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HomeMy WebLinkAbout0045 NEWPORT LANE - Health (3) 45 Newport Lane Osterville A= 166-061 I I I /&& - / Commonwealth of Massachusetts _ Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 45 Newport Ln Property Address Ryan Trust __j Owner Owner's Name a information is required for every Osterville I/ MA 3/8/17 page. City/Town State Zip Code Date of Inspection U1 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 A. General Information 1 filling out forms �� }" 2 on the computer, use only the tab 1. Inspector.- key to move your cursor-do not Darren Michaelis use the return Name of Inspector key. Foresight Engineering Inc. Company Name 518 County Road Company Address West Wareham MA 02576 City/Town State Zip Code 508-245-2148 S13595 1997 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 3/15/17 Inspector's Signature Date The s m 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 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. vs t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 45 Newport Ln Property Address Ryan Trust. Owner Owner's Name information is required for every Osterville MA 3/8/17 page. Cityrrown 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: All components were located and found to be functioning properly. It is recommended that the septic tank be pumped every 2 years to remove excess solids and prevent carryover. Filter REQUIRES ANNUAL CLEANING. { 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. Check the box for"yes", "no"or"not determined" (Y, N, ND)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. ❑ Y ❑ N ❑ ND (Explain below): t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments wM 45 Newport Ln Property Address Ryan Trust Owner Owner's Name information is required for every Osterville MA 3/8/17 page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes (cont.): ❑ 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): brokenpipe(s)are re laced Y N ND (Explain below): ❑ P ❑ ❑ ❑ ( P ) ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ 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 ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): 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 t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ;M 45 Newport Ln Property Address Ryan Trust Owner Owner's Name information is required for every Osterville MA -3/8/17 page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) 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 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 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 Y2 day flow t5ins.doc•rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17. ` x Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 45 Newport Ln Property Address Ryan Trust Owner Owner's Name information is required for every Osterville MA 3/8/17 page. Cityfrown State Zip Code Date of Inspection B. Certification (cont.) i 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 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 a ❑ 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. t5ins.doc•rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 II ' Commonwealth of Massachusetts W Title 5 Official Inspection Form _ Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 45 Newport Ln Property Address Ryan Trust Owner Owner's Name information is required for every Osterville MA 3/8/17 page. CitylTown 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 ® El 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): 4 Number of bedrooms (actual): 4 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 545 t5ins.doc•rev.6116 Title 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 45 Newport Ln Property Address Ryan Trust Owner Owner's Name information is required for every Osterville MA 3/8/17 page. City/Town State Zip Code Date of Inspection D. System Information Description: Single Family Dwelling Number of current residents: 0 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonaluse? ❑ Yes ® No Water meter readings, if available last 2 ears usage ( d)): Town Water 9 ( Y 9 9p Detail: Sump pump? ❑ Yes ® No Last date of occupancy: 2/17Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins.doc-rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °M 45 Newport Ln Property Address Ryan Trust Owner Owner's Name information is required for every Osterville MA 3/8/17 page. City/Town 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: None Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be,obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): l5ins.doc-rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 17 Commonwealth of Massachusetts Title 5 Official .Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �. 