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Home My WebLink About0075 SUNDELIN WAY - Health 75 Sudeliu Way West Barnstable A = 216 - 003 1 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments 75 Sudelin Way Property Address Nancy+Joseph Conley Owner Owners Name information is required for every West Barnstable MA 02668 1-22-13 page. Cityrrown State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be akered in any way. Please see completeness checklist at the end of the form. Important:When A. General Information onng out the computer, . ` 0` ZF►.OF t'MSS��' use only the tab 1. Inspector �o ��c' key to move your ' t20 � JAMES •N= cursor-do not James D.Sears use the return -+= key. Name of Inspector *:: :C* Capewide Ent o o —IL�I Company Name - 1. .TIFP.I G�\```� 153 Commercial Street ''�v„r,. Ns Company Address Mashpee MA 02649 Cityrrown State Zip Code 508477-8877 S1623 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. 1 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 `I 1-22-13 pectors 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 some or different conditions of use.. lsns•l iho rift,5 0fridel Form:S tDsurraw Sewage Disposal System•Page 1 of 17 Je111 LG IJ VV.JJ�J - N'� Commonwealth of Massachusetts Title 5 Official Inspection Form a - Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 75 Sudelin Way Property Address Nancy+Joseph Conley Owner. Owner's Name information is required.for every West Barnstable MA 02668 1-22-13 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E 1 always complete all of Section D A) System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below. Comments: B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass"section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the board of Health, will pass. Check the box for"yes","no°or°not determined" (Y, N, ND)for the following statements. If"not determined,*please explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND(Explain below): ISM-1 VIC Tide 5 Official Inspa don Form Subsurface Sewage Disposal System-Page 2 of 17 J CIII GL IJ VV..J`tl./ I- — � t C Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 75 Sudelin Way Property Address Nancy+Joseph Conley Owner Owner's Name information is West Barnstable MA 02668 1-22-13 required for every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ NO(Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ NO (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ NO (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•I111C Title 5 Official Inspection Form Subsurface Sewage Disposal System-Page 3 of 17 f J CIII GL IJ VU.JYI.J I" . Commonwealth of Massachusetts i Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 75 Sudelin Way Property Address Nancy{-Joseph Conley Owner Owner's Name information is W required for every est Barnstable MA 02668 1-22-13 page. CitYrTown State Zip Code Date of Inspection B. Certification (coat.) 2. System will fail unless the Board of Health(and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑, The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank.and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form. 3. Other. D) System Failure Criteria Applicable to All Systems: You must indicate"Yes"or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ® Discharge or ponding of effluent to.the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ® Static liquid level in the distribution box above outlet invert due to an overloaded El or clogged SAS or cesspool Liquid depth in -amp 'is less than 6° below invert or available volume is less than Y2 day flow.4 EWC*llve ISins•11J1 Rie 5 pfGdal Inapedlon Form;Subsurface Sewage Disposal System-Page 4 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 75 Sudelin Way Property Address Nancy-i-Joseph Conley Owner Owner's Name information is West Barnstable MA 02668 1-22-13 required for every page Cityfrown State Zip Code Date of Inspection B. Certification (cost.) 