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HomeMy WebLinkAbout0019 SUNNY-WOOD DRIVE - Health (2) 97 Sunny-Wood Lane : Hyannis - ---- — — ---- - - -- -- A=273 —235,• ° I 1 ° O I 11 C01�IJT0\Nt�'EALTH OF AlkSSACH-liSETTS €y i E-x-.ECU-TIvE, CF F ICE OF E\T�ZpO\1iE1 T L +Z�� �c !R�. — DEPARTMENT OF ENT IRONAIRINTAL PROTfiCT 0 TITLE 5 OFFICIAL INSPECTION FORM=NOT FOR VOLUNTARY ASSESSAHNTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORNT PART A CERTIFICATION SIG} 9 Property Address: Vp -- ✓1Owner's Name:Owner's Address: 9Date of Inspection: oName of Inspector: lease ��� Company Name: l/� — ��— Mailing Address: O tv �a oa �6 41 a '� Telephone Number: ,So$ — 7�i — 5� CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the istformaron:?po—ied 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 sen-age disposal systems. I am a DEP' approved system inspector pursua=Passes ' 15.340 of Title 5(310 CMR 15.000). The system: Conditionally Passes 'Needs Further Eyaluaiion bv_ the Local Approt irg Aurhoriv� Fails Inspector's Signature: G� o� Date: S o2 0 The system inspector shall submi a copy of this inspection report to the Approving Authoritv(Board of Health or DEP)within 30 days of completing this inspection.If the system is a shared system or has a desi?n t io v�-of 10.0rjp, gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional o =ce oftlte DEP. The original should be sent to the system owner and copies sent to the'buyer. if aDpiicabl . a-d the ap rc,. -2 authority+. _ \ote.s and Comments t ****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. (0/01 Title's Inspection Form 6/15/2000 pale 1 Pase 2 of 11 OFFICIAL INSPECTION FORIM—NOT FOR VOLUNTARY ASSESS"IElTS SUBSURFACE SEWAGE DISPOSAL SYSTFM INSPECTION FORZT PAIR"I'A (� (/ CERTIFICATION (continued) ProoertNI Address: % SG4#7#! (/pod all t-r-- Orx•ner: �GP rl Date of Inspection! -a A0L, Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. Sv em Passes: I have not found any information which indicates that any of the failure criteria described in?.10 CN1R 15._0 or in 310 CVIR 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 m be replaced or repaired. The system; upon completion of the n�placement or repair, as approved by the Board of Health. z 11 pass. Answer yes; no or not determined(Y; ND)in the for the follon;inR state-..ents. If"not deter ruined"olease explain. The septic tank is metal and over 20 years old" or the septic tank-(whether meta'_ or plot) is Srructi�—ally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent.System will pass insp_ecnon if the existing tank is replaced Na-ith a complying septic tank as approved by the Board of"Health. "A metal septic tank«zll pass mspecrion if it is structurally sound;not ieaklng and if a Cer:fcate of Compliance indicating that the taiik is less than 20 years old is available. ND explain: Observation of sewage back-up or break out or hiali static water level in the distribution box due to brol:�n obstructed pipe(s) or due to a broken; settled or uneven distribution box. System:.ilk pars i^spe_t or if(::ish approval of Board of Health): broken pipe(s) are:eplaced obstruction is removed distribution box is leveled or replaced i N'D explain: The system required pumping more than 4 times a year due to broken or obstructed nipe(s). ! pass inspecrion if(with approval of the Board of Health): broken pipe(s)are replaced I obstruction is removed \TD explain: Page 3 of 11 OFFICIAL INSPECTIO`+'FORM- NOT FOR VOLU\T_RY ASSESSMENTS SUBSLRF_4�CE SEN AGE DTSPO:s_4>< SYSTFN•z ENSPECTI01 FORI.r PART A CERTIFICATION(continued) Property Address: % / NN L✓ood Q<<� Owner: lj'i N Date of Inspection:: C. further Evaluation is Required by the Board of Health: Conditions exist which require further evaluation by the Board of Health in ceder to de g_vine is the sys_er? is failing to protect public health; safety or the environment. 1. System will pass unless Board of Health determines in accordance.vith 310 CNIR 15.303(l)(b) that the system is not functioning in a manner which will protect public health,safety and the environment: Cesspool or pricy is within 50 feet of a su.-.';ace water _ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt rnarsh 2. Sy-stem will fail unless the Board of Health(and Public Water Supplier; if any)determines that the s3-stem is functioning in a :Wanner that protects the public health.safety and environment: _ The system has a septic tank and soil absorption system(SAS) and the SAS is R7:';in 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«-:thin a Zone 1 of a public ater su-ply. The system has a septic tank and SAS and the SAS is w th;r 50 feet of a p-ivate ware-sup.. The system has a septic tank and SAS and the SAS is less than 100 f--et bur 50 feet or Wore fro~t a private water supply well"". Method used to determine distance "This system passes if the well water analysis;performed at a DEP cei fed laboratoz-. for clii� bacteria and volatile organic compounds indicates that the well is free from pollution rom that=€ci i z the presence of amrlonia nitrogen and nitrate nitrogen is equal to or less than 5 prOrn,p-o:-ided tra-no o ^ter failure criteria are triggered. A copy of the analysis must be attached to this forri. 