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HomeMy WebLinkAbout0093 PHEASANT WAY - Health 93 Pheasant Wad Centerville F A 228 135 i No. 42101/3 ORA Qu OR 1000 'C7 © 0 m O { 1 .fir -�-� .._ .�.. �� .� -. 1 0 a r t 7 `7 I �- 3 COMMONWEALTH OF MA' SSACMUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION TITLE 5 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 93 Pheasant Way Centerville MA 02632 Owner's Name: Paul Sklareiv Owner's Address: Date of Inspection: .� p October 20;2.. Name of Inspector: (Please Print) Janres M.Ford Company Name: Jhnies M. Ford Mailing Address: P.O. Box 49 Osterville,MA 02655-0049 Telephone Number: (508) 862-9400 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 the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systeiris. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: ✓' Passes nditionally Passes eds Further Evaluation by the Local Approving Authority r'a is h ... Inspector's Signature: Dater October 31,2012 The system inspector shall subs i a copy of this inspection report to the Approving Authority(Board of Health or DEP)within.30 days of complet ig this inspection. If the system is a.shared system or has a design flow of 1.0,000 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. 1 :.< L I,,c: t Notes and Conrnents ****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. ¢ Title 5 Inspection.Form. 6/15/2000 page 1 I,_ x Page 2 of 11 a OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS i SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: _ 93 Pheasant Way Centerville MA Owner: Paul Sklareiv Date of Inspection: October 26 2012 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D y J A. System Passes: ✓ I have not found any information which indicates that any of the failure criteria described in 310 CMR " j .15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B. System Conditionally Passes: is l One or more system components as described in the"Conditional Pass" section need to be replaced or repaired. The system,upon completion of the replacement or repair,as approved by the Board of Health,will pass. Answer yes,no or not determined(Y,N,ND)in the for the following statements. If"not determined",please explain. . The septic tank is metal and over 20..years old* or the septic tank(whether metal or not)is structurally " unsound,exhibits substantial infiltration.or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is"replaced with a complying septic tank as approved 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. ND explain: e � ' t` Observation of sewage backup or broak 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 obstruction is removed distribution box is leveled or replaced ND explain: The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board.of Health): broken pipe(s)are replaced obstruction is removed NN ND explain: 3 2 f r; I: Page 3 of I'1 +, k OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS 1 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) 1, Property Address: 93 Pheasant FVav Centerville MA Owner. Paul Sklarew Date of Inspection: October 26 2012 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 j system, is not functioning in a manner which will protect public health,safety and the environment: i r i 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 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. > > +: iiThe system has aseptic tank and SAS and the SAS is within a Zone 1 of a public water supply. E f.. The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. t' 1',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 coliforn bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of annmonia 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 forn. I 3. Other: i 3 Page 4 of I'l I' OFFICIAL INSPECT ION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 93 Pheasant way j Centerville MA Owner: Pacrl Sldar•ew Date of Inspection: October 26 2012 j D. System Failure Criteria applicable to all systems: You must indicate either"yes"or"no"to each of the following for all inspections: F Yes No,! ✓ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool j ✓ Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or j clogged SAS or cesspool ✓`'° Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS.oi cesspool ✓ Liquid depth in cesspool is less than 6" below invert or available volume is less than%day flow .S Required pumping more than 4 times in the last year NOT due to clogged or obstructed i e s . Number of titres pumped gg p p ( ) t'; .,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 coliform bacteria and volatile organic compounds indicates that the well&free from pollution from that facility and the presence of ammonia P r 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.] No (Yes/No) 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..System:. To be considered a'large system thesystehi must serve a facility with a design flow of 10,000 gpd to 15,000 I gpd r. You must indicate either"yes"or"no"to each of the following: (The following criteria apply to large systems in addition to the criteria above) 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 systein owner should contact the appropriate regional office of the Department. 4 Page 5 of lRl -OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: —93 Pheasant°TVav " " Centerville MA Owner: i'i Paul Sklarew Date of Inspection: October 26 2012 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 t ✓' Were any of the system components pumped out in the previous two weeks? ;j ✓ Has the system received nonnal 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 comppnents,excluding the SAS,located.on site? Were the septic tank`.manholes uncovered,opened,and the interior of the tank inspected for the condition of th e baffl es or tees ,. of construction dimensions,depth of liquid,depth of sludge and depth of scum? ✓ Was the facility owner(and occupants if different from owner maintenance of subsurface sewage disposal systems? )provided with information on the proper The size and location of the Soil Absorption System(SAS)on the site has been determined based on: Yes No e i ✓ 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(3)(b)']. ' . r `+ 1 ,D 5 F l.. r Ji �. Page 6 of l lt, ' OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 93 Pheasant Tfav 't Centerville kA Owner: Paul.Sklareiv Date of Inspection: October-26 2012 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): 5 Number of bedrooms(actual)- 4 DESIGN flow based on310 CMR 15.20.3 (for example: 110 gpd x#of bedrooms): 550 Number of current residents: 0 Does residence have a garbage grinder(yes or no): N/a i Is laundry on a separate sewage system(yes or no): N/a [if yes separate inspection required] Laundry system inspected(yes or no): no Seasonal use(yes or no): no Water meter readings,if available(last 2 years usage(gpd)): Unavailable Sump Pump(yes or no): No Last date of occupancy: Unknown COMMERCI..A INDUSTRIAL Type of establishment: Design flow(based on 3,10 CMR 15.203) ' gpd Basis of design flow(seats/persons/sq/ft etc:): i Grease trap present(yes or no): Industrial waste holding tank present(yes of no) j Non-sanitary"Waste:discharged to the.Title'5 system(yes or no): Water meter readings,if available. Last date of occupancy/use: OTHER(describe): GENERAL INFORMATION Pumping Records Source of information: Unknown Was system pumped as part of the inspection(yes or 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` a;_. . Shared system(yes.or no) (if yes,_attach previous inspection records,if any) Imiovative7Altemative technology.,Attach a copy of the current operation and maintenance contract(to be obtained.from system owner) Tight Tank: Attach a copy of the DEP approval Other,(describe): Approximate age of.all components,date installed(if known)and source of information: Date of installation 8/25/2005 per as-Guilt card Weie sewage odors detected when arriving at the site(yes or no): No 6 k• Page 7 of l l 1 OFFICIAL INSPECTION FORM -NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) i Property Address: 93 Pheasant Tfav Centerville MA Owner: Paul Sklareiv Date of Inspection: October 26 2012 BUILDING SEWER(locate on site plan), Depth below grade: I Materials of construction: _cast iron _40 PVC other(explain): Distance from private water supply well or suction lice: Comments(On condition of joints,venting, evidence of leakage,etc.): SEPTIC TANK: ✓ (locate on site plan) i i Depth below grade:' •25 q r Material of construction: ✓ concrete in fiberglass _polyethylene _other(explain) If tank is metal list age: Is age confirmed by a Certificate of Compliance(yes or no): certificate) (attach a copy of I. Dimensions: 1560 gal. u Sludge depth:.'1 2„ Distance from top of sludge to bottom:ofoutlet tee or baffle: 30" 1 Scum thickness ..Distance froinito'p of scum to top of outlet.tee or baffle: 6" Distance from bottom of scum to bottom of outlet tee or baffle: 101, How were dimensions determined: - Measuring stick Continents(on piiniping recommendations, inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert, evidence of leakage,etc.). I' The tees~ver e resent: The li uid level was even with the outlet invert. There did not appear to be any.sigans of leakalae. The outlet coi&•i•i�as 2"below rade., I rr ; A GREASE TRAP: lNone (locate on site;plan) Depth below grade.