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HomeMy WebLinkAbout0042 RUSTIC LANE - Health 42 Rustic.Lane.,- -,-Hyannis",, A = 288 207 i r r E� C Commonwealth of Massachuset Title 5 Official Insi0 �on Form Subsurface Sewage Disposal System i=or Not for Voluntary Assessments 1rn) l<US�1 L it �N ei Y9 v I Property Address /I a Vl Owner Owners Name information is required for --� I State Zip Code Date o Ins ection every page. City/Town j onl this form. Inspection forms may not be altered in any Inspection results must be submitted way. Please see.completeness checklistjatlthe end of the form. '"'p°' "t: A. General Information When filling out forms on the computer,use 1. Inspector: only the tab key to move your cursor-do not Name of Inspector use the return key. L /v Company Name n m / o ,Q 7 I/off�� Company Address 1 ,Q Da 6ll� I City/Town State Ll D Zip Code ils — ; o 8 9 7S , Telephone Nu er License Number B. Certification I certify that I have personally inspected the swage disposal system at this address and that the information reported below is true, accurate ar d 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 appro�ed system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000). The system: i Passes [] lCdnditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Loca� Approving Authority Z4 !/ / jInspectoSignature Date The system inspector shall submit a copy�f this inspection report to the Approving Authority(Board of Health or DEP) within 30 days of corhpl' ting this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greate( the inspector and the system owner shall submit the report to the appropriate regional officelof the DEP. The original should be sent to the system owner and copies sent to the buyer, if appli.da6le�and the approving authority. I ****This report only describes conditions a the time of inspection and under the conditions of use at that time. This inspection does riot a mess how the system will perform in the future under the same or different conditions ofiuse I l 15ins•09/08 I Title 5 Df cat Inspectio4Form: !face Sewage Disposal System•Page i of 17 , i Commonwealth of iMassachuse t- Tiffe 5 0-fificial Ins ction Form Subsurface Sewage Disposal System Fo Not for Voluntary Assessments �� 1'�v�S 7'►G LiC� ✓1 t� Property Address j ! Owner ! ! information is Owner's Name �' ZY � O 6 required for every page. City/Town State Zip Code Date/of os ecfion B. Certification (cost.) i Inspection Summary: Check A,B,C,D Or I always complete all of Section D A) System Passes: I have not found any information wfiic indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR115N04 exist. Any failure criteria not evaluated are indicated below. Comments: i l B) System Conditionally Passes: I ❑ one or more system components as described in the "Conditional Pass"section need to be replaced or repaired. The system., t,p n completion of the replacement or repair, as approved by the Board of Health, will pass. i Check the box for"yes", "no"or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. ! i The septic tank is metal and over 20 year o old*or the septic tank (whether metal or not)is structurally unsound, exhibits substantial i filtration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank i,6 r.placed with a complying septic tank as approved by the Board of Health. 'A metal septic tank will pass inspection i 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 (E�pl4in below): i 1 { i I ' I i ! 15ins•osroa Titre 5 Official Inspection form:Subsurface Sewage Disposal System•Page 2 of 17 I I 1 i Commonwealth of Massachusetiti Titre 5 Official Insl, Ocition Form Subsurface Sewage Disposal System Arrr - Not for Voluntary Assessments T11 II I ; ay 9,(7�i Property Address I i Cc�s�I I ✓t i � Owner Owner's Name formation is {� q N u Q l� required for every page. City/Town State Zip Code Date f In ection B. Certification (cont.) B) System Conditionally Passes (cont.l): I ❑ 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 ofjR�ard of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled 8r replaced ❑ Y ❑ N ❑ ND (Explain below): i i i ❑ The system required pumping more tl�an 4 times a year due to broken or obstructed pipe(s).iThe system will pass inspection if(with 64roval of the Board of Health): J i i ❑ broken pipe(s) are replace 1 ❑ Y ❑ N ❑ ND (Explain below): . I ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): I i i C) Further Evaluation is Required!by the Board of Health: ❑ Conditions exist which require furthler evaluation by the Board of Health in order to determine if the system is failing to protect publi� Health, safety or the environment. 