HomeMy WebLinkAbout0084 FROST LANE - Health i�
84 FROST LANE, HYANNIS
A=B89-014
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TOWN OF BARNSTABLE
LOCATION may- Ta,,oW LL, SEWAGE#
VILLAGE tA,-.A v4 tj ASSESSOR'S MAP&PARCEL
INSTALLER'S NAME&PHONE NO. .�,�. � r'1-71
SEPTIC TANK CAPACITY
LEACHING FACILITY:(type) (size)
NO.OF BEDROOMS • �C,> �K_ 64A-k 3"1
OWNER v
PERMIT DATE: ' / COMPLIANCE DATE: 1 2
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) M ArkFeet
Edge of Wetland and Leaching Facility(If any wetlands exist within
300 feet of le
aching facility) .
N, Feet j
FURNISHED BY
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No. "4 Fee 166
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
Yes
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS
ftpliLation for -Mispo8al *pstem Construction permit
Application for a Permit to Construct( ) Repair OK Upgrade( ) Abandon( ) ❑Complete System RfIndividual Components
Location Address or Lot No. �C f yYjg+ re Owner's Name,Address,and Tel.No.r)h4/-a1;1 /
1 Gtutivl i S � s'oian� 8y,�r � i.ar�g
Assessor's Map/Parce O/
Ik staller's Name,Address,and Tel.No.6M'W79- SW(A Designer's Name,Address,and Tel.No. S H- k,?- z/5V/'
l�br�i�tX,�%Cloy�s4,r�l�'�n;.Lr+�• �8'?'r�du,s(My� ��Cv/I� � ir�r'iv,� 4 QM4>,.�s'�'
Type of Building:
Dwelling No.of Bedrooms Lot Size /3 I qG sq.ft. Garbage Grinder( )
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow(min.required) _330 gpd Design flow provided 3 7 9 gpd
Plan Date Number of sheets Revision Date
Title 77
t
Size of Septic Tank nc? Type of S.A.S ' o
Description of Soil Ae, 4-4)f jp/k- /4�
Nature of Repairs or'Alter tions Answer when applicable) ' /U ' X - /(ySon
Sma Owned jb-
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 C e not to place the system in operation until a Certificate of
Compliance has been issued by this Board of Health.
Signed Date
Application Approved by Date
Application Disapproved by U Date
for the following reasons
Permit No. �® 1 Date Issued —'
No. Fee ��'F✓
t
x THE COMI4ZNWALTH OF MASSACHUSETTS Entered;ncomputer: Yes
_ PUBLIC HEALTH DIVISION ;TOWN OF BARNSTABLE, MASSACHUSETTS
c>
• cry
2ppliption for MisOosal 6pstem Construction Permit
Application for a Permit to Construct( ) Repair Upgrade( ) Abandon( ) ❑Complete System Individual Components
Location Address or Lot No. 8w '��� h Owner's Name,Address,and
r�Tel.No.71)i/-�1.2- 19 l/�
kne-
Assessor's Map/Parcel �(j� Y V,�,.„; ,,,1
{rj
r� Installer's Name,Address,and Tel.No.5t'b-yi��` ,fib Designer's Name,Address,and Tel.No. $•, - y,;,�j/�
�9r Ic�C� Cl�hS{'YuGE•►'on,3r,C. qS k'/5�ryW ,b j&p j,�ff;rover rj 927 /-0 0.
IMst l"S 1S N;11; M A P1 _[/9 Lip. ._D^r� u
Type of Building:
T` Dwelling No.of Bedrooms 3 Lot Size /*j. /4V G ".: sq.ft. Garbage Grinder( )
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow(min.required) _� � gpd Design flow provided .j q/ gpd
PlanX=' Date }' ,, /9. �(1�1 Number of sheets Revision Date
_��++' F
Title ,T'>/r,t,Size of Septic �4. i4nS f X" 1 rya Q`� /? � f Ce Y1 / C, s�'11Y11 ) 1 r
" 1,166m,l y Type of S.A.S. '1 '5�.�0 141U 0.Atra7�u A-ZK x 12
Description of Soil �)oA y�,� Q ►� � ¢/ ! v i
Nature of Repairs or Alterations(Answer when applicable) 7�l/�i r t9/U �,t /n /+i;•,6zi�,a a 1�X '� - /�OU
, rijn' t
a► W _rla /n�A' Lf s . . e? �r)i�i,►G o t n�u 9u � r- ,� 4- 1�E.PKP
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 a" and7ot to place the system in operation until a Certificate of
Compliance has been issued by this Board of Health. F�
} Signed ,M" ,•-; _ Date
Application Approved by "�, �,� Date ,
,Application Disapproved by Date
for the following reasons
Permit No. a°� Date Issued
THE.COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE,MASSACHUSETTS
-Certificate of Compliance
THIS IS TO CERTIFY,,that the j n-sit//e Sewage Disposal system Constructed( ) Repaired Upgraded( )
Abandoned( )by&,�,� � r"Is —1.►r,ZG b!
at (� �!'r, �i r I P / n zS has been constructed in accordance
with the provisions of Title 5 and the for DisposalSystem Construction Permit No. 2-0�1-2-�Aated "J
Installer&ok if .a n5 an6C T4-x-• Designer 06U)" �ec rot_ A��lt,E tnrS G
#bedrooms Approved design flow gpd
The issuance of this perm tdshall 'ot be construed as a guarantee that the system ill as esi ed.
Date /.� l Inspector
--------- -- - -------- -- - ------------ ------ - - -
Fee
THE COMMONWEALTH OF MASSACHUSETTS
t' PUBLIC HEALTH DIVISION -BARNSTABLE,MASSACHUSETTS
Bisposal 6pstem Construction Permit
Permission is hereby granted to Construct( ) Repair(� Upgrade( ) Abandon( )
System located at 4 _qnQ f`�F�ul, n ti is
and as described in the above Application for Disposal System Construction Permit. The applicant recognized 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 permi.
Date "'� ',� f Approved by _ ✓v.%h,/ l
Town of Barnstable
�ZFtE TQ�
do Inspectional Services
• •
Public Health Division
BAMSrABLF,
1639. �� Thomas McKean, Director
�a 200 Main Street,Hyannis,MA 02601
Office: 508-862-4644 Fax: 508-790-6304
Installer& Designer Certification Form
Date: � 22 2.f Sewage Permit# Assessor's MaplParcel
Designer: e f I �r�i Installer:
Address: G�� Address:
On was issued a permit to install a
(date) (installer)
septic system at 5 4 _ Frost- L--arwl R- OmuS basedon a design drawn by
n (address)
O A0, Fv-lPdated
/ (designer)
�/ I certify that the septic system referenced above was installed substantially according to
the design, which may include minor approved changes such as lateral relocation of the
distribution box and/or septic tank. Strip out (if required) was inspected and the soils
were found satisfactory.
