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Commonwealth of Massachusetts
Ur
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form Not for Voluntary Assessments
48 Sturgis Ln.
Property Address
Ralph Francesconi '
Owner Owner's Name
information is
required for every Barnstable MA 02630 11-19-13
page. Cityrrown State Zip Code Date of Inspection
Inspection results must be submitted on this form. Inspection forms may not be altered in any
way.Please see completeness checklist at the end of the form.
Important:When filling out forms A. General Information
���pumurHrgi
on the computer, 0 IH OF MgSs,,���
use only the tab 1. Inspector. •�`��� •'•9�y%
key to move your o:• G'
cursor-do not �) qu �� •JAMES
use the return James D.Sears (��
Name of Inspector a tJ. ;r„
key. *; ;
CapewideEnterprises,LLC > ��o �a'
IC=11 Company Namep
153 Commercial St. iq �sn.....P1t,00Np
Company Address
Mashpee MA 02649
Cityrrown State Zip Code
508-477-8877 S1623
Telephone Number License Number
B. Certification
1 certify that 1 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 16.340 of
Title 5(310 CMR 15.000).The system:
®Passes ❑ Conditionally Passes ❑ Fails
❑ Needs Further Evaluation by the Local Approving Authority
11-19-13
spector's Signature Date
The system inspector shall submit a copy of this inspection report to the Approving Authority(Board
of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or
has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the
report to the appropriate regional office of the DEP. The original should be sent to the system owner
and copies sent to the_buyer, if applicable,and the approving authority.
****This report only describes conditions at the time of inspection and under the conditions of use
at that time.This inspection does not address how the system will perform in the future under
the same or different conditions of use.
t5ins•3113 Title 5lxfioal Inspectio :Subsurface Sewage Disposal System•Page 1 or 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
48 Sturgis Ln.
Property Address
Ralph Francesconi
Owner Owner's Flame
information is required for every Barnstable MA 02630 11-19-13
page. Cityrrown State Zip Code Date of Inspection.
B. Certification (cunt.)
Inspection Summary: Check A,B,C,D or E/ahvays complete all of Section D
.A) System.Passes:
® 1 have not found any information which indicates that any of the failure criteria described
in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are
indicated below.
Comments:
'B) System Conditionally lasses:
❑ 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 exhItration 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•3113 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 2 of 17
Commonwealth of Massachusetts
ED
Title 5 Official Inspection Forma
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
p 48 Sturgis Ln.
Property Address
Ralph Francesconi
Owner Owner's Name
require ti1br a gamstable MA 02630 11-19-13
required for every
page. Cityrrown State Zip Code Date of Inspection
B. Certification (cont.)
❑ Pump Chamber pumpslalarms not operational. System will pass with Board of Health approval if
pumps/alarms are repaired.
B) System Conditionally Passes(cunt.):
❑ 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 0 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):
0 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
t51ns•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17
Commonwealth of Massachusetts
Title 5 Official -Inspection Fora
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
48 Sturgis Ln.
Property Address
Ralph Francesconi
Owner owner's Name
information
required for every Barnstable MA 02630 11-19-13
page. City/Town State Zip Code Date of Inspection
B. Certification (cunt.)
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 kll 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=wpc*1 is less than 6"below invert or available volume is less
than Y.day flow C1,11 N
t5ins•3M 3 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17
r
Commonwealth of Massachusetts
Owe Title 5 official Inspection Form
)w Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
48 Sturgis Ln.
Property Address
Ralph Francesconi
Owner Owner's Name
information is required for every Barnstable MA 02630 11-19-13
page. Cityrrown State Zip Code Date of Inspection
B. Certification (cunt.)
Yes No
❑ ® Required pumping more than 4 times in the last year NOT due to clogged or
obstructed pipe(s).Number of times pumped:
❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation.
❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or
tributary to a surface water supply.
❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well.
❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well.
❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet
from a private water supply well with no acceptable water quality analysis. [This
system passes if the well water analysis,performed at a DEP certified
laboratory,for fecal coliform bacteria indicates absent and the presence
of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,
provided that no other failure criteria are triggered.A copy of the analysis
and chain of custody must be attached to this form.]
❑ ® The system is a cesspool serving a facility with-a design flow of 2000gpd-
10,000gpd.
