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HomeMy WebLinkAbout2225 MAIN ST./RTE 6A(BARN.) - Health 2225 Main 'Street/Rte 6A (Barn) Barnstable P t 4 Commonwealth of Massachusetts ' Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 2225 Main st. Property Address Patricia O'Buchon Owner Owner's Name information is required for every Barnstable Ma 02668 8/10/11 page. Cityrrown 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. Important:When filling out forms A. General Information on the computer, r �x use only the tab 1. Inspector. I key to move your cursor-do not Chad Hathaway use the return Name of Inspector key. Hathaway Property Service/Pastore Excavation "1�1 Company Name 1 Warwick way Company Address Mashp ee Ma. 02649 Cityrrown State Zip Code 1 774 274 2581 12866 Telephone Number License Number 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 Section 15.340 of Title 5(310 CMR 15.000). The system: c:n3 ® 1 ® Passes k ' ❑ Conditionally Passes ❑ Fa is - n ❑ Needs Further Evaluation by the Local Approving Authority ` µ . -8/10/11 , Inspe s Signature Date t� N i-n The system inspect shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. 4 ****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•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•^Page 1 of 17 4 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 2225 Main st. Property Address Patricia O'Buchon Owner Owner's Name information is required for every Barnstable Ma 02668 8/10/11 page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E7 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: 1500 gal tank good condition both inlet and outlet tees inplace tank is level with no signs of leaks or major cracks Dbox with speed levelers good cond level water flows equal Biodiffusers dry with no staining to indicate failure. 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,20years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5ins•09108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 2225 Main st. Property Address Patricia O'Buchon Owner Owner's Name information is required for every Barnstable Ma 02668 8/10/11 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): ❑ 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 0 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 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 9 t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 or 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments w 2225 Main st. Property Address Patricia O'Buchon _ Owner Owner's Name information is required for every Barnstable Ma 02668 8/10/11 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. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. f - ❑ 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 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 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 ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than%day flow , t5ins•09108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 2225 Main st. Property Address Patricia O'Buchon. Owner Owner's Name information is required for every Barnstable Ma 02668 8/10/11 page. Cityrrown 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. ❑ ® Any portion of cesspool or privy,is within 100 feet of a surface water supply or tributary to a surface water supply. ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for 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. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a 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 D. 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 ❑ ❑ the system is located in a nitrogen sensitive area (interim Wellhead Protection Area—IWPA)or a mapped Zone II of a public water supply well 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•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts Title 5 Official Inspection F orm Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 2225 Main St. Property Address ;. Patricia O'Buchon Owner Owner's Name information is required for every Barnstable Ma 02668 8/10/11 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 ® ❑ 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.not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS,located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: Z ❑ 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): 4 Number of bedrooms(actual): 4 DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): 440 t5ins•09/08 Tide 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 g n f Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary.Assessments M 2225 Main St. Property Address Patricia O'Buchon Owner Owner's Name information is required for every Barnstable Ma 02668 8/10/11 page. Cityrrown State Zip Code Date of Inspection D. System Information Description: Number of current residents: 2 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 Seasonal use? ❑ Yes ® No Water meter readings, if available(last 2,years usage(gpd)): Detail: Sump pump? ❑ Yes ® No Last date of occupancy: 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.ft., 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•09/08 Titie 5 Official inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 p Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments 2225 Main st. Property Address Patricia O'Buchon Owner Owner's Name information is required for every Barnstable Ma 02668 8/10/11 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: pate Other(describe below): ° General Information Pumping Records: Source of information: no info found Was system pumped as part of the inspection?, ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: L