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HomeMy WebLinkAbout0054 FRANKLIN AVENUE - Health 54.Franklin Avenue Hyanms� ,, Q45 4 i i I i i rr 2?a - 0� ` Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ,1 54 Franklin Ave hy Property Address Susan Childs Owner Owner's Name information is required for every Hyannis ✓ Ma 02601 1-30-17 page. City/Town State Zip Code Date of Inspection N Inspection results must be submitted on this form. Inspection'forms may not be altered in any iN way. Please see completeness checklist at the end of the form. Important:When A. General Information filling out forms 5 14$ 1 a I a l on the computer, use only the tab 1. Inspector: key to move your cursor-do not Matthew Gilfoy use the return Name of Inspector key. Excavation Company �y Company Name 374 Route 130 Company Address Sandwich Ma 02563 City/Town State Zip Code (508)477-0653 S113640 Telephone Number License Number B. Certification certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000). The system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority 1-30-17 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•3/13 , Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 17 l.0� (/S Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 54 Franklin Ave Property Address Susan Childs Owner Owner's Name information is required for every Hyannis Ma 02601 1-30-17 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: ® 1 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 was in working order at time of inspection and was installed in 2005. 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): (Sins•3/13 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 M 54 Franklin Ave Property Address Susan Childs Owner Owner's Name information is required for every Hyannis Ma 02601 1-30-17 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): ❑ 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 Title 5 Official Inspection Form _ Subsurface Sewage Disposal System Form - Not for Voluntary Assessments wM 54 Franklin Ave Property Address Susan Childs Owner Owner's Name information is required for every �H annis Ma 02601 1-30-17 page. CityfTown State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. . ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**: Method used to determine distance:. ** This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate"Yes" or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ' ? El ® 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 'h day flow i t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 54 Franklin Ave Property Address Susan Childs Owner Owner's Name information is required for every Hyannis Ma 02601 1-30-17 - page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 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 E] E] Area system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA) or a mapped Zone 11 of a public water supply well If you have answered "yes" to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large . system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 5 of 17 a Massachusetts Commonwealth of L Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 7A, 54 Franklin Ave Property Address Susan Childs Owner Owner's Name information is required for every Hyannis Ma 02601 1-30-17 page. Cityrrown State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes" or"no" as to each of the following: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ❑ ® 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 t5ins•3JQ Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 54 Franklin Ave Property Address Susan Childs Owner Owner's Name information is required for every �H annis Ma 02601 1-30-17 page. City/Town State Zip Code Date of Inspection D. System Information Description: Number of current residents: 0 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 ears usage d See below 9 ( Y 9 (gP ))� Detail: 2016-85,2729allons 2015-81,532gallons Sump pump? ❑ Yes ® No Last date of occupancy: 2 weeks ago Date Commercial/Industrial Flow Conditions: Type of Establishment: NA 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: Pins-31113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form x Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 54 Franklin Ave Property Address Susan Childs Owner Owner's Name information is required for every Hyannis Ma 02601 1-30-17 page. Cityrrown State . Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: Owner- last pumped around 1 year ago Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) 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-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 54 Franklin Ave Property Address Susan Childs Owner Owner's Name information is required for every Hyannis Ma 02601 1-30-17 _ page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: 2005 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 2 8 feet Material of construction: ® cast iron ❑40 PVC ❑ other(explain): Distance from private water supply well or suction line: Town feet Comments(on condition of joints, venting, evidence of leakage, etc.): Septic Tank(locate on site plan): Depth below grade: 1 8 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: 1500gallons A A Sludge depth: 8 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 M 54 Franklin Ave Property Address Susan Childs Owner Owner's Name information is required for every Hyannis annis Ma 02601 1-30-17 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 28 Scum thickness 5 Distance from top of scum to top of outlet tee or baffle 5 Distance from bottom of scum to bottom of outlet tee or baffle 12 How were dimensions determined? Measured 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 was in working order at time of inspection with liquid level equal to outlet invert. Tank is in need of pumping at this time and should be pumped every two years for maintenance. Grease Trap (locate on site plan): Depth below grade: NAfeet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle i r Distance from bottom of scum to bottom of outlet tee or baffle i Date of last pumping: Date t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 54 Franklin Ave Property Address Susan Childs Owner Owner's Name information is required for every Hyannis Ma 02601 1-30-17 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: NA 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 l5ins•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 M 54 Franklin Ave Property Address Susan Childs Owner Owner's Name information is Y required for every Hyannis Ma 02601 1-30-17 - ! page. Cityrrown 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 11 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 working order at time of inspection. D-box had heavy solid carry over present but did not show sign of back up. i iPump 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.): NA * 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: l5ins-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 °M 54 Franklin Ave Property Address Susan Childs Owner Owner's Name information is required for every Hyannis Ma 02601 1-30-17 page. City(rown State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ® leaching chambers number: (2)500 gallon chambers ❑ 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 was in working order at time of inspection. Chambers were dry. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration NA 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 Subsurface Sewage Disposal System Form - Not for Voluntary Assessments .0 54 Franklin Ave Property Address Susan Childs Owner Owner's Name information is required for every Hyannis Ma 02601 1-30-17 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: NA Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t . 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 M 54 Franklin Ave Property Address Susan Childs Owner Owner's Name information is required for every Hyannis Ma 02601 1-30-17 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 B Al.*20'6" B17 241161�. A2=29' B2-W Al -37' 83-34'G" Ui . 3 t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 15 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °M 54 Franklin Ave Property Address Susan Childs Owner Owner's Name information is Hyannis Ma 02601 1-30-17 required for every y page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope ® Surface water ® Check cellar ® Shallow wells Estimated depth to high ground water: >5' below SASfeet 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: 10-19-05 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: i You must describe how you established the high ground water elevation: Plan on file with BOH. 