HomeMy WebLinkAbout0044 ALICIA ROAD - Health 44 ALICIA RD., HYANNIS.
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�T u TO OF BARNSTABLE
LOCATION I LI�'i 1 SEWAGE # *fr,
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VILLAGE ASSESSOR'S CAP&LOTS I3
INSTALLER'S NAME&PHONE 40. '
SEPTIC TANK CAPACITY
LEACHING FACILITY: (type) (size)
NO. OF BEDROOMS
BUILDER OR OWNER
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
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TOWN OF BARNSTABLE (/
LOCATION U c7 A `� (� SEWAGE# CEO e—`/o 9
VILLAGE S ASSESSOR'S MAP&PARCEL
INSTALLERS NAME&PHONE NO. SCA �� `S��' Gt`�f ()b
SEPTIC TANK CAPACITY CX I S° 1000 ll �Qbx
LEACHING FACILITY:(type) c C d (size)1 d Wk �$ Lx hD "0
NO.OF BEDROOMS
OWNER
PERMIT DATE: I C2 / 7 /159- 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) N Feet
Edge of Wetland and Leaching Facility(If any wetlands exist J
within 300 feet of leaching facility) A Feet
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THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS Yes
ftphtation for 30isposal *pstrm Construction permit
Application for a Permit to Construct( ) . Repair(V Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components
Location Address or Lot No.
�k4 LI A\` Lk k (Z Owner's Name, ddress d el No.
Assessor's Map/Parcel
Installer's N e,Address,and el.No. Designer's Name,Address,and Tel.No.
VAS
Type of Building:
Dwelling No.of Bedrooms Lot Size U / sq.ft. Garbage Grinder(/U�
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow(min.required) 330 gpd Design flow provided 7 gpd
Plan Date Number of sheets Revision Date
Title
Size of Septic Tank rst3 Type of S.A.S.
Description of Soil C--*--
Nature of Repairs or Alterations(Answer when applicable)
' '
Date last inspected:
Agreement:
The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in
accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of
Compliance has been issued b this Board of Health.
aD Date /d I 1 a
Application Approved by Date
Application Disapproved by Date
for the following reasons
Permit No. Date Issued
-------------- - - - - - -
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THE COMMONWEALTH'OF MASSACHUSETTS Entered in computer:
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS Yes
fppfication for Misposai bpstem Construction permit
Application for a Permit to Construct( ) Repair(V Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components
Location Address or Lot No.
L4 L4 Av Owner's Name,Address And T_el.No.
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Assessor's Map/Parcel � 7 1
Installer's Name,Address,and el.No. Designer's Name,Address,and Tel.NO.
s CSC c V `JCS �G�S C,
Type of Building:
Dwelling No.of Bedrooms � Lot Size ) U S sq.ft. Garbage Grinder W&
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures l
Design Flow(min.required) '1,3 U gpd Design flow provided (� gpd
4 —�
Plan Date Number of sheets Revision Date
Title
P unto to QXs�i' Type of S.A.S. Cr �-rm_.M
Size of Septic Tank
Description of Soil r., 'J.,
Nature of Repairs or Alterations(Answer when applicable)
Date last inspected:
Agreement:
The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in
accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of
Compliance has been issued by this Board of Health.
i d q o Date /V / Q
Application Approved by Date
Application Disapproved by Date
for the following reasons r
Permit No. Date Issued
------ ------------ ----------- --------------- = -_ = = ---- "
THE COMMONWEALTH OF MASSACHUSETTS J
BARNSTABLE,MASSACHUSETTS
Certificate of Compfiante
THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired(✓f Upgraded( )
Abandoned( )by Ic
at - L' k has been con cte acco d ce
with the provisions of Title 5 and the for isposal System Construction Per
N . ted
Installer Scn H�r tw�1�( Designer�S.A&
#bedrooms Approved design flow
The issuance of this pe its all of a construed as a guarantee that the system will ctionn as
designed. �
Date Inspector � A'0'/1 //!
—No __ -----v- ----- _-• - _ - - - -•--- - ------- - - ` ..
