HomeMy WebLinkAbout0110 BACON ROAD - Health 110 BACON ROAD,HYANNIS
A= 309 040
I '
F
1{
1
TOWN OF BARNSTABLE
�sLOCATION /lU j3alor� SEWAGE# P
VILLAGE /�L/ccn n, f ASSESSOR'S MAP&PARCEL ,?o S ,6
INSTALLERS NAME&PHONE NO.
SEPTIC TANK CAPACITY
LEACHING FACILITY:(type)a2k 6 WdC- C( S6,Q ize) 1 Z X 3 y
NO. OF BEDROOMS
OWNER f,�)r Lc-
PERMIT DATE: 41
COMPLIANCE DATE: (�
Separation Distance Between the:
Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility A0 c�/U.S Feet
Private Water Supply Well and Leaching Facility(If any wells exist L�
on site or within 200 feet of leaching facility) Feet
Edge of Wetland and Leaching Facility(If any wetlands exist
within 300 feet of leaching facility) Feet
FURNISHED BY
"s z q c
. w
i
• ' - .� • 'ti-.:�.ten. - �..-..- _. N+.ti.• • ... • •w -. c.
r
No. . g On7—0 p�L y Fee
� 4
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
eUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes
01ppYication for 3i5po!gat *p6tem Conotructton i3ermit
Application for a Permit to Construct( ) Repair(14 Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components
Location Address or Lot No. 110 '3ACcr% kA-a d Owner's Name,Address,and Tel.No.
fKvi vt i of 13,ft�(,Qan c-o-
Assessor'sMap/Parcel 36 tka1 t160%
Installer's Name,Address,and Tel.No. CO&I;d- tn1 eC�n��) Designer's Name,Address and Tel.No.
C.e�..�-t�„+tl ti ✓vim �a,•ur�� iY►9-
Type of Building:
Dwelling No.of Bedrooms "1 Lot Size /t7,000 sq.ft. Garbage Grinder ( )
Other Type of Building S t-lkt No.of Persons 3 Showers Cafeteria( )
Other Fixtures i
Design Flow(min.required) L'14 0 gpd Design flow provided y 7,�_ gpd
Plan Date 3—to—l'l Number of sheets 2 Revision Date
Title L�I`Ib.-1
Size of Septic Tank ,�oo Type of S.A.S. 3 2 Q,�t cJ_ (4 $T A a I-e S$
Description of Soil
Nature of Repairs or Alterations(Answer when applicable) ec, J—13�1c 3,1 1L( S 2ii-e
Date last inspected: 3— 0}- 2 7
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.
Signed_ �!t�� Date
Application Approved by of Z 6 Date `
Application Disapproved by: Date
for the following reasons
Permit No. DL 6 07—01 Date Issued
.,
TJ
No.
Fee v �!
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
Yes
HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS
1 p�PUBLIC
ZippYication for Dtgpogar *yztem Congtructiou Permit
Application for a Permit to Construct O Repair(w�) Upgrade( ) Abandon O ❑ Complete System ❑Individual Components
Location Address or Lot No. 110 IgACo^ Qda d Owner's Name,Address,and Tel.No.
l-IO.t q.r h:� an%✓9 1.2.6 0 I !I u-c(
Assessor'sMap/Parcel 3(3s/Vb l l,�,sgo� w,a� 0'L60%
Installer's Name,Address,and Tel.No. CIV�,,11d11En ?r��+je) Designer's Name,Address and Tel.No.
37
Type of Building: r �
Dwelling No.of Bedrooms `1 Lot Size 10,010 sq.ft. Garbage Grinder
Other Type of Building 5 t.N t No.of Persons 3 Showers.< ) Cafeteria( )
Other Fixtures
Design Flow(min.required) (4140 gpd Design flow provided q 7,5" gpd
Plan Date 3-tv'Zoe'? Number of sheets Z Revision Date
Titlekc°�1
Size of Septic Tank 1 Sdo Type of S.A.S. y 5 Tc.� e S S
Description of Soil
Nature of Repairs or Alterations(Answer when applicable) p�,_, 1�y 1C 31 ta,a C L Z( S rUl-( 'e.» �..
Date last inspected: - Or Z7
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. .
Signed ��` Q.-�-` Date
U
4 Application Approved by e Date
Application Disapproved by: Date
for the following reasons J
Permit No. 007-010 Date Issued 3 y
------------------ ---------------------------
THE COMMONWEALTH OF MASSACHUSETTS
' BARNSTABLE, MASSACHUSETTS
(Certificate of Compliance
THIS IS TO CERT/�Y,that the On-site Sewage Disposal System Constructed ( ) Repaired ("t- Upgraded ( )
Abandoned( )by V�rQt,aS!e <. kfpr l')t 3 t-L
at ILor+ a� p,.,"1Z
> has been constructed in accordance
with the provisions of Title 5 and th for Disposal System Construction Permit No. DO O°1 d 3 -f y'07
P (� P Y � 7 � dated
Installer „A Q�c,Jt(l�.Q E�1t( >t� �.L C Designer
#bedrooms U Approved design flow s gpd
p cons ue a guarantee that the system el ction as designed.
