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HomeMy WebLinkAbout0030 WAYLAND ROAD - Health 30 Wayland:Road _ HyannlS P ,. ,, r A 271 ',192 uy N u h p I 1 f, 4 TOWN OF BARNSTABLE 4t/ G �' .00,���ION-. 30 ._GJ SEWAGE # . . R LAGE- -is ,v,r AS,SESSOWS MAP di LO T NSTALI.ER'S NAIL PHONE NO. ;EPTdC TANK CAPACITY /OaT GCi l Q , ,EACHNG ACI1<.l T: (type) J , - - - (six ) LeLL 40.OF'EEDROOMS 'MILDER OR OWNER I7A7F.: ieparatiun Distance.Between the: - vlaxim rn Adjusted'Groundwater Table to the Bottom of Leaching Facility eet 'ovate Water Supply Well and Leaching Paacility (If wjy wells exist on site or within 200 feet of leaching facility) idge of Wetland and Leaching Facility(if smy wetlands exist within 300 feet f leaching f cility) / Feet -urnishcd b l ti 6� '1 w q,3 w � Q R� b n to TOWN OF B T%BLT LOCATION m?O �JV �u` SEWAGE # VILLAGE ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY t DO 0. Cr LEACHING FACILITY: (type) t� (size) O GeVt _ NO. OF BEDROOMS BUILDER OR OWNER �-�L(, PERMITDATE: 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 i � " � W � � �� ::. ��. . _ � ,�`� L 0 C A ff T OM SEWAGE PEFIWIT NO. WILL GE,/ INSTILED'S NAM ADDRESS �. � . 0 U-I l:D E R OR IMMR- _0 E rc r r. DATE PERMIT ISSUEQ WATE COMPLIA-NCE IS-SUED- 0 �li -3i r 3 33 4 _T Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ,M 30 Wayland Rd Property Address Green Belt Capitol Owner Owner's Name , information is required for Hyannis MA 02601 1-9-09 every page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. A. General Information 1. Inspector: SI � SZ �� Shawn Mcelroy Name of Inspector Upper Cape Septic Services Company Name 29 Atwater Dr Company Address E. Falmouth MA 02536 City/Town State Zip Code 508-495-0905 S13971 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. 1 am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 C M R 15.000).The system: , ® Passes ❑ ;Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority 1-10-09 Inspector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP.The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority., ****This report only describes conditions at the time of inspection and under the conditions of use` at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. f; t5insp official document•03/08} - Title 5 Official Inspection Form:Subsurface Sewage Disposal System+Page 1 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary'Assessments �M 30 Wayland Rd Property Address Green Belt Capitol Owner Owner's Name information is required for Hyannis MA 02601 1-9-09 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below. Comments: System is in good working order with no sign of failure. B) System Conditionally Passes: ❑ One or more system components as described in the "Conditional Pass"section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health,will pass. Answer yes, no or not determined (Y, N, ND) in the ❑for the following statements. If"not determined,' please explain. ❑ The septic tank is metal and over 20 years old"or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. " A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND Explain: ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ obstruction is removed t5insp official document-03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 30 Wayland Rd Property Address Green Belt Capitol Owner Owner's Name information is Hyannis MA 02601 1-9-09 required for y . every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes (cont.): ❑ distribution box is leveled or replaced r . ND Explain: ❑ 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 ❑ obstruction is removed ND Explain: 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: El Cesspool or privy is within 50 feet of a surface water El- -Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑; The system has a septic tank and soil absorption system (SAS) and the.SAS is within. 