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0068 COVE LANE - Health
68 COVE LANE, BARNSTABLE A= 351 054 c 1 I a I n n a TOWN/OF BARNSTABLE LOCATION C SEWAGE# VILLAGE C—c"Mon,2 L1 J1, AS ESSOR'S MAP&LOT INSTALLER'S NAME&PHONE NO. SEPTIC TANKCAPACITY LEACHING FACILITY:(type) c)W (size) MNO.OF BEDROOMS BUILDER OR OWNER PERMIT DATE: COMPLIANCE DATE: Separation Distance Between the: ` Maximum Adjusted Groundwater Table and Bottom of Leaching Facility %®-F �'" 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 facilit ) Feet Furnished by . rA Cfo �-ff 1 G T 1Y n 6b 57 t � S . r No. l3 1 f� ' 30 Fee UV THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Zippl Lation for Disposal 6pstem Construction 3pPrmit Application for a Permit to Construct( ) Repair Upgrade( ) Abandon A( ) ❑Complete System Individual Components Location Address or Lot No. Owner's Name,Address,and Tel. �occ'mloaa 4sci� f.�y�/1Q 6' Assessor's Map/Parcel Ins er's Name,Address,and Tel.No.X6.0 7Ts^.7��'1� Designer's Name,Address,and Tel.Noj-ad'-_Te-Z- 4ie/ f ryii7 ,Gb w.Z Ce e�* Type of Building: Dwelling No.of Bedrooms Lot Size .d Z 10'c - Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) �.�0 gpd Design flow provided Q gpd Plan Date ec<_� Number of sheets Z Revision Date Title ,�i /� .-f S'.f� Z2�— Size of Septic Tank /Qo y Type of S.A.S. e—��.�rd�i S Description of Soil Nature of Repairs or Alterations(Answer when applicable) 7-A,si4� r 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 Certificate of Compliance has been issued by this Board of Health. Sigped Date Application Approved by Date -7 (:o Application Disapproved by Date for the following reasons Permit No. La .2 3 0 Date Issued "7 No. 1 Ip ' �. �v kkk«e Fee / UV THE COMMONWEALTH OF,MASSACHUSETTS Entered incomputer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS 21ppliCation-for Dispos Y pstPttt ConstructionPr1YYit Application for a Permit to Construct( ) RepairUpgrade( ) Abandon( ) ❑Complete System Individual Components Location Address or Lot No.6;,C7 e'oGe Owner's Name,Address,and Tel.No.,rf-w,eor C.Y Assessor's Map%Parcel f/ s �^V° � Insta ler's Name,Address,and Tel.No.s'06=7» - Designer's Name,Address,and Tel.No�fa�36 z �rfl/ Type of Building: ' --� Dwelling No.of Bedrooms '? Lot Size �S Z Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) :F—?O gpd Design flow provided gpd V`�- Plan Date 5- n<Z" Number of sheets Z Revision Date Title � /1 S' S'.i�� /���•y. Size of Septic Tank oa e7 Type of S.A.S. C�G�rl•>,-S . Description of Soil r Nature of Repairs or Alterations(Answer when applicable) i, 1�y�,e Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in 7 accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance h been Co ace as bee issued b this Board of Health. P Y Signe �� Date 4 {J 1 / /r ApphcationApproved'by �,,. Date —7// /�a f I14 Application Disapproved by �* _.,...,,Date for the following reasons Permit No. off-o 6 - ,2 30 Date Issued ? ---------------------------------------------------------------------------------------------------------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS CPrtif irate Of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired(4-< Upgraded( ) Abandoned( )by -At.- X"-Z has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. 2 0/�"�3� dated 7/. P P Y / Installer _O +� Designer 77 #bedrooms Approved design flow >_?U gpd The issuance of this permit shallof be constfued as a guarantee that the system/�i 1 function de igne . Date / Inspector l `� l ----------------------------------- ----------------------------------------------------------------------------------------------------- No. d Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION -BARNSTABLE,MASSACHUSETTS Disposal 6pstem Construction Permit Permission is hereby granted to Construct( ) Repair(v) Upgrade( ) Abandon( ) System located at and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction Tst be completed within three years of the date of this permit. Date j/ / ( Approved by \ (A I • f�--- it � ;: ¢efos° . a��rvsrn , w �abiig H th��.�9��n . �g 26�9• �� , . hozmaa MW�e�>m, 200 M�Ijn`h-eet,'Hy m ,i J�fA.02601 office. 50>i-862 4644 Fax: so 8-790-004 .. • ; �s�o�����me��C��fdi���uo�.�'ommo�. ID�t�< a7 I sewage�ey�uitfi - z3c� ssesso 's 1V.?1 -PTUCCI I� s rmeye b�}✓L C i Installer: 2 f' c Idta t �d�tes�e 3J Q was issued a permit to install a On (date), / (insialler) septic systen at �J� based on.a design dravmby (addxess) ��,.►�f 6 � . � dated 6 �6. �R • signet). , i I certify hatthe septic system. efewnced above was insialled substanfially accoiding to . the design„which.may utclude.minor approved changes such as later al ielocatian o�the distribution box anNor septic tauk. I aez y that the septic syst.pla iefereuceri above was installed with major changes (i:e. ,. greateT:than lo, latexal relocation of ihf,-'SAS of city vertical relocatio..of any'component . Of the septic system)but'm accoxdance with:State&Local Regulations: plan zevisiam oT Certified as-buili:by designer to follow'. 'WSJ .a /�[')An\lE:!_A. a ` OJA n (installer's SigIIatu e) �V (Designee SiPabuC) ( �PSi�]eT'S`o't3117p N�T�) T� BAMMARE PUBLIC �ALT19 blVJ6�;IO!g. CFIR .[�CA.Tb Offs'` Co MCE WHI, NOT BE I8 eT JaOT. "'IMS FF>O:F�I�d. AlD A�-BU�,T CARD A]�� MCErVm By THE BARNSTABLE PUBLIC HEALTH DU/18I®N. TWTK YOU- all Town of Barnstable P# f 6D7�'V— • ' D P irient of Heart t,�5�fety�,��anfd��ft,ron �ntiill S er�ee 02I 1Publ c Haealth Day-49'io;n Date 1Y ik „ I '367 Main`Sireet,Hyannis MA10260'It HAMSTABLK � DtA89. Illl/ #,I� DIEv raxt" -Date Scheduled ) Time. �' fee P�". � 1 a ►50�I Suatabihty Assessment f or �5*q a"Disposal ('� ( . Performed By ti^G�0 �e, t'ac�l Witnessed By:f i 10 ............:._.. ••�••••�••••••••Owr►er'sName 1_ Location Address /� - �e- 1 �r f', Assesso_r'sMap/Parcel: c3S� `� .s Eng�t%elei's'Name _ NEW CONSTRUCTION'S-�, REPAIRS - Telephone#&A Jot!•Z�T q^r Land Use ( • Slopes(%)- ''Z�5. Surface Stones -• Distances from: Open Water Body--I-� n, Possible`Wet Area AMR Drinking Water Well >Zco ft ^� Drainage Way �l ft Property Line Zo ft Other ' SKETCH:(Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands in proximity to holes) Z+ o b('i vL -1V ;��q F. all vaal t� L i ® as) > .y Parent material(geologic) e, 'l Depth.to.Bedrock Depth to Groundwater: Standing Water in Hole: 1(5 rl Weeping.from Pit Face Estimated Seasonal.High.Groundwater <»::::::;:z;::;»S:f:z>:>:»:'::...................:..............:.:::'.:..,,..,.:..,.....,: >`::..:.;,,;, ,`:''"''<:` s'" '»' <: ....................... '�::yyr�.�.:yy.>.,...:.`.''::.:.,•:,: , :: :.:::::::•'::.;. - Method Used: ::::.....:.... ::•:::.•::::::�/ Depth Observe' standing in obs.hole: ��`, in. Depth to soillmottles: '< in. Depth to weeping from side of obs.hole: in. Groundwater Adjustment_ -1 Z. Index Well#, 11 OReading Date: Index Well level Z�_j Adfdfactor 1 r,"Adj.--Groundwatet Level Gi mad .......... y,:<::::;:;•:::.:::;.�::::::::5:i:r»::>�>::>:::::>::>r:•>::::i:�;i:<:s:;:: ......... %:;: :: t::`•isi ::?i:;:: i: ::is i::: `. <..;: i>':' '3i :i `:;is '•i `';i :.`•c:i:i::i:i:i:ii}':...,:.;..:;::riYo-:[::: .......:...:.......::......:.:.......:........:.. ........................................................................................................................:.... ... {{ Observation Hole;# .. •- .