HomeMy WebLinkAbout0061 TOBEY WAY - Health 61 Tobey Way
Hyannis P
_ cA = 246 078006
I
t�l TOWN OF BARNSTABLE
LOCATION 461 I�, �b� ��l �d1J1� ✓I SEWAGE# l
VILLAGE AGE,�l/LlL`/S Oy ASSES OR'S eMAP & LOTS-07$ �+sb
INSTALLER'S NAME&PHONE NO.
SEPTIC TANK CAPACITY 11�t�0
LEACHING FACILITY: (type) ��A ,�.�.r 14' _giie) ny
NO.OF BEDROOMS
BUILDER OR OWNER - /��✓rJt.o+v,.ee ='' z '
PERMITDATE: 2 2 2 -IT81- COMPLIANCE DATE:
Separation Distance Between the:
Maximum Adjusted Groundwater,Table and Bottom of Leaching Facility Feet
Private Water Supply Well and Leaching Facility (If any wells exist
on site or within 200 feet of leaching facility) Feet
Edge of Wetland and Leaching (If any wetlands-exist
within 300 feet of leaching'-facility) Feet.
Furnished by
r �
t
a h 7TI l
¢ Fee
"
-``' WF2tered in computer:
THE COMMONWEALTH OF MASSACHUSETTS
Yes
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS /
ZippYicatiou for Zi.5pozar 6potem Con!Arurtiou Permit
Application for a Permit to Construct( V)Repair( )Upgrade( )Abandon( ) veomplete System ❑Individual Components
Location Address or Lot No. W-ut Owner's Name,Address and Tel.No. 5/p 6*Y51DFE BL
Al, ItYA,utii5 Poe QE M1?A1F�2�'v0.r/11q `7 71-16�O
Assessor's Map/Pazcel r)q6 / Q 7 F, 60 U
/gag- 3 a��
Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. 775—0735
00r 'b l6 /4YJO qvi 550C
Type of Building:
Dwelling No.of Bedrooms 3 Lot Size A Q F& sq.ft. Garbage Grinder(�Q
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow 3-V gallons per day. Calculated daily flow 6 gallons.
Plan Date _ Number of sheets Revision Date
Title 1,Q? 10 TOP `�/ Uffi I
Size of Septic Tank 5 Type of S.A.S.
Description of Soil
Nature of Repairs or Alterations(Answer when applicable)
Date last inspected:
Agreement:
The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system
in accordance with the provisions of Title 5 of the Environmental Co a and not to place the system in operation until Certifi-
cate of Compliance has been i y t Bo of Health. /
Signed Date J
Application Approved by Date
Application Disapproved for the following reasons
Permit No. Date Issued
i c ry4 Fee
No..
- THE COMMONWEALTH OF MASSACHUSETTS t., ^ltered in computer:
Yes
PUBLIC HEALTH DIVISION -.TOWN OF BARNSTABLE., MASSACHUSETTS
Zipprication for ;izP�ogal *potem Conotruction Permit
Application for a Permit to Construct( VjRepair( )Upgrade( )Abandon( ) PComplete System ❑Individual Components
Location Address or Lot No. Owner's Name,Address and Tel.No. �/p 6.4 y-5 1 PE 6C
Assessor's Map/Parcel y / 0 7 F, 60
Installer's Name,Address,and Tell.No. [ 9 7 3 a i :) Designer's Name,Address and Tel.No. '7`7 j—0735
` OE ) (6 /rwu AvFl_t fl 7/9 550C t'
Type of Building:
Dwelling No.of Bedrooms 3 Lot Size ��r Q sq.ft. Garbage Grinder(,A/Ll
Other Type of Building AltVb t 69 MZ No. of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow 3 3U gallons per day. Calculated daily flow �°6 gallons.
Plan Date 9"/(O 9 Number of sheets Revision-Date
Title L,0 7 (o 7 pP a' ul fi`(
Size of Septic Tank l SIrU Type of S.A.S.
Description of Soil /t 5 !p 1A
Nature of Repairs or Alterations(Answer when applicable)
a
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 6f Title 5 of the Environmental C e and not to place the system in operation until Certifi-
cate of Compliance has been i y t Boarft of Health.