100,feet of a surface water supply or,tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within atone 1 of a public water supply. The4system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. t5insp official document•03/08 4 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �M 30 Wayland Rd Property Address Green Belt Capitol Owner Owner's Name information is required for Hyannis MA 02601 1-9-09 — every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) C) Further Evaluation is Required by the Board of Health'(cont.): ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: ** This system passes if the well water analysis, performed at a DEP certified laboratory, for coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: ' You must indicate"Yes"or"No"to each of the following for all inspections: Yes No El ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6",below invert or available volume is less than 'h day flow El ' ® 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. El ' ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. t5insp official document-03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 4 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ,M 30 Wayland Rd Property Address Green Belt Capitol Owner Owner's Name information is required for Hyannis MA 02601 1-9-09 . every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) D) System Failure Criteria Applicable to All Systems (cont.): Yes No ❑ ® 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`fifes"or"no"to each of the following, in addition to the questions in Section D. Yes No' ❑, , El the system is within 400 feet of a surface drinking water supply '. ❑ ❑ the system is within 200 feet of a'tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA) or a mapped Zone II of a public water supply well If you have answered "yes"to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CM 15.304. The system owner should contact the appropriate regional office of the Department. t5insp official document•03108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 30 Wayland Rd Property Address Green Belt Capitol Owner Owner's Name information is required for Hyannis MA 02601 1-9-09 every page. City/Town State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate "yes" or"no" as to each of the following: Yes No ❑ . 0 Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ❑ . ® Has the system received normal flows in the previous two week period? ❑' ® Have large volumes of water been introduced to the system recently or as part of this inspection? ®. ❑ , Were as built plans of the system obtained and examined? (If they were not available note as N/A) ®- ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, _ dimensions, depth of liquid, depth of sludge and depth of scum?. ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ® ❑ Existing information: For example, a plan at the Board of Health. ® ❑ Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] t5insp official document-03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments . 30 Wayland Rd Property Address Green Belt Capitol- Owner Owner's Name information is required for Hyannis - + - MA 02601 1-9-09 every page. City/Town State Zip Code Date of Inspection D. System Information Residential Flow Conditions: Number of bedrooms (design): 2 Number of bedrooms (actual): 2 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x #of bedrooms): 220 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 ® No Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available (last 2 years usage (gpd)): Sump pump? ❑ Yes ® No Last date of occupancy: 12-08 Date Commercial/Industrial Flow Conditions: - Type of Establishment: Design flow(based on 310 CM 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes. ❑ No Water meter readings, if available:, . Last date of occupancy/use: Date Other(describe): t5insp official document•03/08 , Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 15 Commonwealth of Massachusetts w W Title 5 Official. Inspection .Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 30 Wayland Rd Property Address Green Belt Capitol Owner Owner's Name information is required for Hyannis MA 02601 1-9-09 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) General Information Pumping Records: .Source of information: N/A 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): Approximate age of all components, date installed (if known) and source of information: 1980's Were sewage odors detected when arriving at the site? ❑ Yes ® No t5insp official document•03/08 • Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 16 f Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for•Voluntary Assessments 30 Wayland Rd Property Address Green Belt Capitol Owner Owner's Name information is required for Hyannis MA 02601 1-9-09 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Building Sewer(locate on site plan): Depth below grade: 22 `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.): Good condition. Septic Tank(locate on site plan): 15" Depth below grade: feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age:. . years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No -------------------------------------------------------------------------------------------------------------------------- Dimensions: 1000 Gal Sludge depth: 12' Distance from top of sludge to bottom of outlet tee or baffle 20" ' 6„ Scum thickness Distance from top of scum to top of outlet tee or baffle 4- Distance from bottom of scum to bottom of outlet tee or baffle 14" How were dimensions determined? Tape i t5insp official document•.03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ,M 30 Wayland Rd Property Address Green Belt Capitol Owner Owner's Name information is required for Hyannis MA 02601 1-9-09 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) I . . . Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tank is in good condition with baffles installed. Recommended pumping for solids. r t Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date Comments (on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): t5insp official document•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 30 Wayland Rd Property Address Green Belt Capitol Owner Owner's Name information is Hyannis MA 02601 1-9-09 required for H y - every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Tight or Holding Tank (cont.) Dimensions: Capacity: gallons Design Flow: gallons per day: Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ .No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No Distribution Box(if present must be opened) (locate on site plan): Depth of.liquid level above outlet invert 0 . 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.): Good condition. 4 Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No 'I Alarms in working order: ❑ Yes ❑ No t5insp official document-03/08 - Tiide*5 Official Inspection.Form:Subsurface Sewage Disposal System•Page 11 of 15 - Commonwealth of Massachusetts . Title 5 Official Inspection' ns .p ection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 30 Wayland Rd Property Address Green Belt Capitol Owner Owner's Name information is required for Hyannis MA 02601 1-9-09 _ every page. City/Town State Zip Code Date of Inspection D. System Information (cont.)ContY ( ) 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 why: Type: ® leaching pits number: 1 ❑ leaching chambers number: ❑ leaching galleries' number: ❑ leaching trenches - number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number:' ❑ innovative/alternative system Type/name of technology: Comments (note condition of soil, signs of hydraulic.failure, level of ponding, damp soil, condition of vegetation, etc.): Leach pit in good condition with stain line 24"below inlet invert. .4 t5insp official document•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 15 r Commonwealth of Massachusetts Title 5 Official Inspection - Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 30 Wayland Rd Property Address , Green Belt Capitol Owner Owner's Name