45 Newport Ln Property Address Ryan Trust Owner Owner's Name information is required for every Osterville MA 3/8/17 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: 4/7/10 permit Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 2.5 feet Material of construction: ❑ cast iron ® 40 PVC ❑ other(explain): Distance from private water supply well or suction line: >10feet Comments (on condition of joints, venting, evidence of leakage, etc.): No evidence of leakage or backup, proper venting provided Septic Tank(locate on site plan): Depth below grade: 2 feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1000 gallons Sludge depth: 0" t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Fora Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 45 Newport Ln M Property Address Ryan Trust Owner Owner's Name information is required for every Osterville MA 3/8/17 page. Cityrrown 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 Scum thickness 0" Distance from top of scum to top of outlet tee or baffle 4 Distance from bottom of scum to.bottom of outlet tee or baffle How were dimensions determined? Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): outlet cover just below grade, filter REQUIRES ANNUAL CLEANING, recommend pumping the tank every 2-3 years, no evidence of backup or 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 t5ins.doc•rev.6/16 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 Voluntary Assessments °w 45 Newport Ln M Property Address Ryan Trust Owner Owner's Name information is required for every Osterville MA 3/8/17 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.): Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: R gallons per day Alarm present: ❑ Yes ❑ No Alarm level: h 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 t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Pa a 11 0 P 9 P Y 9 f17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ;M 45 Newport Ln Property Address Ryan Trust Owner Owner's Name information is required for every Osterville MA 3/8/17 page. City/Town 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 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.): No carryover, level distribution Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No" Alarms in working order: ❑ Yes ❑ No`` Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.): *If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: l5ins.doc•rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Fora Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ^M 45 Newport Ln Property Address Ryan Trust Owner Owner's Name information is required for every Osterville MA 3/8/17 page. City/Town State Zip Code Date of Inspection D. System Information cont. Type: ❑ leaching pits number: ® leaching chambers number: 25 infiltrators ❑ 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.): 18'x32.5' bed, vented due to depth below grade, dry soils, no ponding, no evidence of backup or breakout 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 t5ins.doc•rev_6/16 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 ^M 45 Newport Ln Property Address Ryan Trust Owner Owner's Name information is required for every Osterville MA 3/8/17 page. City/Town State 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.): r 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.): t5ins.doc•rev.6/16 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 45 Newport Ln Property Address Ryan Trust Owner Owner's Name information is Osterville MA 3/8/17 required for 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 t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 45 Newport Ln M Property Address Ryan Trust Owner Owner's Name information is required for every Osteryille MA 3/8/17 page. CityfTown 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' dryfeet 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: 3/19/10 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: System was designed and installed with a 5' separation per the approved plans on record. I Before filing this Inspection Report, please see Report Completeness Checklist on next page. l5ins.doc-rev.6/16 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 �^M 45 Newport Ln Property Address Ryan Trust Owner Owner's Name - information is required for every Osterville MA 3/8/17 page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist E Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems) completed E System Information—Estimated depth to high groundwater E Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins.doc•rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 AsBuilt Page 1 of 2 TOWN OF BARNSTABLE LOCATION /*--zlye7 -/n. SEWAGE# VILLAGE 67 ,",e — ASSESSOR'S MAP&PARCEL /GG 1dG 1 INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY Esr's r•� /OHO g LEACHING FACILITY:(type) i„F/try 7 yr f^d s (size) NO.OF BEDROOMS Ll OWNER K P Wti P,i- PERMIT DATE: y- 7-/0 COMPLIANCE DATE: D 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 v .