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HomeMy WebLinkAbout0027 TONELA LANE - Health �A 27 Tonola La � - - - Barnstable A= 335 —024 a o � j o I Y Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-.Not for Voluntary Assessments 27 Tonela Lane p, Property Address � Breidenbach � � Owner Owner s Name information is - required for every Writ Barnstable .Barn/. Ma 3/30/17 City/Town +'°�'page. State Zip Code Date of Inspection CM Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When filling out forms A. General Information on the computer, use only the tab 1. Inspector: key to move your - cursor-do not Chad Hathaway use the return key. Name of Inspector H.P.S. Company Name P.O.Box 151 �I - Company Address Forestdale Ma 02644 City/Town State Zip Code 774-274-2581 12866 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 Inspector's Signature 3/30/17Date 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. l5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 17 '�°��VS Commonwealth of Massachusetts Title 5 Official Inspection Form- Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 27 Tonela Lane Property Address , Breidenbach Owner Owner's Name information is required for every West Barnstable Ma /17 page. City/Town 3/30of i State Zip Code Date of Inspection B. Certification (cunt.) 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: system is in good working order 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. - F1 Y ❑ N ❑ ND (Explain below): t5ins•3113 Title 5 Official Insp ection Form:Sut)siurfaw Sewage Disposal System-Page 2 of 17 r Commonwealth of Massachusetts Am& Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M ••'r 27 Tonela Lane Property Address Breidenbach Owner Owners Name information is required for every West Barnstable Ma 3/30/17 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. 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 F1 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•3113 Title 5 official Inspection Forth:Subsurface Sewage Disposal System•Page 3 of 17 i Commonwealth of Massachusetts Title 5 Official' Inspection Form. Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 27 Tonela Lane Property Address Breidenbach Owner Owner's Name information is required for every West Barnstable Ma 3/30/17 page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) . 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: "*This system passes if the well water analysis, performed'at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate"Yes"or"No"to each of the following for all inspections: Yes No ❑ Z 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 %day flow t5ins•3/13 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 �Y 27 Tonela Lane Property Address Breidenbach Owner Owner's Name information is West Barnstable required for every Ma 3/30/17 page. Citylrown State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 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-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 5 of 17 ' 1 Commonwealth of Massachusetts Title 5 Official 'Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 27 Tonela Lane Property Address Breidenbach Owner Owner's Name information is West Barnstable required for every Ma 3/30/17 ' page. Cltyfrown 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. ❑ Z 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)] stem Inform anon . Y, Residential Flow Conditions: Number of bedrooms(design): , - 3. w Number of bedrooms(actual): 3 DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms):' 330 t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 Commonwealth of Massachusetts Title 5 official InspectionForm Subsurface Sewage Disposal.System Form Not for Voluntary Assessments ,a�yf 27 Tonela Lane Property Address Breidenbach Owner Owner's Name information is required for every West Barnstable Ma page. cityrrown 3/30/17 _ Sta te Zip Code Date of Inspection D. System Information Description: Number of current residents: 1 Does residenceyhave a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system?(Include laundry system inspection information in this report.) ❑ :Yes ® No Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available(last 2 yearn usage(gpd)): Detail: Sump pump? ® Yes ❑ No Last date of occupancy: current Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? . ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 27 Tonela Lane Property Address Breidenbach. Owner Owner's Name information is required for every West Barnstable , Ma page. City/Town 3/30/17 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: purred at time of inspection as maint Was system pumped as part of the inspection? ®. Yes ❑ No If yes, volume pumped: 1000 gallons How was quantity pumped determined? tank size Reason for pumping: Maintenance 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•3/73 Title 5 Official Inspection Fond:Subsurface Sew age Disposal System•Page 8 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form [ Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M a 27 Tonela Lane Property Address ' Breidenbach Owner information is Owner's Name required for every West Barnstable Ma page. cityrrown 3/30/17 -State Zip Code Date of Inspection D. System Information (cont.)- Approximate age of all components, date installed (if known)and source of information: tank unknown pump chamber and leaching 2007 Were sewage odors detected'when arriving at the site? El Yes ® No Building Sewer(locate on site plan): Depth below grade: 2' feet Material of construction: ®cast iron ❑40 PVC ❑other(explain): Distance from private water supply well or suction line: 20+ feet Comments(on condition of joints, venting, evidence of leakage, etc.): Septic Tank(locate on site plan): Depth below grade: 16" feet Material of construction: ® concrete ❑ metal ❑fiberglass ❑ polyethylene El other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance?(attach a copy of certificate) 0 Yes ❑ No Dimensions: 1000 gal Sludge depth: 4" 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 27 Tonela Lane Property Address Breidenbach Owner Owner's Name information is required for every west Barnstable " Ma 3/30/17 page. Cityrrown 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 30" Scum thickness - 3„ Distance from top of scum to top of outlet tee or baffle 41- Distance from bottom of scum to bottom of outlet tee or baffle 18" How were dimensions determined? tape and 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.): pump every 2-3 