1- System will pass unless Board f'Health determines in accordance with 310 CMR 15.303(1)(b) that the system is 'ndt functioning in a manner which will public ublic health, P safety and the environment: ❑ Cesspool or privy is within 50 ieet of a surface water i ❑ Cesspool or privy is within 0 feet of a bordering vegetated wetland or a salt marsh t5ins-09108 Title 5 officiai Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 I I � i I Commonwealth ofMAssachusel?ts i TRIO 5 Official Ih, `,► 'ion Form Subsurface Sewage Disposal System F,ni -Not for Voluntary Assessments L� GG �— Property Address r L4 I Owner Owner's Name information is required for �L71Cz A H Is "ofs every page. Cityfrown I State Zip Code Da on B. Certification (cunt.) 2. System will fail unless the Boars! of Health (and Public Water Supplier, if any) determines that the system is fu�cf Toning in a manner that protects the public health, safety and environment: I ❑ The system has a septicitank and soil absorption system (SAS)and the SAS is within 100 feet of a surface water supply or tiributary to a surface water supply. ❑ The system has a septic tank land SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic'tankand SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and 5A$ and the SAS is less than 100 feet but 50 feet or more from a private water supply'w;e114,-. Method used to determine distance "This system passes if the well water bn�Mysis, performed at a DEP certified laboratory,for coliform bacteria indicates absent and the presencle of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other;fa lure criteria are triggered. A copy of the analysis must be attached to this form. { I � 3. Other: ' i i I I D) System Failure Criteria Applicable tolAlil Systems: You must indicate "Yes" or "No" to elac� of the following for all inspections: Yes No ❑ Backup of sewage ir♦to facility or system component due to overloaded or clogged SAS or,c4s�pool ❑ Discharge or ponc�in' of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ Static liquid level ih the distribution box above outlet invert due to an overloaded or clogged SAS or!c,sspool ❑ Liquid depth in d'e�s�ool is less than 6" below invert or available volume is less than % day flow,, (Sins•09✓0e 7iile 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 4 of 17 f ' I f Commonwealth of Massachuse'is`: Title 5 Official I:nsi -41 ct=ion Form Subsurface Sewage Disposal System*o m -Not for Voluntary Assessments ��. i�w S I41 G Property Address // l Owner Owner's Name / I information is /� �� f ��, 4 required for / , �'L every page. City/Town j State Zip Code Dat of Insl5ection 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: ❑ [J Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ d Any portion of cesspool or privy is within 100 feet of a surface water supply[or tributary to a surfsce 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 supplyvell. ❑ Lid Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private vwa erisupply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified' laboratory, forfg$l coliform bacteria indicates absent and the presence of ammonia nitr n and nitrate nitrogen is equal to or less than 5 ppm, provided thatmol,other failure criteria are triggered. A copy of the analysis and chain of cus!toldy must be attached to this form.] ❑ Q/ The system is a c�stpool 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 d4sdribed in 310 CMR 15.303, therefore the system fails. The system owner shdul� contact the Board of Health to determine what will be necessary to correcti the failure. i E) Large Systems: To be considered la 60,ge system the system must serve a facility with a design flow of 10,000 gpd to 15,000 opd'. For large systems, you must indicate eithdr"yes"or"no"to each of the following, in addition to the questions in Section D. j 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 locaied.