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 Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 54 Franklin Ave Property Address Susan Childs Owner Owner's Name information is required for every Hyannis annis Ma 02601 1-30-17 page. Cityrrown 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 i I l5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 17 /TOWN OFFBARNSTABLE LOCATION " EV/ �i00�`''l•� A,< SEWAGE VILLAGE_.1;Y AVU ASSESSOR'S MAP�& LOr;A c�--®q5 INSTALLER'S NAME&PHONE NO. 1 �0��• ��.�� r`d•✓ S/3�'�9s1 SEPTIC TANK CAPACITY LEACHING FACILITY: (type) SZ)Q 42c l' lae ►`—j-0-(size)•/3 Jf 2f Xl' NO. OF BEDROO 1 3 BUILDER OWNER PERMITDATE: �'a�`I'af COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility f¢ Feet A 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 lleaching facility) Feet Furnished by I �i o � r � r r y No.age� 'Y } n r Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS ZIppYication for W6pogal �&pgtem Cottgtruction i3ermit Application for a Permit to Construct( , )Repair(✓)Upgrade( )Abandon( ) ❑Complete System UJ'i dividual Components Location Address or Lot No. Owner's Na e,Add and Tel.No. Ass 's Map/Parcel �2 Installe 's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. Type of Building: Dwelling No. of Bedrooms Lot Size�sq.ft. Garbage Grinder( � Other Type of Building No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow Jr ;3''0 gallons per day. Calculated daily flow 330 gallons. Plan Date Number of sheets Revision Date Title S Sl D �$` �/Q Size of Septic Tank /90® may`/� Type of S.A.S. 7- Description of Sod, Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued by t i B do Health. _.. Si ed Date Application Approved b.r Date Application Disapproved for the following reasons Permit No. Date Issued e No. , Fee Q THE COMMONWEALTH OF.MASSACFUSTT�S,,, Entered in computer: s y PUBLIC HEALTH DIVISION -TOWN OF.BARNS TABLE,t' ASSACHUSETTS ZIPP41cation for Mtgpogal *pgtem Congtru•Ctton Permit Application for a Permit to Construct( )Repair(�)Upgrade( )'Abandon( ) ❑Complete System "dividual Components r Location Address or Lot No. Owner's Nye,Addrsts and Tel.No. Asysgr's M`p/Pazcel G CJ 'y Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. for 7d loll-, i 7?'�`�J�� Type of Building: Dwelling No.of Bedrooms Lot Size 0� sq.ft. Garbage Grinder(/ b Other a" Type of Building P No. of Persons Showers( ) Cafeteria( ) Other Fixtures ---^ S Design Flow Ile .r5 .5;32W gallons per day. Calculated daily flow �J317 gallons. Plan Date j3_/ /Number of sheets Revision DAe Title S S/ ' ��6'I D 1` !"" 5� �/QliJ�l 40bp Size oPSeptic Tank IMZ� !P,71 Z57 'jcs//A2 Type of S.A.S. Description of Soil, f Naturelof 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 b.,th' o do, Health /Z6� Si ned Date Application Approved by, Date 5 Application Disapproved,for the following reasons YS Permit No. �'� c71Y Date Issued '5 " THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTJWY, that the On-site Sewage/p�tsposai System Constructed( )Repaired(P )Upgraded( ) Abandoned( )b /Jl,/ Xa�O 14 at � rQN.e��i L�//�. ���/I�!'i7�r S' has been constructed in accordance with the rtivi'sions Title • an the for Dis osal S stem Construction Permit No. dated Installer p � y�d I p y Designer q The issuance of this'permit shall not be construed as a guarantee that th sye`st I' it unc 'on as designed. Date J O J{I� I Inspector r No.C�S ------------------------Feed Y THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS Mtgpogal *pgtem Con.5truction Permit Permission is hereby grante'dlto Construct( ) epair(Upgrade( )Abandon( )n System located at 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: Construction must be completed within three years of the date of this pe t Date:_ 15 Approved FROM :down cape engineering inc FAX NO. :15083629880 Oct. 20 2005 03:14PM P1 Town of Barnstable dFTMe gegulatory Services Thomas F. Geller, Director &%"Wreet8. ,,,A �, Public Health Division t6�9 �n►�o+" Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Installer& Designer Certification Form Date: �os" Sewage Per �i©�`� yLABssessor's Map\Parcel C110 i ner: �Owr) �, i Installer: / / G' / D / nDes g � � ,p . Address: h- v v' ' Address: () � ��� nG � . 110-1� 40"40— /!