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HomeMy WebLinkAbout0287 ARROWHEAD DRIVE - Health 287 Arrowhead Drive I-Iyanni's ti A 270 069 2. r r ° o � ° o • ° e o ° a u TOWN OF BARNSTABLE LOCATION' O �R��W n . ��L. SEWAGE# z O 2" 30 ,TILLAGE o is ASSESSOR'S �MAP&PARCEL ;'INSTALLER'S NAME&PHONE.NO. -/U67 6 bl 60rhO ac1 W.(,(.). SEPTIC TANK CAPACITY ��xl�►► j /Ob 6 c,,�Jl LEACHING FACILITY:(type) Dvt u. 11 S (size) T Z/- 3 A 22 NO.OF BEDROOMS OWNER LAIN n�'►�S PERMIT DATE: Iy COMPLIANCE DATE: 10 a 3' I Z Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottbm 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 . �M. � =9 :� a'9 I �� cr _ � M � � ' ,� �� No. ^-EA Fee N THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS l 01ppficatiou for`Dispsal 6pstem Coustruttion Vermit Application for a Permit to Construct( ) Repair e) Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. ,7�7 �/i'c�ic�� / Ow7's Name ddress,and Tel.No. Assessor's Map/Parcel o .7���'•"m'�'ti � ^. . •Installer's Name A�{/�j'ress and Tel.No. au/ /�te•,ve, De ner's Na a Address and Tel.No. 0 3 �.� � /7 fi�g ��ft �•l+�s^ �nf'iN GvL or�ic�t/f<l Q/�vX /!G 3 �„[7c�r✓df• Type of Building: Dwelling No.of Bedrooms .S� Lot Size //, h sq.ft. Garbage Grinder( ) Other Type of Building ,j;,�,p/e 71�,Z No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) J��® gpd Design flow provided —�Ga gpd Plan Date 7��L Number of sheets Z Revision Date Title Size of Septic Tank 0Zee r9 �g� Type of S.A.S. y — J•,a® �� ����i�Pi� Description of Soil Nature of Repairs or Alterations(Answer when applicable) e��xe— PE's.ram.�� /o0 0 aae/ S rL.E' Ce !Z ! /2,617- 3 or l'°�zQ��P41- �i l'-/i �/ � .Sr+a';re= !p�� lP ro cad✓c� Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Healt S' Date d Application Approved by d� Date Application Disapproved by Date for the following reasons jPermit No. ..� Date Issued t Fee No. 0 O THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes_v PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS 6 �pfication for"10-v Piosai Opstem Construction permit I L Application for a Permit to Construct( ) Repair ) Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. ,7�7 �/�oa�Gic'n�✓ / Owner's Name ddress,and Tel.No. Assessor's Map/Parcel ao Installer's Name,Addre>,;d Tel.No. ,e �.yQ�;tiiJ Designer's Naa�e,Address,and Tel.No. -f o� 3g�''3 .C� f0�7?s�,ZdpO �fOf'f /r. JP •� .C7ergef Type of Building: S' Dwelling No.of Bedrooms Lot Size /4 47 3! sq.ft. Garbage Grinder( ) Other Type of Building, ';; /e ?eZ.,--% No.of Persons Showers( ) Cafeteria( ) Other Fixtures v Design Flow(min.required) s�O gpd Design flow provided ,j-6a gpd Plan Date ce Number of sheets Revision Date Title Size of Septic Tank /©42 �r�a� Type of S.A.S. y — ,f"d o Description of Soil Nature of Repairs or Alterations(Answer when applicable) /Z ro Pr�'��-;�a /a o n e�.1 I Ep 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, j Compliance has been issued by this Board of Healt i S' ad Date ,0 �C Application Approved by 0 / Date Application Disapproved by ` Date for the following reasons Permit No. V Date Issued TH E COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS �.y Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired(4) Upgraded) ) Abandoned b oo aO 4i� ui o fc�i / I y( ) Y at �p�' ✓ i��d��r�� d o'. has been cowpucted in acccor�¢ ce with the provisions o Title 5 and the spos stem Construction Permit No 3� at forD' ed Installer l Designer #bedrooms �� Approved deign flow _gpd The issuance of this permit shall not be construed as a guarantee that the systemll fu` s gne. �""""^^ Date ���) � Inspector ------------------------- No. Fee ^ THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION- BARNSTABLE,MASSACHUSETTS Bisposal 6pstem Construction Permit Permission is hereby granted to Construct( ) Repair(!