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0344 OAKMONT ROAD - Health
344 Oakmont Roa'd 'Barnstable A = 334 027 D t q p z - t ' 1 L \�JNo. Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in com ter: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes y 4plication for Zisposar 6pstem Construction Permit Application for a Permit to Construct�/ Repair( ) Upgrade( ) Abandon( ) ,Complete System ❑Individual Components Location Address or Lot No. 3 Yq 00 KAIoY4- Owner's Name Address,and Tel.No. '27 y if 89-0199 A-Iex +AJAaapi, 8�%Q, y aar f,cr- Assessor's Map/Parcel 3 Install rs Address Tel No. ' designer's Name,Address,and Tel`No.; 1� 1c ,down Q% ► .1 n�lrr_Y'i rry,7,ne 93T A{alo sF• D — v 26 Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) Yy gpd Design flow provided V 4 gpd Plan Date �f uj 5 )&X) Number of sheets Revision Date '�� l�, �lU3to Title 3 Size of Septic Tank 1 -5 C)O-R4d A io Type of S.A.S.' ' p s Description of Soil2 e5ii p_�CJC 63 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.de•dind__ to place the system in operation until a Certificate of Compliance has been issued by thk Board of Health. S ed -~' Date r Application Approved by . Date Application Disapproved by OFT Date IV for the following reasons Permit No. r Date Issued NO.. / 1 ! 1 Fee 9l � THE COMMONWEALTH OF MASSACHUSETTS. Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS 0[pplitatio for- isposai *pstrm Construction Permit Application for a Permit to Construct Repair( ) Upgrade( ) Abandon( ) Complete System ❑Individual Components Location Address or Lot No. Owner's Name Address and Tel.No. 9h y_ �y lkiJ�Clrr/or Assessor's Map/Parcel � � �„�rr�, . �.� t. � Installer's Name,Address,and Tel No. t ,�/",r .4 D'esigner's Nam Addresssand Tel.No.��� 03, 60,?I�c07i l )Down (3Zpe la ' 11nc 9_W A4AIra Sf- Type of Building: •• w G 1 w_\� 1 v t< ; Dwelling No.of Bedrooms Lot Si,e ' /A 3; sq.ft.1 Garbage Grinder( ) Other Type of.Building No.of Persaps > Showers( ) Cafeteria( ) Other Fixtures Design•Flow•-(min_required) t f VQ gpd Design flow provided y,5 el gpd ' Plan Date Nh,i C Number of sheets_/ Revision Date Title iTs-=C �1.. �, "� /?,,L; ., ! ' 'aS ;.r�, 1 t PA � Size of Septic Tank :;WC; Type of S.A.S.TZ,„i, �/t '.Z-�c,,,,, _n tArn I A_,f1 f ,ek1,c. Description of Soil.'S. t Nature of Repairs or Alterations(Answer when applicable) `r Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on site ewage disposal system in accordance with the provisions of Title-5.of the Environmental Code-and n,tAo place the system in operation until a Certificate of Compliance has been issued by this Board of Healthate Applicati n�Approved by Date v j v /U Application Disapproved by �/ V, �/ Dateo / for the following reasons y 14 Permit No. Date Issued -------------------------------------------------------------------------- ---- r ------------------------------=--------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( Repaired( ) mUpgraded( ) Abandoned( )byn �ffi 1 , , ,_�! ,' C at 7tJU Ion P , � /�,,:: , � �, � has been constru"accordcewith the provisions of Title 5 and the for Disposal System Construction Permit Noed (r,/ `t 1 A Installer k�.A,_1,"f". l",�,rrc��.^� i►, i:�.r 'Designer !A #bedrooms wf Approved'design flow }` ti gpd The issuance of this permit shall not be construed as a guarantee that the system wi nun, i o as desi ed. Date I Inspector t -------------------------------------------------r----------------------=------------------------------------------------------------- No. U' Fee �} ✓ THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION BARNSTABLE,MA§SACHUSETTS. oisposal 6pstem Construction Permit Permission is hereby granted to Construct O Repair( ) Upgrade( ) Abandon( ) System located at Alwm, and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction mus Abe completed within three years of the date of this permit. ] Date 1 Approved b PP Y TOWN OF BARNSTABLE 1, jOC,ATION � } 1� •�0 Rt\ SEWAGE# C�� • 1�� "V{�LL*E Q _ ESSOR'S MAP&PARCEL -M.3* --L? INSTALLER'S NAME&PHONE NO. -•C- I. a�' -1 1 Y- SEPTIC TANK CAPACITY 4, oa C.,kt- LEACHING FACILITY: (type) �t2XWG!'F (size) NO.OF BEDROOMS :3'�o0-E.s�L OWNER 13tZA561A- PERMIT DATE: -.1�3-146 COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility -�S�.S Feet Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) IM — Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet FURNISHED BY r�L �e S 6c,K b c lo �— 3 MAY-26-2021 23:17 From: To:15087906304 Pa9e:1.12 Town of Barnstable Inspectional Services 's snxrrerae�.e I Public Health Division °'AB8 Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office: 508-8624644 Fax. 508-790-6304 Installer&.Designer Cgrtification Form Date: 2 I .a I Sewage Permit# 6WU-/R3 Assessor's MapWarcel 3. 27 Designer: Dorn eam n Z JAC. Installer: Address: 9sq Izo u-It (04 Address: N.6x r)o u yalrmo ufh Pork, MA o2U75 M4 oaw9 On 90 . D!' was issued a permit to install a '(date) (installer) septic system at 3qq OakM 011+M . l'iuMN14gUld based on a design drawn by (dress) Qx��2l A. 0 gala PS dated 6- �1"2020 design r) 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. Strip out (if required) was inspected and the soils were found satisfactory. V 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. Strip out(if required)was inspected and the soils were found satisfactory. I certify that the sys n referenced above was constructed in c rnpli=e with the to rms of MOP nos the 1 A • ?al-letters(if applicable) VANIELA. y;n OJALA CIVIL '^ ( Inst er's Signature) No.46502 Po (Designer's Signature Aix Designer s tamp Here PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVIgON, CERTIFICATE F COMP LI NCE WILL NOT B ISSUED TIL IJQTH TH14 FORM A D AS - LT CA ARE RECEIVED BY THE BA ABLE PUBLIC HEALTH DIVISION: THAN WcAldepWHEALTMEWER eonnecASIEPTICOasigncr Certlficadon rorm Rev 8.14-11DOC j EL- 75.0 • 0 POOL ?.7. AREA C cm 20.3' N1 ,ad • ,i N O M EXST. DWEWNG TOP MON »` L.