HomeMy WebLinkAbout0045 COVE LANE - Health a 45 COVE LANE, CUMMAQUID
A=351-004
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Commonwealth of Massachusetts .• - - �� ..
Title 5 Official pnspecti®n F6ftn r.
Subsurface Sewage Disposal System Form w Not for Voluntary Assessments
45 Cove Lane, Cummaguid M-351 P 7'004 -
Property Address
Thomas&Joyce Prince
Owner Owner's Name '
information is required for every P.O. Box 1286 Barnstable MA 02630 May 22, 2013 "
page. Cityrrown State Zip Code Date of Inspection
Inspection results must be submitted on this form.Inspection forms may not be-altored in any
way. Please see completeness checklist at the end of the form.
Important:When • _ g
filling out forms A. General Information
on the computer,
use only the tab .1. Inspector:
key to move your ` ' O U, , .
cursor-do not TroyWilliams `' " v
use the return Name of Inspector
key.
Troy Williams Septic Inspections
ICI Company Name
x
19 Hummel Drive
Company Address
South Dennis - MA �'� 02660
Cdyfrown 1- State >. Zip Code
(508)385- 1300 S1682
Telephone Number License Number
B. Certification
I certify that I have personally inspected the sewage disposal system at this address and that the t
information reported below is true, accurate and complete as of the time of the inspection.The inspection
was performed based on my training and experience in the proper function and maintenance of on site
sewage disposal systems. 1 am a DEP approved system inspector pursuant to Section 15.340 of
Title 5(310 CMR 15.000).The.system:
® Passes q ❑ Conditionally Passes_ ❑--Fails
❑ Needs Further Evaluation by the Local Approving Authority -
May 22, 2013
Inspector's Signatu Date P _
The system inspector shall submit a copy of this inspection report to the Approving Authority(Board
' of Health or DEP)within 30 days of completing this inspection. If the system 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, if applicable,and the approving authority:
t ****This report only describes conditions at the time of inspection and under the conditions of use
at that time.This inspection does not address how the system will perform in the future under
the same or different conditions of use. _
t5ins•3/13 3 Title 5 Official Ins n Form:Subsurface Sewage Disposal System•Page 1 of 17
. Commonwealth of Massachusetts
Title 5 official Inspection'Form z
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
°f 45 Cove Lane, Cummaguid M-351 P-004
Property Address
Thomas&Joyce Prince
Owner Owner's Name -
information is p O. Box 1286 Barnstable MA 02630 May 22, 2013
required for every a
C' /Town State Zip Code Date of inspection
page. �Y _ P Pe
4 S. Certification(cont.)
Inspection Summary: Check A,B,C,D or E/always complete all of Section D
A) System Passes:
® 1 have not found any information which indicates that any of the failure criteria described
in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are
indicated below.
Comments:
System meets minimum standards set by Massachusetts DEP at the time of inspection only.This
inspection is not a guarantee or warranty on the future working conditions of leaching, pipes,
components or the future structural integrity of said components and only represents conditions found
at the time of inspection only.
B) System Conditionally Passes:
. One or•more system components as described in the"Conditional Pass"section need to be
replaced or repaired. The system, upon completion of the replacement or repair, as approved by
the Board of Health, will pass.
Check the box for"yes", "no"or"not determined"(Y, N,ND)for the following statements. If"not -
determined," please explain.
The septic tank is metal and over 20 years old*or the septic tank(whether metal or not) is structurally
unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass
inspection if the existing tank is replaced with a complying septic tank as approved by the Board of
Health.
*A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of
Compliance indicating that the tank is less than 20 years old is available.
❑ Y ❑ N ❑ ND(Explain below):
15ins•3113 Title 5 Ottiaal Inspection Form:Subsurface Sewage Disposal System•Page 2 or 17
Commonwealth of Massachusetts`
Title 5 official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
45 Cove Lane, Cummaquid M-'351 P-004
Property Address
Thomas&Joyce Prince
Owner Owner's Name
information is p O. Box 1286, Barnstable MA 02630 r May 22,2013
required for every y
page. C4rrown _ , . State Zip Code Date of Inspection
B. Certification (cont.)
❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if
pumps/alarms are repaired. ` `
B) System Conditionally Passes(cont.):
ElObservation'of sewage backup or break out or high static water level in the distribution box due
to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will
pass inspection if(with approval.of Board of Health):. -
❑ broken pipe(s)are replaced t ❑ Y ❑ N ❑ ND(Explain below):
❑ obstruction is removed x ; ❑ 'Y' ❑ N : ❑ ND(Explain below):
❑ distribution box is leveled or replaced _ ❑ Y ❑ -N `.❑ °ND(Explain below):
❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s).The
system will pass inspection if(with approval of the Board of Health):
❑ broken pipe(s)are replaced • ❑ Y ❑ N ❑ ND(Explain below): . ,
❑ obstruction is removed ❑ Y ' ❑ N ❑ ND(Explain below):
C) further Evaluation is Required by the Board of Health:,-
El Conditions exist which require further evaluation by the Board of Health in"order to determine if
the system is failing to protect public health, safety or the environment.
- 1. System will pass unless Board of Health determines in accordance with 310 CMR-
15.303(1)(b)that the system is not functioning in a manner which will protect public rhealth,
f safety and the environment: `
❑ Cesspool or privy is within 50 feet of a surface water _
El Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh k
t5ins-3113. Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 `
Commonwealth of Massachusetts
Title 5 official Inspection Form
Subsurface Sewage Disposal System Fon°n-Not for Voluntary Assessments
45 Cove Lane, Cummaquid M-351 P-004
Property Address
Thomas&Joyce Prince
Owner Owner's Name
information is P.O. Box 1286, Barnstable MA 02630 May 22, 2013
required for every .
page. Citylrown State Zip Code Date of Inspection
B. Certification (cont.)
2. System will fail unless the Board of Health'(and Public Water Supplier, if any)
determines that the system Is functioning In a manner that protects the public health,
safety and environment:
❑ The system has a septic tank and soil absorption system (SAS)and the SAS is within
100 feet of a surface water supply or tributary to a surface water supply.
❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water
Supply ,
❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water
supply well.
❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or
more from a private water supply well".
.> Method used to determine distance:
*"This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal
coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal
to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must
be attached to this form.