/� Upgrade( ) Abando System located at r 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:Con ct'bn ust be completed within three years of the date of this permit. Date Approved by i � r Town of Barnstable �•�+E Regulatory Services °s Thomas F. Geiler,Director t NAM f Public Health Division � 639. Thomas McKean,Director 200 Main Street, Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Date: 1"2-- Sewage Permit# J 0 fZAssessor's Map/Parcel Installer& Designer Certification Form Designer: -DO A M G I-EL14Vf P.-E , Installer: �(�To 1_ � 0 Address: Eo - 1 6 Address: DE�Q Jlj MA 14 On i-a- � < N was issued a permit to install a (date) (installer) septic system at IV A RM w H FA 9 DR-I\/s based on a design drawn by (address) BOMAf /MCLXU4n) [? dated 1 CIS °�-16• 12-. l (designer) !, V/ I certify that the septic system referenced above was installed substantially according to the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. Stripout (if required) was inspected and the soils were found-satisfactory. I certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system) but in accordance with State & Loc tions. Plan revision or certified as-built by designer to follow. Stripout(if r w ected and the soils were found satisfactory. dr CN L (Installer's Signature) a F (Designer's i ature Af tx Designer' S p 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. gAoffice fonnsWesignercertification fonn.doc I Town of Barnstable P.#--- 1 -3 7 Departitnent of Regulatory.Services i ]Public Health Division t Date ! t �4n. 200 Main Street,Hyannis MA 02601 Date Scheduled- .� Time Fee Pd. �.O.d Foil Suitabilio Assessment for ,fie a e Disposal Performed By: T1J01Y1 A S M UF 1- witnessed By: i LOCATION.& GENERAL INFORMATION Location Address C9 �` `4„_ o Owner's Name �,v^r_r�hJ�C�'R�?�!"►Y 11 Address . . Assessor's Map/Parcel: O � 6 tr a 7t1 6 ��� r'- Engineer's Name ,i� t , /l�cL�eA ,, NEW CONSTRUCTION REPAIR ''[� 1 Telephone# 3-g 5 Land Use: A ) k 1 i �— slopes(96) ' Surface Stones'l`•'orlc Distances from: Open Water Body �— � _ft possible Wet Area-dft Drinking Water Wcll 6A ft Drainage Way /.yT' ft Property Line L 5, ft Other ft SIMTCH:(Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands 4n proximity to holes) N N Parent material(geologic) 4If Depth to Bedrock _ Depth to Groundwater. Standing Water in Hole: N(21VE Weeping from Pit Face 6w/g Estimated Seasonal High Groundwater n/ DETERMINATION FOR SEASONAL HIGH WATER TABLE Method Used: Depth Observed standing in obs.hole: In. 'Depth to sell mottles: In. Dcptb to weeping from side of obs.ho_le: In, Groundwater Adjustment Index Well# Rcading Date: Index Well level Adj,factor- Adj.Groundwater level,,,,,, Observation PERCOLATION TEST bateR--1b- L iu,e,•jEff-I i ' Hole# Tinto at 9" OU - Depth of Peru_ fti Time at G" w Start Pre-soak Time @ Time(9"-6") End Pre-soak (�, S Tfy^A v, RateMin./Inch J/+/ Site Sullability Assessment: Site Passed Sitq Failed: Additional Testing Needed(YIN) -t Original: Public Health Divisioal Observt[tion Hole Data To Be Coirzpleted oIi 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:ISEPTIC\PERCPORM.DO C DEEP-OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture .Sdil Color Soil• Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones;Boulders. i to w.%')ravel) " o �� 3 fL 5 'S c M� SoN� 2.sh 1 DEEP OBSERVATION HOLE LOG Hole# 'I-- Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. cousl5trnov,%Gravel) ]DEEP OBSERVATION HOLE LOG ', .. Hole#. Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Stricture,Stones,Boulders. r ` Consistency. e i • DEEP.OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones;Boulders. Ca si to y Flood Insurance Rate Map: Above 500 year flood boundary No— Yes Within 500 year boundary No Yes ' Within 100 year flood boundary No._,_ Yes Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervious mtiterial exist in all areas observed thrpughout the area proposed for the soil absorption system? If not,what is the depth of naturally occurring pervious matorlalI Certification I certify that on _ (date)I'have passed the soil evaluator examination approved by the Department of Environmental Protection and that the above analysis was performed by me consistent with . the required tra'ning,expertise nd experience described in�10 CMR 15.017. Signature Date Q:\S.EPTlWERCPORM.DOC '1 r ,F 6 e I.a-. Z 1 CG L O -4 f p � � J 1 G Cl Z v rb !