The issuance of this permit shall not '� t�n
Date XIS Inspector '
No. 20 b 7 - ON Fee /,q�) —
s v
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION—BARNSTABLE, MASSACHUSETTS
=igpogaf *Vgtem Congtruction permit
Permission is hereby granted to Construct ( ) Repair°(L ) Upgrade ( ) Abandon ( )
System located at 10 6A w.,
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 a it.
Date 3 - ��. D7 Approved by ,
f i
03/16/2007 15:49 5084775313,' j ENGINEERING WORKS PAGE 01
Town of Barnstable
'} 1 Reoule#ory Services
I
I ! Tbomat F.GeWr, VirecUr'
a
r i Pumk Hadth Division
Thomas McKean,plroc for
200 Maii Street,HyandW MA,02601
Ott"! 508 862-4644 I ' Pam;: 506•790-6m
t Date: 1 b 6 7 Zvi age Pe _ AAsar�o tr's MaplFtlrce! p
_���..,Q,c.•]�-; �c��,�--tee 6�� � �s�r)►R... � �er� � �
f Designer: ,p, l lnstalkr: ,n r S-Q
Addren: � 5 Addretrti: O • �
t
a permit to install a
(:date) lnettallarp
R�d+� ; v4>"� based on x design drawn by
"ptrc system at llC3 _ _ ��.
(address)
PeA4, dated
I (designer)
I Cr
that the se ,tic s stem referenced above ,was installed substeattittlly accaring to
the design, which may err li�dc miner approvod changos such as lateral rclacaelan of the
x andror septic tank.
distribution ba Q
1 Certify that the septic'syystem rofennced above W !s installad with motor changes (.
greater than 10` lateral to 010on of the SAS or any verticAl relocation Of arty Campa�narit
of the septic system)but m $ccordance with Suite& Local ResgulationA, plan revision or
i certified as-built by designer to fbilow, i
j �IH OF A2gS
PETER T.
c, IUIcENTEF � .
_ fun)(lns lhtf'S S riuC) No 5'09
/STE
(Affix nest s Stamp Here)
' ; iQticr's �igr�tu�re}
CIE MLL
j y04
�:Natik'Set><+�1Ck�i�ner Cer[tf4wuon Fvr�n.}•7b•04.dac
1
i
i
,* C-, TOWN OF BBj STABLE
LOCAMN ��C� .ZJe 1 4. SEWAGE,#
YILLAGE ASSESSOR'S MAP & LOT_'
INSTALLER'S NAME&PHONE NO. �' `� J Z°
SEPTIC TANK CAPACITY
LEACHING FACILITY: (type) (size) "e
NO.OF BEDROOMS
BUILDER OR OWNER C-/1d 5 '
PERMIT DATE: 4)—5; COMPLIANCE DATE: r4"
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
N
a.
-�
r.
�,
> �j
y
,.,
t �. �J
�� O
+ .6 � 1�
�r u h'
�-.�����
a
No. Fee$50 . 00`/
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
Yes
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS
01ppfication for Di-oo.5ar 6raem Con6truction Permit
Application for a Permit to Construct( )Repair(X )Upgrade( )Abandon( ) ❑Complete System El Individual Components
Location Address or Lot No. 110 Bacon Road. Owner's Name,Address and Tel.No. —
Hyannis MA Daphne Chase 110 Bacon Rd
Assessor'sMap/Parcel 3 — e llv Hyannis MA 02601
Installer's Name,Address,and Tel.No. 7 7 5-8 7 7 6 Designer's Name,Address and Tel.No.
W E Robinson Septic Service
PO Box 1089, Centerville 02632
Type of Building:
Dwelling No.of Bedrooms 3 Lot Size sq.ft. Garbage Grinder(n9
Other Type of Building No. of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow 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 sand.
Nature of Repairs or Alterations(Answer when applicable) Install Title 5 septic system
consisting of 15009 tank, D-Box, and 2 stonepacked. concrete precast
leaching chambers .
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 by th' B1 d of He
Signed Q Date
Application Approved by 0 Date
Application Disapproved for Ire ollowing reasons
Permit No. Date Issued
No. 97- 4!t� Fe,$50 00
U THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: ✓
Yes
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS
0[pplication for 3Diopozal *pe;tem (Cow6truction Permit
Application for a,Permit to Construct( )Repair(X)Upgrade( )Abandon( ) El Complete System El Individual Components
Location Address or Lot No. 110 Bacon Road. Owner's Name,Address and Tel.No. 775-JJ99
Hyannis MA Daphne Chase 110 Bacon Rd.
Assessor's Map/Parcel 3 c? 7— Hyannis M 02601
Installer's Name,Address,and Tel.No. : 775-8776 Designer's Name,Address and Tel.No.
