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HomeMy WebLinkAbout0195 COUNTRY CLUB DRIVE - Health r7'l95 'Counth .1 flub Drive Barnstable PT 349 042 1 0 i TOWN OF BARNSTABLE �;G O-LOCATION Ca'CaAWW C14S D& SEWAGE VaAGE ¢j 's�� ASSESSOR'S MAP & LO ® -- INSTALLER'S NAME&PHONE NO. RAWP N-0-7Z 4W4:�2 t SEPTIC TANK CAPACITY 0500 LEACHING FACII.ITY: (type) �}� (size) e � NO.OF BEDROOMS BUILDER OR OWNE PERMITDATE: JIML01t COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility (If any wetlands exist within 300 feet of leaching facility) Feet Furnished by i 11 - I' ot v 3 3� No. O�'�� J / = '` Fee ! THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS 2pplication for Mi.5pool *p5tem Construction Permit Application for a Permit to Construct( )Repair( Upgrade( )Abandon( ) O Complete System ❑Individual Components Location Address or Lot No. l q (_a e1-c,8 Owne �err's Name,Address and Tel.No. A*69 6 f 1,&l Assessor's Map/Parcel L.. m r'Y /7� CatvM CU-16 ®K' 3 a— Installer'ss Naam�e,Address,and Tel.No. SAIRY Y®� Designer's Name, dd e,Address and Tel.No. 361 0254 - . Type of Building: Dwelling No.of Bedrooms Lot Size 9 sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow. gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the E i runenqVode and not to place the system in operation until a Certifi- cate of Compliance has been issue Boar o ealth. Si ed Date Application Approved by Date Application Disapproved for the following reasons Permit No. a0J�L '� 7 Date Issued ry, ^00 L4 r �r � No. o� � �"� `�,� *..:.�,k� �' Fee Entered in computer: / THE COMMONWEALTH OF MASSACHUSETTS V Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS ' ZIpplication for Migpool 6rac rY Construction Permit Application for a Permit to Construct( . )Repair(✓)Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or.Lot No. /9 ca.j t#m a&,6 Owner`s Name,Address and Tel.No. A1,4116ci 6 11/& Assessor's-Map/Parcel 8"r `Vr.�rrx31 9it) r Kil�/�7 �L�J� Qa Installer's Name,Address,and Tel.No. Designe'r's Name,Address and Tel.No. 36(1_69�4 (31�1N�/A�o'+7G A LLS 20-?,66Di T CtAl SAHO"Z14 Type of Building: Dwell' N Dwelling o.of Bedrooms Lot Size s .ft..g �� q Garbage Grinder( ) Other - Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision.Date Title Size of Septic Tank Type of S.A.S. Description of Soil:, R Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: f -w The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the En pnmen ode and not to place the system in operation until a Certifi- Cate of Compliance has been issued Board,of th. Sig ed Date Application Approved by Date Application Disapproved for the following reasons Permit No.z C9V e-1 — s 72 Date Issued. THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of (Compliance THIS,IS TO CE ,that the On-site Sewage Disposal System Constructed( )Repaired Upgraded( ) 4 Abandoned( )by at f g cdc 41 L'L ail- PA has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. a U o y-3 76 dated 7�7,�7�D Installer ARl� vo T.f Designer 660 The issuance of this pegnit shall n be on trued as a guarantee that the sys )< wil function as d si ned. Date '-© U Inspector . � / 'I✓, --------------- --- No. � 3 7;1. 'Fee THE COMMONWEALTH OF MASSACHUSETTS ` PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS miopogal *pztem QCon.5truction Permit Permission is hereby granted to Construct( )Repair( Upgrade( )Abandon( ) System located at ✓?!(_ A and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction must be completed within three years of the dame of this pe, 't Date: ��`� l Approved\bye _ r ' Town of Barnstable • '°��.� Regulatory Services Thomas F.Geiler,Director • SARNSfABFB.. Public Health Division Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office;.508-862-4644 Fax: 508-790-6304 Installer&Designer Certification Form Date: r I Designer: D kV I D D. C©O&H !i-W W K Installer: 1f Address: +D' TPWGC(:. CIRCLE Address: RQY 7M�CA S.wc)Wl CH, MA 02,56 3 MW&M6�FLS' On &69256 y ® was issued a permit to install a (date) (installer) se tics stem at iQ` based on a design drawn b P Y �� e���TiQ��1 ?