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HomeMy WebLinkAbout0081 FRAZIER WAY - Health 81 FraZ1er A/la ns Mills` - ,{057 06 t r I t 't i Commonwealth of Massachusetts 3 Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °M 81 Frazier Way Property Address Alpheen Menachery Owner ON�n,e^t's Name ��q I information is 'Y �{J�OU n S Y V U llS 00"�1 MA 2/8/2012 required for every page. Cityfrown State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important: A. General Information 1 When filling out forms the computer, r,use 1. Inspector: v only the tab key to move your Wayne Archambeault cursor-do not Name of Inspector use the return key. Company Name PO Box 914 Company Address Hyannis MA 02601 City/Town State Zip Code 508-775-1362 355 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 Lo al Approving Authority .,r 2/8/2012 nspector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future under the same or different conditions of use. l� vl/o t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 1 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �M 81 Frazier Way Property Address Alpheen Menachery Owner Owner's Name information is required for Cotuit MA 2/8/2012 every 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: 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•11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 81 Frazier Way Property Address Alpheen Menachery Owner Owner's Name information is required for Cotuit MA 2/8/2012 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in 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 ❑ Y ❑ N ❑ ND (Explain below): ❑ 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 )(P se iP . 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 FIND (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•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 4 I Commonwealth of Massachusetts . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ti 81 Frazier Way Property Address Alpheen Menachery Owner Owner's Name information is required for Cotuit MA 2/8/2012 every 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 to 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 '/day flow t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 4 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments � 81 Frazier Way Property Address Alpheen Menachery Owner Owner's Name information is required for Cotuit MA 2/8/2012 every page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 1 0,000g pd. ❑ ® 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 ❑ ❑ 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•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 L Commonwealth of Massachusetts Title 5 Official Inspection Form _ Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �^M 81 Frazier Way Property Address Alpheen Menachery Owner Owner's Name information is required for Cotuit MA 2/8/2012 every page. City/Town State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes"or"no"as to each of the following: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ❑ ® Has the system received normal flows in the previous two week period? Have large volumes of water been introduced to the system recent) or as art of ❑ ® 9 Y Y P this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms (design): 3 Number of bedrooms (actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 1 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �M 81 Frazier Way Property Address AI heen Menache P rY Owner Owner's Name information is Cotuit MA 2/8/2012 required for every page. Cityrrown State Zip Code Date of Inspection D. System Information Description: Number of current residents: 0 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes ® No Laundry system inspected? ❑ Yes ❑ No Seasonal use? ❑ Yes ® No Water meter readings, if available (last 2 years usage (gpd)): na Detail: Sump pump? ❑ Yes ® No Last date of occupancy: 11/2011 Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow (based on 310 CM 15.203): Gallons per day(gpd) Basis of design flow (seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 17 c Commonwealth of Massachusetts f Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �^M 81 Frazier Way Property Address Alpheen Menlachery Owner Owner's Name information is required for Cotuit MA 2/8/2012 every 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: owner 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): t5ins-11/10 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 81 Frazier Way Property Address Alpheen Menachery Owner Owner's Name information is required for Cotuit MA 2/8/2012 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: sas installed 8/18/08 permit#2008-380 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 1.2 feet Material of construction: ❑ cast iron ® 40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments(on condition of