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HomeMy WebLinkAbout0095 CYPRESS POINT - Health 95 P,,ypress Point Barnstable P A = 349 010001 A v o e ^ o- p � a v y p TOWN OF BARNSTABLE / LOCATION 5 &0 b L SEWAGE # >vt -n ASSESSOR'S MAP & LOT 3Y9-0 064 r INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY: (type) L.-mat, pl t- s (size) TLI&n NO.OF BEDROOMS BUILDER OR OWNER PERMITDATE: COMPLIANCE DATE: P kb Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility 7 Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) N/, Feet Edge of Wetland and Leaching Facility (If any wetlands exist within 300 feet of leaching facility). Nl'`� Feet Furnished by��` } �� _ 3Y' 14; TROY WILLIAMS L SEPTIC INSPECTIONS Certified by MA Department of Environmental Protection (508) 5b5-1500 19 Hummel Drive South Dennis, MA 02660 COMMONWEALTH OF MASSACHUSETTS EXECUTIVE, OFFICE OF ENVIRONMENTAL AFFAIRS, DEPARTMENT OF ENVIRONMENTAL R TITLE 5 MAR 1 8 2004 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY 4TTSaBLE SUBSURFACE SEWAGE DISPOSAL SYSTE ORI%LTH DEPT. PART A CERTIFICATION ,3�y MAP Property Address: 95 Cypress Point Cummaquid,MA PARCEL ' L Owner's Name: Dorothy Douglas LOT � 1 Owner's Address: C/o Greg Holmes 72 Bay Road,No.Falmouth,MA 02556 Date of Inspection:. March 16,2004 \l v Name of Inspector: Troy M. Williams CcCompany Name: Troy Williams Septic Inspections Mailing Address: 19 Hummel Drive South Dennis,MA 02660 Telephone Number: (508)385-1300 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. 1 am'a DEP approved sN stem inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system• ./ Passes Conditionally Passes Needs Further Evaluation by the Local Approving Authority Fails Inspector's Signature: Date: 3 //b /o y The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of I lealth 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: Notes and Comments Although system meets the minimum requirements set forth by the Massachusetts Department of Environmental Protection,certification Is not to be construed as a guarantee of future working condition of system,piping or components. This inspection represents the conditions of the system on the Date of Inspection noted above. ****This report only describes conditions at the time of inspection and under the conditions of use at that `time. I his inspection does not address how the system will perform in the future under the saute or different conditions of use. Title 5 Inspection Form 6/15/2000 naee I ar I I 41 Page 2 of I 1 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 95 Cypress Point Cummaquid,MA Owner: Dorothy Douglas Date of Inspection: March 16,2004 luspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes:, JI have not found any information which indicates that any of the failure criteria described in 310 CN 15.303 or in 310 CMR 15.304 exist. Any led are indicated bel failure criteria not evalua 1R ow. Comments: B. System Conditionally Passes: One or mores stem components „ Y nen repaired. The system, u on completion of the replacement or repair, l Pass"section need to be replac or p p p p approved by the Board of He will pass. Answeryes. no or not dete rmined Y N( ,ND)in the for the following statements. If determined"please explain. The septic tank is metal and over 20 years old" or the septic tank(wheth metal or not)is structurally unsound,exhibits substantial infiltration or exfiltration or tank failure is im ` ent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by th oard of Health. 'A metal septic tank will pass inspection if it is structurally sound,n eaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND explain: Observation of sewage backup or break o of high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken,settled even distribution box.System will pass inspection if(with approval of Board of Health): b en pipes)are replaced i obstruction is removed distribution box is leveled or replaced ND explain: The s to required pumping more than 4 times a year due to broken or obstructed pipe(s).The system will pass ins p ton if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed ND explain: s. 2 f 'Page 3 of l l OFFICIAL INSPECTION FORM -NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM ' PART A CERTIFICATION(continued) Property Address: 95 Cypress Point Owner: Cummaquid,MA Date of Inspection: Dorothy Douglas March 16,2004 C. Further Evaluation is Required by the Board of Health: Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. I. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b) at the system is not functioning in a manner which will protect public health,safety and the envir ment: — Cesspool or privy is within 50 feet of a surface water — Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt mar 2. System will fail unless the Board of Health(and Public Water pplier,if any)determines that the system is functioning in a manner that protects the public heal ,safety and environment: _ The system has a septic tank and soil absorption s em(SAS)and the SAS is within 100 feet of a surface eater supply or tributary to a surface water ply. — The system has a septic tank and SAS the SAS is within a Zone I of a public water supply. _ The system has a septic tank and AS and the SAS is within 50 feet of a private water supply well. - The system has a septic to - and SAS and the SAS is less than 100 feet but 50 feet or more front a private water supply well" ethod used to determine distance This system y m pass f the well water analysis,performed at a DEP certified laboratory, for coliform bacteria and Vol 'e organic g compounds indicates that the well is free from pollution from that facilityand the presence ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure c 'eria are triggered.A copy of the analysis must be attached to this form. I 3. Other: . r 3 P "Page 4 of I 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) 95 Cypress Point Property Address: Cummaquid,MA Dorothy Douglas Owner: March 16,2004 Date of Inspection: . D. System Failure Criteria applicable to all systems: You must indicate"yes"or"no"to each of the following for all inspections: Yes No Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool _ ,-j/ Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ___ ✓ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS of cesspool ✓ Liquid depth in cesspool is less than 6"below invert or available volume is less than.%a day flow ✓ Required pumping more than 4 times in the last year NQT due to clogged or obstructed pipe(s).Number of times pumped ✓ Any portion of the SAS,cesspool or privy is below high ground water elevation. — N►,,o Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. Niq Any portion of a cesspool or privy is within a Zone I of a public well. — y t6 Any portion of a cesspool or privy is within 50 feet of a private water supply well. - N/A 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 S ppm,provided that no other failure criteria are triggered. A copy,of the analysis must be attached to this form.] A/D (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 necessary to correct the failure. E. Large Systems: To be considered a large system the system must serve a facility with a desi 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 addition to the criteri ove) yes no the system is within 400 feet of a surface drinkin ater supply _ — the system is within 200 feet of a tribu o a surface drinking water supply _ — the system is located in a nitroge nsitive area(Interim Wellhead Protection Area—I WPA)or a mapped Zone H of a public water sup well If you have answered"yes"to question in Section E the system is considered a significant threat,or answered "yes"in Section A above the ge system hits failed.The owtter pr operator of any large system considered e significant tjtreat under S _ ton E or felled under$action A sh4jjiupgcade the system in accordance with 310 CMR 15.304.The system o, ..or should contact the appropriate region#!Office of the Department. 4 t Page 5 of 11 OFFICIAL INSPECTION FORM -NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART R CHECKLIST Property Address: 95 Cypress Point Cummaquid,MA Owner: Dorothy Douglas Date of Inspection: March 16,2004 Check if the following have been done.You must indicate`yes"or"no"as to each of the following: Yes No (::;:.ping information was provided by the owner, occupant,or Board of health ✓ Were any of the system components pumped out in the previous two weeks _ Has the system received normal flows in the previous two week period / Have large volumes of water been introduced to the system recently or as part of this inspection? _ I Were as built plans of the system obtained and examined?(if they were not available note as N/A) _ Was the facility or dwelling inspected for signs of sewage back up .) Was the site inspected for signs of break out ' ✓ _ Were all system components,excluding the SAS, located on site'? ✓ _ Were the septic tank manholes uncovered,opened,and the interior of the tank inspected for the condition of the baffles or tees,material of construction,dimensions,depth of liquid,depth of sludge and depth of scum? ✓ — Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage d F p disposal stems t; � Y The 'size and location r of the Soil Absorption System(SAS)on.the site has been determined based on: Yes no _ _✓Existing information. For example,a plan at the Board of Health. _ Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable)[310 CMR 15.302(3)(b)] t Page 6 of l 1 OFFICIAL INSPECTION.FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address:95 Cypress Point Cummaquid,MA Owner: Dorothy Douglas Date of Inspection:March 16,2004 RESIDENTIAL FLOW CONDITIONS Number of bedrooms(design): Number of bedrooms(actual): 3 + ) ;„ {,a,� DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): Yyo t�w�t�4J� Number of current residents: I Does residence have a garbage grinder(yes or no): V s Is laundry on a separate sewage system(yes or no):I,lo (if yes separate inspection required] Laundry system inspected(yes or no): .