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HomeMy WebLinkAbout0045 OLD JAIL LANE - Health 45 Old Jail Lane Barnstable • 0• • Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 45 OLD JAIL LN Property Address BATES Owner Owner's Name information isreq for BARNSTABLE MA 1-4-13 page. City/Town State Zip Code Date of Inspection 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. i 'm''°rta"t.When filling out A. General Information (� n forms on the computer,use 1. Inspector: f only the tab key to move your DOUGLAS A BROWN cursor-do not Name of Inspector use the return 'key. DOUGLAS A BROWN INC Company Name P.O. BOX 145 Company Address CENTERVILLE MA 02632 Cityrrown State Zip Code 508-420-4534 S14297 Telephone Number License Number B. Certification u1nteniEInc6-.bf -I certify that I have personally inspected the sewage disposal system at this addre and thaf1he information reported below is true, accurate and complete as of the time of the insection. The inspection was performed based on my training and experience in the proper function and m on- to sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.34e�.-bf Title 5(310 CMR 15.000).The system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority 1-4-13 Lpel!�Itigggnatu4'� Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions'•of use 7. at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. UVW 3 t5ins•11/10 Title 5 official Inspection Forth:Subsurface Sewage Disposal System•Page 1 of 17 • Commonwealth of Massachusetts Title 5 Official Inspection Form i Subsurface Sewage Disposal System Form o -Not for Voluntary Assessments j 45 OLD JAIL LN Property Address BATES Owner Owner's Name information is BARNSTABLE MA 1-4-13 required for , every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are !. indicated below. Comments: THIS INSPECTION IS ON SYSTEM#2 HOUSE HAS 2 SEPTICS#1 S.A.S IS NEW i 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. i The septic tank is metal and over 20 years old*or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration.or tank failure is'imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND(Explain below): t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 17 I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments I "( 45.OLD JAIL LN Property Address BATES Owner Owner's Name information is required for BARNSTABLE MA 1-4-13 every page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) 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): 1 ❑ 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): i i 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 manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 • Commonwealth of Massachusetts - Title 5 Official Onspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 45 OLD JAIL LN Property Address BATES Owner Owner's Name information is required for BARNSTABLE MA 1-4-13 every page. Citylrown State Zip Code Date of Inspection 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 within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or i 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: i I I 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 ❑ z Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool El ® 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 %day flow t5ins•11/10 Title 5 Official Inspection Fond:Subsurface Sewage Disposal System•Page 4 of 17 i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 45 OLD JAIL LN Property Address BATES Owner owner's Name information is required for BARNSTABLE MA 1-4-13 every page. Cityrrown State Zip Code Date of Inspection 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. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [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- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes"or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ` ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA)or a mapped Zone II of a public water supply well If you have answered"yes"to any question in Section E the system is considered a significant threat, or answered"yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins•11/10 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 5 of 17 • Commonwealth of Massachusetts _ Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments r 45 OLD JAIL LN Property Address BATES Owner owners Name information is required for BARNSTABLE MA 1-4-13 every page. Cityrrown State Zip Code Date of Inspection i C. Checklist Check if the following have been done. You must indicate"yes" or"no"as to each of the following: Yes No ❑ ® Pumping information'was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of j this inspection? ® ❑ Were as built plans of the system obtained and examined?(If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ❑ ® Were all system components, excluding the SAS, located on site? . i ® ❑ 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? i 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 i Residential Flow Conditions: Number of bedrooms(design): 3 Number of bedrooms(actual): DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 t5ins•11110 Title 5 Official Inspedion Form:Subsurface Sewage Disposal System•Page 6 of 17 Commonwealth of Massachusetts _ Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 45 OLD JAIL LN Property Address BATES i Owner Owner's Name information is 1-4-13 required for BARNSTABLE MA � every page. City/Town State Zip Code Date of Inspection D. System Information Description: SYSTEM 2 CONSISTS OF A 1500 POLY TANK D-BOX AND LEACH PIT i Number of current residents: 4 Does residence have a garbage grinder? ❑ Yes ❑ No Is laundry on a separate sewage system?[if yes separate inspection required] ❑ Yes ❑ No Laundry system inspected? ❑ Yes ❑ No Seasonaluse? ❑ Yes ❑ No Water meter readings, if available(last 2 years usage (gpd)): Detail: 2010------390 2011----405 Sump pump? ❑ Yes ❑ No Last date of occupancy: CURRENT Date Commercial/Industrial Flow Conditions: I Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): I Grease trap present? ❑ Yes ❑ No i Industrial waste holding tank present? ❑ Yes ❑ No )Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: l5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 17 I� Commonwealth of Massachusetts Title, 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 45 OLD JAIL LN Property Address BATES Owner Owner's Name information is required for BARNSTABLE MA 1-4-13 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) CURRENT Last date of occupancy/use: Date Other(describe below): i General Information Pumping Records: I Source of information: Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: i Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 i • Commonwealth of Massachusetts Title 5 Official Inspection Form 9-- Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 45 OLD JAIL LN Property Address BATES Owner Owners Name information is required for BARNSTABLE MA 1-4-13 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known)and source of information: SYSTEM#2 INSTALLED IN 1991 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: feet Material of construction: ❑ cast iron ❑40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments(on condition of joints, venting, evidence of leakage, etc.): j i I Septic Tank(locate on site plan): Depth below grade: 2 feet I Material of construction: ❑ concrete ❑ metal ❑ fiberglass ® polyethylene ❑ other(explain) I If tank is metal, list age: years � Is age confirmed by a Certificate of Compliance?(attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1000 GALLON Sludge depth: t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 i Commonwealth of Massachusetts _ Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 45 OLD JAIL LN Property Address BATES Owner Owner's Name information is required for BARNSTABLE MA 1-4-13 every page. Citylrown State Zip Code Date of Inspection 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? Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, I liquid levels as related to outlet invert, evidence of leakage, etc.): TANK WAS PUMPED IN 2010 i i I i Grease Trap(locate on site plan): Depth below grade: feet i Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): i i Dimensions: Scum thickness I 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 t5ins•11/10 Title 5 Official Inspection Four:Subsurface Sewage Disposal System•Page 10 of 17 i Commonwealth of Massachusetts upTitle 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 45 OLD JAIL LN Property Address BATES Owner Owner's Name information is required for BARNSTABLE MA 1-4-13 every page. Cityrrown State Zip Code Date of Inspection 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 Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: 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 l5ins-11110 Tcle 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 45 OLD JAIL LN Property Address BATES Owner Owner's Name information is required for BARNSTABLE MA 1-4-13 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 0" Comments(note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): BOX LEVEL NO SIGNS OF LEAKAGE OR FAILURE AT TIME OF INSPECTION Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.): Soil Absorption System(SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins•11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 • I Commonwealth of Massachusetts Title 5 Official Inspection Form. Subsurface Sewage Disposal System Form-Not for Voluntary Assessments i 45 OLD JAIL LN ,p Property Address BATES Owner Owner's Name information is required for BARNSTABLE MA 1-4-13 every page. Cityrrown State Zip Code Date of Inspection M' System-Information (cont.) Type: ® leaching pits number:. 1 1 ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): 4X6 PIT WITH 2 FT OF STONE FOUND TO HAVE @12" OF USABLE SPACE AT TIME OF INSPECTION i Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): i Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No , t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 17 I I I • Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 45 OLD JAIL LN ,p I Property Address BATES . Owner Owner's Name information is required for BARNSTABLE MA 1-4-13 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): i i Privy(locate on site plan): Materials of construction: Dimensions Depth.of solids Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): I 1 t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 I Commonwealth of Massachusetts Title 5 Official Inspection Form A — Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 45 OLD JAIL LN Property Address BATES Owner Owner's Name information is required for BARNSTABLE MA 1-4-13 every page. City/Town State Zip Code Date-of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: 0 hand-sketch in the area below- ® drawing attached separately - 151ns,-11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 15 of 17. i • Commonwealth of Massachusetts _ Title 5 Official Inspection form. Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 45 OLD JAIL LN ! Property Address BATES Owner Owner's Name information is required for BARNSTABLE MA 1-4-13 every page. CitylTown State Zip Code Date of Inspection I D. System Information (cont.) Site Exam: ® Check Slope ® Surface water ® Check cellar ® Shallow wells GREATER THAN 5 Estimated depth to high ground water: feet . Please indicate all methods used to determine the high ground water elevation: I ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date ❑ Observed site(abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health-explain: ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: { You must describe how you established the high ground water elevation: FROM PERC DATA ON SYSTEM# 1 i • I Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 I II l Commonwealth of Massachusetts Title 5 Official Inspection Form . I a Subsurface Sewage Disposal System Form.-Not for Voluntary Assessments I 45 OLD JAIL LN Property Address BATES Owner Owner's Name information is BARNSTABLE MA 1-4-13 required for every page. CitylTown State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems)completed ® System Information—Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file I i. I, 1 1. I I I I I I I i I I I t5ins•11/10 Title 5 Official inspection Form:Subsurface pecG Sewage Disposal System•Page 17 of 17 I j I I f'I, O' CC) sY5 � aa�o 4 f I d _ � :� A S Commonwealth of'MassachuseM Title 6.Official Inspection form Subsurface Sewage Dlsposal:System Form=Not for Voluntary Assessiinerrts 45 OLD JAIL LN Property Address BATES Owner Owner's Name information is BARNSTABLE MA 8/16110 required for � -- ' every page: Cityrrown State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary:A;B,C,_D,or E checked ® Inspection Summary D(System Failure Criteria Applicable'.to All Systems)completed ® System Information—Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attachedin.separate file tsms-MM � Tftr 5 Mr1a1 Insombon.%ft:Bi afface Sewaye Disp a SWem�•Pate 17 of 17 No. -2 — v / Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in com uter: PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS Yes ftpYication for 30isposai 6polem Construttion 3permit Application for a Permit to Construct( ) Repair(14"ou'pgrade( ) Abandon( ) ❑Complete System ndividual Components Loca,gin Address or of No. 1,15-Gl c, I,,,n➢ Owner's Name,Address,and Tel.No. �r �5 2q o-1 Assessor's Map/Parcel Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No. A 13tow•jX;,,c $C6-9C0 7/5`7 �,✓3/..+YY NJ (.Ja.-/es -Y77-5-7/3 Type of Building: Dwelling No.of Bedrooms Lot Size 'SS y7'j sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 3 3C) gpd Design flow provided 2j 3 gpd Plan Date 121 t 4 t 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) t 5{ an s ,_ LNC. � C� -�P-�- -selpi is la,p krnn S I kl►, S. s -�o r Tin e � N ` ' Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. p Date 2 Appl ication Approved by Date Application Disapproved by Date for the following reasons Permit No. a0 �(J N Date Issued .L Z 9� L/Ot No. I , / Fee THE COMMONWEALTH OF,MASSACHUSETTS Entered in com uter- PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS Yes .i.�.T r 11 I ftpIication for ]Disposk Rem Construction Permit Application for a Permit to Construct( ) Repair(, Upgrade( ) Abandon( ) ❑Complete System. ndividual Components l Location Address or Lot No. 1-/S old )c. ,) L Aj Owner's Name,Address,and Tel.No. 13 G(NS N-01bti to Assessor's Map/Parcel -7q 0 q d-PS Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No. .U1G s A Q3(vw j.S,,c SC)B-RICO' 7/5`7 5 Sz0!5-.4177-T 3/3 Type of Building: Dwelling No.of Bedrooms Lot Size :5 S U j'j sq.ft. Garbage Grinder( ) _ I Other Type of Building ,,"o No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 3 gpd Design flow provided 3 3 t gpd Plan Date I ! Number of�shee6 Revision Date Title I Size of Septic Tank eo f 5 Type of S.A.S. Description of Soil I � I Nature of Repairs or Alterations(Answer when applicable) N i Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of ! Compliance has been issued by this Board of Health. � I Srgn v Date Application Approved by Date u Application Disapproved by Date for the following reasons Permit No.)0 _ Date Issued L ------------------------------------ THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired .,/Upgraded( ) Abandoned( )by A n, at - has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. /Z ' %dated 1 2 Z Installer a -s4 Designer m , #bedrooms �'!c101( S V S{P� 54-6k [ Approved design flow gpd - The issuance of this permit shall tt bed as a guarantee that the syste will fu c io sig ed. Date ��//� Inspector - - --------------------------- --------------- ------------------------------------------------------------------- - -- No. ') I ) - y Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE, MASSACHUSETTS Misposai 6pstem nstruction i3ermit Permission is hereby granted to Construct( ) Repair( Upgrade( ) Abandon( ) System located at Old J G ,I (FN :Ft,(n,-s } t 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 m st be completed within three years of the date of this permit. Date Approved by �`V�'• �� Town of Barnstable Regulatory Services $ Thomas F. Geiler,Director = Public Health Division Thomas McKean,Director 200 Main Street, Hyannis,MA 02601 Office: 508-86246144 Fax: 508-790-6304 Date: 4— / Sewage Permit#�Of`2- YOB Assessor's Map/Parcel 2.79 —0 Q7 Installer&Desianer Certification Form Designer: 1✓n�; n�,a.r.�,„� Wa r4s, Inc . Installer: �, `'`�'^ C- Add ress: i z W. Cra s S :e I RJ, Address: A- ._. oz.�3Z- On /02 ;z 2 <, was issued a permit to install a (date (installer) septic system at (AOC /3?r/Lf/q 6 based on a design drawn by / ��-� & oe� (address)' _� _ ��v! dated / �- �- . designer) 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. Stripout (if required) was inspected and the soils were found satisfactory. 