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HomeMy WebLinkAbout0080 CYPRESS POINT - Health 80 Cypress°Point. i� Barnstable F A 349 062 ' e ' w `' TOWW OFIOARNSTABLE a l ATION 80 CYPRESS POINT SEWAGE # 2005-182 ,VILLAGE CUMMAQUID' ASSESSOR'S MAP & LOT -149/42 508-362-6237 INSTALLER'S NAME&PHONE N0. �� 8Ro-THE-S rnnTr— SEPTIC TANK CAPACITY 1 `;®co QL&S'TC 0- LEACHING FACILITY: (type) 41 f i t a'ICAP %N''o T6t 1(siae) /f f X 34 X 10 F` NO.OF BEDROOMS BUILDER OR OWNER MUREIL FEHON PERMTTDATE: 4/29/2005 COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist- on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by v o -All -� CA U3 ti' rr a' i •i�`Y • u.' `� • _ • .� No. � Fee 0��' THE COMMONWEA TH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TO OF BARNSTABLE, MASSACHUSETTS 01p�plica�tion for Mig�p ar 6petem Cou5tructton Permit Application for a Permit to Construct( . )Repair(�)Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. /©7- ✓rP Owner's Name,Address and Tel.No. C Assessor's Map/P cel - 1 PA A- Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. Type of Building: Dwelling No.of Bedrooms Lot Size 37 `f&Osq.ft. Garbage Grinder(1440 Other Type of Building ,O'*&S - No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flowb gallons per day. C lculated daily flow 351 gallons. Plan Date 'e7" Number of sheets Revision Date Title Size of Septic Tank �'-�U® � • �: Type o A.S.A!��A#� /7ibZ /ram✓�%2�'/17�0 Description of Soil. Nature of Repairs or Alterations(Answer when applicable) •z Date last inspected: Agreement: The undersigned agrees to ensure t construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has issu thi o of t - �'� �•�� S ne Date j Application Approved by Date Application Disapproved for the following reasons Permit No. ��0 GJ �gS�` Date Issued C 5 ) -- '!' too No. � Fee --THE COMM ONWEA TH OF.MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION- TO h OF BARNSTABLE., MASSACHUSETTS pYtcation for A i 5p at p5tem Construction Permit Application for a Permit to Construct( )Repair( ).Upgrade( )Abandon( ) ❑Complete System ❑Individual Components .Location Address or Lot No. w f' / ✓ Owners Name,Address and Tel.No. Assessor's Mapyarcel � 7 ' Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. 2 �v M lt�. 3b2' 37S �! G��GSl u� r a � � .-Type of Building: . ` Dwelling No.of Bedrooms Lot Size 3 !,/7,1(Zsq.ft. Garbage Grinder(/Vfp Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow' gallons per day. C lculated daily flow gallons. Plan Date ""' U5 Number of sheets Revision Date Title Size of Septic Tank Type o S.A.S. Description of Soil ` Nature of Repairs orrAlte^rations Answer when applicable).. _�/�s/°"9 !�� / oj'l?;4 f�ii��A)7 5 h Date last inspected: Agreement: The undersigned agrees to ensure t construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of 'tl --,;,,,of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance ha .bee sue is- o of t S gne Date Application Approved by Date Application Disapproved for the following reasons Permit No. O �` Date Issued T'°k�*-PTHE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS , Certificate'of Compliance THIS IS TO CERTIFY,-that the On,-site Se_wage Disposal-System Constructed( ) Repaired ( Upgraded Abandoned( )by ''�� S at 5- Z>o �✓ ��/ has been constructed�54 rdance with the provisions of Itle 5 and the for Disposal Syste Construction Permit o. Jd /I;dated / Installer C'� � 'S , 't = :Designer L— /v ' The issuance of this pegnit/4,l not be construed as a guarantee that the s tamer it f ct• n as designed. Date Inspector —————— —————————————————— ————— No. Fee THE COMMONWEALTH OF MA ACHUSETTS ; . PUBLIC HEALTH DIVISION - BAR ABLE, MASSACHUSETTS a Digogaf *pgtem ongtruction Permit Permission is hereby granted uo Construct( )Repair( )Upgrade( Abandon System located at frf L�--�jL�p_.( i1..C7 S 1.