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HomeMy WebLinkAbout0049 SUNDELIN WAY - Health nIT49 Sundelin Way W. Barnstable A = 216 002002 e s t a t 6 t No. 4210 1/3 BLU a o � a MUD ESS E LTE 10% 0 0 0 0 TO OF BARNSTABLE LOCATION ^YQ � L� Wes/ SEWAGE # 9P614-318 VILLA GE �� • �ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO.aj\K . $ "Ilt (02$4SEPTIC TANK CAPACITY' 1500 �2V LEACHING FACILITY: (type) y ��� 1 (size) (QL NO.OF BEDROOMS BUILDER OR%j PERMIT DATE: iz 12sbL+ COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility 3 S Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) ( a7 Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 fcorri le hin Feet Furnished by (55'' F R�st2S t to` 4 �2 4 i, R%Yr NJ N = Q�' /Z-4 O/V Commonwelh� h usetts Owner Title 5 Official lnspectkiiIn F rm information is Subsurface Sewage Disposal System Form - Not for Voluntary Assessme s requ.red for every page. 49 West Sundelin Way Property Address / Marina Cesar Owner's Name West Barnstable MA 5/4/16 Cityrrown 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 filling out forms A. General Information . on the computer, use wily the tab 1. Inspector: key tc move your cursor-do not Carmen E. Shay use the return key. Name of Inspector Shay Environmental Services VV Company Name P.O. Box 1576 Company Address I Mash pee MA 02649 City/Town i State Zip Code 508-539-7966 ® 3080 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority 5/14/16 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•11f10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 17 ' T Commonwealth of Massachusetts Owner Title 5 Official Inspection Form information is Subsurface Sewage Disposal System Form -,Not for Voluntary Assessments required for every page. 49 West Sundelin Way Property Address Marina Cesar Owner's Name West Barnstable MA 5/4/16 City/Town 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: ® 1 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: System consists of a 1500 gallon tank, a D-box and One 58' long Leach Trench. B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass"section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health,will pass. Check the box for"yes", "no"or."not determined" (Y, N, ND)for the following statements.If"not determined," please explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 Commonwealth of Massachusetts Owner Title 5 Official Inspection Form information is Subsurface Sewage Disposal System Form - Not for Voluntary Assessments required for every page. 49 West Sundelin Way Property Address Marina Cesar Owner's Name West Barnstable MA 5/4/16 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(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins-11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 3 of 17 - Commonwealth of Massachusetts Owner Title 5 Official Inspection Form information is-- ubsurf a e osal System Form -Not for Voluntary Assessments required for every page. 49 West Sund ' e y Address Marina Cesar Owner's Name West Barnstable MA 5/4/16 City/Town State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: f: 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 El ® Liquid depth in cesspool is less than 6" below invert or available volume is less than %day flow t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts Owner Title 5 Official Inspection Form information is Subsurface Sewage