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HomeMy WebLinkAbout0286 OAKLAND ROAD - Health 286 Oakland. Road Hyannis /� A= 271-098 i D Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ,M 286 Oakland Rd Property Address Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for Hyannis MA 02601 10-31-09 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: ._514 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. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000).The system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority 11-2-09 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. t5insp official document-03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal$ys� •Page 1 of 15 Commonwealth of Massachusetts w Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 286 Oakland Rd Property Address Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for Hyannis MA 02601 10-31-09 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 M 286 Oakland Rd Property Address Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for Hyannis MA 02601 10-31-09 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes (cont.): ❑ distribution box is leveled or replaced 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)(4)that the system is not functioning in a mannerwhich 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 borderirig 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 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. t5insp official document•03/08 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 286 Oakland Rd t' Property Address Bank Owned (Contact David-Holt @ Today Real Estate 1-800-966-2448) /. Owner Owner's Name information is required for Hyannis MA 02601 10-31-09 _ F 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 ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool El 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 1/.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. ® 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 286 Oakland Rd Property Address Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for Hyannis , MA 02601 10-31-09 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) D) System Failure Criteria Applicable to All Systems (cont.): Yes No . .I. � i. ❑ ® 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. M ❑ ® 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 20,00gpd- 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.El . El Area 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 CMR 15.304. The system owner should contact the appropriate regional office of the Department. -< - t5insp official document•03/08 Title 6 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �M 286 Oakland Rd Property Address Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for Hyannis MA 02601 10-31-09 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' ❑ ® 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)] t5lnsp official document•03/08 Title 6 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 286 Oakland Rd Property Address Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for Hyannis MA 02601 10-31-09 every page. City/Town State Zip Code Date of Inspection D. System Information Residential Flow Conditions: Number of bedrooms(design): 3 Number of bedrooms (actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x #of bedrooms): 330 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: 7-09 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? El 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 I Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 286 Oakland Rd Property Address Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for Hyannis MA 02601 10-31-09 every