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Home My WebLink About0058 PRAM ROAD - Health 58 Pram. Road Hyannis F/R �- L = 268 049 / 1 4 N X Commonwealth of Massachusetts flog -a6 L W Title 5 Official Inspection Form c�Q Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 58 Pram Road M Property Address CIO Robert Berke , : Owner Owner's Name information is Hyannis / MA 02601 October 4, 2016 required for every Y V ` s page. Citylrown State Zip Code Date of.lnspection CA O} Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When filling out forms A. General Information , on the computer, use only the tab 1. Inspector: key to move your cursor-do not David B. Mason use the return Name of Inspector key. David B. Mason 11b Company Name 4 Glacier Path Company Address East Sandwich MA 02537 City/Town State Zip Code 508-367-1617 S1287 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority October 7, 2016 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 futdr under the same or different conditions of use. t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 17 �0�# Vs Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °M 58 Pram Road Property Address Robert Berke Owner Owner's Name information is required for every Hyannis MA 02601 October 4, 2016 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: The observations noted only represent the condition of the system observed on October 4, 2016 at noon and does not represent the future operation of the system. B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no" or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old* or the septic tank (whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ;M 58 Pram Road Property Address Robert Berke Owner Owner's Name information is required for every Hyannis MA 02601 October 4,.2016 page. Citylrown 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 58 Pram Road Property Address Robert Berke Owner Owner's Name information is required for every Hyannis MA 02601 October 4, 2016 page. Cityrrown 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 ❑ ® 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 '/2 day flow t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Fora Subsurface Sewage Disposal System Form -Not for Voluntary Assessments wM 58 Pram Road Property Address Robert Berke Owner Owner's Name information is required for every Hyannis MA 02601 October 4, 2016 _ page. Cityrrown 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 16,000 gpd. For large systems, you must indicate either"yes" or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA) or a mapped Zone II of a public water supply well If you have answered "yes" to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts - Title 5 Official Inspection Form _ Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �M 58 Pram Road Property Address Robert Berke Owner Owner's Name information is Hyannis MA 02601 October 4, 2016 required for every page. City(rown 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•3/13 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 GSM 58 Pram Road Property Address Robert Berke Owner Owner's Name information is required for every Hyannis MA 02601 October 4, 2016 _ page. City/Town State Zip Code Date of Inspection. D. System Information Description: Number of current residents: 2 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 Yes 9 ( Y 9 (gpd))� Detail: 2014; 76,500 gallons and 2015; 65,250 gallons Sump pump? ❑ Yes ® No Last date of occupancy: UnknownDate 