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0029 OAKMONT ROAD - Health
,t 29 OAKMONT RI)., BARNSTABLE r No. dlooq 0 !" Fee-- d i THE COMMONWEALTH OF MASSACHUSFTTS Entered in computer Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS 01ppgication for �N.5poga[ *pgtem Corgi.5truction Vertu Application for a Permit to Construct( ) Repai Upgrade( ) Abandon( ) ❑.Complete System individual Components Location Address or Lot No. �� QQ�NbON� ,r Owner's Name,Address,and Tel.No. runs°-dbte I&A -'1 ne T*9 C?-0'S5WPr+.j Assessor's Map/Parcel Io E Installer's Name,Address,and Tel.No. NV Designer's Name,Address and Tel.No. µ-per ?,aes��S CARthIGNI 5 kW 'F VA A � to 535 -236 Type of Building: Dwelling No.of Bedrooms 3 Lot Size poo sq.ft. Garbage Grinder W Other Type of Building /0, No.of Persons 4 A Showers(ve) Cafeteria Other Fixtures 4&Q� Stt70�-j t //�� Design Flow(min.required) 3?® gpd Design flow provided "T44'31 gpd Plan Date I ( 8 jocl Number of sheets Revision Date 'e- Title oy- G-C ' C—p-WCQSo` 3> s;�bt':d\ 71t - Size of.Septic Tank 000 LtCL Type of S.A.S. 1 X �tC4 Description of Soil CQ^ LC."G CVxm\eS W]Sr}oc� Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by t4is Board of eal Signed Date dd Application Approved by Date d Application Disapproved b Date for the following reasons Permit No. Z 1 —1ld Date Issued �0 d °?o if No. .r�0o`7 — �l) _ "t s --.a; "r Fee U!/ THE'C MO MONWEALTH OF MASSACHUSETTS ,,I Entered in computer/ +— �.: r; ', Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS ZIppgication for ;i5pont *pgtem (Con truction Permit Application for a Permit to Construct O Repai� Upgrade( Abandon( ❑ Complete System NIndividual,Components Location Address or Lot No. 2et. QQk M,N �� Owner's Name,Address,and Tel.No. �si0102l -Times-Ay C42 S5MR-r Assessor's Map/Parcel .3 E{C] /r)O 5 ra M Pv 1 `A Installer's Name,Address,and Tel.No. Q (� Designer's Name,Address and Tel.No. M{�iNtJ� '�jAQt�o�s CARM S V�AY Type of Building: " v� t f17 . Dwelling No.of Bedrooms q� Lot Size 3,C )Q sq.ft. Garbage Grinder Other Type of Building Al I No.of Persons 4 Showers(✓) Cafeteria( ✓)' Other Fixtures K 46-ow, Sic�1�e t li�K'�c Hva K Design Flow(min.required) �J© gpd Design flow provided 44'',$ r gpd , 4 Plan Date 8 1 CAR Number of sheets ( Revision Date ...-- "'.`,, Title �Cl t ��1hS0C ttCp 1aJQ C o Y'1aS�t� '� y1 Size of.Septic Tank ��(t'S't. I , 000 GC', Type of S.A.S. c� I A X v Description of Soil co- W I SAO-19 Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: • ` `e 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 ,B�oard of _ea�lt Signed V l 1 i'i�w ui_ /,L�/1 Lls� Date Application Approved by ,�t1/ I `L►�94 Date� r k)'I'A" Application Disapproved by Date for the following reasons Permit No. )oi A f t ,Date Issued 1-4 9 --.--- .d — -- =—= — ;THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS (Certificate of (Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed ( ) Repaired (K ) Upgraded " ( ) Abandoned( )by A (1 tJ Q q �it l_3 S at Cr A A l- 0(-)rJT_A_4,A has^^been constructed in accordance / p with the provisions of Title 5 and the for Disposal System Construction Permit No. d U r'K dated / p Installer M.A Kt N"? ��Ct�l rJ � Designer. Cf)zm-Ff j `�#F w #bedrooms Approved design flow -+1�.•i� � (��� gpd The issuance of this per it shall of be construed as a guarantee that the system w 14 function as designed: 4K, rr ,�Date 1. �t�t Ins ector ��f ,4i r p Id v G/ r v �� (�I/f v r-� -_ a ---------/- -------------------..✓--------- No. jbbCl=-1v,X1i------- - Fee /00 THE COMMON WEALTH OF-MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE, MASSACHUSETTS- - ------- ------ ` '11i5po5al qpp5tem Construction permit Permission is hereby granted to Construct ( ) Repair (X) Upgrade ( ) Abandon ( ) System located at q /1L,L . A 12,h - and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to comply with Title S and the following local provisions or special conditions. Provided: Construction omust be completed within three years of the date of tl�s Date Approved by /u' `�IJ — ►i�^ TOWN OF BARNSTABLE LOCATION (24 AV✓h m X''�_ - /P7 SEWAGE # VILLAGE. (° r1M A L Q E?P-7) ASSESSOR'S MAP & LOT j e?' aSm I?*9%kbLTR'S NAME&PHONE NO. A) r-. SEPTIC TANK CAPACITY "'07 %A'5002 LEACHING FACILITY: (type) (size) NO.OF BEDROOMS BUILDER OR OWNER C A—,4 PERMTTDATE: DATE: 3 -1' y 7 Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200.feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist- within 300 feet of leaching facility) Feet Furnished by -D£c.k � o 3 N i 0 ov£Nr �j TOWN OF BARNSTABLEtaO .T„OCATION 201 ®Aw mo'l lZoA-D SEWAGE# V.,,T-LAGE ASSESSOR'S MAP&PARCEL INSTALLERS NAME&PHONE NO. MA nlrP( SEPTIC TANK CAPACITY FGx t::5M_T'3nn o,cM aw, l0 LEACHING FACILITY:(type) (size) �' X L4 w X i 1 NO.OF BEDROOMS 3 . LC Gw'�957-g OWNER csp—ws wi ni PERMIT DATE: COMPLIANCE DATE: Z 09 Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility 1' Feet Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) d Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) A- Feet FURNISHED BY MAtjf4f Ba --p ZS 1 Ak sup 2a�rn � !I �T'i►v 1301p �� O D 8 3,5' 80 .a5 Town of Barnstable �pP'THE Tp� �y do Regulatory Services Thomas F. Geiler, Director * BARNSTABLE, 9� A . �0� Public Health Division Argo 0' Thomas McKean, Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Installer & Designer Certification Form Date: 2/12/09 Designer: _Shay Environmental Services, Inc. Installer: Manny Barrows Address: P.O. Box 627 Address: West Falmouth Hwy. East Falmouth, MA 02536 West Falmouth, MA On 1/28/09 _Manny Barrows was issued a permit to install a (date) (installer) septic system at 29 Oakmont Road, Barnstable, MA based on a design drawn by (address) _ Shay Environmental Services.-Inc.