I certify that the septic system referenced above was installed with major changes (i.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. Strip out (if required) was inspected and the soils
were found satisfactory.
I certify that the system referenced above was constructed in j oFMq c with the to rms of
the I\A approval letters (if applicable) ,� ss9c.a
° DANIELA.
/o OJALA a
CIVIL cn
(Installer's Signature) �o No,465020
CASTER \�Q
�i 1- sS�ONAL LNG
_ = M- �
Desi ner's Si nature (Affix.Designer's Stamp Here)
( g g )
PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE
OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS-
BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION.
THANK YOU.
\\toa\depts\HEALTH\SEWER connect\SEPTICUDesigner Certification Form Rev&14-13.DOC
s 7g
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal S Men =r$r No f A °or�oI tntar t� rents o
Property Address
Ow jer
information Owner's Name
required for every G✓I✓�I J /�/T �o��o Q 9 c2
Page- City/Town State_ Zip Code Date of Ins tion
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.
tnportant:When A. General Information (�
filling out forms V 1 19�3
on the computer,
use onm the tab1. Inspector.
key o move of
cursor-do not
u�the return Name of Inspector
�r Name
Company Address
efty/Town �/ �O State �D � Zip
�
Telephone Number a 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 15.340 of
Title 5(�310 CM 15.000). The system:
,
rasses ❑ Conditionally Passes ❑ Fails
❑ Needs Further Evaluation by the Local Approving Authority
71L� /J/,-"I� A" �/C;�
inspector's ignature 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 god 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 etescribes 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.
t5ns-3113 Title 5Official Ins pection F orm Sumsuface Sewage Disposal Sptem•Page 1 of 17
i.
Commonwealth of Massachusetts
Title 5 Official Inspection Fora'
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
oS-�
Pr7NameWaffnation
Address /
ON no ;fown
is '
requiredforevey
page- State Zip Code t'3ate of hspecfim
E. Report Completeness Checklist
2 Inspection Summary:A, B, C, D, or E checked
inspection Summary D(System Failure Criteria Applicable to All Systems)completed
B System Information—Estimated depth to high groundwater
a Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file
15=a an3 TMe50ff1d9 kUPGCdMFomt Sllt8WWe,%vMeDi pwd System*Pop nd 17
Commonwealth of Massachusetts
Title 5 Offi�:ial Inspection Form
Subsurface Sewage Disp�6sal System Porte -Not for Voluntary Assessments
Property Address
ON ner Ow nees Name
inforimbon is
required for every q&J 41 S �c�-6 0
page. CSty/Town State Zip Code Date of spection
B. Rrtiflcaiaon (corn.)
Inspection Summary: Check A,B,C,D or E!a/wayscomplete all of Section D
A) System sses:
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:
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 ex0ain.
s
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 t6t the tank is less than 20 years old is available.
❑ Y ❑ N ❑ ND(Explain below):
i.
a
t5ns•3M 3 Title 5Offidal Inspection Farr[Subsurface Se%ege Disposal System•Page 2 of 17
i
Commonwealth of Massachuseft
Title 5 official Inspection Form
Subsurface Sewage Disposal System Form .Not for Voluntary Assessments
Property Address ��9
Owner Owner's Name
information is
requaed for every Ll 4 vt v1,s /' /%1 �60/
page. Cityrrown State Zip Code Date oflinspedtion
B. Certification (coat.)
❑ 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 mannerwhich 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
t5rs•3M3 Title5offidel Irspecton Famt:Subsurface SevMe Disposal Splem-Page 3017
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
'3f off L�
Property Address
Owner Cw ner's I�rne `,
information is required for every R✓1 f �✓'/ ya 6 d / oZ/ !
page. G11y/rown —�/ State Zp Code Date of spectan
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.
U.s
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 an overloaded or clogged SAS or cesspool
[Ellatic 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
t8ns-3M3 Tile 50ffiaalInspecfionForm Subseace Seyme Disposal System•Page 4of17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not/ibr Voluntary Assessments
Property Address
Ow ner Qu ne°s Name
hfonrg tion is
required for every ••1✓1l T �oZ 6 O� 9 a
page. Ckyf raw n State Zip Code: Date 9f Inspec n
B. Certifica n (corn.)
Yes No
❑ Required pumping more than 4 times in the last year NOT due to clogged or
obstructed pi pe(s). Number of times pumped: .
❑ L� 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.
❑ L7 y 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.]
❑ T e 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 CM 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.
t5tt;•3M 3 Trtle 5 Official Inspection F o=SubsWece Saw ge Disposal Sim-Page 5 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
Property AddressOm --
net ON nees Name
information is /�v T �1
requQedfor every c ,� Qa 6
page. Q1y/Town State Zip Code Orate d Inspect n
C. Checklist
Check if the following have been done. You must indicate"yes"or"no'as to each of the foilowi ng:
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?
❑ IIJ s 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 NIA)
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 fur 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: 2
Number of bedrooms (design): Number of bedrooms (actual): ?
3J
DESIGN flow based on 310 CMR 15.203(for example: .110 gpd x#of bedrooms):
t5irns 3M 3 Title 50fficial Inspection Form SubsWace Sewage Disposal symm•Page 6of 17
I
Commonwealth of Massachuse#ts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Forth -Not for Voluntary Assessments
Property Address
Owner ON ner's Name /
information is
required for every /'1 ri✓`l�I II j�/4 aa-6 0/ a-2
page. Cftyrrown State Zip Code Date of Inspectio
D. System Information
Description: bra l/o J t C G
Number of current residents:
Does residence have a garbage grinder? ❑ Yes 2 No
Is laundry on a separate sewage system?(Include laundry system inspection ❑ Yes No
information in this report.)
Laundry system inspected? ❑ Yes No
Seasonaluse? ❑ Yes No
Water meter readings, if available(last 2 years usage(gpd)):
Detail:
i
Sump pump? ❑ Yes 0�
/1
Last date of occupancy: 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:
t5ms•3H 3 Title Wfficial Inspection F orm Subsurface Sewage Disposal System•Page 7 of 1 7
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage CD�isposal System Form -Not 1br Voluntary Assessments
2?/ oS�-
Property Address /
q
ON ner Cw nees Nameinfornation is
required for every R✓1 tI ��/C�
page. Cityylrown State Zip Code We of Ins tion
D. System Information (coat.)
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 S m:
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/Aitemative 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 VA system by system operator under contract
❑ Tight tank.Attach a copy of the DEP approval.