� ,i-., Timewati9'aa. . .r Depth of Perc Time'ate6;,t'• Start Pre-soak Time 3 -- Time S End Pre-soakf" xi Bp Rate Min./inch y Site'Suitability Assessmem 'Site°Passed , ='F ASite;F.ailed: rF z Ad0itioinalwTesim Needed(Y/N). r+ . .. !1s t29•i..3�`+':-r's'1i1Y'i �:•;� + ii2"•.' +ii{'u >�` Original: Public Heath Division Observation Hole Data'I'o He Completed on`Back Copy: Applicant (i ,._ ......................�...... ...... ::•::::.:.•::•.::::v::::::::::::::::?:•:�iii:.>::^ii:....••ii:'?i::i:":; Depth from 'Soil Horizon SoilTextufe II oilColoCr y°3 Soil Other Surface(in.) (.USDA).,. „ (Munsell), Mottling (Structure,Stones,Boulderes. Consistency.° M; - t IV #x.J :Cs, s8 o 0,r TAJ V 1A ::: �::: S�EIt'6�ATIQN.:I�[ALE:.�!D:1G:.>;;>;;::<..;:<.;;;;:::::::::;:.;::;.::.:;:.: Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) - (USDA)'+ (Munsell) Mottling (Structure,Stones,Boulderes. n %Gravel) 1.9 , ::.:.: ,e. ....... . . .. ... . ...... o s .....::: .::::::.::::: :: :: :::::::::::::::::::.: :: ::: :::: :. . tD,epth from Soil Horizon Soil Textore Soil Color Soil Other Surface(in.) . (USDA) (Munsell) Mottling (Structure,Slopes,Boulderes. ll o i nc °° ravel) OVA Ve �► Mel IRA ....:...:.::::::::. .. ....... �. ...... ............... 'De;pth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulderes. Consistency.°o Gr e y loodifnsprWnee Rate Niat� _ +:'. t s _f , ss/ +-_; d" ` •: }i}d. Above 500 year flood+oundary r,No— Yes /S , a 'Alf .. W,ithin;500.yeazeboundary No Yes within:-00 yeai`flood'b'oundary'No, .::-,Yes, : rtt Af#Of. ,. xa a , to 'Obth of Naturally Occurring Pervloas Material I3oes at least four feet of naturally occurring pervious terial exist in all areas observed throughout the area proposed for the soil absorption system? IT not,what is the depth of aaturatly occurring pervious material? Certification '_r!�c J date I liave assed the soil evaluator examination approved by the I certify hit-on ( ) P �0- c�°epartment,'ofEnvironinentahPiotection-and.that:the°above analysis was-performed byQme consistent:w;ith ,the required�training,expertise and experience described in 310 CMR 15.0117. Date Signature t TO" OF BARN=STABLE- Health Division— 200 Main Street—Hyannis, MA 026601 Date: 3/17/2015 Number of pages 7 a TO: Cindy Manteiga Fax:'508-945 _ 5549 W. Vernon Whiteley, Inc. From: Health Division Phone: 508 - 862 - 4681 Subj: 68 Cove Lane, Cumaquid, MA Comments: As requested... I have faxed you all the information we have on 68 Cove Lane. If I can be of any further assistance please call..' r x Certfied Septic Inspection for Robert Metafora, 68 Cove Lane, Cummaquid.02637 AM 351, Pcl 54 September 24, 1995, Page 1 of 7 . 1�. SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION PO OC � Address of property 68 Cove Lane, Cummaquid, 02637 T Owner's name Robert Metafora 6' 1�9 Date of Inspection April 28, 1995 � Recertfied on September 24, 1995. v `� PART" A CHECKLIST Check if the following have been done: _X Pumping information was requested of the owner, occupant, .and Board of Health. _ 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 site was inspected for signs of breakout. _ X All system components, excludiiig the SAS, have been located on the site. _x 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. .he size and location of the SAS on the site has been determined based on existing information cr approximated by non-intrusive methods. -__X The facility owner .(and occupants, if different from owner) were prov_ with information on the proper maintenance of SSDS. Certfied Septic Inspection for Robert Metafora, 68 Cove Lane, Cummaquid 02637 AM 351, Pcl 54 September 24, 1995, Page 2 of 7. SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM, PART B SYSTEM INFORMATION _s A FLOW CONDITIONS If -.residential _ ,number of .bedrooms 'number of current residents garbage grinder, yes or no kl�g laundry connected to system, yes or no �a seasonal..-.use, yes or no If nonresidential', - calculated flow: Water meter readings, if available: 199AI -36ovv /9ps -zz vvc� A 1 Last date of occupancy GENERAL INFORMATION Pumping records and source. of information: w * The �Q System pumped as part of inspection, yes or no if yes , volume pumped Reason for pumping: Type of system __►_/Septic tank/distribution box/soil absorption. system Single Overflow cesspool Privy Shared system (yes or no) (if yes, : attach previous inspection records, if any) Other (explain) Approximate age of allii information: _ .� sewage od ors rs detected when ar riving at the site, yes or no Certified Septic Inspection for Robert Metafora, 68 Cove Lane, Cummaquid, 02637 AM 351, Pcl 54 September 24, 1995 Page 3 of 7 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B. SYSTEM INFORMATION continued SEPTIC TANK.• f (locate on site plan) depth below grade: o't ` material of construction: oncrete metal FRP other(explain) dimensions: St'�►.,��2� l Ooo S << o iJ CA-e 1I � hLQLf-sludge depth 4 distance from top of sludge to bottom of outlet tee or baffle ou-escum thickness distance from top of scum to top of outlet tee or baf:fle :,. — distance from bottom of scum to bottom ,of outlet tee or baffle Comments: (recommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid P quid level in relation to outlet invert, structural integrity, evidence of leakage, recommendations for repairs, etc. ) d� S ow rS s cc.a"YIAe a S- Sc,v rocs DISTRIBUTION BOX: (locate on site plan) depth of liquid level above outlet invert Comments: (note if level and distribution is equal, evidence of solids carryover, evidence of leakage into or out' of box, recommendation for repairs, etc. ) PUMP CHAMBER:- (locate on site plan) T PUMPS in working order, yP nc.. Comments: (note condition of pump chamber, condition of pumps and. appurtenances,, . recommendations - for maintenance or repairs,etc. ) Certified Septic Inspection for Robert Metafora, 68 Cove Lane, Cummaquid, 02637 AM 351 Pcl 54 September 24, 1995 . Page 4 0f 7 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B SYSTEM INFORMATION continued SOIL ABSORPTION SYSTEM (SAS) :__ (locate on site plan, if possible; excavation. not required, but may be approximated by—non-intrusive methods)' If not determined to be present, explain: CQA _ N-yw.k N e cL— Vex- Type leaching pits and number leaching galleries and number leaching trenches, number, length leaching fields, number, dimensions overflow cesspool, number Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, recommendations for maintenance or repairs,etc. ) CESSPOOLS (locate on site plan) : number and configuration depth-top of liquid to inlet invert depth of solids layer depth of scum layer dimensions of cesspool materials of construction indication of groundwater inflow (cesspool must be pumped as part of inspection) Comments: (note condition of soil, signs of hydraulic failure, level` of ponding, condition of vegetation, recommendations for maintenance or repairs,,etc. ) PRIVY: (locate on site p1 ?n) . materials of construction dimensions - depth of solids — Comments.: 3 (note -condition of soil:, signs of hydraulic failure, ' level of' ponding, condition of vegetationi recommendations for maintenance or repairs,etc. ) Certfied Septic Inspection for Robert Metafora, 68 Cove Lane,Cummaquid 02637 AM 351, Pcl 54 September 24, 1995, Page$of 7. SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B SYSTEM INFORMATION continued SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent references landmarks or benchmarks locate all wells within 100 ' NO KNOWN WELLS WITHIN 100 FEET Leo e.