�iq Seasonal use:(yes or no):Lvo Water meter readings,if available(last 2 years"tsage(gpd)): 0 3-uy - /oo,,,00 j� ,�� f o - Sump pump(yes or no): No Last date of occupancy: COMMERCIAL/INDUSTRIAL Type of establishment: Design flow(based on 310 CMR 15.203): __gpd 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 syste (yes or no): Water meter readings,if available: _ Last date of occupancy/use: --- OTHER(describe): GENERAL INFORMATION Pumping Records Source of information`. Ova . Let. Was system pumped as part of[he inspe tion(yes or no): ivo If yes, volume pumped: gallons--How was quantity pumped determined? Reason for pumping: TYPE OF SYSTEM Septic tattle,distribution box,soil absorption system _Single cesspool _Overflow cesspool _Privy _Shared system(yes or no)(if yes,attach previous inspection records, if any) _Innovative/Alternative technology.Attach a copy of the current operation and maintenance contract(to be obtained from system owner) _Tight tank —Attach a copy of the DEP approval Other(describe): Approximate age of all/components.date installed(if known)andsource of information: 7 O t10 Were sewage odors detected when arriving at the site(yes,or no): nto 6 f - ' Page 7 of I OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 95.Cypress Point Cummaquid,MA Owner: Dorothy Douglas Date of Inspection: March 16,2004 BUILDING SEWER(locate on site plan) Depth belcm grade: 18" 4- Materials of construction: _cast iron ✓40 PVC mother(explain): /+ ao ! A/C- Dictance front private water supply well or suction line: N/g - Comments(on condition of joints,venting,evidence of leakage,etc.): C H 7 au+� c.I 'f- r_,J-e-C. ,r,•. SEPTIC TANK: ✓ (locate on site plan) Depth below grade: Io„ 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) Dimensions: 6 •3 'x iv• s' ' x r I ,Soo Sludge depth: 5-1. Distance from top of sludge to bottom of outlet tee or baffle: A ' '7 Scum thickness: T4-.,,_(�.y�� Distance from top of scum to top of outlet tee or baffle: " Distance from bottom of scum to bottom of outlet tee or baffle: iy How were dimensions determined: Pw Comments(on pumping recommendations, inlet and outle—t tee or baffle condition,structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): �.....A .Uu -L /,,I fc� ww� ti wTos� r.. __o.oC.r �(j c✓.��_Ncco/°' GREASE TRAP:_(locate on site plan) Depth below grade:_ Material of construction:_concrete_metal fiberglass ethylene_other (explain): Dimensions: Scum thickness: h Distance from top of scum to top of outlet tee or ba Distance from bottom of scum to bottom of outle ee or baffle: Date of last pumping: Comments(on pumping recommendatio ,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of akage,etc.): Page 8 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address:95 Cypress Point Cummaquid,MA Owner: Dorothy.Douglas Date of Inspection:March 16,2004 TIGHT or HOLDING TANK: (tank must be pumped at time of ection)(locate on site plan) Depth below grade: Material of construction: concrete metal fibergl _Polyethylene other(explain): Dimensions: Capacity: gallons Design Flo%%: gallons/day Alarm present(yes or no): Alarm level: Alarm in workin rder(yes or no): Date of last pumping: Comments(condition of alarm a oat switches,etc.): DISTRIBUTION BOX: ✓ (if present must be opened)(locate 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.): J ��I�Oh 11�J�-s 1D ,-.�1 wo✓ / n.- ct /' lw� c < v� / S ✓u a✓� J� c a+`✓yc� c�jv dl� S0.c �✓h p�3 f 74 J. _ —, — 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 mps and appurtenances,etc.): 8 F ' ,~Page 9 of I OFFICIAL INSPECTION FORM—NOT FOR VOLU NTARY ASSESSMENTS E MENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 95 Cypress Point Cummaquid,MA Owner: Dorothy Douglas Date of Inspection: March 16,2004 SOIL ABSORPTION SYSTEM(SAS): ✓ (locate on site plan,excavation not required) If SAS not located explain why.. Type leaching pits, number: o? - 6 x 6 ' L a:. (� p; {-T i,, leaching chambers,number: leaching galleries,number: leaching.trenches,number, length: leaching fields,number,dimensions: overflow cesspool,number: innovative/alternative system Type/name of technology: Comments(note condition of soil,signs of hydraulic failure, level of ponding,damp soil,condition of vegetation, et 4 N rG1 C- . L�t p.,'t- ) 7 N✓� W / / 'I (/d { w I t tit i —I w —� .. 