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HomeMy WebLinkAbout4340 MAIN ST./RTE 6A(BARN.) - Health 4340 MAIN ST./ROUTE 6A; BARNSTABLE A= 351 033 a a . o o c I o TOWN OF BARNSTABLE LOCATION ��u U C1 h 1 - SEWAGE# a Oa) 1 00 VILLAGE Ci. jT Ma$L a ASSESSOR'S MAP&LOT `l INSTALLER'S NAME&PHONE NO. CCI Ce. (0,1 Sg+-c SEPTIC TANK CAPACITY /j 00 r � LEACHING FACILITY.(type) •� ,`le.tj (size) 0 X NO.OF BEDROOMS BUILDER OR OWNER 00nakut PERMIT DATE: T jn )w COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility S sG�� eet Private Water Supply well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) 4e� Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by �QC t�l�lle� � Q S �V W CS f IS �f No. I �I I l Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes ftpliLatlon for -Misposal *pstem Construction permit Application for a Permit to Construct( ) Repair(Upgrade( ) Abandon( ) ❑Complete System individual Components Location Address or Lot No. y3`'�o/`t®°" sr Owner's Name,Address,and Tel.No.rad'- fw q Assessor's Map/Parcel 3S o Ins ller's Name,Address,and Tel.No,5-4a wry' � Designer's Name,Address,and Tel.No. . �/�ieofrfs o4.dC �da� SC.�iv� 9�vv/Gcl� ��iayi��r•eot PyGs��iS Type of Building: Dwelling No.of Bedrooms Lot Size /\�_, dl:f�Z sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided gpd Plan Date 2`,zG/z / Number of sheets L- Revision Date Title Size of Septic Tank /g7�ev Type of S.A.S. c%� Description of Soil Nature of Repairs or Alterations(Answer when applicable) /3oX Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. Signed Date �o Application Approved by Date 3 Application Disapproved by Date for the following reasons Permit No. ��tv Date Issued Z f...-s,.,��kl°,'�• .r ...Jc,,,r1� 'A.,:.�.a=`a` ..�.�i.;:i. `•�,� ,�"'; .,�. ..^i�'+.,^*:'3=. y ,.�-.e., f '[ S-+�-+r""::!,A"l:.'*" i , :a.;-r.,..:.-.. _.. ... ,.,,�„ �.i 144 3 No. r ' r } Fee ED THE,COMMONWEALTH OF,MASSACHUSETTS Entered in computer: Yes,/ PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS y� , 01pphcation for Mispo'sal.&pstpm Cone-traction jhrmit Application for a Permit to Construct( ) Rep k,(k<Upgrade( ) Abandon( ) ❑Complete,System PIndividual Components'• Location Address or Lot No. 5�3�o�d•"� Owner's Name,Address,and Tel.No. S`�� Sv - s� �a rst. f�afl4 ,C57O Assessor's Map/Parcel Ins Iler's Name,Address,and Tel No—f-d0' �'?� Designer's Name,Address'arid Tel.No. J-a f- ��� .�.s2'Q.i to �/... w� ,{/G.rs.°"+^erss..�-�/ :e' Say t,✓.G�'s'�:ra� /F�� ./'��-�SI�Y�iW!`+e� Type of Building: m Dwelling. No.of Bedrooms 4/ Lot Size lam, 6::ff2 sq.ft. Garbage Grinder( ) Other Type of Building t No.of Persons Showers(, ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided Vye,',rl gpd ; Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. ; ,. Description of Soil Nature of Repairs or Alterations(Answer whre�n7 applicable) z.1 4��= ��, �„�,.� ��rr��„G. a�,a s/f�i i/,i(•-C_� ._ /Y'.20 l..�.oX Q.e.�,il /`5r'a/l.�U,s'ea rr-snl' r �i.+..�.T .�G wry G✓.r,�.� :--%.ice .70 Date last inspected: �. Agreement The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of t Compliance has been issued by this Board of Health. Signed Date �� ��•� Application Approved by -^-" N Date 3 . 1 Application Disapproved by--- Date for the following reasons Permit No. "1tv Date Issued _ ! THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance p THIS IS TO CERTIFY,that the On-site.,Sewage Disposal system Constructed( ) Repaired(!/ Upgraded( ) Abandoned( )by at- has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. Cat, ' 1 dated 3/h Installer 'sue r'�r = Designer #bedrooms Approved design flow gpd The issuance of this permit shall not be construed as a guarantee that the system W`ifll"f)un�'on as deJ�"igned. Date ''� Inspector n! / _.....-.---.c=,:.,c.�:r.-.-r'_Jv.-.�-.r.vl-=.e�.-..�/-�.�--._,_-:-._�_.__.-.-..z.:_-._.-..tr.=-ti-.=e.�.-:_.:-:-<-_-el._��-.-.w.2-.��_._....:._.......-...-_•__.r.:�-._._.._.-.-r.-._-.-v.-.-.-.--.._-...,-:f.-�__..:..-.-.o..-._._....Nov [�1 '�`� Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS Misposal 6pstern Construction permit Permission is hereby granted to.Construct( ) Repair(1-� Upgrade( ) Abandon( ) System located atr/�y /�, , T' %�yrlJ�rrr.✓'i and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions: Provided:Construct i n mu�t be completed within three years of the date of this permit. Date 3 Z� Approved by / r �'",W_ o,f�a>rnstable e 1Rquiat® y Selrvices Rickard V. Stali,eirtiterim Drrectoa _.swxtrsra$ e, PubIk Health DiVsi®ira Thomas IYIcKean,Director = 20U Matn Street,Iiyartnis,M4 02601 l s Offce 508=862�3644 740-6304•' WA Iristaller&.Designer..Certification ForTh Dater :�, �:' Sewage Perinit#..�ozl-.1-04 Assessor's 11*parcel ;" Des'�ner Ib c E � n�`c s•� c s �VtC Installer.: Address ?2, l+�lr CrdssJ l c� Q Addi ess On .� CJ— c was issued a permit to=instalfa . (date) � � -i ;(installer):. l septic.system at rlt ��i= c.t a ,��`based on a desg>�drawn by (address) rft 2eti✓1' U n9 6 cs✓Lts�1 datied (designer) 1 I certify that the septic systeriz referenced above`ivas installed substantially according to the design, which inay include minor•approved changes such as lateral ielocation':of the, distribution box.and/or se'tic;'tank Stri out. afre wired was ins ected and tlie:'soils. P p t �I ) p were found..satisfactory. I certify that the septic,systern:referenced above was`installed ��ith;major:changes (i.e. greater than l0' lateral relbeatior:,of the.SAS or,any vertical relocation of any coniponenf ,. . . ( of.the:septic:system) but in accordance with State&,Local'Regttlatioiis :Plan revis'ori or' certified as-built by`designer to follow: Stiip,o .t(ff required),was inspected'and the soils were:found satisfactory; ( I certify that the system referenced abo.Ve%vas,constructed iri ' with the-terips •of the:I1A approval;letters,.