❑ Other (descri be):
Ons•3M 3 YN9 50ffidal lnspecfian Form Subsurface Sewage Disposal System•Page 8 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -II Not for Voluntary Assessments
/'os 7�
Roperty Address l
Ow ner Owner's Name
information is
required for every a H s r/� 0�:i 601 l
page' CRAM State TIP Code Date of Inspection
D. System Information (cont.)
Approximate age of all components,_date installed(if known)and sou of information:
19)2 `/�� -,I q
Were sewage odors detected when arriving at the site? ❑ Yes No
Building Sewer(locate on site plan):
Depth below grade:
_ feet
Material of construction:
El cast iron �PVC ❑ other(explain):
Distance from private water supply well or suction line:
feet
Comments (on condition of joints, venting, evidence of leakage, etc.):
Septic Tank(locate on site plan):
Depth below grade:
feet
Materia 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:
Sludge depth:
15re•'J13
Title 50ffiaal Inspee6an Form Subsurface Semge Dispasa SysMm•Page 9 of 17
Commonwealth of Massachusetts
YJTitle 5 Official Inspection Form
Subsurface Sewage Disposal System Fonn a Not for Voluntary Assessments
Property Address /'os
ON ner Ow nees Name
information is /
required for every c�✓t��j /, ( 4a,6�/
page. C yllown State Zip Code Date of In pection
D. System Information (cost.)
Septic Tank(coat.) /
Distance from top of sludge to bottom of outlet tee or baffle
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
How were dimensions determined? C>L
Comments (on pumping recommendations,'iniet and outlet tee or baffle condition, structural integrity,
liquid levels as related to outlet invert, evidence of leakage, etc.):
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
Lyre-3H 3 Title 5Official Irspecbcn Form Subsurface Sevrage Disposal System•Page 10 d V
Commonwealth of Massachusetts
lug Title 5 Official Inspection Fora
Subsurface Sewage[Disposal System Form -Not for Voluntary Assessments
�os� /—/(/
Property Address
Ow ner 9
inf orn abort's Ouv net's /� q
required for every q✓►�!J / / ®02601
page' Cigfllown State Zip Code Date of Insp
ection
D. System Information (coat.)
Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity,
liquid levels as related to outlet invert, eNidence 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 worldng 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
tgns•3M3 M050fficialInspee timFmrt SubsutaceSe Sewage Dispose!System-
vr�g Sp Page 11 of 17
i"
Commonwealth of Massachusetts
itTitle 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
— -611�� —F-l--q S -� /—A/
Prop"Address
ON ner Ow ner's Name
information is '
required for every q ✓1✓1!J Ip 6 Q/
page. City/Town State Zip Code Date ifAnspecti6n
D. System Information (cons.)
Distribution Box (f 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.):
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:
tSrss•313 Tide 5 official InspectionFoms Subswfacs Savage Disposal Sytem•Page 12of 17
Commonwealth of Massachusetts
IFTitle 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not f)ur Voluntary Assessments 9 / / o S 7
Roperty Address /
Cw ner Om ner's Name
information is
required for every #1 t f G o/ �/c)2
page. city/Town State Zip Code Date of Ins0ection
D. Syste n rmation (corn.)
Type: Soo � /lam► C"�44s sJOV"Y-- 0?5x uy")�
❑ leaching pits number
leaching chambers OC>I—
number-
El leaching galleries number.
❑ leaching trenches number, length:
❑ leaching fields number, dimensions:
❑ overflow cesspool number.
❑ 1nnovative/altemative system
Type/name of technology:
Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of
vegetation, etc.):
/
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 ❑ ye ❑ No
t9ns•3n3
Title 50f5eiai Irspeetian Form Subsutace Sevrdge Disposal SysOBm•Pge 13 of 17
• Commonwealth of Massachusetts
Title 5 official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
lug
Phoperty Address
Owner Ow rte's
information is
required for every ✓� 1 �
Page aty--frown -
State Zip Code Date of Inspection
®. 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.):
i
t5m•W 3
Title50ffid81 InspeotionForm Subsuiace SexageDisposal System-Page 14 of 17
Commonwealth of Massachusetts
Title 5 official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
Property Address / / //
Ow ner /9G `
information is Owner's Name ✓/
requiredforevery / a✓i cJ 0o160 1 9 ��
page. C y/;n State Zip Code Date Ins n
D. System nformation (cunt.)
Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to
at least two rmanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate
where is water supply enters the building. Check one of the boxes below.
hand-sketch in the area below
❑ drawing attached separately
SAC
Q I
Rose"s /j°oo
v-Qo)c
Orr.`3M 3 Title 5 orficlat lrepectcn Farts subsuface Seviege Disposal System•Page 15 of 17
Commonwealth of Massachusetts
ON
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
Rope (Address
ON nor ONInforrilation is
ner s Name ���
forevery
page. Cityfrown State ZP Code Date of N coon
A System Information (coat.)
Site Exam.
❑ Check Slope
❑ Surface water
❑ Check cellar
❑ Shallow wells
Estimated depth to high ground water.
• 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 locP/C'
p
oard of Health-explain:
` 0 f- ' C'S4 /J�/Qf
f
❑ Checked with local excavators, installers-(attach documentation)
❑ Accessed USGS database-explain:
You must describe w you estag�/tlished the high ground water ele;ion:
-
eCl/J l
Vl -,0/ct,u C 0,'
L'0
C D✓'7 B o vh
a�C� /7" OeIO d-e
LI/
Before filing this Inspection Report, please see Report Completeness Checklist on next page.
19rts•'Jt 3
Title S Official trupection Form Subsurface Sewage Disposal S)sOem•Page 16 of 17
TOWN OF BARNSTABLE
LOCATION r.-OC 1" ZOAa SEWAGE #
VILLAGE - ASSESSOR'S MAP & LOT 2- -d
INSTALLER'S AME&PHONE NO. .�. den% ug Goat✓ �'33'^�1��°I'
SEPTIC TANK CAPACITY
LEACHING FACILITY: (type) C*M-4Ksize X�2
NO.OF BEDROOMS .
BUILDS R OWNER *4--AALO� C0402.