information is required for Hyannis MA 02601 1-9-09 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 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 Comments (note condition of soil, signs of hydraulic failure,`level of ponding, condition of vegetation, etc.): Privy(locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5insp official document-03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 15 Commonwealth of Massachusetts r - Title 5 Official Inspection, Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments _ wM 30 Wayland Rd Property Address Green Belt Capitol Owner Owner's Name information is Hyannis MA 02601 1-9-09 required for y _ every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. r '6r,ch r • o � WOO G F A- 9 '6" q-C-sa 6° -E- 33' q-F 39 = - ya t5insp official document-03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 15 A Commonwealth of Massachusetts . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments yt 30 Wayland Rd Property Address Green Belt Capitol Owner Owner's Name information is required for Hyannis MA 02601 1-9-09 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to high ground water: 20 feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date ® Observed site (abutting property/observation hole within 150 feet of SAS) ® Checked with local Board of Health -explain: ® Checked with local excavators, installers- (attach documentation) ® Accessed USGS database-explain: You must describe how you established the high ground water elevation: USGS maps show groundwater at greater than 20'. t5insp official document•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 15 i � 3d�y� --.-.rr.- s-� #{� Ts �'; ;xr:q•- R�•'�^.�A�.` - _ .S..i.L`c...e��J � ��i m 0_'-e. �, '�j S �l -f AL R EC' D JAN 16 2003 TOWN OF BARNSTABLE HEALTH DEPT. ~:�t 51.Ei5S ,T A VI- G-- ?0&4..s_:SST "4` `ol ➢i'3 "P3�zC- a ASS' vs 1�X MAP .� C p e PARCEL € e 's Names D � "3 O ma's n L T --- t op G 3 a "plewce prim. Telepbone CE R� -ATfig 5 —IE � 1 r,e-� a� s. =tip?t this mess amc e e ,iru_gnu ex�E�in.he v?Lt?2� ..z i?and mainte=- ace Cis�^ E i E =or�_..`sa'-2z-t au^ vx�..t5-340 L°i 2�£?= � ���3 .' T u $',v g5•'`iv'` : �w--d,a! �4�5 E as=um,--�'J'_ .asp.' �3 �r'+'r&—ei y Fails 3 t>"..`_s.r-3 •, iasm The sys-t - en vuba--t a of c is imsucc -iepc. 'zo icy h �.Zu.sn "P d Cz. � £Y days C. " y: !his i'n be s '—is c sh—zx i-i sysu'-z-or 1--es c-ic:Sj ---.Tz,,,X t3 '_C'ow X Ve' x'tea:'�2`ie srsS{ his s`jsyte—m L*avR s s' a�ize�. f C+' ml =E"L regional L'�?q u± c ;ten, ra 3r;;`:a,�.' "_n:eynit� i2,n i i� 't:- 'DEP.'''.ne L'��.�T'F..^c�'S^ `tv��e�s, OW's^_-cE .r�L :�S.a�'i,'_ -- - ac:s;:{3zi'aSe. an'i Coln sizes rhLC omy Cr.�T1 t i_ LiY aFa:3 43 4 T e = .. _2�a uder 5e oor-cm-"� T ; F . <i ram?to?`se f arm .3�: bs3.e S-mm time. D's c I�does c a � ko,4 ss a system ma's. �.. page y F OR - --ASSESSMENTS SUBSRUWACE SIEWAGE DISPOSAL-SYSTEM ��"I'A CIER CA' -, dL o ICL � t A- m ems~ 5-3:i3 or m 3=0 C7 i i5J-v�`. C^°' ^,s�'��*. T�G ird`is �.+.�`-E�fi�: �'�iCS'tk'. e'aSs More S��.".om-_ Ss as desm-ibed the u`y S"�ys:•T£? Pass—S=mdw S4m�' +'. ' -�co ;e~ r.efme mplacemem or--pa- as Z-- vroved by u 3x? ,win Pa Answer?tom, it3,-- un-e-iE3�'�'.3�sug a_s�,: ,ex bits s?�---z k 's or exfilml�or as hmnlig sym=WEI pass m exmtmg tank '�Ys-esie.Hta�. - =A p £ ��s 3�'t5 5?":CKTzr' -�s���-,?�;le�.'^-r g':�`Ct'^� fa. '���. vPass i 7:ha:the is less'eh'2 20 yesn old s aY apmovai ofBC-wd of Fkalth abst.—t s remaved b:Ty"sue`dam Car rep a N 5 e izo-me d=L4 i e a-y--w dae � or ri vmt(Ss- I hte Sy'S'ms?*iu NOT T PAIR a � (CLPck, kcR s CQ e Date of P -.the Rerud..f . co �5� 7n rs�+z sC�i L—equ _ s-�-idrtd'the-z ev"mmon?3;ma Bom-d Of Hewt i Ua czmm , _ cYSi£x *x 1 unje s 3 4Df p3 £z Y#R e e 3 . j st £32 'St e Draft—f and the emvimmmmt: � r^,�z__'*3T� $Ski ,c"'S SsF3�`ei�n S a-4�tiLe Board ef.Health(Zcmd �Water SzlisphGY,��2Lyj det-z.'w_are3 ia'i'3£t£2 GS52v '�functioning in a S=a?ne?thaz zr�e=zqtera l�va£#Si���P�4�-t�/� L 3�St/$L�-^•.t i S*G� �'�-'g ".'S;. 