__ dated 1/13/09 (designer) XX_ I certify that the septic system referenced above was installed substantially according to the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. I certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system) but in accordance with State & Local Regulations. Plan revision or certified as-built by designer to follow. (Installer's Signature) o :121 (Designer's Signature) (AffiD;esp J' aSmp Here) PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS- BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. Q: Health/Septic/Designer Certification Form Town of Barnstable P# U Department of Regulatory Services Public Health Division DateMAM / /;. `/f``00&"�` ain Street,Hyannis MA 02601 Date ScheduledTime _ Fee Pd. Soil Suitability Assessment for SewageD osalPerformed By: Witnessed By. LOCATION& GENERAL INFORMATION RS Location Address blo Ck-M,�T_ Owner's Name I-)rr) Address C29 n'r 04&M� 2 P Assessor's Map/Parcel: 3�- �� � Engineer's Name �42tN1 � &to y NEW CONSTRUCTION - iREPAIR Telephone# �s 9 Land Use (A Slopes(4'0) 596 Surface Stones i'J 1A Distances from: Open Water Body ft Possible Wet Area ft Drinking Water Wellft Drainage Way N IR-ft Property Line _�' _ft Other f� 1P3 ft SKETCH:(Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands in proximity to holes) Parent material(geologic) 0y4-11-091StN Depth to Bedrock 1v A Depth to Groundwater. Standing Water in Hole: P!OIL 10tOS- Weeping from Pit Fate'a P QfV Estimated Seasonal High Groundwater ry 1p, DETERMINATION FOR SEASONAL HIGH WATER TABLE Method Used: mIZ Depth Observed standing in obs.hole: —in.in. Depth to soil mottles: Z Depth to weeping from side of obs.hole: in, Groundwater Adjustment flyi Index Well# Reading Date: .. Index Well level , Adl.fketor— Adj.C7rounduvEgr level PERCOLATION TEST Date 08 ^ � X Observation �" I Hole# A _ Time at 9" i' i�i e Q, Depth of Perc (cc) B � Time at 6" C OD Start Pre-soak Time @ Time(9"•6") AL M r End Pre-soak Rate Min✓Inch Site Suitability Assessment: Site Passed_ ` Site Failed: Additional Testing Needed(Y/N) Original: Pubic Health Division Observation Hole Data To Be Completed on Back----------- ***If percolation test is to be conducted within 100' of wetland,you must first notify the. Barnstable Conservation Division at least one(1) week prior to beginning. Q:\SEPTICU'ERCFORM.DOC DEEP.OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture .Sdil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistencv.% rave O��N �. �I�� Loth �,5`I' 8 �,cr�►� p►ocsz . 148 b4 C roes- .� S'� rs.ab�5V C t,►►ea-F►� 2,5If LA ds L DEEP OBSERVATION HOLE LOG Hole# a Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consi ten % (0`ix 3 NIA- (0- log e5k. u8`g C'i}, VAFrR .����8�� IS�.oiG�scve\ DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency.%Gravel) DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. onsi t Flood Insurance Rate Map: Above 500 year flood boundary No Yes _ Within 500 year boundary No Y Yes Within 100 year flood boundary No_ '-, Yes Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring perviou material exist in all areas observed throughout the area proposed for the soil absorption system? yet-- If not,what is the depth of naturally occurring pervious material? Certification I certifythat on (date)I have passed the soil evaluator examination approved by the . Department of Environmental rotection and that the above analysis was performed by me consistent with the required traini x s a d erience described in 310 CMR 15.017. Date Signature Q:\SBPTICVERCFORM.DOC n COMMONWEALTH OF MASSACHUSETTS a Title 5 Official Inspection Form Not for Voluntary Assessments '�M NBy Subsurface Sewage Disposal System Form Inspection results must be submitted on this form. Inspection forms may not be altered in any wa . A.' General Information '��// — 6.SCJ 1. Property Information: MAP 349—PARC 050 29 OAKMONT ROAD - CUMMAQUID, MA 02637 Property Address j LOCKLIN, MAURICE G. Owner's Name 29 OAKMONT ROAD Owner's Address CUMMAQUID MA 02637 City/Town State Zip Code MARCH 2, 2007 Date 2. Inspector: !t JAMES D. SEARS y. Name of Inspector A & B CANCO '-` Company Name 350 MAIN STREET Company Address . WEST YARMOUTH MA 02673 City/Town State Zip Code 508-775-2800 Telephone Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The System: ® Passes ❑ Conditionally Passes ® Fails eeds Further Evaluation by the Local Approving Authority �/ / spector's Signature: Date: The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP) within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer,if applicable,and the approving authority. ****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. =U COMMONWEALTH OF MASSACHUSETTS d Title 5 Official Inspection Form Not for Voluntary Assessments a, Vey Subsurface Sewage Disposal System Form D. Certification (cont.) 29 OAKMONT ROAD Owner's Address C U MMAQ U I D MA 02673 City/Town State Zip Code LOCKLIN, MAURICE G. Owner's Name MARCH 2, 2007 Date of inspection 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 a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of compliance indicating that the tank is less than 20 years old is available. ND Explain: I Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 2 of 16 J COMMONWEALTH OF MASSACHUSETTS Title 5 Official Inspection Form � f e Not for Voluntary Assessments 11b ,eo Subsurface Sewage Disposal System Form i B. Certification (cont.) 29 OAKMONT ROAD Owner's Address CUMMAQU I D MA 02673 City/Town State Zip Code LOCKLIN, MAURICE G. Owner's Name MARCH 2, 2007 Date of inspection B) System Conditionally Passes (cont.): N/A ❑ 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: 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(1) (b)that the system is not functioning in a manner which will protect public health,safety and 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 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 3 of 16 . COMMONWEALTH OF