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 2DOOgpd- 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 16,000 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 El El Area 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 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 iSflLi•17f10 Title 6 Official tnepedlon Fenn:SubeuAace Sewage Disposal System•Page 5 of 17 ,JC111 LL 1 VV.VVfJ r•" Commonwealth of Massachusetts Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 75 Sudelin Way Property Address Nancy+Joseph Conley Owner Owners Name information is required for every West Barnstable MA 02668 1-22-13 page. Cityf1rown 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? ❑ ® ys P ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ElWere as built plans of the system obtained and examined?(if they we re 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? 0 ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ❑ ® Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms(design). 3 Number of bedrooms(actual): 3 DESIGN flow based on 310 CMR 15.203(for example: 110'gpd x#of bedrooms): 330 'Sirs-11110 Tille fi Official Inspection Form:Subsurface Se,.ege Disposal System-Page S of 17 f Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 75 Sudelin Way Property Address Nancy+Joseph Conley Owner Owner's Name information is required for every West Barnstable MA 02668 1-22-13 page_ Citylrown State Zip Code Date of Inspection D. System Information Description: The system is a 1500 Gal precast tank D Box chambers Number of current residents: 0 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system?[if yes separate inspection required] ❑ Yes ® No Laundry system inspected? ❑ Yes ® No Seasonal use? Z Yes ❑ No Water meter readings, if available (last 2 years usage(gpd)): well wager Detail: Sump pump? ❑ Yes ® No NA 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: Mini•11110 Me 5 Official Wepecttcn Form:Subsurface Sewage Disposal System•Paps 7 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 75 Sudelin Way Property Address Nancy Joseph Conley Owner Owner's Name information is required for every. West Bamstable MA 02668 1-22-13 page. CitylTown 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: NA 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/Altemative 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): 01ns.11/10 Title 5 official tnspauon Form:Subsurface Sarage Disposal System•Page 8 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form lip e Subsurface Sewage Disposal System Form- Not for Voluntary Assessments 75 Sudelin Way Property Address Nancy+Joseph Conley Owner Owner's Name information is required for every West Barnstable MA 02668 1-22-13 page. Cityrrown . State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: 1998 Permit#98-282 Were sewage.odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): 2-2 Depth below grade: 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.): Pipeing is 4"PVC SCH 40 Septic Tank(locate on site plan): Depth below grade: 14" feet Material of construction: ® concrete ❑ metal ❑fiberglass ❑ polyethylene Q outer(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) [] Yes ❑ No Dimensions: 1500 Gal precast 1„ Sludge depth: t5ins•11110 Title 5 Official Inspection Form:Subsurface Smvaga Disposal System•Page 9 of 17 r• Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments Us " 75 Sudelin Wa y - Property Address Nancy4-Joseph Conley Owner Owner's Name information is West Barnstable MA 02668 1-22-13 required for every page. cityrrown state Zip Code, Date of Inspection D. System Information (cont.) Septic Tank(font.) Distance from top of sludge to bottom of outlet tee or baffle 29" of, Scum thickness 811 Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle 18" How were dimensions determined? Asbuilt-Tape Sludge Judge 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 and covers at 14"below grade w/outlet tee, Tank at working level. No sign of leakage or over loading. 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•1 tlt 0 Title 5 0ftal InsPecdon Form:rijbsurlaoe Sewage Disposal System-Page mG of 17 f ' Jail GL IJ Vu.Jup N• Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 75 Sudelin Way Property Address Nancy+Joseph Conley Owner Owners Name information is west Barnstable MA 02668 1-22-13 required for every page. City/Town state Zip Code Date of Inspection D. System Information (cont.) Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑concrete ❑ metal ❑fiberglass ❑ polyethylene ❑other(explain): Dimensions: -- Capacity: gallons Design Flow: 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 t5ns-'I ill M!19 5 Offida;Inspection Form Subsurface Sewage Disposal System•Page 11 of 17 .ai �� ivvv.vrN r• � Commonwealth of Massachusetts Title 5 Official Inspection Form Uo Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 75 Sudelin Way Property Address Nancy+Joseph Conley Owner Owner's Name information is required for every West Barnstable MA 02668 1-22-13 Ci (Town State Zip Code page, ty p Date of Inspection D. System Information (cont.) Distribution Box (if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 0 Comments(note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box,etc.): D Box is 16"x16"-26" below grade w/one line out. Box is clean and solid. No sign of over loading or solid carry over. 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: 1°Ins-11r1C Tille 5 Official Inspecdkn Form:Sutucrfaoe Sewage Disposal System-Page 12 a 17 JQ11 GL IJ VV.J7i.! r. iv Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 75 Sudelin Way Property Address Nancy+Joseph Conley Owner Owner's Name information is West Barnstable MA 02668 1-22-13 required for every page. CitytTown State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number ® leaching chambers number: 4 ❑ leaching galleries number. ❑ leaching trenches number, length: ❑ leaching fields number, dimensions. ❑ overflow cesspool number: ❑ innovativelaitemative system Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Leaching is four cultec chambers 12'x36,camera out,prob and T.Kat leaching. No sign of over loading, chambers are dry. 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 t5ltts•11110 Tllle 5 Oflldel Inspection Fomt Sbswfaea Sewage Disposal System-Page 13 d 17 f Commonwealth of Massachusetts Title 5 Official Inspection Form " Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 75 Sudelin Way Property Address Nancy.+Joseph Conley Owner owners Name information is required for every West Barnstable MA 02668 1-22-13 page. Cityfrown 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•1'110 Title 5 Offiaal Inspection Form:Subsurface Sewage Oisposa`•System•Page 14 or 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 75 Sudelin Way Property Address Nancy+Joseph Conley -- Owner Owner's Name information is West Barnstable MA 0266E 1-22-13 required for every page. CiWown 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 rl?o AlT lie 0 o r -/= �27 13 A -a - 33 13 -.2 3 r5ins•11110 TNIe 5 Official hupection Form:Subsurface sewage Ooxsei system•Page 15 or 1 T f VG11 LL 1 v vv.vv,.I . - Commonwealth of Massachusetts IMME,?.U .Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 75 Sudelin Way - ProperW Address Nancy 4-Joseph Conley Owner Owner's Name information is West Barnstable MA 02668 1-22-13 required for every page C ,iToym State Zip Code Gate of Inspection D. System Information (cont.) Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to high ground water: 48+ feet Please indicate all methods used to determine the high ground water elevation: ® Obtained from system design plans on record 1998 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: Per plan leaching bottom 48' above Garretts Pond water level Before filing this Inspection Report, please see Report Completeness Checklist on next page. 151ns-11/10 Tile 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 16 of 17 r Jctrl LL I:7 VV.JVF.J N• " Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments 75 Sudelin Way Property Address Nancy+Joseph Conley Owner Owner's Name information is required for every West Barnstable MA 02666 1-22-13 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 Sevrage Disposal System either drawn on page 15 or attached in separate file tSrns•11/10 Tide 5 Offidd hspecdon Form:Subsurface Sewage Disposal Systern-Page 17 or 17 DATE: �. FEE t 1ARMAKS, j .�'� Town of Barnstable REC. BY �Eo� Board of Health 367 Main Street, Hyannis MA 02601 Office: 508-790-6265 Susan 0.Rask,R-S. FAX: 508-790-6304 Sumner Kaufman,M.S.P.H. Ralph A.Murphy,M.D. VARIANCE REQUEST FORM LOCATION Property Address: F)&(L0 S�L&�y tit D��—�� 1 Assessor's Map and Parcel Number: 2 l z 3 Size of Lot: deg A G Wetlands Within 300 Ft. Yes K Subdivision Name: No Business Name: N q APPLICANT CONTAC Name: CO2 S l Ll Name: E i�[2. �ul_�.