Signed AY Date
Application Approved by A2a Date Y '
Application Disapproved for the following reason
O
Permit No. Date Issued V 4!Z K
---------------------------------------
THE COMMONWEALTH OF MASSACHUSETTS 5
BARNSTABLE, MASSACHUSETTS
(Certificate of (Compliance
THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed(Repaired ( )Upgraded( )
Abandoned( )by JU E 4�' lC/AEU
at W (.t `To ec`l W47 W. H v11*105 P02 r nZ ha en constructed in accordance
with the provisions of Title 5 and the for Disposal System Construction Permit NTIIK'�j 42dated
J
Installer Designer
The issuance of this permit shall not be construed as a guarantee that the system w(ll fu try ion as designed.
Date 1 1 - Inspector
a
No. r---------------------------Fee
----
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION - BARNSTABLE: MASSACHUSETTS
ligozar *pztem Construction Permit
Permission is hereby granted to Construct( )Re air( )Upgrade( )Abandon( )
System located at / 7U��� � `�� I�y�!✓/✓�SPD/c? T
and as described in the above Application for Disposal System Construction Permit. The applicant recognizes his/her duty to
comply with Title 5 and the following local provisions or special conditions.
Provided: Construction must be completed within three years of the date of this permit.
Date: Approved by
---- -------------
I TOWN OF BARNSTABLE
LOCATION 1.e7 6 +6 b E%,1 W 10 ✓I SEWAGE #
VILLAGE UzDdL d�,p,�S aa✓r ASSESSOR'S MAP
INSTALLER'S NAME&PHONE NO.
SEPTIC TANK CAPACITY I Sljb
LEACHING FACILITY: (type) �lYl—,L--c- .(size) tJ 4± .�"•an c>
NO.OF BEDROOMS
BUILDER OR OWNER A'A4,,/��►�-�+-�
I PERMITDATE: 1 COMPLIANCE DATE:
Separation Distance Between the:
Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet
Private Water Supply Well and Leaching Facility (If any wells exist
on site or within 200 feet of leaching facility) Feet
Edge of Wetland and Leaching Facility(If any wetlands exist
within 300 feet of leaching facility). Feet
Furnished by
1
S ��9,Z7iy
Z� � ;0
��v
-
TRbY WILLIAMS
SEPTIC INSPECTIONS t_
Certified by MA Department of Environmental Protection (508) 385-1300
19 Hummel Drive
South Dennis, MA 02660 �,
COMMONWEALTH OF MASSACHUSE17S ��-
EXECUTIVE -
OFFICE OF ENVIRONMENTAL AFFAIIIIS
F ,
DEPARTMI',NT Ol: F�NVIRONMENTAL PROTEGI'I'ION�g
•I ITLE 5 =
OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESS �ENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM� f
PART A s}
CERTIFICATION CD r
61 Tobey Way 'SAP
Propert. Address: West Hyannisport;MA t'r�FiCEI, 1
Leonora Manfredonia ,r
OK"ner's Name: P.O.Box 752 `�" _...:
Owner's Addres.: West Hyannisport,MA 02672
Date of inspection: October 5,2004
Troy M. Williams 1( ))
Name of Inspector: Troy Williams Septic"Inspections
Company Name: 19 Hummel Drive �J
Mailing Address: South Dennis,MA 02660
Telephone Number: (508)385-1300
CERTIFICATION STATEMENT
I certify that I have personally inspected the sewage disposal system at this address and that the information reported
below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my
training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP
approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system
Passes
Conditionally Passes
Needs further Evaluation b) the Local Approving Auil mii)
Fails
Inspector's Signature: 'S.c,d, Date: to /s' /oy
The system inspector shall submit a copy of this inspection report to tile Approving Authority(Boar(l of I lealth 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.
Notes and Comments
Although system meets the minimum requirements set forth by the Massachusetts Department of
Environmental Protection,certification Is not to be construed as a guarantee of future working condition
of system,piping or components. This inspection represents the conditions of the system on the Date of
Inspection noted above:
"••*This report only describes conditions at the time of inspection and under the conditions of use at that
time. 7 his inspection does not address how the system will perform in the future under the same or different
conditions of use.