PERMTTDATE: )_?.COMPLIANCE DATE: q
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
!`
P
o
No. /6 THE COMMONWEALTH OF MASSACHUSETTS FEE
i BOARD &F—HI EALTH
T OF
APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT
Application for a Permit to Construct Repair ( ) Upgrade ( ) Abandon ( ) - ❑Complete System ❑Individual Components
Location Owner's Name
Al
Map/P cel# /-^'�yf���, w Address
Lot# /UI� /� Telephone#
�OrY✓k G ��LGti
Inst er' m D 's Name
Address ef-11/ Address �-
Telephone 9 Telephone#
Type of Building: A-es)�C�, Lot Size /3. `F'1-0 Sq.feet
Dwelling—No.of Bedrooms -' Garbage Grinder ( )
Other—Type of Building No.of persons Showers ( ), Cafeteria ( )
Other fixtures
Design Flow(min.required) 3 7O gpd Calculated design flow ?! 30 gpd Design flow providedU� gpd
Plan: Date ' 3// y/� Number of sheets / Revision Date
Title .5/fT- of
Description of Soil(s)
Soil Evaluator Form No. // Name of Soil Evaluator Date of Evaluation
DESCRIPTION OF REPAIRS OR ALTERATIONS
The undersigned agrees to install the above described Individual Sewage Disposal System in accordance with the provisions of
TITLE 5 and fu r. grees not to place the system in operation until a Certificate of Compliance has
ss]been issued by the Board of Health.
Signed Date
FORM I - APPLICATION FOR DSCP DEP APPROVED FORM 5/96
., n"�, s�, - •� I t !� ,fix _ _ �-
No. /�- ! �6 THE COMMONWEALTH OF MASSACHUSETTS FEE
BOARD EALTH
OF
APPLICATION FO 6POSAL SYSTEM CONSTRUCTION PERMIT
Application for a Permit to Construct` Repair Upgrade Abandon Complete System Individual Components x
. fy /`vr/S. �/o.�.�_ �.t.N►�
Location 1` Owner's Name
Map/P cel# / Address
77kA?y
j Lot# Telephone#
�i ,� Insla er' me y {Dest s Name
"* Address Address
r
Telephone# Telephone#
.Type of Building: F Hl S) r'c- c-�-- Lot Size /�• `> 2.e� Sq.feet 1
Dwelling—No.of Bedrooms 3 Garbage Grinder ( )
1
Other—Type of Building No.of persons Showers ( ), Cafeteria ( )
Other fixtures `
Design Flow(min.require ) gpd Calculated design flow a 3 gpd Design flow provided�3 gpd
Plan: Date 3�/ z�ya Number of sheets Revision Date "7` 3v, s�:
Title S/ -r Sws,GL �L.4wI of '�� ��ST— a.:✓�
Description of Soil(s)
Soil-Evaluator Form No. //^} Name of Soil Evaluator /``6 Date of Evaluation
DESCRIPTION OF REPAIRS.OR-ALTERATIONS
The undersigned agrees to.insiall the above described Individual Sewage Disposal System in accordance with the provisions of
TITLE 55aand fu r grees not to place the system in operation until a Certificate of Compliance has been issued by the Board of Health.
00,
y Signed ` �� .Date 7�/ -
77
FORM I - APPLICATION FOR DSCP DEP APPROVED FORM 5/96
No. 9---Im THE COMMONWEALTH OF MASSACHUSETTS FEE /00
C�C�-✓NS41a4e BOARD OF HEALTH
CERTIFICATE OF COMPLIANCE
Description of Work: ❑ Individual Component(s) mplete System
The undersigned hereby certify'that the Sewage Disposal System;Constructed( ),Repaired( ),Upgraded( ),Abandoned( )
by:
at t7v sya win
has been installed in accordance with the provisions of 310 CMR 1.5.00 (Title 5) and the approved design plans/as-built
;. plans relating to application No.9Y-V9,I41 dated 7-31-9 r Approved Design Flow 'tidy (gpd)
Installer
a Designer: Inspector Date
The issuance of this certificate shall not be construed as a guarantee that the system will function as designed.
FORM 3 - CERTIFICATE OF COMPLIANCE DEP APPROVED FORM 5/96
No. �4 /Ip THE COMMONWEALTH OF MASSACHUSETTS FEE
�1lv�t BOARD OF HEALTH
DISPOSAL SYSTEM 0NSTRUCTION PERMIT
Permission is hereby granted to Construct ( Repair�( ) Upgrade ( ) Abandon ( ) an individual sewage
disposal system at Fy Er- _p as described
in the application for Disposal System Construction Permit'No. / T`V% ,dated 7—
Provided: Construction shall be completed within three years of the date of this permit.All local conditions must be met.
Date Board of Health
FORM 2 - DSCP DEP APPROVED FORM 5/96
FORM 1255 (REV 5/96) H&W HOBBS&WARREN rM PUBLISHERS- BOSTON
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tel.(508)362-4541
939 main street rt 6a tax(508)362-9880
yarmouth port
mass 02675 down cape enfineel 7,f
civil engineers& land surveyors
structural design
Arne H.Ojala P.E.,P.L.S.
Timothy H.Covell,P.L.S.
land court David C.Thulin,P.E.
surveys March 12, 1998
Tim Pearson
site planning Markwood Corporation
110 Breed's Hill Road Unit 10
Hyannis, MA 02601
sewage system
designs
Dear Mr. Pearson:
inspections A public hearing has been scheduled for the Barnstable Board of
Health to take action on your request for a variance from the
Barnstable..Board of Health Regulations for Subsurface Disposal of
Sewage for your proposed construction at 84 Frost Avenue, Hyannis ash
permits follows
""Town of Barnstable 330 Regulation .: Proposed 3 bedroom dwelling to
be constructed in WP District on a lot which is less than one acre.
Said hearing will be held in the Hearing Room of the Barnstable Town
office, 367 Main Street, Hyannis, MA on April 14, 1998 at 7:00 p.m.
S' cerely,�
Sarah B. Ofala
Down Cape Engineering, Inc.
cc: Abutters
file
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Avis AIR AP INC. 101 �
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MASSACHUSETTS CONNECTICUT .51 At.
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-_ .. .._-
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tel.(508)362-4541
939 main street rt 6a fax(508)362-9880
yarmouth port
mass02675 down cape entineeriftg, „
civil engineers& land surveyors e /
structural design
Ame H.Ojala P.E.,P.L.S.
f'� Rom` Timothy H.Covell,P.L.S.