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. Stripout (if required) wa cted and the soils were found satisfactory. OFMgss9 PETER T. tiN g WENTEE staller's Signature) CIVIL y ,9 No.35109 ,BTEp'� S O esigner's Signature) (Affix Design re) PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS- BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. q:\office forms\desigiercertification form.doc o TOWN OF BARNSTABLE -LOCATION L1 5- C?O� t rJe SEWAGE# a101`� -LtQ Ll •VILLAGE(tVs'00) e ASSESSOR'S MAP&PARCEL OZI 0 9 7 INSTALLER'S NAME&PHONE NO.�,k��5 SEPTIC TANK CAPACITY,.r LEACHING FACILITY.(type) Coo G�ullon% C�4A,�Hs N ao(size) NO.OF BEDROOMS 4i Jsic_\ f(opt`(i-Y tt.c.s X t)e_pf ICS OWNER F-r S PERMIT DATE: 1 l "f� 1'2— COMPLIANCE DATE:Separation Distance Between the: Noah 4FNCGVMo-e- lCc� Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility <<NS R'(C Feet Private Water Supply Well and Leaching Facility Of any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) 11 Feet FURNISHED BY 3 tj oar — 0 0 CD P \ I � ar'- D" Sq,H 1) 57;t7 R 'I G 1- 71,5 �a� u w r y m *� ds. ICA Qv e� F s 64 $ c tom ; — a v � C7 g o t7 m a� � z •• � � o, O a a W 00 3 o coo a �'. p I a �g p � • x w oa �r Z. r - p CD n o On to ep HEL . v ? to .... ca Ct cm O A r. b7 IL Aa �� J\11 - o. DEEP.OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture. Shcl Color Soil —Other Surface(in.) .(USDA) (Munsell) Mottling (Stiucture;;Stoncs r Bouldas.' c, s� �0Y�'z ''ly '7z-120 L >`S Z. 7Y le . 4, F(3w� DEEP OBSERVATION HOLE LOG " Hole# 2- Depth from Soil Horizon Soil Texture Soil Color Sal Other. . Surface On.) (USDA) (Munsen) Mottling (Structure:Stones,13oulders. consistgngy.-S 5L �a y� ply a,tSty Qo . s �6 =(.l� c� � i`s z:�Y�r�► Cnbb�QS (�u.�It:J�:�S DEEP-OBSERVATION HOLE LOG 'Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other. Surface(in.) (USDA) (Munsell) Mottling (Structure.Stones',20uklem DEEP OBSERVATION HOLE LOG Hole# Depth-from Soil Horizon Sal Texture Soil Color Soil Other Surface(in,) (USDA) (Munsell) Mottling (Structure.,Stones 1Bouldm. Floodl Intranet Rate Man: AboVe SW-year':flood boundary No_ Yes Within`500 year'boundKV No Yes Within l00 year flood boundary No Yes Depth of Naturally Oceurrin2 Pervious Material Does'at least four ftet of naturally occumng pervi us material exist in all areas observed througlout,the: , area ro for the soil absorption system? �S If not,what is the depth-of naturally occurring pervious tnatorial? -•Cei�ifieation � I certify that>on 1 (a (date)I have passed the soil evaluator examination approved by'the Department of Environmental Protection and that the above analysis was performed by me consistent with the required-training;.texpertise and experience described in�10 CMR 15.017. Date Signature . Q.WEVnC1,PBACPORM.DOC -. I MO No. 3�OFee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: - CS PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS application for 33i!6pq r PAndon em Construction Permit 4, r OL6 Application for a Permit to Construct( ) Repair( ) Upgrade( ( Complete System Individual Components Location Address or Lot No. Owner' Name,Address,and Tel.No. ,S�Ghtt/ jj��1711OTri ��/ �os ^, Assessor's Map/Parcel �y- Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. IT,G. A4. /110 .­r ' zWA Type of Building: SM a51`/ 776 Z 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) gpd Design flow provided gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) �daw�•7 S..s7&.>" moo? (see fi{'r�tLi D.'DiP i�•� fD Js,s�+�1 Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this B of alth. G Signe Date, Application Approved by Date Application Disapproved by: Date for the following reasons Permit No. Date Issued Nor a Fee • THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: es PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS• 0(ppCieation for Miqogar stem Con4.truction:Permit 45- 0/_6 zi4 r�6, Application for a Permit to"Constl'uct O Repair( ) Upgrade( ) Ab�rtdon(V ❑Complete System Individual Components Location Address or Lot No. Owner's Name,Address,and Tel.No. ^a �/ Assessor's Map/Parcel � 7 r Old J4• i Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. TC, A,- /,O"o c,- ,-/ Type of Building: 5M .2 57`/ 77,,- z Dwelling No.of Bedrooms �,a.r Fr �f Lot Size sq. ft. Garbage Grinder ( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min. required) gpd Design flow provided gpd Plan Date 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) S�.s 7e 1o? / Sp E SkP 7'.rL, ) . i i Date last inspected: Agreement: ; The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this o/H Ith. Date A�2 i Application Approved by / Date Application Disapproved by: Date for the following reasons Permit No. Date Issued _ THE COMMONWEALTH OF.MASSACHUSETTS BARNSTABLE; MASSACHUSETTS (Certificate of (Compliance, THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed ( ) Repaired ( ✓) Upgraded ( ) Abandoned( ✓)by fr_ at 1216 / L n has een con ructe 'n a rdance with the provisions of Title 5 and the for Disposal System Construction Permit No. dated Installer J,C, /'/G ✓ C�fl. Designer #bedrooms Approved design flow gpd The issuance of this permit shall not be c/o�nst ed as a guarantee that the system Il func o as signed. Date ( U ).C) Inspector .----No,l.---f._---�`�,��---------_----------- —_,—__ Fee~— i THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS lio0q;al *pgtem Co 5truction Permit Permission is hereby granted to Construct (_ ) Repair ( '\) U gr de Bandon (K System located at y� /� ,�,� Z,,,- Y /C� I 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: Corotructipn must be completed within three years of the date of this permi Date Approved by ` 5 - r F Ro;vT l Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 45 OLD JAIL LN Property Address BATES Owner Owner's Name information is BARNSTABLE required for MA 8/16/10 every page. City/Town State Zip Code Date of Inspection 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. 'mp°'a"t When filling out A. General Information forms on the computer,use 1. Inspector: only the tab key to move your DOUGLAS A BROWN cursor-do not use the return Name of Inspector key. DOUGLAS A BROWN INC Company Name P.O. BOX 145 Company Address CENTERVILLE' MA 02632 `e Cityrrown State Zip Code 508-420-4534 S14297 Telephone Number 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 cr Title 5(310 CMR 15.000).The system: o o ElPasses ® Conditionally Passes ❑ Fails c c� o ❑ Needs Further Evaluation by the Local Approving Authority ~ T CC) W n 8/16/10 7Z-) Cn Inspector's Ognature Date 1✓ y ! The system inspector shall submit a copy of this inspection report to the Approving Authority(BNgd M m of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP.The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. i trine 09A9 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Pepe t of 17 I i Commonwealth of Massachusetts _ Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 45 OLD JAIL LN Properly Address BATES Owner Owner's Name information is BARNSTABLE required for MA 8/16/10 every page. Cllyrrown State Zip Code Date of inspection B. Certification (cunt.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ❑ I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below. Comments: B) System Conditionally Passes: ® 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 Health. "A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND(Explain below): SYSTEM#2 APPEARS TO CONSIST OF A SINGLE LEACH PIT THAT IS IN HYDRAULIC FAILURE, HOUSE HAS 5 BDRMS, SYSTEMS#1 AND#3 CONSIST OF 1000 GALLON TANKS D- BOX AND 1000 GALLON PITS EACH. IF UPON B.O.H REVIEW IT IS DETERMINED TO BE ENOUGH FOR 5 BDRM FLOW,OWNER PROPOSES TO ABANDON FAILED PIT AND CONNECT TO SYSTEM#1 ACCORDING TO AS-BUILT CARDS PIT#3 IS A 4X6FT DEEP PIT WITH 2 FT OF STONE,PIT#11S A4X6FT DEEP PIT WITH 3.5 FT OF STONE BOTH PITS HAVE @ 15"AND 18" OF USABLE SPACE AT THIS TIME erns-09)08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Pape 2 0l 17 I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments j 45 OLD JAIL LN Property Address BATES Owner Owner's Name information is required for BARNSTABLE MA 8/16/10 every page. Cityrrown State Zip Code Date of Inspection B. Certification (cunt.) 