HomeMy WebLinkAbout0325 GREEN DUNES DRIVE - Health 325 GREEN DUNES
Centerville
A = 246 - 157
No. 4210, 1/3 ORA
o a d & 0
ESSELT E
10%
0 0 0 0
A
Town of Balrnsiable P#
Department of Regulatory Services
Public Health Division Date L
�A eag 200 Main Street,Hyannis MA 02601
1 ✓� t
Date Scheduled
Time . Fee Pd.
Sail Suitability assessment f or Se e .his ®s �l o 'm
e.
Performed By:_ enaG l eIt W, Q�U er 61 A i �C.Z . G IS&-
Witnessed By: /r
LOCATION& GENERAL INFORMATION
Location Address 3.:i-5. n aQR e Du�E5 1W Owner's Name ���^+}�`� I0Ce K
�//a"` / e G'ZV�/(f f� Address Po. ow $,' W. 0y4W1S?a
Assessor's Map/Parcel: of"I W 1 I d 7 Engineer's Name �°i�QN Call�C C�1 t�21�5 CLC QvtG�
NEW CONSTRUCTION REPAIR Telephonelk �( —C�� Z `� 5G E*ismearf'j
Land Use 51 12 FamZ1,e 4Q;4.11cos Slopes % 2- j .- S68-273-637 2
P ( ) Surface Stones
Distances from: Open Water Body /Vo t ft Possible Wet Area (�+ ft Drinking Water Well ft
Drainage Way ft Property Line ft Other ft
SIM''TCIi:(street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands in proximity,to holes)
sew a+�ccn.ed �(a4
Parent material(geologic) Ol) LU45�) Depth to Bedrock ^
Depth to Groundwater. Standing Water in Hole: Weeping$•om Pit Face
Estimated Seasonal High Groundwater (0 b _m d{4irwt
DETERMINATION FOR SEA,SONA,L HIGH WATER TABLE
Method Used: VttecF o�osuu.�160
Depth Observed standing in obs.hole: ' In, Depdi to soil inottlem:
Depth to weeping from side of obs.hole: - In, Groundwater AdjustMent ft.
Index Well# - Reading Date: Index Well level Adj.factor A�J.Grouhdwater Level s
PEIRCOLATION TEST Date 3�9 S Time :2-3aa
Observation q
Hole#
Time at 9"
Depth of Pere 34-5`/ ` Time at 6" `
Start Pre-soak Time @ /0.30 4N" _ Time(9".6")
End Pre-soak
Rate Min.flnch < 2-
Site Suitability Assessment: Site Passed ye S Site Failed: — Additional Testing Needed(Y/N). N
Original: Public Health Division Observation Hole Data To Be Completed on Back-----------
***If percolation test is to be conducted within 100' of wetland,you(must rIFSt notify the.
Barnstable Conservation Division at least one (1) week prior to beginning.
Q:\SP-"ICVERCFORM.DOC U
DEE,P.OBSERVATION HOLE LOG mole# i
Depth from Soil Horizon Soil Texture .Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Stnucture,Stones,Boulders.
orrsi tency %Graven
6 -(2- /� 5 IOYr312
12-3(0 13 L S 516
310-82 C-( - N—C Sa,� z, Y 71Z
$2-IoZ C-2- s1.. z, Y $ly — t�fn� tvtaFri�
G-'J 'F- N S onj 2, 5 i 1,/3 @ I a(o _
DEEP OBSERVATION BOLE LOG Hole#—_
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders.
o si�tengy,%Graven
c -(I A s �. 10yr 3/z
SA.
3 72 G-� -
7 2- 16. C-2, s L 2. 5
q6 - 121(a C-3 H s 2_SY �l3 Le.1p81�
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)
DEEP OBSERVATION HOLE LOG bole#
Depth from w Soil Horizon Soil Texture Soil Color soli Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stories,Boulders.
Consistency,
Flood Insurance Rate Map:
Above 500 year flood boundary No_ Yes ._✓__
Within 500 year boundary No it Yes
Within 100 year flood boundary No. Yes
Depth of Naturally Occurring Pervious Material
Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the
area proposed for the soil absorption system? Ile S
If not,what is the depth of naturally occurring pervious material?
Certification
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
the required tr 'ning,expe tine and'experience described in 10 CUR 15.017.
n ture `�"'`"'"'� Date
Stg a
Q:\S EPTICTF-RCPORM.DOC
• I
r
No. V Fee 6 d
THE COMMONWEALTH OF MASSACHUSETTS Entered in co puter:
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes
application for Disposal *pstem Const union Vermit
Application fora Permit to Construct( ) Repair(Upgrade( ) Abandon( ) ❑Complete System [Individual Components
Location Address or Lot No.3�5��9'ir12�ny�¢o /? Owner's Name,Address,and Tel.No.
n� y�— pwbo k C'1 v k_-K {�O•/3v-x
/S�
Assessor's Map/Parcel 2q6 ? (?t1ZZLXd B �-
Installer's Name,Address,and Tel.No. 60 27/- 53`7 Designer's Name,Address,and Tel.No. 3oS-_386=�i�fKS
bo l l Ccnsl�r�x t'cr+,i mac• Ys�y�k�,y_' /d� C' .,i � , Mr t0-80?c /SN7
Type of Building:
Dwelling No.of Bedrooms Lot Size S d/ a sq.ft. Garbage Grinder( )
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow(min.required) S,5:7 gpd Design flow provided _5:5y, 3 pd
Plan Date (_X1r_16,16. ;L I1 Number of sheets f Revision Date
Title plu Qa6d S uiosWda,"S- Sc i SI-e—w jct t,0✓rWA,0
Size of Septic Tank es 4i nc l5'yO .L Type of S.A.S.S- tU act C{�y� , i/!�'X //'
Description of Soil t�e SvA t-
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 Enviro n 1 Code d not to place the system in operation until a Certificate of
Compliance has been issued by this Board of Hea
SiW=d A Date
Application Approved by Date
Application Disapproved by U Date
for the following reasons
Permit No.2 O — �36 Date Issued ( Z
No. Fee �d
- THE COMMONWEALTH OF MASSACHUSETTS • Entered in computer:
A Yes
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS
,plicatioTY for Disposal 6pstrm (Construction Vermit
Application for a Permit to Construct( ) Repair('') Upgrade( ) Abandon( ) ❑Complete System [�Individual Components
Location Address or Lot No.3j`5 (r9'Lcchl) 1c) Owner's Name,Address,and Tel.No. :i U 8-�` `��r'
Assessor's Map/Parcel 2116�
Installer's Name,Address,and Tel.No. `�`5 '�� 3 S Designer's Name,Address,and Tel.No. So9-3&S=19'kS'
e""Eat 4�o�lst r�:c{r cti� Z ,c• Nss y ¢ /�' :''u/ C' d rc f ,t xcCc 7_v��, Oe- -.0.030x /519
r11/1��tiFr�xs t1�� (1� tilt U Exss- nni5, PA4 094W
Type of Building: _ -
Dwelling No.of Bedrooms Lot Size y d/ sq.ft. Garbage Grinder( )
I
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow(min.required) .TX> gpd Design
flow provided _s7511• 3 1 /1 gpd
Plan Date /(_X�-6, I Q, Number of sheets Revision Date
Title Plrl,,,yYi'„�4_�+S ,..xd �u(rStLt2CQtfi�tf�r'�'`�t {I S�{Sfar� P�c.r')�QCZat�;Zt�
v �
Size of Septic Tank ,*x i Sli r S l Uo E Type of S.A.S.S—ORD GJ ecd '( ,,j r%, '0�X /I
Description of Soil Z�q 5,"c.C I(""Z)
r,
Nature of Repairs or Alterations(Answer when applicable)
r
Da a last inspected: �.