� � Y (address) NVI D CQUG J A WC WR, R� dated q nC-6! ' (designer) VI certify that the septic system referenced above was installed substantially according to the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. -, I certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system)but in accordance with State &Local Regulations. Plan revision or certified as-built by designer to follow. DAVID D. staller' afore) co!UGHA�!0WR 9 # 1093 . (Designer's Signature) (Affix Designer's Stamp Here) PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS- BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. Q:Heatth/Septic/Desiper Certification Form _ TOWN OF BARNSTABLEG LOCATION C&OW CUS D9 SEWAGE VILLAGE � �10 ASSESSOR'S MAP & LO �® t" I y� INSTALLER'S NAME&PHONE NO.'--- SEPTIC � SEPTIC TANK CAPACITY LEACHING FACILITY: (ty�) (size) ' NO.OF BEDROOMS _ BUILDER OR OWNEW j a PERMTTDATE: ® COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to-the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility (If any wetlands exist within 300 feet of leaching facility). Feet Furnished by k 000 M L605f '"/ �® w fGr 7 4 �- Commonwealth of Massachusetts 9,0 die► M. Executive Office of Environmental Affairs p � ® ��� Wllllam F.Weld Z Trudy Governor Argon Paul Celluccl j 0U.Gowentor SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A - CERTIFICATION Property Address: 195 Country Club Dr, Cummaquid, �ddressofowner. Patricia Vargas Date of Inspection: 4-1 1 —9 7 (If different) Name of Inspector. W.E. Robinson SR Company Name,Address and Telephone Number. ( 5 0 8 )7 7 5-8 7 7 6 W.E. Robinson Septic Service P.O. Box 1089 Centerville MA CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of 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: �assea Conditionally Passes _ Needs Further Evaluation By the Local Approving Authority _ Fails ,( q Inspector's Signature: !� Date: 4� //^ 17 The System Inspector shall submit a copy of this inspection report to the Approving Authority within thirty(30)days of.eompleting 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. INSPECTION SUMMARY: Check A, B, C,or D: A] SYSTEM PASSES: �I have not found any information which indicates that the system violates any of the failure criteria as defined in 310 CMR 16.303. Any failure criteria not evaluated are indicated below. B] SYSTEM CONDITIONALLY PASSES: One or more system components need to be replaced or repaired. The system,upon completion of the replacement or repair,passes inspection. Indicate yes,no,or not determined(Y,N, or ND). Describe basis of determination in all instances. If"not determined",explain why not) The septic tank is metal,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 conforming septic tank as approved by the Board of Health. (revised 11/03/95) 1 One Winter Street a Boston,Massachusetts 02108 0 FAX(617)556-1049 0 Telephone(617)292-5500 ^1 Printed on Recycled Paper SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Addrew 195 Country Club Dr, Cummaquid, MA Owner. Patridla Vargas Date of Inspection: BI SYSTEM CONDITIONALLY PASSES(continued) Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obatructed 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 obstruction is removed distribution box is levelled or replaced The system required pumping more than four times a year due to broken or obstructed pipe(s). The system will peas inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed C1 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 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 a surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh. SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH(AND PUBLIC