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HomeMy WebLinkAbout0008 CURRYCOMB CIRCLE - Health 8 Currycomb Circle r - West Barnstable A = 152 048 I a o i 4 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form Inspection results must be submitted on this form or on the official Title 5 Inspection Form dated 6/15/2000. Inspection forms may not be altered in any way. A. Certification Important: When filling out 1. Property Information: 2 forms on the ` � 30� computer, use 25 Saddler Lane - West Barnstable, MA only the tab key Property Address to move your Amey Hart cursor-do not Owner's Name use the return key. 25 Saddler Lane Owner's Address West Barnstable MA 02668 City/Town State Zip Code September 27, 2005 Date of Inspection: Date 2. Inspector: David D. Coughanowr, R.S. Name of Inspector Eco-Tech Environmental Company Name 43 Triangle Circle Company Address Sandwich MA 02563 City/Town State Zip Code 508 364 0894 Telephone Number 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 1-5-340 of Title 5 (310 CMR 15.000). The system: t ® Passes ❑ Conditionally Passes ❑ Fails?# - Needs urther Evaluation by the Local Approving Authority R September 27, 2005 rn 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. t52201.doc• 11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 1 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments ,M Subsurface Sewage Disposal System Form A. Certification (cont.) 25 Saddler Lane Property Address West Barnstable MA 02668 City/Town State Zip Code Amey Hart September 27, 2005 Owner's Name Date of Inspection 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: Inspector's Note==> A septic system is deemed to pass this Real Estate Transfer Inspection if it does not trigger any of the failure criteria listed below. The septic system has been evaluated according to the conditions observed on the day it was inspected. No estimate or guarantee of system longevity is made or implied by a passing determination. 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: Lt52.201.doc•11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 2 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form A. Certification (cont.) 25 Saddler Lane Property Address West Barnstable MA 02668 City/Town State Zip Code Amey Hart September 27, 2005 Owner's Name Date of Inspection 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 ❑ 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: 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 t52201.doc• 11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 3of16 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form SVO� A. Certification (cont.) 25 Saddler Lane Property Address West Barnstable MA 02668 City/Town State Zip Code Amey Hart September 27, 2005 Owner's Name Date of Inspection C) Further Evaluation is Required by the Board of Health (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 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: t52201.doc• 11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 4 of 16 I Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form A. Certification (cont.) 25 Saddler Lane Property Address West Barnstable MA 02668 City/Town State Zip Code Amey Hart September 27, 2005 Owner's Name Date of Inspection D) System Failure Criteria Applicable to All Systems: You must indicate "Yes" or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than 'h day flow ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form.] Yes 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. t52201.doc• 11/2004 Title 5 Official Inspection Form: Subsurface Sewage Disposal System Page 5 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments ;M Subsurface Sewage Disposal System Form A. Certification (cont.) 25 Saddler Lane