(if applicable) r>s Si nature M-CE g ) C 3510g O (Designe.. S. lgnattire) (Affx;D"esigne ere) TLEASE.,-RETIJ .TO'BARNSTABL:E PUBLIC4WALTH:DIVISION: CERTIFICATE OF COMPLIANCE WILL. NOT BE ISSUED' UNTIL BOTH THIS FORTI.AND.AS i ILT CARD ARE RECEIVED:BY T'FIE BARNS.TAB"LE;'Pl1BLIC I EAI.0 DIVISION THANK YOU. W ,SepE c`bes gner Certification Form Rev$=NA 3,doc Engineers note:'This certitication is.limited io an as-built inspection of system components as installed prior tb backfill The engineer:did noE supervise construction of,the system.The installer assumes responsibility for ali materials;evorkmanship backfilling: =. to;specified.grad®s with proper camgaot on Arid setting riserscoers as shown on the design plan. 6 �\ COMMONWEALTH OF MASSACHUSETTS E OF ENVIRONMENTAL AFFAIRS EXECUTIVE�OFFIC E• , DEPARTMENT OF ENVIRONMENTAL. PROTECTION r i TITLE 5 OFFICIAL INSPECTION,FORM—NOT FOR VOLUNTARY ASSESSMENTS j SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: Owner's Name: Owner's Addres A- p r t Date of Inspection. , � per Q3 ,p Name of Inspecto 'lease print) Company Name. - Mailing Address: 00(� 6 s~ Telephone`Number: 9 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 performd based on my training and experience in-the proper function and maintenance of on site sewage disposal systems.I am xDEP: approved system inspector pursuant.to Section.15.340 of Title 5.(310 CMR 15 000). The system; /Passes f Conditionally Passes s Further Evaluation by the Local Approving Authority s 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 1i0,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the' DEP.The original should be sent to the system owner and copies sent to the buyer,if applicable,and the approving authority. Notes and Comments ****This report only describes conditions at.the time of inspec tion and under the conditions of use'atthat time.This inspection does not address how the system will perform in the future`under they same or,different tj conditions of use. page 1 Title 5 Inspection Form 6/15/2000 ,f Page 2 of l 1 1 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) P operty Address: _ l . 0 n'er: Date;of I fi ction: Inspection Summary: heck A,B,C,D r E. ALWAYS complete all of Section D A.,lSystem Passes: I have not found any information which indicates that any of the failure criteria described in 310 CMR 1.5:30� or in 310 CMR:15.304 exist.Any failure criteria.not evaluated are indicated below., C imments. I F I B. ' System Conditionally Passes: 4, One or' more system components as described in the"Conditional Pass"section need to be replaced or. repaired:The.system,ystem,upon completion of the replacement or.repair;as approved by the Board of Health,will pass. Answer yes,no or not determined(Y,N;ND)in the. 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 i 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 ind'cating that Ithe tank is less than 20 years old is available. N !explain: G:Observation bf sewage backup or break out or high static water level in the distribution box due to broken or obsitructed pip6(s)or due to a broken,settled or uneven distribution box. System.will pass inspection if(with approval of Board of Health): i; i broken pipe(s).are replaced. . L . obstructionis.removed ..distribution box is leveled or replaced. . ND'explain: 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 p.ipe(s)are replaced obstruction is removed { ND explain: I 2 Page 3 of 11 t G : OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSM ation is R ENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION F��RM PART A CERTIFICATION(continued) :Property Address ` Owne y , Date of spection: ' C. Further Evaluequired 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`accordanee with 310'CNIRa5,303(i)(b)that the system is not functioning in a manner which will protect:public health,safety and the�environment:. Cesspool or privyis.within 50 feet of a surface.water j . Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh, f ; 2. System will fail unless the Board of Health(and Public.Water Supplier,if any).determines that the; system is function'ing.in a manner.that,protects the:public health,safetyand environment: i. The system has a septic-tank-and`soil.absorption system(SAS)and the SAS is within.100 feet ofa, surface water supply or.tributary.to a surface watersupply f The system.has a septic tank and SAS and the SAS is within a Zone 1-of a public.water supply. The system has aseptic 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 S0 feet o 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'and volatile organic compounds indicates that the well.is free',froni 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 i .. . ' 1� 3. Other: 71-7 I 3 Page 4 of If OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 12 f 6 Owner. Date of ection: 61 ( D. System Failure Criteria applicable to all systems: Youimust indicate"yes"or"no"to each of the following for all inspections: Yes N )3ackup 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 _ U Liquid depth in cesspool is less than 6"below invert or available volume is less than '/�day flow — Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number J of times pumped — Any portion of the SASS 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 watersupply. tc Any:portion of a cesspool or,privy is within.a Zone 1 of wpublic 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 Jess than:100'feet but-greater.than SO feet from a.private water supply well with no acceptable waterqualityanalysis.[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.] i b (Yes/No).The system fails.I have determined that y _ 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• You must indicate either"yes"or"no"to each of the following: (The following criteria apply,to large systems in addition to the criteria above) 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. i 4 i Page 5 of 11 f ' OFFICIAL-INSPECTION FORM NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACESEWAGE DISPOSAL; SYSTEM INSPECTION.FORM PART B CHECKLIST Property Address: 00 I Owner: Date of I ection. } Check if the following have been done You must indicate"yes"or"no"as to each of the following: 4 , 1 Yes No Pumping.information was provided by the owner,'occupant;or Board'of Health V Were.any of the system components pumped out.in the previous two weeks? vl*" Has the system received normal flows in the previous two week period?