W E;Robinson Septic Service
P0 Box 1089, 'C-enterville 02632
"Type of Building:
Dwelling No.of Bedrooms 3 Lot Size sq.ft. Garbage Grinder ng
Other Type of Building No.of Persons Showers Cafeteria(
Other Fixtures
Design Flow gallons per day. Calculated daily flow gallons.
Plan Date Number of sheets Revision Date
Title
Size of Septic Tank /0- y`peWH�A.S.
Description of Soil sand
Nature of Repairs or Alterations(Answer when applicable) Install i%Td-tle 5 septic system
consisting of 15009 tank, D-Box, and 2 stobepacked conctete precast
leaching chambers.
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 by this?Bo d of Heajtb.
Signed i, k --of 1,4 4,44 .0 Date
Application Approved by Date
Application Disapproved for kefollowmg reasons
----------(/
r-41
Permit No. //I �2 Date Issued
THE Cb�'MMO-NWEALT"f-MASSACHUSETTS - 0
Chase 6XANSTABLE., MASSACHUSETTS
(Certificate of (Compliance
THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed Repaired (xx)Upgraded
Abandoned( )by
at 110 Bacon Road., Hyannis , ,Ohasconstructed in accordance
s
with the provisions of Title 5 and the for Di�posaj Systeip Construction Permit No. dated
Installer W E Robinson. Septic Service Designer
The issuance of this permit shall not be construed as a guarantee that the system will function as designed.
Date /A Inspector
———————————---——— --————————————
No. ///7 5/Z;,X Fee $50-00
LV
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS
Chase 1Wi9;po5al_*psStem Con!5truction Permit
Permission is hereby granted to Construct( )Repair( X)Upgrade( )Abandon
System located at 110 Bacon Road.
fT)_ra_nn_!s IVIA
installer W E 1,?.ob ins o-n-Se-p-t-re Service
and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his er duty to
comply with Title 5 and the following local provisions or special conditions.
Provided: Construction mu it be dompl d within three years of the date of thQ/perq\niit,
Date:
1�2 Iq eld
Approved by' 77 /4 '0 ZI/
All 3oq -,- o
NOTICE: This Form Is To Be Used For the Repair Of Failed
Septic Systems Only.
CERTIFICATION OF SKETCH AND APPLICATION FOR A
DISPOSAL WORKS CONSTRUCTION PERMIT (WITHOUT
ENGINEERED PLANS)
I, William E. Robinson, Sr. ,hereby certify that the application for disposal works
construction permit signed by me dated 116-9°—9 concerning the
property located at 110 Bacon Road, Hyannis, meets all of the
following criteria:
* There are no wetlands within 100 feet of the proposed leaching facility.
* There are no private wells within 150 feet of the proposed septic system.
* There is no increase in flow and/or change in use proposed.
* There are no variances requested or needed.
* If the proposed leaching facility will be located with 250 feet of any wetlands,the bottom of the
proposed leaching facility will not be located less than fourteen(14)feet above the maximum adjusted
groundwater table elevation.
Please complete the following:
A)Top of Ground Elevation(according to the Engineering Division G.I.S. map)
B)Observed Groundwater Table Evaluation(according to Health Division well map)
SIGNED: DATE
LICENSED SEPTIC SYSTEM INSTALLER IN THE TOWN OF BARNSTABLE NUMBER 20-1998
(Attach a sketch plan of the proposed system. Also if the licensed installer posesses a certified plot plan,
this plan should be submitted).
� i,
- � .._
� �_
t
t
-�
s I
�•
R
1
�. COMMONWEALTH OF MASSACHUSETTS
EXECUTIVE OFFICE OF ENVIRONMENTAL AFF
DEPARTMENT OF ENVIRONMENTAL PR ION
ONE WINTER STREET. BOSTON. MA 02108 617-292-
,I �
l�
li
rr
A'ILLIAM F.R'ELD 30 U13 44s IS R� Y CORE
Governor �+' 9�j Secretan
ARGEO PAUL CELLUCCI D STRUHS
Lt.Govemor SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION F �� ommissioner
PART A /
CERTIFICATION
Property Address: 110 Bacon Rd. Hyannis Address of Owner: D Chase
Date of Inspection: 10/20/98 (If different) 110 Bacon Rd. .
Name of Inspector: Wm E Robinson. Sr Hyannis MA 02601
I am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000)
Company Name: Wm E Robinson Septic Service
Mailing Address: PO Box 1 089, Centervi 1 1 a r M11 02632
Telephone Number,, 5 0 8 7 7 5_8 7 7 ti
CERTIFICATION STATEMENT
I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate
and complete as of the time of inspection. The inspection was performed based on my training and experience in the proper function and
maintenance of on-site sewage disposal systems. The system:
Passes
_ Conditionally Passes
Needs Further Evaluation By the Local Approving Authority
_ Fails
Inspector's Signature: Date: .
