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HomeMy WebLinkAbout0028 TANAGER ROAD - Health 28 Tanager Road _..... _.....�_.. _ _ _ .. � � ._...,,..___.._......�.... w._ _....__.. Hyannis A= 268—023� u a C e ° n v u o0 e � °° Fill Y- a Commonwealth of Massachusetts . Title 5 Official Inspection Form Subsurface Sewage,Disposal:System Form -.Not for'Voluntary Assessments -- 28 Tanager Road Property Address Jane R. Ha Owner Owner's Name information is required foe every Hyannis MA 02601 December 4,201.0 page. Cityfrown State Zip Code Date:of Inspection 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 A. General Information filling out forms I on the computer, r „ use only the tab 1. Inspector �J key to move your cursor-do not David D. Coughanowr use the return Name of Inspector key. � Eco=Tech Environmental Company Name 43 Triangle Circle Company Address Sandwich MA 02563 City/Town State Zip Code Z08 364 0894 1328 Telephone Number License Number B. Certification certify that l 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 or:)Title.5(310 CMR 15.00.0). The system: ' Passes ❑ Conditionally Passes ❑ Fails _ ' i . .� ❑ Needs Further Evaluation by the.Local Approving Authority R� s December 4, 2010 ( Inspector's Signature Date The:system inspectorshall 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. ""*" p y at the time of inspection and under the conditions.of use This re ort only describes conditions at'that time.This i'nspection.does not address how the system will perform iri the future under thesame or different condition&of use. f6irvd 09108 Title 5 Official Inspection Form:Subsurface wage Disposal System•Page 1 of 17 Commonwealth of Ma --ssachusetts - - �v, Tithe`5 Official inspection Form _ — Subsurface Sewage Disposal System Form -Not for Voluntary.Assessments 28 Tanager Road Property Address Jane R.Harty Owner Owner's-Name information is Hyannis MA Q2601 December 4; 2010 required'#or every _ page. cityrrown 'State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B',C,D or E I always complete all of Section D A) System Passes:: I have not found an information vhich indicates that any of the fail ure>criteria described in 310 CMR 15.303 or in 310;CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: Inspector's Note==> A septic system is deemed-to pass this.Real Estate Transfer Inspection if it does not trigger any of the failure criteria listed below. The septic system has-been evaluated according to1he:conditions observed`on the day,it was inspected. No estimate or guarantee of system longevity,is made or implied by a passing determination. Removal of garbage grinder is recommended, 8) System Conditionally Passes: ❑ One-or more:system`comporlentS'ag 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: t .. *.,A metalaeptic 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, ;Q Y ❑ N ❑ ND,(Explain below): t5ins-09108 Title 5°Official InspectionTorm:Subsurface Sewage Disposal system Page 29117 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 28 Tanager Road Property Address Jane R. Harty Owner Owner's Name information is required for every Hyannis MA 02601 December 4,2010 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) 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 tp 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-0901 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Corinmonwealth of Massachusetts Titie 5 Official Inspection Form Subsurface°Sewage Disposal System Form - Not f6tVoluntary Assessments 2$Tanager Road F.roperty AtldreSs- -Jane R,:Harty Owner OwneIrs.Name information