect/ion15.340 of Title 5(310 CMR 15.000). The system:
V Passes,
t Conditionally Passes f
Needs Further Evaluation by the Local App
Fails roving Authority '- _
` Inspector' - - -_
r
s Signature: - --
E Date. f p-
The system inspector shall subnut 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, applicable,and the approving
authority. ,
Notes and Comments
This report only describes conditions at the time of inspection and under the conditions of use at that
time. This inspection does not address how the system will perform in�the future under the same or differ `
conditions of use.' i ent
Title 5 Inspection Form 6/15/2000 `
page 1 ,
Page 2 of 11
OFFICIAL INSPECTION FORM' NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOS
AL SYS
TEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address:
rr Ax
Owner. 6
�
F
Date of Inspection: p a
Inspection Summary: Check A;B;C;D or E 7 ALWAYS complete all of Section D'
A. System es:
have not found any information which indicates that any of the failure criteria described in 310 CMR
15.303 or in 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below.
Comments:
B. System Conditionally Passes:
AOne or more system components as described in the"Conditional Pass"section need to be replaced
re aced.The system,upon completion of the replacement or repair,as approved by the Board of Hlth, will ass.
P
Answer yes,no or not determined Y N ND the
in ` . r
explain. ( ' for the following statements.If"not determined"please
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 Certifica
indicating that the tank is less than 20 years old is available. te of Compliance
ND explain:
,Observation_of-sewage-backup-or-breskout or high static,water level in the distribution.boxdugi to broken or
approval of Board of Health): T�^
obstructed pipe(s)or due ettled or uneven distribution box. System will pass inspection if with
_a broken,s -
brokenpipe(s)are replaced
obstruction is removed
distribution box is leveled or'replaced w
ND explain:
The system required pumping more than 4 times a ye
pass to broken or obstructed pipe(s).The system will
pass inspection if(with approval of the Board of Health):
broken pipe(s)are replaced
R. obstruction is removed
x
ND explain:
*' Title C Tncnunhinn l nrm 411 C/7(Ul(1
2
Page 3 of 11
t
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A-
CERTIFICATION(continued) .
Property Address: 393 o� �e
�.�. (�-6 3?J
Owner: Gi vi 4,— p H 10
Date of Inspection: p col Oj
C. Further Evaluation-is Required by the Board of Health:
�v Conditions exist which require further evaluation*by the Board of Heal th
is failing to protect public health,safety or the environment. in order to determine if the system
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:
s
_ Cesspool or privy is within 50 feet of a surface water
— Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh
2. System will fail unless the Board'of Health(and Public Water Supplier,if any)determines that the
system is functioning in a manner that protects the public health,safety and environment:
The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a
surface water supply or tributary to a surface water supply.
{
— The system has a septic tank and SAS and the SAS is within a-Zone 1 of a public water supply.,
_ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well.
_ The system has a septic tank andSAS and the SAS is less than 100 feet but 50 feet or more from a
private water supply well**.Method used to determine distance
^ y 3
w -
**This system passes if the well water analysis,performed at a DEP certified—laboratory, for coliform---=—---- --
bacteria-and-volatile-organic-compounds-indiia-tes that the well is free from pollution from.that facility and
the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 failure criteria are triggered.A copy of the analysis must be attached to this form provided that no other
3. Other: '
------------
.,q
Tito C Incnnrtinn Fnrm�i/1 .11nnn 3 .
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Page 4 of I I `
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
r SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address: O� 60(MMy P-Ce_
Owner: v. o
Date of Inspection: O /ot tq
D. System Failure Criteria applicable to all systems:
You must indicate"yes"or"no"to each of the following for all inspections: . .
Yes No
kup of sewage into facility or system component due to overloaded or clo ed SAS or '
g8 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
spool
•1
Liquid depth in cesspool is less than 6"below invert or available volume is less than %2 day flow
squired pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number
y�times pumped
y portion of the SAS, cesspool or privy is below high groundwater elevation.
_ Any portion of cesspool or privy is within-100 feet of a surface water supply or tributary to a surface
}eater supply. - t
`/Any portion of a cesspool or privy is within a Zone 1 of a public well.
ny portion of a cesspool or privy is within 50 feet of a private water supply well.
Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water
supply well with no acceptable water quality analysis. [This system passes if the well water analysis,
performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds
indicates that the well is free from pollution from that facility and the presence of ammonia,
- nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria
are triggered.A copy of the analysis must be attached to this form.]
(Yes/No)The system fails.I have determined that one or more of the above failure criteria exist as
described in 310 CMR 15.303, therefore the system fails.The'system owner should contact the Board of
Health•to determine what will be necessary to correct the failure.
E. Large 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
You must indicate either"yes"or"no"to each of the following:, ,
(The following criteria apply to large systems in addition to the criteria above)
yes no
— the. stem is within 400 feet of a surface drinking water supply ~
_ e system is within 200 feet of a tributary to a surface drinking watersupply
• the system is located in a nitrogen`sensitive area(Interim.Wellhead Protection Area—IWPA)ora mapped •� ,Zone II of a public water supply well
If you have an eyed'''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..
T410 G Inc»anfinn Fnrm kii ai�nnn 4
d • ,k - - ^ r
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Page 5 of 11 r '
• • Y.
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST
Property Address:
Owner: 9?,e:;-t 4.4
Date of Inspection: -
IQ�
Check if the following-have been done. You must indicate "yes"or"no"as to each of the following:
Yes NoPu '
minformation
M •
g 1 nformation was provided by the owner, occupant, or Board of Health.
/were an '.
y of�the system components pumped out in the previous two weeks.?
— = Haste system received normal flows in the previous two week period?
�ave 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,rnponents,excluding the SAS,located on site?
Were the septic tank manholes uncovered opened, •
of the bat es or tees,material of construction,dimensions,depth of iqu d depot the
tank and depfor
o scum non
7
_ Was the facility owner(and occupants if different from owner)provided with information on the proper ~
maintenance of subsurface sewage disposal systems?
•
'^ a size andlocatron of the Soil Absorption System(SAS)on the site has been determined based on.
Yes no
_ Existing information.For example,a plan at the Board of Health.
_ Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance
is unacceptable) [310 CNM 15.302(3)(b)]
Title C lncnentinn PA_411 VIM)
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Page,6 of 11
g x OFFICIA
L IN SP EC TIO _NOT FOR
AET ASSESSMENTSSUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C _
SYSTEM,INFORMATION,
t Property Address:
Owner: L-e r I✓
O
Date of Inspection: �,(o�W CONDITIONS
RESIDENTIAL---
Number of bedrooms(design): '
6 Number of bedrooms(actual): ' �DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#o 4 K�
f bedrooms): ��'t7
Number of current residents: b I"r�, �
Does residence have a garbage grinder(yes or no): /
Is laundry on a separate sewage system(yes or'no): fif yes separate inspection required]Laundry system inspected es rO
F, �e
Seasonal use:(yes or no):
Water meter readings, tf available(last 2 years usage t* ��
Sump Pump(yes or no): g (gPd))
Last date of occupancy:
COMMERCIAL/INDUST AL
Type of establishment:
Design flow(based on 310 CMR 15.203): d
Basis of design flow(seats/persons/sgft,etc.): `
Grease trap present(yes or no):
Industrial waste holding tank present(yes or no):
Non-sanitary waste discharged to the Title 5 system(yes or no):
Water meter readings, if available:
Last date of occupancy/use: '
OTHER(describe):
GENERAL NFORMATION F
Pumping Records
Source of information:
Was system pumped as part of the inspectio (yes or no):
If yes; volume pumped: gallons=-How was quantity pumQed determined2_.-
----
Reason-for-pu �__ —
TYP F SYSTEM
eptic tank,distribution box,soil absorption system A
_Single cesspool
_Overflow cesspool -
Privy
Shared system )(. Y * , =
y (yes or no (if es,attach previous inspection records,if any)
_Innovative/Alternative technology.Attach a copy'of the current operation and maintenance contract(to be.
obtained from system owner)
_Tight tank _Attach a copy of the DEP approval '
—Other(describe);
Approximate age of all components,date installed(if own)and source Of 0 L_L�Ar
9 591
Were sewage odors detected when arriving at the site(yes or no):
.. - - .. 1. �, ..i y .. • '
Titlo G Mcnon+inn Fn�m!�/1 S%7IlM
Page 7 of 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM,
PART C'
SYSTEM INFORMATION(continued)
Property Address: CC w/^P,.z e '
Owner: h p
Date of Inspection: 0 fat Or
BUILDING SEWER(locate on site plan) .