-•=��c 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 condition• . Provided: Co�n,(s"!ctioCn�m}ust be completed within three year of the dat• of this pe \ t. Date:_ it !G Approved by kA!GE- TOWN OF BA.RNSTABLE 10N �U�P�" S 7O nSEWAGE # �Q r►'1 S tab 1 e- SESSOR-S MAP & LOT3`� OGa SEPTIC TANK CAPACITY LEACHING FACILITY: (type) � (size) NO.OF BEDROOMS III BA4fl,HIR-9MWNER PERMITDATE: e COMPLIANCE DATE: Separation Distance Between the: ,r Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by TOWN OF BAI&STABLE {LOCATION SEWAGE # VII,rf AGE ►SSESSOR'S MAP &LOT4� INSTALLER'S NAME&PH NO. S/a�Cyr Iz, I ��� S �rov -V� SEPTIC TANK CAPACITY 1 G G ,),,n; rw LEACHING FACILITY: (type) (size) NO.OF BEDROOMS BUILDER OR OWNER PERMTTDATE: OmptTE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by 4 z io COMMONWEALTH OF MASSAUS_ �F;a'WAS �. EXECUTIVE OFFICE OF ENVIRONMENTALS DEPARTMENT OF ENVIROi"ifiLc O TION TITLE $ J OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 80 Cypress Point,Cummaquid,MA 02637 f Owner's Name:Muriel Fehon Owner's Address: 500 southern blvd.,Chatham,N.Z 07928 �® Date of Inspection:03/23/2005 v�� Name of Inspector. REID C.ELLIS Company Name: ELLIS BROTHERS CONST.CO. Mailing Address: 23 ENTERPRISE ROAD, �® P.O.BOX 59,YARMOUICH PORT,MA 02675 Telephone Number: 508-362-6237 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of the inspection.The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems.I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: Passes nditionally Passes Feelsails Further Evaluation by the Local Approving Authority Inspector's Signature: �L�y Date: 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. /1 Notes and Comments 6 2 /11/;41,11L Y>9"LI/v.., 7 ****This report only describes conditions at the time of inspection and'under the conditions of use at that time.This inspection does not address haw the system will perform in the future under the same or different conditions of use. 1 Page 2 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address:80 Cypress Point,Commquid,MA Owner:Muriel Fehon Date of Inspection: 03/23/2005 Inspection Summary: Check A,B,C,D or E f ALWAYS complete all of Section D A. System Passes: IVd JAI have not found any information which indicates that any of the failure criteria described in 310 CUR 15. 03 or in 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below. Comments: B. System Conditionally Passes: One or more system components as described in I ie"Conditional Pass"section need to be replaced or repaired.The system,upon completion of the replacemei t or repair,as approved by the Board of Health,will pass. Answer yes,no or not determined(Y,N,ND)in the or the following statements.If"not determined"please explain. The septic tank is metal and over 20 years old*oi the septic tank(whether metal or not)is structurally unsound,exhibits substantial infiltration or exfilhudon o 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 structura ly sound,not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is availal ile. ' ND explain: Observation of sewage backup or break out or hi static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken,settled or uneven c istribution box.System will pass inspection if(with approval of Board of Health): broken pipe(s)are r placed obstruction is removed distribution box is 1 veled or replaced ND explain: The system required pumping more than 4 times year due to broken or obstructed i inspection if with pipe(s}.The system will Pass insp ( approval of the Board of Health ` broken pipe(s)are re laced obstruction is remov ND explain: 2 Page 3 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address:80 Cypress Point,Cummquid,MA Owner:Muriel Febon Date of Inspection:03R3/2005 C. Further Evaluation is Required by the Board of H the Conditions exist which require further evaluation by 1 he 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 determin s in accordance with 310 CMR 15.303(l)(b)that the system is not functioning in a manner which will F rotect public health,safety and the environment: _ Cesspool or privy is within 50 feet of a surface i