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0146 FLINT ROCK ROAD - Health
146 Flintrock Road ' Barnstable }„ 0 41 v 4 n 4. 0 'CATION SEWAGE PERMIT NO. FA a 3 2 ILLAGE CMSTA LLER'S MANE 8 ADDRESS l 1 , L 1 i B U CL D E R OR OWNER DATE PERMIT ISSUED ��/� DATE COMPLIANCE ISSUED Lzo Is(- t t O r��r No.- Q6._3. ..�- F�s......s�4 THE COMMONWEALTH OF MASSACHUSETTS � BOARD OF HEALTH ------......�l�......0 F............... .......... Appliration for Di-spIIiial Workii Tiamitrurtion Vernfit Application is hereby made for a Permit to Construct (�) or Repair ( ) an Individual Sewage Disposal System at............. ----...-•-- ... ... L .... --- ! , Location Address �D�_ �? _/.- GL/, or Lot No. ---•......................•....._... ..._.................................. _... .... J ..............._ ......._.......... ... Owner e � �V 1 Aaaras........ ......-..... �• ---...----•............................. --- c Ins4311er Address Type of Building Size Lot--- f...:.. ...Sq. feet U Dwelling—No. of Bedrooms............. ..........��..._........_...............Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) A4 Other fixtures ----------------------------•-•. W Design Flow............................................gallons per person per day. Total daily flow..................�i�l .........gallons. 94 W Septic Tank—Liquid capacity_J�gallons Length................ Width................ Diameter---------------- Depth................ x Disposal Trench—No..................... Width.............__.__.. Total Length.................... Total leaching area... J�.-_ ..sq. ft. 3 Seepage Pit No--------------------- Diameter.................... Depth below inlet.................... Total leaching area.......•.../..__....sq. ft. Other Distribution box ( ) Dosing tank Z Percolation Test Results Performed by............................ ........ ......� `°�--. Date.-_.._______..�1..����J. a� Test Pit No. L. W� minutes per inch Depth of Test Pit.................... Depth to ground wate ........................ f= Test Pit No. _ _._minutes per inch Depth of Test Pit.................... Depth to ground water........................ P+ --,..........................................ooe.................................... 0 Description of Soil-•----.......-•-•-----------------•-•...... . -----•... ----------------••----•-•-•-•- U •••-•--•-•-•••---•-•-•-•-•••••---•---•-•-•----•......-•-----•-•....................•••---......._....-• --------------------•--•• ----•-------•--•-•----------•--•--•---•------•--•----_----•- W -•-•••--------------------••---••--••-••---•--••••---••------•-----••-•••--•---•----••----•--•--•••---•---•-------------•---•--•-•-------••-•--•-••.....-•----•••••--••-•---•--........................ VNature 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 TITLL 5 of the State Sanitary Code—.The undersigned further agrees not to place the system in oper t n u it a Certifi to of Compliance has been issued by he board of h th. ��%� Signed. .................... -• -•---.----. ...----•/ ...._... .... . a Application Approved'By.._-••-••-•---•-•-•--•--•-•-----• •_.. ... �°L..._ t,� Date Application Disapproved for the following r ons:--•----•-•-••••••-------•-•--•-----••---•-----•••-•--•-----•--•--•-•••---•---••--•----•---.........•-••--..... ..............................--•...---••----•-------•-•••-•---------•••••-•••••-------------------•--•----•-•••-•------•--•---•--•-----••--•••---•-•-••---•-•••-•-•-•-•----•---•----•..........--•---. Date PermitNo....................................................... Issued....................................................... Date ����-. ------------------------------------- >r1V �t .... .3 Fas...... .. ....... THE COMMONWEALTH OF MASSACHUSETTS r ,. BOARD OF` HEAL-ru V d'y . .............. -- ................OF...........................:.... _............... Appliratinn for Disposal Works. Tonift.rurtinn amit Application is hereby made for a Permit to Construct (j�) or Repair ( ) an Individual Sewage Disposal System at: 5ation-Ad s or„I o, No. ............ ••...-••-- --••-- _---• •------•..:...........•--••-•-•- ...... 6.01..A. / �.' ... O ner ess w ... :.d a , . - ......tl'�... Instal Address d Type of Building Size Lot... fpp��.11_,,2�` .Sq. feet U Dwelling—No. of Bedrooms............ . --------------------Expansion Attic ( ) Ga>'bage Grinder ( ) a aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) d Other fixtures --------------------------------------------------------•-••----•---------••••--••••-•--•-•-••--------••....--•••--•-- c W Design Flow............................................gallons per person per day. Total daily flow..._.......__.__....._......._....._.gallons. 04 W Septic Tank—Liquid capacity.j.�.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 ( ) Percolation Test Results Performed by...................... e, ...... . ....... Date......... . ... ..... Test Pit No. I. minutes per inch Depth of Test Pit.................... Depth to ground w er -------------•-- f=, Test Pit No. .._..fninutes per inch Depth of Test Pit.................... Depth to ground water........................ W ................................ .................................. .........K._._.__.._.....:�------------ _---___----___-_______________--. �... Description of Soil......-•-•-----------•-------•-•-----_••--. -••-•----_-----• ---------- -------------•- ---•••--------•-•--- x w - _ -- U 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 Sanitary Code—.The undersigned further agrees not to place the system in oper tion until a Certifi to of Compliance has been issu d by the board heal - :� Signed. O�at�e - Application Approved 'By..••-------------•••---_..... �. ----- -------------------- .. ...... .............. ............. ._._..----- APPlication Disapproved for the'following re ons:-••----•----•---••-•--•--------•----•----••--------•---•••-•••--•-•-••-•------•-•-•---••••.. •---••••••-•--. --•--•-------------------•---•---..._.........-------------•--••-•------------....._........_........_..............