Y 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): t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 8 of 17 N Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments "e 2225 Main st. Property Address Patricia O'Buchon Owner Owner's Name information is required for every Barnstable Ma 02668 8/10/11 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed(if known) and source of information: 2008 plan Were sewage odors detected when arriving at the site? ❑. Yes ® No Building Sewer(locate on site plan): Depth below grade: 2'feet Material of construction: ® cast iron ❑40 PVC ❑ other(explain): Distance from private water supply well or suction line: 40 feet Comments(on condition of joints, venting, evidence of leakage, etc.): Septic Tank(locate on site plan): 10" Depth below grade: feet Material of construction: ® 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: 1500 gal Sludge depth: tank got pumped upon completion of inspection t5ins•09108 Tide 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 17 Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments 2225 Main st. Property Address Patricia O'Buchon Owner Owner's Name information is required for every Barnstable Ma 02668 8/10/11 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle Scum thickness Distance from top of scum to top of outlet tee or baffle s Distance from bottom of scum to bottom of outlet tee or baffle How were dimensions determined? sludge judge Comments(on pumping recommendations, inlet and outlet tee or baffle condition,.structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): tank got pumped after inspecton was completed Grease Trap(locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑fiberglass El polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins•09108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts l Title 5 official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 2225 Main st Property Address Patricia O'Buchon Owner Owner's Name information is required for every Barnstable Ma 02668 8/10/11 page. City/Town 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.): Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons 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•09/08 Title 5 Official Inspection form:Subsurface Sewage Disposal System-Page 11 of 17 Commonwealth of Massachusetts . Title 5 official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 'Y 2225 Main St. Property Address Patricia O'Buchon Owner Owner's Name information is required for every Barnstable Ma 02668 8/10/11 page. Cityrrown 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 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.): D Box level water flows to each outlet equally 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: inspect port at grade in cast iron cover in driveway at grade biodifusers are dry with no staining to indicate failure t5ins-09108 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 2225 Main St. Property Address . Patricia O'Buchon Owner Owner's Name information is required for every Barnstable Ma 02668 8/10/11 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: f ® leaching chambers• number: 20 biodifusers ❑ leaching galleries number: ❑ leaching trenches number, length: . ❑ leaching fields number, dimensions: ❑ - overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Cesspools(cesspool must be pumped as part of inspection) (locate on site plan): F. Number and configuration Depth-top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments rY 2225 Main st. Property Address Patricia O'Buchon Owner Owner's Name information is required for every Barnstable Ma 02668 8/10/11 page. Cityrrown 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: Dimensions Depth of solids Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 2225 Main st. Property Address Patricia O'Buchon Owner Owner's Name information is Barnstable Ma 02668 8/10/11 required for every page. CityrFown State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately A I , C.h2�ow'� 3 391 - ��) 53 Q 3) y5 c 3) cti) 9 5) 69 t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 2225 Main St. Property Address Patricia O'Buchon Owner Owner's Name information is required for every Barnstable Ma 02668 8/10/11 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope u ® Surface water ® Check cellar 1 y Shallow wells Estimated depth to high ground water: 10.7' . feet Please indicate all methods used to determine the high ground water elevation: ® Obtained from system design plans on record If checked, date of d 2008esign plan reviewed: Date ❑ Observed site(abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health-explain: g ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: plan at health dept. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 Commonwealth of Massachusetts . Title 5 official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 2225 Main st. Property Address Patricia O'Buchon Owner Owner's Name information is required for every Barnstable Ma 02668 8/10/11 page. Cityrrown 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 , t5ins•09/08 Title 5 Official Inspection Fond:Subsurface Sewage Disposal System•Page 17 of 17 TOWN OF ARNST BLE LOCATION Q !