MASSACHUSETTS _ Title 5 Official Inspection Form d Not for Voluntary Assessments Subsurface Sewage Disposal System Form B. Certification (cont.) 29 OAKMONT ROAD Owner's Address CUMMAQU I D MA 02673 Cityf'rown State Zip Code LOCKLIN, MAURICE G. Owner's Name MARCH 2, 2007 , Date of inspection C) N/A-Further evaluation is required by the Board of Health (cont.): 2.System will fail unless the Board of Health(and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health,safety and environment: The system has a septic tank and soil absorption system (SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ® The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well" Method used to determine distance: "This system passes if the well water analysis, performed at a DEP certified laboratory, for coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less that 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3.Other: r Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 4 of 16 COMMONWEALTH OF MASSACHUSETTS d Title 5 Official Inspection Forms Not for Voluntary Assessments Subsurface Sewage Disposal System Form B. Certification (cont.) 29 OAKMONT ROAD Owner's Address CUMMAQUID MA 02673 City/Town State. Zip Code LOCKLIN, MAURICE G. Owner's Name MARCH 2, 2007 Date of inspection D) System Failure Criteria Applicable to All Systems: You must indicate"Yes"or"No"to each of the following for all inspections: Yes No ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ® 0 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 pits is less than 6" below invert or available volume is less than 'h day flow Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: . ® Any portion of the SAS, cesspool or privy is below high ground surface water elevation. N/A Any portion of cesspool or privy is within 100 feet of a surface water supply ortributary to a surface water supply. FN—/A--1 Any portion of a cesspool orprivy is within a Zone 1 of a public well. FN/—A-1 Any portion of a cesspool or privy is within 50 feet of a private water supply well. FN—/—A--1 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. [Phis system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] YES No The system is a cesspool serving a facility with a design flow of 2000 gpd—10,000 gpd. Yes No ® 0 The system fails. 1 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. Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 5 of 16 I COMMONWEALTH OF MASSACHUSETTS w v Title 5 Official Inspection Form Not for Voluntary Assessments ' Subsurface Sewage Disposal System Form B. Certification (cont.) 29 OAKMONT ROAD Property Address CUMMAQUID MA 02673 CityfTown State Zip Code LOCKLIN, MAURICE G. Owner's Name MARCH 2, 2007 Date of inspection E) N/A-Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no"to each of-the following, in addition to the questions in Section D. Yes No ® ® the system is within 400 feet of a surface drinking water supply ® ® the system is within 200 feet of a tributary to a surface drinking water supply ® the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area- IWPA)or a mapped Zone II of a public water supply well If you have answered"yes"to any question in Section E the system is considered a significant threat, or answered"yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 6 of 16 • COMMONWEALTH OF MASSACHUSETTS 4 Title 5 Official Inspection Form d yev`Ob Not for Voluntary Assessments Subsurface Sewage Disposal System Form C. Checklist 29 OAKMONT ROAD Property Address CUMMAQUID MA 02673. City/Town State Zip Code LOCKLIN, MAURICE G. Owner's Name MARCH 2, 2007 Date of inspection 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, including the SAS, located on site? ® 0 Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction dimensions, depth of liquid, depth .of sludge and depth of scum? ® Was the facility owner;and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: ® ® Existing information. For example, a,plan at the Board of Health. ® ® Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable)[310 CMR 15.302(5)). Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 7 of 16 COMMONWEALTH OF MASSACHUSETTS w Title 5 Official Inspection Form a er Not for Voluntary Assessments Subsurface Sewage Disposal System Form D. System Information 29 OAKMONT ROAD Property Address CUMMAQUID MA 02673 City/Town State Zip Code LOCKLIN, MAURICE G. Owner's Name MARCH 2, 2007 Date of inspection Residential Flow Conditions:,( Number of bedrooms(design): 3 Number of bedrooms(actual): 3 DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): 330 Number of current residents: 0 Does residence have a garbage grinder? ® Yes No Is laundry on a separate sewage system?[if yes separate inspection is required] ® Yes ® No Laundry system inspected? ® Yes No Seasonal use? Yes No Water meter readings, if available(last 2 years usage(gpd)): N/A Sump pump? Yes ® No Last date of occupancy: OVER 1 YEAR AGO. Commercial/Industrial Flow Conditions: N/A Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.) Grease trap present? [:] Yes ❑ No Industrial waste holding tank present? ® Yes ® No Non-sanitary waste discharged to the Title 5 system? EJ Yes No Water meter readings if available: Last date of occupancy/use: Date Other(describe): Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 8 of 16 COMMONWEALTH OF MASSACHUSETTS w Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form D. System Information (cont.) 29 OAKMONT ROAD Property Address CUMMAQU I D MA 02673 City/Town State Zip Code LOCKLIN, MAURICE G. Owner's Name MARCH 2, 2007 Date of inspection General Information Pumping Records: ✓ Source of Information: N/A Was system pumped as part of the inspection? Fj Yes No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ® Single cesspool Overflow cesspool ® Privy ® 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) Tight