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HomeMy WebLinkAbout0119 SADDLER LANE - Health I Saddler Lane ' A= 151 062 WOO Commonwealth of Massachusetts Title 5 Official Inspection Form s, Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 119 Saddler Lane _ I Property Address ,n n J _E�arin4x b 1 ,t(Q Kasarjian U U ¢ Y ' Owner Owner's Name 1 4 s information is r - required for every __ MA 02668 04/03/12. page. CltylTown - State Zip Code Date of Inspection Inspection results must be submitted on this form.Inspection forms may not be altered in any way.Please see completeness checklist at the end of the form. Important:When A. General Information - filling out forms `f on the computer, z use only the tab 1. Inspector: J key to move your cursor-do not Michael Kellett use the return Name of Inspector key. Aardvark Environmental Inspections raa Company Name PO box 896 Company Address East Dennis MA 02641 CitylTown State Zip,Code 508-385-7608 SI 3742 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'belowis 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 04/07/12 Inspector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP.The original should be sent to the system owner and copies sent to the buyer,if applicable,and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. ` t5ins-11/10 Title 5 Official Inspection u surface Sewage Disposal System•Page 1 of 17 Commonwealth of Massachusetts _ Title 5 Official Inspection Fora s Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 119 Saddler Lane Property Address Kasarjian Owner Owner's Name information is required for every West Barnstable MA 02668 04/03/12 _ page. Citylrown 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 substantiaf 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•11/10 Title 5Official 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 119 Saddler Lane Property Address Kasai ian 1 Owner Owner's Name information is required for every West Barnstable MA 02668 04/03/12 page. Cityrrown 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 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(i)(b)that the system is not functioning in a mannerwhich will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh wiii3 'i iiitr True 5 inioi8i iris"or,FonnI Su`t uiiace s"ettiage vuyGSai System c image 3 01 i Commonwealth of Massachusetts Title 5 Official Inspection Form s Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 119 Saddler Lane Property Address Kasarjian Owner Owner's Name information is West Barnstable MA 02668 04/03/12 required for every page. Cityfrown 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 mannerthat 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 tor an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6"below invert or available volume is less than '/2 day flow t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 119 Saddler Lane Property Address Kasarjian Owner Owner's Name information is West Barnstable MA 02668 04/03/112 required for 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 coliform bacteria indicates absent and the presence laboratory,for fecal 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 ❑ ❑ the system is located in a nitrogen sensitive area (Interim.Wellhead Protection Area—IWPA)or a mapped Zone 11 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 fated.The owner or operator of any large system considered a significant threat under Section E or fated 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 Depaf ent. t5ins-11/10 Title 5Official Inspection Form:Subsurface Sewage Disposal System-Page 5 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form s Subsurface Sewage Disposal System Form-Not for Voluntary Assessments s 119 Saddler Lane Property Address Kasarjian Owner Owner's Name information is required for every West Barnstable MA 02668 04/03/12 page. Cityfrown State Zip Code Date of Inspection C. Checklist Check:if the following have been done.You must indicate"yes"or"no"as to each of the following: Yes No ® ❑ Pumping information was provided by the owner,occupant,or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components,excluding the SAS,located on site? ® ❑ Were the septic tank manholes uncovered, opened,and the interior of the tank inspected for the condition of the baffles or tees,material of construction, dimensions,depth of liquid,depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System.