HomeMy WebLinkAbout0309 OAKMONT ROAD - Health EA
, 309 Oakmont Road, Cummiquid
= 334-021 Lot 3
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No. �.� XFeeO y
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS
ZIpprication for Zi.5po0al bpgtem Conotruction Permit
Application is hereby made for a Permit to Construct( )or Repair( )an On-site Sewage Disposal System at:
Location Address or Lot No. .3 q 401 0wkmowb rtd• `Owner's N���Address
d Tel.Nolawmo
rnmi utd MA-DA496 9
Assessor's Map/Parcel IMnp a34 Isar-��, �ugtMAcfvid A4A.9
Installer's Name,Address, s and Tel.No. Designer's Name,Addre and Tel.No.
Caal.is Truc-kjR.t XNc- gdt�rd E. k¢l�y #04640
,via.so
YAr1" per4,)MASS.0d6W
Type of Building:
Dwelling No.of Bedrooms 3 Garbage Grinder(IV)
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow 330 gallons per day. Calculated daily flow gallons.
Plan Date Number of sheets Revision Date
Title
Description of Soil 6 S«w Oti
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 Environgwqtal Code a no o place the system in operation until a Certifi-
cate of Compliance has been issue s Board of H
Signed l Date 6,t,74
Application Approved by Date
Application Disapproved for Me.following reasons
Permit No. �lo - h� Date Issued
No. /.� 1 •' ! Fee
THE COMMONWEALTH OF•MA$SACHUSETTS '
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS
ZippYication for Migpooai bp!5tem Contruction Permit
Application is hereby made.for a Permit to Construct( )or Repair(V)an On-site Sewage Disposal System at:
Location Address or Lot No. &I a J — 3Q9 04 mvf Ra • Owner's Name,Address and Tel.No.-1 wrylort,dMs. 09636
Assessor's Map/Parcel Map .939I Qd t �'�rn/r�Aqvt / �Z .
Installer's Name,Address,and Tel.No. Designer's Name, ddre s and Tel.No.
C43ti,s Tr�ki wq SNc . EdwArc( C. Ve Icy A,16/OU ;
Ynrmo�Fltpor�, MAST. odf¢S- ,
Type of Building:
Dwelling No.of Bedrooms :3 Garbage Grinder
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow -33 U gallons per day. Calculated daily flow gallons.
Plan Date Number of sheets Revision Date
Title
` I
Description of Soil
i
t _
r
Nature of Repairs or Alterations(Answer when applicable)
Date last inspected:
f Agreement:
II The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system
in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi-
cate of Compliance has been issuedrby this Board of Hea
Signed r C�•r�v ' Date ?,
i
Application Approved by "� c Date rd- 7 - 99
Li
Application Disapproved for the following reasons
w
-Permit No. !o ' Date Issued
j ————————————————————— ————--——— ---------
THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE, MASSACHUSETTS
Certificate of Compliance
i THIS ISO CERTIFY,that the On-site Sewage Disposal System installed.( Xor repaired/replaced( )on
by CAs�i s /amuck{w Z� . Installer
at 369 Okrr u&A &AW• Cu mnlA IZ MA,s has been constructed in accordance
with the provisions of Title 5 and the for Disposal System Construction Permit No. dated
Date Inspector
l�
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYS-
TEM WILL FUNCTION SATISFACTORY.
— - ----------------------------Fee --
373
06
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION -BARNSTABLE, MASSACHUSETTS
Mopool *potem Contruction Permit
Permission is hereby granted to C45-1'S T uck'n.y Two . /�• dox7i J���ioL7�l,pp�f
to construct( )repair(V)an On-site Sewage System located at No.# 3o9 lgAI-4)0n.f kd C<.,rk' IA!c� 4/
Street
and as described in the above Application for Disposal System Construction Permit. l - 7
No. Date
The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions.
i
All construction must be completed within three years of-the date below.