tank. Attach a copy of the DEP approval. ® Other(describe): Approximate age of all components, date installed(if known)and source of information: TANK AND PIT 1989—NEWER LEACHING 1998 Were sewage odors detected when arriving at the site? ® Yes No Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 9 of 16 e COMMONWEALTH OF MASSACHUSETTS d Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form D. System Information (cont.) 29 OAKMONT ROAD Property Address CUMMAQUID MA 02673 City/Town State Zip Code I LOCKLIN, MAURICE G. Owner's Name MARCH 2, 2007 Date of inspection Building Sewer(locate on site plan):./ Depth below grade: 18" feet Material of construction: cast iron ® 40 PVC ❑ other(explain) Distance from private water supply well or suction line: feet Comments(on conditiomofjoints, venting, evidence of leakage; etc.): GOOD Septic Tank(locate on site plan): ✓ Depth below grade: 20" Meet - - - Material of construction: concrete metal ® fiberglass ® polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance?(attach a copy of certificate) ® Yes ❑ No -------------------------------------------------------------------------------------------------------------------=--------=-----------------=------------------7------------=------- Dimensions: 1000-GALLON PRE CAST Sludge depth: 3" Distance from top of sludge to bottom of outlet tee or baffle 27" Scum Thickness 2" Distance from top of scum to top of outlet tee or baffle 12" Distance from bottom of scum to bottom of outlet tee or baffle 16" How were dimensions determined? ASBUILT-TAPE-SLUDGE JUDGE Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 10 of 16 COMMONWEALTH OF MASSACHUSETTS Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form D. System Information (cont.) 29 OAKMONT ROAD Property Address CUMMAQUID MA 02673 City/Town State Zip Code LOCKLIN, MAURICE G. Owner's Name MARCH 2, 2007 Date of inspection Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): TANK AT WORKING LEVEL, INLET BAFFLE - OUTLET BAFFLE. TANK AT 20" WITH COVER AT 8". NO SIGN OF LEAKAGE OR OVER LOADING. NOTE: MAINTENANCE PUMP AFTER INSPECTION. Grease Trap (locate on site plan): N/A Depth below grade: feet 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 Date Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank (tank must be pumped at time of inspection) (locate on site plan): N/A Depth below grade: Material of construction: ® concrete ❑ metal ❑ fiberglass ® polyethylene ® other(explain) Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 11 of 16 COMMONWEALTH OF MASSACHUSETTS Title 5 Official Inspection Form Not for Voluntary Assessments e� rev` Subsurface Sewage Disposal System Form D. System Information (cont.) 29 OAKMONT ROAD Property Address CUMMAQUID MA 02673 City/Town State Zip Code LOCKLIN, MAURICE G. Owner's Name f MARCH 2, 2007 Date of inspection Tight or Holding Tank (cont.) N/A Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: Yes No Alarm Level: Alarm in working order: Yes No Date of last pumping: Date Comments(condition of alarm and float switches, etc.): Attach a copy of current pumping contract(required). Is copy attached? Yes No Distribution Box(if present must be opened) (locate on site plan): J 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" —30" BELOW GRADE WITH COVER AT 8". ONE LINE IN — TWO LINES OUT. BOX IS CLEAN AND SOLID. Pump Chamber(locate on site plan): N/A Pumps in working order. ® Yes ❑ No Alarms in working order: ❑ Yes ® No Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 12 of 16 . • COMMONWEALTH OF MASSACHUSETTS A Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form D. System Information (cont.) 29 OAKMONT ROAD Property Address CUMMAQU ID MA 02673 City/Town State Zip Code LOCKLIN, MAURICE G. Owner's Name MARCH 2, 2007 Date of inspection Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.): Soil Absorption System (SAS) (locate on site plan, excavation not required): ✓ If SAS not located, explain why: Type: leaching pits number: 1 leaching chambers number: 4 leaching galleries number: leaching trenches number, length: leaching fields number, dimensions: overflow cesspool number: Elinnovative/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 ONE 1000-GALLON PRE CAST PIT, PIT DRY, PIT & COVER AT 4'. NEWER LEACHING, FOUR INFILTRATOR HI CAP WITH 4' STONE. LEACHING DRY PROB & TEST HOLE, NO SIGN OF OVER LOADING. COMMONWEALTH OF MASSACHUSETTS u w Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form D. System Information (cont ) 29 OAKMONT ROAD Property Address C U MMAQ U I D MA 02673 City/Town State Zip Code LOCKLIN, MAURICE G. Owner's Name MARCH 2, 2007 Date of inspection Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): N/A Number and configuration Depth—top of liquid to inlet invert t Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ® Yes ® No Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Privy (locate on site plan): N/A Materials of construction: Dimensions Depth of solids Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.)-. Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 14 of 16 �asyr+- t''TY.#"'s ,ti' FC et P� ��xt a '��.„�'�t�h n^ � � ., er• t .ix. n - 6i *.. e =f ,.: "•ata .+rb� .*«.rr. p e x COMMONW, M r H2OF ASSACHUSETTS h , � r 4 t - Title 5 Officia . , ns ection Form p Not for Voluntary Assessments Subsurface Sewage Disposal System Form D. System Information (cont.) 29 OAKMONT ROAD Property Address CUMMAQU I D MA 02673 Cdy/Town State Zip Code LOCKLIN, MAURICE G. Owner's Name MARCH 2, 2007 Date of inspection Sketch of Sewage Disposal System: Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters,the building. AR w q L� VE�f Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 15 of 16 � II - 6'"Z F S� -tr Lr?4,� � ,+.q, •...X1� k4 E y-Y.-e* ?,�.-�yy ;..svas.s �-:# .i3 ':." G: i `3 ^� v.-.-�. ,i- -�.�i'" �yd' � ,•.