� G TZ �I V' ti � N a �: t e� Ct (,/AA— CeLLq� c s cv C iJ Cl z 4 z �- � � I i i n Y Q e 1 3 G + � � G e 07 TOWN OF BARNSTABLE LOCATION (I��QW� SEWAGE # VILLAGE�'l, fV A) ASSESSOR'S MAP 6z LOT �,a INSTALLER'S NAME & PHONE NO. SEPTIC TANK CAPACITY f Q Qo C AJL, 0 LEACHING FACILITY:(type) (size) NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNER DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No �/ - / �, i ---, �� "� � �� �, ��� �. . 6 TOWN OF BARNSTABLE LOCATION �g� �RiPo�.J�iPi9d b2 SEWAGE #X,6 �7 =g VILLAGE: �y����� ASSESSOR'S MAP & LOT0 ©" ond' INSTALLER'S NAME&PHONE NO.10'i1� t4 Se,o& 22,9-a SAY SEPTIC TANK CAPACITY /Sl3O 6s6 LEACHING FACILITY: (type) Z51 r86 LQ Y-3 (size) 'NO.OF BEDROOMS S� BUEMR-OROWNER PERMIT DATE: 3 '�� COMPLIANCE DATE:f®°~ �✓ �� Separation Distance Between the: Maximum Adjusted Groundwater Table and 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 o leaching facility) Feet Furnished by ��° � '� . N ; � a JQ c. Q 4 � r ASSESSORS of 70 Fee No. FACEL10. 046�9 THE COMMONWEALTH OF Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS 01ppfication for Migogar *proem Construction Permit Application for a Permit to Construct( )Repair(vilu"pgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. a?7 A_1ZjQag)Vk.eC<C) ibr, Owner's Name,Address and Tel.No. 'Assessor's Map/Parcel 70 y s MC5, v Z'e- I— Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. 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 '`a'5_ gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) Y 52f t i d E irT ✓c.�u Y7 SLtt Ova- S i /)L`S l�l �� �.i.y.0e s 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 i his Bo -1 Signed Date - o Application Approved by _���79 Date /d--77;i��_ Application Disapproved for the following reasons ..` �, Permit No. Date Issued /� j�'�:H'r�+raS;.`„'�.`...,,;<rhsr. ..r6.. r�..�:,rv'r"�^i:.kt�•9�`•''C'4:.•.ye'�,�' t•w't*W'aZ+v"'�;�v+S!:�?�f:,`.�S�r1tr-'4,y�-;,f':�`;�.+s,a'i"�. � '..�� �.s.r .l�,:lr9�'�`��" '� D q 70 No. Fee 6v% 1. THE COMMONWEALTH OF MASSA HUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS Zipplication for Miopooaf 6 mem Construction Permit • r Application for a Permit to Construct( )Repair( VKupgrade( )Abandon( ) ❑Complete System ❑Individual Components 1 Location Address or Lot No. a8? .A-9_Qow V4r_1� Qr. Owner's Name,Address and Tel.No. , Assessor's Map/Parcel Y kc%` 0 Z C Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. fA'0-C (A0i-_SPP(_ Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Buildingr'- No. of Persons Showers( ) Cafeteria( ) ` Other Fixtures Design Flow % gallons per day. Calculated daily flow 4�n gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil &-�5 10 C a r �, }S Nature of Repairs or Alterations(Answer when applicable)) /- / � !7) •�".S�ifT/i I G I/1K Il �)- Inc 1 `�'C its-'4,:\(i t 01 1 i -6— t ET, Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued bv this Bo of ealth. 3 Signed _ Date -5L, Application Approved byl Date /a �aF; � Application Disapproved for the fo lowing reasons is Permit No. Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY, thaf'the On-site Sewage Disposal System Constructed( )Repaired (r,�pgraded( ) Abandoned(' )by C-_ at v 14 A/&LL_(_has been constructed in accordance with the provisions of,Title 5 and the for Disposal System Construction Permit o. ted Installer. ��f���s�ia� -��+,951� Designer The issuance of this permit shall not be construed A a guarantee that the syst i 1 function as des; ne . Date �� (� "' Inspector t No. Fee THE COMMONWEALTH OF MASSACHUSETTS d PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS liopogar *pgtem Construction Permit Permission is hereby granted to Construct( )Repair( L)-Upgrade( )Abandon( ) System located'at n 7 400 (e_,_ o ��r,,� �ylew_c. / C and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. ;Provided: Construction must be completed within three years of the date of this 29 t. Date: A24 r = Approved b r .l ' CERTIFICATION OF SKETCH AND APPLICATION FOR A DISPOSAL WORKS CONS"-RUCTION