Depth below grade: / (/
Materials of construction:—cast iron —40`� PVC other(explain):'
ex lain : .
Distance from private water supply well or suction line: P )
Comments(on condition of joints,venting,evidence of leakage,etc.):
SEPTIC T .. ,
A1vK:—(locate on site plan) _ ,
Depth below grade: p�
Material of construction:—c-�ncrete metal fiberglass
-tank
— _polyethylene r ,
If tank is metal list age:___ Is age confirmed by a Certificate of Compliance(yes or no : (attach certificate) _ ) _( ach a copy of
Dimensions: JC -
Sludge depth
—
Distance from top of sludge to bottom of outlet tee or baffle:
Scum thickness:
Distance from top of scum to top of outlet tee or baffle:
Distance from bottom of scum to bottom f outlet tee or baffle:
How were dimensions determined: o% Q ;
Comments(on pumping recommendations, inlet and ou et tee or baffle condition,structural integrity,as elated to outlet invert evidence of leakage,etc.): �tY,liquid levels
of ✓", �,•� wt o,,. (�
' Qvv� rs -
{e
vL I y
GREASE TRAP:
' �cate on site plan) -
Depth below grade-
Material
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 Date of last of outlet tee or baffle:
pumping:
+ Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,
li uid levels
as related to outlet invert,evidence of leakage,etc.):, . , ,., �tY, q eels »
Titiv„C`Inc,nrartinn F'nrm 411 Vlnnn - � • � 7 � >
Page 8 of 11
OFFICIAL INSPECTION FORM=NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: C.v 60VVI MerCg
G A r
Owner:
Date of Inspection: (O
TIGHT or HOLDING TANK (tank must be pumped at time of inspection)(locate on site plan)
F
Depth below grade:
Material of construction: concrete metal fiberglass_Polyethylene other(explain):
Dimensions:
Capacity: allons
Design Flow: >;allons/day
Alarm present(yes or no): t
Alarm level: Alarm in working order(yes or no):
Date�of last pumping: ,
Comments(condition of alarm and float switches,etc.): 5
DISTRIBUTION BOX: �presentust be opened)(locate on site plan)
Depth of liquid level above outlet invert:
Comments(note if box is level and distribution to outlets equal,any evidence of solids carryover, any evidence of
leakage into orwit of box,etc.):
PUMP CHAMBER•A (locate on site plan)
Pumps in working order(yes or no):
_. .Alarms in workin order __no): _ ._ •`
Comments(note condition of pumpchainber;condition of sand
g yes or -- - _
PAP appurtenances, etc.):
Title G Inenwrtinn G'nrml./1�/7M11 8 - -
Page 9 of 11 T ;,
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
4
` SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: ✓�J dne
07f
Owner:- &6% o y�
Date of In Pa Lc t7�
SOIL ABSORPTION SYST.EM-. SAS __(locate on-site plan,excavation-not regaired)
If SAS not located explain why:
Type
leaching pits,number:_
leaching chambers,number: 6f
leaching galleries,number:
leaching trenches,number, length:
leaching fields,number, dimensions:
overflow cesspool, number:
innovative/alternative system Type/name of technology: L
Comments note condition of soil, signs of hydraulic failure,level of ponding,damp soil,condition of vegetation,
etc. : ^�t S4
O yr /✓) CI l
t�8 ii
L.
/ate .0 t. L4
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 ro dwatecinflo_w,(yes=or-no):- ---
g_ un
-- Comments _(note condition of soil sig
ns of hydraulic failure, level of ponding,condition of vegetation,etc.):
/ P
PRIVY:/ // (locate on siteplan)
Materials of construction:
Dimensions:
Depth of solids:
Comments(note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation,etc.):,
Titlo C fncrorfinn Rnrm !/1 C/7t1t1/1 9
Page 10 of 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: v 66�M Pry II
Owner: 61:-4 1✓ Mf--TT—�� ®�-6��0 '
o4Y'
Date of Inspection: O /,t (�!"
