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Home My WebLink About0030 HOLLY LANE - Health Os y �ne Barnstable 03.5y� C d , r Commonwealth of Massachusetts z Title 5 Official Inspection Form GI - Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 30 Holly ,�n Lane ` V"l 35 —03 Property Address Katherine Reed Owner Owner's Name i information is Cummaquid i'1 S MA 02637 07/02/12 required for every 1 page. City/Town State Zip Code Date of Inspection 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. e Important:When A. General Information Milling out forms I on the computer, use only the tab / 1 Inspector: key to move your . � . cursor-do not Michael Kellett use the return key. Name of Inspector ' Aardvark Environmental Inspections ` �--�I Company Name PO Box 896 Company Address East Dennis MA 02641 City/Town State Zip Code 508-385-7608 SI 3742 Telephone Number License Number e B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of the inspection.The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to",5ection 1$340 o Title 5(310 C M R 15.000).The system: 3 � :. t Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority 07/05/12 Inspector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DER The original should be sent to the system owner and copies sent to the buyer,if applicable,and the approving authority. b ****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 , TitlV1p orm:Subsurface Sewage Disposal System•Page 1 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 30 Holly Lane Property Address Katherine Reed Owner Owner's Name information is required for every Cummaq uid MA 02637 07/02/12 page. City1rown 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: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below. Comments: B) System Conditionally Passes: ❑ One or more system components as described in the "Conditional Pass"section need to be replaced or repaired.The system,upon completion of the replacement or repair,as approved by the Board of Health,will pass. Check the box for"yes", "no"or"not determined"(Y, N, ND)for the following statements. If"not _ determined,"please explain. The septic tank is metal and over 20 years old* or the septic tank(whether metal or not)is structurally unsound,exhibits substantial infiltration or exfiltration or tank failure is imminent.System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. t ❑ Y ❑ N ❑ ND (Ex0lain below): tSlns•11/10 Title 6 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Fort Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 30 Holly Lane Property Address Katherine Reed Owner Owner's Name information is required for every Cummaquid MA 02637 07/02/12 page. City/Town 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 ❑ IV ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s).The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ Y.''❑ :N ❑ ND (Explain below):. ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): , C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the-Board of Health in order to determine if the system is failing to protect public health,safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15:303(1)(b)that the system is not functioning in a mannerwhich 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 wins 1 iYi u T tle 5 Official tnspedion Form:Subsurface Sewage Uzposal Sps em Page 3 of V Commonwealth of Massachusetts 4 Title 5 Official Inspection Form s Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 30 Holly Lane Property Address Katherine Reed Owner Owner's Name information is Cumma uid MA 02637 07/02/12 required for every q , 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 mannerthat protects the public health, safety and environment: ❑ The system has aseptic tank and soil absorption system (SAS) and'the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water Supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a`private water supply well ❑ .The system has a septic tank and SAS and the SAS is less than 100 feet-but 50 feet or more from a private water supply well**. Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal, coliform bacteria indicates absent and the presence of ammonia nitrogen and,nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form. 3. Other. D) System Failure Criteria Applicable to All Systems: , You-must indicate"Yes"or"No to each of the following for all inspections: Yes • �No Backup of sewage into facility or system component due to•overloaded or El ® ti clogged SAS or-cesspool - Discharge or ponding of effluent to the surface of the ground or surface waters El ® due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6"below invert or available volume is less than day flow t5ins•11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form & Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 30 Holly Lane Property Address Katherine Reed Owner Owner's Name information is required for every Cummaquid MA •02637 07/02/12 page. City[Town State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping•more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS,cesspool or privy is below high ground water elevation. El ® Any portion of cesspool or privy is within 1.00 feet of a surface water supply or tributary to a surface water'supply. ❑ JZ Any portion of a cesspool or privy is within a Zone 1 of a public well.. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis,performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd 10,000gpd. El ® The system fails. l have determined that one or more,of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails.The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems,you must indicate either"yes"or"no"to each of the following,in addition to the questions in Section?. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ the system is within,200 feet of a tributary to a surface drinking water supply Elthe system is located in a nitrogen sensitive area (Interim Wellhead,Protection El Area—IWPA)or a mapped Zone II of a public water supply well o if you have answered "yes"to any question in Section E the system is considered a.significant threat, or answered "yes"in Section D above the large system has failed.The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304.The system owner should contact the appropriate regional office of the Department. t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 5 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 30 Holly Lane Property Address Katherine Reed - Owner Owner's Name information is Cumma uid MA 02637 07/62/12 required for every q . page. City/Town State Zip Code Date of Inspection C. Checklist Check if the following have been done.You must indicate "yes"or"no"as to each of the following: Yes No t ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were note available note as N/A) f ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components,excluding the SAS,located on site? ® ❑ 'Were the septic tank manholes uncovered, opened,and the interior of the tank inspected for the condition of the baffles or tees,material of construction, dimensions, depth of liquid,depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on,the proper maintenance of subsurface sewage disposal systems?, The size and location of the Soil Absorption System(SAS) on the site has been determined based on: ® . ❑ Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] . D. System Information Residential Flow Conditions: Number of bedrooms(design): 3 Number of bedrooms(actual): 3 DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): 330 t5ins 11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 17 f - Commonwealth of Massachusetts u - Title 5 official Inspection Form s Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 30 Holly Lane Property Address Katherine Reed Owner Owner's Name information is Cumma uid MA 02637 07/02/12 required for every q , page. City/Town State Zip Code, Date of Inspection D. System Information Description: Number of current residents: Does residence have a garbage grinder? ❑ Yes ®, No Is laundry on a separate sewage system?