�• s I �y"p:r a37A-" `-! 3" 63 7/, A I � http://issgl2/intranet/propdata/prebuilt.aspx?mappar=166061&seq=2 3/7/2017 No. F cc —Q � - HE COMMONWEALTH OF MASSACHUSETTS E"'crcd in`omputer: Yw t PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS 2pplication for Disposal &nstrm Construction Permit a Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components ' Location Address or Lot No. / o t Ow /c Name.Add .and'Fel.No. -le e4l �Assessor's MapTarcel Ile Installer's Name,Address,and Tel.No. ,Z Designer's Name,Address,and Tel.No. J.-C. A9/15 G o+s>r-�f 5: a 1-77G .r�f°�t lr•�/ yr vv�r 31%tiJ.r/f1v�f �/� Ct�G`{l I i 1\-pe of Building: Dwelling No.of Bedrooms 1 Lot Size T sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures i Design Flow(min.required) yy0 gpd Design flow provided S"ryy gpd Plan Date � �/' /� Number of sheets Revision Date Title Size of Septic Tank�. Typc of S.A.S. Description of Soil--See- �/9 n Nature of Repairs or Alterations(Answer when applicable) One aot) i Date last inspected: j Agreement The tmdersigned agrees to ensure the construction and maintenance ofthe afore described on-site sewage dispml system in acco"dartce with the provisions of Title 5 ofthe Environmental Code and not to place the system in operation until a Certificate of Compliance bw been issued by this Board :Date /tI ' Application Approved by Date - Application Disapproved by Date for the following reason Permit No. Date Issued THE C0,14MONWEALTH OF MASSACSUSET $ BARNSTABLE,MASSACHUSETTS Certifitatc of Compliaure THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( .) Repaired( ) Upgraded Abandoned ( ) at has been cons4ucted in with the pr� ovisions f7i acctle 5 and the for Disposal System Construction Permit No •d Installer__ Designer ; #bedrooms g Approved design flohv The issuance of this rm shall not be.con"strued'Wh guarantee that the S?stem w' t n as de ^� Date 1� ` 6ncd. Coe THE COMMONWEALTH OF fV1.ASSAICH USETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS Dispnsaf�&pstrnt Construction Permit f Mnission is hereby gmnfed to Construct f ) Repair( ) {.fii pgra e L �} Abandon System located at � t act»n atz+� ix,,uteri t at"yntc u x115z,111•r,1ncluolrg Almscjj,W W101711 ally uofV rbWt;d tt4 the nitrn:r d iJ;i1 of Laid r t f r+,ldcj,h0wevcr,111, all System lnspeeirae;shakk,,U tip ," t � v.t io,t,ly 3, 1,iopertv owner a klat PM'Par,,l by tits-kacak board of hcalth'of I—I J' 1 r� EXISTING PROPOSED INFILTRATOR '" , CONTOUR J CHAMBERS IN FIELD -- O-- 1 CONFIGURATION FENCE r WITHOUT AGGREGATE S; o IP (FND) / , ' �.50' o CB (FND) 111 �.59' Q1 TEST HOLE 1 �� 7QN OSe 0 1� ft 10.1ft o 0 450Feet y` f LOCUS MAP t`P PLAN RET' LCP 31373—B SI•;y S No.ICE � � nni"`a.,_ ASSESSORS MAP, 166 061 "� r •�� ^,��£.a .r f' �� � ZONING: RC SETBACAN.- 20-10'-10' cl� J ^�._ _� y\'K` FLOOD ZONE C i•• S. F PANEL NUMBER 25000..1 0016 D 7 s f BM: NAIL IN PAVEMENT — ELEVATIONI: 93.36' DATED.• 0710211992 r DATUM: ASSIGNED OVERLAY 7,ONES AP RPOD, w ,.2 LOT 69 , �\ss��',\ MA ESTUARILS 328 6 SO \ s � /' ; 0.28 ACRES SEPTIC REPAIR-� Q APPRO PLAN OF LAND O� (FND) LOCATED AT. 45 NE'WPORT LANE .►�.� q} f F OSTERTPILLE, . MA . �5\ .... ..... �!iiii'iiii ":!`ii`i ` / r r\• f; s: 45's's PREPARED FOR. _ ............ ' MICHAEL WALKER < • ! �,� � �i � I _ MARCH 29, 2010 IP ND) REV- REV N �8 20 40« 69 0�a1 REV GRAPHIC SCALE 72,66, w 6g YANKEE LAND SURTIEY ?� o to m a IPCo., INC. LOT 70 LOT 73 _ (FND) ° 40 INDUSTRY.ROAD I inch = 20 fL MARSY19NS KILL: Ma 0.2646 TEL• 508-428-0055 FA.Y• 508-420-55 SHEET 1 OF P JOB f.- 54G11 cr,".L. Svstetn nspector.;of Ian-site wwage disposal systems:penaltyF. SEWAGE SYSTEM PROFILE VIEW N .T.S. 4, ♦�' 10654 I'•d. F,-F1N9 GRADE 96.e• L RISERS 4 VENT _1 1 vLNr 20• FIN GRADE 98'1 20 5� DIA p� FIN GRADE a 98't r . . . OTT' E1.93,82' •". N SYSTEM MAST INV EL 10• MIN. 1MIN e . � _ -_���p. 84,85' `� I 1 INV El_ 93.42' NED _ BELOW FLOW LINE 94.60, ^^ ___ __ - MED ... UQUiD LEVEL 4B• INV EL MIN. 6' INV EL SAND SAND 94.3T SUM 94.1T 6` p• GAS BAFFLE B'STONE 1 5A EXIII ING 100D GALLON TANK DISTRIBUTION BOX 32.25' TEES SMALL BE CONSTRUCTED OF SCHEDULE 40 PVC AND PRECAST REINFORCED CONCRETE DISTRIBUTION BOX MNINUM 0.6•ABOVE THE FLOW UNE OF THE SEPTIC TANK p EXTEND A IN TALL A .H�KpBASE vWIT WATERTIGHT COVER USE FIVE ROWS OF(5) HIGH CAPACITY INFILTRATOR CHAMBERS THE CENTERLINE OF THE SEPTIC TANK LOCATED DIRECTLEY UNDER THE TOTAL CHAMBERS 25 CLEAN-OLT MANHOLE. MINIMUM INSIDE DIMENSION 12" PVC INSPECTION PORT WITH SCREW THE.IM ET PIPE ELEVATION SHALL BE NO LESS THAN OUTLET INVERTS SMALL.BE EQUAL TO EACH OTHER AND AT TO WITHIN 3' OF FINISHED GRADE (4 ` AOVE THE WERT ELEVATION OF THE OUTLET PIPE. 2 NOR MORE THAN 3• 2• MINIMUM BELOW INLET INVERT. SEE PLAN+q�y f SEPIIC TANK SHALL BE INSTALLED LEVEL AND TRUE TO GRADE ON A LEV THE DISTRIBUTION LINES FROM THE DISTRIBUTION BOX SHALL ALL HAVE FlN GRADE 