Disposal System Form -Not for Voluntary Assessments required for every page. 49 West Sundelin Way Property Address Marina Cesar Owner's Name West Barnstable MA 5/4/16 Cityfrown State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CM 15.303,therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA)or a mapped Zone II of a public water supply well If you have answered "yes"to any question in Section E the system is considered a significant threat, or answered"yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 y Commonwealth of Massachusetts Owner Title 5 Official Inspection Form information is Subsurface Sewage Disposal System Form -Not for Voluntary Assessments required for every .page. 49 West Sundelin Way Property Address Marina Cesar Owner's Name West Barnstable MA 5/4/16 City/Town State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes"or"no"as to each of the following: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? 0 ❑ 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,❑ y 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): 5 Number of bedrooms (actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 550 t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 Commonwealth of Massachusetts Owner Title 5 Official Inspection Form informatior is Subsurface Sewage Disposal System Form -Not for Voluntary Assessments required to,every page. 49 West Sundelin Way Property Address Marina Cesar Owner's Name West Barnstable MA 5/4/16 City[Town State Zip Code Date of Inspection D. System Information Description: Tank, D-Box and one-a 58' Long Leach trench present. Number of current residents: 3 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)): Detail: 75,000 gal/82„000 gal Sump pump? ❑ Yes ❑ No Last date of occupancy: Current 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 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 y Commonwealth of Massachusetts Owner Title 5 Official Inspection Form information is Subsurface Sewage Disposal System Form -Not for Voluntary Assessments required for every page. 49 West Sundelin Way Property Address Marina Cesar Owner's Name West Barnstable MA 5/4/16 Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Current Date Other(describe below): General Information Pumping Records: Source of information: Board of Health Was system pumped as part of the inspection? ❑ Yes ❑ No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner)and a copy of latest inspection.of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): t5ins•11/10 - Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts Owner Title 5 Official Inspection Form information is Subsurface Sewage Disposal System Form - Not for Voluntary Assessments required for every page. 49 West Sundelin`Nay Property Address- Marina Cesar Owner's Name West Barnstable MA 5/4/16 Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: 2004 per plan on file at Board of Health . Were sewage odors detected when arriving at the site? ❑ Yes ❑ No Building Sewer(locate on site plan): Depth below grade: 2'6" feet 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.): No evidence of leaks, plumbing properly vented. Septic Tank(locate on site plan): Depth below grade: 1feet 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: 5'x 5'x 10' Sludge depth: 6" t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 Commonwealth of Massachusetts Owner Title 5 