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HomeMy WebLinkAbout0065 SCUDDER'S LANE - Health (2) �7 Scudder Lane l Barnstable I LA 258 013 0 n � , v o i• 2 i a - ,.y R P An Commonwealth of Massachusetts \A- Titl' 5 Official Inspection Form�r, V,k-q- Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 77 SC DDER LN r' LP Property (Address DAVID PARRELLA Owner Owner's i ame information is gAfi is a .MA 02630 10/17/07 required for State Zip Code Date of Inspection every page. Cityrrown Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Important: A.!General Information When filling out forms on the computer,use 1. iInsl ector: S CD N7!) ® O 1 only the tab key t to move your I i hael DeDecko — cursor-do not Name of Inspector use the return key. Compass Realty Development Corporation Corf•tpany Name P.O. Box 2384 Company Address Mashpee Ma 02649 City/Town State Zip Code 508 -221- 5003 - 4 Telephone Number License Number I � B. Certification I certi I 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..l.am a DEP approved system inspector pursuant to'Section-.15.340 of Title 5 (310 CMR 15.000). The system: " i Passes El Conditionally Passes ❑ Fails r- ❑ Needs Further Evaluation by the Local Approving Authority 10/17/07 rig r-- _ I specto's Signature Date The sy 3tem inspector shall submit a copy of this inspection report to the Approving Authority (Board of Hea th or DEP)within 30 days of completing this inspection. If the system is a shared system or h s a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the r port o the appropriate regional office of the DEP. The original should be sent to the system owner a Id cobies sent to the buyer, if applicable, and the approving authority. ****This re ort 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 77 SCUDDER•08/06 I Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 1 of 15 i I I i Commonwealth of Massachusetts Title 5 Official Inspection Form Sub'su ace Sewage Disposal System Form -Not for Voluntary Assessments 77 SC UDDER LN Property Address DAVID jPARRELLA Owner Owner's Evame I ; information is required for BARNSTABLE MA 02630 10/17/07 _ every page. City/Town State Zip Code. Date of Inspection 1 B.ICerti cation (cont:) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) 'Sy stemlPasses: `® I have not found any information which indicates that any of the failure criteria described in 3,0 CMR 15.303 or in 310 CMR 15.304 exist-Any failure criteria not evaluated are indicated below. Comme� ts: . I I• l 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. Anlswer yes, no or not determined (Y, N, ND) in the ❑ for the following Statements. If"not determined," please explain. _. ❑ The septic tank is metal and over 20 years old* or the septic tank (whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A�metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. 1 - ND Explain: ❑I 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): • ❑i broken pipe(s) are replaced ❑� obstruction is removed 77 SCUDDER•08/06 f Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 15 I - Commonwealth of Massachusetts TitheI 5 Official Inspection Form Subsut'face ISewage Disposal System Form -Not for Voluntary Assessments 77 SCL DDER LN Property Address DAVID 1,PARRELLA Owner Owner's Name information is BARNS required for TABLE MA 02630 10/17/07 every page. City/Towji State Zip Code Date of Inspection B. :Cc rtification (cont.) �B) System Conditionally Passes (cont.): I ❑ distribution box is leveled or replaced ,ND Explain: ❑ The!system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced L 0 obstruction is removed ND Explain: y I i • t) 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 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: i. ❑ ; The system has a septic tank and soil absorption system (SAS) and the SAS is within 100i 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. 