Agreement: /
W The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage.disposal'syys m in...,..,,,,,.,,-
` accordance with the provisions of Title 5 of the Environmental CodeFa'd not to place the system in ope a ion until a Certificate of
Compliance has been issued by this Board of,Hee`al&
Signed Date
Application Approved by ,, �r j- �(�, Date / 11.2
� t
Application Disapproved by U Date
ti for the following reasons
Permit No. U ri Date Issued
-----------------------
THE COMMONWEALTH OF MASSACHUSETTS r
A BARNSTABLE,MASSACHUSETTS
Certificate of Compliance
THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired(A� Upgraded( ) {
Abandoned( )by r 16t C../br ,-1►nc
at r-&#.tom D_LtA2a,,_A.'F"• Ceotr_%k E has been constructed in accordance ) r
with the provisions of Title 5 and the for Disposal System Construction Permit No, -3�6 dated
Installer abrtolo�e CDrt,fj- v_ Ci��r.-+C Designer /f n / >�
F t f. gn (f�111U) G1,13,C ? l�l�,u4 ifcL ht ytr, , �T
- ;
#bedrooms 'j Approved design flow < gpd
The issuance of th'js permitMshall not be construed as a guarantee that the system wilt
ction�as designe
! d. �J
Date (N I I InsP ector �Cf� �/
---------------------------------/--------/------- ----- /
No. c7 cT ��to Fee
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION- BARNSTABLE,MASSACHUSETTS
Bisposal *pstem Construction Permit
Permission is hereby granted to Construct(,\ ) Repair Upgrade( ) Abandon( )
System located at ,D 5 � n L,UAq-CAL
`t. I
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 ust be completed within three years of the date of this permit.
Date / 7f Approved by �' �
TOWN OF BARNSTABLE
LOCATION�j g44LV '_! a- _r_g&�,_ SEWAGE#
VILLAGE ASSESSOR'S MAP&PARCEL
INSTALLER'S NAME&PHONE NO.
SEPTIC TANK CAPACITY
LEACHING FACILITY:(type) (size)
$i k
NO.OF BEDROOMS �P' �' jG� -tj_Cry
OWNER ID P ,e—
PERMIT DATE: Le- COMPLIANCE DATE: J a
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) r� z Feet
Edge of Wetland and Leaching Facility(If any wetlands exist within
300 feet of leaching facility)/ i`15~ Feet
FURNISHED BY /Y CerL L�s7 P
lfh
Am el I
TOWN OF BARNSTABLE
I.,CATION 3 2 SEWAGE# �
VILLAGE ram.,,1,��, P� ASSESSOR'S MAP & LOT I5 7
rNSTALLER'S NAME&PHONE NO.
SEPTIC TANK CAPACITY /,,q-C>c�
LEACHING FACILITY: (type) J2 (size) . �(' j�9n en,
NO'.OF BEDROOMS
BUILDER OR OWNER tv,. , B,
PERMITDATE: COMPLIANCE DATE:
Separation Distance Between the:
Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet
Private Water Supply Well and Leaching Facility (If any wells exist
on site or within 200 feet of leaching facility) Feet
Edge of Wetland and Leaching Facility(If any wetlands exist
within 300 feet of leaching facility) Feet
Furnished by
s
'�� /i
,�
CAPE COD ENGINEERING, INC
Robert M. Perry, P.E. 26
P.O.Box 1517W
East Dennis,MA 02641
Tel 508-385-1445/Fax 508-385-1446 ;
bobperry(a-),capecod.net '
M
T%
.n6
November 2, 2018
a
Town of Barnstable
Public Health Division
200 Main Street
Hyannis,MA 02601
Re: 325 Green Dunes Drive, Centerville; Map 246 Parcel 157—Revised Plan
To the Barnstable Health Department,
Enclosed please find 2 copies of a plan revised to add soil evaluations from 2015 and a
clean out on the pipe run between the tank and the D Box.
Please feel free to contact me directly with any questions.
Sincerely,
Cape Cod Engi teering,Inc.
Robert . Perry
TRANS.NO.:
CITY/TOWN:
APPLICANT: �c-
ADDRESS: 32 S C-,e E'E^/ D vn14!E X- lase
--- - DESIGN FL-OW-:---__—_�-.�'�---- ------ --.,._gPd— --- -----=---------- -------------
REVIEWED BY: DATE:
-N/A OK NO---
boundari -
F]
i,�"
Le al es denoted 310 CMR 15.220 4 a
Street,Lot,tax parcel number and lot number noted on plan [310
CMR 15.220(4)(u)]
Locus Provided 310 CMR 15.2204 t
Plan proper scale? (1"=40' for plot plans, 1"=20' or fewer for
components) 310 CMR 15.220(4)]
Easements shown 310 CMR-15.220(4)(b)]
System located totally on lot served [310 CMR 15.405(1)(a)for
upgrades]- if not, a variance is required 310 CMR 15.412(4)]
Location of impervious surfaces (driveways,parking areas etc.)
310 CMR 15.220(4)(d)] ✓
Location all buildings existing and proposed 310 CMR
15.220(4)(c)]
Location and dimensions of system components and reserve
areas. 310 CMR 15.220(4)(e)]
System Calculations 310 CMR 15.220(4)(f)] �—
daily flow ✓
septic tank capacity (required andprovided) .�
soil absorption system(required and rovided ✓
whether system designed for garbage grinder ✓
North arrow 310 CMR 15.220 4
Existing and ro osed contours 310 CMR 15.220 4
Location and log of deep observation holes (existing grade el. on
each test) [310 CMR 15.220(4)(h)]
Names of soil evaluator and BOH representative [310 CMR
15.220 41 h and i
Location and date of percolation tests (performed at proper
elevation?) [310 CMR 15.220(4)(i)]
Percolation test results match loading rate? -3 fO CMR 15.242 ./
Certification statement by Soil Evaluator 310 CMR 15.220(4)(j)`
Observed and Adjusted groundwater(method for adjustment
given or indicated) [310 CMR 15.103(3) and 310 CMR
115.220(4)(n)]
Address Z i2 tF Sheet 1 of 7
N/A OK NO
Location of every water supply, public and private, [310 CMR
15.220(4)(k)]
. within 400 feet of the proposed system location in the case
of surface water supplies and gravel packed public water supply
-within-250-feet of-the- ro osed-system-location in the case
within 150 feet of the proposed system location in the case
of private water supply wells
Location of all surface waters and wetlands located up to 100.ft.
beyond_setbacks-listed m 310 CMR 1-5.2-11 and any catch-basins
located within 50 ft. 310 CMR 15.220(4)(1)]
Water lines and other subsurface utilities located [310 CMR
15.220 4 m if water line cross see 310 CMR 15.211 1 1
Profile of system showing invert elevations of all system
components and the bottom of the SAS 310 CMR15.220 4 o
Stamp of designer 310 CMR 15.220 1 and 310 CMR 15.220(2)]
Stamp of Registered Land Surveyor(required if construction
activities within 5 ft. of lot line) [310 CMR 15.220(3)]
Test Holes adequate(two in each of the primary and reserve
unless trenches as permitted in 310 CMR 15.102(2)or as
approved for an upgrade under LUA at 310 CMR 15.405 1 k
Test hole adequate to demonstrate four feet of suitable material?
310 CMR 15.103(4)]
Test Holes adequate to confirm adequate groundwater separation?
