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Home My WebLink About0048 BLANID ROAD - Health 48 Blanid 8treet -*- , -� F Osterville. F A = 140 061 a ii 7 r P r No. Fee THE COMMONWEALTH OF MASISACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS o� 01ppYication for Oie;pool *p.5tem Construction Permit Application for a Permit to Construct( )Repair( /Upgrade( )Abandon( ) ❑Complete System l4J Mdividual Components Location Address or Lot No. � � F „® Owner's Name,AAddress and Tel.No. Assess r' Map/P c 1 p (� VC 11 Installer's Name,Address,and Tel.No. l/ Designer's Name,Address and Tel.No. . -777-- Type of Building: ¢C5 Dwelling No.of Bedrooms Lot Size Z y eft. Garbage Grinder Other Type of Building v` G4V No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow CO gallons per day. Calculated daily flow �L. gallons. Plan Date O✓� Number of sheets Revision Date Title sJ ,q,,v � W. Size of Septic Tank /t��® /r/r51�� Type of S.A.S. 7— Description of Soil Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued by th' B P of Mealth. _ Signe Date Application Approved by Date Application Disapproved for the following r s s Permit No. -- bc) Date Issued � No. �„+.��..�:w.�' .�'�; •'g,, � ' Fee THE COMMONWEALTH OAF MASSACHUSETTS Entered in computer: Yes ti PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE. MASSACHUSETTS 2ppricationjor 30i6pogal *pgtem-Conztruction. Vermit ,i � � Application for a Permit to Construct( )Repair( 4pgrade( )Abandon( ) El Complete System I Individual Components Location Address or Lot No. r Owner's Name,Address and Tel.No. Ass ss r' Map/R 1 Installers Name.Address,and Tel.No. lr Designer's Name,Address and Tel.No. 77��.3 9 Type of Building: 41�5 Dwelling No.of Bedrooms/ Lot Size Z y st. Garbage Grinder( � Other Type of Building /SG.�/R C�� No. of Persons Showers( Cafeteria( ) i Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. Plan Date /916'25- Number of sheet / _ Revision Date Title / — Size of Septic Tank � �G / sJ`l"�.�`� Type of S.A.S. 7 S_3X e-/y?.s-.� z Description of Soil y ,Nature of Repairs or Alterations(Answer when applicable) i i 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 b th'siB arrd of eat Signe ��"/,. 59 ,e2e- Date Application Approved by l a Date Application Disapproved for the following r aso s Permit No. Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance / THIS IS TO CERTIFY,that the On-site S�ewag isposal stem Constructed( )Repaired ( V)Upgraded( ) Abandoned i )b at y )I /11, / ®S �� has b e-ti constructed i accor nce with the provisions o Title 5 and the fo�isposal System Construction Permit No. dated Installer /�/!/ Designer The issuance of this pe .'t all no b e construed as a guarantee that t e system 'll t� ction V)s esi ned. Date Inspectot� n No. Ji��/+�4 ----- —.— ---------------Fee �/ THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS xigpogat *p!Aem Cow5truction Vermit Permission is hereby grantteed.to Construct( )Repair( �Up°grade( )Abandon System located at l / � !� 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:Constructio f�s � ed within three years of the date of this r'.txtit.Date: / ( 1 Approved by TOWN OF BARNSTABLE ' Z LOCATION Ile SEWAGE # �S' 'VILLAGE�o I�r ASS SSOR'S/MAP & LOT NO 061 INSTALLER'S NAME&PHONE NO. e 7 4'92g SEPTIC TANK CAPACITY O�fO LEACHING FACILITY: (typeZ. ,�l � ��?�_(size) 4 ;l of"x.2 � NO. OF BEDROOMS BUILDER 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 2)4W,> COr � 7 c, �. �� O � , i �� ae � : � I i ` � i., TOWN OF BARNSTABLE LOCATION 81-a n' tL cSt` c e � SEWAGE # ^tirLLAGE O�4ti r ASSESSOR'S MAP & LOT J4O O6/ INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY: (type) (siz/e) 0 NO. OF BEDROOMSAgbVMW* OWNER C�I "' ► S ZE ti PERMITDATE: ` LIANCE DATE: Separation Distance Between thex� 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 JUN-01-2005 11 :47 AM DOWN CAFE ENGINEERING 508 4382' 5880 P. 01 Town of Barnstable Regulatory Services 4 'Thomas F. Geiler,Director >< r�Ws' g 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: Sewage Permit# ✓�-�b g Assessor's Map\Parcel_ ®� Designer 0 A l�. @. �ih �n�� Installer: Address: 9 �A.t�- Address: rOl' 70A1 "o w 2o7.