Property Address West Barnstable MA 02668 City/Town State Zip Code Amey Han` September 27, 2005 Owner's Name Date of Inspection 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. t52201.doc• 11/2004 Title 5 Official Inspection Form: Subsurface Sewage Disposal System Page 6 of 16 Commonwealth of Massachusetts W Title 5 Official Inspection Form Not for Voluntary Assessments ;M Subsurface Sewage Disposal System Form B. Checklist 25 Saddler Lane Property Address West Barnstable MA 02668 City/Town State Zip Code Amey Hart September 27, 2005 Owner's Name Date of Inspection 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? ❑ N/A 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(3)(b)] t52201.dcc• 11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 7 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form ,LAM C. System Information 25 Saddler Lane Property Address West Barnstable MA 02668 City/Town State Zip Code Amey Hart September 27, 2005 Owner's Name Date of Inspection 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 gpd Number of current residents: 1 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)): 56 gpd Sump pump? ❑ Yes ® No Last date of occupancy: currentDate 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: Last date of occupancy/use: Date Other (describe): t52201.doc• 11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 8 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form C. System Information (cont.) 25 Saddler Lane Property Address West Barnstable MA 02668 City/Town State Zip Code Amey Hart September 27, 2005 Owner's Name Date of Inspection 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) ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): Approximate age of all components, date installed (if known) and source of information: Age: 20 years. Design plan dated 914185(Board of Health records) Were sewage odors detected when arriving at the site? ❑ Yes ® No t52201.doc• 11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 9of16 Commonwealth of Massachusetts Title 5 Official Inspection Form i= X Not for Voluntary Assessments iG^M Subsurface Sewage Disposal System Form C. System Information (cont.) 25 Saddler Lane Property Address West Barnstable MA 02668 City/Town State Zip Code Amey Hart September 27, 2005 Owner's Name Date of Inspection Building Sewer(locate on site plan): Depth below grade: 2feet Material of construction: ❑ cast iron ® 40 PVC ❑ other(explain): Distance from private water supply well or suction line: 20+feet Comments (on condition of joints, venting, evidence of leakage, etc.): Sewer appears structurally sound with no evidence of backup or leakage into dwelling Septic Tank (locate on site plan): Depth below grade: 2 feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of ❑ Yes ❑ No certificate) Dimensions: 8.5 ft x 5 ft x 5 ft(1000 gallon) Sludge depth: 4 inches Distance from top of sludge to bottom of outlet tee or baffle 30 inches Scum thickness 1 inch Distance from top of scum to top of outlet tee or baffle 9 inches Distance from bottom of scum to bottom of outlet tee or baffle 14 inches How were dimensions determined? Design Plan t52201.doc• 11/2004 Title 5 Official Inspection Form: Subsurface Sewage Disposal System Page 10 of 16 I Commonwealth of Massachusetts Tithe 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form GSM C. System Information (cont.) 25 Saddler Lane Property Address West Barnstable MA 02668 City/Town State Zip Code Amey Hart September 27, 2005 Owner's Name Date of Inspection Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Pumping not required at this time but maintenance pumping is recommended within and every two years. Tank and tees appear structurally sound and functioning as intended. No evidence of leakage in or out was observed. 