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HomeMy WebLinkAbout0052 DOLPHIN LANE - Health 52 Dolphin Lane Hyannis ' A= 191-163 Commonwealth of Massachusetts w Title 5 Official Inspection Form - Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 52 Dolphin Ln ' Property Address Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for every Wit-- `'Q S MA 02672 7-9-12 page. City/Town i I State Zip Code Date of Inspection I 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. A. General Information 1. Inspector: I Shawn Mcelroy Name of Inspector Upper Cape Septic Services' Company Name 29 Atwater Dr Company Address E. Falmouth .MA 02536 " CityfTown State Zip Code 1-508-495-0905 S 13971 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my'training and experience,in the proper function and rintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant t6tlection 4S 340 qV 'Title 5(310 CMR 15.000).The system: 's W ® Passes y ❑ ,Conditionally Passes- . f❑ Fails - 11 ❑ Needs Further Evaluation by the Local Approving Authority ` R YJ m 7-9-12 Inspector's Signature Date . The system inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 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. t5ins-11110 Title 5 Official Ins o orm:Subsurface Sewage Disposal System-Page 1 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form x - Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ,M 52 Dolphin Ln Property Address Bank Owned (Contact David Holt @Today Real Estate 1-800-966-2448) _ Owner Owner's Name information is required for every Hy p annis ort MA 02672 7-9-12 '-, page. City/Town State Zip Code Date of Inspection B. Certification (cont.) , Inspection Summary: Check A,B,C,D'orE/always complete all of Section D 4 A) System Passes: . w ® 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: System is in good working order with no sign of failure. 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 i Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 17 Commonwealth of Massachusetts " Title 5 Official Inspection -Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 52 Dolphin Ln Property Address Bank Owned (Contact�David Holt @ Today'Real Estate 1-800-966-2448) Owner Owner's Name information is required for every H annis ort' MA 02672 7-9-12 ' y p page. Cityrrown State Zip Code, Date of Inspection B. Certification (cont.)... B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due; to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board'of.Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND,(Explain below): ❑ obstruction is removed. ❑ Y ❑ N . ❑ ND (Explain below): ❑ distribution box is leveled.or replaced ' ❑ Y, ❑ N +❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below);- obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): - _ C) Further Evaluation is Required by the Board of Health: Conditions exist which require further evaluation by the Board of,Health in order to determine if the system is failing to protect public health, safety or the environment. ,. 1�. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a 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 Inspecfion Form:Subsurface Sewage Disposal System-Page 3 of 17 Commonwealth of Massachusetts Title 5 Official -Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments 52 Dolphin Ln Property Address Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is H annis ort MA . 02672 7-9-12 . required for every y p page. City/Town _ State Zip Code Date of Inspection B. Certification (cont.) m 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: f. ❑. 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 r F.. •. to or less`than 5 pprn, provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form. I. 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 N 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 '/2 day flow t5ins-11/10 i Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 4 of 17 Commonwealth of Massachusetts 7 Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 52 Dolphin Ln Property Address e Bank Owned (Contact David Holt @ Today.Real Estate 1-800=966-2448) "y Owner Owner's Name information is required for every Hyannispo'rt MA 02672 7-9-12' page. City/Town State Zip Code Date of Inspection d B. Certification (cont.) Yes No Y. ❑ ® 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. 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 isequal 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- ❑ ® 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 M 5. 