years as maint. to protect leaching. tank in good cond. no visable cracks or leaks tees in place. tank was pumped at time of inspection Grease Trap(locate on site plan): Depth below grade: feet Material of construction: ❑concrete ❑ metal El fiberglass ❑ polyethylene El 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 Disp osal posal System•Page 10 of 17 Commonwealth of Massachusetts ~ Title 5 Official. Lnspection Form e Subsurface Sewage Disposal System Form Not for Voluntary Assessments 27 Tonela Lane . Property Address- Breidenbach-. Owner Owner's Name information is . required for every west Barnstable Ma 3/30/17 page. City/Town state Zip Code Date of Inspection D. System InformationF(Cont.)' Comments(on pumping recommndations, 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 ofconstruction: - 0 concrete- [] metal M fiberglass 9 ❑polyethylene C1 other(explain): Dimensions: a ` Capacity: gallons Design Flow:' M gallons per day Alarm present: El Yes El No Alarm level: Alarm in working order: El Yes n. No Date of last pumping: , l Date Comments(condition of alarm and float switches,-etc.): Attach'copy of current pumping contract(required). Is copy attached? ❑ Yes 0 No t5ins•3113 Title 5 Official Inspection Form:.Subsurface Sewage Disposal.System•Page 11 of 17 f Commonwealth of Massachusetts upTitle 5 Official Inspection Form Subsurface Sewage Disposal System Form-_Not for Voluntary Assessments 27 Tonela Lane Property Address , Breidenbach Owner Owner's Name information is West Barnstable required for every Ma 3/30/17 page. Cltylrown 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 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.): in good condition 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 locatedi explain why: 4"of water at bottom of chambers side walls are'dry with no staining to indicate a past failure t5ins-3113 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 27 Tonela Lane ` Property Address . Breidenbach Owner Owner's Name information is required for every West Barnstable : " Ma page. City/Town State Zip Code,° Date of Inspection" D. System Information (cont) Type: El- leaching pits number. ® .leaching chambers number: 2 500 gal. L.0 leaching galleries � number: leaching trenches number, length: ❑ leaching fields number, i d mensi ons. ` ❑ 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.): no ponding or hydraulic failure system in good condition Cesspools(cesspool must be pumped as part of inspection)(locate on site.plan): Number and configuration M 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 3113, Title 5 Official Insp ection 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 27 Tonela Lane Property Address Breidenbach Owner Owner's Name information is required for every West Barnstable Ma - page. Cityrrown 3130/17 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•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 yt 27 Tonela Lane Property Address Breidenbach Owner Owner's Name in formation Is required for every West Barnstable Ma page. Cityfrown 3/30I17 State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes'b_elow:, ® hand-sketch in the area below ❑ drawing attached separately t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form_ -.Not for Voluntary