(SAS)on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable)[310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms(design): 3 Number of bedrooms(actual): 3 DESIGN flow based on 310 CMR 15203(for example: 110 gpd x#of bedrooms): 330 t5ins•11/10 TFte 5Official 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 119 Saddler Lane Property Address Kasarjian Owner Owner's Name information is required for every West Barnstable MA 02668 04/03/12 _ page. Cityfrown 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 Seasonaluse? ❑ Yes ® No Water meter readings,if available (last 2 years usage (gpd)): Detail: Sump pump? ❑ Yes ® No 10/11 Last date of occupancy: Date 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•11/10 Title eOfficial5 Official Inspection Form:Subsurface,Sewage Disposal.System-Page 7 of 17 f Commonwealth of Massachusetts Title 5 Official Inspection Form s Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 119 Saddler Lane Property Address Kasarjian Owner Owner's Name information is required for every West Barnstable MA 02668 04/03/12. ' page. Citylrown 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: 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 VA 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 s Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 119 Saddler Lane Property Address Kasarjian Owner Owner's Name information is West Barnstable MA 02668 04/03/12 required for every page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components,date installed (if known)and source of information: 20 years Were sewage odors detected when arriving at the site? ❑ Yes Z No Building Sewer(locate on site plan): Depth below grade: 2.3 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): 1.5 Depth below grade: feet P 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 gal Sludge depth: 3" t5ins-11/10 Title 5Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 17 f Commonwealth of Massachusetts Tithe 5 Official Inspection Form s Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 119 Saddler Lane Property Address Kasarjian Owner Owner's Name information is required for every West Barnstable MA 02668 04/03/12 page. City1rown State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle 28" Scum thickness 3" 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 16" How were dimensions determined? measured Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): The tank was sound and fight with tees in place and liquid at outlet invert. 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 I Commonwealth of Massachusetts Title 5 Official inspection Form s Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 119 Saddler Lane Property Address Kasarjian Owner Owner's Name information is required for every West Barnstable MA 02668 04/03/12 page. Cityrfbwn 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 I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 119 Saddler Lane Property Address Kasarjian Owner Owner's Name information is required for every West Barnstable MA 02668 04/03112 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 even 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.): The box was level and tight with no sign of carryover. 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 Tdle 5 Official Inspection Form:Subsutface Sewage Disposal System•Page 12 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form _ s Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 119 Saddler Lane Property Address Kasarjian Owner Owner's Name information is required for every West Barnstable MA 02668 04/03/12 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: ® leaching pits number: 1 ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number,dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments(note condition of soil,signs of hydraulic failure, level of ponding,damp soil, condition of vegetation,etc.): This system has a 6'x 6'precast pit surrounded by 2'of stone.There was no sign of ponding or failure. 