- Material of construction: _concrete _metal _fiberglass _polyethylene _other (explain) ( ° :::i'f: v Dimensions: Scum thickness: : lr_: Distance from.top•of scum to top of outlet tee or baffle: Distance from bottom of scum to bottoin.of outlet tee or baffle: Date of last pumping: Continents(oil pumping reconunendations, inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet,inyert,evidence of leakage;etc.): 7 n 9 1 Page 8 of 11 'j OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 93 Pheasant Way j Centerville MA Owner: Patil Sklarew Date of Inspection: October 26 2012 y TIGHT or HOLDING TANK: None (�ark must be pumped at time of inspection) (locate on site plan) Depth below grade: Material of construction: .._concrete =metal _fiberglass _polyethylene _other(explain): Dimensions: II Capacity: gallons Design Flow: gallons/day, Alarm present(yes or no): Alarm level:. Alarm in working order(yes or no): Date of last pumping: Conunents(condition of alarm and float switches,etc.): DISTRIBUTION BOX: ✓ (if present must be opened)(locate on site plan) Depth of liquid level above outlet uivert: Even Comments.(note if box is level and drstiibution to outlets equal,any evidence of solids carryover,any evidence of leakage into or out of box,etc.): The D-Bo bias nwrinal. , PUMP CHAMBER: None (locate on site plan) Pumps in working Girder(yes or no): Alarms in working.order(yes or no)... Comments'(note condition of pump chamber,condition of pumps and appurtenances,etc.): Y. [ 1 p 1 8 - -r 3 t i,•n ;; 1 � ,e C i Page 9 of I I OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM j I; PART C I SYSTEM INFORMATION (continued) Property Address: 93 Pheasant Way Centerville MA Owner: Paul Sldarew Date of Inspection: October 26 2012 SOIL ABSORPTION SYSTEM(SAS): ✓ (locate on site plan,excavation not required) If SAS not located explain why: w Type leaching pits,number: ✓ Teaching chambers,number: S.-500 gal. chambers Per as built leaching galleries, number: leaching trenches, number, length: leach,q'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.): 77rer•e did not aPpear to be an,si its of failure. A camera was used or the ins ection.. CESSPOOLS: None (cesspool must be pumped as part of inspection)(locate on site plan) Number and configuration: Depth-top of liqu44 id.to inlet invert: Depth of solyds.layer: Depth of scum;layer:. Dimensions.of cesspool: Materials of consn-uction: Indication-of-groundwater inflow(yes or-no);' Comments (note condition of soil;signs-of lydraulic failure,level of ponding,condition of vegetation, etc.): PRIVY: Noiie'''(locate on site.plan) Materials o6 h'-struiction: r ' Dimensions. Depth of solyds Conunentg(note'condition of soil, signs of Hydraulic failure,level of ponding,condition of vegetation,etc.): n r I- 9 j Page 10 of 11 A OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C i f § SYSTEM INFORMATION (continued) Property Address: 93 Pheasant YVav Centerville M� Owner: Paul Sklareiw ` Date of Inspection: October 26. 2012 II' i SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benclimarks. Locate all wells within 100 feet. Locate where public water supply enters the building. .4 i i till + I 4,}, 1 � •I-1 \� I 3 o Y o o S a 3 a3 3 13Q- 3s- Y 36 lag • 10 5 � i Page 11 of l l OFFICIAL INSPECTION FORM- NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM. PART C SYSTEM INFORMATION (continued) 4 Property Address: 93 Pheasant TVav Centerville MA Owner: IPaul Sklarew Date of Inspection: October 26 2012 SITE EXAM Slope . Surface water Check cellar Shallow wells Estimated depth to ground water 18+1- feet Please indicate (check) all methods used tq determine the high ground water elevation: Obtained from system design plans on record- If checked, date of design plan reviewed: Observed site(abutting property/o'bservation hole within 150 feet of SAS) j ✓ Checked with local Board of Healih-explain;_ Topogaprhic and water contottrs maps ! Checked with local excavatOrs,;ins,tallers-(attach documentation) Accessed USGS database-explain:: You must describe how you established the High ground water elevation: ti sc i - UsingBar astable topographic and water''contours maps, the.nzaps were showing approximately 18 +/ to ground water at this site. 211 e This report has been prepared only for the septic system and components described herein. This septic system has been inspected and passed as of,the.date of inspection. This report is not a warranty or guarantee that the system will 1 function properly in the fttttu e,.There have been no warranties or guarantees, either expressed, written or implied, relating to'theseptic system, the inspection, this report and/or any components of the septic system which have not been,located and inspected x-d f ((�� AtALAAES TOWN OF BARNSTABLE LOCATION "13 SEWAGE# VILLAGE CQAr#iCV L� ASSE SOR'S MAP&PARCEL INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY S LEACHING FACILITY:(type) S- S'Up GA' (size) NO.OF BEDROOMS J OWNER S UACU,I PERMIT DATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet FURNISHED BY G6r1 'Fo rJ 10 ,(, �� (UL Q 0 1 a- Q ► 3(o 3 ° 10 ° S a 31 a3 3 y 3G , a9 .' TOWN OF BARNSTABLE i i v Vh l JO C,Al.A47�14/1�b SEWAGE # VTd:LAGE CPii ��/ ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO SEPTIC TANK CAPACITY 1,0 0 C Fx LEACHING FACILTf'Y: (type) �066B�Cy9�lt Cam) (size) NO.OF BEDROOMS J� BUILDER OR OWNER PERMITDATE: 23'0J`r 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) ;r= '' Feet Furnished by ;, A � g a a 1 - 36 - A►a - d8 Bi 4 3� e 3 - ca A5 0191. ab'6 ' �� A No. ®J 13 �rJGC� go BSA Fee HE Cr MIYWEALTH OF MASSACHUSETTS Entered in computer: iIA Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACrUSETTS ZIPPYicatton for �Dtoonl *r5tem Cou5trurtton Vertu Application for a Permit to Construct( )Repair(1/jUpgrade( )Abandon( ) El Complete System El Individual Components Location Address or Lot No. 3 Owner's Name,Address dd Tel.No. Assessor's Map/Parcel CE�vTiPiP(ei//E C{ 'As� b,A7 h �� 6/ olas 35- Installer's Name,Address,and Tel.No. Lae Designer'�-s N ne�Address and Tel.No. �t2�c6 �IACALLIJ(E2 vA-4 �r�CtAerr" O ST QV'i ��' e-ssaq Type of Building: Dwelling No.of Bedrooms_�� Lot Size sq.ft. Garbage Grinder(Wf Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow S5,0 gallons per day. Calculated daily flow gallons. Plan Date O Number of sheets Revision Date —/ -015 Title Size of Septic Tank DO 69 —X 13 %iXr6 Type of S.A.S. c GH - Ch'9t%W) Description of Soil 3 Ac—X� Nature of Repairs or Alterations(Answer when applicable) -: t� DIJ 7, Vff l ' v i-,477J �JI GG 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 issi by this o f Health Signed Date "QJ Application Approved by Date Application Disapproved f e following reasons Permit No. U W Date Issued 4 vo.' E — /3 cif \:✓ �� �� ASS Fee QC� i . t. _, •' - - THE CiMMOINWEALTH OF MASSACHUSETTS Entered in computer. Yes PUBLIC HEALTH DIVISON - 'OWN OF"BARNSTABLES MASS,�ACNUSETTS r Xr-1 2pprication for Migoar *pttem Congtruction Permit Application for a Permit to.Construct( )Repair(k5lupgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address of Lot No. 93 Owner's Name,Address and Tel.No. Ct",,(Ti`1Pt1;fI_F ICr��thw hc�l� 568 _ Assessor's Map/Parcel Lv A-j aa8 j3S Installer's Name,Address,and Tel.No. ' Designer's Name,Address and Tel.No. "�2uc�s �"IF1c6LLIST62 Sv1��vr1�l F,\C� \err .vs O.