joints, venting, evidence of leakage, etc.): Septic Tank(locate on site plan): Depth below grade: 1.5' 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: 8.5'x5'x5' Sludge depth: 3" t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 81 Frazier Way Property Address Alpheen Menachery Owner Owner's Name information is required for Cotuit MA 2/8/2012 every page. Citylrown 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 48" Scum thickness 2" 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 13" How were dimensions determined? measuring rod Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): tank working properly all tees are at right heights and liquid is at proper levels 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•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments G M , 81 Frazier Way Property Address Alpheen Menachery Owner Owner's Name information is required for Cotuit MA 2/8/2012 every page. Cityrrown 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: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments(condition of alarm and float switches, etc.): Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °M 81 Frazier Way Property Address Alpheen Menachery Owner Owner's Name information is required for Cotuit MA 2/8/2012 every 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.): box level and water tight 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.): Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ,M 81 Frazier Way Property Address Alpheen Menachery Owner Owner's Name information is required for Cotuit MA 2/8/2012 every page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ® leaching chambers number: 2 ❑ 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.): (2) 8'x4'x2' chambers with four feet of stone no liquid in chambers stain line shows liquid has been within 1.5'of inlet pipe 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•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 113 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 81 Frazier Way Property Address Alpheen Menachery Owner Owner's Name information is required for Cotuit MA 2/8/2012 every page. Cityrrown 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.): 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-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 17 TOWN OF BARNSTABLE k `,OCATION /���A 4:�4% 6Ur4(� SEWAGE# �JJ VILLAGE ASSESSOR'S MAP&PARCEL A161 INSTALLER'S NAME&PHONE NO. %`t i"✓ cSy ^� ?f ��-g ,�' (, SEPTIC TANK CAPACITY LEACHING FACILITY:(type) — L (size) ✓'`5- NO.OF BEDROOMS ' OWNER 10W .co A-,A C N, t�/X. (/ PERMIT DATE: -/e v COMPLIANCE DATE:. /'c q 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 Ede of Wetland and L.aching Facility i g ty(if any wetlands exist within 300 feet of leaching facility). feet FURNISHED BY . ,, j ti Sy (> M Sys-> m 31 S-3 .jam Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 81 Frazier Way Property Address Alpheen Menachery Owner Owner's Name information is required for Cotuit MA 2/8/2012 every page. Cityrrown 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•11/10 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 81 Frazier Way Property Address Alpheen Menachery Owner Owner's Name information is required for Cotuit MA 2/8/2012 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Site Exami: ® Check Slope ® Surface water ® Check cellar ® Shallow wells Estimated depth to high ground water: 27 feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date ❑ Observed site (abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health -explain: ❑ Checked with local excavators, installers- (attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: plan on file at BOH also town ground water maps Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins-11/10 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 81 Frazier Way Property Address Alpheen Menachery Owner Owner's Name information is required for Cotuit MA 2/8/2012 every page. Cityrrown State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems)completed ® System Information—Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 17 TOWN OF BARNSTABLE LOCATION I /-AA 2 1 to &-JA(7 SEWAGE# VILLAGE /K /1" iP s' ASSESSOR'S MAP&PARCELO a 017, INSTALLER'S NAME&PHONE NO. /T o /w do C-$ ?� SEPTIC TANK CAPACITY It Z, � LEACHING FACILITY:(type) — L C_ (size) S- NO.OF BEDROOMS :3 OWNER &� e A-.4 G 14 a^ U PERMIT DATE: /p .; 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 g . . Cu A -.3 sb'9" b p -i- _20 x 9-3 s3 ,� sNo. r Feed THE COMMONWEALTH OF MASSACHU.SETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLES MASSACHUSETTS ZippYication for �Diopoe;ar braent conOtructiott permit Application for a Permit to Construct( . )Repair( X)Upgrade( )Abandon( ) ❑Corriplete Systerri° ❑Individual Components Locgt wn Address or Lot No. Owner's Name,Address and Tel.No..