----•-•-------------------------------------------------------------•------=•----•-•- Date PermitNo......................................................... Issued-....................................................... Date 1. THE COMMONWEALTH OF MASSACHUSETTS BOARD �HEA .................. _..•...OF....... ....... .............................. ......................... Trrtifirat a of Bout liana THIS IS T09 CF IFY, That he Individual Sewage Disposal System constructed ) or Repaired ( ) by ........... f �...= --------- ::: / Installer s has been installed in accordance.,gwith theo$visions of TITLE 5 of The State Sanitary Code as described in the application for Disposal Works Construction F*,gnit IN'6.................................' 11 ------- dated................................................. THE ISSUANCE (>�4YHtl�`'CERTIFICATE J. HA k-NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEMWILL FU TIOIJS�TFCT@1RY ° DATE................1�J.... � �94 ,_ -.......ra e ns `tor................... ---•- .............................................. alai - y MONWEALTH OF4T�VSACHUSETTS ./ BOAIW6'4 OF EALT nkc.................... .. ..# ...... 1iu41uuttl ko Tonstr ion Permit Permission s hereb ranted... ----- -t.. . 1 y, ............. to Construct or Re air n Individu Sew a l�is System at No.............. .... ..�.�...._. -----•---•-•---------•--------•-••-•.......................'•- Street 9c-33 , as shown on the application for Disposal Works Construction Permit No......... .......... ated_...__.___.'��{�-�-.......-.-:--, ------------------ ............................... DATE..................... _.. ................................... oa FORM 1255 A. M. SUL IN, INC., BOSTON 4 i } _ /"JORE �T..NAv /2."•BELOK� " •------ t-.�- ` ..;, /-O taT. /„y./.,f-- ...-__ ._..... - ------ .:. __ -.._ ;r.-s- J_.._._.. .._.-- ---.--:_ ._._._�.'I:.OE_r�'4 .:24 -0.7AM•' .''-'ER-E'Diy ,�'_-�- - - - - ;. s'NALL°-®F ,®.POUG,y7` T : G,gA p C, ., `G'O3�E•� 9G•S t �NCR�TE M/N. PfTCN h'E.41 Y Cam+S T /•eO/v CO`/ f � ' A-2 ' MiN. CONCRL�'TE GRADE !� is bCNEDUt6$O ',' - •LAYER � 0 a o � a o o C]F ��B p-��® ►.. b M/N. P/TGN /o O d GAL. D/ST,' , • . . • . • . . e o f e. . 'PAR / T. SPT/C TAMfC Q �„ . • , . • • • . 1 . ,. iYASHED SJO/4fE t. . z BOX v o . 1 8 s r • • • .e n �° ° a v P 1 1 •EFFECT/V� � ' . . 3 .¢ _. / �2 t w ` : . ►.1 • OBPrA • • 1 • v WA,�1/,EP STONE `p ,7.:4 = 5� • °- ,�,� 1 f 1 • • o • . '. o p P i`777 . O. &3= �j�(= -_,�,� •' v. . �' � 1 N o o . • • . .' v ,•� PiPEG45 T SEL<PAG E ti T o i • • • o . 1 e o P17 OR EQL//V. 1Nt/�RT ZrLEVAT/l,N,S YS . P t�. (, r /NY�RT AT.:B/J/LD/NG %fllL4�7" .SEPT/G' T.4Nf�t' q/S FT _ FT. O/f7M. C(S�� TAS[fL.4TaoN� OtlTL'ET SEPTIC TANS Fr T DiSTRiB ION BOX . �o.. FT, - GROUND ►14ATE/R TALE ! uT. - SECT/O/V aF No Oi/TLETDISTRlQrlTioN t-tar 90 7 FT - SEWA66 01S)DOSAA L .SY.S7 /W l/VLET'LEACHIM- .�/:T 90.5 FT T�154lLAT1ON LEACH!/VG F'/T K •- o" oIMENSiON A FT. . ITCALE O.ES/G,V C'R/TER/A D/M.ENS/ON �%UMSER OF'BE�ROOH9.S 3 D/NJE'NS/ON C FT.PiN G.ARBAGEO/SPOSAL lJM/T_MIAIM SOIL. LOG. : TOTAL EST/MATED FLOry 3 OQ GAL.1DA4Y SO!-4, Sr #/ SO/l_' TEST#,2 NUMBER QFr..-A Col ING f9/�S�:.: �_ . f^EtGsY. ZK' r`-E=[�Y, ,DATE OF SOl L TEs7P' S/OE L�AGH/NG PEt� PlT Sly P7. 0'-2 LOAM i RESULTS 6VlTNESSED BY :M GO 90TTOM L r-AcA-oNG PAR '17. l��t33 SQ° FT. . d ply .oeRCO[AT/ON RATE ? TOTAL`LEAC/�/NG AREf� _1 Q SQ. FT.' .• Sv$.� F�E'RCOLAT/ON RA7� RESERi�E.LE�G'HlNG AREA FT. /o C.9 �.. WEINaE G. '���. �` .: a •" � 'vl � to t. .. : °/� ', '' ELOREDGEE/VG/NEER/NG C'O,INC �;�� ?s' ja`` 5. "'� ��'Er.E �. QQ .` • 7./2 MAIN ST. NYANNf5 MASS. L ;'�f t NG GROUND .YY�Q T�f$ E/VCOUNTE.�EO G /ENT;. �j. ¢, Q' GRO u/VO -v-A rER A7' FsLE(/. ND. SHEET OF: Z. I' I1}'YI.ICA7 },'()R 11-IRCOLATION 7 .. ! NO. TION — DATE GE pJ — — ICANT� !/ FEE_ Non-refundable..)! ESS / TELEPHONE NO. ` i, VEER TELEPHONE SC}}EDULED r (A plic nt' s signature ) . . . . . . . ... . . . O O O • O • . 4 O • • • O O O • O O O • • • • • • • • • • O • • • • • • • • • • • • • • • • • • O O • O • • • O O • Y • • • • • SOIL LOG YVISION NAME DATE -3/fps ; TIME 1o1Q"�� � -- , SIGN AREA: YES NO ; _ _ (h� G�S ENGINEER ' WATER_,�RIVATE WELL M i' ��e-,✓'u�� �1 BOARD OF HEALTH EXCAVATOR H:' (Street name, etc. , dimensions of lot, exact location of test holes and percolation tests , locate wetlands in proximity to test holes ) NOTES : n p o 0 v' 't. n 03. ------------- V � �30 .�.,� 2•Gs- �y :OLATION HOLE NO: ELEVATION: TEST HOLE NO: ELEVATION: 2 ✓Z 5 U,��,oci. 2 3 _. _...-. 3- 4 - ---- 4' ---- 5 - 5- 6 6 7l2 '{ , ; 8 8 9 9 . 10 10 • 11 --__ - 11 12 12 _ - 13 _ rJa 13 1* 14 15 _ _ 1S 16 T 16 FABLE FOR SUB-SURFACE SEWAGE: LEACHING FIELD LEACHING PITS LEACHING-TRENCHES L JITABLE FOR SUB-SURFACE SEWAGE.. REASONS: - E ; ENGINPERING PLANS MUST SHOW NUMBER ASSIGNED ON PERC TEST APPLICATION .� TOWN OF BARNSTABLE LOCATION I )ir%-1 ROCK RJl SEWAGE# 2013 - 1$7- VILLAGE .Qo rn54a51 C- ASSESSOR'S MAP.&PARCEL S/?" INSTALLER'S NAME&PHONE NO. Aron 77 - G$3 �X ctx�la► y D SEPTIC TANK CAPACITY ,D BOA RQa1 CkC c m c,nA O+N 1 Li LEACHING FACILITY.(type) (size) NO.OF BEDROOMS OWNER Tohn Ou► n✓\ PERMIT DATE:S)ZO 1 13 COMPLIANCE DATE: S•30 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 or%` " 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 At- SL/ o A z• 61 BZ- 3 a-, 0 A3. 