PERMIT(WITHOUT DESIGNED.PLANS) hereby certify that the application for disposal works construction permit signed by me dated /b'C� —5� , concerning the property located at n{�dL�--l4eC er—(� meets all of the following criteria: • There are no wetlands within 300 feet of the proposed septic system • There are no private wells within 150 feet of the proposed septic system The observed groundwater table is 14 feet or greater below the bottom of the leaching facility There is no increase in now and/or change in use proposed • There are no variances requested or needed. GNED: DATE: LICENSED SEPT[ YSTEM INSTALLER IN THE TOWN OF BARNSTABLE NUMBER (Attach a sketch plan of the proposed system. Also if the licensed installer posesses a certified plot plan, this plan should be submitted). �, F I i �• ASSESSORS MAP No: PARCEL N0: Commonwealth of Massachusetts Executive of Environmental Affairs DEP .k 1906 Department of b Environmental Protection C+ : SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A . CERTIFICATION ASSESSORS MAPNOc, PARCR NO: Property Address: 66-1 Address of Owner: utko_ uZ�L (if different) D ate of I nspection: Name of Inspector: Michael 1�eD ecko Company Name, Address and Telephone number: Atlantic Environmental P.o B ox 2384 - M ashpee M a 02649. Tel : (508) 4771420 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of inspection . The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. The system ---- Passes ---- Conditionally Passes ,.� _Needs further evaluation by the local Approving Authority Fails I nspector ' s S ignatu e: D ate: \i � Iq� The system Inspector shall submit a copy of this inspection report to the Approving Authority within thirty (30) days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office or the Department of Environmental Protection. The original should be sent to the system owner and copy sent to the buyer, if applicable and the approving authority. 7 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 10-9-71 ktAov.i Owners : U h;xc.�,��g,,L Date of Inspection :cj 1 P cA 4 INSPECTION SUMMARY: Check A,B, C, or D A)SYSTEM PASSES: -•-- I have not found any information which indicates that the system violates any of the failure criteria as defined in 310 CM 15.303. Any failure criteria not evaluated are indicated below B) SYSTEM CONDITIONALLY PASSES: ---- One or more system components need to be replaced or repaired. The system, upon completion of the replacement or repair, passes inspection. Indicate yes, no, or not determinate (Y,N, or ND). Describe basis of determination in all instances. If "not determinated", explain why not. ---- The septic tank is metal, cracked, structurally unsound, shows substantial infiltration or exfiltration, or tank failure is imminent. The system will pass inspection if the existing septic tank is replaced with a conforming septic tank as approved by the Board of Health. ---- Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. The system will pass inspection if (with approval of the Board of Health). -•-• broken pipe(s) are replaced ----- obstruction is removed •- distribution box is levelled or replaced ---- The system required pumping more than four times a year due to broken or obstructed pipe(s). The system will pass inspection 'if (with approval of the Board of Health): ----- broken pipe(s) are replaced ----- obstruction is removed SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address : 9216'1 Owner : Date of Inspection :CA C) FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: ---- Conditions exist which require further evaluation by the Board of Health in order to de- termine if the system is failing to protect the public health , safety and the environ- ment. 11 SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM IS NOT FUNCTIONING-IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: ---- Cesspool or privy is within 50 feet of a surface of water ---- Cesspool or privy is within 50 feet of a bordering vegetated wetland or a small marsh. 