fater _ Cesspool or privy is within 50 feet of a borderin Y,vegetated wetland or a salt marsh 2. System will fail unless the Board of Health(and blic Water Supplier,if any)determines that the system is functioning in a manner that protects the pu lic 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 st pply. The system has a septic tank and SAS and the S S is within a Zone 1 of a public water supply. _ The system has a septic tank and SAS and the S S is within 50 feet of a private water supply well. The system has a septic tank and SAS and the S S is less than 100 feet but 50 feet or more from a private water supply well".Method used to determ' ie distance "This system passes if the well water analysis,perf ed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrog is equal to or less than 5 ppm,provided that no other failure criteria are triggered A copy of the analysis be attached to this form. 3. Other: 3 Page 4 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address:80 Cypress Point,Cummquid,MA Owner: Muriel Felton Date of Inspection:03/23/2005 D. System Failure Criteria applicable to all systems: You,must indicate"yes"or"no"to each of the following for all inspections: Y No , _ 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 -Alclogged SAS or cesspool p Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or spool N R' iquid depth in cesspool is less than 6"below invert or available volume is less than'h day flow. _ uired pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number 46mes pumped eAny portion of the SAS,cesspool or privy is below high ground water elevation _—V�Kny 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 coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria , are triggered.A copy of the analysis must be attached to this form.] (Yes/No)The system fails.I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails.The system owner should contact the Board of Health to determine what will be neces to correct the failure. E. Large Systems: , To be considered a large system the system m t serve a facility with a design flow of 10,000 gpd to 15,000 gpd- You must indicate either"yes"or`no".to each of the following: (The following criteria apply to large systems in i ddition to the criteria above) yes no the system is within 400 feet of a surfs drinking water supply, the system is within 200 feet of a tribut xy to a surface drinking water supply , the system is located in a nitrogen lens' 've area(Interim Wellhead Protection Area—.I WPA)or a mapped 1 Zone II of a public water supply well If you have answered"yes"to any question in ion E the system is considered a significant threat,or answered "yes"in Section D above the large system has fai The owner or operator of any large system considered a significant threat under Section E or failed under 3ection D shall upgrade the system in accordance with 310 CMR 15304.The system owner should contact the a opiate regional office of theL Department. 4 Page 5 of 11 _. OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B a CHECKLIST, Property Address:80 Cypress Point,Cummquid,MA 02637 Owner:Muriel Fehon Date of Inspecdon:03/23/2005 Check if the following have been done.You must indicate`yes"or`no"as to each of the following: Y No Pumping information was provided by the owner,occupant,or Board of Health ere any of the system components pumped out in'the previous two weeks? the system received normal flows in.the previous two week period? e large volumes of water been introduced to the system recently or as part of this inspection? ere 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 luding the SAS,located on site? s _ _ Were the septic tank manholes uncovered,opened,and the interior of the tank inspected for the condition . oP a 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? Th size and location of the Soil Absorption System(SAS)on the site has been determined based on: Yos n 7— Existing information.For example,a7plan at the Board of Health. 