WATER SUPPLIER,IF APPROPRIATE) DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: The system has a septic tank and soil absorption system and is within 100 feet to a surface water supply or tributary to a surface water supply. The system has a septic tank and soil absorption system and is within a Zone I of a public water supply well. The system has a septic tank and soil absorption system and is within 50 feet of a private water supply well. The system has a septic tank and soil absorption system and 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 leas than 5 ppm. OTHER (revised 11/03/95) 2 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(oontinued) Property Address: 195 Country Club Dr, Cummaquid, MA Owner. Patricia Vargas Date of Inspection: 4—1 1 —9 7 D) SYSTEM FAILS: -1 I have determined that the system violates one or more of the following failure criteria as defined 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. Backup of sewage into facility or system component due to an 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. Liquid depth in cesspool is less than 6"below invert or available volume is less than 1/2 day flow. Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped Any portion of the Soil Absorption System,cesspool or privy is below the high groundwater elevation. Any portion of a 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 I 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. If the well has been analyzed to be acceptable,attach copy of well water analysis for ooliform bacteria,volatile organic compounds, ammonia nitrogen and nitrate nitrogen. El GE SYSTEM FAILS: The following criteria apply to large systems in addition to the criteria above: The system serves a facility with a design flow of 10,000 gpd or greater(Large System)and the system is a significant threat to public health and safety and the environment because one or more of the following conditions exist: the system is within 400 feet of a surface drinking water supply the system is within 200 feet of a tributary to a surface drinking water supply the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area(IWPA)or a mapped Zone 11 of a public water supply well) The r or operator of any such system shall bring the system and facility into fill compliance with the groundwater treatment program require ents of 314 CMR 5.00 and 6.00. Please consult the local regional office of the Department for further information.. (revised 11/03/95) 3 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST PropertyAddrem 195 Country Club Dr, Cummaquid, MA Owner. Patricia Vargas Date of Inspeadon:�I cA .� Check if the following have been done: v?umping information was requested of the owner,occupant,and Board of Health. 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. VAs built plans have been obtained and examined. Note if they are not available with N/A facility or dwelling was inspected for signs of sewage back-up. _i'he system does not receive non-sanitary or industrial waste flow The site was inspected for signs of breakout. All system components, excluding the Soil Absorption System, have been located on the site. The septic 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. ZThe size and location of the Soil Absorption System on the site has been determined based on existing information or approximated by non-intrusive methods. _The facility owner(and occupants, if different from owner)were provided with information on the proper maintenance of Sub- Surface Disposal System. (revised 11/03/95) 4 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 195 Country Club Dr, Cumma_quid, MA Owner. Patricia Vargas Date of Inspection:,/—,! FLOW CONDITIONS RESIDENTIAL: Design flow: '- 0 jallons Number of bedrooms: _c Number of current residents:,,; Garbage grinder(yes or no):A,,.o _ Laundry connected to system(yes or