3. Other: i I Patre 4 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSIyLNTS SUBSURFACE SEWAGE DISPOSAL SYSTEII INSPECTTON FORAL PART A CERTIFICATION(continued) Property Address: / s On �+ ✓v� O�6�.Z V Owner: A✓! Date of Inspection:D. System Failure Criteria applicable to all systems: You must indicate "yes" or"no"to each of the foLo«ing or all inspections: Yes N .-Back-up of sewage into facility or system component due to overloaded or ciou2ed SAS or cesspool ✓ Discharge or ponding of effluent to the surface of The--round or surface waters due to an ov erioade or clogged SAS or cesspool Static liouid level in the distribution box above outlet invert due to an overloaded c_-cloT�ed SAS or cesspool v " ,kiquid dep h in cesspool is less than 5"be.low i:;vert or available volume is less Than i'_day o.: _ �/Required pumping more man 4 times_n the last year NOT due to clogged o:obs-t_rted pi?e(sl.\uMbe- of times pumped _ �-nv y portion of the SAS; cesspool or pr v is below hieh groundRater elevation.portion of cesspool or privy is A'thin' 100 feet of a surface water supply or ttibutar_.-to a surface rater supply. _ y portion of a cesspool or privy is within a Zone 1 of a public v:ell. / �riy portion of a cesspool or privy is«ithin 50 feet of p -•_ :a private water Supp �l� wel" _/_ `= Any portion of a cesspool or pricy, is less than 100 feet but greater than i0 feet fi-or• a priyaTe ,vale- supply well with no acceptable water quality analysis. [This system passes if The«yell Rater analysis.. performed at a DEP certified laboratory. for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm.provided that no other failure criteria are tri;gere'd.A coPy of the analysis must be attached to this form.; 6• (Yesh'o)The system fails.I have determined that one or more.of the above failure cri-e=a e:cat as described in 3 10 C'-,\,fR 15.303,therefore the s-,-stem fails.The system o%.-,.-ner should contacT .he Boa-- of Health to determine what will be necessary to correct the failure. E. Large Systems: To be considered a. large system the s-°stem must serve a facility with a design flow of 10.000 apd to 15.000 gpd You must indicate either'`ves" or "no"To each of the folloxyine: (The following criteria apply to large systems in addition to he criteria above) Xesno system is within 400 feet of a surface drinking water supplysystem is withlin 200 feet of a tributary to a surface dnnldne Prater supptsystem is located in a nitrogen sensitive area(Interim Vweilhead Protectior..zrea—i��•?e I1 of a public�- ter supply-well I If you have ansvuered "yes"to any question in Section E Lae system is considered a s?^_—ni_icarn t:_ez_; or ansr.-e-e yes"in Section D above the large system has failed. The ov;~ier or operator of am%large s;s;en,significant threat under Section E or failed under Section D shall!up grade the _ 5.304. —he system ox-�mer should contact the appropriate regional office of The.De m '' Page 5 of I I OFFICIAL INSPECTION FORM, — 'NOT FOR VOLUNITARY ASSESSMENTS SUBSURFACE SEWAGE DfSPOSAT, SVSTF_","vJ ENNSPECTION FORM PART B CHECKLIST Property Address: — 9 1,504110 1'/00'j �- 6_100- Owner: ra"<�r Date of lnspecti Check if the following have been done. You must indicate "Yes"or"no"as to each of the fol-'ow'Ii nz Ye,s- 10 Pu�xminc2 information was provided by the own,-r,occupant, or Board of Health V <ere any offthe system cornponents pumped out in the previous tw-oxveeks Has the system received normal flo-,vs in the previous hvo weekpeTlod? Have large volumes of water been introduced to the system.recently or as par-of f.'Iis inspoecrion Were as built plans of the system obtained and examined?(If they were not available note as N?'.A,) Was the facility or aNvelling inspected for signs of se'wage back up Was the site inspected for signs of1break out? Were all system components,excluding t1hee SAS. located on site ? Were the septic tank manholes uncovered,opened,and the interior ofithe tank inspected for il—coil"1710"' of the ba s or tees. material of construction,dimensions, depth of liquid,depth of sludge and depth Of Scum, Was the facility owner(and occupants it'different from owner)provided Niith info,, nation on the proper maintenance of subsurface sewage disposal systems 9 The size and location of the Soil Absorption System(SAS)On the sire has'beer,dere-nmined based On: Y s no Existing information. For example, a plan at The Board of Health. Determined in the field(if a-nv of the failure criteria related to Pan C is ar issue app-oxima-,:o.- is unacceptable) [310 CMR 15.302(3)(b)] T Pase 6 of 1 1 OFFICIAL INSPECTION FORM—NOT FOR VOLL1'T' R -kSSE.SSAIE\TS SUBSURFACE SE«'AGE DISPOS_-#L SYSTE-NI INSP ECTIO.,�- FORM PART C: SYSTEM INFORMATION Property Address: 92 t4 h h (.