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 above1lie'large system has failed. The owner or operator of any large System considered a significant threat u�ld6r Section E or failed under Section D shall upgrade the System in accordance with 310 CMR 151364. The system owner should contact the appropriate regional office of the Department. t5ins•09/08 i Title 5 official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 ii i Commonwealth of Massachusetts? Title 5 Official Ins' I ' U0n Form Subsurface Sewage Disposal System Foam'-Not for Voluntary Assessments Property Address / 4 l Owner Owner's Name i 1 �j ,f information is // Uol y X/ required for VolM fS D✓ every page. City/Town State Zip Code Date f I pection C. Checklist i Check if the following have been done. iYou 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? r ❑ 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 of4he system obtained and examined? (If they were not available note as�NVA) �❑ Was the facility or dwelling inspected for signs of sewage back up? [�❑ Was the site inspel{teki for signs of break out? �/❑ Were all system co I ponents, excluding the SAS, located on site? ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the cdndition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? �/❑ Was the facility owrieri'(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems? The size and locat,10 of the Soil Absorption System (SAS)on the site has / been determined'based on: Existing informatiori. For example, a plan at the Board of Health. ❑ Determined in the tier (if any of the failure criteria related to Part C is at issue approximation of IdittAince is unacceptable) (310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms (design): Number of bedrooms (actual): ,330 DESIGN flow based on 310 CMR 15.203Oor example: 110 gpd x#of bedrooms): Mns•Owe Title 5 Official Insoection Form:Subsurface Sewage Disposal System•Page 6 of 17 I I Commonwealth of Massach.us4 Tithe 5 Official inl P fiction Form U Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �Z IF Property Address l�1Sh�n Owner Owner's Name information is required for a nYI rS 49V" I oo�6 V / l every page. Cityrrown State Zip Code Date 6f I pection D. System Information f Description: �,,t C.,:v 410 V1 / t i L' as,c �3 02 on G-G Flo s�� s>� Number of current residents: Does residence have a garbage grinder? ' ❑ Yes No Is laundry on a separate sewage sysfer ?{if yes separate inspection required) ❑ Yes 3---N-o Laundry system inspected? j ❑ Yes 9-'No Seasonal use? ❑ Yes [�No Water meter readings, if available(last 2 years usage (gpd)): Detail: i I Sump pump? ❑ Yes , No I Last date of occupancy: Date Commercial/Industrial Flow Conditlodtsi; Type of Establishment: Design flow (based on 310 CMR 15.20): Gallons per day(gpd) Basis of design flow (sea ts/persons/sq.ft.,'etc.): i Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ 'No Non-sanitary waste discharged to the Title5 system? ❑ Yes ❑ 'No Water meter readings, if available: (sins•os+oe 7iue 5 Official Inspection form:Subsurface Sewage Disposal System•Page 7 of 17 I I Commonwealth of Massachusett Tithe 5 Official In fiction Form Subsurface Sewage Disposal System Fo�f - Not for Voluntary Assessments Property Address / t Owner Owner's Name j �'/ � information is �l- required for Gt vl✓J if d Y 0oZ t every page. City/town State Zip Code Date f I p coon D. System Information (cont.) Last date of occupancy/use: date i. Other(describe below): i .etteral Information L Pumping Records: Source of information: Was system pumped as part of the insp�ption? ❑ Yes ENO If yes, volume pumped: gallons How was quantity pumped determined?l Reason for pumping: Type of S Septic tank, distributionibOx, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or jno) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative t6cihnology. 