6•� w i r� 1 i ✓ I Z S l u,•.i a+ �,� h.C.U./'� i ..S I'.'� �'�•u�- �t/a � �.J..c....�.�.� o �� ,(✓e.J !.: C 44 • + -r CESSPOOLS: (cesspool must be pumped as part of inspection)(locat n site plan) ✓ Number and configuration: Depth-top of liquid to inlet invert: -- - --- Depth of solids layer: Depth of scum la%er: Dimensions of cesspool: Materials of construction: Indication of groundwater inflow(yes or n Comments(note condition of soil,Sig f hydraulic failure, level of ponding,condition of vegetation,etc.): PRIVY: (locate on site plan) Materials of construction: Dimensions: Depth of solids: Comments(note condition of soil,signs of hydraul ilure,level of ponding,condition of vegetation,etc.): y A" F x Page 10 of I I OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) 95 Cypress Point Property Address: Cummaquid,.MA Dorothy Douglas Owner: March 16,2004 Date of Inspection: SKETCH OF SEWAGE DISPOSAL SYSTEM 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. A 1) i3 is A r `) O i Soo �r a4 '"Page I I of 1 OFFICIAL INSPECTION FORM— NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 95 Cypress Point Owner: Cummaquid,MA Dorothy Douglas _ Date of Inspection: March 16,2004 SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water 3 7 feet Adjuslcd high ground wafer elevation — feet Please indicate(check)all methods used to determine the high ground Hater elevation: Obtained from system design plans on record- If checked,date of design plan reviewed: . _y Observed site(abutting property/observation hole within 150 feet of SAS) Checked with local Board of I lealth-explain: Checked with local excavators, installers-(attach documentation) v Accessed USGS database-explain: u S y s ^ �L, z r- /3 2 H.3 You must describe flow you established the high ground water elevation: — V S C, ✓.K u qy .yam w�-,.( ...,,�...- I•,.�l.. This report has been prepared and the system inspected as of the date of inspection. This report is not a r vyarrenty or guarantee that the system will function properly In the future. There have been no warranties or x.= guarantees,either expressed,written or Implled,relating to the systent,the inspedIon and/or this report. 11 LO`CAT10 SEV'ACE PERMIT G0• c .5-e�, V ft VA G E ASSESSORS MAP NO: 3 I v ->.� PARCEL Irv- 01 INSTA LLER'S aACOE & ADDRESS BUILDER OR OCypER � Q DATE PERE31T ISSUED a2 DAT E C 0 M P L I A N C E ISSUED ►�„ „�� �. ... Y ,.� �� � - � � � y rVl �� '��.��4 I l� .,/,.'. O. v .� .r• . . '�� �,, •�,. .r' � � • ;. � ,.: � � �� a � �� 1 \ Ae�. �.�^�< �� ` ' �i1 1 - . 7%�° �5�� (o� a S) TOWN OF BARNSTABLE � LOCATION SEWAGE # VILLAGE / rkg SA.12 >er' ASSESSOR'S MAP & LOT-? INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY /� 0 LEACHING FACILITY: (type) 1,0 (size) X NO.OF BEDROOMS 3 BUILDER OR OWNER PERMITDATE: 24 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 i GG� L A705 y 019 J '/W 1/ slonelOcIpi s 3s s� s ASMSORSMAPNQ' PARCEL N0: No....... .. Fes$..1........._............ THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH TOWN OF BARNSTABL.E Allp iratiou for Di.1jivniitt1 Warkii Tomitrurtiun Permit Application is hereby made for a Permit to Construct (, -S or Repair ( ) an Individual Sewage Disposal System at• .1. �}...-----�/Ze'f-joL,q..vD L/ / - Cvf9ai.� vd0 � ..............•--•--------...-----••-- Location-Address or Lot No. ,�Z/J .J &ZG N0/L I 3 Owner ® S� Address a ...................•.. ! !J.H ........................w............ �ld.H� /d�!f ............................... installer Installer Address d Type of Building Size Lot..�_ ...Sq. feet Dwelling—No. of Bedrooms--------------�-_---_-______-__---__._-_Expansion Attic ( ) Garbage Grinder ( ) PLO Other—Type of Building ________________________ p -._----..-_---.--- Showers ( ' ) — Cafeteria ( ) dOther fixtures ------------------------------------------ -- ----------------------- -------------- --------------•-------------------•---...................... ersons.__....._. W Design Flow-------- .................................... flow............................................ WSeptic Tank—Liquid capacity! �+2_.gallons Length_/�?._�'...._ Width_..'�_._`�.".__ Diameter---------------- Depth._ 8"_-_ x Disposal Trench—No- -------------------- Width-------------------- Total Length-------------------- Total leaching area....................sq. ft. Seepage Pit No-------- _-__.---.- Diameter._---- ----- Depth below inlet...... -------- Total leaching area-_- ...sq. ft. z Other Distribution box ( ) Dosing.tank ( ) `" Percolation Test Results Performed by....�e. .._f, ...w � ............................. Date__��..N�-__.!`� 159SJ aY----------------- ,.] Test Pit No. l--- -4n-_--minutes per inch Depth of Test Pit._.1,5��"----- Depth to ground water-----—------------ - (X4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth-to ground water........................ . Description of Soil--- ---- •`-......---- --..a --....--.=..=..;/--------`3 -----�------•--------t=------c--!y---grip-------. V .---------------------------------------•--------------------...--------------------------------------------------------•--•---------•---- W --••-•-------- -------------------------------------------------------------------------------------- -----------------------------------------........................................................ UNature of Repairs or Alterations—Answer when applicable.--:.__-.._.................................................................................... ............................................... ••-••----•-•---•••-•--------•--•----••---•......--••--..... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliant been issued by the board o health. Siqed .... .. ----------------- ---.----------------------------------------- ------ Application g7 .Approved BY ... _. ..... ..... ............................._. .....------------------------. -...----------- / Dace Application Disapproved for the following reasons- --------------------------------------------------------------------------------------------------------------------- ................... ......................----------------------------------------------- Permit Da- No. ---------.L.-! P ..._.._............._ Issued ------------- --� -�- �s' ------- Daze 1 1.... l� THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Alip irtt#ion for Divi-vttiittl ldnxli ,,. it #r�tr#tnn ernti# Application is hereby made for a Permit to Construct (✓S or Repair ( ) an Individual Sewage Disposal System at: �2or70/_4 vv L�.�t G•MA1iA¢u10 �Y V Z5" . --------------------------------. ....--•------- -. --•--•--.......--------- --••------------------••-- -••-••-----...----••. ......---..............------..-----...--- Location-Address or Lot No. ......................DUA/A L/�--.T ••�•�ZL...Owner Address ----------------------�� 1...... .............................................. plt...---------..........------•-•------ ���-- (H ............ --------- Itutaller Address Of Type of Building 3 Size Lot__ _ - ....Sq. feet Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ---------------------------- No. of persons---------------------------- Showers ( ) — Cafeteria ( ) dOther fixtures -----------• ----------------- -------------------•---------------------------------- ---------•------•--•-•-•--•--------•----•--------•----------- W Design Flow.................''`-ter__-____-_--___-_..gallons per person per day. Total daily flow............................................ WSeptic Tank—Liquid capacity i S°O_gallons Length!v'q'--_-_ Width__ - '�_ Diameter---------------- Depth..s��---_ x Disposal Trench—No- -------------------- Width.................... Total Length-------------------- Total leaching area....................sq. ft. II 3 Seepage Pit No...-----/----------- Diameter------�.z _.... Depth below inlet------6........... Total leaching area..?A�-Z...sq. ft. Z Other Distribution-box ( ) Dosing tank ( ) Percolation Test Results Performed by.__-Ga.W--. __.�'�/Gz-CG-�L Date_ N�:___�`� a p Test Pit No 1..G_Z-_____minutes per inch Depth of Test Pit-_/J;A-. _-__- Depth to ground water----- _---_--... 44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water......................... 9 -----------•-------------------•-•--•--••••••---••••--•-----------•••---------------•--•••-••-------......................................................... U" ��" �a Jc113 -laic. 0 8¢v_ /!Z`' MG�icr�i =s I-A16 - Description of Soil. - ;r---------------------------- ------ x UW -------------- -----------------------------------------------------------------------------------------------------------------------------`........................................................... 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 TITLE 5 of the State Environmental Code—The undersigned further agrees not to.place the system in operation until a Certificate of Complianc a be n issued by the board o health. - — . Dare Application.Approved By %L - - Y� �.- / --------------------------- Date------------ Application Disapproved for the following reasons- ------------------------------------....---.........._----------------------- ---------......--------._....------------------- ................................ ...-------------------------------------------- --------------...................................._.......-----------------------------------------.....---- ........................................ Date Permit No. ........ r` - Issued ���.... ................ Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE lLertifirate of (u1 jamplianre THIS IS TO CERTIFY, Thar the Individual Sewage Disposal System constructed ( V") or Repaired ( ) by -------------------------- --------------.....----------------------------------------.....-- ----.-----.. ----------- ------------ ---------------------- ------------ -----------------------------------............... Installer( ,C. a6 at --------1.1k_.._. ...._ .P.j.....6 74a, ------( . 4- has been installed in accordance with the provisions of TITLE 5 of The State Environmental Code as described in the application for Disposal Works Construction Permit No. VECONSTRUED . SD . dated ---3--'.o?I-_-�_-2,-—_---- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT AS A GUARANTEE THAT THE SYSTEM WILL F/UNCTION.SATISFACTORY. / DATE,r.'./...` �-----.------_...................................... Inspect& ---�% �----- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE No..... ................. FEE.---.................. Uispniitt1 orkiinn�uai #fir r#i�n anti# Permission i ereby granted � n.....IZ-.._��_�.,--------------------------------------------------------------------••-----.........-- to Construct (v ) or Repair ( ) an Individual Sewage Disposal System at No. ... a t'-` - -f-r! CCI� a- - ................. Street n as shown on the application for Disposal Works Consctign Permit-No.rS- r_------ d--____ --. �.-...5 ...... Board of Health DATE...............�.----J�--f---- ------- FORM 36508 HOBBS at WARREN.INC..PUBLISHERS LOCATION SCALr_ . .!�:-."`�f''. . . DATr ,T�?✓, Z¢ /f?-S57 70 70 PLAN RCFERCNC!_ /AS S/YoW.0 DN, /q-, IfC. .385 ._7b' — P�vpo s� 97 . . . . . . . . t-A 7v 43E Cee?9l2Eb 74 �--- Z z 76' • ` j I �i / a o a t Qox TAT Z pTN Q�r �, V ob dF C/1TGH LL�Y E!. LLu GIST, Do���p T,' lil` -T- or Z. o;c- Z .s/V&3rT.V L. . . 7Z,00 •. TOP OF FOUNDATION e CONCRETE COVER CONCRETE COVERS S3yi •'0 4' CAST IRON II "MAX. OR SCHEDULE 402 � 12"MAX. 4"SCHEDULE 40 PVC.(ONLY) P.V.C. PIPE PIPE - MIN. LEACH PITCH 1/4"PER.FT. PITCH 1/4"PER.FT. PIT PRECAST o'o INVjRT�/ , �O Q ••;:: LEACHING EL..... . INVERT INVERT o . e•; PIT OR SEPTIC TANK �� �S' DIS7. S-8 '� ° EQUIV. INVERT EL... .' . . . . . BOX ELl:..<./.. >s /Soo, •• GAL. INVERT INVERT JCL 3 4 ELGsgB.. ww 0• ':�' WASHED2 o � EL6s%.So.. �� J••: w .r• STONE /o. .ro �— DIA PROFI LE OF GROUND WATER TABLE SEWAGE DISPOSAL SYSTEM NO SCALE SOIL LOG WITNESSED BY : DATE JoyE !9 18s'TIME. �"'' 'y T. Ce?A-140,.v BOARD OF HEALTH TEST HOLE I TEST HOLE 2 LoGd $� •Wi .Tv�'. ENGINEER ELEV. . 7/.So. . . ELEV. .. .. . . . . . . iC4n, DESIGN DATA : gy NUMBER OF BEDROOMS S�4•So TOTAL ESTIMATED FLOW , 33D GALLONS/DAY �C. BOTTOM LEACHING AREA SO.FT. /,PIT/C.p D. /` &voem SIDE LEACHING AREA . . !'�0,-P . . . SQ.FT./ PIT/a?o•/ SAwa C•P.D. GARBAGE DISPOSAL !V--46. (50 % AREA INCREASE) TOTAL LEACHING AREA SO.FT PERCOLATION RATE 4E7S,7714'hv 7'w-. , MIN/INCH LEACHING AREA PER PERCOLATION RATE j.Z SQ.FT/. epp. No. .WATER ENCOUNTERED NUMBER OF LEACHING PITS APPROVED BOARD OF HEALTH 7 !�"�T �'c'37a'�!�vs✓ /�3'LG S/DES. DATE . . . . . . . . AGENT OR INSPECTOR u" �, F -.0M Of �bq LO;r Z.r E7 ` r' h. .2 bT[1SCf1' LLInY "J,t ',� PETITIONER DdNACD J:•�c2E,gs�roe f�/�S '"�'"'i^� 'UnrtAeft�� 1 No. - !Z� ` Fim... �. ................. THE COMMONWEALTH OF MASSACHUSETTS 0 0 o®t --�— BOAR® OF HEALTH L.... %�/.......--- ..OF.......13.Z 66�723..R.!-r.6.................--- Appliratiou for Diiprrial Works Tuntitrurtion famit Application is hereby made for a Permit to Construct or Repair ( ) an Individual Sewage Disposal ystem at: [ :SS.....�®jN;r'..-•---...----••--•---------. ................................ ...1�.,� S Ci ✓: i Location-Address or Jot No. r Ow er r Address Installer Address !7 e d Type of Building Size Lot.&42.7..........Sq. feet U Dwelling—No. of Bedrooms...._.. Expansion Attic ( ) Garbage Grinder pa Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) Q, Other fixtures � o ' W Design Flow._ .l_�................................gallons per...per-per day. Total daily flow............ ...............gallons. WSeptic Tank—Liquid capacity/4?®M.gallons Length<9.-6_ Width. _=Ae_ Diameter................ Depth... ...... x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No------�..-------• Diameter._,l Depth below inlet._�.FT..... Total leaching area.6-34....sq. ft. Z Other Distribution box V) Dosing,tank ~' Percolation Test Results Performed by. .................... ...... :..._`NF ��I�ate.._.. . /7.�.....-__.. aTest Pit No.' 1__ __L.-minutes per inch Depth of Test Pit----,l __- Depth to ground water............... (i Test Pit No. 2--: ..minutes per inch Depth of Test Pit--- Depth to ground water---------- -------•---- ---------•--•-•----•--••---•••......