310 CMR 15.103(3)]
Benchmark within 50-75' of system 310 CMR 15.220 4
Materials specifications noted? [various sections of 310 CMR ✓"
15.000
System components not> 36" deep(unless Local Upgrade
Approval or LUA requested) 310 CMR 15.405(1(b)] '
Address 3 2 S� C-,eC��J Sheet 2 of 7
_ N/A OK NO _
Size OK? 310 CUR 15.223(l)] ./
Inlet tee located ten inches below flow line 310 CMR 15.227(6)]
Outlet tee 14" or 14" + 5" per foot for increase ft depth [310 CUR
Outlet tee with gas baffle or-approved filter 310 CUR 15.227(4)]
Note regarding installation on stable compacted base [310 CUR
15.228 1
Separation between inlet and outlet tees(no less than liquid
depth) 310 CUR 15.227(2)]
Inlet/Outlet elevations at least 12" above high groundwater
(except as described 310 CUR 15.227(5))or permitted for /
upgradesunder LUA 310 CUR 15.405 1 k
Minimum cover 9" (Tanks buried more than 9" must have risers
on all openings and on the d-box) [310 CUR 15.2228(1)and 310
CMR 15.232 3
Three access covers(inlet and outlet must be 20" or greater)-
middle access at least 8" b 7/07 310 CMR 15.228(2)]
Access to within 6 " of grade - one port for systems<I 000gpd,
two fors stems>1000 gpd 310 CUR 15.22 8 2
All at-grade covers secured to unauthorized access? [310 CUR /
15.228(2)]
> 10 ft from building foundation 310 CUR 15.211 1
Buoyancy calculation Required/Done 310 CMR 15.221(8)]
H-20 Where appropriate? 310 CUR 15.226(3)]
Setbacks from resources 310 CUR 15.211
.b.Htx '5.' ` v..7aa4Ya s
Required when other than single-family dwelling or flow>1000 IN/
d 310 CUR 15.223 1 b
First compartment 200%daily flow; Second compartment 100%
daily flow 310 CUR 15.224(2)and 3
"U" pipe through or over baffle,outlet of each compartment with
as baffle or approved filter 310 CMR 15.224(4)]
Address L S� G/L ��! 4) wr .e_r Sheet 3 of 7
C� � v _/L E, avtY
R ■/yam C f/yN/A OK+ NO
a1 � 1! hJA .03 UWrd ,�w I�VJ?4itkLu;P 7 5 "?A, , iLi xY{4�Y
Located at least ten feet from any water line? [310 CMR
15.222(2)]
Disposal piping at least 18" below water line(when water and
sewer cross,.see 310_CMR-15.211.(1) 1- - - - - ---- -- -- ----==--- --- —
Cleanouts required/provided? 310 CMR 15.222(8)]
Thrust blocks specified in force mains? 310 CMR 15.221(6)(c)]
Slope of sewer line not less than 0.01 (1/8"/ft) 0.02 preferable /
310 CMR 15.222(6)]
Proper pitch on all runs? (.005 within gravity-distributed trenches
and beds) [310 CMR 15.251(9)and 310 CMR 15.252(2)(c)]
Siphonproblem/ leachfield below pump chamber
Endca s or vent manifoldspecified?
Size and orientation of discharge holes specified? (not smaller
than 3/8" not larger than 5/8") [310 CMR 15.251(8)and 310 /
CMR 15.252(2)(h)]
Materials specified (310 CMR 15.251(5) specifies various pipe
types allowed
D�STRIBIF�IUN BOXY � yazL,u# tit i {
Stable compacted base [310 CMR 15.221(2)and 310 CMR /
15.232(2)(a)]
Splash plate or baffle tee required on inlet/provided? (when
pressure sewer to d-box or steep pitch of gravity sewer) [310 /
CMR 15.323(3)(a)]
Riser if deeper than 9" 310 CMR 15.232 3
Inside minimum dimension 12" 310 CMR 15.232(2)(b)]
Minimum sum 6" 310 CMR15.232 3 e
Watertight cover if<2000gpd); waterproof manhole if>2000gpd
310 CMR 15.232(3)(d)] /
PUN)P CHAMBERS a aR . h £r a X x R u y 1
Capacity (emergency storage above working=design flow)? [310
1CMR 231 2
Proper setbacks 310 CMR 15.211 same as septic tanks
Watertight 20-Lq minium access r:anhole at least 20" MUST BE
ITO GRADE (310 CMR 15.231(5)1
Service components accessible(not too deep with piping,
(disconnects accessible) _ ] -
Alarm floats - alarm on circuit separate from pumps specified?.
Exceeds two units must have two pumps operating in lead-lag
mode. 310 CMR 15.231(6) and 8
Stable Compacted Base 310 CMR 15.221(2)]
IBuoyancy calculations needed ? Provided? 310 CMR 15.221 8
Address 3 ZS� Sheet 4 of 7
i
N/A OK NO
s
O1tP.�'�ONSsS�S�.> 5�
Calculations correct?
4 feet of naturally occurring material demonstrated? [310 CMR /
15.240 1
Re_aired sep
Argfian to. -oundwater?_ 310 CMR 15.212)
Aggregate specified as double washed 310 CUR 15.247(2)]
System Venting required/provided? (system under driveway or
>36" deep) 310 CMR 15.241
Inspection ports specified and within 3"final grade? [310 CMR
15.240 13
Breakout requirements met? (No violation of breakout elevation /
within 15 ft of SAS unless barrier) [310 CMR 15.211(l)[4] and
GGu idance Docc�ument
., ..,n .. ,. 1- .:-„ —•, -... a..-, ro ,.' �.�3"me,� J is��-" �.t�$<C�.°�. '��",�.�3r�:-4'0r:s,.t�t..�r�r
Chambers and Gal. in trench configuration supplied with inlet /
every 20 ft. 310 CMR 15.253(6)]
Each structure with one inspection manhole (if>2000 gpd must /
be tograde) 310 CMR 15.253(2)]
Aggregate I' minimum-4' maximum. 310 CMR 15.253 1 b
2' sidewall credit maximum 310 CMR 15.253 1 a
In bed confi ation, inlet eve 40 s . ft. 310 CMR 15.253(6)]
�T �r �{- s y x'7'
l\ �7� 1� ��� ,'1 �.� ., ty2$"�" ���
'�- - ...a..,, spa✓.x, .s+:',.`.r..w.,r. ..nx. u'--,arc
Width 2' minimum 3' maximum 310 CMR 15.251 1 b
100 feet- maximum length 310 CMR 15.251 1 a
Minimum separation 2x effective depth or width whichever /
eater 3x if reserve between trenches 310 CMR 251 1 d
Situated along contours 310 CMR 15.25 1 2
Breakout OK? 310 CMR 15.211 1 4 and Guidance Document
� �'�'.
BED,SAS agr_mu ize o , edar field5Q00
minimum 2 distribution lines [310 CMR 15.252(2)(a)]
Maximum separation between lines 6' 310 CM R15.252(2)(d)]
Maximum separation between lines and outside of bed 4' [310
CMR 15.252(2)(e)]
Aggregate depth below discharge pipes 6" minimum, 12"
maximum. 310 CMR 15.252 2
Separation between beds 10' minim—m-. 310 CMR 15.252 2
Bottom area used in calculations only [310 CMR 15.252(2)(i) /
Address 3 v.17 e f N!� , Sheet 5 of 7
C nl TAX 61 t dI/Ji9
i
N/A OK NO
*`'
Pressure Dosed System j? Provided pump and piping
calculations as required 310 CMR 15.220(4)(r)]
Pressure dosing required on all systems>20009pd or alternative
systems under remedial approval [310 CMR 15.254(2)and UA
Remedial Use Approvals]
If used in gravelless system- make sure jet is directed as not to ,
scour soil interface Guidance Document
Inspections once per year(systems<2000 gpd) or quarterly
>2000 dgood to note on plan 310 CMR 15.254(2)(d)]
Construction in fill -Did the plan specify that the fill shall meet /
the specification of 310 CMR 15.255 3 ?
Impervious barrier and/or retaining wall ? Guidance Document
Impervious barrier installation must be supervised by /
designer 310 CMR 15.255(2)(b)]
Retaining wall must be designed by Registered Professional
Engineer 310 CMR 15.255(2)(a)]
Side slope not exceed 3:1 ? 310 CMR 15.255(2)]
Breakout requirements met? [310 CMR 15.252(2) and
Guidance Document
At least 5 ft. from impervious barrier to edge of SAS (10 ft.
recommended) r310 CMR 15.255 2 e
-,rid ",,,� f�*. w � Al'.
