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Home My WebLink About0213 FAWCETT LANE - Health ,213 Fawcett Lane Hyannis ' A= 270 - 108 G �]I 1 k 1& Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ILI 213 Fawcett Lane Property Address Estate of Cathy Perry ; Owner Owner's Name n information is f required for every Hyannis Ma 02601 9/6/2017 page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When A. General Information filling out forms on the computer, use only the tab 1. Inspector: key to move your cursor-do not Sean M. Jones use the return Name of Inspector key. S.M.Jones Title V Septic Inspection Company Name 74 Beldan Ln. Centerville Ma 02632 Cityrrown State Zip Code 774-248-4850 smjonestitle5@gmail.com S14522 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 maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 16.340 of Title 5(310 CMR 15.000). The system: ® Passes ❑ Conditionally Passes El Fails ❑ Needs Further Evaluation by the779/6/2017 .Authority 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. P t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 1 of 17 �o US Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 213 Fawcett Lane Property Address Estate of Cathy Perry Owner Owner's Name information is required for every Hyannis Ma 02601 9/6/2017 page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® I have 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: The dwellinglocated at 213 Fawcett Lane Hyannis is served b a Title V septic stem consisting of a Y Y P Y 9 1000 gallon septic tank, distribution box and 2 precast leach chambers. The system was found to be in proper working condition at the time of inspection. 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-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 2 of 17 Commonwealth of Massachusetts L d Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M ' 213 Fawcett Lane Property Address Estate of.Cathy Perry Owner Owner's Name information is required for every Hyannis Ma 02601 9/6/2017 page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. 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): e ❑ 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•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 213 Fawcett Lane Property Address Estate of Cathy Perry Owner Owner's Name information is required for every Hyannis Ma 02601 9/6/2017 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. pp . Y ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate"Yes" or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than %day flow t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 213 Fawcett Lane Property Address Estate of Cathy Perry Owner Owner's Name information is Hyannis Ma 02601 9/6/2017 required for every y page. Cityfrown State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 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 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•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 5 of 17 I Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 213 Fawcett Lane Property Address Estate of Cathy Perry Owner Owner's Name information is required for every Hyannis Ma 02601 9/6/2017 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 ❑ ® 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? ❑ Z 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 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 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 gpd t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 Commonwealth of Massachusetts F L Title 5 Official Inspection Form _ Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 213 Fawcett Lane Property Address Estate of Cathy Perry Owner Owner's Name information is required for every yH annis Ma 02601 9/6/2017 page. City/Town State Zip Code Date of Inspection D. System Information Description: 0 Number of current residents: Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available (last 2 years usage (gpd)): Detail: Sump pump? ❑ Yes ® No Last date of occupancy: vacant Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins•3/13 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 7 of 17 Commonwealth of Massachusetts r Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 213 Fawcett Lane Property Address Estate of Cathy Perry Owner Owner's Name information is Hyannis Ma 02601 9/6/2017 required for every y page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: 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 El cesspool Single 9 ❑ 