�x � , r t;y�- fir'a.=w"M"' � t n '� ��� ��:i' a. d-�'*' �` �"c .� '.`» s .. . '< "ir 4 f'j, "� r F�=�,��+ ?.+,.��' �r�: vT�i� "•c� T.f.: ��' �'- c�: �' ` ". r z' aft•:, � „ 'Sry �._. `''s`5v r:r��.. -Y'��t�". e."..;. `:n.,'sr �Saa.:%� r 'F d<� COMMONWEALTH OF MASSACHUSETTS = r Titl }. e 5 Officialf Inspection Form f ,. Not for Voluntary Assessments Subsurface Sewage Disposal System Form D. System Information (cont.) 29 OAKMONT ROAD Property Address CUMMAQU I D MA 02673 Cdyrrown State Zip Code LOCKLIN, MAURICE G. Owner's Name MARCH 2, 2007 Date of inspection Site Exam: Slope Surface water Check cellar Shallow wells Estimated depth to NO ground water: 14' Please indicate all methods used to determine the high ground water elevation: Obtained from system design plans on record If checked, date of design plan reviewed: Date Observed site(abutting property/observation hole within 150 feet of SAS) Checked with local Board of Health—explain: Checked with local excavators, installers—(attach documentation) Accessed USGS dlatabase—explain: I You must describe how you established the high ground water elevation: t V Pit" TOWN OF BARNSTABLE LOCATION off. C>A SEWAGE # VILLAGE _, ASSESSOR'S MAP &LOT.� Q:3'r� INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY 1 voea . LEACHING FACILITY: (type) y A-stJ-k .(size) y 51&u. NO.OF BEDROOMS BUILDER OR OWNER La Q,+Q�' PERMIT DATE: 11 -1 3-18 COMPLIANCE DATE:_ I/ 2��'-,2R Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by a N Fee o. U 9 THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS Zipplitation for Di-4pooal *p$tem Congtruction Permit Application for a Permit to Construct( )Repair( )Upgrade(V ))Abandon( ) El Complete System LJ Individual Components Location Address or Lot No.0 q 0 q!!�:j aVO Owner's Name,Address and Tel.No. S Assessor's Map/Parcel 3 `D D �C G�`t V�j Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. Type of Building: Dwelling No.of Bedrooms 3 Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow 33 D gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank ��r 5c`�r— 000 fib w'J Type of S.A.S.. e Cry Gc c T✓��tOJ Description of Soil S Nature of Repairs or lter tions(Answer when applicable) . `GT R d ' e f G`t Q �G� 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 th.5_Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has _ ^7 Sin 4 Date / J �� Application Approved by Date Application Disapprove or the ollowing reasons Permit No. Date Issued No. Fee WYes THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS 2pprication for Miopozal 6p5tern Con.5truction Permit Application for a Permit to Construct( )Repair( )Upgrade(V)Abandon( ) El Complete System LJ Individual Components " Location Address or Lot No. Owner's Name,Address and Tel.No. F l Y Assessor's Map/Parcel r Q 0 C Y `1 a Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. Type of Building: Dwelling No.of Bedrooms 3 Lot Size sq.ft. Garbage Grinder( ) Other Type of Building �. `" No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow r330 gallons per day. Calculated daily flow 7S 99 gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank j�!`cfl"a-- 000.90- Type of S.A.S. (,rN Cct Description of Soil �U-- Nature of Repairs or Alter tions(Answer when applicable) � el P-\\ o e���1 v t c� t y z-t 1,-Tr cart a p.S w u 15'r - Sl e e r Date last inspected: ,_ 2 f Agreement: _ , The undersigned agreesto ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the nvironmenta Code a not to place the system in operation until a Certifi- cate of Compliance has, us ed by. o C; Sign - a }' /- Date /� Application Approved b.. / r� J Date Application Disapprove or the following reasons ~ / Permit No. Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Comp ante THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed( )Repaired( )Upgraded Abandoned( )by t r`t b —c-�A p 5 s �. at o�R C) f�KlMovwZ" "�14�(Zf�S\� h be onstructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. ated Installer Designer The issuance of this permit shall no(t..b�e}onstrued as a guarantee that the system will-function as designed. Date Inspectors V No. -----==---------=---------Feed` t' THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS lwigpoar *pgtem Con.5truction Permit Permission is hereby granted to Construct( )R pair( )Upgra Abandon( ) System located at ti v 4�cl G and as described in the above Application for Disposal System Construction Permit. The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided: Construction /mus`t be co pleted within three years of the date of this pe �J / /I PP y !�'/C �i� Ii ,Date: Approved b ✓ j • I N197 NOTICE: This Form Is To Be Used For the Repair Of Failed Septic Systems Only: CERTIFICATION OF SKETCH AND APPLICATION FOR A DISPOSAL WORKS CONSTRUCTION PERMIT (WITHOUT ENGINEERED PLANS) I I, hereby sertify that the application for disposal works � , construction permit signed by me dated �l``D concerning the F. teal at c�Gl �� CG �'�'�� Z�V�b` meets all of the property located following criteria: There are no wetlands located within 100 feet of the proposed leaching facility l/• There are no private wells within 150 feet of the proposed septic system e 4 v There is no increase in now and/or change in use proposed ?here am no variances requested or needed. .P._ If the proposed leaching facility will be located within 250 feet of any wetlands,the bottom of the proposed leaching facility will nM be located less than fourteen(14) feet above the maximum adjusted groundwater table elevation. } Please complete the following: A)Top of Ground Elevation(according to the Engineering Division G.1.S.map) a B)Observed Groundwater Table Elevation(according to Health Division well map) SIGNED DATE: LICENSED SE 1C SYSTEM INSTALLER IN THE TOWN OF BARNSTAHLE NUMBER j [Attach a sketch plan of the proposed system.Also if the licensed installer posesses a certified plot plan, this plan should be submitted]. i i 1:health(older:cul —f- 'c 1 D L6CAT10N A SEWAGE PERMIT NO... 1-- T- VILLAGE Uwt i vM�M� 1 ti e) INSTALLER'S NA E i ADDRESS B U-I L D E R OR OWNER DATE PERMIT ISSUED kIA DATE COMPLIANCE ISSUED tlA+_h^ovjIA V-0 BLS. � e f� � Zg �� 4 Troth K .