- or- V(„g ��SPat P q 80 bo t DEPTH TO GROUNDWATER depth to_ p groundwater method of determination or approximation: The ground elevation where the pits are positioned is 17' ± above the'level of the pond in ihe front of the A�A/ II 1 Certfied Septic Inspection for Robert Metafora, 68 Cove Lane, Cummaquid 02637 AM 351, Pcl 54 September 24, 1995, Page 6 of 7. SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C. FAILURE CRITERIA Indicate yes, no, or not determined (Y, N, or ND) . Describe basis of determination in all instances. If "not determined", explain why not)' Backup of sewage into facility? Discharge or ponding of effluent to the surface of. the ground or surface waters? Static liquid level in the distribution box above outlet invert? CLiquid depth in cesspool <6 below invert or available volume< 1/2 day flow? Required pumping 4 times or more in the last year? number of times pumped 1.. I� Septic tank is metal? cracked? structurally•unsound? substantial infiltration? substantial exfiltration? `tank failure imminent?* . Is any portion of the SAS, cesspool•.or privy below the high groundwater' elevation? ' I within 50 feet of a surface water? within . 100 feet of a surface water su 1 or tributary to a surface - water Y Y water supply? within a Zone I of a public well? within 50 feet of a borderingsalt, marsh vegetated. wetland or salt marsh (cesspools and privies only, 'not the SAS) ? _ within 50 feet of a private water supply well? less than 100 feet but greater„than 50 feet from a private water supply..,'well -with_'no acceptlable' water quality 'analysis? If the well has -been• analyzed. to -be acceptable, attach .copy of well water analysis for coliform bacteria, volatile organic ^omrounr3q; arnon::a ri.trocen :c::: Lute :iitrogen. Certfied Septic Inspection for Robert Metafora, 68 Cove Lane, Cummaquid 02637 AM 351, Pcl 54 September 24, 1995, Page 7 of 7. SUBSURFACE SEWAGE DISPOSAL SYSTEM INspECTION FORK PART D CERTIFICATION Name of Inspector Ralph Ojala Company Name Down Cape Consulting Company Address 939 Route 6A, Yarmoutbport, MA 02675 Certification Statement I certify that,: I" have personally inspected the sewage disposal system at this address and that the information reported is true, accurate and complete as of.-:t�7� time, of inspection. she .inspection was performed and ... any recommendations regarding ,upgrade, maintenance and repair are consistent with my training and experience in the proper function and maar,tenance of on-site sewage disposal systems. Check one: X I have not found any information which indicates that the system fails to adequately protect public health or the environment as defined in 310 CMR 15. 303. Any failure' criteria not evaluated are as stated in the FAILURE CRITERIA section of this form. I have determined that the system fails to protect public health and the environment as defined in 310 CMR 15.303.. The basis for this determination �is provided.:in- the FAILURE CRITERIA section of this form. Inspector's Signature . Date Oeptember 24, 1995 Original to system, owner Robert Metafora, 18'Charming Road, Brookline, MA 01246 Copies to: Ross Joly R.E. Buyer (if applicable) Amy Koff Approving authority Barnstable Board of Health 1 Certfied Septic Inspection for Robert Metafora, 68 Cove Lane, Cummaquid 02637 AM 351, Pc1.54 September 24, 1995, Page 7 of 7. SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART D CERTIFICATION Name of Inspector Ralph Ojala Company Name Down Cape Consulting Company Address 939 Route 6A, Yarmoutbport, MA 02675 Certification Statement I certify thatnI have personally inspected the sewage disposal system at this -address and that the information reported is true, accurate and complete as of.-the time of inspection. jne inspection was performed and any recommendations regarding upgrade, maintenance and repair are consistent with my training and experience in the proper function" and maaritenance of on-site sewage disposal systems. Check one: . X I have not found any information which indicates that the system fails to adequately protect public health or the environment as defined in 310 CMR 15. 303. Any failure criteria not evaluated areas stated in the FAILURE CRITERIA section of this form. I have determined that the system fails to protect public, health and the environment as defined in 310 CMR 15.303. The basis for this determination is provided in the FAILURE CRITERIA section of this form. a �.. Inspector 's Signaturr e f� Date Oeptember 24, 1995 Original to system owner Robert Metafora, 18 Charming Road,'Brookline, MA 01246 Copies to: Ross Joly R.E. Buyer (if applicable) Amy Koff Approving authority Barnstable Board of Health TOWN OF BARNSTABLE ° LOCATION SEWAGE # VILLAGE ASSESSOR'S MAP&LOT —5 NAME&PHO NO. SEPTIC TANK CAPACITY ,'Z rj o " LEACHING FACILITY: (type) r — f Gam , (size) 6--X 4, NO.OF BEDROOMS ' BUILDER OR OWNER �fi=C�fi PERMTTDATE: COMPLIANCE DATE: Separation Distance Between the: �Z�/�J/'. 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 2,00 feet of leaching facility) Feet Edge of Wetland and Leaching Facility (If any wetlands exist /f within 300 feet of leaching facility) yS Feet Furnished by -P&A-W`iwt-- 4.1 6-� Q �� Hq TOWN OF BARNSTABLE N r J LOCATION � �, %il�� SEWAGE # A VILLAGE ,ASSESSOR'S MAP LOT s3.3'j__..,0.{C INSTALLER'S NAME & PHONE NO. A & B CANCO`- 775-6264 SEPTIC TANK CAPACITY..:f odd (9,4//O t1 / R»K- v LEACHING FACILITY:(type)2 (94��sue) C,,Y 4 NO. OF BEDROOMS J PRIVATE WELL O UB�WA BUILDER OR OWNER DATE PERMIT ISSUED: l DATE COMPLIANCE ISSUED: c;� — VARIANCE GRANTED: Yes No 1 ' r � + LD fFh 50 j 1 LOCATION SEWAGE PERMIT N0• G �VF C�9•y` VIl1AGE f INSTA LLER'S NAME A ADDRESS /F /740 BUILDER OR OWN Ell DATE 'PERMIT ISSUE ® ;%®-/7- 7? DATE COMPIIA.NCE LSSUED �z 10 Page 1 of 1 McKean, Thomas From: Cynthia Manteiga [cmanteiga@wvwhiteley.corn] Sent: Tuesday, March 17, 2015 8:41 AM To: Health Subject: Septic stem plan 1 p Y - ,. Good morning, I am submitting a gas service agreement for a resident of Cummaquid,'Dr.Amy Koff.. Her address is 68 Cove Lane, Cummaquid. Do you have a septic plan on file that you could email to me please. I need to'submit this plan with the gas service agreement. Sincerely, Cindy Manteiga W.-VERNON ptt MBING • HEATING NR C0N0IT1QkN G Celebrating 60 Years Cindy Manteiga 28 Village Landing P.O. Box 1266 West Chatham, MA 02669 T:508.945.1100 extension 207 F:508.945.5549 www.wvwhiteley.com 3/17/2015 TOWN OF BARNSTABLE I.(?CATION SEWAGE# VIUFAGE ASSESSOR'S MAP&LOT 1 - "NAME&PHOWE NO. - Z SEPTIC TANK CAPACITY l UY�fJ LEACHING FACILITY: (type) C-2— 1 02, (size) NO.OF BEDROOMS BUILDER OR OWNER PERMITDATE: COMPLIANCE DATE: / Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility .> f Z 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.