[if yes separate inspection required] ❑ Yes ® No Laundry system inspected? ❑ Yes ® No Seasonaluse? ❑ Yes ® No Water meter readings, if available. last 2 ears usage d 9 ( Y 9 (gp )) Detail: P � f Sump pump? ❑ Yes ® No 10/11 Last date of occupancy: Date Date - - Commercial/Industrial flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ff.,etc.): Grease trap present? ❑ 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 Y 1 Commonwealth of Massachusetts Title 5 Official Inspection Fora Subsurface Sewage Disposal System Form-Not for Voluntary Assessments - °r 30 Holly Lane Property Address Katherine Reed Owner Owner's Name information is Cumma uid MA 02637 07/02/12 required for every q ' page. City(rown State 'Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): i 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?" Reason for pumping: Type of System: ® 'Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy r ❑ 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): t5ins•11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts ' R W Title 5 Official Inspection Fora Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 30 Holly Lane Property Address Katherine Reed " Owner Owner's Name information is Cumma uid MA 02637 07/02/12 required for every q - page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components,date installed(if known)'and source of information: 01/23/04 per BOH Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 2.3 feet Material of construction: ❑ cast iron ® 40 PVC ❑ other(explain): Distance from private water supply well or suction line: ' feet Comments (on condition of joints,venting,evidence of leakage,etc.): r Septic Tank(locate on site plan): . r Depth below grade: 1.7 P 9 feet Material of construction: ®concrete ❑ metal ❑ fiberglass ❑polyethylerie Elother(explain) If tank is metal,list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate). ❑ Yes ❑ No Dimensions: 1,500 gal �Sludge depth: 2 t5ins•11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 r Commonwealth of Massachusetts W Title 5 Official Inspection Form s Subsurface Sewage Disposal System Form-Not for Voluntary Assessments f • w ..' 30 Holly Lane Property Address Katherine Reed Owner Owner's Name information is required for every Cummaquid MA 02637 07/02/12 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) 2911 Distance from top of sludge to bottom of outlet tee or baffle - 3 Scum thickness Distance from top of scum to top of outlet tee or baffle 6 Distance from bottom of scum to bottom of outlet tee or baffle 16 How were dimensions determined? Measured Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity,- liquid levels as related to outlet invert, evidence of leakage, etc.): The tank was sound and tight with tees in place and liquid at outlet invert. C, 4' Grease Trap(locate on site plan): Depth below grade: feet Material of construction: ❑ concrete' ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(ekplain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5lns-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 f Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 30 Holly Lane Property Address Katherine Reed Owner Owner's Name information is Cummaquid MA 02637. 07/02/12 required for every - page. Cityrrown State Zip Code 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.): s Tight or Holding Tank(tank must be pumped at time of inspection)(locate on site plan): Depth below grade: f Material of construction: ❑ concrete ❑ metal ❑fiberglass. ❑ polyethylene ❑ other(explain): Dimensions: .f Capacity: gallons i Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments(condition of alarm and float switches,etc.):' "Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins•11/10 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 11 of 17 r r 9 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 30 Holly Lane Property Address Katherine Reed Owner Owner's Name ' information is required for every Cummaquid MA 02637 07/02/92 page. City/Town State Zip Code bate of Inspection D. System Information (cont.) Distribution Box(if present must be opened)(locate on site plan): Depth of liquid level above outlet invert ' even 