- t � _ Have lar a volumes of water been introduced to the system recently or as part of this inspection?: Were as built plan s.of the system obtained and examined?(If they were not available note as N/A) Was the facility or dwelling inspected.foi signs-of sewage back up Was the site inspected for si ns of break out? _ Were all system components,excluding the SAS,located on site? k Were the septic tank manholes uncovered,opened,and the interior of the tank inspected for the condition oft a baffles or tees,material of construction,dimensions,depth.of liquid,depth of sludge and depth of scum 2 _ 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: I 4. Y no ' ]e a plan at the Board of Health. _ information.For example,Existing P P i Determined in the field(if any of the failure criteria related to Part C is at issue approximation'of distance is unacceptable)[310 CMR 15.302(3)(b)] r 5 i Page6ofll! i OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENT S SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART.C SYSTEM-:INFORMATION Property Address: Owner• Date of I pection: F OW CONDITIONS RESIDENTIAL Number of bedrooms(design): Number of bedrooms(actual): f ,off DESTGN flow based on 310 C R 15.203 (for ex mple: 11.0 gpd x#of bedrooms): Number of current residents: i Does residence have a garbage grinder(yes or no): A/a Is laundry onIa separate sewage system(ye or no):W .[ifyes separate inspection required] Laundry system inspected(yes ,r no): /Q Seasonal use:ies or no :. (Y ) Water meter readings, if av lable last 2 ears.usage(g d D� ( X bP ))t / Sump pump(,yes or no): Last date of occupancy: n . COMMERCIAL/INDUSTRIAL. /v d Typet of establishment: .. . Design flow. based on 310 CMR 15.203 : o ( d i - � �P Basis of design flow(seats/persons/sgft,etc.): Grease trap pr';esent(yes or no):— Industrial waste-holding tank present(yes or no): Non-'sanitary waste discharged to the Title 5 system(yes or no):— Water meter readings, if available: Last&te of o cupancy/use: OTHER(describe): GENERAL INFORMATION Pumping Records Source of information: Was system pumped as part of the inspecti' (yes or no): e If yes', volume pumped:_gallons-=How was quantity pumped determined? Reason,for pumping: � i TYP OF SYSTEM Septic tarilc,distribution box,,soil absorption system, Single cesspool Overflow cesspool Privy _Shared system(yes or no)(if yes,attach previous inspection records,if an Innovative/Alternative the technology.Attach a co of the.current operation an d d main — g PY maintenance contract to be obtained l from,system owner) Tight tank —Attach a copy of the DEP approval - 1 Other(describe): j App oximate age of all components,date installed(if known)and source of information: l Were ge o se a dors detected when arriving at the site es or no): 6 Page 7 of 11 i j t i OFFICIAL.INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM.INSPECTION FORM PART C SYSTEM:INFORMATION(continued) 4 V Property Address:. a4&tjo Owner: �.. Date o spection: BUILDING SEWER(locate on site plan)J Depth below grade: Materials of construction: cast iron 40 PVC other(explain): 1 Distance from private water supply-well or suction line: Comments(on condition of joints,venting,evidence of leakage,etc.): { SEPTIC TANK: V (locate on site plan) . t 1. - Depth below grade: (19 - f Material of construction:1�c`oncrete metal—fiberglass_polyethylene ;. other(explain) ' If tank is metal list age:_ Is age confirmed by a Certificate of Compliance(yes or no):_(attach a copy of certificate) Dimensions: Sludge depth: 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: Distance from bottom of scum to bottom of outlet tee or baffle: How were dimensions determined: Comments(on pumping recommen ations, let and outlet tee or baf a condition,structural integrity,liquid levels • elated to outlet invert,evi ence of I age,etc r .): l !f GREASE.TRAP;l (locate on site plan) Depth below grade: Material of construction: concrete metal_fiberglass polyethylene_other (explain): i 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- Comments(on pumping recommendations,inlet and outlet tee.or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): �! f i ' p Page 8 of 11 OFFICIAL.INSPECTION FORM-NOT FORVOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM`INFORMATION(continued) Property Address* U ® ` 4 IA Owner. ' Date o pection: �G�`o)00 69 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: Qallons/day Alarm present(yes or no)- Alarm level: 1 Alarm in working order(yes or no): Date'.of last pumping: F Comments(condition of alarm and float switches, etc.): aI DISTRIBUTION BOX: V (if present must be opened)(locate on site plan) ' Depth of liquid level above outlet invert ���'�outlets o Comments(note if box is level and distribution toal,any.evidence of solids carryover,any evidence of akage into or out of box;et PUMP CHAMBER-/uu (locate on site plan). Pumps in working order(yes or no): Alarms in working order(yes or no): Comments(note condition of pump chamber,condition of pumps and appurtenances,.etc.): , j j } i 8 Page 9ofII OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY-ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C -SYSTEM INFORMATION:(continued) a Property Address Owner: t•4 - Date o spectio — 1: SOIL ABSORPTION SYSTEM(SAS): (locate on site plan,excavation not required) } If SAS not located explain why: Type - leachingpits,number: thing chambers,number: leaching galleries,number: leaching trenches,number,length: leaching fields,number,dimensions: overflow cesspool,number: innovative/altemative system Type/name of technology: Comments(note condition of soil,signs of hydraulic failure,.level of ponding,damp soil,condition of vegetation, etc-): r,; �XW* 9 t. CESSPOOLS:/t� (cesspool must be pumped as part of inspection)(locate on site-plan) {, Number and configuration: Depth—top of liquid to inlet inveit: Depth of solids layer:" Depth of scum layer: Dimensions of cesspool: Materials of construction: Indication of.groundwater inflow(yes or.no): . Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc:): l 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.): i s 9 Page 10 of 11 OFFICIAL INSPECTION FORM NOT FOR VOLUNTARY;ASSESSMENTS (,SUBSURFACE SEWAGEDISPOSAL SYSTEM.INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: Owner: Date of pection: ;f SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system.including ties to at least two permanent reference landmarks or benchmarks.Locate all wells within 100 feet.Locate where public water supply enters the building.- ---- _ 0 CAI lot P O 10 . t s Page 11 of I 1 OFFICIAL INSPECTION FORM—NOT.FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C _ SYSTEM INFORMATION(continued) Property Address: C D Owner. Date of pection: ,. 0C)� SITE EXAM Slope Surface water Check cellar Shallow wells t Estimated depth to ground water feet Please indicate(check)all methods used to determine the high ground water elevation: i Obtained from system design plans on record-If checked,date of design plan reviewed: Observed site(abutting property/observation hole within 150 feet of SAS) Checked with local Board of Health-explain: Checked with.local excavators,installers-(attach documentation) . Accessed USGS database-;explain: i i You must describe how you established the high ground water elevation: Le V i. • I i i I � . f i 11 Permit-Number: Date: Completed by: HIGH GROUND-WATER LEVEL COMPUTATION Site Location: ,4W11 JA .6VL l�,e Lot.No. Owner: 4704 e e D w Lei Address: Contractor:- Address: r-= Notes: STEP 1 Measure depth to water table to nearest 1/10 ft. .................................... ..... .Date Ala ............................... month/day/year, I STEP 2 Using Water-Level Range Zone and Index Well Map locate ; Asite and-determine:. Appropriate index well.... ................ ..........�.!, O OWater-level range zone ........... .......... ........ STEP 3 Using monthly report"Current Water Resources Conditions." determine current depth to s zz� water level for index well ........................... month/year i STEP 4 Using Table of Water-level Adjustments for index well. (STEP 2A);_current depth to water level for index well (STEP 3), .and water-level zone (STEP 2B) 'determine water-level adjustment :.:............:................ r......:.......:...........::.....::......'............. . j. STEP 5 Estimate depth to high water. . by subtracting the water level adjustment (STEP 4) from measured:depth to water level at site (STEP 1} ........................................................... p .... T • t' i Figure 13.—Reproducible computation form. .15 • i f - - Commonweofth of.MassochuseffP AUKS - 199,6 John Grad - ExecutNe Office of ENronnienTtol rs D.E.P: Title V Septic Inspector Department of - - �; P.O. Box 2119 EnAronmental Prote � P.O. MA 02536 - (508) 564-6813 { SUBSURFACE SEWAGE DISPOSAL SYSTEM .INSPECTION FORM 3 - PART A - CERTIFICATION- Property Address:,434o Rt bA Cummaquld Address of Owner: - Date of Inspection:7119196 (if different) .Name of Inspector:John Grad Dunn _ Company Name,Address and Telephone Number: CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true; accurate and complete as of the time of inspection. The inspection was performed based on my training and experience in the proper function and. maintenance of on-site sewage disposal systems. The system: x Passes _ Conditionally Passes Needs Furt er Ev uation By the Local Approving Authority Fails Inspector's Signature: Date: 7129196 The System Inspector shall submit a copy of this inspection report to the Approving Authority within thirty(30)days of completing this inspections. 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 Department of Environmental Protection. The original should be sent to the system owner and copies sent to the buyer, if applicable and the approving authority. INSPECTION SUMMARY: Check A, B, C, or D: A] SYSTEM PASSES: x I have not found.any information which indicates that.the system violates any of the failure criteria. defined as in 310 CMR, 15.303. Any failure criteria not evaluated are indicated below. B] SYSTEM CONDITIONALLY PASSES: - _One or more system components need to be replaced or repaired. The system, upon completion of the replacement or repair,passes inspection. Indicate yes,no,or not determined(Y, N,or ND). Describe basis of determination in all instances. If "not determined explain why'not) The septic tank is metal, cracked,structurally unsound, shows substantial infiltration or exfiltration,or tank failure is imminent.The system will pass inspection if the existing septic tank is replaced with a conforming septic tank as approved by the Board of Health. (revised 11115195) One Winter Street • Boston,Massachusetts 02108 e FAX(617)556-1049 •-Telephone(617)292-5500 1 SUBSURFACE.SEWAGE DISPOSAL SYSTEM.INSPECTION FORM -_ -- PART A -- CERTIFICATION (continued) - Property Address: 4340 RL 6A Cummaquid Owner: Dunn Date of inspection:7119196 — _ Sewage backup-or breakout or high static water level observed in the distribution box is due to a broken, settled or uneven distribution box. The system Will.pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced - _ obstruction is removed - _ - distribution box is beveled or replaced — _ --. -- _The.system required pumping more.than four 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 obstruction is removed: 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 public health, safety.and environment. system is failing to protect the 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND 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. 