HomeMy WebLinkAbout0131 ATTUCKS LANE - Health 131 Attucks Lane
Barnstable
A = 254 - 012
No., Fee C19-5
THE COMMONWEALTH OF MASSACHUSETTS
Entered in computer:
^Ys
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS
application for Bispo8al *pstrm Construction Permit
Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon(✓) EaComplete System ❑Individual Components
Location Address or Lot No./3 19 C'kS Owner's Name,Address,and Tel No. 1'd V&3/a
25d-M64able,/y e q- Ca 0od 5 C0t1s,S-X II ,8a.�''�
Assessor's Map/Parcel 25 -U/2 Ws't'pd, Oren r,�{ Oz&.10
Installer's Name,Address,and Tel.No. P// Designer's Name,Address,and Tel.No.
C•C• �DI'1FhzJG-fide,ZnC
%SDlumavcds Phi S. Dennis W oz�r�n
Type.of Building: 6,93� Fr CBui1P'as
Dwelling No.of Bedrooms nl Lot Size 2,7q q-c.e_rs sq.ft. Garbage Grinder( )
Other Type of Building Co MMeKe t m- No.of Persons 91to- Showers( ) Cafeteria( )
Other Fixtures
Design Flow(min.required) gpd Design flow provided gpd
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) ex1SnN9 SePjjc 'Wk- 4yVU ArMl/Vu7POn1 GO/-
ca/Tl� C.t;�Grt�ieU� Pio�Ng
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 ode and not to place the system in operation until a Certificate of
Compliance has been issued by this Boar e
S ed Date
Application Approved by Dated /
Application Disapproved by Date
for the following reasons
Permit No. (� �� Date Issued �y PS
.x' ti ., v^ri. _, .... �,,,,,-.:Y'w.+«h-tvK i.._�.��F4"•,� k�-•".i,.y.<r ..'Y.t, y�...o..-. +A:.,.,, .tf�+y. .-r`..�. v..,,. -�-' -a.. ... '� 'T,S;
�� - +•`� ,-�, r
No. � Fee
Y +s
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS w
2pplitation for. Bisposaf 6pstem Construction Permit
Application for a Permit to C o/nsmtct( ) Repair( ) Upgrade( ) Abandon(L�-y 2'Complete System ElIndividual Components
Location Address or Lot No.,:/3 j f� Gil'/<.S Owner's Name,Address,and Tel.No:
(l CrY)f�flGle, rli W oed 5(,en ff-_rx 69�5'
Assessor's Map/Parcel 2 5 '- � jq ()Pft P,d, 0 r lP<i r7 r,/+0 UZ&53
Installer's Name,Address,and Tel.No. S_A - /f_ /f'// Designer's Name,Address,and Tel.No.
/S/)IG'l�Ltr�h hi��� S. � hl7i• ,44 p ?L�I.FC
Type of Building:
Dwelling No.of Bedrooms /01,4 Lot Size 2.7y fl«�S sq.ft. Garbage Grinder( )
Other Type of Building '1 p X1`4C ie r 01 No.of Persons p l Showers( ) Cafeteria( )
Other Fixtures
Design Flow(min.required) gpd Design flow provided gpd ?
Plan Date Number of sheetsRevision Date
Title
Size of Septic Tank. 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 I�
1 accordance with the provisions of Title 5 of the Environmental ode and not to place the system in operation until a Certificate of /
Compliance has been issued by this Boar o e
~' Si ed Date n- ��
Application Approved by Date
Application Disapproved by Date
for the following reasons
Permit No. 4;::;— Cr' Date Issued
THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE,MASSACHUSETTS
Certificate of Compliance
THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired( ) Upgraded( )
Abandoned(l/fby �,1:. �O.El�STIeIICTU/� /�/c. /� h14AfoW1)S
at 121 A'Jjl W d1(-NG /���/��� has been constructed in accordance
with the provisions of Title 5 and the for Disposal System Construction Permit Np.� '/9 -al dated
Installer Designer
#bedrooms Approved design flow gpd
The issuance of this permit shall not/be construed as a guarantee that the system will fun ion s e's'gned.
Date /�� / /�" Inspector --.-..'.