77 SCUDDER•08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 15 I Com I onwealth of Massachusetts Title 5 Official, Inspection Form SubsurfaceSewage Disposal System Form -Not for Voluntary Assessments 77 SCUDDE�R LN Property Address DAVID PARRELLA _ Owner Owner's (NIame i information is required for BARNSTABLE MA 02630 10/17/07 every page. City/Towri State , Zip Code Date of Inspection B. 'Certification (cont.) - i . a C) Further Evaluation is Required by the Board of Health (cont.): ❑ 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**. i Method used to determine distance: **Ihis system passes if the well water analysis, performed at a DEP certified laboratory, for coliform bacjterialindicates 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. Dther: D) Sy tem!Failure Criteria Applicable to All Systems: You must indicate"Yes" or"No"to each of the following for all inspections: I — Yes j No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool , s ❑ ® 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 Y2 day flow Required pumping more than 4 times in the last year NOT due to clogged or ❑ ! ® obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. 77 SCUDDER•08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 15 I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 77 SCU,DDEiR LN Property Address DAVID PARRELLA Owner Owner's Name information is BARNS TABLE MA 02630 10/17/07 required for every page. Cityffown State Zip Code Date of Inspection B. Certification (cont.) D) Syitem Failure Criteria Applicable to All Systems (cont.): Yes: No ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. . - f ❑ ® 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 i 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. El ' ® 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) La�ge 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 qu stions 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 answeredy"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 sysitem 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 re tonal office of the Department. i 77 SCUDDER•08106 � Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsu I ace Sewage Disposal System Form- Not for Voluntary Assessments IDDER LN .. 77 SCU Property Address DAVID PARRELLA Owner Owner's dVame information is BARNSTABLE MA 02630 10/17/07 required for State Zip Code Date of Inspection every page. City/Tow 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? El ® Has the system received normal flows in the previous two week period? 0 I ® 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 IIIZZZSSSIII available note as N/A) ® 0 Was the facility or dwelling inspected for signs of sewage back up? 1® ❑ Was the site inspected for signs of break out? ElWere all system components, excluding the SAS, located on site? ® ET - 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? ® 0 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)] y 77 SCUDDER•06106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 15 i i ' Com i onwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 77 SCUD DER LN Property Address DAVID I ARRELLA Owner Owner's Name information is BARNS,TABLE MA 02630 10/17/07 required for State Zip Code Date of Inspection every page. City/Town D. System Information Residential Flow Conditions: .Number of bedrooms (design): 4 Number of bedrooms (actual): 4 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 440 3 Nu ber