`.�T i2Vr LLB L4.IB-ss)9 pslm�v,l\� Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder(^�' Other Type of Building No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow s�d _ gallons per day. Calculated daily flow gallons. Plan Date L(- �-( -O S Number of sheets Revision Date -/ 7-' OS Title Size of Septic Tank /SOQ 66 -x 1)%iAr6 Type of S.A.S. S�$�6H CHAw��3�2) = S Description of Soil m s 0- j Nature of Repairs or Alterations(Answer when applicable)_1 ,3/ .5 -1 oo 66 • )VAm e1 l Date last inspected: Agreements 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 iss e by-this ogr , f Healt� , Signed ri Date _ Appl;r_,atinn,Apinr,�.,ed by .... '14 Date Application Disapproved f the following reasons Permit No. u - �l Date Issued k-- 3- "s THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS (Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sev ge Disposal System Constructed( )Repaired (!/Upgraded( ) Abandoned( )by S Ho fc rr 1 I t- �- Cc,<u S 1 at ��ey5 A,�'T Lv n�. C F)LfTrz-2,, 1117 has been constructed in accordance with the provisions of Title 5 and the fo isposal System Construction Permit No. Ut, / datgd �-,�;,�-a.S Installer �� The issuance of this permits all not be construed as a guarantee that the syste will c'o as designed. Date c:J � Inspector No. P w S `7>/3 Y Fee JG THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLES MASSACHUSETTS Migoml *p!5tem�ongtruction 30ermit Permission is hereby ranted to Construct( )Repair( ✓)Upgrade( )Abandon( ) System located at '?J t-r�1 ^ C ENTH ,?✓aI L E and as described in the above Application for Disposal System Construction Permit. The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided: Construction must be completed within three years of the date of thi pe it. Date:_ �' -0 s Approved by , Town of Barnstable A167 �1 Board of Health 200 Main Street, Hyannis MA 02601 Office: 508-862-4644 Susan G.Rask,R.S. FAX: 508-790-6304 Sumner Kaufman,MSPH Wayne Miller,M.D. July 11, 2005 Mr. Peter Sullivan, P.E. Sullivan Engineering, Inc. P.O. Box 659 Osterville, MA 02655 RE: F 93. .heasant,Way, Centervi le A 228=9 35 `. Dear Mr. Sullivan, You are granted conditional variances on behalf of your client, Martha Kelly, to construct a replacement onsite sewage disposal system at 75 Pheasant Way, Centerville. The variances granted are as follows: Section 360-1, Town of Barnstable Code: To install a soil absorption system 75 feet away from a bordering vegetated wetland, in lieu of the required 100 feet separation distance. These variances are granted with the following conditions: (1) No more than five (5) bedrooms total 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 septic system shall be installed in strict accordance with the revised engineered plans dated June 15, 2005. (3 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 revised plans dated June 15, 2005. SullivanKelly2005 These variances are granted because the physical constraints at the site severely restrict the location of the soil absorption system due to the close proximity wetlands. Sincer y yours, Way a Mill r, M.D. Chai man SulfivanKelly2005 l— FEE:Au, av uxxsraBM L mass �Ar16 39. p� RE C. BY fB Town of SCHED. DATE: S r Board of Health 200 Main Street,Hyannis MA 02601 Office: 508-862-4644 Susan G.Rask,R.S. FAX: 508-790-6304 Sumner Kaufman,M.S.P.H. Wayne A.Miller,M.D. VARIANCE REQUEST FORM LOCATION Q,2✓ p Property Address: / 1 head art z day. &ne7,kn//wa Assessor's Map and Parcel Number: Size of Lot:p acrc Wetlands Within 300 Ft. Yes Business Name: No Subdivision Name: APPLICANT'S NAME: f r a, ' g_ &� Phone _ Did the owner of the property authorize you to represent him or her? Yes No PROPERTY OWNER'S NAME CONTACT PERSON Name: I�1(fM40_ /�i'JIV Name: 106�er 13 Ph Pam_ .77ic Address: rN eY t'Vt lI r I-27 4. OQ G Address: 7 A-rKr,r J�t� Phone: _ 0�� ��J�—J��1 Phone: CSI!'Vj�l e' 50e- Y-Ze-33 qY VARIANCE FROM REGULATION(t.iM Rcg) REASON FOR VARIANCE(May attach if more space needed) mow" O-A ��d 0� S�" c. ►nlct Arh'cb l. L O ea; '67[ O� rn/ /7l✓7'�1'T NATURE OF WORK House Addition [] ????? House Renovation 0 Repair of Failed Septic System 0 Checklist (to be completed by of .lice 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) Four(4)copies of labeled dimensional floor plans submitted(e.g.house plans or restaurant kitchen plans) _✓ Signed letter stating that the property owner authorized you to represent him/her for this request 4SS Applicant understands that the abutters must be notified by certified mail at least ten days prior to meeting date at applicant's expense (for Title V and/or local sewage regulation variances only) Full menu submitted(for grease trap variance requests only) C:\Documents and Settings\decollik\Local Settings\Temporary Internet Fi1es\0LK3\VARIREQ.D0C 1 May 4, 2005 Town of Barnstable Board of Health 200 Main Street Hyannis, MA 02601 RE: 93 Pheasant Way, Centerville Dear Board of Health, As owner of the above referenced property, please be advised that John O'Dea or Peter Sullivan of Sullivan Engineering, Inc. has my permission to represent me before your board in all matters relating to the septic system at my home. Sincerely, ni AA:77 . Martha Kelly ,r.oyv.n of Barnstable U Re gjatorN Serv.ices Thomas F. Geilerj Director BARNSTABLE DiN,ision Public Health. MASS ,'r)) ( , "" Thomas Njc Kean, Director 9. Hyannis, NIA 02001 200 Main Street, a x: 508_S(,2-4644 Installer Certification Form & De si n P U Certification 1 1 Date: V_ L)esiguer: s.,ddress, --- vtdress* CAS_ irry c—, e, I'SSUed rn-i a pe 't 10 install a was On (date,) s (ad �y A- based on a design d ra�t'n by vstern at dated (designer) �js I'Vy that the septic 'oil of lht- ,,,stejjj referenced ahove W I ccrt approved changes such as lateral relocation the design, which may include minor distribution box and.lor septic tank. ur changes (!.C, t. that the septic S'yslern rei'erenced above was installed pith cha I cern c, oil oj-any componc, Ureater than UY lateral relocation 011 the S*AS of any Regulations.I ons. Plan.n revision ul- of the septic system) but in accordance with State & Local Reg certified as-built by designer to follow. %OF PETER SUWVAN N 9733 0.2.R VM 17 CIVIL 4 1 sta ler's Signature) CIVIL {Affix Stamp Here.) {Designer s Signature) PI.F-xSE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF C'0N1FLIAi's'10E WILL NOT BE ISSUED UNTIL BOTH THIS FOR_NzI AND AS- ]VISION. BUILTCA" ARE RECEIVED B7-T-11E B?vRNSTABLE PUBLIC THA, K YOU. Heajth septic.i)esignei cerificatiol, t;­m SULLIVAN ENGINEERING INC. 7 PARKER ROAD/P O BOX 659 OSTERVILLE, MA 02655 Peter Sullivan P. E. Mass Registration No. 29733 psullpe@aol.com phone 508-428-3344 fax 508-428-3115 June 15, 2005 Thomas McKean, Director Town of Barnstable Board of Health 200 Main Street Hyannis, MA 02601 RE: 93 Pheasant Way, Centerville Dear Mr. McKean, Please find attached copies of a revised septic plan for the above referenced property. As requested by the Board of Health at their Public Hearing on June 14, 2005, the plan was revised to move the leaching area to achieve a 75 foot set back to wetlands. We were able to achieve this without a need for any other variance. I trust this meets your present needs. Ve truly yours, 0 Peter Sullivan PE CD zre Sullivan Engineering Inc. G Cc: Peter Kelly �n a -v ca Crn cn m Members of American Society of Civil Engineers, Boston Society of Civil Engineers �3 z--C�\ tovo\� .101 OOS CAL 4 1 r� CA VI\rN------------------ v �`' l A-D TOWN OF BARP,:TA.5',L E P D I v IF C'�'� W�apio- � ell- Pi fY i I 0 ui NI Urivi NO, 170E T_^ - T0)N t of 5 A R Ntz �iN I 3 i N i i 0C`A, 10N SEWAGE PERMIT NO. ILLAGE� INSTA L ER'S NAME ADDRESS LA a 6, 4q R U I L D E R OR OWNER I ' I DATE PERMIT ISSUED DAT E COMPLIANCE ISSUED I 3 tow o r NoAJ—/��� THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HE H l - 1 ................OF...........