Date: Approved by
Board of Health
I
it
TOWN OF BARNSTABLE
LOCATION .fin 041MOD1 R-Mal SEWAGE# 96
� S
VILLAGE ,,!22MAgb1Y ASSESSOR'S MAP& LOTk 3— U
INSTALLER'S NAME&PHONE NO.GSks 72UC�tiC, Lf"-3 .f
SEPTIC TANK CAPACITY mx al/r�
LEACHING FACILITY: (type) _149& /, !1 f (size)
NO.OF BEDROOMS
BUILDER OR OWNER
PERMPTDATE: S �� COMPLIANCE DATE: F 9 A6
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 t`®
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 CASk.5 ruC�tvv!R
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LOCATION
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Oil
SCALE . .�. /�'¢O . . DATE &,I;? ?7 1 ige
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PLAN REFERENCE
VAL W' �•r'
D ��y
/3¢ 7/' �� i 8 L 1 a
I I OLD Rerrn4
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3 Perml
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DRy/D � L�•�'F P�-77T/v�/E�
L. .. 78.ov. ...
TOP OF FOUNDATION
� . CONCRETE COVER
CONCRETE COVERS
Z:oa' .": 4' CAST IRON 2"MAX. r314"T0lVj'
OR SCHEDULE 4 4°SCHEDULE 40 PV.C.(ONLY) 12"MAXP.V.C. PIPE
PITCH 1/4"PER. PIPE- MIN. LEACH
PITCH 1/4"PER.FT. PITTNVERTGSEPTIC TANK INVERT DIST, INVERT !� w EL.,•7547 , >_ .INVERT 000 BOX. • .... GAL. INVERT G' �' a EL.7.s!7 INVERT ww 0' V2'
��
'♦ N°NE
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PROR LE OF GROUND WATER TABLE
SEWAGE DISPOSAL SYSTEM
NO SCALE
44z8
SOIL LOG WITNESSED BY *
DATE . '"Y•�•/•�585 TIME./o, .4-1. . . T4ry�5 Co'!iLo'!• . . . BOARD OF HEALTH
TEST HOLE 1 TEST HOLE 2 ��y✓�20. . ZLG
.� ENGINEER
ELEV. .79,o o . . ELEV. ..-7G:Go. . .
y�L DESIGN DATA '
'
7e.Oc /'4,Gb
HE a, HEM NUMBER OF BEDROOMS 3 . . . . . . .
:n'iD Sin TOTAL ESTIMATED FLOW 330, GALLONS/DAY
�t 7Z" BOTTOM LEACHING AREA �� So• , SO.FT. /PIT/C.P.v.
SIDE LEACHING AREA 8 . . SO.FT./ PIT/-577/C P.Z).
��✓E S��✓� GARBAGE DISPOSAL (50% AREA INCREASE)
SA.,n 13L" TOTAL LEACHING AREA .?G7.o '
v . SQ.FT
EZ. C,fCo
�� CCOe SAD PERCOLATION RATE ,l-�`'S.?�q?`! ,?wq , MIN/INCH
�Z.C¢Co
�O. .WATER ENCOUNTERED
LEACHING AREA PER PERCOLATION RATE .-s. O., SQ.FT.�c.P.D.
.! .t/Gr /��T ,L��irt/
NUMBER OF LEACHING PITS . .G. . , • . .
APPROVED . .. . . . . . . , BOARD OF HEALTHY r��7•°F 'S`��v� oN A.t L. S✓DEs
DATE . . . . . . . • . . . . . . . . . . , . . . . . . . . . . . . . . . . . . . . .
AGENT OR INSPECTOR
LoT a'3 a
G✓ �,r P GIcT�R�� ��`�6 52
STEP
�'yQl Lk'r.'�
PETITIONER J]gy�.D. , G�iLE
CERTIFICATION OF SKETCH AND APPLICATION FOR A DISPOSAL
WORKS CONSTRUCTION PERMIT(WITHOUT DESIGNED PLANS)
I, EKus,q,u S. CAa h , hereby certify that the application for disposal works
construction permit signed by me dated g���9� , concerning the
property located at 399 OA,Ci x l J�ct/ C&xn VL,i,,( meets all of the
following criteria:
t
• There are no wetlands within 300 feet of the proposed septic system
• There are no private wells within 150 feet of the proposed septic system
• The observed groundwater table is 14 feet or greater below the bottom of the leaching facility
• There is no increase in flow and/or change in use proposed
• There are no variances requested or needed.
SIGNED: DATE: . 96
LIC NSED SEPTI CYSTEM INSTAL ER IN THE TOWN OF BARNSTABLE NUMBER 3
[Attach a sketch plan of the proposed system.Also if the licensed installer posesses a certified plot plan,
this plan should be submitted].