2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH(AND PUBLIC WATER SUPPLIER, IF APPROPRIATE) DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECT THE PUBLIC HEALTH AND SAFETYAND THE ENVIRONMENT: _ The system has a septic tank and soil absorption system and is within 100 feet to a surface of water supply or tributary to a surface water supply. The system has a septic tank and soil absorption system and is within a Zone 1 of a public water supply well: The system has a septic tank and soil absorption system and is within.50 feet of a private water supply well _ The system has aseptic tank and soil absorption system and is less than 100 feet but 50 feet or more from a private water supply well, unless a well water analysis for coliform bacteria volatile organic compounds indicates that the well is free from pollution for that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal or less than 5 ppm. 3) OTHER D] SYSTEM FAILS: _ I have determined that the system violates one or more of the following failure criteria as defined in 310 CMR 15.303. The-basis for this determination is identified below. The Board of Health should be. contacted to determine what will be necessary to correct the failure. Backup of sewage in facility,or system,component due to an overloaded or clogged SOS or . cesspool. Discharge or,ponding of effluent to-the surface of-the 1groundor:surface,waters duetto an overloaded or clogged cesspool. SAS is in hydraulic failure. (revised 11115105) _ 2 SUBSURFACE SEWAGE.DISPOSAL SYSTEM INSPECTION FORM .. . - --- . - --- - PART A: _ _. CERTIFICATION (continued) - Property Address: 4340 Rt 6A Cummaquid _ - Owner: - Dunn Date of Inspectiion:7119196 _ D] SYSTEM FAILS(continued). 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 1/2 day flow. Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Numbers of times pumped - _ Any portion of the Soil Absorption System, cesspool-or privy is,below the high groundwater elevation.' Any portion of a 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. If the well has been analyzed to be acceptable, attach copy of well water analysis for coliform bacteria,volatile organic compounds, ammonia nitrogen and nitrate nitrogen. E] LARGE SYSTEM-FAILS: The following criteria apply to large systems in addition to the criteria: The system serves a facility with a design flow of 10,000 gpd or greater(Large System)and the system is a significant threat to public health and safety and the environment because one or more of the following conditions exist: 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) The owner or operator of any such system shall bring the system and facility into full compliance with the groundwater treatment program requirements of 314 CMR 5.00 and 6.00. Please consult the local regional office of the Department for further information. (revised 11115195) 3 Ni SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM _. PART B - CH'ECLIST Property Address: 4340 Rt 6A-Cuinmaquid Owner'"-- Dunn Date of Insp.ection:7119196 - { Check if the following have been done:;: -X Pumping information was requested of the owner,occupant, and Board of Health. _ X None of the system components have been pumped for at least two weeks and the and the system has been receiving normal flow rates during that period. Large volumes of water have not been introduced into the system-recently or.as part of this inspection. - X As built plans have been,obtained'and examined. -Note if they are not available with N/A. X The facility or dwelling was inspected for signs of sewage back-up. X The system does not receive non-sanitary.or industrial waste flow. X. The site was inspected for signs of breakout. X- All system components,excluding the Soil Absorption System,have been located on the site. X The septic tank manholes were uncovered, opened, and the interior of the septic tank was inspected for condition of baffles or tees,material of construction, dimensions, depth of liquid, depth of sludge, depth.of scum. X The size and location of the Soil Absorption System on the site has been determined based on existing information or approximated by non-intrusive methods. X The facility owner(and occupants, if different from owner)were provided with information on the proper maintenance of Sub- Surface Disposal System. (revised 11115195) 4 - ti A" SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM` PART C - - SYSTEM INFORMATION Property.Address: 4340 RL GA Cummaquld Owner: Dunn - - Date of-Inspection 7119196 - �FLOW:CONDITIONS - - RESIDENTIAL: -- - Design flow: 440 gallons Number-of bedrooms:-4 ---- Number of current residents: 1 - Garbage grinder(yes or no): Na Laundry connected to system(yes or no) Yes Seasonal use(yes or-no): No - Water meter readings, if available: nia Last date of occupancy: n/a COMMERCIAL/INDUSTRIAL: Type of establishment: n/a ' Design flow:0. gallons/day Grease trap present:(yes or no) Na Industrial Waste Holding Tank present;(yes orno) No Non-sanitary waste discharged to the Title 5 system: (yes or no)Ao Water meter readings, if available: n1a Last date of occupancy: n/a OTHER: (Describe) n1a Last date of occupancy: GENERAL INFORMATION PUMPING RECORDS and source of information: none System pumped as part of inspection: (yes or no)No If yes,volume pumped: 0 gallons Reason for pumping: n/a TYPE OF SYSTEM X Septic tank/distribution box/soil absorptions system Single cesspool Overflow cesspool Privy Shared system(yes or no) ( if yes, attach previous inspection records,if any) Other(explain) APPROXIMATE AGE of all components,date installed(if known)and source information: 1993 ) Sewage odors detected when arriving at the site: (yes or no) No (revised 11115195) 5"• ,. SUBSURFACE.SEWAGE DISPOSAL SYSTEM INSPECTION FORM -�- - PART G SYSTEM INFORMATION(continued) Property Address: 4340 RL 6A Cummaquld Owner: Dunn ' - - Date of Inspection-711919t3 -- -SEPTIC.TANK: X_ (locate on site plan) j. _ Depth below grade:r _ Material of construction:X concreate_metal_FRO_other(explain) _ Dimensions: 119'6'H 5'7'w 5'8' Sludge depth:6 Distance from top of-sludge to bottom of outlet tee or baffle: o Scum thickness: Distance from top of scum to top of.outiet tee or-baffle:l' Distance form bottom of scum.to bottom of outlet tee or baffle: o Comments: (recommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level.in relation to outlet invert, structural integrity, evidence of leakage,etc.) The septic tank and all components are structurally sound.Recommend pumping the system every two years for maintenance. GREASE TRAP: (locate on site plan) Depth below grade: n1a Material of construction: concrete—metal FRP_other(explain) Dimensions: n1a Scum thickness:n1a Distance from top