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 ❑ El 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 Inspection Form _ - Subsurface Sewage Disposal System Form Not for Voluntary Assessments M 52 Dolphin Ln Property Address Bank Owned (Contact David Holt @.Today Real Estate 1-800-966-2448) Owner Owner's Name information is annis or H t' MA 02672 7-9-12 required for every Y P 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 , i ❑ ® Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ❑. ® Has the system received normal flows in the previous two week period? El ® Have large volumes of water been introduced to the system recently or as part of this inspection? ❑ LL. •® 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, t ` dimensions, depth of liquid, depth of sludge and depth of scum? ;❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: , ❑ ® Existing information: For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information i Residential.Flow Conditions: ` Number of bedrooms (design): 3 Number-of'bedrooms (actual): 3 ` r ' DESIGN flow based on 310 CMR 15.203 (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 W Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 52 Dolphin Ln - Property Address Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is ' - required for every Hyannisport MA 02672 7-9-12 page. City/Town 7 State Zip Code Date of Inspection D. System Information s r Description: Number of current residents: 0 Does residence have a garbage gender? ❑ Yes ® No Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes ® No' Laundry system inspected? 4y ❑ Yes ® No Seasonal use? t .� ,, ❑ Yes ® No -Water meter readings, if available (last 2 years usage (gpd)): • •Detail: ' . - ,. + .. _ _ Sump pump?:. ❑ Yes ® No Last date of occupancy: 5-2012 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?, f. ; El Yes ElNo 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 b Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 17 Commonwealth of Massachusetts Title- 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments 52 Dolphin Ln Property Address Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for every Hy p annis ort MA 02672 7-9-12 page. City/Town State Zip Code Date of Inspection D. System Information (cont.), Last date of occupancy/use: Date Other(describe below): f 6 t General Information Pumping Records: NiA Source of information: Was system pumped as part of the inspection? t ❑ Yes ® No If yes, volume pumped: gallons ' 'How was quantity pumped determined?:_ 4 • • 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 Commonwealth of Massachusetts _ W Title 5 Official Inspection Form Subsurface Sewage Disposal'System Form -Not for Voluntary Assessments 5 52..Dolphin Ln Property Address <, . Bank Owned (Contact David Holt @'TodayReal•Estate 1-860-966-2448)` Owner Owner's Name information is - - '" required for every Hyannisport,° F, e ` MA 02672 7-9-12' page_ city/Town ' State Zip Code bate of Inspection. D. System Information (cont:) . Approximate age of all components, date installed (if known) and'sotirce of information:"F' " 1980's Were sewage odors detected when arriving at the site? ❑ Yes ® Y No Building Sewer(locate on site plan):'* " r a Depth below grader _ 20 ». feet' Material of constriction: o . " ❑ 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:):" a ' Good condition. s r , } Septic Tank(locate;on site plan): r 12,E f Depth below grade: feet , Material of construction: ® concrete '❑ metal ❑ fiberglass` , ' El polyethylene ❑ other(explain) . ov • , s t , If tank is metal, list'age ; k. c " . r years , Is age confirmed b a-,Wticate- of Com oliance?' attach`a co of certificate'')" f 9 y P ( PY � ❑ Yes ❑ No Dimensions: 1000 Gal � Sludge,depth: 12" t5ins•11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 Commonwealth of Massachusetts Title 5 Official Inspection. Form Subsurface Sewage Disposal System Form,-Not for Voluntary Assessments 52 Dolphin Ln Property Address Bank Owned (Contact David Holt @ Today Real Estate 17800-966-2448) Owner Owner's Name information is required for every Hy p annis ort. :a ry`MA 02672 . 7-9-12, page. City/Town State 'Zip Code Date of Inspection U. System Information (cont.) .; . Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle 20" Scum thickness 0 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 16" How were dimensions determined? Tape 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 in good condition with baffles installed and no sign of leakage. 4, T Grease Trap (locate on site plan): f Depth below grade: feet t Material of construction: ❑ concrete ❑ metal - ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: a 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 `^w '� 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 49A. 52 Dolphin Ln Property Address Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) 1 Owner Owner's Name information is required for every Hyannisport MA 02672 7-9-12 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: f Material of construction' ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): *Attach copy of current pumping contract (required). Is copy attached? ❑ Yes ❑ No t5ins-11/10 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System-Page 11 of 17 Commonwealth of*Massachusetts _ W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 52 Dolphin Ln Property Address Bank Owned (Contact David Holt @ Today Real Estate 17800-966-2448). Owner Owner's Name information is required for every Hy p annis ort MA 02672 7-9-12 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.): Good condition with water at working level and no sign of back-up. 1 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: R t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 Commonwealth of Massachusetts = Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -*Not for Voluntary Assessments ' 52 Dolphin Ln ` Property Address Bank Owned (Contact David'Holt c@ Today-Real Estate 1-k0-966-2448) ' Owner Owner's Name A information is required for every H annis ort MA 02672 7-9-12 y p page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Type: ® leaching pits number: 1-1000 gal ❑ 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.): Leach pit in good condition and empty at inspection with stain line at 24" off bottom of pit. 