Loading...
HomeMy WebLinkAbout0109 BACON ROAD - Health `109 BACON ROAD Hyannis . A = 309 — 254 I� i I TOWN OF BARNSTABLE LOCATION SEWAGE# VILLAGE U`tygnn ASSESSOR'S MAP&PARCEL 0 —o2S INSTALLER'S NAME&PHONE NO. RUA' Arol W-S Cc4V— S'Co"'- 2(p�y�3� SEPTIC TANK CAPACITY / 57 �`0 LEACHING FACILITY.(type) &19 (size) 3 X � 1 NO.OF BEDROOMS 2 5 lb����� OWNER S I'9 (� d 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 w 0 i, 3 b33 0 Y ' No. @,®f Fee TH^ ;MMONWEALTH OF MASSACHUSETTS Entered in computer:_1� Yes PUBLIC HEALTH',., . ,SION - TOWN OF BARNSTABLE, MASSACHUSETTS Zipplication for Disposal *pstrm Construction permit Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location A ress r Lot No. I cq &Gek j�_� Owner's Name,Address,and Tel.No. 7'?' 31� 0 � _ 1t �C.N'� r may, ,,�,,/ , Assessdf'? ap/P�SI� ` rpt Y` (YY� 54,l o v'.%*6 23 0� Installr.! y�e °Address,and T No. � " "7 Designer's-n�_s Name,Address,-And Tel.No.c$`c.&-�3� G, cj&'F"s��t a n n r Type of Building: Dwelling No.of Bedrooms 14. Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided gpd Plan Date 010 ; Number of sheets / Revision Date Title Size of Septic Tank O Type of S.A.S. a S Gb�g Description of Soil S-y SC4 Nature of Repairs or Alterations(Answer when applicable) Se-ee�/� Q�S�; j�✓� 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 Boardkofealth. Signed ` Date '"'CApplication Approved by Date Application Disapproved by Date for the following reasons Permit No. �;t 0 1 Ua Date Issued '67-40 � t!/ `p► No. ��I 8 Fee (.�O THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS 0,1ppl cation for Disposal 6pstem Construction Permit Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components 1 Location Address or Lot No. I GG'1 n �1 Owner's Name,Address,and Tel.No. -7 7LI ' 3 8 0 a 6 Assesso 's ap/Parcel 1 t.I; n" m J f'Y t.�, ��r CI(), -3 36, 61h ygl�c°✓ �f// O'S�' �"til Installer's Name,Address,and Tel:No. (D �� Designer's Name,Address,and Tel.No.Sc Type of Building: Dwelling No.of Bedrooms v2 Lot Size sq.ft. Garbage Grinder( ) . r Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures I Design Flow(min.required) gpd Design flow provided gpd Plan Date [M5/' Number of sheets / Revision Date a� / Title Size of Septic Tank ISO 6 Type of S.A.S. S GO e G,,A Description of Soil SP(o Sai Lsi� r Nature of Repairs or Alterations(Answer when applicable) S� Sp't, DnQ7,�r� " 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 ealth. Signed (1��1,I•�.�'�Z`Y` � Date ' Application Approved by `� � ��-Z A�. �r�iC Date Application Disapproved by Date for the following reasons Permit No. a G /� Date Issued 6 —c�U l!/ --------------------------------------------------------------------------------------------------------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS r .. BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired( ) Upgraded( ) Abandoned( )by C I 1 15 L&Tkp/-S c c-7V, at 1 0� 6j(Ot1 n•c 5 d, jA Y/5/In j S (n I has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. dated Installer r I I 1 S l�1 hP( S G✓1 S.� Designer 1C C,, p P//SP r- /l 1,,-1-1-41;!2 #bedrooms a Approved design fldw gpd i The issuance of t s permit shall not be construed as a guarantee that the system wUffin� tion as desinedDateL pIns ectorJ No. O (IG''� `t2 Fee (C at 0 THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS Misposal 6pstem Constrnrtlon Permit Permission is hereby granted to Construct( ) Repair( ) Upgrade( ) Abandon( ) System located at 10 � °I CO r) &C'`1 CAI/ iVf c1 1,11 m� and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction must be completed within three years of the date of this permit. Date �O i Approved by r U I Town of Barnstable �+ Regulatory Services Thomas F. Geiler,Director �s Public Health Division ► � Thomas McKean,Director 200 Main Street, Hyannis,MA 02601 Office: 508- 2-4 4 Fax: 508-790-6304 Date: Sewage Permit# 0 1 Assessor's Map/Parcel 0 Installer& Designer Certification Form Designer: '�W� ��"�w^`���� Installer: Z�c-i5 �of C.Address: �� � 717 ..Address: �Ar- o• On Ebo I 16 E, ,6 &0' , Cai.