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0419 BEARSE'S WAY - Health
419 BEARSE'S�WAY Hyannis A ='292 - 076 a TOWN OF BARRNSTABLE r i, OCATION / f�`` SEW AGE-4 ILLAGE IVY41m )"5 ASSESSOR'S MAP S&p PARCELAJg,- �6 INSTALLER'S NAME&PHONE NO. aR/A SEPTIC TANK CAPACITY ,(�)q(� 4!/pry LEACHING FACILITY:(type)2, y—ZU C111m7xX (size),,?,�7)(/3 )(oZ NO.OF BEDROOMS , OWNER T; O PERMIT DATE: I/ U' I 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 PXOAI-� FO r�6 No. � , FEE COMMONWEALTH OF MASSAC14USEITS Board of Health, ^f ' MA. APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT Application for a Permit to Construct( Repair( �Upamde( Abandon( - O Complete System ndividual Components Location Owner's Name y Map/Parcel# 2 Z Address Lot# /,,,- Telephone# e Installer's Name �VV C --� Designer's Name L-) Q� Address i- Address Telephone# — Telephone# S06 Type of Building Lot Size sq.ft. Dwelling-No.of Bedrooms Garbage grinder ( ) Other-Type of Building No. of persons Showers ( ),Cafeteria( ) Other Fixtures Design Flow (mi re aired) gpd Calculated design flow Design flow provided _gpd Plait: Date Zo I� Number of sheets Revision Date Title Description of Soil(s) Soil Evaluator Form No. `J Name of Soil Evaluato ate of Evaluation DESCRMTION OF REPAIRS OR ALTERATIONS V GJ � N o0 Lot The undersi ed agrees to install the above describe Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and further agrees to no ace system in era' n nW a Certificate of C i pli ce has been issued by the Board of Health. Signed Date No. , FEE I / COMMONWEALTH OF MASSACHUSETTS Board of Health, �L� , MA. APPLICATION FOR LISP® , ` .STEM CONSTRUCTION PERMIT Application for a Permit to Construct( Repair Upgrade( Abandon( - ❑Complete System [P-I>id'dual Components Location Vrte Owner's Name <L-Zq1!�, Map/Parcel# Zri Address Lot# Telephone# Installer's Name C Designer's Name o p4jC Address '� MA Address L��U l r/ —J,�I Telephone# — + Telephone# Z) _ (- 19 Type of Building Lot Size sq.ft. Dwelling-No. of Bedrooms Garbage grinder( ) Other-Type of Building No.of persons Showers ( ),Cafeteria( ) Other Fixtures Design Flow (milt.re-uired) gpd Calculated design flow Design flow provided -Z,9n gpd �� Iv Plan: Date 1(19 Number of sheets Revision Date t Title t Description of Soil(s) 17,A.Vj 4 Soil Evaluator Form No. Name of Soil Evaluato ate of Evaluation / Zd DESC TION OF REPAIRS OR ALTERATIONS U TI I c,� S�Tb�•1 _ The undersi ed agrees to the above describe ndividual Sewage Dis osal System in accordance with the provisions of TITLE 5 and further agree to not ace f)system in era ' ntil a Certificate of C ; Ii ce been issued by the Board of Health. Signed Date s No. �ii G FEE / �V 0C®COMMONWEALTH ®F �,ASSACHiJSETTS Board of Health,,?• q�TC�� �i , MA. CERTIFICATE OF COMPLIANCE Description of Work: Individual Component(s) 0 Complete System The undersign ed hereby certify that the Sewage Disposal System; Constructed ( ),Repaired (KUpgraded ( ),Abandoned ( ( ) by: W / 1 at has been installed in accordance with the provisio �ns of 310 CMR 15.00 (Title 5) and the approved design plans/as-built plans relating to application No. , dated . Approved Design Flow_ �(gpd) Installer i& 11 A} 1 t/ s Designee Al �1( Inspec n A ate: y f Ly The issuance of this permit shall not be construed as a guarantee that the system will function as designed.- f� f..r No.-- -! I) FEE COMMONWEALTH OF MASSAC14USETTS Board of Health,��� MA. DISPOSAL SYSTEM C®N T41UCTION PERMIT Permission is hereby granted to; Constr "ct( ) R pa' ( Upgrade( ) Abandon( ) an individual sewage disposal system at , as described in the application for Sj Disposal System Construction Permit No. �'' da ed Provided: Construction shall be completed with' r e years of e date of�is-p.errm Al,�Iocal conditions must be met. �J A Form1255 Rev.5/96 A.M.Sulkin Co.ChAdWnn,MA Date �!/ Board of Health I rfit .,- Town of Barnstable Regulatory Services Sl, Thomaz F. Geiler,Director .ARNSTABM Public Health Division 39d�`v8' Thomas McKean,Director 200 Main Street, Hyannis,MA 02601 ' Office:;�508-862-4644 Fax: 508-790-6304 Date-lke- Sewage Permit99Wf— v1U Assessor's Map/Parcel Installer& Designer•Certification Form Designer: R,1W)_e0_&WKr3 Installer: ®�✓�.��� C6� (, S3 Address: �T����G4Q D4 d Address: P 01 t Seurl� �is A dl� On l'1 ��/ / CIRV AW, 017(r, was issued a permit to install a (d te) (installer) I , septic system at 4, �i4,2 S �!f Y /�eV.UlS based on a design drawn by , (addre s) PllAJx ,��c ,LUPC�S datedEP /� (designer) 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 101ateral 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 s inspected and the soils we found satisfactory. 1N OF V TERENCE yam M. (Installer' r " HAYES No. 979 0 �GI S T EF'TAW (Designer's Signa (Affix Designer's Stamp Here) PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS- BUELT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. q:\office forms\designercertification form.doc Town of Barnstable Barnstable Regulatory Services Department AFft 'cap j BARNSfABM 1 I I "'" 039. Public Health Division �0 m AlfO1AA�A 200 Main Street, Hyannis MA 02601 2007 Office: 508-8624644 Richard V.Scali,Director FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL#7015 1730 0001 4990 6920 October 11, 2018 — SECOND NOTICE TARANTINO, CRAIG S 78 HAZELWOOD DRIVE PEMBROKE, MA 02359 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 The septic system located at 419 Bearses Way, Hyannis, MA was inspected on 05/10/2018 by %**k , ertified Title V Septic Inspector for the State of Massachusetts. , The inspection of the septic system showed that the system "Fails" under the guidelines of 1995 TITLE V (310 CMR 15.00) due to the following: • Backup of sewage into the house due to an overloaded or clogged SAS or cesspool. You are ordered to repair or replace the septic system within sixty (60) days from the date you receive this notification. Failure to repair/replace the septic system within the deadline period will result in future enforcement action. PER ORDE THE BOARD OF HEALTH Thomas McKean, R.S., CHO Agent of the Board of Health Q:\SEPTIC\Title V Inspection Report Letters Mailing\Failed or Needs Further Evaluation Letters\419 Bearses Way Hyannis second notice.doc °F 1 KME ram, Town of Barnstable Barnstable . .