75 � 83 � A • •; 2 A C3 R ESA, c 0 ti No. AO Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:J� Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS 01ppliLatlon for Disposal 6pstem Construction Permit Application for a Permit to Construct(k) Repair(Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. Fi`of R oa Q C)AA Owner's Name,Address,and Tel.No. J-b h n 0 U( n p Assessor's Map/Parcel bar n s+a b l e �" l q�FI i A+ 964 96. J o a-11( -q 15 d Installer's Name,Address,and Tel.No. 6*6 Excava on Designer's Name,Address,and Tel.No. MTeaber(jW,Forestdale, 5o8-41--no?) N/A Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided gpd Plan Date Number of sheets Revision Date -- Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) of HID DisfribirU 0 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 ofluealth. Signed Date 1-1 13 Application Approved by M,AVVt Date Application Disapproved by Date for the following reasons Permit No. Date Issued '•` .i � _ ^� - Fee No. VU THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: I Yes M _PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS f Tipplitatlon for Disposal 6pstem Construction Permit Application for a Permit to Construct(X) Repair(Upgrade( ) Abandon( ) ❑Complete System El Individual Components `$ Location Address or Lot No. Owner's Name,Address,and Tel.No. So h`� nj J� n n Assessor's Map/Parcel barn Sin 1)i e, �I 1��t �b�� �� Installer's Name,Address,and Tel.No. x(ti cici on Designer's Name,Address,and Tel.No. Iq Teo ber(j fin,roresfA(►I e 5oB-4i-i-oj�,6 N/A Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided gpd Plan Date Number of sheets Revision Date =t: Title Size of Septic Tank_ Type of S.A.S. { Description of Soil Nature of Repairs or Alterations(Answer when applicable) 5 ( T J115fribuhonAox 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 o ealth. Signed - Date 5 (1 13 Application Approved byG Date a Application Disapproved by Date for the following reasons Permit No. ( �j ( Date Issued ' THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS i Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired Upgraded( ) Abandoned( )by ( o V/,t_� l o n at 14 b T1 l n t Po(—L EQ has been constructed in accordance with the proyasigns oTitle 5 and the for Disposal System Construction Permit No. dated Installer ( ` Designer t I #bedrooms Approved design flow gpd r The issuance of this permit shall not be construed as a guarantee that the system-will-function-as&signed. f /� Date ) _.; ' 1 Inspector ___ _ _ - _____ _ _ ____ __._-_ --.___ _-__. ___ _____________ __ ____ _____ _____________ No. Fee THE COMMONWEALTH OF MASSACHUSETTS j PUBLIC HEALTH DIVISION -BARNSTABLE,MASSACHUSETTS F Disposal *pstem' onstrnction Permit Permission is hereby granted to Construct( �) Repair( ) Upgrade( ) Abandon( ) System located at � y�i ( I(�'� ��(�( �U/�� ---Rri(F)s-1 r�_b �:t 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. r Provided:Construction must be completed within three years of the date of this permit. Date / 3j Approved by j , AsBuilt Page 1 of 1 LOy"AT10N " SEWA'CE PERMIT N0. � r t-fi� ii2Gc-k" 3 3 Z_ h Ram,.-,k tr3 6 G. a a INSTA LLER'S )NAME b AD,DRESS B 11 CLD E R OR;, OWpER . t m. . DATE P'ERMITr I.SS.UED DATE Cf0MPL1ANC' E , f551l ED �zo j5h •r Via- - w. f L.©1 8 r http://issgl2/intranet/propdata/prebuilt.aspx?mappar=316080008&seq=1 5/9/2013 Commonwealth :of Massachusetts . _ - Title 5 Official lnspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments M 146 Flint Rock Road Property Address John Quinn Owner Owner's Name "w information is required for every Barnstable MA 02601 5/1.1/13 page:.. tY _:. :,..r N: .y p p :. Ci /Town State Zi Code Date ofins ectlon Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness.checklist at the end.of the form. Important:When filling out forms A. General Information on the computer; use only the tab .1. . Inspector: -' .. - key to move your cursor-do not--- Matthew Gilfo .. y use the return: -• :,- � ' .. key. Name of Inspector B & B Excavation;Inc. :p Company Name .14 Teaberry Lane :. Company Address . Forestdale MA:- 02644 __ . City/Town State I Zip Code 508-477-0653 :. - .: ;. S113640 Telephone Number License.Number _ r B. Certification I certify that I have personally inspected the sewage disposal system at this address and thathe s information reported below is true, accurate and complete as of the time of the:inspection. Th:6 mspS.e tlon was performed based,on my training and experience,in tlie'proper function and mat itenancq Qf on*te .. sewage disposal systems.. I.am:a DEP approved system inspector pursuant to Section 1.Z405 Title 5(310 CMR 15.000). The`system: t: !: ❑ Passes f �, Conditionally Passes ❑ ,Fail!: ? m:. Needs Further Evaluation by the Local Approving Authority 5/13/13 , Inspector's Signature... .... .. A". Date The system inspector shall submit a copy of this inspection reportao-the Approving Authority(Board of Health or.DEP)within 30 days of completing this inspection. If the systerh is a shared system or. e , 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 originalshould be'sent to the system owner and copies sentto.the buyer 'if:applicable, and the.approving_authority ""This report only:describes conditions at the time.of inspection and under-,the conditions of use :- at that time.This inspection does.not address how.the system.will perform in the future under. :. the same or different conditions:of use ' • t5ins•11/10_.: "' Title 5 Official Inspection rVbsurfaceewage:Disposal System Page 1 of 17' .. Commonwealth of Massachusetts W Title 5 Official Inspection Fora Subsurface Sewage Disposal System Form - Not for Voluntary Assessments L °M 146 Flint Rock Road _ Property Address John Quinn Owner Owner's Name information is Barnstable MAY 02601 5/11/13 required for every - page. City/Town State Zip Code Date of Inspection B. Certification (cont.) - Inspection Summary: Check A,B C,D or E/always complete all of Section D A) System Passes: r li ❑ (have not found an information which indicates.that an of.the failure criteria described" Y Y in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: - . t B) System Conditionally Passes: . ® One or more system components as described in the "Conditional Pass" section need to be, replaced or repaired. The system, upon completion of the replacement.or repair, as approved by- the Board of Health, will pass.. Check the box for"yes", "no"or not determined' (Y, N, ND)for the following4 statements. If"not. determined," please explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. ` y *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑,N ❑ ND(Explain below): D-box is deteriorated and must be replaced l5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 Commonwealth of Massachusetts F ti W Title 5 official' Inspection Form - Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 146 Flint Rock Road Property Address John Quinn Owner Owner's Name information is required for every Barnstable MA 02601 . . 