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HomeMy WebLinkAbout0087 TONELA LANE - Health Bamstle . • A= 336 1• TOWN OF BARNSTABLE LOCATION 72 7 SEWAGE-# 7- 7 (`c/ t VILLAGE C v M--t 9 ' U l y, ASSESSOR'S MAP& LOT , INSTALLER'S NAME&PHONE NO. kZ • A ylkcll SEPTIC TANK CAPACITY LEACHING FACILITY: (type) GR,,,C4,, 4�� .iS (size) 6X, i 110.;NO:OF BEDROOMS 3 BUILDER OR OWNERGC7s1,,2 PERMUDATE: t COMPLIANCE DATE: ! �J— Separation Distance Between the: Q`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 r Furnished by " 1 r , A (-r K a Al f3y - /� 5: ✓6: �� ✓ 97Iy► j ASSESSORS;i�l�Pf10. Commonwealth of Massachusetts PARCEL NO. Titles Official Inspection Form Subsurface Sewage Disposal. System Form-.Not for Voluntary Assessments - � s 87 Tonella Lane;-Cummaguid a Property Address Margret White Owner Owner's Name information is' 2 Elizabeth Court, Mystic CT 06355 ' Jul 15, 2009 required for every Y _ —Y page. City/Town. State Zip Code. Date of Inspection Inspection.results must be submitted onFthis form..Inspection forms may.not be.altered in`any, way. A5 � (a [ Important:When filling out forms A. General Information on the computer, use only the tab 1. Inspector: Q (� . key to move your . , cursor-do not Troy Williams use the return —��----=— — -- - key Name of Inspector Troy Williams Se tp is Inspections_ _ rab Company Name 19 Hummel Drive Company Address.--- --- �,� South Dennis MA ; 02660 City/Town State Zip Code 508 385-1300 S1682 Telephone Number License Number a 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 ❑ kFails Q Needs Further Evaluation by the Local Approving Authority Inspector's Signatufe 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 used 87 Tonella'Lane,Cummaquid•03/08 Title 5 Official Inspection Form:Subsurface S age Disposal System.Page 1 of i6 4 ¢., Commonwealth of Massachusetts W Title 5 Official Inspection Form _ Subsurface Sewage Disposal.System Form -Not for Voluntary Assessments , 87 Tonella Lane,`Cummaa uid Property Address Margret White Owner Owner's Name - -- — — information is required for every 2 Elizabeth Court M stic �_ CT 06355 F Jul 15--2009 -- - ----_-- _ ._._y__— __-_-.-- _- _ -=- , -- �— - page. CityrFown State � Zip Code Date of Inspection B. Certification (cont.) —. Inspection Summary'.Check A,B,C,D or E j always complete all of Section D A) System Passes: ® I-have not found any information whicti indicates that any of the failure criteria described y in 310 CMR 15.303 or in 31.0 CMR 15,304exist. Anyfailure criteria not evaluated are indicated below. Comments: System meets minimum standards set by Mass DEP at the time of inspection only. This.inspection is not a guarantee or warranty on the future workinq conditions of leachingg-,_pipes or components. B) System Conditionally Passes: Q -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 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 bythe 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 tankis less than 20 years old is available. ND Explain; N/A' Observation of sewage backup or breakout or,high static water level.inthe 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): E broken pipe(s)are replaced ❑ obstruction is removed 87 Tonella Lane,Cummaquid•03108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 15 Commonwealth of Massachusetts x w Title. 5 Official Inspecti®n:Form o Subsurface Sewage Disposal System Form- Not for Voluntary.Assessments 87 Tonella Lane,Cu mm id Property Address — --. Margret White Owner Owner's Name - — --information is is 2 Elizabeth Court, Mystic CT 06355 Jul 15 2009 required for every �� —y— page. Cityrown State Zip Code Date:of Inspection B. Certification (cont:).