�4, SEWAGE#. VILLAGE n ASSES OR'S MAP&PARC L �J INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY:(ty e) (size) NO.OF BED S OWNER 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 6 `( Id JI /l MIJ No. ®�'•`V S(2 Fee /d G �. THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: 11� Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS ZIppYication for Zigool *potent Cowaruction i3ermit Application for a Permit to Construct( )Repair Upgrade( )Abandon( ) Complete System El Individual Components Location Address or Lot No. 2ZZ5 Mw1 N �i X �A Owner's Name,Address and Tel.No. PATP-i�1A ®-g o C,;i rC1PJ Assessor's Map/Parcel 2.3 t- 036 Installer's Name,Address,and Tel.No. PAST 6QZ GXC,�,V• Designer's Name,Address and Tel.No. eal6 i os�ly oel,% r Type of Building: Dwelling No.of Bedrooms _ Lot Size 2©, Zy 1 sq.ft. Garbage Grinder( ) Other Type of Building RM 1a)T.51'11gL. No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow zlq® gallons per day. Calculated daily flow �J�.� •y gallons. Plan Date O ° Number of sheets Z Revision Date Title Size of Septic Tank;1600 paw;P ca'sF� Type of S.A.S. 1310 - J�1 FrU 5Z(Z Description of Soil `i c PLAN 56 tL L 0 Nature of Repairs or Alterations(Answer when applicable) R6?A1P_ r1c Ago 3J�4TT��fti Date last inspected: Agreement: The undersigned agrees to ensure the construction nd maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the E onmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issue thi oaz f Health. Signed Date /4i9 9 Application Approved by Date 16 Z 41 0 9 Application Disapproved fo he following reasons Permit No. ZOO 5 Date Issued 0 'Z y 0 No. Fee t. THE.COMMONWEALTH OF MASSACHUSETTS Entered in computer: •,,Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLES MASSACHUSETTS ZippYication-for ]Dizpaal 6potem Construction Vomit Application for a Permit to Construct( )Repair O Upgrade( )Abandon( ) iVomplete System ❑Individual Components Location Address or Lot No Z Z Z rj . 1y q IJ } by Owner's Name,Address and Tel.No' P&P—l 6 l A 0 G{i'AN Assessor's Map/Parcel j s Z37 - G3(0 Installer's Name,Address,and Tel.No. PAST 69 C)c C,A�(, Designer's Name,Address and Tel.No. 1=N61 IJ�-Imo,6 1 P o ` 130x 12_ r . 1=o�Dl�+-s Mom, � c�8" 417-T313 Type of Building: Dwelling No.of Bedrooms Lot Size Z o, ZN I sq.ft. Garbage Grinder( ) Other Type of Building PUS I.f ZPr1 PL No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow ' ' yG gallons per day. Calculated daily flow ���Z gallons. j I' Plan Date d U 1710 U a J Number of sheets 2.... Revision Date Title . .,; Size of Septic Tank 1600 4t pe-o t?o'Srsn Type of S.A.S. 8(0 - Al F_'fQ51Z-k �'^^4rip r-~_..--__ PLAW 5b 1l_. LA6 ,y Description of Soil` `�� Nature of Repairs or Alterations(Answer when applicable) P Z?Ai R 0-S' r"A IL-60 51/SM M Date last inspected: a Agreement: The undersigned agrees to ensure the constructioovnd maintenance of the afore described on-site sewage disposal system ,5 in accordance with the provisions of Title 5 of theme, onmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued Yh* Boar� of HealthSigned' Czice%. Date lD g OJO Application Approved by L Date Application Disapproved falthe following reasons Permit No. 00 Date Issued 2 We - —————————————— —————.—————.—————— —-- THE COMMONWEALTH OF MASSACHUSETTS A,BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTf.IFY, that the On-site Sewage Disposal System Constructed( )Repaired ( )Upgraded( ) Abandoned( )by PA7r6M 1�;xC.Ay Ail 010 at 2ZZS MA)N SF 9 muis"f ALA has been constructed;''n accordance with the provisions of Title 5 and the for Disposal System Construction Permit NoZ 00 - y-5,0 dated `0! Z y/ Or Installer &ST&M Q cAV"ON Designer The issuance(of t 's permit shall-ad :e constrhed�as a:guarantee that the sy �m w 1 unctio a§desittlred.� � Date �� %rw1 1°tt t Inspector Ali �It No. 4' ��J�'. ��" Fee !�� `- THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLES MASSACHUSETTS Miq u ar stem Construction ermit � p � Permission is hereby granted to Construct( )Repair( C_ Upgrade( )Abandon( ) System located at 72.?_`s bd A iN�R321�x���� 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 this e'rmit. Date:_ G �2 yT 6�3 "Approved by 1/11/2008 07:25 5084775313 ENGINEERING WORKS PAGE 01 Town of Barnstable Regulatory Services . Thomas F.Geiier,Director t Public Health Division Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 0 : 5."24W Fruc; 508-790-6304 Ing. e e Dlate: . (� Q Sewage Permit# '107�Assesser's MapWaree�P w (yh-- In c Installer: 1 qt +O t'm �Ct Addrep: UU [0' is `- ! ,,..— Address: J?_4• (�ox on_- ��} �' G • was issued ap ermit to install a ....� (installer) W- 13 cwo%j -a b l.0 Septic.sys l:.at 2�Z S- MGM;A S t ` Of G A 7 based on a design drawn by (address) (4esigner) I cast y that the septic system referenced above was installed substantial aecor�g to the dai , which may include minor approved changes such as lateral relocation of the hon box and/or septic tank. I certify that the septic system referenced above was installed with nor changes (i.e. XMW 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 cad as-buil y designer to follow. OF lbes_ Sp PE1'ER ?. .l MCENTE£ coCIVIL . 0 9 No.3009 �9s/ONAL �� (Vegi ris Sipat. re) (Affix Designer's Stamp Here) TB MUM S Q:Hash SgAi (DeeiVw Certification Form 3-26- ,doc down cape engineering,;.in.c:SIEVE SOILS ANALYSIS 08-260 McEntee 2225 Main St. Samstable.xlsx DATE OF REPORT; 10f16108 JOB : GRAIN SIZE ANALYSIS-SIEVE TEST SITE: 2225_MAIN ST. BARNSTABLE, MA. LOCATION: ENGINEERING WORKS:TESTHOLE SIEVE ANALYSIS Weight Sample(Grams): 521.:2 SIZE ;WEIGHT RETAINED ; % RETAINED; %:PASSED (sum) 13/4" 0.0 4 0%: 100.4°10 ------------;-..-..--......_._...--.,.....--------------------_------------------- ..---__----..—.c......_........_.-...-..--..._...A------------ --- ••_—c•---------- r8° --------------. ,_..... - - Y------------------ ------ 0.0: 0.0%: � 100.0%° . --=-------,---= ------------- - -- - #1.0 33:4: ------ - - A--- 93;6°Io #20 .- ---- 7A----------21 6%'---- ......8.4% #!`40 263.0 50,6%: 49.5% #50 334.7; 64.2%: 35,8% +-------------=—o_._.-. —._..-.------ #80: 433.9; 83.310' IV/° ------ ---------------------- -- ------------------- _.