Title 5 Inspection Form 6/15/2000 paee 1 of II
Page 2 of I l
OFFICIA1L�k — NOT FOR VOLUNTARY ASSESSMENTS
SUBS VA ,
� E DIS OS
P AI. SYSTEM INSPECTION FORM
October 5,2004 PART A
CERTIFICATION (continued)
Properq'Address: 61 Tobey Way
West Hyannisport,MA
Owner: Leonora Manfredonia
Date of Inspection: October 5,2004
luspectioa Swnwury: Check A,B,C,p or IE/Al,_ Wgy_S complete all of Section D
A. Systein Passes:
---Z_ I have not found.any information which indicates that any of the failure criteria described in 310 Chi it
15.303 or in 310 CMK 15.304 exist And- failure criteria not evaluated are indicated below.
Comments:
B. System Conditionally Passes:
One or more system components as described in the "Conditional Pass"sectu,n need tKofe
eplaced or
repaired. 1 he system, upuo completion of the replucemcot or repair,as approved by the Bua ca1t11, will pass.
Answer yes. no nr nut determined(Y,N;ND)in the tur the following statemen determined please. If"not ".
explain. -_ .
File septic tank is metal and over 20 years old" or the septic tank( ether metal or no
failu is structurally
unsound,exhibits substantial infiltration or exfiltration or tat►k re i minrnt. S�stem will pass inspection if the
existing tauk is replaced with a complying septic tank as approved b he Board of I Icalth.
•A metal septic tank will pass inspection if it is structurally soon not leaking and it'd Certificate of Compliance
indicating that the tank is less than 20 years old is available.
ND explain:
_ Observation of sewage backup or break o or high static water level in the distribution box due to broken or
obstructed Pipe(s)or due to a broken,settled uneven distribution box. System will pass inspection if(with
approval of Board of Ilealth):
br en pipe(s)are replaced
struction is removed
_ distribution box is leveled or replaced
ND explain:
The system quired pumping more than 4 times a year due to broken or obstructed pipe(s). T he system will
pass inspection ' with approval of the Board of I leaith):
broken pipes)are replaced
_ obstruction is removed
ND explain:
2
Page 3 of 1
OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM '
PART A
CERTIFICATION(continued)
Property Address: 61 Tobey Way
Owner: West Hyannisport,MA
Dale of fnspeetiuu: Leonora Manfredonia
October 5,2004
C. Further Evaluation is Required by the Board of Health:
Conditions exist which require fiu-ther evaluation by the Board of health in order to determine if the syslen►
is failing to protect public health. safety or the environment.
I. System %Hill pass unless Board of health deteru►iues in accordance with310 CNIR 15.303(l) that the
syslcut is not functioning ill a wanner which will protect public health,safety and the envifo�)nment:
Cesspool or privy is within 50 feet of a surface water
Ccsspuol or privy is within 50 feet of a bordering vegetated wetland or a salt in
2. Systew will fail unless the Board of Health(and Public Wate upplier,if any)determines that the
system is functioning in a planner that protects the public bell ,safety and environment:
The system has a septic tank and soil absorption s eiu(SAS)and the SAS is within 100 feet of
surface %%lucr suppl%,or tributary to a surface water pply.
"file systen►has a septic tank and SAS the SAS is wilhin a Zone I of a public water supply.
_. I he s.stela has a septic lank and ' S and the SAS.is %ythin 50 feet of a private water supple well,
The system has a septic tal and SAS and the SAS is less than 100 feel but 50 feet or more from a
privaic water supply well" elbod used to deteri111tIC dlSlal►CC
••This system passes i the well water analysis, perturin d at a DEl certified laborato Y I ry, for co if
bacteria and volad organic compounds indicates that the well is free from pollution from that facility and
the presence o ntonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other
failure crit . a are.triggered.A copy of the analysis must be attached to this form.