-r �� 7-510 T-Faza ey-u`aa, Mct<5-�Oys K)11 s . a4-VI -1 Assessor's Map/Parcel 57 �� &� L a�� j l KA Day95 Installer's Name,Address,and Tel. Designer's Name,Address and Tel.No�9.3 to U-0�4 (h t� Qvl:►nSUr Sr S`T"�� .c _T�2, JF0 3u�x Sbsc� C_eVAr U tale. Type of.Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design.Flow gallons per day. Calculated daily flow. gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) QJ new `�► S 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 beerw4ued by this Board of Health. J Sign- o— Date Application Approved by to Date Application Disapproved for the following reaso s Permit No. '� Date Issued tia �9 Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes . PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS rtcatton for tg ogaI bpttem Construction Permit Application for a Permit to Construct( )Repair( Upgrade( )Abandon( ) ❑Complete System El Individual Components Location Address or Lot No. Owner's Name,Address and Tel.No. , S' l'`AZiPn ( MG�S S K l S • �j'•Fa-Iat'0., MPXI0..Cj2r Assessor's Map/Parcel S7 Ito_9 (p(3 La-oco 96 i t_s , RA o.Dy9.3 Installer's Nam A dress,and Tel,Air Des is Narge�Addd ss and Tel.No. 3 '0 �n1 t Name. ; 'bom S �- v ���1 O 309( 099/ Cev,4.x- U lc r►�n�1�Ca rc�e, �Jn. ' Type of Building: 3 Dwelling No.of Bedrooms Lot Size`' s sq.ft. Garbage Grinder Other Type of Building No. of Persons Showers( ) Cafeteria( ) y - Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets, Revision Date N Title ~ Size of Septic Tank- Type of S.A.S. Description of Soil wfr 5�5� Q� nP �"; fI�S Nature o Re airs or Alterations(Answer when a plicable) ��` -4— Flax 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 'ssu d by th Board of Health. Signed i A / ll � � . I a Date — d� Application Approved by Date > Application Disapproved for the following reasonKr .� Permit No. ..� Date Issued ) THE COMMONWEALTH OF MASSACHUSETTS ��OV BARNSTABLE, MASSACHUSETTS 3 -f` gn u Certificate of (Compliance THIS IS TO CE IFY,,dat the On-site Sewage Dispo al System Constructed( ) Repaired ( X)Upgraded( ) Abandoned )by �M (E76jIs p,SCM S{Z �t C.,, at (_kZA QLA_$ '_\S M YS _has Wed structed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. Installer Designer [—.- ho. The issuance of this permit s all ot�10 e cps . ed as a guarantee that the sys/em ,r1I firma, as de/igne1d� v �� Date Q Inspector / 7/ No. Fee X�1 O•� .-. THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS 4 li!5ponl *pgtem Construction Permit Permission is hereby grantedto Construct( )Repair( � Upgrad`�e�( " )Abandon( ) System located at 48 1 ��Z �-t UY�S �`'� (�S and as described in the above Application for Disposal System Construction Permit. The,,applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided: Con st ion u t b competed within three years of the date of this pe it. Date: Approved by I L -Town of Ba rns#able o Regulatory ServesA. . :-.: _. Thomas F.Gefier,:Director . >�asraHias. �3pP :Tubiie Heaitk Division �t 3 Thomas:McKeau,Director 200-M2in-6treet,Hyannis,MA 02601--- Office: 508-8624644. Fax: 508-790-6304 Installer&-Designer Certification Form Date: Sewage-Permit#: Assessor's MapTarcel Designer: Address: 3`Tri C.i C-C t ; Address: _ Ck :....:::On-- a s issued a permit to.install a (date) : {installer) 1 septic-system.at S M used on-a design drawn by (ad )- �CO— �r dated . e I.certify that:the septic system referenced above was installed substantially according to _ the.design, which may -:approved ehauges-such as lateral--relocation-of the-- . distribution box and/or_septic 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 is accordance with State &-Local Regulations: Plaii revision'or- certifred.as built by designer to follow. . . H OF h1q�s�cy �o DAVID o D. COUGHANOWR `. (Installer's Signature) No. 1093 84 ��G�S7ER�O ARM (Designer's:Signature) .. (Affix-Designer's Stamp.Here) PLEASE RETURN TO BARNSTABLE- PUBLIC HEALTH: DIVI 0N: CERTIFICATE OF COMPLIANCE WILL NOT:BE-ISSUED- UNTIL BOTH THIS -FORM AND.AS-BUILT CARD ARE. RECEIVED BY TBE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU - Q:Health/Septic/Designer Certification Fbrtn 3.26-04.&c FORM30 C&w HOBBSBWARRENTM THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH CITY/TOWN a DEPARTMENT ., d Nam o ADD ss gYvl G,M Svey`0 �a/ 1 LEPHONE Address 0t G �`e� �"t Occupa �� * 'VD411U M �V.-5 Floor Apartment No. No.of Occumnts No.of Habitable Rooms No.Sleeping Rooms,Z No.dwelling or rooming units_ No.St ries Name and address of owner t . - /, Yl H� QU / .Q Ar emwks Reg. Vio. YARD Out Bld s., Fences: Garbage and Rubbish Containers: Drainage O' Infestation Rats or other: STRUCTURE EXT. Steps,Stairs, Porches: Dual Egress:and Obst'n.: ❑ B ❑ F ❑ M Doors,Windows: Roof Gutters, Drains: Walls: Foundation.