of scum to top of outlet tee or baffle:n1a Distance from bottom of scum to bottom of outlet tee or-baffle: nla Comments: (recommendation for pumping, condition of inlet and outlet tees or baffles,depth of liquid level in relation to outlet invert, structural integrity, evidence of leakage, etc.) n1a I (revised 11115195) 6 - — ---SUBSURFACE-SEWAGE-DISPOSAL SYSTEM INSPECTION FORM. - -' - PART C SYSTEM INFORMATION(continued) Property Address: 4340 RL 6A Cummaquid - Owner: Dunn — Date of-Inspection:7119196 - TIGHT OR HOLDING TANK: - (locate on site plan) Depth below grade: n1a Material of construction: concrete_metal_FRP_other(exp[ain) Dimensions: n1a Capacity: n1a gallons Design flow: n1a gallons/day Alarm level: Na Comments: (condition of inlet tee, condition of alarm and float switches, etc.) n!a DISTRIBUTION BOX:X (locate on site plan) Depth of liquid level above outlet invert: Liquid level with bottom of pipe Comments: (note if level and distribution is equal, evidence of solids carryover, evidence of leakage into or out of box etc.) The d-box is structurally sound. PUMP CHAMBER: (locate on site plan) Pumps in working order.(yes or no)_ Comments: (note condition of pump chamber,condition of pumps and appurtenances, etc.) nla (revised 11115195), 7 t"''�" •,f�.„ s:xb e..7F��i#^- ::��. ____ ... -. .. aM"., - .:.:�a7 tm ' u d .ii t# 'a-�T'�'.f ua,_.. --------- - — = SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM • ---- - _----PART-C------- _ _ SYSTEM-INFORMATION(cont[nued) Property Address: 4340 Rt.GA Cummaquid - Owner:. - —Dunn w- -- Date of Inspection:7119196 SOIL ABSORPTION SYSTEM (SAS):X - (locate on site..plan,if-possible;-excavation not required, but may be approximated by non intrusive methods) If not determined to be present;explain: Na - _ Type: leaching pits, number: Na leaching chambers,-number:5 infiltrators with T of stone leaching galleries,number: Na. leaching trenches,number, length: Na leaching fields, number, dimensions:nfa overflow cesspool, number:nfa Comments:(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) . gas is fucnctloning properly. CESSPOOLS:_ (locate on site plan) Number and configuration: Na Depth-top of liquid to inlet invert: nfa Depth of solids layer: Na Depth of scum layer: nfa Dimensions of cesspool: Na Materials of construction: Na Indication of groundwater: nfa inflow(cesspool must be pumped as part of inspection) Na Comments:(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.). Na PRIVY: (locate on site plan) Materials of construction: n1a Dimensions: nfa _ Depth of solids: Na Comments:(note condition of soil, signs of hydraulic failure, level of ponding,condition of vegetation, etc.) PrivyComments (revised 11115195) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C sYSTEM INFORMATION(continued) Property Address: 4349 RL SACummaquid.- Owner: Dunn. Date of Inspection:7119198 - - SKETCH OF SEWAGE DISPOSAL SYSTEM: , - include ties to at least two permanent references landmarks or.benchmarks.- - locate all wells within-100' - Rc � DEPT+I TO GROUNDWATER - Depth-to groundwater.10 feet method of determination or approximation: USGS maps and charts. (revised 11115195) _ 9 TOWN O ABLE LOCATION "V � SEWAGE # 3 (J VILLAGE ASSESSOR'S MAP & LOT 'I INSTALLER'S NAME 6i PHONE NO. SEPTIC TANK CAPACITY 1 LEACHING FACILITY:(type)--Fgv"rle'OyPi�IT'cisize)� NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER :BUILDER OR OWNER d DATE PERMIT ISSUED: 1 • 7-3 DATE COMPLIANCE ISSUED: -7 VARIANCE GRANTED: Yes No �'` l'" W. i � 1� �� n �) � � � . � � � � �, � � r c � R" � � 3 S �.. THE COMMONWEALTH OF MASSACHUSETTS APPROVED BOARD OF HEALTH ' Barnstable Conservation Department TOWN OF BARNSTABLE 7 Applirativtt for Diripwml Worbi TvustrurtintFW__ Application is hereby made for a Permit to Construct ( ) or Repair ( n Individual Sewage Disposal System at: ..... [ ------------•---------------------- =------------- -----•---•-------------------- -- ------•--•----•---•--..............----•-. rthon :\t rr" or Lot No. Owner Ad w , -(� ��D Ste' f ....... Installer Address UType of Building Size Lot............................Sq. feet Dwelling— No. of Bedrooms.-- ------------_----------------------Expansion Attic ( ) Garbage Grinder ( ) pOther—Type of Building ---------------------------- No. of persons---------------------------- Showers ( ) — Cafeteria ( ) 0.t Other fixtures ----------------------------------------------- W Design Flow_.....-..:�J"� ...............:.gallons per person per—day. Total daily flow....... .0.._._...... ......gallons. 'JJ W Septic Tank I Liquid ca acity/S_ allons Length--. .. .--... . Width_.. _"_.... Diameter............._ Depth....._.......... x Disposal Trench--Nc,o5__i-/t�Al. Width_.,F'............. 'Total Length-.3-'2....... .- Total leaching area....................sq. ft. 3 Seepage Pit No--------------------- Diameter.................... Depth below inlet......-............. Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) 4 Percolation Test Results Performed by..--...................................................................... Date........................................ Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water........................ (i Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ GG ......................-...................................................................................................................................... 0 Description of Soil........................................................................................................................................................................ U ---......--•--------------------•--•--•--•-----------------•---•---•---------•-----------•---•---.----•-------------------------•---------------.......-•----•--•---•-------•--..................---•--. ---------------------------------------------------------------------------------------•------------------------......