(£f any,wetlands exist �j/5�# Feet within-300 feet of leaching facility) _ ' Furnished by 4)&4W Q4AV, QA& A&Njp77 27 Q i --=� or 10 t Hq qD 80 too F a 1 � `. Certfied Septic Inspection for Robert Metafora, 68 Cove Lane, Cummaquid 02637 AM 351, Pcl 54 September 24, 1995, Page 1 of 7 . Cj SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FO O /�►�� CT �/� Address of property 68 Cove Lane, Cummaquid, 02637 6 _`U Owner's name Robert Metafora �' qr. Date of Inspection April 28, 1995 � /� � ✓ Recertfied on September 24, 1995 V���^ PART A V Y e9 CHECKLIST Check if the following have been done: ___X_ Pumping information was requested of the owner, occupant, and Beard of Health. 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 e available with N/A. _x- The facility or dwellin 7g was inspected for signs of sewage back-up. _ X The site was inspected for signs of breakout. _X All system components, exclud Ag the SAS, have been located on the _x 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. I --X -he size and location of the SAS on the site has been determined based on existing information cr approximated by non-intrusive methods. The facility owner�' y (and occupants, if different from owner) were prov_ ::ed with information on the proper maintenance of SSDS. A M + ti V Certfied Septic Inspection for Robert Metafora, 68 Cove Lane, Cummaquid 02637 AM 351, Pcl 54 September 24, 1995, Page 2 of 7. SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B f SYSTEM INFORMATION ,v r 1 <!�t � FLOW CONDITIONS 4 If.Presidential • r_num/bli of bedrooms ,number of current residents �rQ garbage grinder, yes or no laundry connected to system, yes or no --&a seasonal,,,use,, yes or no If nonresidential.,, c:alcula`ed --flow, - Water meter readings, if available: !99A/ -36ovc> 1/9pS Zz_1000 ky �9,9_< Last date of occupancy GENERAL INFORMATION Pumping records and source of information: d Gv /L &4,0,j w T 'Tits System pumped as part of inspection, yes or no if yes , volume pumped Reason for pumping: Type of system__/Septic tank/distribution box'/soil absorption system _ SinglP cesc-poc,. Overflow cesspool Privy ` Shared system (yes or no) (if yes, attach previous inspection records, if any) Other (explain) Approximate age of all i ns i:al :.&I, %f .ka:cPti�!. Suurc�_- of information: Q .YA Sewage odors detected when arriving at the site, yes or no I Certified Septic Inspection for Robert Metafora, 68 Cove Lane, Cummaquid, 02637 AM 351, Pcl 54 September 24, 1995 Page 3 of 7 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B SYSTEM INFORMATION continued SEPTIC TANK: f (locate on site plan) depth below grade: of material of construction: concrete metal FRP other(explain) dimensions• Sr�a,���,i1 1 poo c �( o rJ d n� N2NY.sludge depth distance from top of sludge to bottom of outlet tee or baffle o►Oescum thickness distance_ from top of scum to tor' o` o»-?eL tcC :;r iidrfi2 — distance bottom of scum to bottom of outlet tee or baffle 4-�, 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, recommendations for repairs, etc. ) eca%IAYI ►e DISTRIBUTION BOX: \$\X � • W _(locate on site plan) - depth of liquid level above outlet invert Comments: _ . (note if level and distribution is eq ual, evidence of solids carryover, evidence of leakage into or out of box, recommendation for repairs, etc. ) PUMP CHAMBER:_ )0�-_ . (locate"'on site plan) Pumps in work:nix order, or ro Com dz is (note condition of pump chamber, condition of pumps and a ,M, . P P ppurtenances,�;.recommendations •for maintenance or repairs,etc. ) --- — - . � Certified Septic Inspection for Robert Metafora, 68 Cove Lane, Cummaquid, 02637 AM 351 Pcl 54 September 24, 1995 Page 4 Of 7 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B SYSTEM INFORMATION continued SOIL ABSORPTION SYSTEM (SAS) :_ (locate on site plan, if possible; excavation not required, but may be approximated by non-intrusive methods) If not determined to be present, explain: � v1�- Type leaching pits and number Z leaching galleries. and .numbe:r, leaching trenches, number, length leaching fields, number, dimensions overflow cesspool, number Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, recommendations for maintenance or repairs,etc. ) N Al ti� Cc, ry�.t' CESSPOOLS (locate on site plan) : number and configuration depth-top of liquid to inlet invert depth of solids layer depth of scum layer dimensions of cesspool materials of construction indication of groundwater inflow (cesspool must be pumped as part of inspection) Comments: _ (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, recommendations for maintenance or repairs,etc. ) PRIVY: (locate on site elan) . materials of construction dimensions depth of solids — Comments: (note condition of soil', signs of hydraulic failure, - level of ponding, condition of vegetation', recommendations for maintenance or repairs,etc. ) Certfied Septic Inspection for Robert Metafora, 68 Cove Lane, Cummaquid 02637 AM 351, Pcl 54 September 24, 1995, Page$of 7.- F SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B SYSTEM INFORMATION continued ' SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent references landmarks or benchmarks locate all wells within 100 ' NO KNOWN WELLS WITHIN 100 FEET • � ova � � .- IT P HQ l a aT 'o f 9i H4 D 8o p L DEPTH . TO GROUNDWATER �. depth to groundwater /2 P 7 method of determination or-approximation: The ground elevation where the pits are positioned is 17' ± above the level of the pond in the front of the bouse. �-GAZ;A-1 e T ,w ,.r Certfied Septic Inspection for Robert Metafora, 68 Cove Lane, Cummaquid 02637 AM 351, Pcl 54 September 24, 1995, Page 6 of 7. SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C FAILURE CRITERIA Indicate yes, no, or not determined (Y, N, or ND) . Describe basis of determination in all instances. If "not determined", explain why not)" Backup of sewage into facility? Discharge or ponding of effluent to the surface of the ground or surface waters? Static liquid level in the distribution box above outlet invert? I\,[A Liquid depth in cesspool <6" below invert or available volumer •1/2' *day flow? _ Required pumping 4 times or more in the last year? number of times pumped _ Septic tank is metal? cracked? structurally,unsound? substantial infiltration? substantial exfiltration?tank failure imminent? , Is, any portion of the SAS, cesspool or, privy: below the high groundwater elevation? within 50 feet of a surface water? within . 100 feet of a surface water supply. or tributary to a surface water supply? IN- within a Zone I of a public well? within 50 feet of a bordering vegetated, wetland or salt, marsh (cesspools and privies only, not the SAS) ? N-- within 50 feet of a private water supply well? less than 100 feet but greater than 50 feet from a private water :suppl.yi well,,with� 'no acceptabl`� 'water-equality,"analysis? If the well has,,,�been'analyzed to `be acceptable, attach copy of well water analysis for. coliform bacteria, volatile organic ^ompound,; ammonia nitrogen Certfied Septic Inspection for Robert Metafora, 68 Cove Lane, Cummaquid 02637 AM 351, Pcl 54 September 24, 1995, Page 7 of 7. SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART D CERTIFICATION Name of Inspector Ralph Ojala ` v Company Name Down Cape Consulting Company Address 939 Route 6A, Yarmoutbport, MA 02675 Certification Statement I certi f tha Y t: I Mve personally inspected the sewage disposal system at -this -address and that the information reported is true, accurate and complete as of&the time cif inspection.pection. the inspection was performed. and any recommendations regarding upgrade, maintenance and repair are consistent with my training and experience in the proper function and r ma,,itenance. of on-site sewage disposal systems. i Check one: X I have not found any information which indicates that the system fails to adequately protect public health or the environment as defined in 4 310 CMR 15. 