❑ The system fails..I have determined that one or more of the above failure
criteria exist as described in 310 CMR 15.303,therefore the system fails.The
system owner should contact the.Board of Health to determine what wilt: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
❑ Cl 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•3/13 Tdle 5 Official hspecdon Fomf:Subsurface Sewage Disposal System•lie 5 or 17
Commonwealth of Massachusetts
Title 5 -Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
48 Sturgis Ln.
Property Address
Ralph Francesconi
Owner Owner's Name
information is required for every Barnstable MA 02630 11-19-13
page. Cityrrown 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 b the owner, occupant, or Board of Health
Y pa
❑ ® 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): NA Number of bedrooms(actual):. 3
DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): 330
t5ins•3113 rifle 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17
Commonwealth of Massachusetts
Title -5 Official inspection Fora
o Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
48 Sturgis Ln.
Property Address
Ralph Francesconi
Owner Owner's Name
information is required for every Barnstable MA 02630 11-19-13
page. City/Town State Zip Code Date of Inspection
D. System Information
Description:
The system is a 1500 Gal. tank D.Box and two 500 Gal.chambers.
Number of current residents: 2
Does residence have a garbage grinder? ❑ Yes ® No
Is laundry on a separate sewage system?(Include laundry system inspection El Yes ® No
information in this report.)
Laundry system inspected? ❑ Yes ® No
Seasonaluse? ❑ Yes Z No
Water meter readings, if available last 2 ears usage d well water
9 ( Y 9 (gp ))�
Detail:
Sump pump? ❑ Yes ® No
Last date of occupancy: PresentDate
Commerciallindustrial 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:
t51ns-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Fora
Subsurface Sewage Disposal System Form Not for Voluntary Assessments
48 Sturgis Ln.
Property Address
Ralph Francesconi
Owner owner's Flame
information is required for every Barnstable MA 02630 11-19-13
page. ciWown 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: 09/10/11/12/13
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):
t5ins•3113 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
48 Sturgis Ln.
Property Address
Ralph Francesconi
Owner Owner's Name
information is required for every Barnstable MA 02630 11-19-13
page. Cityrrown State Zip Code Date of Inspection
D. System Information (cunt.)
Approximate age of all components, date installed (if known)and source of information:
1999 - Permit # 99-414
Were sewage odors detected when arriving at the site? ❑ Yes ® No
Building Sewer(locate on site plan):
Depth below grade: 34"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: 23"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:
1500 Gal. Precast
Sludge depth:
t5ins•3/13 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
48 Sturgis ln.
Property Address
Ralph Francesconi
Owner Owner's Name
information is required for every Barnstable MA 02630 11-19-13
page. Citylrown State Zip Code Date of Inspection
D. System Information (cunt.)
Septic Tank(cont.)
Distance from top of sludge to bottom of outlet tee or baffle
29"
o„
Scum thickness
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
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 at working level.Tank and outlet cover at 2W below grade wrnlet cover at 6". In and
outlet tees. No sign of leakage or over loading.
Grease Trap(locate on site plan):
Depth below grade: feet
Material of construction:
❑concrete 0 metal 0 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•3113 Title 5,Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
t Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
48 Sturgis Ln.
Property Address
Ralph Francesconi
Owner Owner's Name
information is required for every Barnstable MA 02630 11-19-13
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-3113 Title 5 official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
48 Sturgis Ln.
Property Address
Ralph Francesconi
Owner Owners Name
information is required for every Barnstable MA 02630 11-19-13
page. Cityrrown State Zip Code Date of Inspection
D. System Information (cunt.)
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 new.11-19-13 Box is 16"xl6"-26"below grade w/cover at 6",one line out.
r
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.):
*If pumps or alarms are not in working order, system is a conditional pass. .
Soil Absorption System(SAS)(locate on site plan, excavation not required):
If SAS not located, explain why:
t5ins•3/13 Title 5 Offidal 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
48 Sturgis Ln.
Property Address
Ralph Francesconi
Owner owner's Flame
information is Barnstable MA 02630 11-19-13
required for every
page. Cityfrown State Zip Code Date of Inspection
D. System Information (cont.)
Type:
❑ leaching pits number.
® leaching chambers number: 2
❑ leaching galleries number:
❑ leaching trenches number, length:
❑ leaching fields number, dimensions:
❑ overflow cesspool number:
❑ innovative/altemative 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 two 500 Gal dry well chambers. Chambers at 34"below grade. Chambers are
clean w/4"water. No sign of over loading or solid carry over.