2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH (AND PUBLIC WATER SUPPLIER, IF APPROPRIATE) DETERMINES THAT THE SYSTEM IS FUNC- TIONING IN A MANNER THAT PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT. ---- The system has a septic tank and soil absorption system and is within 100 feet to a surface water supply or tributary to a surface water supply. ---- The system has a septic tank and soil absorption system and is within a Zone I of a public water supply well. ---- The system has a septic tank and soil absorption system and is within 50 feet of a private water supply well ---- The system has a septic tank and soil absorption system and is less than 100 feet but 50 feet or more from a private water supply well, unless a well water analy- sis 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 notrogen is equal to or less than 5 ppm. D)SYSTEM FAILS: I have determined that the system violates one or more of the following failure criteria as defined in 310 CM 15.303. The basis for this determination is identified below. The Board of Health should be contacted to determine what will be necessary to cor- rect the failure. --- Backup of sewage into facilitynr system component due to an overloaded or or clogged SAS or cesspool. SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 91 Ae-Qcv..�KA a d W ,, - Owner: Lj1pa, � Date of Inspection : q1%`ot(, D) SYSTEM FAILS (continued) -- 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 over- loaded or clogged SAS or cesspool. Liquid depth in cesspool is less than 6" below invert or available volume is less than 1/2 day flow. -- Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). number of times pumped --- Any portion of the S oil Absorption System, cesspool or privy is below the high groundwater elevation. --- Any portion of cesspool or privy is within 100 feet of a surface water supply ortributary to a surface water supply. ---Any portion of a cesspool or privy is within a Zone I of a public well. --- Any portion of a cesspool or privy is within 50 feet of a private water supply well --- Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality ana- lysis. 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. SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 9.25) , Owner: .U1ee�,l .Xt_ Date of Inspection : �54 E) LARGE SYSTEM FAILS: The following criteria apply to large systems in addition to the criteria above : The design flow of system is 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 : --- 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 I I of a public water supply well. The owner or operator of any such system shall bring the system and facility into full compli- ance with the groundwater treatment program requirements of 314 CMR 5.00 and 6.00. Please, consult the local regional office of the Department for further information. SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 1keQ0wV Owner: ��,� Date of Inspection: 'X`11� Check if the following have been done : -x Pumping information was requested of the owner , occupant and 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 the period. Large volumes of water have not been introduced into the system recently or as part of this inspection. --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 S oil Absorption System, have been located on the site. ---x The septic tank manholes were uncovered, opened and the interior of the sep- tic tank was inspected for conditions of baffles or tees, material of construc- tion, dimensions,depth of liquid, depth of sludge, depth of scum. ---x The size and location of the Soil Absorption System on the site has been deter- mined based on existing information or approximated by non-intrusive methods -x The facility owners and occupants if different from owner were provided with information on the proper maintenance of Subsurface Disposal System. 