Official Inspection Form information is Subsurface Sewage Disposal System Form -Not for Voluntary Assessments required for every page. 49 West Sundelin Way Property Address Marina Cesar Owner's Name West Barnstable MA 5/4/16 City/Town 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 23" Scum thickness 1/2 Distance from top of scum to top of outlet tee or baffle 4 Distance from bottom of scum to bottom of outlet tee or baffle 14 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.): Tank in good condition. Inlet and Outlet Tee in good condition Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness' Distance from top of scum to top of outlet tee or baffle . Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts Owner Title 5 Official Inspection Form information is Subsurface Sewage Disposal System Form -Not for Voluntary Assessments required for every page. 49 West Sundelin Way Property Address Marina Cesar Owner's Name West Barnstable MA 5/4/16 Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank (tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level`. Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments(condition of alarm and float switches, etc.): *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts Owner Title 5 Official Inspection Form information is Subsurface Sewage Disposal System Form -Not for Voluntary Assessments required for every page. 49 West Sundelin Way Property Address Marina Cesar Owner's Name West Barnstable MA 5/4/16 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 D-box Present. 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.): Four outlets present to leach trenches. no evidence of backup noted or of any 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 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 Commonwealth of Massachusetts Owner Title 5 Official Inspection Form information is Subsurface Sewage Disposal System Form -Not for Voluntary Assessments required for every page. 49 West Sundelin Way Property Address Marina Cesar Owner's Name West Barnstable MA 5/4/16 City[Town State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ® leaching chambers number: 4 chambers w/stone ❑ 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.): Probed stone in field and found No evidence of backup noted. Opened inspection port/chamber cover and found only 4" liquid. 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 i Owner Title 5 Official Inspection Form information is Subsurface Sewage Disposal System Form -.Not for Voluntary Assessments required for every page. 49 West Sundelin Way Property Address Marina Cesar Owner's Name West Barnstable MA 5/4/16 City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): 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-11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14of 17 Commonwealth of Massachusetts Owner Title 5 Official Inspection Form information is Subsurface Sewage Disposal System Form -Not for Voluntary Assessments required for every page. 49 West Sundelin Way Property Address Marina Cesar Owner's Name West Barnstable MA 5/4/16 City[Town State Zip Code Date of Inspection D. System Information (cont.) Sketch of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ❑ hand-sketch in the area below ❑ drawing attached separately SEPTIC TANK CAPACrrY w —w LEACHING FACT IY:I;type) uJ2� ut1 (size) (;a 1C te;i R NO.OF BEDROOMS BUILDER