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HomeMy WebLinkAbout0182 MIDPINE RD - Health 182 Midpine Road Barnstable P A '356 020 } ec i a r .IN. <Sz � 3 COMMONWEALTH OF MASSACHUSETTS .EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS a ;DEPARTMENT OF ENVIRONMENTAL PROTECTION 350 MAIN STREET WEST YARMOUTH,MA ,�R ] 2 20�5 508-775-2800 NSTABLE BARS ,ITN UEPT. TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM, PART A CERTIFICATION MAP 356—PARC 20 ' Property Address: 182 MID PINE ROAD CUMMAQUID,MA 02637 Owner's Name: MCCARTHY,PAMELA _ Owner's Address: P.O.BOX 155 CUTAMAQUID,MA 02637 ` Date of Inspection APP_IL 4,2005 f Name of Inspector:(please print) JAMES D.SEARS Company Name: A&B Canco Mailing Address: 350 Main Street W West Yhrmouth,MA 02673 O Telephone Number: 508475-2800 N 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 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: d Passes Conditionally Passes Needs Further Evaluation by the Local.Approving Authority Fails v - u Inspector's Signature: - �� ��6 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 comple�.ing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the s'vstem 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 tot he buyer,if applicable,and the approving authority. Notes and Comments ****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. r Title 5 Inspection For n 6/1:i/2000 1 Page 2 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 182 MID PINE DRIVE CUMMAQUID,MA 02637 Owner: MCCARTHY,PAMELA Date of Inspection: MARCH 4,2005 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: ./ _ I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B. System Conditionally Passes: N/A _ 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. { 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 is replaced with complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND explain: 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 obstruction is 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 pipe(s)are replaced obstruction is removed ND explain: Title 5 Inspection Form 6/15/2000 2 Page 3 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(CONTINUED) Property Address: 182 MID PINE DRIVE CUMMAQUID,MA 02637 Owner: MCCARTHY,PAMELA Date of Inspection: MARCH 4,2005 C. Further Evaluation is Required by the Board of Health:N/A 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(i)(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 salt marsh 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 public water supply. The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance k k 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. 3. Other: Title 5 Inspection Form 6/15/2000 3 F Page 4 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(CONTINUED) Property Address: 182 MID PINE DRIVE CUMMAQUID,MA 02637 Owner: MCCARTHY,PAMELA . Date of Inspection: MARCH 4,2005 D. System Failure Criteria applicable to all systems: N/A 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 leaching 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 of times pumped ✓ Any portion of the SAS,cesspool or privy is below high ground water elevation N/A Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply N/A Any portion of a cesspool or privy is within a Zone I of a public well " N/A Any portion of a cesspool or privy is within 50 feet of a private water supply well N/A Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. (This system passes if the well water analysis performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal or less than 5 ppm,provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form.) NO (Yes/No)The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E. Large Systems: N/A To be considered is large system the system must service 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 11 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 is 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. Title 5 Inspection