No. " Fee
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION- BARNSTABLE,MASSACHUSETTS
Misposal *pstem Construction i3ermit
Permission is hereby granted to Construct( ) Repair( ) Upgrade( ) Abandon(V
System located at 1.31 A77uCA5 L4A/E' 9494 SM94C. 40 — x
and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with
Title 5 and the following local provisions or special conditions.
Provided:Constructio must be co pleted within three years of the date of this permit.
Date �'�� Approved by
TOWN OF BARNSTABLE t
LOCATION �` /� C `'� SEWAGE# ��� \ ��
VILLAGE ASSESSOR'S MAP&PARCEL
INSTALLER'S NAME&PHONE NO.
SEPTIC TANK-CAPACITY
LEACHING FACILITY: (type) ID Q)Q)X 0 01
(size)
NO. OF BEDROOMS
OWNER 3 P"NUCIVIS
PERMIT DATE: ��r� l� COMPLIANCE DATE: q 1&�N�
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 We and Leaching Facility(If any wetlands exist within
300 feet of leaching facility) Feet
FURNISHED BY
C
O
X
No. / Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS Yes
application for ]Disposal Opstent Construction 30Prtttit
Application fora Permit to Construct( ) Repai Upgrade( ) Abandon( ) ❑Complete System Individual Components
Location Address or Lot No. \J; N �zs ` Owner's Name,Address,and Tel.No.
�c
Assessor's Map/Parcel t4. —0/
I ller's Name,Address,and Te No. R� Designer's Name,Address,and Tel.No.
i oZ`► V 6 1
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(min.required) gpd Design flow provided gpd
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) �Ca p i �� (�}c
C. Q01
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 Certificate of
Compliance has been issued by this Board of lth. /
Si d Date
Application Approved by Date
Application Disapproved by Date
for the following reasons
Permit No. w z ! —ij9 Date Issued
_�a..��dba�����ad_aaaa�a�.aua�aa_,d_a_ti_�_.._�...___�_..__--_--_--_------------------------------------------------------------- � -
No. Fee
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
Yes
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS
2pplicatlon for -isposal 6pstem Construction Permit
Application for a Permit to Construct( ) RepaitJUpgrade( ) Abandon( ) ❑Complete System N individual Components
Location Address or Lot No. `31 O
Map/Parcel
's ame,`A,ddres and Tel.No.
Assessor's Ma —C)/2- �Q'�n l ..E �ct,c.S L L�.o�Jr �
Installer's We,Address,and`e o6 v R Designer's Name,Address,and Tel.No.
Fc � sa�rac7�r v6G 5
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(min.required) gpd Design flow provided gpd
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)
1
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 Certificate of
Compliance has been issued by this Board o alth.
CS-ighqd Date
Application Approved by Date
Application Disapproved by Date
for the following reasons
Permit No. ✓ '1 ` Date Issued Z /
--------------------------------------------------------------------------------------------------------------------------------------- a
THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE MASSACHUSETTS -' ►\ ofi/A/
(Certificate of Compliance 1
THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed•( ) Repaired( V< Upgraded( )
Abandoned( )by
at � A� /A 'A VG\,C.�1�('r• has been constructed in accordance
with the provisions of Title 5 and the for Disposal System Construction Permit No9-C dated
i
Installer Designer
#bedrooms ; Approved design-flow , gpd'
The issuance of this eitts�ha Knot be construed as a guarantee that the system wi i nc ions as,deb igned. /�)� �j
Date J/X-/ / Inspector
No. 9.G/L( -- I 1 A Fee
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS
Misposal *pstem Construction Vertu
Permission is hereby pgranted to Construct( ) Repair�) Upgrade( ) Abandon( )
System located at \ 3 ` tk `A V ukz)
and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with
Title 5 and the following local provisions or special conditions.
r
Provided:Construction inst be comp eted within three years of the date of this ' rmit.
Date 0 C� 1 y Approved by
� � -D►2
l� Commonwealth of Massachusetts
W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
;M 131 Attucks Lane
Property Address
p Y
Songtime Inc.