of current residents: Does residence have a garbage grinder? ❑ Yes ® No i Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes ® No Laundry system inspected? ❑ Yes ® No Sea sonal use? ❑ Yes ® No WIter meter readings, 'if available (last 2 years usage(gpd)): N/A SIP pump? ❑ Yes ® No N/A Last date of occupancy: Date Commercial/Industrial Flow Conditions: Ty e of,Establishment: Design flow (based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): G ease.trap present? ❑ Yes ❑ No g present? ❑ Yes ❑ No Industrial waste holding tank Non-sanitary waste discharged to the Title 5 system? El Yes ❑ No W�ter meter readings, if available: Lest date of occupancy/use: Date Other(describe): 77 SCUDDER•08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 15 I l Com I onwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 77 SCU,DDER LN Property Address DAVID PARRELLA Owner Owner's I ame information is BARN -TABLE MA 02630 10/17/07 required for State Zip Code Date of Inspection every page. City/Tow D. System Information (cont.) General Information Pu ping Records: N/A Source of information: W s system pumped as part of the inspection? ® Yes ❑ No 1500 If yes, volume pumped: gallons Ho, was quantity pumped determined? •Reason for pumping: MAINTAINCE Type of System: ® Septic tank, distribution box, soil absorption system I❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): A ((proximate age of all components, date installed (if known) and source of information: • 2gO3 AS BUILT CARD = Were sewage odors detected when arrivingrat.the site? ❑ Yes Z No 77 SCUDDER•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 15 i I Comirrionwealth of Massachusetts Title 5 Official Inspection Form Subsu lace Sewage Disposal System Form -Not for Voluntary Assessments 77 SCUDDER LN Property Address DAVID PARRELLA — Owner Owner's lame _ information is gARNSTABLE MA 02630 10/17/07 required for State Zip Code Date of Inspection every page. Cityfrown l -1 1 D. System Information (cont.) Buiilding Sewer(locate on site plan): . 2' 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.):, JOINTS TIGHT,YES VENTED,NO LEAKAGE. Septic Tank(locate on site plan): AT GRADE D pth below grade: a feet Material of construction: ®I concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) • e - If I lank is metal, list age: years Is gage confirmed by a Certificate of Compliance? (attach a copy of-certificate) ❑ Yes ❑ No------------------------- . -------------------- -------------------------- ---------------------------------------- i • 1500 GAL. Dimensions: - - 4" Sludge depth: 2811 D stance from top of sludge to bottom of outlet tee or-baffle 4" S um thickness 8" Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle 14" _ H w were dimensions determined? MEASURED 77 SCUDDER•013/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 15 E • CoMrT onwealth of Massachusetts TitleI 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 77 SCU,DDER LN — Property Address DAVID jJ ARRELLA r Owner Owner's dame information is BARNSTABLE MA 02630 10/17/07 required for every page. City/Towh State Zip Code Date of Inspection r 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.): PUMPED FOR MANTAINCE, TEE'S INTACT,STRUCTALLY SOUND, LIQUID LEVEL EQUAL WITH - OUTLET INVERT, NO LEAKAGE, . Grease Trap (locate on site plan): De th below grade: feet I Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): . I " Diensions: d I� - r . ScLim thickness Di tance from top of scum to top of outlet tee or baffle Distance from bottom of.scum to bottom of outlet tee or baffle F • Date of last pumping: Date Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liq id 