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 Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Holding or Tight g g 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): t52201.doc• 11/2004 Title 5 Official Inspection Form: Subsurface Sewage Disposal System Page 11 of 16 Commonwealth of Massachusetts W Title 5 Official Inspection Form _ Not for Voluntary Assessments Subsurface Sewage Disposal System Form iGnM 3Vey`� C. System Information (cont.) 25 Saddler Lane Property Address West Barnstable MA 02668 City/Town State Zip Code Amey Han` September 27, 2005 Owner's Name Date of Inspection Tight or Holding Tank (cont.) 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.): Distribution Box (if present must be opened) (locate on site plan): Depth of liquid level above outlet invert At outlet invert Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): D-box appears structurally sound with no evidence of leakage in or out. Some solids in sump. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No t52201.doc• 11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 12 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form M C. System Information (cont.) 25 Saddler Lane Property Address West Barnstable MA 02668 City/Town State Zip Code Amey Hart September 27, 2005 Owner's Name Date of Inspection 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: 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.): Soils above leaching pit appeared unsaturated. No evidence of surface ponding, breakout, lush vegetation, or other evidence of hydraulic failure was observed. A bucket of water was poured into the distribution box and was observed to ass through in a rapid and unobstructed manner, and could p g p , be heard splashing down loudly into the leach pit t52201.doc• 11/2004 Title 5 Official Inspection Form: Subsurface Sewage Disposal System Page 13 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form 'GSM C. System Information (cont.) 25 Saddler Lane Property Address West Barnstable MA 02668 City/Town State Zip Code Amey Hart September 27, 2005 Owner's Name Date of Inspection 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 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.): t52201.doc•11/2004 Title 5 Official Inspection Form: Subsurface Sewage Disposal System Page 14 of 16 r Commonwealth of Massachusetts Title 5 Official Inspection Form INot for Voluntary Assessments ;M Subsurface Sewage Disposal System Form C. System Information (cont.) 25 Saddler Lane Property Address West Barnstable MA 02668 City/Town State Zip Code Amey Hart September 27, 2005 Owner's Name Date of Inspection 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. LOCATIONS LEACH O PIT A B SEPTIC 1 35 f t 25.5 f t TANK 2 29 Ft 31 f t 10 02 '❑ D-BOX 3 22 ft 38 Ft B A EXISTING DWELLING # 25 W Z J G 3 I SADDLER LANE NOT TO SCALE t52201.doc•11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 15 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form C. System Information (cont.) 25 Saddler Lane Property Address West Barnstable MA 02668 CityiTown State Zip Code Amey Hart September 27, 2005 Owner's Name Date of Inspection Site Exam: Slope Surface water Check cellar Shallow wells Estimated depth to ground water: 90+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: Permit not found 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: USGS topography maps You must describe how you established the high ground water elevation: Approved design plan on file with the Board of Health shows bottom of system to be 5.5 feet above the bottom of a witnessed test pit in which no water was encountered. Town of Barnstable GIS Department records indicate that the property is over 90 feet above groundwater