3. Other:
D) System Failure Criteria Applicable to All Systems:
You must indicate"Yes"or"No"to each of the following for all inspections:
Yes No
R �
❑ ® 11 Backup of sewage into facility or system component due to overloaded or
clogged SAS or cesspool
❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters
due to an overloaded or clogged SAS or cesspool
❑ ® Static liquid level in the distribution box above outlet invert due to an-overloaded
or clogged SAS or cesspool
❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less
than '/:day flow
t5ins•W 3 Tide 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17
Commonwealth of Massachusetts ,
Title 5 Official -Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
45 Cove Lane, Cummaquid M-351 P-004
Property Address
Thomas&Joyce Prince
Owner Owner's Name
information is required for every P.O. Box 1286, Barnstable MA 02630 May 22, 2013
page. Cityrrown State Zip Code Date of Inspection
B. Certification (cunt.)
Yes No
El ® Required pumping more than 4 times in the last year NOT due to clogged or
obstructed pipe(s). Number of times pumped:
❑. ® Any portion of the SAS, cesspool or privy is below high ground water elevation.
❑ ® Any portion of cesspool or privy is within 100,feet of a surface water supply or
tributary to a surface water supply.
❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well.
❑ ® Any portion of a-cesspool or privy is within 50 feet of a private water supply well.
❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet
from a private water supply well with no acceptable water quality analysis. [This
system passes if the well water analysis, performed at a DEP certified
laboratory,for fecal coliform bacteria indicates absent and the presence
of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,
provided that no other failure criteria are triggered.A copy of the analysis
and chain of custody must be attached to this form.]
❑. ® The system is a cesspool serving a facility with a design flow of 2000gpd- `
10,000gpd. -
❑ ® The system fails. I have determined that one or more of the above failure
criteria exist as described in 310 CMR 15.303, therefore the system fails. The
system owner should contact the Board of Health to determine what will be
necessary to correct the failure.
E) Large Systems: To be considered a large system the system must serve a facility with a
design flow of 10,000 gpd to 15,000 gpd.
For large systems, you must indicate either"yes"or"no"to each of the following, in addition to the
questions in Section D.
Yes No
❑ ❑ the system is within 400 feet of a surface drinking water supply
❑ ❑ the system is within 200 feet of a tributay to a surface drinking water supply
the system is located in a nitrogen sensitive area(Interim Wellhead Protection
❑ ❑ Area—IWPA)or a mapped Zone II of a public water supply well
If you have answered"yes"to any question in Section E the system is considered a significant threat,
p 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
4 system in accordance with 310 CMR 15.304. The system owner should contact the appropriate
regional office of the Department.
t5ins-3113 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System-Page 5 of 17
r
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
rf 45 Cove Lane, Cummaquid M-351 P 004
Property Address
Thomas&Joyce Prince
Owner owner's Name
information is p O. Box 1286, Barnstable MA 02630 May 22 2013
required for every y
page. Cityrrown State Zip Code Date of Inspection
C. Checklist
Check if the following have been done. You must indicate"yes"or"no"as to each of the following:
Yes No
® ❑` Pumping information was provided by the owner,occupant, or Board of Health
❑ ® Were any of the system components pumped out in the previous two weeks?
® ❑ Has the system received normal flows in the previous two week period?
❑ ® Have large volumes of water been introduced to the system recently or as part of
this inspection?
® ❑ Were as built plans of the system obtained and examined?(if they were not
available note as N/A)
® ❑ Was the facility or dwelling inspected for signs of sewage back up?
® ❑ Was the site inspected for signs of break out?
® ❑ 'Were all system components, excluding the SAS, located on site?
® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank
inspected for the condition of the baffles or tees, material of construction,
dimensions, depth-of liquid, depth of sludge and depth of scum?
® ❑ Was the facility owner(and occupants if different from owner) provided with
information on the proper maintenance of subsurface sewage disposal systems?
The size and location of the Soil Absorption System(SAS)on the site has
been determined based on:
® ❑ Existing information. For example, a plan at the Board of Health.
® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue
approximation of distance is unacceptable)[310.CMR 15.302(5)]
D. System Information ._
Residential Flow Conditions:
Number of bedrooms(design): 3 Number of bedrooms(actual): 3
DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): 330
t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 o►17
a
Commonwealth of Massachusetts
Title 5 official Inspection F®rm
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
45 Cove Lane, Cummaquid M-351 P-004
Property Address
Thomas&Joyce Prince
Owner Owners Name
information is required for every P.O. Box 1286, Barnstable MA 02630 May 22, 2013
page. Cityrrown State Zip Code Date of Inspection
D. System Information . -
Description:
Number of current residents: r 2
Does residence have a garbage grinder? ❑ Yes•® No
Is laundry on a separate sewage system?(Include laundry system.inspection ❑ Yes Z No'
information in this report.) '
Laundry system inspected? _ . ® Yes ❑ No
Seasonal use? ❑ Yes ® No
- ,000 gals..
Water meter readings, if available(last 2 years usage(gpd)): 12=111=12424,000 gals
Detail:
Sump pump? . ❑ Yes ® r No'
Last date of occupancy: occupied
Date
CommerciaUlndustrial Flow Conditions:
Type of Establishment: N/A
N/A
Design flow(based on 310 CMR 15.203):' Gallons per day(9Pd)
Basis of design flow(seats/persons/sq.ft., etc.): N/A `
Grease trap present? _ iR. ❑ Yes ❑ No
,Industrial waste holding.tank present? : 0-Yes ❑ No,
Non-sanitary waste discharged to the Title 5 system?1 ❑ Yes ❑ No
Water meter readings, if available: _ N/A
t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 7 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
° 45 Cove Lane, Cummaquid M-351 P-004
Property Address
Thomas&Joyce Prince
Owner owner's Name
information is required for every P.O. Box 1286, Barnstable MA 02630 May 22, 2013 .
page. Cityrrown State Zip Code Date of Inspection
D. System Information (cunt.).
Last date of occupancy/use: N/A
. - Date
Other(describe below): R
NIA
General Information
Pumping Records:
Source of information: Last pumped'in 2011 per info from owner.