See A 1-F,acl ed -1 IA,u -! eseru-,:t fc i j d l l ll
11, .. .A✓_ � 4.� ��#'•} �'r y� ..< .. _
_ Commonwealth of Massachusetts ✓U/ Jo - ci �° -
Executive Office of Environmental Affairs :: D.E:F. & 1 eptic Ir>sp ctor
- Department O � .0 119 .
let,
i al Protection lea i 02 �36
El'!Y#!'�'9l�fe�t (�8j°�64-68
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
- ,.. PART-A...
CERTIFICATION - -
Property Address: 309 Oakmont Rd.Cummaquid Address of Owner: _
Date of Inspection-:-7130195 _ (If different) :.
Name of Inspector:JohnGraci Raymond Robinson.Box471 Cummaquid Ma.02657
Company Name,Address and Telephone Number:
CERTIFICATION STATEMENT
I �t�
certify that I have personally inspected the sewage disposal system at this address and that the informs io reportedkie w is true c rate
and complete as of the time of inspection. The inspection was performed based on my training and expe n the proper fun d
maintenance of on-site sewage disposal systems. The system:
_ Passes
Conditionally Passes
_ Needs Further Evaluation By the Local Approving Authority
X Fails
Inspector's Signature: /mit
Date: 7130196
The System Inspector shall su copy of this inspection report to the Approving Authority within thirty(30)days of completing this
inspections. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit
the report to the appropriate regional office of the Department of Environmental Protection.
The original should be sent to the system owner and copies sent to the buyer, if applicable and the approving authority. .
INSPECTION SUMMARY:
Check A, B.C, or D:
A] SYSTEM PASSES:
_I have not found any information which indicates that the system violates any of the failure criteria,
defined as in 310 CMR 15.303. Any failure criteria not evaluated are indicated below.
B] SYSTEM CONDITIONALLY PASSES:
_One or more system components need to be replaced or repaired. The system, upon completion
of the replacement or repair, passes inspection.-
Indicate yes, no, or not determined(Y, N, or ND). Describe basis of determination in all instances. If "not determined",.explain why not.)
The septic tank is metal, cracked, structurally unsound, shows substantial infiltration or exfiltration,or tank failure is
imminent.The system will pass inspection if the existing septic tank is replaced with a conforming septic tank as approved
by the Board of Health.
(revised 1 1 11 519 5)
One Winter Street • Boston,Massachusetts 02108 • FAX(617)556-1049 • Telephone(617)292-5500
URFACE SEWAGE DISPOSAL SYSTEM INSPECTION.FORM
SUBS
PART A - -
CERTIFICATION (continued) -
Property Address: 309 Oakmont Rd.Cummaquld
Owner: - Raymond Robinson:Box471 Cummaquld Ma.02657 -
Date-of inspection:7130196
Sewage backup or breakout or high static water level observed in the distributionbox is due to a broken
settled or uneven distribution box. The system will pass inspection if(with approval of the Board.of Health)':
broken pipe(s)are replaced
obstruction is removed
distribution box is leveled or replaced
The system required pumping more than four times a year due to broken or obstructed pipe(s). The
system will pass inspection if(with approval of the Board of Health):.
broken pipe(s)are replaced
obstruction is removed
C] FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH:
_ Conditions exist which require further evaluation by the Board of Health in order to determine if the
system is failing to protect the public health, safety and the environment.
1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM IS`
NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND
SAFETY AND THE ENVIRONMENT:
Cesspool or privy is within 50 feet of a surface water
Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh. ,
2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH(AND PUBLIC WATER SUPPLIER, IF APPROPRIATE) DETERMINES
THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECT THE PUBLIC HEALTH AND SAFETY AND THE
ENVIRONMENT:
_ The system has a septic tank and soil absorption system and is within 100 feet to a
surface of water supply or tributary to a surface water supply.
_ The system has a septic tank and soil absorption system and is within a Zone 1 of a public water
supply well.
_ The system has a septic tank and soil absorption system and,is within 50 feet of a private water
supply well.
_ The system has a septic tank and soil absorption system and is less than 100 feet but 50 feet or more from a private
water supply well, unless a well water analysis for coliform bacteria volatile organic compounds indicates that the well is
free from pollution for that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal or less than 5 ppm.
3) OTHER
D] SYSTEM FAILS:
_ I have determined that the system violates one or more of the following failure criteria as defined in
310 CMR 15.303. The basis for this determination is identified below. The Board of Health should be
contacted to determine what will be necessary to correct the failure.