Form 6/15/2000 4 Page 5 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 182 MID PINE DRIVE CUMMAQUID,MA 02637 Owner: MCCARTHY,PAMELA Date of Inspection: MARCH 4, 2005 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)has been determined based on: Yes No ✓ Existing information. For example,a plan at the Board of Health. ✓ Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable)(310 CMR 15.302(3Xb)] Title 5 Inspection Form 6/15/2000 5 s Page 6 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 182 MID PINE DRIVE CUMMAQUID,MA 02637 Owner: MCCARTHY,PAMELA Date of Inspection: MARCH 4,2005 FLOW CONDITIONS RESIDENTIAL Number of Bedrooms(design): 3 Number of bedrooms(actual): 3 DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms: 330 Number of current residents: 1 Does residence have a garbage grinder(yes or no): NO Is laundry on a separate sewage system(yes or no): NO [if yes separate inspection required] Laundry system inspected(yes or no): YES Seasonal use(yes or no): NO Water meter readings,if available(last 2 years usage(gpd)): N/A Sump pump(yes or no) NO Last date of occupancy: PRESENT COMMERCIAL/INDUSTRIAL Type of establishment: Design flow(based on 310 CMR 15.203): Basis of design flow(seats/persons/sgft,etc.): Grease trap present(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 date of occupancy/use: OTHER(describe): GENERAL INFORMATION Pumping Records Source of information: N/A Was system pumped as part of the inspection(yes or no): NO If yes,volume pumped: gallons—How was quantity pumped detennined? Reason for pumping: TYPE OF SYSTEM Septic tank,distribution box,soil absorption system Single cesspool Overflow cesspool Privy Shared system(yes or no)(if yes,attach previous inspection records,if any) Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) 5' Tight tank Attach copy of the DEP approval Other(describe): Approximate age of all components,date installed(if known)and source of information: , 2003—2003-006 Were sewage odors detected when arriving at the site(yes or no): NO Title 5 Inspection Form 6/15/2000 6 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM . PART C SYSTEM INFORMATION(continued) Property Address: 182 MID PINE DRIVE CUMMAQUID,MA 02637 Owner: MCCARTHY,PAMELA Date of Inspection: MARCH 4, 2005 BUILDING SEWER(locate on site plan): ✓ Depth below grade: 101, Materials of construction: Cast iron ✓ 40 PVC _ other(explain) Distance from private water supply well or suction line: Comments(on condition of joints,venting,evidence of leakage,etc.): SEPTIC TANK(locate onsite plan): ✓ Depth below grade: 181, Material of construction: concrete metal fiberglass polyethylene _ other(explain) If tank is metal list age: Is age confirmed by a Certificate of Compliance(yes-or no): (attach a copy of certificate) Dimensions: 1000-GALLON PRE CAST Sludge depth: 1" Distance from top of sludge to the bottom of outlet tee or baffle: 29" Scum thickness: 1" Distance from top of scum to top of outlet tee or baffle: 8" Distance from bottom of scum to bottom of outlet tee or baffle: 17" How were dimensions determined: ASBUILT&TAPE Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): MAIN TANK AT WORKING LEVEL,INLET BAFFLE—OUTLET TEE. NO SIGN OF LEAKAGE OR OVER LOADING. GREASE TRAP(located on site plan) N/A Depth below grade: Material of construction: concrete metal fiberglass _ 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: Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): Title 5 Inspection Form 6/15/2000 7 I h Page 8 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 182 MID PINE DRIVE CUMMAQUID,MA 02637 Owner: MCCARTHY,PAMELA Date of Inspection: MARCH 4, 2005 TIGHT or HOLDING TANK: N/A (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/day Alarm present(yes or no) Alarm level: Alarm in working order(yes or no): Date of last pumping Comments(condition of alarm and float switches,etc.): DISTRIBUTION BOX: ✓ (if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: ' 0 + Comments(note