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
t51ns•3/13 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
48 Sturgis Ln.
Property Address
Ralph Francesconi
Owner Owner's Name
information is required for every Barnstable MA 02630 11-19-13
page. Cityrrown State Zip Code Date of Inspection
D. System Information (cunt.)
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-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 17
Commonwealth of Massachusetts
Title 5 official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
48 Sturgis Ln.
Property Address
Ralph Francesconi
Owner Owner's Name
information is required for every Barnstable MA 02630 11-19-13
page. Citylrown State Zip Code Date of Inspection
D. System Information (cunt.)
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
Al
/a -3 0 8
3 0 0
t51ns•3113 Title 5 official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17
` Commonwealth of Massachusetts
lugTitle 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
48 Sturgis Ln.
Property Address
Ralph Francesconi
Owner Owner's Name
information is Barnstable MA 02630 11-19-13
required for every
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Site Exam: -
❑ Check Slope
❑ Surface water
❑ Check cellar
❑ Shallow wells
No 12, ,
Estimated depth to high ground water. 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 8-25-83
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:
T.H. on Design plan 8-25-83. No G.W.at 12'. Bottom of chambers at 5'below grade. Bottom of
chambers at T above T.H. Depth.
Before filing this Inspection Report,please see Report Completeness Checklist on next page.
t5ins-3/13 Title 6 Official inspection Form:Subsurface Sewage Disposal System-Page 16 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
48 Sturgis Ln.
Property Address
Ralph Francesconi
Groner Owner's Name
information is required for every Barnstable MA 02630 11-19-13
page. Cityfrown 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-3113 TO 5 official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 17
No.Cf�o e7 Fee
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
Yes
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS
01ppliCation for Misposal bpeitrm ConstCUCtion j3Prmit
Application for a Permit to Construct( ) Repair( Upgrade( ) Abandon( ) ❑Complete System V/Individual Components
Ir
Location Address or Lot No. rIs Owner's N e,� dres
"ue Z,- f r'CAvXc�ScJ�I ftkA s,and Tel.No.,.5d _ S 7
r
Assessor'sMap/Parcel `•�7 pJ D �t is "
Installer's Name,Adddres d j ti 1 $6� �L Designer's Name, ddress,and Tel.No.
Type of Building: A
Dwelling No.of Bedrooms Lot Size A e'r Garbage Grinder( )
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow(min.required) gpd Design flow provided gpd
Plan Date Number of sheets Revision Date
Title
Size of Septic Tank Type of S.A.S.
Description of Soil
Nature of Repairs or Alterations(Answer when applicable) lb
Date last inspected:
Agreement:
The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in
accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of
Compliance has been issued by this Board of Heal
Signed Date Is aV L 3
Application Approved by Date l
Application Disapproved by Date
for the following reasons
Permit No. v l 9 7? Date Issued l
No. I / Fee v
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
t. Yes
PUBLIC HEALTH-DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS
01pplitatlon for B"ispo$aY,6pBtem CdhstrUttion Vftm' if
Application for a Permit to Construct( )' Repair(�/�Upgrade( ) Abandon( ) ❑Complete System Vndividual Components
Location Address or L;ot No. WA_q Owner's Name Address,and Tel.No.SO -.375-T/g 7
g�tVle— F<,6 vN C--93 Cpv%1
Assessor's Map/Parcel (7 ®3% qR k q_ / M A
Installer's Name,Address,land el.N . Designer's Name, ddress,and Tel.No. t
C ::,,�A w Q C 1 +r r SW C.c-<
Mom►. r��
Type of Building: AA
Dwelling No.of Bedrooms Lot Size o 9� A ct'r'sg5 fl. 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 x
Nature of Repairs or Alterations(Answer when applicable) .b —�Ox
• 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 bythis Brdof H I { $ — (Date '}13
igned
Application Approved by Date
Application Disapproved by Date _
for the following reasons 't
�- f_
Permit No. `�O / 3 t~)5 / Date Issued
-------- ----------------------
THE COMMONWEALTH OF.MASSACHUSETTS
�-. BARNSTABLE,MASSACHUSETTS
Certifitate of Compliance
THIS IS TO CERTIFY,that the On-site Sewage,Disposal system Constructed( ) Repaired(Iel) Upgraded( )
Abandoned( )by C�,, n S.W�C7� EY1 s eS o L LG.