Assessments 27 Tonela Lane Pro PertY Address Breidenbach Owner owner's Name information is West Barnstable required for every Ma 3/30/17 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: 8' 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: 2007 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 round water 9 elevation: 9 plan 2007 bottom.of leaching 3' below grade Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•3/13 Title 5 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 ,•''Y 27 Tonela Lane Property Address Breidenbach ' Owner Owner's Name information is z required for every West Barnstable Ma a 3/30/17 page. Cftyrrown State ZipCode, . Date of Inspection E. Report Completeness ete n e ss Checklis t ® 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•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 ` TOWN OF BARNSTABLE LOCATION 2-7 _71ancAG Lam. SEWAGE#169" 'UZ VILLAGE ��,; � `,�► ASSESSOR'S MAP&PARCELS$ Z�I INSTALLERS NAME&PHONE NO. o� e �llrt'a�c ;®� ®�-771-`13` SEPTIC TANK CAPACITY 1QW -k js4irr IQ�G��1Or+ �e6.P,a� t / LEACHING FACILITY:(type) `L-$n gn�A C"6 (size) V `7(SQ`?( Z.a NO.OF BEDROOMS OWNER \1 et- rc�c�►�a�� 1n PERMIT DATE: 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 Q& WA Cafe, -:ngj&ce oneo C- ID 7--sij CJ3- ig �� 3_ L126 PC� r CAL(' 27 Z qc y . o LOCATION SEWAGE. PERMIT NO. -2 > "f[0 N ez-A /?DO VILLAGE rL.)MMAgulb 33� off ' INS TA LLEROS NAME i ADDRESS B U I L D-E R OR OWN ER . DATE PERMIT ISSUED _ �����,� DATE COMPLIANCE ISSUED /room 20 D/59R/�tr9i0lw aot L—x'ACH F/MCA .. �,•rtlhts.., r �-y�YR _,>^- ._ -.. ,. - ...1,. .-•tt,...-a..a,+i°..r,^.n . No. f r / [J -9U Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes 21ppYication for IN Y *p.5tem Cow5truction der ° Application for a Permit to Construct.( ) Repair(0 Upgrade( ) Abandon( ) ❑Complete System Individual Components Location Addre s or Lot No. p2 / 17�Cq Zak t Owner's Name,Address,and Tel.No. PsseV%p/Pazcel 33S' ✓ �/% '®� ��s��� ' � �e�aml C� t� Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. '�� ovr`4.4w X. /tJ - ,�g-yz� 11-/)1°I/ '" 'ZYC. - y/ op»� ✓rib ,c A..a- Type of Building: Dwelling No.of Bedrooms J Lot Size 3 E 42-n sq. ft. Garbage Grinder ((� Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 3 30 gpd Design flow provided gpd Plan Date 0q► 100"7' Number of sheets / Revision Date Title 7- s� 0 IC 2`7 /®/ttC,e L.&re , u a. Size of Septic Tank /,Ocp -.6 C,cr)XW�5 Type of S.A.S. Description of Soil S�P �/u y V Nature of Repairs or Alterations(Answer when applicable) rj. /� /(� �dwJ Cl7�i�y3.rs- Cr•, /4/d 1,5/1' 3111 1) DOX 4 H .L r,-2,1 //. /0 �w Cot qe-s, °x 3®' x? ,)"e 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 Boa f al Signed Date Application Approved by Date d Application Disapproved by: Date for the following reasons Permit No. 7 Date Issued 2, d • - --.. ... ••-..mot.;. o..r.�.�c..,,.w-+'"'Iv.r.av".. .+arks,• .l -c-..+.1.. of �,• l� .�` �. .,,_z. _ 7K No. 4 +� Fee 4` 1-$4. Entered in computer: THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes ZippYicatiou for �Digpo ar 6p5tem Cowaructiou Peruit� ~ Application for a Permit to Construct( ) Repair Upgrade( ) Abandon( ) ❑Complete System ©Individual Components Location Address or Lot No.p'� a n4-4: L �'r Owner's Name,Address,and Tel.No. ��rr / i^C icl rvr f7c yC 5 ssessor'sMap/Parcel Z�7 3 f6� Sep_ �2 yg �rl �.J.1� .