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Home My WebLink About0054 HEMEON ROAD - Health 54 Hemeon Road Hyannis A - 268' 091; i i II��4 i e i ��f Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System orm - Not for Voluntary Assessmeentt e rMC O v� ,: Property Address Ow ner Ow ner's Name /W A ) l / / information is P61f (Joc required for every page. City/Town Slate Zip Code Dale of Ins ct'ro 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. Mportant:When A. General Information filling out forms i on the computer, I use only the tab 1. Inspector: l key to move your / cursor-do not use the return me of inspector key. QCompany Name eo Company Address ✓i-7 Q.)- & n City IT State Zip Code ow n �� C� D f`J / rD Telephone Nu // 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 R 15.000). The system: Passes ❑ Conditionally Passes ❑ Fails ❑i eds F rther Evaluation by the Local Approving Authority 1 07,—� V—/�4A—( // 3 / Inspector's gnature Date The Syst inspector 0a11 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 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. t5ns•3113 TiOe50iricia1nspecbonFam face Sewage Disposal System age 1017 'Commonwealth of Massachusetts Title 5 Official Inspection Form s Subsurface Sewage Disposal SystemA Form - Not for Voluntary Assessments tmeo,-I lQd Property Address G CO✓J00 Ow ner Ow ner's Name information is 0j 6 required for every ✓tip f page. City/Town State Zip Code Date of Ins ctio B. Certification (cont.) Inspection Summary: Check A,B,C,D or E / a/ways complete all of Section D A) ;Syste 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. i The septic tank is metal and over 20 years old* or the septic tank (whether metal or not) is structurally unsound, exhibits subs)antial 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 Healt h. *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): i t5rs-3113 Title5Officiai Inspection Fam Subsuiace Sewage Disposal System-Page 2of 17 f Commonwealth of Massachusetts AnifflNomm Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 5 Y /ye 014?owl eec Property Address 114 / G CO V?Qlit Ow ner An+ner's Name information Alp-b / ,z infformation is 9(-,)A��f f / i required for every page. Otyfrown State Zip Code Date of Insp cti B. Certification (cost.) ❑ 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 ly,s,3/13 Title 5Offidal Inspection F am Subsafece Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form lug Subsurface Sewage Disposal Syst m Form - Not for Voluntary Assessments � Prop"Address Al 6"A V?D Lt Ouv ner 0W ner's Name information is required for every air, — page. City/Town State Zip Code Date of lnsp6ctiGK B. Certifica Iron (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 Gy-❑ _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 t9rt5•3/13 Title 5 Official Inspection F orm Subsurface Sewage Disposal System•Pape 4 of V Commonwealth of Massachusetts Title 5 official Inspection Form 5 Subsurface Sewage Disposal System Form -Not for Voluntary Ass e ssments J eWI80✓1 Property Address /,//c Cvr ner CW ner's Name information is / -A t/1l/f S Dd p � 2 required for every — page. City/Town State Zip Code Date of Ins ectio B. Certification (cost.) Yes ElNo Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ L� Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ E!r� Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ (E" Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ Lff Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ lam" 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- 0,000g pd. ❑ ;,_�The system &IL,g. I have determined that one or more of the above failure cntena exist as described in 310 CM R 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. t5ns•3113 Title 50 6A Iris pec bon Form Subsurlace SewagaOlsposal System-Pape 5of 17 I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Fo m - Not for Voluntary Assessments � wleo� �ed Property Address G n✓I D L4 ON ner Cw ner's Name information is required for every 9d` 7/ page. City f row n State Zip Code Date of In echo C. Checklist Check if the following have been done. You must indicate "yes"or"no" as to each of the following: Yes ❑ Pumping information o anon was provided by the owner, occupant, or Board of Health ❑ �1111 re 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? a ❑ 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): Number of bedrooms (actual): 3..�0 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x #of bedrooms): t5na•Y13 Title 5 Official U5 pec tion F orm Subsu l ace Sewage Disposal System•Page 6 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form a Subsurface Sewage Disposal System Foorrm - Not for Voluntary Assessments r- S�( //�lMQ0t�-7 Property Address AL 00 v1 p (/1 ON ner Ov ner's Name information is /y/�e required for every Ct �� fJ Al 00)�' � / page. CityrTown State Zip Code Date of In, ecti n D. System nformation Description: r (s 4ri 644-,o v-7 'go� a Soo G-.:; /l C4u V" r Number of current residents: Does residence have a garbage grinder? ❑ Yes No Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes CPo information in this report.) Laundry system inspected? ❑ Yes 0''Wo— Seasonal use? ❑ Yes 9-1 o_ Water meter readings, if available (last 2 years usage (gpd)): Detail: Sump pump? ❑ Yet No Last date of occupancy: e Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CM R 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: *rts•W 3 Title 5 Of fici al Ins pection Form Subsirf ace Sewage Disposal System-Page 7 of 17 r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal SystemForm -Not for Voluntary Assessments °? S y Ae PM e 0"7 "edlI Property Address Ow ner Av ner's Name n information a f L required for every page. Otyfrown State Zip Code Date of In . ' n D. System Triformation (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 D--_No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of Sy 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): t9rz•N1 3 Title 5 Of ficial Ire pec bon Form Subsurface Sewage Disposal System•Page B of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form s Subsurface Sewage Disposal System Form - Not for Voluntary Assessments Lv`'Ieo�► � Property Address /17c"270 0ot� Ow ner Cw ner's Name information Is required for every page. Cityffown State Zip Code Date of Inspection' D. System Information (cont.) Approximate age of all components, date installed (if known) and source of info nation: �t5 r✓� otc..