1C f 11��
land court David C.Thulin,P.E.
surveys March 23, 1998 MAR 1998
Tim Pearson TOWIVOF ARNSTAB�
site planning Markwood Corporation `
110 Breed's Hill Road Unit 10 �,
Hyannis, MA 02601 `��
sewage system
designs
Dear Mr. Pearson:
inspections A public hearing has been scheduled for the Barnstable Board of
Health to take action on your request for a variance from the
Barnstable Board of Health Regulations for Subsurface Disposal of
Sewage for your proposed construction at 84 Frost Avenue, Hyannis as
permits follows:
Town of Barnstable 330 Regulation : Proposed 3 bedroom dwelling to
be constructed in WP District on a lot which is less than one acre.
Said hearing will be held in the Hearing Room of the Barnstable Town
office, 367 Main Street, Hyannis, MA on May 12, 1998 at 7:00 p.m.
Sincerely,
Sarah B. Ojala
Down Cape Engineering, Inc.
cc: Abutters
file
1
01► 1 DATE:
1 LAPMAKx • ]PRE i
NAMToWn of Barnstable RBCa BY
�
,��Board of Health
f� y�FpTrgg�, 8 !1
367 Main Street,Hyannis MA 02601
Office: 508.790-6165
FAX: 508-790-6304 ' -4 Susan O.Rask,R.S.
Sumner Kaufman,M.S.P.R.
Ralph A.Murphy,M.D.
VARIANCE REQUEST FORM
LOCATIO
Property Address:
Assessor's Map and Parcel Number: Size of Lot: 13,'4-Zo S _
Wetlands Within 300 Ft. Yes Subdivision Name:
No k
Business Name: ��
APPLICANT CONTACT PERSON
Name: %-1a.4 L-L,;, C-oe— Name: 1►.� Pea.a sor.�
Address: IN o g2Fe,4 S �-k w 4✓J - Address: `
Phone: '1'lp� _ —l�,.t— Phone:
FAX: '"1'l8 — —7"�� FAX:
VARIANCE FROM REGULATION(List Reg.) REASON FOR VARIANCE(Ma attach ifmore space needed)
•• 3 3� �E�_t r,�-To..1 ' _ 5 E t A---�1-4s.e4-E.✓J
Chedlist(to be completed by office staff-person receiving variance request application)
Four(4)copies of plan submitted(including septic system plans and/or restaurant floor plans)
Applicant understands that the abutters must be notified by certified mail at least ten days prior to meeting
date at applicant's expense(for Title V and/or local sewage'regulation variances only)
Full menu submitted(for grease trap variances only)
Variance request application fee collected lnoreefor lifeguard modifiWionnens al,,grease trap va4sncetvw 2]s[sameo„,vnesseeonly),outside
dining variance renewals)same ownerAeasee only),and—isnrcl to repair failed sewage dispoul system,lonly if no eapwuion to the building propwed])
Variance request submitted at least 15 days prior to meeting date
VARIANCE APPROVED _ Susan G.Rask,R.S.,Chairman
NOT APPROVED Sumner Kaufman,M.S.P.H.
REASON FOR DISAPPROVAL Ralph A.Murphy,M.D.
Q:/WP/VARIREQ
-------------------- -
I
tel.(508)362-4541
939 main street rt 6a fax(508)362-9880
yarmouth port
mass 02675 down cape engineering
civil engineers& land surveyors
structural design
Arne H.Ojala P.E.,P.L.S.
Timothy H.Covell,P.L.S.
land court March 12, 1998 David C.Thulin,P.E.
surveys
Barnstable Board of Health
site planning 367 Main Street
Hyannis,MA 02601
sewage system Re: Local variance request for#84 Frost Lane, Hyannis
designs
Proposed 3 bedroom dwelling
Assessors Map 289,Parcel 14
inspections
Dear Board Members:
permits
The attached is a request for a variance from the "330 regulation". Our client wishes
to construct a three bedroom home on a .31 acre lot at the above-referenced location.
This lot lies within a"WP District" as shown on the "Town of Barnstable Revised
Groundwater Protection Districts",dated April 1993. The surrounding area already
includes 3 bedroom dwellings, with real estate values ranging in the area of $84,000
to $120,000. The currrent real estate value of this lot is $29,300. The projected sales
price of this home would be in the neighborhood of $100,000.
No groundwater was encountered during the perc test. A normal-sized,below grade
Title 5 system can be designed on this lot without the need for any other variances.
The lot is serviced by town water. To require the installation of an alternative-type
system would necessitate the expenditure of greater than 10%of the estimated real
estate value of the proposed house and land.
On behalf of our clients, we are requesting a variance from the Town regulation to
allow a 3 bedroom house on less than an acre of land within a WP District. In that the
area readily supports 3 bedroom homes, we feel that the addition of another 3 .
bedroom dwelling will not appreciably add to the nitrogen concentration in the area.
It should also be noted that this area is slated for town sewer in the future.
Very truly yours, n
Alt,� lT• CG _..4
Arne H. Ojala,PE,PLS
Down Cape Engineering,Inc.
cc: Tim Pearson
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TOWN OF BARNSTABLE
LOCATION Pro SEWAGE # �
VILLAGE ASSESSOR'S MAP & LOT i� -Q
INSTALLER'S AME&PHONE N0. P-E.,% ,lyt Coot P3 s'-'�e"
SEPTIC TANK CAPACITY
LEACHING FACILITY: (type) 50 1,- �' i, size)
NO. OF BEDROOMS -�
BUIl,DE R OWNER
PERMITDATE: 1 jj' COMPLIANCE DATE: Ci
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
TOWN OF BARNSTABLE
TN E T�
w
OFFICE OF
1"19TAHL i BOARD OF. HEALTH
t639• `em 367 MAIN STREET
HYANNIS, MASS.02601
t
May 14, 1998
Tim Pearson
Markwood Corporation
110 Breed's Hill Road
Hyannis, MA 02601 .
RE: 84 Frost Avenue, Hyannis, A=289-014
Dear Mr. Pearson:
You are granted a variance from the Board of Health "330" Regulation limiting sewage
flows to 330 gallons per acre per day within zones of contribution to public water supply
wells at 84 Frost Avenue, Hyannis.
The variance is granted with the following conditions:
(1) The dwelling shall be connected to a public water supply system.
(2) The dwelling is strictly limited to no more than three(3`,,)bedrooms. Dens, study
rooms, finished attics, sleeping lofts and similar-type rooms are considered
"bedrooms" according to the Massachusetts Department of Environmental
Protection. Floor plans for the dwelling shall be submitted to the Public Health
Division prior to obtaining approval of a disposal works construction permit.
