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HomeMy WebLinkAbout0042 CONNEMARA CIRCLE - Health oil42 'C�ONNEMA�RA CIRCLE, HYANNIS ;; a ° ° ° ° o r ° j e ° is ° �+ TOWN OF BAJJRNSTABLE oa // 'LOCATION 14-2 ( yu ina ' C 'y- SEWAGE#- - ,7 S/? t� • VILLAGE JA V 'ASSESSOR'S MAP&PARCEL NAME&PHONE NO �,-�r(L(L SEPTIC TANK CAPACITY /000 � LEACHING FACILITY. (type) . 41 �J�f;I rrca—rO (size) NO.OF BEDROOMS'-3 OWNER pal PERMIT DATE: ATE: 0 C� 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 300 feet of leaching facili ,\ Feet FURNISHED BY J / / J / / J l / / / / I / / / . .. . . . . . . . . . . . . . . . . . \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ / / / J J / / / / J / / ! /:f J J / J / / f / ! / / J \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ 27 22 4 ^ 44 2 ' � f I Commonwealth of Massachusetts 2. Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 42 Connemara Circle Property Address Boullie Owner Owner's Name information is Hyannis MA 02601 November 23, 2009 required for City/Town State Zip Code Date of Inspection every page. 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 theJ^ computer,use 1, Inspector: only the tab key to move your Patrick M. O'Connell cursor-do not Name of Inspector use the return key. Se tic Inspection Services Co. O Company Name 0-1.1 189 Qammett Road ' N Company Address 02648 Marstons Mills MA State Zip Code 6MUDM Q_. Cityriown o" 508,428-1779 S112855 t Telephone Number License Number C..a c=P B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority November 23, 2009 Date Inspector's Signature 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. V Title 5 Official Inspection For m:Sub ace Sewa a Did-system•Page 1 of 15 09-251 Boullie.doc•08106 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments w " 42 Connemara Circle Property Address Boullie Owner Owner's Name information is Hyannis MA 02601 November 23, 2009 required for State Zip Code Date of Inspection every page. Cityrrown 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: Tank is not in need of pumping at this time leaching system shows no signs of saturation. 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. Answer 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. ND Explain: ❑ 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 ❑ obstruction is removed 09-251 Boullie.doc•08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal system•Page 2 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments w 42 Connemara Circle Property Address Boullie Owner Owner's Name information is required for Hyannis MA 02601 November 23, 2009 every page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes (cont.): ❑ 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 ❑ obstruction is removed ND Explain: 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 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. 09-251 Boullie.doc•08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 3 of 15 i Commonwealth of Massachusetts t Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 42 Connemara Circle Property Address Boullie Owner Owner's Name information is Hyannis MA 02601 November 23, 2009 required for y every page. CitylTown State Zip Code Date of Inspection B. Certification (cont.) 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**. Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for 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 El ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ET 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 t. a �® 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 ces spool;or privy is within 100 feet of a surface water supply or tributary to a surface water supply. 09-251 Boullie.doc•08/06 Title 5 official Inspection Form:Subsurface Sewage Disposal System•Page 4 o/15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 42 Connemara Circle Property Address Boullie Owner Owner's Name information is required for Hyannis MA 02601 November 23, 2009 every page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) D) System 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. El ® 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 11 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. 