Backup of sewage in facility or system component due to an overloaded or clogged SAS or
cesspool.
_ Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged
cesspool.
X SAS is in hydraulic failure.
d 1110195
(revised )
2-
!3°
SUBSURFACE.SEWAGE DISPOSAL SYSTEM INSPECTION FORM`
PART A -
CERTIFICATION (continued)
Property Address: 3090akmontRd.Cummaquid -
Owner: Raymond Robinson:BOX471 Cummaquld Ma.02657 ! :
Date of Inspection:7130/96 -
D] SYSTEM FAILS(continued)
_ Static liquid level in the distribution-box above outlet invert due to an overloaded or clogged SAS or cesspool. _
Liquid depth in cesspool is less than 6"below invert or available volume is less than 1/2 day flow.
- Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s): =
Numbers of times pumped _
Any portion of the Soil-Absorption System, cesspool or privy is below the high groundwater elevation.
Any portion of a cesspool-or privy is within 100 feet of a surface water supply or tributary to a surface water supply.
Any portion of a cesspool or privy is within a Zone 1 of a public well.
Any portion of a cesspool or.privy is within 50 feet of a private water supply well.
_ Any portion of a cesspool or privy is less than.100 feet but greater than 50 feet from a.private water supply Well withno
acceptable.water quality analysis. If the well has been analyzed to be acceptable, attach copy of well water analysis for
coliformbacteria,volatile organic compounds, ammonia nitrogen and nitrate nitrogen.
E] LARGE SYSTEM FAILS:
The following criteria apply to large systems in addition to the criteria:
_ The system serves a facility with a design flow of 10,000 gpd or greater(Large System)and the system is a significant threat to
public health and safety and the environment because one or more of the following conditions exist:
the system is within'400 feet of a surface drinking water supply
the system is within 200 feet of a tributary to a surface drinking water supply
the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area (IWPA)or a mapped Zone ILof a
public water supply well)
The owner or operator of any such system shall bring the system and facility into full compliance with the groundwater treatment program
requirements of 314 CMR 5.00 and 6.00. Please consult the local regional office of the Department for further information.
(revised 11115195)
3
SUBSURFACE SEWAGE-DISPOSAL SYSTEM INSPECTION FORM_
PART B =
CH ECLIST _.
P rope rty Address: 309 Oakmont Rd.Cummaquld
Owner: Raymond Robinson:Box 471 Cummaquid Ma.02657
i
Date of I n s pe ct 1 on:7130196
Check if the following have been"done`.-` -
X Pumping information-was requested of the owner, occupant, and Board of Health.
X None of the systemcomponents have been pumped for at.least two weeks and the and the system has been receiving normal-
flow rates during that period. Large volumes of water have not been introduced into the system recently or as part of this
inspection. -
rda As built plans have been obtained and examined. Note if they are not available with N/A.
X The facility or dwelling was inspected for signs of sewage back-up.
X The system does not receive non-sanitary or industrial waste flow:
X The site was inspected for signs of breakout.
X All system components, excluding the Soil Absorption System,have been located on the site.
X The septic tank manholes were uncovered, opened, and the interior of the septic tank was inspected
for condition of baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge, depth of scum.
X The size and location of the Soil Absorption System on the site has been determined based on existing information or
approximated by non-intrusive methods.
X The facility owner(and occupants, if different from owner)were provided with information on the proper maintenance of Sub-
Surface Disposal System.
(revised 11115195)
4
SUBSURFACE SEWAGE.DISPOSAL.SYSTEM INSPECTION FORM
PART C..
SYSTEM INFORMATION r
-i
Property Address: 309 Oakmont Rd.Cummaquid -
Owner: Raymond Robinson:Box 471 Cummaquld Ma.02557
Date of Inspection:7130196
- FLOW CONDITIONS
RESIDENTIAL:
Design flow: 330 gallons
Number of bedrooms: 3
Number of-current residents: 3 _--
Garbage grinder(yes or no): Na
Laundry connected to system(yes or no):-Yes-- - - - _
Seasonal.use(yes-or no): No -
Water mete readings, if available: A - \�� coo �`G5 `�`6 i too
Last date of occupancy: n/a
COMMERCIAL/INDUSTRIAL: -
Type of establishment: Na
Design flow:0 gallons/day
Grease trap present:(yes or no) No
Industrial Waste Holding Tank present: (yes or no) No
Non-sanitary waste discharged to the Title S system: (yes or no) No
Water meter readings, if available: n1a
Last date of occupancy: Na
OTHER: (Describe) Na _
Last date of occupancy:
GENERAL INFORMATION
PUMPING RECORDS and source of information:
System has not been pumped in the last year.