�f �s-��
Check DEP Approval letters for credits and design conditions
If used with pressure dosing do not allow pressure discharge
to scour soil interface
Was DEP Approval Letter provided and/or have you
reviewed the letter for conditions?
Is the technology being properly applied and does it meet all
DEP Approval Conditions?
Is there a note on the plan regarding the requirement for
perpetual maintenanceagreement?
Any alarms involved on separate circuits
Did the applicant submit an operation and maintenance
manual?
Has applicant submitted a copy of a maintenance
Are the variances listed on the plan ? [310 CMR 15.220
4
RLS Stamp necessary on plan if a component is within five
feet of property line 310 CMR 15.412(4)]
New construction or increased flow proposed- [Refer to 310
CMR 15.414
Address 3 Z Sheet 6 of 7
Coo-) 7-oe;:,�L,,,/
N/A OK NO
is ,n, ensae�rea � k�
Is the system in a Designated Nitrogen Sensitive Area(Zone II for
a public supply well)? [310 CUR 15.214, 310 CUR 15.215 and /
310 CUR 15.216 - also refer to Policy regarding upgrades of such
existin s stems
Is the system proposed on the same lot as served by private well
310 CUR 15.214(2)]
Are-the nitrogen-loads proposed in compliance? [310 CUR
4:.. , 0..v...-,.a.d�v�,� ,:�v�"��� 'k��aa°�.x>ak
Pumping to septic tank ? 310 CMR 15.229
Shared System 310 CMR 15.290
Address C2-£g-!q /,)o lye r y,,q Sheet 7 of 7
MAY=30-2019 05:58 From: To:15087906304 Pa9e:1/1
Town of Barnstable
inspectional Services
Public Health Division
t
Thomas McKean,Director
1,61¢ - 200 Main Street,Hyannis,MA 02601
Faz: 508-99o-6304
Office: 509-8624644
Installer Desi Zrn rtif catlon Form /
Date: 2 •/9 sewage Permit# o . 31 Assessor's Map�Parcet 2 46
Designer: ,fie fzT ���" PE -
installer: .,��' Z R:r o tTvLo?�
eivOE �vo 6NenvEE��G���' Address: _' I�1►D �sney R�
Address: E A!T �.^�NiJ• '"q • ,•,,vim r r�•�f •r••"t
cr 26'f 8
8' ' was issued a permit to install a
On / aP— ' S — (installer)
v u P,E based on a design drawn by
septic system at 3 2 S �� ( dress) -
R e8�ai• �E�t�a Y. Age— ems. ,ice Le I F ,
G/a�� Cow �,�rG/ ii✓t . dated O cT. i0.•Ze/a '; R
. (designer)'
certify that the septic system referencedoo above ed ch to
anges such as led s'lot lateral rellocation of the
the design, which may include m pp out if required) was inspected and the soils
distribution box and/or septic tank. Strip ( q
were found satisfactory.
..14 certifythat the septic system referenced above was installed cal with
of any cor omponent
ent
greater than 10, lateral relocation of the SAS or any verb
of the septic system)but in accordance wit pState&Local ed)was in npse plandvthe soils
certified as-built by designer to follow. Strip out(if req
were found satisfactory.
I certi tcm referenced above was constructed i iance with the to rms of
WET etters(if applicable) SRN of RT
ROBERT
M. �
PERRY
CIVIL
(Ins er's S1 ature) 4 No.
8T �m
Y � T
�sS1ONAL
. (Desigilees Signature) (Affix Designer's Stamp Here)
PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE
TV � Xwwff
OF C A
UILT � HE CEIVED BY T BARNSTABLE P BLICHHEAL H DI N SION.
B C
THANK YOU.
\11oo\dopu\HEALT1WEWER conneollserricacsiswrcenification Form Rev&14-13.DOC
S
• � Town of Barnstable r# 70 •
Department ofliegulatery ServicesMAW .
t Public Health Division Date r R_
sap. 200 Mau Street,Hyssop MA 04ti01
--.r_ ly Time Fes Pd, �� 5
Data Scheduled
_Soil 5uitabOy_Assessmentfor Sew a Disposal.._
. LOCAZTON&.GEMUL MORMATION
Own es Nema e-Z Ci
IaentlanAddmu 3
2 5-G/tEEiy p,vnirs� �
AetstaoraMaplPanxl;'Zg�. /.�� tw..ivy��nir�p a�T .a�+.t .
:e.pF/2aY F7
N3WCONMUCIMN RBPAM hmto$ S� 14 A� #-
land Use•_R S Slops(96) fi %' BurPoae Stmtu
Dlataacuftmnt Open WaterBady /.SC ft pmtlbmW*Mma rt 'DdokingWatewell -
Dcaihoseway ' _$ Pmp-ry one.� r cthar�_�t _
SHETCHt(Sheet same dlmenalana et mr,moat leeatiotte of tut hoist 8<pmo tuts,maalo wethnde in lamtimlly to hole.)
2E o 0
- - QD
1- T
. ; • Esc _
Pemnt motmlal(geomgm) 6 X: /cE C iiv m C% Depth to Bedmok
Depth to ammdweter Standing Water to Holm Wasping ftiatn Pit Face
RitImated Susanol High Omundwoter
DETFJYM&TION FOR►SWONAL'HIGH WA'iYR TA33tI -
Method Used:
D�N Obaatved ttandmg la ohs hole ✓t la, Depth to toll mattlul M 176 .
e m to weeping tiom dde of otu Tinier! N, Umundtwter Adjustment tt
Idea welly Rmding Dstm mdea Well level Ad.taetor Adl..Omuedwates
PERCOLATION T=T bate glue
. Obsarvetlmt '
Hole A , 7101e at iN _
Deptivarpem-
Start Pio•e`oekllmo® -:__----_-. _ _ 'Ilipti(9e=8°)
EndPa"anlc SEE /'?TTi4CyE1�
Rota MGtlloah
Sho Sullehlllty Assmamcntt 81td Peeved ✓ she Falk&- Additional Teatmg Needed(M)
—. -- -- Odginait-Pubgu.HeatthDIYWon----- ObaamaHonHcicDataTo_Be.Cotnploted.onBack
ww+IPpsrcolation test is to be conducted within 100'of wetland,you must first notify the
Barnstable.Conservation Division at least one(1)week prior to beginning.
Qti.SBMCU'BRCF RM.DOc
Y
DnP'.0BSERVAn0N HOLE LOG Hole#
Depth fmm suit He&=' San Teehue so Color salt. oihar
amp( .) (WDA) cMmesO) Motmos (Sftwtm%Bhm4Bmldem
DEEP OBSERVATION HODS LOG Hole#
Depth ttom Boll Horizon Sall Tertms Boll Color soil' Omer
BmfPono OW (l1BDA) (Mmmem MOODS (struotmq Blom,Bau[dea.
DM OBSERVATION HOLE LOG Hole#
sDepth o t� eu soil$mbm s Tatum sou color soil other
(USDA) (Mmedo MOODS (shndm%Slma,Bmidem.
anyan
DEEP OBSERVATION HOLE LOG Hole#
Depth flvm son Hadzoa BdI Tesmm Boll Cwcr Boll Other
(U,4DA) (Mumdo MOODS (shmtaro,slow.BauWam.
Mood Inettcance Rota mmi
Abo=500yeerfloodboundsry No— Yee:r -
Wltldn500yeerheoaduy_ No__. Ya
WWdaLOoyaa(looibouadsry No, — Yde.._.