--------•-----•• ------ V Nature of Repairs or Nterations—Answer when applicable. - t �t 'y - -- 5�- 1c.L ! : ` uYS. -( =`�''" ------•--------------------------------- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code —The undersigned further agrees not to place the system in operation until a Certificate of Com liance has been i e rd o ealth. Signed .......... .. ............. .. :..... ../ .. Dare Application Approved By ............3-4� . -^ ... ..................... ... ............................. ......7- Date Application Disapproved for the following reasons: ..... ............................................................................ ............................................ ........... . .......................................................... ......................................................... . . ........................................ e; Date Permit No. .......7..3.........L/ ............................ Issued --- ...... 7.....1.5:... .'1.................. Date /F} w�yNV-�V•-r v..nr..��•+v-' v. - �.•-..v�v V"-r v .• �r /./.��. /..\7. _�._ •`'J' :Y -,., V" „V"..y...gib^._`-`r��9X r��.J .-.'�,d"•. 6. No. N� Fps.. .�.... .... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE 7 -1 4� _A0phration for Diri•pooal Worlui Towitrnrtion omit Application is hereby made for a Permit to Construct ( ) or Repair ( (.)--an Individual Sewage Disposal System at• yU n eatinn- \ddress or Lot No. Owner _ 4 I ............ww...........-......................................Y I I.,................................ ......... --•---•-••--•--•-••--...----•••-........................................ J Installer Address UType of Building / Size Lot............................Sq. feet ,.., Dwelling— No. of Bedrooms---_y___---------------------------------__Expansion Attic ( ) Garbage Grinder ( ) pOther—Type of Building ............................ No. of persons---------------------------- Showers ( ) — Cafeteria ( ) a Other fixtures ...................................................... W Design Flow......... _____________________gallons per person pyerr day. Total daily flow....... _q«...___•._...____.___gallons. WSeptic Tank r Liquid capacity/!`O-egalIons Length---,�i�1_..... Width---A...._...- Diameter________________ Depth................ x Disposal Trench-- No =Z�L Width.•.�.��(___._--__-- Total Length.. Total leaching area_...................sq. ft. 3 Seepage Pit No------------ ------- Diameter.................... Depth below inlet.................... leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by.......................................................................... Date........................................ ,.-I Test Pit No. I................minutes per inch Depth of Test Pit...................• Depth to ground water...._................... Gi, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 04 ----------------------------------------------------------------•--••-------------------..........*--------------------•-------------.... -•....... _•......... ODescription of Soil...............................................................................................---------------------------------------------------------........_....__. W x -- ..__-_--�------•-•--•-- U Nature of Repairs or Alterations—Answer when applicable._..`:_.�'.�.�7+ -!_(-1.d:) C-�•�-�(JK•-.••:(_4I •t-t--,C '—� ✓ w�_C._.... )".r�t,Y._.._..__ •• gK- •f--t -VS.�II'fJ S ' ` = ?t•� r t�-f ,.... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued-by-the•board of'health. Signed ........::�...,. ... .�- :,�'� ....- a-------------- 1.----� Dace Application Approved By ---------- ..� .t.. 7 7..-.t.a:..-...c/..�..... .'...................��----.....--------.................................. Dare Application Disapproved for the following reafonr: .""""""""""""""..........."-"""-""........................................................................"""""..................... ..............................................................:.................... ............................ ............................. ""-"-"""........... .................................. ........................................ 1 Date Permit No. ...... ..-_..71J©--� .......................... Issued ..............�.-.._5....-. ........................ Dare THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE 3 yd CZertifirate of C11omplianre THIS IS TO CERTIFY, That the Indival Sewage Disposal System constructed ( ) or Repaired ( by ................""--"- ! ....... �.. �.... ....... �..-(_• .._.................... Installer at ....................................... ........: .../Ijj.....R...----................ ._--- Cam.---^ ....:.r...`..._._....... -----------.............................-------------------............ has been installed in accordance with the provisions of TITLE 5 of The State Environmental Code as described in the application for Disposal Works Construction Permit No. -------j.3......�0a.Z _..... dated ................. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE t SYSTEM WILL FUNCTION SATISFACTORY. DATE---- -..` � Inspector ..__.- ....:------- ...:_ ............ ..... _......... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE No I •I FEE..... .............. Dispoottl Works Tonotrurtion ramit Permission is hereby granted _./-t__:--�-_--_------�___:c�'t--=�--`-f--_=' to Construct ( ) or Repair (G-)--an Individual Sewage Disposal System t atNo.................................../�) - ' U-' (,,-P L—,✓+'t-V��t �. `` -----------------------------------------••-- street C as shown on the application for Disposal Works Construction Permit No..>t_3r: /.... Dated............ .............................. __ Board of Health DATE................................................................................ FORM 36508 HOBBS 6 WARREN,INC.,PUBLISHERS -100 -- EXISTING CONTOUR x 100.98 EXISTING SPOT GRADE t1 _ W EXISTING WATER SERVICE G EXISTING GAS SERVICE H.#- OVERHEAD WIRES TEST PIT BENCHMARK • r New En9tana : LEGEND - ---`Quarterboards C' mac' 95.36 + LOCUS MAP g CQ � STRIPOUT TO SUITABLE m "CY HORIZON SAND ' 92,66 _�2 x -=_ - - - o BENCHMARK 93.26 I ?' COR./CONC. APRON + 93.37 0 1A7.0*t 93.33 0 • + I EL.=106.77 94.68 93.25 + I x TP-1 0 TP-2 93.29 0 93.61 x o 93.50 r---, 93.57 1 3 4'-�-�..