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HomeMy WebLinkAbout0094 COUNTRY CLUB DRIVE - Health 94 COUNTRY CLUB DR.,.BARNSTABLE r i i u Town of Barnstable BIKE 7Regulatory Services Health BARNRichard V.Scali,Director Inspector �� • ' Office Hours Public Health Division 8:30-9:30 rfD" p Thomas McKean,Director 3:30—4:30 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 ACCESSORY AFFORDABLE APARTMENT PROGRAM APPLICANT SEPTIC QUESTIONNAIRE Date: 1. General Information: /- Property Address: 9y Cou.��r�/ Cl4 Assessor's Map/Parcel Number: Q3 JU ��� Size of Property: , - Applicant(s)Name: Applicant Address: ��/ ���/ ,1�"✓U �� / ; Home Phone: Email: 2a. How man bedrooms exist at our , now? / � Y Y property I , 2b. Are you planning to add any bedrooms as part of AAAP application? Non Yes If yes,how many? Y 2c. How many bedrooms total are proposed at this property(including the Accessory unit)?. 2e. Is the proposed Accessory Apartment contained within the main house or a detached structure 2e.Please include a copy of the floor plans for the entire property, Neatly use a straight-edge. Show all existing rooms in the home and the proposed accessory apartment. Provide width measurements of any open doorways.'Label each room clearly. 3. Is the dwelling connected to public sewer? No' r Yes ' If the dwelling is connected to public sewer,skip questions#4 through#9 below. 4. Location of dwelling is INSIDE ,or OUTSID ' 'a Saltwater Estuary Protection Zone? 5 . Location of dwelling is INSIDE or OUTSIIDDF\ 4 a Zone of Contribution to public supply wells? 6. Is the dwelling connected to an ON-SITE WELL or to PUBLIC WATER? 7. Is a disposal works construction permit on file? YES or f NO 8. If yes,how many bedrooms were approved according to this permit? Bedrooms 9. Were any building permits obtained for construction of.additional bedrooms? OESor NO 10, a. Is there an engineered septic system plan on file'at the Health Division? YES or NO 10 b. If accessory unit is detached, plan on file for this system? YES , or NO 11. Has the septic system been inspected by a DEP certified inspector within the last two years? YES or NO. FOR OFFICE USE ONLY The.Public Health Division has no objection to bedrooms at this property: Special Conditions: Signed: Date: 2&�. A TOWN OF BARN STABLE"BUILDING PERMIT APPLICATION Permit# Map Parcel \ Health Division Date Issued Oz Z1 ZPO 1o'JW— Application Fee — Conservation Division hi Q • ' ' _ ' ` • Permit Fee-- Tax Collector l< ! LL 5� E . Treasurer M SAI - INSTALLED INCOMPLIANCE Planning Dept. WITIN TITLE 5 Date Definitive Plan Approved by Planning Board ENVIRONMENTAL CODE AND TOWN REGULATIONS Historic-OKH Preservation/Hyannis Project Street Address Village 3 Address qq� n�/C'`�-�G PZ_ Owner t Telephone L Permit Request ���h 4 roposed 30� 2nd floor:existing �3 yproposed Total new/CGS Square feet: 1 st floor. existing p Zoning District Flood Plain Groundwater Overlay rro Construction Type 1 �mr Project Valuation O yp Lot Size , 5 I Grandfathered: ;O Yes 0 No If yes,'attach supporting documentation. Dwelling Type: Single Family C� Two Family ❑ a , Multi-Family(#units) Age of Existing Structure 2- �M Historic House: ❑Yes 9No On Old King's Highway' ayes ❑No y i Basement Type: ❑Full tf Crawl . ❑Walkout ❑Other . Basement Unfinished Area.(sq ft) Basement Finished Area,(sq.ft) , Half:existing / - new l Number of Baths: Full:existing Z. ' ` new ,g Number of Bedrooms: existing new l , Total Room Count(not including'baths):sexisting new First Floor Room Count Heat Type and Fuel- Gas 0 Oil , ,❑Electric ' El Other - Central Air: &Yes O No j Fireplaces:Existing f New`'° 0, Existing wood/coal stove: Yes . Detached arage:❑existing ❑new size Pool:El existing ❑new size Barn:O existing ❑new size 9 size .�Shed:❑existing ❑new size Other: Attached garage:04,existing ❑new Zoning Board of Appeals Authorization ❑ Appeal# _ Recorded❑ Commercial ❑Yes ❑No If yes,site plan review# 05/22/2002 17:37 5085390047 JUST PLUMBING PAGE 01 .Bust wee .dust �- r, 9pull!!bing & Heating Just WEPAT"Mad ®i 575 Main Street, Mashpoo, AAA 02649 r6d @a f 539 8047 24 Xmw&n4m . a t� - Robert C. Laliame \I 575 Main Street Mashpee,MA 02649 RE- Paul Reardon 94 Country Club!hive, Cum maquid Heights D have on two occasions, inspected the subsurface sewage disposal system at the above address. i have exposed covers on the main box, the"D"box, and the two leachingits- It is m P Y professional.opinion that this system meets the 440 gallon a day requirements as set fourth in Title 5. Thank You Robert C. Lalime i RVAC. Woo Padron RCOW# COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAI AFFAIRS::,..,,-=John Graci DEPARTMENT OF ENVIRONMENTAL PROTECTION �DEP Title V Septic Inspector ONE.WINTER STREET BOSTON MA 02108(617)292-3500 ;..., Y xM P.O.Box 2119 TeaTicket,Ma. a a (508)564-6813 TRUDY COXE - Secretary ARGEO PAULCELLUCCI DAVID B.STRUHS Governor Commissioner SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION Property Address: 94 COUNTRY CLUB DR..CUMMAQUID MAP 350 PAR 019 L"95 Name of Owner DAVID BURMAN Address of Owner: 94 COUNTRY CLUB DR.YARMOUTH PORT MA.02675 Date of Inspection: 10/11/99 P, f s w Name of Inspector:(Please Print)JOHN GRACI . �(9�` ~ I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000) Company Name: n/a Mailing Address: n/a {` 0ABqD r99 y Telephone Number: n/a } all 9 CERTIFICATION STATEMENT " 1 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 inspection.The inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems.The system: X Passes The Inpection is based on criteria defined in Title V _ Conditionally Pas es ' code 310 CMR 15.303.My findings are of how the system is _ Needs Further E luation By the Local Approving Authority performing at the time of the inspection.My inspection does _ Fails not Imply any warranty or guarantee of the longgevity of the septic system and any