41 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: Xb_l � Owner: Date of Inspection: RESIDENTIAL: j Design flow : '3� gallons Number of bedrooms ©� Number of current residents: Garbage grinder (yes or no) : Laundry connected to system (yes or no): Seasonal use (yes or no) � Water meter readings, if available: N� , Last date of occupancy : COMMERCIALANDUSTRIAL Type of establishment: Design flow : gallons/day 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 Other: (Describe) ........................................................................................................... Last date of occupancy:. GENERAL INFORMATION PUMPING RECORDS and source of information: ..�.yc .................... System pumped as part of inspection (yes or no) :.... ...... if yes, volume pompedgallons Reason for pumping SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 3W3 Owner: Date of inspection: ck\%\`\ TYPE OF SYSTEM --- Septic tank/distribution box/soil absorption system Single cesspool --- Overflow cesspool --- Privy --- Shared system (yes or no) (if yes, attach previous inspection records, if any) --- Other (explain)........................................................................................... APPROXIMATE AGE of all components, date installed(if known) and source of information x... ...t.. ................................................................................................. ................................................................................................................................................ ................................ Sewage odors detected when arriving at the site : (yes or no)....�1 SEPTIC TANK : ... (locate on site plan) Depth below grade: .......... Material of construction: ....... concrete ......... metal ........ FRP ........ other (explain) ................................................................................................................................................ Dimensions: .................. Sludge depth:............... Distance from top of sludge to bottom of outlet tee or baffle:............................... 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 :......................... 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.)...................... . ................................................................................................................................................ ................................................................................................................................................ ................................................................................................................................................ SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 0` b') Owner: k.Svj, Q� Date of inspection: -k`, Z co, GREASE TRAP : ..... (locate on site plan) Depth below grade: ............... Material of construction: ........concrete.........metal........FRP........other(explain).... .......................................................................................................................................... Dimensions:............*'*"*****....*"'* imensions:............................... Scum thickness:........................ Distance from top of scum to top of outlet tee or baffle:....................................... Distance from bottom scum to bottom of outlet tee or baffle°............................... 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.)........................ ................................................................................................................................................ ................................................................................................................................................ TIGHT OR HOLDING TANKS:.....Q0 (locate on site plan) Depth below grade:............... Material of construction:........concrete........metal.........FRP..........other (explain).......... ................................................................................................................................................ Dimensions:............................ Capacity:....................gallons Design flow:...............gallons/day Alarm level:............................. Comments: (condition of inlet tee, condition of'alarm and float switches, etc.) . ................................................................................................................................................ . ................................................................................................................................................ SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PAR T C SYSTEM INFORMATION (continued) Property Address: Owner: Date of inspection: DISTRIBUTION BOX:..I (locate on site plan) Depth of liquid level above outlet invert:................... Comment: (note if level and distribution equal evidence of solids carryover, evidence of leakage into orout of box, etc.)................................................................................................................... ................................................................................................................................................ ................................................................................................................................................ PUMP CHAMBER:....: (locate on the site) Pumps in.working order: (yes or no)............... Comments: (note condition of pump chamber, condition of pumps and appurtenances, etc.).................... ................................................................................................................................................ ................................................................................................................................................ SOIL ABSORPTION SYSTEM (SAS):....:!` ...... (locate on site plan, if possible; excavation not required, but may be approximated by non- intrusive methods) if not determined to be present, explain: ................................................................................................................................................ ....................................................................................................................................... Type: leaching pits, number: .................. leaching chambers, number:........ leaching galleries,number:........... leaching trenches,number , length:..................... leaching fields, number,dimensions:................... overflow cesspool, number:.......... Comments: (note condition of soil , signs of hydraulic failure, level of ponding, condition of vegetation, etc.). ....................................................................................................................................... ..................................................................ti....................................................................:......... SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property address: . 1 Owner: Date of inspection: CESSPOOLS:.......' (locate on site plaM Number and configuration: .... :.. Depth-top of liquid to inlet invert. ..... t?.............. „ Depth of solids layer: ....5...................................... Depth of scum layer: " Dimensions of cesspool: ...( o.71..Qt A Materials of construction: .C'pr _ Indicator of ground water: ... -� ..... inflow (cesspool must be pumped as part of inspection) Nc................................................................................. ................................................................................................. Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc. I tl U . PRIVY : .... (locate on the site) Material of construction: ................................... Dimensions: ...................... Depth of solids: ................ Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.). ................................................................................................................................................ ................................................................................................................................................ SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address : OL8`? ('V2.D-Zw • O- 1 , Owner: Date of inspection: ,0,'1 �� b SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent references landmarks or benchmarks locate at wells within 100' -tt ; lac� DEPTH TO GROUNDWATER: Depth to groundwater: :,�.