09-251 Boullie.doc-08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 42 Connemara Circle Property Address Boullie Owner Owner's Name information is Hyannis MA 02601 November 23, required for H y 2009 every page. Cityrrown 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 ® ❑ 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? ❑ 0 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 ® El 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)] 09-251 Boullie.doc-08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments w 42 Connemara Circle Property Address Boullie Owner Owner's Name information is Hyannis MA 02601 November 23, 2009 required for y every page. Cityrrown State Zip Code Date of Inspection D. System Information Residential Flow Conditions: Number of bedrooms (design): 3 Number of bedrooms(actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 0 Number of current residents: Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes JE No I Laundry system inspected? ❑ Yes ❑ No Seasonal use? ❑ Yes ® No I Water meter readings, if available (last 2 years usage (gpd)): Sump pump? ❑ Yes ® No One week prior Last date of occupancy: to inspection. 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: Last date of occupancy/use: Date Other(describe): 09-251 Boullie.doc•08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 15 i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 42 Connemara Circle Property Address Boullie Owner Owner's Name information is Hyannis MA 02601 November 23, required for Y 2009 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) General Information Pumping Records: Source of information: Tank pumped two years ago. 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) ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): Approximate age of all components, date installed (if known) and source of information: Compliance date: 12/28/99 Were sewage odors detected when arriving at the site? ❑ Yes ® No 09-251 Boullie.doc•08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 15 n I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 42 Connemara Circle Property Address Boullie Owner Owner's Name information is required for Hyannis MA 02601 November 23, 2009 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Building Sewer(locate on site plan): 1' 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.): i Septic Tank(locate on site plan): 4" 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: 8.5' long x 5.2'wide- 1000 gal. 2 Sludge depth: Distance from top of sludge to bottom of outlet tee or baffle 28" Scum thickness Trace ` Distance from top of scum to top of outlet tee or baffle 6" 14 Distance from bottom of scum to bottom of outlet tee or baffle How were dimensions determined? Measured 09-251 Boullie.doc-08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 115 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments 42 Connemara Circle Property Address Boullie Owner Owner's Name information is required for Hyannis MA 02601 November 23, 2009 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.): Tank is not in need of pumping at this time, liquid level was found at bottom of outlet invert. Tees were intact and clear. I 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 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: c ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) 09-251 Boullie.doc-08f06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 42 Connemara Circle Property Address Boullie Owner Owner's Name information is required for Hyannis MA 02601 November 23, 2009 , every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Tight or Holding Tank (cont.) Dimensions: J 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 Distribution Box (if present must be opened) (locate on site plan): 0.1 Depth of liquid level above outlet invert Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): No solids or high stains present. Liquid level was found at bottom of outlet pipe. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No r � , f Alarms in working order: ❑ Yes ❑ No 09-251 Boullie.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 42 Connemara Circle Property Address Boullie Owner Owner's Name information is required for Hyannis MA 02601 November 23, 2009 every page. Cityrrown State Zip Code Date of Inspection 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): i I If SAS not located, explain why: I Type: ❑ leaching pits number: ® leaching chambers number: 4 Infiltrators. ❑ 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.): Soils and stone surrounding Infiltrators were probed with no signs of saturation or hydraulic failure. 