`v�� PE cx (o$ Address: S WA,I r:�9-MQ 7FA2W1 Address: -7?AIP ►C 02 120 0S OP Q t Phone: -q.2j2D- 33�1�1 FAX: FAX: AZ?3- 3 l I S VARIANCE FROM REGULATION(List Reg.) REASON FOR VARIANCE(May attach if more space needed) W C— ID v EP-1I C— �►'ter E fame)vM.'tic :`( O r T1+G LOT t u L eL c t )nF--5 un Ec t tU� 'IZ-F o t — lSb FOOT S(a r9>AKcu-- Checklist(to be completed by office staff-person receiving variance request application) Four(4)copies of plan submitted(including septic system plans and/or restaurant floor plans) Applicant understands that the abutters must be notified by certified mail at least ten days prior to meeting date at applicant's expense(for Title V and/or local sewage regulation variances only) Full menu submitted(for grease trap variances only) Variance request application fee collected(no fee for lifeguard modifcadon renewal,,grease trap variance renewals[name owner/lessee only),outside dining variance renewals[same ownerfleasee only),and variances to repair failed sewage disposal systems(only if no expansion to the building pmposed)) Variance request submitted at least 15 days prior to meeting date VARIANCE APPROVED Susan G.Rask,R.S.,Chairman NOT APPROVED Sumner Kaufman,M.S.P.H. REASON FOR DISAPPROVAL Ralph A.Murphy,M.D. Q:/WP/VARIREQ ^t y0FTHE T�w TOWN OF BARNSTABLE ��P ♦� OFFICE OF BOARD OF HEALTH i639' 367 MAIN STREET �0 MAY M' HYANNIS,MASS.02601 March 24, 1998 Peter Sullivan, P.E. P. O. Box 659 7 Parker Road Osterville, MA 02655 RE: 75 Sundelin Way, West Barnstble Dear Mr. Sullivan: You are granted variances, on behalf of your client J. Corsiglia, to construct an onsite sewage disposal system and replacement well at 75 Sundelin Way, West Barnstble. The variances granted are as follows: Part XII Section 2.00: To install an onsite sewage disposal system 109 feet away from a proposed onsite well, in lieu of the 150 feet minimum separation distance requirement. Part XII Section 2.00: To install an onsite sewage disposal system 135 feet away from a neighbor's well in lieu of the 150 feet minimum separation distance requirement. Part XII Section 2.00: To install a well 117 feet away from a neighbor's leaching pit in lieu of the 150 feet minimum separation distance requirement. Part XII, Section 2.00: To install a well 142 feet away from a neighbor's leaching pit in lieu of the 150 feet minimum separation distance requirement. These variances are granted with the following conditions: (1) The septic system shall be designed based upon the actual percolation rate which is to be determined at this site. s,wva (2) The proposed soil absorption system shall not be installed any closer than 135 feet from the neighbor's well located at#111 Sundelin Way, West Barnstable. These variances are granted because the existing septic system is malfunctioning and is in need of replacement. The geometry of the lot precludes meeting the local Board of Health setback requirements. The proposed new septic system and well locations meet all of the requirements of the State Environmental Code, Title V and appears to be an improvement over the existing situation. Very truly yours, /OU,044 �� Susan G. R , R.S. Chairman Board of Health Town of Barnstable SGR/bcs s,iuvan 1.��,�'• TOWN Or BARNSTABLE l LOCATION - AJ ,,u u4 a SEWAGE # 7 C;"-0 VILLAGE tt , &O C AA4 I P ASSESSOR'S MAP & LOT ;, /G _0 s-*'A INSTALLER'S NAME&PHONE NO._�, K - Ll a. $ SEPTIC TANK CAPACITY LEACHING FACII.ITY: (type) r- gk, Lk� (size) NO.OF BEDROOMS .� I BUILDER OR OWNER Arip C e-i�' l 1 PERMTr DATE: -.A o 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 i 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 j t� C I y1 6,� A _ , , �vC �a �, p..� i� �!� ' � j 4 A _ �, ( , ( LJG ,� f� � ,, .�s -_ . CL (�-" tea ,� No. �"' � Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS ZippYication for Mizpooar 6pztem Construction Permit Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Add5ss or Lot No. UN e— //J OPoe- er's Namey,kddress and Tel.No. Assessor's Map/Parcel Installer's N e ddressd Tel.Nq. _ Designer's Name,Address an Tel.No. 80 L e L 6, Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) 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 prov' ' o i M nvironmen 1 Code and not to place the system in operation until a Certifi- cate of Compliance has een issued b t alt . Si ,ned Date Application Approved by Date !