no): 'g Seasonal use(yes or no): .L 41 Water meter readings,if available: 1995 — 71 , 000 gals. 1996 — 58, 000 gals . Last date of occupancy: COMMERCIALANDUSTRIAL: Type of establishment: Design flow:_gallons/day 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: Lest date of occupancy: OTHER:(Describe) Last date of occupancy: GENERAL INFORMATION PUMPING'RECORDS and source of information: System pumped as part of inspection: (yes or no) b If yes,'volume pumped: gallons Reason for pumping: TYPE QF 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) Other(explain) APPROXIMATE AG}E of all components,date installed(if known)and source of information: Sewage odors detected when arriving at the site: (yes or no) (revised 11/03/95)• 6 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) property Addrem 195 Country Club Dr, Cummaquid, MA Owner. Patricia-Vargas Date of Inspection: 4—1 1 —9 7 SEPTIC TANK:_✓ (locate on site plan) Depth below grade: 7 _ Material of constnution:✓concrete_metal_FRP—other(explain) Dimensions: Sludge depth: 1. Distance from top of sludge to bottom of outlet tee or baffle: �•/ Scum thickness: 7—/V , Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle:-/6_ 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.) /,S 6 O llo - O,, A4 j :,/ 7,,, X C b J P 2 I12 /Z GAI E TRAP:_ (11 on site plan) Depth low grade: Mate ' of construction:_concrete_metal_FRP—other(explain) ions: thickness: from top of scum to top of outlet tee or baffle: from bottom of scum to bottom of outlet tee or baffle: Cc eats: (reoo endation for pumping,condition of inlet and outlet tees or baffles,depth of liquid level in relation to outlet invert,structural integrity, avid ce of leakage,etc.) ` (revised 11/03/95) 6 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 195 Country Club Dr, Cummaquid-,� MA Owner. Patricia Vargas Date of Inspection: TIGHT OR HOLDING TANK_ ( on site plan) Depth grade: Materi�of construction:_concrete_metal_FRP_other(explain) no: Ca ty: Gallons Aow: ¢allons/day Alarm evel: Comma ts: (oondi ' n of inlet tee,condition of alarm and float switches,etc.) DISTRIBUTION BOX: (locate on site plan) Depth of liquid level above outlet invert: 0 Comments: (note if level and distribution is equal,evidence of solids carryover,evidence of leakage into or out of box,etc. P CHAMBER:_ (lots on site plan) Pum in working order:(yes or no) nt . (note n of pump chamber,condition of pumps and appurtenances,etc.) (revised 11/03/95) 7 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(oontinued) PropertyAddresw 195 Country Club Dr, Cummquid, MA Owner. Patricia Vargas Date of Inspection: SOIL ABSORPTION SYSTEM(SAS):j (locate on site plan,if possible;excavation not required,but may a be rosimated PP b9 non-intrusive methods) If not determined to be present,explain: Type: leaching pits,number: leaching chambers,number:_ leaching galleries,number: leaching trenches,number,length: leaching fields,number,dimensions: overflow cesspool,number: Comments: (n//ote condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation,etc.)�U.is o /a ti�? .�. 6 l GO C)E88POOLS:_ (locate on site plan) �I Numb r and configuration: Depth-top of liquid to inlet invert: Depth of solids layer- Depth of scum layer: Dimensions of cesspool: Materials of construction: n of groundwater. inflow(cesspool must be pumped as part of inspection) Co nta: (note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation, etc.) PRIVY _ (locate n site plan) Ma of construction: Dimensions• De of solids: Co nts:(note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation,etc.) (revised 11/03/95) g SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) pr,pertyAddress; 195 Country Club Dr, Cummaquid, mA Owner. Patricia Vargas Date of Inspection:�� SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent references landmarks or benchmarks locate all wells within 100' 3� 1 � DEPTH TO GROUNDWATER Depth to groundwater ` a feet method of determination or approximation: Q cal (revised 11/03/95) 9 - LOCATION iqs SEWAGE PERMIT q0. ��ls lovu� � Plum 8S- ar �VIL'LAGE IWSTA LLEA'S NAME- b ADDRESS Ra&%r B. Ovo BUILDER OR OVC3ER Slim" 16ru TTV" 4Vut4AaVi0, JL4ASs. 