-SJ-, was issued a permit to install a (date) q (installer) septic system at1 based on a design drawn by (address) �✓ dated / (designer) y 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 &Local Regulations. Plan revision or certified as-built by designer to follow. Stripout(if requir 'nspected and the soils were found satisfactory. SN OF ngssq y c < TERENCE ''' HAVES N (Installer' aturel �� No. 979 0 '` ✓' �GI S TER�C (Designer's ignay•e) (Affix Designer's Stamp Here) , PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE ram* 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 formsWesignercertikkion form.doc L SWEETSER ENGINEERING 203 SETUCKET ROAD-P.O. BOX 713—SOUTH DENNIS—MASSACHUSETTS 02660 TEL(508)385-6900 EMAIL sweetsereng,(cr),aol.com FAX(508)385-6991 LAND SURVEYING—ENGINEERING—TITLE 5 SEPTIC SYSTEMS SEPTIC DESIGN PROPOSAL PAGE 2 PROPERTY INFORMATION AND FLOOR PLAN SKETCH :Please fill out this form,including the floor plan sketch,and return to us with the signed proposal and retainer. This information is necessary to properly prepare your Septic System Design. If you are planning an addition,we require a set of plans including a foundation plan 0,�- Total#of Rooms f') Year Round Home _Seasonal Home Owner Occupied Rental ,O.2� #Bedrooms Family Room/Den Living.Room Dining Room J #Bathrooms Washer/Dryer . Dishwasher Garbage Disposal V&F Gas Service VCj Town Water In-ground Electric Wires* Li O .In-Ground Oil Tank* ALJ In-groundd Sprinkler* )LLIn-ground Gas Pipes* Please note on sketch where located..Sweetser Engineering assumes no responsibility if in-ground components are damaged during Soil Testings,Inspections,Locations of and/or Installation of New Septic System. Cellar: Full 4L5—Partial(Crawl) Slab Wells: /J Main Use Irrigation Only (please provide location of all wells) PLEASE USE THE SPACE BELOW AND THE BACK OF THIS SHEET TO PROVIDE US WITH A ROUGH SKETCH OF THE EXISTING FLOOR PLAN(ALL FLOORS). Also include any items that should be avoided,IF FEASIBLE,i.e.shrubs; trees,patios,electric lines,tanks,etc. C�tST'iNG R�o�ruc� 6 m ,Font I IViu6 2obM 6W g6 �.00M R©vim: e r f Power Purchase Agreement,version 9.1.0,November 11,2015 10M 1566074 FAX N0. .:15084777814 Apr. 27 2016 06:33PM P1 z Town of Barnstable P# �� �TMe Department of Regulatory Services BAPIMABM Public Health Division Date 319 14 NAM p� s639. 200 Main Street,Hyannis MA 02601 Date Scheduled 'J6 Time 0 Fee Pd. , r a a Soil Suitability Assessment for Sewage Disposal Performed By: ROBIN W WILCOX Witnessed By: � 1 LOCATION Y& GENEEAL INFORMATION Location Address Owner's Name Sergio Candido 109 °Bacon Road 336 Bumps River Road Hyannis AdaressOsterville, MA 02655 Assessor's Map/Parcel: 3 0 9/2 5 4 Engineer's Name Swe e t s e r Engineer'ng NEW CONSTRUCTION REPAIR XX Telephone# 5 0 8-3 S 5—6 9 0 0 Land Use ('`� D�r� T Slopes(%) Z� r Surface Stones �0 Distances from: Open Water Body /_ ft Possible Wet Area ft Drinking Water Well ft Drainage Way ft Property Line 4W ^46)ft Other ft SKETCH:(Street name,dimensions of lot,exact locations of test hole &perc tests,locate wetlands in proximity to holes) t r 2 i ' Lr . ti Parent`material(geologic) Depth to Bedrock Depth to Groundwater: Standing Water in Hole: Weeping from Pit Face • '� Estimated Seasonal High Groundwater DETERMIN 'ION FOR;SEASONAL HIGH°WATER TABLE. Method Used. Depth Observed standing in obs.hole: r r! in. Depth to soil mottles: <� in. Depth to weeping from side of obs.hole: in. Groundwater Adjustment ft. Index Well# Date: Index Well level •,.-. '• Adj.factor Adj_Groundwater Level PERCOLATIONr Time Observation _ Hole# Time at 9" Depth of Perc � Time at 6" Start Pre-soak Time @ Time(9"-6") End Pre-soak Rate Min./Inch 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 ASEPTIC\PERCFORM.DOC V� r DEEP OBSERVATION fTIOLE LOG_ ` ` ' Hol`e#._ Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistenc %Gravel D-Z Ar L �oy45� / 3 yg y G u 19(� L �2 f• . Z Sy �f� ;.