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): i 77 SCUDDER•08106 ( Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 15 I Commonwealth of Massachusetts . Title 5 Official Inspection Form Subsufface Sewage Disposal System Form Not for Voluntary Assessments 77 SCUDDER LN Property Address DAVID PARRELLA Owner Owner's Name information is BARN TABLEMA 02630 10/17/07 required for State Zip Code Date of Inspection every page. City/Towrt I D. S�,stem Information '(cont.) Tight or Holding Tank(cont.) Din ensions: Capacity: gallons Deign Flow: gallons per day Al�rm present: ❑ Yes ❑ No i Al2 rm level: Alarm inmorking order. El Yes ❑ No. . Date of last pumping: Date Colmments (condition of alarm and float switches, etc.): *Attach co of current pumping contract(required). Is copy attached? ❑ Yes ❑ No PY i Distribution Box (if present must be opened) (locate on site plan): EQUAL WITH OUTLET INVERTS D Ipth of liquid level above outlet invert Comments (note if box is level and distribution to outlets equal, any evidence of.solids carryover,-any evidence of leakage into or out of box, etc.): Di BOX IS LEVEL AND DISTRIBUTION EQUAL, NO SOLID CARRYOVER, NO LEAKAGE. f Pimp Chamber(locate on site plan): P mps in working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No 77 SCUDDER•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 15 i Commonwealth of Massachusetts, Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments t 77 SC IDDER LN iG^M Property Address DAVID PARRELLA Owner Owner's I ame ; information is gARNSTABLE MA 02630 10/17/07 required for State Zip Code' . ' Date of Inspection every page. City/Town D. System Information (cont.) Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): Soil Absorption System (SAS) (locate on site plan, excavation not required): p Y • If AS not located, explain why: ' Type: I� leaching pits number: ! 4/500 GAL i leaching chambers number: I� leaching galleries number: I[] -leaching trenches number, length: leaching fields number, dimensions: overflow cesspool number: El innovative/alt6mative system Type/name of technology: Comments (note condition of soil,�signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc,): SOIL-GRAVEL/SAND, NO SIGNS OF HYDRAULIC FAILURE, PONDING N/A,NO DAMP SOIL, VLGETATION - NORMAL. — I , j • 77 SCUDDER•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 15 I I _ 6 i f • , I Commonwealth of Massachusetts Tithe 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments 77 SCU,DDER LN Property (Address DAVID PARRELLA Owner Owner's (NIame information is BARNSTABLE MA 02630 10/17/07 required for State Zip Code Date of Inspection every page. city/Towli, I D. System Information (cont.) Ce spools (cesspool must be pumped as part of inspection) (locate on site plan): Nu nber and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool M terials of construction Indication of groundwater inflow ❑ Yes ❑ No Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc'.): i Privy (locate on site plan): Materials of construction: Dimensions Depth of solids C'mments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, tc.): i I I t 77 SCUDDER•08/06 i Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 15 i I I i Comrrionwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 77 SC IDDER LN Property Address DAVID PARRELLA Owner Owner's I ame information is BARNSTABLE MA 02630 10/17/07 required for State Zip Code Date of Inspection every page. City/Town D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. • f • II_ 3t �k- as t� 63'S� 1 • • _ A�� aa' L'' 4y I � S` S�°S'� �'gS-10 i k 77 SCUDDER•08/06 ! v + Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 15 i + I Com�onwealth of Massachusetts Title 5 