'DATE PERMIT ISSUED � DATE . COMPLIANCE ISSUED 10 2 4 _ a Q WC5T F99 Nz ., i500 o No...25—_��! Fim$.......�.........�' jly% A= THE COMMONWEALTH OF MASSACHUSETTS ' 31ci o4 a BOAR® OF HEALTH ..........................................OF.......................................................................................... ApplirFation for Disposal Works Tonstrurtinn Prrutit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: /f 5 " eoVAIT/L3. _%u9 ��/Yij /S- ................_......._...................................................................... ............................................ Location-Address or Lot No. ... ....•-•-•- ...� ..-----Yam'=/s o nr� 2/3—cou,1Y71 L, Ge--✓& 0�- c ui r:/�t.iz ....................•---•.... .... 44 e Ow..... A ................................Address Installer Address UType of Building Size Lot:�l P.......Sq. feet U Dwelling—No. of Bedrooms...........;..............................Expansion Attic ( ) Garbage Grinder ( ) Other—Type of Building No. of persons........>.................. Showers — Cafeteria Q' Other fixtures -------•------------------------ W Design Flow... .......gallons per person per day. Total daily flow---------r;�! 13......................gallons. WSeptic Tank—Liquid capacity./'O.!`gallons Length................ Width................ Diameter.-.--.--..---.-- Depth................ x Disposal Trench—No..................... Width.................... Total Length.................... Total,leaching area_..'a-6_1...sq. ft. Seepage Pit No--------------------- Diameter.--......--..--..... Depth below inlet.................... Total leaching area..;)►..6..I---sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by----- �,----- �,`_r..................i�....--•--•--•-_-.... Date..................... ---- ,� Test Pit No. 1...4--a---minutes per inch Depth of Test Pit.-A-b........_ Depth to ground water.....�4. ... f= Test Pit No. 2...Z_X...minutes per inch Depth of Test Pit..1.. C.a�.... Depth to ground water........................ R+' ......-•----------------------------•-•-...........••--....:.......-----r------------......--....._...,-.... O Description of Soil-----.. 1---------��! !1.. fi 5c ••-------" 1--�----- x ------------ U -----•-•----------------••------•-------•--••--••--••-•------------------------------------•---------•------------------------------------------•••---•-----------------••-••-•-•-----------•-••-------- W ------------------------------------------------•--•----------------------------------....-•------------------•----•--------------------•-------------•-------•-----••-------•----••......----------••-- UNature of Repairs or Alterations—Answer when applicable............................................................................................... --------•-----•-------------•-------•-••--•--------------------......----------------------------------------------------------------------------------•------------•------------------------......----- Agreem e indersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with (:.;pplication pr v sions of iIT 5 of the State Sanitary Code— The undersigned further agrees not to place the system in rat' until.'a C to of Compliance has been issued by the board of health. ry Igned= ---•----- --- -----•----- ................. .... Date lication A proved By......... --_------- . . ............................. ------ =��' Date Disapproved for tit following reasons:...............................................•---•-------------------------....-----••--••------------------- ---------------------------------------------•-----------------------------------•------------------...