Was system pumped as part of the inspection? ❑ Yes ® No
If yes, volume pumped: " gallons
How was quantity pumped determined?
Reason for pumping:
Type of System:
® Septic tank, distribution box, soil absorption system
❑ Single cesspool
El Overflow cesspool
❑ Privy
❑ Shared system (yes or no) (if yes, attach previous inspection records, if any)
❑ Innovative/Altemative technology. Attach a copy of the current operation and
maintenance contract(to be obtained from system owner)and a copy of latest
inspection of the I/A system.by system operator under contract
❑ Tight tank.Attach a copy of the DEP approval.
❑ Other(describe): "
t5ins•3113 Title 5 Olfidat Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17
l
Commonwealth of Massachusetts
Title 5 Official Inspection Form -
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
45 Cove Lane, Cummaguid M-351 P=004
Property Address
Thomas&Joyce Prince
Owner Owner's Name
information is required for every P.O. Box 1286, Barnstable MA 02630 May 22, 2013
page. Cityrrown State Zip Code Date of Inspection .
D. System Information (cont.)
Approximate age of all components, date installed (if known)and source of,information:
D-box and leaching were installed to existing tank from 10/6/87 on 2/24/99 per compliance.
Were sewage odors detected when arriving at the site? ❑, Yes No
Building Sewer(locate on site plan):
Depth below grade: fe et 1 et -
.
Material of construction:
❑cast iron .040 PVC ❑other(explain):
Distance from private water supply well or suction line:_ feet
Comments(on condition of joints, venting, evidence of leakage, etc.):
Lines were found clear at the time of inspection.
Septic Tank(locate on site plan):
Depth below grade: $: 1'
feet
Material of construction:
®concrete ❑ metal ❑fiberglass ❑ polyethylene ❑other(explain)
If tank is metal, list age: years
Is age confirmed by a Certificate of Compliance?(attach a copy of certificate) ❑-Yes ❑ No
- Dimensions: 5'X9'X6' 1000 gallon
41'
Sludge depth:.
t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 17
a
Commonwealth of Massachusetts
Title 5 official Inspection Fora
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
45 Cove Lane,Cummaquid M-351 P-004
Property Address
Thomas&Joyce Prince
Owner Owner's Name
information is
required for every P.O. Box 1286+ Barnstable MA 02630 May 22, 2013
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.) -
Septic Tank(cont.) .
Distance from top of sludge to bottom of outlet tee or baffle
2'8"
Scum thickness thin layer
611
Distance from top of scum to top of outlet tee or baffle
Distance from bottom of scum to bottom of outlet tee or baffle
14"
How were dimensions determined? probe/measured
Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity,
liquid levels as related to outlet invert, evidence of leakage, etc.):
Inlet and outlet tees were found present and in working order. No evidence of leakage or damage
was found.Tank was not in need of pumping at this time.
Grease Traplocate on site plan):
( P )
Depth below grade: N/A
feet
Material of construction:
El concrete El metal ❑fiberglass ❑ polyethylene ❑other(explain):
N/A
Dimensions:
Scum thickness N/A
Distance from top of scum to top of outlet tee or baffle N/A
Distance from bottom of scum to bottom of outlet tee or baffle N/A
Date of last pumping: N/ADate
t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17
Commonwealth of Massachusetts, '
Title 5 Official Inspection Forte
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
45 Cove Lane, Cummaquid M-351 P-004
Property Address
Thomas&Joyce Prince
Owner Owner's Name
information is P.O. Box 1286, Barnstable MA 02630 May 22, 2013
required for every
page. Cityrrown State Zip Code Date of Inspedion
D. System Information.(cont.) -
Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity,
liquid levels as related to outlet invert, evidence of leakage, etc.):
Tight or Holding Tank(tank must be pumped at time of inspection)(locate on site plan):
Depth below grade: N/A
Material of construction:
❑concrete ❑ metal ❑fiberglass ❑ polyethylene ❑other(explain):
Dimensions: N/A
Capacity: N/A
p ty' gallons
Design Flow: N/A
gallons per day
Alarm present: ❑ Yes ❑ No
Alarm level: N/A Alarm in working order: ❑ Yes ❑•No
N/A
Date of last pumping: Date
Comments(condition of alarm and float switches, etc.):
N/A
Attach copy of current pumping contract(required). Is.copy attached? ❑ Yes ❑ No
t5ins•3113 r Title 5 official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 17
P -
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
"f 45 Cove Lane, Cummaquid M-351 P-004
Property Address
Thomas&Joyce Prince
Owner Owner's Name
information is P.O. Box 1286, Barnstable MA 02630 May 22, 2013
required for every
page. Cityrrown State Zip Code Date of Inspection
D. System Information (cont.)
Distribution Box(if present must be opened) (locate on site plan):
Depth of liquid level above outlet invert level
Comments(note if box is level and distribution 10 outlets equal, any evidence of solids carryover, any
evidence of leakage into or out of box, etc.):
D-box was found level and in working order with equal distribution to outlet lines through speed
levelers. No evidence of solid carry-over or backup in the past were found at the time of inspection.
D-box is H-20 grade with steel cover to grade in paved driveway.
Pump Chamber(locate on site plan):
Pumps in working order: ❑ Yes ❑ No*
ti
Alarms in working order: ❑ Yes ❑ No*
Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.):
N/A
w
*If pumps or alarms are not in working order, system is a conditional pass.
Soil Absorption System(SAS)(locate on site plan, excavation not required):
If SAS not located, explain why:
t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17
IL
Commonwealth of Massachusetts
Title 5 Official inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
45 Cove Lane, Cummaquid M-.351• P-004
Property Address
Thomas&Joyce Prince
Owner Owner's Name
information is P.O. Box 1286, Barnstable MA 02630 May 22 2013
required for every y � -
page. Cityrrown State Zip Code Date of Inspection
D. System Information (cont.)
-
Type:
❑ leaching pits number:
® leaching chambers r number: 2-500 gal. with
4 of stone
❑ leaching galleries number: 25'X 12'X 2'
❑ leaching trenches - number,•length: +
❑ leaching fields number, dimensions:
❑ overflow cesspool number:
❑ innovative/altemative system
Type/name of technology: t
Comments(note condition of soil, signs`of hydraulic failure;level of pondingi damp soil, condition of '
vegetation, etc.):
Soil was sandy. Chambers were found with a low water level at the time of inspection. Checked stone
and found dry and clean. No evidence of hydraulic failure or problems in the past were found at the _
time of inspection.