_ Fee .I
10' HE W COMMONEALTH OF MASSACHUi.SETTS
PUBLIC HEALTH DIVISION:- BARNSTABLE,MASSACHUSETTS
Misposal Opstem Construction J)ermit
Permission is hereby granted to Construct( ) Repair( � Upgrade( ) Abandon( )
System located at t _W !h)'s t- � JA c, _rs�Z S
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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 mbst 1 co pleted within three years of the date of this permit. /
Date Approved by ,i
Town of Barnstable
�FTHE 1
.Regulatory Services
Thomas F. Geiler,Director
r BAMSTABLE.
MASS. �0� Public Health Division
'E0 MAC A Thomas McKean,Director
200.Main Street,Hyannis,MA 02601
Office: 508-862-4644 Fax: 508-790-6304
Installer & Designer Certification Form
r` Date: c gL-08 c ��_ Sewage Permit# � � �`j Assessor's Map\Parcel
Designer: SL—PHEW h'v4A> ; AE Installer: 'SeoT t-4-
EAe,[ E Svnv�-�ir�C, ive
Address: 94S e A Address: I f3 oz a -//h21.lov-n4 ILbb
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On la 7 6(5 was issued a permit to install a
(date) (installer)
septic system at e A C � , 14 S based on a design drawn by
(address)
Af 6.-,j /4-+,6 E' dated /6/�/06
(designer)
a/ I certify that the septic system referenced above was installed substantially g accordin to
the design, which may include minor approved changes such as lateral relocation of the
distribution box and/or septic tank.
I certify that the septic system referenced above was installed with major changes (i.e.
greater than 10' lateral relocation of the SAS or any vertical relocation of any component
of the septic system) but in accordance with State& Local Regulations. Plan revision or
certified as-built by designer to follow.
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Designer's Signature) (Affix D igne 's Stamp Here)
PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE
OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH.THIS FORM AND AS-
BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION.
THANK YOU.
QASeptic\Designer Certification Form Revised.doc
Town of Barnstable �/�
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gyp' Department of Regulatory Services
UJUMSTABMr Public Health Division Date b
t6Jq �� 200 Main Street,Hyannis MA 02601 11
CFO MA'S A
Date Scheduled F
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Soil Suitability Assessment for Sewage Dis osal o
Performed By: Witnessed By: d
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LOCATION& GENERAL INFORMATION
Location Address �' r Owner's Name A z-e C ✓'�
Address �eSU`1ZC..
Assessor's Map/Parcel: QGja a �,� Engineer's Name
NEW CONSTRUCTION REPAIR �� Telephone# 13
Land Use 4 4.s,_ Slopes(%) lit— Surface Stones 1yU
Distances from: Open Water Body ft Possible Wet Area ft Drinking Water Well ft
Drainage Way ft Property Line _ ly± ft Other ft
SKETCH:(Street name,dimensions of lot,exact locations of test holes&pere tests,locate wetlands in proximity to holes)
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Parent material(geologic)�yTw N Depth to Bedrock �y
Depth to Groundwater. Standing Water in Hole: Pbl Weeping from Pit Fnee A..)k
Estimated Seasonal High Groundwater
DETERNIINATION FOR SEASONAL HIGH WATER TABLE
_Method Used: ,Uo x✓L ��C��v�T-�.iu—a
Depth Observed standing in obs.hole: In. Depth to soil mottles: in.
Depth to weeping from side of obs.hole: in. Oroundwater Adjustment ft.
Index Well# Reading Date: Index Well level Adj.factor Adj.Groundwater Level
PERCOLATION TEST irate `� Time
Observation /
Hole# / Time at 9"
Depth of Perc Time at 6"
Start Pre-soak Time @ UU Time(9"-611)
End Pre-soak
Rate MinJlnch GL
Site Suitability Assessment: Site Passed_� Site Failed: Additional Testing Needed(Y/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 first notify the.
Barnstable Conservation Division at least one (1) week prior to beginning.
Q:\SEPTIC\PERCFORM.DOC
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)
10 A LS 6 ,,-Z/Z
R-14
DEEP OBSERVATION HOLE LOG Hole# Z
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders.
ons' en %
• Z� � l.S vYa y/L
DEEP OBSERVATION HOLE LOG Hole#
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders.
Consistency. oGravel)
DEEP OBSERVATION HOLE LOG Hole#
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders.
Flood Insurance hate Map:
Above 500 year flood boundary No— Yes ..
Within 500 year boundary No Yes
Within 100 year flood boundary No z 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?
If not,what is the depth of naturally occurring pervious material?