of Its components useful life. Inspector's Signature: v ,F Date:10/12/99 R t f , u , The System Inspector shal submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within thirty(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 Department of Environmental Protection The original should be sent to the system owner and copies sent to the buyer;if applicable,and the approving authority. NOTES AND COMMENTS THE SYSTEM PASSES TITLE V'INSPECTION.RECOMMEND PUMPING THE SYSTEM EVERY,TWO YEARS TO PROLONG THE SYSTEM S - USEFULL LIFE: kf i t 4 , i revised 9/2/98 Page 1 of.11 ' e r. r r f SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM" PART A CERTIFICATION(continued) .: ., Property Address: 94 COUNTRY CLUB DR.CUMMAQUID MAP 366 PAR 019 L 95 Owner: DAVID BURMAN Date of Inspection:10111/99 - INSPECTION SUMMARY: Check A, B, C, or D: } k A. SYSTEM PASSES: I have not found any information which indicates that any of the failurerconditions described in 310 CMR 15.303 exist.Any failure criteria not evaluated are indicated below. COMMENTS: .+ System passes Title V inspection B. SYSTEM CONDITIONALLY PASSES: Waal One or more system components as described in the"Conditional Pass"section need to be replaced ror repaired.The system;upon completion of the replacement or repair,as approved by the Board of Health,will pass. , Indicate yes,no,or not determined(Y,N,or ND).Describe basis of determination in all instances.If"not determined',explain why not. ° nta The septic tank is metal,unless the owner or operator has provided the system inspector with a copy of a Certificate of Compliance(attached)indicating that the tank was installed within twenty(20)years prior to the date of the inspection;or the septic tank,whether or not metal,is cracked,structurally unsound,shows substantial infiltration or exfiltration,or tank failure is imminent.The system will pass inspection if the existing septic tank is replaced with a complying septic tank-as approved by the Board of Health. nLa Sewage backup or breakout or high static water level observed in the distribution box is"due'to broken or obstructed pipe(s) or due to a broken,settled or uneven distribution box.The system will pass inspection if(with approval of the Board of Health). broken pipe(s)are replaced r obstruction is removed - distribution box is levelled or replaced Wa The system required pumping more than four times a year due to broken or obstructed pipes) The system will pass ; inspection if(with approval of the Board of Health) _ broken pipe(s)are replaced ... s . obstruction is removed , i 1 - � .,:1A � W::r,A ; '4: •*+F.._ 1� -� �°Y.� �:. � � � r4 r*. 8._ u u , Al a 0 revised 9%2/98 `Page'2 of 11 Fa 1 9 t SUBSURFACE SEWAGE DISPOSAL SY STEM INSPECTION2 FORM + PART A CERTIFICATION(continued) Property Address: 94 COUNTRY CLUB DR.CUMMAQUID MAP 350 PAR 019 L 95 Owner: DAVID BURMAN Date of Inspection:10/11/99 r,.* 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 the public health,safety and the environment. 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES IN ACCORDANCEWITH 310 CMRs15.303(1)(b)THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT ThE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: Cesspool or privy is within 50 feet of surface water Cesspool or privy is within SO,feet of a bordering vegetated wetland or a salt marsh., ` .1 t r s.,-. t r+ ,, ,i',� f r• r4.� �_"a .,4. 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 AND SAFETY AND THE ENVIRONMENT: , The system has a septic tank and soil absorption system(SAS)and the+SAS is within 160 feet of a surface water supply or tributary to a surface water supply. The system has a septic tank and'soil absorption system and the SAS is within a Zone I of a public water supply well: The system has a septic tank and soil absorption system and the SAS is within 50 feet o(a private water supply well, _ The system has a septic,tank and soil absorption system and the SAS is less than 100 feet but 50 feet or more from a private water supply well,unless a well water analysis 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,Method used to determine distance >]La (approximation not valid). 3) OTHER . ''-� 't' & s d • ns r K r F € Ty e revised 9/2/98 s Page 3 of 11 *, SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A k - .CERTIFICATION(continued)-• ' Property Address: 94 COUNTRY CLUB DR.CUMMAQUID MAP 360 PAR 019 LA95 a Owner: DAVID BURMAN _ Date of Inspection:10/11199 ^s D. SYSTEM FAILS: You must indicate either"Yes"or"No"to each of,the following:- W•� I have determined that one or more of the following failure conditions exist as described in 310'CMR 15.303.The basis for this'determination is identified below.The Board of Health should be contacted to determine what will be necessary to correct the failure. Yes No X Backup of sewage into facility or system component due to an overloaded,or clogged SAS or cesspool X Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS•or oessp 61.. X Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool.'Y X Liquid depth in cesspool is less than 6"below invert or,-available volume is less than 1/2 day flow;' X Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped nta. X Any portion of the Soil Absorption System,ficesspool'orprivy is below the high groundwater elevation. X Any portion of a cesspool•or privy is within 100 feet of a surface water supply or tributary to a surface water supply.l X Any portion of a cesspool or privy is within a�Zone I of a public well. � X Any portion of a cesspool or privy is within 50 feet of a private water supply well,n ` X 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.If the well has been analyzed to be acceptable,attach copy of well water analysis for coliform bacteria,volatile organic ompounds, ammonia nitrogen and nitrate nitrogen. X The liquid level in the SAS is over the invert pipe,is in Hydraulic Failure. E. LARGE SYSTEM FAILS: . T.