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 j pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND(Explain below): j ❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND(Explain below): I I I I ❑ 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 [:IN ❑ ND(Explain below): I I I I i 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 manner which will protect public health, safety and the environment: i ❑ 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 fts•09Af3 Title 5 Official Inspection Form:Subsurface Sewage Dlapoael System•Page 3 of 17 I I Commonwealth of Massachusetts -= Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 45 OLD JAIL LN Properly Address BATES Owner Owner's Name information is BARNSTABLE required for MA 8/16l10 every page. City/Town State Zip Code Date of Inspection B. Certification (cunt.) 2. System will fail unless the Board of Health(and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: This system passes if the well water analysis, performed at a DEP certified laboratory, for coliforrn 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 dogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6"below invert or available volume is less than%day flow tsms-09= 7Ne 5 Official Inspection Form:Subsurface Sewage Disposal System•Pepe 4 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 45 OLD JAIL LN Properly Address BATES Owner Owner's Name information is BARNSTABLE required for MA 8/16/10 every page. Cltyrrown State Zip Code Date of Inspection B. Certification (cunt.) 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. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [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- 10,000gpd. ❑ ❑ The system ftiLs. 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 ❑ ❑ 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. t5ins•osuoe TMe 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 45 OLD JAIL LN Property Address BATES Owner Owner's Name information is gARNSTABLE required for MA 8/16110 every page. CltyRbwn State Zlp Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes"or"no"as to each of the following: Yes No ® ❑ Pumping information was provided by the owner,occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined?(If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ❑ ® Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid,depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)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: Number of bedrooms(design): NA Number of bedrooms(actual): 5 DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): Title 5 Official Inspection Form:Subsurface Serrape Dleposal System•Pepe 6 of 17 I I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments I 45 OLD JAIL LN Properly Address I BATES Owner Owner's Name information is BARNSTABLE required for MA 8/16/10 every page. City/Town State Zip Code Date of Inspection D. System Information Description: PROPERTY HAS 3 SYSTEMS CONSISTING OF 2 1000 GALLON TANKS(1 POLY)2 D-BOXES AND THREE 1000 GALLON LEACH PITS#20F WHICH IS NOT CONNECTED TO A TANK AND IS IN HYDRAULIC FAILURE I i Number of current residents: I Does residence have a garbage grinder? ❑ Yes ❑ No Is laundry on a separate sewage system?[if yes separate inspection required] ❑ Yes ® No Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No I Water meter readings, if available(last 2 years usage(gpd)): Detail: �(C( C( Ct)l ce G 1P T i Sump pump? ❑ Yes ❑ No Last date of occupancy: Date Commercial/Industrial Flow Conditions: I Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) 1 Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No j Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins-oeroe Title 5 Official Inspection Form:SubsuRace Sewage Disposal System-Page 7 of 17 i I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 45 OLD JAIL LN Property Address BATES Owner Owner's Name Information is BARNSTABLE required for MA 8/16/10 every page. City/Town State Zip Code Date of Inspection D. System Information (cunt.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: PETE DEBARROWS Was system pumped as part of the inspection? ® Yes ❑ No If yes, volume pumped: 3000 GALLONS gallons How was quantity pumped determined? PETE DEBARROWS Reason for pumping: MAINTENANCE Type of System: ❑ Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system(yes or no)(if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology.Attach a copy of the current operation and maintenance contract(to be obtained from system owner)and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank.Attach a copy of the DEP approval. ® Other(describe): 3 SEPARATE SYSTEMS t5ms•ogoe Title 5 Official Inepectlon Form:SubeuAace Sewage Dlspoael System•Page 8 of 17 i I Commonwealth of Massachusetts Title 5 Official Inspection Form ' Subsurface Sewage Disposal System Form-Not for Voluntary Assessments I 45 OLD JAIL LN Properly Address BATES Owner Owner's Name information is BARNSTABLE required for MA 8/16/10 every page. Cltyrrown State Zip Code Data of Inspection D. System Information (cunt.) Approximate age of all components, date installed(if known) and source of information: SYSTEM#1 1982, SYSTEM#2 UNKNOWN SYSTEM#3 1991 Were sewage odors detected when arriving at the site? El Yes ® No j Building Sewer(locate on site plan): i I Depth below grade: feet I Material of construction: ❑cast iron ❑40 PVC ❑other(explain): Distance from private water supply well or suction line: feet Comments(on condition of joints,venting, evidence of leakage, etc.): i I Septic Tank(locate on site plan): Depth below grade: #1-1.5 FT#2-1 FT#3-2FT feet Material of construction: ❑concrete ❑metal ❑fiberglass El polyethylene ❑other(explain) SYS#1 CONCRETE SYS#3 POLY TANK SYS#2 NO TANK FOUND i If tank is metal, list age: years I Is age confirmed by a Certificate of Compliance?(attach a copy of certificate) ❑ Yes ❑ No Dimensions: Sludge depth: ,sine-09108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 45 OLD JAIL LN Property Address BATES Owner Owner's Name information is required for BARNSTABLE MA 8/16/10 every page. Cityfrown State Zip Code Date of Inspection 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? Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert,evidence of leakage, etc.): BOTH TANKS AND SINGLE PIT WERE PUMPED FOR MAINTENANCE AT TIME OF INSPECTION 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 151ns•09OB Tft 5 Wicial Inspection Form:Subsurface Sewage Dlsposal System•Page 10 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 45 OLD JAIL LN Property Address BATES Owner Owner's Name information is required for BARNSTABLE MA 8/16/10 every page. City/Town State Zip Code Date of Inspection 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 Holding Tank(tank must be pumped at time of inspection)(locate on site plan): Depth below grade: Material of construction: ❑concrete ❑ metal ❑fiberglass ❑ polyethylene ❑other(explain): Dimensions: Capacity: gallons Design Flow: 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 151ns•09108 Title 5 Official Inspection Form:Subsurface Sewage Dlsposel System•Pape 11 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 45 OLD JAIL LN Property Address BATES Owner Owner's Name information is required for BARNSTABLE MA 8/16/10 every page. Cityrrown State Zip Code Data of Inspection D. System Information (cunt.) Distribution Box(if present must be opened)(locate on site plan): Depth of liquid level above outlet invert 0" Comments(note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): BOTH D-BOXES WERE LEVEL WITH NO SIGNS OF LEAKAGE SLIGHT SCUM LAYER IN BOTH PROBABLY DUE TO AGE Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No Comments(note condition of pump chamber,condition of pumps and appurtenances, etc.): Soil Absorption System(SAS)(locate on site plan,excavation not required): If SAS not located,explain why: ALL THREE PITS WERE OPENED AND INSPECTED t5ins•11 W Title 5 Olficlal Inspection Forth:subsurface Se wage Disposal System•Pepe 12 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 45 OLD JAIL LN Property Address BATES Owner Owner's Name information is required for BARNSTABLE MA 8/16/10 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: ® leaching pits number: 3 ❑ leaching chambers number. ❑ leaching galleries number. ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number. ❑ innovative/alternative system Type/name of technology: Comments(note condition of soil,signs of hydraulic failure, level of ponding,damp soil,condition of vegetation,etc.): PIT#1 HAS @ 15"OF USABLE SPACE PIT#3 HAS @ 18"OF USABLE SPACE PIT#2 IS FULL AND IN FAILURE Cesspools(cesspool must be pumped as part of inspection)(locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins-09IDS Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 45 OLD JAIL LN i Property Address BATES Owner Owner's Name information is BARNSTABLE MA required for 8/16/10 every page. City/Town State Zip Code Date of Inspection i D. System Information (cunt.) Comments(note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation, etc.): I i Privy(locate on site plan): j Materials of construction: Dimensions Depth of solids Comments(note condition of soil, signs of hydraulic failure, level of ponding,condition of vegetation, etc.): i I I I I i i i t5ins-osoe Title 5 Official Inspection Form:Subsurface Sewage Deposal System•Page 14 of 17 I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 45 OLD JAIL LN Properly Address BATES Owner Owner's Name i is required for BARNSTABLE MA 8/16/10 every page. Cily/Town State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ❑ hand-sketch in the area below ® drawing attached separately t5tne•09OB Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Pepe 15 of 17 i Commonwealth of Massachusetts I Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 45 OLD JAIL LN Property Address BATES Owner Owner's Name information is required for BARNSTABLE MA 8/16/10 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cunt.) Site Exam: i ® Check Slope ® Surface water I ® Check cellar ® Shallow wells Estimated depth to high ground water: GREATER THAN 5 FT feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record I If checked,date of design plan reviewed: Date ❑ Observed site(abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health-explain: I ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: j I I 1 You must describe how you established the high ground water elevation: HAND AUGERED TO 5 FT ON LOWEST PART OF PROPERTY NO G.W. ENCOUNTERED, ALL THREE SYSTEMS WERE WELL ABOVE WHERE I AUGERED I I i Before filing this Inspection Report, please see Report Completeness Checklist on next page. I tsms•09u0e Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Pape 18 of 17 I I i ' f Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments - 45 OLD JAIL LN Property Address BATES Owner Owner's Name information is BARNSTABLE required for MA 8/16/10 every page. Citylrown State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary:A, B, C, D, or E checked ® Inspection Summary D(System Failure Criteria Applicable to All Systems)completed ® System Information—Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5hs•os)De Me 5 rnrcial Inspectbn Form:Subsurface Sewage Disposal system•Page 17 o1 17 - - ---- ------------- \�` S 01,000 SYS 0 F� NT Cl Sysf-etv\ . I Apr 23 .04 09: 51a Richard Batas 508-362-8479 p. 1 UNREGISTERED LAND FILE NUMBER: 47292 DEED BOOK, 4404 PAGE 162 CLIENTs Apostolica,Gilmartin,Donovan&Donovan PLAN/DEED BOOKt 377359 PAGE:_ �1 �7 LOT(5): 2C OWNER: Loucas S &Consfance A. Dimau PLAN NUMBER: OF . APPL4ICANT Richard Bates REGISTERED L A N D DATE: 3-18-91 SCALE 51"`- REGISTRATION BOOK: PAGE: CENSUS TRACT N/A CERTIFICATE OF TITLES FLOOD HAZARD INFORMATION PLAN NUMBERi LOT(Sh FLOOD MAP COMMUNITY NO,: 250001 ASSESSORS MAP PANEL: 00031C DATED: 8-19-85 MAP:BLOCK PARCEL.:— MORTGAGE INSPECTION PLAN IN B A R N S T A B L E N/F Stteenstra +�30.0 - ---�— v .. ��- -. - ?ro,7 272.41-1 " Pipe i Di 1r `out Breezewpy r. Pd/F . � GagE r- � I :Shed ~- Enclosed Porch c; F 1_Uf s 1 & LC Lot 2D Jacuzzi 55,477 SF- y zr N/F T- Holway La 740.001 OLD JAIL LANE Tt 4I S IS THE RESULT OF TAPE MEASUREMENTS, NOT THE RESULT OF AN I NSTRUOIE:NT SURVEY AND IS CERTIFIED TO THE TITLE INSURANCE COh1PANY, APOSTCL_ICA, GILMARTIN, DONOVAN & DONOVAN AND MORTGAGE CORP OF THE EAST, III, THERE ARE NO EASEMENTS OR ENCROACHMENTS WITH DES LAURIERS&ASSOCIATES,INC. RESPECT TO BUILDINGS SITUATED ON THIS LOT 161 W ASNiN GTO N STREET EXCEPT AS SHOWN. EAST W a L P o L E, MA 02032 --- . lE LOCK ON OF THE DWELLLING SHOWN DOES NOT 800 10 (508) 668-50I0 FALL AIM 1 N A SPECIAL FLOOD HAZARD ZONE. THE LOCATION OF THE MELLING AS SHMN HEREON Ei11iER WAS IN COMPLIANU WITH THE 1 (01 7f1N INfi, 1EE 0w R r II � 11 • A , o�� TOWN OF BARNSTABLE 0 � LOCATIO 6� r N, � c�-' � O � U �--c SEWAGE # VILLAGE j4 tZN S-t ASSESSOR'S MAP 6z LOT-�✓7 INSTALLER'S NAME & PHONE NO. SEPTIC TANK CAPACITY No �y z I C � S 4(��� LEACHING FACILITY:(type) Pg-e -C4S r® (size) NO. OF BEDROOMS-aZZ PRIVATE WELL O B�WAL BUILDER OR OWNER (�- ��(���1' jo, 96,7r:,- S DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: `" � VARIANCE GRANTED: Yes No Al' C� Q -� s c � � o � b � � � `� �- _ � ,�, � � _ -- _ � � � h / � � 1 �� I . . _. -�- � � a ��� � .o, � � � �� � �. l� � �� DUI � � F � � �� -� � � �,: ai � � � � � �, �� ,. No.Z/:._ 2) Fims.... 30....'___ THE COMMONWEALTH OF MASSACHUSETTS a \ BOAR® OF HEALTH TOWN OF BARNSTABLE �� �7 Applirattun for 14spusal Vurks Tonstrnrtiun Famit Application is hereby made for a Permit to Construct ( ) or Repair ( J�n Individual Sewage Disposal System at: Location-Ad ess or Lot No. ............:P :t .x _...... ems.-----------...... ............... ----.......................................... Owner Address a -� ` -- - Installer Address S feet � Type of Building �_ Size Lot___________________________ q. U Dwelling No. of Bedrooms.............................. Expansion Attic a g— -----•--- p ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) dOther fixtures -----------------------------•-----•--------------•--•------•---------------•--•-------...----------- W Design Flow__________ gallons per person day. Total d flow__._.__._ .................gallons. g ?-----------'-...........-g P P �/ y gal WSeptic Tank-1Liquid capacity�'�-!�gallons Length.... .......... Width__.. ...._._... Diameter................ Depth................ x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. � t Seepage Pit No..L_..'.'.A............ Diameter....1Q__........ Depth below inlet....`__....... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date........................................ a Test Pit No. 1................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 V ...........................................................-----••----------------•---------------------•-------------••------------- --••----.....•----•----•-----•------------.......----......_....-- --------------------------------------------------------•----------------------------------•-------•------------------•---------•-----• -------- ------ - ------ U Nature of Repairs or Alterations—AnswGr wlyn applicable____-_d�'_ �Ll.�..1_........__�_ ?......p«_.�i............. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Compli,gnce has beekil issued by the boar of health. Signed ........l Date Application Approved B �pp pp y ----------------ae U - - - -- ----------------------...........------------------------. �..�...�f� Application Disapproved for the following reasons: ............................................................................................... ................................... .................. ----------------------------- - ------------------.................................-------------------............................................................ ----------------------------------- ..................................... --7 Date PermitNo. -------- —--.-.Z-.-1--------------_----_- Issued ........................................................Da Date h ). rY i OJ No.. �-- 7; F$s_. r-- LTH MASS THE BOARD AOF OF HEALTH S TOWN OF BARNSTABLE Appliratiun for Disposal Murks Toustr awn jrrmi# Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal system at: o =---- ------------------------------- ----------------------- -- ---------------------------------___.._._....... P (L\L ocadbn-Addr�s G�- S V+_�or Lot No. ------------------------------------------- .....-'------...._ _ Address W ,-� - - -------------- -- -- ----------------------------------- •--------------------_--------------------------------------- ---- Installer Address d Type of Building Size Lot---------------------------Sq. feet Dwelling—No. of Bedrooms--------------------------------------------Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ____________________________ No. of persons--------------------------- Showers ( ) — Cafeteria Otherfixtures----------------------- -- ------------------------------------------------------------------x T l W Design Flow.