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 Tide 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts : Title 5 Official Inspection Form s Subsurface Sewage Disposal System Form-Not for Voluntary Assessments �7 52 Dolphin Ln Property Address Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) ' Owner Owner's Name information is required for every Hy p annis ort MA 02672 7-9-12 page. CitylTown 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.): 1 _ t5ins•11/10 Tide 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 17 f Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments*," 52 Dolphin Ln Property Address r r Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is i anns ort MA 02672 7-9-12 required for every H y p page. City/Town 4,- 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 Or.Gk . i c- Qs ' B-c - s'C ' i t5ins-11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 15 of 17 Commonwealth of Massachusetts ?' G Title"5 Official. Inspection Form Subsurface Sewage Disposal,System Form Not forVoluntary Assessments " 52 Dolphin Ln • Property Address _ Bank Owned(Contact David Holt @ Today'Real'Estate 1=800-966-2448) k. Owner a, Owner's Name information is " required for every Hyannisport +' " , xy' MA 02672 , 7-9-12 page. City/Town *, _ 'State Zip Code Date of Inspection D. System Information (cont.). Site Exam: • Check Slope A ❑,»Surface water } 4 ❑ Check cellar Shallow wells Estimated depth to high`ground water: feet 4 Please indicate all methods,used o determine the high ground water elevation: ❑y`s Obtained from system design plans on record.r - fi If checked, date�ofkdesign plan reviewed Date " ®} ,Observed site (abutting property/observation hole within 150 feet of SAS) ® Checked with local Board of Health-'explain: ® _Checked'with local excavators, installers- (attach documentation) ® Accessed USGS database-explain You must describe how youestablished the high groundwater elevation:. . USGS and town maps show groundwater at greater than 20'. ` �£ <, a x _ Before«filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins-11/10t' : z 3 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 16 of 17 . Commonwealth of Massachusetts m Title 5 Official Inspection Form Subsurface Sewage Disposal.System Form -Not for Voluntary Assessments G M 52 Dolphin Ln Property Address Bank Owned (Contact David Holt @ Today Real Estate 1.-800-966-2448) Owner Owner's Name information is every H annis ort , required for eve Y p MA 02672 7-9-12 , 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 t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 17 L T0WN OF BARNSTA.BLE DCATzON Sa .Oolvh.�, L SEWAGE l ,At►E t/4.�n;s ASSESSOR'S i &LOT NSTALI EW.S NAME&PHONE NO. il✓ IC TANIC-CAPACITY .EACHINCTACILflM (type)pi (size) l a/ 40.OF'BEDROCfmS_.^.....3:_ _ --- WILDER OR OWNS j 'E ITDAM: COMPUA.NCE DATE: lepartation Distance Between the: liaximurn Adjusted.Groundwater bble to the Bottom of Leaching Facility tee ' ivste Water Supply WoU and.Leaching Facility (if miy wells exist r on site or within 200 feet of leaching facility) ;dge of Wedand and Leaching Facility(If any wetlands exist f° within 300 feet of aching facility) -�� :=-' >�-C t lurnished by —':K000 ' 0 AN 00 �v tP wA 1 "TOWN OF BARNSTABLE "F - •LOCATION .d -2 "A) ��. SEWAGE # � V- VI ,AGE 6, ASSESSOR'S MAP & LOT24rf—f 'INSTALLER'S NAME & PHONE NO.io 11,6 agoo SEPTIC TANK CAPACITY�,2 ,� i LEACHING FACILITY:(type) f ror' ga/. l�c�l (size) X� NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNER,/a2ge,,e- _ DATE PERMIT ISSUED:-4 �'' DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No r•� vND- ter+ r ,6 r A No.... ..!_. y1 Fln$. ... ..- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE ' Applirttttutt for Dixipwml Works Tomitrurttun 1hrmit Application is hereby made for a Permit to Construct ( ) or Repair (,'<an Individual Sewage Disposal System at: .:� ....... d . ........... ....................... ........... .......pd.l.i.............................. �E.oc:ttton::lddri•ss or Lot No. 1......�. ............ ......... ............._. owner Address ....... . .C lo---------------------------- ............................. .....................-•-••-•---•• ••..."•'-•••......••-•.....------..... Installer Address Type of Building Size Lot............................Sq. feet U ........................