�. L v In1#9 av� C' K.�'✓P 1 i Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.N o. '�`'/ C'F ri`04'1/7Q $'-7j,6 A9. /4.J� rY7t's'' ���-�G�' S/J- 1// Type of Building: Dwelling 4 No.of Bedrooms Lot Size 31 /2 tl sq.ft. Garbage Grinder '~ Other X 'Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixture IN Design Flow(min.required) 3 30 gpd Design flow provided 336, gpd Plan Date -z/,r.y >0. Jac'7 / Number of sheets J Revision Date Title 5 5-/4 -PI,717 Size of Septic c�;060 G..G CA. ,,;t .; ! Type of S.A.S.�2 ?2:v -4— Description of Soil Nature'of Repairs or Alterations(Answer when applicable) u� , c. /� /1[) /w* n r�,Fmf, ,,_ G J-1 /v A31 r.1✓X"') /)d G 14 %_1 s`Z �' 'b S/ CU G+C � ���/ew �1�'a e ocJ/ G' 10' X? '�A'r° C-�..C 1�ov�. rc✓ d n1�4 �..er✓ S t7/i!,-lSc"7 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 Boa d of Health. Signed „ /G Date � 7 Application Approved by V Date (� !i Z. Id '7 Application Disapproved by: Date for the following reasons e, Permit No. 29t)-7 ' �?, 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( )by 12o• 1�/a11" (!:2t0 5 T",r X 0_a at 9 7 / �/J 19-�'Ldt Lrct� P, 6401!14 ,cJ has been constructed in accordance r with the provisions of Title 5 and the for DisposalSystem Construction Permit No. ,pp') -a,S3 dated or' Installer ! �a��. f 4: 1/Py ,/'Au d Designer /=1�,� r! �,,�l o rs i„ ,.•,y3 #bedrooms Approved design flow gP d The issuance of thhiisf perm•t shall not a construed as a guarantee that the system unction as jdes�igned. C II Date / /' Inspector le��G/.( C111T "!�i'!i// v�'� ————————---= —————————— ------U _ y ' -- - v✓ —>-- No. Fee /(/V THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION—BARNSTABLE, MASSACHUSETTS lwio ool * 5tem Coultructiou Permit � p Permission is hereby granted to Construct ( ) Repair Upgrade ( ) Abandon ( ) System located at 2 ZoKrCu La,P t/_ y„?ol y yy� Gr and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to comply with Title S and the following local provisions or special conditions. Provided: Construction must be completed within three years of the date of th is-pc it. Date ��1 ( a/U Approved by tN•. 4c,� r . o Town of Barnstable Regulatory Services Thomas F. Geiler, Director M • Public Health. Division sbsp �� 2"q. 61 Thomas McKean, Director 200 Main Street,Hyannis, MA Q2601 Office: 508-862-4644 Fax: 508-790-6304 Installer d Desianer-Certification Form Date: -/ SeR,aae Permitg ailo-7 -.253 Assessor's MaplParcel C! b Des aner: 0vJ n 2 f•�¢� Installer: �0 /yz Address: �ct,, St Address: �s--.�h J•,u�� �� On �'�� /11i /tf• ( � � was issued a permit to install a (date) (installer) septic system at D o tilQ- a - based on a design drawn by (address) dated . (d er) I certify' that the septic system referenced above was installed substantially according to the design; which may include minor approved changes such as lateral relocation of the distribution boa 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 NN ith State & Local Regulations. Plan revision or certifie -built by designer to follow-. .... V'(�A OF MgSSgcyG . DANIELA. s OJALA . (Installer's Signature) CIVIL U) No.46502 �. FG/S T ER�Da�� SIGNAL ECG (Designer's Signature) (.affix