if box is level and distribution to outlets equal,any evidence of solids carryover,any evidence of leakage into or out of box,etc.,); D-BOX IS 16"X 16"—24"BELOW GRADE,ONE LINE IN—TWO LINES OUT BOX IS CLEAN&SOLID,NO SIGN OF OVER LOADING OR SOLID CARRY OVER. PUMP CHAMBER: N/A (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.): w Title 5 Inspection Form 6/15/2000 8 Page 9 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 182 MID PINE DRIVE CUMMAQUID,MA 02637 Owner: MCCARTHY,PAMELA Date of Inspection: MARCH 4, 2005 SOIL ABSORPTION SYSTEM(SAS): ✓ (locate on site plan,excavation not required) If SAS not located explain why: Type s leaching pits,number: leaching chambers,number: 12'X 28' 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.) LEACHING IS 30-50 INFILTRATORS W/INSPECTION CAP,LEACHING IS 26"BELOW GRADE,3"WATER. NO SIGN OF OVER LOADING OR SOLID CARRY OVER. CESSPOOLS: N/A (cesspool must be pumped as part of inspectionXIocate on site plan) 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 or no): Comments(note condition of soil,signs of hydraulic failure,level of.ponding,condition of vegetation etc.): PRIVY: N/A (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.) Title 5 Inspection Form 6/15/2000 9 J: Page 10 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE.SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 182 MID PINE DRIVE;' CUMMAQUID.MA 02637 Owner: MCCARTHY. PAMELA Date of Inspection: MARCH 4, 2005 SKETCH OF SEWAGE DISPOSAL SYSTEM t` 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. lVj • �it��. - - .. j� ^ � o Title 5 Inspection Form 6/:1 5/2000 10 Page 11 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 182 MID PINE DRIVE CUMMAQUID,MA 02637 Owner: MCCARTHY.PAMELA Date of Inspection: MARCH 4, 2005 SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to no groundwater. 10 feet Please indicate(check)all methods used to determine the high ground water elevation: Obtained from system design plans on record-If checked,date of design plan reviewed: Observation 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: - You must describe how you established the high,ground water elevation: TEST HOLE 10'NO WATER. TEST HOLE 6' BELOW BOTTOM OF LEACHING. tVA Title 5 Inspection Form 6/15' 000, 11 TOWN OF BARNSTABLE � LOCATION ` 182• MIDPINE. ROAD SEWAGE J003-006 BARNSTABLE VILLA(;E ASSESSOR'S MAP & LOT356/20 INSTALLER'S NAME & PHONE NOELLIS BROTHERS CONST. CO. 362-6237 SEPTIC TANK CAPACITY LEACHING FACILITY:(type) &i/?5(size) 1_2 NO. OF BEDROOMS 3 PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNER JOHN MCKENNA DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: l7 /2 VARIANCE GRANTED: Yes No � y 2 A v 0 03- - A3 r t� THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH TOWN OF BARNSTABLE AvOration for Di!ittil ial 111r1w Towitrurtion Prrmit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: - / SG `G ----------- -----/ � )........11--b-� - r . ......................................................... Location \dd-- or Lot No. ..................... 1_G.CLrhy . ........................................ _ .... ..2'=� Omer Address Installer (� Address Type of Building 3 Size Lot............................Sq. feet Dwelling— --------- p- ( ) Garbage Grinder ( ) No. of Bedrooms.............................. ....-Ex Expansion Attic aOther—Type of Building ---------------------------- No. of persons_.._-.----_--_-_---._.-.-. Showers ( ) — Cafeteria ( ) Q Other fixtures ----------------------------------------------------- W Design Flow.-_-.--_---_�.1_U--X.3.................gallons per person per day. Total daily flow..C.,IeOl--------------------------------gallons. WSeptic Tank—Liquid capacitv_J 0c.p-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 ( ) Percolation Test Results Performed by----------------------------------------------........................... Date...................................... Test Pit No. I----------------minutes per inch Depth of Test Pit---_----.