5/11/13 page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes(cont.): . ❑ Observation of sewage[backup or break out or,high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box:System will pass inspection if(with approval of Board of Health): broken pipe(s)are replaced$ ❑}Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed„ ❑ Y ❑ N . [—]'ND (Explain below): ❑ distribution box is'leveled or replaced ❑ Y " [:],'N ❑. ND(Explain below): n ❑ The system required pumping more-.than 4 times a year due to broken orobstructed pipe(s). The system will pass inspection if(with approval of.the Board of Health): ❑ ;broken pipe(s) are replaced ` ❑ Y -❑ N ❑ ND (Explain below): ❑. "obstruction'is removed ❑ Y- 2,'❑ N ❑ ;ND (Explain below): 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. .1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the`system is not functioning in manner which will protect public health, safety and the environment: ❑. Cesspool or privy is within 50 feet of a surface water _ „❑ Cesspool or privy is within'50 feet of a bordering vegetated wetland or a salt marsh t5ins•11/10` iR. v'" Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 3 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Forrh #$ Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °M 146 Flint Rock Road h Property Address John Quinn Owner Owner's Name information is required for every Barnstable MA .02601 5/11/13 " page. Cityrrown State Zip Code Date of inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier,if any) determines that the system is functioning in a manner that protects the public health,' safety and environment: _ The system has a septic tank and soil absorption system (SAS)"and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of'.a public water supply. w. The system has,a septic tank and SAS and the SAS is within 50 feet of a`private water, supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 56 feet or more from a private water supply well**. Method used to deterrnineidistance: **This system passes if the well'water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is;equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy.of the analysis must be attached to this form. 3. Other: r i~ o } s ' . F `xa.;, • -is - 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 ` E ® .e clogged SAS or cesspool Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool El ® -Static liquid level in the distribution.box above outlet invert due to an overloaded or clogged SAS or cesspool .t Liquid depth in cesspool is less than 6" below.invert or available volume is'less ® than Y day flow t5ins•11/10 <. ,,Title 5 Official Inspection,Form:Subsurface Sewage Disposal System Page 4 of 17 Commonwealth of Massachusetts F x W Title 5 official` In�s ection Form' _. Subsurface Sewage Disposal System.For�m =:Not for Voluntary Assessments M 146 Flint Rock Road Property Address " John Quinn Owner Owner's Name information is MA '02601x " 5/11713 ~ required for every Barnstable - f page. City/Town c - _ State_ -Zip Code . Date of Inspection B. Certification (contj , Yes' No t ; Required um in n more than 4.times in the'last year NOT due tofciogged p g ipO. .or ' ® _ obstructed i e 'Number of times.pumped:, ' 'y ❑ ® it 1Any`portion.of the SAS,'cesspool or,pnvy,is below high ground water elevation= ' Any portion of cesspool or;p-nyy,is within 100 feet of a surface water.supply or, `tributary to a.surface water supply. *' An ortion`of a cess ool or riv is within a Zone.1 of`a ublic well' ❑ ® Y p P p, Y. p ® ,Any portion of a cesspoollor privy is within 50 feet of a,private water supply,we'll.^ .eR • IT `,.arc.� re °* . z ,,�� _',. -'� n r,� . -. r' +r • E] ® Any portion°of a cesspool,or privy is less than 100 feet_but greater than 50 feet `from a private Water supply well with no acceptable water quality analysis, [This,'* system passes if the well'water analysis, performed•at a DEP certified, " laboratory,,for fecal coliform bacteria indicates'absent;and the presence - of ammonia nitrogen and nitrate nitrogen is equal to or less'than 5 p m, a. p provided that no other failure criteria are triggered.A copy.of the analysis and chain of custody must be attached to,this form.] {., y =The system.'is'a cesspool serving a.facility with a design,flow of 2000gpd The,system fails. I,Phav determined t a �' '' k y e._ hat one or ore.of the above failure E] ® µt Health to determine what will be, criteria.exist as described in 310 CMR 15.303therefore the system system owner`should contact the Board of, fails. The w or necessary to c rect the failure. ' ! § e T. � Rt r }.fit ,. � ✓ x E) Large Systems: To be considered a large system thesystem;must serve a facility with a ^: t , m deli n,flow of.10 000 d-to 15,000. d R' For Large systems;.you:must indicate either;`yes" or"no"to each of the following,;in addition to the questions in Section D Yes No _ x i' • , fi .-. , r ❑ ❑ : •the system'is within 400 feet of a surface drinking water,'supply �. fR ,❑ FT�I the system,is within 200 feet of a.tributary to a surface drinking water supply R the system is,located rn a nitrogen sensitive`'area(Interim`WelI head,Protection r bArea.-IWPA)or a mapped Zone]l of a public water supply:well t _ If you-have answered "yes" to any question in Section E the,syste'm is considered a sigrificant threat, ° t; 'or answered`"yes°' in Section D above theaarge system'lias failed. The owner„or operator:of any:large ` system considered a significant threat under Section E or failed under Section D shall'upgrade.the ,A . � a ' , a system in accordance with.310 CMR 15.304. The system ownerahould contact the appropriate ' regional office of the Department. ' � e 4 t5ins•11/10 a + Title 5 Official Inspecton Form:Subsurface Sewagebisposal System P6ger5 of 17 x a a 6 s ..s- _.... _ ..... Commonwealth :of Massachusetts _ It e 5 Official inspection Form: , . s Subsurface Sewage Disposal System Form- Not for Voluntary Assessments 146 Flint Rock Road,• Property Address John Quinn Owner: Owner's Name information is . Barnstable MA 02601 .5/1.1/13 required for every_ -- ' page: Cltyrrown " ' State ~Zip Code Date ofl`nspection' C. Checklist Check if the following,have been done:.You mu st indicate":yes or"no' as to each:of the following Yes No 0. „E;:.:. Pumping information was provided by the owner, occupant; or Board of Health - E o' .. - .. Were:any of:thasystem 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? b I., El Were:as built.plans of the:systemobtained andexamined?