- 74.34 t'i s w� OARAOE TOP MON EL- 82.32 I ORNEWAY 2D419 JOB #17-335 AS BUILT SEPTIC SYSTEM PLAN PREPARED'EXCLUSIVELY FOR THE PURPOSE OF OBTAINING A SEPTIC CERTIFICATION, NOT FOR ANY OTHER USE LOCATION : 344 OAKMONT RD CUMMAgUID, MA PREPARED FOR: ' SCALE : f" = 30' DATE : MAY 7, 2021 ALEX & ADRIANA BRACk REFERENCE: ASSESS, MAP 334 PARCEL 27 SH OF MA C, DANIEL q on. 90e-302-450 x A. roe 6oB-362-ee80 r', OJALA �'1k down cape engineering, Inc. o N0.40880P CIVIL ENGINEERS " woe LAND SURVEYORS osuR r Z� ` C� 939 maln at. Yarmouth, ma 02675 DATE DANIEL A. OJALA P,L.S,, P.E. a 2/2:a6ed b02906L80sT:0l :Woad LT:22 T202-92-AUW MAY-26-2021 23:18 From: To:15087906304 Pa9e:1,'1 INVERT ELEVA77ONS TANK IN 63.29 :, TANK OUT 63.05. D-90X IN 6 9 ^' D—BOX OUT 62.53 No n POOL HOUSE yg0 TOP FNDN .EL w 75.0 �J O POOL � O AREA 0 20.3' 1 EXST. DWELLING TOP•FND 74.34 GARAGE �p TOP FNDN I EL- 82.32 DRIVEWAY JOB #17-335 AS BUILT SEPTIC SYSTEM PLAN PREPARED EXCLUSIVELY FOR THE PURPOSE OF OBTAINING A SEPTIC CERTIFICATION, NOT FOR ANY OTHER USE LOCATION' : 344 OAKMONT BD PREPARED FOR: , '�CUMMAQUID, MA SCALE : > = 30 DATE : MAY 7, 2021 ALEX & ADBIANA BRAGA REFERENCE: ASSESS. MAP 334 PARCEL 27 SHOFMAs. , OANIEL fir r `7. t A. off. 500-362-4641 c�i OJALA ro: 508-362-9660 No.40980 down caps engineering, inc. R p P � °Fess�°r e� CIVIL ENGINEERS ` �ynSUIRRV(w LAND SURVEYORS 939 main st. yarmouth, ma 02675 DATE DANIEL A. OJALA P,L,S„ P.E. f � f , 9 Le 1 &�,rs 9 V4,406+ Wow Interior Not To Scale 15 , 20 ' --------------------- Ist Level 10 ' DinRoom 20 ' 0 . Deck ;20 . Bath Kitch c 15 ' �►� c I4 24 ' 28 ' w/-d FamRoom L I vRoom [Pf F4R Garage 2 ' 1j 2 15 ' ' 4 10 , 1VIrs. rya Clarke 344 Oakmont Road Barnstable- Village Cummaquid Floor plans for Restore Permit -- - - 20 ' 2nd Level 10 , Den 20 ' sn � 24' Bath 38 ' 28 ' B R JkRM t Story Bth Hall cl Jc I c l l<► d1 Eaves -------------- ------ Cl 2 2 ' 40 ' � F interior Not To Scale FVV s� I 20 ' 15 ' ----------------------, 1st Level 10 ' 20 ' J 0 . Deck 00 , i c I 15 ' cl c4 2 2 8 ' W J c f f I P P c1 2 ' 2 15 ' 40 ' 10 ' 20' 2n Level 10 ' Den 20 ' c1 c I -------------------- - Bath 24 ' 8 ' 28 ' BDRM J BDRM I Sto Bth Hall cl Eaves I 22 B 40 ' D BDRM R M ce' Interior Not To Scale I 20 ' 15 ' ---------------------; 1st Level 10 ' DinRoom 20 ' 0 , Deck ' j2 0 ' Bath B Kitch c 15 ' c I c 24 ' 28 ' w/d. ..__ FamRoom L I vRoom 1 B D I �1 p p Garage - 2 , 2 ' 15 , 40 ' 10 , Mrs. Glorya Clarke 344 Oakmont Road Barnstable- Village Cummaquid j Floor plans for Restore Permit 20 ' 2nd Level 10 ' Den 20 ' sn cI c I ----------------------- Bath 38 , 24' 28 ' B M 1 Story Bth Hail cl - el cl Eaves - - cl r 22 40 ' 04'to 0-J i�L coo Interior Not To Scale F, �r 15 ' 20 ' ----------------- 1st Level 10 ' 20 ' l 0 . Deck 00 f c 1 15 ' c I c 24c 28 ' o-� c � f i I P P +' c1 2 ' 40 ' 10 ' 20 ' 2n Levei 10 ' Den 20 ' S c I c I ----------------------- 24' Bath 8 ' 28 , BDRM j BDRM 1 Stor Bth Hall cl Eaves - - - I 22 ' B 40 ' D BDRM R M I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments Property Address �s�ovr�c. CIG�l,/ ON ner Owner's Name --� information is G�V t�� Q� required for every page. City/Town State Zip Code Date of In pection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Mpo form out forms A. General Information VWen filling out f on the computer, use only the tab 1. Inspector: key to move your cursor-do not use the return Name of Inspector key. 0. -T :::"c! Co f mpany Name �l7 /7 n 7� ! � �d Company Address Ctyfrown State Zip Code Telephone Nu er License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15,340 of Title 5 (310 R 15.000). The system: Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority Inspec r is 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 god 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 aescribes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform In the future under the same or different conditions of use. t5ins•3/13 Title 5 0lficial Ins pection F orm Sututrf ace Sewage Disposal System•Page 1017 �I� u 4 Commonwealth of Massachusetts Title 5 Official Inspection Form s Subsurface Sewage Disposal System Form - Not for Voluntary Assessments Property Address Ow ner Cw ner's Name information is C(,4�� ��t od 6-?2 7b6AV required for every page, CityfTown State Zip Code Date of fnspe.Ztion B. Certification (cont) Inspection Summary: Check A,B,C,D or E /always com plete all of Section D A) System P sses: EL I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CM 15.304 exist, Any failure criteria not evaluated are indicated below. Comments: B) System Conditionally Passes: ❑ One or more system components as described in the "Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no" or"not determined" (Y, N, ND) for the following statements, If"not determined," please explain. The septic tank is metal and over 20 years old" or the septic tank (whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Healt h. 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. ❑ Y ❑ N ❑ ND (Explain below): 15in,3/13 Title 5 Official inspection F orm Subsurface Sewage Disposal System Page 2 of 17 N Commonwealth of Massachusetts u 7 Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments a Property Address G �✓W ner o�ner's Name inf Oa 6 �n information is jo����� Q� � �jg required for every page. City/Town v State Zip Code Date fins ection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes(cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system Is not functioning in a mannerwhich will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh Ons 3113 Tito 501ficial Inspecdcn Form Su baLrf ace Sewage Di Posal system-Page3o(17 I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage /Disposal System Form - Not for Voluntary Assessments Property Address Cw ner Ova ner's Name l information is co�„t 0,1 4b� required for every �Q"r' , page. Cityfrown State Zip Code 2teection B. Certification (cont.) 2• System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning In a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is