----t----------------------------1_,,gallons per person pe�ay. Total daily flow-------.------------.-----.-.---------------gallons. WSeptic Tank—Liquid-capacity-_____.___--gallons Length---------------- Width................ Diameter---------------- Depth--_.___•____-_-. x Disposal Trench—No`____________________ Width-1 ------------ Total Length----------- L Total leaching area-------------------- ft. Seepage Pit No--------------------- Diameter-------------------- Depth below inlet-------------------- Total leaching area------------------sq. ft. Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by-------------------------------------------------------------------------- Date_--------------------------------------- Test Pit No. I________________minutes per inch Depth of Test Pit-------------------- Depth to ground water..___---__-__-__.._-.__. f=, Test Pit No. 2---------------- mutes per inch Depth of Test Pit-------------------- Depth to ground water--____-_-.____-_---_._ a --------------------------*-------------------------------------------------------------------------------------------------------------------------------- 0 Description of Soil---------------------------------------------------------------------------------------------- ------------------------------------------------------------------------- x c, - __... W ------------ ---------------------------------- --------------------------------------------------------------- r, . I U Natured of1L °r Alteratisa�Answ�r, ve> apble r rat�t =< -------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------------------------------------- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation,unril a Certificate of Com_ anc has-been ''su Eby tli-board o h_ealth. tSigned ----------------------------- - ------------------- ---------------------------------------- Da Application Approved,By ----------------- ' �J--- -------, " Dam Application Disapproved for the follouring reasons- ------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------ -------------- -- ---- ------ -- -------------------------------------------- -------------------- -------------------- --�/ 02.E Dre Permit-No. / Issued Dw THE COMMONWEALTH OF MASSACHUSETrS BOARD OF HEALTH --, TOWN OF BARNSTABLE (ger#ifirz& of 01untylianre THIS IS TO CERXIFY� at the I dividual Sewage Dis sal System constructed ( ) or Repaired b -------------------------I v,�°� _ Y - -- ------------------------------- ------------------- -------------------------------------------------------- -- -� S D ' at -------------------------------------------- - Y has been installed in accordance with the provisions of TITLE 5 of4be State Environmental Code as described in the application for Disposal Works Construction Permit No. --------- r----c - -- .-__ dated ------------------------------------------------ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNC�[ON jA�.ISFACTORY. '-�1J DATE ----------------------------------------------------------------------------------------------------- Inspector ---------------------------------------- --------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE _210 Disposal Nor. TPermitp�` L,,� .y , Permission is hereby granted-------- - - -- -- — - -- -- - --------------------------------------------------------- to Construct ( ) or Repair[([ a-can�n�dti du&S, ale DtpaW S stem atNo--------—- --__. -___ _-------- — - -- ----------------------------------------------------------------------------------.-- street as shown on the application for Disposal Works Construction Permit No._- ..................................... __ r Board of Health FortM 365M H088S&WARREN,IW_PUBUSHMM No.—I....a.-!:®/ .� _ . • - - - -�.: s Fx$......`.....�/........... THE COMMONWEALTH OF MASSACHUSETTS b � BOAR® OF HEALTH \wI Appliration for Bh4p sal Works C omarurtimt Frrutit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: ' .. � �1� I L..? �.: ... . - . J....Q.k...... ............. J? r.)S TA g ................................ Location-Address or Lot No. .... --k'r ,��.-s�. �� -. `.i .....7. .......................................... -.......................................... ........ ner Address a -•-•-••-••-••-•--- •-• -- -•----•--•-•-----•-•----•-••- •-----••••-----••.......................... •-•---•-••---......._..................---•-...__. ... M staller Address Q7i Type of Building Size feet aDwelling—No. of Bedrooms.................:_.....................Expansion Attic ( ) Garbage Grinder aOther—Type of Building ____________________________ No. of persons............................ Showers ( ) — Cafeteria ( ) Otherfixtures -----------••-- --------------•-•----•---------•-------•--------•------------------------- W Design Flow......................:. ............gallons per person per day. Total daily flow...... 3 3 _..________._.._._.gallons. WSeptic Tank—Liquid capacity_15.9_0_gallons . Length--A.!......... Width............ Diameter________________ Depth_. ......... x Disposal Trench—No......................Width.................... Total Length.....................Total leaching area....................sq. ft. Seepage Pit No...........l......... Diameter........ _._. Depth below inlet____............ Total leaching area_!'2.(cP....sq. ft. Z Other Distribution box ( y' Dosing tank ( `)--- '-' Percolation Test Results Performed by.........1—_ A !> .._p_ -.... Date....Z ?- _..� .�.:.,..... Test Pit No. 1... .Z____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........................ P ......................... _.......---•.-__..----•-----•-•---�........................................................... •-----._....--- -........-•--•---------•----•---•----- O Description of Soil..............•------•--•--......... .2 �..��......... '`�'`� ----._ .................. 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 Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance ha i sueAbye bo t alth —Signed------ - - --- _ - •• •-----••----_----•--••- ............................... Date Application Approved By___. ... a._!l_.. ,......... --X2,�•-•-_-._- Date Application Disapproved for the following reasons__________________ ...--•---------------•------------------------•--•------__ .-_-_••••_-___ ......................•---•---------•---_....._....•-----._...--••--.....••••---•-•-•--•--•-••------...•---------_...__...•------------------------.................................................... Date PermitNo......................................................... Issued....................................................... Date s ' • j, „ ' V No...... .: .. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH �. ................of.......�.-�.......et..1.s.�.A+3--L=- Appliration for Dispaa al Works Tomarnrtinn rrmi# Application is hereby made for a Permit to* Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: L>...Tts_ LAJ= . ..... z =.................................... •cocation•Ad resc .... Lot No.-••-•--^................................ ca W �,,,� Address ............................................. •--•--- ........... ........... ............----•---•--•---•---........-•-•------••-•-•-•--•••---.........._......--•-- .......14 nstaller Address Type of Building Size Lot_ n nD _Sq. feet,- Dwelling—No. of Bedrooms.................3......................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ____________________________ No. of persons.............................Showers ( ) — Cafeteria ( ) Otherfixtures ........................................... --------•-•••-•-•---•-•••-•-••-•-•-••••------=•-•-••--•--•-•.............•--•...•-•---•_...__._..._.._. W Design Flow............................................gallons per person per day. Total daily flow--------------- ..U____.--____________gallons. WSeptic Tank—Liquid capacity.15— gallons Length-JA.......... Width.... Diameter________________ -------------gallons. x Disposal Trench—No_____________________ Width______.i_._......... Total Length.................... Total leaching area............__......sq. ft. Seepaa"Pit No..........�_________ Diameter....... _._._. Depth below inlet___q.