Owner Owner's Name
information is
required for - AVri Ma. 02601 8/28/2009
every page. City/Town State Zip Code Date of Inspection
Inspection results must be submitted on this form. Inspection forms may not be altered in any
way. Please see completeness checklist at the end of the form.
Important: A. General Information
When filling out �) / v
forms on the
computer,use 1. Inspector:
only the tab key
to move your Robert Paolini
cursor-do not Name of Inspector
use the return
key. Capewide Enterprises,LLC.
Company Name
P.O.Box 763
Company Address
Centerville Ma. 02632 !
�rmn City/Town State Zip Code
(508)428-4028 S14454
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
8/28/2009
Insp tor's g 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•09/08 Title 5 Official Inspection Form:Subsurface Sewage Di- sal System-Page 1 of 17
t
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
131 Attucks Lane
M
Property Address
Songtime Inc.
Owner Owner's Name
information is required for Hyannis Ma. 02601 8/28/2009
every page. 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:
® 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:
The septic system is in proper working order at the present time.
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-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17
Commonwealth of Massachusetts
rZ Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
131 Attucks Lane
Property Address
Songtime Inc.
Owner Owner's Name
information is required for Hyannis Ma. 02601 8/28/2009
every page. City/Town State Zip Code Date of Inspection
B. Certification (cont.)
B) System Conditionally Passes (cont.):
❑ Observation of sewage backup or break out or high static water level in the distribution box due
to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will
pass inspection if(with approval of Board of Health):
❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below):
❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below):
❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below):
❑ The system required pumping more than 4 times a year due to broken or obstructed 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•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17
i
Commonwealth of Massachusetts
W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
,M 131 Attucks Lane
Property Address
Songtime Inc.
Owner Owner's Name
information is required for Hyannis Ma. 02601 8/28/2009
every page. 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 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
or clogged SAS or cesspool
❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less
than Y2 day flow
t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form Not for Voluntary Assessments
131 Attucks Lane
Property Address
Songtime Inc.
Owner .Owner's Name
information is required for Hyannis Ma. 02601 8/28/2009
every page. City/Town 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.
a ® 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 CMR 15.303, therefore the system fails. The
system owner should contact the Board of Health to determine what will be
necessary to correct the failure.
E) Large Systems: To be considered a large system the system must serve a facility with a
design flow of 10,000 gpd to 15,000 gpd.
For large systems, you must'indicate either"yes"or"no"to each of the following, in addition to the
questions in Section D.
Yes No
❑ ❑ the system is within 400 feet of a surface drinking water supply
❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply
❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection
Area— IWPA)or a mapped Zone II of a public water supply well
If you have answered "yes"to any question in Section E the system is considered a significant threat,
or answered "yes" in Section D above the large system has failed. The owner or operator of any large
system considered a significant threat under Section E or failed under Section D shall upgrade the
system in accordance with 310 CMR 15.304. The system owner should contact the appropriate
regional office of the Department.
t5ins•09108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
131 Attucks Lane
Property Address
Songtime Inc.
Owner Owner's Name
information is required for Hyannis Ma. 02601 8/28/2009
every page. City/Town State Zip Code Date of Inspection
C. Checklist
Check if the following have been done. You must indicate"yes"or"no"as to each of the following:
Yes No
® ❑ Pumping information was provided by the owner, occupant, or Board of Health
❑ ® Were any of the system components pumped out in the previous two weeks?
® ❑ Has the system received normal flows in the previous two week period?
❑ ® Have large volumes of water been introduced to the system recently or as part of
this inspection?
® ❑ Were as built plans of the system obtained and examined? (If they were not
available note as N/A)
® ❑ Was the facility or dwelling inspected for signs of sewage back up?
® ❑ Was the site inspected for signs of break out?
® ❑ Were all system components, excluding the SAS, located on site?
® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank
inspected for the condition of the baffles or tees, material of construction,
dimensions, depth of liquid, depth of sludge and depth of scum?
® ❑ Was the facility owner(and occupants if different from owner) provided with
information on the proper maintenance of subsurface sewage disposal systems?
The size and location of the Soil Absorption System (SAS)on the site has
been determined based on:
❑ ® Existing information. For example, a plan at the Board of Health.