-._..----_ Depth to ground water.-..-..----_-_.--..----- 44 Test Pit No. 2................minutes per inch Depth of Test Pit-------------------- Depth to ground water........................ a ........Lr� -------------------------------------•------------------•-------------•----------------•-•--•---------.....-•----- 0 Description of Soil........ :gP..-_ ----•-•----•-•------------•-•----------•------------•-------------•-•--•---------...._.-.------------------------.----- V .................................................••--.....------------------•-•---....--•-----•---------...----------....---------------•-----------......------......-•------------........_---•---•---- W x •--------------- -------------- ------------------------------------------------------------------------------------------------ S�e ------------------•--••-•--------------•----------•-••--------------- U Nature of Repairs or Alterations—Answer when applicable._.--- 7 ...-S' �r '--.-_ - ----•--------------------------------------------------- --•--------------------•--•---------------------.._..........-------------------------------------------------------•-----------------•--•----- 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 Co ance as b �edbe board of health. ge .............. `� " Application.Approved By ..... ........ - --------------------- ---------- ----. ....` � G.. -------.....................--------------------------.......... ((( Date Application.Disapproved for the following reasonr- ------------------------------- ------------------------------------ ...............---------------------------------- . . .........................................---------------------------------------------------------------------------------------- - - --- ---- Date Permit No. �� QQ�i............................ Issued ..........f..6 _ - Date ,h THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE FEE�:!. .............. inttl nx� Tuni#ru#aan permit Permission is hereby granted r.j- ----- .-��{�'ti------ -r'_? ----C p to ConstrTt ) or Repair ( ) an Individual Sewage Disposal System Street r as shown on the application for Disposal Works Construction Permit l�o:�l).3�G�}(r_., ated.-_fir/j2.1 . ........................ •-.� ............ ..__•• ..................................................... DATE Board of Health /�a -------------- FORM 36508 HOBBS&WARREN.INC..PUBLISHERS THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE s M1 Tertifi ate of TOittplianve THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) e.c..................�. S Ins�a Ier :' at '........1.._ .......__j' '1.� {AI}`�'_.... �%r� �.�n..fJ-� )t- ------------f'' `� ----------------------------------------------------- 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. ----- . ._..-_. dated ......f C _r a 3------...._.... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED II A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. t) -, DATE 1 �. ........ - - Inspector �� 1 114 �' ----- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Appliration for Diti-poottl Work,6 Tomitrortion "amit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: /f l_ __l !1/ � ° �� p�,rn..... ,S-C/ `aci<G.-aL• a (� Location-:\ddress rA', or Lot No. q_ owner W 71 S r9Addr ess .af ........................-............--Installer V Address UType of Building Size Lot............................Sq'. feet Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building -..-.---_------------------ No. of persons-------------------------- Showers ( ) — Cafeteria ( ) dOther fixtures ------------------------- ----------------------------------------------------------- W Design Flow------------f 1 GA-3................gallons per person per day. Total daily flow_ _4�0.-_....._................,......gallons. WSeptic Tank—Liquid capacity. 0!2.r,.galIons Length................ Width_-------------- Diameter---------------- Depth................ x Disposal Trench=No. .................... Width.._-...._......