at gg STti IS �tV�� GooC'1'vs'v.a W A has been constructed in accordance i
with the provisions •f Title 5 and the for Disposal System Construction Permit No�i/,3 `�5 (dated I I ' i
Installer �n,p�_..., dle �VI�•eX pej ,,- U - Designer
#bedrooms Approved design flow / gpd
The issuance of this perm �1/not
be construed as a guarantee that the system will fu`ct'on asd�ignedd.Date J Inspector
_ /r/J,(/� ,= ' r+r/ /lj/�l/�� �•
r ! r �- 4
No. �l� 5r7 Feed
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS
Disposal 6p8tell ConstCUttlon permit
Permission is hereby granted to Construct( ) Repair( ) Upgrade( Abandon( )
System located at fs Q N1 Tab e A
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:Construction must be completed within three years of the date of this F6y1_
Date 1 1�� l Approved 1
TOWN OF BARNSTABLE
LOCATION `T 8 S f U rI.)l S Lit/ SEWAGE # 99 - //-
VILLAGE ASSESSOR'S MAP & LOT
INSTALLER'S NAME&PHONE NO.
SEPTIC TANK CAPACITY IS��
LEACHING FACILITY: (type) 3'Ov f Le"�'"5 1 ybK (size)
i NO.OF BEDROOMS 3
BUILDER OR OWNER iy✓ ��
PERMITDATE: COMPLIANCE DATE: �—
Separation Distance Between the:
I
Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet
Private Water Supply Well and Leaching Facility (If any wells exist
on site or within 200 feet of leaching facility) Feet
Edge of Wetland and Leaching Facility (If any wetlands exist
{ within 300 feet of leaching facility) Feet
j Furnished by
s
I
i
i
r
p='r .3 /� TOWN OF BARNSTABLE �
LOCATION `7 6 f U L.AV SEWAGE #
VILLAGE 3arh5 -qbk ASSESSOR'S MAP & LOT I a ®0
INSTALLER'S NAME&PHONE NO. (�3 f LOW S Lin 51
SEPTIC TANK CAPACITY 1700 C:,
LEACHING FACEL=: (type) TM5 (size)
NO. OF BEDROOMS 3 I
BUILDER OR OWNER
PERMITDATE: COMPLIANCE DATE:
Separation Distance Between the:
Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet
Private Water Supply Well and Leaching Facility (If any wells exist
on site or within 200 feet of leaching facility) Feet
Edge of Wetland and Leaching Facility(If any wetlands exist
within 300 feet of leaching facility) Feet
Furnished by
INi'
'Ire / r9p�
/ ..
Y
�loD�cc
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
ees
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS
01ppYication for Migogal *pgtem Cow6tructiou Verrait
Application for a Permit to Construct(X )Repair( )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components
Location Address or Lot No. 9 i j S ru Q c=is LA w C. Ow e� d/ 1.No.
$9 P_"5T0.SLE
Assessor's Map/Parcel Z79 38
Installer's Name,.Add)��s,and Tel.N Designer's Name,Address and Tel.No. AZS
ahVLOI lam$t1 D(FJ '?t 2. Q TZSULL1VAw.l
Po. (&xlut. _
Type of Building:
Dwelling No.of Bedrooms 3 Lot Size 36)25D sq.ft. Garbage Grinder(ki 9
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow $30 gallons per day. Calculated daily flow 33 gallons.
Plan. Date ►SJ 0 0 G 9 9 Number of sheets 2 Revision Date 150 U AU 6 C)E
Title 194D Fos E C> -5 tTE let.A&a
Size of Septic Tank 157b0GAt_L.0KJ Type of S.A.S. k2:X?-"7 F t—C7
Description of Soil O' 3' L oti Wn , 3 U ibso k 1~ A C LA.Y(• 3'— 12' t' N E S,Rtup w t T�1 NHS
Nature of Repairs or Alterations(Answer when applicable)
Date last inspected:
Agreement:
The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system
in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi-
cate of Compliance has been is ed by this d o ealth.