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•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 f Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 213 Fawcett Lane Property Address Estate of Cathy Perry Owner Owner's Name information is required for every Hyannis Ma 02601 9/6/2017 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known)and source of information: system repaired 8/19/2005 per town records Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 2feet 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.): Joint were ok, no leaks, vented through the roof Septic Tank(locate on site plan): Depth below grade: 1.5 feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1000 gallons Sludge depth: 7" t5ins•3/13 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 ,•�''� 213 Fawcett Lane Property Address Estate of Cathy Perry Owner Owner's Name information is required for every Hyannis Ma 02601 9/6/2017 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle 3' 3" Scum thickness 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 10" How were dimensions determined? opened covers, tookmeasurements 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 should be cleaned soon and again every 2 years for proper maintenance. Outlet tee intact. Water level even with outlet invert, tank was structurally sound. Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 f Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 213 Fawcett Lane Property Address Estate of Cathy Perry Owner Owners Name information is required for every Hyannis Ma 02601 9/6/2017 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: 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.): i *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 213 Fawcett Lane Property Address Estate of Cathy Perry Owner Owner's Name information is required for every Hyannis Ma 02601 9/6/2017 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.): D-box was in good condition, water level was even with outlets with no sign of past hydraulic overloading. 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.): * If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS) (locate on site plan,excavation not required): If SAS not located, explain why: t5ins•3/13 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 213 Fawcett Lane Property Address Estate of Cathy Perry Owner Owner's Name information is required for every Hyannis Ma 02601 9/6/2017 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ® 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.): Leaching facility consists of 2 precast leaching chanmbers in a 30'x10'x2'trench. No signs of past failure, Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 213 Fawcett Lane Property Address Estate of Cathy Perry Owner Owner's Name information is required for every Hyannis Ma 02601 9/6/2017 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy (locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments lug 213 Fawcett Lane Property Address Estate of Cathy Perry Owner Owner's Name information is required for every Hyannis Ma 02601 9/6/2017 page. Cityrrown 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 m � i I` F p 36 ql F t Y f I t5ins•3M3 Title 6 Official Inspection Form:SubsLaram Sewage Disposal System•Page 15 of 17 Commonwealth of Massachusetts 4 w Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 213 Fawcett Lane Property Address Estate of Cathy Perry Owner Owner's Name information is required for every Hyannis Ma 02601 9/6/2017 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar Shallow wells Estimated depth to high ground water: 12'+ 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: You must describe how you established the high ground water elevation: Groundwater elevation was determined by accessing Town of Barnstable groundwater contour map. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 213 Fawcett Lane Property Address Estate of Cathy Perry Owner Owner's Name information is required for every Hyannis Ma 02601 9/6/2017 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-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 TOWN OF BARNSTABLE ' �C ;;ATiON O?JJ FaWCe-,"'l Z&,l SEWAGE �Zc1px'; 'T" VELLAGE ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. Zi4/w2il 6mu�i �d•,> 1�'�91f SEPTIC TANK CAPACITY LEACHING FACILITY: (type) "C�G ��•-.� /'` �_. (size) /O X 3a �cd NO.OF BEDROOMS BUILDER O OWNER PERMITDATE: 7--.24-03" COMPLIANCE DATE: ar, 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 JD42M.) �� _ � . � L .,�! � �„ s �. w � .. .r } car � _ �..._ ,A - �i No. Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes - PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS 01pplication for Migp0$af *pgtem CCom6truction permit Application for a Permit to Construct( )Repair( Upgrade( )Abandon( ) EFComplete System O Individual Components Location Address or Lot No. Owner's Name,Address and Tel.No. .�;sessor'`Map/Pa�cel Installer's Name,Add less,and Tel. o,.r� Designer's Name,Address and Tel.No._ Type of Building: Dwelling No.of Bedrooms 3 Lot Size 0i sq.ft. Garbage Grinder( � Other Type of Building No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow 3,30 gallons per day. Calculated daily flow gallons. Plan Date 12 Z5Y0 Number of sheets Revision Date Title - 5 1 �� ® ✓� �'uCe dr. Size of Septic Tank /5-790 Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued this Bo of blealth. _ /Z Signe Date Application Approved by L Date Application Disapproved for the following reasons Permit No. 200 3b Date Issued No. +py~ �� ,; Fee Entered in computer: <: a THE.COMMONWEALTH OF MASSACHUSETTS Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MAS ACHUSETTS 3pplica:tion for �Biqu;ar *pgtent Con!96;tru ion Permit Application for a Permit to Construct( . )Repair(r )Upgrade( )Abandon( ) U/co lete System IndivV Compo e is n Location address or Lot No. ,r�yuC'�7 N Owner's Name,Aydd'ress d Tel.No. V �-/ L c'-<' u se so azcel ��/ �,(� r's Ma 4 Y CCU v Installer's Name,A dress,and T f e:No Designer's Nam',A ress and Tel.No.� f0/7`G�� / C"OfISI p0W 7 7/ Qjg9 36 z- e15 yl Typef Building: J Dwelling No.of Bedrooms n Lot Size sq.ft. Garbage Grinder Other Type of Building ��✓��`�� No. of Per ons Showers( ) Cafeteria( ) ' Other Fixtures l Design Flow m 3 gallons per day. dalculated daily flow 3 ��/ gallons. / Plan- .5 0 Number of sheets Revision Date Title S /7C' Size of Septic Tank 5-OC>l Type of S.A.S. Z3 60' 9'V' Description of Soil `369 / Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: .t The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued by this Boar of�Health. Sign-d Date Application Approved by Date W ' Application Disapproved,for the following reasons .. r Permit No:f ' S 3 Date Issued r .r THE COMMONWEALTH�OF MASSACHUSETTS BARNSTABLE, ! SSACHUSEn�S j i � -�-- Certifica e of woM' Pttakce THIS IS TO CERTIFY, haythe On-site Sewage<Dts osal System Constructed( )Repaired(�)Upgraded( ) Abandoned( )by. /� O %`� at /�' ��L/C'E'�i;` s9 f° s1y0S � has been constrt�eyi i� ordance with the prQaci i�ons oTitle,5 the for Disposal System Construction Permit N. (- dated � 5 Installer �� r- Designer The issuance of this a shalt not be construed as a guarantee that �ste w'' tion as desi ned. Date p <6 1 `� g Inspector y y-— Now 5 �-----------=------------- ,. _.Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS Ifi6po5al *pgte✓(Con$tructi0n Permit Permission is hereby gra ted to Construct( )Repair( )Upgrade( )Abandon(q ) System located at /3 4 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 conditi-0 Provided: Construction must a co eted-within three years of the ate of t Date:_ 7 � � Approved by • 22 TOWN OF BARNSTABLE L"'O CATION 'J �C�(.�C. �' SEWAGE # VILLAGE (,tI1YI lS ASSESSOR'S MAP & LOT INSTALLER'S NAME & PHONE NOk► bIA ` lls- ( 0 SEPTIC TANK CAPACITY b00 &IA`CA,I,. LEACHING FACILITY:(type) (size) Vy NO. OF BEDROOMS PRIVATE ELL OR PUBUI ER BUILDER OR OWNER DATE PERMIT ISSUED: 10 ` DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No � UJ l� �� -�- �' it---� e r q . �; THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Appliration for Biipnsal Works Tnnitrnrtinn , anti# Application is hereby made for a Permit to Construct ( ) or Repair ( Lan Individual Sewage Disposal System at: • -.. .1 ......r ?� it � ................. ..............:1 _ww - -.._.._.................. - Location-Address or Lot No. .......... `*- !' .. .qy- -------------------------•---•-------•-- ---...........v- S V!e_,..�. --- - -.............__ Owner . Ad-r s(o Installer Address Type of Building Size Lot----------------------------Sq. feet U Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) '-� Other—T e of Building .__... No. of persons............................ Showers — Cafeteria P., Other fixtures -----•---------------------•-•----•----------- W Design Flow.•......_�-------------------------gallons per person per day. Total daily flow.:.....- ................. 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.__1r D.- ..... Depth below inlet....io�.......... Total leaching area...................