table. t52201.doc• 11/2004 Title 5 Official Inspection Form: Subsurface Sewage Disposal System Page 16 of 16 TOWN OF BAjRNSTABLE LOCATION SEWAGE # l -V`I.SAGE GI. ,( �,.w.J �Ir ASSESSOR'S MAP & LOT io��� INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY i. OOB Ca L LEACHING FACILITY: (type) rd6 CAL Chawhe -42T (size) /if.V Ta AJ NO.OF BEDROOMS 3 BUILDER O WNER o/ PERMITDATE: COMPLIANCE DATE: Separation Distance Between the: , Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility (If any wetlands exist within 300 feet of leaching facility) Feet Furnished by / yy ell-e ydG...r�rirlt �� ��t � .; tt p ------� 0 No. 0✓ 7/ O( Fee ®v THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Application for Oizpozal *p.5tem Con!5truction Permit Application for a Permit to Construct( , )Repair('a/)Upgrade( )Abandon( ) O Complete System M Individual Components Location Address or Lot No.� Owner's Name, ddress and Tel.No. cat YOON /ss�sssMapOP Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. .7 L eL44Y Type of Building: p. Dwelling No.of Bedrooms ✓3 Lot Size ,Z Z 30 sq.ft. Garbage Grinder(1410 Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow c gallons per day. Calculated daily flow ;�23Z gallons. Plan Date Number of sheets 2 Revision Date Title yr Size of Septic Tank Type of S.A.S. Co 4/7,/s Description of Soil ®��®/�Z Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued b his o of Signed Date �l�✓A`�.S Application Approved by Date Application Disapproved for the following reasons Permit No.�s 44_71U Date Issued 9 1a " --------------------------------------- No.�oC �f raj J L ! � \ Fee �V THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION -TOWN OF BARNSY ABU., MASSACHUSETTS Yes Apolcration for -Mi.5po.5ar *potent Con4truction Permit Application for a Permit to Construct( )Repair(t/)Upgrade( )Abandon( ) El Complete System U Individual Components Location Address or Lot No. C411 Owner's Name,Address and Tel.No. `Map1Pyg Installer's Name,Address,and Tel.No. Desi ner's Name,Address and Tel.No. Of Type of Building: 17 �'3� d Dwelling No.of Bedrooms `� If Lot Size sq.ft. Garbage Grinder Other Type of Building A5/?WeC&No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow 330 gallons per day. Calculated daily flow J'�✓7" b gallons. Plan Date �©5 Number of sheets L Revision Date Title S SJ 14-71 SC 414"►1110W Size of Septic Tank / D� '/ �' /5j'irr� Type of S.A.S. - r Description of Soil; Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued by)thi Bow of Health�._.,.._....__ Signed Date Z✓r O Application Approved by f Date 6 ;S Application Disapproved for the following reasons r Permit No. 5 -L -7�o Date Issued --------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of (Comptiauce THIS IS TO CERTIFY, that thy On-site Se�.age Disposal System Constructed( )Repaired( Upgraded( ) Abandoned( )by r (� at zr�� 1J //'Z7 e w s �a'1L1514 , as been construed in acpordance with the provisions,,of T'ift 5 and,*for Disposal System Construction Permit No. 5 u�� dated Installer Designer The issuance of this permA s alll/Aot be construed as a guarantee that the system r i!' union as desig.. d. Date 50 ( 'S Inspector -- — —1 ——————————————— L-�- --------------- =� No. CJ `� / g Fee G 6 THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS Mi.5pozar *p5te✓Cott.5truction Permit Permission is hereby ranted to Construct )Re air( )Upgrade Abandon )Abandon System located at C�fl y� � i 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 condiyons Provided:Construction ust be completed within three years of the ate oft.'s i Date:_ �� Approved by FROM :down cape engineering inc FAX NO. :15083629880 Oct. 19 2005 11:22RM P1 Town of Barnstable Regulatory Services Thomas F. Geiler, Director Public Hearth Division 16s4 . "Tce3 Thomas McKean, Director 200 Main Street, Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 .Installer& Designer Certification Form Date: ©.