System pumped as part of inspection: (yes or no)No If yes,volume pumped: 0 gallons
Reason for pumping: n1a
TYPE OF SYSTEM
X Septic tank/distribution box/soil absorptions system
Single cesspool
Overflow cesspool
Privy
Shared system(yes or no) ( if yes, attach previous inspection records,if any)
Other(explain)
APPROXIMATE AGE of all components, date installed if known and source information:
1088
Sewage odors detected when arriving at the site: (yes or no) No
(revised 11115195)
5
SUBSURFACE.SEWAGE DISPOSAL SYSTEM INSPECTION.FORM; -
PART C
SYSTEM INFORMATION (continued)"
Property Address: 309 Oakmont Rd.Cummaquid
Owner: Raymond Robinson:Box471 Cummaquid Ma.02657 _
Date of Inspection:7130196 -- - -
SEPTIC TANK: X
(locate on site plan)
Depth below grade:4'
Material-of construction:X concreate_metal_FRP .-other(explain)
Dimensions: L B'6'H 5'T'W 4'10'
Sludge-depth:B'
Distance from top of sludge to bottom-of.outlet tee or baffle: 19' _
Scum thickness:6' -
Distance from top of scum to top of outlet tee or baffle:6'
Distance form bottom of scum to bottom of outlet tee or baffle: 12"
Comments:
(recommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert,structural.integnty,
evidence of leakage, etc.)
Septic tank and all components.structurally sound.Recommend pumping system every two years for maintenance.
GREASE TRAP:_
(locate on site plan)
Depth below grade:rva
Material of construction: concrete_metal_FRP_other(explain)
Dimensions: n1a
Scum thickness:Na
Distance from top of scum to top of outlet tee or baffle:Na
Distance from bottom of scum to bottom of outlet tee or baffle: n1a
Comments:
(recommendation for pumping, condition of inlet and outlet tees or baffles,depth of liquid level in relation to outlet invert, structural integrity,
evidence of leakage,etc.)
Na
(revised 11115195)
6
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM _ -
PART. C.
- SYSTEM INFORMATION(continued) T -
Property Address: 309 Oakmont Rd.Cummaquid
Owner: Raymond Robinson:Box 471 Cummaquid Ma.02657
Date of inspection:7130196
TIGHT OR HOLDING TANK:
(locate on site plan)-
Depth below grade: nla
Material of construction: concrete metal_FRP_other(explain)
Dimensions: n1a
Capacity: nia- gallons -
Design flow: n/a gallonsMay
Alarm level: n1a
Comments:
(condition of inlet tee, condition of alarm and float switches,etc.)
nla
DISTRIBUTION BOX: X
(locate on site plan)
Depth of liquid level above outlet invert: Liquld leve with bottom of pipe.
Comments:
(note if level and distribution is equal,evidence of solids carryover, evidence of leakage into or out of box etc.)
D-box is structurally sound.
PUMP CHAMBER:
(locate on site plan)
Pumps in working order.(yes or no)
Comments:
(note condition of pump chamber, condition of pumps and appurtenances, etc.)
nla
(revised 11115195)
7
SUBSURFACE SEWAGE DISPOSAL SYSTEM-INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 309 oakmontRd.Cummaquld
Owner: Raymond Robinson:Box 471.Cummaquld Ma.02657 _
Date of Inspection:713o196
SOIL ABSORPTION SYSTEM(SAS):X -
(locate on site plan,if possible; excavation not required, but may be approximated by non-intrusive methods) .
If not determined to be present, explain:
Na
Type:
leaching pits, number: 1,090 gallon leach pit -
leaching chambers, number:n!a
leaching galleries, number: n1a
leaching trenches,number, length: Na
leaching fields, number, dimensions:n/a
overflow cesspool, number:n1a
Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.)
