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HomeMy WebLinkAbout0055 SUDBURY LANE - Health 55 Sudbury Lane , -- Hyannis A=271-221 I I I I Lj TOWN OF BARNSTABLE _C°. 10 Yt ! LOCATION SY 0066,JF SBWAGE # VILLAGE r? r.S ASSESSOR'S MAP 6z LOT d N. INSTALLER'S NAME & PHONE NO. A.& B CANCO 775-6264 -SEPTIC TANK CAPACITY LEACHING FACILITY;(type)t egos(size) /,3 �1�7 r NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER BUILDER R O�ER f... DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: '" " VARIANCE GRANTED: Yes No ' s �. r � �� � - :�,.. .;..,. '.�. ;.- '� 'r ,�, .. :, ,.."' �: .; ;•. ��,,'. '„ '�\ (y � V\ 1 9 l 4 ��. ... _. Commonw ealth of Massachusetts Title 5 Official Inspection Form '= Subsurface Sewage Disposal 9 p System Form Not for Voluntary Assessments x 55 Sudbury Lane Property Address Nancy L. Parham Owner Owner's Name xinformation is required for Hyannis MA 02601 April 19, 2011 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. Please see completeness checklist at the end of the form. Important:When filling out A. General Information forms the n / computeto r,use 1. Inspector: ( `IVIn only the tab key to move your David D. Flaherty Jr., R.S. cursor-do not Name of Inspector use the return } key. Flaherty Environmental Services ` Company Name P.O. Box 81 . Company Address t Yarmouth Port MA 02675 �0 City/Town State Zip Code 508-362-1657 S 14713 Telephone Number License Number B. Certification t. 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 15.3406f Title 5(310 CMR 15.000). The system: ® Passes ❑ Conditionally Passes ❑ Fails =� , ❑ Needs Further Evaluation by the Local Approving Authority {fa ( April 20, 2011 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. v �/v t5ins•11/10 I Title 5 Official Inspection Form:Subsurface Sewage Dispos System•Page 1 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments 55 Sudbury Lane Property Address Nancy L. Parham Owner Owner's Name information is required for Hyannis MA 02601 every page. City/Town State Zip Code Date lof Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® 1 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: B) System Conditionally Passes: ❑ One or more system components as described i e"Conditional Pass"section need to be replaced or repaired. The system, upon comp) ion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no"or"not determi d"(Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 y rs old* or the septic tank (whether metal or not) is structurally unsound, exhibits substa ial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing t k is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pas inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that a tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal system•Page 2 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 55 Sudbury Lane Property Address Nancy L. Parham Owner Owner's Name information is required for Hyannis every page. Cltyrrown MA 02601 April 19, 2011 State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes(cont.): ❑ Observation of sewage backup or break out or high static water level in th istribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven di ibution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ND(Explain below): ❑ obstruction is removed ❑ Y ❑ ❑ ND(Explain below): ❑ distribution box is leveled or replaced ❑ Y N ❑ ND (Explain below): ❑ The system required pumping more an 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with pproval of the Board of Health): ❑ broken pipe(s)are repla ed ❑ Y ❑ N ❑ ND(Explain below): ❑ obstruction is remov d ❑ Y ❑ N ❑ ND (Explain below): C) Further Eval ation is Required by the Board of Health: ❑ Conditions xist which require further evaluation by the Board of Health in order to determine if the syste is failing to protect public health, safety or the environment. 1. Sys m will pass unless Board of Health determines in accordance with 310 CMR 15.30 1)(b)that the system is not functioning in a manner which will protect public health, safe and the environment: Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 3 of 17 I , Commonwealth of Massachusetts up Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 55 Sudbury Lane Property Address Nancy L. Parham Owner Owner's Name information is required for Hyannis every page. Cltyrrown MA 02601 April 19, 2011 State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water pplier, if any) determines that the system is functioning in a manner that pr ects the public health, safety and environment: ❑ The system has a septic tank and soil absorption s tem (SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surfac water supply. ❑ The system has a septic tank and SAS and th AS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS a the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and t 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 alysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent an he presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that