✓�� �� 2H Zvi dc3 6 � Owner: t1Gh Date of Inspection: _ RESI73E\TLC O«-CONTITIO\S / �5-1.23 N amber of bedrooms (design): 3 \umber of bedrooms(actual): 3 DESIGN flow based on 310 CtiIR 15.203 (for example: i 10 gad x_"of bedroors): ?3D \umber of cu7.ent residents: O Does residence have a sa-baae grinder(yes or no):-("0 Is laundry on a separate sewage system(yes or no)-;O [if ves separate inspection.requiree_1 Laundry system inspected(yes or no):/f/0 Seasonal use: (ves or no : Water meter readings, if available- (last 2 years usage(gpd)): Sump pump(yes or no): ,(/p Last date of occupancy: !' C0MD4ERCIAL/i 7DUSTR A,L Type of establishment: Design flow(based on 310 CvIR 15.203): epd Basis of design flow(seats/persons/sgft,etc.): Grease-Lap present(yes or no): Industrial waste hording ta.ril:present(yes or no): Non-sanitary waste discharged to the Title 5 system(yes or no): Water meter readings. if available: _ Last date of occupancy/use: OTHER(describe): GE.NTRAL ENFORMATIO\ Pumping Records Source of information: _ J� p�- '7d- /�vs- m v`e a -� iVas system pumped as part of the insp .ction(yes or no)�O v if yes, olume pumped: gallons --Hoy was auaniit'pumped determir_ed? Reason for pumping: TYP F SYSTEM _Septic tank:, distribution box, soil absorption system _Single cesspool _Overflow cesspool _Privy Shared system(yes or. no) (if yes; attach previous inspection records, if any, _Inr!ovativeWternatlye technology. Attach a copy of the current operation_and maintenance obtained from system owner) _Tight tank —Attach a copy of the DEP approval , _Other(describe): i Approximate age fall componen in (if lMoxvi- nd sour e of irl o :a en: Were sewage odors detected when arriNing at the site(yes or no): T;t1 ; 1-_t;-, L .. 4,,,z nnn F Page 7 of 11 OFFICIAL._, I!'SPECTION FOR-N- 1-NOT FOR VOLUNTARY ASSESSAIE TS SLBSURFACE SEWAGE DISPOSA-L SYSTENT I\SPFC'TT0 FOR:\ F AR1' C SYSTEM E FORRMATION(continues) Property Address: ('4nOvl 4/00ol Q✓ O«-ner: eq h -e Date of Inspection: p SLZLDING SENIVT'R(locate on site plan) Depth below grade: Materials of construction: I/cast iron 6/40 PVC_other(explain): Distance from private water supply well or suction line: Comments(on condition of joints; venting; evidence of leakage. etc.): SEPTIC T.4\K (locate on site plan) Depth below grade: A9 Material of construction: onerete—metal—fiberglass -polyethylene —other(explain) If tan':is metal list age:— Is age confirmed by a Certificate of Compliance(des or no): —(mach a cop: Of Dimensions: Sludge depth: Distance from top of sludge to bottom of outlet tee or baffle: o� Scum thiclmess: — /i p ,� Distance from top of scum to top of owlet tee or baffle: O Distance from bottom of scum to botto pf outlet t� or ba 1e/ How were dimensions determined: p e Comments (on pumping recommendations; inlet and utlet tee or baffle condition;stnacrara1_ i nteg liQ_::_d as rpalated to outlet invert; evidence of" akaae, etc.): oe i'? / OV"lih,P.-�c%G1. / Q'' R"►d S �d! ciOQ� COr+�. art, A S GREASE TRAP: _(locate on site plan) Depth below grade:_ -Material of construction:— — —concrete metal fiberglass polyethylene other (explain): y — — Dimensions: i Scum thicLness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or bafaie: Date of last pumping: Comments(on pumping recommendations;inlet and outlet tee or baffle condition,s-uctu:_1 as related to outlet invert. evidence of leakage. etc.): I Pase S of N OFFICIAL INSPECTION FORA—NOT FOR V'OLU--\TARP ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL; SYS=V1 I` SPFC'T7Cj:\- FORA, PART C SYSTEM INFORMATION(continued) Property Address: -92 J t�n WOoc1 9— O,wner:� Date of Inspect n: p TIGHT or HOLDING T_41NK:�(tank must be pumped at time of inspection)(loc.ate on site-plan) Depth below grade: Material of construction: concrete metal_fiberglass_polyethylene o.e_(explain): Dimensions: Capaciil.-: Uallens Design Flow: —gallons/day Alarm present(yes or no): Alarm level: Alarm in working order(yes or no): Date of last pumping: Comments(condition of alarnn and Boat s«=tches, etc.): DISTRIBUTION BOX: (if present must be opened)(iocate on site plan) Depth of liquid level above outlet invert: eiorv7 Comments (note;f box is level and distribution to outlets equal;anv evidence of solids carryover, any ev dencc o leakage itozout f box; e)caa� 40 S_ofi //m PL-TIP CHAMBER: /V �(locate on site plan) Pumps in working order(yes or no): Alarms in working order(yes or no): Comments(note condition of pump chamber, condition ofpumps and appurtenances; etc.): Paze9ofiI OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL. I-SPECTION FORM I'_4.:RT C SYSTEM INFORIMATION(continued) Property Address: ild 07 &100c / ew i Owner: (/ G►�y� Date of Inspection: v► 0/ SOIL ABSORPTION SYSTEM (SAS): (locate on site plan,excavation not required) If SAS not located explain why: Tip 1 6X /�— �GS leaching pits; number: ' leachir_a chambers;number: leaching galleries,number: -0 leaching trenches;number;length: leaching fields,number, dimensions: overflow cesspool,number: irinovative/alternative system 1 ype'name of technology:_ Comments (note condition of soil,-signs of hydraulic.failure,level ofponding; damp soil, condition of•egeta en.. tc. : / C7 1 ✓I v_ CESSPOOLS: /f/ (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 laver: Depth of scum layer: Dimensions of cesspool: Materials of construction: Indication of groundwater inflow(yes or no): nti Conents(note condition of soil,signs of hydraulic failure. level of ponding; conditon of vegetation; e7c.): PRIVY: locate on site plan) Materials of construction: Dimensions: Depth of solids: Comments(note condition of soil; suns of hydraulic failure. level of pondina; conditio-of T:al.. C T__.