- � ` Were sewage odors detected when amving at the site? ❑ Yes No Building Sewer(locate on site plan): Depth below grade: feet Material of constructi;�40 : ❑ cast iron PVC ❑ other(explain): 19 7 Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, eadence of leakage, etc.): Septic Tank (locate on site plan): Depth below grade: / feet Material 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: 151r3•3113 Title50fflcid Iro pactlmFartm SubsLrloco Sewage Disposal Systom•Page 90117 Commonwealth of Massachusetts Title 5 Official Inspection Form a Subsurface Sewage Disposal System For -Not for Voluntary Assessments a` S `f For Not V1 2J Property Address ,� ✓O✓I O v1 Ow ner Owner's Name information is required for every �!J,0*44 �� Uo�� / /j,by page. City/Town State Zip Code Date of In ect' n D. System Mormation (cont.) Septic Tank(cont,) Distance from top of sludge to bottom of outlet tee or baffle ' U 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 a How were dimensions determined? Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): V-V 14 V)W�14 C/ a4i G P1 i1/o L�G�s 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 19rs-3113 Tide 5 Official Ins pectionForm Subsurface Sewage Disposal System-Page 10 of 17 ' Commonwealth of Massachusetts Title 5 Official Inspection Form I; Subsurface Sewage Disposal SystemFoorm - Not for Voluntary Assessments Aeo 610 1,4 /ZC/ Property Address � G /✓O✓I 0 v► Ow ner Cw ner's Name information is 14cl Z� required for every page. City/Town State Zip Code Date of InAectieft 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 days 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 15lm•3113 Title 5 Official Irks pectlonFam Subsirface S"eDisposal System•Page 11 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form - Not for Voluntary Assessments /716-)OW 0✓1 Y��) Property Address 12 G O�Jpv► Ow ner CW ner's Name information is required for every v page, City/town State Zip Code Date of Insl5ectitfri D. System Information (cont.) Distribution Box (if present must be opened) (locate on site plan): --- Depth of liquid level above outlet invert �y`e 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.): saCJS 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: r5ns-3/13 Title 5Official Inspection Form Subsurface Sewage Disposal System-Page 12 of 17 Commonwealth of Massachusetts I UNION Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments Property Address O v1 0 l� 0w ner Owner's Name information is /—&a required for every page. City/Town State Zip Code Date of Ins ectio ormation (cont.) D. System I // Type: (3) Sao 6J" ll / oo C�ofk4j r_r ❑ leaching pits number: ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/a►temative system Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): C_ . 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 Or*,3113 TMe5Official InsowbonForm Subsulace Sewage Disposal System Page 13 of 17 . Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System orm - Not for Voluntary Assessments r / ��0� �v Property Address G �ov�o � ON ner ON ner's Name n information is �_) G /� // 3 required for every G✓��f f o` A4 page. City/Town State Zip Code Date of Insp tion D. System Thformation (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.): t5ns-3/13 Title 501rldal Ins pecticn f am 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 s s �4 Ileoleo '.1 Property Address C 0000434 Cw ner pn ner's Name /yJ information is required for every14(1Q"l page. Gtyrrown State Zip Code Date of lnspp6tion D. System Information (cont.) 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 FR oNr A Cov-er X ke 33 �o(o✓ „ Rtfor 3 C- 3 /3),-02 f,5, 15rB,Y13 Title 5Offcial Inspection Form Subsurface Sewage Disposal System-Page 15 of W 1 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments L5 A v49 eo'i / cCl Property Address Ow ner CW ner's Name information is required for every ✓�! /� f/a 6 / page. City f row n State Zip Code Date of Ins ectio D. System Information (cont.) 