o 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 ❑ ® 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 Y day flow t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 4 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments N 55 Sudbury Lane Property Address Nancy L. Parham Owner Owner's Name information is required for Hyannis MA 02601 every page. City/Town April 19, 2011State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the syste 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" to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is with' 400 feet of a surface drinking water supply ❑ ❑ the system i ithin 200 feet of a tributary to a surface drinking water supply ❑ ❑ the syst 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" s"to any question in Section E the system is considered a significant threat, or answered"yes" i ection D above the large system has failed. The owner or operator of any large system considere a significant threat under Section E or failed under Section D shall upgrade the system in acco ance with 310 CMR 15.304. The system owner should contact the appropriate regional of l of the Department. t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 55 Sudbury Lane Property Address Nancy L. Parham Owner Owner's Name information is required for Hyannis MA 02601 Aril 19, 2011 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)] 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 t5ins-11110 Titte 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 Commonwealth of Massachusetts _ Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 55 Sudbury Lane Property Address Nancy L. Parham Owner owner's Name information is required for Hyannis MA 02601 every page. CltylTown State Zip Code Date Iof inspection D. System Information Description: Number of current residents: 2 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)): Detail: Sump pump? ❑ Yes ® No Last date of occupancy: present Date CommerciaUlndustrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq. ., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tan resent? ❑ Yes ❑ No Non-sanitary waste di s arged to the Title 5 system? ❑ Yes ❑ No Water meter rea ' gs, if available: t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 55 Sudbury Lane Property Address Nancy L. Parham Owner Owner's Name information is required for Hyannis MA 02601 April 19, 2011 every page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: owner, 18 months+/-ago 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/Altemative 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): t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 17 r Commonwealth of Massachusetts I UVTitle 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 55 Sudbury Lane Property Address Nancy L. Parham Owner information is owner's Name required for Hyannis every page. Cityrrown MA 02601 April 19, 2011 State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known)and source of information: existing septic tank, new leachingffacility installed 8/30/2000 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 1.5 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.): joints good, venting through dwelling adequate no evidence of leakage Septic Tank(locate on site plan): Depth below grade: 1 feet Material of construction: ®concrete ❑ metal ❑fiberglass 9 El polyethylene El other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No I Dimensions: 1000 gallons Sludge depth: 6" t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 17 Commonwealth of Massachusetts upTitle 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 55 SudburyLane Property Address Nancy L. Parham Owner Owner's Name information is required for Hyannis MA April 1 02601 9, 2011 every page. Cltyrrown State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle 28" Scum thickness 101. Distance from top of scum to top of outlet tee or baffle 2 Distance from bottom of scum to bottom of outlet tee or baffle 2 How were dimensions determined? sludge judge, tape measure Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): maintenance pumping strongly recommended at this time, inlet&outlet tees in place and in good shape, tank seems structurally sound, liquid level appropriate no evidence of leakage Grease Trap(locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑fib glass ❑ polyethylene El other(explain): Dimensions: Scum thickness Distance from top of scum to p of outlet tee or baffle Distance from bottom of cum to bottom of outlet tee or baffle Date of last pumpi Date t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-page 10 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for VoluntaryAssessments ents M 55 Sudbury Lane Property Address Nancy L. Parham Owner information is Owner's Name required for Hyannis every page. Cltyrrown MA 02601 April 19, 2011 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.): Tight or Holding Tank (tank must be pumped at time of inspection ocate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiber ss ❑ polyethylene El other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumpin Date Comments(con tion of alarm and float switches, etc.): ttach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins•11l10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 17 Commonwealth of Massachusetts i Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 55 Sudbury Lane Property Address Nancy L. Parham Owner Owner's Name information is required for Hyannis MA 02601 A every page. City/Town April 1 9, 2011 State Zip Code Date of Inspection D. System Information (cont.) Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 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.): dbox seems level, no evidence of leakage Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No Comments (note condition of pump amber, condition of pumps and appurtenances, etc.): Soil Absorptio System (SAS) (locate on site plan, excavation not required): If SAS not I ated, explain why: t5ins-11/10 Title 5 Official Inspection form:Subsurface Sewage Disposal System-Page 12 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 55 Sudbury Lane Property Address Nancy L. Parham Owner Owner's Name information is required for Hyannis every page. City/Town MA 02601 April 19, 2011 State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ® leaching chambers number: (2)w'4'stone ❑ 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.): soil sandy, no signs of breakout or hydraulic failure, vegetation typical (lawn) Cesspools (cesspool must be pumped as part of' spection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cessp Materials of con ction Indication groundwater inflow ❑ Yes ❑ No t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments w� 55 Sudbury Lane Property Address Nancy L. Parham Owner Owner's Name information is required for Hyannis MA 02601 April 19, 2011 every page. City/TownState Zip Code Date of Inspection D. System Information(cont.) 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, igns of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 55 Sudbury Lane Property Address Nancy L. Parham Owner Owner's Name information is required for Hyannis MA 02601 April 19, 2011 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view 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. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately PU0 C' Gj S Z q2, Z 5-q V t5ins•11/10 Title 5 Official Insp ection Form:Subsurface Sewage Disposal System•Page 15 of 17 Commonwealth of Massachusetts up Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 55 Sudbury Lane Property Address Nancy L. Parham Owner Owner's Name information is Hyannis MA 02601 A riI 19, 2011 required for y P every page. Cityrrown 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: hand augered to 12', no groundwater encountered Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments N 55 Sudbury Lane Property Address Nancy L. Parham Owner Owner's Name information is Hyannis MA 02601 April 19 required for _Y p �il , 2011 every page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D(System Failure Criteria Applicable to All Systems)completed ® System Information—Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 No. Y!? Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS 01ppficatton for Mk;pool *rmem Construction Permit Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. �'S Sv h 1ry ��/ , Owner's Name,Address and Tel.No. A1.anniS, /4 Me-e— (3-re,e,t� Assessor's Map/Parcel3?/ /aal '7"1/- 7 V Installer's Name,Add O� e. CO Designer's Name,Address and Tel.No. 350 Main Street W. Yarmouth, MA 02673 Type of Building: Dwelling No.of Bedrooms 3 Lot Size sq.ft. Garbage Grinder( ) 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 10d Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) .L h J i a / /� o X ro Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued by this Board of a th. Signed T � C ,�,,,, _ Date Application Approved by _4 6.6,.....ti.. Date E• 2 3 -0 G Application Disapproved for the following reasons Permit No. Ane, 7 Date Issued --------------------------------------- - `/9 7 �." No. .. � Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLEa MASSACHUSETTS Zipplication for Mi$pogar *pgtem Conetruction Permit Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. �? ` C t '?v f j 7w' . Owne 's�ame,Add, ss and Tt�No. Assessor's Map/Parcel / j�� I 7 U n Installer's Name,Addres , Designer's Name,Address and Tel.No. 350 Main Street Vv ray rn^uth, MA 02673 Type of Building: Dwelling No.of Bedrooms `� Lot Size sq.ft. Garbage Grinder( ) .,,.