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) ' ` a-Z (9-tzo DEEP OBSERVATION HOLE LOG dole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency,%Graven DEEP OBSERVATION DOLE LOG Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency.%Graven Flood Insurance Rate Mau:t i Above 500 year flood boundary No_ Yes } Within 500 year boundary No ✓ Yes Within 100 year flood boundary No— Yes Denth of Naturally Occurrine 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? > kip If not,what is the depth of naturally occurring pervious material? Certification I certify that on � _(date)I have passed the soil evaluator examination approved by the '-n Department of Environmental Protection and tha a above analysis was performed by me consistent with the required traini ,e 'se and a erie cribed in 310 CMR 15.017. Signature Date mw Q:\SEPTIC\PERCFORM.DOC Commonwealth of Massachusetts O r Title 5 Official Inspection Form 91 p Subsurface Sewage Disposal System Form - Not for Voluntary Assessm' °M 109 Bacon Road, Hyannis Property Address Diane Berquist Owner Owner's Name information is required for every Hyannis a/ MA 02601 August 23, 2013 page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When filling out forms A. General Information on the computer, �I use only the tab 1. Inspector: key to move your cursor-do not David B. Mason use the return Name of Inspector key. David Mason � Company Name 4 Glacier Path Company Address East Sandwich MA 02537 Cityrrown State Zip Code 508-367-1617 S1287 Telephone Number License Number B. Certification 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 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 ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority • August 23, 2013 Inspector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. t5ins-11/10 Title 5 Official Inspe io,Form:Subsurface Sewage Dispo/alSystem•Page 1 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ,M 109 Bacon Road, Hyannis Property Address Diane Berguist Owner Owner's Name information is Hyannis MA 02601 August 23 required for every Y g , 2013 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® 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: This inspection information represents the condition of the system on Friday August 23, 2013 at 1 PM and only that date and time nor does the inspection guarentee the future operation of the system B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass"section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no" or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 Commonwealth of Massachusetts - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °M 109 Bacon Road, Hyannis Property Address Diane Berquist Owner Owner's Name information is Hyannis MA 02601 August 23, 2013 required for every Y g page. City/Town State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins•11/10 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ,M 109 Bacon Road, Hyannis Property Address Diane Berquist Owner Owner's Name information is Hyannis MA 02601 August 23 required for every Y g , 2013 page. CitylTown State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: '*This system asses if the well water analysis,Y p s s, performed at a DEP certified laboratory, for fecal Y P ry, a coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate"Yes or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than '/z day flow t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 109 Bacon Road, Hyannis Property Address Diane Berquist Owner Owner's Name information is Hyannis MA 02601 August 23, 2013 required for every Y 9 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5.ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to,correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no" to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA)or a mapped Zone II of a public water supply well If you have answered "yes"to any question in Section E the system is considered a significant threat, or answered"yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments °M 109 Bacon Road, Hyannis Property Address Diane Berquist Owner Owner's Name information is August 23, 2013 Hyannis MA 02601 Au required for every y g page. Cityrrown State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes" or"no" as to each of the following: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information y o Residential Flow Conditions: Number of bedrooms (design): 2 Number of bedrooms (actual): 2 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 220 t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 17 Commonwealth of Massachusetts W Title 5' Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 109 Bacon Road, Hyannis Property Address Diane Berquist Owner Owner's Name information is Hyannis MA 02601 August 23 required for every y g , 2013 page.. Cityrrown State Zip Code Date of Inspection D. System Information Description: Number of current residents: 2 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes ® No Laundry system inspected? ❑ Yes ® No Seasonaluse? ❑ Yes ® No Water meter readings, if available (last 2 years usage (gpd)): Detail: 2012; 72,000 gallons and 2011; 69,000 gallons Sump pump? ❑ Yes ® No Last date of occupancy: Current Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 Commonwealth of Massachusetts - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °M 109 Bacon Road, Hyannis Property Address Diane Berquist Owner Owner's Name information is Hyannis MA 02601 August 23 required.for every y 9 , 2013 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: Board of Health Was system pumped as part of the inspection? ® Yes ❑ No If yes, volume pumped: 1000 gallons How was quantity pumped determined? pump truck gauge Reason for pumping: cesspool inspection Type of System: ❑ Septic tank, distribution box, soil absorption system ® Single cesspool ® Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner)and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ,M 109 Bacon Road, Hyannis Property Address Diane Berguist Owner Owner's Name information is August 23, 2013 Hyannis MA 02601 Au required for every y 9 page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: 1961 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade:- 25"feet Material of construction: ❑ cast iron ®40 PVC ❑ other(explain): 10 Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): Observable components appear in working condition Septic Tank(locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: Sludge depth: 4" t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments GSM , 109 Bacon Road, Hyannis Property Address Diane Berquist Owner Owner's Name information is Hyannis MA 02601 August 23 2013 required for every y _ 9 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle 38" Scum thickness 2" Distance from top of scum to top of outlet tee or baffle 4" Distance from bottom of scum to bottom of outlet tee or baffle 12" How were dimensions determined? Scour Stick Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Observable components appear adequte for the age of the tank. Effluent level with outlet invert. Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top p of scum to to of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments °M 109 Bacon Road, Hyannis Property Address Diane Berquist Owner Owner's Name information is ' Hyannis MA 02601 August 23 2013 required for every y 9 page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank (tank must be pumped at.time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments(condition of alarm and float switches, etc.): Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts 0.1 Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ;M 109 Bacon Road, Hyannis Property Address . Diane Berquist Owner Owner's Name information is Hyannis MA 02601 August 23 required for every y 9 , 2013 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert Level with outlet invert Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.): Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: I t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments °M 109 Bacon Road, Hyannis Property Address Diane Berquist Owner Owner's Name information is August 23, 2013 Hyannis MA 02601 Au required for every y g page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ® overflow cesspool number: 1 ❑ 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.): Effluent in overflow cesspool is with in 14 inches of the inlet invert. Increase in use may cause hydraulic failure.No excessive vegetation. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration 2 with overflow Depth—top of liquid to inlet invert Primary 3", Overflow 14" Depth of solids layer 10" Depth of scum layer 10.1 Dimensions of cesspool 6x7 Materials of construction block Indication of groundwater inflow ❑ Yes ® No t5ins•11/10 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �M 109 Bacon Road, Hyannis Property Address Diane Berquist Owner Owner's Name information is August 23, 2013 Hyannis MA 02601 Au required for every y 9 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): The system is comprised of a primary cesspool with outlet tee in place. There is an overlfow cesspool with effluent within 14 inches of the inlet invert. Privy (locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): i t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ^M 109 Bacon Road, Hyannis Property Address Diane Berquist Owner Owner's Name information is August 23 Hyannis MA 02601 Au 2013 required for every y 9 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ❑ hand-sketch in the area below ® drawing attached separately l5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 109 Bacon Road, Hyannis Property Address Diane Berguist Owner Owner's Name information is Hyannis MA 02601 August 23, 2013 required for every y 9 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope ❑ Surface water ® Check cellar ❑ Shallow wells Estimated depth to high ground water: 20 feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date ® Observed site(abutting property/observation hole within 150 feet of SAS) ® Checked with local Board of Health -explain: Grourd water contour map ® Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: gourndwater contour map and septic designs in the area Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 16 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �M 109 Bacon Road, Hyannis Property Address Diane Berguist Owner Owner's Name information is August 23, 2013 Hyannis MA 02601 Au required for every y 9 page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems) completed ® System Information— Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file 1 t5ins•11/10 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 17 of 17 TOWN OF BARNSTABLE LOCATION/o j� iq'�G�°' %'lG' SEWAGE# VILLAGE /�y�f'%''�'�� ASSESSOR'S MAP&PARCEL INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY. (type) (size) NO. OF BEDROOMS OWNER PERMIT DATE: COMPLIANCE.DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet FURNISHED BYi��C: 1 s;- y - I , 20 FT. MINIMUM FROM CELLAR OR CRAWL SPACE BENCHMAIM SAIL TEST TOP OF FOUNDATION MARC 1 10 FT. MINIMUM FROM SLAB DATE SOIL TEST. _ CH 8_20 6�,_ = 100.00 10 FT. MINIMUM b SOI ST DON SWEETSER ENGINEERING ELEV. �____ L TE E BY ___.____________ 14979 (ASSUMED) CLEAN SAND - WITNESSED BY -►�5_1"JQN�RS ( ) CONCRETE INSPECTION PORT COVERS " LOAM AND SEED - 4 .SCHEDULE 40 PVC PIPE OBSERVATION t��c " 2" LAYER OF S �/ TIt� I8.1� ELEV.=�99.2 MIN: PITCH 1/8 PER FT. „ . " 1 8 ;TO 1/2 < 2/ / PERCOLATION.RATE .� -__-.:MIN;/INCH AT 43 INCHES WASHED STONE - 6 MA OR FILTER FABRIC - 4" CAST IRON PIPE _ 99.67 MAX. VENT DEPTH HORIZ TEXTURE COLOR MOTT. OTHER 3.00 07.�42 MIN. NOT REQUIRED 0-2" Ap LOAMY SAND 10YR4/1 NO ROOTS .