_Dwelling— No. o Berooms.--__._.-. Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) a Other fixtures -------------------------------' W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity............gallons Length................ Width................ Diameter................ Depth................ x Disposal Trench--No- -----------........ Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No.-__----_--._._._-- Diameter.................... Depth below inlet..................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by............................-............................................. Date........................................ Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water........................ Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ Q'+ "--•---•'---'-'---•-••--•---"-----•-••-•-•••-•--'-•-•-•••--••'•...............................•••.................................................---...... ODescription of Soil........................................................................................................................................................................ x w ..........................-......................................................................................................... _••---- U Nat re of Repairs or Alterations—A sorer when a plicable._.._ cr--: nh.....................................: Zh16 Agreement: Is_��� 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 Compliance has been issLA by the boar f health. — ��A ApplicationApproved By .............. ... ..................................... ..... ........ .............................................................. ................ ' ; g....% Application Disapproved for the following reasons: ....................... -- ........................ --- --..-- ..............._............................ ........ .. ............................................................ ............................................. Date Permit No. _...---- ` .Ll I.. Issued .........V.qg--q.................I....._....... Date �Ce w No.... / Fas.......... v THE COMMONWEALTH OF MASSACHUSETTS , BOARD OF HEALTH TOWN OF BARNSTABLE Appliration for Ali►i,pugal Wurk,i Tunutrurtiun firrmit Application is hereby made for a Permit to Construct ( ) or Repair (,-J�an Individual Sewage Disposal System at - 'i! ..._...%.1.....i .............-�/-�:..................... 4/7 Y1 i J----... c / .... ..... /6 D /" Location-Address or Lot No. V ........................•----......••-------•••--•---•--•-••-•--------•------ •-•-•----------....--•-•-•----•---•-•-----------••.........•••--..............................•... Owner Address ... ............................................... -•-•-•----...--••---••----•-•-----------------•--...........----•-----•----........--•--......--•- a Installer ` 1 z C Address d Type of Building � Size Lot.................... Sq. feet aDwelling—No. of Bedrooms--/-_-_-_Z ____________________ ___Expansion Attic ( ) Garbage Grinder ( ) p, Other—Type of Building ---------------------------- No. of persons............................ Showers ( ) — Cafeteria ( ) j 04 W Design Flow•Other fixtures ----------------gallons per person per,day1//Total daily flow............................................gallons. Q { 0� Septic Tank—Liquid capacity............gallons Length........ Width---------------- Diameter................ Depth................ Disposal Trench—No. ..................... Width.................... Total Length.................--- Total leaching area....................sq. ft. 3 Seepage Pit No-------------_----- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by..---------P _----------•-----•••-••----------••------•-•------••P•-•--• gate.............•--••.................._.. Test Pit No. I............... ._minutes per inch Depth of Test Pit..................... Depth to round water........................ (i Test Pit-.No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 0 Description ofSoil.............................................................................................---•----•-•-------------....----•-••---•--..._.............--••-------••- V1 ..-•••••-•-•-...._.....••-•-•••--•----.....••---•--•-•-•••-----•---....•--•••-••••--•------•---•--••••••----------------•-•--•-••---•----•------•-••-••-•--•-••-•-•••...........---••------............. W ... ...................... ------------------.....------------------------------....---------------•--------------------------•--- `------. /,LIS ns�►�2 U Nature of Repairs or Alterations—Answer when applicable.____ . ? ___: +� __ __. ..................'............_.___. ._. .. . -------..4-"v"-o'.0 1 a"--S��1.(.------«°o - -- ---- � ./?.6x.... Agreement. ' Sf 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 Compliance has been issued by the boar of health. cc rr,� �g Application Approved B //.................... �. PP PP Y ------------------------------------------------- e. ... ... Application Disapproved for the following reasons: ...................................... .. .. .. .......................................