_._.. Total Length.................... Total leaching area....................sq. ft. �: - Seepage Pit No..................... Diameter......-------------- Depth below inlet............. 1...... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by------------------------------------------------------------------------- Date........................................ a Test Pit No. L---------------minutes per inch Depth of Test Pit.................. _ Depth to ground water........................ fZq Test Pit No. 2................minutes per inch Depth of Test Pit..-----.-------_-- Depth to ground water........................ P4 -------------------------------------------------------------------------------------------------- Description of Soil.= 1 ....(�--...................................................... U •------------••-•-•-------------------•-•-•----•---•-----•--...•-••---•---•------------......-------•--•-•---- --....---•---------•---•-•--•---•••-•-----------••---------•..........-•--•-......•-••--. M. ... •------------------------- ----------------- -•---------- . ..... . U Nature of Repairs or Alterations�' tk nswer when applicable...... 7e-.. .......✓���.� '.�:�............................. ------------------------------•----• ' 1 ------------------------ ......................................... Agreement: r la '' The undersig de'd-ag"-gees Ito >nstall the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLES ofJhe-State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance,has bean�iSs.ued by the board of health. S'gne .r .K -- ' �3 Application.Approved By --- ------... --.- .1.� 0�-------------- r. Ihce Application Disapproved for the following reasonf- -----------------------------------------------------------------------.....----------------------.-------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- � Dace Permit No. r�.....`.nC� Issued -------- Q-3............... _.-.... - Dace TOWN OF BARNSTABLE ` LOCATION 182 MI ROAD SEWAGE �003-006 BARNSTABLE I VILLAGE ASSESSOR'S MAP & LOT356/20 INSTALLER'S NAME & PHONE NOELLIS BROTHERS CONST. CO. 362-6237 SEPTIC TANK CAPACITY LEACHING FACILITY:(type sue) ! 7 NO. OF BEDROOMS 3 PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNER JOHN MCKENNA i DATE PERMIT ISSUED: y /� DATE COMPLIANCE ISSUED: V/ t VARIANCE GRANTED: Yes No kA I--4 A LQ-C T 0N� ��� SEWAGE . PERMI 1 � VILLAGE INSTALLER'SO NAME & ADDRE S ^, BUILDER OR OWNER I ` DATE PERMIT ISSUED DAT E COMPLIANCE ISSUED i a .�' «n No......-- -L Fzs............................. THE COMMONWEALTH' OF MASSACHUSETTS BOARD Off I-1EALT1-I �✓en-yi .........I.... .....0F:.............. ... ....------.._.._.....----.._..........._........ Appliration for MqpwiFai Workii Toni#rnrtion Vamit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System.at: /�L ...................... _ L`location-�jddressqor l�"�.....�.lf!. __ �.�.lJi��h�---��(I.���.1 lt..�✓��.���..�r�':lz�s�_..... /4 Ownet Address �W11 � ' ....__114V ................•...._.........._ 1��'/ -.------......... ...... .-_-----..... Installer Address dType of Building °� Size Lot_. ° ---------Sq. feet U Dwelling—No. of Bedrooms_._____ 1 Expansion Attic Garbage Grinder U aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) a Other xtures ...................................................... -------- --------•- mod•...--...gallons. Design Flow......................../l____.........gallons per person per day. Total daily flow---- _ gal WSeptic Tank—Liquid capacity/Ovgallons Length................ Width................ Diameter................ Depth................ x Disposal Trench—No...................... Width.................... Total Length........... ...____ Total leaching area....................sq. ft. ' Seepage Pit No---------/........ Diameter....../g-...... Depth belo inlet..__..&...._.... Total Wng area-.�_3 1_...sq. ft. Z Other Distribution box ( ) Dosing to ( }�O �G .0 , Percolation Test Res lts Performed by._:^. 