HomeMy WebLinkAbout0559 HUCKINS NECK ROAD - Health p
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COMMONWEALTH OF MASSACHUSETTS
j EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS
DEPARTMENT OF ENVIRONMENTAL PROTECTION
TITLE 5
OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS `
SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM
PART A
CERTIFICATION S. t✓�S� Z
t
Property Address: 39 C(Lcz•n/,)P,2/2ti L,4 f ` Cr
Owner's Name: . C C'I7fz- .C'ttC/fa eL S> '
2GZY
Owner's Address: CD
/ r
Date of Inspection: 0'7t
C,^
Name of Inspector: (please print) Te r- / This inspection-Js based on crite a denne`—d in Ti Ee V
C0mpany.Nawe: s{' T• L e Code 310 CMR 15.303.My ftn Ings are how the system
Mailing Address: 137, Is performing at the time of the nspection.My In�spedlon does not
. /G' g T? 1 �-��� any warranty or guarantee of t e longevity of the septic
Telephone Number:
—5�3l?-- 90 T aysterand any of its components useful life.
CERTIFICATION STATEMENT
1 certify that I have personally inspected the sewage disposal system at this address and that the information reported
below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my
training and experience in the proper function and maintenance of on.site sewage disposal systems. I am a DEP
approved system inspector pursuant to Section 15.340 of Title 5 (3)0 CMR 15.000). The system:
Passes
Conditionally Passes
Needs Further Evaluation by the Local Approving Authority
Fails
Inspector's Signature: J, Date: ��
The system.inspector shall sub a copy of this inspection report to the Approving Authority.(Board of Health or
DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000
gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the
DEP. The original should;bc sent to the system owner and copies sent to the buyer, if applicable,and the approving
authority.
Notes and Comments nn
�eco/►+/h ew�G �u�/-? g'lt.� S� SePT A_ aS
e
•"'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.
Title 5 Inspection Form 6/15/2000 page 1
rage 2 01 11
- OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
m R-p,�3 y poACpj aq& CERTIFICATION (continued)
Property Address:
Owner:
Date of Inspection:
Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D
A. Sy em 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:
Onc or morc system components as described in the"'Conditional Pass"section need to be replaced or
repair .The system,upon completion of the replacement or repair, as approved by the Board of Health,will pass.
Answer yes,no r not determined(Y,N,ND)in the for the following statements. If"not determined"please
explain.
The septic tank is etal and over 20 years old* or the septic tank(whether metal or not)is structurally
unsound, exhibits substantia ' filtration or exfiltration or tank failure is imminent. System will pass inspection if the
existing tank is replaced with a mplying septic tank as approved by the Board of Health,
•A metal septic tank will pass insp ion if it is structurally sound,not leaking and if a Certificate of Compliance
indicating that the tank is less than 20 ars old is available.
ND.explain:
Observation of sewage backup or break out high static water level in the distribution box due to broken or
obstructed pipe(s)or due to a broken, settled or uneven istribution box. System will pass inspection if(with
approval of Board of Health):
broken pipe(s) are repla
obstruction is removed
distribution box is leveled or r aced
ND explain:
The system required pumping more than 4 times a year due to broken or o tructed pipe(s).The system will
pass inspection if'(with approval of the Board of Health):
broken pipe(s)are replaced
obstruction is removed
ND explain:
P -
'h ,
2
rage -) of 11
OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A '
CERTIFICATION (continued)
Property Address: C rn� n a� p0.nC
Owner: T
Date of Inspection: —p
l`vsltlstioe-ts Required by !be Board eF Health:
,
Conditions cxist which require further evaluation by the Board of Health in order to determine if the system
is fail to protect public health, safety or the environment.