3. Other:
3
-.Page 4 of 11
OFFICIAL INSPECTION FORM —NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
61 Tobey Way
Properly Address: West HyannispoM MA
Leonora Manfredonia
Owner: October 5,2004
Date of Inspcction:
D.' System Failure Criteria applicable to all systems:
You nlus indicate "yes"or."no"to each of the following for all inspections:
Yes No
Backup of sewage intu facility or system component due to overloaded or clog-ved.SAS or cesspool
Discharge or ponding of effluent to tile surface of the ground or surface waters due to an overloaded or
clogged SAS or cesspool
✓ Static liquid level hi the dish ibutlon box above Nutlet linverl due to all overloaded or Clogged SAS or
cesspool
)t/,v liquid depth it cesspool is less than 6"below invert or available volume is less than%day flow
✓ Required pumping more than 4 times in the last year VQT 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.
jaL/i Any portion of cesspool or privy is within 100 fee
water supply. t of a surface water supply or tributary to a surface
Any portion of a cesspool or privy is within aL'olle I of a public well.
-i i Any portion of a cesspool or privy is within 50 feet of a private water supply well.
&,14 Any portion of it cesspool or privy is less than 100 feet but greater than 50 feet from a private water
supply well will) no acceptable walei quality analysis. (This system passes if the well water analysis,
performed at a DE:P 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 slid nitrate nitrogen is equal to or less than S ppm,provided that nu other failure criteria
are triggered. A copy of the analysis must be attached to this forni.l
_NV (i CSlNu)TIIC system 411s. I have determined that olle of mole of the above failure criteria exist as
d.>rrihrd in 310 CMR 15 301. therefore the 5vstenl foils. "I he system o%%uer should contact the Board of
IICalih to dctel'llline what will be necessary to cuirccl the 14ilure.
E. "rge Systems:
To be considered a large system the system must serve a facility with a desi flow of 10,000 gpd to 15,000
gpd.
You must indicate either"yes"or"no"to each of the following:
(The following criteria apply to large systems in addition to the criteri ove)
yes no
the system is within 400 feat'of a surface drinkin ater supply
— _ the system is within 200 feet of a tribu o a surface drinking water supply
_ — the system is located in a miroge nsitive area(Interim Wellhead Protection Area—IWPA)or a mapped
Zone 11 of a public water sup well
If you have answered"yes"to a question In Section Ij the sy$tern Is considered a significant threat,or answered
"yes".in Section D above the , ge system h4$failed.The owner or operator of any large system considered a
significant threat under S Ion 1r or failed undcr Section D shiljj 4pgrade t4c system in accordance with 310 CMR
15.304.The system o or should contact thf Appropriate r0giot1111 Off
ce of the Department.
4
Page 5 of I I
OFFICIAL INSPECTION FORM —NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART I3
CHECKLIST
Property Address: 61 Tobey Way
West HyannispoM MA
Owner: Leonora Manfredonia
Date of InspcctHill: October 5,2004
('heck if the tullewing have been done. You must indicate"yes"or"no"as to each of the following
Yes No
in;; inli/rnlation was provided by the owncl, Occupant; or Board of I lealil,
Were any of the system components pumped out in the previous two weeks
_✓ _._._ Has the system received normal flows in the previous two week period'?
I lave large volumes of water been introduced to the systeul recently or as pan of this inspection,?
._._. Were as built plans of the system obtained and examined?(if they were not available note as N/A)
Was the facility or dwelling inspected for signs of sewage back up?
1/ . Was the site inspected for signs of break out 7
"'erc all system components, excluding the SAS, located on site
Were the septic tiulk manholes uncovered, opened,and the interior of the tank impected 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(alld occ.upailts it dlllerent f bin owner)provided with inforinatloll oil the proper
maintenance of subsurface sewage disposal systems ?
The size and location of the Soil Absorption System(SAS)oil the site has been determined based on:
Yes no
Existing infonnation. For example,a plan at the Board of I lealth.
✓ _ Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance
is unacceptable)13 10 CMR 15.303(3)(b)j
S
Page 6 of l l
OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL.SYSTEM INSPECTION FORM
PART C
SYSTEM,INFORMATION
Property Address: 61 Tobey Way
West Hyannisport,MA
Owner: Leonora Manfredonia
Dale of uupectiOn:October 5,2004
RESIDENTIALFLOW CONDITIONS
Number of bedrootl►s(design): 3 Number of bcdruop $(actual): 3
DESIGN flow based on 310 CMR 15.203(for example: 1 l0 gpd x k of bedrooms): 330
Number of curlcut residents: 1
Does residence have a gal'bagC&folder(yes Or 110): yt 5 (At.