The leach pit is in hydrualic failure
CESSPOOLS:
(locate on site plan)
Number and configuration: n1a
Depth-top of liquid to inlet invert: n1a
Depth of solids layer: n1a
Depth of scum layer: n1a
Dimensions of cesspool: n1a
Materials of construction: n1a
Indication of groundwater: n1a
inflow(cesspool must be pumped as part of inspection)
nla
Comments:(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc:)
n1a
PRIVY:_
(locate on site plan)
Materials of construction: nla' Dimensions: nia
Depth of solids: n1a
Comments:(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.)
PrivyComments
(revised 11115195)
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM,
PART C
SYSTEM INFORMATION (continued) - -
Property Address: 309 Oakmont Rd.Cummaquid
Owner: --. Raymond Robinson:Box 471 Cummaquid Ma.02657 _ -- -
Date of Inspection:7130198 ! -,
SKETCH OF SEWAGE DISPOSAL SYSTEM:
include ties to at least two permanent references landmarks or benchmarks _
locate all wells within 100'
o �
A� i5y
R
DEPTH'TO GROUNDWATER
Depth to groundwater:12 feet
method of determination or approximation:
USGS Maps and Charts.
(revised 11115195)
` J
i
TOWN OF BARNSTABLE f�
LOCATION ��% � ��I�'/����ti�/Ti" SEWAGE
VILLAGE Cj 9ypjftj-f}fl�,LjC�:1 ASSESSOR'S MAP & LOT
INSTALLER'S NAME & PHONE
SEPTIC TANK CAPACITY w
LEACHING FACILITYAtype) /,,Y 4 2,u A« (size)/noa-t:�9
NO. OF BEDROOMS �j PRIVATE WELL OR PUBLIC WATER <31
BUILDER OR OWNER
DATE PERMIT ISSUED:
DATE . COMPLIANCE ISSUED: .�
VARIANCE GRANTED: Yes No
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No�� .. �� - Fps....... .. .......� -
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
---- ---- ................................................
Appliratinn for Di-opwial Work,6 Towitrnr#inn 1hrntit
Application is hereby made for a Permit to Construct (&,-) or Repair ( ) an Individual Sewage Disposal
System at:
..� eY7.................... .................
-Address or Lot No.
•- !�� .... fir...... •-_.... .ftjynt�sy 9.............................................
gyner Address
a ..... ........................ -•--••---•------•---------•-----•-----•-•- ----------------------------------------------------------•-----•----•----------•-•-----------•---
Installer Address
d Type of Building Size Lot_68.10� ......Sq. feet 47
U Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( )
aOther—Type
of Building ............................ No. of persons.......--.--................ Showers ( ) — Cafeteria ( )
dOther fixtures -------------------------------------------------------••-•••-••-••............-••-•-•--- ............................................................
Design Flow.................33......_._..._......gallons per person per day. Total daily flow........._3 3o......................gallons.
WSeptic Tank—Liquid capacity-/DAP.gallons Length-_8-6__..-.. Width.` ......._.. Diameter................ Depth..s.8��.
x Disposal Trench—No. -------------------- Width.................... Total Length............. Total leaching area....................sq. ft.
Seepage Pit No..................... Diameter........fq�..... Depth below inlet......6......... Total leaching area.... ....sq. ft.
Z Other Distribution box ( ) Dosing tank ( )
'-' Percolation Test Results Performed by.... w ._...... Date-.M.__ _.. y
----------------------- f•---------••--------
`�a Test Pit No. 1-.L..?-...minutes per inch Depth of Test Pit..../.........._. Depth to ground water..... ...........
(i, Test Pit No. 2---4.........minutes per inch Depth of Test Pit.--- .... Depth to ground water......--............
W ---------------------------------------------------•--...........------..........-------- -...
0 Description of Soil........d Z 4" ........................i 1 " 7 � ` •'SAw
467
W
VNature 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 iITL U 5 of the State Sanitar I Code— The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has issued by th rd of It
Sign _....
9 Date/
Application Approved By........... ....................................•.........•--- v- -A/ •9 .......
Date
Application Disapproved for the following reasons:..................................................................................•-•-•-•-•••-•---....._......_
......................................................:..................................................--.........._.......----•--------------••-------------------------••••.........-•-----•--------
Date
Permit No.......Zi.�---.----�1 ......... Issued_.........................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
..................... ....................OF....... '..-............._.............