Wthin 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 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 must be attached to this form 3. Other: D) System Failure Criteria Applicable to All Systems: You must Indicate ' Yes" or "No" to each of the following for all inspections: Yes No ❑ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ liquid level in the distribution box above outlet invert due to an overloaded ,or clogged SAS or cesspool Static Liquid depth in cesspool is less than 6" below invert or available volume is less than '/z day flow Orr Y13 TiUe501fivallnspocUcnFam:subsLeacesewageoisposal System-Page4or17 Commonwealth of Massachusetts T Title 5 Official Inspection Form Subsurface Sewage olsposai System Form Not for Voluntary Assessments Property Address ON ner Ow ner's Name information is / ��V-1 C1 64LA 1 required for every y page. City/Town State Zip Code Date of ins p tion B. Certification (cont.) Yes No ❑ Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ a Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ L7 Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.) ❑ ;The system is a cesspool serving a facility with a design flow of 2000gpd- 107 000g pd. The system fgJLQ, I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no" to each of the following, in addition to the questions in Section D. Yes No EJ ❑ 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. lSre W13 Title 5 Official InspeedonForm Subsurface Sewage0lsposal System-Page 5of 17 i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments l OG h/cMJVti /�Cam- Property Address Cw ner ON ner's Nameinforn,ation is required for every page. City/Town State Zip Code Date of I spec ion C. Checklist Check if the following have been done. You must indicate "yes" or"no" as to each of the following: Y�o 'um in information was rovided b the owner, occupant, or Board of Health p 9 P Y P ❑ 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) _ �03 Was the facility or dwelling inspected for signs of sewage back up? L�' ❑ Was the site inspected for signs of break out? L� Were all system components, excluding the SAS, located on site? ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? �❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ❑ Existing information. For example, a plan at the Board of Health. �/ ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: y� Number of bedrooms (design): Number of bedrooms (actual): DESIGN flow based on 310 CMR 15,203 (for example: 110 gpd x #of bedrooms), l5ins•3113 Til1e 5 Of ficial Ins pac tlon Form SubsLe ace Sewage Disposal System-Page 6 of 17 Commonwealth of Massachusetts - Title 5 Official Inspection Form Subsurface Sewag e Disposal System Form - Not for Voluntary Assessments Property Address Ow ner Cw ner's Narne� information is CC,( OVV70y 6Z-G41 / /,/7 required for every page. 5 _/_Town State Zip Code DatA of I spection D. System Information Description: 1Gx (rG / 1`f e C rl/1✓�ro---CVIAw��'O,- �fTv✓�.` �O l` /O�. �p� Number of current residents: Does residence have a garbage grinder? ❑ Yes No Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes No information in this report.) Laundry system inspected? ❑ Yes No Seasonal use? ❑ Yes No Water meter readings, if available (last 2 years usage (gpd)): Detail: Sump pump? ❑ Yes 2 No C(A ✓!�N Last date of occupancy: Date Commercial/industrial Flow Conditions: Type of Establishment: Design flow (based on 310 CM R 15.203): Gallons per day(gpd) Basis of design flow (seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5trre•V3 Tido501ficial Inspec bon For m Subsurfwe Sewage Disposal System•Peg 7of 17 Commonwealth of Massachusetts - Title 5 Official Inspection Form s Subsurface Sewage Disposal System Form - Not for Voluntary Assessments Property Address ner Cv✓Owner's NaNae inf /j information is � .� required for every page. City/Town State Zip Code Date o Insp lion D. System Information (cont.) Last date of occupancy/use: Date Other (describe below): General Information Pumping Records: C; Source of information: Was system pumped as part of the inspection? ❑ Yes If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of S em: Septic tank, distribution box, soil absorption system Cl Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract (to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ a rovaI.Tight tank. Attach a copy of the DEP pp ❑ Other (describe): t5Ins 3(13 Title 509delInspectionFormSubsLeace Sewage Disposal System•Page 8of17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not forVoluntary Assessments Property Address GG G✓ ON ner ON ner's Name informations a 6 3,2 3 U / required for every ��"I ` page. Crty/Town State Zip Code Date of I specton D. System Information (cont.) Approximate age of all components, date installed (if known) and source of i for ation: Were sewage odors detected when arriving at the site? ❑ Yes No Building Sewer (locate on site plan): Depth below grade: feet Material of constructi;40 El cast iron PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments (on condition ofjoints, venting, evidence of leakage, etc.): Septic Tank (locate on site plan): !/ Dept h bel ow g ra de: feet Materi 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 certificates) ,[ ❑ Yes ❑ No Dimensions: `� l Sludge depth: t51ns-3/19 Tide 5 Official inspection Form Subsurface SewageDisposd System Pegs 9of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form A Subsurface Sewage Disposal System Form - Not for Voluntary Assessments J` Property Address �/G✓� ON net ON ner's Marne information is /required for every lit k yv7 r, a� (o 30 .�__ �.✓ page. City/Tow n Stale Zip Code Date of nspec ion D. System Information (cont.) Septic Tank (cont.) Distance from top of sludge to bottom of outlet tee or baffle Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle How were dimensions determined? /��o le- C-4 1"�e— Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): _.. vy r✓1 �� Vc'e C;I/, G�' Gvr�✓ Pf J Mo z-,.