Cesspools (cesspool must be pumped as part of inspection)(locate on site plan):
N/A
Number and configuration
Depth-top of liquid to inlet invert N/A
Depth of solids layer N/A
Depth"of scum layer N/A
Dimensions of cesspool '
p N/A
Materials of construction
Indication of groundwater inflow . ❑ Yes ❑ No
t5ins 3113 y Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 17
Commonwealth of Massachusetts
Title 5 official Inspection Form
i Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
J� 45 Cove Lane, Cummaguid M.-351 P-004
Property Address
Thomas&Joyce Prince
Owner Owner's Name
information is required for every P.O. Box 1286, Barnstable, MA 02630 May 22, 2013
page., City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,
etc.):
N/A
Privy(locate on site plan)':
Materials of construction: N/A
Dimensions N/A
Depth of solids N/A
Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,
etc.):
N/A
t5ins"3113 - Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection- Form .
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments _
45 Cove Lane, Cummaguid M-351- P-004
Property Address
Thomas&Joyce Prince
Owner Owner's Name
information is p O. Box 1286, Barnstable MA .02630 May 22, 2013
required for every
page, Cityrrown State Zip Code Date of Inspection-
D. System Information (cont.)
Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to
at least two permanent reference landmarks or benchmarks: Locate all wells within 100 feet. Locate
where public water supply enters the building. Check one of the boxes below:
® hand-sketch in the area below
❑ drawing attached separately
38
i 2- GL)
yor�r' .
�A� �
t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 15 of 17
Commonwealth of Massachusetts
Title 5 official Inspection form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
45 Cove Lane, Cummaguid M-351 P-004
Property Address
Thomas&Joyce Prince
Owner owner's Name
information is required for every P.O. Box 1286+ Barnstable MA.' 02630 May 22, 2013
page. Cityrrown State Zip Code Date of Inspection
D. System Information (cost.)
Site Exam:
® Check Slope
❑ Surface water
® Check cellar
❑ Shallow wells
Estimated depth to high ground water: 13.0'+
feet
Please indicate all methods used to determine the high ground water elevation:
® Obtained from system design plans on record
If checked, date of design plan reviewed: 9/29/86
Date
® Observed site(abutting property/observation hole within 150 feet of SAS)
❑ Checked with local Board of Health -explain:
❑ Checked with local excavators, installers-(attach documentation)
® Accessed USGS database-explain:
SDW 252 Zone A 46.5' .6'adjustment
You must describe how you established the high ground water elevation:
Test hole recorded on plan showed no water found at 16.0'. Hand augered 4' below bottom of
leaching with no water found at a depth of 8.5'. Groundwater adjustment at the time of inspection was
.6'. Bottom of leaching at 4.5'was found not to be located in the high groundwater elevation at the
time of inspection. _.
Before filing this Inspection Report, please see Report Completeness Checklist on next page.
t5ins•3113 f Title 5 official inspection Forth:Subsurfaos Sewage Disposal System•Page 16 of 17
Commonwealth of Massachusetts '
Title 5 official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
45 Cove Lane, Cummaquid M -351 P-004
Property Address
Thomas&Joyce Prince
Owner Owners Name
information is p O. Box 1286, Barnstable - MA 02630 Ma 22 2013
required for every y
page. City/rown State Zip Code Date of Inspection
E. Report Completeness Checklist
® Inspection Summary: A, B, C, D, or E checked
® Inspection Summary D(System Failure Criteria Applicable to All Systems)completed
® System Information—Estimated depth to high groundwater
® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file
i e
t5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 17
TOWN OF BARNSTABLE
LOCATION SEWAGE #
VILLAGE g; ASSESSOR'S MAP & LOT �jSi J
,INSTALLER'S NAME 6t PHONE NO. 3y4h A4 //- -o `lo2i 7
SEPTIC TANK CAPACITY
LEACHING FACILITY:(type) (size)
NO. OF BEDROOMS' PRIVATE WELL O UBLIC WATE
BUILDER O OWNE .✓+-1 iQo/�,
DATE PERMIT ISSUED: -A2
DATE COMPLIANCE ISSUED: —.
VARIANCE GRANTED: Yes No
4�
33 y
A
f3 !5-.2
Yoh �v '
t
� s7
i
No. /Y— ! Fee
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
Yes
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS
3pprication for 30igpoga1 *pgtem Congtruction permit
Application for a Permit to Construct(✓)Repair( )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components
Location Address or Lot No. Owner's Name,Address and Tel.No.
_ YS' Cove GH.,��.�.�A�-;�( Rob,�,'ns,
Assessor's Map/Parcel yS� Co✓e Lr.,
Installer's Name,Address,and Tel.1No. Designer's Name,Address and Tel.No.
Ing
♦- an .A � O2loY�
Type of Building:
Dwelling No.of Bedrooms 3 Lot Size sq.ft. Garbage Grinder( )
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow 330 gallons per day. Calculated daily flow gallons.
Plan Date Number of sheets Revision Date
Title
Size of Septic Tank Am- Type of S.A.S.
Description of Soil
Nature of Repairs or Alterations(Answer when applicable) e
e4l 0-Ir V,7, o P .
Date last inspected:
Agreement:
The undersigned agrees to ensure the construction and'maintenance of the afore described on-site sewage disposal system
in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi-
cate of Compliance has been iss s Bo_4rd of Health.
W
Signed Date 2
Application Approved by Date -1 — 9
Application Disapproved for th follo ng reasons
Permit No. :ZG Date Issued
4 35 w
No. I7 - 79 F..F« Fee
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
PUBLIC HEALTH DIVISION —TOWN OF BARNSTABLES MASSACHUSETTSar Yes
Yr. '
Application for �Digaar *p.5tem Congtruction Permit
Application for a Permit to Construct(✓)Repair( )Upgrade( )Abandon( ) ❑Complete System El Individual Components
Location Address or Lot No. U Owner's Name,Address and Tel.No.
