Loading...
HomeMy WebLinkAbout0068 STURGIS LANE - Health 68 Sturgis Lane Barnstable A = 278 039 l Commonwealth of.Massachusetts . _ Title 5 Official Inspection Form - Subsurface Sewage Disposal System Form Not for Voluntary Assessments 68 Sturgis.Lane Property Address . William &Yvonre Adomonis Owner Owner's Name information is required for every. g Barnstable Village Ma 02630 11-21-13 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. Important:When A. General Information filling out forms on the computer; use only the tab 1. Inspector: _ .. key to move your G cursor-do not. Matthew GiFoy. use the return: key. Name of Inspector B & B Excavation,lnc. Company Name .14 Teaberry Lane. Company Address Forestdale MA:: ::.02644 City/Town State Zip Code 508-477-0653 S113640 Telephone Nunber License.Number B. Certification .... . ....... _ ....... I certify that I have personally inspected the sewage disposal system at this address andahat the information reperted below is true, accurate and complete'as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems.. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CM R 15000). The system: ® Passes.- ❑ Conditionally Passes ❑ .Fails Needs Further Evaluation by the Local Approving:Authority . 11-21-13 Inspector's Sig-iature Date - The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or:DEP)within:30 days of completing this inspection. If the system is a shared system or has a design.flow of 10,000 gpd or greater,:the inspector and the system owner shall:submit the. . report to the appropriate regional office of the DEP. The original should,be sent to the system owner and copies sent to the buyer, if applicable, and the.approving:authority..:: This report only describes conditions at the time.of inspection and under the conditions of use at that time-This inspection does.not address how.the system.will perform in the future under the same or different conditions:of use. r - r l5ins•11/10: .. Title 5 Official Inspection Form: ubturface Sewage pisp sal System ,age 1 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ^M 68 Sturgis Lane Property Address William &Yvonne Adomonis Owner Owner's Name information is Barnstable Village Ma 02630 11-21-13 required for every g page. Cityrrown 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 riot 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): t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 , is Commonwealth of Massachusetts Title 5 Official Inspection Form F. Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ,M 68 Sturgis Lane Property Address William &Yvonne Adomonis Owner Owner's Name information is Barnstable Village Ma 02630 11-21-13 required for every g ' page. City/Town 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): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation its 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 I Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 68 Sturgis Lane Property Address William &Yvonne Adomonis Owner Owner's Name information is Barnstable Village Ma 02630 11-21-13 required for every g page. City/Town 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 more from a private water supply well**. Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate "Yes" or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ M 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 Form:Subsurface Sewage Disposal System•Page 4 of 17 r Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �M 68 Sturgis Lane Property Address William &Yvonne Adomonis Owner Owner's Name information is g required for every Barnstable Village Ma 02630 11-21-13 page. City/Town 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- 1 0,000g pd. ❑ ® 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 Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts w Title 5 Official Inspec ion Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments �M :r 68 Sturgis Lane Property Address William &Yvonne Adomonis Owner Owner's Name information is 9 required for every Barnstable Village Ma 02630 11 21-13 . page. City/Town.. -State Zip 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 - - El Z Pumping information was provided by the owner, occupant, or Board of Health ❑ H 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 El ® this inspection? _.. Were as built plans of the system obtained and examined?