-� ter. Grease Trap (locate on site plan): 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 t9ns-3113 Title SOlficial Inspection F orm Subsurlaoe Sewage Disposal System•Page 10 d 17 i Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments Property-Address Ow ner Cw ner's Nlame information i e V lY�a ��` �✓� Od-G required for every .� page. CitylTown State Zip Code Date of Irfspecti6n D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.). ............ Tight or Molding Tank (tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc,): Attach copy of current pumping contract (required), is copy attached? ❑ Yes ❑ No t5irm•3113 Tide501ficial Ins pecbcn Form:Subsirrace Sewage Disposal System-Page 11 of 17 Commonwealth of Massachusetts r Tide 5 official Inspection Form a Subsurface sewage Disposal System Form - Not for Voluntary Assessments oc, Prope:y Address _ Cw ner Cw ner's ;.Jame information is C(A Wl Me. (�U required for every __. '— page. City rToN•r, State Zip Code Date of In ection D. System Information (cont.) Distribution Box (if present must be opened) (locate on site plan): &ve k17 Depth of liquid level above outlet invert Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): So //o leC. Pump Chamber (locate on site plan): Pumps in worsting order: ❑ Yes ❑ No' Alarms in working order: ❑ Yes ❑ No' Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): If purnps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ire.3113 TiO501ficiallnspectionForm Subsurface Sewage Disposal System-Page 120r 17 i Commonwealth of Massachusetts t Title 5 Official Inspection Form Subsurface Sewage (Disposal System Form - Not for Voluntary Assessments Property Address ON ner Ory ner's N.L me information is , ,V'I �U required for every 6/ page. City[Tow n State Zip Code Date of In ection D. System Information (cont.) Type: leaching pits number: ["�vr r(-- LlC l i leaching chambers number: leaching galleries number: i.._.; leaching trenches number, length: ...; leaching fields number, dimensions: .' overflow cesspool number: innovative/altemative system Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): / Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): N,nib(� r and configuration Depth —top of liquid to inlet invert Depth of solids layer De-.)t h of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ru•3113 Title50fficial InspectlmFor i Subsirface Sewage Disposal System Page 13of V Comn'ionwealth of Massachusetts Title 5 Official Inspection Form 19)0 Sub stir-face Sewage Disposal System Form - Not for Voluntary Assessments Property Cw ner Ow ner's inforn ation is equir C��Y1 A� Oa 63,7 �J equiredforevery r� �/ page. C Y Tow„ State Zip Code Date of In pecti n D.�tem Information (cont,) Ce nfnents (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc..: Privy (locate on site plan): Ma!eriRis of construction: Dimensions Dent i-i of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc 15ris'M3 Title50ffiont tnspecoonForm Subsuface Sewage Disposal System-Page 14 of 17 f , Comn-ionwealth of Massachusetts Title 5 official Inspection Form Subsurtace Sewage Disposal System Form - Not for Voluntary Assessments Floperty V•C" C--,s information i G YVI A&I I /J- e � t/( -�� required for every _...__. page. CAYRov State Zip Code Cjjt—eof/1nSpe6tion D. Sy stem Information (cont.) Sk;;tcr•: Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at 'oast two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate wt =re ttch water supply enters the building. Check one of the boxes below: in the area below O drawing attached separately Y Q12, X 1 r ,qa -aj j 15iru-3/13 Title50ffidal trupectJonForm Subsurface Sewage Disposal System-Page 15 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsur'ace Sewage Disposal System Form - Not for Voluntary Assessments 3(-e Y ©G w v ij o f /zeJ Property ,ridress� G✓hi Cw ner Owner's 'dam- information is C,, mow,A aLA t / �,![ 6c)("o required for every _...._._.W d // page. City/Tov- State Zip Code Date f Inspection D. y':item Information (cont.) Exam: ❑ :heck Slope El Surface water ❑ :heck cellar ❑ `shallow wells Estimated depth to high ground water: feet Ple,.,ise 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: pate ❑ �'hecd site (abutting prop ertylobservation hole within 150 feet of SAS) ked with local Board of Health explain: /qG,,;�.s' L—Sf- /4ole-r ❑ Checked with local excavators, installers - (attach documentation) ❑ Accessed USGS database- explain: Yoij must clee�nbe how/you established the high ground water elevation: 1,� 7z,� 7,,l 121 a Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•3113 Title 500cial Iris poctionForm Subsirface Sewage Disposal System•Page 16of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form ug Subsurface Sewage Disposal System Form Not for Voluntary Assessments Jy Property Address Cw ner ON ner's Name information is6�tM!/t'l, required for every State Zip Code Date of Inspection page. 577 own E. Report Completeness Checklist E3 Inspection Summary: A, B, C, D, or E checked 2--'Inspection Summary D (System Failure Criteria Applicable to All Systems) completed 2 System Information— Estimated depth to high groundwater d Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins•3113 TWe50tflcial InspectionForm Subsurface Sewage Disposal System•Page 17 of 17 No. Fee)f2jQr THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLES MASSACHUSETTS Application for Migaar 6pgtem Cow5truction Permit Application for a Permit to Construct( . )Repair( Upgrade( )Abandon( ) El Complete System Lxdividual Components Location Address or Lot No. Owner's Name,Address and Tel.No. Assess a celo�!7 /,.e �n 411a�l Installer's Name Address,and fel.No. Designer's Name,Address and Tel.No. -7 Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer 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 Certifi- cate of Compliance has bee 'ssued by this oar of lth Sign Date f 1,171. Application Approved b Date Application