page. City/Town State Zip Code Date of Inspection D. System Information (coot.) General Information Pumping Records: i r' s +•t 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 1/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: 2004 Were sewage odors detected when arriving at the site? ❑ Yes ® No t5lnsp official document•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ,M 286 Oakland Rd Property Address Bank Owned Contact David Holt Today Real Estate - - - s to 1 800 966 2448 . ( @ Y ) Owner Owner's Name information is required for Hyannis MA 02601 10-31-09 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Building Sewer(locate on site plan): Depth below grade: 18 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): Depth below grade: 12 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: 1500gal Sludge depth.: . 10" Distance from top of sludge to bottom of outlet tee or baffle 22' Scum thickness. . 0 6" Distance,from.top of scum_to.top of outlet tee or baffle Distance from bottom of scum to,bottom of outlet tee or baffle 16" How were dimensions determined? Tape 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 286 Oakland Rd Property Address Bank Owned (Contact David Holt @ Today Real Estate 1=800-966-2448) - Owner Owner's Name information is required for Hyannis - MA 02601 10-31-09 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 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 and no sign of leakage.- 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 0 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 W Title 5 Official Inspection Form Subsurface.Sewage Disposal System Form -Not for Voluntary Assessments 1M 286 Oakland Rd , Property Address Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for Hyannis MA 02601 10-31-09 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 with water at working level. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes . ❑ No Alarms in working order: ❑ Yes ❑ No t5insp official document•03/08 - Tide 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form - Subsurface Sewage Disposal System Form-Not fog Voluntary Assessments ,M 286 Oakland Rd Property Address Bank Owned (Contact David Holt @ Today Real Estatel-800-966-2448) Owner Owner's Name information is required for Hyannis MA 02601 10-31-09 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 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: ® leaching chambers number: 2-500's ❑ 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 chambers in good condition with stain line at 6"from bottom of chamber. t5insp official document•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments °�M a 286 Oakland Rd Property Address Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for Hyannis MA 02601 10-31-09 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 u - Title 5 Official Inspection Form a Subsurface Sewage Disposal System form-Not.for Voluntary Assessments w 286 Oakland Rd , Property Address Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448)- Owner Owner's Name information is required for Hyannis MA 02601 10-31-09 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. " �jGGK C4!q y� 5-3Yet' O t5lnsp official document•03/08 Idle 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments �M 286 Oakland Rd Property Address Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for Hyannis MA 02601 10-31-09 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: 12' 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: Original design plans show no groundwater at 12'. t5insp official document•03108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 15 of 15 TOWN/OFj6,RNSTAB1LE OCATION co?0 ��`t SEWAGE ALL.AGE 1-4 yan d,'s ASSESSORS