Is laundry Un a scp:uate sewage system (yes or 11'11.vo �i)'1L?separate inspection requircdJ
Laundrysyste111 I11SpCCICd(yes Ur 110): N/q
Seasonal use: (yes or no): Y�_S —
Water n►cter readings, if available(last 2 ycarsllsagc (gpd)):0 3-0'y= 86 dOv ��,, s p t �.3 = 7`J f
Sump puu olp(yes or no):'k� _.__r-- - - ,
Last date of occupancy: Q s
COMM ERCIA1JINDUSTRIAt.
Type Of establishment:
Design flow(based on 310 CMR 15.203): — d
Basis of design flow(scats/persons/sglt,etc.):
Grease Ira) nesellt Industrial waste holding tank present(yes or no):
Non-sanitary waste discharged to the"fide 5 tcnl (yes or no):
Water meter readings, if available:
- --- —
Last date of occupancy/use: — -
OTHER(describe):
GENERAL INFORMATION
l'unlpinb Records
SUInCi of infunu;ltiun: eya�r"., "� ,',� zoo �� /� �+
.[-..._..tJ � i r. ro .A
Was system pumped as part of the inspection(yes or no): Nv
It ycs, volume pumped: gallons -- llow was quantity pumped determined?
Reason for pumping: -- ----
TYPE OF SYSTEM
,L Septic tank,distribution box,soil absorption sysicin
__—Single cesspool
Overflow Cesspool
—privy
Shared system(yes Or 110)(11 yes,attach previous inspection records, if an),)
_Innovative/Alternative technolo jy. Attach a copy of tlic current Operation and maintenance conlract.00 be
obtained from system owner)
Tight tank —Attach it copy of the DEP approval
Other(describe);
proximate age of all components. date installed(if known)and source of information:
Were Sewage odors detected when arriving at the site(yes or no): No
6
Page 7 of 1 I
OFFICIAL INSPECTION FORM -NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM.INFORMATION(continued)
Property Address: 61 Tobey Way
West HyannispoM MA .
Owner: Leonora Manfredonia
Date of tnspectiuu: October 5,2004
BUILDING SEWER (locate on site plan)
Depth belo%� grade: _ +—
Materials of construction: cast iron ,/40 PVC od►er(explain):
hittanct. fion. prn ate watct supply Hell or suction line: —
"11/7 _
Comments(oil condition of joints, venting, evidence of ICakaoe,etc.): -
SEPTIC TANK: _(locate on site plan)
Dcpth below grade: n2
Material of cunstructiuu: ✓concrete-__metal fiberglass _�olycdtylene
_--other(explain)_ -- --
If tank is metal list age:certificate) Is age confirmed by a Certificate of Ctmipliaoce(yes of no): (attach a copy of
Ditneosions: G, i 'x r r)• S 'x...6
Sludge depth: ...- . _...Y.`�- .._.....
Distance fi-om top of sludge to bottom of outlet tee or bufllc: )-'S
Scum thickness:
Distance fiont top of scum to top of outlet tee of ballle
Distance truth bottom of scum to buttom of outlet tee ur ballle: LLB
Iiu"-were dimensions determined. _._f_-1v6_�_..__
Cun►n►cnts(un pun►ping[CL0111111Cndaliolls, inlet and outlet tee or ballle condition, sit uctutal integrity, liquid levels .
