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Home My WebLink About0043 IRIS LANE - Health (3) hs Lan `!)FORMERLY PART OF#39 Barristanle �` in 2QO5:split into two: #37 +43 A = 334-- 051 (443,'has existing house fioin# 39) _ n4 I i I, I 0 u � 1 KINGMAN, ROSERr r KINGMAN, LAUREN AI' tint c1BSOM RUSSELL A JR Qt JAM/E L I uruny I f J27 OAKMONt RD ?96 OA'KMONr RO i I Poles CUMMAOUID MA 027J7 YARMOUTHPORT, MA 02675 II - f v �r I , I Q I I Lot 3 Mi.. f Lt Areom43;0�* Sq. Ff. o 0 I II f Area-51,873f SO Ft. i I I I Lot 2 ;' 1.00 Acres Or I rn`� ' —" (Shape-21.63) 1.19 Acres II I I � `D �Area=43,569f Sq. Ft.I" � (Shape-15.58) I �t:jp Or C I I I I W 1.00 Acres t # pselc �I (Shape= E 16.7'4) % xlaf. I i I fi'I � 0 1 7, it I I y i �,, _ I• ?` S 1OV4'J5 ly .,� �y trls ® ® R I I t 1 I i v I 18•k CONNORS, JOHON N M„?I tit BOS>ojV,M 0 2 6T ? ,. I J,14y. MIS (S0 Wide — Prlyeyets) L ane (Payed Surface 22'Wlde) I I Pam utnny _ Pole - ZONING SUMMARY OWNER OF RECORD ZONING DISTRICT. RF•-1 RESIDENTIAL DISTRICT SA a TRAYWICK A �1 P.O. BOX 216 /�'11 MIN. LOT SIZE 43.560 S.F. WEST HYANN►SPORT, MA 02672 MIN. LOT FRONTAGE 20' MIN. LOT WIDTH 125' JONATHAN TYLER MIN. FRONT SETBACK 30' P.O. BOX 80 MIN. SIDE SETBACK 15 , WEST HYANNISPORT, MA 02672 �C BARNSTABI MIN, REAR SETBACK 15 LELEB ANC, MICHAEL J do KATHLEEN M J 7 BEING A REWA$'iGURATIOr 295 LINCOLN RD ,! t E'1 -1 IC IAA d P610 HYANNIS, MA 02601 p' � _ a rec nrUnln, In0 UiC.ti'!7 OAnaant Roan W . �& un 1 LOURW UAP(NO$Can N bq PROP. - owEtL / IF^ no BENCHMARK Ike. ?4A� TOP OF s TEL RISER ELEv=71.44' PROP- Gm 2 6 s V 7H{ tV ELECTRIC r 43A'� EASEMENT '* ELECTRIC EASEMENT , • %3 � .�% �� ,i IRIS �=� „Q LANE PROPOSED LOT AREAS Il SF ?2z�, 43684 N OTES: ELEVATION APPROX. NGVD r MUNICIPAL WATER IS AVAILABLE1. 4 \ �`l r ASSESSORS MAP 334 P/0 51 '& 50 ZONING: RFI (FRONT: 30'. SIDE. 15'. REAR. 15') SITE PLANS FOR HISTORIC FILING PURPOSES ONLYor J PROP. LOT, IRIS LANE ARNE o, IN TW TOMR1 OF K �, BARNSTABLE �N' ''AfED FOR: J0IVATIMN TYLER � e _ ARNE H. PE. PLS �DATE 30 0 30 60 90 Feel 14-056 SCALE 1" 3W DAZE: JANUARY 4. 2005 F ' N/F N GLORYA GLARKE ROBERT F. do LAUREN M.KINGMAN �-- 1 CERTIFY THAT THE STRUCTURE SHOWN ON THIS N09'50'55"E 128.66 N0 ' --� DRILL HOLE 128.6 ' fnd PLAN IS LOCATED AS SHOWN AND TO THE BEST OF ��- 70.73' 'CBDH MY KNOWLEDGE COMPLY WITH THE DIMENSIONAL STAKE fnd REGULATIONS OF ZONING BY- LAWS OF THE TOWN &TACK OF BARNSTABLE AND IS LOCATED,IN FLOOD ZONE fnd. C(NOT A SPECIAL FLOOD HAZARD AREA) AS a SHOWN ON THE F.E.M.A. FLOOD INSURANCE RATE =r MAP NUMBER 250001 0011D, EFFECTIVE DATE 07/02/1995 IRON ROD fnd 26.3 SHOWER m t,*' � DECK 77•9 Np �y ZO _ F.a,� - i 4.0 FARMER u 1 '� NK PROPERTIES INC MAP 334 PORCH f^ •0' PARCEL 5 9 $ v i ' LOT 3 A435601S.F. IN N/F 0 0 n`CHARIES R h JANET E BAUER x 26, 3, ,. 1 7.9 o, (� 4.8 BULKHE D CHIMNEY (.p(l tom,> ; Dk:697 p9: 2 STAKE SET ON p'AN LOT LINE(TYP) 255.05' ..- - S10'04'35"W SET I IRON ROD WTTH CAP FC"ic PLOT PLAN _ - PAUL&WENDY LAPINE. 43 IRIS LANE �m .4/ BARNSTABLE(CUMMAQUID) A,V •� MASS. y� SCALE.1"_30'INIG DATE:2/17/2009 P.K � BENNETT ENGINEERIN fnd c-23.14' LANENGINEERI.'IG.B DEVELO RVICES --443t TO OAKMONT ROAD -" S1224'12"W "--. " fnd -" PO BOX 297 TEL(SOfl)888.4068 IRIS (50' WIDE— PRIVATE)1 L�N F+ SAGAMORE BEACH,MA 02562 FAx.