MP&LrOT r . K , 'st NAIVIE&PHONE NO. � �w�. A=,s�l �e, iEPTIC TANK-CAPACITY /S0 MAGI ING'FACILL: (type) e� -� s (size) 40.OF'BEDROOMS MLDER OR OWNER separation Disttutce Between the: ✓laximum Adjusted Groundwater Table to the Bottom of Leaching Facility eat 'rivate wator Supply Well and Leaching Patcility (If any welts exist on site or within 200 feet of leaching facility) 1lei;t dge of Wedand and Leaching Facility(If any wetlands exist within 300 feet of leaching faeilitY)_ �e�t �_ Q• � U c`1 '. J � r _ _ . _ _, v ©' C Q � � w .o r �I �:� � � 8 TOWN OF BARNSTABLE C 'LOCATION -2 16 OgV—LA--�,1 SEWAGE # 'TII.LAGE 4-H AN)N+J ASSESSOR'S MAP & LOT i INSTALLER'S NAME&PHONE NO. "Aso- 5t041Tc 5ZAA,ce 6M 77S,,"V716 SEPTIC TANK CAPACITY H t u LEACHING FACILITY: (type) F420 (size) a� x Sam NO.OF BEDROOMS -3 BUILDER OR OWNER 4-63 PERMITDATE: Li , I0q T 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 ` o _, T � t `�; �� i � ' 6 ,�� ►� _ L� .. o ® - Od �. �' � G '. � `�' � � � .F' c � c^ �� �. No. E$$50.00 THE COMMONWEALTH OF MASSACHUSETTS 'nEntered in computer: d/ Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS Zip plication for Ofi5 pool bpotem Cou.gtruction Permit Application for a Permit to Construct( . )Repair( X)Upgrade( )Abandon( ) El Complete System El Individual Components Location Address or Lot No. Owner's Name,Address and Tel.No. Assesso?Mp/P'aMland Rd, Hyannis Celio Dominatto 271 -98 286 Oakland�Rd, . Hyannis Installer's Name,Address,and Tel.No. 7 7 5—8 7 7 6 Designer's Name,Address and Tel.No. 3 9 8—8 31 1 Wm E Robinson Sr Septic Craig Short PO Box 1089 Centerville PO Box 1044 S Dennis Type of Building: Dwelling No.of Bedrooms 3 Lot Size sq.ft. Garbage Grinder�o ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil, Nature of Repairs or Alterations(Answer when applicable) Install Title 5 septic to plans of Craig Short #1 -973 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 Environmen od d not to place the system in operation until a Certifi- cate of Compliance has be issued by this B of He Si ned Date Application Approved b Date Application Disapproved for the following reasons Permit No.�'L�O 4 `E Date Issued O `1 r c7-w ,- r � Ir t + }, , f•'e .i J Fe50 00 No. � �' . Y ✓' THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS 2ppfication for Mi5poml *pgtetn Construction' Permit Application for a Permit to Construct( )Repair(X)Upgrade( )Abandon( ) ❑Complete System O Individual Components Location Address or Lot No. Owner's Name,Address and Tel.No. 2 na�>fland Rd,;Hyannis Celio Doainatto Assessor ap/Faz 271 -98 286 Oakland Rd, Hyannis j _ Installer's Name,Address,and Tel.No. 7 7 5—8 7 7 6 Designer's Name,Address and Tel.No. 3 9 8-8 31 1 Wm E Robinson Sr Septic Craig Short PO Box 1089 Centerville PO Box 1044 S Dennis Type of Building: Dwelling No.of Bedrooms 3 . Lot Size sq.ft. Garbage GrinderRO ) Other Type of Building < No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) Install Title 5 septic to glans of Craig Short #1 -973 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 Environmen Cod d not to place the system in operation until a Certifi- cafe of Compliance has be u sued by this Boaf of He Si ned ��F� ii. DateG "�G Application Approved b `. Date R Application Disapproved for the following reasons �p Permit No. a00`/ ' Date Issued Z11,7 O _. --------------- --�,--------------------- THE COMMONWEALTH OF MASSACHUSETTS Dominatto BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY, that the On-site Sewage Disposai System Constricted( )Repaired(X )Upgraded Abandoned( )by Wm E Robinson %Sr Septic Service at 286 Oakland Rd, Hyannis { has been construct6d iV ac�/ordance with the provisions of Title 5 and the for Disposal System Construction Permit