OR%�&. % PERMUDATE: COMPLIANCE DATE: Separation Distance Between the: f Maximum Adjusted Groundwater Table to the Bottom ofLeaching Facility 3`�[^ Fa Private Water Supply Well and Leaching Facility(If any wells exist 1�7 I Fu on site or within 2W feet of leaching facility) Edge of Wetland and Leaching Facility(If any wetlands exist within300f t Iin 3�� F. ' Furnished by IJ%_i� BDO Q" —ov ^ }SouSrL C=a3.q _ 30G' j.IOI''1" �•� P R,See. L 'T C ]O :11'3" J�p. N=q(o� D. System Information (cont.) Site Exam: t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 Commonwealth of Massachusetts Owner Title 5 Official Inspection Form information is Subsurface Sewage Disposal System Form Not for Voluntary Assessments required for every page. 49 West Sundelin Way Property Address Marina Cesar Owner's Name West Barnstable MA 5/4/16 Cityrrown State Zip Code Date of Inspection ® Check Slope ® Surface water ® Check cellar t ❑ Shallow wells Estimated depth to high ground water: 10 feet+ 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: Topo ❑ Checked with local excavators, installers- (attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: Inspector has performed soil evaluations in this area and is familiar with groundwater depths. Took elevation from pond in front yard. 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 r Commonwealth of Massachusetts Owner Title 5 Official Inspection Form information is Subsurface Sewage Disposal System Form -Not for Voluntary Assessments required for every page. 49 West Sundelin Way Property Address Marina Cesar Owner's Name West Barnstable MA 5/4/16 CityTrown State Zip Code Date of Inspection ❑ Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems) completed ® System Information—Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins•11/10 Tide 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 '' TO OF BARNSTABLE LOCATION .^� I � W SEWAGE # VILLAGE ASSESSOR'S MAP & LOT Z INSTALLER'S NAME&PHONE NO.��`c� SEPTIC TANK CAPAC LEACHING FACILITY: (type) ��� � (size) _[c'JL NO, OF BEDROOMS BUILDER OR!jjj-W�NE PERMITDATE COMPLIANCE DATE: Separation Distance Between the: P 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) ( 7 Feet Edge of Wedand and Leaching Facility(If any wetlands exist within 300 fegnif le hin Feet Furnished by i � -�� _ k orla Q 4 C✓ ,q „ _ So , E coS F S o, 411f it F w rq N aoo -37 a0 No. � FEE — Board of Health, 13 ct',:us.� APPLICATION FOP DISPOSAL SYSTEM[ CONSTRUCTION PERMIT Application for a Permit to Construct(#'fepair("'5UpgradeO Abandon( - ( "Complete System 4J Individual Components Locatioffi— S a N-bo-6 A., GV 4 Owner's Name Su ca b e C,.Aj Map/Parcel# u`�1`m �.— Z Address S,o, (be 4 c(J (,J al l Lot# Telephone# Installer's Name Designer's Name Address Address Telephone# Telephone# Type of Building Lot Size sq.ft. Dwelling-No.of Bedrooms Garbage grinder ( JO Other-Type of Building No.of persons Showers ( ),Cafeteria ( ) Other Fixtures Design Flow (min.required) gpd Calculated design flow 3 36 Design flow provided 3 3 gpd Plan: Date '7— 1 7— 0 I u Number of sheets Revision Date U Title ("40 oy 1 64Ju Description of Soil(s) Soil Evaluator Form No. Name of Soil EvaluatA Jr dGe ate of Evaluation 6 4 0 69 DESCTqPTION OF REPAIRS ORALTERATIONS The ersi d agrees to ins a above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and furthe agr tce the sys in operation until a Certificate o Co hli has been issued by the Board of Health. Sign Date (� aklo y Inspection NR,, +✓ J / lu FEE tt , '" C 10 WaLTWOF MASSACHUSEI�S, 4 Board of Health, ' AL4. APPLICATION FOP DISPOSAL SYSTEM CONSTRUCTION PERMIT `Application,for a Permit to Construct(4)0RepairCO<Upgrade( Abandon( B Complete Syste;W Individual Components r Locatio � r s a 14.1 e c, O.J C4,., Owner's Name 1 / 4,0,n i i Map/Parcel# c 1 C,• , - ?,� Address � S'�.