Certification
I certify that on I`� g (date)I have passed the soil evaluator examination approved by the
Department of EnvirogTental Protection and that the above analysis was performed by me consistent with .
the required train' pe rise and experience described in 310 MR,15.017.
Date %D e o$
Signature ,
Q:\SEPTICIPERCFORM.DOC
i
169
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OF
COMMONWEALTH OF MASACHUSETTS 6E�rH134
EXECUTIVE OFFICE OF ENVIRONMENTAI AFFAIRS
DEPARTMENT OF ENVIRONMENTAL PROTECTION
ONE WINTER STREET BOSTON MA 02108(617)292-3500
TRUDY COXE
Secretary
ARGEO PAUL CELLUCCI DAVID B.STRUHS
Governor Commissioner
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION
Property Address: 44 ALICIA RD HYANNIS, MA 02601 RECEIVE®
�Name.of Owner BILL.WOLLEY
Address of Owner: 17 MURIEL LANE MILFORD MA.01757
Date of Inspection: 10/26/00 Nn I/ 0 4 2000
Name of Inspector: .JOHN GRACI TOWN OF H D RNSTggLE
l am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000) EPT.
Company Name: SEPTIC INSPECTIONS
Mailing Address: P.O.66X 2119 TEATICKET,MA.02536
Telephone Number: 508-564-6813 FAX 608-564-7270
CERTIFICATION STATEMENT
Ij
I certify that I have personally inspected th-'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:
X. Passes
_ Conditionally Passes
_ Needs Further Evaluation By the-,Local Approving Authority.
Fails
Inspector's Signature: Date:10/27/00
The System Inspector shall su it a copy of this inspection report to the Approving Authority(Board of Health or DEP)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.
NOTES AND COMMENTS
"The inspection is based on criteria defined iri Title V code 310 CMR 15.303.My findings are of how the system is performing at the time of inspection.M,
inspection does not imply any warranty'br g6arintee of the longevity of the septic system and any of its component's useful life."
THE SYSTEM PASSES TITLE V INPECTION.RECOMMEND PUMPING THE EVERY TWO YEARS TO PROLONG THE SYSTEM'S USEFULL LIFE.
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revised 9/2/98 Paoe 1 of 11
i
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address: 44 ALICIA RD HYANNIS, MA 02601
Name of Owner BILL WOLLEY
Date of Inspection: 10/26/00
INSPECTION SUMMARY: Check A, B, C, or D:
A. SYSTEM PASSES:
X I have not found any information which indicates that any of the failure conditions described in 310 CMR 15.303 exist.Any failure criteria not
evaluated are indicated below.
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 o
the replacement or repair,as approved by the Board of Health,will pass.
Indicate yes,no,or not determined(Y,N,or,ND).Describe basis of determination in all instances. If"not determined",explain why not.
Na 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 complying septic tank as approved
by the Board of Health.
nla Sewage backup or breakout or high static water level observed in the distribution box is due to.broken or obstructed pipe(s)o
due to a broken,settled or uneven distribution box.The system will'pass inspection if(with approval of the Board of Health).
_broken pipe(s)are replaced
_obstruction is removed
_distribution box is levelled or replaced
n& 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
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revised 9/2/98 Paoe 2 of 11
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address: 44 ALICIA RD HYANNIS, MA 02601
Name of Owner BILL WOLLEY.
Date of Inspection: 10/26/00 s
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 the public health,
safety and the environment.
1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES IN ACCORDANCE WITH 310 CMR 15.303(1)(b)THAT THE SYSTEM It
NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT ThE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT:
- Cesspool or privy is within 50 feet of 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 AND SAFETY AND THE 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 aseptic 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 welli 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 n& (approximation not valid).
3) OTHER
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revised 912/98 Paoe 3 of 11
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address: 44 ALICIA RD H'YANNIS, MA 02601
Name of Owner BILL WOLLEY
Date of Inspection: 10/26/00
D. SYSTEM FAILS:
You must indicate either"Yes"or"No"to each of the following:
I have determined that one or more of the following failure conditions exist as described in 310 CMR 15.303.The basis for this determination is
identified below.The Board of Health should be contacted to determine what will be necessary to correct the failure.
Yes No
- X Backup of sewage into facility or system component due to an overloaded or clogged SAS or cesspool.
- X Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool.
- X Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool.
- X Liquid depth in cesspool is'less than 6"below invert or available volume is less than 1/2 day flow,
- X Required pumping more than 4 times in the last year.NOT due to clogged or obstructed pipe(s). Number of times pumped nla.