1. Sys m will pass unless Board of Health determines in accordance with 310 CMR 15.303(l)(b)that the
syste is not functioning in a manner which will protect public health,safety and the environment:
_ Cessp of or privy is within 50 feet of a surface water
— Cesspoo or privy is within 50 feet of a bordering vegetated wetland or a salt marsh
2. System will fail unless the oard of Health (and Public Water Supplier, if any)determines that the
system is functioning in a,marine that protects the public health,safety and environment:
_ The system has a septic tank soil absorption system (SAS)and the SAS is within 100 feet of a
surface water supply or tributary to a face water supply.
_ The system has a septic tank and SA d the SAS is within a Zone I of a public water supply.
_ The system has a septic tank and SAS and a SAS is within 50 feet of a private water supply well.
— The system has a septic tank and SAS and the S is less than 100 feet but 50 feet or more from a
private water supply well*'. Method used to determine istance
"This system passes if the well water analysis, performed a DEP certified laboratory, for coliform
bacteria and volatile organic compounds indicates that the we is free from pollution from that facility and
the presence of ammonia nitrogen and nitrate nitrogen is equal t r less than 5 ppm, provided that no other
failure criteria are triggered. A copy of the analysis must be attach to this form.
3. Other:
3
Page 4 of I 1
OFFICIAL INSPECTION FORM — NOT FOR VO
LUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address: rr'�-.P
Owner:
.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
ackup of sewage into facility or system component due to overloaded or clogged SAS or cesspool
Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or
/clogged SAS or cesspool
( _ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or
cesspool
_ �!ZpLiquid depth in cesspool is less than 6"below invert or available volume is less than h day flow
Required pumping more than 4 times in the,last year NOT due to clogged or obstructed pipe(s). Number
f times pumped
�y portion of the SAS,cesspool or privy is below high ground water elevation.
y portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface
water supply.
✓Any portion of a cesspool or privy is within a Zone ) of a public well.
A:E� ny portion of a cesspool or privy is within 50 feet of a private water supply well.
Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water
supply well with no acceptable water quality analysis. (This system passes if the well water analysis,
performed at a DEP certified laboratory, for.coliform bacteria and volatile organic compounds
indicates that the well is free from pollution from that facility and the presence of ammonia
nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that.no other failure criteria
are triggered. A copy of the analysis must be attached to this form.)
(Yes/No)The system fails. I have,determined that one or more of the above failure criteria exist as
described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of
Health to determine what will be necessary to correct the failure.
e considered a large system the system must serve a facility with a design now of 10,000 gpd to 15,000
gpd•
You must in I e either"yes"or"no"to each of the following:
(The following trite ' ply to large systems in addition to the criteria above)
yes no
the system is within 400 feet o surface drinking water supply
the system is within 200 feet of a tributary surface drinking water supply
the system is located in a nitrogen sensitive area (listen ellhead Protection Area— IWPA)or a mapped.
Zone 11 of a public water supply well
If you have answered "yes"to any question in Section E the system is considered a s scant threat,or answered
"yes" in Section D above the large system has failed. The owner or operator of any large s considered a
significant threat under Section E or failed under Section D shall upgrade the system in accordan ,ith 310 CMR
15.304.The system owner should contact the appropriate regional office of the Department.
1
4
,Page 5 of 1 I
OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST
Property Address: mck_p pCQj\_CtiQ O�(�
Owner
Date of Inspection:
Chcck if the following have been done: You must indicate'yes" or_"no"as to each of the following:
Ycs o
r—
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
I,,/Has the system received normal flows in the previous two week period ? C^o o �C OkD 5,o c-e TU•�2 0-7�
�/ Have large volumes of water been introduced to the system recently or as pan of this inspection?'
Were as built plans of the system obtained and examined?(If they were not available note as N/A)
Was the faciliry or dwelling inspected for signs of sewage back up?