� .: f w •y ..t.2 y .. ',S� �'.r F 5 CSI. 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: The system `y tem serves a facility with a design flow,of 10,000 gpd or greaterSystem)and the system is a significant threat to public health and safety and the environment because one or more of the following conditions exist: f Yes No X the system is within 400 feet of a surface drinking water supply + .. X the system is within 200 feet of a tributary to a surface drinking water supply " X the system is located in a nitrogen sensitive area Interim Wellhead Protection Area IWPmapped t a - Y g A)or a mappe d Zone II of a public" water supply well) The owner or operator of any such system shall upgrade the system In accordance with 310 CMR 15.30412).Please consult the local regional office of the Department for further information. �. ;. ,,sue ,aa r a w,. "� - 6 -+• � _ "revised 9/2198 Page 4 of 11. ., t . 'q.. - - 4 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM' PART B y . CHECKLIST., Property Address: 94 COUNTRY CLUB DR.CUMMAQUID MAP.350 PAR 019 L 95 Owner: DAVID BURMAN Date of Inspection:10/11199 �' r a. _ 5 { . �t Check if the following have been done:You must indicate'either"Yes"or"No"as to each of the following: ti Yes No _ K X Pumping information was provided by the owner,occupant,or Board of Health. sF „t X None of the system components have been pumped for at least two weeks and-the system has been receiving normal flow rates during that period.Large volumes of water.have not been introduced into the system recently or as part of this inspection. X As built plans have been obtained and examined.Note if they are not available with N/A, X The facility or dwelling was inspected for signs of sewage back-up. X The system does not receive non-sanitary or industrial waste flow. • ;, - rd X The site was inspected for signs of breakout, X All system components,excluding the Soil Absorption System,have been located`on the site.p; - X 'The se ptic tank manholes were uncovered,opened,and the interior of the septic tank was inspected for condition of baffles or tees,material of construction,dimensions,depth of liquid,depth of sludge,depth of scum.The size and location of the Soil Absorption System on the site has been determined based on X Existing information,For example,Plan at B4O,H, X Determined in the field(if any of the failure criteria related to Part C is at issue,approximation of distance is:unacceptable), " (1 5.302(3)(b)1 ., X The facility owner(and occupants if-different from owner)were provided with'information on the proper,maintenance of SubSurface Disposal Systems.. 'N' 44 z a r .. a revised 9/2/98 Page'5' L 11 of 1 � 4 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION. Property Address: 94 COUNTRY CLUB DR.CUMMAQUID MAP 350 PAR 019 L 95 Owner: DAVID BURMAN Date of Inspection:10/11/99 FLOW CONDITIONS '`Y RESIDENTIAL: Design flow:A.1Q g.p.d./bedroom Number of bedrooms(design): 3 Number of bedrooms(actual):.$ Total DESIGN flow: Q Number of current residents:2 Garbage grinder(yes or no):YES Laundry(separate system)(yes or no): NQ If yes,separate inspection required ` Laundry system inspected(yes or no):M Seasonal use(yes or no):DLO Water meter readings,if available(last two year's usage(gpd) nLd Sump Pump(yes or no): Mil y r Last date of occupancy: nLa COMMERCIAL/INDUSTRIAL Type of establishment: nLa @y> Design flow: nta gpd(Based on 15.203) Basis of design flow: nLa Grease trap present:(yes or no):M Industrial Waste Holding Tank present:(yes or no) NQ Non-sanitary waste discharged to the Title 5 system:,(yes or no):NQ Water meter readings.if available:nLa Last date of occupancy: nLa , OTHER: (Describe) nta • r; Last date of occupancy: n& r GENERAL-INFORMATION '" r e PUMPING RECORDS and source of information JAN 2-1998 System pumped as part of inspection:(yes or no),NQ If yes,volume pumped nLa- gallons f Reason for pumping: n1a :+ ` >r TYPE OF SYSTEM , X 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) I/A Technology etc.Attach copy of up to date operation and maintenance contract Tight Tank Copy of DEP Approval" L Other: Wa APPROXIMATE,AGE of all components,date installed(if known)and source of tnformation: ,eon .1�.V.fL ,� a , v a Sewage odors detected when arriving at the site:(yes or no).NQ a revised 9/2/98' '`'° Page 6bf 11 ` •i 4 Y n SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C. SYSTEM INFO RMATION continue Property Address: 94 COUNTRY CLUB DR.CUMMAQUID MAP 350 PAR 019 L 95 Owner: DAVID BURMAN Date of Inspection:10/11/99. ; BUILDING SEWER: (Locate on site plan) '•T ` Depth below grade: 22! Material of construction:_ cast iron _40 PVC X other(explain) ' Distance from private water supply well or suction line: TOWN F Diameter: nLa Comments: (condition of joints,venting,evidence of leakage etc.) nLa - 44. x SEPTIC TANK: X {' - (locate on site plan) M Depth below grade: 1fx Material of construction:X concrete_ metal_ Fiberglass _ Polyethylene, ._,othe'r(explain) �wr nLa p If tank is metal,list age Is age confirmed by Certificate of Compliance(Yes/No). 'NO Dimensions: L 8'B"H5'7"W 4'10" , F` Sludge depth: 1 Distance from top of sludge to bottom of outlet tee or baffle Ir Scum thickness U Distance from top of scum to top of outlet tee or baffle: ' ,7{ Distance from bottom of scum to bottom of outlet tee or baffle:,17" " How dimensions were determined: MEASURED '., ` r Comments: (recommendation for pumping,condition of inlet and outlet tees or baffles,depth of liquid level in relation to outlet invert,structural integrity,evidence of leakage, etc.) f t 7 SEPTIC TANK AND ALL COMPONENTS ARE STRUCTURALLY Y SOUND.RECOMMEND PUh"PING EVERY T�"r0 Y ARS b R GREASE TRAP: (locate on site plan) VJ , grade:Depth below 9 r •. . , Material of construction:_concrete- metal Fiberglass Polyethylene'_other(explain) r Dimensions: nLd Scum thickness: nta * a 4 Distance from top of scum to top of outlet tee or baffle:jita Distance from bottom of scum to bottom of outlettee or baffle Date of last pumping: nLa ° - �. Comments: k (recommendation for pumping,condition of inlet and outlet tees or baffles,depth of liquid level in relation to outlet invert,structural integrity,evidence of leakage, etc.) ^ nta y ��• a :" • revised9/2/98 '` r � � 1 �� � � � fi+°`• aH .