------------_-o- 100 459.8: 88.2%: 11.8/° #200 506:T' 91.1% 2:9%n PAW;----- .........._. _. 521.-2------- --------�r- ----- 0.0% -- ------- ---- --------------- ---*-------------------------"----------- $AMPLE 5-2.1.2; NOTE.:TEST ON PASSING#4 ONLY,:9% RETAINED ON.#4 <45%O.K. RESULTS: _ .. _ ... . SOIL CLASSIFIED.AS AASHTO A-1-b(GRANULAR,.SAND)(UNCOMPACTED) PERCENTAGE OF MATERIAL PASSING#4 SIEVE MEETS: #4 100% (TEST ONLY MATERIAL PASSING#4) #5010%-100°10 x t xse #100 0%20% —��� #200 0% S% �� :a�� a t� j REQUIREMENT FOR FILL IN.TITLE 5. tat "r, .L ! i;5%°PASSING#200 SIEVE 4-1 3UVIL t RESULTS:.PERMEABLE MATERIAL-.CLASS.1 <5 MIN.IIN.MATERIAL NONCOMPACTED SOIL:DESCRIPTION:.MED.SAND,W/GRAVEL,.SO.ME SILT f if � (� 7 l � J �- S p����a A� �mesa A g�� r .iixE firs OFF= VF EN ymoNu.�dZ� AL LET. .Sty D r'PA SgszN-r op EN-mo vTAL PROTECTION T= 5 OPTICL41 INSPECMON FORM--NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM E FORM, PART A CERTMCATION g, l VE® Frap�Adder Owner's Name: -. :'UWN p 1 2002 F ARfivneer's LTH R S7-, jDichogtaN Mk-0 Rate*f €ass: maw of Iispeaor:(plase prin comma IME 9536 OA iag A,dd�rsss: 4 � MAP 2 c� A t -is6$ , Tekphoce Number: XAMS PARCEL s _-- CERTMCATION STATEMENT LOT. 's=afy t'--a.?save MS=MHY icsspected&--=wW ftpnal syswm at this adds and that the Wow is ad complfe as of tia:time of the Via.The vsas perfmwd bmd oa my the aad wsias�Of On sire U wage die 06a{systems.I ass a DEP approved st,scem isspetsar ptarsaaa=ns Sestsoat i5348 o!"ftte {? �3 $ 15 QQ(f- ? sysoeett: i. Passm Coad'atiotaUy passes ? Fmtw Evabudon by The iQcall A g Audwrivy Fa-is Does Sipatam. Taft Tilt sys€om moo€shwa aagodr a copy Of this OR RPME to the Appm mg A ;i gk=4 o€.,s ' or DEP)withm 30 days a€cow the �i€tI gpd or ice,the sY`�is a shard sys�or�a flow of i��Rti DER The o:igina}shMW bed seat to t owner s refract to the awe red o tx to systm mwrseT actcfcopes sent a ehe Dauer,i€8pgrlicab:e, 4 The zviasg M"d Cot� repw,only&MrQW M&tbsat'be 6W i6p�SW U&-Se� d=g �n�not a � 0. rlm ea tint fkftre under the samt or asffereu € MCLAL ITSPEMON FORM—NOT F -ASSESSNOMS SURSURFACK SEWAGE�) ^b POSsAL SVS- IMPECT i FORM PARS'A CERTEnCATION( PrTm ty AMMM Owner. - uste of & System Pax 15CI t= 1 arty. cafes ttt any o€tbe€aihve described it 310 CAR or in 3 TO CUR 153E1+t etdm Ate►;fie crhark not evabxmd we bxffcgtod below_ comes � _ & systm condmommy Pis the ar More system compomm as described at the Pass"sew need to be vtpbcad or repare&Ibe sysmtn,=m comp of*0-TqAwmm Q " ,as aped by*e Baud of He*W wM per. Answer yes,no or rmt deverraked(Y X, M)is the -for the Mowing statemem.If eq)l The sep=tak is meW sad over 200 oI&or the up&tmk(wbedw mum)or act)is wily. ucsovx$ OF tOk&RMC as M2MWMMW Sys wM tM i if t$e Wdsting took is reps with a sep&tank as by the Board of ff eaM. `A�atY sepac tank wf pan' if it is saucmzzRy somd,am kmUng and i€a Cadficam ofCanqWinum that the is tess *rests old is avaflabb ND ObsurrAtion,0 Or btwk�ax high.s�water�is the dam b=due to.taabes of ob ed pipe(s)os a W okm saw a r bay wM pass jf(w� = approval a€Bae�ed of ) broken pips)am �is ranwed ffimibWou box is kutled.or repheed ND Pu=Ping mm dML4 gars aYm due tts brag or obstrutedpiite{s) The system wits Pm 7" if(with � approval of the Bowl o bmkes s)are npUcOd obsmuctioniinmvw- ND cThix Page 3ofII 0 CIAL EgSPECTION FORM-NOT FOR VOLUNTARY RY SUB3SS WACE SEWAGE DISPOSAL SYS MM INSPECTION FORM PART A CERTMCATION(con propextyleYress: 4 0. Dante of bspectfon: C Futher EvgWafw.-is Requked by the Board Of = C wfffaz eda wbib same fWdw avehadmbyihe Board ofHeakh m order to determine iftbesysum is hiling to Forec t pablic beaW safety or to estokonmem 3. Sys wH pass—im lard of Health date�es is&=ordance witlu 310 Xb)tta t the sysftm is not functioning is a manner wbicb wjH pstststt psbfic bea flt, aad the ezVftVft=0zft Cesspool orpivy is wrttb 50 feet of a swf=water T Chi crp ivy is witbk 50 fim ofs bong vegetawd or a sak aaa I Z. Synt m wul bu traits the Board of Rea th( Pablis Water Supplier,if any)deteraffnes that the system is runcaosing in a aasaes thatpal health,say andev4so3ltata The sysaem has a septic tank and icxt system(SAS)agd die SAS is within 100 feet of a Vrrfr WaW SU PPIV, orb t+o a WZUT supply. _ roe ss^stem has.a septic Unit SAS and the SAS 3s W-t a Zone I Ora Public warns supply_ The system bas a septic and SAS and the SAS is Wid3CM 50 fee of a private water supply well. Tbt system bas a task and SAS and tkb-.SAS is I=ftm 100 feet but:50 fee or mom fta a prrvlale wam sq9iy *.Method used to deoxmin ice .-This syszem a€the well water analysis,pa*nmd at a DEP certified is borate,for coiiforin and owe compmoft tw the--reR is five frm poMmon f m*=bafty zad the Presence of qa aka and nrvate tEitro ese is etltta:to or less tlsa e 5 ppm,provided dw no fai''mm c an is t3r*gwod A cosy of the=ahmis be attached:o this fazes. 3. Other b -900 e �$ ! g,. PW c€ "3 um gpllmz MUWADam s=so=8w Simms&w ce sx 'a am m ss ate aq WNW w4wm a plo V riare s ass M mad am vm 4amovew=04 _ =4 Iq seat ap vm gaaapp=sswd=nab=Ul vm4mwAqmb smm 4ufts - xp'I ssa1 s s! � Y tANV a m 3c 4ddas sma *per 001 si 14d,a p ,4a fxv ` mpw'. ��Pd ` Man r paw pals"TVSOA IDVAM IDVAWISRW f n OMCUL MPE ON FORM—NOT FOR VOLUI� FARM ASSF.SSmENTs SUBSURFACE SEWAGE DLSPOSAL SYSTEM INSP£C ON FORAM PARS'B CSC ' / ., Owner: E-tttA Dme oft: »� Si! p '+e$ems -Yar3 tam i7r'0`�D as t4 each of t6it 'Yes NO _ Puw4mm 3nkramon was provided by taw or Board of Health 0( Ware 8ii3/of the system compmem pmuped om t1fthepvvmw Flo ? — HAS&-.SYS=hived=MW flows in the pevxm wm wftk partod 7 .r 4— Have large vokmmes of water bey ftmvduced to to systemy or as pum of*is s Were as buRr plays 4of the s nzem obtained and=amimmd?