35t- -'£JS> v�s.�.�i•T(st_S)and:a....r`AS is�whim 1:J"J `O' •` '3. to a ?.z'z :"_.�-=f_ - i?t`$�e5t 2Z_cs$5�'::'ciG'i�..x Et���A S _S 2::sd tht SAS is w--- _:�La-e i 3i o yi:.Di'aC�nT�'•�s-.'-P_V. t:se S�r5ie:3 XIS¢seodc=­K SAS a"a&e SAS iswienin 50=_ems 0-?r EvVIC'waw- SUPPiy'+ram � = a s c SAS anddm&AS is 1e�S `? __ few bun 550 1e:x mr m Mwe rye we s ue; __= €s3 Ge c is -�Ou krc s e�ia ,se"'�� 3 =: {*3'?d. fori "CMP=I- W—tdmt' the ix�>s Tha:a 'hy=d be once Of- � 'I "'TG,�n:3�Y�3a'�is equal to mr i£SS T�T_�"!i 3 ?�C ?,vrovided m no sYailu-m C im Ti.d�•` '.�iP�_✓�'S of; '.'CI.l�" �S^Mu SE 'i�.'at---r—ed ZO Zq:is PST A (44 01�- C You -ar= ef _ NO dj, g e-er 4 �s!ESE y-.� -M3-�'OF�'.`�^�"�g '� S cesspool CT 7sivyar,yr- '- 100 ie,off'a iScamspo I'm-gw-- f is wiffik$ s--,972$L.3E?:S'c vv.�' j• a��; � �,ss�s sus - y tte WeR wmteramamsiis, 5- /0£ye&-N-'''O he z"r 3 SLR a' yc �a a xs me or i;='m w-f>S: as _ �. ast 3 � y5&.-�is€�-=:- `—.€ova a SaifBm d '_.,._--- _.._-.. :SS'Y''��si'C �� 4.3'v • Q G 3i3.s�+w.. ??.aw-se +L�.X _ 3�35zs�`�Sx ',v�a 1 2-1�A ON FORM—NOT FOR V01 1 .I rS PART B CH—MCIIM F Adder moo .? 1a. 0 die o a tea : if ine fib' Lev^—. Y`wa--arast im&caze `v'ZS"or as w"..ram^�-c?dte f:3L�J.� c Yes NO _ T_ flu--pinging" .z.�.^in5:ccs'#Y':`+`_'".^ iSYa" '�.SY"'''�Ct:P�RPS,�7E."'�.OfF z-,Ws C O --lea -h- y =� ere of -_r`�OLE»`"'. me J� H:---lime tp' M-Ce?Ve£r-M-Mal fiE'"—s yip the rvvio s surd k Period Ys'em as i!.':Bi•=Z✓ia,' vi lbe5,4szem obmT`2r•.a T-.e.�..—ai'�++'^'�cl Z L ,. :m„Q.:mf=le:: a�.�. i7�C3'7�rCNzy, EY-.weii3? Z;z53�: ' :Va SEffi5 Ji z+ i2 Was d-e size� ."w:�i: C33 Signs QF m—r ak wn __ Yr�'e e�:�JS'_'•�'-iY33�g?�g�x�=8='���£�3�3%s� S,�-�7,' �..''S C£5?�a - 'Were me se=i rark m-anhoies+'- wv--p, �-1,ie:�1or o me mspec1'iasr i.`z`-vmdizion �33 T't M—files or Lzes�"zin'rw,,of -" .smsns—Aow"'—c-,li=-- .,e- 's"-. cr Sii?dee am'?di`..q.bm of sc __. ii !he!kCsii .�' ��:. sr"she" >i�L'-:i:�,,,'c`,:?i ±,ni>sJ'lwmcr )Provided WiT.?=in'.an—mno?'on lase pnr-p--� am z�si=and-kwatiom€ss;sue Jodi.Absoarpniem suss Tom'(&A C has de= og- J_3CTr..," :"T; ot'xF Tom=The field(if any of v.-he re .o 2rt L is al aprrcx: m_:to s � Ir wo li S 'Does _ l Lzm..� i cs _psi (yes cr � tyes kt2 tmp=�bes ar toi): :ate �s ND c-yrj ss = k�O S' �' : Sv-;w;-°ovwmm A.=` 'tc oopy a the DEP c FORM—NOT SUBSURFAC.E.SWAIAGR Wi-S S SYSTEM- 1 IN .--r ON r-szr�s-:zss tip;:cm,f i+•ion o2 3L`uns,ve zsc "ate Of is `' iwaa,-r--on. 3 ??ti beiow ode: } - aa copy c€ U.-wIk M r i d �5=Se• _s�e conf-a'm'.3. G f ( lf l ) —FAY IN t� � _/�Sam z:Qi:3 top of$ems" 3 +�'�43_ 'L"+3 to'-a7ul 'v^ €f c" +�fi n.--m-e ,—YS aC� �s i i and v?.�l-:�C9 b e"�.-coadz:so ��a:u;'Y .T� f3:i �s ie�-�� �.;�':�E.�,�.�•�r_t-�©'`���e__ mac.:. n � ` � ?tea tin.um-gzo Cam: =&i °ss: Dice fi-crn tap Of;c=:m-to' of c=:i� is'3r ra : J + 3f3atz^ o Sr i3 ESa,'Ev'sT �s r*I�lei_ Ci'zJ2—'3§_ rate of-!a--zPi �Tt �.�A �.F'i���F��n� �:��2 Ci1?i'.eEi.I�3=.:,�'�'�£TI.3I"Gi 1'�Y'a"s`. j," T'•:� F�U':S 1f3=7.eL S z Y. t Zvi i� c P.am` 8. $ -- O € r� 'S ViSfIPECTION sy _1_ I,e �a �a CA Almm P Eles , _ t & aim=mc em-)- of= %:egg above-- MVeM r s i : K I� f as'z£i��=?"� w u ec ;*Ll `.` OT so-im Vim,amy e?%t#.-s�'=of t OX Q e� � ' _c- 2 J 2 `� v �� -s Ili Plum-, clmoklmm- � I smear s bes or�;_ OF icL � PE-- 0 --IOT FOR V J iTg�' � � °" PART c Property A-ddi ll•cs a o"site Pimp `tea ,na =f sAs oti t wcp 3 ' 3� l ' "Dim overflow acssp-o-OL-sum c-^`e zm O �"2� 5'�'3S 3 � 3&se Ei�,t 3 (yam) G�2ir +il£3S'J"` -[ L `O fs C . i 33be vmr,.,�ped as - of sods v`consr.uOf �om— Tic ORLOW �J of max:, ,.-s �^ _eV_ v 3v V� (a v�vv- ZE . c - - sue f Page II Of A TC pj 30 (6 , �tAM we my L' AN Check leet ^imse is dkamm klcbecl�aU Ods used to mnme the isaasf Ob ma kam S- M r 53 3??:�s3 s'::wx'"' -Y chf—��'' 'tics c`;r"—ign e.1-n die-wed flrse sit- 'abumin Checked '�,---s, = Accesssed,USGS a -se-e-C-Diaarv_ Y,-u Must yescrm how Vol-,es&z14ished*ie bi&gseund w2ter ration_ (�,�_ A + i + L-440- Al + if ICJ I vrLL � a ; J i ( i p CX) THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..............Town.................OF..... ............................................. Appliration for Disposal Works Tonotrurtion Prrutit Application is hereby made for a Permit to Construct or Repair an Individual Sewage Disposal System at: .............................. ......