�. r x Page 7 of 11 d SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM' - PART C SYSTEM INFORMATION(continued) s. Property Address: 94 COUNTRY CLUB DR.CUMMAQUID MAP 350 PAR 019 L 95 " .". Owner: DAVID BURMAN- Date of Inspection:10/11/99 TIGHT OR HOLDING TANK: NO (Tank must be pumped prior to or at time of,inspection) (locate on site plan) , L• yt'�3, ... .. Depth below grade: x ,• Material of construction:_ concrete_ metal Fiberglass Polyethylene_ other(explain) Dimensions: Wa Capacity: Wa gallons Design flow: Wa gallons/day " v ,' a ,• ' Alarm present: NO , s Alarm level:°i!a_ Alarm in working order:Yes_No Date of previous pumping: nLa .,• "k Comments: (condition of inlet tee,condition of alarm and float switches,etc.) nla - . DISTRIBUTION BOX: X (locate on site plan) " Depth of liquid level above outlet invert:LEVEL WITH BOTTOM OF PIPE Comments: (note if level and distribution is equal,evidence of solids carryover,evidence of leakage into or out of box,etc:) f DISTRIBUTON BOX IS STRUCTURALLY SOUND. PUMP CHAMBER: NQ (locate on site plan) z Pumps in working order:(Yes or No):.NQ i Alarms in working order(Yes or No)`. MS2 Comments: (note condition of pump chamber,condition of pumps and appurtenances.etc.) 3 ` i revised 9/2/98 Page 8 of 11 t 6 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C r SYSTEM INFORMATION(continued) Property Address: 94 COUNTRY CLUB DR.CUMMAQUID'_MAP 350 PAR 019 L 95 Owner: DAVID BURMAN Date of Inspection:10/11/99 s t SOIL ABSORPTION SYSTEM(SAS): (locate on site plan,if possible;excavation not required,location may be approximated by non-intrusive methods) If not located,explain: Wa leaching pits,number: 2 LEACH PITS _ leaching chambers,number: .-n/A leaching galleries,number: ji& - y leaching trenches,number,length: ' leaching fields,number,dimensions: nta overflow cesspool,number: nLa Alternative system: nLa , Name of Technology: Comments: (note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation,etc.)ME LEACH PITS-APPEARS To BE ZONING PROPERLY-SY T n SHOmere tiO¢MS OF FAII IIRE ene IS WORKING ,. it .. .x Yn-y ✓ CESSPOOLS: (locate on site plan) ^- Number and configuration: n(a _ Depth-top of liquid to inlet invert: n[a Depth of solids layer: n[a 17- Depthf ' of scum layer. n(a h Dimensions of cesspool: n/a - Materials of construction: n& Y t Indication of groundwater: n& inflow(cesspool must be pumped as part of inspection)nLa Comments: (note condition of soil,signs of hydraulic failure,level of ponding condition`of vegetation;etc.) ` � 4> y . Wa PRIVY: (locate on site plan) "- Materials of construction:nla.f Dimensions n[� Depth of solids: n/H ;,, '` � ;. "'V; • +- Comments: n of ,( e condition of soil,signs of hydraulic failure,level of ponding condition of vegetation,etc) llld v to } I t E f I .•, J. _..q -.' ' ..., ,.'I ' n. _ v., Y ,. ,rid i ... • � ' . F .. . a E , ,. i revised 9/2/98 r as k Page 9 of 11 .,r SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C •,' SYSTEM_ INFORMATION(co t"m ued) , Property Address: 94 COUNTRY CLUB DR.CUMMAQUID MAP 360 PAR 019 L 95 ° Owner: DAVID BURMAN Date of Inspection:10/11/99 , 1 SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent reference landmarks or benchmarks " locate all wells within 100'(Locate where public water supply comes into house) n/a ` ' AD C -. .1./• is_ L fra .w�+.., 13 y. k ..'a'`1� r { ^ , R ...F c ,a ee•°, � qq i`•� 'f « revised 9/2/98 Page 10 of 11 a u - SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM: . .c. PART C SYSTEM INFORMATION(continued) Property Address: 94 COUNTRY CLUB DR.CUMMAQUID MAP 350 PAR 019 L 95 Owner: DAVID BURMAN Date of Inspection:10111/99 NRCS Report name: nLd Soil Type: nLa Typical depth to groundwater: nLa USGS Date website visited: nm �^ Observation Wells checked: NQ g. .L Groundwater depth:Shallow _ Moderate _ Deep SITE EXAM _ Slope s a Su a ce water k " , L' Cellar Check_ � .. �rt Shallow wells ' w 4 Estimated Depth to Groundwater 12 Feet E -Y > Please indicate all the methods used to determine High Groundwater Elevation. -• r _ Obtained from Design Plans on record _ Observed Site(Abutting property,observation hole,basement sump etc:) _ Determined from local conditions t { A _ Checked with local Board of health ! ' ' �',5 , t-'.,e 'ate ,,L.m+� �G•ex,. .. y• Checked FEMA Maps r Ch ecked he ck ed pum ping ing records ' r _ Checked local excavators,installers X Used USGS Data10 Describe how you established the High Groundwater Elevation (Must be completed) USGS MAPS AND CHARTS a 10 _ c v. revised 9/2/98 a P Page.11 of 11 .� 4�i �•' w�, ,,, � '� R 41 y. { �� TOWN OF BARNSTABLEor LOILA,60 `�L/ CtL)bDr SEWAGE # VILLAGE i ASSESSOR'S MAP &YOT O l INST,?ULLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY ®� LEACHING FACILITY: (ty ) �l° (size) NO.OF BEDROOMS BUILDER OR OWNER PERMITDATE: COMPLIANCE DATE: 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 0 o D IF A� 13y AB� AE gA a3� 66 J `y PERMIT CID. LOC ►. � IOp SEWAGE !I(; l L A C E ASSESSORS MAP NO: 3S0 �-- O -T Q1 PARCEL NO: 1NSTA-LLER'S NALIE a ADDRESS LltS S IZo.5 coVQ5 . Cc. 0UILDEIt DO OWCIER 13 91 T r0 . DATE P Ell GlIT ISSUED DATE COINPLIANCE ISSUED I=MES 3 tJ a.y Nol.a,:_ ............... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH a � ..................... -._...............OF..........------------------............--------------•---.........................