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HomeMy WebLinkAbout0141 DOLPHIN LANE - Health 141 Dolphin sane Hyannis A=268 006 �I I r Health Master Detail Page 1 of 1 It Z .._i;tiCed 1:^. Fks: ..KYVVN`oco'tiYie' Health "f C�, Detail r ., Parcel e d Ie�.c ,va i Parcel: 268-006 Location: 1.41 DOLPHIN LANE, HYANNIS Owner: ZASLAVS IY, MARINA YAROSLAV Business name: Business phone: Rental property: F Deed restricted: , Number of bedrooms : 3 Contaminant released: F Fuel storage tank permit: F. Sage Parcel Chan°ges Return to Lookup Parcel Info Parcel ID: 2.68-006 Developer lot:LOT 49 Location: 141 DOLPHIN LANE Primary frontage: 100 Secondary road: Secondary frontage: Village: HYANNIS Fire district:HYANNIS Sewer acct: Road index:0447 Asbuilt Septic Scan: 268006 1 Interactive map L Town zone of contribution:GP (Groundwater Protection Overlay District) State zone of contribution:OUT Owner Info Owner: ZASLAVSKIY, MARINA & YAROSLRV Co-Owner: Streetl: 12 CAROL DR Street2: City:FRANKLIN State:MA Zip: 02038 Deed date: 5/511 2006 Deed reference:20975/227 Lard Info Acres: 0.25 Use: Single Farn [' DL-01 Zoning:RB Neighborhood: Topography: 1.evel Road:Paved yy Utilities:Public b"Jater,Gas, sS€�.;ptic s� Location: Construction Info Biking a' #3'e t.;`ie �(Vf t re'-iISC `t;e^i i.4 Fi^�hrCCi�s 1 1972 2035 3 Bedrooms2 Full Buildings value:$162,000.00 Extra features: $2,600.00 Land value: $163,200,00 I http://issql/intranet/healthMaster/HealthMasterDetall.aspx?ID=268006 7/14/2008 Town of Barnstable 1ME Regulatory Services �p Regulatory Thomas F. Geiler, Director .3 Public Health Division r * BARNSrABLE, "t 9 MASS. Thomas McKean, Director 1659• ♦0 2007 ArFn Mai a 200 Main Street Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 July 14, 2008 Marina Zaslayskiy 12 Carol Drive Franklin, MA 02038 As of October 1, 2006 a new rental registration ordinance was put into affect requiring all property owners of rental units to register their rental units with the Town of Barnstable Health Division. According to our records, you own the rental property at 114 Dolphin Lane, Hyannis. Enclosed is an application. Please use a separate application for each rental unit you own. Should you need more applications, they are available online at «,w-Nv.toivil.barn.stable.m.a.us. Go to the Health Division page by looking in the Department Menu. There is a link to the Rental Registration information on the Health Division page. You may print out as many as you need, and return them to the Health Division with the appropriate 2008 fees included. Failure to comply with this ordinance will result in the issuance of a non-criminal ticket citation in the amount of$100. Each day of non-compliance is considered a separate offense. Should you have any questions, please feel free to call 508-862-4644. Thank you in advance for your cooper "in. Timothy . O'Connell Health Inspector Health Division Direct 4508-862-4646 COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS 4 DEPARTMENT OF ENVIRONMENTAL PROTECTION y e TITLE 5 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 141 DOLPHIN LN HYANNISPORT Owners Name: OLIVEIRA Owner's Address: SAME Date of Inspection:4/11/066J1S Name of Inspector: (please print) Douglas A.Brown Company Name: Douglas A.Brown Septic Inspections Mailing Address:P.O Box 145 Centerville,MA 02632 Telephone Number: 508-420-4534 CERTIFICATION STATEMENT 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: X Passes Conditionally Passes Needs Further Evaluation by the Local Approving Authority Fails Inspector's Signature: l Date: 4/11/06 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. Notes and Comments ****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. Title 5 Inspection Form 6/15/2000 page 1 Revised on 10/31/2000 ` Page 2 of 11 OFFICIAL INSPECTION FORM- NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 141 DOLPHIN LN HYANNISPORT Owner's Name: OLIVEIRA Owner's Address: SAME Date of Inspection: 4/11/06 inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: X I have not found any information winch indicates that any of the failure criteria described in 3 10 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 Pase'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 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 distribution box is leveled or replaced 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 A Page 3 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 141 DOLPHIN LN HYANNISPORT Owner's Name: OLIVEIRA Owner's Address: SAME Date of Inspection: 4/11/06 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 15.3030)(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 I 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 coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen Iand nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: I , Page 4 of 11 OFFICIAL INSPECTION FORM- NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 141 DOLPHIN LN HYANNISPORT Owner's Name: OLIVEIRA Owner's Address: SAME Date of Inspection:4/11/06 D.System Failure Criteria applicable to all systems: You must indicate"yes or no to each of the following for all inspections: Yes No X Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool X Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool X Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool NA Liquid depth in cesspool is less than 6"below invert or available volume is less than 1/2 day flow _ X Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number of times pumped — X Any portion of the SAS,cesspool or privy is below high ground water elevation. X Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. X Any portion of a cesspool or privy is within a Zone 1 of a public well. X Any portion of a cesspool or privy is within 50 feet of a private water supply well. X 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 coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility 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 (Yes/No)The system fails.I have determined that one or more of the above failure criteria exist as described in 3 10 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. You must indicate either"yes"or no to each of the following: (The following criteria apply to large systems in addition to the criteria above) 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 yeilm 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 Page 5 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 141 DOLPHIN LN HYANNISPORT Owner: OLIVEIRA Date of Inspection: 4/11/06 Check if the following have been done. You must indicate"yes"or"no" as to each of the following: Yes No X Pumping information was provided by the owner, occupant,or Board of Health X Were any of the system components pumped out in the previous two weeks ? X _ Has the system received normal flows in the previous two week period? X Have large volumes of water been introduced to the system recently or as part of this inspection? X _ Were as built plans of the system obtained and examined?(If they were not available note as N/A) X — Was the facility or dwelling inspected for signs of sewage back up? X _ Was the site inspected for signs of bre``*out? W \i�Gl\ 3 _ Were all system components,�g,iI SAS,located on site? X of _ Were the septic tank manholes uncovered,opened,and the interior of the tank inspected for the condition the baffles or tees,material of construction,dimensions,depth of liquid,depth of sludge and depth of scum? _ X 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: Yes no X _ Existing information. For example, a plan at the Board of Health. X _ 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(3 ))(b)j 5 rs Page 6 of 11 OFFICIAL INSPECTION FORM- NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 141 DOLPHIN IN HYANNISPORT Owner's Name: OLIVEIRA Owner's Address: SAME Date of Inspection. 