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.): The box was level and tight with no sign of carryover: Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order: ❑ 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 11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form - Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 30 Holly Lane Property Address Katherine Reed Owner Owner's Name information is Cumma uid MA 02637 07/02/12 required for every q page. Cityrrown State Zip Code^ Date of Inspection. D. System Information (cont.) , Type: . Y ❑ `leaching pits number: ® leaching chambers number: 6 ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool - number: - ❑ innovative/alternative system d Type/name of technology: Comments(note condition of soil,signs of hydraulic failure, level of ponding,damp soil, condition of vegetation,etc.): This system has a 6 infiltrators in a6'x45'stone field.There was no sign of ponding or failure in the stones. 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 1 -0 Depth of scum.layer Dimensions of cesspool . Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins•11/10 Tide 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 17 IL— Commonwealth of Massachusetts W Title 5 Official Inspection Fora Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 30 Holly Lane Property Address Katherine Reed _ Owner Owner's Name information is re Cummaquid MA ' 02637 07/02/12 wired for every ry page. own P Cityfr 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.): Privy(locate on site plan): Materials of construction: r Dimensions Depth of solids Comments(note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation, etc.): • f • t t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 a Commonwealth of Massachusetts ,. ti Title 5 ial Ins section. ®r Subsurface Sewage Disposal System Form Not for Voluntary Assessments'. rs 30 Holly Lane t k Property Address Katherine Reed y ., .1 Owner Owner's Name information is required for every Cummaquid A; `MA ,02637 07/02/12 , Pa9e• Citylrown ;'# State ZIp Code i Date of Inspection D. System Information (cont:) ;, Sketch Of Sewage Disposal System:'Provide a view of the sewage^disposal system,including ties to _F. at least two permanent reference landmarks or benchmarks.Locate all wells within 100 feet:Locate' where public water supply enters the building.,Check one-of the boxes below: �•'- ; hand-sketch in the-area'below, }, f '. • ❑ drawing attached separately�s :: Ok IL . s. , „ •as .. - -. * .- - . � _ _ r -�'-. t5ins 11/r0 Me 5 OffeW mspeewn Feral:subsRrace sewitge Disposal sydern•Page 16 er 17 „ f - ' s Commonwealth of Massachusetts W Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 30 Holly Lane Property Address Katherine Reed Owner Owner's Name information is required for every Cummaquid MA 02637 07/02/12 - page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope ® Surface water ® Check cellar ❑ Shallow wells Estimated depth to high ground water: feet 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: Date ❑ Observed site(abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health -explain: d r , ❑ Checked with local excavators,installers-(attach documentation) ® Accessed USGS database-explain: You must describe how you established the high ground water elevation: USGS maps show an elevation of over 20.0 feet. . s 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 F Commonwealth of Massachusetts Title 5 Official Inspection Form ^ Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 30 Holly Lane Property Address , Katherine Reed ✓h Owner Owner's Name information is required for every Cummaquid MA 02637. 07/02/12 page. Cityfrown 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' • ,f r i 't5ins 11/10 Title 5 Official Inspection Form:Subsurface Sewage Di'sposal System Page 17 of 17 TOWN OF BARNSTABLE F- LOI A-11ON 7 L SEWAGE # �'II:.LAGE v�� ll ,, ASSESSOR'S MAP&LOT 336'd INSTALLER'S NAME&PH NO. �a�rc�� i s 3�rve f/'O•✓ T.S 4�- SEPTIC TANK CAPACITY LEACHING FACILPTy: 64-2 (size) C X yV it� NO.OF BEDROOMS BUILDER OR. WNER ,2_5,WA PERMTTDATE:_/g/s12 COMPLIANCE DATE: a3 11 I 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 ufLfin shed by Gri•�s«•�IT S7 G 9 � ,ijc) r� No. Y��.