7_ Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable)[310 CUR 15.302(3)(b)] 5 f Page 6 of 1 I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION "F Property Address: 80 Cypresss Point, Owner:Muriel Felton Date of Inspection:03/23/2005 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): J? Number of bedrooms(actual): DESIGN flow based on 310 CND 15.203(for example: 110 gpd x#of bedrooms). Number of current residents: yw Does residence have a garbage grinder(yes or no): y Is laundry on a separate sewage system(yes or no); ;O[if yes separate inspection required] Laundry system inspected(yes or no): Seasonal use:(yes or no):_,&� Water meter readings,if available(last 2 years usage(gpd)):_3 j�Pr7e, ?/',e, Sump Pump(yes or no):AIV Last date of occupancy. L4h/ O . COMMERCIALA NDUSTRIAL Type of establishment: Designflow on 310 CMR 15.203 d, (based ) �a Basis of design flow(seats/persons/sgft,etc.): Grease trap present(yes or no):, Industrial waste holding tank present(yes or no):,. Non-sanitary waste discharged to the Title 5 system(yes or no): Water meter readings,if available: _ Last date of occupancy/use: OTHER(describe): GENERAL INFORMATION Pumping Records I ;. Source of information: Was stem um as art o e" "on es'or no):fth system pumped P If yes,volume pumped:,,,04 How was quan' a? ped determined? Reason for pumping: .✓ �ls ow 7E OF SYSTEM Septic tank,disWilnierrbox,soil absorption system ¢' _Single cesspool Overflow cesspool _ivy x _Shared system(yes or no)(if yes,attach previous inspection records,if any) _Innovative/Alternative technology.Attach a copy of the currant operation and maintenance contract(to be obtained from system owner) _Tight tank _Attach a copy of the DEP approval , z _Other(describe): Approximalp age of all componVe stalled 'f known) d source of information: Were sewage odors detected when arriving at the site(yes or no):�O s Page 7 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION.FORM PART C SYSTEM INFORMATION(continued) Property Address:80 Cypress Point,Cummquid,MA Owner:Muriel Fehon Date of Inspection:03/M/2005 BURRING SEWER(locate on site plan) Depth below grade. -�� Materials of construction: cast iron _40 PVC other(explain): 0114AI Distance from private water supply well or suction line: Comments(op condition of joints,venting,evidence of I e,etc.): r `iv 4-ele4iv AR AI/7 ,40-19 SEPTIC TANK: h"ocate on site plan) A Depth below grade: i `� ` Material of construction: concrete metal fiberglass polyethylene other(explain) — — If tank is metal list age:_ Is age confirmed by a Certificate of Compliance(yes or no):_ (attach a copy of certificate) �.It L. n�✓ �� C C Dimensions: Sludge depth: a Distance from top of slud�e to bottom of outlet tee or baffle: " Crl- Scum thickness: 2— Distance from top of scum to top of outlet tee or baffle: 1 �' Distance from bottom of scum to bottom of outlet tee or baffler s How were dimensions determined: Comments(on pumping recommendati s,inlet and outlet ted or baffl6 conditila,structural integrity,liquid levels asselatedto outlet invenmof leakage etc.): , ry A•1 .Sao 3 dvw-,�s rVAl a -4 IV dam-; GREASE TRAP: (locate on site plan) , Depth below grade:— Material of construction: concrete_metal—fibi rglass,_polyethylene other., (explain): Dimensions: Scum thickness. Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee o baffle: Date of last pumping: Comments(on pumping recommendations,inlet and ot tlet tee or baffle condition,.structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): 7 r Page 8 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address:80 Cypress Point,Cummaquid,MA Owner:Muriel Fehon t; Date of Inspection:03/23/2005 TIGHT or HOLDING TANK: (tank must be pum at time of inspection)(locate on site plan) Depth below grade: Material of construction: concrete metal fibe rglass Polyethylene othet(explain): ' Dimensions: Capacity: gallons Design Flow: allons/day Alarm present(yes or no): Alarm level: Alarm in working order(yes or no): . Date of last pumping Comments(condition of alarm and float switches,etc.): DISTRIBUTION BOX:?""