�T On /LS`�51l / �.OitS �was issued a permit to install a (date) (installer) septic system at 7t7 q614 n I �J'�� based on a design drawn by n (address) (.L•✓� al^ dated )/R'�®� (d finer) I certifythat the septic system referenced above was installed substantial) according to Irt Y y the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic rank. I certify that the septic system referenced above was installed with major 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. ARNE H o (In ler's Signature) OJALA civil. No. 30762 (Designer's Signature) (Affix DUROWNStamp ere) PLEASE RETURN TO BAR STABLE PUBLIC HEALTH DIVISION, CERTIFICATE OR COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FQRM AND A&BU_1LT CARD RECEIVED BY TEFBARNSTABLE PUBLIC HEALTH DIVISION, THANK YgU. Q: Health/SepticJDesigncr Certification Form 3-26-04.doc V COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTIONCn rs FAILED INSPECTION o TITLE 5 . OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSIFSSMFNTS GR rVI SUBSURFACE SEWAGE DISPOSAL SYSTEM FO `o PART A CERTIFICATION `C Property Address: 48 Blanid Street Osterville. MA 02655 :;RCEL Owner's Name: Chris Mayo Owner's Address: Date of Inspection: February 10, 2005 Name of Inspector: (Please Print) James M. Ford Company Name: James M. Ford Mailing Address: P.O.Box 49 Osterville,ALL 02655-0049 Telephone Number: (508)862-9400 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage.disposal system at this address and that the information reported below is true,accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000).The system: Passes Conditionally Passes Needs urther Evaluation by the Local Approving Authority ✓ Fails Inspector's Signature: Date: February 11, 2005 The system inspector shall sul 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. Notes and Comments ****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. Title 5 Inspection Form 6/15/2000 page 1 4 Page 2 of 1 I OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 48 Blanid Street Osterville. M.4 02655 Owner's Name: Chris Mayo Owner's Address: 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: 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 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: 2 �a Page 3 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 48 Blanid Street Osterville, MA 02655 Owner's Name: Chris Mayo Owner's Address: C. Further Evaluation is Required by the Board of Health: Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health,safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health,safety and the environment: Cesspool or privy is within 50 feet of a surface water _ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 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. 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 and volatile organic compounds indicates that the well is free from pollution from that facility 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: 3 Page 4 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 48 Blanid Street Osterville. MA 02655 Owner's Name: Chris Mao Owner's Address: D. System Failure Criteria applicable to all systems: You must indicate either"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''/z day flow ✓ 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 coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility 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.] Yes (Yes/No)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 System: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. You must indicate either"yes"or"no"to each of the following: (The following criteria apply to large systems in addition to the criteria above) Yes No the system is within 400 feet of a surface drinking water supply the system is within 200 feet of a tributary to a surface drinking water supply the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area-IWPA)or a mapped Zone 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. 4 Page 5 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 48 Blanid Street Osterville, MA 02655 Owner's Name: Chris Mayo Owner's Address: 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: Yes No ✓ 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(3)(b)]. 