9B't' GEOTEXTILE FABRIC_ + J IIEf STABLE RASE THAT HAS BEFN LEVEL COMPACTED AND ON.WHICH E��INVERTS AS DETERMINED BY FLOODING THE DISTRIBUTION 00X TO 6'OF CRUSHED STONE HAS BEEN PLACED TO ENSURE STANDOBILITY AND THE HEIGHT OF THE DISTRIBUTION LINE INVERT AFTER ALL LINES HAVE v TO PREVENT SETTLING. BEEN SEALED IN PLACE SEPTIC TANK SHALL HAVE A MINIMUM COVER OF 9• INVERT ADJUSTMENTS SHALL BE MADE BY FILLING WITH DURABLE AND _ EL9J.82' iN'0 2O'N.At7HOLE5 WITH READILY REMOVABLE IMPERMEABLE COVERS RECONONDENSTRUCTTI G THBLE E�LINES UIAL NTIL ALL I FASTENEDENTLY I E 0 EOUALEEOE gT10N, OF DURABLE MATERIAL SHALL BE FRONDED WITH ACCESS PORTS, t 6 • ••r •• '•;�'DISTRIBUTION BOX SHALL BE INSTALLED LEVEL ANO TRUE TO GRADE ON A LEVEL MIDDLE ACCESS PORT SHALL BE B• UVl MINIMUM. STABLE BASE THAT HAS BEEN MECHANICALLY COMPACTED AND ON WHICH ° EL92.49' THE OUTLET TEE SHALL BE EQUIPPED WITH GAS BAFFLE. 6'OF CRUSHED STONE HAS BEEN PUKED TO ENSURE STABILITY AND 34 CLEAN MEDIUM SANG TO PREVENT SETTLING, 6• SEPARATION BETWEEN ROWS (TYP.) SEPTIC TANK CAPACITY: 17.16' REQUIRED - 440 GALLONS AT 200% USE FIVE ROWS OF(5) HIGH CAPACITY INFILTRATOR CHAMBERS tirj EXISTING - 1000 GALLONS TO REMAIN DESIGN DATA: TOTAL CHAMBERS a 25 EXISTING FOUR BEDROOMS — NO INCREASED FLOW j 4 X 110 = 440 GPD REQUIRED FLOW BorroM of SOIL PT - EL 87.3 No GROUND WATER OR GEP1ERkl NOTES: USE 25 HIGH CAPACITY INFILTRATOR CHAMBERS REDOXIMORPNC FEATURES OBSEHJ IN FIELD CONFIGURATION WITHOUT AGGREGATE i ALL.THE WORKMANSHIP AND MATERIALS SHALL CONFORM TO DEP (25 X 6.25) X 4.72 SF/LF = 737 SF TITLE V AND THE TOWN OF BARNSTABLE RULES AND REGULATIONS 737 X 0.74 = 545 GPD TOTAL DESIGN FLOW FOR THE SUBSURFACE DISPOSAL OF SEWAGE. 2• ACCESS PORTS OVER TANK TEES SHALL BE ACCESSIBLE WITHIN 6" RESERVE FLOW = 105 GPD OF FINISHED GRADE 3. ALL COMPONENTS OF THE SANITARY SYSTEM SHALL BE CAPABLE OF GARBAGE DISPOSAL, NOTALLOWED WITHSTANDING H-10 LOADING UNLESS OTHERWISE NOTED. 4.OFTHE SITEEUTILPIESRPR OR TO R SHALL CALL "DIG Y EXCAVATION. AND SHALLAND BE RESPONSIBLE LOCATION T P #1 PERC <2 M/INCH T.P. #2 PERC <2 M/INCH I ALL MATTERSRELATING TO ELECTRIC AND/OR GAS EASEMENTS.5. SEINER PIPES SHALL BE SCHEDULE 40 PVC. (4" DIA. UNLESS UTHERWISE NOTED) °• ANY MASONRY UNITS USED TO BRING COVERS TO GRADE SHALL BE °q" ° 10°YR 4/2 °A" "LS" 10 YR 4/2 MORTARED IN PLACE. g e' I 1. FINISH GRADE SHALL HAVE A MINIMUM SLOPE OF 0,02 FT. PER FOOT. 10 YR 6/9 "LS" to YR s/g SOIL DATA: "9' °LS° "B" g° i e. EXISTING SYSTEM COMPONENTS — IF ANY — SHALL BE ABANDONED PER EL 98:1 TEST DATE: 03/19/2010 3g" ' TITLE 5 REQUIREMENTS. �-s6.T SOIL EVALUATOR: DNAD B MASON 9• THE EXCAVATOR/CONTRACTOR SHALL BE RESPONSIBLE TO CONTACT YANKEE CO ARSE COARSE APPROVAL DATE: TOj94 SURVEY 24 HOURS PRIOR TO ANY REQUIRED INSPECTIONS. °0" MS' C. MS". HEALTH AGENT: DAVID W STANTON 10. ALL COMPONENTS SHALL BE MARKED WITH MAGNETIC TAPE OR - ITO YR 7/2 10 YR 7/2 COMPARABLE MEANS IN ORDER TO LOCATE THEM ONCE BURIED. .I 144A 144" NO Q\WA'� OR NO G\WATER OR REOOXIMORPHId FEATURES REDOXIMORPHIC .FEATURES �' s7NET z OF 2 JOB ATUAfBER 54Btj_ DATA' USE FIVE ROWS OF (5) HIGH CAPACITY INFILTRATOR CHAMBERS GN D ES I TOTAL CHAMBERS = 25 EXISTING FOUR BEDROOMS — NO INCREASED FLOW 4 X 110 440 GPD REQUIRED FLOW BOTTOM OF SOIL Pff NO GROUND W; USE 25 HIGH CAPACITY INFILTRATOR CHAMBERS REDOXIMORPHIC FEATL IN FIELD CONFIGURATION WITHOUT AGGREGATE (25 X 6.25) X 4.72 SF/LF = 737 SF 737 X 0.74 = 545 GPD TOTAL DESIGN FLOW RESERVE FLOW = 105 GPD GARBAGE DISPOSAL NOT ALLOWED CATION T.P. #1 PERC <2 M/INCH T.P. #2 PERC <2 M/CNCH OR EL. 99.3' o„ EL. 99.3'_ 0,l NOTED) 10 YR 4/2 "A" "LS„ 10 YR 4/2 qA' S» / ,:LS" 10YR 6/8 SOIL. DATA: 3 19 2010 10YR 6 8S" "B" TEST DATE. 0 / /38»96.1' 38EL. 96.1' SOIL EVALUATOR: DAVID B MARSE COARSE APPROVAL DATE: 10/94 E MS" nC„ "Ms» HEALTH AGENT: DAVI D W STA 10 YR 7/2 10 YR 7/2 EL 87.3' 144" 7.3'Ll44" NO G\WATER OR NO G\WATER OR REDOXIMORPHIC FEATURES REDOXIMORPHIC FEATURES SHEET *' OF 2 JOB NUMBE A __ 3 Town of Barnstable ypF� TOw Regulatory Services Thomas F.Geiler,Director 4 � Public Health Division Thomas McKean,Director ti 200 Main Street,Hyannis,MA 02601 Office:,508-862-4644 Fax: 508-790-6304 Installer&Designer Certification Form `ti Date: I.o go 4 Designer:' Installer:kA Address: . >A �DW ��' Address: '`i� 1 -'� a I `7 �tG S Onf� C- 4 i ll was issued a permit to install a (date) - (install ) septic systemat 45 dl�vjpoc Of�1'i l based on a design drawn by (address) AV t j-,) �• �� t dated (designer) rectify that-the septic system refwmced above was installed substantial j►according'to :�3ie design, which may include mind=approved-changes such as Wq&telocation of the h d"ution box and/or septic tank. � I cerlify:fhat the septic system referuwed above was ins4fied wiem*or changes -- - g=tertjWjW latend relocation aftbe SAS or-any verticall400ation-of any component of the sepUV_-sy�t a but in accoiidance with State&U-Cal Re&iiatiOns.'Phn revrsioML or certified as-biht'by desa-gnerto follow , (Installer's Signahme) 4A.S0N Co �bir�lltP er s Signaivre) 'i�c s Staltap Here) : ... PLDEASE RETMN TO RAAfLk -AJ611)l;?