Disapproved for the following rea Permit No. Date Issued i N �' Fee " THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: YI `PUBLIC_IJEALTH DIVISION-TOWN O�F BARNSTABLE, MASSACHUSETTS Rpprication for Migponl 4p!gtem Con!6truction Vermit Application for a Permit to.Construct( )Repair(V)Upgrade( )Abandon( ) ❑Complete System 14dividual Components Location Address or Lot No. Owner's Name,Address and Tel.No. Assess r sA /P' celb ��� c. cl Gf Installer's Name,Address;and fel.No. Designer's Name,Address and Tel.No. - 7 Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No. of Persons Showers( ) Cafeteria( ) Other Fixtures "w Design Flow gallons per day. Calculated daily flow . gallons. Plan Date ',Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil ` Nature of Repairs or Alterations(Answer when applicable)�47/ #0//5 e 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 Certifi- cate of Compliance has bee i sued by this oar of Health Sign / �. ' Date f 1 Application Approved b�V i G C Date Application Disapproved for the following rea o f Permit No. Date Issued THE COMMONWEALTH OF MASSACHUSETTS g BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CE IFY,that the On-site -ewage Disposal System Constructed ( )Repaired ( Upgraded( ) Abandoned( ) y � O % DlfS J` at �` !�� 4 G'a*I rVZ;2' G// has ben constructs in ''cbrdance with the provisions of Title 5 and the for Disposal System Construction Permit N . dated �/�(/o 1 Installer Designer The issuance of this fer/shall not be construed as a guarantee that the sys e wi function signedDate Inspector T ,t No. r� --4�----------------- -------Fee ���.'�—.'`,t• r THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS ligo!gaf *patent Construction Vermit Permission is hereby granted to Construct 4 )Repair(v)Upgra e( )Abandon( ) System located at % Oq'KmO�T /• 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 me b comp a within three years of the date of thisPAIrm, f, Date:_ f r / Approved by 'r TOWN OF BARNST ABLE LCEr►TION SEWAGE # )-OQ t VILLAGE -U YW A" ASSESSOR'S MAP &LOT 3 9 -B Z INSTALLER'S NAME&PHONE NO. ��-6��-1�J SEPTIC TANK CAPACITY f6 ai� LEACHING FACILITY: (type) CAI1/_4 d e&Oklot°4S (size) JqeNO.OF BEDROOMS BUILDER OR OWNER PERMITDATE. �- ,Z, -o I COMPLIANCE DATE: 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) 70 WIL) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) tioy�. Feet Furnished by t A G. oe a 1 -cz73�J y � �� q7 No. Fee / THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS 2pprication for 33igpogal *p5tem Construction Permit Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) El Complete System El Individual Components Location Address or Lot No. Owner's Name,Address and Tel.No. 3LN 6,4 k oiw)f Assessor'sMap/Parcel Q tot- Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. P Ism n �v A63 a Type of Building: Dwelling No.of Bedrooms _ Lot Size �- sq. ft. Garbage Grinder( ) Other Type of Building No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank o Type of S.A.S. X 46 5e Z— W C-'V' �ljly Description of Soil ill Nature of Repairs or Alterations(Answer when applicable) , 5c I )e -L e J 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 T e 5 the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued this o d of lth. Sign / '` `�- Date G Application Approved Date v Application Disapproved for the following reasons Permit No. Date Issued No. !,} Fee 5o Cf''j✓ THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes / PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLES MASSACHUSETTS ✓ 01ppYication for Migogar *pgtem (fongtruction Permit Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. Owner's Name,Address and Tel.No. !3`f if nA k-AtwUt Q U v►�+ v !�i (( C_(art tic. Assessor's Map/Parcel13 C/T G Z„7 .rWt d •1 h... 1 Installer's Name,Address,and Tel.No. Designer's:Name,Address and Tel.No. 19 lie b A6 3 Type of Building: Dwelling No.of Bedrooms 5 Lot Size_. sq.ft. Garbage Grinder( ) Other Type of Building No. of Persons Showers( ) Cafeteria( ) Other Fixtures 14 • `� �a 1 . I� � t li Design Flow gallons per day. Calculated daily1flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank 9 Type of S.A.S. / X 4 e. Y 1— W C:;:rU 1�Jgp Description of Soil i1R 4 Nature of Repairs or Alterations(Answer when applicable) L f j.ew ttG X �2 jl Z rhJ _ M 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 T e 5 of the.Edv roru ental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued b this F6- of 'lth. Sig / +.^'^` v— Date J?' G Application Approved by Date 2r d/ Application Disapproved for the following reasons I Permit No. Date Issued S 1 THE COMMONWEALTH OF MASSACHUSETTS U-1 r BARNSTABLE, MASSACHUSETTS (Certificate of (Compliance THIS IS TO CERTIFY, t at the On-site Sewage Disposal System Constructed( )Repaired()<) Upgraded( ) Abandoned( )by D i a.) at ' 3 DA 6 Cc.rit i has beenp truct d in a cordance with the provisions f Ti e 5 and the for Disposal System Construction Pe it No. ZOO/_3/4dated R 2 3 U t Installer 6 R/ Designer The issuance of this pernlit shall not be construed as a guarantee that the syste '31 fu op- s ne Date $� ? b Inspector 1 ——————————————————————————————————————— No. I C Fee THE COMMONWEALTH OF MASSACHUSETTS —PU- IC HEALTH DIVISION - BARNSTABLES MASSACHUSETTS ligooar bpg;tem Construction Permit Permission is hereby granted to Construct( )Repair( M Upgra e( )Abandon( ) System located at 3� d.4f MLa-'U f 2 L'oM I'A C! C..,/ and as described in the above Application for Disposal System Construction Permit. The applicant recogn'zes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction ust be completed within three years of the date of flu _p Date: 2 Approved byc t/6/99 NOTICE: This Form Is To Be Used For the Repair Of Failed Septic Systems Only. CERTIFICATION OF SKETCH AND APPLICATION FOR DISPOSAL WORKS CONSTRUCTION PERMIT (WITHOUT DESIGNED PLANS) hereby certify that the application for disposal works construction permit signed by me dated concerning the property located at -j 9 q O A-k Kkp k14 L04 meets all of the following criteria: • This failed system is connected to a residential dwelling only. There are no commercial or business uses associated with the dwelling. • The soil is classified as CLASS I and the percolation rate is less than or equal to 5 minutes per inch. • There are no wetlands within 100 feet of the proposed septic system • There are no private wells within 150 feet of the proposed septic system • There is no increase in flow and/or change in use proposed • There are no variances requested or needed. • The bottom of the proposed leaching facility.:will not be located less than five feet above the maximum adjusted groundwater table elevation..