5 ;j Page 6 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 48 Blanid Street Osterville, MA 02655 Owner's Name: Chris Mavo Owner's Address: FLOW CONDITIONS RESIDENTIAL 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: 2 Does residence have a garbage grinder(yes or no): No Is laundry on a separate sewage system(yes or no): n/a [if yes separate inspection required] Laundry system inspected(yes or no): No Seasonal use(yes or no): No Water meter readings,if available(last 2 years usage(gpd)): 2003-66.000 gals.:2004-42.000 gals. Sump Pump(yes or no): No Last date of occupancy: Occupied COMMERCIAL/INDUSTRIAL Type of establishment: Design flow(based on 310 CMR 15.203): gpd Basis of design flow(seats/persons/sgft,etc.): Grease trap present(yes or no): Industrial waste holding tank present(yes or no) Non-sanitary waste discharged to the Title 5 system(yes or no): Water meter readings,if available: Last date of occupancy/use: OTHER(describe): GENERAL INFORMATION Pumping Records Source of information: Pumped 3 years ago per owner Was system pumped as part of the inspection(yes or no): 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) Tight Tank Attach a copy of the DEP approval Other(describe): Approximate age of all components,date installed(if known)and source of information: Approximately 1976-per as-built card Were sewage odors detected when arriving at the site(yes or no): No 6 Page 7 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 48 Blanid Street Osterville, MA 02655 Owner's Name: Chris Mao Owner's Address: BUILDING SEWER(locate on site plan) Depth below grade: Materials of construction: _cast iron _40 PVC _other(explain): Distance from private water supply well or suction line: Comments(on condition of joints,venting,evidence of leakage,etc.): SEPTIC TANK: ✓ (locate on site plan) Depth below grade: 4' Material of construction: ✓ concrete _metal _fiberglass _polyethylene _other(explain) If tank is metal list age: Is age confirmed by a Certificate of Compliance(yes or no): (attach a copy of certificate) Dimensions: 1000 jzal. Sludge depth: 2" Distance from top of sludge to bottom of outlet tee or baffle: 30" Scum thickness: 6" Distance from top of scum to top of outlet tee or baffle: 6" Distance from bottom of scum to bottom of outlet tee or baffle: 10" How were dimensions determined: Measuring stick Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): Tees were present. The liquid level was even with the outlet invert. There did not appear to be any suns of leakagge. The inlet cover was to trade. GREASE TRAP: None (locate on site plan) Depth below grade: 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: Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): � 7 Page 8 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 48 Blanid Street Osterville, MA 02655 Owner's Name: Chris Mao Owner's Address: TIGHT or HOLDING TANK: None (tank must be pumped at time of inspection)(locate on site plan) Depth below grade: Material of construction: _concrete metal _fiberglass _polyethylene _other.(explain): Dimensions: Capacity: gallons Design Flow: gallons/day Alarm present(yes or no): Alarm level: Alarm in working order(yes or no): Date of last pumping: Comments(condition of alarm and float switches,etc.): DISTRIBUTION BOX: None (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.): PUMP CHAMBER: None (locate on site plan) Pumps in working order(yes or no): Alarms in working order(yes or no) Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.): 8 Page 9 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 48 Blanid Street Osterville, MA 02655 Owner's Name: Chris Mayo Owner's Address: SOIL ABSORPTION SYSTEM(SAS): ✓ (locate on site plan,excavation not required) If SAS not located explain why: Type ✓ leaching pits,number: I-6'x 6'(1000 gal.) 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.): The leach pit was full. The liquid level was up to the inletpipe. The bottom to grade was II'. The cover was 4.5'belowgrade. The leach pit is in failure. CESSPOOLS: None (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 or no): Comments (note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): PRIVY: None (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.): 9 y �.f Page 10 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C. SYSTEM INFORMATION(continued) Property Address: 48 Blanid Street Osterville, MA 02655 Owner's Name: Chris Mayo Owner's Address: 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. PL • . a . 