- Other Type of Building No.of Persons Showers( ) Cafeteria( ) ' Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank fCJ �I �'= Type of S.A.S. Description of Soil Nature of Repairs or Alterations(A swer when.applic ble) Ljr C�y A (. Pec,. c �� C�r•4 J aC�� 4c� � `S1�a�� 2 Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued by this Board of eT. Signed Date Application Approved by Ql� Date F`13 Application Disapproved for the following reasons Permit No. ! �O I Date Issued THE COMMONWEALTH OF MASSACHUSETTS ' BARNSTABLE, MASSACHUSETTS '"-j Certificate of (Compliance THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed( )Repaired( --,),-Upgraded( ) Abandoned( )by ( '/4"C U at 1 1 j t'' y At-L-e has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. o dated Installer / Designer �, The issuance o s pg�rmi s no be construed as a guarantee that the sys "hi de 'g ed. Date Inspector --- --------------------------- 7 Fee Sw THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLEa MASSACHUSETTS Mtopooar Opotem Construction Permit Permission is hereby grante .tg_Construct( � Repair( "'SUpgrade( )Abandon( ) System located at �'`� and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction must be completed within three years of the date of this permit. Date: " _®p Approved by i TOWN. OF BARNSTABLE Cal LOCATION , S, 6, /017 . SEWAGE # VILLAGE ASSESSOR'S MAP Cz LOT INSTALLER'S NAME 6z PHONE NO. A & B CANCO 775-6264 SEPTIC174ANK:CAPACITY /2 ' LEACHING FACILITYAtype)a .,#Z ell, ,.cs(sizeV:�Y/l jed ' NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER BUILDER R OWNER DATE PERMIT ISSUED: I DATE COMPLIANCE ISSUED: ' VARIANCE GRANTED: Yes No ' hr I�h , 1/6/99 NOTICE: This Form Is To Be Used For the Repair Of Failed Septic Systems Only. CERTIFICATION OF SKETCH AND APPLICATION FOR A DISPOSAL L WORKS CONSTRUCTION PERMIT (WITHOUT DESIGNED PLANS) I, J t1 r4y�v�iyt , hereby certify that the application for disposal works P P construction permit signed by me dated 9 ` c)-3 ` , concerning the property located at �� �� do 6 4J�Z l An�e. meets all of the following criteria: L..,,/• This failed system is connected to a residential dwelling only. There are no commercial or business / uses associated with the dwelling. The soil is classified as CLASS I and the percolation rate is less than or equal to 5 minutes per inch. There are no wetlands within 100 feet of the proposed septic system • There are no private wells within 150 feet of the proposed septic system �• There is no increase in flow and/or change in use proposed • There are no variances requested or needed. • The bottom of the proposed leaching facility will not be located less than five feet above the maximum adjusted groundwater table elevation. [Adjust the groundwater table using the Frimptor method when applicable] If the S.A.S.will be located with 250 feet of any vegetated wetlands, the bottom of the proposed leaching facility will not be located less than fourteen(14)feet above the maximum adjusted groundwater table elevation, Please complete the following: A) Top of Ground Surface Elevation (using GIS information) Y 7 B) G.W. Elevation +the MAX. High G.W. Adjustment. µ = C)(o DIFFERENCE BETWEEN A and B 3 SIGNED : 0 DATE: 6q •a3'4� [Please Sketch proposed plan of system on back]. NOTICE Based upon the above information, a repair permit will be issued for bedrooms maximum. No additional bedrooms are authorized in the future without engineered septic system plans. q:health folder:cert O z � W vV W v� N N W W � � :� = : N cc d \ ' _ �N '" J �' v !� � M � Ih -��� � � - �.�.r_ �" � _ __ THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH ...----....Town...................OF.........B.a...rna.table--•-,........................................... : ( 3 AVVV tratiou for Uiipos al Works Tumitra.rtion amit 'Application is hereby made for a Permit to Construct (c or Repair ( ) an Individual Sewage Disposal System at: ._......�►n ..#--- r - �. c.................. ----•-••-•--.........U.)ramie.r...bu.......................f................... r Location-Addre s or Lot No. ........ ..lrugt.......................... 7.65...Falmau:th..Raad.. Ilyannis.................. Steve Lobel Owner Address Installer Address d Type of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms.........3.................................Expansion Attic ( ) Garbage Grinder ( ) Other—Type of Building rineh............. No. of persons............................ Showers (2 ) — Cafeteria ( ) a Other fixtures ----------------•-------•----- - - -- ---- . W Design .Flow...-.......55...........................gallons per person per day. Total daily flow__._........3-3Q--------•--_._..__._.._.gallons. WSeptic Tank—Liquid capacit3j.Q0Q....gallons LengtlV.6........ Width! ' 0"... Diameter................ Depths._'.$"...... x Disposal Trench'—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No.._1_______________ Diameter..6'............. Depth below inlet.-�!............. Total leaching area... s ft. � P g �6E3------ q• Z Other Distribution box ( ) Dosing tank ( ) '-' Percolation Test Results Performed by...Eldredg-e---Englnearing.........•• Date.11-25-41................. Test Pit No., _._minutes per inch Depth of Test Pit...l.Z ......... Depth to ground wateno_ne---enCOunter— (�, Test Pit No. 2.-NIPA.....minutes per inch Depth of Test PitN/i........... Depth to ground water.-WIS-------------- e =--•----------------------------------------•--•---•-------•--•-•-------------........