Official Inspection Form SubsurlFace Sewage Disposal System Form-Not for Voluntary Assessments 77 SCU,DDER LN Property Address DAVID PARRELLA Owner Owner's I ame information is BARNSTABLE MA- 02630 10/17/07 required for State Zip Code Date of Inspection every page. ulty/I OW D. S ,stem Information (cont.) sit ® Check Slope ® Surface water ® Check cellar ❑ Shallow wells 57.27' Estimated depth to ground water: feet Phase indicate all methods used to determine the high ground water elevation: [ Obtained from system design plans on record If checked, date of design plan reviewed: Date ❑ Observed site(abutting property/observation hole within 150 feet of SAS) . ❑I Checked with local Board of Health -explain: [�I Checked with local excavators, installers- (attach documentation) I Accessed USGS database-explain: :BARNSTABLE GIS I You must describe how you established the high ground water elevation: BARNSTABLE GIS. e i I ' 77 SCUDDER•08/06 F Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 15 A,K•A �05 TOWN OF BARNSTABLE 1 + LOCATION T 7 da'e—r- - 6` I SEWAGE # 0�003— 25k VILLAGE '3k-rky4X4k ASSESSOFZ MAP & LO I INSTALLER'S NAME&PHONE NO.��S� SEPTIC TANK CAPACITY W LEACHING FACILITY: (type) NO.OF BEDROOMS L BUILDER OR OWNP�( PERMITDATE: O QD03 COMPLIANCE DATE: f Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within et of leaching.facility) Feet Furnished by �� ��, 9 � .� �� �� � �_� � ,� � d � � � s � G'�' ff'v�T' ��► �9�cN r � � � S� � o UJ � �'' � Fee 3 ry� � No. S y ' m THE COMMONWEALTH OF MASSACHUSETTS E� nt`eredincomputer: PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTSLien rt� 01ppYication for ]0igpoga 1 *potem Con0truction permit Application for a Permit to Construct(XI)Repair( )Upgrade( )Abandon( ) El Complete System O Individual Components Location Address or Lot No. 7 5L v OD" LAAIE Owner's Name, Address and Tel.No. A ��-31 6 7 Assessor's Map/Parcel Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. Type of Building: h 6 A C-- Dwelling No.of Bedrooms _ Lot Size 96 &/'?6 sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow 4W gallons per day. Calculated daily flow gallons. Plan Date 3=/2—0 3 Number of sheets Z_ Revision Date Title -'7 7 5(u b 1>6 LAW-F Size of Septic Tank /mod d 9-Z Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued by this Board ofHFalth. Signed Date Application Approved by Date �© G Application Disapproved for the following reasons Permit No. S CO©`3 '6,5'-54?-- Date Issued 6 11&70 115 No/O �{ . Fee c/v THE COMMONWEALTH OF MASSACHUSETTS ' �' Enterea�tn computer: _ Yes n. �. PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS ��►'� 01pprfcation for Mi5po5alkY pgtem ConMruction Permit 4 Application for a Permit to Construct Q0 Repair( )Upgrade( )Abandon( ) 11 Complete System El Individual Components ! Location Address or Lot No.7'7 SL vV DLCk LAIvi: Owner's Name,Address and Tel.No. j;oe.3 6 Z..fed'$_ ' i 6344 s77fi.'c Ytir�/� P)wee CC Assessor's Map/Parcel 2S8 - 0/3 . SGv�vE2 LN 7^7;-,CC • Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. o✓02F Cc Rf�-Oe, r{A160164,77/ ld -Town. f-h4�c s-Q,��c2E �A LN'1I/V 77'fl ,MQ dIr'�Sr/2 2� i Type of Building: /•6 A Dwelling No.of Bedrooms _ Lot Size 6906 sq.ft. Garbage Grinder( ) Other, I r Type of Building No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow t gallons per day. Calculated daily flow gallons. ' Plan Date S-/Z—O 3 Number of sheets Z— Revision Date Title -T+-77 5 c v DDcX LAND Size of Septic Tank /•Sod //- 2 a Type of S.A.S. Description of Soil �M _ Nature of Repairs or.Alterations(Answer when applicable) Date last inspected: K. Agreement: Tl?d undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system , in accordance'with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued by this Board of ealth. Signed `"' Date Application Approved by Date �o /G G x Application Disapproved for the following reasons Permit No.