-............... ............. A11VIiration for Binpoott1 Workii Tonitrnrtion VarA t Application is hereby made for a Permit to Construct ( ) or Repair ( ) � Individual Sewage, osal System at .......... 3.... �.. ._..._.... - .....__ - - -- .................. ��2h Locatio ess Lot No 4 ^• ..._ aC_____________••• wner 17 Address ..... _-----_---•----................ ,'. .. ......................................... Installer Installer Address Type of Building Size Lot............................Sq. feet. Dwelling—No. of Bedrooms................................._____------Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ....___..................... No. of persons......................_..... Showers ( ) — Cafeteria ( ) dOther fixtures .........---....................................................................................... W Design Flow............................................gallons per person per day. Total daily flow......................................-.....gallons. WSeptic Tank—Liquid capacity............gallons Length................ Width................ Diameter................ Depth................ Disposal Trench—No_____________________ Width.................._. Total Length.................... Total leaching area....................sq. ft. Seepage Pit No..................... Diameter......._............ Depth below inlet.................... Total leaching area........._........sq. ft. Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by.............................................-.......................--_.. Date........................................ . Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 44 Test Pit No. 2.........._.....minutes per inch Depth of Test Pit.................... Depth to ground water........................ ----------............-.........•.......................--.......................................--............................_.........-................ 0 Description of Soil...................................................•..........................................................................._.....................•................... W U .............................................-........................................-.................................................................................................................. W ............ ------ ---- ------•-----------•-----•----•--•-•----------------•--------•--...--•--- U Nature of Repairs or Alterations--Answer whe applicable_--.._...-_ -___-_,15 � -: a ..--- - � ••-� `Tlbw-----.-.��. .--. .....-......dam=--•-•--........f/I�..-v2 X---f Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System.in accordance with the provisions of TITLE 5 of the State Sanitary Code—.The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued b the b000f health. Signed-_�s�� Date zf A lication A roved Br- ?:..---•-- •.............................•---.......---.... t-.2............... �. Application Disapproved for the following reasons---------------•------------------------•----•---------... =-------•------.....-----------Date---...._...... -------------•-•-•---...._.....__...--------••--------...--•--------••--------------•----..._..--------.._...._._..--------•-- = E Date Permit No.............. .............. Issued - - Date No............. ........... Fss............._............_ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF H!, � 0 F � . Appliratiun for DisVosal Works Tonotrnrtiun V.erntit Application is hereby made for a Permit to Construct ( ) or Repair ( 4j an Individual Sewage Disposal System at: • ='• .......... ? ••---.....- -- _-------••-•-........... ............ ........................ •,,� Locat�o� ess � ,r'�� ��Lot•No. .._.� q .�' '�+,''.Lrd' s caner f Address ._...y1:2, -------------------------------- ..... Installer Address Type of Building Size Lot............................Sq. feet 1—, Dwelling—No, of Bedrooms.......................:....................Expansion Attic ( ) Garbage Grinder ( ) Other—Type of Building ---------------•---••---•--• No. of persons............................ Showers ( ) — Cafeteria ( ) dOther fixtures ----------------------------------•------------------•-----------•-------•-.._..-----------••---•-...---•--••--•--•-•-----•-•-•-••-•--••••••--••-•-- W Design Flow............................................gallons per person per day. Total daily flow............................ ._._..----------gallons. WSeptic Tank—Liquid capacity............gallons Length................ Width................ Diameter................ Depth................ x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) 0.4 Percolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. I................minutes per inch Depth of Test Pit......:............. Depth to ground water........................ 44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ P4 ••--'-•------•------------•-••---•..............••••----'-......••••---••••••-•-•-•----------'-•••••........................................................ 0 Description of Soil............................................................••--•-•----•-•-•---•--------------------....----------...------......-•-----•-----------•---•--•••••'•-•••-- x U ••-•--•-••--•---•.................••--•-•--..._....--•'-----•--•'----•--'-........•-•----•-----------•-'•---•---•---'--••'•••-•--•-•-----'--•---••----------..............-•••-•-'-----••-•......_...... UW ----•---•------ --- . . ----------•- • ------•-------------------•--•--•-•-...----••••'---. .................. � Nature of Repairs or Iterations--Answer whet applicable ._._. " ._........ ' _._. J( g / / .- �' '��''�1: , ........... ./-- -}.... S. iTf :....---------------•----------------- ----------_____-_------ Agreement. The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE, 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued the board of health. II ;�i�i77 Signed-- �' '_......__.._c�' ^• - 'a _'"'s ...................... Date Application Approved By"-•••-••. A..` ; `"�""- Date Application Disapproved for the following reasons-------------------------••-•----•-•-------------------------...------......-----•------------•-•...-••.......... _.......•------------•--•----•--.._._...--•-••----•-----•••--•-------------------•----•-----••----•-...--'---._..........---•-••-•---------------•-----------------------...---••-----••••--'-•-...------ Date PermitNo.............._cam_'__"_�'--' y .-•-------... Issued........................................................ Date THE COMMONWEALTH OF MASSACHUSETTS BOARD Off, HEALTH c .^../ ...........OF..... .., ...:......................... Trrtif iratr of TomVliaurr THIS I TIFYat the Individual Sewage Disposal System constructed ( ) or Repaired by _ ! . = ------; ---•-•-_ --------- er at ._...._...±'� "X - ---------------- -CG •--- - has been installAd in accordance with the provisions of Tt 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No...... ....................... dated------- ,.1.1.:?.1�` THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CON TRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. \� .................j DATE.....---•-_..�.._----'-��.. .....---- Inspector....-••• ` .. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH Il � ! a0.1"..... ..t...........OF......., ....... Q No._.. FEE_rf.---.....: . irrttl (tons nrtinn rrrmit Permission is hereby granted..------ !' ACV'........ ................................................................... to Construct ( ) or Re air ( �an dividual S wage Disposal System atNo..... S......I � n ......................... Street as shown on the application for Disposal Works Construction Permit No. _ 1_"r Dated.... ,/ ......... DATE_ Board of Health FORM 1255 A. M. SULKIN, INC., BOSTON t r Sullivan Engineering Inc. 7 Parker Road Box 659 Osterville MA 02655 Peter Sullivan P.E. Mass. Registration No. 29733 phone 42&3344 fax 42&3115 e-mail:PSUPE@aol.00m ABUTTER NOTIFICATION LETTER RE: Board of Health Public Hearing To Whom It May Concern: As a direct abutter of a proposed project, please be advised that a Variance Request has been filed with the Town of Barnstable Board of Health. The specific project information is as follows: Applicant : Martha Kelly Project Location: 93 Pheasant Way, Centerville Assessor's Map and Parcel: Map 228 Parcel 135 Project Description: Proposed upgrade of a failed septic system. A variance is required to the Town of Barnstable Chapter 360 On Site Sewage Disposal Systems Article 1: Location of Components. 