❑ ® Determined in the field (if any of the failure criteria related to Part C is at issue
approximation of distance is unacceptable) [310 CMR 15.302(5)]
D. System Information
Residential Flow Conditions:
Number of bedrooms (design): Number of bedrooms (actual):
DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms):
t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
°M 131 Attucks Lane
Property Address
Songtime Inc.
Owner Owner's Name
information is required for Hyannis Ma. 02601 8/28/2009
every page. City/Town State Zip Code Date of Inspection
D. System Information
Description:
Number of current residents:
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:
Sump pump? ❑ Yes ❑ No
Last date of occupancy: Date
Commercial/Industrial Flow Conditions:
Type of Establishment: Office
Design flow(based on 310 CMR 15.203): 300gpdGallons per day(gpd)
Basis of design flow(seats/persons/sq.ft., etc.): Sq.ft.
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•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17
c
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
<c,M 131 Attucks Lane
Property Address
Songtime Inc.
Owner Owner's Name
information is required for Hyannis Ma. 02601 8/28/2009
every page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Last date of occupancy/use: 8/28/2009
Date
Other(describe below):
General Information
Pumping Records:
Source of information:
Was system pumped as part of the inspection? ❑ Yes ® No
If yes, volume pumped:
gallons
How was quantity pumped determined?
Reason for pumping:
Type of System:
® Septic tank, distribution box, soil absorption system
❑ Single cesspool
❑ Overflow cesspool
❑ Privy
❑ Shared system (yes or no) (if yes, attach previous inspection records, if any)
❑ Innovative/Alternative technology.Attach a copy of the current operation and
maintenance contract(to be obtained from system owner)and a copy of latest
inspection of the I/A system by system operator under contract
❑ Tight tank.Attach a copy of the DEP approval.
❑ Other(describe):
t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17
Commonwealth of Massachusetts
. Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
131 Attucks Lane
Property Address
Songtime Inc.
Owner Owner's Name
information is required for Hyannis Ma. 02601 8/28/2009
every page. Cityrrown State Zip Code Date of Inspection
D. System Information (cont.)
Approximate age of all components, date installed (if known)and source of information:
1985
Were sewage odors detected when arriving at the site? ❑ Yes ® No
Building Sewer(locate on site plan):
2'
Depth below grade: feet
Material of construction:
® cast iron ❑40 PVC ❑ other(explain):
Distance from private water supply well or suction line. 10+
feet
Comments (on condition of joints, venting, evidence of leakage, etc.):
Joints appear tight.No evidence of leakage.System vented through the building vents.
Septic Tank (locate on site plan):
2'
Depth below grade: feet
Material of construction:
® concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain)
If tank is metal, list age: years
Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No
Dimensions: 1000 gallon H2O
31.
Sludge depth:
t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
131 Attucks Lane
Property Address
Songtime Inc.
Owner Owner's Name
information is required for Hyannis Ma. 02601 8/28/2009
every page. 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
29"
Scum thickness
0"
Distance from top of scum to top of outlet tee or baffle
8"
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.):
Pump septic tank every two years.lnlet and outlet tees are in place.No evidence of Ieakage.Tank
appears structurally sound.
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•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17
Commonwealth of Massachusetts
W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
;M 131 Attucks Lane
Property Address
Songtime Inc.
Owner Owner's Name
information is required for Hyannis Ma. 02601 8/28/2009
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
t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17
Commonwealth of Massachusetts
W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
;M 131 Attucks Lane
Property Address
Songtime Inc.
Owner Owner's Name
information is required for Hyannis Ma. 02601 8/28/2009
every page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Distribution Box(if present must be opened)(locate on site plan):
Depth of liquid level above outlet invert No
Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any
evidence of leakage into or out of box, etc.):
Box is level.Box has one outlet Iateral.No evidence of solids carryover.No evidence of leakage into or
out of box.
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•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
�M 131 Attucks Lane
Property Address
Songtime Inc.
Owner Owner's Name
information is required for Hyannis Ma. 02601 8/28/2009
every page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Type:
❑ leaching pits number:
® leaching chambers number: 2 flowdiffusors
❑ 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.):
Sandy dry soil.No signs of hydraulic failure.No ponding or damp soil.Leaching was dry at time 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
t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
�M 131 Attucks Lane
Property Address
Songtime Inc.