10 Page 11 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 48 Blanid Street Osterville, MA 02655 Owner's Name: Chris Mayo Owner's Address: SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water 25+/- feet Please indicate(check)all methods used to determine the high ground water elevation: Obtained from system design plans on record-If checked,date of design plan reviewed: Observed site(abutting property/observation hole within 150 feet of SAS) ✓ Checked with local Board of Health-explain: topographic and water contours maps Checked with local excavators,installers-(attach documentation) Accessed USGS database-explain: You must describe how you established the high ground water elevation: Using Barnstable topographic and water contours maps the maps were showing approximately 25'+/-to ground water at this site. This report has been prepared and the system inspected and failed as of the date of inspection. This report is not a warranty or guarantee that the system will function properly in the future. There have been no warranties or guarantees, either expressed,written or implied,relating to the system,the inspection and/or this report. 11 LOCATION : SEVVW:;E PERMIT UO. 0� tW57aLLER 5 W&ME-4 ADDRESS BUILDER 5 Q &VAE 4t, ADDRESS DtI.-TE PER"VT 155U,ED '- - — — — — — DATE COMPLI &&ICE ISSUED .*.- - _ — Af r r IN, N4 I V 9 TOWN OF BARNSTABLE LOCATION k JAn1 SEWAGE # + VILLAGEQSTcrV,4- ASSESSOR'S MAP& LOT INSTALLER'S NAME&PHONE NO. r—n INSPECTION SEPTIC TANK CAPACITY l M12 ,LEACHING FACILITY: (type) �.T L, (size) I 10.OF BEDROOMS 3 BUILDER OR OWNER r is (YI L1 0 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 leachi�g facility) /' Feet Furnished by v ►un rot C) o1 i q A Q DL 0 y/ a� ...... Fics... P�- ... THE COMMONWEALTH OF MASSACHUSETTS BOARDADF HEALTH - -- -- --------OF.... ... Appliratiun -fur 43hiposal Works Tonntrurt ani t Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: ,' Loon:Address or Lot No. 1 ----------- -------------•- -- ..... -. Owner �s Address.... W ---• CV% ................... ..............................................M....................... 1M-1 Install Address Q Type,of Building Size Lot............................Sq. feet v Dwelling—No. of Bedrooms_______________ _____________ _ Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons....__.____.___............. Showers ( ) — Cafeteria ( ) P4 Other fixtures ................................ W Design Flow---____________--------------______.........gallons per person per day. Total daily flow.............___.__._.......................gallons. USeptic Tank—Liquid capacity.----.......gallons Length________________ Width................ Diameter................ Depth-._._-_-._.... x Disposal Trench—No. .................... Width._----------_------- Total Length.................... Total leaching area..............._....sq. ft. Seepage Pit No_____________________ Diameter._______------------ Depth below inlet._--____---......... Total leaching area......._.______..sq. ft. Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by---------- -------.......-•--...................... -------------- Date.............. -------- ---------- Test Pit No. 1________________minutes per inch Depth of Test Pit................._.. Depth to ground water...---_.--_-.---.-._.. 44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water--.--.---,-__-__---..___ .......-•---------------•--- - --------- ------------------------------------- •-•--••---------------•-•--- -------------------------- ODescription of Soil----------- -- ..........................................................-------------------------------------- •---•----------------------•-------- W ---------------------------- ---------...........................--------------- - --- .................................. --•-• -- UN ture of Repairs or ter • s— ns r hen p livable..._.._ ._.. . . ,��--'�--_ _.__.__ _ ...._.._.. -(-.�__6--if-�_�1_ ._A_.. Pen.._ .. .._ _. __^_._ .V-.4�. .... . ........ .At. .__.Wit../.