- X Any portion of the Soil Absorption System,cesspool or privy is below the high groundwater elevation.
- X Any portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply.
- X Any portion of a cesspool or privy is within a Zone I of a public well.
,4'
- X Any portion of a cesspool or privy is'within 50 feet of a private water supply well,
- X 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. LARGE SYSTEM FAILS:
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:
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
- X the system is within 400 feet of a surface drinking water supply
4
- X the system is within 200 feet of a tributary to a surface drinking water supply
- X 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 owner or operator of any such system shall upgrade the system in accordance with 310 CMR 15.30412).Please consult the local regional office of
the Department for further information.
revised 9/2/98 Paoe 4 of 11
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST
Property Address: 44 ALICIA RD HYANNIS, MA 02601
Name of Owner: BILL WOLLEY
Date of Inspection: 10/26/00
Check if the following have been done:You must indicate either"Yes"or"No"as to each of the following:
Yes No
X _ Pumping information was provided by the owner,occupant,or Board of Health.
X _ 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.
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X As built plans have been obtained and examined.Note if they are not available with N/A.
X _ The facility or dwelling was inspected for signs of sewage back-up.
X _ The system does not receive non-sanitary or industrial waste flow.
X _ The site was inspected for signs of breakout.
X - All system components,excluding the Soil Absorption System,have been located on the site.
X The septic tank manhole 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:
X _ Existing information,For example,Plan at.B4O,H,
X _ Determined in the field(if any of the failure criteria related to Part C is at issue,approximation of distance is unacceptable)1 5.302(3)(b))
le
X _ The facility owner(and occupants,if different from owner)were provided with information on the proper maintenance of SubSurface Disposal
Systems.
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revised 9/2/98 Paoe 5 of 11
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
Property Address: 44 ALICIA RD HYANNIS, MA 02601
Name of Owner BILL WOLLEY
Date of Inspection: 10/26/00
FLOW CONDITIONS
RESIDENTIAL:
Design flow: 110 g.p.d./bedroom
Number of bedrooms(design): 3 Number of bedrooms(actual):n/a
Total DESIGN flow: 330 gpd
Number of current residents:2
Garbage grinder(yes or no):YES
Laundry(separate system)(yes or no): NO If yes,separate inspection required
Laundry system inspected(yes or no): NO
Seasonal use(yes or no): NO
Water meter readings,if available(last4wo year's usage): n/a gpd
Sump Pump(yes or no): NO
Last date of occupancy: n/a
COM M ERCIAL/I NDLISTRIAL
Type of establishment: nla
Design flow: n/a gpd(Based on 15.203)
Basis of design flow:n/a
Grease trap present:(yes or no): NO.
Industrial Waste Holding Tank present:(yes or no): NO
Non-sanitary waste discharged to the Title 5 system:(yes or no):NO
Water meter readings.if available: n/a
Last date of occupancy:n/a
OTHER: (Describe)
n/a
GENERAL INFORMATION
PUMPING RECORDS and source of information:
n/a
System pumped as part of inspection:(yes or no):NO
If yes,volume pumped n/a gallons
Reason for pumping:n/a
TYPE OF SYSTEM st
X 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.Attach copy of up to'date operation and maintenance contract
_ Tight Tank Copy of DEP Approval
Other:n/a
.APPROXIMATE AGE of all components,datWinstalled(if known)and source of.information:
APPROXIMATELY 20 YEARS OLD.
Sewage odors detected when arriving at the site:(yes or no): NO
revised 9/2/98 Paoe 6 of 11
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 44 ALICIA RD HYANNIS, MA 02601
Name of Owner BILL WOLLEY
Date of Inspection: 10/26/00
BUILDING SEWER:X
(Locate on site plan)
Depth below grade: 18"
Material of construction: _ cast iron,_ 40 Pvc X other(explain)
Distance from private water supply well or suction line: nla
Diameter: n/a
Comments: (condition of joints,venting,evidence of leakage,etc.)