(if presentmust be openedXlocate on site plan). Depth of liquid level above outlet invert: - Comments(note if box is level and distribution to outlets equal,any evidence of solids carryover,any evidence of leakage into or out of box,etc.): PUMP CHAMBER: (locate on site plan) Pumps in working order(yes or no): Alarms in working order(yes or no): Comments(note condition of pump chamber,condition of I amps and appurtenances,etc.): 8 Page 9 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address:80 Cypress Point,Cummaqid,MA Owner:Muriel Fehon t Date of Inspection:03R3/2005 SOIL ABSORPTION SYSTEM(SAS): (locate on site plan,excavation not required) If SAS not located explain why: Teaching pits,number: Gs19� /A �. ..� �A�L¢ y -1tj , leaching chambers,number. leaching galleries,number: leaching trenches,number,length: leaching fields,number,dimensions: overflow cesspool,number: innovative/alternative system Typethame of technology: Comments(note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation, etc. : < -�f�G r C lL.ti p GL CESSPOOLS:A fil (cesspool must be pumped as part inspectionxlocate 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(yes or no): ` Comments(note condition of soil,signs of hydraulic faili we,level of ponding,condition of vegetation,etc.): M1 .h •/i0 i9 . PRIVY: (locate on site plan) Materials of construction: J Dimensions: Depth of solids: k Comments(note condition of soil,signs of hydraulic n Hure,level of ponding,condition of vegetation,etc.):' y Page 10 of 11 OFFICIAL INSPECTION FORM=NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address:80 Cypress Point,Cummaquid,MA ' Owner:Muriel Fehon Date of Inspection:03/23l?A05 SKETCH OF SEWAGE DISPOSAL SYSTEM 1 } Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks.Locate all wells within 100 feet.Locate where public water supply enters the building. old, h � r , IUA7M f —=1 ' n ; 10 Page 11 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address:80 Cypress Pant,Cummquid,MA Owner.Muriel Fehon a Date of Inspection:03/23/2005 SITE EXAM Slope Surface water Check cellar Shallow wells G , Estimated depth to ground watejji::::2!9f Please indicate(check)all methods used to determine the high ground water elevation: Obtained from system design plans on record-If checked,date of design plan reviewed: z ObServed site(abutting property/observation hole within 150 feet of SAS) ecked with local Board of Health-explain: Checked with local excavators,installers-( Ch documentation)Accessed }' Accessed USGS database-explain: C �4'l�i�� 1- You must describe how you established the high ground water elevation: _/Z_44— AA) r� ,'jam' ;�3•Z . . 11 . Tiwn of Barnstable %guiatory,Sehices Tlnmas F.Geiler Director ' Pl�lic Health Division Thames McKean,Director ' 02601 • • ,/ 200 Mai Street;Hyannis,-MA =E}tfrea: 50&86246 4 ' Fax: 508-79"304 Insfalier 8c Designer Certifica- Form - Desigaj r: � ET5F2 �'N6i, �sc'�.e6 stailer: L I..J �s 63 ra'T"r3 a-8 Kddress: 35 G;i4w:r W eSrek _ Address: 0( 3 • On _,- O5GL<SF % �5 • Co t to install a ,-- was iwued a pemu (daie) er) septic system at d C J(r r-esS' J'ay}i J' based on a design drawn by' , address)77 - _., dated � e rttfy,t t-the septic systean i4f6•enced above was.b stalled substantially according to 46' y d,inc °n�inar apgrov� cfiges such as Literal relocation of the distnbutioii box and/or septic fi aL, I'certify that the septic system referenced.above was installed with major changes (i.e. greater than 10',lateral relocatioi'o the SAS of any vertical relocation of any component of the se tic,systent but irf accard=ke with.State&Local Regulations. Plan rev is or ' ~ � certified as-built by designer to follow OF d T.A.DUMAS- � f fees Signature) Na 8t9 Le Z_7 spasiivgner's Sigaature}'�- ! (Af x Design 'S Stamp �, .t •., PLEASE R BLIC ff AI. D N. OF CO1Vt IJIA1�dCE WILL I�TC)T E ISSUED UN'�m,BOT THIS FORM,-AND'AS $ITILT C ARE RECEIVED BY THE BARNSTABIE P SIC HEAI,TFi DMSIE3N. THANK aYOU. 4 r Q:Redd2meoc/Desipe'Certification Form • r` 5 n� y�/� Fix. No..