- Chimney: BASEMENT Gen.Sanitation: Dampness: Stairs: Lighting: STRUCTURE INT. Hall,Stairway: Obst'n.: Hall, Floor,Wall,Ceiling: Hall Lighting: Hall Windows: HEATING Chimneys: Central ❑ Y ❑ N Equip. Repair TYPE: Stacks, Flues,Vents: PLUMBING: Supply Line: ❑ MS ❑ ST ❑ P Waste Line: H.W.Tanks Safety and Vent(s) ELECTRICAL Panels, Meters,Cir.: ❑ 110 ❑ 220 Fusing,Grnd.: AMP: Gen.Cond. Distrib. Box: Gen. Basement Wiring: DWELLING UNIT Ventil. L to . Outlets Walls Ceils. Wind. Doors Floors Locks Kitchen Bathroom Pantry Den Living Room Bedroom 1 Bedroom 2 Bedroom 3 Bedroom 4 Hot Water Facil. Sup.Ten.,Gas,Oil, Elect.: Stacks, I es,Vents,Safeties: Kitchen Facilities Sink Stove Bathing,Toilet Facil. Vent., Plumb.,Sanit'n.: Wash Basin,Shower or Tub: Infestation Rats, Mice, Roaches or Other-.— Egress Dual and Obst'n: General Building Posted Locks on Doors: ONE OR MORE OF THE VIOLATIONS CHECKED ABOVE IS A CONDITION WHICH MAY MATERIALLY IMPAIR THE HEALTH OR SAFETY AND WELL-BEING OF THE OCCUPANT AS DETERMINED BY 105CMR 410.750 OF THE CODE OR THE AUTHORIZED INSPECTOR. (See Over) "THIS INSPECTION REPORT IS SIGNED AND CERTIFIED UNDER THE PAINS AND PENALTIqPF Y. INSPECTOR TITLE p A. DATE I TIME Z' _ 0 I A.M. THE NEXT SCHEDULED REINSPECTION P.M. � o 410.750: Conditions Deemed to Endanger or Impair Health or Safety The following conditions, when found to exist in residential premises,shall be deemed conditions which may endanger or impair the health, or safety and well-being of a person or persons occupying the premises. This listing is composed of those items which are deemed to always have the potential to endanger or materially impair the health or safety, and well-being of the occupants or the public. Because Chapter 11, 105 CMR 410.100 through 410.620 state minimum requirements of fitness for human habitation, any other violation has the potential to fall within this category in any given specific situation but may.not do so in every case and therefore is not included in this listing. Failure to include shall in no way be construed as a determination that other violations or conditions may not be found to fall-within this category. Nor shall failure to include affect the duty of the local health official to order repair or correction of such violation(s) pursuant to 105 CMR 410.830 through 410.833 nor shall failure to include affect the legal obligation of the person to whom the order is issued to comply with such order. (A) Failure to provide a supply of water sufficient in quantity, pressure and temperature; both hot and cold, to meet the ordinary needs of the occupant in accordance with 105 CMR 410.180 and 410.190 for a period of 24 hours or longer. (B) Failure to provide heat as required by 105 CMR 416.201 or improper venting or use of a space heater or water heater as prohibited by 105 CMR-410.200(B) and 410.202. (C) Shutoff and/or failure to restore electricity or gas. (D) Failure to provide the electrical facilities required by 105 CMR 410.250(B), 410.251(A), 410.253 and the lighting in com- mon area required by 105 CMR 410.254. (E) Failure to provide a safe supply of water. (F) Failure to provide a toilet and maintain a sewage disposal system in operable condition as required by 105 CMR 410.150(A)(1)and 410.300. (G) Failure to provide adequate exits, or the obstruction of any exit, passageway or common area caused by any object, including garbage or trash, which prevents egress in case of an emergency 105 CMR 410.450, 410.451 and 410.452. (H) Failure to comply with the security requirements of 105 CMR 410.480(D). (1) Failure to comply with any provisions of 105 CMR 410.600, 410.601 or 410.602 which results in any accumulation of gar- bage, rubbish, filth or other causes of sickness which may provide a food source or harborage for rodents, insects or other pests or otherwise contribute to accidents or to the creation or spread of disease. (J) The presence of leadbased paint on a dwelling or dwelling unit in violation of the Massachusetts Department of Public Health Regulations for Lead Poisoning Prevention and Control, 105 CMR 460.000. (See M.G.L. c. 111 @@ 190 through 199.) (K) Roof, foundation, or other structural defects that may expose the occupant or anyone else to fire, burns, shock, accident or other dangers or impairment to health or safety. (L) Failure to install electrical, plumbing, heating and gas-burning facilities in accordance with accepted plumbing, heating, gas-fitting and electrical wiring standards or failure to maintain such facilties as are required by 105 CMR 410.351 and 410.352, so as to expose the occupant or anyone else to fire, burns, shock, accident or other danger or impairment to health or safety. (M) Any defect in asbestos material used as insulation or covering on a pipe, boiler or furnace which may result in the release of asbestos dust or which may result in the release of powdered, crumbled or pulverized asbestos material in violation of 105 CMR 410.353. (N) Failure to provide a smoke detector required by 105 CMR 410.482. (0) Any of the following conditions which remain uncorrected for a