The System Inspector shall submit a copy of this inspection report to the Approving Authority within thirty (30) days of completing this
inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit
the report to the appropriate regional office of the Department of Environmental Protection. The original should be sent to the system owner
and copies sent to the buyer, if applicable, and the approving authority.
INSPECTION SUMMARY: Check A, C, or D:
A] SYSTEM PASSES: J
I have not found any information which indicates that the system violates any of the failure criteria as defined in 310 CMR 15.303.
Any failure criteria not evaluated are indicated below.
COMMENTS:
BI STEM 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.
Indicate es, no, or not determined (Y, N, or ND). Describe basis of determination in all instances. If"not determined", explain why not.
_ The septic tank is metal, unless the owner or operator has provided the system inspector with a copy of a Certificate of
Compliance (attached) indicating that the tank was installed within twenty (20) years prior to the date of the inspection; or
the septic tank, whether or not metal, is cracked, structurally unsound, shows substantial infiltration or exfiltration, or tank
failure is imminent. The system will pass inspection if the existing septic tank is replaced with a conforming septic tank
t�
as approved by the Board of Health.
(re ad 04/25/97) Page 1 of 10
DEP on the World Wide Web: http:1twww.magnet.state.ma.usldep
ej Printed on Recycled Paper
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: 110 Bacon Rd. Hyannis
Owner: Chase
Date of Inspection: 10/20/98
B) SY TEM CONDITIONALLY PASSES (continued)
_ Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed
pipe(s) or due to a broken, settled or uneven distribution box. The system will pass inspection if(with approval of the
Board of Health). Describe observations:
broken pipe(s) are replaced
obstruction is removed
distribution box is levelled or replaced
l
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
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
pubic health, safety and the environment.
i
1) SY/STEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER
HICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT:
_\ Cesspool or privy is within 50 feet of a surface water
Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh.
2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH (AND PUBLIC WATER SUPPLIER, IF APPROPRIATE) DETERMINES THAT
THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECTS THE PUBLIC HEALTH AND SAFETY AND THE
ENVIRONMENT:
I
The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet to a surface water supply or
tributary to a surface water supply.
_ The system has a septic tank and soil absorption system and the SAS is within a Zone I of a public water supply well.
_ The system has a septic tank and soil absorption system and the SAS is within 50 feet of a private water supply well.
The system has a septic tank and soil absorption system and the SAS is less than 100 feet but 50 feet or more from a
`!\ private water supply well, unless a well water analysis for coliform bacteria and volatile organic compounds indicates that
the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or
less than 5 ppm. Method used to determine distance (approximation not valid).
3) OTH R
(zeviaed 04/25/97) Page 2 of 10
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address:110 Bacon Rd. Hyannis
Owner: Chase
Date of Inspection: 10/20/98
Dj SYSTEM FAILS:
You st indicate ei;!,er "Yes" or "No" as to each of the following:
I have determined that the system violates one or more of the following failure criteria as defined 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.
t
Yes No
ti
_+ Backup of sewage into facility or system component due to an overloaded or clogged SAS or cesspool.
_ Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or
cesspool.
Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool.
j
Liquid depth in cesspool is less than 6" below invert or available volume is less than 1/2 day flow.
1 Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).
Number of times pumped _.
j
Any portion of the Soil Absorption System, cesspool or privy is below the high groundwater elevation.
Any portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply.
Any portion of a cesspool or privy is within a Zone I of a public well.
Any portion of a cesspool or privy is within 50 feet of a private water supply well.
Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no
acceptable water quality analysis. If the well has been analyzed to be acceptable, attach copy of well water analysis for
coliform bacteria, volatile organic compounds, ammonia nitrogen and nitrate nitrogen.
Ej LARGE SYSTEM FAILS:
You must indicate either "Yes" or "No" as to each of the following:
The following criteria apply to large systems in addition to the criteria above:
The system serves a facility with a design flow of 10,000 gpd or greater (Large System) and the system is a significant threat to
publi health and safety and the environment because one or more of the following conditions exist:
r
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
i the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area- IWPA) or a mapped Zone II of a
i public water supply well)
The owner or operator of any such system shall bring the system and facility into full compliance with the groundwater treatment program
requirements of 3114 CMR 5.00 and 6.00. Please consult the local regional office of the Department for further information.
(revised 04/25/97) Page 3 of'10
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST
Property Address: 110 Bacon Rd Hyannis
Owner: Chase
Date of Inspection: 10/20/98
Check if the following have been done: You must indicate either "Yes" or "No" as to each of the following:
Yes, No
_ Pumping information was provided by the owner, occupant, or Board of Health.
_ None of the system components have been pumped for at least two weeks and the system has been receiving normal
flow rates during that period. Large volumes of water have not been introduced into the system recently or
as part of this inspection.
_ As built plans have been obtained and examined. Note if they are not available with N/A.
The facility or dwelling was inspected for signs of sewage back-up.
The system does not receive non-sanitary or industrial waste flow.
_ The site was inspected for signs of breakout.
All system components, excluding the Soil Absorption System, have been located on the site.