100 foot separation required, 71 feet provided. Applicant's Agent: Peter Sullivan, P. E. Sullivan Engineering Inc. 7 Parker Road Osterville, MA 02655 Public Hearing: Location: Barnstable Town Hall 367 Main St., Hyannis 2nd Floor Conference room Date: June 14, 2005 Time: 7:00 PM Plans and the application describing the proposed activity are on file at the Board of Health office, 200 Main Street, Hyannis and at Sullivan Engineering's offices. Please call if you have any questions regarding this application. °FTHE t°k� Town of Barnstable Regulatory Services BARN 3TABLE, * Thomas F. Geiler,Director MAss. g i639• �� Public Health Division rFD MA't A Thomas McKean,Director 200 Main Street, Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Martha H. Kelly March 1, 2005 93 Pheasant Way Centerville,Ma. 02632 NON-COMPLIANCE WITH STATE ENVIRONMENTAL CODE TITLE V. The septic system owned by you located at 93 Pheasant Way Centerville was inspected on, 5/l/2002 by James D. Sears a Massachusetts licensed septic inspector. The inspection of your septic system showed that your system has failed under the:guidelines of 1995 TITLE 5 (310 CMR 15.00) due to the following: ! Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspouL Our records show that the system has been in a failed state for more than two years. You are ordered to hire a professional engineer or registered sanitarian to prepare!a.plan�.of proposed replacement septic system component(s). This plan is to be submitted.Jo. the•:T"oVM,:of, Barnstable Public Health Division Office (Regulatory Services,200 Main Street, Hyannis);within (90) days receipt of this letter. The plan will bring the septic system into compliance with 310 CMR 15.00,The State Environmental Code, Title V. You are a lso o rdered t o u pgrade o r r eplace t he s eptic s ystem w ithin s ix months (180) days o f y our receipt of this letter. Any person aggrieved by any order issued by the local approval authority may appeal to any c ourt o f competent jurisdiction as provided for by the laws of the Commonwealth. You have the option of requesting an adjudicatory hearing pursuant to 310 CMR 15.422 Failure to comply with this order will automatically result in a public hearing scheduled before the Board of Health. F BOARD OF HEALTH ornas A. McKean, R. ., Agent of the Board of Health CC: Board of Health 1/failed—septic—letters COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE.OF ENVIRONMENTAL AFFAIRS a DEPARTMENT OF ENVIRONMENTAL PROTECTION FAILED INSPECTION TITLE 5 OFFICIAL INSPECTION:FORM-NOT FOR VOLUNTARY AS . ED. SUBSURFACE SEWAGE DISPOSAL SYSTEM F R PART A CERTIFICATION MAY 0 6 2002 , TOWN OF BARNSTABLE Property Address:. !: )ce HEALTH DEPT. mvllp ,4 Owner's Name: Owner's Address: > Date of Inspection: , V. AP 22 5.35 Name of Inspect r: please print) r• �® Company Name. C Mailing Address: `7 Telephone Number: fpQ$ 7 c3C?� CERTIFICATION STATEMENT 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 maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: Passes Conditionally Passes /Needs.Further Evaluation by the Local Approving Authority. ails Inspector's Signature: Date: ! 10 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 ofthe. DEP.The original should be sent to the system owner and copies sent to the buyer, if applicable,and the approving authority. Notes and Comments ****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. Title 5 Inspection Form 6/15/2000 page l ,E t t Page 2`of 1 l OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) TU Address' A9 P Y h,4121 owner:. Date of Inspection: o Inspection Summary: Check A,.B,C,D or E/ALWAYS complete all of Section D A. System Passes: I have not found any information which.indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist.Any-failure criteria not evaluated are indicated below. Comments: 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. Answer yes,no or not determined(Y,N,ND)in the for the following statements. If"not determined"please explain. The septic tank is metal and over 20 years old* or the septic tank(whether metal or not)is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a..complying septic tank as'approved by the Board of.H.ealth. *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. ND explain: 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 obstruction is removed distribution box is leveled or.replaced ND explain: The system.required pumping more than'4 times a year due to broken or obstructed pipe(s).The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction.is removed ND explain: 2 Page 3 of 1'l OFFICIAL INSPECTION.FORM -NOT FOR VOLUN.TARY'ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued). Property Address: Owner: Date of Inspection: 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 mannerwhich.will protect public health,safety and the environments _ 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 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 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,provided that no other failure criteria are triggered.A,copy of the analysis must be.attached to this form: 3. Other: 3 r Page 4 of 1 l OFFICIAL..INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: A Owner: Date of Inspection: D. System Failure Criteria applicable to all systems: You must indicate"yes",or"no"to each of the following for all inspections: Yet/ 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'%Z day flow Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number / of times pumped _ i/ 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 I of a public well. I Any portion of a cesspool or privy is within 50.feet of a private water supply well. i 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 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, provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form.] _)�O(Yes/No)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 1be system must serve a facility with a'design flow of 10,000 gpd to:15,000 gpd. You must indicate either"yes"or"no"to each of the following: (The following criteria apply to large systems in addition to the criteria above 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. 4 Page 5 of 1.1 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGEbISPOSAL SYSTEM INSPECTION`F.ORM :p.ART.B CHECKLIST Property Address: A Owner: "' Date of Inspection: 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 fi 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) I/^_ 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 e of the baffles or tees, material of construction,dimensions,depth of liquid,depth.of sludge and depth of scum?,. p _✓ 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: Yes no �/ 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(3)(b)]. 5 . Page.6 of 11 OFFICIAL-INSPECTION-FORM—.NOT..FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM[INSPECTION FORM PART C SYSTEM INVORMATION Property Address: • Owner:. Date of Inspection: FLOW CONDITIONS RESIDENTIAL Number of bedrooms.(design):-.jam Number of bedrooms(actual): J5 DESIGN flow based*on 310 Cv1R 15.203 (for example: 11:0 gpd x#of bedrooms): Number of current residents: Does residence.have.a garbage grinder(yes or no_-;,� Is laundry on a separate sewage`system (yes or iro): (.if yes separate inspection required] Laundry system inspected(yes or no Seasonal use: (yes or no);/ .. Water meter readings; if available(last 2 years usage(gpd)): Sump pump(yes or n ): Last date of occupancy: COMMERCI UINDUSTRIALL/'"" Type of establishment:.. Design flow.