This variance is granted because the proposed home of three bedrooms is
consistent with the other existing homes in the neighborhood. It is the opinion of
the Board that the installation of one additional septic system which complies with
Title 5, the State Environmental Code, in this area should not significantly alter the
quality of the groundwater.
Also, the Board is of the opinion that, although the proposed septic system does
not strictly meet the nitrogen loading requirements in 310 CMR 15.214, the
applicant has achieved maximum feasible compliance because the use of an
alternative-type system with nitrogen removal would exceed ten percent of the
estimated real estate value,
In addition this site is in an"area of concern" as defined in the Town of Barnstable
Wastewater facilities plan and other alternatives are being explored for wastewater
disposal in this area in the future.
Therefore, the Board of Health is of the opinion that you have achieved maximum
feasible compliance.
Sincerely yours,
Susan G. Ra* R.S.
Chairman
Board of Health
Town of Barnstable
SGRlbcs
pearson
7 to DEP.
This variance is granted because the proposed home of three bedrooms is
consistent with the other existing homes in the neighborhood. It is the opinion of
the Board that the
installation of one additional septic system which complies with Title 5, the State ._.
Environmental Code, in this area should not significantly alter the quality of the
r; groundwater.
Y �{`
14
Also, the Board is of the opinion that, although the proposed septic system does
not strictly meet the nitrogen loading requirements in 310 CMR 15.214, the
applicant has achieved maximum feasible compliance because the use of an
alternative-type system with nitrogen removal would exceed ten percent of the
estimated real estate value.
In addition this site is in an"area of concern' as defined in the Town of Barnstable
Wastewater facilities plan and other alternatives are being explored for wastewater
disposal in this area in the future.
e{'
1
Therefore, the Board of Health is of the opinion that you have achieved maximum
A feasible compliance. 3
Sincerely yours,
urp y
Chairman E
R
Board of Health 3
Town of Barnstable
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tel.(508)362-4541
939 main stree!i•6a fax(508)362-9880
yarmouth pc
mass 026 f` down cape engineering
civil engineers&land surveyors
structural design
Ame H.Oiala P.E.,P.L.S.
Timothy H.Covell,P.L.S.
land court March 12, 1998 David C.Thulin,P.E.
surveys
}� Barnstable Board of Health
site planning 367 Main Street
Hyannis,MA 02601
sewage system Re: Local variance request for 984 Frost Lane, Hyannis
designs
Proposed 3 bedroom dwelling
Assessors Map 289,Parcel 14
inspections
Dear Board Members:
permits
The attached is a request for a variance from the "330 regulation". Our client wishes
to construct a three bedroom home on a .31 acre lot at the above-referenced location.
This lot lies within a "WP District" as shown on the "Town of Barnstable Revised
Groundwater Protection Districts",dated April 1993. The surrounding area already
includes 3 bedroom dwellings, with real estate values ranging in the area of $84,000
to$120,000. The current real estate value of this lot is $29,300. The projected sales
price of this home would be in the neighborhood of $100,000.
No groundwater was encountered during the per e.test. A normal-sized,below grade
Title 5 system can be designed on this lot without the need for any other variances.
The lot is serviced by town water. To require the installation of an alternative-type
system would necessitate the expenditure of greater than 10%of the estimated real
estate value of the proposed house and land.
On behalf of our clients, we are requesting a variance from the Town regulation to
allow a 3 bedroom house on less than an acre of land within a WP District. In that the
area readily supports 3 bedroom homes, we feel that the addition of another 3 -
bedroom dwelling will not appreciably add to the nitrogen concentration in the area.
It should also be noted that this area is slated for town sewer in the future.
Very truly yours,
A�-- // cl�l .
Arne H. Ojala, PE, PLS
Down Cape Engineering,Inc.
cc: Tim Pearson
TOWN OF BARNSTABLE
LOCATION � 21J6�!r SEWAGE# � (
VILLAGE F(—( k1-A V4 tj ASSESSOR'S MAP&PARCEL
INSTALLER'S NAME&PHONE NO.
SEPTIC TANK CAPACITY L_L_k-LnW6
LEACHING FACILITY:(type) 64— (size)
NO.OF BEDROOMS '�-- G-�fk'rL
OWNER
PERMIT DATE: COMPLIANCE DATE: 1
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) Pa Feet
FURNISHED BY
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ACCESS COVER (WATERTIGH� TO ENGINEER:--P,
MINIMUM .75' OF COVER OVER PRECAST WITHIN Ir OF FIN. GRADE 2% SLOPE REQUIRED OVER SYSTEM Zy, WITNESS-
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X SLOPE) 6* CRUSHED STONE OR MECHANICAL C:J 0 0 r-1 F-1 ELEV. ELEV.
COMPACTION. (15.221 [2]) 0 F-I El r__l 0 0 0 0 c 21 0-7 Cr
DEPTH OF FLOW SLOPE) SLOPE)
TEE SIZES: 3/4!' TO 1 1/2- DOUBLE WASHED STONE -
INLET DEPTH - LOCATION MAP SCALE 1
OUTLET DEPTH
17
LEACHING -v "ro- ASSESSORS MAP -k��cj PARCEL
FOUNDATION— -7 — SEPTIC TANK D' BOX FACILITY ZONING DISTRICT:
YARD SETBACKS:
10 ,<4- 1,43 Z 3 -7 FRONT =
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SEPTIC DESIGN: (GARBAGE rosPOSER is 00 1. DATUM IS ,
�; I ` ,'"�''...r.•- ~' s DESIGN FLOW: BEDROOMS 2 GPD) GPD 2. MUNICIPAL WATER IS lil- IP4 A
r USE A _3�50 GPD DESIGN FLOW 3. MINIMUM PIPE, PITCH TO BE llEr PER FOOT.
SEPTIC TANK: GPD 4. DESiGN LOADNG FORM ALL rfRFE%-4Ar77l 'r, DO[ IMS41w
5. PIPE JOINTS TO BE MADE WATERTIGHT.
USE A GALLON SEPTIC TANK 6. CONSTRUCTION DETAILS TO BE IN ACCORDANCE WITH MASS.
LEACHING: ENVIRONMENTAL CODE TITLE V.
7. THIS PLAN IS FOR PROPOSED WORK ONLY AND NOT TO BE
ce, + --A.0 1:�,) a- (�-T+
0�J SIDES: - USED FOR LOT LINE STAKING.
, - � ,__Lot BOTTOM: 8, PIPE FOR SEPTIC SYSTEM TO SCH. 40-4" PVC.