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 :11-�Checked,M bserved site (abutting property/observation hole within 150 feet of SAS) local Board of Health- explain: 11 / ❑ Checked with local excavators, installers - (attach documentation) ❑ Accessed USGS database- explain: You must describe how you established the high ground water elevation: j-4 V-1 S� 77- S v hill- Before filing this Inspection Report, please see Report Completeness Checklist on next page. 15ris•W3 TiU501fidal ImpecUcnForm SubsLeace Sewage Disposal System-Pape 16 d 17 Commonwealth of Massachusetts Title 5 Official Inspection Form V Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 14VV7e0V,1 Property Address f/1 Ott Ow ner Cw ner's Name �1 rO information is 1 required for every � ' // C)d page. City/Town State Zip Code Date of Insp ction E. Report Completeness Checklist Inspection Summary: A, B, C. D, or E checked Inspection Summary D(System Failure Criteria Applicable to All Systems) completed �Sy em Information—Estimated depth to high groundwater LJ Sketch of Sewage Disposal System either drawn on a 15 r h i g po y page o attached n separate file 15ms'3113 Title 5Of ficiel Ire poc Um Form Subsurf ace Sewage Disposal System•Page 17d 17 TOWN OF BA/RNSTABLE LOCATION Xy Aft cra4 ke j` SEWAGE # VILLAGE yAj44A11. r ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO.8p4►J C-1—J& sL w r 79 8 o V Y31 SEPTIC TANK CAPACITY /SO p 6 sr' Q/S7:'ddy� -S®e cuL Ot�wd j,5- LEACHING FACILITY: (type)lQeC-e¢IC (size) /3��( NO. OF BEDROOMS BUILDER OR OWNER -T-ou.A VSF—A PERMITDATE: - C3 , COMPLIANCE DATE: /0 — 3 " Q3 Separation Distance Between the:, Maximum Adjusted Groundwater Table and 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 f: rl 0 -rc 2 116 - No. ram(Uo — /'J" e Fee I� THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: ✓� •,�` Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS 01ppYication for Digpooal *pztem Conotruction Permit Application for a Permit to Construct(\r)Repair( )Upgrade( )Abandon( ) 2/complete System ❑Individual Components Location Address or Lot No. /��j�A�� Owner's Name,Address and Tel.No. Assessor'sMap/Parcel �/_g ( Nv( Installer's Name,Address,and Tel.No. o �,� y y4t Designer's Name,Address d Tel.No. Type of Building: Dwelling No.of Bedrooms Lot Size'Tsq.ft. Garbage Grinder(Wd Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow //O gallons per day. Calculated daily flow 33 o gallons. Plan Date 3 — 28-- a 3 Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S._Mjc4jr C7,) _S-em G t S— Description of Soil 5e,qg e L.a-.al Ze.Tr" &"F L,� Nature of Repairs or Alterations(Answer when applicable) wed T�-rte-_1-_4nF4 cam_ 4EV_2mk."TA �,✓��, /S o 4-Y a`-��A 49,�-f`r' 4U�a��Gs- 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 this Board f Healt Signed G Date Application Approved by S Date Application Disapproved for the ollowing reasons Permit No. Date Issued No. 00 _ /✓— 4V4_ "ice . Fee 1 , r THE COMMONWEALTH OF MASSAGRCJSE'TTS Entered in computer`Yes �� . PUBLIC HEALTH DIVISION -TOWN OF BARNSTAB'LES MASSACHUSETTS ZippYication for Migaar *pgtem Construction Permit Application for a Permit to Construct(/)Repair( )Upgrade( )Abandon( ) M Complete System E)Individual Components