(508)860-4867 PLAN REF: 2EIK2 39/ PG 2 LANE i—r «�4+ i�� 0 30 60 90 DEED REF: 22339/117 JOB NO: 1288 s-` Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ° 43 Iris Lane M Property Address Samuel Traywick Owner Owner's Name information is q required for Cumma uid Ma. 02637 8/2/2007 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. Important: A. General Information When filling out forms on the computer,use 1. Inspector: only the tab key to move your Robert Paolini 15N0 5 1 cursor-do not Name of Inspector use the return key. Capewide Enterprises,LLC Company Name r� P.O.Box 763 Company Address Centerville Ma. 02632 i n Cityrrown State Zip Code (508)428-4028 S14454 Telephone Number License Number B. Certification 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 Eval ation by the Local Approving Authority L AO 8/2/2007 .1 f Insp or's Si ature 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 i_-la shared�system or has a design flow of 10,000 gpd or greater, the inspector and the system owne shall submit th`e report to the appropriate regional office of,the DER The original should be sent to the system oymer and copies sent to the buyer, if applicable, and the approving authority. cs ran ****This report only describes conditions at the time of inspection and under t e 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. 43 iris lane-08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 43 Iris Lane Property Address Samuel Traywick Owner Owner's Name information is q required for Cumma uid Ma. 02637 8/2/2007 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. Answer yes, no or not determined (Y, N, ND) in the ❑for the following statements. If"not determined," please explain. ❑ The septic tank is metal and over 20 years old*or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND Explain: The inlet tee is on sideways in tank.Tee needs to be replaced. ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ obstruction is removed 43 iris lane•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 15 f Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface.Sewage Disposal System Form -Not for Voluntary Assessments M 43 Iris Lane Property Address Samuel Traywick Owner Owner's Name information is q required for Cumma uid Ma. 02637 8/2/2007 � every page. City/Town. State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes (cont.): ❑ distribution box is leveled or replaced ND Explain: ' l ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ obstruction is removed ND Explain: C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50,feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 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. 43 iris lane•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 15 r Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �M 43 Iris Lane Property Address Samuel Traywick Owner Owner's Name information is required for q - Cumma uid Ma. 02637 8/2/2007 . every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) C) Further Evaluation is Required by the Board of Health (cont.): ❑ 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 El ® 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 El ® 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 '%z day flow ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. Any portion of cesspool or privy is within 100 feet of a surface water supply or El ® tributary to a surface water supply. 43 iris lane•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 4 of 15 J J Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 43 Iris Lane Property Address Samuel Traywick Owner Owner's Name information is Cumma uid Ma. 02637 8/2/2007 required for q every page. City/Town State Zip Code Date of Inspection . B. Certification (cont.) 1 D) System Failure Criteria Applicable to All Systems (cont.): Yes No ❑ ® 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 Jess 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 ❑ E] 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. 43 iris lane•08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 15 Commonwealth of Massachusetts . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 43 Iris Lane Property Address Samuel Traywick Owner Owner's Name information is q required for Cumma uid Ma. 02637 8/2/2007 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)] 43 iris lane•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 15 Commonwealth of Massachusetts . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments °M 43 Iris Lane Property Address Samuel Traywick Owner Owner's Name information is q required for Cumma uid Ma. 02637 8/2/2007 every page. . City[Town State Zip Code Date of Inspection D. System Information Residential Flow Conditions: Number of bedrooms (design): 5 Number of bedrooms (actual): 4 DESIGN flow based on 310 CUR 15.203 (for example: 110 gpd x#of bedrooms): . 550 Number of current residents: unknown 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 ears usage d 371,00006: g ( y g (gpd)): 371,000 Sump pump? ❑ Yes ❑ No 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: Last date of occupancy/use: Date Other(describe): 43 iris lane•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 115 I Commonwealth of Massachusetts Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 43 Iris Lane Property Address Samuel Traywick Owner Owner's Name information is q required for Cumma uid Ma. 02637 8/2/2007 every page. Cityrrown State Zip Code Date of Inspection i D. System Information (coat.) 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) ❑ Tight tank.Attach a copy of the DEP approval. ❑ Other(describe): Approximate age of all components, date installed (if known)and source of information: 2004 Were sewage odors detected when arriving at the site? ❑ Yes ® No 43 iris lane-08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 15 i Commonwealth of Massachusetts W Title 5 .Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �M 43 Iris Lane Property Address Samuel Traywick Owner Owner's Name information is 4 required for Cumma uid Ma. 02637 8/2/2007 , every page. City/Town State Zip Code Date of Inspection D. System, Information (cont.) Building Sewer(locate on site plan): Depth below grade: 28„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 Ieakage.Ssytem vented through the house 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: 10'6"x5'10"x57' Sludge depth: 6,. Distance from top of sludge to bottom of outlet tee or baffle 26" 5" Scum thickness Distance from top of.scum to top of outlet tee or baffle 91, Distance from bottom of scum to bottom,of outlet tee or baffle 14" .r How were dimensions determined? measured 43 iris lane•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 15 Commonwealth of Massachusetts W Title 5 'Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 43 Iris Lane Property Address Samuel Traywick Owner Owner's Name information is Cumma uid Ma. 02637 8/2/2007 required for q every page. 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.): Pump tank every 2-3'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 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): 43 iris lane•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 43 Iris Lane Property Address Samuel Traywick Owner Owner's Name information is q required for Cumma uid Ma. 02637 8/2/2007 every page. City/Town State Zip Code Date of Inspection a D. System Information (cont.) Tight or Holding Tank(cont.) Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No. Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): 1 . Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No 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 and has equal distribution to outlets.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 43 iris lane•08106. Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form _ Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 43 Iris Lane Property Address Samuel Traywick, Owner Owner's Name . information is required for Cummaq uid Ma. 02637 8/2/2007 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): I Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: Type: ❑ leaching pits number: ® leaching chambers number: 5-50.0 gallon LC ❑ 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.Chambers had 2"of water in them at time of inspection. 43 iris lane•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 43 Iris Lane Property Address Samuel Traywick Owner Owner's Name information is q required for Cumma uid Ma. 02637 8/2/2007 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy(locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): 43 iris lane•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 15 f Commonwealth of Massachusetts . Title. 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments . 43 Iris Lane Property Address Samuel Traywick Owner Owner's Name information is q required for Cumma uid Ma. 02637 8/2/2007 every page. City/Town State Zip Code bate of inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. -.-: 99,1 30 �{ 43 iris lane•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 15 l I Commonwealth of Massachusetts F Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ^M 43 Iris Lane Property Address Samuel Traywick Owner Owner's Name information is 4 required for Cumma uid Ma. 02637 8/2/2007 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 ground water: Bottom of leaching 60'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: 2004 Date ❑ Observed site (abutting property/observation hole within 150 feet of SAS) ® Checked with local Board of Health-explain: As-Built Card ❑ Checked with local excavators, installers- (attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: Used: Gaherty.& Miller Model 12/16/94 ground water elevations. Used:USGS Observation well data June 1995. Used:Technical Bulletin 92-000-01 plate#2 Annual ranges of ground water elevations. 43 iris lane•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 115 of 15 * No. �� / ( � , Fee d THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS Zipprtcatton for 30tgotal *p5tem (Comaructton Vertu Application for a Permit to Construct( Repair( )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. In S f �e, Owner's blame,Address and Tel.No. Assessor's Map/Parcel �v!n-► �� 7�✓° G Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. Type of Building: Dwelling No.of Bedrooms Lot Size 71, 3-?-sq.ft. Garbage Grinder( ) Other TI pe:of.Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow _ gallons per day. Calculated daily flow -53Y2, gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank 100 Type of S.A.S. 0o r,A, I Description of Soil Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and_aot to place the system in operation until a Certifi- cate of Compliance has been issued s B d of Heal Signed Date Application Approved byM&AQ )� Date Application Disapproved for the following reasons Permit No. 2 go� .2.6 `� Date Issued a 4 ' 1 3 ! No. U� W w.. ..-... Fee THE COMMONWEALTH OF MASSACHUSF�T.TS "' Entered in computer: Yes PUBLIC,HEALTH DIVISION -TOWN OF BARNANBWLE., MASSACHUSETTS Zippfication for Zigozal *p.5tem Con0truction Permit Application for a Permit to Construct(� Repair( )Upgrade( )Abandon( ) ❑Complete System ' ❑Individual Components Location Address or Lot No. 3 Owner's Name,Address and Tel.No. ,A... � Assessor's Map/Parcel '••, y-0_5-1 i Installer's Name,Address,and Tel.No. 16esigner's Name,Address and'Tel.No. 11 i /' A 0 (A 17-7 Type of Building: ,/ 33� 1 :•9 Dwelling No.of Bedrooms J Lot Size i sq:f[' Garbage Grinder( ) Other Type of Building No. of Persons, :� � Showers( ) Cafeteria( ) Other Fixtures �J) 10 e— Design Flow j'�' gallons per day. Calculated daily flow >w� gallons. Plan Date Number of sheets Revision Date:)' i Title Size of Septic Tank ��y. Type of S.A.S. �� Go C 1 Description of Soil Nature of Repairs or Alterations(Answer when applicable)'�-� 1,1 i j r 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 Codefand.not to ace the system in operation until a Certifi- cate of Compliance has been issueh"ts B.o. d of He ,1�. " "3 •Jam; y .