Designers Stamp Here) PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS-BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. Q: HeaIJUSeptidDesigner Certification Form 3-26-04.doc ALARM AND CONTROL PANEL ELECTRICAL PERMIT REQUIRED FROM TOWN OF BARNSTABLE TO BE INSTALLED INSIDE SYSTEM RROF�LE NOTES LEGEND BUILDING ALARM m BE ON (Y� 1 E TOP FNDN. AT EL. 39.9' SEPARATE CIRCUIT FROM PUMP ACCESS COVERS TO WITHIN 6" OF FIN. GRADE (NOT TO SCALE) ACCESS COVER TO WITHI N 3" OF FIN. GRADE (SEE VENT NOTE ON PLAN) 1. DATUM IS APPROXIMATE NGVD `. --••-- accESs c���R (waTERTrGr�l•� To �� sN a ,ar 100.0 PROPOSED SPOT ELEVATION WITHIN 6' OF FIN. GRADE 34.0' 33"5' MINIMUM J5 OF COVER OVER PRECAST 2X SLOPE REQUIRED OVER SYSTEM 2. MUNICIPAL WATER IS EXISTING IOOxO EXISTING SPOT ELEVATION 39.0 i 2" DOUBLE WASHED PEASTONE 32.7 INV. tN 31.2 INSTALL INLET RUN PIPE LEVEL. OR GEOTExTILE FABRIC 3. MINIMUM PIPE PITCH TO BE 1/8" PER FOOT. 100 PROPOSED CONTOUR *EXISTING Y PRESSURE LINE TEE 1" ABOVE FOR FIRST 2' 1000 GAL H-To s/T 00 GAL+ SLOPE TO DRAIN BACK TO PC ouTLEr INVERT 3' MAX.**EXISTING 1000 T 4. DESIGN LOADING FOR ALL PRECAST UNITS TO BE AASHO a ' *# , FLOAT SWFTgi ALARM ON RESERVE WEEP HOLE LOCUS 100 - EXISTING CONTOUR *EXISTING GALLON SEPTLc TANK *31.3 SETTINGS: PUMP ON CHECK VAWE B. -37.6' H- 10 GAS C WORKING RANGE & __ , ,,.: .. � 36.88' ., �, o MYERS SRM 4 37.05' 5. PIPE JOINTS TO BE MADE WATERTIGHT. a 4" SUBMERSIBLE 4/10 HP PUMP 36.8� I� I� I� I� O I� I� 1� I� o PUMP OFF 8 SYSTEM (OR EQUAL) riftm�s� Q I 0 Q I� 17- 0 0 0 '. ' o�000d '� ""' 6" CRUSHED STONE OR MECHANICAL , 0 0 O � I� 0 6. CONSTRUCTION DETAILS TO BE IN ACCORDANCE WITH DEPTH OF FLOW = 4 2 1� � � 0 � � � � I� 0 34,$' p oo MASS. ENVIRONMENTAL CODE T1TtE V. F �TEE SIZES: COMPACTION. (15.221 [2}) �Q *THE INSTALLER SHALL VERIFY THE _ PUMP CHAMBER 3/4" TO 1 1/2" DOUBLE WASHED STONE 7. THIS PLAN IS FOR PROPOSED WORK ONLY AND NOT TO INLET DEPTH 70 BE USED FOR LOT LINE STAKING OR ANY OTHER PURPOSE. !�°ate 64 LOCATIONS OF ALL UTILITIES AND ALL (NOT ro SCALE) BUILDING SEWER OUTLETS AND ELEVATIONS OUTLET DEPTH = 14" PRIOR TO INSTALLING ANY PORTION OF ( 2'5z SLOPS (-!-X SLOPE) 8. PIPE FOR SEPTIC SYSTEM TO SCH. 40-4" PVC. SEPTIC SYSTEM ailfood * SEPTIC 9 PUMP 96' LEACHING 5' 9. COMPONENTS NOT TO f.�E BACKFILLED OR CONCEALED FOUNDATION EXISTING TANK 4 CHAMBER D BOX 10 FACILITY WITHOUT INSPECTION BY BOARD OF HEALTH AND PERMISSION OBTAINED FROM BOARD OF HEALTH. LOCUS MAP **THE INSTALLER SHALL CONFIRM MIN. 10. CONTRACTOR SHALL BE RESPONSIBLE FOR CALLING NOT TO SCALE SEPTIC TANK SIZE AT 1000 GALLONS AND v DIGSAFE (1-888-344-72,33) AND VERIFYING THE LOCATION ITS SUITABILITY FOR RE-USE BUOYANCY��`�Y ��LV�� `, p, ADJ. G.W. EL. 29.8 VARIANCES: OF ALL UNDERGROUND & OVERHEAD UTILITIES PRIOR TO ASSESSORS MAP .335. PARCEL- 24 1000 GAL. H-10 (SHOREY) P.C. WEIGHS COMMENCEMENT OF WORK; 8240 LBS. VARIANCES FOR SEPTIC SYSTEM REPAIRS WHICH MAY BE LOCUS IS WITHIN FEMA FLOOD ZONE "C" IMMEDIATELY GRANTED BY THE BOARD OF HEALTH AGENT OR 11 EXISTING LEACHING FACILITY SHALL BE PUMPED AND SOIL WEIGHT- 0.75' X 4.83 X 8.5 X �0 AS SHOWN LBS./ FT3 = 2771 LBS. DOWN FOR TOTAL BY HEALTH INSPECTOR REMOVED OR PUMPED AND FILLED WITH CLEAN SAND. ON COMMUNITY PANEL #250001 0001 D OF 11,011 LBS. DOWN PAPERWORK AND HEARING REDUCTION PROPOSALS APPROVED 12. ANY UNSUITABLE MATF-RIAL ENCOUNTERED SHALL BE DATED JULY 2, 1992 (29.8 - 27.2) X 8.5 X 4.83 X 62.4 = BY THE BOARD OF HEALTH REVISED DURING A PUBLIC REMOVED 5' BENEATH AND AROUND THE PROPOSED LOCUS IS WITHIN AP OVERLAY DISTRICT 6,661 LBS. UP (OKAY) HEARING HELD ON NOVEMBER 15, 2005 LEACHING FACILITY. 