(OR EQUAL) MINIMUM PITCH 1/4" PER FT. lA FLOW 2--19" 8 LOAMY.SAND SAND 10YR46 ROOTS LEVELERS TEEO&Z - _ / 19-132" C MEDIUM`SAND 2.5Y7/4 132" = 88.2 FLOW LINE '�, NO WATER ENCOUNTERED AT ELEV. ELEV. 97. _ _ 10" -` ODOd0O'DL7 ❑ ❑ O MIN. sr 1 r� 00 ELEV. - _9��33_ LEVEL a ° ❑ d ❑ d d CIO O ©Cl O ° OBSERVATION HOLE 2 ELEV. ELEV. GAS r 6" SUMP L 56.13 ° ° a � - ELEV. 9Q.30 ELEV. -,T - ,..._ ___ -`----- °° a° O ❑ ❑ C7 C7 D D D Cl O Cl 0 2' o DEPTH HORIZ TEXTURE COLOR MOTT. OTHER BAFFLE �a.�j DIS 1RIBUTIO 0 0 0 0 ° 0 0-2". Ap LOAMY SAND 10YR4/1 NO ROOTS ELEV. DODdd ❑D ❑ DDd LIQUID OUTLET ,1�Z_ ° °° ° ° o o ELEV. 93.92 - 2-19' B_ LOAMY SAND 10YR4/6 ROOTS v DEPTH (TO BE PLACED ON FIRM BASE) Q/i 500 GALLON GALLEYS WITH 19-1 4 FEET 14 INCHES TO BE WATER TESTED 2 LLO G LLE 5 TH 20 C MEDIUM SAND 2.5Y7/4 5 FEET 19 INCHES IF MORE THAN ONE OUTLET STONE IN A 120" 6 FEET 24'INCHES 1DDL"L.a NO WATER ENCOUNTERED AT _ ELEV: _ __89.2 7 FEET 29 INCHES ^ (TO BE PLACED ON FIRM BASE) 13 X 25 X 2 TRENCH FORMATION z WELL N A 8 FEET 34 INCHES SEPTIC .TANK ZONE 3/4" TO 1 1/2" CLEAN ��++ �•t St3IL E.7DPP ABSORPTION ;� INDEX DESIGN 1..CLlTI �7 DOUBLE. WASHED STONE ADJUST NUMBER OF BEDROOMS 2 FREE OF FINES & SILT SYSTEM 5 GARBAGE DISPOSAL UNIT USGS PROBABLE WATER TABLE ELEV. = _r TOTAL ESTIMATED FLOW SEWAGE DISPOSAL SYSTEM PROFILE OBSERVED WATER TABLE ( / /, ) ELEV, _ ___ ( 110 GAL./BR./DAY X ....2._'BR,) _mQ_ GAL./DAY NOT TO SCALE BOTTOM OF TEST HOLE ELEV. a _. REQUIRED-SEPTIC TANK CAPACITY GAL ACTUAL SIZE OF SEPTIC TANK 1500 GAL. SOIL CLASSIFICATION DESIGN •PERCOLATION RATE 5 __ MINJIN. EFFLUENT LOADING RATE GAL./DAY S.F, FT,LEACHING AREA 77� SO. (13X25)+(3"=) LEACHING:CAPACITY (AREA•X RATE) GAL:/DAY' 477.00 X 0.74 RESERVE LEACHING CAPACITY A GAL./DAY 'NOTES: 1. ALL WORKMANSHIP AND MATERIALS SHALL CONFORM TO D.E.P. TITLE .5 AND THE TOWN'S RULES AND REGULATIONS FOR 97.2 THE SUBSURFACE, DISPOSAL OF SEWAGE. � 2. ALL COVERS TO 'SANITARY UNITS`SHALL LL BE BROUGHT TO WITHIN 6" OF FINISHED GRADE. 3. ALL COMPONENTS OF THE SANITARY SYSTEM SHALL BE CAPABLE OF 7. WITHSTANDING H-10 LOADING':UNLESS THEY ARE UNDER-OR WITHIN 10 FT. OF DRIVES OR PARKING,AREAS. H-20 .LOADING SHALL BE, -. USED UNDER OR WITHIN'10 FT, OF DRIVES OR PARKING AREAS 98 4. ANY MASONARY UNITS USED TO BRING COVERS TO GRADE SHALL BE MORTARED IN PLACE. � 5. NO DETERMINATION HAS BEEN MADE`. A TO COMPLIANCE" S WITH x 98.1� DEEDED OR ZONING REGULATIONS. OWNER ;/ 'APPLICANT IS TO OBTAIN SUCH DETERMINATION FROM APPROPRIATE_AUTHORITY. • 98.7 98.9 _ 6. UTILITIES SHOWN ARE APPROX►MATE ONLY, EXCAVATION CONTRACTOR , 150 IS TO CALL "DIG.-SAFE" AT 1-688-344-7233 AT LEAST 72 HOURS"-98.8 PRIOR TO COMMENCING WORK ON SITE. F 97,9 7."CONTRACTOR IS TO VERIFY GRADES AND ELEVATIONS AS WELL AS SITE CONDITIONS PRIOR TO COMMENCING WORK ON SITE. ANY VARIATION 99.0 �`P�j� - 0 IS TO BE BROUGHT TO THE ATTENTION OF THE DESIGN-ENGINEER 98.0 99.7 ��©�' °o : IMMEDIATELY.- 4 d x 98.5 8. PARCEL IS IN FLOOD ZONE X y �0 < 98.3 S. LOT IS SHOWN ON ASSESSORS MAP __: AS PARCEL _ 54 ;J,<�y 10. EXISTING CESSPOOL IS' TO BE PUMPED AND BACKFILLED. 99, . 1500 GALLON �, > 11. THE INSTALLER IS TO GIVE 'THE ENGINEER A MINIMUM OF 48 HOURS 4 SEPTIC TANK 1 98.0 (2, WORKING DAYS) NOTICE FOR THE FINAL INSPECTION (NUMBER BELOW). 9 9.1 /�i p��" 99.1 O x 98. GII.., n dF4$3 ' 99.0 o D. BOX 8 4- 99.3 x 98. 4 N �� 99.4 98.1 y y r� �\ �98;3 ' 99. .979 , ST 99.2 A �J D. BOARD F HEAL] SOIL q4 x 99.2 99.3 �.���N1TAR ,+ TEST 1 { SOIL 98.7 TEST 2 x 99.1 `DATE AGENT 99.7 o 0 FOR LOTS 76 & 77 15,000 S.F. _ 0.0 q� Q- z a Qq 4`r109 1►� 98 lDfn 7 x 99.1 LOC. r HYANNfS EAST �g 203 SETUCKET ROAD fia O.;"BOX 713ELEMENARY LEGEND: R® N 38� 6soo SOUTH :DENNIS, M ASS. 0266 V _ � . EXISTING SPOT ELEVATION 00x0 1 C BEA S c3 tr � .B qY EXISTING CONTOUR -___ 0----- 1 -Y '» a E 0 34 DATE SCALE., __ FINAL SPOT ELEVATION oo.o .� �� � MAR. 18 .201� 1. 20,. FINAL CONTOUR SOIL TEST LOCATION , y CIA UTILITY`POLE -•Cr- ,: L LA 5: REV^ JOB N0. 28 �Q16 7 ? C TOWN WATER -W R. W `._ - " _ CATCH BASIN ._ ..GAS. LINE G , REV. C: . ' AN_ T 0 CLEAN OUT LOCATION MAP �VIAY . _ T 8, 2a16 ,:SHEET 1 0F � CESSPOOL C P. . PR -C. �SB� Od 7E74 r70 dw 7674 SA5:DWG 02016 SWEETSER ENGINEERING ,. h, 4