Assessor's Map/Parcel ter L o✓� L.,
Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No.
r ;n AV- / A 0.261 Y'
Type of Building:
Dwelling No.of Bedrooms 3 Lot Size sq.ft. Garbage Grinder( )
Other Type of Building No. of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow 330 gallons per day. Calculated daily flow gallons.
Plan Date Number of sheets Revision Date
Title
Size of Septic Tank /LOOS Type of S.A.S.
Description of Soil
1
Nature of Repairs or Alterations(Answer when applicable) 1 a D
Date last inspected: `
Agreement:
The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system
in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi-
cate of Compliance has been iss b this Bo4rd of Health.
Signed Date �7- eZW 1PT
r Application Appro ed by Date j,__xa—99 Y
Application Disapproved for th follo ng reasons
1 Permit No. Date Issued
———————————————————————————————————L----
THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE, MASSACHUSETTS
Certificate of Compliance
THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed( )Repaired>.-)Upgraded( )
Abandoned( )by
at U 5 ��rU 1,�,� h $� has been constructed in accordance
with the provisions of Title 5 and the for Disposal System Construction Permit No. ?c/- �7 dated
Installer Designer
The issuance of this permits all not bye-egnstrued as a guarantee that the sy inT Will function as_0esigried:"„
Date ° � Inspector's '.
� t-- [..•- .- v K- �,. T Fes.
---------------------------------------
No. �' Fee 115
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION - BARNSTABLES MASSACHUSETTS
lwigpossar *pztem Construction Permit
Permission is hereby granted to Construct( )Repair(k-)Upgrade( )Abandon( )
System located at
and as described in the above Application for Disposal System Construction Permit. The applicant recognizes his/her duty to
comply with Title 5 and the following local provisions or special conditions.
Provided: Construction must be completed within three years of the date of this permit.
Date: -D Approved by
SN&Z7- / o,,C Z SN 7s
LOCATION BA/?�/sL� �G�y,7AgwiD,
SCALE . ,/.�..�� . . DATE
PLAN REFERENCE
.pG..9 . . !aS,.Sf'.,�'S;vrz�s, !`lip .•,�:! . . .-
�5 CoV� L/�t CuHiyr)�r.�a .
G�/GEwE /L, .Qo08i�ts �
Z�� •D. ZS�f ,�
36' . lo-l��NG o,Ot
alo
via
601
10
pp
AD
0
32 i
4 � 14 .0,
i
14
o �
. JV oo,�� 14D
`` / o`r EDWAR/ ° s
tt
KE`LLEY y
wo.,26100 0
�L LAB
�— EL..38.•7�•. � 5f1CX�T 2 oG Z S/��rTS
TOP OF FOUNDATION
CONCRETE COVERS
g,r Zt� � 4��CAST IRON
OR SCHEDULE 40 4
P.V.C. PIPE MIN. ; "SCHEDULE 40 P.V.C. (ONLY) g'jNIN . LEACHING TRENCH (� )REO�" } „
PIPE-MIN. 1/8"- 1/2" WASHED STONE 36 MAX-
;i; PITCH 1/4"PER.FT. PITCH
2"
I/4"PER.FT. _ «.,. • .r. -- a:tMs.:f 8 n
.—
{NVERT ,C7{C7, G7•Q-;Q„ �C7 !�;d; t 4"
GAS BAFFLEti ,ra c7;�'=L- <,[�r o •o 'ra.cl; �-
:�� TANK INVERT " 0 E INVERT q�%0`,C>>C1�:C7�'Ci� �;4;'b;• 24"
. SEPTIC EL 3G.3S�-- EL#Q� _ C7;r_f o•'"�" r� C]�p-.
r•�
INVERT
3G. /000 GAL.. INVERT DI Zz.3Z-37
EL.j!. ..... EL 3,S/p INVERT Precast 500 Gal.Leach 3/4"-I V2"-f
:. .. X EL3 t�7 (Z.) REQ. WASHED-STONE
.,, 6"CRUSHED STONE Chamber WASHED STONE OVC�i 1 , H-Zo i ..
�.. / iSTiivG 6c g - /7 6
4.
Z PROFI LE OF -
•-..•. P- � z o GROUND WATER ►ASLE
SOIL LOG w " SEWAGE DISPOSAL SYSTEM TYPICAL CROSS-SECTION
9/ ii;oo !y NO SCALE LEACH I NG TRENCH .
TIME . . . .DATE ..,1 Z�8`..
NO SC-__
TEST HOLE I TEST HOLE 2
ELEV. 38,•3 0. . ELEV. 37 Z ". .. DESIGN DATA ' " }
. .
9:':.Ii,N. WASHED -36"MAX.
r NUIM2ER ^- BE'ROON"S
Wooq[e,q.-y/ WoopCe v� --
�•Y,� TOTAL ESTIMATED FLOW . . . .. . . . GALLONS/DAY 8"
S�BSoiL Su0soiL - 4„
;Q;0
BOTTOM L=ACHING AREA .. . SO.FT./T'nENCH/2373 �� �'-L7:L��Q•�,+
P.p.
G - 24
80
SIDE LEACHING AREA
. . . . .. . ..Z.. 3-0.Fi./TR- H
o
_
GARBAGE DISPOSAL .!�AN ..(50% AREA INCREASE)
/38�
CORGS� TOTAL LEACHING AREA 47Z'07... SO.= oV4-7Z
Co.RrLS�` SAwb PERCOLATION RATE
. . PER. INCH
LEACHING AREA PER PERCOLATION RATE 3¢9.3SO.FT�C•�p Y
�2,2 GROUND .: �NATER TZ2LE
— — — _ ¢Zc APPROVED BOARD OF HEALTH
/..... . ...WATER ENCOUNTERED �P�(N OF Itl4
DATE i E .. . AGENT OR INSPECTOR
. �P`1N OF Mqs { a. ��� S T cyGN�
�/ WITNESSED BY
!fTa,`1 !1G� . . . . . A 4 EDVVAR� �,
BOARD OF HEALTH lOT = a
rCDGiW�1Z0. .G �!� . . LLEY
ENGINEER .SCOVG � y �0. 26100 o Q�
o SP
•C,U�r1.4�uiD �9A s� GiSiER�w s�[
sL LiA� fVAI�
PETITION
ER G1P,/Ze-W,6� A� riPoBAt9l"S .�
APPLICATION FOR PERCOLATION TEST AND OBSERVATION PITS
LOCATION laf c/ /a e NO. 2Z.