Signed Date
Application Approved by - Date "
Application Disapproved for the following reasons
Permit No. Date Issued
v Nd.. .e. Ee
-s THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
Fes�/
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLES MASSACHUSETTS
01pprication for Digozal *pgtem Construction Permit
Application for a Permit to Construct(X )Repair( )Upgrade( )Abandon( ) O Complete System ❑Individual Components
r
Location Address or Lot No. %`b S T U a 15 LA IC OwnerlsN e, ddress an
a -O�G-0:9-"
ST�BLE ��
Assessor's Map/Par
cel ? 3$ r
Installer's Name,Ad ss;and Tel.No. Designer's Name,Address and Tel.No. �IZf; �"S
rjahOPl arFcwS 2 'SuLL\IjIM. ," P�
p o. (3bx 1u t
LU ',� 62 Type of of Building: I
N,
Dwelling No.of Bedrooms 3 Lot Size 35 t_250 sq.ft. Garbage Grinder(K)Q
Other Type of Building No. of Persons Showers( ) Cafeteria( )
Other fixtures
Design Flow gallons per day..Calculated daily flow gallons.
-Plan Date \5 J u Q E D ) Number of sheets 2 Revision Date ►5 J u w C 7�?
Ti le; ao Fors E`D '�� 1-7= Pt o,ti
Size of°Septic Tank 13 bC)G A\L-La ti Type of S.A.S. G x 2"1 t c C7
Description of Soil. 0'` 3' OA w\ , S u3SO t L A C���(, 3 - 12 1 ,�y F_ jj\�u��
Nature of Repairs or Alterations(Answer when applicable)
Date last inspected:
Agreement: 1 r
The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system
in accordance with the provisions of Title 5.of the Environmental Code and not to place the'system in operation until a Certifi-
cate of Compliance has been is ed by this 7rd o ealth.
f^'
Signed jj A A A I 0Qh
t Date
- Application Approved by4CIdde%% \� Date " v- f_�...
Application Disapproved for the following reasons
Permit No. Date Issued �Z_
-- -------- i--------------------------- -
THE COMMONWEALTH OF MASSACHUSETTS
cols �; BARNSTABLE, MASSACHUSETTS
Certificate of Compliance
THIS IS TO CER Y,thatthe On-site S�jwage Di P al System Constructed( Repaired( )Upgraded( )
Abandoned( )by1�
v _
at '� wf/� has been constructed in accordance
with the provisions of S the for Disposal System Construction Permit No. .• + dated ✓, "°'
Installer Designer! /,; r
r.
V
The issuance o s .e t al not be construed as a guarantee that the syste Ill f cti)n..a d si�
;g�i d. -
`.
Date � Inspector �� /��
r ` v _v ' 0
1` E -
f iNo. 1 � �/ — ------ -- ,17 — �,----- Fee` '
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION - BARNSTABLES MASSACHUSETTS
Migpo5ai *p5tem Con5tgction Permit
Permission is hereby gr nted to Construct )Repair( )Upg de( )Abando
System located at5W 05, + 11 V �
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 gcompleted within three years of the date of this permit.
Date: - `� / Approved by .
„ PENN
Rt FERENCES: CS Af fj p a
Assessors Map: 278 � %0
Parcel: 38 Q
Plan Book 270169 �Qq�
ZONE: ZONE RG ,. N75348.w�
Setbacks: 55'00,
Front: 30' 19B
Side: 15 = ts =
Rear: 15' 'i — \I\\ \ N IN
\ \\\
q -F- Q01 �REgove 'J'ALLAROUND
--�- 202 - / O�'UNSu1TABLatvinr@R1At-
i-�- 203 - IF Rr-Q41 RGD
/ -- 204
205 — -
°h' N r,;
!� I 'ba' ^✓�/ /ice 2°� , ' 100% RESERVG
06
IV I a ce
VI / P#Vposed 2 S god A
` Stone `�I I/ / ( / Dwelling sE a:0.i Lot 2
\ Drive / / 1 /. 2 / Bedroom)( TqN -
"'o� Garage
` / 1 I Ali /
Lot 4 �/ / /. \ -2 11 Tr-1
.01
I /
Asphalt
Lot 3 �� 72.1' 1 / I I ` Drive
90 Melly
35,750fSF _=�\\em
.Lot 6 IN
\ a C810HJ // C8 H\ 1 n.00'
�.� ?o W
y ��� Fnd - -- fn 3621
0.