Was the site inspected for signs of break out
Were all system components, edine 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 constriction,dimensions,depth of liquid, depth of sludge and depth of scum?
t/ Was the facility owner(and occupants if different from ownet) 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:
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 Pan C is at.issue approximation of distance
is unacceptable) [310 CMR 15.302(3)(b)]
5
Page 6 of 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
Property Address rno-p a
Owner: m -).\ �io'e: Q =f I ST:
Date of lttspection: -02
FLOW CONDITIONS
RESIDENTIAL
Number of bedrooms(design): 02- Number of bedrooms(actual):
DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x N of bedrooms):
Number of current residents: D
Does residence have a garbage grinder(yes or no):/�O
Is laundry on a separate sewage system (yes or no):�A(if yes separate inspection required)
Laundry system inspected (yes or no):
Seasonal.use: (yes or no): a v o v 3G 5/�,S G pQ
Water meter readings,if available(last 2 years usage(gpd)): y/.0,4- V/o7 =/6 oao
Sump pump(yes or no): -A) d .
Last date of occupancy: oo-7
Type stablishment:
Design-flow ed on 310 CMR 15.203): Qvd
Basis of design flo ats/persons/sgft,etc.):
Grease trap present(yes or
Industrial waste holding tank pres es or no):_
Non-sanitary waste discharged to the Tit stem (yes or no):_
Water meter readings, if available:
Last date of occupancy/use:-
OTHER(describe):
GENERAL INFORMATION
Pumping Records
Source Orin forTnat ion:��^,Oe —/3—oTJwa lZec alb
Was system pumped as pan of the inspection(yes or no): a
If yes, volume pumped: -o —gallons -- How was quantity pumped determined?
Reason for pumping: xJ 114
TYPiE 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.&om system owner)
_Tight tank _Attach a copy of the DEP approval
Other(describe):
Approximate ave of all components.date in called(if known)and source of informatio
Were sewage odors detected when arriving at the site(yes or no):
6
Page 7 of I I
OFFICIAL INSPECTION FORM —NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: (Y1�p a3y Banc eQ o q
Owner cA,&k
Date of Inspection:
BUILDING SEWER (locate on site plan)
Depth below grade: /f —
Materials of construction: cast iron Z40 PVC_other(explain):
Distance.from private water supply well or suction line:
t Comments(on condition of joints, venting,evidence of leakage,etc.):
Jo ,n7—S AG`�i'
SEPTIC TANK: ✓(locate on site plan)
— P )
i
Depth below grade:,p _ /^�� , � ct� o ociZG�GvJ � w� �r+ �•"o� 6�r c
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): _ (anach a copy of
certificate)
Dimensions: S"�� "�DX/o Z.Dx S� c��J�t,t�CCveL r\iSoo 6A�idrvS�
Sludge depth:/,2"
Distance from top of sludge to bottom of outlet tee or baffle:
Scum thickness: o
Distance from top of scum to top of outlet tee or baffle: C"
Distance from bonom of scum to bottom of outlet tee or baffle:
How were dimensions determined: <eeeW,,-C
Comments(on pumping recommendations,inlet and outlet tee orbaffle condition, structural integrity, liquid levels
as related to outlet inven, evidence of leakage, etc.):
cor+ Pa i4 oG✓ uC / 0 3 o ea So ao�o
--2:;J6e r— o 2 ee' T P �
/S F}�r e ok.;7zT.�uveQ��a IG'v,D�nce o� Lel4KrgGt_.