� _ Y a Fee- THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: r� Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS 01ppYication for Miopool *raem Conztruction Vermit Application for a Permit to Construct( , )Repair(�)Upgrade( )Abandon( ) 114complete System ❑Individual Components Location Address or Lot No. Owner's Name,Address and Tel.No. 30 f�/lly C1- � � ; Assessor's ap/Pazcel /� /'� Installer's Name,Address,and Tel.No. P� Designer's Name,Address and Tel.No. 0601'k1;141� � ��r�� Cole Type of Building: Dwelling No.of Bedrooms�c,;� � Lot Size �`�®a sq.ft. Garbage Grinder( ® Other Type of Building �l9Ge No.of Persons —Showers( ) Cafeteria( ) I Other Fixtures Design Flow gallons per day. Calculated daily flow v? gallons. Plan Date li Number of sheets ! __Revision Date Title S a p . e�l Size of Septic Tan� Type of S.A.S. /'`S Description of Soil S/� �gj�X Z Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued by thi B dof Health. Si ed Date Application Approved by Date J d3 Application Disapproved for the following reasons Permit No. — o Date Issued U 'No ��✓��f Fee - THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes ¢' PUBLIC HEALTH DIVISION--TOWN OF BARNSTABLES MASSACHUSETTS 2pplication for Mioaar *patent Con!6truction Permit Application for a Permit to Construct( )Repair(�)Upgrade( )Abandon( ) L Complete System 0 Individual Components Location Address or Lot No. Owner's Name,Address and Tel.No. 30 /}w/y � . Assessor's Map/Parcel � � Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. Type of Building: Dwelling No.of Bedrooms - Lot Size sq.ft. Garbage Grinder Other Type of Building 6 No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow ///9 gallons per day. Calculated daily flow �.3/9 gallons. Plan Date Z217 ;3 Number of sheets / Revision Date Title _� Si-17' �1� /a 3U A",-A, ✓f, Size of Septic Tan ,/ 5 Alt"% f Type of S.A.S. Description of Soils Nature of Repairs or Alterations(Answer when applicable) 4 Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- Cate of Compliance has been issued by this Board of Health. Sig---! "'�,'rt �-` - - Dated-f/_ � , Application Approved bye _ _ Date.. 2 97/5 fC)3 Application Disapproved for the following reasons - Permit No. (o /L4 Date Issued ---------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed( )Repaired( Upgraded( ) Abandoned( )by r �/Jifi5�``. at 312 /,i /A/ Ay , �G� y I"Zt1-Z a has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. 001-t, 4 dated i 1 1, Installer Designer The issuance of this permit shall not be construed as a guarantee that the system.will function�as designed. Date t h---j 1 . LA Inspector ,l +� ---- No. Fee y THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION . BARNSTABLES MASSACHUSETTS Mi5po5al *pgtem,�on5truction Permit Permission is herebyanted to Construct Re air v Upgrade Abandon � ( ) ( .) Pg ( ) ( ) ; System located at ?Q /7,j-;�'✓/11 'La'f ✓ and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction must be completed within three years of the date of p )C),3 Date:_ 11,5 `y 3 Approved bby TOWN OF BARNSTABLE f L SEWAGE3- 61V LOCATION ASSESSOR'S MAP &LOT 3 36 r d VILLAGE / IT INSTALLER'S NAME&PH NO. SEPTIC TANK CAPACITY (size) LEACHING. FACILITY: (type) NO.OF BEDROOMS BUILDER OR R PERMITDATE: COMPLIANCE DATE:493 Separation Distance Between the: S^ �- Feet Maximum Adjusted Groundwater ble to the Bottom of Leaching Facility Private Water Supply Well and Leaching Facility (If any wells exist Feet on site or within 200 feet of leaching facility) Edge of Wetland and Leaching Facility(If any wetlands exist Ae-,IPO Feet within 300 feet of leaching facility) ,furnish ed by CA j a i S;2e .