�+ oe-6 A) (4-ja1 L Lot# Telephone# Installer's Name Designer's Name Address c-� t .� Address hTlephone# 5og Telephone# Type of Building Lot Size sq.ft. Dwelling-No.of Bedrooms Garbage grinderr Other-Type'of Building No.of persons Showers ( ),Cafeteria ( ) Other Fixtures Design Flow (min.required) gpd Calculated^design flow `�3 J 0 Design flow provided .7 3 gpd Plan: Date 7- Q 11 Number of sheets Revision Date 9 ID U Title C.y0L) oy .,At Description of Soils) ;,'Soi KE is izator Form No. Name of Soil Evaluatrg t de-e► �'i� %"tate of Evaluation VC) i DESC PTION OF REPAIRS ORALTERATIONS og The&arvogo-place to a above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and furt the s in operation until a Certificate Co pli has been issued by the Board of Health. Sig Date�Insp COMMONWEALTH EALTH OF MASSA'l 14USETTS � FEE��_ Board of Health, )�a-�''� �t,Ve , MA. CERTIFICATE Of COMPLIANCE Description of Work: ❑Individual Component(s) U-Complete System The( n ned herebv- that the Sewage Disposal System; Constructed ( ),Repaired (Upgraded (✓),Abandoned\( ) by: � 6V"�./� at .5 v A,Dc C, w► + -41 �t has been installed in accordance with the provisions of 310 CMR 15.00 (Title 5) and the approved design plans/as-built plans relating to applic .0 2v'y dated ldk Jt1 . Approved Design Flow 338 (gpd) Insta � /� Designer: r+/V 4.j C�u►n SuC�7gt�Sspector: Date: !t)�� The issuance of this permit shall not be construed as a guarant9e that the system will function as designed. NQW-\ ---37 FEE /aJ•G� Board of Health,/� ,r� �'r- I MA. DISPOSAL SYSTEM CONSTRUCTION PERMIT Permission is hereby granted to; Construct(—,�' Repair(' Upgrade(/) Abandon( ) an individual sewage disposal system at .j Aj 1'e v`'r as described in the application for Disposal System Construction Permit No.QM9-37 R , dated 7 Provided: Construction shall be completed within three years of the date o this p it. All 104 conditions must be met. Form 1255 Rev.5/96 A.M.Sulkin Co.Boston,MA Date 0 Board of Health 7 Town of Barnstable PAD IHE I Regulatory Services '1 - °^ Thomas F. Geiler,Director enxxsi`AM4 Mom. Public Health Division a6�.q• �� U 7 rEc. p'�a Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Installer & Designer Certification Form Date: 16 IZG lo`t ww�� . Designer: q 0Kt-e_ Sty.✓ C`y,n S Q 0W staller: Address: 7 Address: On 1 was issued a permit to install a (date) (installer) septic system at based on a design drawn by (address) SUly ;D dated s (desi er Av ✓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. OF �o BRUCEG. (Installer's Signature) U MURPHY No. 749 s 9FCISTOW (Designer's Signature) (Affix D@Si er's Stamp Here) PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS- BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. Q:Health/septic/Designer Certification Form t TOWN OF BARNSTABLE BAR-W 2 3826 Ordinance. or Regulation WARNING NOTICE 8 Name of Offender/Manager VA0� or (-DI ROL Address of Offender 1., , )&� ,AI OV MV/MB Reg.