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,
covir
_ ._,.. ... �'. 1 =g .. . ,., • I•� �' � �� is x ..v ; R i
17
"
T tlu C Inen'ortinn P--411 C/7Mn 10
Page 11 of 11
OFFICIAL INSPECTION•FORM—NOT FOR VOLUNTARY ASSESSMENTS
A SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: w
Owner:
Date of Inspection: I
SITE EXAM
Slope • � �&r,
Surface water r I
Check cellar -
Shallow wells w
Estimated depth to groundwater YSfeet �— / ✓l� (9 ,
/ ." /�/� (�
Please indicate(check)all methods used to determine the high ground water elevation:+
Obtained from system design plans on record-If checked,date of design plan reviewed; y
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: "
Tor ,
You must describe how You established the�}1f'6 (gh ground water elevation:
bt✓�d'ow G.-sl ; fie ,-ho✓t r �•-s. -
�• A .S is O!i' � .
w -
S
'Titlo 5 fnenonfinn P—M 411s11n00 11 -
TOWN OF BARNSTABLE
LOCATION LOI�����nrntl GQ �� SEWAGE #
VILLAGESSESSOR'S MAP & LOT.,?/ .
f o.
14 INSTALLER'S NAME & PHONE NO. SCc� 1-i'G�/�� '-),
SEPTIC TANK CAPACITY 5"�p
li LEACHING FACILITY:(type) _ "' . W(t�(size) -�
NO. OF BEDROOMS(0PRIVATE WELL 0 PU L WATER Vic)
BUILDER OR OWNER
DATE PERMIT ISSUED:
DATE COMPLIANCE ISSUED:
IN
VARIANCE GRANTED: Yes No
AiG
A 46 D t3ox
s 4
t�
� i � �o C
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE
Appliration for D1opo3M1 lVork,i Tonotrnrtion Permit
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System at:
... . . .. c ................................... ................=---------•-••-•--------I-.•..---.-•.--.•-•-•....--•---.........----.....---- I�t
._ L.
o atio r r .00u Q) AddreNo.
s s
Installer Address
d Type of Building Size Lot.Psql�!.........Sq. feet
aDwelling—No. of Bedrooms--------6------------------------------Expansion Attic ( ) Garbage Grinder (W)
Q, Other—Type of Building ____________________________ No. of persons............................ Showers ( ) — Cafeteria ( )
a' Other fixtures ------------------------------- - -
W ig .......................gallons per person per day. Total daily flow.._Cn. _���`-_. .......gallons.
Dest n Flow--.----._..:��................
9 Septic Tank—Liquid capacity gallons Length_-//.._._... Width__.s.�;gd--. Diameter_.._..P.... Depth-.,S_le._-.
Disposal Trench—No. .....�............ Width........�________ Total Length...?A........ Total leaching area...:�7&....sq. ft.
Seepage Pit No--------------------- Diameter-------------------- Depth below inlet___-�............ Total leaching a rea..................sq. ft.
Z Other Distribution box (x) Dosing tank ( )
Percolation Test Results Performed b 5.1.�.__"P:_.�:: ._.__ b' Sg/
aY ... f ------•--•.. Date--- !__----•-•--•--
,� Test Pit No. I----------------minutes per inch Depth of Test Pit..-. -------- Depth to ground water....�_q4.........
...
(T, Test Pit No. 2................minutes per inch Depth of Test Pit--.--/I...___._. Depth to ground water....N..A-•------_--.
a2 5����
O Description of Soil----•-. �!1.----®- '��S°'3a-••C•�. ----........ I.=-7••--....•--••f7
x ...........................
U -•-•--•-••-----••-.....-•---•--••-•......-•----.5� ------......-c C- :t,i!..f.----�et��.....�'~.'�------. -7-�-�-�------------------L A, le
----------------------------- c�_ l L�.. f=� ��
................................
C
U Nature of Repairs or Alterations—Answer when applicable-------------------------------------------.....................................................
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the
system in operation until a Certificate of Compliance has been issued by the board of health.
Signed ------ H----- 1��1-1� ��--------------------------------------------------- - 0619t}......:....
Date
Application Approved BY - ' ...... ------ /.�_--�..--`-,cl----
Date
Application Disapproved for the following reasons: ..............:............................------------------------------------._....-------------------------------------------
......---------- ------------------------------------------_...........----------------------............._......._..........._.................... . ........... .. .. ........... .... ....._............. --...