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: 15ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ° 58 Pram Road M Property Address Robert Berke Owner Owner's Name information is required for every Hyannis MA 02601 October 4, 2016 page. Citylrown 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: Board of Health 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, lif 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): l5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 I Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 'w 58 Pram Road M Property Address Robert Berke Owner Owner's Name information is required for every Hyannis MA 02601 October 4, 2016 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: Compliance issued September 9, 2002 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 3 feet Material of construction: ❑ cast iron ® 40 PVC ❑ other(explain): � Distance from private water supply well or suction line: 10+feet Comments (on condition of joints, venting, evidence of leakage, etc.): Septic Tank(locate on site plan): Depth below grade: 20 inches 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: 1500 Typical 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 58 Pram Road Property Address Robert Berke Owner Owner's Name information is required for every Hyannis MA 02601 October 4, 2016 page. Cityrrown 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 36" Scum thickness 5 Distance from top of scum to top of outlet tee or baffle 3" Distance from bottom of scum to bottom of outlet tee or baffle 16" How were dimensions determined? Scour Stick Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Effluent level with outlet invert. Tank is 20 inches below grade. Riser is 6 inches below grade. Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts f Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ° 58 Pram Road Property Address Robert Berke Owner Owner's Name information is Hyannis MA 02601 October 4, 2016 required for every y _ page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank (tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): Attach copy of current pumping contract(requited). Is copy a ttached Ye s ❑ No � t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts W Title 5 official Inspection Fora Subsurface Sewage Disposal System Form- Not for Voluntary Assessments °M 58 Pram Road Property Address Robert Berke Owner Owner's Name information is required for every Hyannis MA 02601 October 4, 2016 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert Level with 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.): Dbox is 34 inches below grade. Riser is 22 inches below grade. No evidence of solids carryover. 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: Leaching is a trench so used camera to inspect t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 58 Pram Road Property Address Robert Berke Owner Owner's Name information is required for every Hyannis MA 02601 October 4, 2016 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ❑ leaching chambers number: ❑ leaching galleries number: ® leaching trenches number, length: 1-54' ❑ 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.): Trench is 54' longx4' wide x 2' deep. Used camera to inspect length of pipe. No observed standing effuent. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration — Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 17 Commonwealth of Massachusetts L r Title 5 Official Inspection Fora Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 58 Pram Road Property Address Robert Berke Owner Owner's Name information is required for every Hyannis MA 02601 October 4, 2016 page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy(locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 58 Pram Road Property Address Robert Berke Owner Owner's Name information is required for every Hyannis MA 02601 October 4, 2016 page. City/Town 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 t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 l Commonwealth of Massachusetts W Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ;M 58 Pram Road Property Address Robert Berke Owner Owner's Name information is required for every Hyannis MA 02601 October 4, 2016 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: 18 feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date ® Observed site (abutting property/observation hole within 150 feet of SAS) ® Checked with local Board of Health -explain: Groundwater Contour Map ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database -explain: You must describe how you established the high ground water elevation: Groundwater Contour Map Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 58 Pram Road Property Address Robert Berke Owner Owner's Name information is required for every Hyannis MA 02601 October 4, 2016 page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems) completed ® System Information— Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 Assessing As-Built Cards Page 1 of 2 TOWN OF BARNSTABLE FC t LOCATION �� '�'��/ .mod SEWAGE#i VILLAGE ASSESSOR'S MAP&LOTt � Jr9 INSTALLER'S NAME&'PHONE NO. �`��- G'C'.r3oF�i.� 77 3 oJc 7 SEPTIC TANK CAPACITY LEACHING FACILrrY:(type) 7�tit�C// (size) SAX X 01 NO.OF BEDROOMS BUILDER OR OWNER PERMITDATE: R'— COMPLIANCE DATE: 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) i Feet Furnished by /^• LCr��ta/` AO X3 mil'�vF http://www.townofbamstable.us/Assessing/HMdisplay.asp?mappar=268049&seq=1 10/13/2016 TOWN OF BARNSTABLE FC. t 110000, 'ffl LOCAP',ON r� �� d SEWAGE # VILLAGE �'/`��°""�`r ASSESSOR'S MAP & LOT-�P—d *9 INSTALLER'S NAME& PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY: (type) i 'C/vC (size) NO. OF BEDROOMS BUILDER OR OWNER PERMITDATE: �`— � 00C COMPLIANCE DATE: 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 o, CA, � b 4 i a y o . N No. (/f ` Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS Zipprication for Mi!5pooar Ap5tem Cougtructiou Permit Application for a Permit to Construct( Repair( )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. Ownerj Name,Address and Tel.No. /Tim ;� 00 'Assessor's Map/Parcel Ua 7 O �A N Installer'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 c''"J: No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow -.?Jf.7 gallons per day. Calculated daily flow gallons. Plan Date Ap—,Z Number of sheets / Revision Date Title Size of Septic Tank ��`Qo�9.�1.. Type of S.A.S. Description of Soil zr-s:�X 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 issue by this Board of Health. Signed A Date _, 4 Application Approved by if Date � a Application Disapproved for the ollowing reasons Permit No. a o d a--397 Date Issued t >" ---------------------- ------ F r. li r f i er. Gf No. �_. Fee .� �< �,. � ti�bw, , L THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION.-TOWN OF BARNSTABLES MASSACHUSETTS Rpprication for Miopogar *pgtem Congtruction Permit Application for a Permit to Construct(�Repair( )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. ��"/(In R O 19� Owner�c Name,Address and Tel.No. Assessor's Map/Parcel //'' !f Installer'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 - 3.7 gallons per day. Calculated daily flow 3 gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank -�J'•�o�9. -6 Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) . Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issue by this Board of Health. Signed Date _9 i Application Approved by - Date � o Application Disapproved for the ollowing reasons Permit No. a G on — 3�?-7 Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY that the On Sewage Disposal System Constructed( Repaired( )Upgraded( ) Abandoned( )by T4 L eeveGF at -J"—P O 0Y. has been construc ed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. P W)- 3 9 7 dated Vqp Installer fro,'.ti G c��d'ol-'�/�C' Designer The issuance of this rmit shall not be construed as a guarantee that the sy t- will f14%)- ction:Les' ned Date to �� Inspector No 7 ` Fee 2Uo2'39-7 THE MMONWEAL"TH OF MASSACHUSETTS PUBLIC HEALTH DI ON - BARNSTABLES MASSACHUSETTS 1wiqo6al *pgtern Congtruction Permit Permission is hereby granted to Construct 6 Repair( )Upgrade( )Abandon( ) System located at S"a' ^-r" ft 4%O. ,f✓`if*.•r/P , 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:Consftruc .on must be completed within three years of the date of this ermit. Date: / 7G 2- Approved by S � v TOWN OF BARNSTABLE FC r LOCATION �d SEWAGE # VILLAGE /�i��`""'�`r ASSESfOR'S MAP & LOT-7 S �9 INSTALLER'S NAME&PHONE NO. ��" �!.�pF lid' ,�s ojG' SEPTIC TANK CAPACITY �Tf":p e'¢'e , I LEACHING FACILITY: (type) T�'C�C (size) NO. OF BEDROOMS BUILDER OR OWNER PERMIT DATE: � 7 a� COMPLIANCE DATE: —o,"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 Furnis i.�. 40r,6y ev/v . Z- ��9 C C06 o 0 ,ee II II II n II II �i�al • D p 4'-O 4'-O 5'-4II B'-O 8'-O Q C ° a 10"CONCRETE FILLED O 10"CONCRETE FILLED -------- SON TU5E FOOTING r r SONOTUBE FOOTING 4'-0"BELOW GRADE 4'-0"BELOW GRADE --- ------------- s 1n"x e In"Parralam Beam EXISTING BASEMENT 42'-8" C -a 11 _--2x8 FLOOR JOISTS o 16 O 1 D'• LU 1—�II 81—OII QI—OII V-411 V-411 QI ^II SI—OII -(J -------------- n -------- 1 1 1 I 1 1 I 1 W 5 In"x 11 In Parralam Boa. U Q 'Q (Y � NQ po MA Z --------- z w w �� O 'a C I 1 I I I I iH•Ji 1 I 1 I 1 I I I 1 I I 1 - • 0 0 � 1 I I I I I OD D 1 1—O" V ' Q 1—OII 1 21—OII (}1 P FOOTING WITH SLAB t SCALE: Ex( OF a"CONCRETE WALL WITH /�� _ 1_O�� EXCAVATION DAMPROOFING "POURED CONCRETE SLAB BACKFILL DATE: 2/2/2006 . " .. . o" o. . o° o o° i 0 i NEW*'lEW WALLS DRAWN BY: " CONCRETE FOOTING �------------ ------------ KEY y ® 1. EXISTING WALLS 1 r DRAWING, NUMBER: 71 A --------I A21 ;41 A21 J" 2 Ca'-O"xi3DECK----- MST BATH4'-10 604'-0c4 TW2036 CN23 TWIS210 TWI8210 ; 3-0 i '_1" BATH »i `9 Y BEDROOM "3 6' ; o _ w O BEDROOM »I Z L1 O z � Lu s'\ I f UL�.DOWN I C� 3'-O" STAIRS ' DOWN TWIS310 TWIS310 ul0 ' 218'I � - -� - - -� , a 2.-411 ; a IY (D ° + ° z �i a' BEDRCIOM »2 0 � Ul I COVERED PORCH `9 UJIC O O ; F (existing) N u; i i (3)DNT206/TW2046 , i ------------------------------L 2'-O" 8'+O11 2'-O" TW28310 i TW28310 32'_�" TW28310 A21-2 '-- A --------' 5'-O" Lq B T_�n----' l'-f0 l'-4" SCALE: 44-0 1/4" = I -O" DATE: 2/2/2005 FIRST FLOOR REVISED HOME . DRAWN BY: ROBERT BERKE DRAWING NUMBER: A-2 LU SSOfp-06L-805 - al m 109ZO VlW 'SINNVUH CK z N ION W' NC4 SS Q m LU z � SONSOISS� S N39 Q N > •01 SNOIIV'AON3N 3V VN V VN119IX3 z ' ' U z z o ' y O o o , ------ ---- - ------ , r LL CA s Q O O z O � x 73 17;7'1 O O O O m � =I Uima _ - - ROOM ■■■e�i eMuu■ems e� — Fl �• e■■1 �■I,11 111 ,III 111 III e:. 1■■■ ■■1�" I❑ ❑ ❑ 111 111 IIII ■ .. 1■■eeeee eiee eeee eeee .a■■ei 1■■■1■y1■■■1■ule■■■I�i 1■■■1 e■■ 1■■�■■n.► .:L...Il■■■■1■L...ea....ea....e 1■■ ■■■.Iy ..y.■uy■su■E.■uy.■uy.■.. 1■■ 1■■ ■■ a■■■r .�■e■ 1■■■e■ e■ ■■■ 1■■■e■ 1■■■1■ 1■■■e 1■■ i■■ ��■ �■ Nib � � LE R�� i � 1 • _ 1 - .ice. ■ 1 ■■■■■1■■■■e■1■■■■1■I■■■■1■1■■■ ' 1■.�...�.1■■■e■1■■ ...��' ■■■■ ■■■■u /' .� ...� III III J ._. ._. .uy.■ 111 L..Iy1...1ye...logor- 1■ 1■e■1 1■■■1� ■ e 1■■1■ a■■■ 1■■■■e■1■■■■1■1■■■■r 1 1■■e■1■■■■1■1■■■■1■1� III IIII IN I NON11 I■■■e.l■■� ■■uy■■..y■■�.. imp on Wo NMI (� �y�: . . goDRAWING 1■e■ eery ' ; ®.::::'!�� iii"� DRAWN NUMBER: i CONTINUOUS VENT AT RIDGE 12 C 4 1/2� 12 �8 ASPHALT SHINGLES WITH 15 LB ROOF FELT 1/2"PLYWOOD SHEATHING CONTINUOUS EAVES PROTECTION (2 COURSES) 2X8 RAFTER _ �—2x8 RAFTERS®I6"OC O DRIP EDGE TYPICAL 1_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ Lu IX8 FASCIA f 2X8 CEILING JOISTS - - - - - — - - - - -- - - - - - - - - - - - - U WITH VENTED SOFFIT �..�w�...,� � O Z O 2x8 CEILING JOISTS 6 16"OC jtu E-2X4BEARING WALL .^ ✓f--! O MASTER WIC O � `ryL- " BATHROOM MASTER BEDROOM `�` IrvO TYPICAL 2X4 SIDING EXTERIOR WALL: l 5"CEDAR SHINGLE SIDING AIR BARRIER -3/4"T<G PLYWOOD SUBFLOOR W O 1/2"SHEATHING 2x4 STUDS o 16"o.c. °u ,m°u°",� � lu b"R-19 FACED INSULATION _ y'a 'a 1/2"TJI'S FLOOR TS a 16"OC �"�• ^• 2X6 P.T.SILL ON SILL SEAL FASTENED TO FOUNDATION WALL WITH - 1/2"DIAMETER ANCHOR BOLTS AT 7-O"O.G. 8"CONCRETE WALL WITH FOOTING 4 KEYWAY 4"POURED CONCRETE SLAB UNFINISHED BASEMENT Compacted Gravel Base SCALE: SECTION A 1/4" V-0" TYPICAL SECTION NTS DATE: 2/2/2005 DRAWN BY: y R05ERT 5ERKE DRAWING NUMBER: A-4 .9 1 i .f, CONTINUOUS VENT AT RIDGE REMOVE EXISTING ROOF STRUCTURE AND REPLACE WITH AN 8 PITCH Tll -- ROOF STRUCTURE AS SHOWN 12 4 1/2 12 ASPHALT SHINGLES WITH 15 LB ROOF FELT 1/2"PLYWOOD SHEATHING CONTINUOUS EAVES PROTECTION (2 COURSES) 2X8 RAFTER 2x8 RAFTERS®16"OC DRIP EDGE TYPICAL 2x6 CEILING JOISTS 6 16"OC w IX8 FASCIA 2X8 CEILING JOISTS _ O 0 O WITH VENTED SOFFIT 1--)—^^ MM lu p w BEDROOM •3 BEDROOM M2 N TYPICAL 2X4 SIDING EXTERIOR WALL: i l w V 5"CEDAR SHINGLE SIDING Z r AIR BARRIER 3/4"TICS PLYWOOD SUBFLOOR N 1/2"SHEATHING 2x4 STUDS a 16"o.c. Lu M 2X8 FLOOR JOISTS o Ir."OC 6"R-19 FACED INSULATION L (z O m� 4` in a . i, yi 2X6 P.T.SILL ON SILL SEAL �I FASTENED TO FOUNDATION WALL WITH - I/2"DIAMETER ANCHOR BOLTS AT 1-0"O.C. BASEMENT 8"CONCRETE WALL WITH FOOTING I KEYWAY s�� 4"POURED CONCRETE SLAB Compacted Gravel Base SCALE: SECTION B 1/4" o V-0" TYPICAL SECTION NTS DATE: 2/2/2005 DRAWN BY: _ ROBERT BERKE DRAWING NUMBER: j ASSESSORS MAP : _ - TEST HOLE LOGS__ _ _ PARCEL : t _ __ SOIL EVALUATOR : WITNESS : AVl t G7 t i ' _ L FLOOD ZONE: 5 fit M0� W�`�u !.rl_r a REFERENCE: . .,. —_ _._&.__....-._. DATE: � � PERCOLATI , w � IL )"v - lrin�,�11--,-,,�-��-� 4 5 _ _. w.. . 7� TH- 1 TH-2 2 � i bJ �v�Nl D"Tl-Ir wn� -� 2b b Tom, I i LOCAT I ON MAP 11 QD 2-0 �r o S E P.TIC SYSTEM DESIGN FLOW E$ i i MATE BEDr.^OMS AT IO GAL/DAY/BED OOM GAL/DAY 7- EPT I C K '. - � AN � MIS` L GA;./DAY x 2 DAYS - GAL o p USE GALLON SEPTIC TANK OIL`At";�RPT WNN SYSTEM , h, i � I � S , DE AREA: X t� t-JTOM AREA: X N _- -- _ SEPT I <. SYS i E SECT , ON //k ;�,,.. _tom ,. � _ �-�t �� 38►�'6 �� __�.__ _ ..___. . _. __-� - '...� � � f 7 •- ..._._^ ,� . .�., .----- ---., b=BMX "` "--- GAL SEPT I C TANK -- UAVI MASOM -A SITE AND SEWAGE PLAN ZL LOCATION �r�porz7 PREPARED FOR : �F,!BnF—&F o �Ir---I� 15 ►�} SCALE: / =20 DAV.I D B . MASON ' DATE: Zo 02 DBC ENVIRONMENTAL DESIGNS W DATE HEALTH AGENT EAST SANDWICH . MA ( 508 ) 833- 217 - W