TOWN WATER
SEPTIC TANK: X
(locate on site plan)
Depth below grade: 12"
Material of construction: X concrete_ metal_ Fiberglass_ Polyethylene_ other
explain: n/a
If tank is metal,list age Is age confirmed by Certificate of Compliance(Yes/No): NO
' Age: n/a
Dimensions: 1000G L 8'6"H 5'7"W 4'10""
Sludge depth: 1"
Distance from top of sludge to bottom of outlet tee or baffle: 33"
Scum thickness: 1"
Distance from top of scum to top of outlet tee or baffle: 6"
Distance from bottom of scum to bottom of outlet tee or baffle: n/a
How dimensions were determined: MEASURED
Comments:
(recommendation for pumping,condition of inlet and outlet tees or baffles,depth of liquid level in relation to outlet invert,structural integrity,evidence of
leakage,etc.)
THE SEPTIC TANK AND ALL COMPONENTS ARE STRUCTURALLY SOUND.RECOMMEND PUMPING EVERY TWO YEARS.
GREASE TRAP: _ a
(locate on site plan)
Depth below grade: n/a
Material of construction: _concrete_ metal_ Fiberglass _ Polyethylene_other
Explain: n/a
Dimensions:n/a
Scum thickness: n/a
Distance from top of scum to top of outlet tee or baffle: n/a
Distance from bottom of scum to bottom of outlet tee or baffle n/a
Date of last pumping: n/a
Comments:
(recommendation for pumping,condition of inlet and outlet tees or baffles,depth of liquid level in relation to outlet invert,structural integrity,evidence of
leakage,etc.)
nla `
revised 9/2/98 Paoe 7 of 11
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
r e PART C
SYSTEM INFORMATION(continued)
Property Address: 44 ALICIA RD`HYANNIS, MA 02601
Name of Owner BILL WOLLEY
Date of Inspection: 10/26/00
TIGHT OR HOLDING TANK: _ (Tank must be pumped prior to,or at time of,inspection)
(locate on site plan)
Depth below grade: n/a
Material of construction: _concrete_ metal_Fiberglass _Polyethylene _other
Explain: n/a
Dimensions: n/a
Capacity: n/a gallons
Design flow: n/a gallons/day
Alarm present: NO
Alarm level:N/A Alarm in working order:NO
Date of previous pumping: n/a
Comments:
(condition of inlet tee,condition of alarm and float switches,etc.)
n/a
L
DISTRIBUTION BOX:_
(locate on site plan)
,r r
Depth of liquid level above outlet invert: n/a '
Comments:
(note if level and distribution is equal,evidence'of solids carryover,evidence of leakage into or out of box,etc.)
n/a
PUMP CHAMBER: _
(locate on site plan)
Pumps in working order:(Yes or No): NO
Alarms in working order(Yes or No): NO
Comments:
(note condition of pump chamber,condition of pumps and appurtenances.etc.)
n/a
f'•
revised 9/2/98 Paoe.8 of 11
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 44 ALICIA RD HYANNIS, MA 02601
Name of Owner BILL WOLLEY
Date of Inspection: 10/26/00
SOIL ABSORPTION SYSTEM(SAS): X
(locate on site plan,if possible;excavation not required,location may be approximated by non-intrusive methods)
If not located,explain:
nla
Type: r
leaching pits,number:(1)1000 GAL 6'X 6'
leaching chambers,number: (n/a)n/a
leaching galleries,number: (n/a)n/a
leaching trenches,number,length: ,(n/a)n/a
leaching fields,number,dimensions: (n/a)n/a
overflow cesspool,number: (n/a)n/a
Alternative system: n/a
Name of Technology: n/a
Comments:
(note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation,etc.)
THE LEACH PIT IS STRUCTURALLY SOUND AND APPEARS TO BE FUNCTIONING PROPERLY.THE PIT HAD I'OF WATER IN IT AT THE TIME
OF THE INSPECTION.THE PIT HAS NOT HAD MORE THAN V OF WATER IN IT.
CESSPOOLS: _
(locate on site plan)
Number and configuration: n/a
Depth-top of liquid to inlet invert: n/a
Depth of solids layer: n/a
Depth of scum layer. n/a
Dimensions'of cesspool: nla
Materials of construction: n/a
Indication of groundwater: n/a inflow(cesspool must be pumped-as part of inspection)NO
i n
Comments: tr '
(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.)
n/a r
PRIVY:
(locate on site plan)
Materials of construction: n/a Dimensions: nla
Depth of solids: n/a �.