4/11/06 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): 3 Number of bedrooms(actual): 3 DESIGN How based on 3 10 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 Number of current residents: 3 Does residence have a garbage grinder(yes or no): NA Is laundry on a separate sewage system(yes or no): NA [if yes separate inspection required] Laundry system inspected(yes or no): NO ( Seasonal use: (yes or no): NO 09 " I9,000�Cc.` I Water meter readings,if available(last 2 years usage(gpd)): S' I Ll, 600C-p( Sump pump(yes or no): .Last date of occupancy: cunENT COMMERCIAL/INDUSTRIAL: Type of establishment: Design flow(based on 310 CMR 15.203): gpd Basis of design flow(seats/persons/sqft,etc.): Grease trap present(yes or no): _ Industrial waste holding tank present(yes or no):_ Non-sanitary waste discharged to the Title 5 system(yes or no): Water meter readings,if available: Last date of occupancy/use: OTHER(describe): GENERAL INFORMATION Pumping Records Source of information: Agb, ' ) Was system pumped as part of the inspection(yes or no). If yes,volume pumped: gallons--How was quantity pumped determined? Reason for pumping: TYPE OF SYSTEM X 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: 7-11-02 ROBINSON SEPTIC Were sewage odors detected when arriving at the site (yes or no)? NO i Page 7 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 141 DOLPHIN IN HYANNISPORT Owner's Name: OLIVEIRA Owner's Address: SAME Date of Inspection: 4/11/06 BUILDING SEWER(locate on site plan) Depth below grade: Materials of construction: cast iron _40 PVC other(explain): Distance from private water supply well or suction line: Comments(on condition of joints,venting,evidence of leakage,etc.): SEPTIC TANK:_ (locate on site plan) Depth below grade: 9° Material of construction: X concrete_metal_fiberglass _polyethylene other(explain) If tank is metal list age:_ Is age confirmed by a Certificate of Compliance(yes or no): _(attach a copy of certificate) Dimensions: 1500 gal Sludge depth: 0 Distance from top of sludge to bottom of outlet tee or baffle: Scum thickness: 0 Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: How were dimensions determined: 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 LOOKS STRUCTUALLY SOUND AT TIES TRARTHERE IS A WHITE COLOR TO THE LIQUID IN THE TANK.??? GREASE TRAP:_(locate on site plan) Depth below grade:_ 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: Comments(on pumping recommendations,inlet and outlet tee or baffle condition, structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): Page 8 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 141 DOLPHIN IN HYANNISPORT Owner's Name: OLIVEIRA Owner's Address: SAME Date of Inspection: 4/11/06 TIGHT or HOLDING TANK: (tank must be pumped at time of inspection) (locate on site plan) Depth below grade: Material of construction: concrete metal fiberglass polyethylene other(explain): Dimensions: Capacity: gallons Design Flow: gallons/day Alarm present(yes or no): Alarm level: Alarm in working order(yes or no): Date of last pumping: . Comments(condition of alarm and float switches, etc.): DISTRIBUTION BOX: (if present must be opened)(locate on site plan) 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.): t l;e L-ve- k 'v 0 b 0 c,-L C, PUMP CHAMBER: (locate on site plan) Pumps in working order(yes or no): Alarms in working order(yes or no): Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.): I Page 9 of 11 OFFICIAL INSPECTION FORM- NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 141 DOLPHIN LN HYANNISPORT Owner's Name: OLIVEIRA Owner's Address: SAME Date of Inspection: 4/11/06 SOIL ABSORPTION SYSTEM(SAS): _(locate on site plan,excavation not required) If SAS not located explain why: Type leaching pits,number: X leaching chambers,number: 2 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.): LIQUID DEPTH IN CHAMBER IS ABOUT 18"'FROM TOP OF CHAMBERAT THIS TEVM CESSPOOLS:_(cesspool must be pumped as art of inspection) 1 n i 1( p p p p sp )locate o 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 or 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.): I s Page 10 of 11 OFFICIAL INSPECTION FORM- NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 141 DOLPHIN LN . HYANNISPORT Owner's Name: OLIVEIRA Owner's Address: SAME Date of Inspection: 4/11/06 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. A _ 3 - It 2 0 Vie-c ��. ." 