[S..feet Method of determintio or approximative: A .S.1. o� ,.c . ................................................................................... ....................................................................................................................I........................... .. ................................................................................................................................................ LOCUS o EXISTINGCONTOUR:---- SEPTIC SYSTEM DESIGN SEPTIC SYSTEM SECTION p PROPOSED CONTOUR:•••••••••••- 2"PEASTONE p EXISTING SPOT ELEVATION:25.5 FLOW ESTIMATE: 3 PROPOSED SPOT ELEVATION: 5®. 5 BEDROOMS AT 110 GAL/DAY= 550 GAL/DAY 102•29 COVERS WITHIN 6" 3/4"-1 1/2" '' O TEST HOLE: TOP OF „ OF FINISHED GRAD WASHED STONE UTILITY POLE: ° FOUNDATION �a '" -a m as UO SEPTIC TANK: INSPECTION PORT 2 Q FENCE LINE: � "��>a =a m�. ��. ,� t ELEV.-97.33 � HYDRANT: 550 GAL/DAY x 1.5 DAYS= 825 GAL(OLD CODE COEFFICIENT) � a� N -b- 3'MAX. RETAINING WALL: USE 1000 GALLON SEPTIC TANK (EXISTING) ELEV a CO MIN) Mq�tiST LEACHING AREA: (EXISTING) ELEV. 97.17 97.0 USE 4-500 GALLON CHAMBERS(8.5'x 4.8'x 2'EFF.DEPTH)WITH 97 7 ELEV. ELEV, 94.5 LOCATION MAP ELEV, D-BOX H . . . . . . . H ELEV. LOT 49 (11,173 SF) 4'OF STONE AROUND (42'x 12.8'x 2'EFF.DEPTH) 1000 GAL (6"STONE UNDER) 4 4 ASSESSORS MAP:270 PARCEL:69 SEPTIC TANK F 42'x 12.8' -� SIDE AREA: (42'+12.8')x 2 x 2=219 SF (0.74)=162 GAUDAY PLAN BOOK:159, PAGE:41 TEE SIZES: (TO BE CONFIRMED) 96.5 4-500 GALLON CHAMBERS WITH FLOOD ZONE:C BOTTOM AREA: 42'x 12.8'=538 SF =398 GAUDAY INLET:6"UP, 13"DOWN ELEV 4'OF STONE ALL AROUND OUTLET:6"UP, 14"DOWN (42'x 12.8'x 2'DEEP) CAPACITY= 30 GAL/DAY GAS BAFFLE AT OUTLET TEE TH-1 TH-2 99.5 BED BED TEST HOLE LOGS O/AHORIZON ELEV. O/AHORIZON ELEV. ROOM BATH KITCHEN BATH ROOM ENGINEER: THOMAS McLELLAN,P.E. LOAMY SAND LOAMY SAND 10YR 3/3 10YR 3/3 6" 99.0 4" 99.2 BED WALL TO BE WITNESS: DON DESMARIS,R.S. B HORIZON B HORIZON ROOM REMOVED DATE: 8-16-12 LOAMY SAND LOAMY SAND BED BED LIVING 30„ 10YR 5/8 97.0 30" 10YR 5/8 97.0 ROOM ROOM ROOM BED PERCOLATION RATE: <2 MIN/IN C HORIZON C HORIZON ROOM MEDIUM SAND MEDIUM SAND 2.5Y 7/4 2.5Y 7/4 1st FLOOR 2nd FLOOR i 144" 87.5 144"1 187.5 EXISTING FLOOR PLAN NO GROUND WATER ENCOUNTERED NOTES: 1.VERTICAL DATUM: ASSUMED / Stockade Fet7ce S 149.224"E 2.MUNICAPAL WATER IS AVAILABLE. / 99.4 3,SCHEDULE 40-4"PVC PIPE TO BE USED THROUGHOUT SEPTIC SYSTEM. �C? 5r6a 99'3 - 4.ALL PRECAST UNITS SUBJECT TO TRAFFIC LOADS TO CONFORM WITH AASHTO H-20 SPECIFICATIONS. tc THA+ h TH-2 i/ - - 100 V `? 5.PIPE PITCH= 1/4" PER FOOT(UNLESS NOTED OTHERWISE). 10 6.FIRST 2'OF PIPE OUT OF D-BOX TO BE SET LEVEL. z/ / / `� FF1 7.THE SEPTIC SYSTEM HAS NOT BEEN DESIGNED TO ACCOMODATE THE USE OF A GARBAGE DISPOSAL. Grave/ Dwe 8.ALL CONSTRUCTION DETAILS ARE TO BE IN CONFORMANCE WITH THE STATE OF MASS.ENVIRONMENTAL o a �. 2p, CODE(TITLE FIVE)AND LOCAL HEALTH REGULATIONS, to min _ 9.CONTRACTOR TO VERIFY LOCATIONS OF ALL UTILITIES PRIOR TO CONSTRUCTION. 99 �N .7 10 2 / �� / ST DECK 10.GROUND COVER OVER ALL SEPTIC SYSTEM COMPONENTS NOT TO EXCEED 3'. o I 11.FIELD SURVEY PROVIDED BY TERRY A.WARNER,P.L.S.,HARWICH,MA. 12.THIS PLAN REQUIRES THE REVIEW AND APPROVAL OF ONE OR MORE TOWN DEPARTMENTS AND ; / = IS SUBJECT TO CHANGE UNTIL SUCH TIME. / c ! s� `p 13.EXISTING LEACH PIT IS TO BE LOCATED,PUMPED AND FILLED WITH SAND OR REMOVED. / , / bh ; o / 14.D-BOX TO BE WATER TESTED TO ENSURE LEVELNESS AND EQUAL FLOW. FXISTi/V w a� ^N p BEORCG / / c Q 1 top fnIUNGM a� CIO _100- d'� 102.29 o , o EC N�i44„� SITE PLAN BENCHMARKAT - LOCATION: PAINT SPOT ON 287 ARROWHEAD DR. HYANNIS, MA CONC.BLOCK ' ELEVATION= 100.53 � PREPARED FOR: 100 DONALD LANDERS Ly 10 DATE:8-23-12 „_ . ' REVISED:9-10-12(5 BEDROOMS) SCALE. 1 -20 m BASS RIVER ENGINEERING M12-27 THOMAS J. McL�LLAN, P.E. P.O.BOX 1163, EAST DENNIS,MA 02641 508-385-3426