Owner Owner's Name
information is Hyannis Ma. 02601 8/28/2009
required for y
every page. Cityrrown State Zip Code Date of Inspection
D. System Information (cont.)
Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,
etc.):
Privy(locate on site plan):
Materials of construction:
Dimensions
Depth of solids
Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,
etc.):
t5ins•09108 Title 5 Official Inspection Form:Subsurface Sewage.Disposal System•Page 14 bf 17
Map v Page e 1 of 2
Town of Barnstable Geographic Information System
Parcel Viewer Custom Map Abutters Map Size zoom Out ,In
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httn://www.town.hamstable.ma.us/arcims/annLyeoann/man.asnx?nronertvTD=254012&man... '9/31/2009
Commonwealth of Massachusetts
W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
M 131 Attucks Lane
Property Address
Songtime Inc.
Owner Owner's Name
information is required for Hyannis Ma. 02601 8/28/2009
every page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Site Exam:
® Check Slope
® Surface water
❑ Check cellar
❑ Shallow wells
Estimated depth to high ground water: Bottom of leaching 4'
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: 1985
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:
USED:USGS Observation well data.USED:Technical Bulletin 92-0001 plate#2 annual ranges of
groundwater elevations.
Before filing this Inspection Reporti please see Report Completeness Checklist on next page.
t5ins•09/08 Title 5 official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17
Commonwealth of Massachusetts
W Title 5 Official Inspection Form
_ Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
131 Attucks Lane
Property Address
Songtime Inc.
Owner Owner's Name
information is required for Hyannis Ma. 02601 8/28/2009
,
every page. City/Town State Zip Code Date of Inspection
E. Report Completeness Checklist
® Inspection Summary: A, B, C, D, or E checked
® Inspection Summary D (System Failure Criteria Applicable to All Systems)completed
® System Information-Estimated depth to high groundwater
® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file
t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17
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l-O CAT ION LCPr la ti^ S E W A G E PERMIT N O.
0)p RiE I3� � ,C.P ;10k)a a, Rd �`35-6 -tom
V 1 gl/L A G E
I N S T A LLER'S NAME A ADDRESS
d UILLDE�R� OR OWNER
e e L u[J.,
DATE PERMIT ISSUED _
DAT E COMPLIANCE ISSUED
i
r qq
�1
(V
V
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a
� r1VY — .;_LAeA C(0tAAMCRCAA4._ -FtL_JE:
t, 'No..... FEs....v®off
THE COMMONWEALTH OF AASSACHUSETTS
13�� BOARD OF HEALTH
-_)bwI j...............OF......I.a ...:�.�. :.
31 ,� rluttfiuit for Disposal Works C> ons#.rudiun rami#
Vs
�;2aA Application is hereby made for a Permit to Construct ( or Repair ( ) an Individual Sewage Disposal
r System at: OL.D U 132-dAND OLD S3e°EWSEMY FIlLgZZ_D,
.2: p --•--...---•••......• ... ---- -- .....................................................
Location- ddress
or Lot No.
H? is..dP.NIw.' .. Uh. ........................................... 7.6�,..1N:.1�1�91t�_.�:I:. h'`�rr�/�!�!.✓.1`........................
W Owner Address
Installer Address
Type of Building Size Lot-17,,.7 QA....Sq. feet
U Dwelling No. of Bedrooms............................................Ex anion Attic a g— p ( ) Garbage Grinder ( )
aM cOther—Type of Building . )%� . .....: No. of persons............................ Showers ( ) — Cafeteria ( )
QOther fixtures .........-•••••-•••-•--•--•-••:--•••....-••.......................-••..........-•••••-•.................•---........................---...-••--.......
W Design �:....gallons per person per day. Total daily flow........z 9-2........................gallons.
WSeptic Tank—Liquid capacity 99q..gallons Length.8.&..... Width:.4A.... Diameter................ Depth....41 EFF
x .Disposal Trench—No.�...r..�............ Width...._..... ..__. Total Length.................... Total leaching ai-ea....................sq. ft.