- B) System�Conditionally Passes (coat.);` distribution.box'is'leveled or replaced ND'Explain: ❑ 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: N/A C) .Further Evaluation is Required by!he Boar&of Health: ❑ Conditions exist which arequire'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 4 ❑ Cesspool orprivy is within 50 feet of a bordering vegetated wetland or a salt.marsh 2. System will fail,unless the Board of Health (and Public.WaterSupplier, 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. . t _❑ ; w The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. 87 Tonella Lane,Cummaquid•03108 + Title 5 Official Inspection Form:Subsurface Sewage Disposal System,Page 3 of 15 Commonwealth of Massachusetts' Title 5 Official -Inspection Form Subsurface Sewage Disposal System Form - Not,foe Voluntary Assessments Y k„ 87 Tonella Lane,"Cummhaquid Prope rty ddres s p Y A Margret White Owner Owner's Name . information is " 2 Elizabeth Court, Mystic CT 06355 Jul 15 2009 required for every —y _ � Cit /T w — - , — — .. page. Y o n 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: N/A` **This system passes if the well water analysls,'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: N/A. A D) System Failure Criteria Applicable to All Systems: 16 You"must indicate"Yes'.'or"No to each of the following for all inspections; Yes No Backup of sewage into.facilify 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 ® 'r due to an'overloaded or clogged SAS or cesspool Static liquid level in the distribution box above outlet invert due to an overloaded El ® or clogged SAS or cesspool Liquid depth in cesspool is less than 6° below invert F•oravailable volume is less than '/day,flow Required pumping more than 44imes:in the last year NOTdue to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water,elevation.El :: ' Any portion of cesspool or privy is within 100 feet of a surface water supply or ® tributary to a surface water supply. 87 7onella Lane,Cummayuid•03108 Title 5 Official Inspection Form:Subswiaee Sewage Disposal System•Page 4 of 15 Commonwealth of Massachusetts x Title 5 Official inspection"' F®rm . Subsurface Sewoge'Disposal System Form -Not for Voluntary Assessments. w 87 Tonella Lane, Cummaquid Property Address r Margret White Owner Owner's Name information is 2 Elizabeth Court, Mystic CT 06355 Jul 15, 2009 required for every Y _- Y page. City/Town _ 'State Zip Code Date of Inspection a B. Certification (cont.) - D) System Failure Criteria Applicable to All Systems (cont.): i Yes No a ❑ ® Any portlon.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- ❑ ® The system fails. l 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.ble necessary to correct the failure... E) Large Systems: To be considered.a largeaystem 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 _ i the system is.located in a nitrogen sensitive area(interim Wellhead Protection Area-IWPA) or a mapped Zone ll of a publicwater supply well If you have answered "yes to"any question in-Section'E the system is.considered a significant threat, oranswered"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. 87 l-onella Lane,Cummaquid-03108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 15 Commonwealth of Massachusetts N. r Title 5 Official Inspection Form Subsurface Sewage Disposal.System Form - Not for Voluntary Assessments 87 Tonella Lane, Cummaguid_ y _ Property Address.