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 sy�tem by system operator under contract ❑ Tight tank. Attach a copy bf the DEP approval. ❑ Other (describe): t5ins 09/08 Tide 5 official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of`Massachusetts Tithe 5 Official llrtStGtion Form Subsurface Sewage Disposal System ForM -Not for Voluntary Assessments Property Address Owner Owner's Name information is /� o G�t required for Alv► f s✓� 1� 9 every page. City/Town C7LState Zip Code D e of nspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of informati Awl l9�os- � `ti�.r�✓ � �o � S. /�.,.S �'oQ3� Were sewage odors detected when arriving at the site? ❑ Yes Q' No Building Sewer(locate on site plan): I Depth below grade: feet O Material of construction: cast iron 40 PVC ?❑ other (explain): Distance from private water supply well orUction line: feet Comments (on condition of joints, venkirg, evidence of leakage, etc.): t . Septic Tank (locate on site plan): Depth below grade: feet M'ateri of construction: concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑other(explain) If tank is metal, list age: i years Is age confirmed by a Certificate of Complilance? (attach a copy of certificate) ElYes ❑ No Dimensions: Sludge depth: isins-ostoe Title 5 Official Inspection form:Subsurface Sewage Disposal System.page 9 o1 17 i ' Commonwealth of'Massachus' ett Tit] 5 Official Ins � ie,, ction For Subsurface Sewage Disposal System Form •Not for Voluntary Assessments L Property Address (f(AS Owner Owners Name o information is ��11 required forState Zip Code DateAlpection every page. City/Town D. System Information (cont.) Septic Tank (cont.) Distance from top of sludge to bottom;oflo'utlet tee or baffle Scum thickness Distance from top of scum to top of ou'tlit tee or baffle Distance from bottom of scum to bottomlo'f outlet tee or baffle �— V How were dimensions determined? Comments (on pumping recommendation;;, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert„evidence of leakage, etc.): vi IM i vl 4-tl cs N C.� ✓� 0 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: Dace 15ins•0"8 Tine 5 Official Inspection Form:Subsurface Seww oisposai System•Page 10:of 17 I Commonwealth & Massachuise. Title 5 Official Inspection Forrn Subsurface Sewage Disposal System FORT -Not for Voluntary Assessments Property Address Owner owner's Name /yJ information is n i S /�/,� ��c f required for (_ every page. City/Town State Zip Code Date of I spection D. System Information (cont.)p Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert,'evidence of leakage, etc.): ' k i 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$witches, etc.): Attach copy of current pumping contract (required). Is copy attached? ❑ Yes ❑ No 15ins-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Pape 11 or 17 Commonwealth of Massachusetts Title 5 Official I�n� � t i;o:n Form Subsurface Sewage Disposal System;Form -Not for Voluntary Assessments Property Address C tAs�1 1 0 ; Owner Owner's Name po.�j nformation is ✓1 If or, �/� Q� / 4 f f required for every page. CitylTown State Zip Code Date if Insbe6on D. System Information (cone.) Distribution Box (if present must be opened) (locate on sjte plan): Depth of liquid level above outlet invert' Comments (note if box is level and d�istribitttion to outlets equal, any evidence of solids carryover; any evidence of leakage into or out of box,;etc.): Z- ko so It C& / l/ 0 �A`✓' S 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.): Soil Absorption System (SAS) (locateion site plan, excavation not required): If SAS not located, explain why: isins•o9✓w Title 5 Official Inspection Form Subsurface Sewage Disposal System•Page 12 of 17 ; Commonwealth of Massachusetts Tittee 5 Official Ins oion Form Subsurface Sewage DisposalSystem Fort. -Not for Voluntary Assessments LG ✓► Property Address Owner Owner's Name information is required for a00tf O, T 006z / [ �� every page. Cityrrown State Zip Code Date ot Irdpection D. System Information (cont.) c✓ c?' 5 X 13 Type: a- Soo ❑ leaching pits number: ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments (note condition of sail, sigri's'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 ❑ Yes ❑ No t5ins•os!oe Title 5 Official inspection Form:Subsurface Sewaoe Disposal System-Page 13 of 17 Commonwealth of Massachusetts} 0 Title 5 Official Inspoe ion Form Subsurface Sewage Disposal System Fotm Not for Voluntary Assessments �tcL � Property Address Owner owner's Name information is required for every page. Cityrrown State tip Code Date o 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 oflhydraulic failure, level of ponding, condition of vegetation, etc.): 15in9 09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 Commonwealth of Massachusetts Title 5 Official lrns�p ctfon Form Subsurface Sewage Disposal System Form!