3_ 2Cg �7 0 Page 11 of 11 OFFICIAL INSPECTION FORM- NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM ] INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 141 DOLPHIN LN HYANNISPORT Owner's Name: OLIVEIRA Owner's Address: SAME Date of Inspection:4/11/06 SITE EXAM Slope: Surface water: Check cellar: Shallow wells Estimated depth to ground water feet Please indicate(check)all methods used to determine the high ground water elevation: Obtained from system design plans on record-If checked,date of design plan reviewed: 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: TOWN OF BARNSTABLE LOCATION /el 1 �o l oi��v.z Lr n� SEWAGE P2?6 VILLAGE ti5 Dori' ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. Goo 6 n5on 5 f p+-C- SEPTIC TANK CAPACITY J5500 o I LEACHING FACILITY: (type)2 3-60 ZaI agrt1LPr.S (size) /a b!g NO. OF BEDROOMS 3 BUILDER OR OWNER ��+-Qp d mzaiV PERMITDATE: 7— -6 COMPLIANCE DATE: 1`0 7_ 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 facility) Feet Furnished by 4c� f 1601 0 o� No. 9G0 Zip-•2,0A6 Fee �er:THE COMMONWEALTH OF MASSACHUSETTS Entered in com PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS 01pplication for �Mtgo!6aY bp5tem Congtructton perinit Application for a Permit to Construct( )Repair(X)Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. 141 Dolphin Ln. Owner's Name,Address and Tel.No. W. Hyannisport, MA Richard Goodman Assessor's Map/Parcel 02672 Same Installer's e,A ss, o� d l,No. Desi ner's Name,Address and Tel.No. m. ` einson Sr.Septic Svc �aniel Johnson P.o. Box 1089 804 Main St. , suite B C Type of Building: Dwelling No.of Bedrooms 3 Lot Size sq.ft. Garbage Grinder( ) Other Type of Building Residential No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow 330 gallons per day. Calculated daily flow 331 .5 gallons. Plan Date 7/1 /0 2 Number of sheets 1 Revision Date Title Subsurface sewage disposal system Size of Septic Tank 1 500 gal. Type of S.A.S."—dryw 1 1 s Description of Soil: medium sand Nature of Repairs or Alterations(Answer when applicable) R e are r e ssT o 1 with a 11,00 gal septic tank and 2 drywells — 25 'Tx12 'Wx2 'H 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 issu by o of Heal Signed � Date Application Approved by `v• Date 7-1Ao,2 Application Disapproved for th following reaso Permit No. Date Issued t ` Nh4 (nol.(//}✓ '4 41Za ter. Fee $5 0 THE dOMMONWEALTH OF MASSACHUSETTS Entered in computer: •� es PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLES MASSACHUSETTS k. ZippYication for ;Dioogal *patent Cow6truction 3permit Application for a Permit to Construct( )Repair( X)Upgrade( ' )Abandon( ) ❑Complete System ❑Individual Components `Location Address or Lot No. 141 Dolphin Ln. Owner's Name,Address and Tel.No. t . W. Hyannisport, MAe" Richard Goodman Assessor's Map/Parcel 02672 Same Installer's N e,Address, d Tel,No. Desi ner's Name,Address and Tel.No. 4�"Iti. t�'obinson Sr.S3ptic Sac r Daniel Johnson P.o. Box 1089 £ 804 Main St. , suite B Centerville., Type of Building: Dwelling No.of Bedrooms 3 Lot Size sq.ft. Garbage Grinder( ) Other Type of Building Residential No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow 330 gallons per day. Calculated daily flow 331 .5 gallons. Plan Date 7/1 /0 2 Number of sheets 1 Revision Date Title Subsurface sewage disposal system Size of.Septic Tank 1 500 gal. Type of S.A.S.2.