— - Mar ret White ` 9 _ Owner Owner's Name information is 2 Elizabeth Court, Mystic CT 06355 Jul 15, 2009 required for every Y _ _ Y page. City/Town State Zip Code Date of Inspection e _ . C. Checklist , Check if the following have been done.You must indicate,'.yes" or"no"as to.each of the following: Yes No ® ❑ Pumping�informa-tion was provided by-the owner, occupant,`or Board of Health }El ® Were an Yof the system stem components pumped out in th e• re_vious`two weeks. ._ M_ ❑ 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? a` ® ❑ 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 `• 0 ` 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)] 87 Tonella Lane,Cumma uid•03/08 ` q Title 5 Official Inspection Form:Subsurface Sewage Disposal System.- 6 of 15.' Commonwealth of Massachusetts W Title 5 Official Inspection Form - Subsurface Sewage Disposal System Fogm Not for Voluntary.Assessments 87 Tonella Lane, Cumma�c uid Property Address. -- Margret White Owner Owner's Name -- , information is 2 Elizabeth Court, M stir CT. 06355 Jul 15, 2009 required for every —Y _ - _�_ _ page. City/Town State Zip Code Date of Inspection D. System Information Residential Flow Conditions: Number of bedrooms (design):. 3 --- Number of bedrooms.(actual)` 3. — DESIGNflow based on 3.10 CMR 15.20.3 (for example: 110 gpd x#of bedrooms): 330 gpd Number of current residents: + Does residence have a grinder? garbage 9 w � ® Yes. ❑ No . Is laundry on a separate sewage system? [if yes separate inspection: required]. ❑ Yes ® No` Laundry system inspected? ® Yes ❑ No r Seasonal uses ® Yes ❑ No. Water meter readin s,,if available last 2 ears usage d rt 08=108;000gals 9 (. Y 9_ (9P )) 07=126,000 ag Is Sump pump? ❑ Yes H' No Last.date of occupancy: i. Occasional use Date„ Commercial/Industrial Flow Conditions: - Type of Establishment: N/A 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 H No Water meter readings, if available: N/A —' N/A Last date of occupancy/use'.. Date N/A Other(describe): --- — — 87 Tonella Lane,Cummaquid-03108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System.-Page 7 of 15. Commonwealth of Massachusetts' Title 5 Official Inspection Form Subsurface.Sewage Disposal System Form -Not for Voluntary Assessments: 87 Tonella Lane, Cummaquid _ rProperty Address . Margret White . - Owner Owner's Name information is 2 Elizabeth Court, Mystic CT 06355 Jul 15, 2009 required for every — _�-- _Y page. City/Town State Zip Code Date of Inspection D. System Information (cont.) General Information Pumping Records: No pumping info available. Source of information: r. — — Was system pumped as part of the inspection? ❑, Yes ® No T If,yes, volume.pumped: N/A ; gallons How was quantity pumped determined? N/A - Reason for pumping: . N/A 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): Approximate age of all components, date installed(if known) and source of information: .Tank,d-box& leaching were installed on 4/27/98 per compliance. . Were sewage odors detected when arriving at the site? ❑ Yes M. No 87 Tonella Lane,Cummaquid•.03108. Title 5 official Inspection Form:Subsurface Sewage Disposal System"Page 8 of 15 , Commonwealth of Massachusetts Title 5 Official .lnspedio' n F®rm Subsurface Sewage Disposal System Form` Not for Voluntary Assessments �;�,•''F 87 Tonella Lane,Curnmayuid Property Address _Ma�cr ret White Owner Owner's Name -- -- — —information ation is 2 Elizabeth Court, M stic CT _ 06355 Jul 15, 2009 required for every L � _` _� page. City/Town State Zip Code Date of Inspection D. System Information (cont) - . • Building Sewer(locate on site plan): Depth below.grade: 18''+ — feet , Material f o constru ion: . ❑ cast Iron'. 40 PVC ❑other(explain): -- - Distance from private water,supply well.or suction line: N/A _= ` feet Comments(on condition of joints, venting,-evidence of leakage, etc.): Flushed lines and found clear at the'time of inspection_ Septic Tank(locate on site plan): 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: _ --- 6'.X 10.5'X 6' 1500 gallon Sludge depth: 4„ Distance from top of sludge to bottom of outlet tee or baffle -- -- - - - Thin Layer . Scum thickness Y fi Distance from top of scum to top of outlet tee or baffle --- - Distance from bottom of scum to bottom of outlet tee or baffle 14 How were dimensions determined? Probe/Measured 871 onella Lane,Curnmaquid•'03108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not'for Yoluntary Assessments 87 Tonella Lane, Cummaquid ` Property Address Margret White Owner '. Owner's Name information is required for every 2 Elizabeth Court, Mystic CT. y :' 06355 Jul 15 2009`. - page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments(on pumping recommendations, inlet and.outlet.te'e or baffle condition,structural integrity, liquid levels as related to outlet invert, evidence of Leakage, etc.): Pvc inlet and outlet,tee's were present. No evidence of leakage or damage was found. Tank was not in need of pumping at this time. Grease Trap(locate on site plan): Depth below grader N/A feet Material of construction: : ❑ concrete ❑metal. ❑fiberglass ❑ polyethylene ❑ other(explain): N/A Dimensions: N/A . N/A Scum thickness Distance from top of scum to top of outlet tee or baffle' N/A Distance from bottom of scum to bottom of outlet tee or.baffle,--. Date of last pumping: N/A _ - 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 ) N/A Tight or Holding Tank(tank must be pumped at time of inspection)'(locate on site plan): N/A-, Depth below'grade: Material of.construction' El concrete.. ❑ metal ❑fiberglass ❑ polyethylene. ❑ other(explain): N/A 87 Tonella Lane,Cummaquid-03108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 15 Commonwealth of Massachusetts v Title 5 Official l6spection Fora . a Subsurface Sewage Disposal System Form Not for Voluntary Assessments 87 Tonella Lane, Cummaquid Property Address -- -- - ---- Margret White Owner ------= =-- ----- _ -- • —. Owner's Name information is ,. required for every 2 Elizabeth Court Mystic" __ _ CT 06355 _ July/ 15, 2009 page. City/Town State Zip Code Date of Inspection .. B 1 D. System Information (cont.) Tight or,Holding Tank(cont.) Dimensions: N/A — Capacity: N/A— — - gallons N/A Design Flow: . ----- gallons per day Alarm present: ❑ Yes ❑ No Alarm level N/A — Alarm in working order: ❑ Yes El No . D NIA - ate of last pumping:. P p 9 . : s Date . Comments (condition of alarm and float switches, etc:): N/A Attach copy of current pumping contract(required). Is copy attactied? ❑ Yes ❑ No Distribution Box(if present must be opened) (locate on site plan): µ Depth of liquid level above outlet invert. Level with _ 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 was found level and in working order: Pump Chamber,(locate on site plan):. Pumps in working order: . . ❑ Yes ❑ No Alarms in.working order: ❑ Yes ❑ No 87 Tonella Lane,cummaquid•03108 Title 5 Official Inspection,Form:Subsurface Sewage Disposal System•Page 11 of 15 Commonwealth of Massachusetts _ Title 5 Officia' I Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments w 87 Tonella Lane, COT maquid Property Address ---- M - Margret White- _ Owner Owner's Name information is 2 Elizabeth.Court, Mystic CT 06355 Jul 15, 2009 required for every y _ _y _ page. CityrFown -,.State• "Zip Code _ Date of Inspection D. System Information (cont) Comments (note condition of pump chamber.,'condition of.pumps-and appurtenances, etc.): - -i 4 Soil Absorption System (SAS)(locate on site plan, excavation not;required): If SAS not located, explain•why: ' N/A Type: ❑ leaching pits number:. — 4-500 gallon ® leaching chambers number. chambers w/stone . ' ❑' leaching galleries.. number: Vends, 6"sides El leaching trenches number;length: El leaching fields - number; dimensions: —- ❑f overflowcesspool- : number: _ ❑ innovative/alternative.system i. Type/name of technology: — -- Comments'(note'condition of.s,oil,r signs'of hydraulic failure, level of ponding, damp soil, condition of vegetation,'etc.): Checked stone and found dry and clean with no-evidence of hydraulic failure orrproblems in the past ` were found at the time of inspection. 87 Tonella Lana,Cummaquid•03/08 Title 6 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form - Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 87 Tonella_LaneCummaguid Property Address —--- — - Margret White - Owner Owner's Name . information is required for every 2 Elizabeth Court, Mystic Y. CT 06355 _ Jul 'l5, 2009 - _ - y _ page. CitylTown State Zip Code° Date of Inspection D. System Information(cont.) Cesspools (cesspool must be pumped as part of.inspection) (locate on.site plan): Numberand configuration N/A Depth—top of liquid to inlet invert N/A` Depth of solids layer N/A Depth of scum layer N/A f , Dimensions of cesspool N/A • Materials of construction N/A Indication of groundwater inflow ❑ Yes ® No Comments (note condition of soil,.'signs of hydraulic failure, level of ponding, condition of vegetation, etc.)-. N/A Privy (locate on site plan): Materials of construction` N/A _- Dimensions N/A — --- Depth`of solids. N/A _ --- -- Comments (note condition of soil, signs of hydraulic failure, level of ponding,condition of vegetation, etc.).- N/A 87 ronella Lane,Cummaquid•03108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 15 Commonwealth of Massachusetts f Title 5 Official lnspecction Form Subsurface Sewage Disposal System Form -Not.for;Voluntary Assessments w 87 Tonella Lane, Cum_maquid Property Address' — Margret White Owner Owner's Name — -- information is 2 Elizabeth Court,'Mystic CT. 06355 Jul 15, 2009 required for every Y —Y page. Cityrown State Zip Code Date 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. f Wa r.- , G(LAI I,h1 • 87 Tonella Lane,Cummaquid•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 15 Commonwealth of Massachusetts r Title 5 Official inspection Form - Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 87 Tonella Lane, Cummaquid Property Address Margret White Owner Owner's Name information is 2 Elizabeth Court, Mystic ._ CT 06355 Jul 15, 2009 required for every Y _- _ Y page. Cityrrown State ;. Zip_Code Date of inspection D. System Information (cont.) Site Exam: ❑ Check Slope, ❑:Surface water ® Check cellar ❑ .Shallow wells x 14' + .,. Estimated depth to high ground water._ feet Please indicate all methods used to determine the high ground water elevation: y ® Obtained from system design.plans on record If checked, date of design plan reviewed: 7/27/95 Date ® Observed site (abutting property/observation hole.within 150 feet of SAS) ❑ Checked with.local Board of Health-explain +❑ '.'Checked with F 4 - , : • . . y. ". local excavators, installers'(attach documentation) ® Accessed USGS database-explain ;. g AIW 247 A ;Zone B 22.9' 2:2' adjustment You must describe how you established the high ground water elevation: . Test hole 6;T below bottorrt of leaching showed no water found_at 13.5'.Groundwater adjustment in area at the time of inspection was 2.2'. Bottom of leaching at 6.8'was found not to'be located in the high groundwater elevation at the time of inspection. 87 Tonella Lane,Cummaquid•03I08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 15 No. / Fee Lfid, THE C,OMMONWEALTH OF MASSACHUSETTS Entered in computer: ,y Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS 0(p p[ication for ;Di5 pozal *pztem Construction Permit Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. �� Owner's Name,Address d Tel C^C' o C_. Assessor's Map/Parcel �y,µq . V �� ► '"1 ' �--I' 3 � V Installer's yNaame,,AdAdress,,and Tel.No. Designer's Name,Address and Tel.No. �)A P&C 1 0 41( lzowv-1 &.-� t4fflnaokl A19 *&I" Type of Building: 1 Dwelling No.of Bedrooms 3 Lot Size3rwO sq.ft. Garbage Grinder t7j Other Type of Building No.of Persons Showeni.( ) Cafeteriwr ) Other Fixtures r'� Design Flow �/ gallons per day. Calculated daily flow 3 1 gallons. Plan Date , ber of shee Revision Date Title SA17 b C. Size of Septic Tank G Type of S.A.S. 1S00 C. r o 3 Description of Soil C)``Z.Zo �= 4�- A C •�LZ� 217 3 IC 411 Nature of Repairs or Alterations(Answer when applicable) C� 5 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 issus d by this Bo d of Healt . Signed Date Application Approved bX, Date /4F" Application Disapproved for the following reasof s Permit No. 7— -7/ 2 Date Issued .. TOWN OF BARNSTABLE LOCATION L�4 .::'��: SEWAGE # 7- 7 (q VILI:AGE c LtiIAr4a t/•� ASSESSOR'S MAP& LOT i - �> r INSTALLER'S NAME.dz HONE NO. SEPTIC TANK CAPACITY. j IEACH]NG FACILITY: (type) .G ,c�✓e �aa+ i (size) N0 OF BEDROOMS BCJILI7ER OR OWNER ccuf- ::.. . PERMI'TDATE: COMPLIANCE DATE: T_7 a ' Separation Distance Between the: Ma i Feel. x mum Adjusted Groundwater t the B t 'n J e o e of om of Leachi Facilit g Y a , ' Pnv�te Water Supply Well and Leaching Facility (If any;wells,exist o&site or within 200 feet of leaching facility) . Feet Eige of Wetland and Leaching Facility(If any wetlands exist "':::iwtthin 300 feet of leaching facility) Feet Furithed by { ; } ......... .44 Y6 7 ly c lNp r 'A' 7 / ►'try' Fee No. S V k THEi�rJMMONWEALTH OF MASSA HUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLEs MASSACHUSETTS ZippYtcat on for Mtgpogar *pgtem Construction Permit t Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. Owner's Name,Address d el. o. Assessor's Map/parcel �� 1 Installer's Name,Address,and Tel.No. .: Designer's Name,Address and Tel.No. Type of Building: V Dwelling No.of Bedrooms 3 Lot Size 3G:=��:' SO.ft. Garbage Grinder Other Type of Building No.of Persons Showers+ Cafeteria-() I Other Fixtures Design Flow gallons per day. Calculated daily flow 33 gallons. Plan Date ber of sheet Revision ate Title ., .r 1A w� C on —'�nD o o7t Size of Septic Tank N-�7y,y0o Type of S.A.S. 500 o C. oL —S Description of Soil d 2 it o I- CZA C •21 A 1�3 Zf!'_ Nature of Repairs or Alterations(Answer when applicable) vJ 5 5 Date last-inspected: 'p 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 issu d by this Board of Health. Signed' Date — Application Approved by Date Application Disapproved for,the following reasoi s 1 Permit Nos 7- 77 / Date Issued A -_+f -- -— — t ————————— THE COMMONWEALTH OF MASSACHUSETTS/ A ! BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO C TY,Abg the On-site Sewage Dispasal System Constructed( L/Repaired( )Upgraded( ) Abandoned( )by - at 97 vi i lz,L A 4 B KU&II"(2 gC,c� 4 has been been constructed in accordance with the pro i 'ons of Title 5 and the for Dispo System C nstruction Permit No.97- 70 / dated / Installer ' esigner The issuance f this permit shall At be,construed as a guarantee that the system will function as designed. Date Inspectors, No. 71 Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLEs MASSACHUSETTS Migpogai *pgtem Con.5truction Permit f Permission A hereby granted to Construct(t/�R_epair( ),Upgrade( )Abandon( ) System located at G k 8l0 ,e-- vh Q P(/I cl and as described in the above Application for Disposal System Construction Permit. The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided: Construction must be completed within three years of the date of this permit. Date: Approved by a HM ] 71 H E A L T H M A S T E R ] HELP [ ] R E C O R D ] ACTION I] For Parcel Number 3361 0621 ] ] Rental Property(Y/N) [ ] Owner Name WHITE, STEPHEN C ] Zone of Contrib (Y/N) [ ] Location 87 TONELA LANE CUMM ] Contaminant Rel (Y/N) [ ] Business Name [ ] Area Number Contact Person [ ] Phone [000] [ ] Fuel Storage Tank Permit [ ] Card on File [ ] Perc Test Well Septic File/Permit No. [P8545 ] [ ] [97-719 ] Issuance Date [ ] [1218971 Completion Date [ ] [0427981 Last Communications [ ] (MMDDYY) Comments [1500 ST DBOX 4-500 CHAM W/1' STONE ENDS, 1 . 5 SIDES] Cancel [ ] NEXT SCREEN [HM ] ACTION [ ] PARCEL NBR [ ] [ ] [ ] TANK NBR [ ] ] [ ] ' I� (� ,� °� 3� mab,�x�l PAR ] Real Estate System - General Property Inquiry] Help [ ] Parcel Id: 336 063- - Account No: 248315 Parent : Location: 71 TONELA LN Neighborhood: 76BB Fire Dist : BA Devel Lot : Lot Size : . 76 Acres Current Own: SMITH, WILLIAM F & IRENE M State Class : 130 TRS W & R TRUST No. Bldgs : Area: 4333 TONELA RD Year Added: BARNSTABLE MA 2630 Deed Date : 100184 Reference : 4281/318 January 1st : SMITH, WILLIAM F & IRENE M Deed MMDD: 1084 Deed Ref : 4281/318 Comments : Values : Land: 71400 Buildings : Extra Features : Road System: 71 Index: 1727 (TONELA LANE ) Frntg: 150 Index: ( ) Frntg: Control Info: Last Auto Upd: 093095 Status : C Last TACS Update : 092595 Land Reviewed By: Date : 0000 Bldgs Reviewed By: Date : 0000 Tax Title : Account : 6252 Taken: 090897 Account Status : PD Hold Status : PD Cancel [ ] Press XMT for more data Next screen [PAR ] Action [ ] Owners Name [ ] Road Index [ ] Road Name [ ] Parcel Number [336] [064] [ ] [ ] [ ] A1'!'LiCATIUN FOR PERCOLATION TEST AND OBSERVATION PITS LOCATION__. �'T T'�s/�� �!4 6�+ �� ' � N0. •��� . VII,I,AGE _�/ DATE FEE2-. APPLICANT firs .lAtaon Cl/g" ADDRESS_ �{v s ,¢Q �,�i21L �{/ j� ��- TELEPHONE NO7 (Non-refundable ENGINEER f L TELEPHONE 'NO.or / DATE SCHEDULED - v �133ro p G2_ �j np• S [Ct . (Applic_ants s � signature SO . G . . . G . . . . . . . C O O Y . . . . . . . Y . Y . . . C Y . YASS o� L G C . . . . . SOIL LOG SUB-DIVISION NAME"fi`ONiZ 4 (_A- L01-6 DATE EXPANSION AREA: YESJ�,_NO__ G ENGINEER ? TOWN WATERPRT1fATE WELL BOARD OF HEALTH Goa o -i EXCAVATOR SKETCH: (Street name,etc, ,dimensiotis of lot, exact location of .test holes and perc la.tion tests, locate wetlands in proximity to test holes ) NOTES. ' I 37 1 1 14 0 4aT- C. � 1 ,J a ' ( LI Ma n f3Y"icX.►�`e�l Sri� � ��t3 � CIO .n I , PERCOLATION RATE: I.<y X M IN ll ri c.� 7/ZI� TEST HOLE NO: o m ELEVATION: TEST HOLE NO: ELEVATION: 1 Z_.. c k. ww�' 1 Z '� �qti� La A 2 a` 2 - _ 4c,� T3�Lil s1�r L -1'*V � 10,1p-7/q cp 't 3 3 � -� -j«r L_wpr�n ,0Y��i3 5;11 IoY27�/ 54 .� 4 5 •, 5 �_- v y,¢7/y 6 � _Low '0/ 9 j. aV►� 9 N me�w►+^`{� .� 1 CVz 10 �y Zo 10 ✓ 712" 11 11 12 No ujPai,(L 12 �¢a..^/o rxo�T o"- 13 oc,Nr£/1 Q0 13 14 1 14 ` 1-3 - 6 Ito 15 15 WtmrL 16 16 tNcp�utifuo SUITABLE FOR SUB-SURFACE SEWAGE: LEACHING FIELD' _LEACHING PITS LEACfgNG `1'RENCIIES 1/ Mar -MR SURFACE SEWA_ . : �'t s__ 5`(sty n�q-t 2�c`�v ►2 uto5u,t4.��a I. wt, mc,�-e�rz-� to NOTE: ENGINEERING PLANS MUST SHOW NUMBER ASSIGNED ON PERC TEST APPLICATION ORIGINAL: COMPLETED IN ENTIRETY BY P . F AND RETURNED TO BOARD OF HEALTH COPY: RETAINED BY APPLICANT " '-" T.O.F. AT EL. SEPTIC PROFILE TEST HOLE LOGS H ACCESS COVER TO WITHIN 6' OF FIN. GRADE (NOT TO SCAIQ �'� >a,�'yi'� ACCESS COVER (WATERTIGHT) TO r"~ �i WTINiN 8' OF FIN. GRADE. ENGINEER: f J1 Ao-rzZ ! �� 4 --,,.o MINIMUM .75' OF COVER OVER PRECAST 2X SLOPE REQUIRED OVER SYSTEM � � � J WITNESS: RUN PIPE LEVEL Y DOUBLE WASHED PEASTONE DATE: • !> FOR FIRST 2' PROPOSED PERC. RATE _ .1... ,. �. �,• ,�, Z ,y " . z 3` f GALLON SEPTIC 3 MAX. `+ > TANK (H- 10) CLASS SOILS Pit ` GAS 1 I �� BAFFLE � � -�H 5 QaOQ Q 1:31--7Q0 ( % SLOPE) 6' CRUSHED STONE OR MECHANICAL Q Q Q Q Q Q Q Q Q ELEV. ELEV. `y COMPACTION. (15.221 [21) 2' Q Q Q Ell O ED O 7 DEPTH OF FLOW ( ! X SLOPE) ( X SLOPE) —T, Cr On V TEE SIZES: 3/4" TO 1 1/2" DOUBLE WASHED STONE INLET DEPTH OUTLET DEPTH LOCATION MAP SCALE 1" � FOUNDATION— '> SEPTIC TANK - �'<� D' BOX , LEACHING FACILITY ASSESSORS MAP ''s PARCEL L �„�• "0•'� /�'T oo>= ZONING DISTRICT: � ti I_ ►o its "'�4 k r >/,f YARD SETBACKS: FRONT = 3a 41 '� Q��o�a-.- cf ���� �3,h�.� �..,1� I 3"• __��``•j`- �'(�-4,. (.�� o y��: k�,� .� SIDE = � ! rt �%• -.:i APB, is 0� �� ,, , nY C. ' �.� REAR PLAN REF.-- 2. Ah htilvMa►r1 (L� V-L ,.� 604. vt.�,b-rk l�laf.1> - ( ',tell"F 00l-"' N_ reN ' (�'�'� ��; 1 rf�� �.dw: G,�� Ta ✓�� o- ,-I� ,r-1 C.-Tc FLOOD BONE: � ..10. ,� k ' v F �G {o .� L. Is• v►,,,,RT F,3s+G. h I , Z. ..�-yam' T , '�` ,,a� fi► ,.1►.1 f I IsG f. !. � 2- >�+c AIC<dM .O4/tw.• r / GZ .. Tic ��(�_ «�,. ,.11� j' � (" � - 2� 1�6t•l--j(�}�'�'lQ� ��t'v 1 M..I` NOTES: tt. _ r i . ' I SEPTIC DESIGN: (GARBAGE DISPOSLR Is 1 . DATUM IS DESIGN FLOW: BEDROOMS ( GPD) _ '�3�GPD 2. MUNICIPAL WATER IS �/ � - - -r USE A ' GPD DESIGN FLOW 3. MINIMUM f'INt PITCH TO BE 1/8 PER FOOT. SEPTIC TANK: �,-,• GPD 4. DESIGN LOADING FOR ALL PRECAST UNITS TO BE AASHO H- !� , -�, (=) _ _ 5. PIPE JOINTS TO BE MADE WATERTIGHT. \ �� J USE A ✓ GALLON SEPTIC TANK 6. CONSTRUCTION DETAILS TO BE IN ACCORDANCE WITH MASS. ` \ (G; I T LEACHING:G. ENVIRONMENTAL CODE TITLE V. J c - ga '4 ? ! %�3 7. THIS PLAN IS FOR PROPOSED WORK ONLY AND NOT TO BE SIDES: USED FOR LOT LINE STAKING. BOTTOM: ( `� �-' 8. PIPE FOR SEPTIC SYSTEM TO SCH. 40-4" PVC. .. ....,ate .RK M'fiG.v�� n �� • 1�T '42 -T TOTAL: S.F. y% GPD 9. COMPONENTS NOT TO BE BACKFILLED OR CONCEALED WITHOUT INSPECTION BY BOARD OF HEALTH AND PERMISSION OBTAINED FROM BOARD OF HEALTH. ~T'' rel ' '= 6-* `''`' !L 10. CONTRACTOR SHALL BE RESPONSIBLE FOR VERIFYING THE -�' ' ��� ( ' �;� r��1 �.•1Ac�.q;�+cti. th .5' c �. ?' rs:• u LOCATION OF ALL UNDERGROUND & OVERHEAD UTILITIES PRIOR $' �� ► Z r, = P ,�,,� �-;`� TO COMMENCEMENT OF WORK. •� >r1 -• � ., cam- c.•� -ta ✓E. 1.c-t..,rt- �t.���� LEGEND SITE AND SEWAG E PLAN PROPOSED SPOT ELEVATION OF 8? f �� ��`, ate•- , 100x0 EXISTING SPOT ELEVATION IN THE TOWN OF: 100 PROPOSED CONTOUR — — 100 — — EXISTING CONTOUR PREPARED FOR: �^ 0 BOARD OF HEALTH MA SCALE: E DATE: �._ .: :�-r ? , Iq j APPROVED DATE 7� ►-i o��, t T ►- r.� 0'u A n v ��o g�.,� -�.� �.Ala�,,—ct ,_� r�.� , ._,._ c A1..,t off 5W-M2-4541 -7 '� �. T o ".k 4c f= We M-9w M I> � • : > 7 EJ +R-tr r+ ,;_ �G `�ov tv� G � s� k-,i:� -J C r+ down cape engineering, Inc. -`" , `" f.0 A4.I,� CIVIL ENGINEERS a ;�GAIA 1 LAND SURVEYORS Z 5-117 JOB# 939 main st. yarmauth, ma 026751 � - Z ors, ., DAra P ' f p'