�Dd Date Issued /O G 3 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 at 9q has been construct d injaccordance with the provisions of Title 5 and the for Disposal System Construction Permit No. 2Ua 3'2 59- dated 6 ( C 3 Installer Designer J V The issuance of this t shall/. oflbeeconstrued as a guarantee that the s,'yste will function as design/A z I c Date / �l Inspector ,-61_0 j' No. Fee THE COMMONWEALTH OF MASSACHUSETTS es PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS Migpog;at *p!gtem (Construction Permit Permission is hereby granted to Construct( )Repair( )Upgrade )Abandon( ) System located at '� Se v L .-„ and as described in the above Application for Disposal System Construction Permit. The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided: Construction must be completed within three years of the date f this Date:_���/C> Approved by �--�--- • �5 TOWN OF BARNSTABLE A,K•�� LOCATION 7 SC-6141-0—r k ,I • SEWAGE # '2003—2:51 VILLAGE �J. '311'-101Y- .6 k-L ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO.'JA507 SEPTIC TANK CAPACITY f 5 60 LEACHING FACILITY: (type) NO.OF BEDROOMS BUILDER OR,OWNS PERMITDATE: 6 In 2Do3 COMPLIANCE DATE: id g Separation Distance Between Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet i Private Water Supply Well and Leaching Facility (If any wells exist ' on site or within 200 feet of leaching facility), Feet Edge of Wetland and Leaching Facility(If any wetlands exist within et of leaching facility) Feet Furnished by Q Itn k 1 -S c A a1 1 6 sel 3 .. ..--. . . . _ I ~ ,,! .. .. �4: e 1,...; . , , . ' . . 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LQ o �,o \ \ \ 1 I \ I Acuff M mauoHwc} z77' - c cP296.90. r - \ \ Op"�y tYYdSEs1CwE � // \ 296.9p v' A S'x ia•:r f � I j °' j I (� \�� ��\\�\� � •P. � // I I ids `� \�\ _ \\ \\�� --- -- �av RENO "Me HN \ I \ •7X Lci \ .LOT 2B O 09 ;. \ I II 11 11 II I 1 II I 1 I N 7 srO I { 11 II I I ! J! I f f It I OF t;1.4 `S 5/12/03 REVISE HOUSE AND SEPTIC LAYOUTS ♦ DATE REVISION N/F GENERAL NOTES: l i CHAEL J yGs��: PLOT PLAN "SCUDDER'S FIELD" ANDREW S. KECK e� L✓i,�ELLI A CERTIFICATE A288820 s CI\/IL ► {{77 SCUDDER'S LANE p, 1. HOUSE NUMBER: 77 ► PREPARED FOR g 2. ASSESSOR'S NUMBER: No 35054 ; BARNSTABLE HARBOR BUILDERS t yi� �4�) �@ i IN BW 3 \ 3. ZONING DISTRICT: R 30' = �. i ♦ BARNSTABLE MA FRONT SETBACK `� G`° A 5VW 4,. \ SIDE AND REAR SETBACK = 15' y.® �'L?f;Al E•` �� PLAN DATE: JULY 29. 2002 PLAN SCALE: 1" = 20' / SVW z• MINIMUM LOT SIZE ,m 43,560 S.F. .44 am 5 '\ FRONTAGE = 20' - CNL ENONEIRIND p,Lm O UT� WETLANDS PERMITTING 4. FLOOD HAZARD ZONE: C WASTEWATw OFSWII COASTAL ENGRHEHRIIAI 5. TOPOGRAPHIC INFORMATION AND PROPERTY LINES COMPILED FROM A PLAN BY OTHERS TTE 5 PLOT PLAINS CS' PM AND DOCKS 6. ELEVATIONS SHOWN ARE BASED ON AN ASSIGNED DATUM LA"USE P<.mmm NGI NEERI� OMMMOICAVRESCENTMI \ 7. PLAN REFERENCE: L.C. PLAN 20950E S—*0 C4-ctv OW Sav*—A"At$90&v ftA 101 TOWN HALL SQUARE- FALMOUTH,MA - 02540- 508.495.1225- S08.495.3229 fax BYW I • - PROJECT NUMBER: 020441 CADFILE NAME:02D44Lo12A DRAWN BY: L.M. I SHEET 1 OF 2 - , -X. .. SOIL TEST DATA: 1 DATE Of SCYL TEST. APR/L ?�1001 AWKR/arA W SV&i Be TW MM1 1%M VWP AU JYYAC Srsmr 0 A - _ . � _ _ 5L7/L -VALUAra?' M/LY/AEL 66W-Mil ' 6- 4 ONA 50EV"V A%C 0P GSr MW APM' _ aY"""Armor nw'wff 0r smw In 021"AY�t IH7NESS• DAND STANTO/Y 10*AdRDW Armor PERCLYAT/GiY RATE.• f5 M/NOTES PER/NCH . xp 0r/A'HCLI/A7tV REMOVABLE COVERS SET TO WITHIN - extr-J73ae T4•OF FINISH GRADE(TOTAL OF�) L7EP7H lO CaPOUNOWAIER. NOT ENCOUNTERED .TEST HOLE#1',. TEST HOLE /2 / S ..Y MAX. . .