No. ,,)t(.. dated �� U q/ Installer Designer q. u The issuance of phis ermit shall not be construed as a guarantee that the% ste wil nction as designed. Date �03 f Inspector • --------------------------------------- No. c�) ' 4 -/&/ F 150 .00 Dominabto THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS 'Wi5poo,ar *pgtem Construction Permit Permission is hereby granted to Construct(�}-Repair-(X )Upgrade( )Abandon System located at 2.86 Oakland Road, Hyannis 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:Con�s-tr/u tion ust be completed within three years of the ate of this Date: �T f/_0 Approved Town of Barnstable Regulatory Services Thomas F. Geiler, Director Public Health Division Thomas McKean, Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Installer & Designer Certification Form Date: 4 Designer: C _,vt t s 12 3 Installer: J.- Address: Z_3.5_ Address: az46c� G , , r�Y���/� � � On 4 4/�`tt /02�I was issued a permit to install a Z� (date) (installer) septic system at z 8 L C7Q /0-'!t6 NyQ-7 ,*-5 based on a design drawn by (address) RAE7 dated 7Z3n 3 r-c v. 9/s/0 3 —T (designer) ✓ I certify that the septic system referenced above was installed substantially according to the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. I certify that the septic system referenced above was installed with ma''or changes (i.e. greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system) but in accordance with State & Local Regulations. Plan.revision or certified as-built by designer to follow. CRAq �G Si-SAT v' (Ins a is Signature) u N&CIVIL (Designer's Signature) (Affix D signer's Stamp Here) PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS- , BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. Q:Health/Septic/Designer Certification Form f TOWN OF BARNSTABLE SEWAGE # LOCATION o� VILLAGE- I' ^D'�' —ASSESSOR'S MAP &LOT ' _ Ti`e 77r 771 INSTALLER'S NAME&PHONE H0. d SEPTIC TANK CAPACITY t u LEACHING FACILITY: (type) yw.�lls (siae) NO.OF BEDROOMS 3 BUILDER OR OWNER PERMIT DATE: �f g f©� COMPLIANCE DATE.— Separation Distance Between the: Feet Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Private Water Supply Well and Leaching Facility (If any wells exist Feet I on site or within 200 feet of leaching facility) etlands exist Edge of Wetland and Leaching Facility( Feet Iwithin 300 feet of leaching facility) Furnished by V�o - t7 O e BENCH . SOIL TEST TOP OF FOUNDATION 20 FT.,MINIMUM FROM CELLAR DATE OF SOIL TEST 5 3 _ ELEV. -- 100-00� 10 FT. MINIMUM 10 FT. MINIMUM FROM SLAB OR CRAWL SPACE ' � jQ CLEAN SAND SOIL TEST DONE BY (ASSUMED) WITNESSED BY $AM-YdjLM_ffjQjL_..PJ=17 CONCRETE COVERS LOAM AND SEED 4" SCHEDULE 40 PVC PIPE OBSERVATION HOLE 1 ELEV.=_ $56- MiN, PITCH 1/8":PER FT. 2" LAYER OF PERCOLATION RATE <__2 MIN./INCH AT .,.. 12-84 INCHES 1/8".TO 1/2" LEGEND: DEPTH HORIZ TEXTURE COLOR MOTT. OTHER 96.0 MAX. WASHED STONE EXISTING SPOT ELEVATION 00,0 #1 32- 4" CAST IRON PIPE " MAX " 94.0 MIN. EXISTING CONTOUR ----00- -- #2 = 36 UNSUITABLE (OR EQUAL) MINIMUM FINAL SPOT ELEVATION 00 0-36- FILL MATERIAL PITCH 1/4" PER FT. a FINAL CONTOUR 0 -ZABEL FILTER g SOIL TEST LOCATION FLOW LINE 93.0 UTILITY POLE -0 #1 ELEV. _ 97:33 10" UNSUITABLE PLUMBING 2 ELEV. �97.00 MIN. 2 coCID D CI ❑ O CI❑ 0 C1 D TOWN WATER W � ` W 36-40 A LOAMY SAND 10YR5 1 NO MATERIAL TO BE RAISED - ELEV. 955,75 ° ° ° CATCH BASIN (11 t�i LE2� VEL o ❑ ©❑ 0 ❑�p 0 ❑ ❑❑ ❑ ° ° GAS LINE C 0 .. UNSUITABLE AND RE-PIPED BY ELEV. _ 96�0Q_ GAS 6" SUMP H2O 0 o CLEAN OUT LICENSED PLUMBER ELEV. - 92.70 ELEV. = 92�50_ o o MATERIAL AS NEEDED BAFFLE DISTRIBUTION ° ❑O O,Ca.C1 D C7 0 ❑ ❑ ❑ 0 2' a CESSPOOL C.P. O 40-72' 8 LOAMY SAND 1OYR5 8 NO EL 89.6 ELEV. o ° ° ❑ © ❑ © ❑ Cl1O ❑ O❑❑ 0 90.25 iQUiD OUTLET v BOX J2..25_ ° °o ° +° ° ° ELEV. __--- MEDIUM TO 4 FEET TEE INCHES (TO BE PLACED ON FIRM LBASE) TO 6E WATER TESTED 2-500 GALLON DRYWELLS WITH 2-144 C COARSE SAND 2.5Y7 4 NO 5 FEET 19 INCHES ') JDO GALLON IF MORE THAN ONE OUTLET STONE IN A 6 FEET 24 INCHES 7 FEET 29 INCHES (TO BE PLACED ON FIRM BASE) 13'x25'x2' TRENCH FORMATION ? 