----•- Alip irFatioaa for Di"vii al Workii Tomitrurtion Frrutit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal SZle .•• ............. .....•••.-...•-.•-•----....._.......______.______________------------------------...........-_-_-- Loc n-Address or Lot No. .._.._.. -----------------------------•--. --------- ----------•-----•--••--•---------------------•--------------------------------------------------- Owner Address Installer Address Type of Building Size Lot____________________ Sq. feet Dwelling—No. of Bedrooms...... _________________________________Expansion Attic ( ) Garbage Grinder aOther—Type of Building ____________________________ No.I of persons............................ Showers ( ) — Cafeteria ( ) Other fixtures --------------------•----------• - W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid*capacity__._._____=_gallons Length---------------- Width................ Diameter---------------- Depth................. x Disposal Trench—No_____________________ Width.................... Total Length.................... Total leaching area.....................sq. ft. Seepage Pit No__________________'__ Diameter-------------------- Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date........................................ 4 Test Pit No. 1----------------minutes per inch Depth of Test Pit--------------------- Depth to ground water........................ 44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water-------_................ ------------------------------------------•---- ...... _--•-------------------------------- •........ •----------------------- 0 Description of Soil------------------- ---------------------------------------------•-----------=-------------------------------------------=------------•-----------•--•••••-•••-••-•-•- 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 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. A�igne -----..._..•••-••••-••-•-••-•••--•-•••-••-•--•-••••-.._...•••--•••••••-•-_---- Application Approved By ------a f� a Date Application Disapprove for a following reasons--------------------------------------------•----------•----------------------------------------------------- Date PermitNo. -----._.___-•--•-••----•------------------ -- �"issued........................................................ Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ��� ���� Applir« tmou» x�� �wspl � Works Tovmwtrudmwn Vamit Application is hereby made for u Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal ---------- ' ---'--- --'-'-----' -------------------- ................................................................................................. Owner Address -----------------'--'__'�����-----'--------'_-_-'- ---'-'-----------'--'---�����-------_-----__'-'--.. � Type ofBuilding ' Size Lot---------------------------- Sq. feet � Dwelling--}Jo. of Bedrooms......3._.............................. Attic ( ) Garbage Grinder , Other—Type of Building ............................ No. of pecuoom-----.-----' G6m°cro ( ) -- Cafeteria ( ) 04 Other fixtures -------- Design Flow............................................gallons per person per day. Total daily flow............................................gallons. Septic Tank—Liquid capacity............gallons Length................ Width................ Diameter--_-..- Depth................ Disposal Trench--No.------............. Width.................... Total Total leaching area....................sq. ft. Seepage-Pit No.--_-'-- Diaoeter------' '� ---------Depth � m� �ol<� ' Iota leaching �--------ur� ag. ft. �� (�t6crD�t�but�obox ( ) Dosing tank ^� Percolation Test Results Performed by.......................................................................... Date........................................ � Test Pit No. l-..----oioutesyerinch Depth of Test PiL--_----- Depth to ground water........................ Test Pb No 3................minutes per inch Depth of Test Pit.................... Depth roground wuter-.----.---. '- ---__-_-.----'-'-_--''--_-'_---__-'---'-'_-'----'-'----------.------'-'---- 0 Description of SoiL_-----__-_-_--'__-_--____'_-____----------_'---'-.._-_-_-__-__-___-- ` .......................... ............................................................................................................................................................................. Nature of Repairs or Alterations--Answer when applicable------__-'-................................................................ '-----------'-------'-'--'-'.'-'''--------- � Agreement:� The undersigned agrees to install the uforc6cazi6c6 Individual Sewage Disposal System in accordance with the provisions ofTIT 1E 5 of the State Sanitary Cod:--The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board ofhealth. � S/igne -----''-- Date Application Daoppcovca7om�"x following reasons:.............................................................................................................. / _-_-_---_-_-__.'-_--_-..__---'---_-___-__-_-_--'-_---_---__'---_-_-----__-..--__- Date Peroit � ! Date THE COMMONWEALTH oFwxssAC*usErrs � BOARD OF HEALTH ......................... ................OF..................................................................................... ' Trrfifirate of To4OtphWtKa PV '>�-OWTQ�VERTIFY, That the Individual Sewage Disposal System constructed ("176� Repaired has been installed in accordance w* le provisions of 'I T.�T L E L of The State Sanitary Code as described in the THE ISSUANCE NOT BE CONSTRUE ~.^^E_�- -_-------------------'-'--'-- Inspector. -----------'---'__'---'----- � THE ooMwomvvsAcr* OF M ssA�Hu�srrs BOARD OF HEALTH ...............OF...................................................................................... m �� F Permission is ereby granted........... �A;0�a. ....................................................................................................... to Construct r�?e ai t.Z,.. aa�p_ di.10 e posal System uz � oauuo�000ro� o�yocuuoo�« uu� Street ms� Works Construction ��ruoz �mu.'