-r
Comments:
(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.)
n/a
j
(cr. .
revised 9/2/98 l lr , Paae 9 of 11
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 44 ALICIA RD HYANNIS, MA 02601
Name of Owner BILL WOLLEY
Date of Inspection: 10126/00
SKETCH OF SEWAGE DISPOSAL SYSTEM:
include ties to at least two permanent reference landmarks or benchmarks
locate all wells within 100',(Locate where public water supply comes into house)
act,
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revised 9/2/98 Paoe 10 of 11
i
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 44 ALICIA RD HYANNIS, MA 02601
Name of Owner BILL WOLLEY
Date of Inspection: 10/26/00
NRCS Report name: n/a
Soil Type: n/a
Typical depth to groundwater: n/a
USGS Date website visited: n/a -
Observation Wells checked: NO
Groundwater depth: Shallow_ Moderate_ Deep_
SITE EXAM _ Slope
_ Surface water
_ Check Cellar
Shallow wells
Estimated Depth to Groundwater 12 Feet n/a
Please indicate all the methods used to determine High Groundwater Elevation:
Obtained from Design Plans on record
Observed Site(Abutting property,observation hole,basement sump etc.)
Determined from local conditions
_ Checked with local Board of health
Checked FEMA Maps
Checked pumping records
Checked local excavators,installers
X Used USGS Data
Describe how you established the High Groundwater Elevation.(Must be completed)
USGS MAPS AND CHARTS-12+FEET
i I
jc
revicerl 912/98 Paoe 11 of 11
7 T.;, W;I 11M11,I-
ACCESS COVERS MUST BE WITHIN INSPECTION MIN 27 OF PEASTONE* INVERT ELEVATIONS : DES I GN CR I TER 1 ,4 : GENERAL . NO TES :
6* OF FINISH GRADE PORT
9' MINIMUM, OR FILTER FABRIC INVERT OUT SEPTIC TANK: 99.65 DESIGN FLOW:
FIRST 2' TO
3' MAXIMUM COVER INVERT IN DIST. BOX: � 99.47 3 BEDROOMS AT 1/0 G.P.D. PER I. THIS PLAN IS FOR THE DESIGN AND CONSTRUCTION
BE LEVEL 314' 1 112* DIA,
DOUBLE WASHED STON,'£ INVERT OUT
OF THE SEWAGE DISPOSAL SYSTEM ONLY.
DIST. BOX: 99.3 BEDROOM EQUALS 330 G.P.D.
4" DIAM PIPE 99.7 INVERT IN LEACH CHAMBER: 99. 13 NO GARBAGE GRINDER 2. VERTICAL DATUM IS ASSUMED. FOR BENCH MARKS
40 MILL POLY BOTTOM OF LEACH CHAMBER: 98.3
0* %0 5' SET, SEE SITE PLAN.-
OAS 1 98.1 VAPOR BARRIER ATjUSTED GROUND WATER: NIA
BAFFL 4 SEPTIC TANK REQUIRED:
5 HIGH CAPACITY INFILTRATOR OBSERVED GROUND WATER: NIA 330 G.P.D. X 200% - 660 GAL. 3. ALL CONSTRUCTION METHODS AND MATERIALS AND
EXISTING 3 OUTLET CHAMBERS WIJ.5'-f STONE AROUND 97.7 BOTTOM OF TEST HOLE *1: 91.2
D-BOX SEPTIC TANK PROVIDED: /000 GAL. EXISTING MAINTENANCE OFTHE SEPTIC SYSTEM SHALL
/000 CAL /0'r x 36 '1 x 10*d CONFORM TO MASS., D.E.P. TITLE 5 AND LOCAL
SEPTIC TANK 6' CRUSHED STONE OR SOIL ABSORPTION SYSTEM REQUIRED: BOARD OF HEALTH REGULATIONS.
COMPACTED BASE DESIGN PERC RATE < 5 MIN/INCH
PROF I L E : NOT TO SCALE SOIL TEXTURAL CLASS - 1 4. ALL SEPTIC SYSTEM COMPONENTS LOCATED UNDER
EFFLUENT LOADING RATE 0. 74 GPD/SF AREAS SUBJECT TO VEHICULAR TRAFFIC OR GREATER
330 GPD / 0.74 GPD/SF 446 S.F. REQUIRED THAN 4' IN DEPTH SHALL BE CAPABLE OF WITH-
STANDING H-20 WHEEL LOADS.