� I
Permit No. -----7 ---Y- ----..-----f q _
/... ...... Issued ------------ --------- ....................Date......
Date
{
G1 - c'jc'
No..- „Fria..... .......:
F THE COMMONWEALTH OF MASSACHUSETTS
w
BOARD OF HEALTH
TOWN OF BARNSTABLE
Applirtaian for Dhip ottl Works Tonotrurtion trrntit
Application is hereby made fora Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System at
C3na1aC -------------------------------- ---------------------------------m------- -----------------------------------------------------
oca6on•A� ress
C�rY._ K.A -----•--•-------------------------------Address
Installer Address
Type of Building y �- Size I ot. 75-3 .--......Sq. feet
a Dwelling—No. of 6Bedrodms_��/-_. _ _______________________Expansion Attic ( ) Garbage Grinder (AX.J)
a, Other—Type of Building ____________________________ No. of persons---------------------------- Showers ( ) — Cafeteria ( )
QI Other fixtures ------------------------------- - -
W Design Flow.........__ _�________________________gallons per person per i day. Total daily flow.-.� .�'.��D-__.e-&O...._.gallons.
G.' Septic Tank—Liquid capacity/gallons Length-_/..�__-_.____ Width_.__�_�'_.._ Diameter-----.r- Depth...-'C...e_..
Disposal Trench— No- -.-.-/........._.. Width_.Z2-......_____ Total Length.-_z.8._.._._. Total leaching area- ...sq. ft.
3 Seepage Pit No--------- ---------- Diameter-------------------- Depth below inlet___--Z.__._._..._. Total leaching area..................sq. ft.
Z Other Distribution box (x) Dosing tank ( )
`" Test Results Performed b `.�T>z-ram H��..._ 5............ Date____�� 4._.s-----------------
Percolation
a Y -------- -- ---- ------
,� Test Pit No. 1................minutes per inch Depth of Test Pit.-./y_____--.-- Depth to ground water....N_14..........
Li, Test Pit No. 2................minutes per inch Depth of Test Pit----- "1.---------- Depth to ground water....AA............
P+ ......................................................... -._�:. ...... ....05?Sa_I L. S 0-6 1
... ............
D Description of Soil.........`�]----�--7-{ 7`��'S`'�� C- - ----------------- - --------------- u�
-------------------- -- . •----_---.
x ......-----.--- K f-a v K .S � .7-"-1°-------------L� L.A `
v = = .............................
----- ------------------------------------------------------------------ - -� 17 A-f . �..
U Nature of Repairs or Alterations—Answer when applicable-----------------------------_-_---..---.--.--_---._______-_._-_-_--_-_-__---_-__------------__.
---------------------------------------------•--------------------------------------•--.........--••------------------------------------------•----------------------------------------......_..--------
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TITLE 5 of the State Environmental Code —The undersigned further agrees not to place the
system in operation until a Certificate of Compliance has been issued by the board of health.
Signed -----_f(V ----rrd.a k----------------------------------------------------- -/..m/ �- y----------
Dace
Application Approved BY � ...... -- .................................... ..1 �..-l.-.. --..Dare
Application Disapproved for the following reasons- -----------------------------------------------------------------------------------------------------------------------------------
----------------------------------------------------------------------------------------------------------- ---------------------------------------------------------------------------- ------------- ----------------------------------------
Date
Permit No. - ..�f�.-... .. C/ ........ Issued pae.......................................
------ -_-_------------- -_------- -- - -----------------= _-- -----
i
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE
Ger#ifi ak, of Toittlaliarire
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( �( ) or Repaired ( )
by -
-----------------------------------------------------------------------------------------
Installer
at
has bee... ailed in accordance with the 4'provisions of TI I_E of T
- --
he State Environmental Code as described in
the application for Disposal Works Construction Permit No. ..-�;?e.1.----:-5_7 -------- dated -----------------------__-----------------
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
ate—
DATE...... �^ '�. ..��..r7�..`.'�+..�,-��, Inspector t'".-r''./�.�',.__............. -�� .......... '�"
-------- --------------------------------------------------------- --------
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE /
No.. .. _ l FEE......,/00
.................