ups related to outlet invert, evidence of IcakagC, Ctc.):
GREASE TRAY: _(locate on site plan)
Depth below grade:—
Material of construction: -__concrete__metal-,__-fiberglass _po thylene —other
(ex lain :
Dimensions:_
Scum thickness: - _---
Distance from top of st um to top o.f'Oil C tee or ballle _ _
Distance from bottom of scum to bottom of outlet t or baffle:
Date of last pumping: _ --- --
Comments(on pumping recommendations, et and outlet tee or baffle condition,structural integrity, liquid levels
as related to outlet invert,evidence of le ge,etc.):
i
Page 8 of 1 I
OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
TART C
SYSTEM INFORMATION(continued)
Property Address: 61 Tobey Way
West Hyannisport,MA
Owner: Leonora Manfredonia
Date of Inspection: October 5,2004
TIGHT or HOLDING TANK: __(tank must be pumped at time of i ection)(locate on site plan)
Depth belts,-grade:
Material of construction: _concrete metal tibcrgl s-__-_polyethylene__other(explain):
Dtmenslons: __
Capacity: — _-- __...___gallons
Design Floss. _ _ ballons/day
Alann present(yes or no):
Alum level: _ Alaml in workin rder(yes or nu):
Date of last pumping:--
Comments(condition of alarm au oat switches, etc.):
DISTRIBUTION BOX: ✓ (if present must be opcned)(locate on site plan)
Depth of liquid level above outlet invert: —
COmllle'lls("Ole if box is level and dislrlbU11011 10 OLHICIS Ctlllal, any evidence of solids leakage into or tut of boa, etc.): Carl')'QVCra any a\'IdC11CC Of
PUMP CIIAMIiF:it: (locate on site plan)
Pumps in working order(yes Or no):
Alarms in working order(yes or no): __
L'ontt»ents(note condition of pump chamber,conditiol pumps and appurtenances, etc.).
8
Page 9 of I I
OFFICIAL INSPECTION FORM —NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PA RT C
SYSTEM INFORMATION (continued)
Property Address:
61 Tobey Way
Owner: West Hyannisport,MA
Date of Inspection: Leonora Manfredonia
October 5,2004
SOIL ABSORPTION SYSTEM (SAS): ,/ (locate un site plan,excavation not required)
if SAS not lucated eX'pldin N'h).
I Ype ------
_ leaching pits. number: _
_7 leaching chambers,number: L 50 o
leaching galleries,number.
__1Cdchlllg IfCI1ChCS,Illllllber, ICllgdl: _______-_
leaching fields,number,dimensions:
overflow cesspool,number:
ilulovative'/alternative system Type/name of technology:
Comments(mule condition of soil, signs of hydraulic failure:, level of ponding, damp soil, condition of vegetation,
Cl
_.C1—�—� r�l�.a,.✓,_1 � /�,�� � ill ._ ..—�'!.J W d�.l_.e-h.;ram
CESSPOOI.S: --- (cesspool must be pumped as part of inspection)(luc eon site plan)
Number and configuration:
Depth-top of liquid to inlet invert:
Depth of solids layer.
Depth of scum, la'\cr:
Dimensions of cesspoul: ___
Materials of construction:
Indication of groundwater inflow(yes or no _
Comments(note condition of soil,signs ydraulic failtue, level of ponding,condition of vegetation,etc.):
PRIVY: (locate on site plan)
Materials of construction: r
Dimensions:
Depth of solids: -__
Comments(note condition of soil, signs of hydrauli ilure, level of ponding,condition of vegetation,etc.):
9
' Page 10 of 11
OFFICIAL INSPECTION FORM —NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
61 Tobey Way
Property Address: West Hyannisport,MA
Leonora Manfredonia
Owner: October 5,2004
Date of lnspectwn: .
SKETCH Ol SL•'WAGE DISPOSAL SYSTEM
Provide a sketch of the sewage disposal system including ties to at least two permanent relcrence landmarks or
benchmarks. locate all wells within 100 feet. Locate where public water supply enters the building.
A
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O O
13v _ y 3
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Pagel 1 of l l
OFFICIAL INSPECTION FORM —NOT FOR VOLUNTARY AS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 61 Tobey way
Owner: West Hyannisport,MA
Date of Inspection: Leonora Manfredonia
October 5,2004
SITE EXAM
Slope
Surface water
Check cellar
Shallow wells
Estimated depth to ground water_i 3F feet -
Adjustcd high ground watcr clevation — fcet
Please indicate(check)all methods used to determine the high giuund eater elevation. --
Obtained from system design plans on record- If checked,dote of design plan reviewed: 3 /ir /Y6
Observed site(abutting propcny/observation hole within 1 SO feet of SAS) ---
___Checked with local Board of I Iealth-explain: _
Checked with local excavators, installers-(attach documentation)
Accessed USGS database-explain: /t^ i,.w z y—•2�, � y 3.