PROVIDED: 5 HIGH CAPACITY INFILTRATOR
CHAMBERS W13 5*1 STONE AROUND, A-460 S.F. 5. ALL SEWER PIPE SHALL BE SCHEDULE 40 PVC OR
460 S.F. x 0.74 340 GPD APPROVED EQUAL.
6., SEPTIC TANK AND D-BOX SHALL BE REINFORCED
SOIL TEST PIT DATA & PRECAST CONCRETE OR APPROVED POLYETHYLENE.
BOTH SHALL BE WATERTIGHT, D-BOX SHALL BE WATER
40 MILL POLY INDICATES N7 I ND I CA TES TESTED FOR LEVEL WHEN THERE IS MORE THAN ONE
PERCOLATION OBSERVED
VAPOR BARRIER 770 A TEST GROUNDWATER OUTLET.
6
TP P#12354 TP *2 7, BEFORE CONSTRUCTION CALL 'DIG-SAFE'.
TP*I
Cr, 1-888-DIG-SAFE AND THE LOCAL WATER DEPT.
ORIZON TEXTURE COLOR HORIZON TEXTURE COLOR I
0* 101.2 0* 01.2 FOR LOCATION OF UNDERGROUND UTILITIES.
TP#2 15 LOAMY IOYR LOAMY IOYR
A SAND 212 A SAND 212
5 HIGH CAPACITY 8. SEPTIC SYSTEM INSTALLER SHALL NOTIFY THE
/0"- ......... ........................ 100.4 8. . .......................................... 100.5
IWILTRATOR CHAMBERS DESIGN ENGINEER TWO DAYS PP/OR TO CONSTRUCTION
10 AKI POOL B LOAMY IOYR B LOAMY IOYR OF THE SYSTEM TO ALLOW FOR SCHEDULING OF THE
W13.5't STONE AROUND SAND 416 SAND 416
CONSTRUCTION INSPECTIONS 26"- -.-............................. 99.0 24.. .......................................... 99.2
MED-COARSE IOYR c MED-COARSE IOYR 9. EXISTING LEACH PIT TO BE PUMPED DRY AND
0*
SAND 518 SAND 518
GRA VEL ORA VEL BACKFILLED.
10'CHERR Y'k 441
EXISTING Li
w.
D-BOX SEPTIC TANK
BULKHEAD CN BM-CORNER
DECK EL-103.0 NO WATER
NO WATER 91.2 120' 91.2
1200
STOCKADeec- DATE: SEPTEMBER 15. 2006
STEPHEN 14AAS
TEST BY.
W1 TNESSED BY: DONNA MIORANDI
BEDROOM DifrtL ING PERC RATE: 2 A41NIINCH
I Of
OX-
A.
MAS
VAR I A NCES REQUIRED :
NO.su I
T/TLE 5. MAXIMUM FEASIBLE COMPLIANCE
L 0 T 137
/0, 151± S. F. SECTION 15.211: tl) MINIMUM SETBACK DISTANCES
20 ' IS REQUIRED BETWEEN THE SAS AND A FOUNDATION (POOL). 15* IS PROVIDED.
'A 5* VARIANCE IS REQUESTED.
CBIDH FND
95.00-
SEPTIC SYSTEM LEES G�
44 AL C A ROAD "AP 292 PA R CE-L e5-5
CATCH BASIN
RIM-99.0 �-A IVIV S
SA RI\1,5 TA St. H r "A •
p R ITPA R JE FOR
L EGEND
A F) A R E C� D A COLD T A//
0 CB CONCRETE BOUND
28
ROUTE'.
W- 91A TER L !NE
S CAL E OCT
'7��DRANT
-G- GAS LINE -Y I N G
OVER HEAD WIRESlv
1� NC
9. F A G L E: SURVEY
OHW-
923 Route 6 A
LIGHT POST
13� �j
-E- UNDERGROUND ELECTRIC LINE Ya rrno u t h p or t MA 02675
( 508 ) 362-6132
f
% -T- UNDERGROUND TELEPHONE LINE
J
( 508 ) 4--3 2-5 3 3-3
CTV- UNDERGROUND CABLEVISION LINE
+40.4 SPOT ELEVATION
�40- EXISTING CONTOUR
40 PROPOSED CONTOUR
L 0 CUS MAP 0 /0 20 40 LOB NO: 08-073 FIELD:CFWIEEK CAL C: SAHICFW CHECK: CFW DRN: SAH
M M COY