--•••••--• ---•-.. . :.................. THE COMMONWEALTH OF MASSACHUSETTS BOARD F HE H L ...�l . 01'1..... ........OF...... . . . ,4 t Appliration for Raposal Marko Tonstrnrtiun Pumit 4slo . Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal Sys ---. ------ rf.. - tion Address or Lot No. -----•---------------- Owner ...........................................Address Installer Address Q Type of Buildi .� Size Lot._Jf, ..Y0...__Sq. feet . Dwelling No. of Bedrooms----------------a------------------------Expansion Attic ( ) Garbage Grinder ( ) 04 Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) P4Other fixtures .......................................................--•----•••-••--....--•.......................i:------- W Design Flow.................... } -...._..._ __gallons per person per day. Total daily flow___-_--____�-------------------------gallons. Septic Tank—Liquid capacity -gallons Length................ Width----------...... Diameter................. Del�til__.._________... W Disposal Trench—No..................... With...... _ . Total Length.........._.... Total leaching area____-_-_____-._. __-s ft. �Tll (r a/j} a r g q Seepage Pit No ........... Diameter... .......... Depth below inlet......... Total leaching are,T. sq. ft. Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by------- ------•----•---••••----•------•---•-...---•--••-•••--•-•-------••. Date---------------------------------------- ,� Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water----__--_-_---___-.----- rl� Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ ►x ------- -- ------- -------------- --•---•---------------------------•----- V O Description of Soil---------------- ----------------- ? ------------------------------------ U ----------------...............-----•-------- =' ------....-•----------......------------.---- -------•----••---•-------•------------.............................•-••------------ W UNature of Repairs or Alterations—Answer when applicable._--_-_-._.-...................................................... __.-___.--------. -----------------------------------•------------------------------------------------....•---•--•-•••----•--------•--•--•....._....------------.-------•------------------------------------------------ Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Article XI of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issue y the boar health. �S) ed -------G------------ ------------ 4j,&,,e Date Application Approved By---- 4 Date Application Disapproved for the following reasons----------------------•-------------------------•----------------•-----------------------....................... •----------••--••-••-•---•-------•-------------------------------•-••-•--•--............6....................----------•--•---------------•-----------•-•-•----•---•-------------------•------•-----•-- --•---Date •.-- Permit No......................................................... Issued... Da e No.._._:'.:_r. . F��V......... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HE4LTH Af of ' OF...... .. � . t Appliration for 'iapiasal Forks (foulitrurtion Vanift Application is hereby made for a Permit, to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at ,, ' ', ' y r a-'✓ ... -•--------------------------------- Y.' . _ f, ation-Address r or Lot No. ..................... ................ ...._.._..._................. $� =•-•-••••••-••--•-••--......-•--------- _.._..._.���y it=-`J- Y.�°ls�r 2���.ijti'•_•• ....................1 Own r Address Insta le��/� Address . UType of Buildin Size Lot_ .....Sq. feet �. Dwelling. No. .of Bedrooms--------------------------------------------Expansion Attic ( ) Garbage Grinder ( ) Other—Type of Building ____________________________ No. of persons:___________________________ Showers ( ) — Cafeteria ( ) a' Other fixtures ------------------------------- - --- -- W �- Design Flow................... _____ _________gallons per person per day. Total daily flow._.