303. Any failure criteria not evaluated are as stated in the FAILURE CRITERIA section of this form. ' I have determined that the system fails to protect public health and the environment as defined in 310 CMR 15.303 . The basis for this determination is provided4;in the •FAILURE CRITERIA section of this- form. Inspector's Si n g ature Date Oeptember 24, 1995 Original to system .owner Robert Metafora, 18 Channing Road, Brookline, MA 01246 Copies t o: Ross Joly R.E. Buyer (if applicable) Amy Koff Approving authority Barnstable Board of Health 7 r SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM Address of pro as y t. czy' caevl - Owner's name `�y�+�. • Date of Inspection PART A CHECKLIST Check if the following have been done: y Pumping 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. V`As built. plans have been obtained and examined. Note if they are not available with N/A. V '^he facility or dwelling was inspected for signs of sewage back-up. _Jee The site was inspected for signs of breakout. . All system components,' excluding the SAS ,: have been located on the Z ite . ' The � P septic tank manholes were uncovered opened, and the interior Iof P the septic tank was inspected for condition of baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge, depth of scum. he size and location of the SAS on the site has been determined based on existing information cr approximated by non-intrusive methods. The facility owner (and occupants, if different from owner) were prov_ ::ed with information on the proper maintenance of SSDS. l 8 SUBSURFXCE SEWAGE,, DISPOSAL SYSTEM INSPECTION FORM PART B SYSTEM INFORMATION =- 4. FLOW CONDITIONS If residential number of bedrooms number of current residents _ garbage grinder, yes or no % laundry connected to system, yes or no seasonal use, yes or no If nonresidential , calculated flow: c Water meter readings, if available: \C�0�3 Last date of occupancy U GENERAL INFORMATION Pumping records a d source of in ation: O ��5�©C2aa �CN" ND System pumped as part of inspection, yes or no if yes , volume pumped Reason for pumping: Type f 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 age of all components. Date installed, if known. Source of information: Sewage odors detected when arriving at the site, yes or no i r 9 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B A SYSTEM INFORMATION continued SEPTIC TANK: ��tIC7 qQ ,r (locate on site =plan) depth below grade: material of construction: concrete metal FRP other(explain) dimensions:- ��S �C S X y.K" NV sludge — , distance -from: top. of sludge to bottom of outlet tee or baffle _ scum s --R distance from top of scum to top of outlet, tee or baffle distance from bottom of scum to bottom of outlet tee or baffle 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, recommendations for repairs, etc. ) DISTRIBUTION BOX: (locate on site plan) f depth of liquid level above outlet 'invert Comments: (note if level and distribution is equal, evidence of solids carryover, evidence of leakage into or out of box, recommendation for repairs, etc. ) hjo I PUMP CHAMBER• R (locate on site plan) pumps in working :order, yes or no Comments: ' (note condition* of pump chamber, condition of pumps and appurtenances, 'recommendations' for' maintenance or repairs,etc. ) r 10 r SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B �� SYSTEM INFORMATION continued SOIL ABSORPTION SYSTEM (SAS) �� (locate on site plan, if possible; excavation not required, but may be approximated by non-intrusive methods) If not determined to be present, explain: 6 Type leaching pits and number tt00 ea MUA %-W leaching chambers and number leaching galleries and number leaching trenches, number, length = leaching fields, number, dimensions overflow cesspool, number Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation., recommendations for maintenance or--repairs,etc. ) C 0 �. CESSPOOLS (locate on site plan) f number and configuration depth-top of liquid to inlet invert depth of solids layer depth of scum layer dimensions of cesspool materials of construction indication of groundwater inflow (cesspool must be pumped as part of inspection) Comments: (note condition of soil , signs of hydraulic failure, level 'of ponding, condition of vegetation, recommendations for maintenance or repairs,etc. ) PRIVY : � � . (locate on site plan) materials of construction dimensions depth of' solids Comments: 1 (note condition of soil signs of hydraulic' failure level of ondin r g Y � P g, condition of veget ation, recommendations for maintenance or repairs etc. ) I� a- SUBSURFACE SEWAGE ,DISPOSAL SYSTEM INSPECTION FORM .PART B ...,SYSTEM INFORMATION continued i .-SKETCH'OF SEWAGE DISPOSAL SYSTEM: i include ties to at least two permanent references landmarks or benchmarks locate all wells within 100' 1_ _ _ Q , K-NOw�1 _v�'�lSr _w� _C1�� - �00, 4 -: ! (Zca►2, ; o� ..►toys� , 1600 �al. s,_ ixC tCW K o DEPTH TO GROUNDWATER 1 �1 depth to groundwater ' method of determination or approximation: 1N. C.Q1 1CS ' 12 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C FAILURE CRITERIA Indicate yes, no, or not determined (Y, N, or ND) . Describe basis of determination in all instances. If "not determined",' 'explain why not) Backup of sewage into facility? �v Discharge or ponding of effluent to the surface of the ground or surface waters? - Static liquid level in the distribution box above outlet invert? " 'Liquid "de h ' in cesspool <611 below_ in`►ert or available vo`lumer 1/2'"day flow? Required pumping 4 times or more in the last year? number of times pumped N Septic tank is metal? cracked? structurally unsound? substantial infiltration? substantial exfiltration? tank failure imminent? ' Is .any portion of the SAS, cesspool or privy: Y below the high groundwater elevation? N within 50 feet of a surface water? within . 100 feet of.a surface water supply or tributary to a surface water supply? iV within a Zone I of a public well? ram{ t .% Nwithin 50 feet of a bordering vegetated wetland or salt marsh (cesspools and privies only, not the SAS) ? within 50 feet of a private water supply well? 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 compounds, ammonia r,itrag.en and nitrate nitrogen. , I __ ` 13 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM i PART D CERTIFICATION Name of Inspector Ralpb Ojala Company. Name Down Cape Consulting Company Address 939 Route 6A, Yarmoutbport, MA 02675 R Certification Statement I certify that I have personally inspected the sewage disposal system at this address and that the information reported is true, accurate and complete as of the time of inspection. The inspection was performed and any recommendations regarding upgrade, .maintenance and repair are f ,. consistent with my training and experience 'in thef proper- function and maaritenance of on-site sewage disposal systems. Chec one: - I have not found any information which indicates that the system fails to adequately protect public health or the environment as defined in 310 CMR 15. 