�°� Regulatory Services Department AlAnWcaC j IBA BM ;� ,. Public Health Division 200 Main Street, Hyannis MA 02601 2007 Office: 508-862-4644 Richard V.Scali,Director FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL#7015 1730 0001 4987 9965 June 7, 2018 TARANTINO, CRAIG S 78 HAZELWOOD DRIVE PEMBROKE, MA 02359 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 The septic system located at 419 Bearses Way, Hyannis, MA was inspected on 05/10/2018 by Fra , certified Title V Septic Inspector for the State of Massachusetts. The inspection of the septic system showed that the system "Fails" under the guidelines of 1995 TITLE V (310 CMR 15.00) due to the following: • Backup of sewage into the house due to an overloaded or clogged SAS or cesspool. You are ordered to repair or replace the septic system within sixty (60) days from the date you receive this notification. Failure to repair/replace the septic system within the deadline period will result in future enforcement action. PER ORDER OF THE BOARD OF HEALTH Agent of the Board of Health Q:\SEPTIC\Title V Inspection Report Letters Mailing\Failed or Needs Further Evaluation Letters\419 Bearses Way Hyannis.doc `otr THE r Town of Barnstable awrr�•lsrrr_ Regulatory Services Department Public Health Division 200 Main Street,Hyannis MA•02601 Office: 508-8624644 Richard Scab Director i FAX 508-790-6304 Thomas A.McKean,CHO Feb 6, 2007 Rev. 5/11/16 DEADLINES TO'REPAR FAMED.SYSTEMS (Town Code §360-44 and Title V: 310 CMR 15.000) _ 'Am`,Z'marked in the ❑ is the failure criteria and associated repair deadline 60 DAY DEADLINE CRITERIA I - ❑Discharge or pouding of effluent to the surface of the ground ❑Pumping more than 4 times during the last year not due to clogged or obstructed pipe. :. • ackup of sewage into the house due to an overloaded or clogged SAS or cesspool ONE(1)YEAR DEADLINE CRITERIA ❑Static liquid level in the distribution box above outlet invert dhe to an overloaded or clogged SAS or cesspool ❑Any portion of the-SAS, cesspool, or privy below high groundwater elevation ❑Any portion of the cesspool witbin a Zone 1 to a public well ❑Any portion of a cesspool within 50 feet of a private water supply well with no acceptable water quality analysis.•(This system passes if the water analysis indicates the well is free from pollution). TWO (2)YEAR DEADLINE CRITERIA q Single'Cesspool. o Any"conditionally passed systems" (broken cover,relocation of a pipe,relocation of a driveway due to H-10 components, etc) o Leaching pit or cesspool with high liquid level,<12"below inlet(per Town Code §360-9.1) ❑Leaching facility with standing liquid level at or above the invert pipe(per Town Code §360-20 h) OTHER Repair deadline: WSEP'FODEADLINES TO REPAIR FAILED SYSTEMS.doc Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments W 9 /fie tG Property Address Graf G�a400 j " Owner Owners Name :�.. information is ��f Q�6 Q/ /Q h,? required for every page. City/Town State Zip Code Date of nsp ction S 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 A. General Information �"/ /3p(p� filling out forms on the computer, use only the tab 1. Inspector: key to move your cursor-do not use the return Name of Inspector ,� �► /key. �/V/yt O Zte�17 Company Name Company Address -- -_ City/Town c)2 Y^�^0 State Zip Code Telephone ber / 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 WFails ❑ Needs Further Evaluation by the Local Approving Authority ---/ a. , /c7 / Inspector 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 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.doc•rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 17 Commonwealth of Massachusetts loom Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 9 &Owfe-s c✓'G Property Address Owner Owner's Name 411f information is h / �p required for every page. City/Town State Zip Code Date of Inspectio 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: 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.doc-rev.6/16 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 9 ge-owse jr t-✓G Property Address T_av-ao�,�� Owner Owner's Name p information is �O a required for every A��� �� Qa 6 Ql page. City/Town State Zip Code Date o insp ction B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. 