_ The septic tank manholes were uncovered, opened, and the interior of the septic tank was inspected for condition of
baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge, depth of scum.
The size and location of the Soil Absorption System on the site has been determined based on:
The facility owner (and occupants, if different from owner) were provided with information on the proper maintenance of
Sub-Surface Disposal System.
Existing information. Ex. Plan at B.O.H.
Determined in the field (if any of the failure criteria related to Part C is at issue, approximation of distance is
unacceptable) [15.302(3)(b)]
(revised 04/25/97) Page 4 of 10
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 110 Bacon Rd. Hyannis
Owner: Chase
Date of Inspection: 10/20/98
BUXDING SEWER:
(Coca on site plan)
Depth low grade:
Materi I of construction: _cast iron _40 PVC_other (explain)
Dista ce from private water supply well or suction line
D iameler
Corn , (condition of joints, venting, evidence of leakage, etc.)
SEPTIC TANK:
(locate on Site plan)
t
Depth below grader
Material of construction: _ oncrete _metal _Fiberglass _Polyethylene _other(explain)
If tank is metal, list age _ Is age confirmed by Certificate of Compliance _(Yes/No)
Dimensions:
Sludge depth:`
Distance from top of sludge to bottom of outlet tee or baffle:
Scum thickness: 0 J
Distance from top of scum to top of outlet tee or baffle:
Distance from bottom of scum to bottom of oust tee or baffle: A5,,
How dimensions were determined: i�-S
Comments:
(recommendation for pumping, condition of inlet and outlet Tes or baffles, depth liquid level in relation to outlet invert, structural
integrity, evidence of leakage, etc.) /' i f/ /'S v !' �s/• / — 1:% s i%U
is/ c�
GRE SE TRAP:
docat on site plan)
Depth low grade:
Mater'a of construction: _concrete _metal _Fiberglass _Polyethylene —other(explain)
Dimen ions:
Scum ickness:
Dista a from top of scum to top of outlet tee or baffle:
Dista ce from bottom of scum to bottom of outlet tee or baffle:
Dat of last pumping:
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.)
(revised 04/25/97) Page 6 of 10
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
Property Address: 110 Bacon Rd. Hyannis
Owner: : Chase
Date of Inspection: 10/20/98
FLOW CONDITIONS
RESIDENTIAL:
Design flow: 9 K0 .p.d./bedroom for S.A.S.
Number of bedrooms:,-
Number of current residents:
Garbage grinder (yes or no):ti 0
Laundry connected to system (yes or no)
Seasonal use (yes or no):A,- 0
Water meter readings, if available (last two (2) year usage (gpd): 9Z5/96 thru 9/11/98 — 15, 200 cu ft
Sump Pump (yes or no):
114, 000g
Last date of occupancy:
CO MERCIAUINDUSTRIAL:
Type f establishment:
Design low: gallons/day
Grease t alp present: (yes or no)_
Industria Waste Holding Tank present: (yes or no)_
Non-sani ry waste discharged to the Title 5 system: (yes or no)_
Water m ter readings, if available:
Last date of occupancy:
OTHER ,bribe)
Last da of occupancy:
GENERAL INFORMATION
PUMPING RECORDS and,aource of information:
' /
A
System pumped as part of inspection: (yes or no)/,E� c1
If yes, volume pumped: Gallons
Reason for pumping:
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)
I/A Technology etc. Copy of up to date contract?
Other
APPROXIMATE AGE of all components, date installed (if known) and source of information: /V �'r-7'
Sewage odors detected when arriving at the site: (yes or no)
(revised 04/25/97) Page 5 of 10
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 110 Bacon Rd. Hyannis
Owner: Chase
Date of Inspection: 10/20/98
SOIL ABSORPTION SYSTEM (SAS):_/
(locate on site plan, if possible; excavation not required, but may be approximated by non-intrusive methods)
If not determined to be present, explain:
Type:
leaching pits, number:_
leaching chambers, number:
leaching galleries, number:
leaching trenches, number,length:
leaching fields, number, dimensions:
overflow cesspool, number:
Alternative system:
Name of Technology:
Comments:
(note condition of soil, signs of hyd�a)lic failure, level f ponding„ condition of vegetation, etc.)
PA c_rC� try /r,
;, �J
CE POOLS: _
(loca a on site plan)
Num r and configuration:
Depth op of liquid to inlet invert:
Depth' f solids layer:
Depth Df scum layer:
Dimen ions of cesspool:—T
Materials of construction:
Indica on of groundwater:
inflow (cesspool must be pumped as part of inspection)
Comments:
(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.)
PRIVY:
(locate Fnsite plan)
Materi s of construction: Dimensions:
Dept' f solids-
Comments:
(note fondition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.)
r
(reviaad 04/25/97) Page 8 of 10
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 110 Bacon Rd. Hyannis
Owner: Chase
Date of Inspection: 10/20/98
TI ooat T OR HOLDING TANK: (Tank must be pumped prior to, or at time, of inspection)
(l on site plan)
Depth low grade:
Material of construction: _concrete _metal _Fiberglass _Polyethylene _other(explain)
Dime ions:
Capa ty gallons
Desi flow: gallons/day
Alarm level: Alarm in working order_ Yes; _ No
Date o previous pumping:
Comm nts:
(condit on of inlet tee, condition of alarm and float switches, etc.)