09.251 Boullie.doc-08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 15 - -- - - - Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 42 Connemara Circle Property Address Boullie Owner Owner's Name information is required for Hyannis MA 02601 November 23, 2009 every page. Cltylrown ,State Zip Code Date of Inspection D. System Information (cont.) 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 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.): 09-251 Boullie.doc-08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form s Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 42 Connemara Circle Property Address Boullie Owner Owner's Name information is Hyannis MA 02601i November 23, 2009 required for y every page. Cityrrown State Zip Code Date of Inspection D. Syst6m 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. Cvnnernara Circle Water Service -111INININININI% % 10, / / I / / / / / % /%/ / I % % NIN 27 .22 42 44 Commonwealth of Massachusetts v' Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments w 42 Connemara Circle Property Address Boullie Owner Owner's Name information is required for Hyannis MA 02601 November 23, 2009 every page. CityfTown State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope ®. Surface water ® Check cellar ® Shallow wells Estimated depth to ground water: 20+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: 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: USGS topo map and town GIS. You must describe how you established the high ground water elevation: Town groundwater contour map shows water at el. 20 and topo map shows property at el. 50. 09-251 Boullie.doc-08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 15 of 15 TOWN OF BARNSTABLE LOCATION fL Z G 101el,- QPeMr G/rGk- SEWAGE VILLAGE ASSESSOR'S MAP & LOT Z INSTALLER'S NAME&PHONE NO. ,�QIDJ SEPTIC TANK CAPACITY /.DOQ G�l LEACHING FACILITY: (type) ,Z.o-41 Jr44-1 (size) NO.OF BEDROOMS BUILDER 0 R f ,dGL„c PERMITDATE: I Z 2--7` COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility .37/ 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 300 feet of leaching facility) & g Feet Furnished by /S G f r r- - - - , I , t �� �?' � ,�, C i ��-. �` • � W S Q �-�• o_ J No. y Fee _ THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS 01ppYication for ;Bigpozaf bpftem Construction 3permit Application for a Permit to Construct( )Repair(!�)Upgrade( . )Abandon( ) El Complete System [JIndividual Components Location Address or Lot No. Owner's Name,Address and Tel.No. Z C ongwala Gib IoA ,�Ou/li Assessor's Map/Parcel 1) S, Installer's Name,Address,and Tel.No Designer's Name,Address and Tel.No. 7 21 Type of Building: Dwelling . No.of Bedrooms Lot Size sq.ft. Garbage Grinder(Xl�p Other Type of Building_49P &,Ce No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow I/B gallons per day. Calculated daily flow v�rJ� gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank /®dy �iY1s7`ir9 Type of S.A.S. //� Description of Soil r 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 is o of ealthAii . Signed Date yJ� Application Approved by Date Application Disapproved for the following reasons Permit No. -.>'� Date Issued -b.J �Eii <'r' f/�i'47=4rr. s,n-.-t`n-.:'. :.t�•M``-x w`w�-- _ar-;,'T`:: :P"--�. n,'S w a . �i'r33rr-=_ ., .'_.. �s No. . (� a Fee THE COMMONWEALTH OF MASSACHUSETTS Ent ed in computer: _= 45 �. PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTSYY/ 1 ZIppYication for aigool *pgtem Construction permit Application for a Permit to Construct( )Repair(✓Upgrade( )Abandon( ) O Complete System 11 dividual Components 1 ' I Location Address or Lot No. Owner's Name,Address and Tel.No. ;• y Z C OIf/1�1a94'/'4 Gi✓� ,�Ou/�i 2 a Assess is Map/Parcel 1� N� S ; /. I R4 Installer's Name,Address,and Tel.No. , Designer's Name,Address and Tel.No. t ���la�`i Coast- f, . 7 / 93 Type of Building: 1 Dwelling No.of Bedrooms L? Lot Size sq.ft. Garbage Grinder( O Other Type of Building PGICee No.of Persons Showers( ) Cafeteria( ) t Other Fixtures Design Flow gallons per day. Calculated daily flow 330 gallons. Plan Date Number of sheets Revision Date Title. - - "Size of Septic Tank /dfJO �ii9}`/�9 Type of S.A.S. Description'of Soil �4.