# Village/State/Zip ltI'm Business Name ae/ on V6:20 I Business Address .! / Sign"ature of E forE:ing Officer, Village/State/Zip t✓ `'lam � .1 Y . f�Y Location of Offense s 6140 , `A r r1-3 f) Enforcing Dept/Drivision Offense FactsrSL-- fi It / ;rk rlw 1" pr) (ey u) J oV A A log Pr /Q M Fr -This will serve only as a warning. At this time no legal action has been taken. It is the goal of Town agencies to achieve voluntary compliance of Town Ordinances, Rules and Regulations. Education efforts and warning notices are attempts to gain voluntary compliance. Subsequent violations will result in appropriate legal action by the Town. WHITE-OFFENDER CANARY-ORD./REG.-PROG.' PINK-ENFORCING OFFICER GOLD-ENFORCING DEPT. TOWN, E &A NST L-E .s BAR4Nv"Q 3829 Y 1 G ('` Ordinario,�e' or Regulation _ WARMING NOTICE` Name of Offender/Manager p l y of Offender ) #u:� �t .l� t � •? MV/M13 Reg.# Village/State/Zip �;. c . t� ��1= '" '7 Business Name w f`x t.__. am/pm, ;Ion ,� 20 Business Address Signature of Enforcing Officer, Village/State/Zip 1 1 / rjf Location of Offensefrr'4 —f:' .. Y lf,f} 7 %` uli' Enforcing Dept/Div°is"ion 1 ,. Offense 1 S�11 J •o a"� 4 � ' Facts �, a .-� 17 a o .This will serve only as a warning: At' this time no legal action has been taken. It is the goal of Town agencies. to achieve voluntary compliance of Town Ordinances, Rules and Regulations. - Education efforts and warning notices are attempts to gain voluntary compliance. Subsequent violationsrwill result in appropriate legal action byrthe Town._ WHITE-OFFENDER CANARY:ORD./REG.-PROGJA PINK-ENFORCING FFICER GOLD-ENFORCING DEPT. .. 1. It - .. 72 - i if i 30 i �2 40 20 Lim- .I 1 2 Fs' S ,3 iqi �cts�t� 3, Na rT RV 1v -T F T + IcAlcx GlVs 4 Lhc�l { �QrrlvZ�O,tiI © �11n1 u � 44 ,,I ; y� + 90 lit i t��4EA G O9 a. .. - t G� Y i. 1 Y. ! i 1 F j i i NOTE: ALL ABUTTING WELLS 150't AWAY FROM gOUTE 6A PROPOSED LEACH FIELD BENCHMARK- TOP G 00 yo. OF NAIL -4RRE7T \\ PAR 2l3 'ly �� i`!, �r� EL=96.7'f (G.I.S.) PON,0 LO US a \� 00 sang/ ru POLE��6 i 1 lay RELL \ C/ 9 go ASP G TEO ► \ HORSE �� 1 :�� LOCUS MAP -- \ • �• � n� CORRAL 1 � 0 \\� \\ �-i-�� ec�` ✓`so PLAN REF 415188 � ASPHALT m \ ,, , ASSESSORS MAP 216 PARCEL 2-2 �3; � \ �� �•r�D�_, ,<"� � SIP �� O� �% \, r- __ �� �0 0 DEED REF 12161494 ID I►arx o.9'— Ex �`` ._ �' 84 s�o ,'� `. o ZONING: ..RF,.. our i CSSPOO •. . QRpe° �i ��` s'p, ?, fm BE PUMPED Ar`. I/SAND) OVERLAY DISTRICT "AP" s� �� ,�,i , _ `ram`:: ._ i `� •'�tA �� �`=`' »y • % '' ,SEPTIC PLAN OF LAND BENCHMARK yo _ SUNDELIN WAY TZP a 7 (GS)FOUNDATION ��'ST BARNS"TABLE MA. s6 7 09�' ✓so \ ���.ye o. PREPARED FOR.• L.T.ei TT'S A.M. zls A. 6B RICHARD R. SUNDF'LIN & MARINA W. CESAR PAR. z—z �yo AREA=59,546-4- S.F. ail "I ill SCALE- 1'=40' APPROx WELL WA TER ;ti 06 g2 PER OWNER DULY 27, 2004 EL=37 7'f (G.I.S. 3 REV SEPTEMBER 21, 2004 REV SEPTEMBER 29, 2004 A.M 216 p HOF��d� :. REV 2baa PAR 2-1 ' ® �o� P�GIS T`�c� 9y✓ '\ }E,^�17 ;:. : Try STEPHEN ► a7,` Ia s U J. ��`v t�RG. u.,E YANKEE SURVEY CONSULTANTS POND I3? ► M,Ui,PHY cn y - °F �r �; No. �a9 UNIT 1, 40 INDUSTRY ROAD •,•`�• I 1�9 t g C P. O. BOX 265 s u R vEa` '�FCIST E���a MARSTONS MILLS, MASS. 00648 �s � /V/T �P TEL• 428-0055 FAX420-5553 t� r SHEET 1 OF 2 J# 53729 71 l T.D.F. = 81.7' 20' MIN. # V�EN-plF MORE THAN 3' ABOVE LEACHING 10' MIN. ; 4" SCHEDULE 40 P.V.G _ CONCRETE COVERS MIN Pl7rH 118 PER FT. 2""LAYER OF ---� 4P + CONCRETE COVER WASHED S77ONE ' !i" MAX �s" MAX / / / , i / / ♦ / / / / .' / , / / / ♦ / / , / EL=BO' / EL=78' 4" SCH40 PYC PIPE B"dlAX (OR EQUAL MINIMUM w B" 114 PER FT C CLEAN SAND �—-----)- FLOW LINE y I EL._ -- EXIST 78.3 N 78.3 INVERT 110" 14" o00o O o000 / - 79.25 M/N. EL.