-----------------------•--------•••-------•----------•-------------......------------•._...-•-- Date PermitNo...... ....................:.._.... Issued........................................................ Date - ----------------- -- - -- - --.�.� - - —. ---- __------------ Now..8,%i FE$ ��................... THE COMMONWEALTH OF. MASSACHUSETTS E®AR ',"O " HEALTH ................ ApvltrFalll, faux Disposal Warks Tonfitrnxtiaan ramit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: xy ................__........._............. .................................................. _.....------------....----•--------•----------•••--•••--------•-......._....--------............•• Location Address ✓ 'T� �" i'Lca�/ / <^ �+ r7i`Y ca°SLot ¢ddr �'ter./�Pr9�g'v/tU ..... -----------------•... .... } Address IW,1 ............. . ......- .. -0=. ........................................ Installer Address Type of Building r' Size Lot .. ....................Sq. feet I—I Dwelling—No:' of Bedrooms......... ..............................Expansion.Attic ( ) Garbage Grinder ( ) a` Other—T e of Building ......._ No. of persons a YP g =- p sons._...'. ............•__._ Showers ( ) — Cafeteria ( ) Other fixtures ............................... -•--••......•---••. •--•••......----- Design Flow.. ,$S gallons per,person per day.; Total daily flow �Fo_______________________gallons. WSeptic Tank—Liquid capacity 1..`y`._gallons Length............... Width Diameter................ Depth x Disposal Trench—No. .....................Width_..._ ......_.._.- Total Length.................... Total.leaching area_:` t-I._:--sq. ft. Seepage Pit No..................... Diameter......................Depth below inlet_................. Total leaching area+ 41---:•sq; ft. Z Other Distribution box ( ) Dosin tank ( ) t Percolation Test Results Performed by.._..___ +. .. ....__. ft...................... Date.. ........ �7 Test Pit No. 1__4.°_A...minutes per inch Depth of Test Pid C + Depth to ground water. /V--- .__. Test Pit No 2..4. 16-_-_minutes per inch Depth of Test Pit].....l.dt..._._.... Depth to ground water........................ j ", * 0 sde 1 ......-tot a U O Description of Soil..... ...... -••-•-•• ---••-. -•-. �...._. ........._.. x , ---- .................. .............................................• •--•• ................................................. = ----- ------- -- ----- `.. ................................ U Nature of Repairs or Alterations—Answer.':when applicable...................... ......... .......:. ................................... ,,, -•-- - : ---------- -'- ----- -1 •--•- --- Agreet. 'he undersigned agrees to install the.aforedescnbed Individual Sewage Disposal System in accordance with the p isions of TIT = 5 of the State Sanitary-Code The.undersigned further agrees not to place the system in opera until a C r to of Compliance has been issued by the board of health. ,« �. tier .. igned_ _ A n ,�By ----- ---- c plicatio proved t .. ._._ Date Application Disapproved for t e following reasons:................... - = pp� Date Permit No..... _'...+c? .... ........_--- Issued...................................................... ' Date �+ THE COMMONWEALTH OF'_MASSACHUSETTS " BOARD O HEALTH �................................. ................ ....... ..... O F......:. «�........................... .. Trrtiftratr of fIaampti6mr, THIS IS ER FY, a e Ind+v1 ual Sewage Disposal System"constructed ( '} or Repaired ( ) by...................A .�-�..... c...T...... ......................................................I................................................................. Injoaller ................................................................. has been installed in accord ' ce with,,the provisions of TITLE j. The State 'Sanitary Code as described in the application for Disposal Works Construction Permit No..