(If they were not.:::,:. available note as N/A) ® E] 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?. , ® 0 - 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? t ' Was the facility owner(and occupants if'different from owner)provided with information on the proper,maintenance.of subsurface sewage disposal systems? . The size"and_location of the Soil:Absorption System (SAS) on the site has. been.determined based on:` ,,.:.,.. _... ...... ® 0 Existing information.,For example, a plan at the Boafd of Health.. Determined in the field (if any.of the failure criteria.related to-Part C is at issue El ® approximation of distance is.unacce table) 310 CMR 15.302(5)] D. System Information Residential.Flow Conditions. jrt. z Y , Number of bedrooms (design,)::,. , { Number;of bedrooms(actual);. DESIGN flow based.on 310 CMR 15.203.(for example: 110 gpd x#of bedrooms): 330 t5ins 11/10 j _ . Title 5 Official Inspection Form:Subsurface Sewage:Disposal System-.Page 6 of 17 Commonwealth of Massachusetts w Title 5 official Inspection Fora Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 146 Flint Rock Road d •I.N SV0 ♦ e Property Address { - John Quinn b - Owner Owner's Name information is Barnstable MA 02601 5/11/13 required for every -- page. City/Town State Zip Code '<, Date of Inspection D. System Information - ti Description: f 0 Number of current residents: ; .Does residence have a garbage grinder? - _ ❑ Yes ® No 1s laundry on a separate sewage system?[if yes separate inspection required] ❑ Yes ®; No Laundry system inspected? ❑..Yes ® No Seasonal use? '' ❑ Yes ®` No Water meter readin s, if available last`2 ,ears usage d n/a Detail: R _ Sump pump? ❑ Yes M. No. Last date of occupancy December 2012 : �, t: date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on"310 CMR 15.203): Gallons per day(gpd) a Basis of design flow(seats/persons/sq.ft., etc.): f Grease trap present? - n ❑ Yes ❑ No Industrial waste holding tank present? `❑' Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: ", t5ins-11/10, Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 f Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 7M 146 Flint Rock Road Property Address John Quinn Owner Owner's Name e information is Barnstable MA 02601 5/11/13 required for every _ page. CitylTown State Zip Code Date of Inspection D. System Information. (cont.) ij Last date of occupancy/use: Date Other(describe below): " General Information Pumping Records: Source of information: Was system pumped as part of the inspection? ❑ Yes ,❑ No If yes, volume pumped: gallons. How'was quantity pumped determined? F Reason for pumping: Type of 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). ❑ innovative/Alternative technology.Attach a copy of the,current operation and maintenance contract(to be obtained from system owner)and a copy of latest inspection of the I/A system by system operator under contract , ❑ Tight tank. Attach a copy of the DEP approval. ❑ ,Other(describe): _ x t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts W Title 5 Official 'inspection Ford . Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 146 Flint Rock Road 7 M . Property Address " John Quinn Owner Owner's Name : information is required for every Barnstable MA ', 02601 5/11/13 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed(if known)and source of information:, 1986 Were sewage odors detected when arriving at the'site? , ❑ Yes ® No Building Sewer(locate on site plan):-, 3'4" Depth below grade: feet Material of construction: ❑ cast iron ® 40 PVC ❑ other(explain)- t >20 Distance from private water supply well'or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): ., At time of inspection building sewer appeared to be in working order. No sign of leakage or blockage. Septic Tank(locate on site plan): , • Depth below grade: feet Material of construction: N concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list-age: years Is age confirmed by a Certificate of Compliance?,(attach a copy of certificate) ❑ Yes ® No Dimensions: 1000 gal Sludge depth: t5ins-11/10 st Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 s Commonwealth of Massachusetts N W Title 5 official 'Inspection Fora Subsurface Sewage Disposal System Form - Not for Voluntary Assessments a �M 146 Flint Rock Road Property Address John Quinn - Owner Owner's Name information is Barnstable MA' 02601 -5/11/13 required for every - page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) W ' Distance from top of sludge to bottom of outlet the or baffle ' ,`33'.. 2„ Scum thickness Distance from top of scum to top of outlet tee or`baffle w16" k Distance from bottom of scum to bottom of outlet tee or baffle , How were dimensions determined? scour stick - Comments(on pumping recommendations, inlet and outlet tee or baffle condition;structural integrity,• liquid levels as related to outlet invert, evidence of leakage,,etc.): At time of inspection septic tank appears to be structurally sound: No sign of back-up but pumping is. recommended. : ;. A' ... -.x'' t. x °p� � •_v�, n ... a k r a `' . Grease Trap-(locate on site plan)' r _ Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene, ❑ other(explain): Dimensions: Scum thickness Distance from top of,scum to top of outlet tee orbaffle'` . Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins•11/10 '_Title 5 Official Inspection form:Subsurface Sewage Disposal System•Page 10 of 17% Commonwealth of Massachusetts W Title 5 official Inspection Fora Subsurface Sewage Disposal System Form - Not for Voluntary Assessments *' 146 Flint Rock Road Property Address - P John Quinn ` Owner Owner's Name • information is Barnstable MA ''02601 5/11/13 ` required for every p page. City/Town State Zip Code s Date of Inspection D. System Information (cont.).,� ,, Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): r , Tight or Holding Tank(tank must be pumped at time of inspection)(locate on site plan): Depth below grade: • Material of construction: d El concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present. ❑ Yes` ❑" No - Alarm level: Alarm inmorking order: ❑<Yes ❑ -:No Date of last pumping: ' Date Comments (condition of alarm and float switches, etc.): r - Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins•11/10 r Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 17 V 1 Commonwealth of Massachusetts - Title 5 officialInspection Forma R Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 146 Flint Rock Road f Property Address John Quinn : . • .` a Owner Owner's NameF, information is required for every Barnstable MA 02601 5/11/13 page. Citylrown `State `Zip Code` Date of Inspection D. System Information (cont.) Distribution Box(if present must be opened)(locate on site plan):. Depth of liquid level above outlet invert 0 - 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.): At time of inspection d-box is deteriorated and must be replaced. Pump Chamber(locate on site plan): 4 Pumps in working order: , . El"'Yes ❑ N'o Alarms in working order: _ Y. ❑ 'Yes ❑`No ' Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): ' Soil,Absorption System (SAS)(locate on site plan, excavation not.required): If SAS not located, explain why' t5ins-11110 4 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12'of'17 Commonwealth of Massachusetts 5 V Title 5 Official Insp ection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments °M 146 Flint Rock Road Property Address John Quinn u Owner Owner's Name information is required for every Barnstable MA 02601 5/11/13 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.)' } r Type: F ® leaching pits number: ❑ leaching chambers number: ❑ leaching galleries number:'' �. ❑ Teaching trenches r `number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool, r 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, etc.): - At time of inspection leaching is dryand,appears to be in working condition.'`No sign of hydraulic , failure F Cesspools (cesspool must be pumped as part of inspection)(locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer. �. r 'Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑-Yes ❑ No 9 , t5ins•11/10 F' Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of'17 f Commonwealth of MassachUsetts W Title 5 Official -inspection Ford- Subsurface Sewage Disposal System Form - Not for Voluntary Assessments y . ;M 146 Flint Rock Road Property Address John Quinn Owner Owner's Name information is required for every Barnstable MA 02601 5/11/13 . page. City/Town State Zip Code Date of Inspection D. System Information (cont:) Comments(note condition of soil, signs of,hydraulic failure, level of ponding, condition of vegetation, etc.): x Privy(locate on site plan): Materials of construction: f ,' Dimensions Depth of solids Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): F ! v t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 17 • � s Commonwealth of Massachusetts Title S Official Inspection Form Subsurface Sewage.Disposal-:System Form -.Not for Voluntary Assessments , y 146 Flint Rock Road' Property Address John Quinn Owner Owner's:Name information is required for every .Barnstable MA' 02601 5/11/13 page. City/Town State Zip Code _ Date of Inspection D.-System Information (60nt.) Sketch Of Sewage Disposal System: Provide akview of the sewage disposal system;including ties to at least two permanent reference landmarks or benchmarks. Locate all wells Within 10.0 feet:Locate { wh"ere public water supply enters-the building. Check one of the boxes below; ®' hand-sketch,in the area below ❑ drawing attached separately Z t 1 w t5ins•11/10 Title 5 Official Inspection form:Subsurface Sewage Disposal System•Page 15`of 17 ' k Commonwealth of Massachusetts Title 5 Official -Inspection Form t` Subsurface Sewage Disposal:System Form -Not for VoluntaryAssessments ' wM 146 Flint Rock Road Property Address John Quinn r Owner Owner's Name information is Barnstable MA 02601 5/11/13 required for every � •` page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: - ® Check Slope ® Surface water Y F. ® Check cellar • . ® Shallow wells » Estimated depth to high'grouInd water: >12 :feet Please indicate all methods used to'determine the high'ground water elevation:` ., ® Obtained from'system design plans-on record _If checked, date of design plan reviewed: 4/15/86 Date ❑ Observed site(abutting.property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health -explain: ❑ Checked with local excavators, installers-(attach documentation) . ❑ Accessed USGS database-explain: ` A ' You must describe how you established the high'ground water elevation: '4 _ Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•11/10' Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Fora o Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 146 Flint Rock Road Property Address J John Quinn - Owner Owner's Name information is required for every Barnstable MA - 02601 5/11/13 page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A,B, C,,D, or E checked ` ® Inspection Summary D (System Failure Criteria Applicable to All Systems)completed ® System Information— Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on,page 15 or attached in separate file a l5ins•11/10 'Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 17 � d �E '�.� M1 • t.. tit J �O� � ' ' {I' �,S ftl,,^,.l. . / --wra+r an.:le�uy�.. N o *.e.r `tom a p,�f / t•, F, o Z`: x t e v , • P o Q .