______..... Total leaching area_L �.._.sq. ft. Z Other Distribution box Dosing tank `" Percolation Test tiResults Performed by.....__.z___. ..._ E:...-- Date....ZIZ Test Pit No. 1__ -___.minutes per inch Depth of Test Pit......._ ....... Depth to ground water_.__1-�_�^?•. ,_ f14 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ P4 ............................................................................................--••••......................................................... Description of Soil------------------------------------�....... - V ---------------.......................................................... ............................................... ................................................. UW -•••----••••----------------•-----•-••-••--•--•---•••--••----•••----••-•-•-•••-------•----•••••---••-N---------------------------..... --------•-------------•---_--•---------•-•-----------•-•--- Nature of Repairs or Alterations—Answer when applicable__ __________________________________________________________________________________________ -=----------•--•-------------•-----....--•-------------•-------._...------•••••••••••----t-=•-•---••••-----•-------•-••----•-••••--•-•-•----------------•-•--•....._._..----•------ Agreement: The und ersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the prox sions of TITIL 5 of the State Sanitary Code— Th&undersined further agrees not to place the..system in until a Certificate of Compliance has e��,%d by e bOar- oDeration Signed --=-- _..__ .. Date Application Approved By--------------- ? ...... S:Tlft Date Application Disapproved for the following reasons----------------•--------- ......................... .....................•----•--•------..._..--•---....-------...-------•----•------....---.....-----...---- ---•----------•---------------------------...-----------------------•• ...................... Date PermitNo...............................:y.-...................... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS 1 . BOARD F HEATH ..... .........OF.............................................................. :._.................... i Qurrfifiratr o;aq umpliFaurr ✓� THIS IS TO CERTIFY, That the In)gkal ewis a to co rutted ( ) or Repaired ( ) by-•---.....-••••-••••-•-•----•-•-•--•------•-......_.._ .................••--•--_--••-- •••-...------.........---•-•-••-•-•--•----•--•---...-•-----•-•-----•••--..._......•-----•-•- at.........•%-- ........ _Ao`•...... .---••-......-••---•I... ---•--•--------•------------•---...---•--•-•---•-•-•--------••-•----------------•-------- has been installed in accord�'>nce with the provisions of TITS S�q�T}ie State Sanitary Code asldescribed in the application for Disposal Works Construction Permit .____.`.............................. da.ted_......-------------:............................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM WILL FUNCTIONSATISFACTORY. DATE... 3. . ;j 1 ................ Inspector............. BUJ.................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD (RF HEALTH No.... OF.•..............................................••-••-......._...._........••-•..... FEE........................ DisposFa1 rk inn, ; midPermission is hereby granted-•--• Pat ------------•----•-------•-----------•-•------.....-----....._.......__...................-•- to Construct or Re aii � Indiv•dua wa a Dis o stem at No 61/ �-1' j Street �p��! �/ 14 as shown on the application for Disposalt'�_�orlcs Construction rm No ............. D ....................... Boar of Health y.............................. DATE....................... ........................................................ FORM 1255 HOBBS & WARREN, INC.,•PUBLISHERS ... TOWN Or BARNSTABLE UNDERGROUND FUEL AND CHEMICAL STORAGE SYSTEMS a S CCi ASSESSORS MAP NO. 7(1 PARCEL NO. 9 ADDRESS�Q.CzT/L L�1/YE �Q +So)( ;S'�/ VILLAGE B.4iF'✓1/J'%ABLE CONTACT PERSON PHONE NUMBER LOCATION OF TANKS: CAPACITY: TYPE OF FUEL AGE: TYPE: LEAK OR CHEMICAL: DETECTION SYSTEM 0,,,e 9i�e/E QG DATE OF PURCHASE OF EACH: 1. 6-.�/p�,2'2. /9y0 3. 4. 5. y DATE OF FIRE DEPARTMENT PERMIT: Eg' �c'o TESTING CERTIFICATION SUBMITTED: �Le-c�,p� PASSED � I�YD OT PASS PLEASE PROVIDE A SKETCH SHOWING THE LOCATION OF TANKS ON THE BACK OF THIS CARD: I 't l i 1, I THE FOLLOWING IS/ARE THE BEST IMAGESFROM POOR QUALITY ORIGINALS) M / DATA "/a e're CERTIFICATION OF COMPLETION i`I Date ....le'' // � ...........BARNSTABLE FIRE DEPARTMENT To: HEAD OF FIRE DEPARTMENT OF COMPLETION- INSTALLATION OR ALTERATION OF FUEL Subject: CERTIFICATION I OIL BURNING EQUIPMENT .1 The undersign or undersigned hereby certifies that the installation ( alltae`attion) of fuel oil burn- ing equipment made under the authority of permit No. •••••.••••� . seeded by yo and �Fre-g�.�.—tio;n­s* to the in or /� ,phas been made in acc dance with provisions at (.�•/... /f�L.....of Chapter 149, G.L., made under authority thereof now currently in effect and pertaining thereto. in Furthermore, this installation has been tplete instructions as to its use and imninten- is now in proper operating condition and comp (or persons) for whom the installati ante have been furnished to the perso The following data applying to such installation ift submitted for the recordon was made. BURNER y Name .............................. Mfg.by .............__.-._._. ....... ............................. ................ Model No. or Siie,. .........._............................_...... � Type ............................................................ ......................................... fuel oil. To use not heavier than •...................••• STORAGE TANK Capacity S .C)... gals. (or) Size ...................................... YP � C^^�- .. Type .... 7 1 *r.... Location ••••�•. /• ' C O N t Type (automatic or manual) f Automatic shut-off valves at burner &tank Inetnlled by (� Manual shut-off valve at Lank ... .................. ................ (additional safety devices) Sellenoid_ -e�P'nn�lc�l3y ------ -------- - l 'AT10N SEWAGE PERMIT q0• VILLAGE INSTA LLER'S NA1RE ADDRESS 6 U I L 0 E R OR OWNER DATE PERMIT ISSUED DATE COMPLIANCE ISSUED ell �� 3S � � �� !�7 K it �p�..i�'' �p 1 y'7'� O ��...- p. �O� / � � � " / �� Zy' �/� 3�L G �Zo N C�� `� 5� Q�!� ��� ,J r T `I'nn ^ J -, N mom, EXISTING SEPTIC TANKco ' (TO REMAIN) EXISTING LEACH PIT �'`1 r INV.(OU T)=111.Of VERIFY TO.BE-PUMPED, FILLED;W PB 327 = PG 51 (Lot 1) '. ( ) °. [��° 5 i `r'► SAND' AND ABANDONEDPB 59 '- PG 47 (Lot ) V'` Q �r 30.00' - 272.47' _ 0 0 114.52 iV 1 l _ N , a LOCUS , r T _ a < , P 2 1P-1VENT BEDROOM la:�6 . 6,,* �f 7-'f LOTS 1 & ;2C APARTMENT �yY ; :1iSoz - L'4 ,44 t MBL -279-097 '� 117.14 116.35 Ro ` �: �, GARAGE LOCUSa MAP ' I x liar �9'' - �• NOT T A 477E . 0 0 SC LE 55 F.S - 6.21 a BRZ. ELL �� us:o1 n LEGEND A W DRl 1/EWA Y - -BN rn - - EXISTING CONTOUR�. 8 } 11325 , 9 1 6 8 ,. r , J I _ x 100.98 EXISTING SPOT GRADE k .a v i a" i12 0 _ x v _ 116.20 ' - -UNDERGROUND WIRES. 116.86 .. r 3.31 -� ° - U _ - .. - �,• +�' ; •:.,���'.: �`• `�`� . �---6.H.blf- OVERHEAD WIRES G EXISTING GAS SERVICE DECK / i 11153 111.36 ` x yy EXISTING WATER SERVICE } x 1 e.ao TEST PIT a x 108.65 `� .� �� BENCHMARK rn g° 119 X . i 111.30 i 4 I10.0 7 r � • i , �• - ,x 1lz:ze x 114:56 HOUSE(#45) �,x� . / _ G Lo, '. GENERAL NOTES: `;' -6 TOF=119.9E - 10. BOARD OF HEALT\ V i \\ \� t �.� 1. ALL CHANGES LTH AND THE DESIGN ENGINEER. TO THIS PLAN MUST BE APPROVED BY THE LOCAL t4 2 ' i i � 17 i i • i W \ , i x V 108,91.i 2: ALL WORK-AND MATERIALS SHALL CONFORM TO THE REQUIREMENTS x i r •` 106.8 . - i z i OF THE STATE ENVIRONMENTAL CODE TITLE V AND ANY APPLICABLE i • � 1\ � • ����Q� G O � a.\ LOCAL' RULES AND REGULATIONS. - SEWAGE DISPOSAL SYSTEM SHALL NOT BE BACKFILLED PRIOR •, 10 6J6 ( . 3. THE E WA G ? i i �, * I •, 4 Q ,.____ /',' i , ., �g� ,, .. .� TO INSPECTION AND APPROVAL BY THE BOARD OF HEALTH AND THE �^ DESIGN ENGINEER. _ - 4 x i 7: 11 95- � Il 46 , ` �\ * 4. ANY CONDITIONS ENCOUNTERED DURING CONSTRUCTION DIFFERING EXISTING SEPTIC --_, _ -_ _ __ % . i GS \ FROM THOSE SHOWN HEREON SHALL BE REPORTED TO THE DESIGN SYSTEM 112- -- `` i �� - ''' x� ' , '' ��` �`� ENGINEER BEFORE CONSTRUCTION CONTINUES. (TO REMAIN) ---112-X 112. �' ' �\ 5. ALL ELEVATIONS BASED ON ASSUMED DATUM. . 0.00 111jt4 x : i >; 6. THE DESIGN ENGINEER IS NOT RESPONSIBLE FOR THE FAILURE OF 10- =-__ `. J �-- SH UB / ''�� / THE CONTRACTOR OR OWNER TO NOTIFY THE LOCAL BOARD OF 113:60 -164: SPIKE3 107.7 `� `� \` pp' HEALTH FOR'PROPER INSPECTIONS DURING CONSTRUCTION. } 8 __1+ ------X_H227 _�o� i i G �' ` W 7. WATER.SUPPLY PROVIDED BY TOWN WATER SERVICE. 