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.doc-rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form s Subsurface Sewage Disposal System Fo�Nt oluntary Assessments • M Property Address l T�GvT�.4O Owner Owner's Name information is required for every /167 � A 41 07. page. City/Town State Zip Code Date of Insg6ction 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 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 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 • ❑ Backup of sewage into facility or system component due to overloaded or ogged 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 ❑ St 'i Iiquid level in the distribution box above outlet invert due to an overloaded r clogged SAS or cesspool ❑ Liquid depth in cesspool is less than 6"below invert or available volume is less than '/Z day flow t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 6Yse5 Vk-7 Property Address —7— Owner Owner's Name , �( information is � ��O/ J /O /� required for every AaMtf - page. City/Town State Zip Code Date of Ins ectio B. Certification (cont.) Yes No ElRequired pumping more than 4 times in the last year NOT due to clogged or ��y structed pipe(s). Number of times pumped: ❑ 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. ❑ ny portion of a cesspool or privy is within a Zone 1 of a public well. ❑ y 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 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 El E] 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.doc•rev.6116 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 9 C�e�e,�Ses a Property Address Owner Owner's Name information is N �h�S Q..G O fWo �toV required for everypage. City(Town State Zip Code Dat C. Checklist Check if the following have been done. You must indicate"yes"or"no"as to each of the following: Yes ❑ ping information was provided by the owner, occupant, or Board of Health ❑ Were any of the system components pumped out in the previous two weeks? ❑ s 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? ElWere the septic tank manholes uncovered, opened, and the interior of the tank nspected 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 El information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS)on the site has een 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 Residential Flow Conditions: of bedrooms (design): — Number of bedrooms(actual):Number3 3Q DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): t5ins.doc-rev.6/16 Title 5 official Inspection Form:Subsurface sewage Disposal System•Page 6 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form a a Subsurface Sewage Disposal System Form -Not for Voluntary Assessments /9 E7eti.�s G✓� Property Address Owner Owner's Name information is �O required for every page. City/Town State Zip Code Date of I pect(n D. System Information Description: Number of current residents: Does residence have a garbage grinder? ❑ Yes ❑ No Is laundry on a separate sewage system? (Include laundry system inspection- ❑ Yes ❑ No information in this report.) Laundry system inspected? ❑ Yes ❑ No Seasonal use? ❑ Yes ❑ No Water meter readings, if available (last 2 years usage (gpd)): Detail: Sump pump? ❑ Yes ❑ No Last date of occupancy: 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.doc•rev.6116 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 1-// 9 ge a"�re_r Property Address TCt!I'Gi- 11 HO Owner Owner's Name ,p information is f 6�,�j 0/ s /O / p required for every page. City/Town State Zip Code Date of I pecti n D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: aol Source of information: Was system pumped as part of the inspection? ❑ Yes ❑ No If yes,volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of Sy m: 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.doc•rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form s Subsurface Sewage Disposal System Form Not for Voluntary Assessments 919 �.� Property Address T-;;Ir,V) ►mod Owner Owner's Name information is SVI/IT Qp` 0/ C t required for every 64 page. City/Town State Zip Code Date o=4! D. System nformation (cont.) ,� Approximate age of all components, date installed (if known)and source of information: �U"`J� t R w r71445 14 4 4— Were sewage odors detected when arriving at the site? ❑ Yes o Building Sewer(locate on site plan): Depth below grade: feet Material of constructi;'40 ❑ cast iron PVC ❑ other(explain): - - - — - Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): l� Septic Tank (locate on site plan): 0- Depth below de: feet Mater' of construction: (� concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain) 001 Ve- If tank is metal, list age: years f Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) El Yes [I No Dimensions: Sludge depth: t5ins.doc•rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System.Page 9 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments j�/ Property Address Gi/GNT/✓�(7 Owner Owners Name C» d of information is Q yt,fS required for every page. City/Town State Zip Code Date of I pection D. System Information (cont.) Septic Tank (cont.) Distance from top of sludge to bottom of outlet tee or baffle q Scum thickness Distance from top of scum to top of outlet tee or baffle � a T / Distance from bottom of scum to bottom of outlet tee or baffle How were dimensions determined? - C'ilc6✓ Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, )/-4qVwj'�' liquid levels as related to outlet invert, evidence of leakage, etc.): w tom'"c/o 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 of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date 15ins.doc•rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -/Not for Voluntary Assessments Property Address _� A irGN�►✓1 O Owner Owner's Name information is required for every -- page. City/Town State Zip Code Date of 196pectAn 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.doc-rev.6116 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments W9 Property Address Owner Owner's Name �O/ /J / information is Al � required for every — page. City/Town State Zip Code Date of Ins ecti D. System Information (cont.) Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert G�OI^e. 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.): " If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS)(locate on site plan, excavation not required): If SAS not located, explain why: t5ins.doc•rev.6116 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 Y/9 Form �G Property Address TG' I ra T,h Owner Owners Name information is #1Kff �/ 6;L60 5 /� g required for every page. City/Town State Zip Code Date of In ecti n D. System Information (cont.) Type: x leaching pits number: ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ---- -- - - ❑ innovative/altemative system Type/name of technology: Comments (note condition of soil, signs of hydraulic failur evel of ponding, damp soil, condition of vegetation, etc.): Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins.doc•rev.6/16 Title 5 offidai inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form R Subsurface Sewage Disposal System Form Not for Voluntary Assessments Property Address Owner Owner's Name information is y�f ,�� CF.)60� O required for every page. City/Town State Zip Code Date of I specti D. System Information (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): 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.): t5ins.doc•rev.6/16 Title 5 Official Inspection Form.Subsurface Sewage Disposal System•Page 14 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments w Yi 9 ISQ c,�a Property Address L Owner Owner's Name /I' f/4,( information is /�' required for every — page. City/Town State Zip Code Date of sp lion D. System Information (cont.) Sketch Of SVage Disposal System: Provide a view of the sewage disposal system, including ties to at least permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate wher ublic water supply enters the building. Check one of the boxes below: hand-sketch in the area below ❑ drawing attached separately I -?dCA �r I 1141 -1) l5ins.doc-rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments /9 Property Address I Ge/�Gt r�T I✓1 t7 Owner Owner's Name information is / ��6 p/_ r0 required for every 12 page. City/Town State Zip Code Date of Inspe tion D. System Information (cont.) Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar. ❑ Shallow wells Estimated depth to high ground water: 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 ;'-� served site (abutting property/observation hole within 150 feet of SAS) Checked with local Board of Health-explain: ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: . S C ��-- t 1/1 u.��(..�` Before filing this Inspection Report, please see Report Completeness Checklist on next page. l5ins.doc•rev.6116 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 19 l Property Address T // f Gz�A✓�'f�✓!,o Owner Owner's Name information is Fj� /o required for every �- page. City/Town State Zip Code Date o nspe on E. Report Completeness Checklist Ins;ction Summary: A, B, C, D, or E checked Inspection Summary D (System Failure Criteria Applicable to All Systems)completed Sys Information—Estimated depth to high groundwater Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file I 15ins.doc•rev.6/16 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 17 of 17 Town of Barnstable P# Department of Regulatory Services R1 .: BARMABMr Public Health Division Date g MASS. � .any 200 Main Street,Hyannis MA 02601 - a N7 l / W Date Scheduled �/�/J Time Fee Pd. $100.00 • C:7 Soil Suitability Assessment fop Sewage Disposal a) Performed By: Witnessed By: e P-3 LOCATION& GENERAL INFORMATION Location Address 419 Bearse's Way owner's Name Craig Tarantino Hyannis 78 Hazelwood Dr, Pembroke, 02359 Address Assessor's Map/Parcel: 292/76 Engineer's Name Terence M. HayesPunkhorn Services NEW CONSTRUCTION T` - 'REPAIR X Telephone# 508-246-1942 Land Use Slopes(%) Surface Stones , f ",Distances from: Open Water Body ' 'ft Possible Wet Area ft Drinking Water Well ft - Drainage Way ft Property Line ft Other ft SKETCH:(Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands in proximity to holes) XA i Lb f 10 ASV44 Parent material(geologic) Depth to Bedrock Depth to Groundwater: Standing Water in Hole: Weeping from Pit Face Estimated Seasonal High Groundwater DETERMINATION FOR SEASONAL HIGH WATER TABLE Method Used: ,_ T Depth Observed standing,in obs.hole: in. Depth to soil mottles: in. Depth to weeping from side of obs.hole: in. Groundwater Adjustment ft. Index Well# Reading Date: Index Well level Adj.factor Adj.Gr. undwater Level_ PERCOLATION TEST Date? Time Observation Hole# 1 Time at 9" Depth of Perc -/D N Time at 6" Start Pre-soak Time® d[�iV� 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:\SEPTIC\PERCFORM.DOC L DEEP OBSERVATION HOLE LOG Hole# I Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency.%Gravel) 0-10 FJAA D--1 AV A0YTJ1-1 �6 n MAP I EQD 0.5Y -/ A�gp" a.5Yg/,3 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) �. j -lad C3L Alaym S444 01.5Y -3 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) 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) Flood Insurance Rate May: Above 500 year flood boundary No— Yes Within 500 year boundary No_ Yes Within 100 year flood boundary No_ Yes Death of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the area proposed for the soil absorption system? If not,what is the depth of naturally occurring pervious material? Certification I certify that on (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 training,expertise and experience described in 310 CMR 15.017. Signature Date Q:\SEPTIC\PERCFORM.DOC To cN OF BARNSTABLE LOCA'ION SEWAGE # VILLAGE ASSESSOR'S MAP & LOT ,X9-1 -6-7fa INSTALLER'S NAME PHONE NO. VoYVM'Lcrrrr SEPTIC TANK CAPACITY 1(fao 4' LEACHING FACILITY:(t ) `—. ype CvIJ (size) NO. OF BEDROOMS PRIVATE WELL OR PCBLIC ATER BUILDER OR WNE -nf0 DATE PERMIT ISSUED: -/�7-1QZ5- DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No Jy. �a �, � \; / A NCO,�� $ � � — 3� �� � �� , . . � � - i3 " ©� a ' ,? ��o � �a 3 .o .. �3-��� . a . • . � XT CO CATION SEWAGE PERMIT NO. -). MMARf Lela' ..