[Adjust the groundwater table using the.Frimptor method when applicable] - ... • If the S.A.S.will be located with 250 feet of any vegetated wetlands, the bottom of the proposed leaching facility will not be located less than fourteen(14)feet above the maximum adjusted groundwater table elevation, Please complete the following: A) Top of Ground Surface Elevation (using GIS information) ,ems B) G.W. Elevation +the MAX. High G.W. Adjustment . DIFFERENCE BETWEEN A and B �•7 0/_SIGNED : AILDATE: [Please Sketch pr osed plan of system on back]. 'tNOTICE Based upon the above information, a repair permirwill be issued for bedrooms maximum. No additional bedrooms are authorized in the future without en-ineered septic system plans. q:health folder:cert . l ' s ► _ u �( I)k (� Z Q r Zs 1 r F �f f N. STABLE LOCATION Q4(T-AWA w SEWAGE # )-CO t JI VILLAGE Vw A"'flq- 41,-f, I ASSESSOR'S MAP & LOT 13 4 -o Z INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY 466 LEACHING FACIUM.(type) idl' ,6 C""<5 (size) k'//- EDROOMS NO.OF B BUILDER OR OWNE14 RW(f 6. DAM`P IWIT COMPLIANCE DATE.�:: Separation Distance Between the: Maximum Adj4sfeddrbundwatdr Table,and Bottom,of LeacWng facility 2 •T66t. Private Water Supply Well.and Leaching Facility (If any.,wells exist g facility)within Feet .,on site or wi n 2.00 feet of leaching fa di Edge of We'dandand LeAdUig Facility{If any,wetlands flands exist within 300 feet.of-.leaching facility). Feet 'Furnished' y b P'z> 51 C 32 L.0 C A T ION � SEWAGE PERMIT NO. Lot 9 Oakmont Rd. 83-633 VILLAGE Cummaquid INSTALLER'S NAME i ADDRESS Robert B. Our Co. Inc. Great Western Rd. North Harwich e U I L D E R OR OWNER Donald Dorr `Oo DATE PERMIT ISSUED 7 3 QDAT E COMPLIANCE ISSUED I ' 9 � rCL 601 b r THE COMMONWEALTH.OF MASSACHUSETTS BOARD OF HEALTH . ....................OF.......................................................................................... Appliratiun for Bi-quuttl Works Tnntrur#inn Frrutit Application is hereby-made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at ................• .... .... Location-Address C t ..............� �_.ry[d ....i . .................................... Owner dress �' p Inn W •-•........ :_. . ..:............•....---........-•---•••.... ........... sJ_j/�!L,�Yt_/�..Zze, �,!l_.�- !._. �X!ti: ,�-. :... Installer dress d Type of Building Lot....... 4.k2J..Sq. feet U Dwelling—No. of Bedroom�s..1....... .. Expansion AYY ( ) Garbage Grinder ( ) Other—Type of Building .In!-OLZ-A-l i!�e No. of persons............ ........• Showers (/ ) — Cafeteria ( ) dOthe fixtures -----------------------................................................................................................................................ W Design Flow...........3�.......................gallons per person per day. Total dail flow----- ........� gallons. WSeptic Tank—Liquid capacity..t60v_gallons Length.... Width....._�.._.. Diameter____._ ...... t x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq.ft. Seepage Pit No.......... Diameter........1_.1 .. Depth below inlet.;.................. Total leaching area..-.. .. ...sq. ft. z Other Distribution box ( ) Dosing tank ( ) Percolation .Test Results Performed b ....... .... Date......._._ Y-----•---•.. • _ 1_t -• aTest Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground ter-___ .._................. Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ �+ -----------------------------------------------------------•----•---•--..........-•--••............•--••--.....--••••......•......_....._........-••......-- ODescription of Soil........................................................................................................................................................................ V -------------------•---------------------------------------....------------------.......--------......--------------....-------------------•----................------..........-•-•-•---••------•. W ------------------------------------------------------------------------------------ -------------------------------------------------------•--------------......_........._.._......... U Nature.of Repairs or Alterations—Answer when applicable............................................................................................... -------------------••---•-•-•-••---•-••••-•.........--•------•-•-••-•••---•••---•-••---.......----•••-•-•-•-•----•------------•-••••----•-•-----•-----•----------•••••..._..--------------••-•-••-•-••-. Agreement: The undersigned agrees to install the aforedescr' ed Individual Sewag Disposal System in accordance with t e rovisions L TI.E of the State Sanitary Co The undersigned f ther agrees not to place the syste in p . 'ti ertifi to of Compliance has en (Ss ed by t b rd th Sid. ..... . ........... . ....... ..............•---•-- .............. Acat' A roved B ........--•---•--------•-•---••-------- --------•............ _...�f...3...-- Date lication Disapproved for o ng ason . .. .............='---•------------- --------............-------------------.........._....---...------•-•--- .........................•-•-...-•---•.....-•••--•-•--.....................---•- ................................................................................................................... Date PermitNo....................................................... Issued........................................................ ------------------------- - - GG No. .......` ......... Fitz....f.....®............... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ...........................................OF................................_.......---------------- .... Appliration fnr Uiipmal World Tomilrur#inn Prnuff Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: ........................................ ..._. . .•..............................••.... ..........__--..--.•.......Z.4 :.F............................................. Location-Address !( 1 ° / j ..... ........... ..............( t.l� ............_... •....... ..... Owner Address a ........ :...... ....-•-----•--------•--•--••-•••--.....••--- L-�/40- --X.rl..4"e ._�._..... ...... Installer . dress d Type of Building Lot_.__--(.:.)!.7l.Sq. feet U Dwelling—No. of Bedrooms_ __.___.. .. --Expansion Att' ( ) Garbage Grinder ( ) Pk Other—Type of Building lo;�. _.l f1te No. of persons............."'Y -•__-___- Showers Cafeteria ( ) Othe,� xLures ........................................................................__........................._.................................................. w Design Flow.........................................gallons per personcp r day. Total dail flow..............3_f7�v_................gallons. WSeptic Tank—Liquid capacitv..r.(0o.gallons Length... .......... Width......F•.._. Diameter......�1:...__. Depth..._''e--•.__. x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. . Seepage Pit No.......... _...__._ Diameter........ ---Lr _. Depth below inlet.................... Total leaching area.....` ...sq. ft. z Other Distribution box ( ) Dosing tank ) '~ Percolation Test Results Performed by............/2A-X.EeA... ¢..I ...................... Date.........�rvlr?..........._. 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........................ 9 •---•--------------------- ----------------•------.................-----..........•---...:--•-•••-•-........................................................ 0 Description of Soil........................................................................................................................................................................ x w U Nature of Repairs or Alterations—Answer when applicable................................................................................................ - -----------------------------------•-•- Agreement: The undersigned agrees to install the aforedescr'bed Individual Sewag Disposal-System in accordance with the rovisions T '1Z of the State Sanitary Co — The undersigned f Ither agrees not to place the.syste in , p zti ertifi to of Compliance een iss ed by t b rd �lth. r` , Si nod �. .........��--• -• .••... ----$ ••-� ••. ✓, �/ . NDa A p ca ' Approved By............ .. �_..`. .`.....-J ...........................�:......... ----- '../ '�.. Date lication Disapproved forV011119ng reasons. ...........................•-•.•.•••-•---•-•-•--•-•-•-••-••••••-••••-----....................--........._ ..........................•--•-•-•-•--•-•••-•----••-•--•-••--•-••---•-•-•••••-•••••--•- Date PermitNo......................................................... Issued-....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOA•RD OF HEA TH . ... 9rdif iratr of Tnntpliattrr .Lell�d TO CERTIFY, That the Individual Sewa Disposal System constructed ( or Repaired ( ) by... ...•... .......-. /.......... . .... .:- •---- ...........---...-•------•---•--•--------•---...---•--....-•----.....-•-......-•----.....---" /..............................................!K � .taller I has been installed in accordance with the provisions. of T F jfD f State Sanitary af/ss/;i�b�-& in the application for Disposal Works Construction Permit No.•' ..`Q_._ .._..._... dated..../..z_/.............................. THE ISSUANC)E OF THIS CERTIFICATE SHALL NOT BE CONSTRU AS A GUARANTEE THAT THE SYSTEM W � CTION SATISFACTORY. .... .DATE....... ..Z�.....••-••--•--...•----•-•-••--•.........-•---•--•-••--- Inspector. ---. -•---••....-•-••••••---•-----•-•--•-----......--••-•............-•-•--••. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF EALTH 3 -`2 � .OF.............. . ...:...----••--.........:- . No......................... FEE..... .............. Dispa k (finu udinn frrutit Permissionis eby grant .............................I................f.................................................. to Construct, ) or i Fy ) an Indivi u 1 See t atNo.................... ....r...... ! IG ? ---- --------------------•---•---•--------------------- --•----- ---••----.....--•--- Street as shown on the application for Disposal Works Construction Permit No..................... f'-Wed ............... r_- � --------- •?' '- DATE----------------11-......._.....--- -------•.................................. B and of Health FORNI 1255 A. M. SULKIN, INC., BOSTON f �A�r�-ow Pc? !i 5EPT"IG TA►JK = 33G: 150% _ �9 5;G.P. Q I �15Po5nL P1"T - v5E= Ivoo GAL. I1 V C OVA u _ N VF. A = 22G s.F x 2 0 = 4SZ6v 4 ; 16 546- � P�PcoLtm�►J �QTF`- _- 1'` �,.1 y. rJ�,���. .�� _ -- /��C:Fc, I . 2 r jt'MCY l7' 2=>. AlAN l lore, 99.o ToP FND= loo.o Ho►-� s/Z3/ _ _� �-F . Y�y 1000 (NV. P 6T. INS94 . S�r3so��- SEv7�c. � • AC 14 S�N✓ ?I.f INV. INV. )y rii✓�� W.'iTu 9G.o 94.Z Vv�rP�F{r.D 6-:TON E sA,42 aq.8 C1=2TIPIGp PLoT P� A1.1 .vorf1•4r. PR?UFIL� LoG4-r ►oN Cu�/f'/QQ(JiU ' N O S CA.-L E .S CA.L E. A5 A/oTEZD. P�-F.r•1 REFE2EN CE G E Ft'r l F Y T 1.1 AT -j NER6o w COMPL`(5 1JITN Z HE S l oELlt-I A► P 5E'r5.GK R.6G�ul2EMENT� oFT41� � a -TOWN ol= �, ►lS-r� AW-D IS �� 1_OCp,TED -WITNIIJ T4� E GLOOD PLAIN DATE-��'� �•�- : c, fQ � IJ r,�t'.� BAXTEcz.e t..tYE INS 'T 111�jy P L Q tl1 1 '5 W orT ' 3 5 p 4>I'd A N O 37 ti✓IZV I LLB MASS. lW57'RUMENT 5u2-. c-y -1' NE 01:F5E75 SuoUZ) No-T DE v5ED-TO G- ETETt/�1tilE L.oT' t•- 'HE-j APPLICANT T>c✓� :��f� l��,c�,t' IL ez.o 8,3 77. -7 �o �. 