-drvwells Description of Soil: medium sand .. Nature of Repairs or Alterations(Answer when applicable) Ren l ac e c a sc;poo 1 with a 1 ti 0 0 a a 1 s ptic tank and 2 drvwells - 25'Lx12'Wx2'H J 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 is b b, of Healt Signed ' 4- Date Application Approved by Date 7" U Application Disapproved for th following reason t Permit No. �Oao� Date Issued a Goodman THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed( )Repaired(XX)Upgraded( ) Abandoned( )by Wm. E. Robinson Sr. Septic Service at 141 Dolphin Ln. , W. Hyannisport has been construct d in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. :200 -44 dated 7,711 Installer William E. Robinson, Hr. Designer Daniel Johnson . The issuance 91 thisipermit shall not be construed as a guarantee that the sy em will function�eigned. Date ! U Inspector No. )' ^Z � t Fee$5 0.0 0 Goodman THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION- BARNSTABLES MASSACHUSETTS lwigozal *pgtent Construction Verntit Permission is hereby granted to Construct( )Repair(XX)Upgrade( )Abandon( ) System located at 141 Dolphin Ln. , W. Hyannisport 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:Constrctio must be completed within three years of the date of this permit. Date: Approved by TOWN OF BARNSTABLE Fc- LOCATION Jill 1 Oo J o�Zane_ SEWAGE # , MM, - PaE, VILLAGE— (Jor+ ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. Ab(n_ n 5e2+1c. SEPTIC TANK CAPACITY LIDO 15n, I LEACHING FACILITY: (type)-2 3-60 !3&{ 6421 LOG-S (size) NO. OF BEDROOMS '3 BUILDER OR OWNER f�a-�n cl m rV PERMITDATE: 6; COMPLIANCE DATE: 2- 11'D�- 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 facility) Feet Furnished by lU�`z v p Jt V >< p 5nwol NOTICE: This Forlails To Be Used'For the Repair Of Failed 4 hp Y yk -Se tic S Oid y r . PERCOLATION TEST AND SOIL EVALUATION EXEMPTION x FORM hereby certify that the engineered plan signed by.me dated 7/t concerning the property located at meets all of the following criteria: — • This failed system is connected to a residential dwelling only. There are no commercial or business uses associated with the dwelling. • The soil is classified as CLASS I and the percolation rate is less than or equal to 5 minutes per inch. The applicant may use historical data to conclude this fact or may conduct preliminary tests at the site without a health agent present. • There is no increase inflow 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 fourteen (I4) feet above the maximum adjusted groundwater table elevation. (Adjust the groundwater table using the Frimptor method when applicable]' Please complete the following: A) Top of Ground Surface)Elevation(using GIS information) 3) B) G.W.Elevation adjustment for high G.W.� �_ �3 DIFFERENCE BETWEEN-A and B ( Q SIGNED DATE: 7/ .1��0 , —Y NO TICE r Based upon the above information, a repair permit will be issued for bedrooms t maximum. No additional bedrooms are authorized in the future'without engineered septic system plans. q:hcihh folder:perceuep t 15M GALLON SEPTIC TANK MODEL: TK-15M ISHEA CONCRETE) (OR EQUIVALENT) .5(_A 4 r : l =!o TEST PIT DA!PA FINISHED GRADE --- performed By: Daniel B. Johnson - 24"DIA - 24"DIA" TIMIN) 24"DIA -` -,oo.oa _.. _ t Date: June 13, 2002 �• 3 H 10 5' S' 4"SCH 40 4 SCN 40 ..� ''►" ','�`�►"� (fir. = 98.7) ,� .00 ,. IS D A, 10YR4/3 Sandy loam 4"SCH40 10'++ FLOW LINE $ 141, ZABEL FILTER A•100 .- 8" - 30�� Bw, 5R5/8 Santry loam i ?' 4"SCH 40 TEE 4�UQU1D LEVEL REQUSEPTIIRE►r ENTS OF TO ET 30" -132N C1, 2.5Y8/2 Medium sand ` GAS BAFFLE 10C RT 226 ,FOR No Observed ESHNT C SCH 40 No Observed Groundwater ! TEE ETC / y .• p�OI.i1'T'xt�N '1Z8'1' D11'1'71 ____ ALL WALL SLEEVES/GASKETS a o 0 0 c:y o o a MECHANICALLY F1 : ! INSERTED CAT FACTO 0R / AS ` x 1�yJ x I E CRUSHED STONE Date: J+.�n@ 1.3r 2002 � STABLE LEVEL BASE <-314"D1A. 5f•FT(L Ti4Nl� ySt'4 I Seil Claris: C1a ge 1 (0 . 74 GISF') SEPTIC TANK DIMENSIONS 10 G'L X 5' Q"W X 51B"H i E�r,rrN o Pore Rate: o _ + � ,... _ _ ..._ ., 9� � _ 9 2 Mp l (�rF��"t. ) I 99�. 