-_-__--' uaznz���zc�c.��_---'-__ --'---------'-----'--'—'-------'-------- | Board of Health DATE............................................................................... � � ronM /255 xoaaowWARREN. INC., ruoLxs*sns t THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH :—t-Owr.S....................oF..... �`2t�1S�� T3 L�................. Appliratilan for Dispnsttl Works Tnnstrnrtion Vamit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: _ ,� )••(fZ v/'•...... r a L.o'r i s -----------------•----•---••-•-----------....-------•-----------••-•-••••--•••••--•-•---•• Location-Address or Lot No. �t ...... ...... � C.L v.................Y �Q�V_ - ... 0111111 Address v►�I�--.v.................... ��LI�staQler Address Type of Building Size Lot_ �.� _....Sq. f Dwelling—No. of Bedrooms............. 1.___.__.___.._...._Expansion Attic ( ) Garbage Grinder � � Other—T e of Building No, of.persons............................ Showers — Cafeteria QI Other fixtures ----------------------------•-••- W Design Flow.................55 ..................gallons per person per day. Total daily flow-___-_...3�2.........................gallons. WSeptic Tank—Liquid capacityZ�'-�..gallons Length.......I.._.. Width---__-.`J_�__--- Diameter.......:........ Depth...'Q'`........ x Disposal Trench—No..................... Width.................... Total Length.....................Total leaching area....................sq. ft. Seepage Pit No........1---------- Diameter...../?......... Depth below inlet........L........ Total leaching area.Z-4.I.....sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by._lt.C.(.L.0 u-c........................................ Date........................................ as Test Pit No. 1-----2—..minutes per inch Depth of Test Pit........................ Depth to ground water.. ..... LL, Test Pit No. 2................minutes per inch Depth of Test Pit..... ...... Depth to ground water./?.��_... ---•------------------------------------------------•••• ------•-----.................••--••.--•.••............... •-------------- •............. ...........•- O Description of Soil..................... �.¢�Lz Z..•..----•``srµ y------.... 2t �i l�� ---------------- x 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 ofXomphaSce has been 'ss y the f ig ............ D _ Application Approved BY `I l--- ----- Date Application Disapprove or ng reasons-----------------------•-------------------------------------•------------------...•-•-••._...---•-•-•••--•-••-- -•-•--•--•-------•-••---••--•--•-•----•---•--• ••-•-••-••----•---•••-------------•---•--••--••---••-----.._...-•---------------•-•---•.........--••••......•. Date PermitNo......................................................... Issued........................................................ Date THE COMMONWEALTH OF MASSACHUSETTS BOAFn OF H A H ...................OF... ..:................ _. (Irrtifiratr of T amplianrr T S T CERTIFY, That the Individual Sewage Disposal System constructed .-> or Repaired ( ) by...... ..................................... --.........-•-•-••••.... .......... -----------------•-- -------------- ---- - ----- Inst er r at ------ ---------- ------- •.•-----.............. been installed in accordance wi ie provisions of TITLE 5 of he State Sanitary Cod as ibe in the application for Disposal Works Construction Permit No.__�!_-...-_4.. v............ dated---/� _-�_________________________________ THE ISSUANCE OF THIS CERTIFICATE SHALT. NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE................................................................................ Inspector.................................................................................... THE COMMONWEALTH OF MASSACHUSETTS Z BOARD F HEA T No.�rxl ...................... FEE........................ E44DispoWorks rkv �1antrnrtivit rrmit Permission is by granted ---------------- -------------------------------------------------------------- ............ to Construc or Repai .w a Di al System at No r ---- ------------- •--•- ........................ . . ..--- ................ '�- Stree 2- as shown on the application for Construction Perm t N ........__________ ated.tl__I_.... .__......___._._.... ...••••. •....... • ...._....t ` .'f: ............................•---•-••----....•-•••- oard of Health DATE................................................................................ FORM 1255 A. M. SULKIN, INC., BOSTON No....................... r..... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH —r-o Uj N__� O F.....�^V_�y�T.� rs L_� ........................................... ...----...........................-------------....--------------------------------- Applirattion for Dispoti al Workii Tonstrnrtion thrutit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal Sy tem at:Z � Lo ation-Address i � or Lot No. ,f� f�UUrJC12'� C.1_e Q � Vt .. .. l ... ......................... . .............................•---•---..--•--Aa ...----------------------...._..._.......--•--- i�'L C�v 1') i t drl 1C. Installer Address Type of Building Size Lot_-,....... Sq. f aDwelling—No. of Bedrooms.............3_._........................Expansion Attic ( ) Garbage Grinder p, Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) a I Other fixtures ............................ c W Design Flow................ ........................_gallons per person per day. Total daily flow.........-.3 U.......................--gallons. WSeptic Tank—Liquid capacity��L"..gallons Length.......2..... Width.--.--.......... Diameter................ Depth... ......... x Disposal Trench No................•...:`Width.................;,. Totat Length.................... Total leaching area....................sq. ft. Seepage Pit No. ..::__.