Deotbt ofNatueally®ecurrineParvlousMalarial
Does at low four feet of naturally occurring porvlous meledal exist in all Braes observed tbrpughout the
LAurtrio
aapmpoaedtarsuU-a eb orptio`n.syeteml
_. _ ,_ _._ If-not,wtiat la.the.depth.of haturally_rnrouning.pervlous Materialf
I certify that an T_(date)I havo passed the soil evaluator a=rim don approved by-the
Department of Enviromnenlal Protection and that the above analysts was performed by the conetatent with
4
the t'cgohed trttirttn rtperdso and ap orltutce:described to 10 CNIIt
tm
— Dal°
Q-%qXn \MCF0RM.DOC
i
77
_r.ASTM-D422 63(2.0.07)
Project Name: CIOLEK Tested By: R. Perry Date: 6/29/2018
_
Location: 325 GREEN DUNE DRIVE Checked By: N.Keith Date: 7/24/2018
Boring No: SAMPLE 1 -C 2 LAYER Test Number: 1
Sample Depth: Gnd Elev.: N/A
USCS Soil Classification: UNIFORM FINE SAND--D601 D10=3.0 -
AASHTO Soil Classification: N/A
-- -�-Weight of-Conta ner(g) -Weight of Container-&-lSoil-(g) == 224-2----- ------
Weight of Dry Sample (9): 21.5.4
Sieve Number Diameter (mm) - Sieve Mass of Sieve Soil Retai n ed Soil Retained Soil Passing
Soil(9) (9) - -(%) (070)..
#10._ _ 2.00 2.5 1.2 98.8
_#20 0.85 7.7 3.6 95.3
#40 0:43 27.0 12.5 82.7
#60 0.25. 75.7 35.1 47.6
#100 0.15 53.2 24.7 ` 22.9
------ ----- ----------
#200 _ . 0.075-___ 40.8 18.9 3.9
Pan. 12.9 6.0 0.0
TC1T01 21Q R I 1ng n
GRAVEL #4 Coarse #10 Medium #40 Fine #200 SILTICLAY
100 SAND SAND SAND
90
8070
!
. I i
.N 60 _
. 50
40 l
\
30
_20 _ - -
10
10.00 __ . __._._ ._..___11:00"-___.._. _._-_..__- __ __ _ 0.10- _ 0.01:. . .
Particle Diameter (mm)
__- rain-Size-Distribution? carve-Results -- - ------ -- ------ -------
%Gravel-- - 0 ...- Duo:. 0.1 -_._ .._ _. C,,:
%Sand: - 95 - D30: cc:
_. % Fines: 5 D60: 0.3
14.333 Sieve Analysis Worksheet Revised 02/13 _of.-
e k ,
OLt
COMMONWEALTH OF MASSACHUSETTS �{
• EXECUTIVE OFFICE OF ENVIRONMENTAL:AFFAIR�X'.,
DEPARTMENT OF ENVIRONMENTA PROI P ON
., �.
ONE WINTER STREET. BOSTON. 1`tA 02108 617-282 �-00 roNt'o rn �
F f�
N17LLIAM F.WELD � .�4�N TRUDY CORE
Governor ( � ' Secretary
elf_j�y
ARGEO PAUL CELLUCCI DAVID B.STRUHS
Lt.Governor SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM Commissioner
PART A
N TIO A
325 Green Dunes CERTIFICATION
Mary Kearney
Property Address: yann iVl�lspOrt a d' I'/Rddress of Owner: �97 8th Street
Date of Inspection: 9^rX`C�' (If different) Unit 203
Name of Inspector: Wm E Robinson Sr Charlestown MA 02129
1 am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000)
Company Name: him E Robinson Septic Service
Mailing Address: PO Box 1 089, Centprvi 1 1 a , MA 02632
Telephone Numbers,, 5 0 8 l 7 7 5 A 7 7 A
CERTIFICATION STATEMENT
I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate
and complete as of the time of inspection. The inspection was performed based on my training and experience in the proper function and
maintenance of on-site sewage disposal systems. The system:
Passes
Conditionally Passes
Needs Further Evaluation By the Local Approving Authority
Fails
Inspector's Signature: d Date:
The System Inspector shall submit a copy of this inspection report to the Approving Authority within thirty (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 Department of Environmental Protection. The original should be sent to the system owner
and copies sent to the buyer, if applicable, and the approving authority.
INSPECTION SUMMARY: Check I, B, C, Or D:
AI SYSTEM PASSES:
I have not found any information which indicates that the system violates any of the failure criteria as defined in 310 CMR 15.303.
Any failure criteria not evaluated are indicated below.
COMMENTS:
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.
Indic to yes, no, or not determined (Y, N, or ND). Describe basis of determination in all instances. If"not determined", explain why not.
The septic tank is metal, unless the owner or operator has provided the system inspector with a copy of a Certificate of
Compliance (attached) indicating that the tank was installed within twenty (20) years prior to the date of the inspection; or
the septic tank, whether or not metal, is cracked, structurally unsound, shows substantial infiltration or exfiltration, or tank
failure is imminent. The system will pass inspection if the existing septic tank is replaced with a conforming septic tank
as approved by the Board of Health.
(revised 04/25/97) Page 1 of 10
DEP on the World Wide Web: http:/Iwww.magnet.state.ma.us/dep
ej Printed on Recycled Paper
T "
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM ,
PART A
r,
CERTIFICATION (continued)
Property Address"325 Green Dunes, W Hyannisport
Owner: Kearney
Date of Inspection:
1B1 YSTEM CONDITIONALLY PASSES (continued)
Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed
pipe(s) or due to a broken, settled or uneven distribution box. The system will pass inspection if(with approval of the
Board of Health). Describe observations:
broken pipe(s) are replaced
obstruction is removed
distribution box is levelled or replaced
The system required pumping more than four times a year due to broken or obstructed pipe(s). The system will pass
inspection if(with approval of the Board of Health):
broken pipe(s) are replaced
obstruction is removed
r
C) FU THER 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 the
public health, safety and the environment.
1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM 15 NOT FUNCTIONING IN A MANNER
WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT:
Cesspool or privy is within 50 feet of a surface water
Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh.
2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH (AND PUBLIC WATER SUPPLIER, IF APPROPRIATE) DETERMINES THAT
THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECTS THE PUBLIC HEALTH AND SAFETY AND THE
ENVIRONMENT:
The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet to a surface water supply or
tributary to a surface water supply.
The system has a septic tank and soil absorption system and the SAS is within a Zone I of a public water supply well.
The system has a septic tank and soil absorption system and the SAS is within 50 feet of a private water supply well.
The system has a septic tank and soil absorption system and the SAS is less than 100 feet but 50 feet or more from a
private water supply well, unless a well water analysis for coliform bacteria and volatile organic compounds indicates that
the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or
less than 5 ppm. Method used to determine distance (approximation not valid).
3) OTHER
(revised 04/25/97) Page 2 of 10
f ,
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: 325 Green Dunes W Hyannisport
Owner: Kearney
Date of Inspection:
D] Sl/STEM FAILS:
You mu t indicate ei;!er "Yes" or "No" as to each of the following:
have determined that the system violates one or more of the following failure criteria as defined in 310 CMR 15.303. The basis
f r this determination is identified below. The Board of Health should be contacted to determine what will be necessary to correct
the failure.
Yes N
Backup of sewage into facility or system component due to an 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 112 day flow.
Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).
Number of times pumped _.
Any portion of the Soil Absorption System, cesspool or privy is below the high groundwater elevation.
Any portion of a 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 I 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. If the well has been analyzed to be acceptable, attach copy of well water analysis for
coliform bacteria, volatile organic compounds, ammonia nitrogen and nitrate nitrogen.
E] LAR E SYSTEM FAILS:
You st indicate either "Yes" or "No" as to each of the following:
The following criteria apply to large systems in addition to the criteria above:
The system serves a facility with a design flow of 10,000 gpd or greater (Large System) and the system is a significant threat to
public health and safety and the environment because one or more of the following conditions exist:
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)
The ow er or operator of any such system shall bring the system and facility into full compliance with the groundwater treatment program
requirem nts of 314 CMR 5.00 and 6.00. Please consult the local regional office of the Department for further information.