(based on 310 CMR.15.203): gpd - Basis of design flow(Seats/persons/sgft,etc,): Grease trap present(yes or no): Industrial waste holding tank present(yes or no): Non-sanitary waste discharged to the Title 5 system(yes or no):- Water meter readings, if available: Last date of occupancy/use: OTHER(describe): GENERAL INFORMATION Pumping Records Source of information:, `-' Was system.pumped as part of-the irfsppction(yes or no)L.,ff 0- I?yes,volume pumped: gallons--How was quantity pumped determined? ReasonTor.pumping; . TYPE OF SYSTEM eptic 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'frorn system owner) —Tight tank _Attach a copy:of the DEP.approval —Other'(describe): proximate age of components,ctafe installed if know )ands9�-urce of information: Were.sewage odors'detected when arriving at the site(yes-or no 6 ' f Page 7 of 11 OFFICIAL INSPECTION FORM.—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: Owner: ' �l Date of Inspection: 'aqCJQ BUILDING SEWER(locate on site planL/90- Depth below grade: Materials of construction:_cast iron _40 PVC._other(explain):- Distance from private water supply well or suction line: Comments(on condition of joints,venting, evidence of leakage, etc.): SEPTIC TANK: t/(locate on site plan) /©1/& Depth below grade( ,C Material of construction:__k,,Mncrete_metal_fiberglass polyethylene —other(explain) If tank is metal list age:_ Is age confirmed by a Certificate of Compliance(yes or no):_(attach a.copy of certificate) Dimensions:,/O. 5`X&'A'S Sludge depth: Distance from top of sludge to bottom of outlet tee or baffle: 2�b Scum.thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bolt m of outlet tee or baffle: How were dimensions determined:. Comments(on pumping recommend tions, inlet and outlet tee or baffle condition,structural integrity, liquid levels s related to outlet invert,evidence of leakage,et ): JA GREASE TRAD/kt,�4locate on.site plan) A Depth below grade:_ 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: Comments (on pumping recommendations, inlet and outlet,tee or baffle condition, structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): 7 t t Page 8'of 11 OFFICIAL-INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM .PART C 'SYSTEM INFORMATION(continued) Property Address: C 0 Owner: , i Date of Inspection: 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/day Alarm.present(yes or no): Alarm level: Alarm in working order(yes or no): Date of fast pumping: Comments(condition of alarm and float switches, etc.): DISTRIBUTION,BOX:—Z,(if present must be opened)(]ocate,on..site plan) Depth of liquid level above outlet invert: Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover,any evidence of Je4age into or out of box, e y \ i —01 PUMP CHAMBEW/(Z— (locate on site plan) Pumps in working order(yes or no):._! Alarms in working order(.yes or no):. Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.): 8 t Page 9 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION. (continued) Property Address: ^ a4a a7Z 2)az/_ A O� Owner: Date of Inspection: oZ SOIL ABSORPTION SYSTEM (SAS):._J,,,,�4ocate on site plan,excavation not required) If SAS not located explain why: Type aching.pits,number:L leaching chambers,number: 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, CESSPOO� (cesspool must be pumped as part of inspection)(locate on site p)an) 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 or no): Comments(note condition of soil,.signs of hydraulic failure,_level of ponding, condition of vegetation,etc.): PRIVly` (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.): 9 i Page 10 of 11 OFFICIAL:INSPECTION.FORM=NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property.Address: XIYA Q Owner: Z ' Date of Inspection: ,00oa SKETCH`OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at.least two permanent reference landmarks or benchmarks.Locate all wells within 100 feet. Locate where public water supply enters the building. toll yl { _ 1 " / Qi 10 Page 11 of 1 l OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS. SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: Owner•�0461/ Date of Inspection: SITE EXAM. Slope Surface water Check cellar. Shallow wells Estimated depth to ground water feet Please indicate(check)all methods used to determine the high ground water elevation: Obtained from.system design plans on record-If checked, date of design.plan reviewed:. 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: II Permit Number: Date: Completed by:. ��� HIGH GROUND-WATER LEVEL COMPUTATION Site Location: �l �Q' Ce�1j ��' � Lot N'o, Owner: 109 1c,/I���La� Address Contractor:_ �70fIGALr �O�S� Address: Zr_- l!S d5s Notes:. STEP . 1 . Measure depth to water table. to nearest.1J10 ft............................ Date month/day/.Year STEP 2 Using.Water-Level.Range Zone and Index Well.Ma.p.locate site and determine: O.Appro.priate.index vvetl_...................................... /fe�LQ Water-level range zone:............._....._............._...._.......... STEP,3:• Using monthly.repo.rt,:"Current - Water Resources Conditions" determine current-depth to J /' water level for index well ........................... month/year STEP. 4. Using.Table.oT_Water;l.evel Adjustments for index well (STEP 2A:),.current depth to water level for index wel.l (STEP 3),, r and water-level zone (STEP 2B) determine water-level adjustment ................. '' ,Z. STEP:, S stimate depth to:high water by subtracting the water level adjustment..(STEP 4) from measured.depth to water level-at site.(STEP 1) ............... ,,7, Figure. I--Repraduel5le computation iwrm. 6� -- � f�IIC Y^ ���j~ � UNITED STATES POSTAL SERVIC % ' Permit �-•-- _mt-CJ,asf�tfF�--�,_ Postage_8-Fee -Paid USPS " _._...,_.w.. L � ��• _ _ No.G-10 • Sender: Please print yo4r,name, address, and ZIP+4 in this.box• SULLIVAN ENGINEERING INC. P.O. BOX 659 OSTERVILLE, MA. 02655 iiif M 111 lfllf!!)!Iffif1!II!!!!II!ffffl!1!1!fild11 11f!1!fld SENDER: COMPLETE THIS SECTION COMPLETE THIS SECTION ON DELIVERY ■'Complete items 1,2,and 3.Also complete Sig 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. gr�teceived by(Fri ted ame) C. a of elive� ■ Attach this card to the back of the mailpiece, F 1� ����• /� U or on the front if space permits.kil r W 1" D. Is delivery address different om item ? Yes 1. Article Addressed to: If YES,enter delivery address below: ❑ No 4j4,-,..,T4 . 3. Service Type Certified Mail ❑Express Mail ❑ Registered ❑ Return Receipt for Merchandise ��(, /L(il.L�.( a •"�' ❑ Insured Mail ❑C.O.D. 4. Restricted Delivery?(Extra Fee) ❑Yes 2. Article Number l +I r 7005 0390 0002 )2193 7=1 �(rransfer from serv/ce ' ' ' PS Form 3811,February 2004 Domestic Return Receipt 102595-02-M-1540 i UNITED STATES POSTAL SERVI"CT -- :. Postage.&Fees..Pq.id � ,/ USPS Permit No.G-10 " • Sender: Please print your,name, address, and ZIP+4 in this box• I SULLIVAN ENGINEERING INC. P.O. BOX 659 OSTERVILLE, MA. 02655 i illlitiYll�Yli!ffll rilllf�l!!lil�tf!!l�li!�llflil3�lil3�flii� SENDER: COMPLETE THIS SECTION COMPLETE THIS SECTION ON DELIVERY ■ Complete items 1',2,and 3.Also complete A. Signature item 4 if Restricted Delivery is desired. ❑Agent ■ Print your name and address on the reverse X10f' ❑Addressee so that we can return the card to you. B. Received b rioted Name) C. Date of Del've ■ Attach this card to the back of the mailpiece, /14 ���� or on the front if space permits. BuAl D. Is delivery address different from Rem 17 ❑Yes 1. Article Addressed to: If YES,enter delivery address below: ❑No d P�F 3. Service Type Certified Mail ❑Express Mail �•� Qa,(�v7 - ❑ Registered ❑ Return Receipt for Merchandise ❑Insured Mail ❑C.O.D. 4. Restricted Delivery?(Extra Fee) ❑Yes 2. Article Number 7005 0390 0002,,2193 7134 j 1 (rransfer from service labs PS Form 3811,February 2004 Domestic Return Receipt 102595-02-M-1540 \ O T.H.-1 a1I 21.7 ,A 0'2K YElI 1I r t3AlI L—OAM IOYR �ti SG ExrsY. PweL unla 110 ------- — qtzNa . •'O• . B D'RK.YEti 1 all BRN i LAA1vS / SAtJ� IOYR 4/(0 •• •-._ w O• C (I- YL—L.. ML=D. ♦..`•p...5 •y •-:a t x=._ SAND 2.5 Y e, F0,% ACZao rj N O r R0u N D Vn/A TL-R eechwood e - e� P`R NC. IC,In! e` 0,- • DP7r=---'. `4/22/06 ••• •� it • ► DEPTH t 5 Sr! _ _ M • / LE SSTHAN 2- NAIN INGH �i • • '• • • M Q,/', Sui-LI\/AN 7--N6_INE5F21Nr, \NG, o Z U/ITNIzSS1.D, 01& A.RAtS, 7,0.0 • •• • •.! T,I-1,- 2 t-L—ram. 21.O = + • °� DRK YFLISt-1 [3QN •' y • • 2L.5• - SAND`/ 1_OAt��S IoYR -3/L1 • ,•� • • 20• , O ao s -- -- M1N. — '� "J 1 - ry O RI! YGI_-1SH l3RN • I h'IY 4r c y L—OA SAND 10 YR OSANO 2• T 6/6 o • >l •• O L o t7'ryi< YLI_I 5 u IE 1 LOCATION MAP: pr SANDY LOAM 10 vR 3/y �A / U 5' 0 1 b' D'RK YLL 1 SN 131R N Scale: 1' = 2000'f ���� LOAMY SAND 1 0 `/R L4/(o �1 NO GR0UIID \A/D.TSR _.. A - •,�;���...' �. c�,.,. r ,r�-c--,�'I�.A,r..! t i.._ "I 'l / I N,I<_! _ I i OV D ON LEACHING AREA DETAIL \ PtoletYE C8/ddh \ Zone A10, B & C (see plan) ( ) � ASSESSORS REF.: Not to Scale \ / Map 228, Parcels 135 Community Panel No. #250001 0008 D \ ° t• Drive OVERLAY DISTRICT: July 2, 1992 i NOTES NOTES: .� � � AP — Aquifer Protection District I. Water Supply For This Lot is Municipal Water. o" / \ As Shown on Plan Entitled 2.Location of Utilities Shown on This Plan Are Approx. 1.) The property line information shown was %A / / 5+6, \ 'Revised Groundwater Protection ZONE. At Least 72 Hours Prior to Any Excavation For7his compiled from available record information. \ °t / 826 \ Overlay Districts" — April, 1993 Project The Contractor Shall Make The Required \ Q o / \ 2O„ \ Notification to DIG SAFE-1-888-344-723a 2.) The topographic information was obtained a\ °� y;o�eP�//// ¢ 8 \ ry RC 3.The Contractor is Required to Sdcure Appropriate from on on the ground performedsurve on \ S ' Area (min.) 43 560 SF Permits From Town Agencies For Construction or between 31 Ma 02 and 18 June 02. / , Defined by This Plan. \ � , , r • Fronta e (min) 20 4.Install Risers as Required to Within 12��of Finished 3.) The datum used is NGVD '29, a fixed mean \ �° � \ Grade. I — \ �/ Ret• Woll Width (min) 100 sea level datum. ' 5.All Structures Buried Four Feet(4�)or More or ti' f_ _ Stone � 75.1' Sto^ 5. Setbacks: Subject to Vehicular to beH-20 Loading. m 1 �� �O/k — — — — , _ _ Fron t 20 6.Septic System tobe Installed in Accordance With ��� \ �' �9T Side 1O' 310 CMR 15.00 Latest Revision And The Town of \ �� 17.2' Barnstable Board of Health Regulations. /\O O a \ �� / , \\ �° N Z Rear 10 7. All Piping to be Sch.40 PVC. \ or / QQ\ O '� �o�n 8.Depth of Inlet Tee Below Flow Line I O"Min. �� Depth of Outlet Tee Below Flow Line:14 Min. Board of Health Variances Required With Gas Baffle. State Title V \ \ / \ 93 \ �, No Variances Required r'� o" / \ W1th o; Cn 'Co DESIGN DATA Town of Barnstable Chapter 360 \ pWelllrl rn o On Site Sewage Disposal Systems \ Exist.ut Base c Single Family-4 Bedroom \ Woo } � No Garbage Grinder Article I:Location of Components o 4 \ / \ o O Accessory Building-1 Bedroom 100 foot separation required r \ \ Basement Floor oR o pmi No Garbage Grinder 75 feet provided Daily Flow=110x5=550gpd / �O \ ` E1.=22.87' I �y �fLQ o PIVL, ' Septic Tank: 550 pdx200%=1100 pd \ _ ` I dr . o Rgus� �pN\`+ Use a 150OGallon Septic Tank.(Existing) o T\L 9 9 r+ I I r0.•o� SG P LEACHING AREA \� OQ 22.8' \ \ S� `� / �v pUt�P� 550gpd/0.74=744s.f.Required r� 9 ,+� .�� \ \ ) Areo 09�0 p pox g Sidewall 96.51.f.x 2=193 s.f. o \ Q Stone rA Bottom Area:558 s.f. 751 s.f.Total Provided LEACHING CHAMBER DESIGN All Piping to be Schedule 40.'Use 5- °r� \> -1\�� / c First Flooi \ 500 Gallon Leaching Chamber in a 8\ \ \ El.=22.4o' 2° ' 16 O Washed Stone Field as Shown Y, \ , / FX/ M\�''22 �t4i o �O \ 23 re 1 \ sf0� Z S \�. \ 7 Filler >' �� y1 \ \\ ro \ / .� i -(N•' \ 'w n Fabric 'Comp«fed FIII °r/6+ {. \ \\ ,PO \ \ /// \ OOO 21—In U Utility + / \ •F ,' Leachlna ' 9 r�, • L° 5 —1 9— c ` r\ See Leaching Area Detail. CROSS SECTION OFCHAMBER ,NOT TO.SCA•,,E _ �— \ \ \ —17 Lot 7� - - � — — h _ A \ _ LQ 18 _14 — — \ O_ — 71, —16 Zone B 15 Existing Latin Area to be Let go - _ 10, Natural. No Future Mowing (3900S.f.) _ \ 14 eFer // �h / !• / / / �2 Al —�3 ale°y / / / / / one B �aA� // \ / / / !,.•j// /� � Zone A10 — 12 yr PLAN VIEW s`'°�e _11 Scale:: I it= 20' �. —10- .��1`A' Ed,e of etlands p A9 9 f town \ - ............ '\ 9 Flagged y ENSR Flood Zone From FIRM Map S A1rA81 2002 Community—Panel Number / on� 250001 00080 July 2, 1992 Z e A1Q \ ` e of �oW......... `'�� / h�• ,�jQ Connect to Existing C p/� ZOt1 — --,._ Edy,,..... _ T / ,\ f0 — F•G. 23.0 �� .-• _ _ — — \- \\ �`A4 / I '\ SepticTonk F.G.21.5 A8� Plo A24r\\I / / tx� \�oG =;t 18.7 —10— / / (Plot Al t .� (Exist.1500 1 1 6 ��k ��Gallon II 19.5 Top El.19.7 1 O '�------ :;'.si A7 A6 / / / 1 1 / QK, I Septic Tank i n BotEl. 16.7 < �9 - — �_ _5 / / tl/ \5� \(�0 r.�:- — 19.3 19_I g - — — Gr `Install Gas Baffle on Bedding as Install Flow 5.7 S P T 5 L I Bot,TH Elo_y. 11.0 r Septic;Tank Ostie?Tee Per Int eve.ers hie Grc..^v�,c►er ■ 6- 5� \ DEVELOPED PROFILE OF PROPOSED SEPTIC SYSTEM S69.909,7 �\ \� Not to Scale O Lot 8 H1GH w<.T+=R tom.>cal< Sss sE3- 43z�_ M 1129733 s p9�S/°ck Fni CIVIL L< v < 6\ � M Va0 LEACH/NbARBA Ptr:1Z �' RwlslotJ fo�15�05 �pi1l1oS N Title: PREPARED BY.• N PREPARED FOR: SITE PLAN Martha KellySullivan Engineering, Inc. CapeSury `-° x, 659 PO Box 718 PROPOSED SEPTIC SYSTEM 93 Pheasant! Way OstePO/BoMA 02655 Hyannis MA 0 601-0718 UPGRADE Centerville, N;a. 02632 (508)428-3344 (508)428-3115 fox (508)790-7902 (508)790-7905 fox 93 PHEASANT WAY PSu11PEC4boLcom copesurv@copecod.net ° CENTERVI LLE , MASS: Field WHK/MDH Deft: MDH 20 0 10 20 40 80 Date: Scale: Comp.: MDH Review: RLH April 4, 2005 As Shown Prof 22005 Drawing # C552G1.dwg o T.H.-I EL.EV. 21.7 A D'2k YEL ISW [3RN • SANDY LOAM IOYR 3/V 50 -._--: •a. 5 ,. '• EKIST. PWEI_LING. 1 b' ... (.T� p !� ••�� '• ' DARK.YEL:ISt-1 BRN , B LAA1�lY SAND IOYR 1416 •• o• • a 26 Pon ARoa NO 6f�OLINDVrAT?R eeChYrOod • )Dfi� • • Dla-TI- 1-1 0S ••• •• '• • t " UEP-T14: 55*11 tl / LESS -7HAt.l 1 MIN NC1,4 .. • p - •• ' r SULLIVAN CN&-INEERING• 1NC.. •••• • •o VIITNGSS'•D" D�SnnaRAIS, 7,0, .F •e - ii" D'RK Y>=L 15 L-1 C-��2 N � 6j `a,• • �l • p` SANDY LoAh� IOYR '3/4 • �' c� — ZO" 04 MIN. N b'RI< Y6L�'ISH [iRtJ • i �� •T J t_O AI"IY SAND 10 VR '-I/(c p' , �O I .it • / I 4 m LA 3 C OLIVE YE L, 1�1GD e ' • .r O SAND 2,$ /fi - ' - - y 1. O 4, O 20 hlo GROUNC)"IV O•• 0 O A• t D'R\< YI-L 15 N C3RN LOCATION MAP: p -W rq, A SANDY LOAM 10 YR 3/�/ b" D'RK Y�L'I SN 1312 N Scale: 1" = 2000 rf ��s LOO.My SAND 1O�tTi 1 }/C� \ NO (21ROL31J1-D Vl/AT ER 5' h 4 26 LESSTI-IAN Z t.nt N 1 NCH Pole C8/dh \ Utility f FLOOD ZONE: LEACHING AREA DETAIL (fnd) Zone A10, B & C (see plan) 1 ASSESSORS REF.: Community Panel No. Not to Scale \ r� Mop 228, Parcels 135 11250001 0008 D o (:p Abutters s;t. Or;yr 1 Jul 2, 1992 OVERLAY DISTRICT: y /NOTES NOTES: AP - Aquifer Protection District I. Water Supply For This Lot is Municipal Water. °r j \ As Shown on Plan Entitled 2.Location of Utilities Shown on This Plan Are Approx. 1.) The property line information shown was /\cA , 7 %'� S6 \ "Revised Groundwater Protection At Least 72 Hours Prior to Any Excavation For This compiled from available record information. \ o 7 82 \ Overlay Districts" - April, 1993 ZONE. Project The Contractor Shall Make The Required \ ee co Notification to DIG SAFE-1-888-344-7.233. 2.) The topographic information was obtained �\ 01 y�o�P//j \ \ 40 RC 3.The Contractor is Required to SOcure 4ppropriate from on on the ground survey performed on N Permits From Town Agencies For Construction or between 31/May/02 and 18/June/02. 1 � S� 1 l Area (min.) 43,560 SF r� Defined by This Plan. Frontage (min) 20' 4Install Risers as Required to Within 12"of Finished 3.) The datum used is NGVD '29, a fixed mean \ \xo - Grade. sea level datum. / t y/oll Width (min) 100' 5.All Structures Buried Four Feet(4")or More or o r'v, / t St`ne Work �\ — — t5.1 �/ Stan pet. c Setbacks: SubjecttoVehiculartobeH-20 Load ing. m V \ �� ' �� ��\ — — e C Front 20' 6.Septic System to be Installed in Accordance With O \ x �� 17,p \ cps Side 1�> O 310 CMR 15.00 Latest Revision And The Town of C O \ / \ �� / ' N Barnstable Board of Health Regulations. O N � �TAZ 70 Rear 1 0> / 6 10• 7All Piping tobe Sch.40 PVC. f- �\ orb 00 \ 0 B.Depth of Inlet Tee Below Flow Line: I O"Min. Depth of Outlet Tee Below Flow Line:14""Min. Board of Health Variances Required /\ ,p9 3 , cb With Gas Baffle. State Title V \ \ / \ No Variances Required �� or / \ e11ingWit� 01p Town of Barnstable Chapter 360 \ OW rs o DESIGN DATA p \ / \ ExiStout Bose Single Family-4 Bedroom On Site Sewage Disposal Systems \ ` 1 Wolk o+ No Garbage Grinder Article 1:Location of Components or \ / \ �ROoR U Q1 Accessory Building-I Bedroom 100 foot separation required X / \ Basement Floor o 4 No Garbage Grinder 75 feet p rovided E1.=22.87' I Daily Flow=110x5=550gpd / y Septic Tank: 550gpdx200%=1100gpd / �+� \ I �\ `OUSG I �k 0 ��' Use a 1500 Gallon Septic Tank.(Existing) j 11:�L_ 11 LEACHING AREA 00 22.8' 550gpd/0.74=744s.f.Required or4 \_9\ Stop e A.i 09"o p x Sidewall:96.51.f.x 2=193 s.f. _ Bottom Area;558 s.f. / \ ' o CQ e 751 0.Total Provided LEACHING CHAMBER DESIGN r� \ \ �� c I F All Piping to be Schedule 40.•Use 5- o \ / \a irst Float / O 500 Gallon Leaching Chamber in a 8� t\ f1.=22.40' 2 <' Q \ Washed Stone Field as Shown 22 p �Z !,9i o 23 r OL ..�. 4P — i \ 0 w"n FI•Mk co.roW.a nn or L. \ / \ \\. x7i n \ �a� ' 20_-`• - I-O - 5 - \ �20. - ,• •oniny Dc I — -- cn.mb., r, Varies See Leaching Area Detail. QC\ / \ ^ I ,�1 S LOT 2 fP CROSS SECTION OF CHAMBER NOT TO SCALELot przopo-SEP 15 — -14 \ .t \ 17 C / �`/ 16 Zone B orb ` \ / / \ '� 71— 15 Existing Lawn Area to be Let go - — / 1" 10— Natural. No Future Mowing - -12vo � � — � _ — ' � � "/�-_ — _ (3900s.f.) -14 ,eF 0 / / / \ �` one •'� �- Zone A10 •'• � _ — 1 PLAN VIEW ooi� Fd e /osQv' \ \ —11 Scale:I 20' d f�o'� A �d B09 _ —10 �/ ( / /�(•'' / ` Bk�2Q ......Ed °(,Lo A3 wn logg_ x _ / ?f etlonds ,0 F 9 �I <� y ENSR Flood Zone From FIRM MapJune 99S Al-Aa?' 2002 Community—Panel Number 250001 0008D July 2, 1992 ZO% \ of t oW^.............. I �.... ��/ +�� Co nett to Existing h� n Zane _,` dgg,.,•� — - - .<`� \\ / A4 ,� �6 F.G.23.0 Septic Tank F.G.21.5 / Plot A24r,, / / tK �" — �_� 9 =11 A8\ �- .11 /I-11 / h`/ 0 18.7 i —10— s , / / (1i�1\Plot Al 6 �1et�' �I Exist,150 ist,1500 iallon t 19.5 ` ,pro Top El.19.� /T 'I J Bo El, 16. A 7 �. A6 _ � / / 1 `/ �o11 �LSeptic Tank 1 19.3 19.1 9 _ J / /, Grp Install Gas Baffle on Bedding as Install Flow Bot.T.H.Elev. I I.0 57 / Septic Tank Outlet Tee Per Title 5 Levelers 7— — — / �\-`�� No Groundwater 6- 5- � DEVELOPED PROFILE OF PROPOSED SEPTIC SYSTEM S 9Q9, NottoScale F tSg29 3 Lot 8 SEs- 43a z � Ch,. \� PUER B/o%P SUUJ A"140.29733 a 3S p / g"'5ack CIVIL " M V�O LEAGNIN6 AREA Pts-R EViS1oN (0�15�05 Gpt ti+�oS D,O.H. HEARtt\1b N Title: PREPARED FOR: PREPARED BY.' 0 0 � Ul M SITE PLAN Martha Kelly Sullivan Engineering, Inc. CapeSury ox PROPOSED SEPTIC SYSTEM 93 Pheasant W'ay OsteP0l , MA 02655 Hyannis MA x 659 PO 01-0718 UPGRADE Centerville, Mo. 02632 (508)428-3344 (508)428-3115 fox (508)790-7902 (508)790-7905 fax 93 PHEASANT WAY PSullPE@ool.com copesurv@copecod.net CENTERVILLE , MASS: Field: WHK/MDH Draf,: MDH 20 o to 20 40 80 Date: April 4 2Q05 � Scale: Comp.: MDH Revi,�w: RLH - "�""""�•"��- " - p - Shown - Proj. 22005 Drawing { C552G1.dwg O T.H.-1 ELEv. 21.7 ' A DRK YEL 151-I [3RN - • '3AN D 4 LOAM I O Y R _',/4 SD j •a Lsxlsr. Dw¢Lltt.l�c B D'RK.YEL\SH BRN r ^ •o• • 5�1 L0,&,M,4 SAN D 10 YR '4/6 .. - ♦`.wee ., SANO 2.5 Y GA, Wn NO GROUND\/N/AT1=R e4C111MOOd i - •�'7 - DPTC- L4/2_2105 • •• Q • bEPTt•It 5S'I _ � • LI=SS"THAN 2M1N/INGH ai •� p •• • f3s/', SULLI\/AN CNG-tNEER1NG \NC, •�•• ^� r •• • - / W1TNr-SSID, DG5MARAIS/ 7,0,5 • '. ' •a •r . • o • •.-• r T,1-\,-2 ALE\/, 'Z 1,O • ^r �• � D'RK_ Y13L1SL-1 C3RN _� • • A SANDY LOAi�^ 1oYR 3/'-� �� �: •; + �•�`11 • 2O. Z6.5• O '20• zs' is h b'RK YGL'\SH L3RN . $ MIN. � _7 6 LOAt'IY SAND 10 YR '-I/!v � . � • • v y v •a' m ti8 C 0L_1VE YEL, M-L> •© : • p v d SAND 2,0 0 6 In • v • M 1.\o GROUNDWATER v• . 4 0 SANoy 10 YR10 LOCATION MAP: a° Ib, 13 D'RK YELL'ISH IaRN Scale: 1'� = 2000�f lv 4tV \ 40 LL.OP.My SAND \O`l r< L4/to a \ 1\IO CROVNP x 40 1 Ah ?f- r6\ LESST FLAN Z T•AI N� 1 NGI-1 -- FLOOD ZONE: \ utility CBldh Pole (tin Zone A10, B & C (see plan) \ � ( � ASSESSORS REF.: Community Pane! No. " LEACHING AREA DETAIL \ Map 228, Parcels 13s Q Abutters 81t. psi #250001 0008 D Not to scale r Q / 'OVERLAY DISTRICT: July 2, 1992 NOTES NOTES: \ / AP - Aquifer Protection District 1. Water Supply For This Lot is Municipal Water. / \ As Shown on Plan Entitled 2.Location of Utilities Shown on This Plan Are Approx. 1.) The property line information shown was /�A 1/ s \ Revised Groundwater Protection ZONE. At Least 72 Hours Prior to Any Excavation For This compiled from available record information. \ Q°tr / / 68?6„ \ Overlay Districts" - April, 1993 Project The Contractor Shall Make The Required Notification to DIG SAFE-1-888-344-7�233. 2.) The topographic information was obtained �- ° �o)eP�e i F \ h RC 3.The Contractor is Required to Secure Appropriate from an on the ground survey performed on 5 �/ 418 Permits From Town Agencies For Construction or between 31/May/02 and 18/June/02. r Defined by This Plan. .S , Area min.) 43 560 SF 4.Install Risers as Required to Within 12"of Finished 3.) The datum used is NGVD 29, a fixed mean \ \ °r� + 1-/_ \ Frontage (min) 20' Grade. sea level datum. I �/ et. WOIL �• Width (min) 100' 5.All Structures Buried Four Feet(4)or More or ate, I Stone Ko/ _1 \ - 15.1, Ston r'� Setbacks: Subject to Vehicular tobe H-20 Loading. m \ 1 - o orb � 1 `�� - -- � c� 6.Septic System to be Installed in Accordance With Front 2O� 310 CMR 15.00 Latest Revision And The Town of 17.2' ® \ t31� Side 1Or Barnstable Board of Health Regulations. O a \ �� \ -, y Rear 10' 7. All Piping lobe Sch.40 PVC. 8.Depth of Inlet Tee Below Flow Line: 10"Min. \ °r� / QQ \ a O o moo r Depth of Outlet Tee Below Flow Line:14' Min. Board of Health Variances Required \ / ` �h• efl"o_ �° f O_ With Gas Baffle. ', State Title V \ � \ / \ 93 \ � No Variances Required `J����///or / \ Weth o e Cn o Town of Barnstable Chapter 360 / / l _ \ E ist p+6 I setll o On-Site Sewage Disposal Systems / \ ou DESIGN DATA Article 1:Location of Components el \ \ - _ Wolk oR 0} Single Family-4 Bedrbom\, ° \ pct0 !y Q1 `V 100 foot separation required No Garbage Grinder p / \ Basement Floor p 4 r Accessory Building-I Bedroom 71 feet provided \ E1.=22.87' No Garbage GrinderDail SepticTonk:1550 gpd x 200%=1100gpd are1�Q Use a 1500Gollon Septic Tank. (Existing) !- QQ 22.8' \ \ 5��� / \ J LEACHING AREA 4 � ''�/ h ) Are O O 9�� •``-pox S' or \ Q \ \ \ Stone C ?f� t-A 550gpd/0.74=744.x2'=.Required / ,t�, Co o �� \` - Sidewall 195.5 Lf.x 2 =191 s.f. \ 0 o Bottom Area:556s.f. •Q o�R c / p 747 s.f.Total Provided \ ° \ \ LEACHING CHAMBER DESIGN or \7 \� / ` First Floor 8\ \ \ E1.=22.40' 20 A \ All Piping to be Schedule 40,Use 5- � � � '= 500 Gallon Leaching Chamber in a 1) \ / Fr/ M-N 22 S it Ho es \ 23 Washed Stone Field as Shown 22 _ \ z Fluor \ \ \♦� S'C, \ // G C.N Z• \ \ 1- '.:,F•b c w•ro•+,a Fill- or 16 �\ �o \ / \ O° 21 utvility b L - pew -- � � \ /2 I +I Cham6ar 3/4"-II/2 DwN• •� O 5 - � t I ! VariesLA See Leaching Area Detail. �\ / \ \ _ Loy" CROSS SECTION OFCHAMBER / _ r \ \ _ _ _ - - - - - -18 - C>"4 _ - NOT TO SCALE ` \ \ r 17 �'"+ ` - o" Lot 7 - - _ _ \ 78 \ N_ ' \ C1.1 orb 7j t�C� / / \ \\ / / _ _ -14 y` \ \ -17 �♦��(/C // �� \ y-' �- - - - ..13 _ _ _ _ - \ ,\M ` --- _-Zone C �-1 16 Zone B 7 7- - 74 / tom Al one B Zone A10 sR� --- \ -72 oli \ _ � / / ter• yj Lid `ti,; \ - _ PLAN VIEW s`'% �O 29/s�'`� \ \ \ ' - -71 X .. / f , Scale:I 20� fr0�7 /p �/p \ ` Bog �10 22 .....Ed e or town Edge of etlands /° Flogged l ei 1d, y ENSR Flood Zone From FIRM Map 9 9S i� / �a AI_AB 02 Community-Panel Number e B � 250001 0008D July 2, 1992 Zon ,r \ ` of �oW^............ - Existing /.PS '\� fO F.G.23.0 ••"` - - �� � A4 /� ,�� Septic Tank F.G.21.5 AB� / Plot A24�, \ -10- / / \\Plot Al F I' 18.7 6 �1 I Exist.1500 e� Il Gallon I� 19.5 ` Top EI.19.7 - A7 A6 / / 1 'c I Septic Tank i ;'s° Bol.El. 16.7 14 A5_/ / 1/ \h'` 0 rt•:: - ^. 19.3 19.1 _ 9 g - - - / /\ ;� Grp 0 *Install Gas Baffleon Bedding as Install Flow 5.7 5 Levelers Sot.T.H.Elea.LI.O 7_ _ Septic Tank Outlet Tee Per Title 5 / ��= No Groundwater 6 5- \`\ DEVELOPED PROFILE OF PROPOSED SEPTIC SYSTEM S 9�g�. Not to Scale qCt e 6'9•2y3 Lot 8 I--11G1-1 WATE.R t.AP.r,I< I' xl O Sr_9 s�3- ti-3z•z. Chrys N F UM r rn 6 f°Oho/•` ,� oc ell.2973 k 6s,�s log. CIVIL Title: N PREPARED FOR: PREPARED BY.• SITE PLAN t Sullivan Engineering; Inc. CapeSury Cb Martha Kelly PROPOSED SEPTIC SYSTEM 93 Pheasant Way OSteP018aMA 02655 Hyannis MA o 601-0ox 718 UPGRADE Centerville, MO. 02632 (508)428-3344 (508)428-3115 fax (508)790-7902 (508)790-7905 fax 93 PHEASANT WAY PsullPECbol.com copesurv@capecod.net CENTERVI LLE , MASS.` Field: WHK/MDH Draft: MDH 20 0 10 20 40 80 Date: - Scale: Comp.: MDH Review: RLH April 4, 2005 As Shown Pro J 22005 Drawing # C552G1.dwg i