One Seepage Pit 1'�0..__... �..eT�Diameter.........+..;i� pth below inlet............:....... Total leaching area.32L ...s�t:6/?o
Z Other,Distribu iot-bx ( ) Dosing tank ( )
aPercolation Test Results Performed by..I�i.�.:4&..CAeE... 1. � �N�.... Date... "�P'.�.:5q.........
4 Test Pit No. 1....!�•Z_...minutes per inch Depth of Test Pit.:••%a...._. Depth to ground water... _........--.
44 Test Pit No. ....minutes per inch Depth of Test Pit...1 4//.... Depth to ground water.JV.,; ....
a
h.0 Description of Soil.. 1.... 4:. _.
............... �1 s'
e ...... ........... - - - �._........ ..f ........ _.----- - ----.---,--.........
................
v .--- A r Vi __ FI 5�
rJ Nature of Repairs or Alterations—Answer when applicable.................. . . .................................................................
:................................•--...........•---•-.........-•-•••--•--•-•••-----•--........-•----...---•••••--...--••••.................--••--.................•............._.................
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of:I':L:; 5 of the State Sanitary Code—The undersigned further agrees not to place the system in
operation
until a Q cate of Compliance has be i ed by�boa of health.
Signed.. ......... ... ..............:.....
D e
Ali ion A roved B ................•-•-----....:---•-•---....................--•---. .._........ .....--•-
P PP Y �_ . S.
pplication Disapproved for the lowing reasons:...................:
------•--•------•.............•-••----•-......-----••-••...------......•--••-•----•....._.......................-•-...._.._..........--•-•-----•.........-•-............--........................-•-•--
Date
r � ... Issued.......•-•--� `"(.�,......F5...
Permit No..-•------�................•------.....--------... ..... ..........
Date
- � Y
k
O�U
3 ^ +
THE COMMONWEALTH OF MASSA;CHUSETTS
BOARD OF HEALTH
. -................o ......13A# c t
-
I ,,,CtAVp1utttivu farRsposal Works Tonstrurtion Permit
N Application is hereby made for a Permit to Construct (X) or Repair ( ) an Individual Sewage Disposal
System at: OLO R.T 132. AND Ot_b STeALve&R_y fuufiD,
Z Ass s_ orz S M A 25 LO`- 1 Z
..... _-- -..._. .. ....... - ......... .............. ........l...-----.........••------•••-----•-----................-__•--••-•-.....--•........._..
Location-Address or Lot No.
C(l! �SUPN :.._Kv!.(v......_.. .....- -- .....-•- 6 _-W:_MAIN.s.?... �I :A �n1S. .....................
W Owner Address
a .......•• ..... ........ .... ....... ..
Installer Address
Type of Building Size Lot.1 1,10 a.....Sq. feet
.-� Dwelling—No. of Bedrooms...........:.:..............................Expansion Attic ( ) Garbage Grinder ( )
..a
aOther—Type of Building F ILK....... No. of persons............................ Showers ( ) — Cafeteria ( )
Q Other fixtures ............. .......... _
W Design Flow_ ����A�-e�O�q__1✓fL_...gallons per person per day. Total daily flow_._.-...z ........................gallons.
04 Septic Tank—Liquid*ca.pacityJAK...gallons Length.f_1!Z...... Width:.;yt..... Diameter................ Depth....'
Disposal Trench—No........:............ Width............ .....Total Length.................... Total leaching area........:...........sq. ft.
3 or+` Seepage Pit No....... Diameter........ .. i,tDepth below inlet.................... Total leaching area.59Z.-I...s�t:6/b
Z Other Distribution box ( ) Dosing tank ( )
aPercolation Test Results Performed by.- ....CANE...�UGI lv��.21•IV��..._ Date... ..........
Test Pit No. l...G .....minutes per inch Depth of Test Pit...9 ....... Depth to ground water..9.N
G4 Test Pit No. .._..minutes per inch Depth of Test Pit--- ._._.__. Depth to ground water../VKZ& ....
W
O Description of Soil....... :: -Z4".10�1!►'1••,t....I 21 �I.:F-L M4l 5�1�0:. 8��.'..c��.. /�1✓ � � ..�J
V ...-•.......................................••-•--•----•----.....................................................--•-••----•........_...........t......_..._....-•••••--••.....:...................