period of five or more days following the notice to or knowledge of the owner of said condition or conditions: (1) Lack of a kitchen sink of sufficient size and capacity for washing dishes and kitchen utensils or lack of a stove and oven or any defect that renders either inoperable. (2) Failure to provide a washbasin and shower or bathtub,as required in 105 CMR 410.150(A)(2) and 410.150(A)(3)or any defect which renders them inoperable. (3) Any defect in the electrical, plumbing or heating system which makes such system or any part thereof in violation of generally accepted plumbing, heating, gasfitting, or electrical wiring standards that do not create an immediate hazard. (4) Failure to maintain a safe handrail or protective railing for every stairway, porch balcony, roof or similar place as required by 105 CMR 410.503(A)and 410.503(B). i (5) Failure to eliminate rodents, cockroaches, insect infestations and other pests as required by 105 CMR 410.550. (P) Any other violation of 105 CMR 410.000 not enumerated in 105 CMR 410.750(A)through (0)shall be deemed to be a con- dition which may endanger or materially impair the health or safety and well-being of an occupant upon the failure of the owner to remedy said condition within the time so ordered by the Board of Health. � Ck.��G. � 2 4Z \ `Cr 0 r T Town of Barnstable P# —/— Department of Regulatory Services WWSUBM Public Health Division Date A of 2� 20dF -- - - z A�� 00 Main Street Hyannis MA Date Scheduled ' ® �/—W— Time _ Fee Pd: ' ' (/ i Soil-Suitability Assessment for Sewage Disposal o, m Performed By: Witnessed By:D&V9 Z M �� 1 J LOCATION& GENERAL INFORMATION Location Address F-"7jPr- Way Owner's Name ` � / _. S fit�u r q IN�,C�l9 It,-r y �l'lt�Srvl75 f Il Address Assessor's Ma /Parcel: 1 ur5 70 q 5 P �� ���� Engineer's Name !�q✓�d � /'v������,� NEW CONSTRUCTION REPAIR Telephone# 5_0 q `3 G C �dg'g� Land Use T`�S td L�H�1 p,Aq Slopes(%) 0 Surface Stones b1iD�rP Distances from: Open Water Body yy O # ft Possible Wet Area LO ft Drinking Water Well 1600 ft Drainage Way SO + ft Property Line C� ft Other ft SKETCH:(Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands in proximity to holes) GROUNDWATER ADJUSTMENT ®® EXISTING GROUNDWATER LEVEL i \ mz / BASED ON TOWN OF BARNSTABLE 01 / 6 GIS DEPARTMENT RECORDS. �Q INDICATED GW 23.00 INDEX WELL SDW-253 ZONE C READING DATE DEC. 2007 READING 49.5 \ ADJUSTMENT 4.5 t ADJUSTED GW 27.5 Q1 I Dvt 5�► A O u Q Parent material(geologic) D�� QLt u 4 � Depth to Bedrock Depth to Groundwater. Standing Water in Hole: Weeping from Pit Face nO 14(2— Estimated Seasonal High Groundwater es e e— 0 6 U e DETERMINATION FOR SEASONAL HIGH WATER TABLE Method Used: See- ai')V e Depth Observed standing in obs.hole: _ _in, Depth to soil mottles: in. Depth to weeping from side of obs.hole: in, Groundwater Adjustment ft. Index Well# Reading Date: Index Well level . , Ad{.factor— Adj.Groundwater Level PERCOLATION TEST DMA15I& nme i►hM Observation Hole# � - Time at 4" Depth of Perc t Time at 6' 14jq Staff Pre-soak Time @ D" � _ Time(9"-6") ....'k�' End Pre-soak ©" Rate MinJlnch Site Suitability Assessment: Site Passed i/ Site Failed: Additional Testing Needed(YIN) Original: Public Health Division Observation Hole Data To Be Completed on Back----------- percolation test is to be conducted within 100' of wetland,you must first notify the. r` Barnstable Conservation Division at least one(1)week prior to beginning. Q:\SEPTIC\PERCFORM.DOC _ _ __PATE, OF TEST: _SEPTEMBER 8. 2008 S 0 I L TEST -L 0 G . APPROVED SOIL EVALUATOR: DAVIO D. COUGHANOWR. #461 WITNESSED BY:` DONNA MIORANDI. HEALTH DEPT. ` P, ERC NUMBER: 12346 NO ENC T E S T PIT I PAARENTUMAATERIIARL': PROGLACIRALD OUTWASH PERC AT 64 in -' 2 MIN/INCH IN C SOILS ELEVATION DEPTH SOIL USDA SOIL SOIL COLOR SOIL OTHER (INCHES) HORIZON TEXTURE (MUNSELL) MOTTLING 66.75 0-3 O WOOD LOAM 10 YR 2/1 NONE FRIABLE ; { 3-5 E LOAMY SAND T+ r 10 YR 3/1 NONE FRIABLE 5-9 A " ' SANDY.LOAM 10 YR 3/4 NONE FRIABLE 63.58 9_38 B . -__ . _SANDY LOAM- 10 YR -4/6 — —NONE FRIABLE 1 _38=132'" " Cad"" _,- .MEDUIM.,SAND.'-:'= :1 '`` _.10 YR�5%4 NONE LOOSE w 55.75 TEST P IT� 2--•- -NO GROUNDWATER ENCOUNTERED PARENT_MATERIAL: PROGLACIAL OUTWASH° 1 2 MIN/INCH IN C SOILS ELEVATION ,DEPTH• SOIL USDA SOIL-- - SOIL COLOR SOIL OTHER 663m (INCHES) HORIZON TEXTURE (MUNSELL) MOTTLING 0'4 O WOOD LOAM 10 YR 2/1 NONE FRIABLE t t- -4-6 E--- LOAMY SAND -10 YR 4/1 NONE - FRIABLE .6-10 - A _ . -SANDY LOAM -- --10-YR 3/4 NONE FRIABLE ` 4 10-36 B SANDY LOAM 10 YR 4/6 NONE FRIABLE 63.70 - 36-138 C MEDUIM SAND 10 YR 6/4 NONE LOOSE 55.20 4 'S6rtace(In:)' '(aUIV9 Mj tUzijrxT (munsell) —mulu1118— Consistency.