(revised 04/25/97) Page 3 of 10
t
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST
Property Address: 325 Green Dunes W Hyannisport
Owner: Kearney
Date of Inspection: 7—;e v—
Check if the following have been done: You must indicate either "Yes" or "No" as to each of the following:
Yesi No
Pumping information was provided by the owner, occupant, or Board of Health.
_ None of the system components have been pumped for at least two weeks and the system has been receiving normal
flow rates during that period. Large volumes of water have not been introduced into the system recently or
as part of this inspection.
As built plans have been obtained and examined. Note if they are not available with N/A.
✓/ _ The facility or dwelling was inspected for signs of sewage back-up.
✓ _ The system does not receive non-sanitary or industrial waste flow.
The site was inspected for signs of breakout.
_ All system components, excluding the Soil Absorption System, have been located on the site.
_ The septic tank manholes were uncovered, opened, and the interior of the septic tank was inspected for condition of
baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge, depth of scum.
The size and location of the Soil Absorption System on the site has been determined based on:
The facility owner (and occupants, if different from owner) were provided with information on the proper maintenance of
Sub-Surface Disposal System.
_ Existing information. Ex. Plan at B.O.H.
Determined in the field (if any of the failure criteria related to Part C is at issue, approximation of distance is
unacceptable) [15.302(3)(b)]
(revised 04/25/97) page 4 of 10
I
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
Property Address: 325 Green Dunes WHYannisport
Owner: Kearney
Date of Inspection:
FLOW.CONDITIONS
RESIDENTIAL:
Design flow:& 4 0 p.d.P room for S.A.S.
i -
Number of bedrooms: —1
Number of current residents: /Ll- 1�
Garbage grinder (yes or no): ZIA
Laundry connected to system (yes or no): -2i
Seasonal use (yes or no):7^S 1996 - 210 , 000g Water meter readings, if available (last two (2) year usage (gpd): a� f
Sump Pump (yes or no): �d
1997 - 226, 000g
Last date of occupancy: 9 9 9'Y-
CO MERCIAUINDUSTRIAL•
Type f establishment:
Desig flo _w: gallons/day
Greas trap present: (yes or no)_
Indust ial Waste Holding Tank present: (yes or no)_
Non-s nitary waste discharged to the Title 5 system: (yes or no)—
Watel meter readings, if available:
Last date of occupancy:
OTH R: (Describe)
Last ate of occupancy:
GENERAL INFORMATION
PUMPING RECORDS and source of information:
System mped as part of inspection: (yes or no)&4
If yes, volume pumped: gallons
Reason for pumping:
TYPE OF yYSTEM
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)
I/A Technology etc. Copy of up to date contract?
Other
APPROXIMATE AGE of all components, date installed (if known) and source of information: L„L `l6';Z^ .C.
Sewage odors detected when arriving at the site: (yes or no)&C)
(revised 04/25/97) Page 5 of 10
s
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 325 Green Dunes W Hyannisport
Owner: Kearney
Date of Inspection:
B LDING SEWER:
(Loc a on site plan)
Depth below grade:
Mater' I of construction: _cast iron _40 PVC_other (explain)
Dist ce from private water supply well or suction line
Dia eter
Co ents: (condition of joints, venting, evidence of leakage, etc.)
SEPTIC TANK:_V
(locate on.bite plan)
Depth below grade:
Material of construction: concrete _metal _Fiberglass _Polyethylene —other(explain)
If tank is metal, list age _ Is age confirmed by Certificate of Compliance _(Yes/No)
Dimensions: IC; '-k G -1 4
Sludge depth: I�
Distance from top of sludge to bottom of outlet tee or baffle: V
Scum thickness: 0 —/ ' i *V
Distance from top of scum to top of outlet tee or baffle: F i
Distance from bottom of scum to bottom of outlet tee or baffle:
How dimensions were determined: CD
Comments:
(recommendation for pumping, condition of inlet and outlet tees orbaffles, d pth of liquid level in relation to ou et invert, structural
integri vidence{of leakage, etc.) 16-� f �/+�- a.0 rr C! 'L A J
GREA E TRAP: .
(locate n site plan)
Depth low grade:
Material f construction: _concrete _metal _Fiberglass _Polyethylene —other(explain)
Dimens' ns:
Scum t ickness:
Dista a from top of scum to top of outlet tee or baffle:
Distance rom bottom of scum to bottom of outlet tee or baffle:
Date of la t pumping:
Comment:
(recomme idation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural
integrity,j vidence of leakage, etc.)
(revised 04/25/97) Page 6 of 10
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
-Property Address: 325 Green Dunes W Hyannisport
Owner: Kearney
Date of Inspection: 9. %z
TIG HOLDING TANK: (Tank must be pumped prior to, or at time, of inspection)
(locate o R site plan)
Depth bel grade:
Material of onstruction: _concrete _metal _Fiberglass _Polyethylene —other(explain)
Dimensions .�
Capacity: gallons
Design flo gallons/day
Alarm le a Alarm in working order_ Yes; _ No
Date of pre ious pumping:
Comments:
(condition f inlet tee, condition of alarm and float switches, etc.)
DISTRIBUTION BOX62'
(locate on site plan)
Depth of liquid level above outlet invert:
Comments:
(note if level and distribution is equal, evidence of solids carryover, evidence of leakage into or out of box, etc.)
PUM CHAMBER:_
(looat on site plan)
Pump in working order: (Yes or No)
Alarm in working order (Yes or No)
Com ents:
(note ondition of pump chamber, condition of pumps and appurtenances, etc.)
(revised 04/25/97) Page 7 of 10
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 325 Green Dunes W Hyannisport
Owner: Ke arnuy
Date of Inspection:,!F-;.'/-9$
SOIL ABSORPTION SYSTEM (SAS):
(locate on site plan, if possible; excavation not required, but may be approximated by non-intrusive methods)
If not determined to be present, explain:
Type:
leaching pits, number:
leaching chambers, number:_
leaching galleries, number:
leaching trenches, number,length:
leaching fields, number, dimensions:
overflow cesspool, number:
Alternative system:
Name of Technology:
Comments:
(note condition of soil, signs of hydraulic failure, level of pondin , con ition of vegetation, etc.) ✓ ��
b��d d, o c el S Ts .z 4 a d<4 6 , - rl C.
CESS OOLS: _
(locat on site plan)
Numbe and configuration:
g
Depth-t p of liquid to inlet invert:
Depth o solids layer:
Depth o scum layer:
Dimensi ns of cesspool:
Material of construction:
Indicati of groundwater:
inflow (cesspool must be pumped as part of inspection)
Com ents:
(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.)
PRIVY:_
(locate n site plan)
Materia s of construction: Dimensions:
Depth f solids:
Commeits:
(note cc ndition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.)
(zevieed 04/25/97) Page 8 of 10
t SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 325 Green Dunes W Hyannisport
Owner: Kearney
Date of Inspection: g—o-Y 97-
J
SKETCH OF SEWAGE DISPOSAL SYSTEM:
include ties to at least two permanent references landmarks or benchmarks
locate all wells within 100' (Locate where public water supply comes into house)
ii
x
i
1
(revised 04/25/97) Page 9 of 10
l
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 325 Green Dunes W H,yannisport
Owner: Kearney
Date of Inspection:
Depth to Groundwater Feet
Please indicate all the methods used to determine High Groundwater Elevation:
Obtained from Design Plans on record
Observation of Site (Abutting property, observation hole, basement sump etc.)