- Not for Voluntary Assessments AS4/ c L-67 Y�-e� Property Address Owner Owners Name JA 1 h L D��/ information is 7 required for ✓�'�If o/� every page. City/Town State--L Zip Code Date I 'on 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 ublic water supply enters the building. Check one of the boxes below: hand-sketch in the area below ❑ drawing attached separately QAGh Q belo�✓ (Sins•09108 Tille 5 Official Inspection form:Subsurface Sewage Disposal System-Page 16 of-17 Commonwealth of Massachusetts,' Title 5 Official Inls-oaction Vorm Subsurface Sewage DisZ,4 l System Form- Not for Voluntary Assessments L1,) G L C:5i vt -el Property Address to Owner information is Owner shame Alc; r /� o� A, required for ✓1✓l r s every page. Cityfrown State Zip Code Date ofinsoection 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 detei�rriine 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) 21 Checked with 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: �� /S l�S�� !�C �✓ /%iv1� Before filing this Inspection Report, please see Report Completeness Checklist on next page. 15ins-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal Syslem.Pape 16 of 17 Commonwealth of Massachusetts Title 5 Official has I etiflon JForrn p Subsurface Sewage Disposal System Form -Not for Voluntary Assessments Property Address i Owner Owner's Name information is /7 required for � every page. City/Town State Zip Code Date of inspection E. Report Completeness Checklist Inspection Summary: A, B, C, D, or E checked 1 [�Inspection Summary D (System Failure Criteria Applicable to All Systems)completed Ell—system Information — Estimated depth to high groundwater Sketch of Sewage Disposal System either drawn one page 15 or attached in separate file I i 1 i i I i i f i (Sins 09M8 Title 5 Ofrdal Insp ection Form:Subsurface Sewage Disposal System•pap 17 of 17 i I TOWN OF BARNSTABLE LbCATION /4 � QUS i c L��- 6 SEWAGE #,Z Q o3 a VILLAGE .�`1'h-vA✓/s /1 eZ 7' ASSESSOR'S MAP & LOT 20 INSTALLER'S NAME&PHONE NO. 91Q ~ SEPTIC TANK CAPACITY / 6-x s'''' 'f's LEACHING FACILITY: (type )�` C�A^ S'=�S(size (3 X NO.OF BEDROOMS / BUILDER OR OWNER PERMITDATE: lG/o"2 7143 COMPLIANCE DATE: !V Z 03 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 � I ►Ti 5 n No. Poo .J J o;Lo Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS 01ppYication for Migpogar 6pgtem Congtruction Permit Application for a Permit to Construct( )Repair()Upgrade( )Abandon( ) El Complete System El Individual Components Location Address or Lot No. OwnZame,Address and Tel.No. / Assessor's MapRarcel SL Installer's Name,Address,and Te.No. Designer's Name,Address and Tel.No. 136 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 gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank /0 670 1_=X I ss I N Type of S.A.S. Description of Soil Z Nature of,Repairs or Alterations(Answer when applicable) /il�'r T i6i �' ,5'?a�✓Lt' o� /l�yc' sy J[�o X, 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 is this -Health Sig Date Application Approved by Date Application Disapproved for the following reasons Permit No. Q0 03 —j5 D-6 Date Issued Fee �11 THE COMMONWEALTH OF MASSACHUSETT Entered in computer: Q. PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLES MASSACHUSETTS Yes Zip plicaction for Mi5po5al 6pgtem Construction Permit pp' Repair (/ ( . ) ❑Complete.System El Individual Components A hcation for a Permit to Construct( ) ( )Upgrade( )Abandon( Location Address or Lot No. Owner' Name,Address and Tel.No. vs;, Gi9 .,.E X49 a/-- s /�E•�.s Assessor's Map/Parcel Installer's Name,Address,and