___y " • Faae 10 of I 1 OFFICIAL INSPECTION FOR_VI-NOT FOR VOL€NTARY ASS ESS-IEN T S SUBSURFACE SEZN'AGE DISPOSAL SYSTE-1 ni SPE C°TTON FnR-A-f PART C SYSTEM INFORMATION(continued) Property Address: Owner: �n Date of Inspection. SKETCH OF SE«%AOE DISPOSAL SYSTEv Provide a sketch of the se«,age disposal system including ties to at least t«-o permanent r eerence landmarks or benchmarks. Locate ali wells within 100 feet.Locate-there public-,cater suppl}v er_te-s the buildim—. U IT- O le- A Tio-lo Tn crnrfinn L.. Lit::nnnn n a�C 11 U1 1 1 OFFICIAL INSPECTION FORAM—NOT FOR VOLUNTARY ASSESSMENTS . SUBSURFACE SEND AGE DISPOSAL SYSTEINI INSPECTION FORM PART C SYSTEM I1<FORRAMATIO\(con nued) Property Address: S vlo G✓'ood P/- Owner C h 9 Date of Inspecti SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to `round water �ot feet T14} ek.„ le"11-ant o 'e--1- Please indicate(check) all methods used to determine the high round rater elevation: Obta' ed from system design plans on record-if checked;date of desicr plan re:lewed: served site (abutting propert)7/observation holey.] hi 150 f yeyt of S Checked with local Board of Health-explain: /'/ � T f�!/�t.�:.: = a 0 Checked with local excavator. installers-(attach documentation) Accessed USGS database-explain: i You must de ribe h99�w� you establis�,iPd the high ground water el. Nation: J � THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH TOWN...........................oF.........SARNS E...--.------......---------...._._..-----...---------- Apphratiaan for Disposal Warks Toustrurtivit Vlerutit Application is hereby made for a Permit to Construct ( X) or Repair ( ) an Individual Sewage Disposal Syst at ���� �.1 l�1�1�.. "`� hy.`:............•--.Wt A.4.2•---......_...__C11, L,on-Address or Lot No. ........G P _ma y- --�� -----------------------------•-- ..................SLln1.1y._ d.-` igxr..._D(—---_--___------•------------ er / Hyannis Address •--•--•-•-----••••. fresl_. . ..----••-•-•---....-----•...................... .........•--••--•-•----••-••-----........-----••----•-•-----••-••----.........._..•--••••-••••---- Installer Address Type of Building Size Lot----JA__1.57J132._Sq. feet U Dwelling—No. of Bedrooms...................3..........._..........Expansion Attic ( ) Garbage Grinder (no) 04 Other—Type of Building ____________________________ No. of persons............................ Showers ( ) — Cafeteria a � Other fixtures _.____....-•----•----------•--•---•-------------------•----••--------_..----••--:---------._...-----•-------------------•--•-------------------------• W Design Flow....................................55____gallons pet person per day. Total daily flow...................:,_3311...............gallons. WSeptic Tank—Liquid'capacity_.].QQQ.gallons Lengths:'-6''__._ Widt1V_=1D_"_....Diameter________________ Depth__5!-_4"_. . x Disposal Trench—No_ ____________________ Width.................... Total Length.....................Total leaching area....................sq. ft. Seepage Pit No...........7......... Diamete'r........12'_____ Depth below inlet_3...6.7.1........ Total leaching area__25L........sq. ft. Z Other Distribution box (X� Dosing tank ( ) '-' Percolation Test Results Performed by.__.___Cape_Cad..Sur'Vey___Cbrisultants_ Date-_12/C/84..................... Test Pit No. I.........2.....minutes per inch Depth of Test Pit.......12_!...... Depth to ground wat ...... Test Pit No. 2................minutes per inch Depth of•Test Pit.................... Depth to ground OF O Description of Soil._Q"_-6": X2S�._1S?arilf.._5"-SQ�.._3nQi6m__Sandyt_5ubSo.7.J_____________________________ g ------Att-YN------- 391."-96..... .mse--- ......'_sand__ana__gzay.el.F...26'7,141"__.atxatifi ed_.sand.---=............. a-----waL-soN------ y W •--•-•••------------••------------------•----•--•••----------------•-----•••---•-••---•••••-----------.. ------------•--•••---------•-•------•--••-••--••-•---•--• --A 'p.NcL3021fii�} UNature of Repairs or Alterations—Answer when applicable._____________________________________________________________ 90,�.� 1gTEa _ -------•---•--•---••----•---•--•-----•-------------•-•------•--•-•--•---•------•-------•----------••----•-•-------------._._._..-----•----------:...--•-------._._...-_--- ASS/DNAI.�N6 Agreement: e r atc- , The undersigned agrees to install the aforedescribed Individual Sewage Disposal System 1 ordance with/-ZK-2S� the provisions of iITLL 5 of the Stat rotary Code— The undersigned further agrees not to place the system in operation until a Certificate of i c has b en issued by the board of h th. Application Approved B ." "---- .,.. _.. 'ate / eS PP PP Y Date Application Disapproved for the following reasons:...........................................•................... ••--•----------•-•-----•---••-----------•-------- ••....---••------••----•--••-•--•-•------•---•----••-•-•------••••-••-•-----•-•••-----•-•---••-----•---••.._..•--•--•-----•-----•--------------=-------•---------•--•---••••----------------------•----•- Date PermitNo......................................................... Issued....................................................... Date No...... `•�-=.1.� r ` FEs.......�!=_ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH `fit N........................OF..........I TS' I,F�...........-•---------.......--•---.................. Appliratinn for Riipuiial Workii Tomitrur#iun 11amit Application is hereby made for a Permit to Construct ( X) or Repair ( ) an Individual Sewage Disposal System at: ................---......_...................................................................... ..................... ........................................................... Location-Address or Lot No. .........C.a�1C�QI Realty .