►'3D X Z/ , S Nature of Repairs or Alterations(Answer when applicable) �/�/P /�i,Q7/✓� 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 iss=byto of ealth. Signed t` Date Application Approved by Date Application Disapproved for the following reasons Permit No. ,, - Date Issued THE COMMONWEALTH OF MASSACHUSETTS T BARNSTABLE, MASSACHUSETTS Certificate of (Compliance THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed( )Repaired ( &<*Uepgraded Abandoned( )by r �vT�J �i75 at ZG d1 ,g q G/ CIgo NV17WOZ5 has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No dated Z.0 j Installer Designer The issuance of this permit shall not be c stnied as a guarantee that the;sy�will n as des..rDateInspector :'�—' i --- --------------------} ------ No. Tf- t_ 1 Q� T7 `Z �I Fee --- THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS Migpogal bpmem Construction 3pertnit Permission is hereby granted to Construct( )Repair( V Up rade( )Abandon( ) System located at �f Z G/rC C. y 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:Co nstruction must be completed within three years of the date of.this PP15mt. �%� Date: / �' Approved by ` , E� To �P 1�p09�1 i it i 1/6/99 NOTICE:.This Form Is To Be Used For the Repair Of Failed Septic Systems Only. - CERTIFICATION OF SKETCH AND APPLICATION FOR A DISPOSAL WORKS CONSTRUCTION PERMIT(WITHOUT DESIGNED PLANS) p A I, /5®�e� y" 4>' Qar � i, hereby certify that the application for disposal works construction permit signed by me dated IZA.-IZ!?t4p concerning the property located at GOh`fifxiy '4r 6�el/SMeets all of the following criteria: /The failed system is connected to a residential dwelling only. There are no commercial or business uses associated with the dwelling. vl The soil is classified as CLASS I and the percolation rate is less than or equal to 5 minutes per inch. I J V There are no wetlands within_100 feet of the proposed septic system +� There are no private wells within 150 feet of the proposed septic system There is no increase in flow and/or change in use proposed . There are no variances requested or needed +' The bottom of the proposed leaching facility will not be located less than five feet above the maximum adjusted groundwater table elevation. [Adjust the groundwater table using the Frimptor method when applicable] Y If the S.A.S. will be located with 250 feet of any vegetated wetlands, the bottom of the proposed leaching facility will not be located less than fourteen(14)feet above the maximum adjusted groundwater table elevation, Please complete the following: 1 Z. A) Top of Ground Surface Elevation(using GIS information) ` J' B) G.W.Elevation � � +the MAX High G.W. Adjustment. = Z Z 3 ow 7a , DIFFERENCE BETWEEN A and B Z I SIGNED : DATE: [Sketch proposed plan of system on back]. q:health folder cat '.:. t .:.'. tin..• r .;;,_- t: ..... �.. 1 .i.' - TOWN OF BARNSTABLE . 1 LOCATION t'�t Z 6M,0,7©13j0117 e14,1/ SEWAGE # j i VILLAGE ASSESSOR'S MAP & LOT Z %- INSTALLER'S NAME&PHONE NO. /�F�4'IDI-gP � ©/�S�` SEPTIC.TANK CAPACITY OG6 G,L LEACHING FACILITY: (type) .Z�,l'L ltrti1 �l (size) x To NO.OF BEDROOMS BUILDER 0l R, i PERMUDATE: /Z- Z 7�77 COMPLIANCE DATE: $f � Separation.Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility f Feet i d Private Water Supply Well and Leaching Facility,(If any wells exist on site or within 200 feet of leaching facility) Feet Edge:of 1Vetlan`d'aad Leaclii g FacitLty(If any wetlands exist within 300 feet of leachingfaciliy l/ P Feet Furnished by 1 • / o£ to i �� O th i -77 0 CATION V-d— SEWAGE PERMIT NO. �t�co�Y�l22�r1�n1� � � rz VILLAGE l )A �4 c J INSTA LLER'S NAME m ADDRESS B U I L D E R OR OWNER ' DATE PERMIT ISSUED �1 — ( 3 ^ 7 � _ DATE COMPLIANCE ISSUED . . Q ; � �� 91� r,� �� I c � �� �ti �� �h .,� - ,, i No........ Fxs....... .................... THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH .............Town................O F............Barnstable............................................. Applira#ilan for Dispaa al Works Cnnnitrns#iun r.erntit Application is hereby made for a Permit to Construct ( X) or Repair ( ) an Individual Sewage Disposal System at: - . ..............................................or6 2 .. ircleaj -------•------•----- Lo t-N-o-.----------•---- ......................... cation-Address o Owner Address w ............................................. -•-•.......................SAN,._..................................................... Installer Address to 000 Type of Building R Aift coo Size Lot.............................Sq. feet V Dwelling—No. of Bedrooms___.-."-------------3------_._ _Expansion Attic ( ) Garbage Grinder 1(0 ) ............................ No. of ersons__......_................... Showers — Cafeteria Other—Type of Building G-'" p ( ) ( ) Q' Other fixtures ..... •--------- --- -- - d W Design Flow.................55......................gallons per person per day. Total daily flow..............3.3.0.....................gallons. r tt WSeptic Tank—Liquid capacitya.QQQgallons Length______________ Width..Q_r__IOrr Diameter---------------- Depth_"1_+_1 n0-._ .