# yar ...M.................*........................................... ocation-Address or Lot No. CaiDricornRealty-Trust............................................. ............................. ....... ................ Steve Lebel Owner Address Installer ler Address U< Type of Building Size Lot............................Sq. feet Dwelling No. of Bedrooms........3 .__..Expansion Attic Garbage Grinder Other—Type of Building ranch.............. No. of persons....._......._...._.....____ Showers (2) Cafeteria Other fixtures Design Flow.........5.5..............................gallons per person per day. T otal daily flow.................3.30...................gallons. 9 Septic Tank—Liquid capacityl.O.O.O.gallons Length Width.A.'.1.0-" Diameter------------_-- Depth.. ...8-1.1.... Disposal Trench—No. .................... Width......_.........._.. Total Length......_............_ Total leaching area.............. Seepage Pit No 1 1..... .......sq. ft. ..................... Diameter.....6............ Depth below inlet..........6.. Total leaching area.....2.6.6....sq. f t. Z Other Distribution box ( ) Dosin tank ( ) Percolation Test Re%;lts Performed by.. arp�agg...E�qgine... .........9;C1K19............. Date.....!I-a5.-B!............ Test Pit No. ...minutes per inch Depth of Test Pit_!?-........... Depth to ground water.la011e....ejacounte Test Pit No. 2..Nl&.....minutes per inch Depth of Test Pit..N/A......... Depth to ground water... .A____._.___. eS ............................................................................................................................................................. 0 Description of Soil..........Q.-I.... ...........I.QRM...&...t.O.P.Sail........................................................................................ W • I I ..........................................2............1Q........nedium,V.ellaw...sand..............*--------------------------------*------"----------------------- ....................................... ........1-2--1......m.e d.,... ........ ..t_rp�.Q_e.S...Qf..gravel/no...wat.ex---At...12 ' U Nature of Repairs or Alterations—Answer when applicable---_...............................................__..................... ................ ...................................................................................................................................................................................................... Agreement: The,undersigned agrees to install the aforedescribed ivid al S ge Disposal System in. accordance with the provisions of'IITT-14, 5 of the State Sanitary 4l_ode< e er . ed further agrees not to place the system in operation "Oil peration until a Certificate of Compliance has bee?Issu y e o of health. Signe .. . ........ . ... . ............................. .... ... ...... Applicat ion Approved.B .. ..................................................................... ...... Date.............. tiol Application LApplication Disapproved r t following reasons:.................................. ............................................................................. .................. ......................................................................................................................................................................................................... Date Permit ermit No........................................................ Issued....................................................... Date I T Z{66 ^J Fps...... .. ........... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..............Tern................OF.....Barnsta-ble..................................................... rE 4 Appliration for Disposal Works Tonstxnrtion r" 'ta Application is hereby made for a Permit to Construct OC ) or Repair ( ) an Individual Sewage Disposal System at: .....L.Q.t.. ...�. ...vv rG?. .. . X- -• ... Hy�T111is� Ml�....----•-----------------------------'...............--.. Location-Address or Lot No. A aAxa.Gs zi.. 1 ...T'r- at .... ......7.6.5...FA.Imo_uth...8e.&d.F...Hy.aii Ls................. Owner Address .......................................................... .................................................................................................. Installer Address Q Type of Building Size Lot............................Sq. feet U Dwelling—No- . of Bedrooms.........3..................... .Expansion Attic ( ) Garbage Grinder ( ) P., Other—Type of Building MnCh............. No. of persons............................ Showers (2) — Cafeteria ( ) a' Other fixtures .................................. W Design Flow......._5,5..............................gallons per person per day. Total daily flow.................3.30...................gallons. 1:4 Septic Tank—Liquid capacity�O.O.O.gallons Length_S.'.6."____ Width..1 .10.'-' Diameter................ Depth.. .'8"._.. W x Disposal Trench—No_ ____________________ Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No..................... Diameter.....6....._..... Depth below inlet.......... .'..... Total leaching area.....Z6.6....sq. tt. Z Other Distribution box ( ) Dosin tank ( ) Hdred e En ineerin 11 2 -81 W Percolation Test Results Performed by..................................._....---i.._..----.-............ Date...._____._-__.lr_____.__...._......_. 04 Test Pit No. 1Ka,0___minutes per inch Depth of Test Pit-_1?..-.......... Depth to ground water.Inone...a nCounte — Lil Test Pit No. 2.11A, ._1A, ..,._minutes per inch Depth of Test Pit..B/A......... Depth to ground water....DVA........... e ----••---------------------------•--........................--................................._...._.....--------------- -............--................ O Description of Soil..........Q i....- 2............a.0am... ...to.P.S.0j.1----------------------------------•------•----------- zQ ......>a edium.zello.W...S9 -d----------------------------------------------------------------------------- W 10-----------1�--------med._..vvh� e._.sand/trace;z 4f_. Yel/. a..wa .a 12 UNature of Repairs or Alterations—Answer when applicable...__........................................................................................... ---------••----•--•--------•-------------------------------•--------------......................--•---_.._----------•------------------------------------------------....--------------...------......_. Agreement: The undersigned agrees to install the aforedescribed 'ivi tal S age Disposal System in accordance with the provisions of:iTI:: 5 of the State Sanitary e er ' ed further agrees not to place the system in operation until a Certificate of Compliance has bIssu d y e bo d of health. .... Signedr ....., ............................. / = � Application Approved Ir ---- -----------------------------------------------------------------•..-- .....4�F..�� � Date ,- Applieation Disapproveollowing reasons---------------•--------•--------------------------------------------------• -............................... ----------------------•--....--------•---••-•---------------------•----...--•---.............---------.....------.....-•-•--•---------------•----•---•-•-----•-----•------------------------------------- Date PermitNo......................................................... Issued........................................................ Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ...Town...........O F.......Barns table .............. .............................................. (Enrtif iratr of Toutplianr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) bSteve Leber, ------------------------------------------------------------------------------------------------------------------•------......._:. --------- y.......................a .