-leam.......................................... ar._ Hj��..�.......--Address.. Installer Address U Type of Building Size Lot.....IA.15,.032.Sq. feet I-. Dwelling—No. of Bedrooms....................3.....................Expansion Attic ( ) Garbage Grinder ( IK) aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) dOther fixtures ....------•-----------------------------------------------•••••••--•-••--------------•--•--••••--••---............•••............................... W Design Flow.....................................55...gallons per person per day. Total daily flow.......................330..............gallons. WSeptic Tank—Liquid*capacity...a.-OQOgallons Length Width4.1...10".. Diameter................ Depth....V..4" x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No............I...... Diameter.......... Depth below inlet..3.C7'...... Total leaching area....25.1.......sq. ft. Z Other Distribution box ( X;9 Dosing tank ( ) aPercolation Test Results Performed by.........Cap..Cod..S=.ey..� 3,tS Date....12/6/$.4................ Test Pit No. I..........2...minutes per inch Depth of Test Pit.........12_._... Depth to ground water fi, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground wa fie. ...QF .. a ------•---------------------------......................................................................................... --'rTEP+4�--- O Description of Soil--0.:.-5��__�91 ( ..7.Qsl;....�"" 9��..3 ? _.� ? y.--,S9S9 ALLYrI_...... r`�n x 3®"-96"-coarse.: : sa?x .and..g ave : "-�-44" st, at fi�ci WILSON y U _.... W 30216 .o-..No....... U Nature of Repairs or Alterations—Answer when applicable.................................................................. 9or G/STEM S�aNAL Agreement: --.* The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in a rdance with jfj�gS the provisions of 11.TLE 5 of the StatSknitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Ca ceXias been issued by the board of It h. gned 1_.O �1 C 1... -•-•--•--••---•-•••••......... Application Approved By....._".':= = ! .. _ y1<. :�4:4. D�eg'�, . .. w_._..A.:... �Date Application Disapproved for the following reasons--------------------------------------------------------------------------------------------------------------- ---------------------•----------------------•------•--------------------.....-----------......------------••••••-••-----•---------••--•-••••---•••••--•-------••-•-••......----•-•••••••--••--------•--- '. Date PermitNo......................................................... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........................................OF..................................................................................... (Intifiratr of Tontphattrr THIS IS TO CERTIFY, at the Indivir— bySe age Disposal System constructed ( ) or Repaired ( ) ....-••••............... ................. ...r~... ------...............-----------------...........----------------------------•••..........•.-- at--= ... �.. 0i+ ... has been installed in accordance wittrt4 provisions of TITIZ j of The State Sanitary Code as described in the application for Disposai Works Construction Permit No.__...E5... 2.-..l._?._ ....... dated........2:. :? ......................... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CON TRUE® AS A GU ANT E THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE--•-•••..•... 1 ................................... ' Inspector........... ----•••-- r THE COMMONWEALTH OF MASSACHUSETTS i BOARD OF HEALTH 2 ..........................................OF........................ ............ NO...................... FEE...... ........ laiilposal or .5,Tnnlit 'Wlt rrntit Permission is hereby granted............... ---•- •-•••••••••-------•-•••-•••---•-•--••••••--•--••...................... to Construct X r �epair (� ) an Individual Sewage Disposal Sy em atNo.... .................................. ..............n... ................... ................ Street _i y' ; as shown on the application for Disposal Works Construction Permit N ..................... �nDated--_-_.:S>/.��� ............. n Board of<Health DATE != 3- - ' ------------------ FORM 1255 HOBBS & WARREN. INC., PUBLISHERS TOWN OF BARNSTABLE LOCATION '99 \I A r)q. —UJ00-6 !E�Q SEWAGE#. ks—"z3 VILLAGE ASSESSOR'S MAP&PARCEL„2??j�,��� INSTALLER NAME&PHONE NO. SEPTIC TANK CAPACITY to p-y �-Q LEACHING FACILITY:(type) R'i (size) C/ NO.OF BEDROOMS—, LdT T OWNER in /v' PERMIT DATE: Z 'f IZ� COMPLIANCE DATE: 1 Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility feet Private Water Supply Well and Leaching Facility(if any wells exist on site or within 200 feet of leaching facility) feet " Edge of Wetland and Leaching Facility(if any wetlands exist within 300 feet of leaching facility). feet FURNISHED BY Yll'T pa:lM— 1-— a tiI o - ! F r y x•o: �I , flu vp" r x illo S 77o i:c vo e ASSESSOR'S MAP NO. PARCEL -'3d 'Fr /a.3 L A 7 ION A, S E W A G E, PE R M I T NO. VILLAGE I INS ('Ll EJVS N i D D R E S S L, S B U I L D E R OR OWN ER h � DATE PERMIT ISSUED Lf a O ` DATE COMPLIANCE ISSUED 5 �� ' � � � � � ` � ,: �.J r � I I .i � - { , � t ;. �i j" �. �� Fint THE COMMONWEALTH OF MAtSACHUSETTS BOARD OF HEALTH. .............3OWN..................OF.................I...�...S T2 1!