VILLAGE /1 /"79 Q CC 1 ) DATE
APPLICANT ,_ j�jo�'s �S` /��/�2/ FEE
ADDRESS TELEPHONE NO. (Non-refundable)
ENGINEER_ �" �,� / /,e P� TELEPHONE NO L3Q
DATE SCHEDULED
(Applicant' s signature)
. . . . . . . . . . . . . . . . . . . . . . . . . . . : . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
ASSESSOR'S MAP & LOT NO:
SOIL LOG
SUB-DXVISION NAME DATE_ TIME
ENGINEER
EXPANSION AREA: YES NO
TOWN WATER PRIVATE WELL ' ' BOARD OF HEALTH
(�7� 7—' — EXCAVATOR
SKETCH: (Street name, etc. ,dimensions of lot, `exact location of test holes and
percolation tests, locate wetlands in proximity to test holes )
/✓
NOTES :
. / =v
401
i
p N/
747,2,
co
PERCOLATION RATE:
PEST HOLE NO: ELEVATION: TEST " LE NO: ELEVATION:
1 4�VqM 1
4
2 2 v 0
v OLv,,9r�
3 3
4 4
7 � .
8 8 ,
10
11 11
12 Cof}ie S.
12
13
14 S,-,) -14
15 15
16
'UITABLE FOR SUB-SURFACE�SEWAGE: LEACHING FIELD LEA RING PITS
LEACHING TRENCHES
NSUITABLE FOR SUB-SURFACE SEWAGE. REASONS:
OTE: ENGINEERING PLANS MUST SHOW NUMBER .ASSIGNED ON PERC TEST APPLICATION
RIGINAL: COMPLETED IN ENTIRETY BY P . B.—AND RETURNED TO BOARD OF HEALTH
OPY: RETAINED BY APPLICANT
I -
Jan 16 as 02i06p JAMES O GAYLEME RODRIMS 508-36R-8865 p. 1
LEVY, EiDREDGE 6 WAGNER ASSOCIATES, INC.
%No+-ea•L.wosrAri,4.+.ec+r.•W-00406
sr writ ruw s*�r.
December 23,1987 ;
w;,i,a,n go an T
Conservation Commission - ly CdV e— IeL
Town *f Barnstable
367 ftir, Street
Hyannis, MA o2601 I �/
T Attn: Mr. Robert Gatewood: Q d I
Dsar tic. Gatewood,
1, vi�
�
ON request a consery
• anon Commission f
des ir�al inspectior. of
property cribed in _
Condition issue June 11,E3987, aicopy of wric'�2isnattachedd Orde: �l
The project (property location is at Lot 4 Cove Large,
Ccmma4uid (Be;nstable assessors Map R351 Lot �� MA .and as
irdic ted on the enclosed sketch plan.
hi 7 s office has reviewed the requirements listed 'sf"141 conditions and 1'3 the
finds that there conditions have been
completed as of this date.
Sincerely,
LEVY, VLDSBDGE i,WAGNER ASSOCIArga
'4 J�
Pat:� L � •,
t
PAL,/mltr
1288cn .
cc:rtr. J. MCK@On
pyw►vl�lrBrptET sR��uwp'e►MA4NSKMlie'T'Tspf7A�
u .
Jam is 99 02106P JAMES 6 swYLENE ROBBIMS SOs-36$-S8$S P. s
a-
,EVY, ELMDGE&WAGNER AsSOctATEs. INC.
lNfiW[A6•LASMSOOM A11Crrg6TL•wNl'ON
�k YYE,�T W W t1w86 .
CIN1101wLLE 11ASSACwIt�Ts I=
16,8,�.,�.. 70: TO n
R Sep4ir- .3%64em 14T
December 23,1987 (Ov&
Conservation Commission
Town of Barnstable xLyA/L� }p {ngtiCt.
367 P4Lir, Street
Hyannis, MA 0360.1 Sl1QE ptrns � fs
Attn: Mr. Robert Gatewood: OTC beevrt- S j0
SQL). rnr9rePoi 1. 404,j
Dear Mr. Gatewood,
we request a Conservation Commission final inspection of
property described in O.E.Q.E, file 1 SE-3-1602 and Orde: of
Condition. issue June 11, 1987, a copy Of which is attached.
The project (property; location is at Lot 4 Cove Lane,
CL;mmaquid (Barnstable Assessors Map #351 Lot @) MA and a&
indicated on the enclosed sketch plan.
?his office has reviewed the requirements listed in the
spacial conditions and finds that these conditions have been
completed as of this date.
Sincerely,
LEVY, ELDREDGE 6/WACNER ASSOCZATBS .
Pack. L
PAL/mlw
1288cn
cc:Mr. J. !McKeon
ITT �f
p w►vEA115111�E1 cMuuG w,r;w>1M10WEf�1f 0+1p - -
TOWN OF DARNS!'ALLE
` OCA'flON t'��' (`�[',v \�v. SEWAGE
,
VILLAGE Q S nSNC,� �e ASSESSOR'S MAP LOT
INSTALLER'S NAME & PHONE NO.
SEPTIC TANK CAPACITY
�.T.s r.•-. - e+ !,:_*�ntf„/s �! :\ J�,,__ .r..a�$12P1--- W
u NO. OF BEDROOMS PRIVATE WELL, OR U LI P1 R
BUILDER OR OWNER
DATE PERMIT ISSUED:
DATE COMPLIANCE ISSUED-.—
VARIANCE GRANTED: Yes No
1 fi
Y
�r,dxA.Y
l
av
-„
(re �^��-
z Ar•.
v ASSESSORS MAP NO: '
��� ' " _
No.. -- .....`t PARCEL NO•. Fizz
° THE COMMONWEALTH OF MASSACHUSETTS
I q� �' BOARD OF HEALTH
Tcr'U.................__OF....`c��I�T�C6 ... _...
liration for Dig .aiial Works Tonstrurtiuu 1hrutit
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
Q_...
System at: J
AV
Location-Address or Lot No.
caner Address
a .... ...._.. _.._ ._._.k.=_ .._.:
Jul
---------- ....................................................---------------------------•-.......-.......