is required.for every Hyannis MA 02601 December 4, 2010 page. cityff6wn State Zip code. Date of Inspection Celrtification (cost ): 2. System.will fail unless the Board of Health (and;PUbli_c Water:Suppiier, if any) determines that th.e.system is functioning in a man;nerthat protects"the:public.health, safety and.environment; 0 The=system has a_septic tank and soil absorption system (SAS) and the SAS is within 100 feet of.a surface water supply ortributary'to a surface water supply. El 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. E; 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; forcoliforrn bacteria indicates absen and the presence of ammonia nitrogenand nitrate nitrogen is equal to or less than 5 ppm; provided`that no other failurI.e,criteria are triggered.A copy of the analysis must be attached to this form. `3- Other. D) System Failure Criteria:Appiicable to All-Systems:. You must indicate "Yes"or"No"to each of the following for all inspections` Yes No. Backup of sewageinto facility:or.system component due to overloaded or Ell Z clogged SAS Ot cesspool M 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 Q Liquid depth in cesspool is less than 6" below invert or available volume is,less than day flow 15ins,09108 Title 5 oracial InspeclionForm:Subsurface Sewage Disposal System s Page 4 of 17 i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments r 28 Tanager Road Property Address -- Jane R. Harty Owner Owner's Name information is required for every Hyannis MA 02601 December 4, 2010 page. Citylrown 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 15,000 gpd. For large systems, you must indicate either"yes"or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area—IWPA)or a mapped Zone 11 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-OSVI Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth ofMassachusetts Titl:e 5 Official Inspection Form — ; Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 28 Tanager Road Pro ert .Address P .y Jane R. Harty Owner Owner's;Name information is required for every ,Hyannis MA 02601 December'4, 2010 page, Cdyffown ,State Zip Code Date of Inspection C. Checkl'ist Check-1,f 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 0 Were any of the system components pumped out in the previous two:weeks? ❑ 1 Has the system received normal flows,in the previous two week period? © Have large volumes of water been introduced tothe system recently or as part of. this'inspection? Were a$ 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 subsun`aceaewage 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 feld (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 bedroorns (design): 3 Number of bedrooms (actual): 3 DESIGN flow based on 310 CIVFR 15.20.3 (for example: 110 gpd x#of bedrooms): 330 gpd i5ins-09i0e' Title 5 official InspeGion Form:Subsurface Sewage:0lsposofSysfem,;Page G.of 17 Commonwealth o€Massachusetts Title 5 Official Inspection Form Subsurface:Sewage Disposal System Form-Not for Voluntary Assessments 28 Tanager Road Property Address Jane R. Harty Owner Owner's Name information is required for every Hyannis MA 02601 December-4,2010 page. Cityrrown state- Zip Code Date of Inspection D. System .Ihforrnation Description: Number of'current residents, 0 Does residence have a garbage grinder? © Yes ❑ No Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes Z No Laundry system,inspected? ❑ Yes ❑ No Seasonal'use? ❑ Yes Z No Water meter readings; if available(last;2-years usage (gpd)) 86 gpd Detail:, 2008, 2009, first half 2010 Sump pump? ❑ Yes. No undetermined