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) aPercolation 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........................ ------•---------------------------------------•---------•------....-------------•-•-•------------•--......................................................... 0 Description of Soil...............................................................................---------------------------------------------------------------------------------------- V .--------------•---•••-------•---•---------=---------•------•---------------------•-••----•------------------•----•--------------•-•-------------•-•-------------•--------------•----•---••---------•---. U Nature f Repairs or Alterations—Answer when applicable______AM........ x_�__._ .._. . _.. .. A.- ..........�_._... ..��.W..�_.. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Com liance has been issued b i the boas d of health. Signed . = .... . .......... ....I..- .. --- ------- -------- ------ /r✓ Dzte Application Approved By .. .. .../Q..-nd2..-.fa--- ... . . ...... ... .........................-.-........................-...-........................................ Date Application Disapproved for the following reasons: .....................................------------------------------------------------------------------...------------------------- -- - -------------------------------------------=-----...........------..--------------..........--..... --------------------............................... Da[e Permit No. -®�� Issued f� o --- Dare i NoAan" �.. r FEs...... _. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Appliration fnr Disposal Works Tonstrnr#iun jrrmit Application is hereby made for a Permit to Construct ( ) or Repair ( Liman Individual Sewage Disposal System at: ....... .� ....__. �"s ..i ............................ .................................................. -- Location-Address - or Lot No. •---------- � Y. pry--------------•---.......--------------- ..........-------=�-'-� --- ---................ Owner Address Installer Address d Type of Building Size Lot............................Sq. feet" V Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) '4 Other—T e of Building No. of persons............................ Showers Cafeteria QI Other fixtures ................................. W Design Flow......._�._r----------------•---gallons per person per day. Total daily flow..........a _.RA�...._..............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-------t------------ Diameter....V.0-___---_- Depth below inlet.....6�......... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ ODescription of Soil......................................................................................................................................................................... x V .-------------•------•-----------•----•....--••------------------------------------•------------•--•-.._..------------•-•----•-•-•-•-•-•--•------.._.......•-•---•-••...•••--.....-•-•--------•-••-----•- W -•-•------•-----------------•------•--------•-•-----•---••----------•----------•-----•-.....-••••--------•••------------••--------•---••............................ (............................... U Nature f Repairs or Alterations—Answer when applicable......Ar.10.)O_......_10.X.C�.....PV..............ye. I�+G-.._ �. -•--------- 1/V.\. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisionstof TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Com fiance has been issued by the boa of health. Signed-------- ------ -------- --- --- --- ......- -- ...... Date TT Application Approved By -- A if'� �" - ..../0-.7,2.. ..�...V.... . G71Daze Application Disapproved for the following reasons- ---------------------------------------------------.............---------------------------------------------- .................................................................................................------------------------------------------------------------------------------------------------------------ ---.................................... � Date Permit No. - -</ - Issued lP -2 .. ... ------------- Date C THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE ,/ (IJertifirate of C�outylianre THIS IS TO CERTIFY, That the Individual Sewage Disposal.System constructed ( ) or Repaired by-----------------------------'O ..5----- \ .Y ....s7r.. ialler...........................................................---.......................------............................_. at c�.�.