4) FAILED SYSTEMS ONLY - SEPTIC TANK OR PUMP CHAMBER PROPOSED TO BE LOCATED LESS THAN 100 FEET BUT MORE THAN 75 FEET AWAY FROM WETLANDS OR A WATER COURSE. TEST HOLE LOGS ENGINEER: DAVID FLAHERTY, R.S. r ♦ i' �/o WITNESS• DONNA M10RAND1, R.S. \ 235.�4 37 ' ° �+ c �± DATE:- JillU SYSTEM DESIGN: PERC. RATE PERC. RATE . - < 5 MIN/INCH (ASSUMED) CONFIRMED BY GARBAGE DISPOSER IS NOT ALLOWED SIEVE ANALYSIS CLASS I SOILS p 11726 PAVED _ _ �I - _ ` I � DRIVE N� ----" I t� DESIGN FLOW: 3 BEDROOMS 0 110 GPD - 330 GPD ° (FAILED) \ \ ` USE A 330 GPD DESIGN FLOW- ______ i ELEV. ELEV. ELEV. it SEPTIC TANK: 330 GPD (2) = 660 0» � 35.0' 0" 38.5' 35.0' t \\ -3 :ENG \ `���� **RE-USE EXISTING 1000 GAL. SEPTIC TANK A A A BRWELLING / t , , \ \ \ 1\ FNDN-39.9' / c0 ;� V REMOVAL'OF UNSUITABLE SOIL S �S /�S / C0 �� REQUIRED AROUND PERIMETER OF LEACHING: LEACHING FACILITY, DOWN TO 10YR 3/2 10YR 4/2 1 OYR 4/2 SIDES: 2,(30, + 9.83) 2 (.74) = 118 GPD 18, 3 .0. 1.5 33.7 .,• � � \ \ \ \ � W----w _ � SUITABLE SOIL..LAYER REPLACE ( c 12 \ \ \ o W 34.0 " " DECK CLEAN MEDIUM SAND. BOTTOM 30 .x 9.83 (.74) = 218 GPD g g B \ \ 0 ./ / /_ . / Z/ TOTAL: 454 SF. 336 GPD / s ` WALKOUT ,•.,; / XISTiNG S. I „- 1. .R 5, 6/� " 1OYR 5/� " 10YR 5/6 , ••'�•. \ \ % \ w USE 2 500 GAL. LEACHING CHAMBERS ACME OR 32.7 .`•.• \ \ LP, \ i SLAB TH-2 • gl O ( , 27 36 35.5_ 36 32.0 @ EQUAL WITH 2.5 STONE AT SIDES 4 AT ENDS AND 5 O eOcE OFF'•• \ \ \ `\ `\ O C,• -� ; ELEV=33.0' I '' ) . O 9 \ 'µA II,LU INSTALL 4X:L OF 40 MIL POLY BETWEEN UNITS �< p�1. C1 � LINER AS SHOWN PER PLAN SILT LOAM :1 � v �` 1 \ I �'a TOP EL 37.6' 88 27.7 / / / / ; \ 11 \ \ \ \ �� r fr,� BOTTOM EL 3&6' GCIEEPfNG . 1OYR 5/6 29 4' ° 3 1� MA ( ) 109 ADJ. G.W: 29.8' PORCH _ -- �: 1 Rio APPROVED DATE BOARD OF HEALTH - }�' � W C1 C2. \ F I -'�- \ HED `�• \ ` - " SILT LOAM 156 10YR 7/2 22.0' SILT�CIA Y LOAM • 1-92" 10YR,7/4 : ..22.5 I I I i \ TH-1 / C2 sly C ` `�`1 I i \ GARDEN , \ Oy \ // C3 SAMPLE LOT 2 �+. \ I I I \ F PROVIDE VENT WITH CHARCOAL FILTER SILT CLAY LOAM �_ MFS - \ AND BUGSCREEN (FINAL PLACEMENT WITH SAMPLE LS 10YR 7-/4 35, 2O SFf \ \��\ ' I I '� \ I \ \ I HOMEOWNER CONSULTATION) __j 11 228 5G 5/'1 240." 2.5Y 4/4 120"- ' � 16,.E 18.5 25.0 , ,�� `\ \ ��•�� ��`.i \ �. \\ I -" _� `\ i BENCHMARK N OBS. WELL INFO: SONf3TttBE WELL- Al W-247 ELEV=34.7 ' ZONE- B UNSUITABLE SOILS DATE- APRtL 2007 READING- 23.5' \ I _ ADJUSTMENT- 2.8 232.581' \ °y� It TITLE 5 SITE PLAN OF 27 TONEL.A LADLE \\ \ \ I iqI (CUMMAQUID) BARNSTABLE, MA � \ \ ` I I It PREPARED FOR -CONST BORTOLOTTI 0 ` ROBERTBPREIDID"BAt it DATE: MAY 10, 2007 Scale: l"= 20' off 508-362-4541 fax 508 362-98`80 0 10 20 30" 40 50 FEET ���ZN OF Vys H oFM,��a q�ti �o ARNE o ARNE H. o H. do wn Cope engineering., _ In C. CIOJAVIL � U OJALA n U No.26348 No. 30792 Cl VIL ENGINEERS 0 /STEM ���``p ` �° SURV � LAND SUR VEYORS DA ARNE H. OJALA, P.E., P.L.S. 9,39 Maim Street YARMOU THPOR T, MASS. D-CE #4 7-05N 07-058..BORTOLOTTI-BREIDENBAGH.DWO (DDF)