(ff=my wac m ambble am as N/A) ___. Was the faoliay or dweltin inspemd far of sewne bad up t 4 Was dlae site kispecmd for sign ofb;eak out? _ Mete sli sysum COMPODeRM,exc the SAS,lom� on site Wem the septic t0k tholes uncovered,opftvA and the idtaior ofthe mule for rhs contim of tit-taffies ar tees,tt -cl of construction,d �d off ' of sludge 7 _ drat tzdge and dq�3t of _ Was!bc b-cility owner(atrd oc=Vwm if diffemt 5vm o►iter)provided with mfor:tmam on the lx'es of saw sewage disposal.syste=? The sfxt and loeatioa of the Soil Absorption Svsb= on the sim leas be=dtdaundbedbred a� Yes r* .r F.xise¢sg iaa�m For h-,a ph,art the Board off. _ Drc named in the old(if any of the faillue csaWiaMIOW to Fart Cis at issue approx3ratim ofdiume pmbL-)C I CAR 15302(:;)(b)] I CLAD.►JQ Foam-NdrymVuLtaffAilly SUDSMWACE SAGE DISPOSAL SWZMM ff4SMC°rMW FORM PAIMC SYSEEM DWORMAIION selaw sysom or V03t.Alf squaft kepec6m 33a�e+�F ides �e►e a �� �r�a� Bey sysaeama imoerfed Qm or no)-- sound aW(V=W 2DX&Q rem, I' ) l 4wa Lat daft of mapow. �t Typeof IXsip fkw(bid an 310 CMR 152M): smd sad&afdcdvftw{ Gas amp (-M cr;o�_..__ i i bb sic or gad No �a f azt&S nr )C"nimy r Lest cm of Rome& Saes o ma oea do 11 Ctk d�LAf �lasas� U��na - T"E"SYSTM bow,wt S oft or too}Ofyes. jfwY) _bul, be. otff i Vim. � OFFICLAL3INSPECnON FORM—NOT FOR.VOL€tfrARY ASSESSbMM SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FOPUVf PART C SYSTEM ROORMATION E Property Address: Qom. ,, Dm of � NAMING SEA(t+oeste an sift plan) of consmudom cmkm 40 PVC c+ i0colawc - D'ssear w ftm privm wMar VmPly weH or Commies(cc wv&don off jahs,vewin&evkteoc a of loge,etc.). SEMC?AraC-_.._(kxWz on sift plan) Dgxh below Va& c�sr(rxph�e) If talc is metal list age: Is age confirmed a Cerditcatc of Compliame Ness or no}:____(a�rach a mom+of yr¢ ceraficaw) moons: Shoe deptr Dim me frcm wV of s3�e to o f off€tee or : Scann baits& Distance from top of scum of outlet me or bad: Disaatue fraan of m 4 of sit t+ee or lsae How Wert dimensions C "u Yeooestme�omc,i flK mast aaadct tft or bsafHc cam,stn nn-4 issrt� , 3evels as r to mot,eviee of.leakmr,em): GREASE T'R"- w sim pbn). below$a&— MMeaarw of cow mecal , ��y ne a rt wars: Scan:hies.: _ Dim um from top o¢ to toffs of o�et Me sar ba#fie: fr= f sc: to mom of outlet m of bye; Dec of bW Comem(on r+�dat(ons,m1a and o•.a 1a tee.or baffle condarom�l imte r, levels rake a of I t OFFICL&L Eimc ON FORK—NQ' TMVOLUNTARY ASSE�?S SUBSURFACE SEWAGE 0GALSYSTRMnqsrwnoN FORM PAKr C SYSTEM EIFORMALnON( PrapmVA Deft of TIGS'T or HOLIDM TALL an sift;(tiku Deptb�m matww of ___pobwh i I3oa� Dadp Fkw. Ada (yes+ra* Absara kwek adw(ya or W)c Date of 1= C ( ofa�m and swiae�s,r�.k DISTRIDIU"t ON Dox.- {tf a be opeoed)(tocate can site pied) Deph of Utpnd kvd above is vac_ Commew(ate if box is and&sbimwo vD c adw ems,any evil of solids cw ,mw,any eve at PL3A 'CHANM£I8: (locaftper) _ Pumps in vroddn owder My- Alum is wwikdbag Pr nor C.taaoams(woe of caf} amaa� coca „ste Paseyot 11 OMCIAL INSPECTION FORM--NOT FOR VOLUNTARY SS3'.,S hE01S SUBSURFACE SEWAC$DISPOSAL SYSTEM VgS7E O-N FORM PART C. SYSTEM WFORMATION(co Dift ofbspeciow - SOIL ABS3FJqWN SYSTEM(SAS): (ire an sstm qua,=Mvsfion DCA nquhvo if SAS mm kx=ed expkia wW- Type pig• :__,. ls, pl •number.lengtk itmosystem Type Of [ of soil,saws of bydmuhc i 9we,level ofpandW&damp soil coc&gioa of veStudon. . erc.): -4, $.. e € LS; (cm4c4li6m be pmped as part of WV ica)(lo=e an 3bg per) N=bcr and moo; .C __-I Y ---- Depth—tog off to irdet.imvet: ' Deep&of solids 07 ofscm Lamnsious of cesspooL- ARawrials Of l I 'Of vouadwaftr i dWw€Yes or pox moments(note condition of soil,signs ofilydtzurm&am&kwei of ndh3g, of ew RO "Lilt ;R1W: (lac sign pin) Macetials of consmx2iow. ems' of solids: commane of soil,si=ofhy&=lic levd of poosii L=kition of uepafm M): SUMACK SYSTM ONO bald PAXrC t ro � it ♦ ' I i I � it f pariiofil No-r pop AR PART C SySTM ,A1107� t4.d Owner- -- Daft of bmsp�ed-WW w wells plan -lf ,damof degp p1mTm - —Obsw4ed site(abutfog b k with= 150 fea of SAS) with focg mad of b5maw, 3 Accemd�� g exia- ia�m: S be bow vcu established ft h Wad water e}evstic��e= t 3 oov YOU M"t d S 1 i Town of B4rnstable P# Department of Regulatory Services eta c Public lKealth Division Date 0 *AW ' 200 Main Street,Hyannis MA 02601 QED NIO�a �' tjoc (?v Date Scheduled VEr�Time Fee Pd. Soil Suitability AssessMeut for Sewage Dis osal �T 1��,i-� �� S� Witnessed By: Performed By- LOCATION & GENERAL INFORMATION Location Address ZZ2a �/� S¢ �l (Q��. Owner's Named nt �VC�o�1 Address it!6 Le j 2�Zr 1 6 bt M A- G G Assessor's Map/Parcel: 03 Engineer's Name Aw M c- £w 1—PR £ 1 . Telephone#. S 0 7 S3 13 NEW CONSTRUE 1[ON REPAIR Slopes(go) Surface Stones Land Use .aCJ / lC`i(Bs�` �'v ft Possible Wet Area--ft Drinking Water Weller >=ft Distances from: Open Water,Body — , Drainage Way 7 J w ft Property Line -=" Other ft SKETCH:(Street name,dimensions of lot,exact locations of test holes&pert tests,locate wetlands in proximity to holes) cm I v' M Cn .• - s} . N S i �L,Z� pr 3 U) _. - • (A cn III Parent material(geologic) Depth to Bedrock �- from Pit Fiat Weeping Depth to Groundwater. Standing Water in Hole: Estimated Seasonal Nigh Groundwater DtTERMINATION FOR SEASONAL HIGH'4�ATER TABLE Method Used: In. in, Depth to sail mottles; ft Depth observed standing in obs.hole: In Groundwater A�ugttnenk Depth to weeping from side of obs.hole: _ A� {aefor,T .a- Adj.