�g f Jtl C7 : 9 3 1 M 3 0�\4 loel - ( l ' orb ,. F t,. L i r c 10, We //O V r 'a el iF IJ C { #NI:XISTIPd0 SWOT -ELEVATION Oa0 / oa ,W CERTIFIED PLOT PLAAI � tp _ s� L A A 4 1 {3a.tib 4i 1./7V r 4i'Ulf sl^!N H,F SPOT ELEVATION [ +.: �;' ' n► (FINISHED CONTOUR , 0 � Q H �--f - !O,VED i '60AR,D ` OF HEALTH w. -f y }t fG tz T Q"' .DATA` . AGENT � x C'}�s� �r t SCALE, / fi y6. DATA 1 Y. DREDGE.-ENG':WEER/NG`Cla IN CLIENT r . ,J� I CERTIFY THAT THE 3�ROPOSED� E 1STlE:RE REGISTERED JO:IE� N0 ^ &', `, 1 . BVILDING SHOWN ON T14i3 PLAN C6�lIL y LAN® CONFORMS TO..THE ZONING LAWS yy 1 1 1! IU E R V E OR.®Y��* GRr � qg,09 ys a1 �, O F R.,� S—lrk3 LC ; MASS i rg712 M1 N STREET ; CN` GY.� S' �yA V£07,.,t"a�' 'i'•t 1 S PI EE '�.d.lr V 1 '"� y.y DAYGG� L�. _ , ^ �URVEYOA r+o-.•,.•.w�.n...re.�.�;-�T.;..,.s..s,.,,rF+.«..--r...--.=n-.m.-..-.-.-.*^,.n+*e.e.^e.yea+-�r�wv,.-re.,-,....-... :...,........,..-:mma•.<• ..-+,..,..+..4.....,.-.....,-m......-.••..,..-.,,.,,-.�.-.,,—«-.,..—.., N .0 FOLDER I m �C& D ATA TOWN OF BARNSTABLE LOCATION. 41--i�SEWAGE#do;v)-3 15 VILLAGE S44!� .ASSESSOR'S MAP&PARCEL 3j�— /&a-OC9 INSTALLER'S NAME,&PHONE NOS SEPTIC TANK CAPACITY �/ � LEACHING FACILITY:(type) i A CA OMg7S(size) 'NO-OF BEDROOMS C 2 OWNER v PERMIT DATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet FURNISHED BY 1 roo M 0 = i - i No. C � C - 3� Fee THE COMMONWEALTH OF MASSACHUSETTS Entered incom uteri Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS 4pliLatI01� OC Disposal *pstem Construction 3permIt Application for a Permit to Construct Repair( ) Upgrade( ) Abandon( ) amplete System ❑Individual Components Location Address or Lot No. 1 yNt VZ0Li:' Owner's Name,Address,and Tel.No. Assessor's Map/Parcel p h'Xi- Pw InstalleKe,' Addr s,an Tel.No.So?�Ip U 4UC> Designer's Name,Address,and Tel.No. 5083Q-Z_ jS`12 ST: Type of Building: Dwelling No.of Bedrooms 45 Lot Size T) p� sq.ft. Garbage Grinder( ) Other Type of Building R4�i&Y1'k Q,� No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 550 gpd Design flow provided qp gpd Plan Date " t0 Number.of sheets Revision Date Title Size of Septic Tank 15oc qaj Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable)1nS' , Isno oadR_0m&, YDu/" qat i-e-athina chl Hers . Sf- h 51Z 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 o ealth. Signe Date Application Approved by _ZLPDate Application Disapproved by V Date for the following reasons Permit No. -)_0 C r -7 Date Issued u ------------—----- _------_- — --------- __ ----- ----- ---- - - r-- - - - --=------------ ti=f, C No. 373 "Fee mot/ rt THE COMMONWEALTH.O!F MASSACHUSETTS Entered inco'mpu�er Xext 4 PUBLIC HEALTH DIVISION - TOWN OF'BARNSTABLE, MASSACHUSETTS' 01pplication for 1��JO�aY p .tPt1l 0l AtCyu�tIOYY Permit - __ co Application for a Permit to Construct 'Repair , U. rade Abandon ' pp p ( ) pg' ( ) omplete System ❑Individual Components Location Address or Lot No. 1 �`1 Ut-- r Owner's Name,AAd and Tel.No. Z.r'e's' Assessor's Map/Parcel re V )6� fkvi4 Installe ' ame,Address,and Tel.No.So ?—n to U 4(yo Designer's Name,Address,(and4Tel.No. Type of Building: w, w 14 Dwelling No.of Bedrooms r. Lot Size 16 19 sq.ft. Garbage Grinder( ) �. Other Type of Building Q•e`y�fVkA 0.t No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 15,7 0 gpd Design flow.provided�(� gpd Plan Date 6 I o' 141 Number of sheets Revision Date Title Size of Septic Tank S( i q(,L ; , Type of S.A.S. Description of Soil r' Nature of Repairs or Alterations(Answer when applicable) 1� G{ n�,(,f ���j '&Qr S—W q9 - , - i Date last inspected: i 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 M Compliance has been issued by this Board o ealth. I ^1 Signe• Date ! Ot Od Application Approved by t• • Date j Application Disapproved by \ Date i for the following reasons o Permit No. 3 Date Issued J r c+ --------------------------------------------------------------------------------------------------------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS 4, BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired( ) Upgraded( ) i Abandoned( )by 9 at ( (p `1tiV1 f�C_lL �� has been constructed in accordance .with the provisions of Title 5 and the for Disposal System Construction Permit No.`2 9?,:1'37 lAated Installer 11�� De§ignerCu�rJ tr GC ifl�1 II(1� \t�l #bedrooms Approved design flow ,SS J gpd The issuance of this permit shatll not be construed as a guarantee that the system will ction as design6d. Date (� Inspector ]/ U ---------------------------- ---------------------------------------------------------------------------------------------- No. Fee C) � �� � � � �, THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS t Misposal *pstrm Construction Permit Permission is hereby granted to Construct( ) Repair( ) Upgrade( ) Abandon( ) System located at t-' 0 i—�1�� �O(_K i , � a 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. i i Provided:Constructio, must be completed within three years of the date of this permit Date { ` ( > Approved by V r �� Town of Barnstable �tHE 1p� Inspectional Services t3nxtvsraei. , M Public Health Division '$ ` 9; �0� Thomas McKean, Director 1 !19 200 Main Street,Hyannis,MA 02601 Office: 508-8624644 Fax: 508-7W6304 Installer & Designer'Certification Form Date: Sewage Permit#.moo r.37J Assessor's MaplParcel 31 bo Designer: 00Wh M& fin(;h`UIQ�I�!Utr , 1K. Installer: I� Address: 9Y1 POO'ft CDA Address: �0 Box 12(o NGrmo"+' ?ort V+h U6YI)A6U� I M/- 026'�4 On 11 11,6 1,�7GX ( peg �—��' 1 hC was issued a permit to install a ( ate) —T (iffstaller) septic system at (4U Ft l a 9- t0C)- Rd . 