�>�A GILA gA9 - .' 'r• i.. S nr AalK AYMWr tux RE/> B e - - 1500 GALLON ° DeNr 9wM LneWrMexn . , S!T/lPSr �e re 4 . SEPTIC TANK ease aoaa ° (H-20 LOADING) °� emomemlamem000 e n .. aolamemamamaae law wn law w - OICS'r 61Q.Y >,':.%: efaememnaemema Eitk Dr'/> m.a vp m m T°�s BASIS FOR DESIGN: fl' r>��'TAAR•A�asnWWA`M F h �, av 6 LAMP wI•c�Bxsmm sravE a ,r PROFILE TOTAL DA/L Y FLOW/S BASED AN f BELL/.£ NO GAAMa-L3'SPOSAL L,L]iiLFILE 8 n N07 TO SCALE "`••' - F[EK 8Lo - .. / O POAI/ f�L34!{21/S= 4f0 CPD NSATAOd$Q 4#MrR l lee 1,4 �7gYI pr t/d QY.fM6YT (B0r70M 0r ltSl AKYF� 7HE CONTRACTOR SHALL E%CAVAIE e'ALL AROUND 4 . TOTAL DA/L Y FLOW- //0 GRJ X ` srsltAl AMW m LA)Wr Or - - - AND DOWN TO THE SAND LAYER (�$7I PRtlPOSED BOT7GMI AREA: 5i9 Srt S&W fW 4N1{rOFrAMSWTH • + ,w" E- ✓ ^ - - ._ -_ ALL COARSE UNSUITABLE UP 70 THE TOP A A D REPLACE _ THE SYSTEM. THECEMENT MATERISANDA SH DLCCONFORMaTO THE 5 c PRL O 9DE AREA. 179 Sr " .:` y _ SPEC itG ONS SET FORTH IN 31 1 SS(3)(TITLE m ;' - ' TOTAL PRaP0_ V 1EA6WNG AREA: 7M SF. Y 9 ` APPL/CA)76W RATE= 074 p'D/SF. - • r ,G - w ZfVZJV LEA0WA/G CAPALYTY=MO iM>440 GpD ai•ax AtA/ONIdCE L»1EW .- ., 4. a% PLAN VIEW CROSS—SECTION ACRA7Nel0'E:PI t vJ. " 4 r ap sE7 LYJTGPS L AE7MYAS'E JV AH LV1FW ( ti..�•�ItE LPFNA $... J•A711f nRav rAMY ro1eW DB-9 DISTRIBUTION BOX (H-20 LOADINGS AMErAAGCXWr ma � `"" „ . --. .. SCALE: 1• 2• .: z-= ._ � ow „ >`.� �y ` c b - _ - '• n W r` nt: . :-` - .. :,. _- a - GTS B.IfrrE I a. i. 77 I a - f - 4 r. ea • a I / 1500 GALLON SEPTIC TANK (H-20 LOADINGS b T -. b .. - >, NOT TO SCALE, .- ®®®® ®®®® y q P CONSTRUCTION NOTES: MIMED®®®®®®®®IMIM 2,• H 1. INSTALLATION OF THE PROPOSED SEPTIC SYSTEM SHALL BE IN ACCORDANCE WITH 71TLE S Ct�ppO�SS�-S�M/V�//y�E AND THE BOARD OF HEALTH REGULATIONS. - JAYYi - 9•_B. ,. . T VENT PIPE 2. A COPY OF THE PLANS SHALL BE AVAILABLE ON SITE FOR REFERENCE AT ALL TIMES / ♦•PVC - .. .a ... ... ...:... :. '. .. �. -' SCREEN DURING THE INSTALLATION OF THE SEPTIC SYSTEM. - - .. s•KNocKouT wpL FINISHED,GRADE 5/12/03 REVISE INVERTS J. NO CHANGES TO THE DESIGN SHALL BE PERFORMED WITHOUT APPROVAL OF BOTH '21•DIAMETER COVER - .. FALMOUTH ENGINEERING INC, AND THE BOARD OF HEALTH. DATE REVISION 5'KNOCKOUT — 5 KNofXOUT PLOT PLAN DETAILS "SCUDDER'S FIELD" 4. THE SEPTIC SYSTEM IS SUBJECT TO INSPECTION BY BOTH FALMOUTH ENGINEERING,INC. - _ PFECN AND THE BOARD OF HEALTx 1t #77 SCUDDED F LANE . x �. ° 4•PVC VENT PIPE PREPARED FOR 5. THE CONTRACTOR SHALL NOTIFY FALMOUTH ENGINEERING,INC.AND THE BOARD OF HEALTH - '�. x 5•KNOCKOUT ` - • " BARNSTAB A BUILDER M INSPECT THE SEPTIC SYSTEM BEFORE BACKFILL IN SOME INSTANCES,MORE THAN ONE INSPECTION MAY BE NEEDED. THE y �� - VMT PIPE DETAIL LE HARBOR S CONTRACTOR SHALL ONLY BACKFILL THE PORTIONS OF THE SYSTEM THAT HAVE BEEN INSPECTED AND APPROVED BY FALMOUTH PLAN wrLw - - NOT.TO SCALE BARNSTABLE NA ENGINEERING INC.AND THE BOARD OF HEALTH. PLAN DATE: JULY 29. 2002 PLAN SCALE: AS SHOW SM r_eE I ON l FACHNNG CHIMM CH-20 LADINGI B. If THE CONTRACTOR ENCOUNTERS ANY VARIATIONS IN THE SIZE CONDITIONS,SUCH AS DIFFERING SOILS TOPOGRAPHY,WETLANDS SCALE: 1 a 2' e - , CIVIL ENUNEDNND I,MO UT WETLANDS PERMITTING OR OTHER CONDITIONS THAT MAY REOUIRE RE-EVALUATION OF THE DESIGN,THE CONTRACTOR SHALL IMMEDIATELY NOTIFY FALMOUTH - �.�i - `7 { ; _ WASTEWATER DE51W COASTAL WDNEQeNG ENGINEERING INC. _ TITLE 5 PLOT PLANS V• PIERS AND DOCKS NGI LAND USE PLANNING Cp1LEA0A1,/RESOENRA - " S&WV 0TW CW YW SOYIAAAff"AkMW.%Wt* 101 TOWN HALL SQUARE- FALMOUTH,MA - 02540- 508.495.1225- 50&495.3229 t'X PROJECT NUMBER: 02044.CADFILE NAME:02044MSTR PLANNUMBER-01. 3T SHEET2'OF 2 -'