%Gravel) - -� DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. ons' ten Flood Insurance Rate Map: Above 500 year flood boundary No_ Yes Within 500 year boundary No V'' Yes Within 100 year flood boundary No 1�' Yes _ Depth of Naturally Occurring Pervious_Material Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the area proposed for the soil absorption system? �e 5 If not,what is the depth of naturally occurring pervious material? Certification I certify that on ��`� �� (date)I have passed the soil evaluator examination approved by the Department of Environmental Protection and that the above analysis was performed by me consistent ofssq the required training,expertise and experience described in 310 CMR 15.017. ,� DAVID oyGN Si nature Date S eP F �' �g 0 D. �+ g COUGHANOWR /C S N SE0 0Q' QASEPTIMERCFORM.DOC �� FVgLUP� �QFTHE r � Certificate# 06 • 771 Town of Barnstable Fee Paid: $130.00 nAWNSTABLE, NIAS639, a� Regulatory Services Department AlFD�� Public Health Division 200 Main Street, Hyannis MA 02601 Office: 508-862-4644 FAX: 508-790-6304 Thomas A.McKean,CHO 2007 CERTIFICATE of REGISTRATION Property Location:81 Frazier Wav Marstons Mills MA 02648- Owner's Name: Menachery, Ittiara& Aluhonsa Owner's Address 68 Laurel Road Weston MA 02493- Owner's Representative's Name (If Applicable) Address: Telephone Number: Number of Rental Units On This Property 1 Number of Bedrooms Authorized: 3 Maximum Number of Motor Vehicles Authorized outside of Buildings Overnight: 4 Maximum Number of Occupants Authorized(occupants under 22 years of age are exempt) 5 2/7/2007 12/31/2007 Date Issued: Expiration Date Thomas A.McKean,R.S.Director of Public Health *This certificate must be conspicuously posted within such dwelling or portion of dwelling* a S FORM30 HOBBS&WARREN'" THE COMMONWEALTH OF MASSACHUSETTS BOARD EALTH CITY/TO W tlG I D PARTMENT 4— ©�6 � - 1 S� - -- ADDFIESS�,-•r�J! 5o TELEPHONE � - L Address _ _ a Occupant_._ _ t � Floor Apartment No. __ No. of Occupants 7—Z No. of Habitable Rooms 5 No.Sleeping Rooms 3 _ No.dwelling or rooming units No.Stories Name and address of ownbr, Remarks Reg. Vio. YARD Out Bld s.: Fences: 01 943 Garbage and Rubbish Containers: Drainage Infestation Rats or other: _- STRUCTURE EXT. Steps,Stairs, Porches: Dual Egress:and Obst'n.: O B ❑ F ❑ M Doors,Windows: Roof Gutters, Drains: 1,4 s Walls: Foundation: Chimney: BASEMENT Gen.Sanitation: Dampness: Stairs: Li htin : STRUCTURE INT. Hall,Stairway: Obst'n.: Hall, Floor,Wall, Ceiling: Hall Lighting: Hall Windows: HEATING Chimneys: Central ❑ Y ❑ N E ui . Repair TYPE: Stacks, Flues,Vents.- PLUMBING: Supply Line: ❑ MS ❑ ST ❑ P Waste Line: H.W.Tanks Safety and Vent(s) ELECTRICAL Panels, Meters,Cir.: ❑ 110 ❑ 220 Fusing,Grnd.: AMP: Gen.Cond. Distrib. Box: Gen. Basement Wiring: I' DWELLING UNIT Ventil. L to . Outlets Walls Ceils. Wind. Doors Floors Locks Kitchen Bathroom ` Pantry Den Living Room Bedroom 1 Bedroom 2 S-� 1 . I Bedroom 3 Bedroom 4 Hot Water Facil. Sup.Ten.,Gas, Oil, Elect.: Stacks, Flues,Vents,Safeties: Kitchen Facilities Sink Stove Bathing,Toilet Facil. Vent., Plumb.,Sanit'n.: Wash Basin, Shower or Tub: Infestation Rats, Mice, Roaches or Other: Egress Dual and Obst'n: General Building Posted Locks on Doors: ONE OR MORE OF THE VIOLATIONS CHECKED ABOVE IS A CONDITION WHICH MAY MATERIALLY IMPAIR THE HEALTH OR SAFETY AND WELL-BEING OF THE OCCUPANT AS DETERMINED BY 105CMR 410.750 OF THE CODE OR THE AUTHORIZED INSPECTOR. (See Over) "THIS INSPECTION REPORT IS SIGNED AND CERTIFIED UNDER THE PAINS AND PENALTIES OF PERJURY." I ?�AINSPECTOR y' d TITLE NPIXILj�� - —� A. . DATE TIME " " •M• THE NEXT SCHEDULED REINSPECTION ` [ J ? P.M. _i%#+. ,t'Y f�.i(r '4P. 410.750: Conditions Deemed to Endanger or Impair Health or Safety The following conditions, when found to exist in residential premises, shall be deemed conditions which may endanger or impair the heaith, or safety and well-being of a person or persons occupying the premises. This listing is composed of those items which are deemed to always have the potential to endanger or materially impair the health or safety, and well-being of the occupants or the public. Because Chapter II, 105 CMR 410.100 through 410.620 state minimum requirements of fitness for human habitation, any other violation has the potential to fall within this category in any given specific situation but may not do so in every case and therefore is not included in this listing. Failure to include shall in no way be construed as a determination that other violations or conditions may not be found to fall within this category. Nor shall failure to include affect the duty of the local health official to order repair or correction of such violation(s) pursuant to 105 CMR 410.830 through 410.833 nor shall failure to include affect the legal,obligation of the person to whom the order is issued to comply with such order. (A) Failure to provide a supply of water sufficient in quantity, pressure and temperature, both hot and cold, to meet the ordinary needs of the occupant in accordance with 105 CMR 410.180 and 410.190 for a period of 24 hours or longer. (B) Failure to provide heat as required by 105 CMR 410.201 or improper