R-204.7'
o
l
U�� 1 ry — ® R-204.5
------ _.1_ —�—_= -
Lot 7
CBIDH
Fnd
Lot 8 TBM EI=208.83' (assumed) Lot 9
Top o/PK Nail in Apron
�kOF41 PLAN VIEW
PETER Scale:I"=40'
SULLIVAN rn
N0.2 PROPOSED SITE PLAN
CIVILIL
AT 48 STURGIS LANE
IN
`S1 A c.. O o Q�Ul1��Gil o��y
UIJUL!"U��o
DATE: 151JUN199 SCALE: 1"=40'
0 10 20 JO 40 60 80 FEET
PREPARED BY: PREPARED FOR:
(�a 9Suw Rosanne Francesconi
Sullivan lEngineering, Inc. 5 Millbrook Dr.
PO Box 659 PO Box 718 Mendon, MA 01756
Osterville, MA 02655 Hyannis MA 02601-0718
(508)428-3344 (508)428-3115 fax (508)790-7902 (508)790-7905 fax DWG l: C395P1 SHEET I of 2
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NOTES DESIGN DATA
Single Family-3 Bedroom
L Water Supply Fornis Lot is Municipal Water. With no Garbage Grinder I
f 2 Location ofUtilitiell Shown on This Plan AreAppro)L Daily Flow=110x3= 330GPD
s At Lust 72 Hours Prior to Any Excavation For This Septic Tank a 330 GPD x 206%=660 GPD
j Pro ad The ContractorSholl Make The Required Use 1500 Gallon Septic Tank
Notification to Di j Safe(1-800-322.4844)
LEACHING AREA
3 The Contractor is'Required to Secure Appropriatat 330 GPD/0T0=472'SF Required
Permits From Town Agencies For Construction . q
Defined by This Plan. SidewalI=2(12'r 27)2=156 S.F.
BotlomArea=l2 x27 = 324S.F-
4 Install Risers as Required to Within leof 480 S.F.Total Provided
Finished Grade. LEACHING CHAMBERUESIGN
5.All Structures Bu•ied Four Feet or Mae or Subject At Pipes to be Schedule 40.Use
to Vehicular Traffic tubs H-20 Loading. 2-500 Gal.Leaching Chambers Ina
6,Septic System toiae Installed in Accordance With 12'x 27'Washed Stone Field as Shown
310 CMR 15.00 Latest Revision And The Townof
Barnstable Board of Health Regulations
T. At I Piping to be Sch.40 PVC.
There are not wetlands within 100 feet of the proposed leaching facility.
There are no private wells within 150 feet of the proposed septic system.
There are no varances requested or needed.
Remove All Unsuitable Material For 5'All Around Proposed System if Required.
EQ.208.0
F.G.207.4 '
206.0 05.0
1500Lallon Top E1.206.0
Septic Tank 205.4 05.2 Sot.EI 203A
2
Bedding as --
Per Title 6 7.6'
10, 10, io, 10' I2
Bottom of Test Hole El.195.4
No Ground Water Encountdd
DEVELOPED PPOFILE OF PROPOSED SEPTIC SYSTEM
Not to Scale
Finish Wade
g
Filbr
�+ Fabrie �-Compacted Fill 0. Test Pit I-El. 207.4
Loam,Subsoil 8 Clay
a +` 1/6 L 1/2" 3
Pea Stony Fine Sand =Test Pit 2 Some
h
" With Soil Profile
LeachingFines
am Chber Double Washed
a 3/4"-I I/2" 12 Percolation Test
Stone Date;8/25/83
4-10 I By:Edward Kelley
I- 12'-0" I Witness R.Gifford,T.O.B.
Depth:48"
6Min./Inch
Ma
CROSS' SECTION OF CHAMBER No.;P2343 1
'NOT TO S-.ALE.
`tN OF A{.
PETER >
SULLIVA?d
NO.19133 PROPOSED SITE PLAN
CIVIL f AT 48 STURGIS LANE'
IN
dN � �LxJNSVnI ` OQ�UV��Q O��9
UL IQITS.'
DATE: 151JUN199 .SCALE:1"=40'
0 10 2030 40 60 60 FEET
PREPARED BY: PREPARED FOR:
Sullivan Engineering, Fic. CDap(OSU M Rosanne Francesconi
PO Box 659 PO Box 718 Mendon, MAk01756
Osterville, MA 02655• Hyannis MA 02601-0718
(508)428-3344 (508)428-3115 fcx (508)790-7902,(508)790-7905 lax DWG C,395PI
PSu1IPE@ool.com copesurv@copecod.net SHEET 2 of 2
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