9a L 9/•7 �� 97 a (�� • � � - � /may G � ��4�oF M �� CHARD GNP or�oS� 103.8 a ,? A. 1 j 6Ax7ER � 97irk -� /oz}saw. �•.�, ° + le-I p-Z1+ uf.,% r. AIAN 3� Ac W. JONES 57 i � P I y T �-s � ��� -CEQTIFIED PLbT P'L-../-�1•J • �1 L o:>CAT I o D poi c . • ,c3�3�� P6. �`f a,6.)CTEIZ �. uYE Inc. REGIS(t1ZL-D 1.A�-1� OSTEV_V%L_ 1 0 /�XId•SS� SYSTEMDESIGN. ALL SYSTEM COMPONENTS SHALL BE LEGEND GARBAGE DISPOSER IS NOT ALLOWED SYSTEM PROFILE MARKED WITH MAGNETIC TAPE OR NOTES (NOT TO SCALE) COMPARABLE MEANS FOR FUTURE LOCATION. 1 �� POOL HOUSE ACCESS COVERS TO WITHIN 6" OF FIN. GRADE CONCRETE COVERS TO WITHIN 3" GRADE 1. DATUM IS NAVD 88 n Rt 65t ���c 99 - EXISTING CONTOUR EXISTING 5 BEDROOM SEPTIC SYSTEM TO REMAIN 2" PEASTONE OR GEOTEXTILE a FOR EXISTING 5 BEDROOM DWELLING \ TOP FOUND. EL. 75.0' FILTER FABRIC OVER STONE 2. MUNICIPAL WATER IS EXISTING z X 99 EXIST. SPOT ELEV. 65.0 MINIMUM .75' OF COVER OVER PRECAST 2% SLOPE REQUIRED OVER SYSTEM PROPOSED 2 BEDROOM ADDITION OVER GARAGE & 3. MINIMUM PIPE PITCH TO BE 1/8" PER FOOT. -[99]- PROPOSED CONTOUR GARAGE PRECAST H-10 WATERTE$T D BOX FOR LEVELNESS BLOCKS OR PROPOSED 2 BEDROOM POOL HOUSE RISERS (TYP.) MIN. 2 CKNESS PRECAST RISERS J 198•41 PROPOSED SPOT EL. E*6 20 4"0SCH40 PVC MORTAR ALL T DESIGN LOADING FOR ALL PROPOSED PRECAST UNITS DESIGN FLOW: 4 BEDROOMS ® 110 GPD 440 GPD *' PIPES LEVEL 1ST 2' �4, COMPONENTS INVERT IN s1.67 TO BE AASHO H-IQ o TH1 USE A 440 GPD DESIGN FLOW POOL HOUSE ENDS (NP') SIDES 62.5' TEST HOLE 10" 1500 GAL H-10 14" ° ° ' • A. o�, 5. PIPE JOINTS TO BE MADE WATERTIGHT. • ' 62.41' TEE SEPTIC TANK TEE ° ® ®® ®�®® ®�_ ® >gogog000 o Locus 2.16' 6" MIN SUMP ° ° ° ° ®®®®®® ® ®® ® ;°o°o°o°0 6. CONSTRUCTION DETAILS TO BE IN ACCORDANCE WITH o SEPTIC TANK: 440 GPD //2 = 880 *62.77' °°°°°°°°°°°° 12" MIN. INT. DIM. °°°°°°°° ®®� ®® ®® °°°°°°°° SLOPE OF GROUND l ) GAS BAFFLE �o,°,o,°o°o�o° ;000000000 o°o°o ® �® � �®�®® o°o°o°o° 31D CMR 15.DD0 (TITLE 5.) � UTILITY POLE USE A 1500 GAL. H-10 SEPTIC TANK 4' LIQ_ LEVEL ACME OR EQUAL • 61.94' 61.77' >°o 0o�o�o�o I Ookmon D ;: s ( EQUAL).!] 59.67 7. THIS PLAN IS FOR PROPOSED WORK ONLY AND NOT TO :'. BE USED FOR LOT LINE STAKING OR ANY OTHER °Oo o°°,co�o'-o,°°,o°°,o,°°,o'000000°o�°o,°°•,°o,°°,°o_�°ono,°°,°o0oo°oo°o° H-10 500 GAL. LEACHING CHAMBERS BY ACME PRECAST OR EQUAL PURPOSE. - 3/4"-1-1/2" DOUBLE WASHED STONE 4' MIN. q FIRE HYDRANT LEACHING: ALL AROUND PRECAST STRUCTURES (3) UNITS REQUIRED I ti� NOTE: NOT ALL SYMBOLS MAY APPEAR IN DRAWING SIDES: 2 (33.5 + 12.8) 2 .74 = 137 GPD 6" CRUSHED STONE OR MECHANICAL OVERALL DIMENSIONS TO OUTSIDE OF STONE: 33.5' X 12.83' 8. PIPE FOR SEPTIC SYSTEM TO SCH. 40-4" PVC. Route 6 COMPACTION. (15.221 [21) BOTTOM 33.5 x 12.8 (.74) = 317 GPD CD Ui 9. COMPONENTS NOT TO BE BACKFILLED OR CONCEALED TOTAL: 614 S.F. 454 GPD (8.2% SLOPE) ( 1 % SLOPE) ( 1 % SLOPE) WITHOUT INSPECTION BY BOARD OF HEALTH AND PERMISSION OBTAINED FROM BOARD OF HEALTH. GARAGE 68' SEPTIC TANK 22' D' BOX 12' LEACHING /a c 54.0' BOTTOM TH-4 10. CONTRACTOR SHALL BE RESPONSIBLE FOR CALLING LOCUS MAP USE (3) 500 GAL. LEACHING CHAMBERS (ACME OR EQUAL) POOL HOUSE-18'� FACILITY / ►/ NO GROUNDWATER FOUND DIGSAFE (1-888-344-7233) AND VERIFYING THE , WITH 4' STONE ALL AROUND 2 LOCATION OF ALL UNDERGROUND & OVERHEAD UTILITIES SCALE 1 =2000 t ( % SLOPE) )_k'te /(/ PRIOR TO COMMENCEMENT OF WORK. ��c��i* ASSESSORS MAP 334 PARCEL 27 *THE INSTALLER SHALL VERIFY THE I 11. ANY UNSUITABLE MATERIAL ENCOUNTERED SHALL BE LOCATIONS OF ALL UTILITIES AND ALL C � t /_ REMOVED BENEATH AND 5' AROUND THE PROPOSED BUILDING SEWER OUTLETS AND '�` 1U� LEACHING FACILITY. MA ELEVATIONS PRIOR TO INSTALLING ANY /l/� r 12. EXISTING LEACHING FACILITY TO REMAIN. ZONING SUMMARY APPROVED DATE BOARD OF HEALTH PORTION OF SEPTIC SYSTEM 13. POOL FENCE TO BE INSTALLED AS PER STATE AND ZONING DISTRICT: RF-1 DISTRICT J TEST HOLE LOGS LOCAL POOL REGULATIONS. PROVIDE DOOR ALARMS AND SELF LATCHING GATES AS REQUIRED. , w 2 MIN. LOT SIZE 87 87120 S.F. MIN. LOT FRONTAGE 6 ENGINEER: DANIEL E. GONSALVES, SE #13587 MIN. LOT WIDTH 125' 64 0 a WITNESS: DAVID STANTON, IRSMIN. FRONT SETBACK 30'S MIN. SIDE SETBACK 15' DATE: 3/20/2020 MIN. REAR SETBACK 15' < 4 MIN/INCH MAX. BUILDING HEIGHT 30' ) PERC. RATE _ SITE IS LOCATED WITHIN THE AQUIFER �s CLASS I SOILS P# 20-43 PROTECTION OVERLAY DISTRICT 61) 55 � 57 56 1 ELEV. ELEV. - ELEV. ELEV. OWNER OF RECORD to 65.0' p' 64.5' 0to 65.0' p" 64.0' A A A A ALEX 76 6ti 344 OAKMONT DRIVE SL SL SL SL YARMOUTH PORT, MA 02675 N w >� B CHMA K SQ �� 310 10YR 4/2 5» 10YR 4/2 6„ 1 OYR 3/2 1090 10YR 3/2 SE NAIL IN TR C EL. 65. ' 62 B B B B REFERENCES LOT 9 W V 43,631t SF SL SL SL SL DEED BOOK 28426 PAGE 268 P O OS D 34„ 10YR 5/8 62 2' 32„ 10YR 5/8 61 8' 36'9 10YR 5/6 62 p, 40„ 10YR 5/6 60 7, PLAN BOOK 354 PAGE 64 TA IN ALL 6� (DfSI Y T 0 ER E 67 a C C C C 79 CLEANOUT /� PERC PERC 6- P OL HOD SE 62 66 M/FS M/FS M/FS M/FS ° T 0 F N 65 5. 69 2.5Y 6/4 2.5Y 6/4 2.5Y 6/3 2.5Y 6/3 �o , a I'D / PATIO S \ 63 PROP D PO 18' x 4 120" 55.0' 120" 545' 120" 55.0' 120" 54.0' POOL H TH l6 \ 6 . EXPAN ooc NO GROUNDWATER ENCOUNTERED NO GROUNDWATER ENCOUNTERED PATIO ,_... '� T ° ,Q \ 3 3 1� ® O sN 65 00 �o a-) .o a 66 61 EXISTING DWELLING DECK N. 0 0 R 70 IP / n P 71 R ZI ED BENCHMARK CONC. BOUND / / ( ✓ PROPOSED (DESIGN BY 74 / ,o GARAGE ADDITIO OTHERS �3 EL. = 79.2' / 79 O SLAB = 81.5 ) PC,, 5 BEDROOM TITLE 5 SITE PLAN EXISTING 75 SYSTEM 9 \ REMAIN TO / / OF (� y� PROPOS 77 /. PAVED Z31344 OAKMONT O / DRIVE A ro"' RE VE ING Lj EXISTING EXIT CUMMAQUID So SECTION CVE 7 � � o 3 22 DRIVE PREPARED FOR \ ��\7 Aso g2, �o ALEX BRAGA o . � (. 78 DATE: MAY 5, 2020 REV: MAY 11 , 2020 POOL SIZE, RETAINING WALL Scale: 1"= 20' n NIFIL �s 0 10 20 30 40 50 FEET DAN I E I_A. yGsi. o OJALA Via, ' M CIVIL v t,0 Ni. 4rC��02 �? off 508-362-4541 � � ~; , FESS`c off. fax 508-362-9880 downcape.com i o down cape engneering, inc. civil engineers _ Ion d surveyors I _ w 939 Main Street ( Rte 6A) DATE DANIEL A. OJALA, P.E., P.L.S. YARMOUTHPORT MA 02675 DCE # 17-335 17-335 BRAGA.DWG