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 13 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form s Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 119 Saddler Lane Property Address Kasarjian Owner Owner's Name information is required for every West Barnstable MA 02668 04/03/12 page. City/Town State Zip Code Date of Inspectim 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 3 { i 1 Commonwealth of Massachusetts � 1WTitle 5 Official Inspection For Subsurface Sewage Disposal System Form-Not for Voluntary Asserments 119 Saddler Lane Property Address Kasarjian Owner Owner's Name information is West Barnstable MA 02668 > 04/03/12 regtered for every page. City/Town State Zip Code' i Date of Inspection D. System Information (cons.) f 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 bores below: hand-sketch in the area below h ❑ drawing attached separately i ff l _ C-A' F i 16 3 f f k 35 } 30 3` t i f { i i t5ins-1 Ill 0 - - Idle 5 Official Inspection Foln:subsurrace sewage Disposal System-Page 15 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form s Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 119 Saddler Lane Property Address Kasarjian Owner Owner's Name information is required for every West Barnstable MA 02668 04/03/12 page. Cityrrown State Zip Code Date of Inspection D. System Information (cant.) Site Exam: ® Check Slope ❑ Surface water ® Check cellar ❑ Shallow wells Estimated depth to high ground water: 20.0 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:. USGS maps show an elevation of over 20.0 feet. 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 f Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 119 Saddler Lane Property Address Kasarjian Owner Owner's Name information is required for every West Barnstable MA 02668 04/03/12 page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary:A, B, C, D,or E checked ® Inspection Summary D(System Failure Criteria Applicable to All Systems)completed ® System Information—Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins•11110 Title 5 Official Inspection Form:Subsurrace Sewage Disposal System-Page 17 of 17 4 . � 1 COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL'PROTECTION TITLE 5 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION oZ L Property Address: 119 Saddler Lane C West Barnstable, MA 02668 Owner's Name: Jack Kasariian ���� 4 r- Owner's Address: 2899 Agoura Road, Ste. 222 9 Westlake Village, CA 91361 >-'? .1 Date of Inspection: May 22, 2006 ( Name of Inspector: (Please Print) James M. Ford ' C, Company Name: James M. Ford Mailing Address: P.O.Box 49 Osterville,MA 02655-0049 Telephone Number: (508)862-9400 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector'pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: ✓ passes Conditionally Passes Needs F er Evaluation by the Local Approving Authority `Fails Inspector's Signature: fmvv& Date: June 4, 2006 The system inspector shall subrn copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 jays of completing this inspection. If the system is a shared system or has a design flow of 10;000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer,if applicable, and the approving authority. Notes.and Cotmnents ****This report only describes condition's at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future under the same or different conditions of use. Title 5 Inspection Form 6/15/2000 page 1 Page 2 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 119 Saddler Lane West Barnstable, MA Owner: Jack Kasariian Date of Inspection: May 22, 2006 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: ✓ I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. . Comments: B. System Conditionally Passes: One or more system components as described in the"Conditional Pass"section need to be replaced or repaired. The system,upon completion of the replacement or repair,as approved by the Board of Health,will pass. Answer yes,no or not determined(Y,N,ND)in the for the following statements. If"not determined",please explain. The septic tank is metal and over 20 years old* or the septic tank(whether metal or not)is structurally unsound,exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND explain: Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken,settled or uneven distribution box. System will pass inspection if (with approval of Board of Health): broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced ND explain: The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed ND explain: 2 Page 3 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 119 Saddler Lane West Barnstable, MA Owner:. Jack Kasariian Date of Inspection: May 22, 2006 C. Further Evaluation is Required by the Board of Health: Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health,safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health,safety and the environment: Cesspool or privy is within 50 feet of a surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2. System will fail unless the Board of Health(and Public Water Supplier,if any)determines that the system is functioning in a manner that protects the public health,safety and environment: The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance **This system passes if the well water analysis,performed at a DEP certified laboratory, for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: 3 Page 4 of I I OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 119 Saddler Lane West Barnstable, MA Owner: Jack Kasariian Date of Inspection: May 22, 2006 D. System Failure Criteria applicable to all systems: You must indicate either"yes"or"no"to each of the following for all inspections: Yes No ✓ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ✓ Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ✓ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ✓ Liquid depth in cesspool is less than 6"below invert or available volume is less than %2 day flow ✓ Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped_. ✓ Any portion of the SAS,cesspool or privy is below high ground water elevation. ✓ Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ✓ Any portion of a cesspool or privy is within a Zone I of a public well. ✓ Any portion of a cesspool or privy is within 50 feet of a private water supply well. ✓ Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form.] No (Yes/No)The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E. Large System: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd• You must indicate either"yes"or"no"to each of the following: (The following criteria apply to large systems in addition to the criteria above) Yes No the system is within 400 feet of a surface drinking water supply the system is within 200 feet of a tributary to a surface drinking water supply the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area-IWPA)or a mapped Zone II of a public water supply well If you have answered"yes"to any question in Section E the system is considered a significant threat,or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 4 Page 5 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 119 Saddler Lane West Barnstable, MA Owner: Jack Kasariian Date of Inspection: May 22, 2006 Check if the following have been done: You must indicate"yes"or"no"as to each of the following: Yes No ✓ _ Pumping infonnation was provided by the owner,occupant,or Board of Health ✓ Were any of the system components pumped out in the previous two weeks ? ✓ _ Has the system received normal flows in the previous two week period? ✓ Have large volumes of water been introduced to the system recently or as part of this inspection? ✓ _ Were as built plans of the system obtained and examined?(If they were not available note as N/A) ✓ Was the facility or dwelling inspected for signs of sewage back up? ✓ _ Was the site inspected for signs of break out? ✓ _ Were all system components, excluding the SAS,located on site? ✓ Were the septic tank manholes uncovered,opened,and the interior of the tank inspected for the condition of the baffles or tees,material of construction,dimensions,depth of liquid,depth of sludge and depth of scum? ✓ Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS)on the site has been determined based on: Yes No ✓ _ Existing information. For example,a plan at the Board of Health. ✓ _ Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable)[310 CMR 15.302(3)(b)]. 5 I Page 6 of 11 OFFICIAL INSPECTION FORM-NOT FOR VO LUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 119 Saddler Lane West Barnstable, MA Owner: Jack Kasariian Date of Inspection: Mav 22, 2006 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): 3 Number of bedrooms(actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 Number of current residents: 2 Does residence have a garbage grinder(yes or no): Yes Is laundry on a separate sewage system(yes or no): n/a [if yes separate inspection required] Laundry system inspected(yes or no): No Seasonal use(yes or no): No Water meter readings, if available(last 2 years usage(gpd)): Unavailable Sump Pump(yes or no): No Last date of occupancy: Currently occupied COMMERCIAL/INDUSTRIAL Type of establishment: Design flow(based on 310 CMR 15.203): gpd Basis of design flow(seats/persons/sgft,etc.): Grease trap present(yes or no): Industrial waste holding tank present(yes or no) Non-sanitary waste discharged to the Title 5 system(yes or no): Water meter readings, if available: Last date of occupancy/use: OTHER(describe): GENERAL INFORMATION Pumping Records Source of information: Pumped in 2005 per owner) Wa s system pumped as part of the inspection(yes or no): No If yes,volume pumped: _gallons--How was quantity pumped determined? Reason for pumping: TYPE OF SYSTEM ✓ Septic tank,distribution box,soil absorption system Single cesspool Overflow cesspool Privy Shared system(yes or no) (if yes, attach previous inspection records,if any) Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) Tight Tank Attach a copy of the DEP approval Other(describe): Approximate age of all components,date installed(if known)and source of information: Installed on 3113187-per as built card Were sewage odors detected when arriving at the site(yes or no): No 6 Page 7 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 119 Saddler Lane West Barnstable, MA Owner: Jack Kasariian Date of Inspection: May 22, 2006 BUILDING SEWER(locate on site plan) Depth below grade: Materials of construction: _cast iron _40 PVC other(explain): Distance from private water supply well or suction line: Comments(on condition of joints,venting,evidence of leakage,etc.): SEPTIC TANK: ✓ (locate on site lap Depth below grade: 15" Material of construction: ✓ concrete _metal _fiberglass _polyethylene _other(explain) If tank is metal list age: Is age confirmed by a Certificate of Compliance(yes or no): (attach a copy of certificate) Dimensions: 1000 gal. Sludge depth: 2" Distance from top of sludge to bottom of outlet tee or baffle: 30" 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: 10" How were dimensions determined: Measuring stick Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.). Tees were present. The liquid level was even with the outlet invert There did not appear to be any suns of leakaze GREASE TRAP: None (locate on site plan) Depth below grade: Material of construction: _concrete _metal _fiberglass _polyethylene _other (explain): Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping: Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): 7 Page 8 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 119 Saddler Lane West Barnstable, MA Owner: Jack Kasarilan Date of Inspection: May 22, 2006 TIGHT or HOLDING TANK: None (tank must be pumped at time of inspection)(locate on site plan) Depth below grade: Material of construction: _concrete _metal _fiberglass _polyethylene _other(explain): Dimensions: Capacity: gallons Design Flow: gallons/day' Alarm present(yes or no): Alarm level: Alarm in working order(yes or no): Date of last pumping: Comments(condition of alarm and float switches,etc.): DISTRIBUTION BOX: ✓ (if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: Even 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.): The D-box was even. No solids were present. PUMP CHAMBER: None (locate on site plan) Pumps in working order(yes or no): Alarms in working order(yes or no) Comments(note condition of pump chamber,condition of pumps and appurtenances, etc.): 8 I Page 9 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 119 Saddler Lane West Barnstable, MA Owner: Jack Kasariian Date of Inspection: May 22, 2006 SOIL ABSORPTION SYSTEM(SAS): ✓ (locate on site plan,excavation not required) If SAS not loca ted explain why: Type ✓ leaching pits,number: 1 -6'x 6'(1000 gal)-per as built card leaching chambers,number: leaching galleries,number: leaching trenches,.number, length: , leaching fields,number, dimensions: overflow cesspool,number: Innovative/alternative system Type/name of technology: Comments(note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation,etc.): A video camera was used for the inspection There did not appear to be any signs of failure CESSPOOLS: None (cesspool must be pumped as part of inspection)(locate on site plan) Number and configuration: Depth-top of liquid to inlet invert: Depth of solids layer: Depth of scum layer: Dimensions of cesspool: Materials of construction: Indication of groundwater inflow(yes or no): Comments (note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): PRIVY: None (locate on site plan) Materials of construction: Dimensions: Depth of solids: Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): 9 I 'I I Page 10 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 119 Saddler Lane West Barnstable, MA Owner: Jack Kasariian Date of Inspection: May 22, 2006 SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. i r< 1 � a 13 ;n 3 i co a3 y y 3 S 3°I 10 ' Page 11 of 11 OFFICIAL INSPECTION FORM -NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 119 Saddler Lane West Barnstable, 1M Owner: Jack Kasariian Date of Inspection: May 22, 2006 SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water 50+/- feet Please indicate(check)all methods used to determine the high ground water elevation: Obtained from system design plans on record-If checked,date of design plan reviewed: Observed site(abutting property/observation hole within 150 feet of SAS) ✓ Checked with local Board of Health-explain: Topographic and water contours maps Checked with local excavators,installers-(attach documentation) Accessed USGS database-explain: You must describe how you established the high ground water elevation: Using Barnstable topographic and water contours maps, the maps were showing approximately 50'+1-to ground water at this site. This report has been prepared only for the septic system and components described herein. This septic system has been inspected and passed as of the date of inspection. This report is not a warranty or guarantee that the system will function properly in the future. There have been no warranties or guarantees, either expressed, written or implied, relating to the septic system, the inspection, this report and/or any components of the septic system which have not been located and inspected. 11 LOCATION I Iq S,a�J�,�N 1 BARNSTABLE SEWAGE# 406- aO t n _ VILLAGE W. 1�/A(A, ASSESSOR'S MAP&PARCEL �` � 04aI WOO IPsSTALLERS NAME&PHONE NO. SEPTIC TANK CAPACITY I M LEACHING FACILITY:(type) V"�T (size) I uD 0 NO.OF BEDROOMS OWNER /a,SAKTI iAn PERMIT DATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well 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 FU RNISHED BY r r . i a 13 a� 3 c� 3 y 3 30 3 S 39 l� TOWN OF BARNSTABLE LOCATION L �`" Sck SEWAGE # Cry '- 9 Q 1 VIL',AGE + XSSOR S MAP & LOT INSTALLER'S NAME & PHONE NO. \9 NV,r X-e SEPTIC TANK CAPACITY \(?0 LEACHING FACILITY:(type) (size) jo0o a NO. OF BEDROOMS PRIVATE WELL O PUBLIC W ® BUILDER OR OWNER k—e- G DATE PERMIT ISSUED: DATE . COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No i 1 kf No..........6_.....f. / F s... 7.S.. THE COMMONWEALTH OF MASSACHUSETTS - OARD QF HEALT w.!)..........OF Appl ration for Di5paiial Works Cho strartinrt Permit Application is hereby made for a Permit to Construct ) or Repair ( ) an Individual Sewage Disposal system at N- ......... ..... - ----- -------- }} o. »..............» 'Location Xer or Lot.N»»....._.. .................»._..._ . ..O dress.................1 ,.. ' .... r� S .r.... .11. ........ ............ ...... .......•............... ... Installer Address y� Uppqq Type of Building yp g 7 Size Lot..... _. Sq. feet ., Dwelling—No. of Bedrooms.......................... ................Expansion Attic ( ) Garbage Grinder '4 Other—Type of Building ............. No. of ersons..._........__..___......... Showers ) a YP g ••---•--------- P ( ) — Cafeteria 0.4 Other fixtures .................................... �,..�..... ... _. Design Flow..............�..- --�•-. . ..-- .gallons per ms per: Total fly c ow................ .._.. _....--.--.......gallon W r t ' �c WSeptic Tank—Llgwd capaclty.___...._gallons Length.... Width: ..__�. Diameter................ Dept . ....�.(�. - x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area.._....... ._.�'y sq. ft. 3 Seepage Pit No. ---- Diameter......[0...... Depth below inlet.........(0..... Total leaching ar;a%Ji.D..sq. ft. Z Other Distribution box Dosing tank Percolation Test Result ] erformed by............. ............ Date................. Test Pit No. 1......... .....minutes per inch Depth of Test Pit... ._. Depth to ground water... f� Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a0 ................................ ... 1 i........... .. Description of Soil... —' . �......�( .. i (, ill- UNature of Repairs or Alterations—Answer when applicable................................................................................................ -•......................................•--•----.................--------...........................................------------..................--•-----......-........-.............................. Agreement: The undersigned agrees to install the afore escribed d' d ewage Disposal System in accordance with the provisions of:ITLZ 5 of the State Sanitary C e n ed further agrees not to pl*thesin operation until aficate of Compliance has en ' e b he d I ealth. � Signed., ... . .... .. ...... . ....................