�e A��- Application Disapproved fo a foNXing reasons Permit No. �2 _ a 9�, Date Issued TOWN OF BARNSTABLE LQCATION u wA SEWAGE # 7V U \/II,IAGE �J P NA IO I P ASSESSOR'S MAP &LOT � 0 6 INSTALLER'S NAME&PHONE NO.�� , - 4 -k 8 'jd S SEPTIC`TANK CAPACITY LEACHING FACILITY: (type) P_. ._ Ck� (size) NO;'Of-BEDROOMS .� BUILDER OR OWNER f' S PERMTTDATE: - 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 i-90i'site or within 200 feet of leaching facility) Feet . Edge o,f.Wedand and Leaching Facility(If any wetlands exist within 30)feet of leaching facility) Feet Fux`tushed by Q �r i • j �£ L7 � :. 9 - •� � � � , Coo 3 No. - _ Fee / a THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes 01pplication for Digpont 6pgtem Congtruction Vermit Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) ❑Complete System El Individual Components Location Address or Lot No. fj,tJ Owner's Name,Address and Tel.No. w OD P N � le, �` S r f t i4 Assessor's Map/Parce G/ Q SO 5" Installer's Name,Addre�sss��`'d Tel.No. Designer's Name,Address and Tel.No. o Fe- �. Type of Building: Dwelling No.of Bedrooms Lot Size sq. ft. Garbage Grinder( ) Other Type of Building No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title . Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) Date lastfinspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provis' s-of T- e 5 of the nvironment 1 Code and not to place the system in operation until a Certifi- cate of Compliance has en issued b hi o alt . , Si•tied Date /4-t Application Approved by Date 4w Application Disapproved f6fle fol ing reasons Permit No.�� Date Issued —————— THE COMMONWEALTH OF MASSACHUSETTS - BARNSTABLE, MASSACHUSETTS Certificate of (Compliance THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed( ) Repaired( >0 Upgraded( ) Abandoned( 4 )by t at has been constructed in accordance A 4 with the provisions o Title 5 and the for Disposal System Construction Permit No. =dated t./- Z S- Installer14- 6t t ,!-$e g gj A,.,C Designers The issuance of this permit shall not be construed as a guarantee that the system will function as designed. Date _t - T Inspector i N — ——— o. ; Fee -� THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS x1i6pont *pgtem ebugtruction Permit a Permission is hereby granted to Construct( )Repair( )Upgrade( )Abandon( ) System located at and as described in the above Application for Disposal System Construction Permit. The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided: Construction must be completed within three years of the date of this permit. Date: _� q Approved by l u�, a ul lfatrlisi.aDIC I ii , /� Department of Health,Safety,and Environmental Services Date 31 1 1�� V Public Health Division 367 Main Street,Hyannis MA 02601 4 l wu�er�� M�4i2.LN 13 19�� Time�� Fee 1Pd. 161P Date Scheduled • Suitability sessment for Sewage Disposal Soil As Witnessed By. Performed By: v`� LOCATION & GENERAL INFORMATION Owner's Location Address Address vi pngineer't Neme� „ v,q,v Q C- Assessor's Map/Parcel: NEW CONSTRUCTION — REPAIR �_ Telephone N -AU 33 Act �aL Slopes(°/.) 4 V 5% Suriece Stones 1J 0 oz_> Land Use ' Z25 fl thinking WOW Well 1� fl Distances from: Open Water Body 2ZS fl Possible Wet Area fl lac,s,(r N6 fl Pmpe'Llne 5�—fl Other Drainage Way�----- "d s of test holes dt Pere tests,locate wetlands in proximity to holes) SKETCH:(Street name,dimensions orlot,exact Iota aQ _` — — T14-1 • � �a , vim . , fi -- I i lx�22C�i 5 �, �D•�-� - Depth to Bedrock Parent material(geologic) �� Weeping tlom Pit Face �� S Depth to Groundwater: Standing Water In Hole: —- �� Et_90 Estimated Seasonal High Groundwater 400 DETERMINATION FOR SEASONAL*HIGH WA'�EI TABLE Mcthod Used: �� D— in. Depth to soil mottles: Depth Observed standing in obs.hole: in. Groundwater Adjustment Depth to weeping from side of obs.hole: Ad factor Adj.Groundwater Level �f Reading Date ��Index Well level___---. j Index well N__...._ ' v. ::.,...bat! � PERCOLATION TEST Observation Time at r 4 Hole N 6b~ Time at 60. ---�'-_ Depth or