-__._el.'"2r„�y".............. dated------- "'_ ................. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. 'sorts'" — . ...._.. Inspector --------DATE .....---------... .................. - THE COMMONWEALTH OF MASSACHUSETTS BOARD ,4DF HEALTH . ' .......OF..: OO ...................:................... No... '`..... FEE. .... �t taa at1 rka� . on �r iaan permit Permission is ereb ranted --�`���. ... _... ----------------•-•---------......------.....----...---•-••-- yg to Construct ( r:�pair ( )" a I divid Sew Me Dis os System ff at No........ ....._... -tzdf_.. Street Q • P d r 7 as shown on the application for:Disposal Works Construction Permit No.___..... _. . Dta�ted__,.,_.___ .. .15............ J r e oard of Health DATE............... .... -•---•-••--••----•••---- FORM 1255 A. M. SULKIN, INC., BOSTON ~ Sf/eET rf v \ 11 N � I' S lr3 4 Z, � o ieo% J, SZ'� 7Z' DBox � i 1-46V sepm O _ o .� NA-P.= rg,S& al v ��\ E 11 v , ; / A \ �6o L.oT /.s 35'8J8 Sep FT- a f v h /98. 3 Z. a`a Cau�v�"2y CLuf3 2>R., vd s'w�n� Nora'= �G'1lA'77UNS. BAstra dN -�- A Is&"t�v voo l Al. LOCATION . CuwH.9Qui D MA Ss. TIA OFfagr SCALE . �.��=,' ? . . DATE EDWARD ,¢ ✓' PLAN REFERENCE . .,,�3'�.`'J«. . . .40.7 a KE..F,yL C.3 26 00 SI-1OW/V UN PZ T/ 460014. ZZ /STEQ PAri �!. . . . . . . . . . . . . . . . . . . . . . . . J AN�SUB, A CERTIFY THAT THE ....... .. ...... SHOWN ON THIS PLAN IS LOCATED ON THE OROUND AS SHOWN HEREON AND THAT IT CONFORMS TO THE SETBACK REQUIREMENTS OF THE TOWN OF WHEN CONSTRUCTED. DATE AG Ps-777-/�'�G-"7Z5 REOISTERED LAND SURVEYOR t TOP OF FOUNDATION 6„ CONCRETE COVER CONCRETE COVERS 9.93 a 4'CAST IRON 2"MAX. OR SCHEDULE 4r� 12"MAX. P.V.C. PIPE 4 SCHEDULE 40 PV.C.(ONLY) 2" PITCH 1/4"PER. PIPE- MIN. I LEACH PITCH 1/4"PER.FT. PIT PRECASt ° J LEACHING INVERT a ' e EL.:!99.57.. INV T INVERT e� W � 4:�. PIT OR °'. SEPTIC TANK DIET. ,q8� EQUIV. ,.e INVERT EL... ..c.�. . . BOX EL.... .... >_ ��: 0. GAL. IE 4PJZ INVERT !''W g:.. :.i: 3/4°TO I V2' 7 EL.108. P ; �o �: WASHED e W •�� STONE 4L' W DIA. —q No E DIA.— PROR LE OF GROUND WATER TABLE SEWAGE DISPOSAL SYSTEM NO SCALE SOIL LOG WITNESSED BY : DATE H! '/!?19.78 TIME. . . . . . . . . . . P,9vL �jveRAty. . . BOARD. OF HEALTH TEST HOLE I TEST HOLE 2 fl iv (�/F�-aRD S• ENGINEER ELEV. . .S/..00. . ; ELEV. .-S --50_. . 77777, DESIGN DATA 34„ S✓B-so,c. 3911 SuB-so�� �Z,•48vo �L.48.bo NUMBER OF BEDROOMS 3 . . . , . . . TOTAL ESTIMATED FLOW . . .33o GALLONS/DAY /�le�/F,�� M`%�•�t BOTTOM LEACHING AREA . 78C 0 . : S0.Ft /PIT/C.P,D. SAND .Sq�D SIDE LEACHING AREA . . . S0.FT./ PIT147/�'.P.D GARBAGE DISPOSAL ?Y-P!40�4. .(50%o AREA INCREASE) TOTAL LEACHI NO AREA . . .0 7. . . . SQ.FT isT isa'' �Z.3B.So PERCOLATION RATES!!Two, MIN/INCH " �. 3B,00 : ^!O. .WATER ENCOUNTERED D LEACHING AREA PER PERCOLATION RATE . , —0.. SQ.FTICA , ��� ��r•w/� NUMBER OF LEACHING PITS . . . . . . . . .APPROVED . . . . . . . . . . . BOARD OF HEALTH � T �� •'� N��� �'�•L.S;.'�ci�3 DATE . . . . . . . . . . AGENT OR INSPECTOR �LSH OF dlgs� T # �y KELLEY 1" 7 v' No.26100 Z ISTSa�`� 4H Ao • { iSTEA •Cc�!'-!�!9•�3�� MASS, e s v 30RAFAP� r r"q PETITIONER ,:, r 'x? ' .. r ,..fi ._s, .,,.. ...i .. ., T .w.....:..,:..rva...• .yn - - - �.'w. t 1a wra a. 3 i, Z $ CUMM PLAN `REFERENCE CONTOURS ROUTE 6A e LLr PLAN: BOOK 221 PAGE 17 EXISTING - - - - - - 50 w 0N L .• � s ASSESSOR'S•MAP: 349 MINIMAL GRADING PROPOSED J v za_ oaw LOT: 42 Lu a. _ H J N -5 'r h { 1 V , OOr ` a 415•ft -x 13 ft x 2- ft �� �w '^ • ¢LEACHiVG GALLERY e 52 E � LOCUS F, _ . `4 + _ • 52 r7 2 179.22 f► DORAL ROAD cl p JQ VN1 Z % o Q Z 14.B ft i - M _ 5�r LL LOCUS MAP wvwim NOT TO SCALE +,' ' -j zISO <W w W ` STO AY LLICL. zs -oT. .. . µ , Fs' a � LEGEND = U, � EXISTM ON 1500.� :x • ....4, :_ -. � � .k > s SEPTIC TAW p.. LL i 1i g o a . , { I O tY �I' y O TEST PIT W� I— N J u, r /r EXIS TM ZJ cV MNr �' � I t(I WATER L6vE a LEACH PIT = n ,'- — — _ -o I / W LLl > U x THE W II 1 , 0 LL O.Z ,. -- _ ; _ •< ;r - -":;L au.