(If they were not. ® El available note as N/A) Z El Was the facility or dwelling inspected for signs of sewage back up? Z El 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)] M System.information Residential Flow Conditions: Number of bedrooms(design):: 3 Number.of bedroom );s(actual 2 DESIGN flow based"on 310 GMR 15203"(for example: 110 gpd x#of bedrooms): 330 t5ins•11/10 Title 5 Official Inspection 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 ^M 68 Sturgis Lane Property Address William &Yvonne Adomonis Owner Owner's Name information is g required for every Barnstable Village Ma 02630 11-21-13 page. CitylTown State Zip Code Date of Inspection D. System Information Description: Number of current residents: 2 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 Water meter readings, if available(last 2 years usage(gpd)): n/a Detail: Sump pump? ❑ Yes ® No Last date of occupancy: current Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form -Not for Voluntary Assessments GSM 68 Sturgis Lane Property Address William &Yvonne Adomonis Owner Owner's Name information is g required for every Barnstable Village Ma 02630 11-21-13 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: owner 2006 Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no)(if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology.Attach a copy of the current operation and maintenance contract(to be obtained from system owner)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 f Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ^M 68 Sturgis Lane Property Address William &Yvonne Adomonis Owner Owner's Name information is g required for every Barnstable Village Ma 02630 11-21-13 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known)and source of information: 1994-coc Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): 1'6' Depth below grade: feet Material of construction: ❑ cast iron ® 40 PVC ❑ other(explain): Distance from private water supply well or suction line: >20feet Comments(on condition of joints, venting, evidence of leakage, etc.): At time of inspection building sewer appeared to be in working order no sign of leakage or blockage. Septic Tank(locate on site plan): 1' Depth below grade: feet Material of construction: ® concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance?(attach a copy of certificate) ❑ Yes ® No Dimensions: 1000 gal Sludge depth: 3" t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 17 r Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �M 68 Sturgis Lane Property Address William &Yvonne Adomonis Owner Owner's Name information is 9 required for every Barnstable Villa a Ma 02630 11-21-13 page. City/Town 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 32" Scum thickness V. Distance from top of scum to top of outlet tee or baffle 6" Distance from bottom of scum to bottom of outlet tee or baffle 15" How were dimensions determined? scour stick Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): At time of inspection septic tank appears to be structurally sound. No sign of back-up. 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 t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts W Title 5 official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 41M 68 Sturgis Lane Property Address William &Yvonne Adomonis Owner Owner's Name information is Barnstable Village Ma 02630 11-21-13 required for every 9 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: f 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 t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 f Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments GSM 68 Sturgis Lane Property Address William &Yvonne Adomonis Owner Owner's Name information is Barnstable Village Ma 02630 11-21-13 required for every 9 page. City/Town 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.): At time of inspection d-box appears to be in good condition. 