9a� � U15TNiB111ION BOX—— N 10 4"S(_0 4° "-99 Deb,+.t� c.7f' T' T�:: Tear ; +r�" .. I,I„ j REMOVABLE COVER / _._ _..._ . - I` 4"SC:H BESET OUTLET LEVEL.FOR A5 o 1lCf ►trL3 t?t' ELEVAT2tS/R , DI�TAtRi;TION AIIX 10 MEEt ��. . ""'� -._.� �; ,HALL / Pao MINIMUM OF THE FIRST TWO L-� oRcr► �v 15.43 ATERT1GHINFS-, sw rif"t�UiRE:MENTS Of ?1r)L"'I+Ng FEET AND CONNECTED TO P I Inv. Out P'CJLIt1da t , n (e»t�:itr t 4) 90 . 0 � w- CAC"H DISTRIBUTION LINE BJLK i s i Inv, In Soot 4c Tank 06. 40 CONSTRUCTION FT(-1 ._.�. ..�� . ... / N4no j WIT►a SgLICr SCH 4CI1�/C 1•wPc ., r Inv. Out ;fie t iry Tank 06. 6% 4"SCH 40 t i ► NO C► 9IJTLFT"� Iit�r. 1n L)tt9k�tltitn BcIt 9�.. ; _ --- Q �, ._ Mc r ►aANIr:A►I c1�I1'7w4rr, Inv, Out: D-Imt-riblition X Q4. 111 � „�, } f."IMIN► o o ,. " S1EINt. I{-3/4"f)IAI / g ENGtf�'tAR K l►SSvM /O•.01 Q Inv. ir1Dry W011E .0 1 f ...., ,t. .... , ..........- ) O "Otrm of Dry WAS1.1� 94 . 00 -me 0sr NTfo . 11 AL:MINI;i C)Fi'r W! l 1`, N111 IiALLtTNFi -- off: tfll. vt f � ► , i A Nh"(7A )", 1A r.I ION 13�E: p2.1 tte S7':j rr'X.i at i ng co'nEQ1,1, ` °►ti M00 l r,1,10RI°r'FlU C:A"i T I;CINCA1 I I ? � i IMAr tsTiA1:11 T t t F;Il %1 A.Ialt 1.°k k', '� � � i�>"'r�P+�.a <� t�t)fi1C�T1,I1 - -•� � _ FINISHED faFlADE(Si.tT • 021 r � . - Test Pit: 11► ;w f1) I ! 12"'�NN1 ill E Finished F'lc)r Elevation -------.+., � WA FrFA STONsk ' LEAC:.HIN(3 DM'WELLS LLB. S , r c. :.. 1I'1�'I_:(4' 1fr'W�F 1"►i . H ' pv6AH�4Nb �. I easement h`loor Elevation► f�FE: r uVT'FIALI,LE'ACH►NG AHFA JJ4'° 1 i/Z"t)t7t1B LE I Water Dine ------ W ► .,.:� 6 :;., `.� WASHED STONE »�b'LX12WX.. N Gas L I ne G r TO COMPLY H THE LEACHING DRY WELLS i � �.- ---5'Ia ---M- ------) REQUIREMENTS OF 310 CMR 15.252 ► rip Ili 4010 o _ • yrM�Purr-M LA ! MI �' sNNtDY �,C Rtoy �t h'R s + lot Z : + NOTES _ .,._.__. _ __.. _ .___-T. _. __._.._e_...._ _.._.__.._ __ •. __ -•' I T A . ,. « w All construction 1 1 . methods shall conform to the Title V ( 310 •%Do 00 4 "`W "` c CMR 15) and the Barnstable Board of Health Regulations . PORT 1 . There are no known private or public wells within 150 D �c.P�I�N feet/400 feet, respectively, from the proposed leaching area . Irn W 6 3 . Existing cesspool to be pumped and removed prior to installing the new septic tank. ( OFtLE 0f�' EPP& SY STE/n 4 . No changer are to be made in the field without the approval Sc4LE R5 SHowN ` . M , ' + f of the t and the design engineer. loa � Board of Health Proposed leaching area is not designed for use with Fr�E'loi, of aarbar.)c disposal . I ��►srrntlr 6�,�ar` ! 6. Contractor to ncati.f'y (jig :3ato "12 hours prior to Do -j , construct"Aon . ( 800) 344wI42:33 .I --� �RoPaS�A �AAO� des 17 , Property lint, i,Tlfo mat lon to4kon from Subdiviznion Elan of Wo4t. 11yantlinport "No rmA Ac~t e, D,°r< o 9 May 10, i. . ) 3E)pt T( Plan nt jt to b" uned an a prop"rty lint) su rvo�y . go CALCVLATIO144 8 �+ ------ 3A _ T I j Redroomm (Exist 1ng) od 110 GPD/Radroom X 3 broome � 3�30 C;T'La nam*rt) s.o v�t+fS. ---'1 t Percolation Rat" - 4 2 MPS (TP-1 ) q{, Soil Claas: ClAsi 1 (0 . 74 G/SF) j PROPOSED LEACHING AREA: br s;eravrro� 6a i?ry Wells : 2 at 25' L x 11' W x 2' H ! _-y Si,3e Area: 148 SF X 0 . 74 G/SF - 109. 5 GPD _K 94 - DAY wec.LS q,op Fir'>rr:c:�rr Area : 300 SF X 0. 74 G/SF - 222 . 0 rE'D 1 �t3,L�• /1w tL �,� Total beaching Capacity: 331 . 5 GPD W /Sv 0 &ALL01V I 7 ��cr�nAtE, SEPrrG rfNK I 9� J J � i W F Z I 9° O 6 I ; U Q o ry A , 0 j W ; cc goner T►-I(fit. ��,�) SUBSURFACE SEWAGE DISPOSAL SYSTEM 141 Dolphin Lane, test Hysnnisport No ORS vii&J" a i,� '`' SCALE: APPROVED BY DRAWN BY o �t 7/1/02 Dsaisl li Johason D.t<. Jelmsslr, LL DATE: Q �. 1`i � ftps.a Richard aooa..n W C;+-oo O+ �p a+,�o O►3 o Otto ©t�D Of bo Ot>o otSo p+90 t+00 r*I o 141 Dolphin Lassa, West MYsnnisport, UK �IOFy l = 14 +7 y 1/ ! 11 J r 4 DRAWING NtlMOEN ! ` sY: $04 Main $tryst, suits @, ostorvills, Mil 4243 1-ft1