DISTRIBUTION BOX: �•/
(locate on site plan)
Depth of liquid level above outlet invert: r�
Comments:
(note if level and distribution is equal, evidence of solids carryover, evidence of leakage into or out of box, etc.)
PUMP CHAMBER:_
(locate on site plan)
Pump in working order: (Yes or No)
Alar, s in working order (Yes or No)
Co ents:
(no condition of pump chamber, condition of pumps and appurtenances, etc.)
(revised 04/25/97) Page 7 of 10
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 110 Bacon Rd. Hyannis
Owner: Chase
Date of Inspection: 10/20/98
SKETCH OF SEWAGE DISPOSAL SYSTEM:
include ties to at least two permanent references landmarks or benchmarks
locate all wells within 100' (Locate where public water supply comes into house)
I
, I
l
I
6
'� ILLL
o'
i
(revised 04/25/97) Page 9 of 10
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 110 Bacon Rd. Hyannis
Owner: Chase
Date of Inspection: 10/20/98
J11
Depth to Groundwater /&�- Feet
Please indicate all the methods used to determine High Groundwater Elevation:
Obtained from Design Plans on record
Observation of Site (Abutting property, observation hole, basement sump etc.)
Determine it from local conditions
Check with local Board of health
Check FEMA Maps
Check pumping records
Check local excavators, installers
Use USGS Data
Describe in your own words how you established the High Groundwater Elevation. (Must be completed)
j.J i 1716)/L�'
(revisid 04/25/97) Page 10 of 20
TOWN OF BSTABLE f
LOCATION Cam' SEWAGE # ' C�
VILLAGE ASSESSOR'S MAP & LOT-? d
INSTALLER'S NAME&PHONE NO. o e -7 'Z L
SEPTIC TANK CAPACITY %S
LEACHING FACII.TTY: (type) —L S ��'`° r (size)
NO.OF BEDROOMS :5—Y
BUILDER OR OWNER 111d a
PERMIT DATE:��J )— COMPLIANCE DATE:%L) —07-"d w pj
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
LEGEND
F�i ,a 9UMPV5 RD M •
gg PROPOSED CONTOUR
98 PROPOSED SPOT GRADEZ CHESTNUT ST
—— —— EXISTING CONTOUR o CHERRY ST
LOCUS
x 96.52 EXISTING SPOT GRADE a
i W— EXISTING WATER SERVICE y
.0 G
.,
—E) t1.W. OVERHEAD WIRES
9.
183 ram: �.' TEST PIT m
BENCHMARK
/ `�5'29-45'10" E
>} VENT 100.00'
�" co
SA
71
EXISTING S.A.S.
LOCUS MAP N.T.S.
TO BE ABANDONED
�'�,4 I I D-eox GENERAL NOTES:
-
��. L L_lil. -__j_ -� EXISTING SEPTIC TANK
1 TP-1 TP 2f L k TOP OF TANK, EL.=102.17 1' ALL CHANGES TO THIS PLAN MUST BE APPROVED BY THE LOCAL
*' t� INV. OUT =100.84t BOARD OF HEALTH AND THE DESIGN ENGINEER.
Benchmark Sets %s' -5 y, N ',� ( ) 2.
ALL WORK AND MATERIALS SHALL CONFORM TO THE REQUIREMENTS
Right cor. bulkhead s % r P- c„7 N'? 1 fv/ .� OF THE STATE ENVIRONMENTAL CODE, TITLE V, AND ANY APPLICABLE
f " "�1 r � LOCAL RULES AND REGULATIONS EXCEPT AS REQUESTED BELOW:
El.=104. 74 (Assumed) °" t� I '' I � +
a G; -310 CMR 15.405(1)(b):
Lu 1) A V variance to the 3' requirement for maximum cover over
the S.A.S. for a maximum cover of 4'. S.A.S. shall be vented.
LO 2) A 4' variance, S.A.S_ to cellar wall (bulkhead), for a 16' setback.
'EX/ST/NG; ,/ ,�i """ O• 3. THE SEWAGE DISPOSAL SYSTEM SHALL NOT BE BACKFILLED PRIOR
O 0114V
TO INSPECTION AND APPROVAL BY THE BOARD OF HEALTH AND THE
rI
` Shed '/ `°'/ , / %HOUSE /P 10) '; /
DESIGN ENGINEER.
' j' / to 4. THERE ARE NO WELLS LOCATED WITHIN 150' OF THE PROPOSED S.A.S.
/ � TOF=104.81
L0 5. ANY CONDITIONS ENCOUNTERED DURING CONSTRUCTION DIFFERING
xek xw nKtt w azuxi�mwa- t y
FROM THOSE SHOWN HEREONSHALL BE REPORTED TO THE DESIGN
ENGINEER BEFORE CONSTRUCTION CONTINUES.