&0undwater Level Index Well# Reading Date: index Well level - PERCOLATION TE+ST Date - p-�-. Observation Tittle at 9" ---- -- Hole# ` Depth of Perc �1'r L 'J7}f�N F?2-tM Time at 6" Z C�-P�2- r ' S i Svc Time(91�41 Start Pre-soak Time.C& - ' End Pre-soak G Rate 4m./Inch Site Suitability Assessment: Site Passed Site Failed; ____— Additional Testing Needed(Y/N) Original: Public Health Division Observation Hole Data To Be Completed on Back-------- ***If percolation test is to be conducted within 100' of wetland,you must first notify the Barnstable C6#servation Division at least one(1)we&prior to beginning- n-xcr:v'rfrAIRM.DOC 'DEEP OBSERVATION HOLE LOG Hole#_�_ Depth from Soil Horizon Soil Texture .Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Struc�re.Stones,Boulders. Cons stenc % ravel C-( 6 —[A4 CIR Z,S Y DEEP OBSERVATION HOLE LOG. Hole#�— Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistent %d ravel LA- M_C !"11-q Z�g SAW4 vff-av 1:;,,z GJG AAA��, S- DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) {USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistent Gravel i DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture 'Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure.Stones,Boulders. Consisten ra el I Flood Insurant Rate Map: Above 500 year flood boundary No_+ Yes within 500 year boundary No_\ Yes Within 100 year flood boundary No Yeses Depth of Natutafly occurring Pervious Material . Does at least fo r feet of naturally occurring pervious ial exist its areas observed throughout the area proposed fbr the soil absorption system? If not,what is the depth of naturally occurring pervious material? Certification • I certify that on. L� I�� (date)I have passed the soil evaluator examination approved by the Department of environmental Protection and that the above analysis was performed by Me consistent with the required trainin ,expertise and experience described in 310 CMR 15.017. Signature Date Q:4SEPTlC BRCMRM.DOC LOCATION SEWAGE PERM.I-T NO. NIL �iGE ' P�tLn5a+ INSTALL R'S NAME & ADDRESS a 8 U I L D E R OR 0,WNER DATE PERMITF-.:ISSUED DATE C. OMIPLIAKCE ISSUED . �._a�J� �j �i z a rf No.82:..3 « Fus...... ...5..00.. . THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH Town. .....o F......Barnstable....... ............................................................................ Appliration for Disposal Works Tonstrnrtiun "unfit Application is hereby made for a Permit to Construct ( ) or Repair (x) an Individual Sewage Disposal System at: •222. Main-.... -..West Barnst4b7�e 0266$........ .................................................................................................. -Address or Lot No. _Edward A. McCarroll2 .:�taan Owner Address a A & B Cesspool ............................................Service .....Hyanni.a.,MA.----D26.01........ . . ........ Installer Address UType of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms............4.............................Expansion Attic ( ) Garbage Grinder ( ) �a Other—Type T e of Building No. of ersons..k........... YP g ---------------•----•---•--- P .....------- Showers ( )--- Cafeteria ( ) Other fixtures ---------------------------------------------------- ...:. W Design Flow............................................gallons per person per day. Total daily flow.-_......._............_....................gallons. WSeptic Tank—Liquid*capacity............gallons Length................ Width.....-.......... Diameter................ Depth................ Disposal Trench—No..................... Width.................... Total Length.A.................. Total leaching area....................sq. ft. Seepage Pit No--------------------- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ fz, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 04 - --------------------------•...._..... O Description of Soil...._.Sanc..-----------------•-----------•-----...----•-------•----....._ U •.......................•---------------............---- W ....................---------------------------------------------------------------------------------------------------------------------------------------------------------•-•------------------------ U Nature of Repairs or Alterations—Answer hen applicableinstallation of a 1,000 gallon, pre-cast . stone__packed__leacY� pit .overflow . -- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of iTL: ; P 5 of the State Sanitary Code— The undersigned further agrees n t to place the system in operation until a Certificate of Compliance has een issued by the boar health. =.---�.'.. 7/21/82 ------ • ------------------------- Application Approved By............. ;_-�,_--. ... - - 7/21[b2 -•---------------------•------- ----------------------.-.-------•------ Date Application Disapproved for the following reasons---------------------------------------------------------------------------------------------------------------« -----------------------------------•--------•-----...--------.....--------------•-------....------.......---•----------------------•-------------------------------------------------------------...---- Date Permit No.......82— .................................................. Issued_ 7/21/82 ------------------------------------•-----•- Date NO ?-.« •« Fins B. ..1a..�� . .� ... ~+ THE COMMONWEALTH OF MASSACHUSETTS R • BOARD OF HEALTH oW-D...........OF.......pa.r ...... ................................................ Appliratiou for Dispaii al Works Tomitrur#ion rranit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: x - 61--------- •-•--••-•••••--•----•----•-•••--•••--•....-•••-•--••----••----•--•-•-••--•---•--•................. Location- cress or Lot No. 'r��' YY Owner...... - 7� ..i 2g21 v., N(Fa 11d�se"s2tS�8�1@, b�+ � •—•-- .. 30�-------------------•----------_-__-------_--_ '�___P v _. . r „.�.........._... Installer 1 c.; s;��hop's errace,nda nnls,' A b��01 Type of Building Size Lot............................Sq. feet U Dwelling No. of Bedrooms........... _Expansion Attic Garbage Grinder Other—T e of Building No. of ersons_4__........................ Showers — Cafeteria Otherfixtures -----------------------------------------------------------------------------------------------------•----------------------._......•--•---------•---- W Design Flow.................................. .......gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity:............gallons Length................ Width................ Diameter---------------- Depth................ x Disposal Trench—No_____________________ Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No--------------------- Diameter............._...... Depth below inlet.................... Total leaching area..................sq. ft. z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water........................ f= Test Pit No. 2................minutes Per inch Depth of Test Pit.................... Depth to ground water........................ _y ...............................'•;--••--------------------------------------------•---•-----------••-------------•-------•--•--------...-••-•--••-•...••-....-- ODescription of Soil--- alA..........--............................................................................................................................................. W ----------------------•---------------------------- ------------------------------------------------------------------------------•-------------------•-•-----•-•-------•--••--------------•-------- UNature of Repairs or Alterations—Answer when applicably pdsta3la�I:on o "'3;flf3 a iron; 'P�e-cast" �zr,e = ?tee lsa�hI1; ,e�ref3 );•------------------•---•----------------------------------- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of'ITT 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board-of health. Sign d �- __ r�..�1_l'�:�... r� / Date Application Approved By...................................................�. .......7/!?i f 1Z2................. , Date Application Disapproved for the following reasons----------------------------••-----------..-------------------------------------•-------•-------•-•--•----••--•- ••--•-•-...--••--•••----••••-•-•-•-•-•-•--•--•••-•••-••-•-•-----••--•--•-•....._..••-•---•.............•---•--••-••-•-••---•-•--•--•-••-•••-•----••••••--•••-=•••-------••----••-••--•••----•••••------- ,jL Date . F Permit No....f-_2'.............................................. Issued_........ `2 r.?..............:. ate THE COMMONWEALTH OF`MASSACHUSETTS BOARD OF HEALTH T !.Q r.r.........0F..Bar ss+a' e........................................................ Trrtifiratr of TompliFattrr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ) Y.....A_&.....r.3 suPM---Seerv1oey.. 2 slogs 1,aee; ryerin s; at......_ 2-2. .Is: .ice sc. 1119et-4,' -netavl-v.'_..D%i7•--•V2 6 F------4Tf:---A --?=eC--a=oll----------------------------•---------------- has been installed in accordance with the provisions of TIT1�iW The State Sanitary Code as described in the application for Disposal Works Construction Permit N6?.?-................................... dated_....7/2.1/02______.______.__.________. THE ISSUANCE OF THIS CERTIFICATE SHALT. NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE , ................................................... Inspector....... t' THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........."'O?rrt...............0F....._.j, ata�149............_.-.._._.......-..._...._._.__._...._.. w No....2................... FEE: K.Ro.......... Permission is hereby granted.------ _________________________________________________________________________________ to Construct ( ) or Repairx( ).an Individual Sewage Disposal System at No..................... -3;r=t ? P�+ as±sri A =.� Qua Street as shown on the application for Disposal Works Construc n miit Y 6 2. ,,. ._____. I)a �7���� ?..__<).................... r� y Board of Health DATE............... /21/82---------.__-_---•-----•---___._----------__--N" + FORM 1255 HOBBS & WARREN. INC., PUBLISHERS r Wf:Y�u,mtlpY�101: [771 �f � � ——gg—— EXISTING CONTOUR 5HED A x 100.98 EXISTING SPOT GRADE Tr r- RaLROAo / � N _ 98 98 \ \ �, N W EXISTING WATER SERVICE 3 M o 0 G EXISTING GAS SERVICE C 100.69 SHED TEST PIT Route 6A ° o I I PA1V0 �I { BENCHMARK C z -s --- 99.��— -- LEGEND o° G� C, 90 \ EXIST. SEWER 25' overhan , ( LOCUS . �Q INV.=96:97t . 00.29 W 1 No. 2225 1 1 STY. I ROUTE 6 cn WD. FRM. l 98- - T.O.F. = 100.47' N p LOCUS MAP NOT TO SCALE EXISTING CESSPOOLS - O , —98 ------, TO BE PUMPED, FILLED WITH I I N � GENERAL NOTES: SAND AND ABANDONED \1 I 1. ALL CHANGES TO THIS PLAN MUST BE APPROVED BY. THIE LOCAL 8' 9 1 7 \ I I BOARD OF HEALTH AND THE DESIGN ENGINEER. 97:38 \ 1 d 2. ALL WORK AND MATERIALS SHALL CONFORM TO TI--IE REOLIf,I_MENTS- PROPOSED SEPTIC TANK — \ Q \ -- OF THE STATE ENVIRONMENTAL CODE TITLE V, AND ANY APPLICABLE \ L----- _9875 _ LOCAL RULES AND REGULATIONS EXCEP"i- AS REQUESTED BELOW: , Tp_1® - \ 310 CMR 15.405(1)(b), Contents of Local Upgrade Approval 9 1) A 1' variance to the 3' maximum cover requirement for .no greater than 4' of cover. S.A.S. shall be vented and H -20 ted. 18' 3. THE SEWAGE DISPOSAL SYSTEM SHALL NOT 13E B.ACKFILLED PRIOR �pCD TO INSPECTION AND APPROVAL BY THE BOARD OF HEALTH .AND THE tro I `Pt2joj '! I ,94.70 DESIGN ENGINEER. O I� F-i--Nit-► I RUCTION DIFF,'R G 4. ANY CONDITIONS ENCOUNTERED DURING CONSTRUCTION .! (n 1 iOiQi i ( Sh I X = FROM THOSE SHOWN HEREON SHALL BE REPORTED TO THE DESIGN. DR[ AY- ENGINEER BEFORE CONSTRUCTION CONTINUES. x 96.58 N U i i jai I i I w 5. ALL ELEVATIONS BASED ON AS�I IMEE DATUM. STRIPOUT i 6. THE DESIGN ENGINEER IS iNIOT rRESPONSIBLE FOR THE FAILURE OF (SEE NOTE 11) I i i it ' i 1'C9 THE CONTRACTOR OR OWNER TO NOTIFY THE LOCAL BOARD OF 11-- ' 93.82 HEALTH FOR PROPER INSPECTIONS DURING CONSTRUCTION. RUCTION. CHARCOAL VENT 95.51\x 4.,2,4 7. WATER SUPPLY PROVIDED BY TOWN WATER SERVICE. 