� O 1 CLIENT: BORTOLOTTI CONSTRUCTION/SMITH LOCUS: 30 HOLLY LANE CUMMAQUID DATE: 1 1/23/03 SIEVE ANALYSIS: WEIGHT SAMPLE: 358.7 SIZE RETAINED % RETAINED % PASSED 0 0 0 3/4„ 0 p p 1/2„ 0 0 0 0 0 0 #4 5.9 1% 99% #10 38.9 10% 90% #20 84.8 23% 77% #40 326.9 91% 9% 80 347.2 96% 4% #200 357.0 99% 1% PAN 358.7 100% THIS MATERIAL IS A CLASS I SOIL WITH 1% PASSING 200 SIEVE 45.6' & SYSTEM PROFILE TEST HOLE LOGS FNDN. AT EL. 44.1' (CRAWLSP AREA) ACCESS COVER TO WITHIN 6" OF FIN. GRADE (NOT TO SCALE) PROVIDE INSPECTION PORT WITHIN ACCESS COVER (WATERTIGHT) TO 6" OF FINISH GRADE ENGINEER: ARNE H. OJALA, PE Locus 43.0' MINIMUM .75' OF COVER OVER PRECAST WITHIN 6" OF FIN. GRADE 2% SLOPE REQUIRED OVER SYSTEM SAM WHITE, IRS 2 DOUBLE WASHED P ST(�dE-"�`41 L+ - 42 0' WITNESS. i •42.5't* RUN PIPE LEVEL DATE: 10/27 & 1 1/24 2003 1 Hour u�Ne FOR FIRST 2' _ 39.0 PERC. RATE _ < 2 MIN/INCH MCS PROPOSED 1500 41.31-2-5/ GALLON SEPTIC 39.0' I TEE o 99 38.17' o CLASS I SOILS P#L11 10609 TANK (H- 10 ) GAS 38 5' & CAN� LnHE BAFFLE COR 38.67' �� MIN 2' ( 2 % SLOPE) t _6" CRUSHED STONE OR MECHANICAL 80 0 14" o F - 4 COMPACTION. (15.221 [21) MIN «'�$ �' 36.17' FAILED ELEV. DEPTH OF FLOW - ' (30-Fq; SLOPE) ( 1 q SLOPE) " " TEE SIZES: 3/4 TO 1 1/2 DOUBLE WASHED STONE A 0 A 41.3' 7RTE INLET DEPTH = 10�� SL /SL OUTLET DEPTH = 14 12„ 1OYR 3/3 12+' 10YR 3/4 UNSUIT LOCATION MAP NTS 28' LEACHING B B FOUNDATION-- MAX. SEPTIC TANK 1' D' BOX 4' FACILIT'r' 1 7, SL �SL ASSESSORS MAP 336 PARCEL 35 0 8 UNSUIT 1OYR 6/6 36" 1OYR 4/6 36" VARIANCES REQUESTED UNDER MAXIMUM FEASIBLE COMPLIANCE: Cl 15.405 lb: REDUCTION IN SETBACK, SAS TO SI LOAM /C 1 FOUNDATION, 20' TO 10'; ST TO FNDN (10' TO 9') 25.3' 100" 10YR 6/4 SILT LOAM NOTE: CRAWLSPACE FLOOR ELEVATION IS ABOVE THE UNSUIT INVERT ELEVATION C2 1OYR 5/5 j LS 144" 29.3' J 5' REMOVAL OF UNSUITABLE SOIL REQUIRED 126" C2 AROUND PERIMETER OF LEACHING FACILITY, C3 MED/COS DOWN TO SUITABLE SOIL LAYER (DOWN 87 SILT LOAM 36 APPROXIMATELY 12' TO C2 LAYER SEE 1 OYR 5/6 TEST HOLE 2 LOG). REPLACE WITH CLEAN 162" MOTTLED MED. SAND. ENGINEER TO INSPECT AND 192++ 25.3 LOT AREA CERTIFY REMOVAL ' NO WATER ENCOUNTERED NOTES: 45,006 SFt PROVIDE SHORING OF FOG-ADATION AS NECESSARY 1 . DATUM IS APPROXIMATE NGVD P,IC DF!7�1 'N:- (r.APBAFF. DISPOSER IS NOT FLOWED \ 2• MUNICIPAL WATER IS ESIGN FLOW: _3 BEDROOMS ( 110 GPD) 330 GPD .3. MINIMUM PIPE PITCH TO BE 1/8" PER FOOT. 3 SSE A 30 GPD DESIGN FLOW 4. DESIGN LOADING FOR ALL PRECAST UNITS TO BE AASHO H- 10 1.e5 SEPTIC TANK: 330 GPD ( 2 ) = 660 5. PIPE JOINTS TO BE MADE WATERTIGHT. +40.27 1500 6. CONSTRUCTION DETAILS TO .BE IN ACCORDANCE WITH MASS. 3 0 37,1 .-// hSE A GALLON SEPTIC TANK +40.76 ENVIRONMENTAL CODE TITLE V. In ° rM �� + LEACHING: - 7. THIS PLAN IS FOR PROPOSED SEPTIC SYSTEM ONLY AND IS NOT .3 11 24" OAK 39.38 2(44.5 + 5.83) 2 (.74) - 149 TO BE USED FOR ANY OTHER PURPOSE. SIDES: 31. a 100 +�o: ` '� 44.5 x 5,83 (.74) _ 191 8. PIPE FOR SEPTIC SYSTEM TO SCH. 40-4" PVC. 36,0 +41,2 +4 .8 EOTTOM: 9. COMPONENTS NOT TO BE BACKFILLED OR CONCEALED WITHOUT c`w s=o 317 `J^ i } FROM BOARD OF HEALTH. OTAL: 455 S.F. 337 GPD INSPECTION BY BOARD OF HEALTH AND PERMISSION OBTAINED +3 .70 USE (6) HIGH CAPACITY INFILTRATORS WITH 1.5' o TH PROVIDE APPROX. 38' OF 10. PUMP & REMOVE (OR FILL W/CLEAN SAND) EXISTING SEPTIC SYSTEM 2 } 40 MIL LINER AT 5' OFF STONE AT SIDES AND 3.5 AT ENDS & 14 UNDER SAS IN AREA SHOWN. +3 ,55 } 11 . WETLAND FLAGGED BY AM WILSON ASSOC. POSS BLE TOP AT EL, 39.0% 3 4 Q+37, 5 CESS COLS BOTTOM AT EL. 35.0' 1 LID LEGEND TITLE 5 SITE PLAN 4 .9 N 01 +37,55 FULL } 1 3 �! +42.66 100.0 PROPOSED SPOT ELEVATION OF BASE. 3 0 H 0 L LY LANE C' 100x0 EXISTING SPOT ELEVATION EXIST. C.O. IN THE TOWN OF: .64 DWELL. 10o PROPOSED CONTOUR (C U M MAQ U I D> BARN STABLE 4 .48 \ / 41,34 3.91 100 EXISTING CONTOUR PREPARED FOR: BORTOLOTTI CONSTRUCTION/SMITH 1-1 'VI \ 44,73 , 6 1-1 "4-44,62 4,71 30 0 30 60 90 43,79 GRAVEL \ DRIVE BOARD OF HEALTH }4 ,80 --4-44, �#44.91 43 4 / 4 ,47 4.51 Sa TH1 APPREIVED DATE MA SCALE: 1 " = 30' DATE: NOVEMBER 25, 2003 4 ,29 W 1 }45,\44,611�(FAILED) REV 12/5/03 (SAS) \ REV 12/11/03 (SAS) /43 6 +4 ,89 off _ 41 44 / 45.16 tax 508 362-9880 --i r43. 6° +41.57 ' 45.12 203.36 down Cape engineering inc, oF ,y ,.I HOF,�S SANE 1 �4 ARNE H. �y� �r. ARNE cy� �10LLY CIVIL ENGINEERS orAL,a r`'+. . H. CIVIL = ; JA ell LAND SURVEYORS ,, 0.30792 9�9 vain st. '+03-298 (3 BR) yarmouth, rya 02675 H. OJAL , ss\ , .L.S. DATE