��1� _ Sewage Permit# 2W O--Zf j6_Assessor's�+Iap�Parcel Designer: <I 0 L ray Installer: Address: MA 4 Address: f yQO oz� 04y� On `76—d✓� � �® ®G 4 �� ` as issued a permit to install a (date) (installer) �1.septic system at CQml C/1 based on a design drawn by 0 (address) dated �J (desi er) V I certify that the septic system referenced above was installed substantially according to the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. I certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system) but in accordance with State & Local Regulations. Plan revision or certified as-built by designer to follow. N OF MA ARNE H. '(.rnstallgrs Signature) OJAI_A Civil- , No. 30792 o- �+ G/STEM �. �sPONAL (Designer's Sign (Affix s Stamp Here) PLEASE RETURN O BAR STABLE PUBLIC HEALTH DIVISION. CERTIF.LATE _OF C MPLIANCE WILL NOT BE ISSUED UN IL BOTH THIS FORM AND-AS-BUILT CARD ARE RECEIVED BY THE BARNS'TABLF P BLIC' HEALTH DCVj . THANK Q:Health/Septic/Designer Certification Form 3-26-04.doc f - 15 /4-00 4 - ao6 � � S 1 I N S T A LLE-IR'S NAME ADDRESS I� DATE PERMIT lSSUED _.r�� 4 - OAT E COMPLIAF,CE ISSUED G} L5 �� r Lo _ g. i5 i 4 �--�- �s �► No.....g :�! F�s......................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ' t.N.................OF..'P}1:�1-..N.ST)2VZL-C------------------......-------- Appliration for Ui_qpusal Works Tonstxnrtion Famit Application is hereby made for a Permit to Construct (✓ror Repair ( ) an Individual Sewage Disposal System at: ....:.C.t�.R�y C-Q..M:7�.._.C..l.l?_G.L.� V.I�;�--1 .T',�.I.�R-N-S-�•-'�-�1==c------ l-U i 3��.3:?._. - location.Address t -- or Lot No• - ..-•---•- ner � - .................. a--- Add�gs -----....-•-- ...._. -,�_.....................•____--- ..----........... 1 � ..............._.................. Installer Address Type of Building Size Lot_ .....Sq. feet U Dwelling—No. of Bedrooms........... .Expansion Attic ( ) Garbage Grinder Other—Type of Building ............................ No. of persons---------------------------- Showers ( ) — Cafeteria ( ) a Other fixtures --------•------------------------------------ W Design Flow_........../__l�j.......................gallons per per day. Total daily flow...__�-�3 O___..___...............__gallons« W Septic Tank—Liquid capacityl.000..gallons Length._8._.4. .. Width..4... �Q... Diameter.:..--'....... Depth...r�__"¢.. x Disposal Trench—No. .................... Width.................... Total Length................ Total leaching area....................sq. ft. 0. Seepage Pit No........)............ Diameter.......I. .I.... Depth below inlet........ Total leaching area..za_`102q. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by..... ..... Date_....77_"-_E1.y_8_r5_........ ,.a Test Pit No. 1.._L 2......minutes per inch Depth of Test Pit....1._-5.6....... Depth to ground water---AQ---V.4AN (� Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ ..............................--------------------•---------...._..-...... ........_................-........................._...........__... 0 Description of Soil-•---•-•-••---���- �� D �v"_ 3(y � SC112-- ......��� o-�..---SA►_iPY. ------..0- .AyrC�.._. 1 l.! = i $ ! GN�' S l�j�l� T12/��- S Cj S i L j W -••••-•--------------------------•••-----•-•-----•--------------------------•-------••-----•••-•--•--------•---•--. -----•-• ----- --- - VNature of Repairs or Alterations—Answer when applicable_-_-- - . .:. Q .......................................... Agreement: The undersigned agrees to install the aforedescribed Ind• ideal Sewage Disposal System.in accordance with the provisions of iITLi. 