/Determine it from local conditions
✓ Check with local Board of health
Check FEMA Maps
Check pumping records
F
Check local excavators, installers
L/Use USGS Data
Describe in your own words how you established the High Groundvyd r Elevation. (Must be completed)
6fa.. 17 Gayd/'s / d dri�l��/2 J�jS" �`
ti
l
(revised 04/25/97) Page 10 of 10
ROUTE 28
' AN
ST
ao
N,
C,
BENCHMARK:
1�0 1�101 41 TOP OF CB/DH
14
ELEV. = 11.97 NAVD88 DEEP OBSERVATION HOLE #I
Test Date:JUNE 29,2018; rr
Witness:Don Desmarais,RS,Barnstable Health Dept.Staff
PERFORMED BY Robert M.Perry,SE#13408,Issue date 12-30-2010
18 / CO BEACH RD'
'906' elevation depth(in.) horizon texture color mottling other CRAIGNALLE
M LOCUS
17.8-16.8 0-12 A sand loam 10 RY 3/3
pHW \ ' \ \ \\ 16.8-15.5 12-28 B sand loam 10 YR 5/6
(7
/ \ , \ \ 15.5-10.8 28-84 Cl loam.sand 2.5Y 7/2
\ \ \ \ coarser CRAIGVILLE HARBOR
12 PIN 10.8-4.3 84-162 C2 fine sand w/depth
10" PINE 14" OAK
U.P ^-V� \ 8" AK Parent material:Ice Contact Deposit CENTERVILLE, MA
14" OAK
C> 1 SX8 Depth to Groundwater:Not found
C.14
co PERC.TEST DATA: Sieve tested C2 Layer- 90 to 95%SAND W/5 TO 10%FINES KEY MAP
co QUALIFIES AS SAND,CLASS 1 SOIL-5MPI MIN.
7" PINE */S�7, • PERC RATE=LESS THAN 5 MPI in C2 layer NO SCALE
STA2 -10,
Aj STA1 S
Tq
15" PINE 0
18x8 5- PINE 0 U�16" OAK�'
10' fINE 16 72-" OAK 00
DEEP OBSERVATION HOLE #A1
o Test Date:MARCH 18,2015;
Ar- 2�PINE *1 1-1 \ -S, PUMP OUT & Al Witness:Donna Mirandi,RS,Barnstable Health Dept.Staff
2" PINE,, SAND FILL I '_1 PERFORMED BY Bradley M.Bertolo,EIT,Soil Eval. Issue date July 2003
EXIST. PITS y f
elevation depth in. horizon texture color mottling other �.,
1-1 1\ " PINE \- I - HALL CREEK 17.4-16.4 0-12 A sand.loarn IORY3/2
STNG 16.4-14.4 12-36 B loam.sand 2.5Y 7/2
180 PROP. EXISTING (TIDAL CREEK)
o CLEAN OUT GRAVELDRIVEWAY G 14.4-10.6 36-82 Cl FWC sand 2.5Y 5/4 GENERAL NOTES
W.M. % I
PROVIDE S EVE 4-0 L 18 10.6 - 8.9 82-102 C2 sand.loam (tight) 1. ELEVATIONS REFER TO NAVD88. ELEVATION BENCHMARK IS THE TOP OF THE PROPERTY LINE
WATER SERff FOR®
8.9 - 6.9 102-126 C3 M/F sand 2.5 Y 6/3 BOUND ALONG THE NORTH LOT LINE WHERE INDICATED. CONTACT CAPE COD ENGINEERING,INC.
10' EACH S FOR ADDITIONAL ELEVATION INFORMATION.
Parent material:Not given 19X8 Z 2. PLAN REFERENCE:TOPOGRAPHIC SURVEY PREPARED BY JC ENGINEERING,INC.,EAST WAREHAM,
Depth to Groundwater:None observed- Indicated by"mottles"106 in.depth el.8.6)*
400 1�; 45*- C� \t/ MA
I coPERC.TEST DATA: Pere.tested C I Layer
IN, 3. ALL SEPTIC SYSTEM CONSTRUCTION MATERIALS AND PROCEDURES SHALL CONFORM TO THE STATE
PERC RATE LESS THAN 5 MPI in C I layer SANITARY CODE,TITLE 5 AND TOWN OF BARNSTABLE HEALTH DEPT.RULES AND APPROVAL FOR THE
DESIGN.
4. THE EXISTING 1,500 GALLON SEPTIC AS DETERMINED BY RECENT PUMPING VOLUME SHALL BE
• xb "?,(sj"
S�SnN / // / / / // INSPECTED DURING THE EXCAVATION. ANY DEFECTS OR QUESTIONABLE CONDITION POINTS SHALL
BE BROUGHT TO THE ATTENTION OF THE ENGINEER. THE TANK SHALL BE FITTED WITH
/ (2 6 10'
&
APPROPRIATE INLET AND OUTLET TEE WITH A GAS BAFFLE.
-kj 22" INE \ �OF DEEP OBSERVATION HOLE #A2 5. THE EXISTING SEPTICTANK SHALL BE EVALUATED FOR EARTH LOADING, RE-FITTED WITH
Test Date:MARCH 18,2015; LIGHTWEIGHT ADS PIPE RISERS AND SINGLE PIECE COVERS AS NECESSARY.
•
S Uc / Witness:Donna Mirandi,RS,Barnstable Health Dept.Staff 6. INSTALLATION CONTRACTOR SHALL VERIFY THE TANK OUTLET PIPE CONDITION AND ELEVATION& PERFORMED BY Bradley M.Bertolo,EIT,Soil Eval. Issue date July 2003 AT THE SEPTIC TANK LOCATION PRIOR TO MAKING THE NEW PVC PIPE CONNECTION FOR THE lfDft
18X9 \I/ \4/
I i elevation depth(in.) horizon texture color mottling other BOX RUN. CONTACT CAPE COD ENGINEERING,INC.PRIOR TO MAKING ANY CHANGES FROM THE
12 INE T.H.1 - - PLAN.
16.8 15.8 0 12 A sand.loam 10 RY 3/2 7. EXISTING WATER SERVICE CROSSING REQUIRES A CONTINUOUS SLEEVE FITTING FOR THE 4 IN.SCH.
40 PVC PIPE WITHIN 10 FT.OF THE CROSSING.
-6 8. MAGNETIC MARKER TAPE SHALL BE PLACED ALONG ALL PIPE RUNS PRIOR TO BACKFILL
17x4 15.8-13.8 12-36 B loam.sand 10YR 5/6
MAP 24 1
9. A 5 FT.PERIMETER EXCAVATION IS REQUIRED 0 REMOVE THE SURFACE SOILS AND THE C1 SOIL
TENT PARCEL 157 13.8-10.8 36-72 C1 fine sand 2.5Y 7/2 LAYER. THE EXCAVATION MUST BE MONITORED TO GUARD THE GARAGE FOUNDATION FOOTING.
J
9x3 10.8- 8.8 72-96 C2 sand.loam 2.5Y 5.4 tight) SPECIFIC INSPECTION DURING THE EXCAVATION MAY ALLOW FOR A REDUCTION OF THE DEPTH
50,482± S.F. (TOTAL) -6/ DEPENDING UPON OBSERVATIONS.BACK FILL WITH CLEAN SAND TO I FT,ABOVE THE SAS
8.8 - 6.3 96-126 C3 Med.sand 2.5 Y 6/3 COMPONENTS. CONSTRUCT THE SAS IN THE NEW MATERIAL.
T28" OAK RE-LOCATE -UTILITY LINES IN VICINITY OF THE
5' PERIMETER Parent material:Not'given 10. PROVIDE MARKOUT AND PRESERVE OR RE OTHER ITY
EXCAVATION.
EXCAVATION Depth to Groundwater:None observed-Indicated by"mottles" 108 in.depth el.7.8)* 11. CONTACT CAPE COD ENGINEERING,INC.PRIOR TO EXCAVATION TO REVIEW SPECIFIC
•
PERC.TEST DATA:See soil eval.Al
SEE NOTE #9 PERC RATE=LESS THAN 5 MPI in Cl layer as indicated in Al REQUIREMENTS FOR THE EXCAVATION AND RELATED SITE WORK.
12. EXISTING SEPTIC SYSTEM LEACH PITS SHALL BE LOCATED,PUMPED OUT AND FULLY SAND FILLED,
14- SEPTIC
AT THE OWNERS OPTION.