74i_y r .,�...... .. .. . _. __ Date.....7'----•�....._�-......_.. Test Pit No. 1� ......._minutes per inch Depth of Test Pit____________________ Dept to ground water.__.:......_____.__.._.. Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ Descriptio of Soil a'° .: -/�:j------------------------------------ _. 9a ..- � '1'� _ ..—_ =................................. x . W U Nature of Repairs or Alterations—Answer when applicable-------------------------------------__........................................................ f ...................•................................_............................................._......_.._................._......_...... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. Sig d ..... . Application Approved By.... ( ''.......................... Date....... Application Disapproved for the following reasons-----------------------------•--•----•--------------.....---...------------------------------------------......-- _.. ----------------------------------------•----------••-••-•--•-•-•••.._--•--••--•---•--.........-••-----•-------•---•••••-•-••••--•-••--•---••---•------------------------------------------------------- Date PermitNo............................................ •••-•_.. Issued /°.... -1 ?- ................... Date Imo-- — — — -- TOWN OF BARNSTABLE 1LOCATION � �� /r � ���E eD SEWAGE # 'VILLAGE c Q /� ALPIJ2 ASSESSOR'S MAP & LOTTS(0 ®L O 1[+FSaAbh-ER'S NAME&PHONE NO. 'A SEPTIC TANK CAPACITY 5 - p 7c— /,v S1f C 7G/V LEACHING FACILITY: (type) (size) NO.OF BEDROOMS - BUILDER OR OWNER C C"51 Pr 1=TDATE: `®-� 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 Wedand and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by _ _ ....,� � �� � � �FeK �- � 4� Q �® r �s-C�� v`l�` t _9 �� ���� �( '� ` � ,i , k s .� No.----.....` ..................... THE COMMONWEALTH OF MASSACHUSETTS BOARD O _HEALTH- .........OF .............. ............. .............................................. for Bbipolial Worko Toutitrurtiott Van tit Application is hereby made for a Permit to. Construct or Repair an Individual Sewage Disposal System at: /9-Y, Location-Address r JQt No. ,or OC 1110 ......Al ...... ZP. Ir Owner Address 4 ......... ..... -4,1X-4-------------------...... f It...Z .............................................................. Installer Address Type of Building Size Lot____,_.. --------- .0.... Sq. feet U Dwelling—No. of Bedrooms... ....3...............................Expansion Attic Garbage Grinder 4-N-P Other—Type of Building ............................. No. of persons___................_.__..__. Showers Cafeteria. Otherj:Ltures ----------------_-_--- ........................................................................................................................ Design Flow­.A�#w....1Z.d..... k.-allons-per person per day. Total daily flow....6--V. .....ZZ6.)..........gallons. 1:4 Septic Tank--' I-iqu'id capacit�y ­ . /..........gallons Length________________ Width______.__._.__._ Diameter_____________.__ Depth_________._..... Disposal Tren&11_1 No .... Width.:_._._._.._._._____ Total Length..._..__._______._.. Total leaching area.--- .....sq. f t. ---------------- Seepage Pit No......... ./---------- Diameter.L.I.-Z--------- Depth'below inlet......j(��........ Total leaching areaJ_?.?._.sq. ft. Ae e7- Z Other Dist4ution box Dosing tank ACV'- .2 4/ Percolation Test R Its Performed by- "YO4 .:16"_ed�...... Date ................................ .....minutes per inch Depth of Test Pit.......... Depth.to.ground water...._._._...:_.__.__. 16t Pit No. test Pit No. 2........:....:..minutes per inch Depth of Test Pit.................. Depth to ground water....____._..________...." .............. ........................................It. .... ......... .......... . .... .. .......... ................................. 0 lopof Soil 4f Descript' .... ---- ---- ...........=. ............ .... ------- ..... ........1�----A.A ............................... .............. U Nature of, Repairs or.Alterations.