[ _ qAL Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal Sy tem in accordance with the provisions of Article NI of the State Sanitary Code- The undersigned further agrees not to place the system in operation until a Certificate of Compliance has en issued b the board f ea Sign -- ----fir- -S 6. T Application Approved BY ; ----- ---- Date Application Disapproved for the following reasons:----------•----------------- -------------------------- ----------..........-•-••--••--••---..........-- .......... ---•----•------------------------- ...............................-..................-----------------------------............................................................. Date PermitNo.......-.........................-................... .. . Issued.........---...... .........-..................... Date ------ D6 THE COMMONWEALTH OF MASSACHUSETTS BOARD F HEALTH J................OF....... G1., M.._................... .................... Appliratiun -for Uiipuiittl Works Tonfitrix n._Vrrniit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: ` J Lo n•Address or Lot No. Address Installe Address UType of Building Size Lot----------------------------Sq. feet Dwelling—No. of Bedrooms--------------------------------------------Expansion Attic ( ) Garbage Grinder ( ) per, Other—Type of Building ____________________________ No. of persons---------------------------- Showers ( ) — Cafeteria ( ) dOther fixtures ----- ----------------------------------------------------•----•-------•-•------------------------------------------------------------------------ W Design Flow...........................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity------------gallons Length---------------- Width_.............. Diameter................ Depth..-..___-.----- x Disposal Trench—No. .................... Width-------------------- Total Length__---_..._-_____--.. Total leaching area........------------sq. ft. Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area-------...........sq. ft. z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by----------- ..............................-............................... Date---------------------------------------- a Test Pit No. 1----------------minutes per inch Depth of "Pest Pit.................... Depth to ground water...._._----_-._-----:--- (_, Test Pit No. 2................minutes per inch Depth of Test Pit-------------'------ Depth to ground water.......--_.-._------._-- 9 ............................................t.....------------------------.......--------•-••----•......................................................... 0 Description of Soil------------------------------------------------------------------------------------------------------------------------- ----•------- --------------------------------- x W ---------------------------- -------------------•------••----------••----•----•-•---------•----------. -------- -------•--------- U Nature of Repairs or A era — swer w en a plicable--.-. :^p... _ .-..__.�'...._ - r_1...:_ ��J fit.,,. .. f� !� _ C�� .� 'I---�------- C1�' Agreement: t The undersigned agrees to install the aforedescribed .Individual Sewage Disposal Syst m in accordance with the provisions of Article NI of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been i sued b the board o ealt _ ! Sig ne ..... i ;-lam( / > i -------- .................................. Mate � Application Approved By------- e_ _ _, (.c�> _ .......•._%/--_____.__� / ^� l - - ' Date Application Disapproved for the following reasons:----••-------------•--••---- • •----------•------------........_.._.......------------..........--•-----•-- -----------•-----•-•------------•--------•---•---•------------------•---------------------•--•---------- Date PermitNo......................................................... Issued------.-------_---- ................................. Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH „��.. ........OF... �......vi.�?.�'y1/.. ..r .................... 1091.rrtifiratr of Toutplittnrr THI,9—IS,.T 0 R" FY, That he I iduA1 Sewage Disposal System constructed ( ) or Repaired .� � � � . by = , - --- Ins er - .....•- has been installed in accordance with the provisions of Arti of The State Sanitary Coe des9b d in the application for Disposal Works Construction Permit No_________________ ?Z6.......... dated...._�`_ ........._1✓.______........ THE ISSUANCE OF THIS CERTIFICATE SMALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL UNCTION SATISFACTORY. r ; DATE Inspector...._ ... ------------••-•••...---- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF H EA1 T y,,,, 7( . ' , r f!"Z�.. OF....... y1... ./ .��...`` '....................... No................ ....... FEE$. , inp 1 r Chu trtt��tiva errant JPermission is hereby granted _..= - ----- ........ ..........f = --- to Constr ct ( or Repair ( a Indi �d al Sew e is osal S �" Inr ........ Street ^ as shown on the application for Disposal Works Construction Per No_____ ____ ______r Dated__-.__(_._1�... ..__........ --/�%r .1..- --------------------- f ( ---------------------------------------------�Js`t 1------------------------------------------------------ FORM 1255 HOBBS & WARREN, INC., PUBLISHERS I s .7 f _ 1 L, `1 4 SYSTEM PROFILE TEST , HOLE LOU— TOP FNDN. AT EL 32.6 t ACCESS COVER TO WITHIN 6" OF FIN. GRADE (NOT TO SCALE) PROVIDE INSPECTION PORT WITHIN ACCESS COVER WATERTIGHT TO 6' OF FINISH GRADE LISA`LYONS, RS (WATERTIGHT) ENGINEER: MINIMUM .75' OF COVER OVER PRECAST WITHIN 6" OF FIN. GRADE 2% SLOPE REQUIRED OVER SYSTEM , 32.2 D. DESMARAIS, RS WITNESS: ' 2' DOUBLE WASHED PEASTON ELEV. 29.9't RUN PIPE LEVEL DATE; 4/19/0 I ¢� FOR FIRST 2' � , 28 3 < 2 MIN/INCH -' EXISTING:12Q4_ Ll PERC. ,RATE GALLON SEPTIC CLASS i SOILS P 10953 TANK (H 10 ) GAS C 27.74� o # BAFFLE 28.0' o000 27.83' Locus - ` ^ 6" CRUSHED STONE OR MECHANICAL L 9 COMPACTION. (15.221 [2]) oo `� 114" 0c 25.74 ELEV. DEPTH OF FLOW = 4 3.8 MIN �F� �� 4 � o (_ ,.% SLOPE) (_I-_% SLOPE) --- ., _ 31.8 TEE SIZES: 3/4" TO "1 1/2" DOUBLE WASHED STONE q INLET DEPTH = 10" „ H-20 HI CAPACITY INFILTRATORS LS ,.. . OUTLET DEPTH = 14 6" 1OYR 3/4 LOCATION MAP NTS FACILITY ASSESSORS MAP 140 PARCEL 61 FOUNDATION EXIST. SEPTIC TANK 13' D' BOX 11' B *THE INSTALLER SHALL VERIFY THE 5.94' LS LOCATIONS OF ALL UTILITIES,AND ALL 10YR 5/6 BUILDING SEWER OUTLETS AND ELEVATIONS 25" 29.7' PRIOR TO INSTALLING ANY PORTION OF SEPTIC SYSTEM C 19.8' PERC F/MS 2.5Y 6/4 NOTE INVERT OF SAS IS BELOW CRAWLSPACE ELEVATION .97 / 0.03 27 144" 19.8' / 4 NGWE NOTES: / o �o .STONE DRIVE 30.38 i I / APPROX. NGVD / a FFNcF SEPTIC DESIGN: . DATUM IS (GARBAGE DISPOSER IS NOT AlAI I nWFI� ) 2, MUNICIPA 9 12g j CF-SIGN FLOW: ,_3 BEDROOMS 110 GPD _ 330 GPn. L WATER IS _EX1SI NG LSE A30 GPD DESIGN FLOW ) 3. .MINIMUM' PIPE PITCH TO BE 1/8" PER FOOT. / 0 4 C!} +3129 . DESIGN LOADING FOR ALL PRECAST UNITS TO BE AASHO H io - SEPTIC TANK: `330 GPD 2 = „ , - � 24" OAK -G--- 9� (,,,,) 660 5. PIPE JOINTS TO BE MADE WATERTIGHT. 1 i +30.27 USE A 100.C- GALLON SEPTIC TANK (RE-'USE EXIST.) 6. CONSTRUCTION DETAILS TO BE IN ACCORDANCE WITH MASS. 1.44 I ENVIRONMENTAL CODE TITLE V. 31.56 FULL BASE. LEACHING: 7. THIS PLAN IS FOR PROPOSED SEPTIC SYSTEM ONLY AND IS NOT +30. oa�` 30.76 SIDES: 2(44.75 + 5.83) 2 (.74) = 149 TO BE USED FOR ANY OTHER PURPOSE. -J -- -- - W 31.92 3 I EOTTOM: 44.75 x 5.83 (.74) = 193 8. PIPE FOR SEPTIC SYSTEM TO SCH. 40-4" PVC. 31 9. COMPONENTS NOT TO BE BACKFILLED OR CONCEALED WITHOUT -I- 93 TOTAL: 462 S,F, 42 GPD INSPECTION BY BOARD OF HEALTH AND PERMISSION OBTAINED 00 + 40 1" MAP 1. 6 EXIST. DWELL. P 31.24 USE (7) H-20 HIGH CAPACITY INFLTRATERS WITH 0.50 FROM BOARD OF HEALTH. SOW OH i + 33 cRAWLSP 3 o STONE AT ENDS AND 1.5' AT SIDES AND 14" UNDER 10. PUMP & REMOVE (OR FILL W/CLEAN SAND) FAILED LEACH PIT 1 WIRES O o APPROX. LP 2 ^- of 33. 1 �' 24" ARS LOCATION LT ON EXIST. GARAGE �- DEP REPORT I t J UNCLEAR) -. DIRT DRIVEWAY v'� STF{ LEGEND _ i !a. TITLE w 1- _ 5 SITE PLAN OF r` 1`J0.0 PROPOSED SPOT ELEVATION 48 BLAND ROAD 3 OAK 100x0 EXISTING SPOT ELEVATION Lo FENCE IN THE TOWN OF; 122.08' 100 PROPOSED-CONTOUR BARNSTABLE PROVIDE VENT Wllli CHARCOAL FILTER (OSTERVILLE) BENCHMARK:"TOP CORNER OF AND BUGSCREEN (FINAL PLACEMENT WITH CONCRETE STEP ELEV. 32.9' HOMEOWNER CONSULTATION) - 100 EXISTING CONTOUR PREPARED FOR; g0 RTO LOTTI CONSTRUCTION/MAYO 20 0 20 40 60 BOARD OF HEALTH MA SCALE: 1" 20' DATE: APRIL 19, 2005 APPROVED DATE r off 508-362-4541 x fox 508 362-9880 .. I ��OF�AAS' down cape engineering, inc, ywT ARF If � Fk OF,,f,;ssq H �° A EH cy� CIVIL ENGINEERS � N CaDq.dA I 3 I� LAND SURVEYORS ' ' 30792 - 939 vain st, arrl t �az �r y ou h, rya 02675 / O�S �Dv�p DATE H. . flJALA, i a . 6 }