5 of the State Sanitary ode—.Th d signed further agrees not to place the system in operation until a Certificate of Compliance has a of health. Signed _.. 44 ate _ Application Approved-By_.__._'_...._ . . / �' Date ------ Application Disapproved for the f l owing reasons---------------••--.....--------------------------------•---....---------------------------...--••----....._._._ ---------•--------------•----••--•--._............---•---•---------------...-----•---------•-------------••-•........-•---•-•••••--••---•--••-••.........--••--.......--••- ............................ Date PermitNo..................................................._..... Issued............---...............-•............_........... Date i - y -- --------------------------------------------- i r ' No................_....._ Fss....... _._.... .. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .................0F...--1 T 1-3.L.C................................. Appliration for Disposal Works Tonstrnr#ion rermi# Application is hereby made for a Permit to Construct (W<or Repair ( ) an Individual Sewage Disposal System at: A P>L—C....... -.4 v.T.... _ Location-Address or Lot No. ............................... . ..............-. .............----.......... ---...----........................... Address w _ ` ._.... �/`!.Jf- ----------------------------- ........................ .................. t .a.---... ,_..................................... Installer Address Type of Building Size Lot... .- Sq. feet U Dwelling—No. of Bedrooms---........ -•--.Expansion Attic ( ) Garbage Grinder '-� Other—Type of Building No. of persons............................ Showers W YP g --------•--•----•-•--•-•-•-• P ( ) — Cafeteria ( a Other fixtures -----------•--...-•......................... W Design Flow...........J..l.0......................gallons per�e"o e day. Total daily flow......310---........--------......gall �� WSeptic Tank—Liquid capacity1000.gallons Length...... .... Width.A..14... Diameter............. Depth....{6.1 . x Disposal Trench—No. ................... Width................. Total Length............. Total leaching area...................sq. ft. Seepage Pit No........I........... Diameter..........Q...... Depth below inlet................ Total leaching area......_.. 4:Q2q. ft. Z Other Distribution box ( ) Dosing tank ( ) ''' Percolation Test Results Performed by.....pv.`!J N..G E-EhlGl hlFC-k N ..... Date.......2-1-7.:...._r6....... a ,.a Test Pit No. I....L.z.....minutes per inch Depth of Test Pit....15.8....... Depth to ground water...14L.v .A!,;— Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ x ----------------------------------------------------•---•....••....---.......--•••-.........•-••-•.........-•---•............•.............................................................. O Description of Soil..............0."" (5.:�._.� U Ja! r .�..:..'�5�. r��.1. :.SL?!�.,..:......3 `•-.2Q ....... N N CzRA.[. _L..j...._t.Q.&-..J:5.8......-i.!.�?N.!`. .`.�A_ ��...E_ T�I�C.ES.._.�.r...Se................................................. ...--•-- W U Nature of Repairs or Alterations—Answer when applicable.....................................................................................:......... •.........................•-----..........---......•-•-••••-•........ Agreement: The undersigned agrees to install the aforedescribed Ind' idual Sewage Disposal System.in accordance with the provisions of TITLE 5 of the State Sanitary ode=.Th d signed further agrees not to place the system in operation until a Certificate of Compliance has b s e e of health. Signed. f.. ......_. ............................................ lrr, _ l, Application�APPr �Y :... � ..........................._ ...• ate s p.r•Date �. Application Disapproved for the f ol�l 'ng reasons:..................