venting or use of a space heater or water heater as prohibited by 105 CMR 410.200(B)and 410.202. (C) Shutoff and/or failure to restore electricity or gas. (D) Failure to provide the electrical facilities required by 105 CMR 410.250(B), 410.251(A), 410.253 and the lighting in com- mon area required by 105 CMR 410.254. (E) Failure to provide a safe supply of water. (F) Failure to provide a toilet and maintain a sewage disposal system in operable condition as required by 105 CMR 410.150(A)(1)and 410.300. (G) Failure to provide adequate exits, or the obstruction of any exit, passageway or common area caused by any object, including garbage or trash, which prevents egress in case of an emergency 105 CMR 410.450, 410.451 and 410.452. (H) Failure to comply with the security requirements of 105 CMR 410.480(D). (1) Failure to comply with any provisions of 105 CMR 410.600, 410.601 or 410.602 which results in any accumulation of gar- bage, rubbish, filth or other causes of sickness which may provide a food source or harborage for rodents, insects or other pests or otherwise contribute to accidents or to the creation or spread of disease. (J) The presence of Ieadbased paint on a dwelling or dwelling unit in violation of the Massachusetts Department of Public Health Regulations for Lead Poisoning Prevention and Control, 105 CMR 460.000. (See M.G.L. c. 111 @@ 190 through 199.) (K) Roof, foundation, or other structural defects that may expose the occupant or anyone else to fire, burns, shock, accident or other dangers or impairment to health or safety. (L) Failure to install electrical, plumbing, heating and gas-burning facilities in accordance with accepted plumbing, heating, gas-fitting and electrical wiring standards or failure to maintain such facilties as are required by 105 CMR 410.351 and 410.352, so as to expose the occupant or anyone else to fire, burns, shock, accident or other danger or impairment to health or safety. (M) Any defect in asbestos material used as insulation or covering on a pipe, boiler or furnace which may result in the release of asbestos dust or which may result in the release of powdered,,crumbled or pulverized asbestos material in violation of 105 CMR 410.353. (N) Failure to provide a smoke detector required by 105 CMR 410.482. (0) Any of the following conditions which remain uncorrected for a period of five or more days following the notice to or knowledge of the owner of said condition or conditions: (1) Lack of a kitchen sink of sufficient size and capacity for washing dishes and kitchen utensils or lack of a stove and oven or any defect that renders either inoperable. 2 Failure to provide a washbasin and shower or bathtub as required in 105 CMR 410.150(A)(2) and 410.150(A)(3)or any defect which renders them inoperable. (3) Any defect in the electrical, plumbing or heating system which makes such system or any part thereof in violation of generally accepted plumbing, heating, gasfitting, or electrical wiring standards that do not create an immediate hazard. (4) Failure to maintain a safe handrail or protective railing for every stairway, porch balcony, roof or similar place as required by 105 CMR 410.503(A)and 410.503(B). (5) Failure to eliminate rodents, cockroaches, insect infestations and other pests as required by 105 CMR 410.550. (P) Any other violation of 105 CMR 410.000 not enumerated in 105 CMR 410.750(A)through (0)shall be deemed to be a con- dition which may endanger or materially impair the health or safety and well-being of an occupant upon the failure of the owner to remedy said condition within the time so ordered by the Board of Health. � , �,us � L0t; ATI N SEWAGE PERMIT N0. VIt. LAGE 30I UtiA ��l� M► LLS j �- -, - I 1 l&ST A LLER S NIAME- ADDRESS f. U I L D E OR OWN ER - DA T E PERMIT ISSUED DATE COMPLIANCE ISSUED FR e ,icol0 ctAL ytr s'. 2 i lk V 3 Oro 1 � 6 ®W ATE O SOIL TEST O G D PROV DFS IL EVALUATOR: D COUGHANOWR. #461 , f ' WITNESSED BY: DONNA MIORANDI. HEALTH DEPT. DESIGN C A L C uLATIONS PERC NUMBER: 12346 DESIGN FLOW: 3 BEDROOMS X 110 GPO = 330 GPD NO GROUNDWATER ENCOUNTERED OUTWASH SEPTIC TANK: 330 GPD X 2 DAYS = 660 GALLONS TEST PIT T a PERC AT A In - : OMIN/INCH IN C SOILS USE EXISTING 1000 GALLON SEPTIC TANK IF IN SOUND STRUCTURAL CONDITION. IF NOT. INSTALL 1500 GALLON SEPTIC TANK (MINIMUM ALLOWED) ELEVATION DEPTH SOIL USDA SOIL SOIL COLOR SOIL OTHER DISTRIBUTION BOX: USE 3 OUTLET O-BOX. 66.75 (INCHES) HORIZON TEXTURE (MUNSELL) MOTTLING SOIL ABSORBTION SYSTEM: A 24 Ft x 12.5 Ft x 2 Ft LEACHING GALLERY CAN LEACH _ 0-3 O WOOD LOAM 10 YR 2/1 NONE FRIABLE Abot = ( 24 x 12.5 ) = 300 sF Asdw = ( 24 + 24 + 12.5 + 12.5 ) x 2 = 146 sF 3-5 E LOAMY SAND 10 YR 3/1 NONE FRIABLE Atot = 446 sF 5-9 A SANDY LOAM 10 YR 3/4 NONE FRIABLE Vt 0.74 x 446 = 330.04 GPD 9-36 B SANDY LOAM 10 YR 4/6 NONE FRIABLE USE A 24 Ft x 12.5 Ft x 2 Ft GALLERY. Vt = 330.04 GPD > 330 GPD REDUIRED 63.58 1 ° 36-132 C MEDUIM SAND 10 YR 5/4 NONE LOOSE ! 