'N 6. ALL ELEVATIONS BASED ON ASSUMED DATUM,
I 1 l any 7. THE DESIGN ENGINEER IS NOT RESPONSIBLE FOR THE FAILURE OF
ri v THE CONTRACTOR OR OWNER TO NOTIFY THE LOCAL BOARD OF
"' -� HEALTH FOR PROPER INSPECTIONS DURING CONSTRUCTION.
t 9 r
l Lots 59 & 60 I 8. WATER SUPPL'> PROVIDED BY TOWN WATER SERVICE.
10,000f S.F. 9: ALL AREAS DISTURBED DURING CONSTRUCTION SHALL BE RESTORED
TO A CONDITION AGREED UPON BETWEEN OWNER AND CONTRACTOR.
Ma 309 10.� .� � IT SHALL BE THE RESPONSIBILITY OF THE CONTRACTOR TO VERIFY THE
�,_ r Parcel 40 THE LOCATION OF ALL UNDERGROUND UTILITIES PRIOR TO BEGINNING
1
� -1- CONSTRUCT ION_
\ r
SUITABLE SOIL
100.00 •^'"" ;,, 1 1 WHERE REQUIRED, CONTRACTOR SHALL REMOVE ALL UN S
�- f........ { IN THE AREA BENEATH AND FOR 5 FT: ON ALL SIDES OF THE S.A.S.
I
5'10�' Wtf �y, y, AND REPLACEWITH CLEAN FILL AS SPECIFIED IN 310 CM 255(3
—._ N 29Y_ 12. ENGINEER IS NOTRESPONSIBLE FOR ANY FUNDOCUMENTED RBURIED
- ;° f� ..1 �' �r`dG •'';c i' T`? SEPTIC SYSTEM COMPONENTS THAT MAY EXIST ON THE PROPERTY.
13. SUBJECT SITE DUES NOT LIE WITHIN A STATE REGULATED ZONE II_
in, \•cry ;,�r. .., �" ;-� � s:;• ,�� OF Mgss
-� C:s' �9 �'` U „�.•' try :.�=` y: �. q
t ti Y s �P Cy
�Y v � r%t M ENREE G PROPOSED SEPTIC SYSTEM UPGRADE PLAN
ROAD S N BACON _ cI�L 110 BACON ROAD, HYAN N IS, MA
0 No. 35109
4 Prepared for: Brian Lawrence, 1 10 Bacon Road, Hyannis, MA 02601
r, R£CIS1 P Y
NAL \ Engineering by: Surveying by: SCALE DRAWN JOB. NO.
EnglneeringWorks WARNER SURVEYING 1"=20' P.T.M. 1 24-07
21()/O 12 West Crossfie 0 Ha Rood Long Road DATE CHECKED SHEET NO.
Forestdale, MA 2644 Harwich, MA 02645
(508) 477-5313 (508) 432-8309 3/10/07 P.T.M. 1 of 2
f,
I
D—BOX NOTE: TO PREVENT BREAKOUT, THE PROPOSED VENT
PROPOSED TANK INSTALL RISER WITH COVER AND SET FINISH GRADE SHALL NOT BE < EL:99.7
INSTALL RISERS WITH COVERS OVER INLET TO WITHIN 6" OF FINISH GRADE FOR A DISTANCE OF 15' AROUND THE
TOP OF PERIMETER OF THE S.A.S.
FOUNDATION & OUTLET TO WITHIN 6" OF FINISH GRADE 24„
(EXISTING) EL.103.9t F.G. EL: 104.1 t F.G. EL.: 104.7 (MAX.
a MAINTAIN 27 MIN SLOPE OVER LEACHING AREA
e
e
e
L = 24' L 8'(MAX) INSPECTION RISER PIPE
g" 4" SCH 40 PVC 4" SCH 40 PVC
a, 10" 48" LIQUID 14' 0 S= 1% (MIN.) s ® S= 1% (MIN.) INVERT � 6
a.
a. LEVEL NV.=100.84 PROPOSED
. ,•a.'.'a.,
EXISTING ADD GAS
BAFFLE D—Box INV.=100.35 4 ROWS OF 8 UNITS AT 4'/UNIT + 2'(END CAPS)= 34.00'
(USE SPEED LEVELERS)INV.=100.43 SOIL ABSORPTION SYSTEM (PROFILE)
EXISTING 1500 GALLON SEPTIC TANK N.T.S. ESTABLISH VEGETATIVE COVER
BACKFILL WITH CLEAN SAND
NOTES: 1) CONTRACTOR SHALL VERIFY ALL EXISTING (NATIVE OR PERC SAND)
PIPE INVERTS PRIOR TO CONSTRUCTION.