Depth ade:_
Material of cons ion: _concrete_metal_fiberglass_polyethylene_other
(explain):
Dimensions:
Scum thickness:
Distance from top of scum to top of outlet tee or e:
'Distance from bottom of scum to bottom of outlet tee or
Date of last pumping:
Comments(on pumping recommendations, inlet and outlet tee or baffle c `,structural integrity, liquid levels
as related to outlet invert, evidence of leakage,etc.):
7
,Page 8 of 11
OFFICIAL INSPECTION FORM ,-NOT FOR VOLUNTARY ASSESSMENTS '
SUBSURFACE SEWAGE DISPOSAL.SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: - Mf�P o-�3� PaACO O q(-o
f
Owner:
Date.of Inspection: - -
Depth belo de:
Material of constru concrete metal fiberglass_polyethylene other(explain):
' Dimensions:
Capacity: gallons
Design Flow: gallons/day
Alarm present(yes or no):
Alarm level: Alarm in working order(yes or no):
Date of last pumping:
Comments(condition of alarm and float switches;etc.):
DISTRIBUTION BOX:ZCf resent must be o e ed I t a�e 9
p p n )( ocate on site plan)
-T'o Tam Co ue-2 /�•�
Depth of liquid level above outlet invert: -1Z> !7 J0
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.):
S472 i3e,(To•-i '3"� DA>-P-- au�Ce -J0 SoG vQf CR /l oue�.
Pumps in wort rder(yes or no):
Alarms in working or a or no):
Comments(note condition of pu amber, condition of pumps and appurtenances,etc.):
8
Page 9 of I I
OFFICIAL INSPECTION FORM —NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: CA � 33 r( , p�znct_o (�
Owner: '
Date of Inspection: — —G
SOIL ABSORPTION SYSTEM (SAS): Zlocate on site plan,excavation not required)
If SAS not located explain why:.
Type
Ie ching pits,number:
eaching chambers, number: YGa ejly / I .S;'6A3.0'
leaching galleries,number: eP��
leaching trenches,number, length:
leaching fields,number,dimensions:
overflow cesspool, number: to Fjo /
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.):
r�dZ ti o a r L e )o 577�- n
L�/C2 N er,J �'o n cl� o �•P G�-n4�o'r, iJ o�rn,�}L
s e pumped as part of inspect ion)(] on site plan)
Number and con r on:
Depth—top of liquid to inlet '
Depth of solids layer:
Depth of scum layer:
Dimensions of cesspool:
Materials Materials of construction:
Indication of groundwater inflow(yes or no):
Comments(note condition o.f soil, signs of hydraulic failure, level of ponding; condition of vegetation, etc.):
Materials of con ion:
Dimensions:
Depth of solids:
Comments(note condition of soil, signs of lic failure, level of ponding, condition of vegetation,etc.}:,
9
Page 10 of 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: MRP oZ3J1C . Q
Owner: r
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 'here public water supply enters the building.
J
is
�61f1�iA i
S
90
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0.,
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�Tv o 13-7-0
= Sy ' =026 Rio ''
10
Page I I of I 1
OFFICIAL INSPECTION FORM —NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address:
MIPIrp a3.4
owner:
Date of Inspection: —Q
SITE EXAM
Slope
Surface wwc
Check cellar
Shallow wells
Estimated depth to ground watero2�_ feet
PleaXbtained
e indicate (check)all methods used to determine the high ground water elevation:
from system design plans on record-If checked,date of design plan reviewed:
Observed site(abutting property/obsmation hole within 150 feet of SAS)
Checked with local Board of Health-explain:
Checked with local excavators, installers- (attach documentation)
Accessed USGS database-explain:
You must describe how you established the high ground water elevation:
Gff� SffocJ-S iJ /O,S p
o i�fJIZ.�STA�TG� S Shy cy5
C�P� Cow 60*'eou..JI-�wa—yd'Ziv,t9lOSlh&,5 J4lW -3S aD
tea, g
-• Su��� g-, o-� V��r�Ti o ri
1l
TOWN OF BARNSTABLE
LOCATION 3,2, L'fZifvJZ e �/ (—IfA)� SEWAGE#
VILLAGE ASSESSOR'S MAP&PARCEL/;I 3 0
�Spec NAME&PHONE NO. (X)#f f 5 r V J� V
SEPTIC TANK CAPACITY SO '
LEACHING FACILITY.(type) 5700 9/3 C 5�,�AvgPXS(size) a'
NO OF BEDROOMS vZ
PERN TT„�. 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 j
within 300 feet of leaching facility) Feet �-
FURNISHED BY � O �l�irr
r '
•' -7age 10 of 11 R `�
t� OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
♦i It
PART C
A — - SYSTEM INFORMATION(continued)
�P `f a1!0,4
Property Address: m a3
� owner: r - ♦ l 1
1. n Date of laspectioo: { t
` I
t' Y SKETCH OF SEWAGE DISPOSAL SYSTEM M
I ' Pro,ide a sketch of the sewage disposal system including ties to at least rwo perman—reference landmarks or r
- benchmarks.Locate all wells within 100 feet.Locate here public water supply enters th,building. /
.P
F �
pci Tv R Ref�✓� cAR S.R.S. / i
Q /
It
1
t',6T72r nub%<o'n S3ol�.