�=.. ................................................ .. ........ ' 11A_ _* ( .2 Appliration for �Wpvsal Workii Tonstrurtion Prrutit Application is hereby made for a Permit to Construct (XX) or Rep'air an Individual Sewage Disposal System at: ............ .............. . ........... ........................................................ Location-Address .............or Lot Xo. .............ca9c,ic�.Ztogku.t .11MY ................................ ............ .................................... Wner Address .... �....7� . . ........Lil............ ...........!�Y ...................................................................I ............. = Installer Address Type of Building Size Lot..��i..(].................Sq. feet U Dwelling—No. of Bedrooms.............3 ...............................Expansion Attic Garbage Grinder (pc) P4 Other—Type of Building ............................ No. of persons............................ Showers Cafeteria P4Other fixtures ... .................................................................................................................................................. Design Flow................................55.......gallons per person per day. Total daily flow.................... ............gallonsW . Septic Tank—Liquid-capacityl.00-0..gallons Length..q..._..6..... Width.1-1710" Diameter________________ Depth.5.'-4' Disposal Trench—No_ .................... Width-____._.__._.__._.__ Total Length..._..____._-_._._._.Total leaching area....................sq. f t. Seepage Pit No------------1------- Diameter..10.!........... Depth below inlet5-.67.1......... Total leaching area...257.......sq. ft. Z Other Distribution box O Dosing tank Percolation Test Results Pei-formed by.JC4P_a._C ..Su COnsultants 8 ....K.V.gy..................................... Date...q:�l Test Pit No. I-----2---------minutes per inch Depth of Test Pit......U1........ Depth to ground w ---F ...............L14 Test Pit No. 2................minutes per inch Depth of T*est Pit__..__.____.__.___.. Depth to ground STEPHEN... ................................................. ........... --------------------- .............. ......MEW....... ........... cn 0 Description of Sofl..kbk---Q.1 77�6"...WQ -24" Brn. Sandy Subsoil Q ................................................... ...t........ ........... .....WIL-Sor#----- I ' stzatified &���Kqj;...72.-'.-.144................................................... ... Na--302 I.. ........ :... -V ....................................................................................................................................................... to U Nature of Repairs or Alterations—Answer when applicable.................................................................... IVAL- ........................................................................................................................................................................... Zo'es o,a— Agreement: - -Fir The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TI Y )f th State Sanitary Code— The undersigned further agrees not to place the system in I'L 0'0 e of mp"ance has b,S_ e d.... Da operation until Aa " f mpliance has been issued by the board of I 11th. a 2�­`eol t .........................pp rftle�� _ . ...... Application Approved By............ ..... . ................0 .................................................... ....... ate Application Disapproved for the following reasons:................................................................................................................ ......................................................................................................................................................................................................... Date PermitNo.......................................................... Issued....................................................... Date No.. .................. FEs........... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ...............TOYaJ.........-......0 F...................B..AAR..NSTA13LE........... Appliratiun for Uiupuual Works Tonstrnrtion VarAft Application is hereby made for a Permit to Construct (Xg or Repair ( ) an Individual Sewage Disposal System at: •--_--•---Lot #..1 ..... ......................•--...----•- Loration-Address or Lot No. Q-1px1t7Jm.bllE'Aa 7..'�1.5 .........---•-------•--------- -------------S�lrill LI�CX -Idi1H......... .._.. f- Owner Address t Installer Address 9 Sr o00 Type of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( p6 Other—Type of Building No. of persons............................ Showers a yP g ---•--•-••----------•------- P ( ) — Cafeteria ( ) QOther fixtures ...................................•--------------.....------------------..............._..........--•--•-•---••---- ------ Design Flow.................. .............55.._...gallons per personper day. Total daily �w---------------------:7"' Q..........gallons. WSeptic Tank—Liquid'capacity.1d�B_gallons Length._ __._6.... �Vidth...4..... __. Diameter________________ Depth_.5 ..4.... x Disposal Trench—No. .................... Width._........._........ Total Length.................... Total leaching area....................sq. ft. 3 Seepage Pit No.............I..... Diameter.._a.0.!.......... Depth below inlet.5.670........ Total leaching area.....2.5.7......sq. ft. Z Other Distribution box ( * Dosing tank ( ) W Percolation Test Results Performed by.._ _jQgd_.59? VM..COrL9Uta??ts...... D ate..... 2/6 Test Pit No. I......2--------minutes per inch Depth of Test Pit.......t2........ Depth to ground w 44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground --STEPHEfW' �yN Ri .........•••-•.....................•-•••---•--------.........----•----••.................------..._.........--.... ALLYM--•-... {n D- Description of Soil.... ._0"_V P.bod Loa-V-24" Brn. Sandy? .�11b i1� y JL50N------ •i x 24"-7 2...Stratified sasz� �_c.-Gve1;..7�.. 11 4" r�at .f_iecd sat`x3 No.3o... V ------... .09 UW -•----------------------------------------•------........-----......---•-----•------------........---•----------..._...------.......---....----._...-••••-......•---•---• o CASTE Nature of Repairs or Alterations—Answer when applicable.....................................................................�`�ssAQN Lea / Ll/ Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with f"1T IT1�. ^ the provisions of it IE 5 of th State Sanitary Code— The undersigned further agrees not to place the system in operation until a�Ceitifi e ofmpliance has been issued by the board of h i Siff .....- ----------_--_-------- ApplicationApproved By. -•-••-------•--...----••--•-•-•----------••--------------------------- ........ - - --------- ate Application Disapproved for the following reasons:................................................................................................................ ................................•-•-••-•••---•-•----•-•-•....--•-•---•--------•••--•-----•--•-•-•••----•--•-•••--•••--••-••----••-------•-••---------•-•---------••-•-•-••-•--•--------••---•....._.._. Date PermitNo......................................................... Issued-....................................................... • Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........................................OF........... .. ....: ............................................................. Trrtifirab of faomplianrr THIT-Q'GE�Z�I� That�eA Individual Sewage Disposal System constructed ( ) or Repaired ( ) by........... ... '_ ..... • ............ -•`u....-'-- 1 `-••-------......... .. .................................... ---- at ... -•-----------•----------------------------------------- ....................................... has been installed in accordance with the provisions of gf1Th.,,,,e State Sanitary " de?s described in the application for Disposal Works Constriction Permit No......................................... dated --.-_______-_----.-__----_-_•----- THE ISSUANCE OF THIS CERTIFICATE SHALT. NOT BE CONSTRUED AS A GUARANTEE THAT THE -SYSTEM WILL FUNCTION SFACTORY. DATE................. 1� ..------..._---••----•...-_.. Inspector...-----------I•-----k....................................................... THE COMMONWEALTH OF MASSACHUSETTS i BOARD OF HEALTH .....................................-...Os=..................................................................................... No......................... FEE........................ Permissi �i��tla',�i�l murk$ �ua����tiun rrnti� on is hereby granted............ ...........=n=r -n 1 to Constrt�c� ) gr, f epair�( nn Indiv�iduial Sec g Di oral Sy t I r� � atNo.... •....•--....--•- ----•-•-•-••--•--... .................................................... = Street �:Z 23 as shown on the application for Disposal Works Construction�,.E_erzx�i o.__.._.... ��/� D ---------- _ -------------------------------------•----------•-----------......---------------•••......•-----......•- li Board of Health DATE............... .................................. L FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS APPLICATION NO. '39z _ f . " --- --— . .« E� fi ,r� NO. DATE {< I - DAn y 0A,rE TFST/NG CJ fti O T a ' Y 6AL. e TAIL: T,77-5,,r By., _ �_ _Lt` _Nz pATE OF TESTING: Uc � tom„ . f ,� s. �, r _ Ns -- ' _y , _ ..._ _� _ __� __ , _-_ — 1 F.. TOT E 5 ! t •w r �';�;�'E5'SED BYE - , � T-; ,-- ! � Nr N4' OF OUT`I. T`S`_ ' _ f1"L Tc) COyF�F!r� G F 'rEDUREME" VEST t9Y' v' 4s_42t� .ccc c•: "'-: --- --- --- - ___- ---_ __ W/TNFssED BY _ '_ fF ?- - -- _ is M012� A/Y ; 3.�C Tii 3�i YY] iS20r'�"tA� k�XS}hxC 2�15 �Sis'a ,,. }- tit �, '- -e — �� ¢ ��` L 7/, 7 ` c /2 T L�` AN I(LF BR0 GHT'TO e ,. _ $ __...._ $ ! Y`°G.,>iV 5 pY. { '. A • ;.� -!' ;, �!N,' h GRADE` 2`'PEASTOI ` a. . G 1 S t� �1 r -- ___ _- - _ - __ c _. - _-- - - ---- -- -_. ---- --- - -- --_ ---_ _ - - 3 CLEAR R ; C�EAR _ t �rfa �- �1i /`""; '. ' TEST - G"M./N. -3"aflN s„MtN � _ i _ ' r AS REOUIRED� <* L _ ! :S.�_ _._o, ' - _ - RA T c /7� -�r'�'..r �h� _ ° INLET TEE • t 'r 10:.M/N � r -:7UTLE7, TE t �` j , BOX ._ E _ a t { M P - � 4 C.1, '^rO GAL, i t ail � INLET ANO OUTLET 4' D MItL'IRs!UR CU% E7' TEE ©Ef TN 1 ��TAB' `gi n�'.:. i c� LIOU;t) DEP 1� ��, /4• Ai lt,�lll:7 JF_PTKelf- q' B / :oi ! 2" 6'' f.:a L ___ t PRECAST OR BLOCK r ££S BE CAS 1 C.RETE I :,v + " % - - - ----- �� N R PAl.r P!T - --- + DEPTH OF TEsT` R a y '¢ _ _ a__ - ��_ `�tT!` pV..C. O S7-iN I tq , °_ �� n� � �� � t 5• E' t �N' __ - ---- -- -- ---- — a ll a -.� Sr � 4 ,U C. ., Tr .__ PL4C'E CONCRETE f i r i --_----- __.._--__--- ..___._. ._.__.__._____ C©rVCR�.TE "�I,i 34 g 8O OM ON LEVEL ST4hLEtj.4.SE _ t ; r" ' - - --- ---- --- - ON,�TRUCTIO.N a+ !