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-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 •J Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 68 Sturgis Lane Property Address William &Yvonne Adomonis Owner Owner's Name information is g required for every Barnstable Village Ma 02630 11-21-13 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Type: ® leaching pits number: 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.): At time of inspection leaching appears to be in working condition. No sign of hydraulic 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•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ° M 68 Sturgis Lane Property Address William &Yvonne Adomonis Owner Owner's Name information is g required for every Barnstable Village Ma 02630 11-21-13 page. City/Town 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.): 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.): t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 J x Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 68 Sturgis Lane Property Address William &Yvonne Adomonis Owner Owner's Name information is required for every Barnstable Village Ma 02630 11-21-13 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: ® hand-sketch in the area below ❑ drawing attached separately 0 0 3 � I AI ' A 1- 11 (0" A 3- z z.' Aq - y3' 134 t5ins 11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 15 of 17 I Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments G'M 68 Sturgis Lane Property Address William &Yvonne Adomonis Owner Owner's Name information is Barnstable Village Ma 02630 11-21-13 required for every g page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope ® Surface water ® Check cellar ® Shallow wells Estimated depth to high ground water: >15' feet Please indicate all methods used to determine the high ground water elevation: ® Obtained from system design plans on record If checked, date of design plan reviewed: 11-24-93 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: Plan on file 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 Commonwealth of Massachusetts F; Title 5 official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ^M 68 Sturgis Lane Property Address William &Yvonne Adomonis Owner Owner's Name information is g required for every Barnstable Village Ma 02630 11-21-13 page. City/Town 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 l5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 Fwic,a .70. !2......._ THE COMMONWEALTH OF MASSACHUSETTS - BOARD OF HEALTH ., TOWN OF BARNSTABLE e lirtttu >tt for Diripoinl IPorlto Towitrurtiolt Permit 41 Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal Systemat: ........................ I .1................................................. .. . Location•.\ddress t LoZ&'4-1.t -•--•--------------------- 1 L....__..... ..... O cncr r d ess .......d-.,EAddress a Installer TypBuilding Size Lot............................Sq. feet U ............................Ex Expansion Attic ) Garbage Grinder ( ) ,.., Dwelling— No. of Bedroom.--...-�. P- ( aOther—Type of Building .--. ........ No. of persons.....4................. Showers ( / ) — Cafeteria ( ) a+ Other fixtures ........................................... .........................••--...••-• ...----............-•----•--•-----•-----....-•-......._..._........_.................................:...._... /'Q-------------------- ---------gallons per person per day. Total daily flow......r�. . ............................ W Design Flow...... ,3l�............. . .........gallons. WSeptic Tank—I_iquid capacity-a0d....-gallons Length................ Width................ Diameter..----.......... Depth................ x Disposal Trench--No. ........•--....._... Width.................... Tot:Il Lengt}I...__....:. ....... Total leaching area...................sq. ft. Seepage Pit No....../............. Diameter......6........... Depth below inlet................ Total leaching area..................sq. ft. z Other Distribution box ( V} Dosing tank ( ) ..4 Date........ :., �r1. ...... a Percolation Test Results Performed by................ S . . . Test Pit No. 1.......��.-.......mtnutes per Inc11 Depth Test Pit.................... epth to ground water...?20.?.l.G........ w Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a .......... .......... .... ............................................................. ODescription of Soil............ .. ...............--•--•----•----•-•..-------•------..............................--••-•--•-•---................... x . ..--•........................................................................................................•••.............•-•...... U 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 Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Complian e has been issued by the board of health. -/ ... Signed .... .......... .... ...G... ........ . ........... .................................. ...... te Application Approved By ................�....... -^—a�...................................