---........................................ ? .......... ......_................................................... .. ... ............................... ................................_..•-- . .. ................................. .:.......................I.............. Date l 1 Permit No. _ ...-... <<.� Issued ......._. ..�19..................................... Date e _ THE COMMONWEALTH OF MASSACHUSETTS BOARD'OF HEALTH TOWN OF BARNSTABLE , C�Ertifirate of C�omplianre THIS IS TO CETIFY That the Ind ividual Sewage Disposal Systemconstructed or Repaired d ( (/)i b .................................. C-. 0 ... ......_........ .......................... ............ .................. ....................y at .......... __......... _ .6..//- ... ................././.. ................ has been 5 of The State Environmental Code as escribed in the pplicationlfor lD sposalaWorkst Construction LE Perm trNu dated ........S.I..1( �..`�-......._...._ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE. . .... .. _.. . ...................................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH Cq y _ I TOWN OF BARNSTABLE .No..... .................. FEE. ................... �iu�uuttl 3�urk� �un,�tr�r#uan �rrmit Permissionis hereby granted----------------------. -----------------------------------•-------•----.......----------------•---........-•---....... to Construct ( ) or Repair ( an Individ al Sewage Disposal System Street / as shown on the application for Disposal Works Construction Permit No..�y..y y�.__ Dated...... 1.y..gy................... �. ------••-•-- -----------------------------•-----••-------- / Board of Health ,Q 6 �--7 DATE--------...=1-_---.-...'-------• -----•..... FORM 36508 HOBBS&WARREN.INC..PUBLISHERS 'ATION SEWAGE PERMIT NO. VI ��LAGE p hug 1 6� � INSTAiLER'S NAME i ADDRESS R U I L D E R OR OWNER a Q a-0 Cl/ Cam DATE PERMIT ISSUED DATE COMPLIANCE ISSUED qJ r� i ^.. No....80-.U2_q° - 1,44A i FEB..... ...5.00... THE COMMONWEALTH OF MASS CHUSETTS BOARD OF HEALTH _.................T own.............O F............Barn stable ..... Appliration for Bii#ooa1 Wvrk i Towitrortion ramit Application is hereby made for a Permit to Construct ( ) or Repair ( x) an Individual Sewage Disposal System at,: 2.Dolphin„Ln,.,...West,_Hyant}is oft,---NIA.....QZ672........................ .......................................................................... o Location-Address _or Lot No. Oakwood Corporatio __________________________________________________ _ Barnstable Rd.t .Hyannis, MA 02601 ---... ..... ................ Owner Address W A-& B..Cesspool..S :r..ie................................................ 128..Bishnps..Terrace,._x rannis....MA-•---Q2fiQ1.._... Installer Address Type of Building Size Lot............................Sq. feet V Dwelling—No. of Bedrooms...............3..........................Expansion Attic ( ) Garbage Grinder ( ) a aOther—Type of Building ............................ No. of persons..........3---------------- Showers ( ) — Cafeteria' ( ) dOther fixtures ----------------------------------------------------------•-----------•---•--•....•---- ----•---•------------•--------•--••-•----------............. W Design Flow............................................gallons per person per day. Total daily flow----........................................gallons. WSeptic Tank—Liquid capacity............gallons Length................ Width---------------- Diameter---------------- Depth................ x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) a' Percolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. 1----------------minutes per inch Depth of Test Pit.................... Depth to ground water------------------------ 0:4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ ------.•.......................•-•--••----•-•-•---------•-•---••--------....---------...._.................--------•-•-......•-----............------.------ Description of Soil................Sand ------------------------------------------------•--......----- W ---------------------------------------------------------........................................................................-•----•---••--•--------•--•------•------•------------------------- U Nature of Repairs or Alterations—Answer when applicable--.--installation.•of--a-.�-,OQQ.-gall On__� e-cast, stone packed leach pit.. (overflow� Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of I y p 5 of the State Sanitary Code— The undersigned further agrees not to lace the system in operation until a Certificate of Compliance has been issued by,the boar f li h. ° ign --- ►.... ----------- .V --•---- A Plication Approved By � ---------------- -•-•--•••-•-9�P 18D 8 0 Date Application Disapproved for the following reasons-----------------------------------------------------••------•---------...-•••----•-•-••--••--••-----...._..... -------------------------------------------------------------•--------------------•-----_...- Date 80- /18 80 Permit No............ Issued 9`•-•--�--• ------. Date r • , ,1 Fms..... ..5.0©........ THE COMMONWEALTH OF MASS CHUSETTS BOARD OF HEALTH ..................T°wn-...........oF...._.....Barn table.. ...........................................i Appliration for Uiipn,13ai Works Tonstrnrtinn Prrulit Application is hereby made for a Permit to Construct ( ) or Repair (X ) an Individual Sewage Disposal System at: 52 Dolphin,Ln.,L..Weat HYaani4,_wt �....42672.................................................................................................. Location-Address or t No. Oakwood Corporatior1,-,-,-„.......................„............„....... -44 Barnstable Rd., yannisr MA 02601 .......... •--- ............................................... Owner Address a A .. B Cesspool.ServiPIP............................................... 12&.. LshAge..Terrace-,-•-I Yannis,--1�1A-•--A26D.1-•---- Installer Address Type of, Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms..............3...........................Expansion Attic ( ) Garbage Grinder ( )Dw p,, Other—Type of Building •___________________________ No. of persons.....__...3................ Showers ( ) — Cafeteria ( ) F, Other fixtures ------------------------------ . W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity............gallons Length................ Width---------------- Diameter................ Depth................ x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No...........:.......... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. z Other Distribution box ( ) Dosing tank ( ) - aPercolation Test Results Performed by.......................................................................... Date--------------------------.....--------. Test Pit No. 1________________minutes per inch Depth of Test Pit.................... Depth to ground water_-___.__________----__-. (1 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water................... ------------------------------------------------------------------------------•• ---------•-•-••--......................................................... DDescription of Soil SA21R-•--•-•----•---------------••-----........----•----•------------------------•-----••-••-------------------------•----•-----•---•--•----------•- W U •-••••---------------•----•--••------------.........................................................•--••••--------•------•----••-----------•--•--•----•-•-----..................................... W x -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- U Nature.of Repairs or Alterat ionk=Answer when applicable....AAgtallat ion Of.a_1 j 000_.ga110n..p 7PADt, stone packed leach pit. overflow) . Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of'TTL E, 5 of the State Sanitary Code— The undersigned further a rees not to place the system in operation until a Certificate of Compliance has be' issued e bo� h i ne 18 80 g --------------•-- /18/80 ................. Application Approved BY % � y "=---------------- 9�Tti o /f Date Application Disapproved for the following reasons-------------------------`✓--•---•----•-----------------------------------------------------------------•--•-..... Date Permit No.$©l--------------•-----...:...........--••-----•-.. Issued_9�18/80 Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ...Town............................o F............Barnstable.......... (Inrtifiratr of Tompliattrr THIS IS TO CERTIFY That th Individual Sewage Disposal System construessed ( ) or e •fired (X) by A & B Cesspool Service, 128 Bishops Terrace, Hyannis, MA 02601 - 75- . -•••-------•••.......--•................... at 52 Dolphin Ln., r+0est Hyannisport, 026"aller Oakwood Corporation ------ has been installed in accordance with.the provisions of TIT � 5 of The State Sanitary Code�ajsl escrribed in the /80 application for Disposal Works Construction Permit No------_.�_�___ ` - dated----------------_-___----_--_-.----- .----:--. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT IE SYSTEM WILL FUNCTION SATISFACTORY. :,.„, DATE................... /18/80............................................ Inspector............................... .................................................... i THE COMMONWEALTH OF MASSACHUSETTS K BOARD OF HEAL' H 80- ...................Town............oF...............Barnstable........................................... No...........:.... r FEE.........................00 Disposal Mork$ Tnn#rnrtion rrnti# A & B Css ool Service Permission is hereby granted --- --- --- ...........••---------•-----••----••--•----••--•-•-----•••••-•--••......................... to Construct ( ) or Repair ((X ) an Individual Sewage Dis sal System at No....5z._Dolphin Ln., West Hyannisport,_ K 02672 - Oakwood Corporation -------------------------------- ' Street as shown on the application for Disposal Works Construction �Pi/ermit No. 4_ Dated..............91l 8./8O ............ 9/1B/8O Board of Health ---------- DATE------------------------•---------------._...---•-------•......----••--•--...... FORM 1255 HOBBS & WARREN. INC., PUBLISHERS