-� i BO LDE x � ��.� 94,29 x ROPOSE[�" 93.93 93.76 29 x 93.8E EXISTING S.A.S. '^;:.' : 1.5 ��.= 93.57/ J 1 TO BE ABANDONED t 93,66 93.92 4.22 x LBM 94.54 P❑L 94.36 ❑ 94.11.• :' GRAVEL;.'.::-:DRIVEWAY.': ,:,-:-�. PK SET T - - GARAGE N SHED 94. 94.33 � X Y9418 91'71 MANHOLE 4.76 94.340 / G------ -- 94.9 = 96,5 y' 0 0) OX) c� X4 95 OLD FNDTN w W (� P� 95167 EXISTING x 97.55 95.64 EXISTING SEPTIC TANK HOUSE/ 4340) (TO REMAIN) 95.68 `� � TOP OF TANK, EL.=94.23t x `T.O.F. VARIES: FF EL.=99.6t INV.(OUT)=92.9:0t 95.85 / c) t J PORCH < 96.80 x 98,06 + / 0 � LOT AREA x 97,87 97.04 15,682 ±S.F. x 97.91 1 0 X 97.59 J F/ { 0 98.1 X 97.63 0 0 0137.2f0 0 0 0 ��4_P34'F0 PK SET 100.00 9•91 10 / SIDEWALK 99.72 edge 9919 of pavement 98.50 97.96 100.19 99.94 MAIN (ROUTE 6A) STREET 111* OF k4SX PETE T. PARCEL ID: 351 -033 o R �, McENTEE � PROPOSED SEPTIC SYSTEM UPGRADE PLAN v CIVIL CIO No. 3511c0o9,� 4340 MAIN STREET, BARNSTABLE, MA 1 ��y\ Prepared for: Cape Cod Septic Services, 350 Main St, W. Yarmouth, MA 02673 1 ' OWNER OF RECORD Engineering by: SCALE DRAWN JOB. NO. DONAHUE, JO-ANNE Engineering Works, Inc. 1"=20' P.T.M. 334-20 Z� 4340 MAIN STREET 12 West Crossfield Road, Forestdole, MA 02644 DATE CHECKED SHEET N0. YARMOUTH PORT, MA 02675 (508) 477-5313 2/26/21 P.T.M. 1 Of 2 1. NOTE: TO PREVENT BREAKOUT, FINAL GRADE SEPTIC TANK SHA FORLA DI NO STANCE OF 115' FROM THE EDGE INSTALL RISERS & COVERS OVER INLET & OF THE PROPOSED S.A.S. OUTLET AND SET TO 6" OF FINISH GRADE PROPOSED D-BOX TFF EL.=99.6f INSTALL RISER & WATERTIGHT COVER SET TO 6" OF GRADE PROPOSED S.A.S. INSTALL INSPECTION _PORT OUTSIDE DRIVEWAY FOOTPRINT F.G. EL.=94.8t F.G. EL.=94.3t F.G. EL.=94.3t F.G. EL.=93.5t MAINTAIN 2% GRADE (MIN.) OVER S.A.S. L = 38' L = 8'(MAX 41' DIAM..INSPECTION PORT, ® S=1% (MIN.) S=1% (MIN. 20' x 34' LEACHING FIELD W/3-4" PERFORATED IN S.A.S., SOLID 4"SCH40 PVC 4"SCH40 PVC SCH 40 PERF. PVC DISTRIBUTION LINE ABOVE S.A.S., WITH SCREW CAP 6•• w SET TO WITHIN 3' OF GRADE. �o..l CAPPED ENDS 14" 6" 6" EFF.DEPTH EXISTING 48" LIQUID I SLOPE OF PERF. PIPE = 0.5% INV. EL.=92.10(END) LEVEL ADD INV.=92.52 PROPOSED INV.=92.35 34' EFFECTIVE LENGTH GAS BAFFLE SOIL ABSORPTION SYSTEM (PROFILE) INV.=92.90t D-BOX INV.=92.27 EXISTING EXISTING SEPTIC TAN K ESTABLISH VEGETATIVE COVER FFINISH GRADE NOTES: `- EL.=93.5t --I 1) CONTRACTOR SHALL VERIFY ALL EXISTING PIPE INVERTS, PRIOR TO INSTALLATION. APPROVED ;V-:•. BREAKOUT ELEV.=92.62 FILTER FABRIC 2) D-BOX SHALL BE SET LEVEL AND TRUE TO GRADE ON A MECHANICALLY COMPACTED STABLE BASE OR BOTTOM ELEV.=91.60pop 3/4"-1 1/2" DOUBLE SIX INCH AGGREGATE BASE, AS SPECIFIED IN 310 WASHED STONE CMR 15.221(2). �QND PARATION TO G.W. 4 6 6 4' 3) INSTALL INLET & OUTLET TEES AS REQUIRED. OF NATURALLY 20' EFFECTIVE WIDTH 4) A GAS BAFFLE SHALL BE INSTALLED ON OUTLET TEE G PERVIOUS SOILS AS MANUFACTURED BY TUF-TITE, ZABEL OR EQUAL. PERCHED G.W. EL: 87.6 SOIL ABSORPTION SYSTEM (SECTION) SEPTIC SYSTEM PROFILE SOIL LOG DATE: JANUARY 15, 2021 (REF# TPT 20-291) SOIL EVALUATOR: PETER McENTEE PE(SE#1542) WITNESS: DAVID STANTON R.S. HEALTH AGENT GENERAL NOTES: ELEV. TP- 1 DEPTH ELEV. TP-2 DEPTH 1. ALL CHANGES TO THIS PLAN MUST BE APPROVED BY THE LOCAL 93.1 A 0" 931 A 0" BOARD OF HEALTH AND THE DESIGN ENGINEER. SANDY LOAM SANDY LOAM 1 B 10YR 4/2 12,E 921 B 10YR 4/2 2. ALL WORK AND MATERIALS SHALL CONFORM TO THE REQUIREMENTS 92 12 OF THE STATE ENVIRONMENTAL CODE, TITLE V, AND ANY APPLICABLE SANDY LOAM SANDY LOAM LOCAL RULES AND REGULATIONS. 10YR 5/4 10YR 5/4 90.1 36" 90.1 36„ 3. THE SEWAGE DISPOSAL SYSTEM SHALL NOT BE BACKFILLED PRIOR C1 C1 TO INSPECTION AND APPROVAL BY THE BOARD OF HEALTH AND THE MED. SAND MED. SAND DESIGN ENGINEER. 10YR 5/8 10YR 5/8 4. ANY CONDITIONS ENCOUNTERED DURING CONSTRUCTION DIFFERING 87.6 C2 66" 87.6 C2 66" PERCHED GW FROM THOSE SHOWN HEREON SHALL BE REPORTED TO THE DESIGN _ ` "ENGINEER-BEFORE CONSTRUCTION CONTINUES. - SILT LOAM SILT LOAM ' lOYR 5/3 10YR 5/3 5. ALL ELEVATIONS BASED ON AN ASSUMED DATUM. 84.8 C3 100" 84.6 C3 102" 6. THE DESIGN ENGINEER IS NOT RESPONSIBLE FOR THE FAILURE OF FINE SAND FINE SAND STRIP OUT TO THE CONTRACTOR OR OWNER TO NOTIFY THE LOCAL BOARD OF 2.5Y 6/4 SY 6/4 HEALTH FOR PROPER INSPECTIONS DURING CONSTRUCTION. DRY 2. DRY "C3" HORIZON 7. WATER SUPPLY PROVIDED BY TOWN WATER SERVICE. (SAMPLED) " 80.8 148" 85.6 150" 8. THERE ARE NO WELLS WITHIN 150' OF THE PROPOSED S.A.S. PERC RATE 8 MIN/IN. PER SIEVE ANALYSIS IN "C3" HORIZON 9. ALL AREAS CLEARED FOR CONSTRUCTION SHALL BE RESTORED AS WEEPING PERCHED GROUNDWATER OVER C2 HORIZON AGREED UPON BY OWNER AND CONTRACTOR OR AS OTHERWISE DIRECTED BY THE APPROVING AUTHORITIES. 10. IT SHALL BE THE RESPONSIBILITY OF THE CONTRACTOR TO VERIFY BACK OF HOUSE THE LOCATION OF ALL UNDERGROUND UTILITIES, PRIOR TO BEGINNING 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 REPLACE WITH CLEAN SAND AS SPECIFIED IN 310 CMR 255(3). _ 12. AREAS REQUIRING STRIPOUT OF UNSUITABLE MATERIALS SHALL BE INSPECTED BY DESIGN ENGINEER PRIOR TO BACKFILL. 13. THIS PLAN IS TO BE USED FOR SEPTIC SYSTEM PURPOSES ONLY AND NOT CONSIDERED TO BE A PROPERTY LINE SURVEY. 14. THE ENGINEER IS NOT RESPONSIBLE FOR ANY UNDOCUMENTED SEPTIC SYSTEM COMPONENTS NOT SHOWN ON THE PLAN GARAGE -P N Ln DESIGN CRITERIAN. N W ��J NUMBER OF BEDROOMS: 4 SOIL TEXTURAL CLASS: CLASS I Lp 00* DESIGN PERCOLATION RATE: 8 MIN/IN (0.66 GPD/SF) ago P DAILY FLOW: 440 GPD ' DESIGN FLOW: 440 GPD GARBAGE GRINDER: NO 1p OPO S D LEACHING A . AREA REQUIRED: (440 GPD) = 666.6 SF ' S. I. -� .66 GPD/SF S.A.S. LAYOUT __ 34' EXISTING SEPTIC TANK: 1500 GALLON CAPACITY PROPOSED D-BOX: I INLET, 3 OUTLET (MIN.), H-20 PROPOSED SEPTIC SYSTEM UPGRADE PLAN INSTALL AN 20' x 34' LEACH FIELD 4340 MAIN STREET, BARNSTABLE, MA SIDEWALL AREA: NOT APPLICABLE Prepared for: Cape Cod Septic Services, 350 Main St, W. Yarmouth, MA 02673 BOTTOM AREA: 20' x 34' = 680 S.F. Engineering by: SCALE DRAWN JOB. N0. TOTAL AREA:.....................................680 S.F.f po Engineering Works, Inc. N.T.S: P.T.M. 334-20 LEACHING CAPACITY = 0.66 GPD/SF x 6X SF = 448.8 GPD 12 West Crossfield Road, Forestdale, MA 02644 DATE CHECKED SHEET NO. (508) 477-5313 2/26/21 P.T.M. 2 Of 2