� Signed '� Date ` Application Approved by Date a U y Application Disapproved for the following reasons 4 Permit No. a Ud Date Issued a Y -- -—=———————————— --— —— —=— ————. THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS r Certificate of Compliance THIS IS TO CER IFY;that the On-site Sewage isposal System Constructed( )Repaired( )Upgraded ( ) Abandoned( )6y Ss t/r"cP at -3 C ��r �� rn has been construct d in a6cordance with the provisions of Title 5 and the for Disposal System Construction Permit No. 7 dated 26Ot Installer Designer .4 The issuance of thicie x>s(4�1�1 pot be construed as a guarantee that the cyst m w n i n as designed. Date +�`1 Inspector r - - No.�VU� —--————————————— ---------Fee 16o '�THE COMMONWEALTH OF MASSACHUSETTS r. PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS Mfgpoal *pStem Construction i3ermit Perm y ranted ission is hereby to Constru t Rep r �* -� c� ( ) ( )Upgrade( )Abandon( ) System located at �Y/>S �n P � 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 ust be completed within three years of the date of is`�permit. Date:_. �/ a 6 6 Approved'byti _ TOWN O,,F//B��A--RNSTABLE LOCATION LA l= SEWAGE# VILLAGE AUV<3 J 2 ASSESSOR'S MAP & LOT_?3 INSTALLER'S NAME&PHONE NO.• 60/1-�// SEPTIC TANK CAPACITY :/ 67-O d 6l/ • LEACHING FACILrrY: (type) 57 (size) NO.OF BEDROOMS_ BUILDER OR OWNER �i s;�,iv,(_ PERMTTDATE: v COMPLIANCE DATE: 11161AQ Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200.feet of leaching-facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist. within 500 feet of leaching facility) Feet Furnished by �- - 3° Town of Barnstable Regulatory Services Thomas F. Geiler,Director "+ BMWSIABLE, MASS. Public Health Division Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Installer& Designer Certification Form Date: Old Sewage Permit# Assessor's Map\Parcel` � Designer: I n w n e n►�g,. Installer:. 2�r/}�— �J Address: �J �A i n �J G Address: j (�/� On was issued a permit to install a d (installer) septic system at C w1 (based on a design drawn by (address) (mot,✓"✓`Q� Q 16( dated (designer) XI 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 dis .bution 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�'�SS � 9 (Installer's Signature) oho? ARNE oyGm a CIVIL 0. 30792 0 (Designer s Signature �/ (Affix De p 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 3-2F-04.doc. r SN z z i 5 s i �' 7-4 . i _ ' r - -. ...- I a . G i ii t a - I g, r ........... l - I rt , • i +-+ / I. ty. 4-01 a . I rtttTttf- 1-1 L.I. r r I I _ IIIIIIIIrI I III ,LII 'IFI .I jI JIIf.lI1' IIIIII 1 :'f111' IIII I 'I IIIII`'IIIIIIII �'�� FM Ftil ma - - N I I i n-I-7.1-F I I r x I IIII � I � o ' I 5_0 Ir -- — - o , f - 61 — , --- y 26' �4 f • ' 1 07- '�y +OO i s _ CP� Co:OA t0 _ * s , Y e �n V . y *. s a y. V • M r f3 Y C , a T I y, i a .. T LL D i x 7-71 TI CD I i - I • /�' I I I � � � i { I _I J ` 4 x N Y i _ i I i I e _ I I rr _ • I I • t _ '--- JI 411 17 d XTI - -._ I - � i r CD c �_ ro 'n T7 i 1 -71 • 4c, _ N N O_ N C n C . .. 4 � r .. ., .. .. .. .. . ..,� .. _ i . /� X � + ,. .t - '- _ _ s �.. �. x � �. . .. � - r . � . � � _ _ �ao �� r y . . o � _ , : .- �; . . a �. ._: , , , .. .. � - : __ . � _ I - � �� . - I . . � �� , . . . .