�D % 1 ae vcttY � D vJ/ 3/f'c. 01', �'i No....... .� � J ` . FF$...... ............ THE COMMONWEALTH OF MASSACHUSETTS $ BOAR® OF HEALTH ::. srV.................OF...... f __................----•--------- Appliration for Disposal Works Tons#rnrtion Frrmit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: ..........V.1QK.. ............ ..................................... ----------------"-7----- .................................................. Locati Address or Lot No � '� l........ ! !� --- Address W Installer Address . Type of Building Size ...Sq. feet Dwelling No. of Bedrooms._....._'�.................................Expansion Attic ( ) Garbage Grinder PLIOther—T e of Building No. of,persons............................ Showers — Cafeteria a Other fixtures -----•-------------------------•---•-•---•.... W Design Flow............................................gallons per person ker day. Total daily flow........... _; -•.---------•.....gallons. WSeptic Tank—Liquid capacityr�----gallons Length.. ........... Width__.-. ......... Diameter................ Depth___. -__-_-. x Disposal Trench—No..................... Width............ Total Length.................... Total leaching area....................sq. ft. Seepage Pit No....../------------ Diameter... �?:__S_..-_- Depth below inlet....4............. Total leaching areal;?.rs( ag, � Z Other Distribution box ( ) Dosing nk ( ). C 'ter° `" Percolation Test Results Performed by... vw. - ..'.��..._.,�!YCt......_. Date_.././°:/la_r �..........:.... `a minutes er inch Depth of Test Pit-_L_VY.. Depth to ground water_0_r._FA1_-.Test Pit No. l._�..__._._. p p r....__ p Test Pit No. 2._3..........minutes per inch Depth of Test Pit.)VY.......... Depth to ground water_..,6P j;eNX_r4_rP a -----•• --------•-•- •-••--....•-•-----•••-•......--•--•................... ---------....------•-•----------••...-•------------._........ O Description of Soil . ........4.7 L x W ----------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------- U Nature of Repairs or Alterations—Answer when applicable................................................................................................ ••--------------------------•-----------------------------•-------•-----------------.....----•-......---...---------------------------------•--•----------------------•------------------•--....._------ Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of iITI- 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been iss ed by thee rd ealt� Z VZ -_-_---------------- Signed- -•--aLj Date ApplicationApproved By....... '. . ------••....................•-•--•-•-•• ........................................ ._........------ ..................•----••.........---••-......_.....••-•••---......_.........-•-•------...-----•••-•--------•--------•---------•-•---•------------•----------------•-•--------------................................................... - Date PermitNo......................................................... Issued....................................................... Date r \ 1 L0, _140tl V h THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH fcjA/.................OF..... 1 Appliration for Uhip sal Works Tongtrurtion Frruti# Application is hereby made for a Permit to Con truct ( ).�,or Repair (. ) an Individual Sewage Disposal System at: ....._...d .�!!_fe (: .. -----------------•---....-•------•--•. _--•-----------4�.T.---• ....... .. - -......•-•_.. - Locat' Address ..�,1. -._fie L " ,C�` -t ems/ �C r Lot NP l� 1 W Owner Address �? Installer Address .. f Type of Building Size ....Sq. feet a Dwelling—No. of Bedrooms_______ ________________________________Expansion Attic ( ) Garbag Grinder) aOther—Type,of`Build'ing ......................... No.No. of persons....._.._............__,___. Showers ( ) — Cafeteria ( ) Other fixtures --------------------------=........ Design Flow............................................gallons per person per day. Total daily flow.......... '___ .__.gallons. W W Septic Tank—Liquidca acitYdam!____gallons Length _ Width__: ........ Diameter__ ..._ De th___. x Disposal Trench—No_ ____________________ Width..................... __ .._.•Total Length............... ....... Total leaching area_._. sq. ft. Seepage Pit No.....1:_`___._____ Diameter Depth below inlet..5;. Total;)`e h>ng area �.rs-... Other Distribution box ( ) ; Dosing ank Percolation Test Results Performed by + ._ _ 4.!•.................. 1� W ,,. 4' .*._. Date../� 1� Test Pit No 1.3..........minutes per inch Depth of Test_Pit o y Depth to groundwater A �??`_ .A!___- ' 44 Test Pit No., 2_3:..-.___...minutes per inch Depth of Test Pit&.11........... Depth to ground water..-.>t_Aji>ty 214FP, a ---•-------------------------------••-•-....•. •. -•-----•--- ---••••••-- ........................ D Description of Soil ---•-•---- .� rldf x ...................................... -------------- ---------------------------- -----------------------------------------------------------------------------------------------•-•••-••••----••.--------------•----------------•-- U Nature of Repairs or Alterations—Answer when applicable---------------------------------------- _______ f - 7... . _ __ _____________________________________________________________________________________________________________.....__. 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 iss ed by the rdq,,alt Signed....... _ .................... .•---__.__-_ --____---._- Date ._.