Tel.No. . Designer's Name,Address and Tel.No. .3 -9- � 5 Y� Type of Building: Dwelling*,, No.of Bedrooms 73 Lot Size sq.ft. Garbage Grinder Other '� Type of Building No.of Persons Showers( ) Cafeteria Other Fixtures ' Design Flow ` .1 gallons per day\Calculated daily flow i gallons. Plan Date Number of sheets Revision Date '2 Title Size of Septic Tank /! tV o IF Y I Type of S.A.S. Description of Soil Nature of jte airs or Alterations(Answer when applicable) (�oZ -,a d � ,.9 5 1" 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-b3�this ard-of Health. Sig a Date Application Approved by Date �j`'A-. Application Disapproved for the following reasons Permit No. _0o O 3 —S�' Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS A viQ,�� ;� Certificate of Compliance P ,� ©�I`���'�~ THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed( )Repaired( )Upgraded( ) Abandoned( )by 1-412 at �/ rr s T L .- .L-- E has been constructe o in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. Z00 3"S Zo dated 101 Zg/d 3 Installer /9 'R l/� Designer ,d a ww The issuance of this pe, 't*all not be construed as a guarantee that the system i1 ncti'n �si ed.)'`'} C Date 10 1'i'1d 3 Inspector // _ .-. _ . -_.--- --5�� -- ———————————————————— No. Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLES MASSACHUSETTS n �iopogal bp�tem ttCon5truction Permit /)'Q ✓'�0 s/r SQL% Permission is hereby granted to C&hstivct( )Repair( grade( )Abandor, System located at v s 7 r c Z 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. IIj Provided:Co.nstructiop must a completed within three years of the date off ii e n Date: /© 1� d.5 Approved by`� TOWN OF BARNSTABLE LOCATIONS .QUs� "c LA.L5 SEWAGEbwO VILLAG %s Po 2 T ASSESSOR'S MAP &LOT INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY: (type S'cr «� SFaS(size)afX (e3�)C f NO.OF BEDROOMS BUILDER OR OWNER PERMITDATE:- O �d COMPLIANCE DATE:. 1 f� Z L,63 Separation Distance Between the: �— Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If-any weUs exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 ftet of leaching facility) Feet Furnished by . I I A o � C Sd Z�60 OJ "a< TOWN OF BARNSTABLE �- LOCATION 'iLO`r 4(9 gLl,,�T?c .� SEWAGE # VILLAGE� _ ASSESSOR'S MAP LOT INSTALLER'S NAME & PHONE NO. K-CLt5 66�s r(?37 ti SEPTIC TANK CAPACITY /Oh Cj C LEACHING FACILITY:(type) (size)_ Nth.OF BEDROOMS PRIVATE WELL OR PUBLIC WATER &d_,I_ BUILDER O NEe�, �5'N�b1•�eA� DATE PERMIT ISSUED; ?7 "TE COMPLIANCE ISSUED: ��� "�o VAIIANCE GRANTED: Yes No_,-,—' 7 �I e d >L4A __. ,-r 11/04 ,2003 16:14 FAX 1 617 328 2030 L.E.M.& D. 0 002 16/:�a/2003 16:43 15087754578 EPOCH Hh1S C HENSEL PAGE e3 1' eaPp�v�SE y . PugP�NS�pg� t� r. TOWN OF BARNSTABLE � 'A• t.1 LOCATION 1C c-'f .i < ��5►.,i' SEWAGE Toe 3 // a. VU.LAGE-A >'A••�',✓�"f� �t . ASSESSOR'S MAP& LOT . INSTALLER'S NAME&t PHONE NO r r S-0 -77_r—r-7 Ir;L SEPTIC TANK CAPACTTY A ,r, LFACEID40 FACEL Y: (type , S"oo_ .�5- (size) r xr 13 x NO-OF BEDROOMS py tiss /� BUII-DER OR OWNER P$RMrrDATE: DATE: C� Separation Distance Between the: Maximum Adjusted Groundwater Tableto,the2f6hom of Leaching Facility _ - feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Peet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Fee Furnished by THE COMMONWEALTH of MA88ACHuSETTS 5JAt �ce,(V BA NSTABLEs MASSACHUSETTS Y sta Certificate of Comprlia>Ite P s Gv*,pl ia� IS IS TO CERTIFY, that the On-site Sewage Disposal Systern Constructed( ) R O�l� Abandon ( )by /2,e,v ePad ( )Upgraded( ) with theP rovisiOns of Tale S and the for Di s l _ � has been construct in ordance posal System Construction Permit No. 00 —5 2e date 10 Zg D 3 Installer ��/a �s.-_ .<_ The issuance of this t Designer o cv 1[' 2SS ball not be construed a guarantee.that the system n s Date S Inspector 11/04,;2003 16:14 FAX 1 617 328 2030 L.E.M.