--IIS .IC H�ALTi3 D SION. ICATE OF CQNM.IANCE - 1 �- UED- B TH1 �` ORI _ASS:- E CARD ARE RECEIiWD THE- - STABLE FUMU : ,7�]I ,SI(3�1V_ TDA�1K YOU. ,}_ <r � , :r Qs Healt isept C-Siper CertiScafi,, Fob 3, ! 2/28/2017 Print Page Runt this page • Owner Information-Map/Block/Lot: 166 /061/- Use Code: 1010 Owner Map/Block/Lot GI�, ���, RYAN, THOMAS F JR & MICHAEL 166 /061/ Owner Name as of S TRS Property Address 1/1/16 PO BOX 158 45 NEWPORT LANE MARSTONS MILLS, M.A. 02648 Village: O stervik Co-Owner Name 69 NEWPORT NOMINEE TRUST Town Sewer At Address: No G1S Zoning Value: RC • Assessed Values 2017 -MapBlockUt: 166/061/-Use Code: 1010 2017 Appraised Value 2017AssessedValue Past Comparisons Building Value: $ 143,300 $ 143,300 Year Assessed Value $ 46,600 $ 46,600 2016 - $ 481,100 Extra Features: 2015 - $ 384,200 $ 3 000 $ 3 000 2014 - $ 384,300 Outbuildings: 2013 - $ 384,400 2012 - $ 431,900 $ 243,900 $ 243,900 2011 - $ 422,000 Land Value: 2010 - $ 445,400 2009 - $ 450,300 2017 Totals $ 436,800 $436,800 2008 - $ 489,400 2007 - $ 517,700 • Tax Information 2017-Map/Block/Lot: 166/061/-Use Code: 1010 Taxes C.O.M.M. FD Tax (Residential) $ 532.90 Community Preservation Act Tax $ 125.01 Town Tax (Residential) $ 4,167.07 Fiscal Year 2017 TAX RATES HERE $ 4,824.98 http://wvwtomofbarnstable.us/Assessing/printl7.asp?ap=O&searchparcel=166061 1/4 2/28/2017 Print Page • Sales History -Map/Block/]Lot: 166/061/-Use Code: 1010 History: Owner: Sale Date Book/Page: Sale Price: RYAN, THOMAS F JR&MICHAEL S TRS 2010-03-08 C 190854 $310500 VALENTINE, MICHAEL S &MARTINA D 1995-04-15 C137020 $155000 GREENLEAF, SHARYN 1993-07-15 C 130698 $1 GREENLEAF, JOHN A& SHARYN 1990-06-15 C 120730 $162500 PARESEAU, WARREN E&CAROL E 1969-07-25 C46175 $0 • Photos 166/061/-Use Code: 1010 r • Sketches -Map/Block/Lot: 166/061/-Use Code: 1010 Fes, AS Built CardS:aick card#to view: Card Al Card #2 • Constructions Details -Map/Block/Lot: 1.66 /061/- Use Code: 101.0 Building Details Land Building value $ 143,300 Bedrooms 4 Bedrooms USE CODE 1010 Replacement Cost $193,582 Bathrooms 2 Full 1 Half Lot Size (Acres) 0.27 http:/Ammvtomofbarnstable.us/Assessing/printl7.asp?ap=0&searchparce1=166061 214 2/28/2017 Print Page Model Residential Total Rooms 7 Rooms Appraised Value $ 243,900 Style Colonial Heat Fuel Gas Assessed Value $ 243,900 Grade Average Heat Type Hot Water Year Built 1968 AC Type Central Effective depreciation 26 Interior Floors Carpet Stories 2 Stories Interior Walls Drywall Living Area sq/ft 1,784 Exterior Walls Wood Shingle Gross Area sq/ft 3,698 Roof Structure Gable/Hip Roof Cover Wood Shingle • Outbuildings & Extra Features -Map/Block/Lot: 166/061/-Use Code: 1010 Code Description Units/SQ ft Appraised Value Assessed Value FOP Open Porch-roof- 62 $ 2,500 $ 2,500 ceiling FPL3 Fireplace 2 story 2 $ 9,900 $ 9,900 FPO Ext FP Opening 1 $ 1,300 $ 1,300 WDCK Wood Decking 292 $ 3,000 $ 3,000 w/railing GAR Attached Garage 576 $ 12,400 $ 12,400 BMT Basement-Unfinished 984 $ 20,500 $ 20,500 • Sketch Legend Property Sketch Legend B2N Barn-any2nd story area FPC Open Porch Concrete Floor REF Reference Only BAS First Floor,Living Area FTS Third Story Living Area (Finished) SOL Solarium BMT Basement Area(Unfinished) FUS Second Story Living Area(Finished) SPE Pool Enclosure BRN Barn GAR Garage TQS Three Quarters Story(Finished) CAN Canopy GAZ Gazebo UAT Attic Area(Unfinished) CLP Loading Platform GRN Greenhouse UHS Half Story(Unfinished) FAT Attic Area(Finished) GXT Garage Extension Front UST Utility Area(Unfinished) FCP Carport KEN Kennel UTQ Three Quarters Story (Unfinished) FEP Enclosed Porch MZ1 Mezzanine,Unfinished UUA Unfinished Utility Attic FHS Half Story(Finished) PRG Pergola UUS Full Upper2nd Story(Unfinished) FOP Open or Screened in Porch PRT, Portico WDK Wood Deck PTO Patio Microsoft VBScript runtime error'800aOla8' http:/Awm.tovvnofbarnstable.us/Assessi ng/printl7.asp?ap=0&searchparcel=166061 3/4 F � Legend 3 � i Parcels Railroad own Boundary 1!�ti4l81 r ;' Tracks ai tr84 � 1,66036002 T�Buildings 166036001 Painted Lines 7r7Q° #.263 Parking Lots wa. ..,� r„" 1u6Q 1 • _ r , Driveways . m.. VT Unpaved p a k Roads Bridges •. \� 1 66044002: N Paved Roads 1031 �,� i?