You must describe huw you established the high ground water elevation:
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This report has been prepored and.the gy4tem Inopecled aq of tho doto pt tn$pactlon. This report Is not a
warranty or guarantee that the.aYet@rn li hlndlarl pSoperly In (utufg, Thera have peer►na warrenlles or
guarantees,elthef pres�0 wrlltpti or 17plied, ±�tIng tQ the l�Att�lrl,thll lnspectlon and/or this repait. i i
TEST HOLE LOG
DATE: MARCH 11, 1986 P-5789
q TEST BY: JOHN JACOBI
T - 3 /• 0 WITNESS: THOMAS McKEEN
PERC RATE: <2 MIN./IN.
38 •
3(ex Q- , 3&0 0"
>(y LOAM&
SUBSOIL
I
36.0 24"
I MEDIUM SAND
---- -
►� FINE SAND
I
26.0 144"
• 43 _
NO WATER ENCOUNTERED
I
o I
. "o o
� o I
e.
E� o DESIGN DATA
- .--r-.I
DAILY FLOW: (3)BDRMS.a 110 GPD= 330 GPD
• Y } I SEPTIC TANK: 330 GPD a 200%= 660 GPD
USE: 1500 GALLON PRECAST SEPTIC TANK
• O LEACHING FACILITY:
USE: (2)500 GAL.DRYWELLS(5'a 8.5'z 2')LINED
w/4'OF WASHED STONE ALL AROUND
0 23 l CAPACITY:
x3 �� SIDEWALL: 76 x 2 z 0.74= 112.5
4 33 BOTTOM: 13 a 25 z 0.74= 240.5
I
TOTAL: 353.0 GPD
I� BRAMAN0/-f
Ip CIVIL
V No.32686C y K a
'Q 40 a
NOTES: a
iO F � Q-
1. ALL PIPE TO BE 4"DIA.SCH 40 PVC.
2. PIPE TO BE LAID LEVEL FOR 2'OUT OF DISTRIBUTION
BOX.
3. RAISE ALL APPLICABLE MANHOLE COVERS TO WITHIN t ��-q 8 d" �Lb
6"OF FINISH GRADE \u
4. SEPTIC SYSTEM IS NOT DESIGNED FOR THE USE OF A
GARBAGE DISPOSAL
5. SEPTIC TANK AND DISTRIBUTION BOX TO BE INSTALLED
ON A 6"LAYER OF STONE.
6. INSTALL GAS BAFFLE IN OUTLET TEE. 2"LAYER OF CIS'PEASTONE OVER
3/4--11/2"WASHED STONE ALL
AROUND
TOP OF FOUND. -r m wi, ,34,(,7
w u'
35,00 4.I0
34.50 34.z7 ? coo s
SEPTIC SYSTEM PROFILE
SITE - SEWAGE PLAN GENERAL NOTES
FOR 1. CONTRACTOR TO BE RESPONSIBLE FOR THE LOCATION
LOT 6 TOBEY WAY WEST HYANNISPORT, MA. OF ALL UTILITIES,ABOVE AND UNDERGROUND,PRIOR
TO ANY EXCAVATION OR CONSTRUCTION.
2. SEPTIC SYSTEM TO BE INSTALLED IN COMPLIANCE WITH
PREPARED FOR 310 CMR 15.00:TITLE V.
BAYSIDE BUILDING INC. 3. THIS PLAN IS NOT TO BE USED FOR PROPERTY LINE
DETERMINATION.
DATE: SEPTEMBER 15,1998 SCALE: 1"=20' 4. ALL DISTURBED AREAS TO LOAMED AND SEEDED.
5. CONTRACTOR TO PROVIDE 24 HOUR NOTICE FOR ANY
REQUIRED INSPECTIONS.
WE II.LLER & ASSOCIATES
1645 FALMOUTH ROAD CENTERVLE, MA. 02632
TEL: (508)775-0735 FAX: (508)775-0754 -
APPROVED BY: