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HomeMy WebLinkAbout0255 GREEN DUNES DRIVE - Health 255 Greeri Dunes Drive Centerville A=245 —031 l SMEAD No. 53LOR UPC 12543 smead.com • Made in USA I No. Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS ftpliLation far Mispo8al *pstrm (Construction Vfmit Application for a Permit to Construct(Repair( ) Upgrade( ) Abandon( ) ❑Complete System CPI ividual Components Location Address or Lot No. Owner's Name,Address,and Tel.No. 2-SS ree-h Dees arYvc ' Rain 4-A^;.4l,' C 4 (14'01),' Assessor's Map/Parcel a 0"?,( ' O Pl%q.oe erea4 Aw ,- Installer's e Address and Tel.No. 7 Designer's Name,Address,and Tel.No J e .L�44�n oSi so 0-`�2 -3 Type of Building: Dwelling No.of Bedrooms s I'tf4Xat) Lot Size �CbE5 sq.ft. Garbage Grinder( ) Other Type of Building f P No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided gpd Plan Date 'S V2 V.20/6 Number of sheets Revision Date � 1.1 �'16 Title -P,'� f6k P aS��nai, i.-n<S / Size of Septic Tank Type of S.A.S. j5 5+,'nc 9--5210 iA Description of Soil -- — 3® �o .1 h F'6!—,4a r f Nature of Repairs or Alterations(Answer when applicable) _Ajo 1i e_ 'C IC4A l� QA4-rk Fy ap j2rC.,,r,. o f /46v4_e AWi 4,c pj. 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 n ace the system in operation until a Certificate of Compliance has been issued by this Board of Healt Signed Date a- Application Approved by Date Application Disapproved by Date for the following reasons Permit No. Date Issued 63 77- N Fee 1 V V � o. � f THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS j �f application �r'Vf;posal *pstem Construction Permit Application for a Permit to Construct(�'Repair( ) Upgrade( ) Abandon( ) ❑Complete System P�Individual Components Location Address or Lot No. Owner's Name, `t Address,and Tel.No. 225 S Gieert 7��e S (7r;✓e "'a,T —^°,. ePo�in 4- AhiZ C4 Assessor's Map/Parcel 2 yz o"3 j P/a p e r A Installer's Name,Address and Tel No. Designer's Name,Address,and Tel.No. 4c7`( �/44dn,S fC°'l/d�t _�h,S;�,c��/,its +�ch>�lL�.i,� ?i►�'. + Type of Building: Dwelling No.of Bedrooms 5 f 4,C �Grd Lot Size j,2 4 i e S sq.ft. Garbage Grinder( ) Other Type of Building $ F No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided gpd ��10�9 Number of sheets Revision Date Z����Zo 6 Plan Date �f 2 Title j - e P(�A tN26eot' Size of Septic Tank Type of S.A.S. C)VJ 4;„, T-.SUu GIr S Description of Soil 57 —J 30 Nature of Repairs or Alterations(Answer when applicable) Ajo i e lae ,'C Tgh f rc--qa r-e o f 14-as-e 4Wj 4,, n. �Date last inspected: L 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-WI-place the system in operation until a Certificate of Compliance has been issued by this Board of Healt >, Signed /' -s / Date Application Approved by % '/ Date Application Disapproved by Date s:t , for the following reasons , \ Permit No. 6 Date Issued off" --------------------------------------------------------------------------------------------------------------------------------------- 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 e rA" I St* at 2-5-5 Gr-ee^ (Dunes -Pr ,'✓`L -has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. dated Installer _. pesigner •4-&Ve?4,> �iti' X i% _ . ✓ #bedrooms Approved design flow gpd The issuance of this permit sh"11 not be 'onstrued as a guarantee that the system ill functio as e ;gned. Date ��E �// Inspector .. f i � ---------------- ----- - rr 2 ---- --------- No. C94 6 J Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION- BARNSTABLE,MASSACHUSETTS Misposal *- pstem Construction errnit Permission is hereby granted to Construct( ) Repair( ) Upgrade( ) Abandon( ) System located at 2 5 S Cr-eeri Z)uh.e S 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 t be cg leted within three years of the date of this permit. O h Date I Approved by / 1 s; gmIV TOWN OF BARNSTABLE LOCATION �j/d e ,2- 4 h e S' &SEWAGE# ��� o`�7 VILLAGES ,,,rl� ASSESSOR'S MAP&PARCEL INSTALLERS NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY:(type) (size) NO.OF BEDROOMS (� OWNER PERMIT DATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility f" 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 C, � 41QO6s Town of Barnstable ti Regulatory r Services ces 0 Richard V. Scali, Interim Director * BARNSTABLE, 10� Public Health Division �E1639n. Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Installer & Designer Certification Form Date: 2 Zo/? Sewage Permit# 2616_037 Assessor's Map\Parcel ZY s <3 1 Designer: 5,111f bpi F LA a,,ip Installer: Address: 7Pe_r-4&- /®D Imo K C,,7 Address: 27 On 2- i 7 201 C 5W�mo 5 was issued a permit to install a (date) (installer) r °septic system at Z S 57Gr-e-ch Pu,?p Pr ,..e- based on a design drawn by (address) dated 12/!2 -12 a I (designer') 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 box and/or septic tank. Strip out (if required) was inspected and the soils were found satisfactory. I certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system) but in accordance with State & Local Regulations. Plan revision or certified as-built by designer to follow. Strip out (if required) was inspected and the soils were found satisfactory. I certify that the system referenced above was constructe ce with the terms of the I Val letters (if applicable) tN0 s q C T. cy� ' D C !L n s Signature) 52 9 4,41, (<z S/bNAL�G� (Designer's Signature) (Affix Designer's 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:\Septic\Designer Certification Form Rev 8-14-13.doc I E & F 8MRONMENTAL S�ERVIC L.L Environmental/Demolition Contractors Commercial I Industrial I Residential September 20, 2016 Barnstable Board of Health 200 Main Street Hyannis, MA 02601 RE: 255 Green Dunes Drive, Hyannisport, MA Dear Sir/Madam: Please be advised that we will be conducting an Asbestos Abatement at the above captioned address on September 27, W6. 1 have attached a copy of the Notification filed with the MASS DEP for your records. Kindly contact us with any further questions or comments you may have. Very truly yours, Susan A. Pappalardo E& F Environmental Services, LLC [Enclosures 129 Newton Road, Plaistow, N{N 03565 (603)97q-2503 Fax: (603)97q-2g71 Massachusetts Department of Environmental Protection - f 100250704 ,• BWP AQ 04 (ANF-001) Asbestos Project# r;. Asbestos Notification Form Project Revision r Project Cancellation A. Asbestos Abatement Description 1.Facility Location: RESIDENCE 255 GREEN DUNES DRIVE Instructions 1.All a.Name of Facility b.Street Address sections of this form BARNSTABLE must be completed in MA 02647 0000000000 order to comply with c.City/rown d.State e.Zip Code f.Telephone MassDEP notification WA N/A requirements of 310 CMR 7.15 and g•Facility Contact Person Name h.Facility Contact Person Title Department of Labor Worksite Location: WCHEN Standards(DLS) notification i.Building Name,Wing,Floor,Room,etc. requirements of 453 2. Is the facility occupied? rV a.Yes r b.No CMR 6.12 3. Is this a fee exempt notification (city, town, district, municipal housing authority, state facility, or owner-occupied residential property of four units or less)? r' a.Yes r b.No MassDEP Use Only 4.Blanket Permit Project Approval,if applicable: Date Received Approval ID# 5.Non-Traditional Asbestos Abatement Work Practice Approval, 2.Submit Original if applicable: Approval ID# Form To: Commonwealth of Massachusetts 6.Asbestos Contractor: P.O.Box 4062 Boston,MA 02211 E&F ENVIRONMENTAL SERVICES LLC 86 CAROLAN AVE a.Name b.Address HAMPTON NH 03842 6032345581 c.City/Town d.State e.Zip Code t Telephone AC000767 h.Contract Type:1✓ 1.Written r,2.Verbal g.DLS License# 7. GUILLERMO A MARGARIN FIRMS AS060373 a.Name of Contractors On-Site Supervisor/Foreman b.DLS Certification# 8. N/A a.Name of Project Monitor b.DLS Certification# 9 ASBESTOS NOTIFICATION LABORATORY AA00208 a.Name of Asbestos Analytical Lab b.DLS Certification# 10. 9/27/2016 9/27/2016 a.Project Start Date(MM/DD/YYYY) b.End Date(MM/DD/YYYY) 74 N/A c.Work Hours-Monday Through Friday d.Work Hours-Saturday&Sunday 11.What type of project is this? r a.Demolition r. b.Renovation r c.Repair r. d.Other-Please Specify: REMOVAL Revised: 11/13/2013 Page 1 of 4 Massachusetts Department of Environmental Protection ,l 1100250704 BWP AQ 04 (ANF-001) Asbestos Project# Asbestos Notification Form r. Project Revision r- Project Cancellation A.Asbestos Abatement Description: (cont.) 12.Abatement procedures(check all that apply): 9- a.Glove Bag� b.Encapsulation (- c.Enclosure r7 d.Disposal Only r e.Cleanup r f Full Containment , g.Other-Please Specify: 13.Job is being conducted: R a.Indoors r b.Outdoors 14 a.Total amount of each type of asbestos Containing materials(ACM)to be removed,enclosed,or encapsulated: 0 300 1.Linear Feet(Lin.Ft.) 2.Square Feet(Sq.Ft.) b.Boiler,Breaching,Duct, c.Transite Pipe Tank Surface Coatings 1.Lin.Ft. 2.Sq.Ft 1.Lin.Ft 2.Sq.Ft. d.Pipe Insulation e.Transite Shingles 1.Lin.Ft. 2.Sq.Ft. 1.Lin.Ft. 2.Sq.Ft. f.Spray-On Fireproofing g.Transite Panels 1.Lin.Ft. 2.Sq.Ft. 1.Lin.Ft. 2.Sq.Ft. h.Cloths,Woven Fabrics i.Other-Please Specify: 1.Lin.Ft. 2.Sq.Ft. j.Insulating Cement FLOORTILE 300 1.Lin.Ft. 2.Sq.Ft. 1.Lin.Ft. 2.Sq.Ft. 15.Describe the decontamination system(s)to be used: FULL CONTAINMENT 16.Describe the containerization/disposal methods to comply with 310 CMR 7.15 and 453 CMR 6.14(2) (g): ALL METHODS WILL COMPLY 17.For Emergency Asbestos Operations,the MassDEP and DLS officials who evaluated the emergency: a.Name of MassDEP Official b.Title of MassDEP Official c.Date of Authorization(MM/DD/YYYY) d.Waiver# e.Name of DLS Official f.Title of DLS Official g.Date of Authorization(MM/DD/YYYY) h.Waiver# 18.Do prevailing wage rates as per M.G.L.c. 149,§26,27 or 27A—F apply to this r a.Yes P b.No project? Revised: 11/13/2013 Page 2 of 4 Massachusetts Department of Environmental Protection - - 100250704 BWP AQ 04 (ANF-001) Asbestos Project# Asbestos Notification Form Project Revision r-, Project Cancellation B. Facility Description 1.Current or prior use of facility: RESIDENCE 2.Is the facility owner-occupied residential with 4 units or less? W a.Yes F, b.No 3 RAM AND ANALI CHUTTANI 255 GREEN DUNES DRIVE a.Facility Owner Name b.Address HYANNISPORT MA 02647 0000000000 c.Cityfrown d.State e.Zip Code f.Telephone 4 N/A WA a.Name of Facility Owner's On-Site Manager b.Address WA MA 00000 0000000000 c.Cityfrown d.State e.Zip Code f.Telephone 5 N/A N/A a.Name of General Contractor b.Address N/A MA 00000 0000000000 c.City/Town d.State e.Zip Code f.Telephone L g.Contractors Worker's Compensation Insurer LIBERTY MUTUAL 12/13/2016 h.Policy# i.Expiration Date(MM/DD/YYYY) 6.What is the size of this facility? 1500 2 a.Square Feet b.#of Floors C. Asbestos Transportation & Disposal 1.Transporter of asbestos-containing waste material from site of generation: a.Directly to Landfill or b.To Temporary Storage Location/Transfer Station E&F ENVIRONMENTAL SERVICES,LLC 86 CAROLAN AVENUE c.Name of Transporter d.Address Note:Temporary storage of Asbestos HAMPTON NH 03842 6039742503 containing waste e.City/Town f.State g.Zip Code h.Telephone material is only allowed at the place of business of a DLS 2.If a temporary storage location/transfer station is used,list name of transporter of asbestos containing licensed Asbestos contractor or a transferwaste material from temporary storage location/transfer station to final disposal site: station that is permitted by SERVICE TRANSPORT GROUP,INC. 58 PYLES LANE MassDEP and a.Name of Transporter b.Address operated in compliance with Solid NEWCASTLE EE 19720 8779999559 Waste Regulations c.Cityfrown d.State e.Zip Code f.Telephone 310 CMR 19.000 Revised: 11/13/2013 Page 3 of 4 " Massachusetts Department of Environmental Protection 100250704 BWP AQ 04 (ANF-001) Asbestos Project# Asbestos Notification Form Project Revision Project Cancellation C.Asbestos Transportation&Disposal: (cont.) 3.Name and address of temporary storage location/transfer station for the asbestos containing waste material: N/A N/A a.Temporary Storage Location Name b.Address N/A MA 00000 0000000000 c.City/Town d.State e.Zip Code f.Telephone 4.Name and location of final disposal site(asbestos landfill): MINERVA LAND FILL N/A a.Final Disposal Site Name b.Final Disposal Site Owner Name 9000 MINERVA ROAD c.Address WAYNESBURG CH 44687 3308663435 d.City/Town e.State f.Zip Code g.Telephone D. Certification FRANK BALOGH FRANK BALOGH "I certify that I have personally 1.Name 2.Authorized Signature examined the foregoing and am OMER 9/13/2016 familiar with the information contained in this document and 3.Posfion/Title 4.Date(MM/DD/YYYY) Note:Contractor must 6039742503 E&F ENVIRO sign this form for DLS all attachments and that,based notification purposes on my inquiry of those 5.Telephone 6.Representing individuals immediately 86 CAROLAN AVENUE HAMPTON responsible for obtaining the 7.Address 8.City/Town information,I believe that the N..I 03842 information is true,accurate,and complete. I am aware that there 9•State 10.Zip Code are significant penalties for submitting false information, including possible fines and imprisonment.The undersigned hereby states that I have read the Commonwealth of Massachusetts regulations governing asbestos abatement (453 CMR 6.00 promulgated by the Department of Labor Standards and 310 CMR 7.15 promulgated by the Department of Environmental Protection), and that I am aware that this permit application or notification shall not be deemed valid unless payment of the applicable fee is made." Revised: 11/13/2013 Page 4 of 4 i Commonwealth of Massachusetts -- Title 5 Official Inspection Form nsp I- Subsurface Sewage Disposal System Form-Not for Voluntary Assessments OM ,.� a 255 Green Dunes Dr. Property Address Alice M. Carey______.__...__._...... Owner Owner's Name information is es 6rAft '/� Ma 02647 5/21/2013required for every ...._........_..... ... K. � _._._.. — _ __......._ __._........__.._. __. page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When f out forms A. Genera! Information onn the computer, use only the tab 1. Inspector: key to move your cursor-do not Sean M. Jones usethe return __.................._..........................._..................._....._....._.. ._....._-... _.. __-.. -------- --....__..._...........................................--- key. Name of Inspector Capewide Enterprises.... _ — .._...._._....................... _........._....._............ .........._....-----.._......................__.... U1_ Company Name 153 Commercial St. Mashpee_...___ __- _—.— Ma 02649 CitylTown State Zip Code 608-477-8877 SI 4522 Telephone Number License Number B. Certification I 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 rr7ja0tenancegf on site sewage disposal systems. I am a DEP approved system inspector pursuant to ection ' 340g Title 5(310 CMR 15.000). The system: fj) *) ® Passes ❑ Conditionally Passes ❑ RMI''s tJ �v ❑ Needs Further Evaluation by the Local Approving Authority -6/21/2013 � rn ...._.._..............._........_........................__.._........._......_...........-..... .............................._ .. .......... ....._.._..___ _....... _ _._...._....._...................._...._..-----__.._......._....._........._...._...__..._.............. Inspector'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. 615 A3 t5ins•3/13 Tice 5 Official Inspect' F r :Subsurface Sewage Disposal System•Page 1 of 17 f Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 255 Green Dunes Dr. Property Address Alice M. Carey Owner Owner's Name information is Hyannis port required for every West ort Ma 02647 5/21/2013 page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® 1 have not found any information which indicates that any of the failure criteria described in 310 CM 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: The dwelling located at 255 Green Dunes Dr. is served by a Title V septic system consisting of a 1500 gallon septic tank, 1000 gallon pump chamber, distribution box and 5 3050 Infiltrators. The system was found to be in proper working condition at the time of inspection. B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no" or"not determined" (Y, N, ND) for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old" or the septic tank (whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 17 i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 255 Green Dunes Dr. Property Address P Alice M. Carey Owner Owner's Name information isequiredore very West H annis ort Ma 02647 5/21/2013 page. Cityrrown 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 ❑ 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 15ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 3 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 255 Green Dunes Dr. Property Address Alice M. Carey Owner Owner's Name required for is every West Hyannis re required for eve port Ma 02647 5/21/2013 page. Citylrown 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 ❑ ® 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 1/z day flow t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 c Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments °M 255 Green Dunes Dr. Property Address Alice M. Carey Owner Owner's Name information is every West H annis required for eve Y Port Ma 02647 5/21/2013 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® 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•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts 4 Title 5 Official Inspection Form _ Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 255 Green Dunes Dr. Property Address Alice M. Carey. Owner Owner's Name information is every West H annis required Y port Ma 02647 5/21/2013 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 by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)) D. System Information Residential Flow Conditions: Number of bedrooms(design): 5 Number of bedrooms (actual): 4 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 577.11 gpd provided t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 255 Green Dunes Dr. Property Address Alice M. Carey Owner Owner's Name information isequired or every very West H annis o rt Ma 02647 5/21/2013 page. City/Town State Zip Code Date of Inspection D. System Information Description: Number of current residents: 2 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available (last 2 years usage (gpd)): Detail: 2011= 227,000 total =622 gpd 2012 = 214,000 total = 586 gpd * includes irrigation system 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•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 17 r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 255 Green Dunes Dr. Property Address Alice M. Carey Owner Owner's Name information is West Hyannis port Ma 02647 5/21/2013 required for every p page. Citylrown 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: Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): l5ins•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 C M 255 Green Dunes Dr. ' Property Address Alice M. Carey Owner Owner's Name required for is every West H required for eve yannlsport Ma 02647 5/21/2013 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: system installed 3/25/2008 per town records Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 5 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.): Joint were ok, no leaks, vented through the roof Septic Tank(locate on site plan): Depth below grade: 4 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 gallons Sludge depth: 6" 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 255 Green Dunes Dr. Property Address Alice M. Carey Owner Owner's Name information is every West H annis o required for eve Y P rt Ma 02647 5/21/2013 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 3" Scum thickness 3" Distance from top of scum to top of outlet tee or baffle 6" Distance from bottom of scum to bottom of outlet tee or baffle 10" How were dimensions determined? opened covers, tookmeasurements 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 does not need to be cleaned now but should be done soon and again every 2 years for proper maintenance. water level was even with outlet, tank was not leaking and was structurally sound. Inlet and outlet covers are on risers Grease Trap(locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 255 Green Dunes Dr. Property Address Alice M. Carey Owner Owner's Name information is West H annis required for every Y port Ma 02647 5/21/2013 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): 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 255 Green Dunes Dr. Property Address Alice M. Carey Owner Owner's Name information is required for every West Hyannisport Ma 02647 5/21/2013 page. CityTTown 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 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.): Distribution box was in good condition, no rot water level was even with outlet invert. 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.): Pump chamber was in good condtion, pump chamber is 6' below grade therefore the pump floats were not able to be activated manually. Stain lines on the wall of the tank indicate that it has never been overfull. * 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 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 255 Green Dunes Dr. Property Address Alice M. Carey Owner Owner's Name information is required for every West Hyannisport Ma 02647 5/21/2013 page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ® leaching chambers number: 5 3050Infiltrators ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Soil surrounding s.a.s. was dry, no lush vegetation. no signs of past saturation 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 15ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 r Commonwealth of Massachusetts w Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 255 Green Dunes Dr. Property Address Alice M. Carey Owner Owner's Name information is every West H annis o required for eve Y P rt Ma 02647 5/21/2013 page. City/Town 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 _ A Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments �•,r .; 255 Green Dunes Dr. ...... __._.._..._......_.._._—._..._.___.___...._..--_-........____ Property Address Alice M. Carey Owner Owner's Name information is West H annis ort Ma 02647 5/21/2013 requiredfor every _ _.._.....___Y.._.._......._......_P.;___.._._ ._................. _._�....... _�..........._...._ __....--- — page. Cdyrrown 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 ail 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 I 1 i I 3 3 i 1 i I t�V 0� 5� r yyb� i 0 1 i t I i l tStns•3,'13 F.Official Ssha,a Ois3_5a,System -a a I c#17 r Commonwealth of Massachusetts . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 255 Green Dunes Dr. Property Address Alice M. Carey Owner Owner's Name information is required for every West H Yannis o P rt Ma 02647 5/21/2013 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: 12'+ 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: 8/1/2007 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 ground water elevation: Design plan on file at Town of Barnstable health department dated 8/1/2007 indicates that no groundwater was encountered at 132"and system is designed to have 5'+ seperation between bottom of s.a.s. and adjusted groundwater elevation. 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 255 Green Dunes Dr. Property Address Alice M. Carey Owner Owner's Name information is required for every West Hyannisport Ma 02647 5/21/2013 page. CityrTown 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 r t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 17 No. ._ __0 W t g Fee OC/ THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: ' PUBLIC HEid►LTH-bIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes application for �Di Y *p5tem Congtruction Permit Application for a Permit to Construct( ) Repair( Upgrade( ) Abandon( ) Complete System ❑Individual Components Location Address or Lot No.orm 1' n ; ner's Name,Address,and Tel.No. bare j N. /7jaranrJ POr� M/� � P-O 130,E /O Assessor's Map/Parcel Installer's Name,Address,and Tel.No. Designer's� Name,Address and Tel.No. ys �-la)4) �J p jam- g�i ray �� f-���L y�.�/lj met s�g-��� a91�• ��'�� .r,,�.,�� �� Type of Building: Dwelling No.of Bedrooms Lot Size sq.8. Garbage Grinder Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) ,) J O gpd . Design flow provided -f7`2 / I gpd Plan Date �'� —�`7 Number of sheets_ C=2- Revision Date �— Title sv t S ne (J sd�� A0s7 ,Tj— D/t [✓. /�DaYr f/lov d�/3 Size of Septic Tank /SOO C,L /�?p /44�Ce�L;2L Type of S.A.S. Description of Soil Y,-.r P�Ak? 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 Certificate of Compliance has been issued by this Bo d of lth. S gned Date Application Approved by Date C Application Disapproved by: Date for the following reasons Permit No. acpDate Issued .:r._.... .. -. � � _ --.--v"'..r• -. .- --.w'.M"yF.',:., _:,t .•..---•tea._ _.,• .. .. No. v lL Y� ®G Fee M BATHE O MONWEALTH OF MASSAC__U_S€TES Entered in computer: % __. Yes PUBLIC HEA%(*,H bIVISION - TOWN OF BARNSTABL'E, MASSACHUSETTS Ztpprtcatton for Otg oar *pgtenY ion truct on permit Application for a Permit to Construct( ) Repair upgrade( ) Abandon( ) U Complete System ❑Individual Components Location Address or Lot No.c�fr &0 0d J 'Wwner's Name,Address,and Tel.No. 6`ar e- Assessor's Map/Parcel ,29s- 7 S-pQ,`77f G/ L✓ ! , �yy)) �'I k)� Installer's Name,Address,and Tel.No. a �� � Designer's Name,Address and Tel.No. D1r1-h 4 ys'�n J1u 4i �� 10 1. 13.x q?I/ �� �/1 !" �s��i ��•f��� /yl� S7j�''.7Gi? ��!'.Z�• L��>✓ .f.�,e•j..�( r�!'1 , ) a ��f I . Type of Building: Dwelling No.of Bedrooms Lot Size sq. ft. Garbage Grinder Other Type of Building No.of Persons Showers( ) Cafeteria( ) t Other Fixtures r Design Flow(min.required) rf O gpd Design flow provided gpd r Plan Date "� —O`7 Number of sheets Revision Date Title srr0 i �, !J tis�• ,feel r• Size of Septic Tank /SGb e,a! /,�90 t LGIDCs`L CP .1 Type of S.A.S. r"-Z; lk Description of Soil Nature of Repairs or Alterations(Answer when applicable) fw 9__ )0417 y 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 Bo d of H Ith. S(ned Date 7— f� X Application Approved by Date Application Disapproved by: Date for the following reasons �. Permit No. =_)M R7 --d 6 Date Issued 13- d L THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS (Certificate of (Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed ( ) Repaired ( j,)�Upgraded ( ) Abandoned( )by 1,44 at Z -�,,, / y r _AIL !/. A4, e, has been constructed in accordance I with the provisions of Title 5 and the for Disposal System Construction Permit No. ,w ig'0 6 rP dated C9 J� Installer D-1i � ,r 6.L./1p.�->!,a.. Designer 9-07 Z'- > . #bedrooms - Approved d�igra�flow S� / gpd The issuance of this permiZsh 11 not be 'bnstrued as a guarantee that the system tll fuDate }��� Inspector - - ----------------------- No. ' �0 " G Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE, MASSACHUSETTS 0h5pogal *p!6tem (Co�nstructton Permit Permission is hereby granted to Construct ( ) Repair ( /,1 Upgrade ( ) Abandon ( ) System located at IL !/ /-rIGO/N rl _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 dat\this p'emtit` Date �.1. 3 / Approved\by,_._' ,_ TOWN OF BARNSTABLE LOCTION_ 1i UyvP �/t- SEWAGE# C0$o66 VILLAGE /7L ASSESSOR'S MAP&PARCEL �_Is - INSTALLERS AME&PHONE NO. V09- B'1JL SEPTIC TANK CAPACITY 4300 GuC 11-,,20 11-,70 ®v 1v�4 LEACHING FACILITY:(type). /�,4� 303-V C.�) (size)`a.16 X NO.OF BEDROOMS OWNER PERMIT DATE: -?—0 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 BYi .,�:��. f 0 ��`` r Town of Barnstable �p'WE Regulatory Services Thomas F. Geiler, Director wutvsrnat.r. 9�A �kn Public Health Division 39. Thomas McKean, Director 200 Main Street,Hyannis,NIA 02601 Office: 503-362-46-1 4 Fax: 508-790-6304 Installer g Designer Certification Form Date: 1% 0 Sewage Permit# $Orb Assessor's NIaplParcel ' G Designer: l " ✓� T� Installer: �" �77`�• f��{-c Address: RC2 - Address: �lr �,Cj VJ i CA e n d 1, gl• We 11% !W* 1) v& 3 .z r 7 On vz 7 3I 4.,/w �b�/�,r,� was issued a permit to install a (date) (installer) septic system at based on a design drawn by D66Yfly", ]� ,, (aaddress �r{9 V! e dated 0 _O (deslgner) I certify that the septic system referenced above was installed substantially according to the design, which may include minor approved changes such as lateral relocation of the distribution box andlor septic tank. I I certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system) but in accordance with State & Local Regulations. Plan revision or certified as-built by designer to follow. S �� !D RRE �r, MEYE —a Installer's Signature) t"40 'AEG/SiEO ' NITAR�I'� . d F-YA (Designer's Signature) (Affix Designer's Stamp Here) �J PLEASE RETURN TO BARNST- LE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORINI AND AS-BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. Q: Heal th/Septic;Designer Certification Form 3-2641doc i Town of B' nstable- Department of Regulatory Services • ' Public H[eafth Division Date ,vuass� : i ,F1 true Mee$ 200 Main Street,Hyannis MA 02601 f heduled ' 'Time ! Fee Pd. Date Sc oil Suitability Assessment for Sewage Disposal Performed By Witnessed By;®/rT'� i LOCATION & GENJERALINFORMATION Location Address'.2 TjS _FEN D V N 6S D p'{VE owner's Name A L 166 M, WIE y F� f. j4Y"N1SP0KT MA ( Address Du�JES l w: N tt,(A- -Aj/SPoa MA Assessor's Map/P4rcel: 2� /,t�3 I Engineer's Name' M LA NEW CONSTRUt>;`CION REP/AIR Teiephone#$O$ 3(0 2- 29 22 tv Surface Stones F ri1 Land Use / ��/ Slopes(%) r ft Drinking Water Well >ZtiO Distances from: (open Water Body,.s/S6 ft Possible Wee Area g I ft Drainage Way y ft Property Line O ft Other i s SKETCH:($treet name,dimensiods'of lot,exact locations of test holes&perc tests,locate wetlands in proximity to holes) M t�— �� j. Parent material(gecildgic) <Q M AVI, 1 Depth to 9edroek Depth to GroundwaWr. Standing Water in Hole: i Weeping froth Estimated Seasonal ifth Groundwater DtTERU TION FOR SEASO"L HIC•]I WATER TABLE Method Used: ! in, Depth observed standing in obs.hole: _in. Depth to Spil mottles; Depth toiweeping from side of obs.hole I in. ©toundwntrrr AdJuetment Index Well# Reading Date IndexWelllevel.�.e s,.a Adj,taCtor,,,,... AtQ.drtluntlWAtePleVul.,,�e d �` PERCOLATION,TEST Dtttt:?.�,�,�--, Observation _ I Time at 91, N '4 Hole# - a y Depth of Perc �& -to�f 4 Time at 6" .......__... /a --- Start Pre-soakTime.0 Time(9"-G') /o zz . End Pre-soak o - Rate MinJInch � Site Suitability Assc$sment: Site Passed Site Failed: Additional Testing Needed(YIN) \ Original:.Public Health Division Observatiod Hole Data To Be Completed on Back--- ***If percola>fibn testis to be conducted within 100' of wetland,,you must first notify the Rarnstable C64servation Division at least one(1)wedk prior to beginning. DEEP OBSERVA 710N HOLE-LOG Hole# 1 Depth from Soil Horizon Sail Texture Soil Color Soil Other Surface(in.) (USDA) 01unseil) Mottling (Structure,Stores,Moulders. Consistenc %Graved_• b"-2q" i! _q" 27" Loa. �� l OW-4/,_ low-ow 2- ? C LSO. (c a. M ey. rtr,! 2.5 Y 7/ DEEP OBSERVATION HOLE LOG Hole# ?� Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.), (USDA) (Mansell). Mottling. .(Structure,Stones,Boulders. ^.onsister� %Gravely_ — 32 0 4/z N �- DEEP OBSERVATION HOLE LOG Hole#-.. Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consiste c %Gravel DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency, gravel) .t Flood Insurance Rate Man: Above 500 year flood haundary No ^ Yes ,- Within 500 year boundary No Yes,. �1 Within 100 year flood boundary No X Yes Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervious material exist.in all areas observed throughout the CC area proposed for the soil absorption system? Vtoc If not what is the depth 1, de th of naturally occurring pervious ma terial? �------�—�--� -� Certification W I certify that on (date)I have passed the soil evaluator examination approved by the Department of Environmental Protection and that the above analysis was performed by me consistent with I the required training,expertise and experience described in 310 CMR 15.017.' ' Signature Date Q:\.SEPTIMERCFORM.DOC Town,of Barnstable Barnstable AFAmedcaUl RARNSTABLE. + � ' UAS& ,�$ Board of Health 'Fo +A 200 Main Street, Hyannis MA 02601 zoos Office: 508-8624644 Wayne Miller,M.D. FAX: 508-790-6304 Paul Canniff,D.M.D. Junichi Sawayanagi September 17, 2007 Mr. Darren M. Meyer, R.S. P.O. Box 981 E. Sandwich, MA 02537 RE: 255 Green Dunes Drive, West`Hyannisport A= 245031 Dear Mr. Meyer, You are granted a conditional variance on behalf of your client, Alice Carey, to construct an onsite sewage disposal system at 225 Green Dunes Drive, West Hy_annisport. The variance granted is as follows: Section 360-1, Town of Barnstable Code: The septic tank and pump chamber will be located 65 feet away from the top of a bank (wetland), in lieu of the 100 feet minimum separation distance required. This variance is granted with the following conditions: (1) No more than five (5) bedrooms maximum are authorized at this property. Dens, study rooms, offices, finished attics, sleeping lofts, and similar-type rooms are considered "bedrooms" according to the MA Department of Environmental Protection. (2) The applicant shall record a properly worded deed restriction, signed by the owner of the property, at the Barnstable County Registry of Deeds restricting the property to five (5) bedrooms maximum. A copy of the recorded deed restriction shall be submitted to the Health Agent prior to obtaining a disposal works construction permit. Q:\WPFILES\MeyerCarey2OO7new.doc (3) The septic system shall be installed in strict accordance with the engineered plans dated August 1, 2007. (4) The designing engineer shall supervise the construction of the onsite sewage disposal system and shall certify in writing to the Board of Health that the system was installed in substantial compliance with the submitted plans dated August 1, 2007. The existing septic system has failed. This variance is granted because the proposed plan appears to meet the maximum feasible design standards contained within the State Environmental Code, Title 5 and local Health Regulations. Since ly yours, VAt Wa ne Iler, M.D. Cha' ma Q:\WPFILES\MeyerCarey2OO7new.doc �ZME Tp� DATE ;. FEE: * BAMSTABLE, y MASS. s6gq. �0� REC. BY —rk019 Town of Barnstable SCHED. DATE: /I a { Board of Health F' 200 Main Street, Hyannis MA 02601 Office: 508-862-4644 Wayne A.Miller,M.D. FAX: 508-790-6304 Paul J.Canniff,D.M.D. VARIANCE REQUEST FORM LOCATION _ • 1 ` / p-�^ Property Address: �S5 G�e�ENII DUN�S D�+IV� �,4NNISt��. Assessor's Map and Parcel Number: Aq slo-31 Size of Lot: Wetlands Within 300 Ft. Yes x Business Name: No Subdivision Name: APPLICANT'S NAME: D44REN Mc yEk Phone Z-08 Did the owner of the property authorize you to represent him or her? Yes No PROPERT[Y�OWNER'S NAME CONTACT PERSON ,, ' Name: /` t- GE ''b• 6kkEy Name: /�-� - t%�L M e�Lc-le Address:Fy•BO( 10( W. VAWNISPW MA Address: ` I U• BOX c�� E•SANOM(4q Phone: � -7 ! S- - Sao Phone: VARIANCE FROM REGULATION(List Reg.) REASON FOR VARIANCE(May attach if more space needed) NATURE OF WORK: House Addition ❑LJLJLJLJLJ House Renovation ❑ Repair of Failed Septic System JR Checklist (to be completed by office staff-person receiving variance request application) Please submit copies in 4 separate completed sets. Four(4)copies of the completed variance request form Four(4)copies of engineered plan submitted(e.g.septic system plans) za Four(4)copies of labeled dimensional floor plans submitted(e.g.house plans or restaurant kitchen plans) tJ Signed letter stating that the property owner authorized you to represent him/her for this request Applicant understands that the abutters must be notified by certified mail at least ten days prior to meeting date at a plicant's ez`pense (for.Title V and/or local sewage regulation variances only) Full menu submitted(for grease trap variance requests only) I Variance request application fee collected(no fee for lifeguard modification renewals,grease trap variance renewals[same owner/leasee ;only], outside dining variance renewals [same owner/leasee only],and variances to repair failed sewage disposal systems [onlyf f No expansiori.io the building proposed]) Variance request submitted at least 15 days prior to meeting date VARIANCE APPROVED Wayne Miller,Chairm t J NOT APPROVED Paul J.Canniff,D.M. a REASON FOR DISAPPROVAL C:\Documents and Settings\decollik\Local Settings\Temporary Internet Fi1es\0LK1\VARIREQ.D0C \/ f 1 August 9, 2007 Barnstable Board of Health 200 Main Street Hyannis, MA 02601 Re: Septic.System Upgrade Residence—255 Green Dunes Drive, West Hyannisport, MA To Whom It May Concern: 1, Alice M. Carey, owner of 255 Green Dunes Drive, authorize Darren M. Meyer, R.S. to represent me before the Barnstable Board of Health in all matters regarding the upgrade of the on-site Title V sewage disposal system at the above referenced property. (w.L' v CCcc�i lice M. Carey, Property Ow r f COMPLETE •N COMPLETE THIS SECTIONON DELIVERY ■ Complete items 1,2,and 3.Also complete A. Signatur item 4 if Restricted Delivery is desired. 1 `' ❑Agent ■ Print your name and address on the reverse X ❑Addressee _so that we can return the card to you. B. Received Printed a ) C. D e of D livery ■ Attach this card to the back of the mailpiece, or on the front if space permits. D. Is delivery address dill rent from item ? ❑Yes 1. Article Addressed to: If YES,enter delive address below: ❑No A4. C446-)l /off 3. Service Type �) MA Of Certified Mail [3 Express Mail V" ❑Registered ❑Return Receipt for Merchandise 666 a2�7Z ❑Insured Mail ❑C.O.D. 4. Restricted Delivery?(Extra Fee) ❑Yes 2. Article Number 7005 1820 00�05 3258 7977 (Transfer from service labeQ i PS Form 3811,February 2004 Domestic Return Receipt 102595-02-M-1540 UNITED STATES POSTAL SERVICE First-Class Mai! Postage&Fees Paid LISPS Permit No.G-10 • Sender: Please print your name, address,and ZIP+4 in this box • Po 80k qC/l M E. S4NO w16N MA 02S3�- COMPLETE • ■ Complete items 1,2,and 3.Also complete A. Signature item 4 if Restricted Delivery is desired. ❑Agent X ■ Print your name and address on the reverse ❑Addressee _so that we can return the card to you. B. Received by(Printed Name) C. Date of Delivery ■ Attach this card to the back of the mailpiece, or on the front if space permits. D. I�delM ss j from item 1? ❑Yes 1. Article Addressed to: ISYI�"""�����I 44� ress below: ❑No Lit! E F. AUG 2 5 2001 'Boy 41 2 111 .Q ry ce Type Ce ' ed Mail ress Mail W. u YA'NN 1 OR.T I PS s etum Receipt for Merchandise Sp 1 ❑Insure C.O.D. Q 2.607 2 4. Restricted Delivery?(Extra Fee) ❑Yes 2. Article Number �- (transfer from se►vicelatieq ' 7005 1820 0005 ,3258 7953 PS Form 3811,February 2004 Domestic Return Receipt 102595-02-M-1540 UNITED STATES POSTAL SERVICE First-Class_Mail Postage&Fees Paid USPS Permit No.G-10 I • Sender:Please print your name, address, and ZIP+4 in this box • I -D- ''- ` po Pax q;�l r w k&U W pzq,37 COMPLETE •N COMPLETE THIS SECTIONON DELIVERY ■ Cbmplete items 1,2,and 3.Also complete A. Sign ture item 4 if Restricted Delivery is desired. ❑Agent ■ Print your name and address on the reverse ❑Addressee so that we can return the card to you. g`� i`" ,�nNtee) C. Date of Delivery ■ Attach this card to the back of the mailpiece, or on the front if space permits. 1. Article Addressed to: AT)• Is delivery address differen�from item 1? El Yes �1�17�j 5,Zte5d€lWadd ss below: ❑No /�- ►� L 76 7 � ) 3.IRegistered Servic}-F(/A,. MA Certified Mail 13 Express Mail v _ - J ❑Return Receipt for Merchandise �2?� ❑Insured Mail ❑C.O.D. 4. Restricted Delivery?(Extra Fee) ❑Yes 2. Article Number 7005 1820 0005 3258 7960 j (Transfer from service label) PS Form 3811,February 2004 Domestic Return Receipt 102595-02-M-1540 UNITED STATES POSTAL SERVICE First-Class Mail Postage&Fees Paid LISPS Permit No.G-10 I • Sender: Please_print your name., address,and ZIP+4 in this box • 'i I �.o 59xMA I oz53� SECTIONSENDER: COMPLETE THIS ■ Complete items 1,2,and 3.Also cotplete A Signatu item 4 if Restricted Delivery is desired Agent ■ Print your name and address on t everse '_ see so that we Can return the Card to you. B. ceived by(Printed Name) C. ate of elivery ■ Attach this card to the back of the.mailpiece, C or on the front if space permits. 42 D. is delivery address different from item 1? Yes 1. Article Addressed to: If YES,enter delivery address below: ❑No bqt-Por24 6 Ll.40q- 01444MEu-A i BEE C��14q �T` 3. Service Type n„65-&n MA - ,Q Certified Mail ❑Express Mail j� (� ❑Registered ❑Return Receipt for Merchandise 0 ❑Insured Mail ❑C.O.D. 1&0 4. Restricted Delivery?(Extra Fee) ❑Yes 2. Article Number '' ' ` 1 " (Transfer from service label) . '7005 '1820 0005 3258 ;7991 I PS Form 3811,February 2004 Domestic Return Receipt 102595-02-M-1540 UNITED STATES POSTAL SERVICE R rstIRssivlall— Postage&Fees P@id M -- usPs . • Sender: Please,print your na ad4r6,-A(,and ZIP+4aa&sA -� I qV sa MA 11iI � I i COMPLETE • ■ Complete items 1,2,and 3.Also complete A. Signature item 4 if Restricted Delivery is desired. �jI� Agent ■ Print your name and address on the reverse �0 ❑❑Addressee .so that we can return the card to you. B. Received by(Printed Name) C. Datq of De'very ■ Attach this card to the back of the mailpiece, �� or on the front if space permits. D. Is delivery address different from item 14 ❑ s 1. Article Addressed to: If YES,enter delivery address below: ❑No sasc-;PH DE�LLO Posroo 20q G RjEEn/ DUNES DR. KCT E '4 LO U6 " eADO�/ Dr( 3. Service Type Certified Mail ❑Express Mail I � ��� O Registered ❑Return Receipt for Merchandise J O� ❑Insured Mail ❑C.O.D. 4. Restricted Delivery?(Extra Fee) ❑Yes 2. Article Number 7005 1820 0005 3258 8004 (Transfer from service labeq i PS Form 3811,February 2004 Domestic Return Receipt 102595-02-M-1540 I UNITED STATES POSTAL SERVICE First-Class Mad Postage&Fees Paid LISPS Permit No.G-10 • Sender: Please print your name, address, and ZIP+4 in this box • i i i Bo cop t, ABUTTOR'S LIST FOR 255 GREEN DUNES DRIVE, W. HYANNISPORT (MAP 245/LOT 031) MAP 245 LOT 025 DELLO RUSSO, JOSEPH AT AL 204 GREEN DUNES DRIVE 204 GREEN DUNES DR RLT TR 14 LONGMEADOW DRIVE WESTWOOD, MA 02090 MAP 245 LOT 026 BROUILLARD, JOHN C &ELAINE F 270 GREEN DUNES DRIVE PO BOX 412 W. HYANNISPORT, MA 02672 MAP 245 LOT 030 DONOVAN, RUTH M. 275 GREEN DUNES DRIVE DONOVAN, SUSAN E 301 EAST 64' STREET NEW YORK,NY 10021 MAP 245 LOT 048 CHARAMELLA, STEPHEN &LINDA 175 SEVENTH AVENUE KAPLAN, JOAN 47 BEECHING STREET WORCESTER, MA 01601 MAP 245 LOT 052 MCKEON, ANN L 0 SEVENTH AVENUE PO BOX 767 W. HYANNISPORT, MA 02672 MAP 245 LOT 03 1-001 CAREY, ALICE M 237 GREEN DUNES DRIVE PO BOX 101 W. HYANNISPORT, MA 02672 August 20, 2007 Joseph Dello Russo, AT AL 204 Green Dunes Dr. RLT TR 14 Longmeadow Drive Westwood, MA 02090 RE: Septic System Upgrade —Variance Request Carey Residence, 255 Green Dunes Drive, W. Hyannisport, MA Dear Abutter (204 Green Dunes Drive): This letter is to notify you of a hearing before the Barnstable Board of Health scheduled on Tuesday September 11, 2007, at 3 pm in the Barnstable Town Hall Hearing Room to present the proposed septic system upgrade plan and the variance requested for the above referenced site. The proposed system design has taken into account requirements set forth in 310 CMR 15.000 (Title V) and the Town of Barnstable Board of Health Regulations. The following variances are requested: 1) Per Barnstable Board of Health Regulations variance to allow septic component (septic tank & pump chamber) to be 65 feet from wetlands vs. required 100 feet. As an abutter of the property in question, state regulations require that you be notified of the hearing a minimum of ten (10) days prior to the hearing date. If you have any further questions regarding this request please feel free to contact me at (508) 362-2922 or attend the hearing on the scheduled date. Sincerely, Darren M. Meyer Registered Sanitarian P.O. Box 981 E. Sandwich, MA 02537 508-362-2922 August 20, 2007 John C. Brouillard Elaine F. Brouillard PO Box 412 W. Hyannisport, MA 02672 RE: Septic System Upgrade —Variance Request Carey Residence, 255 Green Dunes Drive, W. Hyannisport, MA Dear Abutter (270 Green Dunes Drive): This letter is to notify you of a hearing before the Barnstable Board of Health scheduled on Tuesday September 11, 2007, at 3 pm in the Barnstable Town Hall Hearing Room to present the proposed septic system upgrade plan and the variance requested for the above referenced site. The proposed system design has taken into account requirements set forth in 310 CMR 15.000 (Title V) and the Town of Barnstable Board of Health Regulations. The following variances are requested: 1) Per Barnstable Board of Health Regulations variance to allow septic component (septic tank & pump chamber) to be 65 feet from wetlands vs. required 100 feet. As an abutter of the property in question, state regulations require that you be notified of the hearing a minimum of ten (10) days prior to the hearing date. If you have any further questions regarding this request please feel free to contact me at (508) 362-2922 or attend the hearing on the scheduled date. Sincerely, Darren M. Meyer Registered Sanitarian P.O. Box 981 E. Sandwich, MA 02537 508-362-2922 August 20, 2007 Ruth M. Donovan Susan E. Donovan 301 East 64th Street New York, NY 10021 RE: Septic System Upgrade —Variance Request Carey Residence, 255 Green Dunes Drive, W. Hyannisport, MA Dear Abutter (275 Green Dunes Drive): This letter is to notify you of a hearing before the Barnstable Board of Health scheduled on Tuesday September 11, 2007, at 3 pm in the Barnstable Town Hall Hearing Room to present the proposed septic system upgrade plan and the variance requested for the above referenced site. The proposed system design has taken into account requirements set forth in 310 CMR 15.000 (Title V) and the Town of Barnstable Board of Health Regulations. The following variances are requested: 1) Per Barnstable Board of Health Regulations variance to allow septic component (septic tank & pump chamber) to be 65 feet from wetlands vs. required 100 feet. As an abutter of the property in question, state regulations require that you be notified of the hearing a minimum of ten (10) days prior to the hearing date. If you have any further questions regarding this request please feel free to contact me at (508) 362-2922 or attend the hearing on the scheduled date. Sincerely, Darren M. Meyer Registered Sanitarian P.O. Box 981 E. Sandwich, MA 02537 508-362-2922 August 20, 2007 Stephen Charamella Linda Charamella Joan Kaplan 47 Beeching Street Worcester, MA 01601 RE: Septic System Upgrade —Variance Request Carey Residence, 255 Green Dunes Drive, W. Hyannisport, MA Dear Abutter (175 Seventh Avenue): This letter is to notify you of a hearing before the Barnstable Board of Health scheduled on Tuesday September 11, 2007, at 3 pm in the Barnstable Town Hall Hearing Room to present the proposed septic system upgrade plan and the variance requested for the above referenced site. The proposed system design has taken into account requirements set forth in 310 CMR 15.000 (Title V) and the Town of Barnstable Board of Health Regulations. The following variances are requested: 1) Per Barnstable Board of Health Regulations variance to allow septic component (septic tank & pump chamber) to be 65 feet from wetlands vs. required 100 feet. As an abutter of the property in question, state regulations require that you be notified of the hearing a minimum of ten (10) days prior to the hearing date. If you have any further questions regarding this request please feel free to contact me at (508) 362-2922 or attend the hearing on the scheduled date. Sincerely, Darren M. Meyer Registered Sanitarian P.O. Box 981 E. Sandwich, MA 02537 508-362-2922 August 20, 2007 Ann L. McKeon PO Box 767 W. Hyannisport, MA 02672 RE: Septic System Upgrade — Variance Request Carey Residence, 255 Green Dunes Drive, W. Hyannisport, MA Dear Abutter (0 Seventh Avenue): This letter is to notify you of a hearing before the Barnstable Board of Health scheduled on Tuesday September 11, 2007, at 3 pm in the Barnstable Town Hall Hearing Room to present the proposed septic system upgrade plan and the variance requested for the above referenced site. The proposed system design has taken into account requirements set forth in 310 CMR 15.000 (Title V) and the Town of Barnstable Board of Health Regulations. The following variances are requested: 1) Per Barnstable Board of Health Regulations variance to allow septic component (septic tank & pump chamber) to be 65 feet from wetlands vs. required 100 feet. As an abutter of the property in question, state regulations require that you be notified of the hearing a minimum of ten (10) days prior to the hearing date. If you have any further questions regarding this request please feel free to contact me at (508) 362-2922 or attend the hearing on the scheduled date. Sincerely, Darren M. Meyer Registered Sanitarian P.O. Box 981 E. Sandwich, MA 02537 508-362-2922 August 20, 2007 Alice M. Carey PO Box 101 W. Hyannisport, MA 02672 RE: Septic System Upgrade —Variance Request Carey Residence, 255 Green Dunes Drive, W. Hyannisport, MA Dear Abutter (237 Green Dunes Drive): This letter is to notify you of a hearing before the Barnstable Board of Health scheduled on Tuesday September 11, 2007, at 3 pm in the Barnstable Town Hall Hearing Room to present the proposed septic system upgrade plan and the variance requested for the above referenced site. The proposed system design has taken into account requirements set forth in 310 CMR 15.000 (Title V) and the Town of Barnstable Board of Health Regulations. The following variances are requested: 1) Per Barnstable Board of Health Regulations variance to allow septic component (septic tank & pump chamber) to be 65 feet from wetlands vs. required 100 feet. As an abutter of the property in question, state regulations require that you be notified of the hearing a minimum of ten (10) days prior to the hearing date. If you have any further questions regarding this request please feel free to contact me at (508) 362-2922 or attend the hearing on the scheduled date. Sincerely, Darren M. Meyer Registered Sanitarian P.O. Box 981 E. Sandwich, MA 02537 508-362-2922 � V ( gXlLl �va✓✓1 YI l� Xt3 aqy l � r�YA r pro lyc2l" S�� No. 2 0o3- (r 2 Fee / i • �, THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: AL Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS Application for Mie;pogal *pttem Construction Permit Application for a Permit to Construct( )Repair( 1_11u4grade( )Abandon( ) ❑Complete System individual Components Location Address or Lot No�Jr-s/�R��N `�U £S Owner's Name,Address and Tel.No. 'S'6�fl Assessor's Map/Parcel Z�S Q 3� �S—f- �+,p��� �v��S• �� ►"'r�.,��p� T-. Installer's Name,Address,and Tel.No.,sO$`- 7")3-- Designer's Name,Address and Tel.No. AAdC4?/f/co 3sa Type of Building: /J v S F Dwelling No..of Bedrooms /� Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. 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) £ P J4 C£ I'V4IAI A,-£ 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 is5Wj by this Board of Health. Signed Date 3-a2 — o Application Approved by Pi Z Date Application Disapproved for the following reasons Permit No. ?OO'J—(�2 Date Issued Z� 3 No. 2oy3, Z Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS 0[ppYication for Mi2;po9;a1 OpMem Conotruction Permit Application for a Permit to Construct( )Repair(P Upgrade( )Abandon( ) ❑Complete System A'Irt'dividual Components t 4 Location Address or Lot No2.3:S" fs �,e owner's Name,Address and Tel.No. -Sio r 7 rf t G oG'� �f1�e£Y �'�' !_�'•���- s y Assessor's Map/Parcel Zy 5.—o 31 - O,pr- q-57 6+f Er* 031V U F 5 3/e Installer's Name,Address,and Tel.No.s"&4r- 077 S-02 P°G Designer's Name,Address and Tel.No. sT- w-y�10e g Type of Building: `J G V S t +� ' Dwelling No.of Bedrooms r' Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. - Description of Soil l Nature of Repairs or Alterations,(Answer when applicable) R 44 C 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 issued by this Board of Health. Signed - - tie Date y G Application Approved by Date 312 C, Application Disapproved for the following reasons i Permit No. 200 3^ r t Z Date Issued 3 2 4/0 3 THE COMMONWEALTH OF MASSACHUSETTS Y BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY that the On-site Sewage Disposal System Constructed( )Repaired ( Z.�Upgraded( ) Abandoned( )b (0,4V r d 3Sa ST 4w- at SS G ££N D t/ti L S 10 Y PoTpr has been construct�jd in accordance •with the pro sons of Title 5 and the for isposal System Construction Permit No. ZCQ S--/(2 dated 3!Z y 03 Installer Designer The issu .ni a of this perrrAt shall not be construed as a guarantee that the system w'l�fun- asides`! ed Date Inspector Y --------------------------------------- \\ No. 2-00 2- .— Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS ligool *pztem Cottgtructiort Permit Permission is hereby granted to Construct( )Repair( [o"Upgrade( )Abandon System located at ...5-.� /�° ti i/it/ £S W /y� �a�7— 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:Constructio must be completed within three years of the date of this permit. . Date: 3 2`�[p 3 Approved by 4- 4. TOWN OF•BARNSTABLE SJ Glff£� `J v•� s SEWAGE # ZC3� I IZ LOCATION _ VILLAGE �'" ASSESSOR'S MAP & LOT INSTALLER'S NAME& PHONE NO. fI 1,e MNC o SEPTIC TANK CAPACITY IW 'c Z 4,411t, 06A-,f LEACHING FACILITY: (type) (size) NO.OF BEDROOMS BUILDER OR OWNER PERMITDATE: y' COMPLIANCE DATE: 32s03 Separation Distance Between the: /"l0.a,ti l t reP�ac Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist Feet on site or within 200 feet of leaching facility) Edge of Wetland and Leaching Facility (If any wetlands exist Feet within 300 feet of leaching facility) Furnished by why �6 Si j ` TOWN OF BARNSTABLE LOCATION 5--5- 6W£FAl ' (/A-1S aP SEWAGE # Ztx�3� 1 IZ VILLAGE SSESSOR'S MAP & LOT 2 -0 31 INSTALLER'S NAME&PHONE NO. A{,e P191vC y SEPTIC TANK CAPACITY £�L/J"c ✓J1/��iv ,�iiv'£ /i�'°� °v�f LEACHING FACILITY: (type) (size) NO. OF BEDROOMS BUILDER OR OWNER C /9 � PERMIT DATE: -Y a y_ 03 COMPLIANCE DATE: S G Separation Distance Between the: MQI v� t�� re P�Ac c: �� dK�7 3 2S o3 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 C/e y� LEGEND �� it HADWICK AV Sa = BEACH 400 PROPOSED CONTOUR BIKE c s o -n4 ® PROPOSED SPOT GRADE y = v AY cc cn A H -- 98 -- EXISTING CONTOUR -0 \ s 7020'14'E -� r� a� + 96.52 EXISTING SPOT GRADE _ tomrn \ -- \ \ W EXISTING WATER SERVICE vc o WE ES' TO� OfBonk � �� � � � � �\� TEST PIT � C3 HY NN1 A \ \ \ I w qD cr- ~ Lot 4445 \ o of yak \\ \ \\\ { H ParcelAid 31 I \ \ \\ \� z Sri CR`OAY I °,�d \\ \\ s90 LOCUS MAP N.T.S. Q i prlve °oo\\ \ \ \ I DA�EYER FN M. Vi \ mo \ \ N 1140 GENERAL NOTES. 101, \ \ '�\\ \ \ 1• ALL CHANGES TO THIS PLAN MUST BE APPROVED BY THE LOCAL S1 BOARD OF HEALTH AND THE DESIGN ENGINEER. \ NITAR�a� 2. ALL WORK AND MATERIALS SHALL CONFORM TO THE REQUIREMENTS e \ l OF THE STATE ENVIRONMENTAL CODE, TITLE V. AND ANY APPLICABLE ^ Garage ad \ \\ LOCAL RULES AND REGULATIONS, EXCEPT AS REQUESTED BELOW: oM _ 1) A 35 FT. VARIANCE FROM BARNSTABLE BOARD OF HEALTH REGULATIONS 12 1 TO ALLOW SEPTIC TANK AND PUMP CHAMBER TO BE 65 FT FROM #25 20 97 I I 10 I TOP OF BANK VS. REQUIRED 100 FT. Q / �NGVD) \ J 'I 3. THE SEWAGE DISPOSAL SYSTEM SHALL NOT BE BACKFILLED PRIOR I 7' 4 TO INSPECTION AND APPROVAL BY THE BOARD OF HEALTH AND THE DESIGN ENGINEER. � OFM�gS�cyG 4' ANY FROM CONDITIONS THOSE SHOWN ENCOUNTERED SHA LINBECONSTRUCTION TO THE DIFFERING DES DESIGN SOnrpOrn ° of / '• �� TERRY sF-A ENGINEER BEFORE CONSTRUCTION CONTINUES. 0 \ �. P° I / ANN <„ 5. ALL ELEVATIONS BASED ON NGVD DATUM. 1 \ 65' II / / NOA3s 2R 6. THE DESIGN ENGINEER IS NOT RESPONSIBLE FOR THE FAILURE OF �. S THE CONTRACTOR OR OWNER TO NOTIFY THE LOCAL BOARD OF i / / �; 6 � HEALTH FOR PROPER INSPECTIONS DURING CONSTRUCTION. 2 2 1 H_1 �/ e I ( I E t WATER SUPPLY PROVIDED BY TOWN WATER SERVICE. Lija I 8. ALL AREAS DISTURBED DURING CONSTRUCTION SHALL BE RESTORED LLJ / i ' I Doc I I I TO A CONDITION AGREED UPON BETWEEN OWNER AND CONTRACTOR. 1 9. IT SHALL BE THE RESPONSIBILITY OF THE CONTRACTOR TO VERIFY THE / a THE LOCATION OF ALL UNDERGROUND UTILITIES, PRIOR TO BEGINNING 1� T 2 / 127 4 t: 245' I �— CONSTRUCTION. I 10. EXISTING LEACHING PITS TO BE PUMPED, CRUSHED AND REMOVED 1� N 74 4 W 6'50� I PER TITLE V, REPLACE WITH CLEAN MEDIUM SAND °1 11. 48 HOUR NOTICE FOR ENGINEER CERTIFICATION 20 1 12. THIS PLAN IS TO BE USED FOR SEPTIC SYSTEM PURPOSES ONLY c \ \ >,� I Benchmark�)set in pool apron E1.=12.57 '1"0�) ` r"r AND IS NOT TO BE CONSIDERED A PROPERTY LINE SURVEY \ \ 13. NO PRIVATE WELLS WITHIN 150 FT, OF PROPOSED LEACHING W '•� PROPOSED SEPTIC SYSTEM UPGRADE PLAN 1 2 255 GREEN DUNES DRIVE, W. HYANNISPORT, MA Prepared for: Care ,✓ 2 > / >d , 1 Y Engineering by: Surveying by: SCALE DRAWN JOB. N0. I a` DARREN M.MEYER,R.S. Warner Surveying DMM PO BOX 981 22 Long Road EASTSANDWICH,MA02537 Harwich, MA 02645 DATE CHECKED SHEET N0. v_ 50&,W-2922 (508) 432-8309 08/01/07 DMM 1 of 2 ELEV. TOP PROPOSED TANK PUMP CHAMBER D-BOX - FOUNDATION INSTALL RISERS W/IN 6' OF FINISH GRADE INSTALL RISERS W/IN 6" OF FINISH GRADE INSTALL RISERS W/IN 6" OF FINISH GRADE (Existing) 20.97 EL 160 EL FINISH GRADE= 19.25 EL. EL.16.0 . . � .16.0 F.G. EL: 19.5 A MAINTAIN 2% MIN SLOPE OVER LEACHING AREA MAX. COVER OVER S.A.S. = 36" IN$PECTJON PORT TO BE PLACED ON END UNIT SANITARY TEE u SPEED W IN 6 OF FINISH GRADE 4" SCH 40 PVC 2" sC'H 40 �C 8" e - 0 0 0 0 0 0 0 0 0 0 0 0 CELLAR FLOOR • IN lo• 14 o s= IX(MIN.) 1C FORCE MAIN ° ' • TWS ARE TO BE INVD-80 .=15.50 :v 4-SCH PVC INV.= 10.92 26" INV.= 15.70 � ... :: TEE SHALL NOT EXTEND 0 0 0 0 0 0 0 0 0 0 0 0 BAFFLE INV.= PUMP OFF 7" BELOW FLOW LINE PROVIDE COUPLING 10.87 6' EXIST INV. 0 0 0 0 0 0 0 0 0 0 H. 0 PROP SED 1500 GALLON SEPTIC TANK (H-V LOAD) INV.=10.62 GAS BAFFLE TO BE INSTSALLED ON 1000 GALLON PUMP CHAMBER(H-LO) 45.25' OUTLET TEE AS MANUFACTURED BY TUF-TITS, ZABEL, OR EQUAL INV.=1 1.17 rTcrov FAQ' SOX 9" MIN. NOTES: 1) CONTRACTOR SHALL VERIFY ALL EXISTING 3) INSTALL INLET & OUTLET TEES AS REQUIRED. PER TITLE 5 PIPE INVERTS PRIOR TO CONSTRUCTION. 4) GAS BAFFLE TO BE INSTALLED ON OUTLET TEE 2) SEPTIC TANK, PUMP CHAMBER AND D-BOX SHALL BE AS MANUFACTURED BY TUF-TITE, ZABEL OR EQUAL. BREAKOUT EL. = 16.25 SET LEVEL AND TRUE TO GRADE ON A MECHANICALLY 5) INSTALL SANITARY TEE IN D-BOX COMPACTED SIX INCH CRUSHED STONE BASE, AS SPECIFIED INV. ELEV.=15.44 IN 310 CMR 15.221(2). F J��-_ ,_ice• 24» 30 5» SEPTIC SYSTEM PROFILE ��� ° �gsswAs> £ IN VER T N.T.S. D BOTTOM EL.= 13.44 I---48" 50" 8" INSTALL i' PVC CONDUIT TO HOUSE FOR WIRING NO. 114.0 WITH WATERTIGHT JOINTS. WIRE HIGH WATER ALARM PROVIDE WATERTIGHT CONCRETE RISER WITH SECURED COVER TO GRADE I 146" FLOAT TO GP 2000 HIGH WATER ALARM PANAL ON SEPARATION 5.10 FT. CIRCUIT SEPARATE FROM CIRCUIT TO THE PUMP. NEMA 4 JUNCTION BOX CORROSION RESISTANT BYUQII/4nPVC CONDUIT.GHT CABLE JOINTS TO BESUPPORTED NITAR�p� BOTTOM OF TH-1 EL: 8.34 SOIL ABSORPTION SYSTEM (SECTION) HOISTING CABLE 7x19 STAINLESS STEEL (]���� 1/8" DIAMETER. / 1,760 LB. STRENGTH. WATERTIGHT 2"BALL VALVE w/ UNIONS SCH. 80 PVC O PC INV.(IN)= 10.87 GEORGE FISHER Co. MODEL NO. 560 OR EQUAL DESIGN CRITERIA 2"SCH. 40 DISCHARGE TO D-BOX SOIL LOGS ALARM ON EL: 10.12 2"SCH. 40 TEE w/ CLEAN-OUT CAP NUMBER OF BEDROOMS: 5 BEDROOOM (no proposed increase in flow) PUMP ON EL: 7.92 PROVIDE 1/4" WEEP HOLE IN DISCHARGE SOIL TEXTURAL CLASS: CLASS 1 (0.74 GPD/SF) PUMP OFF EL- 7.37 J9" 13. PIPE FOR SELF-DRAINING FORCE MAIN DATE: JULY 18, 2007 DESIGN PERCOLATION RATE: <2 MIN/IN BOTTOM OF s• 2" BALL CHECK VALVE SCH. 80 PVC SOIL EVALUATOR:. DARREN MEYER, R.S., CSE PUMP CHAMBER GAILY FLOW: 110 G.P.D. ELEV.= 6.87 100 P.S.I. FLOWMATIC MODEL No. 208S WITNESS: DON DESMARAIS DESIGN FLOW: 550 G.P.D. PROVIDE 2- WIDE ANGLE FLOATS: 2" SCH. 40 PVC DISCHARGE PIPE HEALTH AGENT GARBAGE,GRINDER: NO (not designed for garbage grinder) FLOAT NO.1: PUMP ON/OFF (BARNES 073618 OR EQUAL) TH- Depth Elev. TH- Depth SEPTIC TANK: 550 gpd x 2 = 1100 gpd USE NEW 1,500 GALLON SEPTIC TANK FLOAT NO.2: ALARM ACTIVATION (BARNES 073612 OR EQUAL) BARNES SEV412 PUMP .5 H.P. 115 V Elev. 2" DISCHARGE PASSING 2" SOLIDS OR EQUAL 19.50 0" 19.50 p" (550) = 743.24 S.F. PUMP CHAMBER, PUMP & ACCESSORIES AVAILABLE AS A UNIT LEACHING AREA REQUIRED: THROUGH WIGGEN PRECAST CORP., BOURNE MA. (800) 564-6774 FILL FILL .74 PUMP & ACCESSORIES AVAILABLE THROUGH WILLIAMSON ELECTRIC (781) 444-6800 17.50 A 24" 17.67 A 22 USE FIVE (5) INFILTRATOR 3050 UNITS WITH 4 FT. STONE LOAMY SAND LOAMY SAND ON ALL SIDES : 45.25' L x 12.16' W x 2'D PUMP DETAIL 10YR 4/2 10YR 4/2 BOTTOM AREA: 45.25 x 12.16 = 550.24 SF N.T.S. 17.25 B 27" 16.83 B 32" SIDE AREA: (45.25 + 12.16) X 2 X 2 = 229.64 SF DOSING & STORAGE REQUIREMENTS LOAMY SAND LOAMY SAND TOTAL SQUARE FEET PROVIDED = 779.88 vs. 743.24 REQ'D i DAILY FLOW: 550 GPD 16.0 C1 MEDIUM 10YR 5/8 42" 1 15.5 C1 tOYR 5/8 48" DESIGN FLOW PROVIDED: 0.74(779.88 S.F.) = 577.11 G.P.D. vs. 550 G.P.D. req'd DOSING REQUIRED: 550YCLE4/= 1375AGALLLONS/CYCLE SAND PERC ®26.8I3 MEDIUM PROPOSED SEPTIC SYSTEM UPGRADE PLAN DISTANCE REQUIRED BETWEEN PUMP 2.5Y 6/4 SAND ON AND PUMP OFF FLOATS: 1317 76"C2 MEDIUM 2.5Y6/4 255 GREEN DUNES DRIVE, W. HYANNISPORT, MA 137.5 GAL/CYCLC- 250 GAL/FT = 0.55 FT/CYCLE (7"') SAND I Prepared for: Carey STORAGE REQUIRED ABOVE WORKING LEVEL: 550 GALLONS 2.5Y 7/3 Engineering by: Surveying by: SCALE DRAWN JOB. N0. STORAGE PROVIDED: 8.34 134" 8.50 132" DARRENM.MEYER,R.S #'arner Surveying N.T.S. DMM INV.(IN) EL:10.87 - PUMP ON EL:98.45 =3.0' PO BOx 981 22 Long Road STORAGE PROVIDED = 3.0' X 250 GAL/FT = 750 GALLONS PERC RATE <2 MIN/IN. ("C" HORIZON) EAST&4NDWICH,MA02537 Harwich, MA 02645 DATE CHECKED SHEET NO. NO GROUNDWATER OBSERVED 508?622922 (508) 432-8309 08/01/07 DMM 2 Of 2 LEGEND rH'A�bWO('BEACH PROPOSED CONTOUR ' Z BIKE ` s _ �. ® " PROPOSED SPOT :GRADE v A. AY.cr N -- 98 -- EXISTING CONTOUR �. N �j s 7020'14'E + 96.52 EXISTING" SPOT GRADE 37 z PIE L ST G ti 6\ 4\ \: io t W— EXISTING WATER SERVICE a o '� o WE T000fBo�\ TEST PIT . � Co =. HY, . N�lI < .. 44 0 of 4 Maa ce 24 31 \ \\ \\ V rT � BRWAY , j OF -n Mqs �y LOCUS MAPy N.T.S. Paved \ \ ) off` ?j t�E'�;: G / Drive qo� \ \ M YER No. 1140 GENERAL NOTES: 101 ALL CHANGES TO THIS PLAN MUST BE APPROVED BY THE LOCAL t BOARD OF HEALTH AND THE DESIGN .ENGINEER, S9NIT00 2. ALL.WORK AND MATERIALS SHALL CONFORM TO THE REQUIREMENTS \ C. Garage \\ OF.THE STATE ENVIRONMENTAL CODE, TITLE V. AND ANY APPLICABLE ' m / LOCAL RULES AND REGULATIONS, EXCEPT AS REQUESTED BELOW: ad 1) A 35 FT. VARIANCE FROM BARNSTABLE BOARD OF HEALTH REGULATIONS �\ b 12 TO ALLOW SEPTIC TANK AND PUMP CHAMBER TO BE 65 FT FROM LL1. #25 20 g� I I to TOP OF BANK .VS. REQUIRED 100 FT. TOF(NGVP) / 8. 6f 3. THE SEWAGE DISPOSAL SYSTEM SHALL NOT BE BACKFILLED PRIOR 1 4 TO INSPECTION AND APPROVAL BY"THE BOARD OF HEALTH AND THE i. Q .:. / \ DESIGN ENGINEER. 4. ANY CONDITIONS ENCOUNTERED-DURING CONSTRUCTION. DIFFERING t j „ FROM THOSE SHOWN HEREON SHALL BE REPORTED, TO THE DESIGN / Sunro°m_ °, pOI f ENGINEER BEFORE CONSTRUCTION CONTINUES. v o r- P 5. ALL ELEVATIONS BASED ON NGVD DATUM. •6. THE DESIGN ENGINEER IS NOT RESPONSIBLE FOR THE FAILURE OF THE CONTRACTOR OR OWNER TO NOTIFY THE LOCAL BOARD. OF, �_ • .� I / ('' HEALTH FOR PROPER.INSPECTIONS DURING CONSTRUCTION.' Z 2 1 c 2 I I I 7. WATER SUPPLY PROVIDED BY TOWN WATER SERVICE. LLJ 8. ALL AREAS DISTURBED DURING CONSTRUCTION SHALL BE RESTORED / v f •: m° I I ' , TO A CONDITION AGREED ,UPON BETWEEN OWNER AND CONTRACTOR. cr _ I 9. IT SHALL BE THE.RESPONSIBILITY.OF THE CONTRACTOR TO VERIFY THE I THE LOCATION OF ALL UNDERGROUND UTILITIES, PRIOR TO BEGINNING \C �27� �°: 245t I Q J I CONSTRUCTION. TH—? , / / 10. EXISTING LEACHING PITS TO BE PUMPED, CRUSHED AND REMOVED• N 7446 50[ W I f PER TITLE V, REPLACE WITH CLEAN MEDIUM SAND \ ' I 11. 48 HOUR NOTICE FOR ENGINEER CERTIFICATION _i ._ i 12. THIS PLAN IS TO BE USED FOR SEPTIC SYSTEM PURPOSES ONLY °c 20 a: IBenchmarkl set in pool apron \ \ 1 E1.=12.57 ( IGVD) \ AND IS NOT TO BE. CONSIDERED A PROPERTY LINE SURVEY \\ \ \\ ' I NO PRIVATE WELLS WITHIN 150 FT. OF PROPOSED LEACHING 1 \ PROPOSED SEPTIC SYSTEM UPGRADE PLAN 255 GREEN DUNES DRIVE, W. HYANNISPORT, MA i Pre ared for: Care 17 rd�• \ Engineering by: Surveying by: SCALE DRAWN JOB. NO. e4l- DARREN M..MEYER,R.S. Mara er .Surveying 1°=20' D M M I wIAAP. 063 PO Box981 22 Long Road -- LOT:044 EAS-SANDWICH,MA 02537 Harwich, MA 02645 DATE CHECKED SHEET NO. i 508362-2922 (508) 432-8309 08/O1/07 DMM 1 Of 2 ELEV. TOP PROPOSED-TANK PUMP CHAMm D-80 +tFOUNDATION INSTALL RISERS W/IN 6", OF FINISH GRADE INSTALL RISERS W/IN'6" OF FINISH GRADE INSTALLX RISERS.W/IN 6' OF FINISH GRADE y�(Existing) 20.97 FINISH GRADE= 19.25 EL.16.0 EL. EL.16.0 EL. F.G. EL: 19.5 ' A. MAINTAIN 2% MIN SLOPE OVER LEACHING AREA MAX.. COVER OVER S.A.S. 36" . GRADE: N END UNIT INSPECTION PORT TO BE PLACED 0 SANITARY TEE U SPEED L sv W/IN 6" OF FINISH DE: • _..• ; 4" SCH'40 'PVC r 5 40 PAC 2 CH CELLAR 'FLOOR (MIN.) lo. t4 o S=.1z (MIN.) �a. FORCE °' TEE'S ARE TO BE ~ 4"SCH.40..PVC1670 • ,. 4 �.:77 . . IN .= 10.92 " « I = - D/ 70.TEE SHALL NOT EXTEND o 0 0 0 0 0 0.i o 0 0 NV. 15 J7. BELOW FLOW LINE CeAFFSLE.. INV.=10.87 PUMP OFF PROVIDE COUPLING �. g" '., . EXIST. INV. PROP SED 1500 GALLON SEPTIC TANK (H-10 LOAD) ' ? o 0 0 0 0 0 INV.=10.62 1000 GALLON PUMP'CHAMBER(H . 0) GAS.BAFFLE TO BE INSTSALLED ON = ' ----- 45 25' OUTLET TEE AS MANUFACTURED, BY TUF=TITS. ZABEL, OR EQUAL --- 9�� M FlcrER rAe�� IN. INV.=11.17 � •-� � NOTES: 1) CONTRACTOR-SHALL VERIFY ALL EXISTING 3) INSTALL INLET & OUTLET TEES-AS REQUIRED.'. I =PER TITLE-Jr PIPE INVERTS PRIOR TO CONSTRUCTION. 4) GAS. BAFFLE TO BE INSTALLED ON OUTLET TEE -2) SEPTIC TANK, PUMP CHAMBER AND D-BOX SHALL BE; AS MANUFACTURED BY TUF-TITE, ZABEL OR EQUAL j BREAKOUT EL.. = 1.6.25 SET LEVEL AND TRUE TO GRADE ON A MECHANICALLY 5) INSTALL SANITARY TEE IN D-BOX COMPACTED SIX INCH CRUSHED STONE BASE, AS SPECIFIED INV�IELEV.=15.44 IN 310 CMR 15.221(2). . SEPTIC .SYSTEM PROFILE ����� �F ,�qs � r� o«��'WASHEDSF f INVERT 24-11 30.5 N.T.S. p DA ( ✓+ BOTTOM EL.= 13.44 INSTALL V PVC CONDUIT TO HOUSE FOR WIRING PROVIDE WATERTIGHT CONCRETE RISER o 11 0 WITH WATERTIGHT JOINTS. WIRE HIGH WATER ALARM WITH SECURED COVER TO GRADE I 146" ;BLOAT TO GP 2000.HIGH WATER ALARM PANAL ON . SEPARATION 5.10 FT. IT TO THE PUMP. NEMA 4 JUNCTION BOX CORROSION RESISTANT clRculr SEPARATE FROM clRcu OIL ABSORPTION SYSTEM SECTION & LIQUID-TIGHT CABLE CONNECTORS. SUPPORTED BY 1-1 4 PVC.CONDUIT. JOINTS TO BE. MADE NLTAR�p - BOTTOM OF.TH- HOISTING.CABLE.7x19 STAINLESS STEEL� / " 1/8 DIAMETER. / 1,760 LB' STRENGTH. WATERTIGHT 2"BALL VALVE w/ UNIONS SCH. 80 PVC. PC INV.(IN)= 10.87 GEORGE FISHER CO. MODEL NO. 560 OR EQUAL 2"SCH. 40 DISCHARGE TO D-Box Sol LOGS DESIGN CRITERIA ALARM ON EL: 10.12 2"SCH. 40 TEE w/ CLEAN,-OUT CAP - / NUMBER F. BEDROOMS: 5 BEDROOMM .(no. proposed increase in flow) . PUMP ON EL: 7.92. a� PROVIDE'1/4." WEEP HOLE IN DISCHARGE . \ c� SOIL T RAL CLASS: CLASS 1 (0.74 GPD/SF) J" PIPE FOR SELF=DRAINING FORCE MAIN DATE: JULY 18,. 2007 1i 'BOTTOM OF PUMP OFF EL 7.37 tJ" \ DESIGN_. ERCOLATION RATE: <2 MIN/IN 1 6• 2 BALL CHECK VALVE SCH. 80 PVC SOIL EVALUATOR:: DARREN MEYER, S., CS E DAILY FL W: 110 G.P.D. PUMP CHAMBER 100 P.S.I. FLOWMATIC'MODEL No. 2085 ELEV.= 6.87 WITNESS: DON .DESMARAIS DESIGN F W: 550 G.P.O. PROVIDE 2- WIDE ANGLE FLOATS: 2" SCH. 40 PVC DISCHARGE PIPE, HEALTH AGENT 'GRINDER: . NO (not designed for garbage grinder) FLOAT N0.1: PUMP ON/OFF (_BARNES `073618 OR EQUAL) ` FLOAT NO.2: ALARM ACTIVATION (BARNES 073612 OR EQUAL); BARNES SEV412 PUMP.5 H.P. 115 V Elev. TH 1 Depth Ele- T Depth SEPTIC TANK: 550 gpd x 2 = 1100 gpd USE NEW 1.500 GALLON SEPTIC TANK 2 DISCHARGE_PASSING 2" SOLIDS OR EQUAL 19 50 O" 19:50 O" (550) = 743.24 S.F. PUMP CHAMBER, PUMP & ACCESSORIES AVAILABLE.AS,A'"UNIT LEACHING AREA REQUIRED: THROUGH WIGGEN PRECAST CORP.., BOURNE MA. (860) 564-6774 FILL FILL .74 . PUMP & ACCESSORIES AVAILABLE THROUGH WILLIAMSON ELECTRIC (781) 444-6800 17.50 A 24" 17.67 A 22" USE FIVE (5) -INFILTRATOR 3050 UNITS WITH 4 FT. STONE PUMP DETAIL LOAMY SAND LOAMY SAND ON ALL SIDES 45.25' L. x 12.16' W x 2'D 10YR 4/2 tOYR 4/2 BOTTOM AREA: .45.25 x 12.16 = 550.24 SF N.T.S. 17.25 B 27" 16.83 B 32"• SIDE AREA: (45.25 + 12.16) .X 2 X 2 = 229.64 SF DOSING & STORAGE REQUIREMENTS LOAMY SAND LOAMY SAND TOTAL SQUARE FEET PROVIDED 779.88 vs. 743.24 REQ'D 10YR 5/8 10YR 5/8 DESIGN FLOW PROVIDED:- 0.74(779.88 S.F.) 577.11 G.P.D. vs. 550 G.P.D. req'd DAILY FLOW: 550 GPD 16.0 Cl MEDIUM 42" 15.5 Cl 48" POSING.REQUIRED:. 4 CYCLES/DAY (SAND) SAND PERC 0 26.83 550 = 4 = 137.5 GALLLONS/CYCLE MEDIUM PROPOSED SEPTIC SYSTEM UPGRADE PLAN DISTANCE REQUIRED BETWEEN PUMP 2.SY 6/4 SAND ON AND PUMP OFF FLOATS: 1317 C2 MEDIUM 76" 2.5Y6/4 255 GREEN DUNES DRIVE, W. HYANNISPORT, MA 137.5 GAL/CYCLE 250 GAL/FT = 0.55 FT/CYCLE (7"') SANG Prepared for: Carey STORAGE REQUIRED ABOVE WORKING LEVEL: 550 GALLONS 2.5Y 7/3 Engineering by: Surveying by: SCALE DRAWN JOB. NO. DARREN M.MEYER,R.S. r STORAGE PROVIDED: 8.34 134" 8.50 132" Nkme;i" Surveying N.T.S. DMM INV.(IN) EL:10,87 - PUMP ON EL:98.45 =3.0' - Po Box981 22 Long Road STORAGE PROVIDED 3.0'. X 2501GAL/Ff 750 GALLONS PERC RATE.<2. MIN/IN. ("C" HORIZON) EAST SANDWICH,MA02537 Harwich, MA 02645 DATE CHECKED SHEET NO. NO GROUNDWATER OBSERVED 5083622922 (508) 432-8309 68/01/07 DMM . 2 Of 2 ASSESSORS REF.. j i t Z Map 245, Parcel 031 a ! , ' ny -' ��`P ° OVERLAY DISTRICT. A • u /�� V ,"3,4"' :•fit :'\,,* �! ,W e'a ' tk *.' m'' jZ Yury Spektorov � AP - Aquifer Protection District • h1cb i ta. ry FLOOD ZONE: :u • Y. / Zones VE ELEV. 16', 'AE ELEV 13', " ��" AE ELEV. 12', Zone XO.2% 0.2% annual cod chance) &• Zone X (minimal flood o :, o� , hazard) ' r I 110 , V Community Panel No. '` #250001 0564 J tk° ,\ro - July 16, 2014a ' x [ � /cbl /j / t t LOCATION MAP: Scale: 1 2000 f • e o t 1 t l Cr ek f i 1 H d ---�- t�. Zoo '4:F , 1 j' £ t (/ i ! f ZONE: RB ' Lawny \ 100 , l Area (min..) 87,120 CO / ' I I Frontage (min) 20' r I j c, £ I { i r` . Width (min) 100' - "N 1 4 .rl 'f ! co / i I i Setbacks: ,r Fron t 2 Side 10' 18 v.� _.� �- � •� , , �� I� 1 ��:. I � '� .. : Rear 10 Is /\ Proposed Work Limit _ - 1 \ Paved Driue I1 �• IRECTION �: , �, j j j ,•, / t'; I From Hyannis - On Main Street enter rotary and t , , I take 3rd exit onto Scudder Ave. Take a slight right onto Smith Street and continue onto Craigivlle Beach Road. Turn left onto Green Dunes �- \ \ � �;�, / •/ � _ ,'� ��\`' ,1 I '; �,- Drive.:.and stay .left. \ / 61, i The property is on the left # 255 Paved Drive O Proposed Septic Tank t Existing SA f \�\ sir D-Box to R main 20.89' Lo ation As per rie Car t Permit# 2008 066 Lawn Existing l f Dwelling ' # 225 \� !� :�\ cp 1 \ 5 SAd say 2 Lawn t , 66e609, ... __ \. . r, LOP�rc Proposed,> 4pron " Deck r� -Existing t , Septic Tartik_&_,PGinp Have been Removed / r j r ..... ! r Pool ITI TION CALCULATIONS Proposed !, j ! 1 / � MITIGATION /� 0J /" Rogf Runoff / , 50 �" Proposed Work le6chfn Pit t 4 r 9 - Front Porch 37 sf O '--" r _ - o i / �o. 4 ,� t f l ,� Front Addition 115 sf / t 43...t„ Hedge ., �' �/ / ,' ' / � / � � J' � � j � Front Bay Window 8 sf / s"4. Rear Addition 242 sf 45 5 100'245 Rear Dining Porch 148 sf 0 / °';E" i 1 f ' , Q 200 l �' Rear Deck 414 sf / ! !./ ( I / I Total 964 sf L I .� Existing Hardscope r, o / Entrance Concrete Walk 50 sf . , i Lawn, t 0 , �......... r / , l r 1 I Stone at rear entrance 84 sf 1 ......:......{ i \ i , t �/ .�..::....:......;.. / I Hardscape Areas , ...ae i �,. ! �. 1 964-84-50=830 SF of added Hardsca e r p Mitigation Required IO 1 830x3=2490 SF of mitigation Required i\ / ` f !� l Mitigation Proposed 2500 sf r , / f ` 1 •/ ��,e .r'\ .�\,�`ti � ! ! �` /� i f r / All areas between plants to be seeded .with New II England Coastal Salt Tolerant Grass Mix. SF Sweet .Fern (20) 2 Gal Pots BB Bearberry (20) 3 Gal Pots F / / , 1 I / Stone Pillar / n BP Beachplam (20) 3 Gal Pots ,6 Typ. t% ` ''yrti ��,� / f�.\ �� 1 '' / ` l / \, \* NB Northern Bayberry (10) 3 Gal Pots SP Sweet pepperbush (20) 2 Gal pots WB Win terberry (10) 2 Gal Pots f x I \ Le end: _V��I�\� Deciduous Tree X V Coniferous Tree ;/ ' OO Water Gate w �, 11 (2 Drain Manhole � o t � ! c� I i ,f; /� I Catch Basin ;s i \ ► a 1; \fir / I i 1 ' Light Post f s ; l / c� �\ i�\ i L Wetland Flag El CB1DH --- -25- - .Elevation Contour i m ; . -A Z ` \`\ \\ ` , rr / - River Front Buffer FEMA Flood Zones Buffer to Resource Area Building Addition 0 2Qp4 S0'E/ r Wetland Flag j, QQ i i I / f /' / / Flagged b 1 y B. Hall. October 2015 � �• �' l ; � �/ i i / '`�, , Proposed Mitigation Area DESIGN DATA ; \ I i / �` i Single Family Jennifer K Odell &_'n/f t : i' £ i ;� �� Plant Code -SBedroom 110GPD Quantity ,, ; � r r, ,Z. � @ Jacqueline Hermsen � i No Garbage Grinder :` I / Total Daily Flow=550 GPD { Use a 1500 Gal Septic Tank i 1 SEPTIC NOTES _ I J i 1.Location of Utilities Shown on This Plan Are Approx.At Least 72 Hours Prior to Any Excavation For This Project the Contractor Shall Make the Required Notifications to Dig Safe 0-888-344-7233)and contact - _ - __ _-_.- - Sullivan En meern -&Consulting Inc. 508-428-3344 .- 2. The Contractor is Required to Secure Appropriate Permits From Town Agencies For Construction Defined by This Plan. 3. Wherever Sewer Lines Must Cross Water Supply Lines Both Lines Shall F.F. E1. 20-PT See Note 6 t Be Constructed of Class 150 Pressure Pipe and Shall be Water Tested to YP �F.G. EL. 19.6 Min Assure Watertightness. In General, Water Lines Shall be Constructed in Coordination With Hyannis Water,and Shall be in Accordance Confirm Existing Elevations With 248 CMR 1.00- 7.00&310 CMR 15.00. Prior To Any Work V _ 4.A Minimum of 9"of Cover is Required for All Components. From Survey 5.All Structures Buried Three Feet or More or Subject Plumber to set EL. 17.74 to Vehicular Traffic to be H-20 Loading.It is the Engineer's Invert to EL. 17.88 EL. 17.64 1500 Gallon Recommendation that H-20 Always be Used. ' Installer To Septic Tank EL. 17.39 6.Install Watertight Risers and Covers to Within 6"of Finished Grade Confirm Prior H-20 Required 16.99 xistinS To An Work D-Box Over Septic Tank Inlet, Outlet,and D-Box. y (See Note 5) All covers are to be maximum 18"for concrete or 24"Cast Iron. 7. Septic System to be Installed in Accordance With 310 CMR 15.00& 249 CMR 1.00 7.00 Latest Revision and the Town ofBarnstable To Be Installed On / Stable Comp acted Base ' Board ofHealth Regulations. a P 8.All Piping to be Sch. 40 PVC. Bedding,"1"s, 9.D-Box Shall Have a Minimum Inside Dimension of 12'; and a Minimum -Inspection Port, 1 Sump of 6". & Baffels 10. Septic Tank Shall be a 1,500 Gallon with a Gas Baffle on the Outlet. as Per Title 5 ', p DEVELOPED' PROFILE OF SYSTEM � � 11: The.Separation Distance Between the Septic Tank Inlets and ' Outlets Shall be No Less than the Liquid Depth.Inlet Tees Shall Extend 5 '" �+^/� / a Minimum of 10"Below the Flow Line. Outlet Tees Shall Extend 14 NOT TO SCALE Below the Flow Line,and Shall be Equipped With a Gas Baffle. �F�S10NAlE�'��E' Revision: Propose new location for septic tank and 1211212016 �^ remove pump Chamber. { j Revision: Show proposed location of septic tank & pump 211612016 f TITLE PREPARED BY. PREPARED FOR: NOTES: Site Plan I Propop j�� pp 1• p 1.) The property line information shown was compiled from C� sed Improvements En ineerin & Rom & Arlon Chuttonl available record information. _ At U Ivan 40 Draper Road 2.) The topographic information was obtained from an on y Consulting, Inc. Dover MA 02030 the ground survey performed on or between 9/1/2015 255 Green Dunes Drive (508)428.3344 • P.O.Box 659 . 7 Parker Road,Osterville, MA 02655 and 912512015. seci@suilivanengin.com • www.sullivanengin.com .3.) The datum used is NAVD '88, a fixed mean sea level •y Barnstable (Centerville) Mass. datum. C) Draft: Field: 4.) The edge of the river was estimated from aerial JOD MDH WHL MLL 20 0 10 20 40 80 photography. DATE "SCALE: » Review: PS Comp./Review: MDH/RRL January21, 2016 1 = 20 Project: 30029 Project: C284.5