------ Diameter.................. Depth below inlet......... _....... Total leaching area..:' 2-----sq. ft. Z Other Distribution box,( ) Dosing tank ( ) ~' Percolation Test Results -.Performed.by... (-.�...... .................0........ Date.............................................. ,1.41 Test Pit No 1 ...�_...minutes per inch Depth of Test Pit.................... Depth Depth to ground water. G''.....:...--. Test Pit No. 2................minutes per inch Depth of Test Pit.... ....... Depth-'to ground water.NU-.......................... a ---------------------------------------------------------------•---•-----•-•-•...._._._........_..---......................................................... O Description of Soil.....................//+ p-"'`f' �'✓/ ..........-`-`=- ?...-•--..-.=-�-�----------U v--n-�i�v^Z!...S..............---------- 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 TITU 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compli ce has bee y the bo q h 1 Application Approved By` =� '`f ----------------------------------------•----------•--------------------- �F' ....''� f Date Application Disapprove or a following reasons---------------------------------••-------------------------------------........................................ ..................••.........-•-.-----•-•...-•-••--•--......................................••--•--•---.......•-•-------••........._............•.....•..•-----------------------.... •----...._.... Date PermitNo......................................................... Issued-....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS . BOAfM OF H H ........................OF ......... ......... .... ........... tT rtifirat a of ToutpliFanr�e T IS 0 CERTIFY, That the Individual Sewage Disposal System constructed or Repaired ( ) by = . ......... -•------•--••. � * r L' Inst lle� r j at. ........................................................ . -- -------•-- �' ........•........------------------••--------- has been installed in accordance w' the provisions of T�TIF 5 of The State Sanitary C . _as red in the application for Disposal Works Construction Permit No. __-.2.-.. _ v............. dated-.�/-- ...---_--.--.................. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE........................................................-----------------------• Inspector.................................................................................... a THE COMMONWEALTH OF MASSACHUSETTS BOARD. F HE T Noy...................... FEE........................ t Ito rkg Taonotr ion panfit Permissione_97 by granted ... ...... .. .... -` _....-------------...----------------------------•--------- ........_....... to ConstRepaC�; a dive ew e D sal System at No.. T.-. ...--- ----------- ......... •--------.............------ -•----. -•------•--------...._ •. --•- -- str as shown on the application for Disposal Works Construction Per it o...... ......... .. Dated��..�_. ..............._._............ ......... -•......... ..........•---... =-•----------------•--•-•------•..........-•--•-•-•-•----. oard of Health DATE..................................•............................................. FORM 1255 A. M. SULKIN. INC., BOSTON a .. $'t o � _ ... •. 1 I'1 01 •III-oI= r .- � _ c ' • yr _ • Y N w n n i • -w %4 , - 1. . - , y r ' y , r , o- .. , , J`• d - ,P OPEN Ov 4 I 41, rl' ' , 0 ' gy,ILly s - �rI t NI R c 1?I 4k- n. Ica a jj • a. y , , , T `N - - a - T I u 3 0 1 6 14 � 1- x �—10 f � �,, I _ o " _ I W k e 7 ,C - r "x {f�IPN I , v Y r . F1' ZIG /{ k CL ?JL - .. a x Cx 5T - r _ , M CE IL.C /L1 P O ° • I 77 - r - - IT, # „ I T � . •.r n' r r _ , _ 1 — a — - d • r p}CIS'r LJ1s,lLS TO 10E1'Vt«IN NCW 2x4 WALLS � KDO �Ftil D�NGf< 94 600N-� .GLUF3.-P2lVE; CUM'hAQUID, r1A-' IF �.L II- II��o- APPROVED.BY. DRAWN By .. - ♦, DATE: II—G—OI '- ` REVISED a , • t a ,: ;��• .:� DRAWING NUM BER • III—pI� III—Oi� 10— ''�-852$ • • o -• LINE Of 64LCOKIY Zv,�TD 6 51ZE9 - Tw244a - 9 -- I _ �fE2 I 310 -O - - fief R l xvo s Fc-GrP To AOOCNON WALL ' - - f R2ovE • . • _ _ - i KEJ�IZf�OrJ '�SITJ�N G� i 1 94 GOUNTFZI' GLUe Y<N!c. Gur MAG2UtR HA SCALE:�L}I��II OIL APPROV ED BY- ,� DRAWN BY GATE: ��-lD-OI • REVISED IRST �L002 f' N DRAW.of ER 4 7 p w r n' ° o u o 0 0 a O ❑° 4 vQ il ° ° �+' e o4 p ° o Q Q ° �p D c r r`� CJ� (E' \1L G? 011 G v V v ,pp � d' ° SECTION - SEWAGE —SEPTIC TANK — "D" BOX — - LEACH ! I ! I -- 6 \ 4 �Z �� tl TOP OF FON �59-R - �n4va✓ s..� uti,culrsauuC _ , +v� ) �� l�c� r� (MSL)a -2-OF aT0 /," > 1 P1A-�E'�3 W1THsN 10 �F. oF' WASHED STQ�a£ 3 _ D .� IN OUT IN OUT- IN I ' � /CLI SSO4 ct SEPTIC I 1 J �. k T�sue- - ql�M; + Z, � 4+g0 TANK Sd'S5r,4.o¢ �l ?_ -nn ✓ v, y IiF a b i w '9. f'f ELEV. ELEV. ELEV. ELEV. (o.o .. f ,� J J yLl .44 `-"7'`+,•r ELEV. ELEV. a 1=J..C"`✓. - OF 3/4••_ WASHED STONE 'fix O r ♦ w 1 Ar Y n / _ s: F 1 u OI _. TEST HOLE LOG fi GQcvv�v_ owr G,�.=olzp „ ,�' T.y�'LI ! d N TEST BY ' ,f j TEST DATE 8 Crs $1 WITNESS DESIGN -- -- BEDROOM HOUSE ) �(2 ', --,L.Oga.c bs6\ T.:M. 1 T.H. +� 2 ! �� �� . ,- t 2-s'\ 1� . RULI V. pp" ELEV. NO t �A �iii PERC RATE .�MIN/IN. DISPOSER; DISPD�' { �g •Q ��� 3�,w. a y w� .� FLOW RATE 330 (GA L./OAY ! 3 0 4�5 f �� �sCa G ✓ 54.0 3Co� / - 5'3.o SEPTIC TANK 330 (ts1= tiS \� 5$ ( 1 5Z oe 13 . --- REQ'D SEPTIC TANK SIZE i._4 ._15G' __ - •'"•`• .._�'� :ram. \` ..a, ' ♦1 ry �' / /, �� f -7 1. � t y ' LEACH FACILITY yc,^-77 i r _ ! g i Q o SIDE WALL,, 1o'iT �°_1854_ _.IZ,S 1 = 4� i G/D. � . y } " t'�t'/�;�?, � ` .`` Z' ,i BOTTOM __��S�S G//D. " •aci i` a c a - T� ro a 0' w Spa-, TOTAL - 7- Coll = 74�, G/D. �'� I P� , t ` tt t't� p% ^?,; -t„ N'' o❑ USE: 'Z"�.1,© LEACHING 144 4 S.r7 t�.4L 4�4.o � N _ ._ 10' 6�':DIA . X Co EFR. 7GP'i'F{ —. ..- -- `• ,_ , 6 WATER ENCOUNTERED , o NOTES: (UNLESS OTHERWISE NOTED) ao� 1. OAT UM (MSLj-TAKEN FROM__.______________.................QUADRANGLE MAP J� a. \ OF + w.