303 . Any failure criteria not evaluated are as stated in the FAILURE CRITERIA section of this form. I have determined that the system fails to protect public health and the environment as defined in 310 CMR 15. 303 . The basis for this determi ation is provided in the FAILURE CRITERIA section of this form. Inspector ' s Signature Date A 99S Original to system owner AM Copies to: / rgd �j AT Buyer (if applicable) Approving authority` t i . =� f �. t,� � ��� �. ® � �.., � ^r � ., fds��. � �o� sl< �Q E �� z; i a '1 'o'v TOWN OF BARNSTABLE LOCATION SEWAGE # VILLAGE AS MAP 6i . � / :INSTALLER'S NAME & PHONE NO. A & B CANCO 775-6264 SEPTIC TANK CAPACITY-,>f t7Q (3,41/0iA / Rr LEACHING FACILITY:(type 44 i3'(size) NO. OF BEDROOMS PRIVATE WELL O UBLIC WA �'��C BUILDER OR OWNER ` DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: r- VARIANCE GRANTED: Yes No !� J FJ , { ��F - you • � - 50 1®0 S (00d 4Y • i No.9,111 Par OSY FIER ............ THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH TOWN OF BARNSTABLE Ap.pliration for Diripuual Works Tontitrnrtitun ratuff Application is hereby made for a Permit to Construct ( ) or Repair (✓�an Individual Sewage Disposal System t - .... a .. 09� __....1,4 ....----- ' r �L t L ------------------- ---- or q Location-:\ddress ----------------- .................Lot No_........................................_ -- ----------- Ow'ner Address a '0 7---------------•--------•-------------------••--•------ •--...---- -----....-----------------------...--••--. •-•-------.......-------•-•---••---......-- Installer Address UType of Building Size Lot............................Sq. feet ►. Dwelling— No. of Bedrooms-------------1.................---------Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ---------------------------- No. of persons---------------------------- Showers ( ) — Cafeteria ( ) a' Other fixtures ------------------------------- - - W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. Septic Tank—Liquid capacity............gallons Length---------------- Width................ Diameter................ Depth................ W Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area........_...........sq. ft. 3 Seepage Pit No............. ....... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) .4 Percolation Test Results Performed by.......................................................................... Date........................................ aTest Pit No. I................rninutes per inch Depth of Test Pit.................... Depth to ground water........................ Test Pit No. 2................minutes per inch .Depth of Test Pit..................... Depth to ground water........................ a •••---••--•-----------------------••---•-------•---•-••-----------•-•••••---•••-•-----------•-•-•-•.......................................................... 0 Description of Soil........................................................................................................................................................................ V W .......................... ............................................................... ------------------------------------------- .............................................................. V Nature of Repairs or Alterations—Answer when ,applicable.._. 11.S r. . ...........'....-)�..P.....j.006........� ........... }-----�k .........+AA)k---�� � ��� ------------------------------------------------------ •---------------.........-------. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has een issued tyy the board of health. q Signed ................. (/f r4P.e�V1......-----.-------------.---------. ...........[.'.0.0:-. �1r Dace Application Approved By ....::..:.. ----------------- ... - �� �� Application Disapproved for the following reasons: .......................................................................................................... ...................... .......................................................... ............................. ................... ....................................... . ..................................:.... ........................................ Permit No. ... '+JJ.j ......... Issued ......��)....�� `'� Da e...... `I Date 1 ..^�'-r�L-a..f-..�.+w..:.•-....._......�-...�--•--.T..a........j.---^•-- ....,o-......-._�..--_.c'. -,rti.��.a.�i. „r,� _.may .....,..,� �.-^..,........-,..... ..�.;,.:+ra.,"1.q.n•....!.h..:�•y...,.r-+...i'r�1:�.Ln a«X-••.*'.-...i:'. �.s�,•�..�„y�y�� t MAP 3,s-c � f • F- par os- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Appliratiuii for Diripim l Wi urkt5 Towitrnrtiinn ramit Application is hereby made for a Permit to Construct ( ) or Repair (✓<an Individual Sewage Disposal System at I (.Mv _• - '- �- . r Location-Address or Lot No. ...: s_S._._.�n�r-i e-� --•--"-'--•-""-'-••-----'..................."'•'••-----•--"...-'-------•----.............--•- ���� Address Installer Address UType of Building Size Lot............................Sq. feet .-I Dwelling— No. of Bedrooms_____________-3----_---_.-_-._.____-._...Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ____________________________ No. of persons----------------------------- Showers ( ) — Cafeteria ( ) dOther 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. 3 Seepage Pit No--------------------- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by........................................................................... Date........................................ Test Pit No. I................ininutes per inch Depth of Test Pit.................... Depth to ground water........................ rZo Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a •--•'••--•----•-•----...-•••---'--------'-•'--•-"-"--.....----•---•---••-'-'-""...........-•-''-......................................................... 0 Description of Soil.............................................................................................-.......................................................................... x U ....................... -•-'---"•-'•••.....---'-•"-•--•-•-'-•-'--•••-"•--•-'-"'•---'•..........--'•-'-'•-••-------"-'---'--'•-'•'---•-'•--•-"-•-•--.....""•'•'-'-'-'-'-"-......"-'-............ w ..........................•------.......--•---•--•----••-••--- --•---•-••-------------'••-•-------------......---------------•----"-'- ..................•-"---'-'--•- -'•'••....._---------------- U Nature of Repairs or Alterations—Answer when applicable.---Ins i�A.1.1............ _-_.k.P.....�n��.�_..._._. •......... - �Jt�.5 a.�t SPr1 �.> - r ti1�C �� I " �C rl�1 ---------------•-----------•------- -------- ---•-•... ......... '-----••--- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued ley the board of health. f __4V Signed f' - .. ......... �ta ..................................... ........... `Doaff[e.Application Approved B " - %� Z................................ ...... PP PP Y ....:.......� .. - .. �... ....