�of cvs TO Wt ETER �y-P w. -y . 0(jl m r rues LETTER^Eraozes.r vE' L•C CC.nK H HMLE P�tE C � GAS — a — f rnL —I (� O s tG tom 54 Co Z1 r Do Q r j I MARK �3 � BENCH r + v yP TOP OF FOUNDATION b' x �^ , I. ,I O z 58 I - a I I O vo USGS DATUM'ASSUMED - v 60 % s- J. .:rya W ✓' - +.� .. aL #M. v f �r A \ ;: , W - Z � W , s b —1 . .Wh ^ o z LOT 5j {{ -� lL �k ..; `$AREA 35898 a � QDISPOSALSYSTEM PLAN , o r cam CL AG 0 0 � UU -- t u _ o, I� ,,, �, . ., R. „ {� TO SERVE EXISTING DWELLING z M ' i o w 60 58 ANCY A. GIVEN a Ia2a0 f► + x u> 5 sa 52 � 195 COUNTRY CLUB DRIVE CUMMAOUID. MA 0° OAVID - Ln ECO TECH ENVIRONMENTAL LL 0 "' _ a ' W.. cc:` ,°�'cLv 43 TRIANGLE CIRCLE SANDWICH MA 0256 ;_i� ,� o F j�( . `PLAN s: k 9�al ,og� 508 364-0894 O .. W W .�. LL ,;CALE: 1 in - 30-ft pATq' P . ETE-1633 MAY 20. 2004 1/2 1 Ri _ TFYS PLAN IS TO BE CONSIDERED A DRAFT PLAN UNLESS IT ;,. r z AND SIGNATURE OF THE DESIGN ENGINEER ., _ BARS THE STAh1P A ORIGNAL'PLANS INTENDED FOR SUBMRTAL TO TFIE BOARD OF HEALTHLYLL,K.SIGNED N BLUE AND STAMPED N RED. SOIL TEST . LOG DESIGN CALCULATIONS DATE OF TEST: MAY 2. 2004 SOIL EVALUATOR: DAVID D. COUGHANOWR, RS DESIGN FLOW: 5 BEDROOMS X 110 GPD - 550 GPD WITNESS REQUIREMENT WAIVED - NO VARIANCES SOUGHT PORENTOUNDWATER EPROG TEREDOUTWASH SEPTIC TANK: 550 GPD X 2 DAYS - 1100 GALLONS TEST PIT XI 1 A ELEVATION - 52.90 •- PERC AT 62 in 2 MIN/INCH IN C SOILS USE EXISTING G 500 GALLON SEPTIC TANK DISTRIBUTION BOX: USE 3 OUTLET H-20 D-BOX. DEPTH SOIL USDA SOIL SOIL COLOR SOIL OTHER (INCHES) HORIZON TEXTURE (MUNSELL) MOTTLING SOIL _A B S O R B T I 0 N SYSTEM.: A 41.5 ft x 13 f t x 2 ft LEACHING GALLERY CAN LEACH - - ) - 0-6 A_ SANDY LOAM 10 YR 2/I NONE - FRIABLE Aboi - ( 41.5 x 13 539.5 sf.- A s d w - ( 41.5 - 41.5 13 + 13 ) x 2 - 218 s f Aiot - 757.5 sf .6-38 B LOAMY SAND 10 YR 4/6 NONE FRIABLE Vt 0.74 x 757.5 - 560.55 GPD 38-138 C MEDIUM SAND 10 YR 6/4 NONE LOOSE USE A 41.5 ft x 13 ft x 2 ft GALLERY. Vt - 560.55 GPD > 550 GPD REQUIRED GROUNDWATER ADJUSTMENT LEACHING GALLERY EXISTING GROUNDWATER LEVEL BASED ON BARNSTABLE GIS DEPARTMENT RECORDS CONSTRUCTION DETAIL INDICATED GW: 18.0 — DRYWELL UNIT - USE H-20 UNITS AND VENT , INDEX WELL: AIW-247 ZONE: C 8'-e'x 4'-[O'x 2'-9',- 2 fi EFF. DEPTH STONE READING: APRIL 2004 41.5 f t LEVEL: 23.9 ADJUSTMENT: 4.3 fi ADJUSTED GW: 22.3 NOTESM M 1) GARBAGE GRINDER NOT ALLOWED WITH THIS DESIGN 2) ALL LINES TO BE SCH 40 PVC AND PITCH AT I/8 INCH PER FOOT MINIMUM: ,4 Fr�, 8.5 4 fr 8.5' 4 it 8.5' 4 Fr NOT TO 3) ALL COMPONENTS INSTALLED SHALL MEET THE MINIMUM REOUIREMENTS 41.5 ft SCALE OF MASSACHUSETTS TITLE 5 SEPTIC CODE (310 CMR 15) 4) INSTALLER TO VERIFY LOCATIONS OF ALL UNDERGROUND UTILITIES BEFORE EXCAVATING FOR SYSTEM. 5) EXISTING LEACH PIT TO BE PUMPED, COLLAPSED. AND FILLED. OR REMOVED 6) ALL STONE TO BE DOUBLE WASHED AND FREE OF IRON. FINES AND DUST IN PLACE 7) LINES EXITING D-BOX TO RUN LEVEL- FOR 2'-0" BEFORE PITCHING DOWN - SEWAGE DISPOSAL SYSTEM PLAN 8) ECO-TECH ENVIRONMENTAL RECOMMENDS THE INSTALLATION OF LOW FLOW FIXTURES AND APPLIANCES. AND BIANNUAL PUMPING.,,,OF';;,THE_ SEPTIC TANK -TO SERVE EXISTING DWELLING xe- 9) SYSTEM IS NOT DESIGNED TO WITHSTAND4,VEHICULAR LOADING. DO NOT PARK OR DRIVE VEHICLES OVER SEPTIC{,SYSTEM. NANCY A. GIVEN. 10) INSTALLER TO OBTAIN DISPOSAL WORKSrPERM1T BEFORE STARTING WORK. 195 COUNTRY CLUB DRIVE CUMMAQUID. MA 11) SEPTIC TANKS SHALL BE INSTALLED LEVEL, AND, TRUE TO GRADE ON A LEVEL STABLE BASE THAT HAS BEEN MECHANICALLY' COMPACTED AND ON TO WHICH ECO-TECH ENVIRONMENTAL SIX INCHES OF CRUSHED STONE HAS BEEN"PLACED TO MINIMIZE UNEVEN SETTLING 12) SEPTIC TANK TO BE PUMPED DRY AT TIME OF SYSTEM REPAIR AND CHECKED 43 TRIANGLE CIRCLE SANDWICH MA 02563 FOR STRUCTURAL INTEGRITY. INSTALL PVC OUTLET TEE PITTED WITH GAS BAFFLE. ETE-1631 ti MAY_ 20. 2004 1 12/2