- �Z O' 0 00 0 0 0 0 0 0 0 0 0 0 0 00 00 EXIST ADD CAS INVERT INVERT BAFFLE EL.=77 4 6 SUM LEVEL o co 0 8 INVERT 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 00 0 INVERT INVERT 00 00000000000 08 = 735 EL.= s EL. 7Rs5 EL. 7s.z5'_ EL.= 7so __ 4 4 -- (7V BE PLACED ON FIR.v BASE) DISTRIBUTION (4) 500 CAL LEACH/NC CHAMBERS 1500 GALLON BOX DB-9 EL.=75.5' 12.8' X 58' TRENCH 1VRMATION ' SEPTIC TANK ( QD (H-20) PROFILE OF M BE WATER 7ESTEDo) SOIL ABSORPTION SEWAGE DISPOSAL SYSTEM IF MORE THAN ONE OUTLET SYSTEM (SAS) PLACE ON 6" S719NE 3/4" 70 1-1/2" �( � NOT TO SCALE DOUBLE WASHED S7VNE H-2 ff 3� CHAMBL'RS) NO OBSER VED WA TER 7ABLE 06 09 2004 EL.= se.5'_ OBSERVATION HOLE 1 ELEV. 127' —�i PERCOLATION RATE 27 MINI INCH AT _4�'_ INCHES TOP OF GARRETT'S' POND EL=_377' _ DEPTH HORIZ TEXTURE? COLOR MOTT OTHER i 0-8" A LOAMY SAND 10YR 5/2 1410 58.0' 8"-36" B LOAMY SAND 10YR 5/6 r.......... ■......................................■.■.......i 4' 4' %3-BEDR a iww' 6Y6"-156' C LOAMY SAND IOYR 6/4 PERC e4' O 5' 6' 51 4'° %;HOUSE ■ •ti 4 H-20 H-20 H-20 80.9' %� 7uununuuouuuuunuuuumuunuunnunmiP NO WATER .�'NCOQNTERED INSTALL- . 'e, '•. OBSERVATION HOLE 2 ELEV=_81.5 _ (4) 500 CAL LEACHING CHAMBERS DEPTH HORIZ TEXTURE COLOR M07T. OTHER (3) CHAMBERS H-20, (I) CHAMBER H-10 GENERAL NOTES °0 WITH 4' STONE ALL AROUND AND 5& 6' �2 0-8" A LOAMY SAND 10YR 5/2 IN BETWEEN (12.8' X 58). "-36" B LOAMY SAND IOYR 5/6 1) ALL WORKMANSHIP AND MATERIALS SHALL CONFORM TO D.E.P. �� " � CALL YANKEE SURVEY 24 HOURS BEFORE INSPECTION TITLE 5 AND THE TOWN OF _BARIUSTABLE __ RULES AND Cog 6 -156 C LOAMY SAN;' 10YR 6/4 REGULATIONS FOR THE SUBSURFACE DISPOSAL OF SEWAGE. 2) ONE COVER ON SEPTIC TANK SHALL BE BROUGHT TO WITHIN 6" OF FINISHED GRADE-- TWO COVERS WITHIN 12" OF GRADE. NO WATER .ENCOUNTERED 3) ALL LE OF WITHSTANDING H-10 LOADING UNLESS YTHEY ARE UNDER ORSTEM SHALL BE ABWITHIN DESIGN CA L C ULA TIONS: 5 FT OF DRIVES OR PARKING AREAS. H-20 LOADING SHALL BE SOIL TEST USED UNDER OR WITHIN 5 FT OF DRIVES OR PARKING AREAS. OVERNIGHT PERC TES ' NUMBER OF BEDROOMS . '3 4) ANY MASONARY UNITS USED TO BRING COVERS TO GRADE SHALL SOIL TEST DONE BY: BRUCE C. MURPHY, RS. GARBAGE DISPOSAL . . . . . . . . . NO BE MORTERED IN PLACE. TOTAL ESTIMATED FLOW 5) NO DETERMINATION HAS BEEN MADE AS TO COMPLIANCE WITH DATE OF SOIL TEST: _0 710 812 0 0 4 & 0710912004 ( 110__GALIBR./DAY x ___3_ BR.) 330 GAL/DAY DEEDED OR ZONING REGULATIONS. OWNER/APPLICANT IS TO WITNESSED .BY: DAV�, STANTON OBTAIN SUCH DETERMINATION FROM APPROPRIATE AUTHORITY. PROPOSED SEPTIC TANK CAPACITY 1500 GAL 6) UTILITIES SHOWN ARE APPROXIMATE ONLY, EXCAVATION CONTRACTOR IS TO CALL "DIG- SAFE" AT 1-800-322-4844 AT LEAST 72 HOURS 77 SOIL CLASSIFICATION . 1 PRIOR TO COMMENCING WORK ON SITE. � DESIGN PERCOLATION RATE . . . . . < 2 - N./IN. 7) CONTRACTOR IS TO VERIFY GRADES AND ELEVATIONS AS WELL AS EFFLUENT LOADING RATE . . . . . 74 —3 3 G L DA Y S.F. > SITE CONDITIONS PRIOR TO COMMENCING WORK ON SITE. / / 8) PARCEL IS IN FLOOD ZONE—__"C"_____. LEACHING _CAPACITY (AREA X RATE) 338 AL/DAY 9) LOT IS SHOWN ON ASSESSORS MAP _216 AS PARCEL _!?2_. (58X12.8X.33)+(58+58+L2.8+12.8)X2X.33) 338 GAL/DA Y 10) PUMP AND REMO VE EXISTING CESSPOOLS SHEET 2 OF 2 J 53729