2) D—BOX SHALL BE SET LEVEL AND TRUE TO GRADE TOP OF CHAMBER EL.=100.7
ON A MECHANICALLY COMPACTED SIX. INCH CRUSHED
STONE BASE, AS SPECIFIED IN 310 CMR 15.221(2). INV.ELEV.=100.35 BREAKOUT EL.=99.68
3) INSTALL INLET & OUTLET TEES AS NEEDED. BOTTOM ELEV.= 99.68 I 1Illmallillmllill EXISTING SUITABLE
4) GAS BAFFLE TO BE INSTALLED ON OUTLET TEE. LMATERIAL
5' MIN. ABOVE BOTTOM OF
21„ 5-4" POLYSEAL OUTLETS EFFECTIVE WIDTH=11.2'
SEPTIC SYSTEM PROFILE T.P. EXCAVATION OR G.W.
2^ 'L" 1-4" POLYSEAL INLETS USE 4 ROWS OF 8—QUICK4 STANDARD INFILTRATOR CHAMBERS
NO G.W. AT EL.=93.7(TP-1) WITH NO SEPARATION BETWEEN EACH ROW & NO STONE
N.T.S. TYPICAL SECTION
j �, ,. 0
;� SOIL LOG
DESIGN CRITERIA
\, \\\ DATE: MA.RCK 8, 2007 NUMBER OF BEDROOMS: 4 BEDROOMS
N' Top View Section \' \, SOIL EVALUATOR: PETER T. MCENTEE P.E. SOIL TEXTURAL CLASS: CLASS I
\'� �� WITNESS: DON DESMARAIS DESIGN PERCOLATION RATE: <5 MIN/IN
D-BOX �• o �. �,,
�� F - (HEALTH AGENT) DAILY FLOW: 440 G.P.D.
16" 00 ` Z O � �\ REFERENCE NO. P-1 1,688 DESIGN FLOW: 440 G.P.D.
GARBAGE
� LIJ \ Elev, , TP- 1 Depth Elev. TP—2 Depth EXISTING SEPTIC TANK:O 1500 GAL..CAPACITY
\ �x LLy ' _L
104.2 A 0" 104.7 0 LEACHING AREA REQUIRED: 440) = 594.6 S.F.
0 0 0: 0 SIDE VIEW \ \, Q) . ��, _
SANDY LOAM SANDY LOAM 74
10YR 3/3 10YR 3/3
103.7 6 104.2 6" USE 4 ROWS OF 8—QUICK4 STANDARD CHAMBER UNITS WITH NO
INSPECTION PO �� \ -
roP vlEw I \\\� SANDY LOAM SANDY LOAM STONE FOR AN S.A.S. HAVING THE DIMENSIONS: 11 2 x 34.0 .
2 �.
8' INVERT
I [n 19. 3.9�. 1OYR 5/8 10YR 5/8 BOTTOM AREA: (GENERAL USE APPROVAL FOR 4.72 SF/LF OF INFILTRATOR)
48" E D CAP Q I �` \� 101.2 8 UNITS + 2 END CAPS PER ROW =. 34.0 FT
EFFECTIVE LENGTH) PT
Q4STDE I 36" 102.0 32"
® ® END VIEW N i \ \�\ C C 4 ROWS x 34.0' x 4.72 SF/LF = 641 9 SF,
�1 MUL TIPORT END CAP c? i i \ *� `\\� / PERC DESIGN FLOW PROVIDED: 0.74(641.9 S.F.) = 475.0 G.P.D.
SIDE VIEW NOMINAL CHAMBER SPECIFICATIONS I O I �\ \\ 58"
SIZE (W x L x H)................ I tj���� ti �\�� �• M—C SAND M—C SAND
.....aa'x as' x t2' O �...+
EFFECTIVE LEACHING AREA: I � I o.. ,` .. ,; 2.5Y 5/6 2.5Y 5/6 PROPOSED SEPTIC SYSTEM UPGRADE PLAN
Zit I n' I �� >20%GRAVEL >20% GRAVEL
BED.. CODE G I.t. G,
TRENCH..............................................PER CODE I ZL�•1 1�.J 110 BACON ROAD HYANNIS MA
34" ----
INVERT ELEVATION..................................................8' I FRONT VIEW STORAGE CAPACITY PER UNIT....................44.4 GAL Prepared for: Brian Lawrence, 1 1 0 Bacon Road, Hyannis, MA 02601
93.7 126" 94.2 126" Engineering by: Surveying by: SCALE DRAWN JOB. NO.
QUICK 4 STANDARD INFILTRATOR CHAMBER xEngineedngWorks WARNER SURVEYING N.T.S. P.T.M. 124-07
INFILTRATOR CHAMBERS S.A.S. LAYOUT NO GROUNDWATER OBSERVED 12 West Crossfield Road 22 Long Road
PERC RATE <2 MIN/IN. ("C" HORIZON) Forestdole, MA 02644 Harwich, MA 02645 DATE CHECKED SHEET NO.
N.T.S. (508) 477-5313 (508) 432-8309 3/10/07 P.T.M. 2 Of 2