Last date of occupancy: Date Commerciai/Industrial FIlow Conditions: Type:of.Establishment Design flow{based;on 310 CMR 15.203;) Gallons per day(gpd) Basis of design flow(seats/persons/sgft., 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•.0§168 Title 5 Official Inspection Form:Subsurlace Sewage Disposal System-Page 7 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form s Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 28 Tanager Road Property Address Jane R. Harty Owner Owner's Name information is required for every Hyannis MA 02601 December 4, 2010 page. Cityfrown 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: 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, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner)and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): 15ins•091o8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth ofi Massachusetts -ti Title 5 Official Inspection Form Subsurface Sewage Dispo$al System Form -Not for Voluntary ASs.essments -28 Tanager Road Property Address Jane R. Harty Owner Owner's Name information is required for every �H annis MA 02601 December 4., 2010 page. City/Town State Zip Code Date o-inspection D. System Information (cont.). Approximate age_of all componerits, date installed (f`known)'and source of information:: Age 3+ years. Certificate of Compliance issued 10/12/2007 (Board of Health files). Were sewage odors detected when arriving at the site? ❑ Yes 0 No Building Sewer(locate on site;plan): ' Depth below grade: Z_feet Material of construction: ❑ cast iron ❑ 40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments;(on condition of joints, venting,,evidence of leakage, etc.); Sewer line not.acCesSible for evaluation',.No evidence of leakage or backup,into dwelling was observed. Septic Tank(locate on:site 1 Depth below grade: feet' Material of construction;. concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank is fnetal, list°age; years .Is.age confirmed by a Certificate of Compliance?(attach a copy-of certificate) ❑ Yes ❑ No .Dimensions: 10.5ftx6ftx5;ft(1500.gal) Sltadged 4 in epth: t5ins.:t 09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System.'Page 9 of 17 Commonwealth of Mas_sachus.etts =_ = Titlle 5 Official lnspectio1n Form — Sub"surface Sewage Disposal System Form-Not for Voluntary Assessments 28"Tanager Road Property Address Jane R.,Harty Owner Owners Name information is required-for every Hyannis MA 02601 December 4, 2010 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 30 in. Scumthickness 1 in Distance fcorn top.of scu _to top of outlet tee or baffle 9,in m, Distance from bottom of scum to bottom of'outlet tee or baffle 14 in How=were dimensions.determineV Design plan 'Comments'(on pumping,;recommendations, in:let.and;outlet tee orbaffle condition', structural integrity, lipid..Ievelst as related to outlet invert, evidence of leakage; etc.): Pumping is not required at this time but maintenance pumping is recommended within and every two years. Tank appears structurally sound:and functioning as intended. No evidence of leakage in or out was observed. Grease Trap (locatei on site plan): Depth below grade: feet Material of construction:, ❑ concrete ❑ metaf ❑ 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 t5ns a 0108 Title 5';Official Inspection Form:Subsurface Sewage;Disposal;System•Page 10 of W Commonwealth of Massachusetts —_ - Title 5 Official Inspection Form Subsurface.Sewage Disposal System'Form-Not,for V6luntary Assessments 28 Tanager Road Property Address Jane EZ. Harty Owner Owner's Name information is required for every Hyannis MA 02601 December 4, 201:0 page. Cityrrown State, Zip Code Date of Inspection D. System Information (coat.