-................._............. ...............tire .......y Application Disapproved for the following reasons: ......................................................................................................................................... ........................................................C................................... ................. Permit No. ! I. �./ ` .... Issued ....................... «.............................fe...... ...........f..... ... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE THIS IS 0 CERTIFY, That the 'Individual Sewage Disposal System constructed ( ) or Repaired ( ) r ...:.......... .. .......... .....................................er................ swil ..................................:..................................:.... .. V .. .. ...... .. ..I..................... ... ..... .............................................................................................. . has been installe�in accordance with tM provisions of TITLE o f The State Environmental Code as described in at ..........L.a the application for Disposal Works.Cunstruction Permit No. ...... .... dated ............................................. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT B ONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. ....... .......................... DATE i. Inspect or :........................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE FEE..... .C'.C)...... No.. .� _. ya. - �i��o�tt1 nrl;� �nii��r�r#inn �ermtt Permission is hereby granted............ n ........--•--........................................ ............._....... to Construct ( ) or Repair ( ) an I.. ividual gewage DispWal System atNo.....................................................................................................................---••-----.......................-••-•---..--.........---................. Street QU /� as shown on the application for Disposal Works Construction Permit No.f--f-`Jf-x Dated......7"-.— ......... ......................................... ..�... .... ......................................... L �IIoard`or"Hcalth DATE.............. .1.-: ....? ---................................ V FORM 36508 HOBBS R WARREN.INC..PUBLISHERS THE COMMONWEALTH OF MASSACHUSETTS /Fims...... BOARD OF HEALTH TOWN OF BARNSTABLE Appliration for Diopoinl Work,6 Tonotrnr#inn Famit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal (�)System at •��''" �p7 Lorit�on-i\d�ress ,� r Lof .......r}- -.c.t.Y_.. . ------------------ 14 '44,; 7 ! O cner dress Uvv Installer Address Typ of Building Size Lot............................Sq. feet U ,., Dwelling—No. of Bedrooms.__._..la--------------------------------Expansion Attic ( ) Garbage Grinder ( ) ` p4 Other—Type of Building .... ........ No. of persons--_-_�................ Showers ( / ) — Cafeteria ( ) a' Other fixtures ------------------------------- - - W Design Flow......114................................gallons per person per day. Total daily flow------3.,30...........................gallons. WSeptic Tank—Liquid capacity/-QOD--___gallons Length---------------- Width................ Diameter....------------ Depth................ x Disposal Trench--No- -------------------- Width.................... Total Length.................... Total leaching area....................sq. ft. 3 Seepage Pit No......1............. Diameter......6........... Depth below inlet................ Total leaching area..................sq. ft. Z Other Distribution box Dosing tank `'' Percolation Test Results Performed by. ... Date.-----��=. � �....�..... Test Pit No. I......�a.:_.._._minutes per inch Depth o Test Pit._.. S.�....... epth to ground water--_?Z4�t�....... (i Test Pit No. 2................minutes per inch Depth of Test Pit--------_........... Depth to ground water........................ Description of Soil............ .. ............� .......•------------�- 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 Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliat; Lhas n issued by the board of health. Signed .... ...G ...Application Approved By .........._...... ....... .w.\.................................................................... .....1.....:..6a,..►... `/i1 , _J Dare Application Disapproved for the following reasons: . .......................... .................................................................................................. ........... ................. ............................... .. ............. ........................ .............. Permit No. ..........::'. .. ..... .............. Issued ................ . ................................. Date...... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Certificate of Compliance THIS IS O CERTIFY, That the Individual Sewage Disposal System constructec ( ) or Repaired ( ) by ......................... ...:...__..� �, .._ .. ............. ....... .. .......--------------._._........ -- ................... .--....................... ........ at ..........&-.7r...... j. * ......---- - - 1 =. - ''t..................................................................................... has been installed in accordance with t4 provisions of T1TI.E 5 of The State Environmental Code as described in the application for D_sposal Works Construction Permit No. ----- .. .._----- --------- dated .......... _._. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY....—.1 15 •^ q � DATE..... c ........ - . ........._......... y Inspector ......................... --�_-�-------�---- ---..l.-.-/----Z---/--! ,............. ...... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH C� TOWN OF BARNSTABLE �i �as�t1 nrkii Tnnitr ion "ami# Permission is hereby granted------ \----- to Construct ( ) or Repair ( ) an Individual Sewage Dispjal System atNo-------------------------------------------------------------------- ------------•-------•--------------------------..-....-..------------------------:..------------------------..----------- street as shown on the application for Disposal Works Construction Permit No..�7..�n/.Y-D, Dated......�./..:Z.-.��1- ......... ...................................... .............................................----------- q Boar o DATE......... '! L; ................................... calt6. C FORM 36508 HOBBS&WARREN.INC.,PUBLISHERS ,y- 4Rs �h''� �3�. "�° „C". r a 9 at"�'+Gta.�d.�+.: '+A.�;,Yt'..r�+.sn:�F::o«r.�•�.,scw-�x�: ',�,�. No...9 _-..J Fxs......1 .r�......... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Applira i>an for Uiripnial Workii (nomitrnrtinn "ami# Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: & tt' ct c�.tCP._ Location-Ad4ress (� ,j �- /�r Lot Nv ..................................... rF n t st 7 C I O�cncr 1lddress Installer Address Si U Dwelling g No. of Bedrooms---....t� -------------------------------Expansion Attic ( ) Sq. feet d Type of Building ze Lot. Garbage Grinder ( ) a4 Other—Type of Building ---/o.,-_AxXd._.-._-- No. of persons.......>Z----------------- Showers ( / ) — Cafeteria ( ) a' Other fixtures ............................... . . W Design Flow......//k--------------------------------gallons per person per day. Total daily flow..----3.3117...........................gallons. WSeptic Tank—Liquid capacityl /F n t ....gallons Length---------------- Width....-........... Diameter---.------------ Depth................ x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No------/............. Diameter_----l._...------ Depth,below inlet............ Total leaching area..................sq. ft. z Other Distribution box Dosing tank ( lA)a Pert /Percolation Test Results Performed by.................�Ae . ......X/4. , .2�Date------I . ::�..:F3-..... 14 Test Pit No. I......4/1------minutes per inch Depth of Test Pit............. ,......45epth to ground water---- ........ Li, Test Pit No. 2................minutes per inch Depth of Test Pit-----------------... Depth to ground water........................ a ............................... --•----------------•....--------------------•-------•--•------...........--------._.......------...........-••-•-•..•••-- 0 Description of Soil------------ ----------------------------------------------•-------------------------------------------------..........••---- -- V ............ •----------------------------- ------------ ------ •--------------------- •---------------------------------- -........................................................... W UNature of Repairs or Alterations—Answer when applicable............................................................................................... --------•---------•---------------------------------------------------•••-----•.............------------------------------......---------------------------------............................................... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal Systep 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 Complian e has been issued by the board of health. Signed . ... ....