Location Address or Lot No. He/(�/�/� /; Owner's Name,Address and Tel.No. Assessor's Map/Parcel / - > 1 Installer's Name,Address,and Tel.No. f, G I/ Designer's Name,Address d Tel.No. a QRiA� C , IsSL� ,IG �bc ��8 y 4< W LGE4 44, $0C1. R�,_oo,e 2�1 6 s �f/�4 uit9' � �. . v c- Type of Building: Dwelling No.of Bedrooms ✓ Lot Size 3/ 943sq.ft. Garbage Grinder((ram) Other Type of Building No.of Persons Showers( ) Cafeteria Other Fixtures Design Flow //0 gallons per day. Calculated daily flow 330 gallons. Plan Date 3 - Z j!- tt3 Number of sheets Revision Date Title Size of Septic Tank Ij-00 e.s T"' Type of S.A.S. PAar,+sr Cz Description of Soil 5as a L.� Nature of Repairs or Alterations(Answer when applicable) n o .g -:��q, Z�- /S� G s r A 15 r 60 X 2 - ArC10 9.1 L 4 0e=C-4 57- 11 A c/k JA,l!_5- i 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 this Board of Healt . t^ Signed ) C. a Date 4- IF- 03. Application Approved by S Date o-? Application Disapproved for the lowing reasons �--� �a Permit No. a UO.3 -ISI) Date Issued 1 ———————— ————— ———— ———— THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS (Certificate of (Compliance THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed( x )Repaired ( , )Upgraded'( ) Abandoned( )by �. C/. 1�;'55( , r_ >' at has been constructed in accordance i with the provisions of Title 5 and the for Disposal System Construction Permit No. /S a dated Installer .C.. k Designer lr LL E _ . c i 4E5 The issuance of this permit shall not be construed as a guarantee that the syst wil nction a_ de igne'd/) Date D b Inspector —�T ——————————————————————————————————————— No. 2U0e�- 1.� Fee w THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS li!6pozal *pgtem (Construction Permit Permission is hereby granted to Construct(X )Repair( )Upgrade( )Abandon( ) 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 erm4. Date:- 1II9 t) Approved by �M �- `~ TOWN OF BARNSTABLE LOCATION SEW4GE #. I VILLAGE At L�R!e,. ..�,t�s,@ ASSESSOR'S MAP & LOT 9-165? ��rnr—�.�— f INSTALLER'S NAME&PHONE NO. A SEPTIC TANK CAPACITY MOO QZ LEACHING FACILITY: (type) (size)NO.OF BEDROOMS - BUILDER OR OWNER PERMITDATE: 9 c3 COMPLIANCE DATE: � I Separation Distance Between the:_ Feet Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Private Water Supply Well and Leaching Facility (If any wells exist Feet on site or within 200 feet of leaching facility) Edge of Wetland and Leaching Facility(If any wetlands exist Feet within 300 feet of leaching facility) Furnished by �J �� ' � 1%. ccvv�� Ca � 4, I i 34'-0" - i f BI.Lco f f TYPE I I IL j HEAD - --� --� L--- ------- -!- --- ------ ----- - f I Y 1 I f II:f7 ' I I I �J F_ -1 I , I —2-2x8 GIRDER i - - 4Gx ..T ALVM POST ETAL POST ANCHOR 1�II II J. I J L_ — I \(2" "SONO TUBE" PLEB TYP, 1'-B M POCK — I BEAM POCKE�I n I .Ih II UP3-2X12 GIRDER I -' .:. .-.6 �•��1 3 1/2" DIA. STEEL COLUMN { I m \ (;\� m 1 I I 30"x30"xl2" CONCRETE PAD "Pl'P. I ---------- -------- —� o,..r Ir• _ 2'�_ * I I _ _ I!�I f. f I o BASEMENT I i RIDGE VENT 1 !(t 3 1/2" CONCRETE SLAB I AS2xI RIDGE BOARD-------S u i I � ; ASPHALT SHINGLES -I 5/5" CDX:5"EATHLNG los - - ——— t f o L_J. L_J J[F -- R30 FIBERGLASS INSUL- 2x8 s 16' 1 <r E In MAINTAIN AIR USPACE Ix3 STRAPPING 112" GYP. BOARD D ------ - ---------- ----------------- t, 2x6:RAFTERS 16"O.C.— In @ COVERED PORCH �. + FINISH FLOOR S— 34'-0" — icy - f-3/4" PLY 541BFLOOR ®. — ' s O .