__._.__._ _._ :___€ _____- __...... WSeptic Tank—Liquid capacit)t_,:�~___gallons Length________________ Width---------------- Diameter---------------- Depth---._________--- x Disposal Trench No_____________________ Width__ �_______ Total Length.__._._.._____ _-_ Total leaching'area__-_ _________sq. ft. ,,rr !. Seepage Pit No /_________________ Diameter _�;_r__ 11 f . ____ Depth below inlet......... ,....... Total leaching area_6—, _t-,6nsq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by:----------------==--------------------------------------•----•----•--••-- Date.......................... -----• ------ Test Pit No. 1________________minutes per rith Depth of Test Pit.................... Depth to ground water_-___________________-- �, Test Pit No. 2................minute's per inch Depth of Test Pit____________________ Depth to ground water-_____________________ f........................./ - ---------------------------------- 0. Description of SoilL `�' {� C 1 �. r E p --------------•--------------- V -------• ••--•-••------•-•--- ---------••--••----- -•--•-.__.-•• ----------------------------- -- --------------- -----------------------------------------------------------------=--------------------------------------•---------------•----------.-------------------------------------------------- V Nature of,Repairs or Alterations—Answer when applicable................................•...................______________----_-__--.--___-_________.-.. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Article XI of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued;by the board-of health. ` ty Date Application Approved By..... ......—� � _i'�. l -=---------------- } ` `- �' -------- &f 1'� f Date Application Disapproved for the following reasons:-----------•---•-----�---------------------------------------•-------•••---••-----••-•------------------- ------------•=---------------•--•---.._.._-•--•---._....------------•----------------•--•---•-------------•-------------------------------------------•---•--•-----•-••----•-•-------------•-•--------- Permit No....................................................... Issued---- Da --- Dat'e - e THE COMMONWEALTH OF MASSACHUSETTS BOARD OFF H7 H ` r1 OF. ,. ..................................:........ Tntif irate of Tnniptiana. THI S TO CERTIFY, t the Individual Sewage,�oDisposal Sy9ste constructed ( or Repaired (. ) Iler > has been installed in accord19 i e with the provisions of Article XI of The State Sanitary Code,as desf ribed in the application for Disposal Works Construction Permit No________________ __ dated ; ._ " _r._r� • --:_____.._. PP P _ '- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL UNCTION SATISFACTORY. r DATE Inspector fir' -11-- --------- ---------------- THE COMMONWEALTH OF MASSACHUSETTS ., B0ARD,9F HE�AVTH r I x j .......... r ` FEE_ :__ 9inVosa - orkii %;AM 1V rtion it Permission is hereby granted .. < __ �,. � � __ ._ ______________ __..____. to Construct ( ) or.Repai,r,( ).an Individual Sewage Disp�isal System at'No, rP xl' t I__a i_. = Q:4 .. s�" e --- iJti,w °? r °xs s. A F lam`✓_Y �/ •Street Ff as shown on the application foi/Disposal Works Construction Pelf-i2it N rr _n..... Dated...• - ---------- .. , s r ...........-- ......�s��` 1 sue' g - -- -------- Board of Health] / x� DATE....... ----- '----------- -----•..._ FORM 1255 HOSES & WARREN. INC., PUBLISHERS, - - �Wr3 20 FT. MINIMUM FROM CELLAR SOIL TEST TOP. OF FOUNDATION DATE OF SOIL TEST APRIL 6. 