�.. - _.. _. A._.. _ I I � z -- i . �. � � .. - . , d I c �---� � _ 3.�� - _ p . , ,, . .:. _ C , . .� , �' _ � � , - - I I I ° - I i II • i Ir � - • • . . I i I� . —�I,-- i 26 to U I — i I I If ,I L II I L I i I t— e4,-0, t L L_JL. 11 cQ I I } .I. " I I 2"x4o@ f6" 1 1 Eb"off 2xlo"Ge( o.c r II I I I � } ILA I I ," I - i iI --- - U�' � I n 8 +4-o e I ,_8„ I a's° 6'-a" 3'-`3" ( IB ( I 8 II ------------� /4'-0, 40 �Y'.S.TEM PROFILE TOP FNDN. AT EL 77,75.7 (M.')T TO SCALE) PROVIDE INSPECTION PORT WITHIN 1ACCESS C TO WITHIN 6' OF FIN. GRADE I OVER ACCESS COVER. (WATERTIC�"T) TO X6* OF FINISH GRADE 74.0' MINIMUM .75' OF COVE PR_F CA57 I AlITHIN 6* OF FIN GRADE 2% SLOPE REDORED OVER SYSTEM LOCUS 17-7 -XI811 WASHED PEAS TONE Ik RLIN PIPE LEVEL T 4.() FOR FIRST PROPOSiED LL 3' M A X. _7 C-ALLON SEPTIC 71 7r' -1,TEE 6 5.8' I TANK. (H-. 1(,'-) GAS F5 25' 1 0 0 0 __5A�PLE 6t,.4 _�2j SLOPE, CI 0 OAKMONT ROAD MIN 6' CRUSHED OF MECHANICAL 0 C3 MIN_ COMPACTION (15.221 [2)) 2' 0 0 0 C_-D CI XpTH Or FLOW a 4' 1 i 10. SLOPE) 'T 7 /4" TO 1 1/2"' [)rJUBLE WASHED STONE TEE SIZE', INLET DEPTH ClUTLIT DEPTH 13.7' kLIHCA FOUNDAT,_)N---- 13. LCACHING -----_ ----- --� EPTICTANK 60' ) Box FACILITY I LOCATION MAP NTS -- NC,TLE ' BOTTOM TH 2 EL. 49 3' ASSESSORS fvIAP 334 PARCEL 51 1 � DATUM IS APPROX. NGVD SEPTIC DESIGN: ((;AREAGE DISPOSER IS-NOT A_LL-L&EL___ ZONING DISTRICT: DESIGN FLOW- BEDROOMS 110 GPD; = 550 GPD YARD SETBACKS: -2 _iPAL WATER IS AVAILABLE FRONT 30' MtJNi(_, USE A _5 + _ GPD DESIGN FLOW 3. MINIMUM PIPE- PITCH TO BE 1/8" PEP FOOT. 10 PTIC TANK: 550 GPD 1100 SIDE 15' 4, DESIGN LOADING FOR ALL PRECAST UNITS TO BE AAr-lHQ H-___ REAR = 15' 5. PIPE JOINTS TO BE MADE 'NATERTIGHT. U�_�"E A 1500 GALLON SEPTIC T4& PLAN REF. 400/82 6 CONSTRUCTION DETAILS TO BE IN ACCORDANCE WITH MASS. LEACHING: ENVIRO!',IMENTAL CODE TITLE V. SIDE"'. - 2(47.5 4- 10 83 2 (,74:) 172 FLOOD ZONE- C 7. THIS PLAN IS FOR PROPOSED SEPTIC S'fSjTEV ONL'y AND 1S NOT TO BE USED FOR ANY OTHER PURPOSE. BOTTOM: -- 47.5 , 10.83 (.74) 380 8. PIPE FOR SEPTIC SYSTEM TO SCH. 40-4" PVC. TOTAL: 747 S.F. 5 5-) GPD 9 COMPONENTS NOT '10 BE BACKFILLED OR CONCEALED WITHOUT - TEST HOLE LOGS INSPECTION BY BOARD OF HEALTH AND PERMISSION -'D13TAINED USE (5) 500 GAL. LFACHIN-3 CHAMBERS (ACME OR AH OJALA, PE FROM BOARD OF HEALTH. EQUAL) WITH 3' STONE AT SIDES AND 2 AT E N I N E E R. WITNESS: DONNA MtORANDI, RS 0/3 V-:�0 0 0 42-06' DATE: PERC RAT= -- < 5 MIN/INCH I C AS— SOILS P# 906 Elt-Ev. co o" 64_0' O/A O /A DARK BROWN )4 00 4 75,37, E I E -4 6-7 ' Ms 4 10'YR �6/_ 4" 10YR 6/2 --- - - - -- -- +75 4�, + +7663 L S I LS 7 4.7 8 28" 10 (R 5/8 61 6' 32" 10 (R 5/8 PROP DWELL TF 7 7.7.5' ` �_ + 73.1C +71,48 M S 5Y 7/3 4.5'(FS 7/4 I 48" 108" SO a7 J_ + 78 37 C z C21 75 PERC L S LS 78' 2.5Y 6/4 144" ICYR 5/8 C3 MED/COS 7 109 + 75 31 l. I C3 72.39 \ + GRAVEL MS 77).2 3 2 5Y 7/4 + 72 3 CONTRACTOR TO 132 10YR 6/8__ 174 L 49_3' SUITABLE SOIL it, AREA OF PROPOSED LEACHING FACILITY NO GPOUNDWATER ENCOUNTERED + 70.37 PRIOR To INSTALLING ANY PORTION OF SEPTIC SYSTEM .70.�9 SEPTIC SYSTEM !S NOT DESIGNED FOR VEHICLE LOADING off -362-4541 fox 508 362-9W� + 7160 +66-.3 + + down cape engineering, i.ne. + 7( 47 +69.46 CAVIL ENGINEERS 67 16 +6548 LAND SURVEYORS 939 main st. yarmouth, ma 02675 +65,5 +66.80 +65,73' 65.37 TH 2 +6'6.40 6911 76 + '9 6954 TITLE .5 SITE PLAN TN I -Ei E( HANDBOX OF -` 9+�4 94 IRIS LANE -," +6c.60 6g.17 +69 16 IN THE TOWN OF: -6542 + BARNSTABLE ELECTRIC fl IRIS PREPARED FOR, Q EASEMENT LANE ,,4M TRAYWICK +64-83 +71.03 LOT 13 +67.87 +70,67 68.79 .30 0 30 60 90 0) 79,336 SF± CID 6 7 z .89 SCALE: 1 = 30' DATE: APRIL 17, 2004 BENCHMARK TOP OF TEL RISER ELEV=71.44' OF NEH. ARNE ARNE OJALA C 'ALA CiVIL 26348 f 0 -056 A OJALA, A E., P.L.S. DATE 4 Rlr vl��' _w w7biqlP