-.... e. Installer Lo � )' - =: has been installed in accordance with the provisions of mI, j f The State Sanitary od ra's disc > d in the application for Disposal Works Construction Permit No.-Z,'.'"_a .->� ........._......... dated_. /� ....._.. --------------- THE ISSUA E �F THIS CERTIFICATE SHALL NOT BE CONSTRU ® S 74 GUARANTEE THAT THE SYSTEM WILL '!'VT' SATISFACTORY. DATE.....__,1�� L -.-.--... Inspector__..._:._ ....... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..................own.......OF..........Barnsta,bl e .... ... FE ..................... Disposal Works Tonotrnrtion rrntit Permission is hereby granted._ Steve Lebel _ to Construct (x ) or Repair ( }� an •ndividu -1 Sewage Disposal System at No... L # ( �C�. I-�,__, H nYiiS P�I.9 �8 1�..: Street as shown on the application for Disposal `'Forks Construction Permit No .- (..._ Dated.�_.__:_fi�i�:...............:..... -••-•----....--•-----------•---....•------ ............................................................ Board of Health DATE-----------------•----------•-----•-•--•-••----•-------•--•-------•------------ FORM 1255 HOBBS & WARREN, INC., PUBLISHERS i 20 F s (3 Io •s a.-� s. ��.. p , t _ 4v-r / z. /a, 00o r,, U -r_= EAsM. Ll L i,4 „` 9p SEAT%G .T1 /✓/< C}. .. .13 t N � P,6posao 3 6c4&0*,, . 41 o c� I 5 /ol M ti0.0 C2 yj OF LA �hCGO c=x=T �­r o 'g J in .p 29874 O 0 SURNF'y' -LEGEND EXISTING SPOT ELEVATION CAA a��t{OFA s, CERTIFIED PLOT PLAN EXISTING CONTOUR --- 0 __._ ��� : �cyG v L o z ,r/,,� FINISHED • SPOT ELEVATION o LB RT / FIIiISHEO CONTOUR 0 / {�0.io o IN AMROVEDs.BOARD OF HEALTH rsTa4 �FSS�0NA1Ea� �� ����� ,� � • '':.DATE - AGENT SCALE, / ` 3 0 DATE$ S /z 19 z. EDGE ENG/NEER/NQ Ca I CLIENT r I CERTIFY THAT THE PROPOSED EGIS E REAISTMED :. OB NO, F�lzvs BUILDING SHOWN ON THIS PLAN . CIVIL :. LAND CONFORMS TO THE ZONING LAWS We Y, A OF BARNSTABLE, SS. 7t2 M'kI N STREET; CH. BYIJ R MYANNIs,. MA.$3. SHEET OF DATE LAND SURVEYOR . a IV07' /F E/TNER THE S':=PT/C TA,t/./,CC OR I z . _E�FG.4�/wG P/T ,4Ae )YORE TNA,-'l /2"'BELDIN fT M/N..: 1.?AOE, A 24 0/AA4 ETER CONCRETE COYER SJdALL BE BROUGHT TO 6RAOE. ��.'✓ EXTR.'4 GONCAETE 9 orC P/PE (. 1yEA V y CAST 14-O/Y C o YER SN,4�L DE USES _ M/_N. P/TCN COYE� YB PeR i 1 /F/N DR/✓EN/A y I CUi/E.4 C::EAN S'A/VO Y4 CK,=/L L ~` 4 .��- 2 LAYER I 4 c.+sT • /RON P/PE. ., l D (7 D - d M1N.P/rca+l OA4, t • • • • • , • t t %q"PER SEPT/C TAAIX D/ST. •"b , . . • . , , ; rYASHED 57riNE F x BOX p • i e • T/VA-• • ' •° • e k a; r • ep t t •Ef • 3�4 �2.. FEC � � • � / a - • ° • . r . • OEPT/I • • t • , WA5,YE0 STONE o • • • • • • • �" o Z, 47`O ► a• • r • • • • • • • • p ••v PRECAST sEEPAaE !N!/GR7 CLEi/�IT/�/VS l Fs8'X v ,. • • • • . • • . o R/T -OR E 411V 7 7 . a EL. 94 v t /NYERT AT O.y/LD/NG l O!.O S �,sd L.�D/'1)' FT. G F . D/,4161. INLET, SEPTJ T.4/VK J o FT' D/i41►9. C SEE TABUL4TION, Ov7[ET SEPTIC -rANX I o0 6 FT at/rZo BOX /woo FT. SECTION OF GROUND 1�lTER TADLE Ot/TLETD/STR/B(/'T/ONBOX /vt2,2 /�yLET LEACN/N .P/T' JU o.o Fr .5Eh/AGE G161.4=05A 4 SYSTEM AB LAT/ON L EACHI"a A/T T V D.ES/6JY Cft/TERli4 -sc.�rtE. D/MEW.S/o/V A 3 FT. D/p!E/VS/oN $ FT:. . NIJM4ER OF BEDROOMS D/MENSlON C 4 F7;M�•t/. (,i4Jg43A6EGISP0.5AL V V/T NOWT SOIL. LOG 336 6WJ- TEST 44 7P.TAL &STI/►'TED FLOW G.4L.1DAY S07 L TEST,1�/ SO/L TE3T 2 *UMBER QF LE`ACN/NG-/R/TS I 'LEY.' 1.02.0 ,DA.TE OF SOJL TEST 1 /DEL1'AGH/NG PER P/T r ,Sa fT. O_; � r RESULTS i�//TNESSED�BY�RE /��oiZA 9o7?O!+*LE�ICN1i�fG PER P/T 7 $Q.: &T. Lo A Al � = PtRCOLAT/OJv MATE,«/ ���-5 M//V /NON f" TOTAC'L'EACH/NG �4REA. 2�O b .SQ, FT.. . -7-UlP L : k �VCO / / !7E Li4T.D/V RATE�2 Tlt•4N M/N.Y INCH RFSERf�ELE�4C/IIN6ARE^ S4. FT. / -`/O �a .. ? SN OF i t,, OF MAss H o MORSE 2�74' No.10951 O a: S��t� FQ� ���o� A9� TE � w' rN C2n,i�L EL DREDGEE/V&/AIRER/NG CO,/NC. NO�Rv�yO o�FSS/ON 9 0,- 7/2 M/1/N ST. • /S�YAicIN/S, M.gSS. AC iYo GRov/yr7 y.�a MER ENCOU/vrE,eEo CZ/EIV T.' FR OEPA775GRO uNO Ls/A JOB /VD` 8l z-OSET