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FtTJ o l3'Ta'o (f-re,v
e 3=Sy c" s=,z3=6" i
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TOWN OFBARNSTABLE
c
LOCATION _ �� Cs y � Lw SEWAGE #: o�OOV-%3`1
. VILLAGE ��,V���e/�% ASSESSOR'S MAP& LOT a3 —014
INSTALLER'S NAME&PHONE NO. �3 i w/w
SEPTIC TANK CAPACITY ZLed- Cd�C
LEACHING FAciLrTY: (type) 5W( (size) ,�.?i f' -X J X�
NO.OF BEDROOMS_
BUMDER OR� Cf S
PERMTTDA'IE g�7'd�-
_ COMPLIANCE DATE:.h`j1ti 2
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 L 61'./
3Q� t
{
i
I O
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;— H3� 231 `�� .5��
N� mt�U ! Fee
e Entered in computer:
w THE COMMONWEALTH OF MASSACHUSETTS
Yes
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS
2pprication for Migogal *pgtem Construction Permit
Application for a Permit to Construct( . )Repair( )Upgrade'( Abandon( ) l�Complete System ❑Individual Components
Location Address or Lot No. Owner's Name,Address and Tel.No.
Assessor's Map/Parcel cell
^ p� Df 1 el-law
Installer's Name,Address,and Tel.No. `! Designer's Name,Address and Tel.No.
Type of Building: �lWAf 0 .1�yy -A ��'c ?'f °2
Dwelling No.of Bedrooms LoUSize sq.ft. Garbage Grinder(146
Other Type of Building of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow 110 gallons per day. Calculated daily flow i gallons.
Plan Date Number of sheets / Revision Date
Title 4� Z
Size of Septic Tank 1,52 Type of S.A.S.
Description of Soil 2 '"SOk9 5VI Ck w h.
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 byAhis Bowd of Walth.
Signed Date �/z4_1/1::PZ
Application Approved by Date UW
Application Disapproved for the following reasons
Permit No. ;?D®a— q3 V Date Issued hK-7
( Fee ✓_ .�
f THE COMMONWEALTH OF._.:MASSACHUSETTS Entered in computer:
t 7
t PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS
4 ` Zippftcation for -Migaaf bp.5tem Congtructfon Permit ~ t;v `Application for a Permit to Construct( . )Repair( )Upgrade(&�Abandon( ) L7Complete System ❑Individual Components
Location Address or Lot No. Owner's Name,Address and Tel>No.
all
Assessor's Map7cel411
Installer's Na e�Address,and Tel.No. 'k/, Designer's Name,Address and Tel.No.
Type of Building: �,) f c�1, ��'
j I Dwelling No.of Bedrooms �� "` LoiXsize l� sq.ft. Garbage Grinder( Cj
Other Type of Building e?,51 �4514No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow gallons per day. Calculated daily flow gallons.
Plan Date W 7 Z T"'I 7 Number of sheets / Revision Date
Title J� ' .5% - 146� 3 Z �4Z-0,hel-eV
Size of Septic Tank / /� Type of S.A.S. 9 X3X 362iY Z
Description of Soil
.r
Nature of Repairs or Alterah (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 provisio s�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, is Board of .ealth.