--•-•-•-•••------- .._.................. --------- ............................. O Description of Soil `- �° - ���, vY3Si c� Gr - „��� •v °� ''� ---------- J�,S t. ' - O JT-•---.Y,0 ` �--C r>'1e�•..................................... cj_-_. .�.l •n U Nature of R0airs-e:-3^-�'t� ' answer whe 2ppl' ble_____` _ _ ..__ G- ._._...._... U42 Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of'T`: y g g p y 5 of the State Sanitary Code— The undersigned further agrees not to lace the system in operation until a Certificate of Compliance has been issued by the board of health. Signed. ------ --------- -----------------•--•--------------------- Date Application Approved By !! ! --------------------- ....f•Z - 2 7 Date - Application Disapproved for the following reasons:...........................................: ------•---•-----••........................•.. .........._ -----------•....- Date PermitNo......................................................... Issued__.... _ Date r1���---------- (7"�01Z" THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..►A/' .............._OF....... ........................ Appliration for Uhipoii al Workii Tonitrurtion rantit Application is hereby made for a Permit to Construct (/) or Repair ( ) an Individual Sewage Disposal System at: L..d.`L 2�5...----•-�c�i.v ............................. --• -_r%�._ ... . ............. Location-Address or Lot No. ......................__........................................................................ _.._..--------•............._.._.........................._....._......._.......................-- Owner Address W •••----------------------------------•••••-•---................................................... --•....--•--------•-------•.......---•--------•-------....................._...nG-•••••---••-•--•--. Installer Address /r t Type of Building Size Lot_4_©.7......___..Sq. feet Dwelling—No. of Bedrooms..........?•�.......:........................Expansion Attic ( ) Garbage Grinder (J() aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) al Other fixtures __________________________________ .< . ------------------------------------------------------------------------------------------- Des>gn Flow_ U_________________________________gallons per-: sen per day. Total daily flow........... .. _gallons. W �.. WSeptic Tank—Liquid capacityh?...gallons LengthR.`6._.. Widthsax.:':�U._ Diameter________________ Depth. . ... x Disposal Trench—No..................... Width................'....Total Length.................... Total leaching area....................sq. ft. Seepage Pit No..... .......... Diameter_1_/J.FT.. Depth below inlet._. .E ....... Total leaching area53 ....sq. ft. Z Other Distribution box Dosing tank ( ) W/4c/19/" 1- i Percolation Test Results Performed by. -----_--.--1---_et. :..._"! «�"date_.__ .? 7.%__..___.... a ,-a Test Pit No. 1..G..Z___minutes per Inch Depth of Test Pit....f20-.-V_.__ Depth to ground water___________ _______ (i Test Pit No. 2--- __ ....minutes per inch Depth of Test Pit__. . _.._ Depth to ground water------------ ------- -------------•-•----•-----------------......•-••-••......--•••••••... Description of Soil <---- -- ------- -�------------------•-----------------------5-------�---------- U -=.1f `- �.r -=L--- ----- --- ..- JU�.4........ /4 4�_Sri `=. s��D--�-•--5�"-!.fit= S U Nature of Rea - er- te�Answer wherappl cable_.__-�� GG1' .�- ft '2 '� ''� ........................................' . �- �` -•--••--•• ----- ` d -: ...�' - .:............. Agreement: The undersigned agrees toinstall the aforedescribed Individual Sewage Disposal System in accordance with the provisions of" 5 of the State Sanitary Code— The undersigned furthelr agrees not to place.the system in operation until a Certineat.e of Compliance has been issued by the board of health. Signed = --------------•------•--•-------------•-- _ D�S e �. 6 Application Approved BY (/!� ..............•••-----•. --:. ------- Date Application Disapproved for the following reasons-----------------------------•------------------------------------------------------------------------........_._ ------------------•--...--•----------•••...----•---------•--•-••-••-•-••••=•----••-•-...........-•--------•••--•-----------•...------------------------------------------------------------------------ Date PermitNo......................................................... Issued-......................................................... Date a< THE COMMONWEALTH OF MASSACHUSETTS BOARD O HEALT ..........`.�... .........OF.*...... ................... �rrtifirFatr of Tontphatirr THIS IS CERTI That the Individual Sewage..,Disposal System constructed ( or Repaired ( ) by....... �// �j I staHer at -�--P--- _ _ <l7 has bee installed in accordance with the provisions of TI > of The State Sanitary Code as escribed in the application for Disposal Works Construction Permit No_______ ________----Z.j............ dated---.