13. SEPTIC SYSTEM INSTALLER SHALL CONTACT ENGINEER AT TIME OF SEPTIC SYSTEM COMPLETION
190,
A REVIEW OF THE SOIL EVALUATION Al&A2 DATA DATED
MARCH 18,2015 AND CONFERENCES WITH BARNSTABLE HEALTH
STAFF RESULTS IN QUALIFICATIONS BY CAPE COD ENGINEERING FOR SYSTEM CERTIFICATION AS REQUIRED.
14. CONTACT ENGINEER IF ANY QUESTIONS OR DOUBTS ARISE REGARDING SOIL CONDITIONS
INC.: ENCOUNTERED DURING CONSTRUCTION.
C1 LAYER PIERCED BUT LACKING 4 FT.THICKNESS;
C2,C3, INDICATE LESS PERMEABILITY 15. NO KNOWN POTOBALE WELLS EXIST WITHIN 200 FT.OF THE PROPOSED SEPTIC SYSTEM.
4b� "MOTTLING"OBSERVED IN SOIL EVAL.Al&A2 AT THE
BOTTOM OF THE C2 SANDY LOAM LAYER AT THE UPPER LEVEL
cb
OF A SAND LAYER IS A VARIAGETED SOIL COLOR EFFECT LIKELY DESIGN DATA
9,t DUE TO THE SOIL TEXTURE DIVISION BOUNDARY, NOT HIGH HYDRAULIC LOADING-5 BEDROOMS X 110 GPD/BR 550.0 GPD rj'i
4 GROUNDWATER.
A MONITORING WELL W/WELL CAP ELEV.= 17.95 INSTALLED SEPTIC TANK DESIGN
/
Q I ON MARCH 10, 2018.GROUNDWATER WAS FOUND AT EL. 200%X 550 GAL. 1,100 GAL. EXISTING TANK IS INDICATED AS A 1,500 GALLON
HALL CREEK 3.7 THRU 3.8 VIA SEVERAL MEASURMENTS TAKEN THROUGH PRECAST CONCRETE SEPTIC TANK TO REMAIN IN SERVICE. INSPECT FOR
Q) MAP 245 THE PERIOD MARCH 2018 THRU APRIL; REFERENCE WELL CONDITION,PROVIDE REPLACEMENT TEE FITTING ON THE INLET AND OUTLETS
PARCEL 28 (TIDAL CREEK) MIW-29 WELL READINGS FOR THAT PERIOD REQUIRED A ZERO
PLAN VALUE ADJUSTMENT FOR ALL ZONES. THE WELL WAS DRY IN W/OUTLET GAS BAFFLE; PROVIDE LIGHT WEIGHT RISERS AND SINGLE PIECE
EARLY JUNE. CONCRETE COVERS WITHIN 6 INCHES TO GRADE
20 10 0 20 60 A THIRD SOIL EVALUATION WAS COMPLETED BY CAPE COD
ENGINEERING, INC.ON JUNE 6, 2018 SHOWN ON THIS PLAN AS
IL- ST 1. SAS DESIGN
PERCOLATION RATE-5 MPI(CLASS 1)
1 inch = 20 ft LONG TERM HYDRAULIC LOAD RATE= 0.74 GAL/S.F.
SIDE AREA=2(29)(47'+11.09)=232.0 S.F.
BOTTOM AREA= 11.0'X 47'=517.0 S.F.
LOADING: (749.0 S.F.X 0.74 GAL/S.F./DAY)=554.3 GPD
TOTAL LEACHING CAPACITY= 554.3 GPD
*THE DESIGN IS NOT SUITABLE FOR USE WITH A GARBAGE DISPOSAL UNIT
IF UNDER PAVEMENT PROVIDE MED.
DUTY C.I.COVERS TO GRADE
TOP OF FOUNDATION PROVIDE 4*0 VENT
EL. - 19.2± MANHOLE AND COVER-MIN 24"DIA.
RAISE COVERS TO WITHIN 6" 18"DIA. MANHOLE WITH CONCRETE COVER
OF FINISH GRADE AND FRAME BROUGHT TO WITHIN 6* REVISED NOVEMBER 1, 2018 ADD ST Al & A2, CLEANOUT
2*LAYER OF 1/8' DIA. OF FINISHED GRADE W/H-20 RISERS*
FINISH GRADE 18± WASHED STONE OR FAB/RIC FINISH GRADE 18.0± SPECIAL NOTE-THIS PLAN IS SUBMITTED PURSUANT TO THE
MAXIMUM EARTH COVER OF 72 IN.OVER THE SAS,COMPONENTS SHOWING
a. INV.=11.51,� CLEAN BACKFILL
3 C3- AND 15.405.(i) FOR SEIVE TESTING IN LIEU OF PERCOLATION PROPOSED SUBSURFACE SEWAGE
_MINIMUM D-BOX 04
,M aINSIDE DIMENSIONS TOP OUNIT
EL 12.4 TEST FOR THE C2 SOIL 115'± LAYER. DISPOSAL SYSTEM REPLACEMENT
12"x12' 1 H-20'�-� 4 H-20 5
00000®oo as MOOFr7 17-1 AT
=0 ED
r-1
17-117-1=1 17-71 325 GREEN DUNES DRIVE, CENTERVILLE, MA
CL / *
-10 17-10 ED 17-1 ED 17-1 E3=1 r
ASSESSORS' MAP 246,PARCEL 157
0 17117 0 00 0 1711-] 0 0 0 17171171 El 1-]0 0
is as 13s2 --i A PIPES
=3 11.83 ALL 11.66 8.5' BOTTOM OF SYSTEM
3/4*- 1 1/2'DIA. I EL=9.5 PREPARED FOR
DOUBLE WASHED STONE71 I ROBERT CIOLEK
6'OF 3/4'TO
P.O.BOX 89,WEST HYANNISPORT,MA 02672
1-1/2*DIA. STONE COMPACTED BASE D-BOX 47'
BELOW TANK W/6-LAYER OF
CRUSHED STONE (H-20) LINE(S)EXITING D-BOX MUST EXIST, SEPTIC TANK TO REMAIN OCTOBER 10, 2018 SCALE -AS NOTED
REMAIN LEVEL FOR 2!-0"
TYPICAL LEACH SYSTEM CROSS SECTION
BEFORE PITCHING DOWN TO RE
PRECAST REINFORCED CONCRETE LEACHING FACILITYOR ROBER
NOTE: CAPACITY: 1500 GALLONS PROVIDE SPEED LEVELS* NO SCALE M. P PARED BY
o CAPE COD ENGINEERING, INC.
PERRY
ALL PIPE TO BE 4" DIA. SAS CONSTRUCTION, 5 PRECAST 500 GALLON DRYWELLS(H-20 RATED)AS MANUFACTURED BY SHOREY CIVIL ROBERT M.PERRY,P.E.
PRECAST, INC. OR APPROVED EQUAL, SET END-TO-END IN A 11 FT. WIDE X 47 FT. LONG EXCAVATION TO .35880
PVC TIGHT JOINT WITH SEPTIC SYSTEM PROFILE THE DEPTH AND ELEVATIONS SHOWN,SURROUNDED BY DOUBLE-WASHED 3/4 TO 1-1/2 INCH GRADED P.O.BOX 1517
TANK SHALL BE
MINIMUM SLOPE OF 1/8- EVALUATED WHEN NEW GRANITE STONE TO THE ELEVATION SPECIFIED ON THE CROSS SECTION. SAS FACILITY SHALL BE COVERED O/STV- EAST DENNIS,MA 02641
PER FT. CONNECTION IS MADE NO SCALE WITH SUITABLE GEOTEXTILE FILTER CLOTH AS A SUBSTITUTION FOR THE 2 INCH PEASTONE COVER LAYER. / ECG
TEL:508-385-1445
CIOLEK.DWG