Signed !�V# Date
Application Approved by S/ •.. ti Date 11&7LO
Application Disapproved for the following4pasonIs
of -
Permit No. L1311 f Date Issued- q l
_ ———— = ---------------= ---_
THE COMMONWEALTH OF MASSACHUSETTS r'
/ BARNSTABLE, MASSACHUSETTS f '
Certificate of Compliance
THIS IS TO CERTIFY,that the On-site Sewa a Disposal System Constructed( )Repaired ( )Upgraded
Abandoned( )by
at 7 G /Ct'rl �!d/�/ �n C_ rr'/9 >eel_/i ale has been constructed in accordance
with the provisions of Title 5 and the for Disposal System Construction Permit No..200. - dated 9 v�
Installer Designer
The issuance of thisjermit"shall not be construed as a guarantee that the sysCe7nwill function a§designed. c~
Date lil 1 r�1�� Inspector 4-- ' _3
---------------------------------------
No. a?c)bA—g3V Fee
THE'COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS
Mfi6po.5ar *pgtem Construction Permit
Permission is hereby granted to Construct] )Repair( Upgrade( Abandon
Y ( )
S stem located at Z G zy'w 1 ell?V
and as described in the above Application for Disposal System Construction Permit. The applicant recognizeshis/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 this.permit
Date: d 0-7- Approved by ' Ilk)"
�S
i
f �blY•lIlrl ����A�� -
S TEST HOLE �o�s
SYSTEM PROFILE
TOP FNDN. AT' EL. 69.5' - woT To SCALE) E
ACCESS COVER TO WITHIN 6 OF FIN, GRADE ARNE H. OJALA, PE
rACCESS COVER (WATERTIGHT) TO ENGINEER;
70,5' MINIMUM .75' OF COVER OVER PRECAST /� WITHIN 6" OF FIN. GRADE 2% SLOPE REQUIRED OVER SYSTEM 70.0' DAVID STANTON
WITNESS • I R°��' �3z
9/17/02
RUN PIPE LEVEL 2" DOUBLE WASHED PEASTONE DATE I Locus
67�.O,f* FOR FIRST 2' PERC. RATE = < 2 MIN/INCH
(EXIST) PROPOSE I
t 66.58' GALLON SEPTIC 66.33 CLASS I SOILS P# 10329
11
I
T
TANK (H- 10 ) GAS $ f� C2 1BAFFLE 66.05' `�«' 65 $ �] C1 CD Cl
65.73' 0m0m o C1 �1CIE:)
MIN
1.5 • ) CRUSHED TONE OR MECHANICAL ® � O � � ED Q Gt ELEV./. SLOE �6" CRUSE S [] [] [� a o a o c O 63.73' 0"COMPACTION. (15.221 [2l) oc `� CMD
A
�EPTH OF FLOW = 4 ( 1 % SLOPE) (-l-/ SLOPE) 3/4' TO 1 1/2' DOUBLE WASHED :;TONE
SL PLEASANT PINES
ES
EE SIZES
INLET DEPTH = 10„po 6„ 10YR 4/3
L❑CATION MAP NTS
OUTLET DEPTH = 14
Bw
FOUNDATION- 2$' SEPTIC TANK 28' D' BOX 17' LEACHINGLS ASSESSORS MAP 234 PARCEL 46
FACILITY 50
f 36" 2.5Y 5/4
I�
+L-76.1 C
58,90'
�J_-�5 �A PERC LS
7� i_ - 75 74 ff- 73,E 5 ��' 1'\+ 7 0,7 6,�5
110.00 y� t Jdl 10YR 7/4
74
69.8
73.---, - / - -
_ - 72 -_= LOT 7
- 71 cv 15,634t SQ. FT. 1 I D
72-- - x �} 126„ 58.70,
NO WATER ENCOUNTERED NOT
71-4- + 71.3
0 71 -- 71.0
SEPTIC DESIGN: (GARBAGE DISPOSER IS NOT ALLOWED ) 1. DATUM IS ASSUMED
\
+ 693
+
DESIGN FLOW -_"r EDRDDMS (110 GPO) = 330 GPD 2, MUNICIPAL WATER IS EXISTING
. T 10" OAKS
y � 3. MI USE A 330 GPD DESIGN FL❑aJ NIMUM PIPE PITCH TO BE 1/8" PER FOOT,
r � ��70 1
6 `+ , LARGE �`- �-- - BENCH MARK - CORNER OF CONCRETE. SEPTIC TANK, 330 GPD ( 2) 660 4, DF-SIGIv Ll�AlliNlr h uhc F��L rk�.L..,+ � ul�a� I :� � �� r
�\ + ` P.PINE5 ~'- 0 BULK HEAD. EL. = 69.3'
!� USE F,. 1500 GALLON SEPTIC TANK 5, PIPE JOINTS TO BE MADE WATERTIGHT.