Installer Address
UType Building 3 Size Lot.................... .....Sq. feet
Dwelling—No. of Bedrooms............................................Expansion Attic W&), Garbage Grinder (•Vi?l
aOther—Type of, Building ._ ..�-------------- No. of persons............................ Showers ( ) — Cafeteria ( )
d Other fixtures ------------------
W Design Flow...........�1 .....................gallons per person per day. Total dai --_0..
IonsWSeptic Tank Liquid capacityl4 __gallons Length _..___ Width._ ___. Diameter________________ Depth... ._._..
x Disposal Trench No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft.
Seepage Pit No._JA416------- Diameter....._/Q Depth below inlet_3!_ Total leaching area./g. ----sq. ft.
Z Other Distribution box (VI Dosing tank ( )
aPercolation Test Results Performed by------.....1.1_1 -----------------r -----._.--_.-.- Date-----II-al� o.............
Test Pit No. 1.!�-____minutes per inch Depth of Test Pit...147�2+�� Depth to ground water....NQ_...........
w Test Pit No. 2.,�Z......minutes per inch Depth of Test Pit....1 S......... Depth to ground water---IJO............
a --------•---------------------------........................................................................................................................
0 Description of Soil...............................................................................................................x
U --•-------------•-..._..--•---•----------...••------------•----•.......------.......-----•••--•-------•--------•......-------•-----------•----..._..•----•---------------.....••--...-------------•----.
UW -•-----------------------------------------------------------------------------------------------------------------------------------------------=------------------------------------------------------
Nature of Repairs or Alterations—Answer when applicable.......iDESIGNINIM.ENGI fEEFt.M 1ST.4-IIPERYISE...
--------------------------------•--••-----------------------------------•-----------:...--••-----•---------------lNSTAL.L.ATIONJ .CERTIE..1[�.WRITING...
Agreement: THE SYSTEM WAS INSTALLED IN STRICT
The undersigned agrees to install the aforedescribed Indiv B1'TjQA9I^tem in accordance with
the provisions of Ti T 5 of the State Sanitary Code—The undersigned further agrees not to place the system in
operation until a Cert to of Compliance has been issued b e o f health.
Siged ----------- .......... -- Z_..� ._._.
APPlica ' n Approved BY ------ � ( f/--p
............................................................
Application Disapproved for the following reasons-------------•-------••-•---•-•--•---------------------------------------------------------------•-----.......---
------------------------------------•-----••-------------------------.....----------•----...----------•--------------•......--------•---------•-----------•-•-------------- ----------------•....------
��/� ..............Date Permit No.- � � "Y'-._.. Issued ...._...
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
..rcJnJ...:.................oF..... ,+t� � -................................
%Trr#ifirtttr of Tuutpliaurr
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed (-I or Repaired ( }
by--------- �+� L.•............Q..--•-Installer
ca
N at �: - -----........
[... ----------------------------•----------------------------•-•--•------------------------------------------
has been installed in accordance with the visions of KmZl ' f T State Sanitary Code as Jescri ed in the
application for Disposal Works Construction Permit No...... ..._ r��. dated_....__ ,7-__-----
THE ISSUANCE OF THIS CERTIFICATE SHALL-NOT BE CONSTRUE® AS A GUARA TEE THAT YHE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE....................................................•---...----------•-•--...--- Inspector....................................................................................
1
� 1
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
t Appliration for wispoii al Works Tumitrurtion ranfit
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System at:
. �f Location-Address or Lot No.
�J l_! `..�1 / '----•-----•-- -----�U t �?V-......---•....................................................
wrer Address
----......ez- C_..CW....s4"_:.i�'-,------------------------------------------ -----------------==
Installer Address
d Type of Building Size Lot............................Sq. feet
U Dwelling—No. of Bedrooms..... .................................Expansion Attic (V,4), Garbage Grinder FQO,
p, Other—Type of Building _ 'r ..j............... No. of persons............................ Showers ( ) — Cafeteria ( )
a' Other fixtu es -----•-••--•---•-•---•---------- • . . -• -
W Design Flow........... ....................gallons per person per day. Total daily flow___330....:..._..................._gallons.
04 Septic Tank—Liquid capacityMQQ...gallons Length?,-."1...... Width._k..._. Diameter________________ Depth... ...........
Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft.
Seepage Pit No.40tMF........ Diameter.....60.._...__ Depth below inlet. t_. ...... Total leaching area_Z$lp.....sq. ft.
Z Other
a Distribution
Test Results Performed bsin ��Percolation ----- � �f_•-•----•-•--•---.-.- Date....�.�zjj&�.............
Test Pit No. 1 ......minutes per inch Depth of Test Pit..� �.... Depth to ground water....!UQ.............
r=, Test Pit No. 2- _ ......minutes per inch Depth of Test Pit---kS�....... Depth to ground water...1U.0.............
01 •-••----•----•---•-•-•-•----------••---••-•--•--••---•--•-------------•...................--•-•••---.........................................................
0 Description of Soil................... -...... ------------....
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 o .f ^,of the State Sanitary Code— The undersigned further agrees not to place the system in
operation until a Cern to of Compliance has been issued by the FMo
f health.
Saved......�24 .............................I.
T
._ Dat
Anica�c/nApproved B � ` -•-------------•------- •-•-•----------------- jY���� -.-
Date
Application Disapproved for the following reasons:..............................................................................................................
...............................-.........................................................................................................................................................................
_ Date
PermitNo.... .-......---- � ---.-- Issued.........................------------------------------
Date
r
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
.. ..w..... ...2- .. (r 74e.C.........................................
Cprrtif irFate of TompliFanrr
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed (1 or Repaired ( }
bc Q------,.l j le.�---------------------------- -------
Y...-----` �^`�zr �t�-s Installer-•............................................................................•-----------•--
Lv7 41
- -----------------•-.-------.---------------------------------
has been installed in accordance with the is -is of i i — of The State Sanitary Code as descr'bed in the
application for Disposal Works Construction Permit No.._.__��J•_.____._..4(S,--- dated--------- __-_---
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUAR NTEE THAT YHE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE................................................................................ Inspector....................................................................................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
\ L� � �I .i�j �!A/.................OF.. "•:• !`i 'k'• !.._....._......................_.. --� nr
�w
1\rO..•-'.................... FEE........... ...._i.:::
Disvos 1 or }�nnstrnr##ion rrmft
sr�e
Permission is ereby granted -----------•-------- ----------------------- ----------
to Construct (��qor Repair .) an Individual Sewage Disposal System-.
at No.............. . 1-..... _.._..._.._. ._._._....--.._.._.... C. ..E+ __U�_ ._....-----•--------------------•---------- ---- -------.......