�.. ..... ...................................... ...� � ce Application Approved By .. ,.._.. ................... '...."..D e.�.. .Ll!. Application Disapproved for the following reasons: ..........................----------------- .....................------------ *----- ----------........................ ........ ...................... . ........... ....................... . .................. ............................... . -- Daie ..Permit No. /..-......`... -- .. Issued ......................................... Dace -ro P o F SU L TEST - P- 6 t 5 6 GENERAL NOTES PIT a� Cri THIS PLAN IS FOR THE DESIGN A�YD wP 1• INVERT ELE�A TION.S• CONSTRUCTION OF THE SEXAGE DISPOSAL SL � S.Od G£!LI.A T•P• '•� T.P. --2 FACILITY ONLY. FLOOR OW. .ELEVY. 8 �8 6R,1/D. ELt-V. _9-8.•3._ INVERT AT BUILDING SS�00 � $ 6.W. ELEV. R. ALL CONSTRUCTION METHODS AND MATERIALS INVERT IN AT SEPTIC TANK ,5260 _ FOR THE SEPTIC SYSTEM SHALL CONFORM 9(c.5� ACCESS COVERS MUST BE WITHIN J2' OF FINISH GRADE. TOP o t�. -ro vso�I. TO MASS. 0.E.0.E. TITLE 5 AND LOCAL INVERT OUT AT SEPTIC TANK S7�._.i 5 5.._ , sv o1 BOARD OF HEAL TH RESULA TIONS. INVERT IN A T DIST. BOX IND.=TES 4 S u 6So ti .pp PERC. TEST T1C91k� sari 3. ALL SEPTIC SYSTEM CDMPONENTS SUBJECT TO INVERT DUT AT DIST. BOX 7• I 7. 8 5 „r VEHICLE LOADING (I, ETC.) �O MIN 2" OF ® CL Y E. UNDER ORIVEf✓AYS, INVERT IN AT LEACH PIT �36• _ . ' SAs'Pk.LA SHALL BE DESIGNED TO WITHSTAND H-20 LOADING. , • .Oo J/8 -J/2 DIA. BOTTOM OF LEACH PIT 0.00 4 kIN. _ 1t/ASHED STONE INDICATES cs>ssv���rta C� 1.1, IR LIQUID � 4. ALL SEVER PIPE SHALL BE SCHEDULE 40 OR OBSERVED 6ROUNDAIATER o - .•-� OBSERVED APPROVED EQUAL. t:1.00 `+ °TH ` GROUNDNATER ADJUSTED GROVNDMA TER JD DIST. W k 3/4'-1 1/2' oIA. p t d 10 t 5. BEFORE STARTING CONSTRUCTION CALL DIG SAFE Q 9 O. 5 4 10 G O SAL. BOX �$ 1✓ASHED STONE J-800 322-4844 FOR LOCATION OF SEPTI TANK N 1 b pjp �p INDICA TES ( �� UNDERGROUND UTILITIES. N 1 O TEST PIT V 4-2d �� �Ua� too 3� G. 3' s, oAruM Is ASscs�v►� � 7. IT SHALL REMAIN THE CLIENT'S RESPONSIBILITY TO OBTAIN ALL PERMITS SPECIAL PERMITS, ��T ��: �� N o~iti,AiYGR ►so W R YARIANCES ETC FOR 7`HIS PROJECT. ,tN oFM,,� ' .\.,��. ROGER <-„ ti � .� �� `. LZ�ti 9% DATA 111214-�q3 r. o G !'� �kUf. 1 8. IT SHALL REMAIN THE CLIENTS RESPONSIBILITY PAUL N f !• TO HAY£ THE PROPOSED Dll✓ELLINS FOUNDATION f'_ ` tti.:t: - ` o nnICHNIEWICZ r Yt_� 6 - 'LQ TEST By.. EA6lxt svP, EY))4 rr- 66 t�C ca coo .,r.. r No.30420 DESIGNED TO ACCOUNT FOR THE EXISTING 6AADE c,vi� i,j� a . 3?:9j AND SOIL CONDITIONS AT THE LOCATION OF THE !✓ITN SSEDT• b u PROPOSED DMELLING E BY. ,.E,o.c 1.1�1JG F,4GILITY i•. .,. _..., 9, THE SicPT1G 9KSTCc�n �� sNJ��L 6.Z. CC3ti. �"PRUG'tf�.b PR�oR T� • PERC, RATE ,'/L✓./ IN. S>i 'r'i co�sTa.UcTa� oG s�� z�Revosw 1•13.911 �o �thv'k`4 DATE PROFESSIONAL ENG VEER CI IL DA T P OF ONAL LAN SURV R DESIGN CRITERIA: Ob 2J9. 23 ION FLOW,• REN10ViL aLL u"Qwu1'TAc%-A-C 6a12._ 40 BEDROOM DWELLING i, JJO GAL,1,9.4Y ,-Z11 ItJ A. tO �T 1+,/ 11�E �4►.�fc. AROun.1.D . i rk.Ar_")W G V-AC I L1 w LEGEND EQUAL S GALS. PER 0,4 Y. Z7ow► 'rd -rM g- &I L'rY 5A►. 4 D LOT 4 N d A sZ 15*6t. G%i ti qeg -t�z�C-t34 4' 9E.PL,&C*_ w 1'C3A GLF.As-s SEPTIC TANK REQUIRED.- uv �, G r v rd 1. i v,,t ,�,,CLd FC pA�c CE 38720E S.F. 50--~= EXISTING CONTOUR w 1"f N "rl"rL.e. S . 88 � SRO X J50X = �� t,-1. , f PROPOSED CONTOUR SEPTIC TANK PROVIDED. = C)C71.� G.lL. � I-•tzAC i•t Q t T 50 = PROPOSED SPOT GRADE SIZE OF LEACHING FACILITY iizauIREO TO IL k P tZ o P, .,-"' = DIRECTION OF STORM IA TER DESIGN PERC. RATE u ;6_ AlI'/�'UTES/Ih'Cfl p.sox PROP, q RUNOFF 3 aD GALLONS PER OAY 10 SIZE OF LEACHING FACILITY PROVIDED.• / �•. T N t��•1E. �c PIT(S) MrTH 3� ' STONE EL . _ , 3 .► o �i SIDE!✓ALL 22(a S.F, X I-6G u 375 Gr:i t .• /,�„ c� q� BOTTOM Ill S.F. ,1'd•• 80 A RQ J� d TOTALS , S.F. 5 Gr�V Ti) 6 \� BREAKOUT CAL CULATIONS• ? 4 l ti Nd w SLOPE _� X 150 ' off, 4 O to REVISIONS' 5 NO. DATE REVISION CA TCH BASIN RIM = 93. 04 + cNrp ? O .M. , —0 AN 9SSU PLAN SHOWING THE DESIGN OF A PROPOSED k '�° 'O'° SUBSURFACE SEPTIC DISPOSAL SYSTEM LOT 4, STURGIS LANE, BARNSTABLE, MA .per SCALE 1 a = 30 ' NOVEMBER 24, 1993 EAGLE SURVEYING S ENGINEERING, INC. .M. OF CONCRE E BO ND 441 ROUTE 130, SANDWICH, MA_ V�l_ EL . = J00, 00 ASSUMED fr PROJECT NUMBER 93-157 W��• �. ISMY/..1R6W1M.i0..•4I WFI M:.M...:.,li'.N....MK1M f.rrrl..r.... :,v.:1 A+AIt1.. .O 4C-M:.u.. . ..... • . -..r