Kiopmat Worb T�otnutiort Wrntit
Permission is hereby granted :. 2- '` = --------------------------------------------------
to Construct (X ) or Repair ( ) an Individual Sewage Disposal System
at No......... /" t,r ��-ryt�s. (. . ------
Street q� t
as shown on the application for Disposal Works Construction Permit No.17.,-�__�� (-__ Dated_ _ _.. .........
..................................................
^� V �� ...............
oard of Health
DATE------.l/ _. _._..1._`�
FORM.38508 HOBBS 6 WARREN.INC..PUBLISHERS
&AZ 4-�ST-AFL.
I.,..
Y
�A .,
yr
ell LOCUS MAP
SCALE: I '- 2083't
\'�
GENERAL NOTES : ' vw NO.A 8VW NO,9
I . THIS PLAN IS FOR THE DESIGN AND / �\
CONSTRUCTION OF THE SEWAGE DISPOSAL /// ,/-- -• '� \\\ MARSH
SYSTEM AND WETLAND PERMITTING ONLY. iC8 Ma yd• , e vw No.
/ �/ / 8VW N0.7
2. ALL CONSTRUCTION METHODS AND Bvw NO.e
MA TER I AL S FOR THE SEPTIC SYSTEM rcB MA No.
SHALL CONFORM` TO MASS. D. E. P a�
TITLE 5 AND LOCAL BOARD OF HEALTH �/ j /'1�`� �� °qs� 8.1 evw NO.a
REGULATIONS. NO C
ovw
J. ALL SEPTIC SYSTEM COMPONENTS LOCATED / / / \\ \ Is, tip,
UNDER AREAS SUBJECT TO VEHICULAR TRAFFIC
BVaY NO.® / / \\ \ \ C`� `\ \ BVw No.5
CAPABLE OF WITHSTANDING H-20 WHEEL LOADS.
0 7`a
OR GREATER THAN 3 ' I N DEPTH SHALL BE .�/ / / �'`'\ \ \ \ �/ �� • \ o
\
4. ALL SEWER PIPE SHALL BE SCHEDULE 40 �\° N9 E
OR APPROVED EQUAL .
Qr\O j' // ✓ `\� \`\ \\\ \\ \\\ \\ 8.a BVW NO.4
5. BEFORE CONSTRUCTION CALL 'DIG-SAFE". �\, ��
1 -800-322-4844 FOR LOCATION OF '�'
UNDERGROUND UT I L I TIES.
\
8 NO Fo�� �/ / // / / �\ �\ \ � \ \ \ \ vw No.3
6. VER T I CAL DATUM I S: NGVD ���,,, �✓ /// /! // %/ // i \\ `�\\ \\\ \\\ \\ �`\ \\ \�\
�BVfy No:N BVIY NO.o �A
i'
BVW N0.2
7. FOR BENCH MARKS SET. SEE SITE PLAN. ------- - •a , �/ // // / �� \\ \\ \ \\ 2r�
TOP / \ a��
�
� \
^)t
-------- �/ �/ �� TOTAL AREA - 47. 536 + S.F. ` \ I f
` ` \ \ i2.1
UPLAND - 41 .936 t S.F.
WETLAND 5. 600 + S.F. \ I / / ! 52 `
3
DES I GN CR I TER 1A : -''"
DESIGN FLOW:
6 BEDROOMS AT 110 G. P. D. PER
BEDROOM EQUALS 660 G. P. D.
3
2.37
NO GARBAGE GRINDER
SEPTIC` TANK REQUIRED:
660 G. P. D. X I50� - 990 - /
GAL
SEPTIC TANK PROVIDED: 1500GAL .
3`
. . GAL .
SIZE OF LEACHING FACILITY REQUIRED:
660 G. P. D.
DESIGN PERC RATE - C 2 MIN/INCH _16)
5-4 'X 4 * GALLEYS. 3 'DEPTH J/ I
WITH 4 ' STONE AROUND /
PROVIDED: � � GARAGEi3�- .. .