__. F. Application Approved By...... - Date Application Disapproved for the following reas ns:----------•-•----•---•-•-••-•-••--•-••••••--•-••--•-••--•---••---••••••----•-•-••---...-•--•••••••.....__.._.-- --••---•-••••---•-•.............•----•--•-••-•••---•--•-••••-•------••••••-••••--•-•-•---•-•:-==-•-•-•••---••-•••-••-••••••---•--•---•-••••••••-••••--•---------••-••--•-•-----••----•-•--•••......-•--- ` Date- Permit,No......................................................... Issued........................................................ Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........................................OF..................................................................................... �ntifiratr of TompliFanrr THIS IS TO TIFY the In ividual Sewage Disposal System constructed ( or Repaired ( ) by------------------- -----•------_-_-•---------------------------------------•-•-----•----------- - Install at °':_ .:.s •--•-- • - ---------------------------------------------------------------------------------------------- has been installed in accordance with the provisions of TITLE 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No-------- --_. _ f...... dated................................................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. / � �p/' DATE.-•••.....................•j•-••-----...............1 qqa•!••�-`.� ......_.. Inspector.......................................... ......................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ............................................OF............---._.........................._...................✓.................... No......................... FEE........................ Difivoll al Workii %Q'Iffnnotra ion eranit Permissionis hereby granted................................................................................................................................................. to Construct ( ) or;.Repair ( ) an Individual Sewage Disposal System atNo.................................................................... Street as shown on the application"for Disposal Works Construction Permit No..................... Dated.......................................... .............•--••-----.......---------------•----------------------....•••-•••-- DATE................................................................................ Board of Health FORM 1255 A. M. SULKIN, INC., BOSTON F 1 r- i /00 0 0 x 50 D i X /7 .oo N C7 64 _ , , r i All 0 1 J f - � i I SEP7IC (�mrnrrnc�rn per- fa. ) of %� �2 wcxsh�td sfori� - TiQNk —_ .�figa • .r r was/-,ed - too 98�4 ✓ ..� f •a ° ,� _�_ ---� r // O' \ ``' ,_ ``_v - q3\•�11 C.�i�C E _ ! -p' E- 9 ~` s 1 /f R) �.� > - r k, i' ! , � �, ~ � �..- . � — __-___.------ GAL 5���?YL:�,�TC.1�'•i --- _ ..-- FAT•/C T9,v.� x f- 5 = SU&so/L 0 4- //''p u, r-; M - 66•& S F• o.9 t 78 8 mot. Q t, i g�3 e/. 67. ( � •< 9='�! � � 92 4 I i r , 94 el. 8�. 1 i4W� mil. 79,o 9(0 / ND JAJ t) c--' / 1 - !.�`V l� / "_ :` !L...! O� THi?` G�'vUer.! D r9 _._ O ry o AR LOT e O of �" �'L r'� ,n_/ j3 U 0Ae 7 -ra 5& r- 7-CP tom/ V/ 0 Yam'2 r-1 o U T H C CJ✓7 r� F3 G2 U / L) - EVERETT zt g -' G ' z NtCKIEY L L.. -2 % /"1 r- e bus x IS--/f) c" ;'e vat� !U r`) fj L.. �% c`� `'E-:�_� �" C-,-- / � �? S't"f't `p��`?� ��c, �1787 C' � r q , s�S i e � s T E , `r',� ,�;? �`'•? C? C,/ T' e le L/CLIL/Gr-7 �E �'!_Jt �?�/` 7� �/T5 :rS/OtiRI �- A. 7 �+f, __ J 5y�kti. , __. r• t_3 0 fa 47 r- Or-- h!C— Fro`C.,. T t--•/ _ _ �..,.. ._ r4 Y9/2 r��c.�"�-/ �-'!ram• __ 8 3 VENT PIPE (0 Least 24 Inches tall) 5w1Rs1f tsrax Schedule 40 PVC w/Charcoal Odor Filter '•,,,r-` �` � •"'��'^y *NOTE: ALL PIPES ARE TO BE 4" SCHEDULE 40 P.V.C. 2-18• DIAM. ACCESS MANHOLES f 10' min. from I Existing Foundation house to septic tank SECTION A --A _ D-BOX cover must be --1 J %""`'#+�°22 + , TOP OF FOUNDATION ELEV. 100.00 withSepin tank covers must be within 6 in. of finished grads �'•!• '�'..':•r{!e4 .•C�% '� •" ^ ` i. ,fwithin 6 I of finished grade PROFILE VIEW OF LEACHING SYSTEM Grade over Septic Tank- 98.00 Grads over D-Box - g5.00 rods over SAS -95 00 yyI V S- 0.02 $/4" to 1 1/2 W"h@d Cvu@h@d Stan@ " of f/a• - 1/2" Waehea Peaetoru \ Eiatfl t s>ei f�' INLET / i 3 HOLE H-10 ;. V \V .1 � t r.. .tLB�:aci -- . 5-0.01 IST. BOX TOP OF SAS-ELEV- 1U0.50 ,, �I C 35' EXIST ! Level for 2 feet then A Ex1ST. PIPE 1000 GAL. 0p 50 0.0 S- 0.01" per foot �• THE ACCESS COVERS FOR THE SEPTIC TANK, FROM EXIST, FOUNDATION 0 SEPTIC TANK ?) t5 V Effective { �' DISTRIBUTION BOX AND LEACHING COMPONENT @- rn N L7 O r�; . �-�7�,*+r. •���t m.^*r+r;•ti SET DEEPER THAN 6 INCHES BELOW FINISHED t --, ' flR' II H-10 r? 0 C3 t) GRADE SHALL BE RAISED TO WITHIN 6' OF CONCRETE FULL FND. II O+ p C 3 C= C� C 3 O coFINISHED GRADE. r 11 a'a > �+ o O �. STEEL REINFORCED PRECAST CONCRETE u 11 rn of CI C� C I CI C1 C 3 C 3 44, 6 In.of 3/4'-1 1/2' Tu II 3 00 INSTALL TUF-TiTE CAS BAFFLES OR EQUALS -� t 4 4' o o a o o PLAN VIEW i� � compacted stone > d d > 11' 11 .. c e 6 Units 2 6' = 36, 3-2e REMOVABLE COVERS -�20ae MLowsoft 4�pp�12dOT neYfLO's ew N@s, Z SYSTEM PROFILE _ ' Not to Scale c , B mpa Led stone e o •' '4 GENERAL NOTES compacted eton@ m -3 min. d@aronC@ • if NOTE: ALL COMPONENTS MUST HAVE RISERS TO WITHIN 6" BELOW GRADE 4 5 INLET 8' mt;i 2' min. Inlet to outl@t t3' eeU[T'f �} 1. Contractor is responsible for Di sofe notification,Effective Length - --j---- °•"'"' OUTLET -}{- P 9 VERIFICATION �Ltitall>�LIat�icla2Fle4.lXL 10'mti. uqurd fev@�U• 1: �J and protection of all underground utilities and pipes. Groundwater Observed - NONE OBSERVED 5• _7• -. 5' _7• 2. The septic tank a distri ution box shall be set E$ level on 6 of 3�4 -1 1�2 stone. b ae,.� Liqud depth 3. Backfiil should be clean sand or gravel with no 1� stones over 3' in size. SOIL ABSORPTION SYSTEM (SAS) 4. This system is subject to inspection during installation t. ,. r ,• .„, ,, „ ,,,,.