(�5� was issued a permit to install a (date) (installer) septic system at!,ft F✓`,t_1I^ five . r &#,based on a design drawn by (address) dated Q.t�� �e a� °� (desz er) I certify that the septic system refreneed above tlateral rll to the design, which may include minoapprd ehan es such as eoatio ofthe distribution box and/or septic tank. Xi certify that the septic system referenced above was installed with major changes 0.e. greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system.) but in accordance with State & Local Regulations. Plan revision or certified as-built by designer to follow. (Ins is Signature). Boa ARNE yGn H. OJAI.A C No.26348 Y (Designer s�Skpa e) (Affix Isere) pI EA5 RE I1RN -rO BA STABLE PURL C HEALTR DIVISION. CERT F'IC TE F' OM LIA ICE WILL NN N ,B B USSU E P EBLI HEALTH DIMS N.O HAIYIC YOU BUrLT C RD ARE RECEIVED BY THE Q:J4cttlth/Scptic/Dcsigner Certification Fonn 3-26-04.doc P FNDN. AT EL. 45.0' SYSTEM PROFILE TEST HOLE LOGS i . , ACCESS COVER TO WITHIN 6" OF FIN. GRADE (NOT TO SCALE) PROVIDE INSPECTION PORT WITHIN LISA LYONS, RS e�fs wAY k` R / ACCESS COVER (WATERTIGHT) TO 6" OF FINISH GRADE ENGINEER: y AUCW MINIMUM .75' OF COVER OVER PRECAST WITHIN 6" OF FIN. GRADE 2% SLOPE REQUIRED OVER SYSTEM 43 8' D. DESMARAIS, RS WITNESS: 2" DOUBLE WASHED PEASTONE DATE: 8/17/05 ELEV. 41.9' RUN PIPE LEVEL FOR FIRST 2' < 2 MIN INCH EXISTING 1000 PERC. RATE _ / Ll LOCUS GALLON SEPTIC 40.50't* 40.8 1 11050 CLASS SOILS P# z TANK (H- 10 ) GAS o000 0 CI 0 0 0 o Y z RE-USE SEE NOTE BAFFLE 40.25' o L 40.08' 40.0 6" CRUSHED STONE OR MECHANICAL F-I 1­71 177 l� COMPACTION. (15.221 [2]) $ 2' IT a a a 177 38.0'. Q ELEV. Q DEPTH OF FLOW = 4 MIN ( 1 % SLOPE) 3 4" TO 1 1 2" DOUBLE 'WASHED STONE � O„ 44.2' 0 43.5' TEE SIZES: ( 1 % SLOPE) / / A A INLET DEPTH 10" LS LS OUTLET DEPTH 14" 5" 1OYR 3/2 8" 1 OYR 3/2 LOCATION MAP NTS B B i FOUNDATION LEAC H'NG EXIST. SEPTIC TANK 15� D' BOX 10' FACILITY LS LS ASSESSORS MAP 292 PARCEL 45 5.8', 10YR 5/6 29" 10YR 5/6 , *THE INSTALLER SHALL VERIFY THE _ 32„ 41 .5, 41.1 LOCATIONS OF ALL UTILITIES AND ALL Cl BUILDING SEWER OUTLETS AND ELEVATIONS PRIOR TO INSTALLING ANY PORTION OF SEPTIC SYSTEM PERC LMS C I. THE INSTALLER SHALL CONFIRM MINIMUM SEPTIC PERC _ TANK SIZE OF 1000 GALLONS, AND DETERMINE 32 2' 2.5Y 6/6 SUITABILITY FOR RE-USE. REPLACE WITH 1500 GAL MS TANK IF NOT SUITABLE FOR RE-USE & ADD 108" SOME REQUIRED TEES AND GAS BAFFLE C2 FINES j 2.5Y 6/6 FS F i i i 144" 32.2' 124" 33.2' + 43.5 NGWE NGWE NOTES: I_ 1. DATUM IS APPROX. NGVD LOT 59 + 43s BENCH MARK NAIL SEPTIC DESIGN: (GARBAGE DISPOSER Is_N4TI,I QW �nT _n SET 12" OAK -EL.=46.7 2. MUN!ICIPAL WATER IS EXIS1ING 9,600t SQ. FT. DESIGN FLOW: 3 BEDROOMS ( 110 GPD) 330 GPD a3.6 16p�p0' USE A 330 GPD DESIGN FLOW 3. MINIMUM PIPE PITCH TO BE 1/8" PER FOOT. 4. DESIGN LOADING FOR ALL PRECAST UNITS TO BE AASHO H- 10 SEPTIC TANK: 330 GPD 2 = 660 + a3.8 � (-) 5. PIPE JOINTS TO BE MADE WATERTIGHT. + 43.9 + 41 6. CONSTRUCTION DETAILS TO BE IN ACCORDANCE WITH MASS. � 10"OAK •PI ? TH1 USE A 1 000 GALLON SEPTIC TANK (RE-USE EXIST, - SEE NOTE) 0 3.9 a4.1 LEACHING: ENVIRONMENTAL CODE TITLE V. I 7. THIS PLAN IS FOR PROPOSED SEPTIC SYSTEM ONLY AND IS NOT EXIST. SEPTIC TANK 2(30 + 9.83) 2 (.74) = 118 43. ? (SEE NOTE) 442 SIDES: TO BE USED FOR ANY OTHER PURPOSE. PIT. 30 x 9.83 (.74) = 218 8. PIPE FOR SEPTIC SYSTEM TO SCH. 40-4" PVC. ,4s.o o 1 as 9a`` GRAVEL DRIVE / �.0 BOTTOM: 9. COMPONENTS NOT TO BE BACKFILLED OR CONCEALED WITHOUT + a3a TOTAL: 454 S.F. 336 GPD INSPECTION BY BOARD OF HEALTH AND PERMISSION OBTAINED DECK G 4. TH2 4. ��C USE (2) 500 GAL. LEACHING CHAMBERS (ACME OR FROM BOARD OF HEALTH. + 45.0 � 44.1 EXIST. --0 so �l EQUAL) WITH 2.5' STONE AT SIDES, 4' AT ENDS AND 5' 10. PUMP & REMOVE (OR FILL W/CLEAN SAND) FAILED PIT(S). DWELL, -Q 4.0 + 44.0 BETWEEN UNITS 16"OAK TOP FNDN 8 43.6 = 45.0' `I O / a + 43.9 0 LEGEND 44.0 TITLE 5 SITE PLAN v 160.00, 100.0 PROPOSED SPOT ELEVATION OF 100x0 EXISTING SPOT ELEVATION 54 FRAN KLI N AVENUE IN THE TOWN OF: 100 __0 PROPOSED CONTOUR ( HYANNIS) BARNSTABLE 100 EXISTING CONTOUR 43.7 PREPARED FOR: BORTOLOTTI CONSTRUCTION/CHILDS 20 0 20 40 60 BOARD OF HEALTH MA SCALE: 1" = 20' DATE: AUGUST 21 , 2005 APPROVED DATE off 508-362-4541 fox 508 362-9880 � OFM� i down cape engineering, inc, o� ARNE H ATE OJALA t f !15 CIVIL ��.t`A►.A , � CIVIL ENGINEERS CIVIL LAND SURVEYORS �o GI ES S 939 vain st, arrlouth rya 026 t EaG� a SURVE /�/ 0� i 05-- 1 80 Y 75 AR OJALA, P.E., P.L.S. DATE f