� .� es eve VILLAGE INST.A LLER'S NAME i ADDRESS BUILDER DATE PERMIT ISSUED , DATE COMPLIANCE ISSUED ��.� P Al 3.3; 13 �? lif e �; _ • 1 �� (7-7 �� No... �CL Fps.............................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Appliratiun for Diupwial Works Tomitrnrtiun f rrmit Application is hereby made for a Permit to Construct ( ) or Repair 0<1 an Individual Sewage Disposal System.at: / !�J t ............yl f..... .. Es=.....• --------- '�' S-••-�----- -------------------------------------------------- ir%v o 41i9 ;� 7 c�f or I o o U ------------------------------------------------------------------•-•-•••• --•---•--•--......"1 Owner Address W � C.� Gf�c�JS 7.. �" lif'� .4 41 c 4I $ . Installer Address Type of Building E� ansion Attic Size Lot.- Grinder feet /.Ia ..� Dwelling—No. of Bedrooms___-.-::----:- No. of persons.....................(._._.)Showers Garbage Cafeteria q. 04 Other—Type of Building p ( ) C ( ) at Other fixtures ................ .............. .. W Design Flow................ ...........gallons per person per day. Total daily flow...............c:7-7d................gallons. WSeptic Tank—Liquid capacity/..O.W__-gallons Length________________ Width................ Diameter---------------- Depth................ x Disposal Trench—No. .................... Width.................... Total Length........... Total leaching area....................sq. ft. Seepage Pit No-------/........... Diameter------/9_.____.-_ Depth below inlet-----4............ Total leaching area..................sq. ft. Z Other Distribution box ( ') Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. I................minutes per inch Depth of Test Pit-------------------- Depth to ground water......................... Li, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ P: ...............................................................••••-•--•-----•-•-•---------......---................--------•-----.....................----- 0 Description of Soil........................................................................................................................................................................ W •--- -------------------------------------------•-.._.....-----------------------------•--•------•-------------------.......----...-•-------•--....-•------•--•-- --••----applicable...... ..... . 3.......:�.....---••-- ----- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code —The undersigned further agrees not to place the system in operation until a Certificate of ComplianFhee is ue y board of health.Signed ........... 0:................. ......................... .... �Application Approved By ..........�...w.�. � ........ .:.................................................................. ...... Application Disapproved for the following reasons: ........................................................................................................................................ ............................................................................................................................................................................................................... ........................................ Permit No. ................ . - Issued C ..........�o :�........... ........ Dace No.._C 1\ © 9�7)_ -7 G 2c FE R.............................. THE'COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Appliration for Dioputial Node, Tonotrnrtion Ilrrmit Application is hereby made for a Permit to Construct ( ) or Repair ( an Individual Sewage Disposal System at: - ...........................,..................................................................... Location•:\ddress or Lot No. �"-�LJ 7" � i,tl•G------•-y/9 E-- CtJ /- ,�J u' .,..._?--------------_._...---•'-• --•----•--•----- ---------------------------------------=•-------- ,-..._._. ..................... Owner Address W !2&..vTT....�r•.�s--......--�-4•' L•✓. ..�._�.y �.j �) t ✓p/I r zc,S - - Installer Address Type of Building Size Lot____________________ q. feet Dwelling— No. of Bedrooms....._......�________________________Expansion Attic ( ) Garbage Grinder_--) /Va pa, Other—Type of Building ............................ No. of persons._-__--_---___-_______-..._. Showers ( ) — Cafeteria ( ) w Design Flow.Other fix.. ). ..�......-----_gallons per person per day. Total daily flow............. d_.__._._._..._gallons. WSeptic Tank—Liquid capacity/4kV.._gallons Length................ Width---------------- Diameter................ Depth................ x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. 3 Seepage Pit No-------/"........... Diameter......./9......... Depth below inlet....._._._._.._. Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. I________________minutes per inch Depth of Test Pit.................... Depth to ground water......................... 44 Test Pit No. 2................minutes per.inch Depth of Test Pit.................... Depth to ground water........................ a .-------•---------------------•--•-------•----•----------•--------•--•-----------•---•-•-•----------...._...•--•-•---------------••-.-_-•-----.._.......•---- ODescription of Soil........................... --------------•--•----------------------------------•-----...---------•----•------------•---•--•---------------------------••---------_-_--• x U .....---•-•-------------•---------------•-----------•----------------••-•-----------._._....--.•----•--•••--•-----------••-••----------•-•---_.---••----------•-------------------•...........--•-------- w x ...... 0 Nature of Repairs or Alterations ' Answer when applicable.------ ____ :__._._� 49_ .�_._... _�_ Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code —The undersigned further agrees not to place the system in operation until a Certificate of Compliance has' ee is ue y ehe board of health. Signed .............. . 1................ ........ �����J .. .......... ............ ...Dace............... A lication Approved B r OJV.... ................. .................................................................... e ApplicationDisapproved for the following,reasons: ................................................................................................._..................................... ............................................................................................................. ::::............................................................................................. .................................. Permit No. ...............��...v...... :�... . J.......... Issued ...............................................---......�........ G�... Dare THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Clelrt#tfirate of Compliance THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired by ................................................................. Glt-9` -LG�/..........0 11 wJ_f./!io/�r—(Gn/................................................................................ at .............................. ................._...............-�W 9............. c% .5 1n1 .. ....... .............................................. has been installed in accordance with the provisions of TITLE 5 of The State Environmental Code as described in the application for Disposal Works Construction Permit No. ........91,S--------P.o..a...... dated ............................................... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTR�S A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATIS FACTO Y. DATE........... Inspe tuft... ..............................................r. THE COMMONWEALTH OF MASSACHUSETTS � 7 BOARD OF HEALTH TOWN OF BARNSTABLE %Vvoal Workii Tunotrurtion Frrmit Permission is hereby granted__________________ �_...._-__G.. ... .........�� to Construct ( ) or Repair an Individual Sewage Disposal System c� atNo......................................... ............ ..�31........2�.......=s-1--......�-�`-�-•-.. �-1f-�-'�JN..5....--•----••---•---.......-- Street qq�� 1 as shown on the application for Disposal Works Construction Permit No.1� __ Dated....... ...... . .....�:5.__ �/ ,Board--; _�- ---------------------------------------------- - of Health DATE........................I.- -•-�..................2....................... FORM 36508 HOBBS&WARREN.INC..PUBLISHERS No.8-3 �/ - Fres......Y..°............_. THE COMMONWEALTH OF MASSACHUSETTS : BOARD OF HEALTH aGa01(0 ............7_0 !/ ......OF.... 1/ ......................... i v 1 - Apli iration for Disposal Iforks Tnnitrnrtion Frrmit Application is hereby made for a Permit to Construct ( or Repair ( ) an Individual Sewage Disposal System at: t ................................... ...-----------•.....�0/ .,:.. ..... . Location-Address r Lot o. Owner Address . Installer Address Type of Building Size Lot. �.......Sq. feet Dwelling—No. of Bedrooms._....__...................................Expansion Attic ( ) Garbage Grinder ( ) 04 Other—T e of Building No. of persons............................ Showers — Cafeteria 04 Other fixtures -------------------------------•-- . Design Flow............. . .....................gallons per person per.d Total dail/fl�w..........�.z®_. ........._._gallons. - Septic Tank—Liquid capacity&tQallons Length...._..._._ Width....r ..�.. Diameter................ Depth. Disposal Trench—No..................... Width.................... Total Length.....................Total leaching area....................sq. ft. Seepage Pit No....... ............. Di eter. ... ._...... Depth below inlet..... ___ Total leaching area__..��®s . ft. P --- g q Z Other Distribution box ( � Dosing tank ( ) Percolation Test Results Performed by__Q.t�-% 6 y .��_As7'_.l ..e......... Date./Z/R-�-�.._..... � Test Pit No. I...G L..minutes per inch Depth of Test Pit../P_.. e"e Depth to ground water.../t/ .__. G% Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ p4 -----------------------------------------•------•...........--•_- --•.............-•-•--••--.---•......................................................... O Description of Soil... C2`Y- 2�-p-- � �� ` -- ?�--(�--..=. `�� ........................... llld�llPl ��-- '-<-------- ------------•-------------------------------------------------------------------------------- U Nature of Repairs or Alterations—Answer when applicable............................................................................................... ..... ........ ..................... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITI:E 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliancy en iss ed by?ear f health. gne ",. to Application Approved By.. . . =......•----• ................•--........ � I� ate Application Disapprove or a following reasons: -----------------------------------------------------------------•-•-- ........ ••--•-......• •---••-•••--•••-• -••-••......................•.... Date PermitNo......................................................... Issued_...............-....................................... Date - Y. ..;� 1 r.--a-. ,. -�s�--,� .. ,.� -L'-v, .. ;...,;ems.:. ;,;r rz:s•�,.-....._--.m_�.W. - .._A�.�• J1'"-4a, x.-- Me I THE COMMONWEALTH OF'MASSACHUSETTS bA p M ; ` BOA RD'-OF H EA'LT11-� u _ h •, ` _ �1 ' lutttuan' for V A licatidiv°is hereb m : y System at: Y• ade for a Permit to Construct ( or Rf pain.( ) an Individual Sewage -D>sposalt y C :i�eat o da�eg9 .............................. �T ..•- .. s4 r -r�nJ�l•,. .- .� c%JCS �-, II', �!�r'e'� f `(�/r�' +�9 Owner v� Y W .ltT ?f`�— !S.�`l�1 J ._ F_ A/l.!?�a !�il� C.a'I' �r 1 ..... L][ �- 'l r Installer •Add eae s?;� ' Type of;„Building SizerLot; - feet '`....Sq -�2 7 V [ ng� .... ... ....... OtherlT eoof BBi diooms No of a sonsnslon Att><c )Showers IGar Gunder z ;r a' YP g P ( ) a eCafeteria [)eslgn Flow Other fixtures.............................gal on p P• r..P Y r ......................gallons: P4" rF S'eptic=Tank—.Liquid paclty. ' gallons Len`rson Width l. ..-_:�Diamet :..:....:.......Depthf �r '" '"• Disposal Trench No Width Total Length Total leaching,area sq..it. +? r 3: SeepagePlt N,o_ �___._... Dla etier,l . �.____ Depth Uelow inlet �6✓ ...:Total leaching area ' Z Other`Distribution box-( G) r�_ Dosing tank ( ) r` Percolation .Test Results Performed by;_ ;.`-� /^�:C Date./ -� ..:..-. .--- . t Test Pit No 1 �(--minutes,per inch Depth of Test Pit. L _.. Depth to ground water ................... t ' . z r , est-Pit No 2....._.: minutes per. inch' Depth of Test Pit Depth to ground water IN.71 ........ .....:... ..............•--.--- ...... D ... ' F escription of, � ' '�✓ ��� �-/ 'C'&A t/ G O ... ,q 1i / f�....f: �14__Y.[+..:_.__ •"... .. _�J/l/7•f� ... �G ,� / .. / rf•^'i� i (, •-. _. - V Nature of".Repairs or Alterations - r a 'Answer when applicable w :._ .............................. -•---- .................................... . _ -- r _} Agreement I s The undersi ed:agrees to install the aforedescribed. Indivldual Sewage Dls osal S stem in accordance with, to Sanitary Code— The undersigned further a ees not;to lace.the s stem in.• A e provislons of 1ITLE 5 of;the Sta gr p y u r operation until a Certificate of Compliance has-beet"" �i s ed Eby the board.of Health. A .. - /fir�r _ gned . :C -�J !rif, rs. N '. tc-• ? ` Application 1 Approved By, _.. ;lt%f ` ate• " y s Application Disapproved or_-t a following reasons... .......: ...::. ........ ........ ....•--- ................. �.1 _.. f Date slV Issued--- •, ± --•- - -. - Date-• _ ......_... . - )'a 4 Arf ' LR THE COMMON, OF MASSACHUSETTS'' lh �v BOARD' OF' HEALTH t :. r r f�rr# f�rtt# of (CIO THIS IS TO CERTIFY, That the Individual. Sewage Disposal System constructed'.;( C-)or Repaired Y Installer r. ri G, P .:.r he rovlslons.of TLTLE The State Sdat dyp�e bed m the �y ``,�° has been installed In accordance wrth ,uctlon�Permlt_No._-:�_,f..Y`_.tx�............. ..._._. .,� :r apphcatlon forzDlsposal Works Co,nstr THE ASIJANCE, OF TI ISM CERTIFICATE .SHALLINOT'BE CONSTRUED AS AA ARANTEE THAT THE:: � SYSTEIoA (WILL. 1U CTIOId SATISFACTORY DATE l�.... ��:.. ...... •-•- Inspector.... 174; THE,COMMONWEALTH OF MA ISACHUSETTS > BOARD OF HEALTH , �I 7276f_.a� r ............ . r OF.:.::: .. .....�... Y No... , . FEE.. ....:_: ± Eisposal Worksu # Uam rr tit i Permissionis hereby granted G__ .:.... ....__ ............. •....... ........ .......................................................... .:.. ; ., to Construct ( G)�Repair ( ):,An Individual Sewage Disposal System r' ' at No .C"?.�....k �� (fa f fib -` , r - Dated Street as shown;on the application for Works Construction Pe I= ............... .. 6' Board of Health DATE....:.. - b _ FORM 1,255 A M SULKIN-,INC- BOSTON ..:,�� __SuL. >_.tiY�.k11s _,r.i..Ir,r• _..`f :x. ¢_::l t.i '-._..._., °ItiJI tr ` -� fop of fourr�". lqar7, 4 G. G o n G __ Go✓laI'S r> * t rvr, or a SC)-,. 40 '-VC- ,pe l2 'r»r�?C Gone �8 �2 Gower JAJa.She d peer ff 4 ¢" Sch. zo pv� pipe Peastone ''• �• - � mi'n pi f-c h ��B" per f-f-. — � --_�_�__ �, �/ /�' � flow d i rr E --- '-----i--_, ..., ✓ �� tV. 117V. E /nv !V MFP e/. ` ' 1 • ., G 4GAT/OA - "' septi�. fca.rr K. inV e J. ` � washed inv. p p 1 11 f1 S . c 117/h S � l.�./i9G SYSTEM P� 0FlL � or - ire e u/✓a le rl �� orri G/. •.,\ Q/`O U r7 C7 w Octet- -/-a 6/e f h/UMB � AF OF B c ®ee Cy�3,til S -._._.__ TE R T� _._ 10" Hoy r? t c?• -R G R - r" "' 1� fl G 7_t1 R L_ ":`� /•" / 1 T F�N k�. 5 1� C _ -" �_._ G R(.. t � r i s C_ r9 c t-,� -'A,E-' N T S . l" � k SitaC LVR L �_ f�R[ .l5.f. , ._ d i T O 7-R+_. r . 67_ R c/-1/J+,J G G R P R G / la, RESc5; ,E?VE LE RCN//`/G GRPRG <7 7' f tt "rP JV T& S J L4.1 0�.'K M/9/l/S H!F' �?AJO /'►'7 A T E eE'I A / .SHRLL f D1liF0� 1-7 -r0 0. E. Gt. E t I T/TLC- $ AA./L, T �liVs/ OF . �? UL & 5 R/•✓t) �.'� GUL RT/on.