6.65' WELL N A NO WATER ENCOUNTERED AT _�2.._ ELEV. _ .. fi_ 8 FEET 34 INCHES SEPTIC TANK 20NE N,/A DOUBLE TO 1 1HE CLEAN SOIL ABSORPTION �, INDEX DESIGN CALCULATIONS DOUBLE WASHED STONE ADJUSTNZA FREE OF FINES & SILT SYSTEM SAS _ NUMBER OF BEDROOMS 3 USGS PROBABLE WATER TABLE ELEV. _ _!�,lA_ GARBAGE DISPOSAL UNIT' NO, ggl1_AIlOWED SEWAGE DISPOSAL SYSTEM PROFILE OBSERVED WATER TABLE ( / / ) ELEV. = A_ TOTAL ESTIMATED FLOW NOT TO SCALE BOTTOM OF TEST HOLE ELEV. _ _ { 110 GAL/BR./DAY X ;_ SR.) _ _ GAL./DAY REQUIRED SEPTIC TANK CAPACITY _ GAL. ACTUAL SIZE OF SEPTIC TANK _t5 GAL. SOIL CLASSIFICATION DESIGN PERCOLATION RATE E MIN./IN. EFFLUENT LOADING RATE A.7-4_ GAL./DAY/S.F. LEACHING AREA �477 SO. FT. (11 98.1 LEACHING CAPACITY (AREA X RATE) _92_ GAL./DAY 477 X 0.74 RESERVE LEACHING CAPACITY _1522 GAL./DAY ((13'x25')+(76'X2'))x0.74 NOTES: 1. ALL WORKMANSHIP AND MATERIALS SHALL CONFORM TO D.E.P. AREA �+d TOd TITLE 5 AND THE TOWN RULES AND REGULATIONS FOR THE SUBSURFACE N 15,J75 S.F f DISPOSAL OF SEWAGE. 2: ALL COVERS TO SANITARY UNITS SHALL BE BROUGHT TO O.35 A CREST WITHIN 6" OF FINISHED GRADE, * 99.3 SHED ,5 3. ALL COMPONENTS OF THE SANITARY SYSTEM SHALL BE CAPABLE OF 99.9 WITHSTANDING H-10 LOADING UNLESS THEY ARE UNDER OR WITHIN 10 FT. OF DRIVES OR PARKING AREAS. H-20 LOADING SHALL BE 99.5 9.2 USED UNDER OR WITHIN 10 FT. OF DRIVES OR PARKING AREAS. �a913.7 9 4. ANY MASONRY UNITS USED TO BRING COVERS TO GRADE SHALL BE MORTARED IN PLACE. I . _. . ... : �X/✓�I� G "i'.,'�J'+Wli'i..l Ai'4`CE a'�PiT`i 99•1 DEEDED OR ZONING REGULATIONS. OWNER f APPLICANT IS TO (� DWrLL/NG OBTAIN SUCH DETERMINATION FROM APPROPRIATE AUTHORITY. 97.4 " -. 6. UTILITIES SHOWN ARE APPROXIMATE ONLY, EXCAVATION CONTRACTOR IS TO CALL "DIG-SAFE" AT 1-888-344-7233 AT LEAST 72 HOURS l PRIOR TO COMMENCING WORK ON SITE. I EL 97.33 7. CONTRACTOR IS TO VERIFY GRADES AND ELEVATIONS AS WELL AS 96.4 B.H. SITE CONDITIONS PRIOR TO COMMENCING WORK ON SITE. ANY VARIATION IS TO BE BROUGHT TO THE ATTENTION OF THE DESIGN ENGINEER 98. IMMEDIATELY, Q 8. PARCEL IS IN FLOOD ZONE C 911 9. LOT IS SHOWN ON ASSESSORS MAP ___27t AS PARCEL 98..._ 7.1 7.8 �4 10. ALL UNSUITABLE MATERIAL SHALL BE REMOVED FROM UNDER, AND h ja FOR A MINIMUM OF 5 FEET FROM AROUND THE SOIL ABSORPTION SYSTEM, ^� AND BE REPLACED WITH SAND AS SPECIFIED IN 310 CMR 15.255: (3) 2 (I.E. TITLE 5) IF ENCOUNTERED BELOW S.A.S. PIPE INVERT. • L 97 DO x 95 0 95. -' 11. EXISTING CESS POOLS TO BE PUMPED AND FILLED WITH SAND C OR REMOVED PROPOSED 12. A ZABEL A1800 FILTER IS TO BE INSTALLED. r ADD17701V DRIVEWAY EXISTINGy �I rc => APPROVED. BOARD OF HEALTH '94GARAGE TO .. :.. -" --�-_ 7.9 BE MOVED � �a .6 �' 98.1 95� 97.5 �, 2 F 3 24 <`�\ 4 97.4 z751 .,\ 3' 9 x r 1' .:� ; 2461 DATE AGENT , 6.0 94.3 _ 96 6 32 '- ?' EXISTING x 94.7 _97.3K_ FENCE .,PROPOSED SEPTIC DESIGN GARA97.4 6.5 x 95. FOR RELOCATION 05.6 35, ROUTE 28 CELIO DOMINA-TTO x 93.3 "'-�-.. 2 ,' to ` Li LOC. LOT 9A. 11D 04 Q 9g 97.3 Q p U if I LiI.J. L-1`I�i l� f IY1 ? J 91.6 0 R.S.A.S. S. - Z 917 N %' 95.5 Q z <t 9i.3 w © CR& R SHORT, P..E. 7 _ �¢ c� 235 GREAT WESTERN ROAD " 97.5 508_ P. C?. BOX 1044 ao�. 3.0 1 tt, f 96.9 ¢ 398--8311 SOUTH DENNIS, MASS. 02660 0, 40 MIL VINYL 5.6 L?ATEJULY �3, 20031 �`sCALE LINER BREAK-OUT $ 7.7 BARRIER 88. DUNN'S sEE NOTE 10 POND REV. SEPT. 3,' 2003 JOB Nc�. 1 --973 REV. LOCATION MAP SHEET 1 OF 1 R -0 ,w R';SHORT, P.E.;: C11 r�373 Dorrsint�tto SP 2 d . . t�2f303 CRAIG S ,