►�q C y �I 2.MUNICIPAL WATER_,____________._____._______________AVAILABLE ��� ��`SJ'C�\ � 3.PIPE PITCH: 1/4' PER FOOT `A y1' �17a ° 4.DESIGN LOADING FOR ALL PRE-CAST UNITS: AASHO ZO /�O ARNE H. G, o� ARN1^ L! 5.MIN.GROUND COVER OVER ALL SEWAGE FACILITIES: (1) FT. � " �i OJALA g H. DISTANCE AS CERTIFIED � a 6. PIPE JOINTS SHALL BE MADE.WATER TIGHT t •�C� c.� CIVIL c OJALA 7.CONSTRUCTION DETAILS TO BE ACCORDANCE WITH COMM.OF RiCHARD . G� No' 307 6 � 'r l 1 HEt*BY CERTIFY TKIAT THE BU �' �^+r--- SITE PLAN y` STATE ENVIRONMENTAL CODE TITLE 5 w - R. 1 rn1 ,o, SHO - S PL�pN IS L( A - HE 1 1 F3AZs �STAt. LG MASS• v FAIRSANK vs �� �f �� @ S LOCUS: o a � Of, �rl 44'' `� f©IST � �Q ( GROt1ND A3� GNAT!T_�...�...,-- N0. 20204 SS/Q �Q v%. CONFORM TO WS OF T4 L O� q rj -„CLaMc�(A U t t7 .SSG►-1TSw tir 'b ?c I � ..r----- -- SUR - '.OWi7 — Q 3'd �,�(y•, k, EG. PROI ESSIU EER ONSTAUCTfDT#�ATE PL.F3� �Z9 pCy ,Ip 1 ,���yy'�I�yy d� REF: ,1�._-- Y.ow*1 Cape ifteefifig � PRFPAFiED F•GR: C _ 2 ./t5�cri 7='0.- �►- I �../�er 3AS/83 y NEERS LANDSURVCIVIL IEYORS -- ----- -^..- C BOARD OF HEALTH 7 fAEG. LAN13Si3'RgEYOR w' t'/5 CONTOURS (EXISTING) ------------ SCAL , -,-- J w (PROPOSED)-0� 0-0 0- APPROVED DATE MA Y YarmoutU-& Orleans,MA �' DA.T� �_ 9,1 I ' t 1 n 0 s7 D .o L'Cf`TIr1A1 eE►ei n //�� -— - -SEPTIC TANK - - "D" BOX - - LEACH1 I + I STif i Mp k5 TOP OF FON SS.o \ I (MSL) �-%A-rQ C Ati+Y -4 KA ,ITALSI r "2"OF'reTO 'h" t' t`M�i�r.aL wYrs-1,,.► Ip -�F. E. — WASHED STONE ,.�, r ' / ' I I��• LfSAGH,l ,G �1T, ' • 11 *S.1' IN OUT- r� ��QQ G IN OUT IN f1 , F 9 LJ SS,00� —SEPTIC — ( r SQ,So L,4.G,5 an 4 ELEV. — TANK 54.OQ I E ELEV. ELEV. ELEV. (o.G� V J7( 1 .O a �� Y ;i t st�rw'" `.�'7 U �4�Cd.Cn 0 �T ;;�'� .� ,,;`+� .� 1 ELEV. ELEV. e ;.g �'1 �t V <<{'j,. y$,iR ,spy R i 1 I Z.4' �-- ---IZro V L f.^,1"j 0. a $�013�1 ,fr y �,r^•i►d II cr 1 y4 OF 3A"- 142.• k y Ka WASHEDSTONE f� a �' In TEST HOLE LOG N ` j cs c QnvvEv_ 'b w, TEST BY — tz� ��'►�Q/ , /- N \ !t g $I WITNESS Cn 2' TEST DATE DESIGN A,V BEDROOM HOUSE .� �. �/ \F.E-=S't.0r �..�„ ► \ J T.H. # 1 S T.H. 2 -7.o 44r` ELEV. pp" ELEV �dA Sir` f 3SorL Z r I NO DISPOSER DISPOSFR r, � Y PERC RATE -MIN/IN. g FLOW RATE 3�Q (GAL./DAY ) 3 0 3L„ S4.o 3�' / S3.o SEPTIC TANK 330 (1.5►= qr� REO'D SEPTIC TANK SIZE ) LEACH FACILITY In&X1 iu sit�.DI4 1b� Co= k2 T. 6, SIDE W A L 4'l I '1 a. art^� a+lir 5�'4^ sAN Sr.� BOTTOMifi— T O T A L - Z-l0'1 = ''aAA.S G�p. (��[ 1 f ,. 7" 1 I ' 144� - -45•r� Iv.W - - 44.o USE: LEACHING _- NQ WATER ENCOUNTERED —' NOTES: (UNLESS OTHERWISE NOTED) 1. DATUM (MSL) +TAKEN FROM ~`CAN"'1+� r Of . 2.MUNICIPAL WATER---------------•1 ------ �, I-4 • in .kR �� H. 4. DESIGN LOADING FOR ALL PRE-CAST UNITS: AASHO - ARPkE ( � y� 4�. ARNE 5. MIN. GROUND COVER OVER ALL SEWAGE FACILITIES: 1) FT. �+ = / H• `n'' DISTANCE AS CERTIFIED s �- .t 6. PIPE JOINTS SHALL BE MADE WATER TIGHT `�`.�� ��� c�a CIVIL pJALA 7.CONSTRUCTION DETAILS TO BE ACCORDANCE WITH COMM.OF FtICH�RD �,'c- Yt pj0, �p� 1; 4$ STATE ENVIRONMENTAL CODE TITLE 5 I HEREBY CERTIFY THAT THE BLI SITE PLAN 6 U FAI SANK 1 ci1 O.e�,�� �, 1t. �k4' ` rYE'�I$� R�C�.4� SHO - D S PLAN IS LOCA .HE - 3p.��.,t•,,,,1STA. LG MA' S• GROUND ASS F I THAT IT LOCUS: No. 201,04 ` / tA� ` ��0 SUR`)�� CONFORM TO T - WS OF THE .� ` -•.`� J �.O----- -- TOWN NC 1-iTS fO3;. G.PROFESSIO EER ONSTRUCTED. DATE l tpT 5 •Il }!/ REF: [ down . cage eng 70ef/46 STEVC gR�-�Tc�l..l PREPARED FOR: — CIVIL ENGINEERS (PROPOSED)—O—O—O—O— APPROVED DATE )' LAND SURVEYORS -----------;R$ — s. BOARD OF HEALTH BEG..LAND SURVEYOR CONTOURS (EXISTING)------------- MA } Yarmouth&Orleans,MA SCALE DATE • B z-o q 9 k - u SECTION - SEWAGEPAID 1 -SEPTIC TANK - - "D"BOX - - LEACH G y r- TOP OF FON J (MSL)tt l tA���AL w,T�i�ha to -FF. aF- —"2"OF`�aTO 4a" LE>A, �4 tT TA WASHED STONE 1 rl e 31,E I IN OUT IN 913 OUT IN- _ _ Tr SgG1/ SEPTIC .. WAG A� TANK 17 51;T; 54,04./ S�'be V ..,.A� I - T@�' S�`2�V �• y �� 4. ,© I ��p�p � ELEV. ELEV. ELEV. �, S�,3S /954. ` ELEV. ' I Id IS CoA 1 0 j ELEV. ELEV. l9 ._iL ISa44 s� Aat,IYx crLA ,I / - aw 1 �GV. OF3d"- lh" � WASHED STONE \ �9 x TEST HOLE LOG I / j. 4'►° % t' \ r NA TEST BYnc's cAc � 'Lo,.1 G,>r. orcD $ CorS1 WITNESS L TEST DATE 3 EL• S 1.0 *. €' DESIGN BEDROOM HOUSE .' T.H. 1 5i T.H. # 2 Q U4 ELEV. pQ" ELEV. NO � �'(,,•� � \ \ \ / PERC RATE Z _MIN/IN. DISPOSER DISPOSER FLOW RATE "�3Q (GAL./DAV ) 3_0_ '� . '— 33'± 3t," S4.o a5co" S3.o �tS Y _ + S SZ \ SEPTIC TANK 330 (45)= i' REQ'D SEPTIC TANK SIZE O ASV C5 a�::_�,\ J // / LEACH FACILITY b «tr nn lu ►n Dlv SIDE WALL_IoTC c '179. 4. (Z.S 1 = `�� 1 _ G/D. S4-9 Ste+ BOTTOM �i 1i41 nT SDI �.o I = "lff.$G/D. , r� rs SA.a TOTAL - 2-4n = '74A.S GAP. � I USE LEACHING PATS i �C r� NC) t0 EFIr b1A . )C <o E_FF'. %>eP-�{ —WATER ENCOUNTERED — NOTES:, (UNLESS OTHERWISE NOTED) ' 1. DATUM (MSL)+TAKEN FROM A� � _��?--_-----__QUADRANGLE MAP %k OF `\ `' OF 2.MUNICIPAL WATER-------------•-,S - �' tN ...............AVAILABLE 3. PIPE PITCH: 44"PER FOOTve,- 4. DESIGN LOADING FOR ALL PRE-CAST UNITS: AASHO � '� ARNE H. yJ, o� ARNE, o © f 5. MIN. GROUND COVER OVER ALL SEWAGE FACILITIES: (1) FT. 1 "L 4` OJALA , H. r"` DISTANCE-AS CERTIFIED 6.PIPE JOINTS SHALL BE MADE WATER TIGHT �L�,1 V CIVIL OJALA i 7.CONSTRUCTION DETAILS TO BE ACCORDANCE WITH COMM.OF RICH,ARU G No. 347 6 I HEREBY CE:RTFFY THAT THE BU SITE PLAN STATE ENVIRONMENTAL CODE TITLE 5 a R. �' 1 p SHO S PLAN IS LOC. rHE v FAIRBANK GROUND ASS e THAT IT LOCUS: M?.S S• { No. 20204 f ` 1 A SURM TO T L' a 14 CONFORM WS OF THE 9S -��Gc►I�rMAG�u►O KCtGNTS_ EG.PROFESSID EER _ ONSTRUCTED. DATE ' A � � REF:Lca-c PL•Vl<. Z29 � PG .to. 1. Cape en ine rin �7,-E..,G P��P•%T_r4 down c ►.1 � ��_ PREPARED FOR: CIVIL ENGINEERS• LAND SURVEYORS =----------- BOARD OF HEALTH / REG. LAND SURVEYOR CONTOURS ( 1q ' (EXISTING) ----•-------- _ PROPOSED)—0-0-0-0— APPROVED DATE MA Yarmouth&Orleans,MA SCALE 1t T DATE19 Cj Z o 9