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet.invert,evidence of leakage, etc:): 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: Des gn.Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm'in:working order: ❑ Yes ❑ No Date of last.purr ping:, Date Comments (condition of alarm and float switches, etc.:): `Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins'•;09108,, Title 5`official Inspection Form;,Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth W Massachusefts *`Title 5' official Inspection Form r Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 0 28'Tanager Road P.ropelty Address Jane R. Harty Owner Owner's Name information is required for every, 'Hyannis MA 02601 December 4, 2010 - page. Cityrrown State Zip Code Date of Inspection D. System .InformMion (cont:). Distribution Box(if present must be opened) (locate'on site plan);. Depth of liquid level above outlet invert at outlet,inverts 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.); Few'solids,in sump. Distribution box- .Pump Chamber(locafe on site plan) Furnps 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)(locate on site plan, excavation not,required): If SAS not located, explain'wily: t5ins•o4i 6 Title 5'04'iciat.lnspection'Form:subsurface sewage.Disposal-system-Pagel 2W 17. Commonwealth of Massachusetts _ Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 28 Tanager Road Property Address Jane R. Harty Owner Owner's Name Information is Hyannis MA 02601 December 4, required for every y 2010 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ❑ leaching chambers number: ® leaching galleries number: 1 ❑ leaching trenches number, length: ❑ 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.): Soils above leaching gallery appear unsaturated. No evidence of surface ponding, breakout, lush vegetation, or other evidence of hydraulic failure was observed. A bucket of water was poured into distribution box and was observed to pass through in a rapid and unobstructed manner and was heard splashing down into leaching gallery. 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•09108 Us 5 official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 ry Commonwealth of'Massachusetts. Title- 5 official Inspection Form O 'S`ubsurface:Sewage:Disposal System Form =Not for Voluntary Assessments 28 Tanager Road _ Property Address Jane R: Harty Owner Owner`s Name information is required for every yannis MA 02601 :December 4, 2010 page. city/rows State Zip£ode Date of Inspection System information (cont.) Comments(note condition of soil,; signs"Qf hydraulic failure, Jebel af'ponding, condition of;vegetation, etc.): Privy(locate,on site plan): Materials of construction: Dimensions Depth of solids Comments.(note condition of soil,signs:of-hydraulicfailure; level,of ponding; condition of vegetation, etc.): t5ins•09108 Title 5 official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 9 Commonwealth of Massachusetts _ - - Title 5 Official Inspection Form 6 Subsurface Sewage Disposal System Form-Not for Voluntary Assessments r 28 Tanager Road Property Address Jane R. Harty Owner Owner's Name information is required for every Hyannis MA 0260.1 December 4,201'0 page. Cityfrown State Zip:Code Date of tnspedtion D. System Information (cost.) Sketch Of Sewage Disposal System: Provide a view of the sewage Aisposal 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 �6e la v�. u zr..r.'