� _• _.___ �._, ..--�_ #, ____ -- __-_-�- --- ----- --- - RATE _J--(W4TERTfGMT1 r i� , # t /NEE. r,6 PROVIDED WN£RE SLOPE # lcpLNpgjt^ON I ; ;'r-- ,•.s _ 0 E P%PE ExCEE05 0,08 % Ok r _------- F lNL T t . _:.e_' _ ._'_-._ TAlVX. i0 BE uegL£ TO bt{!TKST.9NL' !,y 4 PU,MPEO SYSTEM I ! 607TOAf OF TdNK OP! LEVEI_ STAPLE 84SE c./_./0L.040iNv UNLESS�ER 20 Nth: t \ :W.gSHEO S NE'� -' --- - - --- - --- - ---- ---- TO P.A'f/EMENT OH/,'V DR,�%E.N-2U a I t S I Q,^/,p# # I i,OA U/NG UNDER PAVEMENT OR i - I ORIVE SeS V i h .�-.. .:,....._..w. ww.....w.v..m..A.�r.w.c ..,,,».._..........�.........._u....»r.-.....,.,.:—.....:.v�.wvwr:".......�:�v.•..v...—..-.,........weE....+.r.,...a.r.�..vv_•.....-.....,+n._.M. a � F.....=v..�+.'iwu�m....-..�......... .-_........,.... r....,_.,,4.»,....r+.n,.r.......r...w.w.n.+.v...,.<..:.a...w,v..++........".w....,.—.....,::_.........w..rsw++.w:+w.+...er.;.rv+n,..a.v.�a.«..,<.�_w.�..v.+,..w..,..<,a..n_..,......,._�w-...,�.....:.,.....^gym_:..,....•—.... ,....,t...n,_....-w....:.. .s..a+,..... ...�._. .�,._....rw;,,. ..•....,+.+..a.ea...+.,w.,+w.....N_.. � `� � " _._�•..v�,..-..wa._.._..m..,,......�.we....,,..._..—........-......w....w.._wr.ue-,....-r..w-..r.<.�w...,....�+w.......rw.+.....r,w.vA.car,....a...,....,;..w++..+r*.....,..........:�.ua-rw,.,. �,.. y�� M.. t�• _..,_.-- THIS' PLAN/S FOR THE DESIGN AND CONSTRUCT/ON OF THE SEW,46Z- # __ r 015PO SAL FACI L I T Y ONL Y. INV AT BUILDING INV AT SEPTIC TANAWN) �'. ALL CONSTRUCTION METHODS AND MA TER/AL S SHALL :�h'F!`?R,3? T!� t � ,. MASS. D.E.IJ.E. TITLE 5 A.ND TH£_, Nsr•4 c 804RD OF i IN AT, PTIc, TANK�L�1',= ? ' f 1C HEALTH REGULATIONS. ' $ ,,{ :._^� of 4 yri .._ `h V AT Ui T BE?X lIV,� C j ` g � /NV. AT Dlsr. eDx(a✓T) -Z 9, A T LEACHING FACILITY-' BOSTON; MASS. WORCESTER, MASS, A7 Fc?TTO/!? Fp1T- __. .. _.. HAILIFAX, MASS. NORWELL, MASS. ` BEDFORD, MASS, i_. XJINGTGN, MASS. HYANNIS, MASS. MANSFIELl'), MASS. ( C:RANSTON R.I. .BERRY, N.H� 1 S ,.«,...:_,..,_......_r......,..... __ __..,_,._.,..a.�.a..r�.......-.,....—.s..rw��.......w...,.w,.,.,.,.aw.,<,,�,.•.,..m._..-._..w.w...,_....w,.<..<___-'_-. ....w,w__...w.�..,..—,....,.-..,,..,.._,,.......a�.i ti d e r t E f d B C i e 4 r S DESIGN FLC1W� ° f REQUIRED SEPTIC TANK 9 .� SEPTIC TANK f' O ! = .1��r"_ --- G >> CAPE COD SURVEY -�,� REQUIRED SIZE LEACHING FACILITY �Q *� �� - _- --.. r 32fi1 Man Street' Route 5A Barnstable Village, Massachusetts 02630 3 n Number { 62 813.E i t DIVISION OF erf�l"r� I BOSTON SURVEY CONSULTANTS INC. SIZE OF LEACHING FACILITY PROVIDED: ENGINEERING « SURVEYING PLANNING, xi V � TYPE OF SYSTEM • Qf , r ti. I ' sSEWAGE DISPOSAL SYSTEM - -----'-- • r>,",--- .�' ••M` .� -� —�` �-. �,.,, ,% - DESIGN r i ' f 7 '4,? 14 i • a ' t«a.e> , •. 67 �+ I ! l,/""4V,..+•f s"`� p .r. r E ' � � J J, I 't s FOR: �+ t A ,I. REGTy J'C/J fir`� 1/f y 00:�V/`o* .,. cv �`�•'�f" c \ _. f SCALE AS SHOW r METERS C) rS/!J C'``� G`T ./�'f' f r`T i S / T -f.4' .1� 7"" �' , FEET 0 ICJ Zop � f DATE: j-4I c / St,IS'V 'Y' c":iV 7". / F' r�L:'c:!/�'Q ! V `� `''`' S� J".�d4rKd' ,k� G 4eA.Ve COMP./DESIGN: $, f' ai'�•� �, ,A.UA 30 ' c{ECK: ', i ,�,a 7* jam/.4 /G �0/'R 0 6l , 4 R ('G%/L MELD: 1 F' t:�Ch �_ OW T � FILE NO: � ��.tl.% T'N �"JL.%'E" ['� .fi' .F°..y✓✓i,o'W',�tV�'�' "5 c:.�9str'�=, _ - -.__.-__ __..__ -..__-__. _ Pu E3 !E31:: DWG. NC?:.�`t,! J 0 B NO:�._ ? -f 1,V F-E? 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PERC TEST APPLICA7ION NO. P ?914, � REVISIONS: ..+,... •;«` . t a �.. r,,y • "� >.,. .;ea-. # r.;�, x �.. fr ,.,�..'. i r —" "u '.gip°'" � x G 'ra,o'' 4a g ?'� 8�J C '' 4'' 'tk - NO. DAT F DATE OF rEST/NG © '.� _ 48Y_-- - r s :`x_ . �. _. 6. _ s _ > ff TES' /� DATA � � _ _..i L/. b.s� r D ">� T �`� ,./4. � r w.• �, ! ' �� g �^"s � ��{ � .�l./C�� G�4 L.� �'/S� 1��,� � � �.� � � � a� . �,..� � ��{ � .,�. f �.. -- -- TE 5r By , �.-1.�'�G�G.� s.�.5_� r s To CONFORM To T/T t - DATE OF rEsT/rJC L �• �n ��+ `� TANK TO C.'ONf i'1RM rO .l,-Li 5 RF.C/ IRf>1�E,NTS. E 5 REO(il�+'EME,vT; T. P j w1,rNE 5SED BY _: _ = ! N0. Off' W rL ETS` ----�- - _ TEST B Y .a_zv i�.:.�c N (�c, ,7 2 -- ' - W/r N_E SsED BY, _ �a►_ !'`FQ R17 _ $s - ,r ,"Jj, _' rii ,.� ,�, �.h< �nr-::j :' its _ a. _ t '-.>'_ �� __ u `.� _ - REVO C,u4HLE .;OVEF 7 T TO4 L PEAaTOII�EQ,.t./N �N GRaOE. r . 12 (OAMBfILL /2"M/N. - . f , -- - - _ 7 . 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D ? 1 Aar �r'iN F.4 I IT) : ry 3r_6 i Main Street Rotate 6,� Barnstable VIl;age, Massachusetts 026K) rr1:� a Numtk er (617) 362.813" -t DIVISION OF f BUS1"t7N SURVEY Ct�NSULTANTS�INC � `� ` ��` `' "aJ f ry 1:'E OF LEACHING FAC/L./TYPROVIDED cNGINEERING SURVEYING PLANNING e. . •� E OF SYSTEM 0 � '- i - 7Tri-> t:,!" f`'.i.nj 1 �4� ! `• !i.. __ TITI..E. fr ✓ tJ (� �' f 7" i /. { /^�d c� ° 5: Pf> :tip to. ^.. Al av- s SEWAGE DISPOSAL. SYSTEM DESIGN 4,� / 7 / Y , p " � 11 v Z:_ cam" {� F O R w R C'o-Ar'P/c FG Ftt'� rY? G C. C. ✓ ! /' 'u Po,N 0 • SU�'vE.Y G'N TN,�' CC h����lVL �� , ,� , � SCALE AS SHOWN r 1-'' - METERS T- Y �} CS FEET G Z C, DATE. T J.t?N COMP./DESIGN': t S f3-•9C!`C S 9 4 ' �`�r ,�' cc `�`^ CHECK: .✓ f x �L. �s_oe /V <V, V L3. FIE' F' Lr. /'S`fr•�'1�' /�' 3 � 5�"T .r.� -4 /C> G'��?ecrc,4t? „"'c"',a1C.`. _.._---_-_-_____ ___�.r►r------------.__._- --_____..___-....._ .___.. 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