T..: -------="
UNature of Repairs or Alterations—Answer when applicable...............................................................................................
.--•-------------•-•-•-•-•-••---•---..........--------•-•-------.......-----.......................•-•••••.........
Agreement
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of LITLZ 5 of the State Sanitary Code— The undersigned further agrees not to place the system in
o eratio until a Q r sate of Compliance has been iiisssued by the board,of health.
l Signed.t.:.4-�&, i �" ..........................
`............. Qe
7AIicatio A roved B ----•-•...........................•PP Y So
ion Disapproved for the Mowing reasons-----------------I.............--•--••-•----=---------...........--••--.....••................•---...••••.......
�.... ..... ........................... ......... •-••-•••--•••-••••-.....................•............•..-----..........------•....Date .........._
Permit No..... ...... ..5.o----•-•---------_.--. Issued_........... ....... .----•-.....
♦ Date
_, =' -= --, .+..ar;+-._.r -a �.•-.._i s+ �++ —m..———e,;- .r— — s-- r� a� c a:• +6r +. «. +,� �Rr .s- a=.. - .� .�.-- *_�THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
` ..........................................OF....................................................................................
(Irrtif ratr of Tomplinnrr
THIS IS TO C RTIF1Yi That the Individual Sewage Disposal System constructed ( ) or Repaired ( )
by...................+ ......... .!:Il`!_._r�1 .�Z. `,�..................Installer-----^......-^••............................................................................
at......••••. . .._.. .........Q-f- ....... '......1---�-z.-......-:1:.----...W--._.•. [--►' l r�F..�"s ..................
has been installed in accordance with the provisions of TITLE 5 of Th State S-nitar Cod9 as escribed in the
application for Disposal Works Construction Permit No...... i .. dated__.....4/.l. .... ...................
.� 3�.... . ((
THE ISSUANCE.OAF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARA TEE THAT THE
SYSTEM WILL iFUNCTION SATISFACTORY.
DATE................ ................................... Inspector.............
�� + ..........
.
4 THE COMMONWEALTH OF MASSACHUSETTS N .� LfT?E
BOARD OF HEALTH D4F.' 11&NtVN V JFNVrNCf-K
'1 Y AMWSy51£t✓li�l boll
No..... s.. ,�t.>G .......................................OF...............--•--•--.........-- --------•---•-----............................ FEE. 7 0C, W�
t pasa - urkii Tunstrurttan Permit --rttL S.
(� .i
vlttl (i<
Permission is hereb}��granted.......J1r--' .............................:..�...-•---------•-••--••--•----...----._.._..---=---._.....-•----•--•--...................._..--
to Construc ---------5%,"k.......ad:..15.11 .... ... ....0�t�,( ) or Repair°`-( ), an Individual Sewage Disposal Sy em �
Street
{�
as shown on tl'e application for Disposal Works Construction Permit No ___35G._ Dateyd........ '.."17-.'. .......
.... -----•----------- • ------ ........
...._ 74 ... _....._..�
� � and of Health
DATE.._.... T ................
4.
� i
. CleS �-
LO CATION Lcpr' SIEWA G E . PERMI
T NQrd
V I L L A G
IMSTA LLER'S NAME A ADDRESS
8 U I L D E R OR OWNER
e ge L
DATE PERMIT ISSUED
D A T E COMPLIANCE ISSUED
77
I
926 main street /7 362-4541
yarmouth at n
mass. 02675 Will cape en.Viaeeiing
civil engineers&land surveyors
structural design
Arne H.OJala P.E.,R.L.S.
land court Richard R.Fairbank P.E.
surveys
site planning November 4, 1985
sewage system
designs
Barnstable Board of Health
inspections 367 Main Street
Hyannis, MA 02601
permits Dear Sir:
This is to certify that Down Cape Engineering inspected
the construction of the septic system for the Lebel-Sollows
office building located at the junction of Old Strawberry
Hill Road and Old Route 132, and it complies with the intent
of the design shown on our plan #84-247. Revised Septem-
ber 11, 1985.
Yours truly,
�4Arne H. Oj . , .L.S.
AHO/lc
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