./ 34.7 / / � i I � 1 � j � V � #4
S i DEWAL L : 240 S, F,X 2.5 600 GPD 1 roF , / // fit;l l 1 /
t ROOF RUNO F / / / ) 1
BOTTOM: 336 S. F.X 1 . 0 336 GPD i DRYWELL rttYPl
576 936
TOTAL : S.F. GPD
6. t
. . N.E. CORNER CB/DH
EL. . 43. 75 NGVD 4'
/ 0
t i � TEST HOLE
SOIL TES T _ PIT DA TA I , _ `
( I / 35.5
INDICATES y INDICATES I j I // BEDRO01:(
PERCOLATION = OBSER VED I SIX
TEST = GROUNDWATER ) I PROPOSED/ TOF
P-8253 I I 1 DWELL 1 l / % /� i / /..' I
TPA 1 Tp 2 1500 OAL
I :
GRND EL. 39,0 GRND EL. 35.5 SEPTIC TANK
`} 'Y„
G.W.EL. NIA G.W.EL. N/A
w
h I I I 1 1 �/C5 / / % b 5, `\. \` �I k_FLAG MA TOP BANK
TOPSOIL �t, • �.. = D-8O tia,l I / / ✓ ;'/Q� � 8: / / ` \\ /
TOPSOIL SUBSOIL �
SUBSOIL 3' 32.5
TIGHTS"'
�� I $T' oLE
FINE SAND FINE SAND /0;
CLAY a ) 0 39.0
7 28.5 I I .` 1 k, I /
RESERVE / �?• I ,o I I \
�, 1 ;' 1 J l 49.80
7' 32.0 CLAY I I i 1 N / AI MA TOP BA
1
MEDIUM
I O' 25.5 � W/4' S TO E 1 I
FINE SAND
MEDIUM- I I ( /6. u, 2
FINE SAND 1 I 1 E r r x �' % n Y; B vw No.a
GVY POLE NO.5/S
• NO WATER NO WATER ) t j 1 l % 1 I " // / / Q�5 8 vw NO.S
14 25.0 17 18.5 1 ( I I / � Il / �•I ` � / / / I //!
DATE: AUGUST 4.. 1994 ) 1 , I C°✓I! / .` t1P Np.l /51 1
s,/ 1 I / �. A I ( X G M TO�8AlyK
TEST BY STEPHEN HAAS s'9. , / / ► 7a'>U / ) f
GERR Y DUNNING
1 I /
W1 TNESSED 'BY: s�%:/( i / j a I ) _ 1 I I✓ r ) )�,
PERC RATE: { 2 MIN/I NCH 8 vw No.4
IN MEDIUM-FINE SAND s?;• / I I I )p r � > /�e ! r i i�
I4
isvw No.3
INVERT ELEVATIONS
INVERT AT BUILDING: 33. 35
4AG MA TOP PANX
NVER T IN SEPTIC TANK 32.95 - 2a.oa \ j 1 8VW NO.1
e.a
I NVER T OUT SEPTIC TANK: 32. 70
INVERT IN DIST. BOX: 32. 60 \ \ \ 1 I t
INVERT OUT DIST. BOX. 32.40
\ \ \ I evW No.
INVERT .IN LEACH GAL L ES": '32. 00 \\.a
BOTTOM OF LEACH GALLEY: 29. 00
\ V1Y NO.0 !C�
9.3
ACCESS COVERS MUST BE WITHIN
Q ��pp n � Q ' / I / �y �'`�
35.50 12' OF FINISH GRADE M/ \ ��C / V/ ! \ S S T E_ V E V A L 7 E- S
FIRST 2' TO
BE LEVEL
S -P TE_MBER 22 . / 994
4' PVC MIN. 2' OF
SCHEDULE 0 o a PEASTONE
33.J32.95 32,60 Z 3. Gz-,E_ ,.S'UR T�,.L�'Y I NG 8r, ,L'NG' I N�'�R I NG r A7c;l .
3/4' 1 1/2.` D/A.
WASHED STONE 1 S e cz 40 0 cz!' � Z_ cz -2 e
OUTLET 29,oo Z2r afz r2 e s mez
I0', MIN. 0 GAL D-BOX
SEPTIC TANK 4' S-4'X 4" 4
LEACHING GALLEYS
P R OF l-L E : Nor r0 scAc.E
0 10 20, 40
JOB NO: 94-307 FIELD:CFWIR VB CAL C: SAH/CFW CHECK CFW DRN: SAH