• QS fF eNro + ��. B�C..3 L L•. (yY v tol. 1:0 6 0 F i5ins'OgroB Tdlo,S Official Inspection Form:Subsurface Sewago Disposal System Pago 15ot 17 n5 Commonwealth of Massachusetts —`r Title 5 Official Inspection "Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments 28,Tanager Road Property Addiess Jane R.'Harty Owner Owners Name information is required for every Hyannis MA 02601 December 4, 2010 page. GitylTouvn State Zip.Code Date of Inspection, D. System Information (cont.) Site Exam: ❑ Check:Slope. 0 Surface water ❑ Check cellar' ❑ Shallow wells Estimated depth to high;ground water- 5:44+ ftfeet Please indicate,'all;:methods used to determine the high ground water elevation; Obtained from system design plans on record 10/12/p7 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: Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database -explain: You'must describe how you esfablished the`high ground water elevation: •Approved design plan on file with Board of Health shows'bottom of soil absorption system to be,5;44 f6dt-aboVer the bottom of witnessed test pit:in which no groundwater mottling was observed. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•09108 Title,S Afrcial Inspection Form:Subsurface Sewage Disposal system a Pagel.6'af 17 r Commonwealth of Massachusetts Title 5 Official Inspection Form UVWESubsurface Sewage Disposal System Form-Not for Voluntary Assessments 28 Tanager Road Property Address Jane R. Harty Owner Owner's Name information is ,Hyannis MA 02601 December 4 required for every --Y 2010 page. Cityrrown 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•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 FROM :down cape engineering inc FAX NO. :15083629880 Nov. 01 2007 01:57PM P2 Town of Barnstable Reguiatory Services Thomas F. Geiler,Director Public Health Division Thomas McKean,Director 200 Main Street,lipLUXlis.KA 02601 Fax: �D&-790-6344 Office: 509-86=.46" installer & DesLmertertifkatiou Form 00 7� ,._ Assessor's MsLp\Parcel Date: // 1 d Sewage Permirt �r�' Desiper. �+�^� A r— Installer. 0 r'p ill"� Ad dress- 079 9 JT"` Address: Ong ��� � T vG• issusd.a permit to instiall a (dam} � (yns>;aller� septic system W. C� 2-�' l�-�C• basod on a desip drawn by (art ss; Dow�• c}�• �'Y` j 1-\C dated (designer I cartin' that the septic S'%7MM referenced above was installed substantially according to the desicn, which may include minor approves changes such as lateral reloca ion of the dis-:ribution box andlor septic tan, cerdf\' that the �st= referenced end abo-\�e Wn in-rtWled -"'th m2jor chanties (i.e. greater than l 4' lateral septic sl relocation of:the SAS or an-,' Vertical reloca 30 of any component of the septic system)but in, accordance u-ith State FX Lou) Regu ation:s. P12l11 reNnsIon or certified zs-built by designer to follOw- �st►aF nrgs� o DANIELA. min OJAtA U CIVIL Instal 'S Signature) No.46562 o w� C9, (Designer's Signature) Designer's Stamp Here) PL As RL� N TO BARN AB E P -1A TC HEA TH DTtrkS10N, CERTTFICATE OF CC)NIPL AN E WILL NOT BE ISSUED UNT11, BOTH THIS FORM AND AS-BUILT CATtD ARE .E�rED IIITHEI3ARHSTABLE P1��BL1C HEALrN DI\'T5lC�N. THAhK YOLI_ n.w—i,w4z&n,ir.1Dr&iencr Cenifiration Form 3.26•0460c r TOWN OF BARNSTABLE LOCATION ��A : d'�.1/ SEWAGE# o200�-V63 VILLAGE�A&,,9,, 5 ASSESSOR'S MAP&PARCEL ��� INSTALLERS NAME&PHONE NO. p(IS SEPTIC TANK CAPACITY /:Sd LEACIHING FACILITY:(type) a2 -J-Vo 4. C • (size) 10)G3 0 NO.OF BEDROOMS OWNER .f PERMIT DATE: 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 l � b e� W o. o.cvo L Fee THE COVIMONWEALTH OF MASSACHUSETTS i Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Rpplication for �Dioponl 6p9tem Con5tructfon Permit Application for a Permit to Construct O Repair W-114grade( ) Abandon O LJ.Complete System ❑Individual Components Location Address or Lot No.