•...................... • XAp 1' tion r ;v -•--------------------------•-•---•-------••-•-•---.-.-----•----•-------•--•-•----------.P P Y Date Application Disapproved for the following reasons:.............:...•--•...........................................--=:.:.................•-•..................».. Date PermitNo.....................................................»» Issued....................................................... Date / ti �� , LL. J No.._S�?._ ._ l Fps.. . THE COMMONWEALTH OF MASSACHUSETTS B1 OARD OF HEALTH � .__._...t.. .1/l.!.t ...-.......OF......... ... / IL---1�1 .-i-•X' - ............... Applirtttion for Uisposttl Works Tonstrur#ion Permit Application is hereby made for a Permit to Construct(' ) or Repair ( ) an Individual Sewage Disposal System at: -,n T 197 _ � ................-- -_ .......... ...... . .......----....... .!'.v 1..�v.. �1.:..... Location.na ress- � � or Lot No. ! C_ 1 .�..............r--/.11t�.� _ .................. �� �....»�..� •�Owner- J �7._Address _........ ..................._........ Installer Address � � Type of Building � _ .Expansion Attic ( ) Size Lot--Garba .e Grinder � �Sq. feet DwellingNo. of Bedrooms................................. b gVV 444 Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) 6 Other fixtures ....................................f)-47 ....._.... 1 Design Flow............... ... ^gallons per.' perk duly. Total da�ly`flow.._.........._�� " (•'. ..... Septic Tank—Liquid capacity l W. �gallons Length ...��'! !?.. Width:? -. Diameter................ Depth:.-- 17 x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. 3 Seepage Pit No...........1........ Diameter...... ...... Depth below inlet... ZO...... Total leaching area. .+.).sq. ft. Z Other Distribution boxy( D0-4 osing tank Percolation Test Results, Performed by............1 ...d", �,C-..-•--...---. Date..... ..........-•-... .aa Test Pit No. l..!':Z minutes per inch Depth of Test Pit.=.10.:�.t'_. Depth to ground water...&J.ey-K. LL, - Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water...----................. �+ :............... - ................................................... t ...:.........??._... .................. Description of Soil... ©!�y Gawk ' T Q Qi.if t 9 1 U 4. W ...........................-••------- ----------------------------------------•---•-_.... ----.---- �- _ -r/7--1- � na l Y --Y-Y .. ... r__..... .. ........ U Nature of Repairs or Alterations—Answer when applicable................................................................................................ ........................................•-•-----••-•-------•--------•---.......-•----............................------------•---•---•---•-----..........----•----•-•---•-----•----..................... Agreement: The undersigned agrees to install the afore escribed d' d ewage Disposal System in accordance with the provisions of TITLZ 5 of the State Sanitary/C e n ed further agrees not to place,the s stem in operation until a S SVficate of Compliance has eJ �e b h— health. v Signed. `` ............ ....... �... Da P1' tionPeAP ................................................... t_.........- Date Application Disapproved for the following reasons:.............:...................•--...-----•-•----•.....--•-•-----••---................--•••-..............__ •..................................•-•-•-•-----------..........------•--------...............................:-----...............-•----..............................................................._ Date PermitNo......................................................... Issued....-•-----------•--•-..............__................. Date THE COMMONWEALTH OF MASSACHUSETTS BOAR OF HEALTH .. . Trr#ifirtttr of Tautpltttnre THIS IS T CE�FY T h In I.-Sewage Disposal System constructed or Repaired b .............. ............. G..!..r ...... .,,2.. ................. ..........................................(�) .............._ ( ) at.........................r�p�-.......` 7...�.: ........ stal(pr�. ��. ..)..................1 ....�,r�`�l�1,� has been installed in accordance with the provisions of TITLE 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No.......... ._`. _-�.... dated.......�.J?_11..'.G THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. ATE.............. .......................�. _.. '..... ......... Inspector.....!-1:r------...........--•--•--......................--•---................ . .Fa._��,�,,�e��_� ��.. ..DESIGNING ENGINEE* '.~,...�,..s,,...,,...,... ..� 10 R MUST SUPERVISE S4� moo, ► a..,,�,,,�, �Itr� THE COMMONWEALTH OF MASSACHUSEJYs LLATION AND CERTIFY IN WRITING - -c•I'1 fit JJ BOAR OF HEALTH T �E�/S►YaTEM WAS INSTALLED IN STRICT �1f � )c /< � 1j^ RDANCE TO PLAN. No.... ... �� 1:... ......tl ..............OF.. a`��...... >J 1 ---------. .....-----............. FE$........................ Disposttl Workp Tonstrurtion f rrutit 1 Permission is hereby granted........ ( -�. ....../X J to Construct r Re air ( ) an Individual Sewag Disposal System ' 19 at No................... ?. ...r7. .. �� 1 J,1..�� .�: _... . li`J! ,t D �` -�...y. .. ....... Street a JJ as shown on the application for Disposal Works Construction Permit No.bG..-h0 1 Dated........_.._�q._.!!�3/8�-�--.-.. 1. C -ti k,C. ... _ B and or health DATE....................... ..... ...... ....._...............- /fP 362-4541 926 main street. yarmouth mass. 02675 down cope engineering civil engineers& land surveyors structural design Arne H.Ojala P.E.,R.L.S. land court Richard R.Fairbank P.E. surveys site planning October 7, 1986 sewage system designs Board of Health inspections Town of Barnstable South Street Hyannis, MA permits Gentlemen: On.October 6, 1986 Down Cape Engineering inspected the septic system on Lot 75 Saddler Lane, Centerville. The system as installed complies with Mass. Environmental Code Title V and the Barnstable Health Regulations. The installation also conforms to our site plan #85-309-75 except that the location of the septic tank was changed (see attached plan) to avoid excessive tree removal. This alteration will not affect the functioning of the system. Please see attached "As Built Plan Very truly yours, Arne H. Ojala, P.E., R.L.S. Inspected by Carol Young AHO/amp 31/1007 L c��EM L.oT '74 aa, ri y c',9`x Pam• Go t4c, D 1�j POVNDAT1owt 0 SpAG E. /U 4 Q P° joB # 85-309 CERTIFIED PLOT PLAN �'Wl r ".P�i�ll t"��sEPTIG S`(STCM PREPARED FOR: LOCATION: L-75 SADDLER LN . BARN . SCALE., 1=40 DATE. 9/27/86 REFERENCE: IO�Q>�8 Co, PB 420 PG 97 LEBEL / SOLLOWS I HEREBY CERTIFY THAT THE BUILDINGS SHOWN ON THIS PLAN IS LOCATED ON .THE GROUND AS SHOWN HEREON. /�OF. BUILDINGS CONFORM TO SETBACK REQUIREMENTS ydS OF THE TOWN WHEN CONSTRUCTED. AANE OJALA H down cape engineering 02630 `, o CIVIL ENGINEERS ,�� STE LAND SURVEYORS E 6A MA T '�R D uRv ,� .�:D A ROUT YARMOUTH E EG ,�60 _TOWN OFbA9W,40 �A55E55OR5 MAP LOT 20,MIN. _ZONING : Top OF FOUND. IO'MlN. , 5ET&^CKS: FRONT= 151DE5- REArRr- SEPTIC TANK 8 b15T. 60X. 8 LEACHING FACIL17Y . •�' � --_---- �--_l_MIN f�ROUND COVEQ �_ .r/ w GAL. 60 ja 7v: �•3�fy'/ 2ai� SECTION- 5ENA6E �,� Of Z a.W 0oo � } , W TEST H E LOGS 2E516 /V ` - FOR � _���_<�l�,j \✓— a ,� u - s ` - TEST 6' . . 19/h�, E: PERC.RaTE�Z MIN.//N. DATE : FLOW RPcTE//OGAL./DAY�.BR '`3.30 10 l Hl1 TNE55: GGZt/ O.h! SEQTlG 'TANK,,�� !/� �9S / • p t� o�.. ' ` -RE¢ o:'SEPric ranlK %000 P0�3 uJ/ LEACHING FACILITY . �_ ' SIDF WALL 2..5)=07/ZG�D ,Gf _ - Q ?9 .� TT Glo i 80 M =� s .Obill TDTAL .- „ 7p. 5F S�'/•/ +/� ;, .'1 w r�i:i �r 'S �� +—r.'x • I.. .. Y.52-•r�, d wr 1 V 7P T - - U5E ' L EACHlNG - - G'�.E.9 - /O' .EFF. .•�'9rN_ x !a'Elf<OF�T�r'. � � '� ,. '^ :,, '�, � 1. t NOTES 66 6 P SLT Y. DATUM(M5L)t TAKEN FROM IWfAIVl QUADRANGLE WAP F1NE 2. MUNICIPAL HATER /S ,AVAILASLE _ 3. DESI&M LOAOING FOR ALL PRECAST U1J/T5:AASIIO I / _SyYC/O 4•PIPE,c70INT5:S"ALLZS MADE-WATER.TICaHT 1 �;L-ONSTRUCTIO",DETAILS TO i E IN.ACCORDAaNCE. WITH co.m".OF MASS.*St/ITE.ENviRONMeIVTAL CODE Tirce 3L _ -6. TH15, PLAN FOR-PROP05ED!,/ORK GNLY AND-SHOULD nIOT ��/IfT � �� =- V' L•Z 6E I/SED.FoR_PROPERT'Yt W. STAKING... �Z OF t0 OF 'A NE a a ARNE.H, OJA -CIVIL -. ,. LEGENO C�O L0 l! , " . Lc!/1 eh /Yr� 5.� ,. No. co a ir�eADD e ''.r C! TER FCI�EiIE CWLL ;6NGINEERS CONTOU25..�EXIsr) — :RE ��EI�(CE i FJS/OpAI E LI�N D.5l1RvEYORS �.._ (PROP)---o-::--a--- _:PR -- uN FPAREo. �;- _:..CONC..:BO D'. DATE.. L P�.,. ,. .:, - , t1 l I I ,C+ Y C�� , . ...- :. : _ , . . ,.. _, . . . ,. . r t •,. . . , -;5 ATE .t, .bov d.oF"heal h, D ., ,.. ... .. .. qp ->. Arr�1V Y_E.D._ I..V-I'!..• /..- ., 4� -. —_. .X":, S .K..4" - ! 5 , .tx . .,..-. . v 1. , .t�F-. ...:y+�+�^a,x..t+._. .,.. •-_r,.u_F -,''r,rr•:�. - , s n,a�vw.A.,h.',�rtv.•.��p . x,„ a. x' fi.'. v,:ax� :.ti�c ,>:�"�1�i�r,'�:Fi .. - ,3���''"`�''�:!:.n.,�_r��'jt. Y 313�aea...G,����x.:A`�_tfr:_.. .r_-..s. ,uc�rn:.,-.rav:w.'a.�,-,.•a.:'t.�at_.w.x 4.n:.!'�,.d rr�-. �',:45,.r�a C..:'.c�'�'+'. s `t.,..:� ...+e�.;W ,'�v�n `