9. COMPONENTS NOT TO BE BACKFILLED OR CONCEALED WITHOUT
TOTAL: S.F. GPD
-- _ �"" ~\ INSPECTION BY BOARD OF HEALTH AND PERMISSION OBTAINED
'Ile FROM BOARD OF HEALTH.
10. CONTRACTOR SHALL BE RESPONSIBLE FOR VERIFYING THE
AN -4 f4 LOCATION OF ALL UNDERGROUND & OVERHEAD UTILITIES PRIOR
TO COMMENCEMENT OF WORK.
- LEGEND
SITE AND SEWAGE PLAN
�, , 4c100.0 PROPOSED SPOT ELEVATION OF
4'
100X0 EXISTING SPOT ELEVATION IN THE TOWN OF:
Fl 001 PROPOSED CONTOUR
J
100 EXISTING CONTOUR PREPARED FOR:
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0
BOARD OF HEALTH
MA SCALE: DATE: 1 t7
ev ll�l A.* +sAtl APPROVED DATE
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fax 506 362-MM
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down cape engineering, inc. AME AM*
S CIVIL ENGINEERS OJALA
LAND SURVEYORS
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JOB# 939 main st. Yarmouth, ma 02675 AMR H. WAL47 M., P.L.S. DA rR
SEPTIC PROFILE TEST HOLE LOGS
T.O.F. AT EL.
ACCESS COVER TU WITHIN tr OF FIN. GRADE (NOT TO Scmx)
ACCESS COVER (WATERTIGHT) TO ENGINEER:
WITHIN 6" OF FIN. GRADE
MINIMUM .75' OF COVER OVER PRECAST 6; t
2% SLOPE REQUIRED OVER SYSTEM WITNESS:
RUN PIPE LEVEL oto'b'r L-A
r DOUBLE WASHED PFASTONE
DATE:
FOR FIRST 2' v e
I-'
PROPOSED 3 MAX.) PERC. RATE
10 .9;
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GALLON SEPTIC CLASS SOILS P#
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TANK (H- 10 GAS
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-7 r [71 r 0 Z 4? 1411'Z'
% SLOPE) ED STONE OR MECHANICAL 0 = ED 0 0 O O Cl 0ELEV. ELEV.
COMPACTION. (15.221 (21) 2# 17-1 F-I = F-1 ED F-1 0 0 w
Cr
DEPTH OF FLOW X SLOPE) SLOPE) Cr
TEE SIZES: 3/4!' TO 1 112- DOUBLE WASHED STONE 0
INLET DEPTH LOCATION MAP SCALE 1
OUTLET DEPTH A ------
47-
L
LEACHING A- i ArA
FOUNDATION SEPTIC TANK D' BOX -4 FAC I Lj`TY ASSESSORS MAP 1- PARCEL
e) ZONING DISTRICT: '?�
YARD SETBACKS:
1?7 0 FRONT =
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61 REAR lo '
61 C;l B PLAN REF. - I
FLOOD ZONE:
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V,� / SEPTIC DESIGN: (GARBAGE DISPOSER IS OOT A,,t, g
_,,V� j,-) 1 . DATUM IS -� "'i - ,
'- ( DESIGN FLOW: BEDROOMS GPD) _2? GPD 2. MUNICIPAL WATER IS
USE A ,%),2 GPD DESIGN FLOW 3. MINIMUM PIPE PITCH TO BE 1/8 PER FOOT.
SIP'lIC TANK. GPD 4 r)FIR!r.N I OAOINP FOR ALL PRECAST UNIT',; TO RE AASHO H-,__�
I ` 5. PIPE JOINTS TO BE MADE WATERTIGHT.
USE A GALLON SEPTIC TANK 6. CONSTRUCTION DETAILS TO BE IN ACCORDANCE WITH MASS.
LEACHING: ENVIRONMENTAL CODE TITLE V.
i + 7,
7. THIS PLAN IS FOR PROPOSED WORK ONLY AND NOT TO BE
* �,, �� PSI �\ � SIDES: USED FOR LOT LINE STAKING.
BOTTOM: 23-T8. PIPE FOR SEPTIC SYSTEM TO SCH. 40-4" PVC,
p VA 9. COMPONENTS NOT TO BE BACKFILLED OR CONCEALED WITHOUT
TOTAL: S.F. GPD INSPECTION BY BOARD OF HEALTH AND PERMISSION OBTAINED
` '`— ` �- F' 3v.o , 2- FROM BOARD OF HEALTH.
10. CONTRACTOR SHALL BE RESPONSIBLE FOR VERIFYING THE
Aw- LOCATION OF ALL UNDERGROUND & OVERHEAD UTILITIES PRIOR
\�' P TO COMMENCEMENT OF WORK.
LEGEND S17F AND SEWAGE PLAN
PROPOSED SPOT ELEVATION OF
100X0 EXISTING SPOT ELEVATION IN THE TOWN OF:
100. PROPOSED CONTOUR P7
k ` tj Ali
100 — EXISTING CONTOUR PREPARED FOR:
0
WMENE-710 I
BOARD OF HIALTH
I MA SCALE: DATE:
---b—
ew vl 4 -A,:l APPROVED
ATE
off 909-M2--4841
fax 5M 362-OW
down cape engineering, ine.
N. H.
C-.ALA
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CIVIL ENGINEERS
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LAND SURVEYORS
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939 main st, yarmouth, ma 02675
JOB A RNE H. ojALA',v'-Pl-T-., P.L.S. DATE
SYSTEM PROFILE ALL SYSTEM I'HCOMPONENTS MAGNETIC SHALL BE NOTESMARKE em. Sch.
COMPARABLE MEANS FOR FUTURE LOCATION. ns
(NOT TO WALE) 1. DATUM IS NAVD 88 v rte�e
ACCESS COVERS TO WITHIN 6" OF FIN. GRADE CONCRETE COVERS TO WITHIN 3" GRADE
2" pEASTNE OR GEOTEXTiLE Mitchells
\ TOP FOUND. EL. 31.4' FILTER FABRIC OVER STONE 2. MUNICIPAL WATER IS EXISTING y
30.0' MINIMUM .75' OF COVER OVER PRECAST 2X SLOPE REQUIRED OVER SYSTEM 28.0 3. MINIMUM PIPE PITCH TO BE 1/8" PER FOOT. o
PRECAST H-10 WATERTEST„D'BOX FOR LEVELNESS BLOCKS
RISERS (TYP.) MIN. 2 WALL THICKNESS PRECASTORISERS 4. DESIGN LOADING FOR ALL PROPOSED PRECAST m Main
;. 2 .87' 4"mSCH40 PVC _ MORTAR ALL INVERT IN 24.17' UNITS TO BE AASHO H-LQ West Moin St. e St.