& D. 0 001 y t LECOMTE,EMANUELSON& DOYLE A PARTNERSHIP INCLUDING PROFESSIONAL CORPORATIONS ATTORNEYS AT LAW PRESIDENTS PLACE 155 SOUTHMAIN STREET 1250 HANCOCK STREET PLEASE RESPOND TO PROvIDFiNCE,RRODE ISLAND 02903 QUINCY OFFICE (301)45a3r11 QUINCY,MASSACHUSETTS 02169 eme fi�llecomtelAwcom (617)328-1900 FACSIMME (617)328-2030 Exunsion 216 M.0hea J.McDonnell Of coivael FACSE%M.E COVER SHEET DATE: November 4, 2003 TIME: 4:00 pm TO: Joan PHONE: Health Inspector's Office FAX: 508-790-6304 FROM: Matthew J. McDonnell,Esq. PHONE: 617-328-1900 FAX: 617-328-2030 RE: 42 Rustic Lane, Hyannisport, MA Owner: Charles Hensel Certificate of Compliance re: onsite sewerage disposal system Number of pages including this cover sheet: 2 MESSAGE: Joan: As we discussed, herewith find the Certificate of Compliance with the"Awaiting Revised Plans B4 compliance handel over"language. A note confirming that language has been deleted4thela iate by return fax. Manr NTIALITY NOTE mpanying this facsimile transmission contains information from Matthew J. McDonnf Lecomte,Emanuelson&Doyle which is confidential or privileged. The information is intended for the use of the individual or entity named on this transmission sheet, If you are not the intended recipient,be aware that any disclosure,copying, distribution or use of the contents of the fax information is prohibited_ If you have received this facsimile in error,please notify us by telephone y immediately so that we can arrange for the rctricval of the original documents at no cost to you. f TOP FNDN, 33.9' SYSTEM PROFILE TEST HOLE LOGS = _ ACCESS COVER TO WITHIN 6" OF FIN. GRADE (NOT TO SCALE) PROP. INSPECTION PORT, ACCESS COVER (WATERTIGHT) TO ENGINEER: SWEETSER ►,OF FIN. GRADE MINIMUM .75' OF COVER OVER PRECAST WITHIN 6 WTHiN 6 OF FIN. GRADE J. DUNNING BOH WEST wN sT, 27 SLOPE REQUIRED OVER SYSTEM WITNESS: � ) ci vE• L. 30.8' RUN PIPE LEVEL 2 DOUBLE WASHED PEASTONE DATE: 1/23/89 EXISTING 1000kim- jT'EFOR FIRST 2' \,. PERC. RATE - < 2 MIN/INCH GALLON SEPTIC 29 4't* E 28 8' CLASS I SOILS P#TANK (H10 ) ass a � ` locus -11 28.27 ' 2 .10 aOC7 © O aa � � I MIN 28.0' L� O [� l� L7 C7 m '�� 4' AROUND I1nRRINCTON ( 2 SLOPE) 6" CRUSHED STONE OR MECHANICAL C] C] [] [3 [J C] COMPACTION. (15.221 [21) ��$ 2' Cm L � f� C� 0 ED -I � Q 26.0' Q ELEV. ELEV. DEPTH OF FLOW = 4' 14 1 31 .0' o" 31.0' SMITH ST, uaRSTON AVE( % SLOPE) ( 7. SLOPE) �. TEE SIZES: 3/4" TO 1 1/2" DOUBLE WASHED STONE INLET DEPTH = 10 TOP & TOP & OUTLET DEPTH 14" LOCATION MAP NO SCALE SUBSOIL SUBSOIL j LEAC,.-iING 48 27.0' 48 27.0' FOUNDATION~-~ EXIST. SEPTIC TANK 8' D' BOX 12' FAC!!_iTY ASSESSORS MAP 288 PARCEL 207 a 71 *THE INSTALLER SHALL VERIFY THE MED. SAND MED. SAND LOCATIONS OF ALL UTILITIES AND ALL BUILDING SEWER OUTLETS AND ELEVATIONS pf „ PRIOR TO INSTALLING ANY PORTION OF 96 23.0' 96 23.0' SEPTIC SYSTEM 19.0' FNE, WELL I FNE, WELL r, GRADED SAND GRADED SAND 144" 119,01 144" 19.0' NOTES: I NO WATER ENCOUNTERED �J'�a•9 w - - APPROXIMATE NGVD 32., � . DATUM IS + -A- �� 1 I SEPTIC DESIGN: (GARBAGE DISPOSER IS NOT AL!OWED ) / i 11 rl 2. N UNICIPAL WATER IS EXISTING f; r EXIST. SEPTIC DESIGN i 'P1�) _ �'0 rPf) 3Y ! E LOW: = I~cu ��--�NI� l , . 1 TANK (RE-USE) ,. �I ...0 �B nrr, �nnT + 00.00 32.7 330 .a. I�hNiNUNI �ii �: �; USE A GPD DESIGN FLOW ` - Y R DESIGN LOADING FOR ALL PRECAST UNITS TO BE AASHO H- 10 SEPTIC TANK: 330 GPD ( 2 ) = 660, PIPE JOINTS TO BE MADE WATERTIGHT. 32.1 32 FISH POND USE A 1000_ GALLON SEPTIC TANK (RE-USE EXISTING) CONSTRUCTION DETAILS TO BE IN ACCORDANCE WITH MASS. LEACHING: :NVIRONMENTAL CODE TITLE V. 29.7 1 3 •8 3 2 25 + 12.83 2 .74 - 112 THIS PLAN IS FOR PROPOSED WORK ONLY AND NOT TO BE + 32.1 EXIST. LEACH PIT (SEE SIDES: ( ( USED FOR LOT LINE STAKING, I EXIST. DWELL. W 1 NOTE 10) 25 x 12.83 (.74) 237 8 PIPE FOR SEPTIC SYSTEM TO SCH, 40--4" PVC. o DECK I� + 3 . 10' BOTTOM: Iri APPROX. WATERLINE TF = 33.9' !Q 9. CO VENTS NOT TO BE BACKFILLED OR CONCEALED WITHOUT r\ TH1 TH2 Ia 32,8 TOTAL: 472 S.F. 349 GPD INSPEC N BY BOARD OF HEALTH AND PERMISSION OBTAINED USE 2 500 GAL. LEACHING CHAMBERS ACME I OR FROM BOA D OF HEALTH. 20 OR TO CONFIRM a 32• 0 S�TABLETSOILS IN AREA OF EQUAL) WITH a' STONE ALL AROUND 10. EACH PIT T BE PUMPED AND REMOVED. +2 >�0 - , 32 3� BRICK ^ PROPOSED LEACHING FACILITY EMOVE ALL ONTAMINATED SOIL WITHIN 5' OF NEW SAS. .. PATIO PRIOR TO INSTALLATION OF ANY LEGEND PAVED DRIVE PORTION OF SYSTEM. 2.4 GARAGE 6 100.0 P POSED SPOT ELEVATION LOT 49 - TITLE 5 SITE PLAN 7,500t SQ. FT. CONC. DO NOT DISTURB BRICK PATIO + 29.8 3 3 WALKS i 10OX0 XISTING SPOT ELEVATION OF 100. 