�( Dare Application Disapproved for the following reasons: ....................... ............................ ......................... ......................................................... .......... ................ . ........................................................................................... ........................................ Permit No. 'r ' �� Dale -- Gam,/"".- '.��.��... -...... Issued ...................�.�-� ....��...�... ...... Dne THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE VlErti{Yrate of ((V��omplinure THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( ✓}� by ........................�d9.X1(..a..................................................................................------ --------------------------. ......... . ._.... .. . . . ........................ /� /� /� Insrdlcr at .........(2.9--------- -------------- ---C....f/7�i?..Y�A.�t�l.tF� .. ........................ ......... .. ... ................................. has been installed in accordance with the provisions of TIT`I�E 5 of The State Environmental Code as described in the application for Disposal Works Construction Permit No. .,�ff:._.._ h'' a� ! dated THE ISSUANCE OF THIS CERTIFICATE SHALL NOVBE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE........- ' .. ..._ .... - Inspector � � �w�� i ' -:._... —————————————————— ———————————————————— -- --- �----- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH nn RNSTABLE TOWN OF BA30 No`� `p�... FEE.... ........... Boor ial Workv Tonotrudi.an Wrmit Permission is hereby granted......................CQ �. ................................ to Construct ( ) or Repair ( an Individual Sean>age Disposal System �i C at No....f2-�.�LY.............. .........fAnx......• vl`y! Street � � .� as shown on the application for Disposal Works Construction Permit Dated... --...._. ....... .� Board of Health DATE..... •---------•----.....-''---------/-�`-................................•-- FORM 36508 HOBBS 6 WARREN.INC.,PUBLISHERS LO ?AT IORI SEWAGE PERMIT NO. d l-L7� A G E 1 H S T A LLER'�S� NAME b ADDRESS / ���25 C q•�/� B U I L D E R OR OWN ER DATE PERMIT ISSUED „ /0-/7- 7? DAT E C 0 M P L I A N C E ISSUED tv /71eJ CiS �2 140 O�� a 08) .a / • : -•�,�°=.� Goa+ N THE COMMO .LTH OF MASSACHUSETTS BOAR E LT( [ .......... ........OF........ ..1�..� � 'D.-------p- •---------•------- L i Appliration for Bhipvii al Works Timitrurtilatt Frrutit Application is hereby made for a Permit to Construct .( ) or Repair ( ) an Individual Sewage Disposal Sy,atyal:_, ....... .................citm.2p.................................................... ........ ....................................................................... Lo tion-Address Lot . Qt \ . . -----•............................... W .:Own Y dress e � Installer Address Q Type of Building Size Lot. .. .............. U Dwelling—No. of Bedrooms................._._........................Expansion Attic ( ) Garbage Grinder Q Other—T e of Building No. of persons............................ Showers — Cafeteria a Oth fi . u s --------------------- Design Flow......._--_----. ...................gallons per person per day. Total daily flow__.___.... .............................gallons. WSeptic Tank—Liquid capacity_f-__.____gallons . Length................ Width___-.._-___-_-_- Diameter................ Depth................ x Disposal Trench—No .................... Width.......... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No----- I.__,____ Diameter... -. .__. Depth below i et.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing Ank aPercolation Test Results Performed by..... �.�i,-- ,ca, r� ..:.....V) a e...___�__ ". _=......._.. Test Pit No. 1................minutes per inch Depth of eT it .............. Depth to ground water....................... (i Test Pit No. 2................minutes per inch Depth of Test Pit............-..._... Depth to ground water......................... arA-- ................ �o Description of. Soil o_= Gt O �-•- ' -------------- �� .......... x 'I ......•-----•-••-•---- 4-- --- a - -------------- ------ -- ----- CL- x Nature of Repairs or Alterations—Answer when a licable.. U P PP LG Agreement: ° d" �� 6 `-V The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance wit� — the provisions of TLITLE 5 of the State Sanitary Code he n signed f ther agrees not to place the system in operation until a Certificate of Compliance has u d r t . Icy Date Application Approved By.................. ---..-- = ---- -=--------................ -..................... Date Application Disapproved for the following reasons---------------------------------------------------------------------- -------------------------•-•-•-•------•--- ...........•--•-•-••-----...•-•••------------------------•--...-•--------•-•-•--••-----•-------•••••-•-...---...--•••--••-•••-•-••-••----•-•-------••-----------......-- ................................ Date k PermitNo..............................................=........... Issued........................................................ Date No.-- -- .. •' p Fps . Y THE COMMO '4, 4LTH OF MASSACHUSETTS HE L BOAR l� .. ......... l ion ��r � pnsa1 ,ark, C�omuurtinn amit 4�, Application:.is hereby made for a..Permit to=Construct ( ) or Repair ( ) an Individual Sewage Disposal SClll St ...... .. .--.., ....:E! .......-. .........................� "! ... ... ............. ..................... �o tion Addry s iii"' ,y�`.�` I't ... 1.. s F:. ........................... ................�.•. 'mow._... - ................................ � dress Installer Address .. + Type of Building Size Lot. . ."".Sq Dwelling—No. of Bedrooms.................: ...............--------Expansion Attic ( ) Garbage Grinder Vk/�o Other—T e of Building ............................ NO. of persons............................ Showers — Cafeteria Q, Oth fi u s •----------- ; --------------------- ------- -------- ----- ---- WDesign Flow..... .. ...__ allons per person per day. Total dal y'fiow___... ..............................gallons. WSeptic Tank—Liqu'i .apace.. .gallons Length................ Width-------_------- Diameter---------------- Depth___ x Disposal Trench No. Width x........ Total Length...._............... Total leaching area............... ...sq. ft. Seepage Pit No.___Y . ( ) Diameter •. g_. ( ) inlet Total`leaching area..: ._:__sq. ft. __ . ' __ Depth below Z Other Distribution box Dosin nkIc Percolation Test Results Performed,by.___ lm� • - Test �it. No 1 .v;:mmutes'per inch Depth of T sty t it........ Depth Depth to ground water........................ .;�- - Test Ptt. No. 2.... .....minutes per inch Depth.of Test Pit.................:. Depth to ground water........................ 1� tk Description of Soil.__ '.5 .. ° � 14 W 07 • . Mom. _.. . U Nature of Repairs or Alterations—Answer when applicable. __ ... �t _ . i► a Agreement: ...,. The undersigned agrees to install the aforedescribed IndividualhSewage.Disposals,,System in.accordance wig t ""*••- the provisions of TIT 1.;;:. 5 of the State Sanitary Code he n signed f tl:er agrees"not to place the system in Y .. operation until a Certificate of Compliance has b ssu d r t „. D Application Approved By-------•-•------ _ •. ` ..•... - ........................................ hate rY Date Application`Disapproved for the following reasons: ......... .... �::: :__._ ,._. yr ...._._ .. ... ................................................................... - ............................ •--•- Date Permit No....................................••--•-- ---------• Issued --- Date THE COMMONWEALTH OF MASSACHUSETTS BOAR F' . HEAL H 41 a� - ..... ............ OF..,.: .,... .:' ................................................. :. THI S. CER I hat the'-,Individual Sewage�,Dgisposal System constructed ) or Repaired ( ) . 5 C Lly .. Installer �. " - at.. ___..... I... ............... — .__.. �j -•-t 6 F has been installed in accordance with the provisions of T ) of.The ate Sanitary Codedescribed in the application for Disposal Works Construction Permit \T ._ ._._._.� .�' ._.__..._ dated '~jf_ _._ `C '""__________...... THE ISSUANCE OF THIS CERTIFICATE SI° L NOT BE CONSTRUE® AS A GUARANTEE THAT TIME SYSTEM WILL FUNCTION SATISFACTORY. DATE.......................................................................... ins pector..................................y....---••---•-----------._......... ........ THE COMMONWEALTH OF MASSACHUSETTS ' ROAR® ` HEAL H x �• 4 .. ra.. L .. .0F.. t ' ,� ........... F � No............. .. .: .......... Y_ . iq� nrk � in h runt Permission is hereby granted-::; { ...! ......�' ,' E. r... ........... ........................ to Construct . or';Re it ( ) ,nn In4R7UAl Sewa �D�spo`"sal st r e3+x Street r t as shown on the application for Disposal Worls`Construction °Perm�06v, .............. ;t ated '. "" % zrf` t r Board of Health' ` 7 Y DATE. - --• # FORIM 1255 HOBBS & WARREN. INC., PUBLISHERS ? �.�`�}, 3 v t 4. •. 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BSo/L 2 ✓. \ V �Irc�ir Pr s 5r- x k. Rj Q 7-3 1 g 36 B o 7-T a n-? s. . �/•v� _ BG. (d ca.v r `'T y � ,.i cc o Y ;� o�.w c,.o�,• {� i `., `•� \ ��eD .�C.� � 37 � 7'OT:yG ' � � � Q(/�` t - s.9-..,o ram,;So.-I Lc 4''` ,�•.,v u./.Sow-E 3O � _ I 38 `C .1.' STca.^_.�E • .. STo• . E .4 . r 407 MASS 3 � • ' / �' n - { / .!'..., a ,:.. ,. ,. : _:.,•- ,�. . .; :• ... ... ���� ` ' _ ___ lot 40 . 1 _..ate,► ::.mr-4.x- `,lP�+rr� s s+�w ► ar#i� cx , �y�q,�ti/S Ti9 B L E- .6. / ,7won . - _ - ;y ;;+.^nGRY1+' F•'WR3TY:a.apdi.i. ... ib:A'YABrd= :d'„'+:i" :• .. <: x . ... s}:x ...;, r.,. .:. z .• "x..��ra.. 1fY'.+s:.iii�.S.:-.r,-_.' ,� '" "i"' -.w.i•_ r-.#.�rai}...id.. ..:.�.:r+�. ,: Barnstable Harbor LEGEND �/ NOTES SYSTEM STEM PROFILE MARKED WTHCMAGNETIC TTAPE�OR BE 1. DATUM IS NAVD 88 99- EXISTING CONTOUR (NOT TO SCALE) COMPARABLE MEANS FOR FUTURE LOCATION. ACCESS COVERS TO WITHIN 6" OF FIN. GRADE CONCRETE COVERS TO WITHIN 3" GRADE 2. MUNICIPAL WATER IS EXISTING �ooa X 99.1 EXIST. SPOT ELEV. SYSTEM DESIGN.■ 2" PEASTONE OR GEOTEXTILE -[99]- PROPOSED CONTOUR TOP FOUND. EL. 41.85 FILTER FABRIC OVER STONE 3. MINIMUM PIPE PITCH TO BE 1/8" PER FOOT. Po`�ti GARBAGE DISPOSER IS NOT ALLOWED 40.5 MINIMUM .75' OF COVER OVER PRECAST 2% SLOPE REQUIRED OVER SYSTEM 31.0 4. DESIGN LOADING FOR ALL PROPOSED PRECAST UNITS C 198.41 PROPOSED SPOT EL. PRECAST H-10 WATERTEST D'BOX FOR LEVELNESS BLOCKS OR TO BE AASHO H-M Locus TH1 EXISTING 3 BEDROOM DWELLING RISERS (TYP.) MIN. 2" WALL TIdICKNESS PRECAST RISERS a _ c� . 39.4' 4"0SCH40 PVC MORTAR ALL 5. PIPE JOINTS TO BE MADE WATERTIGHT. - _ -- t PIPES LEVEL 1ST 2' �EN 4' COMPONENTS INVERT IN 29.2' 4, �TEST HOLE DESIGN FLOW: 3 BEDROOMS ® 110 GPD 330 GPD (r,rP)DS SIDES 30.03' 6. CONSTRUCTION DETAILS TO BE IN ACCORDANCE WITH 2% SLOPE OF GROUND USE A 330 GPD DESIGN FLOW 10" EXISTING 14" TEE SEPTIC TANK** TEE ®®®® ®®®® ®®�®- �38. * 6' MIN. SUMP o°o°°°°° ®p®®®®®®®®® ®®®®®®®®®®® ° 7: THIS PLAN IS FOR PROPOSED WORK ONLY AND NOT TO e°°°°°°°° ° °°°°° ° ° ° °UTILITY POLE 1- °° 12" MIN. INT. DIM. ;° °°°°°° ®®®®®®®®®®® ®®®®���®®®® '°°°°°°°° r °°°^°^°^ N °°°°°° BE USED FOR LOT LINE STAKING OR ANY OTHER SEPTIC TANK: 330 GPD (2) = 660 �. GAS BAFFLE.., ;ap000000 .o , FIRE HYDRANT **RE-USE EXISTING 1000 GAL. SEPTIC TANK - �..��� 29.47 29.3 '° ° ° •.°o°o°o°0 27.2 PURPOSE. } °tee NOTE: NOT ALL SYMBOLS MAY APPEAR IN DRAWING `H-10 500 GAL. LEACHING CHAMBERS BY ACME PRECAST OR EQUAL. 8• PIPE FOR SEPTIC SYSTEM TO SCH. 40-4" PVC. 3/4"-1-1/2" DOUBLE WASHED STONE 4' MIN. (2) UNITS REQUIRED LEACHING: ALL AROUND PRECAST STRUCTURES 9. COMPONENTS NOT TO BE BACKFILLED OR CONCEALED 6" CRUSHED STONE OR MECHANICAL OVERALL DIMENSIONS TO OUTSIDE OF STONE: 25.00, X 12.83, WITHOUT INSPECTION BY BOARD OF HEALTH AND SIDES: 2 (25 + 12.83) 2 (.74) = 112 GPD COMPACTION. (15.221 [2]) b PERMISSION OBTAINED FROM BOARD OF HEALTH. BOTTOM 25 x 12.83 (.74) = 237 GPD ( 8 % SLOPE) ( % SLOPE) LO 10. CONTRACTOR SHALL BE RESPONSIBLE FOR CALLING DIGSAFE (1-888-344-7233) AND VERIFYING THE TOTAL: 472 S.F. 349 GPD FOUNDATION- EXIST. SEPTIC TANK 106' D' BOX 12' LEACHING LOCATION OF ALL UNDERGROUND & OVERHEAD UTILITIES FACILITY PRIOR TO COMMENCEMENT OF WORK. USE (2) 500 GAL. LEACHING CHAMBERS (ACME OR EQUAL) 11. ANY UIJSUITABLE MATERIAL ENCOUNTERED SHALL BE WITH 4' STONE ALL AROUND 22.2' ADJUSTED GROUNDWATER **INSTALLER SHALL CONFIRM MINIMUM REMOVED 5' BENEATH AND AROUND THE PROPOSED LOCUS MAP*THE INSTALLER SHALL VERIFY THE SEPTIC TANK SIZE AT 1000 GALLONS LEACHING FACILITY. NOT TO SCALE LOCATIONS_ OF ALL UTILITIES AND ALL AND ITS SUITABILITY FOR RE-USE. 12. EXISTING LEACHING FACILITY SHALL BE PUMPED AND BUILDING SEWER OUTLETS AND REPLACE WITH 1500 GALLON SEPTIC _ -- - - - _- _ REMOVED OR._PUMPED_AND FILLED WITH CLEAN SAND. - ASSESSORS MAP--351 -PARCEL---5 -- - ELEVATIONS PRIOR TO INSTALLING ANY TANK APPROPRIATE TO SITE PORTION OF SEPTIC SYSTEM CONDITIONS IF NOT SUITABLE 00 28 2y ?s TEST HOLE LOGS 28 ENGINEER: CRAIG J. FERRARI, SE #13871 OVI 0 IL NE AT 5' S WITNESS: DAVID W. STANTON RS i IN HO N. TOP AT ELE . 30.0', TT DATE: 6/3/2016 26.0't PERC. RATE _ < 2 MIN/INCH 24 ' CLASS I SOILS P# 15070 RE 0 SUITA LE S L ED y 5 AO AR UN ER LEACHING FACILITY f DO TO SUI S0I L E P (FAILED) C N ED. T E S CI AT ON ELEV. ELEV. ELEV. 0 1 .2 i CID z 3 2g (off opt38.0' p» 30.0' p» 30.0' A LS FILL FILL BEN_ EN AR 9„ 10YR 3/2 18„ 16„ � } , 4 / L. - c •\ , LS LS/ 10YR 3/2 10YR 3/2 PAVED 33" 27.3' 32" 27.3' \\ o) DRIVE v 39 38 - \ N \\ C /SiL /SiL o 10YR 6/3 10YR 6/3 , \ 29 60 25.0 58 25.2 0 SiL N\ ,� C2 C2 30 ' 10YR 6/3 23 _ �� M S M S 1 SIEVE 1OYR 7 4 10YR 7 4 � UNSUITABLE / / EXISTING SOIL ' DWELLING TOP OF FND 1 \ EL. 41.85 PATIO 132" 27.0' 120" 20.0' 120" 20.0' \ 1 23 23 ! \ , az NO GROUNDWATER ENCOUNTERED GROUNDWATER ENCOUNTERED AT 108" EL. 21.0 � ,\00.0 G-W ADJ. DATA: �27 \ rn WELL: Al W-247 PATI \ ZONE: B \ ADJ: 2.2' o \• POND \� TITLE 5 SITE PLAN OF 68 COVE LANE LOT 3 CUMMAQUID, MA 2. 62+ AC. i i • a I ,; PREPARED FOR COD SEPTIC/GILBERT39 CAPE o i 27 DATE: JUNE 16, 2016 28 i a 0 i ^� 38 Scale:1"= 30' 0 15 30 45 60 75 FEET ti �� ASS � MASS of MAS ��N of MAoff 508-362-4541 fax 508-362-9880 ti g tN OF M tN OF A N �o DANIELA \';, �o DANIEL'A. y DANIEL ti� o� DANIEL ��� downcape.com 40 o OJALA. 1`"{ OJALA A. A. CIVIL CIVIL" OJF,L.A 0JAL_l1 down cape engineering, /nC. No. 465u, • 6502 No. 098 No.40980 tik A� - ' °���(3s F R�° °��F - �P �,¢i` :R� civil engineers / �� sT� o i -- S G FS c^�� ., � -� Es,�-i� land surveyors SON L �N 939 Main Street ( R to 6A) DCE # > 6- > 64 DATE DANIEL A. OJALA, P.E., P.L.S. YARMOUTHPORT MA 02675 16-164 CAPE COD SEPTIC.DWG