_ PIPES LEVEL 1ST 2' COMPONENTS
f- 4 (�') SIDES 25.0' 5. PIPE JOINTS TO BE MADE WATERTIGHT. cue
ENDS
EXISTING P�
10" 14" ;' °°°°°°° 6. CONSTRUCTION DETAILS TO BE IN ACCORDANCE �� Locus
TEE SEPTIC TANK** TEE 25.54±'* o 0 o S ,6" MIN. SUMP °o°o°g° �® ®�� ® ®® °°o°o°°° WITH 310 CMR 15.000 (TITLE 5.) / F�pS
0 0 0 • • • °°°°°°° ® ® °° °
,9o•c'•�o?,g 12" MIN. TNT. DIM. °o°o°o°o '°oo°°°°°° 7. THIS PLAN IS FOR PROPOSED WORK ONLY AND
°°O°°°°° ®® ®® ®®® ® ® ® ®® °o°o°°°o �o
GAS BAFFLE ° ° °g° go_o�°o° 22.17'
24.73 4.56 .20.
° ° NOT TO BE USED FOR LOT LINE STAKING OR ANY d
OTHER PURPOSE.
H-10 500 GAL. LEACHING CHAMBERS BY ACME PRECAST OR EQUAL. Smith 3/4 1-1/2" DOUBLE WASHED STONE 4' MIN. 2 UNITS REQUIRED "
O 8. PIPE FOR SEPTIC SYSTEM TO SCH. 40-4 PVC. ti1o�
ALL AROUND PRECAST STRUCTURES f,
6" CRUSHED STONE OR MECHANICAL OVERALL DIMENSIONS TO OUTSIDE OF STONE: 25.00, X 12.83' 8
COMPACTION. (15.221 [2]) 9. COMPONENTS NOT TO BE BACKFIL.LED OR
CONCEALED WITHOUT INSPECTION BY BOARD OF
(2 9 X SLOPE) (3.9 X SLOPE) HEALTH AND PERMISSION OBTAINED FROM BOARD
OF HEALTH.
FOUNDATION EXIST. SEPTIC TANK 28' D' BOX 12' LEACHING _ 10. CONTRACTOR SHALL BE RESPONSIBLE FOR
FACILITY CALLING DIGSAFE (1-888-344-7233) AND
17.0' BOTTOM TH-1 VERIFYING THE LOCATION OF ALL UNDERGROUND & LOCUS MAP
NO GROUNDWATER FOUND OVERHEAD UTILITIES PRIOR TO COMMENCEMENT OF
**INSTALLER SHALL CONFIRM MINIMUM WORK. SCALE 1"=2000'f
*THE INSTALLER SHALL VERIFY THE SEPTIC TANK SIZE AT 1500 GALLONS
LOCATIONS OF ALL UTILITIES AND ALL AND ITS SUITABILITY FOR RE-USE. 11. ANY UNSUITABLE MATERIAL ENCOUNTERED SHALL ASSESSORS MAP 289 PARCEL 014
BE REMOVED BENEATH AND 5' AROUND THE
BUILDING SEWER OUTLETS AND
REPLACE WITH 1500 GALLON SEPTIC PROPOSED LEACHING FACILITY. LOCUS IS WITHIN FEMA FLOOD ZONE X
ELEVATIONS PRIOR TO INSTALLING ANY TANK APPROPRIATE TO SITE
PORTION OF SEPTIC SYSTEM CONDITIONS IF NOT SUITABLE 12. EXISTING LEACHING FACILITY SHALL BE PUMPED (AREA OF MINIMAL FLOOD HAZARD) AS
AND REMOVED. SHOWN ON COMMUNITY PANEL #25001 CO568J
LE
C C
C D DATED 7/16/2014
99- EXISTING CONTOUR �� SYSTEM DESIGN:
o _
X 99-1 Exlsr. SPOT ELEV. GARBAGE DISPOSER IS NOT ALLOWED
O
-[991- PROPOSED CONTOUR
�20 EXISTING 3 BEDROOM DWELLING
198.4] PROPOSED SPOT EL. F 6 122� 3
TH1 2 DESIGN FLOW: 3 BEDROOMS 0 110 GPD 330 GPD
TEST HOLE O USE A 330 GPD DESIGN FLOW
SLOPE OF GROUND _ X X �O 31 GRAVEL O
IVE s SEPTIC TANK: 330 GPD (2) = 660
UTILITY POLE Q
ED RE USE EXISTING 1500 GAL. SEPTIC TANK
FIRE HYDRANT tig PATIO
NOTE: NOT ALL SYMBOLS MAY APPEAR IN DRAWING \ LEACHING: _
\ 27 SIDES: 2 (25 + 12.83) 2 (.74) = 112 GPD
BOTTOM 25 x 12.83 (.74) = 237 GPD
DECK y
'� TOTAL: 472 S.F. 349 GPD
TEST HOLE LOGS ti01 .
\ _
v W USE (2) 500 GAL. LEACHING CHAMBERS (ACME OR EQUAL)
CRAIG J. FERRARI, SE 13871
ENGINEER: # o a
WITH 4' STONE ALL AROUND
DAVE STANTON a Z '�
WITNESS: c? �,
DATE: 5/13/2021 N �J °�
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_ < 2 MIN INCH HODS � 1 `__i ►i�_ i rl � EC
-
PERC. RATE - I j t
1 ► i -
CLASS I. SOILS P# 21 -121 \o % II i ,' °
ELEV. ELEV. a f2 i t� i 'L5 ° o ��
0't 28.0 0" 28.3 1 _ -t c V APPROVED DATE BOARD OF HEALTH MA
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FILL FILL HYo me BOL \ T TH2 30 13,146f S.F. /��h� TITLE 5 SITE PLAN
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k DATE: MAY 19, 2021
�No.46502 No. +09t30 �" OjALA 1 cy o O Jr'':LA "
MS IVIS a A F�; cr,IL ,
2.5Y 7/4 2.5Y 7/4 r�Fc'S T EFt�\��°� oF s�°� No.46502 i!o.ac1080„ off 508-362-4541
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NO GROUNDWATER ENCOUNTERED Scale: 1 = 20 �l�°l'2\ , land surveyors
EA W s3s Main Street ( Rte 6A)
SCE #2 ,_ '3 , 0 10 20 30 40 50 FEET DATE DANIEL A. OJALA, P.E., P.L.S. YARMOUTHPORT MA 131 02675
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