Apliliration for Bwvasal Workii Tonstrur#inn rrnti#
Application is hereby made for a Permit to Construct (t.-) or Repair ( ) an Individual Sewage Disposal
System at:
................ .. ........................................................ ---•__---•....•--•-•----•----........•---•-•-•---•----•------•---....---...._.._................--
Location-Address or Lot No.
_1r 1-el
Own ` Address ...................- �•••-
a ° -'�=" --••--•....•.................... . ......_...••••••-••---..._..._•---•-....______.___-___.______........_•-____•-----•--------•-••---
1 Installer Address
UType of Building Size Lot__--::_.__....`...`.{�........Sq. feet
2 Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( )
aOther—Type of Building ____________________________ No. of persons............................ Showers ( ) — Cafeteria ( )
dOther fixtures -------------------•----------------•-•-------------...-------------------------------------••-•----•--
W Design Flow_________________�?'�-------------------gallons per person per day. Total Bail flow_.__._.__._~�'�p................................gallg�,�.
WSeptic Tank—Liquid capacity.�?° _gallons Length__ ________ Width...0�.-.. .......... Diameter_..________.____ Depth..._ _'c__f_._..
x Disposal Trench—No_____________________ Width.................... Total Length................... Total leaching area....................sq. ft.
Seepage Pit No--------------------- Diameter.......... Depth below inlet.................... Total leaching area..__Z4 7._.sq. ft.
Z Other Distribution box ( ) Dosing tank ( )
'-' Percolation Test Results Performed by.........�..`.�'�_.__:..:___'..�__� ............
Date----•--�..._..`,_______ �e--� `��.-:---
W -
,.a Test Pit No. 1___ ._ '___minutes per inch Depth of Test Pit____ 4__._...._ Depth to ground water_._._._'.............
04 Test Pit No. 2..__`-..z____minutes per inch Depth of Test Pit__.._f�.4______ Depth to ground water........................
__.___.___.
.•-----------------------------------••---•••••-_... .•-•---.__•-••-•.....-•••--• _._ ...
D Description of Soil_.____._` '. _ 1/� a 4> � i,�1k/�- a'�` - Z �`7L- 5�39✓L�
--•--- •••-....---•---••-----.•.•-••-=---------•-•------...-•---••----------------------•••--•.........._________..
W
UNature 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 TITLE 5 of the State Sanitar 'Code— The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has issued by t and of h -It -,
Signe •-- - - -'V`
••• -----•---•---- -_--------•-----
atl ......
Application Approved Byc�:�.................. ...... F/�
Date
Application Disapproved for the following reasons:................................................................----.........................................
-
-•-•-•.......................••-•••--•-•......-••---••-•--•------•--.......----•------•--•--------.....----____••----------•------••---•----•••••------•••-•-----•-••--•--•------•••----•••--_____---•--
Date
151
Permit No.______-��.............. ........ Issued_.......................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
OF......:.:...........................................................................
(In ifiratr of Tuntpiivar
THINS TO CERTIFY, That the Individual Sewage Disposal System constructed (i,' or Repaired
by-- 'j."..�..........----•----•-•._...••-•-----•----------•-•-..._...-•------------------ ------------------•...:..._.....---••--•----•-•---•-._.._....._._ ............................
liL
at..............4 .fit '"`' ""` sta
has been installed in accordance with the provisions of TITLE 5 of The State Sanitary Code as descri ed in the
application for Disposal Works Construction Permit No.._ -' ; '______. ..... dated_-_--____-Ems•- ..•..........
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE............................./Z,-1Z-j. �----••-----------------• Inspector_.. -?':!.__.....__......_._...
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
/ r Z^A-5
..r. ................ ��-1.�/. oF._...... .__......_.__��� G_�_.__.......-___._....._._.. ?
No......•................• FEE
..............
nrk� �rrn,�frnrtiun �rrmi# �
Permissionis hereby granted....................-................................--................................................................................. ...
to Construct ( t�' or Repair ( anZividuVewa Disposal ystem �Aat, No...._..__.._ .....................-•••-•-•--•----•-•-•••--•--._:.�_............................................................
Street
as shown on the application for Disposal Works Construction Permit Nd.- --` Dated.. 2"3
�:- � _ .w
to (,..b Board of Health
DATE-------•--•--••--•--•----_•--••-___. _.._._.1.............
FORM 1255 A. M. SULKIN, INC., BOST.ON —
• 'CIA J - '
c._
/ � 4
3
Dz ve
73.E I warn-� 7P3T
vl l . i P�Pos� psi
N � /48'�. \ C47uI \11 ..