55.75 LEACHING GALLERY - TEST PIT 2 NO GROUNDWATER ENCOUNTERED 1000 GALLON SEPTIC TAW PARENT MATERIAL: PROGLACIAL OUTWASH USE SHOREY PRECAST 500 GALLON NOT TO 2 MIN/INCH IN C SOILS LEACHING DRYWELL (H-10 LOADING) SCALE DIMENSIONS AND DETAIL NOT TO ELEVATION DEPTH SOIL USDA SOIL SOIL COLOR SOIL OTHER CONSTRUCTION DETAIL USE EXISTING H-10 UNIT SCALE STON 66.?0 (INCHES) HORIZON TEXTURE (MUNSELL) MOTTLING DRYWELL UNIT SEPTIC TANK IS TO BE PUMPED DRY 0-4 O WOOD LOAM 10 YR 2/1 NONE FRIABLE AT TIME OF INSTALLATION AND IS TO 24.0 Ft BE EXAMINED FOR STRUCTURAL 4-6 E LOAMY SAND 10 YR 4/1 NONE FRIABLE m INTEGRITY. INSTALL NEW PVC OUTLET , TEE EQUIPPED WITH A GAS BAFFLE. 6-10 A SANDY LOAM 10 YR 3/4 NONE FRIABLE �j 63.70 10-36 B SANDY LOAM 10 YR 4/6 NONE FRIABLE � 1 In in TAPER 36-13B C MEDUIM SAND 10 YR 6/4 NONE LOOSE c� N 55.20 1 1 1 1 1m , ® C cYi�` o 3.5 f t 8.5 f t 8.5 f t 5 f t o o 4J 4. - GROUNDWATER ADJUSTMENT 2 0 Ft Ln EXISTING GROUNDWATER LEVEL 500 GALLON DRYWELL BASED ON TOWN OF BARNSTABLE GIS DEPARTMENT RECORDS. DIMENSIONS AND DETAIL 6 INDICATED GW 23.00 USE H-10 UNIT INLET OUTLET INSTALL ONE INSPECTION COVER COVER INDEX WELL SDW-253RISER • fix' EPIC)! � fi'1 �1 ZONE C INCHES TOF FINAL GRADE READING DATE DEC. 200Z AND INDICATE LOCATION —> Al FLOW LINE } READING 49.5 ! ON AS-BUILT PLAN 3 IN DROP —NL, . "•y 4` '� �' +` ADJUSTMENT 4.5 FROM IB ,n 14 TO ADJUSTED GW 27.5 BUILDING BOX 48NOTCS . � LIO U,nI D GAS n pppp 0 Ir7 LEVEL BAFFLE 1) INSTALLER TO OBTAIN DISPOSAL WORKS PERMIT BEFORE STARTING WORK. ooa000poopa ���00 pu pu 2) SEPTIC TANK TO BE PUMPED DRY AT TIME OF SYSTEM REPAIR AND CHECKED FOR STRUCTURAL INTEGRITY. INSTALL PVC OUTLET TEE FITTED WITH GAS BAFFLE. ( �g CROSS SECTION VIEW 3) ALL COMPONENTS INSTALLED SHALL MEET THE MINIMUM REOUIREMENTS 1�21n OF MASSACHUSETTS TITLE 5 SEPTIC CODE (310 CMR 15). 4) INSTALLER TO VERIFY LOCATIONS OF ALL UNDERGROUND UTILITIES• CROSS SECTION VIEW BEFORE EXCAVATING FOR SYSTEM. � SEWAGE DISPOSAL SYSTEM PLAN 5) EXISTING LEACH PIT TO BE PUMPED. COLLAPSED. AND FILLED. 2 �n PEAS TONE 2 to PEAS TONE 61 ALL STONE TO BE DOUBLE WASHED AND FREE OF IRON. FINES AND DUST IN PLACE. J o o TO SERVE EXISTING DWELLING 24 Z) ECO-TECH ENVIRONMENTAL RECOMMENDS THE INSTALLATION OF LOW FLOW FIXTURES 28 314,nTo EFFECTIVE 3i4, ro 26 ITTIARA MENACHERY AND APPLIANCES. AND BIANNUAL PUMPING OF THE SEPTIC TANK. In 1-�- %/L DEPTH 1-112,nC�7AVEE In B) SYSTEM IS NOT DESIGNED TO WITHSTAND VEHICULAR LOADING. DO NOT 81 FRAZIER WAY MARSTONS MILLS. MA PARK OR DRIVE VEHICLES OVER SEPTIC SYSTEM. 46 in 58 in 46 in 9) SEPTIC TANKS SHALL BE INSTALLED LEVEL AND TRUE TO GRADE ON A LEVEL J 150 in ECO-TECH ENVIRONMENTAL STABLE BASE THAT HAS BEEN MECHANICALLY COMPACTED AND ON TO WHICH { INSTALLER MAY SUBSTITUTE AN APPROVED GEOTEXTILE 43 TRIANGLE CIRCLE SANDWICH MA 02563 SIX INCHES OF CRUSHED STONE HAS BEEN PLACED TO MINIMIZE UNEVEN SETTLING. FABRIC IN PLACE of THE z PEASTONE LAYER SPECIFIED.� ETE-3018 I SEPTEMBER 9. 200 2/2 ALL PIFE FIED ARE ATIONS ECI FLOW PROFILE EXPRESSEDLINV DECIMAL FFEET NOT FEET AND INVERT INCHES ELEVATIONS RAISE COVERS TO WITHIN SIX INCH-S OF FINAL GRADE TOP OF FOUNDATION ONE INSPECTION RISER FOR LEACHING GALLERY TO EL = 68.51 +- WITHIN 3 INCHES OF FINAL GRADE AS INSPECTION PORT. 66.75 /D-BOX MAX ALL PIPE .SCHEDULE T 08 VC /3" DROP �f /8 in/FL NDTO PI CH AT 0/ FLOW LINE � g4.GG 10" - 14 48" GAS�� PRECAST BAFFLE ORYWELL BOTTOM OF 64.14 +- STON LEACHING EXISTING 63.38 LEACHING GALLERY EXISTING EXISTING BASE GALLERY 63.55 EXISTING 1000 GALLON 63.25 (END VIEW) 61.25 5.00 ft + SEPTIC TANK SEE DETAIL ON REVERSE EXISTING 14.5 f't 01 13 f t 12.5 FL bl 5 FL I ADJUSTED SEASONAL V 27.50 HIGH GROUNDWATER oz i g Y > �� / U: z o rn o � C) C zm-i = a m Gl ° o (0 � n r z O CI r / N / m o ---i -al ° clam c 0) z O o O / N y O GOO / � /'/ Cu qp o / 00, mti }o-Q / w �nn (� m n 3_B Tj l EO NG to � -� � O I � OWE ��OIr.11 �- y < /' F- x rn z E p o NG l F'vc� �o J -1 \ / n / 3 x > cn \a z =r-om 0= o Ul w �t \ / 3- n r_ CD O� �� �� �� Z o z o a M � =W i z �,� Y ® EpGF p � z"= z O (D (l) p�\ `� 1 �o�pAcn rn 3rn @a EME� rn o �Doz �J n �`� z �oul oZ�cn m 0 CD N� �� \ i yoz>lz�oD zo wm COM Y o i O �' f�l �, O �� O >o,oZ m m o rn 00 3 z o _' 0 0 c v i �m c rn o o A OJ o mCf) M -f- m o z c o z z -�O -I rTl (f) m �rnrn�� o m � ,o �o one �rn m -0x mmX rnz==c A o O < y F w� y, � za Rln (n m 3 -1 -0 -� O O P rn a� -- nI(n 3 zrnrn -I a �i m �m Rl0 y y (n r rnocn mo� N m y Z> M rn - Sll�`' 3m� Ql C nz nm~ I c��n cn 3 z Ul n x O � a o-0o O m Z o c� c Co 03 O Dye QbC y mn rn z0 L m ��oom m N � Y ,� coM F- �; N M (nr �r 2 �2y m rn3�mrn < m 3~ o rn fir- O� M�'1' mop a �m ZO 3 mm3o0- m T m Z , g -�n z oz��� A a � .tl (n N a � oo =ud OOn �Z co oo��� z N (� d z , v „ °m i U7 O o �cnz N r 3 �� O �, n cm O � c ncnz i Ol { rn F- o a m rA X O r 3 < titi A ;10 01 l r i 3 Z -D R Sp�� o �' N p O m �� o mzo-Iz (D COC y r Sll� z > }dM � o � xzmo O3rnp O Z L