} by Carmen E. Shay - Environmental Services, Inc. MODEL LC-6 LEACHING UNITS / MBO PRECAST OR EQIVALENT 6-0' 4• -IW 5. The contractor shall install this system in accordance CROSS SECTION END-SECTION with Title V of the Massachusetts state code, the approved plan (H-20 LOADING) and Local Regulations. 6. If, during installation the contractor encounters any Not to Scale TYPICAL 1000 GALLON SEPTIC TANK soil conditions or site conditions that are different from those shown on the soil log or in our design NOT TO SCALE installation must halt & immediate notification be made to Carmen E. Shay - Environmental Services, Inc. PERCOLATION TEST 7. No vehicle heavy machinery shall drive over the septic system unless noted as H-20 septic components. 8. Install Tuf-rite gas baffles or equals on all outlet tee ends. Date of Percolation Test: OCTOBER 8, 2008 9._All Distribution Lines shall be 4" diameter Sch. 40 NSF PVC pipes. Test Performed By. CARMEN E. SHAY, R.S., C.S.E. 10. All solid piping, tees & fittings shall be 4" diameter Results Witnessed By. DONNA MOIRANDI, BARNSTABLE BOH Schedule 40 NSF PVC pipes with water tight joints. EXCAVATOR: SHAY ENV. SRVCS., INC. 11. MUNICIPAL WATER IS AVAILABLE TO THE SITE and Surrounding Percolation Rate: Less 4 MPI 0 60" ® TP1 Properties. NO PRIVATE WELLS WITHIN 100 FEET of PROPOSED SAS Test Hole Test Hole No. 1 No. 2 O.,4�1�.1 01 V � l ti OA Cep DEPTH SOILS ELEV. DEPTH SOILS ELEV. NOTE: 0 96.00 0 95.00 THE PROPERTY LINES ARE APPROXIMATE AND I y y COMPILED"FROM THE PLAN BY LOWE & WELLER SURVEYING CO. 6 (40 FOOT RIGHT OF WAY) loom Loom ENTITLED CERTIFIED FOUNDATION PLAN OF LOT 209 OAKMONT ROAD, io YR 3/2 10 YR 3/2 W. BARNSTABLE, MA" DATED DECEMBER 29, 1981 _ A. 94.5o AND IS NOT INTENDED TO BE A SURVEY PLOT PLAN ------------------ 92 0 - 6 Sand Sand IT SHOULD BE USED FOR NO PURPOSE OTHER THAN --------------------------------'O---- ------------ ---------- ---------------------------------T---����----------------------.\ r�--=-------------------------- loam Loamy THE SEPTIC SYSTEM INSTALLATION. O______ `�"�„��,_ \I / 10 YR 5/6 10 YR 5/6 \\ I 61- 30" Be 93.50 6'- 30" Be 92.50 102 --------__ -�� I Silt Loam Sift Loam NOTE: ANY STRIPPED OUT SOIL CONTAINING LEACHATE 183. 12' ( `�I I FROM THE EXISTING LEACH PIT & SAS TO BE DISPOSED 104----- \\lr�,- \' \\` ` 2.5 Y 8/4 25 Y 8/4 \C��, \\ `\\ 30"- 48• c, 92.00 30"- 48" c, 91.00 OF AS PER HOARD OF HEALTH SPECIFICATIONS. 106------- G `\ 1 Mod-Fine Mod-Fine \\ \\ I Y 2 Sand Sand EXISTING LEACH PIT & SAS TO BE PUMPED DRY & \9�1 2.5 Y 8/8 2.5 Y 8/6 FILLED IN PLACE 48"- 84" Gi 89.00 48"- 84" CJ- 88.00 Mod-Fine Med-Fine Sand Soma. 2.5 Y 7/4 2.5 Y i%# ASSESSORS MAP - 349 LOT 50 LOT 209 g % �`. ; I I C3 85.00 "_ C 84.00 ZONING - RESIDENTIAL # \ I I I Perc #1 j i i i j 35,000 Square Feet +/- 1 i `�\ I 1 Depth #o Perc: 60" to 78" Perc Rate= 4 MPI Groundwater Not Observed + No Observed ESHWT NO"WETLANDS ARE LOCATED WITHIN A 200 RADIUS �p I -_ f i OF THE PROPERTY ------ ' i I ADJUSTED H2O Elev. = None 1 I 1 1 I •\ I �, � t I ► ASPHALT II \ PORCH f \ GARAGE DRIVEWAY0.4 I 1 I 1 1 \ I I ALL OUTLET PIPES FROM THE SE TRIBUTION BOX SHALL BE LEGEND SET LEVEL FOR AT LEAST 2 FT. 12" CONCRETE COVER ` EXISTING I i � I •.,,,.. . 1 1 I I \ 3-r OUTLET "4'"'• •+.+• 2 PROJECT BENCH MARK - I I I \\ 3 BEDROOM - I I I l 2- KNOCKOUTS DENOTES PROPOSED TOP OF FOUNDATION e�•I I I \ `\ I I I s M 1 I I \ HOUSE \ I I I - S,5• OUTLET I 1r INLET 8X0 ELEV. = 100.00 (Assumed) I I I I \ 1 I i i I SPOT GRADE O� I I 1 \\ #29 1 j� / ''e• �' 2 DENOTES EXISTING / ,as• X 104.46 4" - SCH. 40 T 1.75' ------�'� ,� / SPOT GRADE PLAN SECTION CROSS-SECTION DECK _-- / / / PL PROPERTY LINE r ___ - % 3 HOLE H-10 DISTRIBUTION BOX 1 I CREE -- , r r i i j ROOM O PROPOSED CONTOUR LEACH PIT TO BE VERIFIED 97- - -97 EXISTING CONTOUR EXIST. g TO ENSURE IT IS NOT IN USE ; , I i ,1000 gal. j' / Desian Calculations FOR LAUNDRY OR OTHER FLOW FROM HOUSE f I / / Septic Tank r7 IF IN USE, INTERIOR PLUMBING TO BE M(,}f�IFIED i i I i Failed �/ , DEEP TEST HOLE & / f LEACH PIT r / / DL PERCOLATION TEST LOCATION BY LICENSED PLUMBER /' f ��' / i j / /� Number of Bedrooms: 3 Equivalent to 330 Gal./Day 7 / Garbage Grinder: No Leaching Capacity DESIGNED: 330 Gal./Day Minimum ( 440 GPD PROPOSED AT OWNERS REQUEST) 0 FENCE 0 \ Septic Tank : - 2 x 440 Gal./Day = 880 USE EXIST 1,000 GAL. Septic Tank. �r / / �/ %r SOIL ABSORPTION AREA: Using percolation rate of <2 min./inch PRIVATE DRINKING WATER WELL Bottom Area: 0.74 gal/sq. ft. x 489.5 sq. ft. - 362.23 gollons i ► / i i'��/ Sidewall Area: 0.74 gal./sq. ft. x 111 sq. ft, - 82.14 gallons EXISTING/SAS (APPROX) I � r Providing: 444.37 gallons REVISIONS , TEST HOLE #1 r i Use: (6) ACME PRECAST, INC MODEL LC-125 UNITS, HAVING A 1' EFFECTIVE DEPTH, NO. DATE: DEFINITION ELEV.= 96.00 TEST HOLE #2 / � - I r I 1 TO BE INSTALLED WITH 4' OF WASHED STONE ON THE SIDES AND 4' OF WASHED STONE perc log, move , ELEV. 95.00 ;/ ON THE ENDS. #1 1/27/09 Pit Location & Note \ I i \\ 1 I , \ ^T yTr rrr-� r Vent ,,,,,,,,,, ;,, ; ,, ;+ , , .•, : .,`.;� / r ,- 'r\ \\ , \\ \ Pipe f \'fi �`' • • • : • it I �� / / r \ \\ \ It \ \ " :' tq,{' 1ll, ;,'rt',;: ',r r,l•f•.,4••w' // / \\ \ \\ \\ \\ \\ L'".:v_�rS.�tlltiLI�.L-A:: LLi. i•s�:i��s , //_ \\ \\ \\ It / PROPOSED 1 PREPARED FOR : SUBSURFACE SEWAGE DISPOSAL SYSTEM 171.61 \\ i / OF PORCH - Mr. TIMOTHY CROSSMAN #29 OAKMONT ROAD :GARAGE \\ \\ '� ' �� `� ' r / g \\� ,� � o ,� \ � WEST BARNSTABLE, MA Bedroom Bedroom Living Room ` ` / #29 OA K M 0 N T ROAD c o 0 o O� d' �6 L WEST BARNSTABLE, MA 02675 r PREPARED BY: m m m Dining Kitchen /� SHA YBedroom CAR f'l L/N E• l 0 20 40 50 E'NVIRONM.E'NTAL SERVICES, INC. DECK 185 ASHUMET ROAD MASHPEE, MA 02649 SCALE: 1"=20' TEL/FAX 508-539-7966 3 BE HOUSE FLOOR SCHEMATIC SCALE: 1"=20' DRAWN BY: CES DATE: JANUARY 18, 2009 (Description Provided By Owner) PROJECT#SD-1118 ILENAME: SD1118PP.DWG SHEET 1 OF 1