� CONT.. VENTING DRIP EDGE � 2xi0' 16OC . Ix5 FASCIA FOUNDATION PLAN Ix5 SECOND MEMBER � a � � (j ALUMINUM GUTTERS AND DOWN SPOUTS ,� 5CALE: 114" =,V-D" FRIIZE BOARD AND MOULDINGS N �p c �I FIN1544 STAIRS 13R O Q o �Fc 2xA EXT. STUDS @ 16" O.G.-- — 3-2x12 CARRIERS RI3 F.G. INSUL. W- 1/2"PLYWOOD SHEATHING: TYVEK WRAP - —FINISH FLOOR W_C. SHINGLES 5" T.W. 3/4" PLY SUBFLOOR 'RI9 F:G. INSUL.. _ . .. ' P.T. 2X6 SILL + SILL SEAL 2xI0's @ 16"O-C. ANCHOR AT 8' MAX 3-2x12 GIRT --3 112"0 STEEL COLUMN !U tll Ilj IIhIf Illl •� 13R - hIlU111LIF Ih-{I LIT. I Ilk 3-2xi2 CARRIERS a- n..ill: t F' 8"x7'-9" GONG. MALLS------ 'D 4'-O 14"-O" DAMP PROOF BELOW GRADE -- t2' WET _ - LEA , 3 i!2" CONCRETE SLAB A4 GROSS SECTION JOB: 0402 SCALE: 114" = 1'-0" --_ - 3p_0" 30" DRAWN BY: .KW DATE: 1/15%02 la IA Ip I I O a i I I 'I Y N I Im h yI'lilt — m vl i I� frl i cn I � IS o IS i -g� 0 m 1 N I IT Iw j 71 pia, ' I r i 3 vu 19 s � I I I r a I — i II -------� 4_6nh � 1 Al-,,. N 101_3,� , _ Z fP i 01 I N — N A � —Ij 9 rn I _ m< N Ir m I LAN p -- m C — -- C7 D v ------ ---= O --u } -- I°' I N I <\ V I _ (3) q 1/4" LVL FLUSH .ABC4 ?o— im ° \ •lei �, 2'—IOn �JJ ,L m � i 71 — _ !h L ° I ----- -- 20'-0�— - C T --'----- -3� I `n b I I lY h l ! � I -a-4- D O JOB L.OGATION: —I D O7 z "THE GARDEN COTTAGE'' I i PR0ff I LL- NOT TO SCALE TEST HOLE Loa 3/S EL= LAYER OF PEA5TONE ��O _ FIRST PIPE LENGTH OVER 3/4"—1 1/2 DOUBLE" DATE:MARCH 27,2003 TOP FOUNDATION COVERS TO WITHIN TO m SET LEVEL WASHED STONE TEST 13Y: M.O'L000-lHLN,GSE EL= 43.0t /v" OF FINISHED GRADE. FOR MIN. 2' WI>-NESS: S.WHffE,$ARN.HEALTH DEPT. i PERG RATE:<2 MIN./IN. FINISH GRADE `? EL= 42.Ot 420 d' 41 d' MOW ✓/�� re,EM RD. S6fl 40 q" PVC, X„ PVC TOP @ EL. 39.2 A=d OAMY sArn A=LONNY sAw SGH 40 41.E Vf"/.2 ?" 41A WY"/? 7 LOCUS 6 38.50 °ao 50 e >< POTTGM @ EL. 3G.50 PW=LO*4(Y 6" PW-LO*dy sAw $ INSTALLOAS13AFFLE 39 MR5/S $WR5/ v- 3�75 INOUfLETTEE 7 DIST. Pox w Cg&WLLF—W-A fll ROAD 00 : CHFIM—MIT.�Atr 61.f�E-QED.SAW SEPARATION . 42" 38. 42" LOCATION MAP -1-ON SEPTIC, TANK 02-NlW.-00AR6E 54,D G2+h£D.-LDARSE EMD STONE t5ASE BOTTOM OF TEST HOLE @ EL. 31.5 Zsrr/a zsrr/$ 85 od 31.5 [W' 3j5 1�b" +401v NO WATER ENG NTERED OU ' LOTS 'M6, 'UR & 286 --� DESIGN PATA GENERAL NOTD5 \ DAILY FLOW: (3)BEDROOMS x 110 GPD=330 GPD CONTRACTOR TO 15E RESPON5133LE FOR THE L06ATON OF ALL UTILITIES, SEPT IC,TANK:330 OPP x200%=660 GPD ABOVE AND UNDERGROUND,PR bR TO ANY EXGAVAT ON OR CONSTRUCT UN. USE-1500 GALLON PRECAST SEPT 6 TANK LEAGHING FA(ILfTY. 2. SEPT CSYSTEMTO15E INSTALLED INCOMPLIANCE WIrH310GMR 15,00:TII-LE V 2 USE: (2) 500 67AL. PRECAST DRYWELLS LINED w/A OF POJftE WASHED STONE ALL AROUND 3. THIS PLAN b NOT TO 15E USED FOR PROPERTY LINE DETERMINATION GAPAG►TY: SIDEWALL: 7G x 2 x 0.74 112.5 GPD 4. ALL DISTURPED AREAS TO�E LOAMED AND SEEDED BOTTOM: 13 x: 25 x 034 = 240.5 GPD 353.0 C�PD 5. GONTRAGT'OR TO PROVIDE 24 HOUR NOT 6E FOR ANY REQU I RED I NSPEGTIONS TOTAL: rnrn 4-42.6 ? wL to I I t of MA8, _ 21Lrt_ 9C+ NIEL E. s EVEN yN rt�a' BRA A, I' t1. I T.H. 2 U B � �;� CIVIL 3 7Q �, i, No. 32686C � �� I ,,� �. TE SEV\/AaE PLAN pcPgN5I0N I �FESS10� F i S T SUfN� SSioNgL E� LOCATION: 54 HEMEON R.D., HYANN(SPORT, MA -`�- � PREPARED FOR: TOM POWERS SCALE: DRAWN 15Y: TMW +�t10 Q J01 NWMR:` DATE: SHEET: M00.9A' 03-025 MAR611 28, W0 , \—TAM = EL.44.0 WELLER & ASS06 I AT NAIL SET IN POLE I(O45 FALMOUTH RIP — SUITE 46 CENTERVILLE, MA 02p32 TEL- (508) 775-07 5 � FAX: (508) 775-0754 PROFESSIONAL ENGINEERS & LAND SURVEYORS