2005 10 FT. MINIMUM FROM SLAB OR CRAWL SPACE SOIL TEST DONE BY EF 00.00 CLEAN SAND WITNESSED BY - {ASSUMED) CONCRETE TS„F,�FNGIN RING _\ w INSPECTION PORT ELEV. ----- 10 FT. MINIMUM COVERS LOAM AND SEED 08SRVAll0N H= 1 . ELEV.m 88.60 4" SCHEDULE 40 PVC PIPE PERCOLATION RATE MIN./INCH AT __LCL_ INCHES MIN. PITCH 1/8 PER FT. 2"l LAYER QF /2#1/6 TO 1 DEPTH HORIZ TEXTURE COLOR MOTT. OTHER 9.00 WASHED STONE A X. $9.10 MAX VENT 0-8 A LOAMY SAND 10YR3/1 NO ROOTS v 92.50* 4" CAST-IRON PIPE 6- MAX, 86.85 MIN. NOT REQUIRED SLAB ELE.. (OR EQUAL) MINIMUM PITCH 1/4- PER FT. 8-38 B LOAMY SAND 10YR5/6 ROOTS FLOW 1 38-132 C MEDIUM/ 2.5Y8/4 o" NE 86.10 COARSE SAND \"-ELEV. 91-00 MIN. ;v 88.40 Lj 0'o ELEV. ----- VEL lo ELEV. 84.77 oi ELEV. -06A5 GAS SUMP ELEV. 88.00 im ELEV. BAFFLE DISTRIBUTION LIQUID OUTLET ELEV.. BOX DLPTH TEE 4 HIGH CAPACITY INFIL7RArORS WT� STONE INCHES (TO BE PLACED ON FIRM BASE) TO BE WATER TESTED Z 7.17, 4 FEET 14 5 FEET 19 INCHES IF MORE THAN ONE OUTLET hV AN 11' X 36' X 10:_ TRENCH FORVA 17ON 6 FEET 24 INCHES 1500, GALLON (TO BE PLACED ON FIRM BASE) WELL N/A NO WATER ENCOUNTERED AT '- 132- ELEV. 77.6Q- 7 FEET 29 INCHES SOIL ABSORPTION ZONE 8 FEET 34 INCHES SEPTIC TANK 3/4- TO 1 1/2- CLEAN J INDEX DOUBLE WASHED STONE SYSTEM (SAS) ADJUST FREE OF FINES 6c SILT DESIGN CALCULATIONS USGS PROBABLE WATER TABLE ELEV. = NUMBER OF BEDROOMS 3 -- SEWAGE DISPOSAL SYSTEM PROFILE OBSERVED WATER TABLE ELEV. = GARBAGE DISPOSAL UNIT NO NOT TO SCALE BOTTOM OF TEST HOLE ELEV. = TOTAL ESTIMATED FLOW 110 GAL/SR./bAY X 3 9FQ GAL./DAY 98.5 REQUIRED SEPTIC TANK CAPACITY GAL. ACTUAL SIZE OF SEPTIC TANK _1500 GAL. SOIL CLASSIFICATION DESIGN PERCOLATION RATE MIN./IN. 94.1 97.1E EFFLUENT LOADING RATE 0 J-4- GAL./DAY/S,F. 98.8 LEACHING AREA SQ. FT. (41X36)+(47X2X10/12) LEACHING CAPACITY. (AREA X RATE) 1-5,10 GALJDAY 99.0 474.33 X 0.74 I ( \ \ Q/�T RESERVE LEACHING CAPACITY .35LK GAL/DAY �3 NOTES: x 8.7 Iv 0-,<02.5 1. ALL WORKMANSHIP AND MATERIALS SHALL CONFORM TO D.E.P. TITLE 5 AND THE TOWN RULES AND REGULATIONS FOR THE SUBSURFACE DISPOSAL x 9 2.9 OF SEWAGE. 2. ALL COVERS TO SANITARY UNITS SHALL BE BROUGHT TO WITHIN 6" OF --25.2 FINISHED GRADE. 104.1 3. ALL COMPONENTS OF THE SANITARY SYSTEM SHALL, BE CAPABLE OF 96.7 WITHSTANDING H-10 LOADING UNLESS THEY ARE UNDER OR WITHIN 10 FT. OF DRIVES OR PARKING AREAS. H-20 LOADING SHALL BE USED UNDER OR WITHIN 10 FT. OF DRIVES OR PARKING AREAS. 97 98.2 4. ANY MASONRY UNITS USED TO BRING COVERS TO GRADE SHALL BE MORTARED IN PLACE. ��,7/,,w t 1 5. NO DETERMINATION HAS BEEN MADE As -To COMPLIANCE WITH DEEDED OR ZONING REGULATIONS. OWNER / APPLICANT IS TO OBTAIN SUCH DETERMINATION FROM APPROPRIATE AUTHORITY. 98.5 UTILITIES SHOWN ARE APPROXIMATE ONLY, EXCAVATION CONTRACTOR ;1,87.9 8.5 9 9. IS TO CALL "DIG-SAFE" AT 1-8887344-7233 AT LEAST 72 HOURS 95.2-) 99.0 PRIOR TO COMMENCING WORK ON SITE. 11-1 'm:, 1 .2 7. CONTRACTOR IS TO VERIFY GRADES AND ELEVATIONS AS WELL AS x 1 SITE CONDITIONS PRIOR TO COMMENCING WORK ON SITE. ANY x 8B�q 9.4 x loo/ VARIATION IS TO BE BROUGHT TO THE ATTENTION OF THE DESIGN 91.6 t A,/s ENGINEER IMMEDIATELY. 927 13 77Atc 99 8. PARCEL IS IN FLOOD ZONE c 9. LOT IS SHOWN ON ASSESSOF�__M_AT___A�_ AS PARCEL _ 42 ' 13 p• ( 004i 9. 10' EXISTING SEPTICS ARE TO BE PUMPED AND BACKFILLED. 4.1 11. ALL UNSUITABLE MATEIAL .SHALL BE REMOVED FROM UNDER AND FOR A MINIMUM OF 5' AROUND SOIL ABSORPTION SYSTEM AND BE REPLACED 3. J�k 0*VA WITH SAND AS SPECIFIED IN 310 CMR 15.255:(3). - 1101. 91.2 T.JAk. 5 DUMAS va 91.3 2 93.f 1 x 94.4--�- APPROV. ED: BOARD OF HEALTH 91.2 - �_ 1-1 72 0.0. ti 01.5/ cis 96.7 C 3 105.4 I-Izp o .5 .9 DATE AGENT 50 GALLON %SEP TANK 1-90.8 96\. PROPOSED SEPTIC DESIGN FOR IEL r ERON • go.r, �3.5 LOC. ao� C)�PRLPSS POINT l3All?lqSrrA Blr_,.Avu-., MASS. 36.00 -Y-1- t"�ILIM� I ,��_ .--,�'.R�-S-� SAS/,/ J, � IT 6F 5' (-CLJ&4MA QUID) DIG ti LOT 180 MRCZ 7 'zt 111) C-) m 39,462 .t 5F ("3 '. 235 GREAT WESTERN ROAD 508- P. 0. BOX 713 398-3922 SOUTH DENNIS, MASS. LEGEND: LOCUS , r 90.5 EXISTING SPOT ELEVATION 00,0 DATE 6, 2005 SCALE 1 „ 20$ EXISTING CONTOUR ----00---- FINAL SPOT ELEVATION M_ 1 PO \1b FINAL CONTOUR SOIL TEST LOCATION REVISED JOBSCALE1' 100' NO 61611-00 UTILITY POLE "b TOWN WATER -W .v.v I CATCH BASIN REVISED A 102AGAS LINE -0 SITE OVERVIEW LOCATION MAP SHEET I Or 1 CESSPOOL CP CLEANOUT C. 58\PROJk6161-00 dwg\6161-sas.DKV C2005 t'WEETSER ENGINEEPINGJ