- ........... THE ISSUANCE OF THIS CERTIFICATE SMALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATI................................................................................. Inspector....------------------------------------------ .................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH 7y � � ` `>c .....i ..0"?�! !..........OF......... . . 3 No............. ....... FEE.... ta �a k� ntritr#ion r100-01 rtnit Permission ereby granted.... _ .. '`'���-------------------•-------------------------------------------........................ to Constr)4_1 or pit ( an Individu Se rage D' posal System Street as shown on the application for Disposal Works Construction P it No = ? .'-'�f..... ' J Dated ... ----- ••�� DATE----. .......................................... Board of Het/ FORM 1255 HOBBS & WARREN, INC., PUBLISHERS ��, 1 �n '�' of�a a'F :¢ �"r � •s *`' d;d � � K � ' 4 l :e i r t...n r h� a tz - d Y ,t•"'"/ r v � � t ,r`e;�t� i FF t p ,,.-:. t -.t + r r3 r k �1 r �`P 9�ja � � y�1�.�5'fi"'�' x..>Z,;aSd r���"�^t�� i� °1 i�d�t;''�'4 a ,.� :t ,�+w, *•: 3r�€ ��� n1`':it Sa22M.r �' r r �hv.f�� �� _ter kAl sue'- �' k ,4Nk} pt�Cldfj��,.t+TY 5 +r:,�t�.t^.�5� sv va''1{,.,r�S%te k .^r v :,,t r } '? 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I I I'_''��, ,.-.,��, .!"L��_,�',."�'�,­,�,r,9,", ',:11 , .'?_�,q'- - ., .L� ,i�,,� '. -, ". -I 11 Is .,�,,,, L, -11,llll��--�11, -- �,_ _� :�,�,"�', �� ",I I��21.,ME 1*";, A ,. I,,I I I llll�I I", MMQIM,� " , _� , a I, I "", ,� .1 " Town of Barnstable P# 92 30 Department of Health,Safety,and Environmental Services of Public Health Division Date 618106198 �. 367 Main Street,Hyannis MA 02601 enexeteatE MAM TFor9. �x+IN Date Scheduled �yta. 2S� 1g.9 Time 10:CO A tOOa Fee Pd. ; Soil Suitability Assessment for Sewage Disposal = Performed By: lie LANO&7?J /•E Witnessed By: 67• 06VWVIIUC? LOCATION & IrNItaRAL INFDRNIATIgN Location Address 0 er s Name DAgI� MA►K)% ddress 3Z AC-IZE. RILL MC)AO F SA2a ST�c3L.E Assessor's Map/Parcel:' 33 4 10•0 2 Engineer's Name NI�.MA.rJ G1Z.c�5Swl,aaJ NEW CONSTRUCTION _� REPAIR Telephone# 5' a -(c)2p 0 Land Use Slopes(%) Surface Stones. .Now Distances from: ,Open Water Body � 2.� ft Possible Wet Area 47eS. ft Drinking Water Well TOW N6NG t Drainage Way Ot35. ft Property Line ZS ft Other ft SKETCH:(Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands in proximity to holes) �- - z �Z 85�x _ a N . D' c1(Pt2S 14 Parent material(geologic) _, l r, . ,�j (t. .Depth'to Bedrock Depth to Groundwater: Standing,,Water in Hole: ti�o�� Weeping from Pit Face Estimated Seasonal High Groundwater r DETERIYIINATIQN EURSEASONAL HIGH WAmIt.:'t'ABL ::;.::: :.::...> . Method Used. Depth Observed standing in obs hole: p(�j$ , • in. Depth to soil mottles: in.. Depth to weeping from side of obs.hole: in. Groundwater Adjustment (t Index Well N7. -Reading Date:j _ Index Well level. _ Adi.factor O,�� Adj.Groundwater Level_ PERCULATIICIN TEST Hate tz,meO:ft . 2� G ets IS LAW1.. Observation• 5t� . . Hole# _ 2- -Time at 9" Depth of Perc GO Time at 6" Start Pre-soakTime� �.Zt �0.50 � � 7 ® � Time(9"-6") End Pre-soak Rate Min./Inch 45� 45 Site Suitability Assessment: Site Passed Site Failed: Additional Testing Needed(YM) Original: Public Health Division Observation Hole Data To Be Completed on Back Copy: Applicant 1 >b�1�P d�3SElY�,ATtdN HOI.1��bG 771 `: Hn1e# Depth from Soil Horizon Soil Texture Soil Color Soil Surface(in.) Other (USDA) (Munsell) Mottling (Structure,Stones,Boulderes. %Gravel) b it d 4. 5"— 2c}" 5 1oy12 6•/6 il_ $•, C L MY soya, .4/6 46- lzo .. G 2.5 6 DEEP OBSERVATION;HQLE h�G.:`': :`':: Hole.:#. �, Depth from Soil Horizon Soil TextureHSoilColorSoil ... ..... Other Surface(in.) (USDA) Mottling (Structure,Stones,Boulderes. tit' r7 ' 24u-ram`' G H toy0- Go- Zii C 2•s 6 D 0.... Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in:) (USDA)_ (Munsell) Mottling. g (Structure,Stones,Boulderes. ° DEEP OBSERVATIONillOLE Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell); Mottling (Structure,Stones,Boulderes. ° 1 ! Flood Insurance Rate Man• Above 500 year flood boundary . No_ Yes Within 500 year boundary No— Yes Within 100 year flood boundary No_ Yes Depth of Naturally bccurring Pervious Material Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the area proposed for the soil absorption system? 65 If not,what is the depth of naturally occurring pervious'material? Certification I certify that on LA IN (date)I have passed the soil evaluator examination approved by the Department of En •ronmental Protection and that the above analysis was performed by me consistent with the required tramin ,expertise and experience described in 310 CMR 15.017. Signature Date to-Z"el