�S FO,� . . i SUBSU ' / Rc L7ISP05RL 0)= - I j SANiT�I ,e'Y ,SELt�RG�. ,✓ ( 2_ Go/�1PL 1, P/G� WITH 0-0AJ1n/6, R& GUL T/DNS six y%-vLL SEA !f:)ETEARr'7/AJeL> BY f3U/LD//VC ON S l�� C:_ ?"O Ae- � G o M M I S S 1 O N E 6--XIS71A G f?rV® F1NRL GFZAd�Ea .SHAG L )eC- /`Y7,,9 GS5Bti,/ T/ R4_4-Y THG S'RME . r DtgTC fov a : r 8 U. aF f-!4F--A LTH fa G A/ 7- 4 r.a S f T 1�- P� Iq w o f ��e o � ® S E- n G ©w S T,e uc 7-1 o w a QGA7tp "/GIN o A=- C./ E G 4�- N ty e7Li5�inc� spot eleV /� ,� / G A '/► / G Q l t , / / /� p e?GiSfincJ contour = -- - - - - 6JA S G OA C/V G 1AJ C- G /�. ` /V G I /V C . t j F f yp prop. f'in Spot e/ev. o. o } r-c, G o r7 f o v t' u o s t.., . fey/ hole. loco--),-ion # t - 6/ 7 - 394 - 8812 K t-7 e # SOE TEST TOP OF FOUNDATION ( 20 FT. MINIMUM FROM CELLAR OR CRAWL SPACE BATE OF SOIL TEST SPIJMERG 2Q18 ELEV. = 100.00_ 10 FT. MINIMUM 10 FT MINIMUM FROM SLABSOIL TEST�-- CLEAN SAND WITNESSED B N � ----- WILCOX �g (ASSUMED) CONCRETE t INSPECTION PORT r 4qq 778 COVERS LOAM AND SEED �• I 4MN r PITCH E1/8" PER 40 PVC PIPE 2" LAYER OF O�I�VAT1 HOU ELEV.=__98.3_ } 1/E TO 1/2" PERCOLATION RATE _< _ MIN./INCH AT � sNCHES X\OWRSFILY�ER E STONE { -- MANHOLE COVER FABRIC DEPTH HORIZ TEXTURE COLOR MOTT. !OTHRVENT 3,(o 4" CAST IRON PIPE � 98;55 N�AX• . 0 WIN• REQUIRED 0-10" FILL { NO (OR EQUAL) MINIMUM PITCH 1/4" PER FT. LEVOtERS i TEE Z 10-13" . A LOAMY SAND 110YR5/1 13-30" B LOAMY SAND 00YR7/6 FLOW LINE �5 �30-92" G1 FINE SAND 12.5Y8/4 1COBBLES 596 GRAVES10I ° °__. ❑ ❑ ❑ ❑ ❑ 0 ❑ ❑ ❑ D D ° 92-132" jC2 IMEDIUM SAND j2.5Y8/3 / ELEV. _ _ _ _ LEVOEL o ❑ ❑ ❑ ❑ ❑ ❑ ❑ D D ❑ ❑ I ° °° ° NO WATER ENCOUNTERED AT 132_ ELEV. $7.3 _ j ELEV. = _9$.7Q_ J ADD GAS ELEV. _ _. 95_ 1 6" SUMP ELEV. _ _ o o ( p p I ODD ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ o Z' ,0 OBSERVATION HOLE 2 ELEV.=--95.60 BAFFLE DIS i RIBU�QN ° o ° ° ° 101 LIQUID OUTLET L I ELEV. _ ❑ ❑ D ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ T �flX {H��� _� - ° °° o ° ° ° ELEV. 92 80 DEPTH HORIZ . TEXTURE COLOR MCTT. OTHER -� DEPTH TEE (EXISTING) + 2 500 GALLON GALLEYS WITH �- _ 0-10" IFLL !NO t 4 FEET 14 INCHES ` TO BE WATER TESTED I 5 FEET 19 :NCHES �L GALLON IF MORE THAN ONE OUTLET STONE IN AN I 10-13" A LOAMY SAND 10YR5/1 6 FEET 24 INCHES 7 rEET 29 INCHES (TO BE PLACED ON FIRM BASE) 13' X 28' X 2' TRENCH FORMA,?ION z 5.5 WELL N A 13-30" B iLOAMY SAND 10YR7/6 ` 8 FEET 34 INCHES , SEPTIC TANK ZONE 3/4" TO 1 1/2" CLEAN �°t 1 i INDEX 30-92" Cl FINE SAND I12.5Y8/4 59� GRAVELS & DOUBLE WASHED STONE 54►I .` ABSORPTION I ADJUST N-132" C2 MEDIUM SAND 12.5Y8/3 I ;COBBLES FREE OF FINES & SILT SYSTEM (SAS H--20 NO WATER ENCOUNTERED AT 1327_ ELEV. _ _ 87.3 _ USGS PROBABLE WATER TABLE ELEV. = __-___ SEWAGE DISPOSAL. SYSTEM PROFILE OBSERVED WATER TABLE ( / ) ELEV. = ------- DESIGN CALCULATIONS TO SCALE BOTTOM OF TEST HOLE ELEV'. _ NUMBER OF BEDROOMS _ 3 GARBAGE DISPOSAL UNIT } TOTAL ESTIMATED FLOW 110! REQUIRES SEPTIC/0 TANK CAPACITY ITYW) JIM GAL./DAY ACTUAL SIZE OF SEPTIC TANK (E)OSTING) i1 GAL. SOIL CLASSIFICATION _-_ DESIGN PERCOLATION RATE < ', _ MIN./IN. EFFLUENT LOADING RATE -W4 GAL./DAY/S.F. LEACHING AREA. (� SQ. FT. (13X28)+(4t X2X2) } LEACHING CAPACITY (AREA X RATE) A= GAL./DAY 528.00 X 0.74 �l RESERVE LEACHING CAPACITY .. ;_ GAL,fDAY 1 T.61 97.6 NINES: 1 1. ALL WORKMANSHIP AND MATERIALS SHALL CONFORM TO D.E.P. TITLE 5 AND THE TOWN'S RULES AND REGULATIONS FOR 9 ti } r P&B 11k�9 �� THE SUBSURFACE DISPOSAL OF SEWAGE, F 2. A COVEROF TO SANIDA Y UNITS SHALL BE BROUGHT TO f ALL COMPONENTS OF THE SYSTEM � •-' ..� � r ` .�97.7 SANITARY, ,,. A SHALL BE CAPABLE OF 2 WITHSTANDING H--10 LOADING UNLESS THEY ARE UNDER OR WITHIN NT 10 FT. OF DRIVES OR PARKING AREAS. H-20 LOADING SHALL.. BE SOIL L 98.3 USED 'N 10 FT. OF DRIVES OR PARKING AREAS. } / TEST 1 /EST 2 ju r tzIklroU ;U GtAvL BE MORTARED IN PLACE. 97.1 5 NO DETERMINATION HAS BEEN MADE AS TO COMPLIANCE WITH 1000'GALLON TIC TANKA � � �, DEEDED OR ZONING REGULATIONS. OWNER / APPLICANT IS TO 98.a _ D OBTAIN SUCH DETERMINATION FROM APPROPRIATE AUTHORITY. BOX Q 6. UTILITIES SHOWN ARE APPROXIMATE ONLY, EXCAVATION CONTRACTOR r S O CALL "DIG-SAFE" AT 1-888- 44--. 233 AT LEAST 72 HOURS �9$.6 ,� �� �� PRIOR TO COMMENCING WORK ON SITE. �P&R 7. CONTRACTOR IS TO VERIFY GRADES :AND ELEVATIONS AS WELL AS ;✓ `98.7 \ SITE CONDITIONS PRIOR TO COMMENCING WORK ON SITE, ANY VARIATION IS TO BE BROUGHT TO THE ATTENTION OF THE DESIGN ENGINEER 8.0 �'✓� > M9 IMMEDIATELY.8. PARCEL IS IN FLOOD ZONE __ X 98.9 <\ 9. LOT IS SHOWN ON ASSESSORS MAP _?9?_ AS PARCEL ?$ I 1 10. ONE OF THE EXISTING LEACH PITS IS TO BE PUMPED AND BACKFILLED (P&B) �t�, ` AND THE OTHER IS TO BE PUMPED AND REMOVED ALONG WITH ANY POLLUTED SOILS ENCOUNTERED (P&R). r,v 98.3 11. THE INSTALLER IS TO GIVE THE ENGINEER A MINIMUM OF 48 HOURS 9 � (2 WORKING DAYS) NOTICE FOR THE FINAL INSPECTION (NUMBER BELOW). APPRfVDe BOARD OF HEALT f r Op DATE AGENT jOa HYMNIS, �S. PROPOSED SEPTIC DESIGN TE �ucg. w rFOR L 0 T 5+6 , C R 1#'1RANTINO 1 1D,930. 1 it S.F. AYF �. I f LOC. 419 DEARSE'S WAY HYANNIS, LASS. } ALA� �•t',' { p RKSARWAS Of Mqs w� l j ROBIN �\�\•/ 508- F. 0. BOX 46M t to SOU I H DENNIS, , ASS. 1 LEGENDS II�LI . fir ram` 564-8379 ---_ ____�-- 02660 a \q cn EXISTING SPOT ELEVATION OOxO �t�41 \ c __ -�----� EXISTING CONTOUR ----00---- Np' a o .� f DATE �7- ,� SCALE :> ` FINAL SPOT ELEVATION- p _� ' `"� I � FINAL CONTOUR SOIL ! REV. I JG13 ?vC~ ._ SOIL TEST LOCATION �► �1AL UTILITY POLE �. -_o- 1 8 0 TOWN WATER W W-,� w s I CATCH BASSIN .". :.. ,. "" fi � ,._ .. GAS LINE ----- ,,,� _.�..__.�. __. __._ ��� ^_ OF CLEAN OUT ---_- - " -� A__..10r�_._ � A �F"-t CESSPOOL C P. CI „ 55 ^'ROU 8082 G/'.,jW( 808 ,- 5 D WG C ;�.._._ pr+„ES, R.S. .�, -,y,...a.,,...o..,,.....,a"r.W.N,�»,"«.�.,;, .,".,.:,.:>,,,...,,».x,.�,�e.<,,. .. "»n _ ...x.,,,•,.«.+�,., w�=w�•. •.rt..,,.�.,,,,...,�,.. ,ate »�,,,,,�..F,�.,,�;. 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