� 5�: �•s;,, 4��a . Unpaved Roads f Or r � i 44 Streams Marsh N Water Bodies �x x. tlef :lG6t163 ��`, 166,0440036 > 16074 16661 � ,� > � � o �4. S 45 ' 't 40 116, 1 a3xv 6 3'1 3' #114 3 1 r , 3 W • � 22 �5 1uQ2 � t 4�4 z MAI'b., tit 1 � 6 1 " " 'fix i _... ,. ... ,s .a ; a IN Mli 166032 x Aif If Niw 1G+ 7S f 16666E b ( 5� 2 v� 4, 1661x1 . .._K 16Q34 3G Map printed on: 2/28/2017 This map is for illustration purposes only.It Is not Parcel lines shown on this map are only graphic Town of Barnstable GIS Unit adequate for legal boundary determination or representations of Assessor's tax parcels.They are Feet regulatory interpretation.This map does not represent not true property boundaries and do not represent 367 Main Street,Hyannis,MA 026oi O 83 167 an on-the-ground survey.It maybe generalized,may not accurate relationships to physical objects on the map 5o8-862-4624 reflect current conditions,and may contain such as building locations. Approx.Scale: 1 inch= 83 feet cartographic errors or omissions. gis@town.barnstable.ma.us TOWN OF BARNSTABLE LOCATION �,e v eT Alm. SEWAGE# VILLAGE ©S/`erv,Ae ASSESSOR'S MAP&PARCEL 144WD,w' INSTALLER'S NAME&PHONE NO. &I SEPTIC TANK CAPACITYc'f7`�=r�/DO�� LEACHING FACILITY:(type) i.,E /Ara��rf"25_ (size) t 7 16 K R d NO.OF BEDROOMS y ' OWNER ,'A P 1414 PERMIT DATE: 7' /O COMPLIANCE DATE: D 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 4 s y „ 3 a v/3, .13 R I T/3 k6h) 0/? No. Fee HE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS ftplication for Nsposal *pstem Construction Permit Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. / + Owner's Name,Addre s,and Tel.No. Assessor's Map/Parcel Installer's Name,Address and Tel.No. Designer's Name Address,and Tel.No. J.C. 0./a �C'on S�v�rt:viz J�o?9�/-7J,o Z g 3c/ /y1,u'S�d-1 ,1� �� /4kee 1u,,� �vr✓e�i us 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(min.required) 7 / gpd Design flow provided 4"1j'6— gpd Plan Date 3'o?�j- /� Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil See JOIY!o Nature of Repairs or Alterations(Answer when applicable) SPe AR, 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 Certificate of Compliance has been issued by this Board [ea h. e Date Application Approved by_ 4Date Application Disapproved by Date for the following reasons Permit No. Date Issued 0 —0 No. Fee /HE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION, TOWN OF BARNSTABLE, MASSACHUSETTS; Yes application for Misposaf *pstrm Construction permit Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. y,$1A e r , Owner's Name,Address,and Tel.No. Assessor's Map/Parcel Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No. `J.C. .4y //� Con S/✓.-e -'uh �j J� a tl,g fiPP � 5"', '/9 O �0 `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(min.required) 41110 gpd Design flow provided gpd Plan Date _3,�?`- /o Number of sheets ;7— Revision Date Title — Size of Septic Tank Type of S.A.S. Description of Soil SPe �42/9 n 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 Certificate of Vern Compliance has been issued by this Board ea h. S' ne Date — /0 Application Approved by r ' 47A Date Application Disapproved by �_ Date for the following reasons Permit No. 42Us Date Issued - - -------------- ----- ----- -------------------- -- -- ---------------------- ----- --- --------- - ------------------ THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired( ) Upgraded( ) Abandoned( )by C. ��, l,Uo.� at �/5� / pu/ oy f /h, has been constructed in acc d with the provisions of Title 5 and the for Disposal System Construction Permit No 4 a ed Installer ), �, Al /f(7 Designer�Y",(p { #bedrooms Approved design floky gpd The issuance of this erm t shall not be construed1s1`a guarantee that the system w' c i n as de -gned. Date w� Inspector 1� No. Fee —0 THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS Disposal *Pstem Construction Vermit Permission is hereby granted to Construct( ) Repair( ) Upgra e V� Abandon( ) EISystem located at 7 /�/vc/ pr �„ a and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. i Provided:Cons r tioll ust be completed within three years of the date of this permit. (� t Date Approved by \) t Town of Barnstable Regulatory Services h Thomas F.Geiler,Director ya ]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: Designer: Installer: Address: . v'�-DW Address: �Tb�e_? 1( �j On` �� C was issued a permit to install a (date) (install ) septic system at � �'"I��i" �J� (lll��based on a design drawn by (address) i �. � I �✓ dated (designer) - V - I eertify that-the septic system referenced above was installed substantially according to she design, which may include minor approved-changes such as lateral relocation of the d$stribution box and/or septic tank. I certify that the septic system referenced above was instaRed with''=3 or.changes'q:e, greater thaw 10' lateral relocation of the SAS or-any vertical relooatidn of any component of the.septi -§ stem}but is aEcordance with State &Local.Regzflatons. plan revisork or certified as brlt` y designer to follow. 03` DAVID �y- h. (Installer's Signature) � �> MASON m 9 No,1066 SgNITAR��� (B iefrs Signature) f Aixe 's Statixp Here) PLEASE RETURN TO BA STAB �E PUBLIC:HEALTH DIV SION e RTIFICATE OF C0112PLIANCE SILL=Nts�'F E__'_ISSUED NTII BOTH`T -FOB AUII..T jQA D ARE RECEIVED BYTHE:B . S ABL-E PUBI:I R EA1f -D SION THANK YOU. , Q:Healtfi/septic/Desiper Certification Fom ;. 