1 8. THERE ARE NO WELLS WITHIN 150' OF THE PROPOSED S.A.S. _ , / 9. ALL AREAS CLEARED FOR CONSTRUCTION SHALL BE RESTORED AS / \ AGREED UPON BY OWNER :AND CONTRACTOR OR AS. OTHERWISE / ) DIRECTED BY THE APPROVING AUTHORITIES. / APN 237-03G 10. IT SHALL BE THE RESPONSIBILITY OF TH.- CONTR*..CTOR TC VERIFY / THE LOCATION OF ALL UNDERGROUND UTILITIES, PRIOR TO BEGINNING / 20,2415F CONSTRUCTION, 11. WHERE REQUIRED, CONTRACTOR SHALL REMOVE ALL UNSUITABLE SOILS IN THE AREA BENEATH AND FOR 5 ON .ALL SIDES OF THE S.A.S. AND BENCHMARK: REPLACE WITH CLEANSAND AS SPECIFIED IN 310 CMR 25` (3;. / CTR. OF CATCH BASIN 12. AREAS REQUIRING STRIPOUT OF UNSUITABLE MATERIALS SHALL BE i ELEVATION = 93.64 INSPECTED BY HEALTH DEPARTMENT PRIOR TO BACKFILL. (ASSUMED DATUM) 13. THIS PLAN IS TO BE USED FOR SEPTIC SYSTEM PURPOSES ONLY ,AND I 15.00' 1 k IS NOT TO BE CONSIDERED A PROPERTY LINE SURVEY. N70013'20"E �� uF Mgss PROPOSED SEPTIC SYSTEM UPGRADE PLAN CATCH o PETER T LP BASIN MCENTEE 2225 MAIN STREET (RTE.... 6A), WEST BARNSTABLE, MA - �1 0 EDGE OF PAVEMENT o CIVIL35109 N Prepared for: Patricia Obuchon, 2225 Main St (Rte 6A), W. Barnstable, MA 02668 c �' �'t c C o� 4 No Engineering by: SCALE DRAWN JOB. NO. �'£GIS�F� �� 1 =20' P.T.M. 241-08 STATE h I G h WAY ROUTE GA �F �� `� Engineering Works, Inc. "- Nf1 d Forestdale MA 02644 DATE CHECKED SHEET NO. 1 12 West Crossfield Roa , PLAN REFERENCE: PLAN BOOK 286 - PAGE 21 (508) 477-5313 10/17/08 P.T.M. 1 of 2 I , NOTE: TO PREVENT BREAKOUT, THE PROPOSED FINISH GRADE: SHALL NOT BE t EL:94,3 FOR A DISTANCE OF 15' AROUND THE PROPOSED SEPTIC TANK PROPOSED D-BOX PROPOSED S.A.S. PERIMETER OF THE S.A.S. INSTALL RISERS & COVERS OVER INLET & INSTALL RISER & COVER INSTALL A 4" DIAMETER INSPECTION -'OR f OVERR ONE CHAMBER OUTLET AND SET TO 6" OF FINISH GRADE SET TO 6" OF GRADE (MIN.) AND SET TO 3 OF F.G. CHARCOAL - 21 5-4' POLYSEAL OUTLETS PROVIDE AN H-20 PROTECTIVE FRAME & COVER VENT 2„ „£ 1-4" POLYSEAL INLETS EXISTING F.G. EL.=101.7t F.G. EL: 96.0f F.G. EL: 95.0-96.3(MA)C.) BIAXIAL GEOGRID-BX TYPE 00 L 46' = L = 9'(MAX) EXTEND 1 FT. BEYOND S.A.S. N in - LO S=2% (MIN.) SL1% (MIN.) © S=1% (MIN.) 4'SCH40 PVC 4"SCH40 PVC 4"SCH40 PVC - T OD 6" 12" I' , 14. s" MY EFF. INV.=95.25 48" LIQUID �INV.=95.00 DEPTH N Top View X Section D-' ®/�LEVEL , GAS BAFFLE PD-BOOSTED INV.=94.50 (5 ROWS OF 4 UNITS AT 6.25'/UNIT) + 1' WEDGE = 26' ' INV.=94.67 INv.=91:94 SOIL ABSORPTION SYSTEM (PROFILE) PROPOSED SEPTIC TANK TIE IN TO EXISTING 4" SEWER BIAXIAL GEOGRID / BX TYPE RESTORED SHELL PARKING ' PRODUCED BY TENSAR CORP. COMPACTED, CLEAN GRAVEL BACKFI L OUTSIDE OF BUILDING. ATLANTA GEORGIA - BACKFILL WITH CLEAN PERC SAND 75 INV.=96.97 Fi 1, TO TOP OF CHAMBERS � NOTES: 1) SEPTIC TANK & D-BOX SHALL BE SET LEVEL AND BREAKOUT=TOP OF UNIT ° act, e-,' TRUE TO GRADE ON A MECHANICALLY COMPACTED TOP ELEV.=92.33 y v• I :,. SIX INCH CRUSHED STONE BASE, AS SPECIFIED 'IN INV. ELEV.=91.94 ':' `, 12" 310 CMR 15.221(2). BOTTOM ELEV.=91.00 1 1 ml�uull�imiL�li - 2) INSTALL INLET & OUTLET TEES AS REQUIRED. �^ - 3) GAS BAFFLE TO BE INSTALLED ON OUTLET TEE ? 2.83 4' MIN. ABOVE BOTTOM OF - � AS MANUFACTURED BY TUF-TITE, ZABEL OR EQUAL. T.P..EXCAVATION OR G.W. EFFECTIVE WIDTH=14.2' EXISTING SUITABLE PROFILE NO GROUNDWATER AT EL.=84.3 __ MATERIAL OR PERC SAND USE 5 ROWS OF HIGH CAPACITY ADS BIODIFFUSER UNITS . WITH NO SEPARATION BETWEEN EACH ROW & NO STONE SEPTIC SYSTEM PROFILE N.T.S. TYPICAL SECTION 11.2 16„ -------- , SOIL LOG � i DATE: 'OCTOBER 9, 2008 (REF#12 376) �----34"- -*--I DESIGN CRITERIA I i SOIL EVALUATOR: PETER McENTEE PE SECTION END CAP NUMBER OF BEDROOMS: 4 BEDROOMS WITNESS: DONNA MIORANDI R.S. N -------- HEALTH AGENT »v SOIL TEXTURAL CLASS: C - 16 HIGH CAPACITY (H-2Q�B10DIFFUSER UNIT DESIGN PERCOLATION RA :<5 MIN/IN ZT 9'3 ELEV. TP-Il DEPTH ELEV. . TP-2 DEPTH 96.3 A 0° a6.3 - MODEL 16" HICAP DAILY FLOW: 440 P.D. ---= T� ,1 SANDY LOAM SANDY' (LOAM LENGTH 76 DESIGN FLOW: 440 G.P. I y'. IOYR 3/3 OYE' S/3 . NOTE: UNIT CONFIGURATION AND AVAILABILITY SUBJECT �vi i 95.0 -- �" 9r.0 ------- EFFECTIVE LENGTH 75" TO CHANGE WITHOUT NOTICE. PRODUCT DETAIL MAY GARBAGE GRINDER: NO DIFFER SLIGHTLY FROM ACTUAL PRODUCT APPEARANCE. N i as i B SANDY )LOAM H SANDY LOAM SIDE WALL HEIGHT 11.2" PROPOSED SEPTIC TANK: 1500 GALLON CAPACITY i oN i i O: I 10YR 5/6 0YR 5/6 . 1i a i 92.3 G8" 92.5 48 LEACHING AREA REQUIRED: 440 " OVERALL HEIGHT 16" ^' ( ) = 5946 S.F. r`____ S.A.S. LAYOUT C1 1 C1 OVERALL WIDTH 34" a 4640 TRUEMAN BLVD .74 I-14.2=-1 HILLIA.RD, OHIO 43026 13.6 CF `• � I � DISTRIBUTION BOX: 5 OUTLETS (MINIMUM) SANDY LOAM SANDY LOAM CAPACITY (101.7 GAL) ADVANCED DRAINAGE SYS71EA4S. INC. 2.5Y 7/3 2.5Y '13 USE 5 ROWS OF 4 HIGH CAPACITY ADS BIODIFFUSER H-20 UNITS , 88.3 96" 88.3 ��" PROPOSED SEPTIC SYSTEM UPGRADE PLAN W/ NO STONE AND EXTENED 1 W/ CONTOURED WEDGE (14.2 x26 ) C2 C2 SIDEWALL AREA: NOT APPLICABLE SILT LOAM ti -C SAND 2225 MAIN STREET RTE fA , EARNSTAELE, MA 5Y 6/4BOTTOM AREA: (GENERAL USE APPROVAL FOR 4.70 SF/LF OF BIODUFUSER) 2.5Y 5/3 2, Prepared for: Patricia Obuchon, 2225 Main St (Rte 6A), W. Barnstable, MA 02668 (BIODIFFUSERS) 20 UNITS x 6.25 LF ,x 4.70 SF/LF = 587.5 SF (SAMPLED) (CONTOURED WEDGE) 5 ROWS x 1.0' x 4.70 SF/LF = 23.5 SF 84.3 -J i 44" 84.3 1 144h Engineering by: SCALE DRAWN JOB. No. TOTAL AREA = 611.0 SF Engineering Works, Inc. NTS P.T.M. 241-08 PERC RATE 2 N41N/IN. (SIEVE ANALYSIS) 12 West. Crossfield Road, Forestdale, MA 02644 DATE CHECKED SHEET NO. DESIGN FLOW PROVIDED: 0.74(611.0 S.F.) = 452.4 G.P.D. NO GROUNDWATER ENCOUNTERED (508) 477-5313 10/17/08 P.T.M. 2 Of 2