__. x Disposal Trench—No. ................. Width.................... Total Length..................... Total leaching area.....................sq. ft. Seepage Pit No....... ............ Diameter---__2J)t__-_-_- Depth below inlet,..... .. ........ Total leaching area..267._ q./�/ ..._.s ft. Z Other Distribution box (X ) Dosing tank ( ) '-' Percolation Test Results Performed by.!saPe___CQ.d...5.11 vju._._-OI1,9RItant,�ate__._.1 24�7g______________ ,al Test Pit,No. 1.....2........minutes per inch Depth of Test Pit.....12......... Depth to ground water......................... Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water.....�>. . .. ..............................•--------------......-----•-•--------------=••---•-......----•-------................................. _4g�. O Description of Soil__O.t0-2_,•0...loam..&-_-sub_ o11...."-2.tQ7:.9.,.0..med-,-"-brown- sand_,• �.` ................ v �x� 12.0--med_... white sand. -- -••----- ._RENwu,l(_. tiN B. U Nature of Repairs or Alterations—Answer when applicable_._ _.....__ ___ _ .__ __ ............................... __... .N}o.-276A--- .............."---"...._.................._...__...._............................................._..._. A Agreement: NAL The undersigned agrees to install the aforedescribed Indivi ual Sewage Disposal System in acco the provisions of I IT,IZ 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been ' sued by the board of health. Sig . •-•-- - .. ..................................................... -----�V/ Application Approved By--... . ----••• . ............... ...�l�P�. -°��....__......... 6�= 'Date 7 , . Date Application Disapproved for the following reasons-------------•---------------------...----------------------------"-------------------------------------......... --•..............••••---••-•--•--....------•••--•-------••----•-•-•----------•••-•--••-•••-•-••---•........ Date PermitNo......................................................... Issued....................................................... • r Date No. 1 :.. FEB...Z. ... ... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .........Tom. ................O F............Barnstable--------------------------.-----.-------.-._- Applira#ion for Biopos al Works Toni#rnr#ion Prrmi# Application is hereby made for a Permit to Construct ( X) or Repair ( ) an Individual Sewage Disposal System at: ...................._.._...GA.m ma m...Circle...............------ ................................La t...b2.........._..... ......... Location.Address or Lot No. Q .» Owner ddress W ........................... .............................................. ............... ......_.......__...' Installer Address to oo0 d Type of Building , f Size Lot--------I......_ _---------Sq. feet U Dwelling—No. of Bedrooms....................3........ ._ .....Expansion Attic ( ) Garbage Grinder 00 ) Other—Type of Building ............... No. of persons............................ Showers ( ) — Cafeteria ( ) Otherfixtures ..'--------------------------------------------------------------------------------------------------------------• ...--"---"- Desi Flow.................5.5_.....................gallons er erson er da Total daily flow.._........_.. I.1 ..gallons. tm P P P Y- Y 3 3 -------------------- Septic Tank—Liquid'capacity)O.00.gallons Length-__--1.6n. Width.. f.1.Q.n Diameter________________ Depth-1y.0"... W Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. x Seepage Pit No......1-------..... Diameter-----1 101------- Depth below'inlet,_... 1....... Total leaching area..267_.......sq. ft. Z Other Distribution box (R ) Dosing tank ( ) Percolation Test Results Performed byCa?le...C.Qd..S t1;'V� ._. Q?"ISLt�,L.8Y1CS�ate...._1/24./a9-•------------- ,aa Test Pit No. I.....2........minutes per inch Depth of Test Pit..___a.2i....... Depth to ground water......A ...... Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water_ FP��j}pF fr7gs� •-••---•--•--•""•--- -------"•""•"•..................................•"""-"-"-""-"-......_........_.............................. . . ............. .90 O Description of Soil_ •0-2 __1© ..&--_dub 41 }.__ .1•Q-9.�..aod-....b.Tow...salido.. g----&ErtsactcK-. ya �1�12.(? ME'C�.. W�1 -tiG 3 1�+`.e____________________________________ z B. W o----------------------- -a ........................... ! ' c� CHAPMAN ti UNature of Repairs or Alterations—Answer when applicable... . ............................ Fs�UNAL Agreement: Z 3�? �„�. The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TIT1.;�. 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. Sig `Xr te •0.- .---------------------Appl>cation Approved BY �6 .Zr" Date Application Disapproved for the following reasons:_ -•---•---•----••.............•"--•---••-•---•-"...--•-•-•"............................... """...""----.. ------------------••--......__.........--•-----"•----•-.•-""-"-"-""-""--•"---...-"--------------------------------------•-----------""-•-•""""---"----" Date PermitNo......................................................... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARfb_"O'F. ALTH ...........Y�o ...O F..............� .. �............................. (9rr#if irtt#r of Ton phanrr THIS IS'TO CERTif Y, That the Individual Sewage Disposal System constructed A) or Repaired ( ) bl.: ........"----------------"--.................------•-----------------------------"---------...--•-•"......--•--••-" Y-•-•-•......--"•"•-""-" p Installer atl4l--•-...bl.....E241 444,A,4......C-4.1Zf.............PI .A. --------------•-••----•---..."------•---------•--•--••-------------"-- has been installed in accordance with the provisions of T T j of The State Sanitary Code as described in the application for Disposal Works Construction Permit No__.._. _--__A,4e.-..._....... da.ted.....% `�.T'+g�/��J�............. THE ISSUANCE OF THIS CERTIFICATE SHAL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. U DATE........ ...... .. ..... Inspector...... ---- -------............ - THE COMMONWEALTH OF MASSACHUSETTS 11-1. BOARD % r HEALTH ...........OF............./�j;�/..�iij/. ... ............................... NC)--" ........... Dio FEE. �--........... �rosttl orko �on�#rnr#ion rani# Permission is hereby granted .- ,I.................."----"----------------"--------•---•--.......-•--•-•----•-----••----................... to Construct.( ) or Repair ( ) an Individual Sewage Disposal System at No�1� '- -. -.t +r1rl� u� l tl r Cr_1;• Nl �c -.i% I;=S--.......---"--------------------------------•--.......-•--•- _..___.' ___•_._ .7"rrF'c•'"•, ._........ . Y............... 1 .,t . T$CICEt+ as shown on the application for Disposal Works Construction Permit o.......... ...... D to ............ Board of eal r - -"-------..... DATE--------y-/.. ~T ,f. FORM 1255 HOBBS & WARREN. INC., PUBLISHERS i ~ , SOIL - LOG w , . . �X•.S,t(/riic..,w,uc4•.,r.�,.,4.•..a:r/`7��'¢'L4,-" • •' (.Ol.-I 2•PEASTONE ...LOAM S FILL— — 12.MAX, LOA•�1A - -• !; — =e Sues 1w 4'-C.I. DIST. A °•�::: °„ I ME.QI um. RG.1000 BOX I;.o•,0 1000 GAL. e�' I TEi't. __- IO'MIN. GAL. Ise%': PRECAST . OR b, 24" 13 p " . SEPTIC I•'::°•' �' % 1 MIN I,•,,,•,. BLOCK °.o .I • SEEPAGE TANK 6 I .. ° O•p0� O PIT I l e, • . s,D a s� . 20 MIN. `'" - - -- - - - • •'.d _mIDIvm V�!•N.I TE w AN0 •FOUNDATION 1 ,; I /2 WASHED , STONE I _ N'O W,AT E R ELEVATION,, SKETCH tip' - to' ,'` I' PERC. RATE= uNpri 2 mutts/mc-H < SCALE • '1" = 4' TEST BY I M --Ni-5 • 4..• TOWN INSPECTOR: P. •GA-RPN IR '- BACKHOE•OPERATOR: 5UI-L it*N% CYAR 0��3 • : ` -TEST MADE ON : TAi�?. 2 }'A'1 3 3`a�o�q�►�rs('n�0'�:a Sac}a..GerkoQ�}'k.:f,o GAc /oAy%e,�• = 3 to Gac./p�rp.. - Z�/ylAX. AtGoj✓IQBC.� `G.7A/L•y �'Gow f�,Q TH/s SY9T'�r? - .SiO w�1t,G,S' I,B�•�•R x 2.3 G}R�./s:R - 47o CRA/P4y. ` .13�rra� 7 9 s � ,k i a 4�?,Q.�.�';f ,= 7 4 G��./.a�� •- - . . • -JV IS 'G OT ', • , • •- •�.._t• •'� ' `1, s....+:, -..•.-- �..�`.._.....J-_ .....r...--. a.•.....__....rw....:.-.-..•-z..r,.�. -FJ,1 ,-_ �.. ,-..- ..«._.. --.,•••---•• _.-..—..+,...1.. .r. -«, ..�.:i_:.....�-•"..:. N, 82° 55`-4d' E, ' a ' I IQI .r 80. 00' f i L-OT 62. ol �. ��� ` T I gRs19 1 PIT t ' �O� • �p odl� tic At. log, .... T. lyk 10 01 In 0 r Z " fi �R0-o 4_�' := -- IU - r07 — .�- 3 BENCH MARS' t T FOM? 109•d � -20 TOFF STAKE L <'-'• �p5 EL, = 10 5.42 60#1 106 I Q ' � I rod-? C2 � .� 1� `_ 1 O4 — "a E ........ •S 80- 5 �4 o W �„a. w— y Eato�c;r IQf .. _ .�\ -- - _. _��---.....�.- .�.•.,..�.:.:. •_ - . - __ _ _ .___ E M R A �a/ CIRCLE u � .n``aOF�'QS 4-0' WIDE,) + 6 X RENVIICK �; 1 - E p G EE -O PAV .�, w.... EMENT �ca f VpAYMAN rnj U"Q • E-LE VAT ION SCHEDULE = PROPOSED SITE PLAN I. INV.' AT FOUNDATION = 104''52. a SEWAGE SYSTEM DESIGN 2. INV. INTO SEPTIC TANK = 06• 't.. IN 3. INV. OUT OF SEPTIC TANK = 06'07� LOT 6Z , CONNEMARA• CIRCA F_ 4. INV. INTO DISTRIBUTION BOX = /�S• HY•ANNIS, MASS. SCALE: I"= 20'• F ES, 1979 5. INV. OUT OF DISTRIBUTION. BOX = ADS; 0 C - 752 6. INV. INTO SEEPAGE PIT = /05.70 CAPE COD SURVEY CONSULTANTS ROUTE 132 7. BOTTOM OF PIT = 99 7o HYANNIS,MASS. P,