=Answer when applicable.................I---------_------...........I......I................ ....................... ..................................................................................................................................................................................................... Agreement: The undersigned agrees=t,_Q install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Sanitary Code The Undersigned further agrees not to place the system in f until n C i Q eraton ut a Certificate o ` o;�p e P Compliance has been issued by the board of health. Si d 7------------------------*......... ................................ Datr- ..............?4. ..... Ig Application Approved By......�e44........... ....................... ..7 ... ; Date Application Disapproved for the following reasons:.................................................................................................................. ................................................................................................................................................................................. ---------------- Date PermitNo......................................................... Issued..................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD' OF HEALTH ..........� ........OF..........64441................................................ I '—TO$Eb That the Individual Sewage Disposal System constructed or Repaired ,,RTIF - ---------------------------- by,.. 7X�1517r. aller ......... ------ --.......................................................1 — ---- ---- -- 0- .... ....�teSafitya has been installed in accor-Z"tice!wit the provisions. 'f of The State Sa. itary Code as described in the application f6t Disposal Woiks.'Coistruction Perrilk No----- ..... e.1 ated............... & ............. -THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE................................................................................ Inspector............................................................. ..................... THE COMMONWEALTH OF MASSACHUSETTS J BOARD " HEALTH ...............I .......41111/7 .........OF..... .. ............................................. N FEE.... PermissioA�reby granted...... ............ ...... .. .... ........................................................................... 0 S t to Construct Repair an vil, al Sewage Dispos stem/0 ..........m- at No..=..... 24- - ------ -- ---------4------ ............. .. ........ ........./.24....... Street ....... / / I ;Z -�;� — as shown on the application for Disposal Works Construction Permit ...........( 7atq0-f_7................... ........... . D DATE............. Board of Health ......................................... FORM 1255 HOB19S & WARREN. INC.. PUBLISHERS v a m i bw� # r' to wc ' - icl 7ft fry .) s .� i�• a i �'`-' d>A0o 46E Ae-5 `7-10 AS15: 194114-y— r'r'/elf e► �i vas E O GAe Gym "1 d.' •�'6�c sc.�v or rcry!/ ;�<r" ,`�, '/� t eler I ��s r /esrs%�`,E'T i •?� �� `'.-.._ _ ��LLcs�/ l�!/eie, � 'ra fvrr�.�r` 9:Q Ae /t/1/E '' i S Ems' JG TegAl. - S� O r✓ 99g Do- - ,Q•eav�� PF? OFI LE OF SANITARY D1 SPOSAL SY ,.. E,M DEStGN DATA NOT TO SCALE BEDROOMS CONS 'P` tR& T { ON OF SANITARY 'DISPOSAL DESIGN FLOW GAL ./DAY SYSTEM SHALL CONFORM TO KAAS .S . LEACH MATE MIN./INCH tNVIR0NiMENTAL CODE TiTL. EM PROPOSED LEACH CA PAC IT Y : AND €' H E TOWN OF $., �. _ __._ _ / ,- -- „ HEALTH R E G U L A T 1 O N S. - 7 - ��. 'w d GAL. DAY SI T E PL AN SHOWING PROPOSED CONSTRUCTION F R '' '• ` is '� ;� = e APP' P0VEL e__. _ __ 1977 _- g D ..J , .� BOAR, D H E A L T H C : . L. E �.� . A - A E REFER E N C E DATE AGENT SOIL TEST -- - TOP OF FOUNDATION I 20 FT. MINIMUM FROM CELLAR ELEV. = 100.00_ I 10 FT. MINIMUM 10 F?. MINIMUM FROM SLAB OR CRAWL SPACE i -- CLEAN SAND SOIL OIL TEDATE OST DONE F SOIL TEST S iEI��IlyEEBI+�G r v (ASSUMED) CONCRETE WITNESSED BY -_-___---____-.-__ COVERS \ INSPECTION PORT 4" SCHEDULE 40 PVC PIPE \ - LOAM AND SEED OBSERVATION HOLE 1 ELEV.