•---•--------•----•--•-------............---•-------•---•-----...--••-••---••.......••----- ..--••------•-•••••...................•-••--..............•--•-•................-••••••••....-•-•••.........-••-•••-•-•-•-•••-.......---•--...............•---•••••--••---•-.............••••-••.....__ Date PermitNo......................................................... Issued-................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOAR OF HEALT ..........................................oF. 1r%. .y. .......... ............................ wrfif irtt#.e of Tomplianrr THIS IS TO URTIFY, That the Individual Sewage Disposal System constructed or Repaired11 ( ) by.............. .. .................................................�- , ...�......�.-. -..... f l / .............. Inst at 7 ._...._ f,r has been installed in accordance with the provisions of TITLE j of The State Sanitary Code as described in.'the': application for Disposal Works Construction Permit No.......... —..7 /...... dated.........to/�.a , s.'............... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUN TON ATISFACTORY. DATE.............. 1 �....................................... Inspector-•••-:Z�....-•--........................................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH, ' ..........................O F.............................................-•--•-.................................. No..... ...... j Fn.....��'". .�-, Disposal nr � �u frnr#iun rrrmi# Permission is hereby granted.. • _ ................................................................ -- to Construcct�(--��Repair ( ) an Individual Sewage Dispo�e stem / r 1 at No......� l""I"""'.....-..: �f - ... .�,:: ..1: aa:. 1. •-- -.1 . f.� . --.-.- -.�l�,!`.1.��.._..... Street as shown on the application for Disposal Works Construction Permit No..................... Dated........!! Q .............................•--.....•••-- ... ..... _.:. Bo f +' DATE ........L........ ..................................... FORM 1255 A. M. SULKIN. INC.,,.BOSTON '7 LEGEND ASSESSORS MAP 152 PARCEL 48 i SFR�� 100.0 PROPOSED SPOT ELEVATION FLOOD ZONE: C 100x0 P T EL EXISTING S O E ELEV ATION 100 PROPOSED CONTOUR SR oar 100 EXISTING CONTOUR DERBY LOCUS GO BOARD OF HEALTH GJe� LOCATION MAP LOT AREA APPROVED PATE MA 17,930± SQ. FT. NOTES: 1. DATUM IS APPROXIMATE NGVD / 2. MUNICIPAL WATER IS EXISTING 12 121 3. MINIMUM PIPE PITCH TO BE 1/8" PER FOOT. 4. DESIGN LOADING FOR ALL PRECAST UNITS TO BE AASHO H- 10 O 122 00 122 5. PIPE JOINTS TO BE MADE WATERTIGHT. \ 6. CONSTRUCTION DETAILS TO BE IN ACCORDANCE WITH MASS. \ ENVIRONMENTAL CODE TITLE V. LI G TREES SAVE) 7. THIS PLAN IS FOR PROPOSED WORK ONLY AND NOT TO BE \ USED FOR ANY OTHER PURPOSE. 27' 8. PIPE FOR SEPTIC SYSTEM TO SCH. 40-4" PVC. �Q\ \� CAUTION: 1 2 K 9. COMPONENTS NOT TO BE BACKFILLED OR CONCEALED WITHOUT QP GI GAS LINE TH 1 INSPECTION BY BOARD OF HEALTH AND PERMISSION OBTAINED EXIST. DWELLING \ FROM BOARD OF HEALTH. 10. PUMP & REMOVE (OR FILL WITH SAND) EXISTING LEACH PIT. cc) ti 11. WATER-TEST D'BOX FOR LEVELNESS FpcF�Ti�lc 8" O </ / EXIST. ��� _� �' SHEET 1 OF 2 \ \ ST s H 2 �_1 a6 a' 122 TITLE 5 SITE PLAN � \ o•w o OF 8 CURRYCOMB CIRCLE B C CLE BENCH MARK — TOP CORNER 9LF �� 1 c,So IN THE TOWN OF: OF BRICK STOOP ELEV. = 124.5 \ �6 \\ S c, / � � Nw (WEST) BARNSTABLE PREPARED FOR: BORTOLOTTI CONSTRUCTION/HELMAN n1 �� off 508—362— O� fox 508 62-9880 880 � G 0 down cape engineering, inc, 12 5 �� ZN � OF 20 20 40 60 :.;c'of � ssq�� CIVIL ENGINEERS ARNE GN H. a SCALE: 1" = 20' DATE: SEPT. 6, 2005 LAND SURVEYORS / Gv� c�i v 939 main st, yarmouth, ma 02675 / ss\ 05— 1 9 > i ARNE H. 0 SCR L.S. DATE x SYSTEM PROFILE TOP FNDN. AT EL. 124.23 F' ACCESS COVER TO WITHIN 6" OF FIN. GRADE (NOT TO SCALE) ACCESS COVER (WATERTIGHT) TO PROVIDE OBSERVATION P IN WITHIN 6" OF FIN, GRADE 6" OF FINAL GRADE MINIMUM .75' OF COVER OVER PRECAST 2% SLOPE REQUIRED OVER SYSTEM 123.0' — 124.0' ELEV._ 1 22.58' RUN PIPE LEVEL 2" DOUBLE WASHED PEASTONE-, FOR FIRST 2' EXISTING 1000 3' MAX. GALLON SEPTIC 121.18't* Z?