100 PROPOSED CONTOUR 42 RUSTIC LANE 00� + 32, IN THE TOWN OF: 32.5 100 EXISTING CONTOUR ( HYANNISPORT) BARN STABLE BENCH MARK - CORNER OF PREPARED FOR: CHARLES & MARCIA HENSEL CONC. BULKHEAD EL. 32.9 BOARD HEALTH 20 0 20 40 60 Feet MA APPROVED DATE SCALE: 1" = 20' DATE: OCTGH. 13, 2003 off 508-362-4541 fox 508 362-9880 down cape engineering, inc. �1N OF UF� � t�.1� �As�• �� �y CIVIL ENGINEERS AR t o ARNEH. tun LAND SURVEYORS �� awin av� No.26 939 main st, yarrrOuth, ma 02675 Qj l CASTE ��,�Q �� <zf6 AR �nt� ALA, N 03-307 . .s. DATE TOP FNDN. = 33.9' SYSTEM PROFILE TEST HOLE LOGS ACCESS COVER TO WITHIN 6" OF FIN. GRADE (NOT TO SCALE) PROP. INSPECTION PORT, ACCESS COVER (WATERTIGHT) TO WITHIN 6" OF FIN. GRADE ENGINEER: SWEETSER WEST MAIN ST. WITHIN 6" OF FIN. GRADE MINIMUM .75' OF COVER OVER PRECAST BOH DUNNING 2% SLOPE REQUIRED OVER SYSTEM WITNESS: J. ( ) .0 �� oER PvF EL. 30.8' RUN PIPE LEVEL 4" DOUBLE WASHED PEASTON' DATE: 1 l23/89 sG�� FOR FIRST 2' �I EXISTING 1000 PERC. RATE = < 2 MIN/INCH �` GALLON SEPTIC 9 4'f* IT CLASS i SOILS P# 29.0 Locus TANK (H- 10 ) 8.10' - . GAS BAFFLE MIN - 28.27' o 0 [] 0 Q O [] �, 0 [� HARRINGTON 2$.0 � M M E1 E i � C-i M 0 t4' ROUND ( 2 % SLOPE) 6" CRUSHED STONE OR MECHANICAL 0 m 71 m � = 0 m 000 COMPACTION. (15.221 [2]) 80 DEPTH OF FLOW 4' 14 2 C L�7 C7 0 26.0' Q ELEV. C� ELEV. ( % SLOPE) ( 1 % SLOPE) 0" 31 .0' p" 31 .p' SMITH ST. MARSTON AVE TEE SIZES: 3/4" TO 1 1/2" DOUBLE WASHED STONE INLET DEPTH = 10" OUTLET DEPTH = 14" TOP & TOP & LOCATION MAP NO SCALE SUBSOIL SUBSOIL FOUNDATION--- EXIST. 48 27 0' 48 27 p' SEPTIC TANK $' � �aACHING D BOX 12 FACILITY ASSESSORS MAP 288 PARCEL 207 I { 7' *THE INSTALLER SHALL VERIFY THE MED. SAND MED. SAND LOCATIONS OF ALL UTILITIES AND ALL I BUILDING SEWER OUTLETS AND ELEVATIONS r PRIOR TO INSTALLING ANY PORTION OF 96" 23.0' 96 23.0' SEPTIC SYSTEM 19.0' I FNE, WELL FNE, WELL GRADED SAND RADED SAND J 144" 19.0' 144" 19.0' NO WATER ENCOUNTERED NOTES: +�0.9 N I + 32.1 ) . + 2 + 30.2 g� -� I SEPTIC DESIGN: (GARBAGE DISPOSER Is NOT ALLOWED 1 DATUM IS APPROXIMATE NGVD- ��� EXIST SEPTIC - 33p Gp0 EXISTING ;^ 1-._YAtw'(R� �E) DESIG"4 ,FLOW 3:. _f Ef1ROOMS (�_��._GPD) 2. MUNICIPAL WATER IS w.00 32.7 USE A J30 GPD DESIGN FLOW J� MINIMUM I'lF PITCH TO BE 1/8' PER FOOT. 4. DESIGN LOADING FOR ALL PRECAST `UNITS TO BE AASHO H- 10 SEPTIC TANK: 330 GPD ( 2 ) = 660 5. PIPE JOINTS TO BE MADE WATERTIGHT. / � 32a o 32. FISH POND USE A 1000- GALLON SEPTIC TANK (RE-USE EXISTING) 6. CONSTRUCTION DETAILS TO BE IN ACCORDANCE WITH MASS. ENVIRONMENTAL CODE TITLE V. 3 4 LEACHING: 7. THIS PLAN IS FOR PROPOSED WORK ONLY AND NOT TO BE I + 32.1 EXIST. LEACH PIT (SEE SIDES: 25 + 12.83) 2 (.74) = 112 USED FOR LOT LINE STAKING. I p EXIST. DWELL. DECK .1 + 3 to, NOTE 10) 25 x 12.83 (.74) - 237 8. PIPE FOR SEPTIC SYSTEM TO SCH. 40-4" PVC. APPROX. BOTTOM: - I ^ ox. WgrERLINE TF = 33.9' Q 9. COMPONENTS NOT TO BE BACKFILLED OR CONCEALED WITHOUT I TH1 TH2 la 32,2 TOTAL: 472 S,F, 349 GPD ,� INSPECTION BY BOARD OF HEALTH AND.PERMISSION OBTAINED 20' o CONTRACTOR TO CONFIRM USE (2) 500 GAL. LEACHING CHAMBERS (ACME OR FROM BOARD OF HEALTH. g _ 4 32. a SUITABLE SOILS IN AREA OF EQUAL) WITH 4' STONE ALL AROUND 10. LEACH PIT TO BE PUMPED AND REMOVED. +2310 32, 3 3 BRICK ^ PROPOSED LEACHING FACILITY PATIO PRIOR TO INSTALLATION OF ANY LEGEND REMOVE ALL CONTAMINATED SOIL WITHIN 5' OF NEW SAS. i PAVED DRIVE PORTION OF SYSTEM. -- ` _ 2.4 GARAGE 100.0 PROPOSED SPOT ELEVATION I LOT 49 -' `-� CONC. T DO NOT DISTURB BRICK PATIO T,1 TL r� � S.I. TE �'L AN I 7,500f SQ. FT. WALKS LU 100x0 EXISTING SPOT ELEVATION 29.8 3 .3 z 42 RUSTIC LAN 1 32.1 + 32. 1 O0 PROPOSED CONTOUR OF E �O.Op I� 1N THE TOWN OF: 32.5 100 EXISTING CONTOUR ( HYANNISPO.RT) BARNSTABLE BENCH MARK - CORNER OF PREPARED FOR: CHARLES & Wkf(31A HENSEL CONC. -BULKHEAD EL. = 32.9 BOARD OF HEALTH '' 20 0 20 40 60 Feet - APPROVED DATE MA SCALE: 1 " 20' DATE: OCTOBER 13, 2003 REV. 10/28/03 (ADD 2" PEAST.) off 508-362-4541 fox 508 362-98M ( down cape engineering, inc, IN OF CIVIL ENGINEERS �b ARNEM, ` �HOF Mq OJALR sfgcy LAND SURVEYORS a CIVIL ARNE Na 30782E H. 939 ruin st, yarmouth, ma 02675 sTE o.asp 03-307 AR J At Lny4= L.S. DATE