--�J. �n -------------- has been installed in accordance with the provisions of TITLE 5 of The State Environmental Code as described in the application for Disposal Works Construction Permit No. ... .-.. �r./....../o.... dated ..../O r ....:Q'O................. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRId AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. / DATE..-- 6 ----------------------------------------------------------------- Inspector .... .1.. / (.� .... ......... ... _ U THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE No.... ............ r FEE.. ... ............. Disposal Works Tonstrnrtion "prrmit Permission is hereby granted................ vI. L—*. `'-6._�-�F.I-L�. ...................................................... to Construct ( ) or Repair (C,�_an_Individual Sewage Disposal System atNo............ ...... 'rZ__ •--------------- ........----................................ Street as shown on the application for Disposal Works Construction Permit No.9a. .. Dated....... ............ DATE---_,l 0 /`Board of Healt.............•--.....-----....................... l� FORM 36508 HOBBS&WARREN.INC..PUBLISHERS TOP FNDN. AT EL. 43.5' SYSTEM PROFILE TEST HOLE LOGS ACCESS COVER TO WITHIN 6" OF FIN. GRADE (NOT TO SCALE) PROVIDE INSPECTION PORT WITHIN ACCESS COVER (WATERTIGHT) TO 6" OF FINISH GRADE ENGINEER: LISA LYONS, RS WE 28 43.5' MINIMUM .75' OF COVER OVER PRECAST WITHIN 6" OF FIN. GRADE 2% SLOPE REQUIRED OVER SYSTEM DON DESMARAIS, RS 43.0 WITNESS. .10 2" DOUBLE WASHED PEASTONE 6 3 05 RUN PIPE LEVEL DATE: / / 41.2'f* FOR FIRST 2' � ' p PROPOSED 1500 3 MAX. PERC. RATE _ < 2 MIN/INCH £ 40.5 GALLON SEPTIC 40.25 40.0' CLASS I SOILS P# �o? WAY �Q TANK (H- 10 ) GAS 39.25' -196 ' BAFFLE 39.42' �� 0 0 0 O 0 O � O 39.17' OaaO CI 0 � 0 > 4 O O O 0 ( % SLOPE) 6 CRUSHED STONE OR MECHANICAL COMPACTION. LEV. 0 (15.221 [2]) $ 2' 0 r 0 � F v'73 � 0 37.17' Opp 43 5' �" 4' E42 5' Locus `` DEPTH OF FLOW = 4 ( 3 % SLOPE) ( 1 % SLOPE) 3/4" TO 1 1/2" DOUBI ""D STONE TEE SIZES: A INLET DEPTH = 10" FILL LS OUTLET DEPTH = 14" 14" A/E g" 10YR 3/2 LOCATION MAP NTS FOUNDATION 16' SEPTIC TANK 26' D' BOX 10' LEACHING LS ASSESSORS MAP 270 PARCEL 108 FACILI•lY 5' 17" 10YR 2/2 B *THE INSTALLER SHALL VERIFY THE LOCATIONS OF ALL UTILITIES AND ALL LS BUILDING SEWER OUTLETS AND ELEVATIONS B PRIOR TO INSTALLING ANY PORTION OF SEPTIC SYSTEM LS 10YR 3/6 24" 40.5' 32.17' 10YR 3/6 28" 41.2' C C \ PERC MS MS 2.5Y 5/6 +�41.1 2.5Y 5/6 N " w � � 125" 33.1' 124" 3217' + 38.1 NGWE NGWE NOTES: -I- � �pp•pp' 1 . DATUM IS ASSUMED 44. "�+ 38.7 SEPTIC DESIGN: (GARBAGE DISPOSER IS NOT ALLOWED ) U D lro 9 ,t- 36.5 DESIGN FLOW: _3 BEDROOMS ( 110 GPD) 330 GPD 2. MUNICIPAL WATER IS EXISTING EL TR 3. MINIMUM PIPE PITCH TO BE 1/8" PER FOOT. BENCH MARK TOP OF r'` LOT 60T36.4 1 USE A 330 GPD DESIGN FLOW BULKHEAD (ON CONCRETE] 1G OOOt SQ. FT. 4. dESIGN LOADING FOR ALL PRECAST UNITS TO BE AASHC� H- 10ELEVATION = 43.5 / .. DECK SEPTIC TANK: 330 GPD ( 2 ) 660 5. PIPE JOINTS TO BE MADE WATERTIGHT. + 37.9 USE A 1500 GALLON SEPTIC TANK-- 6. CONSTRUCTION DETAILS TO BE IN ACCORDANCE WITH MASS. ENVIRONMENTAL CODE TITLE V. + 44.7 / LEACHING: 7. THIS PLAN IS FOR PROPOSED SEPTIC SYSTEM ONLY AND IS NOT € EXISTING DWELL. / SIDES: 2(30 + 9.83) 2 (.74) = 118 TO BE USED FOR ANY OTHER PURPOSE. o G RDEN o F 30 x 9.83 (.74) _ 218 8. PIPE FOR SEPTIC SYSTEM TO SCH. 40-4" PVC. BOTTOM: NOTE: ACCORDING TO A EA F 9. COMPONENTS NOT TO BE BACKFILLED OR CONCEALED WITHOUT AS-BUILT ON FILE WITH THE J, / TOP FNDN = TOTAL: 454 S.F. 336 GPD INSPECTION BY BOARD OF HEALTH AND PERMISSION OBTAINED HEALTH DEPT., A CESSPOOL / 3 43.5' `''�� / 4 USE (2) 500 GAL. LEACHING CHAMBERS (ACME OR FROM BOARD OF HEALTH. EXISTS IN THE AREA OF w / , 10. PUMP & REMOVE EXISTING SEPTIC SYSTEM THE PROPOSED SEPTIC ff EQUAL) WITH 2.5 STONE AT SIDES, 4 AT ENDS AND 5 TANK 7 0' 7 40.1 t 36.0 4 'BETWEEN UNITS GRAVEL 6 + 44.5 v� o� 7.4 PARKING O / ^' ,,`n +/ 35.8 43 LEGEND j& + 42. �� 7 � TITLE 5 SITE PLAID TH2 + 3 3 36.4 / 35 f 100.0 PROPOSED SPOT ELEVATION OF o w �Q 213 FAW C ETT LANE / 100x0 EXISTING SPOT ELEVATION IN THE TOWN OF: 00 PROPOSED CONTOUR 1 ( HYANNIS)- BAR N STAB LE 42.0 100.0 9a -- p / 100 EXISTING CONTOUR PREPARED FOR: 13ORTOLOTTI CONSTRUCTION/PERRY V, + 9.4 oo rn� + �53'5.2 20 0 20 40 60 BOARD OF HEALTH I : JUNE 5,20 2005 : 1 SCALE " - ' DATE - APPROVED DATE MA _ ' off 508-362-4541 fox 508 362-9880 OF M,yS 0311A OF Mqs down cape engineering, inc, ARNE Hc� �o` ARNEcyN OJALA CIVIL_ ENGINEERS CIVIL OJALA y No. 30797 No.26348 LAND SURVEYORS ISTS q0 s\0 d� 05- 1 16 939 Main st, yarMouth, rya 02675 AR DATE OJALA, P.E., i s