60�ll �blebased on a design drawn by (address) A- O'olcL PE dated Oq-10—OVq (desi er) �I certify that the septic system referenced above was installed substantially according to the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. Strip out (if required) was inspected and the soils were found satisfactory. I certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system) but in accordance with State & Local Regulations. Plan revision or certified as-built by designer to follow. Strip out(if required) was inspected and the soils were found satisfactory. I certify that the system referenced above was constructed ce with the terms of the IAA approval letters (if applicable) `,Va��iN OF .4s, DANIELA, o OJALA a CIVIL N (Installer's Signature) P No.46502Q sStflNAL ECG (Designer's Signature) 7 / (Affix Designer's Stamp Here) PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS- BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. WoAdeptAREALTMSEWER connecASEPTIODesigner Certification Form Rev&14-13.DOC ALL SYSTE SYSTEM PROFILE MARKED WITHC MAGNETIC TTAPE'"OR BE NOTES LEGEND PROVIDE MIN. 20" DIAM COMPARABLE MEANS FOR FUTURE LOCATION. . WATERTIGHT (NOT TO SCALE) 1. DATUM IS � o 99 - EXISTING CONTOUR \ TOP FOUND. EL. 96.0 ACCESS COVERS TO WITHIN 6" OF FIN. GRADE 2" PEASTONE OR GEOTEXTILE CONCRETE COVERS TO WITHIN 3" GRADE � X 99 EXIST. SPOT ELEV. FILTER FABRIC OVER STONE 2. MUNICIPAL WATER IS EXISTING -[99]--- PROPOSED CONTOUR 87.0 MINIMUM .751 OF COVER OVER PRECAST 2% SLOPE REQUIRED OVER SYSTEM 88.0' 3. MINIMUM PIPE PITCH TO BE 1/8" PER FOOT. PRECAST H-10 NOTE: 2" MIN. WALL ., : RISERS (TYP.) PRECAST H-10 THICKNESS REQUIRED BLOCKS OR 4. DESIGN LOADING FOR ALL PROPOSED PRECAST UNITS 198.4 PROPOSED SPOT EL. 2'o RISERS (TYP.) 93.78 2'0 4"0SCH40 PVC PRECAST RISERS TO BE AASHO H-1Q O Gr PIPES LEVEL 1ST 2' COMPONENTS H-10 0 0� unite �c TH1 '+ °' ,: s" MIN. SUMP �ENDS 4' S. PIPE JOINTS TO BE MADE WATERTIGHT,TEST HOLE *92.25 12 MIN. INT. DI . (TYP-) INV'S EL. 84.20 4' 6. CONSTRUCTION DETAILS TO BE IN ACCORDANCE WITH J 10" EXISTING 14" ° SIDES. a M. TEE SEPTIC TANK TEE " rF]i� ° *92.48' , 10 1500 GAL H-10 14 , )°o°o°o°o ,000000�o r Bro9gS y Q rJ r 84.68 :. ® ®®®® ®®®® ®® '°°o°°°m° 310 CMR 15.000 (TITLE 5.) o SEPTIC TANK °O°O°O°O ® ®®®®®®®®� ®®®®®®` ®®®® 'O°Oa°a�0 Locus SLOPE OF GROUND GAS BAFFLE w 84.93 TEE TEE o 0 0 0 0 o a o o �j o 0 0 0 4' LIQ. LEVEL o°000°000000 WATERTEHT 'BOX o a a a a ° ° ° m GAS BAFFLE °o°o0o�o�o�� �00000000 ®�®p®®® p�® ®�®®®®L�J® ®® °o°o°owo 7. THIS PLAN IS FOR PROPOSED WORK ONLY AND NOT TO a C� UTILITY POLE ACME OR EQUAL �`�^•^ ^ FOR LEVELNESS N >°0000000 ®®® ®®® ®®®®®®®®�®® .aoa000a�� °°°°°°°° BE USED FOR LOT LINE STAKING OR ANY OTHER .,.. . 84.51' 84.34' ° a a a oo�o�o�D 82.20' PURPOSE. FIRE HYDRANT 'c,,.......:..; ;,:• ^ •• :':...,•..: :- ' c0000o0605000000000000000000000000000000000`0;0 NOTE: NOT ALL SYMBOLS MAY APPEAR IN DRAWING ^0o°,o,°,0090909q*no�00000000000�0�0�0„0�0�00000. H-10 500 GAL. LEACHING CHAMBER BY ACME PRECAST OR EQUAL 8. PIPE FOR SEPTIC SYSTEM TO SCH. 40-4 PVC. Route 6 3/4"-1-1/2" DOUBLE WASHED STONE 4' MIN. (4) UNITS REQUIRED _ 10 ALL AROUND PRECAST STRUCTURES 9. COMPONENTS NOT TO BE BACKFILLED OR CONCEALED ( % SLOPE) OVERALL DIMENSIONS TO OUTSIDE OF STONE: 42.00' X 12.83' WITHOUT INSPECTION BY BOARD OF HEALTH AND sLAB aa0 t EXISTING 6" CRUSHED STONE OR MECHANICAL Communication COMPACTION. (15.221 [2]) 2� PERMISSION OBTAINED FROM BOARD OF HEALTH. `.����•� FOUNDATION EXISTING SEPTIC TANK 70' ^ lyoy-_� *THE INSTALLER SHALL VERIFY THE '? 10. CONTRACTOR SHALL BE RESPONSIBLE FOR CALLING LOCATIONS OF ALL UTILITIES AND ALL ( 1 % SLOPE) ( 1 % SLOPE) DIGSAFE (1-•888-344-7233) AND VERIFYING THE BUILDING SEWER OUTLETS AND * ( 2 % SLOPE) LOCATION OF ALL UNDERGROUND & OVERHEAD UTILITIES LOCUS MAP ELEVATIONS PRIOR TO INSTALLING ANY 85.45 PROPOSED LEACHING 75.0' BOTTOM TH-2! PRIOR TO COMMENCEMENT OF WORK. FOUNDATION 26' SEPTIC TANK 17' D' BOX 16 FACILITY NO GROUNDWATER FOUND SCALE 1 =2000 t PORTION OF SEPTIC SYSTEM t1. ANY UNSUITABLE MATERIAL ENCOUNTERED SHALL BE REMOVED-BENEATH AND 5' AROUND THE PROPOSED ASSESSORS MAP 316 PARCEL 80-8 LEACHING FACILITY. 12. EXISTING LEACHING FACILITY SHALL BE PUMPED AND SITE IS NOT LOCATED WITHIN A ZONE II c REMOVED OR, PUMPED AND FILLED WITH CLEAN SAND. N7 9•31,4B SYSTEM DESIGN: _ GARBAGE DISPOSER IS NOT ALLOWED I -- __-- ZONING PROPSOED 5 BEDROOM DWELLING SETBACK LINELO (TYP) DESIGN FLOW: 5 BEDROOMS ® 110 GPD = 550 GPD USE A 550 GPD DESIGN FLOW a O Co. 92 TEST HOLE LOGS SEPTIC TANK: 550 GPD (2) = 1100 �V g3 USE A 1500 GAL. SEPTIC TANK 9Q I ENGINEER: CRAIG J. FERRARI, SE #13871 SHED WITNESS: DAVID W. STANTON RS LEACHING: SIDES: 2 (42 + 12.83) 2 (.74) = 162 GPD LOT 8 DATE: 6/26/2019 BOTTOM 42 x 12.83 (.74) = 398 GPD ' 48,192±S.F. ( PERC. RATE = < 2 MIN/INCH (0 DECK TOTAL: 756 S.F. 560 GPD � CLASS I SOILS P# 19-39 USE (4) 500 GAL. LEACHING CHAMBERS (ACME OR EQUAL) pAVEo DRIVEWAY f WITH 4' STONE ALL AROUND 4 .6' ELEV. � ELEV. � ELEV. � ELEV. 0„ 4 87' 0„ 86' 0„ 4 89' 099 `\/" 89' w EXISTING FILL FILL A A " LS LS MA DWELLING 12---� 12 10YR 2/2 FFLR=97.0 K 9„ 10„ 10YR 22 / APPROVED DATE BOARD OF HEALTH A A 9k ` LS LS B B 0'� 10YR 2/2 10YR 2/2 LS LS aN I I(J\I 1810 16" 24" 10YR 5/8 87, 4 10YR 5/8 , ` ,� B B 8 85 BENCHMARK: , o,��- o LS LS ZONING SUMMARY CATCH BASIN __-- I ° =94.9 NAVD88 G G G G 3 �? 54" 10YR 5/8 82.5' 10YR 5/8 C C ZONING DISTRICT: RF-1 DISTRICT 0 0 42" 82.5' PROP ED _ -P' PERC E E E S E DI 0 a6 MS MS MIN. LOT SIZE 87,120 S.F. PERC MIN. LOT FRONTAGE 20' O Ch CIO C C MIN. LOT WIDTH 125' n• gg.0 '0 15' 10YR 7/4 10YR 7/4 MIN. FRONT SETBACK 30' 5• ( s, MIN. SIDE SETBACK 15' 4 MS MS MIN. REAR SETBACK 15' T TH1 MAX. BUILDING HEIGHT 30' 10YR 7/4 10YR 7/4 SITE IS LOCATED WITHIN THE AQUIFER 132" 76' 132" 75' 132" 78' 132" PROTECTION OVERLAY DISTRICT ` 2 I 78' NO GROUNDWATER ENCOUNTERED NO GROUNDWATER ENCOUNTERED TITLEZ 5 %ec"31 "I' ME PLAN \ \ \ OF #146 FLINT ROCK ROAD 5' R OVAL UNSUITABLE SOIL RE IRED 0 BARNSTABLE, MA ROU PERIM R OF LEACHING FACILI 'T SUITA R. REP H CLE ED. SAND, TO PE IFICATIO 0 310 CMR 15.255(3) z � ( � J PREPARED FOR 93 � PETER & JESSICANOFM BURKE 01 94o DAN11E1_ V ��� DANIEL A. OJALA A. DATE: SEPTEMBER 10, 2019 I OJ ALA f CIVIL ��� 9s No.40980 J ,o No.46502 103 �� .,5���¢� � ONAL F°�`N� Scale: 1"= 20' 9� S R`Jt O ���HOFM,gSs9c `G�\�NOF4f.1,q O 10 20 30 40 50 FEET W 00 o DANIEL ti\ �'� DANIF_LA OJf,LA cn'r� o OJALA ' U S U C (n 100 q No.40980 o No.46502 off 508-362-4541 °FEss�°�P �o �F �° �`` I fax 508-362-9880 aky0 Sum ti�O� SSG/ST downcape.com �o2 down cape too keerk) inc. civil engineers - _NO-n �_� � land surveyors S-� /7- I J 939 Mcin Street ( Rte 6A) DATE DANIEL A. OJA!A, P.E., P.L.S. YARMOUTHPORT MA 02675 BICE # 19-- > 73 19-173