+ 8.1 - + 7 6. CONSTRUCTION DETAILS TO BE IN ACCORDANCE WITH MASS.
+ LEACHING: ENVIRONMENTAL CODE TITLE V.
0 68 2(30 + 9.83) 2 (.74) = 118
SIDES 7. THIS PLAN IS FOR PROPOSED SEPTIC SYSTEM ONLY AND IS NOT
101, -161, I 69.2{ BOTTOM. 30 x 9,83 (.74) = 218 TO BE USED FOR ANY OTHER PURPOSE
OAKS CAR 69A CV 8. PIPE FOR SEPTIC SYSTEM TO SCH. 40-4" PVC,
PORT EXIST. DWELL. TOTAL: 454 S.F. 336 GPD 9, COMPONENTS NOT TO BE BACKFILLED OR CONCEALED WITHOUT
Cd
2 + 68.2 i TF - 69.5' 'ISE (2) 500 GAL. LEACHING CHAMBERS (ACME OR INSPECTION B BOARD OF HEALTH AND PERMISSION OBTAINED
j `QUAL) WITH 2.5' STONE AT SIDES, 4' AT ENDS AND 5' FROM BO D 0
68.4 / 3ETWEEN UNITS 10, PUMP & REMOVE EXISTING CESSPOOLS
/ 68.4 (0 69.2
/ 6
/18.2 G 9/
_ (0 '; + 6 /71 68.3 y w LEGEND TITLE' 5 SITE PLAN
PROPOSED SPOT ELEVATION OF
32 CRANBERRY LAME _
/ 68, 100x0 EXISTING SPOT ELEVATION
7.8 x IN THE TOWN OF:
+''6 .4 67 G R=421 . 4 00 PROPOSED CONTOUR ( CENTERVILLE ) B A R N S T A B L E
J s ! 0.00t L=20.00 100 EXISTING CONTOUR PREPARED" FOR: BORTOLOTTI CONSTRUCTION/GRADY
+ 6 1 69.5 �_ + 703
2
69 ----6 0 40 20 0 20
I
6 -
--- -- f,
- T - _ _ 67J __ - 't- �/1-�. - _ _ . _D? - _... - _ - - -+- 66,0
+ 65.3 BOARD OF HEALTH
CRANBERRY LANE MA SCALE: 1"`� 20' DATE: SEPTEMBER 22, 2002
APPROVED DATE
off 508-362-4541
fax 508 362-9880
Of M4J, Di~
+
_ down cape engineering, Inc, o`` ARNE MAq�,
H. ' ARNE H. yG
o OJALA z OJALA
CIVIL ENGINEERS No 26348 CI
� IsTER``n 2
u. LAND SURVEYORS .rs 4
,1ST
02--287 939 vain st, yarmouth, rya 02675 ARNE H. OJALA, .s. DATE
- __ _