4 r2e5er�✓E a �t.��3 aRsi v. T•
it-
� fir/ 1 r � P-44zo
P.Go4'7 .per• � � �2.If L
06 %9Gcs
�,'JI• Z9$ 82, EDWAR ,
LEYzi
0. 26100
CERTI FI ED PLOT PLAN
4%,6. 7�984
r�3r/�otr i LOCATION q!A; v47198GE �Cu!yavAq;;i;D�„
7Z.00 v .
SCALE . . ._s.. .... DATE
PLAN REFERENCE
Ez. 0.00 S!�ii7WA/ ON
. . . . . . . . . . . . . . :. . . . . . . . . . . . . . . . . . . . . .
/lo" e¢. 6Z.a� iS NG �vivD o�/
_ I CERTIFY THAT THE ..T! ......9�. . . . .
�iN�S6hvD SHOWN ON THIS PLAN IS LOCATED ON THE GROUND
g AS SHOWN HEREON AND THAT IT CONFORMS TO THE
HwB�
SETBACK REQUIREMENTS OF THE TOWN OF .
. .... . . . .WHEN CONSTRUCTED.
DATE
�. .c it
VE777ia.vE7L `.. REGISTERED LAND SURV OR
a
TOP OF FOUNDATION
r CONCRETE COVER
CONCRETE COVERS
4r CAST IRON 12"MAX.
•; OR SCHEDULE 40 12"MAX. "''""�'�"%�
• P.V_C. PIPE 4rr SCHEDULE 40 PV.C.(ONLY)
PITCH 1/4'•PER. PIPE- MIN. LEACH
PITCH 1/4"PER.FT PIT
PRECAST
NVERT a LEACHING
INVERT INVERT n . Q•t PIT OR
n'. SEPTIC TANK ! g DIST. .�� w ';•. EQUIV.
EL....Ic. .9. BOX /r-..... ' : >
INVE
,.v RT /000 .... GAL. INVERT 70 0! :i. 3 �� ..
EL.....:...... INVERT
ELA�:-�8.. /4 TOIV2
e EL.�S'.00 �� -: WASHED
STONE
6'DIA. --►� ,,, ��
/V DIA. e*}
PROR LE OF GROUND WATER TABLE
SEWAGE DISPOSAL SYSTEM
NO SCALE
SOIL LOG _ WITNESSED BY :
DATE .!7 / ",.�7r8S. TIME.!O%9� A"? . `��!`'Ie3. �-o^!��. BOARD OF HEALTH
TEST HOLE I TEST HOLE 2 �1�1!✓�hGD G- � Y. ENGINEER
ELEV.. 78,0o. . . ELEV. .7�-6`�. . .
Woo pez"
1, S1107pa- Wov p(oR r>
DESIGN DATA :
ez.7Goa Z,7¢,60
NUMBER OF BEDROOMS 3. . . . . .
Servo Spa TOTAL ESTIMATED FLOW . . 330. . GALLONS/DAY
7e G'Z.7Z.vo 7Z� BOTTOM LEACHING AREA !�3•/. . SQ.FT./PIT/93,JGP.D.
E2. 7o.6v
SIDE LEACHING AREA . . .?ZG•.Z . . , SO.FT./PIT/4SZ,4CPA
GARBAGE DISPOSAL".N&n,��-.:(50% AREA INCREASE) .
.Si}!✓D E�1.13Z�
V,es:.Go TOTAL LEACHING AREA . . 33J� 3. . . SO.FT
tee». T�/aru Fov e
i9;" �z.G6.00 J�p PERCOLATION RATE less . MIN/INCH
-fee
."--WATER....
Nc..WATER ENCOUNTERED LEACHING AREA PER PERCOLATION RATE �:3. SQ.FT./c,PD•
NUMBER OF LEACHING PITS . QNG,- P/7-•l%?
APPROVED : .. . . . . . . . . . BOARD OF HEALTH •?! �'? .oT.STw✓� D.v /�-LL .
DATE. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
AGENT OR INSPECTOR
E.
47*3
�GYIL!�iv iv 7" o No
S7b�
!'`l!`>i� !I?/ �fL}SS. •^* L-I:ss4d'r'' SANRAvffi►�`�"
PETITIONER : �/�,y�� •���