04/20/2010 12:47 5084205553 YANKEE SURVEY PAGE 01/02 t y Town of Barnstable p o Depnrtinent of iteplatory Services MAAM } Public Health Division Date 3 I o 2W Main Streei,HYMN MA W.ddl Date Scheduled�3 / d Time J ��� Fee 1'd.__/e s Soil Suitability Assessment for Se ag Disposal I'erfbnned Dy; Witnetmed Dy WS LOCATION&GENI RA.L MORMATION fNEW etr address - y5' /1/�w rf G a owner's Name ,� r Addremp pf'Oteer's Name ONS(RUCTION RBPAIR ,�� Tel honeg 77, I.tmd Use y L .S10PGa(96) Srrr(hQa$rOnC9 ff>7/'/CS�Y✓�'4. Dletanees Rom: OPon Water body n 0osslbie Wet Arvt [a.rief����T R Drinking Water Well R Dmlenge Wny It Roperty une _R Other R SKETCH:(Sheet name,dimenplone of let.exact loenrlonv of test holes&pare testa,locate Wetlnmtr(n Proximity to holm) i t m 77 Fj) N Nrent Material(geologic) x�J � = gal Depth to Berlrock Depth to Oroundwnter;Standing Water In HLnir Weeping Rom Pit Pace Bsdmated Sensorial Wph Oroundwnter o`f Method UsN; DrTERMINATION TOR SEASONAL HIGH wATE;t TABLE Depth obxerved xmnding In obs.hole: In; Depth to loll mottlex In. De6tlt to weePing from plde of ebs.hole: _„_�„!,lm Om th to Ball AdltIft, t In Index Wea lr Rending Dorn. (odes well level Ad).1heWm Adf.OrolmdwW Level _ Ohscrvndon PERCOLATION TEST Late Theo ~ flole 01'inle nt 9" Depth of Pen; Time nt d" Starr Pro-soak Time tR Tlmo 19^.n'ry 1211d Irre•aonk Rare MlnAneh �I Site 9ultohlllry Aveessmenh Slte Pnaxch Sim Palled:z� Additional Trsling•Noeded(YIN) odainnh Arblle Henirll Dlvlslon Observation I•Iole Data To tie Completed on Bork-- ***If percoiMAon test Is to he conducted witbin 100'of wetlnnd,you must first notify the Bnriustnble Contrervation DlvWon at lenst one(1)week prior to beginning. 17:\CP..Pf'It1PRRCi''ORM.DOC 04/20/2010 12:47 5084205553 YANKEE SURVEY PAGE 02102 DEMPOBSERVATION HOLE LOG hole# Depth from Sell Wetimn Soll Texture Son Cnlnr Boll Other Bud=(in.) t� (USDA) (Munsetl) Monling (Swetert;Srones:Deutdets. jo S � DEEP OBSERVATION HOLE LOG Hole# D"tlh from Sell Horizon Soil Texture Sall Color Sett Other Surlhee(In.) (USDA) (Mansell) Moltlln (Stru g eturr,Sronea,Doetders. i910Jtey�Ornveh ,� ' 14, DEEP OBSERVATION HOLE LOG Hole# Depth froze' -loll Horlmn Soll Texture Sall Color Salt Other Surface(In.) (USDA) (MnnRell) Mottling (Stmetom.Stoned,Doutders. �og9l,tencv 96 Ornvrh DEEP OBSERVATION HOL,LOG Hole# Depth from Soil Harman Sall Texture Sall Color Sall Other 9arfiee(In.) (USDA) (Mansell) Mottling (Slntetum,Stallm Bouldam. soalalonCY,�Omyen . a Mood InMonee irate Man: AW1,500 yeor flood boundary No_ es Within Son yrnr boundary NO . Within(00 year Hood boundary No peat-of ptaraliv Occurring Pervious Material Does at least four feet of naturally occurring p o erial exist in All areas observed throughout the Area proposed for the roll Absorption eyslent9 If n04 what is the depth of naturally occurring p ous material l �• Coitittcatlon I Certify flint on (date)I have passed the coil evniun tar examination Approved by the Department of Envl n tat Protection And that tho above nnnlysls was etf tined by me consistent with . (he reOuir fining, e a an c erience described in�10 CMR 15. 7. 1� 5lgnnture Dntc ` Q��SPrfiC1CflRC1''ORM.DOC TOWN OF BARNSTABLE LOCA!flNN ' SEWAGE # ?01 VILLAGE� ASSESSOR'S MAP & LOT ��(�J ®� INSTALLER'S NAME & PHONE NO.�& b)61AA10 0-`W �Ci T SEPTIC TANK CAPACITY LEACHING FACILITY:(type) �/� (size) NO. OF BEDROOMS-PRIVATE WELL OR PUBLIC WATER_ C. BUILDER OR OWNER HA DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: cT VARIANCE GRANTED: Yes No 0 -� 1 174NIt LEGEND PROPOSED INFILTRATOR EXISTING 100 — — — CHAMBERS IN FIELD CONTOUR CONFIGURATION A 0— FENCE WITHOUT AGGREGATE o IP (FND) S 28.80 .�' ■ CB (FND) �.59 ' ,1 � TEST HOLE. �.. .Q O `• �— 1 .Oft - Co W o o « f 10.1 ft o xo,tr,rb nor OFNjgss9 N 0 450 Feet �� :• ) DAVID �' a MASON LOCUS MAP a N0.1066 �y l PLAN REF LCP 31373—B SK 1 IST0"o R G;,j Fo CERT REF. 190854 S A `P O�j ✓�C D e• . : P°.; �F A ASSESSORS MAP 166 061 ZONING: RC ��� SETBACKS. 20'-10'-10' � F� FLOOD ZONE: C °�0 o. BM: NAIL IN PAVEMENT PANEL NUMBER— 250001 0016 D ELEVATIONI: 93.36' DATED.• 0710211992 LOT 69 ��� P DATUM: ASSIGNED OVERLAY ZONES., AP, RPOD, O 12328.6 SQ. FT. `�� MA ESTUARIES o O 0.28 ACRES sc, SEPTICREPAIR APPROXIMATE PLAN OF'' LAND WATER LINE '`_ CB / qQ�::O (FND) LOCATED AT ..........//..,, ,,,,,,,,,,,,,,,,,, o:.: 45 NEWPORT LANE' .......................... ,,,,,,,,,,,,,,,,......, ' ,,,,,,,,,,,,,,,,,,,,,,,,,,,,, ;,,,,,,,,,,,,,......,,,, O,S'TER VILLE MA ......,/,//,///„/,/////, s .,��, ® ,,,,,,,,,,,,,,,,,,,,,,,,, PREPARED FOR.• Q p Q• .� O ...,/.////////,/.../,././...,..././,//.///../..