-Al 7"as"- R� Owner's Name,Address,and Tel.No. A79 Assessor's Map/Parcel a26 Q/23 j;a "77Y"1-7/d h4 Installer's Name,Address,and Tel.No.13�v5/�dpLi r'� Designer's Name,Address and Tel.No. �4Pt. � �d`''^'O Ao,v Y" 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(min.required) 330 gpd Design flow provided 334 gpd Plan Date���/9,;6"7 Number of sheets Revision Date �^ Title �S+!-� Puy C C .1�1$ TQn,?s _j Size of Septic Tank /Y,10(5�6_ Type of S.A.S. -*'- �o iC l C' �,�,►-J Description of Soil �-) —42JV Nature of Repairs or Alterations(Answer when applicable) A 1 cr ✓,J,4.t Gam, 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 Certificate of Compliance has been issued by this B of eal h. gned Date Application Approved Date Application Disapproved by: Date for the following reasons Permit No. Date Issued l o. c� / ( � ✓ vl. x• Y Fee V "7" �'1 ! c3 Entered in computer: THE COMMDWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS application for �Dig;po$AY 6p5tem Con5trUction Permit Application for a Permit to Construct( ) Repair(Upgrade( ) Abandon( ) U.Complete System ❑Individual Components Location Address or Lot No. ��nas " Owner's Name,Address,and Tel.No. 1`4,1 Assessor's Map/Parcel �G Q s?j `77y 7/v Installer's Name,Address,and Tel.No./3Pr r/./ji Designer's Name,Address and Tel.No. �`�""" r�a�►f �`'� "°^"' 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(min.required) 3 30 gpd Design flow provided 336, gpd Plan Date� �/�/,ado -7 Number of sheets Revision Date �^ Title S p/. �oy c L nggs .r#,� Size of Septic Tank 15 a0 6'r/ `� Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) 114 _;411 Date last inspected: — Agreement: 1 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 Certificate of Compliance has been issued by this Board of Health. ((S'gned �c--�L� Date Application Approved by 1', Date Application Disapproved by: 1 Date for the following reasons Permit No. (' —y (p ,� Date Issued Z Q 11'ale, THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed ( ) Repaired ( 4--} Upgraded ( ) Abandoned( )by at g T*a_,*— has been constructed in accordance / with the provisions of Title 5 and the for Disposal System Construction Permit No.1—c5c�'"``�� dated l7 Installer ww /,L} &_Mf J1 -/I' �'- Designer !,o.(awl C&,00� �'»S'rr�.-,--,•�; #bedrooms Approved design flow 3C f /�_ gpd The issuance of this permit shall not g�construed as a guarantee that the system dh function as designed. Date �r1J Inspector 1 7� �N�✓li(I/'` �'// --------- ff— r------------------------ / ----- No. yE/ Fee t 'r THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE, MASSACHUSETTS lwiopozal *p!gtem Cow5trUction Permit Permission is hereby granted to Construct ( ) Repair ( ) //Upgrade ( ) Abandon ( ) System located at and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to comply with Title S and the following local provisions or special conditions. Provided: Construction must be completed within three years of the date 6,Q P.�rmi . Date Approved b�,_ L R� Sri 4C.0 I�j �(O Van C awvX c i.,-- 00'C kT ION �ou�e SEWAGE PERMIT NO. 