�l 121 .0' TANK (H— 10 ) GAS(RE—USE — SEE NOTE) BAFFLE 1 20.48' c20.31' ooa 00oo0ooao � 120.17' aoc� o a oaao 6" CRUSHED STONE OR MECHANICAL o C7 a o a o 0 DEPTH OF FLOW = 4 COMPACTION. (15.221 [2]) o0 0 2 = = = O = = = = = oc�� 1 18.17' TEE SIZES: ( 1.5 % SLOPE) ( 1 3 4" TO 1 1 2" DOUBLE WASHED STONE INLET DEPTH = 1 0 , % SLOPE) / / „ OUTLET DEPTH = _ 14 FOUNDATION— EXIST. SEPTIC TANK 45' D' BOX 16' LEACHING FACILITY 5.57' *THE INSTALLER SHALL VERIFY THE LOCATIONS OF ALL UTILITIES AND ALL TEST HOLE LOGS BUILDING SEWER OUTLETS AND ELEVATIONS PRIOR TO INSTALLING ANY PORTION OF ENGINEER: RICK JUDD, RS SEPTIC SYSTEM D. DESMARAIS, RS THE INSTALLER SHALL CONFIRM MIN. SEPTIC TANK WITNESS: SIZE AT 1000 GALLONS AND ITS SUITABILITY FOR 112.6' DATE: 8/30/05 RE-USE PERC. RATE _ < 5 MIN/INCH CLASS I SOILS p# 11066 SEPTIC DESIGN: {GARBAGE DISPOSER IS NOT ALLOWED ) Q ELEV. E:�l DESIGN FLOW: 3 BEDROOMS ( 110 GPD) = 330 GPD 0" 123.5' 0" 123.6' USE A 330 GPD DESIGN FLOW 2" O SEPTIC TANK: 330 GPD ( 2 ) = 660 FILL A/E 8" 122 9' USE A 1000 GALLON SEPTIC TANK (RE-USE EXISTING - SEE NOTE) LS LEACHING: 11 9„ 10YR 4/1 SIDES: 2(30 + 9.83) 2 (.74) = 118 Bw BOTTOM. 30 x 9.83 (.74) 1 = 218 LFS SHEET 2 OF 2 O TOTAL: 454 s.F, 336 GPD 29„ 1OYR 6/6 121.1 USE (2) 500 GAL. LEACHING CHAMBERS (ACME OR PERC TITLE 5 SITE PLAN LFS EQUAL) WITH 2.5' STONE AT SIDES, 4' AT ENDS AND 5' BETWEEN UNITS OF c 8 CURRYCOMB CIRCLE PERC 2.5Y 5/4 IN THE TOWN OF: LFS W/LAYERS OF ,��oFs , (WEST) BARNSTABLE S.L. & MS o�'� ARNE H. cyo 2.5Y 7/4 �� OJALA j PREPARED FOR: BORTOLOTTI CONSTRUCTION/HELMAN W/IRREG. 10% COBBLES u CIVIL y , BANDS OF MS & STONES No. 307 2 1 10% COBBLES T < SEPT. 6, 2005 SCALE: 1" = 20' DATE: 122" 113.3' 132" 112.6' DATE ®S— 191 NGWE NGWE y. .SECTION SEWAGE - yq -SEPTIC TANK _"D"BOX - 3 LEACH '_ )T f TOP OF FDN ..(2r2,A2(MSwt► ..2..OF ttsTO�h" ly WASHED STONE s i IN• . OUT• IN• I 1 1. IG� SEPTIC Z TANK W-s_1 I�:D0 1 ELEV. 2+1 ELEV. ELEV.. ELEV. r ELEV. ELEV. A. i3AK0U7 �(� ..Z OF'i4't..lyt•• �:� WASHED STONE t.oT-i 7 O ��6 TEST.-HOLE.LOG. bbt 1 gF 1 . . TEST BY �k�rt Ca , �• Gan 1 ar-t C I3 r,�,N a� l© .o e�6 ' 5� " _��8 TEST DATE !3 WITNESS DESIGN BEDROOM HOUSE T.d, �► 1 ELEV. IZO- T.H. � 2 i� ELEV. to iz- PERC RATE .G MIN/IN. NO DISPOSER DISPOSERi I 11 v VI,0 FLOW RATE':.f O4GAL./DAY II SEPTIC TANK.`33 0 (ram= REQ:D SEPTIC TANK SIZE LEACH FACILITY I G lC/ �� c 3' I t[a4 I I I.O SIDE WALL O 4= 12 (z 15) Icj BOTTOM 7O 2 -= -t l,d 1 = �i G/D. vl. �Zo VZ TOTAL 204.2 SPir 15®" sI loco,O USE: LEACHING, l ) • �, �" �� fQ _WATER ENCOUNTERED . I o'�.FF_DI6 M-X -4' E.FF. PE P r N \ ,GO NOTES: (UNLESS OTHERWISE NOTED) 1.DATUM(MSLIa TAKEN FROM aVAILABOEADRANGLE MAP O��?�. � SCT��'k� 7S• C� . 2:MUNICIPAL WATER 1 lCEI�►�-fi-�nN d� 3.PIPE PITCHt'A PER FOOT 4.DESIGN LOADING FOR ALL PRECAST UNITS:AASHO• -44 IR O,jALA 5.MIN.GROUND COVER OVER ALL SEWAGE FACILITIES:(1)FT. CIVIL I I -77i �1 6.PIPE JOINTS SHALL BE MADE WATERTIGHT 7.CONSTRUCTION DETAILS TO.BE ACCORDANCE WITH COMM.OF MASS. SITE PLAN STATE ENVIRONMENTAL CODE TITLE S of. t3. T�-1�� Pt.s. • t=oL t-ICG7 .� 1�10t�iL Gt��f t►..ap b.-��a b ~ LOT 33 I'7 Cu2RYcca,ir3 CII�L� �-w V t'f3 tJFi 1At.��O K _ AfiNE G LOCUS: t/ H. -• ��.••.�,�'T" 17_��turS�'j-I►..t�t�.� ►�fri WE ------ --- G.PROFESSIONAL ENGINEER• I •� I/ c , REF: LO 33/l-r Kvo�crioz, ALA Lc� B2(o! down cape eagsneerie�� PREPARED FOR: CIVIL ENGINEERS . BOARD OF HEALTH LAND SURVEYORS ---- - --- (EXISTING)...........-• p'"Alain8L* O REG.LAN SURVEY CONTOURS tPRO1tOSE0).-O-O-O-O- APPROVED DATE BA `�A� + MA r SCALE