1 TH :P P D S.A.S. • 8. THERE ARE NO WELLS WITHIN 50' OF E, RO OSE 9. ALL AREAS CLEARED FOR CONSTRUCTION SHALL BE RESTORED AS. � a x 102:91 `" AGREED UPON BY OWNER AND CONTRACTOR OR AS OTHERWISE ° \GS DIRECTED BY THE APPROVING AUTHORITIES. y , � 10. IT SHALL BE THE RESPONSIBILITY OF THE CONTRACTOR TO VERIFY i103.40 THE LOCATION OF 'ALL UNDERGROUND UTILITIES, PRIOR TO BEGINNING `. 104.44 x - , IP'F ; 0 4,\ 03.17 \ / _`. CONSTRUCTION..' • 10 .3 Ni)-_, -�-----` '` ` •'ry 14 .Do' ` �- - 11. WHERE REQUIRED, CONTRACTOR SHALL REMOVE ALL UNSUITABLE SOILS 101.23 - - i./ __�QO IN THE AREA BENEATH AND FOR 5' ON ALL SIDES OF THE S.A.S. AND `---____- --- z 10�6b _ __------ REPLACE WITH CLEAN SAND AS SPECIFIED IN 310 CMR 255(3). _ -�4 --------- 101.96�� ` -}OB-'- _--__-__- -- $--- 12 AREAS REQUIRING STRIPOUT OF UNSUITABLE MATERIALS SHALL BE - -------------------IO'Z EL ��yy _ - ,� 101.91 EDGE 101:34 F . - E__y X'g 09 98 34 13. THIS PLAN IS TO 8E USED FOR PRIOR 70 BACKFILL. 100,73 PAVEMENT INSPECTED BE CONSIDEREDARTMOR SEPTIC SYSTEM PURPOSES ONLY AND IN P��� �F Mgss9c k O ISPROPERTY LINE SURVEY. = PETER T. �Gs BENCHMARK McENTEE OLD. JA l LANE CTR. OF GRANITE LANDING PROPOSED SEPTIC SYSTEM UPGRADE PLAN CIVIL "' EL.=11s.8s (Assu�►ed) 45 OLD JAIL LANE, BARNSTABLE, MA No. 3510�9 Q Prepared for: D. A. Brown, Inc., P.O. Box 145, Centerville, MA 02632 RfGISSF-R �� OWNER OF RECORD FS1 NG\� , s Engineering by: SCALE DRAWN JOB. NO. BATES, RICHARD H & PATRICIA�,TRS" En ineerin Works, Inc. . 1"=30' P.T.M. 275-12 45 OLD: JAIL LANE g 9 BARNSTABLE, MA 02630 12 West Crossfield Road, Forestdole, MA 02644 DATE CHECKED SHEET NO. ('� I (508) 477-5313 _ 12/19/12 P.T.M. 1 Of 2 • NOTE: TO PREVENT BREAKOUT,- THE-PROPOSED ' ' " FINISH_ GRADE SHALL NOT BE < EL: 110.9 FOR A DISTANCE OF 15' AROUND THE PERIMETER OF THE S.A.S. �.•. SEPTIC TANK 'TM ,:, PROPOSED D-BOX PROPOSED S.A.S. INSTALL RISERS & COVERS OVER INLET INSTALL WATERTIGHT RISER & AND SET TO 6" OF FINISH GRADE. COVER SET TO 6" OF GRADE PROVIDE-TWO •ACCESS MANHOLES TO WITHIN 3" PROVIDE ACCESS TO GRADE OVER OUTLET COVER OF FINISH GRADE FOR INSPECTION PURPOSES T.O.F. F.G. EL.=1 14.Of CH\AEN OAL � EXISTING . F.G. EL:=114.3t F.G. EL.=114.0t ' MAINTAIN 2% GRADE (MIN.) . OVER S.A.S. VV _ : ® S=1% (MIN.) © S=1% (MIN.) 4"SCH40 PVC 4"SCH40 PVC ; PROP�48•t' " asASS GARAGE io"I 14" s MME3000O �29 EXISTING 48" LIQUID aaaaaaa LEVEL ADDr. 4' 5.2' 4'(SIDES) 5>>, ' GAS BAFFLE. fNV.`=110.73 PROPOSED INV.=110.56 . - • INV.-1.:1,1;0t` . D-BOX EFFECTIVE WIDTH = 13.2 �. (FIELD VERIFY) (H720) INV.=1 10.39 EXISTING SEPTIC TANK - 2-500 GALLON 'LEACHING CHAMBERS SURROUNDED WITH STONE AS SHOWN H=20 RATED TOP CONC, ELEV.=111.5t ., BREAKOUT, ELEV.=110.89 NOTES: - INV. 'ELEV.=1 10:39 OBESE a ON ' 1) CONTRACTOR-SHALL VERIFY ALL EXISTING PIPE aaaaa mammy. mma S.A.S. ' LAYOUT r mmaa aay.ay. ease INVERTS,. PRIOR TO INSTALLATION... BOTTOM,ELEV.=108.39 • 4' ENDS 8.5' 4' 2) D-BOX SHALL BE SET LEVEL AND TRUE TO GRADE ' ` 4' OF NATURALLY OCCURING EFFECTIVE LENGTH = 29.0' = ON A MECHANICALLY COMPACTED SIX INCH CRUSHED PERVIOUS MATERIAL AND 4' STONE BASE, AS SPECIFIED IN 310 CMR 15.221(2): ABOVE GROUNDWATER LEACHING SYSTEM SECTION ®�® ® ®®®® z 3) INSTALL INLET & OUTLET•"TEES AS REQUIRED. , NO GROUNDWATER, EL.=104.0 �- ®®®EO E3 ®® 37" 4) CONTRACTOR SHALL INSPECT EFFLUENT._.FILTER ON 3/4" TO 1-1/2" DOUBLE �t N > ®®®®®® ® ®®®5a OUTLET TEE AND REPLACE IF NECESSARY. _ . WASHED STONE Z ®��®®® ® ®®®® SEPTIC SYSTEM PROFILE 3"-LAYER OF 1/8" TO 1/2" - DOUBLE .WASHED STONE N.T.S. - (OR APPROVED FILTER FABRIC) 1O2" S01 L LOG 4" KNOCKOUT. DESIGN CRITERIA DATE: NOVEMBER 13, !2012 (REF P#13,790) 20" DIA. COVER ` .SOIL EVALUATOR: PETER MCENTEE PE .(SE#1542) NUMBER OF BEDROOMS: 3 (2 MAIN HOUSE + 1 APARTMENT) WITNESS: DAVID' STANTON R.S. HEALTH AGENT 4" KNOCKOUT 11 4" KNOCKOUT 62" 1 _ • CLASS I SOIL TEXTURAL CLASS: ELEV. •TP 1 •ELEV. TP=2 DEPT H DEPTH DESIGN PERCOLATION RATE:' 5 MIN/IN i14.o D' 1 4.2 0" DAILY FLOW: '330 GPD: FILL �. FILL 4" KNOCKOUT DESIGN FLOW: 330 .GPD 113.3' 8" 113.5 8 C1 c1 GARBAGE GRINDER: NO-AND NOT PERMITTED WITH THIS DESIGN 500 GALLON CAPACITY, H=20 LOADING EXISTING SEPTIC TANK: 1500 GALLON CAPACITY (H,-20) SANDY LOAM SANDY -LOAM CHAMBERS 10YR 6/4 10YR 6/4 PERC LEACHING AREA REQUIRED: (330 GPD)- = 550.0 .SF COBBLES & I COBBLES & 30"/42" N.T.S. 60 GPD/SF •BOULDERS BOULDERS USE 2-500 GALLON LEACHING CHAMBERS IN SERIES' , PROPOSED SEPTIC SYSTEM UPGRADE PLAN 108.0 72" 108.7 6g" SURROUNDED BY DOUBLE WASHED STONE-ALL SIDES , C2 C2 45 OLD JAIL LANE BARNSTABLE MA FINE SAND FINE SAND SIDEWALL AREA: 2 13.2' + 29.0' X 2 = 168.8 SF 2.5Y 6/4 2.5Y 6/4 ( ) COBBLES & COBBLES & Prepared for: D. A. Brown, Inc., P.O. Box 145, Centerville, MA 02632 BOTTOM AREA: 13.2' x 29.0' = 382.8 SF- BOULDERS BOULDERS . Engineering by: SCALE DRAWN JOB. N0. TOTAL AREA:..... ... ...... :...... . . ................ SF 04.0 120" 104.2 120" Engineering Works, Inc. N.T.S. P.T.M. 275-12 27 , DESIGN FLOW PROVIDED: 0.60 GPD/SF(551 .6 SF) - 331 .0 .GPD PERC RATE 5 MIN/IN. ("Cl" HORIZON) 12 West Crossfield Road, Forestdole, MA 02644 DATE CHECKED SHEET N0. NO GROUNDWATER ENCOUNTERED (508) 477-5313 12/19/12 , P.T.M. 2 of 2 > > 2 e Doak fp 0> De N� J� � R 2'-p" G'-4" 6'-p" G•-q• II'-p• Now cedar cloa.} ____________ Fin T.v.aid I 6torwgc�ni} i i Q i 0 e e R And.raano bOL Ty✓2 4 4 II iP -2 Z p i L o 9 And V-6, ro0.1-W 2 4 4 E p d n po a S n la Th.rmwrruo PG 1 B :. �,_ 7hcrmarruo PG 1 B — .. x/o•Die _ r, .a O And.Sono ra L 1 2(4" ulll e a a w T S a � 0 H qg —ry S mo � mb -� F /\I ` 4'-1 1 1/4" 1.210 e/4" (fl T Copyright®2004 by Kenneth Sadler Associates: DRANN BY: S These plans are protected under Federal FROJr;rT: Bedroom/1�akhr'oom�eadikion for: y rn p copyrlghcLaws-rneorlglna pu chaseratthls Plan # 1 5bD weNNeTH ISPAr L-CIP— . ADi t plan Is authorized to construct one and only one home using this Z '¶ g plan Modlficatlon or Professional Building Dealgner N C T° ease is prohibited fthe exprer.written F-16HAF-P and PA �?-16A 13ATE�° ° permission of the Designer. 0 rn °j Any disc parries,errore and/or amissbns A p —I— ` REVISIONS: in the notes,dimerelons.and/or a' Kenneth Sadler f.,,,i c ates to the attention of O ' - can t preliminary Designs I/25/05 - =-- prvfessienal building design•- 4 r7 eVId JA11 Lane the �9 pro,o�u oe;�d1.10 � p?-e,vised Fiver pfans%/15/O 4 _..-• --.--L-;--. v�ion constitutes c acceptance commercial•reeldentiaf a e cumcntaanoaj eleva+ionsferHi7G 4/1 5/04 1�arns!ab1e,1"A a:c p.nci..erroreand/oramealore P.O.BOX 1 1 4 q•Hgam19,MA o2 b01•5O3.1 q0.3 q22 become the respensibility of the GO"IS�'fUG}IOn plans !O/2/04 ._..._.....,_ksadlereksadesign.tom•www.ksadeeigncom bWeine contractor. SECTION - SEWAGE if f — SEPTIC TANK — — "D" BOX — — LEACH TOP OF FDN 1 ,<J —••2„OF+fsTO +/z" (MSL)# ` WASHED STONE — OUT- / ��G IN OUT- IN- I !I 7 c�f^. / TANEPTIK �E,6; �r�� .✓L7 j i ifi ELEV.' ELEV. ELEV. � ELEV. ) ELEV. ELEV. -- .'77 OF 'r4"- Ph" I f7 WASHED STONE f 1 TEST HOLE LOG TEST BY ,� WITNESS IESr DATE _ DESIGN -- BEQROOM HOUSE ;. T.H. # 1 T.H. # 2 " , ' -V Lru ELEV. ELEV. NO f �/ s b P E R C RATE DISPOSER DISPOSER �� � s�•*- �9,-� � �?- —MIN/I N. ----r � I FLOW RATE 3J(GAL./DAY ) y� F"^-~ ; i ! SEPTIC TANK REO'D SEPTIC TANK SIZE I i LEACH FACILITY `t SIDE WALL _.`� ^_ 1 `r- -(� ' ) _ _rri G/D ) I` BOTTOM -- _1T .<. - )x. ( ) ) G,D , TO TA L 4t- c. \� l LSE WATER ENCOUNTERED NOTES: (UNLESS OTHERWISE NOTED) 1. DATUM (MSL) +. TAKEN FROM y. _ QUADRANGLE MAP 2. MUNICIPAL WATER V.-:�_._ - ___AVAILABLE J. PIPE PI f CH: �,4"PER FOOT 1. DESIGN L-OADING FOR ALL PRE-CAST UNITS:AASHU _ 2 ti 44 r�w /` tLti.�:.3 p ' — 4 - DISTANCE AS CERTIFIED 5. MIN.GROUND COVER OVER ALL SEWAGE FACILITIES: (1) FT. 6. PIPE JOINTS SHALL BE MADE WATER TIGHT SITE PLAN ( Y'.^\)`1 1. CONSTRUCTION DETAILS TO BE ACCORDANCE WITH COMM. OF MASS. � � ! HEREBY CERTIFY THAT THE BUILDING STATE ENV I RONMENTAL CODE TITLE 5 r 1 -C"3v 4 SHOWN ON THIS PLAN IS LOCATED ON THE GROUND AS SHOWN HEREON &THAT 17 ___ LOCUS --- / CONFORM TO THE ZONING BY LAWS OF THE if F ?. TOWN OF REG. P �IQ�LNGINEER WHEN CONSTRUCTED. DATE / I REF: _�— (/OW#7 Cilpe enfineefing PREPAREDFOR: T -- '' .TrII� CIVIL ENGINEERS 1 LAND SURVEYORS REG. LAND SURVEYOR y T BOARD OF HEALTH (EXISTING) ------------- SCALE--:-___-__=_3..L.— CONTOURS (PROPOSED) -- --O 0 O— APPROVED ---DATE------ MA Yarmouth & Orleans,MA DATE