'y III/ VII'LLAGE iS d Lu) INSTA LLER S NAME ADDRESS BUILDER OR OWNER = 1 DATE PER IT ISSUED DAT E COMPLIANCE ISSUED • 4 I ! G j1TG1\U t SYSTEM PROFILE NOTES ALL SYSTEM COMPONENTS SHALL BE TOP FNDN. AT EL. 43.3' COMPARABLE MAGNETIC OR FUTURE LOCATION. ACCESS COVERS TO WITHIN 6" OF FIN. GRADE ( NOT TO Ste) 1. DATUM IS APPROXIMATE NGVD ACCESS COVER (WATERTIGHT) TO ACCESS COVER TO WITHIN 3" OF FIN. GRADE ine St. Cb 43.0' MINIMUM .75' OF COVER OVER PRECAST /` WITHIN 6" OF FIN. GRADE 2. MUNICIPAL WATER IS EXISTING g 2X SLOPE REQUIRED OVER SYSTEM 43.0' ��a. y to\A,��e RUN PIPE LEVEL 2 OR G oTWASHED DTI EE FAPEIC ONE 3. MINIMUM PIPE PITCH TO BE 1/8" PER FOOT. o o\a *40.9' - FOR FIRST 2' m c PROPOSED 1500 3' MAX. 4. DESIGN LOADING FOR ALL PRECAST UNITS TO BE AASHO `° E GALLON SEPTIC 39.87' , H- 10 ono n -14� 40.37 TANK H- 10 40.24 �o �o ( '� GAS 11 39.62' 5. PIPE JOINTS TO BE MADE WATERTIGHT. .. BAFFLE 39.79' O p p l� p p p p 0 39.44' p p p p p p p p p , 0 6. CONSTRUCTION DETAILS TO BE IN ACCORDANCE WITH ( 2_X SLOPE) �6" CRUSHED STONE OR MECHANICAL p [] p p p p p • .`� COMPACTION. (15.221. [2]) 2 p p p p p p p p p MASS. ENVIRONMENTAL CODE TITLE V. I c 37.44 rai ville Beach d. "I DEPTH OF FLOW = 4 7. THIS PLAN 1S FOR PROPOSED WORK ONLY AND NOT TO TEE SIZES: 3/4" TO 1 1/2" DOUBLE WASHED STONE BE USED FOR LOT LINE STAKING OR ANY OTHER PURPOSE. aae INLET DEPTH = 10_ �GP� OUTLET DEPTH = 14" ( 1 X SLOPE) ( 1 z SLOPE) j 8. PIPE FOR SEPTIC SYSTEM TO SCH. 40-4" PVC. 9. COMPONENTS°NOT..TO BE BACKFILLED OR CONCEALED FOUNDATION 21' SEPTIC TANK 8' D' BOX 20' LEACHING 5.44' WITHOUT INSPECTION BY BOARD OF HEALTH AND FACILITY LOCUS MAP *THE INSTALLER SHALL VERIFY THE PERMISSION OBTAINED FROM BOARD OF HEALTH. LOCATIONS OF ALL UTILITIES AND ALL 10. CONTRACTOR SHALL BE RESPONSIBLE SCALE: 1 = 2,000 t BUILDING SEWER OUTLETS AND ELEVATIONS LE FOR CALLING PRIOR TO INSTALLING ANY PORTION OF DIGSAFE (1-888-344-7233) AND VERIFYING THE LOCATION ASSESSORS MAP 268 PARCEL 23 BOTTOM TH-2 EL. 32.0' OF ALL UNDERGROUND & OVERHEAD UTILITIES PRIOR TO SEPTIC SYSTEM COMMENCEMENT OF WORK. LOCUS IS WITHIN WP/GP OVERLAY DISTRICT LEGEND 11. EXISTING LEACHING FACILITY SHALL BE PUMPED AND REMOVED OR PUMPED AND FILLED WITH CLEAN SAND. 100.0 PROPOSED SPOT ELEVATION 12. ANY UNSUITABLE MATERIAL ENCOUNTERED SHALL BE REMOVED 5' BENEATH AND AROUND THE PROPOSED +100.00 EXISTING SPOT ELEVATION LEACHING FACILITY. o- 100 PROPOSED CONTOUR " SYSTEM DE 1 N. 100 EXISTING CONTOUR GARBAGE DISPOSER IS NOT ALLOWED - DESIGN FLOW: 3 BEDROOMS ® 110 GPD = 330 GPD ip 0' USE A 330 GPD DESIGN FLOW SEP'i'IC TANK: 330 GPD (2) - 660 TH-1 :lE A 500 GAL. ,SE 'TIC TANK ,�-H-2 LEACHING: TEST HALE LOGS / N S �� ,� SIDES: 2 (30 + 9.83) 2 (.74) 118 GPD CP / BOTTOM 30 x 9.83 (.74) = 218 GPD ENGINEER: DAVID FLAHERTY, R.S. SE2755 0 O BUSHES TOTAL: 454 S.F. 336 GPD WITNESS: DONNA MIORANbI, R.S. DECK " USE (2)- 500-GAL. LEACHING CHAMBERS (ACME OR DATE: SEPTEMBER 7, 2007 / rr LOT 16 10,003t SF EQUAL) WITH 2.5' STONE AT SIDES, 4' AT ENDS AND 5' PERC. RATE _ < 2 MIN/INCH GARAGE 0.2t AC. BETWEEN UNITS CLASS i SOILS P 11905 / (SLAB) k EXISTING 3 BR MA ELEV. ELEV. / DWELLING x APPROVED DATE BOARD OF HEALTH 0„ 43.0' 0" 43.0' TOP OF FNDN EL. 43.3 A A 43 PAVED o LS LS DRIVE 1OYR 4/3 1OYR 4/3 / TITLE 5 SITE PLAN 6" 42.5' 8" 42.3OF B B \ 43 Ls Ls r00 3 �� BENCH MARK: 28 TANAGER RD. 25" 10YR 6/6 40.9' 30" 1 OYR 6/6 40.5' \ 00' TOP 3 3FNDN � (HYANNIS) BARNSTABLE, MA PREPARED FOR c c 4'PERC ,� BORTOLOTTI - CONST _ JANE HARTY MS MS DATE: SEPTEMBER- 14, 2007 2.5Y 7/4 2.5Y 7/4 4541 5% COBBLES . 5% COBBLES 0� PM AP off 508 fax 508 362-962-9880 �tH hfq; �� fox A,RNE H. b� ARNE „ „ ojA� I I. N down cape en gin e erin g, in C. 124 32.7 132 32.0 CIVIL 0i No. 3079 No. 6 C/1//L ENGINEERS LAND 'SURVEYORSNO, GROUNDWATER ENCOUNTERED Scale:1"= 20' , �Fc F 1�ti2 r G� � Essti yo 939 Moin Street - YARMOU It1POR T, MASS. 0 10 20 30 40 50 FEET` DATE A OJALA, ., .S. DCE #07-189 07-189 BORTO-HARTY.DWG (DDF} `