-- - --- -�
s r et -�
as shown on the application for Disposal Works Construction Pe it��ctt, � :__Dated..............��.........._:..._....
� 11 �.
ti ioard of Health
DA2E._� --- -----------------•----------------
FORM I2 5 HOBBS & WARRE INC.. PUBLISHERS j
4
/�f .� �,�r
Al
THEpoi TOWN OF BARNSTABLE
OFFICE OF
rAnlIMBLIC E30ARD OF HEALTH
°'gyp kpY 367 MAIN STREET
-- HYANNIS, MASS. otsot
Sewage Permit # : � �— GjJ�CO
Applicant 12i�1�c# � 1=1 Jarnosk3bin
Proposed Installer: J'o.%A acobt
The plan for the on-site sewage disposal. system at Lot GOV- Lane,
�i,C mma v i e� Inn
has been approved with the condition that the design engineer must be on-site
and supervise installation as well as certify in writing that the system was
installed in strict accordance to the approved plan.
Approved By Date
.
. . .
R P - _ {
a ... .. -
'� I _ . . 7......�_�_. .._
1 }�
qp
i a ?y ,s i r •. "i
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- - - - ..
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y
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20 FT. MIN.
TOP OF FOUND.
EL. _ ��� 10 FT MIN. XP SOIL TEST
DATE OF SOIL TEST
CONCRETE WITNESSED BY
4�� SCH. 40 P C PIPE C._EAN SAND
COVERS MIN. PITCH 1/B�YPER FT. PERCOLATION RATE MIN INCH
CONCRETE OBSERVATION HOLE I OBSERVATION HOLE 2
4" CAST IRON PIPE 12
CO'rERS 2" LAYER OF ELEV = ELEV.=
FOR EQUAL,) MIN. 1/8"- 1/2" WASHED
PITCH 1/4 PER FT 'C -J STONE fJc�r a �- 0Am
j.&S "
FLOW LINE R Y o�
EL:
MIN. < L
E Al
EL.= 20
EL = LEVELr.�� PND
wr• EL=
EL w
DIS T _ E
BOX o v o j WATER AT EL.= WATER AT EL.=
0
3/4"— 1 1/2" C so
r)l�� GALLON WASHED STON 0 o C ° °oo •
SEPTIC TANK w ° DESIGN CALCULATIONS
J v EL =
PRECAST LEA,HING NUMBER OF BEDROOMS
BASIN OR EQLYV. I GARBAGE DISPOSAL UNIT
6 DIAM. TOTAL ESTIMATED FLOW
SEWAGE DISPOSAL SYSTEM PROFILE I ( —GAL /BR /DAY x BR ) GAL /DAY
NOT TO SCALE
r ---------- - --- ---- -------- REQUIRED SEPTIC TANK CAPACITY GAL.
i
ACTUAL SIZE OF SEPTIC TANK GAL.
BOTTOM Of 'EST HOLE OR USGS PROBABLE WATER TABLE EL = LEACHING AREA REQUIREMENTS
OBSERVED WATER TABLE / ! ) EL = SIDEWALL AREA bAL /S F.
: ? BOTTOM AREA _ GAL./SF
r LEACHING CAPACITY BOTTOM+ SIDEWALL) �� GAL.
- LEGEND
EXISTING SPOT ELEVATION OOxO RESERVE LEACHING CAPACITY " .- ' GAL
- ..,. , .
EXISTING CONTOUR — - - -- 00— ---
FINAL SPOT ELEVATION
FINAL CONTOUR - ------- _—__ NOTES
I I ALL WORKMANSHIP ANU MATERIALS SHALL CONFORM TO D.E O.E.
T Al 1 O ��A (DNS T I' t RULES AND
/ �O i EST LOCATION
REGUL 5 AND THE TOWN OF T uF CIIRSIIRFA( F DISPOSAL. OF SFWAGF
�> TOW
N k _�W _---
' CATCH BASIN ( ®} 2. ALL COVERS TO SANITARY UNITS SHALL BE BROUGHT TO
\ WITHIN 12 OF FINISHED GRADE .
3. EXISTING AND FINAL GRADES SHALL REMAIN ESSENTIALLY THE SAME
4. ALL COMPONENTS OF THE SANITARY SYSTEM SHALL BE CAPABLE
OF WITHSTANDING H- 10 LOADING UNLESS THEY ARE UNDER OR
�°` �+ +cm,'h WITHIN 10 FT OF DRIVES OR PARKING AREAS. H-20 LOADING
R&` `y+ MIN FRONT SETBACK SHALL BE USED UNDER OR WITHIN 10 FT OF DRIVES OR PARKING.
MIN. REAR SETBACK 5. ANY MASONARY UNITS USED TO BRING COVERS TO GRADE
MK.-SIDE__.SET BACK- _ _-____ SHALL BE MORTARED IN PLACE.
6. NO DETERMINATION HAS BEEN MADE AS TO COMPLIANCE WITH
Lc v as
DEEDED OR ZONING REGULATIONS. OWNER /APPLICANT IS TO
.r
• .,; r ,1 _. 8 AN SUCH DETERMINATION FROM APPROPRIATE AUTHORITY.
PPROVED : BOARD OF HEALTH
k•f r ' DATE AGENT
PROJECT LOCATION,
S C 1) E7 L A N F-5
(,BAPNsTAP ._E MA
APPLICANT:
t v
LEVY; F_L DREDGE, 8 W!J G/VER A SSOC /NC
1-NGINEERS - LANDSCAPE ARCH,TEC?5
kzA PLANNERS LAND SURVEYORS
PFFT
IN
*b+x w P� CBNTERVIL1LE,FMA s02632
"*
60
;r 7 7�
LOCATION MAP JOe NO. SHEET / OF l
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