//././. TEo," =� C ......: v ® "::::::::::: :::::::::::::::::::::::::::::::::::::::::::::::::" /,,,,,,/,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, ,,,,,,,,,,,,,, ( MICHAEL WALKER t I MARCH 29, 2010 ®►�q D 5U`, 4 IP ND) REV SHED Qi ,1p' REV 2 N ;78`20'40 �' S a1 REV GRAPHIC SCALE 1'2.66' w 6g g IP YANKEE LAND SURVEY 20 o io 20 ao (FND) CO., INC. LOT 73 — — LOT 70 40 INDUSTRY ROAD 1 inch = 20 fL MARSTONS MILLS, MA 02648 TEL• 508-428-0055 FAX 508-420-5553 SHEET 1 OF 2 JOB # 54611 SH 4S SWAG E SYSTEM ' PPOFILE . VIEW N . T . S . f 4" PVC T.O.F. EL. 100.54 VENT i FIN GRADE = 98.0' cD RISERS FIN GRADE — 98't FIN GRADE = 98't 20" 20" V cD EL.93.82' IN EL DIA. DIA NOTE: SYSTEM MUST 95.2' RISER INV EL. ]�SAND o°.° BE=VENTED. �C 93.42' MED ^^ INV EL 10". MIN. f 14" MIN. INV EL. SAND —� 94.60' 94.85' INV EL. MIN. 6" INV EL. o 6 0 BELOW FLOW LINE LIQUID LEVEL 48" 94.3T SUMP 94.17' GAS BAFFLE 6 STONE EXISTING 1000 GALLON TANK DISTRIBUTION BOX 32.25' PRECAST REINFORCED CONCRETE DISTRIBUTION BOX USE FIVE ROWS OF (5) HIGH CAPACITY INFILTRATOR CHAMBERS T TEES SHALL BE CONSTRUCTED OF SCHEDULE 40 PVC AND SHALL EXTEND A INSTALL ON A LEVEL BASE WITH WATERTIGHT COVER TOTAL CHAMBERS = 25 .MINIMUM OF 6" ABOVE THE FLOW LINE OF THE SEPTIC TANK AND BE ON MINIMUM WALL THICKNESS = 2" PVC INSPECTION PORT WITH SCREW CAP THE CENTERLINE OF THE SEPTIC TANK LOCATED DIRECTLEY UNDER THE MINIMUM INSIDE DIMENSION = 12" TO WITHIN 3" OF FINISHED GRADE (4 TYP) CLEAN—OUT MANHOLE. OUTLET INVERTS SHALL BE EQUAL TO EACH OTHER AND AT SEE PLAN VIEW. THE INLET PIPE ELEVATION SHALL BE NO LESS THAN 2" NOR MORE THAN 3" 2" MINIMUM BELOW INLET INVERT. FIN GRADE = 98't GEOTEXTILE FABRIC ABOVE THE INVERT ELEVATION OF THE OUTLET PIPE. THE DISTRIBUTION LINES FROM THE DISTRIBUTION BOX SHALL ALL HAVE / SEPTIC TANK SHALL BE INSTALLED LEVEL AND TRUE TO GRADE ON A LEVEL, EQUAL INVERTS AS DETERMINED BY FLOODING THE DISTRIBUTION BOX TO i iI i 1 i STABLE BASE THAT HAS BEEN MECHANICALLY COMPACTED AND ON WHICH THE HEIGHT OF THE DISTRIBUTION LINE INVERT AFTER ALL LINES HAVE 6" OF CRUSHED STONE HAS BEEN PLACED. TO ENSURE STABILITY AND BEEN SEALED IN PLACE. EL.93.82' TO PREVENT SETTLING. INVERT ADJUSTMENTS SHALL BE MADE BY FILLING WITH DURABLE AND } ° ° ° ° 0 ° ° roo ° 0 ° ° ° ° ° o o° c o c o o° 0 0 o° o 0 0 0 NONDEFORMABLE MATERIAL PERMANENTLY FASTENED TO THE LINE OR » ° o 0 0 0 0 o 0 0SEPTIC TANK SHALL HAVE A MINIMUM COVER OF 9" 16 ° o° o ° c0 o o o ' °° °o° TWO 20" MANHOLES WITH READILY REMOVABLE IMPERMEABLE COVERS RECONSTRUCTING THE LINES UNTIL ALL INVERTS ARE OF EQUAL ELEVATION. 0 o° o0 0 o o o o 0 OF DURABLE MATERIAL SHALL BE PROVIDED WITH ACCESS PORTS. DISTRIBUTION BOX SHALL BE INSTALLED LEVEL AND TRUE TO GRADE ON A LEVEL o o o o o° o 0 0 o EL.92.49' MIDDLE ACCESS PORT SHALL BE 8" DIA. MINIMUM. STABLE BASE THAT HAS BEEN MECHANICALLY COMPACTED AND ON WHICH 3411 _^ CLEAN MEDIUM SAND 6" OF CRUSHED STONE HAS BEEN PLACED TO ENSURE STABILITY AND THE OUTLET TEE SHALL BE EQUIPPED WITH GAS BAFFLE. TO PREVENT SETTLING. 6" SEPARATION BETWEEN ROWS (TYP.) ` 17.16 N SEPTIC TANK CAPACITY: p USE FIVE ROWS OF (5) HIGH CAPACITY INFILTRATOR CHAMBERS REQUIRED - 440 GALLONS AT 200% TOTAL CHAMBERS = 25 EXISTING — 1000 GALLONS TO REMAIN DESIGN DATA: EXISTING FOUR BEDROOMS — NO INCREASED FLOW 4 X 110 = .440 GPD REQUIRED FLOW BOTTOM OF SOIL PIT = EL 87.3' NO GROUND WATER OR USE 25 HIGH CAPACITY INFILTRATOR CHAMBERS REDOXIMORPHIC FEATURES OBSERVED IN FIELD CONFIGURATION WITHOUT AGGREGATE GENERAL NOTES: ` 1 . ALL THE WORKMANSHIP AND MATERIALS SHALL CONFORM TO OEP (25 X 6.25) X 4.72 SF/LF = 737 SF TITLE V AND THE TOWN OF BARNSTABLE RULES AND REGULATIONS 737 X 0.74 = 545 GPD TOTAL DESIGN FLOW FOR THE SUBSURFACE DISPOSAL OF. SEWAGE. RESERVE FLOW = 105 GPD 2. ACCESS PORTS OVER TANK TEES SHALL BE _ACCESSIBLE WITHIN 6" OF FINISHED GRADE GARBAGE DISPOSAL NOT ALLOWED 3. ALL COMPONENTS OF THE SANITARY SYSTEM SHALL BE CAPABLE OF WITHSTANDING H-10 LOADING UNLESS OTHERWISE NOTED. 4. THE EXCAVATOR/CONTRACTOR SHALL CALL "DIG SAFE" AND VERIFY THE LOCATION T.P. #1 PERC <2 M/INCH T.P. #2 PERC <2 M/INCH OF SITE UTILITIES PRIOR TO ANY EXCAVATION, AND SHALL BE RESPONSIBLE FOR ALL MATTERSRELATING TO ELECTRIC AND/OR GAS EASEMENTS. EL. 99.3' 0.1 EL. 99.3' o., 5. SEWER PIPES SHALL BE SCHEDULE 40 PVC. (4" DIA. UNLESS UTHERWISE NOTED) „A„ „LS„ 10 YR 4/2 „A„ „LS„ 10 YR 4/2 6. ANY MASONRY UNITS USED TO BRING COVERS TO GRADE SHALL BE MORTARED IN PLACE. » 10 YR 6/8 "Ls., 10 YR 6/8 SOIL DATA: ` 7. FINISH GRADE SHALL HAVE A MINIMUM SLOPE OF 0.02 FT. PER FOOT. "B" LS" "B" TEST DATE: 03/19/2010 8. EXISTING SYSTEM COMPONENTS — IF ANY SHALL BE ABANDONED PER EL- s6:1' 38 EL. 96.1' 38 SOIL EVALUATOR: DAVID B MASON TITLE 5 REQUIREMENTS. COARSE COARSE APPROVAL DATE: 10/94 9. THE EXCAVATOR/CONTRACTOR SHALL BE RESPONSIBLE TO CONTACT YANKEE "MS" "C', "MS" HEALTH AGENT: DAVID W STANTON SURVEY 24 HOURS PRIOR TO ANY REQUIRED INSPECTIONS. 10 YR 7/2 10 YR 7/2 10. ALL COMPONENTS SHALL BE MARKED WITH MAGNETIC TAPE OR EL 87.31L144" 1 EL- 87.3' 14411 COMPARABLE MEANS IN ORDER TO LOCATE THEM ONCE BURIED. NO G\WATER OR NO G\WATER OR REDOXIMORPHIC FEATURES REDOXIMORPHIC FEATURES SHEET 2 OF 2 JOB NUMBER _ 54611_