------.................-•---------•---------•••-------•-•--......... = O Description of Soil........ 0.'... ---2$.........1.oaf--cis...topsoll----------------------------------------------------------------------------------- xm�- , Vx 2-'--------1-Q-'---•..madi ...yel.low sa.na-------------------------------------------------------------•-------- ..•••- -------------•--...--- -` �� �2' med..._white sand,/tracer of �^avel,�na ovate at 12 ' U Nature of Repairs or Alterations—Answer when applicable............................................................................................... --------•----------------------•--------•---------------•----•-------------------........--•-----•--•-•----------•-------------------------•-----------•---------........................_..... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of i1T 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued b the board of health. Ithefollowing ig -�! ?ems.... . Date A lication A rovedv- ....._ll .�� ..� -.:.-- PP PP '�J ate ApplicationDisapprove f reasons------------------•---------.................................................................................--- Date PermitNo......................................................... Issued........................................................ Date 4 4 No. ft........5..... ................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ...........T.own..................OF..........14rMtable.............................................. ........ ... Appliration for Disposal Works Tonstrartion Vvrrmit `Application is hereby made for a Permit to Construct (x ) or Repair an Individual Sewage Disposal System at: ............. ......................Hyanaia,_XL........................ ............... L Addrese or Lot No. .........Cai)ric-orn---Re-_ ...IrAst......................... ......7.6-5...F&IMOnth.2aado...Hy.anriim.................. .....—---------------- --- Owner Address Steve Lebel .................................................................................................. .................................................................................................. Installer Address Type of Building Size Lot............................Sq. feet Dwelling No. of Bedrooms__........3................................Ex ansion Attic Garbage Grinder Other—Type of Building rAXIC:h............. No. of persons...._................._.__.. Showers (2 ) — Cafeteria Otherfixtures .......................................................................................................................................... Design Flow............55..........................gallons per person per,day. Total daily flow.............3.3Q.......................gallons. Septic Tank—Liquid capaci4.Q.00...gallons LengtA.-.'.6........ Width.4*10".. Diameter................ Depth.5.1.8# Disposal Trench.' No. .................... Width.........*........­ Total Length.._.._._____.,_..... Total leaching area..................."sq. ft. Seepage Pit No..................... Diameter_._6.............. Depth below inlet.___._...:_:..._. Total leaching area...2,66......sq. ft. Z Other Distribution box Dosing tank Percolation Test Results Performed by....EldredgeL..Engineering........... Datell_�2_5..81................. Test Pit No. 1,(' 2.0 minutes per inch Depth of Test Pit_'JV K ........ Depth to ground wateinone...encounte fSl Test Pit No. 2..... per inch Depth of Test Pit.N/^k.......... Depth to ground water..n/a eR C4 ............................................................................................................................................................. 0 Description of Soil........ .......01, .........loam-.&...uppoil....... �4 . .... ........................................................................... ....................2'... .....neAlui..yellaw---sand..................................................................... -------------- -i .... .. .............................................10....... 12........mad.__white---sanc/trazed---af--gravel/.no...watar.'..a-b 12' U Nature of Repairs or Alterations—Answer when applicable......................... .................................................................. .................................................................................................................................. ...................................................................... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TTTLE '5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. --------------- Si ....... at ApplicationApproved y.. ......... ........................................................................ a, Application Disapprovq�or lt4ejoll�owing reasons:................................................................................................................ .......................................................................................................................................................................................................... Date PermitNo......................................................... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ...............Town..............OF...........Barnstable.......................................... T.Lrdifirate of Toutpliattrr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed (X ) or Repaired by........3.teae...Lahel.......................................................................................................................................................... 4 Installer at.. Lot -- )QJ !:.e—------------------------------------ ........ ---J ...... Q­- .- - , I LE e State Sanitary Code s,( scribed----------- has been installed in accordance with theprovisions of 'IT '' in the S ( ,/,)d k O� dated.application for Disposal Works Construction Permit No.. ............... - ------------------------------ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® S A GUARANTEE THAT THE SYSTEM W�11. F)JNCTION SATISFACTORY. DATE--- ........................................................ Inspector--..... . ... ................................. .................................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF' HEALTH .....Town........................OF..........B MstaUe....................................... N .. ................. FE ................ Disposal Works 0b,11notrurtion "trutit Permissionis hereby granted------..&teve...Le-bal..................................................................................................... to Construct:E ) or Repair an Individual Sewage Disposal System atNo..._......ot---#....3 ---------------------------------------Hyannis-j--- .................... as shown on the application for Disposal Works Construction Permit _1.......... ...... . ated/; ... ............................. V3� .................................................................. .................. Board of Health DATE..... ................................................. A FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS F` OF o { . ..r N L .�no.Z9d74 L--o-r oT �618TWO SuR��� R , , sir E%- 90,18 +� I� 4 c� io wn�wc t1 /, p ..S T d PIP' PRoCcsCD ``, n d Fu I LOT Z01JE Io, o0o s. FF LEGEND '=' CERTIFIED PLOT PLAN EXISTING SPOT ELEVATION OxO -\\6OFM4ssI, EXISTING CONTOUR --- 0 --- `` ` L._v 7. FINISHED SPOT ELEVATION .' � 1"�« y �;/i/i,s FINISHED CONTOUR o.R i :No.i14fl51�, ? I N APPROVED ARD OF HEALTH J' , -°I `1 s j 41,E N ASS* ' DATE AGENT ' SCALE' / "_. 30 DATE S /l�i v/ 2— k L17R DBE ENGINEERING Ca NV CLIENT I CERTIFY THAT THE PROPOSED EGISTERE REGISTERED �'�z �S BUILDING SHOWN ON THIS PLAN i JOB N0. CIVIL LAND CONFORMS TO THE ZONING LAWS ENGINEER SURVEY R DR. � °` OF ®ARNSTAS E , M ;SS. t / 712 MAIN STREET CN. 9Y, ,/ •�• _ H YA N N I S, MASS. SHEET / OF � DATE R� 0, LAND SURVEYOR t = w j".h ....1.,, cv £ .,wro k:: t ..a� :Y�,- .. „ }. -.. :..• .... .:-v_, j :..... k 3 �'. - 'a t ...-, s l.".:a.- 1.c 1.,f , �'.•,._.,, 4-"•k;..- '.K .� 'bj: .„ .,,a:. t �`.:.st' _h>,. ..•'d°5 {.. �Y 4 e ,` --`,. , � ..„t: • ';< : � :,. ,,,;-... ,:: 3 -20 ElTNE'R' TXE SEPT/C=Z-,q�/ : _. -;NOTE °/F f� 2¢:O/AMETEQ CONCR-.T.E COVER /O I•T - M1 = StIACL•CIF BROuGNT TO 4MAZ>J- /✓ k 4 PYC P. r GGNCRt'Tc I`/EA{Ny C/1 ST N "/.e0/Y Co{�FR SHALL C3E f/SFL�.., MI .,P/TCN EL ,.95 5 co t /F/N'DR/✓EN/R Y . •.. �8 /pEip FT A — 2%�J MiN. CONCRETE. _ GI�CAOE COVER CL EA IV .SA/V 10. r &ACXF/LL U©u/o LEVEL 4: 4 Gts - - 2*LAyER /Roiv d o c� d MIN.P/TC/V GAL',` e • . . loop e •40 t D/ST. • s • • • •. • • • • • • e:° • WAShIFO STONE /qr�T SZPT/C "TANK BOX n • � 8e • . • • � .•e • e e tD n t • •E.FFECTl VL • • ,� 314 �2 .• At • • • DEPTH • • • • WA5NED STONE D o- • • •. •. • • � • • v o ~ • 1 7 /,0 = 4 t�3 L j,aQ y i a' • • • • • e' • • • • p •�p PRECAST SEEPAGE , C;T S'4-G / s • • • • • • • • • • e o P/TOR EQU/V. IAIX&Ar. CLEYAT/O/YS /SIT CAPA �`= d � � s c eL= /NYERT: 84.5 AT QI/1LD/NG 9�L.S. FT. 6 Fr: DRAM: . INLET .SEPTIC .TA/YK: - 4 FT 1 y FT_ O/4M. �� C(SEE TfiBUL.d_T/oN� 0071-ET SEPTIC TANK:: /HEFT DlSTR/8!/T/ON Boy. Gh•OUND 1�TER TADLE r' SECT/ON 4F' O!1lTLETD/STR/B11770N BQX �n 8 FT. !HEFT' LgACNiwG rPi�-_. 90• Fr. SELVAGE O/sPO%S'AL SYSTEM: A NG PIT T BULATION LEACHI s _' �4• s /'_D D/MENS/ON A FT. cA�E 3 DES/GX, CRITER1A DL�f.Exs/a'/v $ MUM9ER OF BEDR04MS �vNc SOIL 'LOG DIMENSION C ET. Oh s ue• GARQAGED/SPO.SAL Ui1IIT TOTAL EJT/M.�TEQ,FLOII/' 3 3 V G.4L.�DAY SO/L TEST/iE! SOIL.TEST�if2 S0/L TEST XuMBE,P QF cEarR/NG Pl75_ fE[E✓ 2-:� . �`-ELFK ,DATE of so/L TEsr 5 � &=2 - SIDE LG`A.CHING PER PIT° .S`L• RT. i RESClLTS N//TNESSPD BY C�r�Fo2 t7 90TTOM .Er t4CN/NG PER P/T �� $Q. FTPERCOLAT/ON:HATE MINt//NCK TOTAL LEACH//YG:;•4REA Z�0 �' SQ FT �' ' AEhCO3LA77ON RATE 2 "M MIN, INCH A4,sERvEGEACNIN6 AREA b SQ..FT.` T�PS° 3/. , M E o `'1E �o 1U951' o D EL REDGE ENGINEERING CDI NG ° tgTE hoc � r ST712 `M�7/K ST. , f/Y.gAIA07 ,, fAss ~` .� ,�.- Np .q�E•�/ 'ass;'" E:,aC� G�gOUN17 .P%4TER EN G`L/EItIT: DRTE`� 11 L v �r-z GROU/5/Do-4LvATER_AT FEE( • x f� - w � ✓OB.:NO:, �-- SHEET Z- --OF xZ--- m 't y �+