Pere 3:�puy Times(q"-6") Start Pre-soak Time Q — End Pre-soak Rate Min./Inch GS Site Failed: _ Additional Testing Needed(Y/N)�1.Q_ Site Suitability Assessment: Site Passed original: public Health Division Observation Hole Data To Be Completed on Back--� LUG Hole# 1 ION 1IdLE, Soil Other Iloulden s. 1�1i,[;1s U1151:1tVA� • Soli Color Mottling (Structure.Stones, Soillexlrrre (Munsell) Ikpllr from Soll I lorizon (uSUA) Surface(in.) _———— LA S 90 Co.:,ai-6S t- 7„ SAND` 2J ! s� ll 5 � �a a �Iv7E Lo AVIA 3o-120 11OLSo L�f* Soil UATI il Color Mottling (Structure.Stones. C�� OUsE Donldercs• )(W Soil Texture (Munsell) Uep Ih from Soil I lorizon (USDA) Surface(in.) I.asw.a.� to J --14 Sall UI;I:p d1ISCrtVA'I'�dry 1<1oL Soil alar Mottling (Slnreture.Stones,Douldercs. Soli Texture (Munsell) Ikpllr from Soil I lorizon (us A) Surface(In•) :. . oBsri IIOLC LUG Ilouldercs. RVATION soil, other llCCI Soil Color Mottling (Structure.Stones. Soll'fexture pcplh from Soil II rizon (USDA) (Munsell) Surface(in.) r Yes Above Soo year flood boundary No Within Soo year boundary No—5.- Yes Within I00 year flood boundary No Yes cc material exist in all areas observed throughout the rourDoes at l 8st for tl et s pervious of naturally occurring ccurring oil absorption sys em7 V_ 5� area prop Pervious material? If not,what is the depth of naturally o � • S (date)I have passed the soil evaluator examinatlon approved by the " c I certify flint on ectioii and that the above analysis was performed by me consistent whit r�,� .nvironmcntnl Prot .;t_, l„ 1tn r^.MR 15:017. 1° r• .. •• -, * _ \� \ �I i, �i' ;; T/ ,,\\ \ ' ',, 1 o i ;°o r a. EGG �p° ^ l 38 Y It 1 91 AC ZIL it 0 , o a 1 �,........ LOCUS LAN - 'r�S / SCALE:1"=2000 ASSESSORS ExistingWells 8c Septic Systems Were MAP 216 ARCEL ` \ \ �� ,:•"- Fie Id Varifled \ Topography Taken From Town of ` �, \ ,�. E � JO ', _ .... sT; •\�.._....::�; Barnstable G.I.S. , _ \ , New NOTES DESIGN DATA ,WMLL_ \ i�,J� \„ \\ \ } / \\ "\ --� I.Water Supply ForThis Lot is a Private Wel I. Single Family-3 Bedroom ..... / 0.\ 2. Son on This Plan Are Approx. With y Flowa=110 x Grinder GPD \ \ ,• �' \ , Location of Utilities Shown Dail At Least 72 Hours Prior to Any Excavation For This o = Septic Tank:330 D -660_ GP 200 Pt x /o GPD ` � \x �\ \\\ \\ . ',., `,,, ` \ '•-,,, •-1-- ,, .,K,,. .,, ctorShall Make squired Use 1500 Tank ,I � \ \ „• .,,, . Protect The Contra The R Gallon Sep Notification to Dig Safe(1-800-322-4844) tic \ \ \ \ ' \.._.. \ \ � - ' .., �._ `-.._`_-----__ `' �'.' _•_ � LEACHING AREA \\ � '` __--___ _'-• . , ,-Y,.�...._�:..........._.....v'• y!,,..-''"•�~__ tract red t riots The Contractor is Required o Secure Appropriate Permits From Town Agencies For C ' 330 GPD/0.74=446•L, ; �\ \ �. ---.____._, .,., `� ,,., . ;,, Construction SF Required Defined by This Plan. Sidewall = 202+3512= 188 S.F. Instal Risers " Bottom Area= 12x35 = 420S.F. \\1 t 4 I sets as Regviredto Within 12 of 608 S.F.Total Provided ,01\ A�\ Finished Grade. \ . '_ LEACHING CHAMBER DESIGN 5. Structures Bu Feet or More ct H BER DES N \ \ •F' :,r„,, __. --_., i All Stru tied F orSub'e \ � \ � \ \ �- :\ � _/ `,\�••`�,�.,:�,--••' �.-•- � , our t AlAll Pipes to be Schedule 40.PVC to Vehicular Traffic tobe H-20 Loading. Perforated With Capped Ends. Use Septic System to be Installed' Accordance With - \\ __..y\ P Ys in Distribution Line in Leach*n �\ \• �\ ` `_, % `-�' o s fhambers �n12x35Washed Stone 310 CMR 15.00 Latest Revision ,And The- Town o. . ..... \ `Barnstable Board of Health Regulations. Field as Shown 7. All Piping to be Sch.40 PVC. �� \ \ �i ` EXIST\ Yip\ �` \l` W E L t \ '• `� PLAN VI EW � Scale: I"=40' Finish Grade Fi FL.92 PROPOSED SEPTIC UPGRADE Compacted Fi I 1 3 Maximum FG.91.5 F.G. 91.0 --�` SITE PLAN, trzz a I/8"- I/2" A T 89. O Pea! Stone 75 SUN DELI N WAY 88.8 1500 886 880 W. BARN STABLE ,MA GALLON _ Leaching 81 .4 Bot.E1.86.0 '� 3/4"-1 1/2"Double FOR 86.2 c� Chamber Washed J. CORSIGLIA Bedding as Per Title 5 1 10" 10.5 10 10� 12' 52" SCALE AS NOTED DATE MAR.3:, 1998 ` Garretts Pbnd *6te 12'-0"r SULLIVAN ENGINEERING INC. 'E Ieu.38.0 - - 7 PARKER ROAD OSTERVILLE , MA 02655 -DEVELOPED -PROFILE OF PROPOSED SEPTIC SYSTEM CROSS SECTION OF CHAMBER (508) 428- 3344 Not to Scale Not to Scale 98028 f