= \ PERCOLATION RATE _ __ MIN./INCH AT 72-__ INCHES / MIN. PITCH 1/8" PER FT. 2" LAYER OF ' cMNR; DEPTH HORIZ TEXTURE COLOR MOTT. OTHER 6' MA + I�B.40 MAX. \\WASHED S?ONE I VENT r 4" CAST IRON PIPE " Mq 4 \ s 1 EXISTING SPOT ELEVATION 00,,0 1 0-14 FILL I NO 3.00 ! t .id MMl. NOT REQUIRED EXISTING CONTOUR ---- (OR EQUAL) MINIMUM \ r--- PITCH './4" PER FT. \ "z FINAL SPOT ELEVATION t-� 4-23 A LOAMY SAND /IOYR3 3 ROOTS FINAL CONTOUR FLOW LINE ram-- SOIL TEST LOCATION I23-52 8 LOAMY SAND 10YR5/8 ROOTS & UTILITY POLE -O 10% COBBLES 10" __ J TOWN WATER = k —W nE -R7.QDJ - MIN ; 220„ a o . e . . . CATCH BASIN \ I52-132 C MEDIUM SAND t0YR6/4 20% COBBLES ELEV. a 96.4� E o I a . : . : 'i: , 0 24 ! _ �'j.q0 GAS LINE- •� 400 GAS I ELEV. _ _ " SUMP L-F = __»a.o _ __ ELEV. CLEAN OUT � BAFFLE ` � CESSPOOL C.P CC, ; I DISTRIBUTION = i �LEV. 050 INFILTRATORS WITH LIQUID OUTLET 6O)( STONE IN A , DEPTH TEE (EXIS . 4 FEET 14 INCHES T . TC dE VVA'ER TESTED , T � 50 5 FEET 19 INCHES I IF MORE THAN ONE OUTLET 12' X 28 X 2 TRENCH FORMA ION 6 FEET 24 INCHES 1 1000 GALLON " -_-^ - - N0 WATER ENCOUNTERED AT __132 ELEV. _ 87.40 7 FEET 29 INCHES (TO BE PLACED ON FIRM BASE) SOIL ABSORPTION WELL NIA _ ! 8 FEET 34 INCHES SEPTIC TANK ZONE 3/4" TO 1 1/2" CLEAN - ( r j INDEX DOUBLE WISHED STONE SYSTEM (SAS" ADJUST FREE OF FINES & SILT DESIGN CALCULATIONS USGS PROBABLE WATER 'ABLE ELEv. _ NUMBER OF BEU eOOM`` 3 _ SEWAGE DISPOSAL SYSTEM PROFILE OBSERVED WATER TABLE ( / ) ELEV. _ __ __ GARBAGE DISPOSAL UNIT NO- _ NUT TO SCALE BOTTOM OF TES' VOLE ELEV. = _87,40._ TOTAL ESTIMATED FLOW ( 110 GAL/ K/DAY X 3 _ W) _ 3,W GAL./DAY REQUIRED SEPTIC TANK CAPACITY _ Q_ GAL. ACTUAL SIZE OF SEPTIC TANK MOSTING) _1Q00 GAL. SOIL CLASSIFICATION DESIGN PERCOLATION RATE �_� MIN./IN. EFFLUENT LOADING RATE 4- GAL./DAY/S.F. LEACHING AREA QQ SO. FT. (12X2e)+(40X2X2) LEACHING CAPACITY (AREA X RATE) 26104 GAL./DAY 4N.00 X 0.74 { RESERVE LEACHING CAPACITY AQW, GAL./DAY I I i 0 NOTES: ALL WORKMANSHIP AND MATERIALS SHALL CONFORM TO D.E.P. TITLE 5 AND THE TOWN OF _ @ARN5TABLE--_-P, RULES AND REGULATIONS FOR THE SUBSURFACE DISPOSAL OF SEWAGE. n 2. ALL COVERS TO SANITARY UNITS SHALL BE BROUGHT TO WITHIN 6" OF FINISHED GRADE. i 3. ALL COMPONENTS OF THE SANITARY SYSTEM SHALL BE CAPABLE OF WITHSTANDING H-10 LOADING UNLESS THEY ARE UNDER OR WITHIN � 5 10 FT. OF DRIVES OR PARKING AREAS. H-20 LOADING SHALL BE USED UNDER OR WITHIN 10 FT. OF DRIVES OR PARKING AREAS. 4D 4. ANY MASONARY UNITS USED TO BRING COVERS TO GRADE SHALL BE MORTARED IN PLACE .0 _-OMP�ANCE 1,ViTH I ' 1 DEEDED OR ZONING REGULATIONS. OWNER / APPLICANT, IS TO OBTAIN SUCH DETERMINATION FROM APPROPRIATE AUTHORITY. 1 r 6. UTILITIES SHOWN ARE APPROXIMATE ONLY, EXCAVATION CONTRACTOR iS TO CALL "DIG-SAFE" AT 1-888-344-7233 AT LEAST 72 HOURS PRIOR TO COMMENCING WORK ON SITE. 1 " 7. CONTRACTOR IS TO VERIFY GRADES AND ELEVATIONS AS WELL AS SITE CONDITIONS PRIOR TO COMMENCING WORK ON SITE. ANY VARIATION " IS TO BE BROUGHT TO THE ATTENTION OF THE DESIGN ENGINEER IMMEDIATELY, 8. PARCEL IS IN FLOOD 'ZONE - C____ 9. LOT IS SHOWN ON ASSESSORS MAP __33d _ AS PARCEL _ 20__. i0. EXISTING LEACHING PIT IS TO BE PUMPED AND REMOVED. 11. ALL UNSUITABLE MATERIAL SHALL BE REMOVED FROM UNDER AND FOR A I�V�J MINIMUM OF 5' AROUND SOIL ABSORPTION SYSTEM AND BE REPLACED 1 a WITH SAND AS SPECIFIED IN 310 CMR 15.255:(3). a a _" .l DRAIN APPROVED: BOARD OF HEALTH 4� /' •�,r ;/ }� IA ENT j iI CGS f DECK I v , LIMIT OF PROPOSED SEPTIC DESIGN 5' OVERDIG `°T 128 A KENNA AREA 24,550E S F ROUTE 6 JOHN MC( i j 1000 GALLON D.�BOk N �\ SEPTIC TANK PROJECT LOCATION LOT 128 �a r� , , % ; 182 MIDPINE RD. , BARNSTABIF� �� SOIL I ° TEST LOCUS J SWROSSM? AM -G_ 185.59l _ 235 GREAT WESTERN ROAD 508 i P. 0 BOX 713 SOUTH DENNIS, MASS. 39 8—3922 02660 ! An - j b LDATE DEC. 12, 2002 j scALE , „ = 20'_' i REVISE 55oI-D JOB NO- I JJ�T�VV00 LOCATION MAP I I REVISED ` lSHEET 1 OF 1 _ _ _ C: �S8rPROJ�5584-00�dw2k5584-OO.DHG ©2002 SWEETSER ENGINEERIN:J